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PubMed2003

[Evolution of inflammatory parameters after fibroid embolization].

PURPOSE: To describe the rise of classical laboratory tests for inflammation following transarterial uterine fibroid embolization (UFE) in order to monitor the normal course following UFE. MATERIALS AND METHODS: In 20 females, white blood cell (WBC) count and C-reactive protein (CRP) were determined before and up to 5 days after UFE. With the exception of one noninflammatory complication, the post-procedure course was uneventful in all patients. The measured values were correlated with both the total uterine volume and the amount of instilled embolizing agent. RESULTS: Following UFE, an increase in the WBC count to an average maximum of 10.8 +/- 3.5/wL (range 5.9 - 18.6/wL) was found. In 13 of 20 patients, the WBC count was above normal on at least one day following UFE. The increase reached the maximum on the third post-interventional day and subsided within 5 days after the UFE. The CRP values increased significantly to an average maximum of 41.9 +/- 28.8 mg/l. The maximum was found on the 2nd post-interventional day in 8 patients, on the 3rd day in 11 patients and on the 4th day in one patient. No correlation to the total uterine volume or to the amount of the instilled embolizing agents was detected. CONCLUSION: Following uncomplicated UFE, a steep increase in CRP occurs with no or only a mild increase in the WBC count, which does not indicate an infected fibroid. The maximum is reached on the 3rd or 4th post-interventional day, followed by a decline in CRP and normalization of the WBC count.

Adult↗
PubMed1990

Inflammatory fibroid polyp of the stomach.

Among 3,200 polyps of the stomach, we diagnosed inflammatory fibroid polyp in 143 patients (4.5%). The average age of the patients was 63.6 years (women) and 63.9 years (men), the sex ratio being 1.6 women to 1.0 men. In 77.6% of the cases, the polyp was located within the antrum, in 9.8% in the angular notch region, 1.4% in the pylorus, and 0.7% each in the fundus and cardia. The characteristic histological feature of these lesions is an eosinophil-containing, loosely structured fibrous tissue comprising an onion-skin-like arrangement of reticular fibers with spindle-shaped nuclei localized in the submucosa and the base of the mucosa. The polypous bulging mucosa was eroded in 26.8% and ulcerated in 3.5% of the cases. A comparison of the 147 cases collected from the literature with our own 143 cases revealed no differences. The rarity of inflammatory fibroid polyps in the stomach, their predominant location in the antrum, the age distribution and the observation that, after removal, these lesions do not recur, all go to suggest that the lesion is a reactive process (allergic or foreign body reaction), possibly a residual state following infestation by a parasite larva.

Adult↗
PubMed2000

Uterine artery embolization: a minimally invasive technique for the treatment of uterine fibroids.

Uterine artery embolization (UAE) as a primary therapy for symptomatic fibroids was first used in France in 1991. Currently, there are at least 250 centers in the United States, as well as centers in Canada and England, with experience in this technique. Initial published results worldwide indicate that after UAE, uterine fibroids shrink at least 50% in volume on average and symptoms of refractory vaginal bleeding and chronic pelvic pain are controlled in approximately 85% of patients. Major complications are rare. Overall, this technique is minimally invasive, preserves the uterus, and requires a shorter hospitalization than hysterectomy or myomectomy.

Arteries↗
PubMed1997

Medroxyprogesterone acetate with Zoladex for long-term treatment of fibroids: effects on bone density and patient acceptability.

A randomized trial was carried out to investigate the effect of 12 months administration of the gonadotrophin-releasing hormone agonist (GnRHa) Zoladex in combination with either placebo or medroxyprogesterone acetate (MPA) from the third month. Bone density, markers of bone resorption, symptoms and uterine volume were monitored in 24 women with symptomatic fibroids or menstrual problems. A total of 21 women were recruited to act as controls for the assessment of bone parameters. Vasomotor side-effects were reduced significantly in the MPA-treated group. The reduction in uterine volume in women with fibroids was not impaired by the addition of MPA. The bone markers osteocalcin and alkaline phosphatase were assessed in plasma, and the cross-links pyridinoline and deoxypyridinoline measured in urine. Changes in these markers are reported which suggest increases in bone resorption during the period of observation. Bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry at the spine and forearm. The net reduction in BMD at the spine in the treated groups was 4.30 +/- 0.59% at 6 months and 7.50 +/- 0.78% at 1 year, with no change in the control group. No change was seen in forearm BMD. No protective effect was observed when MPA was added. At 1 year after the completion of treatment, BMD remained significantly below baseline, and this has implications for the prolonged use of GnRHa.

