Uterine artery embolisation for symptomatic adenomyosis with polyzene F-coated hydrogel microspheres: three-year clinical follow-up using UFS-QoL questionnaire.

PURPOSE: This study was designed to assess midterm outcome of uterine artery embolisation (UAE) for women with therapy-resistant adenomyosis using polyzene F-coated hydrogel microspheres. METHODS: Between September 2006 and January 2010, 29 consecutive women with adenomyosis (15 in combination with fibroids) were treated with UAE using polyzene F-coated hydrogel microspheres. Junction zone thickness was assessed with MRI at baseline and 3 months. Women filled out the uterine fibroid symptom and quality of life questionnaire at baseline, 3 months and after a mean clinical follow-up of 37 months (median 35, range 29-64 months). RESULTS: At baseline, symptom severity score of 29 women was mean 67 (median 72, range 23-100). At 3 months, this score decreased to mean 22 (median 15, range 0-66) and mean 15 (median 17, range 0-34) at final follow-up. At final follow-up of mean 37 months (median 35, range 29-64 months), 22 of 29 (76 %) patients were asymptomatic. Of these 22 women, 3 underwent a second UAE at 6, 7, and 14 months. The remaining seven patients clinically improved but still had symptoms; one underwent a hysterectomy. There was no difference in outcome between women with pure adenomyosis and women with additional fibroids. The junction zone of 4 women with additional therapy was significantly thicker compared with the remaining 25 patients. CONCLUSIONS: In women with therapy resistant adenomyosis, UAE using polyzene F-coated hydrogel microspheres resulted in 3 years preservation of the uterus in 28 of 29 (97 %) with good clinical outcome in the vast majority of patients. Initial thickness of the junction zone is related to additional therapy.

Long-term follow-up of uterine artery embolization for symptomatic adenomyosis.

INTRODUCTION: Long-term results of uterine artery embolization (UAE) for adenomyosis are largely unknown. We assess long-term outcome of UAE in 40 women with adenomyosis. MATERIALS AND METHODS: Between March 1999 and October 2006, 40 consecutive women with adenomyosis (22 in combination with fibroids) were treated with UAE. Changes in junction zone thickness were assessed with magnetic resonance imaging (MRI) at baseline and again at 3 months. After a mean clinical follow-up of 65 months (median 58 [range 38-129]), women filled out the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire, which had additional questions on the long-term evolution of baseline symptoms and adverse events. RESULTS: During follow-up, 7 of 40 women (18%) underwent hysterectomy. Among these 7 women, the junction zones were significantly thicker, both at baseline (mean 23 vs. 16 mm, P = 0.028) and at 3-month follow-up (mean 15 vs. 9 mm, P = 0.034). Of 33 women with preserved uterus, 29 were asymptomatic. Four patients had symptom severity scores of 50 to 85 and overall QoL scores of 60 to 66, indicating substantial clinical symptoms. There was no relation between clinical outcome and the initial presence of fibroids in addition to adenomyosis. CONCLUSION: In women with therapy-resistant adenomyosis, UAE resulted in long-term preservation of the uterus in the majority. Most patients with preserved uterus were asymptomatic. The only predictor for hysterectomy during follow-up was initial thickness of the junction zone. The presence or absence of fibroids in addition to adenomyosis had no relation with the need for hysterectomy or clinical outcome.

SNP analyses of postprandial responses in (an)orexigenic hormones and feelings of hunger reveal long-term physiological adaptations to facilitate homeostasis.

BACKGROUND: The postprandial responses in (an)orexigenic hormones and feelings of hunger are characterized by large inter-individual differences. Food intake regulation was shown earlier to be partly under genetic control. OBJECTIVE: This study aimed to determine whether the postprandial responses in (an)orexigenic hormones and parameters of food intake regulation are associated with single nucleotide polymorphisms (SNPs) in genes encoding for satiety hormones and their receptors. DESIGN: Peptide YY (PYY), glucagon-like peptide 1 and ghrelin levels, as well as feelings of hunger and satiety, were determined pre- and postprandially in 62 women and 41 men (age 31+/-14 years; body mass index 25.0+/-3.1 kg/m(2)). Dietary restraint, disinhibition and perceived hunger were determined using the three-factor eating questionnaire. SNPs were determined in the GHRL, GHSR, LEP, LEPR, PYY, NPY, NPY2R and CART genes. RESULTS: The postprandial response in plasma ghrelin levels was associated with SNPs in PYY (215G>C, P<0.01) and LEPR (326A>G and 688A>G, P<0.01), and in plasma PYY levels with SNPs in GHRL (-501A>C, P<0.05) and GHSR (477G>A, P<0.05). The postprandial response in feelings of hunger was characterized by an SNP-SNP interaction involving SNPs in LEPR and NPY2R (668A>G and 585T>C, P<0.05). Dietary restraint and disinhibition were associated with an SNP in GHSR (477G>A, P<0.05), and perceived hunger with SNPs in GHSR and NPY (477G>A and 204T>C, P<0.05). CONCLUSIONS: Part of the inter-individual variability in postprandial responses in (an)orexigenic hormones can be explained by genetic variation. These postprandial responses represent either long-term physiological adaptations to facilitate homeostasis or reinforce direct genetic effects.

