Lichong decoction inhibits micro-angiogenesis by reducing the expressions of hypoxia inducible factor-1α and vascular endothelial growth factor in hysteromyoma mouse model.

OBJECTIVE: To investigate the efficacy of Lichong decoction (LD) from Traditional Chinese Medicine, on micro-angiogenesis in a mouse model of hysteromyoma. METHODS: A mouse model of hysteromyoma was developed by orthotopic intrauterine injection of primary human myoma cells isolated from patients from the Beijing Obstetrics and Gynecology Hospital into CB-17 Scid mice. Mice were administered high-dose LD, low-dose LD, mifepristone or water (control) daily by gavage for 4 weeks. Uterine diameter and coefficient (uterine weight/body weight) were measured. Uterine morphology was assessed by light microscopy (hematoxylin and eosin) and transmission electron microscopy. Serum levels of estradiol, progesterone, follicle-stimulating hormone and luteinizing hormone (LH) were measured by enzyme-linked immunosorbent assay. Uterine protein expression of hypoxia inducible factor (HIF)-1α, CD31 and proliferating cell nuclear antigen (PCNA) was detected by immunohistochemistry. VEGF and HIF-1α mRNAs were quantified by RT-PCR. RESULTS: High-dose LD, low-dose LD and mifepristone reduced uterine diameter and coefficient, and attenuated the morphologic abnormalities associated with hysteromyoma. High-dose LD, low-dose LD and mifepristone inhibited hysteromyoma-induced micro-angiogenesis, as evidenced by a decrease in the number of new microvessels co-immunostaining for CD31 and PCNA (P < 0.01). High-dose LD and mifepristone lowered serum levels of estradiol, progesterone and LH (P < 0.05). High-dose LD, low-dose LD and mifepristone down-regulated HIF-1α mRNA and protein expressions and VEGF mRNA expression (P < 0.01). CONCLUSION: The inhibition of hysteromyoma by LD may involve reductions in HIF-1α and VEGF expression and suppression of micro-angiogenesis.

A Prospective Intervention Trial on Tailored Radiofrequency Ablation of Uterine Myomas.

Background and Objective: Investigating the use of radiofrequency myolysis (RFM) for the treatment of fibroids through less invasive access by combining transvaginal ultrasound, hysteroscopy and laparoscopy. Materials and Methods: Fifty-four premenopausal women with 106 symptomatic uterine myomas. Patients underwent RFM in three ways: Vaginal Ultrasound-guided RFM (VU-RFM), Laparoscopic RFM (L-RFM) and Hysteroscopic-RFM (H-RFM). The mean patient age was 43 years; 52 symptomatic uterine myomas were subserosal, 44 intramural and 10 submucosal. The outcomes evaluated at 1 and 12 months after RFM were myoma size (volume-diameter), "Uterine Fibroid Symptom and Quality of Life (UFS-QOL)" questionnaire and a 10-point Visual Analogue Scale (VAS). The therapy was completed with a single ablation in all patients, no complication was registered. The average number of fibroids treated per intervention was two with the use of different accesses: 64/106 VU-RFMs (60.4%), 32/106 L-RFMs (30.2%) and 10/106 H-RFMs (9.4%). Results: Volume and diameter of fibroids were significantly reduced by, respectively, 51.3% and 20.1% in the first 30 days post-intervention (p < 0.001) up to a maximum of 73.5% and 37.1% after the second follow-up visit at 12 months (p < 0.001). A similar trend was shown in terms of disability with a progressive and significant reduction of symptoms (menorrhagia, dysmenorrhea, dyspareunia and pollakiuria) demonstrated by percentage variation of UFS-QOL Symptom Severity and VAS scores to -74.3% and -45.3% as well as -84.9% and -74.3%, respectively, at 1 and 12 months after RFM (p < 0.001). An overall improvement in the quality of life was also demonstrated by a significant increase in the UFS-QOL total score of +38.2% in the first 30 days post-intervention up to +44.9% after the second follow-up visit at 12 months (p < 0.001). The overall average surgery time of the RFM for each patient was 48 minutes, and the time to treat each fibroid by Vaginal Ultrasound-guided RFM (23 min) was found to be significantly less than those of laparoscopy or hysteroscopy (respectively 35 and 34 min) (p < 0.05). An electromagnetic virtual needle tracking system (VNTS) was successfully tested during the RFM procedures, and real-time contrast-enhanced ultrasound (CEUS) has proven to be effective in determining the duration of myolysis through the identification of eventual residual areas of enhancement within the fibroids. Conclusion: Radiofrequency can be considered a minimally invasive and safe procedure for the treatment of uterine myomas through the customization and possible combination of transvaginal, laparoscopic or hysteroscopic accesses. The standardization of the ablation technique with pre-intervention biopsy and new technologies such as VNTS and CEUS spares healthy uterine tissue and may change the future management of symptomatic uterine fibroids.

