SEARCH · Search PubMed
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.
Interventional radiology has advanced rapidly in recent years as new technology has become available, and now offers viable alternatives to some surgical techniques. An example of this evolution is arterial embolisation of uterine fibroids. This article will explore some of the nursing issues associated with this procedure.
Uterine leiomyomas, commonly called fibroids, are benign tumours of myometrial origin. The tumours enlarge in as many as 30% of women over 30 years of age, causing significant morbidity. Recent research has been directed towards understanding the factors involved in their enlargement. The ovarian steroid hormones oestrogen and progesterone contribute to the pathology of leiomyomas but in unexpected ways. During the follicular phase, oestrogen maintains the high expression of several genes that are normally expressed in the expanding myometrium of pregnancy; however, increased mitotic activity is not induced. During the luteal phase, increased mitotic activity is observed in leiomyomas, particularly in younger women. Progesterone increases the mitotic rate of the tumours in vitro and may induce the production of growth factors and/or their respective receptors during the luteal phase. In addition, a number of non-random chromosomal translocations have been observed in developing clonal tumours. This review will survey factors that may promote enlargement of uterine leiomyomas.
We report a case of traumatic rupture of uterine fibroid with a haemo-peritoneum in a non-gravid uterus of a 40 year old Nigerian woman whose life was saved by surgical intervention. Treatment consisted of subtotal hysterectomy. A high index of suspicion is required in order to enable prompt surgical intervention.
Three cases of inflammatory fibroid polyps of the stomach are presented. Immunoreactivity for vimentin, actin, and for hystiocytic markers confirmed the myofibroblastic and hystiocytic origin of the lesions, as research has shown.
OBJECTIVE: To determine what symptoms of leiomyomata uteri prompted women to seek uterine artery embolization (UAE) and what factors were most frequently cited in the decision making leading to choosing UAE over other treatments. STUDY DESIGN: Eighty-four consecutive women with symptomatic leiomyoma presenting for UAE completed a questionnaire that inquired about their pelvic symptoms and the issues that were important in their decision to request UAE. All subjects previously had been told that they were surgical candidates. RESULTS: Pelvic symptoms that the 84 women most frequently noted were bleeding (n = 61), anemia (41), pelvic pain (29), frequent urination (24) and pelvic pressure (21). The majority of women (78) reported significant worry about their health from the fibroids, and (72) reported that the symptoms caused daily discomfort. Although the majority of women wanted a treatment that would give permanent relief of symptoms and thought UAE would do this, other factors frequently cited in the decision making included quality-of-life reasons, such as the desire to avoid adverse effects of other treatments (76), anticipated prolonged postoperative recovery from surgery (70) and avoiding surgery (66). Many women considered the uterus an important female organ, believed that the uterus was a source of femininity (33), stated that the uterus was necessary to maintain self-image (49) and reported that the uterus was necessary to maintain sexual image (49). CONCLUSION: In this cohort of women with symptomatic leiomyomas, treatment preferences did not interfere with the current lifestyle. In addition, the uterus was considered a source of femininity and sexuality. It is not clear whether women requesting UAE differ from women requesting surgical intervention in terms of how they assess the importance of the uterus, but these data suggest that many women still consider the uterus an important aspect of their femininity and that those seeking nonsurgical options should be thoroughly counseled about uterine function and how it relates to sexuality.
Uterine artery embolization for symptomatic leiomyomas is a new attractive treatment in patients who do not desire pregnancy and for whom conventional therapy has failed. Uterine fibroid embolization can also be considered for patients who desire pregnancy when myomectomy is technically difficult or/and in case of recurrence after myomectomy. 90% improvements are commonly reported in abnormal bleeding, pelvic pain, and in bulk-related symptoms. This technique allows reduction of the hospital stay, the convalescence period, the morbidity and the mortality rate compared to conventional surgical treatment.
A retrospective study to determine the incidence, clinical presentation and management of uterine fibromyoma at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Five hundred and sixty-nine consecutive cases of histologically confirmed uterine fibroid over a ten-year period were reviewed. Uterine fibromyoma constituted 13.4% of gynaecological admission and was responsible for 26.2% of major gynaecological surgery. Majority of the patients (78.4%) were aged between 30 and 44 years and 60.8% were of low parity (0-2). The common presentations were menstrual disorders (64.3%), infertility (56.2%) and lower abdominal swelling (35.5%). Hypertension was present in 26.5% and 42% were obese. Pelvic adhesion was noted in 58.9% of patients. Total abdominal hysterectomy was the surgical procedure in 52% of cases. Pyrexia (32.5%), Anaemia (29.3%), Prolonged hospital stay (24.1%) and Wound infection (20.2%) were the common postoperative morbidities. Fibromyoma at the University of Ilorin Teaching Hospital follows a pattern similar to other parts of the world. It is responsible for a number of gynaecological complaints. Surgery still remains the main mode of treatment.
