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Accuracy of saline infusion sonohysterography in diagnosis of uterine intracavitary pathology
GYNECOLOGY A Pilot Study of the Effectiveness of Citalopram in Patients with Premenstrual Syndrome with Prior Selective Serotonin Reuptake Inhibitor Treatment Failure Ellen W. Freeman, PhD University of Pennsylvania, Philadelphia, PA
S. Jabara, MD, S.J. Sondheimer, MD, and R. Auletto, MSN Premenstrual syndrome (PMS) is a chronic mood disorder experienced by reproductive-aged women. Evidence suggests that the selective serotonin reuptake inhibitors (SSRIs) effectively reduce PMS symptoms. A randomized, placebocontrolled study of citalopram (CIT), the most selective SSRI, demonstrated that intermittent dosing (luteal phase) significantly reduced PMS symptoms. Objective: This study examined the effectiveness of CIT in patients with PMS who did not respond to previous SSRIs. Methods: Sixteen women (10 intermittent, 6 daily) with no symptom improvement after two menstrual cycles on an SSRI were given open-label CIT (20 – 40 mg/day). Scores on the 17-item daily symptom report (DSR) and for each of 5 symptom clusters measured CIT efficacy. Intermittent and daily dosing scores were compared. Results: Baseline DSR scores were significantly improved (P ⫽ 0.02) in both groups, with no difference between the intermittent and daily dosing groups. Clinical improvement (ⱖ50% decrease in DSR) was reported by 80% and 66% of the intermittent and daily dosing groups, respectively. Symptoms were reduced to postmenstrual levels in 60% of the intermittent dosing group. Mood (P ⫽ 0.01) and appetite (P ⫽ 0.01) improved significantly. Function and pain also improved. Conclusion: Citalopram significantly reduced PMS symptoms in patients who failed previous SSRI treatment. These data suggest that intermittent CIT dosing is effective in the treatment of PMS.
Accuracy of Saline Infusion Sonohysterography in Diagnosis of Uterine Intracavitary Pathology Elvire Jacques, MD University of Miami/ Jackson Memorial Hospital, Miami, FL
Usha Verma, MD, and R. W. Whitted, MD Objective: To assess the accuracy of saline infusion sonohysterography versus transvaginal sonography in detecting intracavitary uterine pathology.
18S Monday Posters
Method: We reviewed ultrasonography reports of 29 patients who had undergone saline infusion sonohysterography for evaluation of the endometrial cavity. These patients were suspected of having uterine cavity pathology by transvaginal sonography. They underwent operative hysteroscopy or hysterectomy or both after sonohysterography. The findings at each stage were compared. We also assessed the reliability of transvaginal sonography in detecting intracavitary disease. Results: The findings were as follows: polyps were diagnosed in 23 patients and myoma in 2 patients; presence of intrauterine contraceptive device (IUD) was noted in 2 patients, and findings were normal in 2 patients. Polyps were accurately diagnosed in 21 (91.3%) of the patients. In two patients, there was a false diagnosis of polyps based on sonohysterography. The presence of intracavitary myoma and IUD were correctly diagnosed. Of two patients with normal sonohysterography, one had polyps diagnosed histopathologically. By simple transvaginal sonography, polyps were correctly diagnosed in only 8 (34%) of the patients. Intracavitary pathology could not be identified. Conclusion: Saline infusion sonohysterography is a simple, noninvasive procedure. Our study suggests that it is highly sensitive in diagnosing intracavitary uterine pathologies. Saline infusion sonohysterography can be beneficial in guiding the physician toward the selection of procedures that cause relatively less morbidity.
