Thesis (DMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Chapter 1 is a literature review investigating the incidence of cancer in children and
young adults. It describes the most important treatment options including
chemotherapy, radiotherapy and surgery and the effect of treatment on future
endocrine development and fertility. Different primary cancer sites are discussed in
more detail.
Chapter 2 is a literature review on the effects of cancer surgery in women and the
options for fertility sparing. Cervical cancer and pre-cancer are discussed in detail
with options for more conservative surgery in selected patients. A summary of the
available published cases of trachelectomy with pregnancy outcomes is included.
Other gynaecological cancers requiring surgery are also discussed with reference to
conservative options.
Chapter 3 is a literature review about the medical (pharmacological) options for
protection of ovarian function in patients undergoing oncotherapy. The role of
gonadotrophin releasing hormone analogues and hormonal contraceptives in ovarian
suppression is discussed in detail.
Chapter 4 This chapter examines germ cell physiology with reference to cryopreservation. It
includes two major parts. Part 1 is the description of germ cell- and follicle physiology, the principles of cryobiology followed by a review of oocyte
cryopreservation and ovarian tissue preservation. Both slow freezing and vitrification
techniques are described. The second part of chapter 4 is a report on a randomised
controlled evaluation of two different slow freezing cryopreservation protocols. This
experimental study compared ultrastructural changes in fresh and previously
cryopreserved ovarian cortical tissue after equilibration and thawing using two
different cryoprotectants. This is the first randomised investigation into DMSO and
PROH as cryoprotectants.
Chapter 5 is an investigation into cryopreservation of ovarian tissue as a strategy to
protect hormonal function and fertility against gonadotoxic treatment. This chapter
consists of two parts. The first part is a thorough literature review of all the published
work about grafting of previously cryopreserved ovarian tissue. The largest case
series found from a single institution was five patients. Another report of six patients
included patients from various sites in Denmark.
Part 2 is a description of a cohort of patients followed up after re-implantation of
previously cryopreserved ovarian cortical tissue. Follow-up hormone levels of 13
individual cases are described in detail. This is the largest case series ever
reported.
The experimental study described in Chapter 4 and the clinical study described in
Chapter 5 was approved by the ethical research committee of the Faculty of Health
Sciences, Stellenbosch University, project number N05/10/182. Chapter 6 provides an integrated overview of the incidence and treatment of cancer
in young women and how its negative effects may be prevented or mitigated.
Aspects of chemotherapy, radiotherapy and surgery are evaluated where it may
affect future reproductive health. The role of oocyte and ovarian tissue
cryopreservation is discussed. Guidelines are provided for clinicians. / AFRIKAANSE OPSOMMING: Hoofstuk 1
Hierdie is ‘n literatuuroorsig wat die insidensie van kanker in kinders en jong
volwassenes ondersoek. Dit sluit die mees belangrike behandelingsopsies in,
naamlik chemoterapie, radioterapie en chirurgie en die effek wat behandeling mag
hê op toekomstige endokriene ontwikkeling en fertiliteit. ‘n Verskeidenheid kanker
tipes word in meer detail beskryf.
Hoofstuk 2
Hoofstuk 2 is ‘n literatuuroorsig oor die effekte van kankerchirurgie in vroue en die
geleenthede tot beskerming van fertiliteit. Servikale kanker en voorlopers van
servikale kanker word bespreek en die opsies vir konserwatiewe chirurgie in
uitgesoekte pasiënte word gegee. ‘n Opsomming van die inligting wat beskikbaar is
oor tragelektomie en swangerskap uitkomste word ingesluit. Ander ginekologiese
kankers wat chirurgie mag benodig, word ook bespreek met verwysing na
konserwatiewe hantering.
Hoofstuk 3
‘n Literatuuroorsig oor die mediese (farmakologiese) opsies vir die beskerming van
ovariële funksie in pasiënte wat behandeling ontvang vir kanker. Die rol van
gonadotropien-vrystellingshormoon-analoë en hormonale kontrasepsie vir ovariële
onderdrukking word in detail bespreek.
Hoofstuk 4
Hierdie hoofstuk ondersoek kiemselfisiologie met verwysing na vriesbewaring. Dit is
verdeel in twee dele. Deel 1 is ‘n beskrywing van kiemsel- en follikelfisiologie en die beginsels van vriesbiologie. Dit word gevolg deur ‘n oorsig van oösiet vriesbewaring
en ovariële weefselbewaring. Stadige bevriesing en vitrifikasie- metodes word
bespreek. Die tweede deel van hoofstuk 4 is ‘n verslag oor ‘n gerandomiseerde,
gekontroleerde evaluasie van twee stadige bevriesingsmetodes. Hierdie
eksperimentele studie het die ultrastrukturele veranderinge vergelyk in vars en
voorheen bevrore ovariële kortikale weefsel na ekwilibrasie en ontdooiing met twee
verskillende vriesbeskermers. Dit is die eerste gerandomiseerde studie oor DMSO
en PROH as vriesbeskermers.
Hoofstuk 5
Hierdie hoofstuk handel oor ‘n ondersoek na vriesbewaring van ovariële weefsel as
‘n benadering tot beskerming van hormonale funksie en fertiliteit teen
gonadotoksiese behandeling. Die hoofstuk bestaan uit twee dele. Die eerste deel is
‘n deeglike oorsig van die literatuur oor al die beskikbare werk wat handel oor
terugplasing van voorheen bevrore ovariële weefsel. Die grootste pasiëntreeks van
‘n enkel instelling was slegs vyf pasiënte. ‘n Ander beskrywing van ses pasiënte het
pasiënte van verskeie eenhede in Denemarke ingesluit.
Deel 2 is ‘n beskrywing van ‘n groep pasiënte wat opgevolg is na oorplanting van
voorheen bevrore ovariële kortikale weefsel. Opvolg hormoonvlakke van 13 gevalle
word in detail bespreek. Hierdie is die grootste pasiëntreeks wat tot nog toe beskryf
is.
Die eksperimentele studie wat in hoofstuk 4 beskryf word en die kliniese studie wat
in hoofstuk 5 beskryf word, is goedgekeur deur die etiese navorsingskomitee van die Fakulteit Gesondheidswetenskappe van die Universiteit Stellenbosch met die
projeknommer N05/10/182
Hoofstuk 6
Hierdie is ‘n geïntegreerde oorsig van die voorkoms en behandeling van kanker in
jong vroue en hoe die negatiewe effekte daarvan voorkom of verminder kan word.
Aspekte van chemoterapie, radioterapie en chirurgie word geëvalueer ten opsigte
van die effek op toekomstige reproduktiewe gesondheid. Die rol van oösiet- en
ovariële weefselvriesbewaring word bespreek. Riglyne vir klinici word gegee.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/5145 |
| Date | 12 1900 |
| Creators | Botha, Matthys Hendrik |
| Contributors | Kruger, T.F., University of Stellenbosch. Faculty of Health Sciences. Dept. of Obstetrics and Gynaecology. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 287 p. : ill. (some col.) |
| Rights | University of Stellenbosch |
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