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Patel N, Chaudhari K, Patel D, Joshi J. High-Intensity Focused Ultrasound Ablation of Uterine Fibroids: A Review. Cureus 2023; 15:e44680. [PMID: 37809132 PMCID: PMC10550780 DOI: 10.7759/cureus.44680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Leiomyomas, or uterine fibroids, are growths consisting of muscle and tissue that develop in or on the uterine wall. The most frequent benign uterine tumours in women of reproductive age are thought to be fibroids. Dysmenorrhea, spotting, hypermenorrhoea, abdominal pain, pressure on surrounding organs, and issues with micturition and defecation are among the symptoms that are often present. Fibroids can form as a single nodule or as a cluster. Uterine fibroids, especially large submucosal and intramural uterine fibroids, can cause obstacles to implantation and lead to pregnancy loss. Uterine fibroids can be treated without surgery and with little downtime using focused ultrasound. There is published research showing that women can conceive and have healthy children after therapy, thus protecting fertility. The ablation of uterine fibroids by high-intensity focused ultrasound (HIFU) is successful since the volume of the fibroids is significantly reduced.
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Affiliation(s)
- Nainita Patel
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dharmesh Patel
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jalormy Joshi
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Effectiveness and Safety of Ultrasound-guided Percutaneous Microwave Ablation for a Single Uterine Fibroid Greater than 300 cm 3. J Minim Invasive Gynecol 2022; 30:290-299. [PMID: 36563871 DOI: 10.1016/j.jmig.2022.12.013] [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: 10/07/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE To evaluate the effectiveness and safety of ultrasound-guided percutaneous microwave ablation (MWA) for a single uterine fibroid greater than 300 cm3. DESIGN Retrospective observational study. SETTING China-Japan Union Hospital of Jilin University, China. PATIENTS Thirty-seven patients each with a single fibroid greater than 300 cm3 diagnosed by ultrasound and core needle biopsy. INTERVENTIONS Ultrasound-guided percutaneous MWA. MEASUREMENTS AND MAIN RESULTS All patients were followed up for 12 months postoperatively to assess the postoperative lesion volume reduction rate, degree of symptomatic relief, improvements in quality of life, and occurrence of adverse events. All 37 patients met the criteria for complete ablation, and the lesion volume significantly decreased from 334.28 cm3 (95% confidence interval [CI] 326.75-366.73) preoperatively to 52.01 cm3 (95% CI, 46.95-74.69) at the 12-month follow-up (difference: 280.15 cm3; 95% CI, 267.92-294.65; p <.001). The lesion volume reduction rates at 1, 3, 6, and 12 months postoperatively were 27.30% (95% CI, 24.12-31.45), 52.90% (95% CI, 47.95-55.80), 67.90% (95% CI, 63.03-70.77), and 84.00% (95% CI, 80.22-85.94), respectively. The differences in the preoperative and postoperative Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire scores were significant (p <.01). The hemoglobin levels of the anemic patients were significantly elevated after the procedure (p <.001). Of the 37 patients in this study, 29 patients (78.38%) had a highly significant treatment effect, and 8 patients (21.62%) had a significant treatment effect. Seventeen patients (45.95%) had Society of Interventional Radiology grade A to B adverse effects that required no clinical intervention or only simple clinical intervention. CONCLUSION Ultrasound-guided percutaneous MWA has good clinical efficacy and high safety in the treatment of a single uterine fibroid greater than 300 cm3.
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Plöger TA, Koep S, Militzer HC, Göller AH. Combined experimental and quantum mechanical elucidation of the synthetically accessible stereoisomers of Hydroxyestradienone (HED), the starting material for vilaprisan synthesis. J Comput Aided Mol Des 2020; 35:505-516. [PMID: 33094408 DOI: 10.1007/s10822-020-00353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
Selective progesterone receptor modulators are promising therapeutic options for the treatment of uterine fibroids. Vilaprisan, a new chemical entity that was discovered at Bayer is currently in clinical development. In this study we provide a combined experimental and quantum chemical approach providing the data that allowed to present hydroxyestradienone as an acceptable starting material for drug substance synthesis. Hydroxyestradienone has four stereogenic centers leading to 8 diastereomers and 16 enantiomers of which only six diastereomers were synthetically accessible but two not. A computational multistep protocol resulting in density functional P2PLYP-D3(BJ)/dev2-TZVPP Gibbs free energies and SMD solvation free energies led to a clear separation between the existing and the synthetically not accessible enantiomers, whereas multiple geometry-based and cheminformatic descriptors were not able to explain experimental findings.
