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Reita H Nyberg

Tampere University, Faculty of Medicine and Health Technology (MET), Post-Doc

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MD, PhD. Chief of Medical Education (Unit of Medical Education, Tampere Surgical Education Centre) in Tampere University Hospital, The Wellbeing Services County of Pirkanmaa,Tampere, Finland.
Research interests: sentinel node techniques in gynaecological cancer, cancer surgery, surgical education and surgical skills training.
Other interests: eating disorders, Family-Based Treatment and its variations.
Phone: +358503847500
Address: Tampere University Hospital
Tampere Surgical Education Centre
PO Box 272
FI - 33101 Tampere

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University College Cork

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Papers by Reita H Nyberg

COVID-19 pandemic impact on gynecologic cancer treatment pathways in a Finnish tertiary center

by Reita H Nyberg, Hanna Pikkujämsä, Karolina Louvanto, and Tiina Luukkaala

Acta Obstet Gynecol Scand, 2024

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more

Syömisen välttämis-ja rajoittamishäiriö (ARFID)

Duodecim, 2024

Syömisen välttämis-ja rajoittamishäiriö (avoidant-restrictive food intake disorder, ARFID) on uus... more Syömisen välttämis-ja rajoittamishäiriö (avoidant-restrictive food intake disorder, ARFID) on uusi syömishäiriö DSM-5-ja ICD-11-tautiluokituksissa. Syömisen erityispiirteet, ruoan aistittaviin ominaisuuksiin tai syömisen seurauksiin liittyvät pelot tai vähäinen ruokahalu rajoittavat sairastuneen syömistä niin paljon, että kasvu, painonkehitys tai ravitsemustila häiriintyvät tai syömisen rajoittuneisuus aiheuttaa huomattavaa psykososiaalista haittaa. Diagnoosi perustuu terveydentilan monipuoliseen arviointiin. Syömisen erityispiirteitä voidaan kartoittaa oirekyselyillä tai diagnostisilla haastatteluilla. Syömisen välttämis-ja rajoittamishäiriöön liittyy usein kroonisia sairauksia, mielenterveyden oireita ja autismikirjon piirteitä. Vaikeimmin oireilevat tarvitsevat moniammatillista kuntoutusta. Ravitsemusterapeutin, toimintaterapeutin, puheterapeutin, psykologin tai psykoterapeutin erityisosaaminen on hyödyksi kuntoutuksen suunnittelussa. Lasten ja nuorten ruokavalion kehittymistä monipuoliseksi voidaan tukea myös ruokakasvatuksen keinoin.

Ulkosynnytinsyövän hoito

Duodecim, 2021

Ulkosynnytinsyövistä suurin osa on levyepiteelisyöpiä, jotka kehittyvät joko kroonisten ihosairau... more Ulkosynnytinsyövistä suurin osa on levyepiteelisyöpiä, jotka kehittyvät joko kroonisten ihosairauksien tai papilloomavirusinfektion seurauksena. Tyyppioireita ovat ulkosynnyttimien paikallishoitoon huonosti reagoiva kipu, ärsytys ja kutina. Perusterveydenhuollossa olennaista on tutkia potilas gynekologisessa asennossa ja ottaa epäilyttävistä alueista kudosnäytteet. Levinneisyyttä selvitetään vartalon TT:llä ja lantion magneettikuvauksella. Paikalliset kasvaimet hoidetaan kirurgisesti. Kookkaiden kasvaimien ensileikkauksissa käytetään apuna plastiikkakirurgiaa. Paikallisesti levinneet syöpäkasvaimet hoidetaan kemosädehoidolla. Laajalle levinneessä syövässä hoitolinjana on hidastaa syövän etenemistä. Kura? tiivisen hoidon jälkeen potilasta seurataan erikoissairaanhoidossa viiteen vuoteen saakka ja sen jälkeen perusterveydenhuollossa. Uusiutumien toteamisen lisäksi seurannan tarkoitus on havaita ja lievittää syöpähoitojen aiheuttamia jälkioireita, joita ulkosynnytinsyövän sairastaneilla potilailla usein esiintyy.

Fluoresenssilla vartijaimusolmukkeet esiin

Duodecim, 2018

Kun ulkosynnytinsyöpä todetaan alkuvaiheessa, sen hoito on kirurginen. Imusolmukelevinneisyys on ... more Kun ulkosynnytinsyöpä todetaan alkuvaiheessa, sen hoito on kirurginen. Imusolmukelevinneisyys on tärkeä ennustetekijä, ja noin kymmenen vuoden ajan sitä on voitu määrittää myös vartijaimusolmuketutkimuksella. Vartijaimusolmukkeet paikannetaan tavanomaisesti siniväri- ja isotooppiruiskutuksen jälkeen gammakoettimen avulla ja silmämääräisesti. Uudet kuvantamistekniikat helpottavat vartijaimusolmukkeiden paikantamista. Kuvaamme potilaan, jonka vartijaimusolmuketutkimus tehtiin sinivärin ja teknetiumisotoopin avulla, ja lisäksi leikkauksessa käytettiin nykyaikaisempaa merkkiainetta, indosyaniinivihreää. Yksifotoniemissiotomografia (SPECT-TT) ennen leikkausta helpotti vartijaimusolmukkeen paikantamista keskilinjan kasvaimen yhteydessä.

Nuorten laihuushäiriön perhepohjainen hoito

Duodecim, 2020

Tumor cell-specific Serpin A1 expression in vulvar squamous cell carcinoma

Archives of Gynecology and Obstetrics, 2019

Purpose The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulvar... more Purpose The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulvar dermatosis lichen sclerosus (LS) and high-risk human papillomavirus (hrHPV). Serpin A1 (α1-antitrypsin) is a serine protease inhibitor, which plays a role in the tumorigenesis of various cancer types. The aim of the study was to evaluate the expressions of Serpin A1 in LS, premalignant vulvar lesions, and vSCC using immunohistochemistry (IHC) and serum analysis, and to compare Serpin A1 stainings to the tumor markers p53 and p16. Methods In total, 120 samples from 74 patients were studied with IHC for Serpin A1, p53 and p16: 18 normal vulvar skin, 53 LS, 9 premalignant vulvar lesions (dVIN/HSIL) and 40 vSCC samples. Serum concentrations of Serpin A1 were analyzed from 30 LS, 44 vSCC and 10 control patients. Expressions were compared to clinical data. Results Tumor cell-specific Serpin A1 overexpression was detected in 88% of vSCC samples, independent of the etiology. The intensity of Serpin A1 expression was significantly higher in vSCC than in healthy vulvar skin, LS, or premalignant vulvar lesions. Serpin A1 showed an association with p53 positivity. No difference in overall survival was found between Serpin A1-, p53-, or p16-positive vSCC patients. Serum concentrations of Serpin A1 were equal in the LS, vSCC, and control groups. Conclusion Tumor cell-specific Serpin A1 overexpression is a potential biomarker in vSCC.

