Laparoscopic adenomyomectomy under transient occlusion of uterine arteries with an endoscopic vascular clip.

BACKGROUND: To introduce the safe and effective surgical technique of laparoscopic adenomyomectomy with transient occlusion of uterine arteries (TOUA) in patients with symptomatic uterine adenomyoma. SUBJECTS AND METHODS: In a prospective case study, we examined all cases of laparoscopic adenomyomectomy with TOUA performed by a single surgeon at Ulsan University Hospital, Ulsan, Korea, between May 2011 and September 2012. Surgical outcomes included operative time, intraoperative injury of blood vessels, nerves, and pelvic organs, as well as intraoperative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia and the recurrence of adenomyomic lesions by ultrasonography at the 6-month follow-up after laparoscopic adenomyomectomy with TOUA. RESULTS: Thirty-four women who were refractory to medical treatment or who wanted surgical treatment for preserving their uterus underwent laparoscopic adenomyomectomy with TOUA using an endoscopic vascular clip. The mean age was 43.79 ± 4.94 years. The mean diameter of the adenomyomas was 5.29 ± 1.82 cm. The mean TOUA time, operation time, and hospital stay were 7.33 ± 4.12 minutes, 84.09 ± 31.48 minutes, and 3.82 ± 1.24 days, respectively. The mean estimated blood loss was 148.18 ± 93.99 mL, and no injury to the uterine arteries or pelvic nerves occurred. No cases of conversion to a laparotomy or major complications occurred. At the 6-month follow-up, complete remission of dysmenorrhea and menorrhagia occurred in 72.2% and 87.5% of patients, respectively. CONCLUSIONS: Laparoscopic adenomyomectomy with TOUA could be a safe and effective surgical method for women with symptomatic uterine adenomyoma who want to preserve their fertility.

Effects of angiogenesis inhibitor TNP-470 on the development of uterine adenomyosis in mice.

OBJECTIVE: To investigate the effects of angiogenesis inhibitor TNP-470 on uterine microvessels in mice. Pituitary grafting frequently induced uterine adenomyosis. DESIGN: In vivo experimental study. SETTING: Department of Biological Sciences, University of Tokyo and Medical Research Institute, Tokyo Medical and Dental University. ANIMAL(S): SHN mice, which are known to develop uterine adenomyosis spontaneously, and also very soon after pituitary grafting. INTERVENTION(S): Immunohistochemical study on uterine blood vessels using an antibody to von Willebrand factor in pituitary gland-implanted mice with or without TNP-470. MAIN OUTCOME MEASURE(S): Reduced incidence of uterine adenomyosis. RESULT(S): Twelve of 15 mice developed uterine adenomyosis with dilated blood vessels, but none of the TNP-470-treated mice with shrunken microvessels. The number of bromodeoxyuridine immunoreactive cells and activities of thymidylate synthase and thymidine kinase in uterine tissues were markedly reduced in TNP-470-treated mice. CONCLUSION(S): TNP-470, a potent inhibitor of the development of vascular endothelium, reduced the development of endometrial blood vessels resulting in a lowered incidence of uterine adenomyosis induced by pituitary grafting in mice, and reduced the increase in S-phase cells and enzyme activity for pyrimidine nucleotide synthesis.

[Color Doppler ultrasound determination of the differential structure of breast tumors]. / Farbdopplersonographische Dignitätsbeurteilung von Mammatumoren.

Eighty-seven women with mammographically suspicious breast lesions were investigated prior to surgery. 32 breast carcinomas and 55 benign lesions were evaluated for the resistance index, the pulsatility index, the flow velocity and the acceleration index. Our study showed the resistance index with a threshold value of 0.70 to be best suited to differentiate benign tumors from malignant ones. In this series, the sensitivity of color Doppler ultrasonography for the detection of breast carcinomas was 84%, and the specificity 80%. The positive predictive value was 71% and the negative predictive value 90%. Color Doppler scanning offers one possible method for further investigation of patients with mammographic abnormalities and can help to reduce the number of unnecessary breast biopsies.