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Sample records for symptomatic uterine fibroids

  1. 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.

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

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    Mutai, John Kiprop; Vinayak, Sudhir; Stones, William; Hacking, Nigel; Mariara, Charles

    2015-01-01

    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. PMID:25883858

  3. 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.

  4. Hypertension risk in Dutch women with symptomatic uterine fibroids

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    Haan, Yentl C.; Oudman, Inge; de Lange, Maria E.; Timmermans, Anne; Ankum, Willem M.; van Montfrans, Gert A.; Brewster, Lizzy M.

    2015-01-01

    Female-specific risk factors for cardiovascular disease are understudied. We assessed whether women with uterine fibroids have a greater hypertension risk, independent of the shared risk factors for both conditions. Blood pressure was measured in women scheduled for fibroid surgery compared to women

  5. Uterine artery embolization with Pingyangmycin lipiodol emulsion for treatment of symptomatic uterine fibroids

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    Li Yanhao; Liu Biao; Zeng Qingle; Jiang Zhongpu; Chen Yong; Huang Weilang; Shen Qi; Zhao Zhongqing

    2000-01-01

    Objective: To evaluate the effectiveness and side effects of uterine arterial embolization with Pingyangmycin(a homogenous bleomycin) lipiodol emulsion(PLE) for symptomatic uterine fibroids. Methods: Uterine arterial embolization with PLE was performed in 25 patients. The improvement of symptoms and uterine size changes were followed up in 3-18 months(mean 6 months) after the procedure. Results: All but 2 cases were successfully treated bilaterally. Super-selective angiography showed enlargement of uterine artery, accompanied by tortuous branches. The uterine size was increased. The uterus itself was significantly stained and emptied slowly. Coagulation necrosis was found in resected fibroids after embolization in 3 patients. One month after the procedure, a mean 40% reduction of uterine volume was obtained in 18 followed-up cases. The clinical symptoms were relieved significantly. The main side effects were hypogastric pain(13/25),which was intense in 6 cases. Conclusion: Uterine arterial embolization with PLE is a good non-surgical therapy in symptomatic uterine fibroids with mild side effects

  6. Effect of uterine arterial embolization on symptomatic uterine fibroids and ovarian function

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    Li Zhang

    2016-04-01

    Full Text Available Objective: To investigate the effect of uterine artery embolization (UAE in the treatment of symptomatic uterine fibroids and the effect on ovarian function. Methods: Clinical data of 20 UAE cases admitted from August 2014 to August 2015 were retrospectively analyzed. They had uterine leiomyoma, and received UAE after menstruation 3-7 d. Seldinger technology was used to puncture the right femoral artery, microspheres was alginated or polyvinyl alcohol particles were injected into the target vessel embolism vascular leiomyoma. Broken Gelfoam embolization of uterine artery was used to stop fibroids blood supply; imaging examination of symptomatic uterine fibroids was performed before and 3 months, 6 months, 12 months after UAE. The volume of uterus myoma volume changes was observed; luteinizing hormone (LH, prolactin (PRL, follicle stimulating hormone (FSH, progesterone (PROG, estradiol (E2 changes were detected before and 3 months, 6 months, 12 months after UAE. Results: Three months, 6 months, 12 months after UAE surgery, all patients were followed up for 3 months. The volume of uterus and tumor volume were significantly reduced, and the degree of reduction was moresignificant (P0.05. Conclusions: UAE has definite efficacy, and it has little effect on ovarian function.

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

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    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

  8. Transcatheter uterine arterial embolization for treatment of symptomatic uterine fibroids: preliminary experience

    International Nuclear Information System (INIS)

    Wang Zhongpu; Wang Maoqiang; Wu Chaoyang

    2000-01-01

    Objective: To evaluate the effectiveness of uterine arterial embolization (UAE) in the management of symptomatic uterine fibroids (UF). Methods: Ten patients with refractory vaginal bleeding, pelvic pain; and/or pelvic compression related to UF underwent UAE. The UF was diagnosed by radiological imaging and gynecological examination. 11 times of UAE were done in the ten patients, including bilateral uterine arterial embolization in 9 patients and un-bilateral embolization in 1 patient. The embolic materials used in this study was polyvinyl alcohol (PVA) particles. Results: All 10 patients underwent technically successful embolization. No serious complications related to the procedure have occurred. Follow-up data was available in 9 patients. Eight of the patients were experienced symptomatic relief after the treatment. One woman (the only patient undergoing un-bilateral UAE) exhibited no clinical response. The volume of dominant UF showed a mean 42% reduction 2 months after the treatment. Conclusions: Transcatheter uterine arterial embolization is a safe and effective method for the management of symptomatic UF. Longer follow-up is needed to evaluate the long term effects

  9. Mid-term Clinical Results and Patient Satisfaction After Uterine Artery Embolization in Women with Symptomatic Uterine Fibroids

    International Nuclear Information System (INIS)

    Smeets, Albert J.; Lohle, Paul N. M.; Vervest, Harry A. M.; Boekkooi, P. Focco; Lampmann, Leo E.H.

    2006-01-01

    Purpose. To evaluate the mid-term clinical results and patient satisfaction following uterine artery embolization (UAE) in women with symptomatic fibroids. Methods. Between August 1998 and December 2002, 135 patients had UAE for symptomatic uterine fibroids. All patients were asked to fill in a questionnaire. Questions were aimed at changes in bleeding, pain, and bulk-related symptoms. Symptoms after UAE were scored as disappeared, improved, unchanged or worsened. Adverse events were noted, such as vaginal dryness and discharge, menopausal complaints or fibroid expulsion. Patient satisfaction after UAE was assessed. Patient satisfaction of women embolized with polyvinyl alcohol (PVA) particles was compared with satisfaction of women embolized with calibrated microspheres. Results. The questionnaire was returned by 110 of 135 women (81%) at a median time interval of 14 months following UAE. In 10 women additional embolization or hysterectomy had been performed. Of the 110 responders, 86 (78%) were satisfied with the result of UAE. The proportion of satisfied women was higher in the group embolized with calibrated microspheres than in women embolized with PVA, although this difference was not statistically significant (p = 0.053). Conclusion. UAE in women with symptomatic uterine fibroids leads to improvement of symptoms and patient satisfaction is good in the vast majority after a median follow-up period of 14 months

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

    International Nuclear Information System (INIS)

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

    2005-01-01

    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

  11. 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.

  12. New uterine-preserving therapies raise questions about interdisciplinary management and the role of surgery for symptomatic fibroids.

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    Pron, Gaylene

    2006-01-01

    Mounting evidence to support the safety and effectiveness of new uterine-preserving fibroid therapies is raising questions not only about changing indications for surgery but also about gynecologists' role in therapies offered by other specialists. New collaborative relationships are needed to provide the best possible treatment; without them, those lag times of 10-15 years often cited as the time it takes for advances in clinical research to diffuse into clinical practice will be even longer for women with symptomatic fibroids.

  13. Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study

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    Roshdy, Eman; Rajaratnam, Veera; Maitra, Sarbani; Sabry, Mohamed; Allah, Abdou S Ait; Al-Hendy, Ayman

    2013-01-01

    Background Uterine fibroids (UFs, also known as leiomyoma) affect 70% of reproductive-age women. Imposing a major burden on health-related quality-of-life (HRQL) of premenopausal women, UF is a public health concern. There are no effective medicinal treatment options currently available for women with symptomatic UF. Objectives To evaluate the efficacy and safety of green tea extract (epigallocatechin gallate [EGCG]) on UF burden and quality of life in women with symptomatic UF, in a double-blinded, placebo-controlled randomized clinical trial. Methods A total of 39 reproductive-age women (age 18–50 years, day 3 serum follicle-stimulating hormone <10 \\U/mL) with symptomatic UF were recruited for this study. All subjects had at least one fibroid lesion 2 cm3 or larger, as confirmed by transvaginal ultrasonography. The subjects were randomized to oral daily treatment with either 800 mg of green tea extract (45% EGCG) or placebo (800 mg of brown rice) for 4 months, and UF volumes were measured at the end, also by transvaginal ultrasonography. The fibroid-specific symptom severity and HRQL of these UF patients were scored at each monthly visit, using the symptom severity and quality-of-life questionnaires. Student’s t-test was used to evaluate statistical significance of treatment effect between the two groups. Results Of the final 39 women recruited for the study, 33 were compliant and completed all five visits of the study. In the placebo group (n = 11), fibroid volume increased (24.3%) over the study period; however, patients randomized to green tea extract (n = 22, 800 mg/day) treatment showed significant reduction (32.6%, P = 0.0001) in total UF volume. In addition, EGCG treatment significantly reduced fibroid-specific symptom severity (32.4%, P = 0.0001) and induced significant improvement in HRQL (18.53%, P = 0.01) compared to the placebo group. Anemia also significantly improved by 0.7 g/dL (P = 0.02) in the EGCG treatment group, while average blood loss

  14. Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors.

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    Torre, Antoine; Fauconnier, Arnaud; Kahn, Vanessa; Limot, Olivier; Bussierres, Laurence; Pelage, Jean Pierre

    2017-07-01

    To evaluate the fertility of women eligible for surgical multiple myomectomy, but who carefully elected a fertility-sparing uterine artery embolization (UAE). Non-comparative open-label trial, on women ≤40 years, presenting with multiple symptomatic fibroids (at least 3, ≥3 cm), immediate pregnancy wish, and no associated infertility factor. Women had a bilateral limited UAE using tris-acryl gelatin microspheres ≥500 μm. Fertility, ovarian reserve, uterus and fibroid sizes, and quality of life questionnaires (UFS-QoL) were prospectively followed. Fifteen patients, aged 34.8 years (95%CI 32.2-37.5, median 36.0, q1-q3 29.4-39.5) were included from November 2008 to May 2012. During the year following UAE, 9 women actively attempting to conceive experienced 5 live-births (intention-to-treat fertility rate 33.3%, 95%CI 11.8%-61.6%). Markers of ovarian reserve remained stable. The symptoms score was reduced by 66% (95%CI 48%-85%) and the quality of life score was improved by 112% (95%CI 21%-204%). Uterine volume was reduced by 38% (95%CI 24%-52%). Women were followed for 43.1 months (95%CI 32.4-53.9), 10 live-births occurred in 8 patients, and 5 patients required secondary surgeries for fibroids. Women without associated infertility factors demonstrated an encouraging capacity to deliver after UAE. Further randomized controlled trials comparing UAE and myomectomy are warranted. • Women without infertility factors showed an encouraging delivery rate after UAE. • For women choosing UAE over abdominal myomectomy, childbearing may not be impaired. • Data are insufficient to definitively recommend UAE as comparable to myomectomy. • Further randomized trials comparing fertility after UAE or myomectomy are warranted.

  15. Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study

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    Roshdy E

    2013-08-01

    Full Text Available Eman Roshdy,1,* Veera Rajaratnam,2,* Sarbani Maitra,2 Mohamed Sabry,3,4 Abdou S Ait Allah,3,4 Ayman Al-Hendy2 1Department of Public Health and Community Medicine, Sohag University, Sohag, Egypt; 2Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, TN, USA; 3Department of Obstetrics and Gynecology, Sohag University, Sohag, Egypt; 4Ibn Sina IVF Center, Ibn Sina Hospital, Sohag, Egypt*These authors contributed equally to this workBackground: Uterine fibroids (UFs, also known as leiomyoma affect 70% of reproductive-age women. Imposing a major burden on health-related quality-of-life (HRQL of premenopausal women, UF is a public health concern. There are no effective medicinal treatment options currently available for women with symptomatic UF.Objectives: To evaluate the efficacy and safety of green tea extract (epigallocatechin gallate [EGCG] on UF burden and quality of life in women with symptomatic UF, in a double-blinded, placebo-controlled randomized clinical trial.Methods: A total of 39 reproductive-age women (age 18–50 years, day 3 serum follicle-stimulating hormone < 10 mIU/mL with symptomatic UF were recruited for this study. All subjects had at least one fibroid lesion 2 cm3 or larger, as confirmed by transvaginal ultrasonography. The subjects were randomized to oral daily treatment with either 800 mg of green tea extract (45% EGCG or placebo (800 mg of brown rice for 4 months, and UF volumes were measured at the end, also by transvaginal ultrasonography. The fibroid-specific symptom severity and HRQL of these UF patients were scored at each monthly visit, using the symptom severity and quality-of-life questionnaires. Student's t-test was used to evaluate statistical significance of treatment effect between the two groups.Results: Of the final 39 women recruited for the study, 33 were compliant and completed all five visits of the study. In the placebo group (n = 11, fibroid volume increased (24.3% over the study

  16. Uterine fibroids

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    ... Instructions Hysterectomy - abdominal - discharge Hysterectomy - laparoscopic - discharge Hysterectomy - vaginal - discharge Uterine artery embolization - discharge Images Pelvic laparoscopy Female ...

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

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    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.

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

    International Nuclear Information System (INIS)

    Kim, Man Deuk; Lee, Hyun Seok; Lee, Mee Hwa; Kim, Hee Jin; Cho, Jin Ho; Cha, Sun Hee

    2010-01-01

    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 μm). 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. Uterine fibroids: current perspectives

    Directory of Open Access Journals (Sweden)

    Khan AT

    2014-01-01

    Full Text Available Aamir T Khan,1 Manjeet Shehmar,1 Janesh K Gupta21Birmingham Women's Hospital, Edgbaston, Birmingham, UK; 2Academic Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham, UKAbstract: Uterine fibroids are a major cause of morbidity in women of a reproductive age (and sometimes even after menopause. There are several factors that are attributed to underlie the development and incidence of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on the woman's menstrual cycle or pelvic pressure symptoms. Leiomyosarcoma is a very rare entity that should be suspected in postmenopausal women with fibroid growth (and no concurrent hormone replacement therapy. The gold standard diagnostic modality for uterine fibroids appears to be gray-scale ultrasonography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medically, surgically, and even by minimal access techniques. The recent introduction of selective progesterone receptor modulators (SPRMs and aromatase inhibitors has added more armamentarium to the medical options of treatment. Uterine artery embolization (UAE has now been well-recognized as a uterine-sparing (fertility-preserving method of treating fibroids. More recently, the introduction of ultrasound waves (MRgFUS or radiofrequency (VizAblate™ and Acessa™ for uterine fibroid ablation has added to the options of minimal access treatment. More definite surgery in the form of myomectomy or hysterectomy can be performed via the minimal access or open route methods. Our article seeks to review the already established information on uterine fibroids with added emphasis on contemporary knowledge.Keywords: leiomyoma, menorrhagia, ultrasonography, selective progesterone receptor modulators, uterine artery embolization, myomectomy

  20. Magnetic Resonance–Guided High-Intensity Focused Ultrasound (MRgHIFU) Treatment of Symptomatic Uterine Fibroids: An Evidence-Based Analysis

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    Pron, G

    2015-01-01

    Background Magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) is a noninvasive uterine-preserving treatment alternative to hysterectomy for women with symptomatic uterine leiomyomas (fibroids). Uterine fibroids commonly occur, have a broad impact on women's health and lifestyle, continue to be the main indication for hysterectomy, and represent a costly public health burden. Objectives The objectives of the analysis were to evaluate patients’ eligibility for MRgHIFU treatment of symptomatic uterine fibroids and the technical success, safety, effectiveness, and durability of this treatment. The review also compared the safety and effectiveness of MRgHIFU with other minimally invasive uterine-preserving treatments and surgeries for uterine fibroids. Methods A literature search was performed on March 27, 2014, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to March 27, 2014. Results The evidence review identified 2 systematic reviews, 2 RCTs, 45 cohort study reports, and 19 case reports involving HIFU treatment of symptomatic uterine fibroids. Eligibility for MRgHIFU treatment was variable, ranging from 14% to 74%. In clinical cohort studies involving 1,594 patients, 26 major complications (1.6%) were reported. MRgHIFU resulted in statistically and clinically significant reductions in fibroid-related symptoms in studies conducted in 10 countries, although few involved follow-up longer than 1 year. Retreatment rates following MRgHIFU were higher in early clinical studies involving regulated restrictions in the extent of fibroid ablation than in later reports involving near-complete ablation. Emergent interventions, however, were rare. Although a desire for fertility was an exclusion criteria for treatment, spontaneous term pregnancies did occur following HIFU. There were no

  1. Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) Treatment of Symptomatic Uterine Fibroids: An Evidence-Based Analysis.

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    Pron, G

    2015-01-01

    Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) is a noninvasive uterine-preserving treatment alternative to hysterectomy for women with symptomatic uterine leiomyomas (fibroids). Uterine fibroids commonly occur, have a broad impact on women's health and lifestyle, continue to be the main indication for hysterectomy, and represent a costly public health burden. The objectives of the analysis were to evaluate patients' eligibility for MRgHIFU treatment of symptomatic uterine fibroids and the technical success, safety, effectiveness, and durability of this treatment. The review also compared the safety and effectiveness of MRgHIFU with other minimally invasive uterine-preserving treatments and surgeries for uterine fibroids. A literature search was performed on March 27, 2014, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to March 27, 2014. The evidence review identified 2 systematic reviews, 2 RCTs, 45 cohort study reports, and 19 case reports involving HIFU treatment of symptomatic uterine fibroids. Eligibility for MRgHIFU treatment was variable, ranging from 14% to 74%. In clinical cohort studies involving 1,594 patients, 26 major complications (1.6%) were reported. MRgHIFU resulted in statistically and clinically significant reductions in fibroid-related symptoms in studies conducted in 10 countries, although few involved follow-up longer than 1 year. Retreatment rates following MRgHIFU were higher in early clinical studies involving regulated restrictions in the extent of fibroid ablation than in later reports involving near-complete ablation. Emergent interventions, however, were rare. Although a desire for fertility was an exclusion criteria for treatment, spontaneous term pregnancies did occur following HIFU. There were no randomized trials comparing MRgHIFU and

  2. Minimally invasive treatments of uterine fibroids

    NARCIS (Netherlands)

    Voogt, M.J.

    2012-01-01

    This thesis assesses clinical results and technical developments of two minimally invasive treatments for symptomatic uterine fibroids: uterine artery embolization (UAE) and magnetic resonance-guided high intensity focused ultrasound (MR-HIFU). Part I: Uterine artery embolization The results of a

  3. The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids.

    Science.gov (United States)

    Pron, Gaylene; Bennett, John; Common, Andrew; Wall, Jane; Asch, Murray; Sniderman, Kenneth

    2003-01-01

    To evaluate fibroid uterine volume reduction, symptom relief, and patient satisfaction with uterine artery embolization (UAE) for symptomatic fibroids. Multicenter, prospective, single-arm clinical treatment trial. Eight Ontario university and community hospitals. Five hundred thirty-eight patients undergoing bilateral UAE. Bilateral UAE performed with polyvinyl alcohol particles sized 355-500 microm. Three-month follow-up evaluations including fibroid uterine volume reductions, patient reported symptom improvement (7-point scale), symptom life-impact (10-point scale) reduction, and treatment satisfaction (6-point scale). Median uterine and dominant fibroid volume reductions were 35% and 42%, respectively. Significant improvements were reported for menorrhagia (83%), dysmenorrhea (77%), and urinary frequency/urgency (86%). Mean menstrual duration was significantly reduced after UAE (7.6 to 5.4 days). Improvements in menorrhagia were unrelated to pre-UAE uterine size or post-UAE uterine volume reduction. Amenorrhea occurring after the procedure was highly age dependent, ranging from 3% (1%-7%) in women under age 40 to 41% (26%-58%) in women age 50 or older. Median fibroid life-impact scores were significantly reduced after UAE (8.0 to 3.0). The majority (91%) expressed satisfaction with UAE treatment. UAE reduced fibroid uterine volume and provided significant relief of menorrhagia that was unrelated to initial fibroid uterine size or volume reduction. Patient satisfaction with short-term UAE treatment outcomes was high.

  4. 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. 2015 BMJ Publishing Group Ltd.

  5. Clinical outcome of magnetic-resonance-guided focused ultrasound surgery (MRgFUS) in the treatment of symptomatic uterine fibroids

    International Nuclear Information System (INIS)

    Kamp, J.E.K.; Scheurig-Muenkler, C.; Beck, A.; David, M.; Hengst, S.

    2013-01-01

    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.)

  6. Selective progesterone receptor modulators for fertility preservation in women with symptomatic uterine fibroids.

    Science.gov (United States)

    Ali, Mohamed; Al-Hendy, Ayman

    2017-09-01

    Uterine fibroids (UFs, AKA leiomyoma) are the most important benign neoplastic threat to women's health, with costs up to hundreds of billions of health care dollars worldwide. Uterine fibroids caused morbidities exert a tremendous health toll, impacting the quality of life of women of all ethnicities, especially women of color. Clinical presentations include heavy vaginal bleeding, pelvic pain, bulk symptoms, subfertility, and obstetric complications. Current management strategies heavily lean toward surgical procedures; nonetheless, the choice of treatment is generally subject to patient's age and her desire to preserve future fertility. Women with UF who desire to maintain future fertility potential face a dilemma because of the limited treatment choices that are currently available to help them achieve that goal. Recently, ulipristal acetate the first of the promising family of oral selective progesterone receptor modulators has been approved for UF treatment in Europe, Canada, and several other countries and is under review for possible approval in the USA. In this review article, we discuss recent advances in the management options against UF with a bend toward oral effective long-term treatment alternatives who are particularly suited for those seeking to preserve their future fertility potential. We also explore the transformative concept of primary and secondary UF prevention using these new anti-UF agents. We envision a remarkable shift in the management of UF in future years from surgical/invasive treatment to orally administrated options; clearly, this potential shift will require additional intense clinical research. © The Authors 2017. Published by Oxford University Press on behalf of Society for the Study of Reproduction.

  7. A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design

    Directory of Open Access Journals (Sweden)

    Park Noh

    2009-01-01

    Full Text Available Abstract Background Laparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by uterine fibroids in place of hysterectomy. The current study was designed to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to evaluate the efficacy of laparoscopic uterine artery ligation which can treat symptomatic uterine fibroids with the preservation of uterus. Methods and design Patients enrolled the current study are randomized to laparoscopic uterine artery ligation or laparoscopy-assisted vaginal hysterectomy. The primary outcome is to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer patients version 3.0. Secondary outcomes are to evaluate the volume reduction of uterus, uterine fibroids and ovaries by the 2 treatments, to compare the improvement of subjective symptoms using 11-point symptom score and postoperative clinical outcomes between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to investigate the improvement of postoperative vaginal bleeding by laparoscopic uterine artery ligation. Discussion Among treatment methods for symptomatic uterine fibroids with the preservation of uterus, laparoscopic uterine artery ligation is expected to have the efficacy like uterine artery embolization, which appeared to be safe for routine use with

  8. A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design.

    Science.gov (United States)

    Kim, Hee Seung; Kim, Jae Weon; Kim, Mi-Kyung; Chung, Hyun Hoon; Lee, Taek Sang; Jeon, Yong-Tark; Kim, Yong Beom; Jeon, Hye Won; Yun, Young Ho; Park, Noh Hyun; Song, Yong Sang; Kang, Soon-Beom

    2009-01-29

    Laparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by uterine fibroids in place of hysterectomy. The current study was designed to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to evaluate the efficacy of laparoscopic uterine artery ligation which can treat symptomatic uterine fibroids with the preservation of uterus. Patients enrolled the current study are randomized to laparoscopic uterine artery ligation or laparoscopy-assisted vaginal hysterectomy. The primary outcome is to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer patients version 3.0. Secondary outcomes are to evaluate the volume reduction of uterus, uterine fibroids and ovaries by the 2 treatments, to compare the improvement of subjective symptoms using 11-point symptom score and postoperative clinical outcomes between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to investigate the improvement of postoperative vaginal bleeding by laparoscopic uterine artery ligation. Among treatment methods for symptomatic uterine fibroids with the preservation of uterus, laparoscopic uterine artery ligation is expected to have the efficacy like uterine artery embolization, which appeared to be safe for routine use with symptomatic relief. The current study fully recruited in June 2008 and

  9. 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.

  10. A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design

    OpenAIRE

    Park Noh; Yun Young; Jeon Hye; Kim Yong; Jeon Yong-Tark; Lee Taek; Chung Hyun; Kim Mi-Kyung; Kim Jae; Kim Hee; Song Yong; Kang Soon-Beom

    2009-01-01

    Abstract Background Laparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by ut...

  11. 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.

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

    International Nuclear Information System (INIS)

    Martin, Jason; Bhanot, Kunal; Athreya, Sriharsha

    2013-01-01

    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.

  13. Uterine Fibroids Fact Sheet

    Science.gov (United States)

    ... a woman's chances of getting other forms of cancer in the uterus. What if I become pregnant and have fibroids? ... a woman's chances of getting other forms of cancer in the uterus. What if I become pregnant and have fibroids? ...

  14. Pain and Return to Daily Activities after Uterine Artery Embolization and Hysterectomy in the Treatment of Symptomatic Uterine Fibroids: Results from the Randomized EMMY Trial

    International Nuclear Information System (INIS)

    Hehenkamp, Wouter J.K.; Volkers, Nicole A.; Birnie, Erwin; Reekers, Jim A.; Ankum, Willem M.

    2006-01-01

    Purpose. To evaluate the safety and efficacy of uterine artery embolization (UAE) and hysterectomy for symptomatic uterine fibroids by means of a randomized controlled trial. The present paper analyses short-term outcomes, i.e., pain and return to daily activities. Methods. Patients were randomized (1:1) to UAE or hysterectomy. Pain was assessed during admission and after discharge, both quantitatively and qualitatively, using a numerical rating scale and questionnaires. Time to return to daily activities was assessed by questionnaire. Results. Seventy-five patients underwent hysterectomy and 81 patients underwent UAE. UAE patients experienced significantly less pain during the first 24 hr after treatment (p = 0.012). Non-white patients had significantly higher pain scores. UAE patients returned significantly sooner to daily activities than hysterectomy patients (for paid work: 28.1 versus 63.4 days; p < 0.001). In conclusion, pain appears to be less after UAE during hospital stay. Return to several daily activities was in favor of UAE in comparison with hysterectomy

  15. Herbal preparations for uterine fibroids

    Science.gov (United States)

    Liu, Jian Ping; Yang, Hong; Xia, Yun; Cardini, Francesco

    2011-01-01

    Background Uterine fibroids are the most common non-malignant growths in women of childbearing age. They are associated with heavy menstrual bleeding and subfertility. Herbal preparations are commonly used as alternatives to surgical procedures. Objectives To assess the benefits and risks of herbal preparations for uterine fibroids. Search strategy Authors searched following electronic databases: the Trials Registers of the Cochrane Menstrual Disorders and Subfertility Group and the Cochrane Complementary Medicine Field, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, the Chinese Biomedical Database, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), AMED, and LILACS. The searches ended on 31st December 2008. Selection criteria Randomised controlled trials comparing herbal preparations with no intervention, placebo, medical treatment or surgical procedures in women with uterine fibroids. We also included trials of herbal preparations with or without conventional therapy. Data collection and analysis Two review authors collected data independently. We assessed trial risk of bias according to our methodological criteria. We presented dichotomous data as risk ratios (RR) and continuous outcomes as mean difference (MD), both with 95% confidence intervals (CI). Main results We included two randomised trials (involved 150 women) with clear description of randomisation methods. The methodological risk of bias of the trials varied. There were variations in the tested herbal preparations, and the treatment duration was six months. The outcomes available were not the primary outcomes selected for this review, such as symptom relief or the need for surgical treatment; trials mainly reported outcomes in terms of shrinkage of the fibroids. Compared with mifepristone, Huoxue Sanjie decoction showed no significant difference in the disappearance of uterine fibroids, number of

  16. Uterine artery embolization to treat uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    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)

  17. Uterine artery embolization to treat uterine fibroids

    International Nuclear Information System (INIS)

    Machan, L.; Martin, M.

    2001-01-01

    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)

  18. Uterine fibroid embolization: Is there a role?

    International Nuclear Information System (INIS)

    Sandhu, Amarjeet K.; Hassan, Wadi Y.

    2004-01-01

    We present a case of uterine fibroid embolization (UFE) in Salmanya Medical Complex, Bahrain as a primary theraputic option for a selected case symptomatic fibroid uterus.Within 6 weeks of UFE, this patient developed life threatening infection due to sloughing of the fibroid through the cervix but she conceived within 11-months of the procedure and delivered normally at term. As this patient developed life threatening infection, the author is left with the predicament whether to try it again or not in the next selected case. Our patient was a 20-year-old, nulliparous girl who had fibroid uterus extending 2 fingers above the umbilicus. Ultrasound and computed tomography confirmed a large intramural posterior wall fibroid uterus measuring 17 x 15 cms Uterine fibroid embolization was carried out by single puncture using 700 polyvinyl alcohol particles lodged permanently inside both the uterine arteries to block or damp the flow of the blood through these vessels. On 6th week, she had vaginal myomectomy for sloughing of submucous fibroid through the cervix. (Figure 1) Postoperatively, she showed immediate improvement. She conceived after 11-months of treatment and pregnancy till normal delivery was uneventful. Patients who have had fibroid embolization have become pregnant as in our patient, after 11-months of embolization. Bradley et al4 described a woman who conceived immediately after the procedure. Ravina et al1 also reported a successful twin pregnancy in his patients. There have been no studies that define the incidence of pregnancy after the procedure and further studies are necessary to delineate the impact of UFE on fertility. Many gynecologists consider UFE as safe, exciting, promising, minimally invasive and highly effective non surgical primary treatment for symptomatic fibroid uterus. In spite of this, patient should me made aware of the limitations of the treatment and she should recognize that complications of the procedure may lead to hysterectomy. As

  19. Uterine artery embolization for adenomyosis without fibroids

    International Nuclear Information System (INIS)

    Kim, M.D.; Won, J.W.; Lee, D.Y.; Ahn, C.-S.

    2004-01-01

    AIM: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for symptomatic adenomyosis in patients without uterine fibroids. MATERIALS AND METHODS: Uterine artery embolization using polyvinyl alcohol particles sized 250-710 mm was performed in 43 patients (mean; 40.3 years, range; 31-52 years) with dysmenorrhoea, menorrhagia, or bulk-related symptoms (pelvic heaviness, urinary frequency) due to adenomyosis without fibroids. All patients underwent pre-procedural and 3.5 months (range 1-8 months) follow-up magnetic resonance imaging (MRI) with contrast enhancement. Clinical symptoms were also assessed at the time of MRI before and after embolization. RESULTS: Significant improvement of dysmenorrhoea (95.2%) and menorrhagia (95.0%) was reported in most patients. Contrast-enhanced MRI revealed non-enhancing areas suggesting coagulation necrosis of adenomyosis in 31 patients (72.1%), decreased size without necrosis in 11 patients (25.6%), and no change in one patient (2.3%). The mean volume reduction of the uteri after uterine artery embolization was 32.5% (from 321.7±142.9 to 216.7±130.1 cm 3 ). CONCLUSION: Transcatheter uterine artery embolization is an effective therapy for the treatment of symptomatic pure adenomyosis, and may be a valuable alternative to hysterectomy

  20. 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. © The Author(s) 2014.

  1. Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients.

    Science.gov (United States)

    Trumm, Christoph G; Stahl, Robert; Clevert, Dirk-André; Herzog, Peter; Mindjuk, Irene; Kornprobst, Sabine; Schwarz, Christina; Hoffmann, Ralf-Thorsten; Reiser, Maximilian F; Matzko, Matthias

    2013-06-01

    The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)-guided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio. This is a retrospective analysis of 115 women (mean age, 42 years; range, 27-54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean ± SD total volume and number of treated fibroids (per patient) were 89 ± 94 cm and 2.2 ± 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio. Magnetic resonance imaging-guided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% ± 15% (range, 38%-100%). Mean applied energy level was 5400 ± 1200 J, and mean number of sonications was 74 ± 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio. With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials.

  2. 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

  3. Magnetic Resonance Imaging (MRI) Analysis of Fibroid Location in Women Achieving Pregnancy After Uterine Artery Embolization

    International Nuclear Information System (INIS)

    Walker, Woodruff J.; Bratby, Mark John

    2007-01-01

    The purpose of this study was to evaluate the fibroid morphology in a cohort of women achieving pregnancy following treatment with uterine artery embolization (UAE) for symptomatic uterine fibroids. A retrospective review of magnetic resonance imaging (MRI) of the uterus was performed to assess pre-embolization fibroid morphology. Data were collected on fibroid size, type, and number and included analysis of follow-up imaging to assess response. There have been 67 pregnancies in 51 women, with 40 live births. Intramural fibroids were seen in 62.7% of the women (32/48). Of these the fibroids were multiple in 16. A further 12 women had submucosal fibroids, with equal numbers of types 1 and 2. Two of these women had coexistent intramural fibroids. In six women the fibroids could not be individually delineated and formed a complex mass. All subtypes of fibroid were represented in those subgroups of women achieving a live birth versus those who did not. These results demonstrate that the location of uterine fibroids did not adversely affect subsequent pregnancy in the patient population investigated. Although this is only a small qualitative study, it does suggest that all types of fibroids treated with UAE have the potential for future fertility

  4. Uterine Artery Embolization for Ureteric Obstruction Secondary to Fibroids

    International Nuclear Information System (INIS)

    Mirsadraee, Saeed; Tuite, David; Nicholson, Anthony

    2008-01-01

    This case series examines the safety and efficacy of uterine artery embolization (UAE) in the treatment of obstructive nephropathy caused by large fibroids. Between 2004 and 2007, 10 patients referred with symptomatic uterine fibroids that were found to be causing either unilateral (7 patients) or bilateral (3 patients) hydronephrosis were treated by UAE. Presenting complaints included menorrhagia, dysmenorrhea, bulk symptoms, loin pain, postobstructive atrophy, and mild renal impairment. All had posterior intramural dominant fibroids >11 cm in maximum sagittal diameter and uterine volumes between 3776 and 15,625 ml. Outcome measures at between 12 and 36 months included procedural success, repeat intervention, relief of symptoms, resolution of hydronephrosis, stable renal function and size, and avoidance of hysterectomy. In all cases the cause of renal obstruction was confirmed to be a giant fibroid compressing the ureter at the pelvic brim. In all cases UAE was technically successful, though two patients required a repeat procedure. In eight patients hydronephrosis resolved and the obstruction was relieved, though two still had some bulk symptoms not requiring further treatment. Renal function improved or was stable in all cases. Renal size was stable in all cases. Where menorrhagia was part of the symptom complex it was relieved in all cases. Two patients diagnosed as having postobstructive atrophy of one kidney underwent retrograde ureteric stenting on the nonatrophied side prior to UAE. This was unsuccessful in one of the cases due to the distortion caused by the fibroid. Despite improvement in hydronephrosis this patient underwent hysterectomy at 7 months after a renogram demonstrated persistent obstruction at the pelvic brim. In the second patient a double pigtail stent was inserted with difficulty and eventually removed at 8 months. This patient has had stable renal function and size for 3 years post-UAE. We conclude that UAE is safe and effective in

  5. Case Report: Massive Ascites Complicating Uterine Fibroids ...

    African Journals Online (AJOL)

    A rare case of massive ascites complicating uterine fibroid is presented. At presentation, she was emaciated with grossly distended abdomen and a mass, which corresponded to 36 weeks gestation. At operation a large soft mass attached to the uterus by fibrous strands and to the omentum by large dilated new vessels was ...

  6. Fertility after uterine artery embolization of fibroids

    DEFF Research Database (Denmark)

    Karlsen, K; Hrobjartsson, A; Korsholm, M

    2018-01-01

    for relevant information in PubMed and Embase for randomized controlled trials (RCT), controlled clinical trials, comparative before-after trials, cohort studies, case-control studies and case series where UAE treatment of premenopausal women was performed for uterine fibroids with and where a control...

  7. Krukenberg Tumour Simulating Uterine Fibroids and Pelvic ...

    African Journals Online (AJOL)

    To report a case of cancer of the colonwhich presented as secondaries to the ovaries. Case report. The case presented is that of a 39 year old female who presented with lower abdominal pain and a multinodular pelvic mass which led to an initial diagnosis of multiple uterine fibroids and pelvic inflammatory disease.

  8. MR-guided Focused Ultrasound for Uterine Fibroids

    Science.gov (United States)

    ... Share your patient story here Related Articles and Media Magnetic Resonance Imaging (MRI) - Body Uterine Fibroid Embolization (UFE) Magnetic Resonance Imaging (MRI) Safety Blood Clots Images related to MR-guided Focused Ultrasound for Uterine ...

  9. Pregnancies complicated by uterine fibroids: A case series on ...

    African Journals Online (AJOL)

    handling, speed but careful closure/hemostasis in addition to judicious post operative care can guarantee a successful pregnancy sparing myomectomy. Key words: Early pregnancy; infertility; myomectomy; pregnancy loss; uterine fibroids. Introduction. Myomectomy is a form of surgical management for uterine fibroids when ...

  10. Presentation and Management of Uterine Fibroids at the Lagos ...

    African Journals Online (AJOL)

    To review the clinical presentation and management of uterine fibroids at the Lagos University Teaching Hospital, Idi-Araba, Lagos. women with uterine fibroids that presented at the Gynaecological outpatient clinic were followed up till surgery and data on sociodemographic profile, parity, presenting signs and symptoms, ...

  11. Surgical findings at laparatomy for uterine fibroid in University of ...

    African Journals Online (AJOL)

    A palpable abdominal swelling represents the commonest symptom of uterine fibroid in this study and as was present in sixty nine point nine. Other factors found to be associated with uterine fibroid are the numbers, size, location and associated pelvic inflammatory disease, which are common in low resource countries.

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

    International Nuclear Information System (INIS)

    Park, Hye Ri; Kim, Nack Keun; Lee, Mee Hwa; Kim, Man Deuk; Kim, Hee Jin; Yoon, Sang-Wook; Park, Won Kyu

    2005-01-01

    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 μm). 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

  13. The Ontario Uterine Fibroid Embolization Trial. Part 1. Baseline patient characteristics, fibroid burden, and impact on life.

    Science.gov (United States)

    Pron, Gaylene; Cohen, Marsha; Soucie, Jennifer; Garvin, Greg; Vanderburgh, Leslie; Bell, Stuart

    2003-01-01

    To determine baseline characteristics of women undergoing uterine artery embolization (UAE) for symptomatic fibroids. Multicenter, prospective, single-arm clinical treatment trial. Eight Ontario university and community hospitals. Five hundred fifty-five women undergoing UAE for fibroids. Baseline questionnaires completed before UAE. Questionnaires were analyzed for demographic, medical, and gynecologic histories. Fibroid symptoms, impact of symptoms, previous consultations, and treatments were also analyzed. The Ontario cohort (66% white, 23% black, 11% other races) had an average age of 43. Thirty-one percent were under age 40. Most women were university educated (68%) and working outside the home (85%). Women reported heavy menstrual bleeding (80%), urinary urgency/frequency (73%), pain during intercourse (41%), and work absences (40%). They experienced fibroid-related symptoms for an average of 5 years and consulted with on average of three gynecologists before UAE. High fibroid life-impact scores were reported by 58%. Black women were significantly younger (40.7 vs. 44.0 years), more likely to experience symptoms longer (7 vs. 5 years), and more likely to undergo myomectomy before UAE (24% vs. 9%) than white women. Our study illustrates that large numbers of women with highly symptomatic fibroid disease are averse to surgery despite their burden of suffering and are actively seeking alternatives to hysterectomy.

  14. Pharmacological Treatment of Uterine Fibroids

    African Journals Online (AJOL)

    estimated that they affect up to 80% of women by 50 years; however, the prevalence of symptomatic patients is much lower, reaching 20-30% of these women.[1] The etiology of UF is generally unknown, but many genetic, hormonal and biologic features of the disease have been described, contributing to its understanding.

  15. 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

  16. 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.

  17. Uterine Fibroid Embolization Can Still Be Improved: Observations on Post-Procedure Magnetic Resonance Imaging

    International Nuclear Information System (INIS)

    Dorenberg, E.J.; Novakovic, Z.; Smith, H.J.; Hafsahl, G.; Jakobsen, J.Aa.

    2005-01-01

    PURPOSE: To evaluate the efficacy and completeness of uterine fibroid embolization (UFE) measured by changes in volume and signal intensity at magnetic resonance imaging (MRI), and to compare with clinical outcome. MATERIAL AND METHODS: 40 women with symptomatic uterine fibroids underwent bilateral uterine artery embolization. At MRI studies, including post-contrast sequences before and repeatedly after treatment, the uterus and dominant fibroids were evaluated for volume, location, and contrast enhancement. Prior to treatment, all myomas showed significant contrast enhancement. The mean uterine volume was 929 ml. Clinical examinations with emphasis on menorrhagia, pelvic pain, and urinary dysfunction were performed before and 6 and 12 months after treatment. RESULTS: UFE was bilaterally successful in 38 patients. After UFE, MRI showed no enhancement of myomas in 30 patients. In 8 patients, post-procedural MRI revealed partially remaining vascularization of fibroids despite angiographically complete embolization of the uterine arteries. On average, uterine volume decreased by 46.2% at 12 months. There was significant improvement of symptoms in the majority of patients, but slightly less improvement in patients with partially remaining vascularization of myomas. CONCLUSION: UFE causes significant volume reduction of myomas and clinical improvement. MRI can reveal remaining vascularization in myomas despite angiographically complete embolization of uterine arteries

  18. Role of Transforming Growth Factor β in Uterine Fibroid Biology.

    Science.gov (United States)

    Ciebiera, Michał; Włodarczyk, Marta; Wrzosek, Małgorzata; Męczekalski, Błażej; Nowicka, Grażyna; Łukaszuk, Krzysztof; Ciebiera, Magdalena; Słabuszewska-Jóźwiak, Aneta; Jakiel, Grzegorz

    2017-11-17

    Uterine fibroids (UFs) are benign tumors of the female genital tract made of the smooth muscle of the uterus. UF growth depends mostly on the influence of the steroid hormones and selected growth factors. Transforming growth factor β (TGF-βs) is a polypeptide that consists of three isoforms: TGF-β1, TGF-β2, and TGF-β3. At present, TGF-β is considered to be one of the key factors in the pathophysiology of UFs. It plays a major role in cellular migration within the tumor, stimulates tumor growth, and enhances tumor metabolism. As a consequence of various dependencies, the synthesis and release of TGF-β in a UF tumor is increased, which results in excessive extracellular matrix production and storage. High concentrations or overexpression of TGF-β mediators may be responsible for clinically symptomatic UFs. The aim of this review was to check the available evidence for the influence of the TGF-β family on UF biology. We conducted their search in PubMed of the National Library of Medicine with the use of the following selected keywords: "uterine fibroid", "leiomyoma", and "transforming growth factor β". After reviewing the titles and abstracts, more than 115 full articles were evaluated. We focused on the TGF-β-related molecular aspects and their influence on the most common symptoms that are associated with UFs. Also, we described how the available data might implicate the current medical management of UFs.

  19. Feasibility of ultrasound-guided high intensity focused ultrasound ablating uterine fibroids with hyperintense on T2-weighted MR imaging

    International Nuclear Information System (INIS)

    Zhao, Wen-Peng; Chen, Jin-Yun; Zhang, Lian; Li, Quan; Qin, Juan

    2013-01-01

    Purpose: To retrospectively investigate whether uterine fibroids with hyperintense on pretreatment T2-weighted magnetic resonance imaging (MRI) could be treated with ultrasound-guided high intensity focused ultrasound (USgHIFU). Materials and methods: 282 patients with 282 symptomatic uterine fibroids who underwent USgHIFU treatment were retrospectively analyzed. Based on the signal intensity of T2-weighted MRI, uterine fibroids were classified as hypointense, isointense and hyperintense. Hyperintense fibroids were subjectively further subdivided into heterogeneous hyperintense, slightly homogeneous hyperintense and markedly homogeneous hyperintense based on the signal intensity of fibroid relative to myometrium and endometrium on T2-weighted MRI. Enhanced MRI was performed within one month after HIFU treatment. Non-perfused volume (NPV, indicative of successful ablation) ratio, treatment time, treatment efficiency, energy effect ratio and adverse events were recorded. Results: The median volume of uterine fibroids was 70.3 cm 3 (interquartile range, 41.1–132.5 cm 3 ). The average NPV ratio, defined as non-perfused volume divided by the fibroid volume after HIFU treatment, was 76.8 ± 19.0% (range, 0–100%) in the 282 patients. It was 86.3 ± 11.9% (range, 40.9–100.0%) in the group with hypointense fibroids, 77.1 ± 16.5% (range, 32.2–100.0%) in isointense fibroids, and 67.6 ± 23.9% (range, 0–100.0%) in hyperintense fibroids. The lowest NPV ratio, lowest treatment efficiency, more treatment time, more sonication energy and pain scores were observed in the slightly homogeneous hyperintense fibroids, and the NPV ratio was 55.8 ± 26.7% (range, 0–83.9%) in this subgroup. Conclusion: Based on our results, the heterogeneous and markedly homogeneous hyperintense fibroids were suitable for USgHIFU, and only the slightly homogeneous hyperintense fibroids should be excluded

  20. Prolapsed submucous uterine fibroid polyp associated with urinary ...

    African Journals Online (AJOL)

    protruding down the vagina, irregular bleeding per vagina and offensive vaginal discharge. She had a preoperative diagnosis of infected proplased submucous uterine fibroid measuring 10cm by 10 cm with a stalk measuring 6cm. At laparotomy, the fibroid polyp was excised from its base in the posterior wall of the uterus.

  1. Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids. Early clinical experience

    International Nuclear Information System (INIS)

    Mikami, Koji; Osuga, Keigo; Tomoda, Kaname; Nakamura, Hironobu; Murakami, Takamichi; Okada, Atsuya

    2008-01-01

    The aim of this study was to assess the feasibility and effectiveness of magnetic resonance (MRI)-guided focused ultrasound (MRIgFUS) ablation for uterine fibroids and to identify the candidates for this treatment. A total of 48 patients with a symptomatic uterine fibroid underwent MRIgFUS. The percent ablation volume was calculated, and the patients' characteristics and the MR imaging features of the fibroids that might predict the effect of this treatment were assessed. Changes in the symptoms related to the uterine fibroid were assessed at 6 and 12 months. The planned target zone were successfully treated in 32 patients with bulk-related and menstrual symptoms but unsuccessfully treated in the remaining 16 patients. These 16 patients were obese or their uterine fibroid showed heterogeneous high signal intensity on T2-weighted images. The 32 successfully treated patients were followed up for 6 months. At the 6-month follow-up, bulk-related and menstrual symptoms were diminished in 60% and 51% of patients, respectively. Among them, 17 patients were followed up for 12 months, and 9 of them who showed alleviation of bulk-related symptoms at 6 months had further improvement. The mean percent ablation volume of those nine patients was 51%. In 5 (33%) of the 15 patients with alleviation of menstrual symptoms at 6 months, the symptoms became worse at 12 months. There was a significant difference in the mean percent ablation volume between patients with alleviation of menstrual symptoms and those without (54% vs. 37%; P=0.03). MRIgFUS ablation is a safe, effective treatment for nonobese patients with symptomatic fibroids that show low signal intensity on T2-weighted images. Ablation of more than 50% of the fibroid volume may be needed with a short-term follow-up. (author)

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study

    International Nuclear Information System (INIS)

    Mahmoud, Mustafa Z.; Alkhorayef, Mohammed; Alzimami, Khalid S.; Aljuhani, Manal Saud; Sulieman, Abdelmoneim

    2014-01-01

    High-intensity focused ultrasound (HIFU) is a highly precise medical procedure used locally to heat and destroy diseased tissue through ablation. This study intended to review HIFU in uterine fibroid therapy, to evaluate the role of HIFU in the therapy of leiomyomas as well as to review the actual clinical activities in this field including efficacy and safety measures beside the published clinical literature. An inclusive literature review was carried out in order to review the scientific foundation, and how it resulted in the development of extracorporeal distinct devices. Studies addressing HIFU in leiomyomas were identified from a search of the Internet scientific databases. The analysis of literature was limited to journal articles written in English and published between 2000 and 2013. In current gynecologic oncology, HIFU is used clinically in the treatment of leiomyomas. Clinical research on HIFU therapy for leiomyomas began in the 1990s, and the majority of patients with leiomyomas were treated predominantly with HIFUNIT 9000 and prototype single focus ultrasound devices. HIFU is a non-invasive and highly effective standard treatment with a large indication range for all sizes of leiomyomas, associated with high efficacy, low operative morbidity and no systemic side effects. Uterine fibroid treatment using HIFU was effective and safe in treating symptomatic uterine fibroids. Few studies are available in the literature regarding uterine artery embolization (UAE). HIFU provides an excellent option to treat uterine fibroids

  5. Control for Uterine Fibroid Embolisation- An Initial Experience in ...

    African Journals Online (AJOL)

    Uterine fibroid embolisation (UFE) generates moderate to severe post-procedural pain. We present a case series of 24 patients who underwent UFE during our first experience in managing the sometimes excruciating pain that accompanies embolisation of the uterine arteries. We also show the evolution of our protocol for ...

  6. Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry.

    Science.gov (United States)

    Goodwin, Scott C; Spies, James B; Worthington-Kirsch, Robert; Peterson, Eric; Pron, Gaylene; Li, Shuang; Myers, Evan R

    2008-01-01

    To assess long-term clinical outcomes of uterine artery embolization across a wide variety of practice settings in a large patient cohort. The Fibroid Registry for Outcomes Data (FIBROID) for Uterine Embolization was a 3-year, single-arm, prospective, multi-center longitudinal study of the short- and long-term outcomes of uterine artery embolization for leiomyomata. Two thousand one hundred twelve patients with symptomatic leiomyomata were eligible for long-term follow-up at 27 sites representing a geographically diverse set of practices, including academic centers, community hospitals, and closed-panel health maintenance organizations. At 36 months after treatment, 1,916 patients remained in the study, and of these, 1,278 patients completed the survey. The primary measures of outcome were the symptom and health-related quality-of-life scores from the Uterine Fibroid Symptom and Quality of Life questionnaire. Mean symptom scores improved 41.41 points (P<.001), and the quality of life scores improved 41.47 points (P<.001), both moving into the normal range for this questionnaire. The improvements were independent of practice setting. During the 3 years of the study, Kaplan-Meier estimates of hysterectomy, myomectomy, or repeat uterine artery embolization were 9.79%, 2.82%, and 1.83% of the patients, respectively. Uterine artery embolization results in a durable improvement in quality of life. These results are achievable when the procedure is performed in any experienced community or academic interventional radiology practice. III.

  7. Comparison of clinical and MR imaging outcomes after uterine fibroid embolization with Bead Block and Embosphere

    International Nuclear Information System (INIS)

    Liaw, Jonathan V.P.; Yun, Chun-Ho; Walker, T. Gregory; Kalva, Sanjeeva P.; D’Othée, Bertrand Janne

    2012-01-01

    Purpose: To compare clinical and imaging outcomes after uterine fibroid embolization (UFE) with Embosphere versus Bead Block microspheres. Materials and methods: Our institutional review board approved this HIPAA-compliant study. We conducted a retrospective review of all consecutive UFEs performed for symptomatic uterine fibroids at our academic institution from 2001 to 2008. UFE was performed using Embosphere (n = 70) or Bead Block (n = 55) microspheres. Patient symptoms and MR images were reviewed before and following UFE. The MR images were analyzed for changes in the size and contrast enhancement of the dominant fibroid and the uterus. Results: 125 patients underwent UFE. Pre-treatment characteristics (patient age, presenting symptoms, fibroid location, and volume of the largest fibroid) were similar across groups. Procedure endpoint (near-stasis, reached in 94% of cases), duration, and sedation medication doses were also similar. Clinical follow-up was available in 69 (55%) patients (mean duration: 13.6 months). Of these, 92% had clinical improvement of their main presenting symptom(s) and 3% developed early menopause. MRI follow-up was available in 105 (84%) patients (mean 7.8 months). Mean volume reduction of the largest fibroid was similar after Embosphere (48%) and Bead Block (53%, p = NS). Residual enhancement ≥5% in the dominant fibroid was similarly uncommon after Bead Block (19%) or Embosphere (16%, p = NS). Mean uterine volume reduction was similar across groups (38%); no myometrial infarction occurred. Conclusion: This retrospective study showed no superiority of Embosphere over Bead Block microspheres in terms of clinical and imaging outcomes after UFE.

  8. Clinical and pathological observation of transcatheter embolization for uterine fibroids

    International Nuclear Information System (INIS)

    Chen Xiaoming; Du Juan; Zuo Yuewei; Sun Dawei; Hu Xiaoping; Lin Huahuan; Luo Pingfei; Hong Danhua

    2001-01-01

    Objective: To investigate the efficiency and safety of transcatheter uterine artery embolization (TUAE) as well as the pathological changes and it's significance after embolization. Methods: 44 cases of uterine fibroids were treated by TUAE using lipiodol-pingyangmycin emulsion (LPE) and Gelfoam sponge particle. Seven of 44 cases underwent hysterectomy or myomectomy from 1 to 6 weeks after TUAE. The specimens were studied to observe pathological changes of fibroids and myometrium. 37 of 44 patients were followed up for 1 to 6 months to observe the changes of fibroid size and uterine volume. The changes of ovarian function and myometrium after TUAE were found out by observation on mensis, test of ovarian hormone, premenstrual diagnostic curettage and pathology of the resected specimens. Results: Total improvement of symptoms occurred in 91.9%(34/37), including control of menorrhagia in 91.4%(32/35), disappearance of lumbago and lower abdominal pain in 85.3% (29/34), relief of frequency and urgency of micturition in 50.0%(7/14). Average decrease of fibroid and uterine volume at 6 months after TUAE was 61.3% and 50.6% respectively. No amenorrhea happened. Premenstrual diagnostic curettage showed secretory endometrium. There was no significant difference in ovarian hormone level before and after embolization. Pathological study showed that lipiodol was found to deposit in fibroids and was no seen in myometrium. Spotty necrosis 2 weeks occurred in fibroid and extensive patchy necrosis 3 weeks after embolization. The necrotic area became larger with elapse of time postoperative. Necrosis was not seen in myometrium. Conclusion: TUAE is a new, and effective procedure for uterine fibroid and LPE as an embolizing agent is safe without damage on myometrium

  9. ERα inhibited myocardin-induced differentiation in uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Liao, Xing-Hua, E-mail: xinghualiao@hotmail.com [Institute of Biology and Medicine, Wuhan University of Science and Technology, Wuhan, 430065 (China); Key Laboratory of Industrial Fermentation Microbiology, Ministry of Education and Tianjin, College of Biotechnology, Tianjin University of Science and Technology, Tianjin 300457 (China); Li, Jun-Yan [Henan Vocational College of Applied Technology, Zhengzhou 450042 (China); Dong, Xiu-Mei [Institute of Biology and Medicine, Wuhan University of Science and Technology, Wuhan, 430065 (China); Yuncheng County People' s Hospital, Shandong 274700 (China); Wang, Xiuhong [Xianning Central Hospital, Department of Obstetrics and Gynecology, Xianning, Hubei 437100 (China); Xiang, Yuan; Li, Hui; Yu, Cheng-Xi; Li, Jia-Peng; Yuan, Bai-Yin [Institute of Biology and Medicine, Wuhan University of Science and Technology, Wuhan, 430065 (China); Zhou, Jun, E-mail: zhoujun@wust.edu.cn [Institute of Biology and Medicine, Wuhan University of Science and Technology, Wuhan, 430065 (China); School of Medicine, Wuhan University of Science and Technology, Wuhan 430065 (China); Zhang, Tong-Cun, E-mail: zhangtongcun@wust.edu.cn [Institute of Biology and Medicine, Wuhan University of Science and Technology, Wuhan, 430065 (China); Key Laboratory of Industrial Fermentation Microbiology, Ministry of Education and Tianjin, College of Biotechnology, Tianjin University of Science and Technology, Tianjin 300457 (China)

    2017-01-01

    Uterine fibroids, also known as uterine leiomyomas, are a benign tumor of the human uterus and the commonest estrogen-dependent benign tumor found in women. Myocardin is an important transcriptional regulator in smooth and cardiac muscle development. The role of myocardin and its relationship with ERα in uterine fibroids have barely been addressed. We noticed that the expression of myocardin was markedly reduced in human uterine fibroid tissue compared with corresponding normal or adjacent myometrium tissue. Here we reported that myocardin induced the transcription and expression of differentiation markers SM22α and alpha smooth muscle actin (α-SMA) in rat primary uterine smooth muscle cells (USMCs) and this effect was inhibited by ERα. Notably, we showed that, ERα induced expression of proliferation markers PCNA and ki-67 in rat primary USMCs. We also found ERα interacted with myocardin and formed complex to bind to CArG box and inhibit the SM22α promoter activity. Furthermore, ERα inhibited the transcription and expression of myocardin, and reduced the levels of transcription and expression of downstream target SM22α, a SMC differentiation marker. Our data thus provided important and novel insights into how ERα and myocardin interact to control the cell differentiation and proliferation of USMCs. Thus, it may provide potential therapeutic target for uterine fibroids.

