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James B Spies

Publications and source records attributed to James B Spies.

At least 37 records · Page 2Linked to original sources
PubMed2004

Recovery after uterine artery embolization for leiomyomas: a detailed analysis of its duration and severity.

PURPOSE: To determine the duration and severity of recovery after uterine artery embolization (UAE) for leiomyomas. MATERIALS AND METHODS: As part of a study comparing different embolic materials used for UAE, detailed data on the severity of postprocedural recovery were gathered in 99 patients. These data included patient-controlled analgesia records, visual analogue scale (VAS) pain scores of daily peak pain levels for 7 days, medication use in the first week, and severity of constitutional symptoms experienced over the course of the first month after the procedure. The VAS scale assesses acute pain severity on a 10-cm linear scale and yields a continuous measure from 1 to 10. The constitutional symptoms were scored based on a questionnaire. The data were analyzed with use of summary statistics, and linear regression analysis was used to determine the impact of various baseline factors on the severity of recovery. RESULTS: The mean peak VAS score for the first 24 hours after UAE was 3.03 (SD, 0.26) and the mean maximum score in the first week was 4.89 (SD, 0.26). Only 11 patients had an in-hospital VAS score greater than 7, and 19 had a VAS score of greater than 7 on any of the first 7 days after discharge. The mean number of oral narcotic tablets used per patient was 10.8 in the first week. Although 33 patients had a temperature higher than normal sometime in the first postprocedural week, high temperature (>38.5 degrees C) occurred in only two patients. There were no differences detected in the measured parameters based on the type of embolic material used. CONCLUSION: Despite the reputation of UAE to the contrary, when current techniques are used, recovery after UAE for fibroids is relatively mild, with few instances of severe pain, high fever, or severe constitutional symptoms.

Acrylic Resins↗
PubMed2004

Uterine fibroid tumors: long-term MR imaging outcome after embolization.

PURPOSE: To assess and report the long-term magnetic resonance (MR) imaging outcomes of fibroid tumors treated with uterine artery embolization (UAE). MATERIALS AND METHODS: Contrast material-enhanced pelvic MR imaging was performed in 20 patients before UAE, at 3 months after UAE, and then yearly for up to 3 years. Two readers compared the uterine fibroid, dominant (ie, largest) fibroid, and percentage of perfusion measurements from each of these examinations by using intraclass correlations. Seventeen patients underwent contrast-enhanced MR imaging at baseline and 3 months and 3 years after treatment. Among these patients, those with complete infarction were compared with those with incomplete infarction of the dominant fibroid at 3 years to determine extents of infarction, differences in baseline characteristics, degrees of volume reduction of the uterus and fibroid, and extents of symptom change. Comparisons were performed by using t and Pearson chi(2) tests. Differences in proportions, with 95% CIs, were calculated. Each follow-up MR image was also evaluated for the presence of myometrial perfusion defects and new fibroids. RESULTS: Intraclass correlation coefficients calculated for the two readers (range, 0.974-0.995) and with the MR imaging data (range, 0.966-0.988) were high. Of the 17 patients included in the outcome analysis, the 12 with complete fibroid infarction were more likely not to have enhancing lesions at 3-year follow-up (P =.002) than were those with incomplete infarction. No significant differences in volume or symptom changes between the two groups were detected, but growth of residual perfused portions of the incompletely infarcted fibroids was seen in three patients, two of whom had recurrent symptoms. Four patients developed new fibroids, none of which has caused symptoms. There were no instances of myometrial infarction. CONCLUSION: Although the small study population prevented the drawing of definitive conclusions, the data suggest that although incomplete fibroid infarction may not affect outcome immediately, regrowth of uninfarcted fibroid tissue may result in symptom recurrence.

Adult↗
PubMed2003

Changes in blood coagulation markers associated with uterine artery embolization for leiomyomata.

PURPOSE: To determine whether a transient hypercoagulable state is induced by the uterine artery embolization (UAE) procedure. MATERIALS AND METHODS: Serial periprocedure blood samples were obtained from 27 patients undergoing the UAE procedure. Five blood samples were obtained from each patient at set time intervals: before the procedure (for baseline determination), immediately before and after embolization of the uterine arteries, 90 minutes after conclusion of the procedure, and between 18 and 24 hours later. Each blood sample was analyzed for the peripheral levels of the following parameters: thrombin-antithrombin complex (TAT), prothrombin fragment 1.2 (F1.2), platelet factor 4 (PF4), D-dimer, and plasmin-alpha(2)-antiplasmin complex (PAP). For each parameter, the baseline values were statistically compared with the pre- and postembolization values for each individual to detect change over time. Overall and global occasion effects for continuous variables were assessed with the Friedman statistic and individual comparisons between occasions with the Wilcoxon signed-rank test. RESULTS: No evidence was found for a difference in coagulability among the five occasions for D-dimer (P =.7645) or PF4 (P =.09). All three of the remaining measures were found to have statistically significant differences (P <.0001 for F1.2, P =.0026 for PAP, and P =.0006 for TAT). No evidence was found for a difference between preprocedure and preembolization levels for these three latter parameters (P =.595 for F1.2, P =.128 for PAP, P =.9705 for TAT). Hypercoagulability potential as measured by prothrombinase and F1.2 generation increased between preembolization samples and each of the successive postprocedure samples (P <.0001, P <.0001, P =.0082), whereas PAP increased at 90 minutes (P =.0023) and TAT increased immediately after embolization (P <.0001). No clinically apparent thrombotic complications occurred among any of the patients studied. CONCLUSIONS: Surrogate markers of hypercoagulability increase as a result of UAE, suggesting that a prothrombotic state may result after the procedure.

