Women’s Health
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21699
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Browsing Women’s Health by Author "Anderson, Ralph"
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Item Osteonecrosis Following Radiation and Osteoporosis(2017-03-14) Anderson, Ralph; Miroshnichenko, Gennady; Keck, Erin; Zimmerman, Leah; Mello, LeahObjective: This case report describes osteonecrosis of the pelvis, two and half years after receiving radiation therapy for a leiomyosarcoma of the vagina in a 40 year old female. Methods: The patient presented with a vaginal mass measuring 8 cm which on biopsy showed a leiomyosarcoma (20 mitotic figures / 10 high power fields). She had a resection of the tumor followed by radiotherapy to the pelvis and 6 months of Doxil chemotherapy finishing in March of 2013. Three years later she presented with pelvic pain and instability of walking. A combination of radiologic imaging including a CT scan of her pelvis, a bone scan and a MRI scan of her lumbosacral spine revealed necrotic lesions in the pelvic ischium and bilateral pelvic insufficiency fractures in the sacrum. Biopsy of the tissues showed necrotic tissue but no cancer. A DEXA scan was performed which showed diagnostic T scores as L spine -0.6, femoral neck -3.1, total hip -3.1, giving a WHO classification of osteoporosis. Results: Her treatment for osteonecrosis and osteoporosis includes calcium, vitamin E, oyster shell, weight bearing exercises and Fosamax 70 milligrams daily. Her pain has improved and she no longer requires utilizing a walker. Conclusions: In women who present with pelvic pain after pelvic radiotherapy, bony destruction and fractures can be indicative of a late radiation effect rather than osseous metastases. Patients with osteoporosis are at a much higher risk for developing post-radiotherapy osteonecrosis and fractures. Conservative treatment together with Fosamax have begun to show improvement in the clinical condition of the patient. Radiological imaging will be utilized as appropriate to determine improvement in the status of the pelvic bone.Item Outcomes Associated with a Trial of Labor After Cesarean Section (2017)(2017-03-14) Anderson, Ralph; Felini, Martha; Baker, Austin; Papa, Tracy; Benson, Meagan; Flood-Shaffer, Kellie; Zimmerman, Leah; Westbrook, BrettObjective: To examine the outcomes of women attempting a trial of labor after cesarean section (TOLAC). Methods: A retrospective chart review was performed on all patients who attempted a TOLAC from June 2012 to May 2016 at John Peter Smith Hospital (JPS). Delivery characteristics and prevalence of adverse delivery outcomes were assessed and then compared to a previous TOLAC study at JPS (2004-2008). Stratified analysis was performed and statistical significance was calculated with χ2 and fishers exact statistics (α Results: 660 patients attempted a trial of labor during the study period. This was 2% of the total births at the hospital during the time period. 444/660 delivered vaginally (67%). Successful VBAC was significantly more likely when the patient presented in spontaneous labor versus when the patient was induced (74% vs 49%, p= Conclusions: The overall success rate of 67% is within the expected range based on public data. However, the success rate at JPS Hospital had decreased from the previous study. This decrease in success coincides with an increase in the rate of induction of labor. Indeed, the success rates for patients who are induced is lower than the patients who present in spontaneous labor. Based on this data, we will reevaluate our practice of induction of labor in trial of labor candidates.