Objective: The purpose of this study was to evaluate the use of upper vaginectomy for the treatment of vaginal intraepithelial neoplasia (VAIN). Study design: We conducted a retrospective review. Between August 1, 198...Objective: The purpose of this study was to evaluate the use of upper vaginectomy for the treatment of vaginal intraepithelial neoplasia (VAIN). Study design: We conducted a retrospective review. Between August 1, 1985 and April 30, 2004, 105 patients were identified who had undergone upper vaginectomy for VAIN. Results: Thirty-six patients had previously been treated for VAIN. Mean operative time and estimated blood loss were 55 minutes and 113 mL, respectively. Ten percent had intraoperative complications. Twenty-three (22% ) patients had negative findings on final pathologic examination, and invasive cancer was found in 13 (12% ) patients. Four patients had postoperative complications. Follow-up was available in 52 patients; 46 (88% ) remain without recurrence at a mean follow-up of 25 months. Conclusion: In our patients, upper vaginectomy was efficacious for the treatment of VAIN. The procedure led to the diagnosis of occult invasive cancer in 12% of these women.展开更多
Objectives. To review our experience with the diagnosis and prognosis of pulmonary embolism (PE) in gynecologic oncology patients. Methods. Spiral CT pulmonary angiography (CTPA) studies on gynecologic oncology patien...Objectives. To review our experience with the diagnosis and prognosis of pulmonary embolism (PE) in gynecologic oncology patients. Methods. Spiral CT pulmonary angiography (CTPA) studies on gynecologic oncology patients were collected from our radiology database from 6/2001 to 6/2003. Patient charts were retrospectively reviewed. Data were abstracted relative to presenting symptoms, demographics and laboratory and diagnostic evaluations. Patient data were compared using chi-square contingency tables and logistic regression analysis. Survival was studied using the Kaplan-Meier method and the log rank test. The effect of PE on survival was adjusted using a proportional hazards regression model. Results. One-hundred and eleven CTPA studies were performed over 2 years and 25 patients were diagnosed with PE.Both PE (n = 25) and non-PE (n = 86) groups were similar for age, race, BMI and cancer diagnosis. Tachycardia (P = 0.02, OR = 3.03 95% CI 1.16-7.94 ) and leukocytosis (P = 0.04, OR = 2.93 95% CI 1.05-8.18 ) were more frequent among PE patients and confirmed as independently prognostic of PE.All other clinical and laboratory findings were similar between patients with and without PE. Overall survival for patients with and without PE was 63% versus 94% , respectively, at 2 years (P = 0.02). Conclusion. In a gynecologic oncology patient with high clinical suspicion for PE, our clinical pre-test probability was 23.0% . Two-year mortality rates were 6-fold higher for patients diagnosed with PE. The significant overlap in clinical presentations, multiple risk factors and higher mortality rates encourage the aggressive diagnosis and treatment of PE among this population. Further work is needed to reduce the incidence and mortality rate of PE.展开更多
Background. Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likel...Background. Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likely not the first time, in which a patient delayed her cancer treatment due to domestic abuse and her disease progressed. Case. A 41-year-old female with vaginal bleeding was diagnosed with cervical cancer. After several years of declining recommendations for treatment, she was questioned separate from her partner and she revealed a long-standing history of abuse. Conclusions. Physicians must be aware of the signs of spousal abuse to lessen negative impact on the treatment of their patients. Once domestic violence is discovered, there are many resources available to help patients with their needs.展开更多
文摘Objective: The purpose of this study was to evaluate the use of upper vaginectomy for the treatment of vaginal intraepithelial neoplasia (VAIN). Study design: We conducted a retrospective review. Between August 1, 1985 and April 30, 2004, 105 patients were identified who had undergone upper vaginectomy for VAIN. Results: Thirty-six patients had previously been treated for VAIN. Mean operative time and estimated blood loss were 55 minutes and 113 mL, respectively. Ten percent had intraoperative complications. Twenty-three (22% ) patients had negative findings on final pathologic examination, and invasive cancer was found in 13 (12% ) patients. Four patients had postoperative complications. Follow-up was available in 52 patients; 46 (88% ) remain without recurrence at a mean follow-up of 25 months. Conclusion: In our patients, upper vaginectomy was efficacious for the treatment of VAIN. The procedure led to the diagnosis of occult invasive cancer in 12% of these women.
文摘Objectives. To review our experience with the diagnosis and prognosis of pulmonary embolism (PE) in gynecologic oncology patients. Methods. Spiral CT pulmonary angiography (CTPA) studies on gynecologic oncology patients were collected from our radiology database from 6/2001 to 6/2003. Patient charts were retrospectively reviewed. Data were abstracted relative to presenting symptoms, demographics and laboratory and diagnostic evaluations. Patient data were compared using chi-square contingency tables and logistic regression analysis. Survival was studied using the Kaplan-Meier method and the log rank test. The effect of PE on survival was adjusted using a proportional hazards regression model. Results. One-hundred and eleven CTPA studies were performed over 2 years and 25 patients were diagnosed with PE.Both PE (n = 25) and non-PE (n = 86) groups were similar for age, race, BMI and cancer diagnosis. Tachycardia (P = 0.02, OR = 3.03 95% CI 1.16-7.94 ) and leukocytosis (P = 0.04, OR = 2.93 95% CI 1.05-8.18 ) were more frequent among PE patients and confirmed as independently prognostic of PE.All other clinical and laboratory findings were similar between patients with and without PE. Overall survival for patients with and without PE was 63% versus 94% , respectively, at 2 years (P = 0.02). Conclusion. In a gynecologic oncology patient with high clinical suspicion for PE, our clinical pre-test probability was 23.0% . Two-year mortality rates were 6-fold higher for patients diagnosed with PE. The significant overlap in clinical presentations, multiple risk factors and higher mortality rates encourage the aggressive diagnosis and treatment of PE among this population. Further work is needed to reduce the incidence and mortality rate of PE.
文摘Background. Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likely not the first time, in which a patient delayed her cancer treatment due to domestic abuse and her disease progressed. Case. A 41-year-old female with vaginal bleeding was diagnosed with cervical cancer. After several years of declining recommendations for treatment, she was questioned separate from her partner and she revealed a long-standing history of abuse. Conclusions. Physicians must be aware of the signs of spousal abuse to lessen negative impact on the treatment of their patients. Once domestic violence is discovered, there are many resources available to help patients with their needs.