  10. Review of magnetic resonance-guided focused ultrasound in the treatment of uterine fibroids

    Directory of Open Access Journals (Sweden)

    Pedro Felipe Magalhães Peregrino

    Full Text Available Uterine leiomyoma is the most frequently occurring solid pelvic tumor in women during the reproductive period. Magnetic resonance-guided high-intensity focused ultrasound is a promising technique for decreasing menorrhagia and dysmenorrhea in symptomatic women. The aim of this study is to review the role of Magnetic resonance-guided high-intensity focused ultrasound in the treatment of uterine fibroids in symptomatic patients. We performed a review of the MEDLINE and Cochrane databases up to April 2016. The analysis and data collection were performed using the following keywords: Leiomyoma, High-Intensity Focused Ultrasound Ablation, Ultrasonography, Magnetic Resonance Imaging, Menorrhagia. Two reviewers independently performed a quality assessment; when there was a disagreement, a third reviewer was consulted. Nineteen studies of Magnetic resonance-guided high-intensity focused ultrasound-treated fibroid patients were selected. The data indicated that tumor size was reduced and that symptoms were improved after treatment. There were few adverse effects, and they were not severe. Some studies have reported that in some cases, additional sessions of Magnetic resonance-guided high-intensity focused ultrasound or other interventions, such as myomectomy, uterine artery embolization or even hysterectomy, were necessary. This review suggests that Magnetic resonance-guided high-intensity focused ultrasound is a safe and effective technique. However, additional evidence from future studies will be required before the technique can be recommended as an alternative treatment for fibroids.

  11. Pharmacological treatment of uterine fibroids | Moroni | Annals of ...

    African Journals Online (AJOL)

    Uterine fibroids (UF) are common, benign gynecologic tumors, affecting one in three to four women, with estimates of up to 80%, depending on the population ... The treatment of UF is classically surgical; however, various medical options are available, providing symptom control while minimizing risks and complications.

  12. Management of uterine fibroids at the University of Ilorin Teaching ...

    African Journals Online (AJOL)

    Management of uterine fibroids at the University of Ilorin Teaching Hospital: A 5 year review. A Aiyeyemi, AAG Jimoh, OR Balogun. Abstract. No Abstract. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/nhp.v2i5.53441 · AJOL African Journals ...

  13. The Incidence of Uterine Fibroid Among Reproductive Age Women ...

    African Journals Online (AJOL)

    This study is a 5 year retrospective analysis on the incidence and age distributions of uterine fibroid among reproductive age women presenting at the gynecology department of Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo, Nigeria, from January 2008 to December 2012. Using judgmental probability technique to ...

  14. Infarction of Uterine Fibroids After Embolization: Relationship Between Postprocedural Enhanced MRI Findings and Long-Term Clinical Outcomes

    International Nuclear Information System (INIS)

    Katsumori, Tetsuya; Kasahara, Toshiyuki; Kin, Yoko; Nozaki, Taiki

    2008-01-01

    Purpose. To retrospectively evaluate the relationship between the degree of infarction of uterine fibroids on enhanced MRI after embolization and long-term clinical outcomes. Methods. During 92 months, 290 consecutive patients with symptomatic uterine fibroids were treated with embolization; 221 who underwent enhanced MRI before embolization and 1 week after embolization were included in this study. The infarction rates of all fibroid tissue were assessed using enhanced MRI after embolization. Patients were divided into three groups according to the infarction rates: group A (100% infarction, n 142), group B (90-99% infarction, n = 74), group C (<90% infarction, n = 5). The cumulative rates of clinical outcomes were compared among groups using the Kaplan-Meier limited method. Results. Group A had a significantly higher rate of symptom control than groups B and C. The cumulative rates of symptom control at 5 years were 93%, 71%, and 60% in groups A, B, and C, respectively. Group A had a significantly lower rate of gynecologic intervention after embolization than groups B and C. The cumulative rates of additional gynecologic intervention at 5 years were 3%, 15%, and 20% in groups A, B, and C, respectively. Conclusions. The degree of infarction of uterine fibroids after embolization on enhanced MRI was related to long-term clinical outcomes. Complete infarction of all fibroid tissue can induce a higher rate of symptom control, with a lower rate of additional gynecologic intervention in the long term compared with incomplete infarction of fibroid tissue

  15. The positive effect of targeted marketing on an existing uterine fibroid embolization practice.

    Science.gov (United States)

    Chrisman, Howard B; Basu, Pat Auveek; Omary, Reed A

    2006-03-01

    Although uterine fibroid embolization is an effective treatment option for symptomatic women, it is unclear what methods can be used to expand referrals in an already established practice. The authors tested the hypothesis that an advertising strategy focused on a defined target market can expand an existing uterine fibroid embolization practice. A market-driven planning sequence was employed. This included a determination of goals, an examination of current competition, determination of target market based on local environment and previous consumer use, pretest of product sample, and implementation of advertisement. Based on the analysis the authors determined that the target audience was professional black women aged 35 to 45. A specific weekly magazine was selected due to readership demographics. An advertisement was run for 8 consecutive weeks. The authors prospectively tracked patient inquiries, clinic visits, cases performed, and revenues generated for 3 months following the initial advertisement. All patients were seen in a fully staffed, preexisting fibroid clinic located within an urban, university-based academic practice performing 250 uterine fibroid embolizations annually. Ninety calls were received directly related to the advertisement. There were 35 clinic visits, which resulted in 17 uterine fibroid embolizations and 52 total MR imaging procedures. Eighteen patients were not considered candidates based on established protocols. The 17 extra cases performed over 3 months represented a 27% increase in case volume. Total professional cash collections for these cases (including MR imaging) were 58,317 US dollars. The cost of advertising was 8,000 US dollars. As a result of existing infrastructure, no additional costs were necessary. This resulted in a net revenue gain 50,317 US dollars and a nonannualized rate of return of approximately 625%. As Interventional Radiologists look to develop and expand existing practices, traditional marketing tools such as

  16. Clinical 3-year follow-up of uterine fibroid embolization

    International Nuclear Information System (INIS)

    Radeleff, B.A.; Satzl, S.; Eiers, M.; Fechtner, K.; Hakim, A.; Kauffmann, G.W.; Richter, G.M.; Rimbach, S.

    2007-01-01

    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 2.9 ± 0.2 after one year, 2.6 ± 0.3 after two

  17. Does Uterine Fibroid Adversely Affect Obstetric Outcome of Pregnancy?

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    Hend S. Saleh

    2018-01-01

    Full Text Available Background. Fibroid is the most common benign tumor of the uterus and if associated with pregnancy may adversely affect the outcome of pregnancy. Objective of the present study was to assess the obstetric outcome (maternal and fetal in pregnancy with fibroid. Methods. A prospective observational study was performed over a period from May 2015 to August 2017 at Obstetrics and Gynecology Department in Zagazig University Hospitals, Egypt. 64 pregnant patients with >2 cm fibroid were taken in the study. Routine fundamental investigations were done for all. They were followed during antenatal period clinically and scanned by ultrasonogram which was done at booking visit and during subsequent visits to assess the change in the size of the fibroid and other obstetric complications. Maternal age, parity, size of fibroid, complications during pregnancy, and mode of delivery were noted. Results. 64 pregnant patients with uterine fibroids were recruited; 47 of them completed the study to the end. The average age was 31.80±3.27 years, body mass index (BMI [calculated as weight in kilograms divided by the square of height in meters] was 24.67±2.46, primigravida was 23.4%, multigravida was 76.6%, duration of menstrual cycle/day was 29.68±3.10, and duration of menstrual period/day was 6.46±1.12. The percentage of spontaneous conception was 59.57% and 40.43% for using assisted reproductive technology. The results of obstetric outcome were spontaneous abortion in 2%, premature delivery in 27.7%, and delivery at 37–41 weeks of pregnancy in 70.2%. The mode of delivery was vaginal delivery in 15% and cesarean sections in 85%. Also, 34% had threatened miscarriage, 21% had preterm labor, 2% had antepartum bleeding in the form of placenta previa, 4% had abdominal pain needing admission, one of them underwent laparotomy and was diagnosed as red degeneration, 2 (4% had postpartum hemorrhage, and only one needed blood transfusion. Cesarean sections were done in

  18. Use of Ulipristal Acetate for the Management of Fibroid-Related Acute Abnormal Uterine Bleeding.

    Science.gov (United States)

    Arendas, Kristina; Leyland, Nicholas A

    2016-01-01

    Episodes of acute abnormal uterine bleeding related to uterine fibroids can cause significant morbidity. Traditional management with high-dose hormonal regimens may not be as effective when used in women with fibroids. A 32-year-old woman with a 12 cm uterine fibroid presented with an episode of acute abnormal uterine bleeding requiring blood transfusion. In lieu of using a hormonal maintenance regimen after the bleeding had stabilized, the patient was treated with ulipristal acetate 5 mg daily for three months. Amenorrhea was induced rapidly and the patient had no further episodes of acute excessive uterine bleeding. She subsequently underwent a laparoscopic myomectomy with a satisfactory outcome. Ulipristal acetate has been shown to induce amenorrhea rapidly in women with uterine fibroids, and it can be a useful treatment in the emergency management of fibroid-related acute abnormal uterine bleeding. Copyright © 2016 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  19. FEMIC (Fibromes Embolises aux MICrospheres calibrees): Uterine Fibroid Embolization using Tris-acryl Microspheres. A French Multicenter Study

    International Nuclear Information System (INIS)

    Joffre, Francis; Tubiana, Jean-Michel; Pelage, Jean-Pierre

    2004-01-01

    Purpose: A French multicenter registry was set up to confirm the safety and efficacy of large calibrated tris-acryl gelatin microspheres for embolization of symptomatic fibroids. Methods: Technical recommendations included embolization using large microspheres (>500 μm) with no secondary embolization agent. Postprocedural pain, clinical improvement and adverse events were prospectively evaluated during a follow-up period of at least 6 months.Results: Eighty-five women complaining of fibroid-related symptoms entered the study. In seven women, a secondary embolization agent was used in addition to microspheres. Complete resolution of menorrhagia was achieved in 84% of women at 24 months and significant uterine and fibroid volume reductions were noted after 6 months (37% and 73%, respectively). Three women experienced definitive amenorrhea (4%) and two women required hysteroscopic resection of a fibroid. Eight women were treated by hysterectomy because of treatment failure. In seven of these women, treatment failure was explained by an additional cause of symptoms including diffuse adenomyosis, endometrial hyperplasia or ovarian artery supply to the fibroids.Conclusion: Limited uterine artery embolization using large microspheres has good clinical success rate with low postprocedural pain and complications. Women can expect excellent midterm results with a high level of symptom control and significant fibroid volume reduction. Confidence in the end-point recommended here may require the experience of several cases

  20. 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.

  1. Current status, questions and challenges of transcatheter uterine artery embolization for the treatment of uterine fibroids

    International Nuclear Information System (INIS)

    Chen Xiaoming; Luo Pengfei

    2006-01-01

    Current status, questions and challenges of transcatheter uterine artery embolization (UAE) in the treatment of uterine fibroids were summarized and analysed. It has been proved that UAE presents a good effectiveness in controlling the symptoms and shrinkage of fibroid and uterine volumes during follow-up of 4 to 6.9 years domestically and abroad, but relapse of the fibroid may however occur in 2 years or longer after UAE. Generally speaking, UAE is safe in the treatment of uterine fibroids but has a possibility of serious complications. UAE has no damage on normal uterine tissues but may affect pregnancy and delivery of patients significantly later on the cause of hypoxia and inertia of uterus. UAE may cause amenorrhea in the minority of women with ovarian failure and endometrium atrophy. The current questions are how to improve long-term efficiency to reduce relapse of tumor and to insure the safety of UAE. It is our further task to exploit more new effective and safe embolic agents by using animal and clinical study on the basic knowledge of pathology, pharmacology, biochemistry, endocrinology and molecular biology. (authors)

  2. A five-year review of uterine fibroids at the university of Uyo ...

    African Journals Online (AJOL)

    Background: Uterine fibroids are benign tumours that arise from myometrial smooth muscle cells. They are the most common tumours found in humans and are particularly common in Negros. We determined the prevalence modes of presentation and treatment modalities of uterine fibroid at the University of Uyo Teaching ...

  3. Uterine artery embolization for uterine fibroids: mid-long term follow up

    International Nuclear Information System (INIS)

    Guo Wenbo; Yang Jianyong; Chen Wei; Zhuang Wenquan; Li Lijuan; Zhu Yunxiao

    2006-01-01

    Objective: To evaluate the mid-long term effects of uterine fibroids embolization. Methods: Uterine artery embolization (UAE) was performed in 110 patients with uterine fibroids with follow up of 48-72 months. All the patients were examined with transvaginal color ultrasound. 51 cases were embolized with mixed liquor of lipiodol and pingyangmycin and another 59 cases with polyvinyl alcohol particles (350-700 μm, in diameter). The mid-long term clinical effects, complications, change of serum sexual hormone, pregnancy and delivery after UAE were observed. Results; Bilateral uterine artery embolization was performed in 110 cases with following outcomes in improvements of menorrhagia in 93/94 (98.9%) and the bulked-related symptoms in 26/26 (100%), decrease of the volumes of uterus 51.5% ± 3.1% (t value 2.861, P<0.01) and fibroids 64.2% ± 6.6% (t value 2.664, P<0.01). No statistical differences in serum levels of luteinizing, follicle stimulating hormone and estradiol before and after the uterine artery embolization were found. All events included abdominal pain in 6/110 (5.5%), fever in 90/110 (81.8%), colporrhagia in 95/110 (86.4%), haematuria in 11/110 (10.0%), non-targeted embolization of bladder in 1/110 (0.9%), transient amenorrhea in 3/110 (2.7%), permanent amenorrhea due to ovarian failure in 3/110 (2.7%), failure of embolization in 1/110 (0.9%) and recurrence after uterine fibroids embolization in 4/110 (3.6%). There were 7 times of pregnancies in 5 patients, including 4 times of deliveries in 4 patients, and one patient accepted artificial abortion 3 times, but with no fibroids recurrences or enlargement under ultrasound follow up. Conclusion: The mid-long term effects of uterine fibroids embolization are positive, stable and safe, but with a low recurrence rate slight ovarian functional change and still safe for pregnancy and delivery. (authors)

  4. Preoperative medical therapy before surgery for uterine fibroids.

    Science.gov (United States)

    Lethaby, Anne; Puscasiu, Lucian; Vollenhoven, Beverley

    2017-11-15

    Uterine fibroids occur in up to 40% of women aged over 35 years. Some are asymptomatic, but up to 50% cause symptoms that warrant therapy. Symptoms include anaemia caused by heavy menstrual bleeding, pelvic pain, dysmenorrhoea, infertility and low quality of life. Surgery is the first choice of treatment. In recent years, medical therapies have been used before surgery to improve intraoperative and postoperative outcomes. However, such therapies tend to be expensive.Fibroid growth is stimulated by oestrogen. Gonadotropin-hormone releasing analogues (GnRHa) induce a state of hypo-oestrogenism that shrinks fibroids , but has unacceptable side effects if used long-term. Other potential hormonal treatments, include progestins and selective progesterone-receptor modulators (SPRMs).This is an update of a Cochrane Review published in 2000 and 2001; the scope has been broadened to include all preoperative medical treatments. To assess the effectiveness and safety of medical treatments prior to surgery for uterine fibroids. We searched the Cochrane Gynaecology and Fertility Group specialised register, CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL in June 2017. We also searched trials registers (ClinicalTrials.com; WHO ICTRP), theses and dissertations and the grey literature, handsearched reference lists of retrieved articles and contacted pharmaceutical companies for additional trials. We included randomised comparisons of medical therapy versus placebo, no treatment, or other medical therapy before surgery, myomectomy, hysterectomy or endometrial resection, for uterine fibroids. We used standard methodological procedures expected by The Cochrane Collaboration. We included a total of 38 RCTs (3623 women); 19 studies compared GnRHa to no pretreatment (n = 19), placebo (n = 8), other medical pretreatments (progestin, SPRMs, selective oestrogen receptor modulators (SERMs), dopamine agonists, oestrogen receptor antagonists) (n = 7), and four compared SPRMs with placebo. Most

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Uterine fibroids at routine second-trimester ultrasound survey and risk of sonographic short cervix.

    Science.gov (United States)

    Blitz, Matthew J; Rochelson, Burton; Augustine, Stephanie; Greenberg, Meir; Sison, Cristina P; Vohra, Nidhi

    2016-11-01

    To determine whether women with sonographically identified uterine fibroids are at higher risk for a short cervix. This retrospective cohort study evaluated all women with singleton gestations who had a routine second-trimester ultrasound at 17-23 weeks gestational age from 2010 to 2013. When fibroids were noted, their presence, number, location and size were recorded. Exclusion criteria included a history of cervical conization or loop electrosurgical excision procedure (LEEP), uterine anomalies, maternal age greater than 40 years, and a previously placed cerclage. The primary variable of interest was short cervix (cervix was increased in women with fibroids (OR 2.29, 95% CI: 1.40, 3.74). The number of fibroids did not affect the frequency of short cervix. Fibroids were significantly associated with preterm delivery (cervix. Fibroids are also associated with several adverse obstetric and neonatal outcomes.

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

    International Nuclear Information System (INIS)

    Yang, Seung Boo; Im, Han Hyeok; Chang, Yun Woo; Goo, Dong Erk

    2006-01-01

    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

  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. Uterine artery embolisation for symptomatic adenomyosis-Mid-term results

    International Nuclear Information System (INIS)

    Bratby, M.J.; Walker, W.J.

    2009-01-01

    Purpose: To evaluate the role of uterine artery embolisation (UAE) in the treatment of adenomyosis. Materials and methods: 27 women with symptomatic adenomyosis diagnosed on magnetic resonance imaging (MRI) underwent UAE between 1998 and 2004. Clinical evaluation using a standardised questionnaire was made at regular intervals after embolisation to assess patient outcome. Results: The diagnosis of adenomyosis was confirmed histologically by transvaginal biopsy in 5 women. There were 14 women with associated uterine fibroids. Diffuse adenomyosis was identified in 18 women. A focal adenomyoma was present in another 8 women. In 1 patient adenomyosis was not classified. All patients except one underwent bilateral uterine artery embolisation. There was an initial favourable clinical response, with improvement of menorrhagia in 79% (13/16) of patients at 12 months. Follow-up data was available on a total of 14 patients at 2 and 3 years after embolisation. 45.5% (5/11) reported a deterioration in menorrhagia symptoms at 2 years. Conclusion: UAE for symptomatic adenomyosis is effective in the short-term but there is a high rate of recurrence of clinical symptoms 2 year following treatment.

  10. Uterine artery embolisation for symptomatic adenomyosis-Mid-term results

    Energy Technology Data Exchange (ETDEWEB)

    Bratby, M.J. [Radiology Department, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX (United Kingdom); Walker, W.J. [Radiology Department, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX (United Kingdom)], E-mail: wjwalker@doctors.org.uk

    2009-04-15

    Purpose: To evaluate the role of uterine artery embolisation (UAE) in the treatment of adenomyosis. Materials and methods: 27 women with symptomatic adenomyosis diagnosed on magnetic resonance imaging (MRI) underwent UAE between 1998 and 2004. Clinical evaluation using a standardised questionnaire was made at regular intervals after embolisation to assess patient outcome. Results: The diagnosis of adenomyosis was confirmed histologically by transvaginal biopsy in 5 women. There were 14 women with associated uterine fibroids. Diffuse adenomyosis was identified in 18 women. A focal adenomyoma was present in another 8 women. In 1 patient adenomyosis was not classified. All patients except one underwent bilateral uterine artery embolisation. There was an initial favourable clinical response, with improvement of menorrhagia in 79% (13/16) of patients at 12 months. Follow-up data was available on a total of 14 patients at 2 and 3 years after embolisation. 45.5% (5/11) reported a deterioration in menorrhagia symptoms at 2 years. Conclusion: UAE for symptomatic adenomyosis is effective in the short-term but there is a high rate of recurrence of clinical symptoms 2 year following treatment.

  11. 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.

  12. Analysis of adverse reactions and complications of transcatheter uterine artery embolization (TUAE) for uterine fibroids

    International Nuclear Information System (INIS)

    Chen Xiaoming; Luo Pengfei; Du Juan; Zuo Yuewei; Hu Xiaoping; Hong Danhua; Lin Huahuan; Li Gaowen; Liu Suyun

    2002-01-01

    Objective: To investigate the adverse reactions and complications as well as their preventive and therapeutic measures of TUAE for uterine fibroids. Methods: One hundred and eighty-two patients with uterine fibroids were treated by TUAE. Bilateral uterine arteries were embolized using lipiodol-pingyangmycin emulsion (LPE), together with Gelfoam particles. All patients were hospitalized for 3 to 10 days after TUAE and were followed up for 1 to 24 months to observe the adverse reactions and complications. Results: Adverse reactions of TUAE included postembolization syndrome ( n 182); urinary irritation ( n = 24), and hyporrhea of vagina ( n = 25 ) . Complications of TUAE included expelling of necrotic fibroids per vagina ( n = 5 ); urinary retention ( n = 10); urinary tract infection ( n = 1 ); ulcer of labia minora ( n = 1 ); ecchymosis and ulceration on buttock ( n = 1), and secondary infection of chocolate cyst of ovary. ( n = 1 ). All the above-mentioned side effects of TUAE recovered to normal after expectant or especial treatment without any sequels left. Conclusion: The adverse reactions of TUAE are reversible and the complications of TUAE are preventable and curable

  13. 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.

  14. Admixture mapping of uterine fibroid size and number in African American women.

    Science.gov (United States)

    Bray, Michael J; Edwards, Todd L; Wellons, Melissa F; Jones, Sarah H; Hartmann, Katherine E; Velez Edwards, Digna R

    2017-12-01

    To evaluate the relationship between genetic ancestry and uterine fibroid characteristics. Cross-sectional study. Not applicable. A total of 609 African American participants with image- or surgery-confirmed fibroids in a biorepository at Vanderbilt University electronic health record biorepository and the Coronary Artery Risk Development in Young Adults studies were included. None. Outcome measures include fibroid number (single vs. multiple), volume of largest fibroid, and largest fibroid dimension of all fibroid measurements. Global ancestry meta-analyses revealed a significant inverse association between percentage of European ancestry and risk of multiple fibroids (odds ratio: 0.78; 95% confidence interval 0.66, 0.93; P=6.05 × 10 -3 ). Local ancestry meta-analyses revealed five suggestive (Pancestry is associated with multiple fibroids but not with fibroid size. Local ancestry analyses identified several novel genomic regions not previously associated with fibroid number and increasing volume. Future studies are needed to explore the genetic impact that ancestry plays into the development of fibroid characteristics. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Analysis of amenorrhea after transcatheter uterine artery embolization for uterine fibroids

    International Nuclear Information System (INIS)

    Chen Xiaoming; Li Yong; Lu Ligong; Hu Baoshan; Luo Pengfei; Du Juan; Zuo Yuewei; Hu Xiaoping; Hong Danhua

    2005-01-01

    Objective: To investigate the causes of amenorrhea after transcatheter uterine artery embolization (TUAE) for uterine fibroids. Methods: Two hundreds thirty-one cases of uterine fibroids with the range of age from 29 to 51 years (mean, 39.5 years) underwent TUAE between April 1999 and May 2004. TUAE was performed by injecting lipiodol-pingyangmycine emulsion (LPE) into bilateral uterine arteries, followed by administration of gelatin sponge particles in 186 of 231 patients. LPE was prepared with pingyangmycine 8-16 mg and ultra fluid lipiodol 6-20 ml. Results: Amenorrhea occurred in 2 of 231 (0.87%) patients respectively at 3 and 4 months after TUAE. Premature ovarian failure was proved to be etiology of amenorrhea in one patient because her serum estradiol (E 2 ) became decreased and serum follicle-stimulating hormone (FSH) level increased. This woman had normal amenorrhea later after receiving estrogen-progestogen sepuential therapy for 12 months. Another patient's amenorrhea was proved to be associated with endometrial atrophy after TUAE by hysteroscope. Conclusion: Amenorrhea caused by premature ovarian failure and endometrial atrophy may occur in a tiny minority of women undergoing TUAE. (authors)

  16. [Myomectomy and uterine desarterialization as conservative treatment for uterine fibroids: Review of clinic case].

    Science.gov (United States)

    Garcia-de la Torre, J I; Aguirre-Ramos, M A; Ramos-Alvarado, A M; Villa-Ponce, D; González-Cantú, G

    2016-02-01

    Uterine fibroids are the most common gynecological tumors; the prevalence increases with age. They can cause symptoms (20-50%). Myomectomy is an alternative for women who wish to preserve their fertility, increased risk of blood loss and longer operative time. Since 2000, a significant number of surgeons have performed occlusion of uterine arteries prior to myomectomy successfully. We report the case of a 24-year-old patient, with a history of premature birth; and starts her condition after obstetric event with abnormal uterine bleeding and postcoital bleeding, accompanied by intense, oppressive and stabbing abdominal pain and increased ab-dominal volume. At physical examination an enlarged abdominal wall by a tumor involving, abdominal pain on palpation, at the gynecological examination: frankly enlarged uterus, about 25 x 20 cm, painful and tenderness. Prior to myomectomy, uterine externalization takes place and proceeds to dearterialization of uterine arteries under the García-González technique, removing the tumor without complications, with an estimated 100 cc bleeding. The bilateral uterine artery ligation, is one of the methods used to re-duce intraoperative blood loss. It is a quick, simple technique, whose theoretical basis is that 90% of the irrigation of the uterus comes from the uterine arteries.

  17. 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.

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

    International Nuclear Information System (INIS)

    Gutierrez, Luis B.; Bansal, Anshuman K.; Hovsepian, David M.

    2012-01-01

    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.

  19. 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.

  20. Pain control for uterine fibroid emboliSation-an initial exPerience

    African Journals Online (AJOL)

    2011-06-06

    Jun 6, 2011 ... HacKinG and W. StoneS. SUMMARy. Uterine fibroid embolisation (UFE) generates moderate to severe post-procedural pain. We present a case series of 24 patients who underwent UFE during our first experience in managing the sometimes excruciating pain that accompanies embolisation of the uterine ...

  1. Recent scientific advances in leiomyoma (uterine fibroids) research facilitates better understanding and management.

    Science.gov (United States)

    Taylor, Darlene K; Holthouser, Kristine; Segars, James H; Leppert, Phyllis C

    2015-01-01

    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.

  2. Identification of Polycomb Group Protein EZH2-Mediated DNA Mismatch Repair Gene MSH2 in Human Uterine Fibroids.

    Science.gov (United States)

    Yang, Qiwei; Laknaur, Archana; Elam, Lelyand; Ismail, Nahed; Gavrilova-Jordan, Larisa; Lue, John; Diamond, Michael P; Al-Hendy, Ayman

    2016-10-01

    Uterine fibroids (UFs) are benign smooth muscle neoplasms affecting up to 70% of reproductive age women. Treatment of symptomatic UFs places a significant economic burden on the US health-care system. Several specific genetic abnormalities have been described as etiologic factors of UFs, suggesting that a low DNA damage repair capacity may be involved in the formation of UF. In this study, we used human fibroid and adjacent myometrial tissues, as well as an in vitro cell culture model, to evaluate the expression of MutS homolog 2 (MSH2), which encodes a protein belongs to the mismatch repair system. In addition, we deciphered the mechanism by which polycomb repressive complex 2 protein, EZH2, deregulates MSH2 in UFs. The RNA expression analysis demonstrated the deregulation of MSH2 expression in UF tissues in comparison to its adjacent myometrium. Notably, protein levels of MSH2 were upregulated in 90% of fibroid tissues (9 of 10) as compared to matched adjacent myometrial tissues. Human fibroid primary cells treated with 3-deazaneplanocin A (DZNep), chemical inhibitor of EZH2, exhibited a significant increase in MSH2 expression (P DNA mismatch repair gene MSH2, through epigenetic mark H3K27me3. MSH2 may be considered as a marker for early detection of UFs. © The Author(s) 2016.

  3. Midterm Clinical and First Reproductive Results of a Randomized Controlled Trial Comparing Uterine Fibroid Embolization and Myomectomy

    International Nuclear Information System (INIS)

    Mara, Michal; Maskova, Jana; Fucikova, Zuzana; Kuzel, David; Belsan, Tomas; Sosna, Ondrej

    2008-01-01

    The purpose of this study was to compare the midterm results of a radiological and surgical approach to uterine fibroids. One hundred twenty-one women with reproductive plans who presented with an intramural fibroid(s) larger than 4 cm were randomly selected for either uterine artery embolization (UAE) or myomectomy. We compared the efficacy and safety of the two procedures and their impact on patient fertility. Fifty-eight embolizations and 63 myomectomies (42 laparoscopic, 21 open) were performed. One hundred eighteen patients have finished at least a 12-month follow-up; the mean follow-up in the entire study population was 24.9 months. Embolized patients underwent a significantly shorter procedure and required a shorter hospital stay and recovery period. They also presented with a lower CRP concentration on the second day after the procedure (p < 0.0001 for all parameters). There were no significant differences between the two groups in the rate of technical success, symptomatic effectiveness, postprocedural follicle stimulating hormone levels, number of reinterventions for fibroid recurrence or regrowth, or complication rates. Forty women after myomectomy and 26 after UAE have tried to conceive, and of these we registered 50 gestations in 45 women. There were more pregnancies (33) and labors (19) and fewer abortions (6) after surgery than after embolization (17 pregnancies, 5 labors, 9 abortions) (p < 0.05). Obstetrical and perinatal results were similar in both groups, possibly due to the low number of labors after UAE to date. We conclude that UAE is less invasive and as symptomatically effective and safe as myomectomy, but myomectomy appears to have superior reproductive outcomes in the first 2 years after treatment

  4. Sexuality and Body Image After Uterine Artery Embolization and Hysterectomy in the Treatment of Uterine Fibroids: A Randomized Comparison

    International Nuclear Information System (INIS)

    Hehenkamp, Wouter J. K.; Volkers, Nicole A.; Bartholomeus, Wouter; Blok, Sjoerd de; Birnie, Erwin; Reekers, Jim A.; Ankum, Willem M.

    2007-01-01

    In this paper the effect of uterine artery embolization (UAE) on sexual functioning and body image is investigated in a randomized comparison to hysterectomy for symptomatic uterine fibroids. The EMbolization versus hysterectoMY (EMMY) trial is a randomized controlled study, conducted at 28 Dutch hospitals. Patients were allocated hysterectomy (n = 89) or UAE (n 88). Two validated questionnaires (the Sexual Activity Questionnaire [SAQ] and the Body Image Scale [BIS]) were completed by all patients at baseline, 6 weeks, and 6, 12, 18, and 24 months after treatment. Repeated measurements on SAQ scores revealed no differences between the groups. There was a trend toward improved sexual function in both groups at 2 years, although this failed to reach statistical significance except for the dimensions discomfort and habit in the UAE arm. Overall quality of sexual life deteriorated in a minority of cases at all time points, with no significant differences between the groups (at 24 months: UAE, 29.3%, versus hysterectomy, 23.5%; p = 0.32). At 24 months the BIS score had improved in both groups compared to baseline, but the change was only significant in the UAE group (p = 0.009). In conclusion, at 24 months no differences in sexuality and body image were observed between the UAE and the hysterectomy group. On average, both after UAE and hysterectomy sexual functioning and body image scores improved, but significantly so only after UAE

  5. A network pharmacology approach to investigate the pharmacological effects of Guizhi Fuling Wan on uterine fibroids.

    Science.gov (United States)

    Zeng, Liuting; Yang, Kailin; Liu, Huiping; Zhang, Guomin

    2017-11-01

    To investigate the pharmacological mechanism of Guizhi Fuling Wan (GFW) in the treatment of uterine fibroids, a network pharmacology approach was used. Information on GFW compounds was collected from traditional Chinese medicine (TCM) databases, and input into PharmMapper to identify the compound targets. Genes associated with uterine fibroids genes were then obtained from the GeneCards and Online Mendelian Inheritance in Man databases. The interaction data of the targets and other human proteins was also collected from the STRING and IntAct databases. The target data were input into the Database for Annotation, Visualization and Integrated Discovery for gene ontology (GO) and pathway enrichment analyses. Networks of the above information were constructed and analyzed using Cytoscape. The following networks were compiled: A compound-compound target network of GFW; a herb-compound target-uterine fibroids target network of GWF; and a compound target-uterine fibroids target-other human proteins protein-protein interaction network, which were subjected to GO and pathway enrichment analyses. According to this approach, a number of novel signaling pathways and biological processes underlying the effects of GFW on uterine fibroids were identified, including the negative regulation of smooth muscle cell proliferation, apoptosis, and the Ras, wingless-type, epidermal growth factor and insulin-like growth factor-1 signaling pathways. This network pharmacology approach may aid the systematical study of herbal formulae and make TCM drug discovery more predictable.

  6. Ovarian Artery: Angiographic Appearance, Embolization and Relevance to Uterine Fibroid Embolization

    International Nuclear Information System (INIS)

    Pelage, J.P.; Walker, W.J.; Le Dref, O.; Rymer, R.

    2003-01-01

    Purpose: To describe the angiographic appearance of the ovarian artery and its main variations that may be relevant to uterine fibroid embolization. Methods: The flush aortograms of 294 women who had been treated by uterine artery embolization for fibroids were reviewed. Significant arterial supply to the fibroid, and the origin and diameter of identified ovarian arteries were recorded. In patients with additional embolization of the ovarian artery, the follow-up evaluation also included hormonal levels and Doppler imaging of the ovaries. Results: A total of 75 ovarian arteries were identified in 59 women (bilaterally in 16 women and unilaterally in 43 women). All ovarian arteries originated from the aorta below the level of the renal arteries with a characteristic tortuous course. Fifteen women had at least one enlarged ovarian artery supplying the fibroids. Fourteen women (14/15, 93%) presented at least one of the following factors: prior pelvic surgery, tubo-ovarian pathology or large fundal fibroids. Conclusion: We advocate the use of flush aortography in women with prior tubo-ovarian pathology or surgery or in cases of large fundal fibroids. In the case of an ovarian artery supply to the fibroids, superselective catheterization and embolization of the ovarian artery should be considered

  7. Uterine fibroid embolization efficacy and safety: 15 years experience in an elevated turnout rate center.

    Science.gov (United States)

    Di Stasi, Carmine; Cina, Alessandro; Rosella, Francesco; Paladini, Andrea; Amoroso, Sonia; Romualdi, Daniela; Manfredi, Riccardo; Colosimo, Cesare

    2018-01-22

    To evaluate effectiveness and safety of UFE as alternative to surgery, in treatment of uterine fibromatosis. 255 patients (aged 26-55) with symptomatic UF, indication for surgery, followed in our center (2000-2014), single or multiple fibroids, pain and/or functional/compressive disorders, underwent embolization: injection of PVA particles (150-900 μm) from distal portion of uterine arteries (ascending section). Primary end-point: flow-stop distally to injection site, disappearance of lesion design, preservation of flow in main trunk of UA. Secondary end-point: control of pain and functional/compressive disorders during follow-up (2-7 years). Procedure was performed bilaterally in 250 patients (98%). Mean duration: 47 min (average fluoroscopy: 10:50 min). Post-embolization pelvic pain (according with VAS score) was on average 2.2 at discharge (24 h). Follow-up at 2 years: resolution of menstrual disorders in 78% of patients and improvement in 14%; pain disappeared in 66%; significant improvement of menstrual flow and HCT/HB levels, decrease in total uterine (57.7%)/dominant fibroid (76.1%) volume. Recurrence in 18 patients. UFE represents an excellent alternative to surgical treatment: it is safe, tolerable and effective both in short and long term, with evident advantages in economic and social terms.

  8. Associations between uterine fibroids and obstetric outcomes in twin pregnancies.

    Science.gov (United States)

    Wang, Hong-Mei; Tian, Yu-Cui; Xue, Zhi-Fang; Zhang, Yue; Dai, Yin-Mei

    2016-10-01

    To examine potential associations between the presence of fibroids and obstetric outcomes in twin pregnancies. A prospective cohort study compared obstetric outcomes between individuals with twin pregnancies who did and did not have fibroids. Patients were considered for inclusion if they underwent first-trimester ultrasonography examination, and went on to deliver at the Beijing Obstetrics and Gynecology Hospital between September 1, 2012 and December 31, 2014. Participants were grouped based on the presence or absence of fibroids and baseline demographics, fibroid characteristics, and obstetric outcomes were recorded and compared between the two groups. In total, 153 patients with twin pregnancies were recruited; 51 had fibroids and 102 did not. Patients in the fibroid group demonstrated a higher maternal age (Pobstetric outcomes, and obstetric outcomes were unaffected by the number, size, location, and type of fibroids (all P>0.05). Fibroids were not a risk factor for any adverse obstetric outcomes among patients with twin pregnancies. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  9. Pelvic Blood Flow Predicts Fibroid Volume and Embolic Required for Uterine Fibroid Embolization: A Pilot Study With 4D Flow MR Angiography.

    Science.gov (United States)

    Malone, Christopher D; Banerjee, Arjun; Alley, Marcus T; Vasanawala, Shreyas S; Roberts, Anne C; Hsiao, Albert

    2018-01-01

    We report here an initial experience using 4D flow MRI in pelvic imaging-specifically, in imaging uterine fibroids. We hypothesized that blood flow might correlate with fibroid volume and that quantifying blood flow might help to predict the amount of embolic required to achieve stasis at subsequent uterine fibroid embolization (UFE). Thirty-three patients with uterine fibroids and seven control subjects underwent pelvic MRI with 4D flow imaging. Of the patients with fibroids, 10 underwent 4D flow imaging before UFE and seven after UFE; in the remaining 16 patients with fibroids, UFE had yet to be performed. Four-dimensional flow measurements were performed using Arterys CV Flow. The flow fraction of the internal iliac artery was expressed as the ratio of internal iliac artery flow to external iliac artery flow and was compared between groups. The flow ratios between the internal iliac arteries on each side were calculated. Fibroid volume versus internal iliac flow fraction, embolic volume versus internal iliac flow fraction, and embolic volume ratio between sides versus the ratio of internal iliac artery flows between sides were compared. The mean internal iliac flow fraction was significantly higher in the 26 patients who underwent imaging before UFE (mean ± standard error, 0.78 ± 0.06) than in the seven patients who underwent imaging after UFE (0.48 ± 0.07, p flow fraction correlated well with fibroid volumes before UFE (r = 0.7754, p flow (r = 0.6776, p = 0.03). Internal iliac flow measured by 4D flow MRI correlates with fibroid volume and is predictive of the ratio of embolic required to achieve stasis on each side at subsequent UFE and may be useful for preprocedural evaluation of patients with uterine fibroids.

  10. Pregnancy Following Uterine Artery Embolization with Polyvinyl Alcohol Particles for Patients with Uterine Fibroid or Adenomyosis

    International Nuclear Information System (INIS)

    Kim, Man Deuk; Kim, Nahk Keun; Kim, Hee Jin; Lee, Mee Hwa

    2005-01-01

    Purpose:To determine whether uterine fibroid embolization (UFE) with polyvinyl alcohol (PVA) particles affects fertility in women desiring future pregnancy.Methods:Of 288 patients managed with UFE with PVA particles for uterine myoma or adenomyosis between 1998 and 2001, 94 patients were enrolled in this study. The age range of participants was 20-40 years. The data were collected through review of medical records and telephone interviews. Mean duration of follow-up duration was 35 months (range 22-60 months). Patients using contraception and single women were excluded, and the chance of infertility caused by possible spousal infertility or other factors was disregarded. Contrast-enhanced magnetic resonance imaging was performed in all patients before and after UFE, and the size of PVA particles used was 255-700 μm.Results:Among 94 patients who underwent UFE with PVA, 74 were on contraceptives, 6 had been single until the point of interview, and 8 were lost to follow-up. Of the remaining 6 patients who desired future pregnancy, 5 (83%) succeeded in becoming pregnant (1 patient became pregnant twice). Of a total of 8 pregnancies, 6 were planned pregnancies and 2 occurred after contraception failed. Five deliveries were vaginal, and 2 were by elective cesarean. Artificial abortion was performed in 1 case of unplanned pregnancy. There was 1 case of premature rupture of membrane (PROM) followed by preterm labor and delivery of an infant who was small-for-gestational-age. After UFE, mean volume reduction rates of the uterus and fibroid were 36.6% (range 0 to 62.6%) and 69.3% (range 36.3% to 93.3%), respectively.Conclusion:Although the absolute number of cases was small, UFE with PVA particles ultimately did not affect fertility in the women who underwent the procedure

  11. Effects of clinical pathways used in surgery for uterine fibroids: A meta-analysis

    Directory of Open Access Journals (Sweden)

    Song Xuping

    2014-01-01

    Conclusion: CPWs could significantly improve the quality of care in patients undergoing uterine fibroids surgery, which were associated with a significant reduction in average length of stay and days of waiting for surgery, a decrease in inpatient expenditures and an improvement in patient satisfaction. Formulating evidence based CPWs and variation control in CPWs should be focused in the future.

  12. Clinical Presentation of Uterine Fibroids in Nnewi, Nigeria: A 5‑year ...

    African Journals Online (AJOL)

    [4,5] Theories attribute this to genetic predisposition, diet, or environmental factors. However, few studies have addressed these relationships. A history of pelvic infection seems to increase the risk for uterine fibroids, with the risk increasing with the number of infectious episodes.[6,7] Pelvic inflammatory disease as seen in.

  13. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries.

    Directory of Open Access Journals (Sweden)

    Rong Zhao

    Full Text Available To estimate the association between uterine fibroids and adverse obstetric outcomes.This was a retrospective cross-sectional study of 112,403 deliveries from 14 provinces and 39 different hospitals in 2011 in mainland China. We compared pregnancy outcomes in women with and without uterine fibroids who underwent detailed second trimester obstetric ultrasonography during 18 to 22 weeks. Obstetric outcomes include cesarean delivery, breech presentation, preterm delivery, placenta previa, placental abruption, premature rupture of membranes and neonatal birthweight. Univariate analyses and multivariate logistic regression analyses were performed.Of 112,403 women who underwent routine obstetric survey, 3,012 (2.68% women were identified with at least 1 fibroid. By univariate and multivariate analyses, the presence of uterine fibroids was significantly associated with cesarean delivery (Adjusted odds radio [AOR] 1.8, 95% confidence interval [CI] 1.7-2.0, breech presentation (AOR 1.3, 95% CI 1.2-1.5 and postpartum hemorrhage (AOR 1.2, 95% CI 1.1-1.4. The size of uterine fibroids and location in uterus had important effect on the mode of delivery. The rates of PPH were significantly higher with increasing size of the uterine fibroid (P<0.001. And the location of fibroid (intramural, submucosal or subserosal also have a statistically significant impact on the risk of PPH (5.6% [subserosal] vs 4.7% [submucosal] vs 8.6% [intramural].Pregnant women with uterine fibroids are at increased risk for cesarean delivery, breech presentation and postpartum hemorrhage. And different characteristics of uterine fibroids affect obstetric outcomes through different ways. Such detailed information may be useful in risk-stratifying pregnant women with fibroids.

  14. The Association of Uterine Fibroids and Pregnancy Outcomes Following 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

    2017-01-01

    Objective To investigate the association of non-cavity distorting uterine fibroids and pregnancy outcomes following ovarian stimulation-intrauterine insemination (OS-IUI) in couples with unexplained infertility. Design Secondary analysis from a prospective, randomized, multicenter clinical trial investigating fertility outcomes following OS-IUI. Setting Reproductive Medicine Network clinical sites Patients Nine-hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial. Intervention 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. Main outcomes measures Conception (serum hCG increase), clinical pregnancy (fetal cardiac activity), and live birth rates. Results 102/900(11.3%) participants 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 anti-Mullerian hormone levels, and fewer antral follicles than women without fibroids. In conception cycles, clinical pregnancy rates were significantly lower in participants with fibroids than those without uterine fibroids. Pregnancy loss prior to 12-weeks was more likely in African American women with fibroids compared to non-African American women with fibroids. There was no difference in conception and live birth rates in subjects with and without fibroids respectively. Conclusions 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. PMID:28089575

  15. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries.

    Science.gov (United States)

    Zhao, Rong; Wang, Xin; Zou, Liying; Li, Guanghui; Chen, Yi; Li, Changdong; Zhang, Weiyuan

    2017-01-01

    To estimate the association between uterine fibroids and adverse obstetric outcomes. This was a retrospective cross-sectional study of 112,403 deliveries from 14 provinces and 39 different hospitals in 2011 in mainland China. We compared pregnancy outcomes in women with and without uterine fibroids who underwent detailed second trimester obstetric ultrasonography during 18 to 22 weeks. Obstetric outcomes include cesarean delivery, breech presentation, preterm delivery, placenta previa, placental abruption, premature rupture of membranes and neonatal birthweight. Univariate analyses and multivariate logistic regression analyses were performed. Of 112,403 women who underwent routine obstetric survey, 3,012 (2.68%) women were identified with at least 1 fibroid. By univariate and multivariate analyses, the presence of uterine fibroids was significantly associated with cesarean delivery (Adjusted odds radio [AOR] 1.8, 95% confidence interval [CI] 1.7-2.0), breech presentation (AOR 1.3, 95% CI 1.2-1.5) and postpartum hemorrhage (AOR 1.2, 95% CI 1.1-1.4). The size of uterine fibroids and location in uterus had important effect on the mode of delivery. The rates of PPH were significantly higher with increasing size of the uterine fibroid (Pobstetric outcomes through different ways. Such detailed information may be useful in risk-stratifying pregnant women with fibroids.

  16. Embolization therapy of uterine fibroids by using pingyangmycin lipiodol emulsion or polyvinyl alcohol particles: a clinical comparative study

    International Nuclear Information System (INIS)

    Zhang Dazhong; Yin Jianlin; Liu Hairi; Zhang Fuqiang; Huang Hai; Gu Youmei

    2010-01-01

    Objective: To evaluate the efficacy and safety of embolization of uterine fibroids by using pingyangmycin lipiodol emulsion or polyvinyl alcohol particles as embolismic materials. Methods: Seventy-three patients with uterine fibroids were divided into two groups. Patients in group A (29 cases) were treated with pingyangmycin lipiodol emulsion as embolismic materials, while patients in group B (44 cases) with polyvinyl alcohol particles (with a diameter of 300-700 μm) as embolismic materials. Embolization therapy of uterine fibroids was performed in all patients. The uterus volume, the size of uterine fibroid and sex hormone level both before and after the treatment were estimated and the results were compared between two groups. The occurrence of complications was observed. Results: The technical success of catheterization and embolization was 100% in both groups. After the therapy,both the uterus volume and the uterine fibroid size decreased significantly, but no significant difference in the size reduction existed between the two groups (P>0.05). The clinical symptoms showed a marked improvement in all patients, while the sex hormone level showed no obvious changes. No serious complications occurred. Conclusion: In treating uterine fibroids with embolization technique, both pingyangmycin lipiodol emulsion and polyvinyl alcohol particles are safe and effective embolismic materials. However, use of polyvinyl alcohol particles may be safer than pingyangmycin, as pingyangmycin is a kind of chemotherapeutic drugs, which might potentially cause some short-term or long-term complications. (authors)

  17. Molecular targets of dietary phytochemicals for possible prevention and therapy of uterine fibroids: Focus on fibrosis.

    Science.gov (United States)

    Islam, Md Soriful; Akhtar, Most Mauluda; Segars, James H; Castellucci, Mario; Ciarmela, Pasquapina

    2017-11-22

    Uterine fibroids (myomas or leiomyomas) are common benign tumors of reproductive aged women. Fibroids are clinically apparent in 20-50% of women, and cause abnormal uterine bleeding, abdominal pain and discomfort, pregnancy complications and infertility. Unfortunately, limited numbers of medical treatment are available but no effective preventive strategies exist. Moreover, the benefits of medical treatments are tempered by lack of efficacy or serious adverse side effects. Fibrosis has recently been recognized as a key pathological event in leiomyoma development and growth. It is defined by the excessive deposition of extracellular matrix (ECM). ECM plays important role in making bulk structure of leiomyoma, and ECM-rich rigid structure is believed to be a cause of abnormal bleeding and pelvic pain/pressure. Dietary phytochemicals are known to regulate fibrotic process in different biological systems, and being considered as potential tool to manage human health. At present, very few dietary phytochemicals have been studied in uterine leiomyoma, and they are mostly known for their antiproliferative effects. Therefore, in this review, our aim was to introduce some dietary phytochemicals that could target fibrotic processes in leiomyoma. Thus, this review could serve as useful resource to develop antifibrotic drugs for possible prevention and treatment of uterine fibroids.

  18. RADIOLOGICAL AND HISTOPATHOLOGICAL CORRELATION IN PATIENTS WITH UTERINE AND EXTRAUTERINE FIBROIDS

    Directory of Open Access Journals (Sweden)

    Dayananda Kumar R

    2016-08-01

    Full Text Available Leiomyomas are the most common benign uterine tumours. They are usually asymptomatic but may cause menometrorrhagia, abdominal pain and infertility. They may be single or multiple and may have variable size. When fibroids increase in size, their vascular supply becomes insufficient causing hyaline, myxoid, cystic and haemorrhagic degeneration. Differential diagnoses include adenomyosis, solid adnexal masses, and focal contraction of myometrium and leiomyosarcomas of the uterus. Our purpose was to describe USG, MR imaging findings, histological features and clinical aspects of uterine fibroids. MATERIALS AND METHODS This prospective study was conducted in the Department of Radiodiagnosis and Department of Pathology, MVJ Medical College and Research Hospital from January 2014 to December 2015. Our MR protocol includes sagittal, coronal, axial T2-weighted fast spin-echo, T1-weighted axial spin echo and axial short tau inversion recovery sequence. Optional sequences include sagittal and coronal short tau inversion recovery, axial diffusion weighted sequence, axial GRE sequence and sagittal T2 weighted 3D space sequence. RESULTS Uterine leiomyomas typically appear as well-defined, homogeneously hypointense masses on T2-weighted images and with intermediate signal intensity on T1-weighted images. Hypercellular leiomyomas show higher signal intensity than that of nondegenerated leiomyomas on T2 weighted images. Degenerated leiomyomas show signal intensity on T2-weighted images and on T1-weighted images obtained before and after contrast administration. 75 cases of leiomyomas were detected. In our study, majority of the cases belonged to the 41-50 years age group. Intramural fibroids were seen in 45 cases, subserosal fibroids were seen in 23 and submucosal fibroids in 15 cases. Both intramural and subserosal fibroids were seen in 7 cases. Broad ligament fibroids were seen in two cases. Pathological features of hyaline degeneration were noted in 5 cases

  19. Dietary phytochemicals for possible preventive and therapeutic option of uterine fibroids: Signaling pathways as target.

    Science.gov (United States)

    Islam, Md Soriful; Segars, James H; Castellucci, Mario; Ciarmela, Pasquapina

    2017-02-01

    A growing interest has emerged on dietary phytochemicals to control diverse pathological conditions. Unfortunately, dietary phytochemical research in uterine fibroids is still under construction. Uterine fibroids/leiomyomas are benign tumors developing from the myometrium of the uterus in premenopausal women. They may occur in more than 70% of women, and approximately 25% of women show clinically significant symptoms. These include heavy and prolonged menstrual bleeding, pelvic pressure (urinary frequency, incontinence, and difficulty with urination), pelvic pain, pelvic mass, infertility, and reproductive dysfunction. Due to lack of medical treatments surgery has been definitive choice for fibroid management. Moreover, surgery negatively affects women's quality of life, and its associated cost appears to be expensive. The molecular mechanism of fibroids development and growth is not fully elucidated. However, accumulated evidence shows that several signaling pathways, including Smad 2/3, PI3K/AKT/mTOR, ERK 1/2 and β-catenin are involved in the leiomyoma pathogenesis, indicating that they could serve as targets for prevention and/or treatment of this tumor. Therefore, in this review, we discuss the involvement of signaling pathways in leiomyoma development and growth, and introduce some potential dietary phytochemicals that could modulate those signaling pathways. Copyright © 2016 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  1. Ovarian Artery Embolization in Patients With Collateral Supply to Symptomatic Uterine Leiomyomata

    International Nuclear Information System (INIS)

    Scheurig-Muenkler, C.; Poellinger, A.; Wagner, M.; Hamm, B.; Kroencke, T. J.

