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Perrot D, Fernandez H, Levaillant JM, Capmas P. Quality assessment of pelvic ultrasound for uterine myoma according to the CNGOF guidelines. J Gynecol Obstet Hum Reprod 2017. [PMID: 28643658 DOI: 10.1016/j.jogoh.2017.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION French guidelines regarding the minimum criteria for gynaecological ultrasound were given in a recent report in 2016, by the French National College of Obstetricians and Gynaecologists (CNGOF). An accurate report is essential for the optimal care of women, especially those presenting myomas. The goal of this study was to evaluate the quality of gynaecological ultrasound reports for women with type 0 to 2 uterine myomas, referring to the items contained in the French guidelines. MATERIALS AND METHODS A retrospective descriptive study was conducted from reports of ultrasounds performed in private offices and in the gynaecologic department of a hospital, between June 2014 and June 2016 (before the report of CNGOF). These reports involved women who underwent hysteroscopic resection of myoma(s). A search of validated items was conducted for all of the reports, and the missing items were analysed. The different types of practitioners and between hospital and private medical offices were also compared with Chi-square tests. RESULTS A total of 138 reports were analysed; 71 were performed in private offices and 67 were performed in the gynaecologic unit of the hospital. Many items were missing in the reports, with disparities between the type of institution (private offices or hospital) and the speciality of practitioners (radiologists or gynaecologists). Specific items regarding myomas, such as the International Federation of Gynaecologists and Obstetricians (FIGO) classification or measurement of the posterior wall, were more often missing in reports from radiologists (89.7% and 79.5%, respectively) than in reports from gynaecologists (21.2% and 34.3%, respectively) (P<0.05). A significant difference was also observed for these data between private offices' reports and hospitals' reports. Items relative to ultrasound structures, such as the appearance of myomas or associated abdominal effusion, were more frequently missing in gynaecologists' reports (88.9% and 49.5%, respectively) compared to radiologists' reports (56.4% and 12.8%, respectively) (P<0.05). CONCLUSIONS Certain items are present in all the reports, while others are insufficiently mentioned. These inequalities can be explained in part by the type of practice; however, methods to overcome these difficulties must be developed. Information campaigns to educate professionals on the minimum reporting and training conducted jointly by radiologists and gynaecologist surgeons might improve reports and improve the care of women.
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Affiliation(s)
- D Perrot
- Service de gynécologie obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France
| | - H Fernandez
- Service de gynécologie obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France; Inserm, centre of research in epidemiology and population health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France; Faculty of medicine, université Paris Sud, 94276 Le Kremlin-Bicêtre, France
| | - J M Levaillant
- Service de gynécologie obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France
| | - P Capmas
- Service de gynécologie obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France; Inserm, centre of research in epidemiology and population health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France.
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Liu C, Lu Q, Qu H, Geng L, Bian M, Huang M, Wang H, Zhang Y, Wen Z, Zheng S, Zhang Z. Different dosages of mifepristone versus enantone to treat uterine fibroids: A multicenter randomized controlled trial. Medicine (Baltimore) 2017; 96:e6124. [PMID: 28207540 PMCID: PMC5319529 DOI: 10.1097/md.0000000000006124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of 10 mg and 25 mg mifepristone per day compared with 3.75 mg enantone in treating uterine fibroids. METHODS This is a Multicenter randomized controlled trial. A total of 501 subjects with symptomatic uterine fibroids were enrolled and randomized into the group of 10mg, 25mg mifepristone and 3.75 enantone (with 307, 102 and 92 subjects respectively), with 458 subjects completed the treatment. Three months of daily therapy with oral mifepristone (at a dose of either 10 mg or 25 mg) or once-monthly subcutaneous injections of enantone (at a dose of 3.75 mg) were used. Change in volume of the largest uterine fibroid was the primary efficacy variable, and secondary efficacy variables included changes in anemia and relevant symptom. Safety evaluation included the analyses of adverse events, laboratory values, and relevant endometrial changes. RESULTS After three months of treatment, the mean volume of the largest leiomyoma was significantly reduced by mifepristone 10 mg or 25 mg or enantone 3.75 mg (40.27%, 42.59% and 44.49% respectively) (P < 0.0001). Percentage change from baseline in largest leiomyoma volume was not statistically significant among the three groups (P = 0.1057). Most of the patients in all groups experienced amenorrhea after the treatment. There were also significant elevations in red blood cell count, hemoglobin and hematocrit (P < 0.0001), and significant reductions in prevalence of dysmenorrhea, pelvic pressure, non-menstrual abdominal pain (P < 0.0001) in each group, while no significant difference among the three groups.All study medications are well-tolerated, and no serious adverse event was reported. Treatment-related adverse event rate was significantly lower in mifepristone 10 mg group, compared to Enantone 3.75 mg group (13.59% vs. 32.58%, P = 0.0002). In both mifepristone groups, estradiol levels were maintained in the premenopausal range, whereas patients in the enantone group had a significant reduction to postmenopausal levels (P < 0.0001). CONCLUSION 10mg is as effective as 25mg mifepristone and 3.75 mg enantone with minimal drug-related side effects, and may provide an alternative for clinical application, especially for patient who are in perimenopause with uterine fibroids.
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Affiliation(s)
- Chongdong Liu
- Department of Obstetrics and Gynaecology,Beijing Chaoyang Hospital
| | - Qi Lu
- Department of Obstetrics and Gynaecology,Beijing Chaoyang Hospital
| | - Hong Qu
- Department of Obstetrics and Gynaecology,Beijing Chaoyang Hospital
| | - Li Geng
- Department of Obstetrics and Gynaecology, Peking University Third Hospital
| | - Meilu Bian
- Department of Obstetrics and Gynaecology, China-Japan Friendship Hospital, Beijing
| | - Minli Huang
- Department of Obstetrics and Gynaecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai
| | - Huilan Wang
- Department of Obstetrics and Gynaecology, The Second Hospital of Hebei Medical University, Hebei
| | - Youzhong Zhang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Shandong
| | - Zeqing Wen
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong, China
| | - Shurong Zheng
- Department of Obstetrics and Gynaecology, Peking University First Hospital
| | - Zhenyu Zhang
- Department of Obstetrics and Gynaecology,Beijing Chaoyang Hospital
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Islam MS, Segars JH, Castellucci M, Ciarmela P. Dietary phytochemicals for possible preventive and therapeutic option of uterine fibroids: Signaling pathways as target. Pharmacol Rep 2017; 69:57-70. [DOI: 10.1016/j.pharep.2016.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/03/2016] [Accepted: 10/19/2016] [Indexed: 02/07/2023]
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Uterine fibroid shrinkage after short-term use of selective progesterone receptor modulator or gonadotropin-releasing hormone agonist. Obstet Gynecol Sci 2017; 60:69-73. [PMID: 28217674 PMCID: PMC5313366 DOI: 10.5468/ogs.2017.60.1.69] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this study was to evaluate the effect of short-term use of selective progesterone receptor modulator (SPRM) or gonadotropin-releasing hormone (GnRH) agonist on uterine fibroid shrinkage among Korean women. Methods This retrospective study involved 101 women with symptomatic uterine fibroids who received ulipristal acetate (SPRM, n=51) and leuprolide acetate (GnRH agonist, n=50) for 3 months between November 2013 and February 2015. The fibroid volume was measured both before and after treatment using ultrasonography, computed tomography, and magnetic resonance imaging. The outcomes were compared between the SPRM and GnRH agonist groups. Results The median rate of fibroid volume reduction after SPRM treatment was 12.4% (IQR −14.5% to 40.5%) which was significantly lower than the reduction rate observed after GnRH agonist treatment (median 34.9%, IQR 14.7% to 48.6%, P=0.004). 19 of 51 (37.3%) patients with SPRM treatment did not show any response of volume shrinkage, while 7 of 50 (14.0%) women with GnRH agonist showed no response (P=0.007). Conclusion Short-term SPRM treatment yields lower volume reduction than GnRH agonist treatment in Korean women with symptomatic fibroids. Further large-scale randomized trials are needed to confirm our findings.
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Prise en charge des léiomyomes utérins. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S550-S576. [PMID: 28063565 DOI: 10.1016/j.jogc.2016.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Prise en charge des fibromes utérins en présence d'une infertilité autrement inexpliquée. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S597-S608. [PMID: 28063569 DOI: 10.1016/j.jogc.2016.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIF Formuler des recommandations quant à la façon optimale d'assurer la prise en charge des fibromes dans le contexte de l'infertilité. Les options habituelles et novatrices de prise en charge des fibromes seront analysées en mettant l'accent sur leur applicabilité chez les femmes qui souhaitent obtenir une grossesse. OPTIONS La prise en charge des fibromes chez les femmes qui souhaitent obtenir une grossesse met d'abord en jeu la documentation de la présence des fibromes en question et la détermination de la probabilité que ces derniers affectent le potentiel génésique. Dans un tel contexte, la prise en charge des fibromes s'effectue principalement de façon chirurgicale; toutefois, il faut s'assurer au préalable de mettre en balance les avantages factuels de l'approche chirurgicale en matière d'amélioration des issues cliniques et les risques propres à une telle approche. ISSUES L'amélioration des taux et des issues de grossesse que permet la prise en charge des fibromes chez les femmes aux prises avec l'infertilité constitue l'issue principale sur laquelle nous nous sommes attardés. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed, CINAHL et Cochrane Systematic Reviews en novembre 2013 au moyen d'un vocabulaire contrôlé (p. ex. « leiomyoma », « infertility », « uterine artery embolization », « fertilization in vitro ») et de mots clés (p. ex. « fibroid », « myomectomy ») appropriés. Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs publiés en anglais et français. Aucune restriction n'a été appliquée en matière de date. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en novembre 2013. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques, et auprès de sociétés de spécialité médicale nationales et internationales. VALEURS La qualité des résultats est évaluée au moyen des critères décrits par le Groupe d'étude canadien sur les soins de santé préventifs (Tableau). AVANTAGES, DéSAVANTAGES ET COûTS: Les présentes recommandations devraient permettre la prise en charge adéquate des femmes qui présentent des fibromes et qui sont aux prises avec l'infertilité, et ce, par la maximisation de leurs chances de grossesse grâce à la minimisation des risques mis en cause par la tenue de myomectomies inutiles. L'atténuation des complications et l'élimination des interventions inutiles devraient également mener à une baisse des coûts pour le système de santé. DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Spontaneous Rupture of a Leiomyoma Causing Life-Threatening Intra-Abdominal Hemorrhage. Case Rep Obstet Gynecol 2017; 2017:3701450. [PMID: 28127487 PMCID: PMC5239864 DOI: 10.1155/2017/3701450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/15/2016] [Accepted: 12/18/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Uterine fibroids are common benign tumors in women. Clinical manifestations are well known. Acute complications necessitating emergent surgical intervention are rare. Case. We report a case of a 53-year-old woman with a history of uterine fibroids presenting with acute-onset severe abdominal pain. Imaging indicated massive free fluid and a large partially solid uterine mass. Vitals were consistent with hypovolemic shock. Examination revealed a surgical abdomen. She underwent an emergent laparotomy and total hysterectomy. Surgery revealed 4.5 L of hemoperitoneum and a 15 cm degenerated uterine fibroid with active bleeding. Pathology was consistent with intraoperative findings. She required transfusion of numerous blood products perioperatively. Her postoperative course was uncomplicated. Conclusion. It is rare for a uterine fibroid to spontaneously rupture. However, prompt recognition of this severe complication is critical for expeditious, life-saving surgical management.
