Myoma Group Research Articles

Serum sestrin 2 levels in patients with uterine leiomyomas

Our aim was to evaluate SESN2 levels in patients with uterine leiomyomas by comparing serum SESN2 levels in myoma patients with the levels in healthy women to deepen our understanding of the pathophysiology of uterine leiomyomas. Patients 18–50 years of age who applied to the University of Health Sciences Turkey, Istanbul Kanuni Sultan Suleyman Training and Research Hospital between January and March 2021 and who were diagnosed with uterine leiomyoma were defined as the ‘myoma group’. The control group included patients without any sign of leiomyomas in routine ultrasonography. The patients’ demographic features, gynecological symptoms, myoma volume and classification were recorded. Serum SESN2 concentrations in venous blood samples were measured using a sandwich enzyme-linked immunosorbent assay (ELISA) kit. The study included 31 patients in the myoma group and 30 in the control group. The mean age/gravid/parity or BMI values did not differ significantly between the groups. The only gynecological symptom that showed a significant difference was menorrhagia. Serum SESN2 levels were significantly higher in the myoma group then the control groups (11.7 ± 2.5) (p < 0.001). In conclusion, although uterine leiomyoma is the most common benign tumour in women of reproductive age, there are no known markers for predicting the development of leiomyomas. Based on the results of the current study, SESN2 could be such a marker. IMPACT STATEMENT What is already known on this subject? Uterine leiomyoma is the most common type of benign tumour in women of reproductive age as well as the most common indication for a hysterectomy. Symptoms associated with uterine leiomyoma include abnormal bleeding, chronic pelvic pain, menorrhagia, dysmenorrhoea, dyspareunia and anaemia, which adversely affect the patient’s quality of life. Sestrins are a family of metabolic regulator proteins that play a potential role in carcinogenesis. What the results of this study add? This is the first study evaluating the role of sestrin in the development of uterine leiomyomas. Significantly higher levels of sestrin 2 (SESN2) were detected in patients with leiomyomas. What are the implications of these findings for clinical practice and/or further research? Although uterine leiomyoma is the most common type of benign tumour in women of reproductive age, there are still many unknowns regarding its pathophysiology. Further, there are still no known markers for predicting the development of leiomyomas. Hence, primary prevention is not possible. Based on the results of the current study SESN2, could be such a marker. Further studies are needed to confirm the results of this study.

The association between chronic endometritis and uterine fibroids.

Background:Some studies reported the association between fibroids with uterine inflammation. By considering this hypothesis, the formation and recurrence of uterine fibroids can be prevented by diagnosis and treatment of inflammation, and complications and costs can be reduced. This study aimed to evaluate the association between chronic endometritis and uterine fibroids in non-menopausal women.Materials and Methods:This prospective case-control study was performed on non-menopausal women referred to Al-Zahra Hospital in Rasht during April 2019-April 2020. Non- menopausal women of reproductive age (20-55 years old) with abnormal uterine bleeding who were candidates for hysteroscopy based on medical history and ultrasound reports were included in this study. The case group with fibroids were divided into two groups of intramural and subserosal myoma group and submucosal group based on the location of fibroids. The control group was patients with abnormal uterine bleeding complaints and no uterine fibroid. Endometrial specimens were examined by a pathologist for histological and immunochemistry assessments. In interpreting the results of endometrial biopsy, a positive result was indicated by the presence of one or more plasma cells per 10 high power field. Data were gathered by a form including age, parity, history of recurrent miscarriage, patient’s complaint (abnormal uterine bleeding), hysteroscopic results (submucosal myoma-polyp-normal), uterine histology (polyp, endometritis, and hyperplasia) and prevalence of chronic endometritis based on plasma cell in the biopsy. Data were analyzed by SPSS software version 21. Data were reported by descriptive statistics including number, percent, mean and standard deviation. The normality of quantitative data was assessed by the Kolmogorov- Smirnov test. Mann-Whitney U test, Chi-square and Fisher exact tests were used to compare groups and logistic regression was used to control the effect of confounders.Results:The incidence of chronic endometritis was 39% (38 out of 97) and a higher incidence of chronic endometritis was noted in the case group than the control group (46% vs. 31%), No significant difference was observed between the two groups (P > 0.05). However, the incidence of chronic endometritis in women with submucosal myoma was higher than the intramural and subserosal groups (64% vs. 37%) (P = 0.04). To control the effect of age on the rate of chronic endometritis in both groups, no significant effect was observed in logistic regression.Conclusions:The results showed the overall incidence of chronic endometritis was higher than previous studies and also the incidence was higher and more significant in women with submucosal myoma than in the intramural and subserosal group. As in this study, authors assessed the association between chronic endometritis and uterine fibroids, further studies assessing the cause and effect relationships are recommended.

