Uterine Fibroids Research Articles

Postmenopausal Shrinkage of Uterine Myomas: A Retrospective Study of 97 Cases Monitored Annually for 10 Years.

Introduction and aim Both patients and gynecologists are concerned about how much and how quickly myomas shrink after menopause. This study aimed to elucidate clinical findings that may be associated with postmenopausal shrinkage of uterine myomas. Materials and methods This study included 97 patients who underwent menopause by August 2012, had myoma nodules with the longest diameter between 50 mm and 160 mm, and visited our specialized myoma clinic annually for at least 10 years after menopause. They underwent transabdominal ultrasonography at least once per year. An experienced gynecologist measured the longest diameter of myoma nodules with a maximum diameterbetween 50 mm and 160 mm. The shrinkage rate of myoma diameters after menopause compared to premenopausal diameters was calculated each year for 10 years. The shrinkage rate of the longest diameter of the largest nodule 10 years after menopause (10-year shrinkage rate) and its relationship with clinical findings (the age at menopause, parity, body mass index {BMI}, number of nodules, MRI findings on T2-weighted image, location of the nodule, and longest diameter of the largest nodule before menopause) were analyzed. Additionally, we examined annual changes in shrinkage rate of myomas over a 10-year period after menopause (annual trend), and the relationship between annual trends and factors such as BMI and the number of nodules. Results In this examination of 10-year shrinkage rate, the group with a BMI of less than 25 showed a significantly greater shrinkage rate compared to the group with a BMI of 25 or more (25.0% vs 15.7%, p=0.023). Additionally, the group with a single nodule showed a significantly greater 10-year shrinkage rate compared to the group withfour or more nodules(26.3% vs 15.2%, p=0.036). For annual trends, the rate of change in the first two years after menopause was significantly faster compared to the trend from the third to the 10th year (difference in slope: 3.888 points per year, p<0.001).When divided into two groups based on the number of nodules (one or two nodules groupand three or more nodules group), the group with one or two nodules showed a significant difference in the shrinkage rate between up to two years after menopause and from the period from the third to the 10th year(difference in slope: 4.590 points per year, p<0.001). However, for the group with three or more nodules, there was no significant difference in the annual trend between the first two years after menopause and the rate from the third to the 10th year (difference in slope: 1.626 points per year, p=0.107). Conclusion BMI and the number of myoma nodules were significantly related to the 10-year shrinkage rate. Although myomas shrank significantly faster within the first two years after menopause compared to the later period, the early annual trend did not differ significantly from the trend in the later period when there were multiple nodules with a maximum diameter of 50 mm or more.

Assessment IL-6, TGF-1, CRP, and Vit-D in Women With Uterine Fibroid

Background: Uterine fibroids, also known as UFs, are the most common type of tumor that occurs in the female reproductive system. They affect a significant majority, around 70-80%, of women during their lifetime. Various factors that increase the incidence of Uterine Fibroids (UFs) have been found, including as vitamin D deficiency, inflammation, DNA repair deficit, and exposure to endocrine-disrupting chemicals (EDCs) in the environment. Objective: The purpose of this study to evaluated the level of IL-6, TGF-1, CRP, and Vit-D in women with uterine fibroid and study the relation these parameter with different ages. Materials and methods: 90 blood samples were collected and divided into (50) blood samples from women with uterine fibroids who received a diagnosis from a qualified medical specialist, and (40) blood samples from healthy women, whose ages ranged from (20-50). Assessment level of IL-6, TGF-1, CRP, and Vit-D have been done by using ELISA technique. Result: The results showed that there was no significant difference at the probability level (P&gt;0.05) in the level of IL-6 in women with uterine fibroids, as it reached (44.9±4.4 pg/ml) when compared with healthy women (42.5±4.1 pg/ml). The results of this study showed a significant increase in the levels of both β-TGF and CRP in women with uterine fibroids at the probability level (P&lt;0.05), reaching (2.870±0.760ng/ml, 62.9±6.4 pg/ml), respectively, when compared with Healthy women: As for Vit.D3, it showed a significant decrease in women with uterine fibroids at the probability level (P≤0.05), as it reached (5.92±1.87 ng/ml). Conclusion: This result concluded no differences in the level of IL-6 in women with uterine fibroids, while increase in the levels of both β-TGF and CRP . Furthermore, decrease level of Vit.D3.

