Improvement in parameters of quality of life and uterine volume reduction after uterine fibroid embolization / Melhora em parâmetros de qualidade de vida e redução do volume uterino após embolização de artérias uterinas

ABSTRACT Objective To evaluate improvement in quality of life, reduction of uterine volume, and the correlation between these two variables after uterine fibroid embolization. Methods Data on quality of life before and after uterine fibroid embolization were collected from 60 patients using the Uterine Fibroid Symptom - Quality of Life questionnaire. In 40 of these patients, uterine volume information on magnetic resonance imaging examinations performed before and after uterine fibroid embolization was collected, and compared using the nonparametric Wilcoxon test for paired data. Correlation between quality of life and uterine volume before and after procedure was measured using Spearman's correlation coefficient. Results There was significant improvement in quality of life after uterine fibroid embolization on Uterine Fibroid Symptom - Quality of Life questionnaire, in both subscales scores and the total score. There was a significant median reduction of -37.4% after uterine fibroid embolization, but no correlations between uterine volume and quality of life scores were found before or after embolization. Conclusion Uterine embolization is an alternative to treat uterine fibroids, resulting in relief of symptoms and better quality of life. Although reduction in uterine volume plays an important role in the evaluation of therapeutic success, it does not necessarily have a definitive correlation with relief of symptoms.

RESUMO Objetivo Avaliar a melhora na qualidade de vida e a redução do volume uterino, além da correlação entre essas duas variáveis, após a embolização de artérias uterinas. Métodos Foram coletados dados de 60 pacientes sobre qualidade de vida antes e depois da embolização de artérias uterinas com a aplicação do questionário Uterine Fibroid Symptom - Quality of Life. Informações sobre o volume uterino em exames de ressonância magnética realizada antes e depois do procedimento foram coletadas em 40 dessas pacientes e comparadas por meio de teste não paramétrico de Wilcoxon para dados pareados. A correlação entre qualidade de vida e volume uterino antes e depois do procedimento foi determinada pelo coeficiente de Spearman. Resultados Houve melhora significativa na qualidade de vida das pacientes após embolização de artérias uterinas nos escores do questionário Uterine Fibroid Symptom - Quality of Life, tanto das subescalas como do total. Houve redução mediana significativa (-37,4%) no volume uterino após embolização de artérias uterinas, embora não tenha sido estabelecida qualquer correlação entre volume uterino e escores de qualidade de vida antes e depois da embolização. Conclusão A embolização de artérias uterinas é alternativa para o tratamento de fibroide uterina, resultando na melhora dos sintomas e da qualidade de vida. Embora a redução do volume uterino seja fator importante na avaliação do sucesso terapêutico, não está necessariamente correlacionada com melhora de sintomas.

Radiation-Induced Uterine Carcinosarcoma after Concurrent Chemoradiotherapy for Cervical Squamous Cell Carcinoma

Abstract Objective To describe a case of radiation-induced uterine carcinosarcoma 6 years after a cervical squamous cell carcinoma treatment, which imposed some diagnostic and management challenges. Case Report A 57-year-old woman with a history of pelvic chemoradiotherapy ~ 6.5 years before the event described in this study, following an International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer, presented with a cervical mass, involving the uterine cavity, the cervical canal and the upper two thirds of the vagina. The biopsy showed a poorly differentiated carcinoma, and a positron emission tomography (PET) scan excluded distant metastasis, although it was unable to define the origin of the tumor as either a new primary malignancy of the endometrium/cervix or as a cervical recurrence. Surgical staging procedure was performed, and the diagnosis was endometrial carcinosarcoma, FIGO stage IIB. The patient was not able to complete the adjuvant therapy, and the progression of the disease was remarkable. Conclusion The present case highlights one of the less common but more serious consequences of radiotherapy for cervical cancer, which has an increasing incidence in younger women, raising concerns about the long-termconsequences of its management.

Leiomiosarcoma primario vaginal en el embarazo. A propósito de un caso / Primary vaginal leiomyosarcoma in pregnancy. About A case

RESUMEN Los sarcomas primarios de vagina son extremadamente raros especialmente durante la gestación. Se presenta el caso de una gestante de 25+2 semanas que acude a urgencias con clínica de sangrado vaginal objetivándose a la exploración una formación nodular dependiente de pared vaginal derecha. Dada la clínica se reseca en quirófano con el hallazgo histopatológico de leiomiosarcoma. A la gestante se le realiza sin incidencias una cesárea en la semana 34 de gestación, previa maduración pulmonar fetal, completándose en el puerperio inmediato el estudio de extensión sin encontrarse ningún hallazgo relevante. Finalmente, se somete a la paciente a una histerectomía y salpinguectomía bilateral con preservación ovárica. El seguimiento y los controles sucesivos de la gestante en los meses posteriores muestran ausencia de enfermedad.

