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Sample records for comparing uterine fibroid

  1. Uterine Fibroids

    Science.gov (United States)

    ... permits the doctor to see fibroids inside the uterine cavity. Hysterosalpingography is a special X-ray test. It ... used to remove fibroids that protrude into the cavity of the uterus. A resectoscope is inserted through the hysteroscope. The ...

  2. Uterine Fibroid Embolization (UFE)

    Science.gov (United States)

    ... embolization. This occurs when fibroids located inside the uterine cavity detach after embolization. Women with this problem may require a procedure called D & C (dilatation and curettage) to ... who undergo uterine fibroid embolization, normal menstrual cycles resume after the ...

  3. Uterine Fibroids Fact Sheet

    Science.gov (United States)

    ... uterus through the vagina, instead of making a cut in the abdomen. In some cases hysterectomy can ... into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. UFE can be an outpatient ... warning on power morcellators in treatment for uterine fibroids If your ...

  4. Infertility and uterine fibroids.

    Science.gov (United States)

    Zepiridis, Leonidas I; Grimbizis, Grigoris F; Tarlatzis, Basil C

    2016-07-01

    Uterine fibroids are the most common tumors in women and their prevalence is higher in patients with infertility. At present, they are classified according to their anatomical location, as no classification system includes additional parameters such as their size or number. There is a general agreement that submucosal fibroids negatively affect fertility, when compared to women without fibroids. Intramural fibroids above a certain size (>4 cm), even without cavity distortion, may also negatively influence fertility. However, the presence of subserosal myomas has little or no effect on fertility. Many possible theories have been proposed to explain how fibroids impair fertility: mechanisms involving alteration of local anatomical location, others involving functional changes of the myometrium and endometrium, and finally endocrine and paracrine molecular mechanisms. Nevertheless, any of the above mentioned mechanisms can cause reduced reproductive potential, thereby leading to impaired gamete transport, reduced ability for embryo implantation, and creation of a hostile environment. The published experience defines the best practice strategy, as not many large, well-designed, and properly powered studies are available. Myomectomy appears to have an effect in fertility improvement in certain cases. Excision of submucosal myomas seems to restore fertility with pregnancy rates after surgery similar to normal controls. Removal of intramural myomas affecting pregnancy outcome seems to be associated with higher pregnancy rates when compared to non-operated controls, although evidence is still nοt sufficient. Treatment of subserosal myomas of reasonable size is not necessary for fertility reasons. The results of endoscopic and open myomectomy are similar; thus, endoscopic treatment is the recommended approach due to its advantages in patient's postoperative course.

  5. Uterine artery embolization to treat uterine fibroids

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    Machan, L.; Martin, M. [Univ. of British Columbia Hospital, Dept. of Radiology, Vancouver, BC (Canada)

    2001-06-01

    The first reported application of uterine artery embolization, in 1979, was to treat life-threatening hemorrhage after a failed hysterectomy. Since then, uterine artery embolization has been used very successfully to control acute or delayed post-partum hemorrhage, post-surgical hemorrhage and hemorrhage from ectopic pregnancy, to treat uterine arteriovenous malformations and as prophylaxis before high-risk surgery, such as cesarean delivery in women with placenta previa. In contrast to these proven but underutilized applications, uterine embolization for fibroids has, in a short time, achieved significant notice in the lay press and is being widely offered. Ravina and colleagues, first reported uterine fibroid shrinkage after embolization for the treatment of acute bleeding. Since then, his group has performed over 100 procedures with up to a 6-year follow-up. The cumulative clinical success rate for the treatment of abnormal uterine bleeding due to fibroids is reported to be approximately 85% and for treatment of pain or pressure symptoms, about 75%. Six-month follow-up sonography reveals an average reduction of fibroid size of approximately 40%. However, to date, no studies have compared patients who undergo embolization with a nontreatment cohort or with surgical intervention. (author)

  6. [Electrotherapy and uterine fibroids].

    Science.gov (United States)

    Deroover, J

    2009-01-01

    At the end of the 19th century, uterine fibroids cause huge therapeutic issues: on the one hand they can reach an impressive massive volume; on the other hand they provoke endless haemorrhages. Dr Apostoli develops galvanotherapy which becomes the reference in French and international medicine before its rapid downfall as gynaecological surgery makes great progress at the beginning of the 20th Century.

  7. Uterine fibroid: a review.

    Science.gov (United States)

    Akinyemi, B O; Adewoye, B R; Fakoya, T A

    2004-01-01

    Uterine fibroid is a benign tumour of uterine smooth muscle. The purpose of this review is to bring to light the current spectra of presentation and management status of this benign and very important cause of menstrual and fertility disturbance in African women and the Black race in general. This is especially so with the trivialization of its aetological factors and treatment by claims from alternative medical practitioners. This review, therefore sought to document what is currently known about the condition and what could possibly be done to achieve better results in its management. Literature on the subject above was reviewed using manual library search, electronic books such as CD-ROMS and journals articles published by various local and international authors on the subject; it also included internet search on relevant aspects of the topic. Fibroid is the commonest benign tumour of the female genital tract, it contributes about 70 to 80% of new growths in the female genital tracts, it is a cause of significant morbidity in women of reproductive age group and when complicated could be a significant cause of mortality. Spectrum of presentation mainly involves disturbance of menstruation, reduction in fertility, pressure and obstructive symptoms and rarely malignant presentations. When recognized early effective conservative and definitive therapies are available to offer relief for women and to make their menstrual and reproductive life more meaningful. From the literature reviewed, it was obvious that the subject of uterine fibroid is still not fully exhausted and there were a lot of research questions waiting to be answered on the aetiopathogenesis of the disease. There is also the need to fashion out better treatment alternatives that will reduce morbidity in the process of managing the patient as well as those that will further enhance reproductive potentials after treatment.

  8. Uterine fibroids: clinical manifestations and contemporary management.

    Science.gov (United States)

    Doherty, Leo; Mutlu, Levent; Sinclair, Donna; Taylor, Hugh

    2014-09-01

    Uterine fibroids (leiomyomata) are extremely common lesions that are associated with detrimental effects including infertility and abnormal uterine bleeding. Fibroids cause molecular changes at the level of endometrium. Abnormal regulation of growth factors and cytokines in fibroid cells may contribute to negative endometrial effects. Understanding of fibroid biology has greatly increased over the last decade. Although the current armamentarium of Food and Drug Administration-approved medical therapies is limited, there are medications approved for use in heavy menstrual bleeding that can be used for the medical management of fibroids. Emergence of the role of growth factors in pathophysiology of fibroids has led researchers to develop novel therapeutics. Despite advances in medical therapies, surgical management remains a mainstay of fibroid treatment. Destruction of fibroids by interventional radiological procedures provides other effective treatments. Further experimental studies and clinical trials are required to determine which therapies will provide the greatest benefits to patients with fibroids.

  9. Alterations in uterine hemodynamics caused by uterine fibroids and their impact on in vitro fertilization outcomes.

    Science.gov (United States)

    Moon, Jei-Won; Kim, Chung-Hoon; Kim, Jun-Bum; Kim, Sung-Hoon; Chae, Hee-Dong; Kang, Byung-Moon

    2015-12-01

    To investigate the impact of fibroids on the blood flow of the uterine and subendometrial arteries and in vitro fertilization (IVF) outcomes. In this study, we analyzed 86 IVF/intracytoplasmic sperm injection (ICSI) cycles in which a gonadotropin-releasing hormone antagonist protocol was used for controlled ovarian stimulation between January 2008 and March 2009. The subjects comprised 86 infertile women with (fibroid group, n=43) or without (control group, n=43) uterine fibroids. Patient characteristics were similar between the fibroid and control groups. The IVF/ICSI outcomes in patients with fibroids were similar to those of patients in the control group. The resistance index (RI) and pulsatile index (PI) of the uterine and subendometrial arteries on the day of embryo transfer were also comparable between the two groups. IVF outcomes and uterine hemodynamics in patients with multiple (≥2) fibroids were similar to those of patients with a single fibroid. However, clinical pregnancy and implantation rates were significantly lower in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05). The RI and PI of the subendometrial artery were significantly higher on the day of embryo transfer in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05). Fibroids which distorting the uterine cavity might impair the subendometrial artery blood flow clinical pregnancy rate and embryo implantation rate in infertile patients undergoing IVF. Otherwise, IVF outcomes were not influenced by the presence of uterine fibroids.

  10. Uterine Fibroid Embolization (UFE)

    Science.gov (United States)

    ... resembling coarse sand Gelfoam™, a gelatin sponge material microspheres, polyacrylamide spheres with a gelatin coating All of ... who wishes to have more children consider surgical removal of the individual tumors rather than undergo uterine ...

  11. Induced and Spontaneous Abortion and Risk of Uterine Fibroids.

    Science.gov (United States)

    Song, Lulu; Shen, Lijun; Mandiwa, Chrispin; Yang, Siyi; Liang, Yuan; Yuan, Jing; Wang, Youjie

    2017-01-01

    The relationship between abortion and uterine fibroids has received little attention. The aim of the present study was to explore the association between number of induced and spontaneous abortions and the risk of uterine fibroids in middle-aged and older Chinese women. A total of 14,595 retired female employees from the Dongfeng-Tongji cohort study were included in our analysis. Information on induced and spontaneous abortions was collected by trained interviewers through face-to-face interviews. Diagnosis of uterine fibroids was based on ultrasound or self-reported physician diagnosis of uterine fibroids. Logistic regression models were used to explore the associations between number of induced and spontaneous abortions and the risk of uterine fibroids. The prevalence of uterine fibroids was 15.1% among all participants. Higher number of induced abortions was associated with an increased risk of uterine fibroids (1 induced abortion: odds ratios [ORs] = 1.32, 95% confidence interval [CI] 1.18-1.48; 2 induced abortions: OR = 1.45, 95% CI 1.28-1.64; and ≥3 induced abortions: OR = 1.62, 95% CI 1.39-1.90). Compared with women without induced abortion, ORs for women with 1, 2, and ≥3 were 1.17 (95% CI 1.03-1.32), 1.21 (95% CI 1.06-1.39), and 1.36 (95% CI 1.15-1.61), respectively, after adjustment for potential confounders. No association was observed between the number of spontaneous abortions and the risk of uterine fibroids. The findings of this study showed that induced abortion may be an independent risk factor for uterine fibroids in middle-aged and older Chinese women.

  12. Diffusion-weighted imaging properties of uterine fibroids pre- and post-uterine fibroid embolisation

    Energy Technology Data Exchange (ETDEWEB)

    Kirpalani, Anish, E-mail: kirpalania@smh.ca [Department of Medical Imaging, University of Toronto, St. Michael’s Hospital, 30 Bond Street, 3CC, Toronto, ON M5B 1W8 (Canada); Chong, Jennifer [Department of Medical Imaging, University of Toronto, St. Michael’s Hospital, 30 Bond Street, 3CC, Toronto, ON M5B 1W8 (Canada); Yang, Natalie [Department of Radiology, Austin Health, Heidelberg, Victoria 3084 (Australia); Jenkins, Sarah J. [Department of Radiology, Memorial University of Newfoundland, St. John’s, NL A1B 3V6 (Canada); Nisenbaum, Rosane [Centre for Research on Inner City Health, the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8 (Canada); Prabhudesai, Vikramaditya; Anthwal, Shalini; Colak, Errol [Department of Medical Imaging, University of Toronto, St. Michael’s Hospital, 30 Bond Street, 3CC, Toronto, ON M5B 1W8 (Canada)

    2014-09-15

    Highlights: • Change in ADC and contrast enhancement of uterine fibroids following UFE was studied. • ADC of fibroids rises post-UFE. Previous studies assessing this change have conflicting results. • ADC rise post-UFE is associated with degree of loss of contrast enhancement. • ADC measurement using DWI is not yet a proven replacement for GBCA-enhanced MRI. - Abstract: Objective: To determine the change in apparent diffusion coefficient (ADC) of uterine fibroids following uterine fibroid embolisation (UFE), and if the ADC change correlates with either volume loss or degree of contrast enhancement post-UFE. Materials and methods: This study was approved by our institutional review board with waiver of consent. The pelvic MRI examinations, including diffusion-weighted MRI (DWI) using 4 b-values, of 50 consecutive patients prior to and 6 months post-UFE were analyzed. The volume, ADC and amount of enhancement were calculated for each fibroid both pre- and post-UFE. The percent residual enhancement for each fibroid was categorized as either: no (0–1%) residual enhancement or residual (>1%) enhancement. Statistical analysis compared ADC, enhancement and volume for each fibroid pre- and post-UFE using paired t-tests and Pearson correlation coefficients. Results: The mean ADC of all (n = 88) fibroids pre-UFE was 1.30 ± 0.20 × 10{sup −3} mm{sup 2}/s, and increased to 1.68 ± 0.24 × 10{sup −3} mm{sup 2}/s post-UFE (p < 0.0001). Lower pre-UFE ADC correlated with greater ADC change post-UFE (r = −0.50; p < 0.0001). There was no correlation between ADC change and volume change post-UFE (r = 0.07; p = 0.59). However, fibroids with no residual enhancement post-UFE had larger ADC change than those with residual enhancement (p = 0.003). Conclusion: The ADC of fibroids rises post-UFE. ADC change post-UFE is associated with the degree of loss of enhancement and may therefore be valuable in predicting response to treatment in pre-procedural counseling.

  13. Dealing with uterine fibroids in reproductive medicine.

    Science.gov (United States)

    Gambadauro, P

    2012-04-01

    Women who wish to conceive are nowadays more likely to present with uterine fibroids, mainly because of the delay in childbearing in our society. The relationship between uterine fibroids and human reproduction is still controversial and counselling patients might sometimes be challenging. This paper is to assist those involved in the management of patients of reproductive age presenting with uterine fibroids. The interference of fibroids on fertility largely depends on their location. Submucous fibroids interfere with fertility and should be removed in infertile patients, regardless of the size or the presence of symptoms. Intramural fibroids distorting the cavity reduce the chances of conception, while investigations on intramural fibroids not distorting the cavity have so far given controversial results. No evidence supports the systematic removal of subserosal fibroids in asymptomatic, infertile patients. Myomectomy is still the 'gold standard' in fibroid treatment for fertility-wishing patients. In experienced hands, hysteroscopic myomectomy is minimally invasive, safe, and effective. Abdominal and laparoscopic myomectomy might be challenging, but potential risks could be reduced by new strategies and techniques.

  14. Successful Pregnancy after Treatment with Ulipristal Acetate for Uterine Fibroids

    OpenAIRE

    Javier Monleón; Alicia Martínez-Varea; Daniela Galliano; Antonio Pellicer

    2014-01-01

    This case report presents a clinical pregnancy after ulipristal acetate (UA) to decrease uterine fibroid size. A 37-year-old patient, gravida 1, abortus 1, with uterine fibroids was treated with 5 mg of UA daily for 13 weeks starting eight months after a multiple laparotomic myomectomy. Fibroid shrinkage and restoration of the morphology of endometrial cavity were evaluated in order to allow a subsequent pregnancy. A decrease of the uterine fibroids and a normal morphology of the endometrial ...

  15. Association of intakes of fat, dietary fibre, soya isoflavones and alcohol with uterine fibroids in Japanese women.

    Science.gov (United States)

    Nagata, Chisato; Nakamura, Kozue; Oba, Shino; Hayashi, Makoto; Takeda, Noriyuki; Yasuda, Keigo

    2009-05-01

    Certain dietary components which could affect oestrogen may have implications in the aetiology of uterine fibroids. We previously found that soya intake was inversely associated with a subsequent risk of hysterectomy, suggesting a potentially protective effect of soya against uterine fibroids, the major clinical indication for hysterectomy. We cross-sectionally assessed the associations of intakes of fat, soya foods, dietary fibre and alcohol with uterine fibroids. Study subjects were 285 premenopausal Japanese women participating in a health-check up programme, including gynaecological examinations, provided by a general hospital between October 2003 and March 2006. The presence of fibroids was confirmed by transvaginal sonogram. If women had undergone hysterectomy, self-report of fibroids was accepted. Each subject's usual diet, including alcohol, was determined with the use of a validated FFQ. Fifty-four women were identified as prevalent cases of fibroids or having had hysterectomy due to fibroids. The mean alcohol intake was statistically significantly higher among women with fibroids than among those without fibroids after controlling for known or suspected risk factors. For the highest compared with the lowest tertile of alcohol intake, the OR of uterine fibroids was 2.78 (95% CI 1.25, 6.20). There was no significant association of intake of fats, soya isoflavones or dietary fibre with uterine fibroids. The data suggest that higher alcohol intake is associated with a higher prevalence of uterine fibroids. Further studies on diet, especially phyto-oestrogens, and uterine fibroids are needed given the limited data currently available.

  16. Uterine fibroid tumors: diagnosis and treatment.

    Science.gov (United States)

    Evans, Patricia; Brunsell, Susan

    2007-05-15

    The incidence of uterine fibroid tumors increases as women grow older, and they may occur in more than 30 percent of women 40 to 60 years of age. Risk factors include nulliparity, obesity, family history, black race, and hypertension. Many tumors are asymptomatic and may be diagnosed incidentally. Although a causal relationship has not been established, fibroid tumors are associated with menorrhagia, pelvic pain, pelvic or urinary obstructive symptoms, infertility, and pregnancy loss. Transvaginal ultrasonography, magnetic resonance imaging, sonohysterography, and hysteroscopy are available to evaluate the size and position of tumors. Ultrasonography should be used initially because it is the least invasive and most cost-effective investigation. Treatment options include hysterectomy, myomectomy, uterine artery embolization, myolysis, and medical therapy. Treatment must be individualized based on such considerations as the presence and severity of symptoms, the patient's desire for definitive treatment, the desire to preserve childbearing capacity, the importance of uterine preservation, infertility related to uterine cavity distortions, and previous pregnancy complications related to fibroid tumors.

  17. Leiomyosarcoma: a rare complication of uterine fibroid

    Directory of Open Access Journals (Sweden)

    Shazia Parveen

    2014-04-01

    Full Text Available Uterine sarcomas are rare tumours of mesodermal origin. Malignant change occurring in uterine fibroid is termed as leiomyosarcoma. They constitute around 2-6 % uterine malignancies and 25-36% of uterine sarcomas1. The tumour is common in women between the age group 40-50 years. It has an aggressive course and usually metastasis goes to the lungs. The prognosis for women with uterine sarcoma primarily depends on the extent of disease at the time of diagnosis and mitotic index3. Women with tumor size >5 cm in maximum diameter have poor prognosis. These tumours should be diagnosed and managed with no delay and must be followed vigilantly as the rate of recurrence and metastasis is very high. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 486-487

  18. Comparison of Sexual Dysfunction Using the Female Sexual Function Index following Surgical Treatments for Uterine Fibroids

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    Allison Ryann Louie

    2012-01-01

    Full Text Available Uterine fibroids are a common problem in women. Statistics showing 20–50% of fibroids produce symptoms and consequently patients seek surgical intervention to improve their quality of life. Treatments for fibroids are typically successful in controlling the fibroid disease, yet sexual function following invasive surgical treatments for fibroids can be jeopardized. The Sexual Function Index (FSFI is a valid instrument producing quantifiable reproducible results. In this paper three case reports are evaluated by the FSFI and compared between the following treatment groups: hysterectomy, myomectomy, and uterine embolization. Our goal is to illustrate how each of these treatment outcomes can result in sexual dysfunction and therefore decreased quality of life. Effects of invasive fibroid treatments on sexual functioning would be helpful in guiding patient’s ultimate decisions regarding treatment.

  19. Uterine Fibroids: Pathogenesis and Interactions with Endometrium and Endomyometrial Junction

    Directory of Open Access Journals (Sweden)

    Andrea Ciavattini

    2013-01-01

    Full Text Available Uterine leiomyomas (fibroids or myomas are benign tumors of uterus and clinically apparent in a large part of reproductive aged women. Clinically, they present with a variety of symptoms: excessive menstrual bleeding, dysmenorrhoea and intermenstrual bleeding, chronic pelvic pain, and pressure symptoms such as a sensation of bloatedness, increased urinary frequency, and bowel disturbance. In addition, they may compromise reproductive functions, possibly contributing to subfertility, early pregnancy loss, and later pregnancy complications. Despite the prevalence of this condition, myoma research is underfunded compared to other nonmalignant diseases. To date, several pathogenetic factors such as genetics, microRNA, steroids, growth factors, cytokines, chemokines, and extracellular matrix components have been implicated in the development and growth of leiomyoma. This paper summarizes the available literature regarding the ultimate relative knowledge on pathogenesis of uterine fibroids and their interactions with endometrium and subendometrial myometrium.

  20. Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility.

    Science.gov (United States)

    Styer, Aaron K; Jin, Susan; Liu, Dan; Wang, Baisong; Polotsky, Alex J; Christianson, Mindy S; Vitek, Wendy; Engmann, Lawrence; Hansen, Karl; Wild, Robert; Legro, Richard S; Coutifaris, Christos; Alvero, Ruben; Robinson, Randal D; Casson, Peter; Christman, Gregory M; Christy, Alicia; Diamond, Michael P; Eisenberg, Esther; Zhang, Heping; Santoro, Nanette

    2017-03-01

    To investigate the association of non-cavity-distorting uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination (OS-IUI) in couples with unexplained infertility. Secondary analysis from a prospective, randomized, multicenter clinical trial investigating fertility outcomes after OS-IUI. Reproductive Medicine Network clinical sites. Nine hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial. Participants were randomized to one of three arms (clomiphene citrate, letrozole, or gonadotropins), and treatment was continued for up to four cycles or until pregnancy was achieved. Conception (serum hCG increase), clinical pregnancy (fetal cardiac activity), and live birth rates. A total of 102/900 participants (11.3%) had at least one documented fibroid and a normal uterine cavity. Women with fibroids were older, more likely to be African American, had a greater uterine volume, lower serum antimüllerian hormone levels, and fewer antral follicles than women without fibroids. In conception cycles, clinical pregnancy rates were significantly lower in participants with fibroids than in those without uterine fibroids. Pregnancy loss before 12 weeks was more likely in African American women with fibroids compared with non-African American women with fibroids. There was no difference in conception and live birth rates in subjects with and without fibroids. No differences were observed in conception and live birth rates in women with non-cavity-distorting fibroids and those without fibroids. These findings provide reassurance that pregnancy success is not impacted in couples with non-cavity-distorting fibroids undergoing OS-IUI for unexplained infertility. NCT01044862. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Knowledge of, Perception of, and Attitude towards Uterine Fibroids among Women with Fibroids in Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    M. A. Adegbesan-Omilabu

    2014-01-01

    Full Text Available Objectives. The study was to assess the level of knowledge of, perception of, and attitude towards uterine fibroids among women diagnosed with the condition. Methods. It is a cross-sectional descriptive study carried out among women diagnosed as having uterine fibroids in two gynaecological clinics in Lagos, Nigeria. Eligible women were recruited and a structured interviewer-administered questionnaire was used to collect the required information. Statistical analysis of data was done using EPI Info 2008. Results. Knowledge of fibroids was reported in 98.6% of the respondents and the information on uterine fibroids was obtained from radio, parents/relatives, health workers, and television in 29%, 27.3%, 18.7%, and 18.3%, respectively, by the respondents. Most of the women believed that being black, being nulliparous, or having positive family history predisposes women to having uterine fibroids. Up to 69.0% of the respondents believed that fibroid is a spiritual problem and many thought it requires spiritual healing. Fear of complications of surgery keeps most sufferers away from the hospital until fibroids become advanced or associated with complications. Conclusion. Awareness of uterine fibroids is high, but correct knowledge on aetiology and proper treatment is low. Intensive enlightenment of the populace using the mass media by trained personnel is recommended.

  2. Mechanistic Study of the Inhibitory Effect of Kaempferol on Uterine Fibroids In Vitro.

    Science.gov (United States)

    Li, Yanxia; Ding, Zhaoxia; Wu, Chuanzhong

    2016-12-08

    BACKGROUND This study examined the effect of kaempferol on uterine fibroids in vitro and the underlying mechanism, and investigated the potential of kaempferol as a clinical drug for the treatment of uterine fibroids. MATERIAL AND METHODS Uterine fibroid tissue and surrounding smooth muscle tissue were collected for primary culture. Different concentrations of kaempferol (12 μM, 24 μM, and 48 μM) were used to treat the cells for 24, 48, and 72 hours. Ethanol was used in the control group. A CCK-8 colorimetric assay was used to detect cell proliferation. Real-time PCR and immunoblot were used to detect estrogen receptor (ER), insulin-like growth factor-1 (IGF-1), and vascular endothelial growth factor (VEGF) levels in mRNA and protein. RESULTS The differences in proliferation at different time points and concentrations of kaempferol were statistically significant. The inhibitory effect of kaempferol on mRNA levels of ER and IGF, and protein levels of ER, VEGF, and IGF-1 were positively correlated with kaempferol concentration. Changes in kaempferol concentration showed no effect on VEGF mRNA expression. Treatment with kaempferol significantly lowered myocardin levels in uterine fibroid tissue compared to normal uterine smooth muscle (PKaempferol might be used for clinical treatment of uterine fibroids due to its inhibitory effect on the proliferation of uterine fibroids cells.

  3. A retrospective comparison of microwave ablation and high intensity focused ultrasound for treating symptomatic uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Wen-Peng, E-mail: zwp215@163.com; Han, Zhi-Yu, E-mail: hanzhiyu301@hotmail.com; Zhang, Jing, E-mail: zjbch@sina.com; Liang, Ping, E-mail: liangping301@hotmail.com

    2015-03-15

    Highlights: •Both HIFU and PMWA are thermal ablation techniques and they all provide safe and reliable alternative treatment methods for uterine fibroids. •However, whether there are obvious difference between these two kinds of approaches in improving symptom, treatment time, ablation rate, regression rate and adverse events, until now, there are no clinical trials which have been performed to compare the therapeutic effects of HIFU and PMWA. •In this research, we retrospectively compare the results of these two treatment methods. •To our knowledge, our study is the first directly comparing long-term outcome after PMWA and HIFU in patients with uterine fibroids. -- Abstract: Objectives: To retrospectively compare the effectiveness and safety of percutaneous microwave ablation (PMWA) and ultrasound-guided high-intensity focused ultrasound (USgHIFU) for treating symptomatic uterine fibroids. Methods: Seventy-three women with symptomatic uterine fibroids who met the inclusion criteria were enrolled in our study from September 2012 to December 2013. Thirty-one patients with forty uterine fibroids underwent PMWA, and forty-two patients with fifty-one uterine fibroids underwent USgHIFU. A contrast-enhanced MRI was performed before and after treatment, and all patients were followed up for 6 months. Assessment endpoints included symptom severity scores (SSS), treatment time, ablation rate, fibroid regression rate and adverse events. Results: The mean age of the patients in our study was 35.4 ± 6.2 years (range, 21–49 years), and the median volume of uterine fibroids was 95.7 cm{sup 3} (60.3–131.5 cm{sup 3}). The ablation rate of uterine fibroids was 79.8 ± 18.2% and 77.1 ± 14.9% in the PMWA group and the USgHIFU group, respectively, and showed no significant difference between the groups. Changes in SSS after PMWA were similar in the PMWA group (47.7 pre-treatment vs. 29.9 post-treatment) and USgHIFU group (42.1 pre-treatment vs. 24.6 post-treatment). The

  4. Distinct expression profile in fumarate-hydratase-deficient uterine fibroids

    DEFF Research Database (Denmark)

    Vanharanta, S; Pollard, PJ; Lehtonen, HJ

    2006-01-01

    Defects in mitochondrial enzymes predispose to severe developmental defects as well as tumorigenesis. Heterozygous germline mutations in the nuclear gene encoding fumarate hydratase (FH), an enzyme catalyzing the hydration of fumarate in the Krebs tricarboxylic acid cycle, cause hereditary...... leiomyomatosis and renal cell cancer; yet the connection between disruption of mitochondrial metabolic pathways and neoplasia remains to be discovered. We have used an expression microarray approach for studying differences in global gene expression pattern caused by mutations in FH. Seven uterine fibroids...... carrying FH mutations were compared with 15 fibroids with wild-type FH. The two groups showed markedly different expression profiles, and multiple differentially expressed genes were detected. The most significant increase in FH mutants was seen in the expression of carbohydrate metabolism- and glycolysis...

  5. Use of Chinese Medicine and Subsequent Surgery in Women with Uterine Fibroid: A Retrospective Cohort Study

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    Shan-Yu Su

    2012-01-01

    Full Text Available Background. Chinese medicine (CM has been used to relieve symptoms relevant to uterine fibroids. Objective. This study investigated the association between the use of CM and the incidence of uterine surgery in women with uterine fibroids. Subjects and Methods. This retrospective cohort study extracted records for 16,690 subjects diagnosed with a uterine fibroid between 2000 and 2003 from the National Health Insurance reimbursement database. The risk factors for surgery were examined via Cox proportional hazard analysis, and the difference in incidence of surgery between CM users and nonusers was compared using incidence rate ratios (IRRs derived from Poisson's models. Results. After an average follow-up period of 4.5 years, the cumulative incidence of uterine surgery was significantly lower in CM users than CM nonusers (P<0.0001. Compared to CM nonusers, CM users were more unlikely to undergo uterine surgery (adjusted hazard ratio = 0.18, 95% confidence interval (CI = 0.17, 0.19. The incidence of surgery in CM users was dramatically different from that for CM nonusers (IRR = 0.17, 95% CI = 0.16, 0.18. Conclusion. The risk of uterine surgery among fibroid patients who used CM was significantly decreased, implying an effective treatment of fibroid-related symptoms provided by CM.

  6. Radiofrequency Ablation for Treatment of Symptomatic Uterine Fibroids

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    Siân Jones

    2012-01-01

    Full Text Available The use of thermal energy-based systems to treat uterine fibroids has resulted in a plethora of devices that are less invasive and potentially as effective in reducing symptoms as traditional options such as myomectomy. Most thermal ablation devices involve hyperthermia (heating of tissue, which entails the conversion of an external electromagnetic or ultrasound waves into intracellular mechanical energy, generating heat. What has emerged from two decades of peer-reviewed research is the concept that hyperthermic fibroid ablation, regardless of the thermal energy source, can create large areas of necrosis within fibroids resulting in reductions in fibroid volume, associated symptoms and the need for reintervention. When a greater percentage of a fibroid's volume is ablated, symptomatic relief is more pronounced, quality of life increases, and it is more likely that such improvements will be durable. We review radiofrequency ablation (RFA, one modality of hyperthermic fibroid ablation.

  7. Successful Pregnancy after Treatment with Ulipristal Acetate for Uterine Fibroids

    Directory of Open Access Journals (Sweden)

    Javier Monleón

    2014-01-01

    Full Text Available This case report presents a clinical pregnancy after ulipristal acetate (UA to decrease uterine fibroid size. A 37-year-old patient, gravida 1, abortus 1, with uterine fibroids was treated with 5 mg of UA daily for 13 weeks starting eight months after a multiple laparotomic myomectomy. Fibroid shrinkage and restoration of the morphology of endometrial cavity were evaluated in order to allow a subsequent pregnancy. A decrease of the uterine fibroids and a normal morphology of the endometrial cavity were noted by transvaginal ultrasound after treatment. An endometrial biopsy excluded histologic endometrial changes. Three months after the end of UA the patient reported amenorrhea for 5 weeks and a clinical pregnancy was confirmed with transvaginal ultrasound. She underwent a subsequent uneventful pregnancy. Thus, the spontaneous pregnancy after UA to reduce fibroid size may support the potential clinical utility of this selective progesterone receptor modulator in the management of women with pregnancy desire and uterine fibroids after a prior myomectomy. Patients who refuse a new surgical procedure and/or those who are going to undergo assisted reproductive techniques would benefit from UA. It effectively shrinks fibroids, avoids risks of a new surgical procedure, and allows an immediate attempt at conception after the end of treatment.

  8. Successful pregnancy after treatment with ulipristal acetate for uterine fibroids.

    Science.gov (United States)

    Monleón, Javier; Martínez-Varea, Alicia; Galliano, Daniela; Pellicer, Antonio

    2014-01-01

    This case report presents a clinical pregnancy after ulipristal acetate (UA) to decrease uterine fibroid size. A 37-year-old patient, gravida 1, abortus 1, with uterine fibroids was treated with 5 mg of UA daily for 13 weeks starting eight months after a multiple laparotomic myomectomy. Fibroid shrinkage and restoration of the morphology of endometrial cavity were evaluated in order to allow a subsequent pregnancy. A decrease of the uterine fibroids and a normal morphology of the endometrial cavity were noted by transvaginal ultrasound after treatment. An endometrial biopsy excluded histologic endometrial changes. Three months after the end of UA the patient reported amenorrhea for 5 weeks and a clinical pregnancy was confirmed with transvaginal ultrasound. She underwent a subsequent uneventful pregnancy. Thus, the spontaneous pregnancy after UA to reduce fibroid size may support the potential clinical utility of this selective progesterone receptor modulator in the management of women with pregnancy desire and uterine fibroids after a prior myomectomy. Patients who refuse a new surgical procedure and/or those who are going to undergo assisted reproductive techniques would benefit from UA. It effectively shrinks fibroids, avoids risks of a new surgical procedure, and allows an immediate attempt at conception after the end of treatment.

  9. Comparing the Use of Uterine Artery Embolization to Gonadotropin-Releasing Hormone Agonists in Shrinking Fibroid Size: A Pilot Study in Kazakhstan

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    Balkenzhe Imankulova

    2015-09-01

    Full Text Available Introduction: Uterine fibroids are the most common benign tumor in women in Kazakhstan. In the past two decades, endoscopic surgery has played an important role in the development of gynecologic surgery, particularly in the treatment of uterine fibroids. The goal of this paper is to evaluate whether uterine artery embolization (UAE or gonadotropin-releasing hormone agonists (GnRHa prior to myomectomy was more effective in decreasing fibroid size and improving surgical outcomes in a pilot study of women in Kazakhstan.Methods: This pilot investigation included 24 patients separated into 2 groups: medication group (pre-treatment with GnRHa – 13 patients and embolization group (pre-treatment with UAE – 11 patients. All patients had uterine fibroids, 3-10 cm in diameter, and were treated with myomectomy at the National Research Center for Maternal and Child Health, Astana, Kazakhstan. All patient data were obtained by a retrospective medical records review. Descriptive statistics were utilized to characterize participant demographics data. Independent t-tests were used to analyze continuous variables, and Chi-square and Fisher’s exact tests were used where appropriate for count data.Results: The group treated with GnRHa had an operating time of 40±10 minutes longer than the group treated with UAE, due to the peri-operative difficulties encountered by surgeons in detecting the layer between the myometrium and fibroid capsule. The group treated with UAE experienced better patient outcomes (less blood loss, less surgical time, and reduced use of anesthesia and was a technically easier surgery due to visible differences in uterine layers.Conclusions: Despite the fact that both treatments (GnRHa and UAE were effective for fibroid shrinking, embolization resulted in more optimal surgical time and improved patient outcomes. Results of this pilot study need to be confirmed in a randomized clinical trial, specifically focused on Kazakhstan and the

  10. Uterine Fibroid Embolization for Symptomatic Fibroids: Study at a Teaching Hospital in Kenya

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    John Kiprop Mutai

    2015-01-01

    Full Text Available Objective: Characterization of magnetic (MRI features in women undergoing uterine fibroid embolization (UFE and identification of clinical correlates in an African population. Materials and Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed the study population. The baseline MRI features, baseline symptom score, short-term imaging outcome, and mid-term symptom scores were analyzed for interval changes. Assessment of potential associations between short-term imaging features and mid-term symptom scores was also done. Results: UFE resulted in statistically significant reduction (P < 0.001 of dominant fibroid, uterine volumes, and reduction of symptom severity scores, which were 43.7%, 40.1%, and 37.8%, respectively. Also, 59% of respondents had more than 10 fibroids. The predominant location of the dominant fibroid was intramural. No statistically significant association was found between clinical and radiological outcome. Conclusion: The response of uterine fibroids to embolization in the African population is not different from the findings reported in other studies from the west. The presence of multiple and large fibroids in this study is consistent with the case mix described in other studies of African-American populations. Patient counseling should emphasize the independence of volume reduction and symptom improvement. Though volume changes are of relevance for the radiologist in understanding the evolution of the condition and identifying potential technical treatment failures, it should not be the main basis of evaluation of treatment success.

  11. Expulsion of dominant submucosal fibroids after uterine artery embolization

    Energy Technology Data Exchange (ETDEWEB)

    Radeleff, Boris, E-mail: Boris_radeleff@med.uni-heidelberg.d [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Eiers, Michael; Bellemann, Nadine; Ramsauer, Stefanie [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Rimbach, Stefan [Department of Gynecology, University of Konstanz (Germany); Kauczor, Hans-Ulrich [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Richter, Goetz M. [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Clinic of Diagnostic and Interventional Radiology, Katharinenhospital, Stuttgart (Germany)

    2010-07-15

    Purpose: Purpose of this study was to evaluate the frequency, probability, and factors associated with expulsion of submucosal fibroids after uterine artery embolization (UAE) in addition to the technical and clinical results at 1-year follow-up. Materials and methods: We determined the preinterventional volume of each dominant submucosal fibroid using the commonly used ellipsoid formula and a 3D volumetry in the MRI to define a threshold value in milliliters that indicates the probability for a fibroid expulsion. Assessment of fibroid expulsion was done by MRI at 3-month intervals for a year. Assessment of clinical mid term success was achieved by applying questionnaires at 1-year follow-up. Results: Technical success was observed in all 20 patients (mean age of 41.4 {+-} 5.6 years; range: 29.2-51.1 years). Two (10%) minor and one (5%) major complications occurred. 10/20 dominant submucosal fibroids were completely expelled during the follow-up. Using 3D MRI volumetry the preinterventional mean volume of the later expelled fibroids was 56.8 {+-} 57.0 ml (range 2.3-198.0 ml) and the mean volume of non-expelled fibroids was 123.8 {+-} 147.3 ml (range 24.0-531.8 ml). This difference was statistically significant, but weak (p = 0.0494). Fibroids with a volume equal or less than the threshold value (66.0 ml) were 73% likely to be expelled and fibroids larger than 66.0 ml were 78% likely not to be expelled. All 20 patients demonstrated a significant reduction in the fibroid related symptoms. Conclusion: In our study the complication rate was low despite increased rates of fibroid expulsion (50%); simultaneously the rate of treatment satisfaction was very high. Patients with a dominant submucosal fibroid under 66.0 ml should be informed about the probability of fibroid expulsion and the accompanying symptoms.

  12. The Influence of Oxytocin on the Blood Perfusion of Uterine Fibroids: Contrast-enhanced Ultrasonography Evaluation

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    Yang Wang

    2016-03-01

    Conclusion: This CEUS study demonstrated that the use of parenteral oxytocin can significantly reduce the blood perfusion of the uterine fibroids, which may help to enhance the therapeutic efficacy for high intensity focused ultrasound ablation of uterine fibroids.

  13. Rationale and design of ASTEROID 2, a randomized, placebo- and active comparator-controlled study to assess the efficacy and safety of vilaprisan in patients with uterine fibroids.

    Science.gov (United States)

    Seitz, Christian; Bumbuliene, Žana; Costa, Ana Rosa; Heikinheimo, Oskari; Heweker, Andrea; Hudeček, Robert; Jacquemyn, Yves; Melis, Gian Benedetto; Parashar, Pooja; Rechberger, Tomasz; Sánchez, Antonio Cano; van Aken, Bart; Zatik, János; Gemzell-Danielsson, Kristina

    2017-04-01

    Uterine fibroids (UFs) may be treated with progesterone receptor modulators (PRMs), which have been shown to reduce heavy menstrual bleeding and the size of UFs. To date, one PRM (ulipristal acetate) has received regulatory approval for the treatment of UFs; therapy comprises intermittent treatment courses of up to 3months each, followed by a break to allow two menstruations to occur. We report the design of ASTEROID (Assess Safety and efficacy of vilaprisan in patients with uTERine fibrOIDs) 2, a phase 2 study examining the efficacy and safety of a novel PRM, vilaprisan, in women with UFs. In this randomized multi-arm study, vilaprisan (2mg daily) will be administered in different regimens: continuous treatment for 12 or 24weeks, or two 12-week treatment periods separated by a break to allow one menstruation to occur. Efficacy and safety will be compared with that of ulipristal acetate (5mg daily) and placebo. Patients randomized to receive placebo for 12weeks will also be given active treatment for 12weeks. The primary measure of efficacy will be amenorrhoea rate; secondary measures include time to normalized menstrual bleeding and percentage change in UF volume. Endometrial changes will be monitored throughout the study. The placebo- and active comparator-controlled trial ASTEROID 2 is the first study to evaluate systematically the efficacy and safety of different treatment regimens of PRMs in women with UFs. The findings of this study will direct the planning of future clinical trials of vilaprisan. Copyright © 2017 Bayer AG. Published by Elsevier Inc. All rights reserved.

  14. Ulipristal acetate: a novel pharmacological approach for the treatment of uterine fibroids

    Directory of Open Access Journals (Sweden)

    Biglia N

    2014-02-01

    Full Text Available Nicoletta Biglia,1 Silvestro Carinelli,2 Antonio Maiorana,3 Marta D'Alonzo,1 Giuseppe Lo Monte,4 Roberto Marci4 1Department of Obstetrics and Gynaecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, 2Department of Pathology, European Institute of Oncology, Milan, 3Department of Obstetrics and Gynecology, ARNAS Civico Hospital, Palermo, 4Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Infertility Unit, University of Ferrara, Ferrara, Italy Abstract: Uterine fibroids are the most common benign tumors of the female genital tract. The management of symptomatic fibroids has traditionally been surgical; however, alternative pharmacological approaches have been proposed to control symptoms. To date, gonadotropin-releasing hormone analogs are the only available drugs for the preoperative treatment of fibroids. However, the US Food and Drug Administration recently authorized ulipristal acetate (UPA, an oral selective progesterone-receptor modulator, for the same indication. UPA is a new, effective, and well-tolerated option for the preoperative treatment of moderate and severe symptoms of uterine fibroids in women of reproductive age. According to clinical data, UPA shows several advantages: it is faster than leuprolide in reducing the fibroid-associated bleeding, it significantly improves hemoglobin and hematocrit levels in anemic patients, and it grants a significant reduction in the size of fibroids, which lasts for at least 6 months after the end of the treatment. Furthermore, UPA displays a better tolerability profile when compared to leuprolide; in fact, it keeps estradiol levels at mid follicular phase range, thereby reducing the incidence of hot flushes and exerting no impact on bone turnover. On the grounds of this evidence, the administration of 5 mg/day ulipristal acetate for 3 months is suggested for different patient categories and allows for planning a treatment strategy

  15. Ayurvedic management of recurrent abortions due to uterine fibroid

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    Shailendra Dadarao Katakdound

    2017-01-01

    Full Text Available Uterine fibroids are present in 30-70% of women of reproductive age. Uterine fibroids distort the uterine cavity. Therefore there is consensus of a negative impact on both the clinical pregnancy and delivery rates.[2] In addition, studies have also reported an increased risk of spontaneous miscarriage with submucosal fibroids. In biomedicine, myomectomy is considered the treatment of choice and Assisted Reproductive Technology is advised to overcome infertility. In Hārita Saṃhitā treatment is given for recurrent abortion (Garbhasrāvī. In this study, considering pitta doṣa and altered uterine receptivity (kṣetra duṣṭi as causative factors, purgation (virecana karma was done, enema (yoga basti was given after post purgation protocol (saṃsarjana karma. After body purification (śodhana, garbhasthāpaka drugs were given to the patient for one month. Patient conceived in the second month with this treatment. In Antenatal Care, haematinics and calcium supplements and month wise Ayurvedic medication (Māsānumāsika kaṣāya were given for nine months. Elective caesarean section as done after GA 38 weeks (USG followed by inj. Wymesone 8 mg. The procedure uneventful. Thus proving Ayurvedic management of recurrent abortion due to uterine fibroid. It is cost effective and improves and normalises uterine receptive environment.

  16. Uterine artery embolization for the treatment of symptomatic fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Ah; Kim, Man Deuk; Kim, Hee Jin; Lee, Mee Hwa; Cho, Jin Ho; Cha, Sun Hee; Yoon, Sang Wook; Ahn, Eun Hee [Bundang CHA General Hospital Pochon CHA University, Sungnam (Korea, Republic of)

    2005-07-15

    The aim of this study was to determine the potential usefulness of uterine artery embolization (UAE) for the management of uterine leiomyoma. Sixty nine patients (mean age; 40.3 years, age range; 31-52 years) who underwent UAE for symptomatic fibroids (with menorrhagia, dysmenorrhoea and bulk-related symptoms) from January 2000 to December 2000 were retrospectively analyzed. The mean follow-up period was 3.5 months (range: 1-8 months). The fibroids ranged in size from 2.0 cm to 13.2 cm with a mean size of 5.8 cm. We performed embolization using polyvinyl alcohol particles (250-710 {mu} m). The improvement of the clinical symptoms was analyzed. Reduction of the uterine and predominant fibroid volumes was assessed using MRI. Symptom improvement for the menorrhagia (87.5%), dysmenorrhoea (83.3%) and the bulk-related symptoms (79.2%) was reported. Complications includes ovarian failure in four patients (5.8% of the total patients, mean age: 43.3 yrs) and infection in three patients (4.3% of the total patients) who underwent conservative management with intravenous antibiotics and analgesics. The volume reduction rate of the uterus and the predominant fibroids after uterine artery embolization were 36.3% and 56.6%, respectively. UAE is a promising new treatment for symptomatic fibroids and may be a valuable alternative to hysterectomy.

  17. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment for uterine fibroids

    Science.gov (United States)

    Abdullah, BJJ; Subramaniam, RV; Omar, SS; Wragg, P; Ramli, N; Wui, AL; Lee, CC; Yusof, Y

    2010-01-01

    Magnetic Resonance-guided focused Ultrasound Surgery (MRgFUS) is gaining popularity as an alternative to medical and surgical interventions in the management of symptomatic uterine fibroids. Studies have shown that it is an effective non-invasive treatment with minimal associated risks as compared to myomectomy and hysterectomy. MRgFUS can be offered to a majority of patients suffering from symptomatic uterine fibroids. It has been suggested that the use of broader inclusion criteria as well as the mitigation techniques makes it possible to offer MRgFUS to a much larger subset of patients than previously believed. This paper will describe how MRgFUS treatment for uterine fibroids is performed at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. PMID:21611036

  18. Alterations in uterine hemodynamics caused by uterine fibroids and their impact on in vitro fertilization outcomes

    OpenAIRE

    Moon, Jei-Won; Kim, Chung-Hoon; Kim, Jun-Bum; Kim, Sung-Hoon; Chae, Hee-Dong; Kang, Byung-Moon

    2015-01-01

    Objective To investigate the impact of fibroids on the blood flow of the uterine and subendometrial arteries and in vitro fertilization (IVF) outcomes. Methods In this study, we analyzed 86 IVF/intracytoplasmic sperm injection (ICSI) cycles in which a gonadotropin-releasing hormone antagonist protocol was used for controlled ovarian stimulation between January 2008 and March 2009. The subjects comprised 86 infertile women with (fibroid group, n=43) or without (control group, n=43) uterine fib...

  19. Comparison of Sexual Dysfunction Using the Female Sexual Function Index following Surgical Treatments for Uterine Fibroids

    OpenAIRE

    Allison Ryann Louie; Jennifer Alice Armstrong; Laura Katherine Findeiss; Scott Craig Goodwin

    2012-01-01

    Uterine fibroids are a common problem in women. Statistics showing 20–50% of fibroids produce symptoms and consequently patients seek surgical intervention to improve their quality of life. Treatments for fibroids are typically successful in controlling the fibroid disease, yet sexual function following invasive surgical treatments for fibroids can be jeopardized. The Sexual Function Index (FSFI) is a valid instrument producing quantifiable reproducible results. In this paper three case repor...

  20. ROLE OF MIFEPRISTONE IN MEDICAL MANAGEMENT OF UTERINE FIBROID

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    Shradha

    2015-10-01

    Full Text Available BACKGROUND: Uterine leiomyoma is the most common benign tumour of uterus affecting women of reproductive age group and accounting for most common indication of hysterectomy in India. Effective medical treatment option can prevent hysterectomy related morbidity. MATERIALS AND METHODS: A total of 50 women with symptomatic leiomyoma and asymptomatic with uterine volume >160cc and fibroid size >2.5cm were included in the study. 20mg/day mifepristone was given to them over period of 3 months. Follow up was done at 1, 3 and 6 months of starting treatment. At each visit patients were evaluated for symptomatic improvement of menorrhagia, dysmenorrhoea and ultrasound for myoma volume, haemogram was done. Endometrial biopsy was done at the beginning of therapy, 3rd month and at end of treatment. RESULTS: At the beginning of study, all patients had menorrhagia. At 3 months, 80% developed amenorrhea and 20% scanty menses. At 6 months, 56% had scanty menses and 38% had normal menses but none had menorrhagia. 50% of patients had dysmenorrhoea at the beginning of study with severe dysmenorrhoea in 36% of cases. Only 10% of patients at 3 months and 14% at 6 months had dysmenorrhoea. Improvement in haemoglobin percentage from 9.6 gram% to 10.8 gram% at 3 months of therapy. The reduction in mean uterine volume was 12.28%after 1 month, 26.95% after 3 months and 11.13% at end of 6 months, as compared to pre-treatment level. Fibroid volume decreased by 14.34% after 1 month ,29.8% after 3 months and 24.98% at end of 6 months, as compared to pre-treatment level. At the end of 3 months, 50% of patients experienced no side effect. Rest 50% experienced minor side effects like nausea (8%, hot flushes (4%, liver dysfunction as evidenced by mild increase in transaminase (8% and simple endometrial hyperplasia in 30%. Follow up of these patients at 6 month i.e., 3 months after stopping the drug does not show any evidence of persistence of these effects. CONCLUSION: 20mg

  1. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids : 10-year outcomes from the randomized EMMY trial

    NARCIS (Netherlands)

    de Bruijn, Annefleur M.; Ankum, Willem M.; Reekers, Jim A.; Birnie, Erwin; van der Kooij, Sanne M.; Volkers, Nicole A.; Hehenkamp, Wouter J. K.

    2016-01-01

    BACKGROUND: Since 1995 uterine artery embolization has been described as an alternative for hysterectomy in patients with symptomatic fibroids. Many studies including several randomized controlled trials established uterine artery embolization as a valuable treatment. These randomized controlled

  2. Incarceration of a sessile uterine fibroid in an umbilical hernia during pregnancy.

    Science.gov (United States)

    Seims, A D; Lube, M W

    2009-06-01

    On rare occasions, uterine fibroids complicate pregnancy. More commonly, fibroids exert a mass effect that either prevents implantation of an egg or becomes problematic as a fetus grows. Less frequently, pregnancies are affected by fibroid herniation through a fascial defect. Several publications describing herniation of pedunculated fibroids exist, two of which were in umbilical hernia sacs. There is, to our knowledge, only one publication describing the presence of a sessile uterine fibroid in an umbilical hernia. This case report adds to the literature by describing a 34-year-old primigravid woman with an umbilical hernia that contained a sessile uterine fibroid and provides parameters that can be used in the initial evaluation of a pregnant woman with an abdominal wall hernia.

  3. Uterine restoration after repeated sloughing of fibroids or vaginal expulsion following uterine artery embolization

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hye Ri; Kim, Nack Keun; Lee, Mee Hwa [Pochon CHA University, Department of Obstetrics and Gynecology, Bundang CHA General Hospital, Sungnam-si, Kyonggi-do (Korea); Kim, Man Deuk; Kim, Hee Jin; Yoon, Sang-Wook [Pochon CHA University, Department of Diagnostic Radiology, Bundang CHA General Hospital, Sungnam-si, Kyonggi-do (Korea); Park, Won Kyu [Yeungnam University, Department of Diagnostic Radiology, Kyongson, Dyongbuk (Korea)

    2005-09-01

    The aim of our study is to present our experience with uterine restoration after repeated sloughing of uterine fibroids or transvaginal expulsion following uterine artery embolization (UAE) and to determine its safety and outcome. One hundred and twenty-four women (mean age, 40.3 years; age range, 29-52 years) with symptomatic uterine fibroids were included in this retrospective study. We performed arterial embolization with poly(vinyl alcohol) particles (250-710 {mu}m). Clinical symptoms and follow-up information for each patient were obtained through medical records. At an average of 3.5 months (range, 1-8 months) after embolization, magnetic resonance imaging examinations with T1- and T2-weighted and gadolinium-enhanced T1-weighted images were obtained for all patients. The mean follow-up duration was 120 days (90-240 days). Eight (6.5%) patients experienced uterine restoration after repeated sloughing of uterine fibroids or spontaneous transvaginal expulsion. The locations of the leiomyomas were submucosal (n=5), intramural (n=2) and transmural (n=1). The maximum diameter of the fibroids ranged from 3.5 to 18.0 cm, with a mean of 8.4 cm. The time interval from embolization to the uterine restoration was 7-150 days (mean 70.5 days). The clinical symptoms before and during vaginal sloughing or expulsion were lower abdominal pain (n=4), vaginal discharges (n=3), infection of necrotic myomas (n=2) and cramping abdominal pain (n=1). Gentle abdominal compression (n=1) and hysteroscopic assistance (n=1) were required to remove the whole fibroid. No other clinical sequelae, either early or delayed, were documented. Magnetic resonance images revealed the disappearance of leiomyomas, intracavitary rupture resulting in transformation of intramural or transmural myomas into submucosal myomas and localized uterine wall defects. Although the small size of this study precludes a strict conclusion, there appear to be few serious complications directly related to vaginal

  4. Ileo-uterine fistula in a degenerated posterior wall fibroid after Caesarean section.

    Science.gov (United States)

    Shehata, Ayman; Hussein, Naglaa; El Halwagy, Ahmed; El Gergawy, Adel; Khairallah, Mohamed

    2016-03-01

    Uterine fibroids are benign tumors of the myometrium with a diverse range of manifestations. Fibroids can dramatically increase in size during pregnancy due to the increase in estrogen levels. After delivery, the fibroids usually shrink back to their pre-pregnancy size. Uterine myomas may have many complications, including abnormal uterine bleeding, infertility, pressure on nearby organs, degeneration, and malignant transformation. No previous reports have indicated that a fistula may develop between a uterine fibroid and the bowel loops, although previous studies have documented the occurrence of fistulas from the uterus to the bowel following myomectomy or uterine artery embolization performed to treat a myoma. In our case report, we document the rare complication of a fistula occurring between a degenerated myoma in the posterior wall and the ileum 1 week postoperatively in a patient who underwent a Caesarean section but did not have a history of uterine artery embolization.

  5. Vegetarian diet and reduced uterine fibroids risk: A case-control study in Nanjing, China.

    Science.gov (United States)

    Shen, Yang; Wu, Yanting; Lu, Qing; Ren, Mulan

    2016-01-01

    The aim of this study was to investigate whether a vegetarian diet correlates with a potential reduced risk of uterine fibroids. We used data from a case-control study conducted in Southeast University Zhongda Hospital between February 2010 and December 2014. Cases included 600 Chinese Han women with uterine fibroids (case group) whose clinical diagnosis dated back no more than 1 year. Controls were 600 patients without uterine fibroids as well as healthy volunteers (control group). All of the information gathered through the questionnaire survey was analyzed for the risk factors of the uterine fibroids pathogenesis. The multifactor analysis showed that women with uterine fibroids reported a less frequent consumption of broccoli (odds ratio [OR]: 0.552; 95% confidence interval [CI]: 0.316-0.964), cabbage (OR: 0.446; 95%CI: 0.211-0.943), Chinese cabbage (OR: 0.311; 95%CI: 0.102-0.946), tomato (OR: 0.453; 95%CI: 0.241-0.853), and apple (OR: 0.416; 95%CI: 0.213-0.814) (P < 0.05). The original evidence from this epidemiological investigation shows that a high consumption of broccoli, cabbage, Chinese cabbage, tomato and apple seems to be a protective factor for uterine fibroids. We suggest that greater intake of fresh fruits and cruciferous vegetables may be able to reduce the incidence of uterine fibroids. © 2015 Japan Society of Obstetrics and Gynecology.

  6. CT-Monitored Percutaneous Cryoablation of Uterine Fibroids after Uterine Artery Embolization

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    OBJECTIVE To investigate the effects of percutaneous cryoablation on uterine fibroids using computed tomographic (CT) guidance after uterine artery embolization.METHODS Twelve patients who failed to respond to uterine artery embolization were treated using percutaneous cryoablation. All patients had undergone previous uterine artery embolization an average of 1.2 years (0.7~1.6 years) ago. Two cases had abnormal bleeding, and the other 10 suffered from pressure and/or pelvic pain. Myoma diameters were 4 cm to 16.5 cm. By using CT guidance, 2.0, 2.4, 3.0 or 3.8 mm cryoprobes were placed into the fibroid, and two 15~20 min freezing processes were performed. Hemostasis was achieved only by pressing the incisions for several minutes.MR-imaging was performed before the procedure to measure the size and number of fibroid tumors, and follow- up MR-imaging determined the reduction of the lesions.RESULTS All patients were discharged within 48 h of treatment. Almost no hemorrhage was found in all of the cases. No bladder or bowel injury or significant postsurgery pain was reported. Ice spheres were readily visualized at CT. Beam-hardening artifact from the metal probes was present, but did not interfere with the procedure. Myomas regressed up to 76.3% after 12 months of treatment, and the primary symptoms improved in all treated women.CONCLUSION CT-monitored percutaneous cryoablation is an effective and minimally invasive therapy for symptom relief and fibroid shrinkage after the failure of uterine artery embolization.

  7. Mechanistic Study of the Inhibitory Effect of Kaempferol on Uterine Fibroids In Vitro

    OpenAIRE

    Li, Yanxia; Ding, Zhaoxia; Wu, Chuanzhong

    2016-01-01

    Background This study examined the effect of kaempferol on uterine fibroids in vitro and the underlying mechanism, and investigated the potential of kaempferol as a clinical drug for the treatment of uterine fibroids. Material/Methods Uterine fibroid tissue and surrounding smooth muscle tissue were collected for primary culture. Different concentrations of kaempferol (12 μM, 24 μM, and 48 μM) were used to treat the cells for 24, 48, and 72 hours. Ethanol was used in the control group. A CCK-8...

  8. Ovarian protection by selective coil embolization of a uteroovarian anastomosis before uterine fibroid embolization: a report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Im, Han Hyeok [Soonchunhyang University, Gumi (Korea, Republic of); Chang, Yun Woo; Goo, Dong Erk [Soonchunhyang University Hospital, Gumi (Korea, Republic of)

    2006-09-15

    Premature menopause can be developed as a result of undesired nontarget ovary embolization during the performance of uterine fibroid embolization. The etiology of varian failure after uterine fibroid embolization is not yet clearly defined, but one of the leading possibilities is nontarget embolization of the varies. We report here on two cases in which superselective coil embolization of distal uterine artery collateral pathways to the ovary was performed during uterine fibroid embolization.

  9. Midterm Results after Uterine Artery Embolization Versus MR-Guided High-Intensity Focused Ultrasound Treatment for Symptomatic Uterine Fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Froeling, V., E-mail: vera.froeling@charite.de; Meckelburg, K., E-mail: katrin.meckelburg@charite.de; Scheurig-Muenkler, C., E-mail: christian.scheurig-muenkler@charite.de; Schreiter, N. F., E-mail: nils.schreiter@charite.de; Kamp, J., E-mail: julia.kamp@charite.de; Maurer, M. H., E-mail: martin.maurer@charite.de; Beck, A., E-mail: alexander.beck@charite.de; Hamm, B., E-mail: bernd.hamm@charite.de; Kroencke, T. J., E-mail: Thomas.kroencke@charite.de [Charite-Universitaetsmedizin Berlin, Department of Radiology (Germany)

    2013-12-15

    Purpose: To compare the rate of reintervention and midterm changes in symptom severity (SS) and Total health-related quality of life (HRQoL) scores after uterine artery embolization (UAE) and magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Methods: Eighty women (median age 38.3 years), equally eligible for MR-g HIFU and UAE who underwent one of both treatments between 2002 and 2009 at our institution, were included. The primary end point of the study was defined as the rate of reintervention after both therapies. The secondary outcome was defined as changes in SS and Total HRQoL scores after treatment. SS and Total HRQoL scores before treatment and at midterm follow-up (median 13.3 months) were assessed by the uterine fibroid symptom and quality-of-life questionnaire (UFS-QoL) and compared. Results: The rate of reintervention was significantly lower after UAE than after MR-g HIFU (p = 0.002). After both treatments, SS and Total HRQoL scores improved significantly from baseline to follow-up (UAE: p < 0.001, p < 0.001; MR-g HIFU: p = 0.002, p < 0.001). Total HRQoL scores were significantly higher after UAE than after MR-g HIFU (p = 0.032). Changes in the SS scores did not differ significantly for both treatments (p = 0.061). Conclusion: UAE and MR-g HIFU significantly improved the health-related quality of life of women with symptomatic uterine fibroids. After UAE, the change in Total HRQoL score improvement was significantly better, and a significantly lower rate of reintervention was observed.

  10. Treatment of uterine fibroids for abnormal uterine bleeding: myomectomy and uterine artery embolization.

    Science.gov (United States)

    Al-Mahrizi, Sharifa; Tulandi, Togas

    2007-12-01

    Uterine myoma is a common benign tumour in women and most cases do not require treatment. Excessive uterine bleeding is usually due to a submucous myoma or an intramural myoma that is encroaching into the uterine cavity. After eliminating endometrial malignancy, perimenopausal women could be managed expectantly or with gonadotrophin-releasing hormone agonist until menopause. Hysteroscopic myomectomy is highly effective in controlling menorrhagia that is related to submucous myoma. Concomitant endometrial ablation improves menorrhagia; however, the subsequent hysterectomy rate remains the same. For those with an intramural myoma, abdominal myomectomy results in good bleeding control. It could also be done by laparoscopic approach; however, the surgeon should have expertise in laparoscopic suturing and the uterine incision should be properly sutured. In women who have completed their family, hysterectomy remains the most effective treatment for excessive uterine bleeding. Compared with uterine artery embolization (UAE), it is associated with better improvement in pelvic pain. Nevertheless, UAE is a good alternative to hysterectomy.

  11. Hypovitaminosis D and "small burden" uterine fibroids: Opportunity for a vitamin D supplementation.

    Science.gov (United States)

    Ciavattini, Andrea; Delli Carpini, Giovanni; Serri, Matteo; Vignini, Arianna; Sabbatinelli, Jacopo; Tozzi, Alessandra; Aggiusti, Alice; Clemente, Nicolò

    2016-12-01

    The aim of this study was to evaluate the effect of vitamin D supplementation in women with hypovitaminosis D and "small burden" uterine fibroids.This study focused on 208 women diagnosed with uterine fibroids and concomitant hypovitaminosis D, from January to December 2014. One hundred eight women of the initial study population were diagnosed with "small burden" uterine fibroids. Among them, those who underwent a proper vitamin D supplementation constituted the "study group" (n = 53), while women who spontaneously refused the therapy or did not perform it properly, constituted the "control group" (n = 55). The characteristics of uterine fibroids, the fibroid-related symptoms, and the vitamin D serum levels were evaluated 12 months after the initial diagnosis.In women with uterine fibroids, a negative correlation emerged between the baseline 25-hydroxy-cholecalciferol (25-OH-D3) concentration and both the volume of the largest fibroid (r = -0.18, P = 0.01) and the total volume of fibroids (r = -0.19, P = 0.01). No correlation was found between the baseline 25-OH-D3 levels and the number of fibroids per patient (r = -0.10, P = 0.16). In women of the "study group," a significant increase in the 25-OH-D3 serum level was observed after 12 months of supplementation, and a lower rate of surgical or medical treatment due to the "progression to extensive disease" was reported (13.2% vs 30.9%, P = 0.05).Supplementation therapy with 25-OH-D3 restores normal vitamin D serum levels in women with "small burden" fibroids. In these women, vitamin D supplementation seems to reduce the progression to an extensive disease, and thus the need of conventional surgical or medical therapy.

  12. Uterine Artery Embolization for Symptomatic Uterine Fibroids: a Prospective Study on 102 Patients in Iran

    Directory of Open Access Journals (Sweden)

    M. Shakiba

    2005-06-01

    Full Text Available Background/Objectives : To evaluate the safety, efficacy an d complication rate of uterine artery embolization in symptomatic fibroid patients in Iran. Patients and Methods: A hundred and two patients aged 20-48 years (mean age: 35.7 ±6.4 years with symptomatic fibroids entered th e study from September 2001 to November 2004. The most common presenting symptom was increased menstrual bleeding, which occurred in 74.5% of all patients. Urinary symptoms occurred in 43%, and bulk-related symptoms were seen in 63.7 % of our patients. We performed bilateral UAE (uterine artery em bolization using PVA (pol yvinyl alcohol particles (500-710 micron and assessed the patients before UAE and at regular follow- ups at 1, 3, 6 and 12-month intervals by questionnaires / interviews and ultrasound. MRI without gadolinium (Gd-DTPA injection was done before emboliz ation and at 6 and 12 months after the procedure. Results: By Friedman test, sequential follow-up (up to 12 months showed that the vaginal bleeding severity significantly decreased (p <0.0001, with menorrhagia resolving in 59.4% of patients at 1 month, and in 69% at 12 months. The mean uterus volume decreased 38.5 ±30% after 12 months .The paired t-test showed that dominant fibroid volume changed from 273.7±439.2 cm3 to 112.1±141.6 cm3 at month 6 (n=58, p=0.001 and from 246.1±314.5 cm3 to 70.1±73.5 cm3 at month 12 (n=41, p<0.0001 . The initial size of the fibroids did not affect the success rate. Conclusion: The study showed the high efficacy of UAE in controlling fibroid related symptoms, with only few complications.

  13. Patient-reported prevalence and symptomatic burden of uterine fibroids among women in the United States: findings from a cross-sectional survey analysis

    Directory of Open Access Journals (Sweden)

    Fuldeore MJ

    2017-06-01

    Full Text Available Mahesh J Fuldeore, Ahmed M Soliman Health Economics and Outcomes Research, AbbVie Inc., North Chicago, IL, US Purpose: To estimate the prevalence of women diagnosed with uterine fibroids and the associated symptom burden in the US.Patients and methods: Responses of women aged 18–54 years, who completed an online survey, were analyzed. Data were weighted based on age, education, race, geographic region, income, and propensity score to derive national estimates of the prevalence of women diagnosed with uterine fibroids and associated symptom burden. Weighted means and percentages were reported. Prevalence across age and ethnic groups was examined. Symptom burden among women with and without uterine fibroids was compared using weighted logistic regressions.Results: Of 59,411 respondents who met study inclusion criteria, 7.7% reported receiving a diagnosis of uterine fibroids. Of these, 5,670 women (1,402 in the uterine fibroid group and 4,268 in the control group were excluded from analysis because they had a hysterectomy. Among the non-hysterectomized study participants, 3,031 self-reported a diagnosis of uterine fibroids (prevalence: 5.8%, 95% confidence interval [CI]: 5.5%–6.1%; prevalence increased as women aged and was greatest in the 50–54 age group (11.4%; 95% CI: 10.4%–12.4%. In addition, prevalence was greater in black vs white women (9.8%; 95% CI: 8.7%–11.0% vs 5.4%; 95% CI: 5.1%–5.7%. A greater percentage of women with uterine fibroids (vs those without experienced severe heavy menstrual bleeding (16.7% vs 7.7%, severe constipation/bloating/diarrhea (7.7% vs 4.7%, severe passage of clots (6.7% vs 2.4%, severe spotting/bleeding between periods (1.7% vs 1.0%, and severe pelvic pressure (1.6% vs 0.6%. Among uterine fibroid patients with these typical uterine fibroid-related symptoms, 56.4%, 32.3%, 26.4%, 25.8%, and 20.4% reported heavy menstrual bleeding, passage of clots, spotting/bleeding between periods, constipation

  14. Uteroenteric Fistula Resulting From Fibroid Expulsion After Uterine Fibroid Embolization: Case Report and Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Gutierrez, Luis B., E-mail: lbgutier@stanford.edu [Stanford University, School of Medicine (United States); Bansal, Anshuman K., E-mail: abansal@mednet.ucla.edu [University of California at Los Angeles, Department of Radiology (United States); Hovsepian, David M., E-mail: hovsepian@stanford.edu [Stanford University, School of Medicine (United States)

    2012-10-15

    A 44-year-old woman underwent uncomplicated uterine fibroid embolization (UFE) for menstrual and bulk-related symptoms in an enlarged, myomatous uterus. After surgery, she spontaneously sloughed a large mass of fibroids that arrested in the cervical canal during passage. Four days after gynecological extraction, she developed copious vaginal discharge that contained enteric contents. Contrast-enhanced computed tomography (CT) demonstrated a fistula between the small bowel and the uterus. She subsequently underwent hysterectomy, left oophorectomy, and small-bowel resection. Her postoperative recovery was uneventful.

  15. Application of a Patient Derived Xenograft Model for Predicative Study of Uterine Fibroid Disease.

    Directory of Open Access Journals (Sweden)

    Martin Fritsch

    Full Text Available Human uterine fibroids, benign tumors derived from the smooth muscle layers of the uterus, impose a major health burden to up to 50% of premenopausal women in their daily life. To improve our understanding of this disease, we developed and characterized a patient-derived xenograft model by subcutaneous transplantation of pieces of human uterine fibroid tissue into three different strains of severe combined immunodeficient mice. Engrafted uterine fibroid tissue preserved the classical morphology with interwoven bundles of smooth muscle cells and an abundant deposition of collagenous matrix, similar to uterine fibroids in situ. The grafts expressed both estrogen receptor 1 and progesterone receptor. Additionally, both receptors were up-regulated by estrogen treatment. Growth of the fibroid grafts was dependent on 17β-estradiol and progesterone supplementation at levels similar to women with the disease and was studied for up to 60 days at maximum. Co-treatment with the antiprogestin mifepristone reduced graft growth (four independent donors, p<0.0001 two-sided t-test, as did treatment with the mTOR inhibitor rapamycin (three independent donors, p<0.0001 two-sided t-test. This in vivo animal model preserves the main histological and functional characteristics of human uterine fibroids, is amenable to intervention by pharmacological treatment, and can thus serve as an adequate model for the development of novel therapies.

  16. Contemporary management of uterine fibroids: focus on emerging medical treatments.

    Science.gov (United States)

    Singh, Sukhbir Sony; Belland, Liane

    2015-01-01

    This review provides an overview of therapeutic options, with a specific focus on the emerging role of medical options for UF management. PubMed, Google Scholar, and Cochrane Systematic Reviews were searched for articles published between 1980 and 2013. Relevant articles were identified using the following terms: 'uterine fibroids', 'leiomyoma', 'heavy menstrual bleeding', and 'menorrhagia'. The reference lists of articles identified were also searched for other relevant publications. Because of the largely benign nature of UFs, the most conservative options that minimize morbidity/risk and optimize outcomes should be considered. Watchful waiting, or no immediate intervention combined with regular follow-up, is an appropriate option for the majority of UF patients who experience no symptoms. For women with symptomatic UFs, the optimal treatment should restore quality of life through rapid relief of UF signs and symptoms, reduce tumor size for a sustained period, and maintain or improve fertility. Invasive surgical treatments, such as hysterectomy, have historically been the mainstay of UF treatment. Less invasive surgical and interventional techniques, such as myomectomy, uterine artery embolization, endometrial ablation, and myolysis provide alternatives to hysterectomy. Until recently, medical management of UFs was characterized by short-term treatments and therapies that provided symptomatic control. In addition to controlling abnormal uterine bleeding, newer medical therapies, including the recently Health-Canada-approved ulipristal acetate, act directly to shrink the tumor. Although no agent is currently approved for such use, emerging evidence suggests the potential for long-term medical management of UFs. The advent of novel medical therapies may diminish the long-held reliance on more invasive surgical UF treatment options.

  17. Clinical utility of ulipristal acetate for the treatment of uterine fibroids: current evidence

    Directory of Open Access Journals (Sweden)

    Trefoux Bourdet A

    2015-03-01

    Full Text Available Alice Trefoux Bourdet, Dominique Luton, Martin Koskas Department of Obstetrics and Gynecology, Bichat University Hospital, Paris Diderot University, Paris, France Abstract: Uterine myoma is the most common benign uterine tumor in women of reproductive age and occurs in 20%–25% of the worldwide population. No currently approved medical treatment is able to completely eliminate fibroids. Surgery, particularly hysterectomy, predominates as the treatment strategy of choice, even though it is associated with risks and complications and causes infertility. Until recently, gonadotropin-releasing hormone agonists were the only available drugs for the preoperative treatment of fibroids. However, ulipristal acetate (UPA, an oral selective progesterone receptor modulator, was recently licensed in Europe for the same indication. Recent studies have demonstrated the efficacy and safety of UPA in the medical management of fibroids before surgery, with a better tolerability profile than leuprolide acetate. Analyzing the literature, we identified new management strategies involving UPA and surgery, considering advantages of both medical and surgical therapy. The advent of UPA will undoubtedly modify the surgical approach to fibroids, but the heterogeneity of these possible indications now requires various original clinical studies to identify the optimal indications for UPA in patients with symptomatic fibroid(s. Keywords: uterine fibroids, medical treatment, selective progesterone receptor modulator, ulipristal acetate, surgery

  18. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5‐year results

    National Research Council Canada - National Science Library

    Moss, JG; Cooper, KG; Khaund, A; Murray, LS; Murray, GD; Wu, O; Craig, LE; Lumsden, MA

    2011-01-01

    .... Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5‐year results. BJOG 2011;118:936–944. Objective...