Continuous adaptation of conversation aids for uterine fibroids treatment options in a four-year multi-center implementation project

BackgroundFibroids are non-cancerous uterine growths that can cause symptoms impacting quality of life. The breadth of treatment options allows for patient-centered preference. While conversation aids are known to facilitate shared decision making, the implementation of these aids for uterine fibroids treatments is limited. We aimed to develop two end-user-acceptable uterine fibroids conversation aids for an implementation project. Our second aim was to outline the adaptations that were made to the conversation aids as implementation occurred.MethodsWe used a multi-phase user-centered participatory approach to develop a text-based and picture-enhanced conversation aid for uterine fibroids. We conducted a focus group with project stakeholders and user-testing interviews with eligible individuals with symptomatic uterine fibroids. We analyzed the results of the user-testing interviews using Morville’s Honeycomb framework. Spanish translations of the conversation aids occurred in parallel with the English iterations. We documented the continuous adaptations of the conversation aids that occurred during the project using an expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME).ResultsThe first iteration of the conversation aids was developed in December 2018. Focus group participants (n = 6) appreciated the brevity of the tools and suggested changes to the bar graphs and illustrations used in the picture-enhanced version. User-testing with interview participants (n = 9) found that both conversation aids were satisfactory, with minor changes suggested. However, during implementation, significant changes were suggested by patients, other stakeholders, and participating clinicians when they reviewed the content. The most significant changes required the addition or deletion of information about treatment options as newer research was published or as novel interventions were introduced into clinical practice.ConclusionsThis multi-year project revealed the necessity of continuously adapting the uterine fibroids conversation aids so they remain acceptable in an implementation and sustainability context. Therefore, it is important to seek regular user feedback and plan for the need to undertake updates and revisions to conversation aids if they are going to be acceptable for clinical use.

Morphology of endometrial inflammatory changes in foci of endometriosis and adenomyosis

The high prevalence of endometriosis, its impact on menstrual and reproductive functions, obstetric complications, and the quality of life of women in the reproductive age determines the urgency of the problem.The objective: to assess the prevalence of inflammatory changes in foci of heterotopic endometrium in patients with endometriosis and adenomyosis.Materials and methods. 92 women of reproductive age – from 21 to 46 years old – who applied for surgical treatment for symptomatic adenomyosis (47 women – 1st group) and ovarian endometriosis (45 patients – 2nd group), and 30 practically healthy women of the same age (control group) were examined.Histological examination of adenomyosis and ovarian endometriosis biopsies was performed using a light microscope at magnifications of 40 and 100. For immunohistochemical examination, primary and secondary antibodies were used to determine CD34, CD68, and CD138 markers.Results. In patients with adenomyosis and ovarian endometriosis the following concomitant gynecological pathologies as uterine fibroids, endometrial hyperplasia, chronic endometritis, chronic abnormal uterine bleeding, the frequency of which is significantly higher in adenomyosis, were diagnosed. This may indicate the pathogenetic role of chronic inflammation in the development of these pathological conditions.In patients with adenomyosis the positive expression of CD68 in the epithelial component of heterotopias was determined in 8 (17.0±5.6%) women, and in 4 (8.9±4.2%) women with ovarian endometriosis, which indicated a low phagocytic activity. During the assessment of CD34 expression in vessel walls and the stromal component of endometrioid heterotopias, a positive reaction was determined in 16 (34.0±6.9%) patients with adenomyosis and in 10 (22.2±6.2%) patients with ovarian endometriosis, which reflects the processes of neoangiogenesis and the activity of the pathological process.Positive expression of CD138 in endometrioid heterotopias prevailed in the group of patients with adenomyosis – 12 (25.5±6.4%) cases versus 4 (8.9±4.2%) cases in the group of patients with ovarian endometriosis (p&lt;0.05). This confirmed the histological results and clinical data regarding the presence of chronic endometritis and isthmocele.Conclusions. The identified inflammatory changes, weak phagocytic activity and signs of neoangiogenesis in foci of heterotopic endometrium are more significant in patients with adenomyosis, which is confirmed by clinical and morphological data.

