Publications by authors named "Tri A Dinh"

26 Publications

  • Page 1 of 1

Laparoscopic Transillumination for Extrapelvic Superficial Abdominal Wall Endometriosis.

J Minim Invasive Gynecol 2021 Jul 5. Epub 2021 Jul 5.

Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida (all authors).

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http://dx.doi.org/10.1016/j.jmig.2021.07.001DOI Listing
July 2021

Correcting the Fundamentals of Laparoscopic Surgery "Illusion of Validity" in Laparoscopic Vaginal Cuff Suturing.

J Minim Invasive Gynecol 2021 May 16. Epub 2021 May 16.

Department of Medical and Surgical Gynecology (Drs. Leon, Dinh, and DeStephano).

Study Objective: The "illusion of validity" is a cognitive bias in which the ability to interpret and predict surgical performance accurately is overestimated. To address this bias, we assessed participants comparing fundamentals of laparoscopic surgery (FLS) and non-FLS tasks with cadaveric vaginal cuff suturing to determine the most representative simulation task for laparoscopic vaginal cuff suturing.

Design: Validity (Messick framework) study comparing FLS and non-FLS tasks with cadaveric vaginal cuff suturing.

Setting: Simulation center cadaver laboratory.

Participants: Obstetrics and gynecology residents (n = 21), minimally invasive gynecologic surgery fellows (n = 3), gynecologic surgical subspecialists (n = 4), general obstetrician/gynecologists (n = 10).

Interventions: Tasks included a simulated vaginal cuff (ipsilateral port placement), needle passage through a metal eyelet loop (contralateral and ipsilateral), and intracorporeal knot tying (contralateral and ipsilateral). Simulation task times were compared with the placement of the first cadaveric vaginal cuff suture time, as well as the in-person and blinded Global Operative Assessment of Laparoscopic Skills (GOALS) score ("relations to other variables" validity evidence). Statistical analyses included Spearman's test of correlation (continuous and ordinal variables) or Wilcoxon rank sum test (categoric variables).

Measurements And Main Results: There was a stronger association with cadaver cuff suturing time for simulated vaginal cuff suturing time (r = 0.73, p <.001) compared with FLS intracorporeal contralateral suturing time (r = 0.54, p <.001). Additional measures associated with cadaveric performance included subspecialty training (median: 82 vs 185 seconds, p = .002), number of total laparoscopic hysterectomies (r = -0.53, p <.001), number of laparoscopic cuff closures (r = -0.61, p <.001), number of simulated laparoscopic suturing experiences (r = -0.51, p <.001), and eyelet contralateral time (r = 0.52, p <.001). Strong agreement between the in-person and blinded GOALS (intraclass correlation coefficient = 0.80) supports response process evidence. Correlations of cadaver cuff time with in-person (Spearman's r = -0.84, p <.001) and blinded GOALS (r = -0.76, p <.001) supports relations to other variables evidence CONCLUSION: The weaker correlation between FLS suturing and cadaver cuff suturing compared with a simulated vaginal cuff model may lead to an "illusion of validity" for assessment in gynecology. Since gynecology specific validity evidence has not been well established for FLS, we recommend prioritizing the use of a simulated vaginal cuff suturing assessment in addition to FLS.
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http://dx.doi.org/10.1016/j.jmig.2021.05.002DOI Listing
May 2021

A pilot trial of intravital microscopy in the study of the tumor vasculature of patients with peritoneal carcinomatosis.

Sci Rep 2021 Mar 2;11(1):4946. Epub 2021 Mar 2.

Department of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA.

Aberrancies in the tumor microvasculature limit the systemic delivery of anticancer agents, which impedes tumor response. Using human intravital microscopy (HIVM), we hypothesized that HIVM would be feasible in patients with peritoneal carcinomatosis (PC). During cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for PC, HIVM was performed in both tumor and non-tumor areas. The primary outcome was HIVM feasibility to measure vessel characteristics. We secondarily evaluated associations between HIVM vessel characteristics and oncologic outcomes (RECIST response to neoadjuvant therapy and disease-specific survival). Thirty patients with PC were enrolled. Nineteen patients (63.3%) received neoadjuvant therapy. HIVM was feasible in all patients. Compared to non-tumor (control) areas, PC areas had a lower density of functional vessels, higher proportion of non-functional vessels, smaller lumenal diameters, and lower blood flow velocity. Qualitative differences in these vessel characteristics were observed among patients who had partial response, stable disease, or progressive disease after receiving neoadjuvant therapy. However, no statistically significant relationships were found between HIVM vessel characteristics and oncologic outcomes. These novel findings comprise the first-in-human, real-time evidence of the microscopic differences between normal and tumor-associated vessels and form the basis for our larger, ongoing clinical trial appropriately powered to determine the clinical utility of HIVM (NCT03823144).
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http://dx.doi.org/10.1038/s41598-021-84430-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925603PMC
March 2021

Phase II trial of ribociclib and letrozole in patients with relapsed oestrogen receptor-positive ovarian or endometrial cancers.

ESMO Open 2020 10;5(5):e000926

Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA.