Diagnostic Value of Ultrasonography Combined with Hysteroscopy in Intrauterine Space-Occupying Abnormalities.

The aim of this study was to analyze the diagnostic significance of ultrasonography combined with hysteroscopy for intrauterine space-occupying abnormalities. A total of 99 patients with uterine space-occupying abnormalities treated in hospitals were enrolled. The patients were divided into three groups according to different disease types: the submucosal myoma group, endometrial polyp group, and placenta residue group, with 33 patients in each group. The differences and diagnostic effects in intrauterine ultrasound, hysteroscopic findings, and surgical histopathology were observed in each group. Outcome measures: it was to compare the sensitivity, specificity, and accuracy of intrauterine ultrasound and angiography for intrauterine space-occupying lesions using surgical and pathological examination methods as the gold standard; the relationship between the location, number, size, appearance, and serosal layer of intrauterine lesions was clearly shown; the location, number, appearance, and echogenicity of space-occupying abnormalities under hysteroscopy were observed. The results showed that the diagnostic rates of endometrial polyps, submucous myoma, and residual placenta were 90.9%, 80.8%, and 72.7%, respectively. However, the sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of endometrial polyps were 90.0%, 66.7%, and 87.9%, respectively; those of hysteroscopy in the diagnosis of endometrial polyps were 96.7%, 66.7%, and 93.9%, respectively; and combined diagnosis was 96.7%, 100.0%, 97.0%, 100.0%, and 75.0%. The sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of submucous myoma of the uterus were 88.9%, 50.0%, and 81.8%, respectively; those of hysteroscopy in the diagnosis of submucous myoma of the uterus were 96.3%, 83.3%, and 93.9%, respectively; and combined diagnosis was 100.0%, 83.3%, 97.0%, 96.4%, and 100.0%. The sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of uteroplacental remnants were 87.5%, 66.7%, and 81.8%, respectively; those of hysteroscopy in the diagnosis of uteroplacental remnants were 91.7%, 77.8%, and 87.9%, respectively; and combined diagnosis was 95.8%, 88.9%, 93.9%, 95.8%, and 88.9%. In summary, ultrasonography combined with hysteroscopy can improve the diagnostic sensitivity and accuracy for intrauterine space-occupying abnormalities.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ СТРУКТУРЫ СОМАТИЧЕСКОЙ ПАТОЛОГИИ У БОЛЬНЫХ МИОМОЙ И РАКОМ ТЕЛА МАТКИ

Objective: to conduct a comparative analysis of the structure of somatic pathology in patients with myoma and cancer of the uterine body. Materials and methods: 522 women were examined, including 40 gynecologically healthy (group 1), 314 patients suffering from uterine myoma (group 2), 168 patients with malignant neoplasms of the uterine body (group 3). All patients, in addition to General clinical, histological and instrumental diagnostic methods, were calculated the Charlson comorbidity index, which determines the presence of concomitant diseases and the prognosis of mortality. Results. A comprehensive assessment of concomitant pathology in patients with group 3 showed that the leading positions among all patients in frequency are occupied by arterial hypertension - 72%, coronary heart disease - 28,6%, obesity - 27,9%, endocrinopathy - 25,6%, gastropathy - 23,1%, pathology of the hepatobiliary system - 20,8%. When analyzing somatic pathology in patients with uterine myoma, it was found that arterial hypertension is most common - 23,6% (3,5 times less often than in group 3), anemia - 26,8% (3.8 times more often than in group 3), endocrinopathy - 10,8% (2,4 times less often than in group 3), gastrotopathy - 15% (0,8 times less often than in group 3), pathology of the hepatobiliary system - 15,2% (0,7 times less than with group 3). At the same time, comorbidity has its own characteristics depending on the main pathology and the age of the patients. Thus, the total number of extragenital pathology in women with group 3 was 73% compared to 27,4% in patients with uterine myoma. The Charlson comorbidity index for group 3 was 1,78 overall, and 0,35 for group 2, which is 5 times lower. Conclusion. The range of somatic conditions in patients with benign and malignant uterine tumors is very wide. The age Association is obvious. The leading positions in the two compared groups are occupied by cardiovascular diseases. The total number of extragenital pathology in women with group 3 is 2,7 times higher, and the comorbidity index is 5 times higher, compared to those in patients with uterine myoma.

