Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
- Small cell neuroendocrine carcinoma of cervix and leiomyoma between the vagina and rectum. [JOURNAL ARTICLE]
- J Obstet Gynaecol 2014 Jul 24.:1-2.
- Haemoperitoneum: An extremely rare complication of leiomyoma. [JOURNAL ARTICLE]
- J Obstet Gynaecol 2014 Jul 24.:1-2.
- Uterine artery Doppler flow velocity waveform analysis following uterine fibroid embolisation. [JOURNAL ARTICLE]
- J Obstet Gynaecol 2014 Jul 24.:1-2.
The objective was to evaluate the relation of uterine artery Doppler flow pulsatility index (PI) with total uterine volume reduction following bilateral embolisation of uterine fibroids by injection of polyvinyl alcohol particles. Doppler flow velocity was examined before and within 8 days after embolisation (n = 13). Uterine size was assessed by magnetic resonance imaging (MRI) before, and at 3 and 6 months after, the procedure. Mean PI values (mean of right and left side) obtained before embolisation were negatively related to uterine size (r = -0.68, p = 0.010) but not to uterine volume reduction after the procedure. Mean PI values after the procedure were related to the percentage decrease in uterine volume both at 3 (r = 0.74, p = 0.004) and 6 months (p = 0.73, p = 0.005). Doppler ultrasound measures of the uterine arteries may be used to evaluate reduction of uterine size following fibroid embolisation.
- 5-hydroxymethylcytosine Promotes Proliferation of Human Uterine Leiomyoma: a Biological Link to a New Epigenetic Modification in Benign Tumors. [JOURNAL ARTICLE]
- J Clin Endocrinol Metab 2014 Jul 24.:jc20142264.
Context: Uterine leiomyoma, or fibroids, represent the most common benign tumors of the female reproductive tract. A newly discovered epigenetic modification, 5-hydroxymethylation (5-hmC), and its regulators, the TET enzymes, were implicated in the pathology of malignant tumors, however, their roles in benign tumors, including uterine fibroids, remain unknown. Objective: To determine the role of 5-hmC and TET proteins in the pathogenesis of leiomyoma using human uterine leiomyoma and normal matched myometrial tissues and primary cells. Design: 5-hmC levels were determined by ELISA and immunofluorescent staining in matched myometrial and leiomyoma tissues. TET expression was analyzed by qRT-PCR and immunoblotting. TET1 or TET3 were silenced or inhibited by siRNA or 2-HG to study their effects on 5-hmC content and cell proliferation. Results: We demonstrated significantly higher 5-hmC levels in the genomic DNA of leiomyoma tissue compared to normal myometrial tissue. The increase in 5-hmC levels was associated with the upregulation of TET1 or TET3 mRNA and protein expression in leiomyoma tissue. TET1 or TET3 knockdown significantly reduced 5-hmC levels in leiomyoma cells and decreased cell proliferation. Treatment with 2-HG, a competitive TET enzyme inhibitor, significantly decreased both 5-hmC content and cell proliferation of leiomyoma cells. Conclusion: An epigenetic imbalance in the 5-hmC content of leiomyoma tissue, caused by upregulation of the TET1 and TET3 enzymes, might lead to discovery of new therapeutic targets in leiomyoma.
- [Ultrasound-guided focused ultrasound ablation of intramural, submucosal and subserosal uterine fibroids: 12-month follow-up results]. [English Abstract, Journal Article]
- Nan Fang Yi Ke Da Xue Xue Bao 2014 Jul 20; 34(7):978-82.