Objective: We describe a phase II clinical trial of the combination of ribociclib and letrozole for treatment of relapsed oestrogen receptor (ER)-positive ovarian cancer (OC) and endometrial cancer (EC). The primary endpoint was the proportion of patients alive, progression-free survival (PFS), and still on treatment at 12 weeks (PFS12), with 45% or greater considered positive.

Methods: Patients with measurable, relapsed ER-positive OC or EC (platinum-sensitive or resistant) were eligible and treated with 400 mg of oral ribociclib and 2.5 mg of oral letrozole daily. Patient-derived xenografts (PDXs) were created from imaging-guided tumour biopsies.

Results: Forty patients (20 OC and 20 EC) were enrolled. A PFS12 of 55% was observed in the EC cohort and 50% in the OC cohort. A PFS greater or equal to 24 weeks (PFS24) was seen in 20% (4/20) of the OC cohort and 35% (7/20) of the EC cohort. The greatest benefit was seen in low-grade serous OC (LGSOC) (3/3, 100% PFS24) and grades 1 and 2 EC (5/11, 45% PFS24). All three LGSOC patients obtained at least a partial response lasting for over 2 years, with two of the three patients still on treatment. PDX tumour engraftment was feasible in 45% of patients. Positive survival effects of the combination of ribociclib and letrozole were observed in two of three EC PDX models.

Conclusion: Ribociclib and letrozole have promising clinical activity in relapsed ER-positive OC and EC, particularly in LGSOC and relapsed ER-positive grade 1 and 2 EC. Generation of PDX models is feasible with positive survival effects observed in EC models.

Trial Registration Number: ClinicalTrials.gov registry (NCT02657928).
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http://dx.doi.org/10.1136/esmoopen-2020-000926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592247PMC
October 2020

Association of uterine dimensions and route of contained morcellation following laparoscopic hysterectomy.

Minerva Ginecol 2020 Oct 17;72(5):316-324. Epub 2020 Jul 17.

Department of Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.

Background: The aim of this study was to determine if uterine dimensions on preoperative imaging are associated with route of contained morcellation during laparoscopic hysterectomy.

Methods: This is a prospective cohort study of patients undergoing laparoscopic hysterectomy and requiring morcellation for specimen extraction from March 2017 through August 2019. A contained extraction system was inserted and manual morcellation was performed vaginally, abdominally, or via a combination of both methods in cases of failed vaginal extraction.

Results: A total of 47 patients were treated. Median age was 47 (range 38-70). Morcellation was performed vaginally for 29 patients (61.7%), abdominally for 13 patients (27.7%), and via combined approach for 5 patients (10.6%). The combined group had the highest frequency of patients who were black (vaginal: 24%, abdominal: 31%, combined: 100%; P=0.005), the longest median total operating time (vaginal: 167 minutes, abdominal: 183 minutes, combined: 268 minutes; P=0.006) and the longest median time of uterine morcellation (vaginal: 14 minutes, abdominal: 37 minutes, combined: 85 minutes; P<0.001). There was strong evidence of a positive correlation with time of uterine morcellation for both largest uterine diameter (Spearman's r: 0.62, P<0.001) and uterine volume (Spearman's r: 0.70, P<0.001). These associations remained consistent after multivariable linear regression models that were adjusted for route of morcellation, hysterectomy type, and BMI (both P<0.001).

Conclusions: Larger uterine dimensions are associated with increased total operating and morcellation times. Uterine size and volume on preoperative imaging were not associated with route of morcellation, but there was a trend towards failed vaginal extraction when uterine dimensions exceeded 16 centimeters.
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http://dx.doi.org/10.23736/S0026-4784.20.04602-XDOI Listing
October 2020

Diagnostic office hysteroscopy with the Storz TrophyScope® versus Cooper surgical Endosee®.

Minerva Ginecol 2020 Oct 13;72(5):310-315. Epub 2020 May 13.

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Background: Office hysteroscopy (OH) is becoming increasingly popular. Our objective was to determine the use patterns, reported pain scores, and success rates of OH with the 2.9 mm Storz TrophyScope® and handheld portable Cooper surgical Endosee® device in a clinic without previous office hysteroscopy experience.

Methods: A prospective cohort study of a hysteroscopy quality improvement database was conducted in a tertiary care center gynecology clinic. Patients undergoing OH with either the Storz TrophyScope® or Cooper Surgical Endosee® device were included.

Results: Of the 171 office hysteroscopies, 77 utilized the TrophyScope®, with 8 (10%) being inadequate, while 94 utilized Endosee®, with 13 (14%) being inadequate (P=0.50). Of the 13 inadequate Endosee® hysteroscopies, 4 (31%) were due to visualization, 4 (31%) to patient intolerance, 3 (23%) to cervical stenosis, and 2 (15%) to a combination of these factors. Of the 8 inadequate TrophyScope® hysteroscopies, 7 (87%) were due to patient intolerance and 1 (13%) to cervical stenosis. Of the 150 adequate office procedures performed, 52 cases underwent subsequent procedures in the operating room (OR). Of these, 26 (84%) of 31 Endosee® cases and 18 (86%) of 21 TrophyScope® cases were in agreement with OR procedure findings. A subgroup analysis comparing mean pain levels did not significantly differ between the two hysteroscopes.