ABSTRACT Primary sarcomas of the vagina are extremely rare, especially during pregnancy. We report a case of a 25-week-pregnant who came to emergency room complaining of vaginal bleeding. Pelvic examination revealed a globular mass located on the right vaginal wall. Given the persistent bleeding, resection of the mass was performed. The specimen was sent to pathology and confirmed to be a leiomyosarcoma. At 34-weeks of pregnancy after fetal lung maturation a cesarean section is done. It was completed the extension study during immediate postpartum without any relevant finding. Finally, she had a totally hysterectomy and bilateral salpingectomy with ovarian preservation. Clinical follow-up over the following months shows no evidence of disease.

Major clinical research advances in gynecologic cancer in 2015 / 부인종양

In 2015, fourteen topics were selected as major research advances in gynecologic oncology. For ovarian cancer, high-level evidence for annual screening with multimodal strategy which could reduce ovarian cancer deaths was reported. The best preventive strategies with current status of evidence level were also summarized. Final report of chemotherapy or upfront surgery (CHORUS) trial of neoadjuvant chemotherapy in advanced stage ovarian cancer and individualized therapy based on gene characteristics followed. There was no sign of abating in great interest in immunotherapy as well as targeted therapies in various gynecologic cancers. The fifth Ovarian Cancer Consensus Conference which was held in November 7–9 in Tokyo was briefly introduced. For cervical cancer, update of human papillomavirus vaccines regarding two-dose regimen, 9-valent vaccine, and therapeutic vaccine was reviewed. For corpus cancer, the safety concern of power morcellation in presumed fibroids was explored again with regard to age and prevalence of corpus malignancy. Hormone therapy and endometrial cancer risk, trabectedin as an option for leiomyosarcoma, endometrial cancer and Lynch syndrome, and the radiation therapy guidelines were also discussed. In addition, adjuvant therapy in vulvar cancer and the updated of targeted therapy in gynecologic cancer were addressed. For breast cancer, palbociclib in hormone-receptor-positive advanced disease, oncotype DX Recurrence Score in low-risk patients, regional nodal irradiation to internal mammary, supraclavicular, and axillary lymph nodes, and cavity shave margins were summarized as the last topics covered in this review.

Evaluación económica del tratamiento antimicrobiano en pacientes histerectomizadas por fibroma uterino / Economic evaluation of antimicrobial treatment in hysterectomized patients for uterine fibroma

ANTECEDENTES: Las infecciones constituyen la principal causa de morbilidad luego de las cirugías ginecológicas. Debido al uso irracional de los antimicrobianos y la poca adherencia a los protocolos de actuación, se decidió investigar la alternativa clínica más eficiente entre las existentes para alcanzar un objetivo sanitariamente deseable. OBJETIVOS: Realizar una evaluación económica del uso de los antimicrobianos en las pacientes operadas con diagnóstico de fibroma uterino en el Hospital "Agostinho Neto", Guantánamo, Cuba, durante el periodo abril-mayo de 2012 para lograr un uso racional de estos medicamentos, disminuir riesgo de resistencia antimicrobiana, incidencia de infección de la herida quirúrgica y costos por concepto de medicamentos. MÉTODO: Estudio retrospectivo, en base a revisión de historias clínicas, se determinó la edad de las pacientes, tipo de cirugía, antimicrobianos más utilizados y duración del tratamiento. Se realizó una evaluación económica total del tipo minimización de costos. RESULTADOS: El 61,64% de las pacientes tenían entre 41-50 años. El 81,62% de las cirugías se clasificó como limpia contaminada; el antimicrobiano más utilizado fue la cefazolina como monoterapia (51,28%); el 84,62% de las pacientes recibió tratamiento durante 2 días; el 100% de las prescripciones resultó inadecuada; el costo global por concepto de antimicrobianos fue de 3.242,65 pesos cubanos y se hubiese obtenido un ahorro aproximado de 827,80 pesos cubanos de haberse aplicado correctamente las protocolos de actuación. CONCLUSIÓN: Los profesionales del servicio de ginecología no se adhieren a los protocolos de profilaxis antibiótica preoperatoria, aumentando los costos por medicamentos.

BACKGROUND: Infections are the main cause of morbidity after gynecological surgeries. Due to the irrational use of antimicrobials and little adherence to protocols, it decided to investigate the most efficient clinical alternative among existing sanitary desirable to reach a goal. AIMS: To perform an economic evaluation of the use of antimicrobials in patients operated with a diagnosis of uterine fibroid in the "Agostinho Neto" Hospital, Guantanamo, Cuba, during the period April-May 2012 to achieve a rational use of these drugs reduce risk of antimicrobial resistance, incidence of surgical wound infection and costs for drugs. METHOD: A retrospective study was made, the medical records were reviewed, the patient age, type of surgery, most commonly used antimicrobial and duration of treatment was determined: an overall economic assessment, the type was minimization of costs. RESULTS: 61.64% of the patients were between 41-50 years old; the 81.62% of the surgeries were classified as clean contaminated; cefazolin was the most antimicrobial used as monotherapy (51.28%); 84.62% of the patients received treatment for 2 days; 100% of prescriptions was inadequate; the overall cost was 3,242.65 Cuban pesos and has been obtained savings of approximately 728.80 Cuban pesos if the protocols have been correctly applied. CONCLUSION: Gynecology service professionals do not adhere to the protocols of preoperative antibiotic prophylaxis, increasing drug cost.

