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Liu JL, Liang ZH, Cui B, Liu JY, Sun L. Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment: A prospective study. World J Clin Cases 2024; 12:2551-2559. [PMID: 38817222 PMCID: PMC11135432 DOI: 10.12998/wjcc.v12.i15.2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus. It is the most common gynecological disorder, affecting up to 80% of women of reproductive age. Uterine fibroids can cause various symptoms such as abnormal uterine bleeding, pelvic pain, infertility, and pregnancy complications. The treatment options for uterine fibroids include medical therapy, surgical intervention, and minimally invasive techniques. AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization (UAE). METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE, and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments. The two groups were matched for age, body mass index, parity, and baseline characteristics of uterine fibroids. The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH), as well as ovarian reserve tests, such as antral follicle count (AFC) and ovarian volume (OV). The secondary outcome was fertility that was evaluated based on the menstrual cycle, ovulation, conception, pregnancy, and delivery. The participants were followed-up for 36 months and assessed at 1, 3, 6, 12, 24, and 36 months after treatment. RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women, resolving within a week. No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones (FSH, LH, E2, AMH) and ovarian reserve indicators (AFC, OV) at any point up to 36 months post-treatment. Additionally, there were no significant differences in conception, pregnancy, or delivery rates, with the average time to conception and gestational age at delivery being similar between the two groups. Birth weights were also comparable. Finally, there was no significant correlation between ovarian function, fertility indicators, and the type or amount of embolic agent used or the change in fibroids post-treatment. CONCLUSION UAE resulted in significantly positive pregnancy outcomes, no adverse events post-treatment, and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.
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Affiliation(s)
- Jing-Lei Liu
- Department of Interventional Treatment, 980 (Bethune International Peace) Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050082, Hebei Province, China
| | - Zhi-Hui Liang
- Department of Interventional Treatment, 980 (Bethune International Peace) Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050082, Hebei Province, China
| | - Bao Cui
- Department of Interventional Treatment, 980 (Bethune International Peace) Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050082, Hebei Province, China
| | - Jian-Yu Liu
- Department of Interventional Treatment, 980 (Bethune International Peace) Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050082, Hebei Province, China
| | - Li Sun
- Department of Obstetrics and Gynecology, 980 (Bethune International Peace) Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050082, Hebei Province, China
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Yin J, Wang X, Sun X, Dai H, Song X, Li B, Zhang Y, Chen P, Dong X. Thrombin Based Photothermal-Responsive Nanoplatform for Tumor-Specific Embolization Therapy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2105033. [PMID: 34729905 DOI: 10.1002/smll.202105033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/10/2021] [Indexed: 06/13/2023]
Abstract
The specific coagulation in the tumor vasculature has the potential for the ablation of solid tumors by cutting off the blood supply. However, the safe delivery of effective vessel occluding agents in the tumor-specific embolization therapy remains challenging. Herein, it is reported that the photothermal responsive tumor-specific embolization therapy based on thrombin (Thr) is delivered by intravenous injection via the phase-change materials (PCM)-based nanoparticles. The wax sealing profile of PCM enables safe delivery and prevents the preleakage of Thr in the blood circulation. While in the tumor site, the thermal effect induced by IR780 triggers the melting of PCM and rapidly releases Thr to generate coagulation in the tumor blood vessels. Based on the safe delivery and controllable release of Thr, thermal responsive tumor-specific embolization therapy could be achieved with high efficiency and no significant damage to normal organs and tissues. The safe administration of Thr to induce vascular infarction in tumors based on PCM nanoparticles in this work shows a promising strategy for improving the therapeutic specificity and efficacy of coagulation-based tumor therapy.
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Affiliation(s)
- Jiajia Yin
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing, 211816, China
| | - Xiaorui Wang
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing, 211816, China
| | - Xu Sun
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing, 211816, China
| | - Hanming Dai
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing, 211816, China
| | - Xuejiao Song
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing, 211816, China
| | - Buhong Li
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou, 350007, China
| | - Yewei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, China
| | - Peng Chen
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 62 Nanyang Drive, Singapore, 637459, Singapore
| | - Xiaochen Dong
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing, 211816, China
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Management of disseminated intravascular coagulation associated with placental abruption and measures to improve outcomes. Obstet Gynecol Sci 2019; 62:299-306. [PMID: 31538072 PMCID: PMC6737058 DOI: 10.5468/ogs.2019.62.5.299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 11/08/2022] Open
Abstract
Placental abruption is a condition that should be carefully considered in perinatal management because it is associated with serious events in both the mother and neonate, such as intrauterine fetal death, cerebral palsy, obstetric critical bleeding, and uncontrollable bleeding. The concomitant presence of disseminated intravascular coagulation (DIC) more easily causes critical bleeding that may necessitate hysterectomy or multi-organ failure resulting in maternal death. Therefore, early management should be provided to prevent progression to serious conditions by performing both hemostatic procedures and DIC treatment. To take measures to improve the outcomes in both the mother and neonate, health guidance for pregnant women, early diagnosis, early treatment, development of the emergency care system, and provision of a system for transport to higher-level medical institutions should be implemented.
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Impact of grayscale and Doppler ultrasound characteristics on reducing the size of tumors in the treatment of uterine fibroids by uterine artery embolization. Contemp Oncol (Pozn) 2019; 23:32-36. [PMID: 31061634 PMCID: PMC6500395 DOI: 10.5114/wo.2019.84111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/03/2019] [Indexed: 11/21/2022] Open
Abstract
Aim of the study Uterine fibroids are one of the most prevalent benign tumors. This study aimed to evaluate the effect of uterine artery embolization on treating and reducing the size of symptomatic uterine fibroids. Material and methods Eighty patients with uterine fibroids were selected for this study. Then ultrasound and Doppler were performed by a radiologist to evaluate the size, number, echogenicity, vascularity, and location of fibroids in the uterine wall. Before performing uterine artery embolization, prothrombin time, partial thromboplastin time, international normalized ratio, blood urea nitrogen, and creatinine tests were performed for all the patients to identify background problems. Finally, SPSS 22 was used for data analysis. Results The dominant fibroid volume before the embolization was 244.57 cm3, which decreased to 219.96 cm3, 190.58 cm3, 114.18 cm3, 140.51 cm3, and 78.86 cm3 in the first week, first month, third month, sixth month and first year after embolization, which was statistically significant (p < 0.001 in all cases). Uterine volume in multiple tumor before the embolization was 486.27 cm3, which decreased to 408.36 cm3, 387.60 cm3, 299.67 cm3, 190.00 cm3 and 172.33 cm3 after the first week, first month, third month, sixth month and first year after embolization, which in the first week and third month was statistically significant and not significant in other cases (p = 0.003, p = 0.500, p = 0.028, p = 0.068, p = 0.109). The relationships of the number of fibroid tumors, echogenicity and vascularity with volume reduction were not statistically significant (p = 0.924, p = 0.208, p = 0.455). Conclusions Uterine artery embolization is an effective treatment for fibroid tumors. In this study, the number of tumors, echogenicity, and vascularity of tumors had no effect on tumor volume reduction.
