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Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. Zowall H, Cairns JA, Brewer C, Lamping DL, Gedroyc WM, Regan L. BJOG. 2008 Apr;115(5):653-62. "OBJECTIVE: To estimate the cost-effectiveness of a treatment strategy for symptomatic uterine fibroids, which starts with Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) as compared with current practice comprising uterine artery embolisation, myomectomy and hysterectomy." PubMedCentral Parasitic leiomyoma: a diagnostic dilemma. A case report. Okoro I, Ododo N, Egejuru R. Niger J Clin Pract. 2007 Dec;10(4):349-51. Department of Surgery, Imo State University Teaching Hospital, Umuna Orlu, Federal Medical Centre Owerri, Imo State, Nigeria. "Leiomyomata (uterine fibroids) are the most common tumours of the female pelvis. Presentation of most cases of fibroids are usually straightforward making diagnosis and management easy. However, when they undergo various kinds of pathologic changes, they pose both diagnostic and management difficulties. This article presents a rare case of a large degenerated parasitic leiomyoma in the peritoneal cavity deriving its blood supply from the omentum and attached to a normal looking uterus by a narrow avascular stalk. Ultrasound, x-ray and physical examination did not help with the diagnosis. It was at laparatomy that the diagnosis was made and later confirmed by histological examination." PubMed
Medical Term:
The impact of race as a risk factor for
symptom severity and age at diagnosis of uterine leiomyomata among
affected sisters. Huyck KL, Panhuysen CI, Cuenco KT, Zhang J,
Goldhammer H, Jones ES, Somasundaram P, Lynch AM, Harlow BL, Lee H,
Stewart EA, Morton CC.
"OBJECTIVE: The objective of the study was to identify risk factors for uterine leiomyomata (UL) in a racially diverse population of women with a family history of UL, and to evaluate their contribution to disease severity and age at diagnosis. STUDY DESIGN: We collected and analyzed epidemiologic data from 285 sister pairs diagnosed with UL." PubMed Risk Estimates of Hysterectomy and Selected Conditions Commonly Treated with Hysterectomy. Merrill RM, Layman AB, Oderda G, Asche C. Ann Epidemiol. 2008 Mar;18(3):253-260."For example, corrected compared with uncorrected rates of uterine fibroids per 1000 women were 2.9 vs. 2.7 for ages 18-44 and 5.0 vs. 3.4 for ages 45-64. The uncorrected and corrected 10-year risk of being diagnosed with uterine fibroids among women aged 50 who have not previously had fibroids is 3.87 (1 in 26) and 4.54 (1 in 22), respectively. CONCLUSIONS: The correction method employed produces greater incidence and age-conditional-risk estimates of hysterectomy and of conditions commonly treated with hysterectomy. Corrected rates and age-conditional risk estimates may allow women with intact uteri to better assess their probability of undergoing a hysterectomy and certain other conditions of the reproductive system." PubMed Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry. Goodwin SC, Spies JB, Worthington-Kirsch R, Peterson E, Pron G, Li S, Myers ER; Fibroid Registry for Outcomes Data (FIBROID) Registry Steering Committee and Core Site Investigators. Obstet Gynecol 2008 Jan;111(1):22-33"OBJECTIVE: To assess long-term clinical outcomes of uterine artery embolization across a wide variety of practice settings in a large patient cohort. METHODS: The Fibroid Registry for Outcomes Data (FIBROID) for Uterine Embolization was a 3-year, single-arm, prospective, multi-center longitudinal study of the short- and long-term outcomes of uterine artery embolization for leiomyomata. Two thousand one hundred twelve patients with symptomatic leiomyomata were eligible for long-term follow-up at 27 sites representing a geographically diverse set of practices, including academic centers, community hospitals, and closed-panel health maintenance organizations. At 36 months after treatment, 1,916 patients remained in the study, and of these, 1,278 patients completed the survey. The primary measures of outcome were the symptom and health-related quality-of-life scores from the Uterine Fibroid Symptom and Quality of Life questionnaire. RESULTS: Mean symptom scores improved 41.41 points (P<.001), and the quality of life scores improved 41.47 points (P<.001), both moving into the normal range for this questionnaire. The improvements were independent of practice setting. During the 3 years of the study, Kaplan-Meier estimates of hysterectomy, myomectomy, or repeat uterine artery embolization were 9.79%, 2.82%, and 1.83% of the patients, respectively. CONCLUSION: Uterine artery embolization results in a durable improvement in quality of life. These results are achievable when the procedure is performed in any experienced community or academic interventional radiology practice. LEVEL OF EVIDENCE: III." PubMed Changes in ultrasound morphology of
the uterus and ovaries during the menopausal transition and early
postmenopause: a 4-year longitudinal study.