Predictive factors for pelvic magnetic resonance in response to arterial embolization of a uterine leiomyoma

OBJECTIVE: Minimally invasive methods are used as alternatives to treat leiomyomas and include uterine artery embolization, which has emerged as a safe, effective method. This study aims to evaluate the magnetic resonance imaging predictors for a reduction in leiomyoma volume in patients undergoing uterine artery embolization. METHODS: This prospective longitudinal study was performed at a university hospital. We followed 50 symptomatic premenopausal women with uterine leiomyomas who underwent uterine artery embolization. We examined 179 leiomyomas among these patients. Magnetic resonance imaging was performed one month before and six months after uterine artery embolization. Two radiologists who specialized in abdominal imaging independently interpreted the images. Main Outcome Measures: The magnetic resonance imaging parameters were the uterus and leiomyomas volumes, their localizations, contrast perfusion pattern and node-to-muscle ratio. RESULTS: Six months after treatment, the average uterine volume reduction was 38.91%, and the leiomyomas were reduced by 55.23%. When the leiomyomas were submucosal and/or had a higher node-to-muscle ratio in the T2 images, the volume reduction was even greater (greater than 50%). Other parameters showed no association. CONCLUSIONS: We conclude that symptomatic uterine leiomyomas in patients undergoing uterine artery embolization exhibit volume reductions greater than 50% by magnetic resonance imaging when the leiomyomas are submucosal and/or had a high node-to-muscle ratio in the T2 images. .

Embolização das artérias uterinas com partículas de PVA-PVAC esférico como preparo para posterior ressecção cirúrgica de miomas / Uterine artery embolization with spherical pva-pvac particles as preparation for surgical resection of miyomas

OBJETIVO: avaliar a utilização de uma nova partícula de polivinil álcool e polivinil acetato (PVA-PVAc) esférica, para embolização das artérias uterinas, em pacientes portadoras de mioma, com indicação cirúrgica. MÉTODOS: doze pacientes foram submetidas à embolização de miomas uterinos com partículas de PVA-PVAc. Três a nove meses depois, realizou-se uma laparotomia com miomectomia. Analisaram-se os seguintes parâmetros: volume do útero e do maior mioma; concentrações do hormônio folículo estimulante e de hemoglobina; sangramento menstrual (número de dias e de absorventes utilizados), sinais e sintomas antes do tratamento, após a embolização e após a miomectomia. RESULTADOS: a média de idade foi 37 anos e a média do volume uterino, previamente ao tratamento, de 939,3cc. Três anos após a embolização, observou-se diminuição do volume uterino (p=0,0005). Houve melhora na concentração de hemoglobina (p= 0,0004), com elevação após a embolização, sem variação subsequente à miomectomia. Não ocorreu variação significante do hormônio folículo estimulante, (p=0,17). Não foi constatado nenhum caso de falência ovariana, mas uma das pacientes apresentou atrofia de endométrio. Duas pacientes engravidaram, com bons indicadores obstétricos. Quanto aos sinais e sintomas, houve melhora após a embolização, que se manteve após a miomectomia. CONCLUSÃO: a embolização arterial com partículas de PVA-PVAc esférico mostrou-se promissora no preparo para uma intervenção cirúrgica com retirada dos miomas, pois, associou-se à redução do volume uterino, à diminuição do sangramento operatório e tornou possível a utilização de incisões menores, aumentando a chance de preservação do útero.

OBJECTIVE: To evaluate the use of a new spherical particle of polyvinyl alcohol and polyvinyl acetate (PVA-PVAc) for uterine artery embolization in patients with myoma with surgical indication. METHODS: twelve patients underwent uterine myoma embolization with PVA-PVAc particles. Three to nine months later, they were submitted to laparotomy with myomectomy. We analyzed the following parameters: volume of the uterus and of the bigger myoma; concentrations of follicle stimulating hormone and hemoglobin; menstrual bleeding (number of days and used absorbents), signs and symptoms before treatment, after embolization and after myomectomy. RESULTS: The mean age was 37 years and mean uterine volume prior to treatment, 939.3 cc. Three years after embolization, there was reduction in uterine volume (p = 0.0005), increase in hemoglobin concentration after embolization (p = 0.0004), without variation after the myomectomy. There was no significant variation of the follicle stimulating hormone (p = 0.17). There was no case of ovarian failure, but one of the patients had endometrial atrophy. Two patients became pregnant, with good obstetric indicators. Signs and symptoms improved after embolization, and remained after myomectomy. CONCLUSION: Arterial embolization with spherical PVA-PVAc particles is promising in the preparation for myoma surgery, since it was associated with a reduction in uterine volume, decrease in intraoperative bleeding and made possible the use of smaller incisions, increasing the chance of preserving the uterus.