Combination Treatment of Preoperative Embryo Cryopreservation and Endoscopic Surgery (Surgery-ART Hybrid Therapy) in Infertile Women with Diminished Ovarian Reserve and Uterine Myomas or Ovarian Endometriomas.

STUDY OBJECTIVE: To analyze the clinical outcomes of and predictive factors for the therapeutic effect of combination treatment of preoperative embryo cryopreservation and endoscopic surgery (surgery-assisted reproductive technology [ART] hybrid therapy) in infertile women with diminished ovarian reserve (DOR) with uterine fibroids and/or ovarian endometriomas. DESIGN: Retrospective cohort study. SETTING: Data from all patients who underwent surgery-ART hybrid therapy at Juntendo University Hospital and Sugiyama Clinic between 2014 and 2016 were analyzed retrospectively. We compared women who experienced live birth (success group) and implantation failure or miscarriage (failure group) after surgery-ART hybrid therapy and evaluate the predictive factors for live birth. PATIENTS: A total of 39 infertile women underwent surgery-ART hybrid therapy with 86 embryo transfer cycles. INTERVENTIONS: All women underwent ART treatment for embryo cryopreservation preoperatively, reproductive surgery, and warmed embryo transfer after the postoperative contraceptive interval (surgery-ART hybrid therapy) for women with DOR (anti-Müllerian hormone <1.0 ng/mL) and/or advanced reproductive age (>40 years) with uterine myomas and/or ovarian endometriomas who required surgery. RESULTS: Among 39 women underwent surgery-ART hybrid therapy, 1 woman acquired no embryo after oocyte retrieval trials and abandoned efforts to conceive, 14 experienced childbirth (success group) and 24 (63.2%) experienced implantation failure or miscarriage (failure group) after surgery-ART hybrid therapy. The median patient age was 40 years (interquartile range [IQR], 38-41 years) in the success group and 41.5 years (IQR, 41-42 years) in the failure group (p = .032). The respective serum anti-Müllerian hormone levels were 2.5 ng/mL (range, 0.1-8.6 ng/mL) and 1.3 ng/mL (range, 0.1-4.2 ng/mL) (p = .396), and the respective numbers of preoperative frozen were 5.0 (range, 4.0-6.0) and 2.0 (range, 1.0-3.0) (p < .001). There were no significant differences in surgical findings of myomas and endometriosis between the 2 groups. Compared with the 24 women who experienced hybrid therapy failure, the 14 who underwent successful surgery-ART hybrid therapy were significantly younger and had a greater number of cryopreserved embryos. CONCLUSION: Successful surgery-ART hybrid therapy requires a sufficient preoperative age-specific number of frozen embryos, establishment of ART treatment with stable pregnancy outcomes and skillful reproductive surgery, and a strong desire of the patient and doctor for pregnancy.