    2011-01-01

    Purpose: To evaluate the safety and outcome of ovarian artery embolization (OAE) in patients with collateral supply to symptomatic uterine leiomyomata. Materials and Methods: Thirteen patients with relevant leiomyoma perfusion by way of enlarged ovarian arteries underwent additional OAE during the same (N = 10) or a second procedure (N = 3). Uterine artery embolization (UAE) was performed bilaterally in 10 and unilaterally in 2 patients with a single artery. One patient had no typical uterine arteries but bilaterally enlarged ovarian arteries, prompting bilateral OAE. OAE was accomplished with coil embolization in one and particle embolization in 12 patients. Symptoms before therapy and clinical outcome were assessed using a standardized questionnaire. Contrast-enhanced magnetic resonance (MR) imaging after embolization was available in 11 of 13 patients and was used to determine the percentage of fibroid infarction. Results: UAE and OAE were technically successful in all patients. One patient experienced prolonged irritation at the puncture site. Median clinical follow-up time was 16 months (range 4–37). Ten of 13 patients showed improvement or complete resolution of clinical symptoms. One patient reported only slight improvement of her symptoms. These women presented with regular menses. Two patients (15%), 47 and 48 years, both with unilateral OAE, reported permanent amenorrhea directly after embolization. Their symptoms completely resolved. Seven patients showed complete and 4 showed >90% fibroid infarction after embolization therapy. Conclusions: OAE is technically safe and effective in patients with ovarian artery collateral supply to symptomatic uterine leiomyomata. The risk of permanent amenorrhea observed in this study is similar to the reported incidence after UAE.

  2. African genetic ancestry interacts with body mass index to modify risk for uterine fibroids.

    Directory of Open Access Journals (Sweden)

    Ayush Giri

    2017-07-01

    Full Text Available Race, specifically African ancestry, and obesity are important risk factors for uterine fibroids, and likely interact to provide the right conditions for fibroid growth. However, existing studies largely focus on the main-effects rather than their interaction. Here, we firstly provide evidence for interaction between categories of body mass index (BMI and reported-race in relation to uterine fibroids. We then investigate whether the association between inferred local European ancestry and fibroid risk is modified by BMI in African American (AA women in the Vanderbilt University Medical Center bio-repository (BioVU (539 cases and 794 controls and the Coronary Artery Risk Development in Young Adults study (CARDIA, 264 cases and 173 controls. We used multiple logistic regression to evaluate interactions between local European ancestry and BMI in relation to fibroid risk, then performed fixed effects meta-analysis. Statistical significance threshold for local-ancestry and BMI interactions was empirically estimated with 10,000 permutations (p-value = 1.18x10-4. Admixture mapping detected an association between European ancestry and fibroid risk which was modified by BMI (continuous-interaction p-value = 3.75x10-5 around ADTRP (chromosome 6p24; the strongest association was found in the obese category (ancestry odds ratio (AOR = 0.51, p-value = 2.23x10-5. Evaluation of interaction between genotyped/imputed variants and BMI in this targeted region suggested race-specific interaction, present in AAs only; strongest evidence was found for insertion/deletion variant (6:11946435, again in the obese category (OR = 1.66, p-value = 1.72x10-6. We found nominal evidence for interaction between local ancestry and BMI at a previously reported region in chromosome 2q31-32, which includes COL5A2, and TFPI, an immediate downstream target of ADTRP. Interactions between BMI and SNPs (single nucleotide polymorphisms found in this region in AA women were also detected

  3. African genetic ancestry interacts with body mass index to modify risk for uterine fibroids.

    Science.gov (United States)

    Giri, Ayush; Edwards, Todd L; Hartmann, Katherine E; Torstenson, Eric S; Wellons, Melissa; Schreiner, Pamela J; Velez Edwards, Digna R

    2017-07-01

    Race, specifically African ancestry, and obesity are important risk factors for uterine fibroids, and likely interact to provide the right conditions for fibroid growth. However, existing studies largely focus on the main-effects rather than their interaction. Here, we firstly provide evidence for interaction between categories of body mass index (BMI) and reported-race in relation to uterine fibroids. We then investigate whether the association between inferred local European ancestry and fibroid risk is modified by BMI in African American (AA) women in the Vanderbilt University Medical Center bio-repository (BioVU) (539 cases and 794 controls) and the Coronary Artery Risk Development in Young Adults study (CARDIA, 264 cases and 173 controls). We used multiple logistic regression to evaluate interactions between local European ancestry and BMI in relation to fibroid risk, then performed fixed effects meta-analysis. Statistical significance threshold for local-ancestry and BMI interactions was empirically estimated with 10,000 permutations (p-value = 1.18x10-4). Admixture mapping detected an association between European ancestry and fibroid risk which was modified by BMI (continuous-interaction p-value = 3.75x10-5) around ADTRP (chromosome 6p24); the strongest association was found in the obese category (ancestry odds ratio (AOR) = 0.51, p-value = 2.23x10-5). Evaluation of interaction between genotyped/imputed variants and BMI in this targeted region suggested race-specific interaction, present in AAs only; strongest evidence was found for insertion/deletion variant (6:11946435), again in the obese category (OR = 1.66, p-value = 1.72x10-6). We found nominal evidence for interaction between local ancestry and BMI at a previously reported region in chromosome 2q31-32, which includes COL5A2, and TFPI, an immediate downstream target of ADTRP. Interactions between BMI and SNPs (single nucleotide polymorphisms) found in this region in AA women were also detected in an

  4. 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.)

  5. Uterine fibroid embolization with spheric micro-particles using flow guiding: safety, technical success and clinical results

    International Nuclear Information System (INIS)

    Richter, G.M.; Radeleff, B.; Kauffmann, G.W.; Rimbach, S.

    2004-01-01

    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.)

  6. Therapeutic response assessment of high intensity focused ultrasound therapy for uterine fibroid: Utility of contrast-enhanced ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Zhou Xiaodong [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China)]. E-mail: zhouxd@fmmu.edu.cn; Ren Xiaolong [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China)]. E-mail: renxiaolong70@hotmail.com; Zhang Jun [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); He Guangbin [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Zheng Minjuan [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Tian Xue [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Li Li [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Zhu Ting [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Zhang Min [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Wang Lei [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Luo Wen [Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China)

    2007-05-15

    Purpose: To assess the utility of contrast-enhanced ultrasonography (ceUS) in the assessment of the therapeutic response to high intensity focused ultrasound (HIFU) ablation in patients with uterine fibroid. Materials and methods: Sixty-four patients with a total of 64 uterine fibroids (mean: 5.3 {+-} 1.2 cm; range: 3.2-8.9 cm) treated with HIFU ablation under the ultrasound guidance were evaluated with ceUS after receiving an intravenous bolus injection of a microbubble contrast agent (SonoVue) within 1 week after intervention. We obtained serial ceUS images during the time period from beginning to 5 min after the initiation of the bolus contrast injection. All of the patients underwent a contrast enhanced MRI (ceMRI) and ultrasound guided needle puncture biopsy within 1 week after HIFU ablation. And as a follow-up, all of the patients underwent US at 1, 3, 6 and 12 months after HIFU treatment. The volume change was observed and compared to pre- and post-HIFU ablation. The results of the ceUS were compared with those of the ceMRI in terms of the presence or absence of residual unablated tumor and pathologic change in the treated lesions. Results: On ceUS, diagnostic accuracy was 100%, while residual unablated tumors were found in three uterine fibroids (4.7%) and failed treatment was found in eight uterine fibroids (12.5%). All the 11 fibroids were subjected to additional HIFU ablation. Of the 58 ablated fibroids without residual tumors on both the ceUS and ceMRI after the HIFU ablation, the volumes of all the fibroids decreased in different degrees during the 1 year follow-up USs. And histologic examinations confirmed findings of necrotic and viable tumor tissue, respectively. Conclusion: CEUS is potentially useful for evaluating the early therapeutic effect of percutaneous HIFU ablation for uterine fibroids.

  7. Therapeutic response assessment of high intensity focused ultrasound therapy for uterine fibroid: Utility of contrast-enhanced ultrasonography

    International Nuclear Information System (INIS)

    Zhou Xiaodong; Ren Xiaolong; Zhang Jun; He Guangbin; Zheng Minjuan; Tian Xue; Li Li; Zhu Ting; Zhang Min; Wang Lei; Luo Wen

    2007-01-01

    Purpose: To assess the utility of contrast-enhanced ultrasonography (ceUS) in the assessment of the therapeutic response to high intensity focused ultrasound (HIFU) ablation in patients with uterine fibroid. Materials and methods: Sixty-four patients with a total of 64 uterine fibroids (mean: 5.3 ± 1.2 cm; range: 3.2-8.9 cm) treated with HIFU ablation under the ultrasound guidance were evaluated with ceUS after receiving an intravenous bolus injection of a microbubble contrast agent (SonoVue) within 1 week after intervention. We obtained serial ceUS images during the time period from beginning to 5 min after the initiation of the bolus contrast injection. All of the patients underwent a contrast enhanced MRI (ceMRI) and ultrasound guided needle puncture biopsy within 1 week after HIFU ablation. And as a follow-up, all of the patients underwent US at 1, 3, 6 and 12 months after HIFU treatment. The volume change was observed and compared to pre- and post-HIFU ablation. The results of the ceUS were compared with those of the ceMRI in terms of the presence or absence of residual unablated tumor and pathologic change in the treated lesions. Results: On ceUS, diagnostic accuracy was 100%, while residual unablated tumors were found in three uterine fibroids (4.7%) and failed treatment was found in eight uterine fibroids (12.5%). All the 11 fibroids were subjected to additional HIFU ablation. Of the 58 ablated fibroids without residual tumors on both the ceUS and ceMRI after the HIFU ablation, the volumes of all the fibroids decreased in different degrees during the 1 year follow-up USs. And histologic examinations confirmed findings of necrotic and viable tumor tissue, respectively. Conclusion: CEUS is potentially useful for evaluating the early therapeutic effect of percutaneous HIFU ablation for uterine fibroids

  8. Symptomatic Uterine Leiomyoma in a 65-year old Postmenopausal ...

    African Journals Online (AJOL)

    She presented with constipation suggestive of intestinal obstruction with no history of previous surgery, and investigations confirmed a calcified uterine leiomyoma. She had exploratory ... Symptomatic uterine leiomyoma in an elderly postmenopausal woman is rare, and its coexistence with CIN III in a virgin, is even rarer.

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    International Nuclear Information System (INIS)

    Kaicker, Jatin; Wu Ke; Athreya, Sriharsha

    2013-01-01

    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 benchmarks revealed lack

  12. Noninvasive, in vivo determination of uterine fibroid thermal conductivity in MRI-guided high intensity focused ultrasound therapy.

    Science.gov (United States)

    Zhang, Jiming; Fischer, John; Warner, Lizette; Oto, Aytekin; Hor, Pei-Herng; Muthupillai, Raja

    2015-06-01

    To estimate the local thermal conductivity of uterine fibroid in vivo at a high temperature range (60-80°C) typically encountered in magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) surgery. The thermal conductivity of uterine fibroids in vivo is unknown and knowledge about tissue thermal conductivity may aid in effective delivery of thermal energy for ablation. All subjects (nine women) provided written informed consent to participate in this Institutional Review Board-approved study. A total of 10 fibroids were treated using MRgHIFU surgery with real-time temperature monitoring during both heating and cooling periods. The local thermal conductivity was determined by analyzing the spatiotemporal spread of temperature during the cooling period. The thermal conductivity of MRgHIFU-treated uterine fibroids was 0.47 ± 0.07 W·m(-1) ·K(-1) (range: 0.25∼0.67 W·m(-1) ·K(-1) ) which is slightly lower than the reported value for skeletal muscle at temperatures of thermal conductivity of uterine fibroids in vivo from the spatiotemporal spread of temperature around the HIFU focus during the cooling period. © 2014 Wiley Periodicals, Inc.

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

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    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

  14. 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

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    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.)

  15. Radiation Exposure During Uterine Fibroid Embolization (UFE): A Confounder-Controlled Comparison Between a State-of-the-Art Angiography Unit and a Conventional Angiography unit.

    Science.gov (United States)

    Sommer, Christof-Matthias; Voigt, Wieland; Klapp Oliger, Michel; Schlett, Christopher L; Erpenbach, Stefan; Thomas, Katrina; Hatopp, Andreas; Kurz, Patrick; Richter, Goetz M

    2018-03-01

     To compare radiation exposure of a state-of-the-art and a conventional angiography unit in patients undergoing uterine fibroid embolization (UFE).  Between January 2009 and December 2016, 286 patients underwent UFE in our Interdisciplinary Fibroid Center. The inclusion criteria for this retrospective analysis were first-time transarterial embolization for symptomatic fibroids, bilateral embolization, procedures applying a state-of-the-art (Group 1) or a conventional angiography unit (Group 2), and bilateral technical success with an adequate embolization endpoint after the injection of microspheres. Study endpoints included radiation exposure, major complications, morphological success (MRI), and clinical success (questionnaire on quality-of-life). Propensity score matching controlled for confounders.  The inclusion criteria were met by 58 (Group 1) and 177 (Group 2) patients. After propensity score matching, there was no significant difference between Group 1 (n = 46) and Group 2 (n = 92) regarding age, body-mass index, volume of the dominant fibroid and the uterus, fluoroscopy time, and amount of embolic agent (p ≥ 0.10 each). The dose-area product was significantly lower in Group 1 than in Group 2 (1159.0 cGycm 2 vs. 3123.5 cGycm 2 ; p  0.99). There were no significant differences between both groups regarding shrinkage of the dominant fibroid and the uterus and no relevant differences regarding patient-reported quality-of-life.  A state-of-the-art angiography unit has the potential to reduce radiation exposure in patients undergoing UFE without increasing the risk of major complications and with comparably high morphological and clinical success.   · A state-of-the-art angiography unit potentially reduces radiation exposure in patients undergoing UFE.. · Reduced radiation exposure does not seem to negatively influence the rate of major complications.. · Reduced exposure does not seem to negatively affect morphological and clinical

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

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    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

  17. Evaluation of GWAS candidate susceptibility loci for uterine leiomyoma in the multi-ethnic NIEHS uterine fibroid study

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    Brahim eAissani

    2015-07-01

    Full Text Available We evaluated the association of 56 candidate SNPs identified in two published genome-wide association studies (GWAS of uterine leiomyoma (UL, or fibroids, with the risk and tumor size in the multi-ethnic uterine fibroid study (NIEHS-UFS. The selected SNPs were genotyped in 916 premenopausal women of African American (AA and European American (EA descents and their association with the outcomes was evaluated in race-stratified models and in meta-analysis of risk in NIEHS-UFS and discovery and replication GWAS in the Japanese population. We report moderate associations of variant rs4954368 in THSD7B (thrombospondin, type I, domain containing 7B with tumor size in pooled analysis of AA and EA samples (P = 0.004, and at TNRC6B (trinucleotide repeat containing 6B variants rs138039 and rs139909 in EA (P = 0.001 and P = 0.008, respectively. The most significant associations with risk in meta-analysis were observed at TNRC6B variants rs739182 (P = 3.7 x 10-10 and rs2072858 (P = 1.1 x 10-9 and were stronger than those reported in the discovery GWAS (P =2.01 x 10-8 and P = 2.58 x 10-8, respectively. The present study failed to replicate the associations reported for CCDC57 and FASN in a discovery GWAS in populations of European descent. Consistent with previous replication studies in the Right From the Start Study (RFTS and the BioVU DNA repository, we provide independent evidence for association of TNRC6B with both risk and size of UL. The present study is the first to report a replicated association of THSD7B with UL, albeit with tumor size and not with risk.

  18. Embolization of angiographically visible type I and II utero-ovarian anastomoses during uterine artery embolization for fibroid tumors: impact on symptom recurrence and permanent amenorrhea.

    Science.gov (United States)

    Salazar, Gloria M M; Gregory Walker, T; Conway, Raymond F; Yeddula, Kalpana; Wicky, Stephan; Waltman, Arthur C; Kalva, Sanjeeva P

    2013-09-01

    To compare the incidences of symptom recurrence and permanent amenorrhea following uterine artery embolization (UAE) for symptomatic fibroid tumors in patients with type I and II utero-ovarian anastomoses (UOAs) with versus without ovarian artery embolization (OAE). A retrospective, institutional review board-approved study of 99 women who underwent UAE for symptomatic fibroid tumors from April 2005 to October 2010 was conducted to identify patients who had type I or II UOAs at the time of UAE. Based on the embolization technique, patients were categorized into standard (ie, UAE only), combined (ie, UAE and OAE), and control (patients without UOAs who underwent UAE) groups. Data collected included patient characteristics, procedural technique and findings, symptom recurrence, secondary interventions, and permanent amenorrhea. Statistical analysis was performed with the Fisher exact test, with significance reached at P amenorrhea after procedures (follow-up, 561 d ± 490). There was a significantly higher incidence of symptom recurrence in the standard group compared with the control group (P = .01), with no differences between combined and control groups (P = 1). There were no statistical differences in permanent amenorrhea rates in the groups studied, with significantly higher symptom recurrence rates observed when OAE was not performed in the setting of UOA. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Ravn, Pernille; Green, Anders

    2016-01-01

    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...... 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 (χ2 test, p PVA particles 500–700 µm showed high reintervention rate...

  20. Clinical Presentation of Uterine Fibroids in Nnewi, Nigeria: A 5-year Review.

    Science.gov (United States)

    Ezeama, Co; Ikechebelu, Ji; Obiechina, Nj; Ezeama, Nn

    2012-07-01

    Uterine leiomyomas are the commonest benign tumors in women, with a higher preponderance amongst Africans. Several etiological factors have been suggested, with subtle variations in clinical presentation being reported in different studies. This may constitute a determinant for the management measures undertaken. To review the clinical presentation and management measures undertaken for uterine leiomyoma. A retrospective study was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, from January 2002 to December 2006. A review of case records of patients with a diagnosis of uterine leiomyoma was done. The data were analyzed and presented in tables using comparative percentages. Uterine leiomyoma constituted 117 of the 1094 gynecological admissions during this study period (10.7%, 117/1094). The mean (SD) age of presentation was 35.7 (6.1) years. Most of the patients were nulliparous (76.7%, 79/103) and 51.5% (53/103) were married. The commonest mode of presentation was lower abdominal mass (66.9%, 67/103) and the least was recurrent abortion (1%, 1/103). Surgery was employed in all cases, with myomectomy being the commonest modality used in 90.3% (93/103) of cases. The common postoperative complications were prolonged pain (49.5%, 51/103) and postoperative pyrexia (34.9%, 36/103). The symptom of lower abdominal mass correlates with late presentations in our setting. This makes the application of newer therapies like laparoscopic myomectomy difficult even when they are available. Other therapies which are independent of fibroid size (like uterine artery embolization) are not readily available in our environment. This further emphasizes the importance of myomectomy as the most important treatment modality in our environment.

  1. The timing of natural menopause after uterine fibroid embolization: a prospective cohort study.

    Science.gov (United States)

    Tropeano, Giovanna; Amoroso, Sonia; di Stasi, Carmine; Vizzielli, Giuseppe; Bonomo, Lorenzo; Scambia, Giovanni

    2011-10-01

    To determine whether uterine fibroid embolization before the age of 45 years advances the timing of natural menopause. Prospective cohort study. University tertiary-care center. Forty-three regularly cycling women aged 35-44 years who underwent embolization and 43 age-matched control subjects. Annual assessments of menopausal status using prospectively recorded menstrual diaries and hormonal (serum FSH and E(2)) and ultrasound measures (ovarian volume and antral follicle count). Women were followed for 7 years or until they reached menopause. Age at menopause as computed by subtracting the date of birth from the exact date of the last menstrual period. Over the study period, 9 patients (25%) and 12 control subjects (33%) became menopausal, 19 patients (53%) and 18 control subjects (50%) entered the menopausal transition (irregular cycles), and 8 patients (22%) and 6 control subjects (17%) continued to menstruate regularly. Mean menopausal age in the embolization group (48.94 ± 2.48 years) was not significantly different from that in the control group (49.52 ± 1.25 years). There was no significant difference of menopause occurrence between the groups. Longitudinal changes in hormonal and ultrasound measures were similar for the two groups. This long-term follow-up study found no evidence for fibroid embolization advancing the timing of menopause in women before the age of 45 years. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. Effect of Modified and accumulated decoction on serum ER, PR, sex hormone, IGF-I and IGF-I in patients with uterine fibroids

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    Yi-Sha Li

    2017-11-01

    Full Text Available Objective: To study the effect of Modified and accumulated Decoction on serum ER, PR, sex hormone, IGF-I and IGF-I in patients with uterine fibroids. Method: A total of 90 patients with uterine fibroids in our hospital from January 2015 to January 2017 were enrolled in this study. The subjects were divided into the control group (n=45 and the treatment group (n=45 randomly. The control group was treated with mifepristone, the treatment group was treated with Modified and accumulated Decoction combined with mifepristone, and both the two groups were treated for 3 months. The uterine fibroid volume and uterine volume of the two groups before and after treatment were compared. The serum ER, PR, P, E 2 , LH, FSH, IGF-I and IGF-IR of the two groups before and after treatment were compared. Result: There were no significantly differences of the uterine fibroid volume and uterine volume of the two groups before treatment. The uterine fibroid volume and uterine volume of the two groups after treatment were significantly less than before treatment, and that of the treatment group after treatment were significantly less than the control group. There were no significantly differences among the serum ER, PR, P, E 2 , LH, FSH, IGF-I and IGF-IR of the two groups before treatment. The serum ER, PR, P, E 2 , LH, FSH, IGF-I and IGF-IR of the two groups after treatment were significantly lower than before treatment, and that of the treatment group after treatment were significantly lower than the control group. Conclusion: Modified and accumulated Decoction combined with mifepristonecan significantly reduce the uterine fibroid volume, improve the serum ER, PR, sex hormone, IGF-I and IGF-I levels of the patients with uterine fibroids, and it was worthy clinical application.

  3. Emergency Laparotomy in a Case of Large Anterior Wall Subserus Uterine Fibroid Causing Strangulated Umbilical Hernia in a Primary Infertile Woman

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    Debmalya Maity

    2017-05-01

    Full Text Available Fibroid is the commonest benign tumour of uterus seen in women of reproductive age group. There have been case reports of pedunculated fibroid presenting as a content of hernial sac but herniation of intestinal loops through anterior abdominal wall due to pressure effect of a large fibroid resulting in strangulation and gangrene has rarely been reported. Here we report the case of a 32-year-old infertile woman, who underwent emergency Laparotomy and resection anastomosis of a strangulated small intestinal umbilical hernia which resulted due to pressure effect of a large subserous uterine fibroid.

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

    International Nuclear Information System (INIS)

    Kooij, Sanne M. van der; Moolenaar, Lobke M.; Ankum, Willem M.; Reekers, Jim A.; Mol, Ben Willem J.; Hehenkamp, Wouter J. K.

    2013-01-01

    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 €191 and €355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were €105 and €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

  5. Uterine Fibroids

    Science.gov (United States)

    ... body. Resectoscope: A slender telescope with an electrical wire loop or rollerball tip used to remove or ... Journal Clinical Updates Practice Management Coding Health Info Technology Professional Liability Managing Your Practice Patient Safety & Quality ...

  6. Uterine Fibroids

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    ... NICHD Research Information Find a Study More Information Preeclampsia and Eclampsia About NICHD Research Information Find a ... of the Director Director's Corner Office of Administrative Management (OAM) Office of Communications (OC) Office of Global ...

  7. Translation and validation of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL questionnaire for the Brazilian Portuguese language

    Directory of Open Access Journals (Sweden)

    Luiz Gustavo Oliveira Brito

    2017-03-01

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: Uterine fibroids (UF, also known as leiomyomas, are the most prevalent gynecological tumors. The Uterine Fibroid Symptoms and Quality of Life (UFS-QOL is the only specific questionnaire that assesses symptom intensity and quality-of-life issues for women with symptomatic UF; however, it only exists in the English language. Thus, we aimed to translate and culturally validate the UFS-QOL questionnaire for the Brazilian Portuguese language. DESIGN AND SETTING: Cross-sectional study, Department of Gynecology and Obstetrics, FMRP-USP. METHODS: 113 patients with UF (case group and 55 patients without UF (control group were interviewed using the UFS-QOL questionnaire after translation and cultural adaptation. The Short Form-36 questionnaire was used as a control. Demographic and psychometric variables were analyzed. RESULTS: Women with UF presented higher mean age, body mass index, weight, parity and comorbidities than the control group (P < 0.05. The most prevalent complaints were abnormal uterine bleeding (93.8%, pelvic pain (36.3% and extrinsic compression (10.6% and these presented adequate construct validity regarding UFS-QOL severity (P < 0.05. The UFS-QOL questionnaire presented good internal consistency regarding symptom severity and quality-of-life-related domains (intraclass correlation coefficient, ICC = 0.82/0.88. Structural validity presented correlation coefficients ranging from 0.59 to 0.91. Test-retest comparison did not show differences among the UFS-QOL subscales. After treatment, women with UF presented improvements on all subscales. CONCLUSION: The UFS-QOL questionnaire presented adequate translation to the Brazilian Portuguese language, with good internal consistency, discriminant validity, construct validity, structural validity and responsiveness, along with adequate test-retest results.

  8. 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. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  9. Real-world data of 197 patients treated with ulipristal acetate for uterine fibroids: PREMYA study French population main outcomes.

    Science.gov (United States)

    Fernandez, H; Descamps, P; Koskas, M; Lopès, P; Brun, J L; Darai, E; Agostini, A

    2017-09-01

    To characterize and describe treatment with ulipristal acetate (UPA) in a preoperative setting and to evaluate the safety, effectiveness, and Health Related Quality of Life (HRQoL) outcomes in a French population treated according to standard clinical practice. Multicentre, prospective, non-interventional study (PREMYA) of patients diagnosed with moderate to severe symptoms of uterine fibroids and undergoing a preoperative treatment with UPA 5mg (Esmya ® ). Patients were followed for a total of 15months (3months UPA treatment and 12months after). Data were collected approximatively every 3months according to centre usual visit schedule. A total of 206 women were enrolled in France, of whom 197 were found to be eligible for data analysis. Physicians' assessments of patients' overall symptomatic changes, as measured on the Clinical Global Impression-Improvement (CGI-I) scale, indicated that 83.7% of patients were improved at end of treatment (month 3). On the patients' treatment benefit scale (PTBS), 94.7% of patients reported an improvement. These 2 measurements, pain and quality of life, remained improved after treatment cessation and during the entire period of follow-up. Only 58.4% of patients underwent surgery within the timeframe of the study follow-up of which the majority were of a conservative/minimal invasive nature. Many patients did not undergo surgery during the planned 12months follow-up period after treatment whereas all patients had an indication of surgery. All measurements of treatment outcome were markedly improved by 3 months of UPA 5mg treatment. NCT01635452. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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.)

  12. Uterine artery embolisation for uterine leiomyomas

    African Journals Online (AJOL)

    in the public health sector in the Western Cape. Inclusion criteria were women with symptomatic uterine fibroids who declined surgery, had risk factors for surgery such as obesity or medical co-morbidities, or objected to blood products. Patients were treated by a multidisciplinary team comprising infertility specialists, general.

  13. Torsion of an iatrogenic parasitic fibroid related to power morcellation for specimen retrieval

    Science.gov (United States)

    Narasimhulu, Deepa Maheswari; Eugene, Ellis; Sumit, Saraf

    2015-01-01

    Parasitic fibroids are generally diagnosed incidentally at the time of surgery performed for symptomatic uterine fibroids. Torsion of a parasitic fibroid causing severe acute onset pain is extremely rare. We report a torsed parasitic fibroid in a patient who underwent hysterectomy using power morcellation for specimen retrieval. A 40-year-old patient with a history of laparoscopic supracervical hysterectomy 8 years prior presented with severe abdominal pain. She was diagnosed with degenerating parasitic fibroids on magnetic resonance imaging and was managed conservatively. Surgery was performed 3 days later for persistent pain, and the parasitic fibroid was found to have undergone torsion. Torsed ischemic fibroids can undergo necrosis and gangrene and can potentially cause life-threatening coagulopathy and peritonitis. Awareness of this potential complication will reduce errors in diagnosis and facilitate timely management. PMID:26692779

  14. Effectiveness of intra-arterial anesthesia for uterine fibroid embolization using dilute lidocaine

    Energy Technology Data Exchange (ETDEWEB)

    Zhan, Songhua; Li, Yi; Wang, Guoliang; Han, Hongjie; Yang, Zhenyan [Tongji Hospital of Tongji University, Department of Radiology, Shanghai (China)

    2005-08-01

    A modified protocol of uterine fibroid embolization (UFE) is proposed for alleviating the postinterventional pain. This randomized and double-blinded clinical trial is to evaluate the effectiveness of intra-arterial infusion of dilute lidocaine for postinterventional pain relief in UFE. Forty-six patients who underwent UFE were randomly grouped equally. In the test group, after the poly(vinyl alcohol) embolization was complete, a dilute lidocaine solution with 40 mg in 6.0 ml, 3.0 ml for each side or 4.0 and 2.0 ml for two sides, was given through the catheter. In the control group, the patients received 6.0 ml of saline solution as a placebo. A simple pain degree classification method for patient self-evaluation was developed. A questionnaire was completed by each patient to record the degree of pain during five periods; these were during the procedure, the first 12 h, the second 12 h, between 24 and 48 h, and between 48 and 72 h. The numbers of patients with the same degree of pain in the five time segments from the two groups were statistically compared. Compared with the control group, the patients in the test group experienced less pain within 48 h after the procedure (p<0.01). The results suggest that this improved UFE protocol is a simple approach to prevent the acute postinterventional pain of UFE. (orig.)

  15. Contribution of contrast-enhanced ultrasound with Sonovue to describe the microvascularization of uterine fibroid tumors before and after uterine artery embolization.

    Science.gov (United States)

    Henri, Marret; Florence, Eboué; Aurore, Bleuzen; Denis, Herbreteau; Frederic, Patat; Francois, Tranquart; Lobna, Ouldamer

    2014-10-01

    The principal objective of this study was to use contrast-enhanced ultrasonography to describe the characteristics of fibroid microvascularization before and after embolization. Forty women had contrast-enhanced ultrasonography with Sonovue(®) injections before uterine artery embolization, the day afterwards, and at 6-12 months afterwards. An MRI was also performed before and after the procedure. Two thirds of the fibroids took up the contrast product before the myometrium did, and 45.8% were vascularized along the peripheral rim of the fibroid, compared with 41.6% with a principal pedicle and from the center in three (12.6%). After embolization at day one (D1), the myometrium was fully enhanced, that is, perfusion of the myometrium was plainly visible, in 25 cases (69.4%; n=36), partially enhanced in eight (22.2%), and totally avascular in three (8.4%). Analysis of the failures according to imaging criteria the day after embolization (D1) showed failure in seven women, with partial enhancement for six, and total for one. In the imaging at 6 months (M6), contrast ultrasonography showed failure for three women, with enhancement of the largest fibroid. This enhancement was total in two cases and partial (40%) in one. There were five failures according to MRI at M6, with partial enhancement. Only two of these failures were simultaneously failures according to the contrast-enhanced ultrasonography. There were five clinical failures, two consistent with the imaging at 6 months and four predictable on D1. Contrast-enhanced ultrasonography is feasible and useful to understand fibroid vascularization and for monitoring embolization; its correlation with MRI is good, its concordance less so. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Preperitoneal Fat Thicknesses, Lipid Profile, and Oxidative Status in Women With Uterine Fibroids.

    Science.gov (United States)

    Vignini, Arianna; Sabbatinelli, Jacopo; Clemente, Nicolò; Delli Carpini, Giovanni; Tassetti, Marta; Zagaglia, Giulia; Ciavattini, Andrea

    2017-10-01

    There is growing evidence supporting a possible role for metabolic syndrome and its determinants, such as dyslipidemia, in uterine fibroid (UF) pathogenesis. The present study aims to investigate the association between UFs and visceral and subcutaneous fat thickness (SFT), lipid profile, and oxidative and antioxidative status. In this cross-sectional study, 35 patients diagnosed with UFs and 15 women without UFs were enrolled. Clinical history and anthropometric parameters were collected for every woman. Characteristics of UFs, preperitoneal fat thickness (PFT), and SFT were assessed ultrasonically. Lipid profile, glucose, thiobarbituric acid reactive substances (TBARs), and superoxide dismutase (SOD) activity were evaluated on plasma from participants. Women with UFs showed a significantly increased PFT (11.63 ± 3.39 vs 7.01 ± 3.10 mm; P HDL-C; 45.4 ± 8.3 vs 57.2 ± 13.4 mg/dL; P = .017), higher levels of low-density lipoprotein cholesterol (LDL-C; 92.3 ± 21.5 vs 72.0 ± 14.6 mg/dL; P = .007), and oxidized LDL (65.2 ± 20.7 vs 43.0 ± 11.3 U/L; P = .002). In patients, TBARs concentration was significantly higher (9.41 ± 6.49 vs 2.92 ± 1.65 nmol malondialdehyde/100 μg prot; P body mass index, oxidized LDL, and TBARs. At multivariate analysis, PFT and HDL-C maintained a significant correlation with the diagnosis of UFs. Chronic inflammation triggered and sustained by visceral fat could play a determinant role in cell differentiation and proliferation processes, necessary for the development of UFs. Alterations in cholesterol fractions may be explained as a consequence of the increased visceral fat deposits and can reflect an increased risk of subclinical atherosclerosis in patients with UF.

  18. 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.)

  19. Anastomoses of the Ovarian and Uterine Arteries: A Potential Pitfall and Cause of Failure of Uterine Embolization

    International Nuclear Information System (INIS)

    Matson, Matthew; Nicholson, Anthony; Belli, Anna-Maria

    2000-01-01

    Four women with symptomatic uterine fibroids were treated by uterine artery embolization (UAE). In all cases both uterine arteries were embolized via a single femoral puncture with polyvinyl alcohol using a selective catheter technique. In three cases, the ovarian artery was not visible on the initial angiogram before embolization, but appeared after the second uterine artery had been treated. In one case of clinical failure following UAE, a repeat angiogram demonstrated filling of the fibroids from the ovarian artery. Anastomoses between uterine and ovarian arteries may cause problems for radiologists performing UAE and are a potential cause of treatment failure

  20. 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.

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

    International Nuclear Information System (INIS)

    Butori, Noemie; Tixier, Herve; Filipuzzi, Laurence; Mutamba, William; Guiu, Boris; Cercueil, Jean-Pierre; Douvier, Serge; Sagot, Paul; Krause, Denis; Loffroy, Romaric

    2011-01-01

    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.

  2. A comparison of ultrasound-guided high intensity focused ultrasound for the treatment of uterine fibroids in patients with an anteverted uterus and a retroverted uterus.

    Science.gov (United States)

    Zhang, Wenyi; He, Min; Huang, Guohua; He, Jia

    2016-09-01

    The aim of this study was to compare the treatment outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids in patients with an anteverted uterus versus a retroverted uterus. Based on the principles of statistics we enrolled 221patients with an anteverted uterus and 221 with a retroverted uterus. All patients had a solitary uterine fibroid and every fibroid was identified as hypointense on the T2 weighted images (T2WI) on magnetic resonance. The baseline characteristics of the patients, treatment results and adverse events were compared between the two groups. There were no significant differences in baseline characteristics between the two groups. The average non-perfused volume ratio of fibroids was 85.2 ± 18.7% in the group of patients with a retroverted uterus, while it was 87.7 ± 11.8% in patients with an anteverted uterus (P uterus were treated using lower sonication power and longer sonication time. During the procedure patients with a retroverted uterus had a higher incidence of sciatic/buttock pain and groin pain, while patients with an anteverted uterus complained of lower abdominal pain or a burning sensation on the skin. Immediately after USgHIFU, the rates of sciatic/buttock pain and skin burn were significantly higher in patients with a retroverted uterus. The results of this study indicated that uterine fibroids with hypointensity on T2WI in a retroverted uterus can be safely and effectively treated with USgHIFU. However, the fibroids in an anteverted uterus are easier to treat with USgHIFU.

  3. 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.

  4. Discussing sarcoma risks during informed consent for nonhysterectomy management of fibroids: an unmet need.

    Science.gov (United States)

    Seagle, Brandon-Luke L; Alexander, Amy L; Strohl, Anna E; Shahabi, Shohreh

    2018-01-01

    There is no reliable way to distinguish symptomatic uterine fibroids from sarcoma without a surgical specimen. Many women with a uterine sarcoma are initially managed without hysterectomy under a presumed fibroid diagnosis, without understanding sarcoma risks. Currently many alternatives to hysterectomy, including medical and procedural interventions, for treatment of fibroids are promoted. The sarcoma incidence among women with presumed fibroids is 0.29% (1/340) to 0.05% (1/2000). Nonmetastatic leiomyosarcoma has a 63% 5-year survival rate whereas metastatic leiomyosarcoma has a 14% 5-year survival rate. In uterine sarcoma, we often cannot identify who has sarcoma before making a potentially cure-denying decision by delaying surgery. Therefore, women electing an alternative to hysterectomy for fibroids should undergo an informed consent process that specifically includes discussion of uterine sarcoma incidence and mortality. Alternatives to hysterectomy for presumed fibroids remain preferable treatment options for many women with symptomatic fibroids, so long as underlying sarcoma risks are adequately discussed. The challenge for obstetrician- gynecologists then is how to provide better informed consent and maintain the primacy of patient autonomy over our concern to "First, do no harm." Major threats to patient's autonomy are faced in the sarcoma risk discussion. How we should present sarcoma risk information to avoid being dismissive of sarcoma or frightening women toward hysterectomy is unstudied. Research is needed to determine how to provide sarcoma risk information with less bias during informed consent. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. The impact of uterine artery embolisation on fibroid volume at 43.6 ...

    African Journals Online (AJOL)

    2017-12-05

    Dec 5, 2017 ... UAE has a good clinical effect on fibroid volume reduction. It is a treatment option that can be ... allergies to contrast media, previous pelvic radiation/malignancy, renal insufficiency and active pelvic ... outcome measures included adverse events, reintervention rates and follow-up haemoglobin levels.

  6. Long-Term Follow-up of Uterine Artery Embolization for Symptomatic Adenomyosis

    International Nuclear Information System (INIS)

    Smeets, A. J.; Nijenhuis, R. J.; Boekkooi, P. F.; Vervest, H. A. M.; Rooij, W. J. van; Lohle, P. N. M.

    2012-01-01

    Introduction: Long-term results of uterine artery embolization (UAE) for adenomyosis are largely unknown. We assess long-term outcome of UAE in 40 women with adenomyosis. Materials and methods: Between March 1999 and October 2006, 40 consecutive women with adenomyosis (22 in combination with fibroids) were treated with UAE. Changes in junction zone thickness were assessed with magnetic resonance imaging (MRI) at baseline and again at 3 months. After a mean clinical follow-up of 65 months (median 58 [range 38–129]), women filled out the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire, which had additional questions on the long-term evolution of baseline symptoms and adverse events. Results: During follow-up, 7 of 40 women (18%) underwent hysterectomy. Among these 7 women, the junction zones were significantly thicker, both at baseline (mean 23 vs. 16 mm, P = 0.028) and at 3-month follow-up (mean 15 vs. 9 mm, P = 0.034). Of 33 women with preserved uterus, 29 were asymptomatic. Four patients had symptom severity scores of 50 to 85 and overall QoL scores of 60 to 66, indicating substantial clinical symptoms. There was no relation between clinical outcome and the initial presence of fibroids in addition to adenomyosis. Conclusion: In women with therapy-resistant adenomyosis, UAE resulted in long-term preservation of the uterus in the majority. Most patients with preserved uterus were asymptomatic. The only predictor for hysterectomy during follow-up was initial thickness of the junction zone. The presence or absence of fibroids in addition to adenomyosis had no relation with the need for hysterectomy or clinical outcome.

  7. Clinical utility of a microbubble-enhancing contrast (“SonoVue”) in treatment of uterine fibroids with high intensity focused ultrasound: A retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Peng, Song [State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, Department of Biomedical Engineering, Chongqing Medical University, Chongqing 400016 (China); Non-invasive and Minimally Invasive Therapeutic Research Center for Uterine Benign Diseases of Chongqing, Chongqing 401121 (China); Xiong, Yu [Department of Obstetrics of Chongqing Haifu Hospital, Chongqing 401121 (China); Non-invasive and Minimally Invasive Therapeutic Research Center for Uterine Benign Diseases of Chongqing, Chongqing 401121 (China); Li, Kequan [State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, Department of Biomedical Engineering, Chongqing Medical University, Chongqing 400016 (China); Non-invasive and Minimally Invasive Therapeutic Research Center for Uterine Benign Diseases of Chongqing, Chongqing 401121 (China); He, Min [Department of Obstetrics of Chongqing Haifu Hospital, Chongqing 401121 (China); Department of Obstetrics and Gynecology, Suining Central Hospital, Sichuan 629000 (China); Deng, Yongbin; Chen, Li; Zou, Min [Department of Obstetrics of Chongqing Haifu Hospital, Chongqing 401121 (China); Chen, Wenzhi; Wang, Zhibiao [State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, Department of Biomedical Engineering, Chongqing Medical University, Chongqing 400016 (China); Non-invasive and Minimally Invasive Therapeutic Research Center for Uterine Benign Diseases of Chongqing, Chongqing 401121 (China); He, Jia, E-mail: hejia0820@sina.com.cn [Department of Obstetrics and Gynecology, Suining Central Hospital, Sichuan 629000 (China); and others

    2012-12-15

    Purpose: To evaluate the clinical value of the contrast agent SonoVue in the treatment of uterine fibroids with ultrasound-guided high intensity focused ultrasound (HIFU) therapeutic ablation. Materials and Methods: A total of 291 patients with solitary uterine fibroid from three centers were treated with ultrasound-guided HIFU. Among them, 129 patients from Suining Central Hospital of Sichuan were treated without using SonoVue. 162 patients from the First Hospital of Chongqing Medical University and Chongqing Haifu Hospital were treated with using SonoVue before, during and after HIFU procedure to assess the extent of HIFU. Results: The non-perfused volume (indicative of successful ablation) was observed in all treated uterine fibroids immediately after HIFU ablation; median fractional ablation, defined as non-perfused volume divided by the fibroid volume immediately after HIFU treatment, was 86.0% (range, 28.8–100.0%) in the group with using SonoVue, and 83.0% (8.7–100.0%) without SonoVue. The rate of massive gray scale changes was higher with SonoVue than without the agent. The sonication time to achieve massive gray scale changes was shorter with SonoVue than without. The sonication time for ablating 1 cm{sup 3} of fibroid volume was significantly shorter with using SonoVue than without. No major complications were observed in any patients. Conclusions: Based on our results, SonoVue may enhance the outcome of HIFU ablation and can be used to assess the extent of treatment.

  8. Clinical utility of a microbubble-enhancing contrast ("SonoVue") in treatment of uterine fibroids with high intensity focused ultrasound: a retrospective study.

    Science.gov (United States)

    Peng, Song; Xiong, Yu; Li, Kequan; He, Min; Deng, Yongbin; Chen, Li; Zou, Min; Chen, Wenzhi; Wang, Zhibiao; He, Jia; Zhang, Lian

    2012-12-01

    To evaluate the clinical value of the contrast agent SonoVue in the treatment of uterine fibroids with ultrasound-guided high intensity focused ultrasound (HIFU) therapeutic ablation. A total of 291 patients with solitary uterine fibroid from three centers were treated with ultrasound-guided HIFU. Among them, 129 patients from Suining Central Hospital of Sichuan were treated without using SonoVue. 162 patients from the First Hospital of Chongqing Medical University and Chongqing Haifu Hospital were treated with using SonoVue before, during and after HIFU procedure to assess the extent of HIFU. The non-perfused volume (indicative of successful ablation) was observed in all treated uterine fibroids immediately after HIFU ablation; median fractional ablation, defined as non-perfused volume divided by the fibroid volume immediately after HIFU treatment, was 86.0% (range, 28.8-100.0%) in the group with using SonoVue, and 83.0% (8.7-100.0%) without SonoVue. The rate of massive gray scale changes was higher with SonoVue than without the agent. The sonication time to achieve massive gray scale changes was shorter with SonoVue than without. The sonication time for ablating 1cm(3) of fibroid volume was significantly shorter with using SonoVue than without. No major complications were observed in any patients. Based on our results, SonoVue may enhance the outcome of HIFU ablation and can be used to assess the extent of treatment. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. Clinical utility of a microbubble-enhancing contrast (“SonoVue”) in treatment of uterine fibroids with high intensity focused ultrasound: A retrospective study

    International Nuclear Information System (INIS)

    Peng, Song; Xiong, Yu; Li, Kequan; He, Min; Deng, Yongbin; Chen, Li; Zou, Min; Chen, Wenzhi; Wang, Zhibiao; He, Jia

    2012-01-01

    Purpose: To evaluate the clinical value of the contrast agent SonoVue in the treatment of uterine fibroids with ultrasound-guided high intensity focused ultrasound (HIFU) therapeutic ablation. Materials and Methods: A total of 291 patients with solitary uterine fibroid from three centers were treated with ultrasound-guided HIFU. Among them, 129 patients from Suining Central Hospital of Sichuan were treated without using SonoVue. 162 patients from the First Hospital of Chongqing Medical University and Chongqing Haifu Hospital were treated with using SonoVue before, during and after HIFU procedure to assess the extent of HIFU. Results: The non-perfused volume (indicative of successful ablation) was observed in all treated uterine fibroids immediately after HIFU ablation; median fractional ablation, defined as non-perfused volume divided by the fibroid volume immediately after HIFU treatment, was 86.0% (range, 28.8–100.0%) in the group with using SonoVue, and 83.0% (8.7–100.0%) without SonoVue. The rate of massive gray scale changes was higher with SonoVue than without the agent. The sonication time to achieve massive gray scale changes was shorter with SonoVue than without. The sonication time for ablating 1 cm 3 of fibroid volume was significantly shorter with using SonoVue than without. No major complications were observed in any patients. Conclusions: Based on our results, SonoVue may enhance the outcome of HIFU ablation and can be used to assess the extent of treatment.

  10. Uterine Fibroid Torsion during Pregnancy: A Case of Laparotomic Myomectomy at 18 Weeks’ Gestation with Systematic Review of the Literature

    Directory of Open Access Journals (Sweden)

    Annachiara Basso

    2017-01-01

    Full Text Available Uterine myomas are the most common benign growths affecting female reproductive system, occurring in 20–40% of women, whereas the incidence rate in pregnancy is estimated from 0.1 to 3.9%. The lower incidence in pregnancy is due to the association with infertility and low pregnancy rates and implantation rates after in vitro fertilization treatment. Uterine myomas, usually, are asymptomatic during pregnancy. However, occasionally, pedunculated fibroids torsion or other superimposed complications may cause acute abdominal pain. There are many controversies in performing myomectomy during cesarean section because of the risk of hemorrhage. Nevertheless, the majority of indication arises before labor and delivery due to acute symptoms leading to a discussion regarding the need for intervention during pregnancy. Therefore, we present a case of successful multiple laparotomic myomectomy at 17 + 2 weeks of gestational age and a systematic review of the literature in order to clarify the approach to this pathologic condition and its effect on pregnancy outcome.

  11. 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.)

  12. Contemporary Management of Fibroids in Pregnancy

    Science.gov (United States)

    Lee, Hee Joong; Norwitz, Errol R; Shaw, Julia

    2010-01-01

    Uterine fibroids are a very common finding in women of reproductive age. The majority of fibroids do not change their size during pregnancy, but one-third may grow in the first trimester. Although the data are conflicting and most women with fibroids have uneventful pregnancies, the weight of evidence in the literature suggests that uterine fibroids are associated with an increased rate of spontaneous miscarriage, preterm labor, placenta abruption, malpresentation, labor dystocia, cesarean delivery, and postpartum hemorrhage. PMID:20508779

  13. Preservation of the endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound ablation of submucosal uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young-sun [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Seoul (Korea, Republic of); Uterine Fibroid Integrated Management Center, MINT Intervention Hospital, Department of Radiology, Seoul (Korea, Republic of); Kim, Tae-Joong; Lee, Jeong-Won; Kim, Byoung-Gie [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of); Lim, Hyo Keun [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Seoul (Korea, Republic of); SAIHST, Sungkyunkwan University, Department of Health Sciences and Technology, Seoul (Korea, Republic of); Rhim, Hyunchul [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Seoul (Korea, Republic of); Jung, Sin-Ho [SAIHST, Sungkyunkwan University, Department of Health Sciences and Technology, Seoul (Korea, Republic of); Samsung Medical Center, Department of Biostatistics and Clinical Epidemiology, Seoul (Korea, Republic of); Ahn, Joong Hyun [Samsung Biomedical Research Institute, Samsung Medical Center, Biostatistics Team, Seoul (Korea, Republic of)

    2017-09-15

    To evaluate the integrity of endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation of submucosal uterine fibroids based on contrast-enhanced MRI findings, and to identify the risk factors for endometrial impairment. In total, 117 submucosal fibroids (diameter: 5.9 ± 3.0 cm) in 101 women (age: 43.6 ± 4.4 years) treated with MR-HIFU ablation were retrospectively analysed. Endometrial integrity was assessed with contrast-enhanced T1-weighted images at immediate (n = 101), 3-month (n = 62) and 12-month (n = 15) follow-ups. Endometrial impairment was classified into grades 0 (continuous endometrium), 1 (pin-point, full-thickness discontinuity), 2 (between grade 1 and 3), or 3 (full-thickness discontinuity >1 cm). Risk factors were assessed with generalized estimating equation (GEE) analysis. Among 117 fibroids, grades 0, 1, 2 and 3 endometrial impairments were observed at initial examination in 56.4%, 24.8%, 13.7% and 4.3%, respectively. Among 37 fibroid cases of endometrial impairment for which follow-ups were conducted, 30 showed improvements at 3- and/or 12-month follow-up. GEE analysis revealed the degree of endometrial protrusion was significantly associated with severity of endometrial injury (P < 0.0001). After MR-HIFU ablation of submucosal fibroids, endometrial enhancement was preserved intact or minimally impaired in most cases. Impaired endometrium, which is more common after treating endometrially-protruded fibroids, may recover spontaneously. (orig.)

  14. Preservation of the endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound ablation of submucosal uterine fibroids

    International Nuclear Information System (INIS)

    Kim, Young-sun; Kim, Tae-Joong; Lee, Jeong-Won; Kim, Byoung-Gie; Lim, Hyo Keun; Rhim, Hyunchul; Jung, Sin-Ho; Ahn, Joong Hyun

    2017-01-01

    To evaluate the integrity of endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation of submucosal uterine fibroids based on contrast-enhanced MRI findings, and to identify the risk factors for endometrial impairment. In total, 117 submucosal fibroids (diameter: 5.9 ± 3.0 cm) in 101 women (age: 43.6 ± 4.4 years) treated with MR-HIFU ablation were retrospectively analysed. Endometrial integrity was assessed with contrast-enhanced T1-weighted images at immediate (n = 101), 3-month (n = 62) and 12-month (n = 15) follow-ups. Endometrial impairment was classified into grades 0 (continuous endometrium), 1 (pin-point, full-thickness discontinuity), 2 (between grade 1 and 3), or 3 (full-thickness discontinuity >1 cm). Risk factors were assessed with generalized estimating equation (GEE) analysis. Among 117 fibroids, grades 0, 1, 2 and 3 endometrial impairments were observed at initial examination in 56.4%, 24.8%, 13.7% and 4.3%, respectively. Among 37 fibroid cases of endometrial impairment for which follow-ups were conducted, 30 showed improvements at 3- and/or 12-month follow-up. GEE analysis revealed the degree of endometrial protrusion was significantly associated with severity of endometrial injury (P < 0.0001). After MR-HIFU ablation of submucosal fibroids, endometrial enhancement was preserved intact or minimally impaired in most cases. Impaired endometrium, which is more common after treating endometrially-protruded fibroids, may recover spontaneously. (orig.)

  15. [The percutaneous treatment of uterine fibromas by means of transcatheter arterial embolization].

    Science.gov (United States)

    Golfieri, R; Muzzi, C; De Iaco, P; Maffei, M; Giampalma, E; Amore, B; Muzzupapa, G; Baroncini, S; Bovicelli, L

    2000-01-01

    We report our preliminary experience with arterial embolization of uterine fibroids in seven women, focusing on the technical aspects of the procedure and the clinical and morphological results during the follow-up. February to December 1999 seven women (mean age 47) underwent transcatheter arterial embolization of both uterine arteries as a permanent treatment for fibroids. We included in this study single or multiple, bleeding and/or large fibroids, symptomatic on compression, contraindicated for myomectomy because of high surgical or anesthesiologic risks or myomata in which myomectomy could probably be converted into hysterectomy. Fibroids enlarging the uterus to the size of 25 weeks' pregnancy or more, pedunculated myomata or small submucous fibroids--smaller than 5 cm--were excluded. Uterine arterial embolization was performed bilaterally, till a total blockage of flow, by injecting permanent embolization material: polyvinyl-alcohol (PVA) particles of increasing size from 150 to 500 mu and in varying amounts from 10 to 24 mL, depending on fibroid size and degree of vascularization. A technical success was achieved in all cases and no late complications were seen. At 6-month clinical follow-up all compressive symptoms had disappeared; regular menses had returned in 57% of patients, milder hyper-dysmenorrhea was present in 28% compared to pretreatment symptoms; only in one case (14%) was permanent amenorrhea observed. The 3-month and 6-month US follow-up studies showed an average 40.7% (range 10-50%) and 51% (range 25-83%) reduction in the fibroid size, respectively. All the small myomata (about 2 cm in size) were unidentifiable at 6-month US follow-up. In no cases did new fibroids appear. Surgery is the traditional treatment for symptomatic uterine fibroids (hysterectomy, myomectomy). More recently, hormone therapy and operative endoscopy (laparoscopy and hysteroscopy) have been introduced as alternatives, together with uterine embolization previously applied

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

    International Nuclear Information System (INIS)

    Zhang Lian; Chen Wenzhi; Liu Yinjiang; Hu Xiao; Zhou Kun; Chen Li; Peng Song; Zhu Hui; Zou Huiling; Bai Jin; Wang Zhibiao

    2010-01-01

    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 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 3 , slightly enlarged because of edema. The average non-perfused volume was 83.3 ± 71.7 (range, 7.7-282.9) cm 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 60.0%) in average, with paired t

  17. 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

  18. Serum vitamin D3 level inversely correlates with uterine fibroid volume in different ethnic groups: a cross-sectional observational study

    Science.gov (United States)

    Sabry, Mohamed; Halder, Sunil K; Allah, Abdou S Ait; Roshdy, Eman; Rajaratnam, Veera; Al-Hendy, Ayman

    2013-01-01

    Purpose Currently there is no effective medicinal treatment for uterine fibroids (UFs), a common health disorder that affects women of reproductive age. Identification of modifiable risk factors such as vitamin D (Vit D) deficiency could help develop novel strategies for the prevention and/or treatment of UFs. The purpose of this study was to identify whether low serum Vit D3 levels correlate with increased risk of UFs. Methods A total of 154 premenopausal women were recruited for this cross-sectional study. The control group comprised 50 subjects with a normal, fibroid-free uterine structure, confirmed by transvaginal ultrasonography. The 104 case subjects had at least one fibroid lesion that was 2 cm3 in volume or larger, confirmed by transvaginal ultrasonography. For each case subject, total uterine volume and total volume of all existing fibroids were measured in three perpendicular planes, with volume determined according to the prolate ellipse formula (a × b × c × 0.523), where a is height, b is width, and c is depth. Serum Vit D [25(OH) D3] levels were measured by radioimmunoassay. The independent t-test was used to compare serum Vit D levels across groups. Correlations were assessed by Spearman’s rank correlation test. Results Lower serum 25-(OH) Vit D levels were significantly associated with the occurrence of UFs (P = 0.01). A statistically significant inverse correlation was also observed between serum 25-(OH) Vit D levels and total UF volume (r = −0.31; P = 0.002) within the case cohort. Subjects with larger fibroid volumes had lower serum Vit D levels and vice versa. Data stratified for ethnicity showed a statistically significant inverse correlation between serum 25-(OH) Vit D levels and total fibroid volume in black subjects (r = −0.42; P = 0.001). An inverse correlation was also evident in white subjects (r = −0.86; P = 0.58) but this did not reach statistical significance. Conclusion Lower serum Vit D levels are inversely correlated with

  19. [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.

