Comparison of outcomes of hysteroscopic myomectomy of type 2 submucous fibroids greater than 4 cm in diameter via pretreatment with HIFU or GnRH-a.

OBJECTIVE: To compare the efficacy and safety of high-intensity focused ultrasound (HIFU) and gonadotropin-releasing analogues (GnRH-a) as pretreatments for the hysteroscopic transcervical resection of myoma (TCRM) for type 2 submucosal fibroids greater than 4 centimeters in diameter. MATERIALS AND METHODS: Seventy-nine patients were assigned into two groups according patient preference: 42 in HIFU and 37 in GnRHa. TCRM was performed after 3 months of pretreatment with HIFU or GnRHa. RESULTS: Following pretreatment with HIFU or GnRHa, uterine-fibroid symptom (UFS) scores and hemoglobin levels (HGB) showed improvement. The fibroid maximum diameter, size of fibroids, and volume of the uterus were decreased. Following HIFU pretreatment, one case reported complete vaginal fibroid expulsion, and four reported partial fibroid expulsion. No similar cases were found in the GnRHa group. Eighteen patients were lost to follow-up prior to TCRM. Among the 31 patients in HIFU, the fibroids were downgraded to type 0 in 10 cases and type 1 in 5 cases. Of the 30 patients in GnRHa, the treated fibroids were downgraded to type 1 in 9 cases. The mean operation time and intraoperative blood loss of the HIFU group were significantly lower than those in the GnRHa group. No significant differences were observed in the incidence of intraoperative complications and the one-time resection rate of fibroids between the two groups (p>.05). CONCLUSIONS: HIFU seems to be superior to GnRHa as a pretreatment method prior to TCRM for type 2 submucosal fibroids greater than 4 centimeters in diameter.

High-intensity Focused Ultrasound for Treatment of Type 2 Submucous Myomas More Than 4 Centimeters in Diameter Prior to Hysteroscopic Myomectomy.

STUDY OBJECTIVE: To assess the feasibility of treating type 2 submucous myomas more than 4 cm in diameter with high-intensity focused ultrasound (HIFU) prior to hysteroscopic myomectomy (HM). DESIGN: Retrospective case series evaluating HIFU treatment of type 2 submucous myomas before HM, with efficacy compared with baseline (i.e., before treatment). SETTING: Teaching hospital. PATIENTS: Five women with type 2 submucous myomas more than 4 cm in diameter (mean, 5.6 cm; range, 4.7-6.3 cm). The mean age of the patients was 40.6 years (31-47 yr); median age 42 years. INTERVENTIONS: Type 2 submucous myomas were treated with HIFU. HM was performed in one step. MEASUREMENTS AND MAIN RESULTS: The time between HIFU and HM was 136 days. The mean volumes of the corpora and myomas were significantly less after HIFU. The mean shrinkage of the corpora and myomas (volume before HIFU/volume before HM × 100%) were 41.4 ± 18.1% and 67.6 ± 17.0%, respectively, which did not differ statistically. All 5 of the submucous myomas changed from type 2 to type 1 or type 0 after HIFU treatment. The percentage of the uterine cavity occupied by the myoma at baseline and after HIFU was 38.8% ± 2.8% and 78.0 ± 21.4%, respectively, a significant increase associated with HIFU. The hemoglobin increased with HIFU, significantly with an elevated value of 11.0 ± 7.5. CONCLUSION: Treatment of type 2 submucous myomas more than 4 cm in diameter with HIFU before HM was effective, with reductions in myoma type (from 2 to 1 or 0) and shrinkage of myoma size. HIFU as a pretreatment should increase the safety of HM.

Magnetic resonance imaging T2WI hyperintense foci number and the prognosis of adenomyosis after high-intensity focused ultrasound treatment.

OBJECTIVE: To investigate the relationship between the number of hyperintense foci of T2-weighted imaging (T2WI) and the efficacy of high-intensity focused ultrasound (HIFU) in the treatment of adenomyosis. METHODS: This prospective cohort study enrolled 102 patients with adenomyosis. Participants were classified into two groups: 50 patients in whom the number of hyperintense foci on magnetic resonance imaging (MRI) T2WI was more than five were placed in the >5 group and 52 patients in whom the number of hyperintense foci on MRI T2WI was five or fewer were placed in the ≤5 group. Uterine fibroid symptoms (UFS) and visual analog scale (VAS) scores were recorded as indicators for the course of adenomyosis treatment. RESULTS: Among the enrolled patients, 84 received HIFU treatment and were followed up. At 6, 12, 24, and 36 months after HIFU treatment, the UFS score of women in the >5 group was higher than that of the patients in the ≤5 group (P < 0.05). The ablation rate of MRI T2WI in the hyperintense foci ≤5 group was higher than the hyperintense foci >5 group (P < 0.05). CONCLUSION: Number of MRI T2WI hyperintense foci is a factor affecting the ablation rate and the clinical efficacy of HIFU treatment in women with adenomyosis. It is likely to be a predictor of the efficacy of HIFU in adenomyosis treatment.