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Takeda J, Makino S, Hirai C, Shimanuki Y, Inagaki T, Itakura A, Takeda S. Long-term uterine balloon tamponade for treatment and obliteration of ruptured uterine pseudoaneurysm. Taiwan J Obstet Gynecol 2018; 57:329-331. [PMID: 29880159 DOI: 10.1016/j.tjog.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE Rupture of uterine artery pseudoaneurysm (UAP) is a life-threatening event after childbirth. Hysterectomy or uterine arterial embolization was often needed for hemostasis. However, such procedures may cause severe morbidities for these women. To estimate the efficacy of uterine balloon tamponade (UBT) for controlling ruptured UAP bleeding, a retrospective analysis in a single teaching hospital was performed. MATERIALS AND METHODS We reviewed the medical record of Juntendo University Hospital in 2015. All the women diagnosed with UAP were recruited to this study and management for UAP was investigated. RESULTS Three women were treated with UBT for ruptured UAP. All cases achieved hemostasis. One case had recurrent UAP after 24 h of UBT, and was retreated with UBT for a longer duration. The UAP was obliterated after more than 2 days of UBT in all cases. CONCLUSION UBT has potential as a therapeutic technique not only for treatment of a ruptured UAP but also for obliteration of a UAP.
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Affiliation(s)
- Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Chihiro Hirai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yota Shimanuki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tetsunori Inagaki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Neis KJ, Zubke W, Fehr M, Römer T, Tamussino K, Nothacker M. Hysterectomy for Benign Uterine Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:242-9. [PMID: 27146592 DOI: 10.3238/arztebl.2016.0242] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hysterectomy is the second most common operation in obstetrics and gynecology after Cesarean section. Until now, there has not been any German clinical guideline with recommendations concerning the indications for hysterectomy for benign uterine conditions, in consideration of the available uterus-preserving alternative treatments. METHODS We systematically searched the Medline database in 2013, in 2014, and in December 2015, focusing on aggregate evidence, and assessed the retrieved literature. The guideline recommendations were developed by a consensus process with structured independent moderation. RESULTS 30 systematic reviews and 8 randomized controlled trials were analyzed. Among the study patients treated with either hysterectomy (by any technique) or an organ-preserving alternative, at least 75-94% were satisfied with their treatment. Vaginal hysterectomy was associated with lower complication rates, shorter procedure duration, and more rapid recovery than abdominal hysterectomy and is therefore the preferred technique. If vaginal hysterectomy is not possible, a laparoscopic approach should be considered. Abdominal hysterectomy should be reserved for special indications. In 2012, the frequency of abdominal hysterectomy in Germany, Austria, and Switzerland was lower than elsewhere in the world, at 15.7% , 28.0% , and 23.9% , respectively. Uterus-preserving techniques were associated with higher reintervention rates compared to hysterectomy (11-36% vs 4-10% ). CONCLUSION The main objective is to reduce the frequency of abdominal hysterectomy. Patients should be counseled and made aware of uterus-sparing alternatives to hysterectomy so that they are able to make informed decisions.
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Affiliation(s)
- Klaus J Neis
- Department of Obstetrics, Gynecology and Reproductive Medicine, Saarland University Medical Center, Germany, Department of Obstetrics and Gynecology, Tübingen University Hospital, Germany, Cantonal Hospital, Frauenfeld, Switzerland, Evangelisches Krankenhaus, Köln-Weyertal, Germany, Department of Obstetrics and Gynecology, Medical University of Graz, Austria, AWMF Institute of Medical Knowledge Management, c/o Philipps University Marburg, Germany
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Fortin C, Flyckt R, Falcone T. Alternatives to hysterectomy: The burden of fibroids and the quality of life. Best Pract Res Clin Obstet Gynaecol 2017; 46:31-42. [PMID: 29157931 DOI: 10.1016/j.bpobgyn.2017.10.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 10/06/2017] [Indexed: 01/21/2023]
Abstract
Uterine fibroids are the most common benign tumor in reproductive-aged women. While the majority of women are asymptomatic, those with symptoms may suffer from abnormal uterine bleeding, infertility, pelvic pain or pressure, and urinary dysfunction. Fibroids represent a significant healthcare burden for women and society as a whole. Women with fibroids have compromised overall quality of life and impairment in many specific domains including work productivity, sexuality, self-image, relationships, and social emotional and physical well-being. Many women are reluctant to ask for help and delay seeking treatment. To date, myomectomy remains the gold standard for treating fibroid-related symptoms in reproductive-aged women. However, many less invasive uterine preserving approaches have been developed. Quality of life is improved in many women following treatment for fibroids. This article aims to provide an overview of the substantial impact of fibroids on health-related quality of life.
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Affiliation(s)
- Chelsea Fortin
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca Flyckt
- 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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Tanaka K, Koizumi T, Higa T, Imai N. Hyperkalemia and acute kidney failure associated with preoperative uterine artery embolization for a large uterine fibroid: a case report. J Med Case Rep 2016; 10:306. [PMID: 27799061 PMCID: PMC5088677 DOI: 10.1186/s13256-016-1092-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preoperative uterine artery embolization has been shown to help reduce blood loss, with few complications. Most reports indicated that uterine artery embolization is safe for uterine fibrosis; the occurrence of hyperkalemia and acute kidney failure as complications of preoperative uterine artery embolization has not been reported previously. Here we report the occurrence of hyperkalemia and acute kidney failure after preoperative uterine artery embolization for a large uterine fibroid. To the best of our knowledge, this is the first report on the occurrence of hyperkalemia and acute kidney failure after preoperative uterine artery embolization. CASE PRESENTATION A 48-year-old Japanese woman presented to our hospital complaining of compression in her abdomen and an abdominal mass. Magnetic resonance imaging showed a large uterine fibroid measuring 37.5×27×13.5 cm. Therefore, we planned preoperative uterine artery embolization to help reduce blood loss. However, hyperkalemia and acute kidney failure occurred owing to the development of necrotic tissue after uterine artery embolization; therefore, emergency total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. She experienced 105 g of blood loss intraoperatively. The weight of her uterus was 10.8 kg and the volume was 9964 cm3, with extensive necrotic tissue. Her hyperkalemia and kidney failure resolved after the surgery. CONCLUSIONS We reported the occurrence of serious complications, including hyperkalemia and acute kidney failure, after preoperative uterine artery embolization for a large uterine fibroid.