Comparison of different types of single-port laparoscopic surgery in posterior uterine fibroid resection

This study aims to objectively assess the effect of three surgical approaches for posterior uterine fibroid resection: transumbilical laparoendoscopic single-site surgery (LESS), vaginal natural orifice transluminal endoscopic surgery (vNOTES) in prone position (vNOTES-P), and vNOTES in the lithotomy position (vNOTES-L). A retrospective analysis was conducted on data pertaining to all patients who underwent vNOTES and LESS for single posterior fibroids at our institution from January 2023 to July 2023. Patients were categorized into three groups based on the surgical approach: vNOTES-P group (n = 30), vNOTES-L group (n = 17), and LESS group (n = 32). Comparative analysis was performed on the demographic characteristics and perioperative outcomes among the three groups of patients. All 79 patients underwent surgery without the need for conversion to laparotomy. There were no statistically significant differences among the LESS group, vNOTES-P group, and vNOTES-L group in terms of operative time, intraoperative blood loss, and perioperative complication rates. In the vNOTES-L group, two patients required conversion to LESS during surgery. Patients had faster return of bowel function (less time to flatus) in the vNOTES group compared to the LESS group (P < 0.05). However, three cases of postoperative infection occurred in the vNOTES group, while none were reported in the LESS group. Compared to LESS, vNOTES demonstrates significant advantages in alleviating postoperative pain, shortening time to passage of flatus, speeding recovery and enhancing cosmetic outcomes. Particularly, vNOTES-P for posterior uterine fibroid resection, as an emerging surgical approach, offers certain advantages in facilitating surgical maneuverability and reducing operative time, rendering it more suitable for posterior uterine fibroid resection.

Surgical menopause and its management. Analysis of literature data and own data

The article presents the main clinical variants of the surgical menopause syndrome (SMS), provides modern views on the treatment of this pathology.The purpose of the study was to identify the features of the clinical course of SMS compared to the typical climacteric syndrome, to present modern views on its management, and to determine ways of prevention.To achieve this goal, a literature search and analysis was conducted in the PubMed scientometric database for the last 15 years, and domestic scientific publications related to the mechanisms of development, clinical course, and management of SMS were selected. At the current stage, there is a significant increase in the prevalence of uterine leiomyomas, as well as a tendency to increase the frequency of this pathology in young women. Given that 50% of uterine leiomyomas have symptomatic course, the number of surgical interventions for leiomyomas is also increasing.Hysterectomy occupies a significant place among operative interventions for benign tumors of the uterus and ovaries. As a result of hysterectomy (with or without oophorectomy) in women, SMS occurs. The main pathogenetic mechanism of SMS is hypoestrogeny. As a result, a symptom complex of menopausal disorders develops: vegetative-vascular, neuropsychic, metabolic and urogenital disorders. Compared to the classic climacteric syndrome, the clinical condition in surgical menopause is more acute and progresses faster.The management of SMS depends on the volume of surgical intervention, the age of the patient, and concomitant pathology. Treatment of SMS should be individualized and include the use of menopausal hormone therapy, herbal preparations, multivitamin complexes against the background of lifestyle modification.The prevention of SMS consists in the wide use of modern conservative and minimally invasive operations in the case of surgical treatment of benign tumors of the uterus and ovaries, a balanced approach to determining the volume of operations.

Transducer module apodization to reduce bone heating during focused ultrasound uterine fibroid ablation with phased arrays: A numerical study.