Changes of coagulation function in patients with adenomyosis and its clinical significance

Objective: To measure the coagulation function of patients with adenomyosis so as to explore its relationship with increased menstrual amount and its clinical significance. Methods: From January 2014 to May 2019, clinical data of patients with hysterectomy in which 111 pathologically diagnosed adenomyosis (case group) and 115 with uterine myoma (control group) in Peking University First Hospital were retrospectively analyzed. The changes in coagulation function of the two groups were compared, and the correlation between coagulation and uterine volume in the adenomyosis group was analyzed. Results: (1) The activated partial thromboplastin time (APTT) was longer in the adenomyosis group than that in the uterine myoma group [(30.4±3.1), (29.6±2.5) s, respectively; P<0.05], while the thrombin time (TT) was shorter than that in the control group [(14.2±1.2), (14.6±1.0) s, respectively; P<0.05]. (2) According to the results of the Pearson correlation test, there was a positive correlation between prothrombin time (PT; r=0.135, P=0.042) and fibrinogen (FIB-C; r=0.139, P=0.036). (3) Platelet counts were higher in the anemia group of adenomyosis than that in the non-anemia group [(323±79)×109/L, (274±56)×109/L, respectively; P<0.05]. (4) FIB-C in non-anemia group of adenomyosis was lower than non-anemia group of uterine myoma [(2.8±0.5), (3.0±0.6) g/L, respectively; P<0.05], the anemia group of adenomyosis shortened TT compared with the anemia group of uterine myoma [(14.4±1.2), (15.2±0.9) s, respectively; P<0.05]. Conclusion: Patients with adenomyosis have abnormal coagulation function, which may be related to the increase amount of menstruation, and anemia may also be involved in coagulation disorders.

Analysis of the effect of laparoscopy and hysteroscopy on ovarian function, immune function and quality of sexual life of patients with hysteromyoma at different ages.

This study aims to comparatively analyze the impact of laparoscopic myomectomy (LM) and transcervical resection of myoma (TCRM) on ovarian function, immune function and quality of sexual life of patients with hysteromyoma. Two hundred and forty patients with hysteromyoma admitted into the Second Affiliated Hospital of Zhengzhou University from June 2014 to June 2016 were divided into laparoscopic myomectomy group (LM group, n=120) and transcervical resection of myoma group (TCRM group, n=120) according to random figure table. The difference between the two surgical methods were compared among hysteromyoma patients of different age in the following aspects: perioperative indicators, ovarian function, immune function and quality of sexual life before treatment and after operation. 1) there was no significant difference in age structure between LM and TCRM group (P>0.05). 2) There were no significant differences in the amount of bleeding, operative time, analgesics usage rate between the groups (P>0.05), but the anal exhaust time, postoperative ambulation time, hospitalization time and hospitalization costs in TCRM group were significantly less than that in LM group, the difference was statistically significant (P<0.01). 3) Before treatment and in the 3rd, and 6th month after operation, there was no significant difference on follicle stimulating hormone (FSH), luteinizing hormone (LH) or estradiol (E2) level between the two groups (P>0.05); but in the 3rd month after operation, the level of E2 decreased remarkably, with FSH and LH level increased significantly compared with the 6th month after operation and before treatment (P<0.05). 4) Compared with the preoperative status, there was no significant decrease in humoral immunity (IgG, IgA, IgM) and cellular immune function (CD4+, CD8+) in TCRM group at the 3rd and 6th month after operation (P>0.05). While at the 3rd month after operation, the levels of CD4+, CD8+ were decreased significantly in comparison to those at the 6th month after operation (P<0.05), but the levels of IgG, IgA and IgM were not decreased significantly (P>0.05). 5) There was no significant difference in the quality of sexual life between the two groups before operation or at the 3rd and 6th month after operation (P>0.05). In recent years, endoscopic treatment has become the main treatment evolution of hysteromyoma, patients of all ages are paying attention to the preservation of the uterus. This study showed that TCRM is approaching through the natural cavity, which has the features of less damage to body, faster recovery and lower cost of hospitalization than LM. The two surgical methods have no obvious influence on ovarian function, immune function and quality of sexual life.

Distinct Pattern of Inflammatory Enzyme Activities in Human Ovarian Cancer and Benign Myoma