Acesso a serviços de saúde para o controle do câncer do colo uterino na atenção básica / Acceso a los servicios de salud para la lucha contra el cáncer de cuello uterino en atención primaria / Access to health services for the control of cancer of the uterine cervix in primary care

Objetivo: Analisar o controle do câncer do colo uterino a partir do enfoque do acesso a serviços de saúde. Método: Estudo transversal utilizando-se consulta documental e inquérito domiciliar com análise do cálculo de frequências de varáveis selecionadas. Resultados: Os resultados do último exame citológico mostraram maior frequência de metaplasia escamosa imatura; lesão intraepitelial de baixo grau (LSIL); lesão intraepitelial de alto grau (HSIL) e células escamosas atípicas de significado indeterminado (ASC-US), predominantemente em mulheres na faixa etária de 25 a 64, pardas, casadas/convivência marital e donas de casa, com queixas clínicas de corrimento, sangramento e ocorrência de DSTs (inclusive HPV). Conclusão: Não há acompanhamento longitudinal das mulheres na área geográfica de adscrição 47 da USF Nova Natal II desde a coleta do exame citológico até a liberação da mulher, pela alta, do programa de controle do câncer de colo uterino

Objective: To analyze the control of cancer of the cervix from the focus of access to health services. Method: A crosssectional study using consultation documentary and household survey with analysis of calculation of frequencies of selected variables. Results: The results of the last cytological examination showed higher frequency of squamous metaplasia immature; intraepithelial lesion of low grade (LSIL); Intraepithelial Lesion high grade (HSIL) and atypical squamous cells of undetermined significance (ASC-US), predominantly in women In the age group 25 to 64, brown, married/marital harmony and housewives, with clinical complaints of vaginal discharge, bleeding and the occurrence of stds (including HPV). Conclusion: There is no longitudinal follow-up of women in the geographical area of enrollment 47 of USF Nova Natal II from the collection of cytological examination until the discharge by cure

Objetivo: Analizar la lucha contra el cáncer del cuello del útero con el enfoque de acceso a los servicios de salud. Método: Estudio transversal mediante consulta documental y una encuesta de hogares con análisis de cálculo de frecuencias de variables seleccionadas. Resultados: Los resultados del último examen citológico mostraron una mayor frecuencia de metaplasia escamosa inmadura; lesión intraepitelial de baixo grado (ILSA); lesión escamosa intraepitelial de alto grado (NIEA) y células escamosas atípicas de significado indeterminado (ASC-US), principalmente en las mujeres en el grupo de edad de 25 a 64, de piele morena, casadas/armonía conyugal y amas de casa, con quejas clínicas de la secreción vaginal y sangrado, y la aparición de las ETS (incluyendo el VPH). Conclusión: No hay un seguimiento longitudinal de las mujeres en el área geográfica de inscripción 47 de USF Nova Natal II a partir de la colección de examen citológico hasta la liberación de la mujer, por la alta del programa de control de cáncer del cuello uterino

Leiomiomatose uterina: revisão / Uterine leiomyomatosis: review

Os leiomiomas uterinos são tumores monoclonais que se originam de uma mutação somática em um miócito progenitor. Representam a neoplasia benigna mais comum do útero. A causa precisa relacionada ao seu desenvolvimento ainda não foi totalmente esclarecida. As apresentações clínicas mais frequentes são o sangramento anormal, a dor e pressão pélvicas, massa pélvica não diagnosticada anteriormente e infertilidade. O diagnóstico baseia-se na história clínica, no exame físico, que pode ser completamente normal em alguns casos, e nos achados de exames complementares, como a ultrassonografia endovaginal, a histerossonografia e a ressonância magnética. O tratamento varia de acordo com a apresentação clínica e pode ser expectante, clínico ou cirúrgico.

The uterine leiomyomas are monoclonal tumors that originate from a somatic mutation in a myocyte progenitor and are the most common benign tumor of the uterus. The precise cause related to its development has not been fully clarified. The most common clinical presentations are abnormal vaginal bleeding, pelvic pain and pressure, previously undiagnosed pelvic mass, and infertility. The diagnosis is based on clinical history, physical examination, which may be completely normal in some cases, and the findings of laboratory tests such as transvaginal ultrasound, the sonohysterography, MRI. Treatment varies according to clinical presentation and may be expectant, medical or surgical.

RE: Uterine Fibroid Treatment Planning with the Diffusion Weighted Imaging Tool

No abstract available.