During magnetic resonance-guided focused ultrasound (MRgFUS) surgery for uterine fibroids, ablation of fibrous tissues in proximity to the hips and spine is challenging due to heating within the bone that can cause patients to experience pain and potentially damage nerves. This far-field bone heating limits the volume of fibroid tissue that is treatable viaMRgFUS. To investigate transducer module apodization for improving the ratio of focal-to-bone heating ( ) when targeting fibroid tissue close to the hips and spine, to enable MRgFUS treatments closer to thebone. Acoustic and thermal simulations were performed using 3D magnetic resonance imaging (MRI)-derived anatomies of ten patients who underwent MRgFUS ablation for uterine fibroids using a low-frequency ( ) 6144-element flat fully-populated modular phased array system (Arrayus Technologies Inc., Burlington, Canada) at our institution as part of a larger clinical trial (NCT03323905). Transducer modules ( per module) whose beams intersected with no-pass zones delineated within the field were identified, their output power levels were reduced by varying blocking percentage levels, and the resulting temperature field distributions were evaluated across multiple sonications near the hip and spine bones in each patient. Acoustic and thermal simulations took approximately ( ) and ( ) to run for a single near-spine (near-hip) target,respectively. For all simulated sonications, transducer module blocking improved compared to the no blocking case. In just over half of sonications, full module blocking maximized (increase of 82% 38% in 50% of hip targets and 49% 30% in 62% of spine targets vs. no blocking; mean±SD), at the cost of more diffuse focusing (focal heating volumes increased by 13%±13% for hip targets and 39%±27% for spine targets) and thus requiring elevated total (hip: 6%±17%, spine: 37%±17%) and peak module-wise (hip: 65%±36%, spine: 101%±56%) acoustic power levels to achieve equivalent focal heating as the no blocking control case. In the remaining sonications, partial module blocking provided further improvements in both (increased by 29%±25% in the hip and 15%±12% in the spine) and focal heating volume (decrease of 20%±10% in the hip and 34%±17% in the spine) relative to the full blocking case. The optimal blocking percentage value was dependent on the specific patient geometry and target location of interest. Although not all individual target locations saw the benefit, element-wise phase aberration corrections improved the average compared to the no correction case (increase of 52%±47% in the hip, 35%±24% in the spine) and impacted the optimal blocking percentage value. Transducer module blocking enabled ablative treatments to be carried out closer to both hip and spine without overheating or damaging the bone (no blocking: / , full blocking: / , optimal partial blocking: / for hip/spine). The proposed transducer apodization scheme shows promise for improving MRgFUS treatments of uterine fibroids, and may ultimately increase the effective treatment envelope of MRgFUS surgery in the body by enabling tissue ablation closer to bonystructures.

Presurgical treatment of uterine myomas with the GnRH-antagonist relugolix in combination therapy: an observational study.

To evaluate if a preoperative medical treatment with the GnRH-antagonist relugolix in combination therapy in a series of patients with abnormal uterine bleeding associated with uterine myomas may correct the anemia before scheduled surgery for myoma-associated AUB. Thirty-one patients scheduled for surgery underwent a pre-operative three-month course with a daily oral tablet of 40mg relugolix, 1mg estradiol, and 0.5mg norethindrone acetate. Hemoglobin levels, uterine volumes, largest myoma diameter, and VAS score for dysmenorrhea, pelvic pressure and bleeding discomfort, and indication to surgery were evaluated at study enrollment and at the end of therapy. Mean hemoglobin levels increased by 25%, from 9.3 ± 1.1 to 11.6 ± 1.7g/dL after three months (p < 0.001). Uterine volume decreased from 380.7 ± 273.4 mL to 281.7 ± 198.7 mL (p < 0.001), whereas the diameter of the largest myoma decreased from 6.4 ± 2.8cm to 5.5 ± 2.2cm (p < 0.001). Four patients (13%), initially planned for a laparotomy procedure, were converted to a minimally-access procedure, whereas in eight patients (26%) surgery was avoided after medical therapy. Dysmenorrhea score improved from 4.7 ± 3.2 to 0.6 ± 1.1 (p < 0.0001). Pelvic pressure score decreased from 5.9 ± 2.1 to 3.1 ± 2.3 (p < 0.0001), whereas bleeding discomfort decreased from 7.4 ± 3.0 to 0.4 ± 1.6 (p < 0.0001). Preoperative GnRH-antagonist therapy may enhance hemoglobin levels, decrease uterine and myoma size, and alleviate symptoms, potentially enabling safe surgical procedures.

Effect of “T2-rim sign” related parameters on high-intensity focused ultrasound ablation of uterine fibroids

PurposeTo investigate the effect of “high-signal-intensity peripheral rim on T2-weighted MR images (T2-rim sign)” related parameters on non-perfused volume ratio (NPVR) after high-intensity focused ultrasound (HIFU) ablation of uterine fibroids. MethodsData from 616 patients with uterine fibroids treated with HIFU were retrospectively analyzed. Univariate and multivariate logistic regression was used to analyze the factors influencing the ablation effect. The effect of T2-rim sign on ablation parameters and results was also analyzed. Spearman correlation analysis was used to compare the correlation between coverage ratio, average thickness of T2-rim sign and NPVR in 207 cases of fibroids with T2-rim sign. ResultsThe presence of T2-rim sign was an independent risk factor affecting the ablation effect. The coverage ratio of T2-rim sign was negatively correlated with treatment efficiency (r = -0.174, p = 0.012) and NPVR (r = -0.186, p = 0.007), and positively correlated with energy efficiency factor (EEF) (r = 0.156, p = 0.024). The average thickness of T2-rim sign was positively correlated with treatment intensity (r = 0.203, p = 0.003) and negatively correlated with NPVR (r = -0.363, p < 0.001). There was a negative correlation between the average thickness of the T2-rim sign and NPVR in isointense fibroids (r = -0.484, p < 0.001). ConclusionThe presence of T2-rim sign increases the difficulty of ablation and reduces the ablation effect. In clinical practice, the presence and related parameters of T2-rim sign should be fully considered when screening for HIFU indications and formulating treatment plans.