609 Tumor cell-specific Serpin A1 overexpression in vulvar squamous cell carcinoma

Journal of Investigative Dermatology, 2017

The AMPK-related kinase NUAK2 is considered to play some role in melanoma development and progres... more The AMPK-related kinase NUAK2 is considered to play some role in melanoma development and progression. In our past studies, we showed that NUAK2 is a gene that has a prognostic significance in acral melanoma patients by verifying a public array comparative genomic hybridization (CGH) database and immunohistochemistry of 56 primary acral melanomas (PNAS, 2011) and that pharmacologic inhibition of CDK2 is sufficient to suppress the growth of NUAK2 amplified and PTEN-deficient melanoma cells (Cancer Res, 2015). This time, in order to validate the previous survival data with an increased number of cases, we performed immunohistochemical analyses using 87 specimens of acral melanomas. We also examined its relevance with DNA copy number gains revealed by metaphase CGH. We performed immunohistochemical analyses by using formalin-fixed, paraffin-embedded tissues from 87 acral melanomas and 40 Non-CSD melanomas, and performed metaphase CGH analyses from 12 acral melanomas and 6 Non-CSD melanomas. The Kaplan-Meier curves showed that both the relapse-free survival and the overall survival time of patients with acral melanomas expressing NUAK2 were significantly shorter than patients without the NUAK2 expression. The Cox regression model showed a significant difference in relapse-free survival in acral melanomas. All 6 cases with 1q32 gain, where NUAK2 resides, over-express NUAK2. These data demonstrate that over-expression of NUAK2 has a significant impact on the survival of acral melanoma patients.

Can vascular endothelial growth factor C expression be of use in predicting surgical stage or prognosis in vulvar cancer ?

Journal of Cancer Research & Therapy, 2017

Introduction: Nodal metastasis is a main prognostic factor in vulvar cancer. Increased vascular e... more Introduction: Nodal metastasis is a main prognostic factor in vulvar cancer. Increased vascular endothelial growth factor C (VEGF-C) expression has been associated with lymph node metastasis and poor prognosis in many cancers. The aim of this retrospective study was to investigate VEGF-C expression pattern in the invasive edge of vulvar cancer and in sentinel lymph node metastasis, and its association with the stage and prognosis. Methods: Tumor and sentinel lymph node samples from 44 patients were evaluated with immunohistochemistry, and the results were linked with the clinicopathological data. Results: Sixty-seven percent of primary tumors and 76% of sentinel lymph node metastases expressed VEFG-C. Positive VEGF-C expression of the primary tumor did not predict surgical Stage or sentinel lymph node involvement. The risk of relapse was not significantly higher with VEGF-C expressing tumors than with VEGF-C negative tumors (RR 2.55, 95% CI 0.66-9.90, p = 0.18). The risk of groin recurrence was significantly lower with VEGF-C positive than negative tumors (RR 0.36, 95% CI 0.16-0.79, p = 0.01). Survival was similar in both groups. No non-sentinel lymph node metastases were found in case of negative VEGF-C expression in the sentinel lymph node metastasis, whereas with positive VEGF-C expression they were found in 5/13 (38%) of cases. Conclusions: Tumoral VEGF-C expression was not associated with higher surgical Stage or poorer prognosis in vulvar cancer. However, absence of its expression in sentinel lymph node metastasis might indicate a low risk for non-sentinel lymph node metastases.

Sentinel Node and Ovarian Tumors: A Series of 20 Patients

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, May 1, 2017

Intraoperative detection of ovarian sentinel nodes has been shown to be feasible. We examined the... more Intraoperative detection of ovarian sentinel nodes has been shown to be feasible. We examined the detection rate and locations of sentinel nodes in patients with ovarian tumors. We also aimed to assess the reliability of sentinel node method in predicting regional lymph node metastasis. Twenty patients scheduled for laparotomy because of a pelvic mass were recruited to the study. In the beginning of the laparotomy, radioisotope and blue dye were injected under the serosa next to the junction of the ovarian tumor and suspensory ligament. The number and locations of the hot and/or blue nodes/spots were recorded during the operation. If the tumor was malignant according to the frozen section, systematic lymphadenectomies were performed, the sentinel nodes sampled separately, and their status compared with other regional lymph nodes. Eleven patients had a right-sided ovarian tumor, 7 patients a left-sided tumor, and 2 patients had bilateral tumors. A median of 2 sentinel nodes/locations...

Reduction in ERRα is associated with lichen sclerosus and vulvar squamous cell carcinoma

Gynecologic Oncology, 2015

OBJECTIVE ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and inflam... more OBJECTIVE ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and inflammatory processes in both normal and cancer cells. Chronic inflammation induced by lichen sclerosus (LS) or human papilloma virus (HPV) precedes vulvar squamous cell carcinoma (vulvar SCC). We investigated the expression of ERRα, ERRβ and ERRγ in normal vulvar skin, LS as well as LS-dependent and LS-independent/HPV-related vulvar SCC. METHODS A total of 203 samples were analyzed for ERRα, ERRβ and ERRγ by using immunohistochemistry. These included 37 normal vulvar skin samples, 110 LS samples, 6 vulvar intraepithelial neoplasia (VIN) samples and 50 vulvar SCC samples. RESULTS A substantial reduction in or disappearance of ERRα was detected in all vulvar SCC samples. A total of 79% of childhood-onset LS and 51% of adulthood-onset LS lesions showed decreases in ERRα staining. A gradual reduction in ERRα cytoplasmic staining was observed from healthy vulvar skin to precursor lesions and further to SCC. Nuclear ERRα staining was observed in 8/33 (24%) LS-dependent and 10/17 (59%) LS-independent SCC samples. CONCLUSIONS ERRα, a key regulator of cell energy metabolism, may play a role in the pathogenesis of both LS and vulvar SCC.

