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PubMed2001

Uterine leiomyoma: a treatable condition.

Many risk factors have been identified as having either a protective or a negative effect on the development of fibroids, but due to methodological issues and a lack of long-term studies, the exact effect of these factors is ambiguous. In similar dispute is the proper treatment of fibroids. Recent technological advances have introduced newer, less invasive techniques that can remove part or most of the fibroids, but do not eliminate fibroid redevelopment or adhesion formation. In addition, the long-term effects of these procedures have not been studied fully. More prospective research is required to better understand the epidemiology and treatment of this highly morbid condition.

Animals↗
PubMed1992

[Myomectomy via hysteroscopy. Indications, technics, results].

Nowadays operative hysteroscopy represents the elective treatment of submucous and partially intramural fibroids. Seventy patients underwent hysteroscopic resection of fibroids, because of abnormal uterine bleeding in 58 (82.8%) cases, and infertility in 12 (17.2%) cases. The evaluation of the lesion was performed by diagnostic hysteroscopy and abdominal (57 patients) or transvaginal (13 patients) ultrasounds. In particular, for the evaluation of the intramural portion of the lesion, the hysteroscopic study of the angle between fibroid and myometrium was fundamental: the more acute the angle is the more intracavitary the myoma is. Forty-six (65.7%) out of 70 had a completely intracavitary fibroid; in 14 (20%) cases the intramural development was less than 1.5 cm and in the remaining 10 (14.3%) cases was more than 1.5 cm. Integration of hysteroscopy and ultrasounds for the assessment of myomas and the preoperative preparation by LH-RH analogues allow to perform an endoscopic resection of myomas which has up to, and sometimes over, 50% of their volume in the uterine wall.

Female↗
PubMed1984

Contrast enhancement versus vasculature of uterine tumors.

The relative contrast enhancement of normal myometrium and small or medium size uterine fibroids and clinical stage I endometrial carcinomas were correlated to their microangiographically demonstrable vascularity. In four cases small uterine fibroids showed contrast enhancement equal to normal myometrium, independent of their vascularity in microangiography. In five, endometrial carcinomas contrast enhancement was always below that of the surrounding myometrium in CT. Intratumour vasculature showed great variability in microangiography. No correlation between the topographic variations in the arrangement or density of tumour blood vessels and the degree of contrast enhancement was found. Contrast enhancement of small uterine fibroids was greater than that of small adenocarcinomas. More contrast material accumulates tissue of the fibroid than into the extravascular space of endometrial carcinoma.

Aged↗
PubMedDate not supplied

[Indications, surgical modality and complications of hysterectomy for benign pathology: results of a Lombard study. Gruppo di Studio Lombardo sull'Isterectomia].

The results of descriptive epidemiological study on hysterectomy for benign conditions are presented. Between October 1990 and September 1991, 1189 surgeries for fibroids, disorders of menstruation and ovarian cysts performed in 15 gynaecological clinics in Lombardy (Northern Italy) were registered using standard sheets. Fibroids was the most common indication for hysterectomy (74.3% of total). Most surgeries were performed in women aged 40-59. We observed a relatively high frequency of longitudinal incision in young and thin women with small fibroids, a relatively high execution of bilateral oophorectomy in premenopausal women (35% of surgeries for fibroids or menstrual disorders), a median hospital stay of 12 days, a great variability in thromboembolic and antibiotic prophylaxis.

Adnexal Diseases↗
PubMed1976

[The effect of extracts from Fallopian tube tissues, uterine fibromas and uterine adenocarcinomas on the growth and capacity for cell division of a human cell line].

Effects of the extracts prepared from tissues of fallopian tubes, uterine fibroid and uterine adenocarcinoma on mitotic activity and amitotic division in culture Tg33 were studied. Extracts with two protein concentrations, 25 and 100 mkg/ml, resp., were used. Differences were found between effects of extracts from malignant tissue and those of histologically unchanged fallopian tube extracts, and also the extract from tissues of uterine fibroid. The extracts from fallopian tubes removed during operation of the ovarian cyst and uterine fibroid (protein concentration 25 and 100 mkg/ml), and the extract of uterine fibroid (100 mkg/ml) caused the increase in mitotic activity. The extract from malignant tissues of adenocarcinoma (protein concentration 25 mkg/ml) and fallopian tubes (25 and 100 mkg/ml) caused no increase in the number of mitoses. The extract from tissues of uterine adenocarcinoma (protein concentration 100 mkg/ml) inhibited the number of mitoses in the culture. The above extracts effecting Tg33 cells caused the increase in the number of amitoses. The number of pathological mitoses did not increase under the influence of all the tested extracts.