Miomas sintomáticos: ¿miomectomía o embolización de las arterias uterinas? / Symptomatic uterine leiomyoma: myomectomy or uterine artery embolization?

Objetivo: Evaluar las complicaciones asociadas a la miomectomía laparotómica y a la embolización de las arterias uterinas en mujeres con miomas sintomáticos. Métodos: Estudio descriptivo restrospectivo efectuado en el Complejo Hospitalario Universitario de Vigo desde el año 2008 al 2010. La población en estudio la conformaron aquellas mujeres sometidas a una miomectomía laparotómica o a una embolización de las arterias uterinas. Se recopilaron las complicaciones registradas en las historias clínicas de las pacientes tras las técnicas. Resultados: La tasa de complicaciones en el grupo de las pacientes sometidas a miomectomía fue de 15,2 por ciento; las más frecuentes fueron fiebre, anemia, necesidad de trasfusión y hematoma subcutáneo. La tasa de complicaciones en el grupo de embolización fue de 4,5 por ciento recogiéndose casos de síndrome postembolización, mioma parido y un caso de histerectomía. Conclusión: La adecuada indicación de cada técnica es fundamental para tener una baja tasa de complicaciones. Se debe tener en cuenta la sintomatología, tipo y número de miomas, edad y deseo genésico de cada paciente.

Objective: This study was undertaken to evaluate the complications after laparotomy myomectomy and uterine artery embolization in women with symptomatic uterine leiomyoma. Methods: This was a descriptive and retrospective study of patients who were treated with embolization and myomectomy for leiomyomas from 2008-2010. Complications were measured. Results: The rate of complications collected in the myo-mectomy group was 15.2 percent; there were cases of fever, anemia, need for transfusion and subcutaneous hematoma. The rate of complications collected in the embolization group was 4.5 percent; there were cases of embolization syndrome, transcervical fibroid expulsion and a case of hysterectomy. Conclusion: The suitable indication of every tecnic is fundamental to have a low rate of complications. It is necessary to bear in mind the symptomatology, type and number of myomas and age and reproductive desire of each patient.

Uterine Artery Embolization for Symptomatic Fibroids with High Signal Intensity on T2-Weighted MR Imaging

OBJECTIVE: To evaluate the effectiveness of uterine artery embolization (UAE) for treating symptomatic fibroids with high signal intensity (SI) on magnetic resonance (MR) T2-weighted imaging (T2WI). MATERIALS AND METHODS: A total of 537 cases, consisting of 14 patients with high SI fibroids on T2WI (T2 high group), were retrospectively included and compared with 28 randomly selected patients with low SI fibroids on T2WI (control group). High SI of a predominant fibroid on T2WI was defined as having the same or higher SI than the myometrium. Patient ages ranged from 28 to 52 years (mean, 38.1 years). All patients underwent MRI before and after UAE. Predominant fibroid and uterine volumes were calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, with 0 being no symptoms and 10 being the baseline, or initial symptoms. RESULTS: Of the patients in the T2 high group, 13 out of 14 (92.9%) patients demonstrated complete necrosis of the predominant fibroids. The mean volume reduction rates of the predominant fibroids in the T2 high group was 61.7% at three months after UAE, which was significantly higher than the volume reduction rates of 42.1% noted in the control group (p < 0.05). Changes in symptom scores for menorrhagia and dysmenorrhea after UAE (baseline score minus follow-up score) were 4.9 and 7.5 in T2 high group and they were 5.0 and 7.7 in control group, suggesting a significant resolution of symptoms (p < 0.01) in both groups but no significant difference between the two groups. CONCLUSION: UAE is effective for uttering fibroids showing high SI on T2WI. The mean volume reduction rate of the predominant fibroids three months after UAE was greater in the T2 high group than in the control group.

Impacto da embolização arterial do leiomioma uterino no volume uterino, diâmetro do mioma dominante e na função ovariana / Impact of the myoma arterial embolization by uterine volume, diameter myoma greater and in the ovarian function

RESUMO OBJETIVO: Avaliar o impacto da embolização arterial de miomas (EAM) sobre o volume uterino (VU), na função ovariana. MÉTODOS: Trinta pacientes com leiomioma se submeteram à EAM. Foram realizados exames de USPTV e FSH antes e três meses após a EAM. Foram analisados o VU em cm³, o diâmetro do mioma dominante (DMD) em cm e o FSH em UI/mL, expressos por média desvio padrão (DP) e submetidos a análise estatística pelo teste não paramétrico de Mann-Whitney. RESULTADOS: Foram incluidos na análise 29 casos. A média do VU pré-EAM foi 402,4 165,9 cm³, DMD pré-EAM 5,9 2,1 cm. O VU pós-EAM foi 258,9 118,6 cm³, DMD pós-EAM foi 4,6 1,8 cm. A média da dosagem de FSH pré-EAM foi 4,9 3,5 UI/mL e pós-EAM foi 5,5 4,7 UI/mL com p=0,5. Houve redução de 35 por cento do VU, de 22 por cento no DMD e a EAM não alterou significativamente os valores de FSH após três meses. CONCLUSÃO: O procedimento diminui significativamente o VU e DMD e, não há aumento significativo dos níveis séricos de FSH, não havendo, portanto, alterações na função ovariana.