  19. Uterine artery embolisation for symptomatic fibroids: the University of Malaya Medical Centre experience

    Science.gov (United States)

    Subramaniam, RN; Vijayananthan, A; Omar, SZ; Nawawi, O; Abdullah, BJJ

    2010-01-01

    Background: Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic fibroids has been performed in several centres in the United States, Western Europe and Asia with promising results. This study reports the authors' experience with UAE at the University Malaya Medical Centre. Method: Fifty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via patient-controlled analgesic pump. The patients were followed up at an interval of 6/12 clinically and with MRI. Results: Transcatheter UAE was performed on all 50 patients with no major complications. 49 patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery due to previous myomectomy. The mean hospital stay was 3.5 days (range, 2 to 7). At a mean follow-up of 24/52, all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on MRI. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) after 6 months and subsequent endometrial sampling revealed cystic glandular hyperplasia for which total abdominal hysterectomy was performed. Two other patients had no change in symptoms and after hysterectomy, the pathology revealed concurrent adenomyosis. Another 2 patients with cervical fibroids were treated with hysterectomy as there was no gross reduction in the size of fibroid following UAE. Overall, 90% of the patients had dramatic improvement of anaemia and symptoms at 1 year follow-up. Conclusion: Out of the 50 patients, 17 patients had total disappearance of their fibroids and 28 patients had more than 50% reduction in the size of fibroids after 1 year. 5 patients

  20. Hypovitaminosis D and “small burden” uterine fibroids: Opportunity for a vitamin D supplementation

    Science.gov (United States)

    Ciavattini, Andrea; Delli Carpini, Giovanni; Serri, Matteo; Vignini, Arianna; Sabbatinelli, Jacopo; Tozzi, Alessandra; Aggiusti, Alice; Clemente, Nicolò

    2016-01-01

    Abstract The aim of this study was to evaluate the effect of vitamin D supplementation in women with hypovitaminosis D and “small burden” uterine fibroids. This study focused on 208 women diagnosed with uterine fibroids and concomitant hypovitaminosis D, from January to December 2014. One hundred eight women of the initial study population were diagnosed with “small burden” uterine fibroids. Among them, those who underwent a proper vitamin D supplementation constituted the “study group” (n = 53), while women who spontaneously refused the therapy or did not perform it properly, constituted the “control group” (n = 55). The characteristics of uterine fibroids, the fibroid-related symptoms, and the vitamin D serum levels were evaluated 12 months after the initial diagnosis. In women with uterine fibroids, a negative correlation emerged between the baseline 25-hydroxy-cholecalciferol (25-OH-D3) concentration and both the volume of the largest fibroid (r = −0.18, P = 0.01) and the total volume of fibroids (r = −0.19, P = 0.01). No correlation was found between the baseline 25-OH-D3 levels and the number of fibroids per patient (r = −0.10, P = 0.16). In women of the “study group,” a significant increase in the 25-OH-D3 serum level was observed after 12 months of supplementation, and a lower rate of surgical or medical treatment due to the “progression to extensive disease” was reported (13.2% vs 30.9%, P = 0.05). Supplementation therapy with 25-OH-D3 restores normal vitamin D serum levels in women with “small burden” fibroids. In these women, vitamin D supplementation seems to reduce the progression to an extensive disease, and thus the need of conventional surgical or medical therapy. PMID:28033263

  1. Aberrant Methylation of the E-Cadherin Gene Promoter Region in the Endometrium of Women With Uterine Fibroids.

    Science.gov (United States)

    Li, Yan; Ran, Ran; Guan, Yingxia; Zhu, Xiaoxiong; Kang, Shan

    2016-08-01

    A uterine fibroid is a leiomyoma that originates from the smooth muscle layer of the uterus. A variety of endometrial abnormalities are associated with uterine fibroids. This study aims to investigate the methylation status of the E-cadherin gene (CDH1) promoter region in the endometrium of patients with uterine fibroids. The methylation of CDH1 was studied using methylation-specific polymerase chain reaction in the endometrial tissue of 102 patients with uterine fibroids and 50 control patients. The E-cadherin expression was examined by flow cytometry. The methylation rate of CDH1 promoter region was 33.3% in the endometrium of patients with uterine fibroids and 8% in the endometrium of women without fibroids. The frequency of CDH1 promoter methylation in the endometrium of patients with fibroids was significantly higher than that in the endometrium of women without fibroids (P = .001). Furthermore, the E-cadherin expression level in methylation-positive tissues was significantly lower than that in methylation-negative tissues (P = .017). These results suggest that epigenetic aberration of CDH1 may occur in the endometrium of patients with fibroids, which may be associated with E-cadherin protein expression in endometrial tissue.

  2. Clinical Long-Term Outcome and Reinterventional Rate After Uterine Fibroid Embolization with Nonspherical Versus Spherical Polyvinyl Alcohol Particles

    Energy Technology Data Exchange (ETDEWEB)

    Duvnjak, Stevo, E-mail: stevo.duvnjak@rsyd.dk [Odense University Hospital, Department of Radiology (Denmark); Ravn, Pernille [Odense University Hospital, Department of Gynecology (Denmark); Green, Anders [Odense University Hospital, Odense Patient Data Explorative Network (Denmark); Andersen, Poul Erik [Odense University Hospital, Department of Radiology (Denmark)

    2016-02-15

    PurposeThis study was designed to evaluate the long-term clinical outcome and frequency of reinterventions in patients with uterine fibroids treated with embolization at a single center using polyvinyl alcohol microparticles.MethodsThe study included all patients with symptomatic uterine fibroids treated with uterine fibroid embolization (UFE) with spherical (s-PVA) and nonspherical (ns-PVA) polyvinyl alcohol microparticles during the period January 2001 to January 2011. Clinical success and secondary interventions were examined. Hospital records were reviewed during follow-up, and symptom-specific questionnaires were sent to all patients.ResultsIn total, 515 patients were treated with UFE and 350 patients (67 %) were available for long-term clinical follow-up. Median time of follow-up was 93 (range 76–120.2) months. Eighty-five patients (72 %) had no reinterventions during follow-up in the group embolized with ns-PVA compared with 134 patients (58 %) treated with s-PVA. Thirty-three patients (28 %) underwent secondary interventions in the ns-PVA group compared with 98 patients (42 %) in s-PVA group (χ{sup 2} test, p < 0.01).ConclusionsSpherical PVA particles 500–700 µm showed high reintervention rate at long-term follow-up, and almost one quarter of the patients underwent secondary interventions, suggesting that this type of particle is inappropriate for UFE.

  3. DNA microarray data integration by ortholog gene analysis reveals potential molecular mechanisms of estrogen-dependent growth of human uterine fibroids

    Directory of Open Access Journals (Sweden)

    Shou Jianyong

    2007-04-01

    Full Text Available Abstract Background Uterine fibroids or leiomyoma are a common benign smooth muscle tumor. The tumor growth is well known to be estrogen-dependent. However, the molecular mechanisms of its estrogen-dependency is not well understood. Methods Differentially expressed genes in human uterine fibroids were either retrieved from published papers or from our own statistical analysis of downloaded array data. Probes for the same genes on different Affymetrix chips were mapped based on probe comparison information provided by Affymetrix. Genes identified by two or three array studies were submitted for ortholog analysis. Human and rat ortholog genes were identified by using ortholog gene databases, HomoloGene and TOGA and were confirmed by synteny analysis with MultiContigView tool in the Ensembl genome browser. Results By integrated analysis of three recently published DNA microarray studies with human tissue, thirty-eight genes were found to be differentially expressed in the same direction in fibroid compared to adjacent uterine myometrium by at least two research groups. Among these genes, twelve with rat orthologs were identified as estrogen-regulated from our array study investigating uterine expression in ovariectomized rats treated with estrogen. Functional and pathway analyses of the twelve genes suggested multiple molecular mechanisms for estrogen-dependent cell survival and tumor growth. Firstly, estrogen increased expression of the anti-apoptotic PCP4 gene and suppressed the expression of growth inhibitory receptors PTGER3 and TGFBR2. Secondly, estrogen may antagonize PPARγ signaling, thought to inhibit fibroid growth and survival, at two points in the PPAR pathway: 1 through increased ANXA1 gene expression which can inhibit phospholipase A2 activity and in turn decrease arachidonic acid synthesis, and 2 by decreasing L-PGDS expression which would reduce synthesis of PGJ2, an endogenous ligand for PPARγ. Lastly, estrogen affects retinoic

  4. MR-guided high-intensity focused ultrasound treatment of uterine fibroids

    OpenAIRE

    2016-01-01

    Antonia Wiggermann,1 Michael Beldoch,1 Friederike Hoellen,2 Peter Hunold1 1Clinic for Radiology and Nuclear Medicine, 2Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Lübeck, Germany Abstract: Uterine fibroids are benign, encapsulated uterine tumors, representing the most common reason for hysterectomy in premenopausal women. High-intensity focused ultrasound (HIFU; also known as focused ultrasound surgery) is a noninvasive technique leading to tissu...

  5. MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre

    Energy Technology Data Exchange (ETDEWEB)

    Mindjuk, Irene; Herzog, Peter; Matzko, Matthias [Helios-Amper Klinikum Dachau, Department of Diagnostic and Interventional Radiology, Helios-Amper Klinikum Dachau, Dachau, Dachau (Germany); Trumm, Christoph G.; Stahl, Robert [Klinikum der Ludwig-Maximilians-Universitaet Muenchen-Grosshadern, Muenchen, Department of Clinical Radiology, Muenchen (Germany)

    2015-05-01

    To assess the technical and clinical results of MRgFUS treatment and factors affecting clinical treatment success. A total of 252 women (mean age, 42.1 ± 6.9 years) with uterine fibroids underwent MRgFUS. All patients underwent MRI before treatment. Results were evaluated with respect to post-treatment nonperfused volume (NPV), symptom severity score (SSS), reintervention rate, pregnancy and safety data. NPV ratio was significantly higher in fibroids characterized by low signal intensity in contrast-enhanced T1-weighted fat saturated MR images and in fibroids distant from the spine (>3 cm). NPV ratio was lower in fibroids with septations, with subserosal component and in skin-distant fibroids (p < 0.001). NPV ratio was highly correlated with clinical success: NPV of more than 80 % resulted in clinical success in more than 80 % of patients. Reintervention rate was 12.7 % (mean follow-up time, 19.4 ± 8 months; range, 3-38). Expulsion of fibroids (21 %) was significantly correlated with a high clinical success rate. No severe adverse events were reported. Adequate patient selection and correct treatment techniques, based on the learning curve of this technology, combined with technical advances of the system, lead to higher clinical success rates with low complications rate, comparable to other uterine-sparing treatment options. (orig.)

  6. Effect of biological characteristics of different types of uterine fibroids, as assessed with T2-weighted magnetic resonance imaging, on ultrasound-guided high-intensity focused ultrasound ablation.

    Science.gov (United States)

    Zhao, Wen-Peng; Chen, Jin-Yun; Chen, Wen-Zhi

    2015-02-01

    The aims of this study were to assess the effects of the biological characteristics of different types of uterine fibroids, as assessed with T2-weighted magnetic resonance imaging (MRI), on ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation. Thirty-five patients with 39 symptomatic uterine fibroids who underwent myomectomy or hysterectomy were enrolled. Before surgery, the uterine fibroids were subdivided into hypo-intense, iso-intense, heterogeneous hyper-intense and homogeneous hyper-intense categories based on signal intensity on T2-weighted MRI. Tissue density and moisture content were determined in post-operative samples and normal uterine tissue, the isolated uterine fibroids were subjected to USgHIFU, and the extent of ablation was measured using triphenyltetrazolium chloride. Hematoxylin and eosin staining and sirius red staining were undertaken to investigate the organizational structure of the uterine fibroids. Estrogen and progesterone receptor expression was assayed via immunohistochemical staining. The mean diameter of uterine fibroids was 6.9 ± 2.8 cm. For all uterine fibroids, the average density and moisture content were 10.7 ± 0.7 mg/mL and 75.7 ± 2.4%, respectively; and for the homogeneous hyper-intense fibroids, 10.3 ± 0.5 mg/mL and 76.6 ± 2.3%. The latter subgroup had lower density and higher moisture content compared with the other subgroups. After USgHIFU treatment, the extent of ablation of the hyper-intense fibroids was 102.7 ± 42.1 mm(2), which was significantly less than those of the hypo-intense and heterogeneous hyper-intense fibroids. Hematoxylin and eosin staining and sirius red staining revealed that the homogeneous hyper-intense fibroids had sparse collagen fibers and abundant cells. Immunohistochemistry results revealed that estrogen and progesterone receptors were highly expressed in the homogeneous hyper-intense fibroids. This study revealed that lower density, higher moisture content, sparse collagen

  7. Targeted Vessel Ablation for More Efficient Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Voogt, Marianne J., E-mail: m.voogt@umcutrecht.nl [University Medical Center Utrecht, Department of Radiology (Netherlands); Stralen, Marijn van [University Medical Center Utrecht, Image Sciences Institute (Netherlands); Ikink, Marlijne E. [University Medical Center Utrecht, Department of Radiology (Netherlands); Deckers, Roel; Vincken, Koen L.; Bartels, Lambertus W. [University Medical Center Utrecht, Image Sciences Institute (Netherlands); Mali, Willem P. Th. M.; Bosch, Maurice A. A. J. van den [University Medical Center Utrecht, Department of Radiology (Netherlands)

    2012-10-15

    Purpose: To report the first clinical experience with targeted vessel ablation during magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) treatment of symptomatic uterine fibroids. Methods: Pretreatment T1-weighted contrast-enhanced magnetic resonance angiography was used to create a detailed map of the uterine arteries and feeding branches to the fibroids. A three-dimensional overlay of the magnetic resonance angiography images was registered on 3D T2-weighted pretreatment imaging data. Treatment was focused primarily on locations where supplying vessels entered the fibroid. Patients were followed 6 months after treatment with a questionnaire to assess symptoms and quality of life (Uterine Fibroid Symptom and Quality of Life) and magnetic resonance imaging to quantify shrinkage of fibroid volumes. Results: In two patients, three fibroids were treated with targeted vessel ablation during MR-HIFU. The treatments resulted in almost total fibroid devascularization with nonperfused volume to total fibroid volume ratios of 84, 68, and 86%, respectively, of treated fibroids. The predicted ablated volumes during MR-HIFU in patients 1 and 2 were 45, 40, and 82 ml, respectively, while the nonperfused volumes determined immediately after treatment were 195, 92, and 190 ml respectively, which is 4.3 (patient 1) and 2.3 (patient 2) times higher than expected based on the thermal dose distribution. Fibroid-related symptoms reduced after treatment, and quality of life improved. Fibroid volume reduction ranged 31-59% at 6 months after treatment. Conclusion: Targeted vessel ablation during MR-HIFU allowed nearly complete fibroid ablation in both patients. This technique may enhance the use of MR-HIFU for fibroid treatment in clinical practice.

  8. Association between menarche age and menstrual disorder with the incidence of uterine fibroid in medan, Indonesia: based on hospital data

    Directory of Open Access Journals (Sweden)

    Muhammad Fidel Ganis Siregar

    2015-08-01

    Full Text Available Background: Uterine fibroids are benign, monoclonal tumors of the smooth muscle cells found in the human uterus. The incidence of uterine fibroid in Indonesia is between 2.39% - 11.7% in all gynecology inpatient. Despite the fact that their cause is still unknown, there is considerable evidence that estrogens and progestogens proliferate tumor growth, as the fibroids rarely appear before menarche and regress after menopause. Methods: An observational analytic study with case control approach. Total sample from this study was 498 people, with 249 cases and 249 controls. The samples were collected through purposive sampling. The study was conducted in the medical record division of Adam Malik General Hospital Medan. Results from the study were analyzed with chi square. Results: The result of this study demonstrated an association between menarche age with uterine fibroid incidence, with a p-value < 0.05, and odds ratio = 2.487 (CI 1.585-3.902. This indicate that the incidence of uterine fibroid is 2.5 greater in women with menarche age of < 10 years old. P-value < 0.05 and odds ratio = 0.258 (CI 0.178-0.375 were obtained from the association between menstrual disorder and uterine fibroid incidence. Conclusions: The result of this study demonstrates a significant association correlation between menarche age and the development of uterine fibroid. Early menarche age increases risk of uterine fibroid incidence, whereas menstrual disorder is more likely a clinical manifestation of uterine fibroid, rather than a risk factor. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1025-1028

  9. A Split-and-Merge-Based Uterine Fibroid Ultrasound Image Segmentation Method in HIFU Therapy.

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    Menglong Xu

    Full Text Available High-intensity focused ultrasound (HIFU therapy has been used to treat uterine fibroids widely and successfully. Uterine fibroid segmentation plays an important role in positioning the target region for HIFU therapy. Presently, it is completed by physicians manually, reducing the efficiency of therapy. Thus, computer-aided segmentation of uterine fibroids benefits the improvement of therapy efficiency. Recently, most computer-aided ultrasound segmentation methods have been based on the framework of contour evolution, such as snakes and level sets. These methods can achieve good performance, although they need an initial contour that influences segmentation results. It is difficult to obtain the initial contour automatically; thus, the initial contour is always obtained manually in many segmentation methods. A split-and-merge-based uterine fibroid segmentation method, which needs no initial contour to ensure less manual intervention, is proposed in this paper. The method first splits the image into many small homogeneous regions called superpixels. A new feature representation method based on texture histogram is employed to characterize each superpixel. Next, the superpixels are merged according to their similarities, which are measured by integrating their Quadratic-Chi texture histogram distances with their space adjacency. Multi-way Ncut is used as the merging criterion, and an adaptive scheme is incorporated to decrease manual intervention further. The method is implemented using Matlab on a personal computer (PC platform with Intel Pentium Dual-Core CPU E5700. The method is validated on forty-two ultrasound images acquired from HIFU therapy. The average running time is 9.54 s. Statistical results showed that SI reaches a value as high as 87.58%, and normHD is 5.18% on average. It has been demonstrated that the proposed method is appropriate for segmentation of uterine fibroids in HIFU pre-treatment imaging and planning.

  10. A Case of Pyomyoma following Uterine Fibroid Embolization and a Review of the Literature

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    Chika C. Obele

    2016-01-01

    Full Text Available Background. Since its introduction in 1996, uterine fibroid embolization (UFE has become standard medical practice in the management of symptomatic uterine fibroids. An extremely rare complication, pyomyoma, has been reported only 5 times previously in the literature following UFE. Case. A 37-year-old woman underwent UFE for symptomatic leiomyomas of the uterus. Signs and symptoms of uterine infection ensued, beginning at 6 days following the procedure. Recurrent fevers and increasing leukocytosis despite the intravenous administration of appropriate antibiotics eventually necessitated surgical intervention on postprocedure day #18. Conclusion. An extremely rare complication of UFE is herein presented, pyomyoma, with a review of other reported cases. Commonalities are sought among these few reported cases with the hope of increasing diagnostic acumen in the detection of this disease.

  11. Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: Long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Froeling, V., E-mail: Vera.Froeling@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Meckelburg, K., E-mail: Katrin.Meckelburg@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Schreiter, N.F., E-mail: Nils.Schreiter@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Scheurig-Muenkler, C., E-mail: Christian.Scheurig@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Kamp, J., E-mail: Julia.Kamp@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Maurer, M.H., E-mail: Martin.Maurer@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Beck, A., E-mail: Alexander.Beck@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Hamm, B., E-mail: Bernd.Hamm@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); and others

    2013-12-01

    Objectives: To compare the long-term outcome after uterine artery embolization (UAE) versus magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Methods: Seventy-seven women (median age, 39.3 years; range, 29.2–52.2 years) with symptomatic uterine fibroids, equally eligible for UAE and MR-g HIFU based on our exclusion criteria underwent treatment (UAE, N = 41; MR-g HIFU, N = 36) from 2002 to 2009 at our institution. Symptom severity (SS) and total health-related quality of life (Total HRQoL) scores were assessed by the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire before treatment and at long-term follow-up after UAE (median 61.9 months) and after MR-g HIFU (median: 60.7 months). Re-intervention rates were assessed for each therapy and compared. Results: Re-intervention was significantly lower after UAE (12.2%) than after MR-g HIFU (66.7%) at long-term follow-up (p < 0.001). After UAE changes in SS (50 pre-treatment vs. 6.3 post-treatment) and Total HRQoL (57.8 pre-treatment vs. 100 post-treatment) were significantly better than changes in SS (42.2 pre-treatment vs. 26.6 post-treatment) and Total HRQoL score (66.4 pre-treatment vs. 87.9 post-treatment) after MR-g HIFU (p = 0.019 and 0.049 respectively). Conclusions: Improvement of SS and Total HRQoL scores was significantly better after UAE resulting in a significant lower re-intervention rate compared to MR-g HIFU.

  12. Tunable delivery of niflumic acid from resorbable embolization microspheres for uterine fibroid embolization.

    Science.gov (United States)

    Bédouet, Laurent; Moine, Laurence; Servais, Emeline; Beilvert, Anne; Labarre, Denis; Laurent, Alexandre

    2016-09-10

    Uterine arteries embolization (UAE) is a recent technique that aims, by means of particles injected percutaneously, to stifle fibroids (leiomyomas). This treatment is non-invasive, compared with uterine ablation, but generates pelvic pain for a few days. A strategy to reduce the post-embolization pain would be to use calibrated embolization microspheres preloaded with a non-steroidal inflammatory drug (NSAID). In this study, we first compared four drugs, all active at low concentration on cyclooxygenase-2, i.e. ketoprofen, sodium diclofenac, flurbiprofen and niflumic acid (NFA), for their capacity to be loaded on resorbable embolization microspheres (REM) 500-700μm. NFA had the highest capacity of loading (5mg/mL) on resorbable microspheres. Then, we evaluated in vitro the NFA release profiles from REM having various degradation times of one, two or five days. NFA release was biphasic, with an initial burst (about 60% of the loading) followed by a sustained release that correlated significantly to REM's hydrolysis (rho=0.761, pdegradation rate of REM to provide an antalgic effect for a few days after UAE.

  13. Ulipristal acetate: a novel option for the medical management of symptomatic uterine fibroids.

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    Talaulikar, Vikram S; Manyonda, Isaac T

    2012-08-01

    Fibroids, the most common tumor in women of reproductive age, impact negatively on women's health and quality of life, and have significant cost implications for their management. The current mainstay treatments are surgical (myomectomy and hysterectomy) and more recently radiological (UAE and focused ultrasound surgery). Hysterectomy is curative but precludes future fertility, whereas the impact of the other treatments on reproduction is uncertain. With women in Western societies deferring childbearing to their 30s and 40s, when fibroids are most symptomatic, there is a pressing need for a uterus-sparing medical therapy that is cheap, effective, and enhances reproductive potential. Serendipity and meticulous translational research has shown that progesterone augments fibroid proliferation, raising the possibility that progesterone receptor modulators could inhibit fibroid growth; this research has culminated in the emergence of ulipristal acetate (UA), a first-in-class, oral selective progesterone receptor modulator (SPRM) that has successfully completed phase III clinical trials. It has been licensed in Western Europe for short-term clinical use prior to surgery, and has shown efficacy with a significant reduction in uterine bleeding, fibroid volume, and improved quality of life, without the side effects associated with other medications such as gonadotropin-releasing hormone (GnRH) agonists. As with all new medicines, there are concerns surrounding UA, not least its effect on the endometrium and the long-term impact on general health and reproduction. Research to date has tended to be industry led, and therefore, there is a need for researcher/clinician-led studies to address the wider issues concerning SPRMs. UA may not turn out to be the "Holy Grail" of medical therapy in the treatment of symptomatic uterine fibroids, but it has rightly given cause for a huge optimism. Further laboratory and clinical research into PRMs and related compounds will no doubt lead

  14. Establishment of a scoring system for predicting the difficulty level of high-intensity focussed ultrasound ablation of uterine fibroids.

    Science.gov (United States)

    Liu, Zhongqiong; Gong, Chunmei; Liu, Yunchang; Zhang, Lian

    2017-05-19

    To establish a scoring system that predicts the difficulty level of high-intensity focussed ultrasound (HIFU) ablation of uterine fibroids. Four hundred and twenty-two patients with fibroids were enrolled. The energy efficiency factor (EEF) and sonication time were set as dependent variables, with factors possibly affecting EEF and sonication time including age, body mass index (BMI), the volume of fibroids, the location of the uterus, the type of fibroids, the signal intensity on the T2-weighted imaging (T2WI), the enhancement type, the thickness of the rectus abdominis and the subcutaneous fat layer, the distance from the anterior/posterior surface of the fibroid to the skin, and the abdominal wall scars were set as predictors for building optimal scaling regression models. The volume of the fibroids, the location of the uterus, the signal intensity on T2WI, enhancement type, rectus abdominis thickness, subcutaneous fat thickness, and distance from the anterior surface of fibroid to the skin were related to EEF. Signal intensity on T2WI, the volume of fibroids, distance from the posterior surface of fibroid to the skin, and enhancement type were related to sonication time. Models that can predict the difficulty level of HIFU for fibroids have been established: for EEF, y ' = 0.338X '1 - 0.231X '2+0.156X '3+0.167X '4 ; for sonication time, y = 0.227X1+0.321X2+0.157X3+0.194X4. A scoring system for predicting the difficulty level of HIFU treatment for uterine fibroids has been established and it can be used to help select patients and to predict the sonication time for a given fibroid.

  15. Scaled signal intensity of uterine fibroids based on T2-weighted MR images: a potential objective method to determine the suitability for magnetic resonance-guided focused ultrasound surgery of uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyun [CHA University, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, Gyunggi-do (Korea, Republic of); Yoon, Sang-Wook [CHA University, Department of Diagnostic Radiology, CHA Bundang Medical Center, Sungnam-si, Gyunggi-do (Korea, Republic of); Sokolov, Amit [InSightec Ltd., Haifa (Israel)

    2015-12-15

    Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) is a non-invasive method to treat uterine fibroids. To help determine the patient suitability for MRgFUS, we propose a new objective measure: the scaled signal intensity (SSI) of uterine fibroids in T2 weighted MR images (T2WI). Forty three uterine fibroids in 40 premenopausal women were included in this retrospective study. SSI of each fibroid was measured from the screening T2WI by standardizing its mean signal intensity to a 0-100 scale, using reference intensities of rectus abdominis muscle (0) and subcutaneous fat (100). Correlation between the SSI and the non-perfused volume (NPV) ratio (a measure for treatment success) was calculated. Pre-treatment SSI showed a significant inverse-correlation with post treatment NPV ratio (p < 0.05). When dichotomizing NPV ratio at 45 %, the optimal cut off value of the SSI was found to be 16.0. A fibroid with SSI value 16.0 or less can be expected to have optimal responses. The SSI of uterine fibroids in T2WI can be suggested as an objective parameter to help in patient selection for MRgFUS. (orig.)

  16. Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kooij, Sanne M. van der, E-mail: s.m.vanderkooij@amc.uva.nl; Moolenaar, Lobke M.; Ankum, Willem M. [Academic Medical Centre, Department of Gynaecology (Netherlands); Reekers, Jim A. [Academic Medical Centre, Department of Radiology (Netherlands); Mol, Ben Willem J. [Academic Medical Centre, Department of Gynaecology (Netherlands); Hehenkamp, Wouter J. K. [VU University Medical Centre, Department of Gynaecology (Netherlands)

    2013-12-15

    Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were Euro-Sign 191 and Euro-Sign 355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were Euro-Sign 105 and Euro-Sign 179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.

  17. Randomized Comparison of Uterine Artery Embolization (UAE) with Surgical Treatment in Patients with Symptomatic Uterine Fibroids (REST Trial): Subanalysis of 5-Year MRI Findings

    Energy Technology Data Exchange (ETDEWEB)

    Ananthakrishnan, Ganapathy, E-mail: ganapathy.ananthakrishnan@nhs.net [Gartnavel General Hospital, Department of Interventional Radiology (United Kingdom); Murray, Lilian, E-mail: Lilian.murray@glasgow.ac.uk [Vital Statistics (United Kingdom); Ritchie, Moira, E-mail: moira.ritchie@ggc.scot.nhs.uk [Gartnavel General Hospital, Department of Interventional Radiology (United Kingdom); Murray, Gordon, E-mail: Gordon.murray@ed.ac.uk [Centre for Population Health Sciences, University of Edinburgh, Department of Medical Statistics (United Kingdom); Bryden, Fiona, E-mail: Fiona.bryden@ggc.scot.nhs.uk [Stobhill Hospital (United Kingdom); Lassman, Sue, E-mail: sue.lassman@ggc.scot.nhs.uk [Gartnavel General Hospital, Department of Interventional Radiology (United Kingdom); Lumsden, Mary Ann, E-mail: Maryann.lumsden@glasgow.ac.uk [Room 12, Level 4, Walton Building, Department of Medical Education and Gynaecology, Reproductive and Maternal Medicine (United Kingdom); Moss, Jon G., E-mail: jon.moss@ggc.scot.nhs.uk [Gartnavel General Hospital, Department of Interventional Radiology (United Kingdom)

    2013-06-15

    Purpose. To report 5-year contrast-enhanced magnetic resonance imaging findings of the REST trial recruits who underwent either uterine artery embolization (UAE) or myomectomy. Methods. A total of 157 patients were randomized to UAE or surgery (hysterectomy or myomectomy). Ninety-nine patients who had UAE and eight patients who had myomectomy were analyzed. MRI scans at baseline, 6 months, and 5 years were independently interpreted by two radiologists. Dominant fibroid diameter, uterine volume, total fibroid infarction (complete 100 %, almost complete 90-99 %, partial <90 %), and new fibroid formation were the main parameters assessed and related to the need for reintervention. Results. In the UAE group, mean {+-} standard deviation uterine volume was 670 {+-} 503, 422 {+-} 353, and 292 {+-} 287 mL at baseline, 6 months, and 5 years, respectively. Mean dominant fibroid diameter was 7.6 {+-} 3.0, 5.8 {+-} 2.9, and 5 {+-} 2.9 cm at baseline, 6 months, and 5 years. Fibroid infarction at 6 months was complete in 35 % of women, almost complete in 29 %, and partial in 36 %. Need for reintervention was 19, 10, and 33 % in these groups, respectively (p = 0.123). No myomectomy cases had further intervention. At 5 years, the prevalence of new fibroid was 60 % in the myomectomy group and 7 % in the UAE group (p = 0.008). Conclusion. There is a further significant reduction in both uterine volume and dominant fibroid diameter between 6 months and 5 years after UAE. Complete fibroid infarction does not translate into total freedom from a subsequent reintervention. New fibroid formation is significantly higher after myomectomy.

  18. Percutaneous uterine artery embolization for the treatment of symptomatic fibroids: current status

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    Lupattelli, Tommaso; Basile, Antonio; Garaci, Francesco Giuseppe; Simonetti, Giovanni

    2005-04-01

    Uterine artery embolization (UAE) is increasingly being used as an alternative treatment to hysterectomy for symptomatic fibroids. Symptoms of pelvic pressure, urinary frequency and menorrhagia are controlled in 73-98% of patients who undergo UAE. At the 1-year follow-up, the uterus may shrink by up to 55% but re-growth of fibroid may however occur. The rate of major complications and amenorrhoea following this procedure is low, ranging in most series from 1 to 3.5% and 1 to 7%, respectively. Nevertheless, the rate of amenorrhoea in women over 45 seems to be higher. In order to completely block the arterial supply to the fibroid, UAE is typically performed in both uterine arteries. Different embolic agents are used such as polyvinyl alcohol, gelfoam and more recently gelatine tris-acryl microspheres. After UAE, perfusion of the uterus is maintained. Uterine function is therefore conserved and although women who become pregnant after UAE seem to be at risk for malpresentation, pre-term birth, cesarean delivery and postpartum hemorrhage, successful pregnancies after UAE have been reported in some series. A major technical problem with UAE remains the possible presence of fibroid blood supply from other sources, such as the ovarian arteries or other pelvic branches, which can lead to failure of the procedure. In conclusion, although randomized trials are still underway, UAE appears a good option for those patients who wish to conserve their fertility or when surgery is contra-indicated. However, to evaluate the long-term effects of UAE longer follow up is required.

  19. Impact of periodic health examination on surgical treatment for uterine fibroids in Beijing: a case-control study

    Directory of Open Access Journals (Sweden)

    Yang Ling-Ling

    2010-12-01

    Full Text Available Abstract Background During the past 2 decades, there has been a rapid proliferation of "health examination center (HEC" across China. The effects of their services on public's health have not been systemically investigated. This study aimed to assess the impact of periodic health examination (PHE at HEC on surgical treatment for uterine fibroids in Beijing residents. Methods We identified 224 patients with a primary diagnosis of uterine fibroids who had surgical treatment at four Level-1 general hospitals in Beijing, from June 1, 2009 to October 20, 2009. Controls were women who did not have surgery for uterine fibroids, matched (1:1 ratio for age (within 2 years. A standard questionnaire was used to inquire about whether participants had PHE at HEC during the previous 2 years. Results PHE at HEC within 2 years were associated with surgical treatment for uterine fibroids. Odds ratios was 4.05 (95% CI, 2.61-6.29 P Conclusions Our study showed PHE currently provided at HEC in China were associated with significantly increased use of surgical treatment for uterine fibroids in women. Further studies are needed to assess the effects of PHE on clinical as well as on broad societal outcomes in Chinese in contemporary medical settings.

  20. Cerebral Venous Sinus Thrombosis following Diagnostic Curettage in a Patient with Uterine Fibroid

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    Xiao-Qun Zhu

    2014-01-01

    Full Text Available Cerebral venous sinus thrombosis (CVST is a relatively rare cerebrovascular disease, of which the risk has been documented in patients with numerous conditions. However, CVST has never been previously described in association with the use of a diagnostic curettage in patient with uterine fibroid. Herein, we described a 43-year-old woman who presented with recurrent convulsive seizures and severe and progressive headache 1 day after a diagnostic curettage of the uterus, which was confirmed to be uterine fibroid pathologically later, and her condition subsequently progressed to confusion. Brain magnetic resonance imaging (MRI revealed an acute extensive thrombosis of the left transverse and sigmoid sinus and the ipsilateral cerebellum infarction. Evaluation for primary thrombophilia revealed that an iron deficiency anemia (IDA due to the fibroid bleeding induced menorrhagia together with a diagnostic curettage might be the sole hypercoagulable risk factor identified. Treatment with anticoagulation led to full recovery of her symptoms and recanalization of the thrombosis was proven on magnetic resonance venography (MRV 2 months later. We suggest that CVST should be recognized as a potential complication related to this diagnostic technique, especially in patient with IDA. The early diagnosis and timely treatment would be of significance in improving the prognosis of this potentially lethal condition.

  1. Assessing the Reliability and Quality of Online Uterine Fibroid Embolization Resources

    Energy Technology Data Exchange (ETDEWEB)

    Kaicker, Jatin; Wu Ke; Athreya, Sriharsha, E-mail: sathreya@stjoes.ca [Michael G. Degroote School of Medicine, Department of Medical Imaging (Canada)

    2013-04-15

    This study was designed to examine the best internet resources about uterine fibroid embolization (UFE) pertinent to medical trainees, radiologists, gynecologists, family physicians, and patients. The terms 'uterine fibroid embolization,' 'uterine fibroid embolization,' and 'uterine artery embolization' were entered into Google, Yahoo, and Bing search engines; the top 20 hits were assessed. The hits were categorized as organizational or nonorganizational. Additionally, 23 radiological and obstetrical organizations were assessed. The DISCERN instrument and Journal of the American Medical Association (JAMA) benchmarks (authorship, attribution, currency, disclosure) were used to assess the information critically. The scope, strength, weaknesses, and unique features were highlighted for the top five organizational and nonorganizational websites. A total of 203 websites were reviewed; 23 were removed in accordance with the exclusion criteria and 146 were duplicate websites, for a total of 34 unique sites. It was found that 35 % (12/34 websites) were organizational (family medicine, radiology, obstetrics/gynecology) and 65 % (22/34 websites) were nonorganizational (teaching or patient resources). The overall mean DISCERN score was 49.6 (10.7). Two-tailed, unpaired t test demonstrated no statistically significant difference between organizational and nonorganizational websites (p = 0.101). JAMA benchmarks revealed 44 % (15/34 websites) with authorship, 71 % (24/34 websites) with attribution, 68 % (23/34 websites) with disclosure, and 47 % (16/34 websites) with currency. The overall quality of websites for UFE is moderate, with important but not serious shortcomings. The best websites provided relevant information about the procedure, benefits/risks, and were interactive. DISCERN scores were compromised by sites failing to provide resources for shared decision-making, additional support, and discussing consequence of no treatment. JAMA

  2. Stromal fibroblast activation and their potential association with uterine fibroids (Review)

    Science.gov (United States)

    ZHENG, LI-HUA; CAI, FENG-FENG; GE, ISABELL; BISKUP, EWELINA; CHENG, ZHONG-PING

    2014-01-01

    Uterine fibroids are the most common type of benign, gynecologic neoplasm and are the primary indication for performance of a hysterectomy, accounting for >200,000 hysterectomies annually in the USA. At present, females are younger and exhibit larger leiomyomas at the time of diagnosis. Cancer-associated fibroblasts in tumor microenvironments have emerged as an important target for cancer therapy. Repeated stimulation by infectious or non-infectious agents in the uterine tissues, including inflammation, mechanical forces or hypoxia, stimulate the resident fibroblasts to undergo specific activation and, thus, are significant in tumorigenesis. Furthermore, complex signaling pathways regulate the mechanisms of fibroblastic activation. The current review focuses on the molecular mechanisms of fibroblastic activation and the potential association with uterine leiomyoma pathogenesis, enabling an integrated pathogenic analysis for review of the therapeutic options. PMID:25013460

  3. Chronic anorexia and weight loss due to extensive fibroid compression of the bowel: an unusual complication of uterine fibroids in a patient with a twin pregnancy.

    Science.gov (United States)

    Narayan, Bhaskar; McCarthy, Fergus; Nelson-Piercy, Catherine

    2016-05-05

    A 36-year-old homeless Eritrean nulliparous woman was admitted to hospital, with abdominal pain, nausea and loss of appetite. She was found to be 17 weeks pregnant with dichorionic diamniotic twins. She was cachectic and had large palpable uterine fibroids. An extensive search for infection and malignancy did not yield any significant results. She was managed with enteral nutritional support and delivered healthy twins by emergency caesarean section at 36 weeks' gestation. She re-presented 19 days postpartum, with fever and abdominal pain. Imaging revealed multiple abdominal collections and large degenerating fibroids. At laparotomy, the fibroids were found to be adherent to, compressing and enveloping large sections of bowel. The patient required a right hemicolectomy, small bowel resection and total abdominal hysterectomy. Histology confirmed an infarcted leiomyoma and the patient made a good postoperative recovery.

  4. Incorporating ulipristal acetate in the care of symptomatic uterine fibroids: a Canadian cost-utility analysis of pharmacotherapy management

    Directory of Open Access Journals (Sweden)

    Tsoi B

    2015-04-01

    Full Text Available Bernice Tsoi,1,2 Gord Blackhouse,1,2 Simon Ferrazzi,3 Clare J Reade,4 Innie Chen,5,6 Ron Goeree1,2,7 1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; 2Programs for Assessment of Technology in Health (PATH Research Institute, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada; 3Independent Consultant, Oakville, ON, Canada; 4Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada; 5Department of Obstetrics and Gynaecology, University of Ottawa, 6Ottawa Hospital Research Institute, Ottawa, ON, Canada; 7Centre for Evaluation of Medicines (CEM, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada Objective: To present a Canadian economic evaluation on the cost-utility of ulipristal acetate (5 mg orally daily compared to leuprolide acetate (3.75 mg intramuscular monthly in the treatment of moderate-to-severe symptoms of uterine fibroids in women eligible for surgery. Methods: A probabilistic decision tree was constructed to model the pre-operative pharmacological management of uterine fibroids under the primary perspective of the Ontario public payer. The model parameterized data from clinical trials, observational studies, and public costing databases. The outcome measure was the incremental cost-utility ratio. Uncertainty in the model was explored through sensitivity and scenario analyses. Results: Ulipristal was associated with faster control of excessive menstrual bleeding, fewer symptoms of hot flashes and lower health care resource consumption. The ulipristal strategy dominated leuprolide as it provided patients with more quality-adjusted life years (0.177 versus 0.165 at a lower cost ($1,273 versus $1,366. Across a range of sensitivity analyses, the results remained robust except to the dose of the comparator drug. If leuprolide was administered at 11.25 mg, once every 3 months, the expected cost for the leuprolide strategy would decline and the associated incremental

  5. T2-based temperature monitoring in abdominal fat during HIFU treatment of patients with uterine fibroids

    Science.gov (United States)

    Ozhinsky, Eugene; Kohi, Maureen; Ghanouni, Pejman; Rieke, Viola

    2017-03-01

    In this study, we have implemented T2-based monitoring of near-field heating in patients undergoing HIFU ablation of uterine fibroids using Insightec ExAblate system. In certain areas, near-field heating can reach 18°C and the tissue may experience sustained heating of more than 10°C for the period of 2 hours or more. This indicates a cumulative thermal dose that may cause necrosis. Our results show the feasibility and importance of measuring near-field heating in subcutaneous fat.

  6. Incidence and clinical characteristics of unexpected uterine sarcoma after hysterectomy and myomectomy for uterine fibroids: a retrospective study of 10,248 cases

    Directory of Open Access Journals (Sweden)

    Zhao WC

    2015-10-01

    Full Text Available Wan-Cheng Zhao,1 Fang-Fang Bi,1 Da Li,2 Qing Yang11Department of Obstetrics and Gynecology, 2Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of ChinaBackground: Uterine fibroids often require a hysterectomy or myomectomy via laparotomy or laparoscopy. Morcellation is often necessary to perform a laparoscopic surgery. The objective of this study is to determine the incidence of unexpected uterine sarcomas (UUSs after hysterectomy and myomectomy for uterine fibroids and to reduce the occurrence and avoid the morcellation of UUSs by analyzing their characteristics.Methods: Women who had a hysterectomy or myomectomy for uterine fibroids in Shengjing Hospital of China Medical University between November 2008 and November 2014 were selected for the study, and their clinical characteristics were analyzed.Results: During the period, 48 UUSs were found in 10,248 cases, and the overall incidence was 0.47%. There was no statistical difference (P=0.449 regarding the incidence (0.50% vs 0.33% between 42 UUSs in 8,456 cases undergoing laparotomy and six UUSs in 1,792 cases undergoing laparoscopy. Most of the UUSs were stage I (89.58%, which occurred more commonly (56.25% in women aged 40–49. Abnormal uterine bleeding (39.58% was the main clinical manifestation. Rapidly growing pelvic masses (12.5%, rich blood flow signals (18.75%, and degeneration of uterine fibroids (18.75% prompted by ultrasonography may suggest the possibility of UUSs. The margins of most UUSs (93.75% were regular, which may cause UUSs to be misdiagnosed as uterine fibroids. Fifteen cases underwent magnetic resonance imaging examinations. Approximately 73.33% showed heterogeneous and hypointense signal intensity on T1-weighted images, and 80% showed intermediate-to-high signal intensity on T2-weighted images, with necrosis and hemorrhage in 40% of cases. After contrast administration, 80% presented early heterogeneous

  7. Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fibroids: a pictorial guide to relevant findings in screening pelvic MRI

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sang-Wook; Kim, Kyoung Ah [Pochon CHA University Bundang CHA General Hospital, Department of Diagnostic Radiology, College of Medicine, Gyunggi-do (Korea); Lee, Chan; Na, Young-Jeong; Jung, Sang-Geun; Kim, Seung-Jo [Pochon CHA University Bundang CHA General Hospital, Comprehensive Gynecologic Cancer Center, College of Medicine, Gyunggi-do (Korea); Cha, Sun Hee [Pochon CHA University Bundang CHA General Hospital, Department of Obstetrics and Gynecology, College of Medicine, Gyunggi-do (Korea); Yu, Jeong-Sik [YongDong Severance Hospital, Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul (Korea)

    2008-12-15

    Uterine leiomyomas (fibroids), the most common benign tumor in women of childbearing age, can cause symptoms including dysmenorrhea, menorrhagia, urinary symptoms, pain and infertility. Hysterectomy is a common approach to treating uterine fibroids, and less invasive surgical approaches such as myomectomy and uterine artery embolization also have been shown to alleviate symptoms. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is the only totally non-invasive surgical approved method for treating uterine fibroids. In clinical trials, MRgFUS resulted in significant relief of uterine fibroid symptoms. The safe and effective use of MRgFUS is affected by fibroid type and location, position relative to adjacent anatomical structures and the presence of co-existent pelvic disease. Additionally, successful outcomes with MRgFUS have been correlated with the volume of fibroids ablated during the procedure. Thus, selection of patients in whom sufficient fibroid volumes can be treated safely using the MRgFUS system is critical for successful outcomes. The MR images in this pictorial essay provide examples of uterine fibroids for which MRgFUS should be considered and is designed to facilitate the selection of patients for whom MRgFUS is most likely to provide sustained symptom relief. (orig.)

  8. Interest of uterine artery embolization with gelatin sponge particles prior to myomectomy for large and/or multiple fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Butori, Noemie [Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Tixier, Herve; Filipuzzi, Laurence; Mutamba, William [Department of Gynecology and Obstetrics, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Guiu, Boris; Cercueil, Jean-Pierre [Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Douvier, Serge; Sagot, Paul [Department of Gynecology and Obstetrics, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Krause, Denis [Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Loffroy, Romaric, E-mail: romaric.loffroy@chu-dijon.fr [Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France)

    2011-07-15

    Purpose: To evaluate the efficacy of pre-myomectomy uterine artery embolization with gelatin sponge particles to reduce operative blood loss and facilitate removal of fibroids. Materials and methods: This retrospective study included 33 women (mean age, 36 years; range, 24-45 years), of whom at least 18 wished to preserve fertility. They presented with at least one large myoma (mean diameter, 90 mm; range, 50-150 mm) and had undergone preoperative uterine artery embolization with resorbable gelatin sponge by unilateral femoral approach between December 2001 and November 2008. Clinical, radiological and surgical data were available for all patients. Mean haemoglobin levels before and after surgery were compared with Student's t-test. Results: No complication or technical failure of embolization occurred. The myomectomies were performed during laparotomy (25 cases) or laparoscopy (8 cases). Dissection of fibroids was easier (mean, 3 per patient; range, 1-11), with a mean operating time of 108 {+-} 50 min (range, 30-260 min). Bloodless surgery was the rule with a mean estimated peroperative blood loss of 147 {+-} 249 mL (range, 0-800 mL). Mean pre-(12.9 {+-} 1.3 g/dL) and post-therapeutic (11.4 {+-} 1.2 g/dL) haemoglobin levels were not statistically different (p > 0.05). There was no need for blood transfusion. None of the patients required hysterectomy. The mean duration of hospital stay was 7.5 {+-} 1.3 days (range, 3-12 days). Conclusion: Preoperative uterine artery embolization is effective in reducing intraoperative blood loss and improves the chances of performing conservative surgery. It should be considered a useful adjunct to myomectomy in women at high hemorrhagic risk or who refuse blood transfusion.

  9. Complications and Reinterventions in Uterine Artery Embolization for Symptomatic Uterine Fibroids: A Literature Review and Meta Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Jason, E-mail: Jason.martin@medportal.ca; Bhanot, Kunal, E-mail: Kunal.Bhanot@medportal.ca [Michael G. DeGroote School of Medicine, McMaster University (Canada); Athreya, Sriharsha, E-mail: harshavbs@yahoo.com [St. Joseph' s Health Care Hamilton, McMaster University, Faculty of Health Sciences (Canada)

    2013-04-15

    To perform a literature review of the spectrum of complications associated with UAE relative to surgery and compare the risk of reintervention as well as minor, major, and overall complications. Literature review was conducted in PubMed, MEDLINE, Cochrane, and CINAHL databases, and meta-analysis was performed. In randomized clinical trials, common complications were discharge and fever (4.00 %), bilateral uterine artery embolization (UAE) failure (4.00 %), and postembolization syndrome (2.86 %). Two trials showed a significantly decreased risk in major complications with UAE, with odds ratios (ORs) of 0.07143 (0.009426-0.5413) and 0.5196 (0.279-0.9678). None of the trials showed a significant difference in OR for minor complications of UAE. None of the trials showed a significant difference in risk for overall complications of UAE. Three trials showed a significantly increased risk for reintervention with UAE with ORs of 10.45 (2.654-41.14), 2.679 (1.289-5.564), and 9.096 (1.269-65.18). In 76 nonrandomized studies, common complications were amenorrhea (4.26 %), pain (3.59 %), and discharge and fever (3.37 %). In 41 case studies, common complications were discharge and fever (n = 22 cases), repeat UAE (n = 6 cases), and fibroid expulsion (n = 5 cases). Overall, UAE has a significantly lower rate of major complications relative to surgery, but it comes at the cost of increased risk of reintervention in the future. Educating patients about the rate and types of complications of UAE versus surgery, as well as the potential for reintervention, should help the patient and clinician come to a reasoned decision.

  10. Long-term intermittent pharmacological therapy of uterine fibroids – a possibility to avoid hysterectomy and its negative consequences

    Directory of Open Access Journals (Sweden)

    Anita Olejek

    2016-03-01

    Full Text Available Uterine fibroids are found in almost 20-40% of women of reproductive age. For each woman an individualised treatment method should be applied because the hysterectomy procedure is not a good option in every case. The uterus is an organ necessary not only in reproduction. Its removal may result in: pelvic floor dysfunction and stress urinary incontinence, negative impair on life quality, depressive disorders, increased risk of cardiovascular and neurodegenerative diseases, and higher incidence of neoplastic disease. According to the last scientific reports, selective progesterone receptor modulators are the effective therapeutic option in uterine fibroids in women of reproductive age because progesterone is an important factor in their pathogenesis. Ulipristal acetate (UPA is a progesterone receptor antagonist. It inhibits cell proliferation and angiogenesis in uterine fibroids and also reduces collagen deposits in extracellular matrix. Significant data concerning ulipristal acetate efficacy have been provided by scientific research, especially from the consecutive PEARL studies. Oral ulipristal acetate effectively and safely controls bleeding and pain in patients with symptomatic fibroids. It reduces fibroid volume and restores quality of life. The results of UPA long-term intermittent treatment are largely maintained during the off-treatment periods.

  11. PROMISe trial: a pilot, randomized, placebo-controlled trial of magnetic resonance guided focused ultrasound for uterine fibroids.

    Science.gov (United States)

    Jacoby, Vanessa L; Kohi, Maureen P; Poder, Liina; Jacoby, Alison; Lager, Jeanette; Schembri, Michael; Rieke, Viola; Grady, Deborah; Vittinghoff, Eric; Coakley, Fergus V

    2016-03-01

    To evaluate the feasibility of a full-scale placebo-controlled trial of magnetic resonance-guided focused ultrasound for fibroids (MRgFUS) and obtain estimates of safety and efficacy. Pilot, randomized, placebo-controlled trial. University medical center. Premenopausal women with symptomatic uterine fibroids. Participants randomized in a 2:1 ratio to receive MRgFUS or placebo procedure. change in fibroid symptoms from baseline to 4 and 12 weeks after treatment assessed by the Uterine Fibroid Symptom Quality of Life Questionnaire (UFS-QOL); secondary outcome: incidence of surgery or procedures for recurrent symptoms at 12 and 24 months. Twenty women with a mean age of 44 years (±standard deviation 5.4 years) were enrolled, and 13 were randomly assigned to MRgFUS and 7 to placebo. Four weeks after treatment, all participants reported improvement in the UFS-QOL: a mean of 10 points in the MRgFUS group and 9 points in the placebo group (for difference in change between groups). By 12 weeks, the MRgFUS group had improved more than the placebo group (mean 31 points and 13 points, respectively). The mean fibroid volume decreased 18% in the MRgFUS group with no decrease in the placebo group at 12 weeks. Two years after MRgFUS, 4 of 12 women who had a follow-up evaluation (30%) had undergone another fibroid surgery or procedure. Women with fibroids were willing to enroll in a randomized, placebo-controlled trial of MRgFUS. A placebo effect may explain some of the improvement in fibroid-related symptoms observed in the first 12 weeks after MRgFUS. NCT01377519. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  12. Early ultrasonographic findings after a uterine fibroid embolization: the value of differentiate from procedure-related uterine infection

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Goo, Dong Erk; Chang, Yun Woo [Soonchunhyang University, Gumi Hospital, Gumi (Korea, Republic of); Choi, Jin Soo [School of Medicine, Keimyung University, Daegu (Korea, Republic of)

    2008-03-15

    To evaluate the early ultrasonographic (US) findings from the uterus and myoma after a uterine fibroid embolization (UFE). From March 2004 to January 2006, eleven patients (27-48 years, mean:37 years) with UFE to treat symptomatic uterine myoma, were retrospectively reviewed. A serial follow up gray-scale and color Doppler US were performed from one day to two weeks following a UFE. The US findings were evaluated for the presence and distribution pattern of air, time of air loss, and presence of fluid collection in the uterine cavity and color Doppler (SD Comment: Doppler is name. Should perhaps be upper case) signal. Numerous high echoes with reverberation artifacts (which suggest air), were observed within the myoma (in all cases), one day after UFE. A branching linear echo pattern was observed in 4 cases (36%), whereas scattered echoes were observed in 7 cases (64%). Progressive loss of air, within 7 days of a UFE, was observed in 9 cases (82%), whereas 2 cases (12%) were observed within 14 days of a UFE. Abnormal fluid collection in the uterine cavity and a color Doppler signal within the myoma was not observed for all cases. Branching or scattered echoes (suggesting air), are normally found within the myoma after a UFE, but these echoes disappeared within 2 weeks. These early US findings can be useful in differentiating from myoma infections after a UFE.

  13. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women

    Directory of Open Access Journals (Sweden)

    Zimmermann Anne

    2012-03-01

    Full Text Available Abstract Background In 2009 the Uterine Bleeding and Pain Women's Research Study (UBP-WRS was conducted interviewing 21,479 women across 8 countries in order to gain patient-based prevalence data on uterine pain and bleeding indications and investigate uterine symptoms and women's treatment experiences. This article shows relevant results of the study for the indication uterine fibroids providing data on self-reported prevalence, symptomatology and management of uterine fibroids. Methods 2,500 women (USA: 4,500 women in each country (Brazil, Canada, France, Germany, Italy, South Korea, the UK, the USA completed an online survey. Women included were in their reproductive age (age group 15-49 years; USA: 18-49 years and had ever experienced menstrual bleedings. Quotas were applied for age, region, level of education and household income of respondents. Variables have been analyzed descriptively and exploratory statistical tests have been performed. Results The self-reported prevalence of uterine fibroids ranged from 4.5% (UK to 9.8% (Italy, reaching 9.4% (UK to 17.8% (Italy in the age group of 40-49 years. Women with a diagnosis of uterine fibroids reported significantly more often about bleeding symptoms than women without a diagnosis: heavy bleedings (59.8% vs. 37.4%, prolonged bleedings (37.3% vs. 15.6%, bleeding between periods (33.3% vs. 13.5%, frequent periods (28.4% vs. 15.2%, irregular and predictable periods (36.3% vs. 23.9%. Furthermore women with diagnosed uterine fibroids reported significantly more often about the following pain symptoms: pressure on the bladder (32.6% vs. 15.0%, chronic pelvic pain (14.5% vs. 2.9%, painful sexual intercourse (23.5% vs. 9.1% and pain occurring mid-cycle, after and during menstrual bleeding (31.3%, 16.7%, 59.7%, vs. 17.1%, 6.4%, 52.0%. 53.7% of women reported that their symptoms had a negative impact on their life in the last 12 month, influencing their sexual life (42.9%, performance at work (27

  14. Uterine leiomyomas/fibroids are the most common pelvic tumors of the female genital tract. Transforming growth factor beta (TGF β family members are multi-functional cytokines that play a key role in cellular growth, proliferation and differentiation. The aim of this study was to investigate whether TGF β1 - 509 C/T polymorphism could be used as a susceptibility marker in Uterine fibroids pathogenesis. ARMS PCR was carried out for controls and patients (n=103 to identify the specific genotypes. Genotypes and allelic frequencies in both groups were compared. Proportions of C homozygote, heterozygote and T homozygote for TGF β1gene polymorphisms were 37.9%, 44.7%, 17.5% in the control individuals and 37%, 51.5%, 11.7% in the uterine fibroid patients. There was no significant difference between the controls and the patients thus indicating the tumor suppressor effect of TGF β1 in the early stages of tumor pathogenesis. The study was found to be in association with the earlier reported data wherein TGF β1 acts as tumor suppressor in the early stages and as a tumor promoter in the later stages of tumor pathogenesis

    Directory of Open Access Journals (Sweden)

    M.Veronica

    2013-06-01

    Full Text Available Uterine leiomyomas/fibroids are the most common pelvic tumors of the female genital tract. Transforming growth factor beta (TGF β family members are multi-functional cytokines that play a key role in cellular growth, proliferation and differentiation. The aim of this study was to investigate whether TGF β1 - 509 C/T polymorphism could be used as a susceptibility marker in Uterine fibroids pathogenesis. ARMS PCR was carried out for controls and patients (n=103 to identify the specific genotypes. Genotypes and allelic frequencies in both groups were compared. Proportions of C homozygote, heterozygote and T homozygote for TGF β1gene polymorphisms were 37.9%, 44.7%, 17.5% in the control individuals and 37%, 51.5%, 11.7% in the uterine fibroid patients. There was no significant difference between the controls and the patients thus indicating the tumor suppressor effect of TGF β1 in the early stages of tumor pathogenesis. The study was found to be in association with the earlier reported data wherein TGF β1 acts as tumor suppressor in the early stages and as a tumor promoter in the later stages of tumor pathogenesis

  15. Telomerase expression abrogates rapamycin-induced irreversible growth arrest of uterine fibroid smooth muscle cells.

    Science.gov (United States)

    Suo, Guangli; Sadarangani, Anil; Tang, Wingchung; Cowan, Bryan D; Wang, Jean Y J

    2014-09-01

    Uterine fibroids are the most common solid tumors found in women of reproductive age. It has been reported that deregulation of the mammalian target of rapamycin (mTOR) pathway plays an important role in the etiology of leiomyoma. Here, we investigated the effect of rapamycin, an inhibitor of mTORC1, on the growth of primary fibroid smooth muscle cells (fSMCs) and human telomerase reverse transcriptase (hTERT)-transduced and immortalized fSMCs. With the primary fSMCs, a 24-hour treatment with rapamycin was sufficient to trigger a growth arrest that was not reversible upon drug removal. By contrast, the growth inhibitory effect of rapamycin on the hTERT-transduced fSMCs was readily reversible, as these cells resumed proliferation upon the withdrawal of the drug. These results suggest that rapamycin-induced irreversible growth arrest of fSMCs is dependent on the senescence barrier that is abrogated by the ectopic expression of telomerase.

  16. Racial/Ethnic Differences in Women's Experiences with Symptomatic Uterine Fibroids: a Qualitative Assessment.

    Science.gov (United States)

    Sengoba, Katherine S; Ghant, Marissa S; Okeigwe, Ijeoma; Mendoza, Gricelda; Marsh, Erica E

    2017-04-01

    The purpose of this study is to determine racial/ethnic differences in treatment experiences and expectations among women with fibroids. Sixty women with symptomatic uterine fibroids completed semi-structured interviews, demographic surveys, and a health literacy assessment. Participants were recruited from community-based organizations and health care organizations. Data from interviews were analyzed using a grounded theory approach. Three coders identified major themes and subthemes. The kappa (κ) among coders was 0.94. The mean age of participants was 43.0 ± 6.8 (mean ± SD). A total of 61.7 % of subjects were African-American (AAW), 25.0 % were non-Hispanic White (WW), 8.3 % were Hispanic (HW), and 5.0 % were Asian (ASW). When considering treatment options, AAW were more likely to want a permanent intervention. They were also more likely to demonstrate an aversion toward conventional treatments. Of the women who received a surgical intervention, AAW were also more likely to have had a difficult recovery and to be dissatisfied with their treatment. Finally, AAW disproportionately expressed concern regarding financial challenges. AAW have high treatment expectations, have more financial obstacles, and are less satisfied with their treatment outcomes than women of other racial/ethnic groups. Our findings suggest a need to create targeted patient interventions and education to ameliorate these disparities in experience.

  17. Impact of spontaneous fibroid expulsion of uterine leiomyoma on pregnancy outcome after uterine arteries embolization

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    Medvediev M.V.

    2015-09-01

    Full Text Available Uterine leiomyoma (UL is common benign tumor of female genitals. Uterine artery embolization (UAE is widely used method of organ-sparing UL treatment. Safe ty of this procedure for future fertility and labor is controversial. We present a case of pregnancy in woman who previously underwent uterine artery embolization. During 12-months’ follow-up period patient periodically noted vaginal di¬scharge. No signs of UL have been found on ultrasound in 12 months of follow-up. Normal pregnancy occurred 1.5 years after UAE procedure which ended in normal labor without complications. Most authors report increased risk of pregnancy complications such as postpartum hemorrhage, preterm delivery, malpresentation after UAE. Our point of view is that a lot of pregnancy complications are possibly associated with persistence of necrotic leiomyoma tissue in uterine wall after UAE. Presented case allowed to draw preliminary conclusions that complete disappearance of UL nodule after UAE could improve pregnancy outcomes.

  18. Long-term results of symptomatic fibroids treated with uterine artery embolization: In conjunction with MR evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Man Deuk [Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of)], E-mail: mdkim@cha.ac.kr; Lee, Hyun Seok [Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of); Lee, Mee Hwa [Department of Obstetrics and Gynecology, Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of); Kim, Hee Jin [Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of); Cho, Jin Ho; Cha, Sun Hee [Department of Obstetrics and Gynecology, Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of)

    2010-02-15

    Objective: The aim of the present study is to determine long-term clinical efficacy of uterine fibroid embolization (UFE) for symptomatic fibroids in conjunction with MR evaluation. Materials and methods: Sixteen patients with a follow-up period of 4 years or longer were analyzed retrospectively. Ages ranged from 27 to 45 (mean 39.5) years. Mean follow-up periods were 5.8 years (range: 4.1-6.9 years). The symptom changes, in terms of menorrhagia and dysmenorrhea and bulk-related symptoms, were assessed. The primary embolic agent was polyvinyl alcohol particle (250-710 {mu}m). All patients underwent preprocedural and long-term follow up MR imaging. Uterine volumes were calculated using MRI. Results: Symptom improvements were reported for menorrhagia (8/9, 88.9%), dysmenorrhea (5/5, 100%), and bulk-related symptoms (7/9, 77.8%) at long-term follow up. Two patients (12.5%) had symptom recurrences at long-term follow-up. Tumor regrowth from incomplete infarction was a cause of recurrence in one patient and newly developed leiomyomas in the other one. One patient underwent hysterectomy because endometriosis developed 4 years after UFE. Of the 14 necrotic myomas on short-term follow up MR after UFE, eight (57.1%) demonstrated maintaining necrosis with further shrinkage and six (42.9%) were no longer visualized on long-term follow up MR images. Overall, the mean volume reduction rates of the predominant fibroid and uterus were 80.5%, 36.7% at long-term follow up, respectively. Conclusion: UFE is an effective treatment for symptomatic fibroids with an acceptable long-term success rate. Long-term MR imaging after UFE revealed persistent necrotic fibroid, non-visualization of fibroids and tumor regrowth when incompletely infarcted.

  19. Safety after extended repeated use of ulipristal acetate for uterine fibroids

    Science.gov (United States)

    Donnez, Jacques; Bouchard, Philippe; Barlow, David H.; Vázquez, Francisco; Skouby, Sven O.; Palacios, Santiago; Tomaszewski, Janusz; Lemieszczuk, Boguslaw; William, Alistair R. W.

    2017-01-01

    Objective To assess long term safety of extended repeated 3-month courses of ulipristal acetate (UPA) 10 mg/day, for up to 8 courses, with focus on endometrial and laboratory safety parameters. Methods This long-term, multi-center, open-label cohort, follow up study consisted of up to 8 consecutive 3-month courses of daily UPA 10 mg, each separated by a drug free period of 2 spontaneous menstrual bleeds. Sixty-four pre-menopausal women, with moderate to severe symptomatic uterine myoma(s) and heavy bleeding were enrolled and were studied for approximately 4 years. The main outcome measures were endometrial histology, laboratory parameters and general safety. Results All data was reported in a descriptive manner with no formal statistical comparisons. In the 64 women, non-physiological changes (mostly cyst formation, epithelial and vascular changes) in endometrial histology at screening and after treatment courses 4 and 8 were observed in 18.0%, 21.4% and 16.3% of biopsies, respectively. After treatment cessation, such changes were observed in 9.1% of biopsies. All endometrial biopsies were benign after course 8. The median endometrial thickness was 7.0 mm, 10–18 days after the start of menses following treatment courses 5–8, compared to 9.0 mm at screening (before UPA treatment). No changes in the number and type of laboratory results outside the normal ranges were observed with the increasing treatment courses. In total, adverse events were reported in 10 (16%), 12 (19%), 8 (14%) and 5 (9%) subjects, during treatment courses 5, 6, 7 and 8, respectively of which the most frequent adverse events were headache and hot flush. Conclusion The results of this study further support the safety profile of extended repeated 3 months treatment of symptomatic fibroids with ulipristal acetate 10 mg/day. Repeated UPA treatment courses did not result in any changes of concern in endometrial histology, endometrial thickness, or laboratory safety measures. PMID:28267814

  20. Role of levonorgestrel releasing intra-uterine system in the treatment of menorrhagia due to dysfunctional uterine bleeding and fibroid uterus

    Directory of Open Access Journals (Sweden)

    Reena Gupta

    2014-06-01

    Full Text Available Background: This study was carried out to assess the clinical effectiveness of levonorgestrel releasing intrauterine device (LNG-IUS in the treatment of menorrhagia due to either Dysfunctional Uterine Bleeding (DUB or fibroid in Indian patients, and to assess patient satisfaction with this treatment modality. Methods: Sixty women with menorrhagia, 30 due to fibroid and 30 due to DUB, meeting inclusion criteria, received LNG-IUS and were prospectively followed up for 9 months with periodic clinical assessments and transvaginal ultrasounds. Patient satisfaction was assessed on a five-point scale. Results: One patient in DUB group was lost to follow-up. In DUB patients, the treatment failure rate was only 3.4% (1 out of 29 patients. The median PBAC score reduced by 95% at 9 months. Fibroid patients also had an equally impressive 97.7% reduction of PBAC score at 9 months, although the failure rate was higher (23.3%; 7 out of 30. Majority of patients were either and lsquo;very satisfied' or and lsquo;satisfied' with the treatment, although this percentage was more in DUB (82.8% than in the fibroid group (66.7%. Haemoglobin and serum ferritin levels significantly increased in both groups. No major side effect was noted. Conclusions: LNG-IUS is an excellent treatment modality for patients of DUB, with good patient satisfaction. It is also a useful treatment option in non-submucosal small fibroids for the symptoms of menorrhagia, can reduce uterine volume and can help avoid hysterectomy, but there is no effect on fibroid volume. Majority of patients are satisfied, although satisfaction rates are less than in DUB patients. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 671-677

  1. Unplanned pregnancy after ultrasound-guided percutaneous microwave ablation of uterine fibroids: A follow-up study.

    Science.gov (United States)

    Bing-song, Zhang; Jing, Zhang; Zhi-Yu, Han; Chang-tao, Xu; Rui-fang, Xu; Xiu-mei, Li; Hui, Liu

    2016-01-06

    A follow-up study was performed with 169 women of childbearing age who underwent ultrasound-guided percutaneous microwave ablation (UPMWA) therapy for symptomatic uterine fibroids in the Chinese PLA General Hospital from June 2007 to December 2014. This study aimed to observe the incidence of unplanned pregnancies in these women after UPMWA treatment in order to evaluate its effect on natural conception. Ten unplanned pregnancies in nine women were occurred. Of the nine patients, six did not want the pregnancy and chose for induced abortion to end the pregnancy at an early stage. Three chose to continue with the pregnancy and gave birth to a healthy term infant delivered by cesarean section (of these three patients, two had been previously diagnosed as infertility). None of the patients had any serious obstetric complications. After UPMWA treatment for uterine fibroids, patients may conceive naturally, the impact of the procedure on fertility and pregnancy outcomes is worthy of further prospective study in larger sample.

  2. Use of dietary phytochemicals to target inflammation, fibrosis, proliferation, and angiogenesis in uterine tissues: promising options for prevention and treatment of uterine fibroids?

    Science.gov (United States)

    Islam, Md Soriful; Akhtar, Most Mauluda; Ciavattini, Andrea; Giannubilo, Stefano Raffaele; Protic, Olga; Janjusevic, Milijana; Procopio, Antonio Domenico; Segars, James H; Castellucci, Mario; Ciarmela, Pasquapina

    2014-08-01

    Uterine leiomyomas (fibroids, myomas) are the most common benign tumors of female reproductive tract. They are highly prevalent, with 70-80% of women burdened by the end of their reproductive years. Fibroids are a leading cause of pelvic pain, abnormal vaginal bleeding, pressure on the bladder, miscarriage, and infertility. They are the leading indication for hysterectomy, and costs exceed 6 billion dollars annually in the United States. Unfortunately, no long-term medical treatments are available. Dysregulation of inflammatory processes are thought to be involved in the initiation of leiomyoma and extracellular matrix deposition, cell proliferation, and angiogenesis are the key cellular events implicated in leiomyoma growth. In modern pharmaceutical industries, dietary phytochemicals are used as source of new potential drugs for many kinds of tumors. Dietary phytochemicals may exert therapeutic effects by interfering with key cellular events of the tumorigenesis process. At present, a negligible number of phytochemicals have been tested as therapeutic agents against fibroids. In this context, our aim was to introduce some of the potential dietary phytochemicals that have shown anti-inflammatory, antiproliferative, antifibrotic, and antiangiogenic activities in different biological systems. This review could be useful to stimulate the evaluation of these phytochemicals as possible therapies for uterine fibroids.

  3. Uterine fibroids - therapy from the point of view of the gynaecologist; Uterusmyome - Behandlungsoptionen aus der Sicht des Gynaekologen

    Energy Technology Data Exchange (ETDEWEB)

    Middendorf, K. [Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Grosshadern, Ludwig-Maximilians-Universitaet Muenchen (Germany); Klink und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Grosshadern, Klinikum der Universitaet, Marchioninistr. 15, 81377, Muenchen (Germany); Burges, A.; Strauss, A.; Hepp, H. [Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Grosshadern, Ludwig-Maximilians-Universitaet Muenchen (Germany)

    2003-08-01

    Uterine fibroids are the most common benign tumour affecting the female reproductive tract, 20% of all women older than 35 years are afflicted. Patients with fibroids tend to be asymptomatic, but fibroids may lead to meno-, metrorrhagia, hyper- and dysmenorrhoea and urination and defecation problems. If the fibroids do not cause any clinical symptoms and if there is no suspicion of a malignant tumor, there is no need for therapeutic intervention. Otherwise, besides the medical management with gestagenes and GnRH (gonadotropin-releasing hormone) analog, surgery represents the classical treatment. Hysterectomy is the common approach for women with completed family planning. For women who wish to conserve their fertility enucleation of the fibroids can be considered. These surgical procedures can be performed endoscopically or abdominally. Uterine artery embolisation, a radiological intervention, is less invasive and represents an interesting therapeutic alternative. (orig.) [German] Uterusmyome sind die haeufigste benigne Raumforderung im weiblichen Genitaltrakt, 20% aller Frauen ueber 35 Jahren sind davon betroffen. Meist sind sie asymptomatisch, Myome koennen jedoch auch zu Meno-, Metrorrhagien, Hyper- und Dysmenorrhoe sowie Beschwerden bei Miktion und Defaekation fuehren. Waehrend bei fehlender klinischer Symptomatik und insuspektem Befund kein therapeutischer Handlungsbedarf besteht, wird bei klinischer Symptomatik die Indikation zur therapeutischen Intervention gestellt. Neben der medikamentoesen Therapie mit Gestagenen und GnRH-(Gonadotropine-releasing-hormone-)Analoga ist die Operation das Verfahren der Wahl. Waehrend bei abgeschlossener Familienplanung eine Hysterektomie sinnvoll ist, wird bei Wunsch nach Organerhalt eine Myomenukleation durchgefuehrt, wobei endoskopische Verfahren und ein abdominaler Zugangsweg gewaehlt werden koennen. Die radiologisch interventionelle Myomembolisation stellt aufgrund ihrer geringeren Invasivitaet eine interessante

  4. Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Kurinchi S Gurusamy

    Full Text Available Uterine fibroids are common, often symptomatic and a third of women need repeated time off work. Consequently 25% to 50% of women with fibroids receive surgical treatment, namely myomectomy or hysterectomy. Hysterectomy is the definitive treatment as fibroids are hormone dependent and frequently recurrent. Medical treatment aims to control symptoms in order to replace or delay surgery. This may improve the outcome of surgery and prevent recurrence.To determine whether any medical treatment can be recommended in the treatment of women with fibroids about to undergo surgery and in those for whom surgery is not planned based on currently available evidence.Two authors independently identified randomised controlled trials (RCT of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials.gov until December 2013.Two authors independently extracted data from identified studies.A Bayesian network meta-analysis was performed following the National Institute for Health and Care Excellence-Decision Support Unit guidelines. Odds ratios, rate ratios, or mean differences with 95% credible intervals (CrI were calculated.A total of 75 RCT met the inclusion criteria, 47 of which were included in the network meta-analysis. The overall quality of evidence was very low. The network meta-analysis showed differing results for different outcomes.There is currently insufficient evidence to recommend any medical treatment in the management of fibroids. Certain treatments have future promise however further, well designed RCTs are needed.

  5. A giant uterine myometrium cyst mimicking an ovarian cyst in pregnancy: An uncommon presentation of hydropic degeneration of uterine fibroid

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    Elsayed Elbadawy Awad

    2015-06-01

    Full Text Available Myometrial cysts of the uterus are extremely rare. Uterine leiomyomas commonly undergo degenerative changes, which can lead to variable imaging features. Diffuse hydropic change is an unusual form that presents a considerable diagnostic challenge to both radiologists and pathologists. A 27-year old nulliparous patient admitted to our hospital for antenatal care and left sided pelvic pain. Transvaginal ultrasonographic examination revealed a 20 cm intramural cystic lesion in the left region of the corpus uteri suspicious of degenerated myoma. Repeated aspiration was done. Spontaneous abortion occurred in the first trimester. Rapid distension of the abdomen despite repeated aspirations occurred. MRI revealed degenerated myoma. Ultrasound performed one day before surgery revealed a turbid content instead of the clear fluid. Laparotomy was performed revealing a huge interstitial myoma with bloody collection inside so, myomectomy was performed. Histopathology showed hydropic degenerated myoma. Although fibroids usually have a characteristic sonographic appearance, degenerating myomas have variable patterns and can pose a diagnostic dilemma. Extensive cystic degeneration can mimic an ovarian tumour.

  6. Abnormal excessive per vagina (PV) bleeding on Esmya-selective progesterone receptor modulator (SPRM) in a symptomatic patient with uterine fibroid.

    Science.gov (United States)

    Matytsina-Quinlan, Lyubov; Matytsina, Laura

    2015-05-14

    A woman in her late 40s presented with excessive per vagina (PV) bleeding and uterine fibroid. She reported excessive PV bleeding after starting Esmya; she was brought in by ambulance to the emergency department with profuse bleeding. Abnormal uterine bleeding (AUB) developed after selective progesterone receptor modulator (SPRM) administration in this symptomatic patient with uterine fibroid. The drug was withheld and surgical treatment considered. Progressive deterioration of PV bleeding after receiving SPRM led to an urgent laparoscopic total hysterectomy, which had to be postponed due to severe anaemia. Surgery took place regardless because the excessive bleeding continued. Histology revealed a 6 cm submucosal uterine fibroid (SMUF) and adenomyosis. Physicians prescribing SPRMs to stop PV bleeding should be aware of potential AUB, which could lead to urgent hysterectomy. The mechanism of action of SPRMs is not clearly understood. Awareness of the side effects of Esmya, such as AUB, must be kept in mind when administering SPRMs.

  7. EFFECTIVENESS AND SAFETY OF MIFEPRISTONE IN DIFFERENT DOSE (10 MG AND 25 MG FOR THE TREATMENT OF UTERINE FIBROIDS AND TO EVALUATE QUALITY OF LIFE

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    Pratibha Rai

    2016-07-01

    biopsy was also done to note the changes prior to starting Mifepristone. Both groups A and B were advised to come at one month interval for clinical assessment and USG examination was performed to see the size of fibroids and uterine volume. At three months interval endometrial thickness associated with Mifepristone, Liver function test to see the level of Aspartate Transaminase (ASAT, Alanine Transaminase (ALAT level and also other side effects of Mifepristone if any. Haematological examination was also performed at 1st visit and at 3 and 6 months’ interval. This research is to give quality of life without side effects in a short period, eg: 3 to 6 months or even earlier. RESULTS Benign changes associated with PRM (Selective Progesterone Receptor Modulator was diagnosed in (15/20 75% and (12/20 60% of patient in 25 mg and 10 mg group respectively. Elevation of hepatic transaminase were observed in only four cases. Complete amenorrhoea observed in 25 mg group and scanty and infrequent period in 10 mg group. Occasional hot flushes observed in 4 cases on 10 mg and 5 cases on 25 mg group. Relief in pressure symptoms was 98% in 25 mg group as compared to 72% in 10 mg group. CONCLUSION For better results, 25 mg Mifepristone can be given safely after proper scrutiny for earlier improvement.