Adenocarcinoma↗
PubMedDate not supplied

[Use of GnGH (GnRH-A) in gynecology].

GnRH-agonist therapy is used in the management of many gynaecological pathologies: uterine fibroids, endometriosis, ovarian cystic pathology, breast cancer, dysfunctional uterine bleeding and, in males, prostatic cancer. In the case of uterine fibroids, this therapy can be used as a pre-treatment before conservative or demolitive surgery or as an alternative to hysterectomy. At the Centre for Therapy of Uterine Pathologies (I Institute of Obstetrics and Gynaecology of the University of Rome "La Sapienza") the use of Gn-RH-A therapy in uterine fibroids has been investigated and results consistent with those of many other groups of study have been obtained. The two most important results are: 1. the decrease of both the myoma's size and the uterine volume; 2. the block of menometrorrhagiae symptoms, with improvement of the haematic crasis and possibility to convert a demolitive surgery to a conservative surgery. GnRH-agonists can represent a definitive treatment for patients with symptomatic uterine fibroids and in perimenopausal age.

Female↗
PubMedDate not supplied

Hysterosalpingography after hysteroscopic surgery.

We reviewed pre- and postoperative appearances of the uterine cavity on hysterosalpingography (HSG) in 28 patients who had hysteroscopic surgery. Twelve patients presented with primary infertility and 16 patients with secondary infertility. The uterine abnormalities included synechiae (12), septa (8), submucosal fibroids (7), and polyp (1). The size and number of lesions in the uterus, the extent of improvement after surgery, and the postoperative pregnancy rate were recorded. The uterine cavity was restored to a normal appearance in 23 (82%) of 28 patients. In patients after fibroid resection, all uterine cavities reverted to normal after surgery. Two patients developed adhesions after septal resection. Three patients with lysis of synechiae remained unchanged or had worsened intrauterine scarring. The postoperative pregnancy rate was 35% (six of 17) in those patients followed for more than 6 months. One patient had a spontaneous abortion. In the six patients who became pregnant, four had secondary infertility, and all had normal or substantial improvement in the appearance of the uterine cavity after surgery. Perforation of the uterus occurred in one patient after resection of a fibroid.

Adult↗
PubMedDate not supplied

Cannonball metastases with favourable prognosis.

BACKGROUND: Secondary 'cannonball' metastases to the lung are frequent and usually associated with disseminated malignancy and poor prognosis. AIM: To report the case of a patient with metastatic pulmonary endometrial stromal sarcoma who had a previous hysterectomy for benign uterine fibroids and no past history of malignancy. RESULT: A 70-year-old female presented with cannonball metastases in her lung. Four years previously she had a hysterectomy for 'fibroids'. Review of the original histology revealed endometrial stromal sarcoma, similar to the lung metastasis. She currently has a good prognosis. CONCLUSION: A patient with 'cannonball' metastases can have a favourable prognosis. A female patient with a previous hysterectomy for uterine fibroids, should be considered to have metastatic sarcoma until proven otherwise.

Aged↗
PubMed2005

The value of sonohysterography in detecting intracavitary benign abnormalities.

