C. De Vries

Uterine artery embolisation for symptomatic fibroids: the effect of the large uterus on outcome

Objective  The aim of this study was to evaluate the efficacy of uterine artery embolisation (UAE) in myomatous uteri larger than 24 weeks gestation (780 cm3).

Uterine artery embolization for symptomatic fibroids.

Objectives: The aim of this study was to introduce uterine artery embolization (UAE) as an effective and safe treatment option in patients with symptomatic fibroids. Methods: Sixty‐one patients underwent UAE with a 3‐ and 12‐month follow‐up. Results: The procedure was well tolerated in all patients with the following symptoms improving: heavy bleeding [90% (95% CI 80.21%; 95.4%)]; dysmenorrhea [median −4 (95% CI −5; −4)]; feeling of a mass [74% (95% CI 57.9%; 85.8%)]; abdomino‐pelvic discomfort [88% (95% CI 75.5%; 94.9%)]; and deep dyspareunia [90% (95% CI 71.1%; 97.3%)]. Uterine volume decreased by a median difference of 188 cm3 (95% CI 146.5; 236), which related to a median % reduction of 37.7% (95% CI 32.4%; 45%) at 12‐month follow‐up. Most (91%) patients were satisfied with the procedure and only minor complications occurred. Conclusions: Uterine artery embolization can be performed effectively and safely at centers with the necessary expertise and can be used with success in Africa.

The state of affairs of the public sector mammography service in the Free State Pprovince of South Africa

Abstract Background: The Cancer Association of South Africa stated that breast health services in South Africa were “fragmented and not comprehensive.” The aim of study was to investigate the current state of public sector mammography in the Free State, and to recommend a way forward. Method: A retrospective review of data was performed. Data on all female patients who received mammograms at Universitas Academic Hospital, Bloemfontein, South Africa from April 2008 to March 2010 were evaluated, as well as data on patients diagnosed with breast cancer during this period. A comparison was made between the number of mammograms performed and the number of breast cancer diagnoses during these two years at the hospital. A literature review of screening protocols and burden of disease was also carried out. Results: A complete mammography service breakdown occurred during June 2009. During service breakdown, an average reduction of 72% was observed in the number of mammograms performed monthly, while a reduction of 41% in breast cancer diagnoses occurred. However, breast cancer has a lower burden of disease compared to many other diseases in South Africa. Effective management of breast cancer has a much greater impact on patient outcomes than screening, and should receive priority. Conclusion: Breast health services, specifically mammography, are very limited in the Free State. However, priority may be given to other disease with a greater burden. Breast health care should initially focus on effective management of breast cancer.

Audit on breast biopsies of non-palpable and difficult-to-access lesions

Fine-needle aspiration biopsy (FNAB) is done regularly at our mammography unit on lesions that are non-palpable and difficult to access. Studies done at other hospitals on palpable and non-palpable lesions show a wide variety of results. Therefore we wanted to develop a database of information regarding FNAB results at our own unit. A retrospective descriptive study was done from the reports of all patients who had FNABs at our unit over a 1-year period (15 December 2004 – 1 December 2005). A convenient sampling of 48 women of all ages was used. Four patients did not fit the study criteria and were excluded. Cytological data were retrieved from the original reports and no standardised criteria were used to determine adequacy. Of the available cytology results 23.9% (11 of 46) were positive for malignancy, 17.4% (8 of 46) were negative for malignancy, 4.4% (2 of 46) showed atypical cells and 54.3% (25 of 46) of reported results were inconclusive. In the group of fine-needle aspirations that showed atypical cells (2 patients), neither had a follow-up ultrasound after 3 or 6 months, but both patients were followed up with a mammogram after 6 months. In patients with fine-needle aspiration results that were inconclusive, 20% were followed up with ultrasound after 3 months. After 6 months 8% had a follow-up ultrasound and 36% had a follow-up mammogram. Four per cent of the patients had a routine mammogram at 1 year and 56% were referred to the surgery department. (Some patients had more than one follow-up examination.) The aim of our audit was to develop baseline statistics regarding FNAB results for our unit. The high number of inconclusive results in our study (56.82%) could be due to the fact that FNABs of non-palpable lesions are more difficult to perform. The level of experience of each radiologist performing the aspiration as well as the skill of the cytologist should also be considered. FNABs will be continued at our unit and a follow-up study for comparison of statistics is planned. Such a comparison between studies will assist us in setting a standard for future FNAB results at our unit. South African Journal of Radiology Vol. 10 (2) 2006: pp. 4-5