HISTOPATHOLOGIC FINDINGS IN WOMEN UNDERGOING HYSTEROSCOPIC RESECTION OF ENDOMETRIAL POLYPS AND UTERINE MYOMAS.

The aim of our study was to determine the prevalence of endometrial premalignant and malignant lesions in women undergoing hysteroscopy and to identify anthropologic factors related to the presence of malignancy. Data on 3470 women with submucosal myomas or endometrial polyps suspected on ultrasound were retrospectively analyzed. Hysteroscopy was performed in all these women in order to make a more precise diagnosis. Histologic analysis of endometrial samples obtained during hysteroscopy was used to confirm the diagnosis. Statistical analysis was performed using the SPSS 20.0.0 software. The mean age of study women was 49.1±13.3 years. The number of procedures performed due to the referral diagnosis of endometrial or submucosal myoma significantly increased over the 16-year study period. A significantly higher number of women had a benign histopathologic diagnosis. Histologic analysis revealed malignancy in 67 women. The youngest woman and oldest woman with malignant findings was aged 32 and 75, respectively. A significantly higher number of women with atypical hyperplasia and malignancy were in menopause. A comparable number of women with different histologic findings lived in urban and rural areas. There were a significantly larger proportion of widows among women with the histologic diagnosis of atypical hyperplasia or malignancy. The prevalence rate of malignancy in women having undergone hysteroscopy for polyps and myoma found by ultrasound was 1.93%. Postmenopausal status and older age were associated with an increased risk of malignancies, but premalignant changes and malignancies were also found in young and premenopausal women. Therefore, diagnostic hysteroscopy can be recommended in women of all age groups.

Myomas and Adenomyosis: Impact on Reproductive Outcome.

Among uterine structural abnormalities, myomas and adenomyosis represent two distinct, though frequently coexistent entities, with a remarkable prevalence in women of reproductive age. Various mechanisms have been proposed to explain the impact of each of them on reproductive outcome. In respect to myomas, current evidence implies that submucosal ones have an adverse effect on conception and early pregnancy. A similar effect yet is not quite clear and has been suggested for intramural myomas. Still, it seems reasonable that intramural myomas greater than 4 cm in diameter may negatively impair reproductive outcome. On the contrary, subserosal myomas do not seem to have a significant impact, if any, on reproduction. The presence of submucosal and/or large intramural myomas has also been linked to adverse pregnancy outcomes. In particular increased risk for miscarriage, fetal malpresentation, placenta previa, preterm birth, placenta abruption, postpartum hemorrhage, and cesarean section has been reported. With regard to adenomyosis, besides the tentative coexistence of adenomyosis and infertility, to date a causal relationship among these conditions has not been fully confirmed. Preterm birth and preterm premature rupture of membranes, uterine rupture, postpartum hemorrhage due to uterine atony, and ectopic pregnancy have all been reported in association with adenomyosis. Further research on the impact of adenomyosis on reproductive outcome is welcome.

Response to comment on "Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation".

According to the literature review, CO2 insufflation on parasitic myoma implantation is not well studied, and we concur that our study is related to "Morcellation-induced parasitic myomas." We did not compare CO2 insufflation to non-insufflation in our study. The reason is the efficacy of gasless laparoscopic myomectomy and morcellation is not well established and this modality is seldom performed. Moreover, the effects of pneumoperitoneum on mesothelial cells and the role of the entire peritoneal cavity as a cofactor in adhesion formation have become well established, the role of CO2 insufflation in the establishment of parasitic myomas has not yet been studied. As such, more in-depth and well-designed studies for the role of CO2 insufflation are needed.

[Clinical features of patients of older age groups with uterine myoma].

The study analyzed 301 patients with uterine cancer at the age of 45 years and older and 304 patients with uterine myoma 45 years. It was found that patients with uterine myoma of the older age group (45 and older) have the following clinical features: overweight and thus increased BMI these women, a lower percentage of a family history of uterine cancer, a smaller percentage of infertility, a greater number of pregnancies, births, medical abortions, the high prevalence of diseases of the cardiovascular system and pathology of the cervix, large size fibroids and as a consequence more common compartment syndrome adjacent organs by myoma nodes (disuric disorders).