Analysis of characteristics of peripheral blood lymphocytes in endometrial carcinoma: a single-center study based on five-year clinical data

IntroductionThis study analyzed and discussed the characteristics of peripheral blood lymphocytes (PBLs) in patients with endometrial carcinoma (EC) to explore the PBLs’ clinical application value.MethodsThis single-center case‒control study analyzed the clinical data of patients with EC and uterine fibroids who underwent surgery at the First Affiliated Hospital of Chongqing Medical University between October 2018 and October 2023 retrospectively. The Center for Clinical Molecular Medical Detection of our hospital performed PBLs detection using flow cytometry, and recorded the detection results in the electronic medical records system. Between-group and subgroup comparisons of PBLs in patients with EC were analyzed using t-test or Mann–Whitney U test. The effect of surgery on PBLs in patients with EC was assessed using a paired t-test or the Wilcoxon signed rank test.ResultsThe immune function of patients with EC was significantly lower than that of healthy people (P < 0.05) and those with benign uterine diseases (P < 0.05) and was related to body mass index (BMI), hypertension, diabetes, and blood lipids (P < 0.05). In patients with EC, the PBLs counts decreased significantly after surgery (P < 0.05) and more kinds of lymphocytes were affected in the laparoscopic surgery group than in the open surgery group.ConclusionsWith the decrease of PBLs counts, the immune status of patients with EC is impaired. Metabolic syndrome (Mets), including obesity, hypertension, diabetes, and high blood lipids, also affects the immune function of patients with EC. And for EC patients, the effect of laparoscopic surgery is greater than that of open surgery. PBLs has the potential to be one of indicator during the diagnosis and treatment of EC.Trial registrationThis study was retrospectively registered by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (approval number K2023-578).

Single-stage resection of uterine fibroids and intravascular leiomyomatosis: a case report

BackgroundUterine Fibroids (UFs) are common benign tumors in the female reproductive tract, but their progression to intravascular leiomyomatosis (IVL) is rare. Presently, there are few reports on single-stage resection of UFs and IVL.Case presentationA 47-year-old woman, G2P2, had been diagnosed multiple UFs four years ago and now developed heart failure. Imaging examinations revealed that UFs had invaded the right iliac vein and extended into the right atrium through the inferior vena cava. Through multidisciplinary collaboration and a single-stage resection, the patient has survived for over 24 months post-surgery, and her heart function has significantly improved compared to preoperative levels, with no recurrence of UFs observed.ConclusionsSingle-stage resection of IVL and UF is feasible and advantageous for this case, and selecting the appropriate surgical approach is crucial.

Factors associated with uterine fibroids in women of reproductive age: A cross-sectional study

Background. Uterine fibroids is a benign monoclonal tumor originating from the smooth muscle layer of the uterus. Non-modifiable risk factors for the development of uterine fibroids, such as age, ethnicity, age at menarche, etc, have been studied quite extensively, while the role of many controllable factors remains debatable.The aim of the study. To identify the main modifiable factors associated with uterine fibroids in women of reproductive age living in the Baikal region, including certain ethnic groups.Materials and methods. We carried out a multicenter cross-sectional study in 2016–2019 in institutions of Irkutsk and Bokhan (Irkutsk region) and Ulan-Ude (Republic of Buryatia). The subjects of the study were women to have annual workplace medical examination. The study included 1,347 participants of reproductive age (34.33 ± 6.37 years) who met the inclusion criteria. Among all women included in the study, there were 867 (64.37 %) Caucasians, 361 (26.80 %) Asians, and 119 (8.83%) women of mixed (Caucasian-Asian), ethnicity. The research methods included a questionnaire, general clinical and gynecological examination, and pelvic ultrasound examination.Results. According to our study, the main non-modifiable factors associated with the presence of uterine fibroids were: Asian ethnicity; age at menarche 12–13 years; age of the study participant 40–44 years; menopausal symptoms; adenomyosis. The “controllable” factors included: city residency; body mass index over 40 kg/m2; history of abortions and miscarriages; metabolic syndrome; using combined oral contraceptives; lack of sexual activity; smoking; presence of anumber of occupational hazards.Conclusion. Our study identified the main controllable factors associated with the presence of uterine fibroids in a multiethnic population of women of reproductive age.

