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Min CJ, Cameo T, Ross WT, Bardawil EC, Biest SW, de Souza KM. Vasopressin Injection Purse-String Ectopic Resection technique for laparoscopic management of cornual ectopic pregnancy. Am J Obstet Gynecol 2023; 229:340-343. [PMID: 37150283 DOI: 10.1016/j.ajog.2023.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023]
Abstract
Although cornual pregnancy is a rare form of ectopic pregnancy, the associated mortality rate is considerably higher than that of ectopic pregnancy overall. Historically, cornual ectopic pregnancy has been treated via laparotomy. With advancements in technology, equipment, and technique, laparoscopy offers a safer approach for the management of cornual pregnancy. However, laparoscopy of this nature requires excellent technique. The Vasopressin Injection Purse-String Ectopic Resection technique serves as an effective strategy for the laparoscopic management of cornual ectopic pregnancy. First, dilute vasopressin is administered into the myometrium surrounding the pregnancy. Next, a purse-string stitch is placed in the myometrium circumferential to the pregnancy. Finally, the pregnancy is excised by cornual wedge resection, and the defect is repaired using the attached remaining suture from the purse-string stitch. The Figure shows the graphical depiction of the Vasopressin Injection Purse-String Ectopic Resection technique, and the Video shows a laparoscopic recording of the Vasopressin Injection Purse-String Ectopic Resection technique. Between 2012 and 2022, 17 patients underwent a laparoscopic cornual ectopic pregnancy resection at a high-volume academic hospital and its affiliated community hospital. This case series revealed a mean operative time of 107 minutes, with a mean estimated blood loss of 41 mL for nonruptured ectopic pregnancies and 412 mL for ruptured ectopic pregnancies. No case was converted to laparotomy. Our findings suggest that the integration of the vasopressin administration and the pursue-string stitch placement minimizes blood loss and mitigates the risk of conversion to laparotomy for both nonruptured and ruptured cornual ectopic pregnancies.
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Affiliation(s)
- Caroline J Min
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
| | - Tamara Cameo
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Whitney T Ross
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Elise C Bardawil
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Scott W Biest
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Katherine M de Souza
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
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Kosmacki A, Cameo T, Bardawil E, de Souza K, Ross W, Biest S. 8244 Laparoscopic Approach to Endometriosis and Fibrosis in the Lateral Pelvic Sidewall. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cameo T, Jenkins J, Okuagu C, Huang R, Biest S, Ross W, Bardawil E. Transition to Universal Same Day Discharge (SDD) in Times of Corona Virus Disease-19 (COVID): A Success Story. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bligard KH, Cameo T, McCallum KN, Rubin A, Rimsza RR, Cahill AG, Palanisamy A, Odibo AO, Raghuraman N. The association of fetal acidemia with adverse neonatal outcomes at time of scheduled cesarean delivery. Am J Obstet Gynecol 2022; 227:265.e1-265.e8. [PMID: 35489441 DOI: 10.1016/j.ajog.2022.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fetal acidemia at the time of a scheduled cesarean delivery is generally unexpected. In the setting of reassuring preoperative monitoring, the duration of fetal acidemia in this scenario is presumably brief. The neonatal sequelae and risks associated with brief fetal acidemia in this setting are unknown. OBJECTIVE We aimed to assess whether fetal acidemia at the time of a scheduled prelabor cesarean delivery is associated with adverse neonatal outcomes. STUDY DESIGN This was a retrospective cohort study of singleton, term, nonanomalous, liveborn neonates delivered by scheduled cesarean delivery that was performed under regional anesthesia from 2004 to 2014 at a single tertiary care center with a universal umbilical cord gas policy. Neonates born to laboring gravidas and those whose cesarean delivery was performed for nonreassuring fetal status were excluded. All included patients had reassuring preoperative fetal monitoring. The primary outcome was a composite adverse neonatal outcome that included neonatal death, encephalopathy, therapeutic hypothermia, seizures, intubation, and respiratory distress. This outcome was compared between patients with and those without fetal acidemia (umbilical artery pH <7.2). A multivariable logistic regression was used to adjust for confounders. Cases of fetal acidemia were further characterized as respiratory, metabolic, or mixed acidemia based on additional umbilical cord gas values. Secondary analyses examining the association between the type of acidemia and neonatal outcomes were also performed. RESULTS Of 2081 neonates delivered via scheduled cesarean delivery, 252 (12.1%) had fetal acidemia at the time of delivery. Acidemia was more common in breech neonates and in neonates born to gravidas with obesity and gestational diabetes mellitus. Compared with fetuses with normal umbilical artery pH, those with fetal acidemia were at a significantly increased risk for adverse neonatal outcome (adjusted relative risk, 2.95; 95% confidence interval, 2.03-4.12). This increased risk was similar regardless of the type of acidemia. CONCLUSION Even a brief period of mild acidemia is associated with adverse neonatal outcomes at the time of a scheduled cesarean delivery despite reassuring preoperative monitoring. Addressing modifiable intraoperative factors that may contribute to fetal acidemia at the time of a scheduled cesarean delivery, such as maternal hypotension and prolonged operative time, is an important priority to potentially decrease neonatal morbidity in full-term gestations.
