This review article discusses when hysterectomy should replace myomectomy for treating benign uterine conditions like fibroids. It summarizes various treatment options for fibroids including myomectomy, hysterectomy, uterine artery embolization, magnetic resonance-guided focused ultrasound, and hormonal therapies. The costs of fibroids and different surgical approaches like hysteroscopic, laparoscopic, and robotic myomectomy are also considered. Key factors in deciding between myomectomy and hysterectomy include the patient's desire to preserve fertility, the size and location of fibroids, risk of recurrence, and potential for complications.
A Retrospective Study on Evaluation of Patients with Uterine Fibroid in a Ter...ijtsrd
Uterine fibroids are a major cause of morbidity in women of reproductive age. Hence it is important to evaluate the occurrence of fibroid. An observational retrospective study was carried out in Obstetric and Gynecology Department over a period of 2 months. Each of the cases was scrutinized for sociodemographic, clinical profile and other necessary information. In this study, Fibroid was found to be predominant in premenopausal women. .Parity and number of abortions had no much significance with fibroid diagnosed. The primary management of obese patients were found as weight reduction and diet control. Hysterectomy was done based on large fibroid size. Anju Mam Thomas | Blessy Rachal Boban | Jiya Ann Mathew "A Retrospective Study on Evaluation of Patients with Uterine Fibroid in a Tertiary Care Hospital" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd20311.pdf
Paper URL: https://www.ijtsrd.com/pharmacy/pharmacy-practice/20311/a-retrospective-study-on-evaluation-of-patients-with-uterine-fibroid-in-a-tertiary-care-hospital/anju-mam-thomas
Twins prevalence, problems, and preterm births ajog2010martin-inga
The rate of twin pregnancies in the United States has stabilized at 32 per 1000 births in 2006. Aside from determining chorionicity, first-trimester screening and second-trimester ultrasound scanning should ascertain whether there are structural or chromosomal abnormalities. Compared with singleton births, genetic amniocentesis–related loss at <24 weeks of gestation for twin births is higher (0.9% vs 2.9%, respectively). Selective termination for an anomalous fetus is an option, although the pregnancy loss rate is 7% at experienced centers. For singleton and twin births for African American and white women, approximately 50% of preterm births are indicated; approximately one-third of these births are spontaneous, and 10%
This document discusses the role of ultrasound in managing twin pregnancies. It covers several topics:
1) Ultrasound can accurately determine chorionicity and amnionicity as early as 8-14 weeks, which is important for risk assessment and monitoring.
2) Twin pregnancies have higher risks of complications and congenital anomalies than singletons. Ultrasound screening can detect some anomalies.
3) The risks of chromosomal abnormalities are different for dizygotic and monozygotic twins based on chorionicity. Ultrasound and biochemical screening have lower detection rates for abnormalities in twins compared to singletons.
Histopathological Patterns of Germ Cell Tumours of Ovary in a Tertiary Level ...inventionjournals
This document summarizes research on histopathological patterns of germ cell tumors of the ovary. The study found that benign cystic teratomas (dermoid cysts) made up the highest percentage at 26.47%, followed by dysgerminoma at 1.96%, immature teratoma at 0.98%, and yolk sac tumor at 0.98%. Germ cell tumors are more common in younger patients and can be benign or malignant. The histopathological patterns and characteristics of various germ cell tumors are described, including dysgerminoma, yolk sac tumor, embryonal carcinoma, polyembryoma, choriocarcinoma, and teratomas. Tumor markers such
This document discusses endometrial receptivity and the need for objective biomarkers to diagnose it. While past research identified some potential molecular markers, none have proven clinically useful. Recent transcriptomic analyses using microarrays have defined a gene expression signature that can classify endometrial status, including receptivity, regardless of histological appearance. This led to the development of the Endometrial Receptivity Array (ERA) tool, which uses a customized microarray and algorithm to identify the personalized window of implantation in individual patients, improving outcomes over histological dating alone.
Adenomyosis, is a defined mass of cells within the uterine wall, is characterized as ectopic endometrial tissue within the myometrium in the uterus.
In adenomyosis, a series of immune responses is activated, including changes in both cellular and humoral immunity.
To know related details refer doctors answer --> https://www.icliniq.com/qa/adenomyosis/can-i-conceive-with-adenomyosis
1) Metformin, a drug used to treat type 2 diabetes, inhibits the proliferation, migration, and induces apoptosis of uterine serous carcinoma (USC) cells in both p53-dependent and p53-independent manners.
2) Metformin downregulates the insulin/IGF-I signaling pathway in USC cells by suppressing the IGF-I receptor pathway and activating AMPK, which in turn inhibits mTOR signaling.
3) By inhibiting these growth factor signaling pathways, metformin shows promise as a potential novel therapeutic approach for treating human USC, an aggressive form of endometrial cancer.
A Retrospective Study on Evaluation of Patients with Uterine Fibroid in a Ter...ijtsrd
Uterine fibroids are a major cause of morbidity in women of reproductive age. Hence it is important to evaluate the occurrence of fibroid. An observational retrospective study was carried out in Obstetric and Gynecology Department over a period of 2 months. Each of the cases was scrutinized for sociodemographic, clinical profile and other necessary information. In this study, Fibroid was found to be predominant in premenopausal women. .Parity and number of abortions had no much significance with fibroid diagnosed. The primary management of obese patients were found as weight reduction and diet control. Hysterectomy was done based on large fibroid size. Anju Mam Thomas | Blessy Rachal Boban | Jiya Ann Mathew "A Retrospective Study on Evaluation of Patients with Uterine Fibroid in a Tertiary Care Hospital" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd20311.pdf
Paper URL: https://www.ijtsrd.com/pharmacy/pharmacy-practice/20311/a-retrospective-study-on-evaluation-of-patients-with-uterine-fibroid-in-a-tertiary-care-hospital/anju-mam-thomas
Twins prevalence, problems, and preterm births ajog2010martin-inga
The rate of twin pregnancies in the United States has stabilized at 32 per 1000 births in 2006. Aside from determining chorionicity, first-trimester screening and second-trimester ultrasound scanning should ascertain whether there are structural or chromosomal abnormalities. Compared with singleton births, genetic amniocentesis–related loss at <24 weeks of gestation for twin births is higher (0.9% vs 2.9%, respectively). Selective termination for an anomalous fetus is an option, although the pregnancy loss rate is 7% at experienced centers. For singleton and twin births for African American and white women, approximately 50% of preterm births are indicated; approximately one-third of these births are spontaneous, and 10%
This document discusses the role of ultrasound in managing twin pregnancies. It covers several topics:
1) Ultrasound can accurately determine chorionicity and amnionicity as early as 8-14 weeks, which is important for risk assessment and monitoring.
2) Twin pregnancies have higher risks of complications and congenital anomalies than singletons. Ultrasound screening can detect some anomalies.
3) The risks of chromosomal abnormalities are different for dizygotic and monozygotic twins based on chorionicity. Ultrasound and biochemical screening have lower detection rates for abnormalities in twins compared to singletons.
Histopathological Patterns of Germ Cell Tumours of Ovary in a Tertiary Level ...inventionjournals
This document summarizes research on histopathological patterns of germ cell tumors of the ovary. The study found that benign cystic teratomas (dermoid cysts) made up the highest percentage at 26.47%, followed by dysgerminoma at 1.96%, immature teratoma at 0.98%, and yolk sac tumor at 0.98%. Germ cell tumors are more common in younger patients and can be benign or malignant. The histopathological patterns and characteristics of various germ cell tumors are described, including dysgerminoma, yolk sac tumor, embryonal carcinoma, polyembryoma, choriocarcinoma, and teratomas. Tumor markers such
This document discusses endometrial receptivity and the need for objective biomarkers to diagnose it. While past research identified some potential molecular markers, none have proven clinically useful. Recent transcriptomic analyses using microarrays have defined a gene expression signature that can classify endometrial status, including receptivity, regardless of histological appearance. This led to the development of the Endometrial Receptivity Array (ERA) tool, which uses a customized microarray and algorithm to identify the personalized window of implantation in individual patients, improving outcomes over histological dating alone.
Adenomyosis, is a defined mass of cells within the uterine wall, is characterized as ectopic endometrial tissue within the myometrium in the uterus.
In adenomyosis, a series of immune responses is activated, including changes in both cellular and humoral immunity.
To know related details refer doctors answer --> https://www.icliniq.com/qa/adenomyosis/can-i-conceive-with-adenomyosis
1) Metformin, a drug used to treat type 2 diabetes, inhibits the proliferation, migration, and induces apoptosis of uterine serous carcinoma (USC) cells in both p53-dependent and p53-independent manners.
2) Metformin downregulates the insulin/IGF-I signaling pathway in USC cells by suppressing the IGF-I receptor pathway and activating AMPK, which in turn inhibits mTOR signaling.
3) By inhibiting these growth factor signaling pathways, metformin shows promise as a potential novel therapeutic approach for treating human USC, an aggressive form of endometrial cancer.
This document discusses several types of rare childhood intestinal tumors, including pediatric gastrointestinal stromal tumors (GIST), myofibromatosis, carcinoid tumors, colorectal carcinoma, inflammatory pseudotumors, leiomyoma, and lymphoma. It notes that pediatric GISTs differ from adult GISTs in their multifocal location, lack of common mutations, and indolent behavior. Myofibromatosis commonly involves the skin, muscle or viscera and can spontaneously regress, while extensive intestinal involvement carries significant risks. Carcinoid tumors typically originate in the stomach, small intestine or appendix. Colorectal carcinoma is rare in children but accounts for 2% of adolescent malignancies.
Wilm's tumor, also known as nephroblastoma, is a type of kidney cancer that typically affects children under the age of 5. It makes up about 6% of all childhood cancers. The tumor is caused by the abnormal growth of kidney cells that would normally develop into mature kidney tissue. Wilm's tumor is associated with genetic syndromes that involve mutations in genes like WT1. Patients with certain birth defects like WAGR or Beckwith-Wiedemann syndrome have a higher risk of developing Wilm's tumor. The cancer presents as a soft, homogeneous mass in the kidney and is characterized by the presence of blastemal, stromal, and epithelial cells under the microscope. Treatment involves
Gestational trophoblastic diseases (GTD) are a group of pregnancy-related neoplasms originating from abnormal proliferation of trophoblast cells. They range from benign conditions like complete and partial hydatidiform moles to malignant tumors such as choriocarcinoma. The incidence of GTD varies significantly worldwide depending on factors like maternal age, prior molar pregnancies, and ethnicity. Molecular studies show that complete hydatidiform moles have a paternal chromosomal contribution and lack expression of maternally imprinted genes like p57, distinguishing them from partial moles which are triploid. Immunohistochemistry is useful in diagnosis and classification of GTD.
This document discusses pineal region tumors (PRTs). It covers the epidemiology, pathology, clinical presentation, radiological features, and treatment of various PRTs. The most common PRTs are germ cell tumors (GCTs), which make up about 70% of cases. GCTs include germinomas and non-germinomatous germ cell tumors. Primary parenchymal tumors and other rare tumor types can also affect the pineal region. Surgical resection or biopsy is needed for diagnosis and treatment planning, though radiological features alone cannot determine the tumor type. Management involves controlling hydrocephalus, obtaining a tissue diagnosis, and utilizing adjuvant therapies like radiation and chemotherapy based on the specific tumor pathology.
Fertility Preservation In Cancer Pt Fin (2)guest7f0a3a
This document summarizes fertility preservation techniques for cancer patients, including embryo freezing, oocyte freezing, and ovarian tissue banking. It discusses methods such as slow freezing versus vitrification for oocyte cryopreservation. The document also reviews factors that influence chemotherapy-induced premature menopause and the potential protective effects of GnRH analogues. Surgical procedures for fertility preservation like ovarian transposition are also mentioned.