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Flyckt R, Soto E, Nutter B, Falcone T. Comparison of Long-Term Fertility and Bleeding Outcomes after Robotic-Assisted, Laparoscopic, and Abdominal Myomectomy. Obstet Gynecol Int 2016; 2016:2789201. [PMID: 28163718 PMCID: PMC5259613 DOI: 10.1155/2016/2789201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/10/2016] [Accepted: 11/24/2016] [Indexed: 11/23/2022] Open
Abstract
Background/Aims. To compare long-term fertility and bleeding outcomes of women who underwent robotic-assisted, laparoscopic, and abdominal myomectomy at our institution over a 15-year period. Methods. This was a retrospective cohort study of myomectomy patients 18-39 years old that had surgery between January 1995 and December 2009 at our institution. Long-term follow-up on fertility and bleeding outcomes was collected from the patient directly. The uterine fibroid symptom and quality of life survey was also administered to assess current bleeding patterns. Baseline characteristics were compared across groups. Univariable comparisons of fertility and bleeding outcomes based on surgical approach were made using analysis of variance, Kruskal-Wallis analysis of ranks, and Chi-square tests as appropriate. Results. 134/374 (36%) subjects agreed to participate in the study. 81 subjects underwent an open procedure versus 28 and 25 subjects in the laparoscopic and robotic groups, respectively. Median follow-up after surgery was 8 years. 50% of patients desired pregnancy following surgery and, of those, 60% achieved spontaneous pregnancy; the spontaneous pregnancy rate did not differ between groups. Additionally, UFS-QOL scores and/or subscores did not differ between groups. Conclusion. There is no significant difference in long-term bleeding or fertility outcomes in robotic-assisted, laparoscopic, or abdominal myomectomy.
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Affiliation(s)
- Rebecca Flyckt
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Enrique Soto
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Nutter
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tommaso Falcone
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
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Bondagji NS, Morad FA, Al-Nefaei AAA, Khan IA, Elango R, Abdullah LS, M.Al-Mansouri N, Sabir J, Banaganapalli B, Edris S, Shaik NA. Replication of GWAS loci revealed the moderate effect of TNRC6B
locus on susceptibility of Saudi women to develop uterine leiomyomas. J Obstet Gynaecol Res 2016; 43:330-338. [DOI: 10.1111/jog.13217] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/23/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Nabeel Saleem Bondagji
- Department of Obstetrics and Gynecology; King Abdulaziz University Hospital; Jeddah Saudi Arabia
- Department of Pathology; King Abdulaziz University Hospital; Jeddah Saudi Arabia
| | - Fatima Amanullah Morad
- Princess Al-Jawahara Al-Brahim Center of Excellence in Research of Hereditary Disorders; King Abdulaziz University; Jeddah Saudi Arabia
- Genomics and Biotechnology Section, Department of Biological Sciences, Faculty of Science; King Abdulaziz University; Jeddah Saudi Arabia
| | - Afnan Abed Abdullah Al-Nefaei
- Princess Al-Jawahara Al-Brahim Center of Excellence in Research of Hereditary Disorders; King Abdulaziz University; Jeddah Saudi Arabia
- Genomics and Biotechnology Section, Department of Biological Sciences, Faculty of Science; King Abdulaziz University; Jeddah Saudi Arabia
| | - Imran Ali Khan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences; King Saud University; Riyadh Saudi Arabia
| | - Ramu Elango
- Department of Genetic Medicine; King Abdulaziz University; Jeddah Saudi Arabia
- Princess Al-Jawahara Al-Brahim Center of Excellence in Research of Hereditary Disorders; King Abdulaziz University; Jeddah Saudi Arabia
| | - Layla Saleh Abdullah
- Department of Pathology; King Abdulaziz University Hospital; Jeddah Saudi Arabia
| | - Nisma M.Al-Mansouri
- Department of Obstetrics and Gynecology; King Abdulaziz University Hospital; Jeddah Saudi Arabia
| | - Jamal Sabir
- Genomics and Biotechnology Section, Department of Biological Sciences, Faculty of Science; King Abdulaziz University; Jeddah Saudi Arabia
| | - Babajan Banaganapalli
- Department of Genetic Medicine; King Abdulaziz University; Jeddah Saudi Arabia
- Princess Al-Jawahara Al-Brahim Center of Excellence in Research of Hereditary Disorders; King Abdulaziz University; Jeddah Saudi Arabia
| | - Sherif Edris
- Genomics and Biotechnology Section, Department of Biological Sciences, Faculty of Science; King Abdulaziz University; Jeddah Saudi Arabia
| | - Noor Ahmad Shaik
- Department of Genetic Medicine; King Abdulaziz University; Jeddah Saudi Arabia
- Princess Al-Jawahara Al-Brahim Center of Excellence in Research of Hereditary Disorders; King Abdulaziz University; Jeddah Saudi Arabia
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Preoperative 3-dimensional Magnetic Resonance Imaging of Uterine Myoma and Endometrium Before Myomectomy. J Minim Invasive Gynecol 2016; 24:309-314. [PMID: 27903466 DOI: 10.1016/j.jmig.2016.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 10/23/2016] [Accepted: 10/26/2016] [Indexed: 11/20/2022]
Abstract
Uterine myomas are the most common gynecologic benign tumor affecting women of childbearing age, and myomectomy is the main surgical option to preserve the uterus and fertility. During myomectomy for women with multiple myomas, it is advisable to identify and remove as many as possible to decrease the risk of future myomectomies. With deficient preoperative imaging, gynecologists are challenged to identify the location and size of myomas and the endometrium, which, in turn, can lead to uterine rupture during future pregnancies. Current conventional 2-dimensional imaging has limitations in identifying precise locations of multiple myomas and the endometrium. In our experience, we preferred to use 3-dimensional imaging to delineate the myomas, endometrium, or blood vessels, which we were able to successfully reconstruct by using the following imaging method. To achieve 3-dimensional imaging, we matched T2 turbo spin echo images to detect uterine myomas and endometria with T1 high-resolution isotropic volume excitation-post images used to detect blood vessels by using an algorithm based on the 3-dimensional region growing method. Then, we produced images of the uterine myomas, endometria, and blood vessels using a 3-dimensional surface rendering method and successfully reconstructed selective 3-dimensional imaging for uterine myomas, endometria, and adjacent blood vessels. A Web-based survey was sent to 66 gynecologists concerning imaging techniques used before myomectomy. Twenty-eight of 36 responding gynecologists answered that the 3-dimensional image produced in the current study is preferred to conventional 2-dimensional magnetic resonance imaging in identifying precise locations of uterine myomas and endometria. The proposed 3-dimensional magnetic resonance imaging method successfully reconstructed uterine myomas, endometria, and adjacent vessels. We propose that this will be a helpful adjunct to uterine myomectomy as a preoperative imaging technique in future studies.
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Uterine rupture in pregnancies following myomectomy: A multicenter case series. Obstet Gynecol Sci 2016; 59:454-462. [PMID: 27896247 PMCID: PMC5120064 DOI: 10.5468/ogs.2016.59.6.454] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/01/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022] Open
Abstract
Objective The purpose of this case series was to retrospectively examine records of cases with uterine rupture in pregnancies following myomectomy and to describe the clinical features and pregnancy outcomes. Methods This study was conducted as a multicenter case series. The patient databases at 7 tertiary hospitals were queried. Records of patients with a diagnosis of uterine rupture in the pregnancy following myomectomy between January 2012 and December 2014 were retrospectively collected. The uterine rupture cases enrolled in this study were defined as follows: through-and-through uterine rupture or tear of the uterine muscle and serosa, occurrence from 24+0 to 41+6 weeks’ gestation, singleton pregnancy, and previous laparoscopic myomectomy (LSM) or laparotomic myomectomy (LTM) status. Results Fourteen pregnant women experienced uterine rupture during their pregnancy after LSM or LTM. Preterm delivery of less than 34 weeks’ gestation occurred in 5 cases, while intrauterine fetal death occurred in 3, and 3 cases had fetal distress. Of the 14 uterine rupture cases, none occurred during labor. All mothers survived and had no sequelae, unlike the perinatal outcomes, although they were receiving blood transfusion or treatment for uterine artery embolization because of uterine atony or massive hemorrhage. Conclusion In women of childbearing age who are scheduled to undergo LTM or LSM, the potential risk of uterine rupture on subsequent pregnancy should be explained before surgery. Pregnancy in women after myomectomy should be carefully observed, and they should be adequately counseled during this period.