[Effects of CO2 and 5% dextrose solution on expression of CD44 and ICAM-1 in endometrial carcinoma cells].

OBJECTIVE: To investigate the effects of 5% dextrose solution and different CO2 pressures on expression of adhesion molecules (including CD44 and ICAM-1) of endometrial carcinoma cells in vitro. To provide experimental base for the safety question of hysteroscope operation and the selection of better distending medium for the patients with suspected endometrial cancer. METHODS: Endometrial cancer cells (HEC-1-B) were put in 5% dextrose, 70 mmHg 100% CO2, 100 mmHg 100% CO2 at 37 degrees C, the control group was not given any administration, respectively for 1 hour. Expression of CD44 and ICAM-1 were measured at 0, 12, 24, 48 and 72 hours by using flow cytometry. RESULTS: The expression of CD44 and ICAM-1 increased significantly at 0 h-72 h after the cells were exposed to 5% dextrose, 70 mmHg 100% CO2, 100 mmHg 100% CO2 for 1 hour (P<0.05) respectively, and returned to the control levels by 72 h. With the increase of the CO2 pressure, the expression of the CD44 and ICAM-1 increased (P<0.05). The expression of the CD44 and ICAM-1 totally increased significantly compared with control. CONCLUSION: Both high pressure CO2 (100 mmHg) and 5% dextrose solution can increase the expression of CD44 and ICAM-1 in endometrial cancer cells, and may promote the capability of adhesion of endometrial cancer cells. Lower CO2 pressure does not change the expression of CD44 and ICAM-1 in endometrial cancer cells, therefore the low CO2 pressure (70 mmHg) is safer as distending medium for the patients with suspected endometrial cancer.

Management of lumbar spondylodiscitis developing after laparoscopic sacrohysteropexy with a mesh: A case report and review of the literature.

INTRODUCTION: Lumbar spondylodiscitis is a rare and severe complication of laparoscopic sacrohysteropexy with a polypropylene mesh. However, a case of lumbar spondylodiscitis following laparoscopic sacrohysteropexy has not been reported so far. We present a case of lumbar spondylodiscitis following laparoscopic sacrohysteropexy with a mesh. We also discuss 33 cases of lumbar spondylodiscitis following sacral colpopexy and (or) rectopexy with a mesh. PATIENT CONCERNS: A 46-year-old woman with 3 previous vaginal deliveries underwent laparoscopic mesh sacrohysteropexy for stage III uterine prolapse. One month after surgery, the patient developed persistent symptoms, such as stiffness of the lumbosacral portion, low back pain (LBP), persistent swelling, pain between the right iliac crest and the buttock, inability to bend down, and pain in the right lower limb. Symptoms were alleviated by a nonsteroidal anti-inflammatory drug. However, in the last 7 days, symptoms worsened and she was unable to stand or walk. The patient had very limited leg mobility. DIAGNOSIS: Blood routine examination, erythrocyte sedimentation rate, C-reactive protein, and magnetic resonance imaging (MRI) of the lumbar spine indicated lumbar pyogenic spondylodiscitis. INTERVENTIONS: Removal of mesh and hysterectomy via laparoscopy were performed immediately, and antibiotics were given simultaneously. However, on the basis of MRI findings and persistent symptoms, debridement, laminectomy, spinal canal decompression, bone grafting, and internal fixation via pedicle screw placement were performed 5 months after laparoscopic sacrohysteropexy. OUTCOMES: All symptoms were alleviated 5 days after the operation. The patient could stand in the erect position and raise her lower limbs within 2 weeks. She could resume her normal activities within 2 months after the operation, and her X-ray appeared normal. CONCLUSION: Persistent LBP and radiating pain may be the signals of lumbar spondylodiscitis. MRI is the gold standard diagnostic examination for lumbar spondylodiscitis. Awareness of symptoms, such as LBP and radiating pain symptoms, timely diagnosis, mesh removal, and referral to orthopedists are important to prevent more severe complications. Surgical practice needs to be improved further and any other infections should be treated immediately as the most likely causes of lumbar spondylodiscitis are related to the mesh and other infections.