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Affiliation(s)
- Tobias A Plöger
- Product Supply, Pharmaceuticals, Bayer AG, 59192, Bergkamen, Germany
| | - Stefan Koep
- Product Supply, Pharmaceuticals, Bayer AG, 42096, Wuppertal, Germany
| | | | - Andreas H Göller
- Computational Molecular Design, Digital Technologies, Pharmaceuticals, Bayer AG, 42096, Wuppertal, Germany.
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D'Hondt M, Verbeke F, Wuytens P, Skirtach A, De Spiegeleer B, Wynendaele E. Hot-Melt Preparation of a Non-Biodegradable Peptide Implant: A Proof of Principle. Protein Pept Lett 2019; 26:691-701. [PMID: 31215364 DOI: 10.2174/0929866526666190619113724] [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: 01/10/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Both biodegradable and non-biodegradable peptide-loaded implants are already developed for the long-term treatment of patients, thereby reducing the frequency of drug administration. To further improve peptide formulation, extending the scope of implant-based drug delivery systems towards other polymers and processing techniques is highly interesting. OBJECTIVE In this study, as a proof-of-principle, the feasibility of hot-melt processing of a peptide active pharmaceutical ingredient was assessed by developing a non-biodegradable poly(ethylenevinyl acetate) (33% VA) implant loaded with 20% (w/w) buserelin acetate. METHODS Cross-sectional implant characterization was performed by Raman microscopy. The stability of buserelin acetate in the polymeric matrix was evaluated for 3 months under ICH stability conditions and the quantity as well as the degradation products analyzed using LC-UV methods. An in vitro dissolution study was performed as well and buserelin acetate and its degradants analyzed using the same chromatographic methods. RESULTS No significant quantities of buserelin acetate-related degradation products were formed during the hot-melt preparation as well as during the stability study. Together with the consistent buserelin acetate assay values over time, chemical peptide stability was thus demonstrated. The in vitro buserelin acetate release from the implant was found to be diffusion-controlled after an initial burst release, with stable release profiles in the stability study, demonstrating the functional stability of the peptide implant. CONCLUSION These results indicate the feasibility of preparing non-biodegradable peptide-loaded implants using the hot-melt production method and may act as a proof of principle concept for further innovation in peptide medicinal formulations.
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Affiliation(s)
- Matthias D'Hondt
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Frederick Verbeke
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Pieter Wuytens
- Department of Molecular Biotechnology, Centre for Nano-Biophotonics, Ghent University, Ghent, Belgium
| | - Andre Skirtach
- Department of Molecular Biotechnology, Centre for Nano-Biophotonics, Ghent University, Ghent, Belgium
| | - Bart De Spiegeleer
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Evelien Wynendaele
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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Zhang C, Jacobson H, Ngobese ZE, Setzen R. Efficacy and safety of ultrasound-guided high intensity focused ultrasound ablation of symptomatic uterine fibroids in Black women: a preliminary study. BJOG 2019; 124 Suppl 3:12-17. [PMID: 28856855 DOI: 10.1111/1471-0528.14738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the therapeutic effect and safety of ultrasound-guided high-intensity focused ultrasound (USgHIFU) treatment on symptomatic uterine fibroids in Black women. DESIGN A feasibility study. SETTING Gynaecological department in a teaching hospital in South Africa. POPULATION Premenopausal women with uterus fibroids. METHODS Twenty-six patients with 53 fibroids who underwent USgHIFU treatment were enrolled. The USgHIFU treatment information was recorded, including treatment time, sonication time and total energy. Adverse events were also observed and recorded during and after treatment. MAIN OUTCOME MEASURES Safety and efficacy of USgHIFU for the treatment of uterine fibroids in Black women. RESULTS The median volume of fibroids was 52.7 (interquartile range, 18.6-177.4) cm3 . According to USgHIFU treatment plan, total energy of 298.6 ± 169.3 kJ (range, 76.0-889.2) within treatment time of 90.3 ± 43.3 minutes (range, 14.0-208.0), in which sonication time of 774.0 ± 432.9 seconds (range, 190.0-2224.0) was used to ablate fibroids. The average ablation rate was 80.6 ± 9.7% (range, 46.5-94.5%). During the procedure, 69.2% of the patients reported lower abdominal pain, 57.7% sciatic/buttock pain, 38.5% burning skin, and 34.6% transient leg pain. No severe complications were observed. CONCLUSIONS USgHIFU is feasible and safe to use to treat symptomatic uterine fibroids in Black women. TWEETABLE ABSTRACT Multiple uterine fibroids are more frequently detected in Black women. USgHIFU is feasible and safe for the treatment of uterine fibroids in Black women.
