Development and evaluation of a positive youth development course for university students in Hong Kong.

With higher education, university graduates are important elements of the labor force in knowledge-based economies. With reference to the mental health and developmental problems in university students, there is a need to review university's role in nurturing holistic development of students. Based on the positive youth development approach, it is argued that promoting intrapersonal competencies is an important strategy to facilitate holistic development of young people in Hong Kong. In The Hong Kong Polytechnic University, a course entitled Tomorrow's Leader focusing on positive youth development constructs to promote student well-being will be offered on a compulsory basis starting from 2012/13 academic year under the new undergraduate curriculum structure. The proposed course was piloted in 2010/11 school year. Different evaluation strategies, including objective outcome evaluation, subjective outcome evaluation, process evaluation, and qualitative evaluation, are being carried out to evaluate the developed course. Preliminary evaluation findings based on the piloting experience in 2010/11 academic year are presented in this paper.

Cervical priming with oral misoprostol in pre-labor rupture of membranes at term.

OBJECTIVE: To investigate the effectiveness of oral misoprostol as a cervical priming agent for patients presenting with pre-labor rupture of membranes at term. METHODS: Eighty patients presenting with pre-labor rupture of membranes at term were randomized to receive either 200 micrograms of misoprostol or 50 mg of vitamin B6 orally 1 hour after admission. Labor was induced with intravenous oxytocin infusion 12 hours after oral medication if the patient did not go into labor. We compared the induction rate, duration of labor, mode of delivery, and leaking-to-delivery interval in the two groups. RESULTS: The cervical score was significantly improved and the induction rate was also reduced in the misoprostol group when compared with the control group. The interval from recruitment to onset of labor, duration of labor, and the interval from recruitment to delivery were significantly shorter in the misoprostol group. The mode of delivery and the perinatal outcome were similar for the two groups. CONCLUSION: Oral misoprostol is an effective agent for cervical priming and labor induction in patients with pre-labor rupture of membranes at term.

Vaginal misoprostol compared with oral misoprostol in termination of second-trimester pregnancy.

OBJECTIVE: To compare the efficacy of vaginal with oral misoprostol in termination of second-trimester pregnancy after pretreatment with mifepristone. METHODS: Women requesting termination of second-trimester pregnancy were randomized into two groups. Thirty-six to 48 hours after oral administration of 200 mg of mifepristone, women were given either oral or vaginal misoprostol 200 microg every 3 hours for a maximum of five doses in the first 24 hours. Women receiving oral misoprostol also were given a vaginal placebo (vitamin B6), whereas those receiving vaginal misoprostol were given an oral placebo. If they failed to abort, a second course was given by the same route. RESULTS: The median induction-abortion interval in the vaginal group (9 hours) was significantly shorter than that in the oral group (13 hours). The percentage of women aborting within 24 hours in the vaginal group (90%) was significantly higher than that in the oral group (69%). The median amount of misoprostol used in the vaginal group (600 microg) also was significantly less than that in the oral group (1000 microg). There was no significant difference in the incidence of side effects between the two groups except for fatigue and breast tenderness, which were more common in the oral group. Seventy-six percent of the women preferred the oral route, and 24.5% of the women preferred the vaginal route. CONCLUSION: Vaginal misoprostol is more effective than oral misoprostol in termination of second-trimester pregnancy after pretreatment with mifepristone, but more women preferred the oral route.

Could the incidence of postoperative urinary tract infection be reduced by reversing the sequence of vaginal cleansing and urethral catheterization?

Postoperative urinary tract infection (UTI) is a common hospital infection after gynaecological operations. A prospective randomized study was performed to examine whether the incidence of UTI could be reduced by reversing the sequence of vaginal cleansing and urethral catheterization. Subjects were randomly allocated to: (1) urethral catheterization before vaginal cleansing; and (2) urethral catheterization after vaginal cleansing. Urine cultures were performed immediately after the procedures as the baseline, on the day of catheter removal, and two days after catheter removal. Patients were examined daily after the operation for any urinary symptoms and fever. The incidences of preoperative asymptomatic bacteriuria were similar in both groups, seven of 84 in group 1 vs. eight of 83 in group 2. Among those with negative urine culture before the operation, 77 in group 1 and 75 in group 2, there was no significant difference in postoperative bacteriuria at catheter removal (23 vs. 22) and two days later (35 vs. 42). No significant difference was noted in the incidence of UTI (5 vs. 10, P = 0.25), with a trend towards less UTI in group 1. Voiding discomfort was more common, and fever less common in group 1. There were significant associations between urine culture results at three different occasions. Bacteriuria at catheter removal is associated with a 7.2 times risk of bacteriuria two days later, 2.4 times risk of urinary symptoms and 3.2 times risk of UTI. Routine surveillance at catheter removal is not cost-effective. We conclude that postoperative bacteriuria and UTI are common. Reversing the sequence of the procedures cannot reduce the incidence. There is no evidence to change the status quo.

Oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration in women in the sixth to twelfth week of gestation.

The effectiveness of oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration was compared in women in the 6th to 12th week of pregnancy. Sixty-four nulliparous women requesting termination of pregnancy between 6th to 12th weeks of gestation were randomized to receive either 400 micrograms misoprostol orally or 1 mg vaginal gemeprost at 12 hr or 3 hr prior to vacuum aspiration, respectively. The cervical dilatation at vacuum aspiration, the ease of the subsequent surgical procedure, and the incidence of complications and side effects were compared between these two methods of cervical priming. The median cervical dilatation at vacuum aspiration in the misoprostol group was significantly greater than that in the gemeprost group (8.0 mm versus 7.0 mm, p < 0.02). Preoperative side effects were significantly less frequent in the misoprostol group (p < 0.01). The ease of dilatation assessed subjectively by the operating surgeons was also improved significantly in the misoprostol group (p < 0.01). However, the duration of operation and blood loss were similar in both groups. Since misoprostol is also much cheaper and more convenient to use, we conclude that oral misoprostol is better than vaginal gemeprost for cervical dilatation prior to vacuum aspiration in first trimester pregnancy.

PIP: Given the importance of adequate cervical dilatation to vacuum aspiration abortion, the effectiveness of oral misoprostol and vaginal gemeprost was compared. The 64 study subjects, all in the first 6-12 weeks of pregnancy, were randomly assigned either to take 400 mcg of misoprostol the night before pregnancy termination or were given 50 mg of vitamin B6 (placebo for misoprostol) to be taken the night before the procedure followed by vaginal insertion of 1 mg of gemeprost three hours preoperatively. Preoperative side-effects--nausea, vomiting, abdominal pain, and vaginal spotting--were significantly greater (p 0.01) in the gemeprost group; 28 out of 32 women in the misoprostol group compared to only 17 out of 32 in the gemeprost group experienced no side effects. The mean baseline cervical dilatation of 8.1 mm in the misoprostol group was significantly greater (p 0.01) than that in the gemeprost group (7.0 mm) and the ease of further dilatation was rated by surgeons as easier than normal for 87.5% of women in the former group compared to 59.4% in the latter group (p 0.01). The duration of the procedure and mean blood loss were similar in both groups. In addition to being more effective than gemeprost, misoprostol is less expensive and stable at room temperature. This is the first prospective, randomized study of oral as opposed to vaginal administration of misoprostol for cervical dilatation.

Colon cancer in pregnancy. A case report.

BACKGROUND: Carcinoma of the colon diagnosed during pregnancy is very rare. Delayed diagnosis is common because of the similarity between early signs and symptoms of colon cancer and gastrointestinal complaints often experienced by pregnant women. We report a case of early-stage colon cancer in pregnancy with a good outcome. CASE: A 35-year-old woman presented with rectal bleeding at 26 weeks of gestation. Initial assessment with digital examination and proctoscopy revealed only a mild degree of hemorrhoids. Colonoscopy and biopsy at 30 weeks of gestation showed sigmoid colon cancer. Cesarean section was performed after steroid therapy. Subtotal colectomy and ileosigmoid anastomosis were then performed at the same setting. Postoperative adjuvant chemotherapy was given. There was no evidence of recurrence at this writing, 28 months after surgery. CONCLUSION: Colon cancer is a rare complication of pregnancy. The associated poor prognosis is usually due to delay in diagnosis. A high index of suspicion is essential, and it is important not to underestimate the patient's symptoms. Early diagnosis is the key to longer survival.

Gastric adenocarcinoma presenting with persistent, mild gastrointestinal symptoms in pregnancy. A case report.