Uterine Leiomyomas and Reproduction.

There is a prevailing opinion by gynecologists, much of it based on expert opinion or anecdotal evidence, that myomas are detrimental to pregnancy. Newer data challenge much of this dogma, but incorrect assumptions remain. Although not impeccable, multiple data address the correlation between myomas and reproduction, and some emerging evidence addresses surgical removal of these myomas and subsequent outcomes. A thorough literature search was performed, and the amassed data were analyzed to answer some of our most important queries about the role that myomas play in pregnancy and delivery. Uterine leiomyomas ultimately decrease in size during late pregnancy and postpartum. Spontaneous abortion rates are similar in women with and without leiomyomas. The data addressing leiomyoma effects on preterm prelabor rupture of membranes, placental abruption, cesarean delivery, and postpartum hemorrhage rates are conflicting, but the best evidence does not show a significant correlation compared with women without myomas. Preterm delivery rates are elevated in women with leiomyomas. Myomectomy does not decrease preterm deliveries and may increase this risk. Women with myomectomies have increased elective cesarean delivery rates and more blood loss at delivery compared with women with leiomyomas in situ.

Abdominal Parasitic Fibroids after Laparoscopic Surgery Using a Power Morcellation: A Novel Insight from Vietnam and a Narrative Revew of the Literature

Abstract Parasitic fibroid is a rare benign pathology that can be negotiated because of its rarity. The etiology remains unknown following prior intervention related to uterine fibroids. The assessment of this rare disease is usually based on clinical features and imaging modalities. In addition, appropriate management should be individualized where appropriate. Herein, we report an uncommon case at our center and raise proper recognition for all gynecologists. Particularly, in low-and middle-income countries such as Vietnam, where the health-care system is insufficient to follow-up the long-term postoperation. A 40-year-old woman (gravida 3, para 2) presented to the gynecologic examination room due the abdominal pain and increased size of abdominal circumference. The patient had undergone laparoscopy involving the power morcellator without a contained-bag system for myomectomy at our hospital 6 years prior. The imaging diagnostic tools showed multiple hypoechoic disseminated masses in the abdominal cavity. The laparotomy intervention and histopathological endpoints confirmed completely the diagnosis of parasitic fibroid. Although an extremely rare occurrence, parasitic fibroids should be informed to all patients after laparoscopic intervention for uterine fibroids. In addition, the diagnosis of parasitic fibroid should be warranted among the patients presenting with abdominal pain after a history of fibroid resection. The power morcellation in the contained bag, uterine extraction in hysterectomy, as well as relieving the surgical specimen of uterine fibroids should be gently performed to minimize fibroid tissue disruption.

Comparison of Hidden Blood Loss between Laparoendoscopic Single-Site Myomectomy and Conventional Laparoscopic Myomectomy

Objective: Laparoendoscopic single-site myomectomy (LESS-M) is widely applied for the treatment of uterine leiomyoma. The purposes of this study were to investigate differences in hidden blood loss between LESS-M and conventional laparoscopic myomectomy (CLM) during treatment of uterine leiomyoma and to identify the associated risk factors. Design: This is a retrospective study. Participants: The participants of this study were patients who underwent laparoscopic myomectomy (114 and 156 for LESS-M and CLM, respectively) between July 1, 2019, and October 10, 2020, at the Second Affiliated Hospital of Wenzhou Medical University. Setting: The study was conducted at the Second Affiliated Hospital of Wenzhou Medical University. Methods: We enrolled a total of 114 and 156 patients who were treated with LESS-M and CLM, respectively, between July 1, 2019, and October 10, 2020. We collected clinical data, then applied the Nadler and Gross formula and multiple linear regression analysis to calculate the HBL and identify the associated risk factors, respectively. Results: Patients in the LESS-M group had a VBL of 115.4 ± 180.6 mL and an HBL of 364.3 ± 252.6 mL, accounting for 74.4 ± 22.4% of true TBL. On the other hand, patients in the CLM group had VBL of 187.9 ± 198.5 mL, and HBL of 306.8 ± 304.7 mL, accounting for 58.9 ± 30.2% of true TBL. HBL was significantly higher in the LESS-M than the CLM group (p = 0.000). Limitations: This study was the small sample size used. Conclusions: HBL accounted for a significant percentage of TBL in laparoscopic myomectomy, especially in patients treated with LESS-M. Paying attention to perioperative blood changes coupled with fully understanding HBL might promote postoperative recovery of patients.