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Bligard KH, Cameo T, McCallum K, Rubin A, Rimsza RR, Cahill AG, Raghuraman N. Is fetal acidemia at the time of scheduled cesarean associated with neonatal morbidity? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bligard KH, Cameo T, McCallum K, Rubin A, Rimsza RR, Cahill AG, Raghuraman N. Risk factors for fetal acidemia at time of scheduled cesarean delivery. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Breidbart E, Cameo T, Garvin JH, Hibshoosh H, Oberfield SE. Pubertal outcome in a female with virilizing adrenocortical carcinoma. J Pediatr Endocrinol Metab 2016; 29:503-9. [PMID: 26812773 PMCID: PMC4836965 DOI: 10.1515/jpem-2015-0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 11/30/2015] [Indexed: 11/15/2022]
Abstract
Adrenocortical tumors are neoplasms that rarely occur in pediatric patients. Adrenocortical carcinoma (ACC) is even more uncommon, and is an aggressive malignancy with 5-year survival of 55% in a registry series. There is a lack of information on long-term endocrine outcome in survivors. We describe a 10-year follow-up in a patient who presented at 3 years 5 months with a 1-year history of axillary odor and 6 months' history of pubic hair development with an increased clitoral size. Androgen levels were increased and a pelvic sonogram revealed a suprarenal mass of the left kidney. The tumor was successfully removed. At 6 years 11 months, androgen levels increased again. Workup for tumor recurrence was negative and the findings likely represented early adrenarche. The patient had menarche at an appropriate time and attained a height appropriate for her family.
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Affiliation(s)
- Emily Breidbart
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, New York, NY, USA
| | - Tamara Cameo
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, New York, NY, USA
| | - James H. Garvin
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, New York, NY, USA
| | - Hanina Hibshoosh
- Division of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Sharon E. Oberfield
- Division of Pediatric Endocrinology, Diabetes and Metabolism, New York Presbyterian Hospital-Columbia University Medical Center, 622 West 168th Street PH 5E 522, New York, NY 10032, USA
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Sopher AB, Grigoriev G, Laura D, Cameo T, Lerner JP, Chang RJ, McMahon DJ, Oberfield SE. Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents. J Pediatr Endocrinol Metab 2014; 27:1175-9. [PMID: 25003376 PMCID: PMC4415850 DOI: 10.1515/jpem-2014-0128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/12/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to [1] confirm that nonobese adolescents with polycystic ovary syndrome (PCOS) have higher anti-Mullerian hormone (AMH) than controls; [2] examine the relationship of AMH with PCOS features and hormonal profile; and [3] approximate an AMH value that discriminates between adolescents with PCOS and controls. DESIGN Case-control study. SETTING Subspecialty ambulatory clinic. PATIENTS Thirty-one nonobese adolescent girls (age 13-21 years), 15 with PCOS diagnosed using the National Institutes of Health (NIH) criteria and 16 healthy control subjects. Subjects and controls were comparable for body mass index z-score, age and ethnicity. MAIN OUTCOME MEASURE(S) AMH in PCOS subjects and control groups, correlation of AMH with hormonal parameters. RESULTS AMH was higher in PCOS subjects (4.4±3.4 ng/mL) than in controls (2.4±1.3 ng/mL), when adjusted for menstrual age. In the entire group (PCOS and controls), AMH correlated with androgens, ovarian size and the presence of polycystic ovary (PCO) appearance. There was no difference in average ovarian size between PCOS (7.1±2.6 cm³) and controls (6.7±1.8 cm³). PCOS subjects were 1.49 times more likely to have AMH >3.4 ng/mL (confidence interval 0.98-2.26 ng/mL). CONCLUSIONS Our data suggest that AMH may be a useful adjunct in the diagnosis of PCOS in adolescents.
