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- Hypertension Risk in Dutch Women With Symptomatic Uterine Fibroids. [JOURNAL ARTICLE]
- Am J Hypertens 2014 Sep 20.
Female-specific risk factors for cardiovascular disease are understudied. We assessed whether women with uterine fibroids have a greater hypertension risk, independent of the shared risk factors for both conditions.Blood pressure was measured in women scheduled for fibroid surgery compared to women scheduled for nonfibroid gynecological surgery and women randomly sampled from the general population. We used multivariable binary logistic regression to assess whether hypertension was more common with surgically treated fibroids, independent of age, body mass index, and African ancestry.We included 1,342 women (542 of African ancestry), of which 272 scheduled for fibroid surgery, 385 controls scheduled for nonfibroid gynecological surgery, and 685 random population controls, with a mean age (SD) of, respectively, 43.4 (6.6), 41.3 (10.2), and 45.1 (6.6) years; and a mean body mass index (SD) of, respectively, 27.4 (5.3), 25.7 (5.7), and 28.2 (5.6) kg/m(2). Hypertension was found more frequently with surgically treated fibroids, with an occurrence of 41.9% in women with fibroids vs. 27.5% in surgical controls, and 28.3% in population controls (P < 0.001 for fibroids vs. controls). The association with hypertension was independent of age, body mass index, and African ancestry (odds ratio, 2.4; 95% confidence interval, 1.7-3.4).Hypertension risk is higher in Dutch women with surgically treated fibroids than in surgery or population controls, independent of age, body mass index, and African ancestry. Our data add to the body of evidence indicating that women with uterine fibroids are eligible for hypertension screening.
- A Case of Reed's Syndrome: An Underdiagnosed Tumor Disorder. [Journal Article]
- Case Rep Dermatol 2014 May; 6(2):189-93.
Cutaneous leiomyomas are uncommon, benign smooth muscle tumors originating from the arrector pili muscle of the hair follicle that are frequently unrecognized and underdiagnosed by clinicians. They sometimes coexist with common uterine fibroids in an inherited disorder named multiple cutaneous and uterine leiomyomatosis, also referred to as Reed's syndrome. We report a case of Reed's syndrome in a young woman who had been misdiagnosed for many years.
- The Clinical Pharmacology and Pharmacokinetics of Ulipristal Acetate for the Treatment of Uterine Fibroids. [JOURNAL ARTICLE]
- Reprod Sci 2014 Sep 16.
Uterine fibroids are benign hormone-sensitive tumors of uterine smooth muscle cells leading to heavy menstrual bleeding and pelvic pain. Ulipristal acetate (UPA) is an emerging medical treatment of fibroids with the potential to be used for long-term treatment. In this context, the present article summarizes UPA's main clinical pharmacology and pharmacokinetic (PK) properties. Ulipristal acetate has good oral bioavailability and a half-life allowing one single oral administration per day for the management of fibroids. As a steroid, UPA is a substrate for cytochrome P450 (CYP) 3A4 but does not act as an inducer or inhibitor of the CYP system or transporter proteins. With the exception of drugs modulating CYP3A4 activity, risks of drug-drug interactions with UPA are unlikely. In conclusion, besides its pharmacodynamic characteristics, UPA shows favorable PK properties that contribute to a good efficacy-safety ratio for the long-term management of uterine fibroids in clinical practice.
- The role of hypoxia related angiogenesis in uterine smooth muscle tumors. [JOURNAL ARTICLE]
- Biotech Histochem 2014 Sep 16.:1-9.