Objective: Inflammatory cells and their products are significant components of malignancies. This study was performed to determine the activity of inflammatory enzymes myeloperoxidase (MPO) and N-acetylglucosaminidase (NAG) in ascitic fluid, sera or peritoneal lavage fluid from patients with epithelial ovarian cancer (EOC). Methods: Eighteen patients age ranging from 25 to 79 years (54.6±2.9 years) with epithelial ovarian cancer submitted to surgical treatment (EOC group) and 17 patients with uterine myoma (Myoma group) submitted to abdominal hysterectomy (control group) were prospectively studied. MPO and NAG activities were evaluated colorimetrically in sera, ascites or peritoneal lavage fluid obtained from the patients at the time of laparotomy. Results: In a total of 18 EOC, there were stage I in 1 case (5.5%), II in 3 (16.7%), III in 11 (61.1%) and IV in 3 cases (16.7%). MPO activity in sera of EOC was higher than in the ascitic fluid from the same patients. Conversely, MPO activity was similar in sera from both EOC and myoma-bearing patients. Comparison between NAG activities in sera from both groups showed much higher values in the OEC patients. Furthermore, inflammatory enzyme activities were overall associated with the stage of the disease. Conclusions: Our results show that inflammation has been positively correlated with cancer and that the pattern of a systemic inflammatory response induced by EOC differs quantitatively from that of a typical benign pelvic condition. The most important limitation lies in the fact that the number of patients and controls was relatively small. Further studies with a larger number of patients and longer follow-up are necessary to assess the accuracy of the diagnostic and prognostic impact of these results.

Efficacy of the levonorgestrel-releasing intrauterine system in uterine leiomyoma

Objective To evaluate the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) in reducing menstrual blood loss (MBL) in myoma-related menorrhagia and to assess the effect of the LNG-IUS on uterine and leiomyoma volume. Methods A prospective comparative study investigated the effect of LNG-IUS use in women with myoma-related menorrhagia (n = 54) and women with idiopathic menorrhagia (n = 50). The outcome was assessed in terms of reductions in MBL and in myoma and uterine volume. Results Within 1 month of LNG-IUS insertion, the Pictorial Blood Loss Assessment Chart score in the myoma group fell by 86.8% ( P < 0.0001). At 3, 12, 24, 36, and 48 months, the MBL was reduced by 92.1%, 97.4%, 97.4%, 99.5%, and 99.5%, respectively, similar to the effect seen in the idiopathic menorrhagia group. The mean uterine volume was significantly reduced in both groups, but the reduction was greater in the group with leiomyomas (idiopathic menorrhagia, P = 0.038; myoma-related menorrhagia, P = 0.012). There was no statistically significant reduction in the myoma volume ( P = 0.409). Conclusion Use of the LNG-IUS appears to lead to a significant reduction in the uterine volume of women with menorrhagia, as well as reducing the MBL in women with uterine leiomyomas.

OP37.10: Ophthalmic artery Doppler in pregnant women with systemic lupus erythematosus

The Doppler changes and pregnancy outcomes were analyzed with independent sample t-test, Fisher’s exact test and Pearson’s correlation using the SPSS statistical software (version 12.0; SPSS Inc, Chicago, IL). Results: Twenty one patients with myomas and 30 normal patients were enrolled in this study. The RI and S/D ratio of the uterine artery on both sides were not differ in the myoma group and in control group (P = 0.42, P = 0.15, P = 0.29, P = 0.12, in Right RI, Left RI, Right S/D, Left S/D, respectively). In patients with right side dominant myoma and with left side dominant myoma, the uterine artery Doppler RI and S/D ratio were not differ significantly (P = 0.65, P = 0.22, P = 0.39, P = 0.28, in Right RI, Left RI, Right S/D, Left S/D, respectively). Age is significantly higher in the myoma group (P = 0.03), but there were no differences in gestational age at birth, birth weight, five minute APGAR score, Cesarean section due to fetal distress and neonatal intensive unit care (P = 0.62, P = 0.20, P = 0.08, P = 0.99, P = 0.10, respectively). Conclusions: According to this study, the presence of myoma as well as the location and the size of myoma didn’t change the uterine artery Doppler velocimetry and didn’t affect the pregnancy outcome. Cesarean section or early delivery due to large myoma could be reserved in prenatal management. Further study with a larger study population would be needed for better outcome.

The Peritoneal Leptin, MCP-1 and TNF-α in the Pathogenesis of Endometriosis-Associated Infertility

To explore the roles of leptin, monocyte chemotactic protein (MCP)-1, and tumour necrosis factor (TNF)-α in the peritoneal fluid (PF) in the pathogenesis of endometriosis-associated infertility. Leptin, MCP-1, and TNF-α levels in the PF from 28 infertile women with endometriosis (study group), 23 women with fallopian-associated infertility (controls), and 24 women with myoma (controls) were determined by performing enzyme-linked immunosorbent assay (ELISA). Leptin and TNF-α levels in the PF showed no significant difference among three groups. The MCP-1 level in patients with endometriosis was higher than those in fallopian-associated infertility group and myoma group (P < 0.01). There was a positive correlation between leptin and MCP-1 levels in the PF of patients with endometriosis (P < 0.05). Peritoneal leptin and MCP-1 play important roles in the pathogenesis of infertility in the early stage of endometriosis.

