THE HOUSTON GYNECOLOGICAL & OBSTETRICAL SOCIETY (HGOS)
To promote excellence in the practice of gynecology and obstetrics, enhance the opportunities for continuing education, encourage leadership and serve as the representative society for obstetrics and gynecology in the Houston area
We are also very grateful to Linda Gist who devoted
so many years to our society and who played a key
role in the success of our group. She was always
very resourceful, hard working, creative, and very
dedicated. We were certainly very fortune and
honored to have her as part of our Executive
Executive Committee Updates
The most recent Executive Committee meeting was
held on October 27th, 2009. The topics discussed
-Dr. Ivey highlighted the difficulties and
obstacles encountered by local OBGYNs practices in
obtaining the H1N1 vaccine. He will speak to the
membership for a brief period during the Introduction
in our next meeting. A letter will be formulated and
submitted to the Department of Health and to our
State Governor to express the frustrations of our
I am very pleased to announce that we have a very specialty with these issues.
exciting event scheduled for our November General
-The Board members discussed perspectives
meeting. On November 5th, 2009, we have the pleasure on the type of venue used for the General Meeting. It
of having Dr. Gazala Siddiqui lead a discussion was agreed that Trevisio’s lends itself as a convenient
titled-“Hot Topics in Urogynecology”. Dr. Sidiqqui is an site given its location within the medical center. In
Assistant Professor in Urogynecology at the University of addition, the room set-up, acoustics, organization, and
Texas Health Science Center. The meeting will be set food quality are all favorable. However, one concern
up in the form of a panel debate and Dr. Sidiqqui will expressed was the ability to capture the attendance of
moderate a session where other expert urogynecologist physician’s practicing in the outskirts of town. A
will discuss relevant and controversial issues such as proposal was made to consider other venues for
mesh kits, overactive bladder, recurrent prolapse, and future meetings rather than a standing commitment to
surgical complications. Other panelists will include Dr. Trevisio’s.
Resident’s night where local residents would present
The meeting will be held on November 5th at 7 pm.
their research to the society and a winning
presentation would be awarded a prize of $500. The
proposal was made on the basis that this would be an
6550 Bertner Street, Houston, Texas 77030
academic presentation and at the same time, it would
provide an opportunity to network and for local
physician members of the society to recruit potential
Announcements
candidates to their practice. This was approved by the
Board and Dr Frumovitz will assume leadership of this
It is my pleasure to officially welcome Ms. Lisa Gasper event.
as the new Executive Director of our Society. Lisa
-Dr. Ivey proposed that membership should
comes to us with very high credentials and qualifications be based on a yearly basis and that dues paid would
and we are very proud that she has accepted our grant a member only a one year membership. There
invitation to join us. All members who wish to reach Ms. will be a small penalty for late dues.
THE HOUSTON GYNECOLOGICAL & OBSTETRICAL SOCIETY (HGOS)
2009 HGOS Executive Board President
-Lisa Gasper announced that correspondence with the members of the
society will move towards a paper-less system where the priority will be placed
-Three new members were approved for the Society:
Dr. Sophie Fletcher, Dr. Deepali Patni, and Dr. Concepcion Diaz-Arrastia
President-Elect Research Updates
In this section of the newsletter we offer highlights of recent publications
relevant to our field. The goal of this segment is to keep the members of the
society abreast of recent sentinel publications that may impact their clinical
Vice President
practice and patient care. Each article that is referenced may be found through
a link in the Society website at www.hgos.org. ONCOLOGY: Secretary Robotic approach for cervical cancer: Comparison with laparotomy: A Case Control Study. Angelo Maggioni, Lucas Minig, Vanna Zanagnolo, Michele Peiretti, Fabio Sanguineti, Luca Bocciolone, Nicoletta Colombo, Fabio Landoni, Giovanni Roviglione, Jorge Ivan Vélez Treasurer Gynecologic Oncology 2009;115:60-64
OBJECTIVE: To compare the surgical outcome of robotic radical hysterectomy
(RRH) versus abdominal radical hysterectomy (ARH) for the treatment of early
Immediate Past President
METHODS: A prospective collection of data of all RRH for stages IA2–IIA
cervical cancer was done. The procedures were performed at the European
Institute of Oncology, Milan, Italy, between November 1, 2006 and February 1,
Members at Large
RESULTS: A total of 40 RRH were analyzed, and compared with 40 historic
ARH cases. The groups did not differ significantly in body mass index, stage,
histology, or intraoperative complications, but in age (p = 0.035). The mean
(SD) operative time was significantly shorter for ARH than RRH, 199.6 (65.6)
minutes and 272.27 (42.3) minutes respectively (p = 0.0001). The mean (SD)
estimated blood loss (EBL) was 78 ml (94.8) in RRH group and 221.8 ml
(132.4) in ARH. This difference was statistically significant in favor of RRH
group (p < 0.0001). Statistically significantly higher number of pelvic lymph
nodes was removed by ARH than by RRH, mean (SD) 26.2 (11.7) versus 20.4
Ex Officios
(6.9), p < 0.05. Mean length of stay was significantly shorter for the RRH group
(3.7 versus 5.0 days, p < 0.01). There was no significant difference in terms of
postoperative complications between groups.
