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- Submucosal uterine fibroid prolapsed into vagina in a symptomatic patient with IUS. [Journal Article]
- BMJ Case Rep 2014.
A female patient in her mid 40s presents with heavy menstrual bleeding (HMB) and a history of spotting/irregular light per vagina (PV) bleeding since intrauterine system (IUS) insertion 1 year ago. She is known to have submucosal uterine fibroid (SMUF). The patient reported abdominal pain and sudden onset of 'miscarriage-like' HMB with clots 2 days ago. On speculum examination there was a smooth round-shaped mass lying over the external cervical os. On bimanual examination PV, a round-shaped smooth mass of a walnut's size was palpable in the upper third of the vagina. Subsequent ultrasound imaging revealed an SMUF prolapsed into the vagina. Further surgical treatment was undertaken. Histology showed a fibroid (leiomyoma) with no evidence of malignancy.
- [Expression of nerve growth factor produced by ectopic endometrium from patients with adenomyosis and its relationship with pain scales and innervation]. [English Abstract, Journal Article]
- Zhonghua Fu Chan Ke Za Zhi 2014 Feb; 49(2):120-4.
To investigate the expression of nerve growth factor (NGF) in the ectopic endometrium in adenomyosis patients, and explore the relationship between NGF expression and innervation or pain scales.From Mar. 2009 to Oct. 2009, 45 adenomyosis patients undergoing hysterectomy in Obstetrics and Gynecology Hospital of Fudan University were enrolled in this study, which were classified into 33 cases in pain group and 12 cases in non-pain group based on symptom. The degree of dysmenoreal, chronic pelvic pain and dyspareunia was evaluated by visual analogue scale, including no pain, mild to moderate pain and severe pain group. In the mean time, 26 patients with leiomyoma or cervical intraepithelial neoplasia III (CIN III) undergoing hysterectomy were defined as control group. Ectopic endometrium from experimental group and eutopic endometrium from control group were collected in the surgery. The expression of NGF was examined by immunohistochemistry. The density of protein gene product (PGP) 9.5 positive nerve fibers was detected by immuno-fluorescence.The NGF level and the density of PGP 9.5 positive nerve fibers in adenomyosis pain group (0.25 ± 0.08, 16 ± 8 )were higher than adenomyosis painless (0.19 ± 0.05, P = 0.007;11 ± 5, P = 0.018) and control group (0.18 ± 0.05, P = 0.000; 9 ± 4, P = 0.000) . The NGF level and the density of PGP9.5 positive nerve fibers in severe dysmenorrheal group (0.29 ± 0.07, 19 ± 10) were higher than mild to moderate dysmenorrheal (0.22 ± 0.07, P = 0.018;13 ± 4, P = 0.035) and painless group (0.18 ± 0.05, P = 0.000;11 ± 5, P = 0.006) of adenomyosis patients. There was no difference of NGF level and the density of PGP 9.5 positive nerve fibers in chronic pelvic pain group and no chronic pelvic pain group of adenomyosis patients, so was dyspareunia group and no dyspareunia group.The increased NGF level of adenomyosis nodules and improving innervation might be involved in the mechanism of adenomyosis related pain.
- Endometrial stromal sarcoma presented as an incidental lung mass with multiple pulmonary nodules. [Journal Article]
- Tuberc Respir Dis (Seoul) 2014 Mar; 76(3):131-5.
Low-grade endometrial stromal sarcoma (ESS) is an uncommon gynecologic malignancy of mesodermal origin. Pulmonary metastasis of low-grade ESS can occur years and decades after the treatment of the primary disease. Low-grade ESS is frequently mistaken as benign uterine neoplasm like uterine leiomyoma, which can potentially lead to a misdiagnosis. We present a case of a 42-year-old woman with low-grade ESS, that initially presented as an incidental lung mass with multiple pulmonary nodules, seven years after an uterine myomectomy. A 6.9×5.8 cm-sized intrapelvic mass suspected of uterine origin was discovered while searching for potential extrathoracic primary origin. A pelviscopy and simultaneous thoracoscopic lung biopsy were conducted for pathologic diagnosis. Finally, the diagnosis was confirmed as low-grade ESS with lung metastasis based on the histopathologic examination with immunohistochemical stain, which was showed positive for CD10 and hormone receptor markers (estrogen and progesterone receptors) in both pelvic and lung specimens.
- Cotyledonoid dissecting leiomyoma. [JOURNAL ARTICLE]
- Int J Gynaecol Obstet 2014 Feb 11.
- [Obscure gastrointestinal bleeding due to an inflammatory fibroid polyp (of Vaneck).] [LETTER]
- Gastroenterol Hepatol 2014 Apr 7.
- Effect of Isopropanolic Cimicifuga racemosa Extract on Uterine Fibroids in Comparison with Tibolone among Patients of a Recent Randomized, Double Blind, Parallel-Controlled Study in Chinese Women with Menopausal Symptoms. [Journal Article]
- Evid Based Complement Alternat Med 2014.:717686.