  20. Laparoscopic subtotal hysterectomy using the plasma kinetic and lap loop systems: an alternative approach in the surgical management of women with uterine fibroids.

    Science.gov (United States)

    Erian, John; El-Shawarby, Salem A; Hassan, Mohsen; Wissa, Ihab; Chandakas, Stefanos; Hill, Nicholas

    2008-03-01

    To evaluate the safety and applicability of laparoscopic subtotal hysterectomy (LSH) using the plasma kinetic (PK) and lap loop systems as an alternative surgical approach in the management of uterine fibroids in women who have completed their families. Sixty-two consecutive LSH were performed during this prospective study from March 2003 to March 2005 at Princess Royal University Hospital, Kent, UK. All study patients had menorrhagia resistant to at least one form of therapy, with a mean duration of symptoms of 3.5 years. In addition, four patients had previous myomectomy. The mean number of fibroids removed was 2.7. The mean weight of the uterus was 141.9 g. The mean operative time was 46.8 min, and the mean blood loss was 126.6 mL. The overall perioperative complication rate was 4.8% with no visceral injury, or return to theatre. At follow-up, all patients were satisfied with surgery. The study describes the first application of the PK and Lap Loop systems in LSH for the surgical management of uterine fibroids in women in whom fertility is not an issue, and its findings suggest that this minimally invasive technique is a safe, and valid alternative. Larger adequately-powered studies are however still required.

  1. 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.

  2. Overhydroxylation of Lysine of Collagen Increases Uterine Fibroids Proliferation: Roles of Lysyl Hydroxylases, Lysyl Oxidases, and Matrix Metalloproteinases

    Directory of Open Access Journals (Sweden)

    Marwa Kamel

    2017-01-01

    Full Text Available The role of the extracellular matrix (ECM in uterine fibroids (UF has recently been appreciated. Overhydroxylation of lysine residues and the subsequent formation of hydroxylysylpyridinoline (HP and lysylpyridinoline (LP cross-links underlie the ECM stiffness and profoundly affect tumor progression. The aim of the current study was to investigate the relationship between ECM of UF, collagen and collagen cross-linking enzymes [lysyl hydroxylases (LH and lysyl oxidases (LOX], and the development and progression of UF. Our results indicated that hydroxyl lysine (Hyl and HP cross-links are significantly higher in UF compared to the normal myometrial tissues accompanied by increased expression of LH (LH2b and LOX. Also, increased resistance to matrix metalloproteinases (MMP proteolytic degradation activity was observed. Furthermore, the extent of collagen cross-links was positively correlated with the expression of myofibroblast marker (α-SMA, growth-promoting markers (PCNA; pERK1/2; FAKpY397; Ki-67; and Cyclin D1, and the size of UF. In conclusion, our study defines the role of overhydroxylation of collagen and collagen cross-linking enzymes in modulating UF cell proliferation, differentiation, and resistance to MMP. These effects can establish microenvironment conducive for UF progression and thus represent potential target treatment options of UF.

  3. Imaging before and after uterine artery embolization

    International Nuclear Information System (INIS)

    Kroencke, T.J.

    2008-01-01

    Percutaneous catheter-based embolization treatment of symptomatic uterine fibroids has evolved into the most widely used alternative therapeutic approach to surgical treatment worldwide. Uterine artery embolization (UAE) induces infarction of leiomyomas, resulting in ischemic necrosis, hyaline degeneration, and size reduction with resolution of associated symptoms. Published experience suggests that UAE is an effective and reliable option for treating uterine fibroids with high patient satisfaction. Magnetic resonance imaging (MRI) is superior to ultrasonography for determining the site, size and number of fibroids, which is important for establishing the indication for UAE. Other potential advantages of MRI include the option of performing MR angiography (MRA) and obtaining contrast-enhanced images for monitoring the outcome of UAE and assessing possible complications after UAE. (orig.) [de

  4. The management of uterine leiomyomas.

    Science.gov (United States)

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

    2015-02-01

    investigations. For symptomatic fibroids such as those causing menstrual abnormalities (e.g. heavy, irregular, and prolonged uterine bleeding), iron defficiency anemia, or bulk symptoms (e.g., pelvic pressure/pain, obstructive symptoms), hysterectomy is a definitive solution. However, it is not the preferred solution for women who wish to preserve fertility and/or their uterus. The selected treatment should be directed towards an improvement in symptomatology and quality of life. The cost of the therapy to the health care system and to women with fibroids must be interpreted in the context of the cost of untreated disease conditions and the cost of ongoing or repeat investigative or treatment modalities. The quality of evidence in this document was rated using the criteria described in the Report of the Caadian Task Force on Preventive Health Care (Table 1). Summary Statements 1. Uterine fibroids are common, appearing in 70% of women by age 50; the 20% to 50% that are symptomatic have considerable social and economic impact in Canada. (II-3) 2. The presence of uterine fibroids can lead to a variety of clinical challenges. (III) 3. Concern about possible complications related to fibroids in pregnancy is not an indication for myomectomy except in women who have had a previous pregnancy with complications related to these fibroids. (III) 4. Women who have fibroids detected in pregnancy may require additional maternal and fetal surveillance. (II-2) 5. Effective medical treatments for women with abnormal uterine bleeding associated with uterine fibroids include the levonorgestrel intrauterine system, (I) gonadotropin-releasing hormone analogues, (I) selective progesterone receptor modulators, (I) oral contraceptives, (II-2) progestins, (II-2) and danazol. (II-2) 6. Effective medical treatments for women with bulk symptoms associated with fibroids include selective progesterone receptor modulators and gonadotropin-releasing hormone analogues. (I) 7. Hysterectomy is the most effective

  5. Multi-scale and shape constrained localized region-based active contour segmentation of uterine fibroid ultrasound images in HIFU therapy.

    Directory of Open Access Journals (Sweden)

    Xiangyun Liao

    Full Text Available To overcome the severe intensity inhomogeneity and blurry boundaries in HIFU (High Intensity Focused Ultrasound ultrasound images, an accurate and efficient multi-scale and shape constrained localized region-based active contour model (MSLCV, was developed to accurately and efficiently segment the target region in HIFU ultrasound images of uterine fibroids.We incorporated a new shape constraint into the localized region-based active contour, which constrained the active contour to obtain the desired, accurate segmentation, avoiding boundary leakage and excessive contraction. Localized region-based active contour modeling is suitable for ultrasound images, but it still cannot acquire satisfactory segmentation for HIFU ultrasound images of uterine fibroids. We improved the localized region-based active contour model by incorporating a shape constraint into region-based level set framework to increase segmentation accuracy. Some improvement measures were proposed to overcome the sensitivity of initialization, and a multi-scale segmentation method was proposed to improve segmentation efficiency. We also designed an adaptive localizing radius size selection function to acquire better segmentation results.Experimental results demonstrated that the MSLCV model was significantly more accurate and efficient than conventional methods. The MSLCV model has been quantitatively validated via experiments, obtaining an average of 0.94 for the DSC (Dice similarity coefficient and 25.16 for the MSSD (mean sum of square distance. Moreover, by using the multi-scale segmentation method, the MSLCV model's average segmentation time was decreased to approximately 1/8 that of the localized region-based active contour model (the LCV model.An accurate and efficient multi-scale and shape constrained localized region-based active contour model was designed for the semi-automatic segmentation of uterine fibroid ultrasound (UFUS images in HIFU therapy. Compared with other

  6. 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

  7. A single baseline ultrasound assessment of fibroid presence and size is strongly predictive of future uterine procedure: 8-year follow-up of randomly sampled premenopausal women aged 35-49 years.

    Science.gov (United States)

    Baird, D D; Saldana, T M; Shore, D L; Hill, M C; Schectman, J M

    2015-12-01

    How well can a single baseline ultrasound assessment of fibroid burden (presence or absence of fibroids and size of largest, if present) predict future probability of having a major uterine procedure? During an 8-year follow-up period, the risk of having a major uterine procedure was 2% for those without fibroids and increased with fibroid size for those with fibroids, reaching 47% for those with fibroids ≥ 4 cm in diameter at baseline. Uterine fibroids are a leading indication for hysterectomy. However, when fibroids are found, there are few available data to help clinicians advise patients about disease progression. Women who were 35-49 years old were randomly selected from the membership of a large urban health plan; 80% of those determined to be eligible were enrolled and screened with ultrasound for fibroids ≥ 0.5 cm in diameter. African-American and white premenopausal participants who responded to at least one follow-up interview (N = 964, 85% of those eligible) constituted the study cohort. During follow-up (5822 person-years), participants self-reported any major uterine procedure (67% hysterectomies). Life-table analyses and Cox regression (with censoring for menopause) were used to estimate the risk of having a uterine procedure for women with no fibroids, small (value for interaction = 0.88). Once fibroid size at enrollment was accounted for, having a prior diagnosis at the time of ultrasound screening was not predictive of having a procedure. Exclusion of women with a submucosal fibroid had little influence on the results. The 8-year risk of a procedure based on lifetable analyses was 2% for women with no fibroids, 8, 23, and 47%, respectively, for women who had small, medium or large fibroids at enrollment. Given the strong association of fibroid size with subsequent risk of a procedure, these findings are unlikely to be due to chance. Despite a large sample size, the number of women having procedures during follow-up was relatively small. Thus

  8. Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids : a pilot study

    NARCIS (Netherlands)

    Vaessen, Hermanus H B; Knuttel, F M; van Breugel, J M M; Ikink, M E; Dieleman, J M; van den Bosch, Maurice; Knape, J T A

    2017-01-01

    BACKGROUND: Magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids is rapidly gaining popularity as a treatment modality. This procedure is generally uncomfortable, painful, and requires minimal or absence of movement and an MR-HIFU synchronised breathing

  9. Enhancing ablation effects of a microbubble-enhancing contrast agent ("SonoVue") in the treatment of uterine fibroids with high-intensity focused ultrasound: a randomized controlled trial.

    Science.gov (United States)

    Jiang, Nan; Xie, Bin; Zhang, Xin; He, Min; Li, Kequan; Bai, Jin; Wang, Zhibiao; He, Jia; Zhang, Lian

    2014-10-01

    To evaluate the role of the ultrasound contrast agent SonoVue in enhancing the ablation effects of ultrasound-guided high-intensity focused ultrasound (HIFU) on uterine fibroids. Eighty patients with solitary uterine fibroids at a single center were randomly assigned to a control or SonoVue group. Of these, 40 were treated using HIFU alone; 40 who were pretreated with SonoVue received a bolus before the HIFU procedure. All patients underwent magnetic resonance imaging (MRI) scan before and after HIFU treatment. The post-HIFU MRI showed the nonperfused volume (NPV) in all of the treated uterine fibroids; the mean fractional ablation (NPV ratio) was 90.4 ± 8.3 % (range 66.4-100 %) in the SonoVue group and 82.8 ± 13.3 % (range 53.4-100 %) in the control group. The frequency of massive gray-scale changes that occurred during HIFU was greater in the group that received SonoVue than the group that did not. The average sonication time to reach massive gray-scale changes was significantly shorter in the group receiving SonoVue than the group without SonoVue. The acoustic energy for treating 1 mm(3) of uterine fibroid was less in the SonoVue group than the control group. No any major complication occurred in this study. Based on the results of this randomized controlled trial, SonoVue could be safely used to enhance the effects of HIFU treatment for uterine fibroids.

  10. Uterine myomas in pregnancy, childbirth and puerperium

    Directory of Open Access Journals (Sweden)

    Sparić Radmila

    2014-01-01

    Full Text Available Fibroids are the most common benign tumors of the genital organs of women in reproductive age. Achieving reproductive function later in life, with more frequent use of assisted reproductive technologies, leads to an increased number of pregnancies complicated with fibroids. Their size may change during pregnancy, but the changes are mostly individual. Most fibroids stop growing or decline during the puerperium. The effect of fibroids on pregnancy depends on their number, size and location. The mechanisms bringing about perinatal complications are not fully understood. Fibroids during pregnancy can cause many perinatal complications, such as bleeding in pregnancy, miscarriage, pain due to red degeneration, malpresentation, preterm labor, premature rupture of membranes, placental abruption and obstruction of delivery and are associated with higher incidence of cesarean section, operative vaginal delivery, uterine atony and postpartum hemorrhage. Postpartum hysterectomy in these women is also more likely than in general population. Postpartum infections are more common in patients with fibroids, and myomas may also cause retained placenta. The most common cause of neonatal morbidity is prematurity, due to pregnancy ending in an earlier gestational age. Monitoring of pregnancies complicated with fibroids is essentially indistinguishable from monitoring normal pregnancies. Therapy includes only bed rest and observation, symptomatic therapy in case of pain and intensive fetal surveillance, and surgery in the acute situations.

  11. Uterine Fibroid Embolization (UFE)

    Science.gov (United States)

    ... consists of a radiographic table, one or two x-ray tubes and a television-like monitor that is located ... the procedure. The video is produced by the x-ray machine and a detector ... a long, thin plastic tube that is considerably smaller than a "pencil lead", ...

  12. Rhabdomyoma Mimicking Uterine Fibroid:

    African Journals Online (AJOL)

    O&G Dept

    the pubic symphysis(16 weeks gestation). It was fixed, firm to hard in consistency and non tender. A working diagnosis ... Histological report showed soft tissue tumor, composed of stratified cells having moderate to abundant ... represents a genetic variant of striated muscle development. Drugs or environmental factors have.

  13. Effect of Isopropanolic Cimicifuga racemosa Extract on Uterine Fibroids in Comparison with Tibolone among Patients of a Recent Randomized, Double Blind, Parallel-Controlled Study in Chinese Women with Menopausal Symptoms

    Directory of Open Access Journals (Sweden)

    Sisi Xi

    2014-01-01

    Full Text Available Objective. Effect of isopropanolic Cimicifuga racemosa extract (iCR on uterine fibroid size compared with tibolone. Method. The randomized, double-blind, controlled study in China enrolled 244 patients aged 40–60 years with menopausal symptoms (Kupperman Menopause Index ≥ 15. The participants were treated with either iCR of 40 mg crude drug/day (N=122 or tibolone 2.5 mg/day (N=122 orally for 3 months in 2004. Now, we investigated the subset of all women (N=62 with at least one uterine fibroid at onset of treatment for the effect of iCR (N = 34 on fibroid size compared with tibolone (N=28 by transvaginal ultrasonography. Results. The median myoma volume decreased upon iCR by as much as −30% (P=0.016 but increased upon tibolone by +4.7%. The percentage of volume change, mean diameter change and geometric mean diameter change of the iCR group compared to tibolone were statistically significant (P=0.016, 0.021, 0.016 respectively. Conclusion. Our results suggest that iCR (Remifemin is a valid herbal medicinal product in patients with uterine myomas as it provides adequate relief from menopausal symptoms and inhibits growth of the myomas in contrast to tibolone.

  14. Effect of Isopropanolic Cimicifuga racemosa Extract on Uterine Fibroids in Comparison with Tibolone among Patients of a Recent Randomized, Double Blind, Parallel-Controlled Study in Chinese Women with Menopausal Symptoms

    Science.gov (United States)

    Liske, Eckehard; Wang, Shuyu; Liu, Jianli; Zhang, Zhonglan; Geng, Li; Hu, Lina; Zheng, Shurong; Zepelin, Hans-Heinrich Henneicke-von; Bai, Wenpei

    2014-01-01

    Objective. Effect of isopropanolic Cimicifuga racemosa extract (iCR) on uterine fibroid size compared with tibolone. Method. The randomized, double-blind, controlled study in China enrolled 244 patients aged 40–60 years with menopausal symptoms (Kupperman Menopause Index ≥ 15). The participants were treated with either iCR of 40 mg crude drug/day (N = 122) or tibolone 2.5 mg/day (N = 122) orally for 3 months in 2004. Now, we investigated the subset of all women (N = 62) with at least one uterine fibroid at onset of treatment for the effect of iCR (N = 34) on fibroid size compared with tibolone (N = 28) by transvaginal ultrasonography. Results. The median myoma volume decreased upon iCR by as much as −30% (P = 0.016) but increased upon tibolone by +4.7%. The percentage of volume change, mean diameter change and geometric mean diameter change of the iCR group compared to tibolone were statistically significant (P = 0.016, 0.021, 0.016 respectively). Conclusion. Our results suggest that iCR (Remifemin) is a valid herbal medicinal product in patients with uterine myomas as it provides adequate relief from menopausal symptoms and inhibits growth of the myomas in contrast to tibolone. PMID:24719645

  15. Evaluation of life quality after arterial uterine embolization for leiomyoma

    International Nuclear Information System (INIS)

    Liu Zhaoyu; Shan Ming; Lu Zaiming; Zheng Jiahe; Zhang Jun; Sun Wei

    2007-01-01

    Objective: To evaluate the quality of life in women with uterine leiomyoma after treatment by uterine arterial embolization. Methodes: 118 patients of uterine leiomyoma were treated by uterine arterial embolization (UAE) from January 2003 to March 2005. The quality of life was measured by a fibroid specific symptom and HRQOL questionnaire pre-and post-embolization. Patients satisfaction was surveyed together with decrease of fibroids' mass measurement. Results: The decrease of fibroid size and uterine volume were 49.6% and 45.2% at 6 months after embolization with simultaneously obvious improvement of clinical symptoms. The scores of quality of life obviously improved in all follow-up subscales (P<0.001). No amenorrhea occurred during the period of observation with more than 60% of respondents acknowledging the positive improvement in fibroid-related symptoms though UAE; and 80% would probably or definitely take UAE as the first choice of treatment again. Conclusion: The treatment of symptomatic leiomyomas by UAE can improve the quality of life dramatically with a promising satisfaction. (authors)

  16. 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.

  17. Laparoscopic resection versus myolysis in the management of symptomatic uterine adenomyosis: alternatives to conventional treatment

    Directory of Open Access Journals (Sweden)

    Wachyu Hadisaputra

    2006-03-01

    Full Text Available Effective therapy preserving reproductive function in adenomyosis is warranted. From June 2003 to June 2004, patients diagnosed as having adenomyosis by transvaginal ultrasound and had symptoms of menorrhagia, dysmenorrhea, and pelvic pain were randomly allocated to either receive laparoscopic resection or myolysis. GnRH analog was given for 3 cycles after surgery. Within 6 months, symptoms were evaluated using questionnaires and at the end of follow up, adenomyosis volume was assessed by transvaginal ultra-sound. There were 20 patients included, 10 patients had resection and the rest underwent myolysis. Both procedures did not yield sig-nificant complications. Subjective evaluation by questionnaires was done in all patients. Three patients could not be evaluated objec-tively by transvaginal ultrasound, 2 patients resigned and 1 was pregnant. There was no significant difference in menorrhagia and dysmenorrhea reduction score between the 2 groups (p=0.399 and 0.213, respectively. In both groups, dysmenorrhea was reduced significantly after treatment. No significant statistical difference was found in median adenomyosis volume increment (p=0.630 be-tween the resection (median=+15.35% (-100-159} and myolysis groups (median=+48.43% (-100-553. Five patients were pregnant, 3 from the resection group and 2 from the myolysis group. Uterine rupture was found in 1 patient (from the myolysis group at the age of 8 months of pregnancy. The effectiveness of laparoscopic adenomyosis resection was not significantly different compared with lapa-rascopic myolysis as an alternative conservative surgery in treating symptomatic adenomyosis. Myolysis was not recommended for women who wish to be pregnant. (Med J Indones 2006; 15:9-17Keywords: laparascopy, resection, myolysis, conservative surgery, symptomatic adenomyosis

  18. Fibroids and menorrhagia.

    Science.gov (United States)

    West, C P; Lumsden, M A

    1989-06-01

    Fibroids are an important cause of menorrhagia, resistant to conventional methods of medical treatment. The mechanism of their effect on menstrual blood loss is poorly understood but may involve abnormalities of local venous drainage, enlargement of the uterine cavity and abnormalities in prostaglandin production. Their cause remains unknown although it has long been assumed that they are oestrogen-dependent. In the past, study of their aetiology, prevention and treatment has received scant attention. Recent developments including measurement of tissue receptors for steroids and growth factors, non-invasive methods of monitoring fibroid growth and the use of LHRH agonists have enabled further study of their nature and of their response to therapy although much work remains to be done. The majority of women with uterine fibroids associated with menorrhagia are treated by hysterectomy although developments in endoscopic surgery have enabled a more conservative approach in some circumstances. LHRH agonists are the only medical agents which cause substantial shrinkage of fibroids although regression is not permanent. These agents are of value in short-term relief of symptoms and are likely to be a useful adjunct to surgery by reducing both uterine volume and bloodflow. However, because of the consequences of prolonged ovarian suppression, they are not suitable for long-term use unless there are medical contraindications to surgery. It remains to be seen whether their use in low-dose regimens or in combination with other agents will provide a successful, safe and cost-effective alternative to hysterectomy in women whose primary problem is heavy menstrual loss. They do however offer a means of conserving reproductive function in women wishing to retain this option.

  19. 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.)

  20. Long-term MR Imaging after Uterine Artery Embolization for Symptomatic Adenomyosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Shin Jae; Kim, Man Deuk; Lee, Hyun Seok; Lee, Mee Hwa; Kim, Hee Jin; Cho, Jin Ho; Cha, Sun Hee [Bundang CHA General Hospital, Seongnam (Korea, Republic of)

    2009-05-15

    We wanted to assess the long-term follow-up MR (LTFU-MR) imaging of adenomyosis that was treated with uterine artery embolization (UAE). From 1998 to 2000, 22 patients who underwent UAE for symptomatic adenomyosis were enrolled. The pattern of adenomyosis was divided into two categories: focal (n=14) and diffuse type (n=8). All the patients underwent contrast-enhanced MR imaging 3 months before embolization and over 3 years after embolization. The MR findings for the volume change and the existence and alteration of necrosis were analyzed. In the focal adenomyosis, LTFU-MR revealed contrast enhancement in the completely necrotized area before in five out of seven patients and persistent necrosis with atrophy in the remaining two cases. In the six cases without necrosis, four showed global enlargement of the uterus. In the eight patients with diffuse adenomyosis, LTFU-MR revealed contrast enhancement in the necrotized area in four of the patients. Of the remaining four patients who had no necrosis, two showed global enlargement of the uterus. LTFU-MR revealed three common patterns: persistent necrosis or atrophy, viable tissue replacement in the previously necrotized area and global enlargements of the uterus.

  1. [Malignant neoplasms of the uterus in women treated with uterine artery embolization for presumed leiomyoma--description of three cases].

    Science.gov (United States)

    Gajewska, Małgorzata; Panek, Grzegorz

    2013-03-01

    Leiomyomas are the most common tumors of the uterus. Uterine artery embolization has been accepted as an alternative method for myomectomy or hysterectomy However lack of histologic conformation carries the risk of misdiagnosis of cancer so a thorough diagnostic testing is needed. Leiomyosarcomas are rare but very aggressive tumors of the uterine tract. The risk of leiomyosarcoma in myomata is very low, but it is necessary to remember about it, especially when we have no tissue for histological examination. Our report presents three cases of women diagnosed with leiomyosarcomas or endometrial cancer after uterine artery embolization for suspected symptomatic uterine fibroids.

  2. 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

  3. Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

    International Nuclear Information System (INIS)

    Kwon, Joon Ho; Kim, Man Deuk; Lee, Kwang-hun; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Park, Sung Il; Lee, Do Yun

    2013-01-01

    We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.

  4. Fertility and pregnancy outcomes after uterine artery occlusion with or without myomectomy

    Directory of Open Access Journals (Sweden)

    Kun-Min Chang

    2012-09-01

    Full Text Available Uterine artery occlusion (UAO is one of the minimally invasive procedures used to treat uterine fibroids. It has demonstrated the potential to reduce fibroid growth and related symptoms with few complications and adverse effects. Meanwhile, it may preserve the uterus and ovarian blood supply to allow pregnancy in women with symptomatic fibroids. Similarly, myomectomy is an alternative to hysterectomy in the treatment of symptomatic fibroids, especially for patients who want to maintain fertility. However, only few articles have focused on fertility and pregnancy outcomes after the combined procedures of UAO and myomectomy. We reviewed the effects of UAO with or without myomectomy on fertility and pregnancy outcomes by searching the MEDLINE biomedicine database, using uterine artery occlusion, myomectomy and pregnancy as key words. In conclusion, conception and term pregnancy were possible after these procedures, but evidence on whether risks of abortion and preterm birth have been increasing simultaneously remains inconclusive. Therefore, good counseling on benefits and risks of pregnancy outcomes before performing these procedures is mandatory.

  5. Long-term results after fibroid embolization; Langzeitergebnisse nach Myomembolisation

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Huelsbeck, S. [Medizinischer Klinikverbund Flensburg, Akademisches Lehrkrankenhaus des Universitaetsklinikums Schleswig-Holstein, Abt. Diagnostische und interventionelle Radiologie/Neuroradiologie, Ev.-Luth. Diakonissenanstalt zu Flensburg, Flensburg (Germany)

    2008-07-15

    Fibroids (leiomyoma) are the most frequent benign tumors of the uterus during female reproductive age. In the case of clinical symptoms, uterine artery embolization (UAE) is a well established treatment option for symptomatic fibroids, resulting in promising long-term results. In order to estimate long-term success after UAE, reduction of fibroids and uterus volume is less important than complete improvement and disappearance of fibroid-related symptoms. In addition to a high technical success rate and a low perioperative complication rate, UAE results in high short-term and long-term patient satisfaction (>87%) and improvement of symptoms (>81%). Candidates for UAE should be informed about potential reinterventions in terms of repeated UAE (up to 18% of cases) or surgical treatment options. (orig.) [German] Myome sind die haeufigsten gutartigen soliden Tumoren des weiblichen Genitaltrakts im reproduktiven Alter. Bei klinischen Beschwerden stellt die Uterusarterienembolisation (UAE) zur Therapie des symptomatischen Uterus myomatosus einen fest etabliertes Verfahren dar, das mit viel versprechenden Langzeitergebnissen aufwarten kann. Im Vordergrund der Abschaetzung eines lang andauernden Therapieerfolgs nach UAE stehen weniger die Volumenreduktion eines dominanten Myoms bzw. des gesamten Uterus nach der Behandlung, sondern vielmehr die Besserung oder das voellige Verschwinden der von der Patientin initial vor der UAE angegebenen (myombedingten) Beschwerden. Neben einer hohen technischen Erfolgsrate und geringen perioperativen Komplikationsrate fuehrt die fachkundig durchgefuehrte UAE sowohl im Kurz- als auch Langzeitverlauf zu einem hohen Mass an Patientenzufriedenheit (>87%), verbunden mit einer deutlichen Symptombesserung (>81%). Ueber eine Reintervention (in bis zu ca. 18% der Faelle) im Sinne einer erneuten UAE oder einer operativen Massnahme sollten die Patientinnen allerdings im Vorfeld aufgeklaert werden. (orig.)

  6. Advanced Cancer Of The Cervix Coexisting With Multiple Fibroids In ...

    African Journals Online (AJOL)

    A case of a 47 year old nulliparous woman with advanced cervical cancer coexisting with uterine fibroid is presented. The nulliparity and the presence of Fibroids presented diagnostic challenges especially because epidemiologically the factors present are not commonly associated. Diagnosis was assisted by a thorough ...

  7. Innovative Oral Treatments of Uterine Leiomyoma

    Directory of Open Access Journals (Sweden)

    Mohamed Sabry

    2012-01-01

    Full Text Available Uterine fibroids (leiomyoma, the benign tumors of the uterine wall, are very common cause of morbidity in reproductive age women usually in the form of excessive vaginal bleeding, chronic pelvic pain, miscarriage and infertility. These tumors are the leading indication for hysterectomy in the United States. Uterine fibroids are about 4 times higher in blacks compared to whites and constitute a major health disparity challenge. The estimated cost of uterine fibroids is up to $34.4 billion annually. Additionally, women who suffer from this disease and desire to maintain their future fertility have very limited treatment choices. Currently, there is no effective long-term medicinal treatment for uterine fibroids. While surgery has traditionally been the gold standard for the treatment of uterine fibroids, there is growing interest towards orally administered medications for the management of leiomyoma-related symptoms. In this paper, we will discuss these promising innovative oral medical treatments in detail.

  8. Pregnancy after uterine arterial embolization

    Directory of Open Access Journals (Sweden)

    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.

  9. How Are Uterine Fibroids Diagnosed?

    Science.gov (United States)

    ... YouTube follow us on Flickr follow us on Instagram Español NICHD Theme Browse AZTopics Browse A-Z ... Publications Sitemap Español facebook twitter pinterest youtube flickr Instagram NEWSROOM NICHD News Videos OUTREACH Safe to Sleep® ...

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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

    2018-03-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  13. Percutaneous microwave ablation with artificial ascites for symptomatic uterine adenomyosis: initial experience.

    Science.gov (United States)

    Hai, Ning; Zhang, Jing; Xu, Ruifang; Han, Zhi-Yu; Liu, Fang Yi

    2017-09-01

    To evaluate the feasibility, safety and technical efficacy of ultrasound-guided percutaneous microwave ablation with artificial ascites for adenomyosis. Between May 2015 and May 2016, a total of 25 patients with symptomatic adenomyosis who underwent ultrasound-guided percutaneous microwave ablation with artificial ascites were included in this retrospective study. A matching cohort of 50 patients underwent ultrasound-guided percutaneous microwave ablation without artificial ascites as controls. The technical efficacy, complications and short-term treatment effectiveness were assessed and compared with the controls. Artificial ascites was successfully achieved in all of the 25 patients with the administration of a median of 550 mL (range, 250-1200 mL) of solution. There was substantial improvement in achieving a better antenna path in 100% (20/20) of the cases with a poor antenna path. The complete separation was achieved in 23 of 25 patients. The mean ablation time was 26.5 ± 7.3 min and the median non-perfusion volume ratio was 76% which was similar to the control group (p > .05). No serious complications were observed. Patient pain scores for dysmenorrhoea showed a statistically significant decline from the baseline of 6.71 ± 0.96 to 2.92 ± 0.79 and the symptom severity score declined statistically significantly from 21.8 ± 5.5 to 16.4 ± 4.8 at 3 months follow-up. Percutaneous microwave ablation with artificial ascites is feasible, safe and can be effective in improving access for treatment of adenomyosis.

  14. Epidemiology of Uterine Leiomyomata at the Lagos University ...

    African Journals Online (AJOL)

    ... Diabetes mellitus, family history of fibroid and history of infertility. Future studies are recommended to expand the existing knowledge base of uterine fibroid as well as other inconsistent and potential risk factors with a view to identifying preventive measures. Keywords: Uterine Leiomyomata, Diabetes Mellitus, Infertility.

  15. Selective Embolisation of a Heavily Bleeding Cervical Fibroid in a Pregnant Woman

    NARCIS (Netherlands)

    Lohle, Paul N. M.; Boekkooi, Peter F.; Fiedeldeij, Cora A.; Berden, Hubert J. J. M.; de Jong, Wim; Reekers, Jim A.; Franx, Arie; van Rooij, Willem Jan J.

    2015-01-01

    We report a case of a 20-week pregnant woman, who underwent embolisation of a cervical fibroid to end a life-threatening massive bleeding. This is the first reported case in the literature of a super-selective uterine fibroid embolisation (UFE) in a pregnant woman, even though pregnancy is

  16. Imaging before and after uterine artery embolization; Bildgebende Diagnostik vor und nach Uterusmyomembolisation

    Energy Technology Data Exchange (ETDEWEB)

    Kroencke, T.J. [Charite - Universitaetsmedizin Berlin, Radiologische Klinik, Campus Virchow-Klinikum, Berlin (Germany)

    2008-07-15

    Percutaneous catheter-based embolization treatment of symptomatic uterine fibroids has evolved into the most widely used alternative therapeutic approach to surgical treatment worldwide. Uterine artery embolization (UAE) induces infarction of leiomyomas, resulting in ischemic necrosis, hyaline degeneration, and size reduction with resolution of associated symptoms. Published experience suggests that UAE is an effective and reliable option for treating uterine fibroids with high patient satisfaction. Magnetic resonance imaging (MRI) is superior to ultrasonography for determining the site, size and number of fibroids, which is important for establishing the indication for UAE. Other potential advantages of MRI include the option of performing MR angiography (MRA) and obtaining contrast-enhanced images for monitoring the outcome of UAE and assessing possible complications after UAE. (orig.) [German] Die perkutane kathetergestuetzte Uterusmyomembolisation ist inzwischen weltweit die am meisten verbreitete Alternative zur operativen Behandlung des symptomatischen Uterus myomatosus. Der durch Embolisation der Aa. uterinae (Syn. Uterusarterienembolisation, UAE) bewirkte 'Myominfarkt' fuehrt zu ischaemischer Nekrose, hyalinem Umbau und Groessenreduktion der Myome unter Rueckbildung myomassoziierter Beschwerden. Die bisher publizierten Erfahrungen zeigen, dass es sich bei der Embolisation um eine effektive und sichere Methode mit hoher Patientinnenzufriedenheit handelt. Die Magnetresonanztomographie (MRT) ist dem Ultraschall in der fuer die Indikationsstellung wichtigen Beurteilung von Lage, Groesse und Zahl der Myomknoten ueberlegen. Weitere moegliche Vorteile ergeben sich durch den Einsatz der MR-Angiographie (MRA) sowie kontrastmittelunterstuetzter Aufnahmen zur Erfolgskontrolle und Abklaerung von Komplikationen nach Embolisation. (orig.)

  17. Fibroid interventions: reducing symptoms today and tomorrow: extending generalizability by using a comprehensive cohort design with a randomized controlled trial.

    Science.gov (United States)

    AbdElmagied, Ahmed M; Vaughan, Lisa E; Weaver, Amy L; Laughlin-Tommaso, Shannon K; Hesley, Gina K; Woodrum, David A; Jacoby, Vanessa L; Kohi, Maureen P; Price, Thomas M; Nieves, Angel; Miller, Michael J; Borah, Bijan J; Gorny, Krzysztof R; Leppert, Phyllis C; Lemens, Maureen A; Stewart, Elizabeth A

    2016-09-01

    Uterine fibroids are an important source of morbidity for reproductive-aged women. Despite an increasing number of alternatives, hysterectomies account for about 75% of all fibroid interventional treatments. Evidence is lacking to help women and their health care providers decide among alternatives to hysterectomy. Fibroid Interventions: Reducing Symptoms Today and Tomorrow (NCT00995878, clinicaltrials.gov) is a randomized controlled trial to compare the safety, efficacy, and economics of 2 minimally invasive alternatives to hysterectomy: uterine artery embolization and magnetic resonance imaging-guided focused ultrasound surgery. Although randomized trials provide the highest level of evidence, they have been difficult to conduct in the United States for interventional fibroid treatments. Thus, contemporaneously recruiting women declining randomization may have value as an alternative strategy for comparative effectiveness research. We sought to compare baseline characteristics of randomized participants with nonrandomized participants meeting the same enrollment criteria and to determine whether combining the 2 cohorts in a comprehensive cohort design would be useful for analysis. Premenopausal women with symptomatic uterine fibroids seeking interventional therapy at 3 US academic medical centers were randomized (1:1) in 2 strata based on calculated uterine volume (<700 and ≥700 cc(3)) to undergo embolization or focused ultrasound surgery. Women who met the same inclusion criteria but declined randomization were offered enrollment in a parallel cohort. Both cohorts were followed up for a maximum of 36 months after treatment. The measures addressed in this report were baseline demographics, symptoms, fibroid and uterine characteristics, and scores on validated quality-of-life measures. Of 723 women screened, 57 were randomized and 49 underwent treatment (27 with focused ultrasound and 22 with embolization). Seven of the 8 women randomized but not treated were

  18. Success of uterus-preserving treatments for abnormal uterine bleeding, chronic pelvic pain, and symptomatic fibroids: age and bridges to menopause.

    Science.gov (United States)

    Learman, Lee A; Nakagawa, Sanae; Gregorich, Steven E; Jackson, Rebecca A; Jacoby, Alison; Kuppermann, Miriam

    2011-03-01

    The purpose of this study was to determine whether age at first uterus-preserving treatment (UPT) predicts symptom resolution among women with common pelvic problems. We conducted an analysis of 557 participants in the Study of Pelvic Problems, Hysterectomy and Intervention Alternatives cohort who reported having undergone a UPT. We performed multivariable regression modeling age at first UPT, hysterectomy, menopause, and other covariates to predict symptom resolution. Mean ± SD age at enrollment was 42.7 ± 4.7 years; mean follow-up time was 4.4 ± 2.7 years. Sixteen percent of the women underwent hysterectomy; 37% of the women entered menopause. Hysterectomy was a strong predictor of symptom resolution (P 40 years old. Copyright © 2011 Mosby, Inc. All rights reserved.

  19. Laparoscopic myomectomy for infertile patients with intramural fibroids

    African Journals Online (AJOL)

    family history, polycystic ovarian syndrome, diabetes and hypertension.3,4 Patients with uterine fibroids usually .... The pre-operative work-up included a thorough history, examination, confirmation of ovulation in the fertility group, and a ... had artificial insemination (AI). Of the non-pregnant group, 9/35 (25.7%) attempted ...

  20. Endovascular uterine artery interventions

    Directory of Open Access Journals (Sweden)

    Chandan J Das

    2017-01-01

    Full Text Available Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs, as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH, placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.

  1. Short-term advantages of laparoscopic uterine vessel occlusion in the management of women with symptomatic myoma

    Directory of Open Access Journals (Sweden)

    Kuan-Chin Wang

    2012-12-01

    Conclusions: Both LUVO and LM might be effective in the management of symptomatic myomas in selected cases, but LUVO seemed to be more acceptable and less invasive in this 1-year short-term follow-up.

  2. Surgical Treatments for Fibroids

    Science.gov (United States)

    ... NICHD Research Information Find a Study More Information Preeclampsia and Eclampsia About NICHD Research Information Find a ... Treatments Share Facebook Twitter Pinterest Email Print Surgical Treatments for Fibroids If you have moderate or severe ...

  3. 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.

  4. Efficiency and safety of fibroid embolisation

    International Nuclear Information System (INIS)

    Berczi, V.

    2012-01-01

    Full text: Introduction: Uterine Fibroid Embolisation (UFE) has been introduced in 1995 in France. It has been performed on growing number of cases in most countries. In Hungary, the first centre started these procedures in large number of cases approximately 7 years ago. Our group introduced this techniques in Budapest in 2008, and reached a steady rate of 60-80 fibroids per year. We regularly perform an audit of our cases. Patients and methods: Indication is decided by the interventional radiologist and the gynecologist knowing and accepting UFE. Most gynecologists in Hungary, however, still not inform the patient about UFE. Very often the patient finds the solution following an offer from the gynecologist to perform hysterectomy which she does not accept; searching on the internet leads her to our group in numerous cases. Prior to the embolisation, MR is performed in most cases. Fibroid embolisation is performed through to common femoral puncture using 500-700 μm PVA particles. Follow-up MR is performed 6 months following the procedure. Results: Between May, 2008 and October, 2011, 217 patients had UFE in our centre (mean age 42.2 years, range 24-55 years). Indications by symptoms: (n=218) Menorrhagia and metrorrhagia: 197, Pelvic pressure or pain: 117, Frequent urination: 85, Lack pain: 21, Lower complaints: 6, Risk reduction of future moymectomy: 3, Dyspareunia: 3. Indications based on morphology: (n=217), fibroid: 196, adenomyosis: 8, fibroid +adenomyosis: 13. Morphological changes: (n=50) decrease in volume at 6 months follow-up MR 55.3±3.8% (range 0-97.6%). Bilateral uterine artery catheterization and embolisation: 201/217=95.4%; 10/217=4.6% in ten cases, selective uterine artery was not possible due to the tortousity of the artery. Bilateral embolisation: 196/217=90%; 11/217=5% in eleven cases, unilateral embolisation was performed due to early venous filling or retrograde ovaric artery filling. Volume reduction at bilateral embolisation: 55.6±4.1% (n

  5. What Are the Symptoms of Uterine Fibroids?

    Science.gov (United States)

    ... YouTube follow us on Flickr follow us on Instagram Español NICHD Theme Browse AZTopics Browse A-Z ... Publications Sitemap Español facebook twitter pinterest youtube flickr Instagram NEWSROOM NICHD News Videos OUTREACH Safe to Sleep® ...

  6. Focused Ultrasound Surgery for Uterine Fibroids

    Science.gov (United States)

    ... electronic devices inside your body, such as metallic joint prostheses, artificial heart valves, implanted electronic devices, cochlear implants, body piercings or dental implants. Other precautions The day of treatment you' ...

  7. How to manage multiple fibroids in reproductive laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Wachyu Hadisaputra

    2013-11-01

    Full Text Available The incidence of fibroids ranges from 30% to 70% in women of reproductive age, with the peak incidence occurring between 35 and 49 years of age. Risk factors for fibroids include nulliparity, obesity, black ethnicity, family history, polycystic ovarian syndrome, diabetes, and hypertension. Fibroids are present in 5–10% of the patients presenting with infertility. Laparoscopic myomectomy is preferred over abdominal myomectomy because several small incisions are used rather than one larger incision. Related to the small incisions, recuperation is usually associated with minimal discomfort. Women with infertility and fibroids become pregnant after myomectomy in approximately 50% of cases. The pregnancy rate in patients undergoing hysteroscopic and laparoscopic/abdominal myomectomy is 45–49%. Laparoscopic myomectomy is a technically challenging procedure with surgeon-specific limitations. Preoperative treatments with gonadotropin-releasing hormone have been shown to reduce blood loss and shorten operative time. The consensus states that the maximal size must be 8–10 cm and the total number of fibroids should not exceed four. It is important not to perform laparoscopic myomectomies with more than 5–7 large fibroids because in these cases, the procedure is excessively time-consuming and gives the surgeon opportunities to miss the smaller fibroids after the uterus has been incised and repaired in too many places. The role of vasoconstrictors such as vasopressin, epinephrine, and ornipressin help with the control of bleeding from the incised sites. Temporary clipping of the uterine artery is an effective procedure in reducing hemoglobin loss during laparoscopic myomectomy.

  8. Degenerated uterine leiomyomas mimicking malignant bilateral ovarian surface epithelial tumors

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Yi Boem Ha; Lee, Hae Kyung; Lee, Min Hee; Choi, Seo Youn; Chung, Soo Ho [Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of)

    2017-07-15

    Uterine leiomyomas are the most common benign uterine neoplasms. Undegenerated uterine leiomyomas are easily recognizable by the typical imaging findings on radiologic studies. However, degenerated fibroids can have unusual and variable appearances. The atypical appearances due to degenerative changes may cause confusion in diagnosis of leiomyomas. In this article, we report a case of a patient with extensive cystic and myxoid degeneration of uterine leiomyoma, mimicking malignant bilateral ovarian surface epithelial tumors.

  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. Proportion of Uterine Malignant Tumors in Patients with Laparoscopic Myomectomy: A National Multicenter Study in China

    Directory of Open Access Journals (Sweden)

    Hua Yang

    2017-01-01

    Conclusions: The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy. Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential, and morcellation should be avoided.

  11. [OPPORTUNITIES OF HIFU TECHNOLOGY FOR TREATMENT FIBROIDS DISEASES SUCH AS NON-INVASIVE AND ALTERNATIVE METHOD TO SURGERY].

    Science.gov (United States)

    Gincheva, D; Gorchev, G; Tomov, S

    2015-01-01

    Concepts of medical treatment are constantly evolving and improving. This opportunity provides treatment with High Intensity Focused Ultrasound (HIFU). In Europe and Asia more than 10,000 patients with uterine fibroids have been successfully treated with HIFU technology until now. This is completely innovative technology for non-invasive extracorporeal treatment of benign and malignant tumors. Neighboring healthy tissue is not damaged. The main indication in HIFU-Center in Pleven is uterine fibroid. It is the most common solid tumor in the female pelvis and is the leading cause of hysterectomy. The methods of treatment are hysterectomy, myomectomy or embolization of uterine arteries. HIFU-methodology allows non-invasive treatment of fibroids disease.

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

    International Nuclear Information System (INIS)

    Koh, Jieun; Kim, Man Deuk; Jung, Dae Chul; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Lee, Do Yun; Park, Sung Il; Lee, Kwang Hun

    2012-01-01

    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 3 and was decreased to a mean of 278.81 ± 202.70 cm 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

  13. [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.

  14. 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).

  15. Administration of goserelin acetate after uterine artery embolization does not change the reduction rate and volume of uterine myomas.

    Science.gov (United States)

    Vilos, George A; Vilos, Angelos G; Abu-Rafea, Basim; Pron, Gaylene; Kozak, Roman; Garvin, Greg

    2006-05-01

    To determine if goserelin immediately after uterine artery embolization (UAE) affected myoma reduction. Randomized pilot study (level 1). Teaching hospital. Twenty-six women. All patients underwent UAE, and then 12 patients received 10.8 mg of goserelin 24 hours later. The treatment group was 5 years older: 43 versus 37.7 years. Uterine and myoma volumes were measured by ultrasound 2 weeks before UAE and at 3, 6, and 12 months. Uterine and fibroid volumes. Pretreatment uterine volume was 477 versus 556 cm3, and dominant fibroid volume was 257 versus 225 cm3 in the control versus goserelin groups. Analysis of variance measurements indicated that the change over time did not significantly differ between the two groups. By 12 months, the control group had a mean uterine volume reduction of 58%, while the goserelin group had a reduction of 45%. Dominant fibroid changes over time did not differ between the two groups. At 12 months, the mean fibroid volume had decreased by 86% and 58% in the control and goserelin groups, respectively. The addition of goserelin therapy to UAE did not alter the reduction rate or volume of uterine myomas.

  16. Three-dimensional digital rotation angiography for embolization therapy of uterine leiomyomas: first results; Dreidimensionale digitale Rotationsangiographie in der Embolisationstherapie von Uterusmyomen: Erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Bucek, R.A.; Reiter, M.; Dirisamer, A.; Kettenbach, J.; Lammer, J. [Universitaetsklinik fuer Radiodiagnostik, Abt. fuer Angiographie und interventionelle Radiologie, AKH Wien (Austria)

    2004-07-01

    Purpose: To evaluate three-dimensional rotational digital subtraction angiography (3D-RDSA) in the embolization of the uterine artery in the treatment of symptomatic uterine leiomyomas (fibroids). Materials and Methods: Eight women with complex pelvic vessel anatomy caused by large fibroids were embolized using 3D-RDSA. The raw data were sent to an external workstation, and video files with a resolution of one image/3 and a scan range of 180 in a surface-shaded display mode were produced. The primary goal was to assess an image intensifier angulation for the optimal visualization of the origin of the uterine artery. In addition, the intervention parameters were compared with those of 48 patients with standard angiography. Results: The analysis revealed no single angulation that can be recommended for standard angiography. No statistical differences were found between both groups concerning fluoroscopy time, dosage area product and amount of administered contrast medium (p > 0.05). Conclusion: It can be stated that 3D-RDSA is a feasible method that facilitates the catheterization of the uterine artery even in patients with complex pelvic vessel anatomy, with the potential to reduce the radiation exposure and the amount of administered contrast medium in future embolization therapy of symptomatic uterine fibroids. (orig.) [German] Ziel: Evaluierung der dreidimensionalen digitalen Rotationsangiographie (3-D-RDSA) in der Embolisation der Arteria uterina bei Patientinnen mit symptomatischen Leiomyomen des Uterus. Material und Methoden: 8 Frauen mit komplexer Beckengefaessanatomie aufgrund von ausgedehnten Myomen wurden mit Hilfe der 3-D-RDSA embolisiert, aus den Rohdaten der Rotationsangiographie wurden in einer externen Auswertestation Videos mit einer Aufloesung von einem Bild/3 und einem Scanbereich von 180 in Surface-Shaded-Display-Darstellung produziert. Unser erstes Ziel war die Evaluierung eines optimalen Einstellwinkels zur Darstellung des Abganges der Arteria

  17. Interventions to reduce haemorrhage during myomectomy for fibroids.

    Science.gov (United States)

    Kongnyuy, Eugene J; Wiysonge, Charles Shey

    2014-08-15

    Benign smooth muscle tumours of the uterus, known as fibroids or myomas, are often symptomless. However, about one-third of women with fibroids will present with symptoms that are severe enough to warrant treatment. The standard treatment of symptomatic fibroids is hysterectomy (that is surgical removal of the uterus) for women who have completed childbearing, and myomectomy for women who desire future childbearing or simply want to preserve their uterus. Myomectomy, the surgical removal of myomas, can be associated with life-threatening bleeding. Excessive bleeding can necessitate emergency blood transfusion. Knowledge of the effectiveness of the interventions to reduce bleeding during myomectomy is essential to enable evidence-based clinical decisions. This is an update of the review published in The Cochrane Library (2011, Issue 11). To assess the effectiveness, safety, tolerability and costs of interventions to reduce blood loss during myomectomy. In June 2014, we conducted electronic searches in the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and PsycINFO, and trial registers for ongoing and registered trials. We selected randomised controlled trials (RCTs) that compared potential interventions to reduce blood loss during myomectomy to placebo or no treatment. The two authors independently selected RCTs for inclusion, assessed the risk of bias and extracted data from the included RCTs. The primary review outcomes were blood loss and need for blood transfusion. We expressed study results as mean differences (MD) for continuous data and odds ratios for dichotomous data, with 95% confidence intervals (CI). We assessed the quality of evidence using GRADE methods. Eighteen RCTs with 1250 participants met our inclusion criteria. The studies were conducted in hospital settings in low, middle and high income countries.Blood lossWe found significant

  18. Epidemiological and genetic clues for molecular mechanisms involved in uterine leiomyoma development and growth

    NARCIS (Netherlands)

    Commandeur, Arno E.; Styer, Aaron K.; Teixeira, Jose M.

    2015-01-01

    Uterine leiomyomas (fibroids) are highly prevalent benign smooth muscle tumors of the uterus. In the USA, the lifetime risk for women developing uterine leiomyomas is estimated as up to 75%. Except for hysterectomy, most therapies or treatments often provide only partial or temporary relief and are

  19. 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

    Directory of Open Access Journals (Sweden)

    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.

  20. Presentation and management of giant fibroid uterus in an adolescent girl

    Directory of Open Access Journals (Sweden)

    Tanweer Karim

    2010-03-01

    Full Text Available Tanweer Karim, Kundan Patil, Anuradha Panchal, Chandramauli BasuGeneral Surgery, Department of Surgery, Medical College and Hospital, Kamothe, Navi Mumbai, IndiaAbstract: Leiomyoma of the uterus is the most common tumor of the female pelvis. Its occurrence in females under the age of 20 years is not frequent. Moreover, its presence in the adolescent population has not been well documented. With the advent of high frequency ultrasonography and magnetic resonance imaging it is now possible to diagnose such cases at an early stage. Asymptomatic uterine fibroids can be left untreated as long as they are monitored closely. However, larger tumors usually require surgical treatment. Medical management by prescribing gonadotropin-releasing hormone analogue has been used to suppress estrogen production, thereby reducing the size of existing myomas to make them amenable to laparoscopic surgery. Selective embolization of uterine artery has been used successfully in the treatment of uterine fibroids. We came across a similar case of a large leiomyoma in a sexually inactive adolescent girl. She presented with a lump in her abdomen and without a history of menstrual disturbances or intake of oral contraceptives.Keywords: leiomyoma of uterus, fibroid uterus

  1. Chronic Epilepsy in Uterine Leiomyoma Controlled by Myomectomy ...

    African Journals Online (AJOL)

    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 ...

  2. Uterine Artery Embolization: A Systematic Review of the Literature and Proposal for Research.

    Science.gov (United States)

    1999-01-01

    of the blood supply to uterine myomas: report of 2 cases ," Australian & New Zealand Journal of Obstetrics & Gynaecology , 1999; 39:1...embolization: A report of three cases ," Journal of Reproductive Medicine. 1999; 44(4):373-6. Bradley E, Reidy J, Forman R, Jarosz J, Braude P...Transcatheter uterine artery embolisation to treat large uterine fibroids," British Journal of Obstetrics and Gynaecology

  3. [Primary intestinal parasitic fibroid, an incidental finding during gynecological laparoscopic surgery].

    Science.gov (United States)

    Alcalá-Alcalde, M M; Pantoja-Garrido, M; Frías-Sánchez, Z

    2016-09-01

    Uterine fibroids are the most frequent solid pelvic benign tumors in women. Their most common location is the uterine corpus, cervix and broad ligament but they can also be found in other areas, less commonly as extragenital locations and/or in a parasitic way. A 40 years old patient, who consulted for menorrhagia and dysmenorrhea on long evolution. On physical examination, the enlarged uterus, inflamated, hard consistency and normal mobility was identified. The sonographic features and location suggested a fibroid nodule type II (Wamsteker classification), which deformed the endometrial cavity. It was decided to perform the surgery and during the procedure the enlarged uterus, deformed at the expense of a localized fundal formation, like a intramural fibroid. By mobilizing the intestinal loops and change the position of the patient (Trendelenburg) a solid tumor, cranially separated from the internal genitals it was observed. In reviewing the insertion site, it was visualized that remained attached to antimesial of the jejunum. Total hysterectomy was performed with monopolar and bipolar energy, and vascular sealant. The postoperative was favorable, without complication. The pathological study reported a primary leiomyoma of the small intestine, while in the uterus of multiple myomas was confirmed. The parasitic fibroids are those located separately from the uterus that receive vascular irrigation from another organ or abdominopelvic structure. They are a very rare pathology. The diagnosis has made as an accidental event, during an abdominal surgery or during the differential diagnosis of a abdominopelvic tumor. The therapeutical choice depends on the clinical presentation, the location of the fibroid and the reproductive desires of the patient, most commonly recomending their surgycal removal.