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Affiliation(s)
- C Zhang
- State Key Laboratory of Ultrasound Engineering in Medicine, Chongqing Medical University, Chongqing, China.,Department of Obstetrics and Gynecology, Suining Central Hospital, Sichuan, China
| | - H Jacobson
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Z E Ngobese
- Department of Diagnostic Imaging and Radiology, Christ Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - R Setzen
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
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Identification of Incident Uterine Fibroids Using Electronic Medical Record Data. EGEMS 2019; 7:5. [PMID: 30972354 PMCID: PMC6450248 DOI: 10.5334/egems.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Uterine fibroids are the most common benign tumors of the uterus and are associated with considerable morbidity. Diagnosis codes have been used to identify fibroid cases, but their accuracy, especially for incident cases, is uncertain. Methods We performed medical record review on a random sample of 617 women who received a fibroid diagnosis during 2012-2014 to assess diagnostic accuracy for incident fibroids. We developed 2 algorithms aimed at improving incident case-finding using classification and regression tree analysis that incorporated additional electronic health care data on demographics, symptoms, treatment, imaging, health care utilization, comorbidities and medication. Algorithm performance was assessed using medical record as gold standard. Results Medical record review confirmed 482 fibroid cases as incident, resulting a 78 percent positive predictive value (PPV) for incident cases based on diagnosis codes alone. Incorporating additional electronic data, the first algorithm classified 395 women with a pelvic ultrasound on diagnosis date but none before as incident cases. Of these, 344 were correctly classified, yielding an 87 percent PPV, 71 percent sensitivity, and 62 percent specificity. A second algorithm built on the first algorithm and further classified women based on a fibroid diagnosis code of 218.9 in 2 years after incident diagnosis and lower body mass index; yielded 93 percent PPV, 53 percent sensitivity, and 85 percent specificity. Conclusions Compared to diagnosis codes alone, our algorithms using fibroid diagnosis codes and additional electronic data improved identification of incident cases with higher PPV, and high sensitivity or specificity to meet different aims of future studies seeking to identify incident fibroids from electronic data.
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Posterior reversible encephalopathy syndrome in a woman who used gonadotropin-releasing hormone agonists: a case report. Obstet Gynecol Sci 2018; 62:69-72. [PMID: 30671396 PMCID: PMC6333760 DOI: 10.5468/ogs.2019.62.1.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/27/2018] [Accepted: 04/18/2018] [Indexed: 11/08/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a newly described adverse effect possibly associated with gonadotropin-releasing hormone (GnRH) agonist therapy. We report a case of PRES after 2 doses of depot GnRH agonists in a 44-year-old woman with a huge myoma uteri and iron-deficiency anemia. Brain magnetic resonance imaging showed high signal lesions in both occipital lobes on fluid-attenuated inversion-recovery (FLAIR) images, compatible with PRES. After treatment with anticonvulsant, she recovered both radiographically and clinically. The association between PRES and GnRH agonist use is still enigmatic, and thus should be further clarified.
