Case Report: Treatment of Vaginal Venolymphatic Malformation With Sirolimus in a 2 Year Old Girl

Abstract

logistic regression was conducted to examine the odds of initiating the HPV vaccine series, after adjusting for age, race/ethnicity, insurance coverage, and belief that is acceptable for 16 year olds to have sex. Results: Among 235 sexually active US adolescent females surveyed, 62% initiated the HPV vaccine series after sexual debut. Compared with adolescent females who initiated the HPV vaccine series before sexual debut, those initiating the HPV vaccine series after sexual debut were significantly more likely to have a younger age at sexual debut (15 years old vs. ! 16 years old; P<.01) and visited a usual source of care in the last 12 months (93% vs.76%; P<.01); and less likely to have had formal education about sexually transmitted infections prior to sexual activity (49% vs. 98%; P<.01), to have had formal education on where to get birth control prior to sexual activity (68% vs. 95%; P¼.02), and to have had formal education on contraception prior to sexual activity (46% vs. 96%; P<.01). In multivariable analyses, older age (adjusted odds ratio [aOR], 1.7; 95% CI, 1.2-2.4) and believing that is was acceptable for 16 year-olds to have sex (aOR, 1.9; 95% CI, 1.1-3.1) were associated with almost double the odds of initiating the HPV vaccine series after sexual debut. Having public insurance was associated with over nine times the odds (aOR, 9.2; 95% CI, 1.5-55.4) of initiating the HPV vaccine series after sexual debut. American Indian, Asian-Pacific Islander, and multiracial race/ethnicity was associated with reduced odds (aOR, 0.1; 95% CI, 0.02-0.97) of initiating the HPV vaccine series after sexual debut. Conclusions: Almost two-thirds of sexually active US adolescent females initiated the HPV vaccine series after sexual debut. Adolescent females who are older, believe that it is acceptable for 16 year-olds to have sex, and are publicly insured have significantly higher odds of initiating the HPV vaccine series after sexual debut. The study findings suggest that targeting these at-risk populations for more focused HPV-vaccine education and counseling may prove useful in increasing the number of adolescent females who initiate the HPV vaccine series prior to sexual debut, and ultimately could reduce the number of HPV infections and future cervical cancer cases in the US.

Treatment of Lymphatic Malformations with the mTOR Inhibitor Sirolimus: A Systematic Review

“…Through these methods, 20 articles were identified, containing a total of 71 cases in which sirolimus was used to treat lymphatic malformations, venolymphatic malformations, and capillary-lymphatico-venous malformations. 8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] After identifying these articles, all text and figures were carefully assessed for relevant data. The following information on study characteristics and clinical treatments was extracted from all included studies: publication metrics (name of first author and year of publication), subject information (age, gender, and localization of malformation), and treatment information (sirolimus dose, planned target trough level, treatment duration, treatment outcomes, additional therapies, and adverse events).…”

“…Fourteen studies commented on adverse events associated with and probably being a result of sirolimus therapy. 8,12,15,16,18,20,21,23,24,[26][27][28][29][30] In three studies patients (n = 5) experienced no side effects. 15,23,28 In the other 11 studies different adverse effects were reported.…”

“…17 In six publications, the initial dose of sirolimus was not reported. 15,18,19,22,25,28 The target blood level of sirolimus was similar (£15 ng/mL), but slightly differed between the studies. The target blood level was 10-15 ng/mL in seven studies, 8,12,18,22,23,26,27 5-15 ng/mL in four studies, 21,24,29,30 10-13 ng/mL in one study, 16 and 4-8 ng/mL in one study.…”

“…8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Most studies were retrospective case series or case reports, and there was only one phase II trial. In all, 16 publications about 45 patients with lymphatic malformations were identified (Table 1), 8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] five publications about eight patients with venolymphatic malformations (Table 2), 12,21,[27][28][29] and four publications about 18 patients with capillary-lymphatico-venous malformations (Table 3). 8,12,29,30 All patients had extensive malformations, which were distributed about the w...…”

“…20 In seven studies, the authors did not mention the target blood level of sirolimus. [13][14][15]17,19,25,28 Not in all studies the planned target trough level for sirolimus was achieved. For example, Kim et al 27 reported a marked clinical response at a trough level for sirolimus of 3.5 ng/mL, which was below the planned target trough of 10-15 ng/mL.…”