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Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review. Case Rep Obstet Gynecol 2016; 2016:9803250. [PMID: 27885348 PMCID: PMC5112332 DOI: 10.1155/2016/9803250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/11/2016] [Indexed: 12/30/2022] Open
Abstract
Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE. Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015. Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma.
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Takahashi N, Yoshino O, Hiraike O, Maeda E, Nakamura M, Hori M, Harada M, Koga K, Saito S, Fujii T, Osuga Y. The assessment of myometrium perfusion in patients with uterine fibroid by arterial spin labeling MRI. SPRINGERPLUS 2016; 5:1907. [PMID: 27867814 PMCID: PMC5095089 DOI: 10.1186/s40064-016-3596-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 10/24/2016] [Indexed: 11/10/2022]
Abstract
Background It has been suggested that an inadequate blood supply caused by uterine fibroids may lead to decreasing fertility. Therefore, a quantitative evaluation of blood flow in the uterus might be a good tool for infertility treatments. For the first step, the ability to perform arterial spin labeling (ASL)-MRI in pelvic organs was examined by measuring blood flow in the uterine muscle layer. Results Three normal volunteer women, seven patients with one uterine fibroid and four patients treated with GnRH analogue for uterine fibroids, were enrolled in this study. Perfusion of normal uterine myometrium was examined using non-enhanced ASL-MRI. The region of interest was set in the uterine muscle layer, with a point in the iliopsoas or gluteus muscle. The ASL perfusion index was calculated as (ASL value in uterus—ASL value in iliopsoas/gluteus muscle). The ASL perfusion indexes in the secretory phase of all 3 volunteers were significantly lower than the indexes in the proliferative phases (P < 0.05). In patients with fibroids, all three types of fibroids (subserosal, intramural and submucosal types) were included. In seven patients harboring a single uterine fibroid, the ASL perfusion indexes of myometrium on the fibroid-positive side increased 4.9 fold compared with that of the fibroid-negative side. With GnRH analogue treatment, ASL perfusion in myometrium decreased to 39% on average (P < 0.05). Conclusion We utilized the ASL-MRI technique to evaluate perfusion of uterine myometrium. For clinical use, an inadequate blood supply caused by uterine fibroids is known to lead to decreasing fertility. The ASL-MRI technique might be useful to evaluate blood supply as a quantitative measurement of fertility in patients with uterine fibroids.
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Affiliation(s)
- Nozomi Takahashi
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, 113-8655 Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, The University of Toyama, Toyama, 930-0194 Japan
| | - Osamu Hiraike
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, 113-8655 Japan
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, 113-8655 Japan
| | | | - Masaaki Hori
- Department of Radiology, The University of Juntendo, Tokyo, 113-8421 Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, 113-8655 Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, 113-8655 Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, The University of Toyama, Toyama, 930-0194 Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, 113-8655 Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, 113-8655 Japan
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Hachiya K, Kato H, Kawaguchi S, Kojima T, Nishikawa Y, Fujiwara S, Matsuo M. Red degeneration of a uterine fibroid following the administration of gonadotropin releasing hormone agonists. J OBSTET GYNAECOL 2016; 36:1018-1019. [DOI: 10.1080/01443615.2016.1234449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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165
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Ciebiera M, Włodarczyk M, Słabuszewska-Jóźwiak A, Nowicka G, Jakiel G. Influence of vitamin D and transforming growth factor β3 serum concentrations, obesity, and family history on the risk for uterine fibroids. Fertil Steril 2016; 106:1787-1792. [PMID: 27743697 DOI: 10.1016/j.fertnstert.2016.09.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the influence of 25-hydroxyvitamin D and transforming growth factor β3 (TGF-β3) serum concentrations, weight, and family history on the risk of developing uterine fibroids. DESIGN Retrospective cohort study. SETTING University hospital. PATIENT(S) A total of 188 women, including patients admitted for uterine fibroid surgery (n = 105) as the study group and healthy women of similar age (n = 83) as controls. INTERVENTION(S) Medical history and completion of specially designed questionnaire, transvaginal or transabdominal genital ultrasound scan, blood sampling, and measurement of vitamin D and TGF-β3 serum concentrations. MAIN OUTCOME MEASURE(S) Evaluation of the impact of family history, vitamin D, and TGF-β3 serum concentrations on the risk of developing uterine fibroids. RESULT(S) Mean 25-hydroxyvitamin D serum concentrations were 21.9 ± 8.9 ng/mL and 26.7 ± 11.9 ng/mL in patients with uterine fibroids and controls, respectively. The difference was statistically significant. The TGF-β3 serum concentrations in the fibroid-positive group ranged from 1.20 to 436.15 pg/mL (half the patients had concentrations >16.25 pg/mL). Concentrations in the control group ranged from 0.96 to 49.08 pg/mL (half the women had concentrations of >11.80 pg/mL). The differences were statistically significant. Higher body mass index (BMI) and positive family history were also found to be among the risk factors for uterine fibroids. CONCLUSION(S) Our study confirmed higher BMI, positive family history, and lower vitamin D and higher TGF-β3 serum concentrations as risk factors for uterine fibroids.
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Affiliation(s)
- Michał Ciebiera
- First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | - Marta Włodarczyk
- Department of Biochemistry and Clinical Chemistry, Department of Pharmacogenomics, Medical University of Warsaw, Warsaw, Poland
| | | | - Grażyna Nowicka
- Department of Biochemistry and Clinical Chemistry, Department of Pharmacogenomics, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Tung SL, Chou TY, Tseng HS, Lee CM. A retrospective study of magnetic resonance-guided focused ultrasound ablation for uterine myoma in Taiwan. Taiwan J Obstet Gynecol 2016; 55:646-649. [DOI: 10.1016/j.tjog.2015.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 01/08/2023] Open
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167
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Wise LA, Palmer JR, Rosenberg L, Haddad SA, Ruiz-Narváez EA. FASN, dietary fat intake, and risk of uterine leiomyomata in the Black Women's Health Study. Fertil Steril 2016; 106:1136-1141. [PMID: 27375065 PMCID: PMC5048502 DOI: 10.1016/j.fertnstert.2016.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To replicate results from a previous genome-wide association study of European ancestry women, in which a positive association was found between uterine leiomyomata (UL) and rs4247357, a single-nucleotide polymorphism located near the fatty acid synthase (FASN) gene. DESIGN Prospective cohort study. SETTING Not applicable. PATIENT(S) African-American women aged 23-50 years, who were premenopausal and had an intact uterus in 1997. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) We genotyped rs4247357 among 2,301 incident UL cases and 3,005 controls from the Black Women's Health Study (1997-2011). Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using logistic regression with control for age, geographic region of residence, and percent European ancestry using a panel of validated ancestry informative markers. RESULT(S) Overall, rs4247357 was not associated with UL risk. Relative to the CC genotype, ORs were 1.04 (95% CI 0.92-1.19) for the AC genotype and 1.09 (95% CI 0.93-1.29) for the AA genotype. A positive association was found, however, among those with higher European ancestry (≥40%). Relative to the CC genotype, ORs were 2.03 (95% CI 1.12-3.69) for the AC genotype and 2.44 (95% CI 1.20-4.96) for the AA genotype. Dietary fat intake also appeared to modify the FASN-UL association. CONCLUSION(S) Although there was little overall association between rs4247357 and UL risk, a positive association was observed among women with ≥40% European ancestry. Direct sequencing of this genomic region might be warranted to determine whether rs4247357, or some other variant, is causally related to UL.
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Affiliation(s)
- Lauren A Wise
- Slone Epidemiology Center at Boston University, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Stephen A Haddad
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
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168
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Celik O, Acet M, Kucuk T, Haberal ET, Acet T, Bozkurt M, Sahin L, Verit FF, Caliskan E. Surgery for Benign Gynecological Disorders Improve Endometrium Receptivity. Reprod Sci 2016; 24:174-192. [DOI: 10.1177/1933719116654993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Onder Celik
- Private Clinic, Obstetrics and Gynecology, Usak, Turkey
| | - Mustafa Acet
- Department of Obstetrics and Gynecology, Medipol University School of Medicine, Istanbul, Turkey
| | - Tansu Kucuk
- Department of Obstetrics and Gynecology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Esra Tustas Haberal
- Obstetrics and Gynecology, Umraniye Education and Research Hospital, İstanbul, Turkey
| | - Tuba Acet
- Obstetrics and Gynecology, Medicine Hospital, Istanbul, Turkey
| | - Murat Bozkurt
- Department of Obstetrics and Gynecology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Levent Sahin
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
| | - Fatma Ferda Verit
- Obstetrics and Gynecology, Süleymaniye Education and Research Hospital, İstanbul, Turkey
| | - Eray Caliskan
- Department of Obstetrics and Gynecology, Bahcesehir University School of Medicine, Kocaeli, Turkey
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169
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Kriplani A, Srivastava A, Kulshrestha V, Kachhawa G, Agarwal N, Bhatla N, Hari S. Efficacy of ormeloxifene versus oral contraceptive in the management of abnormal uterine bleeding due to uterine leiomyoma. J Obstet Gynaecol Res 2016; 42:1744-1752. [PMID: 27647770 DOI: 10.1111/jog.13105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/09/2016] [Accepted: 06/19/2016] [Indexed: 11/30/2022]
Abstract
AIM To compare ormeloxifene with combined oral contraceptive (COC) in abnormal uterine bleeding (AUB) due to leiomyoma (AUB-L). METHODS 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. RESULTS 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 (<100) compared with only two (8%) in group II. In group I, PBAC score in FIGO-PALM-COEIN leiomyoma types 2, 3, 4, 5, 6 reduced by 90.2%, 82.5%, 93.3%, 56.4% and 100%, respectively and 14 (56%) developed amenorrhea; compared with reduction of 64%, 27.5%, 25.9% in types 4, 5 and 6, respectively in group II. Dysmenorrhea visual analog scale score decreased in both groups. Mean leiomyoma volume increased in both groups: by 25.7% with ormeloxifene versus 16.9% with COC; only grade 2 leiomyoma in group I reduced by 44%. One patient in group II with grade 2 leiomyoma discontinued treatment at 3 months. Seven patients (28%) developed ovarian cyst in group I with no other major adverse effect in either group. CONCLUSION 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.