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Affiliation(s)
- Aviva B. Sopher
- Corresponding author: Aviva B. Sopher, MD, MS, Phone: +1 212 30056559, Fax: +1 212 3054778,
| | - Galina Grigoriev
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY, USA
| | - Diana Laura
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY, USA
| | - Tamara Cameo
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY, USA
| | - Jodi P. Lerner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - R. Jeffrey Chang
- Department of Reproductive Medicine, University of California – San Diego, La Jolla, CA, USA
| | - Donald J. McMahon
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Sharon E. Oberfield
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY, USA
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Shams K, Cameo T, Fennoy I, Hassoun AA, Lerner SE, Aranoff GS, Sopher AB, Yang C, McMahon DJ, Oberfield SE. Outcome analysis of aromatase inhibitor therapy to increase adult height in males with predicted short adult stature and/or rapid pubertal progress: a retrospective chart review. J Pediatr Endocrinol Metab 2014; 27:725-30. [PMID: 24756052 PMCID: PMC4497551 DOI: 10.1515/jpem-2013-0470] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/28/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aromatase inhibitors (AIs) have been used off-label to increase adult height in short adolescent males. Studies have shown that AIs increase the predicted adult height (PAH) while delaying bone age (BA) maturation. We sought to determine whether AI therapy increases PAH in boys with short stature or rapid pubertal progression, and to evaluate any untoward effects. METHODS The charts of 27 boys with BA ≥ 13 and short stature [height ≥ 2 standard deviation (SD) below the mean or ≥ 2 SD below mid-parental target height (MPTH)] or rapid pubertal progress, treated with anastrozole were reviewed. Outcome measures included anthropomorphic, hormonal, and metabolic data. RESULTS The AI therapy averaged 21 months (range 14-30 months) for all, with Rx group 1 receiving <18 months therapy (n=7) and Rx group 2 receiving 18-30 months therapy (n=20). Post-therapy, in Rx group 1 and all subjects, there was no significant change in the PAH, height SDS, or BA/chronological age (CA). In Rx group 2, there was a small, nonsignificant increase in PAH, no change in height SDS, and a small decrease in BA/CA. Post-therapy PAH was different from MPTH in all and in both Rx groups 1 and 2, p<0.02. Eight of them achieved near-final height, averaging 6.73 ± 1.40 cm less than MPTH and 1.91 ± 0.86 cm less than the pre-therapy PAH. Post-therapy, the initially decreased estradiol did not persist but mildly increased testosterone and decreased high-density lipoprotein were noted, as was an increase in hematocrit, and decrease in growth velocity. CONCLUSIONS We suggest that although bone age progression may be slightly delayed with longer duration of therapy, an overall short-term AI therapy does not lead to a final height that is greater than the predicted pre-therapy height.
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Affiliation(s)
- Kim Shams
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Tamara Cameo
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Abeer A. Hassoun
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Shulamit E. Lerner
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Gaya S. Aranoff
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Aviva B. Sopher
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Christine Yang
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Donald J. McMahon
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Sharon E. Oberfield
- Corresponding author: Sharon E. Oberfield, MD, Division of Pediatric Endocrinology, Diabetes and Metabolism, Department of Pediatrics, 622 W 168th Street, PH 5E 522, New York, NY 10032, USA, Phone: +212-305-6559, Fax: +212-305-4778,
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Abstract
Although the diagnostic criteria for polycystic ovary syndrome (PCOS) have become less stringent over the years, determination of the minimum diagnostic features in adolescents is still an area of controversy. Of particular concern is that many of the features considered to be diagnostic for PCOS may evolve over time and change during the first few years after menarche. Nonetheless, attempts to define young women who may be at risk for development of PCOS is pertinent since associated morbidity such as obesity, insulin resistance, and dyslipidemia may benefit from early intervention. The relative utility of diagnostic tools such as persistence of anovulatory cycles, hyperandrogenemia, hyperandrogenism (hirsutism, acne, or alopecia), or ovarian findings on ultrasound is not established in adolescents. Some suggest that even using the strictest criteria, the diagnosis of PCOS may not valid in adolescents younger than 18 years. In addition, evidence does not necessarily support that lack of treatment of PCOS in younger adolescents will result in untoward outcomes since features consistent with PCOS often resolve with time. The presented data will help determine if it is possible to establish firm criteria which may be used to reliably diagnose PCOS in adolescents.
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Affiliation(s)
- Sophia E Agapova
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Tamara Cameo
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Aviva B Sopher
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
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Cameo T, Gumer LB, Williams KM, Gomez J, McMahon DJ, Oberfield SE. A retrospective review of newborn screening for congenital hypothyroidism and newborn thyroid disease at a major medical center. Clin Pediatr (Phila) 2013; 52:1054-8. [PMID: 23785061 PMCID: PMC4051144 DOI: 10.1177/0009922813491824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To study the frequency of congenital hypothyroidism (CH)/thyroid disorders at a major, urban medical center. Methods. We conducted a retrospective review of a preexisting database for 2007 to 2011. Infants were classified as having CH, secondary/tertiary hypothyroidism, thyroid-binding globulin deficiency, and other types of newborn thyroid dysfunctions. Results. A total of 353 (50%) abnormal newborn screens were found to be normal and 42% were abnormal on repeat. Of the latter, 14% had true CH, 1% had thyroid-binding globulin deficiency, and 27% had other causes of thyroid dysfunction. The 5-year incidence of CH at NYP Morgan Stanley Children's Hospital was significantly greater than in New York City, New York State, and Upstate New York. Conclusion. The incidence of CH and other thyroid dysfunctions were greater in our population for 2007 to 2010, after which there was an unexplained decline. The study underlines the importance of continued newborn screening for thyroid dysfunction.
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Affiliation(s)
- Tamara Cameo
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | | | - Kristen M Williams
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Jackie Gomez
- Newborn Screening Program, New York-Presbyterian Hospital, New York, NY
| | - Donald J McMahon
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Sharon E Oberfield
- Department of Pediatrics, Columbia University Medical Center, New York, NY
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