  8. Outcome of unintended pregnancy after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids.

    Science.gov (United States)

    Qin, Juan; Chen, Jin-Yun; Zhao, Wen-Peng; Hu, Liang; Chen, Wen-Zhi; Wang, Zhi-Biao

    2012-06-01

    To evaluate the safety of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids among women with unintentional pregnancy within 1 year of therapy. A retrospective analysis was conducted of 435 women who underwent USgHIFU therapy at Chongqing Medical University, China, between October 1, 2006, and October 1, 2009. Unplanned pregnancy was reported by 24 women within 1 year of USgHIFU ablation; 8 of these women had desired pregnancy before undergoing treatment. A total of 27 fibroids were detected, 24 of which were treated (mean volume 65.9±58.8 cm(3)). Pregnancy was continued by 7 women without any complications. One pregnant woman who had desired pregnancy before therapy underwent an induced abortion owing to concerns about the effects of USgHIFU on the fetus. Fourteen women without pregnancy intention before USgHIFU therapy chose to undergo induced abortion; 2 women experienced spontaneous abortion. No adhesion occurred after USgHIFU therapy. Furthermore, USgHIFU, labor, and abortion had no effect on subsequent menstruation or sexual activities. Pregnancy within 1 year after USgHIFU ablation of uterine fibroids appears safe; however, large scale studies are required to confirm these data. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  9. Growth factors and myometrium: biological effects in uterine fibroid and possible clinical implications

    Science.gov (United States)

    Ciarmela, Pasquapina; Islam, Md. Soriful; Reis, Fernando M.; Gray, Peter C.; Bloise, Enrrico; Petraglia, Felice; Vale, Wylie; Castellucci, Mario

    2011-01-01

    BACKGROUND Growth factors are proteins secreted by a number of cell types that are capable of modulating cellular growth, proliferation and cellular differentiation. It is well accepted that uterine cellular events such as proliferation and differentiation are regulated by sex steroids and their actions in target tissues are mediated by local production of growth factors acting through paracrine and/or autocrine mechanisms. Myometrial mass is ultimately modified in pregnancy as well as in tumour conditions such as leiomyoma and leiomyosarcoma. Leiomyomas, also known as fibroids, are benign tumours of the uterus, considered to be one of the most frequent causes of infertility in reproductive years in women. METHODS For this review, we searched the database MEDLINE and Google Scholar for articles with content related to growth factors acting on myometrium; the findings are hereby reviewed and discussed. RESULTS Different growth factors such as epidermal growth factor (EGF), transforming growth factor-α (TGF-α), heparin-binding EGF (HB-EGF), acidic fibroblast growth factor (aFGF), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), platelet-derived growth factor (PDGF) and TGF-β perform actions in myometrium and in leiomyomas. In addition to these growth factors, activin and myostatin have been recently identified in myometrium and leiomyoma. CONCLUSIONS Growth factors play an important role in the mechanisms involved in myometrial patho-physiology. PMID:21788281

  10. Embolização de mioma uterino em mulheres portadoras de miomas volumosos Uterine fibroid embolization in women with giant fibroids

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    Felipe Nasser

    2010-11-01

    ógico. Pode ser considerada uma opção para as pacientes que desejam a preservação uterina e também servir como terapêutica adjuvante à miomectomia de alto risco.PURPOSE: to evaluate the effectiveness of uterine fibroid embolization (UFE in patients with giant fibroids, with regard to both clinical outcomes and size reduction. METHODS: twenty-six patients with a mean age of 36.5 years, carrying symptomatic fibroids with a volume over 1,000 cm³, were referred for UFE. All patients had indication for percutaneous treatment. The procedures were performed under epidural anesthesia and sedation, using an institutional protocol. By unilateral femoral access, selective catheterization of uterine arteries and infusion of calibrated microspheres through microcatheter were carried out. Clinical evaluation was performed by means of regular outpatient gynecology consultation. All patients underwent magnetic resonance imaging (MRI before the procedure and 15 patients underwent control MRI after 6 months. RESULTS: technical success was 100%. There was no complication related to the procedures. Mean uterine volume of the 15 patients studied was 1,401 cm³ before embolization (min 1,045 cm³, max 2,137 cm³ and 799 cm³ after 6 months (525 cm³ min, max. 1,604 cm³, resulting in a total reduction of 42.9%. Clinical improvement was observed in 25 of 26 patients. One woman with uterine volume of 1,098 cm³ who developed necrosis and partial fibroid expulsion underwent myomectomy. Another patient was submitted to myomectomy six months after the procedure because she wanted to become pregnant, despite partial fibroid size reduction. One patient with a uterine volume of 2,201 cm³ required a second intervention to achieve an adequate angiographic result. No patient underwent hysterectomy. On average, 9.2 microsphere syringes were used per patient. CONCLUSION: embolization of giant uterine fibroids is a feasible procedure with acceptable clinical and radiological outcomes. It can be

  11. Ultrasonographic Evaluation of the Change in Uterine Fibroids Induced by Treatment with a Gnrh Analog

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    Chun-Chieh Chia

    2006-06-01

    Conclusion: We found that the volumes of the uterus and fibroids decreased significantly after treatment with two consecutive doses (given a month apart of GnRHa. The 3D color Doppler including a histogram and blood flow parameters is another useful tool for fibroid evaluation.

  12. Central cervical fibroid mimicking as chronic uterine inversion: a case report

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    Swati Singh

    2013-08-01

    Full Text Available Leiomyomas are most common benign gynaecological tumor. Most of the fibroids are situated in the body of the uterus, but only in 1-2% cases, they are confined to cervix. We report a case of 33 years old women, para 2 live 2 diagnosed as myomatous polyp on ultrasound and clinically as chronic inversion of uterus. On surgery, we found it as central cervical fibroid with uterus sitting on the fibroid i.e. lantern on the St. Paul’s. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 687-688

  13. Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) for Treatment of Symptomatic Uterine Fibroids: An Economic Analysis

    Science.gov (United States)

    Babashov, V; Palimaka, S; Blackhouse, G; O'Reilly, D

    2015-01-01

    Background Uterine fibroids, or leiomyomas, are the most common benign tumours in women of childbearing age. Some women experience symptoms (e.g., heavy bleeding) that require aggressive forms of treatment such as uterine artery embolization (UAE), myomectomy, magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU), and even hysterectomy. It is important to note that hysterectomy is not appropriate for women who desire future childbearing. Objectives The objective of this analysis was to evaluate the cost-effectiveness and budgetary impact of implementing MRgHIFU as a treatment option for symptomatic uterine fibroids in premenopausal women for whom drugs have been ineffective. Review Methods We performed an original cost-effectiveness analysis to assess the long-term costs and effects of MRgHIFU compared with hysterectomy, myomectomy, and UAE as a strategy for treating symptomatic uterine fibroids in premenopausal women aged 40 to 51 years. We explored a number of scenarios, e.g., comparing MRgHIFU with uterine-preserving procedures only, considering MRgHIFU-eligible patients only, and eliminating UAE as a treatment option. In addition, we performed a one-year budget impact analysis, using data from Ontario administrative sources. Four scenarios were explored in the budgetary impact analysis: MRgHIFU funded at 2 centres MRgHIFU funded at 2 centres and replacing only uterine-preserving procedures MRgHIFU funded at 6 centres MRgHIFU funded at 6 centres and replacing only uterine-preserving procedures Analyses were conducted from the Ontario public payer perspective. Results The base case determined that the uterine artery embolization (UAE) treatment strategy was the cost-effective option at commonly accepted willingness-to-pay values. Compared with hysterectomy, UAE was calculated as having an incremental cost-effectiveness ratio (ICER) of $46,480 per quality-adjusted life-year (QALY) gained. The MRgHIFU strategy was extendedly dominated by a

  14. Information-seeking behavior of women in their path to an innovative alternate treatment for symptomatic uterine fibroids.

    Science.gov (United States)

    Ankem, Kalyani

    2007-04-01

    The purpose of the study was to discover how women found out about uterine fibroid embolization (UFE) for the treatment of symptomatic uterine fibroids. The study retrospectively tracked women from the beginning of their illnesses and analyzed their information-seeking behaviors. Twenty-eight women who had the procedure at the Detroit Medical Center were interviewed using a standard script. Median values and frequencies were calculated to represent information needs, information sources, and perceived helpfulness. Spearman correlations were calculated to find relationships between demographics and information needs. Although the women expressed a great need for almost all types of information (median = 5), those with higher levels of education indicated a greater need to know the reasons that their doctors had for suggesting treatments (r = 0.55). The gathered frequencies indicated that friends, magazines, television, and the Internet were important information sources. A preliminary model of information seeking showed that while friends, magazines, and television made several of the women aware of the new procedure, the Internet was heavily utilized for learning about treatment options. Health sciences librarians may inform women about their health and treatment options by guiding women to easily readable, authoritative, and reliable information sources, including Web information sites.

  15. Quality and safety control of tumor-shrinking decoction (TSD): A Chinese herbal preparation for the treatment of uterine fibroids.

    Science.gov (United States)

    Chen, Xiao-Xin; Lin, Wai Ling; Yeung, Wing Fai; Song, Tian-He; Lao, Li-Xing; Zhang, Yan-Bo; Meng, Wei

    2017-01-01

    Reproducible efficacy assessments of Chinese herbal medicines are largely based on well-established quality control procedures. This study presents a comprehensive quality control procedure for tumor-shrinking decoction (TSD), a 15-herb preparation under study as a potential therapy for uterine fibroids. Morphological, microscopic, and physicochemical authentications were first carried out on individual herbal medicines composing TSD. Contaminant tests on TSD for the presence of heavy metals and pesticide residues were performed by atomic absorption spectrophotometry and gas chromatography-mass spectrometry analysis. Furthermore, batch-to-batch quality monitoring of the decoction was investigated via ultra-performance liquid chromatography (UPLC) and high-performance liquid chromatography (HPLC). An aqueous extract of the herbal medicines was prepared and formulated into TSD. The tested contaminants were within the maximum permitted levels of the Hong Kong government in proprietary Chinese medicines. UPLC and HPLC fingerprints for quality tracking on TSD were established. The decoction was quantitatively standardized by UPLC and HPLC, respectively, with five and three chemical compounds serving as references. Collectively, the procedure established in this study will not only serve as a fundamental basis for the investigation and development of TSD as a novel therapy for uterine fibroids, but also as a protocol for studying other polycomponent herbal preparations. © 2015 International Union of Biochemistry and Molecular Biology, Inc.

  16. Simulation study of the effects of near- and far-field heating during focused ultrasound uterine fibroid ablation using an electronically focused phased array: A theoretical analysis of patient safety

    Energy Technology Data Exchange (ETDEWEB)

    Ellens, Nicholas, E-mail: nicholas.ellens@utoronto.ca; Hynynen, Kullervo [Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada and Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5G 1L7 (Canada)

    2014-07-15

    Purpose: Assess the feasibility of using large-aperture, flat ultrasonic transducer arrays with 6500 small elements operating at 500 kHz without the use of any mechanical components for the thermal coagulation of uterine fibroids. This study examines the benefits and detriments of using a frequency that is significantly lower than that used in clinical systems (1–1.5 MHz). Methods: Ultrasound simulations were performed using the anatomies of five fibroid patients derived from 3D MRI. Using electronic steering solely, the ultrasound focus from a flat, 6500-element phased array was translated around the volume of the fibroids in various patterns to assess the feasibility of completing full treatments from fixed physical locations. Successive temperature maps were generated by numerically solving the bioheat equation. Using a thermal dose model, the bioeffects of these simulations were quantified and analyzed. Results: The simulations indicate that such an array could be used to perform fibroid treatments to 18 EM{sub 43} at an average rate of 90 ± 20 cm{sup 3}/h without physically moving the transducer array. On average, the maximum near-field thermal dose for each patient was below 4 EM{sub 43}. Fibroid tissue could be treated as close as 40 mm to the spine without reaching temperatures expected to cause pain or damage. Conclusions: Fibroids were successfully targeted and treated from a single transducer position to acceptable extents and without causing damage in the near- or far-field. Compared to clinical systems, treatment rates were good. The proposed treatment paradigm is a promising alternative to existing systems and warrants further investigation.

  17. [Epidemiological data for uterine fibroids in France in 2010-2012 in medical center--analysis from the French DRG-based information system (PMSI)].

    Science.gov (United States)

    Fernandez, H; Chabbert-Buffet, N; Koskas, M; Nazac, A

    2014-10-01

    Uterine fibroids are a common disorder, responsible for menorrhagia/metrorrhagia and pelvic pain and remain the leading reason for hysterectomy in France. Although it is common disorder, French epidemiological data are locking. The objective of this study was to realize an epidemiological analysis from the medicalized information system program (PMSI). The diagnosis codes were selected from 10th version of the International Classification Disease. The medical procedures concerning uterine fibroids were selected (so called: procedures listed). A descriptive analysis was performed from hospitals stays, patients' characteristics and medical procedures (mean, standard distribution, median, range, quartile). In 2012, 46,126 patients (median age: 46 years old) were admitted in hospital (public or private hospitals) due to uterine fibroid corresponding to 47,690 hospital stays (hospital stays for surgery: 32,397). Diagnosis of anemia was reported in approximately 8% of patients and 7.1% of patients hospitalized in 2012 had already been hospitalized between 2004-2012. The median length of hospital stay was 4 days. In 2012, 16,070 hospital stays were reported for total or subtotal hysterectomy, 16,384 hospitals stays for myomectomy and 1376 hospital stays for embolization. In terms of management care, among 46,126 patients with uterine fibroids (principal or related diagnosis), 31,846 patients received a procedure listed in a surgical diagnostic related groups (DRG). To conclude, the study permits to update the epidemiological data concerning uterine fibroid management between 2010-2011-2012 in final. Because the PMSI collects partially information regarding epidemiological data, a clear epidemiological study is needed either with database from health insurance or with dedicated study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  18. Recent scientific advances in leiomyoma (uterine fibroids research facilitates better understanding and management [v1; ref status: indexed, http://f1000r.es/54a

    Directory of Open Access Journals (Sweden)

    Darlene K. Taylor

    2015-07-01

    Full Text Available Uterine leiomyomas (fibroids are the most prevalent medical problem of the female reproductive tract, but there are few non-surgical treatment options. Although many advances in the understanding of the molecular components of these tumors have occurred over the past five years, an effective pharmaceutical approach remains elusive. Further, there is currently no clinical method to distinguish a benign uterine leiomyoma from a malignant leiomyosarcoma prior to treatment, a pressing need given concerns about the use of the power morcellator for minimally invasive surgery. This paper reviews current studies regarding the molecular biology of uterine fibroids, discusses non-surgical approaches and suggests new cutting-edge therapeutic and diagnostic approaches.

  19. Volumetric ablation of uterine fibroids using Sonalleve high-intensity focused ultrasound in a 3 Tesla scanner--first clinical assessment.

    Science.gov (United States)

    Dorenberg, Eric J; Courivaud, Frédéric; Ring, Eva; Hald, Kirsten; Jakobsen, Jarl Å; Fosse, Erik; Hol, Per Kristian

    2013-04-01

    The purpose of this study was to evaluate the feasibility and safety of the Sonalleve high-intensity focused ultrasound (HIFU; Philips Healthcare, Vantaa, Finland) system in ablating uterine fibroids in a 3T magnet. Seven women were included in this study. Treatment was performed according to the manufacturer's recommendation. Technical data describing the HIFU procedures were collected. On MR images at baseline, immediately and 30 days after ablation, we evaluated the volumes of the uterus, the dominant fibroid and the ablation zone. The Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire was used to assess potential clinical response. The procedure was technically feasible in all patients. The median number of sonications performed during each procedure was 20 (range 2-27) per patient, the maximum temperature in all sonication cells was about 68°C. The median procedure time was 156 minutes (range 95-164). The non-perfused volume after treatment ranged from 1 to 27 ml and was unchanged or decreased in all but one patient at 30 days follow-up. There were no major adverse events. In our 3T magnet the system was able to heat tissue and induce areas of non-enhancement within uterine fibroids without major complications. Clinical benefit remains to be proven.

  20. Diffusion-weighted magnetic resonance imaging using different b-value combinations for the evaluation of treatment results after volumetric MR-guided high-intensity focused ultrasound ablation of uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Ikink, Marlijne E.; Voogt, Marianne J.; Bosch, Maurice A.A.J. van den; Nijenhuis, Robbert J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Keserci, Bilgin [Samsung Medical Center, High-intensity Focused Ultrasound (HIFU) Center, Seoul (Korea, Republic of); Philips Healthcare, Advanced Science and Development, Seoul (Korea, Republic of); Kim, Young-sun [Samsung Medical Center, High-intensity Focused Ultrasound (HIFU) Center, Seoul (Korea, Republic of); Samsung Medical Center, Sunkyunkwan University, Department of Radiology and Center for Imaging Science, Seoul (Korea, Republic of); Vincken, Koen L.; Bartels, Lambertus W. [University Medical Center Utrecht, Department of Radiology and Image Sciences Institute, Utrecht (Netherlands)

    2014-09-15

    To assess the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) mapping using different b-value combinations for treatment evaluation after magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) of uterine fibroids. Fifty-six patients with 67 uterine fibroids were treated with volumetric MR-HIFU. Pre-treatment and post-treatment images were obtained using contrast-enhanced T1-weighted MRI (CE-T1WI) and DWI using b = 0, 200, 400, 600, 800 s/mm{sup 2}. ADC maps were generated using subsets of b-values to investigate the effects of tissue ablation on water diffusion and perfusion in fibroids treated with MR-HIFU. Four combinations of b-values were used: (1) all b-values; (2) b = 0, 200 s/mm{sup 2}; (3) b = 400, 600, 800 s/mm{sup 2}; and (4) b = 0, 800 s/mm{sup 2}. Using the lowest b-values (0 and 200 s/mm{sup 2}), the mean ADC value in the ablated tissue reduced significantly (p < 0.001) compared with baseline. Calculating the ADC value with the highest b-values (400, 600, 800 s/mm{sup 2}), the ADC increased significantly (p < 0.001) post-treatment. ADC maps calculated with the lowest b-values resulted in the best visual agreement of non-perfused fibroid tissue detected on CE images. Other b-value combinations and normal myometrium showed no difference in ADC after MR-HIFU treatment. A decrease in contrast agent uptake within the ablated region on CE-T1WI was correlated to a significantly decreased ADC when b = 0 and 200 s/mm{sup 2} were used. (orig.)

  1. Ulipristal acetate for pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands: cost minimization analysis and budget impact analysis.

    Science.gov (United States)

    Zakiyah, N; van Asselt, A D I; Postma, M J

    2017-03-01

    Ulipristal acetate has been found to be non-inferior to other pre-operative treatments of uterine fibroids, particularly leuprolide. The objective of this study was to assess the pharmacoeconomic profile of ulipristal acetate compared to leuprolide for the pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands. The analysis was performed and applied within the framework of the ulipristal acetate submission for reimbursement in 2012. A decision model was developed to compare the total costs of ulipristal acetate compared to leuprolide, the standard care in The Netherlands. The target population of this study corresponded to the type of patients included in the PEARL II clinical trial; i.e. women of reproductive age requiring pre-operative treatment for uterine fibroids. Sensitivity analysis was implemented to assess uncertainties. Data regarding costs, effects, and other input parameters were obtained from relevant published literatures, the Dutch Healthcare Insurance Board, and expert opinion obtained by means of a panel of experts from several medical centers in The Netherlands. In The Netherlands, the total costs of ulipristal acetate and leuprolide were estimated at €4,216,027 and €4,218,095, respectively. The annual savings of ulipristal acetate were, therefore, estimated at €2,068. The major driver of this cost difference was the cost of administration for leuprolide. Sensitivity analyses showed that ulipristal acetate mostly remained cost-saving over a range of assumptions. The budget impact analysis indicated that the introduction of ulipristal acetate was estimated to result in cost savings in the first 3 years following the introduction. The results of this study were used in the decision on reimbursement of ulipristal acetate according to the Dutch Reference Pricing system in 2012. Ulipristal acetate was cost saving compared to leuprolide and has the potential to provide substantial savings on

  2. A novel method to aid in the visualisation and treatment of uterine fibroids with MRgFUS in patients with abdominal scars

    Energy Technology Data Exchange (ETDEWEB)

    Zaher, Summia, E-mail: summia.zaher@imperial.nhs.uk [Imperial College/St Mary' s Hospital, Praed Street, London W2 1NY (United Kingdom); Gedroyc, Wladyslaw, E-mail: w.gedroyc@imperial.ac.uk [Imperial College/St Mary' s Hospital, Praed Street, London W2 1NY (United Kingdom); Lyons, Deidre, E-mail: deidre.lyons@imperial.nhs.uk [Imperial College/St Mary' s Hospital, Praed Street, London W2 1NY (United Kingdom); Regan, Lesley, E-mail: l.regan@imperial.ac.uk [Imperial College/St Mary' s Hospital, Praed Street, London W2 1NY (United Kingdom)

    2010-11-15

    The purpose of this research was to identify a method for performing Magnetic Resonance Imaging Guided Focused Ultrasound Surgery (MRgFUS) of symptomatic uterine fibroids in patients with abdominal scars, by visualisation of these scars on MR images. 25 patients who presented with treatable symptomatic uterine fibroids and having transverse abdominal scars were treated with MRgFUS. A solution containing MRI contrast paramagnetic iron oxide particles was used to demark the skin surface scar tissue on the treatment planning MR images. During treatment, the focused ultrasound energy was steered around the scar based on its enhanced visual location. After the treatment, contrast enhanced MR images were acquired for immediate results evaluation. Adverse events and fibroid related symptoms were captured during the 6-months follow up period. All the women were treated with no complications. No episodes of skin burns, ulceration or skin redness were reported. The post-treatment contrast-enhanced MR images showed an average fibroid non-perfused volume ratio of 64%. At their 6-month follow-up, 92% of the patients reported a clinical improvement. Using paramagnetic iron oxide solution to highlight transverse abdominal scars helps in their identification on MR images, thereby enabling the operator to avoid scars and facilitating the treatment of women who were previously excluded.

  3. Evaluation of uterine fibroids as a cause of AUB by pelvic ultrasound

    OpenAIRE

    Handa, Kriti; Tayade, Atul; Kale, Sushilkumar; Phadke, Akshay

    2016-01-01

    The present prospective diagnostic cross sectional was carried out in the Department of Radio-diagnosis from October 2013 to July 2015. A total of 158 patients were included as per the predefined study criteria. Transabdominal and transvaginal sonography was done on all patients and the diagnosis was correlated with final histopathological diagnosis. Clinically, most common pathology diagnosed was fibroid uterus (53.80%). Similarly on  transabdominal and transvaginal sonography, majority (37....

  4. 围绝经期子宫肌瘤及子宫腺肌病所致异常出血%Perimenopausal abnormal bleeding caused by uterine fibroids and uterine adenomyosis

    Institute of Scientific and Technical Information of China (English)

    汪利群; 黄欧平

    2012-01-01

    Uterine fibroids and adenomyosis is the most common benign gynecological diseases, they are one important reason for abnormal uterine bleeding in perimenopausal period. This article summarizes the e-tiology, diagnosis and treatment of abnormal uterine bleeding caused by fibroids and adenomyosis in perimenopausal women,which should lead to attention.%子宫肌瘤与子宫腺肌病是妇科最常见的良性肿瘤,是导致围绝经期子宫异常出血的重要原因之一.该文概述了子宫肌瘤与子宫腺肌病导致围绝经期异常子宫出血病因、诊断及治疗,以期引起关注.

  5. 妊娠合并巨大子宫肌瘤17例临床分析%Clinical Analysis of 17 Cases of Pregnancy Complicated with Gigantic Uterine Fibroids

    Institute of Scientific and Technical Information of China (English)

    晋兴林; 花怀珍

    2014-01-01

    0bjective:To explore the management of pregnancy complicated with gigantic uterine fibroids in ce-sarean section.Methods:A retrospective case-control study was done to review the clinical data of 17 cases of preg-nancy with gigantic uterine fibroids (A group),17 cases of pregnancy with fibroids (B group), 17 cases of pregnancy without fibroids (C group).The operation time,blood loss,postpartum hemorrhage,peuparium infection and hospital-ization days were compared.Results:The mean operative time in group A was significantly longer than group B、C (P0.05).Conclusions:Myomectomy of gigantic uterine fibroids during Cesarean section is safe and feasible,but careful perioperative management is very critical.%目的:探讨妊娠合并巨大子宫肌瘤的剖宫产术中的处理方式。方法:选择某医院妊娠合并巨大子宫肌瘤17例(A组)、妊娠合并子宫肌瘤17例(B组)及单纯行剖宫产17例(C组)的患者临床资料进行回顾性分析。对手术时间、术中失血量、产后出血情况、产褥感染率、术后住院天数等指标进行比较。结果:研究组A组的手术时间、术中出血量、产后出血例数明显高于对照组B、C组(P0.05)。结论:剖宫产术中同时处理巨大子宫肌瘤安全、可行,但必须强调整个围手术期管理的重要性。

  6. Electromagnetic image guidance in gynecology: prospective study of a new laparoscopic imaging and targeting technique for the treatment of symptomatic uterine fibroids

    OpenAIRE

    Galen, Donald I.

    2015-01-01

    Background Uterine fibroids occur singly or as multiple benign tumors originating in the myometrium. Because they vary in size and location, the approach and technique for their identification and surgical management vary. Reference images, such as ultrasound images, magnetic resonance images, and sonohystograms, do not provide real-time intraoperative findings. Methods Electromagnetic image guidance, as incorporated in the Acessa Guidance System, has been cleared by the FDA to facilitate tar...

  7. Magnetic resonance guided focused ultrasound surgery of uterine fibroids-The tissue effects of GnRH agonist pre-treatment

    Energy Technology Data Exchange (ETDEWEB)

    Smart, O.C. [Department of Academic Obstetrics and Gynaecology, St. Mary' s Hospital and Imperial College School of Medicine, Praed Street, London W2 1NY (United Kingdom); Department of Magnetic Resonance Imaging, St. Mary' s Hospital and Imperial College School of Medicine, Praed Street, London W2 1NY (United Kingdom); Hindley, J.T. [Department of Academic Obstetrics and Gynaecology, St. Mary' s Hospital and Imperial College School of Medicine, Praed Street, London W2 1NY (United Kingdom); Regan, L. [Department of Academic Obstetrics and Gynaecology, St. Mary' s Hospital and Imperial College School of Medicine, Praed Street, London W2 1NY (United Kingdom); Gedroyc, W.M.W. [Department of Magnetic Resonance Imaging, St. Mary' s Hospital and Imperial College School of Medicine, Praed Street, London W2 1NY (United Kingdom)]. E-mail: w.gedroyc@imperial.ac.uk

    2006-08-15

    Objective: The purpose of this study was to determine the ablative effect of magnetic resonance guided focused ultrasound (MRgFUS) on fibroid tissue following the administration of gonadotrophin releasing hormone (GnRH) agonist. Study design: Fifty women with clinically symptomatic uterine fibroids were treated. Those with uterine diameter of 10 cm or greater were given 3 months pre-treatment with GnRH agonists. Data regarding number of ultrasound sonications, Joules of energy delivered and volume of thermal destruction was recorded. Results: Twenty-seven subjects were given GnRH agonist therapy before MRgFUS and 23 women underwent MRgFUS without pre-treatment. All patients in both study groups completed MR guided FUS as an outpatient procedure with no device related adverse events reported. In the group of women who received GnRH agonists, the volume of ablation was significantly larger than that in the control group (0.06 cm{sup 3} versus 0.03 cm{sup 3}, P < 0.05), per Joule of energy applied. Conclusion: The use of GnRH agonists potentiates the thermal effects of MRgFUS in women undergoing treatment of uterine fibroids.

  8. Feasibility of magnetic resonance imaging-guided high intensity focused ultrasound therapy for ablating uterine fibroids in patients with bowel lies anterior to uterus

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Lian; Chen Wenzhi [Clinical Center for Tumour Therapy of 2nd Affiliated Hospital of Chongqing University of Medical Sciences, Chongqing 400010 (China); Liu Yinjiang; Hu Xiao [National Engineering Research Center of Ultrasound Medicine, Chongqing 400010 (China); Zhou Kun [Clinical Center for Tumour Therapy of 2nd Affiliated Hospital of Chongqing University of Medical Sciences, Chongqing 400010 (China); Chen Li [National Engineering Research Center of Ultrasound Medicine, Chongqing 400010 (China); Peng Song; Zhu Hui [Clinical Center for Tumour Therapy of 2nd Affiliated Hospital of Chongqing University of Medical Sciences, Chongqing 400010 (China); Zou Huiling [National Engineering Research Center of Ultrasound Medicine, Chongqing 400010 (China); Bai Jin [Institute of Ultrasound Engineering in Medicine of Chongqing University of Medical Sciences, Chongqing 400016 (China); Wang Zhibiao [Clinical Center for Tumour Therapy of 2nd Affiliated Hospital of Chongqing University of Medical Sciences, Chongqing 400010 (China); National Engineering Research Center of Ultrasound Medicine, Chongqing 400010 (China); Institute of Ultrasound Engineering in Medicine of Chongqing University of Medical Sciences, Chongqing 400016 (China)], E-mail: wangzhibiao@haifu.com.cn

    2010-02-15

    Purpose: To prospectively evaluate the feasibility of magnetic resonance (MR) imaging-guided high intensity focused ultrasound (HIFU) therapeutic ablation of uterine fibroids in patients with bowel lies anterior to uterus. Materials and methods: Twenty-one patients with 23 uterine fibroids underwent MR imaging-guided high intensity focused ultrasound treatment, with a mean age of 39.4 {+-} 6.9 (20-49) years, with fibroids average measuring 6.0 {+-} 1.6 (range, 2.9-9.5) cm in diameter. After being compressed with a degassed water balloon on abdominal wall, MR imaging-guided high intensity focused ultrasound treatment was performed under conscious sedation by using fentanyl and midazolam. This procedure was performed by a Haifu JM focused ultrasound tumour therapeutic system (JM2.5C, Chongqing Haifu Technology Co., Ltd., China), in combination with a 1.5-Tesla MRI system (Symphony, Siemens, Germany), which provides real-time guidance and control. Contrast-enhanced MR imaging was performed to evaluate the efficacy of thermal ablation immediately and 3 months after HIFU treatment. The treatment time and adverse events were recorded. Results: The mean fibroid volume was 97.0 {+-} 78.3 (range, 12.7-318.3) cm{sup 3}. According to the treatment plan, an average 75.0 {+-} 11.4% (range, 37.8-92.4%) of the fibroid volume was treated. The mean fibroid volume immediately after HIFU was 109.7 {+-} 93.1 (range, 11.9-389.6) cm{sup 3}, slightly enlarged because of edema. The average non-perfused volume was 83.3 {+-} 71.7 (range, 7.7-282.9) cm{sup 3}, the average fractional ablation, which was defined as non-perfused volume divided by the fibroid volume immediately after HIFU treatment, was 76.9 {+-} 18.7% (range, 21.0-97.0%). There were no statistically significant differences between the treatment volume and the non-perfused volume. Follow-up magnetic resonance imaging (MRI) at 3 months obtained in 12 patients, the fibroid volume decreased by 31.4 {+-} 29.3% (range, -1.9 to 60

  9. Clinical 3-year follow-up of uterine fibroid embolization; Klinische 3-Jahres-Ergebnisse nach Uterusmyomembolisation

    Energy Technology Data Exchange (ETDEWEB)

    Radeleff, B.A.; Satzl, S.; Eiers, M.; Fechtner, K.; Hakim, A.; Kauffmann, G.W.; Richter, G.M. [Universitaetsklinikum Heidelberg (Germany). Abt. Radiodiagnostik; Rimbach, S. [Klinikum Konstanz (Germany). Frauenklinik

    2007-06-15

    Purpose: The purpose of this study was to evaluate the clinical long-term success of uterine artery embolization (UAE) in patients with symptomatic fibroids using spherical particles (Embosphere). Materials and Methods: 34 consecutive patients treated with UAE were initially enrolled in the study which had the following study goals (1) 1-year follow-up MRI evaluation of the fibroid behavior and (2) clinical long-term success due to standardized assessment of the main fibroid-related symptoms (hypermenorrhoea, dysmenorrhoea and dysuria) of the patients' individual overall health status and their therapy satisfaction at 1-year, 2- year and 3-year intervals after UAE. Results: Technical success was achieved in all procedures. Four patients had to be excluded from the long-term evaluation schedule: one because of a hysterectomy due to bleeding after 6 weeks, 3 patients were not available for the designated minimum follow-up interval. The preinterventional severe hypermenorrhoea (n = 27) with a score of 4.4 {+-} 0.7 (5 = extreme menstrual bleeding) decreased after one year to 2.1 {+-} 0.5 (p = 0.0001), after two years to 1.7 {+-} 0.5 (p = 0.0042) and after three years to 1.3 {+-} 0.6 (p = 0.0001). The preinterventional dysmenorrhoea (n = 15) with a score of 3.1 {+-} 1.5 (3 = distinctly increased dysmenorrhoea) decreased after one year to 1.1 {+-} 0.3 (p = 0.0001), after two years to 1.2 {+-} 0.2 and after three years to 1.2 {+-} 0.4 (p = 0.148). The pretreatment dysuria (n = 12) with a preinterventional score of 3.1 {+-} 1.5 (3 = distinctly increased dysuria) decreased after one year to 1.1 {+-} 0.3 (p = 0.0069) and remained after two years at 1.1 {+-} 0.2 and after three years at 1.2 {+-} 0.4 (p = 0.905). The initial overall health status was 54.7 {+-} 20.1 (maximal value 100). After one year it rose to 90.5 {+-} 15.4 (p = 0.0001), was 91.8 {+-} 5.6 after two years and was 91.3 {+-} 8.5 (p = 0.8578) after three years. The satisfaction with the therapy was 2

  10. [Anti-Müllerian hormone serum levels in women with and without uterine fibroids].

    Science.gov (United States)

    Carranza-Lira, Sebastián; Bustamante-Mendoza, Jenifer Alejandra; Leaños-Miranda, Alfredo; Campos-Galicia, Inova; Estrada-Moscoso, Isaías; Chan-Verdugo, Rosario; Ramos-Godínez, María del Pilar; Moncada-Claudio, Guadalupe; Peña-Torres, Maria de Lourdes

    2013-12-01

    The etiology of uterine leiomyomatosis is multifactorial and it is unknown if a relation between anti-Müllerian hormone (hormona anti-mülleriana) and uterine leiomyomatosis exists. To determine the differences of hormona anti-mülleriana levels in women with and without uterine leiomyomatosis. 60 women were studied (30 with and 30 without uterine leiomyomatosis). The diagnosis was confirmed by histopathology. Both groups were paired by age and in all them serum levels of hormona antimülleriana were measured using ELISA, also estradiol and progesterone serum levels were determined. hormona anti-mülleriana-RII immunohistochemistry was done in healthy myometrium and in leiomyomas. The mean age between the groups didn't show statistical difference (41.8 +/- 5.6 years vs. 41.4 +/- 5.7 years). Also no differences were found in weight, height and body mass index. Serum levels of hormona antimülleriana were lower in those with leiomyomatosis [0.21 (0-10.4) ng/ml vs. 1.83 (0-6.38) ng/ml, p hormona antimülleriana receptor was no expressed neither in the healthy myometrium nor in the leiomyomas. Women with leiomyomatosis had lower hormona antimülleriana levels. More studies are needed to determine if a relation exists between hormona antimülleriana and uterine leiomyomas.

  11. A Method of Time-Intensity Curve Calculation for Vascular Perfusion of Uterine Fibroids Based on Subtraction Imaging with Motion Correction

    Science.gov (United States)

    Zhu, Xinjian; Wu, Ruoyu; Li, Tao; Zhao, Dawei; Shan, Xin; Wang, Puling; Peng, Song; Li, Faqi; Wu, Baoming

    2016-12-01

    The time-intensity curve (TIC) from contrast-enhanced ultrasound (CEUS) image sequence of uterine fibroids provides important parameter information for qualitative and quantitative evaluation of efficacy of treatment such as high-intensity focused ultrasound surgery. However, respiration and other physiological movements inevitably affect the process of CEUS imaging, and this reduces the accuracy of TIC calculation. In this study, a method of TIC calculation for vascular perfusion of uterine fibroids based on subtraction imaging with motion correction is proposed. First, the fibroid CEUS recording video was decoded into frame images based on the record frame rate. Next, the Brox optical flow algorithm was used to estimate the displacement field and correct the motion between two frames based on warp technique. Then, subtraction imaging was performed to extract the positional distribution of vascular perfusion (PDOVP). Finally, the average gray of all pixels in the PDOVP from each image was determined, and this was considered the TIC of CEUS image sequence. Both the correlation coefficient and mutual information of the results with proposed method were larger than those determined using the original method. PDOVP extraction results have been improved significantly after motion correction. The variance reduction rates were all positive, indicating that the fluctuations of TIC had become less pronounced, and the calculation accuracy has been improved after motion correction. This proposed method can effectively overcome the influence of motion mainly caused by respiration and allows precise calculation of TIC.

  12. The Dual Action of Varunadi Kwath in Renal Calculi as well as Uterine Fibroid- A Case Study

    Directory of Open Access Journals (Sweden)

    Padavi D. M.

    2015-09-01

    Full Text Available Mutrashmari (Renal Calculi is very common disorder. This distressing urinary disorder affects around 5-7 million people in India [11]. The chances of recurrence are always high and the surgery having disadvantage of high cost. The available treatment in modern science is only conservative and surgical in this present study an effort was made to evaluate the role of Varunadi Kwath in Mutrashmari. The main aim of this particular study was inclined towards the disintegration, dissolution, dislodgement and expulsion of renal calculi. The contents of Varunadi Kwath are easily available, economical and are easy to administer, which are having Anti-inflammatory, Diuretic and Antilithic properties. A case of renal calculi with uterine fibroid was diagnosed and the treatment was given for a period of 9 months. The size of the calculus was studied by periodic ultrasonography; the symptoms Mutrakruchrata (Dysuria, Shula (Pain in abdomen, Sadaha Mutrata (Burning micturition are significantly reduced within less than 45 days and total expulsion of calculi in less than 180 days.

  13. HEALTHY AND PATHOLOGICAL CHANGES OF MYOMETRIUM: PREGNANT MYOMETRIUM, UTERINE FIBROIDS AND LEIOMYOSARCOMA. Cambios normales y patológicos del miometrio: miometrio del embarazo, fibrosis uterina y leiomiosarcoma

    Directory of Open Access Journals (Sweden)

    Pasquapina Ciarmela

    2016-03-01

    Full Text Available El miometrio, la pared muscular del útero, puede modificar su misma masa y las propiedades celulares en el embarazo y también en los tumores como el leiomioma y el leiomiosarcoma. El leiomioma, dicho también fibroma, es un tumor benigno del útero y se considera como  una de las causas más frecuentes de infertilità en el período reproductivo femenino. El leiomiosarcoma, en cambio, es un tumor maligno y agresivo de la musculatura lisa uterina. La presente revisión discute las características generales del leiomioma y el leiomiosarcoma y los relativos tratamientos clínicos actualmente usados y además describe las características del miometrio normal en el embarazo.  The myometrium, the muscular wall of the uterus, can modify its mass and cellular properties in pregnancy as well as in tumor conditions such as leiomyoma and leiomyosarcoma. Leiomyomas, also known as fibroids, are benign tumors of the uterus, considered to be one of the most frequent causes of infertility in reproductive years of women. Leiomyosarcomas in turn, are rare aggressive malignant uterine smooth-muscle tumors. The present review is discussing the general features of leiomyoma and leiomyosarcoma with their current treatments and also discussing the characteristics of normal pregnant myometrium and compare with leiomyoma.

  14. The management of uterine fibroids in women with otherwise unexplained infertility.

    Science.gov (United States)

    Carranza-Mamane, Belina; Havelock, Jon; Hemmings, Robert; Cheung, Anthony; Sierra, Sony; Carranza-Mamane, Belina; Case, Allison; Dwyer, Cathie; Graham, James; Havelock, Jon; Hemmings, Robert; Liu, Kimberly; Murdock, Ward; Vause, Tannys; Wong, Benjamin; Burnett, Margaret

    2015-03-01

    Objectif : Formuler des recommandations quant à la façon optimale d’assurer la prise en charge des fibromes dans le contexte de l’infertilité. Les options habituelles et novatrices de prise en charge des fibromes seront analysées en mettant l’accent sur leur applicabilité chez les femmes qui souhaitent obtenir une grossesse. Options : La prise en charge des fibromes chez les femmes qui souhaitent obtenir une grossesse met d’abord en jeu la documentation de la présence des fibromes en question et la détermination de la probabilité que ces derniers affectent le potentiel génésique. Dans un tel contexte, la prise en charge des fibromes s’effectue principalement de façon chirurgicale; toutefois, il faut s’assurer au préalable de mettre en balance les avantages factuels de l’approche chirurgicale en matière d’amélioration des issues cliniques et les risques propres à une telle approche. Issues : L’amélioration des taux et des issues de grossesse que permet la prise en charge des fibromes chez les femmes aux prises avec l’infertilité constitue l’issue principale sur laquelle nous nous sommes attardés. Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans PubMed, CINAHL et Cochrane Systematic Reviews en novembre 2013 au moyen d’un vocabulaire contrôlé (p. ex. « leiomyoma », « infertility », « uterine artery embolization », « fertilization in vitro ») et de mots clés (p. ex. « fibroid », « myomectomy ») appropriés. Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs publiés en anglais et français. Aucune restriction n’a été appliquée en matière de date. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu’en novembre 2013. La littérature grise (non publiée) a

  15. 三维数字化模型在子宫肌瘤术前规划中的应用%The Application of Three-dimensional Models for the Preoperative Planning of the Uterine Fibroids

    Institute of Scientific and Technical Information of China (English)

    薛迎峰; 王栋; 张璐; 宗丽菊; 张友忠

    2015-01-01

    To explore the significance of the individualized preoperative planning with three‐dimensional (3D) models of the uterus and uterine fibroids via applying 3D reconstruction and virtual reality techniques based on MRI scan data .The MRI scan data of the 25 enrolment patients with uterine fibroids were collected .The MRI scan data of the uterus and uterine fibroids was transferred to the self‐developed 3D preoperative planning software for 3D reconstruction and spatial analysis . The 3D models of the uterus and uterine fibroids were reconstructed successfully .The complex internal spatial structure of the 3D models of the uterus and uterine fibroids can be intuitively displayed .Gynecologists can perform various operations on the 3D models ,such as rotation ,scaling ,painting ,transparency adjustment ,measuring and moving ,to judge the type of the uterine fibroids accurately .The accurate judgment can guide gynecologists to select the individualized surgery .The self‐developed 3D preoperative planning software can provide an ideal platform for selecting the scientific treatment planning of uterine fibroids gynecological surgery . Applying this software , the type of uterine fibroids and the individualized preoperative planning can be decided .%应用三维重建及虚拟现实技术构建子宫肌瘤数字化模型,探讨三维模型在不同类型子宫平滑肌瘤术前个体化手术规划中的意义。收集盆腔M RI检查子宫肌瘤患者25例。将M RI原始数据集中的子宫及其平滑肌瘤进行三维重建及空间分析。成功重建出结构清晰、三维效果逼真、立体感强,可真实反映子宫及病灶实际空间结构关系的三维模型,并可进行旋转、放大、缩小、上色、透明度选择、测量及移动等操作,通过观察、测量病灶大小、数目、位置、临近解剖关系精确判断肌瘤的8种类型,可成功实现肌瘤分型,以指导选择个体化手术治疗方案。

  16. In-office rapid volumetric ablation of uterine fibroids under ultrasound imaging guidance: Preclinical and early clinical experience with the Mirabilis transabdominal HIFU treatment system

    Science.gov (United States)

    Leal, José G. Garza; León, Ivan Hernandez; Sáenz, Lorena Castillo; Aguirre, Juan M. Aguilar; Lagos, Joel J. Islas; Parsons, Jessica E.; Darlington, Gregory P.; Lau, Michael P. H.

    2017-03-01

    Mirabilis Medica, Inc. (Bothell, WA, USA) has developed a high-intensity focused ultrasound (HIFU) system for producing rapid transabdominal volumetric ablation of uterine fibroids in an office-based setting. The Mirabilis HIFU Treatment System utilizes integrated ultrasound imaging guidance and short treatment times under 15 minutes. Treatment with the Mirabilis system is generally well tolerated using only oral analgesia without anesthesia or sedation. This paper summarizes certain technical aspects of the Mirabilis HIFU technology, the preclinical development process, and the results of the first in-human clinical study using the Mirabilis system. During preclinical studies, an in vivo transcutaneous porcine lower extremity model was used in a total of 180 adult swine to develop the HIFU treatment regimen parameters. Additionally, 108 excised human uteri with fibroids obtained from scheduled hysterectomies were treated in an ex vivo experimental setup and evaluated. These preclinical activities resulted in a HIFU treatment technique referred to as Mirabilis Shell Ablation, which enables rapid volumetric fibroid ablation by directing the HIFU energy to the outer perimeter of the target volume (the `shell') without insonating its core. This method results in efficient fibroid treatment through a synergistic combination of direct tissue ablation, cooperative heating effects, and indirect ischemic necrosis in the interior of the volume. After refining this technique and performing safety testing in the in vivo porcine model, a clinical pilot study was conducted to assess the initial safety and performance of the Mirabilis HIFU Treatment System for transabdominal treatment of uterine fibroids in eligible women who were scheduled to undergo hysterectomy following treatment with the device. A total of 37 women meeting certain eligibility criteria were treated at two clinical sites in Mexico. Twenty-nine (29) of these 37 women received only prophylactic sublingual

  17. Measuring the volume of uterine fibroids using 2- and 3-dimensional ultrasound and comparison with histopathology.

    Science.gov (United States)

    Zivković, Nikica; Zivković, Kreiimir; Despot, Albert; Paić, Josip; Zelić, Ana

    2012-12-01

    The aim of this study was clinical testing of the reliability and usability of three-dimensional (3D) and two-dimensional (2D) ultrasound (US) technology. The ultimate aim and purpose of this study was to establish ultrasound methods, standards and protocols for determining the volume of any gynecologic organ or tumor. The study included 31 women in reproductive age and postmenopause. All patients were examined with a RIC 5-9 3D-endovaginal probe (4.3-7.5 MHz) on a Voluson 730 Pro ultrasound device. The volume of myomas was measured by using the existing 2D and 3D ultrasound methods on the above mentioned device. All patients underwent myomectomy or hysterectomy due to clinically and ultrasonographically diagnosed uterine myomas indicating operative intervention. After the operation, the pathologist determined the volume of removed myomas by measuring them in a gauge bowl containing water, i.e. using Archimedes' principle (lift), serving as the control group with histopathologic diagnosis. A total of 155 myoma volumes were processed on 2D display, 31 myoma volumes were preoperatively measured on 3D display and 31 myoma volumes were measured by the pathologist. The values of US measurements for each US method were expressed as mean value of all measurements of myoma volumes. Statistical processing of the results and Student's t-test for independent samples revealed that the 2nd examined US method (measuring of myoma by using an ellipse and the longer tumor diameter) and 4th examined US method (measuring of myoma by using the longer and shorter tumor diameters together with establishing their mean values) in 2D US technique, as well as the 6th examined US method in 3D US technique showed no significant measurement differences in comparison with control measurement in a gauge bowl containing water (p < 0.05), indicating acceptability of the US methods for verifying tumor volumes. The standard error in determining the volume of myomas by the above US methods varied

  18. The clinical value of the special functions of DSA in interventional embolization for uterine fibroids%DSA特殊功能在子宫肌瘤栓塞治疗中的价值

    Institute of Scientific and Technical Information of China (English)

    何玉圣; 鲁东; 吕维富; 张劲松

    2009-01-01

    目的 评价DSA特殊功能在子宫肌瘤栓塞治疗中的价值.方法 46例子宫肌瘤栓塞中26例应用DSA特殊功能:3D-DSA、最佳工作体位、路图技术,20例采用常规DSA造影,对两种方法的对比剂用量、介入手术时间和透视时间进行比较和分析.结果 术中应用DSA特殊功能与常规DSA组比较,对比剂用量和透视时间明显减少(P0.05).结论 DSA特殊功能在子宫肌瘤栓塞中的应用能缩短手术时间,降低手术风险.可视化三维重建技术对介入手术操作具有重要指导意义.%Objective To evaluate the special functions of DSA in interventional embolization therapy for uterine fibroids. Methods The special functions of DSA, including 3D-DSA, the optimal working position and road-mapping technique, were utilized in performing interventional embolization therapy for uterine fibroids in twenty-six cases (experimental group). Routine DSA angiography was employed in twenty cases (control group). The volume of contrast media used, the time of completing the interventional procedure and the total fluoroscopic time in two groups were compared and the results were analyzed. Results The difference in the volume of contrast agent used and in the total fluoroscopic time between two groups was statistically significant (P 0.05). Conclusion In treating uterine fibroids with interventional embolization, the use of the special functions of DSA can reduce the manipulation time and lower the operation risk. Moreover, the technique of visible 3D reconstruction image is of great significance in guiding the procedure.

  19. B超在子宫肌瘤诊断中的应用价值分析%The Analysis of B Ultrasound Examination Value in Diagnosis of Uterine Fibroids

    Institute of Scientific and Technical Information of China (English)

    赵波

    2015-01-01

    Objective Application value of B ultrasound examination in diagnosis of uterine fibroids is to be investigated. Methods Chose 45 patients with uterine fibroids received and treated in our hospital from August 2013 to August 2014 and separate them into X-ray examination group and B ultrasound examination group respectively and take patients’pathology result as the examination standard; and then observe and compare the diagnosis accuracy of X-ray examination and B ultrasound examination. Results The diagnosis accuracy rate of B ultrasound examination was up to 93.33%,while the diagnosis accuracy rate of X-ray examination was 77.78%; there was a diagnosis accuracy differential between two groups,and such a differential had statistic value(P<0.05). Conclusion B ultrasound examination is of high accuracy,besides,its operation is simple,economic,safe and non-invasive in diagnosis of uterine fibroids; therefore,it is quite worthwhile to be promoted.%目的:分析子宫肌瘤诊断中 B 超的应用价值。方法选取2013年8月~2014年8月间我院收治的子宫肌瘤患者45例,分为 X 线检查组与 B 超检查组,以病理结果作为检验标准,对比 B 超与 X 线检查的准确性。结果 B 超检查组诊断准确率(93.33%)高于 X 线检查组(77.78%),两组诊断准确率差异显著,有统计学意义(P<0.05)。结论子宫肌瘤应用 B 超诊断准确率高,操作简单,经济适用,安全无创。

  20. Rare case of giant broad ligament fibroid with myxoid degeneration

    Directory of Open Access Journals (Sweden)

    R R Godbole

    2012-01-01

    Full Text Available Giant fibroids are known to arise from the uterus, although very rarely from extra-uterine sites. Among extra-uterine fibroids, broad ligament fibroids generally achieve enormous size and generally present with pressure symptom like bladder and bowel dysfunction. Myxoid degeneration is a rare complication of benign fibroid, where presence of cystic changes mimics the metastatic malignant ovarian tumor. We report a case of true broad ligament fibroid measured about 13 kg. This case is reported for its rarity and the diagnostic difficulties in differentiating malignant ovarian tumor and benign fibroid with myxoid degeneration.

  1. Studying the effect of some factors on the high incidence of uterine fibroid in Libyan women

    Directory of Open Access Journals (Sweden)

    Fathia M. Ben Ashour

    2015-12-01

    Methods: The Factors implicated in this case are analyzed using questionnaire on a random patient sample (152 cases within (2010-2014 from the archive of Aljalaa hospital. Results: Results show that, UF could affect women in young ages and above 40 years as well (P = 0.14. Marital status and the race of the patients significantly affect the rate of UF. The number of UF increased among married and white women comparing with single one and black one (P = 0.00 respectively. UF cases in the women holding O+ blood group were significantly higher than other groups (P=0.00. The educated women exhibit significant decrease in the UF incidence compared with less education status (P=0.00. Both normal delivered mode women and those received contraception pills showed a significant high rate of UF comparing with caesarian cut and with non-treated group (P=0.00, respectively. Menorrhagia was significantly higher than abdominal pain and infertility. Recurrent and family history was invaluable in UF incidence. Its ratio was significantly higher among women with no previous history and who have no family history (P=0.00. Myomectomy was significantly different from other choices; trans-abdominal hysterectomy and others (P=0.00. Conclusions: According to our results, marital status, hormones disturbances, life style including stress factors, race and knowledge about the case are the most implicated causes in the incidence of the case. Further studies on the ultra-structural level (Model are needed to verify the possible role/s for genes. [Int J Reprod Contracept Obstet Gynecol 2015; 4(6.000: 1954-1960

  2. Transarterial embolization for uterine fibroids: clinical success rate and results of magnetic resonance imaging; Transarterielle Embolisation bei Uterus myomatosus: klinische Erfolgsrate und kernspintomographische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Kroencke, T.J.; Scheurig, C.; Kluener, C.; Fischer, T.; Klessen, C.; Rudolph, J.; Siara, K.; Zimmermann, E.; Hamm, B. [Inst. fuer Radiologie, Charite Universitaetsmedizin Berlin, Campus Mitte, Humboldt-Univ. zu Berlin (Germany); Gauruder-Burmester, A. [Klinik fuer Frauenheilkunde und Geburtshilfe, Charite Universitaetsmedizin Berlin, Campus Mitte, Humboldt-Univ. zu Berlin (Germany); Gronewold, M. [Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Universitaetsklinikum Hamburg-Eppendorf (Germany)

    2005-01-01

    Purpose: to analyze the clinical success rate and the findings of magnetic resonance imaging (MRI) after uterine artery embolization of symptomatic leiomyomas (fibroids) of the uterus. Materials and methods: this is a prospective single-center case study of 80 consecutively treated patients, followed for 3-6 months (group I), 7-12 months, (group II), and 13-25 months (group III). MRI was used to determine the uterine volume and size of the dominant leiomyoma. Symptoms and causes requiring repeat interventions were analyzed. Results: significant (p < 0.01) volume reduction of the uterus (median: 34.95% confidence interval [CI]: 30.41 - 41.76%) and dominant leiomyoma (median: 52.07%, CI: 47.71 - 61.57%) was found. The decrease in uterine volume (I-III: 22.68%, 33.56%, 47.93%) and dominant leiomyoma volume (I-III: 41.86%, 62.16%, 73.96%) progressed with the follow-up time. Bleeding resolved significantly (p < 0.0001) in all three follow-up groups (groups I-III: 92.86%, 95.23%, 96.67%). Furthermore, urinary frequency (groups I-III: 70%, 75%, 82.35%) and sensation of pelvic pressure (groups I-III: 42.86%, 60%, 93.75%) improved, which was statistically significant in group III (p < 0.01). The number of leiomyomas correlated (p < 0.05) with improvement of the bleeding and the pelvic pressure. Repeat therapy was necessary for complications in four patients (5%) and for therapeutic failure in three patients (3.8%). Permanent amenorrhea was observed in four patients (5%) of age 45 years or older. Conclusion: uterine artery embolization of uterine leiomyomas has a high clinical success rate with an acceptable incidence of complications and repeat interventions. (orig.)

  3. Living with uterine fibroids

    Science.gov (United States)

    ... Advisor 2016 . Philadelphia, PA: Elsevier; 2016:1271-1272. Katz VL. Benign gynecologic lesions: Vulva, vagina, cervix, uterus, oviduct, ovary. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. ...

  4. Perfusion volume correlates, percentage of involution, and clinical efficacy at diverse follow-up survey times after MR-guided focused ultrasound surgery in uterine fibroids: first report in a Mexican mestizo population

    Energy Technology Data Exchange (ETDEWEB)

    Carrasco-Choque, Ana Luz; Fernandez-de Lara, Yeni; Vivas-Bonilla, Ingrid; Romero-Trejo, Cecilia [Medica Sur Clinic and Foundation, Magnetic Resonance Unit, Mexico City (Mexico); Villa, Antonio R. [UNAM, Division de Investigacion, Facultad de Medicina, Mexico City (Mexico); Roldan-Valadez, Ernesto [Medica Sur Clinic and Foundation, Magnetic Resonance Unit, Mexico City (Mexico); Medica Sur Clinic and Foundation, Coordination of Research and Innovation, Magnetic Resonance Unit, Mexico City (Mexico)

    2015-10-15

    To evaluate the clinical efficacy of magnetic resonance-guided focused ultrasound surgery in a Mexican mestizo population. This retrospective study included 159 women (mean age 37 ± 6.4 years, range 22-53 years) from 2008 to 2010. Two hundred sixty-eight symptomatic uterine fibroids were treated using MR-guided focused ultrasound surgery. Parameters included initial perfused volume, final perfused volume, non-perfused volume (NPV), and treated volume ratio (TVR). Follow-up up to 15 months assessed treatment efficacy and symptomatic relief. Non-parametric statistics and the Kaplan-Meier method were performed. T{sub 2}-weighted hypointense fibroids showed a frequency of 93.6 %; isointense and hyperintense fibroids had frequencies of 5.60 and 1.1 %. There was a negative correlation between NPV and age (r = -0.083, p = 0.307) and treatment time (r = -0.253, p = 0.001). Median TVR was 96.0 % in small fibroids and 76.5 % in large fibroids. Involution of 50 % and 80 % was achieved at months 6-7 and month 11, respectively. Relief of symptoms was significant (p < 0.05). Our data show that higher TVR attained immediately post-treatment of MRgFUS favours higher involution percentages at follow-up; however, careful patient selection and use of pretreatment imaging are important components for predicting success using MR-guided focused ultrasound surgery. (orig.)

  5. 58例腹腔镜手术与传统开腹手术剔除子宫肌瘤的临床对比%Clinical Comparison of 58 Cases of Laparoscopic Surgery and Conventional Open Surgery for Removing Uterine Fibroids

    Institute of Scientific and Technical Information of China (English)

    闫利弘

    2014-01-01

    目的:探讨腹腔镜手术与传统开腹手术剔除子宫肌瘤的临床疗效。方法选取2012年8月-2013年3月在该院就诊的58例子宫肌瘤患者作为研究对象,随机分为实验组和对照组,回顾分析两组患者的临床疗效。结果观察组患者在术后住院、使用止痛药情况、排气以及术中出血轻快,都显著优于对照组,两组疗效效果差异有统计学意义(P<0.05)。结论腹腔镜手术治疗子宫肌瘤疗效显著,且并发症发生率低,具有广泛推广的临床价值。%Objective To investigate and compare the clinical efficacy of laparoscopic surgery and conventional open surgery for removing uterine fibroids. Methods 58 patients with uterine fibroids admitted in our hospital from August, 2012 to March, 2013 were selected as the subjects, and randomly divided into the experimental group and the control group. The clinical efficacy be-tween the two groups was analyzed retrospectively. Results The postoperative hospitalization, use of painkillers, exhaust and brisk bleeding of the patients in the observation group were significantly better than those of the control group, the differences between two groups in the effect were statistically significant (P<0.05). Conclusion Laparoscopic surgery is quite effective in the treatment of uterine fibroids with low complication rate and a value of wide promotion in clinical practice.

  6. 选择性子宫动脉栓塞术对症状性子宫肌瘤的治疗作用%Effect of Selective Uterine Artery Embolization on Symptomatic Uterine Fibroids

    Institute of Scientific and Technical Information of China (English)

    冯丽霞; 刘冬萍; 熊宁; 刘仙; 侯新民

    2011-01-01

    目的 观察选择性子宫动脉栓塞术(selective uterine artery embolization,SUAE)治疗症状性子宫肌瘸的疗效.方法 2007年2月~2009年6月,对34例症状性子宫肌瘤行选择性双侧子宫动脉栓塞术.肌壁间肌瘤31例,黏膜下肌瘤3例;单发29例,多发5例;肌瘤直径4 ~8.5 cm,平均5.3 cm.32例合并贫血,血红蛋白49 ~ 101 g/L.术前及术后3、6、12个月采用月经失血图(pictorial blood loss assessment chart,PBAC)评估月经量,检测血红蛋白值,B超测量子宫及肌瘤体积. 结果 栓塞成功率100%.3例黏膜下子宫肌瘤分别于术后31天、43天及52天坏死脱出宫颈外口,予以摘除.1例肌壁间肌瘤患者于术后10个月受孕.30例肌壁间肌瘤患者术后3个月月经量评分由术前162.4±22.6下降至87.8±13.4(t= 18.325,P=0.000),12个月降至34.3±10.8(t=25.380,P=0.000);血红蛋白术前为(76.5±11.7)g/L,术后6个月及12个月分别上升至( 103.7±7.3)g/L(t= 10.994,P=0.000),(109.5±5.8)g/L(t= 12.338,P=0.000);子宫及肌瘤体积自术后6个月显著逐渐缩小,子宫体积术前( 266.3±49.3) cm3,术后6个月缩小至( 175.6±53.4) cm3(t =9.047,P=0.000),12个月缩小至(135.3±44.2) cm3(t=11.036,P=0.000);肌瘤体积术前(101.5±23.4) cm3,术后6个月缩小至(54.1±16.7)cm3(t=9.888,P=0.000),12个月缩小至(35.6±11.5)cm3(t=14.119,P=0.000). 结论 SUAE能有效减少子宫肌瘤患者月经量,改善贫血,缩小子宫及肌瘤体积,且能保留女性生育能力,是治疗症状性子宫肌瘤安全、有效、微创的方法.%Objective To evaluate the efficacy of selective uterine artery embolization ( SUAE ) in the treatment of symptomatic uterine fibroids. Methods SUAE were performed on 34 patients with symptomatic uterine fibroids from Feburary 2007 to June 2009. There were 31 cases of intramural myoma and 3 cases of submucous myoma. Mono-myoma was found in 29 patients, and multi-myoma in 5 patients. The diameter of the fibroids was 4-8.5 cm with

  7. Effect of Continuing Nursing on the Mood and Life Quality of Patients with Uterine Fibroids%延续护理对子宫肌瘤患者情绪及生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    李秀青; 卢晓声

    2016-01-01

    目的评价延续护理对子宫肌瘤患者情绪状态、生活质量的影响,为子宫肌瘤患者随访健康干预管理提供指导。方法纳入2013年7月至2015年5月子宫肌瘤患者274例,采用随机数字表法随机分成延续护理组137例、常规随访组137例,延续护理组采用专门制定的延续护理措施+常规随访措施,对照组采用常规随访措施,干预6个月后,采用Zung焦虑、抑郁自评量表评价患者情绪状态变化,利用SCL-90量表评价患者的生活质量,比较两组情绪状态及生活质量的差异性。结果本研究干预6个月后:延续护理组较常规随访组大幅降低子宫肌瘤患者焦虑、抑郁评分,差异有统计学意义(P<0.05);延续护理组较常规随访组大幅降低生活质量评价中躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对、恐怖和精神病性维度得分,差异有统计学意义(P<0.05)。结论延续护理对子宫肌瘤患者离院后情绪状态、健康状态均有积极影响。%Objective To evaluate the impact of continuing nursing on the mood and life quality of patients with uterine fibroids so as to provide health intervention management guidance for their follow-up visits.Methods 274 patients with uterine fibroids from July 2013 to May 2015 were included in the study. They using random were divided into the continuing nursing group (n=137) and routine follow-up visit group (n=137) with random number table. The continuing nursing group took specifically developed continuing nursing measures and routine follow-up visit measures while the control group only took routine follow-up visit measures. After six months' intervention, evaluated patients' mood change with Zung self-rating anxiety and depression scale. Compared the emotional state and differences of life quality between two groups after evaluating patients' life quality with SCL-90 scale.Results After six months' intervention, the anxiety and

  8. Application Value of Clinical Pathway in Perioperative Nursing of Patients with Uterine Fibroids%临床路径在子宫肌瘤患者围术期护理中的应用价值

    Institute of Scientific and Technical Information of China (English)

    刘晓艳; 孙红运; 苗丽竺

    2016-01-01

    目的:探讨临床路径在子宫肌瘤患者围术期护理中的应用价值。方法选取2014年6月至2015年5月在大连市妇女儿童医疗中心接受手术治疗的84例子宫肌瘤患者为研究对象,按随机数字表法将其分为对照组和观察组,各42例。对照组患者给予围术期常规护理,观察组患者在对照组基础上实施临床护理路径,比较两组患者的术后恢复情况及护理满意度。结果观察组患者的肛门排气时间、住院时间均明显短于对照组,差异均有统计学意义(均P<0.05);观察组患者的护理满意度明显高于对照组,差异有统计学意义(P<0.05)。结论在子宫肌瘤患者围术期护理中应用临床路径,有助于促进患者康复进程,提升护理质量。%Objective To investigate the clinical path in the value of uterine fibroids in patients undergoing surgery of nursing.Methods From June 2014 to May 2015,84 cases of patients with uterine fibroids treated by surgical treatment of women and children's Medical Center in Dalian city were randomly divided into control group and experimental group by random number table method,42 cases in each group.The control group were treated with routine nursing,and the patients in the experimental group were treated with clinical nursing pathway on the basis of the control group.Compared with the two groups of patients, the postoperative recovery and nursing satisfaction were compared.Results The time of anus exhaust and hospital stay in the experimental group were significantly shorter than those in the control group,the difference was statisticaly significant(P<0.05),the nursing satisfaction of the experimental group was significantly higher than that of the control group,the difference was statisticaly significant (P<0.05).Conclusion The application of clinical pathway in perioperative nursing of patients with uterine fibroids is helpful to promote the rehabilitation process and improve

  9. 临床护理路径应用于子宫肌瘤妇女的满意度分析%Satisfaction analysis of clinical nursing pathway applied in women with uterine fibroids

    Institute of Scientific and Technical Information of China (English)

    江桂玲

    2014-01-01

    Objective To analyze and evaluate the satisfaction situation of the clinical nursing pathway applied in women with uterine fibroids. Methods 104 patients with uterine fibroids treated in our hospital from October 2011 to October 2012 were randomly divided into the observation group and the control group, with 52 patients in each group.Both groups received surgical treatment.The control group implemented conventional nursing measures and the observation group implemented clinical nursing pathway.The clinical nursing effects of the two groups of patients were analyzed comparatively. Results The observation group had shorter hospital stay and lower total hospitalization cost than the control group,with significant difference (P0.05).The observation group had higher nursing satisfaction degrees in the aspects of psychological support,technical level,health education,patient care and service attitude than the control group,with statistically significant differences between the two groups(P < 0.05 for all). Conclusion The implementation of clinical nursing pathway is conducive to enhancing the knowledge of patients with uterine fibroid, shortening hospital stay, reducing hospitalization cost,improving patient satisfaction to nursing services and enhancing nursing service quality.%目的:分析并评价临床护理路径应用于子宫肌瘤妇女的满意度情况。方法将我院自2011年10月~2012年10月期间收治的子宫肌瘤的患者104例随机分成观察组与对照组,每组各52例,均开展手术治疗,对照组实施常规护理措施,观察组实施临床护理路径,对比分析两组患者的临床护理效果。结果观察组的住院天数以及住院总花销均少于对照组,差异显著(P<0.05);观察组的健康教育知识达标率高于对照组,其并发症发生率低于对照组,两组比较差异均显著(P均<0.05);但两组治愈率相比无明显差异(P>0.05);观察组在心理支持、

  10. 缩宫素对超声消融治疗子宫肌瘤效果的影响%Effect of oxytocin on uterine fibroids treated by ultrasound ablation

    Institute of Scientific and Technical Information of China (English)

    黄秀; 何敏; 刘映江; 张炼; 王智彪

    2011-01-01

    目的 探讨缩宫素对超声消融治疗子宫肌瘤效果的影响.方法 采用MRI引导下的超声消融肿瘤治疗系统,以单点辐照的方式,选择确诊的26例子宫肌瘤患者的29个肌瘤中的82个靶点进行研究,比较使用缩宫素前、后辐照单点达到60℃时所需的能量、时间及升高单位温度(1℃)所需的能量.结果 使用缩宫素前,辐照单点温度达到60℃所需的能量为(5320±910)J,时间为(21±20)s,升高1 ℃所需的能量为(255±302)J;静脉滴注缩宫素后,辐照单点温度达到60℃所需的能量为(2890±325)J,时间为(12±7)s,升高1℃所需的能量为(126±94)J.使用缩宫素前、后,各指标间比较,差异均有统计学意义(P值分别为0.002、0.001、0.002).结论 缩宫素能明显降低超声消融治疗子宫肌瘤所需的能量,缩短治疗时间,从而提高治疗效率,具有很好的临床应用价值.%Objective To explore the effect of oxytocin on uterine fibroids treated by ultrasound ablation. Methods Eighty-two single points in 29 uterine fibroids from 26 patients were sonicated with magnetic resonance imaging guided by high intensity focused ultrasound before and after using oxytocin. The required total energy, sonication time required to reach 60 ℃ and the acoustic energy for increasing 1 ℃ of temperature at the single point before and after using oxytocin were compared. Results Before intravenous infusion of oxytocin, the average total sonication energy required to reach 60 ℃ was (5320 ±910) J and it took (21 ±20) seconds for sonicating a single point, the energy required for increasing 1 ℃ was (255 ± 302) J. In contrast, after intravenous infusion of oxytocin, the average total sonication energy required to reach 60 ℃ was (2890 ±325) J, and it took (12 ±7) seconds for sonicating a single point, the energy required for increasing 1 ℃ was ( 126 ± 94 ) J. Those three index all reached statistical difference ( P = 0.002, P = 0.001, P= 0

  11. 腹腔镜和射频消融术治疗子宫肌瘤的临床观察%Clinical Observation of Laparoscopic Radiofrequency Ablation in Treatment of Uterine Fibroids

    Institute of Scientific and Technical Information of China (English)

    初华

    2013-01-01

    Objective:Observed in patients with uterine fibroids be the clinical effect of radiofrequency catheter ablation by laparoscopic myomectomy.Methods:Were retrospectively analyzed the clinical data of patients of the hospital since November 2008 to November 2011, in the treatment of our department, 252 cases of uterine fibroids were randomly divided into AB two groups, each group of patients with 126 cases, group Aapplication of radiofrequency ablation, group B of laparoscopic myoma excluding surgery, the amount of contrast were observed intraoperative bleeding and the time of surgery and hospitalization time, be in the six months after the review B, the size of two groups of patients with endometriosisshape, and follow-up in two groups the fertility requirements of the patient's pregnancy.Results:Contrast AB two groups of patients with intraoperative blood loss was significantly different (P<0.05); AB, two sets of times for surgery in patients with contrast showed a significant difference (P<0.05).Group A were not hospitalized, only observed 2-4 hours from hospital after surgery, comparison of the AB, two groups of patients the hospital stay, was significantly different (P<0.05).Group B, 96 cases of childbearing, fertility in group A and 84 cases, 90 cases of pregnancy (93.75%) in group B within one year, 50 cases of pregnancy(59.52%) in group A within one year, compared with two groups was significant difference (P<0.05).Conclusion:Uterine fibroids in patients with LM and RF treatment were able to achieve the purpose of cure. Submucosal fibroids and intramural fibroids (convex to the uterine cavity) can reduce the patient's natural conception rate and embryo implantation rate (IVF), but the LM treatment in patients with pregnancy rate can improve, and effective, safe, minimally invasive should be used as fertility requirements of the patient's preferred; RF treatment time is shorter, not only less bleeding, and rapid postoperative recovery, while medical costs are

  12. 人文关怀在妇科子宫肌瘤全切术患者中的应用%Application of humanistic care in nursing care of patients with uterine fibroids hysterectomy

    Institute of Scientific and Technical Information of China (English)

    叶燕珊; 肖俊英; 潘颖珊

    2015-01-01

    目的:探讨人文关怀在妇科子宫肌瘤全切患者中的应用效果。方法:选择我院2013年1~12月收治的子宫肌瘤手术患者80例患者为研究对象,随机等分为观察组和对照组,对照组术后实施常规护理,观察组在此基础上增加人文关怀,出院前比较两组患者的护理满意度及心理状态改善情况。结果:观察组的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分明显低于对照组(P <0.05);观察组患者满意度明显高于对照组,差异有统计学意义(P <0.05)。结论:对子宫肌瘤全切术后患者实施细致的人文关怀,有助于消除患者不良情绪及满意度,提高生活质量。%Objective:To investigate the effect of the application of humanistic care in hysteromyoma patients with total resection .Methods:uterine fibroids surgery patients in our hospital from January to December in 2013 were 80 cases of patients as the research object,were randomly divided into the observation group and the control group,after surgery in the control group the implementation of routine care,the observation group in the control group on the basis of humanistic care increases, before discharge were compared between the two groups of nursing satisfaction and psychological state of improvement.Results:Self -rating anxiety scale(SAS) and Self -Rating Depression Scale(SDS) scores were significantly lower than the control group (P <0.05);satisfaction of observation group were significantly higher, the difference was statistically significant(P <0.05).Conclusion: of uterine fibroids resection were treated with humane care,help to eliminate the negative emotions of patients,improve customer satisfaction, and improve the quality of life.

  13. 子宫肌瘤变性继发血小板升高一例并文献分析%An analysis of one case of uterine fibroids degeneration secondary to platelet elevated

    Institute of Scientific and Technical Information of China (English)

    张甦; 仲丽丽; 韩凤娟; 吴效科

    2013-01-01

      子宫肌瘤变性是指肌瘤失去原有的典型结构,可能引起腹痛等症状,子宫肌瘤合并腹痛、感染、变性,合并血液改变非常少见;本文报道一例子宫肌瘤变性继发血小板升高罕见病例;临床医师应该认识到排除血液系统疾病,抗炎治疗血小板仍然处于高水平状态,可提示血液改变可能与子宫肌瘤变性、感染有关,为以后的临床治疗提供诊治思路。%Uterine fibroids degeneration refers to the fibroid losing its original typical structure,which can be leaded to the symptoms of abdominal pain,uterine fibroids with abdominal pain, infection, modifying,and then degenerating blood changes is very rare. This paper reported a rare cases of a secondary increased platelet following uterine myoma degeneration, clinicians should recognize that blood change may be associated with uterine myoma degeneration and infection if anti-inflammatory treatment platelets were still in a state of high level and no other blood system diseases, this study would provide an idea for future clinical diagnosis and treatment.

  14. Advances in the Medical Treatment of Uterine Leiomyomas Fibroids%子宫肌瘤药物治疗进展

    Institute of Scientific and Technical Information of China (English)

    张慧英

    2013-01-01

    子宫平滑肌瘤是女性生殖系统最常见的肿瘤,育龄妇女约20%患有子宫肌瘤.有些患者无症状,有些患者由于月经过多出现严重贫血.手术治疗是根治肌瘤的首选方案,但由于患者年龄及对生育的要求不同等原因,有些患者不愿手术,有些患者不宜手术,促性腺激素释放激素激动剂及米非司酮等药物可以通过降低体内雌激素水平抑制肌瘤的生长,并能使肌瘤缩小,改善肌瘤所致的临床症状,也是子宫肌瘤治疗的重要手段之一.%Uterine leiomyoma is the most common benign tumor of female reproductive system,which approximately 20% of women during reproductive years suffer from.Some patients are asymptomatic,while some suffer from severe anemia because of menorrhagia.As for treatment,surgery is the preferred solution for radical cure.However,due to the patients' age and different fertility requirement,some patients do not want surgery,and some are not suitable for operation.Then gonadotropinreleasing hormone agonists and other drugs such as mifepristone can help reduce estrogen levels to inhibit the growth of myoma,and to make the myoma shrink,so as to improve clinical symptoms,which is one of another important treatments for uterine leiomyoma.