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Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Astha Srivastava
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Nutan Agarwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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170
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Walker CL, Burroughs KD, Davis B, Sowell K, Everitt JI, Fuchs-Young R. Preclinical Evidence for Therapeutic Efficacy of Selective Estrogen receptor Modulators for Uterine Leiomyoma. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/107155760000700410] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cheryl Lyn Walker
- University of Texas M. D. Anderson Cancer Center-Science Park, research Division, Smithville, Texas; the national Institute of Environmental Health Sciences, Research Triangle Park, North Carolina; Chemical Industry Institute of Toxicology, Research Triangle Park, North Carolina
| | | | | | | | | | - Robin Fuchs-Young
- University of Texas M. D. Anderson Cancer Center-Science Park, research Division, Smithville, Texas; the national Institute of Environmental Health Sciences, Research Triangle Park, North Carolina; Chemical Industry Institute of Toxicology, Research Triangle Park, North Carolina
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171
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Kayisli UA, Berkkanoglu M, Kizilay G, Senturk L, Arici A. Expression of Proliferative and Preapoptotic Molecules in Human Myometrium and Leiomyoma Throughout the Menstrual Cycle. Reprod Sci 2016; 14:678-86. [DOI: 10.1177/1933719107305866] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | | | - Aydin Arici
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, & Reproductive Sciences,Yale University School of Medicine, New Haven, CT,
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172
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Jeong JH, Hong GP, Kim YR, Ha JE, Lee KS. Clinical Consideration of Treatment to Ablate Uterine Fibroids with Magnetic Resonance Imaging-guided High Intensity Focused Ultrasound (MRgFUS): Sonalleve. J Menopausal Med 2016; 22:94-107. [PMID: 27617244 PMCID: PMC5016510 DOI: 10.6118/jmm.2016.22.2.94] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/17/2016] [Accepted: 07/26/2016] [Indexed: 12/18/2022] Open
Abstract
Objectives Magnetic resonance imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) is a newly emerging non-invasive technique for the treatment of uterine fibroids. The purpose of this study is to review the clinical impact of MRgFUS. Methods This study examined 157 patients. The high intensity focused ultrasound (HIFU) utilized in this study was Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, the Netherlands) and Sonalleve HIFU system. The patients were followed in post-operative Month 1, Month 3, and Month 6 to investigate any change. Then, these were further classified according to the use of uterine stimulant (oxytocin) in parallel, Funaki Type of uterine fibroid, HIFU intensity, and non-perfused volume (NPV) ratio. Results When the uterine stimulant was utilized, the HIFU intensity was measured at significantly lower levels, compared with the group not using uterine stimulant, and treatment duration was significantly. The NPV ratio was found significantly higher in the group using uterine stimulant. Concerning the correlation between Funaki Type of uterine fibroid and average sonication power, it was found that the closer to Type I, the lower the sonication power, the shorter the treatment duration, and the higher the NPV ratio significantly. Conclusions In this study, it was found that the lower the Funaki Types of uterine fibroids, and the higher the NPV ratio immediately after the operation, the larger the uterine fibroid volume decrease and SSS change were. Also, if uterine stimulant was used in parallel in treatment, treatment duration and HIFU intensity could become shorter and lower.
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Affiliation(s)
- Jae-Hyeok Jeong
- Department of Obstetrics & Gynecology, Hwa Myung Il Sin Christian Hospital, Busan, Korea
| | - Gil Pyo Hong
- Department of Obstetrics & Gynecology, Hwa Myung Il Sin Christian Hospital, Busan, Korea
| | - Yu-Ri Kim
- Department of Obstetrics & Gynecology, Hwa Myung Il Sin Christian Hospital, Busan, Korea
| | - Jae-Eun Ha
- Department of Obstetrics & Gynecology, Hwa Myung Il Sin Christian Hospital, Busan, Korea
| | - Kyu-Sup Lee
- Department of Obstetrics & Gynecology, Pusan National University School of Medicine, Busan, Korea
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173
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Baird DD, Kesner JS, Dunson DB. Luteinizing Hormone in Premenopausal Women May Stimulate Uterine Leiomyomata Development. ACTA ACUST UNITED AC 2016; 13:130-5. [PMID: 16443507 DOI: 10.1016/j.jsgi.2005.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Human chorionic gonadotropin (hCG) has proliferative effects on uterine smooth muscle and leiomyoma tissue in vitro. We hypothesized that luteinizing hormone (LH) would have the same effect by activating the LH/hCG receptor, and it would follow that premenopausal women with higher basal LH levels would be more likely to have leiomyomata. METHODS Randomly selected women, aged 35 to 49 years, from a prepaid health plan were screened for leiomyomata with pelvic ultrasound. Urine samples collected during the first or last 5 days of the menstrual cycle were analyzed for LH by immunofluorometric assay, and concentrations were corrected for creatinine (n = 523). Logistic regression and Bayes analyses were used to evaluate the association of LH with presence and size of leiomyomata, adjusting for age, and other risk factors. RESULTS Women with higher LH were more likely to have leiomyomata (adjusted odds ratios for second and third tertiles were 1.7 and 2.0 compared with lower tertile; 95% confidence intervals, 1.0 to 2.7 and 1.2 to 3.4, respectively). The association was stronger for large leiomyomata. Bayes analyses designed to estimate LH effects on tumor onset separately from tumor growth showed significantly accelerated tumor onset but little evidence of effects on tumor growth. Age, an independent risk factor for leiomyomata, was not affected by inclusion of LH in the logistic models. CONCLUSIONS As hypothesized, women with higher LH were more likely to have leiomyomata, but this did not explain the age-related increase in leiomyomata during perimenopausal ages. Determining whether LH is causal or a marker for susceptibility will require further research.
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Affiliation(s)
- Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina 27709, USA.
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Janjusevic M, Greco S, Islam MS, Castellucci C, Ciavattini A, Toti P, Petraglia F, Ciarmela P. Locostatin, a disrupter of Raf kinase inhibitor protein, inhibits extracellular matrix production, proliferation, and migration in human uterine leiomyoma and myometrial cells. Fertil Steril 2016; 106:1530-1538.e1. [PMID: 27565262 DOI: 10.1016/j.fertnstert.2016.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the presence of Raf kinase inhibitor protein (RKIP) in human myometrium and leiomyoma as well as to determine the effect of locostatin (RKIP inhibitor) on extracellular matrix (ECM) production, proliferation, and migration in human myometrial and leiomyoma cells. DESIGN Laboratory study. SETTING Human myometrium and leiomyoma. PATIENT(S) Thirty premenopausal women who were admitted to the hospital for myomectomy or hysterectomy. INTERVENTION(S) Myometrial and leiomyoma tissues were used to investigate the localization and the expression level of RKIP through immunohistochemistry and Western blotting. Myometrial and leiomyoma cells were treated with locostatin (10 μM) to measure ECM expression by real-time polymerase chain reaction, GSK3β expression by Western blotting, cell migration by wound-healing assay, and cell proliferation by MTT assay and immunocytochemistry. MAIN OUTCOME MEASURE(S) The expression of RKIP in human myometrial and leiomyoma tissue; ECM components and GSK3β expression, migration, and proliferation in myometrial and leiomyoma cells. RESULT(S) RKIP is expressed in human myometrial and leiomyoma tissue. Locostatin treatment resulted in the activation of the mitogen-activated protein kinase (MAPK) signal pathway (ERK phosphorylation), providing a powerful validation of our targeting protocol. Further, RKIP inhibition by locostatin reduces ECM components. Moreover, the inhibition of RKIP by locostatin impaired cell proliferation and migration in both leiomyoma and myometrial cells. Finally, locostatin treatment reduced GSK3β expression. Therefore, even if the activation of MAPK pathway should increase proliferation and migration, the destabilization of GSK3β leads to the reduction of proliferation and migration of myometrial and leiomyoma cells. CONCLUSION(S) Our results indicate that RKIP may be involved in leiomyoma pathophysiology.
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Affiliation(s)
- Milijana Janjusevic
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Stefania Greco
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Md Soriful Islam
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, Ancona, Italy; Biotechnology and Microbiology Laboratory, Department of Botany, University of Rajshahi, Rajshahi, Bangladesh
| | - Clara Castellucci
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Ciavattini
- Department of Clinical Science, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Toti
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Felice Petraglia
- Department of Molecular and Developmental Medicine, Obstetrics, and Gynecology, University of Siena, Siena, Italy
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, Ancona, Italy; Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy.
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175
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Yun JW, Kim YY, Ahn JH, Kang BC, Ku SY. Use of nonhuman primates for the development of bioengineered female reproductive organs. Tissue Eng Regen Med 2016; 13:323-334. [PMID: 30603414 DOI: 10.1007/s13770-016-9091-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/13/2015] [Accepted: 12/09/2015] [Indexed: 01/02/2023] Open
Abstract
Nonhuman primates (NHPs) have been widely used in reproductive biology, neuroscience, and drug development since a number of primate species are phylogenetically close to humans. In this review, we summarize the use of NHPs for nonclinical application in the reproductive system disorders including the loss or failure of an organ or tissue. Causes of infertility include congenital aplasia and acquired disorders of the reproductive organs. In addition, anti-cancer treatments can deplete ovarian follicles, leading to premature ovarian failure, infertility and long-term health risks. Along with a limited supply of human reproductive organs, anatomic/physiologic similarities to humans support the need for NHP models (New-World monkeys such as the common marmoset and Old-World monkeys such as cynomolgus and rhesus monkeys) to promote the advances in female infertility studies. For maintaining and executing animal studies using NHP, special protocols including animal care, anesthetic protocol, surgical technique, and immunosuppressive protocol are necessary. With a growing interest in the potential therapies such as endometrial tissue engineering, and ovary/follicle cryopreservation and grafting in Korea, this review can be useful in selecting appropriate animal models and can bridge between nonclinical studies and clinical applications by providing detailed information on the use of NHPs in the field of reproductive organ disorders.