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Affiliation(s)
| | | | - Takeru Higa
- Hachinohe City Hospital, Hachinohe City, Japan.
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Effect of Direct Marketing for Uterine Artery Embolization on Rates of Leiomyomas, Incidental Findings, and Management After Pelvic MRI. J Am Coll Radiol 2016; 13:775-9. [DOI: 10.1016/j.jacr.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/04/2016] [Accepted: 02/09/2016] [Indexed: 11/24/2022]
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Sano Y, Takeda J, Kuroda K, Makino S, Itakura A, Takeda S. Embrittlement of uterus after uterine artery embolization: a case of uterine perforation. HYPERTENSION RESEARCH IN PREGNANCY 2016. [DOI: 10.14390/jsshp.hrp2015-017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yasuko Sano
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
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Abstract
The evolution of modern interventional radiology began over half century ago with a simple question. Was it possible to use the same diagnostic imaging tools that had revolutionized the practice of medicine to guide the real-time treatment of disease? This disruptive concept led to rapid treatment advances in every organ system of the body. It became clear that by utilizing imaging some patients could undergo targeted procedures, eliminating the need for major surgery, while others could undergo procedures for previously unsolvable problems. The breadth of these changes now encompasses all of medicine and has forever changed the way we think about disease. In this brief review article, major advances in the field, as chronicled in the pages of Radiology, will be described.
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Affiliation(s)
- Richard A Baum
- From the Department of Interventional Radiology, Brigham and Women's Hospital, Boston, Mass (R.A.B.); and Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 370, Philadelphia, PA 19104 (S.B.)
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Prediction of early response to uterine artery embolization in fibroids: Value of MR signal intensity ratio. Magn Reson Imaging 2015; 33:51-5. [DOI: 10.1016/j.mri.2014.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/28/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
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Lee JY, Hwang KR, Won KH, Lee DY, Jeon HW, Moon MH. Uterine infarction in a patient with uterine adenomyosis following biochemical pregnancy. Clin Exp Reprod Med 2014; 41:174-7. [PMID: 25599041 PMCID: PMC4295945 DOI: 10.5653/cerm.2014.41.4.174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 11/12/2014] [Accepted: 11/14/2014] [Indexed: 11/16/2022] Open
Abstract
Adenomyosis is a common gynecological disorder characterized by the presence of endometrial glands and stroma deep within the myometrium associated with myometrial hypertrophy and hyperplasia. Focal uterine infarction after IVF-ET in a patient with adenomyosis following biochemical pregnancy has not been previously reported, although it occurs after uterine artery embolization in order to control symptoms caused by fibroids or adenomyosis. We report a case of a nulliparous woman who had uterine adenomyosis presenting with fever, pelvic pain and biochemical abortion after undergoing an IVF-ET procedure and the detection of a slightly elevated serum hCG. Focal uterine infarction was suspected after a pelvic magnetic resonance imaging demonstrated preserved myometrium between the endometrial cavity and inner margin of the necrotic myometrium. This case demonstrates that focal uterine infarction should be considered in the differential diagnosis of acute abdominal pain, vaginal bleeding and infectious signs in women experiencing biochemical abortion after an IVF-ET procedure.
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Affiliation(s)
- Jae-Yeon Lee
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea. ; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu-Ri Hwang
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea. ; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu-Hee Won
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea. ; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Da-Yong Lee
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea. ; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Won Jeon
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea. ; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Hwan Moon
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
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Park Y, Kim MD, Jung DC, Lee SJ, Kim G, Park SI, Won JY, Lee DY. Can measurement of apparent diffusion coefficient before treatment predict the response to uterine artery embolization for adenomyosis? Eur Radiol 2014; 25:1303-9. [DOI: 10.1007/s00330-014-3504-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 10/26/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
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Bongers M, Brölmann H, Gupta J, Garza-Leal JG, Toub D. Transcervical, intrauterine ultrasound-guided radiofrequency ablation of uterine fibroids with the VizAblate® System: three- and six-month endpoint results from the FAST-EU study. ACTA ACUST UNITED AC 2014; 12:61-70. [PMID: 25774122 PMCID: PMC4349947 DOI: 10.1007/s10397-014-0873-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
This was a prospective, longitudinal, multicenter, single-arm controlled trial, using independent core laboratory validation of MRI results, to establish the effectiveness and confirm the safety of the VizAblate® System in the treatment of symptomatic uterine fibroids. The VizAblate System is a transcervical device that ablates fibroids with radiofrequency energy, guided by a built-in intrauterine ultrasound probe. Fifty consecutive women with symptomatic uterine fibroids received treatment with the VizAblate System. Patients had a minimum Menstrual Pictogram score of 120, no desire for fertility, and met additional inclusion and exclusion criteria. The VizAblate System was inserted transcervically and individual fibroids were ablated with radiofrequency energy. An integrated intrauterine ultrasound probe was used for fibroid imaging and targeting. Anesthesia was at the discretion of each investigator. The primary study endpoint was the percentage change in perfused fibroid volume, as assessed by contrast-enhanced MRI at 3 months. Secondary endpoints, reached at 6 months, included safety, percentage reductions in the Menstrual Pictogram (MP) score and the Symptom Severity Score (SSS) subscale of the Uterine Fibroid Symptom-Quality of Life questionnaire (UFS-QOL), along with the rate of surgical reintervention for abnormal uterine bleeding and the mean number of days to return to normal activity. Additional assessments included the Health-Related Quality of Life (HRQOL) subscale of the UFS-QOL, medical reintervention for abnormal uterine bleeding, and procedure times. Fifty patients were treated, representing 92 fibroids. Perfused fibroid volumes were reduced at 3 months by an average of 68.8 ± 27.8 % (P < 0.0001; Wilcoxon signed-rank test). At 6 months, mean MP and SSS scores decreased by 60.8 ± 38.2 and 59.7 ± 30.4 %, respectively; the mean HRQOL score increased by 263 ± 468 %. There were two serious adverse events (overnight admissions for abdominal pain and bradycardia, respectively) and no surgical reinterventions. These 6-month results suggest that the VizAblate System is safe and effective in providing relief of abnormal uterine bleeding associated with fibroids, with appropriate safety and a low reintervention rate.