The aim of this retrospective study was to assess the diagnostic value and the usefulness of sonohysterography in the detection of uterine intracavitary benign abnormalities, compared with other diagnostic methods (transvaginal ultrasonography and diagnostic hysteroscopy). From January 2003 to December 2003, a total of 73 patients (47 premenopausal (middle age 38.9) and 26 postmenopausal women (middle age 60.5)) underwent transvaginal ultrasonography (TVS) and sonohysterography (SHG), consisting of an intrauterine infusion of saline solution during transvaginal ultrasound. The women referred to our Ultrasonography Center because of intermenstrual (38) or postmenopausal bleeding (19), or an abnormal or a poorly defined endometrial interface (16) as seen as baseline ultrasonography. The findings at TVS and SHG were compared with hysteroscopy (HS). In one case, the SHG was technically impossible to perform. In premenopausal group the sensitivity of SHG had been 100% in detecting submucosal fibroids, endometrial polyps and hyperplasia and 75% in detecting normal uterus. The specificity had been always 100%. In postmenopausal group the sensitivity of SHG had been 75% in detecting submucosal fibroids, 93.8% in endometrial polyps and 100% in hyperplasia and normal uterus. The specificity had been 100% in submucosal fibroids and hyperplasia and had been 90.0 and 95.5% in endometrial polyps and normal uterus, respectively. SHG allows to obtain a precise diagnosis of benign uterine pathology and it is more accurate in the diagnosis of intracavitary abnormalities than that obtained by TVS. Preoperative use of SHG may assist in choosing the best surgical treatment for the patient.

Adult↗
PubMed2006

Complications in laparoscopic myomectomy.

BACKGROUND: An increasing number of patients with fibroids wish to retain their uterus without improving fertility. We evaluated the rate of complications in our teaching hospital and its association with patients' age. METHODS: Chart records of 351 patients were evaluated according to patients' age. RESULTS: A total of 654 fibroids were removed. Mean size of fibroids was 5.3 cm; mean duration of surgery was 113.2 min. Blood transfusion was necessary in one patient. The intraoperative complication rate was 2.6% and postoperative complications occurred in 5.7% of patients. Sonographic evaluation showed a hyperechogenic scar in 29.2%. A total of 57.1% pregnancies ended in term infants. No uterine rupture was reported. As a sign of contentment, 87% of patients would choose the same procedure again. Indication for myomectomy in elder women was more often associated with uncertain sonographic findings due to intraligamentary localization. CONCLUSION: Morbidity was low. Age had no impact. Laparoscopic myomectomy can be offered to all women.

Adult↗
PubMed1994

Uterine leiomyomata and endometrial proliferation in postmenopausal women treated with the anti-oestrogen tamoxifen.

Two cases of fibroid growth and endometrial proliferation in postmenopausal women on tamoxifen (anti-oestrogen) therapy for breast cancer are described. Oestrogen in association with growth factors may control fibroid growth and differentiation. The possible mechanisms and consequences of tamoxifen-induced fibroid growth are discussed. Oestrogen responsive tissues demonstrate a differential and contrasting response to tamoxifen and caution should be exercised in the expansion of its clinical application. Women on long-term tamoxifen therapy may benefit from ultrasound surveillance of their uterus and endometrium, with biopsy in suspicious cases, as there is a paucity of data on malignant transformation of these benign lesions induced by tamoxifen therapy.

Breast Neoplasms↗
PubMed1988

The measurement of phospholipase A2 activity in human myometrium: physiological and pathological implications.

Phospholipase A2 activity was measured in human myometrium obtained at hysterectomy in a group of 41 patients using a double isotope ratio assay based on the liberation of [14-C] oleic acid from 1-palmitoyl-2-[14-C] oleoyl phosphatidylcholine. The enzyme was shown to be calcium independent and to have an optimum pH of 7. There was no significant difference (Mann Whitney U test) in myometrial phospholipase A2 activity between proliferative and secretory phases of the menstrual cycle (ranges: 3.88-30.8 and 0.47-25.85 nmol/mg protein per h respectively) but there was a significant (P less than 0.01) increase in activity in myometrium from uteri with fibroids (median 11.33, range 2.18-30.88 nmol/mg protein per h) compared to those without fibroids (median 6.94, range 0.31-25.85 nmol/mg protein per h). Myometrial phospholipase A2 activity was significantly lower (P less than 0.001) in the 33-40 age group (median 4.71, range 0.31-6.94) compared to the 41-50 age group (median 11.35, range 2.18-30.88 nmol/mg protein per h). In the 51-55 age group phospholipase A2 activity (median 8.71, range 2.5-17.71 nmol/mg protein per h) was not significantly different from that of the other two groups. The increase in activity in the 41-50 age group was not due to the increased incidence of uterine fibroids. These findings suggest that myometrial phospholipase A2 may be important in the pathophysiology of the uterus.