Reconstruction of the Vulva with Sensate Gluteal Fold Flaps

Scandinavian Journal of Surgery, 2013

Backround and Aims: Soft-tissue reconstruction of the vulva following resection of malignancies i... more Backround and Aims: Soft-tissue reconstruction of the vulva following resection of malignancies is challenging. The function of perineal organs should be preserved and the reconstructed area should maintain an acceptable cosmetic appearance. Reconstruction with local flaps is usually sufficient in the primary phase after a radical vulvectomy. Numerous flaps have been designed for vulvar reconstruction usually based on circulation from the internal pudendal artery branches. In this paper we introduce our modification of the gluteal fold V–Y advancement flap as a primary reconstruction after a radical vulvectomy. Patients and Methods: Twenty-two patients were operated with a radical vulvectomy because of vulvar malignancies. The operation was primary in eight and secondary in 14 patients. The reconstruction of the vulva was performed in the same operation for each patient Results: All flaps survived completely. Wound complications were registered in three patients. Late problems with ...

The 48,XXYY syndrome: A case detected by maternal serum alpha-fetoprotein screening

Prenatal Diagnosis, 1994

A 17-year-old woman was referred for amniocentesis due to a low maternal serum alpha-fetoprotein ... more A 17-year-old woman was referred for amniocentesis due to a low maternal serum alpha-fetoprotein (AFP) concentration in a voluntary screening test. The fetal karyotype was 48,XXYY, and the pregnancy was terminated. Autopsy of the fetus disclosed agenesis of the corpus callosum and unusual facial features. KEY woms48,XXYY syndrome, corpus callosum agenesk, MS-AFP screening.

Ovarian Sentinel Node: Is It Feasible?

International Journal of Gynecologic Cancer, 2011

ObjectiveTo examine whether the intraoperative combined injection technique is feasible in locati... more ObjectiveTo examine whether the intraoperative combined injection technique is feasible in locating the sentinel node(s) of the ovary.Methods/MaterialsIn 16 patients with high-risk uterine cancer and normal postmenopausal ovaries, technetium isotope and blue dye were injected in the right or left ovary during laparotomy, respectively. During the operation, the pelvic and para-aortic lymphatic areas were searched, and the number, method of detection, and location(s) of the hot and/or blue node(s) were recorded.ResultsOne to 3 sentinel nodes per patient were identified in all but 1 patient (15 of 16, 94%). The sentinel nodes (n = 30) were all located in the para-aortic area. The sentinel nodes of the left ovary were mainly (9 of 14, 64%) located above the inferior mesenteric artery level, as the most sentinel nodes of the right ovary (15 of 16, 94%) were found below the inferior mesenteric artery level (P = 0.001). There were no contralateral or bilateral sentinel nodes.ConclusionsThe...

Port-site metastasis following laparoscopic hysterectomy and bilateral salpingo-ophorectomy for endometrial carcinoma

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2009

European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 143, Issue 1, Pa... more

Reply to the letter from Woods and Smith

Clinical Genetics, 2008

The letter by Woods and Smith (Clin Genet 1993: 44: 166) emphasizes the theoretical distinction a... more The letter by Woods and Smith (Clin Genet 1993: 44: 166) emphasizes the theoretical distinction and diagnostic difficulties between chimerism and mosaicism. We wish to add the following clinical data to our report (Nyberg et al. 1992): All karyotypes were obtained from phytohemagglutinin-stimulated blood leukocytes. In 1983, when the twins were born, DNA-studies were unavailable and no fetal tissue was preserved. A study of Q-band chromosomal polymorphisms was done, but the result was considered inconclusive and was therefore not added to our report. The pathologist's examination showed no evidence of a third fetus, thus making the possibility of feto-fetal transfusion rather improbable. The hypothesis proposed by Woods & Smith suggests that the mosaicism of the A-twin was the result of a 3:l meiotic segregation with a subsequent mitotic loss of the normal chromosome 14. This mechanism is based on an assumption of two unrelated mutations. It is therefore less likely than our proposal of a single remutation, i.e. an independent deletion of 14q in the somatic cells of a chromosomally normal male fetus. The suggested prezygotic origin of deletion mosaicism (Cantu et al. 1985) could equally well explain this phenomenon. Because there is no possibility at present of obtaining formal proof of any of the alternatives, we consider further complicated explanations to be futile. We read with interest the paper by Siffroi et al. (1988), describing mosaicism of a t(14;21) in the male descendant of a t(14;21) carrier father. The

Case of human chimerism detected by unbalanced chromosome translocation?

Clinical Genetics, 2008

To the Editor, We were interested to read the article by Nyberg et al. (1992), entitled "A case o... more To the Editor, We were interested to read the article by Nyberg et al. (1992), entitled "A case of human chimerism detected by unbalanced chromosomal translocation". They described a family with a chromosome translocation t(14;20)(q3 l;ql3.3), into which twins were born to a balanced carrier. One twin was female and had a balanced translocation karyotype,

Sentinel node and vulvar cancer: a series of 47 patients

Acta Obstetricia et Gynecologica Scandinavica, 2007

There is growing interest to apply the sentinel node technique in the treatment of vulvar cancer.... more There is growing interest to apply the sentinel node technique in the treatment of vulvar cancer. All charts of the patients operated on for vulvar cancer at Tampere University Hospital from January 1, 2001 through June 30, 2005 were retrospectively reviewed. Demographic, clinical, and histopathological information was collected from each patient. The sentinel lymph node mapping was done intraoperatively either with a combination of the radioisotope and dye techniques (40 patients) or with the dye technique alone (7 patients). The sentinel lymph node was dissected separately for histopathological evaluation, and then a routine inguinal lymphadenectomy was performed. The final FIGO surgical Stage distribution was: Stage I, 11 (23%); Stage II, 14 (30%); Stage III, 21 (45%); and Stage IV, 1 (2%). Sentinel lymph node was identified in 46 (98%) women with either one or both of the methods. In Stage I-II, the sentinel lymph node identification rate was 25/25 (100%) with the combined method. The only patient with unidentified sentinel lymph node had lymphatic spread beyond inguinal area or Stage IV disease. Eighteen of the sentinel lymph nodes (39%) were positive for tumor cells, and in 5 cases additional metastatic nodes were found. One patient with macroscopically enlarged metastatic inguinal nodes and Stage III disease had a negative sentinel lymph node. In the 25 patients with Stage I-II disease, the false-negative rate of the sentinel lymph node method was 0/4, giving a negative predictive value of 1.00. A sentinel node identification rate of 98% with a false-negative rate of 0% in the patients with Stage I-II disease is an encouraging finding.

Reduction in ERRα is associated with lichen sclerosus and vulvar squamous cell carcinoma

Gynecologic Oncology, 2015

Objective: ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and infla... more Objective: ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and inflammatory processes in both normal and cancer cells. Chronic inflammation induced by lichen sclerosus (LS) or human papillo-ma virus (HPV) precedes vulvar squamous cell carcinoma (vulvar SCC). We investigated the expression of ERRα, ERRβ and ERRγ in normal vulvar skin, LS as well as LS-dependent and LS-independent/HPV-related vulvar SCC.