Objective.Effect of isopropanolic Cimicifuga racemosa extract (iCR) on uterine fibroid size compared with tibolone.
Method.The randomized, double-blind, controlled study in China enrolled 244 patients aged 40-60 years with menopausal symptoms (Kupperman Menopause Index ≥ 15). The participants were treated with either iCR of 40 mg crude drug/day (N = 122) or tibolone 2.5 mg/day (N = 122) orally for 3 months in 2004. Now, we investigated the subset of all women (N = 62) with at least one uterine fibroid at onset of treatment for the effect of iCR (N = 34) on fibroid size compared with tibolone (N = 28) by transvaginal ultrasonography.
Results.The median myoma volume decreased upon iCR by as much as -30% (P = 0.016) but increased upon tibolone by +4.7%. The percentage of volume change, mean diameter change and geometric mean diameter change of the iCR group compared to tibolone were statistically significant (P = 0.016, 0.021, 0.016 respectively).
Conclusion.Our results suggest that iCR (Remifemin) is a valid herbal medicinal product in patients with uterine myomas as it provides adequate relief from menopausal symptoms and inhibits growth of the myomas in contrast to tibolone.
- Early evaluation of magnetic resonance imaging guided focused ultrasound sonication in the treatment of uterine fibroids. [Journal Article]
- Indian J Med Res 2014 Feb; 139(2):267-72.
Background & objectives: Uterine leiomyomas (fibroids) are common cause of morbidity in women of reproductive age group. High intensity focused ultrasound with the imaging guidance of magnetic resonance imaging (MRI) known as magnetic resonance guided focused ultrasound sonication (MRgFUS) is now available. However, there are no available studies with this non invasive modality of treatment in Indian subjects. The objective of this study was to determine the safety and clinical efficacy of MRgFUS in the treatment of uterine fibroids.
Methods:This prospective study included 32 consecutive women with clinically symptomatic uterine fibroids who were treated with MRgFUS from February 2011 to October 2011. Pre and post treatment symptom severity scores (SSS) were assessed at the time of enrolment and at one, three and six months follow up using a validated uterine fibroid symptom - quality of life questionnaire (UFS-QOL). Pre and post treatment fibroid volumes were compared immediately after treatment and at six months follow up using contrast enhanced MRI scan. Non perfused volume (NPV) ratios were calculated and correlated with fibroid volume reductions immediately after the treatment and at the end of six months follow up.
Results:This procedure was well tolerated by the patients and procedure related adverse effects were non significant. Significant reductions in SSS were seen at one, three and six month intervals after the treatment (P<0.01). Significant reductions were noticed in fibroid volumes at six months follow up compared to pretreatment fibroid volumes (P<0.01). Significant positive correlations were observed between NPV ratios and reduction in fibroid volumes at six months follow-up (r=0.659, P<0.01). Interpretation & conclusions: MRgFUS is relatively a safe and effective non invasive treatment modality for treating uterine fibroids in selected patients. Its long term efficacy is yet to be tested and compared with other available minimally invasive treatment options.
- Leiomyoma of renal pelvis. [Journal Article]
- J Coll Physicians Surg Pak 2014 Mar.:S57-9.
Leiomyoma is a benign tumour of smooth muscle origin, which can also affect many organs specially kidneys. In kidneys, it is mostly found in the renal capsule but rarely does it also involve the renal pelvis. It is mostly found in middle-aged women. A 25-year-old man presented with hematuria histologically secondary to proven leiomyoma of left renal pelvis with unusual clinical features underwent minimally invasive surgical management.
- Vitamin D and female fertility. [JOURNAL ARTICLE]
- Curr Opin Obstet Gynecol 2014 Apr 8.
Apart from the well known effects of vitamin D on maintaining calcium homeostasis and promoting bone mineralization, there is some evidence suggesting that vitamin D also modulates human reproductive processes. We will review the most interesting and relevant studies on vitamin D and female fertility published over the past year.In the past year, several observational studies reported a better in-vitro fertilization outcome in women with sufficient vitamin D levels (≥30 ng/ml), which was mainly attributed to vitamin D effects on the endometrium. One randomized controlled trial found an increased endometrial thickness in women with polycystic ovary syndrome (PCOS) receiving vitamin D during intrauterine insemination cycles. Further, vitamin D supplementation had a beneficial effect on serum lipids in PCOS women. Vitamin D treatment improved endometriosis in a rat model and increased vitamin D intake was related to a decreased risk of incident endometriosis. Vitamin D was also favorably associated with primary dysmenorrhea, uterine leiomyoma, and ovarian reserve in late reproductive aged women.In women undergoing in-vitro fertilization, a sufficient vitamin D level (≥30 ng/ml) should be obtained. Vitamin D supplementation might improve metabolic parameters in women with PCOS. A high vitamin D intake might be protective against endometriosis.
- Splenic artery pseudoaneurysm presenting as massive hematemesis: a diagnostic dilemma. [Journal Article]
- Case Rep Surg 2014.:501937.