Delayed presentation of a paracytic myoma fragment after laparoscopic supracervical hysterectomy requiring small bowel resection. A case report.

BACKROUND: Uterine myomas are commonly treated with laparoscopic myomectomy or hysterectomy. Morcellation is often required to evacuate tissue through the laparoscopic incisions using a designated morcellator or through extension of a port site with self-retaining retractor and a cold scalpel. Both techniques carry a risk of inadvertently leaving tissue fragments behind. CASE: We present a case of a parasitic fragment of morcellated uterus that became adherent to the small bowel, resulting in severe abdominal pain and requiring exploratory laparotomy and small bowel resection 5 months later. CONCLUSION: Gynecologic surgeons should be aware of possible delayed postoperative complications that can result from parasitic myoma fragments inadvertently left behind followinig morcellation.

[Results of uterine artery embolization in the treatment of symptomatic uterine myoma].

OBJECTIVE: To evaluate the uterus and myomatous nodules by ultrasonography and magnetic resonance imaging in different periods after uterine artery embolization (UAE). MATERIAL AND METHODS: UAE was performed in 632 patients with different forms of uterine myoma. With this aim in mind, 120 cases with different forms of uterine myoma were analyzed. RESULTS: Following 1, 3, 6, and 12 months, the reduction in myomatous nodules was estimated to be 18.4 and 17.3, 40.7 and 42.9, 60.4 and 61.8 and 72.5 and 74.7%, respectively (p < 0.05). Necrotic exposure of a nodule, expulsion of myomatous nodules, and removal of a partially nascent submucous nodule were observed in 18 (15%) patients. Laparoscopic myomectomy of subserous myomatous nodules was carried out in 12 (10%) cases after UAE. In doing this, interoperative blood loss was 50-80 ml. CONCLUSION: UAE is an organ-sparing, highly effective uterine myoma treatment performed alone or in combination with surgery in relation to its different forms.

Mioma intracervical: morcelación histeroscópica / Intracervical myoma: Hysteroscopic morcellation

A lo largo de la historia de la histeroscopia, múltiples cambios se han producido en la técnica a nivel del medio de distensión, de la óptica o mejora de la imagen para disminuir sus complicaciones. Recientemente se ha diseñado un morcelador histerosco´pico con la intención de facilitar el uso y disminuir los riesgos de la técnica previa. Caso clínico: Mujer premenopáusica que presenta hipermenorreas con anemia acompañante muy sintomática. En la ecografía transvaginal se objetiva mioma intracervical de 2 cm. La histeroscopia diagnóstica corrobora el diagnóstico. Mediante la exposición del siguiente caso clínico, se pretende presentar las ventajas del OHS (Operative Hysteroscopy System). Conclusión: El morcelador histeroscópico significa un gran avance de la histeroscopia en términos de seguridad, eficacia, reproducibilidad y rapidez(AU)

Throughout the history of hysteroscopy, many technical changes have been made to reduce its complications, involving the distension medium, optics and image enhancement. Recently, we designed a hysteroscopic morcellator intended to facilitate hysteroscopy use and reduce the risks of the previous technique. Case report: A premenopausal woman presented with hypermenorrhea and highly symptomatic anemia. Transvaginal ultrasound revealed a 2-cm myoma. The diagnosis was confirmed by diagnostic hysteroscopy. This case illustrates the benefits of the operative hysteroscopy system. Conclusion: The hysteroscopic morcellator represents a major advance in hysteroscopy in terms of safety, efficiency, reproducibility and speed(AU)

Primeros 3 casos en España de gestación a término tras tratamiento de miomas mediante cirugía no invasiva MRgFUS / First three cases in Spain of term pregnancy after treatment of uterine fibroid with non-invasive MRgFUS surgery

