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PubMed2001

Uterine artery embolisation for treatment of fibroids: experience in Chinese women.

Twelve women with symptomatic fibroids were treated with transcatheter uterine artery embolisation with the use of polyvinyl alcohol (PVA) particles. For the nine women who were due for follow-up, reduction in uterine volume and dominant fibroid size were observed on magnetic resonance imaging. All the nine women had normal luteinising hormone (LH) and follicle stimulating hormone (FSH) levels before the procedure and during the follow-up. Seven of the nine women reported noticeable symptomatic improvement during the follow-up. Pain experienced was of variable level, but well controlled. Adequate analgesia is essential for the procedure. Longer follow-up and prospective fertility studies are required to evaluate the long-term effects before this procedure could be safely extended to younger age groups.

Adult↗
PubMed2001

Mullerian duct remnant fibroids: a case report.

Uterine fibroids are the most common benign tumours in women and are particularly common in women of African descent. Mullerian dysgenesis is uncommon and the association of a pelvic mass rare. Only three cases of the association of this syndrome with fibroids have been described and none of these has been in a woman of African descent.

Adult↗
PubMed2001

Abdominal myomectomy versus abdominal hysterectomy for symptomatic and big uterine fibroids.

OBJECTIVE: To compare abdominal myomectomy with abdominal hysterectomy in women with big and symptomatic uterine fibroids. METHODS: The hospital records at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia were reviewed to identify women who underwent abdominal myomectomy or abdominal hysterectomy between 1989 and 1999. Inclusion criteria were the presence of symptoms and size of the uterus equaling that of 12 weeks gestation or more. Women who underwent myomectomy as a treatment of infertility were excluded. RESULTS: During the study period, 111 women met the inclusion criteria. Thirty-eight women underwent abdominal myomectomy and 73 women underwent abdominal hysterectomy. Forty women were excluded because of myomectomy for infertility. Abdominal myomectomy was successfully performed in all women for whom it was scheduled. Hysterectomy, internal iliac ligation, or other procedures were not necessary to control the bleeding. The primary indication for myomectomy was abnormal vaginal bleeding in 23 women and pelviabdominal mass in 15 women compared to 6 women and 67 women in the hysterectomy group. There were statistically significant differences in the mean age and parity (p value 0.01 and <0.001) between women who underwent abdominal myomectomy and abdominal hysterectomy. The uterine size clinically (mean +/- standard deviation), size of largest myoma by ultrasonography, and from histopathology reports were 15.4 +/- 3.8, 11.8 +/- 2.8, and 13.6 +/- 3.2 compared to 17.9 +/- 4.4, 16.9 +/- 4.2, and 13.8 +/- 3.7 (p values not statistically significant). Similarly, there were no statistically significant differences in the pre- and postoperative hemoglobin, estimated blood loss, rate of blood transfusion, operative time, and numbers of days in hospital. CONCLUSION: Abdominal myomectomy for big and symptomatic uterine fibroids carries similar risks to abdominal hysterectomy.

Adult↗
PubMedDate not supplied

Time course of pain after uterine artery embolization for fibroid disease.

UNLABELLED: Uterine artery embolization (UAE) is emerging as a nonsurgical therapy for fibroid disease in many women. One of the major issues in the continuing development of UAE is pain control after the procedure. The authors' experience has been that postprocedural pain after UAE follows a consistently predictable course. This study is designed to define the time course of pain after UAE for the management of fibroid disease. METHODS: The records of patient-controlled analgesia usage after UAE in 50 patients were reviewed and analyzed, and compared with the general population of UAE patients. RESULTS: The pain experienced after UAE follows a consistent pattern over time. Pain increases over the first 2 hours after the procedure is completed and then plateaus for several hours. Pain then decreases fairly rapidly to a much lower level. CONCLUSIONS: This observation can serve as a baseline for evaluation of different pain-control protocols after UAE.

Analgesia, Patient-Controlled↗
PubMed2002

Uterine fibroid: clinical presentation and relative morbidity of abdominal myomectomy and total abdominal hysterectomy, in a teaching hospital of Karachi, Pakistan.