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Affiliation(s)
| | - Hans Brölmann
- Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands
| | | | | | - David Toub
- Gynesonics, Inc., Redwood City, CA USA
- Department of Obstetrics and Gynecology, Albert Einstein Medical Center, Philadelphia, PA USA
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Zlotnik E, Lorenzo Messina MD, Nasser F, Affonso BB, Baroni RH, Wolosker N, Baracat EC. Predictive factors for pelvic magnetic resonance in response to arterial embolization of a uterine leiomyoma. Clinics (Sao Paulo) 2014; 69:185-9. [PMID: 24626944 PMCID: PMC3935123 DOI: 10.6061/clinics/2014(03)07] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 08/16/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Minimally invasive methods are used as alternatives to treat leiomyomas and include uterine artery embolization, which has emerged as a safe, effective method. This study aims to evaluate the magnetic resonance imaging predictors for a reduction in leiomyoma volume in patients undergoing uterine artery embolization. METHODS This prospective longitudinal study was performed at a university hospital. We followed 50 symptomatic premenopausal women with uterine leiomyomas who underwent uterine artery embolization. We examined 179 leiomyomas among these patients. Magnetic resonance imaging was performed one month before and six months after uterine artery embolization. Two radiologists who specialized in abdominal imaging independently interpreted the images. MAIN OUTCOME MEASURES The magnetic resonance imaging parameters were the uterus and leiomyomas volumes, their localizations, contrast perfusion pattern and node-to-muscle ratio. RESULTS Six months after treatment, the average uterine volume reduction was 38.91%, and the leiomyomas were reduced by 55.23%. When the leiomyomas were submucosal and/or had a higher node-to-muscle ratio in the T2 images, the volume reduction was even greater (greater than 50%). Other parameters showed no association. CONCLUSIONS We conclude that symptomatic uterine leiomyomas in patients undergoing uterine artery embolization exhibit volume reductions greater than 50% by magnetic resonance imaging when the leiomyomas are submucosal and/or had a high node-to-muscle ratio in the T2 images.
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Affiliation(s)
- Eduardo Zlotnik
- Hospital Israelita Albert Einstein, Interventional Radiology Department, São PauloSP, Brazil, Hospital Israelita Albert Einstein, Interventional Radiology Department, São Paulo/SP, Brazil
| | - Marcos de Lorenzo Messina
- Hospital das Clínicas, Faculdade de Medicina, Universidade de Universidade de São Paulo, Gynecology Clinic, São PauloSP, Brazil, Hospital das Clínicas da Faculdade de Medicina da Universidade de Universidade de São Paulo, Gynecology Clinic, São Paulo/SP, Brazil
| | - Felipe Nasser
- Hospital Israelita Albert Einstein, Interventional Radiology Department, São PauloSP, Brazil, Hospital Israelita Albert Einstein, Interventional Radiology Department, São Paulo/SP, Brazil
| | - Breno Boueri Affonso
- Hospital das Clínicas, Faculdade de Medicina, Universidade de Universidade de São Paulo, Gynecology Clinic, São PauloSP, Brazil, Hospital das Clínicas da Faculdade de Medicina da Universidade de Universidade de São Paulo, Gynecology Clinic, São Paulo/SP, Brazil
| | - Ronaldo Hueb Baroni
- Hospital Israelita Albert Einstein, Interventional Radiology Department, São PauloSP, Brazil, Hospital Israelita Albert Einstein, Interventional Radiology Department, São Paulo/SP, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, Interventional Radiology Department, São PauloSP, Brazil, Hospital Israelita Albert Einstein, Interventional Radiology Department, São Paulo/SP, Brazil
| | - Edmund Chada Baracat
- Hospital das Clínicas, Faculdade de Medicina, Universidade de Universidade de São Paulo, Gynecology Clinic, São PauloSP, Brazil, Hospital das Clínicas da Faculdade de Medicina da Universidade de Universidade de São Paulo, Gynecology Clinic, São Paulo/SP, Brazil
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Firouznia K, Ghanaati H, Jalali AH, Shakiba M. Uterine artery embolization for treatment of symptomatic fibroids: a review of the evidence. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e16699. [PMID: 24693405 PMCID: PMC3955520 DOI: 10.5812/ircmj.16699] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/25/2013] [Accepted: 08/27/2013] [Indexed: 12/17/2022]
Abstract
Fibroids are the most common benign tumors of the uterus during female reproductive age. Uterine artery embolization (UAE) using embolic particles (PVA, Gelfoam) to occlude the uterine arteries, have been reported as a relatively safe, effective, and durable nonsurgical alternative to hysterectomy in diminishing fibroid-related symptoms. To block the arterial blood supply to the fibroid completely, UAE is typically performed in both uterine arteries by an experienced interventional radiologist. Reduction in menorrhagia has been reported as 80-93 percent and the mean decrease in fibroid size varies from 50-78% in the literature. In our center improvement in menstrual bleeding after 6 months was 80.3%, and uterine fibroids underwent shrinkage of 63.7±33.7% after12 months. Complication rate including amenorrhea ranges from 1% - 7% in the literature. UAE may be followed by menopause in 1% of cases. Nevertheless, it is usually encountered in women in their late 40s. It seems that the future of UAE depends on optimal selection of patients according to volume-shrinkage prediction and fertility outcome. Although pregnancy is possible after embolization, however neither fertility preservation nor improvement can be guaranteed following UAE. Indeed, Women who desire to become pregnant should be cautioned about potential complications during pregnancy. The aim of this review is to discuss about the efficacy, safety, technique, and choice of embolic agent. Also we present the effects of this technique on fertility and pregnancy outcome and also methods for dose reduction during this procedure.
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Affiliation(s)
- Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Kavous Firouznia, Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166581579, Fax: +98-2166581578, E-mail:
| | - Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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Levine DJ, Berman JM, Harris M, Chudnoff SG, Whaley FS, Palmer SL. Sensitivity of myoma imaging using laparoscopic ultrasound compared with magnetic resonance imaging and transvaginal ultrasound. J Minim Invasive Gynecol 2013; 20:770-4. [PMID: 24021910 DOI: 10.1016/j.jmig.2013.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To determine the efficacy of laparoscopic ultrasound (LUS) as compared with contrast-enhanced magnetic resonance imaging (CE-MRI) and transvaginal ultrasound (TVUS) in detection of uterine myomas. DESIGN Retrospective study of imaging methods used in a trial of LUS-guided radiofrequency volumetric thermal ablation in women with symptomatic myomas (Canadian Task Force classification II-2). SETTING Eleven medical university or private outpatient surgery clinics in the United States (nine sites) and Latin America (two sites). PATIENTS One hundred thirty-five women with symptomatic myomas and objectively confirmed moderate to severe heavy menstrual bleeding. INTERVENTIONS LUS-guided radiofrequency volumetric thermal ablation of myomas. MEASUREMENTS AND MAIN RESULTS Preoperative TVUS scans and CE-MRIs were read at each site, and all CE-MRIs were read by a central reader. LUS-guided scans were obtained intraoperatively by each surgeon by mapping the uterus just before radiofrequency volumetric thermal ablation. The imaging methods and their yields in terms of number of myomas found per subject were as follows: TVUS, 403 myomas (mean [SD] 3 [1.8]; range, 1-8); site CE-MRI, 562 myomas (4.2 [3.8]; range, 1-18); central reader, 619 myomas (4.6 [3.7]; range, 0-20); and LUS, 818 myomas (6.1 [4.9]; range, 1-29) (p < .001). LUS was superior to TVUS, CE-MRI, and the central reader for detection of small (≤1 cm(3)) myomas. Most imaged myomas were intramural: 197 (50.9%) by TVUS, 298 (55.5%) by site CE-MRI, 290 (48.7%) by the central reader, and 386 (48.5%) by LUS. CONCLUSION Compared with CE-MRI and TVUS, LUS demonstrates the most myomas, regardless of size or type.