  4. First trimester myomectomy as an alternative to termination of pregnancy in a woman with a symptomatic uterine leiomyoma: a case report

    Directory of Open Access Journals (Sweden)

    Leach Kara

    2011-12-01

    Full Text Available Abstract Introduction Performing a myomectomy during pregnancy is extremely rare due to the risk of pregnancy loss, hemorrhage and hysterectomy. Favorable outcomes have been demonstrated with select second trimester gravid myomectomies. Literature documenting first trimester surgical management of myomas during pregnancy is scant. Patients with symptomatic myomas failing conservative management in the first trimester may be counseled to abort the pregnancy and then undergo myomectomy. Reports focusing on myomectomy in the first trimester are needed to permit more thorough options counseling for patients failing conservative management in the first trimester. Case presentation A 30-year-old Caucasian primagravid (G1P0 was referred for termination of her pregnancy at 10 weeks due to a 14 cm myoma causing severe pain, constipation and urine retention. Her referring physician planned an interval myomectomy following the abortion. Instead, our patient underwent myomectomy at 11 weeks. Two leiomyomas were successfully removed; she delivered a healthy infant at term. Conclusion Patients in the first trimester should not be counseled that termination followed by myomectomy is the best option for symptomatic myomas, failing conservative treatment. Management should be individualized after taking into account the patient's symptoms, gestational age and the location of the myomas in relation to the placenta. Any field providing women's health services will be impacted by the ability to offer more thorough options counseling for women with refractory myomas in the first trimester.

  5. Uterine Artery Anatomy Relevant to Uterine Leiomyomata Embolization

    International Nuclear Information System (INIS)

    Gomez-Jorge, Jackeline; Keyoung, Andrew; Levy, Elliot B.; Spies, James B.

    2003-01-01

    To categorize the anatomic variants of uterine arteries, and determine the incidence of menopausal symptoms where the tubo-ovarian branches were seen prior to embolization. Between July 1997 and June 2000, 257 (n = 257) uterine fibroid embolizations were performed at our institution. Arteriograms were retrospectively evaluated. Uterine arteries were classified into groups: type I (the uterine artery as first branch of the inferior gluteal artery), type II (the uterine artery as second or third branch of the inferior gluteal artery), type III (the uterine artery, the inferior gluteal and the superior gluteal arteries arising as a trifurcation), type IV (the uterine artery as first branch of the hypogastric artery), inconclusive, or not studied. Tubo-ovarian branches were recorded if visualized prior to and/or after embolization. Menopausal symptoms were recorded (n = 175 at 3 months, n = 139 at 6 months, n = 98 at 1 year, n = 22 at 2 years) using written questionnaires. Five hundred and fourteen uterine arteries (n = 514) were evaluated. There were 38% classifiable types, 23% inconclusive, and 39% not studied. Classification was as follows: type I, 45%; type II, 6%; type III, 43%; type IV, 6%. Among 256 patients, tubo-ovarian arteries were seen in 36 prior to embolization, but not afterwards. In this group, 25 patients reported transient menopausal symptoms (hot flashes, amenorrhea). Five patients did not report any menopausal symptoms. Six patients did not answer the questionnaires. Type I is the most common type of anatomy, followed by type III. The tubo-ovarian arteries may be visualized prior to and/or after embolization. The embolization was monitored to avoid embolization of the tubo-ovarian branches. Menopausal symptoms were transient all patients when the tubo-ovarian branches were seen prior to embolization

  6. Medical Treatment of Uterine Leiomyoma

    Science.gov (United States)

    Sabry, Mohamed; Al-Hendy, Ayman

    2012-01-01

    Uterine leiomyomas (also called myomata or fibroids) are the most common gynecologic tumors in the United States. The prevalence of leiomyomas is at least 3 to 4 times higher among African American women than in white women. Pathologically, uterine leiomyomas are benign tumors that arise in any part of the uterus under the influence of local growth factors and sex hormones, such as estrogen and progesterone. These common tumors cause significant morbidity for women and they are considered to be the most common indication for hysterectomy in the world; they are also associated with a substantial economic impact on health care systems that amounts to approximately $2.2 billion/year in the United States alone. Uterine myomas cause several reproductive problems such as heavy or abnormal uterine bleeding, pelvic pressure, infertility, and several obstetrical complications including miscarriage and preterm labor. Surgery has traditionally been the gold standard for the treatment of uterine leiomyomas and has typically consisted of either hysterectomy or myomectomy. In recent years, a few clinical trials have evaluated the efficacy of orally administered medications for the management of leiomyoma-related symptoms. In the present review, we will discuss these promising medical treatments in further detail. PMID:22378865

  7. 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.

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

    International Nuclear Information System (INIS)

    So, Minna J.; Fennessy, Fiona M.; Zou, Kelly H.; McDannold, Nathan; Hynynen, Kullervo; Jolesz, Ferenc A.; Stewart, Elizabeth A.; Rybicki, Frank J.; Tempany, Clare M.

    2006-01-01

    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

  9. Usefulness of modified intravenous analgesia: initial experience in uterine artery embolization for leiomyomata

    International Nuclear Information System (INIS)

    Yang, Seung Boo; Jung, Young Jin; Goo, Dong Erk; Jang, Yun Woo

    2006-01-01

    We wanted to evaluate the usefulness of modified intravenous analgesia for the management of pain during uterine artery embolization for leiomyomata. Between April 2004 and July 2004, 15 patients with symptomatic fibroids underwent uterine artery embolization and pain management. Except the three patients for whom the Visual Analogue Scale (VAS) score was not obtained, twelve patients were included in this study. For pain management, epidural PCA (Patient Controlled Analgesia) was used in two patients, intravenous PCA was used in two patients and modified intravenous analgesia injection was used in eight patients. For all the patients, we used the 2.8 Fr coaxial microcatheter and 500-710 μ m PVA particles for the embolic materials. The protocol of the modified intravenous analgesia injection was as follow, 1) prior to femoral artery puncture, 30 mg of ketorolac tromethamine (Tarasyn)was injected via an intravenous route. 2) At the time that the one side uterine artery embolization was finished, normal saline mixed 150 mg meperidine (Demerol) was administered through the side port of the intravenous line that was used for hydration. 3) Additional ketorolac tromethamine 30 mg was injected after 6 hour. The VAS score and side effects were then checked. After 12 hours, the VAS score was rechecked. If the VAS score was above 4, this was considered as failure of pain management. The VAS scores, complications and side effects for the modified intravenous analgesia injection were compared with that of IV PCA and epidural PCA. The average VAS score of the modified intravenous analgesia injection, intravenous PCA and epidural PCA was 1.4, 1 and 0, respectively; the number of additional intramuscular injections of analgesia was 0.5, 0.5 and 0, respectively. All the patients who underwent epidural PCA had back pain at the puncture site and 1 patient who underwent modified intravenous analgesia injection experienced mild dyspnea, but they easily recovered with such

  10. 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 ...

  11. Caesarean hysterectomy in a nullipara with multiple uterine fibroids ...

    African Journals Online (AJOL)

    Background:· There are various reports in literature of successful surgical intervention of leiomyoma in pregnancy mainly, in the second trimester, with a few in the first trimester. These surgeries were undertaken when conservative management of leiomyoma symptoms failed.Almost all reported cases were carefully ...

  12. 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...

  13. 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.

  14. Uterine artery embolization angiography and fertility related aspects

    Directory of Open Access Journals (Sweden)

    Irina A. Horhoianu

    2016-05-01

    Full Text Available Purpose. Uterine artery embolization is a minimally invasive technique. It applies the principle of targeted anatomical structure devascularisation with utility in fibroid conservative therapy, including for future fertility preserving status. The objective of our paper represents a description and evaluation of angiography utility as a predictive method for fertility maintenance. Material and Methods. The angiography and ultrasound aspects obtained from a prospective study in which selected patients have undergone uterine artery embolization for fertility preservation are detailed. Results. The following angiography aspects have been detected: left- right shunt and utero-ovarian collaterals; these have been compared with the ultrasound aspects related to the fibroid evolution form a volumetric and Doppler ultrasound point of view. The angiographical description predicts the impact on post embolization fibroid evolution and upon fertility. An analysis is made in order to assess the way in which angiography can contribute to fertility alteration. Conclusions. The angiography aspects during embolization and the following ultrasound aspects can represent predictive factors as to fertility evolution after uterine artery embolization.

  15. Uterine malignant degeneration after low-dose endometrial irradiation

    International Nuclear Information System (INIS)

    Nikkanen, V.; Salmi, T.; Groenroos, M.

    1980-01-01

    The effectiveness of low-dose intrauterine irradiation for benign diseases and its possible carcinogenic effect on the uterus was studied in 190 patients who were treated during the years 1952-1974. The indications for irradiation were premenopausal functional bleeding, leukemia, hemophilia, fibroids, endometriosis or other benign reason. Radiation was also performed on patients with severe neurologic diseases that contraindicated surgery and on some mentally retarded patients whose restlessness and epileptic seizures were aggravated premenstrually and during menstruation. The mean follow-up period was 15 years. Uterine bleeding recurred in 21 percent of the patients. No cases of uterine malignant degeneration were found. (author)

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Uterine Cancer

    Science.gov (United States)

    ... I find more information about uterine and other gynecologic cancers? Centers for Disease Control and Prevention: 800-CDC-INFO or www. cdc. gov/ cancer/ gynecologic National Cancer Institute: 800-4-CANCER or www. ...

  18. The analysis of the causes of uterine bleeding occurred after cesarean section and the evaluation of interventional therapy for bleeding

    International Nuclear Information System (INIS)

    Hu Peng; Li Yuwei; Li Yunhui; Luo Bin; Wen Wen; Yang Bo

    2011-01-01

    Objective: to analyze the causes of uterine hemorrhage occurred after cesarean section and to investigate the value of angiography and transcatheter artery embolization (TAE) in the diagnosis and treatment of postpartum hemorrhage after cesarean section. Methods: During the period from Jan. 2001 to Dec. 2011, a total of 65 cases suffering from uterine bleeding after cesarean section had underwent uterine arteriography to clarify the diagnosis, which was followed by transcatheter uterine artery embolization (TUAE). The clinical data, the causes of bleeding and the angiographic features were retrospectively analyzed. Results: The causes of uterine bleeding after cesarean section included uterine artery pseudoaneurysm (n=26), uterine atony (n=18), placental factors (n=11), gestational hypertension (n=8), coexisting uterine fibroids (n=1) and uterine bleeding of unknown reason (n=1). Uterine artery angiography revealed contrast extravasation in all patients except one patient. The angiographic findings confirmed the diagnosis of uterine artery bleeding after cesarean section. The bleeding stopped after TUAE, and the patients were in stable condition. No serious complications occurred. Conclusion: Pseudoaneurysm is the primary cause of postpartum uterine hemorrhage after cesarean section. Transcatheter uterine artery angiography can promptly and reliably determine the causes of bleeding, and, at the same time, embolization therapy can be carried out to effectively stop the bleeding. (authors)

  19. The Natural History of Uterine Leiomyomas: Morphometric Concordance with Concepts of Interstitial Ischemia and Inanosis

    OpenAIRE

    Flake, Gordon P.; Moore, Alicia B.; Flagler, Norris; Wicker, Benita; Clayton, Natasha; Kissling, Grace E.; Robboy, Stanley J.; Dixon, Darlene

    2013-01-01

    Based upon our morphologic observations, we hypothesize and also provide morphometric evidence for the occurrence of progressive developmental changes in many uterine fibroids, which can be arbitrarily divided into 4 phases. These developmental phases are related to the ongoing production of extracellular collagenous matrix, which eventually exceeds the degree of angiogenesis, resulting in the progressive separation of myocytes from their blood supply and a condition of interstitial ischemia....

  20. Abnormal Uterine Bleeding

    Science.gov (United States)

    ... uterine cancer isn’t the cause. Women after menopause Hormone replacement therapy is a common cause of uterine bleeding after menopause. Other causes include endometrial and uterine cancer. These ...

  1. Abnormal uterine bleeding

    Science.gov (United States)

    Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding ... ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2015. ACOG. ...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. Antiproliferative effect of adiponectin on rat uterine leiomyoma ELT-3 cells.

    Science.gov (United States)

    Wakabayashi, Atsuko; Takeda, Takashi; Tsuiji, Kenji; Li, Bin; Sakata, Masahiro; Morishige, Ken-ichirou; Yaegashi, Nobuo; Kimura, Tadashi

    2011-01-01

    Although fibroids greatly affect reproductive health, the pathophysiology and epidemiology are not well known. Recently, we have reported the relationship between uterine leiomyoma and metabolic syndrome. Many studies have indicated that reductions in plasma adiponectin levels play major roles in the development of metabolic syndrome. In this study, we investigated the significant repressive effect of adiponectin on rat uterine leiomyoma ELT-3 cells proliferation. Expression of adiponectin receptor 1 and receptor 2 was evaluated by RT-PCR and Western blot analysis. Cell proliferation was assessed by the MTS assay and cell counting. Apoptosis was evaluated by Hoechst staining and cleaved poly (ADP-ribose) polymerase (PARP). Adiponectin receptor 1 and receptor 2 were expressed in ELT-3 cells. Adiponectin repressed rat uterine leiomyoma ELT-3 cells cell proliferation without inducing apoptosis. The repression of adiponectin on leiomyoma cell proliferation in the rat may explain a crucial role of adiponectin in the association of metabolic syndrome with uterine leiomyoma.

  4. 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.

  5. 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

  6. Clinical audit of foetomaternal outcome in pregnancies with fibroid uterus

    International Nuclear Information System (INIS)

    Sarwar, I.; Habib, S.; Bibi, A.; Malik, N.; Parveen, Z.

    2012-01-01

    Background: Leiomyoma, myoma, leiomyoma or fibroids are synonymous terms. They may be present in as many as 1 in 5 women over age 35 years. If pregnancy is associated with fibroids, it leads to multiple complications. Objectives of this study were to evaluate the maternal and foetal outcome in women having pregnancy with fibroids in uterus and the complications associated with fibroids during the pregnancy. Methods: This descriptive study was conducted in the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital Abbottabad from March 2009 to March 2010. Data were collected on proforma regarding demographic variables, obstetrical history, mode of delivery, maternal outcome, maternal complications, and foetal outcome. Mean and standard deviation was calculated for age, period of gestation, and obstetrical history. Frequency and percentages was calculated for booking status, maternal outcome, maternal complications and foetal outcome. Results: Thirty patients were included in this study who had pregnancy with fibroid. Normal delivery was achieved in 14 (46.66%) patients. Eight (26.67%) patients had caesarean section and eight (26.67%) had miscarriages. Seven (23.33%) patients had no complications while 8 (26.67%) had miscarriages, 8 (26.67%) had postpartum haemorrhage, 10 (33.33%) had preterm delivery, and 3 patients had ante-partum haemorrhage. Two (10%) patients had premature rupture off membranes and 1 patient (3.33%) had pain abdomen and technical difficulty during caesarean section. There were 12 (40%) healthy babies. Five (16.67%) babies delivered with morbidity but recovered. There were 4 (13.33%) intrauterine deaths and one early neonatal death. Conclusion: Fibroid in pregnancy, especially multiple intramural fibroids and fibroids larger than 10 Cm, cause miscarriage and preterm labour. (author)

  7. Human prolyl hydroxylase expression in uterine leiomyoma during the menstrual cycle

    OpenAIRE

    Iwahashi, Masaaki; Muragaki, Yasuteru; Ino, Kazuhiko

    2012-01-01

    Abstract Background To investigate the role of prolyl hydroxylase (PH), a key enzyme of collagen synthesis, in human uterine leiomyoma, PH expression was determined in the normal uterine myometrium and the leiomyoma tissues during the menstrual cycle. Methods The tissues were obtained from 40 regularly cycling women (aged 29 to 53 yr) who were undergoing abdominal hysterectomy for symptomatic uterine leiomyoma. Immunohistochemistry for human PH with specific monoclonal antibody was used for a...

  8. Two uncommon cases of uterine leiomyosarcomas displaying heterologous osteosarcomatous de-differentiation

    Directory of Open Access Journals (Sweden)

    Pinki Parikh

    2015-01-01

    Full Text Available Uterine leiomyosarcomas uncommonly arise on a background of leiomyomas. Still rare is osteosarcomatous dedifferentiation in such tumors. A 60-year-old female presented with abdominal pain and underwent radiological imaging that disclosed a large, well-defined, heterogeneously enhancing uterine tumor. She underwent total abdominal hysterectomy with bilateral salpingectomy. Another, 38-year-old female with the complaints of infertility underwent myomectomy for multiple fibroids. Multiple tumor sections from both the cases showed leiomyomas along with leiomyosarcomas and osteosarcomatous dedifferentiation. Immunohistochemically, both the tumors displayed diffuse expression of smooth muscle markers in areas of leiomyomas, reduced expression of the same in areas of leiomyosarcoma and absent expression in areas of osteosarcomatous dedifferentiation. Unfortunately, both the cases were lost to follow-up. Present cases constitute as rare documentations of uterine leiomyosarcomas, arising on a background of leiomyomas and exhibiting osteosarcomatous dedifferentiation. The value of identifying these tumor components, with extensive tumor sampling relates to their relatively aggressive clinical course.

  9. [Bleeding gastric inflammatory fibroid polyp (Vanek's tumor)].

    Science.gov (United States)

    Guţu, E; Ghidirim, Gh; Mişin, I; Iakovleva, Iraida; Vozian, M

    2010-01-01

    Inflammatory fibroid polyp's (IFP) or Vanek tumor of the gastrointestinal tract represents a relatively unusual entity. IFP is an extremely rare cause of upper gastrointestinal bleeding. We report herein a case of a 30-year-old woman who had a gastric IFP complicated by gastrointestinal bleeding and obstructive symptoms. The lesion was mistaken on endoscopic, radiologic examination and in the operating room for a gastrointestinal stromal tumor (GIST). Preoperative endoscopic examination revealed a protruding oval-shaped submucosal lesion (approximately 7 cm in size) of the gastric antrum, with ulceration of the mucosal surface. Multiple endoscopic biopsies were negative for neoplastic changes. Barium meal study disclosed a large tumor in the prepyloric area of the stomach. Presumptive preoperative diagnosis was GIST. Subtotal Bilroth II gastrectomy en bloc with the mass and lymphadenectomy was performed. Surprisingly, the final histological diagnosis was IFP. Postoperative course was uneventful and no recurrences were observed during 4 years follow-up. With reference to case report, the etiology, diagnosis and treatment strategy of IFP will be discussed. This case highlights an unusual presentation of IFP. Although bleeding may represent a rare complication due IFP, it should be considered in the differential diagnosis of upper gastrointestinal hemorrhage of uncertain etiology.

  10. Small bowel obstruction due to inflammatory fibroid polyp.

    Science.gov (United States)

    Das, S; Mandal, T S; Sinhababu, A K; Chatterjee, T K; Khamrui, T K; Bhattacharya, H

    2012-01-01

    Inflammatory fibroid polyp is a benign and non-neoplastic condition of the intestinal tract, commonly affecting the gastric antrum, though it can affect any part of the gastro-intestinal tract. It is a submucosal, sessile, poypoid mass composed of myofibroblast like mesenchymal cells, numerous small blood vessels and marked inflammatory cell infiltrate mainly eosinophils. It commonly presents as intestinal obstruction or intussusception. A case of recurrent partial small intestinal obstruction due to intermittent intussusception associated with inflammatory fibroid polyp of jejunum is being reported.

  11. Solitary uterine metastasis of invasive lobular carcinoma after adjuvant endocrine therapy: a case report.

    Science.gov (United States)

    Toyoshima, Masafumi; Iwahashi, Hideki; Shima, Takashi; Hayasaka, Atsushi; Kudo, Takako; Makino, Hiromitsu; Igeta, Saori; Matsuura, Rui; Ishigaki, Nobuko; Akagi, Kozo; Sakurada, Junko; Suzuki, Hiroyoshi; Yoshinaga, Kosuke

    2015-02-14

    Solitary uterine metastases from extragenital cancers are very rare. Breast cancer is the most frequent primary site of metastasis to the uterine corpus, with invasive lobular carcinoma more likely to spread to gynecologic organs than invasive ductal carcinoma. A 62-year-old postmenopausal Japanese woman was diagnosed with uterine leiomyomata more than 20 years ago and had been managed conservatively until menopause. Seven years prior to her presentation, she was diagnosed with breast cancer and underwent a partial resection of her right breast for stage IIA invasive lobular carcinoma. She underwent adjuvant chemotherapy, radiotherapy, and five years of anastrozole hormonal therapy. She presented with a growing uterine mass. Her tumor marker levels were markedly increased over the course of her follow-up, but a systemic examination revealed only a solitary uterine tumor. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. A histopathological examination, including detailed immunohistochemistry, confirmed metastatic invasive lobular carcinoma, infiltrating both her uterine myometrium and fibroid tissue. We report a very rare metastatic pattern of invasive lobular carcinoma and demonstrate that gross cystic disease fluid protein-15 and mammaglobin are useful in the diagnosis of metastatic breast cancer.

  12. A rare presentation of cervical fibroid in pregnancy

    African Journals Online (AJOL)

    Annals of African Medicine. Page | 88. Case Report. Annals of African Medicine Vol. 13, No. 2; 2014. Access this article online. Quick Response Code: Website: www.annalsafrmed.org. DOI: 10.4103/1596-3519.129889. PMID: ******. A rare presentation of cervical fibroid in pregnancy. Animesh C. Gandhi, Hemant I. Dugad, ...

  13. Myomectomy for Retained Placenta Due to Incarcerated Fibroid Mass

    African Journals Online (AJOL)

    Introduction. Retained placenta is a significant cause of maternal morbidity and mortality throughout the developing world with a case mortality rate of nearly 10% in rural areas.[1,2] It is associated with complications which may have immediate and remote effects on the woman's reproductive life. Fibroid mass as a cause of ...

  14. 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.

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

    NARCIS (Netherlands)

    Fauser, Bart C. J. M.; Donnez, Jacques; Bouchard, Philippe; Barlow, David H.; Vazquez, Francisco; Arriagada, Pablo; 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

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

    DEFF Research Database (Denmark)

    Fauser, Bart C J M; Donnez, Jacques; Bouchard, Philippe

    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...... 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...... 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....

  17. Predictive factors for pelvic magnetic resonance in response to arterial embolization of a uterine leiomyoma

    Directory of Open Access Journals (Sweden)

    Eduardo Zlotnik

    2014-03-01

    Full Text Available OBJECTIVE: Minimally invasive methods are used as alternatives to treat leiomyomas and include uterine artery embolization, which has emerged as a safe, effective method. This study aims to evaluate the magnetic resonance imaging predictors for a reduction in leiomyoma volume in patients undergoing uterine artery embolization. METHODS: This prospective longitudinal study was performed at a university hospital. We followed 50 symptomatic premenopausal women with uterine leiomyomas who underwent uterine artery embolization. We examined 179 leiomyomas among these patients. Magnetic resonance imaging was performed one month before and six months after uterine artery embolization. Two radiologists who specialized in abdominal imaging independently interpreted the images. Main Outcome Measures: The magnetic resonance imaging parameters were the uterus and leiomyomas volumes, their localizations, contrast perfusion pattern and node-to-muscle ratio. RESULTS: Six months after treatment, the average uterine volume reduction was 38.91%, and the leiomyomas were reduced by 55.23%. When the leiomyomas were submucosal and/or had a higher node-to-muscle ratio in the T2 images, the volume reduction was even greater (greater than 50%. Other parameters showed no association. CONCLUSIONS: We conclude that symptomatic uterine leiomyomas in patients undergoing uterine artery embolization exhibit volume reductions greater than 50% by magnetic resonance imaging when the leiomyomas are submucosal and/or had a high node-to-muscle ratio in the T2 images.

  18. Rectal inflammatory fibroid polyp in a Nigerian: case report & brief ...

    African Journals Online (AJOL)

    yp of the stomach. Endoscopy. 1990;22(5):203-7. DOI: 10.1055/s-2007-1012848. 2. Hirasaki S, Matsubara M, Ikeda F, Taniguchi H, Suzuki. S. Inflammatory fibroid polyp occurring in the transverse colon diagnosed by endoscopic biopsy. World J Gastroen- terol. 2007; 13(27): 3765-3766. DOI: 10.3748/wjg.v13. i27.3765. 3.

  19. Gastric Inflammatory Fibroid Polyp Treated by Endoscopic Submucosal Dissection

    Directory of Open Access Journals (Sweden)

    Y. Hattori

    2008-08-01

    Full Text Available The endoscopic examination of a 64-year-old male patient revealed a gastric submucosal tumor in the anterior wall of the gastric antrum. The lesion increased in diameter to 25 mm and was resected completely with endoscopic submucosal dissection (ESD. Histological examination of the submucosal tumor gave a diagnosis of an inflammatory fibroid polyp (IFP. It is suggested that ESD may be an effective and safe therapy for gastric submucosal tumors.

  20. 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.

  1. Symptomatic epilepsy in children

    OpenAIRE

    Еlaginykh E.S.

    2014-01-01

    Research goals were to evaluate the etiological structure of symptomatic epilepsy in children, age structure of period of disease manifestation, average length of latent period among children with different characters of lesions, dependence between frequency of seizures and character of lesion. Material and methods. A total of 180 case-records of patients with symptomatic epilepsy were analyzed by the next criteria: anamnesis, materials of electroencephalogram and neurovisualization. Results....

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

    OpenAIRE

    Sukainah S.; Nasir TK; Zulkifli K.; Roziana R.

    2016-01-01

    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

  3. Uterine Didelphys with blind hemivagina, hematocolpos, ipsilateral renal agenesis (UD-BHRA) and bilateral ovarian tumors : a case report

    International Nuclear Information System (INIS)

    Lee, Young Rae; Choi, Byung Ik; Park, Hae Won; Kook, Shin Ho

    1998-01-01

    Uterine didelphys is a congenital malformation characterized by the presence of two separated hemiuteri and hemivaginas, due to lack of midfusion of the mullerian ducts. We report a case of UD-BHRA (uterine didelphys with blind hemivagina and ipsilateral renal agencies), a rare type of uterine dedelphys characterized by symptomatic unilateral hematocolpos due to blind hemivagina after menarche and ipsilateral renal agenesis. The MRI findings in 22-year-old woman with bilateral ovarian tumors demonstrated two separated uterine horns and cervical and vaginal canals, with left hematocolpos and left agenesis. (author). 7 refs., 1 fig

  4. The non-target bi-ovarian branches occlusion in fibroids embolization on resumption of menses and ovarian function

    International Nuclear Information System (INIS)

    Guo Wenbo; Yang Jianyong; Chen Wei; Zhuang Wenquan; Yao Shuzhong

    2005-01-01

    Objective: To evaluate the effect of the non-target bi-ovarian branches occlusion in fibroids embolization on resumption of menses and ovarian function. Methods: The patients with the non-target bi-ovarian branches occlusion in uterine fibroids embolization (UFE) were classified into two groups, one for lipiodol deposited in bi-ovarian areas (Group A) , another for non lipiodol deposited in ovarian areas or in single ovarian area (Group B of non lipiodol deposited in bi-ovarian areas). The statistical difference between the data of group A and group B were assessed with Fisher test. All UFE were performed with the mixture of lipiodol and pingyangmycin. The serum level of Follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) were measured before UFE and 6 months after UFE. The statistical difference between the data of before and after UFE was assessed with t test. Results: Fifteen patients [age ranged 26-46 years, average (39.00 ± 5.62) years] had been followed up for an average (30.5±6.4) months (range 16-47 months). In 12 of 15, regular menses resumed after an average of (3.0 ±0.3) weeks (range 2-6 weeks). In 3 of 15 (20%), regular menses did not resume. The sexual hormone findings of menopause were found in three cases with amenorrhea after UFE. Amenorrhea was found in three cases with lipiodol deposited in bi-ovarian areas (Group A). Non-amenorrhea was found in the group of non-lipiodol deposited in bi-ovarian areas (Group B). There were significant statistical difference between Group A and Group B (P=0.002 19). Non amenorrhea was found in the patients aged over 45 years old. Three patients were found amenorrhea in the patients aged younger than 45 years old. There were no significant statistical difference between the serum level of FSH, LH and E2 before and 6 months after UFE (P>0.05). Conclusion: The incidence of amenorrhea is very high in the patients with lipiodol deposited in bi-ovarian areas when the bi-ovarian branches of

  5. Puerperal uterine inversion managed by the uterine balloon ...

    African Journals Online (AJOL)

    The uterine inversion is a rare and severe puerperal complication. Uncontrolled cord traction and uterine expression are the common causes described.We report a case of uterine inversion stage III caused by poor management of the third stage of labor. It was about a 20 years old primigravida referred in our unit for ...

  6. Does coupling of uterine contractions reflect uterine dysfunction ...

    African Journals Online (AJOL)

    Patients who developed coupled contractions had a longer duration of labour, a higher uterine activity integral and an increased incidence of caesarean section for failure to progress. Because coupling of uterine contractions may be indicative of dysfunctional uterine activity, and hence a prolonged first stage of labour, ...

  7. The changes of serum levels of sexual hormones before and after uterine artery embolization

    International Nuclear Information System (INIS)

    Guo Wenbo; Yang Jianyong; Chen Wei; Zhuang Wenquan; Yao Shuzhong; Yu Shenping

    2002-01-01

    Objective: To investigate the changes of serum hormones before and after uterine artery embolization. Methods: 27 cases of uterine fibroids were performed with uterine artery embolization (UAE). In all cases, follicle stimulating hormone (FSH), luteinizing hormone (LH) and estriol (E2) were measured before and after the UAE. Results: The serum levels of FSH before embolization were (8.63 +- 10.33) IU/L and (15.8 +- 27.89) IU/L months after embolization. The serum levels of LH before embolization were (11.77 +- 12.21) IU/L and (25.79 +- 37.24) IU/L3 months after embolization. The serum levels of E2 before embolization were (160 +- 67) pg/ml and (184 +- 87) pg/ml 3 months after embolization. There was no statistical difference between the measurements of FSH, LH, E2 before UAE and after UAE (P > 0.05, t TEST). But FSH, LH, E2 appeared to have menopause change in two cases. Conclusions: Uterine artery embolization would not affect the serum levels of FSH, LH and E2

  8. Submucous Myoma Induces Uterine Inversion

    Directory of Open Access Journals (Sweden)

    Yu-Li Chen

    2006-06-01

    Conclusion: Nonpuerperal inversion of the uterus is rarely encountered by gynecologists. Diagnosis of uterine inversion is often not easy and imaging studies might be helpful. Surgical treatment is the method of choice in nonpuerperal uterine inversion.

  9. Spontaneous Expulsion of Intramural Fibroid Six Weeks after Emergency Caesarean Section

    Directory of Open Access Journals (Sweden)

    Balvinder Sagoo

    2015-01-01

    Full Text Available We present a thirty-six-year-old woman with a high risk pregnancy, complicated by multiple congenital anomalies, severe hyperemesis, a pulmonary embolus, and a large intramural fibroid. This fibroid grew in size during the pregnancy. At 34 + 5 weeks, there were reduced fetal movements and a pathological CTG. A live infant was delivered by an emergency cesarean section. Five weeks postpartum, she presented with abdominal pain, offensive vaginal discharge, and fevers. She was given antibiotics and ferrous sulphate. An abdominal ultrasound showed an 11 × 12 × 9 cm fibroid with a coarse degenerative appearance. Clinically, she showed signs of sepsis; a CT scan and laparotomy performed under general anesthetic did not find any collections as a source of sepsis. When stable, she was discharged. She re-presented two days later with a large mass (necrotic fibroid in her vagina. This is the first case of spontaneous expulsion of fibroid six weeks after caesarean section. Presentation of pain and fever after the delivery may be due to red degeneration of the fibroid, caused by diminished blood supply, ischaemia, and necrosis. This case highlights the importance of considering fibroids as a cause for abdominal pain during and after pregnancy, even up to 6 weeks after delivery.

  10. Uterine sarcoma - current perspectives.

    Science.gov (United States)

    Benson, Charlotte; Miah, Aisha B

    2017-01-01

    Uterine sarcomas comprise a group of rare tumors with differing tumor biology, natural history and response to treatment. Diagnosis is often made following surgery for presumed benign disease. Currently, preoperative imaging does not reliably distinguish between benign leiomyomas and other malignant pathology. Uterine leiomyosarcoma is the most common sarcoma, but other subtypes include endometrial stromal sarcoma (low grade and high grade), undifferentiated uterine sarcoma and adenosarcoma. Clinical trials have shown no definite survival benefit of adjuvant radiotherapy or chemotherapy and have been hampered by the rarity and heterogeneity of these disease types. There is a role of adjuvant treatment in carefully selected cases following multidisciplinary discussion at sarcoma reference centers. In patients with metastatic disease, systemic chemotherapy can then be considered. There is activity of a number of agents, including doxorubicin, trabectedin, gemcitabine-based chemotherapy, eribulin and pazopanib. Patients should be considered for clinical trial entry where possible. Close international collaboration is important to allow progress in this group of diseases.

  11. Uterine Vascular Lesions

    Science.gov (United States)

    Vijayakumar, Abhishek; Srinivas, Amruthashree; Chandrashekar, Babitha Moogali; Vijayakumar, Avinash

    2013-01-01

    Vascular lesions of the uterus are rare; most reported in the literature are arteriovenous malformations (AVMs). Uterine AVMs can be congenital or acquired. In recent years, there has been an increasing number of reports of acquired vascular lesions of the uterus following pregnancy, abortion, cesarean delivery, and curettage. It can be seen from these reports that there is confusion concerning the terminology of uterine vascular lesions. There is also a lack of diagnostic criteria and management guidelines, which has led to an increased number of unnecessary invasive procedures (eg, angiography, uterine artery embolization, hysterectomy for abnormal vaginal bleeding). This article familiarizes readers with various vascular lesions of the uterus and their management. PMID:24340126

  12. Perceived racial discrimination and risk of uterine leiomyomata.

    Science.gov (United States)

    Wise, Lauren A; Palmer, Julie R; Cozier, Yvette C; Hunt, Matthew O; Stewart, Elizabeth A; Rosenberg, Lynn

    2007-11-01

    The incidence of uterine leiomyomata (fibroids, myomas) is 2-3 times higher in black women than white women. Black women also report higher levels of racial discrimination. We evaluated the hypothesis that greater exposure to racism increases myoma risk in black women. Data were derived from the Black Women's Health Study, a prospective cohort study of US black women age 21-69 years in 1995. In 1997, women reported on "everyday" and "lifetime" experiences of racism. From 1997 through 2003, we followed 22,002 premenopausal women to assess the association between self-reported racism and risk of myomas. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated from Cox regression models. During 107,127 person-years of follow-up, 3440 new cases of uterine myomas confirmed by ultrasound (n = 2774) or surgery (n = 666) were reported. All IRRs for "lifetime" and "everyday" experiences of racism were above 1.0. Using a summary variable that averaged the responses from 5 "everyday" racism items, multivariable IRRs comparing quartiles 2, 3, and 4 to quintile 1 (lowest) were 1.16 (95% CI = 1.04-1.29), 1.19 (1.06-1.32), and 1.27 (1.14-1.43), respectively. Multivariable IRRs comparing women who reported 1, 2, or 3 lifetime occurrences of major discrimination (ie, job, housing, or police) relative to those who reported none were 1.04 (0.96-1.13), 1.17 (1.07-1.28), and 1.24 (1.10-1.39), respectively. Results did not vary according to case definition (ultrasound vs. surgery) or health care utilization. Associations were weaker among foreign-born women and among women with higher coping skills. Perceived racism was associated with an increased risk of uterine myomas in US-born black women.

  13. Therapeutic efficacy of uterine arterial embolization for intractable uterine hemorrhage

    International Nuclear Information System (INIS)

    Liu Lang; Lu Lianwei; Ke Mengjia; Zhao Ru'en; Zeng Shaolan

    2010-01-01

    Objective: To evaluate the therapeutic efficacy of uterine arterial embolization (UAE) for intractable uterine hemorrhage. Methods: 16 patients with intractable uterine hemorrhage underwent bilateral UAE after failed conventional conservative treatment. Results: Uterine hemorrhage ceased within 12 hours in 15 patients (93.8%) after bilateral super-selective UAE. Internal iliac artery embolization was performed on one patient (6.2%) and hysterectomy was eventually carried out because of recurrent hemorrhage. Conclusion: UAE is a rapid and effective treatment method obviating hysterectomy for intractable uterine hemorrhage. (authors)

  14. 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.

  15. Sonographic evaluation of surgical repair of uterine cesarean scar defects.

    Science.gov (United States)

    Pomorski, Michal; Fuchs, Tomasz; Rosner-Tenerowicz, Anna; Zimmer, Mariusz

    2017-10-01

    The aim of the study was to assess the clinical outcomes of surgical repair of uterine cesarean scar defects with sonography (US). Seven nonpregnant women with history of cesarean section and a large uterine scar defect were enrolled. The surgical repair was performed by minilaparotomy. The US assessment of the uterine scar was performed using a standardized approach at baseline, then at a first visit 2-3 days following the surgical intervention (V1) and at a follow-up visit 3 months later (V2). Residual myometrial thickness (RMT), width, and depth of the scar defect were measured. The mean RMT increased significantly from 1.9 mm at baseline to 8.8 mm at V1 and 8.0 mm at V2. No intraoperative complications were observed. Postmenstrual spotting and abdominal pain reported preoperatively resolved after the operation. A surgical repair procedure for an incompletely healed uterine cesarean scar is effective in increasing RMT thickness, decreasing the depth of the scar, and reducing symptoms related to the cesarean section scar defect. Further studies on post-repair pregnancy outcomes are required to evaluate whether the procedure affects the rate of cesarean scar pregnancy, morbidly adherent placenta, and/or uterine scar dehiscence and rupture. The repair of a cesarean scar defect is recommended only for symptomatic women. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:455-460, 2017. © 2017 Wiley Periodicals, Inc.

  16. Spontaneous uterine rupture

    African Journals Online (AJOL)

    ABSTRACT. Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 34 weeks in a 35 year old patient ...

  17. 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.

  18. The Feasibility of Contrast-Enhanced Ultrasound During Uterine Artery Embolization: A Pilot Study

    International Nuclear Information System (INIS)

    Dorenberg, Eric J.; Jakobsen, Jarl A.; Brabrand, Knut; Hafsahl, Geir; Smith, Hans-Jorgen

    2007-01-01

    Purpose. To evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) during uterine artery embolization (UAE) in order to define the correct end-point of embolization with complete devascularization of all fibroids. Methods. In this prospective study of 10 consecutive women undergoing UAE, CEUS was performed in the angiographic suite during embolization. When the angiographic end-point, defined as the 'pruned-tree' appearance of the uterine arteries was reached, CEUS was performed while the angiographic catheters to both uterine arteries were kept in place. The decision whether or not to continue the embolization was based on the findings at CEUS. The results of CEUS were compared with those of contrast-enhanced magnetic resonance imaging (MRI) 1 day as well as 3 months following UAE. Results. CEUS was successfully performed in all women. In 4 cases injection of particles was continued based on the findings at CEUS despite angiographically complete embolization. CEUS imaging at completion of UAE correlated well with the findings at MRI. Conclusion. The use of CEUS during UAE is feasible and may increase the quality of UAE

  19. Uterine Cancer: Cancer of the Uterus

    Science.gov (United States)

    ... receive Publications email updates Enter email Submit Uterine cancer Cancer of the uterus (uterine cancer) is cancer ... Institute . Expand all | Collapse all What is uterine cancer? Cancer is a disease in which certain body ...

  20. [Uterine arteriovenous malformation as cause of uterine bleeding of sudden onset. Doppler ultrasound utility, other imaging methods and the minimally invasive treatment].

    Science.gov (United States)

    Hernández-Escobar, C E; Carrillo-Martínez, M A; Arroyo-Lemarroy, T; ZamoraMorales, M T; Garza-García, G A; Campos-Sanmiguel, E

    2016-08-01

    Uterine arteriovenous malformation is a rare disorder that can cause sudden life-threatening vaginal bleeding. To present the clinical features in addition to the use of office gynecologic ultrasound and other imaging techniques in the diagnosis and minimally-invasive treatment of a patient with sudden vaginal bleeding resulting from a uterine arteriovenous malformation. A 31 year old woman presented sudden onset vaginal bleeding requiring the transfusion of 3 units of red blood cells. An initial diagnosis of uterine arteriovenous malformation was made using an office gynecological ultrasound and Color Doppler sonography. The patient was referred to interventional radiology for confirmation of the diagnosis and patient care. The diagnosis and localization of the uterine arteriovenous malformation was confirmed using magnetic resonance imaging. Therapeutic management proceeded with superselective angiography and embolization of the supplying arteries resulting in immediate symptomatic resolution. The use of office gynecologic ultrasound in combination with other imaging techniques is an important tool in the diagnosis and localization of uterine arteriovenous malformation. Embolization of supplying arteries is considered a safe and effective therapeutic option due to advances in radiologic intervention techniques. Advantages of this procedure include a minimally-invasive technique, low morbidity and preservation of uterine function.

  1. 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.

  2. Efficacy of ormeloxifene versus oral contraceptive in the management of abnormal uterine bleeding due to uterine leiomyoma.

    Science.gov (United States)

    Kriplani, Alka; Srivastava, Astha; Kulshrestha, Vidushi; Kachhawa, Garima; Agarwal, Nutan; Bhatla, Neerja; Hari, Smriti

    2016-12-01

    To compare ormeloxifene with combined oral contraceptive (COC) in abnormal uterine bleeding (AUB) due to leiomyoma (AUB-L). Fifty women with AUB-L were randomized after informed consent and institute ethics clearance. Group I (n = 25) was given ormeloxifene (a SERM i.e. selective estrogen receptor modulator) 60 mg twice per week and group II (n = 25) was given COC (ethinyl estradiol 30 μg with desogestrel 150 μg) on days 1-21 for 6 months. Menstrual blood loss was assessed on pictorial blood loss assessment chart (PBAC) score and leiomyoma volume was assessed on ultrasound. Fibroids were classified according to FIGO-PALM-COEIN classification for AUB where leiomyomas were further sub-classified as types 0 to 8 according to their location. Follow up was done at 1, 3, 6 and 9 months. Mean PBAC score reduced by 81% with ormeloxifene (group I) compared with 43.8% for COC (group II). After 6 months, 18 patients (72%) in group I had PBAC score in the non-menorrhagic range (adverse effect in either group. Ormeloxifene with its convenient twice-weekly dosage schedule was effective in treating AUB-L, with 72% of patients responding to 6-month treatment compared with 8% with COC, even though leiomyoma volume increased insignificantly with both ormeloxifene and COCs. © 2016 Japan Society of Obstetrics and Gynecology.

  3. Symptomatic mesodiverticular bands in children

    African Journals Online (AJOL)

    Materials and methods A computer-assisted (PubMed) search of the literature to identify all cases of symptomatic. MDB reported in English with patients' age ranging from. 0 to 14 years was performed. Results Eight cases of symptomatic MBD in pediatric age. (0–14 years) were found in the literature in the last. 50 years.

  4. Uterine culture in mares.

    Science.gov (United States)

    Brook, D

    1984-05-01

    A guarded, sterile swab is used to obtain samples for uterine culture. With the mare in stocks, the tail bandage and the perineum washed, the culture rod is introduced into the vagina with a gloved hand. After the rod is guided through the cervix, the guard cap is dislodged and the swab is rubbed along the endometrium, after which the rod is extracted. Samples for uterine culture should only be obtained during full estrus. Swabs should be directly plated onto agar within 2 hours of collection. Blood agar is appropriate for initial screening, but use of specialized types of agar expedites identification of microbes. Plates are incubated at 37 C and inspected for growth every 12 hours. The type and number of bacterial colonies should be coupled with the history and clinical signs in deciding on the necessity and type of treatment. Pure, heavy bacterial growth is usually accompanied by clinical signs of infection. Interpretation of the significance of moderate bacterial growth may be aided by cytologic examination of endometrial smears, made by rolling the swab onto a glass slide and staining with Diff - Quik . Large numbers of neutrophils indicate the need for antibiotic therapy. Mixed bacterial growth and variable numbers of neutrophils usually indicate faulty sampling technic. Microaerophilic or anaerobic cultures may aid diagnosis in cases of equivocal aerobic culture results.

  5. MR features of isolated uterine relapse in an adolescent with acute lymphoblastic leukaemia

    Energy Technology Data Exchange (ETDEWEB)

    Novellas, Sebastien; Fournol, Maude; Geoffray, Anne; Chevallier, Patrick [Regional Hospital Centre and University of Nice, Medical Imaging Service, Archet 2 Hospital, 151 route de Saint Antoine de Ginestiere, B.P. 3079, Nice Cedex 3 (France); Deville, Anne [Regional Hospital Centre and University of Nice, Paediatric Service, Archet 2 Hospital, Nice (France); Kurzenne, Jean-Yves [Regional Hospital Centre and University of Nice, Paediatric Surgery Service, Archet 2 Hospital, Nice (France)

    2008-03-15

    Relapses of lymphoblastic leukaemia traditionally involve the central nervous system and testes in boys. Involvement of the female pelvic organs is frequently found at autopsy; however, involvement of the cervical uterus is rare and even less commonly symptomatic. A 13-cm uterine mass was discovered in a 15-year-old adolescent with a history of lymphoblastic leukaemia during childhood. Pelvic MRI was the best tool to assess the size, characteristics and invasive nature of this lesion of the uterine cervix. To our knowledge, this is a unique case in that we describe the MRI appearance of a relapsing lymphoblastic leukaemic mass both before and after treatment. (orig.)

  6. Radiation Therapy, Paclitaxel, and Carboplatin in Treating Patients With Uterine Cancer

    Science.gov (United States)

    2015-01-16

    Stage IA Uterine Sarcoma; Stage IB Uterine Sarcoma; Stage IC Uterine Sarcoma; Stage IIA Uterine Sarcoma; Stage IIB Uterine Sarcoma; Stage IIIA Uterine Sarcoma; Stage IIIB Uterine Sarcoma; Stage IIIC Uterine Sarcoma; Stage IVA Uterine Sarcoma; Stage IVB Uterine Sarcoma; Uterine Carcinosarcoma

  7. Combining affinity propagation clustering and mutual information network to investigate key genes in fibroid.

    Science.gov (United States)

    Chen, Qian-Song; Wang, Dan; Liu, Bao-Lian; Gao, Shu-Feng; Gao, Dan-Li; Li, Gui-Rong

    2017-07-01

    The aim of the present study was to investigate key genes in fibroids based on the multiple affinity propogation-Krzanowski and Lai (mAP-KL) method, which included the maxT multiple hypothesis, Krzanowski and Lai (KL) cluster quality index, affinity propagation (AP) clustering algorithm and mutual information network (MIN) constructed by the context likelihood of relatedness (CLR) algorithm. In order to achieve this goal, mAP-KL was initially implemented to investigate exemplars in fibroid, and the maxT function was employed to rank the genes of training and test sets, and the top 200 genes were obtained for further study. In addition, the KL cluster index was applied to determine the quantity of clusters and the AP clustering algorithm was conducted to identify the clusters and their exemplars. Subsequently, the support vector machine (SVM) model was selected to evaluate the classification performance of mAP-KL. Finally, topological properties (degree, closeness, betweenness and transitivity) of exemplars in MIN constructed according to the CLR algorithm were assessed to investigate key genes in fibroid. The SVM model validated that the classification between normal controls and fibroid patients by mAP-KL had a good performance. A total of 9 clusters and exemplars were identified based on mAP-KL, which were comprised of CALCOCO2 , COL4A2 , COPS8 , SNCG , PA2G4 , C17orf70 , MARK3 , BTNL3 and TBC1D13 . By accessing the topological analysis for exemplars in MIN, SNCG and COL4A2 were identified as the two most significant genes of four types of methods, and they were denoted as key genes in the progress of fibroid. In conclusion, two key genes ( SNCG and COL4A2 ) and 9 exemplars were successfully investigated, and these may be potential biomarkers for the detection and treatment of fibroid.

  8. [Inflammatory fibroid polyp: a report of three cases including an oesophageal tumor].

    Science.gov (United States)

    Pavageau, Aude-Hélène; Valo, Isabelle; Lavoine, Eric; Bourgois, Jean-Louis; Verrièle, Véronique

    2009-12-01

    We report three different cases in location with an original occurrence in the oesophagus. The gross appearance showed polypoid pedonculated masses with a whitish cut surface, arising from the submucosa. On microscopic examination, the tumor consisted of spindle cell dispersed in a loose fibromyxoid stroma containing numerous blood vessels and inflammatory cells with abundant eosinophils. At immunohistochemistry, the cells were strongly positive for CD34. Inflammatory fibroid polyp is a rare benign lesion of the gastro-intestinal tract. The pathogenesis of this lesion remains throat and unclear. Diagnosis on biopsy is difficult with various histologic pattern and because the inflammatory fibroid polyp share common pathologic features with digestive spindle cells tumor.

  9. 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 ...

  10. Uterine artery blood flow in patients with copper intrauterine device-induced abnormal uterine bleeding

    Directory of Open Access Journals (Sweden)

    Usama M. Fouda

    2010-07-01

    Conclusion: The results of our study confirm the hypothesis that there is an increase in the uterine blood flow (as indicated by decreased PI and RI in uterine artery in women with CIUD-induced abnormal uterine bleeding.

  11. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications.

    Science.gov (United States)

    Tower, Amanda M; Frishman, Gary N

    2013-01-01

    The gynecologic sequelae due to deficient uterine scar healing after cesarean section are only recently being identified and described. These include conditions such as abnormal bleeding, pelvic pain, infertility, and cesarean scar ectopic pregnancy, as well as a potentially higher risk of complications and difficulties during gynecologic procedures such as uterine evacuation, hysterectomy, endometrial ablation, and insertion of an intrauterine device. The proposed mechanism of abnormal uterine bleeding is a pouch or "isthmocele" in the lower uterine segment that causes delayed menstrual bleeding. The prevalence of symptomatic or clinically relevant cesarean scar defects (CSDs) ranges from 19.4% to 88%. Possible risk factors for CSD include number of cesarean sections, uterine position, labor before cesarean section, and surgical technique used to close the uterine incision. There are no accepted guidelines for the diagnostic criteria of CSD. We propose that a CSD be defined on transvaginal ultrasound or saline infusion sonohysterography as a triangular hypoechoic defect in the myometrium at the site of the previous hysterotomy. We also propose a classification system to aid in standardized classification for future research. Surgical techniques for repair of CSD include laparoscopic excision, resectoscopic treatment, vaginal revision, and endometrial ablation. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  12. 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.

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

    International Nuclear Information System (INIS)

    Park, Jeong Seon; Lee, Do Yon; Kim, Yong Tae; Park, Ki Hyun; Park, Yong Won; Cho, Jae Sung; Kim, Myung Jun; Won, Je Hwan; Kang, Byung Chul

    1999-01-01

    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

  14. Abnormal uterine bleeding as a presenting symptom is related to multiple uterine leiomyoma: an ultrasound-based study

    Directory of Open Access Journals (Sweden)

    Fonseca-Moutinho JA

    2013-10-01

    Full Text Available José Alberto Fonseca-Moutinho,1,2 Lígia Silva Barbosa,1 Daniel Gonçalves Torres,1 Sara Morgado Nunes31Faculty of Health Sciences, School of Medicine, Beira Interior University, Covilhã, Portugal; 2Child and Women Department, Cova da Beira Academic Medical Center, Covilhã, Portugal; 3Polytechnic Institute of Castelo Branco, Castelo Branco, PortugalPurpose: To determine the prevalence of uterine leiomyomas, diagnosed by ultrasound, in a private health care setting located in the central eastern region of Portugal, and to explore the demographic and clinical factors related to diagnosis and symptomatology.Patients and methods: The files of 624 patients attending a private clinic in Covilhã, Portugal, from January 2 to December 31, 2010 were retrieved for evaluation. Pelvic ultrasound record, age, weight, height, age at menarche, number of pregnancies and deliveries, marital status, menstrual cycles characteristic, and contraceptive method at consultation were included in the analysis.Results: Uterine leiomyoma (UL was diagnosed by ultrasonography in 161 (25.8% patients. A single UL was diagnosed in 80 (49.7% patients. In 79 (49.1% patients, the largest leiomyoma had a dimension <20 mm. Prevalence of UL was age dependent: at 11.0% for women 20–39 years old; 45.4% for those aged 40–59 years; and 19.5% for women 60 years or older. Metrorrhagia was the most distressing presenting symptom. When menorrhagia was the presenting symptom, the probability of having an ultrasound diagnosis of UL was 73.3%. Metrorrhagia or menorrhagia, as presenting symptom, was significantly related to the ultrasound diagnosis of multiple ULs.Conclusion: UL was especially prevalent in women aged between 40 and 59 years. Patients with multiple ULs had significantly more abnormal uterine bleeding. In patients with menorrhagia or metrorrhagia, special attention should be taken in searching for the presence of multiple ULs during ultrasound.Keywords: fibroid, leiomyoma

  15. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    ... Metrorrhagia and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding ... of regular ovulation (anovulation). Doctors call the problem abnormal uterine bleeding (AUB) . AUB is more common in teenagers and ...

  16. Sterility of the uterine cavity

    DEFF Research Database (Denmark)

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

    1995-01-01

    In a prospective open study the sterility of the uterine cavity was evaluated in 99 women admitted for hysterectomy. The indications for hysterectomy were in most cases persistent irregular vaginal bleeding and fibromyomas of the uterus. Samples for both aerobic and anaerobic bacteria, Chlamydia ...... 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...

  17. Imaging of uterine cervix carcinoma

    International Nuclear Information System (INIS)

    Viala, J.

    2000-01-01

    Imaging of uterine cervix carcinoma has evolved during the last decade. Recent developments in magnetic resonance imaging have expanded the role of MRI in evaluating the pathology of uterine cervix carcinoma. MRI is now the modality of choice for tumor staging, evaluating tumor response to treatment, diagnosing recurrences and for evaluating pregnant patients. MRI images will soon be used to calculate dosimetry for brachytherapy with matching and fusion software. (author)

  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. The Natural Product Acivicin as a Tool for ABPP and the Activity of Serine Hydrolases in Uterine Fibroids

    OpenAIRE

    Kreuzer, Johannes

    2015-01-01

    The target proteins of acivicin and structure derived probes in tumor cells were identified using activity-based protein profiling. The target proteins were further characterized and their relation to the antitumor activity of acivicin pointed out. In a further project, the activity of serine hydrolases in myoma and myometrium was examined from tissue samples. This revealed a different activity of mast cell proteases. Mittels Activity-based Protein Profiling wurde eine Identifikation der Z...