Adult↗
PubMed2004

Patient satisfaction and disease specific quality of life after uterine artery embolization.

OBJECTIVES: This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after uterine artery embolization (UAE) and to consider the impact of these changes on satisfaction with the procedure. STUDY DESIGN: A validated, fibroid specific, symptom, and HRQOL questionnaire was mailed to 80 women who had undergone UAE from 1998 through 2002. Pre- and postprocedure symptom severity and HRQOL scores were obtained. The primary outcome measure was change in fibroid symptoms and HRQOL after UAE. Secondary outcomes included objective measures of patient satisfaction, and the decrease in uterine volume after UAE. RESULTS: Questionnaires were completed by 64 women (80.0%) at a mean of 32.1 months from UAE (range: 57.5-6 months). After UAE, mean uterine volume decreased by 26.3% (95% CI 19.6-33.0), and 17 of 79 women (21.5%) underwent an additional procedure after a mean of 18.6 months. Symptom severity scores decreased by a mean of 35.2% (95% CI 29.3-41.1) and HRQOL scores increased by a mean of 35.7% (95% CI 28.9-42.4). Satisfaction with UAE was correlated with the change in symptom severity and HRQL scores (P <.0001 and P=.0004, respectively) and the decrease in uterine volume after UAE (P=.0196). CONCLUSION: Women who undergo UAE have a significant decrease in symptom severity and increase in HRQOL, associated with high levels of satisfaction with the procedure, even when subsequent therapies are pursued.

Adult↗
PubMed2006

Long-term results of hysteroscopic myomectomy in 235 patients.

OBJECTIVE: To assess the efficacy of transcervical resection of submucous fibroids according to type and size. MATERIALS AND METHODS: Retrospective follow-up of 235 women with submucous fibroids at outpatient hysteroscopy who underwent a hysteroscopic transcervical resection. The main indications were the abnormal uterine bleeding and fertility problems. Thirty-seven percent of patients had an associated endometrial ablation and 32% had a polyp resection. Fifty-one percent of women were menopausal. In cases of incomplete resection a repeat procedure was offered. RESULTS: Intra-operative complications were rare (2.6%) and there was no major complication. Eighty-four percent of cases were followed-up. The median follow-up was 40 months (range 18-66 months). The procedure was classed as a success in 94.4% of patients. Among the cases that were classed as a failure, four patients had a repeated hysteroscopic procedure, three patients had a subsequent hysterectomy and four patients presented with abnormal uterine bleeding at follow-up. CONCLUSION: The hysteroscopic transcervical resection of submucous fibroids is a safe and highly effective long-term therapy for carefully selected women presenting with abnormal uterine bleeding and fertility problems. It produces satisfactory long-term results with few complications.

Adult↗
PubMed2006

Uterine artery embolization versus myomectomy: a multicenter comparative study.

OBJECTIVE: To determine whether there is significant quality of life score improvement after uterine artery embolization (UAE) and to compare UAE and myomectomy outcomes. DESIGN: Prospective cohort controlled study. SETTING: Sixteen medical centers in the United States. PATIENT(S): One hundred forty-nine UAE patients and 60 myomectomy patients. Patients were assigned to myomectomy or UAE on the basis of a best treatment decision made by the patient and her physician. All patients were observed for 6 months. The UAE patients also had follow-up examinations at 1 year. INTERVENTION(S): Myomectomy or UAE. MAIN OUTCOME MEASURE(S): Quality of life score changes, menstrual bleeding score changes, uterine size differences, time off, and adverse events. RESULT(S): Both groups experienced statistically significant improvements in the uterine fibroid quality of life score, menstrual bleeding, uterine volume, and overall postoperative quality of life. The mean hospital stay was 1 day for the UAE patients, compared with 2.5 days for the myomectomy patients. The UAE and myomectomy patients returned to their normal activities in 15 days and 44 days, respectively, and returned to work in 10 days and 37 days, respectively. At least one adverse event occurred in 40.1% of the myomectomy patients, compared with 22.1% in the UAE group. CONCLUSION(S): The uterine fibroid quality of life score was significantly improved in both groups. No significant differences were observed in bleeding improvement, uterine volume reduction, uterine fibroid quality of life score improvement, and overall quality of life score improvement between groups. Patients receiving UAE required fewer days off work, fewer hospital days, and experienced fewer adverse events.