  15. Clinical outcome of magnetic-resonance-guided focused ultrasound surgery (MRgFUS) in the treatment of symptomatic uterine fibroids; Klinische Ergebnisse der Behandlung symptomatischer Uterusmyome mittels MRgFUS (Magnetresonanztomografie-gesteuerter fokussierter Ultraschall)

    Energy Technology Data Exchange (ETDEWEB)

    Kamp, J.E.K.; Scheurig-Muenkler, C.; Beck, A. [Charite - Universitaetsmedizin Berlin (Germany). Klinik fuer Radiologie; David, M. [Charite - Universitaetsmedizin Berlin (Germany). Klinik fuer Gynaekologie; Hengst, S. [Klinikum Barnim GmbH, Werner Forssmann Krankenhaus, Eberswalde (Germany). Klinik fuer Radiologie

    2013-02-15

    Purpose: To investigate the clinical outcome of magnetic-resonance-guided focused ultrasound surgery (MRgFUS) treatment for symptomatic uterine fibroids in premenopausal women using the validated USF-QOL (Uterine Fibroid Symptom and Quality of Life) Questionnaire. Materials and Methods: 54 patients with symptomatic uterine fibroids were enrolled in this prospective study. The patients completed the UFS-QOL Questionnaire prior to MRgFUS treatment as well as after 3, 6, and 12 months. Results: The rate of technical success was 91.5 % (95.2 % after subtraction of screening errors). 6/54 patients (11 %) had other treatments (surgery, n = 4; UAE, n = 2), 8/54 (15 %) dropped out due to pregnancy, and 8/54 were lost to follow-up. The remaining group showed considerable symptom relief as early as after 3 months. The median overall quality of life score increased from 64.7 (quartile range QR: 49.8 - 77.6) before treatment to 77.6 (QR: 61.4 - 87.1) (p < 0.001), 78.4 (QR: 66.4 - 89.7) (p < 0.001), and 82.8 (QR: 69.8 - 92.2) (p < 0.001) at 3, 6, and 12 months, respectively. The corresponding median symptom severity score decreased from 46.9 (QR: 28.1 - 56.2) to 34.4 (QR: 21.9 - 43.7) at 3 months (p = 0.003) and 28.1 at 6 and 12 months (QR: 18.7 - 38.3, QR: 15.6 - 34.4) (p < 0.001, p = 0.002). The rate of complications requiring treatment was 9 %, and the rate of overall complications was 39 %. No major complications occurred. Conclusion: Our results indicate significant alleviation of fibroid-related symptoms within 12 months of MRgFUS with improvement beginning as early as 3 months after treatment. We observed no major complications, and some women became pregnant after MRgFUS. There was a low treatment failure rate of 11 %. (orig.)

  16. Change and studies of ovarian function after uterine fibroids hysterectomy%子宫肌瘤子宫全切术后卵巢内分泌功能的变化与研究

    Institute of Scientific and Technical Information of China (English)

    汪川; 吴震溟

    2012-01-01

    目的 探讨子宫肌瘤子宫全切术后卵巢内分泌功能的变化情况.方法 选取2008年4月~2011年3月入住某院妇科并接受治疗的子宫肌瘤患者共66例,选取在其他科室就诊的无内分泌系统疾病,月经、子宫卵巢均正常,年龄结构相近的妇女20例为对照组.观察组所有患者均行常规B超、X光片以及探测宫腔检查,当确诊为子宫肌瘤,即行子宫全切术进行治疗.观察组在术前月经d5及术后1、3、7月,对照组在月经后d5进行FSH(促卵泡激素)、LH(黄体生成素)、PRL(催乳素)、E2(雌激素睾酮)等几种激素的免疫测定,同时对观察组术前及术后1、3、7月的卵巢衰退症状进行统计分析.结果 术前FSH(促卵泡激素)、LH(黄体生成素)、PRL(催乳素)3种激素水平与对照组相比不存在显著性差异,术后,各类激素水平均出现显著性升高,在术后7个月时测量值最高,E2的水平在术前术后均处于较高水平.观察组患者术后出现盗汗,脱发,阴道干涩等症状的几率显著增加,从术前的39.4%增加到术后7个月的69.7%.结论 行子宫切除术的患者在术后都不同程度地出现了卵巢衰退迹象,且FSH(促卵泡激素)、LH(黄体生成素)、PRL(催乳素)3种激素水平与术后时间基本呈现正相关关系.%OBJECTIVE To investigate the changes of ovarian function after total hysterectomy due to uterine fibroids. METHODS From April 2008 to March 2011, a total of 66 cases treated for uterine fibroids in our hospital were selected, 20 cases without endocrine system diseases in the other sections, whose menstruation, ovary and uterus were normal, age structure was similar in the control group. All patients in the observation group underwent conventional B-ultrasound, X-rays, and the detection of uterine examination, the cases of ultimate diagnosed uterine fibroid were conducted on hysterectomy for treatment. In observation group, the preoperative 5th day and

  17. Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Mara, Michal; Kubinova, Kristyna, E-mail: kristyna.kubinova@gmail.com [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Maskova, Jana [Aberdeen Royal Infirmary, Department of Radiology (United Kingdom); Horak, Petr [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Belsan, Tomas [Central Military Hospital, Department of Radiology (Czech Republic); Kuzel, David [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic)

    2012-10-15

    Purpose: To compare outcomes of two different types of occlusive therapy of uterine fibroids. Methods: Women with fibroid(s) unsuitable for laparoscopic myomectomy (LM) were treated with uterine artery embolization (UAE) or laparoscopic uterine artery occlusion (LUAO). Results: Before the procedure, patients treated with UAE (n = 100) had a dominant fibroid greater in size (68 vs. 48 mm) and a mean age lower (33.1 vs. 34.9 years) than surgically treated patients (n = 100). After 6 months, mean shrinkage of fibroid volume was 53 % after UAE and 39 % after LUAO (p = 0.063); 82 % of women after UAE, but only 23 % after LUAO, had complete myoma infarction (p = 0.001). Women treated with UAE had more complications (31 vs. 11 cases, p = 0.006) and greater incidence of hysteroscopically verified intrauterine necrosis (31 vs. 3 %, p = 0.001). Both groups were comparable in markers of ovarian functions and number of nonelective reinterventions. The groups did not differ in pregnancy (69 % after UAE vs. 67 % after LUAO), delivery (50 vs. 46 %), or abortion (34 vs. 33 %) rates. The mean birth weight of neonates was greater (3270 vs. 2768 g, p = 0.013) and the incidence of intrauterine growth restriction lower (13 vs. 38 %, p = 0.046) in post-UAE patients. Conclusion: Both methods are effective in the treatment of women with future reproductive plans and fibroids not suitable for LM. UAE is more effective in causing complete ischemia of fibroids, but it is associated with greater risk of intrauterine necrosis. Both methods have low rate of serious complications (except for a high abortion rate).

  18. Analysis of prognosis of TCRM in the treatment of uterine fibroid complicated with infertility%TCRM 治疗子宫肌瘤伴不孕生殖预后分析

    Institute of Scientific and Technical Information of China (English)

    刘喻; 王明波; 李琼

    2015-01-01

    Objective To analyze pregnancy outcome by transcervical resection of myoma (TCRM) in the treatment of uterine fibroid complicated with infertility, in order to provide reference for optimal surgical plan. Methods There were 86 patients undergoing trans-laparoscopy myomectomy (TLM) as TLM group, and 72 patients undergoing TCRM for main treatment of uterine fibroid as TCRM+TLM group. All patients received follow-up for 6~36 months, and their postoperative pregnancy rate, and spontaneous abortion rate before and after operation were observed. Results The difference of cumulative pregnancy times and spontaneous abortion rate between the two groups had no statistical significance before operation (P>0.05). The difference of spontaneous abortion rate between the two groups before operation had statistical significance (P0.05). Conclusion TCRM in treating uterine fibroid complicated with infertility provides little uterine damage, with increased pregnancy rate and decreased spontaneous abortion rate. Its combination with TLM can provide assessment and treatment for pelvic cavity, and that is much better than single TLM treatment.%目的:分析宫腔镜子宫肌瘤电切术(TCRM)治疗子宫肌瘤伴不孕患者的妊娠结局,为制定最佳手术方案提供参考。方法86例采用腹腔镜子宫肌瘤剔除术(TLM)的患者作为 TLM 组,72例采用TCRM 治疗为主的子宫肌瘤伴不孕患者,设为 TCRM+TLM 组,所有患者均随访6~36个月,观察两组患者术后妊娠率、手术前后自然流产率。结果手术前两组累计妊娠次数与自然流产率比较,差异无统计学意义(P>0.05)。手术前后各组自然流产率比较,差异具有统计学意义(P0.05)。结论TCRM 治疗子宫肌瘤伴不孕对子宫的损伤较小,可明显增加妊娠率,降低自然流产率,与 TLM 共同进行可同时对盆腔情况予评估及治疗,明显优于单纯 TLM 治疗。

  19. A COMPARATIVE STUDY ON COPPER-PLATED UTERINE CAVITY SHAPED IUD AND NON-COPPER BEARING UTERINE CAVITY SHAPED IUD

    Institute of Scientific and Technical Information of China (English)

    ZENGQing-Gu; etal

    1989-01-01

    A comparative randomized clinical trial was carried out between two uterine cavity shaped IUDs: the copper-plated uterine cavity shaped IUD(UCDCu) and non-copper bearing uterine cavity shaped IUD(UCD). The IUDs were used by 1004 and 1005 women

  20. Embolização uterina para tratamento de miomas sintomáticos: impacto na qualidade de vida Uterine embolization for management of symptomatic fibroids: quality-of-life impact

    Directory of Open Access Journals (Sweden)

    Nestor Kisilevzky

    2007-10-01

    Full Text Available OBJETIVO: Verificar a mudança na qualidade de vida de pacientes portadoras de miomatose uterina sintomática submetidas a tratamento por embolização. MATERIAIS E MÉTODOS: Quarenta mulheres portadoras de miomatose uterina sintomática que foram tratadas com a técnica de embolização responderam a um questionário de qualidade de vida antes e 12 semanas após o procedimento. RESULTADOS: Verificou-se que o escore médio relacionado com a gravidade dos sintomas nas 40 pacientes antes da embolização foi de 62,07 ± 6,34 e se modificou, com significância estatística após o tratamento, quando se verificou escore médio de 20,42 ± 3,81. Da mesma forma, comprovou-se a melhora na qualidade de vida pela modificação dos escores antes e depois do tratamento, o que também apresentou significância estatística, passando de 40,26 ± 2,98 para 85,06 ± 2,57. CONCLUSÃO: A embolização uterina provoca alívio evidente dos sintomas relacionados com a miomatose e proporciona melhora substancial da qualidade de vida das pacientes.OBJECTIVE: To determine the impact on the quality of life in patients with symptomatic uterine fibroids submitted to uterine artery embolization. MATERIALS AND METHODS: Forty patients with symptomatic fibroids submitted to embolization have answered a quality-of-life questionnaire before and 12 weeks after the procedure. RESULTS: Mean score for symptoms severity before the procedure was 62.07 ± 6.34 and decreased with statistical significance to 20.42 ± 3.81 after the procedure. Similarly, scores for quality of life have improved from 40.26 ± 2.98 before the procedure to 85.06 ± 2.57 after the procedure, which again was statistically significant. CONCLUSION: Uterine embolization results in evident symptoms relief and significant improvement in the quality of life of patients with symptomatic fibroids.

  1. Uterine fibroid embolization with spheric micro-particles using flow guiding: safety, technical success and clinical results; Uterusmyomembolisation mit sphaerischen Mikropartikeln unter Flusssteuerung: Sicherheit, technischer Erfolg und klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Richter, G.M.; Radeleff, B.; Kauffmann, G.W. [Ruprecht-Karls-Univ. Heidelberg, Abt. fuer Radiodiagnostik, Radiologische Universitaetsklinik (Germany); Rimbach, S. [Ruprecht-Karls-Univ. Heidelberg, Univ.-Frauenklinik (Germany); RWTH Aachen, Univ.-Frauenklinik (Germany)

    2004-11-01

    Materials and Methods: Twenty of the first 26 consecutive patients referred for potential UFE were enrolled in the study. Pre-interventional MRI was used to assess morphologic contraindication to UFE. The embolization procedures were performed from a unilateral femoral approach using 4F selective catheters in straight vessels, >2 mm in diameter, and micro-catheters in smaller and tortuous arteries. The endpoint of the 'flow guided' embolization was defined by reaching the angiography 'pruned tree' appearance and sluggish flow in the main stem of the uterine artery. Assessment of morphologic mid term success was done by MRI 10 days, 3 months, 6 months, 9 months and 1 year after UFE. The clinical mid term success was assessed by having questionaires completed for menstrual bleeding, retention of clinical (symptomatic) benefit and quality of life. Results: Technical success was 100%, with 8 minor (2 post-interventional collapses, 2 hematomas, 4 relevant post-embolizations syndromes, 1 spontaneous expulsion of a submucous myoma) and 3 major complications (1 hysterectomy because of vaginal bleeding for 5 weeks, 1 transient amenorrhea and 1 spontaneous expulsion of myoma with transient bleeding requiring admission). In 17 of 19 patients, MRI showed total fibroid devascularization throughout the entire follow-up. The average shrinkage of the dominant fibroid was 71.3% at one year. The menstrual bleeding record in the cohort group fell from an average of 501.6 before treatment to 76.2 points at one year. At the same time, the clinical symptoms significantly improved. The patient satisfaction with the applied therapy was >95% at 1 year. One patient with residual fibroid perfusion underwent a second procedure, which achieved complete devascularization and adequate clinical success at one year. The second patient with incomplete devascularization had a persistent clinical benefit. (orig.)

  2. Activin-A and Myostatin Response and Steroid Regulation in Human Myometrium: Disruption of Their Signalling in Uterine Fibroid

    Science.gov (United States)

    Bloise, Enrrico; Gray, Peter C.; Carrarelli, Patrizia; Islam, Md. Soriful; De Pascalis, Flavio; Severi, Filiberto Maria; Vale, Wylie; Castellucci, Mario; Petraglia, Felice

    2011-01-01

    Context: Investigation of activin-A (A) and myostatin (M) in human myometrium (HM) and leiomyoma (HL) will explain their involvement in human myometrial pathophysiology. Objective: We aimed to investigate A and M response and steroid regulation in HM. We also evaluated A and M expression and response in HL. Design: Tissues were analyzed and cultured. Patients: Patients included fertile (in proliferative phase) and menopausal women undergoing hysterectomy. Interventions: HM explant cultures were treated with A and M (for Smad-7 mRNA quantification) or estrogen and progesterone (for A and M mRNA quantification). A and M expression levels were also evaluated in menopausal (physiological absence of steroids) HM specimens. A and M and their receptors were evaluated in HL (n = 8, diameter 5–8 cm) compared with their matched HM. HL explants cultures were treated with A and M (for Smad7 mRNA quantification), and, to explain the absence of response, the levels of follistatin, follistatin-related gene (FLRG), and Cripto were evaluated. Results: A and M increased Smad7 expression in HM explants. A and M mRNAs were both reduced after estradiol treatment, unchanged after progesterone treatment, but were higher in menopausal than fertile (in proliferative phase) specimens. A, M, and FLRG were expressed at higher levels in HL compared with adjacent HM, whereas the receptors, follistatin, and Smad7 mRNAs resulted unchanged. Cripto mRNA was expressed only in HL. Conclusions: A and M act on human HM and are regulated by steroids. In HL there is an increase of A, M, FLRG, and Cripto expression. PMID:21177794

  3. Less-Invasive Fibroid Treatment May Be 'Under-Used'

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_163933.html Less-Invasive Fibroid Treatment May Be 'Under-Used' But ... hysterectomy remains much more common compared with a less-invasive procedure called embolization. Fibroids are non-cancerous ...

  4. Clinical Study on Treatment for Uterine Fibroids with Intratumoral Injection of Methotrexate Com-bined with Levonorgestrel%甲氨蝶呤瘤体内注射联合左炔诺孕酮治疗子宫肌瘤的临床研究

    Institute of Scientific and Technical Information of China (English)

    董梅

    2015-01-01

    Objective To explore the efficacy and safety of intratumoral injection of methotrexate com-bined with levonorgestrel in treating uterine fibroids .Methods A total of 186 patients with uterine fibroids who were treated in Zoucheng People′s Hospital from Jan.2011 to Jan.2012 were selected and divided into combination group(n=92) and control group(n=94) according to random number table.Patients in combi-nation group were treated with intratumoral injection of methotrexate (50-60 mg) combined with levonorg-estrel(20 μg).While patients in control group were only treated with levonorgestrel(20 μg).Improvement of clinical symptomschanges of uterine fibroids volume,efficiency,incidences of adverse reactions were com-pared between the two groups.Results After treatment,the menstrual recovery rate,disappearance rate of lower abdomen and waist pain, disappearance rate of frequent and urgent micturition in combination group were significantly higher than those in control group (P<0.05).Six months,twelve months after treatment, the uterine myoma volumes of the combination group were significantly smaller than those of the control group [(43.7 ±18.3) cm3 vs (49.2 ±18.0) cm3,(30.4 ±17.0) cm3 vs (42.5 ±16.5) cm3,P<0.05].The efficiency of the combination group was higher than that of the control group(94.6% vs 85.1%,P<0.05). Adverse reactions occurred 1-3 days after injection of methotrexate in the combination group were mild and recovered rapidly,while no obvious adverse reaction occurred in the control group.Conclusion Treating uterine fibroids with levonorgestrel release system combined with intratumoral injection of methotrexate can reduce uterine fibroids volume and improve clinical symptoms more quickly,with better curative effect,com-pared with simple treatment with levonorgestrel release system.%目的:探讨甲氨蝶呤瘤体内注射联合左炔诺孕酮治疗子宫肌瘤的疗效及安全性。方法选择2011年1月至2012年1月于邹城市人民医院妇科

  5. 子宫动脉栓塞联合宫腔镜治疗巨大子宫黏膜下肌瘤临床分析%Uterine artery embolization combined with hysteroscopy in treatment of gigantic submucosal fibroids of uterus

    Institute of Scientific and Technical Information of China (English)

    都君君

    2015-01-01

    目的 探讨对巨大子宫黏膜下肌瘤行子宫动脉栓塞联合宫腔镜治疗的临床效果.方法 随机选取本院2013年8月至2014年3月期间收治的巨大子宫黏膜下肌瘤患者64例,按照治疗方案的不同将其分为观察组和对照组.其中对照组患者行宫腔镜电切术,观察组患者则采用子宫动脉栓塞联合宫腔镜进行治疗,对两组患者的临床治疗效果及其并发症的发生情况进行观察对比.结果 观察组患者的手术治疗总有效率为96.88%,明显高于对照组患者(40.63%);观察组患者术后并发症的发生率为12.50%,明显低于对照组患者(40.63%);差异具有统计学意义(P<0.05).结论 采用子宫动脉栓塞联合宫腔镜治疗巨大子宫黏膜下肌瘤,效果显著,有助于彻底清除肌瘤组织,促进患者术后恢复,建议在临床上进一步推广.%Objective To investigate the clinical effect of uterine artery embolization combined with hysteroscopy in the treatment of gigantic submucosal fibroids of uterus.Methods 64 patients with gigantic submucosal fibroids of uterus admitted in our hospital from August 2013 to March 2014 were randomly selected and were divided into an observation group and a control group according to different treatment regimens.The control group was treated with hysteroscopic surgery and the observation group with uterine artery embolization and hysteroscopy.The clinical therapeutic effect and the incidence of relevant complication in both groups were observed and compared.Results The total effective rate of the surgical treatment of the observation group was 96.88%, which was significantly higher than that of the control group (40.63%);the incidence of postoperative complications of the observation group was 12.50%, which was significantly lower than that of the control group (40.63%);the differences were statistically significant (P<0.05).Conclusions Uterine artery embolization combined with hysteroscopy in the

  6. Medical Treatments for Fibroids

    Science.gov (United States)

    ... NICHD Research Information Clinical Trials Resources and Publications Medical Treatments for Fibroids Skip sharing on social media ... Page Content Your health care provider may suggest medical treatments to reduce the symptoms of fibroids or ...

  7. 植物性雌激素对子宫肌瘤合并缺铁性贫血患者血清激素水平、NOS及氧化应激产物影响%Effect of plant estrogen on serum hormone levels, NOS and oxidative stress products in patients with uterine fibroids with iron deficiency anemia

    Institute of Scientific and Technical Information of China (English)

    胡艳萍; 李璐; 李馨

    2015-01-01

    Objective To investigate the effect of plant estrogen on serum hormone levels, NOS and oxidative stress products in patients with uterine fibroids with iron deficiency anemia.Methods 80 cases of hysteromyoma patientswith uterine fibroids with iron deficiency anemia were selected, according to the different medication were randomly divided into experiment group and control group,40 cases in each group.Two groups were treated with anemia correction , mifepristone oral ,and the experiment group were treated on the base of the control group with plant estrogen, 12 weeks for a course.serum sex hormone, NOS, SOD and MDA level were detected.ResuIts Compared with the control group, the indexes of patients in the experimental group were lower(P<0.05), level of serum NOS were higher(P<0.05), level of serum SOD were higher(P<0.05), level of serum MDA were lower ( P<0.05 ) .ConcIusion Plant estrogen can improve the serum levels of serum hormone, NOS and oxidative stress levels of the treatment of uterine fibroids, worthy of clinical promotion.%目的:探讨植物性雌激素对子宫肌瘤合并缺铁性贫血患者血清激素水平、NOS及氧化应激产物的影响。方法收集子宫肌瘤患者80例,根据用药不同随机分为实验组和对照组,每组各40例,2组患者给与贫血纠正治疗,对照组给与米非司酮口服,实验组在对照组基础上给与植物性雌激素治疗,连续12周后对患者的血清性激素、NOS、SOD、MDA水平进行检测。结果治疗后,与对照组相比,实验组血清性激素各指标均较低(P<0.05),血清NOS水平较高(P<0.05),血清SOD水平较高(P<0.05),MDA水平较低( P<0.05)。结论植物性雌激素能够通过改善患者血清激素水平、NOS及氧化应激产物水平治疗子宫肌瘤,对临床具有指导意义。

  8. 超声消融治疗子宫肌瘤的安全性及有效性%Study on the efficacy and safety of ultrasound ablation in treatment of uterine fibroids

    Institute of Scientific and Technical Information of China (English)

    陈文直; 令狐华; 陈锦云; 朱丽; 邓勇斌; 王智彪; 唐良萏; 杨武威; 张彦; 李静; 夏文秀; 周洁敏; 祝宝让; 赵纯全

    2010-01-01

    Objective To investigate the safety and efficacy of ultrasound ablation in treatment of uterine fibroids. Methods Ninety-nine patients with 117 leiomyomas in total treated by Haifu JC focused ultrasound tumor therapeutic system were enrolled in prospective and non-randomized clinical trial in First Affiliated Hospital of Chongqing Medical University and Academy of Military Medical Sciences. Ultrasound ablation was performed guided by real-time ultrasonography under conscious sedation for single session. All patients were followed up at 6 months after treatment. On the day of treatment and after 1 month, patients were given by magnetic resonance imaging(MRI) exam to evaluate the effect of fibroids ablation. At 3 and 6months after treatment, the ratio of ablated area and volume reduction of fibroids more than 50% were evaluated by MRI exam again. The symptoms improvements were evaluated by uterine fibroid symptom (UFS) and complications were analyzed by guideline of society of international radiation (SIR). Results The average ablated area ratio of the target fibroid was (76 ± 24)%. The average reduction in fibroid volume determined by MRI at 3 and 6 months after treatment was (45 ± 21)% and (59 ± 26)%. Which were significantly decreased than those before treatment (P < 0. 05). At 6 months after treatment, 84. 6% (99/117) of patients showed more than 50% volume reduction, the rate of improved symptom score was 92%(66/72). All patients could resume normal daily activities at 2 hours after treatment. The adverse reactions of SIR C - D included delayed hospitalization, repeat treatment and increased level of nursing. E - F included permanent sequelae and death. In this study, no adverse reactions of C - F were recorded. Common complications (SIR A- B, only observation or simple management without sequelae) were 35% (35/99).Four cases with adverse reactions B of SIR were found, including 2 cases with skin burning of degree Ⅱ and 2 cases with febrile, they were

  9. 不同手术方法治疗子宫肌瘤对患者性功能影响的临床研究%Effect of different treating methods for uterine fibroids on the sexual function of patients

    Institute of Scientific and Technical Information of China (English)

    郑蕊; 薛惠英; 胡捷

    2014-01-01

    目的:探讨子宫肌瘤剔除术与子宫次全切除术对患者性功能的影响,并对患者的性功能情况及婚姻质量情况进行调查分析。方法:选择2011年4月至2013年11月期间在我院接受诊治的子宫肌瘤患者114例作为研究对象。根据不同手术方式将114例患者分为观察组(n=57)与对照组(n=57)。观察组行子宫肌瘤剔除术,对照组行子宫次全切除术;对比分析两组患者性功能情况及婚姻质量情况。结果:两组患者术前性功能对比无显著性意义;观察组术后6个月在性欲方面、性高潮方面、性心理方面、射精时间、性唤起方面及性行为中异常症状评分显著高于对照组,且有显著性意义(P<0.05);两组患者术前婚姻质量对比无显著性意义;观察组在术后6个月性生活、夫妻交流及婚姻满意度评分均显著高于对照组,且有显著性意义(P<0.05)。结论:子宫肌瘤剔除术临床效果好且对患者性功能及婚姻质量影响小,故对于子宫肌瘤患者应尽可能保留子宫,具有重要临床意义。%To investigate the effect of myomectomy and hysterectomy surgery on the sexual function of patients,and to investigate the situation of sexual function and marital quality of patients.Methods:1 14 patients with uterine fibroids in our hospital from April 201 1 to November 2013 were selected as study objects and divided into two groups observation group (n=57)and control group (n=57)according to the surgical approach. Observation group underwent myomectomy,while the control group underwent hysterectomy surgery.The sexual function and marital quality of the two groups were compared and analyzed.Results:No significant difference could be found before treatment.Six months after the treatment,the scores of observation group were much higher than the control group in terms of sexual desire,orgasm,sexual psychology,ejaculation,sexual arousal and abnormal

  10. Effect of uterine fibroids on fetal growths and neonatal outcomes in twin pregnancies%子宫肌瘤对双胎胎儿生长发育及新生儿结局的影响

    Institute of Scientific and Technical Information of China (English)

    王红梅; 代荫梅; 田玉翠; 薛智方

    2015-01-01

    Objective To prospectively estimate the effect of fibroids on fetal growths and neonatal outcomes in twin pregnancies. Methods Data of 46 twin pregnancies with fibroids delivered from June 2013 to December 2014 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University who have already established their records were collected. And data were also collected from 63 twin pregnancies without fibroids as matched group. The monitoring parameters of ultrasounds in their early, middle and late pregnancy and neonatal conditions and obstetric outcomes were observed and recorded. Results Twin pregnancies with fibroids were more likely to be of advanced maternal age ﹝(35.04±4.24)years vs (31.67±3.56)years, P=0.000﹞, higher pre-pregnancy body mass index ﹝(21.46± 3.69)kg/m2 vs (20.77±2.38)kg/m2, P=0.009﹞ and had lower amniotic fluid volume﹝(3.14±0.55)cm vs (3.38±0.55)cm, P=0. 001﹞ in 11-14 weeks ultrasound compared with twin pregnancies without fibroids. However, other parameters of fetal growths in early, middle and late pregnancy, neonatal conditions and obstetric outcomes had no statistical significance between twin pregnancies with fibroids and those without fibroids. Conclusion Fibroids’ effect on fetal growths and neonatal outcomes in twin pregnancies is not obvious. But twin pregnancy is a high risk factor for pregnancy and we should give more monitoring and management for twin pregnancy with fibroids, so that mothers and newborns get more reasonable and secure treatment.%目的:前瞻性评估子宫肌瘤对双胎胎儿生长发育及新生儿结局的影响。方法选取在首都医科大学附属北京妇产医院建档并于2013年6月至2014年12月分娩的双胎妊娠合并子宫肌瘤患者共46例作为研究组,以及双胎妊娠无肌瘤者63例作为对照组,观察并记录其孕早期、中期、晚期B超监测胎儿生长发育指标、新生儿出生情况及妊娠结局。结果与对照组相比,双胎妊娠合

  11. Comprehensive nursing care on the application of the pregnancy with uterine fibroids%综合化护理在妊娠合并子宫肌瘤中的应用

    Institute of Scientific and Technical Information of China (English)

    冯秀芬

    2017-01-01

    Objective: to summarize analysis with comprehensive nursing methods of pregnancy with hysteromyoma patients and their nursing effect.Methods: 120 cases of pregnancy with hysteromyoma patients as the research object, the control group of 60 cases of routine nursing care, observation group of 60 cases of integrated management, nursing effect were reviewed as well as the key indicators.Results: the disease control time, length of hospital stay, the nursing service satisfaction and incidence of complications such as indicators, obvious differences in group and the control group (P < 0.05), with statistical significance.Conclusion: pregnancy with uterine fibroids were treated by comprehensive care, help to improve the prognosis of patients, reduce complications and improve the quality of service, worthy of clinical popularization and application.%目的:总结分析妊娠合并子宫肌瘤患者应用综合化护理的方法及其护理效果.方法:以120例妊娠合并子宫肌瘤患者为研究对象,对照组60例常规护理,观察组60例综合化护理,回顾分析护理效果以及关键指标.结果:在疾病控制时间、住院时间、护理服务满意度以及并发症发生率等指标方面,观察组和对照组差异明显(P<0.05),具有统计学意义.结论:妊娠合并子宫肌瘤患者采用综合化护理,有助于改善患者预后,减少并发症的发生,提高服务质量,值得临床推广应用.

  12. Comparison of Two Endovascular Steerable Robotic Catheters for Percutaneous Robot-Assisted Fibroid Embolization.

    Science.gov (United States)

    Del Giudice, C; Pellerin, O; Nouri Neville, M; Amouyal, G; Fitton, I; Leré-Déan, C; Sapoval, M

    2017-09-08

    To compare outcomes of percutaneous robot-assisted uterine fibroid embolization (UFE) using two different endovascular robotic catheters. Twenty-one patients with a symptomatic uterine fibroid were prospectively enrolled in a single-center study to be treated with a percutaneous robot-assisted embolization using the Magellan system. Fourteen patients were treated using a first generation steerable robotic catheter, version 1.0 (group 1), and seven were treated using the new version 1.1 (group 2). Demographic, pathologic, and procedural variables were recorded. Dose Area Product (DAP) and physician equivalent doses were registered for each procedure. Procedural related complications and clinical midterm outcomes were also evaluated. Successful robot-assisted UFE was obtained in eight patients (57.1%) in group 1 and 7 patients (100%) in group 2 (p = 0.01). A successful robot-assisted catheterization of the internal iliac artery anterior branch was performed in all patients of both groups. Median selective target vessel catheterization time was 21.0 ± 12.8 vs 13.4 ± 7 min (p = 0.04) and total fluoroscopy time was 30.3 ± 11.2 vs 19.3 ± 5.9 min, respectively, in group 1 and 2. Mean DAP decreased from 18472.6 ± 15622 to 5469.1 ± 4461.0 cGy·cm(2) (p = 0.04). All patients obtained a symptoms relief at 6 months follow-up. Robot-assisted uterine fibroid embolization is safe and effective. New version of steerable robotic catheter allows performing a faster procedure without related adverse events compared to old version.

  13. The Effect of Mifepristone on the SULT1E1 in Uterine Fibroid Tissue,ERαand ERβProtein Levels%米非司酮对子宫肌瘤组织SULT1 E1和雌激素受体α、β受体蛋白的影响

    Institute of Scientific and Technical Information of China (English)

    高玲; 李红霞

    2016-01-01

    Objective To evaluate the effect of mifepristone on the uterine fibroid tissue sulfotransferases 1E1 (SULT1E1), estrogen receptorα(ERα) and ERβprotein levels.Methods Total of 110 patients with uterine fibroid tissue in People′s Hospital of Chongqing Dadukou District from Oct.2013 to Apr.2015 were included.According to the random number table method they were divided into an observation group and a control group,55 cases each.The control group given preoperative oral placebo after a routine clinical exami-nation,taking 90 consecutive surgery treatment in the future.Observation group on the basis of preoperative routine clinical examination joint treated with mifepristone ,the first day of menstruation in patients with oral mifepristone 12.5 mg,taking 90 consecutive surgery in the future.Changes in the two groups before and after treatment were compared with tumor volume level,SULT1E1 content, ERα, ERβintegration level changes and therapeutic effect of the two groups were compared .Results Total effective rate of the observation group was higher than the control group[83.64%(46/55) vs 45.45%(25/55)], the difference was statistically significant( P <0.05 );after treatment, tumor volume of the observation group was lower than the control group[(96.32 ±4.65) mm3 vs (132.58 ±4.64) mm3],the difference was statistically significant(P<0.01);SULT1E1,ERα, ERβof the observation group were lower than the control group [(28.24 ± 3.47)% vs (33.67 ±3.92)%,(0.32 ±0.05)% vs (0.58 ±0.04)%,(0.09 ±0.01)% vs (0.12 ± 0.01)%],the differences were statistically significant(P <0.01).Conclusion Mifepristone has good effect for uterine fibroid patient,which can reduce tumor size, lower SULT1E1 and ERα, ERβlevel, with significantly improved efficacy,thus is worthy of promotion in clinical.%目的:探讨米非司酮对子宫肌瘤组织雌激素硫酸转移酶(SULT1E1)、雌激素受体(ER)α和ERβ蛋白的影响。方法选择2013年10月至2015年4月重庆市

  14. Laparoscopic power morcellation of presumed fibroids.

    Science.gov (United States)

    Brolmann, Hans A; Sizzi, Ornella; Hehenkamp, Wouter J; Rossetti, Alfonso

    2016-06-01

    Uterine leiomyoma is a highly prevalent benign gynecologic neoplasm that affects women of reproductive age. Surgical procedures commonly employed to treat symptomatic uterine fibroids include myomectomy or total or sub-total hysterectomy. These procedures, when performed using minimally invasive techniques, reduce the risks of intraoperative and postoperative morbidity and mortality; however, in order to remove bulky lesions from the abdominal cavity through laparoscopic ports, a laparoscopic power morcellator must be used, a device with rapidly spinning blades to cut the uterine tissue into fragments so that it can be removed through a small incision. Although the minimal invasive approach in gynecological surgery has been firmly established now in terms of recovery and quality of life, morcellation is associated with rare but sometimes serious adverse events. Parts of the morcellated specimen may be spread into the abdominal cavity and enable implantation of cells on the peritoneum. In case of unexpected sarcoma the dissemination may upstage disease and affect survival. Myoma cells may give rise to 'parasitic' fibroids, but also implantation of adenomyotic cells and endometriosis has been reported. Finally the morcellation device may cause inadvertent injury to internal structures, such as bowel and vessels, with its rotating circular knife. In this article it is described how to estimate the risk of sarcoma in a presumed fibroid based on epidemiologic, imaging and laboratory data. Furthermore the first literature results of the in-bag morcellation are reviewed. With this procedure the specimen is contained in an insufflated sterile bag while being morcellated, potentially preventing spillage of tissue but also making direct morcellation injuries unlikely to happen.

  15. Efficacy and satisfaction rate comparing endometrial ablation by rollerball electrocoagulation to uterine balloon thermal ablation in a randomised controlled trial.

    NARCIS (Netherlands)

    Zon-Rabelink, I.A.A. van; Vleugels, M.P.; Merkus, J.M.W.M.; Graaf, R.M. de

    2004-01-01

    OBJECTIVE: To compare two methods of endometrial ablation, hysteroscopic rollerball electrocoagulation (RBE) and non-hysteroscopic uterine balloon thermal ablation (Thermachoice trade mark ), regarding efficacy for reducing dysfunctional uterine bleeding and patients satisfaction rate. METHODS: A ra

  16. The management of uterine leiomyomas.

    Science.gov (United States)

    Vilos, George A; Allaire, Catherine; Laberge, Philippe-Yves; Leyland, Nicholas

    2015-02-01

    The aim of this guideline is to provide clinicians with an understanding of the pathophysiology, prevalence, and clinical significance of myomata and the best evidence available on treatment modalities. The areas of clinical practice considered in formulating this guideline were assessment, medical treatments, conservative treatments of myolysis, selective uterine artery occlusion, and surgical alternatives including myomectomy and hysterectomy. The risk-to-benefit ratio must be examined individually by the woman and her health care provider. Implementation of this guideline should optimize the decision-making process of women and their health care providers in proceeding with further investigation or therapy for uterine leiomyomas, having considered the disease process and available treatment options, and reviewed the risks and anticipated benefits. Published literature was retrieved through searches of PubMed, CINAHL, and Cochrane Systematic Reviews in February 2013, using appropriate controlled vocabulary (uterine fibroids, myoma, leiomyoma, myomectomy, myolysis, heavy menstrual bleeding, and menorrhagia) and key words (myoma, leiomyoma, fibroid, myomectomy, uterine artery embolization, hysterectomy, heavy menstrual bleeding, menorrhagia). The reference lists of articles identified were also searched for other relevant publications. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date limits but results were limited to English or French language materials. Searches were updated on a regular basis and incorporated in the guideline to January 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies. The majority of fibroids are asymptomatic and require no intervention or further

  17. Fibroid Tumors in Women: A Hidden Epidemic?

    Science.gov (United States)

    ... Issue Past Issues Fibroid Tumors in Women: A Hidden Epidemic? Past Issues / Spring 2007 Table of Contents ... fibroids@rics.bwh.harvard.edu , or visit our Web site: www.fibroids.net . You may also write ...

  18. Outcomes following unilateral uterine artery embolisation.

    Science.gov (United States)

    McLucas, B; Reed, R A; Goodwin, S; Rappaport, A; Adler, L; Perrella, R; Dalrymple, J

    2002-02-01

    Uterine artery embolisation has been described as successful only when both arteries are embolised. However, results in patients with one congenitally absent or previously ligated artery are unknown. Women suffering from symptomatic uterine myomata were treated at a university teaching hospital, a community hospital and an outpatient surgery centre. Retrospective review of patient response to embolisation was assessed by chart review and questionnaire. Uterine and dominant fibroid size response was assessed by comparing pre- and post-embolisation ultrasound examinations. This study analysed three patient groups within the general population: those who underwent unilateral embolisation because of technical failure, those who ultimately underwent bilateral embolisation after initial technical failure and those who underwent unilateral embolisation because of an absent uterine artery. 12 patients underwent unilateral embolisation, 4 of whom underwent this procedure because of an absent uterine artery. Three of these four patients had a congenitally absent uterine artery arising from the internal iliac artery and all three experienced successful outcomes. The fourth patient had a previously ligated internal iliac artery and her symptoms worsened after the procedure. Eight patients had unilateral embolisation due to technical failure. Five of these patients underwent a subsequent procedure during which the contralateral uterine artery was embolised. Four of these five patients had successful outcomes and one was lost to follow-up. Another of the eight patients suffered an arterial injury leading to technical failure, and was lost to follow-up. Of the two remaining patients with unilateral technical failure, only one had a successful outcome. This study concluded that patients who undergo unilateral embolisation for technical reasons should be offered a second embolisation procedure shortly after the initial procedure. Patients with a congenitally absent uterine artery

  19. [GnRH analogues for the treatment of fibroids].

    Science.gov (United States)

    Murillo, Ester Ortiz; Cano, Antonio

    2013-07-01

    Uterine fibroids are benign tumors that are very common in women and may present significant symptoms in 20%-50% of cases. When they require action, their traditional management has been surgery (hysterectomy or fibroidectomy); however medical alternatives have been proposed, given that surgery is associated with a certain morbidity and mortality and involves healthcare costs. Within the pharmacological management of uterine fibroids, GnRH analogues are the best known and most commonly used drugs, although their indications are limited by the side effects associated with long-term treatment. Their primary indication is based on preoperative treatment (to hysterectomy or fibroidectomy) and in selected cases of patients close to menopause or who want more conservative management. These analogues are able to significantly reduce the uterine volume, the size of the fibroid and their accompanying symptoms. Their main disadvantage, however, lies in the reversibility of their effect when treatment is discontinued, along with the side effects associated with hypoestrogenism, such as climacteric symptoms and loss of bone mass. "Add-back" therapies, which associate low-dose estrogens to aGnRH, allow for extended use thanks to decreased side effects without affecting the benefits. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  20. The etiopathogenesis of uterine fibromatosis

    Science.gov (United States)

    Manta, L; Suciu, N; Toader, O; Purcărea, RM; Constantin, A; Popa, F

    2016-01-01

    Uterine fibroids or uterine leiomyomas are the most common benign tumors of the uterus among women of fertile age, while the etiology is still incompletely elucidated. The occurrence and development of the fibromatosis may be related to certain risk factors and genic mechanisms, although the exact causes are not yet fully known. The development of uterine fibroids is correlated not only with the metabolism and with the level of female sexual hormones, estrogen, and progesterone, but also with the number of these hormone receptors expressed on the surface of the myometrium. Proliferative effects of estrogen and progesterone may be exercised through proinflammatory factors (TNF alpha), growth factors (IGF1, IGF2, TGFbeta3 and betaFGF) or inhibitors of apoptosis (p53 suppression). A number of predisposing factors such as ethnicity – black skin, early menarche, nulliparity, caffeine and alcohol, chronic inflammation, obesity, were also identified. Approximately 40% of the uterine fibroids are caused by the same cytogenetic alterations found in the other tumor types such as kidney, lung, or leiomyosarcoma. As part of a system dysfunction, uterine fibromatosis was connected to other disorders such as AHT (arterial hypertension), endometrium adenocarcinoma, adenomyosis, endometriosis, diabetes mellitus, breast tumors, seemingly with a common causality. The action and effect of some hormonal imbalances over the various organs depend on the histological and local expression particularities of the various receptors, being the cause for many disorders, among which the uterine fibromatosis, coexisting or accompanying the later. This article examines and summarizes the latest data refreshed literature etiopathogenesis offering indicators of uterine fibroids. PMID:27974911

  1. Genome-wide DNA methylation indicates silencing of tumor suppressor genes in uterine leiomyoma.

    Directory of Open Access Journals (Sweden)

    Antonia Navarro

    Full Text Available BACKGROUND: Uterine leiomyomas, or fibroids, represent the most common benign tumor of the female reproductive tract. Fibroids become symptomatic in 30% of all women and up to 70% of African American women of reproductive age. Epigenetic dysregulation of individual genes has been demonstrated in leiomyoma cells; however, the in vivo genome-wide distribution of such epigenetic abnormalities remains unknown. PRINCIPAL FINDINGS: We characterized and compared genome-wide DNA methylation and mRNA expression profiles in uterine leiomyoma and matched adjacent normal myometrial tissues from 18 African American women. We found 55 genes with differential promoter methylation and concominant differences in mRNA expression in uterine leiomyoma versus normal myometrium. Eighty percent of the identified genes showed an inverse relationship between DNA methylation status and mRNA expression in uterine leiomyoma tissues, and the majority of genes (62% displayed hypermethylation associated with gene silencing. We selected three genes, the known tumor suppressors KLF11, DLEC1, and KRT19 and verified promoter hypermethylation, mRNA repression and protein expression using bisulfite sequencing, real-time PCR and western blot. Incubation of primary leiomyoma smooth muscle cells with a DNA methyltransferase inhibitor restored KLF11, DLEC1 and KRT19 mRNA levels. CONCLUSIONS: These results suggest a possible functional role of promoter DNA methylation-mediated gene silencing in the pathogenesis of uterine leiomyoma in African American women.

  2. Embolización arterial de miomas uterinos: resultados morfológicos y funcionales a corto y mediano plazo Uterine fibroid embolization: morphologic and functional results at short-to-medium term

    Directory of Open Access Journals (Sweden)

    Sergio Lucino

    2010-06-01

    (UAE is an alternative to conventional surgical therapy. Purpose: The objective of this study was to evaluate the usefulness of UAE as treatment for symptomatic myomatosis at short and intermediate term, to evaluate the safety of this technique and to compare its results with other alternative treatments. Material and methods: Prospective study of 28 selected patients who underwent UAE from December 2000 to April 2005 and followed up until April 2008 whose average age was 41 years. All the patients presented with symptomatic myomatosis with menstrual bleeding disorders. All the patients desired to keep their uterus. The embolizing material was polyvinyl alcohol particles of 500-1000 μm. Results: Twenty seven patients were discharged 24 hours after the UAE. One patient remained hospitalized 12 more hours and 1 was readmitted 48 hours after the procedure, both due to pelvic pain. All the patients returned to their usual activities 7 + days after the UAE. None of the patients presented complications. All the patients remained satisfied with the results of the procedure at the 6-month control. Conclusion: UAE is an outstanding alternative to conventional treatment, with high technical success and safety. It should be considered for patients with symptomatic uterine myomas.

  3. Comparing two Uterine Manipulators During Total Laparoscopic Hysterectomy: A Randomized Controlled Trial.

    Science.gov (United States)

    Husslein, Heinrich; Frecker, Helena; Shore, Eliane M; Lefebvre, Guylaine; Latta, Eleanor; Montanari, Eliana; Satkunaratnam, Abheha

    To compare 2 different types of uterine manipulators (i.e., tight fitting vs loose fitting) used for total laparoscopic hysterectomy (TLH). A randomized controlled trial. The primary end points were time for colpotomy, time from skin incision to detachment of the uterus, and histologic assessment of thermal damage to the vagina (Canadian Task Force classification I). A university teaching hospital. All consecutive women scheduled for TLH from May 2014 to December 2015. Patients were excluded if pregnancy or malignancy was suspected or uterine size exceeded 20 weeks' gestation. Patients were randomized to undergo TLH with 1 of the following uterine manipulators: (1) Colpo-Probe Vaginal Fornix Delineator (Cooper Surgical, Inc, Trumbull, CT) or (2) Hohl manipulator (KARL STORZ AG, Tuttlingen, Germany). A total of 91 patients, 49 in the Hohl manipulator group and 42 in the Colpo-Probe group, were included in the final analysis. There was no difference in patient characteristics, uterine weight, or estimated blood loss. The median time for insertion of the manipulator (2 minutes [interquartile range (IQR), 2-5 minutes] vs 6 minutes [IQR, 5-7], p manipulator. Thermal damage to the vagina varied greatly and ranged from 32 μm to 5232 μm but was not significantly different between groups (median maximum thermal damage = 1043 μm [IQR, 682-1934] vs 1522 μm [IQR, 884-2144], p = .211). Use of the Hohl manipulator results in a shorter operative time from skin incision to detachment of the uterus during TLH. Although the colpotomy time is shorter using the Hohl manipulator, this did not translate to less thermal damage to the vaginal cuff. Further studies comparing uterine manipulators are warranted to find the optimal instrument for ease of surgery and decreased thermal spread. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Inflammatory response in patients undergoing uterine artery embolization as compared to patients undergoing conventional hysterectomy

    DEFF Research Database (Denmark)

    Brøchner, A C; Mygil, B; Elle, B;

    2009-01-01

    : To investigate whether uterine artery embolization generates a reduced inflammatory response as compared with conventional hysterectomy. MATERIAL AND METHODS: 40 women, 20 in each group, entered this prospective, non-randomized study. The two groups were comparable concerning age, comorbidity, and body......-mass index (BMI). RESULTS: We found a significant difference between the inflammatory responses in women undergoing embolization compared with the inflammatory response in women having an abdominal hysterectomy. Women undergoing embolization were subjected to a much smaller inflammatory burden, their total...... morphine consumption was lower, and their return to work was faster than women subjected to conventional hysterectomy. CONCLUSION: Uterine artery embolization generates a reduced inflammatory response compared with conventional hysterectomy....

  5. A retrospective study of magnetic resonance-guided focused ultrasound ablation for uterine myoma in Taiwan

    Directory of Open Access Journals (Sweden)

    Sheng-Ling Tung

    2016-10-01

    Conclusion: The results obtained from this study demonstrated that MRgFUS can be safely and effectively used to ablate uterine fibroids to produce a significant decrease in mean fibroid volume and improve SSS for up to 6 months after treatment.

  6. [Hormonal treatments for hemorrhaging secondary to fibroids. An alternative or complement to surgery?].

    Science.gov (United States)

    Cancelo Hidalgo, María Jesús

    2013-07-01

    The main objective of treatment in women with uterine fibroids is the control of associated symptoms such as abnormal uterine bleeding, pain and pressure. Although the cost and potential adverse effects of the long-term use of medical treatment may limit its use for a long time, this alternative should be considered before indicating surgical treatment. At present, we have a considerable variety of drugs that, although not specific treatments for fibroids, may be used for the short to medium-term management of bleeding; however, we have still not found an alternative that eliminates the need for invasive treatments. Further research in this field is therefore warranted. Given the heterogeneity of fibroids and the lack of effective treatments in controlling their growth, the identification of signals that stimulate the onset and growth of these fibroids opens doors to the development of new therapies. In the future we may be able to differentiate classes of fibroids by molecular techniques and thereby implement specific treatments that control their development and their associated symptoms. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  7. Comparative study between ormeloxifene and oral contraceptive pills in the treatment of dysfunctional uterine bleeding

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    Jimitkumar Jamanadas Chhatrala

    2015-04-01

    Full Text Available Background: Dysfunctional uterine bleeding is the most common cause of abnormal uterine bleeding. It can cause anemia, reduces the quality of life and increases healthcare costs. The present study was carried out to study the efficacy of ormeloxifene and compare it to combined oral contraceptive pills in the treatment of dysfunctional uterine bleeding. Methods: 140 patients with dysfunctional uterine bleeding were selected randomly and divided into 2 groups of 70 each. Group A was given ormeloxifene tablet 60 mg twice a week for 12 weeks followed by 60 mg once a week for next 12 weeks. Group B was given low dose oral contraceptive pills containing 30 and #956;g of ethinyl estradiol and 150 and #956;g levonorgestrel from day 1 of the menstrual cycle to day 21 for 6 consecutive cycles. Follow up for six months on every cycle was done to assess the symptoms in the form of amount of bleeding (which was assessed by pictorial blood loss assessment chart score, recurrence of symptoms and also the side effects of each drug. Patient's improvement was assessed by performing blood hemoglobin level. Patient's level of satisfaction was judged by general health, limitation of social activity, sexual life and patient's wish to continue treatment with the same drug. Results: The reduction in mean pictorial blood loss assessment score with ormeloxifene (174 to 75 was significantly more than with oral contraceptive pills (171 to 106 at 6 months (P 0.05. Recurrence of symptoms was 11% with ormeloxifene and 24% with oral contraceptive pills. The side effects were minimal in both the groups. 68.6% patients with ormeloxifene and 47.2% with oral contraceptive pills were highly satisfied with their treatment. Conclusions: Ormeloxifene is more effective, with convenient dose schedule, well tolerated, with better compliance and shows less recurrence rate in treatment of dysfunctional uterine bleeding than oral contraceptive pills. [Int J Reprod Contracept Obstet Gynecol

  8. Safety and Effectiveness of UFE in Fibroids Larger than 10 cm

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    Bérczi, Viktor, E-mail: berczi@hotmail.com; Valcseva, Éva, E-mail: evapeneva@gmail.com; Kozics, Dóra, E-mail: dora.kozics@gmail.com; Kalina, Ildikó, E-mail: ilkalina@t-online.hu; Kaposi, Pál, E-mail: kaposipal@gmail.com [Semmelweis University, Department of Radiology and Oncotherapy (Hungary); Sziller, Péter, E-mail: psziller@t-online.hu; Várbíró, Szabolcs, E-mail: varbiroszabolcs@gmail.com [Semmelweis University, 2nd Department of Gynaecology and Obstetrics (Hungary); Botos, Erzsébet Mária, E-mail: erzsebetbotos@gmail.com [Semmelweis University, Department of Radiology and Oncotherapy (Hungary)

    2015-10-15

    IntroductionEarly literature suggested that the size of the uterus, the size of the dominant fibroid, and the amount of applied embolization particles would be the risk factors for major postprocedural complications, but recent publications have confuted these early results. The purpose of our study was to evaluate whether the size of the dominant fibroid would influence the complication rate and effectiveness in a large single-center cohort.Patients and MethodsFrom 28 April 2008 until 31 December 2012, 303 patients had uterine artery embolization (UAE). 262 patients had small [largest diameter <10 cm (Group 1)], 41 patients had large [largest diameter >10 cm (Group 2)] fibroid. UAE was performed from unilateral femoral access using 500–710 and 355–500 µm polyvinyl alcohol particles. Periprocedural and postprocedural complications and numerical analog quality-of-life scores (0—unbearable symptoms; 100—perfect quality of life) were listed and statistically analyzed.ResultsDuring the mean follow-up time [7.79 ± 5.16 (SD) month], data on 275 patients (275/303 = 90.8 %) were available. Quality-of-life score was 33.3 ± 23.5 and 33.5 ± 24.1 before, whereas 85.6 ± 16.0 and 81.5 ± 23.5 after UAE in Group 1 and Group 2, respectively, (Mann–Whitney U test one-sided, p = 0.365). There were 4 myoma expulsions, 1 acute myomectomy, and 2 acute hysterectomies reported from Group 1, meanwhile 1 myoma expulsion, 1 acute myomectomy, and 2 acute hysterectomies were documented from Group 2 (NS differences).ConclusionThere was no significant difference in the effectiveness and in the number of minor and major complications between fibroids with <10 cm largest diameter compared to those >10 cm.

  9. Successful spontaneous pregnancy and delivery following myomectomy and uterine artery embolization (UAE – A case report

    Directory of Open Access Journals (Sweden)

    Z.K. Balghari

    2011-03-01

    Full Text Available Uterine artery embolization has emerged as an effective treatment for symptomatic uterine fibroids. Nevertheless because of the uncertainty about the effects of UAE on fertility, women who still want to become pregnant are sometimes excluded from treatment. Pregnancy after UAE has been described in the published literature in the form of case reports, case series and retrospective cohort studies. We present an interesting case of a successful spontaneous pregnancy and delivery in a 42year old woman, who was diagnosed to have fibroids and endometriosis. She had a myomectomy followed by two procedures of UAE for recurrent fibroids and was treated for extensive endometriosis.

  10. Clinical Observation on Treatment of Uterine Fibroid Artery Embolization Induced Postoperative Syndrome by Therapy of Promoting Blood Circulation and Removing Stasis in Patients with Uterus Myoma%化瘀散结法治疗子宫肌瘤动脉栓塞术后综合征的临床观察

    Institute of Scientific and Technical Information of China (English)

    冷观群; 亢雪峰; 魏毅利; 邱永秀

    2010-01-01

    目的 观察化瘀散结法治疗子宫肌瘤患者行子宫动脉栓塞术(uterine fibroid artery embolization,UFAE)后并发症的近期临床疗效.方法 将60例瘀阻胞宫证子宫肌瘤患者随机分为治疗组和对照组各30例,两组均采用Sldinger技术完成UFAE治疗.治疗组在术后3个月服用活血化瘀、散结消癥类中药,对照组酌情予对症治疗.两组患者均术后随访6个月,详细观察并记录患者治疗前后月经变化,栓塞综合征出现的时间、程度、缓解方法及消失时间.结果 两组术后均未发现闭经;对照组出现1例轻度泌尿生殖系统感染,治疗组无泌尿生殖系统感染;治疗组发生盆腔疼痛的病例数显著低于对照组;治疗组盆腔疼痛评分、持续时间和阴道不规则流血持续时间显著低于对照组(P<0.05).结论 化瘀散结法治疗UFAE并发症具有明显优势,不良反应少,临床具有较好的应用前景.

  11. Comparative effectiveness and impact on health-related quality of life of hysterectomy vs. levonorgestrel intra-uterine system for abnormal uterine bleeding.

    Science.gov (United States)

    Cozza, G; Pinto, A; Giovanale, V; Bianchi, P; Guarino, A; Marziani, R; Frega, A; Caserta, D

    2017-05-01

    To compare hysterectomy and levonorgestrel intra-uterine system (LNG-IUS) for the treatment of abnormal uterine bleeding (AUB) and iron deficiency anemia. Retrospective study evaluating quality of life, sexual function, satisfaction and blood hemoglobin concentration improvement in 60 pre-menopausal women treated with hysterectomy or LNG-IUS. All analysis was performed with statistical software SPSS 21.0 (SPSS Inc., Chicago, IL, USA). Despite superior control of bleeding and dysmenorrhea observed after hysterectomy, LNG-IUS showed similar impact on blood hemoglobin levels, quality of life, satisfaction and sexual function resulting more cost-effective. In the absence of contraindications, LNG-IUS should always be the first therapeutic choice for chronic AUB. Surgical treatment must be considered as an "extrema ratio".

  12. Reptile Pregnancy Is Underpinned by Complex Changes in Uterine Gene Expression: A Comparative Analysis of the Uterine Transcriptome in Viviparous and Oviparous Lizards

    Science.gov (United States)

    Brandley, Matthew C.; Belov, Katherine; Thompson, Michael B.

    2016-01-01

    The evolution of new organs is difficult to study because most vertebrate organs evolved only once, more than 500 million years ago. An ideal model for understanding complex organ evolution is the placenta, a structure that is present in live bearing reptiles and mammals (amniotes), which has evolved independently more than 115 times. Using transcriptomics, we characterized the uterine gene expression patterns through the reproductive cycle of a viviparous skink lizard, Pseudemoia entrecasteauxii. Then we compare these patterns with the patterns of gene expression from two oviparous skinks Lampropholis guichenoti and Lerista bougainvillii. While thousands of genes are differentially expressed between pregnant and non-pregnant uterine tissue in the viviparous skink, few differentially expressed genes were identified between gravid and non-gravid oviparous skinks. This finding suggests that in P. entrecasteauxii, a pregnant-specific gene expression profile has evolved, allowing for the evolution of pregnancy-specific innovations in the uterus. We find substantial gene expression differences between the uterus of the chorioallantoic and the yolk sac placenta in P. entrecasteauxii, suggesting these placental regions are specialized for different placental functions. In particular, the chorioallantoic placenta is likely a major site of nutrient transport by membrane-bound transport proteins, while the yolk sac placenta also likely transports nutrients but via apocrine secretions. We discuss how the evolution of transcription factor networks is likely to underpin the evolution of the new transcriptional states in the uterine tissue of viviparous reptiles. PMID:27635053

  13. An evidence-based approach to hormonal therapies for premenopausal women with fibroids.

    Science.gov (United States)

    Lethaby, Anne E; Vollenhoven, Beverley J

    2008-04-01

    Ovarian steroids, particularly oestrogen, are important factors for fibroid growth. This has provided a rationale for the investigation of hormonal therapies for women with fibroids. This chapter will assess the role of hormonal therapies for pre-menopausal women with fibroids. A comprehensive search of MEDLINE and EMBASE was undertaken in December 2006. Twenty-nine relevant randomized controlled trials and two systematic reviews were found. The included studies assessed gonadotrophin-releasing hormone analogues (GnRHa) alone, GnRHa plus add-back (with either progestagen, tibolone, combined oestrogen and progestagen, or raloxifene) and GnRHa given for at least 3 months prior to surgery for fibroids. Two trials assessed the effects of raloxifene alone. One trial assessed the effects of low-dose mifepristone, and a pilot study assessed the role of the selective progesterone receptor modulator, asoprisinil. GnRHa reduce fibroid and uterine volume and heavy bleeding but are associated with menopausal symptoms and bone loss, which limit long-term use. There is some evidence that add-back therapy, either progestagen, tibolone, combined oestrogen and progestagen, or raloxifene, can reduce the menopausal symptoms associated with GnRHa and/or loss of bone density, but there is insufficient good-quality research to make definitive conclusions. GnRHa given for at least 3 months before fibroid surgery improve pre-operative haemoglobin concentration and haematocrit, reduce uterine and pelvic symptoms, and reduce the rate of vertical incisions during laparotomy. Women undergoing hysterectomy are more likely to have a vaginal than an abdominal procedure. Limited evidence suggests that raloxifene may be useful in older premenopausal women with lower concentrations of background oestradiol. Limited short-term evidence of two progestogenic therapies indicates that low-dose mifepristone may improve quality of life and bleeding in the short term, and asoprisinil may improve bleeding

  14. Complementary roles of hysteroscopy and saline infusion hysterosonography in uterine cavity assessment beforein vitro fertilization

    Institute of Scientific and Technical Information of China (English)

    Ibrahim A Abdelazim; Amro Abo Elezz

    2012-01-01

    Objective:This comparative study was designed to assess the role of saline infusion hysterosonography in refining the diagnosis of uterine cavity abnormalities diagnosed by hysteroscopy in infertile, asymptomatic women beforein vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) treatment.Methods:One hundred and twenty four asymptomatic infertile women were included in this study before IVF/ICSI treatment. Hysteroscopy was done as routine procedure for uterine cavity assessment before the first attempt of IVF/ICSI treatment. Patients agreed to have an ultrasound assessment of uterine cavity with the use of saline as the contrast medium (Saline infusion hysterosonography, SIHS) beside the hysteroscopic assessment. Both hysteroscopy & SIHS procedures were scheduled post menstrual period in the early-mid follicular phase of a cycle of the same menstrual cycle, 1-3 months before starting the IVF/ICSI treatment.Results:The uterine cavity abnormalities were detected in 40.3% of the patients included in this study before IVF/ICSI treatment (17.7% endometrial polyps, 10.5% sub-mucous fibroid, 4.8% uterine septum, 3.2% uterine adhesions, 2.4% endometrial hyperplasia and 1.6% thin or atrophic endometrium). In this study, the hysteroscopy was more sensitive (98.0% versus 96.2%), more specific (100.0% versus 98.7%) and more accurate (99.2% versus 97.6%) than SIHS, and the hysteroscopy also had higher predictive values (100% versus 98% positive predictive value; 98.7% versus 97.4% negative predictive value) than SIHS during uterine cavity assessment before IVF/ICSI treatment.Conclusions: Infertile asymptomatic women should be screened for possible uterine cavity abnormalities before IVF/ICSI; SIHS is a simple, well tolerated procedure that can be used as a complementary tool to confirm the diagnosis of uterine cavity abnormalities detected by hysteroscopy.

  15. Degeneração cística maciça de leiomioma uterino em gestante simulando neoplasia ovariana: relato de caso Degenerating cystic uterine fibroid mimics an ovarian cyst in a pregnant patient: a case report

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    Arildo Corrêa Teixeira

    2008-08-01

    Full Text Available Os autores descrevem o caso de uma gestante encaminhada por apresentar massa anexial. A ultra-sonografia demonstrou volumosa lesão sólido-cística sugestiva de neoplasia ovariana. A ressonância magnética mostrou que a lesão era recoberta pela serosa uterina, sugerindo mioma degenerado. O correto diagnóstico das massas pélvicas na gestação é fundamental para o estabelecimento da terapêutica. A ressonância magnética traz importantes contribuições no diagnóstico dessas entidades.The authors describe the case of a pregnant woman referred to the institution to be evaluated for an adnexal mass. Ultrasonography showed a voluminous solid-cystic lesion suggestive of ovarian neoplasm. Magnetic resonance imaging demonstrated that the lesion was located within the uterine serosa, suggesting the presence of a degenerated leiomyoma. A correct diagnosis of pelvic masses in pregnancy is essential for the definition of a therapeutic approach. Magnetic resonance imaging represents a relevant tool in the diagnosis of these abnormalities.

  16. Uterine artery remodeling in pseudopregnancy is comparable to that in early pregnancy.

    NARCIS (Netherlands)

    Heijden, O.W. van der; Essers, Y.P.; Spaanderman, M.E.A.; Mey, J.G. de; Eys, G. van; Peeters, L.L.

    2005-01-01

    During pregnancy, the lumenal diameter and wall mass of the uterine artery (UA) increase, most likely in response to the increased hemodynamic strain resulting from the chronically elevated uterine blood flow (UBF). In this remodeling process, the phenotype of vascular smooth-muscle cells (VSMC) is

  17. 帕瑞昔布钠超前镇痛对子宫肌瘤患者术后镇痛效果及细胞免疫功能的影响%Effect of Parecoxib Sodium Preemptive Analgesia on Postoperative Analgesia and Cellular Immune Function in Patients with Uterine Fibroids

    Institute of Scientific and Technical Information of China (English)

    李明勇; 王倩青

    2014-01-01

    目的:探讨帕瑞昔布钠超前镇痛对子宫肌瘤患者术后镇痛效果以及细胞免疫功能的影响。方法选取2011年3月至2014年4月择期行子宫肌瘤切除术患者116例,随机分为超前组(n=58)和对照组(n=58),麻醉前30 min ,超前组采用40 mg帕瑞昔布钠进行静脉注射,对照组采用5 mL生理盐水进行静脉注射。利用视觉模拟评分法(VAS法)对两组患者术后疼痛情况进行评价,记录两组患者 PCIA泵首次触发时间、有效按压次数和芬太尼总量。分别于术前(T0)、术后6 h(T1)、24 h(T2)、48 h(T3)和72 h(T4)采集患者静脉血,采用FACS Calibur流式细胞仪检测T淋巴细胞亚群CD3+、CD4+和CD8+以及N K细胞,计算CD4+/CD8+。结果术后4、8、12、24和48 h ,超前组患者疼痛评分均低于对照组,差异均具有统计学意义(均 P<0.05);超前组患者PCIA首次触发时间晚于对照组,有效按压次数和芬太尼总量均少于对照组(均 P<0.05)。T1、T2和T3时点,超前组CD3+与CD4+细胞比例均高于对照组(均 P<0.05);T1和 T2时点,超前组CD4+/CD8+均高于对照组(均 P<0.05);T2和T3时点,超前组NK细胞比例均高于对照组(均 P<0.05)。结论帕瑞昔布钠超前镇痛应用于子宫肌瘤患者能够减轻患者术后疼痛,减少镇痛药用量,减轻免疫抑制,改善患者术后细胞免疫功能。%Objective To investigate effects of parecoxib sodium preemptive analgesia on postoperative analgesia and cellu‐lar immune function in patients with uterine fibroids.Methods Totally ,116 cases of patients receiving uterine fibroids surgery were selected from March 2011 to April 2014 in our hospital.All cases were randomly divided into advanced group(n=58)and control group(n=58). The cases in the advanced group were intravenously injected with parecoxib sodium(40 mg)30 min before anesthesia ,while

  18. Uterine myomatosis and portal vein thrombosis: a rare association

    Directory of Open Access Journals (Sweden)

    Elamurugan Sujindra

    2016-09-01

    Full Text Available Uterine leiomyomas are the most common pelvic tumors in women and occur in 20 and ndash;30% of women over 30 years of age. Many complications are seen with fibroid. We report a rare case of a large uterine leiomyoma associated with portal vein thrombosis. 50-year patient presented lower abdomen swelling associated with pain and breathlessness, diagnosed as multiple fibroids. She had massive splenomegaly. Abdomen Doppler revealed splenomegaly with thrombosis of portal, splenic and superior mesenteric vein. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. Iron deficiency anaemia with thrombocytosis caused by fibroid was the identified cause for portal vein thrombosis. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3265-3267

  19. Comparing vaginal and sublingual administration of misoprostol for labour induction in women with intra-uterine fetal death.

    NARCIS (Netherlands)

    Geels, Y.P.; Gouberville, M.C. de; Visser, L.; Asten, H.A.G.H. van

    2010-01-01

    The objective of this study was to compare complications and effectiveness of induction after vaginal and sublingual administration of misoprostol for labor induction in women with intra-uterine fetal death (IUFD). In a district hospital in Ghana, 23 women with IUFD who underwent labor induction

  20. Comparing vaginal and sublingual administration of misoprostol for labour induction in women with intra-uterine fetal death.

    NARCIS (Netherlands)

    Geels, Y.P.; Gouberville, M.C. de; Visser, L.; Asten, H.A.G.H. van

    2010-01-01

    The objective of this study was to compare complications and effectiveness of induction after vaginal and sublingual administration of misoprostol for labor induction in women with intra-uterine fetal death (IUFD). In a district hospital in Ghana, 23 women with IUFD who underwent labor induction wit

  1. Hemoperitoneum Secondary to Arterial Rupture of Subserosal Uterine Leiomyoma

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    Pankaj Aggarwal

    2017-09-01

    Full Text Available Uterine leiomyomatas (ULs affect up to 80% of women during their reproductive years. Though relatively benign, they can have life-threatening complications. This case report presents a 50-year-old, postmenopausal female who presented with severe abdominal pain secondary to massive hemoperitoneum. Upon exploratory laparotomy, a large, pulsing artery was seen on the uterus, consistent with a ruptured subserosal uterine fibroid. This case offers unique insight into the presentation and management of this surgical emergency.

  2. Diagnostic value of saline contrast sonohysterography comparing with hysteroscopy for detecting endometrial abnormalities in women with abnormal uterine bleeding

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    Farzaneh Goharzad

    2011-01-01

    Full Text Available Background: Abnormal uterine bleeding is a common presentation of uterine abnormalities among premenopausal and postmenopausal women.Objective: To evaluate and compare the diagnostic accuracy of saline contrast sonohysterography and hysteroscopy for detecting the cause of abnormal uterine bleeding.Materials and Methods: A total of 65 women with abnormal uterine bleeding were enrolled in this study. A prior saline contrast sonohysetrography followed by a hysteroscopy was performed in all cases. Sensitivity, specificity, positive and negative predictive value and test accuracy were calculated.Results: As the most common abnormality, SCSH showed hyperplasia in 19 patients while hysteroscopy diagnosed polyp in 15 cases. A sensitivity of 73.3%, 71.4% and 90.9% were reported for polyp, hyperplasia and submucous myoma respectively whereas the specificity was calculated 96% for polyps, 82.3% for hyperplasia and 90.7% for submucous myoma.Conclusion: Comparing with hysteroscopy, sonohysterography showed a high sensitivity and specificity for detecting submucous myoma but not for endometrial polyp and endometrial hyperplasia

  3. Craniocaudal tumour extension in uterine cervical cancer on MRI compared to histopathology

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    Peter de Boer

    2015-01-01

    Conclusion: MRI represents the histopathological craniocaudal tumour extension in the majority of patients with early stage uterine cervical cancer, but with a systematic small underestimation of the real craniocaudal tumour extension.

  4. Bleeding versus Clotting: A Complex Case of a Large Fibroid Uterus Causing Menorrhagia and a DVT

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    Sangeeta Ramanan

    2016-01-01

    Full Text Available A 43-year-old woman presented with severe anaemia secondary to menorrhagia. Pelvic ultrasound showed a large intramural posterior fundal fibroid. Hysteroscopy showed the fibroid distorting the endometrial cavity, precluding Mirena® device insertion. As she was initially hesitant to have a hysterectomy, medical management with the oral contraceptive pill (OCP and tranexamic acid was instituted, with good effect. Months later, after a long road trip, she presented with left leg swelling, and a Doppler ultrasound confirmed an extensive deep vein thrombosis (DVT. She was commenced on warfarin for anticoagulation but presented again with menorrhagia precipitated by overanticoagulation. After initial stabilization with multiple blood transfusions and reversal of anticoagulation, the warfarin was ceased in favour of enoxaparin and she underwent inferior vena cava (IVC filter insertion prior to a total abdominal hysterectomy. Mass effect from large uterine fibroids can cause venous thromboembolism (VTE. A duplex ultrasound of the lower limbs if a woman presents with a large fibroid could identify asymptomatic DVTs in such women. A prehysterectomy IVC filter would then reduce their risk of postoperative pulmonary embolism. Medical management of menorrhagia with procoagulants should be avoided for management of menorrhagia in such women given their higher risk of developing VTE.

  5. Estratégias para redução da exposição de radiação ionizante em mulheres submetidas à embolização de miomas uterinos Strategies for reduction of exposure to ionizing radiation in women undergone to uterine fibroid embolization

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    Breno Boueri Affonso

    2010-02-01

    the ovaries and the skin of patients undergoing uterine fibroid embolization (UFE, and to suggest a radiologic protocol directed at reducing the risks involved in this procedure. METHODS: seventy-three consecutive women (mean age: 27 years participating in an institutional research protocol, having symptomatic uterine fibroids with indication for minimally invasive treatment, underwent UFE. We estimated the radiation absorbed by the ovaries by means of vaginal dosimeters and the radiation dose absorbed by the skin by means of indirect calculations of radiation absorption. The first 49 patients belonged to the Pre-modification Group, and the last 24, to the Post-modification Group. The second group received a modified protocol of X-ray imaging, with a reduction by half of the frames number per second during arteriography, in an attempt to match the values obtained to those of the literature, and avoiding as much as possible unnecessary exposure to the X-ray beam. RESULTS: there were no technical complications in any of the procedures performed. There were no differences in the mean fluoroscopy time or in the mean number of arteriographies between the two groups. We obtained a 57% reduction in the estimated absorbed ovarian dose between groups (29.0 versus 12.3 cGy and a 30% reduction in the estimated dose absorbed by the skin (403.6 versus 283.8 cGy. CONCLUSIONS: a significant reduction in the absorption of radiation in patients undergoing UFE can be achieved by changing the number of frames per second in angiographic series, and by the routine use of radiological protection standards.

  6. Uterine infarction in a patient with uterine adenomyosis following biochemical pregnancy.

    Science.gov (United States)

    Lee, Jae-Yeon; Hwang, Kyu-Ri; Won, Kyu-Hee; Lee, Da-Yong; Jeon, Hye-Won; Moon, Min-Hwan

    2014-12-01

    Adenomyosis is a common gynecological disorder characterized by the presence of endometrial glands and stroma deep within the myometrium associated with myometrial hypertrophy and hyperplasia. Focal uterine infarction after IVF-ET in a patient with adenomyosis following biochemical pregnancy has not been previously reported, although it occurs after uterine artery embolization in order to control symptoms caused by fibroids or adenomyosis. We report a case of a nulliparous woman who had uterine adenomyosis presenting with fever, pelvic pain and biochemical abortion after undergoing an IVF-ET procedure and the detection of a slightly elevated serum hCG. Focal uterine infarction was suspected after a pelvic magnetic resonance imaging demonstrated preserved myometrium between the endometrial cavity and inner margin of the necrotic myometrium. This case demonstrates that focal uterine infarction should be considered in the differential diagnosis of acute abdominal pain, vaginal bleeding and infectious signs in women experiencing biochemical abortion after an IVF-ET procedure.

  7. Comparing surgical outcomes in obese women undergoing laparotomy, laparoscopy, or laparotomy with panniculectomy for the staging of uterine malignancy.

    Science.gov (United States)

    Eisenhauer, Eric L; Wypych, Kelly A; Mehrara, Babak J; Lawson, Carrie; Chi, Dennis S; Barakat, Richard R; Abu-Rustum, Nadeem R

    2007-08-01

    Limiting surgical morbidity while maintaining staging adequacy is a primary concern in obese patients with uterine malignancy. The goal of this study was to compare the surgical adequacy and postoperative morbidity of three surgical approaches to staging the disease of obese women with uterine cancer. The records of all patients with a body mass index (BMI) of >or=35 undergoing primary surgery for uterine corpus cancer at our institution from January 1993 to May 2006 were reviewed. Patients were assigned to three groups on the basis of planned surgical approach-standard laparotomy, laparoscopy, or laparotomy with panniculectomy. Standard statistical tests appropriate to group size were used to compare the three groups. In all, 206 patients with a BMI of >or=35 were grouped as follows: laparotomy, 154 patients; laparoscopy, 25 patients; and laparotomy with panniculectomy, 27 patients. Median BMI was 41 (range, 35-84). Regional lymph nodes were removed in 45% of the laparotomy patients, 40% of the laparoscopy patients, and 70% of the panniculectomy patients (P = .04). Compared with laparotomy, both laparoscopy and panniculectomy yielded higher median pelvic and total lymph node counts (P = .001). Operative time was shortest after standard laparotomy, and blood loss was greatest after panniculectomy. The incidence of all incisional complications was lower for panniculectomy (11%) and laparoscopy (8%) compared with standard laparotomy (35%) (P = .002). On multivariate analysis, a significantly lower risk of total incisional complications was seen for patients undergoing panniculectomy (risk ratio, .25; 95% confidence interval, .071-.88) and laparoscopy (risk ratio, .19; 95% confidence interval, .04-.94). Both laparoscopic staging and panniculectomy in a standardized fashion were associated with an improved lymph node count and a lower rate of incisional complications than laparotomy alone. Although definitive conclusions are limited by low patient numbers, the

  8. Persistent organic pollutants (POPs) and fibroids: results from the ENDO Study

    Science.gov (United States)

    Trabert, Britton; Chen, Zhen; Kannan, Kurunthachalam; Peterson, C. Matthew; Pollack, Anna Z.; Sun, Liping; Buck Louis, Germaine M.