BACKGROUND: Mild gastrointestinal symptoms are common during pregnancy but can also be the only symptoms in stomach cancer until the late stage. Clinicians' reluctance to pursue diagnostic studies appears to be a major contributing factor to delayed diagnosis and poor outcome. We report a case of maternal death to alert clinicians to this rare possibility. CASE: A 36-year-old woman had persistent, mild epigastric discomfort, nausea, vomiting and frequent episodes of dark stools since the second trimester of pregnancy. These were attributed to peptic ulcer and an iron supplement given, without investigation. Gastroscopy was performed only at 32 weeks of gestation, when the patient had heavy hematemesis. Biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma of the stomach. Cesarean section was performed after steroid therapy. Advanced stomach cancer with stomach perforation was found. Curative surgery was not possible. The patient died four weeks after delivery. CONCLUSION: Stomach cancer is a rare complication of pregnancy. Delay in diagnosis is commonly due to clinicians' reluctance to request diagnostic studies and the nonspecific symptoms of the disease. Early recognition and diagnosis are the only possibilities for a better outcome. Clinicians must be alert to this possibility and include this in the differential diagnosis of minor gastrointestinal discomfort during pregnancy.

Eclampsia-an 11-year experience.

A retrospective study of all deliveries from 1983 to 1993 at the Tsan Yuk Hospital to evaluate the incidence was performed and outcome of eclampsia. Eclampsia occurred in 12 patients. The incidence was approximately 2 per 10,000 deliveries and was relatively constant during the study period. Most convulsions occurred during the intrapartum (41.7%) and post-partum (50.0%) periods, and about half of them had no warning signs. There were no maternal or perinatal deaths. Prophylactic anticonvulsants should be given to all patients with warning signs; however, eclampsia is not always preventable.

Randomized comparison of vaginal (200 microg every 3 h) and oral (400 microg every 3 h) misoprostol when combined with mifepristone in termination of second trimester pregnancy.

It is known that when misoprostol is given at 200 microg every 3 h after mifepristone pretreatment, the vaginal route is more effective than the oral route. However, women prefer the oral route. This randomized study was to test our hypothesis that oral misoprostol 400 microg is as effective as vaginal misoprostol 200 microg when given every 3 h in termination of second trimester pregnancy after priming with mifepristone. A total of 142 patients was randomly assigned to group 1 (200 mg mifepristone + 400 microg oral misoprostol every 3 h up to five doses) or group 2 (200 mg mifepristone + 200 microg vaginal misoprostol every 3 h up to five doses). The incidence of side-effects and the preference study were assessed through a standardized questionnaire during and after the abortion. For the oral group, both the incidence of diarrhoea (40.0 versus 23.2%, P = 0.03) and the amount of drug used (1734 compared with 812 microg, P < 0.0001) were significantly higher than that of the vaginal group but the incidence of fever appeared to be lower (not significant). There was no significant difference in complete abortion rate: 81.4% in the oral group and 75.4% in the vaginal group. The median induction-abortion interval was similar in the two groups (10.4 versus 10.0 h). The percentage of women who aborted in 24 h was also similar: 57/70 (81.4%) in the oral group and 58/69 (87.0%) in the vaginal group. Overall, 82.0% of women preferred the oral route. Oral misoprostol (400 microg) given every 3 h up to five doses, when combined with mifepristone, was as effective as the vaginal (200 microg) route in second trimester termination of pregnancy. This regimen could also be offered to those women who found repeated vaginal administration unacceptable.

The use of misoprostol prior to hysteroscopy in postmenopausal women.

BACKGROUND: This study examined whether oral misoprostol exerted a cervical priming effect in postmenopausal women prior to hysteroscopy. METHOD: Thirty-seven patients were randomized to receive either oral misoprostol (400 microg) or placebo (vitamin B(6)) 12 h prior to hysteroscopy. The resistance of the cervix to dilatation was objectively assessed by a cervical tonometer. RESULTS: The mean baseline cervical dilatation (4.2 mm in misoprostol group versus 4.4 mm in placebo group) was similar between the two groups. The mean cumulative force measured (27.7 N in misoprostol group versus 21.8 N in placebo group) was also comparable. None of the patients suffered from any significant side-effects. CONCLUSIONS: These data showed that there were no significant benefits from giving misoprostol pre-operatively in postmenopausal women, and it was concluded that oral misoprostol had no significant cervical priming effect in postmenopausal women.

Vaginal misoprostol alone for medical abortion up to 9 weeks of gestation: efficacy and acceptability.