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Affiliation(s)
- David J Levine
- Department of Obstetrics and Gynecology, St. John's Mercy Hospital, St. Louis, Missouri.
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Takeda J, Makino S, Ota A, Tawada T, Mitsuhashi N, Takeda S. Spontaneous uterine rupture at 32 weeks of gestation after previous uterine artery embolization. J Obstet Gynaecol Res 2013; 40:243-6. [PMID: 23945024 DOI: 10.1111/jog.12122] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Abstract
Uterine artery embolization (UAE) is a common treatment for post-partum hemorrhage and uterine fibroids. However, the effects of UAE on subsequent pregnancies have not been established. Here, we present a case of spontaneous uterine rupture after previous UAE. A 31-year-old woman underwent UAE for a cervical ectopic pregnancy. Contrast-enhanced magnetic resonance imaging (MRI) at days 5 and 25 post-UAE suggested a regionally decreased blood supply in the mid-posterior wall of the uterine fundus. During a subsequent pregnancy at age 35 years, she underwent an emergency cesarean delivery due to spontaneous uterine rupture at the mid-posterior wall of the uterus at 32 weeks of gestation. Obstetricians should be attentive to the possibility of spontaneous uterine rupture in pregnant women who have previously undergone UAE. Detection of ischemic uterine muscle on MRI may predict potential for uterine rupture in a subsequent pregnancy.
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Affiliation(s)
- Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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21
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Is uterine artery embolization for patients with large myomas safe and effective? A retrospective comparative study in 323 patients. J Vasc Interv Radiol 2013; 24:772-8. [PMID: 23566524 DOI: 10.1016/j.jvir.2013.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the effectiveness, safety, and complications of uterine artery embolization (UAE) in women with large fibroid tumors. MATERIALS AND METHODS From January 2005 to February 2011, 323 patients underwent UAE for symptomatic uterine leiomyomas without adenomyosis and were included in this study. Patients were divided into two groups: those with a large tumor burden (group 1; n = 63), defined as a dominant tumor with a longest axis of at least 10 cm or a uterine volume of at least 700 cm(3); and the control group (group 2; n = 260). Tumor infarction and volume reduction were calculated based on magnetic resonance imaging findings. Symptom status was assessed with a visual analog scale. Postprocedure complications and repeat interventions were recorded. The data were analyzed with appropriate statistical tests. RESULTS No significant differences were seen between the two groups in volume reduction of dominant tumors (46.5% in group 1 vs 52.0% in group 2; P = .082) or percentage volume reduction of the uterus (40.7% in group 1 vs 36.3% in group 2; P = .114). Also, no significant differences were seen between the two groups regarding satisfaction scores at immediate or midterm follow-up (P = .524 and P = .497) or in the presence of procedure-related complications (P = .193). CONCLUSIONS UAE outcomes in large fibroid tumors were comparable to those in smaller tumors, without an increased risk of significant complications. Tumor size may not be a key factor in predicting successful outcomes of UAE.
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David M, Kröncke T. Uterine Fibroid Embolisation - Potential Impact on Fertility and Pregnancy Outcome. Geburtshilfe Frauenheilkd 2013; 73:247-255. [PMID: 26633901 PMCID: PMC4647484 DOI: 10.1055/s-0032-1328318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The current standard therapy to treat myomas in women wishing to have children consists of minimally invasive surgical myomectomy. Uterine artery embolisation (UAE) has also been discussed as another minimally invasive treatment option to treat myomas. This review evaluates the literature of the past 10 years on fibroid embolisation and its impact on fertility and pregnancy. Potential problems associated with UAE such as radiation exposure of the ovaries, impairment of ovarian function and the impact on pregnancy and child birth are discussed in detail. Previously published reports of at least 337 pregnancies after UAE were evaluated. The review concludes that UAE to treat myomas can only be recommended in women with fertility problems due to myomas who refuse surgery or women with an unacceptably high surgical risk, because the evaluated case reports and studies show that UAE significantly increases the risk of spontaneous abortion; there is also evidence of pathologically increased levels for other obstetric outcome parameters. There are still very few prospective studies which provide sufficient evidence for a definitive statement on the impact of UAE therapy on fertility rates and pregnancy outcomes.
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Affiliation(s)
- M David
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - T Kröncke
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, Berlin, Germany
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23
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Different management strategies for postoperative hematoma after pelvic organ prolapse surgery. Taiwan J Obstet Gynecol 2013; 51:656-9. [PMID: 23276577 DOI: 10.1016/j.tjog.2012.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/21/2022] Open
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Robles R, Aguirre VA, Argueta AI, Guerrero MR. Laparoscopic radiofrequency volumetric thermal ablation of uterine myomas with 12 months of follow-up. Int J Gynaecol Obstet 2012; 120:65-9. [DOI: 10.1016/j.ijgo.2012.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/20/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
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Poly(acrylic acid) microspheres loaded with lidocaine: Preparation and characterization for arterial embolization. Int J Pharm 2012; 436:527-35. [DOI: 10.1016/j.ijpharm.2012.07.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 07/08/2012] [Accepted: 07/09/2012] [Indexed: 01/04/2023]
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Comparison of Sexual Dysfunction Using the Female Sexual Function Index following Surgical Treatments for Uterine Fibroids. Case Rep Obstet Gynecol 2012; 2012:368136. [PMID: 22957283 PMCID: PMC3432328 DOI: 10.1155/2012/368136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 07/12/2012] [Indexed: 12/21/2022] Open
Abstract
Uterine fibroids are a common problem in women. Statistics showing 20–50% of fibroids produce symptoms and consequently patients seek surgical intervention to improve their quality of life. Treatments for fibroids are typically successful in controlling the fibroid disease, yet sexual function following invasive surgical treatments for fibroids can be jeopardized. The Sexual Function Index (FSFI) is a valid instrument producing quantifiable reproducible results. In this paper three case reports are evaluated by the FSFI and compared between the following treatment groups: hysterectomy, myomectomy, and uterine embolization. Our goal is to illustrate how each of these treatment outcomes can result in sexual dysfunction and therefore decreased quality of life. Effects of invasive fibroid treatments on sexual functioning would be helpful in guiding patient's ultimate decisions regarding treatment.