Conclusions: There was no difference in accuracy with OR pathologic diagnoses, adequacy of procedure, and reported pain scores when comparing the TrophyScope® and Endosee® in this prospective cohort. Larger studies are needed to confirm the sensitivity, and specificity for these newer, disposable office hysteroscopic devices.
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http://dx.doi.org/10.23736/S0026-4784.20.04568-2DOI Listing
October 2020

Factors Associated with Burnout and Frustration among Minimally Invasive Gynecologic Surgery Fellows.

J Minim Invasive Gynecol 2021 01 28;28(1):75-81. Epub 2020 Mar 28.

Department of Gynecologic Surgery (Drs. Jijon, Carrubba, Destephano, and Dinh), Mayo Clinic Florida, Jacksonville, Florida.

Study Objective: Determine the prevalence of burnout and frustration among participants currently completing a fellowship in minimally invasive gynecologic surgery (FMIGS).

Design: Cross-sectional survey.

Setting: An anonymous survey was distributed to fellows in November 2018.

Participants: Current FMIGS fellows.

Interventions: Not applicable.

Measurements And Main Results: A total of 57 of 83 (67.7%) FMIGS participants in American Association of Gynecologic Laparoscopists-accredited programs completed a survey regarding fellowship characteristics and experiences. Overall, 40 participants (70.2%) indicated that they were satisfied with their fellowship program experience. There were 33 participants (57.9%) who reported burnout, and 38 participants (66.7%) had experienced anxiety, depression, or extreme fatigue during the last month. Of those who reported burnout, 26 (76.5%) reported that they did not receive support from their fellowship program. Participants who experienced burnout were more likely to be in their second year (p = .003), spent less time per week doing scholarly activities (p = .048), and were less satisfied with their fellowship experience (p <.001). Participants who experienced anxiety, depression, or extreme fatigue had more cofellows in their program (p = .031), worked on average more hours per week (p = .020), and were more often required to practice obstetrics in their fellowship (p = .022).

Conclusion: Burnout symptoms are common among physicians across multiple specialties. Our findings suggest that this issue is prevalent among FMIGS participants. In addition, there is a lack of access to emotional and psychologic support programs for fellows experiencing burnout. We hope that this study will prompt attention to this important topic by both individual programs and American Association of Gynecologic Laparoscopists as a society to increase awareness and access to resources and promote wellness for fellows.
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http://dx.doi.org/10.1016/j.jmig.2020.03.004DOI Listing
January 2021

Complex management of acute superior mesenteric venous thrombosis in the setting of metastatic ovarian cancer.

Gynecol Oncol Rep 2019 Aug 26;29:85-88. Epub 2019 Jul 26.

Department of Suergery, Division of Vascular Surgery, Mayo Clinic, Florida, USA.

•Superior mesenteric vein thrombosis (SMVT) is rare but seen in patients with hypercoagulable states.•Prevention of mortality in patients with SMVT requires immediate diagnosis and complex management.•A hierarchical approach to treatment progresses to more aggressive treatment as needed.•Supportive care, medication, and endovascular and/or surgical interventions are available management options.•In patients with underlying conditions, long-term treatment such as anticoagulation must also be initiated.
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http://dx.doi.org/10.1016/j.gore.2019.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698922PMC
August 2019

Internet Use by Gynecologic Oncology Patients and Its Relationship with Anxiety.

J Health Commun 2018 23;23(3):299-305. Epub 2018 Feb 23.

d Department of Medical and Surgical Gynecology , Mayo Clinic , Jacksonville , Florida , USA.

This study describes the use of the Internet for health information research by patients attending a gynecologic oncology practice and examines the association between its use and anxiety. A self-administered survey assessed patients' demographic information and Internet use. The Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI) were administered concurrently. Of 212 patients who consented to the study, 98 (46%) had an appointment because of a cancer diagnosis. Of 199 respondents, 91 (46%) reported searching the Internet for information about their condition. Internet searching was unassociated with race/ethnicity and positively associated with education level, annual household income, and married/partnered civil status. Only 16% of the patients reported that a health-care provider recommended use of the Internet for research. Comparing patients who used the Internet for research with those who did not, the STAI state and trait anxiety scores were similar. The HADS anxiety subscale score was higher for those who used the Internet versus those who did not, which suggests heightened anxiety. Internet use for research is common in gynecologic oncology patients, and its use is associated with increased anxiety. Physicians can use this medium to educate patients about their disease, build trust, and alleviate fear.
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http://dx.doi.org/10.1080/10810730.2018.1442529DOI Listing
October 2019

Use of the Limbs and Things Hysterectomy Model to Describe the Process for Establishing Validity.

J Minim Invasive Gynecol 2018 Sep - Oct;25(6):1051-1059. Epub 2018 Feb 9.

Department of Surgical Gynecology, Mayo Clinic, Jacksonville, Florida.

Study Objective: To demonstrate the process for establishing or refuting validity for the Limbs and Things hysterectomy model.

Design: Prospective study using Kane's framework for establishing validity (Canadian Task Force classification: II-2).

Setting: Total laparoscopic hysterectomy (TLH) assessments completed in the operating room (OR) and simulation at 3 academic medical centers.