This document provides an overview of Wilms tumor, including its epidemiology, pathogenesis, clinical presentation, diagnosis, staging, and treatment. Key points include:
- Wilms tumor is the most common renal tumor in children and occurs most often in children around 3 years old.
- Treatment involves surgery to remove the tumor, chemotherapy, and sometimes radiation therapy. A multidisciplinary approach with these modalities can cure Wilms tumor in most cases.
- Prognosis depends on staging and histopathology. Earlier stages and tumors with favorable histology have a better prognosis. Current therapies have increased overall survival rates to around 90%.
Endometrial cancer is the most common gynecologic malignancy in developed countries. Symptoms include postmenopausal bleeding, irregular heavy periods, and endometrial cancer cells found on Pap smear. Risk factors include obesity, infertility, estrogen therapy, and genetics. Diagnosis involves ultrasound, biopsy, and CT or MRI. Staging involves assessing for spread beyond the uterus to the cervix, ovaries, lymph nodes, or distant sites. Treatment depends on stage but commonly involves hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection, with radiation or chemotherapy for more advanced stages. Prognosis is best for stage I disease.
Early Prediction, Proper Planning can lead to Prevention of Disastrous Progre...Indraneel Jadhav
Uterine Leiomyosarcoma (LMS), the rare, aggressive tumours carrying poor prognosis are mostly diagnosed incidentally at time of myomectomy/hysterectomy done for a presumed benign condition.
The incidence of LMS is1 in 10,000 general population. The incidence of leiomyosarcoma in uterine leiomyomas is between 0.13 to 0.29%
LMS generally arise from a solitary lesion and are a result of genetic instability (errors in p16, p53, Ki67) with aggressive biology and chemotherapy resistance.
LMS is characterized by early dissemination with an overall survival of less than 50% at 2 years.
The modern diagnosis of LMS is based on the work of Bell et al and includes a combination of features including
Diffuse moderate to severe cellular atypia
Mitotic count >10 mitotic figures/10 HPF
Coagulative tumor necrosis
This document discusses prenatal genetic diagnosis and genomics. It notes that 80% of rare disorders are genetic in origin and 20% of infant deaths are due to congenital malformations. Chromosomal microarray analysis is useful for detecting monogenic disorders, X-linked conditions, and some cases of idiopathic hydrocephalus. While it identifies more abnormalities than karyotyping and gives quicker results, it also poses challenges like data interpretation and finding variants of uncertain significance. Whole exome sequencing can help in detecting disorders caused by multiple genes. The document provides examples of using these techniques to diagnose single gene disorders, X-linked conditions, and multiple gene disorders prenatally.
Max Wilms first described Wilms tumor in 1899 after examining childhood kidney tumors. Wilms tumor is the most common malignant renal tumor in children, affecting around 7 per million children under 15 years old. The tumor is named after Max Wilms. Treatment has improved survival rates to around 90% with surgery, chemotherapy, and radiation therapy depending on tumor stage and histology. Genetic factors like WAGR, Beckwith-Wiedemann, and Denys-Drash syndromes increase risk by predisposing to mutations in genes like WT1 and CTNNB1.
This document summarizes a study investigating the role of the estrogen receptor coregulator Repressor of Estrogen Receptor Activity (REA) in suppressing the progression of endometriosis using a murine model. The study found that reducing REA levels in both donor uterine tissue and host mice led to enhanced proliferation, vascularization, and inflammation of endometriotic lesions. Depletion of REA in human endometriotic cells also increased proliferation. Additionally, levels of REA were significantly lower in human endometriotic tissue compared to normal endometrium. Therefore, REA appears to act as a brake on estrogen signaling and restrain multiple processes that contribute to endometriosis progression.
This document discusses a study to create tissue engineering models of breast cancer metastasis. The researchers will develop 3D scaffolds mimicking adipose and bone tissue with varying stiffness. They will seed metastatic breast cancer cells onto the scaffolds to study changes in gene expression, histology, and markers as the cells metastasize from softer adipose-like scaffolds to stiffer bone-like scaffolds. The goal is to better understand the mechanisms driving breast cancer metastasis in order to develop new prevention and treatment strategies.
Cancer testis antigens and NY-BR-1 expression in primary breast cancer: prog...Enrique Moreno Gonzalez
Cancer–testis antigens (CTA) comprise a family of proteins, which are physiologically expressed in adult human tissues solely in testicular germ cells and occasionally placenta. However, CTA expression has been reported in various malignancies. CTAs have been identified by their ability to elicit autologous cellular and or serological immune responses, and are considered potential targets for cancer immunotherapy. The breast differentiation antigen NY-BR-1, expressed specifically in normal and malignant breast tissue, has also immunogenic properties. Here we evaluated the expression patterns of CTAs and NY-BR-1 in breast cancer in correlation to clinico-pathological parameters in order to determine their possible impact as prognostic factors.
This document discusses neuroblastoma, a common childhood cancer. Some key points:
- Neuroblastoma arises from neural crest cells and can occur in adrenal glands or sympathetic nervous system. Half of children present with metastatic disease.
- It is the most common cancer in infancy and accounts for 8-10% of childhood cancers. The median age of diagnosis is 19 months.
- Familial cases have an autosomal dominant pattern of inheritance and a younger median age of diagnosis. Amplification of the N-MYC oncogene and deletion of chromosome 1p are common genetic factors.
- Treatment involves surgery to remove the tumor if possible, chemotherapy, and sometimes radiation therapy to control local
This document discusses Wilms' tumor, a type of childhood kidney cancer. It accounts for about 6% of pediatric cancers and develops from immature kidney tissue. Survival rates have improved from 30% in the 1930s to over 85% currently. Treatment typically involves surgery to remove the kidney along with chemotherapy and sometimes radiation therapy. Prognosis depends on factors like tumor stage, histology, and presence of anaplasia. Coordinated treatment protocols through organizations like the National Wilms Tumor Study Group have helped increase survival rates by standardizing treatment.
This document discusses genetic considerations in the prenatal diagnosis of fetal overgrowth syndromes. It reviews several overgrowth syndromes that can be detected prenatally through ultrasound findings or molecular testing, including Pallister-Killian syndrome, Beckwith-Wiedemann syndrome, Sotos syndrome, and Simpson-Golabi-Behmel syndrome. Prenatal diagnosis of an overgrowth syndrome can help prepare for potential neonatal complications and recurrence risks. However, genetic causes are often not diagnosed prenatally due to overlapping features and limitations of prenatal testing.
Uterine fibroids are benign tumors that develop in the uterus. They affect around 20-80% of women by age 50 and are more common in African American women. The three main types are intramural, subserosal, and submucosal fibroids. Symptoms include heavy bleeding, pelvic pain, pressure symptoms, and infertility. Treatment options include medical management with drugs to shrink fibroids, surgical removal via myomectomy or hysterectomy, or minimally invasive procedures like uterine artery embolization or ablation. Complications can include degeneration, infection, and rarely sarcoma. Nursing care focuses on managing pain, preventing infection, addressing bowel issues, and supporting emotional adjustment to changes in fertility status
Uterine sarcoma is a rare and challenging type of cancer that grows rapidly. It accounts for 2-5% of uterine malignancies and is diagnosed in about 17 per 1000 women annually. Risk factors include prior pelvic radiation and black race. Long-term tamoxifen use also increases the risk. The most common presenting symptom is vaginal bleeding. Surgery is the primary treatment but the benefits of adjuvant radiation and chemotherapy are unclear due to limited data. Prognosis is generally poor, especially for later stages, and more research is needed to determine optimal adjuvant therapies.
Cervical cancer is caused by human papillomavirus (HPV) infection and develops slowly over time. Screening through regular Pap tests can detect precancerous changes in the cervix so they can be treated before cancer develops. Most cervical cancers are preventable with vaccination against HPV and appropriate screening. Screening guidelines recommend annual Pap tests beginning at age 21 and can be less frequent or stop at age 70 if previous results have been normal. Abnormal results may require further tests like colposcopy and HPV testing and possible treatment of precancerous lesions.
Fibroids may run in the family. What about hormones?Jia Maheshwari
Causes of fibroids aren’t yet known, but family history could predispose you to suffer this painful condition. It couldbe hormonal too. Early diagnosis through an ultrasound can significantly help, so have heavy menstrual bleeding and cramps checked out asap.
This document discusses several types of rare childhood intestinal tumors, including pediatric gastrointestinal stromal tumors (GIST), myofibromatosis, carcinoid tumors, colorectal carcinoma, inflammatory pseudotumors, leiomyoma, and lymphoma. It notes that pediatric GISTs differ from adult GISTs in their multifocal location, lack of common mutations, and indolent behavior. Myofibromatosis commonly involves the skin, muscle or viscera and can spontaneously regress, while extensive intestinal involvement carries significant risks. Carcinoid tumors typically originate in the stomach, small intestine or appendix. Colorectal carcinoma is rare in children but accounts for 2% of adolescent malignancies.
Wilm's tumor, also known as nephroblastoma, is a type of kidney cancer that typically affects children under the age of 5. It makes up about 6% of all childhood cancers. The tumor is caused by the abnormal growth of kidney cells that would normally develop into mature kidney tissue. Wilm's tumor is associated with genetic syndromes that involve mutations in genes like WT1. Patients with certain birth defects like WAGR or Beckwith-Wiedemann syndrome have a higher risk of developing Wilm's tumor. The cancer presents as a soft, homogeneous mass in the kidney and is characterized by the presence of blastemal, stromal, and epithelial cells under the microscope. Treatment involves
Gestational trophoblastic diseases (GTD) are a group of pregnancy-related neoplasms originating from abnormal proliferation of trophoblast cells. They range from benign conditions like complete and partial hydatidiform moles to malignant tumors such as choriocarcinoma. The incidence of GTD varies significantly worldwide depending on factors like maternal age, prior molar pregnancies, and ethnicity. Molecular studies show that complete hydatidiform moles have a paternal chromosomal contribution and lack expression of maternally imprinted genes like p57, distinguishing them from partial moles which are triploid. Immunohistochemistry is useful in diagnosis and classification of GTD.
This document discusses pineal region tumors (PRTs). It covers the epidemiology, pathology, clinical presentation, radiological features, and treatment of various PRTs. The most common PRTs are germ cell tumors (GCTs), which make up about 70% of cases. GCTs include germinomas and non-germinomatous germ cell tumors. Primary parenchymal tumors and other rare tumor types can also affect the pineal region. Surgical resection or biopsy is needed for diagnosis and treatment planning, though radiological features alone cannot determine the tumor type. Management involves controlling hydrocephalus, obtaining a tissue diagnosis, and utilizing adjuvant therapies like radiation and chemotherapy based on the specific tumor pathology.
Fertility Preservation In Cancer Pt Fin (2)guest7f0a3a
This document summarizes fertility preservation techniques for cancer patients, including embryo freezing, oocyte freezing, and ovarian tissue banking. It discusses methods such as slow freezing versus vitrification for oocyte cryopreservation. The document also reviews factors that influence chemotherapy-induced premature menopause and the potential protective effects of GnRH analogues. Surgical procedures for fertility preservation like ovarian transposition are also mentioned.
This document provides an overview of Wilms tumor, including its epidemiology, pathogenesis, clinical presentation, diagnosis, staging, and treatment. Key points include:
- Wilms tumor is the most common renal tumor in children and occurs most often in children around 3 years old.
- Treatment involves surgery to remove the tumor, chemotherapy, and sometimes radiation therapy. A multidisciplinary approach with these modalities can cure Wilms tumor in most cases.
- Prognosis depends on staging and histopathology. Earlier stages and tumors with favorable histology have a better prognosis. Current therapies have increased overall survival rates to around 90%.