건강 관련 요인이 자궁근종에 미치는 영향

여성의 자궁근종에 대한 유병률을 초음파진단장비로 확인하고 건강 관련 요인과 자궁근종과의 상관관계를 분석하여 건강 관련 요인이 자궁근종의 발생에 미치는 구체적인 발생 요인을 확인하고자 한다. 자궁근종이 진단된 모집단과 자궁근종이 없는 대조군을 대상으로 자가 기입식 설문조사를 실시한 결과 초음파진단 장비로 진단된 자궁근종의 유병률은 29.7%로 나타났으며, 자궁근종군의 연령분포는 40~49세가 41.4%로 가장 높게 나타났다(p<0.05). 자궁근종의 유병률에 영향을 미치는 각 요인에 대하여 조사한 결과, 연령, 결혼력, 직업의 활동량, 생활의 만족도, 체중, 비만도, 분만력, 수유, 유산, 피임 등은 자궁근종과의 상관관계에서 통계적으로 유의하였다.(p<0.05) Prevalence of female uterine myoma was determined using ultrasound diagnosis instrument, and correlation between health-related factors and uterine myoma was analyzed to investigate concrete factors for production of uterine myoma. Subjects in uterine myoma group and control group were asked to answer the questionnaire survey. The results were determined that prevalence of uterine mayma was 29.7%, and 40~49 aged group showed the highest level of uterine myoma by 41.4%. (p<0.05). The analysis showed that there were significant correlations between uterine myoma and collected variables such as age, marital status, occupational activity level, satisfaction level of life, weight, obesity, delivery history, breast feeding, abortion, and contraceptive experience (p<0.05).

Office Endometrial Ablation with Local Anesthesia Using the HydroThermAblator System: Comparison of Outcomes in Patients with Submucous Myomas with Those with Normal Cavities in 246 Cases Performed Over 5½ Years

Study Objective To estimate the safety and efficacy of the HydroThermAblator (HTA) system for performance of endometrial ablation in the medical office setting using local anesthesia and minimal oral sedation and to compare results obtained in patients with submucous myomas with those in patients with normal endometrial cavities. Design Retrospective cohort analysis of 246 HTA procedures (Canadian Task Force classification II-2). Setting Medical offices of a suburban community medical center that is part of a large health maintenance organization. Patients Two hundred forty-six women aged 28 to 63 years (mean [SD], 45.1 [6.0] years) with abnormal uterine bleeding unresponsive to conservative management, including 104 patients (42.3%) with submucous myomas. Type 0 or type I myomas were present in at least 86 patients with submucous myomas (82.7%) and ranged from 1 to 4 cm in greatest diameter. In the other 18 patients, submucous myomas were not classified by type. Patients were evaluated at 2 to 70 months after the procedure (median follow-up, 31.0 months). Three patients were lost to follow-up, and 12 patients underwent hysterectomy for indications other than abnormal bleeding and were excluded from the analysis. Thus, 231 patients were included in the analysis. Interventions Endometrial ablation was performed using the HTA system with paracervical or intracervical block after oral premedication with ibuprophen, diazepam, and acetominophen or hydrocodone and intramuscular ketorolac. No intravenous or intramuscular narcotics were used. The anesthesia regimen was the same in patients with submucous myomas as in those with normal cavities, and the procedure was performed in exactly the same manner. All procedures were performed in the medical office procedure room by 7 board-certified gynecologists; most procedures were performed by the authors. Measurements and Main Results Of the 231 patients included in the analysis, 121 (53.4%) reported postablation amenorrhea, 62 (26.8%) reported light menses or spotting, 21 (9.1%) reported normal menses, 15 (6.5%) reported menorrhagia, and 12 (5.2%) underwent hysterectomy because of bleeding. In the 136 patients with normal cavities, amenorrhea was achieved in 84 patients (61.8%), oligomenorrhea in 35 (25.7%), and eumenorrhea in 12 (8.8%). Four patients (2.9%) continued to have menorrhagia requiring medical treatment. In the 95 patients with submucous myomas, amenorrhea was reported by 37 patients (38.9%), oligomenorrhea by 27 (28.4%), eumenorrhea by 9 (9.5%), and menorrhagia by 11 (11.6%). In 11 patients (11.6%), hysterectomy was performed because of menorrhagia. All patients who underwent hysterectomy had multiple myomas, and 9 (81.8%) also had adenomyosis. The failure rate, defined as patients with menorrhagia or undergoing hysterectomy because of bleeding, was 11.7% overall. The failure rate in patients with submucous myomas and normal cavities was 23.2% and 3.7%, respectively (relative risk, 6.3; 95% confidence interval, 2.5–16.0). While the failure rate in the group with myomas was statistically significantly higher than in the group without myomas, the failure rate in the myoma group was still comparable to that achieved using electrosurgical resection and ablation of similar types of myomas as reported in the literature. The amenorrhea rate achieved in the myoma group (38.9%) was also comparable to that achieved in US Food and Drug Administration pivotal trials in patients with normal cavities treated using all of the nonhysteroscopic global ablation devices as well those treated using rollerball endometrial ablation. The rate of hysterectomy because of bleeding was 5.2% overall. The hysterectomy rate in patients with submucous myomas and normal cavities was 11.6% and 0.7%, respectively. Only 1 procedure was discontinued (at 8 minutes) because of pain. Four patients had postoperative endometritis, with 2 requiring hospitalization for intravenous antibiotic therapy. Two false passages were created while dilating the cervix, with subsequent inability to perform the procedure. Conclusions Hydrothermablation performed in the medical office using local anesthesia seems to be a safe, effective, and cost-saving procedure for treatment of abnormal uterine bleeding in women with both normal and myomatous uteri. Although the success rate in patients with normal cavities was higher than that achieved in patients with submucous myomas, hysterectomy because of abnormal bleeding related to myomas was avoided in 88.4% of the group with myomas.