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Affiliation(s)
- Jun-Won Yun
- 1Department of Experimental Animal Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Yoon Young Kim
- 2Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hun Ahn
- 1Department of Experimental Animal Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,3Graduate School of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byeong-Cheol Kang
- 1Department of Experimental Animal Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,3Graduate School of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,4Designed Animal Research Center, Institute of GreenBio Science Technology, Seoul National University, Pyeongchang, Korea.,5Biomedical Center for Animal Resource and Development, N-BIO, Seoul National University, Seoul, Korea.,6Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
| | - Seung-Yup Ku
- 2Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,7Graduate School of Translational Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
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176
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Hiremath SB, Benjamin G, Gautam AA, Panicker S, Rajan A. Disseminated peritoneal leiomyomatosis: a rare cause of enigmatic peritoneal masses. BJR Case Rep 2016; 2:20150252. [PMID: 30459968 PMCID: PMC6243359 DOI: 10.1259/bjrcr.20150252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 11/17/2022] Open
Abstract
Disseminated peritoneal leiomyomatosis (DPL) is an unusual extrauterine form of leiomyoma that has been found to coexist with its intrauterine counterpart in individuals who have previously undergone laparoscopic myomectomy. The presence of extrauterine masses with the density of smooth muscle on CT imaging and/or with a low signal intensity similar to that of smooth muscle on T2 weighted MRI in a patient presenting with associated intrauterine leiomyoma and/or a history of previous laparoscopic myomectomy suggests the possibility of DPL. Imaging studies help in diagnosing and delineating the location and extent of the lesion and also follow-up the masses to look for sarcomatous transformation. Here we report the case of a 43-year-old female who presented initially with right lower quadrant pain. Her CT scan and MRI demonstrated a fundal fibroid with multiple intraperitoneal soft tissue masses of similar appearance and contrast enhancement in the sigmoid mesocolon, the left paracolic gutter and adjacent to the ascending colon. The suspected diagnosis of DPL was confirmed during abdominal hysterectomy, bilateral salphingo-oophorectomy and excision of peritoneal masses.
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Affiliation(s)
- Shivaprakash Basavanthaiah Hiremath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Geena Benjamin
- Department of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, India
| | - Amol Anantrao Gautam
- Department of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, India
| | - Sathibhai Panicker
- Department of Pathology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, India
| | - Aji Rajan
- Department of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, India
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Mozzachio K, Linder K, Dixon D. Uterine Smooth Muscle Tumors in Potbellied Pigs (Sus scrofa) Resemble Human Fibroids: A Potential Animal Model. Toxicol Pathol 2016; 32:402-7. [PMID: 15307213 DOI: 10.1080/01926230490440880] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Uterine leiomyomas, commonly termed fibroids, clinically affect approximately 25% of women of reproductive age in the United States, with a subclinical incidence as high as 77%. The pathogenesis of fibroid formation remains poorly understood, due in large part to the lack of a suitable animal model. This retrospective study characterizes the clinical, gross, and histopathologic features of similar, spontaneously occurring uterine tumors in potbellied pigs. Medical records available through a local Potbellied Pig Spay/Neuter Program, pig sanctuaries, and the Duchess Fund database were reviewed for evidence of reproductive disease or surgery. One-hundred and six female potbellied pigs were evaluated and uterine neoplasia was identified in 17 animals; tissues were available for 13 of these. Uterine leiomyoma was diagnosed in 11 of 13 cases, leiomyosarcoma in 1 of 13 cases, and undifferentiated sarcoma in 1 case. Pigs presented with clinical signs including abdominal distension or vaginal bleeding or were subclinical and identified during ovariohysterectomy. Tumors ranged from microscopic to 45 kg, were often multiple, and primarily involved the uterine horns. Hematoxylin and eosin and trichrome-stained sections were evaluated for morphological features of human and animal leiomyomas; immunohistochemistry to detect smooth muscle actin was also performed. The cellular pattern/morphology and variable degree of fibroplasia of the leiomyomas were similar to that reported for human fibroids. These results support further investigation of uterine leiomyomas in potbellied pigs as a potentially valuable animal model for studying human fibroids.
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Affiliation(s)
- Kristie Mozzachio
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27606, USA
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Cohen SL, Senapati S, Gargiulo AR, Srouji SS, Tu FF, Solnik J, Hur HC, Vitonis A, Jonsdottir GM, Wang KC, Einarsson JI. Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: a randomised controlled trial. BJOG 2016; 124:262-268. [PMID: 27362908 DOI: 10.1111/1471-0528.14179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if higher-volume, fixed-dose administration of vasopressin further reduces blood loss at the time of minimally invasive myomectomy. DESIGN Randomised multicentre clinical trial. SETTING Tertiary-care academic centres in the USA. POPULATION Women undergoing conventional laparoscopic or robot-assisted laparoscopic myomectomy. METHODS All participants received the same 10-unit (U) dose of vasopressin, but were randomly assigned to one of two groups: (i) received 200 ml of diluted vasopressin solution (20 U in 400 ml normal saline), and (ii) received 30 ml of concentrated vasopressin solution (20 U in 60 ml normal saline). MAIN OUTCOME MEASURES The primary study outcome was estimated blood loss; the study was powered to detect a 100-ml difference. RESULTS A total of 152 women were randomised; 76 patients in each group. Baseline demographics were similar between groups. The primary outcome of intraoperative blood loss was not significantly different, as measured by three parameters: surgeon estimate (mean estimated blood loss 178 ± 265 ml and 198 ± 232 ml, dilute and concentrated groups respectively, P = 0.65), suction canister-calculated blood loss, or change in haematocrit levels. There were no vasopressin-related adverse events. CONCLUSION Both dilute and concentrated vasopressin solutions that use the same drug dosing demonstrate comparable safety and tolerability when administered for minimally invasive myomectomy; however, higher volume administration of vasopressin does not reduce blood loss. TWEETABLE ABSTRACT This randomised trial failed to show benefit of high-volume dilute vasopression.
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Affiliation(s)
- S L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - S Senapati
- Division of Gynecological Pain and Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston IL & Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - A R Gargiulo
- Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA, USA
| | - S S Srouji
- Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA, USA
| | - F F Tu
- Division of Gynecological Pain and Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston IL & Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - J Solnik
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - H-C Hur
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Vitonis
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - G M Jonsdottir
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - K C Wang
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - J I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Alkatout I, Mettler L, Günther V, Maass N, Eckmann-Scholz C, Elessawy M, Anapolski M. Safety and economical innovations regarding surgical treatment of fibroids. MINIM INVASIV THER 2016; 25:301-313. [DOI: 10.1080/13645706.2016.1190380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Murji A, Crosier R, Chow T, Ye XY, Shirreff L. Role of ethnicity in treating uterine fibroids with ulipristal acetate. Fertil Steril 2016; 106:1165-1169. [PMID: 27336213 DOI: 10.1016/j.fertnstert.2016.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/02/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study differences in treatment effect between black and white premenopausal women prescribed ulipristal acetate (UPA) for symptomatic uterine fibroids. DESIGN Prospective observational cohort study. SETTING Gynecology clinics. PATIENT(S) Premenopausal women aged 18-55 years, at least one symptomatic uterine fibroid, UPA-naïve, and no contraindications for UPA treatment. INTERVENTION(S) One 3-month course of UPA at 5 mg daily. MAIN OUTCOME MEASURE(S) Patients' ethnicity self-identification adapted from Statistics Canada National Household Survey. Change in fibroid symptoms according to Uterine Fibroid Symptoms Quality of Life Questionnaire symptom severity and health-related quality of life score. Bleeding symptoms and amenorrhea rates according to Aberdeen Bleeding Score. RESULT(S) A total of 148 patients enrolled (45 black, 59 white, 44 other ethnicity). Black patients were younger (40.3 y vs. 44.5 y) with larger uteri (523 mL vs. 351 mL) than white counterparts. Baseline symptom severity was similar between groups. After 3 months of UPA treatment, both groups experienced similar improvements in symptom severity. White women had 52% greater improvement in bleeding score (-40.3 vs. -26.5) and were more likely to be amenorrheic at the end of treatment (66% vs. 41%). Both groups experienced adverse events at similar frequencies. Black women were more dissatisfied with UPA compared with white women (27.3% vs. 8%). CONCLUSION(S) Black women had greater fibroid burden at baseline. Both ethnicities had similar improvement in fibroid symptomatology following UPA treatment, but white women experienced higher amenorrhea rates. Black women were more dissatisfied with UPA treatment, which may be related to the lower amenorrhea rates.
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Affiliation(s)
- Ally Murji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
| | - Rebecca Crosier
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Tiffany Chow
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Lindsay Shirreff
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
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181
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Huang PS, Sheu BC, Huang SC, Chang WC. Intraligamental Myomectomy Strategy Using Laparoscopy. J Minim Invasive Gynecol 2016; 23:954-61. [PMID: 27327965 DOI: 10.1016/j.jmig.2016.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/19/2022]
Abstract
UNLABELLED STUDY OBJECTIVE Intraligamental myomas (IMs) represent 6% to 10% of all uterine myomas. An IM growing from the lateral uterine wall into the broad ligament often presents as a large pelvic mass without symptoms. Removing a large IM can be difficult because of the limited operative field and poses challenges during conventional laparoscopic surgical approaches. The risk of injury to the ureter and uterine artery during myomectomy is greater than that during other types of myoma. DESIGN Retrospective study (Canadian Task Force classification III). SETTING University-affiliated hospital. PATIENTS IM was classified into 3 types according to the location: (1) anterior intraligamental myoma (AIM), (2) posterior intraligamental myoma (PIM), and (3) lateral intraligamental myoma (LIM). From April 2007 to July 2015, 83 consecutive patients with IM underwent laparoscopic myomectomy at National Taiwan University Hospital, Taipei, Taiwan, including 23 AIM, 27 PIM, and 33 LIM. INTERVENTIONS Several techniques are described, and videos are supplied for performing laparoscopic myomectomy safely and easily in different types of IM. MEASUREMENTS AND MAIN RESULTS Urinary frequency (31%) and a palpable abdominal mass (31%) were the 2 most common presenting symptoms. Most of the lesions were 33 LIM (40%) followed by 27 PIM (32%) and 23 AIM (28%). The mean myoma sizes were 11.0, 8.0, and 7.8 cm; the mean myoma weights were 478, 279, and 309 g; the mean operative times were 134, 108, and 104 minutes; and the mean blood loss during surgery was 224, 94, and 107 mL for LIM, PIM, and AIM, respectively. LIMs had relatively more blood loss because they were heavier and commonly rested alongside the uterine artery. The only complication was late postoperative hemorrhage in 1 case of LIM. Histopathology showed leiomyoma in all cases. Three patients were spontaneously conceived after myomectomy, and each had a successful pregnancy and cesarean delivery. CONCLUSION Surgical treatment of IM is empirically difficult. It is important to use an approach that considers the location, size, and shape of the myoma. All types of IM presented with similar symptoms, and the highest blood loss occurred during laparoscopic myomectomy of a LIM.
