Multiple fibroid

Some authors suggest that in the presence of a large subserosal fibroid, the laparoscopic removal needs to be offered as the first option. In patients with multiple fibroids and a large subserosal fibroid, a combined laparoscopic resection of the subserosal fibroid and UFE is a good alternative to hysterectomy. Systematic use of MRI will help with appropriate patient selection, reducing the possibility of failure after UFE. 

Fig. 41.4a-c. A 48-year-old female with uterine fibroid. The conventional DSA shows the extent of the fibroid as seen when contrast has been injected through the left internal iliac artery (a). C-arm CT clearly demonstrates that the same artery supplied multiple fibroids (b). With injection of contrast through the right internal iliac artery (c), one of the major fibroids seems to receive blood from both internal iliac arteries asterisk)... 

The effects of multiple changes were not always additive. A combination of many of these changes led to the discovery of potent agonists which are currently on the market for the treatment of prostate cancer, breast cancer and some non-malignant conditions such as endometriosis and uterine fibroids. The marketed drugs include Zoladex [D-Ser(Bu ) , Azgly ]-... 

Endocrine disruptors are exogenous chemicals (for example, PCBs) that enter the body and act like hormones. They can dismpt physiology, sometimes with devastating consequences. Startling evidence from animal studies shows that male fish in detergent-contaminated water express female characteristics, turtles are sex-reversed by PCBs, male frogs exposed to a common herbicide form multiple ovaries, pseudohermaphroditic offspring are produced by polar bears found in contaminated waters, and seals in contaminated water have an excess of uterine fibroids.46... 

D Angelo A, Amso NN et al (2003) Spontaneous multiple pregnancy after uterine artery embolization for uterine fibroid case report. Eur J Obstet Gynecol Reprod Biol 110 245-246... 

In conclusion, uterine artery embolization is both a safe and effective procedure to offer patients with symptomatic uterine fibroids. UFE has been described as a valuable alternative to hysterectomy and recurrent multiple myomectomy. Clinical success rates for control of heavy menstrual bleeding, pelvic pain and bulk-related symptoms have been reported to be 80%-95% of patients treated with a low rate of recurrence. The risk of major complications, including pulmonary embolism, uterine... 

Endometrial ablation is a permanent and invasive therapeutic option which relieves excessive menstrual bleeding in 62%-79% of cases [175]. Thermoablation of the endometrium is performed using a balloon or roller ball technique and a hysteroscopic access. The success of endometrial ablation in the presence of fibroids is small since not the entire endometrium is accessible in women with multiple leiomyomas because of enlargement and deformity of the uterine cavity. 

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