OBJECTIVE: To compare clinical presentation and morbidity of abdominal myomectomy and hysterectomy. METHODS: We reviewed medical records of 441 patients with symptomatic fibroid, treated by myomectomy (135) or hysterectomy (306) at The Aga Khan University Hospital, Karachi, from January 1991 to December 1995. Z-test and risk estimates with 95% confidence intervals were calculated. RESULTS: Pregnancy loss [Risk Ratio = 2.79, 95% Confidence Interval = 1.90-4.10], pelvic mass [Risk Ratio = 2.22, 95% Confidence Interval = 1.68-2.92] and infertility [Risk Ratio = 1.44, 95% Confidence Interval = 1.05-1.96] were more likely to be managed by myomectomy than in the absence of these complaints. Abnormal uterine bleeding was less likely to be treated by myomectomy than in its absence [Risk Ratio = 0.54, 95% Confidence Interval = 0.41-0.71]. With myomectomy, both the estimated mean intra-operative blood loss and the risk of febrile morbidity were significantly less than with hysterectomy [Mean (S.D.): 386 milliliters (48) versus 567 milliliters (62), p-value 0.000 and Risk Ratio = 0.37, 95% Confidence Interval = 0.16-0.87, respectively]. The risk of visceral injury [Risk Ratio = 2.24, 95% Confidence Interval = 0.74-6.82], blood transfusion [Risk Ratio = 0.69, 95% Confidence Interval = 0.44-1.07], mean duration of operating time [Mean (S.D.) 127 minutes (35) versus 131 minutes (47), p-value 0.93] and mean duration of hospital stay [Mean (S.D.): 5.44 days (1.28) versus 5.42 days (1.09), p-value 0.92] did not differ significantly between the groups. CONCLUSION: Myomectomy can be considered as a safe alternative to hysterectomy for the surgical management of uterine fibroids, with an added advantage of preservation of women's sexual and reproductive functions.

Adult↗
PubMed2002

[Embolization of uterine fibroids].

Uterine artery embolization (UAE) for symptomatic leiomyomas is a new attractive treatment in patients who don't desire pregnancy and for which conventional therapy has failed. Uterine fibroid embolization can also be considered for patients who desire pregnancy when myomectomy is technically difficult or impossible and in case of recurrence after myomectomy. 90% improvements are commonly reported in abnormal bleeding, pelvic pains, and in bulk-related symptoms. Although numerous pregnancies have been reported after UAE, the fertility rate after UAE remains to be compared to myomectomy. Absolute contra-indications are pregnancy, endometrial carcinoma, gynaecologic infections, adnexal masses, and rapid growth of uterine leiomyomas (considered as a significant sign of sarcoma). Besides procedure related risks of angiography some specific complications are reported: deep pelvic vein thrombosis with exceptional pulmonary embolus, vaginal discharges with sometime transcervical expulsion of fibroid (5%), transient or permanent amenorrhea (4-5%) and extensive necrosis (1-2%) with possible perforation and infection. A hysterectomy is needed to manage this complication in 0.9 to 0.3% of case. The mortality rate of embolisation is evaluated to 1/3.000 against 6/10.000 for the hysterectomy. UAE is proposed as a less invasive alternative to hysterectomy and myomectomy for the treatment of symptomatic leiomyomas. This technique allows reducing the hospital stay, the convalescence period, the morbidity and the mortality rate compared to conventional surgical treatment.

Contraindications↗
PubMed2002

Intraperitoneal haemorrhage secondary to perforation of uterine fibroid after cystic degeneration. Unusual CT findings resembling malignant pelvic tumor: case report.

Intraperitoneal haemorrhage is a rare complication of myomatous uterus. We present a case of a 37-year-old white nullipara who presented in the emergency room with acute, lower-abdominal pain which reportedly started after riding over a bump on a motorcycle. On examination, the abdomen was diffusely tender, with moderate spasm and rebound tenderness in both iliac fossae. Pregnancy test was negative. Computed tomography revealed a soft-tissue mass with cystic components and inhomogeneous appearance. Free fluid in the peritoneal cavity suggested ascites. The patient underwent an exploratory laparotomy. A ruptured, actively bleeding, subserosal, nonpedunculated, cystic degenerated uterine fibroid was found, as well as approximately two liters of free, bloodstained peritoneal fluid and clots. Subtotal hysterectomy without salpingo-oophorectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, definitive, preoperative diagnosis of a perforated, haemorrhaging, uterine fibroid is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.

Abdominal Pain↗
PubMed2002

Inflammatory fibroid polyp of the jejunum presenting as intussusception.

Inflammatory fibroid polyp (IFP) of jejunnum is a rare nonneoplastic lesion of gastrointestinal tract. We report a case of a 45-year-old man presenting with small bowel obstruction due to jejuno-jejunal intussusception of an inflammatory fibroid polyp. To the best of our knowledges, this is the eighth reported case with such a presentation in English medical literature. Segmental resection of the jejunum was performed and histopathology confirmed the diagnosis.

Humans↗
PubMedDate not supplied

Inflammatory fibroid polyp of small intestine in a child.

Inflammatory fibroid polyps are rare lesions that are usually solitary and affect adults. We report an inflammatory fibroid polyp in a 7-year-old boy who presented with intestinal obstruction. He recovered after excision of the affected segment of ileum.

Child↗
PubMed2004

Inflammatory fibroid polyp of the ileum causing intussusception: a case report.

Inflammatory fibroid polyp is a rare polypoid lesion of the gastrointestinal tract, histologically characterized by an admixture of numerous small blood vessels, fibroblasts and edematous connective tissue, accompanying a marked inflammatory cell infiltrate which contains eosinophils. Although it generally presents as a polypoid mass in the gastric antrum, it can be seen throughout the gastrointestinal tract. It is believed to represent a reactive, nonneoplastic condition, but its histogenesis remains controversial. A case of inflammatory fibroid polyp of the ileum presenting clinically as intestinal obstruction due to intussusception is presented here.