Participants: Obstetrics and gynecology residents (n = 26 postgraduate years 3-4), a gynecologic oncology fellow (postgraduate year 5), and a gynecology oncology attending.

Interventions: Participants were rated with the myTIPreport feedback application by nonblinded faculty in the OR after TLH. In-person, simulation-based assessments were provided by 2 faculty members blinded to experience level using myTIPreport and Global Operative Assessment of Laparoscopic Skills (GOALS). Videos of simulated TLHs were rated by 2 minimally invasive gynecology fellows.

Measurements And Main Results: OR scores for TLH steps were significantly higher than simulation assessments (p < .001) with "competent" marked more frequently in the OR. Number of robotic + conventional TLHs performed as primary surgeon was not significantly correlated with OR myTIPreport rating (Spearman r = .30, p = .14) but was significantly correlated with myTIPreport and GOALS in-person simulation ratings (Spearman r = .39-.58, p = .001-.04). Agreement between in-person simulation rater 1 and 2 myTIPreport assessments was 71.4% (weighted κ, .68; 95% confidence interval, .45-.90), and intraclass correlation for the GOALS overall assessment was .71 (95% confidence interval, .46-.85), indicating substantial agreement. Blinded video reviews showed similar agreement (73.1%) between raters but less correlation with experience (Spearman r = .32-.42, p = .11-.03) than in-person reviews. Using area under the receiver operating characteristic curve, mean score for the individual components of GOALS that best differentiated myTIPreport noncompetent and competent levels of performance was 4.3. Feedback acceptability and model realism were rated highly.

Conclusion: The scoring and generalization validity inferences for Limbs and Things and myTIPreport are supported when global assessments of performance are evaluated but not for individual components of the assessment instruments.
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http://dx.doi.org/10.1016/j.jmig.2018.02.003DOI Listing
July 2019

A Preliminary Observational Study of Anovulatory Uterine Bleeding After Aneurysmal Subarachnoid Hemorrhage.

J Neurosci Nurs 2017 Dec;49(6):363-371

Susan W. Fifield, BSN RN CNRN SCRN, is Staff Nurse, Department of Nursing, Mayo Clinic, Jacksonville, FL. Michael A. Pizzi, DO PhD, is Assistant Professor of Neurology, Neurocritical Care Fellow, Mayo Clinic, Jacksonville, FL. David Alejos, MD, is Mayo Clinic Observer, Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL. Alexa N. Richie, MPH DHSc CCRP, is Assistant Professor of Health Care Administration, College of Medicine, Mayo Clinic, Jacksonville, FL. Tri A. Dinh, MD, is Assistant Professor of Obstetrics and Gynecology, College of Medicine, Mayo Clinic, Jacksonville, FL. William P. Cheshire Jr, MD, is Professor of Neurology, Department of Neurology, Mayo Clinic, Jacksonville, FL. Shon E. Meek, MD PhD, is Assistant Professor of Medicine, College of Medicine, Mayo Clinic, Jacksonville, FL. William D. Freeman, MD, is Professor of Neurology and Neurosurgery, Departments of Neurology, Critical Care Medicine, and Neurologic Surgery, Mayo Clinic, Jacksonville, FL.

Introduction: It was observed that women with aneurysmal subarachnoid hemorrhage (aSAH) tended to have earlier menses than a typical 21- to 28-day cycle. The goal was to determine whether there is an association between aSAH and early onset of menses.

Methods: All cases of aSAH in women aged 18 to 55 years who were admitted to our facility's neuroscience intensive care unit from June 1, 2011, to June 30, 2012, were reviewed. The electronic healthcare record for each of these patients was examined for documentation of menses onset, computed tomography of the head, brain aneurysm characteristics, modified Fisher score and Glasgow Coma Scale on admission, presence/absence of vasospasm, medical/surgical history, and use of medications that affect the menstrual cycle. The mean onset of menses in this study population was compared with the mean of 21 to 28 days with the 1-sample t test.

Results: During the study period, 103 patients with subarachnoid hemorrhage were admitted. Sixty-one were women, and 15 were aged 18 to 55 years. Nine of the 15 (60%) had documentation of menses occurring during their initial week of hospitalization; 1 patient had documentation of menses on hospital day 12. There is a significant difference when the mean onset of menses in our patient population is compared with the approximate normal menstrual cycle of 21 to 28 days (P < .01).

Conclusion: Early onset of menses or abnormal uterine bleeding after SAH may occur in women with aSAH and typically within the first 7 to 10 days after intracranial aneurysm rupture. The physiologic cause of early onset of menses after aSAH, whether primary or secondary, remains unknown.
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http://dx.doi.org/10.1097/JNN.0000000000000318DOI Listing
December 2017

Phase 2 trial of everolimus and letrozole in relapsed estrogen receptor-positive high-grade ovarian cancers.

Gynecol Oncol 2017 07 28;146(1):64-68. Epub 2017 Apr 28.

Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, United States.

Objectives: We report the results of a phase 2 clinical trial of the combination of everolimus and letrozole in patients with relapsed estrogen receptor-positive high-grade ovarian cancer. The trial's primary endpoint was the proportion of patients alive and progression-free after 12weeks of therapy with the combination of everolimus and letrozole. A 12-week PFS of 45% or greater was considered a positive result. The feasibility of generating patient-derived xenograft (PDX) models from biopsy specimens was also evaluated.