Adult↗
PubMed2006

Malignant transformation of myomas: myth or reality?

The possibility that a fibroid may actually be a smooth muscle tumor of uncertain malignant potential or a leiomyosarcoma often dictates the clinical management of rapidly growing fibroids. This article provides a clinicopathologic background regarding uterine leiomyosarcomas and answers common questions that obstetricians and gynecologists have about the management of rapidly growing fibroids and leiomyosarcoma. The clinician must be aware that the infrequent occurrence of uterine leiomyosarcomas makes it difficult to establish absolutely firm recommendations for the diagnosis and management of this disease, particularly with regard to fertility preservation. Nevertheless, this article addresses major issues that a clinician might face in the evaluation of a smooth muscle tumor of the uterus that clinically may be malignant.

Cell Transformation, Neoplastic↗
PubMed1999

Predictors of hysterectomy: an Australian study.

OBJECTIVE: We evaluated the relative importance of predictors of hysterectomy. STUDY DESIGN: A questionnaire survey of an Australia-wide sample of adult female twins was conducted; self-report data were validated against reports from treating physicians. RESULTS: A total of 3096 women (94%) and 366 physicians (87%) responded. The sensitivity of patient report of hysterectomy was 98.2%. Best predictors of hysterectomy were endometriosis (odds ratio 4.85, 95% confidence interval 3.17-7.43), medical consultation for menorrhagia (odds ratio 3.55, 95% confidence interval 2.47-5.12), joint effects of fibroids with medical consultation for chronic or persisting pelvic pain (odds ratio 3.34, 95% confidence interval 1. 42 to 7.87), having smoked >40 cigarettes per day (odds ratio 3.24, 95% confidence interval 1.10-9.55), joint effects of fibroids with consultation for menstrual problems (odds ratio 2.61, 95% confidence interval 1.36-5.01), and tubal ligation (odds ratio 1.77, 95% confidence interval 1.31-2.39). Less-important predictors were age and higher education level (protective). CONCLUSION: Consulting a physician about pelvic pain and menstrual problems, especially heavy bleeding, are recognized steps toward hysterectomy. Of particular interest for future genetic analyses are the high odds of hysterectomy for women with endometriosis, fibroids, or menorrhagia.

Adult↗
PubMed2002

Contraception and treatment in the perimenopause with a novel "frameless" intrauterine levonorgestrel-releasing drug delivery system: an extended pilot study.

The objective of the study was to evaluate the contraceptive performance, acceptability, side effects, and adverse events of a novel "frameless" intrauterine drug delivery system (IUS), FibroPlant-levonorgestrel (LNG) releasing 14 microg of LNG/day, in perimenopausal women. An ancillary objective was to evaluate the effect of the new IUS on menstrual blood loss in women with or without fibroids. The study, consisting of 109 women, suggests that FibroPlant-LNG IUS is an effective contraceptive. No pregnancies occurred with the FibroPlant-LNG IUS. The total use-related discontinuation rate at 1 year is low (1.9) and results in a high rate of continuation of use (98.1). In addition, the FibroPlant-LNG IUS demonstrated a high level of effectiveness in reducing bleeding in women with excessive menstrual flow even when medium or large fibroids were present. However, an effect on the size of the fibroids could not be demonstrated. Patient satisfaction with the method is high, which is a prerequisite for continuance of the method, and may be linked with the advantageous design characteristics of the FibroPlant-LNG IUS, the virtual absence of hormonal side effects, and the low incidence of irregular bleeding and spotting even during the first 3 months after insertion of the FibroPlant IUS. Counseling remains important though to explain to women about the possible occurrence of changes in their menstrual pattern that may sometimes be annoying but harmless. It is concluded that many women over age 40 years could substantially benefit from the advantages of this intrauterine drug delivery technology which provides contraception and treatment of a possible associated condition such as menorrhagia. The treatment also creates the opportunity to pass through the transitional perimenopausal period smoothly and to benefit fully from the advantages hormone replacement therapy offers in terms of treatment of short-term symptoms and long-term prevention by gradually replacing the waning estrogens.

Adult↗