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Yu O, Scholes D, Schulze-Rath R, Grafton J, Hansen K, Reed SD. A US population-based study of uterine fibroid diagnosis incidence, trends, and prevalence: 2005 through 2014. Am J Obstet Gynecol 2018; 219:591.e1-591.e8. [PMID: 30291840 DOI: 10.1016/j.ajog.2018.09.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/24/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite considerable public health burden, uterine fibroid population-based incidence estimates are few. Secular trends over time are even more limited. OBJECTIVE We sought to evaluate the incidence, 10-year secular trends, and prevalence of uterine fibroid diagnoses and describe the proportion of symptomatic women. STUDY DESIGN We performed a retrospective population-based cohort study of women, aged 18-65 years, enrolled 2005 through 2014 in Kaiser Permanente Washington. Uterine fibroid diagnoses identified by International Classification of Diseases, Ninth Revision codes and potential covariates were extracted from computerized databases. Women with prior hysterectomy and, for incidence estimates, women with prior fibroid diagnoses were excluded. Linear trends in incidence rates over the 10-year study period were evaluated using Poisson regression models. Rates and trend tests were examined for all women, by age groups, and by race/ethnicity. RESULTS Associated International Classification of Diseases, Ninth Revision symptom-related codes were observed in 90% of incident cases. Incidence rates for fibroid diagnoses were highest for the age group 45-49 years, 240.3 per 10,000 woman-years in 2014, and for black women across all years. Overall age-adjusted estimated incidence rates declined during the 10-year study interval, from 139.4 per 10,000 woman-years in 2005 to 101.4 in 2014 (P value trend .0008). Overall prevalence in 2014 was 9.6%, and was highest among women aged 50-54 years (15.9%). Black women had higher prevalence (18.5%) than other racial/ethnic groups. CONCLUSION We found a decreasing trend of new uterine fibroid diagnoses among predominantly symptomatic women ages 18-65 years in a recent 10-year interval. This finding was due, perhaps in part, to secular trends of decreasing hysterectomies. Nonetheless, uterine fibroids remain a common health burden, with a prevalence of nearly 10%. Rates are disproportionately high and occur at younger ages for black women, and possibly for other non-white racial/ethnic groups. These findings are of concern, as current available long-term medical therapies remain limited.
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Melis GB, Neri M, Piras B, Paoletti AM, Ajossa S, Pilloni M, Marotto MF, Corda V, Saba A, Giancane E, Mais V. Vilaprisan for treating uterine fibroids. Expert Opin Investig Drugs 2018; 27:497-505. [DOI: 10.1080/13543784.2018.1471134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Gian Benedetto Melis
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Manuela Neri
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Bruno Piras
- Dipartimento Materno Infantile, clinica ostetrica e ginecologica, policlinico universitario Duilio Casula, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Anna Maria Paoletti
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Silvia Ajossa
- Dipartimento Materno Infantile, clinica ostetrica e ginecologica, policlinico universitario Duilio Casula, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Monica Pilloni
- Dipartimento Materno Infantile, clinica ostetrica e ginecologica, policlinico universitario Duilio Casula, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Maria Francesca Marotto
- Dipartimento Materno Infantile, clinica ostetrica e ginecologica, policlinico universitario Duilio Casula, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Valentina Corda
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Alessandra Saba
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Elena Giancane
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Valerio Mais
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
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Sinai Talaulikar V. Medical therapy for fibroids: An overview. Best Pract Res Clin Obstet Gynaecol 2018; 46:48-56. [DOI: 10.1016/j.bpobgyn.2017.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
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Ferrero S, Vellone VG, Barra F. Pharmacokinetic drug evaluation of ulipristal acetate for the treatment of uterine fibroids. Expert Opin Drug Metab Toxicol 2017; 14:107-116. [DOI: 10.1080/17425255.2018.1417389] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Valerio Gaetano Vellone
- Department of Surgical and Diagnostic Sciences, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
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Mas A, Tarazona M, Dasí Carrasco J, Estaca G, Cristóbal I, Monleón J. Updated approaches for management of uterine fibroids. Int J Womens Health 2017; 9:607-617. [PMID: 28919823 PMCID: PMC5592915 DOI: 10.2147/ijwh.s138982] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Uterine anatomy and uterine fibroids (UFs) characteristics have been classically considered as almost a unique issue in gynecology and reproductive medicine. Nowadays, the management of UF pathology is undergoing an important evolution, with the patient's quality of life being the most important aspect to consider. Accordingly, surgical techniques and aggressive treatments are reserved for only those cases with heavy symptomatology, while the clinical diagnostic based on size and number of UFs remains in a second plane in these situations. Moreover, the development of several noninvasive surgical techniques, especially the appearance of ulipristal acetate as a medical etiological treatment, has substantially changed the clinical indications. As a consequence, after almost 2 decades without relevant updates, it has been necessary to update the protocols for the management of UFs in the Spanish Society of Gynecology and Obstetrics twice. Accordingly, we believe that it is necessary to translate our experience to protocolize the medical care for patients with UFs, incorporating these new therapeutic options, and selecting the best treatment for them. We highlight the importance of achieving the patient's goals and decisions by improving the clinical diagnosis for these type of pathologies, allowing enhanced personalized treatments, as well as the reduction of potential risks and unnecessary surgeries.