PURPOSE: To evaluate the impact of uterine artery embolization (UAE) on uterine volume (UV), greater myoma diameter (GMD) and ovarian function three months after the procedure, by transvaginal pelvic ultrasonography (TVPUS) and by the determination of follicle-stimulating hormone (FSH). METHODS: Thirty patients with leiomyomas were submitted to UAE. TVPUS and FSH determination were performed before and three months after UAE. UV was determined in cm³, GMD in cm and FSH in IU/mL. Data are reported as as mean standard deviation (SD) and were analyzed statistically by the nonparametric Mann-Whitney test. RESULTS: Twenty-nine patients were analyzed. Before UAE, mean UV was 402.4 165.9 cm³ and GMD was 5.9 2.1 cm. After UAE, mean UV was 258.9 118.6 cm³ and GMD was 4.6 1.8 cm. Mean FSH concentration was 4.9 3.5 IU/mL before UAE and 5.5 4.7 IU/mL after UAE, with p=0.5. There was a 35 percent reduction of UV and a 22 percent reduction of GMD, with no changes in FSH values after three months. CONCLUSION: The procedure significantly reduced UV and GMD but did not cause a significant increase in FSH levels, thus causing no changes in ovarian function.

Pregnancy after uterine arterial embolization

OBJECTIVE: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. METHODS: A retrospective study of 187 patients treated with uterine arterial embolization for symptomatic uterine fibroids between 2005-2008 was performed. Uterine arterial embolization was performed using polyvinyl alcohol particles (500-900 mm in diameter). Pregnancies were identified using screening questionnaires and the study database. RESULTS: There were 15 spontaneous pregnancies. Of these, 12.5 percent were miscarriages (n = 2), and 87.5 percent were successful live births (n = 14). The gestation time for the pregnancies with successful live births ranged from 36 to 39.2 weeks. The mean time between embolization and conception was 23.8 months (range, 5-54). One of the pregnancies resulted in twins. The newborn weights (n = 14) ranged from 2.260 to 3.605 kg (mean, 3.072 kg). One (7.1 percent) was considered to have a low birth weight (2.260 kg). There were two cases of placenta accreta (12.5 percent, treated with hysterectomy in one case [6.3 percent]), one case of premature rupture of the membranes (PRM) (6.3 percent), and one case of preeclampsia (6.3 percent). All of the patients were delivered via Cesarean section. CONCLUSION: In this study, there was an increased risk of Cesarean delivery. There were no other major obstetric risks, suggesting that pregnancy after uterine arterial embolization is possible without significant morbidity or mortality.

Embolização de mioma uterino em mulheres portadoras de miomas volumosos / Uterine fibroid embolization in women with giant fibroids

OBJETIVO: avaliar a eficácia da embolização de mioma uterino (EMUT) em pacientes com miomas volumosos no que diz respeito tanto à evolução clínica quanto à redução do tamanho dos mesmos. MÉTODOS: vinte e seis pacientes com média etária de 36,5 anos, portadoras de miomas uterinos sintomáticos com volume acima de 1.000 cm³, foram submetidas à EMUT. Todas possuíam indicação para tratamento percutâneo. Os procedimentos foram realizados sob anestesia epidural e sedação, empregando-se protocolo institucional de analgesia. Após punção femoral unilateral, foi realizado o cateterismo seletivo das artérias uterinas e infusão de microesferas calibradas por meio de microcateter. A avaliação clínica pós-procedimento foi realizada em ambulatório de ginecologia segundo o protocolo de atendimento. Todas as pacientes tinham ressonância nuclear magnética (RNM) antes do procedimento e 15 pacientes RNM de controle após 6 meses. RESULTADOS: o sucesso técnico foi de 100 por cento. Não houve complicação relacionada aos procedimentos. A média de volume uterino das 15 pacientes foi 1.401 cm³ antes da embolização (min. 1.045 cm³, max. 2.137 cm³) e, após 6 meses 799 cm³ (min. 525 cm³, max. 1.604 cm³), constituindo uma redução média de 42,9 por cento. A melhora clínica foi constatada em 25 das 26 pacientes. Uma paciente com útero de 1.098 cm³ apresentou necrose e expulsão parcial do mioma, sendo submetida à miomectomia. Outra paciente foi submetida à miomectomia após seis meses devido ao desejo de gravidez, apesar da redução parcial do volume dos miomas. Uma paciente com volume uterino de 2.201 cm³ necessitou de segunda intervenção para alcançar um resultado adequado. Nenhuma paciente foi submetida à histerectomia. Foram utilizadas em média 9,2 seringas de microesferas por paciente. CONCLUSÃO: a embolização de miomas uterinos de grande volume é um procedimento factível, com aceitáveis resultados clínico e radiológico. Pode ser considerada uma opção para as pacientes que desejam a preservação uterina e também servir como terapêutica adjuvante à miomectomia de alto risco.