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Affiliation(s)
- Pei-Shen Huang
- Department of Obstetrics and Gynecology, Buddhist Tzu-Chi General Hospital, Taipei Branch, Taipei, Taiwan
| | - Bor-Ching Sheu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Su-Cheng Huang
- Department of Obstetrics and Gynecology, Buddhist Tzu-Chi General Hospital, Taipei Branch, Taipei, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan.
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Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, Berghella V. Trial of labor after myomectomy and uterine rupture: a systematic review. Acta Obstet Gynecol Scand 2016; 95:724-34. [DOI: 10.1111/aogs.12920] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Alexis C. Gimovsky
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; Sidney Kimmel College of Medicine; Thomas Jefferson University; Philadelphia PA USA
| | - Anna Locatelli
- Department of Obstetrics and Gynecology; University of Milan Bicocca; Milan Italy
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; Sidney Kimmel College of Medicine; Thomas Jefferson University; Philadelphia PA USA
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Najjar M, Mandel M. Round Ligament Leiomyoma Presenting as an Incarcerated Inguinal Hernia: Case Report and Review of the Literature. Case Rep Surg 2016; 2016:9380212. [PMID: 27144048 PMCID: PMC4837254 DOI: 10.1155/2016/9380212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/27/2016] [Indexed: 11/17/2022] Open
Abstract
Leiomyomas are common benign gynecologic tumors occurring in up to 30% of women. Round ligament leiomyomas however are very rare and, if symptomatic, can present as an inguinal hernia. We report the case of a 47-year-old woman who presented with an irreducible inguinal mass consistent with an incarcerated hernia. Intraoperatively, the mass was found to be a round ligament leiomyoma, a diagnosis that was confirmed by histopathology following excision of the mass. Although rare, round ligament leiomyomas should be part of the differential diagnosis of an inguinal hernia in females.
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Affiliation(s)
- Marc Najjar
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Marc Mandel
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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185
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Wise LA, Sponholtz TR, Rosenberg L, Adams-Campbell LL, Kuohung W, LaValley MP, Palmer JR. History of uterine leiomyoma and risk of endometrial cancer in black women. Cancer Causes Control 2016; 27:545-52. [PMID: 26923705 PMCID: PMC4798859 DOI: 10.1007/s10552-016-0728-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have found an association between uterine leiomyomata (UL) and uterine malignancies. This relation has not been studied in black women, who are disproportionately affected by UL. METHODS We investigated prospectively the association between self-reported physician-diagnosed UL and endometrial cancer in the Black Women's Health Study. During 1995-2013, 47,267 participants with intact uteri completed biennial health questionnaires. Reports of endometrial cancer were confirmed by pathology data from medical records and cancer registries. Cox regression was used to derive incidence rate ratios (IRR) and 95% confidence intervals (CI). RESULTS There were 300 incident endometrial cancer cases during 689,546 person-years of follow-up. In multivariable models, UL history was associated with a 42% greater incidence of endometrial cancer compared with no such history (95% CI 1.12-1.80). IRRs for cancer diagnosed 0-2, 3-9, and ≥10 years after UL diagnosis were 3.20 (95% CI 2.06-4.98), 0.95 (95% CI 0.60-1.52), and 1.35 (95% CI 1.03-1.77), respectively. Stronger overall associations between UL history and endometrial cancer were observed for later stages at cancer diagnosis (IRR = 2.25, 95% CI 1.09-4.63) and type II/III cancers (IRR = 3.13, 95% CI 1.64-5.99). CONCLUSIONS In this large cohort of black women, a history of UL was positively associated with endometrial cancer, particularly type II/III tumors. The strongest association was observed for cancer diagnosed within 2 years of UL diagnosis, a finding that might be explained by greater surveillance of women with UL or misdiagnosis of cancer as UL. However, an association was also observed for cancer reported ≥10 years after UL diagnosis.
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Affiliation(s)
- Lauren A Wise
- Slone Epidemiology Center at Boston University, Boston, MA, USA.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Todd R Sponholtz
- Slone Epidemiology Center at Boston University, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Michael P LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
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Ojo-Carons M, Mumford SL, Armstrong AY, DeCherney AH, Devine K. Is Myomectomy Prior to Assisted Reproductive Technology Cost Effective in Women with Intramural Fibroids? Gynecol Obstet Invest 2016; 81:442-6. [PMID: 26990761 DOI: 10.1159/000443391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the cost effectiveness of surgery to remove intramural (IM) fibroids prior to assisted reproductive technology (ART). METHODS The decision tree mathematical model along with sensitivity analysis was performed to analyze cost effectiveness of: (1) myomectomy followed by ART or (2) ART with IM myoma(s) in situ. RESULTS At the median ongoing pregnancy (OP) rate (OPR) reported in the literature for a fresh, autologous ART cycle with IM fibroids in situ vs. post-IM myomectomy, average cost per OP was $72,355 vs. 66,075, indicating a cost savings with myomectomy. Sensitivity analysis over the range of reported OPRs demonstrated that pre-ART IM myomectomy was always cost effective when OPR among women with in situ myomas was <15.4%. However, for OPRs ≥15.4%, pre-ART IM myomectomy was only cost effective if it increased OPR by at least 9.6%. At the high end of OPRs reported for patients with IM myomas in situ (31.4%), a 19.5% improvement in OPR was needed to justify IM myomectomy from a cost perspective. CONCLUSION Myomectomy should be used sparingly in cases where the goal of surgery is to achieve improvement in the outcomes of ART.
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Affiliation(s)
- Mary Ojo-Carons
- The Mount Sinai School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Services, New York, N.Y., USA
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187
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Kapur A, Angomchanu R, Dey M. Efficacy of Use of Long-Term, Low-Dose Mifepristone for the Treatment of Fibroids. J Obstet Gynaecol India 2016; 66:494-8. [PMID: 27651652 DOI: 10.1007/s13224-016-0861-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/09/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Fibroid or myoma is the commonest reported tumor of uterus, and is one of the important reasons for hysterectomy in our setting. Different drugs are available for medical management of fibroid uterus including mifepristone, a progesterone antagonist. Varying dosage regimen for mifepristone was studied as medical management of fibroid uterus. The aim of the project was to study the effect of mifepristone on the symptoms and size of fibroids, especially using a low-dose regimen for 6 months. In addition, any symptomatic improvement of menorrhagia and dysmenorrhea was also studied. METHODS The study was designed as an observational prospective "before-after" study. Women diagnosed with uterine fibroids attending OPD of a tertiary care hospital were selected according to the inclusion criteria. A total of 36 patients were enrolled in the study. Sample size was calculated to study changes in various parameters after 6 months treatment with mifepristone 50 mg once a week. Baseline investigations were performed and menstrual blood loss was assessed using pictorial blood assessment charts. Fifty milligrams of mifepristone weekly was used, and patient assessed at 1 and 6 month. They were also further followed up till 3 months after stopping the drug to observe the changes in menstrual pattern, fibroid volume, hemoglobin and liver function tests. Baseline endometrial biopsy and another at 6 month on cessation of drug therapy were done for all patients. RESULTS Majority of the study population comprised of perimenopausal women, i.e., 41-45 years (44 %). Fifty percent of the patients were Para 2 and belonged to the perimenopausal age-group (18 out of 36). The dominant presenting symptom was menorrhagia associated with dysmenorrhea and pelvic pain. After 6 months of treatment with mifepristone, the mean fibroid volume reduced from 204.33 to 113.16 cm(3) (n = 33); p ≤ 0.001, and the percentage mean volume reduction of the fibroid in the study population was 44.57 % (range 1.10-100 %). Immediate reduction in bleeding PV was observed in 100 %, and 88.89 % (32/36) patients attained amenorrhea. The mean hemoglobin increased from 9.18 to 10.82 g/dl (p = 0.001). There was a transient rise in mean transaminases (AST/ALT) levels at 6 months which reverted to normal at 9 months follow-up. CONCLUSION To conclude, 6 months therapy with 50 mg of mifepristone given weekly is efficacious and acceptable for the treatment of symptomatic leiomyoma, especially in a select group of patients. Although its use as a primary medical therapy is limited due to recurrence of fibroid after stopping treatment, it is useful for perimenopausal women whose myoma would regress after menopause, and younger infertile patients with small-size deep intramural myomas not easily accessible to either hysteroscopic or laparoscopic surgery. It is also beneficial as a preoperative adjunct, in patients with preoperative severe anemia and large fibroids where surgery is technically difficult. Mode of surgery can be changed to a less-invasive vaginal hysterectomy rather than an abdominal procedure.