La tecnología MRgFUS (magnetic resonance guided focused ultrasound surgery) es una técnica de cirugía no invasiva basada en la necrosis coagulativa térmica del tejido mediante la concentración —focalización— de ultrasonidos guiados por resonancia magnética. Es una novedosa tecnología aprobada por la Food and Drug Administration norteamericana en 2004 y por la Unión Europea (marca CE) en 2006 para el tratamiento de los miomas uterinos. En 2010 recibió la aprobación CE para el tratamiento de la adenomiosis y se está desarrollando para el tratamiento no invasivo de otras patologías tumorales, principalmente en oncología. Presentamos los primeros 3 casos de gestaciones tras tratamiento de miomas conseguidos en Instituto Cartuja, único centro en España con la tecnología MRgFUS, concluyendo que se trata de una técnica fiable, segura y efectiva para el tratamiento de fibromas uterinos incluso en mujeres con deseo genésico (AU)

Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a non-invasive surgical technique based on thermal coagulative necrosis of tissue by focused ultrasound guided by magnetic resonance. This fairly recent technique was approved by the American Food and Drug Administration in 2004 and by the European Union in 2006 for the treatment of uterine fibroids. In 2010 MRgFUS was approved by the European Union (CE label) for the treatment of adenomyosis and is being developed for the non-invasive treatment of other tumoral diseases, mainly in oncology. We present the first three cases of pregnancy achieved at the Instituto Cartuja, the only site in Spain with MRgFUS technology. We conclude that MRgFUS is a safe, reliable and effective technique for the treatment of uterine fibroids, even in women with a desire to preserve fertility (AU)

Myomas and reproductive function.

The purpose of this Educational Bulletin is to examine the relationship between myomas and reproductive function and to review current methods for their management.

¿Cuál es la utilidad de la histeroscopia en la posmenopausia? / How useful is hysteroscopy in the postmenopausal period?

En los últimos años se ha desarrollado la histeroscopia, tanto desde el punto de vista diagnóstico como terapéutico, que se ha llevado desde los quirófanos hasta el consultorio. La histeroscopia permite con una mayor precisión definir el diagnóstico etiológico de un síntoma muy importante en la mujer mayor como es el sangrado uterino anormal. La mujer en edad de posmenopausia, que utiliza o no terapia hormonal, en algunas circunstancias se puede valorar con la ayuda de la histeroscopia, enfatizando que no es un estudio para uso rutinario (AU)

In the last few years, hysteroscopy has been developed both from the diagnostic and therapeutic points of view and its use has been extended from the operating room to the physician’s office. This technique improves the accuracy of etiologic diagnosis of abnormal uterine bleeding in older women. Postmenopausal women, irrespective of whether they are receiving hormone replacement therapy, may undergo hysteroscopic examination in some circumstances. However, we emphasize that this procedure should not be used routinely (AU)

Implantation in IVF.

The recent advances in assisted reproduction have made it possible to study and interfere in almost every step of the human reproductive process except for implantation. The most complex and important step remains in great part unknown. Implantation in human has proven to be less efficient compared with other species. However, in in vitro fertilization (IVF) patients, it has been evaluated to be even poorer. This paper highlights the factors related to infertile patients and IVF treatments that can affect implantation and implantation's clinical aspects related to these treatments: implantation failure and early pregnancy loss.

The use of levonorgestrel - IUD in the treatment of uterine myoma in Thai women.