  20. Short-course palliative radiotherapy for uterine cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hyun; Lee, Ju Hye; Ki, Yong Kan; Kim, Won Taek; Park, Dahl; Kim, Dong Won [Dept. of Radiation Oncology, Biomedical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of); Nam, Ji Ho; Jeon, Sang Ho [Dept. of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2013-12-15

    The purpose of this retrospective study was to evaluate the efficacy and feasibility of short-course hypofractionated radiotherapy (RT) for the palliation of uterine cervical cancer. Seventeen patients with cancer of the uterine cervix, who underwent palliative hypofractionated 3-dimensional conformal radiotherapy between January 2002 and June 2012, were retrospectively analyzed. RT was delivered to symptomatic lesions (both the primary mass and/or metastatic regional lymph nodes). The total dose was 20 to 25 Gy (median, 25 Gy) in 5 Gy daily fractions. The median follow-up duration was 12.2 months (range, 4 to 24 months). The median survival time was 7.8 months (range, 4 to 24 months). Vaginal bleeding was the most common presenting symptom followed by pelvic pain (9 patients). The overall response rates were 93.8% and 66.7% for vaginal bleeding control and pelvic pain, respectively. Nine patients did not have any acute side effects and 7 patients showed minor gastrointestinal toxicity. Only 1 patient had grade 3 diarrhea 1 week after completion of treatment, which was successfully treated conservatively. Late complications occurred in 4 patients; however, none of these were of grade 3 or higher severity. Short-course hypofractionated RT was effective and well tolerated as palliative treatment for uterine cervical cancer.

  1. Unexpected uterine leiomyosarcoma during laparoscopic hysterectomy

    DEFF Research Database (Denmark)

    Brink Laursen, Jacob; Istre, O.

    2016-01-01

    , Hungary; ulipristal acetate; UPA), and her symptoms were reduced. However, subsequently in September 2015, she was then admitted to the gynecologic department of a hospital because she had increased pain. A high level of C-reactive protein was found, and necrosis of the fibroid was assumed...... to be the reason. She decided in December 2015 to opt for a laparoscopic hysterectomy at the hospital because of her increasing pain and pressure symptoms caused by her fibroid and a lack of conviction that the pharmaceutical treatment was sufficient. During a preoperative examination, ultrasound showed a 106 × 73...

  2. 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.

  3. Distribution of CYP17α polymorphism and selected physiochemical factors of uterine leiomyoma in Barbados

    Science.gov (United States)

    Alleyne, Angela T.; Austin, Shane; Williams, Angela

    2014-01-01

    Uterine leiomyoma is a major reproductive health disease among women and in particular Black women. The present study sought to determine whether a single nucleotide polymorphism (SNP) of CYP17 (rs743572) was associated with the risk of developing uterine leiomyoma (UL) in affected women in Barbados; a majority Black population. It also sought to determine if BMI, waist circumference and oestradiol levels were associated with UL in this group. A total of 96 random persons were assessed in a case–control study using a PCR-RFLP assay, and measurements of body mass index, waist circumference, and oestradiol levels were also assessed. Our results showed no genetic association with the risk of UL and this gene. The genetic distribution of CYP 17α- alleles resembled a normal Hardy–Weinberg distribution, and a relatively low risk of 0.25 at a confidence interval at 95%, of UL disease development. However, a significant association was found between oestradiol levels and fibroids, as well as oestradiol levels and BMI, at P physiochemical factors comprising BMI, waist circumference, and oestrogen levels are disease indicators in this population. In conclusion, our findings suggest that obesity and its associated risk factors are important in a majority Black Caribbean population, although the sample size needs to be increased. PMID:25606420

  4. 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.

  5. 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.

  6. Secondary postpartum haemorrhage with uterine artery ...

    African Journals Online (AJOL)

    a left uterine artery PA, which measured 4 cm in diameter, with extravasation of contrast into a pocket that connected to the uterine cavity. After obtaining the patient's consent, selective left uterine artery embolisation was performed with a mixture of Gelfoam and contrast media, followed by one stainless steel coil insertion.

  7. Ultrasound assessment of endometrial cavity in perimenopausal women on oral progesterone for abnormal uterine bleeding: comparison of diagnostic accuracy of imaging with hysteroscopy-guided biopsy.

    Science.gov (United States)

    Dasgupta, Subhankar; Dasgupta, Shyamal; Sharma, Partha Pratim; Mukherjee, Amitabha; Ghosh, Tarun Kumar

    2011-11-01

    To investigate the effect of oral progesterone on the accuracy of imaging studies performed to detect endometrial pathology in comparison to hysteroscopy-guided biopsy in perimenopausal women on progesterone treatment for abnormal uterine bleeding. The study population comprised of women aged 40-55 years with complaints of abnormal uterine bleeding who were also undergoing oral progesterone therapy. Women with a uterus ≥ 12 weeks' gestation size, previous abnormal endometrial biopsy, cervical lesion on speculum examination, abnormal Pap smear, active pelvic infection, adnexal mass on clinical examination or during ultrasound scan and a positive pregnancy test were excluded. A transvaginal ultrasound followed by saline infusion sonography were done. On the following day, a hysteroscopy followed by a guided biopsy of the endometrium or any endometrial lesion was performed. Comparison between the results of the imaging study with the hysteroscopy and guided biopsy was done. The final analysis included 83 patients. For detection of overall pathology, polyp and fibroid transvaginal ultrasound had a positive likelihood ratio of 1.65, 5.45 and 5.4, respectively, and a negative likelihood ratio of 0.47, 0.6 and 0.43, respectively. For detection of overall pathology, polyp and fibroid saline infusion sonography had a positive likelihood ratio of 4.4, 5.35 and 11.8, respectively, and a negative likelihood ratio of 0.3, 0.2 and 0.15, respectively. In perimenopausal women on oral progesterone therapy for abnormal uterine bleeding, imaging studies cannot be considered as an accurate method for diagnosing endometrial pathology when compared to hysteroscopy and guided biopsy. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

  8. Uterine sarcoma – current perspectives

    Directory of Open Access Journals (Sweden)

    Benson C

    2017-08-01

    Full Text Available Charlotte Benson,1 Aisha B Miah1,2 1Sarcoma Unit, Royal Marsden Hospital, 2Department of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK Abstract: Uterine sarcomas comprise a group of rare tumors with differing tumor biology, natural history and response to treatment. Diagnosis is often made following surgery for presumed benign disease. Currently, preoperative imaging does not reliably distinguish between benign leiomyomas and other malignant pathology. Uterine leiomyosarcoma is the most common sarcoma, but other subtypes include endometrial stromal sarcoma (low grade and high grade, undifferentiated uterine sarcoma and adenosarcoma. Clinical trials have shown no definite survival benefit of adjuvant radiotherapy or chemotherapy and have been hampered by the rarity and heterogeneity of these disease types. There is a role of adjuvant treatment in carefully selected cases following multidisciplinary discussion at sarcoma reference centers. In patients with metastatic disease, systemic chemotherapy can then be considered. There is activity of a number of agents, including doxorubicin, trabectedin, gemcitabine-based chemotherapy, eribulin and pazopanib. Patients should be considered for clinical trial entry where possible. Close international collaboration is important to allow progress in this group of diseases. Keywords: sarcoma, leiomyosarcoma, endometrial stromal sarcoma, undifferentiated uterine sarcoma, leiomyoma

  9. Endometrium evaluation with high-field (3-Tesla) magnetic resonance imaging in patients submitted to uterine leiomyoma embolization

    International Nuclear Information System (INIS)

    Jacobs, Monica Amadio Piazza; Nasser, Felipe; Zlotnik, Eduardo; Messina, Marcos de Lorenzo; Baroni, Ronaldo Hueb

    2013-01-01

    To evaluate the endometrial alterations related to embolization of uterine arteries for the treatment of symptomatic uterine leiomyomatosis (pelvic pain and/or uterine bleeding) by means of high-field (3-Tesla) magnetic resonance. This is a longitudinal and prospective study that included 94 patients with a clinical and imaging diagnosis of symptomatic uterine leiomyomatosis, all of them treated by embolization of the uterine arteries. The patients were submitted to evaluations by high-field magnetic resonance of the pelvis before and 6 months after the procedure. Specific evaluations were made of the endometrium on the T2-weighted sequences, and on the T1-weighted sequences before and after the intravenous dynamic infusion of the paramagnetic contrast. In face of these measures, statistical analyses were performed using Student's t test for comparison of the results obtained before and after the procedure. An average increase of 20.9% was noted in the endometrial signal on T2-weighted images obtained after the uterine artery embolization procedure when compared to the pre-procedure evaluation (p=0.0004). In the images obtained with the intravenous infusion of paramagnetic contrast, an average increase of 18.7% was noted in the post-embolization intensity of the endometrial signal, compared to the pre-embolization measure (p<0.035). After embolization of the uterine arteries, there was a significant increase of the endometrial signal on the T2-weighted images and on the post-contrast images, inferring possible edema and increased endometrial flow. Future studies are needed to assess the clinical impact of these findings

  10. Gemcitabine Hydrochloride, Docetaxel, and Radiation Therapy in Treating Patients With Uterine Sarcoma That Has Been Removed By Surgery

    Science.gov (United States)

    2015-01-16

    Stage IA Uterine Sarcoma; Stage IB Uterine Sarcoma; Stage IC Uterine Sarcoma; Stage IIA Uterine Sarcoma; Stage IIB Uterine Sarcoma; Stage IIIA Uterine Sarcoma; Stage IIIB Uterine Sarcoma; Stage IIIC Uterine Sarcoma; Stage IVA Uterine Sarcoma; Stage IVB Uterine Sarcoma; Uterine Corpus Leiomyosarcoma

  11. 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.

  12. 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.

  13. Contrast-Enhanced Ultrasound for Evaluation of High-Intensity Focused Ultrasound Treatment of Benign Uterine Diseases

    Science.gov (United States)

    Cheng, Chong-Qing; Zhang, Rui-Tao; Xiong, Yu; Chen, Li; Wang, Jian; Huang, Guo-Hua; Li, Ke-Quan; Zhang, Lian; Bai, Jin

    2015-01-01

    Abstract As a noninvasive treatment technique, ultrasound-guided high-intensity focused ultrasound (HIFU) has been considered as a routine treatment for uterine fibroids and adenomyosis in China. Contrast-enhanced ultrasound (CEUS) has been proposed as another option to assess the treatment efficacy during HIFU treatment. The aim of this investigation is to evaluate the adverse effects of HIFU ablation for benign uterine diseases in a group of patients studied with ultrasound contrast agent (UCA), in comparison with a group of patients not exposed to UCA. From November 2010 to December 2013, 2604 patients with benign uterine diseases were treated with HIFU. Among them, 1300 patients were exposed to an UCA, whereas 1304 patients were not. During HIFU procedure, the incidences of leg pain, sacral/buttock pain, groin pain, treatment area pain, and the discomfort “hot” sensation on skin were higher in the patients who were exposed to SonoVue (Bracco, Milan, Italy) than those who were not (20.5% vs 11.7%, 52.5% vs 42.3%, 6.5% vs 4.5%, 68.9% vs 55.4%, and 48.1% vs 42.9%, respectively). Among the postoperative adverse effects, the incidence of lower abdominal pain was significantly higher in patients who were exposed to an UCA than those who were not (51.2% vs 39.9%, P < 0.05). Two patients who were exposed to an UCA had acute renal function failure. In conclusion, UCA may increase the incidences of some common HIFU-related adverse effects during HIFU treatment for benign uterine diseases, but most of which were acceptable and self-limited. After HIFU treatment, renal function should be monitored in patients with a history of hypertension or taking nonsteroidal anti-inflammatory drugs. PMID:25906100

  14. MR Imaging in symptomatic osteochondromas

    International Nuclear Information System (INIS)

    Kim, Soo Young; Kim, Jee Young; Kim, Sang Heum; Chun, Kyung Ah; Park, Young Ha

    1998-01-01

    The purpose of this study is to assess the MR findings of symptomatic osteochondromas. We evaluated 31 patients who between July, 1994 and May, 1997 underwent MR imaging for symptomatic osteochondroma. Fourteen were males and 17 were females, and their ages ranged from 8 to 49 (mean, 23) years. Using T1WI, T2WI and gadolinium-DTPA-enhanced T1WI, images were analysed according to signal intensity in the osseous component of the osteochondroma, thickness of the cartilage cap, and associated change in surrounding soft tissue. Clinical manifestation included a palpable mass or tendency to grow (n=22) and pain on movement (n=9). Complications were of three types : that which followed change in the osseous component of the tumor, associated change in surrounding soft tissue, and malignant transformation. In the osseous component, bone marrow edema or contusion was seen in 21 cases (67.7%), and in two (65%), fracture was observed. In surrounding soft tissue, muscle impingement was seen in 21 cases (67.7%), bursitis was in 7 cases (22.6 %), tenosynovitis in seven (22.6 %), and vascular compression in five (16.1 %). In three cases (9.7%), transformation to chondrosarcoma had occurred; two of these were derived from osteochondromatosis and one from a single osteochondroma. The thickness of the cartilage cap was as follow : 10 mm (n=3). In patients with symptomatic osteochondroma, MR imaging is useful for detecting both complications and malignant transformation. (author). 21 refs., 1 tab., 6 figs

  15. Successful live births after surgical treatments for symptomatic cesarean scar pregnancies: report of 3 cases.

    Science.gov (United States)

    Yang, Gayoung; Lee, Daeun; Lee, Sara; Jeong, Kyungah

    2014-01-01

    There is no current consensus on the best treatment modality for cesarean scar pregnancy (CSP) with favorable reproductive and pregnancy outcome. We treated 3 cases of symptomatic CSP with fetal cardiac activity. The first case underwent laparoscopic repair at 6 weeks' gestational age of unruptured CSP. The second patient underwent laparoscopic repair due to massive vaginal bleeding after suction curettage. Both patients conceived naturally 6 months later and underwent repeated cesarean section at term. These were successful live births although the second patient was treated with uterine artery embolization for postpartum hemorrhage. The last patient underwent emergency exploratory laparotomy due to ruptured CSP and delivered a preterm baby. Earlier surgical treatment of CSP is indicated for a subsequent successful pregnancy and live birth. The laparoscopic approach might be advisable prior to uterine rupture. © 2014 S. Karger AG, Basel.

  16. Inflammatory responses after laparoscopic uterine myomectomy compared to open surgery in current clinical practice

    International Nuclear Information System (INIS)

    Holub, Z.; Kliment, L.; Jabor, A.; Sprongl, L.

    2006-01-01

    Objective was to determine the differences in inflammatory response and clinical outcome of current clinical practice in women undergoing laparoscopic myomectomy (LM) and abdominal myomectomy (AM) for symptomatic fibroid. A total of 36 women entered the study between October 2004 to June 2005 at the Department of Gynecology and Obstetrics and the Endosopy Training Center at the Baby Friendly Hospital in Klando, Czech Republic, based upon an ultrasonographic assessment size of dominant fibroid (DM) before surgery. All women were allocated to one of 2 groups: group 1 (n=17), DM -6cm, treated with open myomectomy. Surgical characteristics, hospital stay and complications were analyzed. Blood samples for assay of the acute phase reactants and markers of tissue trauma [C-reactive protein (CRP), interleukin-6 (IL-6), serum amyloid kinase (CK)] were taken preoperatively and on the first and third postoperative day. The difference between the groups in mean size of DM was statistically significant (4.8 cm in group 1 versus 6.9 cm in group 2, p<0.05). Statistically, significant differences were found between the compared groups in intra-operative blood loss (p<0.05) and length of hospital stay (p<0.001). No complication was reported after LM. There were significantly higher levels of CRP, IL-6, SAA, WBC and CK in both groups after surgery. Increased levels of IL-6, WBC and CK were greatest on the first postoperative day in the open group. The serum CRP, IL-6, SAA, WBC, CK and the fall in the hemoglobin were statistically different between the 2 groups. Compared with open myomectomy, LM was associated with a less intensive inflammatory response and a more favorable clinical outcome. (author)

  17. Acquire uterine vascular malformation: Clinical outcome of transarterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Chae Hoon [Dept. of Radiology, Gangneung Asan Hospital, Gangneung (Korea, Republic of); Yang, Seung Boo; Goo, Dong Erk; Kim, Yong Jae; Lee, Jae Myung; Lee, Woong Hee [Dept. of Radiology, Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of)

    2017-02-15

    To evaluate clinical outcomes of transarterial embolization of bilateral uterine arteries (UAE) in patients with acquired uterine vascular malformation (UVM). This retrospective study was performed on the medical records of all 19 patients who underwent transarterial embolization of bilateral UAE for the treatment of symptomatic UVMs from January 2003 to June 2011. Embolization was performed via the unilateral femoral artery approach with a catheter and angiographic techniques. Clinical success was defined as definitive resolution of abnormal vaginal bleeding. Post-procedural complications included all adverse events related to the embolization procedure. A total of 20 procedures were performed in 19 patients. One patient required repeat embolization because of incomplete embolization related to prominent high flow malformation. Clinically, in all patients, bleeding was controlled immediately after embolization. No complications occurred in all patients during the follow up period. In all patients who underwent successful UAE, menstrual cycles were normally restored within 1-2 months. Normal pregnancy with term delivery was observed in two of the 19 cases. Transarterial bilateral UAE is a safe and effective treatment in patients with vaginal bleeding caused by acquired UVM, and it allows the possibility of future pregnancy.

  18. Uterine rupture without previous caesarean delivery

    DEFF Research Database (Denmark)

    Thisted, Dorthe L. A.; H. Mortensen, Laust; Krebs, Lone

    2015-01-01

    OBJECTIVE: To determine incidence and patient characteristics of women with uterine rupture during singleton births at term without a previous caesarean delivery. STUDY DESIGN: Population based cohort study. Women with term singleton birth, no record of previous caesarean delivery and planned...... vaginal delivery (n=611,803) were identified in the Danish Medical Birth Registry (1997-2008). Medical records from women recorded with uterine rupture during labour were reviewed to ascertain events of complete uterine rupture. Relative Risk (RR) and adjusted Relative Risk Ratio (aRR) of complete uterine...... rupture with 95% confidence intervals (95% CI) were ascertained according to characteristics of the women and of the delivery. RESULTS: We identified 20 cases with complete uterine rupture. The incidence of complete uterine rupture among women without previous caesarean delivery was about 3...

  19. 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.

  20. Review literature on uterine carcinosarcoma.

    Science.gov (United States)

    Singh, Rajendra

    2014-01-01

    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.

  1. Uterine sarcoma – current perspectives

    Science.gov (United States)

    Benson, Charlotte; Miah, Aisha B

    2017-01-01

    Uterine sarcomas comprise a group of rare tumors with differing tumor biology, natural history and response to treatment. Diagnosis is often made following surgery for presumed benign disease. Currently, preoperative imaging does not reliably distinguish between benign leiomyomas and other malignant pathology. Uterine leiomyosarcoma is the most common sarcoma, but other subtypes include endometrial stromal sarcoma (low grade and high grade), undifferentiated uterine sarcoma and adenosarcoma. Clinical trials have shown no definite survival benefit of adjuvant radiotherapy or chemotherapy and have been hampered by the rarity and heterogeneity of these disease types. There is a role of adjuvant treatment in carefully selected cases following multidisciplinary discussion at sarcoma reference centers. In patients with metastatic disease, systemic chemotherapy can then be considered. There is activity of a number of agents, including doxorubicin, trabectedin, gemcitabine-based chemotherapy, eribulin and pazopanib. Patients should be considered for clinical trial entry where possible. Close international collaboration is important to allow progress in this group of diseases. PMID:28919822

  2. Abnormal uterine bleeding in perimenopause.

    Science.gov (United States)

    Goldstein, S R; Lumsden, M A

    2017-10-01

    Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office or primary-care setting. The wider availability of diagnostic tools has allowed prompt diagnosis and treatment of an increasing number of menstrual disorders in an office setting. This White Paper reviews the advantages and disadvantages of transvaginal ultrasound, blind endometrial sampling and diagnostic hysteroscopy. Once a proper diagnosis has been established, appropriate therapy may be embarked upon. Fortunately, only a minority of such patients will have premalignant or malignant disease. When bleeding is sufficient to cause severe anemia or even hypovolemia, prompt intervention is called for. In most of the cases, however, the abnormal uterine bleeding will be disquieting to the patient and significantly affect her 'quality of life'. Sometimes, reassurance and expectant management will be sufficient in such patients. Overall, however, in cases of benign disease, some intervention will be required. The use of oral contraceptive pills especially those with a short hormone-free interval, the insertion of the levonorgestrel intrauterine system, the incorporation of newer medical therapies including antifibrinolytic drugs and selective progesterone receptor modulators and minimally invasive treatments have made outpatient therapy increasingly effective. For others, operative hysteroscopy and endometrial ablation are proven therapeutic tools to provide both long- and short-term relief of abnormal uterine bleeding, thus avoiding, or deferring, hysterectomy.

  3. Dual repressive effect of angiotensin II-type 1 receptor blocker telmisartan on angiotensin II-induced and estradiol-induced uterine leiomyoma cell proliferation.

    Science.gov (United States)

    Isobe, Aki; Takeda, Takashi; Sakata, Masahiro; Miyake, Asako; Yamamoto, Toshiya; Minekawa, Ryoko; Nishimoto, Fumihito; Oskamoto, Yoko; Walker, Cheryl Lyn; Kimura, Tadashi

    2008-02-01

    Although uterine leiomyomas or fibroids are the most common gynecological benign tumor and greatly affect reproductive health and well-being, the pathophysiology and epidemiology of uterine leiomyomas are poorly understood. Elevated blood pressure has an independent, positive association with risk for clinically detected uterine leiomyoma. Angiotensin II (Ang II) is a key biological peptide in the renin-angiotensin system that regulates blood pressure. In this study, we investigated the potential role of Ang II (1-1000 nM) in the proliferation of rat ELT-3 leiomyoma cells in vitro. RT-PCR and western blot analysis with cell proliferation and DNA transfection assays were performed to determine the mechanism of action of Ang II. Ang II induced ELT-3 leiomyoma cell proliferation (P estradiol-induced cell proliferation (P < 0.01). AT(1)R, but not AT(2)R, plays a role in Ang II-induced ELT-3 cell proliferation. These experimental findings in vitro highlight the potential role of Ang II in the proliferation of leiomyoma cells.

  4. 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.

  5. MR Imaging in symptomatic osteochondromas

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Soo Young; Kim, Jee Young; Kim, Sang Heum; Chun, Kyung Ah; Park, Young Ha [Catholic University of Korea, Seoul (Korea, Republic of)

    1998-06-01

    The purpose of this study is to assess the MR findings of symptomatic osteochondromas. We evaluated 31 patients who between July, 1994 and May, 1997 underwent MR imaging for symptomatic osteochondroma. Fourteen were males and 17 were females, and their ages ranged from 8 to 49 (mean, 23) years. Using T1WI, T2WI and gadolinium-DTPA-enhanced T1WI, images were analysed according to signal intensity in the osseous component of the osteochondroma, thickness of the cartilage cap, and associated change in surrounding soft tissue. Clinical manifestation included a palpable mass or tendency to grow (n=22) and pain on movement (n=9). Complications were of three types : that which followed change in the osseous component of the tumor, associated change in surrounding soft tissue, and malignant transformation. In the osseous component, bone marrow edema or contusion was seen in 21 cases (67.7%), and in two (65%), fracture was observed. In surrounding soft tissue, muscle impingement was seen in 21 cases (67.7%), bursitis was in 7 cases (22.6 %), tenosynovitis in seven (22.6 %), and vascular compression in five (16.1 %). In three cases (9.7%), transformation to chondrosarcoma had occurred; two of these were derived from osteochondromatosis and one from a single osteochondroma. The thickness of the cartilage cap was as follow : < 5 mm (n=16), 5-10 mm (n=12), and > 10 mm (n=3). In patients with symptomatic osteochondroma, MR imaging is useful for detecting both complications and malignant transformation. (author). 21 refs., 1 tab., 6 figs.

  6. [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.

  7. Symptomatic management in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Pushkar Shah

    2015-01-01

    Full Text Available Multiple sclerosis (MS is the commonest cause of disability in young adults. While there is increasing choice and better treatments available for delaying disease progression, there are still, very few, effective symptomatic treatments. For many patients such as those with primary progressive MS (PPMS and those that inevitably become secondary progressive, symptom management is the only treatment available. MS related symptoms are complex, interrelated, and can be interdependent. It requires good understanding of the condition, a holistic multidisciplinary approach, and above all, patient education and empowerment.

  8. 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

  9. Immunohistochemical analysis of collagen expression in uterine leiomyomata during the menstrual cycle

    Science.gov (United States)

    IWAHASHI, MASAAKI; MURAGAKI, YASUTERU; IKOMA, MAKOTO; MABUCHI, YASUSHI; KOBAYASHI, AYA; TANIZAKI, YUUKO; INO, KAZUHIKO

    2011-01-01

    To investigate the possible involvement of collagen in the characteristic features of human leiomyoma, type I, III and IV collagen expression was determined at the protein level in normal myometrium and leiomyoma tissues throughout the menstrual cycle. The tissues were obtained from 40 pre-menopausal women (29–53 years of age) at various stages of the menstrual cycle who were undergoing abdominal hysterectomy for symptomatic uterine leiomyoma. Immunohistochemical staining was performed with specific monoclonal antibodies against type I, III and IV collagen in the leiomyoma and the myometrial tissues. Immunohistochemical analysis revealed that type I collagen expression was increased in the leiomyoma tissues at the protein level as compared to that in the normal myometrium tissues throughout the menstrual cycle. These results suggest that increased expression of type I collagen plays a key role in the pathogenesis of uterine leiomyoma. PMID:22977499

  10. Does coupling ofuterine contractions reflect uterine dysfunction?

    African Journals Online (AJOL)

    Abstract In a cohort analytical study 47 primigravidas in spontaneous nonnal labour at tenn were divided into two groups depending on the presence or absence of coupled uterine contractions during active labour. During Inonitoring with a pressure- tip intra-uterine catheter, 24 patients developed coupled contractions and ...

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

    Science.gov (United States)

    ... Feelings Expert Answers Q&A Movies & More for Teens Teens site Sitio para adolescentes Body Mind Sexual Health ... English Español Abnormal Uterine Bleeding (AUB) KidsHealth / For Teens / Abnormal Uterine Bleeding (AUB) What's in this article? ...

  12. Hysterosalpingography in itrogenic uterine fistula | Nwankwo | West ...

    African Journals Online (AJOL)

    Fistulae were found in the fornices of the patients and these were the openings through which the contrast refluxed into the vagina preventing demonstration of the uterine cavity and fallopian tubes. These fistulae were cannulated after using the volselum forceps to clip the anterior and posterior lips of the cervix. The uterine ...

  13. Intrasellar Symptomatic Salivary Gland Rest

    Directory of Open Access Journals (Sweden)

    Chih-Hao Chen

    2007-05-01

    Full Text Available Ectopic salivary gland tissue in sellar turcica is frequently observed in microscopic examination at autopsy. This tissue is considered clinically silent. Only 2 symptomatic cases have been previously reported. Here we report a 28-year-old woman presenting with galactorrhea and hyperprolactinemia. Magnetic resonance imaging revealed a 6×5-mm nodule in the posterior aspect of the pituitary gland. This nodule showed isointensity on T1- and T2-weighted images and less enhancement on post-contrast T1-weighted images. Transsphenoidal exploration revealed a cystic lesion within the pituitary gland, which consisted of a grayish gelatinous content. The pathologic examination confirmed the diagnosis of salivary gland rest.

  14. Desired Diversity and Symptomatic Anxiety

    DEFF Research Database (Denmark)

    Friis Christensen, Jannick; Muhr, Sara Louise

    2018-01-01

    This paper conceptualises organisational diversity as constituted by psychoanalytic lack. Empirically, we show how diversity as Lacanian lack is understood as nothing in or of itself, but as an empty signifier with no signified. The lack of diversity becomes a catalyst for desiring particular ideas...... of diversity that, however, constantly change due to the empty form of diversity. Anxiety manifests itself in the obsession of unobtainable idealised forms of diversity as well as in the uncertainty associated with the traumatic experience of always falling short of what is desired in an object...... – the experience of failed diversity. Conclusively, we discuss the productive potential of the power of lack. The impossibility of diversity is what, at once, conditions the possibility of diversity. We therefore suggest that the symptomatic anxiety provoked by the lack should be enjoyed in order to engage...

  15. Symptomatic outcome after laparoscopic cholecystectomy.

    Science.gov (United States)

    Niranjan, B; Chumber, S; Kriplani, A K

    2000-01-01

    Patients with gallstones often present with multiple complaints. We wanted to study the major complaints of our patients undergoing laparoscopic cholecystectomy and the symptomatic relief afforded by the operation. We studied 113 patients with symptomatic gallstone disease who underwent laparoscopic cholecystectomy in a single surgical unit. Patients with proven common bile duct stones, obstructive jaundice, cholangitis, present or past associated abdominal pathology or cholecystoenteric fistula were excluded from the study. The mean follow up period was 18 months (range 10-22 months). A detailed account of the symptoms of gallstones, length of post-operative stay, persistence of symptoms, development of fresh symptoms and resumption of fat containing diet were assessed. The male to female ratio was 1:4. Common presenting symptoms were abdominal pain (96%), flatulence or feeling of fullness of abdomen (85%), heartburn (66%), belching (62%), sour eructation (52%), vomiting (48%) and nausea (45%). Mean postoperative hospital stay was 28 hours (range 9-68 hours). Biliary pain was relieved in 99% of patients after laparoscopic cholecystectomy (p cholecystectomy. Fresh symptoms that developed after laparoscopic cholecystectomy were heart-burn (6%), belching (3.5%), sour eructation (1%) and vomiting (0.5%). Post-cholecystectomy post-prandial diarrhoea occurred in 20% of the patients. The patients' appreciation of a satisfactory cosmetic result of operation scars was 100 percent. Fifteen female patients (13.5%) complained of increased weight gain of more than 5 kg after laparoscopic cholecystectomy [(p > 0.05; not significant (NS)]. Laparoscopic cholecystectomy significantly relieved symptoms of gall stone disease. Biliary pain, nausea, vomiting and sour eructations had better outcome compared to belching, flatulence and heartburn, which are also relieved in majority. Postcholecystectomy post-prandial diarrhea was a significant new symptom after cholecystectomy. Pre

  16. Comparison of clinical outcomes and spectral Doppler indices of uterine and ovarian stromal arteries in women undergoing myomectomy with or without hypogastric arterial ligation.

    Science.gov (United States)

    Fu, H-C; Huang, K-H; Tseng, C-W; Liang, H-M; Lin, H; Chou, Y-J; Kung, F-T

    2006-11-01

    To compare clinical outcomes and hemodynamic alterations of uterine and ovarian stromal arteries between patients with symptomatic myomas undergoing myomectomy preceded by arterial ligation and those undergoing myomectomy alone. In this prospective, non-randomized comparative study, myomectomy was performed on 69 women with symptomatic myomas. Myomectomy alone was performed in 31 patients (Group I) and myomectomy with concomitant bilateral hypogastric arterial ligation was performed in 38 patients (Group II). In both groups, surgical results and clinical outcomes were evaluated by peripheral hemoglobin levels, a pictorial blood-loss assessment chart, and visual analog scales. Spectral Doppler indices of uterine and ovarian stromal arteries, including peak systolic velocity, end-diastolic velocity, pulsatility index and resistance index were performed preoperatively, and 1 day and 1 or more months postoperatively. Twenty-two patients in Group I and 31 patients in Group II received regular follow-up examinations for a mean follow-up period of 10.1 months. Menstrual flow, dysmenorrhea and hemoglobin levels improved significantly after surgery in both groups. Blood loss during surgery was less in Group II than it was in Group I (P=0.02). Doppler indices of uterine and ovarian stromal arteries from preoperation to mean follow-up point were not significantly different between the groups, except for a significantly lower uterine artery pulsatility index in Group II (P=0.01). Myomectomy with hypogastric arterial ligation for symptomatic myomas is as efficient as is myomectomy alone and reduces blood loss during surgery. Serial Doppler studies showed that hypogastric ligation does not block uterine and ovarian perfusion, and even reduces the impedance of the uterine arteries. The long-term recurrence rate after myomectomy with hypogastric arterial ligation remains to be determined. Copyright (c) 2006 ISUOG.

  17. Prevalence of Cyclospora cayetanensis among symptomatic and ...

    African Journals Online (AJOL)

    Naguib M. Massoud

    2012-04-24

    Apr 24, 2012 ... There was no sig- nificant difference between symptomatic Cyclospora infected and noninfected cases as regards the duration of diarrhea and clinical presentations. Conclusion: Cyclospora infection in immune-competent symptomatic and asymptomatic children in Alexandria is common. Physicians should ...

  18. Symptomatic mesodiverticular bands in children | Bertozzi | Annals ...

    African Journals Online (AJOL)

    Symptomatic mesodiverticular bands in children. ... Abstract. Objective: The aim of this study was to review the English literature about a rare condition such as symptomatic mesodiverticular bands (MDBs) in children. Background: The MDB is an ... All cases reported an intestinal occlusion as clinical picture. Internal hernia ...

  19. 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.)

  20. Symptomatic splenomegaly and palliative radiotherapy

    International Nuclear Information System (INIS)

    Yaneva, M.; Vlaikova, M.

    2005-01-01

    We analysed the effect of irradiation of an enlarged spleen in some hematologic diseases: chronic myelaemia, osteomyelophybrosis and chronic lymphadenosis, where splenectomy had been contraindicated and where pain has been a leading symptom and also the discomfort because of an enlarged spleen. For 20 years in the Clinic of Radiotherapy have been treated 23 patients with the above mentioned diseases. We have irradiated all patients using X-ray and later- Co-60. To reach a palliative effect we have irradiated patients with single doses from 50 cGy to 100 cGy with an interval of 2-3 days between each fraction, but the total doses have been different- from 400 cGy to 1500 cGy. The enlarged spleen has reached the pelvis in 3 cm to 17 cm below the costal margin, and in some patients has crossed the median line of the body going in some centimetres on the other side. The reduction of splenic size and volume is as follows: full reduction in 6 patients (26.1%) and partial in 17 (73.9%). All patients resulted in decreases in pain and tension in abdomen and the total discomfort. No serious side haematologic effects were encountered. Our experience indicates that cautious splenic irradiation can be a safe and useful therapeutic alternative. The symptomatic palliation in patients, where splenectomy is not an option, is effective and is an additional alternative for an improvement of their general condition

  1. Embolization of iatrogenic uterine pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Luca Boi

    2017-05-01

    Full Text Available Uterine artery pseudoaneurysms (UAPs are rare vascular lesions that may be life threatening if not diagnosed and properly treated. The clinical presentation of UAPs includes a spectrum of symptoms that are often associated with other and more frequent gynecologic/obstetric pathologies, both with and without vaginal bleeding, and may span from postpartum hemorrhage to the absence of symptoms. We report cases of two patients with UAP, both of whom were diagnosed with ultrasonography and contrast-enhanced computed tomography and successfully treated with transcatheter embolization. The first patient presented delayed hypovolemic shock following surgery for endometriosis, whereas the second patient suffered from postpartum hemorrhage after cesarean section. Diagnosis of UAPs relies on noninvasive imaging; transcatheter arterial embolization is an effective treatment to control bleeding in both hemodynamically stable and unstable patients.

  2. Prolactin receptors in uterine leiomyomas

    International Nuclear Information System (INIS)

    Baban, Rayah S.; Farid, Yahya Y.; Al-Zuheiri, Shatha T.

    2008-01-01

    Objective was to identify the location of prolactin receptors in patientswith uterine leiomyomas and their host myometrium as well as normalmyometrium. A case control study was conducted at the College of MedicineAl-Nahrain University, Baghdad, Iraq during the period from 2004-2006. Thesamples were collected at Obstetrics and Gynecological Departments of 4hospitals in Baghdad City (Al-Khadimiya Teaching Hospital, Al-Noor,Al-Kharch, and Al-Sadoon Hospital). Sections from large and small tumors(n=53) with their host myometriums and from normal myometriums (n=40) werestained immunohistochemically for prolactin receptors. Prolactin receptorswere positively seen in all cases examined including patient and comparisontissues, in the form of dark brown staining. Staining was heterogeneous andvaried in intensity from one case to another and sometimes from one are toanother in the same section. The increase in prolactin receptors in leiomyomais expected given that the underlying host myometrium abnormal. (author)

  3. Uterine prolapse prevention in Eastern Nepal

    DEFF Research Database (Denmark)

    Radl, Christina Mathilde; Rajwar, Ranjita; Aro, Arja R.

    2012-01-01

    Abstract: Uterine prolapse is a major reproductive health issue in Nepal. There is a wide range of literature available on the causes and risk factors of uterine prolapse and on the ways to prevent and treat it. There is still a lack of published evidence on what prevention and treatment services......: It was found that patriarchy, gender discrimination, and cultural traditions such as early marriage and pregnancy make it difficult for people to discontinue uterine prolapse risk behaviors. Women are aware of risk factors, prevention, and treatment, but are powerless to change their situations. Health......, should be conducted. Furthermore, the involvement of other target groups (husbands, adolescents, and mothers-in-law) needs to be increased in order to make it easier for women to adapt low-risk behaviors. Finally, uterine prolapse prevention should be better integrated in national reproductive health...

  4. Postmenopausal spontaneous uterine perforation: Case report

    Science.gov (United States)

    İşlek Seçen, Elçin; Ağış, Hilal; Altunkaya, Canan; Avşar, Ayşe Filiz

    2015-01-01

    Spontaneous uterine rupture and generalized peritonitis caused by pyometra occurs rarely with high morbidity and mortality. A correct and definite diagnosis can be made with laparotomy or laparoscopy. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and gynecologic symptoms are less frequent, which makes preoperative diagnosis difficult. We report a case of a patient aged 82 years who underwent surgery for spontaneous uterine rupture and generalized peritonitis as a result of pyometra. PMID:28913055

  5. Uterine rupture at Lagos University Teaching Hospital

    OpenAIRE

    Omololu Adegbola; Adesumbo Kanyinsola Odeseye

    2017-01-01

    Background: Uterine rupture remains a major life-threatening obstetric disaster encountered in many developing countries and is associated with a high maternal and perinatal mortality and morbidity. Objectives: The objective of this study was to determine the incidence, associated risk factors, trend, clinical presentation, management as well as maternal and fetal outcome of uterine rupture at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Materials and Methods: This was a ret...

  6. [Hysteroscopic polypectomy, treatment of abnormal uterine bleeding].

    Science.gov (United States)

    de Los Rios, P José F; López, R Claudia; Cifuentes, P Carolina; Angulo, C Mónica; Palacios-Barahona, Arlex U

    2015-07-01

    To evaluate the effectiveness of the hysteroscopic polypectomy in terms of the decrease of the abnormal uterine bleeding. A cross-sectional and analytical study was done with patients to whom a hysteroscopic polypectomy was done for treating the abnormal uterine bleeding, between January 2009 and December 2013. The response to the treatment was evaluated via a survey given to the patients about the behavior of the abnormal uterine bleeding after the procedure and about overall satisfaction. The results were obtained after a hysteroscopic polypectomy done to 128 patients and were as follows. The average time from the polypectomy applied until the survey was 30.5 months, with a standard deviation of 18 months. 67.2% of the patients reported decreased abnormal uterine bleeding and the 32.8% reported a persistence of symptoms. On average 82.8% of the. patients were satisfied with the treatment. Bivariate and multivariate analysis showed no association between the variables studied and no improvement of abnormal uterine bleeding after surgery (polypectomy). There were no complications. Hysteroscopic polypectomy is a safe surgical treatment, which decreases on two of three patients the abnormal uterine bleeding in the presence of endometrial polyps, with an acceptable level of satisfaction.

  7. Hysterectomy for complications after uterine artery embolization for leiomyoma: results of a Canadian multicenter clinical trial.

    Science.gov (United States)

    Pron, Gaylene; Mocarski, Eva; Cohen, Marsha; Colgan, Terence; Bennett, John; Common, Andrew; Vilos, George; Kung, Rose

    2003-02-01

    To determine the complication-related hysterectomy rate after uterine artery embolization (UAE) for symptomatic uterine leiomyomas. Prospective, multicenter, nonrandomized, single-arm clinical trial (Canadian Task Force classification II-2). Eight Ontario University-affiliated teaching and community hospitals. Five hundred fifty-five women. Polyvinyl alcohol particles were delivered through a catheter into uterine arteries under fluoroscopic guidance. Prospective follow-up investigations consisted of telephone interviews, ultrasound examinations, and reviews of pathology and surgery reports. Median follow-up was 8.1 months, and all but five patients had complete 3-month follow-up. At 3 months, eight women (1.5%, 95% CI 0.6-2.8) underwent complication-related hysterectomy. Half of the surgeries were performed at institutions other than where UAE had been performed. Indications for hysterectomies were infections (2), postembolization pain (4), vaginal bleeding (1), and prolapsed leiomyoma (1). The 3-month complication rate resulting in hysterectomy after UAE in a large cohort of women was low. Hysterectomy after UAE is an important measure of safety and a key outcome measure of this new therapy.

  8. Antenatal risk factors for symptomatic congenital CMV disease following primary maternal CMV infection.

    Science.gov (United States)

    Hadar, Eran; Salzer, Liat; Dorfman, Elizabeta; Amir, Jacob; Pardo, Joseph

    2016-04-01

    This study aimed to evaluate antenatal risk factors associated with symptomatic congenital cytomegalovirus (CMV) disease, following in utero vertical infection. This study included a retrospective cohort of 155 neonates with congenital CMV infection, following primary maternal CMV infection during pregnancy, and were divided to symptomatic (n=95) and asymptomatic (n=60) newborns. Young maternal age (29.1±5.12 vs. 31.6±5.36 years, P=0.005), high risk occupation for viral exposure (20.0% vs. 11.7%, P=0.04), CMV IgG seroconversion at diagnosis (83.1% vs. 63.3%, P=0.005) and abnormal fetal MRI (11.6% vs. 0%, P=0.003) were found to be prognostic risk factors associated with symptomatic CMV disease of the newborn. Maternal febrile illness at diagnosis, IgG avidity, US findings and the timing of maternal infection were not associated with the occurrence of neonatal symptoms. Knowledge of the reported risk factors may assist in counseling parents with intra uterine CMV infection.

  9. Successful pulpal anesthesia for symptomatic irreversible pulpitis.

    Science.gov (United States)

    Drum, Melissa; Reader, Al; Nusstein, John; Fowler, Sara

    2017-04-01

    Profound pulpal anesthesia after a successful inferior alveolar nerve block can be difficult to achieve when the clinical condition is a pulpal diagnosis of symptomatic irreversible pulpitis. The authors reviewed the literature as it relates to the anesthesia necessary for endodontic therapy of patients with painful, vital, mandibular teeth diagnosed with symptomatic irreversible pulpitis. Supplemental anesthetic techniques and medications are available that can be used to improve pulpal anesthesia for patients with the clinical condition of symptomatic irreversible pulpitis. The authors identified treatment recommendations for anesthesia in the case of symptomatic irreversible pulpitis based on a review of the available evidence. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

  10. Symptomatic pericardial cyst: a case series.

    Science.gov (United States)

    Najib, Mohammad Q; Chaliki, Hari P; Raizada, Amol; Ganji, Jhansi L; Panse, Prasad M; Click, Roger L

    2011-11-01

    Pericardial cysts are most commonly located at the cardiophrenic angle or, rarely, in the posterior or anterior superior mediastinum. The majority of pericardial cysts are asymptomatic and are found incidentally. Symptomatic pericardial cysts present with dyspnoea, chest pain, or persistent cough. We describe four patients with symptomatic pericardial cysts who were treated with either echocardiographically guided percutaneous aspiration or video-assisted thoracoscopic surgery, or both; thoracotomy; or conservative therapy.

  11. 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.

  12. Adenocarcinoma of the Uterine Cervix

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Eun Ji; Shin, Hyun Soo; Lee, Hyung Sik; Kim, Gwi Eon; Loh, Juhn Kyu; Suh, Chang Ok [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1991-12-15

    Survival data, prognostic factors, and patterns of failure were retrospectively analyzed for a total of 76 patients with adenocarcinoma of the uterine cervix treated between January 1981 and December 1987, which represents 4.1% of all primary cervical carcinomas treated, at Department of Radiation Oncology, Yensei Cancer Center, Yonsei University College of Medicine. The mean age of the patients was 49years(range, 27-79years) and the peak incidence was in the group 50 to 59years of age. More half of the patients were postmenopausal (46/76=60.5%). Most patients(76%)had abnormal vaginal bleeding either alone or in combination with other symptoms. The proportion of stage Iib was 43.4%. There were 4 major histologic subtypes: pure adenocarcinoma(48/76=63.2%), adenosquamous carcinoma(20/76=26.3%), papillary (5/76=6.6%) and clear cell carcinoma(3/76=3.9%). Of the many clinicopathologic variables evaluated for prognosis, the most significant prognostic factors were stage of disease and the size of tumor. The overall 5-year survival rate was 68%, and the 5-year survival rates for stage Ib, II and III were 90%, 66% and 54%, respectively. Control of pelvic tumors was achieved in 938%, 90.2% and 50.0% of cases of stage Ib, II and III disease, respectively. In present study, treatment modalities (radiation therapy alone/combined operative and radiation therapy) did not affect the local control of tumor and the survival.

  13. Relationship of uterine artery with ureter.

    Science.gov (United States)

    Ara, Z G; Khalil, M; Rahman, M H; Mannan, S; Sultana, S Z; Rahman, M M; Ahmed, M S; Zaman, K S; Islam, M S

    2008-07-01

    The study was done to see the relationship of right and left uterine artery with corresponding ureter. Their distance from lateral border of uterus and site of crossing in relation to internal os in Bangladeshi female were observed. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected from cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the relationship and distance of uterine artery where it crosses the corresponding ureter and the site of crossing in relation to internal os. In the present study our findings were compared with those of the standard text books. In this study, there were no variations regarding relations of right and left uterine artery with corresponding ureter. In all cases of all age groups, ureters were found to cross the uterine artery anteriorly on both sides. Site of crossing of uterine artery of both sides with ureter at the level of internal os was 50% in 2-12 years (Group A) 20.45% in 13-45 years (Group B) and 12.50% in 46-80 years (Group C) age group. Below the level of the os was found in remaining cases except one which crosses above the level of the os in group B. In this study mean distance of uterine artery where it crosses the ureter from lateral border of uterus was more on right side in all age groups, which was 1.67 cm, 2.30 cm and 2.11 cm in age Group A, B & C respectively.

  14. Air pollution and risk of uterine leiomyomata.

    Science.gov (United States)

    Mahalingaiah, Shruthi; Hart, Jaime E; Laden, Francine; Terry, Kathryn L; Boynton-Jarrett, Renée; Aschengrau, Ann; Missmer, Stacey A

    2014-09-01

    Air pollution, particularly from vehicle exhaust, has been shown to influence hormonal activity. However, it is unknown whether air pollution exposure is associated with the occurrence of uterine leiomyomata, a hormonally sensitive tumor of the uterus. For 85,251 women 25-42 years of age at enrollment in the Nurses' Health Study II, we examined proximity to major roadways and outdoor levels of particulate matter less than 10 microns (PM10) or 2.5 microns (PM2.5) or between 10 and 2.5 microns (PM10-2.5) in diameter for all residential addresses from September 1989 to May 2007. To be eligible for this analysis, a woman had to be alive and respond to questionnaires, premenopausal with an intact uterus, and without diagnoses of cancer or prevalent uterine leiomyomata. Incidence of ultrasound- or hysterectomy-confirmed uterine leiomyomata and covariates were reported on biennial questionnaires sent through May 2007. Multivariable time-varying Cox proportional hazard models were used to estimate the relationship between distance to road or PM exposures and uterine leiomyomata risk. During 837,573 person-years of follow-up, there were 7760 incident cases of uterine leiomyomata. Living close to a major road and exposures to PM10 or PM10-2.5 were not associated with an increased risk of uterine leiomyomata. However, each 10 μg/m increase in 2-year average, 4-year average, or cumulative average PM2.5 was associated with an adjusted hazard ratio of 1.08 (95% confidence interval = 1.00-1.17), 1.09 (0.99-1.19), and 1.11 (1.03-1.19), respectively. Chronic exposure to PM2.5 may be associated with a modest increased risk of uterine leiomyomata.

  15. Clinical application of uterine artery embolization in treating uterine scar pregnancy

    International Nuclear Information System (INIS)

    Li Tonghuai; Zheng Hongfeng

    2011-01-01

    Objective: To evaluate uterine artery embolization in treating uterine scar pregnancy. Methods: During the period from November 2007 to February 2010, 11 patients with uterine scar pregnancy were encountered in authors' hospital. All the patients had a history of lower uterine segment cesarean section. Four patients had to receive an emergency uterine artery embolization due to acute massive vaginal bleeding. The other 7 patients received intravenous chemotherapy with MTX (0.4 mg/kg/day, every 5 days as a treatment course). Emergency uterine artery embolization had to be carried out in three patients as they developed acute massive vaginal bleeding (blood loss ≥ 100 ml/hour) during the course of chemotherapy, while subsequent uterine artery embolization was performed in the remaining 4 patients after they had completed two courses of treatment when their blood HCG showed no significant decrease. The clinical results were analyzed. Results: Remarkable decrease in serum HCG was seen in all 11 patients after interventional management. The vaginal bleeding in 7 patients was significantly reduced within half an hour after uterine artery embolization. The uterus together with intact fertility was successfully preserved in all 11 patients. Conclusion: For the treatment of uterine scar pregnancy complicated by massive vaginal bleeding (blood loss ≥ 500 ml/24 h) and/or abnormal elevation of serum HCG (blood β-HCG ≥ 20000 IU/L), ectopic pregnancy with the mass diameter ≥ 5 cm, uterine artery embolization treatment is very safe and effective. This technique can well preserve female patient's uterus and fertility ability. It is of value to employ this treatment in clinical practice. (authors)

  16. Uterine biology in pigs and sheep

    Directory of Open Access Journals (Sweden)

    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.

  17. Uterine biology in pigs and sheep

    Science.gov (United States)

    2012-01-01

    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. PMID:22958877

  18. 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.

  19. Alternative Oral Agents in Prophylaxis and Therapy of Uterine Fibroids—An Up-to-Date Review

    Directory of Open Access Journals (Sweden)

    Michał Ciebiera

    2017-12-01

    Full Text Available Uterine fibroids (UFs are the most common tumors of the female genital tract. The effect of UFs on the quality of life and the overall cost of treatment are significant issues worldwide. Tumor size and location are the two specific factors which influence the occurrence of symptoms, the need for, and method of, treatment (some tumors require surgery while some can be treated with selected drugs. Primary prevention and treatment of early UF disease are worthy goals that might have a great impact on health care systems. Several treatments and prophylactic methods can be used in this endeavor. This publication presents current data about lesser-known substances which may have a beneficial effect on the treatment or prophylaxis of UFs and can be administered orally, serving as an alternative to (or complement of surgery or selective progesterone receptor modulators (SPRMs. Early prevention and treatment of UFs in women from high-risk groups should be our priority. Innovative forms of UF management are under intensive investigation and may be promising options in the near future. Many of them evaluated vitamin D, paricalcitol, epigallocatechin gallate (EGCG, elagolix, aromatase inhibitors (AIs, and cabergoline and deemed them to be safe and effective. The next step in such projects should be properly constructed randomized control trials (RCTs, carried out by successive phases.

  20. [Uterine rupture in the third trimester after a hysteroscopic metroplasty].

    Science.gov (United States)

    Chokri, A; Chekib, M; Fethi, Z; Anis, F; Sadok, M

    2000-01-01

    Uterine rupture during a pregnancy may occur following hysteroscopic metropasty. We report the case of a patient with a history of hysteroscopic resection complicated by of uterine rupture during pregnancy.

  1. Abnormal Uterine Bleeding Is Associated With Increased BMP7 Expression in Human Endometrium.

    Science.gov (United States)

    Richards, Elliott G; El-Nashar, Sherif A; Schoolmeester, John K; Keeney, Gary L; Mariani, Andrea; Hopkins, Matthew R; Dowdy, Sean C; Daftary, Gaurang S; Famuyide, Abimbola O

    2017-05-01

    Abnormal uterine bleeding (AUB), a common health concern of women, is a heterogeneous clinical entity that is traditionally categorized into organic and nonorganic causes. Despite varied pharmacologic treatments, few offer sustained efficacy, as most are empiric, unfocused, and do not directly address underlying dysregulated molecular mechanisms. Characterization of such molecular derangements affords the opportunity to develop and use novel, more successful treatments for AUB. Given its implication in other organ systems, we hypothesized that bone morphogenetic protein (BMP) expression is altered in patients with AUB and hence comprehensively investigated dysregulation of BMP signaling pathways by systematically screening 489 samples from 365 patients for differences in the expression of BMP2, 4, 6, and 7 ligands, BMPR1A and B receptors, and downstream SMAD4, 6, and 7 proteins. Expression analysis was correlated clinically with data abstracted from medical records, including bleeding history, age at procedure, ethnicity, body mass index, hormone treatment, and histological diagnosis of fibroids, polyps, adenomyosis, hyperplasia, and cancer. Expression of BMP7 ligand was significantly increased in patients with AUB (H-score: 18.0 vs 26.7; P reporting heavy menstrual bleeding (menorrhagia) as their specific AUB pattern demonstrated significantly higher BMP7 expression. Significantly, no differences in the expression of any other BMP ligands, receptors, or SMAD proteins were observed in this large patient cohort. However, expression of BMPR1A, BMPR1B, and SMAD4 was significantly decreased in cancer compared to benign samples. Our study demonstrates that BMP7 is a promising target for future investigation and pharmacologic treatment of AUB.

  2. Medical First-Trimester Termination of Pregnancy with Massive Fibroid Uterus

    Directory of Open Access Journals (Sweden)

    Michael Saad-Naguib

    2017-01-01

    Full Text Available First-trimester termination of pregnancy by medical or surgical route is highly effective with a low complication rate. Uterine abnormalities can complicate a procedure due to distortion of normal anatomy. In this case presentation, medical termination of pregnancy is performed using fetal intracardiac potassium chloride injection and intramuscular methotrexate.

  3. OSTEOPOROSIS AS A NOVEL MARKER OF UTERINE CANCER RISK FACTOR

    OpenAIRE

    Zena Abdul Monim Al-Jawadi; Zainab Mahfoth Al-noaymy

    2014-01-01

    Due to limited available information on the occurrence and treatment of uterine cancer, health institutions in major countries trend to study some factors and diseases that may relation or plays as predisposing factors of the occurrence of uterine cancer and the lack of previous studies on the impact of osteoporosis on the incidence of uterine cancer and the rapid spread of uterine cancer in recent years all over the world and till know the exact mechanism is not fully clear. This study focus...

