Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Fibroids”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 181 records · Page 10Linked to original sources
PubMed2000

Software development for registration of digital subtraction angiography (DSA) images in uterine fibroid embolization.

The ISIS Center at Georgetown University Medical Center has developed a comprehensive program for image-guided procedures in the spine. As part of this program, ISIS has developed a software application known as I-SPINE (ISIS's Spine Procedure Imaging Navigation Engine). I-SPINE is a Windows NT application, which is based on the Analyze/AVM libraries. The software architecture follows the Microsoft Foundation Classes (MFC) single document, multiple view paradigm. This has allowed the developers to add new visualization modules to I-SPINE that aid physicians in procedures outside the spine. One such procedure I-SPINE has been expanded for is uterine fibroid embolization. The idea is that by registering and subtracting post-embolization angiographic images from pre-treatment images the resulting image can be used to quantify the embolization effect on the fibroid circulation and predict the treatment response. The I-SPINE digital subtraction angiography (DSA) module allows the interventional radiologist to open a series of pre and post-embolization DSA images that shows the vascular structures of the uterus and the fibroid or fibroids. From these images, the radiologist selects an appropriate image from each series. The selected images are then hand registered using pixel shifting. Once the images are registered, the pixels are subtracted resulting in an image that shows the embolized arteries that were supplying the fibroids.

Angiography, Digital Subtraction↗
PubMed2000

The presence of small uterine fibroids not distorting the endometrial cavity does not adversely affect conception outcome following embryo transfer in older recipients.

PURPOSE: To determine if uterine fibroids have a negative impact in older patients having embryo transfer (ET). METHODS: Comparison of clinical and viable pregnancy rates, implantation rates, and spontaneous abortion rates in older (>35) oocyte or embryo recipients with uterine leiomyomata compared to comparable patients without fibroids. RESULTS: The clinical pregnancy rate per transfer was 56% in the fibroid group vs 64% for the controls. Implantation rates were also very similar (33 vs 32%7). There were no spontaneous abortion or preterm deliveries <32 weeks in the fibroid group and the average term of pregnancies was also similar. CONCLUSION: Small fibroids not distorting the uterine cavity do not seem to negatively affect conception outcome even in older women.

Adult↗
PubMed2001

Uterine artery embolization to treat uterine fibroids.

Except for choice of embolization agent, the technique of uterine artery embolization for the treatment of fibroids is similar to that performed as emergent therapy for hemorrhage. The unique and more difficult aspects of fibroid embolization relate to patient recruitment and periprocedural care. There are few procedures in interventional radiology where timely and thoughtful pre- and postprocedure care are as important to building a practice. This is because of the intense and often prolonged clinical consequences of fibroid embolization, the attitude of many gynecologists toward interventional radiology and interventions for fibroids and especially because of the patient demographic. Patients seeking fibroid embolization tend to be highly motivated, educated women in their 20s to 40s with Internet access. The interventional radiologist unable to provide adequate answers or time to this group of patients in particular will find that they are an unforgiving lot!

Embolization, Therapeutic↗
PubMed2002

Uterine artery embolization for the treatment of fibroids.

Uterine artery embolization (UAE), or uterine fibroid embolization, is a non-surgical treatment for uterine fibroids that preserves the uterus and offers women an alternative to surgical procedures such as hysterectomy and myomectomy. Evidence from controlled trials comparing fibroid treatments is not yet available. Case series reports indicate that UAE is a relatively safe and effective treatment for symptomatic fibroids. The effect of UAE on fertility and pregnancy is not known, though pregnancies following UAE have been reported. UAE may reduce health care costs associated with treating fibroids through shorter hospital stays and faster recoveries.

Canada↗
PubMed2005

Inpatient surgical treatment patterns for patients with uterine fibroids in the United States, 1998-2002.

OBJECTIVE: To analyze the impact of patient and organizational characteristics on surgical treatment patterns for patients with uterine fibroids. METHODS: Unadjusted means and percentages were calculated from a population-based inpatient sample (HCUPNIS). Multiple logistic regression analysis was used to estimate the prevalence odds ratios for the association of uterine fibroid treatments and covariates of interest. RESULTS: More than 1.2 million patients with a primary diagnosis of uterine fibroids were treated from 1998 to 2002. Of these, 84.4% received a hysterectomy and 12.3% received a myomectomy. Total abdominal hysterectomy was the most common procedure. The number of supracervical hysterectomies increased 18.1% over the five-year period. Black women and Asians/Pacific Islanders were more likely than white women to receive a myomectomy. All types of hysterectomies were more common in Medicaid patients compared with private/HMO patients. With the exception of patients in ZIP codes with a median income of <$25,000 per year, an inverse relationship was identified between income and hysterectomy rates. CONCLUSIONS: The management of uterine fibroids appears to differ across a variety of socioeconomic factors and institutional characteristics. This study suggests that additional research should be conducted to assess the impact of nonclinical factors on treatment decisions for patients with uterine fibroids.