Biopsy, Needle↗
PubMed1992

Shrinkage of uterine fibroids by preoperative LHRH analogue injection.

Six patients with large uterine fibroids were given a single subcutaneous implant of an LHRH analogue (goserelin 3.5 mg) prior to elective hysterectomy. Overall fibroid volume decreased by 30-47% within six weeks of implantation. All patients reported improvement in their symptoms of pressure and pain, and were rendered amenorrhoeic prior to surgery.

Adult↗
PubMed1992

Clinical presentations of gastrointestinal inflammatory fibroid polyps.

Two cases of inflammatory fibroid polyps are described. They involved the uncommon sites of the terminal ileum and ileocecal region respectively. Both lesions, although benign, presented as possible malignant tumours. One was associated with anemia and the other with obstructive symptoms. From a review of the literature and the two case reports the authors believe that the diagnosis of such inflammatory fibroid polyps, on clinical and gross appearance, can be difficult, and they emphasize the importance of awaiting histologic assessment before proceeding with extensive definitive surgery.

Aged↗
PubMed2004

Uterine artery embolization for the treatment of uterine fibroids.

Uterine artery embolization can be regarded as a less invasive procedure for the treatment of fibroids compared with myomectomy, hysterectomy, and laparoscopic myolysis. The aim of this study was the evaluation of safety and efficacy of uterine artery embolization and of womens' opinion about this treatment. After gynecological examination sixty-nine premenopausal women underwent uterine artery embolization. All procedures but four were technically successful; three women underwent unilateral embolization because of vascular malformation and one of them had an allergic reaction to contrast medium. Of the 69 patients: 58 went home the day after embolization, and 11 within first week. The follow-up examinations after 3, 6 and 12 month showed a significant reduction of uterine and fibroid volume with significant improvement of bleeding. Therefore, according to this report, uterine artery embolization is a successful, minimal invasive treatment of myoma that preserves the uterus and requires shorter hospitalization and recovery times than surgery.

Adult↗
PubMed2005

Uterine artery embolization for fibroids.

UAE is an alternative to surgery for treatment of uterine fibroids that uses injections of small plastic or gelatin beads to thrombose fibroid vessels arising from the uterine artery. Clinical studies have reported less menorrhagia and pelvic pain in patients who have undergone the procedure. After embolization, many patients experience pain requiring an overnight hospital stay and administration of parenteral opioids. UAE is generally not recommended for women who have not completed childbearing.

Arteries↗
PubMed2005

[Inflammatory fibroid polyp of the ileum causing intestinal invagination].

Inflammatory fibroid polyps are rare benign tumor-like lesions of the gastrointestinal tract. Most frequently they are localized in the gastric antrum but can develop anywhere in the GI tract. In the small intestine the ileum is the most common site, where these polyps can cause invagination and intussusception. This happened to the patient we describe here. The latest immunohistochemical, ultrastructural and molecular genetic studies are suggestive of dendritic cell origin of inflammatory fibroid polyps, with myofibroblastic differentiation in some cases.

Cell Differentiation↗
PubMed1992

Changes in serum electrolytes after transcervical resection of endometrium and submucous fibroids with use of glycine 1.5% for uterine irrigation.

OBJECTIVE: We evaluated the postoperative changes in serum electrolytes in relation to the amount of irrigating fluid absorption and the occurrence of nausea and vomiting after transcervical resection of endometrium and submucous fibroids. METHODS: From May 1989 to October 1991, 101 consecutive patients were operated on for menometrorrhagia with transcervical resection of endometrium and submucous fibroids using glycine 1.5% for uterine irrigation. The deficit of glycine was assessed during and at the end of the operation. During the postoperative course, attention was paid to the occurrence of cerebral confusion, nausea (defined by at least one incident of vomiting), and dyspnea. The serum levels of sodium, potassium, and chloride were assessed before the operation, at the end of the procedure, and after 4, 8, and 12 hours. RESULTS: No marked water intoxication or signs of volume overload were seen, but 33% of the patients had nausea and vomiting in the postoperative period. These patients showed a more pronounced postoperative decrease in serum sodium (P = .0001) and a larger glycine deficit (P = .004) than did patients without nausea. The postoperative decrease in serum sodium correlated significantly to the glycine deficit (R2 = 0.83, P less than .001). CONCLUSION: Postoperative hyponatremia after transcervical resection of the endometrium correlated with the deficit of irrigant fluid but not with the operation time or the total amount of irrigant fluid used. We recommend that serum sodium be controlled and corrected if necessary postoperatively in patients with nausea and vomiting.

Absorption↗
PubMed1986

Inflammatory fibroid polyp of the jejunum causing intussusception.

A case of inflammatory fibroid polyp of the jejunum is presented. This is the seventh case of this type of polyp in the jejunum and, to the best of our knowledge, the first one producing jejunojejunal intussusception. Symptoms of the inflammatory fibroid polyp in this part of the intestine are usually those of intermittent obstruction or intussusception, as in our patient. The treatment is surgical excision of the polyp.

Female↗