Adult↗
PubMed2003

Disintegration and stepwise expulsion of a large uterine leiomyoma with restoration of the uterine architecture after successful uterine fibroid embolization: case report.

Uterine fibroid embolization (UFE) is a new minimally-invasive treatment option for leiomyomata of the uterus leading to symptomatic improvement and shrinkage of the fibroids. We present a case of restoration of the uterine architecture after disintegration and stepwise expulsion of infarcted leiomyoma tissue 7 months after UFE for leiomyoma-related menorrhagia.

Embolization, Therapeutic↗
PubMed1992

Potential role for medroxyprogesterone acetate as an adjunct to goserelin (Zoladex) in the medical management of uterine fibroids.

Twenty women with symptomatic uterine fibroids were treated with the luteinizing hormone-releasing hormone (LHRH) agonist goserelin (Zoladex) combined with medroxyprogesterone acetate (MPA) in an open pilot study comparing two protocols. Ten women received goserelin 3.6 mg monthly combined with oral MPA 15 mg daily for 6 months. The mean uterine volume (497 cm3) measured by ultrasound fell by only 18% after 3 months, with no further reduction at 6 months. The other 10 women received goserelin alone for the initial 3 months, followed by combined treatment for 3 months. The mean uterine volume (557 cm3) fell by 39% after 3 months with no significant regrowth by 6 months. At 6 months post-treatment, uterine volume had not returned to pretreatment size. MPA significantly reduced the frequency of vasomotor side-effects. There were no differences in plasma oestradiol, luteinizing hormone or follicle stimulating hormone concentrations between the protocols and good symptomatic relief was experienced by both groups. Two years after completion, three women in each group have requested surgical treatment. The results indicate that MPA may be a useful adjunct to LHRH analogues in women with fibroids, reducing side-effects and possibly prolonging the response, although positive effects on bone density have yet to be confirmed. The optimum regimen of administration remains to be clarified as the clinical results were the same with both protocols.

Adult↗
PubMed2003

Massive vaginal hemorrhage after uterine fibroid embolization.

A 48-year-old woman underwent uterine fibroid embolization (UFE) for menorrhagia. One-month after the procedure she developed massive vaginal bleeding and required an emergency hysterectomy. Pathologic evaluation of the uterus revealed ulceration of the endometrium overlying the necrotic fibroid. Physicians performing UFE should be aware of this rare but potentially life-threatening complication.

Embolization, Therapeutic↗
PubMed2006

A prospective multicenter comparative study between myomectomy and uterine artery embolization with polyvinyl alcohol microspheres: long-term clinical outcomes in patients with symptomatic uterine fibroids.

PURPOSE: To prospectively evaluate the safety and effectiveness of polyvinyl alcohol (PVA) microspheres in patients undergoing uterine artery embolization (UAE) to treat uterine fibroid tumors and to compare the long-term changes in health-related quality of life (QOL) after UAE with the changes seen after myomectomy. MATERIALS AND METHODS: One hundred forty-six patients with uterine myomas were enrolled into this multicenter study, with 77 patients undergoing UAE with PVA and 69 patients undergoing myomectomy. Six-month follow-up was completed for the myomectomy, whereas 2-year follow-up was completed for the UAE group. Outcomes were assessed with the Uterine Fibroid QOL Questionnaire and based on adverse event incidence, time to return to normal activity, and changes in tumor symptom scores, QOL scores, and menorrhagia bleeding scores. For the UAE cohort, changes in total uterine volume and dominant tumor size on magnetic resonance (MR) imaging were assessed. RESULTS: In the UAE cohort, 88.3% of patients experienced a reduction of tumor-related symptoms (increase >or=5 points from baseline measurement) at 6 months, with 75.4% of patients in the myomectomy group experiencing similar improvement. Median QOL questionnaire scores at 6 months were found to be significantly higher in patients treated with UAE (P = .041), with sustained improvement seen at 12 and 24 months. Both procedures resulted in significant reductions in 6-month menorrhagia bleeding scores, with sustained improvement in the UAE cohort at 12 and 24 months. MR imaging at 6 months revealed significant uterine and tumor volume reductions after UAE (P < .05). At least one adverse event occurred in 42% of patients in the myomectomy group, compared with 26% in the UAE group (P < .05). CONCLUSIONS: UAE performed with PVA microspheres was associated with greater sustained improvements in symptom severity and health-related QOL and with fewer complications compared with myomectomy. Six-month MR imaging data demonstrated significant reductions in uterine and tumor volumes, although the degree of tissue infarction after UAE was not assessed with contrast medium-enhanced MR imaging.