CONCLUSION: This study shows that RRH is safe and feasible. However, a
comparison of oncologic outcomes and cost-benefit analysis is still needed
and it has to be carefully evaluated in the future. OBSTETRICS HGOS Office Antiviral Medications for Pregnant Women for Pandemic and Seasonal Influenza: An Economic Computer Model Lee, Bruce Y. MD, MBA; Bailey, Rachel R. MPH; Wiringa, Ann E.; Assi, Tina-Marie MPH; Beigi, Richard H. MD, MSc Obstetrics and Gynecology 2009;114:971-980
(Cont’d on page 3)
THE HOUSTON GYNECOLOGICAL & OBSTETRICAL SOCIETY (HGOS)
Obstetrics and Gynecology 2009;114:1041-1048
OBJECTIVE: To estimate the economic value of OBJECTIVE: To examine factors associated with
administering antiviral medications to pregnant undergoing laparoscopic hysterectomy compared
women who have come in contact with an with abdominal hysterectomy or vaginal
infectious individual with influenza.
METHODS: A computer-simulation model was METHODS: This is a cross-sectional analysis of
developed to predict the potential economic effect the 2005 Nationwide Inpatient Sample. All women
of antiviral use for postexposure prophylaxis aged 18 years or older who underwent
among pregnant women in both seasonal hysterectomy for a benign condition were
influenza and pandemic influenza scenarios. The included. Multivariable analyses were used to
model allowed us to examine the effects of varying examine demographic, clinical, and health-system
influenza exposure risk, antiviral efficacy, antiviral factors associated with each hysterectomy route.
cost, and the probability of different influenza
outcomes such as hospitalization, preterm
RESULTS: Among 518,828 hysterectomies, 14%
were laparoscopic, 64% abdominal, and 22%
vaginal. Women older than 35 years had lower
RESULTS: For a variety of pandemic influenza rates of laparoscopic than abdominal (odds ratio
scenarios (attack rate 20% or more, probability of [OR] 0.85, 95% confidence interval [CI] 0.77–0.94
preterm birth for women with influenza 12% or for age 45–49 years) or vaginal hysterectomy (OR
more, mortality for a preterm neonate 2% or more, 0.61, 95% CI 0.540.69 for age 45–49 years). The
and probability of influenza-attributable odds of laparoscopic compared with abdominal
hospitalization 4.8% or more), the postexposure hysterectomy were higher in the West than in the
prophylactic use of antiviral medications was Northeast (OR 1.77, 95% CI 1.2–2.62). African-
strongly cost-effective, with incremental cost- American, Latina, and Asian women had 40–50%
effectiveness ratio values below $50,000 per lower odds of laparoscopic compared with
quality-adjusted life-year. Antiviral prophylaxis abdominal hysterectomy (P<.001). Women with
became an economically dominant strategy (that low income, Medicare, Medicaid, or no health
is, less costly and more effective) when the insurance were less likely to undergo laparoscopic
influenza attack rate is 20% or more and preterm than either vaginal or abdominal hysterectomy
birth rate is 36% or more, and when attack rate is (P<.001). Women with leiomyomas (P<.001) and
30% or more and preterm birth rate is 24% or pelvic infections (P<.001) were less likely to
more. Antiviral prophylaxis was not cost-effective u n d e r g o l a p a r o s c o p i c t h a n a b d o m i n a l
under seasonal influenza conditions.
hysterectomy. Women with leiomyomas (P<.001),
endometriosis (P<.001), or pelvic infections (P<.