  4. Uterine rupture at Lagos University Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Omololu Adegbola

    2017-01-01

    Full Text Available Background: Uterine rupture remains a major life-threatening obstetric disaster encountered in many developing countries and is associated with a high maternal and perinatal mortality and morbidity. Objectives: The objective of this study was to determine the incidence, associated risk factors, trend, clinical presentation, management as well as maternal and fetal outcome of uterine rupture at the Lagos University Teaching Hospital (LUTH, Lagos, Nigeria. Materials and Methods: This was a retrospective study of patients with uterine rupture at the LUTH, Idi-Araba, Lagos, Nigeria, from June 1, 2005 to May 31, 2013. The case records of patients in this period were retrieved from the medical health records department. The relevant data of sociodemographic characteristics, clinical presentation, management as well as maternal and perinatal outcome were collated using a structured questionnaire. Results: Of the 13,138 deliveries during the study period, there were eighty cases of uterine rupture giving a hospital incidence of 6.1/1000 deliveries. Patients with parities of 1 (28.36% and 2 (38.81% were identified to be at higher risk of uterine rupture. Previous caesarean section (46.28%, obstructed labor (26.87%, and injudicious use of oxytocin (16.42% were the common associated factors. Rupture along previous anterior scar was the most common site affected in 32.84%; repair with bilateral tubal ligation was the surgical procedure in most of the cases (47.76%. The case fatality rate for ruptured uterus was 11.94% for the mothers and the perinatal mortality rate of 791/1000 babies. Conclusion: Uterine rupture is a major cause of maternal and perinatal death in Lagos, Nigeria.

  5. Uterine Rupture due to Traumatic Assisted Fundal Pressure

    Directory of Open Access Journals (Sweden)

    Shen-Chuan Wei

    2006-06-01

    Conclusion: Assisted fundal pressure during painful delivery can be traumatic and results in uterine rupture. In this article, we suggest that uterine rupture should be considered whenever a pregnant woman experiences a sudden onset of abdominal pain during the course of assisted uterine fundal pressure.

  6. 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

    OpenAIRE

    Pasquapina Ciarmela; Soriful Islam; Pasquale Lamanna; Andrea Tranquilli; Mario Castellucci

    2016-01-01

    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 ge...

  7. Is a history of cesarean section a risk factor for abnormal uterine bleeding in patients with uterine leiomyoma?

    OpenAIRE

    Kinay, Tugba; Basarir, Zehra O.; Tuncer, Serap F.; Akpinar, Funda; Kayikcioglu, Fulya; Koc, Sevgi; Karakaya, Jale

    2016-01-01

    Objectives: To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. Methods: We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women?s Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnose...

  8. Radiotherapy for carcinoma of the uterine cervix with short uterine cavity

    International Nuclear Information System (INIS)

    Tsuchida, Emiko; Sugita, Tadashi; Matsumoto, Yasuo; Sasamoto, Ryuta; Sakai, Kunio; Sueyama, Hiroo; Yamanoi, Tadayoshi; Ito, Takeshi; Umetsu, Hisao

    2001-01-01

    We have reviewed 11 patients treated with radiotherapy for carcinoma of the uterine cervix with short uterine cavity less than 3 cm. They consisted of 5 patients with stump cancer and 6 with atrophic uterus. Two patients with stump cancer had local failure and died of tumor progression. The 5-year cause-specific survival was 82%. Rectal and bladder injuries occurred in 5 and 2 patients, respectively. These complications were observed frequently in the patients with atrophic uterus. (author)

  9. Uterine pathologies to be considered before uterus-preserving surgery in cases of uterine prolapse

    OpenAIRE

    Eskicioğu, Fatma; Özyurt, Beyhan

    2016-01-01

    Objective: Investigation of unpredictable risks due to abnormal uterine pathology after the choice of uterus-preserving reconstructive surgical procedure for women who have uterine prolapse and no other complaints was aimed.Methods: The data of 121 women (105 postmenopausal and 16 premenopausal) who underwent vaginal hysterectomy due to pelvic organ prolapse was examined and the post-hysterectomy histopathology results were evaluated.Results: Senile cystic atrophy was the most common endometr...

  10. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

    The intention of this study is to share the experience of the author in the occurrence, possible causative factors, and treatment of surgically symptomatic prolapsed lumbar and sacral intervertebral discs in females, and to compare this experience in Switzerland, Nigeria, and Jamaica using surgery records for a period of over ...

  11. Endovascular treatment of symptomatic intracranial atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    Syed I Hussain

    2011-02-01

    Full Text Available Abstract: Symptomatic intracranial atherosclerotic disease (ICAD is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis greater than 70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ICAD studies lead to the question that whether angioplasty and or stenting is a safe, suitable and efficacious therapeutic strategy in patients with critical stenoses that are deemed refractory to medical management. Most of the currently available data in support of angioplasty and or stenting in high risk patients with severe symptomatic ICAD is in the form of case series and randomized trial results of endovascular therapy versus medical treatment are awaited. This is a comprehensive review of the state of the art in the endovascular approach with angioplasty and or stenting of symptomatic intracranial atherosclerotic disease.

  12. Prevalence of Cyclospora cayetanensis among symptomatic and ...

    African Journals Online (AJOL)

    Microsporidia, Giardia lamblia and Hymenolepis nana were also detected in the symptomatic group. There was no significant difference as regards age and residency of Cyclospora positive and negative cases in both groups. In asymptomatic group, Cyclospora infected cases were males while in negative cases, 50% were ...

  13. Prevalence and incidence of symmetrical symptomatic peripheral ...

    African Journals Online (AJOL)

    Background. Symptomatic symmetrical peripheral neuropathy (SSPN) is common in patients with HIV infection. It is also a common adverse event associated with both tuberculosis (TB) treatment and antiretroviral therapy (ART), particularly stavudine. While tenofovir is the one of recommended first-line nucleotide reverse ...

  14. Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy.

    Science.gov (United States)

    Wald, Arnold

    2003-03-01

    Constipation, diarrhea, and symptomatic hemorrhoids are disorders common in the general population, particularly in women. These conditions, if mild, often are self-treated with various home remedies or nonprescription preparations. Few of these patients, moreover, are referred to gastroenterologists, as primary care providers generally are confident managing these conditions, unless they are severe, refractory to conventional management, or require additional diagnostic studies.

  15. Intra-uterine insemination for male subfertility

    NARCIS (Netherlands)

    Bensdorp, A. J.; Cohlen, B. J.; Heineman, M. J.; Vandekerckhove, P.

    2007-01-01

    BACKGROUND: Intra-uterine insemination (IUI) is one of the most frequently used fertility treatments for couples with male subfertility. Its use, especially when combined with ovarian hyperstimulation (OH) has been subject of discussion. Although the treatment itself is less invasive and expensive

  16. Dysfunctional uterine bleedings of a climacteric period

    International Nuclear Information System (INIS)

    Prilepskaya, V.N.

    1993-01-01

    Climacteric period of some women is complicated by dysfunctional uterine bleedings (DUB). Bearing in mind the fact that DUBS are caused by disorder of estrin rhysmic secretion, the paper presents the methods of differential diagnostics for investigations into functional disorders in the hypothalamus -hypophysis - ovaries - uterus system. The preference is given to roentgenologic and radioimmunologic diagnostic methods

  17. Uterine inversion complicating traditional termination of pregnancy ...

    African Journals Online (AJOL)

    Abortion services remain cladenstine and unsafe in most parts of Africa. This is a case of a mid-trimester abortion induced by traditional methods which resulted in uterine inversion, a previously unreported complication of induced abortion. Until abortion services are accessible and safe on the continent, morbidity and ...

  18. Intra-uterine hematoma in pregnancy

    DEFF Research Database (Denmark)

    Glavind, K; Nøhr, S; Nielsen, P H

    1991-01-01

    In 60 patients with a live fetus and an intra-uterine hematoma (IUH) proven by ultrasonic scanning the outcome of pregnancy was spontaneous abortion in 12% and premature delivery in 10%. No correlation between the outcome of the pregnancy and the maximum size of the hematoma or the week...

  19. CORRELATION BETWEEN UTERINE ARTERY FLOW VELOCITY ...

    African Journals Online (AJOL)

    CORRELATION BETWEEN UTERINE ARTERY FLOW VELOCITY WAVEFORMS AND ENDOMETRIAL HISTOPATHOLOGY IN WOMEN WITH PERIMENOPAUSAL AND POSTMENOPAUSAL BLEEDING. Dr. Ebtesam Saied, Dr. Ismail El Garhy(MD), Dr. Farid I. Hassan(MD), Dr. Adel-Gamil Abd-Allah, Abd El Shafy Ibrahim ...

  20. Ovarian function after uterine artery embolisation

    African Journals Online (AJOL)

    2009-08-05

    Aug 5, 2009 ... Premature menopause has been documented in 1 - 2% of patients after UAE and was believed to result from non- target embolisation of vessels to the ovaries from the uterine arteries.8 Doppler studies on ovarian vasculature showed evidence of significant vascular derangements in ovarian arterial ...

  1. Intestinal Infarctus following Dilatation and Uterine Curettage

    Directory of Open Access Journals (Sweden)

    N.M. Ngowe

    2007-03-01

    Full Text Available We present a case of intestinal infarctus through the vagina. This was a consequence of induced abortion done clandestinely. The main objective was to point out the surgical complications of uterine dilatation and curettage by means of this rare case.

  2. The significance of a uterine rupture in subsequent births.

    Science.gov (United States)

    Eshkoli, Tamar; Weintraub, Adi Yehuda; Baron, Joel; Sheiner, Eyal

    2015-10-01

    To determine whether women with a previous uterine rupture have a higher risk of adverse perinatal outcome in subsequent births. A retrospective study comparing all subsequent singleton cesarean deliveries (CD) of women with a previous uterine rupture, with CD of women with no such history, during the years 1988-2011 was conducted. Out of 34,601 singleton CD that occurred during the study period, 0.1 % (n = 46) were of women with a previous uterine rupture. Previous uterine rupture was significantly associated with preterm delivery (birth weight (<2500 g), cervical tears, and dehiscence of the uterine scar. Pregnancies following a previous uterine rupture were associated with lower Apgar scores at 5 min. However, the perinatal mortality rate did not differ between the two groups. A recurrent uterine rupture occurred in 15.2 % of patients with a previous uterine rupture. Previous uterine rupture is a risk factor for adverse maternal and perinatal outcome and specifically recurrent uterine rupture. Appropriate consultation regarding these risks is needed for patients with a previous uterine rupture.

  3. Area detection of uterine peristalsis using cine-MR images

    International Nuclear Information System (INIS)

    Sato, Tetsuo; Fujita, Nao; Nakai, Asako; Togashi, Kaori; Kuhara, Shigehide; Okada, Tomohisa

    2011-01-01

    In this paper, a technique for evaluating uterine peristalsis obtained by magnetic resonance images is proposed. Uterine peristalsis is the wavelike movement of uterine muscle contractions with rhythm and direction. Correlation between direction of uterine peristalsis and menstrual cycle has been reported, which is supposed to help sperm transpotation and implantation. While evaluation of uterine peristalsis has been done, they are very subjective and no quantitative evaluation has been established. In the proposed method the peristalsis area and their contraction intensity were calculated. The points of uterine peristalsis was estimated by the spatio-temporal map, which reflect the time series behavior of the intensities around points set on uterine endometrial boundaries. Then peristalsis area was decided as the estimated points. The contraction intensity was defined as the ratio of the signal intensity change in the peristalsis area. (author)

  4. Fibroid polyps of intestinal tract are inflammatory-reactive proliferations of CD34-positive perivascular cells.

    Science.gov (United States)

    Wille, P; Borchard, F

    1998-06-01

    Our aim was to determine the histogenesis of fibroid polyps (FP). These polyps are rare inflammatory-reactive, tumour-like lesions of unknown aetiology, arising in the submucosa or mucosa of the gastrointestinal tract. They are mainly due to a proliferation of characteristic spindle cells. Nine FP were investigated by light microscopy and immunohistochemistry with endothelial markers (Factor VIII, CD34, CD31), a neuronal marker (S100), muscular markers (desmin, alpha-smooth muscle actin) and histiocytic markers (PGMI, KP1, MAC387) using the highly sensitive avidin-biotin-peroxidase technique. We demonstrate, for the first time, a consistent positivity of the characteristic spindle cells of FP for CD34. The proposed endothelial, histiocytic or neuronal origin of FP could be completely ruled out. Because of the consistent positivity of the spindle cells of FP for CD34 we suggest an origin of these lesions from primitive perivascular or vascular cells. This origin and a probable relationship to gastrointestinal stromal tumours (GIST) is discussed.

  5. Is a history of cesarean section a risk factor for abnormal uterine bleeding in patients with uterine leiomyoma?

    Science.gov (United States)

    Kinay, Tugba; Basarir, Zehra O; Tuncer, Serap F; Akpinar, Funda; Kayikcioglu, Fulya; Koc, Sevgi; Karakaya, Jale

    2016-08-01

    To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding. In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding. A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors.

  6. Uterine and chorioallantoic angiogenesis and changes in the uterine epithelium during gestation in the viviparous lizard, niveoscincus conventryi (Squamata: Scincidae).

    Science.gov (United States)

    Ramírez-Pinilla, Martha Patricia; Parker, Scott L; Murphy, Christopher R; Thompson, Michael B

    2012-01-01

    We used immunofluorescent confocal microscopy and scanning electron microscopy to quantify uterine vascularity and to describe uterine surface morphology during gestation in pregnant females of the lecithotrophic lizard Niveoscincus coventryi. As uterine angiogenesis and epithelial cell morphology are thought to be under progesterone control, we studied the effect of a progesterone receptor antagonist (mifepristone) on uterine and chorioallantoic microvasculature and features of the uterine epithelial surfaces. Although intussuceptive angiogenesis was observed in both, uterine and chorioallantoic, vascular beds during gestation, the only significant increases were in the diameters of the uterine vessels. An ellipsoid vessel-dense area grows in the mesometrial hemisphere of the developing conceptus, which parallels the expansion of the allantois to form the chorioallantoic placenta. Uterine surface topography changed during gestation. In particular, uterine blood vessels bulge over the luminal surface to form marked ridges on the uterine embryonic hemisphere, especially during the last stage of pregnancy, and ciliated cells are maintained in the embryonic and abembryonic hemispheres but disappear in both the mesometrial and antimesometrial poles. This distinct regionalization of uterine ridges and ciliated cells in the uterine surface and in the shape of the epithelial component of the chorion might be related to the function of both chorioallantoic and yolk sac placentae during gestation. There was no significant difference between females treated with or without mifepristone, which may be related to the partial function of mifepristone as a progestin antagonist and/or with the function and time of action of progesterone in the uterus during gestation in N. coventryi. Differences in the pattern of angiogenesis and uterine surface morphology during gestation among squamates may be related to the functional diversity of the uterine component of the different

  7. Uterine massage for preventing postpartum haemorrhage.

    Science.gov (United States)

    Hofmeyr, G Justus; Abdel-Aleem, Hany; Abdel-Aleem, Mahmoud A

    2013-07-01

    Postpartum haemorrhage (PPH) (bleeding from the genital tract after childbirth) is a major cause of maternal mortality and disability, particularly in under-resourced areas. In these settings, uterotonics are often not accessible. There is a need for simple, inexpensive techniques which can be applied in low-resourced settings to prevent and treat PPH. Uterine massage is recommended as part of the routine active management of the third stage of labour. However, it is not known whether it is effective. If shown to be effective, uterine massage would represent a simple intervention with the potential to have a major effect on PPH and maternal mortality in under-resourced settings. To determine the effectiveness of uterine massage after birth and before or after delivery of the placenta, or both, to reduce postpartum blood loss and associated morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013). All published, unpublished and ongoing randomised controlled trials comparing uterine massage alone or in addition to uterotonics before or after delivery of the placenta, or both, with non-massage. Two researchers independently considered trials for eligibility, assessed risk of bias and extracted the data using the agreed form. Data were checked for accuracy. The effect of uterine massage commenced before or after placental delivery were first assessed separately, and then the combined for an overall result. This review included two randomised controlled trials. The first trial included 200 women who were randomised to receive uterine massage or no massage following delivery of the placenta, after active management of the third stage of labour including use of oxytocin. The numbers of women with blood loss more than 500 mL was small, with no statistically significant difference (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.16 to 1.67). There were no cases of retained placenta in either group. The mean

  8. Hysterosalpingography

    Medline Plus

    Full Text Available ... and to determine the presence and severity of tumor masses, adhesions and uterine fibroids. Hysterosalpingography can occasionally ... the presence and severity of these abnormalities, including: Tumor masses Adhesions Uterine fibroids Hysterosalpingography is also used ...

  9. Hemodynamics of ovarian veins: MR angiography in women with uterine leiomyomata

    International Nuclear Information System (INIS)

    Kin, Yoko; Katsumori, Tetsuya; Kasahara, Toshiyuki; Nozaki, Taiki; Ito, Hirotoshi; Nishimura, Tsunehiko

    2007-01-01

    Purpose: The passive reflux into ovarian veins (OVs) is well known as a common finding in normal asymptomatic women. The purpose of this study was to investigate the hemodynamics of OVs in women with myomatous uterus. Materials and methods: Thirty-two women with symptomatic uterine leiomyomata underwent time-of-flight MR (TOF-MR) angiography, including venography and arteriography, and contrast-enhanced MRI. The frequency of reflux into OVs on TOF-MR angiography was retrospectively assessed with uterine volume, and compared to that of normal women in previous publication. The statistical evaluation was performed using Fisher's exact test. Results: The mean uterine volume was 932 ± 612 ml (range, 301-2627 ml). The reflux into left OVs was observed in 4 of 32 women (13%) and that into right OVs was noted in 0 of 32 women (0%). These rates were significantly lower than those of normal asyptomatic women in the previous publication (p < 0.05). The reflux into OVs was observed in 0 of 19 women (0%) with 600 ml or larger myomatous uterus, whereas it was noted in 4 of the remaining 13 women (31%) with less than 600 ml myomatous uterus, with significant difference between the two groups (p = 0.02). Conclusions: We found that reflux into OVs was infrequent in the vast majority of women with myomatous uterus, especially those with larger uterus due to leiomyomata on the basis of TOF-MR angiography. These findings suggested myomatous uterus could affect the flow direction of OVs, and passive reflux into OVs might be prevented due to the influence of antegrade flow of OVs

  10. Uterine sarcoma Part II—Uterine endometrial stromal sarcoma: The TAG systematic review

    Directory of Open Access Journals (Sweden)

    Huann-Cheng Horng

    2016-08-01

    Full Text Available Endometrial stromal tumors are rare uterine tumors (<1%. Four main categories include endometrial stromal nodule, low-grade endometrial stromal sarcoma (LG-ESS, high-grade endometrial stromal sarcoma (HG-ESS, and uterine undifferentiated sarcoma (UUS. This review is a series of articles discussing the uterine sarcomas. LG-ESS, a hormone-dependent tumor harboring chromosomal rearrangement, is an indolent tumor with a favorable prognosis, but characterized by late recurrences even in patients with Stage I disease, suggesting the requirement of a long-term follow-up. Patients with HG-ESS, based on the identification of YWHAE-NUTM2A/B (YWHAE-FAM22A/B gene fusion, typically present with advanced stage diseases and frequently have recurrences, usually within a few years after initial surgery. UUS is, a high-grade sarcoma, extremely rare, lacking a specific line of differentiation, which is a diagnosis of exclusion (the wastebasket category, which fails to fulfill the morphological and immunohistochemical criteria of translocation-positive ESS. Surgery is the main strategy in the management of uterine sarcoma. Due to rarity, complex biological characteristics, and unknown etiology and risk factors of uterine sarcomas, the role of adjuvant therapy is not clear. Only LG-ESS might respond to progestins or aromatase inhibitors.

  11. New techniques using transcervical uterine cannulation for the diagnosis of uterine disorders in bitches.

    Science.gov (United States)

    Watts, J R; Wright, P J; Lee, C S; Whithear, K G

    1997-01-01

    A technique for collecting uterine samples from bitches without the need for surgery was developed. This technique involved visualizing the cervix with a rigid endoscope and passing a catheter through the cervix into the uterus. Samples for microbiology and cytology were obtained by the infusion and aspiration of sterile normal saline. This technique allowed uterine microbiology and cytology of the normal bitch throughout the reproductive cycle. Microorganisms were frequently recovered from the uterus during pro-oestrus and oestrus, but rarely at other stages of the reproductive cycle. The uterine microflora often reflected the vaginal microflora during pro-oestrus and oestrus. The cells found in uterine cytology samples from normal bitches included endometrial epithelial cells, leukocytes, erythrocytes, cervical cells, spermatozoa and bacteria. The types, proportions, morphology and numbers of cells varied throughout the reproductive cycle. The endoscope could be passed into the uterus and the endometrium examined from parturition until day 23 post partum. These procedures and contrast hysterography were used to investigate the reproductive tract of bitches. The above techniques have facilitated the diagnosis of postpartum metritis (n = 3), pyometra (n = 2), endometritis (n = 1), abortion (n = 1), retained placenta (n = 1), postpartum uterine rupture (n = 1), endometrial subinvolution (n = 1) and misalliance (n = 1) in 21 bitches investigated.

  12. Expression and prognostic value of lactate dehydrogenase-A and -D subunits in human uterine myoma and uterine sarcoma.

    Science.gov (United States)

    Song, Ke-Juan; Yu, Xiao-Ni; Lv, Teng; Chen, Yu-Long; Diao, Yu-Chao; Liu, Su-Li; Wang, Yan-Kui; Yao, Qin

    2018-04-01

    This study aimed to determine the expression of lactate dehydrogenase (LDH)-A and LDH-D in patients with uterine myoma, cellular leiomyoma (CLM), and uterine sarcoma and to evaluate their prognostic significance. Protein expression levels of LDH-A and LDH-D were determined in tissue samples from 86 patients (26 uterine myoma, 10 CLM, 50 uterine sarcoma) by immunohistochemistry and their associations with clinicopathologic parameters and outcomes were analyzed in patients with uterine sarcoma. The positivity rates for LDH-A and LDH-D were significantly higher in patients with uterine sarcoma compared with those with uterine myoma or CLM (P sarcoma were classified as having uterine leiomyosarcoma (LMS), malignant endometrial stromal sarcoma, and malignant mixed Mullerian tumor, with 5-year overall survival rates of 59%, 71%, and 29%, respectively (P sarcoma. Furthermore, the overexpressions of LDH-A and LDH-D in uterine sarcoma patients may contribute to further understanding of the mechanism of LDH in tumor metabolism in uterine sarcoma. Positive expression of LDH-A in patients with LMS may act as a potential prognostic biomarker in these patients.

  13. Radiation therapy of the uterine cancer

    International Nuclear Information System (INIS)

    Noguchi, Hiroshi

    1999-01-01

    Cervical and endometrial cancer of the uterus, and ovarian cancer are three major malignant diseases in gynecology in Japan. These diagnosis and therapy are almost established. In uterine cervical cancer, radiation therapy and surgery of these diseases are two main treatment methods, and both treatment results are almost the same. And radiation therapy is also used as postoperative treatment to patients with high risk factors. In endometrial cancer, surgery is main therapy. Radiation therapy is undergone only to medically inoperable cases preoperative radiation is widely carried out in Europe and America, but almost none in Japan. Postoperative irradiation is adapted to the cases with high risk factors. But recent advance of chemotherapy changes the importance of radiation therapy in such patients. I review the literatures of radiation therapy of uterine cervical cancer and of endometrial cancer. (author)

  14. Uterine artery embolization for cervical ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Qiao Zhou, MD

    2015-12-01

    Full Text Available A 36-year-old woman with 3 prior C-sections is diagnosed with a caesarean scar ectopic pregnancy. Despite receiving intramuscular and transvaginal methotrexate injection 2 months before presentation, the beta human chorionic gonadotropin was recorded to be 73 mIU/mL at the time of encounter. The patient complained of vaginal bleeding with a significant drop in hematocrit from 40% to 33%. Transvaginal ultrasound confirmed retroplacental hemorrhage and because of the patient's desire to retain fertility, interventional radiology was consulted to perform an uterine artery embolization. The uterine artery embolization was successful in achieving hemostasis and resulted in a decrease of betaHCG to 46 on postprocedure day 1 to <1 mIU/mL by postoperative week 3.

  15. Epidemiology of Uterine Myomas: A Review

    Directory of Open Access Journals (Sweden)

    Radmila Sparic

    2016-12-01

    Full Text Available Myomas are the most common benign tumors of the genital organs in women of childbearing age, causing significant morbidity and impairing their quality of life. In our investigation, we have reviewed the epidemiological data related to the development of myomas in order to homogenize the current data. Therefore, a MEDLINE and PubMed search, for the years 1990-2013, was conducted using a combination of keywords, such as "myoma," "leiomyoma," "fibroids," "myomectomy," "lifestyle," "cigarette," "alcohol," "vitamins," "diet," and "hysterectomy". Randomized controlled studies were selected based upon the authors’ estimation. Peer-reviewed articles examining myomas were sorted by their relevance and included in this research. Additional articles were also identified from the references of the retrieved papers and included according to authors’ estimation. Many epidemiologic factors are linked to the development of myomas; however, many are not yet fully understood. These factors include age, race, heritage, reproductive factors, sex hormones, obesity, lifestyle (diet, caffeine and alcohol consumption, smoking, physical activity and stress, environmental and other influences, such as hypertension and infection. Some of the epidemiological data is conflicting. Thus, more research is needed to understand all the risk factors that contribute to myoma formation and how they exactly influence their onset and growth.

  16. Isotope applications on uterine cervix cancer

    International Nuclear Information System (INIS)

    Pinto, A.C.L.C.; Vigna Filho, E. del

    1978-01-01

    Techniques for the treatment of uterine cervix carcinoma are presented with isotopes used in the Instituto de Radioterapia Geral e Megavoltagem de Minas Gerais - Belo Horizonte (Brazil). Gynecological applicators, dosimetry care, diagnostic methods, stage and treatment are described that are the same as in the M.D. Anderson Hospital and Tumor Institute, Houston, Texas. The need for the use of 'After-loading' methods is emphasized, as well as radium substitutes, mainly Cs-137 and accurate dosimetry [pt

  17. Uterine Necrosis Associated with Fusobacterium necrophorum Infection

    Directory of Open Access Journals (Sweden)

    T. Widelock

    2015-01-01

    Full Text Available Fusobacterium necrophorum is infrequently implicated as a pathogenic organism. When pathogenic, the typical clinical presentation is that of pharyngitis, cervical adenopathy, and unilateral thrombophlebitis of the internal jugular vein. Infections caused by Fusobacterium necrophorum within the fields of obstetrics and gynecology have been infrequently reported. We describe a 19-year-old woman who underwent a cesarean delivery complicated by sepsis and purulent uterine necrosis secondary to Fusobacterium necrophorum infection.

  18. Uterine disorders and pregnancy complications: insights from mouse models

    OpenAIRE

    Lim, Hyunjung Jade; Wang, Haibin

    2010-01-01

    Much of our knowledge of human uterine physiology and pathology has been extrapolated from the study of diverse animal models, as there is no ideal system for studying human uterine biology in vitro. Although it remains debatable whether mouse models are the most suitable system for investigating human uterine function(s), gene-manipulated mice are considered by many the most useful tool for mechanistic analysis, and numerous studies have identified many similarities in female reproduction be...

  19. Uterine cancer in the writings of ancient Greek physicians.

    Science.gov (United States)

    Tsoucalas, Gregory; Karamanou, Marianna; Sgantzos, Markos; Deligeoroglou, Efthimios; Androutsos, George

    2015-01-01

    In this article, we present the views on uterine cancer of the ancient Greek physicians. We emphasize on uterine's cancer aetiology according to the dominant in antiquity humoural theory, on its surgical treatment suggested by Soranus of Ephesus, and in the vivid description provided by Aretaeus of Cappadocia. During that period, uterine cancer was considered as an incurable and painful malignancy and its approach was mainly palliative.

  20. Invaginación intestinal por pólipo fibroide inflamatorio del íleon: Presentación de 1 caso

    Directory of Open Access Journals (Sweden)

    Isnerio Valerio Arzuaga Anderson

    2001-03-01

    Full Text Available Los pólipos fibroides inflamatorios del tractus gastrointestinal son lesiones raras. Se reporta el caso de una mujer de 86 años de edad que fue operada de urgencia en el Hospital Clinicoquirúrgico Docente «Joaquín Albarrán» de Ciudad de La Habana, con diagnóstico preoperatorio de oclusión intestinal por bridas. La laparotomía exploradora detectó un tumor invaginado en el íleon a 20 cm de la válvula ileocecal. El diagnóstico anatomopatológico fue de pólipo fibroide inflamatorio. Se documentan los aspectos clínicos y patológicos de este casoInflammatory fibroid polyps of the gastro-intestinal tract are rare lesions. The case of a 86-year-old woman with preoperative diagnosis of intestinal occlusion due to bridle that underwent emergency surgery at the "Joaquín Albarrán" Clinical and Surgical Teaching Hospital of Havana City is reported. An invaginated tumor in the ileum, 20 cm from the ileocaecal valve, was detected by explorative laparotomy. The anatomopathological diagnosis was inflammatory fibroid polyp. The clinical and pathological aspects of this case were documented

  1. [Therapy of polyneuropathies. Causal and symptomatic].

    Science.gov (United States)

    Müller-Felber, W

    2001-05-28

    In the first instance, polyneuropathies are treated causally. The most common underlying cause is diabetes mellitus or alcohol abuse. In a large number of patients with polyneuropathy, however, the underlying cause cannot be definitively identified. For these--but equally for patients with etiologically clear polyneuropathy--a stock-taking of clinical symptoms should be carried out and, where indicated, symptomatic treatment initiated. In addition to medication aimed at combating pain, muscular spasm, autonomic functional disorders, and for the prevention of thrombosis, physical measures (physiotherapy, foot care, orthopedic shoes) are of primary importance.

  2. Uterine Artery Embolization: A Systematic Review of the Literature and Proposal for Research

    National Research Council Canada - National Science Library

    Broder, Michael

    1999-01-01

    .... The objective of this project was to review and synthesize the existing literature on a minimally invasive technique for reducing symptoms from uterine leiomyomata, uterine artery embolization (UAE...

  3. Symptomatic and asymptomatic candidiasis in a pediatric intensive care unit.

    Science.gov (United States)

    Arslankoylu, Ali Ertug; Kuyucu, Necdet; Yilmaz, Berna Seker; Erdogan, Semra

    2011-11-21

    This study aimed to examine the incidence, epidemiology, and clinical characteristics of symptomatic and asymptomatic candidiasis in a pediatric intensive care unit (PICU), and to determine the risk factors associated with symptomatic candidiasis. This retrospective study included 67 patients from a 7-bed PICU in a tertiary care hospital that had Candida-positive cultures between April 2007 and July 2009. Demographic and clinical characteristics of the patients, Candida isolates, antimicrobial and antifungal treatments, and previously identified risk factors for symptomatic candidiasis were recorded, and symptomatic and asymptomatic patients were compared. In all, 36 (53.7%) of the patients with Candida-positive cultures had asymptomatic candidiasis and 31 (46.3%) had symptomatic candidiasis. Candida albicans was the most common Candida sp. in the asymptomatic patients (n = 20, 55.6%), versus Candida parapsilosis in the symptomatic patients (n = 15, 48.4%). The incidence of central venous catheter indwelling, blood transfusion, parenteral nutrition, and surgery was higher in the symptomatic patient group than in the asymptomatic patient group (P candidiasis according to forward stepwise multivariate logistic regression analysis (OR: 6.1; 95% CI: 1.798-20.692). Surgery was the only risk factor significantly associated with symptomatic candidiasis and non-albicans Candida species were more common among the patients with symptomatic candidiasis. While treating symptomatic candidiasis in any PICU an increase in the incidence of non-albicans candidiasis should be considered.

  4. Patient, Physician, and Nurse Factors Associated With Entry Onto Clinical Trials and Finishing Treatment in Patients With Primary or Recurrent Uterine, Endometrial, or Cervical Cancer

    Science.gov (United States)

    2016-10-26

    Recurrent Cervical Carcinoma; Recurrent Uterine Corpus Carcinoma; Recurrent Uterine Corpus Sarcoma; Stage I Uterine Corpus Cancer; Stage I Uterine Sarcoma; Stage IA Cervical Cancer; Stage IB Cervical Cancer; Stage II Uterine Corpus Cancer; Stage II Uterine Sarcoma; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Uterine Corpus Cancer; Stage III Uterine Sarcoma; Stage IV Uterine Corpus Cancer; Stage IV Uterine Sarcoma; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer

  5. Uterine uptake of iodine-123 metaiodobenzylguanidine during the menstrual phase of uterine cycle

    International Nuclear Information System (INIS)

    Bomanji, J.; Britton, K.E.

    1987-01-01

    Radioiodinated I-123 metaiodobenzylguanidine (MIBG) has been used for diagnostic purposes for detection of apudomas. In this paper normal physiological uptake of I-123 MIBG by the uterus during the menstrual phase of the uterine cycle is reported. It is likely that I-123 MIBG can be used to evaluate some of the problems in this context

  6. Uterine uptake of iodine-123 metaiodobenzylguanidine during the menstrual phase of uterine cycle

    Energy Technology Data Exchange (ETDEWEB)

    Bomanji, J.; Britton, K.E.

    1987-08-01

    Radioiodinated I-123 metaiodobenzylguanidine (MIBG) has been used for diagnostic purposes for detection of apudomas. In this paper normal physiological uptake of I-123 MIBG by the uterus during the menstrual phase of the uterine cycle is reported. It is likely that I-123 MIBG can be used to evaluate some of the problems in this context.

  7. Law 16.097 Prevention program of uterine cervix cancer in Uruguay: Uterine cervix cancer

    International Nuclear Information System (INIS)

    2004-01-01

    Every year in Uruguay, is diagnosed around 600 new cases of cancer of uterine cervix. Next important information was related on this cancer and the evolution that will have the carrying of this illness, it was informed about the prevention, symptoms, I diagnose and treatment of the same one

  8. Radiological features of a symptomatic splenic hamartoma

    International Nuclear Information System (INIS)

    Thompson, S.E.; Walsh, E.A.; Cramer, B.C.; Pushpanathan, C.C.; Hollett, P.; Ingram, L.; Price, D.

    1996-01-01

    Symptomatic splenic hamartomas are rare in the pediatric age group, with only four previous reports in the literature. Splenic hamartoma has been reported as a solid homogeneous mass without calcification on CT and ultrasound (US), and only one previous report of the findings on MRI has been published. We report a case of a large symptomatic splenic hamartoma in a 14-year-old girl who presented with splenomegaly, pancytopenia and growth retardation. A solid mass with multiple punctate foci resembling calcifications was seen on US. The mass was heterogeneous and better demarcated on enhanced CT. Radiocolloid scintigraphy demonstrated uptake within the lesion, but less than that of normal spleen. The mass was isointense relative to normal splenic tissue on T1-weighted MRI (0.5 T) and of increased intensity with T2 weighting. At splenectomy, a red pulp hamartoma was identified, which contained nodules of hyalinization and necrosis thought to account for the punctate foci seen on US. (orig.). With 4 figs

  9. Palliative radiotherapy for symptomatic osseous metastases

    International Nuclear Information System (INIS)

    Shigematsu, Naoyuki; Ito, Hisao; Toya, Kazuhito; Ko, Weijey; Kutsuki, Shouji; Tsukamoto, Nobuhiro; Kubo, Atsushi; Dokiya, Takushi; Yorozu, Atsunori.

    1995-01-01

    Bone matastases are one of the most common and serious conditions requiring radiotherapy, but there is still a considerable lack of agreement on optimal radiation schedule. We analyzed patients with symptomatic osseous matastases from lung (72 patients) and breast (63 patients) carcinoma treated by palliative radiotherapy between 1983 and 1992. In this series, the incidences of symptomatic bone metastases appearing within 2 years after the first diagnosis of the primary lesion were 96% and 36% for lung and breast carcinomas, respectively. Thirty percent of bone metastases from breast carcinoma were diagnosed more than 5 years after the first diagnosis. Thus careful follow-up must be carried out for a prolonged period. Pain relief was achieved at almost the same rate for bone metastases from lung and breast carcinomas (81% and 85%, respectively), an the rapid onset of pain relief (15 Gy or less) was obtained in about half the patients for both diseases. The rapid onset of pain relief and the lack of association between the onset of pain relief and primary tumor argued against the conventional theory that tumor shrinkage is a component of the initial response. In contrast to the fact that almost all lung carcinoma patients had very poor prognoses, one third of the breast carcinoma patients were alive more than 2 years after palliative radiotherapy. Thust, the late effects of radiation, such as radiation myelopathy, must be always considered especially in breast carcinoma patients even when it is 'just' palliative radiotherapy for bone metastases. (author)

  10. Review of acute symptomatic urolithiasis in Auckland.

    Science.gov (United States)

    Loeff, Stephanie; Saluja, Manmeet; Rice, Michael

    2018-02-02

    To evaluate the incidence of acute symptomatic urolithiasis in the Auckland region. Associated epidemiological factors and stone characteristics were also studied and compared to previous research conducted in order to analyse trends. All patients that presented acutely with symptomatic urolithiasis to the Auckland District Health Board (AHDB) between July 2014 and June 2015 were studied. Clinical data was obtained from medical records and population data was based on estimates provided by the Ministry of Health. Two-tailed tests and the Pearson Chi-Square tests were used for analysis. Overall, 1,125 patients (1,328 events) presented with an incidence of 85 per 100,000 per year, which was lower than that reported in 2006. The highest incidence was found among the Middle Eastern ethnic subgroup (0.130 %), followed by Māori (0.102%), Asian (0.087%), European (0.084%) and Pacific (0.041%) ethnicity. Males were more likely to be affected than females. Urolithiasis was most common in the fifth decade of life (25%). Forty-seven percent of the study population presented with multiple stones and 64% had recurrent urolithiasis or were 'high risk' stone formers. Distal ureteric stones Auckland. This deviation could be attributed to the large influx of Asian immigrants observed in this period of time. A caucasian male, between 40-49 years, with a calculus <5mm in the distal ureter with a history of a previous urolithiasis has the highest chance to present with renal colic.

  11. Radiological features of a symptomatic splenic hamartoma

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, S.E. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Walsh, E.A. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Cramer, B.C. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Pushpanathan, C.C. [Department of Pathology, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Hollett, P. [Department of Nuclear Medicine, Health Sciences Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Ingram, L. [Department of Pediatrics, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Price, D. [Department of Surgery, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada)

    1996-09-01

    Symptomatic splenic hamartomas are rare in the pediatric age group, with only four previous reports in the literature. Splenic hamartoma has been reported as a solid homogeneous mass without calcification on CT and ultrasound (US), and only one previous report of the findings on MRI has been published. We report a case of a large symptomatic splenic hamartoma in a 14-year-old girl who presented with splenomegaly, pancytopenia and growth retardation. A solid mass with multiple punctate foci resembling calcifications was seen on US. The mass was heterogeneous and better demarcated on enhanced CT. Radiocolloid scintigraphy demonstrated uptake within the lesion, but less than that of normal spleen. The mass was isointense relative to normal splenic tissue on T1-weighted MRI (0.5 T) and of increased intensity with T2 weighting. At splenectomy, a red pulp hamartoma was identified, which contained nodules of hyalinization and necrosis thought to account for the punctate foci seen on US. (orig.). With 4 figs.

  12. [Uterine Carcinosarcoma: Clinicopathological Features and Prognostic Factors].

    Science.gov (United States)

    Luz, Rita; Ferreira, Joana; Rocha, Mara; Jorge, Ana Francisca; Félix, Ana

    2016-10-01

    Uterine carcinosarcoma is a rare and aggressive biphasic malignancy and is currently included in the high risk endometrial carcinoma group. The aims of this study were to determine the clinicopathological profile, treatment, recurrence/progression patterns, survival and prognostic factors. Retrospective study of 42 patients, surgically staged and followed-up at a cancer centre, between 2005 and 2013. Clinical data was retrieved from records and pathological characteristics were reviewed for this study. Median age was 72 years (61 - 78) and the majority presented comorbid diseases. Stage distribution as follows: 13 (31.0%) stage I; eight (19.0%) stage II; nine (21.4%) stage III; and 12 (28.6%) stage IV. Chemotherapy was instituted in 12 patients and 21 received radiotherapy. Disease progressed in 16 patients and recurred in nine after a short interval. Median overall survival was 18 months (6.8 - 40) and median disease-free survival was 6 months (0 - 22.8). The only independent prognostic factor related with poor survival was serosal invasion (p = 0.02; HR adjusted 4.22; IC 95% 1.29 - 13.79). In accordance to other studies, diagnosis of uterine carcinosarcoma is frequently done with advanced disease and presents a high rate of progression/recurrence. The variable which has been consistently identified as main prognostic factor is stage, but in this study the only independent factor was serosal invasion. The present study represents the larger series of uterine carcinosarcoma studied in Portugal and reflects the clinical presentation, histopathological characteristics and stage at diagnosis and confirms the aggressiveness of this rare tumor.

  13. Reduction of subacute uterine inversion by Haultain's method: A ...

    African Journals Online (AJOL)

    Reduction of subacute uterine inversion by Haultain's method: A case report. ... South African Journal of Obstetrics and Gynaecology ... Abstract. Uterine inversion is a rare but potentially life-threatening obstetric emergency of unknown aetiology, which is often associated with inadvertent traction on the umbilical cord before ...

  14. Endometriosis and uterine malformations: infertility may increase severity of endometriosis.

    Science.gov (United States)

    Boujenah, Jeremy; Salakos, Eleonora; Pinto, Mélodie; Shore, Joanna; Sifer, Christophe; Poncelet, Christophe; Bricou, Alexandre

    2017-06-01

    The aim of our study was to compare the stage and severity of endometriosis in fertile and infertile women with congenital uterine malformations. We performed an observational study from September 2007 to December 2015 in a tertiary care university hospital and assisted reproductive technology center. A total of 52 patients with surgically proven uterine malformations were included. We compared 41 infertile patients with uterine malformations with 11 fertile patients with uterine malformation. The main outcome was the stage, score and type of endometriosis in regard to infertility and class of uterine malformation. The rate of endometriosis did not differ between the two groups (43.9 vs. 36.4%). The mean revised American Fertility Society score was higher in infertile patients with uterine malformations (19.02 vs. 6, p endometriosis (43.9 vs. 37.5%). Endometrioma and deep infiltrating endometriosis were associated with uterine malformations in infertile women, respectively 14.6 and 0%. No difference in the characteristics of endometriosis was found regarding the class of malformation. The association of uterine malformations and infertility may increase the severity of endometriosis and raise the issue of their diagnosis and management. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  15. Non-Puerperal Uterine Inversion Following a Prolapsed Leiomyoma ...

    African Journals Online (AJOL)

    Non-Puerperal Uterine Inversion Following a Prolapsed Leiomyoma in a Cameroonian Woman. ... F Fouelifack Ymele, P Nana, JH Fouedjio, E Bechem, RE Mbu. Abstract. Non-puerperal uterine inversion is a rare condition that occurs as a complication of intrauterine tumors, especially giant submucosal leiomyomas.

  16. Acute Uterine Inversion: A Simple Modification of Hydrostatic ...

    African Journals Online (AJOL)

    Acute Uterine Inversion: A Simple Modification of Hydrostatic Method of Treatment. ... P Gupta, RL Sahu, A Huria ... Repositioning of acute uterine inversion in six patients in emergency was done using trans.urethral resection of prostate set (TURP set), used in endoscopic resection of prostate, and two 3 L saline bags.

  17. Posterior uterine rupture secondary to use of herbs leading to ...

    African Journals Online (AJOL)

    Uterine rupture is a potentially avoidable complication resulting in poor perinatal and maternal outcomes. This case had a number of unusual features including delivery of a healthy live baby; spontaneous posterior uterine rupture in a primigravida (and unscarred uterus); and delayed presentation with signs of peritonitis ...

  18. Spontaneous Uterine Rupture at Twenty Weeks of Pregnancy ...

    African Journals Online (AJOL)

    Uterine rupture is one of the most feared obstetric complications affecting the pregnant woman and fetus. It is an obstetric dilemma. Most of the cases have various risk factors and mainly occur during the third trimester. However, spontaneous uterine rupture during the first and second trimester are extremely rare.

  19. Ultrasound Evaluation of the Uterine Scar Thickness after Single ...

    African Journals Online (AJOL)

    Background: The degree of the lower uterine segment (LUS) thinning and the risk of uterine scar defect have been studied. However, the relationship between the methods of closure and the degree of thinning needs further elucidation. Aim: The aim of this study was to determine whether a LUS transverse cesarean section ...

  20. Acute puerperal uterine inversion : Case report | Mbaluka | East ...

    African Journals Online (AJOL)

    Acute puerperal uterine inversion is a rare potentially life-threatening complication of the third stage of labour that should be expeditiously managed to avert maternal mortality. A 21-year primigravida who was admitted in labour had a spontaneous vertex delivery and her third stage of labour was complicated by uterine ...

  1. Non-Puerperal Uterine Inversion: A Case Report

    OpenAIRE

    Fofie, C O; Baffoe, P

    2010-01-01

    Non-puerperal uterine inversion is rare. A 42-year old woman presented with lower abdominal pain, offensive vaginal discharge and a huge protruding mass per vaginum. A clinical diagnosis of non-puerperal uterine inversion was made and she successfully underwent vaginal hysterectomy. A high index of suspicion is required to make a prompt diagnosis.

  2. Non-puerperal uterine inversion: A case report | Fofie | Ghana ...

    African Journals Online (AJOL)

    Non-puerperal uterine inversion is rare. A 42-year old woman presented with lower abdominal pain, offensive vaginal discharge and a huge protruding mass per vaginum. A clinical diagnosis of non-puerperal uterine inversion was made and she successfully underwent vaginal hysterectomy. A high index of suspicion is ...

  3. Monitoring of fetal heart rate and uterine activity

    NARCIS (Netherlands)

    Graatsma, E.M.

    2010-01-01

    In this thesis a renewed monitoring technique for fetal heart rate (FHR) and uterine activity has been investigated. Through non-invasive measurements of electrical signals as recorded from the maternal abdomen, both the fetal-electrocardiogram (fECG) and uterine electrohysterogram (EHG) can be

  4. A pilot study of robotic uterine and vaginal vault manipulation: the ViKY Uterine Positioner™.

    Science.gov (United States)

    Akrivos, Nikolaos; Barton-Smith, Peter

    2013-12-01

    A pilot study of uterine and vaginal vault manipulation using a new surgical robot-The ViKY Uterine Positioner™--enrolled 36 cases comprising 31 hysterectomies, two myomectomies, two sacrocolpopexies and one excision of severe endometriosis performed between July 2010 and February 2012 in a tertiary referral District General Hospital in the UK. Mean age was 48 years, body mass index 25.7 kg/m(2) and uterine weight 231 g. Nine cases were foot-controlled and 27 by Bluetooth voice control. ViKY UP™ docking time once V-Care™ was inserted was 4.3 min. The device caused no peri-operative complications. Adequate mobilization, visualization and range of movement was possible in 81, 78 and 61 % of cases, respectively, with most of the problems arising in cases with uterine weight >350 g. ViKY UP™ was detached and an assistant was required in three cases, whilst V-Care™ came out of the uterus in one case. The learning curve led to various adjustments including optimizing patient position, increasing the device range of movement and adjusting device sensitivity. As a result, problems were minimized in our last nine cases. Adding robotic uterine manipulation is the obvious next step to give the gynecologist the ultimate control and stability of the uterus during robotic-assisted surgery without having to lift their head from the viewfinder or rely on a remotely situated perineal assistant. ViKY UP™ is the first device to deliver this. Pilot study results did not demonstrate compromised safety, and the device appears to be effective and easy to learn.

  5. Carcinosarcoma arising from uterine adenomyosis: A case report.

    Science.gov (United States)

    Kiuchi, Kaori; Hasegawa, Kiyoshi; Kanamori, Anriko; Machida, Hiromi; Kojima, Masaru; Fukasawa, Ichio

    2016-03-01

    Carcinosarcoma arising from uterine adenomyosis is extremely rare. We encountered such a patient and herein provide a review of the literature. A 56-year-old woman was referred for a huge pelvic tumor, suspected to be an advanced uterine leiomyosarcoma. Intraoperative inspection revealed a mass, mainly located in the uterine myometrium, invading the uterine serosa. The tumor had previously spontaneously ruptured and disseminated to the pelvic cavity. Pathological and immunohistochemical examination revealed an infiltrative pattern of biphasic tumor cells composed of endometrioid adenocarcinoma and a nonepithelial component with rhabdomyosarcomatous differentiation. Benign endometrial glands with stromal cells were found adjacent to the area of the carcinosarcoma. The endometrium and both ovaries and fallopian tubes were microscopically free of tumor cells. The final diagnosis was heterologous type carcinosarcoma with rhabdomyosarcomatous differentiation, originating from uterine adenomyosis. © 2015 Japan Society of Obstetrics and Gynecology.

  6. Serial ultrasonographic appearance of postpartum uterine involution in beagle dogs.

    Science.gov (United States)

    Yeager, A E; Concannon, P W

    1990-09-01

    Postpartum changes in uterine shape, architecture, echogenicity and diameter were determined during the serial examinations of five beagle bitches. During postpartum Week 1, the uterine horns were tubular structures composed of multiple layers of various echogenicity and had multiple, discrete enlargements with hypoechoic centers at placental sites. Diameters ranged from 1.1 to 3.8 cm at placental site enlargements, and 0.5 to 1.4 cm between enlargements. Uterine involution appeared to be completed by 15 wk post partum. At 15 weeks the uterine horns of each dog were uniform hypoechoic, tubular structures without enlargements and had a reduced diameter of 0.3 to 0.6 cm. These ultrasonographic findings are similar to previously reported gross and light microscopic descriptions of canine uterine involution.

  7. Indocyanine green fluorescence imaging for evaluation of uterine blood flow in cynomolgus macaque.

    Directory of Open Access Journals (Sweden)

    Iori Kisu

    Full Text Available BACKGROUND: Uterine blood flow is an important factor in uterine viability, but the number of blood vessels required to maintain viability is uncertain. In this study, indocyanine green (ICG fluorescence imaging was used to examine uterine hemodynamics and vessels associated with uterine blood flow in cynomolgus macaque. METHODS: The uterus of a female cynomolgus macaque was cut from the vaginal canal to mimic a situation during trachelectomy or uterine transplantation surgery in which uterine perfusion is maintained only with uterine and ovarian vessels. Intraoperative uterine hemodynamics was observed using ICG fluorescence imaging under conditions in which various nutrient vessels were selected by clamping of blood vessels. A time-intensity curve was plotted using imaging analysis software to measure the T(max of uterine perfusion for selected blood vessel patterns. Open surgery was performed with the uterus receiving nutritional support only from uterine vessels on one side. The size of the uterus after surgery was monitored using transabdominal ultrasonography. RESULTS: The resulting time-intensity curves displayed the average intensity in the regions of the uterine corpus and uterine cervix, and in the entire uterus. Analyses of the uterine hemodynamics in the cynomolgus macaque showed that uterine vessels were significantly related to uterine perfusion (P=0.008, whereas ovarian vessels did not have a significant relationship (P=0.588. When uterine vessels were clamped, ovarian vessels prolonged the time needed to reach perfusion maximum. Postoperative transabdominal ultrasonography showed that the size of the uterus was not changed 2 months after surgery, with recovery of periodic menstruation. The cynomolgus macaque has got pregnant with favorable fetus well-being. CONCLUSION: Uterine vessels may be responsible for uterine blood flow, and even one uterine vessel may be sufficient to maintain uterine viability in cynomolgus macaque. Our

  8. [Feasibility and diagnostic value of hysterosonography performed in bleeding time in the exploration of abnormal uterine bleeding].

    Science.gov (United States)

    Bouzid, A; Ayachi, A; Ben Khedija, M; Menjli, S; Mkaouar, L; Mourali, M

    2016-11-01

    The aim of our study is to evaluate the feasibility, safety and diagnostic value of hysterosonography performed in an emergency setting among patients consulting for active abnormal uterine bleeding. In this prospective study, we included 216 patients visiting our emergency department for abnormal uterine bleeding. All patients had a transvaginal ultrasound with doppler study and an hysterosonography. Secondly, the patients, in whom we diagnosed a suspected organic lesion, were addressed to an endoscopic or surgical procedure with pathological examination. Initially, we evaluated the feasibility and the safety of hysterosonography and secondly, we compared the two techniques (EEV and hysterosonography), sensitivity, specificity, LHR+and LHR-. The hysterosonography was performed in 98.1 % of patients and its realization has resulted in an additional period of 1.2minutes on average (extreme: 6-12) compared to ultrasound. The tolerance of the hysterosonographic examination was very good in 73.5 % of patients and good in 23.1 % of them. For the 167 patients who had been diagnosed with presumed organic lesions, pathological examination found an endometrial hyperplasia in 34.7 % of cases, polyps in 40.1 % of cases, sub-mucosal fibroids in 11.3 % of cases, endometrial cancer in 0.7 % of cases and other lesions in 13.2 % of cases. The diagnostic value of hysterosonography was superior to ultrasound in the detection of polyps (AUC: 0.894 vs 0.778, P=0.003) and fibromas (AUC: 1.000 vs 0.716, P=0.001) while the two methods showed no significant difference in the detection of hyperplasia. The purpose of our study was to focus on a particular context of use of the hysterosonography consisting on hemorrhagic period and on its realization in the emergency room. We were able to demonstrate that hysterosonography is compatible with the emergency situation as to its feasibility and its diagnostic value and that its realization would contribute to the sorting of patients

  9. Radiation-induced uterine changes: MR imaging

    International Nuclear Information System (INIS)

    Arrive, L.; Chang, Y.C.; Hricak, H.; Brescia, R.J.; Auffermann, W.; Quivey, J.M.

    1989-01-01

    To assess the capability of magnetic resonance (MR) imaging to demonstrate postirradiation changes in the uterus, MR studies of 23 patients who had undergone radiation therapy were retrospectively examined and compared with those of 30 patients who had not undergone radiation therapy. MR findings were correlated with posthysterectomy histologic findings. In premenopausal women, radiation therapy induced (a) a decrease in uterine size demonstrable as early as 3 months after therapy ended; (b) a decrease in signal intensity of the myometrium on T2-predominant MR images, reflecting a significant decrease in T2 relaxation time, demonstrable as early as 1 month after therapy; (c) a decrease in thickness and signal intensity of the endometrium demonstrable on T2-predominant images 6 months after therapy; and (d) loss of uterine zonal anatomy as early as 3 months after therapy. In postmenopausal women, irradiation did not significantly alter the MR imaging appearance of the uterus. These postirradiation MR changes in both the premenopausal and postmenopausal uteri appeared similar to the changes ordinarily seen on MR images of the nonirradiated postmenopausal uterus

  10. Radiotherapy Results of Early Uterine Cervix Cancer

    International Nuclear Information System (INIS)

    Choi, Doo Ho; Huh, Seung Jae

    1996-01-01

    Purpose : This study was done to analyze survivals, patterns of failure, and complications of early uterine cervix cancer after curative radiotherapy. Methods and Materials : Eighty patients with uterine cervix cancer FIGO Stage IB (48 cases) and Stage IIA (32 cases) treated with radiotherapy were analyzed retrospectively. Patients were treated from November 1985 to May 1993, and minimum follow up period was 24 months. and 6 cases were lost to follow up. All of them were treated with external radiotherapy and different fractions of high dose rate intracavitary radiotherapy. Survival rates, failure patterns, complication rates and degrees of severity were analyzed according to several factors. Results : Overall 5 year survival rate and relapse free survival rate were 72.3%, and 72.8% respectively. Prognostic factors were stage, size, pathology, RT response and there was no significant survival difference among the reasons of radiotherapy choice. There were 19 cases of treatment failure, another 3 cases were not tumor related death, and most of treatment related failure occurred within 24 months. Late complication rate of bladder and rectum were 8.8%, 15% respectively, frequency and severity of complication were correlated with ICR fractionation dose and total dose. Conclusion : These results showed that survival rates of early stage radiation treated cervix cancer patients were comparable to surgical series, but more aggressive treatment methods needed for stage IIA poor prognostic patients, To decrease late complication, choice of proper ICR dose and meticulous vaginal packing is needed

  11. [Laparoscopic cleavage in splenic symptomatic cyst].