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Prediction of early response to uterine arterial embolisation of adenomyosis: value of T2 signal intensity ratio of adenomyosis. Eur Radiol 2012; 22:2044-9. [DOI: 10.1007/s00330-012-2436-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/25/2012] [Accepted: 02/13/2012] [Indexed: 11/27/2022]
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Yamane T, Takaoka A, Kita M, Imai Y, Senda M. 18F-FLT PET performs better than 18F-FDG PET in differentiating malignant uterine corpus tumors from benign leiomyoma. Ann Nucl Med 2012; 26:478-84. [PMID: 22477262 DOI: 10.1007/s12149-012-0597-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 03/15/2012] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study is to test the hypothesis that positron emission tomography (PET) with 3'-deoxy-3'-[(18)F]-fluorothymidine ((18)F-FLT) can differentiate malignancy from benign leiomyoma better than PET with 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG), and to evaluate whether (18)F-FLT and (18)F-FDG uptake correlate with immunohistochemical index of cell proliferation. METHODS The protocol of this prospective study was approved by the institutional ethics committee, and all patients gave written informed consent. Fifteen patients (aged 26-65 years, median 44 years) with uterine corpus tumor which has the possibility of being leiomyosarcoma underwent (18)F-FLT and (18)F-FDG PET scans. Maximum standard uptake value (SUV(max)) of PET scans and Ki-67 labeling index of surgical specimens were evaluated. Mann-Whitney's U test was used for comparing uptakes between benign and malignant, and linear regression analysis was used for evaluating the correlation between Ki-67 labeling index and SUV(max). RESULTS Five cases were diagnosed as malignant (leiomyosarcoma for 3 cases, and carcinoma for 2 cases), and the others were benign leiomyoma. Sensitivity and negative predictive value of both tracers for detecting malignancy was 100%. Specificity, positive predictive value and accuracy of (18)F-FLT PET were higher than those of (18)F-FDG PET. Difference in SUV(max) between malignant and benign was significant for (18)F-FLT PET (P < 0.01), but not for (18)F-FDG PET. While all the malignant cases showed positive uptake in both tracers, a case of leiomyosarcoma with huge necrosis showed relatively low uptake. Uptake of (18)F-FLT showed better correlation with Ki-67 labeling index compared with (18)F-FDG (R(2) = 0.91 vs. R(2) = 0.26). CONCLUSION Negative findings on additional (18)F-FDG or (18)F-FLT PET may rule out the possibility of malignancy for the patients with suspected leiomyosarcoma diagnosed by conventional methods. (18)F-FLT PET is superior to (18)F-FDG PET in differentiating malignant from benign leiomyoma. Moreover, (18)F-FLT uptake correlated well with the immunohistochemical index of cell proliferation.
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Affiliation(s)
- Tomohiko Yamane
- Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan.
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29
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Interventional radiologic treatment of pelvic hemorrhage after placement of mesh for reconstructive pelvic surgery. Obstet Gynecol 2012; 119:459-462. [PMID: 22270438 DOI: 10.1097/aog.0b013e31822ad840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report two cases of vascular complications after reconstructive pelvic surgery successfully treated with pelvic artery embolization. CASES Two patients who underwent mesh placement complicated by postoperative pelvic hemorrhage were treated successfully with selective arterial embolization. CONCLUSION The widespread adoption of reconstructive pelvic surgery procedures with dissection in deep vascular spaces has brought with it the prospect of challenging vascular morbidity. A thorough understanding of pelvic anatomy is essential for management of vascular complications from reconstructive pelvic surgery.
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Goldman KN, Hirshfeld-Cytron JE, Pavone ME, Thomas AP, Vogelzang RL, Milad MP. Uterine artery embolization immediately preceding laparoscopic myomectomy. Int J Gynaecol Obstet 2011; 116:105-8. [PMID: 22098788 DOI: 10.1016/j.ijgo.2011.08.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 08/30/2011] [Accepted: 10/17/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether performing uterine artery embolization (UAE) immediately before laparoscopic myomectomy can facilitate a minimally invasive surgical approach for larger uterine fibroids. METHODS In a retrospective case-control study, laparoscopic myomectomy with and without preoperative UAE was examined. Data were analyzed from 26 laparoscopic myomectomies performed by a single surgeon at Northwestern University Feinberg School of Medicine between 2004 and 2010. Controls were matched for age, calendar year, surgeon, and number of fibroids removed. Surgical outcomes included preoperative clinical uterine size, operative time, operative blood loss, and postoperative myoma specimen weight. Data were analyzed via 2-tailed Student t test. RESULTS Twelve women underwent laparoscopic myomectomy within 169 ± 16minutes (mean ± SEM) of preoperative UAE. Fourteen control patients underwent laparoscopic myomectomy alone. The UAE group had a greater mean preoperative clinical uterine size (19.7 versus 12.4 weeks, P<0.001) and a greater mean myoma specimen weight measured postoperatively (595.3 versus 153.6 grams, P<0.05). There were no significant differences in operative time or blood loss, and there were no intra-operative complications. CONCLUSION UAE performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery for larger uteri and larger uterine myomas, with no differences in operative time or blood loss.
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Affiliation(s)
- Kara N Goldman
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Radiopaque microspheres for improved transarterial chemical embolization (TACE). J Control Release 2011; 152 Suppl 1:e74-5. [DOI: 10.1016/j.jconrel.2011.08.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy. Eur Radiol 2011; 22:411-7. [PMID: 21901565 PMCID: PMC3249029 DOI: 10.1007/s00330-011-2262-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 08/18/2011] [Accepted: 08/29/2011] [Indexed: 02/03/2023]
Abstract
Objective The purpose of this prospective multicenter study was to assess the safety and technical feasibility of volumetric Magnetic Resonance-guided High Intensity Focused Ultrasound (MR-HIFU) ablation for treatment of patients with symptomatic uterine fibroids. Methods Thirty-three patients with 36 fibroids were treated with volumetric MR-HIFU ablation. Treatment capability and technical feasibility were assessed by comparison of the Non-Perfused Volumes (NPVs) with MR thermal dose predicted treatment volumes. Safety was determined by evaluation of complications or adverse events and unintended lesions. Secondary endpoints were pain and discomfort scores, recovery time and length of hospital stay. Results The mean NPV calculated as a percentage of the total fibroid volume was 21.7%. Correlation between the predicted treatment volumes and NPVs was found to be very strong, with a correlation coefficient r of 0.87. All patients tolerated the treatment well and were treated on an outpatient basis. No serious adverse events were reported and recovery time to normal activities was 2.3 ± 1.8 days. Conclusion This prospective multicenter study proved that volumetric MR-HIFU is safe and technically feasible for the treatment of symptomatic uterine fibroids. Key Points • Magnetic-resonance-guided high intensity focused ultrasound allows non-invasive treatment of uterine fibroids. • Volumetric feedback ablation is a novel technology that allows larger treatment volumes • MR-guided ultrasound ablation of uterine fibroids appears safe using volumetric feedback
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Popovic M, Puchner S, Berzaczy D, Lammer J, Bucek RA. Uterine artery embolization for the treatment of adenomyosis: a review. J Vasc Interv Radiol 2011; 22:901-9; quiz 909. [PMID: 21570318 DOI: 10.1016/j.jvir.2011.03.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/10/2011] [Accepted: 03/14/2011] [Indexed: 11/19/2022] Open
Abstract
During the past 10 years, uterine artery embolization (UAE) has been investigated as a possible therapy for adenomyosis. All publications available from 1999 through 2010 are included in this report. Levels of evidence and trial classifications were evaluated according to the guidelines developed by the United States Preventive Services Task Force. Long-term data are available from 511 affected women from 15 studies. Improvements were reported by 387 patients (75.7%). The median follow-up was 26.9 months. UAE as treatment for adenomyosis shows significant clinical and symptomatic improvements on a short- and long-term basis.