To evaluate the effect of ultrasound-guided focused ultrasound ablation (US-FUA) in the treatment of intramural, submucosal and subserosal uterine fibroids.We prospectively assessed the efficacy of US-FUA for treatment of symptomatic uterine fibroids by determining the volume ablation ratio immediately after the treatment and evaluating the volume changes of the uterine fibroids on contrast-enhanced MRI at 6 and 12 months after the treatment. The symptom severity score (SSS) was examined before and at 6 and 12 months after the treatment.A total of 110 women with 145 symptomatic fibroids undergoing US-FUA between August 2011 and December 2012 were enrolled. The fibroids were located intramurally in 72 (49.7%), submucosally in 49 (33.8%) and subserosally in 24 (16.6%) patients, who had comparable mean volume ablation ratios [(93.2∓13.1)% vs (94.9∓9.3)% vs (89.6∓19.3)%, P>0.05]. The volume of the treated fibroids was reduced by (47.3∓20.8)%, (70.3∓22.2)% and (47.8∓13.6)% at 6 months after US-FUA and by (58.9∓19.9)%, (82.0∓21.2)%, and (50.5∓17.8)% at 12 months, respectively, demonstrating a more obvious volume reduction for submucosal fibroids (P<0.05). The SSS scores of the 3 groups before treatment were 29.1∓15.2, 34.8∓14.5 and 26.6∓23.4, respectively, which decreased significantly to 18.4∓15.8, 15.5∓10.7, and 11.6∓11.7 at 6 months (P<0.05) and to 18.9∓13.2, 16.8∓14.0, 11.5∓9.1 at 12 months (P<0.05). No major complications occurred in these patients during the 12-month follow-up.US-FUA can yield high ablation ratios for intramural, submucosal and subserosal fibroids and result in significant volume reduction and symptomatic improvement at 6 and 12 months after the treatment, suggesting its value as a new noninvasive option for fibroid treatment in patients who wish to preserve the uterus.
- Concentrated ascites re-infusion therapy for pseudo-Meigs' syndrome complicated by massive ascites in large pedunculated uterine leiomyoma. [Journal Article]
- J Obstet Gynaecol Res 2014 Jul; 40(7):1944-9.
Pseudo-Meigs' syndrome accompanied by massive ascites in uterine leiomyoma is rare. We encountered a rare case of a 37-year-old, nulliparous woman with a lower abdominal tumor and severe abdominal distention due to massive ascites. Serum cancer antigen 125 and vascular endothelial growth factor levels were elevated to 1007.9 U/mL and 103 pg/mL, respectively. She was tentatively diagnosed with ovarian cancer. Emergency concentrated ascites re-infusion therapy was performed to improve dyspnea, abdominal pain, and her preoperative respiratory condition. Concentrated ascites re-infusion therapy eliminated dyspnea and abdominal discomfort without decreasing serum albumin levels. The patient underwent laparotomy, which revealed a fist-sized pedunculated uterine leiomyoma arising from the right uterine fundus. Myomectomy was performed. Pseudo-Meigs' syndrome mimics advanced ovarian cancer due to massive ascites and markedly elevated serum cancer antigen 125 and vascular endothelial growth factor levels. Concentrated ascites re-infusion therapy was effective in improving the subjective symptoms of pseudo-Meigs' syndrome and the patient's preoperative condition.
- Comparison of gadolinium-enhanced magnetic resonance imaging with ultrasound in evaluation of cesarean scar pregnancy. [Journal Article]
- J Obstet Gynaecol Res 2014 Jul; 40(7):1890-3.
The aim of this study was to evaluate the validity of gadolinium-enhanced magnetic resonance imaging (MRI) in diagnosing cesarean scar pregnancy (CSP) and to compare this with ultrasound results.Forty-two consecutive patients underwent both gadolinium-enhanced MRI and ultrasound to evaluate CSP before treatment from May 2010 to September 2013. The results of both MRI and ultrasound were reviewed and compared to each other with diagnosis of CSP confirmed by pathological findings and clinical outcome.MRI and ultrasound were performed in all 42 patients, with ultrasound performed more than twice in 29 cases. Pathological findings confirmed CSP in all 42 patients, 41 of whom were diagnosed correctly using MRI, with one misdiagnosed as uterine fibroid. Misdiagnosis occurred in seven cases in the first ultrasound, and report was inconclusive in one case. However, correct and definite diagnosis was achieved in repeated ultrasound in seven of the eight cases. The case misdiagnosed as uterine fibroid using MRI was also misdiagnosed as blood clot by ultrasound. The specificity of MRI in diagnosing CSP was 97.6% (41/42) versus 81% (34/42) of the initial ultrasound (P < 0.05). No contrast-agent-related complications occurred in our series.Gadolinium-enhanced MRI is highly specific in the diagnosis of CSP. Ultrasound is relatively less specific when initially performed, but it can be repeated conveniently, with specificity greatly improved. Repeated ultrasound is as specific as MRI in confirming diagnosis of CSP.