PURPOSE: to evaluate the effectiveness of uterine fibroid embolization (UFE) in patients with giant fibroids, with regard to both clinical outcomes and size reduction. METHODS: twenty-six patients with a mean age of 36.5 years, carrying symptomatic fibroids with a volume over 1,000 cm³, were referred for UFE. All patients had indication for percutaneous treatment. The procedures were performed under epidural anesthesia and sedation, using an institutional protocol. By unilateral femoral access, selective catheterization of uterine arteries and infusion of calibrated microspheres through microcatheter were carried out. Clinical evaluation was performed by means of regular outpatient gynecology consultation. All patients underwent magnetic resonance imaging (MRI) before the procedure and 15 patients underwent control MRI after 6 months. RESULTS: technical success was 100 percent. There was no complication related to the procedures. Mean uterine volume of the 15 patients studied was 1,401 cm³ before embolization (min 1,045 cm³, max 2,137 cm³) and 799 cm³ after 6 months (525 cm³ min, max. 1,604 cm³), resulting in a total reduction of 42.9 percent. Clinical improvement was observed in 25 of 26 patients. One woman with uterine volume of 1,098 cm³ who developed necrosis and partial fibroid expulsion underwent myomectomy. Another patient was submitted to myomectomy six months after the procedure because she wanted to become pregnant, despite partial fibroid size reduction. One patient with a uterine volume of 2,201 cm³ required a second intervention to achieve an adequate angiographic result. No patient underwent hysterectomy. On average, 9.2 microsphere syringes were used per patient. CONCLUSION: embolization of giant uterine fibroids is a feasible procedure with acceptable clinical and radiological outcomes. It can be considered an option for patients who desire to preserve the uterus, and it may serve as adjuvant therapy for high-risk myomectomy.

Virus del papiloma humano: Marcador de respuesta a radioterapia/quimiorradioterapia en cáncer cervical / Human papilloma-virus: Marker of response to radiotherapy/chemoradiotherapy in cervical cancer / Papilomavírus humano: marcador de resposta à radioterapia / quimiorradioterapia em câncer de colo uterino

El cáncer cérvico-uterino (CaCU) representa el 6% de todas las neoplasias malignas en mujeres. Evidencia epidemiológica y molecular implican al virus del papiloma humano (VPH) en la etiopatogenia del CaCU y los genotipos más frecuentemente asociados son el 16 y 18 (VPH-16 y -18). La radioterapia (RT) y la quimiorradiación (RT-QT) son las dos modalidades de tratamiento primario para el CaCU, con tasas variables de resistencia o persistencia de la enfermedad. El objetivo de este trabajo fue estudiar, por primera vez, la respuesta tumoral antes, durante y después de la RT y la RT-QT y analizar la carga viral de VPH-16 y -18 en pacientes mexicanas con CaCU. Se obtuvieron muestras de tejido tumoral en pacientes con CaCU: antes, durante y después de la RT y RT-QT, se determinó el número de copias absolutas del VPH-16 o -18 y se estudió la respuesta en relación a la carga viral por PCR en tiempo real. La disminución de la carga viral de VPH para RT-QT y RT fue de 100 y 62%, respectivamente. Se observó una mejor respuesta con la modalidad de tratamiento combinado, por lo que se sugiere que la carga viral de VPH (-16 y -18) podría ser un potencial indicador para evaluar la respuesta de ambos tratamientos en el CaCU.

Cervical cancer (CaCU) represents 6% of all malignancies in women. Molecular and epidemiological evidence relate the human papilloma virus (HPV) with the pathogenesis of the CaCU genotypes, the most frequent genotypes being 16 and 18 ( VPH-16 and -18). Radiotherapy (RT) and chemoradiotherapy (ChRT) are the two primary treatment modalities for CaCU, with variable rates of resistance or persistence of the disease. The aim of this work was to study for the first time, the tumorai response before, duríng and after RT and RT-QT and analyze HPV-16 and -18 viral load in a Mexican population with CaCU. Samples of tumor tissue were collected from patients with CaCU: before, duríng and after RT and ChRT. The absolute number of HPV-16 or -18 copies was determined, and the response related with viral load in both treatments was studíed by real-time PCR-based in fluorescence. The percentage of decrease ín HPV viral load for ChRT and RT was 100% and 62%, respectívely With ChRT, the response was better than with RTalone. HPV (-16 and -18) viral load ís suggested to be a potentíal índícator to evalúate CaCU response in both treatments.