    2015-01-01

    To evaluate the association between persistent organic pollutants (POPs) and uterine fibroids we used previously collected data from a cohort of women 18–44 years of age undergoing laparoscopy or laparotomy at 14 participating hospital surgical centers (n=473). POP concentrations were measured in omental fat and serum. Presence of fibroids was defined based on a postoperative diagnosis (n=99). Odds ratios (OR) and 95% confidence interval (CI) for each POP by biologic medium was estimated using unconditional logistic regression adjusted for identified covariates. Concentrations were higher in omental fat than in serum for all POPs. Serum p,p′-dichlorodiphenyldichloroethylene (p,p′-DDE) was the only POP associated with fibroids [per 1-SD increase in log-transformed p,p′-DDE OR (95% CI): 1.37 (1.05–1.80)]. In analyses excluding women diagnosed with endometriosis, a number of polychlorinated biphenyls (PCBs) measured in omental fat were associated with fibroids [PCB 99: 1.64 (1.08, 2.49); PCB 138: 1.64 (1.03, 2.59); PCB 146: 1.54 (1.01, 2.37); PCB 153: 1.88 (1.12, 3.13); PCB 196: 1.60 (1.02, 2.51); PCB 206: 1.52 (1.01, 2.29)]. Although exploratory, our study suggests that PCBs may be associated with fibroids in the absence of other gynecologic disorders such as endometriosis, but the associations varied by biologic media with more POPs emerging when quantified in fat. PMID:24802554

  9. Avaliação da proporção de colágeno no tecido uterino antes e após tratamento do leiomioma uterino pela embolização arterial Collagen histomorphometric evaluation in uterin tissue samples before and after treatment of uterine fibroids with arterial embolization

    Directory of Open Access Journals (Sweden)

    Cláudio Emílio Bonduki

    2009-12-01

    Full Text Available OBJETIVO: analisar as repercussões histomorfométricas da embolização das artérias uterinas (EAU no tecido uterino, especialmente mediante quantificação de tecido colágeno, através de biópsia uterina antes e após tratamento de leiomioma uterino. MÉTODOS: participaram do estudo 15 pacientes portadoras de leiomiomas sintomáticos e/ou com infertilidade, submetidas à EAU após ciência do termo de consentimento livre e esclarecido, obedecendo aos critérios de exclusão do estudo. Foi realizada biópsia uterina na fase secretória do ciclo menstrual antes e três meses após o procedimento, para avaliação do colágeno. Após o processamento histológico do material, foram feitos cortes de 3µ, sendo alguns corados pela hematoxilina-eosina (HE, e outros pela coloração específica para fibras colágenas (Picrosirius red. Em seguida, foi realizada a leitura e interpretação das lâminas e a quantificação do colágeno. Sua quantificação foi calculada como o percentual da área composta por colágeno, e o resultado expresso em média±desvio padrão (DP. Os dados foram então submetidos à análise estatística pelo teste t de Student pareado (pPURPOSE: to analyze histomorphometric consequences of the uterine arteries embolization (UAE in the uterine tissue, especially by collagen tissue quantification through uterine biopsy, before and after treatment of uterine leiomyoma. METHODS: 15 patients with symptomatic leyomioma and/or infertility, submitted to UAE, participated in the study according to the study exclusion criteria, after having signed an informed consent. Uterine biopsy was performed in the secretory phase of the menstrual cycle, before and three months after the procedure, to evaluate the collagen. After the histological processing of the material, 3 µ slices were prepared, some of them dyed with hematoxiline-eosin (HE and others with the specific dye for collagen fibers (Picrosirius red. Then, the slides were examined

  10. Pregnancy after uterine arterial embolization

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    Cláudio E. Bonduki

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. METHODS: A retrospective study of 187 patients treated with uterine arterial embolization for symptomatic uterine fibroids between 2005-2008 was performed. Uterine arterial embolization was performed using polyvinyl alcohol particles (500-900 mm in diameter. Pregnancies were identified using screening questionnaires and the study database. RESULTS: There were 15 spontaneous pregnancies. Of these, 12.5% were miscarriages (n = 2, and 87.5% were successful live births (n = 14. The gestation time for the pregnancies with successful live births ranged from 36 to 39.2 weeks. The mean time between embolization and conception was 23.8 months (range, 5-54. One of the pregnancies resulted in twins. The newborn weights (n = 14 ranged from 2.260 to 3.605 kg (mean, 3.072 kg. One (7.1% was considered to have a low birth weight (2.260 kg. There were two cases of placenta accreta (12.5%, treated with hysterectomy in one case [6.3%], one case of premature rupture of the membranes (PRM (6.3%, and one case of preeclampsia (6.3%. All of the patients were delivered via Cesarean section. CONCLUSION: In this study, there was an increased risk of Cesarean delivery. There were no other major obstetric risks, suggesting that pregnancy after uterine arterial embolization is possible without significant morbidity or mortality.

  11. Comparative Study of Ormeloxifene and Medroxyprogesterone Acetate in Abnormal Uterine Bleeding.

    Science.gov (United States)

    Godha, Zeepee; Mohsin, Zehra; Hakim, Seema; Wasim, Saeeda

    2016-10-01

    The purpose of this study was to compare the effects of ormeloxifene with medroxyprogesterone acetate in patients with abnormal uterine bleeding. 440 Patients were divided into two groups. In group A, ormeloxifene was given at the dosage of 60 mg twice a week for 3 months followed by 60 mg once a week for 1 month. In group B, medroxyprogesterone acetate was given at the dosage of 10 mg twice a day from day 5 to day 25 of the menstrual cycle. At follow-ups, patients were assessed for PBAC score, endometrial thickness by USG, hemoglobin level, and the side effects of drug therapy. There were 240 patients in group A and 200 in group B. Reduction in median PBAC score was 79.4 % in group A and 75 % in group B after 4 months of treatment. The mean duration of bleeding reduced to 4.8 from 9 in group A and 5 from 8.7 in group B. Mean hemoglobin was increased from 8.6 to 9.8 g % in group A and from 8.7 to 9.9 g % in group B; endometrial thickness was reduced from 7.7 mm to 6.8 mm in group A and from 7.4 mm to 6.9 mm in group B. We conclude from this study that ormeloxifene should be considered the first choice in the management of AUB, especially in the perimenopausal age group where amenorrhea is acceptable.

  12. Anatomic outcomes after pelvic-organ-prolapse surgery: comparing uterine preservation with hysterectomy.

    Science.gov (United States)

    Marschalek, Julian; Trofaier, Marie-Louise; Yerlikaya, Guelen; Hanzal, Engelbert; Koelbl, Heinz; Ott, Johannes; Umek, Wolfgang

    2014-12-01

    Pelvic organ prolapse (POP) is of growing importance to gynecologists, as the estimated lifetime risk of surgical interventions due to prolapse or incontinence amounts to 11-19%. Conflicting data exist regarding the effectiveness of POP surgery with and without uterine preservation. We aimed to compare anatomic outcomes in patients with and without hysterectomy at the time of POP-surgery and identify independent risk factors for symptomatic recurrent prolapses. In this single-centre retrospective analysis we analyzed 96 patients after primary surgical treatment for POP. These patients were followed up with clinical and vaginal examination six months postoperatively. For comparison of the groups, the chi-squares test were used for categorical data and the u-test for metric data. A logistic regression model was calculated to identify independent risk factors for recurrent prolapse. Of 96 patients, 21 underwent uterus preserving surgery (UP), 75 vaginal hysterectomy (HE). Median operating time was significantly shorter in the UP group (55 vs. 90min; p=0.000). There was no significant difference concerning postoperative urinary incontinence or asymptomatic relapse (p>0.05), whereas symptomatic recurrent prolapses were significantly more common in the UP group (23.8% vs. 6.7%; p=0.023). However, in multivariate analysis, only vaginal parity and sacrospinous ligament fixation were identified as independent risk factors for recurrent prolapse after POP surgery. Uterus-preservation at time of POP-surgery is a safe and effective alternative for women who wish to preserve their uterus but is associated with more recurrent symptomatic prolapses. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. MR-guided Focused Ultrasound for Uterine Fibroids

    Science.gov (United States)

    ... uterus and prevents a woman from ever getting pregnant. MRgFUS helps preserve the uterus (and thus a woman’s ability to potentially become pregnant) and is performed on an outpatient basis. top ...

  14. MR-guided Focused Ultrasound for Uterine Fibroids

    Science.gov (United States)

    ... being imaged, send and receive radio waves, producing signals that are detected by the coils. The electric current does not come in contact with the patient. A computer then processes the signals and generates a series of images, each of ...

  15. Research on genesis of adipocytic metaplasia in uterine fibroids.

    Science.gov (United States)

    Sośnik, Henryk; Jeleń, Michał; Kosiński, Mariusz; Sośnik, Katarzyna

    2015-12-01

    The genesis of lipoleiomyoma has not been explained yet. Immunohistochemical examinations were performed on 17 lipoleiomyomas in women aged 43-82 (mean age: 51 ±9 years). Four types of myomas were distinguished: 1) pure leiomyoma, 2) fibroleiomyoma, 3) hyalinizing leiomyoma, 4) strongly hyalinized myoma, along with three degrees of progression of adipocytic metaplasia: 1) up to 25% of lipocytes, 2) up to 50% of lipocytes, and 3) over 50% of lipocytes in the analyzed sample, along with three degrees of progression of adipocytic metaplasia: 1) up to 25% of lipocytes, 2) up to 50% of lipocytes, and 3) over 50% of lipocytes in the analyzed sample. A positive correlation was found between the age of women and rate of development of metaplasia (r = 0.51, p = 0.035) as well as with activity of the estrogen receptor in the primary tumor (r = 0.53, p = 0.03). New mucous perivascular tissue was reported among 11.8% of patients and on this basis lipocytes were formed. The appearance of subendothelial granular cells of large blood vessels with a positive reaction for smooth muscle actin (SMA) and CD68 was reported in 17.7%. Results of immunohistochemical research seem to confirm that lipocytes de novo come from the primal pluripotent cells of the tumor stroma and not from the fatty degeneration of myocytes.

  16. Distinct expression profile in fumarate-hydratase-deficient uterine fibroids

    DEFF Research Database (Denmark)

    Vanharanta, S; Pollard, PJ; Lehtonen, HJ

    2006-01-01

    Defects in mitochondrial enzymes predispose to severe developmental defects as well as tumorigenesis. Heterozygous germline mutations in the nuclear gene encoding fumarate hydratase (FH), an enzyme catalyzing the hydration of fumarate in the Krebs tricarboxylic acid cycle, cause hereditary...

  17. Prospective study on magnetic resonance-guided focused ultrasound surgery for symptomatic uterine fibroid : short-term follow up%MRI引导的聚焦超声术治疗症状性子宫肌瘤的前瞻性研究

    Institute of Scientific and Technical Information of China (English)

    范融; 朱兰; 龚晓明; 薛华丹; 石海峰; 金征宇; 陈广俊

    2013-01-01

    的HRQL评分分别为(74±15)、(82±13)、(89±10)分,术后较术前明显提高,差异也有统计学意义(P<0.01).(5)治疗前后血红蛋白水平变化:治疗前11例患者贫血,平均血红蛋白为(87±6) g/L,治疗后3个月及1年时的血红蛋白含量分别为(106±14)、(112±10) g/L,术后较术前血红蛋白含量明显升高,差异有统计学意义(P<0.01).结论 MRgFUS是治疗症状性子宫肌瘤安全的无创疗法,其短期疗效确定,术后1年时子宫肌瘤症状及患者生命质量均明显改善,但两年内有一定的再手术率.%Objective To evaluate the safety and efficacy of magnetic resonance-guided focused ultrasound surgery (MRgFUS) in treatment of symptomatic uterine leiomyoma among Chinese reproductive age women.Methods From April 2010 to April 2012,80 premenopausal women with symptomatic leiomyoma volunteered to participate in this prospective study in Department of Outpatient of Peking Union Medical College Hospital.Among 23 reproductive aged patients with size of uterus less than 16th gestational weeks,2.5 to 10 cm of diameter of myoma,less than 10 myomas and expressing symptoms clearly were treated by MRgFUS.Treatment data,non-perfused volume ratio (NPVR) and adverse events were recorded.After treatment,patients were followed up at 1 week,1,3,6,12 and 24 months,respectively.Patients at initial screening and each time of the follow-up filled out uterine fibroid symptoms quality of life (UFS-QOL),which include symptoms severity score (SSS) and health-related quality of life (HRQL).The volumes of leiomyoma and uterine were evaluated on MRI before and after the treatment (at 6 and 12 months,respectively).Before operation,routine blood test were performed on all patients,anemia patients at 3 months and 1 year after treatment were checked with blood test.Results (1) Treatment data and adverse events:the mean therapeutic temperature was (69 ± 7) ℃,the mean treatment time was (144 ±62) min,the mean NPVR was (62 ±23)%.Adverse events

  18. Pregnancy outcome in patients with fibroid

    Directory of Open Access Journals (Sweden)

    Antima Kirtikumar Maliwad

    2014-06-01

    Full Text Available Background: Fibroids are benign smooth muscle cell tumour of the uterus. In some patients of pregnancy associated with fibroid, it does not affect the outcome of pregnancy. On the other hand, various complications have been reported. Objective of current study was to assess the prevalence and obstetric complications of fibroid during pregnancy and it management. Methods: This was a prospective study. The study was conducted at tertiary care centre, obstertrics and gynecology department over a period of nine months September 2013 to May 2014. Total 17 pregnant patients with >3 cm fibroid were included in the study. They were followed during antenatal period. Maternal age, parity, size of fibroid, complications during pregnancy, labour, and delivery, mode of delivery and indications of cesarean section were noted. Results: Incidence of fibroid during pregnancy was 0.4%. Out of 17 patients, majority 9 (52.9% were between 26-30 years of age group, majority 7 (41.1% were diagnosed between 21-28 weeks and 14 (82.3% were multigravidas. Normal vaginal delivery occurred in 3 (20%, while 12 (80% delivered by cesarean section. There were 8 (47% patients who had no complication whereas 9 (52.9% had some complication. Pain was present in 7 (41.1%. PROM and preterm labour was present in 3 (17.6% and 2 (11.7% respectively. Abortion and IUD occurred in 2 (11.7% and in 1 (5.8% respectively. LBW and IUGR was present in 5 (29.4% and 3 (17.6% respectively. PPH was present in 6 (35.2%. Antenatal myomectomy performed in 1 (5.8% and myomectomy at cesarean section performed in 2 (11.7%. Blood transfusion was given to 8 (47% patients. Conclusions: Pregnant patients who have fibroids are to be carefully screened in the antenatal period, so as to have a regular follow up. The wide spread use of ultrasonography has facilitated diagnosis and management of fibroids in pregnancy. The site and size of fibroid is very important to predict its effect on the pregnancy. In

  19. Uterine Cancer

    Science.gov (United States)

    ... is pregnant. There are different types of uterine cancer. The most common type starts in the endometrium, ... the uterus. This type is also called endometrial cancer. The symptoms of uterine cancer include Abnormal vaginal ...

  20. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities

    NARCIS (Netherlands)

    Bosteels, Jan; Kasius, Jenneke; Weyers, Steven; Broekmans, Frank J.; Mol, Ben W illem J; D'Hooghe, Thomas M.

    2015-01-01

    BACKGROUND: Observational studies suggest higher pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions, which are detectable in 10% to 15% of women seeking treatment for subfertility. OBJECTIVES: To assess the effects of t

  1. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities

    NARCIS (Netherlands)

    Bosteels, Jan; Kasius, Jenneke; Weyers, Steven; Broekmans, Frank J.; Mol, Ben Willem J.; D'Hooghe, Thomas M.

    2013-01-01

    Background Observational studies suggest higher pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions, which are detectable in 10% to 15% of women seeking treatment for subfertility. Objectives To assess the effects of the

  2. Fracture of the Femur of A Newborn after Cesarean Section for Breech Presentation and Fibroid Uterus :A Case Report and Literature Review

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    Ibrahima Farikou

    2014-01-01

    Full Text Available Introduction: The practice of cesarean section is known to decrease the occurrence of long bone fractures. We present here an unusual diaphyseal fracture of the femur of a newborn after cesarean section, the only case observed in our 14 years of practice. Case Report: The patient was a 3.4-kg female child born at 38 weeks of gestation. The mother was a primipara and aged 39 years. Ultrasound examination at 20th week revealed intrauterine fibroids with a breech presentation. Therefore, elective cesarean section was indicated. There was no apparent bone disorder that could predispose to sustain femur fracture. The fracture was treated successfully with a bilateral spica cast. The cesarean section was indicated in an aged primipara, bearer of uterine fibroids, and breech presentation. She had a good general health status, but her bone density was unknown since this examination is not routinely performed in our clinical settings in Africa. Conclusion: Elderly age, primipara status, presence of uterine fibroids, and breech presentation are usual indications for cesarean section. However, there are not many reports on femur fracture after cesarean section. Our present case suggests that despite the latest advances in delivery techniques, cesarean section for breech presentation predisposes the neonate to femoral fractures. Keywords: Femur fracture; Cesarean section; Fibroid; Breech presentation; Africa.

  3. Fetal Arthrogryposis Secondary to a Giant Maternal Uterine Leiomyoma

    Directory of Open Access Journals (Sweden)

    José María Vila-Vives

    2012-01-01

    Full Text Available Arthrogryposis multiplex congenital is a rare condition defined as contractures in multiple joints at birth due to disorders starting in fetal life. Its etiology is associated with many different conditions and in many instances remains unknown. The final common pathway to all of them is decreased fetal movement (fetal akinesia due to an abnormal intrauterine environment. Causes of decreased fetal movements may be neuropathic abnormalities, abnormalities of connective tissue or muscle, intrauterine vascular compromise, maternal diseases, and space limitations within the uterus. When the cause of arthrogryposis is space limitations in uterus, the most common etiology is oligohydramnios. The same can result from intrauterine tumours as fibroids, although to our knowledge there are only two papers reporting cases of fetal deformities related to uterine leiomyomas. We describe a well-documented exceptional case of arthrogryposis associated with the presence of a large uterine fibroid. It could illustrate the importance of a careful and appropriate assessment of uterine fibroids before and in the course of a pregnancy considering that they can cause both serious maternal and fetal complications.

  4. Uterine Artery Embolisation for Symptomatic Adenomyosis with Polyzene F-Coated Hydrogel Microspheres: Three-Year Clinical Follow-Up Using UFS–QoL Questionnaire

    Energy Technology Data Exchange (ETDEWEB)

    Nijenhuis, R. J., E-mail: nijenhuis@maastrichtuniversity.nl; Smeets, A. J., E-mail: a.smeets@elisabeth.nl; Morpurgo, M., E-mail: m.morpurgo@elisabeth.nl [St. Elisabeth Ziekenhuis, Department of Radiology (Netherlands); Boekkooi, P. F., E-mail: f.boekkooi@elisabeth.nl; Reuwer, P. J. H. M., E-mail: p.reuwer@elisabeth.nl; Smink, M., E-mail: m.smink@elisabeth.nl [St. Elisabeth Ziekenhuis, Department of Obstetrics and Gynecology (Netherlands); Rooij, W. J. van, E-mail: wjjvanrooij@gmail.com; Lohle, P. N. M., E-mail: radiol@eztilburg.nl, E-mail: paullohle@gmail.com [St. Elisabeth Ziekenhuis, Department of Radiology (Netherlands)

    2015-02-15

    PurposeThis study was designed to assess midterm outcome of uterine artery embolisation (UAE) for women with therapy-resistant adenomyosis using polyzene F-coated hydrogel microspheres.MethodsBetween September 2006 and January 2010, 29 consecutive women with adenomyosis (15 in combination with fibroids) were treated with UAE using polyzene F-coated hydrogel microspheres. Junction zone thickness was assessed with MRI at baseline and 3 months. Women filled out the uterine fibroid symptom and quality of life questionnaire at baseline, 3 months and after a mean clinical follow-up of 37 months (median 35, range 29–64 months).ResultsAt baseline, symptom severity score of 29 women was mean 67 (median 72, range 23–100). At 3 months, this score decreased to mean 22 (median 15, range 0–66) and mean 15 (median 17, range 0–34) at final follow-up. At final follow-up of mean 37 months (median 35, range 29–64 months), 22 of 29 (76 %) patients were asymptomatic. Of these 22 women, 3 underwent a second UAE at 6, 7, and 14 months. The remaining seven patients clinically improved but still had symptoms; one underwent a hysterectomy. There was no difference in outcome between women with pure adenomyosis and women with additional fibroids. The junction zone of 4 women with additional therapy was significantly thicker compared with the remaining 25 patients.ConclusionsIn women with therapy resistant adenomyosis, UAE using polyzene F-coated hydrogel microspheres resulted in 3 years preservation of the uterus in 28 of 29 (97 %) with good clinical outcome in the vast majority of patients. Initial thickness of the junction zone is related to additional therapy.

  5. Retained fetal bones: an unusual cause of abnormal uterine bleeding

    Directory of Open Access Journals (Sweden)

    Sonia Chawla

    2016-06-01

    Full Text Available Abnormal uterine bleeding (AUB is a common gynaecological problem with most common causes being fibroid, polyp, endometritis, neoplasia and coagulation disorder. Presence of retained intrauterine fetal bones as a cause of AUB, is a rare but well recognized entity. Patient may present with subfertility, secondary infertility, chronic pelvic pain, vaginal discharge, pelvic inflammatory disease, abnormal uterine bleeding. Incidence reported in literature is 0.15% among patients undergoing diagnostic hysteroscopy. Calcification appears as hyperechoeic area on ultrasound. Hysteroscopy guided removal of bony fragments is the gold standard and leads to complete resolution of symptoms. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 2032-2033

  6. INTERESTING CASES OF DIFFERENT TYPES OF CERVICAL FIBROIDS

    Directory of Open Access Journals (Sweden)

    Narmadha

    2014-05-01

    Full Text Available The incidence of cervical fibroids is 0.5-1%. It is usually single; they are usually confined to supravaginal portion of the cervix. Rarely it becomes submucous and polypoidal. So it is usually subserous or interstitial. It can be anterior, posterior or central in position. We had different types of cervical fibroids of which we will describe a few. Usually cervical fibroids cause infertility, difficulty in labor, infections, metrorrhagia, menorrhagia, constipation, retention of urine and dyspareunia. The cervical fibroid distorts the shape of cervix and grows bigger. It pushes the uterus upward giving the appearance of lantern of Saint Paul’s dome in a case of a central cervical fibroid. Most of the patients in the reproductive age get admitted for menorrhagia due to fibroid. Its growth is dependent on estrogen. It does not grow after menopause

  7. Postoperative Quality of Life and Sexual Function in Premenopausal Women Undergoing Laparoscopic Myomectomy for Symptomatic Fibroids: A Prospective Observational Cohort Study

    Science.gov (United States)

    Radosa, Julia Caroline; Radosa, Christoph Georg; Mavrova, Russalina; Wagenpfeil, Stefan; Hamza, Amr; Joukhadar, Ralf; Baum, Sascha; Karsten, Maria; Juhasz-Boess, Ingolf; Solomayer, Erich-Franz; Radosa, Marc Philipp

    2016-01-01

    Introduction Uterine leiomyomas are the most common benign gynecologic tumors. To date laparoscopy myomectomy is the gold standard for treatment of symptomatic fibroids in reproductive-aged women. Detailed counseling about the effects of this procedure on postoperative sexuality and quality of life is important in these patients. However, available data on these subjects are limited and contradictory. The aim of this study was to assess sexual function and quality of life in premenopausal women undergoing laparoscopic myomectomy for symptomatic uterine fibroids. Material and Methods All premenopausal women who underwent laparoscopic myomectomy for symptomatic fibroids between April 2012 and August 2014 at a tertiary university center were enrolled in this prospective observational cohort study. Sexual function and quality of life were assessed for the pre- and postoperative (six months post-operatively) state using two validated questionnaires, the Female Sexual Function Index (FSFI) and the European Quality of Life Five-Dimension Scale (EQ-5D). Results Ninety-five of the 115 (83%) eligible patients completed the study. Overall a significant improvement in quality of life and sexual function was observed in the study cohort: Median FSFI (28 (18.7–35.2)) and EQ-5D scores (1 (0.61–1) after laparoscopic myomectomy were significantly higher than preoperative scores (21.2 (5.2–33.5); 0.9 (0.2–1); p ≤ 0.01). The number, position and localization of the largest fibroids were not correlated with pre- or postoperative sexual function or quality of life. Conclusion Laparoscopic myomectomy might have positive short-term effects on postoperative quality of life and sexual function in premenopausal women suffering from symptomatic fibroids. PMID:27898669

  8. Keloids and ultrasound detected fibroids in young African American women.

    Directory of Open Access Journals (Sweden)

    Quaker E Harmon

    Full Text Available OBJECTIVE: Keloids and fibroids share a number of biologic and demographic similarities however there are no published reports of the association between them. The objective of this study was to investigate the association between self-reported keloids and ultrasound detected fibroids in a population of young African American women. STUDY DESIGN: The Study of Environment, Life-style & Fibroids (SELF, is a volunteer cohort of over 1600 African American women aged 23-34 years recruited in Detroit, Michigan. Enrollment occurred between December 2010 and December 2012. Data are available for the first 1196 participants. Participants self-reported a history of raised (hypertrophic scars or scars extending beyond the limits of the original injury (keloid and had an enrollment pelvic ultrasound examination to detect prevalent fibroids. Log linear regression was used to model the association between abnormal scars and prevalent fibroids controlling for possible covariates. Among women with fibroids, associations between particular fibroid characteristics (tumor location, size or number and scarring were assessed using chi-square and Mann Whitney U-tests. RESULTS: Both abnormal scarring (keloids, 9.0%; hypertrophic scars, 28.3% and fibroids (23.3% were common in this cohort. There was no indication [adjusted Risk Ratio (95% Confidence Interval: 0.7 (0.5-1.1] of an association between self-reported keloids and prevalent fibroids. Nor was there any association with hypertrophic scars. Specific characteristics of the prevalent fibroids were not associated with abnormal scarring. CONCLUSION: Despite similarly dysregulated extracellular matrices in keloids and fibroids, these conditions did not tend to co-occur in this young African American population.

  9. Treatment of uterine prolapse stage 2 or higher: a randomized multicenter trial comparing sacrospinous fixation with vaginal hysterectomy (SAVE U trial).

    Science.gov (United States)

    Detollenaere, Renée J; den Boon, Jan; Stekelenburg, Jelle; Alhafidh, Akeel H H; Hakvoort, Robert A; Vierhout, Mark E; van Eijndhoven, Hugo W F

    2011-02-15

    Pelvic organ prolapse is a common health problem, affecting up to 40% of parous women over 50 years old, with significant negative influence on quality of life. Vaginal hysterectomy is currently the leading treatment method for patients with symptomatic uterine prolapse. Several studies have shown that sacrospinous fixation in case of uterine prolapse is a safe and effective alternative to vaginal hysterectomy. However, no large randomized trials with long-term follow-up have been performed to compare efficacy and quality of life between both techniques.The SAVE U trial is designed to compare sacrospinous fixation with vaginal hysterectomy in the treatment of uterine prolapse stage 2 or higher in terms of prolapse recurrence, quality of life, complications, hospital stay, post-operative recovery and sexual functioning. The SAVE U trial is a randomized controlled multi-center non-inferiority trial. The study compares sacrospinous fixation with vaginal hysterectomy in women with uterine prolapse stage 2 or higher. The primary outcome measure is recurrence of uterine prolapse defined as: uterine descent stage 2 or more assessed by pelvic organ prolapse quantification examination and prolapse complaints and/or redo surgery at 12 months follow-up. Secondary outcomes are subjective improvement in quality of life measured by generic (Short Form 36 and Euroqol 5D) and disease-specific (Urogenital Distress Inventory, Defecatory Distress Inventory and Incontinence Impact Questionnaire) quality of life instruments, complications following surgery, hospital stay, post-operative recovery and sexual functioning (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire). Analysis will be performed according to the intention to treat principle. Based on comparable recurrence rates of 3% and considering an upper-limit of 7% to be non-inferior (beta 0.2 and one sided alpha 0.025), 104 patients are needed per group. The SAVE U trial is a randomized multicenter trial that will

  10. Can {sup 1}H MR Spectroscopy be Used to Assess the Success of Uterine Artery Embolisation?

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    Macnaught, Gillian, E-mail: gillian.macnaught@ed.ac.uk [University of Edinburgh, Clinical Research Imaging Centre, Queen’s Medical Research Institute (United Kingdom); Ananthakrishnan, G., E-mail: a.radiology@gmail.com [Gartnavel General Hospital, Interventional Radiology Unit (United Kingdom); Hinksman, L., E-mail: laurahinksman@nhs.net [Wishaw General Hospital, Radiology Department (United Kingdom); Yadavali, R., E-mail: reddi.yadavali@nhs.net [Gartnavel General Hospital, Interventional Radiology Unit (United Kingdom); Bryden, F., E-mail: Fiona.Bryden@ggc.scot.nhs.uk [Stobhill Hospital, Radiology Department (United Kingdom); Lassman, S., E-mail: Sue.Lassman@ggc.scot.nhs.uk [Gartnavel General Hospital, Radiology Department (United Kingdom); Ritchie, M., E-mail: moirasim9@gmail.com [Gartnavel General Hospital, Interventional Radiology Unit (United Kingdom); Gallacher, K., E-mail: k.gallacher.3@research.gla.ac.uk [University of Glasgow, School of Mathematics and Statistics, University Gardens (United Kingdom); Hay, C., E-mail: c.hay@nhs.net [Royal Infirmary of Edinburgh, Interventional Radiology (United Kingdom); Moss, J. G., E-mail: jon.moss@ggc.scot.nhs.uk [Gartnavel General Hospital, Interventional Radiology Unit (United Kingdom)

    2016-03-15

    PurposeAbsence of contrast on contrast enhanced MRI (CEMRI) and reduction in uterine volume at 6 months post-uterine artery embolisation (UAE) currently indicate the successful disruption of the fibroid blood supply by UAE. This study assesses whether {sup 1}H MR spectroscopy ({sup 1}H MRS) can also indicate the success of UAE.Method20 patients with symptomatic fibroids were randomised 1:1 to undergo UAE with either Gelfoam or Embospheres. CEMRI and spectra (1.5 T) were acquired pre-, 24-h and 6 months post-UAE. LCModel was used to detect significant levels of choline, creatine and lactate in fibroid spectra. Uterine volumes were measured and paired t tests (p < 0.05) assessed volume reduction over time. Qualitative assessments of CEMRI were performed.ResultsCholine was detected in 17/18 spectra pre-UAE, 12/14 at 24-h and 6/16 at 6 months post-UAE. Choline was not detected in the 7/7 spectra available for the Embospheres group at 6 months. These fibroids were non-enhancing on CEMRI and associated with a significant reduction in mean uterine volume at 6 months (mean/min/max 396.5/84.1/997.5 cm{sup 3}, p = 0.003). Choline was detected in 6/9 fibroid spectra available for the Gelfoam group at 6 months. Of these fibroids, four demonstrated persistent enhancement on CEMRI and two were non-enhancing. This group did not demonstrate significant uterine volume reduction (mean/min/max 117.2/−230.6/382.6 cm{sup 3}, p = 0.15). The negative minimum value indicates fibroid growth.ConclusionsThis study has demonstrated the potential of {sup 1}H MRS to provide an additional marker of the success of UAE.

  11. A COMPARATIVE STUDY OF CLINICAL EXAMINATION, ULTRASOUND FINDINGS, DIAGNOSTIC HYSTEROSCOPY WITH HISTOPATHOLOGICAL EXAMINATION REPORT OF ENDOMETRIUM IN PATIENTS WITH ABNORMAL UTERINE BLEEDING

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    Sathenahalli Devegowda Prathibha

    2016-08-01

    Full Text Available BACKGROUND AND OBJECTIVES Abnormal Uterine Bleeding (AUB is a very frequent gynaecological complaint and occurs across the entire age spectrum, approximately 75000 hysterectomies are carried out each year with 30% of these for menstrual problems alone. These menstrual aberrations occur more commonly at extremes of reproductive life. The introduction of hysteroscopy has opened a new dimension in evaluation of patient with AUB replacing the blind technique of Dilatation and Curettage. The present study was undertaken to know the accuracy of various tests with Histopathology. MATERIALS AND METHODS The present prospective study was carried out on 100 patients from reproductive, perimenopausal and postmenopausal age group with abnormal uterine bleeding in Dr. B. R. Ambedkar Medical College and Hospital. RESULTS In the present study, in relation to histopathological examination, clinical findings and hysteroscopy had better accuracy (72% as compared to ultrasound findings (41% in diagnosis of abnormal uterine bleeding. CONCLUSION Hysteroscopy guided biopsy and histopathology complements each other in the evaluation of patient with abnormal uterine bleeding for accurate diagnosis and further treatment.

  12. Uterine Prolapse

    Science.gov (United States)

    ... Lose weight if you're overweight or obese. Kegel exercises Kegel exercises strengthen your pelvic floor muscles, which support ... from symptoms associated with uterine prolapse. To perform Kegel exercises, follow these steps: Tighten (contract) your pelvic ...

  13. A comparative qualitative study of misconceptions associated with contraceptive use in southern and northern Ghana

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    Philip Baba Adongo

    2014-09-01

    Full Text Available Evidence from Ghana consistently shows that unmet need for contraception is pervasive with many possible causes, yet how these may differ by cultural zone remains poorly understood. This qualitative study was designed to elicit information on the nature and form of misconceptions associated with contraceptive use among northern and southern Ghanaians. Twenty-two focus group discussions (FGDs with married community members were carried out. Community Health Officers, Community Health Volunteers, and Health Care Managers were also interviewed using a semi-structured interview guide. Focus group discussions and in-depth interviews were recorded digitally, transcribed verbatim, and analyzed using QSR Nvivo 10 to compare contraceptive misconceptions in northern and southern Ghana. Results indicate that misconceptions associated with the use of contraceptives were widespread but similar in both settings. Contraceptives were perceived to predispose women to both primary and secondary infertility, uterine fibroids, and cancers. As regular menstrual flow was believed to prevent uterine fibroids, contraceptive use-related amenorrhea was thought to render acceptors vulnerable to uterine fibroids as well as cervical and breast cancers. Contraceptive acceptors were stigmatized and ridiculed as promiscuous. Among northern respondents, condom use was generally perceived to inhibit erection and therefore capable of inducing male impotence, while in southern Ghana, condom use was believed to reduce sensation and sexual gratification. The study indicates that misconceptions associated with contraceptive use are widespread in both regions. Moreover, despite profound social and contextual differences that distinguish northern and southern Ghanaians, prevailing fears and misconceptions are shared by respondents from both settings. Findings attest to the need for improved communication to provide accurate information for dispelling these misconceptions.

  14. Safe laparoscopic removal of a 3200 gram fibroid uterus.

    Science.gov (United States)

    Demir, Richard H; Marchand, Gregory J

    2010-01-01

    Hysterectomy using minimally invasive techniques yields fewer complications, less blood loss, and quicker recovery time compared with traditional abdominal hysterectomy. Despite these advantages, 65% of all hysterectomies in the United States are still performed using traditional laparotomy, and many clinicians still exclude patients with a history of prior abdominal surgery, significant obesity, or a large fibroid uterus from these procedures. Among physicians skilled in minimally invasive surgery, the prior largest uteri removed included a 2421g uterus removed vaginally, and a 2418g uterus removed via hand-assisted laparoscopic hysterectomy. We performed a laparoscopic-assisted hysterectomy on a significantly obese 50-year-old woman with a 3200g uterus. The patient required a 2-day hospital stay and recovered unremarkably. The patient was able to return to work within one week and quickly returned to activities of daily life. In the hands of experienced minimally invasive surgeons, laparotomy can be avoided in almost all instances of hysterectomy for benign disease.

  15. Fracture of the Femur of A Newborn after Cesarean Section for Breech Presentation and Fibroid Uterus : A Case Report and Literature Review.

    Science.gov (United States)

    Farikou, Ibrahima; Bernadette, Ngo Nonga; Daniel, Handy Eone; Aurélien, Sosso Maurice

    2014-01-01

    The practice of cesarean section is known to decrease the occurrence of long bone fractures. We present here an unusual diaphyseal fracture of the femur of a newborn after cesarean section, the only case observed in our 14 years of practice. The patient was a 3.4-kg female child born at 38 weeks of gestation. The mother was a primipara and aged 39 years. Ultrasound examination at 20th week revealed intrauterine fibroids with a breech presentation. Therefore, elective cesarean section was indicated. There was no apparent bone disorder that could predispose to sustain femur fracture. The fracture was treated successfully with a bilateral spica cast. The cesarean section was indicated in an aged primipara, bearer of uterine fibroids, and breech presentation. She had a good general health status, but her bone density was unknown since this examination is not routinely performed in our clinical settings in Africa. Elderly age, primipara status, presence of uterine fibroids, and breech presentation are usual indications for cesarean section. However, there are not many reports on femur fracture after cesarean section. Our present case suggests that despite the latest advances in delivery techniques, cesarean section for breech presentation predisposes the neonate to femoral fractures.

  16. Microarray comparative genomic hybridization detection of chromosomal imbalances in uterine cervix carcinoma

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    García José

    2005-07-01

    Full Text Available Abstract Background Chromosomal Comparative Genomic Hybridization (CGH has been applied to all stages of cervical carcinoma progression, defining a specific pattern of chromosomal imbalances in this tumor. However, given its limited spatial resolution, chromosomal CGH has offered only general information regarding the possible genetic targets of DNA copy number changes. Methods In order to further define specific DNA copy number changes in cervical cancer, we analyzed 20 cervical samples (3 pre-malignant lesions, 10 invasive tumors, and 7 cell lines, using the GenoSensor microarray CGH system to define particular genetic targets that suffer copy number changes. Results The most common DNA gains detected by array CGH in the invasive samples were located at the RBP1-RBP2 (3q21-q22 genes, the sub-telomeric clone C84C11/T3 (5ptel, D5S23 (5p15.2 and the DAB2 gene (5p13 in 58.8% of the samples. The most common losses were found at the FHIT gene (3p14.2 in 47% of the samples, followed by deletions at D8S504 (8p23.3, CTDP1-SHGC- 145820 (18qtel, KIT (4q11-q12, D1S427-FAF1 (1p32.3, D9S325 (9qtel, EIF4E (eukaryotic translation initiation factor 4E, 4q24, RB1 (13q14, and DXS7132 (Xq12 present in 5/17 (29.4% of the samples. Conclusion Our results confirm the presence of a specific pattern of chromosomal imbalances in cervical carcinoma and define specific targets that are suffering DNA copy number changes in this neoplasm.

  17. Microarray comparative genomic hybridization detection of chromosomal imbalances in uterine cervix carcinoma

    Science.gov (United States)

    Hidalgo, Alfredo; Baudis, Michael; Petersen, Iver; Arreola, Hugo; Piña, Patricia; Vázquez-Ortiz, Guelaguetza; Hernández, Dulce; González, José; Lazos, Minerva; López, Ricardo; Pérez, Carlos; García, José; Vázquez, Karla; Alatorre, Brenda; Salcedo, Mauricio

    2005-01-01

    Background Chromosomal Comparative Genomic Hybridization (CGH) has been applied to all stages of cervical carcinoma progression, defining a specific pattern of chromosomal imbalances in this tumor. However, given its limited spatial resolution, chromosomal CGH has offered only general information regarding the possible genetic targets of DNA copy number changes. Methods In order to further define specific DNA copy number changes in cervical cancer, we analyzed 20 cervical samples (3 pre-malignant lesions, 10 invasive tumors, and 7 cell lines), using the GenoSensor microarray CGH system to define particular genetic targets that suffer copy number changes. Results The most common DNA gains detected by array CGH in the invasive samples were located at the RBP1-RBP2 (3q21-q22) genes, the sub-telomeric clone C84C11/T3 (5ptel), D5S23 (5p15.2) and the DAB2 gene (5p13) in 58.8% of the samples. The most common losses were found at the FHIT gene (3p14.2) in 47% of the samples, followed by deletions at D8S504 (8p23.3), CTDP1-SHGC- 145820 (18qtel), KIT (4q11-q12), D1S427-FAF1 (1p32.3), D9S325 (9qtel), EIF4E (eukaryotic translation initiation factor 4E, 4q24), RB1 (13q14), and DXS7132 (Xq12) present in 5/17 (29.4%) of the samples. Conclusion Our results confirm the presence of a specific pattern of chromosomal imbalances in cervical carcinoma and define specific targets that are suffering DNA copy number changes in this neoplasm. PMID:16004614

  18. Pregnancy after Uterine Artery Embolization: A Case Report in a Woman with Leiomyomata

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    Helena Isabel Lopes

    2015-01-01

    Full Text Available Background. Several pregnancies have been reported after embolization of uterine artery. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids but its safety in women desiring future childbearing is not well established. Case Report. We present a 40-year-old woman with leiomyomata who became pregnant after previously undergone uterine artery embolization for three times. The placenta was previa and the fetus was in transverse position. She had a cesarean delivery of an appropriately grown fetus at 37 weeks, which was followed by uterine atony requiring hysterectomy. Conclusion. Although pregnancy-related outcomes remain understudied, the available reports evidence that pregnancies after uterine artery embolization may be at significantly increased risk for postpartum hemorrhage, cesarean delivery, abnormal placentation, and malpresentation. In patients who are undergoing this type of treatment and contemplating pregnancy, the possibility of adverse complications should be taken in consideration and women should be appropriately advised.

  19. Uterine Leiomyoma and Prolapse in a Live-stranded Atlantic Spotted Dolphin (Stenella frontalis).

    Science.gov (United States)

    Díaz-Delgado, J; Fernández, A; Edwards, J F; Sierra, E; Xuriach, A; García-Álvarez, N; Sacchini, S; Groch, K R; Andrada, M; Arbelo, M

    2015-07-01

    A uterine prolapse associated with a leiomyoma (fibroid) was observed in a live-stranded Atlantic spotted dolphin (Stenella frontalis). A 7 cm segment of the reproductive tract including the cervix, uterine neck and caudal uterine body had intussuscepted and prolapsed into the cranial vaginal vault. In the leading edge of the intussuscepted/prolapsed uterine wall was a 6 × 3 × 3.5 cm leiomyoma expanding the myometrium. The leiomyoma and prolapse were associated with necrotizing exposure endometritis. This is the first report of a uterine prolapse associated with a leiomyoma in a cetacean. This lesion was believed to be the underlying cause of the live stranding. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. A comparative study of antiestrogen action: temporal patterns of antagonism of estrogen stimulated uterine growth and effects on estrogen receptor levels.

    Science.gov (United States)

    Ferguson, E R; Katzenellenbogen, B S

    1977-05-01

    Studies were undertaken to ascertain the effects of structural modification of two well-known antiestrogens (CI-628 and U-11,100A) on their estrogenic and antiestrogenic potencies and temporal patterns of effectiveness in the immature rat uterus. Changes in the chemical structures of these anti-estrogens produce compounds with markedly different affinities for the uterine estrogen receptor as measured in an in vitro cell-free cytosol system; binding affinities relative to estradiol (100%) are: CI-628, 4%; CI-680, 34%; 94X1127 (94X),222%; U-11,100A (UA), 6%; and U-23,469 (U-23), 0.1%. Although all five antiestrogens (daily injections of 50 microng over three days) appear equally effective in stimulating 72 h uterine weight when given alone, or in blocking the estradiol-stimulated weight increase when given with estradiol, marked differences in their potencies are noted when the effects of the compounds are monitored beyond 24 h following a single injection. The compounds CI-628, CI-680 and UA (50 microng sc in saline), which have a methylated hydroxyl group (at the site analogous to the steroid position 3), show a prolonged maintenance of elevated levels of nuclear receptor (beyond 48 h) and elevated uterine weight (until 72 h); this correlates with a prolonged period of depressed cytoplasmic receptor levels (beyond 48 h) and prolonged uterine insensitivity to estrogen (beyond 36 h as monitored by 3 h wet weight response). In contrast, a single injection of 50 microng of 94X (having a free hydroxyl group) or U-23 (with a side chain and central ring different from UA) maintained nuclear receptor levels elevated for only 12 h (94X) or 36 h (U-23) and uterine weights declined after 36-48 h; cytoplasmic receptor levels remained depressed for only 12 h (94X) or 24 h (U-23) and then returned to control levels or above by 36 h. These latter compounds likewise evoked the shortest period of uterine insensitivity to estrogen (ineffective as antagonists by 36 h). Comparative

  1. A comparative study of glycodelin concentrations in uterine flushings in women with subseptate uteri, history of unexplained recurrent miscarriage and healthy controls.

    Science.gov (United States)

    Salim, R; Miel, J; Savvas, M; Lee, C; Jurkovic, D

    2007-07-01

    To compare the concentration of glycodelin in uterine flushing at the implantation window obtained from women with subseptate uteri, women with a history of recurrent first trimester miscarriage and fertile controls. Glycodelin concentration was assessed using Enzyme Linked Immunohistochemistry (ELISA) at The Early Pregnancy & Gynaecology Assessment Unit, King's College Hospital, London, England. Eight women with a subseptate uterus, 20 women with a history of unexplained recurrent first trimester miscarriage and 16 fertile controls had uterine cavity flushing, for glycodelin concentration, done 7 days after the luteinising hormone surge. Glycodelin concentrations in uterine flushing obtained from women with subseptate uteri (n=8) (median 32.9 ng/ml, range 17.1-52.4 ng/ml) and recurrent miscarriage (n=20) (median 26.8 ng/ml, range 9.7-78.5 ng/ml) were significantly lower than in the control group (n=16) (median 67.7 ng/ml, range 59.0-77.6 ng/ml) (chi(2)=19.565, p<0.001). Peri-implantation levels of glycodelin are lower in women at high risk of early pregnancy failure.

  2. Chronic epilepsy in uterine leiomyoma controlled by myomectomy

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    M. O. N. Ibe

    2010-01-01

    Full Text Available Objective: We have seen many black African women with uterine fibroids. We have also seen many with just epileptic attacks only. This is the first female, to our knowledge, to present with both afflictions; the convulsions stopping after the myomectomy. Hence, this report. Materials and Method: This 30-year old single nulliparous black Nigerian female was first seen in August 2002 in our outpatient′s department. She had complained of having frequent generalized convulsions since 1988. Native medications had been of no help. Clinical examination revealed no gross neurological deficit, but a large uterine fibroid. With the diagnosis also of grand mal epilepsy, she was placed on epanutin and phenobarbitone, which prolonged the intervals of the attacks. She eventually asked for the removal of the fibroid, which was done on the 1 st of March, 2006. She was discharged home 7 days later, when the stitches were removed, and to continue the same anti-epileptic drugs, as mentioned earlier. She was to return for follow-up checks 7 days after discharge from hospital. Result: The patient tolerated the myomectomy very well. The histopathology of the specimen was that of a leiomyoma with degenerative changes. The attacks reduced greatly in severity, with prolonged intervals, 3 months after surgery. We have not seen her again, but reports reaching us suggest that she is alive, well and free of convulsions. Conclusion: This is an unusual case of a huge uterine leiomyoma in an epileptic female or vise versa. The removal of the tumor appeared to have controlled the seizures.

  3. A rare case of uterine leiomyosarcoma: a case report

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    Chinamotu Rao N

    2010-07-01

    Full Text Available Abstract Introduction Malignant change in a leiomyoma or uterine fibroid is termed leiomyosarcoma. It arises from smooth muscle of the uterus and is a rare tumor that accounts for 2% to 5% of all uterine malignancies. Very few cases are reported in the literature. Our patient did not have any history of genital bleeding, which is the usual presentation in uterine sarcoma. We report an original case report of an unusual presentation of this rare tumor arising from the uterus. Case presentation A 40-year-old nulliparous woman of South Indian origin presented with a mass in her abdomen for one year with a rapid increase in size over the previous three months. Tumor marker CA-125 was raised, and a computed tomography scan showed a mass arising from the pelvis. An exploratory laparotomy was performed and the histopathology report confirmed the diagnosis of uterine leiomyosarcoma. Conclusion Because of their rarity, uterine sarcomas are not suitable for screening. Diagnosis is by histopathologic examination and surgery is the only treatment. The prognosis for women with uterine sarcoma primarily depends on the extent of disease at the time of diagnosis and the mitotic index.

  4. Application of 3D Ultrasonography in Detection of Uterine Abnormalities

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    Firoozeh Ahmadi

    2011-01-01

    Full Text Available Structural pathologies in the uterine cavity such as müllerian duct anomalies (MDAs and intrauterinelesions (fibroids, polyps, synechiae may have important roles in subinfertility, implantation failure andpregnancy outcome. Various imaging modalities such as hysterosalpingography (HSG, sonography,laparoscopy and hysteroscopy are used in the evaluation of MDAs and intrauterine lesions. Recently,three-dimensional ultrasound (3DUS has been introduced as a non-invasive, outpatient diagnosticmodality. With increased spatial awareness, it is superior to other techniques used for the same purpose.

  5. Endometrial Cancer: Hidden Pathology in a Patient with Abnormal Uterine Bleeding and Known Leiomyoma.

    Science.gov (United States)

    Sri, Trisha; Steren, Albert J; Stratton, Pamela

    2015-01-01

    Uterine leiomyomas and endometrial pathology are both associated with abnormal uterine bleeding. We report a case in which a nulliparous woman with heavy uterine bleeding and leiomyomas had undergone two prior hysteroscopic myomectomies for benign leiomyomas. She was evaluated, but was ineligible for a clinical trial of a novel Magnetic Resonance guided High Intensity Focused Ultrasound (MRgx200B;HIFU) device. The 8 cm, prolapsed submucosal leiomyoma hindered endometrial sampling and was inaccessible to HIFU treatment. Preoperatively, neither endometrial sampling nor saline sonohysterography was technically feasible. She underwent hysterectomy, and on histological examination of specimen, stage 1A grade 1 endometrial carcinoma was found on the endometrial side of the prolapsing fibroid. Endometrial pathology is an important consideration in the evaluation of abnormal uterine bleeding, even in women with large prolapsing leiomyoma.

  6. Metastatic uterine leiomyosarcoma presenting as a breast lump.

    LENUS (Irish Health Repository)

    Sibartie, S

    2009-01-31

    BACKGROUND: It is uncommon to encounter a breast metastasis from an extramammary malignancy and even rarer from a uterine leiomyosarcoma. AIMS: We describe the third case report in the medical literature of a breast metastasis from a uterine leiomyosarcoma. METHODS: We report the management of a 56-year-old patient who presented with a breast lump 3 years after hysterectomy for a fibroid uterus. We conducted a literature review of breast leiomyosarcomas. RESULTS: The excision of the breast mass revealed a low-grade leiomyosarcoma. Radiographic examinations demonstrated metastases to the lung, liver, pelvis and bone. Retrospective pathology review of her uterus identified a small focus of leiomyosarcoma. She received chemotherapy and palliative radiotherapy but passed away within few months. CONCLUSION: Metastasis to the breast from a non-breast primary is generally a sign of disseminated disease and; thus, a poor prognostic indicator.

  7. Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section.

    Science.gov (United States)

    Fogelberg, Maria; Baranov, Anton; Herbst, Andreas; Vikhareva, Olga

    2017-09-01

    To determine the true incidence of complete uterine rupture and uterine dehiscence among women delivered by cesarean section after a previous cesarean section. Medical records of all women who delivered at University Hospital in Malmö, Sweden, during 2005-2009 (n = 21 420) were retrieved from the electronic patient record system (EPRS). After adjustment for inaccuracies, 716 women who had undergone repeat cesarean section were identified and their operation reports were reviewed. Descriptions of complete uterine rupture or uterine dehiscence in operation reports were compared with diagnoses registered in EPRS with International Classification of Diseases codes version 10 (ICD-10). Sensitivity and specificity of complete uterine rupture registration were calculated. There were 13 women with a registered diagnosis of uterine rupture. After reviewing medical records of women with repeat cesarean section, seven additional cases of complete uterine rupture, 33 cases of uterine dehiscence and 39 cases of extremely thin myometrium were identified. The incidence of complete uterine rupture and uterine dehiscence for women who delivered by repeat cesarean section was 2.8% and 10.1%, respectively. Diagnosis of complete uterine rupture was underreported in the EPRS by 35% and diagnosis of uterine dehiscence was missing in 100% of cases.

  8. Quantitative morphological assessment of microvascular network of leiomyoma tissue and the layers of myometrium in patients with uterine leiomyoma with hypo- and hyperestrogenic conditions induced by different schemes of gonadotroping relising hormone agonists therapy

    Directory of Open Access Journals (Sweden)

    Medvedev M.V.

    2011-01-01

    Full Text Available Microvascular components of myomatous tissue and the layers of myometrium were evaluated using mорmorphometric analysis in 35 patients with uterine leiomyoma with long-term and short-term preoperative hormonal correction with Gosereline Acetate. Our results show that the microvessels density depends on morphological type of the fibroid, which in case of the cellular leiomyoma is 2.9 times greater compared to the regular one. The tissue is characterized by decreased vascularization of simple leiomyoma as compared to surrounding myometrium. In conditions of a drug-induced 3-month menopause density of microvessels was significantly decreased. In conditions of elevated levels of sex steroids amount of microvessels in fibrois tissue increases, with expanding of the lumen of arterioles and metarterioles and thickening of their walls. Hipoestrogenic condition contributes significantly to reduction of the average diameter of arterioles in the tissue of cellular and simple leiomyoma, which in some cases leads to complete obliteration of the vessels. Short-time hypere-strogenemia leads to a statistically significant increase in wall thickness of arterioles in fibroid tissue samples. Similar changes observed in vessels of pseudocapsula of women with cellular leiomyoma.

  9. TRANSVAGINAL SONOGRAPHY COMBINED WITH SALINE CONTRAST SONOHYSTEROGRAPHY IN EVALUATING THE UTERINE CAVITY IN PREMENOPAUSAL PATIENTS WITH ABNORMAL UTERINE BLEEDING

    Directory of Open Access Journals (Sweden)

    K. G. M. Premleel

    2016-06-01

    Full Text Available OBJECTIVES To evaluate whether saline contrast sonohysterography (SCSH improved the diagnostic accuracy of transvaginal sonography (TVS for predicting endometrial abnormality in premenopausal patients with abnormal uterine bleeding. PATIENTS AND METHODS The uterine cavity was evaluated with TVS and SCSH in 60 premenopausal patients with abnormal uterine bleeding. All 58 patients underwent operative hysteroscopy or hysterectomy within 4 months which provided a detailed description of the uterine cavity and was used as the true value for exclusion of polyps and submucous myomas. RESULT Out of 60 patients, 45 had uterine abnormalities on TVS and SCSH and rest of the patients who appeared normal but had other abnormalities such as ovarian haemorrhagic cyst. Out of the 45 patients, 9 patients had submucous myomas and 9 were diagnosed as endometrial polyp. The findings were confirmed using hysterectomy/hysteroscopy/endometrial sampling. CONCLUSION The use of TVS without saline contrast left nine submucosal fibroids and five in nine of the polyps undiagnosed in referred patients with complaints of abnormal bleeding. It also helps in reducing the rate of more invasive procedures such as hysteroscopy. However, studies carried out for longer duration and large study population are required to validate our findings

  10. Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review

    Science.gov (United States)

    Paredes Saenz, Carmen; Raju, Rubin; Cuthpert, Sierra; Kanzy, Abed; Abhari, Sina; Hebert III, John; Rocha, Frederico G.

    2016-01-01

    Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE. Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015. Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma. PMID:27885348

  11. Focal adenomyosis (intramural endometriotic cyst) in a very young patient - differential diagnosis with uterine fibromatosis

    Science.gov (United States)

    Manta, L; Suciu, N; Constantin, A; Toader, O; Popa, F

    2016-01-01

    Introduction. Adenomyosis is a widespread disease usually affecting the late reproductive years of the women’s life, which has a great impact on their fertility. The most common form is diffuse adenomyosis, while focal adenomyosis, a cystic variant, is very rare, particularly in patients younger than 30 years old. Materials and methods. We reported a rare case of a 20-year-old Caucasian woman with cystic adenomyosis who was admitted in our service with severe chronic pelvic pain, dysmenorrhea, and menorrhagia, who had received conservative surgical treatment to preserve fertility and improve her obstetrical prognosis. Results and Discussions. Although the necrobiosis of a uterine fibroid was suspected preoperatively, the extemporaneous histopathological exam revealed adenomyosis associated with fibroleiomyoma with hyaline dystrophy and multiple foci of endometriosis of cystic formation in the wall of a young woman without any risk factors. Conclusion. Although a rare lesion in young patients, cystic adenomyosis should be considered when chronic pelvic pain is exacerbated during menstruation and is associated with a uterine tumor. In young patients, the differential diagnosis should be made with uterine malformations (hematometra), necrobiosis of uterine fibroids, pelvic endometriosis. The surgical treatment should be conservative with the excision of the lesion, always taking into account fertility preservation in young patients. PMID:27453751

  12. Laparoscopic sacrohysteropexy and myomectomy for uterine prolapse: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Faraj Radwan

    2009-11-01

    Full Text Available Abstract Introduction A large number of hysterectomies are carried out for uterine prolapse, menorrhagia and other symptomatic but benign gynaecological conditions, which has increased interest in new approaches to treat these disorders. These new procedures are less invasive and offer reduced risk and faster recovery. Case presentation Sacrohysteropexy can be carried out instead of vaginal hysterectomy in the treatment of uterine prolapse. It involves using a synthetic mesh to suspend the uterus to the sacrum; this maintains durable anatomic restoration, normal vaginal axis and sexual function. A laparoscopic approach has major advantages over the abdominal route including shorter recovery time and less adhesion formation. We describe a laparoscopic sacrohysteropexy in a 55-year-old Caucasian British woman that was technically difficult. An intramural uterine fibroid was encroaching just above the uterosacral ligament making mesh positioning impossible. This was removed and the procedure completed successfully. Conclusion Posterior wall fibroid is not a contraindication for laparoscopic sacrohysteropexy. This procedure has increasingly become an effective treatment of uterine prolapse in women who have no indication for hysterectomy.

  13. Laparoscopic sacrohysteropexy and myomectomy for uterine prolapse: a case report and review of the literature

    Science.gov (United States)

    2009-01-01

    Introduction A large number of hysterectomies are carried out for uterine prolapse, menorrhagia and other symptomatic but benign gynaecological conditions, which has increased interest in new approaches to treat these disorders. These new procedures are less invasive and offer reduced risk and faster recovery. Case presentation Sacrohysteropexy can be carried out instead of vaginal hysterectomy in the treatment of uterine prolapse. It involves using a synthetic mesh to suspend the uterus to the sacrum; this maintains durable anatomic restoration, normal vaginal axis and sexual function. A laparoscopic approach has major advantages over the abdominal route including shorter recovery time and less adhesion formation. We describe a laparoscopic sacrohysteropexy in a 55-year-old Caucasian British woman that was technically difficult. An intramural uterine fibroid was encroaching just above the uterosacral ligament making mesh positioning impossible. This was removed and the procedure completed successfully. Conclusion Posterior wall fibroid is not a contraindication for laparoscopic sacrohysteropexy. This procedure has increasingly become an effective treatment of uterine prolapse in women who have no indication for hysterectomy. PMID:19946516

  14. New procedures for uterine prolapse.

    Science.gov (United States)

    Khunda, Azar; Vashisht, Arvind; Cutner, Alfred

    2013-06-01

    Traditionally, vaginal hysterectomy and Manchester repair were the surgical approaches to treating uterine prolapse; however, both are associated with a relatively high subsequent vaginal vault recurrence. Laparoscopic uterine suspension is a new way of maintaining uterine support. Many women are keen to keep their uterus for a variety of reasons, including maintaining reproductive capability and the belief that the uterus, cervix, or both, may play a part of their gender identity. Non-removal of the uterus may retain functional (e.g. bowel, bladder and sexual) benefits. Therefore, the concept of uterine preservation for pelvic-organ prolapse has been of interest to pelvic-floor surgeons for many decades. In this review, we provide an overview of the available evidence on treating uterine prolapse surgically. We describe techniques to support the vault during hysterectomy, and examine the evidence for uterine-sparing surgery. Comparative outcomes for vaginal, abdominal and laparoscopic routes will be made. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Management of abnormal uterine bleeding in women with mechanical heart valve prosthesis and anticoagulant therapy.

    Science.gov (United States)

    Saha, Pradip Kumar; Rakshit, Bibek Mohan; Jana, Narayan; Dutta, Sanjib; Roy, Subesha Basu; Sengupta, Gautam

    2011-12-01

    In a prospective observational case series, we assessed the effects and management and outcome of oral anticoagulant associated abnormal uterine bleeding in women with mechanical heart valve prosthesis. Six women with mechanical heart valve prosthesis, who were admitted with persistent severe vaginal bleeding between 2003 and 2010, were evaluated. For each woman, detailed history, treatment received, if there was any complication and their final outcome and satisfaction were recorded. All the 6 women were parous, with their ages ranging from 27 to 50 years. They were receiving oral anticoagulant therapy for mechanical heart valve prosthesis. Of the 6 women, 4 had uterine fibroids, and the other 2 had dysfunctional uterine bleeding.Three patients with uterine fibroids underwent abdominal hysterectomy, and one underwent balloon thermal ablation of endometrium. While 1 patient with dysfunctional uterine bleeding underwent hysterectomy, the other patient desirous for further children, required levonorgestrel intra-uterine system. Two women requiring hysterectomy, developed postoperative complications, one a massive intraperitoneal haemorrhage and another a rectus sheath haematoma. At follow-up, 5 women were satisfied, and 1 woman had died suddenly at home 1 year after hysterectomy. Because of the twin problem of heart disease and anticoagulant therapy, treatment of abnormal vaginal bleeding in these women is extremely challenging. Although medical treatment yields only temporary relief, endometrial ablative procedures or levonorgestrel intra-uterine system provides more durable solution. As anticoagulant associated peri-operative haemorrhage can be potentially fatal, hysterectomy should be reserved for women with major pelvic pathologies. Proper counselling and integrated management involving gynaecologist, cardiologist, haematologist and anaesthesiologist is essential to tackle this problem.

  16. Comparative performance analysis of cervix ROI extraction and specular reflection removal algorithms for uterine cervix image analysis

    Science.gov (United States)

    Xue, Zhiyun; Antani, Sameer; Long, L. Rodney; Jeronimo, Jose; Thoma, George R.

    2007-03-01

    Cervicography is a technique for visual screening of uterine cervix images for cervical cancer. One of our research goals is the automated detection in these images of acetowhite (AW) lesions, which are sometimes correlated with cervical cancer. These lesions are characterized by the whitening of regions along the squamocolumnar junction on the cervix when treated with 5% acetic acid. Image preprocessing is required prior to invoking AW detection algorithms on cervicographic images for two reasons: (1) to remove Specular Reflections (SR) caused by camera flash, and (2) to isolate the cervix region-of-interest (ROI) from image regions that are irrelevant to the analysis. These image regions may contain medical instruments, film markup, or other non-cervix anatomy or regions, such as vaginal walls. We have qualitatively and quantitatively evaluated the performance of alternative preprocessing algorithms on a test set of 120 images. For cervix ROI detection, all approaches use a common feature set, but with varying combinations of feature weights, normalization, and clustering methods. For SR detection, while one approach uses a Gaussian Mixture Model on an intensity/saturation feature set, a second approach uses Otsu thresholding on a top-hat transformed input image. Empirical results are analyzed to derive conclusions on the performance of each approach.

  17. Impact single versus double layer uterine closure in caesarean section to uterine rupture

    Directory of Open Access Journals (Sweden)

    Budi Iman Santoso

    2016-07-01

    Full Text Available Caesarean section (CS is one of the most frequent delivery methods in the world whereas the rates of CS were varied according to developing (from 3.5 to 29.2% and developed countries (21.1%. The study aims to known the impact of single versus double layer uterine closure to uterine rupture in the history of cesarean section (CS. In this case report, the clinical question is single versus double-layer uterine closure on the previous CS, gives better outcome to reduce the risk of uterine rupture. To answer this question, we search the evidence from Pub Med and Cochrane database with the keywords: and ldquo;cesarean section" and "uterine rupture" and and ldquo;uterine closure and rdquo;. The inclusion criteria are written in English and focused comparing single and double layer uterine closure to uterine rupture in the previous CS. From the searching literature, we found 3 systematic reviews and 23 articles which were relevant to the topic. After screening the abstract and language, we got 2 systematic reviews and 4 articles. At the end, only 4 articles consisting of 1 systematic review and 3 articles were included to be appraised. Based on evidences, single layer uterine closure did not increase the risk of uterine rupture. Apart from that, shorter operative times and lower estimated blood loss became the superiority of single-layer uterine closure. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2074-2078

  18. Uterine prolapse in 2 dromedary camels.

    OpenAIRE

    Gutierrez, C.; Corbera, J.A.; Morales, I.; Morales, M; Navarro, R.

    2001-01-01

    Two cases of uterine prolapse in dromedary camels in a herd with concomitant cases of white muscle disease are described. Serum selenium and glutathione peroxidase in whole blood were investigated in both patients and showed statistical difference compared with a control group. Results suggest that selenium deficiency could promote uterine prolapse in dromedary camels.

  19. Oral misoprostol in the prevention of uterine bleeding after surgical evacuation of first trimester abortion: a comparative study of three uterotonic agents.

    Science.gov (United States)

    Aramide, T M; Olusegun, A K; Akinfolarin, A C; Oriola, D F

    2014-01-01

    This comparative study was aimed at determining the effectiveness of oral Misoprostol compared with intravenous Ergometrine and intravenous Oxytocin in reducing vaginal bleeding following surgical evacuation for first trimester abortions. This was a single-blind placebo-controlled study in which patients with first trimester uncomplicated abortions were divided into three groups using computer-generated randomization table. The first group was administered oral Misoprostol, the second group had intravenous Ergometrine, and the third group was administered intravenous Oxytocin. The uterotonic agents were administered before the surgical evacuation was carried out. There was statistically significant reduction in blood loss after the evacuation in the Misoprostol group ( P Misoprostol group (2.00 ± 0.86) compared with 4.43 ± 0.92 and 4.64 ± 1.06 days in the Ergometrine and Oxytocin groups, respectively ( P Misoprostol and Ergometrine groups (60.7% and 57.1%, respectively) compared with the Oxytocin group. Oral Misoprostol appeared to demonstrate superior efficacy in reducing uterine bleeding after surgical evacuation, compared to the other commonly used uterotonic agents.

  20. Single versus double-layer uterine closure at cesarean: impact on lower uterine segment thickness at next pregnancy.

    Science.gov (United States)

    Vachon-Marceau, Chantale; Demers, Suzanne; Bujold, Emmanuel; Roberge, Stephanie; Gauthier, Robert J; Pasquier, Jean-Charles; Girard, Mario; Chaillet, Nils; Boulvain, Michel; Jastrow, Nicole

    2017-07-01

    Uterine rupture is a potential life-threatening complication during a trial of labor after cesarean delivery. Single-layer closure of the uterus at cesarean delivery has been associated with an increased risk of uterine rupture compared with double-layer closure. Lower uterine segment thickness measurement by ultrasound has been used to evaluate the quality of the uterine scar after cesarean delivery and is associated with the risk of uterine rupture. To estimate the impact of previous uterine closure on lower uterine segment thickness. Women with a previous single low-transverse cesarean delivery were recruited at 34-38 weeks' gestation. Transabdominal and transvaginal ultrasound evaluation of the lower uterine segment thickness was performed by a sonographer blinded to clinical data. Previous operative reports were reviewed to obtain the type of previous uterine closure. Third-trimester lower uterine segment thickness at the next pregnancy was compared according to the number of layers sutured and according to the type of thread for uterine closure, using weighted mean differences and multivariate logistic regression analyses. Of 1613 women recruited, with operative reports available, 495 (31%) had a single-layer and 1118 (69%) had a double-layer closure. The mean third-trimester lower uterine segment thickness was 3.3 ± 1.3 mm and the proportion with lower uterine segment thickness cesarean delivery is associated with a thicker third-trimester lower uterine segment and a reduced risk of lower uterine segment thickness <2.0 mm in the next pregnancy. The type of thread for uterine closure has no significant impact on lower uterine segment thickness. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. 回顾性研究射频消融治疗子宫肌瘤的影响因素%Retrospective study on the factors related to the treatment of uterine leiomyoma by radio-frequency caloric ablation

    Institute of Scientific and Technical Information of China (English)

    刘畅; 张煦

    2011-01-01

    目的 观察消融治疗子宫肌瘤的局限性、影响手术疗效的相关因素.方法 62例子宫肌瘤患者,按肌瘤大小、数目、类型、子宫位置、宫腔深度、患者年龄进行分类,用妇科多功能射频治疗仪(BBT)消融子宫肌瘤,分析其与手术时间及术中出血量的关系及手术前后肌瘤光镜、电镜下病理变化的关系.结果 肌瘤大小与手术时间相关(P<0.05),各组间有统计学差异(P<0.05).肌瘤类型与术中出血量相关(P<0.05),各组间有统计学差异(P<0.05);但与手术时间无关.而其余因素则与手术时间、术中出血量无关.结论 射频消融是通过使肌瘤发生凝固性坏死来达到治疗目的 的一种微创、安全、有效的方法.%Objective To provide a guide for the clinic appilications and the effectiveness prediction of radio -frequency caloric ablation therapy (BBT) by evaluating the limitations, the factors related to operative efficacy of BBT. Methods A total of 62 patients with uterine fibroids (72 uterine fibroids in total) were treated with BBT. All the operations were done by one surgeon. The patients was divided into several groups according to the different diameters, numbers, types of uterine fibroids and the lengths of uterine cavity, uterus positions, ages. We investigated the relation of operative duration, blood loss and these factors, and the pathological changes after radio -frequency caloric ablation therapy.Results Sizes of uterine fibroids were related to the operation duration (P < 0. 05 ). Types of uterine fibroids were related to the blood loss (P < 0. 05), but it was unconcerned with operative duration. The other factors were not related to the operation duration and the blood loss.Conclusion Radio- frequency caloric ablation therapy played a role in the treatment of uterine fibroids by coagulative necrosis, it was a less invasive, safe and effective therapeutic method.

  2. Comparison of an Additional Transdermal Fentanyl Patch Compared to Intravenous NSAID and Opioid Analgesics within 24 Hours of an Uterine Artery Embolization for Myoma and Adenomyosis

    Energy Technology Data Exchange (ETDEWEB)

    Song, Suk Yun; Kang, Byung Chul; Rho, Kyung Min [Dept. of Radiology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul (Korea, Republic of)

    2011-05-15

    To evaluate the effectiveness of an additional transdermal fentanyl patch compared to intravenous analgesics in pain control during the 24-hour period following uterine artery embolization (UAE) for myoma and adenomyosis. Between September 2009 and August 2010, 42 patients underwent UAE for myoma or adenomyosis. Of these, 21 received an intravenous opioid (pethidine) and a nonsteroidal anti-inflammatory drug (group A), and 21 received an additional transdermal fentanyl patch (group B). Pain perception levels were established verbally on a 0-10 scale during the 24-hour period following UAE. Differences in pain trends, mean dose of intravenous pethidine, and adverse effects were compared between the two groups. Pain perception was most severe at 6 hours after UAE and the mean pain level of group B at that time was 6.3 {+-} 0.7, which was significantly lower than that of group A, 8.2 {+-} 0.7 (p<0.05). The mean dose of intravenous pethidine was 114.3 {+-} 59.5 mg in group A and 90.5 {+-} 49.0 mg in group B, while the incidence of nausea was 67% in group A and 77% in group B. In both cases, the differences were not significantly different (p>0.05), and no evidence of respiratory distress was demonstrated. The addition of a transdermal fentanyl patch to intravenous analgesics is effective in reducing post-embolization pain during the 24-hour period after UAE.

  3. pain control for uterine fibroid embolisation-an initial experience in ...

    African Journals Online (AJOL)

    East African Medical Journal Vol 88 No. 6 June 2011 .... nasal prongs and oxygen flow at 3litres/. • minute .... and devices used while facilitating the rapid recovery to keep the inpatient stay ... table 3 and none required additional pain control in.

  4. Evaluation and management of abnormal uterine bleeding in premenopausal women.

    Science.gov (United States)

    Sweet, Mary Gayle; Schmidt-Dalton, Tarin A; Weiss, Patrice M; Madsen, Keith P

    2012-01-01

    Up to 14 percent of women experience irregular or excessively heavy menstrual bleeding. This abnormal uterine bleeding generally can be divided into anovulatory and ovulatory patterns. Chronic anovulation can lead to irregular bleeding, prolonged unopposed estrogen stimulation of the endometrium, and increased risk of endometrial cancer. Causes include polycystic ovary syndrome, uncontrolled diabetes mellitus, thyroid dysfunction, hyperprolactinemia, and use of antipsychotics or antiepileptics. Women 35 years or older with recurrent anovulation, women younger than 35 years with risk factors for endometrial cancer, and women with excessive bleeding unresponsive to medical therapy should undergo endometrial biopsy. Treatment with combination oral contraceptives or progestins may regulate menstrual cycles. Histologic findings of hyperplasia without atypia may be treated with cyclic or continuous progestin. Women who have hyperplasia with atypia or adenocarcinoma should be referred to a gynecologist or gynecologic oncologist, respectively. Ovulatory abnormal uterine bleeding, or menorrhagia, may be caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease), endometrial polyps, and submucosal fibroids. Transvaginal ultrasonography or saline infusion sonohysterography may be used to evaluate menorrhagia. The levonorgestrel-releasing intrauterine system is an effective treatment for menorrhagia. Oral progesterone for 21 days per month and nonsteroidal anti-inflammatory drugs are also effective. Tranexamic acid is approved by the U.S. Food and Drug Administration for the treatment of ovulatory bleeding, but is expensive. When clear structural causes are identified or medical management is ineffective, polypectomy, fibroidectomy, uterine artery embolization, and endometrial ablation may be considered. Hysterectomy is the most definitive treatment.

  5. Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.

