Predictive value of negative cone margin status for risk of residual disease among women with cervical adenocarcinoma in situ

OBJECTIVE

To determine the value of negative cone margins in predicting residual disease in women with adenocarcinoma in situ (ACIS).

METHODS

Data were retrospectively analyzed from 60 women with ACIS who underwent conization at Chiang Mai University Hospital between March, 1998, and December, 2010. Negative margin status was defined as absence of neoplastic epithelium at all margins, coupled with presence of normal cervical epithelium. The association between the incidence of residual lesions and cone margin status was analyzed via χ(2) or Fisher exact test.

RESULTS

When adjusted for age and completeness of visualization of the cervical squamocolumnar junction during colposcopy, women who underwent loop electrosurgical excision procedure were 4 times more likely to have positive cone margins than those who underwent cold-knife conization (95% CI, 1.13-16.43). Residual disease was not found among 26 women who had negative cone margins, but was observed in 17 (65.4%) of 26 women with positive cone margins (P<0.001).

CONCLUSION

Women with ACIS who had negative cone margins were found to have a notably low risk of residual disease. Adherence to the standard method of cone sampling and criteria for negative margin status might contribute to a high predictive value of negative cone margins.

Patient satisfaction with the service at Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital

OBJECTIVE

To evaluate patient satisfaction of service at the Menopause Clinic and to identify factors affecting patient satisfaction.

MATERIAL AND METHOD

Cross sectional descriptive study was conducted at the Menopause Clinic, Maharaj Nakorn Chiang Mai hospital. Three hundred twenty six subjects were included. The questionnaire consists of two parts, demographic and patient satisfaction. The patient satisfaction was evaluated in five aspects.

RESULTS

The overall patient satisfaction level was good (mean 4.2 +/- 0.71). The satisfactions about service behavior quality of care and health information were in excellent level (mean 4.29 +/- 0.69, 4.25 +/- 0.65, and 4.26 +/- 0.69, respectively). The satisfaction about clinic facilities/conveniences and medical expense were in good level (mean 3.83 +/- 0.79 and 3.87 +/- 0.75). There are three variables that could affect patient satisfaction: Occupation and level of education affected satisfaction in medical expense aspect (p < 0.001 and p < 0.05) and number of visits affected the clinic facilities/convenience aspect (p < 0.05).

CONCLUSION

Some patient characteristics affected the patient satisfaction. However, system and structure of service in different setting hospitals are of concerned.

Symptoms of estrogen deficiency in nursing personnel in Maharaj Nakorn Chiang Mai Hospital

OBJECTIVE

To determine the self-reported prevalence and severity of climacteric symptoms of estrogen deficiency in nursing personnel working in Maharaj Nakorn Chiang Mai Hospital during the year 2002.

DESIGN

Cross-sectional descriptive study.

SETTING

Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University.

SUBJECT

Six-hundred and eight nursing personnel, including professional nurses and practical nurses, aged 40-60 years, working in Maharaj Nakorn Chiang Mai Hospital.

MATERIAL AND METHOD

The same sets of questionnaires were provided and distributed to each subject. Subjects had self assessment under individual decision with written consent and data was prospectively collected. The data were analyzed using software SPSS version 10 and presented in frequencies and percentage.

MAIN OUTCOME MEASURE

The prevalence and severity of each climacteric symptoms.

RESULTS

Five-hundred and seventy five of 608 subjects (94.6%) responded to the questionnaires, 62.6% of them were in normal reproductive period, while the remainder (37.4%) were in the menopausal period. The latter group was divided into 4 subgroups of pre/peri-menopause, post menopause, surgical menopause and premature ovarian failure. The prevalence of climacteric symptoms was systematically classified as follows, vasomotor instability 40.7% (severe cases, 5.4%), psychosomatic symptoms 50.9% (severe cases, 3.9%), lower urinary tract symptoms 29.1% (severe cases, 2.4%), lower genital tract symptoms 34.0% (severe cases, 2.7%), and other symptoms 50.7% (severe cases, 4.3%). The first five most common symptoms were as follows, forgetful 84.1% (severe cases, 7.9%), myalgia 74.3% (severe cases, 10.6%), anxious 71.0% (severe cases, 5.3%), tired 70.0% (severe cases, 4.1%), headache 68.3% (severe cases, 8.3%). The least common symptom was needle pain, the prevalence was 19.7% (severe cases, 1.3%). The overall prevalence of women using hormone replacement therapy was 13.1%, only 8.9% were current users.

CONCLUSION

Focusing on each symptom of climacteric symptoms, the authors found high prevalence in psychosomatic symptoms and other symptoms such as forgetful, myalgia, anxious, tired and headache. While the classic symptom (vasomotor instability) was found to be low in the present study which was different from the previous reports. This may be due to the racial or cultural and educational factors among different populations.

Mammographic change in hysterectomized women on 0.625 mg/day of conjugated equine estrogen

OBJECTIVE

To compare the mammographic change before and after conjugated equine estrogen (CEE) 0.625 mg/day in hysterectomized women.

DESIGN

A retrospective descriptive study.

SETTING

Menopause clinic, Maharaj Nakorn Chiang Mai Hospital.

MATERIAL AND METHOD

Dedicated mammograms and demographic data of 66 women who had been hysterectomized were reviewed. Post surgical menopausal women were recruited for the study. CEE 0.625 mg/day was given just after the operation. The baseline mammography was done before the initiation of HRT and they were compared with the follow-up mammography performed 12-18 months after therapy. The degree of increase in mammographic density was classified as follows: minimal changes (10-25% increased density), moderated change (26-50% increased density), and marked change (> 50% increased density).

RESULTS

The mean age +/- SD was 47 +/- 4.3 years old. The mean duration +/- SD of hormone used was 13.5 +/- 2.4 months. The most common indication for operation was myoma uteri (43.9%). On the baseline mammogram, 5 cases had cystic change and one case had a small circumscribed solid mass suspected to be fibroadenoma. On the follow-up mammograms, there were 2 cases (3.0%) detected to have significantly increased breast density. One was moderately increased and the other was markedly increased, but cystic changes and one fibroadenoma were not changed.

CONCLUSION

CEE has little effect on increased mammographic density.