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Affiliation(s)
- Aymara Mas
- Reproductive Medicine Research Group, Institute of Health Research La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
- Research and Development Department, Igenomix Foundation, Valencia, Spain
| | - Marta Tarazona
- Gynecology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Joana Dasí Carrasco
- Gynecology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Gloria Estaca
- Obstetrics and Gynecology Department, La Zarzuela Hospital, Madrid, Spain
- Obstetrics and Gynecology Department, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ignacio Cristóbal
- Obstetrics and Gynecology Department, La Zarzuela Hospital, Madrid, Spain
- Obstetrics and Gynecology Department, Universidad Francisco de Vitoria, Madrid, Spain
| | - Javier Monleón
- Gynecology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
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Wagenfeld A, Saunders PTK, Whitaker L, Critchley HOD. Selective progesterone receptor modulators (SPRMs): progesterone receptor action, mode of action on the endometrium and treatment options in gynecological therapies. Expert Opin Ther Targets 2016; 20:1045-54. [PMID: 27138351 PMCID: PMC4989858 DOI: 10.1080/14728222.2016.1180368] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: The progesterone receptor plays an essential role in uterine physiology and reproduction. Selective progesterone receptor modulators (SPRMs) have emerged as a valuable treatment option for hormone dependent conditions like uterine fibroids, which have a major impact on women’s quality of life. SPRMs offer potential for longer term medical treatment and thereby patients may avoid surgical intervention. Areas covered: The authors have reviewed the functional role of the progesterone receptor and its isoforms and their molecular mechanisms of action via genomic and non-genomic pathways. The current knowledge of the interaction of the PR and different SPRMs tested in clinical trials has been reviewed. The authors focused on pharmacological effects of selected SPRMs on the endometrium, their anti-proliferative action, and their suppression of bleeding. Potential underlying molecular mechanisms and the specific histological changes in the endometrium induced by SPRMs (PAEC; Progesterone receptor modulator Associated Endometrial Changes) have been discussed. The clinical potential of this compound class including its impact on quality of life has been covered. Expert Opinion: Clinical studies indicate SPRMs hold promise for treatment of benign gynecological complaints (fibroids, heavy menstrual bleeding; HMB). There however remains a knowledge gap concerning mechanism of action.
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Affiliation(s)
- Andrea Wagenfeld
- a Bayer HealthCare , Drug Discovery, TRG Gynecological Therapies , Berlin , Germany
| | - Philippa T K Saunders
- b MRC Centre for Inflammation Research , The University of Edinburgh , Edinburgh , UK
| | - Lucy Whitaker
- c MRC Centre for Reproductive Health , The University of Edinburgh , Edinburgh , UK
| | - Hilary O D Critchley
- c MRC Centre for Reproductive Health , The University of Edinburgh , Edinburgh , UK
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Selektive Progesteronrezeptormodulatoren. GYNAKOLOGISCHE ENDOKRINOLOGIE 2016. [DOI: 10.1007/s10304-015-0050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Unplanned pregnancy after ultrasound-guided percutaneous microwave ablation of uterine fibroids: A follow-up study. Sci Rep 2016; 6:18924. [PMID: 26733265 PMCID: PMC4702107 DOI: 10.1038/srep18924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/25/2015] [Indexed: 11/08/2022] Open
Abstract
A follow-up study was performed with 169 women of childbearing age who underwent ultrasound-guided percutaneous microwave ablation (UPMWA) therapy for symptomatic uterine fibroids in the Chinese PLA General Hospital from June 2007 to December 2014. This study aimed to observe the incidence of unplanned pregnancies in these women after UPMWA treatment in order to evaluate its effect on natural conception. Ten unplanned pregnancies in nine women were occurred. Of the nine patients, six did not want the pregnancy and chose for induced abortion to end the pregnancy at an early stage. Three chose to continue with the pregnancy and gave birth to a healthy term infant delivered by cesarean section (of these three patients, two had been previously diagnosed as infertility). None of the patients had any serious obstetric complications. After UPMWA treatment for uterine fibroids, patients may conceive naturally, the impact of the procedure on fertility and pregnancy outcomes is worthy of further prospective study in larger sample.