Misoprostol and mifepristone have been shown to be effective for medical abortion up to 9 weeks of gestation. When used alone, the successful complete abortion rate dropped to approximately 60%. It has been demonstrated that by adding water to misoprostol, the success rate rose to 92%. This is the first randomized study to investigate the efficacy of misoprostol and water versus misoprostol alone for first trimester medical abortion in women at

A randomized, double blind, placebo-controlled study to investigate the use of conscious sedation in conjunction with paracervical block for reducing pain in termination of first trimester pregnancy by suction evacuation.

BACKGROUND: This study evaluated the role of conscious sedation in pain relief during termination of first trimester pregnancy by suction evacuation (SE) under local anaesthesia. METHODS: A hundred women undergoing SE before 12 weeks gestation were randomized by computer using the sealed envelope method to receive placebo (saline) or conscious sedation (2 mg midazolam and 25 microg fentanyl) i.v. 5 min before cervical dilatation. Paracervical block was given to all patients, 2 min later. Pain scores during and after SE, post-operative side-effects and satisfaction level were compared. RESULTS: No statistically significant differences in pain scores were found between the two groups. Post-operative side-effects such as dizziness (P = 0.015) and drowsiness (P < 0.001) were significantly more severe in the conscious sedation group. However, patients in the conscious sedation group reported better satisfaction levels than the control group (P = 0.003). CONCLUSION: The use of conscious sedation significantly improved patient satisfaction during termination of first trimester pregnancy by SE under local anaesthesia, despite a lack of improvement in pain relief and the presence of increased severe dizziness/drowsiness in the post-operative period.

Oral misoprostol versus placebo for cervical dilatation before vacuum aspiration in first trimester pregnancy.

Intravaginal misoprostol has been shown to be effective for cervical priming before a surgically induced abortion. The objective was to investigate the effectiveness of oral misoprostol in cervical dilatation prior to vacuum aspiration between the 6th and 12th weeks of pregnancy. The results showed that in nulliparous patients, the median cervical dilatation in the treatment group (7.8 mm) was significantly greater than that in the placebo group (3.7 mm). In multiparous patients, the difference was also statistically significant (9.8 versus 6.0 mm). The ease of dilatation, assessed subjectively by the operating surgeons, was significantly improved in the treatment group. There was also a significant reduction in the duration of the operation and in the mean blood loss in the treatment group. The side-effects encountered in the treatment group were mild and well accepted by the women. Oral misoprostol is an effective and safe method for cervical dilatation prior to vacuum aspiration in first trimester pregnancy.

PIP: The effectiveness of oral misoprostol for cervical dilatation prior to first-trimester (6-12 weeks of pregnancy) vacuum aspiration was evaluated in a case-control study of 75 women referred to a Hong Kong clinic for induced abortion. 36 women were randomly assigned to receive misoprostol (400 mcg 12 hours before the procedure), while 39 women were given a placebo; 21 women in the treatment group and 22 controls were nulliparous. Among nulliparous women, median cervical dilatation was significantly greater in the treatment group (7.8 mm) than the placebo group (3.7 mm). In multiparous women, these medians were 9.8 and 6.0 mm, respectively. The ease of further dilatation, subjectively assessed by operating surgeons, was rated easier than normal in 88% of women in the treatment group compared with 26% of controls. There was also a significant reduction in the median duration of vacuum aspiration in nulliparous cases (4.5 minutes) compared with controls (5.5 minutes) and in median blood loss (20 and 28 ml, respectively). Side effects (lower abdominal pain, vaginal spotting, nausea) were mild and well-tolerated in both groups. These findings suggest that oral misoprostol is a safe, cost-effective (US$0.40 per tablet) alternative for cervical priming prior to vacuum aspiration.

The use of misoprostol for pre-operative cervical dilatation prior to vacuum aspiration: a randomized trial.

Misoprostol is effective for cervical priming prior to vacuum aspiration for first trimester termination of pregnancy. Previous studies showed that the oral route was more acceptable to patients but there were higher incidences of side-effects when compared with the vaginal route. This study is to determine the optimal dosage and route of administration of misoprostol for pre-operative cervical dilatation. A double-blind, randomized trial was undertaken for 225 nulliparous women with 8-12 weeks amenorrhoea. They were randomly assigned to groups given 0 (placebo), 200 or 400 microg oral or vaginal misoprostol 3 h prior to vacuum aspiration. In misoprostol-treated groups the baseline cervical dilatation was significantly increased when compared with the placebo group; the effect was dose-related in the oral but not in the vaginal group. The cumulative force and blood loss was significantly decreased in the misoprostol-treated groups. The incidences of side-effects were more frequent in misoprostol groups but were not related to the route and dosage of medication. The duration of procedure, incidences of post-operative complications, the duration of post-operative bleeding and the interval to the first period were similar in the five treatment groups. We conclude that a 3 h pre-treatment interval is effective for both oral and vaginal routes. When given orally, 400 microg is more effective than 200 microg. The efficacy was otherwise similar when compared with the vaginal route. We recommend 400 microg oral misoprostol 3 h prior to vacuum aspiration for cervical dilatation.

Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage.

BACKGROUND: Misoprostol is effective for cervical priming prior to suction evacuation in first trimester pregnancy termination. This is the first randomized study to compare vaginal misoprostol versus expectant treatment in women presenting with spontaneous miscarriage. METHODS: Sixty women presenting with spontaneous miscarriage were recruited to the study at the Queen Mary Hospital between 1998 and 1999. They were randomized to group 1: misoprostol; and group 2: expectant management. Women in the misoprostol group received vaginal misoprostol 400 microg on days 1, 3 and 5. The expectant group was followed up according to the same schedule. Suction evacuation was performed if there was excessive bleeding or abdominal pain; or if a gestational sac was detected by transvaginal scan on day 15. RESULTS: Fifty-nine women completed the trial. Those who did not require suction evacuation up to the time of return of normal menstruation were considered to be successful. The incidence of side-effects was comparable between the two groups. Three women in the expectant group and one in the misoprostol group underwent emergency suction evacuation because of excessive bleeding. The mean duration of vaginal bleeding was similar for both groups (14.6 days in the misoprostol group versus 15.0 days in the expectant group). The successful rate in the misoprostol group was significantly higher than that of the expectant group (83.3 versus 48.3%, P < 0.05). CONCLUSION: We recommend repeated vaginal misoprostol 400 microg given on days 1, 3 and 5 as a treatment option for women with first trimester spontaneous miscarriage.

Oral misoprostol for cervical priming in non-pregnant women.

Endometrial biopsy and hysteroscopy are important investigations in women presenting with abnormal vaginal bleeding. Endometrial biopsy is often performed as an outpatient procedure by endometrial aspiration. Difficulty in entering the internal cervical os may be encountered, especially in nulliparous women. The same problem may occur during hysteroscopy or dilatation and curettage. It is well known that use of a cervical priming agent is effective in reducing complications during cervical dilatation in pregnant women. However, its use in non-pregnant women is not well established. We compared oral misoprostol versus placebo for a cervical priming effect in non-pregnant women prior to hysteroscopy. The cumulative force required for cervical dilatation was significantly lower whereas the baseline cervical dilatation was significantly greater in the misoprostol group. We conclude that oral misoprostol is effective for pre-operative cervical dilatation in non-pregnant women.

PIP: Difficulties with entering the internal cervical os in nonpregnant women (especially nulliparous women) can hinder performance of endometrial aspiration or hysteroscopy in patients presenting with abnormal vaginal bleeding. This study investigated the usefulness of oral misoprostol--shown to be effective in cervical dilatation in first and third trimester abortion--for preoperative cervical dilatation in non-pregnant women. 44 nulliparous women presenting to Hong Kong's Queen Mary Hospital for diagnostic hysteroscopy and endometrial biopsy and curettage were randomly assigned to receive either 400 mcg of misoprostol 12 hours prior to the procedure (n = 21) or placebo (n = 23). Pretreatment with misoprostol significantly reduced the amount of force required to dilate the cervix to 8 mm from 103.7 Newtons in controls to 40.0 Newtons in women treated with misoprostol. The mean baseline cervical dilatation was significantly greater in the misoprostol group (6.0 mm) than in controls (3.3 mm). There were no immediate intraoperative complications and all women were discharged within 12 hours of the procedure. Another potential use of misoprostol is for cervical dilatation prior to IUD insertion in nulliparous women.

Oral misoprostol versus mifepristone for cervical dilatation before vacuum aspiration in first trimester nulliparous pregnancy: a double blind prospective randomised study.