- MRI-Guided Focused Ultrasound Surgery for Uterine Fibroid Treatment: A Cost-Effectiveness Analysis. [JOURNAL ARTICLE]
- AJR Am J Roentgenol 2014 Aug; 203(2):361-371.
OBJECTIVE. The purpose of this article is to evaluate the cost effectiveness of a treatment strategy for symptomatic uterine fibroids that uses MRI-guided focused ultrasound as a first-line therapy relative to uterine artery embolization (UAE) or hysterectomy. MATERIALS AND METHODS. We developed a decision-analytic model to compare the cost effectiveness of three first-line treatment strategies: MRI-guided focused ultrasound, UAE, and hysterectomy. Treatment-specific short- and long-term utilities, lifetime costs, and quality-adjusted life years (QALYs) were incorporated, allowing us to conduct an incremental cost-effectiveness analysis, using a societal willingness-to-pay (WTP) threshold of $50,000/QALY to designate a strategy as cost effective. Sensitivity analyses were subsequently performed on all key parameters. RESULTS. In the base-case analysis, UAE as a first-line treatment of symptomatic fibroids was the most effective and expensive strategy (22.75 QALYs; $22,968), followed by MRI-guided focused ultrasound (22.73 QALYs; $20,252) and hysterectomy (22.54 QALYs; $11,253). MRI-guided focused ultrasound was cost effective relative to hysterectomy, with an associated incremental cost-effectiveness ratio (ICER) of $47,891/QALY. The ICER of UAE relative to MRI-guided focused ultrasound was $234,565/QALY, exceeding the WTP threshold of $50,000/QALY, therefore rendering MRI-guided focused ultrasound also cost effective relative to UAE. In sensitivity analyses, results were robust to changes in most parameters but were sensitive to changes in probabilities of recurrence, symptom relief, and quality-of-life measures. CONCLUSION. First-line treatment of eligible women with MRI-guided focused ultra-sound is a cost-effective noninvasive strategy. For those not eligible for MRI-guided focused ultra-sound, UAE remains a cost-effective option. These recommendations integrate both the short- and long-term decrements in quality of life associated with the specific treatment modalities.
- What is too big? Uterine artery embolization of a large fibroid causing abdominal compartment syndrome. [Journal Article, Review]
- Semin Intervent Radiol 2014 Jun; 31(2):207-11.
- Sydney Contained In Bag Morcellation for Laparoscopic Myomectomy. [JOURNAL ARTICLE]
- J Minim Invasive Gynecol 2014 Jul 15.
To demonstrate a new technique of contained in bag morcellation of a fibroid after laparosocpic myomectomy.Step-by-step explanation of the technique with a narrated video SETTING: Recent controversy regarding the risk of disseminating occult leiomyosarcomatous tissue during morcellation means we need to revise our current approach to tissue extraction at laparoscopic myomectomy and morcellation in general. We would like to present a novel technique, conceived by Dr Danny Chou called the Sydney Contained In Bag Morcellation technique for laparoscopic myomectomy. In this technique an Endo Catch bag (Endo Catch II Auto Suture Specimen Retrieval Pouch, Covidien, Mansfield, MA 02048, USA) is introduced in the typical fashion, the myoma retrieved and the mouth of the bag exteriorized onto the abdominal wall. A 12mm trocar is then introduced within the bag and a pneumoperitoneum created prior to introducing an optical balloon tip port (KII balloon blunt tip system, Applied Medical, Rancho Santa Margarita, CA 92668, USA) and the power morcellator device. Morcellation is then performed within the bag, under direct vision. This technique may offer a safer approach to morcellation as the bowel is not within the morcellating field and a lower risk of disseminating occult leiomyosarcomatous tissue during morcellation. Subsequent to the morcellation process, suctioning of the bag removes any aerosolized particles of fibroid, minimizing risk of possible dissemination further.Contained In Bag Morcellation of myoma after laparoscopic myomectomy.This technique may allow a minimally invasive approach to myomectomy to continue as a viable option in the post FDA warning era.