Effect of thread pitch on pull‐out strength of laparoscopic myoma screws

The purpose of this study was to evaluate the effect of thread-pitch on pull-out strength and bending strength of buttress-thread screws designed for laparoscopic myoma extraction. The ultimate failure load of four 5-mm diameter buttress-thread screws with 3-, 4-, 5-, and 6-mm thread pitch, 40 mm in thread-length were examined on fresh myoma specimens. The myoma tissue at each traction site was evaluated histologically to determine its density. The critical minimal pull-out strength based on moderate-density myoma group was estimated. The bending strength was also determined for each screw. A wide range of ultimate failure loads with a mean +/- SE of 129.3 +/- 5.5 N (range, 30.4-255.7 N) for all screws and tissue densities was recorded. In moderate-density myomas, the mean ultimate failure loads decreased linearly with increasing thread-pitch from 3 mm (148.0 +/- 9.5 N) to 6 mm (119.8 +/- 9.4 N) (test for trend: P < 0.05). Based on the criterion of a minimum pull-out strength of at least 50 N in not less than 95% of tractions in medium-density myomas, the 3-mm and 5-mm pitch screws were found to have acceptable properties. The 5-mm pitch screw had less thread-turn than the 3-mm pitch for the same thread-length and would need less application time. The bending strength also decreased with increasing thread pitch from 3 to 5 mm, then became stable at around 15 N. The pull-out strength of soft tissue buttress-thread screws decreased linearly with increasing thread-pitch. Thread-pitch should be considered when designing laparoscopic myoma-screws.

Transcervical resection of myoma in treatment of hysteromyoma, experience in 962 x\cases

To study the technique and effect of transcervical resection of myoma (TCRM) in treatment of hysteromyoma. 962 women suffering type 0 hysteromyoma (n = 281), 316 type 1 hysteromyoma (n = 316), type 2 hysteromyoma (n = 282), submucous and intramural myoma (n = 34), cervical myoma (n = 11), prolapse myoma (n = 23), and adenomyoma (n = 15) underwent TCRM with "five-step technique", monitored by B-ultrasound or laparoscopy, Follow-up lasted more than 6 months. The primary operation successful rate was 99.77%. The mean size and depth of uterus were 7.44 +/- 1.3 gestation weeks and (8.31 +/- 1.43) cm, the diameter of the biggest myoma was 7.2 cm. The mean weight of the resected tissues was (22.63 +/- 31.41) g, and the mean operation time and blood loss during the operation were 32.50 +/- 172.72 minutes and (7.75 +/- 19.49) ml. No transfusion was needed. The complications included postoperative fever (3 cases), uterine bleeding (1 case), uterine perforation (1 case), and TURP syndrome (2 cases). Postoperative scanty menstrual rate was 100% in the type 0 hysteromyoma group, 99.1% in the type I hysteromyoma group, 94.02% in the type II hysteromyoma group, 100% in the cervical myoma and prolapse myoma group, 84% in the multiple myoma and intramural myoma group, and 87% in the adenomyoma group respectively. The alleviation rates of dysmenorrhea and anemia were 78% and 82.95% respectively. Those who have severe complications of internal medicine showed obvious improvement. The residual myoma of 2 cases were resected during the secondary operation 9 days and 3 months after the primary operation. 455 cases (52.17%) resumed their work in 1 month postoperatively. 32 living infants were delivered. Safe and highly effective, TCRM can be the first choice in treatment of submucous and intramural hysteromyoma.

Serum and tissue levels of six trace elements and copper/zinc ratio in patients with cervical cancer and uterine myoma.