OBJECTIVE: To compare the effectiveness of oral misoprostol and mifepristone for cervical priming before first trimester termination of nulliparous pregnancy. DESIGN: Prospective double blind randomised study. SETTING: Department of Obstetrics and Gynaecology, University of Hong Kong. PARTICIPANTS: One hundred nulliparous women undergoing termination of pregnancy between 8 and 12 weeks of gestation were recruited for this prospective randomised trial. The women were allocated to either the oral misoprostol or mifepristone group. Subjects in misoprostol group were given placebo and misoprostol 400 micrograms 36 h and 12 h respectively before vacuum aspiration. Subjects in mifepristone group were given 200 mg mifepristone and placebo 36 h and 12 h respectively prior to operation. MAIN OUTCOME MEASURES: Baseline pre-operative cervical dilatation, the incidence of side-effects, the amount of blood loss and duration of procedure. RESULTS: There were no significant differences in the baseline cervical dilatation, incidence of side-effects, amount of blood loss and duration of procedure. CONCLUSIONS: Misoprostol and mifepristone are of similar effectiveness for cervical priming prior to vacuum aspiration in nulliparous women. Misoprostol has additional advantages of being widely available and inexpensive.

Labour characteristics and uterine activity: misoprostol compared with oxytocin in women at term with prelabour rupture of the membranes.

OBJECTIVE: To compare the labour pattern and uterine activity of oral misoprostol with oxytocin for labour induction in women presenting with prelabour rupture of membranes at term. DESIGN: Prospective randomised study. SETTING: Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong. PARTICIPANTS: Eighty women presenting with prelabour rupture of membranes at term. METHODS: The women were randomised to receive either 100 microg misoprostol orally every 4 hours to a maximum of three doses, or intravenous oxytocin infusion according to the hospital protocol. Intrauterine pressure transducers were inserted one hour before induction of labour in both groups of women. We compared the pattern of uterine activity, the induction-to-delivery interval, duration of labour, mode of delivery and neonatal outcome between the two groups. RESULTS: Both oxytocin and oral misoprostol caused an increase in uterine activity within one hour of labour induction. Peak uterine activity was reached 6-8 h after oral misoprostol, with persistent effects, and 8-10 h after oxytocin, requiring continuous titration of medication. The duration of labour was significantly reduced in nulliparous women, but not in those who were multiparous in the misoprostol group. The induction-to-delivery interval, the mode of delivery and the perinatal outcome were similar for the two groups. CONCLUSION: Oral misoprostol caused earlier peak uterine activity, compared with oxytocin (6-8 h vs 8-10 h). Oral misoprostol was not only as effective as oxytocin in inducing labour in women at term with prelabour rupture of the membranes, but it reduced significantly the duration of labour in nulliparous women.

Effect of pre-incision skin infiltration on post-hysterectomy pain--a double-blind randomized controlled trial.

In this double-blind placebo-controlled randomized trial, we compared the analgesic effect of preoperative 0.25% bupivacaine (n = 21) skin infiltration with normal saline (n = 19) in patients undergoing abdominal hysterectomy through a lower midline incision. All patients received postoperative patient-controlled analgesia with morphine and were followed for 72 hours. The main outcome measures were morphine consumption and pain score at rest, and the contribution of different components of pain was also assessed prospectively. No statistically significant differences were found. All except one patient (n = 39) could distinguish the different characteristics of somatic and visceral pain. Visceral pain predominated in the first 48 hours. We concluded that local anaesthetic infiltration is not effective in reducing pain after abdominal hysterectomy. Effective postoperative analgesia should aim to eliminate the visceral pain component.

Aggressive angiomyxoma in females: is radical resection the only option?

BACKGROUND: Aggressive angiomyxoma is a rare mesenchymal tumor, characterized by frequent local recurrences. Our aim is to assess the role of radical resection. METHODS: Retrospective case review. The records of five patients with aggressive angiomyxoma during the period from 1984 to 1998 were reviewed and analyzed. A MEDLINE search from 1983 to May 1999 was performed. The clinical presentation, surgical treatment, resection margin involvement and clinical outcomes were analyzed. RESULTS: Together with our five cases, 106 cases have been reported in the world literature. The female-to-male ratio was 6.6:1. The age distribution was wide, with the peak incidence at 31 to 35. The local recurrence rate was high. Seventy-one percent of recurrence occurred within the first 3 years. Patients with clear resection margins have similar chances of remaining disease-free compared with those having tumor-involved resection margins. There was no correlation between the size of the tumors and the chance of recurrence. CONCLUSIONS: Though we aim for complete resection, incomplete or partial resection is acceptable, especially when high operative morbidity is anticipated and preservation of fertility is an issue. Long-term follow-up and careful monitoring with imaging techniques are essential for timely identification of recurrence and prompt resection.