The impact of uterine fibroid embolization on resumption of menses and ovarian function

PURPOSE

To evaluate the effect of uterine fibroid embolization (UFE) on menstruation and ovarian function.

METHODS

The authors performed an observational study of UFE for the treatment of symptomatic fibroids. All patients had regular predictable menses before intervention and none had clinical or laboratory findings of menopause. UFE was performed with use of standard methods with 355-700-microm-diameter polyvinyl alcohol (PVA) foam particles. The incidence of ovarian failure was calculated for women younger than 45 years and for those 45 years or older, based on retrospective stratification by age. The authors assessed statistical differences in ovarian failure between the two age groups with use of the X2 test.

RESULTS

Sixty-six premenopausal women (age range, 30-55 years) underwent bilateral UFE and were followed for an average of 21 weeks (range, 12-77 weeks). In 56 of 66 (85%) patients, regular menses resumed after an average of 3.5 (range, 1-8) weeks. In 10 of 66 (15%) patients, regular menses did not resume. Clinical and biochemical findings consistent with ovarian failure and presumed menopause were seen in nine of 10 patients without resumption of menses (14% of total patients). Ovarian failure occurred in nine of 21 (43%) women older than 45 years and in none of the 45 women younger than 45 years (P < .05). There were no differences in presenting symptoms, amount of PVA used, or fibroid size between patients who did and did not resume menses.

CONCLUSION

The majority of patients undergoing UFE will have resumption of menses, but the incidence of postprocedure ovarian failure is considerably higher than reported to date. Loss of menses induced by UFE is significantly more likely to occur in women older than 45 years.

Late recurrences of vaginal clear cell adenocarcinoma

Recurrent vaginal clear cell adenocarcinoma was diagnosed in two DES-exposed patients 17 and 19 years after initial therapy. These cases demonstrate the need for continued clinical evaluation, since patients with clear cell carcinoma of the vagina seem to be at greater risk for developing late recurrences than patients with squamous cell carcinomas.

Cryosurgical treatment of cervical intraepithelial neoplasia: four-year experience

Cryosurgical therapy was used to treat 393 patients with cervical intraepithelial neoplasia. Therapeutic success was evaluated in relation to lesion size, grade, and endocervical extension. The overall cure rate with cryosurgical therapy was 84%. Size alone was found to be the major determinant of cryosurgical success. For one-quadrant lesions, there was a 99% cure rate. For two-quadrant lesions, the cure rate was 93%. For three- or four-quadrant lesions, the success rate was only 61%. Lesion size was found to be positively correlated with grade of dysplasia. As the grade of cervical intraepithelial neoplasia progressed, lesion size tended to increase. When this association was controlled for, grade of dysplasia was not a significant determinant of success rate. When endocervical extension occurred, although the upper limits of the lesion were seen, there was a significantly reduced success rate of 64%. Patients with large lesions or endocervical extension are at a much higher risk for failure with cryosurgical treatment. If cryotherapy is chosen for these patients, careful, long-term follow-up is essential to ensure adequate treatment of disease.

Perception, Awareness, and Acceptance of Human Papillomavirus Disease and Vaccine Among Parents of Boys Aged 9 to 18 Years

Male human papillomavirus (HPV) vaccination rates remain very low. The study objective was to gain an understanding of the perceptions of HPV disease and acceptance/barriers to HPV vaccine by parents of boys aged 9 to 18 years. An anonymous, written survey was administered from January 1, 2011 to September 30, 2013 in private pediatric offices (PPOs) and public health clinics (PHCs) in Chicago, Illinois. A total of 230 PPO parents (PPOPs) and 286 PHC parents (PHCPs) completed the survey. Despite significant differences ( P < .0001) in education level, socioeconomic status, and HPV disease and vaccine knowledge/awareness between the PPOP and PHCP, there was no difference between PPOP and PHCP who would vaccinate their sons with HPV vaccine. For both groups, health care provider recommendation was the primary influence for vaccination. The major barrier to vaccination was lack of information on HPV disease/vaccine. Health care providers need to proactively discuss and use HPV vaccine in male patients.

Malignant tumors of the vagina. Classification and approach to treatment

While primary carcinoma of the vagina is relatively rare, metastatic lesions arising from the endometrium are more common, and extension from cervical or vulvar tumors can also affect the vagina. Adenocarcinoma related to diethylstilbestrol exposure in utero is a recently recognized type of vaginal lesion, and melanoma and sarcoma occur rarely in the vagina. Familiarity on the physician's part with these various presentations and their proper management will help ensure early treatment and preservation of normal vaginal function in affected patients.

Awareness, perceptions and knowledge of recommended adult vaccines among a nationwide sample of adult primary care providers

OBJECTIVE

To examine the awareness, knowledge, barriers to usage and acceptance of recommended adult vaccines among obstetrician/gynecologists (OB/GYNs) compared to other adult primary care providers (APCPs).

STUDY DESIGN

A self-administered survey was sent to 1,000 OB/GYN, 1,000 family practice and 1,000 internal medicine physicians nationwide.

RESULTS

Of 3,000 mailed surveys, 733 (24.8%) were returned. Of those, 617 (84.18%) reported providing primary care to adults. Only 53.04% of APCPs reported having a vaccine record on > 50% of their primary care patients, with 33.15% of OB/GYNs having no record. This absence of a record was significantly greater for OB/GYNs vs. other APCPs. OB/GYNs were also significantly less likely to routinely discuss the importance of vaccines and offer any vaccines. With the exception of HPV vaccine, other providers were significantly more likely to provide Td, Tdap, influenza, hepatitis B and MMR compared to OB/GYNs. Overall 58.24% of APCPs administered vaccines to pregnant women: 4.86% administered MMR and 2.86% administered HPV vaccine, vaccines not recommended during pregnancy. Poor reimbursement and lack of knowledge and training in vaccine use were major factors that prevented APCPs from offering vaccines. The greatest perceived barriers to patient vaccine acceptance included concern about adverse effects, perceived lack of disease risk, distrust of vaccines, lack of disease awareness and cost.

CONCLUSION

Intensive programs aimed at familiarizing APCPs with vaccine-preventable diseases and the importance of using vaccines are needed in order to improve vaccination rates.

Primary choriocarcinoma of the ovary

Eight patients with choriocarcinoma of the ovary treated at the Choriocarcinoma Research and Treatment Center are presented and the previously reported cases reviewed. A more optimistic prognosis can be offered for these tumors than previously. Four of the 8 patients are in remission and 4 have died. Triple therapy should be used for these tumors despite the increase in toxicity.