Methods: A total of 203 samples were analyzed for ERRα, ERRβ and ERRγ by using immunohistochemistry. These included 37 normal vulvar skin samples, 110 LS samples, 6 vulvar intraepithelial neoplasia (VIN) samples and 50 vulvar SCC samples.

Results: A substantial reduction in or disappearance of ERRα was detected in all vulvar SCC samples. A total of 79% of childhood-onset LS and 51% of adulthood-onset LS lesions showed decreases in ERRα staining. A gradual reduction in ERRα cytoplasmic staining was observed from healthy vulvar skin to precursor lesions and further to SCC. Nuclear ERRα staining was observed in 8/33 (24%) LS-dependent and 10/17 (59%) LS-independent SCC samples.

Conclusions: ERRα, a key regulator of cell energy metabolism, may play a role in the pathogenesis of both LS and vulvar SCC.

Tumor cell-specific Serpin A1 expression in vulvar squamous cell carcinoma

Archives of Gynecology and Obstetrics, 2019

Purpose: The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulva... more Purpose: The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulvar dermatosis lichen sclerosus (LS) and high-risk human papillomavirus (hrHPV). Serpin A1 (α1-antitrypsin) is a serine protease inhibitor, which plays a role in the tumorigenesis of various cancer types. The aim of the study was to evaluate the expressions of Serpin A1 in LS, premalignant vulvar lesions, and vSCC using immunohistochemistry (IHC) and serum analysis, and to compare Serpin A1 stainings to the tumor markers p53 and p16.
Methods: In total, 120 samples from 74 patients were studied with IHC for Serpin A1, p53 and p16: 18 normal vulvar skin, 53 LS, 9 premalignant vulvar lesions (dVIN/HSIL) and 40 vSCC samples. Serum concentrations of Serpin A1 were analyzed from 30 LS, 44 vSCC and 10 control patients. Expressions were compared to clinical data.
Results: Tumor cell-specific Serpin A1 overexpression was detected in 88% of vSCC samples, independent of the etiology. The intensity of Serpin A1 expression was significantly higher in vSCC than in healthy vulvar skin, LS, or premalignant vulvar lesions. Serpin A1 showed an association with p53 positivity. No difference in overall survival was found between Serpin A1-, p53-, or p16-positive vSCC patients. Serum concentrations of Serpin A1 were equal in the LS, vSCC, and control groups. Conclusion: Tumor cell-specific Serpin A1 overexpression is a potential biomarker in vSCC.

Fluoresenssilla vartijaimusolmukkeet esiin [Use of fluorescence in finding sentinel lymph nodes]

by Reita H Nyberg and Koivunen Sanna

Duodecim, 2018

Kun ulkosynnytinsyöpä todetaan alkuvaiheessa, sen hoito on kirurginen. Imusolmukelevinneisyys on ... more Kun ulkosynnytinsyöpä todetaan alkuvaiheessa, sen hoito on kirurginen. Imusolmukelevinneisyys on tärkeä ennustetekijä, ja noin kymmenen vuoden ajan sitä on voitu määrittää myös vartijaimusolmuketutkimuksella. Vartijaimusolmukkeet paikannetaan tavanomaisesti siniväri- ja isotooppiruiskutuksen jälkeen gammakoettimen avulla ja silmämääräisesti. Uudet kuvantamistekniikat helpottavat vartijaimusolmukkeiden paikantamista. Kuvaamme potilaan, jonka vartijaimusolmuketutkimus tehtiin sinivärin ja teknetiumisotoopin avulla, ja lisäksi leikkauksessa käytettiin nykyaikaisempaa merkkiainetta, indosyaniinivihreää. Yksifotoniemissiotomografia (SPECT-TT) ennen leikkausta helpotti vartijaimusolmukkeen paikantamista keskilinjan kasvaimen yhteydessä.

COVID-19 pandemic impact on gynecologic cancer treatment pathways in a Finnish tertiary center

by Reita H Nyberg, Hanna Pikkujämsä, Karolina Louvanto, and Tiina Luukkaala

Acta Obstet Gynecol Scand, 2024

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more

Syömisen välttämis-ja rajoittamishäiriö (ARFID)

Duodecim, 2024

Syömisen välttämis-ja rajoittamishäiriö (avoidant-restrictive food intake disorder, ARFID) on uus... more Syömisen välttämis-ja rajoittamishäiriö (avoidant-restrictive food intake disorder, ARFID) on uusi syömishäiriö DSM-5-ja ICD-11-tautiluokituksissa. Syömisen erityispiirteet, ruoan aistittaviin ominaisuuksiin tai syömisen seurauksiin liittyvät pelot tai vähäinen ruokahalu rajoittavat sairastuneen syömistä niin paljon, että kasvu, painonkehitys tai ravitsemustila häiriintyvät tai syömisen rajoittuneisuus aiheuttaa huomattavaa psykososiaalista haittaa. Diagnoosi perustuu terveydentilan monipuoliseen arviointiin. Syömisen erityispiirteitä voidaan kartoittaa oirekyselyillä tai diagnostisilla haastatteluilla. Syömisen välttämis-ja rajoittamishäiriöön liittyy usein kroonisia sairauksia, mielenterveyden oireita ja autismikirjon piirteitä. Vaikeimmin oireilevat tarvitsevat moniammatillista kuntoutusta. Ravitsemusterapeutin, toimintaterapeutin, puheterapeutin, psykologin tai psykoterapeutin erityisosaaminen on hyödyksi kuntoutuksen suunnittelussa. Lasten ja nuorten ruokavalion kehittymistä monipuoliseksi voidaan tukea myös ruokakasvatuksen keinoin.