Adult↗
PubMed2006

Uterine artery embolisation - a treatment alternative for women with fibroids.

BACKGROUND: Fibroids are a common benign tumour of the female reproductive tract. Uterine artery embolisation is a minimally invasive catheter based technique that compares favourably with surgical treatments. OBJECTIVE: Uterine artery embolisation is an intervention that is especially suited to women who wish to preserve their uterus. This article briefly outlines the medical and surgical treatment options for fibroids with an in depth focus on fibroid embolisation. DISCUSSION: Australian interventional radiologists have been performing uterine artery embolisation for fibroid disease successfully for a number of years. This procedure - like any intervention - is not without complication, but it does enable women a valid alternative treatment pathway for fibroids. General practitioners can discuss the procedure with their local interventional radiologist and can foster a broader understanding of the process with their female patients when considering treatment options.

Embolization, Therapeutic↗
PubMed2006

Survey of gynecologists' and interventional radiologists' opinions of uterine fibroid embolization.

PURPOSE: To evaluate the opinions of gynecologists and interventional radiologists regarding uterine fibroid embolization (UFE). METHODS: We mailed surveys to all gynecologists and interventional radiologists practising in Toronto, Ontario. Study criteria excluded those physicians who did not assess or treat patients with uterine fibroids. We evaluated whether they educated patients regarding UFE, together with their opinion of current and future effectiveness of UFE, self-rated knowledge of fibroid treatment options, and recommendations for treatment in several clinical scenarios. RESULTS: A total of 102 gynecologists (46.4% response rate) and 28 interventional radiologists (51.9% response rate) completed the survey. After applying the exclusion criteria, the final study population was 82 gynecologists and 17 interventional radiologists. Both groups reported high rates of patient education regarding UFE (gynecologists 100% and interventional radiologist 88.2%, P > 0.05). Interventional radiologists had higher self-rated knowledge of UFE (P = 0.05), and gynecologists had higher self-rated knowledge of all other treatment options (P = 0.00). Interventional radiologists had a more favourable opinion of the current effectiveness (P < 0.05) and future use (P > 0.05) of UFE. In 5 of the 7 clinical scenarios, interventional radiologists chose UFE, whereas gynecologists chose other treatment options (P < 0.05). CONCLUSIONS: Although most gynecologists and intterventional radiologists educate their patients regarding UFE as a treatment option for uterine fibroids, interventional radiologists have greater self-rated knowledge and a higher opinion of current effectiveness and future use and recommend UFE more often for uterine fibroid scenarios.

Adult↗
PubMed1990

The secretion of insulin-like growth factors I and II by explant cultures of fibroids and myometrium from women treated with a gonadotropin-releasing hormone agonist.

The gonadotropin-releasing hormone agonist (GnRH-a) leuprolide acetate depot was used as a biologic probe to investigate the possible roles of insulin-like growth factors (IGFs) I and II in fibroid growth. The secretion of IGF-I and IGF-II by explant cultures of fibroids and myometria from women treated with a GnRH-a was compared with that of tissue obtained from placebo-treated controls. Patients were randomized to receive either leuprolide 3.75 mg every 28 days (N = 9) or placebo injections (N = 8) before myomectomy. Fresh tissue was diced into 2-mm3 explants and cultures were established in serum-free media. The media were assayed for IGF-I, IGF-II, and total protein. Patients treated with GnRH-a demonstrated a 34% reduction in uterine volume, whereas placebo-treated patients exhibited no change. The secretion of IGF-I and IGF-II by fibroid explants obtained from women treated with the GnRH-a was significantly less than that in tissue obtained from placebo-treated controls (P less than .01 and P less than or equal to .05, respectively). Similarly, the secretion of IGF-I and IGF-II by myometrial explants was significantly less in tissue obtained from women treated with GnRH-a (P less than .0001 for both IGF-I and IGF-II). Protein secretion by fibroid tissue obtained from women treated with GnRH-a was not significantly different when compared with tissue from placebo-treated controls. In conclusion, fibroids and myometria from women pretreated with the GnRH-a secreted significantly less IGF-I and IGF-II than did tissue obtained from placebo-treated controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension.