Endometrial cancer is the most common gynecologic malignancy in developed countries. Symptoms include postmenopausal bleeding, irregular heavy periods, and endometrial cancer cells found on Pap smear. Risk factors include obesity, infertility, estrogen therapy, and genetics. Diagnosis involves ultrasound, biopsy, and CT or MRI. Staging involves assessing for spread beyond the uterus to the cervix, ovaries, lymph nodes, or distant sites. Treatment depends on stage but commonly involves hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection, with radiation or chemotherapy for more advanced stages. Prognosis is best for stage I disease.
Early Prediction, Proper Planning can lead to Prevention of Disastrous Progre...Indraneel Jadhav
Uterine Leiomyosarcoma (LMS), the rare, aggressive tumours carrying poor prognosis are mostly diagnosed incidentally at time of myomectomy/hysterectomy done for a presumed benign condition.
The incidence of LMS is1 in 10,000 general population. The incidence of leiomyosarcoma in uterine leiomyomas is between 0.13 to 0.29%
LMS generally arise from a solitary lesion and are a result of genetic instability (errors in p16, p53, Ki67) with aggressive biology and chemotherapy resistance.
LMS is characterized by early dissemination with an overall survival of less than 50% at 2 years.
The modern diagnosis of LMS is based on the work of Bell et al and includes a combination of features including
Diffuse moderate to severe cellular atypia
Mitotic count >10 mitotic figures/10 HPF
Coagulative tumor necrosis
This document discusses prenatal genetic diagnosis and genomics. It notes that 80% of rare disorders are genetic in origin and 20% of infant deaths are due to congenital malformations. Chromosomal microarray analysis is useful for detecting monogenic disorders, X-linked conditions, and some cases of idiopathic hydrocephalus. While it identifies more abnormalities than karyotyping and gives quicker results, it also poses challenges like data interpretation and finding variants of uncertain significance. Whole exome sequencing can help in detecting disorders caused by multiple genes. The document provides examples of using these techniques to diagnose single gene disorders, X-linked conditions, and multiple gene disorders prenatally.
Max Wilms first described Wilms tumor in 1899 after examining childhood kidney tumors. Wilms tumor is the most common malignant renal tumor in children, affecting around 7 per million children under 15 years old. The tumor is named after Max Wilms. Treatment has improved survival rates to around 90% with surgery, chemotherapy, and radiation therapy depending on tumor stage and histology. Genetic factors like WAGR, Beckwith-Wiedemann, and Denys-Drash syndromes increase risk by predisposing to mutations in genes like WT1 and CTNNB1.
This document summarizes a study investigating the role of the estrogen receptor coregulator Repressor of Estrogen Receptor Activity (REA) in suppressing the progression of endometriosis using a murine model. The study found that reducing REA levels in both donor uterine tissue and host mice led to enhanced proliferation, vascularization, and inflammation of endometriotic lesions. Depletion of REA in human endometriotic cells also increased proliferation. Additionally, levels of REA were significantly lower in human endometriotic tissue compared to normal endometrium. Therefore, REA appears to act as a brake on estrogen signaling and restrain multiple processes that contribute to endometriosis progression.
This document discusses a study to create tissue engineering models of breast cancer metastasis. The researchers will develop 3D scaffolds mimicking adipose and bone tissue with varying stiffness. They will seed metastatic breast cancer cells onto the scaffolds to study changes in gene expression, histology, and markers as the cells metastasize from softer adipose-like scaffolds to stiffer bone-like scaffolds. The goal is to better understand the mechanisms driving breast cancer metastasis in order to develop new prevention and treatment strategies.
Cancer testis antigens and NY-BR-1 expression in primary breast cancer: prog...Enrique Moreno Gonzalez
Cancer–testis antigens (CTA) comprise a family of proteins, which are physiologically expressed in adult human tissues solely in testicular germ cells and occasionally placenta. However, CTA expression has been reported in various malignancies. CTAs have been identified by their ability to elicit autologous cellular and or serological immune responses, and are considered potential targets for cancer immunotherapy. The breast differentiation antigen NY-BR-1, expressed specifically in normal and malignant breast tissue, has also immunogenic properties. Here we evaluated the expression patterns of CTAs and NY-BR-1 in breast cancer in correlation to clinico-pathological parameters in order to determine their possible impact as prognostic factors.
This document discusses neuroblastoma, a common childhood cancer. Some key points:
- Neuroblastoma arises from neural crest cells and can occur in adrenal glands or sympathetic nervous system. Half of children present with metastatic disease.
- It is the most common cancer in infancy and accounts for 8-10% of childhood cancers. The median age of diagnosis is 19 months.
- Familial cases have an autosomal dominant pattern of inheritance and a younger median age of diagnosis. Amplification of the N-MYC oncogene and deletion of chromosome 1p are common genetic factors.
- Treatment involves surgery to remove the tumor if possible, chemotherapy, and sometimes radiation therapy to control local
This document discusses Wilms' tumor, a type of childhood kidney cancer. It accounts for about 6% of pediatric cancers and develops from immature kidney tissue. Survival rates have improved from 30% in the 1930s to over 85% currently. Treatment typically involves surgery to remove the kidney along with chemotherapy and sometimes radiation therapy. Prognosis depends on factors like tumor stage, histology, and presence of anaplasia. Coordinated treatment protocols through organizations like the National Wilms Tumor Study Group have helped increase survival rates by standardizing treatment.
This document discusses genetic considerations in the prenatal diagnosis of fetal overgrowth syndromes. It reviews several overgrowth syndromes that can be detected prenatally through ultrasound findings or molecular testing, including Pallister-Killian syndrome, Beckwith-Wiedemann syndrome, Sotos syndrome, and Simpson-Golabi-Behmel syndrome. Prenatal diagnosis of an overgrowth syndrome can help prepare for potential neonatal complications and recurrence risks. However, genetic causes are often not diagnosed prenatally due to overlapping features and limitations of prenatal testing.
Uterine fibroids are benign tumors that develop in the uterus. They affect around 20-80% of women by age 50 and are more common in African American women. The three main types are intramural, subserosal, and submucosal fibroids. Symptoms include heavy bleeding, pelvic pain, pressure symptoms, and infertility. Treatment options include medical management with drugs to shrink fibroids, surgical removal via myomectomy or hysterectomy, or minimally invasive procedures like uterine artery embolization or ablation. Complications can include degeneration, infection, and rarely sarcoma. Nursing care focuses on managing pain, preventing infection, addressing bowel issues, and supporting emotional adjustment to changes in fertility status
Uterine sarcoma is a rare and challenging type of cancer that grows rapidly. It accounts for 2-5% of uterine malignancies and is diagnosed in about 17 per 1000 women annually. Risk factors include prior pelvic radiation and black race. Long-term tamoxifen use also increases the risk. The most common presenting symptom is vaginal bleeding. Surgery is the primary treatment but the benefits of adjuvant radiation and chemotherapy are unclear due to limited data. Prognosis is generally poor, especially for later stages, and more research is needed to determine optimal adjuvant therapies.
Cervical cancer is caused by human papillomavirus (HPV) infection and develops slowly over time. Screening through regular Pap tests can detect precancerous changes in the cervix so they can be treated before cancer develops. Most cervical cancers are preventable with vaccination against HPV and appropriate screening. Screening guidelines recommend annual Pap tests beginning at age 21 and can be less frequent or stop at age 70 if previous results have been normal. Abnormal results may require further tests like colposcopy and HPV testing and possible treatment of precancerous lesions.
Fibroids may run in the family. What about hormones?Jia Maheshwari
Causes of fibroids aren’t yet known, but family history could predispose you to suffer this painful condition. It couldbe hormonal too. Early diagnosis through an ultrasound can significantly help, so have heavy menstrual bleeding and cramps checked out asap.
This document provides an overview of endometriosis, including its definition, pathology, clinical diagnosis, differential diagnosis, relationship to endometrial cancer and menopause, etiologies and theories, and treatment options. Key points include that endometriosis is the growth of endometrial tissue outside the uterus, which can cause pelvic pain and infertility. Diagnosis involves physical exam and laparoscopy with biopsy. Treatment involves medications like danazol or GnRH agonists to suppress hormones, or surgery to remove endometrial lesions and adhesions. Recurrence is common without continued treatment.
The Effect of Deep Oscillation in Fibrocystic Breast Disease. A Randomized C...Mary Fickling
A randomized controlled trial of 401 women randomly assigned to three groups has come to remarkable conclusions: treatment with deep oscillation not only reduced the patients' pain perception statistically significantly; above all, it reduces the proportion of fibrosed and cystic tissue, both in comparison to a control group treated with a non-steroidal anti-inflammatory drug (NSAID) and a control group without intervention. The research group led by Solangel Hernández Tápanes concludes that Deep Oscillation favors the absorption of fibrosed and cystic tissue due to its tissue relaxant and vasoconstrictor action.
The study was published in the current issue Vol. 11, no. 14 of the Open Access Journal "International Archives of Medicine"
Uterine Fibroids (Leiomyomata): Investigations and Treatment Michelle Fynes
Uterine fibroids (UF) are the most common benign neoplastic threat to women's health, costing hundreds of billions of health care dollars worldwide. The objective of this presentation is to review risk factors, aetiology, classification and clinical presentation of Uterine fibroids.
Treatment of breast cancer by chemotherapy AsifaKanwal1
This document discusses the treatment of breast cancer using chemotherapy. It begins with an introduction to breast cancer, its causes, risk factors, signs and symptoms, diagnosis, and general treatment options. It then focuses on chemotherapy as a treatment, describing the different types of chemotherapy drugs used to treat breast cancer like doxorubicin, cyclophosphamide, fluorouracil, and epirubicin. It discusses how these drugs work and their common side effects. The document provides details on chemotherapy regimens and administration methods like intravenous or oral routes. Overall, it provides a comprehensive overview of chemotherapy as a treatment for breast cancer.
This document discusses various topics related to reproductive health including abortion, reproductive system diseases and infections, cancers that affect the reproductive system, and the ethical and social issues surrounding abortion. It provides definitions and examples of abortion, describes how it is performed and its controversial nature. It also outlines different types of reproductive infections and diseases, examples of cancers like breast cancer, cervical cancer and ovarian cancer, and some of the hypothesized links between induced abortion and certain cancers. The document also briefly discusses laws and regulations around abortion in different areas as well as the main ethical arguments regarding when a fetus becomes a human being.
Endometriosis: an invisible and neglected disease that affects 180 million women. Celebrities and famous women over the years have been known to be affected by this Queen Victoria to Marilyn Monroe to Katrina Kaif who had surgery for endometriosis.
Endometriosis: an invisible and neglected disease that affects 180 million women. Celebrities and famous women over the years have been known to be affected by this Queen Victoria to Marilyn Monroe to Katrina Kaif who had surgery for endometriosis. The old theories of Endometriosis such as Sampsons Theory Angiogenesis, Lymphogenesis theory are no longer acceptable. The Epigenetic/ Genetic theorey has been postulated. ROle of biomarkers in diagnosis Risk factrs affecting Endometriosis and Risk of Cancer is discussed
Determinants of Malignant Transformation in Fibrocystic Disease of BreastKETAN VAGHOLKAR
This document discusses determinants of malignant transformation in fibrocystic breast disease. It begins with an introduction to fibrocystic breast disease and its potential for malignant change. It then presents a case report of a woman who developed breast carcinoma after a history of recurrent fibrocystic breast disease. The document discusses various pathological features that can indicate higher risk of malignant transformation, including type 1 breast cyst fluid, multiplicity of cysts, apocrine metaplasia, atypical ductal hyperplasia, and sclerosing adenosis. Understanding these determinants may help identify patients with fibrocystic disease who are more likely to develop breast cancer.
The document discusses uterine fibroids, which are benign tumors that develop from the muscle tissue of the uterus. Key points include:
- Fibroids are very common among women and often do not cause symptoms. When they do cause issues, common symptoms include heavy bleeding, pelvic pain, and pressure.