Mechanisms of hypoxia-related angiogenesis are important for uterine smooth muscle tumors. Factors that are related to angiogenesis during hypoxia include vascular endothelial growth factor (VEGF), hypoxia inducible factor 1α (HIF1α), T-cell intracellular antigen1 (TIA1), eukaryotic translation initiation factor 2α (eIF2α) and thrombospondin 1 (TSP1). We investigated immunoreactivities of VEGF, HIF1α, TIA1, eIF2α and TSP1 using an indirect immunoperoxidase method for formalin fixed, paraffin embedded tumors that had been diagnosed as leiomyoma (LMY), cellular leiomyoma (CLM) or leiomyosarcoma (LMS). TSP1 immunoreactivity was scored as moderate, mild or minimal, while VEGF, eIF2α and TIA1 immunoreactivities were scored as mild, moderate and strong in LMY, CLM and LMS samples, respectively. HIF1α immunoreactivity was scored as mild to minimal in LMY, CLM and LMS samples, but showed no statistically significant differences among samples. Although angiogenic factors showed strong immunohistochemical staining intensity in LMS, anti-angiogenic factors showed minimal immunohistochemical intensity. There was no difference in HIF-1α immunoreactivity compared to LMY, CLM and LMS samples. We suggest that HIF1α protein synthesis could be suppressed by eIF2α and TIA1. Furthermore, VEGF could be activated by pathways such as COX2, Ras, NF-ĸB or c-myc instead of HIF1α. Angiogenesis could trigger and accelerate tumor development; therefore, anti-angiogenic therapy could be useful for treatment of tumors.
- Recurrence of uterine tissue residues after laparoscopic hysterectomy or myomectomy. [Journal Article]
- Pak J Med Sci 2014 Sep; 30(5):1134-6.
To report a new complication after laparoscopic surgery i.e recurrence of endometrium and leiomyoma fragments from uterine tissue residues after laparoscopic hysterectomy or laparoscopic myomectomy. Methods : This study was carried out on three patients with the recurrence of endometrium or leiomyoma fragments from tissue residues after laparoscopic hysterectomy or laparoscopic myomectomy in the First Affiliated Hospital, Yangtze University, China. We also explored the possible reasons and corresponding preventative strategies.Small residues of endometrium and leiomyoma fragments could implant into normal tissue anywhere in the peritoneal cavity after laparoscopic myomectomy or laparoscopic hysterectomy.These cases emphasize the importance of removing every single fragment to prevent the recurrence of endometrium and leiomyoma from tissue residues.
- Autoamputated leiomyoma of the uterus as a rare cause of the mechanical bowel obstruction - report of a case. [Journal Article]
- Pol Przegl Chir 2014 Jul 1; 86(7):341-4.
Abstract Mechanical obstruction of the gastrointestinal tract is one of the most common causes of the emergency surgical intervention. A rare cause of such condition might be the effect of the external pressure on the intestine exerted by i. e. tumor, lymph node package, aneurysm of the abdominal aorta. An extremely rare cause is the pressure of the large loose mass located in the peritoneal cavity called "loose body". We present a case of the mechanical bowel obstruction caused by a giant loose autoamputated leiomyoma of the uterus lying free in the peritoneal cavity. According to our best knowledge it is the largest described loose body in the literature. Moreover, we present a literature review regarding this issue.
- Incidental benign metastasizing leiomyoma in a patient with bone sarcoma: a case report. [Journal Article]
- Case Rep Surg 2014.:439061.
Background.The benign metastasizing leiomyoma is an exceptionally rare entity; it presents with ectopic leiomyoma nodules with a benign pattern. Symptoms vary according to the anatomic location. The diagnosis is histopathological, usually in patients with history of hysterectomy. Case Presentation. A 36-year-old female with 2-month history of left knee pain was diagnosed with bone fibrosarcoma. A CT scan showed pulmonary nodules. The patient started neoadjuvant chemotherapy. Conservative surgery of pelvic limb was achieved. A new CT scan reported pulmonary nodules that remained in relation to the previous CT. A nodule resection by thoracotomy and TOB (transoperative biopsy) was performed. The final pathology report described benign proliferative lesions consistent with benign metastatic leiomyoma.
Conclusions.Benign metastatic leiomyoma is a rare condition presenting with uterine and extrauterine nodules most commonly in the lung. The diagnosis is histopathological. The surgical procedure must be reserved for selected patients.
- Hilus cell hyperplasia of fallopian tubes: a rare and incidental finding with uterine leiomyomas. [Journal Article]
- Kathmandu Univ Med J (KUMJ) 2014 Jan-Mar; 12(45):64-6.