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Affiliation(s)
- Anupam Kapur
- Department of Obstetrics and Gynecology, INHS Asvini, Mumbai, India
| | | | - Madhusudan Dey
- Department of Obstetrics and Gynecology, Armed Forces Medical College, Pune, 411040 India
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Iavazzo C, Mamais I, Gkegkes ID. Robotic assisted vs laparoscopic and/or open myomectomy: systematic review and meta-analysis of the clinical evidence. Arch Gynecol Obstet 2016; 294:5-17. [DOI: 10.1007/s00404-016-4061-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/24/2016] [Indexed: 11/28/2022]
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Clinical Characteristics and Prognosis of Unexpected Uterine Sarcoma After Hysterectomy for Presumed Myoma With and Without Transvaginal Scalpel Morcellation. Int J Gynecol Cancer 2016; 26:456-63. [DOI: 10.1097/igc.0000000000000638] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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190
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Cystic Endometriosis in a Huge Degenerated Subserous Leiomyoma Mimicking Bilateral Multicystic Endometriomas in an Infertile Woman with Diminished Ovarian Reserve: A Rare Endometriotic Implantation. Case Rep Obstet Gynecol 2016; 2016:2713943. [PMID: 27057369 PMCID: PMC4789423 DOI: 10.1155/2016/2713943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/07/2016] [Indexed: 11/17/2022] Open
Abstract
Uterine leiomyomas are the most common pelvic tumor in women. Leiomyoma can show atypical locations and degenerations and may not be easily differentiated from adnexal masses. Uterine leiomyoma can undergo cystic degeneration and is said to be found in 4% of all types of degenerations. The commonest type of degeneration is hyaline seen in 60% of patients. Usually uterine leiomyoma does not present as clinical and radiological diagnostic challenge. However, when leiomyoma undergoes massive cystic degeneration they may become clinical and radiological diagnostic dilemmas. The MRI showed a huge cystic mass protruding up to the pelvis not differentiated from bilateral endometriomas and accompanying subserous myomas. Surgery revealed that the mass is not bilateral endometriomas but a huge pedunculated leiomyoma with cystic degeneration and cystic endometriosis. Endometriosis is a troubling gynecologic condition occurring in 10% to 15% of women of reproductive age and is associated with fertility problems. As a peritoneal disease, the locations of endometriotic lesions are predominantly the ovaries (96.4%), followed by the soft tissue (2.8%), gastrointestinal tract (0.3%), and urinary tract (0.2%) and other rare locations. The presented case is multiple sized cystic endometriosis (endometriomas) located in a huge pedunculated subserous leiomyoma in an infertile woman having a history of laparoscopic bilateral endometrioma surgery. Conclusion. To our knowledge, this is the first reported case for endometriotic cysts (endometriomas) located in a huge cystic degenerated leiomyoma. PubMed search revealed no report concerning endometriotic implantation in the leiomyomas.
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Ulubay M, Öztürk M, Firatligil FB, Fidan U, Keskin U, Dede M, Yenen MC. Comparison of the Perioperative Outcomes of a Vessel Sealing Instrument-Assisted Technique with a Conventional Technique in Abdominal Myomectomy. J Clin Diagn Res 2016; 10:QC01-3. [PMID: 26894124 DOI: 10.7860/jcdr/2016/14825.7053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 10/06/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In gynaecologic practice, LigaSure Precise(TM) is generally used in endoscopic and open surgeries, such as hysterectomy, adnexectomy, and cancer surgery. However, there is no case report or main research article where LigaSure Precise(TM) has been used for myomectomy. We want to compare a technique using a vessel sealing instrument with a conventional technique in abdominal myomectomy. MATERIALS AND METHODS Fifty-five women who underwent abdominal myomectomy were divided two groups: (1) a vessel sealing instrument-assisted technique (24 patients); and (2) a conventional technique (31 patients) between January 2011 and December 2014 at the Department of Gynaecology and Obstetrics, Gulhane Military Medical Academy, Ankara, Turkey. The data for the operation times, the occurrence of perioperative complications, the hospitalization times, and changes in haemaglobin and haematocrit levels for the two techniques were collected and compared. RESULTS The mean operation time was 48 minutes for the vessel sealing instrument-assisted technique and 54 minutes for the conventional technique. No statistically significant differences were determined for haemoglobin and haematocrit changes, hospital stay and perioperative complications. CONCLUSION We did not find any difference in the occurrence of complications, changes in haemoglobin or haematocrit levels, or hospital stay. The vessel sealing instrument-assisted technique is feasible and effective in reducing operation times.
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Affiliation(s)
- Mustafa Ulubay
- Assistant Professor, Department of Obstetrics and Gynecology, Gulhane Military Medical Academy , Etlik, Ankara, Turkey
| | - Mustafa Öztürk
- Specialist, Department of Obstetrics and Gynecology, Gulhane Military Medical Academy , Etlik, Ankara, Turkey
| | - Fahri Burçin Firatligil
- Specialist, Department of Obstetrics and Gynecology, Gulhane Military Medical Academy , Etlik, Ankara, Turkey
| | - Ulas Fidan
- Assistant Professor, Department of Obstetrics and Gynecology, Gulhane Military Medical Academy , Etlik, Ankara, Turkey
| | - Ugur Keskin
- Assistant Professor, Department of Obstetrics and Gynecology, Gulhane Military Medical Academy , Etlik, Ankara, Turkey
| | - Murat Dede
- Associate Professor, Department of Obstetrics and Gynecology, Gulhane Military Medical Academy , Etlik, Ankara, Turkey
| | - Müfit Cemal Yenen
- Professor, Department of Obstetrics and Gynecology, Gulhane Military Medical Academy , Etlik, Ankara, Turkey
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Removal of uterine fibroids by mini-laparotomy technique in women who wish to preserve their uterus and fertility. Wideochir Inne Tech Maloinwazyjne 2016; 10:561-6. [PMID: 26865893 PMCID: PMC4729736 DOI: 10.5114/wiitm.2015.56998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/14/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The minilaparotomy is considered to be a safe and effective alternative to laparoscopy and abdominal laparotomy in myomectomy cases. AIM To perform a retrospective analysis of pre-surgical assessment, surgical course and post-operational parameters in women wishing to preserve their uterus and fertility who underwent myomectomy by minilaparotomy in the Department of Gynecology and Gynecological Oncology at the Polish Mother's Memorial Hospital - Research Institute in Lodz in the years 2008-2014. MATERIAL AND METHODS A total of 76 patients were qualified for minilaparotomy due to a benign gynecological pathology. Only 21 patients with uterine fibroids who wanted to preserve their uterus and fertility were appropriate for this study. Patients' records were analyzed in terms of: epidemiological history, surgical course, postoperative stay and pathological data. All studied patients were asked in 2014 about conception and pregnancy after minilaparotomy. RESULTS The median age was 35.7 years. The median patient body mass index (BMI) was 24 kg/m(2). The average decrease of hemoglobin was 1.5 g/dl. The size of the myoma was between 1.5 and 15 cm. There were no serious post-surgical complications. The size of the myoma did not correlate significantly with operation time, BMI or blood loss. There was no statistically significant dependence between operation time and average hematocrit and hemoglobin decrease. In our group 7 patients who had undergone myomectomy tried to achieve conception. Four of them succeeded in pregnancy and gave birth to healthy infants. CONCLUSIONS Myomectomy performed via minilaparotomy is a safe procedure for patients willing to preserve their uterus and fertility, and it combines some advantages of both laparotomy and laparoscopy.
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Simpson PD, McLaren JS, Rymer J, Morris EP. Minimising menopausal side effects whilst treating endometriosis and fibroids. Post Reprod Health 2016; 21:16-23. [PMID: 25802141 DOI: 10.1177/2053369114568440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medical management of endometriosis and fibroids involves manipulation of the hypothalamic-pituitary-gonadal axis to alter the balance of sex hormones thereby inhibiting disease progression and ameliorate symptoms. Unfortunately, resultant menopausal symptoms sometimes limit the tolerability and duration of such treatment. The use of gonadotrophin-releasing hormone agonists to treat these diseases can result in short-term hypoestrogenic and vasomotor side effects as well as long-term impacts on bone health and cardiovascular risk. The routine use of add-back hormone replacement has reduced these risks and increased patient compliance, making this group of drugs more useful as a medium-term treatment option. The estrogen threshold hypothesis highlights the concept of a 'therapeutic window' in which bone loss is minimal but the primary disease is not aggravated. It explains why add-back therapy is appropriate for such patients and helps to explain the basis behind new developments in the treatment of hormonally responsive gynaecological conditions such as gonadotrophin-releasing hormone antagonists and progesterone receptor modulators.
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Affiliation(s)
- Paul D Simpson
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, UK
| | - James S McLaren
- Department of Obstetrics and Gynaecology, Croydon University Hospital, UK
| | - Janice Rymer
- Department of Gynaecology, King's College School of Medicine, UK
| | - Edward P Morris
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, UK
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194
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Chaffee BK, Beck AP, Owston MA, Kumar S, Baze WB, Magden ER, Dick EJ, Lammey M, Abee CR. Spontaneous Reproductive Tract Lesions in Aged Captive Chimpanzees. Vet Pathol 2016; 53:425-35. [PMID: 26823448 DOI: 10.1177/0300985815620654] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chimpanzees (Pan troglodytes) have served as an important model for studies of reproductive diseases and aging-related disorders in humans. However, limited information is available about spontaneously occurring reproductive tract lesions in aging chimpanzees. In this article, the authors present histopathologic descriptions of lesions identified in the reproductive tract, including the mammary gland, of 33 female and 34 male aged chimpanzees from 3 captive populations. The most common findings in female chimpanzees were ovarian atrophy, uterine leiomyoma, adenomyosis, and endometrial atrophy. The most common findings in male chimpanzees were seminiferous tubule degeneration and lymphocytic infiltrates in the prostate gland. Other less common lesions included an ovarian granulosa cell tumor, cystic endometrial hyperplasia, an endometrial polyp, uterine artery hypertrophy and mineralization, atrophic vaginitis, mammary gland inflammation, prostatic epithelial hyperplasia, dilated seminal vesicles, a sperm granuloma, and lymphocytic infiltrates in the epididymis. The findings in this study closely mimic changes described in the reproductive tract of aged humans, with the exception of a lack of malignant changes observed in the mammary gland and prostate gland.