Methods: Eligibility criteria included relapsed estrogen receptor-positive ovarian, fallopian tube or primary peritoneal carcinomas with measurable disease, not previously treated with everolimus or AIs. Both platinum-resistant and sensitive tumors were included. Xenografts were created from image-guided tumor biopsies at baseline. Patients received oral everolimus 10mg daily and letrozole 2.5mg daily.

Results: Twenty patients were enrolled, 19 were evaluable. Nine out of 19 were alive, progression-free, and still on treatment at the 12week evaluation time-point (12-week PFS of 47%) with a median PFS of 3.9months (95% CI: 2.8-11.0). The median overall survival was 13.0months. Twelve patients (63%) experienced at least one grade 3 or worse adverse events. PDX tumor engraftment was feasible in the majority of patients (9 out of 17, 52.9%).

Conclusions: The combination of everolimus and letrozole is associated with a promising 47% 12-week PFS rate in patients with ER-positive relapsed high-grade ovarian cancer with acceptable toxicity. PDX tumor models can be generated from biopsies of ovarian tumors.
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http://dx.doi.org/10.1016/j.ygyno.2017.04.020DOI Listing
July 2017

Symptomatic Ovarian Steroid Cell Tumor not Otherwise Specified in a Post-Menopausal Woman.

Rare Tumors 2016 Jun 28;8(2):6200. Epub 2016 Jun 28.

Department of Medical and Surgical Gynecology.

Steroid cell tumor not otherwise specified (NOS) is a rare subtype of sex cord stromal tumor of the ovary and contributes less than 0.1% of all ovarian neoplasms. The majority of tumors occur in pre-menopausal women (mean age: 43 years), in which 56-77% of patients present with virilization due to excess testosterone. An 80-year-old woman with worsening alopecia and excessive growth of coarse hair on abdomen and genital area was found to have elevated serum testosterone level (462 ng/mL). Radiologic studies were consistent with bilateral adrenal adenomas. Bilateral adrenal venous sampling ruled out the adrenal gland as origin of hormone secretion. A diagnostic and therapeutic bilateral salpingo-oophorectomy confirmed steroid cell tumor NOS of the left ovary. Post-operatively, the patient had complete resolution of her symptoms and normalization of testosterone level. Our case emphasizes the importance of a clinical suspicion for an occult testosterone secreting ovarian tumor in a symptomatic patient without obvious ovarian mass on imaging.
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http://dx.doi.org/10.4081/rt.2016.6200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935824PMC
June 2016

High Grade Leiomyosarcoma Mimicking a Recurrent Angiomyxoma in the Perineum.

Rare Tumors 2015 May 19;7(2):5875. Epub 2015 May 19.

Department of Medical and Surgical Gynecology, Mayo Clinic Florida , Jacksonville, FL, USA.

Perineal leiomyosarcoma is an extremely rare and aggressive cancer with a high metastatic potential and no defined standard treatment. There are only a few (six) reported cases in the literature. We report the case of a 67-year-old woman with a perineal leiomyosarcoma arising at the same site of a previously resected superficial angiomyxoma. Initially, she was treated for a presumptive recurrence of angiomyxoma. As she did not respond to medical therapy, she underwent repeat surgical excision. Pathology revealed a high grade leiomyosarcoma, histologically strikingly distinct from the initial diagnosis. She received adjuvant local radiation therapy, and remains without evidence of recurrent disease 36 months after completion of all therapy. This is the first reported case of a high grade perineal leiomyosarcoma originating at the same site as a resected benign superficial angiomyxoma. Our case emphasizes the necessity of a prompt histological diagnosis in cases of presumed recurrent perineal angiomyxoma.
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http://dx.doi.org/10.4081/rt.2015.5875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508648PMC
May 2015

Vietnamese Health Care Providers' Preferences Regarding Recommendation of HPV Vaccines.

Asian Pac J Cancer Prev 2015 ;16(12):4895-900

Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA E-mail :

Physician recommendation is an important predictor of HPV vaccine acceptance; however, physician willingness and preferences regarding HPV vaccination may be influenced by factors including patient age, vaccine type, and cost. A cross-sectional survey was administered to a convenience sample of health care providers in Da Nang, Vietnam, to evaluate awareness, perceptions about HPV and HPV vaccines, and willingness to vaccinate a female patient. Willingness to vaccinate was evaluated using a full-factorial presentation of scenarios featuring the following factors: vaccine cost (free vs 1,000,000 VND), patient age (12, 16, or 22 years), and HPV vaccine type (bivalent vs quadrivalent). Responses from 244 providers were analyzed; providers had a mean age of 34±11.9 years; a majority were female, married, and had children of their own. Thirty-six percent specialized in obstetrics/gynecology and 24% were providers in family medicine. Of the three factors considered in conjoint analysis, vaccine cost was the most important factor in willingness to vaccinate, followed by patient age, and vaccine type. The most favorable scenario for vaccinating a female patient was when the vaccine was free, the patient was 22 years of age, and the HPV4 vaccine was described. In multivariable analysis, older age, being a physician, being married, and having children were all associated with increased willingness to recommend HPV vaccination (p<0.05). Provider willingness is an important aspect of successful HPV vaccination programs; identifying preferences and biases in recommendation patterns will highlight potential areas for education and intervention.
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http://dx.doi.org/10.7314/apjcp.2015.16.12.4895DOI Listing
April 2016

High-grade endometrial stromal sarcoma as the initial presentation of an adult patient with Peutz-Jeghers Syndrome: a case report.