- Risk factors include nulliparity, early menstruation, increasing age, obesity, and genetic factors.
- Treatment options depend on symptoms and desire for future fertility, ranging from watchful waiting to drug therapy, myomectomy (surgical removal of fibroids), and hysterectomy (removal of the uterus).
Breast Cancer Essay examples
Essay on Breast Cancer Treatment
Essay on Breast Cancer
Essay On Breast Cancer
Essay on Breast Cancer
Breast Cancer Essay
Essay on Breast Cancer
Essay on Breast Cancer Awareness
Essay on Breast Cancer
3 hours agoTiffany Jones WEEK 1 Main PostCOLLAPSETop of .docxrhetttrevannion
3 hours ago
Tiffany Jones
WEEK 1 Main Post
COLLAPSE
Top of Form
Week 1 Main Post
I chose to focus this post on colon cancer with the factor, genetics. Genetics plays a larger role in cancer diagnoses than a lot of people are aware of. Some genetics testing and syndromes are still not even well known to a lot of practitioners, but hopefully, with more research and education this will become something that is used when testing for certain types of cancers or for being proactive to help prevent it.
The patient scenario I chose is a personal one. My Aunt was diagnosed with colon and gastric cancer. When another of my paternal aunts was diagnosed with colon cancer their oncologist realized that there could be a genetic factor in play. After doing some genetic testing, it was discovered that my aunts had Lynch Syndrome. “Lynch syndrome is an inherited condition that increases your risk of colon cancer, endometrial cancer, and several other cancers. Lynch syndrome has historically been known as hereditary nonpolyposis colorectal cancer (HNPCC)” (Mayo Clinic, 2018). People with Lynch syndrome typically have a higher chance of getting colon, gastric, and endometrial cancers, along with several others. Lynch syndrome also causes people to get cancer at much younger ages than someone without it; For instance, colon cancer before the age of 50. If a family has a history of Lynch syndrome there is a 50/50 chance that their children and grandchildren will have it also.
Colon cancer will typically start as small polyps that are not benign (cancerous), but then become cancerous over time. “It is a multifactorial disease process, with etiology encompassing genetic factors, environmental exposures (including diet), and inflammatory conditions of the digestive tract” (Dragovich, T. 2019). There are many signs and symptoms of colon cancer so it can be difficult to diagnose sometimes, especially since most signs and symptoms do not present early on in the disease process. This is why it is so important to get yearly colonoscopies, especially in people who have Lynch Syndrome. Some of the signs and symptoms patients can experience include changes in bowel habits, blood in the stool, abdominal pain that is persistent, not feeling like your bowels are emptying enough when you go, unexplained weight loss, and weakness or fatigue with no known cause (Mayo Clinic, 2019).
A large percentage of colorectal cancer develops from preexisting adenomas. However, this does not mean that every adenoma will become malignant. “The earliest phases of colorectal tumourigenesis initiate in the normal mucosa, with a generalized disorder of cell replication, and with the appearance of clusters of enlarged crypts (aberrant crypts) showing proliferative, biochemical and biomolecular abnormalities” (Leon, P., Gregorio, D., 2001). MicroRNA are small, single-stranded RNA that are noncoding and that can interfere with translation within a cell or cause degradation of the target miRNA. (Y.
Nsg. care of clients with specific health problems rel. to reprod'n. & sexualityaireenong
This document discusses nursing care for clients with reproductive and sexual health issues. It covers sexually transmitted diseases (STDs) like gonorrhea and syphilis. Gonorrhea causes symptoms like pain with urination and discharge. If untreated, it can spread to the fallopian tubes and cause infertility. Syphilis presents with painless sores and rashes and can affect the heart and nervous system if untreated. Both are treated with antibiotics. The document also discusses breast cancer and fibrocystic breast disease, a common benign condition causing lumps and tenderness related to hormones.
gyanaecology.endometriosis and adenomyosis.(dr.salama)student
The document summarizes endometriosis and adenomyosis. Endometriosis occurs when endometrial tissue grows outside the uterus, most commonly on the ovaries, uterine ligaments and pelvis. It causes pain and infertility. Adenomyosis involves endometrial tissue in the uterine wall. Both can be diagnosed by laparoscopy and treated through drugs or surgery, with hysterectomy providing definitive treatment for severe adenomyosis.
Similar to International Journal of Reproductive Medicine & Gynecology (17)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
A 36-year-old female developed right upper quadrant pain and nausea after taking the herbal supplement kratom for two weeks to manage back pain. Laboratory tests showed elevated liver enzymes. A liver biopsy ruled out other causes and determined she had drug-induced liver injury from kratom use. Her symptoms and liver enzymes gradually returned to normal over six weeks after stopping kratom. The case report discusses kratom's potential for hepatotoxicity and advises clinicians to consider its effects on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
2. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 0011
International Journal of Reproductive Medicine & Gynecology
INTRODUCTION
One of the multiple treatment possibilities for myomasis
hysterectomy which can be performed as Total Laparoscopic
Hysterectomy (TLH) or Subtotal Laparoscopic Hysterectomy (SLH)
(Figure 1). As it is a less invasive procedure, patients with myomas
can consider a subtotal approach (SLH); however, only Total
Laparoscopic Hysterectomy can protect 100% from new fibroid
formations, avoid later sarcoma formation, uncontrolled bleedings or
any other problems arising from the uterus.
The etiology of fibroid formation remains unclear in spite of
numerous theories. Nevertheless, a genetic disposition must be
given, as Africans have a much higher frequency of multiple myomas
than Caucasians. Although certain up- and down-regulations in the
genes of patients with and without myomas have been described,
no clear strategy for the prevention of fibroids is available. It is
known that patients who have close relatives with fibroids are more
likely to develop fibroids themselves. In some patients, fibroids are
clustered with other disorders. Hereditary leiomyomatosis and renal
cell carcinoma syndrome is a rare syndrome involving fibroids.
Individuals with the gene that leads to both fibroids and skin
leiomyomas are at increased risk for a rare case of kidney cell cancer
(papillary renal cell carcinoma).
Understanding which genes are involved in fibroids does not
automatically tell us why fibroids develop or how to control them.
From our understanding of fibroid behavior, we would guess that
genes involved in estrogen or progesterone production, metabolism,
or action would be involved. Unfortunately, science is seldom that
straightforward. Most guesses regarding these “candidate genes” turn
out to be wrong and many studies are usually required to find out
how these genes lead to disease. There are also small variations called
polymorphisms in genes that may play a role in influencing the risk
of fibroids. Both polymorphisms and mutations are changes in the
sequence of genes, but the difference is in the degree of change. A
mutation makes a major change in the gene that leads to a change in
the protein the gene is coding for, e.g. it can change the amino acid
from alanine to glycine or cause the protein to be prematurely cut off.
Evidence for the role of genes in fibroid development and
growth
Studies of women with fibroids suggest several reasons to suspect
that genes play a role in fibroid formation [1,2]. The first is that both
women in a pair of identical twins are twice as likely to have had a
hysterectomy as both women in a pair of fraternal (non identical)
twins. Identical twins share 100 percent of their genes, while fraternal
twins share only 50 percent of their genes. This suggests that the genes
that identical twins share make them more likely to form fibroids,
since both identical and non identical twins have equal exposure
to environmental factors. This difference between identical and
fraternal twins has been observed in a general population of women
undergoing hysterectomy and a population of women with fibroids
leading to hysterectomy [3,4].
Thereisalsoevidencethatwomenwhohavecloserelatives,suchas
a mother or sister, with fibroids are much more likely to have fibroids
themselves [5,6]. This propensity is called familial aggregation. Just
as with breast cancer, if you have many relatives affected by fibroids,
your risk of disease is likely to be increased.
Molecular genetics and genome wide scan for fibroid
genes
In the age of molecular genetics, we can look for genes involved
in a disease which is effectively looking for a needle in a haystack. This
process is called a genome-wide scan. This is a common approach
to finding genes in complex diseases, such as diabetes, asthma, and
heart disease. With a genome-wide scan, women who are sisters
and both have fibroids (an affected sibling pair) are recruited to
participate in the study. Their DNA is studied for common genes. If
hundreds of women are studied, each region of every chromosome
can be examined, and it can be determined which genes are shared by
the sisters who share the fibroid phenotype but are different in many
other respects. This approach often produces novel genes that were
not previously thought to be involved in the disease process [7-10].
Abstract
Uterine fibroids are the most frequent benign tumors of the female genital tract. Fibroids are associated with a variety of clinical
problems, e.g. pain, bleeding disorders, bulk-related symptoms or infertility. For women wishing to preserve their uterus, fibroids can
be surgically removed by hysteroscopy, laparoscopy or laparotomy. While hysterectomy remains the only definitive solution, many
alternative treatment possibilities of uterine preservation are available today. The indication for treatment has to be taken carefully after
weighing up alternative treatment methods, such as expectant management, medical treatment or interventional radiologic methods, and
after obtaining informed consent. The optimal method of treatment takes into account the patient’s interests and wishes and the practical
feasibility in the clinical setup. Surgical skills and experience play an important role as surgical procedures on the uterus are not without
risk and can lead to severe complications. The decision to operate anticipates an improvement of the initial situation and, therefore, the
ideal surgical approach is of utmost importance.
Keywords: Etiology of fibroids; Laparoscopic myomectomy; Laparoscopic hysterectomy
Figure 1: Ultrasound picture of intramural myoma.
3. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 0012
International Journal of Reproductive Medicine & Gynecology
Microscopic facts and fibroid viability
Fibroids are composed primarily of smooth muscle cells. The
uterus, stomach and bladder are all organs made of smooth muscle.
Smooth muscle cells are arranged so that the organ can stretch,
instead of being arranged in rigid units like the cells in skeletal muscle
in arms and legs that are designed to “pull” in a particular direction.
In women with fibroids, tissue from the endometrium typically looks
normal under the microscope. Sometimes, however, over sub mucosal
fibroidsthereisanunusualtypeofuterineliningthatdoesnothavethe
normal glandular structures. The presence of this abnormality, called
aglandularfuntionalis (functional endometrium with no glands), in
women having bleeding disorders is sometimes a clinical clue for
their doctors to look more closely for a sub mucosal fibroid [11]. A
second pattern of endometrium, termed chronic endometritis, can
also suggest that there may be a sub mucosal fibroid, although this
pattern can also be associated with other problems such as retained
products of conception and various infections of the uterus. Once we
move beyond hysterectomy as a one-size-fits-all solution to fibroids,
distinctions in size, position, and appearance will likely be important
for treating fibroids. Once we understand these issues, we may be able
to tell why some women have severe bleeding and other women with
a similarly sized fibroid have no problem.
COSTS OF FIBROIDS
In fact, accurately capturing all the costs attributable to uterine
fibroids will help us move toward more, and more effective, innovative
therapies. When deciding whether or not to launch a new concept,
companies typically look at the amount currently spent for other
treatments. The economics of fibroids has chiefly been discussed in
terms of the health care costs of hysterectomy. This in itself is a huge
amount of money. According to a recent estimate, in the United
States, more than $2 billion every year is spent on hospitalization costs
due to uterine fibroids alone [12]. Additionally, one study estimates
that the health care costs due to uterine fibroids are more than $4,600
per woman per year [13].
When you incorporate all the costs of fibroids, however, the total
is even more significant.
• The costs of myomectomy, Uterine Artery Embolization
(UAE), and other minimally invasive therapies
• The costs of birth control pills and other hormonal treatments
to control bleeding
• The costs of tampons, pads, and the adult diapers many
women require to contain the bleeding
• The costs of alternative and complementary therapies
• The cost of doing nothing (for many women this means
missing work or working less productively during their
period).