    Directory of Open Access Journals (Sweden)

    Michael A Seidman

    Full Text Available BACKGROUND: Power morcellation has become a common technique for the minimally invasive resection of uterine leiomyomas. This technique is associated with dissemination of cellular material throughout the peritoneum. When morcellated uterine tumors are unexpectedly found to be leiomyosarcomas or tumors with atypical features (atypical leiomyoma, smooth muscle tumor of uncertain malignant potential, there may be significant clinical consequences. This study was undertaken to determine the frequency and clinical consequence of intraperitoneal dissemination of these neoplasms. METHODOLOGY/PRINCIPAL FINDINGS: From 2005-2010, 1091 instances of uterine morcellation were identified at BWH. Unexpected diagnoses of leiomyoma variants or atypical and malignant smooth muscle tumors occurred in 1.2% of cases using power morcellation for uterine masses clinically presumed to be "fibroids" over this period, including one endometrial stromal sarcoma (ESS, one cellular leiomyoma (CL, six atypical leiomyomas (AL, three smooth muscle tumor of uncertain malignant potential (STUMPs, and one leiomyosarcoma (LMS. The rate of unexpected sarcoma after the laparoscopic morcellation procedure was 0.09%, 9-fold higher than the rate currently quoted to patients during pre-procedure briefing, and this rate may increase over time as diagnostically challenging or under-sampled tumors manifest their biological potential. Furthermore, when examining follow-up laparoscopies, both from in-house and consultation cases, disseminated disease occurred in 64.3% of all tumors (zero of one ESS, one of one CL, zero of one AL, four of four STUMPs, and four of seven LMS. Only disseminated leiomyosarcoma, however, was associated with mortality. Procedures are proposed for pathologic evaluation of morcellation specimens and associated follow-up specimens. CONCLUSIONS/SIGNIFICANCE: While additional study is warranted, these data suggest uterine morcellation carries a risk of disseminating

  6. A rare case of cervical fibroid presenting as retained placenta with postpartum hemorrhage

    Directory of Open Access Journals (Sweden)

    Meenakshi Chowdhury

    2015-04-01

    Full Text Available Fibroids during pregnancy are often asymptomatic but sometimes may lead to various complications and unusual presentations. We are reporting an unusual case of cervical fibroid during pregnancy that presented as retained placenta with postpartum hemorrhage following a full term normal vaginal delivery. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 505-507

  7. Parasitic fibroid: case report and novel approach in reducing incidence of future cases

    Directory of Open Access Journals (Sweden)

    Sukainah S.

    2016-08-01

    Full Text Available We report a case of parasitic fibroid which developed less than 1 year following laparoscopic myomectomy using power morcellation. Following this case, a novel approach in reducing the incidence of future parasitic fibroid is described. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000: 2836-2839

  8. Role of transvaginal sonography and hysteroscopy in abnormal uterine bleeding: does the diagnostic yield increase by combining transvaginal sonography, hysteroscopy and biopsy?

    Directory of Open Access Journals (Sweden)

    Nivedita Krishnamoorthy

    2014-08-01

    Methods: This was a descriptive cross sectional study between January 2013 to June2014 in Sri Manakula Vinayagar medical college and hospital. After obtaining ethics committee approval, 100 consecutive patients with abnormal uterine bleeding between the age group of 35 and 55 years, who consented to participate in the study, were subjected to transvaginal sonography followed by diagnostic hysteroscopy combined with a directed biopsy. TVS and hysteroscopy was performed by two different investigators. The endometrial curettings and any intracavitary lesion were subjected to histopathological examination. Results tabulated and analysed using MS EXCEL and cross tabulation using Epi-info. Sensitivity, specificity, PPV, NPV for each pathology by TVS and hysteroscopy with HPE as the gold standard was calculated. Also the pathology causing abnormal uterine bleeding was computed by taking into account the endometrial characteristics and the associated lesions diagnosed by TVS, hysteroscopy and histopathological examination report. Results: 61 patients had only single lesions in the form of normal endometrium, atrophic endometrium, endometrial hyperplasia, endometrial polyp, malignancy and IU synechiae whereas 39 patients had lesions like intramural fibroids, adenomyosis, submucus myoma and polyps associated with different types of endometrium. The diagnostic accuracy of TVS and hysteroscopy were comparable for normal endometrium whereas hysteroscopy was found to be more accurate for endometrial polyps, endometrial hyperplasia and atrophic endometrium. Conclusions: The combination of transvaginal sonography, hysteroscopy and directed biopsy was found to increase the diagnostic yield in patients with abnormal uterine bleeding. As the diagnostic accuracy increased by combining the three modalities, an effective and appropriate management can be planned. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 919-923

  9. Endometrial Volume Measured by VOCAL Compared to Office Hysteroscopy for Diagnosis of Endometrial Polyps in Premenopausal Women with Abnormal Uterine Bleeding

    Science.gov (United States)

    Laban, Mohamed; Eisa, Marwa M.

    2016-01-01

    The aim is to compare hysteroscopy, two-dimensional transvaginal ultrasound (2D TVUS), and three-dimensional (3D) Virtual Organ Computer-aided AnaLysis™ (VOCAL) to detect endometrial polyps (EPs) in premenopausal women with abnormal uterine bleeding (AUB). This prospective study was done at Ain Shams Maternity Hospital, Egypt, from March 5, 2015, to December 30, 2015, enrolling 118 premenopausal women with AUB. 2D TVUS, 3D VOCAL, and hysteroscopy were done. 109 patients reached final analysis. 36 women (33%) were diagnosed with EP by 2D TVUS. 50 (45.9%) had EP by hysteroscopy. Endometrial thickness was 10.1 mm by 2D TVUS and endometrial volume was 4.92 mL by VOCAL in women with EP by hysteroscopy compared to 9.9 mm and 3.50 mL in women with no EP, respectively (P = 0.223; P = 0.06). 2D TVUS has sensitivity, specificity, and positive and negative predictive values of 54%, 84.7%, 75%, and 68.5%, respectively. Endometrial thickness of >7.5 mm has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 82%, 37.3%, 52.6%, 71%, and 57.8%, respectively. Endometrial volume of >1.2 mL has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 90%, 42.4%, 57%, 83.3%, and 64.2%, respectively. 3D VOCAL may be used as a noninvasive method for the diagnosis of EP in premenopausal women with AUB. PMID:28003825

  10. Endometrial Volume Measured by VOCAL Compared to Office Hysteroscopy for Diagnosis of Endometrial Polyps in Premenopausal Women with Abnormal Uterine Bleeding.

    Science.gov (United States)

    Laban, Mohamed; Hussain, Sherif H; Hassanin, Alaa S; Khalaf, Waleed M; Etman, Mohamed K; Elsafty, Mohammed S E; Bahaa Eldin, Ahmed M; Hasanien, Ahmad S; Sakna, Noha A; Taema, Mohammed; Mostafa, Mohammed H; Eisa, Marwa M

    2016-01-01

    The aim is to compare hysteroscopy, two-dimensional transvaginal ultrasound (2D TVUS), and three-dimensional (3D) Virtual Organ Computer-aided AnaLysis™ (VOCAL) to detect endometrial polyps (EPs) in premenopausal women with abnormal uterine bleeding (AUB). This prospective study was done at Ain Shams Maternity Hospital, Egypt, from March 5, 2015, to December 30, 2015, enrolling 118 premenopausal women with AUB. 2D TVUS, 3D VOCAL, and hysteroscopy were done. 109 patients reached final analysis. 36 women (33%) were diagnosed with EP by 2D TVUS. 50 (45.9%) had EP by hysteroscopy. Endometrial thickness was 10.1 mm by 2D TVUS and endometrial volume was 4.92 mL by VOCAL in women with EP by hysteroscopy compared to 9.9 mm and 3.50 mL in women with no EP, respectively (P = 0.223; P = 0.06). 2D TVUS has sensitivity, specificity, and positive and negative predictive values of 54%, 84.7%, 75%, and 68.5%, respectively. Endometrial thickness of >7.5 mm has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 82%, 37.3%, 52.6%, 71%, and 57.8%, respectively. Endometrial volume of >1.2 mL has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 90%, 42.4%, 57%, 83.3%, and 64.2%, respectively. 3D VOCAL may be used as a noninvasive method for the diagnosis of EP in premenopausal women with AUB.

  11. Endometrial Volume Measured by VOCAL Compared to Office Hysteroscopy for Diagnosis of Endometrial Polyps in Premenopausal Women with Abnormal Uterine Bleeding

    Directory of Open Access Journals (Sweden)

    Mohamed Laban

    2016-01-01

    Full Text Available The aim is to compare hysteroscopy, two-dimensional transvaginal ultrasound (2D TVUS, and three-dimensional (3D Virtual Organ Computer-aided AnaLysis™ (VOCAL to detect endometrial polyps (EPs in premenopausal women with abnormal uterine bleeding (AUB. This prospective study was done at Ain Shams Maternity Hospital, Egypt, from March 5, 2015, to December 30, 2015, enrolling 118 premenopausal women with AUB. 2D TVUS, 3D VOCAL, and hysteroscopy were done. 109 patients reached final analysis. 36 women (33% were diagnosed with EP by 2D TVUS. 50 (45.9% had EP by hysteroscopy. Endometrial thickness was 10.1 mm by 2D TVUS and endometrial volume was 4.92 mL by VOCAL in women with EP by hysteroscopy compared to 9.9 mm and 3.50 mL in women with no EP, respectively (P=0.223; P=0.06. 2D TVUS has sensitivity, specificity, and positive and negative predictive values of 54%, 84.7%, 75%, and 68.5%, respectively. Endometrial thickness of >7.5 mm has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 82%, 37.3%, 52.6%, 71%, and 57.8%, respectively. Endometrial volume of >1.2 mL has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 90%, 42.4%, 57%, 83.3%, and 64.2%, respectively. 3D VOCAL may be used as a noninvasive method for the diagnosis of EP in premenopausal women with AUB.

  12. Follow-ups of mid-term and long-term outcomes for uterine intramural myomas after percutaneous microwave ablation therapy%子宫肌壁间肌瘤经皮微波消融后中远期疗效观察

    Institute of Scientific and Technical Information of China (English)

    郝艳丽; 张晶; 韩治宇; 徐瑞芳; 马霞; 杨宇; 周洪雨; 葛海龙; 董雪娟

    2014-01-01

    Objective To evaluate the mid-term and long-term clinical outcomes for symptomatic intramural uterine myoma after ultrasound-guided percutaneous microwave ablation therapy (PMAT). Methods A total of 123 women with intramural uterine myoma underwent PMAT. Prospective studies were conducted to compare the dominant fibroid volume (FV), hemoglobin (HGB) and Uterine Fibroid Symptoms and Quality of Life Questionnaire (UFS-QOL) at baseline and 1, 2, 3 and 4 years of follow-up Results Comparing with the baseline, the shrinkage rate of FV at 1 year follow-up was 74.5%. HGB of anemic patients pre-PMAT increased from 91±11 to 114±20 g/L. Two parts of UFS-QOL symptoms severity scores (SSS) and health-related quality of life (HRQL) changed from 43±10 to 18±16 and 41±21 to 90±16 respectively at 1year follow-up. All four items stayed nearly the same at 2, 3 and 4 years post-therapy. Conclusion Ultrasound-guided PMAT of uterine fibroids can effectively ameliorate the mid-term and long-term clinical syndromes and improve quality of life by shrinking fibroids effectively or even disappearing completely.%目的 评价超声引导经皮微波消融(PMAT)治疗症状性子宫肌壁间肌瘤中远期临床疗效.方法 前瞻性研究解放军总医院2008年8月至2012年8月123例超声引导PMAT治疗的症状性子宫肌壁间肌瘤患者临床疗效.比较治疗前、治疗后1、2、3及4年肌瘤体积(FV),血红蛋白量(HGB),子宫肌瘤症状及与健康相关生活质量(UFS-QOL)评分.结果 治疗后1年,FV缩小74.5%;贫血患者HGB从(91±11) g/L上升至(114±20) g/L;UFS-QOL中子宫肌瘤症状评分(SSS)及与健康相关生活质量评分(HRQL)分别从43±10、41±21变化至18±16、90±16;治疗后2、3、4年4项参数均维持在治疗后1年时水平无明显变化.结论 超声引导PMAT子宫肌壁间肌瘤可使肌瘤有效缩小甚至完全消失,有效改善患者中远期临床症状,提高生活质量.

  13. Adenocarcinoma involving the uterine cervix: magnetic resonance imaging findings in tumours of endometrial, compared with cervical, origin

    Energy Technology Data Exchange (ETDEWEB)

    Haider, M.A. [Univ. of Toronto, Dept. of Medical Imaging, Univ. Health Network, Mount Sinai Hospital, Toronto, Ontario (Canada)]. E-mail: mhaider@utoronto.ca; Patlas, M. [McMaster Univ., Dept. of Radiology, Hamilton General Hospital, Hamilton, Ontario (Canada); Jhaveri, K. [Univ. of Toronto, Dept. of Medical Imaging, Univ. Health Network, Mount Sinai Hospital, Toronto, Ontario (Canada); Chapman, W. [Univ. of Toronto, Dept. of Pathology, Univ. of Health Network, Toronto, Ontario (Canada); Fyles, A. [Univ. of Toronto, Dept. of Radiation Oncology, Princess Margaret Hospital, Univ. Health Network, Toronto, Ontario (Canada); Rosen, B. [Univ. of Toronto, Dept. of Obstetrics and Gynecology, Univ. Health Network, Toronto, Ontario (Canada)

    2006-02-15

    To determine the distinctive magnetic resonance imaging (MRI) features of cervical and endometrial adenocarcinoma that present clinically as cervical mass. From 1999 to 2002, 56 patients with adenocarcinoma on the initial biopsy of a cervical mass underwent MRI at our institution. Of these, 42 had a visible mass on MRI. Pathology review of all available tissue was the reference standard. A site of origin was determined by the pathologist in 38 of the 42 patients, and these were the cases evaluated; of these patients, 32 cases had adenocarcinoma and 6 had adenosquamous cancers. Findings were significantly more prevalent in patients with adenocarcinomas of endometrial, compared with cervical, origin for endometrial thickening (11 [73%] and 3 [13%], respectively; P = 0.0003), endometrial mass (11 [73%] and 1 [4%], respectively; P < 0.0001), endometrial cavity expansion by a mass (9 [60%] and 2 [9%], respectively; P = 0.001), and invasion of myometrium from endometrium (9 [60%] and 0, respectively; P < 0.0001). Adenocarcinomas of the endometrium that involve the cervix have MRI features that help distinguish them from primary adenocarcinomas of the cervix. (author)

  14. 异常子宫出血子宫内膜病理与B超对比观察%Comparative observation of endometrial pathology and B ultrasound in abnormal uterine bleeding

    Institute of Scientific and Technical Information of China (English)

    章达桂; 郑守广; 倪慕兰

    2016-01-01

    Objective:To compare the endometrial pathology and B ultrasound diagnosis result of abnormal uterine bleeding. Methods:120 patients with abnormal uterine bleeding were selected.They were respectively given B ultrasound examination and pathology examination,and the diagnosis results of the two methods were compared.Results:B ultrasound diagnosed 80 cases.The coincidence rate of pathology diagnosis result was 66.67%,and the diagnosis accuracy rate of intrauterine fetal residue was highest. Conclusion:Compared with the results of pathological examination,the coincidence rate of abnormal uterine bleeding by B ultrasound is higher.%目的:比较异常子宫出血子宫内膜病理与B超诊断结果。方法:收治异常子宫出血患者120例,分别给予B超检查和病理检查,比较两种方式的诊断结果。结果:B超检查诊断出80例患者,与病理诊断结果的符合率66.67%,其中宫腔胚胎残留的诊断准确率最高。结论:与病理学检查结果相比较,B超诊断异常子宫出血的符合率较高。

  15. Contrast-enhanced MR angiography of uterine arteries for the prediction of ovarian artery embolization in 349 patients.

    Science.gov (United States)

    Lee, Mu Sook; Kim, Man Deuk; Lee, Myungsu; Won, Jong Yun; Park, Sung Il; Lee, Do Yun; Lee, Kwang-Hun

    2012-09-01

    To assess contrast-enhanced magnetic resonance (MR) angiographic findings of uterine arteries (UAs) and to evaluate the diagnostic utility of this imaging modality for the prediction of ovarian artery (OA) embolization (OAE). The authors retrospectively evaluated 349 patients who underwent contrast-enhanced MR angiography before UA embolization (UAE) for symptomatic fibroid tumors or adenomyosis. The diameters of the UAs were compared with those of the inferior mesenteric arteries (IMAs) and classified into two groups: group I, in which the diameters of both UAs were the same as or greater than that of the IMA; and group II, in which at least one UA was smaller than the IMA or was not visible. The presence of an enlarged OA was also evaluated. Sensitivity and specificity were calculated for UA diameter, enlarged OA, and the combination of the two. Nine of 22 patients (40.9%) in group II underwent OAE, which was a significantly higher incidence (P contrast-enhanced MR angiography allows a comparison between UA and IMA diameters and therefore can be helpful for the prediction of OAE. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

  16. Treatment of uterine prolapse stage 2 or higher: a randomized multicenter trial comparing sacrospinous fixation with vaginal hysterectomy (SAVE U trial)

    NARCIS (Netherlands)

    Detollenaere, R.J.; Boon, J. den; Stekelenburg, J.; Alhafidh, A.H.; Hakvoort, R.A.; Vierhout, M.E.; Eijndhoven, H.W. van

    2011-01-01

    BACKGROUND: Pelvic organ prolapse is a common health problem, affecting up to 40% of parous women over 50 years old, with significant negative influence on quality of life. Vaginal hysterectomy is currently the leading treatment method for patients with symptomatic uterine prolapse. Several studies

  17. Doppler indicates of uterine artery Doppler velocimetry by placental location

    Energy Technology Data Exchange (ETDEWEB)

    Han, Sung Shik; Park, Yong Won; Cho, Jae Sung; Kwon, Hye Kyeung; Kim, Jae Wook [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2001-09-15

    Our purpose was to investigate the relation between the vascular resistance of uterine artery and placental location and to establish the reference value of Doppler index in uterine artery by placental location. Placental location and flow velocity waveforms of both uterine arteries in 7,016 pregnant women after 18 weeks gestation were examined using color Doppler ultrasonography. Placental location was classified as central and lateral placental and the uterine artery with lateral placental were divided into ipsilateral uterine artery (same side of the placental) and contralateral uterine artery (opposite side of the placenta). The uterine artery with central placental was classified as the central uterine artery. Systolic-Diastolic ratio (S/D ratio) of uterine arteries by gestational weeks were calculated and compared with the placental location and perinatal outcomes. In the lateral placental group, the S/D ratio of the contralateral uterine artery was higher than the ipsilateral one (mean=2.08+0.34 vs 1.89+0.34, p=0.0001). S/D ratio of the uterine artery decreased during second trimester and the ratio after 27 weeks was a tendency to have a constant values(ipsilateral: 1.85+ 0.34, central : 1.96+ 0.40, contralateral: 2.01+0.54). S/D ratio of the uterine artery was affected by placental location. So when we evaluate Doppler spectrum of uterine artery, placental location should be considered and we established the reference value of Doppler index of uterine artery by placental location.

  18. Current status of high-intensity focused ultrasound for the management of uterine adenomyosis

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Vincent Y. T. [Dept. of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong (China)

    2017-04-15

    While high-intensity focused ultrasound has been used for some time in the management of uterine fibroids, its effectiveness and safety in managing adenomyosis is less well established. A literature review was performed of all eligible reports using this modality as a treatment for adenomyosis. Relevant publications were obtained from the PubMed electronic database from inception through March 2016. Eleven articles, including information from 1,150 treatments and follow-up data from 990 patients, were reviewed. High-intensity focused ultrasound appears to be effective and safe in the management of symptomatic adenomyosis, and can be considered as an alternative uterine-sparing option for women with this condition.

  19. UTERINE INVERSION OF ONE HORN OF BICORNUATE, UNICOLLIS UTERUS. A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Rooplekha

    2014-01-01

    Full Text Available Puerperal uterine inversion is rare; inversion of one horn of bicornute unicollis uterus is even rarer. Uterine malformations can make the diagnosis difficult , challenging emergency treatment and could prove potentially life threatening too. In our case the patient after two months of delivery had continuous vaginal bleeding , speculum examination revealed a mass at vaginal vault , reddish colored , about 5 cm in size and cervical rim was felt all around it , but for the colour which was red , it was suspected to be a fibroid polyp as the ultrasound reports had shown a normal uterus. When polypectomy was attempted it was discovered that the mass was probably an inverted uterus. Consequently laparotomy was done which revealed a bicornuate uterus with inversion of one rig ht horn. The inverted horn was reposited with great difficulty but was unsuitable to sustain future pregnancy hence a hemihyterectomy had to be performed. Patient recovered well.

  20. PROSPECTIVE STUDY OF UTERINE LEIOMYOMAS I N A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Ch. Nirmala

    2015-04-01

    Full Text Available BACKGROUND: Fibroids are benign smooth muscle neoplasms that may occur singly, but more often are multiple. Uterine tumors are the most common and the leading cause of hysterectomy in women. METHODS: The present study is a prospective study conducted in the department of pathology, Andhra Medical College, King George Hospital, Visakhapatnam in the period of one year, from M arch 2014 to M arch 2015. RESULTS: We received a total of 368 hysterecto my and 5 myomectomy specimens during this period, out of which, 249(66.7% were single and 124(33.3% were multiple. The age group ranged from 20 to 69. The most common location was intramural 243(65.1% cases, subserosal were 51(13.7%, submucosal were 18 (4.8%, cervical were 7(1.8% and 2(0.5% were broad ligament fibroids. The size ranged from as large as 19 cm to as small as seedling fibroids of size 0.1cm. Microscopically, the most common degeneration was hyaline degeneration 80 cases, 5 myxoid, 5 cyst ic and one case of chondroid degeneration. 6 cases showed calcifications. The most common age group was seen in the age group of 40 - 49 which were 207 cases (55.5%. 51(13.7% cases were associated with adenomyosis. The results from our study were comparabl e with those reported in literature and provide a simple integrated pathogenetic view for further thinking, to establish new therapeutic options. CONCLUSIONS: The clinico - social and economic burden of uterine leiomyomas is increasing and requires future st udies to clarify the etiopathogenesis and elaborate new and effective therapies for this condition

  1. Effects of estradiol on uterine perfusion in anesthetized cyclic mares affected with uterine vascular elastosis.

    Science.gov (United States)

    Esteller-Vico, A; Liu, I K M; Vaughan, B; Steffey, E P; Brosnan, R J

    2016-01-01

    Uterine vascular elastosis in mares is characterized by degeneration of uterine vasculature through thickening of the elastin layers. Factors commonly associated with this degeneration include age, parity, and chronic uterine endometritis. Affected mares have also been shown to exhibit decreases in uterine blood flow and perfusion of the uterus. Due to the increased thickness of the elastin layers, we hypothesize that vasodilatation of the uterine vasculature is also impaired. To test the functionality of these vessels, we evaluated the vasodilatory effects of estradiol on the uterine vascular bed in mares with normal vasculature and mares with severe elastosis. Both groups were tested in estrus and diestrus. Fluorescent microspheres were used to determine basal blood perfusion, followed by the intravenous administration of 1.0 μg/kg of 17β-estradiol. After 90 min, perfusion was measured once again to determine the vascular response to estradiol. Control mares in estrus displayed a significant increase in total uterine blood flow after the administration of estradiol when compared to baseline levels. No other group had a significant increase in total blood flow and perfusion after estradiol administration. The administration of estradiol in control mares induced regional increases in perfusion in the uterine horns and uterine body during estrus and only in the uterine horns during diestrus. Mares affected by elastosis exhibited no regional differences in perfusion levels post-estradiol administration. The difference in the vasodilatory response induced by estradiol between reproductively healthy mares and mares affected with elastosis indicates that the functionality of the affected vessels is compromised.

  2. CT differentiation of solid ovarian tumor and uterine subserosal leiomyoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Rae; Cho, Kyoung Sik [Asan Medical Center, Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Sohn, Chul Ho [Dongsan Medical Center, Keimyung Univ. College of Medicine, Taegu (Korea, Republic of); Ji, Eun Kyung [Bombit Hospital, Seoul (Korea, Republic of)

    1999-06-01

    On the basis of CT findings, to differentiate between solid ovarian tumor and uterine subserosal myoma. In eight surgically proven cases of solid ovarian tumor and in ten uterine subserosal myoma patients, contrast-enhanced CT images were obtained. Two genitourinary radiologists reviewed the findings with regard to degree of enhancement of the mass as compared with enhancement of uterine myometrium, thickening of round ligaments, visualization of normal ovaries, contour of the mass, and the presence of ascites in the pelvic cavity. Six of eight ovarian tumors but only two of ten uterine myomas were less enhanced than normal uterine myometrium (p<0.05). Pelvic ascites were seen in six of eight ovarian tumors, but in only one of ten uterine myomas (P<0.05). Three of 16 ovaries in ovarian tumor patients, but 12 of 20 ovaries in uterine myoma patients, were normal (p<0.05). Six of 16 round ligaments of the uterus in ovarian tumor patients, were thichened but 11 of 20 round ligaments in uterine myoma patients, were thickened (p>0.05). The contour of the mass was lobulated in two of eight ovarian tumor patients, but in five of ten uterine myoma patients (p>0.05). CT findings suggestive of solid ovarian tumor were less contrast enhancement of the mass than of normal uterine myometrium, pelvic ascites, and nonvisualization of normal ovary.

  3. Uterine Leiomyoma: Hysterosalpingographic Appearances

    Directory of Open Access Journals (Sweden)

    Firoozeh Ahmadi

    2008-01-01

    Full Text Available Uterine leiomyoma is the most common benign tumor of genital tract. The etiology of myomasis unknown. Leiomyoma shows a broad spectrum of radiographic appearances depending on thenumber, size, and location of the tumor. The diagnostic method for uterine leiomyomas is basedprimarily on the clinical situation. Despite of the varied diagnostic options such as; transvaginalsonography, sonohysterography, hysteroscopy, laparoscopy and MRI; hysterosalpingography isstill one of the valuable imaging methods for identification of uterine leiomyoma.The various features of the proved leiomyoma are illustrated in this pictorial review. The incidence,risk factors and clinical features will also be discussed briefly.

  4. Uterine artery embolization (UAE) for diffuse leiomyomatosis of the uterus: Clinical and imaging results

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Jieun [Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul 120-752 (Korea, Republic of); Kim, Man Deuk, E-mail: mdkim@yuhs.ac [Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul 120-752 (Korea, Republic of); Jung, Dae Chul; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Lee, Do Yun; Park, Sung Il; Lee, Kwang Hun [Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul 120-752 (Korea, Republic of)

    2012-10-15

    Purpose: The aim of the current study was to evaluate the efficacy of uterine artery embolization (UAE) in the management of diffuse uterine leiomyomatosis with mid-term follow-up. Materials and methods: All patients who underwent UAE between 2008 and 2010 for symptomatic fibroids were analyzed. Among 360 cases, a total of 7 patients with diffuse uterine leiomyomatosis diagnosed based on MRI were included in this retrospective study. Patient ages ranged from 29 to 38 (mean 32.7) years. The median follow-up period was 16 (range; 6–31) months. The embolic agent was non-spherical polyvinyl alcohol particles. All patients underwent follow-up MRI at 3 months after UAE. Uterine volumes were calculated using MRI. Menorrhagia symptom changes were assessed at mid-term follow-up. Results: There were no technical failures to catheterize the uterine artery and no adverse events requiring therapy after UAE. Contrast-enhanced MRI showed complete necrosis of the leiomyomatous nodules in 5 patients (71%) 3 months after embolization. Two patients (28%) showed mostly leiomyomatous nodules that were necrotized, some of which were still viable. All 7 patients with menorrhagia had improvement of symptoms at the mid-term follow-up. The initial mean uterine volume was 601.30 ± 533.92 cm{sup 3} and was decreased to a mean of 278.81 ± 202.70 cm{sup 3} at 3 months follow-up, for a mean uterus volume reduction rate of 50.1% (p < 0.05). One patient became pregnant 5 months after UAE treatment. Conclusion: UAE was a highly effective treatment for diffuse uterine leiomyomatosis with mid-term durability and may be a valuable alternative to hysterectomy.

  5. Giant ileal inflammatory fibroid polyp: a rare cause of intestinal intussusception

    Directory of Open Access Journals (Sweden)

    Daniel Cury Ogata

    2012-09-01

    Full Text Available Ileal inflammatory fibroid polyp is a rare non-neoplastic lesion of the gastrointestinal tract. Intussusception caused by an inflammatory fibroid polyps is uncommon. The authors report a case of a 75 year-old female patient presenting with ileal obstruction due to intussusception of a polypoid lesion. The patient underwent surgical treatment and histopathology confirmed the diagnosis.Os pólipos fibroides inflamatórios são raras lesões não neoplásicas do trato gastrointestinal e a intussuscepção devido a essa entidade é incomum. Os autores relatam um caso de paciente do sexo feminino, 75 anos, que apresentou obstrução ileal devido a uma intussuscepção por lesão polipoide. A paciente foi submetida a tratamento cirúrgico, sendo diagnosticado pólipo fibroide inflamatório do íleo.

  6. Clinical implications of disturbances of uterine vascular morphology and function.

    Science.gov (United States)

    Hickey, M; Fraser, I S

    2000-12-01

    Menstrual disturbances are one of the most common problems presenting to the gynaecologist. In order for the endometrium to bleed, vessels must break down. Disruption in the regulation of endometrial vascular growth and function has been found in association with spontaneous and sex steroid-induced disturbances of menstrual bleeding. Although circulating oestrogens and progestogens influence the endometrial vessels, this effect appears to be indirect, and regulation is primarily via local factors. Deficient vasoconstriction and haemostasis with excessive fibrinolysis is seen in menorrhagia. Breakthrough bleeding in users of progestogen-only contraceptives is associated with increased superficial vascular fragility and disruptions in the supporting basement membrane. Blood vessels in uterine fibroids are abnormal in distribution and appearance. Adenomyosis is also commonly associated with menstrual disturbance, and alterations in vascular distribution suggest altered angiogenesis. Successful human embryo implantation requires endometrial vascular breakdown. Excessive thrombosis associated with the antiphospholipid syndrome may interfere with this re-modelling and compromise implantation. Arteriovenous malformations are a rare but important cause of excessive or irregular vaginal bleeding. Abundant vessels with abnormal morphology, associated with aberrant angiogenesis can be seen, and embolization of these vessels may be an effective conservative treatment. Improved understanding of the regulation of the uterine vasculature is likely to lead to targeted therapies to prevent unscheduled vascular breakdown and to control menstrual disturbance at an endometrial level.

  7. Uterine primitive neuroectodermal tumor.

    Science.gov (United States)

    Aminimoghaddam, Soheila; Seifirad, Soroush; Abbasi Dezfouli, Golbahar; Abbasi, Neda; Zare Mehrjardi, Ali; Razavi, Seyed Mohsen; Mahmoudzadeh, Fatemeh

    2015-04-01

    Primitive neuroectodermal tumors are fairly rare in uterus. A case of uterine body primitive neuroectodermal tumor in a 32-year-old Iranian woman is presented. The patient was admitted with abdominal pain and fever and underwent emergency exploratory surgery with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. Posterior wall of the uterus was necrotic and ruptured and a huge tumor disrupted the uterine body. The tumor was strongly positive for CD99, NSE, and chromogranin; No reaction was seen for CD10, CD45 and myogenin. To the best of our knowledge, this is the first report of an uterine body primitive neuroectodermal tumor and the second report of uterine primitive neuroectodermal tumor from Iran.

  8. Uterine Cancer Statistics

    Science.gov (United States)

    ... Research AMIGAS Fighting Cervical Cancer Worldwide Stay Informed Statistics for Other Kinds of Cancer Breast Cervical Colorectal ( ... Skin Vaginal and Vulvar Cancer Home Uterine Cancer Statistics Language: English Español (Spanish) Recommend on Facebook Tweet ...

  9. Abnormal Uterine Bleeding FAQ

    Science.gov (United States)

    ... FREQUENTLY ASKED QUESTIONS FAQ095 GYNECOLOGIC PROBLEMS Abnormal Uterine Bleeding • What is a normal menstrual cycle? • When is bleeding abnormal? • At what ages is abnormal bleeding more ...

  10. Spontaneous uterine rupture

    African Journals Online (AJOL)

    After ultrasound scan, uterine rupture was diagnosed and an ... delivery. The birth weights ranged between 2900 and 3200g. The last 2 .... abdominal pains and signs of shock, at which made up of altered blood and we think that the.

  11. Dysfunctional Uterine Bleeding

    OpenAIRE

    1987-01-01

    Dysfunctional uterine bleeding (DUB) is defined as abnormal uterine bleeding that results from an ovarian endocrinopathy. It may be associated with ovulatory and anovulatory cycles. The diagnosis of DUB depends on a thorough history and physical examination to exclude organic disorders. In older women, endometrial biopsy should be done before starting therapy. The treatment depends on an understanding of the menstrual cycle. In less urgent cases, anovulatory cycles are managed using progester...

  12. DNA level and stereologic estimates of nuclear volume in squamous cell carcinomas of the uterine cervix. A comparative study with analysis of prognostic impact

    DEFF Research Database (Denmark)

    Sørensen, Flemming Brandt; Bichel, P; Jakobsen, A

    1992-01-01

    Grading of malignancy in squamous cell carcinomas of the uterine cervix is based on qualitative, morphologic examination and suffers from poor reproducibility. Using modern stereology, unbiased estimates of the three-dimensional, volume-weighted mean nuclear volume (nuclear vv), were obtained...... in pretreatment biopsies from 51 patients treated for cervical cancer in clinical Stages I through III (mean age of 56 years, follow-up period greater than 5 years). In addition, conventional, two-dimensional morphometric estimates of nuclear and mitotic features were obtained. DNA indices (DI) were estimated...

  13. PSEUDO CENTRAL CERVICAL FIBROID IN A NULLIPAROUS GIRL: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Priyankur

    2014-08-01

    Full Text Available Fibroids are benign (non-cancerous growths on the uterus. There is an overall incidence of 20% in women more than 30yrs of age. The incidence of cervical fibroids is much lower at 1-2%. An unmarried girl presented with complaints of difficulty in passing urine, lower abdominal pain and spasmodic dysmenorrhea for 4 months. Per abdomen there was a firm, non-tender midline mass arising from the pelvis corresponding to 20 weeks size gravid uterus with restricted mobility. Cervix could not be felt. Ultrasonographic examination showed 10.2x10.7 cm fibroid in the posterior wall with no adnexal pathology and bilateral mild hydronephrosis. On laparotomy, the uterus was found to be sitting like a lantern on the dome of St. Paul's Cathedral. A 25x18 cm pseudo central cervical fibroid, partly intramural, partly sub mucous was seen to arise from the posterior cervico isthmic region. Myomectomy was performed successfully. Central cervical fibroid expands the cervix equally in all directions and the uterus is elevated on top of the large tumor. Diagnosis is by ultrasonogram and HSG. Management in cervical fibroid of supravaginal portion is hysterectomy if fertility is not desired and myomectomy if the patient is young and fertility is desired, as in our case.

  14. Hysteropexy in the treatment of uterine prolapse stage 2 or higher: a multicenter randomized controlled non-inferiority trial comparing laparoscopic sacrohysteropexy with vaginal sacrospinous hysteropexy (LAVA-trial, study protocol).

    Science.gov (United States)

    van IJsselmuiden, Mèlanie N; Coolen, Anne-Lotte W M; Detollenaere, Renée J; den Boon, Jan; Bongers, Marlies; van de Pol, Geerte; Vollebregt, Astrid; Radder, Celine M; Deprest, Jan; van Eijndhoven, Hugo W F

    2014-09-17

    Pelvic organ prolapse is a common health problem: the lifetime risk of undergoing surgery for pelvic organ prolapse by the age of 85 years is 19%. Pelvic organ prolapse has significant negative effects on a woman's quality of life. Worldwide, vaginal hysterectomy is the leading treatment method for patients with symptomatic uterovaginal prolapse. Several studies have shown that vaginal sacrospinous hysteropexy and laparoscopic sacrohysteropexy are safe and effective alternatives in treating uterine descent. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Therefore, we conducted the LAVA trial. The LAVA trial is a randomized controlled multicenter non-inferiority trial. The study compares laparoscopic sacrohysteropexy with vaginal sacrospinous hysteropexy in women with uterine prolapse stage 2 or higher. The primary outcome of this study is surgical success of the apical compartment at 1 and 5 years follow-up. Secondary outcomes are subjective improvement on urogenital symptoms and quality of life (assessed by disease-specific and general quality of life questionnaires), complications following surgery, hospital stay, post-operative recovery, sexual functioning and costs-effectiveness. Evaluation will take place pre-operatively, and 6 weeks, 6 months, 12 months and annually till 60 months after surgery. Validated questionnaires will be used.Analysis will be performed according to the intention to treat principle. Based on comparable recurrence rates of 3% and a non-inferiority margin of 10%, 62 patients are needed in each arm to prove the hypothesis with a 95% confidence interval. The LAVA trial is a randomized controlled multicenter non-inferiority trial that will provide evidence whether the efficacy of laparoscopic sacrohysteropexy is non-inferior to vaginal sacrospinous hysteropexy in women with symptomatic uterine prolapse stage 2 or higher. Netherlands Trial Register (NTR): NTR4029.

  15. INFLAMMATORY FIBROID POLYPS OF GASTRO-INTESTINAL TRACT

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To review the diagnosis and differential diagnosis of inflammatory fibroid polyp (IFP) of gastrointestinal tract. Methods: The clinical symptoms, histopathologic features and immunohistochemical (ABC method) staining in 9 cases were observed. Results: IFP presented either as a solitary pedunculated or sessile lesion arising from the submucosa and protroding into the lumen; composed of a background of fibroblasts and blood vessels infiltrated by a variable number of inflammatory cells, often numerous eosinophilias leukocytes. Immunohistochemical staining: the spindle cells of all cases reacted with Vimentin. The partial cells of several cases react with Actin, NSE, a -AT. 7 cases were follow-up. No patients had a recurrence of the lesion. Conclusion: IFP are rare lesions, and may represent an exaggerated response to inflammatory or other injury process. The prognosis is good when treated by segmental resections of endoscopic removals.

  16. Inflammatory Fibroid Polyp Causing Colocolic Intussusception in an Infant

    Directory of Open Access Journals (Sweden)

    Mark Walton

    1994-01-01

    Full Text Available A three-month-old infant presented to the emergency department with a 24 h history of irritability and lesion prolapsing intermittently per anus. The child had a six-week history of blood and mucus per rectum. Digital rectal examination and sigmoidoscopy revealed what appeared to be a large mobile polypoid lesion arising from the rectum. Plans for excision were made. Sigmoidoscopy performed the following morning failed to demonstrate any lesion in the rectum or sigmoid. Barium enema demonstrated a sessile ‘apple core type’ lesion in the descending colon. Segmental resection of the descending colon with end-to-end anastomosis was performed. Pathological examination of the resected bowel demonstrated features consistent with an inflammatory fibroid polyp. This case appears to be unique because of the young age of the patient, its unusual location and its presentation as an intermittent colocolic intussusception.

  17. Tratamento do abortamento incompleto por aspiração manual ou curetagem Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion

    Directory of Open Access Journals (Sweden)

    Pedro Paulo Pereira

    2006-10-01

    Full Text Available OBJETIVOS: Comparar aspiração manual intra-uterina (AMIU com curetagem uterina (D&C em abortamentos no primeiro trimestre no que se refere a eficiência para eliminar restos ovulares do método de aspiração manual intra-uterina com a dilatação e curetagem, ocorrência de complicações (perfuração uterina, laceração cervical, hemorragia pós-tratamento, tempo duração dos procedimentos e tempo de internação das pacientes. MÉTODOS: Cinqüenta pacientes no grupo AMIU e 50 pacientes no grupo D&C foram incluídas prospectivamente de maneira aleatória. Critérios de inclusão: abortamento espontâneo, idade gestacional de até 13 semanas, colo pérvio, espessura endometrial maior que 15 mm, estado afebril, hemoglobina superior a 10 g/dl. Amostras sangüíneas foram colhidas antes e após os procedimentos cirúrgicos para controle dos níveis de hemoglobina; anestesia foi realizada em todos os casos. O tempo para realização de cada procedimento cirúrgico foi cronometrado. RESULTADOS: Os grupos eram semelhantes quanto à idade gestacional (9,93±2,40; 9,73±2,58, p 0,71, espessura endometrial antes da cirurgia (22,14±4,80; 22,68±5,68, p 0,65. Não foram observadas complicações cirúrgicas ou anestésicas em nenhum grupo. Os tempos de realização do procedimento e internação foram significativamente menores nas pacientes do grupo AMIU (3,71; 10,18 min, p OBJECTIVES: To compare manual vacuum aspiration (MVA and uterine curettage (D&C for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before

  18. Dysfunctional Uterine Bleeding (DUB) (For Teens)

    Science.gov (United States)

    ... the Right Sport for You Shyness Abnormal Uterine Bleeding (AUB) KidsHealth > For Teens > Abnormal Uterine Bleeding (AUB) ... español Hemorragia uterina disfuncional What Is Abnormal Uterine Bleeding? Abnormal uterine bleeding (AUB) is the name doctors ...

  19. Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?

    DEFF Research Database (Denmark)

    Andersen, Malene M; Thisted, Dorthe L A; Amer-Wåhlin, Isis;

    2016-01-01

    OBJECTIVE: To compare cardiotocographic abnormalities recorded during labour in women with prior caesarean delivery (CD) and complete uterine rupture with those recorded in controls with prior CD without uterine rupture. STUDY DESIGN: Women with complete uterine rupture during labour between 1997...

  20. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    There are many causes of abnormal vaginal bleeding. HORMONES Most often, abnormal uterine bleeding is caused by a hormone imbalance. When hormones are the cause, doctors call the problem dysfunctional uterine bleeding (DUB) . DUB is more ...

  1. Uterine mesenchymal tumors

    Directory of Open Access Journals (Sweden)

    Nikhil A Sangle

    2011-01-01

    Full Text Available Uterine mesenchymal tumors are a heterogeneous group of neoplasms that can frequently be diagnostically challenging. Differentiation between the benign and malignant counterparts of mesenchymal tumors is significant due to differences in clinical outcome, and the role of the surgical pathologist in making this distinction (especially in the difficult cases cannot be underestimated. Although immunohistochemical stains are supportive toward establishing a final diagnosis, the morphologic features trump all the other ancillary techniques for this group of neoplasms. This review therefore emphasizes the key morphologic features required to diagnose and distinguish uterine mesenchymal tumors from their mimics, with a brief description of the relevant immunohistochemical features.

  2. Development and Characterization of Uterine Glandular Epithelium Specific Androgen Receptor Knockout Mouse Model.

    Science.gov (United States)

    Choi, Jaesung Peter; Zheng, Yu; Skulte, Katherine A; Handelsman, David J; Simanainen, Ulla

    2015-11-01

    While estrogen action is the major driver of uterine development, androgens acting via the androgen receptor (AR) may also promote uterine growth as suggested by uterine phenotypes in global AR knockout (ARKO) female mice. Because AR is expressed in uterine endometrial glands, we generated (Cre/loxP) uterine gland epithelium-specific ARKO (ugeARKO) to determine the role of endometrial gland-specific androgen actions. However, AR in uterine gland epithelium may not be required for normal uterine development and function because ugeARKO females had normal uterine development and fertility. To determine if exogenous androgens acting via AR can fully support uterine growth in the absence of estrogens, the ARKO and ugeARKO females were ovariectomized and treated with supraphysiological doses of testosterone or dihydrotestosterone (nonaromatizable androgen). Both dihydrotestosterone and testosterone supported full uterine regrowth in wild-type females while ARKO females had no regrowth (comparable to ovariectomized only). These findings suggest that androgens acting via AR can promote full uterine regrowth in the absence of estrogens. The ugeARKO had 50% regrowth when compared to intact uterine glands, and histomorphologically, both the endometrial and myometrial areas were significantly (P glandular epithelial AR located in the endometrium may indirectly modify myometrial development. Additionally, to confirm Cre function in endometrial glands, we generated uge-specific PTEN knockout mouse model. The ugePTEN knockout females developed severe endometrial hyperplasia and therefore present a novel model for future research.

  3. Uterine geometry and IUD-induced pain.

    Science.gov (United States)

    Toppozada, M; Ismail, A A; Bakry, M A

    1986-06-01

    Sixty women using IUDs were included in two equal groups in the present study. Group I consisted of women presenting with pelvic pain for which they requested removal of the IUD, while the comparison group (group II) requested removal of the IUD for non-medical reasons. After extraction of the IUD, the Wing Sound II device was used to measure uterine cavity length and fundal transverse diameter. The uterine cavity measurements in both groups were not significantly different. When the ratios of IUD dimensions to uterine cavity measurements were compared, it was also found that there were no significant differences between groups. Factors other than discrepancies in size probably contribute to the pathogenesis of IUD-induced pain.

  4. Analysis on value of sonohysterography in diagnosis of uterine cavity diseases%宫腔声学造影技术对宫腔疾病的诊断价值分析

    Institute of Scientific and Technical Information of China (English)

    宋朝芳; 金淑君; 陈体平; 陈蓉; 徐应臣

    2016-01-01

    目的:探讨经阴道超声宫腔声学造影(SHG)对宫腔疾病的诊断价值。方法对2015年8~12月该院收治的68例有异常阴道出血或不孕症患者行经阴道超声检查(TVS)和SHG检查,并以宫腔镜手术(HSC)/病理检查作为诊断“金标准”,然后对检查结果进行比较分析。结果宫腔镜手术-病理检查诊断子宫内膜息肉39例,黏膜下子宫肌瘤21例,子宫内膜增生症5例,宫腔粘连2例,子宫内膜癌1例;TVS诊断子宫内膜息肉22例,黏膜下子宫肌瘤11例,子宫内膜增生症2例,宫腔粘连1例;SHG诊断子宫内膜息肉38例,黏膜下子宫肌瘤20例,子宫内膜增生症4例,宫腔粘连2例。TVS对宫腔疾病的诊断符合率为52.94%(36/68);SHG对宫腔疾病的诊断符合率为94.12%(64/68),二者比较,差异有统计学意义(P<0.05)。结论 SHG检查能明显提高宫腔病变的显示率,是诊断宫腔疾病的有效方法,对宫腔疾病临床治疗方式的选择具有重要指导意义,值得临床推广应用。%Objective To investigate the diagnostic value of transvaginal sonohysterography (SHG) in uterine cavity diseases . Methods Sixty-eight patients with abnormal vaginal bleeding or infertility underwent transvaginal sonography (TVS) and SHG examinations with hysteroscopy surgery(HSC)/pathological examination as the diagnostic gold standard. Then the detection results were compared and analyzed. Results HSC and pathological biopsy diagnosed 39 cases of endometrial polyps ,21 cases of sub-mucosal uterine fibroids,5 cases of endometrial hyperplasia,2 cases of uterine cavity adhesion and 1 case of endometrial cancer;TVS diagnosed endometrial polyps in 22 cases,submucosal myoma of uterus in 11 cases,endometrial hyperplasia in 2 cases and uterine cavity adhesion in 1 case;SHG diagnosed endometrial polyps in 38 cases,submucosal myoma of uterus in 20 cases, endometrial hyperplasia in 4 cases and uterine cavity

  5. Potential therapeutic effect of the secretome from human uterine cervical stem cells against both cancer and stromal cells compared with adipose tissue stem cells.

    Science.gov (United States)

    Eiró, Noemí; Sendon-Lago, Juan; Seoane, Samuel; Bermúdez, María A; Lamelas, Maria Luz; Garcia-Caballero, Tomás; Schneider, José; Perez-Fernandez, Roman; Vizoso, Francisco J

    2014-11-15

    Evidences indicate that tumor development and progression towards a malignant phenotype depend not only on cancer cells themselves, but are also deeply influenced by tumor stroma reactivity. The present study uses mesenchymal stem cells from normal human uterine cervix (hUCESCs), isolated by the minimally invasive method of routine Pap cervical smear, to study their effect on the three main cell types in a tumor: cancer cells, fibroblasts and macrophages. Administration of hUCESCs-conditioned medium (CM) to a highly invasive breast cancer MDA-MB-231 cell line and to human breast tumors with high cell proliferation rates had the effect of reducing cell proliferation, modifying the cell cycle, inducing apoptosis, and decreasing invasion. In a xenograft mouse tumor model, hUCESCs-CM reduced tumor growth and increased overall survival. In cancer-associated fibroblasts, administration of hUCESCs-CM resulted in reduced cell proliferation, greater apoptosis and decreased invasion. In addition, hUCESCs-CM inhibited and reverted macrophage differentiation. The analysis of hUCESCs-CM (fresh and lyophilized) suggests that a complex paracrine signaling network could be implicated in the anti-tumor potential of hUCESCs. In light of their anti-tumor potential, the easy cell isolation method, and the fact that lyophilization of their CM conserves original properties make hUCESCs good candidates for experimental or clinical applications in anticancer therapy.

  6. Influence of mirena treatment on uterine blood flow dynamics and serum related indexes of patients with uterine adenomyosis

    Institute of Scientific and Technical Information of China (English)

    Qing-Yun Wang; Hua Zhang; Zhen-Zhen Liu

    2016-01-01

    Objective:To study the influence of mirena treatment on uterine blood flow dynamics and serum related indexes of patients with uterine adenomyosis.Methods:A total of 58 patients with uterine adenomyosis who were treated in our hospital during the time from June 2014 to July 2015 were randomly divided into two groups, 29 patients in the control group were treated with danazol, and 29 patients in the observation group were treated with mirena. Then the total effective rate, adverse reaction rates, uterine blood flow dynamics indexes, serum MMP related indexes and other disease related indexes of the two groups before the treatment and at first, third and sixth month after the treatment were compared.Results:The total effective rate and adverse reaction rate of observation group were both worse than that of control group (allP0.05). While the uterine blood flow dynamics indexes of the observation group at different time after the treatment were all significantly better than those of control group (allP<0.05).Conclusions:Mirena treatment can effectively improve the uterine blood flow dynamics and serum related indexes of patients with uterine adenomyosis, and it has application value for the patients with uterine adenomyosis is higher.

  7. Evaluation of clinico-pathological features and Helicobacter pylori infection in gastric inflammatory fibroid polyps.

    Science.gov (United States)

    Albuquerque, Andreia; Rios, Elisabete; Carneiro, Fátima; Macedo, Guilherme

    2014-12-01

    Inflammatory fibroid polyps are rare mesenchymal lesions. The frequency of Helicobacter pylori infection in the gastric mucosa overlying inflammatory fibroid polyps and its relation with the histologic features of the polyps are undetermined. The clinico-pathological features of inflammatory fibroid polyps, the frequency of Helicobacter pylori infection in the overlying gastric mucosa, and its putative impact on the phenotype of the polyps were evaluated. Gastric inflammatory fibroid polyps diagnosed in our Hospital from 1998 to 2012 were reviewed and the histological. The histological sections were stained with hematoxylin and eosin and modified Giemsa for the evaluation of Helicobacter pylori infection. Inconclusive cases were further analyzed by immunohistochemistry with anti-Helicobacter pylori antibody. Diagnosis was confirmed in 54 polyps, 85 % developed in females, mean age 63 ± 11 years. Most polyps were sessile (74 %), with a mean size of 15 ± 12 mm, 96 % were located in the antrum and 85 % were removed by snare polypectomy. Helicobacter pylori infection was identified in 48 % of the polyps. Most inflammatory fibroid polyps developed in the submucosa, and mucosal extension was observed in 96 % of the cases. Chronic gastritis was observed in all cases (63 % with activity, 31 % with intestinal metaplasia, and 61 % with foveolar hyperplasia). Erosion and ulceration of the overlying gastric mucosa was observed in 48 % and 11 % of the polyps, respectively. Onion skin features were present in 52 % of the polyps and were more frequently observed in cases without evidence of Helicobacter pylori infection. Background changes in gastric mucosa were not distinctive according to Helicobacter pylori infection. Chronic atrophic gastritis with intestinal metaplasia was associated with the presence of perivascular onion skin lesions. To our knowledge, this is the second largest series of gastric inflammatory fibroid polyps. Helicobacter pylori infection was

  8. 核磁共振成像技术在子宫肿瘤诊断上的成像特征分析%Imaging feature analysis of magnetic resonance imaging in the diagnosis of uterine tumor

    Institute of Scientific and Technical Information of China (English)

    陈巧军; 朱大荣; 杨进

    2015-01-01

      查,S E 序列,横断面T1、T2加权及矢状面、冠状面T2加权成像,并对图像进行分析。结果:子宫肌瘤患者检出42个病灶,分别为圆形、类圆形、椭圆形、不规则分叶状,子宫呈现均有不同程度增大,宫腔变形。T1 WI上大多数病灶呈中低信号,T2 WI 上瘤体信号低或混杂信号。结论:MRI 对子宫肌瘤在观察大小、形态、位置与子宫腔的关系和肌瘤在定性方面上有较高的诊断价值,临床上值得推广应用。%Objectives:To research the imaging feature analysis of magnetic resonance imaging in the diag-nosis of uterine tumor.Methods:26 patients were examined with uterine fibroids MRI,SE sequence,cross-sec-tional T1 ,T2 -weighted and sagittal,coronal T2 -weighted imaging and the image analysis was conducted. Results:42 lesions were detected from uterine fibroids patients,the shapes of which were round,oval,elliptical and irregular lobulated.The imaging of uterus indicated varying degrees of increased uterine deformation.Most le-sions on T1 WI showed low signal.T2WI’s signal on tumor showed low or mixed signals.Conclusion:MRI obser-vation of uterine fibroids in size,shape,position and relationships with fibroid uterine cavity has a high diagnostic value,which should be widely applied clinically.

  9. IDENTIFICATION OF DIFFERENTIAL PROTEINS IN UTERINE LEIOMYOMA BY TWO-DIMENSIONAL ELECTROPHORESIS

    Institute of Scientific and Technical Information of China (English)

    ZHU Xue-qiong; ZHU Chun-dan; L(U) Jie-qiang; DONG Ke

    2006-01-01

    Objective: To establish and optimize the two-demensional electrophoresis maps of uterine leiomyoma and to study the difference of global protein patterns between uterine leiomyoma and normal myometrium. Methods: Using Two-dimensional electrophoresis followed by computer-assisted image analysis, the differential proteins between uterine leiomyoma and normal myometrium were compared. Results: The well-resolved and reproducible two-dimensional gel electrophoresis patterns of uterine leiomyoma and normal myometrium were established. Totally 1085(108 and 1103(151 protein spots were obtained by using the pH 4-7 IPG strips in uterine leiomyoma and normal myometrium map, respectively, of which 7 spots increased and 15 spots decreased in quantity in uterine leiomyoma compared with normal myometrium. Conclusion: The differentially expressed proteins are useful for studying the mechanism of the cause of uterine leiomyoma.

  10. Inflammatory fibroid polyp occurring in the transverse colon diagnosed by endoscopic biopsy

    Institute of Scientific and Technical Information of China (English)

    Shoji Hirasaki; Minoru Matsubara; Fusao Ikeda; Hideaki Taniguchi; Seiyuu Suzuki

    2007-01-01

    A case of an inflammatory fibroid polyp occurring in the transverse colon and diagnosed by endoscopic biopsy is reported. The patient was an 82-year-old man who visited our hospital for further evaluation of occult blood in stool. The Colonoscopy revealed a small,red, and peduncular polyp, about 6 mm in diameter,in the transverse colon. Histological examination of the biopsy specimen obtained from the polyp revealed proliferation of fibroblasts and infiltration of inflammatory cells such as plasma cells and eosinophils. This polyp was diagnosed as an inflammatory fibroid polyp, which can appear in many different locations throughout gastrointestinal tract, though still rare in the transverse colon.

  11. Evaluation of abnormal uterine bleeding: role of diagnostic hysteroscopy and its correlation with histopathology

    Directory of Open Access Journals (Sweden)

    Rebecca Edwin

    2014-08-01

    Full Text Available Background: The objective was to assess the accuracy of diagnostic hysteroscopy in evaluation of abnormal uterine bleeding and to correlate hysteroscopic findings with histopathology reports. Methods: A prospective study was carried out at our institute from January 2010 to December 2013. Ninety cases were included in this study. Patients' age varied from 20 to 60. Those women with the history of abnormal uterine bleeding were admitted. In all cases diagnostic hysteroscopic examination and dilatation and curettage were carried out. Endometrium was sent for histopathology and correlation of hysteroscopic findings with histopathology reports was studied. Results: Various findings on hysteroscopy are as following: proliferative endometrium 36.66%, secretary endometrium 17.77% endometrial hyperplasia 24.44%, atrophic endometrium 5.55%, endometrial polyp 8.88%, submucous fibroid 4.44%, and endometrial carcinoma 2.22%. Conclusions: Hysteroscopy is an eye in uterus and it provides more accurate diagnosis than dilatation and curettage alone in patients with abnormal uterine bleeding. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 1082-1086

  12. ENDOVASCULAR HEMOSTASIS IN UTERINE BLEEDING IN PATIENTS WITH UTERINE LEIOMYOMA

    Directory of Open Access Journals (Sweden)

    M. M. Damirov

    2017-01-01

    Full Text Available We report results of treatment for 72 patients with uterine leiomyoma (LM of various sizes and location, who had arrived with excessive uterine bleeding. All patients underwent urgent or urgently-delayed endovascular hemostasis by performing uterine arteries embolization (UAE. We analyzed clinical features of the disease after UAE in various sizes of tumors and studied immediate and long-term results of UAE in patients with LM.

  13. Endometrial Expression of Homeobox Genes and Cell Adhesion Molecules in Infertile Women With Intramural Fibroids During Window of Implantation.

    Science.gov (United States)

    Makker, Annu; Goel, Madhu Mati; Nigam, Dipti; Bhatia, Vikram; Mahdi, Abbas Ali; Das, Vinita; Pandey, Amita

    2017-03-01

    This study was designed to examine the expression and cellular distribution of homeobox ( HOX) genes ( HOXA10 and HOXA11) and cell adhesion molecules (E-cadherin, N-cadherin, and β-catenin) during the window of implantation in infertile women with noncavity-distorting intramural (IM) fibroids (n = 18) and in fertile controls (n = 12). Quantitative real-time polymerase chain reaction and immunohistochemistry were used to evaluate the messenger RNA (mRNA) levels and protein expression, respectively. When compared to fertile controls, reduced HOXA10 and HOXA11 transcript and protein levels were observed in infertile women. However, changes only in the expression of HOXA10 mRNA (-1.72-fold; P = .03) and stromal protein ( P = .001) were statistically significant. Significantly lower E-cadherin mRNA (-10.97-fold; P = .02) and protein levels were seen in infertile patients. E-cadherin immunostaining was significantly reduced both in the luminal ( P = .048) and in the glandular ( P = .014) epithelium of endometrium from infertile patients when compared to controls. No significant change was observed either in the mRNA levels or in the immunoexpression of N-cadherin and β-catenin. However, a trend toward lower N-cadherin expression in the luminal epithelium ( P = .054) and decreased β-catenin expression in the glandular epithelium ( P = .070) was observed in infertile patients. The present findings suggest that altered endometrial HOXA10 and E-cadherin mRNA and protein expression observed in infertile women with IM fibroids during the mid-secretory phase might impair endometrial receptivity leading to infertility in these patients.

  14. Uterine peristalsis evaluated in menorrhagia ifbroid patients by cine magnetic resonance imaging%MRI电影对月经过多子宫肌瘤患者子宫蠕动的研究

    Institute of Scientific and Technical Information of China (English)

    屈亚林; 吕富荣; 肖智博; 吕发金; 谢惠; 李佳; 赵飞飞

    2016-01-01

    AbstractObjective:To evaluate uterine peristalsis in menorrhagia ifbroid patients by cine magnetic resonance imaging and to investigate the possible inlfuence of leiomyoma locations on uterine peristalsis.Materials and Methods:Thirty menorrhagia ifbroid patients and 30 healthy volunteers participated in this study. MR imaging of uterus in axis T1, axis T2-stir and sagittal T2 and cine MRI were prospectively performed with a 1.5 T scanner during the peri-ovulatory phase. The presence and frequency of normal peristalsis were compared between healthy volunteers and ifbroid patients. The relationships between the locations of fibroids and the types of peristalsis were also analyzed.Results: The presence and frequency of normal peristalsis were signiifcantly decreased in menorrhagia ifbroid patients compared to healthy volunteers (P< 0.01). Menorrhagia ifbroid patients showed a variety of types of peristalsis and patients with submucosal showed no peristalsis.Conclusion: In menorrhagia ifbroid patients, the presence of normal peristalsis is significantly decreased, which is not conducive to the rapid transport of sperm to the fallopian tubes. Cine MRI can facilitate evaluation of uterine peristalsis in menorrhagia fibroid patients and provide useful functional information of uterine peristalsis for clinic.%目的:应用MR电影成像技术(cine MRI)探讨月经过多子宫肌瘤患者排卵期子宫蠕动情况及肌瘤位置对子宫蠕动的影响。材料与方法采用1.5 T MRI仪对30名健康志愿者及30例月经过多子宫肌瘤患者于排卵期行盆腔T1轴面、T2-抑脂轴面、T2矢状面及子宫cine MR扫描。比较健康志愿者与月经过多肌瘤患者子宫正常蠕动存在率及蠕动频率,分析肌瘤位置与蠕动形式的关系。结果月经过多子宫肌瘤患者排卵期子宫正常蠕动存在率及蠕动频率较健康志愿者显著降低,两者均有统计学意义(P值均<0.01),黏膜下肌瘤患者主要表现为无蠕

  15. Uterine transplantation: a systematic review

    Science.gov (United States)

    Ejzenberg, Dani; Mendes, Luana Regina Baratelli Carelli; de Paiva Haddad, Luciana Bertocco; Baracat, Edmund Chada; D’Albuquerque, Luiz Augusto Carneiro; Andraus, Wellington

    2016-01-01

    Up to 15% of the reproductive population is infertile, and 3 to 5% of these cases are caused by uterine dysfunction. This abnormality generally leads women to consider surrogacy or adoption. Uterine transplantation, although still experimental, may be an option in these cases. This systematic review will outline the recommendations, surgical aspects, immunosuppressive drugs and reproductive aspects related to experimental uterine transplantation in women. PMID:27982170

  16. Uterine transplantation: a systematic review

    Directory of Open Access Journals (Sweden)

    Dani Ejzenberg

    Full Text Available Up to 15% of the reproductive population is infertile, and 3 to 5% of these cases are caused by uterine dysfunction. This abnormality generally leads women to consider surrogacy or adoption. Uterine transplantation, although still experimental, may be an option in these cases. This systematic review will outline the recommendations, surgical aspects, immunosuppressive drugs and reproductive aspects related to experimental uterine transplantation in women.

  17. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse.

    Science.gov (United States)

    Korbly, Nicole B; Kassis, Nadine C; Good, Meadow M; Richardson, Monica L; Book, Nicole M; Yip, Sallis; Saguan, Docile; Gross, Carey; Evans, Janelle; Lopes, Vrishali V; Harvie, Heidi S; Sung, Vivian W

    2013-11-01

    The purpose of this study was to describe patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse symptoms and to describe predictors of preference for uterine preservation. This multicenter, cross-sectional study evaluated patient preferences for uterine preservation vs hysterectomy in women with prolapse symptoms who were being examined for initial urogynecologic evaluation. Before meeting the physician, the women completed a questionnaire that asked them to indicate their prolapse treatment preference (uterine preservation vs hysterectomy) for scenarios in which the efficacy of treatment varied. Patient characteristics that were associated with preferences were determined, and predictors for uterine preservation preference were identified with multivariable logistic regression. Two hundred thirteen women participated. Assuming outcomes were equal between hysterectomy and uterine preservation, 36% of the women preferred uterine preservation; 20% of the women preferred hysterectomy, and 44% of the women had no strong preference. If uterine preservation was superior, 46% of the women preferred uterine preservation, and 11% of the women preferred hysterectomy. If hysterectomy was superior, 21% of the women still preferred uterine preservation, despite inferior efficacy. On multivariable logistic regression, women in the South had decreased odds of preferring uterine preservation compared with women in the Northeast (odds ratio [OR], 0.17; 95% CI, 0.05-0.66). Women with at least some college education (OR, 2.87; 95% CI, 1.08-7.62) and those who believed that the uterus is important for their sense of self (OR, 28.2; 95% CI, 5.00-158.7) had increased odds for preferring uterine preservation. A higher proportion of women with prolapse symptoms who were examined for urogynecologic evaluation preferred uterine preservation, compared with hysterectomy. Geographic region, education level, and belief that the uterus is important for

  18. [Study of effective components and molecular mechanism for Guizhi Fuling formula treatment of dysmenorrhea, pelvic inflammatory disease and uterine fibroids].

    Science.gov (United States)

    Ke, Zhi-peng; Zhang, Xin-zhuang; Ding, Yue; Cao, Ze-yu; Li, Na; Cao, Liang; Wang, Tuan-jie; Zhang, Chen-feng; Ding, Gang; Wang, Zhen-zhong; Xiao, Wei; Xu, Xiao-jie

    2015-03-01

    In this study, the active components and potential molecular .mechanism of Guizhi Fuling formula in treatment on dysmenorrhea, pelvic inflammation, and hysteromyoma were investigated using network pharmacological methods. Sterols and pentacyclic triterpenes, with high moleculal network degree, revealed promising effects on anti-inflammatory, analgesic, anti-tumor, and immune-regulation, according to D-T network analysis. On the other hand, the targets with high degree were involved in inflammatory, coagulation, angiopoiesis, smooth muscle contraction, and cell reproduction, which showed the novel function in anti-dysmenorrhea, pelvic inflammation, and hysteromyoma. Furthermore, the formula was indicated to play a key role in smooth muscle proliferation, inhibition of new vessels, circulation improvement, reduction of hormone secretion, alleviation of smooth muscle, block of arachidonic acid metabolism, and inflammation in uterus. Thus, the main mechanism of Guizhi Fuling formula was summarized. In conclusion, Guizhi Fuling formula was proven to alleviated dysmenorrhea, pelvic inflammation, and hysteromyoma by acting on multiple targets through several bioactive compounds, regulating 21 biological pathways.

  19. Lajjalu treatment of uterine prolapse

    Science.gov (United States)

    Shivanandaiah, T. M.; Indudhar, T. M.

    2010-01-01

    Mimosa pudica was found useful in cases of uterine prolapse with bleeding, consistent with my experience of working with the condition for more than 45 years, and treating hundreds of such cases of uterine prolapse. Hysterectomy has been avoided up to this date, and is not now expected to be recommended. PMID:21836800

  20. Lajjalu treatment of uterine prolapse

    Directory of Open Access Journals (Sweden)

    T M Shivanandaiah

    2010-01-01

    Full Text Available Mimosa pudica was found useful in cases of uterine prolapse with bleeding, consistent with my experience of working with the condition for more than 45 years, and treating hundreds of such cases of uterine prolapse. Hysterectomy has been avoided up to this date, and is not now expected to be recommended.

  1. Transvaginal color Doppler imaging of uterine contractions in early pregnancies: Significance of uterine contractions in early pregnancy failure

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Ju; Han, Chang Jin; Suh, Jung Ho; Kwon, Hyuck Chan [Aju University SChool of Medicine, Suwon (Korea, Republic of)

    1999-06-15

    To assess uterine contractions in early pregnancies using transvaginal color Doppler sonography (TVCDS) and to determine the role of uterine contractions in the diagnosis of early pregnancy failure. 76 patients with abnormal pregnancy diagnosed by sonography or histopathology up to 10 weeks of gestation and 38 normal pregnant women as the control group were examines with TVCDS. The presence of uterine contractions was determined by complete or partial disappearance of the color flow signals of vessels within myometrium, and the direction, amplitude (grade 1-3), and interval of uterine contractions were also evaluated. Uterine contractions were identified in 42 (55.3%) of 76 patients with abnormal pregnancy, whereas they were detected only in 2 (5.3%) of 38 normal pregnant women who had initial grade 1 contraction but disappeared in the follow-up study. In 26 patients with blighted ovum or missed abortion, 15 patients (57.7%),showed uterine contraction of grade 1 in 3 cases, grade 2 in 8 cases, and grade 3 in 4 cases and interval from 45 seconds to 5 minutes. In 30 patients with inevitable or incomplete abortion, 23 patients (76.6%) showed uterine contraction of grade 1 in 2 cases, grade 2 in 9 cases, and grade 3 in 12 cases and interval from 1 to 5 minutes. 4 (20%) of 20 patients with threatened abortion had uterine contraction of grade 2 and interval from 2 to 4 minutes. The presence of uterine contractions was significantly different in abnormal pregnancies compared with that of normal and also among the tree different groups of abnormal pregnancies, but the amplitude did not differ.

  2. Ultrasound -- Pelvis

    Medline Plus

    Full Text Available ... ovarian cysts and uterine fibroids ovarian or uterine cancers A transvaginal ultrasound is usually performed to view ... detect: uterine anomalies uterine scars endometrial polyps fibroids cancer, especially in patients with abnormal uterine bleeding Some ...

  3. Ultrasound -- Pelvis

    Medline Plus

    Full Text Available ... ovarian cysts and uterine fibroids ovarian or uterine cancers A transvaginal ultrasound is usually performed to view ... detect: uterine anomalies uterine scars endometrial polyps fibroids cancer, especially in patients with abnormal uterine bleeding Some ...

  4. The Impact of Sacrospinous Hysteropexy and Vaginal Hysterectomy With Suspension of the Uterosacral Ligaments on Sexual Function in Women With Uterine Prolapse: A Secondary Analysis of a Randomized Comparative Study.

    Science.gov (United States)

    Detollenaere, Renée J; Kreuwel, Ilse A M; Dijkstra, Jeroen R; Kluivers, Kirsten B; van Eijndhoven, Hugo W F

    2016-02-01

    Studies on pelvic organ prolapse (POP) surgery show conflicting evidence regarding the impact of uterus preservation and hysterectomy on sexual function and no large randomized trials with long-term follow-up have been published on this topic. The aim of this secondary analysis was to evaluate and compare sexual function after sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse. This is a secondary analysis of the SAVE U trial data, a multicenter trial in 4 nonuniversity hospitals in the Netherlands comparing sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in primary surgery of uterine prolapse stage II or higher. Primary outcome of the original study was recurrent prolapse stage II or higher of the uterus or vaginal vault (apical compartment) evaluated by POP-Q examination in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse at 12 months follow-up. Secondary outcomes were overall anatomical recurrences, functional outcome, complications, hospital stay, postoperative recovery, and sexual functioning. Data from patients who had completed the POP/urinary incontinence sexual questionnaire (PISQ-12) at baseline and 24 months after surgery were used in the present trial. Total, subscale, and individual question analyses were performed. The SAVE U trial is registered in the Dutch trial registry, number NTR1866. Differences and changes in sexual function 24 months after surgery, measured by the PISQ-12 questionnaire. Between November 2009 and March 2012, 208 women were randomized between sacrospinous hysteropexy (n = 103) and vaginal hysterectomy with suspension of the uterosacral ligaments (n = 105). Of these, 99 women completed questionnaires at baseline and after 24 months follow-up and were included in the present study. During a follow-up period of 24 months, no significant differences in total PISQ-12

  5. Role of MRI in detecting involvement of the uterine internal os in uterine cervical cancer: Systematic review of diagnostic test accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Boer, Peter de, E-mail: p.deboer@amc.uva.nl [Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam (UvA), Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Adam, Judit A. [Department of Radiology, AMC, UvA (Netherlands); Department of Nuclear Medicine, AMC, UvA (Netherlands); Buist, Marrije R. [Department of Gynaecology and Obstetrics, AMC, UvA (Netherlands); Vijver, Marc J. van de [Department of Pathology, AMC, UvA (Netherlands); Rasch, Coen R. [Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam (UvA), Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Stoker, Jaap; Bipat, Shandra [Department of Radiology, AMC, UvA (Netherlands); Stalpers, Lukas J.A. [Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam (UvA), Meibergdreef 9, 1105 AZ Amsterdam (Netherlands)

    2013-09-15

    Purpose: In patients with uterine cervical cancer, pretreatment recognition of uterine extension is crucial in treatment decision-making for fertility-sparing surgery and for target delineation in radiotherapy. Although MRI is generally considered the most reliable method, its value for detecting involvement of the uterine internal os is unclear. Methods: Medline, Embase and Cochrane databases were systematically searched (January 1997–December 2012) for MRI studies that measured the accuracy of involvement of the uterine internal os compared to histopathology as reference standard in patients with uterine cervical cancer. Data were assessed using the QUADAS tool. Accuracy concerned either involvement (yes/no) of the uterine internal os, or measuring invasion distance toward the uterine corpus. Results: Two retrospective and two prospective studies described 366 patients diagnosed with uterine cervical cancer FIGO stage IIB or below, in whom 64 (17%) had uterine internal os involvement. For three studies the summary estimates of specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and accuracy were 91%, 97%, 99%, 79% and 95%, respectively; one study had an area under the curve (AUC) of 0.8. Conclusion: MRI has a high level of accuracy; however, data are limited and for validation a large prospective study is needed that compares actual measurements on MRI with histopathological examination.

  6. 经子宫动脉栓塞治疗子宫肌瘤的护理%Care of uterine fibroids after treatment of uterine artery embolization

    Institute of Scientific and Technical Information of China (English)

    魏虹; 张艳华; 汤铭

    2011-01-01

    @@ 子宫肌瘤又称子宫平滑肌瘤,是女性生殖器官中最常见的肿瘤[1],也是妇科子宫非急性出血的常见原因,育龄期妇女发病率为20%~25%,癌变率为0.4%~1%.子宫切除、肌瘤摘除术、肌瘤溶解、冷冻及激素治疗等传统的治疗方法均存在一定缺陷.1997年法国Ravina[2]及美国Goodwin[3]相继报道了子宫肌瘤的介入治疗.因操作简便、微创、可保留子宫及其生理功能、费用低及住院时间短,易于被患者接受等优势,子宫肌瘤的介入治疗已广泛应用于临床,同时对相应的护理水平提出了更高的要求.我院于1998~2009年经子宫动脉栓塞治疗子宫肌瘤1 000例,疗效满意,现将护理体会介绍如下.

  7. Expression and significance of transforming growth factor β-activated kinase 1 in uterine myoma tissue

    Institute of Scientific and Technical Information of China (English)

    Xiao-Ping Chen; Li Zhao

    2016-01-01

    Objective:To compare the expression of TAK1 in normal myometrium and uterine leiomyoma tissue, and explore the relationship between these molecules and pathogenesis of uterine leiomyoma. Methods:Formaldehyde-fixed, paraffin-embedded specimen from 76 patients with uterine leiomyoma and normal myometrium adjacent were obtained from our hospital. The expression of TAK1 was detected by immunohistochemical staining and PCR analysis. Results:The expression of protein and mRNA levels TAK1 in uterine leiomyoma tissues were significantly increased when compared with normal myometrium, but not related to the number of leiomyoma. Furthermore, TAK1 expression was associated with the size of uterine leiomyoma. Conclusion:The present results suggest that the abundant expression of TAK1 protein may have a molecular basis characteristic of leiomyomas in the human uterus, and TAK1 may be a therapeutic target for the treatment of uterine leiomyoma.

  8. Triplex Doppler evaluation of uterine arteries in cyclic and pregnant domestic cats.

    Science.gov (United States)

    Pereira, B S; Freire, L M P; Pinto, J N; Domingues, S F S; Silva, L D M

    2012-01-01

    The aims were to determine resistance index (RI) and pulsatility index (PI) in the uterine arteries of cyclic and pregnant domestic cats comparing the left and right uterine horns, as well as the majority or minority uterine horns, based on fetus number per horn; to determine the presence or absence of an early diastolic notch (EDN) in the uterine artery of pregnant queens. Ten domestic cats were followed during one cycle and one pregnancy until 63rd days after mating. The estrous cycle length was 16 ± 9.57 days. The uterine horn with the highest number of fetuses (majority uterine horn - MUH) presented 2.0 ± 1.0 fetus and the lower (minority uterine horn - miUH) presentes 0.78 ± 0.67 fetus. There were no differences in indexes between uterine arteries during the cycles and pregnancies. The RI and PI of MUH were lower than miUH (Ppregnancy, uterine artery presented reductions in both indexes for the miUH. On D56, the PI was reduced in the miUH. The indexes depended on the week of pregnancy. EDN was present on the uterine arteries of all cats until D35, but disappeared by D49. The blood flow varied according to the category of horn.