Oral exposure and sensory-specific satiety.

Satiety has been shown after oral exposure to food that was chewed but not eaten (Modified Sham Feeding (MSF)). The aim of the study was to explore the role of sensory-specific satiety (SSS) in satiety development with MSF. Subjects were studied on three test days in a randomized crossover design; they received, in random order, water, MSF, or a meal. At the start and the end of each course of the lunch condition subjects evaluated appetite sensations, taste perception and pleasantness of taste using Visual Analogue Scales. SSS was present when eating soup and salad. SSS also occurred with MSF of salad. When eating the soup no significant changes in appetite ratings occurred. Hunger decreased and satiety increased while the salad was eaten (p<0.0004). In this condition taste perception did not change significantly and a decrease in pleasantness coincided with an increase in satiety. During the MSF salad taste perception changed, i.e. creaminess and intensity increased (p<0.05 and p<0.02, respectively). When the salad was eaten satiety increased and hunger and desire to eat (DTE) decreased. Chewing the salad resulted only in a decrease in DTE. In this experiment merely chewing a salad produced SSS. We conclude that when SSS takes place during feeding, it is related to an increase in satiety, and a decrease in hunger and DTE. With SSS during MSF, satiety does not increase, nor does hunger decrease, yet DTE decreases. Thus MSF is sufficient for a sensory decrease in DTE despite of lack of satiety.

Uterine fibroids: targeted embolization, an update on technique.

Uterine fibroid embolization has become an attractive alternative therapy for symptomatic uterine fibroids. Since its introduction, the applied embolization technique has undergone several refinements. Complete fibroid devascularization to block uterine arteries was the initial goal. Thereafter, more sophisticated techniques for targeted embolization of the fibroid to preserve cervical and vaginal branches and ovarian anastomosis were being performed by more and more interventionists. In addition, the use of calibrated embolic agents has become more and more popular. In this article we provide an update on the modern uterine fibroid, targeted embolization technique, including a summary of catheterization-related problems, flaws, and tricks.

Skin thickness does not reflect bone mineral density in postmenopausal women.

Skin and bone both contain primarily type I collagen in connective tissue matrices and are assumed to be related due to this common organic constituent. The purpose of this study was to investigate whether skin thickness measurements by ultrasound (US) could be used for screening for low bone mass. In 94 healthy, white, non-smoking women, 1-3 years postmenopause, the thickness of the skin of the left upper arm and forearm was measured by ultrasound (US). These measurements were compared with values of bone mineral density (BMD) as measured by quantitative computed tomography (QCT) of the lumbar spine and quantitative video micro-densitometry (QMD) of the hand. The correlation found between US skin thickness measurements and BMD results was of low magnitude and not significant. It is concluded that US measurements of skin thickness cannot be used to screen early postmenopausal women for low bone mass.

Evaluation of abdominal lymph nodes by ultrasound.

To evaluate the significance of sonographically detected abdominal lymph nodes, the medical records of 100 consecutive patients with abdominal lymphadenopathy were reviewed. The number of lymph nodes, their localizations, dimensions, shape, and architecture were recorded. One hundred ninety-four lymph nodes were found in 63 patients known to have a malignancy; 68 lymph nodes were found in 37 patients with benign diseases. The localization, size, shape, and architecture of all lymph nodes were evaluated. Of the different variables we studied in the evaluation of the abdominal lymph nodes, echogenicity, shape, age of the patient, and a periaortic localization are helpful in the differentiation between benign and malignant involvement. There remains a considerable overlap; in these cases fine-needle aspiration biopsy is the method of choice to establish the diagnosis.

Sonographically detected costo-chondral dislocation in an abused child. A new sonographic sign to the radiological spectrum of child abuse.

A case of an abused child with fractures of the skull, ribs and long bones is presented. Sonographically a costochondral dislocation of the left lower ribs was detected, which has not been reported in the literature.