Ulkosynnytinsyövän hoito

Duodecim, 2021

Ulkosynnytinsyövistä suurin osa on levyepiteelisyöpiä, jotka kehittyvät joko kroonisten ihosairau... more Ulkosynnytinsyövistä suurin osa on levyepiteelisyöpiä, jotka kehittyvät joko kroonisten ihosairauksien tai papilloomavirusinfektion seurauksena. Tyyppioireita ovat ulkosynnyttimien paikallishoitoon huonosti reagoiva kipu, ärsytys ja kutina. Perusterveydenhuollossa olennaista on tutkia potilas gynekologisessa asennossa ja ottaa epäilyttävistä alueista kudosnäytteet. Levinneisyyttä selvitetään vartalon TT:llä ja lantion magneettikuvauksella. Paikalliset kasvaimet hoidetaan kirurgisesti. Kookkaiden kasvaimien ensileikkauksissa käytetään apuna plastiikkakirurgiaa. Paikallisesti levinneet syöpäkasvaimet hoidetaan kemosädehoidolla. Laajalle levinneessä syövässä hoitolinjana on hidastaa syövän etenemistä. Kura? tiivisen hoidon jälkeen potilasta seurataan erikoissairaanhoidossa viiteen vuoteen saakka ja sen jälkeen perusterveydenhuollossa. Uusiutumien toteamisen lisäksi seurannan tarkoitus on havaita ja lievittää syöpähoitojen aiheuttamia jälkioireita, joita ulkosynnytinsyövän sairastaneilla potilailla usein esiintyy.

Fluoresenssilla vartijaimusolmukkeet esiin

Duodecim, 2018

Kun ulkosynnytinsyöpä todetaan alkuvaiheessa, sen hoito on kirurginen. Imusolmukelevinneisyys on ... more Kun ulkosynnytinsyöpä todetaan alkuvaiheessa, sen hoito on kirurginen. Imusolmukelevinneisyys on tärkeä ennustetekijä, ja noin kymmenen vuoden ajan sitä on voitu määrittää myös vartijaimusolmuketutkimuksella. Vartijaimusolmukkeet paikannetaan tavanomaisesti siniväri- ja isotooppiruiskutuksen jälkeen gammakoettimen avulla ja silmämääräisesti. Uudet kuvantamistekniikat helpottavat vartijaimusolmukkeiden paikantamista. Kuvaamme potilaan, jonka vartijaimusolmuketutkimus tehtiin sinivärin ja teknetiumisotoopin avulla, ja lisäksi leikkauksessa käytettiin nykyaikaisempaa merkkiainetta, indosyaniinivihreää. Yksifotoniemissiotomografia (SPECT-TT) ennen leikkausta helpotti vartijaimusolmukkeen paikantamista keskilinjan kasvaimen yhteydessä.

Nuorten laihuushäiriön perhepohjainen hoito

Duodecim, 2020

Tumor cell-specific Serpin A1 expression in vulvar squamous cell carcinoma

Archives of Gynecology and Obstetrics, 2019

Purpose The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulvar... more Purpose The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulvar dermatosis lichen sclerosus (LS) and high-risk human papillomavirus (hrHPV). Serpin A1 (α1-antitrypsin) is a serine protease inhibitor, which plays a role in the tumorigenesis of various cancer types. The aim of the study was to evaluate the expressions of Serpin A1 in LS, premalignant vulvar lesions, and vSCC using immunohistochemistry (IHC) and serum analysis, and to compare Serpin A1 stainings to the tumor markers p53 and p16. Methods In total, 120 samples from 74 patients were studied with IHC for Serpin A1, p53 and p16: 18 normal vulvar skin, 53 LS, 9 premalignant vulvar lesions (dVIN/HSIL) and 40 vSCC samples. Serum concentrations of Serpin A1 were analyzed from 30 LS, 44 vSCC and 10 control patients. Expressions were compared to clinical data. Results Tumor cell-specific Serpin A1 overexpression was detected in 88% of vSCC samples, independent of the etiology. The intensity of Serpin A1 expression was significantly higher in vSCC than in healthy vulvar skin, LS, or premalignant vulvar lesions. Serpin A1 showed an association with p53 positivity. No difference in overall survival was found between Serpin A1-, p53-, or p16-positive vSCC patients. Serum concentrations of Serpin A1 were equal in the LS, vSCC, and control groups. Conclusion Tumor cell-specific Serpin A1 overexpression is a potential biomarker in vSCC.

609 Tumor cell-specific Serpin A1 overexpression in vulvar squamous cell carcinoma

Journal of Investigative Dermatology, 2017

The AMPK-related kinase NUAK2 is considered to play some role in melanoma development and progres... more The AMPK-related kinase NUAK2 is considered to play some role in melanoma development and progression. In our past studies, we showed that NUAK2 is a gene that has a prognostic significance in acral melanoma patients by verifying a public array comparative genomic hybridization (CGH) database and immunohistochemistry of 56 primary acral melanomas (PNAS, 2011) and that pharmacologic inhibition of CDK2 is sufficient to suppress the growth of NUAK2 amplified and PTEN-deficient melanoma cells (Cancer Res, 2015). This time, in order to validate the previous survival data with an increased number of cases, we performed immunohistochemical analyses using 87 specimens of acral melanomas. We also examined its relevance with DNA copy number gains revealed by metaphase CGH. We performed immunohistochemical analyses by using formalin-fixed, paraffin-embedded tissues from 87 acral melanomas and 40 Non-CSD melanomas, and performed metaphase CGH analyses from 12 acral melanomas and 6 Non-CSD melanomas. The Kaplan-Meier curves showed that both the relapse-free survival and the overall survival time of patients with acral melanomas expressing NUAK2 were significantly shorter than patients without the NUAK2 expression. The Cox regression model showed a significant difference in relapse-free survival in acral melanomas. All 6 cases with 1q32 gain, where NUAK2 resides, over-express NUAK2. These data demonstrate that over-expression of NUAK2 has a significant impact on the survival of acral melanoma patients.

Can vascular endothelial growth factor C expression be of use in predicting surgical stage or prognosis in vulvar cancer ?

Journal of Cancer Research & Therapy, 2017

Introduction: Nodal metastasis is a main prognostic factor in vulvar cancer. Increased vascular e... more Introduction: Nodal metastasis is a main prognostic factor in vulvar cancer. Increased vascular endothelial growth factor C (VEGF-C) expression has been associated with lymph node metastasis and poor prognosis in many cancers. The aim of this retrospective study was to investigate VEGF-C expression pattern in the invasive edge of vulvar cancer and in sentinel lymph node metastasis, and its association with the stage and prognosis. Methods: Tumor and sentinel lymph node samples from 44 patients were evaluated with immunohistochemistry, and the results were linked with the clinicopathological data. Results: Sixty-seven percent of primary tumors and 76% of sentinel lymph node metastases expressed VEFG-C. Positive VEGF-C expression of the primary tumor did not predict surgical Stage or sentinel lymph node involvement. The risk of relapse was not significantly higher with VEGF-C expressing tumors than with VEGF-C negative tumors (RR 2.55, 95% CI 0.66-9.90, p = 0.18). The risk of groin recurrence was significantly lower with VEGF-C positive than negative tumors (RR 0.36, 95% CI 0.16-0.79, p = 0.01). Survival was similar in both groups. No non-sentinel lymph node metastases were found in case of negative VEGF-C expression in the sentinel lymph node metastasis, whereas with positive VEGF-C expression they were found in 5/13 (38%) of cases. Conclusions: Tumoral VEGF-C expression was not associated with higher surgical Stage or poorer prognosis in vulvar cancer. However, absence of its expression in sentinel lymph node metastasis might indicate a low risk for non-sentinel lymph node metastases.