  9. Uterine Contraction Modeling and Simulation

    Science.gov (United States)

    Liu, Miao; Belfore, Lee A.; Shen, Yuzhong; Scerbo, Mark W.

    2010-01-01

    Building a training system for medical personnel to properly interpret fetal heart rate tracing requires developing accurate models that can relate various signal patterns to certain pathologies. In addition to modeling the fetal heart rate signal itself, the change of uterine pressure that bears strong relation to fetal heart rate and provides indications of maternal and fetal status should also be considered. In this work, we have developed a group of parametric models to simulate uterine contractions during labor and delivery. Through analysis of real patient records, we propose to model uterine contraction signals by three major components: regular contractions, impulsive noise caused by fetal movements, and low amplitude noise invoked by maternal breathing and measuring apparatus. The regular contractions are modeled by an asymmetric generalized Gaussian function and least squares estimation is used to compute the parameter values of the asymmetric generalized Gaussian function based on uterine contractions of real patients. Regular contractions are detected based on thresholding and derivative analysis of uterine contractions. Impulsive noise caused by fetal movements and low amplitude noise by maternal breathing and measuring apparatus are modeled by rational polynomial functions and Perlin noise, respectively. Experiment results show the synthesized uterine contractions can mimic the real uterine contractions realistically, demonstrating the effectiveness of the proposed algorithm.

  10. Comparison of transvaginal ultrasonography and hysteroscopy in the diagnosis of uterine pathologies

    OpenAIRE

    Babacan, Ali; Gun, Ismet; Kizilaslan, Cem; Ozden, Okan; Muhcu, Murat; Mungen, Ercument; Atay, Vedat

    2014-01-01

    A thorough evaluation of the uterine cavity is frequently required in gynecology practice. The aim of this study was to compare the diagnostic values of transvaginal ultrasound examination and hysteroscopy in detecting uterine abnormalities in a group of patients within a range of menopausal status and symptomatology. This study included 285 patients admitted with complaints of abnormal uterine bleeding, postmenopausal bleeding, lower abdominal pain, abnormal vaginal discharge or for a routin...

  11. Two parallel, pragmatic, UK multicentre, randomised controlled trials comparing surgical options for upper compartment (vault or uterine) pelvic organ prolapse (the VUE Study): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Glazener, Cathryn; Constable, Lynda; Hemming, Christine; Breeman, Suzanne; Elders, Andrew; Cooper, Kevin; Freeman, Robert; Smith, Anthony R B; Hagen, Suzanne; McDonald, Alison; McPherson, Gladys; Montgomery, Isobel; Kilonzo, Mary; Boyers, Dwayne; Goulao, Beatriz; Norrie, John

    2016-09-08

    One in three women who have a prolapse operation will go on to have another operation, though not necessarily in the same compartment. Surgery can result in greater impairment of quality of life than the original prolapse itself (such as the development of new-onset urinary incontinence, or prolapse at a different site). Anterior and posterior prolapse surgery is most common (90 % of operations), but around 43 % of women also have a uterine (34 %) or vault (9 %) procedure at the same time. There is not enough evidence from randomised controlled trials (RCTs) to guide management of vault or uterine prolapse. The Vault or Uterine prolapse surgery Evaluation (VUE) study aims to assess the surgical management of upper compartment pelvic organ prolapse (POP) in terms of clinical effectiveness, cost-effectiveness and adverse events. VUE is two parallel, pragmatic, UK multicentre, RCTs (Uterine Trial and Vault Trial). Eligible for inclusion are women with vault or uterine prolapse: requiring a surgical procedure, suitable for randomisation and willing to be randomised. Randomisation will be computer-allocated separately for each trial, minimised on: requiring concomitant anterior and/or posterior POP surgery or not, concomitant incontinence surgery or not, age (under 60 years or 60 years and older) and surgeon. Participants will be randomly assigned, with equal probability to intervention or control arms in either the Uterine Trial or the Vault Trial. Uterine Trial participants will receive either a vaginal hysterectomy or a uterine preservation procedure. Vault Trial participants will receive either a vaginal sacrospinous fixation or an abdominal sacrocolpopexy. Participants will be followed up by postal questionnaires (6 months post surgery and 12 months post randomisation) and also reviewed in clinic 12 months post surgery. The primary outcome is the participant-reported Pelvic Organ Prolapse Symptom Score (POP-SS) at 12 months post randomisation

  12. [Uterine defibrillation in uterine inertia. Report of 2 cases].

    Science.gov (United States)

    Viñals, F; Correa, G; Quiroz, V

    1993-01-01

    The uterine atony are the most common cause of postpartum hemorrhage. Manual compression and pharmacologic methods are usually used with a successful result. When pharmacologic methods fail to control hemorrhage from atony, surgical measures should be undertaken to arrest the bleeding before it becomes life-threatening. We presents the utilization of electrical uterine defibrillation in two cases with acute hemorrhage confirming the effectivity of the proceeding.

  13. Measurement of phenolic environmental estrogens in women with uterine leiomyoma.

    Directory of Open Access Journals (Sweden)

    Yang Shen

    Full Text Available OBJECTIVES: To investigate the effect of phenolic environmental estrogens on uterine leiomyoma from the perspective of clinical epidemiology. METHODS: Urine and blood samples were collected from Han women with uterine leiomyoma and women without uterine leiomyoma, living in Nanjing, China, between September 2011 and February 2013. A total of 156 urine samples and 214 blood samples were collected from the uterine leiomyoma group and 106 urine samples and 126 blood plasma samples from the control group. Bisphenol A (BPA, nonylphenol (NP and octylphenol (OP concentrations were determined by solid-phase extraction (SPE coupled with liquid chromatography-tandem mass spectrometry (HPLC-MS/MS. RESULTS: Phenolic environmental estrogens in the uterine leiomyoma and control groups were compared based on: gravida>3 and gravida ≤ 3. In participants with gravida>3, urine OP concentration was significantly (P0.05 different between gravida>3 and gravida ≤ 3 patients. There was no significant (P>0.05 difference in plasma concentrations of BPA, OP and NP between the leiomyoma group and control group. Mean exposure concentration and range of distribution of BPA, OP and NP plasma concentration differed between the uterine leiomyoma and control group. CONCLUSION: Exposure level of phenolic environmental estrogens in human was related with leiomyoma tumorigenesis.

  14. Glandular epithelial AR inactivation enhances PTEN deletion-induced uterine pathology.

    Science.gov (United States)

    Choi, Jaesung Peter; Zheng, Yu; Handelsman, David J; Simanainen, Ulla

    2016-05-01

    Phosphatase and tensin homolog (PTEN) deletion induces uterine pathology, whereas androgen actions via androgen receptor (AR) support uterine growth and therefore may modify uterine cancer risk. We hypothesized that the androgen actions mediated via uterine glandular epithelial AR could modify PTEN deletion-induced uterine pathology. To test our hypothesis, we developed uterine glandular epithelium-specific PTEN and/or AR knockout mouse models comparing the uterine pathology among wild-type (WT), glandular epithelium-specific AR inactivation (ugeARKO), PTEN deletion (ugePTENKO), and the combined PTEN and AR knockout (ugePTENARKO) female mice. The double knockout restricted to glandular epithelium showed that AR inactivation enhanced PTEN deletion-induced uterine pathology with development of intraepithelial neoplasia by 20 weeks of age. In ugePTENARKO, 6/10 (60%) developed intraepithelial neoplasia, whereas 3/10 (30%) developed only glandular hyperplasia in ugePTENKO uterus. No uterine pathology was observed in WT (n=8) and ugeARKO (n=7) uteri. Uterine weight was significantly (P=0.002) increased in ugePTENARKO (374±97 mg (mean±s.e.)) compared with WT (97±6 mg), ugeARKO (94±12 mg), and ugePTENKO (205±33 mg). Estrogen receptor alpha (ERα) and P-AKT expression was modified by uterine pathology but did not differ between ugePTENKO and ugePTENARKO, suggesting that its expressions are not directly affected by androgens. However, progesterone receptor (PR) expression was reduced in ugePTENARKO compared to ugePTENKO uterus, suggesting that PR expression could be regulated by glandular epithelial AR inactivation. In conclusion, glandular epithelial AR inactivation (with persistent stromal AR action) enhanced PTEN deletion-induced uterine pathology possibly by downregulating PR expression in the uterus.

  15. Uterine arterial embolization for uterine leiomyoma: efficacy and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Seon; Lee, Do Yon; Kim, Yong Tae; Park, Ki Hyun; Park, Yong Won; Cho, Jae Sung; Kim, Myung Jun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of); Won, Je Hwan [Ajou Univ. College of Medicine, Suwon (Korea, Republic of); Kang, Byung Chul [Ewha Womans Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To determine the efficacy and clinical outcome of uterine arterial embolization as a new approach to the management of uterine leiomyomas. Uterine arterial embolization was performed in 21 patients aged 26-62(mean, 42) years. Twenty of these had menorrhagia, dysmenorrhea, and mass-related symptoms (low abdominal discomfort, backache, urinary frequency, etc.) and one was diagnosed incidentally. Bilateral uterine arteries were selected individually and polyvinyl alcohol and/or gelfoam was used as an embolic material. Nineteen patients were followed up after embolization. Seventeen (89.5 %)reported satisfactory improvement of symptoms and follow-up sonography three months later showed a 58.5 % reduction in mean myoma volume. In 17 patients (89.5 %), the menstrual cycle returned to normal. All patients experienced pain after the procedure and other complications were vaginal bleeding (26.3 %) and fever (23.8 %). Uterine arterial embolization represents a new approach to the management of uterine leiomyoma-related symptoms. Further investigations and long-term follow-up are, however, enquired.

  16. Pregnancy outcome of a patient following myomectomy performed during first trimester for red degeneration of fibroid

    Directory of Open Access Journals (Sweden)

    Asma Habib

    2016-08-01

    Full Text Available Pain due to red degeneration of fibroid during pregnancy is usually associated with large myomas. Necrobiosis / red degeneration typically manifests itself about midpregnancy when Lhe leiomyoma suddenly becomes acutely painful, enlarged and tender. The common differential diagnosis of this condition are torsion of the pedicle of an ovarian cyst/a leiomyoma, abruplion placentae, acute pyelitis or any abdominal catastrophe. Ultrasound can easily delineate the presence of myomas of mixed echogenicity along with pregnancy and clinical findings usually suggest the diagnosis of pregnancy complicated by red degeneration of fibroid. The acute pain usually subsides within 3-10 days of conservative treatment. Only refractory cases (2% of patients may demand surgical intervention in early gestation with the known risk of miscarriage. Here we report a pregnancy managed at 13 weeks by myomectomy for red degeneration. The patient ultimately delivered a healthy female child at 38 weeks by lower segment caesarean section.

  17. Intususcepción intestinal por pólipo fibroide inflamatorio en una anciana

    Directory of Open Access Journals (Sweden)

    Antonio M. Maya

    2013-10-01

    Full Text Available El pólipo fibroide inflamatorio es un tumor benigno poco frecuente del tubo digestivo, descripto por Vanek en 1949. Son lesiones de etiología desconocida, originadas en la submucosa. Están formadas por células mononucleares y mesenquimatosas con citoplasma fusocelular, con una importante proporción de eosinófilos. Sus síntomas son variables, dependiendo de su localización, y son una r ara causa de intususcepción intestinal en adultos. Presentamos el caso de una mujer de 82 años, que sufrió una rara intususcepción de intestino delgado, originada en un pólipo fibroide inflamatorio.

  18. Focused ultrasound for treatment of uterine myoma: From experimental model to clinical practice

    Directory of Open Access Journals (Sweden)

    Terzić Milan

    2008-01-01

    Full Text Available It is well known that focused ultrasound has a biologic effect on tissue. High intensity focused ultrasound (HIFU on a small target area raises the temperature of the tissue enough to denaturate proteins and cause irreversible cell damage. The tight focus of the ultrasound energy allows delivery of the intended dose to a very precise location. The resulting coagulation necrosis is relatively painless. The application of this method in the human clinical setting has required pilot studies on an animal model. Although the treatment had a high success rate, there was a significant percentage of complications, mainly attributed to the technical drawbacks of the procedure. Therefore, this method has been modified for use in humans, and the HIFU is now guided, monitored and controlled by magnetic resonance imaging (MRI. In October 2004, Food and Drug Adiministration (FDA approved MRI guided focused ultrasound treatment of uterine fibroids in humans. Since then, successful treatment of uterine myomas by HIFU has been performed in thousands of women.

  19. Does the phase of menstrual cycle affect MR-guided focused ultrasound surgery of uterine leiomyomas?

    Energy Technology Data Exchange (ETDEWEB)

    So, Minna J. [Department of Radiology, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA (United States); Fennessy, Fiona M. [Department of Radiology, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA (United States); Zou, Kelly H. [Department of Radiology, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA (United States); McDannold, Nathan [Department of Radiology, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA (United States); Hynynen, Kullervo [Department of Radiology, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA (United States); Jolesz, Ferenc A. [Department of Radiology, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA (United States); Stewart, Elizabeth A. [Department of Obstetrics and Gynecology, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA (United States); Rybicki, Frank J. [Department of Radiology, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA (United States); Tempany, Clare M. [Department of Radiology, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA (United States)]. E-mail: ctempanyafdhal@partners.org

    2006-08-15

    Purpose: To determine whether the phase of menstrual cycle at the time of MR-guided focused ultrasound surgery (MRgFUS) treatment for uterine leiomyomas affects treatment outcome. Methods: We enrolled all patients participating in a prospective phase III clinical trial from our center who completed 6 months of clinical and imaging follow-up. Patients with irregular cycles and those on oral contraceptives were excluded. Data prospectively documenting the date of the last menstrual period (LMP) at the time of treatment, length and duration of cycle, and raw symptom severity score (SSS) from the Uterine Fibroid Symptom and Quality of Life questionnaire, at baseline and 6 months were collected. Proliferative phase patients were determined retrospectively as those who were treated within less than 14 days from LMP; secretory phase patients were classified as those who were treated greater than 14 days from LMP. Results: A total of 58 patients were enrolled. There was no significant difference in the mean SSS at baseline and mean SSS at 6 months between patients treated in the proliferative versus secretory phase of the cycle. No significant difference in the SSS change from baseline to 6 months was seen between the two groups. Conclusions: Menstrual cycle phase does not influence MRgFUS treatment outcome. Symptomatic improvement occurs with treatment during either phase of the menstrual cycle. Thus, the scheduling of MRgFUS treatment need not be based upon the phase of the menstrual cycle.

  20. Human uterine wall tension trajectories and the onset of parturition.

    Directory of Open Access Journals (Sweden)

    Peter Sokolowski

    Full Text Available Uterine wall tension is thought to be an important determinant of the onset of labor in pregnant women. We characterize human uterine wall tension using ultrasound from the second trimester of pregnancy until parturition and compare preterm, term and twin pregnancies. A total of 320 pregnant women were followed from first antenatal visit to delivery during the period 2000-2004 at the John Hunter Hospital, NSW, Australia. The uterine wall thickness, length, anterior-posterior diameter and transverse diameter were determined by serial ultrasounds. Subjects were divided into three groups: women with singleton pregnancies and spontaneous labor onset, either preterm or term and women with twin pregnancies. Intrauterine pressure results from the literature were combined with our data to form trajectories for uterine wall thickness, volume and tension for each woman using the prolate ellipsoid method and the groups were compared at 20, 25 and 30 weeks gestation. Uterine wall tension followed an exponential curve, with results increasing throughout pregnancy with the site of maximum tension on the anterior wall. For those delivering preterm, uterine wall thickness was increased P < 0.05 compared with term. For twin pregnancies intrauterine volume was increased compared to singletons (P < 0.001, but wall thickness was not. There was no evidence for increased tension in those delivering preterm or those with twin gestations. These data are not consistent with a role for high uterine wall tension as a causal factor in preterm spontaneous labor in singleton or twin gestations. It seems likely that hormonal differences in multiple gestations are responsible for increased rates of preterm birth in this group rather than increased tension.

  1. Human uterine wall tension trajectories and the onset of parturition.

    Science.gov (United States)

    Sokolowski, Peter; Saison, Francis; Giles, Warwick; McGrath, Shaun; Smith, David; Smith, Julia; Smith, Roger

    2010-06-23

    Uterine wall tension is thought to be an important determinant of the onset of labor in pregnant women. We characterize human uterine wall tension using ultrasound from the second trimester of pregnancy until parturition and compare preterm, term and twin pregnancies. A total of 320 pregnant women were followed from first antenatal visit to delivery during the period 2000-2004 at the John Hunter Hospital, NSW, Australia. The uterine wall thickness, length, anterior-posterior diameter and transverse diameter were determined by serial ultrasounds. Subjects were divided into three groups: women with singleton pregnancies and spontaneous labor onset, either preterm or term and women with twin pregnancies. Intrauterine pressure results from the literature were combined with our data to form trajectories for uterine wall thickness, volume and tension for each woman using the prolate ellipsoid method and the groups were compared at 20, 25 and 30 weeks gestation. Uterine wall tension followed an exponential curve, with results increasing throughout pregnancy with the site of maximum tension on the anterior wall. For those delivering preterm, uterine wall thickness was increased P < 0.05 compared with term. For twin pregnancies intrauterine volume was increased compared to singletons (P < 0.001), but wall thickness was not. There was no evidence for increased tension in those delivering preterm or those with twin gestations. These data are not consistent with a role for high uterine wall tension as a causal factor in preterm spontaneous labor in singleton or twin gestations. It seems likely that hormonal differences in multiple gestations are responsible for increased rates of preterm birth in this group rather than increased tension.

  2. Uterine/Endometrial Cancer: Chemotherapy

    Science.gov (United States)

    ... Types of Gynecologic Cancers Uterine/Endometrial Cancer Chemotherapy Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for endometrial cancer is usually given intravenously (injected ...

  3. Sterility of the uterine cavity

    DEFF Research Database (Denmark)

    Møller, Birger R.; Kristiansen, Frank V.; Thorsen, Poul

    1995-01-01

    from the same sites. Nearly a quarter of all the patients harbored one or more microorganisms in the uterus, mostly Gardnerella vaginalis, Enterobacter and Streptococcus agalactiae. We found that in a significant number of cases, the uterine cavity is colonized with potentially pathogenic organisms...... which may play a causative role in endometritis. The results indicate that inflammation of the uterine cavity should be evaluated by hysteroscopic examination before hysterectomy is undertaken in patients with persistent irregular vaginal bleeding. Udgivelsesdato: 1995-Mar...

  4. Decreased type III collagen expression in human uterine cervix of prolapse uteri

    Science.gov (United States)

    IWAHASHI, MASAAKI; MURAGAKI, YASUTERU

    2011-01-01

    The precise mechanism of prolapse uteri is not fully understood. There is evidence to suggest that abnormalities of collagen, the main component of extracellular matrix, or its repair mechanism, may predispose women to prolapse. To investigate the characteristic structure of human uterine cervix of patients with prolapse uteri, various types of collagen expression in the uterine cervix tissues of the prolapse uteri were compared to those of normal uterine cervix. After informed consent, 36 specimens of uterine cervical tissues were obtained at the time of surgery from 16 postmenopausal women with prolapse uteri (stage III–IV by the Pelvic Organ Prolapse Quantification examination) and 20 postmenopausal women without prolapse uteri (control group). Collagens were extracted from the uterine cervix tissues by salt precipitation methods. The relative levels of various collagens were evaluated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The uterine cervix was longer in the patients with prolapse uteri than those of postmenopausal controls without prolapse uteri. The ratios of type III to type I collagen in the uterine cervical tissues were significantly decreased in the prolapse uteri, as compared to those of the postmenopausal uterine cervix without prolapse. These results suggest that decreased type III collagen expression may play an important role in determing the physiology and structure of the uterine cervix tissues of prolapse uteri. PMID:22977496

  5. Postpartum uterine health in cattle.

    Science.gov (United States)

    Sheldon, I M; Dobson, H

    2004-07-01

    Uterine health is often compromised in cattle because postpartum contamination of the uterine lumen by bacteria is ubiquitous, and pathogenic bacteria frequently persist causing clinical disease. The subfertility associated with uterine infection involves perturbation of the hypothalamus, pituitary and ovary, in addition to the direct effects on the uterus, and appears to persist even after clinical resolution of the disease. Absorption of bacterial components from the uterus can prevent the follicular phase LH surge and ovulation. In addition, the first postpartum dominant follicle has a slower growth rate and secretes less estradiol at the end of the growth phase. There are also localised ovarian effects of high uterine bacterial growth density, because fewer first dominant follicles are selected in the ovary ipsilateral than contralateral to the previously gravid uterine horn. Thus, it is important to diagnose and treat uterine disease promptly and effectively. Examination of the contents of the vagina for the presence of pus is the most useful method for diagnosis of endometritis. The character and odor of the vaginal mucus can be scored and this endometritis score is correlated with the growth density of pathogenic bacteria in the uterus, and is prognostic for the likely success of treatment. The challenge for the future is to design prevention and control programs to reduce the incidence of disease, and understand how the immune and endocrine systems are integrated.

  6. Role of 3-Dimensional Sonography in the Assessment of Submucous Fibroids: A Pilot Study.

    Science.gov (United States)

    Keizer, Alieke L; Nieuwenhuis, Lotte L; Twisk, Jos W R; Huirne, Judith A F; Hehenkamp, Wouter J K; Brölmann, Hans A M

    2017-08-04

    To investigate the accuracy and reliability of 3-dimensional (3D) transvaginal sonography in classifying submucous fibroids using the International Federation of Gynecology and Obstetrics PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified) classification and protrusion (percent) compared to 2-dimensional (2D) transvaginal sonography, 2D saline infusion sonography, and 3D saline infusion sonography, using hysteroscopy as a reference test. A prospective cohort pilot study was performed among 14 consecutive patients undergoing hysteroscopic surgery, preceded by routine sonography (2D transvaginal sonography, 2D saline infusion sonography, 3D transvaginal sonography, and 3D saline infusion sonography). The intraclass correlation coefficient (ICC) for 2D transvaginal sonography versus hysteroscopy was 0.69 (95% confidence interval [CI], 0.06, 0.90) compared to 0.94 (95% CI, 0.83, 0.98) for 2D saline infusion sonography. The ICCs for 3D transvaginal sonography versus hysteroscopy were 0.69 (95% CI, 0.03, 0.90 [investigator A]) and 0.55 (95% CI, -0.48, 0.86 [investigator B]). The ICCs for 3D saline infusion sonography versus hysteroscopy were 0.94 (95% CI, 0.81, 0.98 [investigator A]) and 0.87 (95% CI, 0.60, 0.96 [investigator B]). Interobserver agreement of 3D transvaginal sonography was 0.81 (95% CI, 0.43, 0.94) compared to 0.86 (95% CI, 0.56, 0.96) for 3D saline infusion sonography. In these preliminary data, 3D transvaginal sonography was not as accurate as 2D or 3D saline infusion sonography and was not more accurate than 2D transvaginal sonography. There was moderate interobserver agreement for 3D transvaginal sonography. There might be room for improvement, as 3D transvaginal sonography is more accurate when endometrial thickness increases. Further study is warranted to evaluate in which patients saline infusion sonography eventually can be obviated. © 2017 by

  7. The Risk of Uterine Rupture in Labour Induction of Women With Previous Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Kurdoglu Zehra

    2016-01-01

    Full Text Available Objective: Due to the increased number of labour inductions in women with previous cesarean section, the risk of uterine rupture leading to maternal and fetal mortality is also increasing. In this manuscript, we aimed to review the risk of uterine rupture in labour induction of women with prior cesarean section. Materials and Methods: Data from 48 reports belonging to the years 1994 through 2015, obtained via a search on various internet sources by the words "labour induction", "previous cesarean", "uterine scar", "uterine rupture" were used to characterize the risk factors, methods and complications of labour induction in women with previous cesarean section. Results: The success of labour induction after a previous cesarean section is related to a history of prior vaginal delivery, the indication of prior cesarean delivery, age, body mass index and ethnicity. The risk of uterine rupture is lower with mechanical dilatators compared to prostaglandins when they are used for cervical ripening. Oxytocin is associated with an increased risk of uterine rupture in such women but induction and augmentation of labor is an option for all women undergoing a trial of labor after cesarean section. Although some guidelines discourage the use of prostaglandin E1, some others support the use of prostaglandin E1 or E2 for induction of labor in rare situations provided that the women be informed of the higher risk of uterine rupture. Conclusions: Previous uterine surgery is the most common underlying reason for an increased risk of uterine rupture in subsequent trial of labour. When indicated, before considering a labour induction in these patients, a risk assessment should be performed based on various parameters. For prediction of uterine rupture, lower uterine segment may be measured by ultrasonography. Individually selected methods for labour induction should be discussed with the patients since they are mostly associated with increased risk of uterine

  8. Obstetric outcome of women with uterine anomalies in China

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yan; ZHAO Yang-yu; QIAO Jie

    2010-01-01

    Background Congenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aimed to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations.Methods This retrospective study evaluated the fertility and obstetric outcome of 116 inpatients with uterine malformations with pregnancy in Peking University Third Hospital from June 1998 to June 2009. A total of 270 randomly selected pregnant women with a previously confirmed normally shaped uterus as a control group. Student's t test and analysis of variance (ANOVA) were used to compare means for normally distributed variables. The analysis was carried out using the SPSS.Results Among 21 961 deliveries in Peking University Third Hospital, 116 (0.45%) were in women with uterine anomalies. A septate uterus was present in 43 (37.1%) and the uterus didelphys in 28 (24.2%) of the 116 women identified. Bicornuate uterus, arcuate and unicomate uterus were observed in 12 (10.3%), 18 (15.5%) and 15 (12.9%) patients, respectively. Patients with uterine anomalies had significantly higher rates of malpresentation (38.8%), preterm delivery (19.8%), and cesarean section (78.5%) compared with the group of women with a normal uterus. Patients with uterine anomalies had significantly lower mean birth-weight neonates and a significantly higher incidence of small for gestationalage (SGA) neonates; women with uterus didelphys more frequently required infertility treatment than patients with other uterine anomalies (P <0.001). The rate of malpresentation was significantly higher in patients with septated uterus in comparison with patients with uterus unicorns (P <0.05).Conclusions Women with congenital uterinemal formation usually have higher incidence of complications during pregnancy and delivery. A septate uterus appears to be associated with poorer obstetric outcomes.

  9. Prognostic features of surgical stage I uterine carcinosarcoma.

    Science.gov (United States)

    Ferguson, Sarah E; Tornos, Carmen; Hummer, Amanda; Barakat, Richard R; Soslow, Robert A

    2007-11-01

    Uterine carcinosarcomas (CSs) are aggressive neoplasms, with 5-year overall survival (OS) rates of less than 35%. They are customarily separated into types harboring either heterologous or homologous mesenchymal elements, but the prognostic significance of this finding is controversial. Our goal was to study clinicopathologic features of possible prognostic relevance in surgical stage I uterine CS. A retrospective clinical and histopathologic review was performed for all women diagnosed with surgical stage I uterine CS. These tumors were compared with stage I high-grade endometrial (HGEm) carcinomas for clinical outcomes. There were 42 cases of surgical stage I uterine CS identified between January 1990 and January 2004. The disease-free survival and OS rates for patients with stage I CS were significantly worse compared with stage I HGEm (P=0.001; P=0.01). The median disease-free survival for patients with heterologous CS was 15 months and had not been reached for women with homologous CS (P=0.001). The 3-year OS rates were 45% versus 93% in women with heterologous compared with homologous stage I CS (P90%. Homologous stage I CSs have survival outcomes that are similar to HGEm. This further supports the concept that homologous stage I CSs are carcinomas with sarcomatoid features, not sarcomas. More importantly, the presence of heterologous sarcomatous elements is a powerful negative prognostic factor in surgical stage I uterine CS.

  10. Partial regeneration and reconstruction of the rat uterus through recellularization of a decellularized uterine matrix.

    Science.gov (United States)

    Miyazaki, Kaoru; Maruyama, Tetsuo

    2014-10-01

    Despite dramatic progress in infertility treatments and assisted reproduction, no effective therapies exist for complete loss of uterine structure and/or function. For such patients, genetic motherhood is possible only through gestational surrogacy or uterine transplantation. However, many ethical, social, technical and safety challenges accompany such approaches. A theoretical alternative is to generate a bioartificial uterus, which requires engineering of uterine architecture and appropriate cellular constituents. Here, rat uteri decellularization by aortic perfusion with detergents produced an underlying extracellular matrix together with an acellular, perfusable vascular architecture. Uterine-like tissues were then regenerated and maintained in vitro for up to 10 d through decellularized uterine matrix (DUM) reseeding with adult and neonatal rat uterine cells and rat mesenchymal stem cells followed by aortic perfusion in a bioreactor. Furthermore, DUM placement onto a partially excised uterus yielded recellularization and regeneration of uterine tissues and achievement of pregnancy nearly comparable to the intact uterus. These results suggest that DUM could be used for uterine regeneration, and provides insights into treatments for uterine factor infertility.

  11. Saline contrast hysterosonography in abnormal uterine bleeding : a systematic review and meta-analysis

    NARCIS (Netherlands)

    de Kroon, CD; de Bock, GH; Dieben, SWM; Jansen, FW

    2003-01-01

    Objective To assess the diagnostic accuracy of saline contrast hysterosonography in the evaluation of the uterine cavity in women complaining of abnormal uterine bleeding. Design A systematic review and meta-analysis of diagnostic studies that compared saline contrast hysterosonography to a gold sta

  12. 宫腔疾病与不孕症%Uterine Cavity Disease and Infertility

    Institute of Scientific and Technical Information of China (English)

    孟跃进; 杨金金

    2016-01-01

    女性不孕症的发病率呈逐年上升趋势,宫腔疾病和输卵管病变是导致女性不孕的两大主要因素,不论自然受孕亦或采用辅助生殖技术,宫腔正常是成功妊娠最基本的条件。然而,临床在诊治不孕症时,相当数量的医生更多地关注输卵管通畅情况的检查及治疗,而对宫腔因素引起不孕症的关注则相对不足。导致不孕症的常见宫腔疾病包括子宫内膜息肉、宫腔粘连、子宫畸形、子宫肌瘤等。国内外报道的主要宫腔疾病的病因基本相似,所不同的是主要病因的前后顺序。宫腔镜检查作为一种新的、微创性妇科诊疗技术,可以直观地了解宫内情况,及时发现导致不孕的宫腔疾病,同时可手术处理宫腔的异常情况,已经成为不孕症检查和治疗的首选方法。%The incidence of female infertility is increasing year by year.Uterine cavity disease and fallopian tube lesion are two main factors of female infertility. The normal uterine cavity is the basic condition of successful pregnancy in both natural conception and assisted reproductive technology. However, a considerable number of doctors pay more attention to the examination and treatment of tubal patency, and not enough attention to the uterine cavity factors causing infertility, in their clinical diagnosis and treatment of infertility. The common uterine diseases causing infertility include endometrial polyps, intrauterine adhesion, uterine abnormalities, uterine fibroids, and so on. At home and abroad,the etiology of uterine diseases are basically similar,the different is the main cause of the order. Hysteroscopy, as a new and minimally invasive gynecological diagnosis and treatment technology, can be used to observe intuitively the uterine cavity, to understand whether there is a uterine cavity disease related to infertility, and to treat synchronously the abnormalities of uterine cavity. Hysteroscopy has become one of

  13. Isolated cutaneous metastasis of uterine leiomyosarcoma: case report and review of literature

    LENUS (Irish Health Repository)

    Corcoran, Shane

    2012-07-18

    AbstractA 54 year old lady presented for routine excision of a scalp lesion thought clinically to represent a sebaceous cyst of the right occiput. 4 years earlier she underwent total abdominal hysterectomy and right salpingo-oophorectomy for 3 large uterine fibroids. Histo-pathological examination of the hysterectomy specimen revealed an incidental low-grade leiomyosarcoma. Staging imaging was negative for metastatic disease. She made an uneventful recovery and was treated further by adjuvant pelvic radiotherapy.She noticed an uncomfortable and unsightly cystic swelling on her occiput four years after hysterectomy and was referred for routine excision of what was believed to be a benign lesion. The lesion was excised and sent for histopathological examination. Microscopic analysis including immuno-histochemistry demonstrated an ER and PR positive metastatic deposit of leiomyosarcoma. The margins of excision were histologically clear of disease.At Multi-Disciplinary Team (MDT) discussion a diagnosis of metastatic scalp deposit from previous uterine leiomyosarcoma was made. Re-staging CT brain, thorax, abdomen and pelvis and MRI brain were negative for local recurrence or distant metastases. She is currently undergoing radiotherapy to the scalp and surrounding tissues and will be followed up closely by the involved teams.To the best of our knowledge, this is the first case described in the worldwide literature of isolated cutaneous metastasis to the scalp of uterine leiomyosarcoma without evidence of disseminated disease at other sites.Virtual slidesThe virtual slide(s) for this article can be found here: http:\\/\\/www.diagnosticpathology.diagnomx.eu\\/vs\\/1311834987345566.

  14. Isolated cutaneous metastasis of uterine leiomyosarcoma: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Corcoran Shane

    2012-07-01

    Full Text Available Abstract A 54 year old lady presented for routine excision of a scalp lesion thought clinically to represent a sebaceous cyst of the right occiput. 4 years earlier she underwent total abdominal hysterectomy and right salpingo-oophorectomy for 3 large uterine fibroids. Histo-pathological examination of the hysterectomy specimen revealed an incidental low-grade leiomyosarcoma. Staging imaging was negative for metastatic disease. She made an uneventful recovery and was treated further by adjuvant pelvic radiotherapy. She noticed an uncomfortable and unsightly cystic swelling on her occiput four years after hysterectomy and was referred for routine excision of what was believed to be a benign lesion. The lesion was excised and sent for histopathological examination. Microscopic analysis including immuno-histochemistry demonstrated an ER and PR positive metastatic deposit of leiomyosarcoma. The margins of excision were histologically clear of disease. At Multi-Disciplinary Team (MDT discussion a diagnosis of metastatic scalp deposit from previous uterine leiomyosarcoma was made. Re-staging CT brain, thorax, abdomen and pelvis and MRI brain were negative for local recurrence or distant metastases. She is currently undergoing radiotherapy to the scalp and surrounding tissues and will be followed up closely by the involved teams. To the best of our knowledge, this is the first case described in the worldwide literature of isolated cutaneous metastasis to the scalp of uterine leiomyosarcoma without evidence of disseminated disease at other sites. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1311834987345566.

  15. Evidence-Based Treatment for Newly Diagnosed Patients with Uterine Myoma%初诊子宫肌瘤患者的循证治疗

    Institute of Scientific and Technical Information of China (English)

    李琴

    2012-01-01

    目的借助循证医学的方法为初诊子宫肌瘤患者确定治疗目标及治疗方案.方法在充分评估患者情况后,提出临床问题,从Cochrane图书馆(2012年第1期)、Medline (1990.1-2012.3)、Embase(1990.1-2012.3)和Pubmed (1990.1-2012.3),检索主题词为: uterine myoma, treatment strategy, hysterectomy, myomectomy, uterine leiomyoma, RCT, laparoscopic, human, meta-analysis,systematic review.结果共检索出与不同问题相关的随机对照试验65篇,系统评价或Meta分析19篇.通过对检索结果进行分析,为患者制定了合理的治疗方案.经随访证实,该方案适合患者.结论采用循证治疗的方法,为初诊的子宫肌瘤患者制定合理的治疗目标和治疗方案,可有效提高治疗效果.%Objective Methods of evidence-based medicine were used to make an individualized treatment plan concerning newly diagnosed uterine fibroids. Methods After clinical problems were put forward, evidence was collected from first issue, 2012, Cochrane Library; Medline (1990.1 -2012.3); Embase (1990.1-2012.3); Pubmed (1990.1-2012.3). Subject words were: uterine myoma, treatment strategy, hysterectomy, myomectomy, uterine leiomyoma, RCT, laparoscopic, human, meta-analysis,systematic review. Results A total of 65 RCTs, and 19 systematic reviews were identified. A rational treatment plan was made up on a serious evaluation of the data. After follow-up, the plan was proved optimal. Conclusion The treatment efficacy in newly diagnosed uterine fibroids has been improved by determining an individualized treatment plan according to evidence-based methods. The therapeutic effect and the life quality of the patient have been improved effectively.

  16. Uterine responses to three techniques of breast stimulation.

    Science.gov (United States)

    Curtis, P; Evens, S; Resnick, J; Rimer, R; Lynch, K; Carlson, J R

    1986-01-01

    Uterine contractions produced by three methods of breast stimulation and a placebo were compared in 202 high-risk women between 35 and 44 weeks' gestation during contraction stress tests. Manual stimulation produced significantly more successful responses of three or more contractions within ten minutes than did a heating pad or a placebo, but did not show significant differences when compared with a breast pump. The placebo group showed an increase in contractions over a resting state. Of the women with successful contraction stress tests, over 50% demonstrated exaggerated uterine activity (a hypertonic contraction of greater than 90 seconds, or five or more contractions in a ten-minute period).

  17. Pregnancy with asymptomatic uterine complete rupture after uterine artery embolization for postpartum hemorrhage

    Directory of Open Access Journals (Sweden)

    Hiroaki Soyama

    2017-08-01

    Conclusion: Many studies have been reported that uterine artery embolization for postpartum hemorrhage did not affect subsequent pregnancy outcomes. However, we report that this procedure contains a potential risk for asymptomatic uterine rupture in a subsequent pregnancy. Although it is difficult to diagnose uterine rupture without symptoms, the obstetrician should be aware of the possibility of uterine rupture.

  18. Enhanced myometrial autophagy in postpartum uterine involution

    Directory of Open Access Journals (Sweden)

    Keng-Fu Hsu

    2014-09-01

    Conclusion: Autophagy of myocytes may play an important role in uterine involution. These results have implications for our understanding of myometrial functional adaptations during pregnancy and the physiological role of autophagy in the uterine remodeling events in the postpartum period.

  19. Treatment Options by Stage (Uterine Sarcoma)

    Science.gov (United States)

    ... Cancer Prevention Endometrial Cancer Screening Research Uterine Sarcoma Treatment (PDQ®)–Patient Version General Information About Uterine Sarcoma ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment ...

  20. Does coupling ofuterine contractions reflect uterine dysfunction?

    African Journals Online (AJOL)

    spontaneous nonnal labour at tenn were divided into two groups ... irregular uterine contractions during labour occurred ... Oxytocin was administered when the uterine activity was less than .... Greater cervical dilatation at the onset of labour in.

  1. 宫腔病变与不孕症的关系及诊治进展%Uterine Cavity Lesions and Infertility

    Institute of Scientific and Technical Information of China (English)

    高蜀君; 隋龙

    2016-01-01

    About 10% to 15% of infertile women are related to the uterine cavity abnormalities. The common uterine cavity lesions include endometrial polyps, submucous fibroids, uterine septum and intrauterine adhesions. Other lesions are often found including chronic endometritis, tuberculosis, retained products of conception, and so on. These lesions may result incavity morphological abnormalities, dysfunctional uterine contractility, abnormal uterine vascularization, chronic endometrial inflammation, and the impaired endometrial receptivity, which affect the fertilization, implantation and pregnancy maintenance. Diagnostic and operative hysteroscopy can significantly improve the outcomes of clinical pregnancy in those women with uterine cavity abnormalities and unexplained infertility.%不孕症中10%~15%为宫腔因素所致,最为常见的原因是子宫内膜息肉、子宫黏膜下肌瘤、子宫纵隔和宫腔粘连,其他如慢性子宫内膜炎、子宫内膜结核、宫腔妊娠物残留等,可引起宫腔形态失常、收缩异常、异常血管形成、炎症反应、内膜容受性下降等,影响受孕和导致流产发生。适时而恰当地给予子宫性不孕、不明原因不孕症患者宫腔镜检查和治疗,可以显著改善这部分人群的妊娠率和妊娠结局。

  2. Uterine prolapse in a primigravid woman.

    Science.gov (United States)

    Kim, Jeong Ok; Jang, Shin A; Lee, Ji Yeon; Yun, Nae Ri; Lee, Sang-Hun; Hwang, Sung Ook

    2016-05-01

    Uterine prolapse during pregnancy is an uncommon condition. It can cause preterm labor, spontaneous abortion, fetal demise, maternal urinary complication, maternal sepsis and death. We report the case of uterine prolapse in a 32-year-old healthy primigravid woman. She had no risk factors associated with uterine prolapse. She was conservatively treated, resulting in a successful vaginal delivery. This report is a very rare case of uterine prolapse in a young healthy primigravid woman, resulting in a successful vaginal delivery.

  3. First Trimester Spontaneous Uterine Rupture in a Young Woman with Uterine Anomaly

    Directory of Open Access Journals (Sweden)

    Esra Nur Tola

    2014-01-01

    Full Text Available Spontaneous uterine rupture is a life-threatening obstetrical emergency carrying a high risk for the mother and the fetus. Spontaneous uterine rupture in early pregnancy is very rare complication and it occurs usually in scarred uterus. Uterine anomalies are one of the reasons for spontaneous unscarred uterine rupture in early pregnancy. Obstetricians must consider this diagnosis when a pregnant patient presented with acute abdomen in early pregnancy. We present a case of spontaneous uterine rupture at 12 weeks of gestation in 24-year-old multigravida who had uterine anomaly presenting as an acute abdomen. Our preoperative diagnosis was ectopic pregnancy. Emergency laparotomy confirmed a spontaneous uterine rupture. Uterine anomaly is a risk factor for spontaneous uterine rupture in the early pregnancy. Clinical signs of uterine rupture in early pregnancy are nonspecific and must be distinguished from acute abdominal emergencies.

  4. 宫腔镜在诊治异常子宫出血中的作用%The Role of Hysteroscopy in the Diagnosis and Treatment of Abnormal Uterine Bleeding

    Institute of Scientific and Technical Information of China (English)

    李杰

    2013-01-01

    Objective:To investigate the cause of uterine bleeding and the diagnostic value of hysteroscopy.Method:Hysteroscopy examination were retrospectively analyzed the clinical data of 20 patients with uterine bleeding.Result:12 cases were cervical polyp and 3 cases were dysfunctional uterine bleeding and one was submucosal uterine fibroids. Endoscopic diagnosis and biopsy was 100%.Conclusion:The combination of hysteroscopy and histological examination could improve the accuracy of diagnostic for uterine bleeding.%  目的:探讨子宫出血的病因以及宫腔镜的诊断价值。方法:回顾性分析行宫腔镜检查的20例子宫出血患者的临床资料。结果:20例患者出血病因中,子宫内膜息肉12例,子宫颈管息肉4例,功能性子宫出血3例,子宫黏膜下肌瘤1例。镜下诊断与病理活检的符合率为100%。结论:宫腔镜检查与组织学检查结合可提高诊断准确性。

  5. Management options for women with uterine prolapse interested in uterine preservation.

    Science.gov (United States)

    Kow, Nathan; Goldman, Howard B; Ridgeway, Beri

    2013-10-01

    A variety of nonsurgical and surgical treatment options exist for the treatment of pelvic organ prolapse. While nonsurgical management is often selected as first-line treatment, many women eventually elect to undergo surgical management. Traditionally, prolapse repair often includes concomitant hysterectomy; however, women increasingly desire uterine preservation for a myriad of reasons. Multiple surgical procedures have been described to correct apical prolapse while preserving the uterus. Many studies suggest similar anatomic and functional outcomes compared to prolapse procedures with concomitant hysterectomy. Potential benefits include decreased operative time and avoidance of hysterectomy-specific complications, although there are several unique issues to consider if the uterus is retained. Surgeons must provide adequate counseling and preoperative evaluation before proceeding with uterine preservation.

  6. Uterine morphology and peristalsis in women with polycystic ovary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Leonhardt, Henrik; Hellstroem, Mikael [Department of Radiology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg (Sweden)], E-mail: henrik.leonhardt@vgregion.se; Gull, Berit; Nilsson, Lars; Janson, Per O. [Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg (Sweden); Kishimoto, Keiko [Department of Radiology, St Marianna University School of Medicine, Kanagawa (Japan); Kataoka, Masako [Department of Radiology, Kyoto University Hospital, Kyoto (Japan); Stener-Victorin, Elisabet [Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg (Sweden)

    2012-12-15

    Background. Polycystic ovary syndrome (PCOS) is associated with chronic oligo-anovulation and high circulating sex hormone levels. Women with PCOS have an increased risk of developing endometrial cancer. In anovulatory women with PCOS a positive relationship between endometrial thickness and endometrial hyperplasia has been observed. Uterine peristalsis, which has been suggested to be of importance for female fertility, has not previously been studied in PCOS. Purpose. To assess whether women with PCOS have altered endometrial thickness, uterine wall morphology, and peristalsis. Material and Methods. In this prospective case-control study 55 women with PCOS (mean age, 29.5 years {+-} 4.5 SD) and 28 controls (27.6 {+-} 3.2) were examined using magnetic resonance imaging (MRI), assessing thickness of endometrium, junctional zone (JZ), and myometrium, and evaluating the occurrence, frequency (waves/min), strength (amplitude), pattern, and direction of peristalsis. Uterine morphology was also assessed by transvaginal ultrasonography (TVUS). Results. The endometrium was thinner in PCOS with oligo-amenorrhea compared to controls, also after adjustments for age and BMI (adjusted P = 0.043). There was no difference in thickness of the JZ or the myometrium in cases versus controls. Uterine peristalsis was less commonly observed in women with PCOS than in controls (adjusted P = 0.014). Conclusion. There were no differences in myometrial morphology between PCOS and controls, but the endometrium was thinner in PCOS with oligo-amenorrhea. Based on cine MRI, uterine peristalsis was less common in PCOS than in controls.

  7. [Uterus preserving surgery versus vaginal hysterectomy in treatment of uterine descent: a systematic review].

    NARCIS (Netherlands)

    Detollenaere, R.J.; Boon, J. den; Vierhout, M.E.; Eijndhoven, H.W. van

    2011-01-01

    OBJECTIVE: To compare the outcomes of uterus preserving procedures and vaginal hysterectomy in treatment of uterine prolapse. DESIGN: Systematic review. METHOD: We searched in Pubmed, Embase, the Cochrane Library and the reference lists of relevant publications for articles comparing uterus

  8. Ge-Gen Decoction attenuates oxytocin-induced uterine contraction and writhing response: potential application in primary dysmenorrhea therapy.

    Science.gov (United States)

    Yang, Lu; Chai, Cheng-Zhi; Yue, Xin-Yi; Yan, Yan; Kou, Jun-Ping; Cao, Zheng-Yu; Yu, Bo-Yang

    2016-02-01

    The uterine tetanic contraction and uterine artery blood flow reduction are possible reasons for primary dysmenorrhea (PD). In the present study, we aimed to evaluate the uterine relaxant effect and the influence on uterine artery blood velocity of Ge-Gen Decoction (GGD), a well-known Chinese herbal formula. In female ICR mice, uterine contraction was induced by oxytocin exposure following estradiol benzoate pretreatment, and the uterine artery blood velocity was detected by Doppler ultrasound. Histopathological examination of the uterine tissue samples were performed by H&E staining. Ex vivo studies demonstrated that oxytocin, posterior pituitary, or acetylcholine induced contractions in isolated mouse uterus. GGD inhibited both spontaneous and stimulated contractions. In vivo study demonstrated that GGD significantly reduced oxytocin-induced writhing responses with a maximal inhibition of 87%. Further study demonstrated that GGD normalized oxytocin-induced abnormalities of prostaglandins F2 alpha (PGF2α) and Ca(2+) in mice. In addition, injection of oxytocin induced a decrease in uterine artery blood flow velocity. Pretreatment with GGD reversed the oxytocin response on blood flow velocity. Histopathological examination showed pretreatment with GGD alleviated inflammation and edema in the uterus when compared with the model group. Both ex vivo and in vivo results indicated that GGD possessed a significant spasmolytic effect on uterine tetanic contraction as well as improvement on uterine artery blood velocity which may involve PGF2α and Ca(2+) signaling, suggesting that GGD may have a clinic potential in PD therapy.

  9. Transabdominal color doppler ultrasonography: A relevant approach for assessment of effects of uterine torsion in buffaloes

    Directory of Open Access Journals (Sweden)

    Devender

    2016-08-01

    Full Text Available Aim: The present study was conducted on advanced pregnant buffaloes suffering from uterine torsion to assess the status of fetus and uterus by transabdominal ultrasonography, and the findings were compared with normal advanced pregnant buffaloes. Materials and Methods: The study was conducted on 20 clinical cases of uterine torsion and 20 normal advanced pregnant buffaloes (control group. The lower ventral area just lateral to linea alba (on both sides of the udder in standing animals was scanned transabdominally by the two-dimensional convex transducer for various ultrasonographic findings. The data collected were statistically analyzed by “one-way ANOVA” and “independent sample t-test” using computerized SPSS 16.0 software program. Results: Transabdominal ultrasonography revealed dead fetus in 95% uterine torsion cases and proved useful in imaging internal structures of fetuses while no dead fetus was reported in the control group. Size of umbilicus was found significantly decreased (p0.05 in uterine torsion group. Average thickness of the uterine wall and mean pixel values of fetal fluids (echogenicity were found significantly increased (p<0.05 in uterine torsion affected buffaloes in comparison to control group. Conclusion: Status of fetus (whether live or dead, internal status of uterus, and its contents could be determined by transabdominal ultrasonography in uterine torsion cases and thus determining the prognosis of the uterine torsion cases before going for further manipulations. This will also help in taking all the precautions to avoid death of the fetus.

  10. Diagnostic double guarded low-volume uterine lavage in mares

    DEFF Research Database (Denmark)

    Christoffersen, Mette; Brandis, Louise; Samuelsson, Julia;

    2014-01-01

    Endometritis constitutes a major problem in the management of broodmares; hence diagnostic tests with a high sensitivity and specificity are desired. We hypothesize that a double guarded uterine flush technique for bacterial culture and cytology is comparable to standard diagnostic tests, the end...

  11. Selection for uterine capacity improves lifetime productivity of sows

    Science.gov (United States)

    Selection for 11 generations for uterine capacity (UC) increased litter size in gilts by 1.6 more fully formed pigs at birth compared to an unselected control line (CO) despite averaging 1 less ova shed. Our objective was to quantify line-by-parity interactions and characterize litter performance tr...

  12. THE INFLUENCE OF THE PUERPERAL AFFECTIONS ON INSEMINATION INDEX AND UTERINE REPOSE IN COWS

    Directory of Open Access Journals (Sweden)

    PĂCALĂ N.

    2007-01-01

    Full Text Available The observations were made, through a year, at SD Timisoara on cows fromHolstein-Friesian and Fleckvieh breed. The puerperal period was observed, theincidence of the endometrites was recorded and there were calculated tworeproduction parameters: the Insemination Index (Ig and the Uterine Reposeduration (UR (Open days. The Insemination Index (service/conception (Igrepresents the mean number of artificial inseminations performed in order to obtaina pregnancy. Uterine Repose represents the time interval, in days, from calving untilthe fecund insemination. The Uterine Repose has two components: VoluntaryWaiting Period (VWP (time interval from calving until the introduction of thefemale to reproduction and Service Period (SP (time interval from the end of theVWP until the fecund insemination. There were noticed that the incidence of theuterine infections were significant higher (p<0.05 at cows from Holstein-Friesianbreed (63.3%, compared to the cows from Fleckvieh breed (41.3%. TheInsemination Index was significant lower (p<0.05 at cows without uterine infections(1.9, compared to the cows with uterine infections (2.5. The mean duration of theUterine Repose was significant lower (p<0.05 at healthy cows (114.7 days,compared with cows with uterine infections after calving (182.2 days. It seams thatthe cows from Fleckvieh breed are more resistant to the exploitation conditions formilk production than compared with cows from Holstein-Friesian breed.

  13. THE INFLUENCE OF THE PUERPERAL AFFECTIONS ON INSEMINATION INDEX AND UTERINE REPOSE IN COWS

    Directory of Open Access Journals (Sweden)

    N. PĂCALĂ

    2013-12-01

    Full Text Available The observations were made, through a year, at SD Timisoara on cows fromHolstein-Friesian and Fleckvieh breed. The puerperal period was observed, theincidence of the endometrites was recorded and there were calculated tworeproduction parameters: the Insemination Index (Ig and the Uterine Reposeduration (UR (Open days. The Insemination Index (service/conception (Igrepresents the mean number of artificial inseminations performed in order to obtaina pregnancy. Uterine Repose represents the time interval, in days, from calving untilthe fecund insemination. The Uterine Repose has two components: VoluntaryWaiting Period (VWP (time interval from calving until the introduction of thefemale to reproduction and Service Period (SP (time interval from the end of theVWP until the fecund insemination. There were noticed that the incidence of theuterine infections were significant higher (p<0.05 at cows from Holstein-Friesianbreed (63.3%, compared to the cows from Fleckvieh breed (41.3%. TheInsemination Index was significant lower (p<0.05 at cows without uterine infections(1.9, compared to the cows with uterine infections (2.5. The mean duration of theUterine Repose was significant lower (p<0.05 at healthy cows (114.7 days,compared with cows with uterine infections after calving (182.2 days. It seams thatthe cows from Fleckvieh breed are more resistant to the exploitation conditions formilk production than compared with cows from Holstein-Friesian breed.

  14. Doppler Assessment of Uterine Blood Flow in Recurrent Pregnancy Loss

    Directory of Open Access Journals (Sweden)

    Maryam Barzin

    2011-05-01

    Full Text Available Recurrent spontaneous abortion affects 2%-5% of"ncouples. Uterine perfusion is considered as one of the"nfactors that influences the success of implantation."nDuring the normal menstrual cycle, the impedance"nto uterine artery blood flow diminishes progressively"nduring the luteal phase, reaching the lowest values"nin the period coinciding with the implantation time."nImpedance of uterine arteries is a good indicator of"nthe possibility of a subsequent pregnancy. High blood"nflow resistance is associated with a reduced conception"nrate and women with lower pulsatility index values"nhave the highest possibility of becoming pregnant. An"nimpaired uterine perfusion could play a major role in"nthe pathogenesis of recurrent spontaneous abortion. In"nthis study, we examined sixty women with recurrent"nspontaneous abortion and a control group including"nthirty normal women with at least one previous"nuncomplicated pregnancy and without history of any"nabortion. Transvaginal sonography associated with"nDoppler flow measurement was performed during"nthe midluteal phase of a cycle in all women. The"nmeasurement of the ascending branch of both right"nand left uterine arteries was taken lateral to the cervix"nat the level of the internal os. The pulsatility and"nresistance index of both uterine arteries were calculated"nand compared in both groups. In this presentation we"nreport our finding in two groups. We also explain the"nexact method of study and present some interesting"ncases

  15. A rare case of repeated expulsions of a giant cervical fibroid per vaginum followed by delivery of near term babies in two consecutive pregnancies

    Directory of Open Access Journals (Sweden)

    Vaibhav Kanti

    2014-06-01

    Full Text Available Huge cervical fibroid polyp with red degeneration, obstructing birth canal might be a night mare for obstetricians. Most of us will plan for a caesarean section but somehow due to lack medical consultation; a patient in rural setup with a huge cervical fibroid, delivered normal in two consecutive pregnancies. This case is unique because no such case has been reported in literature where normal delivery took place twice in the same patient, with such a huge fibroid with red degeneration, obstructing the birth canal. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 790-792

  16. A Fibroid or Cancer? A Rare Case of Mixed Choriocarcinoma and Epithelioid Trophoblastic Tumour

    Directory of Open Access Journals (Sweden)

    Wan Yu Luk

    2013-01-01

    Full Text Available Background. Gestational trophoblastic disease (GTD is a rare complication of pregnancy which is characterised by abnormal growth of the trophoblasts at the placental site. It is categorised into benign and malignant forms, which include hydatidiform moles (HMs and gestational trophoblastic neoplasia (GTN, respectively. A mixed choriocarcinoma (CC and epithelioid trophoblastic tumour (ETT is an extremely rare subgroup of GTN, which is a highly curable but aggressive form of malignancy. Case. We report a case of mixed CC and ETT in a 41-year-old patient who presented with a 2-year history of menorrhagia and fibroid uterus in the absence of previous history of molar pregnancy. She had a 12-year interval between the antecedent pregnancy and presentation. She was treated with intensive regimen of adjuvant chemotherapy, etoposide, methotrexate, and actinomycin-D with etoposide and cisplatin (EMA-EP. She has remained disease free for more than 5 years. Conclusion. This case highlights the importance of considering GTN as one of the differential diagnoses value of β-HCG in patients presented with menorrhagia and growing fibroids.

  17. Central cervical fibroid with a typical Lantern on top of St. Paul's cathedral appearance

    Directory of Open Access Journals (Sweden)

    Ambarisha Bhandiwad

    2016-03-01

    Full Text Available Leiomyoma of the uterus in one of the common benign gynecological conditions and one of the rare locations of a fibroid is from the cervix with an incidence of upto 2%. We are reporting a case of a 46 year old patient who came with complaints of mass per abdomen and with a history of retention of urine twice in the past one and half months. Abdominal examination revealed a firm mass of 24 weeks size gravid uterus with restricted mobility arising from the pelvis and a speculum examination, showed a mass protruding through the vagina with all the walls ballooned out and it appeared as if a head of the baby was protruding out in second stage of labor. It was a 1.9kg central cervical fibroid with a typical "Lantern on top of St. Paul's cathedral" appearance which was operated without any complications. [Int J Reprod Contracept Obstet Gynecol 2016; 5(3.000: 924-926

  18. Complete uterine prolapse without uterine mucosal eversion in a queen.

    Science.gov (United States)

    Bigliardi, E; Di Ianni, F; Parmigiani, E; Cantoni, A M; Bresciani, C

    2014-04-01

    A five-year-old female cat weighing 3 kg was presented by the owner after noticing a large pink, bilobed mass protruding through the vulva during labour. The cat was in good condition, with appropriate lactation, and the newborn kittens were nursing normally. The uterus was not reverted or invaginated at examination, and there was rupture of the mesovarium, mesometrium and uterine-vaginal connection around the cervix. Manual reduction of the prolapsed uterus was not possible because of torn ligaments. A coeliotomy was performed to remove the ovaries, and the apex of the uterine horns was passed by the vaginal route. The remaining part of the mesometrium was disconnected, and the prolapsed uterus was removed. The queen and kittens were discharged from the hospital on the second day after surgery. An unusual feature of this case is that the prolapse was complete, without eversion of any part of the uterus through a vaginal tear.

  19. Totally inverted cervix due to a huge prolapsed cervical myoma simulating chronic non-puerperal uterine inversion.

    Science.gov (United States)

    Turhan, Nilgun; Simavli, Serap; Kaygusuz, Ikbal; Kasap, Burcu

    2014-01-01

    Inversion of the uterus is an extremely rare complication of the non-puerperal period and is commonly caused by benign submucous, especially fundal, leiomyomas. A case of a totally inverted cervix due to a prolapsed huge cervical leiomyoma mimicking chronic non-puerperal uterine inversion in a perimenopausal woman is presented. A 52-year-old perimenopausal woman was admitted to our clinic with an ulcerated, necrotic, infected and swollen prolapsed mass. Gynecologic history revealed that she was advised myomectomy because of her cervical myoma 2 years ago but she refused to have an operation as she believed that her positive thoughts would shrink the myoma. Presumed diagnosis before surgery was chronic non-puerperal uterine inversion. An intraoperative diagnosis was totally inverted cervix due to a huge cervical leiomyoma. Vaginal hysterectomy without adnexectomy, was performed. This is the first case in the literature which a totally inverted cervix due to a prolapsed huge cervical leiomyoma. Cervical fibroids can grow in perimenopausal period and in extremely rare cases can cause total cervical inversion. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Uterine torsion in term pregnancy

    Directory of Open Access Journals (Sweden)

    Sparić Radmila

    2007-01-01

    Full Text Available Introduction Uterine torsion has been defined as a rotation of more than 45 degrees of the uterus around its long axis that occurs at the junction between the cervix and the corpus. The extent of the rotation is usually 180 degrees, although cases with torsion from 60 to 720 degrees have been reported. Aetiopathogenesis of this condition is still unclear. Establishing clinical diagnosis of this condition is difficult, but very important for reducing maternal and fetal morbidity and mortality. Clinical symptoms are either absent or nonspecific, and the diagnosis is usually made at laparotomy. Case outlineA 31-year old patient was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, as an emergency, seven days upon the established intrauterine fetal demise in the 40th gestation week. On uterine examination, the cervical length of 1.5 cm and dilatation of 3 cm were determined, as well as a palpable soft tissue formation, not resembling placenta praevia. Ultrasound examination confirmed fetal demise and exclusion of the presence of placenta praevia. The labor was completed by caesarean section. During surgery, uterine torsion of 180 degrees to the right was diagnosed. There was a stillborn male baby, and the cause of death was intrauterine asphyxia. A fibrosing and calcified accessory lobe 9x6x2.5 cm in size was observed on placental examination, which is a possible sign of initial gemellary pregnancy. Conclusion The clinical presentation of uterine torsion is variable and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. The method of choice for establishing the diagnosis is magnetic resonance imaging. Once the diagnosis of uterine torsion in pregnancy is established, emergency laparotomy is indicated. Following caesarean delivery, it is necessary to surgically remove all the anatomical causes of torsion, and rotate the uterus back to its normal position. There are some

  1. Effects of vascular elastosis on uterine blood flow and perfusion in anesthetized mares.

    Science.gov (United States)

    Esteller-Vico, A; Liu, I K M; Vaughan, B; Steffey, E P; Brosnan, R J

    2015-04-01

    In the uterus of the mare, data obtained using transrectal Doppler ultrasonography indicate that uterine blood flow (UBF) is dynamic and changes throughout the estrous cycle. Degenerative lesions in the uterus are associated with subfertility and infertility. Among these lesions, vascular elastosis has been reported in aged, multiparous, and infertile mares. Angiosis of the uterine vasculature could potentially compromise UBF. The objectives of this experiment are to determine levels of UBF and perfusion of reproductively healthy mares and compare them to levels of subfertile/infertile mares affected by uterine vascular elastosis. Twenty mares were classified on the basis of degree of vascular degeneration and stage of cycle. A fluorescent microsphere technique was used to measure reproductive organ perfusion, where microspheres were injected into the left ventricle of the heart and became trapped in capillary beds in proportion to blood flow and tissue perfusion. The reproductive tract was removed, sectioned, and the fluorescent intensity evaluated to measure blood flow and perfusion. Additionally, full-thickness samples of the uterine wall were examined postmortem to further assess the degree of vascular degeneration in all layers of uterine wall. The mean value of uterine perfusion for the control mares during estrus (n = 5) was higher (P perfusion was not different (P > 0.05) during estrus (n = 5) and diestrus (n = 5); 5.9 and 7.2 mL/min/100g, respectively. Uterine perfusion in subfertile/infertile mares affected by elastosis was lower than that of control mares during both estrus (P perfusion between the control and elastosis groups indicate that elastosis of the uterine vasculature is associated with decreased uterine perfusion during both phases of the estrous cycle. In the uterus, a compromise in UBF could have implications in endometrial glandular development, postbreeding endometritis, uterine clearance, development of the conceptus, and

  2. Complete and partial uterine perforation and embedding following insertion of intrauterine devices. II. Diagnostic methods, prevention, and management.

    Science.gov (United States)

    Zakin, D; Stern, W Z; Rosenblatt, R

    1981-08-01

    This paper discusses the various methods used to diagnose uterine perforation caused by an IUD. Radiography, or plain film, has a limited use in the diagnosis of uterine perforation since its usefulness depends on the radiopacity of the particular IUD; if the IUD appears on film, plain film does not allow one to conclude whether the device is in its proper position. Several modifications of plain film have been tried but all methods fall short of their goals. Hysterography permits the best diagnostic assessment since it allows the visualization of the entire uterine cavity so that the position of the IUD is immediately evident in cases of embedding and of perforation. Pelvic pneumography can differentiate between intraperitoneal or extraperitoneal locations of perforated IUDs; it can be enhanced by hysterosalpingography and can be done on an ambulatory basis. Ultrasonography simply determines the presence or absence of an IUD, but has the advantage of accurately demonstrating a concomitant pregnancy; the sonogram is not reliable if the IUD is surrounded by omentum or by loops of bowel; ultrasonography can be advantageously coupled with hysterography. Laparoscopy is still the method most used to diagnose uterine IUD perforation; when removal of the device is advisable laparotomy is usually carried out concomitantly; successful laparoscopy requires a skilled and experienced operator. Hysteroscopy is a new and extremely valuable technique which should not be chosen as a primary procedure because it carries a risk of complications. The best prevention of uterine perforation is a meticulous and well executed insertion technique, done only by an experienced operator and after a careful pelvic examination. Uterine size, consistency and position must be exactly known; IUD insertion is easier during or immediately after menstruation. Perforated IUDs should be removed even if considered innocuous, although this is a matter still debated by the specialists. Spontaneous IUD

  3. Uterosacral ligament smooth muscle cell apoptosis is increased in women with uterine prolapse.

    Science.gov (United States)

    Takacs, Peter; Nassiri, Mehdi; Gualtieri, Marc; Candiotti, Keith; Medina, Carlos A

    2009-05-01

    The purpose of this study was to compare the smooth muscle content and apoptosis of the uterosacral ligament in women with and without uterine prolapse. Uterosacral ligaments were sampled in women with (n = 9) or without (n = 9) uterine prolapse undergoing hysterectomy. Smooth muscle of the uterosacral ligament was identified by immunohistochemistry. Digital image analysis was used to determine the fractional area of smooth muscle in the histologic cross sections. Apoptosis was assessed by terminal deoxynucelotidyl-transferase-mediated dUTP nick-end-labeling method. The fractional area of nonvascular smooth muscle in the uterosacral ligament of women with uterine prolapse was significantly decreased compared to women without prolapse (0.32 +/- 0.12 vs. 0.42 +/- 0.03, P = .02) and the apoptotic index was significantly higher compared to women without prolapse (0.20 +/- 0.06 vs. 0.08 +/- 0.04, P uterine prolapse compared to women without prolapse.

  4. Comparison of simple uterine manipulator-injector (SUMI with the Cohen cannula in gynecologic laparoscopy

    Directory of Open Access Journals (Sweden)

    Karim Hassanein Abd-El-Maeboud

    2011-12-01

    Conclusion: Although SUMI takes longer to insert, the ease of its use is comparable with the Cohen cannula. A major advantage of its use is increased range of uterine maneuverability with better surgical field exposure.

  5. Clinical and laboratory characteristics of women with uterine leiomiyoma

    Directory of Open Access Journals (Sweden)

    Özgür ÖZKUL

    2009-06-01

    Full Text Available The aim of this study was to compare clinical and laboratory findings of women with or without uterine leiomyoma.Study group consisted of 82 women with uterine leiomyoma and the control group comprised 42 healthy women. Women’s age, gravity, parity, blood groups, pattern of menstrual cycles, complaints at presentation, fertility, ultrasonographical findings, surgical operations and thyroid function tests were evaluated.There were no significant differences in blood group distribution, gravity, parity and thyroid function test results between the patients and the control subjects (P>0.05. A significant difference was found in the complaints at presentation between two groups (P<0.001. Mentrual cycles irregularity was more frequently found in the patients compared with the controls (57.3% vs. 42.9%, respectively, P=0.009. Although no infertile woman was found in the control group, 8.5% of patients were found to have infertility. The sensitivity of ultrasonography was found to be 97.6%. Except for the existence of higher infertility rate and the menstrual cycles irregularities, no significant difference was found in the clinical and laboratory findings between women with or without uterine leiomyoma. Therefore, physical examination and imaging methods are remained as the most important diagnostic tools for uterine leiomyoma.

  6. Dietary melatonin alters uterine artery hemodynamics in pregnant Holstein heifers.

    Science.gov (United States)

    Brockus, K E; Hart, C G; Gilfeather, C L; Fleming, B O; Lemley, C O

    2016-04-01

    The objective was to examine uterine artery hemodynamics and maternal serum profiles in pregnant heifers supplemented with dietary melatonin (MEL) or no supplementation (CON). In addition, melatonin receptor-mediated responses in steroid metabolism were examined using a bovine endometrial epithelial culture system. Twenty singleton pregnant Holstein heifers were supplemented with 20 mg of melatonin (n = 10) or no melatonin supplementation (control; n = 10) from days 190 to 262 of gestation. Maternal measurements were recorded on days 180 (baseline), 210, 240, and 262 of gestation. Total uterine blood flow was increased by 25% in the MEL-treated heifers compared with the CON. Concentrations of progesterone were decreased in MEL vs CON heifers. Total serum antioxidant capacity was increased by 43% in MEL-treated heifers when compared with CON. Activity of cytochrome P450 1A, 2C, and superoxide dismutase was increased in bovine endometrial epithelial cells treated with melatonin, whereas the melatonin receptor antagonist, luzindole, negated the increase in cytochrome P450 2C activity. Moreover, estradiol or progesterone treatment altered bovine uterine melatonin receptor expression, which could potentiate the melatonin-mediated responses during late gestation. The observed increase in total uterine blood flow during melatonin supplementation could be related to its antioxidant properties. Compromised pregnancies are typically accompanied by increased oxidative stress; therefore, melatonin could serve as a therapeutic supplementation strategy. This could lead to further fetal programming implications in conjunction with offspring growth and development postnatally.

  7. Adenocarcinoma of the uterine cervix.

    Science.gov (United States)

    Rutledge, F N; Galakatos, A E; Wharton, J T; Smith, J P

    1975-05-01

    From January 1, 1947, through December 31, 1971, 219 patients with primary adenocarcinoma of the intact uterine cervix were treated at the M.D. Anderson Hospital and Tumor Institute. Two modes of therapy were primarily used, namely, irradiationtherapy alone and irradiation therapy plus operation. The 5 year survival resultsare 83.7 per cent for patients with Stage i disease, 48.0 per cent for patients with Stage ii disease, 29.2 per cent for patients with Stage iii disease, and 0.0 per cent for patients with Stage iv disease. The group with irradiation plus operation had a better over-all survival rate. In addition, the incidence of central and pelvic recurrent disease was remarkably lower (fourfold difference). The urologic and bowel complications are discussed. This review lends support for our practice of preoperative irradiation followed by simple (constructive) hysterectomy for selected patients eith adenocarcinoma of the uterine cervix.

  8. 子宫肌瘤中医证型与腹腔镜镜像相关性研究%The relationship between TCM symptom type and the laparoscope vision in uterine myoma

    Institute of Scientific and Technical Information of China (English)

    林忠; 葛丽婷; 刘英

    2012-01-01

    [Objective] To study uterus mirror typical performance of myoma under laparoscopy in different TCM syndromes and provide an objective basis for TCM syndrome differentiation. [Methods] In accordance with the inclusion criteria, 105 cases of myoma of uterus were identified . Preoperative differentiation of traditional Chinese Medicine, the uterine fibroids were divided into four basic patterns: Qi stagnation and blood stasis phlegm, stasis, moist heat and blood stasis, deficiency of kidney and blood stasis. Uterine appearance, color, shape, position, number of myomas, scope, types, distribution of surface vessels, section structure (tissue and its relation to) etc were intraoperative observed under laparoscopy. [Results] The damp-heat and blood stasis treated with uterine overall color was red, kidney deficiency blood stasis of patients with uterine overall color was pale red, Phlegm Blood Stasis of patients with uterine overall color was white, the stagnancy of Qi and blood stasis in patients with uterine overall color was dark purple. Patients with uterine fibroids uterine vascular rich surface, which type of qi stagnation and blood stasis vascular color to dark purple, Phlegm Blood Stasis to pale red, red of moist heat and blood stasis, deficiency of kidney and blood stasis was light red. [ Conclusions ] Laparoscopic mirror with TCM syndrome type exists between internal relation and regularity. These rules for uterine fibroids with integrated traditional Chinese and Western medicine diagnosis and treatment is of great significance.%目的 探讨腹腔镜下不同中医证型子宫肌瘤镜像典型表现,为中医辨证提供客观依据.方法 按照纳入标准确定子宫肌瘤患者105例,术前进行中医辨证,将子宫肌瘤分为4种基本证型:气滞血瘀、痰湿瘀结、湿热瘀阻、肾虚血瘀.术中腹腔镜下观察子宫外观、颜色、肌瘤数目、形态、位置、范围、类型、表面血管分布、剖面结

  9. Features of Postmenopausal Uterine Haemorrhage

    OpenAIRE

    Izetbegovic, Sebija; Stojkanovic, Goran; Ribic, Nihad; Mehmedbasic, Eldar

    2013-01-01

    ABSTRACT Introduction: Postmenopausal uterine bleeding is a „cancer until proven otherwise”. Endometrial cancer is a typical disease among postmenopause woman, because every bleeding in this age etiology associated with endometrial cancer (10-30%). The lifespan of women today has been extended and post menopause today last one third of a woman’s life. Early diagnosis of endometrial cancer has a very high cure rate. Screening for this cancer has limits in practice and is necessary given the de...

  10. [Effect of D-(-)-norgestrel on uterine contractility in the puerperium (author's transl)].

    Science.gov (United States)

    Romero-Salinas, G; La Torre-Rasguido, F; Vera-Cáceres, R; Escalera-Villarreal, G; Bandera-Gonzalez, B

    1981-01-01

    It is usual for women to ask for temporary control of fertility during the puerperium. When hormonal therapy is administered, the selection of the adequate pill is very important. The effect of D-(-)-norgestrel 300mg was studied on uterine contractility values during puerperium is seven patients breast feeding and was compared with a control group of 26. The 33 patients had the following characteristics: multiparous during puerperium without recent episiotomy, with healthy cervix, absence of genital septic focus, uterine tumours or malformations; all of them breast feeding. In the hypothesis, it was considered that the endogenous oxytocin increases and stimulates the mammary mioepithelium and uterine contractilities. For recording uterine contractility, the technique of Jaumandreu and Hendricks was used. The recordings were made during 24 hours postpartum, and at 5, 10, 20, 30, and 40 days with a duration 2 to 3 hours. All the studies were longitudinal. The changes of the human uterine contractility during normal puerperium were estimated. The range of the tonus was 22--41 mm Hg, the intensity 5--18 mm Hg, the frequency 17--23 contractions in 10 minutes, and the uterine activity 102--223 Montevideo Units. In the control group the following results were obtained: The range of the tonus was 24--34 mm Hg, the intensity 9--16 mm Hg, the frequency 17--37 contractions in 10 minutes, and the uterine contractility 137--524 Montevideo Units. In the comparative study Student's t test was used and p estimated.

  11. Review literature on uterine carcinosarcoma

    Directory of Open Access Journals (Sweden)

    Rajendra Singh

    2014-01-01

    Full Text Available Carcinosarcoma of the uterus is a rare gynaecological neoplasm, which is also known as malignant mixed mesodermal tumor. Traditionally this tumour has been regarded as a subtype of uterine sarcoma, and its origin remains controversial. The exact nature and prognosis was not clear in the past. It is believed that uterine carcinosarcoma have a Mullerian duct origin and have a capacity to differentiate into various mesenchymal and epithelial components. Regarding the histogensis, various theories have been given; of which ′conversion theory′ was broadly accepted. Carcinosarcoma are mostly of monoclonal origin with the carcinomatous component being the driving force. This type of tumor is broadly divided into two groups, homologous and heterologous, depending on the characteristics of the stroma or mesenchymal components of endometrial tissue. It is more frequent in black women and postmenopausal women. Radiation is a possible etiological factor but the exact etiology is not known yet. However, tamoxifen may induce carcinogenesis in some patients. Its clinical feature is very similar to endometrial carcinoma i.e. postmenopausal vaginal bleeding, have a very aggressive behavior and a poor prognosis. This pelvic malignancy is treated by multimodality therapy including surgery, chemotherapy and radiotherapy. Here we are reviewing old concepts about the disease and modern understandings of the origin, classification, pathogenesis and recent advances in the treatment of the uterine carcinosarcoma.