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Affiliation(s)
- B K Chaffee
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - A P Beck
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - M A Owston
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - S Kumar
- National Animal Disease Center, US Department of Agriculture Agricultural Research Service, Ames, IA, USA
| | - W B Baze
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - E R Magden
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - E J Dick
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - M Lammey
- Alamogordo Primate Facility, Alamogordo, NM, USA
| | - C R Abee
- Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
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195
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Saridogan E. Surgical treatment of fibroids in heavy menstrual bleeding. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:53-62. [PMID: 26693796 PMCID: PMC5779570 DOI: 10.2217/whe.15.89] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Uterine fibroids can cause abnormal uterine bleeding and their removal is beneficial in the treatment of heavy menstrual bleeding associated with fibroids for women who would like to preserve their uterus and fertility. Endoscopic (hysteroscopic and laparoscopic) approaches are the preferred methods of fibroid removal when appropriate. In the presence of submucosal fibroids, hysteroscopic resection is a simple, safe and effective treatment for heavy menstrual bleeding and reduces the need for more major surgery, such as hysterectomy. When abdominal myomectomy is required, laparoscopic myomectomy is the preferred choice in selected cases due to its advantages over open myomectomy.
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Affiliation(s)
- Ertan Saridogan
- Women's Health Division, University College London Hospitals, 250 Euston Road, London, NW1 2PG, UK
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196
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Jeong JH, Kim YR, Hong KP, Ha JE, Kim EJ, Hong DK, Lee KS. Clinical experience with single-port access laparoscopic cystectomy and myomectomy. Clin Exp Reprod Med 2016; 43:44-50. [PMID: 27104157 PMCID: PMC4838581 DOI: 10.5653/cerm.2016.43.1.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 11/13/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022] Open
Abstract
Objective This study was performed to assess our clinical experience with single-port access (SPA) laparoscopic cystectomy and myomectomy and the surgical outcomes of those procedures at our institution. Methods The authors evaluated the surgical outcomes of SPA laparoscopic cystectomy in 293 patients and SPA laparoscopic myomectomy in 246 patients. The surgical outcomes comprised operation time, the amount of blood loss during the operation, the change in hemoglobin (before and after the operation), the change in hematocrit (before and after the operation), switching to the multi-port access method, complications, transfusions, and the duration of the postoperative hospital stay. Results The Pearson correlation coefficient and the Spearman correlation coefficient between the operation time and the amount of blood loss were 0.312 and 0.321 for SPA laparoscopic cystectomy, respectively, and 0.706 and 0.674 for SPA laparoscopic myomectomy, respectively. The drops in hemoglobin and hematocrit were 1.33±0.78 g/dL and 4.14%±2.45%, respectively, in SPA laparoscopic cystectomy, while the corresponding figures were 1.34±1.13 g/dL and 4.17%±3.24% in SPA laparoscopic myomectomy, respectively. Conclusion This study reported the surgical outcomes of SPA laparoscopic cystectomy and myomectomy and compared them to previously published findings on traditional laparoscopic cystectomy and myomectomy. No significant differences were found in the surgical outcomes between SPA and traditional laparoscopic cystectomy and myomectomy.
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Affiliation(s)
- Jae-Hyeok Jeong
- Department of Obstetrics and Gynecology, Hwamyeong Ilsin Christian Hospital, Busan, Korea
| | - Yu-Ri Kim
- Department of Obstetrics and Gynecology, Hwamyeong Ilsin Christian Hospital, Busan, Korea
| | - Kil-Pyo Hong
- Department of Obstetrics and Gynecology, Hwamyeong Ilsin Christian Hospital, Busan, Korea
| | - Jae-Eun Ha
- Department of Obstetrics and Gynecology, Hwamyeong Ilsin Christian Hospital, Busan, Korea
| | - Eun-Jeong Kim
- Department of Obstetrics and Gynecology, Hwamyeong Ilsin Christian Hospital, Busan, Korea
| | - Da-Kyo Hong
- Department of Obstetrics and Gynecology, Hwamyeong Ilsin Christian Hospital, Busan, Korea
| | - Kyu-Sup Lee
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea
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197
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Moon JW, Kim CH, Kim JB, Kim SH, Chae HD, Kang BM. Alterations in uterine hemodynamics caused by uterine fibroids and their impact on in vitro fertilization outcomes. Clin Exp Reprod Med 2015; 42:163-8. [PMID: 26816875 PMCID: PMC4724601 DOI: 10.5653/cerm.2015.42.4.163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/06/2015] [Accepted: 11/20/2015] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate the impact of fibroids on the blood flow of the uterine and subendometrial arteries and in vitro fertilization (IVF) outcomes. Methods In this study, we analyzed 86 IVF/intracytoplasmic sperm injection (ICSI) cycles in which a gonadotropin-releasing hormone antagonist protocol was used for controlled ovarian stimulation between January 2008 and March 2009. The subjects comprised 86 infertile women with (fibroid group, n=43) or without (control group, n=43) uterine fibroids. Results Patient characteristics were similar between the fibroid and control groups. The IVF/ICSI outcomes in patients with fibroids were similar to those of patients in the control group. The resistance index (RI) and pulsatile index (PI) of the uterine and subendometrial arteries on the day of embryo transfer were also comparable between the two groups. IVF outcomes and uterine hemodynamics in patients with multiple (≥2) fibroids were similar to those of patients with a single fibroid. However, clinical pregnancy and implantation rates were significantly lower in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05). The RI and PI of the subendometrial artery were significantly higher on the day of embryo transfer in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05). Conclusion Fibroids which distorting the uterine cavity might impair the subendometrial artery blood flow clinical pregnancy rate and embryo implantation rate in infertile patients undergoing IVF. Otherwise, IVF outcomes were not influenced by the presence of uterine fibroids.
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Affiliation(s)
- Jei-Won Moon
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Chung-Hoon Kim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jun-Bum Kim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sung-Hoon Kim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hee-Dong Chae
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Byung-Moon Kang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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198
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Kalogiannidis I, Stavrakis T, Dagklis T, Petousis S, Nikolaidou C, Venizelos I, Rousso D. A clinicopathological study of atypical leiomyomas: Benign variant leiomyoma or smooth-muscle tumor of uncertain malignant potential. Oncol Lett 2015; 11:1425-1428. [PMID: 26893755 DOI: 10.3892/ol.2015.4062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 06/25/2015] [Indexed: 12/17/2022] Open
Abstract
Atypical leiomyomas are histopathologically recognized by moderate to severe pleomorphic atypical tumor cells showing low mitotic counts without coagulative tumor cell necrosis. The histopathological features and clinical behavior of these tumors are unclear. The surgical management of these lesions includes myomectomy and hysterectomy. The current study presents 5 cases of women with atypical leiomyomas that were managed surgically. The clinicopathological characteristics of the patients and recurrences were analyzed. The median age of the patients was 43 years old. While 3 out of 5 patients were treated by hysterectomy (with or without salpingo-oophorectomy), the remaining 2 patients were treated by myomectomy. The median mitotic index was 3 mitotic figures/10 high-power fields. The post-operative course of all patients was uneventful, and there was no evidence of local or distant recurrence in a median follow-up time of 72 months. The treatment of choice for atypical leiomyomas is hysterectomy. However, myomectomy may be an option for fertility sparing cases. A thorough consultation with regard to the uncertain behavior of such tumors and a rigorous follow-up must be offered in such patients.
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Affiliation(s)
- Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Thomas Stavrakis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Stamatios Petousis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Christina Nikolaidou
- Department of Pathology, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Ioannis Venizelos
- Department of Pathology, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - David Rousso
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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199
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Abstract
In recent years, there has been an increasing focus on the contributory role of uterine fibroids to infertility. The prevalence of these tumors increases with age, which becomes significant as more women are delaying childbearing. Therefore, fibroids and infertility frequently occur together. Treatment varies with fibroid location and size. The various methods of treatment include open myomectomy, laparoscopic or robot-assisted myomectomy, medical treatment, uterine artery embolization and magnetic resonance guided focused ultrasound surgery. While there is a general consensus on the treatment of submucosal fibroids, the management of intramural fibroids in the infertility patient remains controversial. This paper aims to review and summarize the current literature in regards to the approach to uterine fibroids in the infertile patient.
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Affiliation(s)
- Kristin Van Heertum
- Department of Obstetrics & Gynecology, Abington Memorial Hospital, 1200 Old York Road, Abington, PA 19001, USA
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200
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Mozzachio K, Moore AB, Kissling GE, Dixon D. Immunoexpression of Steroid Hormone Receptors and Proliferation Markers in Uterine Leiomyoma and Normal Myometrial Tissues from the Miniature Pig, Sus scrofa. Toxicol Pathol 2015; 44:450-7. [PMID: 26692562 DOI: 10.1177/0192623315621414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Uterine leiomyomas in miniature pet pigs occur similarly to those in women with regard to frequency, age, parity, and cycling. Clinical signs, gross, and histologic features of the porcine tumors closely resemble uterine leiomyomas (fibroids) in women. Although fibroids are hormonally responsive in women, the roles of estrogen and progesterone have not been fully elucidated. In this study, immunohistochemistry was used to assess the expression of the steroid hormone receptors, estrogen receptor alpha (ER-α), estrogen receptor beta (ER-β) and progesterone receptor (PR), and cell proliferation markers, proliferating cell nuclear antigen (PCNA) and Ki-67 in tumor and matched myometrial tissues sampled from miniature pigs. A "quickscore" method was used to determine receptor expression and labeling indices were calculated for the markers. ER-α/β and PR were localized to the nuclei of smooth muscle cells in both tissues. PR expression was intense and diffuse throughout all tissues, with correlation between tumors and matched myometria. Conversely, ER-α expression was variable between the myometrial and tumor tissues, as well as between animals. ER-β expression was low. PCNA and Ki-67 were localized to the nucleus and expression varied among tumors; however, normal tissues were overall negative. These findings support further investigation into the use of the miniature pig as a model of fibroids in women.
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Affiliation(s)
| | - Alicia B Moore
- Molecular Pathogenesis Group, National Toxicology Program Laboratory (NTPL), Division of the NTP, Research Triangle Park, North Carolina, USA
| | - Grace E Kissling
- Biostatistics Branch, National Institute of Environmental Health Sciences, National Institutes of Health, US Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Darlene Dixon
- Molecular Pathogenesis Group, National Toxicology Program Laboratory (NTPL), Division of the NTP, Research Triangle Park, North Carolina, USA
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