Why should a patient have a hysterectomy today when so many
alterative treatment options are available? Firstly, up to a certain
size of the enlarged uterus, laparoscopic subtotal hysterectomy
completely solves the problem and if women want to eliminate every
risk of recurrent fibroids, hysterectomy is their only choice. Secondly,
hysterectomy also cures coexisting problems, such as adenomyosis,
endometriosis, endometrial polyps or cervical dysplasia. There is also
no danger of ever leaving a sarcoma behind.
Review of all uterine-preserving treatment possibilities
for fibroids (medical and surgical options)
The surgical treatment of fibroids can be differentiated between
less invasive and more invasive surgical techniques. Time and type of
treatment have to be chosen individually and are dependent on the
patient and the treating gynecologist (Tables 1,2).
Expectant management
Wait-and-see is a possibility if patients are asymptomatic, decline
medical or surgical treatment or have contraindications to any kind
of treatment. However, existing data describe the possibility that
fibroidscanshrinksubstantiallyeitherbyoptimizingendocrinological
disorders, such as hypothyroidism, or during the postpartum period
[14,15].
To pursue the idea of expectant management, the pelvic mass
must definitely be classified as a fibroid and differentiated from
an ovarian mass. The complete blood count should be regular,
especially in patients with severe symptoms, such as menorrhagia or
hypermenorrhea. The women must also be informed that the risk of
miscarriage, premature labor and delivery, abnormal fetal position
and placental abruption is increased [16].
Medical therapy
The benefit of medical treatment in the management of women
with symptomatic fibroids is still difficult to prove. Medical therapy
can provide adequate symptom relief, especially in cases where
hypermenorrhea is the leading problem. The benefit of symptom
improvement decreases in long-term treatment periods so that more
than 50% undergo surgery within two years. Ulipristalacetate in an
application of 5 mg daily proved to be a satisfying treatment in many
clinical studies [17].
Nevertheless, there has been a shift in traditional thinking that
medical treatment of fibroids is solely based on the manipulation of
steroid hormones. A deeper analysis and understanding of specific
genes or pathways associated with leiomyomatosis may open new
possibilities for prevention and medical treatment [18].
Alternative treatment methods
If the patient does not want to undergo surgery or there are
contraindications to surgery, there are alternative procedures:
Uterine artery embolization: This minimally invasive
therapeutical option allows an occlusion of the specific arteries
supplying blood to the fibroids. A catheter is introduced via the
femoral artery under local anesthesia and particles are injected to
Table 1: Indications for myomectomy.
Fibroid
Symptoms
Yes Treatment
No
No measures if:
-no growths
-no desire for children
Growths
Yes Control
No
No measures if:
-no Symptoms
-no desire for children
Desire for
children
Yes
Treatment
Dependent on: size, localisation,
number
No
No measures if:
-no Symptoms
-no growths
4. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 0013
International Journal of Reproductive Medicine & Gynecology
block the blood flow to the fibroid. This can be an effective treatment
option if the uterus should not be removed, surgery is contraindicated
and family planning is completed. It results in myoma shrinkage
of up to 46%. Nevertheless, there is still a significant rate of post
interventional complications [19,20].
Magnetic resonance-guided focused ultrasound: This is a more
recent treatment method for uterine fibroids in premenopausal
women. Again, the patients must have completed their family
planning. In a noninvasive thermo ablative technique multiple waves
of ultrasound energy are converged on a small volume of tissue,
resulting in maximal thermal destruction. The limiting factors are
size, vascularity and access [21,22].
Uterine preserving surgical treatment of fibroids
Indications: Surgical treatment of fibroids is still the main pillar
in the treatment of leiomyomas. Hysterectomy is the only definitive
solution and can be performed as supracervical or total hysterectomy.
Myomectomy performed by hysteroscopy, laparoscopy, abdominal
access or with robotic assistance is an alternative surgical method.
Indications for surgical therapy of uterine fibroids are table 1:
1. Abnormal uterine bleeding disorders (hypermenorrhea,
dysmenorrhea, menorrhagia- and metrorrhagia)
2. Bulk-related symptoms
3. Primary or secondary infertility and recurrent pregnancy
loss.
Counseling and informed consent: Patients undergoing an
operative procedure have to be informed of the risks and potential
complications as well as alternative operating methods. Counseling
before surgery should include discussion of the entry technique and
the associated risks: injury of the bowel, urinary tract, blood vessels,
omentum and other surrounding organs and, at a later date, wound
infection, adhesion-associated pain and hernia formation.
Counseling needs to integrate the individual risk dependent
on the BMI of the patient. Depending on the medical history, it is
important to consider anatomical malformations, number of vaginal
births, midline abdominal incisions, a history of peritonitis or
inflammatory bowel disease [23].
Myomectomy: Myomectomy is a surgical treatment option
for women who have not completed their family planning or who
wish to retain their uterus for any other reasons. The enucleation
of fibroids by any method is an effective therapy for bleeding
disorders or displacement pressure in the pelvis. Nevertheless, the
risk of recurrence remains after myomectomy. Furthermore, if any
other pathologies might be causative or only co-causative for the
symptoms (such as adenomyosis uteri), these problems will persist
[24]. Enucleated myomas and pregnancy - related complications have
been investigated extensively. All operating possibilities, especially
laparoscopic versus laparotomic, but recently also laparoscopic
versus robotic - assisted myomectomy have been evaluated. Uterine
rupture or uterine dehiscence is rare and occurs in only 2% - 4% of
laparoscopic cases and even less seldom in robotic - assisted and
laparotomic cases. Careful patient selection and secure preparation
and suture techniques appear to be the most important variables
for myomectomy in women of reproductive age [25,26]. Uteri with
multiple fibroids have an increased number of uterine arterioles and
venules. Therefore, myomectomy can lead to a significant blood loss
and corresponding arrangements should be made [27].
Hysteroscopic myomectomy: Sub mucosal fibroids have
their origin in myometrial cells underneath the endometrium and
represent about 15 to 20% of all fibroids. Before the establishment of
hysteroscopy as a minimally invasive and effective treatment method,
these myomas were removed by hysterotomy or even hysterectomy.
Increased surgical training, improvement of technology and the
widespread use of hysteroscopic myomectomy have made it a safe,
fast, effective and cheap method of fibroid resection while preserving
the uterus [28].
Patient selection concentrates on intra cavitary sub mucous and
some intramural fibroids. More than 50% of the fibroid circumference
needs to be protruding into the uterine cavity. Deep myometrial
leiomyomas require advanced operative skills and have an increased
risk for perioperative complications and incomplete resection.
The depth of myometrial penetration correlates with the volume
of distension fluid absorbed [29,30]. Few data are available on the
size of myoma that prevents the use of the hysteroscopic approach.
The European Society of Hysteroscopy suggests to limit the myoma
size to 4 cm but the few existing data report a significant increase of
complications in fibroids that are > 3cm. Surgical skills determine the
size and number of myomas that can be resected [31].
Prior to hysteroscopy, knowledge of the patient’s medical history
is important e.g. history of caesarean section or any other reason to
expect an anatomical disorder. A vaginal ultrasound scan must be
performed to precisely determine the uterus location, size and all
cervical and uterine pathologies [32]. If available and feasible, fluid
hysteron - sonography should be performed to better differentiate
the relationship of leiomyoma to the endometrial cavity and the
myometrium. No prophylactic antibiotic is required to prevent
surgical site infection.
The first step is the dilation of the cervical channel with Hegar
dilators up to Hegar 9. The most commonly used instrument for
fibroid resection is the monopolar or bipolar wire loop. Using a
Table 2: Treatment options for uterine fibroids.
Treatment options for uterine fibroids
Conservative Alternative Surgical
Expectant treatment Uterine artery Embolization Myomectomy Hysterectomy
Medical therapy High intensity focused ultrasound Hysteroscopic laparoscopic abdominal
Robotic
assisted
Vaginal laparoscopic abdominal
- hormonal
Miscellaneous methods (myoma
coagulation, myolysis
- supracervical
- GnRH agonists
and antogonists
- total
- Ulipristalacetate
5. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 0014
International Journal of Reproductive Medicine & Gynecology
monopolar device the fluid medium must be non-electrolytic, using
a bipolar device the fluid medium is isotonic [33]. A continuous flow
allows the clearance of blood out of the uterine cavity to improve
visualization. Furthermore, the resected pieces can be retracted.
Nevertheless, the surface of the myoma and the time needed for
resection increase the risk of excessive fluid absorption [34].
The resectoscope is inserted through the cervix into the uterine
cavity and after distension with fluid the uterine cavity is carefully
inspected. The monopolar resectoscope requires a cutting current
of 60 to 120 watts. Bipolar resectoscopes offer the possibility of
simultaneous cut and coagulation. The wire loop passes easily through
the tissue. The incision starts at the highest point of the myoma. Only
in pedunculated fibroids might the incision cut the peduncle first. The
loop is then moved towards the surgeon using the spring mechanism
and simultaneously the entire resectoscope is gently pulled
backwards. The wire loop must be in view of the surgeon during the
whole procedure. This motion is repeated until the whole myoma
has been resected and the surrounding myometrium (depth) and
endometrium (side) can be differentiated. All resected specimen is
sent to the pathologist. In cases of heavy bleeding and reduced vision
the endometrium and the cutting surface have to be reinspected.
These areas can be desiccated with the coagulating current.
The resected area will be recovered by the surrounding
endometrium during the following weeks. The complication rate is
low (0.8% – 2.6%) [34,35]. Complications that can occur, especially
after extensive resection, are uterine perforation or excessive
fluid absorption. Absorption of distension fluid might result in
hyponatremia or volume overload [36]. The recurrence rate is about
20% in a follow - up period of more than 3 years [31].
5.2.5 Laparoscopic myomectomy: With the improvement of
laparoscopic techniques and skills, myomectomy can be performed
laparoscopically in most women. The laparoscopic approach is usually
used for intramural or subserosal fibroids. The main advantage
compared to abdominal myomectomy is decreased morbidity and a
shorter recovery period. Nevertheless, laparoscopic myomectomy is
limited by surgical expertise and especially laparoscopic suturing skills
[37,38]. Selection criteria for laparoscopic myomectomy are location,
size and number of fibroids. Nevertheless, these characteristics are
variable in relation to the surgical expertise. Preoperative imaging is
performed by vaginal ultrasound to assess the precise features of the
leiomyomas [32,39-41].
Laparoscopic myomectomy starts with the usual placement of
ports and trocars. After placement of the initial port in the umbilicus,
two ancillary trocars are placed in the lower abdomen about 2 cm
medial of each iliac crest [41-43]. Myomectomy can lead to severe
bleeding that will complicate the procedure due to reduced vision.
Vessel bleeding is controlled by bipolar electrosurgical paddles.
Intraoperative bleeding can be reduced using vasopressin or other
vasoconstrictors. Vasopressin is diluted (e.g. 20 units in 100 ml of
saline) and injected into the planned uterine incision site. Vasopressin
constricts the smooth muscle in the walls of capillaries, small
arterioles and venules. Nevertheless, due to side effects the surgeon
should pull back the plunger of the syringe before insertion to check
that the needle is not inserted intravascularly [44-46]. Alternatively,
misoprostol can be administered vaginally about one hour before
surgery to reduce blood loss [47].
The uterine incision is preferably made vertically as this allows
a more ergonomic suturing of the defect. The incision is performed
with a monopolar hook directly over the fibroid and carried through
deeply until the entire myoma tissue has been reached. After
exposure of the myoma, it is grasped with a tenaculum or sharp
forceps and traction and countertraction are applied. The removal of
the myoma can easily be performed with blunt and sharp dissecting
devices. Capsular vessels should be coagulated before complete
removal of the myoma as coagulation becomes more difficult if
traction is unsuccessful and bipolar coagulation occurs in the
remaining myometrium wall. Subsequent to removal, the myoma
is morcellated with an electromechanical device under direct vision
and at a safe distance to all structures, such as the small bowel, to
avoid inadvertent injury. The myoma tissue is removed and sent
for pathologic evaluation. The uterine defect is closed with delayed
absorbable sutures in one or two layers, depending upon the depth
of the myometrial defect. It is important that the suture starts at the
deepest point to avoid any cavity that might lead to a weak uterine
wall. Furthermore, we tie the knot extra corporeally so that the knot
can be pushed into the deep layers with full strength (Figures 1-4).