Sokalska
A,
Valentin L.
Ultrasound Obstet
Gynecol. 2008 Jan 15
PubMed Symptomatic Uterine Fibroids:
Treatment with Uterine Artery Embolization or Hysterectomy Results from
the Randomized Clinical Embolisation versus Hysterectomy (EMMY) Trial.
Hehenkamp WJ,
Volkers NA,
Birnie E,
Reekers JA,
Ankum WM.
Radiology. 2008 Jan 9
http://radiology.rsnajnls.org/cgi/content/full/2463070260/DC1
Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids - early experience. Morita Y, Ito N, Hikida H, Takeuchi S, Nakamura K, Ohashi H. PubMed"CONCLUSION: MRgFUS can safely be used to non-invasively treat symptomatic uterine fibroids and avoid the need for surgical intervention in the short term. With large treatment volumes, MRgFUS also results in significant fibroid shrinkage in a relatively short time. Additional follow-up is needed to determine the long-term durability of this promising non-invasive approach." Increased Frequency of Thyroid Nodules and Breast Fibroadenomas in Women with Uterine Fibroids. Spinos N, Terzis G, Crysanthopoulou A, Adonakis G, Markou KB, Vervita V, Koukouras D, Tsapanos V, Decavalas G, Kourounis G, Georgopoulos NA. Thyroid. 2007 Nov 8 "Fibroids or leiomyomas or myomas of the uterus are the most common benign gynecologic disease, while fibroadenomas of the breast are most frequently seen in young women, usually within 20 years after puberty. Multiple tumors in one or both breasts are found in 10-15% of patients. Single thyroid nodules are much more common in women than in men, and their prevalence increases with age. The aim of the present study was to determine cross-sectionally the incidence of solitary thyroid nodules and fibroadenomas of the breast in women with uterine fibroids. In women with uterine adenomas, the frequency of fibroadenomas of the breast was 65% and of thyroid nodules was 38.7%, while in women with a normal uterus, the frequency was 35% and 20%, respectively. Therefore, women with uterine fibroids have an increased incidence of thyroid nodules (t = 4.68, p = 0.030) and of fibroadenomas of the breast (t = 11.74, p = 0.001)." PubMed Leiomyomata uteri: hormonal and
molecular determinants of growth. Blake RE.
"OBJECTIVE: To review the available English literature that examines the biology of leiomyoma uteri in African-American women and other ethnic groups. Factors that influence the growth and development of leiomyomas are examined to understand the basis for larger myomas in African-American women. DESIGN: Literature review of 176 articles regarding the pathobiology of leiomyoma in various ethnic groups. RESULTS: The initiating factor(s) associated with the transformation of a normal myometrial cell into a leiomyoma cell remain(s) to be determined. Epidemiological studies have confirmed that different ethnic groups develop leiomyomas. However, African-American ethnicity is a risk factor for the development of leiomyomas. Studies have examined diet, genetics, hormonal, growth, enzymatic and molecular determinants of myoma biology, with critical advances in some of these areas. The best radiological tools to identify and monitor leiomyomas are ultrasonography and/or magnetic resonance imaging. Evidence supports progesterone and growth factors (e.g., transforming growth factor-B), have significant impact on the development of leiomyomas. CONCLUSIONS: Early monitoring and intervention should become standard for African-American women who are at greater risk for developing leiomyomas. There are plausible biological mechanisms that explain the predisposition for developing larger leiomyomas in African-American women as compared with other ethnic groups." PubMed Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy. Ghomi A, Hantes J, Lotze EC.: J Minim Invasive Gynecol. 2005 May-Jun;12(3):201-5 "STUDY OBJECTIVE: The aim of the study was to estimate the incidence of cyclical bleeding after laparoscopic supracervical hysterectomy (LSH) when the uterus is amputated at or below the level of internal cervical os. CONCLUSION: Our data suggest the overall incidence of post-LSH cyclical bleeding is 19%. When the uterus is amputated at or below the level of internal os, the incidence is 17%. To our knowledge, this is the first study in the medical literature to report on cyclical bleeding after LSH when the uterine amputation is demonstrated to have occurred at or below the level of internal cervical os." - PubMed Subtotal vs total hysterectomy: Does the evidence support saving the cervix? Preservation of the cervix reduces sexual dysfunction, incontinence, or surgical complications? OBG Management
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