  12. Use of an Intubating Stylet as a Guide to Complete Uterine Curettage Complicated by Uterine Perforation

    OpenAIRE

    Baum, Jonathan D.; Sherlock, Douglas J.; Atkinson, Andrew L.

    2013-01-01

    Completion of uterine curettage may be challenging following uterine perforation even under sonographic and laparoscopic monitoring. This report illustrates the use of a flexible intubating stylet as a guide to place the suction curette into the uterine cavity when sonography and laparoscopy alone are not successful. Use of a malleable instrument such as an intubating stylet as a guide should be considered an option when insertion of the suction curette into the uterine cavity is complicated ...

  13. Potential Therapeutic Targets in Uterine Sarcomas

    OpenAIRE

    2015-01-01

    Uterine sarcomas are rare tumors accounting for 3,4% of all uterine cancers. Even after radical hysterectomy, most patients relapse or present with distant metastases. The very limited clinical benefit of adjuvant cytotoxic treatments is reflected by high mortality rates, emphasizing the need for new treatment strategies. This review summarizes rising potential targets in four distinct subtypes of uterine sarcomas: leiomyosarcoma, low-grade and high-grade endometrial stromal sarcoma, and undi...

  14. Spontaneous Uterine Rupture during Pregnancy: Case Report and ...

    African Journals Online (AJOL)

    After ultrasound scan, uterine rupture was diagnosed and an emergency .... Uterine rupture in multiparity occurs usually during labour. We think that our patient may have had uterine scar from ... abdominal pains and signs of shock, at which.

  15. Maternal uterine vascular remodeling during pregnancy.

    Science.gov (United States)

    Osol, George; Mandala, Maurizio

    2009-02-01

    Sufficient uteroplacental blood flow is essential for normal pregnancy outcome and is accomplished by the coordinated growth and remodeling of the entire uterine circulation, as well as the creation of a new fetal vascular organ: the placenta. The process of remodeling involves a number of cellular processes, including hyperplasia and hypertrophy, rearrangement of existing elements, and changes in extracellular matrix. In this review, we provide information on uterine blood flow increases during pregnancy, the influence of placentation type on the distribution of uterine vascular resistance, consideration of the patterns, nature, and extent of maternal uterine vascular remodeling during pregnancy, and what is known about the underlying cellular mechanisms.

  16. [Chronic renal failure secondary to uterine prolapse].

    Science.gov (United States)

    Peces, R; Canora, J; Venegas, J L

    2005-01-01

    Acute and chronic renal failure secondary to bilateral severe hydroureteronephrosis is a rare sequela of uterine prolapse. We report a case of neglected complete uterine prolapse in a 72-year-old patient resulting in bilateral hydroureter, hydronephrosis, and chronic renal failure. In an attempt to diminish the ureteral obstruction a vaginal pessary was used to reduce the uterine prolapse. Finally, surgical repair of prolapse by means of a vaginal hysterectomy was performed. In conclusion, all patients presenting with complete uterine prolapse should be screened to exclude urinary tract obstruction. If present, obstructive uropathy should be relieved by the reduction or repair of the prolapse before irreversible renal damage occurs.

  17. Skeletal muscle metastasis from uterine leiomyosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    O' Brien, J.M.; Brennan, D.D.; Taylor, D.H.; Eustace, S.J. [Cappagh National Orthopaedic Hospital, Department of Radiology, Dublin (Ireland); Holloway, D.P.; O' Keane, J.C. [Cappagh National Orthopaedic Hospital, Department of Pathology, Dublin (Ireland); Hurson, B. [Cappagh National Orthopaedic Hospital, Department of Orthopaedics, Dublin (Ireland)

    2004-11-01

    A case of a 68-year-old woman who presented with a rapidly enlarging painful right thigh mass is presented. She had a known diagnosis of uterine leiomyosarcoma following a hysterectomy for dysfunctional uterine bleeding. She subsequently developed a single hepatic metastatic deposit that responded well to radiofrequency ablation. Whole-body MRI and MRA revealed a vascular mass in the sartorius muscle and a smaller adjacent mass in the gracilis muscle, proven to represent metastatic leiomyosarcoma of uterine origin. To our knowledge, metastatic uterine leiomyosarcoma to the skeletal muscle has not been described previously in the English medical literature. (orig.)

  18. Skeletal muscle metastasis from uterine leiomyosarcoma.

    Science.gov (United States)

    O'Brien, J M; Brennan, D D; Taylor, D H; Holloway, D P; Hurson, B; O'Keane, J C; Eustace, S J

    2004-11-01

    A case of a 68-year-old woman who presented with a rapidly enlarging painful right thigh mass is presented. She had a known diagnosis of uterine leiomyosarcoma following a hysterectomy for dysfunctional uterine bleeding. She subsequently developed a single hepatic metastatic deposit that responded well to radiofrequency ablation. Whole-body MRI and MRA revealed a vascular mass in the sartorius muscle and a smaller adjacent mass in the gracilis muscle, proven to represent metastatic leiomyosarcoma of uterine origin. To our knowledge, metastatic uterine leiomyosarcoma to the skeletal muscle has not been described previously in the English medical literature.

  19. Application of detergents or high hydrostatic pressure as decellularization processes in uterine tissues and their subsequent effects on in vivo uterine regeneration in murine models.

    Directory of Open Access Journals (Sweden)

    Erna G Santoso

    Full Text Available Infertility caused by ovarian or tubal problems can be treated using In Vitro Fertilization and Embryo Transfer (IVF-ET; however, this is not possible for women with uterine loss and malformations that require uterine reconstruction for the treatment of their infertility. In this study, we are the first to report the usefulness of decellularized matrices as a scaffold for uterine reconstruction. Uterine tissues were extracted from Sprague Dawley (SD rats and decellularized using either sodium dodecyl sulfate (SDS or high hydrostatic pressure (HHP at optimized conditions. Histological staining and quantitative analysis showed that both SDS and HHP methods effectively removed cells from the tissues with, specifically, a significant reduction of DNA contents for HHP constructs. HHP constructs highly retained the collagen content, the main component of extracellular matrices in uterine tissue, compared to SDS constructs and had similar content levels of collagen to the native tissue. The mechanical strength of the HHP constructs was similar to that of the native tissue, while that of the SDS constructs was significantly elevated. Transmission electron microscopy (TEM revealed no apparent denaturation of collagen fibers in the HHP constructs compared to the SDS constructs. Transplantation of the decellularized tissues into rat uteri revealed the successful regeneration of the uterine tissues with a 3-layer structure 30 days after the transplantation. Moreover, a lot of epithelial gland tissue and Ki67 positive cells were detected. Immunohistochemical analyses showed that the regenerated tissues have a normal response to ovarian hormone for pregnancy. The subsequent pregnancy test after 30 days transplantation revealed successful pregnancy for both the SDS and HHP groups. These findings indicate that the decellularized matrix from the uterine tissue can be a potential scaffold for uterine regeneration.

  20. Application of detergents or high hydrostatic pressure as decellularization processes in uterine tissues and their subsequent effects on in vivo uterine regeneration in murine models.

    Science.gov (United States)

    Santoso, Erna G; Yoshida, Keita; Hirota, Yasushi; Aizawa, Masanori; Yoshino, Osamu; Kishida, Akio; Osuga, Yutaka; Saito, Shigeru; Ushida, Takashi; Furukawa, Katsuko S

    2014-01-01

    Infertility caused by ovarian or tubal problems can be treated using In Vitro Fertilization and Embryo Transfer (IVF-ET); however, this is not possible for women with uterine loss and malformations that require uterine reconstruction for the treatment of their infertility. In this study, we are the first to report the usefulness of decellularized matrices as a scaffold for uterine reconstruction. Uterine tissues were extracted from Sprague Dawley (SD) rats and decellularized using either sodium dodecyl sulfate (SDS) or high hydrostatic pressure (HHP) at optimized conditions. Histological staining and quantitative analysis showed that both SDS and HHP methods effectively removed cells from the tissues with, specifically, a significant reduction of DNA contents for HHP constructs. HHP constructs highly retained the collagen content, the main component of extracellular matrices in uterine tissue, compared to SDS constructs and had similar content levels of collagen to the native tissue. The mechanical strength of the HHP constructs was similar to that of the native tissue, while that of the SDS constructs was significantly elevated. Transmission electron microscopy (TEM) revealed no apparent denaturation of collagen fibers in the HHP constructs compared to the SDS constructs. Transplantation of the decellularized tissues into rat uteri revealed the successful regeneration of the uterine tissues with a 3-layer structure 30 days after the transplantation. Moreover, a lot of epithelial gland tissue and Ki67 positive cells were detected. Immunohistochemical analyses showed that the regenerated tissues have a normal response to ovarian hormone for pregnancy. The subsequent pregnancy test after 30 days transplantation revealed successful pregnancy for both the SDS and HHP groups. These findings indicate that the decellularized matrix from the uterine tissue can be a potential scaffold for uterine regeneration.

  1. Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Cuilan Li

    2016-01-01

    Full Text Available Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum. Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS, and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery. Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05, respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40. Three patients (3/40 = 7.5% developed partial improvement, and 1/40 (2.5% was lost to follow-up. Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

  2. Time from uterine incision to delivery and hypoxic neonatal outcomes.

    Science.gov (United States)

    Spain, Janine E; Tuuli, Methodius; Stout, Molly J; Roehl, Kimberly A; Odibo, Anthony O; Macones, George A; Cahill, Alison G

    2015-04-01

    The objective of this study was to estimate the association between time from uterine incision to delivery and hypoxic neonatal outcomes in nonanomalous term infants. All women undergoing in-labor term cesarean deliveries (CDs) in the first 2 years of an ongoing prospective cohort study were included. The primary exposure was time in seconds from uterine incision to delivery. The primary outcome was a composite of hypoxia-associated neonatal outcomes, defined as at least one of: seizures, hypoxic ischemic encephalopathy, need for hypothermia treatment, and death within 7 days. Of 812 patients who underwent in-labor CD, the composite hypoxia outcome occurred in 18 (2.2%) neonates. There was no significant difference in the rate of hypoxic morbidity with increasing increments of 60 seconds from uterine incision to delivery (p = 0.35). There was a significantly increased risk of hypoxic morbidity in those delivered in the highest quintile (>240 seconds) compared with those in the lowest quintile (≤ 60 seconds) in cesareans performed for an indication other than nonreassuring fetal status (relative risk, 5.58; 95% confidence interval, 1.30-23.91). Overall, duration from uterine incision to delivery for in-labor cesareans of nonanomalous term infants was not associated with an increase in risk of hypoxia-associated morbidities. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Medroxyprogesterone in Treating Patients With Endometrioid Adenocarcinoma of the Uterine Corpus

    Science.gov (United States)

    2016-03-17

    Endometrial Adenocarcinoma; Endometrial Adenosquamous Carcinoma; Endometrial Endometrioid Adenocarcinoma, Variant With Squamous Differentiation; Recurrent Uterine Corpus Carcinoma; Stage I Uterine Corpus Cancer; Stage II Uterine Corpus Cancer; Stage III Uterine Corpus Cancer; Stage IV Uterine Corpus Cancer

  4. Use of an Intubating Stylet as a Guide to Complete Uterine Curettage Complicated by Uterine Perforation

    Directory of Open Access Journals (Sweden)

    Jonathan D. Baum

    2013-01-01

    Full Text Available Completion of uterine curettage may be challenging following uterine perforation even under sonographic and laparoscopic monitoring. This report illustrates the use of a flexible intubating stylet as a guide to place the suction curette into the uterine cavity when sonography and laparoscopy alone are not successful. Use of a malleable instrument such as an intubating stylet as a guide should be considered an option when insertion of the suction curette into the uterine cavity is complicated by anatomic variation and uterine perforation.

  5. Uterine and eggshell structure and histochemistry in a lizard with prolonged uterine egg retention (Lacertilia, Scincidae, Saiphos).

    Science.gov (United States)

    Stewart, James R; Mathieson, Ashley N; Ecay, Tom W; Herbert, Jacquie F; Parker, Scott L; Thompson, Michael B

    2010-11-01

    The eggshell of lizards is a complex structure composed of organic and inorganic molecules secreted by the oviduct, which protects the embryo by providing a barrier to the external environment and also allows the exchange of respiratory gases and water for life support. Calcium deposited on the surface of the eggshell provides an important nutrient source for the embryo. Variation in physical conditions encountered by eggs results in a tradeoff among these functions and influences eggshell structure. Evolution of prolonged uterine egg retention results in a significant change in the incubation environment, notably reduction in efficiency of gas exchange, and selection should favor a concomitant reduction in eggshell thickness. This model is supported by studies that demonstrate an inverse correlation between eggshell thickness and length of uterine egg retention. One mechanism leading to thinning of the eggshell is reduction in size of uterine shell glands. Saiphos equalis is an Australian scincid lizard with an unusual pattern of geographic variation in reproductive mode. All populations retain eggs in the uterus beyond the embryonic stage at oviposition typical for lizards, and some are viviparous. We compared structure and histochemistry of the uterus and eggshell of two populations of S. equalis, prolonged egg retention, and viviparous to test the hypotheses: 1) eggshell thickness is inversely correlated with length of egg retention and 2) eggshell thickness is positively correlated with size of shell glands. We found support for the first hypothesis but also found that eggshells of both populations are surprisingly thick compared with other lizards. Our histochemical data support prior conclusions that uterine shell glands are the source of protein fiber matrix of the eggshell, but we did not find a correlation between size of shell glands and eggshell thickness. Eggshell thickness is likely determined by density of uterine shell glands in this species.

  6. Pure compared with mixed serous endometrial carcinoma: two different entities?

    NARCIS (Netherlands)

    Roelofsen, T.; Ham, M.A. van; Wiersma van Tilburg, J.M.; Zomer, S.F.; Bol, M.; Massuger, L.F.A.G.; Bulten, J.

    2012-01-01

    OBJECTIVE: : To analyze whether mixed compared with pure uterine papillary serous carcinoma histology affects clinical outcome, and to assess uterine papillary serous carcinoma for its association with the precursor lesion endometrial intraepithelial carcinoma. METHODS: : A multi-institution observa

  7. Differential expression of uterine NO in pregnant and nonpregnant rats with intrauterine bacterial infection.

    Science.gov (United States)

    Fang, L; Nowicki, B; Yallampalli, C

    2001-05-01

    Previous studies have demonstrated that nitric oxide (NO) is involved in the uterine host defense against bacterial infection. In nonpregnant rats, NO production in the uterus was shown to be lower, and inducible NO synthase (NOS) expression was undetectable. However, studies in pregnant rats show abundant expression of inducible NOS with significant elevation in NO production in the uterus. We have recently reported that intrauterine Escherichia coli infection caused a localized increase in uterine NO production and inducible NOS expression in the nonpregnant rat. In our present study, we examined whether the uterine NO production, NOS expression, and uterine tumor necrosis factor-alpha protein are increased in pregnant rats with intrauterine pathogenic Escherichia coli infection. Unlike the nonpregnant state, the NO production in the infected uterine horn of pregnant rats was not significantly elevated after bacterial inoculation compared with the contralateral uterine horn. The expression of uterine NOS (types II and III) also did not show significant upregulation in the infected horn. This is in contrast to that in nonpregnant animals, in which type II NOS was induced in the uterus on infection. Moreover, intrauterine infection induced an elevated expression of tumor necrosis factor-alpha protein in the infected horn both of nonpregnant and of pregnant rats. These data suggest that the sequential stimulation of NOS expression, especially the inducible isoform, and generation of uterine NO are lacking during pregnancy despite an elevated tumor necrosis factor-alpha after infection. In summary, NO synthesis response may be maximal at pregnancy, and infection may not further induce the NO system. Present studies, together with our previous report that intrauterine infection-induced lethality in pregnancy rats was amplified with the inhibition of NO, suggest that pregnancy is a state predisposed for increased complications associated with intrauterine infection and

  8. Traction force needed to reproduce physiologically observed uterine movement: technique development, feasibility assessment, and preliminary findings.

    Science.gov (United States)

    Swenson, Carolyn W; Luo, Jiajia; Chen, Luyun; Ashton-Miller, James A; DeLancey, John O L

    2016-08-01

    This study aimed to describe a novel strategy to determine the traction forces needed to reproduce physiologic uterine displacement in women with and without prolapse. Participants underwent dynamic stress magnetic resonance imaging (MRI) testing as part of a study examining apical uterine support. Physiologic uterine displacement was determined by analyzing uterine location in images taken at rest and at maximal Valsalva. Force-displacement curves were calculated based on intraoperative cervical traction testing. The intraoperative force required to achieve the uterine displacement measured during MRI was then estimated from these curves. Women were categorized into three groups based on pelvic organ support: group 1 (normal apical and vaginal support), group 2 (normal apical support but vaginal prolapse present), and group 3 (apical prolapse). Data from 19 women were analyzed: five in group 1, five in group 2, and nine in group 3. Groups were similar in terms of age, body mass index (BMI), and parity. Median operating room (OR) force required for uterine displacement measured during MRI was 0.8 N [interquartile range (IQR) 0.62-3.22], and apical ligament stiffness determined using MRI uterine displacement was 0.04 N/mm (IQR 0.02-0.08); differences between groups were nonsignificant. Uterine locations determined at rest and during maximal traction were lower in the OR compared with MRI in all groups. Using this investigative strategy, we determined that only 0.8 N of traction force in the OR was required to achieve maximal physiologic uterine displacement seen during dynamic (maximal Valsalva) MRI testing, regardless of the presence or absence of prolapse.

  9. Physiological remodelling of the maternal uterine circulation during pregnancy.

    Science.gov (United States)

    Mandala, Maurizio; Osol, George

    2012-01-01

    Sufficient uteroplacental blood flow is essential for normal pregnancy outcome and is accomplished by the coordinated growth and remodelling of the entire maternal uterine vasculature. The main focus of this MiniReview is to provide information on upstream (pre-placental) maternal uterine vascular remodelling that facilitates gestational increases in uterine blood flow. Consideration of the three-dimensional pattern of remodelling (circumferential enlargement versus axial elongation), changes in vessel biomechanical properties, and underlying mechanisms [shear stress, nitric oxide, vascular endothelial growth factor (VEGF)/placental growth factor (PlGF), the renin-angiotensin system] and pathways (local versus systemic; venoarterial exchange) are provided using the rat as the principal animal model, although findings from other species are incorporated wherever possible to provide a comparative perspective. The process of maternal gestational uterine vascular remodelling involves a number of cellular processes and mechanisms, including trophoblast invasion, hyperplasia and hypertrophy, and changes in extracellular matrix composition. In addition, changes in cellular function, e.g. the secretory and contractile properties of smooth muscle and an up-regulation of endothelial vasodilatory influences may contribute to uteroplacental blood flow increases through changes in tone as well as in structure. Future studies aimed at better understanding the inter-relationship between changes in vessel structure (remodelling) and function (reactivity) would likely generate new mechanistic insights into the fascinating process of maternal gestational uterine vascular adaptation and provide a more physiological perspective of the underlying cellular processes involved in its regulation. © 2011 The Authors. Basic & Clinical Pharmacology & Toxicology © 2011 Nordic Pharmacological Society.

  10. Clinical application of hysteroscopy in the diagnosis and therapy of pa-tients with abnormal uterine bleeding%宫腔镜在异常子宫出血诊治中的临床应用

    Institute of Scientific and Technical Information of China (English)

    厉霞玲; 刘德佩; 张月存; 冷丽丽

    2015-01-01

    Objective To explore the clinical value of hysteroscopy in the diagnosis and treatment of patients with ab-normal uterine bleeding. Methods Clinic date of 65 cases of abnormal uterine bleeding admitted in Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing University of Chinese Medicine from January to November 2014 were retrospectively analyzed. The patients were checked by hysteroscopy, lesion removal, biopsy for diagnosis and treatment. Through the comparative analysis of the above methods, the clinical application of hysteroscopy in the diagnosis and treatment of abnormal uterine bleeding was analyzed. Results Hysteroscopy found that various degree of endometrial hyperplasia in 20 cases,13 cases of endometrial polyps, 16 cases of endometritis, 9 cases of endometrial hyperplasia or secretory phase change, 4 cases of uterine fibroids, 3 cases of pregnancy residues. After hysteroscopy, all patients were given biopsy,curettage, lesion removal (large polyps and submucosal fibroids were givn hysteroscopic polypectomy). Pathology showed that 27 cases of various degree of endometrial hyperplasia, 10 cases of endometrial polyps, 9 cases of endometritis, 4 cases of endometrial hyperplasia or secretory phase change, submucous myoma of uterus 2 cases, 3 cases of pregnancy residues. The coincidence rate of diagnosis between pathology and pathological examination was 78.46%. Postoperative follow-up, 5 cases of recurence, recurence rate was 9.09%; 50 cases of cure, the cure rate was 93.85%. Conclusion Hysteroscopy can directly observe the intrauterine pathologies, and to assist pathological examination in the diagnosis and treatment of abnormal uterine bleeding, achieve the goal of comprehen-sive, detailed and accurate, is worthy of clinical promotion.%目的:探讨宫腔镜在异常子宫出血诊治中的临床价值。方法回顾分析2014年1~11月南京中医药大学附属南京市中西医结合医院异常子宫出血患者65例的临床

  11. Polyarteritis nodosa with uterine involvement

    Directory of Open Access Journals (Sweden)

    Chihiro Hirai

    2012-12-01

    Full Text Available Polyarteritis nodosa (PAN is characterized by multisystem necrotizing vasculitis, primarily affecting small-to-medium-sized muscular arteries, and it is typically found in middle-aged men. PAN is rarely found in the female genital tract (including the uterus, and imaging of the uterus with PAN has not previously been reported. Reported is a case of a 78-year-old patient with uterus enlargement who was diagnosed with PAN through clinical findings and images. Computed tomography and magnetic resonance imaging findings of a uterus affected by PAN are presented and reviewed, and potential characteristic findings of the uterine with PAN are discussed.

  12. Uterine metrology devices for IUD selection.

    Science.gov (United States)

    1981-11-01

    Accurate measurements of the length of the uterine cavity would make it feasible to select an IUD that is compatible with a given cavity size. Considerable evidence exists to indicate that selecting an IUD on the basis of accurate longitudinal measurements of the uterine cavity improves IUD performance. There are study findings to suggest that as more data are available, specific IUDs can be prescribed for defined ranges of uterine cavity length. Metrology (uterine measuring) devices improve the ability of the clinican to measure accurately longitudinal and, in some instances, lateral dimensions of the uterine cavity. Longitudinal measurements depend on identifying the location of the internal os in order to determine the total length of the cervical canal. Lateral metrology devices also provide a measurement of uterine cavity width. Pain and discomfort associated with the use of the prototype lateral measurement instruments developed thus far is a major deterrent to their wide-scale use. 2 metrology devices -- the Crochet Hook Sound and the Hasson Wing Sound -- are designed to obtain longitudinal measurements of total uterine cavity length and of the length of the cervical canel. 2 new instruments -- the Cavimeter and the Hasson Wing Sound 2 -- designed to obtain both lateral and longitudinal measurements are now available for evaluation. The Hasson Wing Sound appears to be the only uterine metrology device available for service programs that could affect continuation rates of IUD users. It can measure the length of the uterine cavity directly, thus permitting improved IUD selection of individual women or the ability to exclude women who should not be IUD users because of small uterine size. An illustration of the prescriptive approach is included in a table.

  13. Uterine caliper and depth gauge

    Science.gov (United States)

    King, Loyd L.; Wheeler, Robert G.; Fish, Thomas M.

    1977-01-01

    A uterine caliper and sound consisting of an elongated body having outwardly biased resilient caliper wings and a spring-loaded slidable cervical stop. A slide on the body is operatively connected to the wings by a monofilament and operates with respect to a first scale on the body as a width indicator. A rod extending longitudinally on the body is connected to the cervical stop and cooperates with a second scale on the body as a depth indicator. The instrument can be positioned to measure the distance from the outer cervical ostium to the fundus, as read on said second scale. The wings may be allowed to open by moving the slide, and when the wings engage the utero-tubal junctions, the width may be read on said first scale. By adjustment of the caliper wings the instrument may be retracted until the resistance of the inner ostium of the cervix is felt, enabling the length of the cervical canal to be read directly by the position of the longitudinal indicator rod with respect to said second scale. The instrument may be employed to measure the width of the uterine cavity at any position between the inner ostium of the cervix and the fundus.

  14. Familial myomatosis cutis et uteri, segmental type 2

    Directory of Open Access Journals (Sweden)

    Palak Deshmukh

    2013-01-01

    Full Text Available Reed′s syndrome or familial myomatosis cutis et uteri, an autosomal dominant inherited condition with incomplete penetrance, is characterized by multiple cutaneous and uterine leiomyomas. [1] Uterine leiomyomas usually commence earlier compared to that in the general population and cutaneous leiomyomas may precede, follow or occur concurrently. Few patients may have associated renal cell carcinoma. Herein we report a case of a 50-year-old female with multiple, painful cutaneous leiomyomas and who had undergone hysterectomy owing to large uterine fibroids. Her 18-year-old daughter also has uterine fibroids.

  15. Comparison of transvaginal ultrasonography and hysteroscopy in the diagnosis of uterine pathologies.

    Science.gov (United States)

    Babacan, Ali; Gun, Ismet; Kizilaslan, Cem; Ozden, Okan; Muhcu, Murat; Mungen, Ercument; Atay, Vedat

    2014-01-01

    A thorough evaluation of the uterine cavity is frequently required in gynecology practice. The aim of this study was to compare the diagnostic values of transvaginal ultrasound examination and hysteroscopy in detecting uterine abnormalities in a group of patients within a range of menopausal status and symptomatology. This study included 285 patients admitted with complaints of abnormal uterine bleeding, postmenopausal bleeding, lower abdominal pain, abnormal vaginal discharge or for a routine gynecological examination. All patients had available transvaginal ultrasonography and hysteroscopy data for evaluation. A biopsy was obtained from all patients during the hysteroscopy session. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio were calculated for both methods and compared, considering the histopathological diagnosis as the gold standard. The mean age of the patients was 49.5±12.9 years (range, 24-89 y). Majority of the patients admitted for abnormal uterine bleeding (n=198, 69.4%). For the diagnosis of polyps of any size, hysteroscopy had better sensitivity (puterine pathologies, hysteroscopy seems to offer better diagnostic value for uterine pathologies in general, and uterine polyps in particular.

  16. Gene expression and immunoreactivity of elastolytic enzymes in the uterosacral ligaments from women with uterine prolapse.

    Science.gov (United States)

    Liang, Ching-Chung; Huang, Hong-Yuan; Chang, Shuenn-Dhy

    2012-04-01

    Altered elastin metabolism has been documented in pelvic tissues from women with pelvic floor dysfunction. This study was conducted to quantify the expression of elastolytic enzymes in uterine cervix and uterosacral ligaments from women with uterine prolapse compared to asymptomatic normal controls. Paired tissues of uterosacral ligament and cervical tissues were obtained from 27 women with uterine prolapse and 14 normal controls. Steady state of matrix metalloproteinase 2 (MMP-2), tissue inhibitor of metalloproteinase 2 (TIMP-2), neutrophil elastase, α-1 antitrypsin immunoreactivity, and messenger RNA (mRNA) expression were analyzed by immunohistochemistry and real-time polymerase chain reaction, respectively. When compared with controls, women with uterine prolapse had a significantly greater level of MMP-2 immunoreactivity and mRNA expression, but less TIMP-2 and α-1 antitrypsin immunoreactivity and mRNA expression in their uterosacral ligaments. However, neutrophil elastase mRNA expression was similar between uterine prolapse and control tissue. Our results showed that there was a close relationship between expressions of MMP-2, TIMP-2, and α-1 antitrypsin in uterosacral ligament and the occurrence of uterine prolapse.

  17. Adolescent and adult uterine volume and uterine artery Doppler blood flow among subjects treated with bone marrow transplantation or chemotherapy in pediatric age: a case-control study.

    Science.gov (United States)

    Beneventi, Fausta; Locatelli, Elena; Giorgiani, Giovanna; Zecca, Marco; Mina, Tommaso; Simonetta, Margherita; Cavagnoli, Chiara; Albanese, Mara; Spinillo, Arsenio

    2015-02-01

    To compare uterine and ovarian volumes and uterine artery (UA) Doppler blood flow among women who were treated with antineoplastic regimens when pediatric aged versus healthy controls. Case-control study. Tertiary obstetric and gynecologic center. One hundred twenty-seven women who were treated for childhood cancer with bone marrow transplantation (BMT) and∖or chemotherapy and total body irradiation (TBI) and 64 age-matched healthy controls. Ultrasonographic and clinical evaluations. Uterine and ovarian volume, detection of follicles, and UA pulsatility index (PI). Median uterus and ovarian volumes were reduced by 64% (95% CI, 56.6-70.6) and 83.6% (95% CI, 79.6-86.7), respectively, among cases compared with controls. Median UA PI among cases was increased by 30.3% (95% CI, 19.6-40.8) compared with controls. Ovarian follicles were identified in 24 (18.9%) of 127 cases and 25 (39%) of 64 controls. Uterine volume was reduced after TBI (percent reduction 81.9%; 95% CI, 71.8-87.8) or busulfan (percentage reduction 67.4%; 95% CI, 58.5-75.6) compared with those who had not received a conditioning regimen (percentage reduction 24.4%; 95% CI, 7.6-38.2). The only factors independently associated with reduced uterine and ovarian volumes compared with controls were TBI, busulfan, and BMT. The worst effect on UA PI resulted from BMT and a diagnosis of hematologic disease. Bone marrow transplantation as main treatment and TBI and busulfan as conditioning regimens had the worst effect on uterine and ovarian sizes compared with controls. These data should be considered in counseling families on preserving future fertility in children undergoing BMT. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Diffuse uterine leiomyomatosis in a child

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Deepa; Coletti, Monette C.; Ladino-Torres, Maria; Caoili, Elaine [University of Michigan Health System, Department of Radiology, Section of Pediatric Radiology, Ann Arbor, MI (United States); Elkins, Matthew [University of Michigan Health System, Department of Pathology, Ann Arbor, MI (United States)

    2012-01-15

    Leiomyomas are the most common benign uterine tumor; however, this entity is relatively uncommon in the pediatric population. Although leiomyomas most commonly present as solitary uterine masses, unusual patterns of growth have been described including diffuse leiomyomatosis. In this condition, the myometrium of the uterus is symmetrically expanded by innumerable confluent leiomyomas; this pattern of growth is quite uncommon and has never been reported in a pediatric patient. This case report illustrates the imaging appearance of diffuse uterine leiomyomatosis in an otherwise healthy 16-year-old girl. (orig.)

  19. Neonatal uterine prolapse - a case report.

    Science.gov (United States)

    Saha, D K; Hasan, K M; Rahman, S M; Majumder, S K; Zahid, M K; Chakraborty, A K; Bari, M S

    2014-04-01

    Uterine prolapse is commonly seen in the geriatric age group. Congenital vaginouterine prolapse is a rare condition occurring in neonates and is usually associated with spinal cord malformations in about 85% of cases. Several modalities of treatment have been described for neonatal uterine prolapse. Conservative treatment in the form of simple digital reposition, use of pessary or other self-retaining device is usually sufficient to treat this condition, which is self-limiting and regressive. Here we report our first case of neonatal uterine prolapse, managed successfully with simple digital reposition.

  20. Malignancies of the uterine body among Ibo women in Nigeria.

    Science.gov (United States)

    Osefo, N

    1980-12-01

    Out of the 85 malignancies of the uterus seen at the University of Nigeria Teaching Hospital, Enugu, in the past seven years, only seven were malignancies of the uterine body. Compared with reports by other authors, the incidence is low and suggests the influence of racial and geographical factors. With the exception of one patient, the majority presented in the 50-70 year age group. More than one half of the patients were of high parity; menorrhagia was a common presenting symptom. In the absence of facilities for radiotherapy, surgery alone produces a reasonably good result for the early stages of this disease. Abnormal uterine bleeding in women over 30 years of age should be fully investigated.

  1. [Radiotelemetric studies of uterine motility in cows with acute endometritis].

    Science.gov (United States)

    Kostov, I

    1980-01-01

    Thirty two cows with postpartum complication were radiotelemetrically studied to register uterine motility. The results were compared with those of the control group of 42 cows with normal calving and no complications. Enhanced uterine reactivity to oxytocin and other agents was established in all cows with complications in the postpartum period. It is manifested in the spring also by intensified motor activity of the uterus. Motor activity of the uterus is hardly registered during to summer months in cows with normal peurperium and complications following day 2 of calving. No essential difference was found in estradiol-17 beta content in the blood plasma of both groups of cows. Body temperature rises in cows with postpartum complications.

  2. [The clinical characteristics of women with uterine hemorrhages in premenopause].

    Science.gov (United States)

    Rachev, E

    1989-01-01

    The clinical characteristics was studied on 431 women with uterine bleedings during the premenopaussal phase of the climacterium. The author established that menarche, duration of menstrual interval and the menstruation itself before the bleeding did not differ from those of female population in the country. The same was referred to the reproductive characteristics. Premenopausal bleeding reached its peak between 46 and 48 years of age as its duration was relatively great. It was connected with frequent neuro-endocrine and metabolic pathology. The most frequent manifestations were obesity and hypertension. The number of the former hepatitis patients was comparatively large. Diseases of the uterine body were frequent in the structure of genital pathology. The frequency of benign, precancerous and malignant neoplastic processes (without myoma) was high-12.7%.

  3. Urinary selenium excretion in patients with cervical uterine cancer.

    Science.gov (United States)

    Navarrete, M; Gaudry, A; Revel, G; Martínez, T; Cabrera, L

    2001-02-01

    In this work, we report on a relationship between urinary selenium and the development of cervical uterine cancer. A simple chemical method was developed to concentrate trace amounts of selenium from relatively large urine samples by use of small activated carbon filters. When these filters are irradiated with thermal neutrons, selenium can be determined either by 77mSe (t1/2 = 17.5 s) or 75Se (t1/2 = 120 d). In this article, we report the results for 82 urine samples from women with cervical uterine cancer in several stages of development and from healthy controls. These results show a statistically significant increase of selenium excretion in cancer patients as compared to controls. Urinary selenium excretion is highest for patients in the intermediate stages of the disease.

  4. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results

    DEFF Research Database (Denmark)

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Birthe Margrethe

    2003-01-01

    To compare total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases.......To compare total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases....

  5. Congenital absence of uterine cervix

    Directory of Open Access Journals (Sweden)

    Selvaraj Ravi Lakshmy

    2016-10-01

    Full Text Available Cervical agenesis or dysgenesis is an extremely rare congenital anomaly. Patients with congenital absence of the cervix present with primary amenorrhea and infertility. Though it poses a diagnostic challenge to the clinician, correct diagnosis prior to surgery is possible with the help of ultrasound. Early diagnosis offers significant advantages in patient care and effective presurgical planning. This case report reviews two cases of cervical agenesis diagnosed with the help of ultrasound and later confirmed with the help of MRI. Ultrasonography is the modality of choice to define the internal genital anatomy and helps us to classify the level of obstruction or aplasia in obstructive uterine anomalies. [Int J Reprod Contracept Obstet Gynecol 2016; 5(10.000: 3634-3636

  6. Associated factors for uterine prolapse.

    Science.gov (United States)

    Gautam, S; Adhikari, R K; Dangol, A

    2012-01-01

    Uterine prolapsed is a significant public health problem in Nepal. The study was conducted in 50 women having second and third degree of uterus prolapse who were admitted in Dhulikhel Hospital for vaginal hysterectomy. A total 200 individual were taken as a control groups who were OPD attendants of Dhulikhel hospital without any sign or had no any sign and symptom of uterus prolapse . Data were collected by structured and semi-structured questionnaires and analysis done by using z test. The occurrence of uterus prolapse had significant difference among ethnicity (p value-prolapse were parity, gravida and age at last birth and work after delivery. Therefore civil society and concerned authority should work to raise awareness on the preventive measure of uterus prolapsed.

  7. Uterine phenotype of young adult rats exposed to dietary soy or genistein during development.

    Science.gov (United States)

    Eason, Renea R; Till, S Reneé; Velarde, Michael C; Geng, Yan; Chatman, Leon; Gu, Liwei; Badger, Thomas M; Simmen, Frank A; Simmen, Rosalia C M

    2005-10-01

    Dietary soy intake is associated with protection from breast cancer, but questions persist on the potential risks of the major soy isoflavone genistein (GEN) on female reproductive health. Here, we evaluated intermediate markers of cancer risk in uteri of cycling, young adult Sprague-Dawley rats lifetime exposed to one of three AIN-93G semipurified diets: casein (CAS), soy protein isolate (SPI+ with 276 mg GEN aglycone equivalents/kg) and CAS+GEN (GEN at 250 mg/kg). Postnatal day 50 (PND50) rats lifetime exposed to GEN or SPI+ had similar uterine luminal epithelium height, myometrial thickness, endometrial gland numbers, endometrial immunoreactive proliferating cell nuclear antigen (PCNA), and serum estrogen and progesterone, as CAS-fed rats. GEN-fed rats showed modestly increased apoptosis in uterine glandular epithelium, compared to those of CAS- or SPI+-fed groups. Diet had no effect on the uterine expression of genes for the tumor suppressors PTEN, p53 and p21, and the apoptotic-associated proteins Bcl2, Bax and progesterone receptor. Uterine tissue and serum concentrations of total GEN were higher in rats fed GEN than in those fed SPI+. Human Ishikawa endocarcinoma cells treated with GEN-fed rat serum tended to exhibit increased apoptotic status than those treated with CAS-fed rat serum. Exogenously added GEN (0.2 and 2 microM) increased, while estradiol-17beta (0.1 microM) decreased Ishikawa cell apoptosis, relative to untreated cells. Results suggest that lifetime dietary exposure to soy foods does not alter uterine cell phenotype in young adult rats, while GEN, by enhancing uterine endometrial glandular apoptosis in vivo and in vitro, may confer protection against uterine carcinoma. Given its limited influence on uterine phenotype of young adult females, GEN, when taken as part of soy foods or as supplement, should be favorably considered for other potential health benefits.

  8. Uterine dysfunction in biglycan and decorin deficient mice leads to dystocia during parturition.

    Directory of Open Access Journals (Sweden)

    Zhiping Wu

    Full Text Available Cesarean birth rates are rising. Uterine dysfunction, the exact mechanism of which is unknown, is a common indication for Cesarean delivery. Biglycan and decorin are two small leucine-rich proteoglycans expressed in the extracellular matrix of reproductive tissues and muscle. Mice deficient in biglycan display a mild muscular dystrophy, and, along with mice deficient in decorin, are models of Ehlers-Danlos Syndrome, a connective tissue anomaly associated with uterine rupture. As a variant of Ehlers-Danlos Syndrome is caused by a genetic mutation resulting in abnormal biglycan and decorin secretion, we hypothesized that biglycan and decorin play a role in uterine function. Thus, we assessed wild-type, biglycan, decorin and double knockout pregnancies for timing of birth and uterine function. Uteri were harvested at embryonic days 12, 15 and 18. Nonpregnant uterine samples of the same genotypes were assessed for tissue failure rate and spontaneous and oxytocin-induced contractility. We discovered that biglycan/decorin mixed double-knockout dams displayed dystocia, were at increased risk of delayed labor onset, and showed increased tissue failure in a predominantly decorin-dependent manner. In vitro spontaneous uterine contractile amplitude and oxytocin-induced contractile force were decreased in all biglycan and decorin knockout genotypes compared to wild-type. Notably, we found no significant compensation between biglycan and decorin using quantitative real time PCR or immunohistochemistry. We conclude that the biglycan/decorin mixed double knockout mouse is a model of dystocia and delayed labor onset. Moreover, decorin is necessary for uterine function in a dose-dependent manner, while biglycan exhibits partial compensatory mechanisms in vivo. Thus, this model is poised for use as a model for testing novel targets for preventive or therapeutic manipulation of uterine dysfunction.

  9. [Study on the treatment of pelvic organ prolapse complicated with uterine myoma].

    Science.gov (United States)

    Teramoto, Sakiko; Narushima, Masahiro; Kojima, Ippei; Takagi, Yasuharu; Shimoji, Toshio

    2014-10-01

    We studied the association between uterine myoma and recurrent pelvic organ prolapse (POP) after transvaginal mesh (TVM) repair. Between June 2010 and January 2012, 103 female patients (mean age 67.8 years, mean parity 2.3, mean body mass index (BMI) 23.7) with POP underwent TVM procedures at our hospital. Sixtynine patients were qualified as stage 3 according to the POP quantification (POP-Q) system and 34 patients were stage 4. Twenty-six patients underwent anterior TVM (A-TVM) and 77 patients underwent anterior and posterior TVM (AP-TVM). All patients underwent a physical examination using the POP-Q system before and 6 month after surgery. Recurrence of prolapse was defined according to the International Continence Society by a measured value ≥ - 1, as most dependent portion of POP stage 2 or greater. One hundred-three patients were divided into group with uterine myoma larger than 5 cm in diameter and group without uterine myoma. Anatomical outcomes before and after TVM repair were compared between two groups. Preoperative Aa value, Ba value and gh value in group with uterine myoma were greater than in group without uterine myoma. Postoperative Aa value and Ba value in group with uterine myoma were greater than in group without uterine myoma, too. Postoperative recurrence of prolapse of stage 2 or greater was not found a statistical difference between two groups. The risks of anterior vaginal wall descent seem to be high in POP with uterine myoma. Therefore it should be kept in mind on treatment choice.

  10. Detection of congenital uterine malformation by using transvaginal three-dimensional ultrasound.

    Science.gov (United States)

    Yu, Li-Li; Zhang, Xuan; Zhang, Ting; Chen, Han-Rong; Wang, Ze-Hua

    2014-10-01

    This study assessed the clinical application of transvaginal three-dimensional ultrasound (3D TVUS) in the diagnosis of congenital uterine malformation. A retrospective study was performed on 62 patients with congenital uterine malformation confirmed hysteroscopically and/or laparoscopically. The patients were subjected to transvaginal two-dimensional ultrasound (2D TVUS) and 3D TVUS. The accuracy rate was compared between the two methods. The accuracy rate of 3D TVUS was (98.38%, 61/62), higher than that of 2D TVUS (80.65%, 50/62). 3D TVUS coronal plane imaging could demonstrate the internal shape of the endometrial cavity and the external contour of the uterine fundus. It allowed accurate measurement on the coronary plane, and could three-dimensionally show the image of cervical tube, thereby providing information for the diagnosis of some complex uterine malformation. 3D TVUS imaging can obtain comprehensive information of the uterus malformation, and it is superior to 2D TVUS for the diagnosis of congenital uterine malformations, especially complex uterine anomaly.

  11. Impact single versus double layer uterine closure in caesarean section to uterine rupture

    OpenAIRE

    Budi Iman Santoso; Raymond Surya; Rima Irwinda

    2016-01-01

    Caesarean section (CS) is one of the most frequent delivery methods in the world whereas the rates of CS were varied according to developing (from 3.5 to 29.2%) and developed countries (21.1%). The study aims to known the impact of single versus double layer uterine closure to uterine rupture in the history of cesarean section (CS). In this case report, the clinical question is single versus double-layer uterine closure on the previous CS, gives better outcome to reduce the risk of uterine ru...

  12. [Obstructive anuria secondary to uterine prolapse].

    Science.gov (United States)

    Rodríguez Alonso, A; González Blanco, A; Cachay Ayala, M E; Bonelli Martín, C i; Porta Vila, A; Lorenzo Franco, J; Cuerpo Pérez, M A; Nieto García, J

    2002-10-01

    The prevalence of obstructive uropathy linked to uterine prolapse ranges between 4% and 80%, depending on the series, probably due to the varying degree of severity of the prolapses under consideration. Renal failure or anuria is an unusual complication. Several etiopathogenic theories regarding obstructive uropathy secondary to prolapse have been put forward: ureteral compression by the uterine vessels, severe urethral angulation, ureteral compression against levator ani muscles and the elongation and narrowing of the distal ureter. The major radiological exploration used in studying the urinary tract of these patients is intravenous urography in bipedestation. Emergency treatment for obstructive anuria resulting from a uterine prolapse consists of manually replacement of the prolapse. Surgery is considered to be the definitive ideal treatment, although in the case of surgical or anaesthetic high risk patients, inserting a permanent pessary may constitute a satisfactory solution. We present a case of obstructive anuria resulting from uterine prolapse, which was successfully treated with the insertion of a ring pessary.

  13. Ovarian function after uterine artery embolisation

    African Journals Online (AJOL)

    2009-08-05

    Aug 5, 2009 ... Uterine artery embolisation (UAE) has been firmly ... Methods. Twenty-nine patients with myomas of the uterus underwent UAE using polyvinyl alcohol (PVA) particles .... that myomectomy may also limit postoperative ovarian.

  14. CT of uterine cervical myeloma: case report.

    Science.gov (United States)

    Salomon, C G; Posniak, H V; Pyle, J M

    1992-01-01

    Myelomatous involvement of the uterine cervix is rare and, to our knowledge, has not been reported previously in the radiologic literature. This report describes the computed tomographic (CT) findings and reviews differential diagnostic considerations.

  15. Uterine rupture without previous caesarean delivery

    DEFF Research Database (Denmark)

    Thisted, Dorthe L. A.; H. Mortensen, Laust; Krebs, Lone

    2015-01-01

    .3/100,000 deliveries. Multiparity (RR 8.99 (95% CI 1.86-43.29)), induction of labour (RR 3.26 (95% CI 1.24-8.57)), epidural analgesia (RR 10.78 (95% CI 4.25-27.39)), and augmentation by oxytocin (RR 9.50 (95% CI 3.15-28.63)) were associated with uterine rupture. Induction of labour was not significantly related...... to uterine rupture when adjusted for parity, epidural analgesia and augmentation by oxytocin. CONCLUSION: Although uterine rupture is rare, its association with epidural analgesia and augmentation of labour with oxytocin in multipara should be considered. Thus, vigilance should be exercised when labour...... is obstructed and there is need for epidural analgesia and/or augmentation by oxytocin in multiparous women. Due to the rare occurrence of uterine rupture caution should be exerted when interpreting the findings of this study....

  16. Uterine blood flow evaluation in bitches suffering from cystic endometrial hyperplasia (CEH) and CEH-pyometra complex.

    Science.gov (United States)

    Batista, P R; Gobello, C; Rube, A; Corrada, Y A; Tórtora, M; Blanco, P G

    2016-04-15

    Doppler ultrasound is a useful diagnosis tool to evaluate uterine blood flow in different canine reproductive states. The aim of this study was to describe and compare uterine blood flow in bitches suffering from cystic endometrial hyperplasia (CEH) and CEH-pyometra complex (CEH-P). Ninety diestrous bitches were clinically, hematologically, and ultrasonographically classified into four groups: (1) clinical signs, leukocytosis, CEH, and uterine luminal contents (CEH-P, n = 31); (2) asymptomatic bitches with CEH and uterine contents (CEH-C, n = 15); (3) asymptomatic bitches with CEH without uterine contents (CEH, n = 16); and (4) normal diestrous bitches (ND, n = 28). The widest cross-sectional diameter and uterine wall thickness (W) of uterine horns were measured using two-dimensional ultrasound. Peak systolic velocity and end diastolic velocity of uterine arteries were measured by Doppler ultrasound in all the bitches. Peak systolic velocity and end diastolic velocity were higher in CEH-P than in CEH-C, CEH, and ND (P  0.1). Conversely, resistance index (RI) reported lower values in CEH-P than that in the other three groups (P  0.1). When all the bitches were considered, correlation between RI and cross-sectional diameter was r = -0.69 (P  0.1). It is concluded that the uterine artery blood flow velocity of bitches suffering from pyometra was higher, not only from normal bitches, but also from females with endometrial hyperplasia. Furthermore, endometrial hyperplasia, accompanied or not by luminal contents, had a higher blood flow velocity than normal uterus. Hemodynamic parameters appear as useful markers to differentiate uterine pathologic conditions.

  17. 中西医结合治疗剖宫产后子宫复旧不良研究进展%A review on treating poor uterine involution following cesarean section in the integrative medicine

    Institute of Scientific and Technical Information of China (English)

    郭晓玲; 贾留顺

    2015-01-01

    产后子宫复旧不良也称产后子宫复旧不全,是指产后6周子宫仍未能恢复到非孕状态。其原因复杂,如由于部分胎盘、胎膜残留;子宫内膜炎或盆腔感染;子宫过度后倾、后屈,影响恶露排出;多胎妊娠,羊水过多,过大胎盘;也有因伴子宫肌瘤,子宫肌腺瘤,使子宫复旧功能受到障碍。%Poor uterine involution following cesarean section means that the uterus failed to return to the non-pregnant state in six weeks. The situation was resulted from complicated causes, such as partial placenta, fetal membranes residue, endometritis or pelvic infections, excessive dumping and the bend of uterus, multiple pregnancy, polyhydramnios, large placenta, uterine fibroids and uterine adenomyosis,which obstructed recovery of uterus.

  18. A Phenotypic Analysis of Regulatory T Cells and Uterine NK Cells from First Trimester Pregnancies and Associations with HLA-G

    DEFF Research Database (Denmark)

    Djurisic, Snezana; Skibsted, Lillian; Hviid, Thomas Vauvert F

    2015-01-01

    receptors or activation markers on immune cells were determined. RESULTS: In the placental bed, CD45RA surface expression on Tregs was similar to peripheral Tregs in pregnant women, but T cells with lower CD4 and CD8 expression were accumulated. HLA-G receptor expression was increased on NK cells from...... 'uterine blood'. Soluble HLA-G was significantly increased in 'uterine blood' compared with peripheral blood, but no correlation was found between sHLA-G and mHLA-G in the uterine compartment. A correlation was found between sHLA-G and the fraction of KIR2DL4-positive NK cells in the uterine compartment...

  19. Sonographic Findings of Uterine Endometrial Stromal Sarcoma

    OpenAIRE

    Kim, Jeong-Ah; Lee, Myung Sook; Choi, Jong-Sun

    2006-01-01

    Objective The study was performed to present the sonographic findings of uterine endometrial stromal sarcoma (ESS). Materials and Methods We conducted a retrospective review of sonographic findings of 10 cases that were diagnosed as uterine ESS. The patients' ages ranged from 25 to 51 years (mean age: 36.1 years). The reviews focused on the location, margin, size, number and echotexture of the lesions. Hysterectomy (n = 9) and myomectomy (n = 1) were performed and a pathologic diagnosis was o...

  20. Uterine Prolapse: From Antiquity to Today

    Directory of Open Access Journals (Sweden)

    Keith T. Downing

    2012-01-01

    Full Text Available Uterine prolapse is a condition that has likely affected women for all of time as it is documented in the oldest medical literature. By looking at the watershed moments in its recorded history we are able to appreciate the evolution of urogynecology and to gain perspective on the challenges faced by today's female pelvic medicine and reconstructive surgeons in their attempts to treat uterine and vaginal vault prolapse.

  1. Potential Therapeutic Targets in Uterine Sarcomas

    Directory of Open Access Journals (Sweden)

    Tine Cuppens

    2015-01-01

    Full Text Available Uterine sarcomas are rare tumors accounting for 3,4% of all uterine cancers. Even after radical hysterectomy, most patients relapse or present with distant metastases. The very limited clinical benefit of adjuvant cytotoxic treatments is reflected by high mortality rates, emphasizing the need for new treatment strategies. This review summarizes rising potential targets in four distinct subtypes of uterine sarcomas: leiomyosarcoma, low-grade and high-grade endometrial stromal sarcoma, and undifferentiated uterine sarcoma. Based on clinical reports, promising approaches for uterine leiomyosarcoma patients include inhibition of VEGF and mTOR signaling, preferably in combination with other targeted or cytotoxic compounds. Currently, the only targeted therapy approved in leiomyosarcoma patients is pazopanib, a multitargeted inhibitor blocking VEGFR, PDGFR, FGFR, and c-KIT. Additionally, preclinical evidence suggests effect of the inhibition of histone deacetylases, tyrosine kinase receptors, and the mitotic checkpoint protein aurora kinase A. In low-grade endometrial stromal sarcomas, antihormonal therapies including aromatase inhibitors and progestins have proven activity. Other potential targets are PDGFR, VEGFR, and histone deacetylases. In high-grade ESS that carry the YWHAE/FAM22A/B fusion gene, the generated 14-3-3 oncoprotein is a putative target, next to c-KIT and the Wnt pathway. The observation of heterogeneity within uterine sarcoma subtypes warrants a personalized treatment approach.

  2. Potential Therapeutic Targets in Uterine Sarcomas

    Science.gov (United States)

    Cuppens, Tine; Tuyaerts, Sandra; Amant, Frédéric

    2015-01-01

    Uterine sarcomas are rare tumors accounting for 3,4% of all uterine cancers. Even after radical hysterectomy, most patients relapse or present with distant metastases. The very limited clinical benefit of adjuvant cytotoxic treatments is reflected by high mortality rates, emphasizing the need for new treatment strategies. This review summarizes rising potential targets in four distinct subtypes of uterine sarcomas: leiomyosarcoma, low-grade and high-grade endometrial stromal sarcoma, and undifferentiated uterine sarcoma. Based on clinical reports, promising approaches for uterine leiomyosarcoma patients include inhibition of VEGF and mTOR signaling, preferably in combination with other targeted or cytotoxic compounds. Currently, the only targeted therapy approved in leiomyosarcoma patients is pazopanib, a multitargeted inhibitor blocking VEGFR, PDGFR, FGFR, and c-KIT. Additionally, preclinical evidence suggests effect of the inhibition of histone deacetylases, tyrosine kinase receptors, and the mitotic checkpoint protein aurora kinase A. In low-grade endometrial stromal sarcomas, antihormonal therapies including aromatase inhibitors and progestins have proven activity. Other potential targets are PDGFR, VEGFR, and histone deacetylases. In high-grade ESS that carry the YWHAE/FAM22A/B fusion gene, the generated 14-3-3 oncoprotein is a putative target, next to c-KIT and the Wnt pathway. The observation of heterogeneity within uterine sarcoma subtypes warrants a personalized treatment approach. PMID:26576131

  3. Inflammatory fibroid polyp in the duodenum of a common marmoset (Callithrix jacchus).

    Science.gov (United States)

    Yokouchi, Yusuke; Imaoka, Masako; Sayama, Ayako; Jindo, Toshimasa; Sanbuissho, Atsushi

    2013-01-01

    A 32-month-old male common marmoset had a firm and white-colored mass in the duodenal wall. The cut surface was smooth and grayish white in color. Histologically, the mass consisted of a proliferation of spindle cells with an oval to spindle-shaped nucleus and scant eosinophilic cytoplasm in a loose myxoid or fibrotic background. Most of the lesion displayed no specific growth pattern whereas some of the cells concentrated around the vessels and created an onion-bulb structure. Additionally, marked inflammatory cellular infiltration, mainly eosinophils, was observed throughout the lesion. Immunohistochemically, the spindle cells were positive for vimentin, α-smooth muscle actin, fascin, and cyclin D1, and negative for S-100, factor VIII-related antigen, and c-kit. These histological and immunohistochemical features did not meet any differential diagnoses such as gastrointestinal stromal tumor, inflammatory myofibroblastic tumor, solitary fibrous tumor/hemangiopericytoma, smooth muscle tumor, schwannoma, and hemangiosarcoma. Collectively, the authors diagnosed the mass as a lesion that corresponded to an inflammatory fibroid polyp (IFP) in humans. IFP is defined as a mesenchymal proliferation composed of spindle stromal cells, small blood vessels, and inflammatory cells, particularly eosinophils, and is currently classified as a nonneoplastic lesion. To the best of our knowledge, this is the first case of spontaneous IFP in nonhuman primates.

  4. Variables influencing the integrity of lower uterine segment in post-cesarean pregnancy.

    Science.gov (United States)

    Brahmalakshmy, B L; Kushtagi, Pralhad

    2015-04-01

    There is significant increase in proportion of cases with previous cesarean delivery requiring obstetric care. The available literature fails to provide uniform opinion on each woman's characteristics to identify risk of uterine rupture while planning trial of labor after cesarean. To study the association of abnormal lower uterine segment with some of the present and previous obstetric variables including patient characteristics and surgical techniques at previous cesarean operation. Consenting consecutive 96 post-cesarean singleton pregnancies admitting after 36 weeks gestation at the same facility from July 2011 to December 2012 for repeat cesarean, were studied. Only the cases with cephalic presentation and vertex as presenting part, having no placenta previa, polyhydramnios, uterine anomaly or fibroid and those who had previous one lower segment cesarean were recruited. Based on the intra-operative finding the lower uterine segment (LUS) was categorized into those having a normal and abnormal (grades 2-4) LUS. Sonographic assessment of LUS thickness and any abnormalities if any were noted. The findings of abnormal LUS (direct observation at surgery and sonographic impression within a week before surgery) were looked for association with some of the present and previous obstetric variables including patient characteristics and surgical techniques at previous cesarean operation using Student t, Chi square or Fisher's exact test for analysis as appropriate. Receiver operating curve analysis was used to determine the optimal cut off value for prediction of LUS integrity by ultrasound. Of the women recruited for the study, 36 were admitted in early labor and ultrasound evaluation of LUS was performed in 48 of the remaining 60 women admitted antenatal for elective cesarean delivery. There were 38 abnormal LUS (39.6%) with 22 of them (57.9%) graded as 'thinned out LUS'. The incidence of scar dehiscence (grade 3, cases 5) was 5.2% of 96 cases and there were no cases

  5. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis.

    Science.gov (United States)

    Roberge, Stéphanie; Demers, Suzanne; Berghella, Vincenzo; Chaillet, Nils; Moore, Lynne; Bujold, Emmanuel

    2014-11-01

    A systematic review and metaanalysis were performed through electronic database searches to estimate the effect of uterine closure at cesarean on the risk of adverse maternal outcome and on uterine scar evaluated by ultrasound. Randomized controlled trials, which compared single vs double layers and locking vs unlocking sutures for uterine closure of low transverse cesarean, were included. Outcomes were short-term complications (endometritis, wound infection, maternal infectious morbidity, blood transfusion, duration of surgical procedure, length of hospital stay, mean blood loss), uterine rupture or dehiscence at next pregnancy, and uterine scar evaluation by ultrasound. Twenty of 1278 citations were included in the analysis. We found that all types of closure were comparable for short-term maternal outcomes, except for single-layer closure, which had shorter operative time (-6.1 minutes; 95% confidence interval [CI], -8.7 to -3.4; P type of uterine closure for optimal maternal outcomes and is insufficient to conclude about the risk of uterine rupture. Single-layer closure and locked first layer are possibly coupled with thinner residual myometrium thickness.

  6. Different surgical methods on uterine myoma postoperative ovarian function and sexual impact%不同手术方式对子宫肌瘤术后卵巢功能及性功能的影响

    Institute of Scientific and Technical Information of China (English)

    罗秀霞

    2014-01-01

    目的:探讨不同手术方法治疗子宫肌瘤对患者术后卵巢功能及性功能的影响。方法:回顾性分析2011年5月至2013年10月高州市妇幼保健院收治的120例子宫肌瘤患者的临床资料,其中68例行子宫肌瘤剔除术(观察组),52例行全子宫切除术保留附件(对照组)。采用女性性功能调查问卷及婚姻质量调查问卷,观察两组患者术后6、12个月的卵巢功能与性功能变化情况及术后夫妻生活质量。结果:术后6个月,两组 FSH 水平较术前明显升高(P0.05), significant but 12 months is more difference (P<0.05). Two groups of six months after sexual function score than preoperative obviously increase, observation group is better than that of control group, the difference was statistically significant ( P < 0. 05). Conclusion:Ovary and uterus is women very important endocrine organs, whether patients with uterine fibroids excision uterus and ovaries should be considered. Uterine fibroids out on ovarian and sexual function in patients with small, surgery is better than that of hysterectomy and keep all accessories.

  7. Differential expression of smooth muscle regulatory proteins in the uterosacral ligaments of women with uterine prolapse.

    Science.gov (United States)

    Takacs, Peter; Gualtieri, Marc; Nassiri, Mehdi; Candiotti, Keith; Fornoni, Alessia; Medina, Carlos A

    2010-06-01

    To compare smooth muscle regulatory protein expression in the uterosacral ligament (USL) of women with and without uterine prolapse. USLs ligament were sampled in women with (n = 9) or without (n = 9) uterine prolapse. Caldesmon, smooth muscle actin (SMA), myosin heavy chain, and zinc finger protein messenger RNA expression was assessed by quantitative real-time polymerase chain reaction. Immunohistochemistry and digital image analysis were used to determine protein expression. Caldesmon messenger RNA expression and the ratio of caldesmon-SMA messenger RNA expression was significantly increased in the USL from women with uterine prolapse compared with women without prolapse (caldesmon mean +/- standard deviation messenger RNA, 0.81 +/- 0.46 vs 0.39 +/- 0.16; P = .01 and caldesmon-SMA messenger RNA ratio, mean +/- standard deviation, 0.11 +/- 0.04 vs 0.07 +/- 0.02; P = .01). In addition, the ratio of caldesmon-SMA staining was significantly increased in women with uterine prolapse compared with women without prolapse (mean +/- standard deviation, 0.44 +/- 0.28 vs 0.28 +/- 0.16; P = .03). Uterine prolapse is associated with an increased ratio of caldesmon-SMA actin expression. Copyright 2010 Mosby, Inc. All rights reserved.

  8. Uterine sarcoma Part I—Uterine leiomyosarcoma: The Topic Advisory Group systematic review

    Directory of Open Access Journals (Sweden)

    Kuo-Chang Wen

    2016-08-01

    Full Text Available Uterine sarcomas account for 3–7% of all uterine cancers. Because of their rarity, unknown etiology, and highly divergent genetic aberration, there is a lack of consensus on risk factors for occurrence and predictive poor outcomes as well as optimal therapeutic choices. Tumor types according to the World Health Organization classification include leiomyosarcoma, endometrial stroma sarcoma, and undifferentiated sarcoma. Staging is done using the 2014 Federation International Gynecology and Obstetrics and 2010 American Joint Committee on Cancer tumor, lymph node, and metastases systems. Tumor grade can be classified based on the French Federation of Cancer Centers Sarcoma Group system or the Broder’s system that incorporates tumor differentiation, mitotic count, and tumor necrosis. This review is a series of articles discussing uterine sarcoma, and this is Part I, which focuses on one of the subtypes of uterine sarcomas—uterine leiomyosarcoma. The clinical characteristics, diagnosis, outcome, and recent advances are summarized in this article.

  9. Clinicopathological evaluation of abnormal uterine bleeding in perimenopausal women

    Directory of Open Access Journals (Sweden)

    Lithingo Lotha

    2016-09-01

    Conclusions: Clinicopathological evaluation of AUB showed that fibroid uterus followed by DUB is the most common cause in perimenopausal women. Occurrences of endometrial hyperplasia increases in perimenopause which is of great value as it is a forerunner of carcinoma. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3072-3074

  10. Abnormal uterine bleeding: a critical analysis of two diagnostic methods

    Directory of Open Access Journals (Sweden)

    Manisha Jain

    2014-02-01

    Conclusions: Fibroids and polyps are the two commonest structural lesions causing AUB in the women of reproductive age group. TVS has a role as primary screening method for the initial work-up AUB before resorting to invasive procedure such as hysteroscopy. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 48-53

  11. Intra-uterine contraceptive devices.

    Science.gov (United States)

    Elias, J

    1985-05-01

    Among the advantages of IUDs are the device's high continuation rate, the lack of systemic side effects, and the absence of a need for continual motivation to practice contraception. The effectiveness of plastic IUDs is directly proportional to their surface area, but the degree of excessive bleeding experienced is inversely related to device size. Thus, devices represent a compromise between large size for effectiveness and small size for acceptability. The optimum time to fit an IUD is during the 1st hald of the menstrual cycle. Absolute contraindications to IUD use include the presence of active pelvic inflammatory disease, undiagnosed irregular bleeding, a history of ectopic pregnancy or tubal surgery, and a distorted uteine cavity. Failure rates associated with IUD use range from 2-3% in the 1st year and then decrease. Since the main mechanism of action appears to be production of a sterile inflammatory reaction in the uterine cavity, the IUD prevents intrauterine pregnancy more effectively than ectopic pregnancy. Nonetheless, there is little evidence to suggest that IUD use actually increases the incidence of ectopic pregnancy. Resumption of fertility after IUD removal is not delayed. There is not need to change inert plastic IUDs in women who remain symptom free. The copper devices should be changed every 3-4 years. A search is under way for antifertility agents that can be incorporated into the device to reduce side effects. In general, the IUD is most suitable for older, parous women.

  12. Does uterine prolapse alter endometrial cyclooxygenase 2 expression and promote the development of premalignant lesions?

    Science.gov (United States)

    Genc, Mine; Sivrikoz, Oya Nermin; Sahin, Nur; Celik, Esin; Turan, Guluzar Arzu; Guclu, Serkan

    2015-01-01

    The aim of this study was to evaluate the expression of cyclooxygenase 2 (COX-2) and its association with the development of premalignant lesions in gland structures of the endometrium in patients with uterine prolapse, a condition which exposes the uterus to mechanical and infectious stress. The study included 102 patients who underwent hysterectomy to correct grade 3-4 uterine prolapse and 105 patients who underwent hysterectomy for other causes. Endometrial gland structures underwent immunohistochemical staining and COX-2 expression was graded. Grades 0 and 1 represent low expression; grades 2 and 3 correspond to high levels of COX-2 expression. The prevalence of grade 2-3 COX-2 expression was significantly higher in the endometrial gland structures of patients with prolapse and hyperplasia compared to the remaining patients (p = 0.014). Grade 0-1 COX-2 expression was significantly more common in the endometrial gland structures of patients without uterine prolapse or hyperplasia (p = 0.004). Among the patients without endometrial hyperplasia, COX-2 expression was elevated in the endometrial gland structures of those with uterine prolapse compared to those without prolapse. Elevated COX-2 expression may explain the presence of unexpected premalignant lesions of the endometrium in patients with uterine prolapse. © 2015 S. Karger AG, Basel.

  13. Androgens and estradiol-17beta production by porcine uterine cells: In vitro study.

    Science.gov (United States)

    Franczak, A; Kotwica, G

    2010-01-15

    Porcine (Sus scrofa domestica) uterine slices harvested during both early pregnancy and luteolysis produce steroid hormones. The aim of the present study was to determine (1) which porcine separated uterine cells secrete androgens: androstenedione (A(4)) and testosterone (T), and estradiol-17beta (E(2)) in culture; (2) if the production of A(4), T and E(2) in the uterine cells is regulated by P4 and OT; (3) if uterine tissues expressed cytochrome P450arom gene (CYP19). Uteri were collected on Days 14 to 16 of early pregnancy and the estrous cycle. Enzymatically separated epithelial cells, stromal cells, and myocytes were cultured in vitro for 2, 6, and 12h with control medium, progesterone (P(4); 10(-5) M), oxytocin (OT; 10(-7) M), and both hormones (P(4)+OT). The studied cells secreted A(4), T, and E(2) in vitro. Progesterone served as a substrate for steroid synthesis in the uterine cells. Isolated uterine cells, cultured separately, contributed in equal portion to the basal production of androgens (A(4) and T) during both early pregnancy and luteolysis. In pregnant pigs, the epithelial and stromal cells were rich sources of E(2) compared with myocytes. Myocytes produced E(2) mainly during luteolysis. Pregnant porcine endometrium and myometrium expressed the gene CYP19, which encodes for P450 aromatase, a steroidogenic enzyme. The results indicate an active steroidogenic pathway in porcine uterine cells. The epithelial cells, stromal cells, and myocytes participate in steroid production as an alternative source for their action in pigs.

  14. Inhibition of PPARγ during Rat Pregnancy Causes Intrauterine Growth Restriction and Attenuation of Uterine Vasodilation

    Directory of Open Access Journals (Sweden)

    Natalia I Gokina

    2013-07-01

    Full Text Available Decreased peroxisome proliferator-activated receptor gamma (PPARγ activity is thought to have a major role in preeclampsia through abnormal placental development. However, the role of PPARγ in adaptation of the uteroplacental vasculature that may lead to placental hypoperfusion and fetal growth restriction during pregnancy is not known. Here, pregnant Sprague-Dawley rats (n=11/group were treated during the second half of pregnancy with the PPARγ inhibitor GW9662 (10 mg/kg/day in food or vehicle. Pregnancy outcome and PPARγ mRNA, vasodilation and structural remodeling were determined in maternal uterine and mesenteric arteries. PPARγ was expressed in uterine vascular tissue of both non-pregnant and pregnant rats with ~2-fold greater expression in radial vs. main uterine arteries. PPARγ mRNA levels were significantly higher in uterine compared to mesenteric arteries. GW9662 treatment during pregnancy did not affect maternal physiology (body weight, glucose, blood pressure, mesenteric artery vasodilation or structural remodeling of uterine and mesenteric vessels. Inhibition of PPARγ for the last 10 days of gestation caused decreased fetal weights on both day 20 and 21 of gestation that was associated with impaired vasodilation of radial uterine arteries in response to acetylcholine and sodium nitroprusside. These results define an essential role of PPARγ in the control of uteroplacental vasodilatory function during pregnancy, an important determinant of blood flow to the placenta and fetus. Strategies that target PPARγ activation in the uterine circulation could have important therapeutic potential in treatment of pregnancies complicated by hypertension, diabetes or preeclampsia.

  15. Uterine biology in pigs and sheep

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    Bazer Fuller W

    2012-07-01

    Full Text Available Abstract There is a dialogue between the developing conceptus (embryo-fetus and associated placental membranes and maternal uterus which must be established during the peri-implantation period for pregnancy recognition signaling, implantation, regulation of gene expression by uterine epithelial and stromal cells, placentation and exchange of nutrients and gases. The uterus provide a microenvironment in which molecules secreted by uterine epithelia or transported into the uterine lumen represent histotroph required for growth and development of the conceptus and receptivity of the uterus to implantation. Pregnancy recognition signaling mechanisms sustain the functional lifespan of the corpora lutea (CL which produce progesterone, the hormone of pregnancy essential for uterine functions that support implantation and placentation required for a successful outcome of pregnancy. It is within the peri-implantation period that most embryonic deaths occur due to deficiencies attributed to uterine functions or failure of the conceptus to develop appropriately, signal pregnancy recognition and/or undergo implantation and placentation. With proper placentation, the fetal fluids and fetal membranes each have unique functions to ensure hematotrophic and histotrophic nutrition in support of growth and development of the fetus. The endocrine status of the pregnant female and her nutritional status are critical for successful establishment and maintenance of pregnancy. This review addresses the complexity of key mechanisms that are characteristic of successful reproduction in sheep and pigs and gaps in knowledge that must be the subject of research in order to enhance fertility and reproductive health of livestock species.

  16. Laparoscopic sacral suture hysteropexy for uterine prolapse.

    Science.gov (United States)

    Krause, Hannah G; Goh, Judith T W; Sloane, Kate; Higgs, Peta; Carey, Marcus P

    2006-06-01

    This study aims to describe and review a new method of uterine conservation in pelvic reconstruction for women with uterine prolapse. This is a prospective study of women who have undergone laparoscopic sacral suture hysteropexy. Structured questions, visual analogue patient satisfaction score (VAS), and vaginal examination were undertaken. Follow-up was performed by non-surgical reviewers. From July 2001 until August 2003, a total of 81 women underwent laparoscopic sacral suture hysteropexy for uterine prolapse. At a mean of 20.3 months follow-up, 76 women (93.8%) were available for questioning and 57 (70.3%) attended for examination. Sixty-five women (87.8%) had no symptoms of pelvic floor prolapse, 54 women (94.7%) had no objective evidence of uterine prolapse, and 61 women (82.4%) were satisfied with their surgery (VAS > or = 80%). Laparoscopic sacral suture hysteropexy attaches the posterior cervix to the sacral promontory via the right uterosacral ligament. Follow-up data of laparoscopic sacral suture hysteropexy indicate it to be an effective method in the management of uterine prolapse.

  17. Dysfunctional Uterine Bleeding: Questions to Discuss with Your Doctor

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    ... delivered to your inbox ! When You Visit Your Doctor - Dysfunctional Uterine Bleeding Dysfunctional Uterine Bleeding Questions to Discuss with Your Doctor: Do you have regular menstrual cycles? When was ...

  18. Uterine vascular lesions: a rare cause of abnormal uterine bleeding, reporting of two cases

    Directory of Open Access Journals (Sweden)

    Sunita Arora

    2014-06-01

    Full Text Available Uterine vascular lesions in the form of arteriovenous malformation or pseudo aneurysm are rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manner are essential because instrumentation that is often used for other causes of uterine bleeding can lead to massive hemorrhage. We describe two cases of uterine vascular malformation, one presenting as postabortal hemorrhage and other as postpartum hemorrhage. Case one presented as postabortal hemorrhage after induced abortion following dilatation and curettage. Case two presented as delayed postpartum hemorrhage after six weeks following cesarean section. In both cases diagnosis of uterine arteriovenous malformation was made on Doppler ultrasonography which was subsequently confirmed on pelvic angiography. The embolization of affected uterine arteries was performed successfully in both cases. Uterine vascular lesion should be suspected in patient with abnormal vaginal bleeding, especially who has recent medical history of induced abortion or dilatation and curettage or cesarean section and so on. Although angiography remains the gold standard for making diagnosis, Doppler ultrasonography is also a good noninvasive technique for the same. Uterine artery embolization offers a safe and effective treatment. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 749-753

  19. Superselective uterine arterial embolization with pingyangmycin-lipiodol emulsion for management of symptomatic uterine leiomyoma

    Institute of Scientific and Technical Information of China (English)

    单鸿; 黄明声; 关守海; 姜在波; 朱康顺; 李征然

    2004-01-01

    Background Uterine arterial embolization (UAE) is a safe and effective therapy for symptomatic uterine leiomyoma. This study was to assess the effectiveness and the feasibility of pingyangmycin-lipiodol emulsion (PLE) for the management of symptomatic uterine leiomyoma.Methods One hundred consecutive patients (aged 21-53 years, with 38 in average) with symptomatic uterine leiomyoma underwent superselective UAE with PLE. Clinical symptoms of the patients (including menorrhagia, bulk-related symptoms, and postprocedure-related abdominal pain) and the changes in uterine volume and tumor size after the embolization were analyzed. The patients were followed up for 8-21 months (mean, 15 months).Results Ninety-nine patients (99%, 99/100) were interviewed in their first menses circle after embolization, showing improvements in their abnormal bleeding and bulk-related symptoms to some extent. Imagiological results during follow-up showed a mean of 48% reduction in uterine volume at 6 months and a mean of 75% reduction in tumor size at 9 months. Eighty-three percent of the patients reported complete resolution of postprocedure pain within 7 days.Conclusions PLE is effective in the management of uterine leiomyoma, having superiority in alleviating postprocedure-related pain.

  20. PECULIARITIES OF CHANGES ОF IMMUNOREGULATORY SYSTEM OF WOMEN WITH BACKGROUNG PATHOLOGY OF UTERINE CERVIX (NA

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    N.B. Zakharova

    2009-03-01

    Full Text Available A comparative research of cytokines IL-1b, IL-4, IL-6, IL-8, INF-/, TNF-a and its concentration in cellular material suspension on surface of pseudo erosion of uterine cervix was carried out. It was clarified that inefficient activation of local protective factors of immune system plays the main