Sentinel Node and Ovarian Tumors: A Series of 20 Patients

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, May 1, 2017

Intraoperative detection of ovarian sentinel nodes has been shown to be feasible. We examined the... more Intraoperative detection of ovarian sentinel nodes has been shown to be feasible. We examined the detection rate and locations of sentinel nodes in patients with ovarian tumors. We also aimed to assess the reliability of sentinel node method in predicting regional lymph node metastasis. Twenty patients scheduled for laparotomy because of a pelvic mass were recruited to the study. In the beginning of the laparotomy, radioisotope and blue dye were injected under the serosa next to the junction of the ovarian tumor and suspensory ligament. The number and locations of the hot and/or blue nodes/spots were recorded during the operation. If the tumor was malignant according to the frozen section, systematic lymphadenectomies were performed, the sentinel nodes sampled separately, and their status compared with other regional lymph nodes. Eleven patients had a right-sided ovarian tumor, 7 patients a left-sided tumor, and 2 patients had bilateral tumors. A median of 2 sentinel nodes/locations...

Reduction in ERRα is associated with lichen sclerosus and vulvar squamous cell carcinoma

Gynecologic Oncology, 2015

OBJECTIVE ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and inflam... more OBJECTIVE ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and inflammatory processes in both normal and cancer cells. Chronic inflammation induced by lichen sclerosus (LS) or human papilloma virus (HPV) precedes vulvar squamous cell carcinoma (vulvar SCC). We investigated the expression of ERRα, ERRβ and ERRγ in normal vulvar skin, LS as well as LS-dependent and LS-independent/HPV-related vulvar SCC. METHODS A total of 203 samples were analyzed for ERRα, ERRβ and ERRγ by using immunohistochemistry. These included 37 normal vulvar skin samples, 110 LS samples, 6 vulvar intraepithelial neoplasia (VIN) samples and 50 vulvar SCC samples. RESULTS A substantial reduction in or disappearance of ERRα was detected in all vulvar SCC samples. A total of 79% of childhood-onset LS and 51% of adulthood-onset LS lesions showed decreases in ERRα staining. A gradual reduction in ERRα cytoplasmic staining was observed from healthy vulvar skin to precursor lesions and further to SCC. Nuclear ERRα staining was observed in 8/33 (24%) LS-dependent and 10/17 (59%) LS-independent SCC samples. CONCLUSIONS ERRα, a key regulator of cell energy metabolism, may play a role in the pathogenesis of both LS and vulvar SCC.

Reconstruction of the Vulva with Sensate Gluteal Fold Flaps

Scandinavian Journal of Surgery, 2013

Backround and Aims: Soft-tissue reconstruction of the vulva following resection of malignancies i... more Backround and Aims: Soft-tissue reconstruction of the vulva following resection of malignancies is challenging. The function of perineal organs should be preserved and the reconstructed area should maintain an acceptable cosmetic appearance. Reconstruction with local flaps is usually sufficient in the primary phase after a radical vulvectomy. Numerous flaps have been designed for vulvar reconstruction usually based on circulation from the internal pudendal artery branches. In this paper we introduce our modification of the gluteal fold V–Y advancement flap as a primary reconstruction after a radical vulvectomy. Patients and Methods: Twenty-two patients were operated with a radical vulvectomy because of vulvar malignancies. The operation was primary in eight and secondary in 14 patients. The reconstruction of the vulva was performed in the same operation for each patient Results: All flaps survived completely. Wound complications were registered in three patients. Late problems with ...

The 48,XXYY syndrome: A case detected by maternal serum alpha-fetoprotein screening

Prenatal Diagnosis, 1994

A 17-year-old woman was referred for amniocentesis due to a low maternal serum alpha-fetoprotein ... more A 17-year-old woman was referred for amniocentesis due to a low maternal serum alpha-fetoprotein (AFP) concentration in a voluntary screening test. The fetal karyotype was 48,XXYY, and the pregnancy was terminated. Autopsy of the fetus disclosed agenesis of the corpus callosum and unusual facial features. KEY woms48,XXYY syndrome, corpus callosum agenesk, MS-AFP screening.

Ovarian Sentinel Node: Is It Feasible?

International Journal of Gynecologic Cancer, 2011

ObjectiveTo examine whether the intraoperative combined injection technique is feasible in locati... more ObjectiveTo examine whether the intraoperative combined injection technique is feasible in locating the sentinel node(s) of the ovary.Methods/MaterialsIn 16 patients with high-risk uterine cancer and normal postmenopausal ovaries, technetium isotope and blue dye were injected in the right or left ovary during laparotomy, respectively. During the operation, the pelvic and para-aortic lymphatic areas were searched, and the number, method of detection, and location(s) of the hot and/or blue node(s) were recorded.ResultsOne to 3 sentinel nodes per patient were identified in all but 1 patient (15 of 16, 94%). The sentinel nodes (n = 30) were all located in the para-aortic area. The sentinel nodes of the left ovary were mainly (9 of 14, 64%) located above the inferior mesenteric artery level, as the most sentinel nodes of the right ovary (15 of 16, 94%) were found below the inferior mesenteric artery level (P = 0.001). There were no contralateral or bilateral sentinel nodes.ConclusionsThe...