Alternatively, barbed sutures, such as V-lock, can be used to tighten
the tissue or a third ancillary trocar can be inserted to hold the suture
tight. The security of the uterine closure has bearing on the risk of
uterine rupture in subsequent pregnancy. Different kinds of adhesion
prevention barriers can be applied [48-50]. Women should wait at
least 4 to 6 months before attempting to conceive [51].
Abdominal myomectomy: Abdominal or open myomectomy
has its origin in the early 1900s as a uterus- preserving procedure.
Today, it is mostly performed for women with intramural or
subserosalmyomas and less frequently for sub mucosal localization.
Since the introduction of endoscopic procedures, the indication for
abdominal myomectomy has become rare. It becomes an option
if hysteroscopic or laparoscopic myomectomy is not feasible or
if a laparotomy is required for any other reason. The indication to
exclude uterine sarcomas has to be taken very strictly; however,
uterine sarcoma is a very rare malignancy and the rate of sarcoma
after clinical diagnosis of myoma is very low. The risk of severe
complications in association with open surgery is higher than with
hysteroscopic or laparoscopic moymectomy. Prophylactic antibiotics
should be given for any abdominal fibroid operation [52,53]. After
the Pfannenstil incision either a vertical or transverse uterine incision
is performed [54]. The myoma enucleation is performed by traction
on the myometrial edges, e.g. with Allis clamps. After exposure of the
Figure 2: Longitudinal incision of capsule.
6. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 0015
International Journal of Reproductive Medicine & Gynecology
fibroid it can be extirpated. The pseudo capsule is typically dissected
bluntly. The uterine defects are closed with sutures in several layers
to reapproximate the tissue and achieve hemostasis without excessive
bipolar coagulation.
Robotic myomectomy: Robot-assisted myomectomy is a
relatively new approach. The advantages of robotic surgery are three-
dimensional imaging, mechanical improvement, including 7 degrees
of freedom for each instrument, stabilization of the instruments
within the surgical field and improved ergonomics for the surgeon.
Technical difficulties are decreased as suturing is easier than during
conventional laparoscopy; however, there are few data comparing
robot-assisted with conventional laparoscopic myomectomy [55-57].
The advantages compared to abdominal myomectomy are decreased
blood loss and shorter recovery time. Nevertheless, operation
duration and operating costs are much higher than for conventional
procedures. Furthermore, robotic devices are large and bulky. Robotic
surgery is limited by the lack of tactile feedback and additional team
training is necessary to minimize the risk of mechanical failure [58].
To date no advantage compared to conventional laparoscopy could
be demonstrated regarding blood loss or operative duration. A more
secure myometrial closure has not yet been proven [56]. In obese
patients robot-assisted surgery might be beneficial [59].
HYSTERECTOMY AS TREATMENT FOR
MYOMAS
As fibroids are the most common indication for hysterectomy
(30% of hysterectomies in white and 50% of hysterectomies in black
women), specific focus is given to hysterectomies within this article.
The decision for a hysterectomy in a multifibroid uterus depends on
the wish of the patient, her health status and whether childbearing has
been completed. Only if the patient suffers from metrorrhagia does
the disorder need to be examined pre-operatively in more detail as
this may be a sign of endometrial cancer or sarcoma. The combined
evaluation of MRI and tumor makers pre-operatively leads to a more
specific diagnosis of rapidly growing uterine masses or adnexas in
the case of a leiomyomatous uterus or adnexal tumors. Only in those
cases where malignancy is not suspected is a simple TLH or SLH
recommended, otherwise an oncological approach has to be selected.
Hysterectomy, as TLH or SLH, is recommended for the following
indications:
- Acute hemorrhage with non-response to other therapies
- Completion of family planning and current or increased
future risk of other diseases, such as cervical intraepithelial
neoplasia, endometrial hyperplasia or an increased risk of
uterine or ovarian cancer. Precondition for the indication
for hysterectomy is that these risks can be eliminated or
decreased by hysterectomy.
- Failure of previous treatment.
- Completion of family planning and significant symptoms
(e.g. multiple fibroids or adenomyosis) and the desire for a
definitive solution.
The main advantage of hysterectomy over all other therapeutical
possibilities is the definitive solution in eliminating all existing
symptoms and the risk of recurrence. Nevertheless, the advantage of a
definitivesolutionthatallowsfreedomfromfutureproblemscanbean
obstacle if family planning has not been completed or the patient has
a personal inhibition against the removal of the central genital female
organ [60]. These issues must be discussed in advance with the patient
before the decision for a hysterectomy is taken. Furthermore, for a
solitary sub mucous, subserous, pedunculated or intramural myoma,
the complication rate of a hysterectomy has to be compared with the
complication rate of a myomectomy. The operational risks have to
be compared to the operational risks of hysteroscopy, laparoscopic
enucleation or conservative management. With the advances in
cervical cancer screening the prevention of future cervical or uterine
pathologies is no longer a relevant indication for hysterectomy. The
decision must be tailored to meet the needs of each individual patient.
Laparoscopic hysterectomy was first introduced in 1989 with the
aim of reduci
ng the morbidity and mortality of abdominal hysterectomy to
the level reached with vaginal hysterectomy. Laparoscopic assistance
for vaginal hysterectomy can be of advantage if there is a need for
adhesiolysis, a need to treat endometriosis simultaneously, a need to
treat large leiomyomas and to ensure an easier and safer adnexectomy.
If feasible, vaginal hysterectomy allows a more rapid and less painful
recovery than open or laparoscopic surgery and is much cheaper [61].
Removal of ovaries and/ or fallopian tubes
Generally, the ovaries are not removed when a hysterectomy is
Figure 3: Individual steps of laparoscopic myomectomy including morcellation
and extraction.
Figure 4: Final situs with enucleated fibroid.
7. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 0016
International Journal of Reproductive Medicine & Gynecology
performed for uterine fibroids. Removing the uterus alone will cure
the bleeding and the size-related symptoms caused by the fibroids.
When treating fibroids it is not necessary to remove the ovaries
as is sometimes the case when treating other diseases, such as
endometriosis or gynecologic cancers.
According to new research presented at the Annual Clinical
Meeting of the American College of Obstetricians and Gynecologists
in 2013, bilateral salpingectomy at hysterectomy, with preservation
of the ovaries, is considered a safe way of potentially reducing the
development of ovarian serous carcinoma. Removing the fallopian
tubes does not cause the onset of menopause, as does the removal of
the ovaries. Furthermore, prophylactic removal of the fallopian tubes
during hysterectomy or sterilization would rule out any subsequent
tubal pathology, such as hydrosalpinx, which is observed in up to 30%
of women after hysterectomy. Women undergoing hysterectomy
with retained fallopian tubes or sterilization have at least double the
risk of subsequent salpingectomy. Removal of the fallopian tubes at
hysterectomy should therefore generally be recommended [62].
Should the ovaries be removed or left in place?
Many physicians were taught that at a set age (which varies
between 35 and 50) women should be told that removal of the ovaries
is recommended as part of the surgery, with the speculation of “while
we are there, we may as well.” The general teaching had been that
ovaries have no function after menopause and the risk of ovarian
cancer increases with increasing age, so removing the ovaries near
the time of menopause was a no-lose proposition. This was especially
true if hormone replacement therapy could be used to help younger
women transition to the time when they would naturally go through
menopause.
However, more recent research suggests that although after
menopause the ovaries produce little estradiol (the major estrogen
in premenopausal women), they make a tremendous amount of
androgens (usually thought of as male hormones) [63]. It is thought
that these androgens may be important in maintaining mood and
sex drive [64-66]. In addition, the risks of hormone replacement
have become clearer, and many women choose to use hormones
following menopause [67,68]. (Most women are aware that there has
been research form the Women`s Health Initiative demonstrating
significantcomplicationswithpostmenopausalhormonereplacement
therapy. However, it is not widely known that the risks are lower for
women without a uterus, who are able to take estrogen alone [68].
Recently the association of premature loss of ovarian function and the
increasing risk of heart disease has also been explored [69].
Considering all these factors, there are good reasons to retain the
ovaries if possible. The major reason to remove them at the time of
fibroid surgery is if the woman has a high risk of ovarian cancer.
Should the fallopian tubes be resected in cases of
hysterectomy?
Once the reproductive function is completed, the tubes of a
female should be removed within the reproductive age while ovaries
need to stay to support the female wellbeing. Beyond the reproductive
age, the fallopian tubes should always be removed with the uterus
while ovaries are routinely removed only above the age of 65 years.
According to new research presented at the 2013 Annual Clinical
Meeting of the American College of Obstetricians and Gynecologists,
bilateral salpingectomy, the removal of both fallopian tubes during
hysterectomy while preserving the ovaries, is considered a safe way of
potentially reducing the development of ovarian serous carcinoma,
the most common type of ovarian cancer. Increasing evidence
points toward the fallopian tubes as the origin of this type of cancer.
Removing the fallopian tubes does not cause the onset of menopause,
as does removal of the ovaries.
Prophylactic removal of the fallopian tubes during hysterectomy
or sterilization would rule out any subsequent tubal pathology,
such as hydrosalpinx, which is observed in up to 30% of women
after hysterectomy. Moreover, this intervention is likely to offer
considerable protection against later tumor development, even if the
ovaries are retained. Thus, we recommend that any hysterectomy
should be combined with salpingectomy. Women undergoing
hysterectomy with retained fallopian tubes or sterilisation have at
least a doubled risk of subsequent salpingectomy. Removal of the
fallopian tubes at hysterectomy should therefore be recommended
[62,70].
As the indication for abdominal hysterectomy in benign diseases
has become very rare, it is not discussed in this article. Even as
robot-assisted laparoscopy has not yet shown any advantage for the
experienced surgeon in the treatment of hysterectomy and therefore
is not recommended by the American Association of Gynecologic
Laparoscopists (AAGL), we are sure it will one day replace
conventional laparoscopic or vaginal procedures [71].
Vaginal hysterectomy
Before starting a vaginal hysterectomy a bimanual pelvic
examination is performed to assess uterine mobility and descent,
and to exclude unsuspected adnexal pathology. Only then can a final
decision be made whether to proceed with a vaginal or abdominal
approach. The operation starts with entry into the cul-de-sac. The
uterosacral ligaments are identified and clamped, including the lower
portion of the cardinal ligaments. In the next step the vesicovaginal
space is opened and after identification of the peritoneal fold it is cut
and the cardinal ligaments are lighted, including the uterine vessels.
Most adnexa can be removed by grasping the ovary and clamping
the infundibulopelvic ligament. The uterus can then stepwise be
enucleated from the remaining peritoneal fold at a safe distance
from the bladder. The peritoneum can either be closed or left open
and the vaginal epithelium is reapproximated in either a vertical or
a horizontal manner. A myomatous uterus has to be morcellated in
a piecemeal manner. Sometimes it is necessary to enucleate solitary
large myomas or to perform intramyometrial coring, especially in
cases of diffusely enlarged uteri [72,73].
Subtotal Laparoscopic Hysterectomy (SLH)
The supracervical hysterectomy was first described in 1990 by
Lyons and in another technique by Semm. The operative technique is
similartothetotallaparoscopichysterectomy.Onlyafteroccludingthe
ascending branch of the uterine artery is the uterine corpusresected as
reverse conus down to the endocervical canal [74]. For SLH and TLH
the trocar placement is the same as for laparoscopic myomectomy
(see above). There is no need to perform ureterolysis at the beginning
of the operation as the ureter is at a safe distance if the suturing line is
kept strictly at the uterine wall. The infundibulo pelvic ligament and
the round ligament are divided from the pelvic side wall and, if the
adnexa are to remain in situ, division of the adnexa from the uterus.