Hered Cancer Clin Pract 2015 23;13(1). Epub 2015 Jan 23.

Department of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA.

A 46-year-old female presents with a pelvic mass and is diagnosed as having a high-grade endometrial stromal sarcoma. During surgery, she is noted to have areas of intussusception of the small bowel secondary to large hamartomatous polyps. The patient had a previous history of small bowel obstruction secondary to what had been thought to be hyperplastic polyps but represented hamartomatous polyps on further review. Additional examination revealed the presence of subtle hyperpigmented macules on the fingers leading to a diagnosis of Peutz-Jeghers Syndrome (PJS). The diagnosis was confirmed by the presence of a germ-line STK11 mutation. Immunohistochemistry analysis of the tumor showed decreased expression of STK-11 as compared to one of the patient's hamartomatous polyps. Next generation sequencing of the tumor specimen failed to demonstrate a "second hit" somatic mutation in STK-11. This case represents the first case of endometrial stromal sarcoma associated with PJS and illustrates the importance of increased awareness of this condition among oncologists. PJS is associated with dysregulation of the mTOR pathway; treatment with an mTOR inhibitor was not effective in this case.
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http://dx.doi.org/10.1186/s13053-015-0027-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314827PMC
February 2015

Photoimmunotherapy and irradiance modulation reduce chemotherapy cycles and toxicity in a murine model for ovarian carcinomatosis: perspective and results.

Isr J Chem 2012 Sep;52(8-9):776-787

Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.

Significant toxicities from multiple cycles of chemotherapy often cause delays or early termination of treatment, leading to poor outcomes in ovarian cancer patients. Complementary modalities that potentiate the efficacy of traditional agents with fewer cycles and less toxicity are needed. Photodynamic therapy is a mechanistically-distinct modality that synergizes with chemo and biologic agents. A combination regimen with a clinically relevant chemotherapy cocktail (cisplatin + paclitaxel) and anti-EGFR targeted photoimmunotherapy (PIT) is evaluated in a murine model for ovarian carcinomatosis. Mice received either 1 or 2 chemotherapy cycles followed by PIT with a chlorin-Erbitux photoimmunoconjugate and 25 J/cm light. PIT + 1 cycle of chemotherapy significantly reduced tumor burden, comparable to multiple chemotherapy cycles. Relative to 1 cycle of chemotherapy, the addition of PIT did not cause significant mouse weight loss, whereas 2 cycles of chemotherapy led to a significant reduction in weight. Irradiance-dependence on PIT efficacy was a function of the conjugation chemistry, providing an additional variable for optimization of PIT outcome.
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http://dx.doi.org/10.1002/ijch.201200016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634612PMC
September 2012

Awareness and knowledge of osteoporosis in Vietnamese women.

Asia Pac J Public Health 2015 Mar 14;27(2):NP95-105. Epub 2011 Nov 14.

University of Texas, Galveston, TX, USA Mayo Clinic Rochester, MN, USA

Purpose: Vietnamese women are at particular risk of osteoporosis and its complications. This study examined osteoporosis knowledge and awareness among Vietnamese women who have accessed health care.

Methods: A sample of 217 women, 13 to 76 years of age, who were attending 1 of 2 health care facilities in Da Nang, Vietnam, between November and December 2009 completed a questionnaire assessing their awareness of osteoporosis and measuring their knowledge using a 30-item instrument reflecting 9 knowledge domains (eg, risk factors, diagnosis, prognosis).

Results: A majority (81.6%) of the women had heard of osteoporosis. Awareness was associated with education, working in health care, and having a family member with osteoporosis. On average, Vietnamese women answered 49% of the knowledge questions correctly; scores ranged from 0 to 26 questions correct out of 30 (mean = 14.71 ± 5.2, median = 15). Mean knowledge scores were higher among those reporting a family member with osteoporosis, nurses (vs other vocations), and women with a high school education or greater (relative to those who had not completed high school). More than 90% of the women expressed interest in a prevention and treatment program.

Conclusions: Vietnamese women may have heard of osteoporosis, yet they would benefit from education targeting prevention and treatment of the disease.
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http://dx.doi.org/10.1177/1010539511423569DOI Listing
March 2015

Human papillomavirus vaccine decision-making in Da Nang, Vietnam: perceived spousal and adolescent-parent concordance.

Vaccine 2009 Apr 13;27(17):2367-71. Epub 2009 Feb 13.

Department of Obstetrics & Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0587, USA.