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Hoellen F, Hornemann A, Alkatout I, Bohlmann M. Operative Optionen bei Uterus myomatosus. GYNAKOLOGISCHE ENDOKRINOLOGIE 2015. [DOI: 10.1007/s10304-015-0023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Commentary on the article "Pre-treatment with ulipristal acetate before ICSI procedure: a case report" published in Menopause Review 6/2013 (Przegląd Menopauzalny 2013; 6: 496-500). MENOPAUSE REVIEW 2015; 13:150-1. [PMID: 26327846 PMCID: PMC4520355 DOI: 10.5114/pm.2014.42719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bohlmann MK, Hornemann A, Sänger N, Hackethal A, von Horn K, Wilkens P, Hoellen F. Medikamentöse Myomtherapie. GYNAKOLOGISCHE ENDOKRINOLOGIE 2015. [DOI: 10.1007/s10304-015-0021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tafi E, Scala C, Leone Roberti Maggiore U, Bizzarri N, Candiani M, Venturini PL, Ferrero S. Drug safety evaluation of ulipristal acetate in the treatment of uterine fibroids. Expert Opin Drug Saf 2015; 14:965-77. [DOI: 10.1517/14740338.2015.1021773] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Di Tommaso S, Massari S, Malvasi A, Vergara D, Maffia M, Greco M, Tinelli A. Selective genetic analysis of myoma pseudocapsule and potential biological impact on uterine fibroid medical therapy. Expert Opin Ther Targets 2014; 19:7-12. [DOI: 10.1517/14728222.2014.975793] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Erratum to: Update of Conservative Systemic Treatment of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0093-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pérez-López FR, Ornat L, Ceausu I, Depypere H, Erel CT, Lambrinoudaki I, Schenck-Gustafsson K, Simoncini T, Tremollieres F, Rees M. EMAS position statement: Management of uterine fibroids. Maturitas 2014; 79:106-16. [DOI: 10.1016/j.maturitas.2014.06.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Update of Conservative Systemic Treatment of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0089-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Di Tommaso S, Tinelli A, Malvasi A, Massari S. Missense mutations in exon 2 of the MED12 gene are involved in IGF-2 overexpression in uterine leiomyoma. Mol Hum Reprod 2014; 20:1009-15. [PMID: 25015674 DOI: 10.1093/molehr/gau055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Uterine leiomyoma (UL), the most common benign tumour found in females, is associated with many recurrent genetic aberrations, such as translocations, interstitial deletions and specific germline mutations. Among these, mutations affecting exon 2 of the mediator complex subunit 12 (MED12) gene are commonly detected in the majority of ULs. Mutational analysis of the MED12 gene, performed on 36 UL samples, revealed that 12 leiomyomas (33.4%) exhibited heterozygous missense mutations in codon 44 of exon 2 of the MED12 gene, four leiomyomas (11.1%) showed internal in-frame deletions, and two leiomyomas (5.5%) exhibited deletions involving intron 1-exon 2 junction, which caused a predicted loss of the splice acceptor. No mutations were detected in uterine myometrium (UM) and pseudocapsule (PC) samples, including those from women with a MED12 mutation in UL. These data showed that the PC is a healthy tissue that surrounds the UL to maintain UM integrity. Analysis of insulin-like growth factor 2 (IGF-2) and collagen type IV alpha 2 (COL4A2) mRNA expression levels in the same set of ULs revealed that only those with MED12 missense mutations expressed significantly higher levels of IGF-2 mRNA. In contrast, MED12 gene status does not appear to affect mRNA expression levels of the COL4A2 gene. On the basis of this finding, we suggest that the MED12 status stratifies the ULs into two mutually exclusive pathways of leiomyoma genesis, one with IGF-2 overexpression and the other with no IGF-2 activation. The occurrence of IGF-2 overexpression could be therapeutically targeted for the non-surgical treatment of leiomyomas.