CONCLUSION: These findings support the use of 001) were more likely to have laparoscopic than
antiviral medications for postexposure prophylaxis vaginal hysterectomy. Laparoscopic hysterectomy
among pregnant women in a pandemic influenza had the highest mean hospital charges ($18,821,
scenario but not in a seasonal influenza setting.
P<.001) and shortest length of stay (1.65 days,
GYNECOLOGY
CONCLUSION: In addition to age and clinical
Nationwide Use of Laparoscopic Hysterectomy diagnosis, nonclinical factors such as race/ Compared With Abdominal and Vaginal
ethnicity, insurance status, income, and region
Approaches
appear to affect use of laparoscopic hysterectomy
compared with abdominal hysterectomy and
Jacoby, Vanessa L. MD, MAS; Autry, Amy MD; Jacobson, Gavin MD; Domush, Robert MD; Nakagawa, Sanae MA; Jacoby, Alison MD
THE HOUSTON GYNECOLOGICAL & OBSTETRICAL SOCIETY (HGOS)
CONCLUSION: The results of this study did not
show any advantage to the use of letrozole over
REPRODUCTIVE ENDOCRINOLOGY
clomiphene citrate as a first-line treatment for
Clomiphene citrate or letrozole for ovulation
induction of ovulation in women with PCOS. induction in women with polycystic ovarian syndrome: a prospective randomized trial Ahmed Badawy, Ibrahim Abdel Aal, Mohamed Abulatta Fertility and Sterility 2009;92:849-852 UPCOMING EVENTS:
OBJECTIVE: To compare the effects of letrozole
(5 mg) and clomiphene citrate (100 mg) for Updates in Urogynecology
ovulation induction in women with polycystic ovary November 5
treatment with 5 mg of letrozole daily (218
patients, 545 cycles) or 100 mg of clomiphene AMA Interim Meeting
citrate daily (220 patients, 518 cycles) for 5 days November 7-10
starting on day 3 of menses. Timed intercourse Houston, TX
was advised 24 to 36 hours after hCG injection. Contact: Terrie Gibson 202-863-2515
follicles, serum estradiol, serum progesterone,
endometrial thickness, and pregnancy and
American Board of Obstetrics and Gynecology
RESULTS: The mean age, parity, and duration of Dallas, TX
infertility in both groups were similar. The total Contact: Laurie Daniels 214-871-1619
number of follicles was statistically significantly
greater in the clomiphene citrate group (6.8 ± 0.3
versus 4.4 ± 0.4). Endometrial thickness at the TMA Winter Conference
time of hCG administration was statistically January 29-30, 2010
significantly greater in the CC group (9.2 ± 0.7 mm Austin, TX
versus 8.1 ± 0.2 mm). The duration to reach a Contact: 800-880-1300
dominant follicle was statistically significantly
longer in the letrozole group (12.1 ± 1.3 versus 8.8
± 2.9 days). Ovulation occurred in 365 out of 540 TAOG 81st Annual Meeting
cycles (67.5%) in letrozole group and 371 out of April 16-18, 2010
523 cycles (70.9%) without a statistically Moody Gardens Hotel, Galveston, TX
significant difference. Levels of serum estradiol Contact: Karen O’Briant 866-935-1959
and progesterone were statistically significantly
higher in the clomiphene citrate group. The
pregnancy rate per cycle was 15.1% in the
letrozole group and 17.9% in the clomiphene
citrate group without statistically difference
THE RENEWABLE DEAL, ASPECT TWO, PLANK 6: HEALTH Chapter 2 THE CAUSES OF THE UNITED STATES HEALTHCARE SYSTEM CRISIS Sixteen percent of the U.S. economy as of 2006 is consumed by health care costs; in 1960, 5.2percent of GDP went to pay for health care. From 1997 to 2003 U.S. health care spending wentfrom 13.1 percent to 15.3 percent of GDP. In March 2008 the Centers for Medicare andMedicai
Delaware Health Alert Network #174 April 27, 2009 6:21 pm Health Update SWINE INFLUENZA A (H1N1) UPDATE: DELAWARE SITUATION UPDATE The Delaware Division of Public Health provides the following situation e on the ongoing Swine Influenza investigation. The situation continues to evolve and additional information will be released as it becomes available.