The broad ligament is then opened, dissected and each leaf separately
coagulated. The bladder is separated from the uterus by opening the
8. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 0017
International Journal of Reproductive Medicine & Gynecology
vesico uterine ligament and pushing the bladder downwards for
about 1-2 cm. This is followed by presentation of the ramus ascendens
of the uterine artery and division of the uterine pedicles with the same
stepwise dissection of the left adnexa. A thorough inspection of the
cervix then takes place. The cervix is separated from the uterus with
the help of the electric cutting loop or any other cutting instrument.
This is followed by coagulation of the cervical canal and closure of
the peritoneum over the remaining cervical stump for infection and
adhesion prevention. Afterwards morcellation of the uterine body is
performed and, if the adnexa are also resected, they should be put into
an endo bag for extraction.
Total Laparoscopic Hysterectomy (TLH)
SLH should be avoided if adenomyosis uteri are suspected
because parts of the endometrial glands remain in the cervical
and paracervical channel. These can cause an early recurrence or
persistence of the symptoms although the few existing data offer no
direct confirmation of this view [75,76].
The surgical steps of the TLH are identical to the SLH, the only
difference being that a uterine manipulator is placed in the vagina
before the operation. After separation of the bladder from the uterus,
the bladder is pushed and dissected down 2-3 cm to clearly visualize
the rim of the cervical cap. In cases of post-cesarean section, a gentle,
blunt and intermediate sharp dissection has to be carried out. The
uterus is lateralized by pushing up the manipulator. The uterine
artery and vein with collateral arteries are completely coagulated near
the cervix and dissected. The vagina is resected from the cervix with
the monopolar hook by firmly stretching the manipulator cranially
and carefully performing an intrafascial dissection leaving the sacro-
uterine ligaments almost completely in place. This is in accordance
with the Classic Intrafascial Supracervical Hysterectomy (CISH)
technique introduced by Kurt Semm [77]. The uterus is then retracted
through the vagina while still fixed to the manipulator. If the uterus
is too large, it has to be morcellated either intra-abdominally or
transvaginally. The vagina is closed with 2 corner sutures and 1 or 2
sutures in between the corner sutures. The sacro-uterine ligaments
and the middle portion of the vagina are stitched and elevated to
prevent vaginal prolapse or enterocele formation at a later time.
Peritonealization and drainage are not required.
With the improvement of endoscopic surgery and above all the
improvement in endoscopic suturing laparoscopic-assisted vaginal
hysterectomy has become obsolete, especially as this technique does
not include a suspension of the cardinal and sacro-uterine ligaments.
CONCLUSIONS
Treatment options for uterine leiomyomas vary. The choice of
treatment should be made on an individual basis taking into account
the following factors: the patient’s level of suffering due to bleeding
disorders or displacement-caused pain, the status of family planning
and the patient’s preferences regarding the different treatment
options.
In asymptomatic women expectant management is suggested
exceptforhydronephrosiscausedbydisplacementorhysteroscopically
resectable submucous fibroids in women who pursue pregnancy.
In postmenopausal women without hormonal therapy fibroids
usually shrink and become asymptomatic. Therefore, expectant
management is the method of choice. However, sarcoma should
be excluded if a new or an enlarging pelvic mass occurs in a
postmenopausal woman. Surgical treatment is the option of choice
if the leiomyomas are symptomatic. If there are contraindications
to operative procedures or hysterectomy is declined by the patient
for personal reasons, any of the alternative treatment options can be
considered (medical, embolization or guided ultrasound).
In premenopausal women appropriate submucosal leiomyomas
should be resected hysteroscopically if the women wish to preserve
their childbearing potential and / or they are symptomatic (e.g.
bleeding, miscarriage). Intramural and subserosal leiomyomas
in women who wish to preserve their fertility can be removed
laparoscopically. Nevertheless, an appropriate surgical technique
and advanced laparoscopic skills are necessary. If this cannot be
guaranteed, abdominal myomectomy has to be recommended or
referral to a laparoscopic center to maximize the possibility and safety
of pregnancy after uterine reconstruction. The risk of uterine rupture
in pregnancy following myomectomy needs to be discussed with the
patient.
Robotic assistance might make laparoscopic suturing easier;
however, to date there are too few data to support this contention.
For women who have completed their family planning,
hysterectomy is the definitive procedure for relief of symptoms and
prevention of recurrence of fibroid-related problems. With increasing
experience in laparoscopic hysterectomies, the risk of side effects has
become manageable. In relation to the compliance and individuality
of the patient, the suitable solution can be laparoscopic supracervical
or total laparoscopic hysterectomy.
REFERENCES
1. Watson JD, Crick FH. Molecular structure of nucleic acids: a structure for
deoxyribose nucleic acid. Nature. 1953; 171: 737-738. https://goo.gl/osiYd8
2. Watson JD, Crick FH. Genetical implications of the structure of
deoxyribonucleic acid. Nature. 1953; 171: 964-967. https://goo.gl/ib72iM
3. Treloar SA, Martin NG, Dennerstein L, Raphael B, Heath AC. Pathways to
hysterectomy: insights from longitudinal twin research. Am J Obstet Gynecol.
1992; 167: 82-88. https://goo.gl/wxAjGt
4. Snieder H, MacGregor AJ, Spector TD. Genes control the cessation
of a woman’s reproductive life: a twin study of hysterectomy and
age at menopause. J Clin Endocrinol Metab. 1998; 83: 1875-1880.
https://goo.gl/60Iy37
5. Vikhlyaeva EM, Khodzhaeva ZS, Fantschenko ND. Familial predisposition
to uterine leiomyomas. Int J Gynaecol Obstet. 1995; 51: 127-1231.
https://goo.gl/vOh8or
6. Van Voorhis BJ, Romitti PA, Jones MP. Family history as a risk factor for
development of uterine leiomyomas. Results of a pilot study. J Reprod Med.
2002: 47: 663-669. https://goo.gl/NZVmMG
7. Al-Hendy A, Salama SA. Catechol-O-methyltransferase polymorphism is
associated with increased uterine leiomyoma risk in different ethnic groups. J
Soc Gynecol Investig. 2006; 13: 136-144. https://goo.gl/1cwEmk
8. Tsibris JC, Segars J, Coppola D, Mane S, Wilbanks GD, O’Brien WF, et
al. Insights from gene arrays on the development and growth regulation of
uterine leiomyomata. Fertil Steril. 2002; 78: 114-121. https://goo.gl/qz2F7e
9. Wang H, Mahadevappa M, Yamamoto K, Wen Y, Chen B, Warrington
JA, et al. Distinctive proliferative phase differences in gene expression
in human myometrium and leiomyomata. Fertil Steril. 2003; 80: 266-276.
https://goo.gl/3PH9MB
10. Gross K, Morton C, Stewart E. Finding genes for uterine fibroids. Obstetrics
and Gynecology. 2000; 95: 60. https://goo.gl/oXYrHu
11. Patterson-Keels LM, Selvaggi SM, Haefner HK, Randolph JF Jr. Morphologic
assessment of endometrium overlying submucosal leiomyomas. J Reprod
Med. 1994; 39: 579-584. https://goo.gl/vs0zPj
12. Flynn M, Jamison M, Datta S, Myers E. Health care resource use for uterine
fibroid tumors in the United States. Am J Obstet Gynecol. 2006; 195: 955-
9. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 0018
International Journal of Reproductive Medicine & Gynecology
964. https://goo.gl/itln1d
13. Hartmann KE, Birnbaum H, Ben-Hamadi R, Wu EQ, Farrell MH, Spalding J,
et al. Annual costs associated with diagnosis of uterine leiomyomata. Obstet
Gynecol. 2006; 108: 930-937. https://goo.gl/tEFc4k
14. Peddada SD, Laughlin SK, Miner K, Guyon JP, Haneke K, Vahdat HL, et
al. Growth of uterine leiomyomata among premenopausal black and white
women. Proc Natl Acad Sci U S A. 2008; 105: 19887-19892. https://goo.gl/
SszvQ6
15. Laughlin SK, Hartmann KE, Baird DD. Postpartum factors and natural fibroid
regression. Am J Obstet Gynecol. 2011; 204: 496. https://goo.gl/dCKih0
16. Zaima A, Ash A. Fibroid in pregnancy: characteristics, complications, and
management. Postgrad Med J. 2011; 87: 819-828. https://goo.gl/SY3d2W
17. Donnez J, Vazquez F, Tomaszewski J, Nouri K, Bouchard P, Fauser BC, et
al. Long-term treatment of uterine fibroids with ulipristal acetate. Fertil Steril.
2014; 101: 1565-1573. https://goo.gl/I9jXuD
18. Al-Hendy A, Lee EJ, Wang HQ, Copland JA. Gene therapy of uterine
leiomyomas: adenovirus-mediated expression of dominant negative estrogen
receptor inhibits tumor growth in nude mice. Am J Obstet Gynecol. 2004; 191:
1621-1631. https://goo.gl/HPwEKh
19. Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al.
Uterine-artery embolization versus surgery for symptomatic uterine fibroids.
N Engl J Med. 2007; 356: 360-370. https://goo.gl/3IoDqH
20. Van der Kooij SM, Bipat S, Hehenkamp WJ, Ankum WM, Reekers JA. Uterine
artery embolization versus surgery in the treatment of symptomatic fibroids: a
systematic review and metaanalysis. Am J Obstet Gynecol. 2011; 205: 317.
https://goo.gl/7cQCpp
21. Kim HS, Baik JH, Pham LD, Jacobs MA. MR-guided high-intensity focused
ultrasound treatment for symptomatic uterine leiomyomata: long-term
outcomes. Acad Radiol. 2011; 18: 970-976. https://goo.gl/lJBpmQ
22. Funaki K, Fukunishi H, Sawada K. Clinical outcomes of magnetic resonance
- guided focused ultrasound surgery for uterine myomas: 24-month follow-up.