The aim of this study is to investigate the relationship between trace elements and the incidence of cervical cancer. Tissue and serum levels of six elements (Cu, Zn, Fe, Mn, Ca, and Se) and the Cu/Zn ratio in 40 cases of patients with cervical cancer, 30 cases of uterine myoma, and 50 healthy subjects were measured by atomic absorption spectrophotometry; the selenium content was determined by atomic fluorescence spectrometry. The results showed that the tissue contents of Zn, Se, and Ca were significantly lower and the Cu and Fe concentrations and Cu/Zn ratio were significantly higher in cervical cancer tissue than that for paired nonlesion tissue (p<0.02 and p<0.001, respectively). The serum levels of Zn, Se, Ca, and Fe were lower and Cu and Mn levels and Cu/Zn ratio were higher in patients with cervical cancer than in healthy subjects (p<0.01 and p<0.001, respectively) and in the uterine myoma group compared with healthy subjects (p<0.05-0.001). There are no significant differences in the contents of six elements and the Cu/Zn ratio between uterine myoma tissue and paired nonlesion tissue. The results showed also that the Fe level and Cu/Zn ratio were significantly higher and the Zn and Se levels were significantly lower in cervical cancer tissue than in uterine myoma tissue (p<0.01 and p<0.001, respectively). The serum Cu level and Cu/Zn ratio were significantly higher in the cervical cancer group than the uterine myoma group (p<0.01). Data were also analyzed using multivarate logistic regression. After adjustment for age, occupation, life habit, and other covariates for the development of cervical cancer, the odds ratios were 22.64 (95% confidence interval [CI]: 5.64-90.88, p=0.001) for Cu, 0.11 (95% CI: 0.034-0.373; p=0.005) for Zn, and 0.60 (95% CI: 0.36-0.99, p=0.01) for Se. Thus, the serum and tissue levels of Cu increase and the deficiency of Zn and Se may be risk factors for the development of cervical cancer.

Hysteroscopic myomectomy: long-term effects on menstrual pattern and fertility

Objective: To determine the effects of hysteroscopic myomectomy on menorrhagia and infertility and the influence of intramural extension on surgical feasibility and long-term outcomes. Methods: We studied 108 women who had first-line hysteroscopic resection of submucous pedunculated ( n = 54), sessile ( n = 30), or intramural ( n = 24) leiomyomas over 7 years at an academic department specializing in endoscopic surgery. Results: The mean (± standard deviation) operating time and distension medium deficit were 18 ± 7 minutes and 204 ± 276 mL in the pedunculated lesion group, 23 ± 9 minutes and 278 ± 269 mL in the sessile lesion group, and 32 ± 8 minutes and 335 ± 272 mL in the intramural lesion group, respectively. More than one procedure was required to complete myoma removal in 14 (26%) of 54, eight (26%) of 30, and 12 (50%) of 24 subjects in the pedunculated, sessile, and intramural lesion groups, respectively. After a mean follow-up of 41 months, myomas recurred in 27 subjects, with a 3-year cumulative rate of 34%. Twenty women had recurrent menorrhagia, with a 3-year cumulative probability of 30%. The 3-year cumulative probability of conception was 49% in women with pedunculated lesions, 36% in those with sessile lesions, and 33% in those with intramural lesions. The study had 80% power to detect five- and three-fold increases in menorrhagia recurrence and conception rates, respectively, in the mainly intramural myoma group com- pared with the completely or mainly intracavitary myoma group. Conclusion: Hysteroscopic resection of submucous myomas gives satisfactory menorrhagia control and limited recurrence, but the benefit for infertility was less impressive. Myoma intramural extension did not have a substantial influence on any of the long-term outcomes but affected operating time and the number of procedures needed for complete removal.

Interface vessels on color/power Doppler US and MRI: a clue to differentiate subserosal uterine myomas from extrauterine tumors.

In subserosal myomas, vessels are often demonstrated between the masses and the uterus. This study was performed to assess the usefulness of demonstrating these vessels in differentiating subserosal myomas from extrauterine tumors on color or power Doppler US (CDUS/PDUS) and MRI. This retrospective study included 41 patients with subserosal myomas and 27 patients with solid extrauterine tumors. The incidence and shape of these vessels seen on CDUS/PDUS and MRI were compared in the myoma and extrauterine tumor groups. The interface vessels were demonstrated in 39 of 41 subserosal myomas (18 on CDUS/PDUS, 14 on MRI, 7 on both), whereas they were seen in only 3 of 27 extrauterine tumors (1 on CDUS/PDUS, 2 on MRI). These three extrauterine tumors were ovarian malignancies that directly invaded the uterus. The shapes of these interface vessels were 7 intervening, 12 crossing, and 20 mixed in the myoma group, whereas they were mixed in all three extrauterine tumor groups. The sensitivity/specificity of this finding in differentiating subserosal myomas and extrauterine tumors was 100/92%, 91/91%, and 95/89%, respectively, with CDUS/PDUS, MRI, and either CDUS/PDUS or MRI. Observation of the interface vessels between the uterus and juxtauterine masses seems to be a useful clue in differentiating subserosal myomas from extrauterine tumors.