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Affiliation(s)
- Martin Popovic
- Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Garza Leal JG, Hernandez Leon I, Castillo Saenz L, Lee BB. Laparoscopic Ultrasound-Guided Radiofrequency Volumetric Thermal Ablation of Symptomatic Uterine Leiomyomas: Feasibility Study Using the Halt 2000 Ablation System. J Minim Invasive Gynecol 2011; 18:364-71. [DOI: 10.1016/j.jmig.2011.02.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 02/11/2011] [Accepted: 02/19/2011] [Indexed: 10/18/2022]
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DeLonzor R, Spero RK, Williams JJ. The electrical conductivity of in vivo human uterine fibroids. Int J Hyperthermia 2011; 27:255-65. [DOI: 10.3109/02656736.2011.555875] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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[A rapid growing giant uterine leiomyoma]. Cir Esp 2011; 90:54-6. [PMID: 21411069 DOI: 10.1016/j.ciresp.2010.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 05/02/2010] [Accepted: 05/03/2010] [Indexed: 11/21/2022]
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Garza-Leal JG, Toub D, León IH, Saenz LC, Uecker D, Munrow M, King D, Bajor J, Coad J. Transcervical, intrauterine ultrasound-guided radiofrequency ablation of uterine fibroids with the VizAblate System: safety, tolerability, and ablation results in a closed abdomen setting. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10397-010-0655-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bonduki CE, Feldner PC, Silva JD, Castro RA, Sartori MGF, Girão MJBC. Pregnancy after uterine arterial embolization. Clinics (Sao Paulo) 2011; 66:807-10. [PMID: 21789384 PMCID: PMC3109379 DOI: 10.1590/s1807-59322011000500016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 02/11/2011] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. METHODS A retrospective study of 187 patients treated with uterine arterial embolization for symptomatic uterine fibroids between 2005-2008 was performed. Uterine arterial embolization was performed using polyvinyl alcohol particles (500-900 mm in diameter). Pregnancies were identified using screening questionnaires and the study database. RESULTS There were 15 spontaneous pregnancies. Of these, 12.5% were miscarriages (n = 2), and 87.5% were successful live births (n = 14). The gestation time for the pregnancies with successful live births ranged from 36 to 39.2 weeks. The mean time between embolization and conception was 23.8 months (range, 5-54). One of the pregnancies resulted in twins. The newborn weights (n = 14) ranged from 2.260 to 3.605 kg (mean, 3.072 kg). One (7.1%) was considered to have a low birth weight (2.260 kg). There were two cases of placenta accreta (12.5%, treated with hysterectomy in one case [6.3%]), one case of premature rupture of the membranes (PRM) (6.3%), and one case of preeclampsia (6.3%). All of the patients were delivered via Cesarean section. CONCLUSION In this study, there was an increased risk of Cesarean delivery. There were no other major obstetric risks, suggesting that pregnancy after uterine arterial embolization is possible without significant morbidity or mortality.
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Affiliation(s)
- Cláudio E Bonduki
- Department of Gynecology, Federal University of São Paulo, São Paulo, SP, Brazil
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Voogt MJ, Arntz MJ, Lohle PNM, Mali WPTM, Lampmann LEH. Uterine fibroid embolisation for symptomatic uterine fibroids: a survey of clinical practice in Europe. Cardiovasc Intervent Radiol 2010; 34:765-73. [PMID: 20857108 PMCID: PMC3132385 DOI: 10.1007/s00270-010-9978-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 08/20/2010] [Indexed: 11/25/2022]
Abstract
Purpose To assess current uterine fibroid embolisation (UFE) practice in European countries and determine the clinical environment for UFE in different hospitals. Material and Methods In May 2009, an invitation for an online survey was sent by e-mail to all members of the Cardiovascular and Interventional Radiologic Society of Europe, representing a total number of 1,250 different candidate European treatment centres. The survey covered 21 questions concerning local UFE practice. Results A total of 282 respondents completed the questionnaire. Fifteen questionnaires were excluded because they were doubles from centres that had already returned a questionnaire. The response rate was 267 of 1,250 centres (21.4%). Ninety-four respondents (33%) did not perform UFE and were excluded, and six centres were excluded because demographic data were missing. The remaining 167 respondents from different UFE centres were included in the study. Twenty-six percent of the respondents were from the United Kingdom (n = 43); 16% were from Germany (n = 27); 11% were from France (n = 18); and the remaining 47% (n = 79) were from other European countries. Most centres (48%, n = 80) had 5 to 10 years experience with UFE and performed 10 to 50 procedures annually (53% [n = 88]) of respondents). Additional demographic data, as well as specific data on referral of patients, UFE techniques used, and periprocedural and postprocedural, care will be provided. Conclusion Although UFE as an alternative treatment for hysterectomy or myomectomy is widespread in Europe, its impact on the management of the patient with symptomatic fibroids seems, according to the overall numbers of UFE procedures, somewhat disappointing. Multiple factors might be responsible for this observation.
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Affiliation(s)
- Marianne J Voogt
- Department of Radiology, University Medical Centre Utrecht, P.O. Box 85500 3508 GA, Utrecht, The Netherlands.