Hilus cells are ovarian counterpart of testicular leydig cells seen at hilar region of ovary. We present an interesting case of hilus cell hyperplasia in fallopian tube associated with multiple leiomyomata of uterus in a postmenopausal woman. To our knowledge very few cases reported the existence of hilus cells outside the ovary. We received a specimen of hysterectomy with bilateral salpingooopherectomy. On gross examination both the tubes showed multiple small yellowish nodules. Microscopic examination showed aggregation of hilus cells beneath a normal tubal epithelium. Hilus cell hyperplasia was not seen in the ovaries. On immunohistochemistry, hilus cell showed positivity for vimentin and calretinin. Co-existence of hilus cell hyperplasia of fallopian tube and leiomyoma is very rare and may be subjected to further research.
- Granulosa cell tumor induced massive recurrence of post hysterectomy leiomyoma. [Journal Article]
- Indian J Nucl Med 2014 Jul; 29(3):179-81.
The authors report a very unusual occurrence of a massive recurrence of leiomyoma from post hysterectomy stump diagnosed on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT). The case also has an additional complexity of granulosa cell tumor (GCT) of ovary probably contributing to the recurrence and massive size.
- Variables influencing the integrity of lower uterine segment in post-cesarean pregnancy. [JOURNAL ARTICLE]
- Arch Gynecol Obstet 2014 Sep 11.
There is significant increase in proportion of cases with previous cesarean delivery requiring obstetric care. The available literature fails to provide uniform opinion on each woman's characteristics to identify risk of uterine rupture while planning trial of labor after cesarean.To study the association of abnormal lower uterine segment with some of the present and previous obstetric variables including patient characteristics and surgical techniques at previous cesarean operation.Consenting consecutive 96 post-cesarean singleton pregnancies admitting after 36 weeks gestation at the same facility from July 2011 to December 2012 for repeat cesarean, were studied. Only the cases with cephalic presentation and vertex as presenting part, having no placenta previa, polyhydramnios, uterine anomaly or fibroid and those who had previous one lower segment cesarean were recruited. Based on the intra-operative finding the lower uterine segment (LUS) was categorized into those having a normal and abnormal (grades 2-4) LUS. Sonographic assessment of LUS thickness and any abnormalities if any were noted. The findings of abnormal LUS (direct observation at surgery and sonographic impression within a week before surgery) were looked for association with some of the present and previous obstetric variables including patient characteristics and surgical techniques at previous cesarean operation using Student t, Chi square or Fisher's exact test for analysis as appropriate. Receiver operating curve analysis was used to determine the optimal cut off value for prediction of LUS integrity by ultrasound.Of the women recruited for the study, 36 were admitted in early labor and ultrasound evaluation of LUS was performed in 48 of the remaining 60 women admitted antenatal for elective cesarean delivery. There were 38 abnormal LUS (39.6 %) with 22 of them (57.9 %) graded as 'thinned out LUS'. The incidence of scar dehiscence (grade 3, cases 5) was 5.2 % of 96 cases and there were no cases of scar rupture. Proportion of cases with abnormal LUS was significantly high when primary cesarean was done in preterm (p = 0.02); it was a single layer uterine closure (p = 0.02), and inter-cesarean interval was 54 months (p = 0.01). Abnormal LUS was also seen to be associated with maternal age beyond 35 years (p = 0.2), when cesarean was performed in labor (p = 0.5), following 18 h of rupture of membranes (p = 0.75), for a baby weight more than 3 kg (p = 0.4), and different suture materials (polyglactin 910 and chromic catgut) were used to close uterus at primary cesarean delivery (p = 0.1), and also if they had post-partum fever (p = 0.3). Ultrasound measurement of LUS by abdominal scan correlated with the intra-operative LUS grading and a thickness of more than 3.2 mm within a week before delivery and was seen to be the safe cut off above which most of the women had a normal LUS (sensitivity 92.3 %, specificity 81.1 %).Factors at primary cesarean operation significantly influence the state of LUS at term in subsequent pregnancy .