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Affiliation(s)
- S Di Tommaso
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce 73100, Italy
| | - A Tinelli
- Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy and Technology, Department of Gynecology and Obstetrics, Vito Fazzi Hospital, Lecce 73100, Italy
| | - A Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari 70100, Italy
| | - S Massari
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce 73100, Italy
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D’Hondt M, Fedorova M, Peng CY, Gevaert B, Taevernier L, Hoffmann R, De Spiegeleer B. Dry heat forced degradation of buserelin peptide: Kinetics and degradant profiling. Int J Pharm 2014; 467:48-9. [DOI: 10.1016/j.ijpharm.2014.03.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 11/15/2022]
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Benagiano G, Bastianelli C, Farris M, Brosens I. Selective progesterone receptor modulators: an update. Expert Opin Pharmacother 2014; 15:1403-15. [PMID: 24787486 DOI: 10.1517/14656566.2014.914494] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Several selective progesterone receptor modulators (SPRMs) show promise in several areas of medicine and this work has been summarized by us in 2008. AREAS COVERED Since the publication of our reviews, several developments have taken place in the field of reproductive medicine. The first is emergency contraception (EC). Two SPRMs are clinically utilized today: mifepristone (MFP) and ulipristal acetate (UPA). MFP is available for EC in up to 120 h following unprotected intercourse. A dose of 10 mg is significantly more effective than levonorgestrel (LNG). In a metanalysis of the use of UPA versus LNG up to 72 h after unprotected intercourse, failure rates of 1.4 versus 2.2% were reported. The second is contraception. A daily dose of 2 mg MFP can block ovulation and several MFP regimens are being tested, including a vaginal ring releasing MFP. The third is the preoperative administration in women harboring leiomyomas, where clinical testing of several SPRM has shown that they can decrease uterine leiomyomas' size and substantially reduce uterine bleeding. SPRM can induce unusual, specific endometrial appearances. Many believe that these changes should not cause concern, but the issue remains controversial. EXPERT OPINION SPRMs are very effective in EC and for the preoperative treatment of uterine leiomyomas.
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Affiliation(s)
- Giuseppe Benagiano
- University of Rome, 'Sapienza', Department of Gynaecology, Obstetrics and Urology , C/O AIED Via Toscana 30, 00187 Rome , Italy
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Bohlmann MK, Hoellen F, Hunold P, David M. High-Intensity Focused Ultrasound Ablation of Uterine Fibroids - Potential Impact on Fertility and Pregnancy Outcome. Geburtshilfe Frauenheilkd 2014; 74:139-145. [PMID: 24741124 DOI: 10.1055/s-0033-1360311] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/11/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022] Open
Abstract
Laparoscopic myomectomy is regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant. High-intensity focused ultrasound (HIFU or MRgFUS) ablation of uterine fibroids is also being discussed as a non-surgical, minimally invasive, therapeutic option. This review examines the available data on the impact of HIFU/MRgFUS on fertility and pregnancy, focusing particularly on potential direct side-effects of this type of intervention on ovaries, fallopian tubes and uterus and potential late effects on pregnancy and birth, based on the current literature. All pregnancies after HIFU/MRgFUS published to date (around 100 cases) were evaluated. The published case series suggest that HIFU/MRgFUS ablation has no impact on the rate of miscarriages or other obstetrical outcome parameters. Because no prospective studies exist which permit firm conclusions to be drawn on the impact of HIFU/MRgFUS on fertility and pregnancy outcome in women with symptomatic fibroids, this approach is currently only recommended for women with suspected fertility problems due to uterine fibroids who either decline surgery or who have an unacceptably high surgical risk.
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Affiliation(s)
- M K Bohlmann
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein - Campus Lübeck, Lübeck
| | - F Hoellen
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein - Campus Lübeck, Lübeck
| | - P Hunold
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein - Campus Lübeck, Lübeck
| | - M David
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin
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Hoellen F, Rody A, Ros A, Bruns A, Cirkel C, Bohlmann MK. Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: case report and review of the literature. MINIM INVASIV THER 2013; 23:184-7. [PMID: 24329014 DOI: 10.3109/13645706.2013.870577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Minimally invasive hysterectomy in obese patients may be limited by laparoscopic sight on the one hand and by intraoperative complications related to reduced ventilation due to pneumoperitoneum on the other. Retractor-based laparoscopy offers an operative technique reducing anesthesia risks. We report the case of laparoscopic hysterectomy in an obese patient of short stature. Laparoscopic supracervical hysterectomy was performed by a hybrid approach of a retractor system exerting its effects on lifting the abdominal wall through gravity and conventional laparoscopy, thus bypassing the adverse effects of pneumoperitoneum on ventilation.
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Affiliation(s)
- Friederike Hoellen
- Department of Gynecology and Ostetrics, University Hospital Schleswig Holstein , Campus Luebeck, Luebeck , Germany
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