Port-site metastasis following laparoscopic hysterectomy and bilateral salpingo-ophorectomy for endometrial carcinoma

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2009

European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 143, Issue 1, Pa... more

Reply to the letter from Woods and Smith

Clinical Genetics, 2008

The letter by Woods and Smith (Clin Genet 1993: 44: 166) emphasizes the theoretical distinction a... more The letter by Woods and Smith (Clin Genet 1993: 44: 166) emphasizes the theoretical distinction and diagnostic difficulties between chimerism and mosaicism. We wish to add the following clinical data to our report (Nyberg et al. 1992): All karyotypes were obtained from phytohemagglutinin-stimulated blood leukocytes. In 1983, when the twins were born, DNA-studies were unavailable and no fetal tissue was preserved. A study of Q-band chromosomal polymorphisms was done, but the result was considered inconclusive and was therefore not added to our report. The pathologist's examination showed no evidence of a third fetus, thus making the possibility of feto-fetal transfusion rather improbable. The hypothesis proposed by Woods & Smith suggests that the mosaicism of the A-twin was the result of a 3:l meiotic segregation with a subsequent mitotic loss of the normal chromosome 14. This mechanism is based on an assumption of two unrelated mutations. It is therefore less likely than our proposal of a single remutation, i.e. an independent deletion of 14q in the somatic cells of a chromosomally normal male fetus. The suggested prezygotic origin of deletion mosaicism (Cantu et al. 1985) could equally well explain this phenomenon. Because there is no possibility at present of obtaining formal proof of any of the alternatives, we consider further complicated explanations to be futile. We read with interest the paper by Siffroi et al. (1988), describing mosaicism of a t(14;21) in the male descendant of a t(14;21) carrier father. The

Case of human chimerism detected by unbalanced chromosome translocation?

Clinical Genetics, 2008

To the Editor, We were interested to read the article by Nyberg et al. (1992), entitled "A case o... more To the Editor, We were interested to read the article by Nyberg et al. (1992), entitled "A case of human chimerism detected by unbalanced chromosomal translocation". They described a family with a chromosome translocation t(14;20)(q3 l;ql3.3), into which twins were born to a balanced carrier. One twin was female and had a balanced translocation karyotype,

Sentinel node and vulvar cancer: a series of 47 patients

Acta Obstetricia et Gynecologica Scandinavica, 2007

There is growing interest to apply the sentinel node technique in the treatment of vulvar cancer.... more There is growing interest to apply the sentinel node technique in the treatment of vulvar cancer. All charts of the patients operated on for vulvar cancer at Tampere University Hospital from January 1, 2001 through June 30, 2005 were retrospectively reviewed. Demographic, clinical, and histopathological information was collected from each patient. The sentinel lymph node mapping was done intraoperatively either with a combination of the radioisotope and dye techniques (40 patients) or with the dye technique alone (7 patients). The sentinel lymph node was dissected separately for histopathological evaluation, and then a routine inguinal lymphadenectomy was performed. The final FIGO surgical Stage distribution was: Stage I, 11 (23%); Stage II, 14 (30%); Stage III, 21 (45%); and Stage IV, 1 (2%). Sentinel lymph node was identified in 46 (98%) women with either one or both of the methods. In Stage I-II, the sentinel lymph node identification rate was 25/25 (100%) with the combined method. The only patient with unidentified sentinel lymph node had lymphatic spread beyond inguinal area or Stage IV disease. Eighteen of the sentinel lymph nodes (39%) were positive for tumor cells, and in 5 cases additional metastatic nodes were found. One patient with macroscopically enlarged metastatic inguinal nodes and Stage III disease had a negative sentinel lymph node. In the 25 patients with Stage I-II disease, the false-negative rate of the sentinel lymph node method was 0/4, giving a negative predictive value of 1.00. A sentinel node identification rate of 98% with a false-negative rate of 0% in the patients with Stage I-II disease is an encouraging finding.

Reduction in ERRα is associated with lichen sclerosus and vulvar squamous cell carcinoma

Gynecologic Oncology, 2015

Objective: ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and infla... more Objective: ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and inflammatory processes in both normal and cancer cells. Chronic inflammation induced by lichen sclerosus (LS) or human papillo-ma virus (HPV) precedes vulvar squamous cell carcinoma (vulvar SCC). We investigated the expression of ERRα, ERRβ and ERRγ in normal vulvar skin, LS as well as LS-dependent and LS-independent/HPV-related vulvar SCC.

Methods: A total of 203 samples were analyzed for ERRα, ERRβ and ERRγ by using immunohistochemistry. These included 37 normal vulvar skin samples, 110 LS samples, 6 vulvar intraepithelial neoplasia (VIN) samples and 50 vulvar SCC samples.

Results: A substantial reduction in or disappearance of ERRα was detected in all vulvar SCC samples. A total of 79% of childhood-onset LS and 51% of adulthood-onset LS lesions showed decreases in ERRα staining. A gradual reduction in ERRα cytoplasmic staining was observed from healthy vulvar skin to precursor lesions and further to SCC. Nuclear ERRα staining was observed in 8/33 (24%) LS-dependent and 10/17 (59%) LS-independent SCC samples.

Conclusions: ERRα, a key regulator of cell energy metabolism, may play a role in the pathogenesis of both LS and vulvar SCC.

Tumor cell-specific Serpin A1 expression in vulvar squamous cell carcinoma

Archives of Gynecology and Obstetrics, 2019

Purpose: The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulva... more Purpose: The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulvar dermatosis lichen sclerosus (LS) and high-risk human papillomavirus (hrHPV). Serpin A1 (α1-antitrypsin) is a serine protease inhibitor, which plays a role in the tumorigenesis of various cancer types. The aim of the study was to evaluate the expressions of Serpin A1 in LS, premalignant vulvar lesions, and vSCC using immunohistochemistry (IHC) and serum analysis, and to compare Serpin A1 stainings to the tumor markers p53 and p16.
Methods: In total, 120 samples from 74 patients were studied with IHC for Serpin A1, p53 and p16: 18 normal vulvar skin, 53 LS, 9 premalignant vulvar lesions (dVIN/HSIL) and 40 vSCC samples. Serum concentrations of Serpin A1 were analyzed from 30 LS, 44 vSCC and 10 control patients. Expressions were compared to clinical data.
Results: Tumor cell-specific Serpin A1 overexpression was detected in 88% of vSCC samples, independent of the etiology. The intensity of Serpin A1 expression was significantly higher in vSCC than in healthy vulvar skin, LS, or premalignant vulvar lesions. Serpin A1 showed an association with p53 positivity. No difference in overall survival was found between Serpin A1-, p53-, or p16-positive vSCC patients. Serum concentrations of Serpin A1 were equal in the LS, vSCC, and control groups. Conclusion: Tumor cell-specific Serpin A1 overexpression is a potential biomarker in vSCC.