Adult↗
PubMed1978

Inflammatory fibroid polyp of the gastrointestinal tract.

Details of 13 new cases of inflammatory fibroid polyp of the gastrointestinal tract and of 76 patients recorded in the literature (total 89) are described and analysed. The lesion is always benign, may occur at any age but is commonest in the sixth and seventh decades, and involves the stomach most frequently. Abdominal pain, often related to obstruction, is the principal symptom. Eosinophilia of the peripheral blood does not occur. The lesions are sessile or polypoidal, originate in the gut submucosa, vary greatly in cellularity, and have a wide range of tissue eosinophilia. Some are very vascular, many of the larger vessels having a notably broad zone of connective tissue about them. The aetiology of the condition is discussed and reasons for distinguishing it from eosinophilic gastroenteritis, with which it is frequently confused, are given. The precise nature and aetiology of the inflammatory fibroid polyp remains undetermined.

Adult↗
PubMed1991

The histogenesis of inflammatory fibroid polyps of the gastrointestinal tract.

Inflammatory fibroid polyps are lesions occurring in the submucosa of the gastrointestinal tract. These lesions have been identified by a variety of names, indicative of their uncertain histogenesis. Three cases were studied by light microscopy and cytochemistry and, in one case, by electronmicroscopy. The most characteristic feature consisted of concentric fibrovascular structures. Peroxidase reaction for muscle actin and Ulex europeus agglutinin was positive in the two main cellular components. Electronmicroscopy revealed that the two principal cell constituents were endothelial and myocytic cells. These observations support the conclusion that inflammatory fibroid polyps are lesions of vascular origin.

Actins↗
PubMed1986

Inflammatory fibroid polyp of the stomach.

Fourteen cases of inflammatory fibroid polyp of the stomach were studied in terms of immunohistochemistry and ultrastructure. They occurred as polypoid lesions in the antrum, except for two found in the body of the stomach. Out of the 14 cases, two were found to be multiple and the remainder solitary. In all but one lesion, the mucosal layer was involved and six lesions were entirely localized within the mucosal layer, suggesting that inflammatory fibroid polyps of the stomach originate in the mucosal layer. Neither S100 protein, factor VIII-related antigen, alpha 1-antitrypsin nor lysozymes were found in the cytoplasm of the proliferating cells. The ultrastructures of the proliferating cells were fibroblastic rather than neurogenic, angiogenic, or myofibroblastic. These findings suggest that the cells are fibroblasts, though the possibility that they are facultative fibroblasts remains. An interesting observation made with electron microscope was the infection of micro-organisms similar to mycoplasma. This seems to deserve further investigation as a possible etiologic factor of the disease.

Adult↗
PubMed1979

Pituitary gonadotrophins and prolactin in patients with endometrial cancer, fibroids or ovarian tumours.

The serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and, prolactin (PRL) were measured before and after gonadotrophin releasing hormone (GnRH) and thyrotrophin releasing hormone (TRH) stimulation in 17 patients with endometrial cancer, in 15 patients with uterine fibroids, in 11 patients with ovarian cystadenomas or cancer and in 14 age-matched controls. The women with fibroids had a low FSH level and a diminished FSH response to GnRH but an excessive PRL response to TRH while the other patient groups did not differ from the controls. The results indicate no relation between pituitary function and endometrial or ovarian tumor.

Cystadenoma↗
PubMed2000

The effect of submucous fibroids on the dose-dependent modulation of uterine bleeding by trimegestone in postmenopausal women treated with hormone replacement therapy.

OBJECTIVE: To assess the value of identifying endometrial structural abnormalities at baseline hysteroscopy in predicting the pattern of bleeding in postmenopausal women treated with hormone replacement therapy. DESIGN: A randomised, double-blind, dose-ranging study. SETTING: A teaching hospital in the UK. POPULATION: One hundred and seventy-six healthy postmenopausal women. METHODS: Women were randomised to receive one of four doses of oral trimegestone (0.05, 0.1, 0.25 and 0.5 mg per day), from day 15-28, and a daily dose of 2 mg oral micronised oestradiol for six treatment cycles. Women completed diaries in which the bleeding episodes were recorded. Hysteroscopy under local anaesthesia and endometrial biopsy were performed at baseline and on day 24 of the last treatment cycle. RESULTS: Women with submucous fibroids had more prolonged (P = 0.026) and heavier (P = 0.002) progestogen-associated bleeding (odds ratio 4.54). The incidence of intermenstrual bleeding, but not its duration or severity, was higher in women with submucous fibroids (P = 0.017). There was a clear dose-dependent effect of trimegestone, with a consistently later onset of progestogen-associated bleeding occurring with increasing doses of trimegestone (P < 0.001), and such episodes became progressively lighter and of shorter duration over time (P < 0.001). CONCLUSION: Hysteroscopic evaluation of the endometrial cavity in women treated with hormone replacement therapy, predicts the occurrence of heavy and unscheduled bleeding.