The Causal Role of Uterine Fibroid in Keloid and Hypertrophic Scar: A Bidirectional Mendelian Randomization Study on European Populations.

The relationship between uterine fibroids and keloid/hypertrophic scars has been contradictory. Our research employs a bidirectional Mendelian Randomization (MR) approach to establish a clearer understanding of this potential causal link. This study aimed to determine the effect of uterine fibroids on keloid/hypertrophic scars and the effect of keloid/hypertrophic scars on uterine fibroids. We aimed to demonstrate the relationship between uterine fibroids and keloid/ hypertrophic scars. Our bidirectional MR study utilized summarized data from genome-wide association studies (GWAS) focused on European populations. Our primary tool for establishing causality was the Inverse-Variance Weighted (IVW) method. To reinforce the IVW findings, we also applied four alternative MR methods: MR-Egger, Maximum Likelihood, Weighted Mode, and Weighted Median. The IVW method indicated a significant causal link, with uterine fibroids greatly raising the likelihood of developing keloids (Odds Ratio [OR] = 1.202, 95% Confidence Interval [CI]: 1.045-1.381; P=0.010) and hypertrophic scars (OR = 1.256, 95% CI: 1.039-1.519; P=0.018). Parallel results were observed with the MR-Egger, Maximum Likelihood, Weighted Mode, and Weighted Median methods. Sensitivity analyses indicated robustness in these findings, with no evidence of heterogeneity or horizontal pleiotropy. Conversely, the reverse MR analysis did not demonstrate an increased risk of uterine fibroids due to keloids or hypertrophic scars. This study elucidates a significant causal effect of uterine fibroids on the development of keloid and hypertrophic scars, offering valuable insights into their pathogenesis and potential therapeutic targets.

Evaluation of Leiomyoma: A Clinicopathological Study in a Tertiary Care Center in Kathmandu

Uterine leiomyoma is one of the common gynecological benign tumors. It is usually observed in female of reproductive age group and often presented with symptoms like abdominal pain, dysmenorrhea and fertility disorders. Hysterectomy and myomectomy are the procedure for management of uterine leiomyoma. The prime objective of our study was to evaluate the demographic distribution and clinicopathological changes in hysterectomy and myomectomy specimens with leiomyomas. A descriptive hospital based cross-sectional study was conducted in the Department of Pathology, Nepal Medical College Teaching Hospital (NMCTH), Nepal from May 2023 to October 2023. A total of 57 uterine leiomyoma samples received in the department of Pathology for histopathological examination were included in the study. Ethical approval for the study was obtained from Institutional Review Committee of NMCTH and informed consent was taken from each patient. The tissue biopsies were routinely processed and stained with Hematoxylin and Eosin (H and E). The observed findings were managed in MS Excel sheet and later analyzed using SPSS 17. The most common age group diagnosed with uterine leiomyoma was 41 to 50 years (64.9%). The leiomyomas were highly prevalent in women from Janajati community (47.4%). Pelvic pain, menorrhagia and bleeding disorders were the most frequent clinical manifestations. Intramural was the commonest site (77.2%) and the hyalinization was the most usual secondary changes (19.2%) found. The correlation between age distribution and site of leiomyoma, age distribution and secondary changes and site of leiomyoma and secondary changes were statistically not significant. However, detailed histopathological examination gives many information related to leiomyoma and it is necessary for the effective management.

Evaluation of morphology, apoptosis, and cell proliferation of the uterus in postmenopausal women.