Estratégias para redução da exposição de radiação ionizante em mulheres submetidas à embolização de miomas uterinos / Strategies for reduction of exposure to ionizing radiation in women undergone to uterine fibroid embolization

OBJETIVO: quantificar a dose de radiação ionizante absorvida pelo ovário e pela pele em pacientes submetidas à embolização de miomas uterinos (EMUT), assim como sugerir um protocolo radiológico voltado à redução dos riscos envolvidos neste procedimento. MÉTODOS: setenta e três mulheres consecutivas (média etária de 27 anos), participantes de protocolo de pesquisa institucional, portadoras de miomas uterinos sintomáticos com indicação de tratamento minimamente invasivo, foram submetidas a procedimento de EMUT. Foram calculadas a estimativa de radiação absorvida pelos ovários por meio de dosímetros vaginais e a estimativa de dose de entrada na pele, por cálculos indiretos de absorção de radiação. As primeiras 49 pacientes fizeram parte do Grupo Pré-alteração e as últimas 24, do Grupo Pós-alteração. O segundo grupo recebeu um protocolo modificado de imagem radiológica, com redução pela metade do número de quadros por segundo durante as arteriografias, idealizado na tentativa de enquadrar os valores obtidos aos existentes na literatura, assim como foi evitado ao máximo a exposição desnecessária ao feixe de raios X. RESULTADOS: não houve complicações técnicas em nenhum dos procedimentos realizados. Não houve diferenças entre o tempo médio de fluoroscopia ou entre o número médio de arteriografias entre os dois grupos. Foi obtida uma redução de 57 por cento na estimativa de dose ovariana absorvida entre as pacientes dos dois grupos (29,0 versus 12,3 cGy), assim como uma redução de 30 por cento na estimativa de dose absorvida pela pele (403,6 versus 283,8 cGy). CONCLUSÕES: a redução significativa da absorção de radiação em pacientes submetidas a procedimentos de EMUT pode ser alcançada pela modificação do número de quadros por segundo nas aquisições arteriográficas, assim como pela implantação rotineira das normas de proteção radiológica.

PURPOSE: to determine the dose of ionizing radiation absorbed by the ovaries and the skin of patients undergoing uterine fibroid embolization (UFE), and to suggest a radiologic protocol directed at reducing the risks involved in this procedure. METHODS: seventy-three consecutive women (mean age: 27 years) participating in an institutional research protocol, having symptomatic uterine fibroids with indication for minimally invasive treatment, underwent UFE. We estimated the radiation absorbed by the ovaries by means of vaginal dosimeters and the radiation dose absorbed by the skin by means of indirect calculations of radiation absorption. The first 49 patients belonged to the Pre-modification Group, and the last 24, to the Post-modification Group. The second group received a modified protocol of X-ray imaging, with a reduction by half of the frames number per second during arteriography, in an attempt to match the values obtained to those of the literature, and avoiding as much as possible unnecessary exposure to the X-ray beam. RESULTS: there were no technical complications in any of the procedures performed. There were no differences in the mean fluoroscopy time or in the mean number of arteriographies between the two groups. We obtained a 57 percent reduction in the estimated absorbed ovarian dose between groups (29.0 versus 12.3 cGy) and a 30 percent reduction in the estimated dose absorbed by the skin (403.6 versus 283.8 cGy). CONCLUSIONS: a significant reduction in the absorption of radiation in patients undergoing UFE can be achieved by changing the number of frames per second in angiographic series, and by the routine use of radiological protection standards.

Clear cell carcinoma of the uterus

The aim of this study was to determine the characteristics and outcome of patients presenting with clear cell carcinoma [CCC] of the endometrium treated in a single institution. We reviewed the records of patients treated in the Salah-Azaiz institute for CCC of the endometrium. A histopathological stage was retrospectively assigned to these patients according to the FIGO classification and was compared to the clinical stage. Pathological features were studied in order to determine predictive factors of extrauterine disease extention and failure patterns. 12 patients were included in the study. The mean age at diagnosis was 64 years [50 to 84 yrs]. Upstaging after surgery was found in 9 patients. 9 patients had extrauterine extension. Deap myometrial invasion was not correlated with extrauterine extension. After a median follw up of 32 months, 4 patients presented with recurrences: one vaginal recurrence, two cases of pelvic and abdominal recurrence and abdominal recurrence in one patient. All recurrences occurred during the first year after surgery. Tumor recurrence was located within the radiation field in one case. Two paients with abdomino-pelvic recurrences progressed despite the association of surgery, radiation therapy and chemotherapy. Extrauterine extension is frequent at diagnosis and not correlated to classical risk factors observed in endometrioid carcinoma. A comptlete surgical staging is necessary for adjuvant treatment. Locoregional and distant recurrences are frequent and have a poor outcome