PURPOSE: To evaluate the feasibility to perform laparoscopically assisted vaginal hysterectomy in patients who were not suitable for vaginal hysterectomy. PATIENTS AND METHODS: LAVH Gasless was carried out on 31 patients with uterine fibroids. Uterine weight ranged of 420-800 gr. RESULTS: There were 2 laparotomy conversion (6%) for uterus 800 gr; median operating time was 79 +/- 18 minutes (range 75-89); the average haemoglobin drop was 1.7 +/- 0.9 g/dl; the mean in postoperative stay was 3.7 +/- 0.7 days (range 3-5). Febrile morbidity > 38 degrees C were found in 3 cases. CONCLUSIONS: Laparoscopic assistance has advantages in performing transection of round and infundibolo-pelvic ligaments in vaginal steps and in controlling post-operative blood loss.
A new case of ileal inflammatory fibroid polyp (IFP) is reported. A 76 years old woman presented with abdominal pain due to intestinal obstruction; an ileo-ileal intussusception caused by an ulcerated submucosal polyp was found at laparotomy. The IFP usually appears as a solitary benign lesion, rarely located in the ileum. It is made up of fibrous tissue with a dense infiltrate composed predominantly of eosinophils.
Lower gastrointestinal tract bleeding as a manner of presentation of the Crohn's disease is uncommon. In most cases there is an other concomitant pathology responsible for that bleeding. We report a case of lower gastrointestinal tract bleeding to an inflammatory fibroid bowel polyp in a patient with ileal Crohn's disease. A commentary is made about the etiopathogenic factors of the both diseases.
OBJECTIVES: The purpose of the research was to (1) understand the influence of information sources on the awareness and adoption of uterine fibroid embolization (UFE) by interventional radiologists in Michigan and (2) to decipher communication relations in the social network of interventional radiologists that were most conducive to the flow of information about UFE. METHODS: Diffusion of innovations theory and constructs in social network analysis formed the basis for the development of an interview guide. Thirty-two interventional radiologists in Michigan were interviewed over the phone. Chi-square statistics were employed to analyze the awareness and adoption of UFE. Factor analysis was applied to decipher important communication relations in the social network of interventional radiologists. RESULTS: Conferences were found to be an initial source of information, creating awareness among early adopters (P < 0.05), but other individuals were found to be influential sources in the adoption of UFE by later adopters (P < 0.05). Radiologists rarely browsed Websites for information. Work relations in everyday clinical practice were the communication relations most conducive to the flow of information about UFE. Preliminary qualitative data indicated that opinion leaders in the diffusion of UFE in Michigan were located in hospitals primarily dedicated to practice rather than in hospitals affiliated with universities. CONCLUSIONS: Journals are important information sources for creating awareness and stimulating adoption of innovation among both early and late adopters of new procedures in interventional radiology. Conferences, however, are significantly more important for creating early awareness, while interactions with colleagues is the most important factor in stimulating use of the innovation among later adopters. Among colleagues, opinion leaders in nonacademic hospitals may be more influential than individuals in the academic community.
A 69-year-old Japanese woman with early carcinoma of the stomach was treated. Postoperative pathological examination of the resected stomach disclosed a widely spreading early carcinoma and two concomitant submucosal lesions which were histologically compatible with inflammatory fibroid polyp (IFP). Neither IFP showed a polypoid appearance: instead they had a down-growth pattern. The covering mucosa was replaced by gastric carcinoma cells. The IFPs were located mainly in the submucosa, but reached invasively to the subserosa through the proper muscular layer. The boundaries of the lesions were well demarcated in the submucosa but poorly demarcated in the subserosa. This case is very rare because the two IFPs showed a down-growth pattern and were concomitant with early gastric carcinoma.
The case of a 56-year old male with a jejunal intussusception due to the inflammatory fibroid polyp is presented. In the literature, eleven cases with jejunojejunal intussusception due to IFP were reported. This rare entitiy was reviewed with different perspectives in this report.
A 15 year-old gravida 1, abortus 1 black girl presented with chief complaints of menorrhagia, severe dysmenorrhea, and progressively worsening abdominal pain, which was caused by a very large uterine leiomyoma. The symptoms began 6 months earlier, shortly after a 10-week spontaneous abortion at age 14. A solitary 25-cm uterine leiomyoma was removed uneventfully with an abdominal laparotomy. In the English literature of the past 50 years, this case represents the sixth, and we believe, the largest, documented uterine fibroid among teenagers, which required corrective surgery.
This review covers literature published between December 1990 and November 1991. It shows a continuous outpouring of publications on the use of gonadotropin-releasing hormone agonists and operative hysteroscopy as part of the background of alternatives to hysterectomy. The new technologies question traditional management of fibroids, which may vary considerably in different areas. Abdominal myomectomy, which never received adequate recognition as an alternative in the past, is also discussed. The review concludes with a section on abdominal hysterectomy.
Intussusceptions originating in the jejunum are rare. We report a 20-year-old woman who had a chronic jejuno-jejunal intussusception due to an inflammatory fibroid polyp manifesting in the post-partum period as peritonitis. Resection-anastomosis of the intussuscepted segment was done. She is well one year later.
To our knowledge, there have been no reported cases of ureteric obstruction resulting in a non-functioning hydronephrotic kidney after uterine fibroid embolization. We report a case of a patient who required surgical intervention for management of symptoms.
Intussusception in adults is a rare cause for intestinal obstruction and is usually secondary to some lesion in the gastrointestinal tract GIT. We report a case of intestinal obstruction due to ileo-colic intussusception; an inflammatory fibroid polyp formed the leading edge of the intussusceptum, which is a rare polypoidal lesion of the GIT.