The aim of this study was to evaluate the morphology (atrophy and fibrosis), apopto-sis, and cell proliferation in the uterine wall. The research material came from postmenopausal women who had undergone hysterectomy due to uterine myomas or prolapse of the reproductive organ and were not taking menopausal hormone therapy (MTH). The collected material was divided into three groups. Group I (n=18) con-sisted of uterine sections taken 1 to 5 years after the last menstruation, Group II (n=17) 6 to 10 years after the last menstruation, and Group III (n=15) over 11 years after the last menstruation. To assess morphology and fibrosis, the uterine sections were subjected to hematoxylin and eosin (HE) staining and to Mallory's staining. In addition, we performed a histochemical examination to identify apopto-sis in endometrial and myometrial cells using the TUNEL method. An immunohistochemical analysis of endometrial and myometrial cells was also performed to detect the location of the proliferating cell nuclear antigen (PCNA). Differences in apoptosis were only found in the myometrium between Group I and Group III, and were strongest in Group I myometrial cells, and weakest in Group III. Neither the endome-trium nor the myometrium showed statistically significant differences in the overall percentage of PCNA(+) cells between groups. Morphological changes in the endometrial and myometrial layers of postmenopausal uteri increased with time since the last menstruation.

A Multicenter Retrospective Cohort Study Assessing the Incidence of Anemia in Patients Associated With Uterine Fibroids.

Uterine fibroids are benign tumors that develop from the smooth muscle tissue of the uterus, typically during a woman's reproductive years. A substantial proportionof women with uterine fibroids exhibit symptoms, including menorrhagiathat considerably compromise theirquality of life. This study aims to characterizethe fibroid subtype most commonly associated with the incidence ofanemia. This retrospective multi-center cohort study investigated the incidence of anemia in premenopausal women who were diagnosed with uterine fibroids between January 2016 and December 2022. Fibroid position, size, location, and number were assessed by trans-abdominal/vaginal ultrasound and hysteroscopy and correlated to the pre-treatment hemoglobin level. Three-quarters of patients (n=6) with submucosal fibroid presented with any form of anemia followed by 59.3% (n=115) of patients with intramural fibroid and only 36.8% (n=25) of patients with sub serousal fibroid. Interestingly, there was no difference between the groups with regard to the severity of anemia at presentation. Most red blood cells (RBCs) and hemoglobin (Hb) indices were comparable between the groups, except for mean corpuscle volume (MCV) as it was significantly lower in patients with intramural fibroids. Moreover, our investigations showed that the submucosal fibroids tend to present in a higher number as well as the biggest in size. The multivariable logistic regression showed that subserosal fibroids are associated with the lowest risk of developing anemia. In conclusion, our results suggest that the occurrence of anemia should always be considered in women with submucosal fibroids. However, after adjusting for other contributing factors such as menorrhagia, submucosal fibroid did not show an increase in the risk of anemia.

Minimal Invasive Resection of Large Retrosternal Thyroid Goiter.

Resecting a large goiter extending into the retrosternal space is challenging, especially when a sternotomy or thoracotomy is required. The transthoracic approach is linked to higher postoperative morbidity, reaching up to 30% when compared to the transcervical approach. Although alternative options like thoracoscopic resection have shown promising results, the morbidity of mediastinal dissection remains a concern. Thoracoscopic-assisted transcervical approach might be a feasible, less invasive alternative. This video outlines the steps and potential pitfalls of the procedure. The patient is positioned supine with an extended neck. Initially, the endocrine surgeon mobilizes the thyroid gland through cervical access. If a transcervical resection is not feasible, the patient is mobilized into a lateral decubitus position, and a second team thoracoscopically guides the mediastinal tumor through the thoracic inlet. This allows a stepwise controlled transcervical dissection of the retrosternal mass until complete resection is achieved, thus eliminating the need for mediastinal dissection. To demonstrate the procedure, we present the case of an 84-year-old male with lymph node-positive oncocytic thyroid carcinoma and a large retrosternal goiter extending posteriorly into the mediastinum up to the aortic arch. Thoracoscopic-assisted transcervical resection was performed. The recurrent laryngeal nerve was identified and monitored with a neurostimulation device during dissection. No palsy was noted in the postoperative evaluation. The patient had an uneventful postoperative course and was discharged on the second postoperative day. Thoracoscopic-assisted transcervical resection of large retrosternal goiter seems a feasible alternative to mitigate risks associated with thoracotomy, sternotomy, or thoracoscopic mediastinal dissection. Potential advantages include decreased postoperative morbidity and length of stay. This technique requires thoracoscopic expertise and may be limited depending on the goiter's size and mediastinal positioning.