OBJECTIVE: To examine the results of transcervical resection of submucous fibroids in relation to the degree of intramural extension. METHODS: A prospective 3-year observational study was performed of transcervical resection of submucous fibroids for abnormal uterine bleeding. The mean follow-up was 20 months (range 10-34). Fifty-one patients with a mean age of 38 years (range 23-55) were treated with transcervical resection after classification according to the degree of intramural extension of the submucous fibroids. The intention was to perform complete resection, established at control hysteroscopy. A repeat procedure was performed in cases of incomplete resection unless the patient denied further hysteroscopic treatment. Outcome measures were control of bleeding, subsequent surgery, number of procedures, number of complete resections, and number of recurrences. RESULTS: Bleeding was controlled in 48 (94.1%) of all patients after final resection. Hysterectomy was performed in three patients (5.9%) because of persistent complaints: in two cases after incomplete resection and in one case after complete resection. Three patients were lost to follow-up. Of the remaining 45 patients (42 with complete and three with incomplete final resection), three (6.7%) had a recurrence (one after complete and two after incomplete final resection). With more extensive intramural involvement, the chance to achieve complete resection decreased and the mean number of procedures to achieve complete resection increased. CONCLUSIONS: Complete resection improves the long-term results of transcervical resection of submucous fibroids for control of abnormal uterine bleeding. Transcervical resection of submucous fibroids with more than 50% intramural extension should be performed only in selected cases, as complete resection usually necessitates repeat procedures.

Adult↗
PubMed2000

Magnetic resonance-guided percutaneous laser ablation of uterine fibroids.

Laser ablation of uterine fibroids using a percutaneous approach under local anesthetic in an open magnetic resonance (MR) scanner was performed in 12 symptomatic women awaiting hysterectomy. Accurate laser fiber placement was assisted by the use of an MR needle tracking system, as well as laser heat dissipation monitored during treatment by a real-time imaging processor. This day case procedure was well tolerated by all women, with eight women subsequently declining their planned surgery. Follow-up measurements of treated fibroid volume by MRI demonstrated a mean decrease of 37.5% at 3 months. This novel minimally invasive approach offers an alternative to surgery for women with fibroids, but longer follow-up is required to ascertain maximal fibroid shrinkage and to compare outcome with traditional surgery.

Adult↗
PubMedDate not supplied

Mid-term clinical results and patient satisfaction after uterine artery embolization in women with symptomatic uterine fibroids.

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

Adult↗
PubMed2006

Incarceration of umbilical hernia during pregnancy due to a sessile fibroid.

The incidence of both umbilical hernias and fibroids during pregnancy is reported to be rare. Another rare entity is the incarceration of fibroids in pregnancy. We report here the case of a 30-year-old woman in her 32nd gestational week with an incarcerated umbilical hernia. She was operated on an emergency basis, the sessile fibroid was mobilized and the hernia defect was repaired with the Mayo technique. No complications were observed during the post-operative period. She gave birth to a baby girl during the 38th gestational week by means of a cesarean section. The possibility of a fibroid entrapped in the hernial sac should always be taken into consideration at the evaluation of incarcerated hernias during pregnancy. If the contents of the hernial sac cannot be pushed into the abdominal cavity easily, an emergency operation should be considered as a means to prevent further complications related to pregnancy.

Adult↗
PubMed1990

Luteinizing hormone-releasing hormone analog therapy of uterine fibroid: analysis of results obtained with buserelin administered intranasally and goserelin administered subcutaneously as a monthly depot.

From January 1987 to February 1988 patients affected by uterine fibroid were offered medical treatment with luteinizing hormone-releasing hormone analogs as an alternative to surgery. The aim was to compare results obtained with two different analog formulations. 42 patients were randomly assigned to receive either intranasal buserelin, preceded by a short period of subcutaneous injections (500 micrograms thrice daily for 10 days) or subcutaneous goserelin. Treatment was always started in the luteal phase. Response to therapy was evaluated through periodic clinic, endocrine and echotomographic controls. There were no significative differences in fibroid reduction between the two treatment groups. After 6 months of treatment, a fibroid reduction of more than 30% of the initial volume was observed in 16 patients in the buserelin group and in 18 patients in the goserelin group. The fibroid regrowth observed in all patients during the follow-up period severely limits the usefulness of this medical approach to selected clinical cases.

Administration, Cutaneous↗
PubMed2005

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

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

Diagnostic Imaging↗
PubMed2004

Molecular characterization of uterine fibroids and its implication for underlying mechanisms of pathogenesis.