Fluoresenssilla vartijaimusolmukkeet esiin [Use of fluorescence in finding sentinel lymph nodes]

by Reita H Nyberg and Koivunen Sanna

Duodecim, 2018

Kun ulkosynnytinsyöpä todetaan alkuvaiheessa, sen hoito on kirurginen. Imusolmukelevinneisyys on ... more Kun ulkosynnytinsyöpä todetaan alkuvaiheessa, sen hoito on kirurginen. Imusolmukelevinneisyys on tärkeä ennustetekijä, ja noin kymmenen vuoden ajan sitä on voitu määrittää myös vartijaimusolmuketutkimuksella. Vartijaimusolmukkeet paikannetaan tavanomaisesti siniväri- ja isotooppiruiskutuksen jälkeen gammakoettimen avulla ja silmämääräisesti. Uudet kuvantamistekniikat helpottavat vartijaimusolmukkeiden paikantamista. Kuvaamme potilaan, jonka vartijaimusolmuketutkimus tehtiin sinivärin ja teknetiumisotoopin avulla, ja lisäksi leikkauksessa käytettiin nykyaikaisempaa merkkiainetta, indosyaniinivihreää. Yksifotoniemissiotomografia (SPECT-TT) ennen leikkausta helpotti vartijaimusolmukkeen paikantamista keskilinjan kasvaimen yhteydessä.

Sentinel Lymph Node Method in Vulvar and Ovarian Cancer - Reflections on lymphatic spread and its prediction

Acta Electronica Universitatis Tamperensis, 2017

Lymphatic spread if one of the most important prognostic factors in gynecological cancers. Theref... more Lymphatic spread if one of the most important prognostic factors in gynecological cancers. Therefore, nodal staging is an essential part of cancer diagnosis and treatment planning. The sentinel lymph node (SLN) is the first lymph node to receive lymphatic fluid from the tumor and is at greatest risk of metastasis. According to the SLN concept, with locating and retrieving the SLN for analysis it is possible to predict the stage of the regional lymph nodes in relation to cancer metastasis without extensive surgical procedures.

Sektioarven kuvantaminen ja varhainen accreta

Vulvakarsinooman ja –melanooman dg ja hoito Nyberg

FINGOG päivät, 2022

Yleistyykö syöpä - kohonneen syöpäriskin taustat? Ulkosynnytin-, emätin- ja kohdunkaulasyöpä [Backgrounds for an elevated risk of cancer - Vulvar, vaginal and cervical cancer]

SGY syyskoulutuspäivät, 2016

VULVODYNIAPOTILAAN KOHTAAMINEN JA HOIDON HAASTEET [How to encounter a woman with vulvodynia and to face the challenges in treatment]

Koulutuspäivä perusterveydenhuollon lääkäreille, Tampere, 2019

Esityksen sisältö: Mitä on vulvodynia? Milloin vulvodyniaa voisi epäillä? Vulvodyniapotilaan tutk... more

ICG gynekologisessa syöpäkirurgiassa [ICG in Gynaecological Cancer Surgery]

7. valtakunnalliset gynekologisen syövän koulutuspäivät (FIN-GOG), Turku, 2019

Kohdunkaulan ja kohdun runko-osan maligniteetit Ruscito et al. 2016 meta-analyysi: ICG vs. muut m... more Kohdunkaulan ja kohdun runko-osan maligniteetit Ruscito et al. 2016 meta-analyysi: ICG vs. muut menetelmät (n = 538, 6 tutkimusta)  löytymisosuus:  ICG parempi kuin siniväri (OR 0.27; 95 % CI 0.15-0.50; p<0.0001)  ICG yhtä hyvä kuin Tc (OR 1.08; 95 % CI 0.52-2.26; p = 0.83) tai siniväri+Tc (OR 0.96; 95 % CI 0.45-2.02; p = 0.91)  bilateraaliset vartijat:  ICG parempi kuin siniväri (OR 0.27; 95 % CI 0.19-0.40; p<0.00001)  ICG yhtä hyvä kuin Tc (OR 1.21; 95 % CI 0.80-1.81; p = 0.36)  ICG vähintään yhtä hyvä kuin siniväri+Tc (OR 0.37; 95 % CI 0.07-2.12; p = 0.27)  väärät negatiiviset:  ei eroa ICG:n ja sinivärin välillä (OR 0.26; 95 % CI 0.02-3.06; p = 0.28), HUOM! pieni potilasmäärä  ICG vs. Tc / siniväri+Tc ei voitu verrata, koska vääriä negatiivisia ei ollut / ei oltu raportoitu 5.9.2019 FIN-GOG © 2019 REITA NYBERG 5.9.2019 FIN-GOG © 2019 REITA NYBERG MITÄ TIEDETÄÄN ICG:N SOVELTUVUUDESTA VARTIJAIMUSOLMUKETUTKIMUKSEEN? Kohdunkaulan ja kohdun runko-osan maligniteetit FILM-tutkimus (Frumowitz et al. 2018)  randomoitu, prospektiivinen, non-inferiority tutkimus ICG vs. ISB ( n = 163)  ICG ei ollut vain yhtä hyvä vaan parempi kuin siniväri vartijaimusolmukkeiden löytämisessä  vartijaimusolmukkeista 96 % löytyi ICG:llä, 46 % ISB:llä (ero 50 %-yks, 95 % CI 39-61, p<0.0001)  vähintään yksi vartija löytyi ICG:llä 98 %:lta ja ISB:llä 76 %:lta potilasta (p<0.0001)  bilateraalisesti vartijat löytyivät ICG:llä 81 %:lta ja ISB:llä 32 %:lta potilaista (p<0.0001)

NUOREN PAINONPUDOTUS - MILLOIN HUOLESTUA [A Teen Is Dieting - When to Worry]

Reproduktioendokrinologian koulutuspäivät, Helsinki, 2020

Vartijaimusolmukkeet - missä mennään? [Sentinel Nodes in Gynaecological Cancer - Where are we?]

GKS-päivät, 2018

Sektioarven kuvantaminen ja varhainen accreta [Imaging of uterine cesarean scar and early placenta accreta]

Lääketieteellinen Ultraääniseura, Kevätkoulutuspäivät, 2015

The Use of OSATS in Training

Nordic Conference of Gynaecological Endoscopy, 2015

Incorporating OSATS (Objective Structured Assessment of Technical Skills) into clinical training ... more

Simulation and Cadaver Training

Nordic Society of Gynaecological Oncology Conference, 2017

What is the use of simulation and cadaver training in educating new gynaecologic oncologists?

Sektioarpi gynekologisena ongelmana [Uterine cesarean scar as a gynecological complication]

SGY Kevätkoulutuspäivät, 2015

Vartijaimusolmuketekniikat gynekologisissa syöpäleikkauksissa [Sentinel Node Techniques in Gynecologic Cancer]

GKS-päivät, 2013

Istmocelen diagnostiikka ja hoito [Istmocele: Diagnosis and Treatment]

GKS-päivät, 2012

Laparoskopia raskauden aikana raskauden aikana [Laparoscopy during Pregnancy]

GKS-päivät, 2010