Significance of E2,PRO Level in Serum and Tissue Extraction of Patients with Utcrus Myoma

Objective assess significance of Estradiol(E2)、Progesterone(PRO) level in serum and tissue extraction of patients with uterus myoma.Methods 24 paticnts with utcrus myoma were studied(age of 34～51 years old).Their serum E2、PRO content was determined by RIA pre-and post-operation.E2/PRO ratio was calculated.So did control group of 20 cases.A piece of myoma and normal muscle tissue was taken just the time for operation and this samples were extracted;the E2,PRO level of extraction was detected by RIA.Results The serum E2 content and E2/PRO ratio of uterus myoma group was significant lower than that of control group.E2 content within tissue extraction of myoma was significantly higher than that of normal muscle,as well as the E2/PRO ratio.Conclusion For uterus myoma the abnormal E2/PRO ratio in serum may be the main factor related to that disease,and increase of E2 and imballance of E2/PRO ratio inside myoma may be the direct cause of uterus myoma.

Hysteroscopic Myomectomy

In Brief Objective To determine the effects of hysteroscopic myomectomy on menorrhagia and infertility and the influence of intramural extension on surgical feasibility and long-term outcomes. Methods We studied 108 women who had first-line hysteroscopic resection of submucous pedunculated (n = 54), sessile (n = 30), or intramural (n = 24) leiomyomas over 7 years at an academic department specializing in endoscopic surgery. Results The mean (± standard deviation) operating time and distension medium deficit were 18 ± 7 minutes and 204 ± 276 mL in the pedunculated lesion group, 23 ± 9 minutes and 278 ± 269 mL in the sessile lesion group, and 32 ± 8 minutes and 335 ± 272 mL in the intramural lesion group, respectively. More than one procedure was required to complete myoma removal in 14 (26%) of 54, eight (26%) of 30, and 12 (50%) of 24 subjects in the pedunculated, sessile, and intramural lesion groups, respectively. After a mean follow-up of 41 months, myomas recurred in 27 subjects, with a 3-year cumulative rate of 34%. Twenty women had recurrent menorrhagia, with a 3-year cumulative probability of 30%. The 3-year cumulative probability of conception was 49% in women with pedunculated lesions, 36% in those with sessile lesions, and 33% in those with intramural lesions. The study had 80% power to detect five- and three-fold increases in menorrhagia recurrence and conception rates, respectively, in the mainly intramural myoma group compared with the completely or mainly intracavitary myoma group. Conclusion Hysteroscopic resection of submucous myomas gives satisfactory menorrhagia control and limited recurrence, but the benefit for infertility was less impressive. Myoma intramural extension did not have a substantial influence on any of the long-term outcomes but affected operating time and the number of procedures needed for complete removal. Hysteroscopic myomectomy is safe, provides satisfactory menorrhagia control, and limits lesion recurrence but has little benefit for infertility.

The potential of serum levels of soluble tumour necrosis factor receptor I as a biochemical marker in cervical cancer.

To investigate the significance of serum levels of soluble tumour necrosis factor receptor I (sTNF-RI) as a potential biochemical marker in women with cervical cancer. A prospective, case-controlled study. Seventy-one women with cervical cancer and 33 women with myoma were enrolled in this study. Pre-operative serum levels of sTNF-RI were measured with a standard enzyme-linked immunosorbent assay utilising murine monoclonal antibody against sTNF-RI. All data in both groups were evaluated and correlated with the pre-operative serum levels of sTNF-RI. Data analysis was carried out using ANOVA with multiple comparison and linear regression. The mean serum level of sTNF-RI in the cervical cancer group was significantly lower than that in the myoma group (P < 0.001). The sTNF-RI levels decreased sequentially with disease progression from Stage Ia to IIb in women with cervical cancer. The mean serum level of sTNF-RI was also significantly lower in women with positive lymph node (P < 0.05) or recurrent cancer (P < 0.001). A negative correlation was observed between serum levels of sTNF-RI and tumour size (r = -0.622, P < 0.0001). Decreased pre-operative serum levels of sTNF-RI are observed in women with cervical cancer. The results do not support that the use of sTNF-RI as a biochemical marker for cervical cancer.