OBJECTIVE: To identify genes involved in fibroid development by performing global expression profiling on tissues of normal myometrium and uterine leiomyoma origin using Affymetrix HG-U133A GeneChip microarrays. DESIGN: Whole-genome analysis of mRNA levels in leiomyoma and normal myometrium tissue samples. SETTING: University research laboratory. PATIENT(S): Eight patients of varying age and race undergoing surgery for symptomatic fibroids. INTERVENTION(S): After tissue collection of five tumors and five normals from human pathological specimens, labeled cRNA was generated and hybridized to the oligonucleotide-composed arrays. MAIN OUTCOME MEASURE(S): Quantification of transcript expression levels in uterine fibroids relative to normal myometrium. RESULT(S): Model-based expression analysis revealed that of the 22,500 transcripts represented on the arrays, 226 genes were found to be dysregulated by a > or =1.5-fold change between leiomyoma and normal myometrium. Moreover, our research identified many dysregulated apoptosis-related genes, of particular interest was TRAIL and Ask1, and also found numerous differentially expressed proliferation genes, including TGFB1, PDGFC, and two dual specificity phosphatases. CONCLUSION(S): These results indicate that these genes may play a significant role in the development of leiomyomas from normal uterine tissue. We hypothesize that the deregulation of apoptotic and proliferative processes is pivotal to fibroid development.

Female↗
PubMed2004

[Embolization of uterine fibroids and infertility: is a clinical trial conceivable?].

Uterine artery embolization is a recent technique intended for treating uterine fibroids, as an alternative to hysterectomy. The possible side effects putting at stake the prognosis of fertility after embolization are considered as a brake to its use for the treatment of infertility associated with myoma. Secondary hysterectomy and permanent amenorrhea are the two main risks. But they are not so frequent and can be prevented. To date, the experience in the field of fertility and pregnancy after arterial embolization for fibroids is quite limited. However, first results are encouraging and not very different from those observed after surgical myomectomy. A therapeutic trial using arterial embolization for the management of fibroids within a context of infertility can be devised in the presence of submucosal or intramural myomas responsible for metromenorrhagia and with no major infertility factors associated. It is likely that uterine artery embolization should provide results equivalent or superior to those of surgical myomectomy in case of numerous and intramural fibroids with no prevailing myoma. Arterial embolization could be also interesting in case of recurrent myoma after laparotomic myomectomy.

Embolization, Therapeutic↗
PubMed2004

[Embolization of uterine arteries for uterine fibroids: state-of-the-art].

Embolization of uterine arteries for fibroids is a modern minimally invasive method for treatment of uterine fibroids. Results from published data show a substantial short-term uterine reduction, an improvement in menorrhagias, and a reduction in fibroid related pain. Hospital stay and recovery are shortened compared with hysterectomy. One randomised comparative trial EAU vs hysterectomy has showed a reduction in hospital stay length and in the rate of major complications, but an increased rate of minor complications. Pregnancies and uneventful deliveries have been reported after uterine arteries embolization. Rare but severe complications have been described. Embolization of uterine arteries can be considered as a safe alternative to hysterectomy or myomectomy in selected cases. It cannot be a routine method for treating fibroids with women of childbearing age.

Arteries↗
PubMed2004

[Ileum inflammatory fibroid polyp revealed by intussusception. About one familial case].

INTRODUCTION: Acute ileum intussusception is a frequent and mostly benign condition in childhood. Conversely, it is a rare condition during adulthood and generally associated with an underlying malignancy. We report a familial form of benign inflammatory fibroid polyps, revealed by an acute ileum intussusception. EXEGESIS: A 41-year-old man, whose mother had undergone three surgical procedures for acute ileum intussusception associated with inflammatory fibroid polyp, was admitted for a abdominal pain that started three month ago. The patient displayed alteration of the intestinal transit, weight loss and sub-occlusive syndrome. Upper and lower endoscopies, performed before admission, were normal. In the emergency room, the abdominal computed tomography-scan revealed an acute intussusception of the last loop of the small intestine, probably caused by a tumor and leading to an occlusive syndrome. Surgical resection and histological analysis concluded to an inflammatory fibroid polyp. Clinical outcome was excellent. CONCLUSION: Inflammatory fibroid polyp is always a benign tumor. It is usually isolated, expressing itself mainly in the form of an acute intussusception when located in the small bowel. The familial form presented here is exceptional and illustrates the possibility of an inherited transmission of this disease. However the pathogenesis of this type of polyp is still unclear.

Abdominal Pain↗