OBJECTIVE: This study was designed to evaluate the potential usefulness of the levonorgestrel-releasing intrauterine device (LNG - IUD ; Mirena) in treating women with uterine myomas. DESIGN: Prospective before-and-after (comparing) study. SETTING: Department of Obstetrics and Gynecology King Chulalongkorn Memorial Hospital. SUBJECTS: Sixteen women with uterine myomas who intended to receive treatment with the LNG IUD. INTERVENTION(S): Clinical and ultrasound examinations were performed prior to and at 1, 3 and 6 months after the LNG IUD insertion. MAIN OUTCOME MEASURES: Myoma and Uterine volume, menstrual blood loss assessed with pictorial blood loss assessment charts and hematocrit. RESULTS: Use of the LNG IUD was associated with a statistically significant reduction in the total myoma volume, average uterine size and marked reduction in menstrual blood loss. After 6 months of use, the median total myoma volume decreased from 19.82 mL to 11.63 mL (p < 0.05), median pictorial blood loss assessment chart score declined from 89 to 3 (p < 0.05). Hematocrit level increased over 6 months of use. The most common side effects were bleeding disturbances (68.8%). No pregnancies occurred during the study. CONCLUSION: The LNG IUD was associated with a profound reduction in myoma and uterine volume. For women with myomas of this size, the LNG IUD provides effective medical treatment of bleeding.

[Submucosal isthmicocervical myoma--problems of diagnosis, labor and puerperium]. / Submukozna istmikotservikalna mioma--problemi na diagnozata, razhdaneto i puerperiuma.

A case of submucosal isthmicocervical myoma, 85 mm in diameter, diagnosed for first time during CS. The neonate is with atrophy of left m. sternocleidomastoideus and facial asymmetry due to impression in the left temporoparietal region, without neurological impairment. Multiple ultrasound examinations were done but the fibroids vas not diagnosed. During one examination we presume that the fibroid was mistaken for the head because the BPD was in great discrepancy with other ultrasound parameters of the fetus. During the operation OICC was not found that is why the dilatation was made through the vagina. A myomectomy was not made during the operation. Because of the pressure and the deformation of the cervical canal from the myoma a drain was inserted through the canal to facilitate the evacuation of the lochia. The post operative period passed without any complications, the drainage was taken off on the 7th post operative day and the patient was discharged on the 8th day.

Uterine myomas and factors associated with hysterectomy in premenopausal women.

OBJECTIVE: Our purpose was to describe clinical characteristics in premenopausal women with uterine myomas and to identify factors associated with hysterectomy. STUDY DESIGN: Data were collected by chart abstraction in 421 premenopausal women with myomas and analyzed by univariate and multivariable regression. RESULTS: Over a median follow-up period of 29 months, 86% of women had symptoms associated with myomas and 40% had an increase in uterine size of > 2 gestational weeks. By multivariable regression, bleeding symptoms at presentation and previous surgical history of cholecystectomy and adhesiolysis were significantly associated with greater odds of hysterectomy. There was a significant interaction between age and uterine size, so that as age increased, uterine size had a greater impact on the likelihood of hysterectomy. CONCLUSIONS: In this cohort of premenopausal women myomas were associated with symptoms in almost all women over the follow-up period. Hysterectomy was performed in 22% of women overall.

Miomatósis uterina. Estudio retrospectivo 1993

El presente es un estudio retrospectivo realizado amediante la revisión de historias clínicas con diagnóstico clínico e hispatológico de miomatósis uterina, desde enero a diciembre de 1993, en el Hospital Gineco-obstétrico Isidro Ayora. Obtuvimos un total de 60 casos, la media de la edad de las pacientes fue de 42.96 años con una desviación estandar de 6.18. El 90.3 por ciento fueron multíparas y solo un 4.8 por ciento utilizaron anticonceptivos orales,. El cuadro clínico dominante fue: dolor hipogástrico, sangrado genital anormal, palpitación dolorosa, irregularidad uterina y masa pélvica. Se confirmó el diagnostico mediante ECO pélvico en 96.6 por ciento de pacientes. El 63.3 por ciento presentó PAP TEST clase II con una media de la edad en estas pacientes de 43.25 años. En la mayor parte de pacientes el tumor invadió una sola capa uterina (45 por ciento) y de estos el 74 por ciento fue de localizaci{on intramural...