Dose-Response Relationship, Drug↗
PubMed2000

Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids.

OBJECTIVE: To compare laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH) in patients with uterine fibroids. DESIGN: A prospective randomised study. SETTING: The San Paolo Hospital, Milan. POPULATION: Sixty-two patients, who were not suitable for a vaginal hysterectomy, requiring treatment for uterine fibroids. METHODS: Randomisation between LAVH and TAH. Comparison of outcomes on the whole series, patients with uteri < or = 500 g (Group 1) and patients with uteri > 500 g (Group 2). MAIN OUTCOME MEASURES: To establish operating time, blood loss, complications, febrile morbidity, analgesics administration and hospital stay for both treatment approaches. RESULTS: Median uterine weight was 400 g in both LAVH and TAH group. Median operating time was longer for LAVH (135 min compared with 120 min for TAH; P = 0.001), but patients undergoing LAVH had less analgesics administration (23% compared with 77%, P < 0.001) and a shorter median hospital stay (3.8 compared with 5.8 days; P < 0.001). LAVH, when compared with TAH in the two weight subgroups, required a significantly longer operating time only in Group 2, significantly reduced analgesics administration only in Group 1, and significantly reduced hospital stay in both groups. Conversions of LAVH to laparotomy were significantly more frequent in Group 2 (3/11) than in Group 1 (0/20) (P = 0.04). CONCLUSIONS: Compared with TAH, LAVH has advantages in removing uteri weighing < or = 500 g, with comparable operating time, less post-operative pain and shorter recovery. Among uteri weighing > 500 g LAVH showed a shorter recovery, but longer operating time than TAH and a 27% rate of conversion to laparotomy.

Adult↗
PubMed1986

The management of prolapsed submucous fibroids.

Prolapsed submucous fibroids, are not an uncommon finding in young women of fertile age. They may be either ordinary fibromyomas of any size, or else occur as necrotic or degenerated tumours. They are expelled by the uterus, and usually present in the vagina on a pedicle, following uterine contractions. In a retrospective study of 142 patients seen over a 10-year period at the Golda Meir Medical Center, 46 were managed by vaginal myomectomy, 12 by abdominal myomectomy, 68 by abdominal hysterectomy, usually following vaginal removal of the fibroids, and in 16 women vaginal hysterectomy was performed. The postoperative course and morbidity in these patients was comparable to that of abdominal and vaginal hysterectomy, performed for intramural or subserous fibromyomas.

Adult↗
PubMed1991

Pelvic pain complicating LHRH analogue treatment of fibroids.

We present these 3 cases to alert others to the possibility of severe pain with rapid shrinkage of fibroids occurring during LHRH analogue treatment. We suggest management of such events should not be surgical except for vaginal excision of prolapsed fibroid polyps.

Adult↗
PubMed1993

Submucous fibroids: clinical profile and hysteroscopic management.

Fifty submucous fibroids were removed by hysteroscopic resection from 37 patients with abnormal uterine bleeding. Thirty-seven fibroids were completely resected and 13 incompletely resected. Nine patients also had rollerball endometrial ablations. The average follow-up period was 14 months (4 to 51 months) in 33 patients available for follow-up. All of these patients had cure of their symptoms, 3 after repeat operations. The 1 immediate complication was a postoperative infection. A normal uterine cavity was found in 13 of 14 patients examined by office hysteroscopy at follow-up.

Adult↗
PubMed1978

Radiologic-pathologic correlation from the Armed Forces Institute of Pathology. Inflammatory fibroid polyp.

The inflammatory fibroid polyp of the stomach, sometimes called eosinophilic granuloma, is a relatively uncommon lesion usually presenting a solitary, benign-appearing filling defect. The differential diagnoses include polypoid adenocarcinoma, hyperplastic mucosal polyp, adenoma, leiomyoma, epitheliod leiomyoma and leiomyosarcoma, and aberrant pancreas. Although difficult to distinguish by gross morphologic features, the inflammatory fibroid polyp shows a distinctive inflammatory response of the mucosal stroma in which eosinophils may be prominent. It is unrelated to the eosinophilic granuloma of lung or bone.

Adenocarcinoma↗