Ultrasound Obstet Gynecol. 2009; 34: 584-589. https://goo.gl/s4PKqQ
23. Preventing entry-related gynecological laparoscopic injuries. RCOG Green-
top Guideline. 2008; 49: 1-10. https://goo.gl/9T7oDA
24. Wallach EE, Vlahos NF. Uterine myomas: an overview of development,
clinical features, and management. Obstet Gynecol. 2004; 104: 393-406.
https://goo.gl/HJhfyl
25. Myo Sun Kim, You Kyoung Uhm, Ju Yeong Kim, Byung Chul Jee, Yong Beom
Kim. Obstetric outcomes after uterine myomectomy: Laparoscopic versus
laparotomic approach. Obstet Gynecol Sci. 2013; 56: 375-381. https://goo.gl/
hzHsvu
26. Lonnerfors C, Persson J. Pregnancy following robot-assisted laparoscopic
myomectomy in women with deep intramural myomas. Acta Obstet Gynecol
Scand. 2011; 90: 972-977. https://goo.gl/ljUEt6
27. Mettler L, Schollmeyer T, Tinelli A, Malvasi A, Alkatout I. Complications of
Uterine Fibroids and Their Management, Surgical Management of Fibroids,
Laparoscopy and Hysteroscopy versus Hysterectomy, Haemorrhage,
Adhesions, and Complications. Obstet Gynecol Int. 2012; 2012: 791248.
https://goo.gl/bkanVb
28. Di Spiezio Sardo A, Mazzon I, Bramante S, Bettocchi S, Bifulco G, Guida
M, et al. Hysteroscopic myomectomy: a comprehensive review of surgical
techniques. Hum Reprod Update. 2008; 14: 101-119. https://goo.gl/Pvi8bm
29. Emanuel MH, Hart A, Wamsteker K, Lammes F. An analysis of fluid loss
during transcervical resection of submucous myomas. Fertil Steril. 1997; 68:
881-886. https://goo.gl/Pi3yYO
30. Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic
resection of submucous fibroids for abnormal uterine bleeding: results
regarding the degree of intramural extension. Obstet Gynecol. 1993; 82: 736-
740. https://goo.gl/OKOUD6
31. Hart R, Molnár BG, Magos A. Long term follow up of hysteroscopic
myomectomy assessed by survival analysis. Br J Obstet Gynaecol. 1999;
106: 700-705. https://goo.gl/0HXWPX
32. Mettler L, Sammur W, Alkatout I, Schollmeyer T. Imaging in gynecologic
surgery. Womens Health (Lond Engl). 2011; 7: 239-248. https://goo.
gl/1AxtHN
33. Varma R, Soneja H, Clark TJ, Gupta JK. Hysteroscopic myomectomy for
menorrhagia using Versascope bipolar system: efficacy and prognostic
factors at a minimum of one year follow up. Eur J Obstet Gynecol Reprod
Biol. 2009; 142: 154-159. https://goo.gl/0T1apq
34. Loffer FD, Bradley LD, Brill AI, Brooks PG, Cooper JM. Hysteroscopic fluid
monitoring guidelines. The ad hoc committee on hysteroscopic training
guidelines of the American Association of Gynecologic Laparoscopists. J Am
Assoc Gynecol Laparosc. 2000; 7: 167-168. https://goo.gl/Rz91GI
35. Jansen FW, Vredevoogd CB, van Ulzen K, Hermans J, Trimbos JB, Trimbos-
Kemper TC. Complications of hysteroscopy: a prospective, multicenter study.
Obstet Gynecol. 2000; 96: 266-270. https://goo.gl/TL7C2E
36. Propst AM, Liberman RF, Harlow BL, Ginsburg ES. Complications of
hysteroscopic surgery: predicting patients at risk. Obstet Gynecol. 2000; 96:
517-520. https://goo.gl/0nko0m
37. Parker WH, Rodi IA. Patient selection for laparoscopic myomectomy. J Am
Assoc Gynecol Laparosc. 1994; 2: 23-26. https://goo.gl/jTmP2Z
38. Lefebvre G, Vilos G, Allaire C, Jeffrey J, Arneja J, Birch C, et al. The
management of uterine leiomyomas. J Obstet Gynaecol Can. 2003; 25: 396-
418. https://goo.gl/rjm8vO
39. Alkatout I, Bojahr B, Dittmann L, Warneke V, Mettler L, Jonat W, et al.
Precarious preoperative diagnostics and hints for the laparoscopic excision
of uterine adenomatoid tumors: two exemplary cases and literature review.
Fertil Steril. 2011; 95: 1119. https://goo.gl/mq3jKE
40. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of
magnetic resonance imaging and transvaginal ultrasonography in the
diagnosis, mapping, and measurement of uterine myomas. Am J Obstet
Gynecol. 2002; 186: 409-415. https://goo.gl/wLC7XG
41. Alkatout I, Honemeyer U, Strauss A, Tinelli A, Malvasi A, Jonat W, et al.
Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv.
2013; 68: 571-581. https://goo.gl/nY2XJ6
42. Alkatout I, Schollmeyer T, Hawaldar NA, Sharma N, Mettler L. Principles and
safety measures of electrosurgery in laparoscopy. JSLS. 2012; 16:130-139.
https://goo.gl/NPA11T
43. Alkatout I, Stuhlmann-Laeisz C, Mettler L, Jonat W, Schollmeyer T. Organ-
preserving management of ovarian pregnancies by laparoscopic approach.
Fertil Steril. 2011; 95: 2467-2470. https://goo.gl/yIj1AK
44. Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during
myomectomy for fibroids. Cochrane Database Syst Rev. 2011: p. CD005355.
https://goo.gl/p7QzBy
45. Zhao F, Jiao Y, Guo Z, Hou R, Wang M. Evaluation of loop ligation of
larger myoma pseudocapsule combined with vasopressin on laparoscopic
myomectomy. Fertil Steril. 2010; 95:762-766. https://goo.gl/CB1dDA
46. Tinelli A, Liselotte M, Malvasi A, Hurst B, Catherino W, Ospan AM, et al.
Impact of surgical approach on blood loss during intracapsular myomectomy.
Minim Invasive Ther Allied Technol. 2013; 23: 87-95. https://goo.gl/H1qEI3
47. Celik H, Sapmaz E. Use of a single preoperative dose of misoprostol is
efficacious for patients who undergo abdominal myomectomy. Fertil Steril.
2003; 79: 1207-1210. https://goo.gl/VYI5E5
48. Mettler L, Sammur W, Schollmeyer T, Alkatout I, et al. Cross-linked sodium
hyaluronate, an anti-adhesion barrier gel in gynaecological endoscopic
surgery. Minim Invasive Ther Allied Technol. 2013; 22: 260-265. https://goo.
gl/GDH1z2
49. Mettler LT. Schollmeyer T, Alkatout I. Adhesions during and after surgical
procedures, their prevention and impact on women’s health. Womens Health
(Lond). 2012; 8: 495-498. https://goo.gl/5hlkOD
50. Tulandi TC, Murray C, Guralnick M. Adhesion formation and reproductive
outcome after myomectomy and second-look laparoscopy. Obstet Gynecol.
1993; 82: 213-215. https://goo.gl/Ed0omX
51. Tsuji S, Takahashi K, Imaoka I, Sugimura K, Miyazaki K, Noda Y. MRI
evaluation of the uterine structure after myomectomy. Gynecol Obstet Invest.
2006; 61: 106-110. https://goo.gl/0mwhBW
10. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 0019
International Journal of Reproductive Medicine & Gynecology
52. D’Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol. 2009; 116:
131-139. https://goo.gl/DhT14E
53. Mukhopadhaya N, De Silva C, Manyonda IT. Conventional myomectomy.
Best Pract Res Clin Obstet Gynaecol. 2008; 22: 677-705. https://goo.gl/
Z22ugL
54. Discepola F, Valenti DA, Reinhold C, Tulandi T. Analysis of arterial blood
vessels surrounding the myoma: relevance to myomectomy. Obstet Gynecol.
2007; 110: 1301-1303. https://goo.gl/4DRQy5
55. Pundir J, Pundir V, Walavalkar R, Omanwa K, Lancaster G, Kayani S.
Robotic-assisted laparoscopic vs abdominal and laparoscopic myomectomy:
systematic review and meta-analysis. J Minim Invasive Gynecol. 2013. 20:
335-345. https://goo.gl/SYqCdU
56. Barakat EE, Bedaiwy MA, Zimberg S, Nutter B, Nosseir M, Falcone T.
Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison
of surgical outcomes. Obstet Gynecol. 2011; 117: 256-265. https://goo.gl/
LZ7zk4
57. Mettler L, Clevin L, Ternamian A, Puntambekar S, Schollmeyer T, Alkatout I.
The past, present and future of minimally invasive endoscopy in gynecology:
a review and speculative outlook.Minim Invasive Ther Allied Technol. 2013;
22: 210-226. https://goo.gl/snh2Nc
58. Schollmeyer T, et al. Robotic surgery in gynecology. The Gynecologist. 2011;
44(3): p. 196-201.
59. George A, Eisenstein D, Wegienka G. Analysis of the impact of body
mass index on the surgical outcomes after robot-assisted laparoscopic
myomectomy. J Minim Invasive Gynecol. 2009; 16:730-733. https://goo.gl/
as1jjV
60. Falcone T, Parker WH. Surgical management of leiomyomas for fertility or
uterine preservation. Obstet Gynecol. 2013; 121: 856-868. https://goo.gl/
hQm4v0
61. Garry R, Fountain J, Brown J, Manca A, Mason S, Sculpher M, et al.
EVALUATE hysterectomy trial: a multicentre randomized trial comparing
abdominal, vaginal and laparoscopic methods of hysterectomy. Health
Technol Assess. 2004; 8: 1-154. https://goo.gl/NZphQ6
62. Dietl J, Wischhusen J, Hausler SF. The post-reproductive Fallopian tube:
better removed? Hum Reprod. 2011; 26: 2918-2924. https://goo.gl/YcCCqJ
63. Adashi EY. The climacteric ovary as a functional gonadotropin-driven and
rogen-producing gland. Fertil Steril. 1994; 62: 20-27. https://goo.gl/qzzz5A
64. Shifren JL. The role of androgens in female sexual dysfunction. Mayo Clin
Proc. 2004; 79: S19-S24. https://goo.gl/I0rxgV
65. Buster JE, Kingsberg SA, Aguirre O, Brown C, Breaux JG, Buch A, et al.
Testosterone patch for low sexual desire in surgically menopausal women: a
randomized trial. Obstet Gynecol. 2005; 105: 944-952. https://goo.gl/XeGaTh
66. Nyunt A, Stephen G, Gibbin J, Durgan L, Fielding AM, Wheeler M, et al.
Androgen status in healthy premenopausal women with loss of libido. J Sex
Marital Ther. 2005; 31: 73-80. https://goo.gl/R696Vs
67. Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL, et al.
Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med.
2003; 349: 523-534. https://goo.gl/Vw7u6C
68. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H,
et al. Effects of conjugated equine estrogen in postmenopausal women with
hysterectomy: the Women’s Health Initiative randomized controlled trial.
JAMA. 2004; 291: 1701-1712. https://goo.gl/4gUc5O
69. Parker WH, Broder MS, Liu Z, Shoupe D, Farquhar C, Berek JS. Ovarian
conservation at the time of hysterectomy for benign disease. Obstet Gynecol.
2005; 106: 219-226. https://goo.gl/5SYfI7
70. Guldberg R, Wehberg S, Skovlund CW, Mogensen O, Lidegaard O.
Salpingectomy as standard at hysterectomy? A Danish cohort study, 1977-
2010. BMJ Open. 2013; 3. https://goo.gl/dq1g2u
71. AAMIG W. AAGL position statement: Robotic-assisted laparoscopic surgery
in benign gynecology. J Minim Invasive Gynecol. 2013; 20: 2-9. https://goo.
gl/Wp42V0
72. Meeks GR, Harris RL. Surgical approach to hysterectomy: abdominal,
laparoscopy-assisted, or vaginal. Clin Obstet Gynecol. 1997; 40: 886-894.
https://goo.gl/RERosM
73. Mazdisnian F, Kurzel RB, Coe S, Bosuk M, Montz F. Vaginal hysterectomy
by uterine morcellation: an efficient, non-morbid procedure. Obstet Gynecol.
1995; 86: 60-64. https://goo.gl/3b4mW8
74. Jenkins TR. Laparoscopic supracervical hysterectomy. Am J Obstet Gynecol.
2004; 191: 1875-1884. https://goo.gl/QQIoPy
75. Berner E, Qvigstad E, Myrvold AK, Lieng M. Pelvic Pain and Patient
Satisfaction After Laparoscopic Supracervical Hysterectomy: Prospective
Trial. J Minim Invasive Gynecol. 2014; 21: 406-411. https://goo.gl/arHXat
76. Alkatout I, Mettler L, Beteta C, Hedderich J, Jonat W, Schollmeyer T, et
al. Combined surgical and hormone therapy for endometriosis is the most
effective treatment: prospective, randomized, controlled trial. J Minim
Invasive Gynecol. 2013; 20: 473-481. https://goo.gl/WqWK3Z
77. Semm K. Hysterectomy via laparotomy or pelviscopy. A new CASH method
without colpotomy. Geburtshilfe Frauenheilkd. 1991; 51: 996-1003. https://
goo.gl/bHN7Cs