An Evaluation of a Systematic Approach to Encourage Minimally Invasive Surgery in the Treatment of Benign Uterine Disease Stuart Lovett, MD Hill Physicians Medical Group, Oakland, CA
Robert A. Ameo, PhD Purpose of the study: To evaluate a health care system’s attempt to increase the use of less invasive procedures (endometrial ablations) and a less invasive route (vaginal) for hysterectomies performed for benign disease. Interventions included the adoption of treatment guidelines, physician education, peer review, and second-opinion options. Clinical, economic, and quality-of-life parameters were monitored in all subject patients. Also monitored were changes in the relative use of endometrial ablations and changes in the use of abdominal and vaginal routes and laparoscopic methods in hysterectomies performed over a 1-year period. Methods: Clinical data were extracted from both the outpatient and inpatient records of 213 patients who underwent either endometrial ablation or hysterectomy for benign disease during a 1-year period. SF-36 scores were collected preproce-
Obstetrics & Gynecology
S. Jabara, MD, S.J. Sondheimer, MD, and R. Auletto, MSN Premenstrual syndrome (PMS) is a chronic mood disorder experienced by reproductive-aged women. Evidence suggests that the selective serotonin reuptake inhibitors (SSRIs) effectively reduce PMS symptoms. A randomized, placebocontrolled study of citalopram (CIT), the most selective SSRI, demonstrated that intermittent dosing (luteal phase) significantly reduced PMS symptoms. Objective: This study examined the effectiveness of CIT in patients with PMS who did not respond to previous SSRIs. Methods: Sixteen women (10 intermittent, 6 daily) with no symptom improvement after two menstrual cycles on an SSRI were given open-label CIT (20 – 40 mg/day). Scores on the 17-item daily symptom report (DSR) and for each of 5 symptom clusters measured CIT efficacy. Intermittent and daily dosing scores were compared. Results: Baseline DSR scores were significantly improved (P ⫽ 0.02) in both groups, with no difference between the intermittent and daily dosing groups. Clinical improvement (ⱖ50% decrease in DSR) was reported by 80% and 66% of the intermittent and daily dosing groups, respectively. Symptoms were reduced to postmenstrual levels in 60% of the intermittent dosing group. Mood (P ⫽ 0.01) and appetite (P ⫽ 0.01) improved significantly. Function and pain also improved. Conclusion: Citalopram significantly reduced PMS symptoms in patients who failed previous SSRI treatment. These data suggest that intermittent CIT dosing is effective in the treatment of PMS.
Accuracy of Saline Infusion Sonohysterography in Diagnosis of Uterine Intracavitary Pathology Elvire Jacques, MD University of Miami/ Jackson Memorial Hospital, Miami, FL
Usha Verma, MD, and R. W. Whitted, MD Objective: To assess the accuracy of saline infusion sonohysterography versus transvaginal sonography in detecting intracavitary uterine pathology.
18S Monday Posters
Method: We reviewed ultrasonography reports of 29 patients who had undergone saline infusion sonohysterography for evaluation of the endometrial cavity. These patients were suspected of having uterine cavity pathology by transvaginal sonography. They underwent operative hysteroscopy or hysterectomy or both after sonohysterography. The findings at each stage were compared. We also assessed the reliability of transvaginal sonography in detecting intracavitary disease. Results: The findings were as follows: polyps were diagnosed in 23 patients and myoma in 2 patients; presence of intrauterine contraceptive device (IUD) was noted in 2 patients, and findings were normal in 2 patients. Polyps were accurately diagnosed in 21 (91.3%) of the patients. In two patients, there was a false diagnosis of polyps based on sonohysterography. The presence of intracavitary myoma and IUD were correctly diagnosed. Of two patients with normal sonohysterography, one had polyps diagnosed histopathologically. By simple transvaginal sonography, polyps were correctly diagnosed in only 8 (34%) of the patients. Intracavitary pathology could not be identified. Conclusion: Saline infusion sonohysterography is a simple, noninvasive procedure. Our study suggests that it is highly sensitive in diagnosing intracavitary uterine pathologies. Saline infusion sonohysterography can be beneficial in guiding the physician toward the selection of procedures that cause relatively less morbidity.
An Evaluation of a Systematic Approach to Encourage Minimally Invasive Surgery in the Treatment of Benign Uterine Disease Stuart Lovett, MD Hill Physicians Medical Group, Oakland, CA
Robert A. Ameo, PhD Purpose of the study: To evaluate a health care system’s attempt to increase the use of less invasive procedures (endometrial ablations) and a less invasive route (vaginal) for hysterectomies performed for benign disease. Interventions included the adoption of treatment guidelines, physician education, peer review, and second-opinion options. Clinical, economic, and quality-of-life parameters were monitored in all subject patients. Also monitored were changes in the relative use of endometrial ablations and changes in the use of abdominal and vaginal routes and laparoscopic methods in hysterectomies performed over a 1-year period. Methods: Clinical data were extracted from both the outpatient and inpatient records of 213 patients who underwent either endometrial ablation or hysterectomy for benign disease during a 1-year period. SF-36 scores were collected preproce-
Obstetrics & Gynecology