OBJECTIVE To assess the risk of venous thrombosis associated with nonoral contraceptives (ie, injectable depot-medroxyprogesterone acetate contraceptives, hormone [levonorgestrel]-releasing... Show moreOBJECTIVE To assess the risk of venous thrombosis associated with nonoral contraceptives (ie, injectable depot-medroxyprogesterone acetate contraceptives, hormone [levonorgestrel]-releasing intrauterine devices, a contraceptive patch, or a contraceptive implant). METHODS AND RESULTS Analyses were performed in the Multiple Environmental and Genetic Assessment study, a large case-control study on risk factors for venous thrombosis. For the current analyses, we selected premenopausal women, aged 18 to 50 years, who were not pregnant nor within 4 weeks postpartum and were not using oral contraceptives; 446 patients and 1146 controls were included. Injectable depot-medroxyprogesterone acetate contraceptives were associated with a 3.6-fold (95% CI, 1.8- to 7.1-fold) increased risk of venous thrombosis compared with nonusers of hormonal contraceptives. The use of a levonorgestrel intrauterine device was not associated with an increased risk (odds ratio, 0.3; 95% CI, 0.1 to 1.1). Unfortunately, the few women using a contraceptive patch or an implant prevented a reliable estimate of the risk of thrombosis. CONCLUSIONS The risk of venous thrombosis was increased for injectable depot-medroxyprogesterone acetate contraceptive users, while we were able to reliably exclude an increased risk associated with levonorgestrel intrauterine device use. Therefore, the latter seems to be the safest option regarding the risk of venous thrombosis. Show less
Objective-To assess the risk of venous thrombosis associated with nonoral contraceptives (ie, injectable depot-medroxyprogesterone acetate contraceptives, hormone [levonorgestrel]-releasing... Show moreObjective-To assess the risk of venous thrombosis associated with nonoral contraceptives (ie, injectable depot-medroxyprogesterone acetate contraceptives, hormone [levonorgestrel]-releasing intrauterine devices, a contraceptive patch, or a contraceptive implant). Methods and Results-Analyses were performed in the Multiple Environmental and Genetic Assessment study, a large case-control study on risk factors for venous thrombosis. For the current analyses, we selected premenopausal women, aged 18 to 50 years, who were not pregnant nor within 4 weeks postpartum and were not using oral contraceptives; 446 patients and 1146 controls were included. Injectable depot-medroxyprogesterone acetate contraceptives were associated with a 3.6-fold (95% CI, 1.8- to 7.1-fold) increased risk of venous thrombosis compared with nonusers of hormonal contraceptives. The use of a levonorgestrel intrauterine device was not associated with an increased risk (odds ratio, 0.3; 95% CI, 0.1 to 1.1). Unfortunately, the few women using a contraceptive patch or an implant prevented a reliable estimate of the risk of thrombosis. Conclusion-The risk of venous thrombosis was increased for injectable depot-medroxyprogesterone acetate contraceptive users, while we were able to reliably exclude an increased risk associated with levonorgestrel intrauterine device use. Therefore, the latter seems to be the safest option regarding the risk of venous thrombosis. (Arterioscler Thromb Vasc Biol. 2010;30:2297-2300.) Show less
Background: Tumor recurrence in the surgical scar after radical hysterectomy for cervical cancer has been reported, but the incidence is unknown. Facts about patient and tumor characteristics and... Show moreBackground: Tumor recurrence in the surgical scar after radical hysterectomy for cervical cancer has been reported, but the incidence is unknown. Facts about patient and tumor characteristics and follow-up are lacking. The objective of this study was to analyze the incidence and characteristics of cervical cancer scar recurrences. Methods: All patients who were surgically treated for cervical cancer in our center between 1984 and 2007 were reviewed for scar recurrences. For each case, 5 random controls were selected. Clinical characteristics were compared between the cases and controls. Results: Eleven (1.3%) of 842 patients developed a scar recurrence. Mean time between surgery and scar recurrence was 16 months (range, 2Y45 months). For 8 patients (73%), the scar recurrence was the first disease recurrence. Five patients (45%) died, and 2 (18%) were lost to follow-up. Mean time between scar recurrence and death was 9 months. Ninety-one percent of the cases had recurrent disease besides the scar recurrence during follow-up. The case group had a higher percentage of advanced FIGO (International Federation of Gynecology and Obstetrics) stage and postoperatively found involvement of parametria or resection margins and tumor diameter greater than 4 cm, whereas lymph nodes were more often involved in the control group. Conclusions: The incidence of scar recurrences after primary surgery for cervical cancer was 1.3%. Time to development was variable, and prognosis was poor. Besides higher FIGO stage and concurrent unfavorable pathological characteristics, we found no outstanding characteristics of patients with scar recurrence. Scar recurrences go hand in hand with recurrent disease at other locations and seem a manifestation of tumors with extensive metastatic potential. Show less