This descriptive study examined parents' perceptions of the role of mothers, fathers, and daughters in the decision to have their daughter receive the human papillomavirus (HPV) vaccine; perceived concordance between spouses and between parents and daughters; and the relationships between vaccine decision-making and (1) who takes the daughter to the doctor, and (2) the daughter's age. Health care workers (N=139) with a daughter 9-21 years old completed a self-administered questionnaire including demographic and HPV vaccine-related questions. Health care workers were employed by Da Nang General Hospital or the Da Nang Center for Reproductive Health Care in Vietnam. Most (73%) parents favored having their daughter receive the HPV vaccine and 84% would consult their spouse about having their daughter vaccinated. Sixty-six percent of parents believed that HPV vaccination should be a joint decision involving both parents and the daughter. Parents perceived concordance between themselves and their spouse, with 91% agreement between their own decision and what they thought their spouse would decide; less concordance (77%) was observed between themselves and what they thought their daughter would want. Most (87% of mothers and 62% of fathers) would consider his/her spouse's opinion in the decision regarding HPV vaccination when accompanying the daughter to a health care visit in the absence of the spouse. Perceived spousal concordance was 94% for parents of daughters under the age of consent in Vietnam (16 years). Decisions regarding HPV vaccination will likely be made jointly by parents and adolescents. Educating fathers about HPV vaccination may be important.
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http://dx.doi.org/10.1016/j.vaccine.2009.02.021DOI Listing
April 2009

Worldwide impact of the human papillomavirus vaccine.

Curr Treat Options Oncol 2009 Apr 23;10(1-2):44-53. Epub 2009 Apr 23.

The Methodist Hospital, Houston, TX, USA.

Opinion Statement: Nearly 500,000 new cases of cervical cancer and 274,000 cervical cancer deaths are occurring worldwide each year. Approximately 80% of the 500,000 new cases occur in developing countries and this percentage is expected to increase to 90% by 2020. In developing countries, cervical cancer tends to affect relatively young poor women and is the single largest cause of years of life lost to cancer, since screening and treatment programs, and health care, in general, are relatively inaccessible to these women. Each 5-year delay in vaccinating women against HPV may lead to the deaths of 1.5 to 2 million women from cervical cancer in developing countries. The high efficacy of the two available cervical cancer vaccines and their proven ability to reduce the incidence of cervical cancer precursor lesions offer hope that the vaccine will have enormous worldwide impact and may dramatically reduce the cervical cancer burden. The current vaccines protecting against HPV-16 and HPV-18 may prevent up to 70% of new cervical cancers. Vaccine cross-reactivity for HPV-31, -33, -45, and -52 suggest that an even higher percentage of cervical cancers might be prevented with its use. Currently, the prohibitive cost of the vaccine precludes its widespread implementation. Cooperation between governments, international health organizations, and the vaccine industry is needed to overcome this significant barrier so that women are no longer denied a potentially life-saving advance. Worldwide HPV vaccination and cervical cancer screening should be made an international priority.
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http://dx.doi.org/10.1007/s11864-009-0094-4DOI Listing
April 2009

Attitudes of mothers in Da Nang, Vietnam toward a human papillomavirus vaccine.

J Adolesc Health 2007 Jun 12;40(6):559-63. Epub 2007 Apr 12.

Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas 77555-0587, USA.

Purpose: To describe attitudes and acceptability toward a human papillomavirus (HPV) vaccine among mothers in Da Nang, Vietnam and examine factors that may influence HPV vaccine uptake.

Methods: Women who were the primary caregiver of a girl 10-18 years old ("mothers") were eligible to participate. Mothers were recruited face-to-face from Da Nang General Hospital. Participants completed a survey addressing general vaccine attitudes, attitudes toward an HPV vaccine, beliefs about sexuality, recommendations from others, and likelihood of having their daughter vaccinated against HPV. A total of 194 surveys were returned; 181 (93%) contained analyzable data.

Results: Eleven percent of mothers were aware of an HPV vaccine. Ninety-four percent believed that the HPV vaccine will be effective and 90% disagreed that their daughter would have sex early if she was vaccinated. Beliefs regarding premarital sex, such as "girls who have sex before marriage are not respected" and "it would be hard to find a husband" were held by 76% and 62% of mothers, respectively. Despite this, over 90% were in favor of their daughter receiving the HPV vaccine. Ninety-five percent indicated that a recommendation from their doctor would be very important in their decision-making, and 78% indicated that the media would be very important.

Conclusions: Initial responses to the HPV vaccine for girls in Vietnam appear favorable. Beliefs regarding negative social consequences for girls who engage in premarital sex are prevalent but unassociated with HPV vaccine acceptability. Accurate and consistent recommendations from doctors and media sources will be important for vaccination efforts.
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http://dx.doi.org/10.1016/j.jadohealth.2007.02.003DOI Listing
June 2007

Human papillomavirus vaccine: progress and the future.

Expert Opin Biol Ther 2007 Apr;7(4):479-85

The Methodist Hospital, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, 6550 Fannin, Suite 901, Houston, TX 77030, USA.

A vaccine to prevent infection by human papillomavirus is available in the US. This article reviews the biology of human papillomavirus that allows for the development of both therapeutic and prophylactic vaccines. Issues that may delay the acceptance of the vaccine are discussed.
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http://dx.doi.org/10.1517/14712598.7.4.479DOI Listing
April 2007

Computer-enhanced robotic surgery in gynecologic oncology.