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Zurawin RK, Fischer JH, Amir L. The effect of a gynecologist-interventional radiologist relationship on selection of treatment modality for the patient with uterine myoma. J Minim Invasive Gynecol 2010; 17:214-21. [PMID: 20226411 DOI: 10.1016/j.jmig.2009.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/20/2009] [Accepted: 12/23/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND On the basis of consistent published scientific evidence, the American College of Obstetricians and Gynecologists has given uterine artery embolization (UAE) a level A recommendation as a viable alternative treatment for uterine myomas, describing it as a safe and effective option for appropriately selected women who wish to retain their uteri. Despite the growth of favorable clinical outcome information, many gynecologists do not routinely offer UAE as an alternative to abdominal hysterectomy or abdominal myomectomy. The percentage of laparoscopic hysterectomies in the United States remains less than 20%, reflecting the reluctance or inability of gynecologic surgeons to perform other minimally invasive procedures such as hysteroscopic myomectomy, laparoscopic myomectomy, laparoscopic hysterectomy, or even vaginal hysterectomy. Of great significance, many patients do not wish to have any kind of surgery, no matter how "minimally invasive." As a result, patients seeking less invasive treatments may bypass the gynecologist and be referred directly to an interventional radiologist by their primary care physician, or they may self-refer. Little has been published on the referral relationship between gynecologists and the interventional radiologist who performs uterine artery embolization. The absence of a structured routine referral relationship causes some women to undergo treatments that potentially are not aligned with all of her treatment desires. This study was undertaken to gain insight into the interventional radiologist-gynecologist dynamic and the benefit to patients who are informed of all of their options for the treatment of myomas. STUDY OBJECTIVES Investigate the course of myoma treatment in a cohort of patients either self-referred to an interventional radiologist or referred to the interventional radiologist by their gynecologist. Determine the effect of a cooperative referral network of interventional radiologists and gynecologists that informs patients about the options of UAE and minimally invasive surgical alternatives on the choice of myoma treatment. STUDY DESIGN Prospective data acquisition of patient referral source, UAE evaluation, patient decision on treatment options, and continued follow-up with a network gynecologist. SETTING Hospital-based interventional radiologist and gynecologist both practicing in a large urban teaching setting. PATIENTS A total of 226 women, representing 73% of women presenting to an interventional radiologist in 2007 seeking UAE for symptomatic myomas. One hundred thirty-eight of these patients were referred to the interventional radiologist by a gynecologist, and 88 were self-referred. Patient outcome relative to referral was traced with 76 patients in the myoma surgery group treated from 2007-2008 by a gynecologist in the referral network. INTERVENTIONS Evaluation for suitability for UAE procedure, followed either by UAE procedure with return to referring gynecologist for follow-up, return to referring gynecologist for treatment, or referral to another gynecologist for minimally invasive surgical management when the primary gynecologist is unable to perform alternative treatment. MEASUREMENTS AND MAIN RESULTS All patients in the study initially evaluated by the interventional radiologist were referred to a gynecologist. Overall, 62% of patients were candidates for UAE, and 38% underwent the procedure during the study period. Patients who did not receive UAE were returned to the referring gynecologist for further evaluation and treatment. Patients who underwent UAE were referred to a gynecologist for ongoing care. In all, 70% of self-referred patients and 92% of gynecologist-referred patients expressed satisfaction with their original gynecologist and were referred back to that physician. Patients who did not have a gynecologist or who were dissatisfied with their original gynecologist were referred to a network gynecologist for continued gynecologic care. In our study 26 self-referred women were sent as new patients to gynecologists in the interventional radiologist's referral network, resulting in a 119% return on the original 138 gynecologist-to-interventional radiologist-referred patients. Among the 8% of gynecologist-referred women who switched to a different gynecologist within the referral network, the primary reasons for dissatisfaction were the gynecologist's failure to fully disclose treatment options or offer desired minimally invasive procedures. On follow-up with a network gynecologist, 8 newly referred patients underwent myoma surgery, and 8 newly referred patients continued to be seen by that gynecologist. Four patients referred to the gynecologist for treatment were originally referred by the gynecologist to the interventional radiologist for UAE evaluation. Ten patients switched from their named gynecologist to a different gynecologist willing to disclose all treatment options for uterine myomas and able to provide minimally invasive surgical treatment as medically indicated. Of the 10 women who switched to this network gynecologist, 8 underwent myoma surgery. CONCLUSIONS Establishing a referral relationship with an interventional radiologist for comprehensive uterine myoma treatment supports a trusting, collaborative, long-term, noncompetitive "win-win" relationship between the gynecologist and radiologist, meets the patient's desire for full disclosure of all myoma treatment options, improves the patient's overall medical care and physician/patient experience, and has been demonstrated to improve patient flow to a gynecologist practice. With the guidelines established in this study, no patients were inappropriately left to the gynecologist for post-UAE care. The authors acknowledge that this dynamic is dependent on the individual interventional radiologist and their relationships and open communication with the gynecologist. Finally, the study revealed that failure to fully disclose alternative treatment options, or offer minimally invasive surgical techniques may result in a loss of patients due to patient dissatisfaction.
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Affiliation(s)
- Robert K Zurawin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA.
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Hemorragia post-parto: embolización terapéutica. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chegini N. Proinflammatory and profibrotic mediators: principal effectors of leiomyoma development as a fibrotic disorder. Semin Reprod Med 2010; 28:180-203. [PMID: 20414842 DOI: 10.1055/s-0030-1251476] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Leiomyomas are believed to derive from the transformation of myometrial smooth muscle cells/connective tissue fibroblasts. Although the identity of the molecule(s) that initiate such cellular transformation and orchestrate subsequent growth is still unknown, conventional evidence indicates that ovarian steroids are essential for leiomyoma growth. Ovarian steroid action in their target cell/tissue is mediated in part through local expression of various growth factors, cytokines, and chemokines. These autocrine/paracrine molecules with proinflammatory and profibrotic activities serve as major contributing factors in regulating cellular transformation, cell growth and apoptosis, angiogenesis, cellular hypertrophy, and excess tissue turnover, events central to leiomyoma growth. This review addresses the key regulatory functions of proinflammatory and profibrotic mediators and their molecular mechanisms, downstream signaling that regulates cellular events that result in transformation, and commitments of specific cells into forming a cellular environment with a possible role in development and subsequent growth of leiomyomas.
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Affiliation(s)
- Nasser Chegini
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida 32610, USA.
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Magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment for uterine fibroids. Biomed Imaging Interv J 2010; 6:e15. [PMID: 21611036 PMCID: PMC3097768 DOI: 10.2349/biij.6.2.e15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 01/19/2010] [Accepted: 01/24/2010] [Indexed: 11/23/2022] Open
Abstract
Magnetic Resonance-guided focused Ultrasound Surgery (MRgFUS) is gaining popularity as an alternative to medical and surgical interventions in the management of symptomatic uterine fibroids. Studies have shown that it is an effective non-invasive treatment with minimal associated risks as compared to myomectomy and hysterectomy. MRgFUS can be offered to a majority of patients suffering from symptomatic uterine fibroids. It has been suggested that the use of broader inclusion criteria as well as the mitigation techniques makes it possible to offer MRgFUS to a much larger subset of patients than previously believed. This paper will describe how MRgFUS treatment for uterine fibroids is performed at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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