    Science.gov (United States)

    Fernández-López, Antonio-José; Candel-Arenas, Marifé; González-Valverde, Francisco-Miguel; Luján-Martínez, Delia; Medina-Manuel, Esther; Albarracín Marín-Blázquez, Antonio

    2017-12-01

    Splenic cysts are rare diseases that are diagnosed incidentally during imaging studies. When cysts are recognized, surgical treatment is recommended adapted to the particular case, depending on the size and location of the cyst and the age of the patient in order to avoid dangerous complications such as spleen rupture or cyst infection with abscess. We report 2patients with symptomatic splenic epidermoid cyst treated by laparoscopic cleavage. Laparoscopic cleavage is a surgical option for splenic cyst, with the goal of reducing postoperative complications while preserving splenic function. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  12. 25-Hydroxyvitamin D and symptomatic ischemic stroke

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Nordestgaard, Børge G; Schnohr, Peter

    2013-01-01

    OBJECTIVE: We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population. METHODS: We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen...... City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively. In a meta-analysis of ischemic stroke, we included 10 studies, 58,384 participants, and 2,644 events. RESULTS: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations...... were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D (p for trend ≤ 2 × 10(-3) ). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D...

  13. The application of uterine artery embolization for the treatment of uterine scar pregnancy after cesarean section

    International Nuclear Information System (INIS)

    Chen Yi; Xie Chunming; Yang Minling; Feng Duiping; Pang Ningdong; Cui Liping; Cui Jinxi; Liu Wenying

    2012-01-01

    Objective: To assess the clinical value of uterine arterial embolization (UAE) in treating uterine scar pregnancy after cesarean section. Methods: A total of' 35 cases with cesarean scar pregnancy, admitted to authors' hospital during the period from Jan. 2007 to June 2011, were divided into two groups: embolization group (n=21) and non-embolization group (n=14). By using Seldinger technique, UAE was performed via the right femoral access and gelatin sponge particle was used as embolization agent to occlude the uterine artery. In embolization group, sixteen patients received uterine cavity curettage one or two days after UAE, while five patients received laparotomy or perineotomy surgery to remove the lesions after UAE. In non-embolization group, uterine cavity curettage was performed directly in 8 patients, local injection of' methotrexate followed by uterine cavity curettage was carried out in 3 patients, and direct laparotomy to remove the lesions was adopted in the remaining 3 patients. The blood loss during the procedure, the hospitalization days and the time for β-HCG levels falling to normal were documented. The results were compared between the two groups. Results: UAE was successfully accomplished in all the 21 patients of embolization group and the uterus was preserved in all patients. For the embolization group, the mean hospitalization time was (11.5±3.6) days, and the time for β-HCG levels falling to normal was (18.6±4.9) days. For the non-embolization group, the mean hospitalization time was(20.4±5.2)days, and the time for β-HCG levels falling to normal was (28.7±5.6)days. Hysterectomy had to be carried out in two patients of non-embolization group due to the massive bleeding occurred in therapeutic procedures. Conclusion: For the treatment of cesarean scar pregnancy, UAE is very effective and mini-invasive with high success rate. UAE can preserve the patient's reproductive function, and it also plays a significant role in preventing hemorrhage

  14. A non-surgical uterine lavage technique in large cats intended for treatment of uterine infection-induced infertility.

    Science.gov (United States)

    Hildebrandt, T B; Göritz, F; Boardman, W; Strike, T; Strauss, G; Jewgenow, K

    2006-10-01

    This paper presents the successful use of a non-surgical, transcervical uterine lavage technique for the treatment of uterine infection-induced infertility in three female large cats. We developed a non-surgical uterine lavage technique, which allowed repeated flushing of the uterine lumen and installation of therapeutic antibiotics. The entire procedure was performed under general anaesthesia (duration of anesthesia ranged from 40 to 70 min). It was successfully applied in a Sumatran tiger (Panthera tigris sumatrae), a Corbett tiger (Panthera tigris corbetti) and an Amur leopard (Panthera pardus orientalis). The tigers were treated only once, whereas the leopard received four uterine treatments, due to re-infection after mating. Decisions to conduct uterine treatments were based on detection of uterine fluid during previous transrectal ultrasound examinations. The catheter was guided into the vagina, with the aid of an endoscope, passing the urethra, and then into the uterus, with the aid of transrectal ultrasonography. Both uterine horns were separately flushed with approximately 300 mL of cell medium M199, followed by an antibiotic infusion. Upon ultrasonographic re-examination, the topical uterine treatments resulted in an apparent decline in the inflammatory and/or degenerative processes. The Corbett tiger had the most severe uterine alterations, in addition to an aseptic pyometra. As a result, she was treated 1 month prior to ovariohysterectomy (in order to reduce the surgical risk). The Sumatran tiger was artificially inseminated twice after hormone-induced estrus, and the Amur leopard expressed a spontaneous estrus and re-initiated mating behaviour.

  15. Spontaneous pregnancy during ulipristal acetate treatment of giant uterine leiomyoma.

    Science.gov (United States)

    Hrgovic, Z; Habek, D; Cerkez Habek, J; Hrgovic, I; Jerkovic Gulin, S; Gulin, D

    2018-02-01

    Ulipristal acetate, a progesterone receptor modulator, pharmacologically inhibits endometrial proliferation and thereby prevents pregnancy. It is primarily used as emergency contraception, but also for the treatment of fibroids in women of reproductive age. There have been no published cases of pregnancy, while on therapy with ulipristal acetate. In this article, we present a case report of spontaneous pregnancy during ulipristal acetate therapy. To our knowledge, this is the first patient with spontaneous conception, while on ulipristal acetate treatment. There were no drug-related complications, and the pregnancy resulted in the delivery of a healthy baby. © 2017 John Wiley & Sons Ltd.

  16. Investigating uterine disease in the bitch: uterine cannulation for cytology, microbiology and hysteroscopy.

    Science.gov (United States)

    Watts, J R; Wright, P J

    1995-05-01

    A technique for transcervical cannulation of the uterus of the bitch for the collection of samples for cytology and microbiology was developed. This technique involved passing a cannula into the uterus with the aid of an endoscope. The uterus was cannulated successfully in mature bitches (over 10 kg) 110 times in 144 attempts. Success of cannulation was influenced by the experience of the operator and ease of cannulation by the stage of the reproductive cycle, the size of the bitch and the type of cannula. Complications associated with the procedure were endometritis, vaginitis and vaginal tears. Uterine cannulation was generally possible in all bitches studied at all stages of the reproductive cycle. Techniques for the collection of samples from the uterus for cytology and microbiology and for the processing of samples for uterine cytology are outlined. Hysteroscopy was performed on seven occasions in post partum bitches and was found to be possible at least until day 17 after whelping.

  17. Patterns of uterine enhancement with helical CT

    International Nuclear Information System (INIS)

    Kaur, H.; Loyer, E.M.; Charnsangavej, C.; Minami, M.

    1998-01-01

    Objective: The purpose of this study was to evaluate the enhancement characteristics of the normal uterine body and cervix using dynamic contrast-enhanced helical CT. Methods: Thirty-eight women scheduled for pelvic CT for non-gynecologic malignancies underwent dynamic contrast-enhanced helical CT of the pelvis. Data acquisition was during the arterial phase (30-45 s after the start of injection), the parenchymal phase (90-120 s after the start of injection), and delayed phase (3-9 min after the start of injection). The images were evaluated by four radiologists for the pattern of myometrial and cervical enhancement. Correlation was made with the age and menstrual status of the patients. Results: In the uterine body, three types of enhancement were observed. Type 1 enhancement, seen in 16 patients (42%), was characterized by the visualization of a subendometrial zone of enhancement, 30-120 s after the start of injection. Eight of these patients also showed an enhancing zone in the outer myometrium. Both zones were transitory, and in all cases, the uterus became homogeneous in the delayed phase. This pattern was seen predominantly in premenopausal women with a mean age of 34 years. Type 2 enhancement, seen in 17 cases (45%), was defined by the absence of subendometrial enhancement in the early phase. Enhancement was either diffuse from the outset or originated in the outer myometrium. This pattern was seen nearly equally in premenopausal and postmenopausal women with a mean age of 40 years. Type 3 enhancement was seen in five postmenopausal patients (13%) with a mean age of 53 years and was characterized by faint diffuse enhancement. In the cervix, a zonal pattern of enhancement defining inner and outer stroma was seen in 23 patients (61%). Fifteen patients were premenopausal and eight were postmenopausal. Conclusion: In this study, we have shown a transitory zonal distribution of the contrast in the myometrium and cervix using dynamic contrast-enhanced helical CT

  18. Symptomatic relapse of HIV-associated cryptococcal meningitis in ...

    African Journals Online (AJOL)

    Objectives. Cryptococcal meningitis is the most common cause of adult meningitis in southern Africa. Much of this disease burden is thought to be due to symptomatic relapse of previously treated infection. We studied the contribution of inadequate secondary fluconazole prophylaxis to symptomatic relapses of cryptococcal ...

  19. Diffusion-weighted MR imaging of uterine leiomyomas following uterine artery embolization

    International Nuclear Information System (INIS)

    Sutter, Olivier; Shotar, Eimad; Guerrache, Youcef; Place, Vinciane; Oprea, Raluca; Le Dref, Olivier; Boudiaf, Mourad; Soyer, Philippe; Dohan, Anthony; Dautry, Raphael; Sirol, Marc; Ricbourg, Aude

    2016-01-01

    To test whether variations in apparent diffusion coefficient (ADC) values of uterine leiomyomas after uterine artery embolization (UAE) may correlate with outcome and assess the effects of UAE on leiomyomas and normal myometrium with magnetic resonance imaging (MRI). Data of 49 women who underwent pelvic MRI before and after UAE were retrospectively reviewed. Uterine and leiomyoma volumes, ADC values of leiomyomas, and normal myometrium were calculated before and after UAE. By comparison with baseline ADC values, a significant drop in leiomyoma ADC was found at 6-month post-UAE (1.096 x 10 -3 mm 2 /s vs. 0.712 x 10 -3 mm 2 /s, respectively; p < 0.0001), but not at 48-h post-UAE. Leiomyoma devascularization was complete in 40/49 women (82 %) at 48 h and in 37/49 women (76 %) at 6 months. Volume reduction and leiomyoma ADC values at 6 months correlated with the degree of devascularization. There was a significant drop in myometrium ADC after UAE. Perfusion defect of the myometrium was observed at 48 h in 14/49 women (28.5 %) in association with higher degrees of leiomyoma devascularization. Six months after UAE, drop in leiomyoma ADC values and volume reduction correlate with the degree of leiomyoma devascularization. UAE affects the myometrium as evidenced by a drop in ADC values and initial myometrial perfusion defect. (orig.)

  20. Diffusion-weighted MR imaging of uterine leiomyomas following uterine artery embolization

    Energy Technology Data Exchange (ETDEWEB)

    Sutter, Olivier; Shotar, Eimad; Guerrache, Youcef; Place, Vinciane; Oprea, Raluca; Le Dref, Olivier; Boudiaf, Mourad [Hopital Lariboisiere, AP-HP, Department of Body and Interventional Imaging, Paris (France); Soyer, Philippe; Dohan, Anthony [Hopital Lariboisiere, AP-HP, Department of Body and Interventional Imaging, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); UMR INSERM 965, Hopital Lariboisiere, Paris (France); Dautry, Raphael; Sirol, Marc [Hopital Lariboisiere, AP-HP, Department of Body and Interventional Imaging, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); Ricbourg, Aude [Hopital Lariboisiere-AP-HP, Department of Obstetrics and Gynecology, Paris (France)

    2016-10-15

    To test whether variations in apparent diffusion coefficient (ADC) values of uterine leiomyomas after uterine artery embolization (UAE) may correlate with outcome and assess the effects of UAE on leiomyomas and normal myometrium with magnetic resonance imaging (MRI). Data of 49 women who underwent pelvic MRI before and after UAE were retrospectively reviewed. Uterine and leiomyoma volumes, ADC values of leiomyomas, and normal myometrium were calculated before and after UAE. By comparison with baseline ADC values, a significant drop in leiomyoma ADC was found at 6-month post-UAE (1.096 x 10{sup -3} mm{sup 2}/s vs. 0.712 x 10{sup -3} mm{sup 2}/s, respectively; p < 0.0001), but not at 48-h post-UAE. Leiomyoma devascularization was complete in 40/49 women (82 %) at 48 h and in 37/49 women (76 %) at 6 months. Volume reduction and leiomyoma ADC values at 6 months correlated with the degree of devascularization. There was a significant drop in myometrium ADC after UAE. Perfusion defect of the myometrium was observed at 48 h in 14/49 women (28.5 %) in association with higher degrees of leiomyoma devascularization. Six months after UAE, drop in leiomyoma ADC values and volume reduction correlate with the degree of leiomyoma devascularization. UAE affects the myometrium as evidenced by a drop in ADC values and initial myometrial perfusion defect. (orig.)

  1. Uterine Arteriovenous Malformation with Sudden Heavy Vaginal Hemmorhage

    Directory of Open Access Journals (Sweden)

    Marianne Haughey

    2013-09-01

    Full Text Available Dysfunctional uterine bleeding (DUB is a common presentation in the emergency department and has a wide differential. Most presentations of DUB are in hemodynamically stable patients and can be evaluated as an outpatient. Uterine arteriovenous malformation (AVM is one presentation that can result in a life-threatening medical emergency with unexpected sudden and massive vaginal bleeding. We describe a case of a 24-year-old female with sudden heavy vaginal bleeding requiring a blood transfusion, ultrasound evidence of uterine AVM, and a treatment method of expectant management using an intrauterine device in an attempt to preserve fertility. [West J Emerg Med. 2013;14(5:411-414.

  2. Symptomatic unruptured cerebral aneurysms. Features and surgical outcome

    International Nuclear Information System (INIS)

    Date, Isao

    2010-01-01

    Development of less invasive imaging studies, such as magnetic resonance angiography, has increased the chances that unruptured cerebral aneurysms are found. The rupture risk of 'symptomatic' aneurysms is higher than for 'asymptomatic' aneurysms; so 'symptomatic' aneurysms are more often surgically treated. Many reviews examine 'asymptomatic' unruptured cerebral aneurysms, but few evaluate 'symptomatic' aneurysms. The author has treated many patients with symptomatic unruptured cerebral aneurysms and found that improved cranial nerve signs can be expected if the surgical treatment is performed before the symptoms become irreversible; the critical period is approximately 3 months. It is important to suppress the pulsation of the aneurysms compressing the cranial nerves; both a clipping procedure and endovascular coiling are effective. Cranial nerve signs are more commonly the symptoms of unruptured cerebral aneurysms, but large to giant aneurysms can also be the causes of hemiparesis, hydrocephalus, epilepsy, or even cerebral infarction. This review summarizes the features and surgical outcome of symptomatic unruptured cerebral aneurysms. (author)

  3. Pregnancy Downregulates Actin Polymerization and Pressure-Dependent Myogenic Tone in Ovine Uterine Arteries

    OpenAIRE

    Xiao, Daliao; Huang, Xiaohui; Yang, Shumei; Longo, Lawrence D.; Zhang, Lubo

    2010-01-01

    Pregnancy is associated with significantly decreased uterine vascular tone and increased uterine blood flow. The present study tested the hypothesis that the downregulation of actin polymerization plays a key role in reduced vascular tone of uterine arteries in the pregnant state. Uterine arteries were isolated from nonpregnant and near-term pregnant sheep. Activation of protein kinase C significantly increased the filamentous:globular actin ratio and contractions in the uterine arteries, whi...

  4. Polypropylene mesh as an alternative option for uterine preservation in pelvic reconstruction in patients with uterine prolapse.

    Science.gov (United States)

    Huang, Kuan-Hui; Chuang, Fei-Chi; Fu, Hung-Chun; Kung, Fu-Tsai

    2012-01-01

      The aim of this study was to evaluate the efficacy and safety of polypropylene mesh for uterine preservation during pelvic reconstruction in patients with severe uterine prolapse. The study included 67 women with severe uterine prolapse (pelvic organ prolapse quantification stage III/IV) who received transvaginal mesh reconstruction with uterine preservation. Surgery combined with a transobturator membrane sling procedure (tension-free vaginal tape-transobturator route) was performed in 54 patients. Among them, 18 had urodynamic stress incontinence, 30 had occult stress urinary incontinence, and six had mixed urinary incontinence. Objective assessments were carried out with the pelvic organ prolapse quantification staging system, urodynamic examination, and 1-h pad test. Evaluation of urinary and prolapse symptoms comprised the subjective assessment. The mean follow-up interval was 19.6 months (12-40 months). The objective cure rate for the treatment of uterine prolapse was 89.5%, and the objective cure rate for the treatment of urinary incontinence was more than 90%. Uterine preservation in pelvic reconstruction is technically feasible and the subjective and objective assessments imply that uterine preservation in pelvic reconstruction is an alternative option for indicated patients. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

  5. Non-communicating Rudimentary Uterine Horn Pregnancy

    Directory of Open Access Journals (Sweden)

    I Upadhyaya

    2011-12-01

    Full Text Available Pregnancy in a non-communicating rudimentary horn is an extremely rare form of ectopic gestation. The rudimentary horn may or may not communicate with the uterine cavity with the majority of cases being non-communicating. The patient exhibits features of acute abdomen and carries a high risk of maternal death. Even modern scans remain elusive whereas laparatomy remains the confi rmatory procedure for the diagnosis. Because of the varied muscular constitution in the thickness and distensibility of the wall of the rudimentary horn, pregnancy is accommodated for a variable period of gestation. Here, we report three cases of pregnancy in a non-communicating rudimentary horn of the uterus in different periods of gestation, their outcome and a review of the available literature. Keywords: Mullerian anomalies, non-communicating rudimentary horn pregnancy, surgical management.

  6. Radiotherapy in benign uterine bleeding disorders

    International Nuclear Information System (INIS)

    Ryberg, M.; Pettersson, F.; Lundell, M.

    1989-01-01

    Radiotherapy was earlier a method of choice for treatment of benign bleeding disorders (metropathia), especially in woman of high surgical risk. During the period 1912 to 1977 933 women with benign bleeding disorders were treated at Radiumhemmet with intracavitary brachytherapy or external irradiation or a combination of both. The result with regard to cure of the uterine bleedings was good (48%). Hormonal withdrawal symptoms after treatment were noted in 45% of the patients. In the long term follow up an increased risk of cardiovascular death was found in women treated before menopause. Malignant tumours occurred in 107 cases versus 90.2 expected. The estimated ovarian dose of ionizing radiation varied from 3.5 Gy to 6.0 Gy for the three standard techniques. Two women gave birth to a healthy child 4 and 5 years after intracavitary radium treatment. The estimated absorbed dose to the ovaries in these two women were 1 Gy and 4 Gy, respectively

  7. Outcome analysis in patients with uterine sarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Yu, To Sol; Kim, Hak Jae; Wu, Hong Gyun; Ha, Sung Whan; Song, Yong Sang; Park, Noh Hyun; Kim, Jae Won [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2015-03-15

    To analyze the prognostic factors for survivals and to evaluate the impact of postoperative whole pelvic radiotherapy (WPRT) on pelvic failure in patients with uterine sarcoma treated with radical surgery. We retrospectively analyzed 75 patients with uterine sarcoma who underwent radical surgery with (n = 22) or without (n = 53) radiotherapy between 1990 and 2010. There were 23 and 52 patients with carcinosarcoma and non-carcinosarcoma (leiomyosarcoma, 22; endometrial stromal sarcoma, 25; others, 5), respectively. The median follow-up period was 64 months (range, 17 to 269 months). The 5-year overall survival (OS) and pelvic failure-free survival (PFFS) of total patients was 64.2% and 83.4%, respectively. Multivariate analysis revealed that mitotic count (p = 0.006) was a significant predictor of OS. However, factors were not found to be associated with PFFS. On analyzing each of the histologic subtypes separately, postoperative WPRT significantly reduced pelvic failure in patients with carcinosarcoma (10.0% vs. 53.7%; p = 0.046), but not in patients with non-carcinosarcoma (12.5% vs. 9.9%; p = 0.866). Among the patients with carcinosarcoma, 4 patients (17%) had recurrence within the pelvis and 3 patients (13%) had recurrence in other sites as an initial failure, whereas among the patients with non-carcinosarcoma, 3 patients (6%) experienced pelvic failure and 13 patients (25%) experienced distant failure. The most significant predictor of OS was mitotic count. Based on the improved PFFS after postoperative WPRT only in patients with carcinosarcoma and the difference in patterns of failure between histologic subtypes, optimal adjuvant treatment options should be offered to patients based on the risk of recurrence patterns.

  8. Diagnostic challenges of symptomatic uncomplicated diverticular disease.

    Science.gov (United States)

    Cremon, Cesare; Bellacosa, Lara; Barbaro, Maria R; Cogliandro, Rosanna F; Stanghellini, Vincenzo; Barbara, Giovanni

    2017-06-01

    Colonic diverticulosis is a common condition in Western industrialized countries occurring in up to 65% of people over the age of 60 years. Only a minority of these subjects (about 10-25%) experience symptoms, fulfilling Rome III Diagnostic Criteria for irritable bowel syndrome (IBS) diagnosis (IBS-like symptoms) in 10% to 66% of cases. Symptomatic uncomplicated diverticular disease (SUDD) is a syndrome characterized by recurrent abdominal symptoms attributed to diverticula in the absence of macroscopically evident alterations other than the presence of diverticula. Due to the different peak of incidence, the overlap between SUDD and IBS is predominantly present in middle-aged or older patients. In these cases, it is very complex to establish if the symptoms are related to the presence of diverticula or due to an overlapping IBS. In fact, the link between gastrointestinal symptoms and diverticula is unclear, and the mechanism by which diverticula may induce the development of IBS-like symptoms remains to be elucidated. Currently, the etiology and pathophysiology of SUDD, particularly when IBS-like symptoms are present, are not completely understood, and thus these two entities remain a diagnostic challenge not only for the general practitioner but also for the gastroenterologist. Although many issues remain open and unresolved, some minimize the importance of a distinction of these two entities as dietary and pharmacological management may be largely overlapping.

  9. [Laparoscopic management of symptomatic urachal anomalies].

    Science.gov (United States)

    Sánchez-Ismayel, Alexis; Cruz-González, Germán; Sánchez, Renata; Sánchez-Salas, Rodolfo; Rodríguez, Omaira; Sanabria, Erasmo; Sotelo, Rene; Sánchez-Salas, Rafael E

    2009-03-01

    Acquired urachal anomalies are a rare pathology. Gold-standard treatment for this clinical situation remains the resection of the urachus in its entire tract with or without partial resection of the bladder. Our aim is to up-date authors's experience in the minimally invasive surgical treatment of acquired urachal disease. From 2001 to 2007, 14 patients were operated for acquired urachal disease at our institution. A three portal technique previously described by the authors was employed. The diagnosis of acquired uracal disease was confirmed in all cases and the resection of the urachus in its entire tract performed in cephalocaudal direction onto the bladder. Operative and demographic data was prospectively collected and analysis retrospectively performed. Mean operative time was 63 minutes (45,110), minimal blood loss, and no conversions to open surgery or perioperative complications were verified. The majority of the patients were discharged in the first 24 hours. At a follow-up of 22 months no recurrences of urachal pathology recurrences have been verified. Laparoscopy plays a significant role in the management of symptomatic urachus anomalies. It allows objective confirmation of clinical diagnosis and adequate resection of the urachus in a safe and efficient fashion, while providing the well-known advantages of minimally acces surgery. Preoperative evaluation work-up has minimal impact of therapeutical decision.

  10. Acute symptomatic hyponatremia in a flight attendant.

    Science.gov (United States)

    Madero, Magdalena; Monares, Enrique; Domínguez, Aurelio Méndez; Ayus, Juan Carlos

    2015-08-01

    Acute symptomatic hyponatremia after thiazide diuretic initiation is a medical emergency. Here we describe the case of a flight attendant who developed acute hyponatremia during a flight and the potential risk factors for developing this condition. A 57-year-old flight attendant with history of essential hypertension was recently started on a thiazide diuretic. As she did routinely when working, she increased her water intake during a flight from London to Mexico City. She complained of nausea and headache during the flight. Upon arrival, she developed severe disorientation and presented to the hospital emergency room (ER) with a Glasgow scale of 12, hypoxia, and a generalized tonic clonic seizure. Her laboratory results on arrival were consistent with severe hyponatremia (serum Na 116 mEql/L) and severe cerebral edema by CT scan. She was treated with hypertonic saline, with complete resolution of the neurologic symptoms. We describe high water intake and hypoxia related to decreased partial pressure of oxygen in the cabin as the two main risk factors for thiazide-induced acute hyponatremia in this case.

  11. Neonatal management of symptomatic transplacental cryoglobulinaemia.

    Science.gov (United States)

    Laugel, V; Goetz, J; Wolff, S; Beladdale, J; Sibilia, J; Messer, J

    2004-04-01

    This study reports the first case of symptomatic placental transfer of cryoglobulins and discusses the potential pathogenic processes and the basic guidelines for neonatal management. A 32-y-old woman was affected by essential type I cryoglobulinaemia and displayed the cold-triggered cutaneous symptoms of the disease due to a monoclonal immunoglobulin G (IgG) cryoglobulin. She gave birth to healthy dizygotic twins who were placed in incubators immediately after birth and did not show any cutaneous or visceral lesion in the first 2 d. Cyanotic macules appeared on the hand and foot of one of the newborns when they were removed from the incubators. The same monoclonal IgG-lambda cryoglobulin was identified in the two newborns' cord blood and in the mother's serum. The skin lesions disappeared within 1 wk as both twins were transiently replaced in incubators. No recurrence of skin lesions was observed even at room temperature and, 6 mo later, both twins were healthy and their clinical examination was normal. To the authors' knowledge, this is the first report of placental transfer of cryoglobulins and the first description of any neonatal effect. Neonates born to mothers suffering from IgG cryoglobulinaemia should be protected against cold to avoid precipitation of the pathogenic cryoglobulins, until spontaneous resolution.

  12. Misdiagnosed uterine rupture of an advanced cornual pregnancy

    DEFF Research Database (Denmark)

    Sant, Christian Linus Hastrup; Andersen, Poul Erik

    2012-01-01

    Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination...

  13. Uterine involution and progesterone level during the postpartum ...

    African Journals Online (AJOL)

    2015-02-05

    Takayama et al., 2010). ... follicles (Vinoles et al., 2004), pregnancy (Medan and. Abd El-Aty, 2010) and uterine pathology (Yilmaz et ..... 2000. Seasonal changes in ovulatory activity, plasma prolactin, and melatonin concentrations, in.

  14. Blood supply of human uterine cervix - a SEM study.

    Science.gov (United States)

    Bereza, Tomasz; Skrzat, Janusz; Brzozowska, Iwona; Maduzia, Dawid; Matuszyk, Aleksandra; Chmielewski, Przemyslaw; Klimek-Piotrowska, Wieslawa; Tomaszewski, Krzysztof

    2013-01-01

    The main goal of this study was assessment of vascular structure of human uterine cervix. The study was carried out on 25 human uteri of females aged 25-45, collected upon autopsy. Vessels were injected with synthetic resin, next corroded and coated with gold, finally observed using scanning electron microscope. On a sagittal section we have distinguished several zones in the vascular picture of the uterine cervix consisted of differently arranged veins, arteries, arterioles and capillaries. Due to technical reasons we were unable to receive a picture of vascular composition of cervical uterine canal on transverse section. Scanning elector microscopy is a method which might be applied to study the structure of human uterine cervix.

  15. Atypical olfactory groove meningioma associated with uterine fibromatosis; case report

    Directory of Open Access Journals (Sweden)

    Toma I. Papacocea

    2016-11-01

    Full Text Available The concomitant presence of the olfactory groove meningioma with uterine fibrosis is very rare. Our report presents the case of a giant olfactory groove meningioma revealed after a uterine fibroma resection in a 44 years-old female, due to a generalized seizure 10 days after operation. Cranial CT-scan identified the tumor as an olfactory groove meningioma. The tumor was operated with a macroscopically complete resection; the endothermal coagulation of the dura attachment was performed (Simpson II with a good postoperative evolution. Laboratory results showed the presence of receptors for steroid hormones both in meningioma and uterine tumor, and the histopathological examination revealed an atypical meningioma with 17% proliferation markers. Our findings suggest that even though meningiomas are benign tumors and a complete resection usually indicates a good prognosis, the association with uterine fibromatosis and the presence of high percentage of steroid receptors creates a higher risk to relapse, imposing therefore a good monitoring.

  16. Vesicovaginal fistula complicating uterine evacuation: a case report ...

    African Journals Online (AJOL)

    Vesicovaginal fistula complicating uterine evacuation: a case report. MA Ijaiya, AP Aboyeji, GA Fawole, AAG Jimoh, OO Alabi, AO Olarinoye, OL Akintade, OK Ogah, DNC Nwachukwu, OA Alabi, SA Esuga, ZB Ijaiya ...

  17. Abnormal Uterine Bleeding: American College of Nurse-Midwives.

    Science.gov (United States)

    2016-07-01

    Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach. © 2016 by the American College of Nurse-Midwives.

  18. Apparatus for treating carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Kumar, P.P.

    1984-01-01

    Disclosed is an apparatus for treating carcinoma of the uterine cervix by judiciously applying radioactive material immediately adjacent the uterine cervix for an extended period of time empirically determined by the radiologist. The novel apparatus comprises three radioactively chargeable components including a central tubular tandem vaginally insertable longitudinally into the uterine cervix and two non-lineal tubular ovoidal assemblies longitudinally locatable at the cervix and positioned laterally between the respective vaginal walls and the uterine cervix. The ovoidal assemblies are conveniently removably and pivotably connected to the central tandem component externally of the vaginal along the sagittal plane through a novel adapter member whereby the radioactively chargeable ovoidal assemblies tend to remain within a laterally extending plane located substantially midway the transversely separated vasicovaginal and rectovaginal septa, even though the patient periodically shifts her reclining posture during the extended treatment by said vaginally protruding apparatus

  19. Misdiagnosed Uterine Rupture of an Advanced Cornual Pregnancy

    Directory of Open Access Journals (Sweden)

    Christian Linus Hastrup Sant

    2012-01-01

    Full Text Available Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination and computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal pain and haemodynamic instability.

  20. Effect of Aloe Barbadensis on Rat's Uterine Contractility | Iranloye ...

    African Journals Online (AJOL)

    The present study was undertaken to investigate the effect of the aqueous extract of Aloe barbadensis on the contractility of the uterine stip of a rat. Aqueous extract at final bath concentrations (FBC)1x10-4 mg/ml to 3x101 mg/ml produced a progressive increase in frequency of contraction of the uterine strip. The force of ...

  1. Importance of histopathological examination of endometrium in Dysfunctional Uterine Bleeding.

    Directory of Open Access Journals (Sweden)

    Dr. Yaminee Rana

    2017-12-01

    Full Text Available Introduction: Abnormal uterine bleeding is a common condition affecting women of reproductive age that has significant social and economic impact. Dysfunctional uterine bleeding (DUB is defined as abnormal uterine bleeding in the absence of organic disease. Dysfunctional uterine bleeding is one of the most commonly encountered gynaecological problems. Objectives: This study is done to evaluate the histopathological pattern of the endometrial biopsies of patients with dysfunctional uterine bleeding and its correlation with clinical data. Methods: The present prospective study included evaluation of 208 cases of dysfunctional uterine bleeding in the Department of Pathology, B. J. Medical College, Ahmedabad over a period of 10 months, from January 2017 to October 2017. Women presenting with abnormal uterine bleeding were included in the study. Those women in which bleeding is secondary to systemic causes, organic causes and due to cervical and vaginal causes were excluded. The specimens were processed, embedded and cut into sections of 3-4 microns. The histopathological patterns were studied. Results: Age distribution varied from 18 years to 70 years, majority of the patients were between 21 to 30 years. Among the cases of DUB, proliferative phase accounted for 66.3% and secretory phase accounted for 21.3%. 18 cases (8.6% of atrophic endometrium, four cases (1.9% of irregular shedding and two cases of luteal phase insufficiency were received. Conclusion: Dysfunctional uterine bleeding is a common and debilitating condition in women of reproductive age. Endometrial biopsy could be effectively used as the first diagnostic step in DUB and thus ensures correct management.

  2. Abnormal uterine bleeding in reproductive-aged women.

    Science.gov (United States)

    Matthews, Michelle L

    2015-03-01

    Abnormal uterine bleeding is a common medical condition with several causes. The International Federation of Gynecology and Obstetrics published guidelines in 2011 to develop universally accepted nomenclature and a classification system. In addition, the American College of Obstetrics and Gynecology recently updated recommendations on evaluation of abnormal uterine bleeding and indications for endometrial biopsies. This article reviews both medical and surgical treatments, including meta-analysis reviews of the most effective treatment options. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Vegetarian diet as a risk factor for symptomatic gallstone disease.

    Science.gov (United States)

    McConnell, T J; Appleby, P N; Key, T J

    2017-06-01

    Previous small studies have shown either no difference or a lower risk of symptomatic gallstone disease in vegetarians than in non-vegetarians. This study examined the incidence of symptomatic gallstone disease in a cohort of British vegetarians and non-vegetarians, and investigated the associations between nutrient intake and risk of symptomatic gallstone disease. The data were analysed from 49 652 adults enroled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, one-third of whom were vegetarian. The linked databases of hospital records were used to identify incident cases. Risk by diet group was estimated using Cox proportional hazards models. Further analysis quantified risk by intakes of selected macronutrients. There were 1182 cases of symptomatic gallstone disease during 687 822 person-years of follow-up (mean=13.85 years). There was a large significant association between increasing body mass index (BMI) and risk of developing symptomatic gallstone disease (overall trend Pvegetarians had a moderately increased risk compared with non-vegetarians (HR: 1.22; 95% CI: 1.06-1.41; P=0.006). Although starch consumption was positively associated with gallstones risk (P=0.002 for trend), it did not explain the increased risk in vegetarians. There is a highly significant association of increased BMI with risk of symptomatic gallstone disease. After adjusting for BMI, there is a small but statistically significant positive association between vegetarian diet and symptomatic gallstone disease.

  4. Plasticity in Uterine Innervation: State of the Art.

    Science.gov (United States)

    Brauer, Monica M

    2017-01-01

    Early studies often claimed that autonomic nerves were unimportant for uterine function, since denervation of the uterus had little effects on reproductive success. In 1979, Thorbert wrote, "It seems unlikely that Nature has equipped the uterus with a complex innervation merely as a structural ornament. Our ignorance in this area may be rather due to defects in methods of study". Investigations carried out over the last four decades proved that Thorbert's words were correct, because it is now clear that autonomic and sensory nerves regulate many critical uterine functions. However, the most remarkable aspect of uterine innervation is its capacity to change in response to physiological fluctuations in levels of sex hormones, as those accompanying pregnancy, the sex cycle and puberty. The present review provides an overview about how sex hormones influence uterine innervation. Data are presented about how this physiological plasticity is mimicked by exogenous administration of sex hormones, particularly estrogen. We will review recent developments illustrating the complex multifactorial mechanisms regulating uterine neural plasticity and the nature of molecular signals involved. Finally, we will go through recent findings pointing to the relevance of uterine innervation in gynecological diseases leading to pain and infertility. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  5. Use of ICD-10 codes to monitor uterine rupture

    DEFF Research Database (Denmark)

    Thisted, Dorthe L A; Mortensen, Laust Hvas; Hvidman, Lone

    2014-01-01

    OBJECTIVES: Uterine rupture is a rare but severe complication in pregnancies after a previous cesarean section. In Denmark, the monitoring of uterine rupture is based on reporting of relevant diagnostic codes to the Danish Medical Birth Registry (MBR). The aim of our study was to examine the vali......OBJECTIVES: Uterine rupture is a rare but severe complication in pregnancies after a previous cesarean section. In Denmark, the monitoring of uterine rupture is based on reporting of relevant diagnostic codes to the Danish Medical Birth Registry (MBR). The aim of our study was to examine...... the validity of registration of uterine rupture in the MBR within the population of pregnant women with prior cesarean section by conducting a review of the medical records. STUDY DESIGN: We reviewed 1709 medical records within the population of singleton pregnant woman delivering at term between 1997 and 2007....... We retrieved the medical records of all women in the MBR with a code for uterine rupture during labor regardless of whether or not a prior cesarean section had been reported to the registry. In addition medical records of all women with a code for previous cesarean section and delivery of a child...

  6. Risk awareness on uterine cancer among Australian women.

    Science.gov (United States)

    George, Mathew; Asab, Nihad Abu; Varughese, Elizabeth; Irwin, Matthew; Oldmeadow, Christopher; Hollebone, Keith; Apen, Kenneth; Renner, Stefan

    2014-01-01

    Uterine cancer is the most common invasive gynaecological cancer in Australia. Early detection is a key predictive factor achieved by increasing public awareness and participation in screening. This observational study measures awareness of gynaecological malignancies, particularly uterine, among women in two rural areas of New South Wales, Australia. Patients presenting to gynaecology clinics in January to March 2014 were invited to complete a structured questionnaire. Women with a history of cancer and incomplete questionnaires were excluded. Of the 382 patients invited to participate, 329 (86%) responded with complete feedback. Most respondents were younger than than 50 years (66%) and married with at least 2 children (74%). The majority (94%) of participants had no awareness of uterine cancer and many (46%) were unable to identify common risk factors including obesity, diabetes and hypertension. The ability to identify risk factors was correlated to age, marital status and obesity. The study identifies poor awareness on uterine malignancies in two typical areas of rural Australia. Although external validity is limited by sociological factors, poor awareness of uterine cancer among rural patients in this study represents a valid public health concern. It is imperative to improve awareness of uterine cancer and available screening programs to facilitate early detection and cure.

  7. Value of vaginal cervical position in estimating uterine anatomy.

    Science.gov (United States)

    Fidan, Ulaş; Keskin, Uğur; Ulubay, Mustafa; Öztürk, Mustafa; Bodur, Serkan

    2017-04-01

    The anatomy of the uterus is defined with the angles of the vagina, cervix and uterine corpus. Hereunder there are angles of version and flexion. The cervical position observed during the vaginal speculum examination, may give information about the uterine anatomy. In this study, we investigated the place of the cervical position in the estimation of the uterine anatomy observed during the cervical examination. We enrolled 240 patients in our study, who applied to our routine gynecology outpatient clinic with various complaints. We divided these patients into two groups according to the cervical position (anterior cervical position and posterior cervical position) observed during the speculum examination. We recorded the uterine anatomy also with the transvaginal ultrasonography. During the speculum examination, we determined that 90% of the cases with posterior fornix position were anteverted and 10% retroverted; 64.2% of the cases with anterior fornix position were anteverted and 35.8% retroverted. According to these findings, cervical position observed during the speculum examination might be useful in the estimation of the uterine anatomy regarding the angles of the version. However, the ultrasonographic examination is essential for a definitive determination of the uterine anatomy. Clin. Anat. 30:404-408, 2017. © 2017 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists. © 2017 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

  8. Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding

    DEFF Research Database (Denmark)

    Dueholm, M; Forman, A; Jensen, ML

    2001-01-01

    OBJECTIVES: To evaluate whether saline contrast sonohysterography (SCSH) adds additional information to that obtained by transvaginal sonography (TVS) for predicting endometrial abnormality in premenopausal patients with abnormal uterine bleeding. PATIENTS AND METHODS: This was a two......-center prospective study at a university clinic and a central hospital in Denmark. The uterine cavity was evaluated with TVS and SCSH in 470 premenopausal patients with abnormal uterine bleeding. One hundred and eighty-nine of the patients had operative hysteroscopy or hysterectomy within 4 months which provided...... uterine bleeding. All abnormalities except one were found at SCSH, while TVS alone missed polyps and had almost one in four equivocal findings. The use of TVS, without saline contrast, left one in five of the polyps undiagnosed in referred patients with abnormal bleeding....

  9. Pediatric intracerebral hemorrhage: acute symptomatic seizures and epilepsy.

    Science.gov (United States)

    Beslow, Lauren A; Abend, Nicholas S; Gindville, Melissa C; Bastian, Rachel A; Licht, Daniel J; Smith, Sabrina E; Hillis, Argye E; Ichord, Rebecca N; Jordan, Lori C

    2013-04-01

    Seizures are believed to be common presenting symptoms in neonates and children with spontaneous intracerebral hemorrhage (ICH). However, few data are available on the epidemiology of acute symptomatic seizures or the risk for later epilepsy. To define the incidence of and explore risk factors for seizures and epilepsy in children with spontaneous ICH. Our a priori hypotheses were that younger age at presentation, cortical involvement of ICH, acute symptomatic seizures after presentation, ICH due to vascular malformation, and elevated intracranial pressure requiring urgent intervention would predict remote symptomatic seizures and epilepsy. Prospective cohort study conducted between March 1, 2007, and January 1, 2012. Three tertiary care pediatric hospitals. Seventy-three pediatric subjects with spontaneous ICH including 20 perinatal (≥37 weeks' gestation to 28 days) and 53 childhood subjects (>28 days to Acute symptomatic seizures (clinically evident and electrographic-only seizures within 7 days), remote symptomatic seizures, and epilepsy. Acute symptomatic seizures occurred in 35 subjects (48%). Acute symptomatic seizures as a presenting symptom of ICH occurred in 12 perinatal (60%) and 19 childhood (36%) subjects (P = .07). Acute symptomatic seizures after presentation occurred in 7 children. Electrographic-only seizures were present in 9 of 32 subjects (28%) with continuous electroencephalogram monitoring. One-year and 2-year remote symptomatic seizure-free survival rates were 82% (95% CI, 68-90) and 67% (95% CI, 46-82), respectively. One-year and 2-year epilepsy-free survival rates were 96% (95% CI, 83-99) and 87% (95% CI, 65-95), respectively. Elevated intracranial pressure requiring acute intervention was a risk factor for seizures after presentation (P = .01; Fisher exact test), remote symptomatic seizures, and epilepsy (P = .03, and P = .04, respectively; log-rank test). Presenting seizures are common in perinatal and childhood ICH. Continuous

  10. Placental histopathology lesions and pregnancy outcome in pregnancies complicated with symptomatic vs. non-symptomatic placenta previa.

    Science.gov (United States)

    Weiner, Eran; Miremberg, Hadas; Grinstein, Ehud; Schreiber, Letizia; Ginath, Shimon; Bar, Jacob; Kovo, Michal

    2016-10-01

    The mechanisms involved in bleeding in cases of placenta previa (PP) and the effect on pregnancy outcome is unclear. We aimed to compare pregnancy outcome and placental histopathology in pregnancies complicated with symptomatic (bleeding) vs. non-symptomatic PP, and to study the effects of the co-existence of histopathological retro-placental hemorrhage (RPH) in cases of symptomatic PP on neonatal and maternal outcomes. Labor and maternal characteristics, neonatal outcome and placental histopathology lesions of pregnancies with PP, delivered between 24 and 42weeks, during 2009-2015, were reviewed. Results were compared between PP who had elective cesarean delivery (CD) (previa group) and PP with bleeding necessitating emergent CD (symptomatic previa group). Placental lesions were classified to lesions consistent with maternal malperfusion or fetal thrombo-occlusive disease (vascular and villous changes), and inflammatory lesions. Compared to the previa group (n=63), the symptomatic previa group (n=74) was characterized by older patients (pPlacentas within the symptomatic previa group were smaller, with higher rates of weightplacenta previa is associated with increased placental malperfusion lesions suggesting an association of maternal malperfusion with abnormal placental separation. The coexisting finding of RPH with symptomatic placenta previa can be seen as a marker for more extensive/severe placental separation, hence the association with maternal transfusion requirements and poorer fetal outcome. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Uterine contractions evaluated on cine MR imaging in patients with uterine leiomyomas

    Energy Technology Data Exchange (ETDEWEB)

    Nishino, Mizuki E-mail: mizuki@mbox.kyoto-inet.or.jpnishinomizuki@hotmail.com; Togashi, Kaori; Nakai, Asako; Hayakawa, Katsumi; Kanao, Shotarou; Iwasaku, Kazuhiro; Fujii, Shingo

    2005-01-01

    Purpose: Submucosal leiomyoma is one of the most recognized causes of infertility and habitual abortion. The purpose of this study is to evaluate uterine peristalsis, a cycle-related inherent contractility of uterus probably responsible for sperm transport and conservation of pregnancy, in patients with uterine leiomyomas using cine magnetic resonance (MR) imaging. Materials and methods: Study population consisted of 26 female patients (age range: 19-51 years, mean: 41 years), in which 16 patients had submucosal leiomyomas and 10 patients had intramural or subserosal leiomyomas. We prospectively performed MR imaging of the midsagittal plane of uterus using 1.5 T magnet (Symphony, Siemens Medical Systems) with a body array coil, and obtained 60 half-Fourier acquisition single shot turbo spin echo (HASTE) images (Echo time=80 ms, FOV=300 mm, slice thickness 5 mm, matrix 256x256) within 2 min, and displayed them on cine mode at 12x faster than real speed. Evaluated were peristaltic movements at the endometral-myometrial junction and focal myometrial movements, adjacent to leiomyomas, regarding presence, direction, frequency, and conduction. Results: The peristaltic movements were identified in 12/16 patients with submucosal lesions and 10/10 with other leiomyomas. The frequency and direction were cycle-related. Loss of peristalsis was noted adjacent to submucosal myomas in 4/12 patients, but was not in others. Focal myometrial movements were noted in 9/16 patients with submucosal myomas, but not in others. Conclusions: Uterine peristaltic movements were partly interrupted by submucosal leiomoymas, but not by myometrial or subserosal leiomyomas. Loss of peristalsis and focal myometrial movements was noted only adjacent to submucosal leiomyomas. These findings are considered to represent dysfunctional contractility, and may be related with pregnancy loss.

  12. Uterine contractions evaluated on cine MR imaging in patients with uterine leiomyomas

    International Nuclear Information System (INIS)

    Nishino, Mizuki; Togashi, Kaori; Nakai, Asako; Hayakawa, Katsumi; Kanao, Shotarou; Iwasaku, Kazuhiro; Fujii, Shingo

    2005-01-01

    Purpose: Submucosal leiomyoma is one of the most recognized causes of infertility and habitual abortion. The purpose of this study is to evaluate uterine peristalsis, a cycle-related inherent contractility of uterus probably responsible for sperm transport and conservation of pregnancy, in patients with uterine leiomyomas using cine magnetic resonance (MR) imaging. Materials and methods: Study population consisted of 26 female patients (age range: 19-51 years, mean: 41 years), in which 16 patients had submucosal leiomyomas and 10 patients had intramural or subserosal leiomyomas. We prospectively performed MR imaging of the midsagittal plane of uterus using 1.5 T magnet (Symphony, Siemens Medical Systems) with a body array coil, and obtained 60 half-Fourier acquisition single shot turbo spin echo (HASTE) images (Echo time=80 ms, FOV=300 mm, slice thickness 5 mm, matrix 256x256) within 2 min, and displayed them on cine mode at 12x faster than real speed. Evaluated were peristaltic movements at the endometral-myometrial junction and focal myometrial movements, adjacent to leiomyomas, regarding presence, direction, frequency, and conduction. Results: The peristaltic movements were identified in 12/16 patients with submucosal lesions and 10/10 with other leiomyomas. The frequency and direction were cycle-related. Loss of peristalsis was noted adjacent to submucosal myomas in 4/12 patients, but was not in others. Focal myometrial movements were noted in 9/16 patients with submucosal myomas, but not in others. Conclusions: Uterine peristaltic movements were partly interrupted by submucosal leiomoymas, but not by myometrial or subserosal leiomyomas. Loss of peristalsis and focal myometrial movements was noted only adjacent to submucosal leiomyomas. These findings are considered to represent dysfunctional contractility, and may be related with pregnancy loss

  13. Oncomirs Expression Profiling in Uterine Leiomyosarcoma Cells

    Directory of Open Access Journals (Sweden)

    Bruna Cristine de Almeida

    2017-12-01

    Full Text Available MicroRNAs (miRNAs are small non-coding RNAs that act as regulators of gene expression at the post-transcriptional level. They play a key role in several biological processes. Their abnormal expression may lead to malignant cell transformation. This study aimed to evaluate the expression profile of 84 miRNAs involved in tumorigenesis in immortalized cells of myometrium (MM, uterine leiomyoma (ULM, and uterine leiomyosarcoma (ULMS. Specific cell lines were cultured and qRT-PCR was performed. Thirteen miRNAs presented different expression profiles in ULM and the same thirteen in ULMS compared to MM. Eight miRNAs were overexpressed, and five were underexpressed in ULM. In ULMS cells, five miRNAs exhibited an overexpression and eight were down-regulated. Six miRNAs (miR-1-3p, miR-130b-3p, miR-140-5p, miR-202-3p, miR-205-5p, and miR-7-5p presented a similar expression pattern in cell lines compared to patient samples. Of these, only three miRNAs showed significant expression in ULM (miR-1-3p, miR-140-5p, and miR-7-5p and ULMS (miR-1-3p, miR-202-3p, and miR-7-5p. Our preliminary approach identified 24 oncomirs with an altered expression profile in ULM and ULMS cells. We identified four differentially expressed miRNAs with the same profile when compared with patients’ samples, which strongly interacted with relevant genes, including apoptosis regulator (BCL2, epidermal growth factor receptor (EGFR, vascular endothelial growth factor A (VEGFA, insulin like growth factor 1 receptor (IGF1R,serine/threonine kinase (RAF1, receptor tyrosine kinase (MET, and bHLH transcription factor (MYCN. This led to alterations in their mRNA-target.

  14. A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding.

    Science.gov (United States)

    Cooper, Natalie A M; Middleton, Lee; Smith, Paul; Denny, Elaine; Stobert, Lynda; Daniels, Jane; Clark, T Justin

    2016-01-01

    Uterine polyps can cause abnormal bleeding in women. Conventional practise is to remove them under general anaesthesia but advances in technology have made it possible to perform polypectomy in the office setting. We conducted a patient-preference study to explore women's preferences for treatment setting and to evaluate the effectiveness and treatment experience of women undergoing uterine polypectomy. Three hundred ninety-nine women with abnormal uterine bleeding who were found to have uterine polyps at diagnostic hysteroscopy were recruited. Office polypectomies were performed in office hysteroscopy clinics, and inpatient procedures were undertaken in operating theatres. Three hundred twenty-four of 399 (81 %) expressed a preference for office treatment. There was no difference found between office treatment and inpatient treatment in terms of alleviating abnormal uterine bleeding as assessed by patients and in improving disease-specific quality of life. Acceptability was lower and patient pain scores were significantly higher in the office group. When offered a choice of treatment setting for uterine polypectomy, patients have a preference for office over inpatient treatment. Ambulatory gynaecology services should be available within healthcare systems to meet patient demand.

  15. Analysis of clinical manifestations of symptomatic acquired jejunoileal diverticular disease

    OpenAIRE

    Liu, Chia-Yuan; Chang, Wen-Hsiung; Lin, Shee-Chan; Chu, Cheng-Hsin; Wang, Tsang-En; Shih, Shou-Chuan

    2005-01-01

    AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.

  16. Surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis

    NARCIS (Netherlands)

    Keus, F.; Broeders, I. A. M. J.; van Laarhoven, C. J. H. M.

    2006-01-01

    Indications for cholecystectomy are limited to clearly symptomatic gallstones. Relatively high failure rates of pain relief are probably caused by incorrect selection of patients for the operation. Contraindications for (laparoscopic) cholecystectomy are related to anaesthesiological considerations.

  17. ACUTE NEUROINFECTIONS AND SYMPTOMATIC EPILEPSY IN CHILDREN: CAUSAL RELATIONSHIP (review

    Directory of Open Access Journals (Sweden)

    E. Yu. Gorelik

    2017-01-01

    Full Text Available Convulsions in case of acute neuroinfections can both complicate the disease course and transfer to symptomatic epilepsy which is one of the most important medical and social problems. The review article presents the data on epidemiology of convulsive disorder and symptomatic epilepsy in case of neuroinfections in children. There are considered the current immune and biochemical aspects of epileptogenesis in case of infectious pathology. There is given the information on neurophysiological and radial features of symptomatic epilepsy developed in case of neuroinfections of different etiology. There is underlined the practical significance of timely complex etio-pathogenetic therapy for neuroinfections complicated by convulsion that allows to reduce the frequency of symptomatic epilepsy development. There are presented the data on the results of transcranial magnetic stimulation in case of refractory epilepsy.

  18. Urinary nitrite in symptomatic and asymptomatic urinary infection.

    OpenAIRE

    Powell, H R; McCredie, D A; Ritchie, M A

    1987-01-01

    The dipstrip test for urinary nitrite is fairly unreliable in symptomatic urinary infections and only 104 (52%) of 200 symptomatic children with urinary infection attending an emergency department had a positive result. The test yielded positive results, however, in 83 of 100 outpatients with largely asymptomatic urinary infection attending a follow up clinic because of known predisposition to urinary infection. This difference was highly significant. The finding of urinary nitrite is highly ...

  19. The incidence of symptomatic malrotation post gastroschisis repair.

    LENUS (Irish Health Repository)

    Abdelhafeez, A

    2011-12-01

    Gastroschisis is known to be associated with abnormal bowel rotation. Currently, the broadly accepted practice is not to perform Ladd\\'s procedure routinely at the time of closure of gastroschisis defects. However the incidence of symptomatic malrotation and volvulus post gastroschisis repair is unknown; this incidence is important in view of the current practice of bedside gastroschisis closure. This study examined the incidence of symptomatic malrotation and volvulus following gastroschisis repair.

  20. Mechanisms of symptomatic spinal cord ischemia after TEVAR

    DEFF Research Database (Denmark)

    Czerny, Martin; Eggebrecht, Holger; Sodeck, Gottfried

    2012-01-01

    To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR).......To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR)....