Adult↗
PubMed2003

Adenomyosis: MRI of the uterus treated with uterine artery embolization.

OBJECTIVE: The purpose of this study was to determine the MRI features seen after uterine artery embolization and to evaluate the clinical response in patients with adenomyosis. MATERIALS AND METHODS: Thirty women with adenomyosis underwent uterine artery embolization and follow-up MRI for 1 year. Of the 30, 27 patients were diagnosed with uterine fibroids and adenomyosis on the basis of MRI before uterine artery embolization. In six of the 27 patients, the dominant disease was adenomyosis. Three of the 30 patients had adenomyosis alone. The distribution, thickness, and enhancement of adenomyosis were analyzed in each patient. Patients completed a symptom questionnaire. RESULTS: After uterine artery embolization, the junctional zone-myometrial ratio did not change significantly. There were regions of devascularization of adenomyosis on contrast-enhanced images in 12 patients, all with a junctional zone thickness before uterine artery embolization of more than 20 mm (mean thickness, 39.2 mm). Eleven of the 12 patients had focal or asymmetric distribution patterns of adenomyosis. All three patients with pure adenomyosis and all six patients with dominant adenomyosis reported an improvement in symptoms. CONCLUSION: In patients treated with uterine artery embolization, MRI shows changes in areas of adenomyosis with a decrease in junctional zone vascularity in patients with thickening of the junctional zone greater than 20 mm. Devascularization may be related to the distribution of adenomyosis. The presence of adenomyosis should not be used as a contraindication to uterine artery embolization because most patients show clinical improvement after undergoing this procedure.

Adult↗
PubMed2002

The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata.

OBJECTIVE: To create and validate a questionnaire for assessing symptom severity and symptom impact on health-related quality of life for women with leiomyomata. METHODS: The questionnaire was derived from focus groups of women with leiomyomata. Content validity was established through cognitive debriefings of women with leiomyomata and review by expert clinicians. Patients for the validation study were recruited from five gynecologists' offices, an interventional radiology department, and a University campus. Instruments used for validation were the Short Form-36, Menorrhagia Questionnaire, the Revicki-Wu Sexual Function Scale, and a physician and a patient assessment of severity. Item and exploratory factor analysis were performed to assess the subscale structure of the questionnaire. Psychometric evaluation was conducted to assess reliability and validity. Test-retest was performed on a random subset of the sample within 2 weeks of the initial visit. RESULTS: A total of 110 patients with confirmed leiomyomata and 29 normal subjects participated in the validation. The final questionnaire consists of eight symptom questions and 29 health-related quality of life questions with six subscales. Subscale Cronbach's alpha ranged from 0.83 to 0.95, with the overall health-related quality of life score alpha = 0.97. The Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire subscales discriminated not only from normal controls but also among leiomyomata patients with varying degrees of symptom severity. Test-retest reliability was good with intraclass correlation coefficients of 0.76-0.93. CONCLUSION: The UFS-QOL appears to be a useful new tool for detecting differences in symptom severity and health-related quality of life among patients with uterine leiomyomata. Additional study is underway to determine the responsiveness of the UFS-QOL to therapies for leiomyomata.

Adult↗
PubMed2002

Complications after uterine artery embolization for leiomyomas.

OBJECTIVE: To determine the frequency and severity of complications that occur as a result of uterine artery embolization for leiomyomas. METHODS: As part of an ongoing study of outcome after uterine embolization, prospective data regarding complications that occurred in 400 consecutive patients were gathered. Each patient had a minimum of a 3-month interval from the procedure at the time of analysis. Each complication was categorized and graded as to severity and outcome using the complication classification developed by the Society of Cardiovascular and Interventional Radiology (SCVIR) and a modified set of The American College of Obstetricians and Gynecologists (ACOG) criteria for complications of hysterectomy and myomectomy. All adverse events that occurred during the follow-up period were included, including those that occurred after the 3-month minimum interval. Confidence intervals (CIs) were calculated for each complication. RESULTS: There were no deaths and no major permanent injuries. One patient required hysterectomy as a result of a complication, and one patient had an undiagnosed leiomyosarcoma. There were ten in-hospital complications and an additional 27 complications within the first 30 days, with 34 patients experiencing a periprocedural complication for a rate of 8.5% (95% CI 6.0%, 11.7%). There were five serious complications (SCVIR class D), comprising 1.25% (95% CI 0.3%, 2.5%) of the study group. Using ACOG definitions for perioperative complications, the overall morbidity was 5% (95% CI 3.1%, 7.7%). CONCLUSION: The short-term complication rate was low in women undergoing uterine embolization.

Adult↗
PubMed2002

Uterine artery replacement by the round ligament artery: an anatomic variant discovered during uterine artery embolization for leiomyomata.

The authors report a case of an unusual anatomic variation encountered during uterine embolization, that of absence of a uterine artery, with replacement by an enlarged round ligament artery. This case highlights the importance of understanding the arterial anatomy of the uterus and its potential variations and their potential impact on the outcome of the procedure.

Arteries↗