Surg Endosc 2007 Feb 19;21(2):244-6. Epub 2006 Dec 19.

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, William Beaumont Hospital, 3601 W. Thirteen Mile Road #302, Royal Oak, MI 48073-6769, USA.

Background: This study aimed to report the computer-enhanced robotic surgery experience of the authors' gynecologic oncology division.

Methods: From January 2001 to August 2006, 41 patients underwent laparoscopic surgery by our gynecologic oncology service using a computer-enhanced surgical robot. This report describes a retrospective review of these patients.

Results: The patients ranged in age from 27 to 77 years (mean, 44.2 years), in weight from 44 to 131 kg (mean, 72.1 kg), in operative time from 1 h and 50 min to 9 h (mean, 5 h and 2 min), and in estimated blood loss from 50 to 1,500 ml (mean, 253 ml). Of the 20 patients with gynecologic malignancies, 14 had cervical cancer. A total of 21 patients had benign indications for surgery. Complications included shoulder palsy, robot failure, colotomy, bradycardia, and intraabdominal bleeding requiring minilaparotomy and ligation of a bleeding pedicle.

Conclusion: This case series is one of the first to report the use of a computer-enhanced surgical robot in gynecologic oncology. This approach proved to be feasible and well tolerated in this series of patients and deserves further study for clarification of its indications, benefits, and safety.
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http://dx.doi.org/10.1007/s00464-006-0894-6DOI Listing
February 2007

Using cytology to evaluate the endocervical canal after loop excision.

J Low Genit Tract Dis 2002 Jan;6(1):27-32

Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA.

Objective: This study assesses cytology to evaluate the endocervical canal immediately after loop excision.

Material And Methods: In 103 patients, we performed a cytologic smear and endocervical curettage immediately after loop excision. Diagnoses were made independently by two cytopathologists and compared to histology. Diagnostic agreement was evaluated statistically.

Results: Cytopathologist "A" found a sensitivity of 1.0, specificity of 0.9, positive predictive value (PPV) of 0.44 and negative predictive value (NPV) of 1.0. Cytopathologist "B" found a sensitivity of 0.88, specificity of 0.78, PPV of 0.3 and NPV of 0.98. There was good agreement between the two cytopathologists (kappa = 0.42, 95% CI = 0.25, 0.60). Twenty-five endocervical curettage specimens were insufficient for diagnosis. Seven and 4 cytology specimens were judged unsatisfactory by each cytopathologist, respectively. Histologic and cytologic evaluation charges were $283 and $60.50 per patient, respectively.

Conclusion: The use of cytology efficiently evaluates the endocervical canal after loop excision.
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http://dx.doi.org/10.1046/j.1526-0976.2002.61006.xDOI Listing
January 2002

Small cell carcinoma of the ovary with hypercalcemia and ectopic parathyroid hormone production.

Arch Pathol Lab Med 2005 Apr;129(4):531-3

Department of Pathology, The University of Texas Medical Branch, Galveston, USA.

Small cell carcinoma of the ovary is a rare malignant tumor of the ovary. It is the most common undifferentiated ovarian carcinoma in young women. Approximately two thirds of patients with ovarian small cell carcinoma have hypercalcemia. The mechanism of development of hypercalcemia is unclear, although parathyroid hormone-related protein has been found in some of the cases. Parathormone expression in tumor cells, rarely reported, was seen in this case, suggesting that ectopic parathyroid hormone production by the tumor cells may be the cause of hypercalcemia.
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http://dx.doi.org/10.5858/2005-129-531-SCCOTODOI Listing
April 2005

The treatment of uterine leiomyosarcoma. Results from a 10-year experience (1990-1999) at the Massachusetts General Hospital.

Gynecol Oncol 2004 Feb;92(2):648-52

Vincent Memorial Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.

Objective: Uterine leiomyosarcomas (LMS) are rare tumors with a poor prognosis. The purpose of this study is to review the presentation, therapy and outcome of patients with leiomyosarcoma originating from the uterus treated at the Massachusetts General Hospital from 1990 to 1999.

Methods: A retrospective chart review was done to patients treated for uterine leiomyosarcoma during the study period. One author reviewed all available histologic specimens. Statistical analysis was done to determine whether there is an association between histologic criteria or therapy used and overall survival.

Results: Forty-seven charts were reviewed to identify 27 patients with leiomyosarcoma arising from the uterus treated in the decade from 1990 to 1999. Most patients received multimodality therapy with surgery followed by chemotherapy and/or radiotherapy. Patients who had no visible disease at the conclusion of primary surgery had a better overall survival than patients who did not achieve surgical remission (P < 0.0003). There is a trend toward improved survival in patients with lower number of mitotic figures per 10 high-power fields (P = 0. 062). Current chemotherapy drugs were minimally effective with 80% of treated patients having progression of disease. Adjuvant therapy after optimal cytoreduction does not decrease the rate of recurrence.

Conclusion: Uterine leiomyosarcoma continues to be a deadly disease. Aggressive surgical cytoreduction at the time of initial diagnosis offers the possibility of prolonged survival or cure.
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http://dx.doi.org/10.1016/j.ygyno.2003.10.044DOI Listing
February 2004
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