The Contribution of Uterine Artery Embolization as a Safe Treatment Option for Uterine Fibroids

Uterine fibroids have remarkably heterogeneous clinical characteristics with unknown exact etiology. The treatment of fibroids should be individualized based on their size, location, growth rate, the symptoms that they cause, the desire to have children and the age of the woman. Embolization is currently the most advanced non-surgical technique. The majority of women report satisfactory post-treatment results like shorter hospitalization period and recovery time in comparison to hysterectomy and improvement or complete remission of clinical symptoms. Complications include amenorrhea (in the majority of cases: recurrence after three months) and infections that are generally treated with antibiotics. The results from most clinical studies and our published experience indicate that embolization improves pelvic symptoms related to uterine fibroids. Collaborative efforts between gynecologists and interventional radiologists are necessary in order to optimize the safety and efficacy of this procedure. In the future, embolization could be generally recommended as treatment option for women who desire future fertility/pregnancy.

Adolescence endometriosis with abnormal uterine bleeding: A challenging case report

Endometriosis is the presence of endometrial tissue outside the Uterus. The true incidence of endometriosis is not really known, but it is believed that 10-15% of all women in their reproductive age will develop endometriosis and 25-35% of all women who are infertile have endometriosis. The true incidence of endometriosis in adolescents is difficult to quantify and estimates vary among different studies. Although in the past it was assumed that endometriosis presented only after many years of menstruation, studies have shown endometriosis to occur prior to menarche and between 1-6 months after the onset of menarche. A 66% of adult women with endometriosis report the onset of pelvic symptoms prior to age 20. Although etiology and pathophysiology of endometriosis is not well‐understood, but increased rate of retrograde menstruation in patients with heavier menses as with bleeding disorder, is a possible mechanism of disease. Here, we report an early adolescent admitted with dysmenorrhea with bleeding disorder, suspected Von Willebrand disease, presenting abnormal uterine bleeding.

Are symptoms distinguishable in ovarian cancer? A nested case control study of insurance claims.

6063 Background: Over 60% of ovarian cancer cases are diagnosed with Stage III and IV disease. The US healthcare system does not support a standard screening method for ovarian cancer. Our goal was to determine whether certain symptoms based on ICD-9 categories are distinguishable among women diagnosed with ovarian cancer and women without ovarian cancer. Methods: Women diagnosed with ovarian cancer were randomly matched 1:1 to women without cancer to support a nested case-control analysis of health insurance claims between 2008 through 2013 from a commercial payer. The following eligibility criteria were applied: 1) 24 years of age or older; 2) continuously enrolled in healthcare plan for a minimum period of 6 months; 3) experienced more than 1 symptom over the observation period; and 4) an observation period of a minimum of 6 months. Symptoms were based on 47 ICD-9 diagnosis codes and categorized specific to pain, abdominal and pelvic, digestive, and bladder. The analysis was based on 1,578 women (789 cases; 789 controls). Results: Overall, 90% (n = 1,421) of the women experienced abdominal and pelvic symptoms, and 92% (n = 725) of the women with ovarian cancer visited their physician for this complaint 6-70 months prior to diagnosis, OR 1.66 (CI 1.14 to 2.41; p = .008). Pain was reported as a complaint by cases at nearly 60% (n = 464) and controls at 48% (n = 376); OR 1.75 (CI 1.39 to 2.19; p < .001). Symptoms for bladder and digestive combined represented 68% of complaints for both cases (n = 507) and controls (n = 555), p = .024 and p = .298, respectively. Of the 1,578 women, 77% (cases = 621; controls = 595) experienced more than one category of symptoms. Both cases (n = 206) and controls (n = 153) complained of abdomen and pelvic symptoms along with pain; OR 1.54 (CI 1.19 to 1.99; p = .001). A second combination included abdomen and pelvic symptoms with pain and digestive symptoms in 14% of women (cases n = 99; controls n = 67); OR 1.58 (CI 1.13 to 2.22; p = .008). Sixty percent (n = 473) of women with ovarian cancer experienced the majority of associated pre-diagnosed symptoms analyzed for the study. Conclusions: Certain recurring symptoms associated with abdomen and pelvic as well as pain appear to indicate an association with ovarian cancer, signifying that symptom awareness remains relevant to this disease that is diagnosed at a late stage and currently does not have routine screening methods to support early detection.

Medical malpractice claim risk in emergency departments

Medical malpractice claims are a major problem for emergency physicians and for the health system which must be addressed in a rational and effective fashion: claim analysis seems the best way to identify risk factors and risk areas and to elaborate risk management recommendations. The Emergency Department (ED) is one of the areas at higher risk. Medical diagnoses associated with the highest number of claims are acute myocardial infarction, fractures, appendicitis, abdominal/pelvic symptoms, aortic aneurism and open wounds to fingers. The present paper emphasizes the necessity for ED emergency physicians to pay special attention when facing these health conditions and seeks to provide indications in order to reduce litigation.

Assessment of urinary incontinence

Involuntary loss of urine is subdivided primarily into stress, urgency, or mixed urinary incontinence. The history and examination aim to identify underlying mechanisms, and indicators of more complex causes, or serious medical conditions. Associated lower urinary tract symptoms (LUTS) should be catalogued in detail. History should also cover symptom bother, as this is the prime driver of therapy. Validated questionnaires are the most effective way to capture aspects of incontinence and associated LUTS. Wider pelvic symptoms, such as pelvic organ prolapse, sexual function, and anal symptoms should also be evaluated. Physical examination needs to cover general aspects, including occult neurological disease. Abdominal and pelvic examination evaluates the genitalia, pelvic floor muscle function, and pelvic masses, along with urethral hypermobility in women and the prostate in men.

Pelvic symptoms after radiotherapy in prostate cancer: a cross-sectional study

Introduction: Despite the technical and scientific progress that improved therapeutic resources available in Oncology, adverse effects of treatment can be prominent, impacting the quality of life (QoL). Objective: This research aims to determine the prevalence of post-radiotherapy pelvic symptoms in prostate cancer (PC) and its impact on QoL. Methods: We assessed three groups of patients at different stages during radiotherapy (RT): Pre-RT, evaluated before of RT; Post-RT#1, evaluated between six months and one year post-RT; Post-RT#2, evaluated between two and a half and four years post-RT. The presence of urinary incontinence (UI), its characteristics and impact on daily living activities (DLA) were evaluated by ICIQ-SF questionnaire. WHOQOL-BREF questionnaire was used to assess QoL. Student t test was used, considering significant p < 0.05. Results: Thirty-three men were assessed (pre-RT, n = 12; Post-RT#1, n = 10; Post-RT#2, n = 11). The prevalence of lower urinary tract symptoms (LUTS) was highest in Post-RT#1 group. Post-RT#2 group had the highest prevalence of post-RT UI. In QoL, Pre-RT and Post-RT#2 groups experiencing the greatest impact on physical, environmental and overall QoL. Conclusion: Acute effect of RT is characterized by a high prevalence of LUTS. Post-RT#2 group experienced the most adverse effects on DLA due to a higher prevalence of post-RT UI.