Uterus fibroids

Uterine Fibroids Adenomyosis Endometrial polyps Gynecologic cancers Alteration of endometrium, changes in uterine contractility Alteration of endometrium, changes in uterine contractility Alteration of endometrium Various dysplastic alterations of endometrium, uterus, cervix... 

Ulcerative colitis chronic inflammatory disease affecting the large intestine and the rectum Urticaria a skin condition characterised by pruritus Uterine fibroids fibrous tissue growth in the uterus Verrucas viral skin infection, wart... 

Uterine leiomyomata are benign, estrogen-sensitive, fibrous growths in the uterus that can cause menorrhagia, with associated anemia and pelvic pain. Treatment for 3-6 months with a GnRH agonist reduces fibroid size and, when combined with supplemental iron, improves anemia. Leuprolide, goserelin, and nafarelin are approved for this indication. The doses and routes of administration are similar to those described for treatment of endometriosis. 

Menispermum palmatum L. Pulegone, pinenes, limonene, lauric acid, myristic acid, palmitic acid, beta-methyl-adipic acid, phenol, cresols, eugenal.100 For uterine tumors, uterine fibroids, indurations of the uterus. 

Case (v) A 35-year-old female had primary infertility with secondary amenorrhea, ceasation of ovarian function and uterine fibroid tumour on the posterior wall at the junction of upper one-third and lower two-third of the uterus. Symptoms Amenorrhea for the last two years, obase, sweaty palms and soles, craving for eggs, irregular menstruation earlier. 

Fibroids (fibromyomas) benign smooth-muscle tumours of the uterus. They are common in women over 40, about 20% of whom have them. They are often symptomless but can cause severe pain associated with menstruation and heavy menstrual bleeding. They are oestrogen-dependent and shrink down after the menopause. 

McLucas B, Goodwin SC, Kaminsky D (1998) The embolised fibroid uterus. Min InvasTher 8c Allied Technol 7 267-271... 

The mechanism by which fibroids cause abnormal uterine bleeding is not known. However, there have been several theories proposed. One theory claims that the increase in size of the endometrial surface area causes the bleeding and is therefore most pertinent to submucosal fibroids [91]. The increased vascularity and vascular flow to the uterus as a result of fibroids has also been held responsible... 

Leiomyosarcomas are malignant tumors of the uterus with an incidence of less than 0.3% in fibroid uteri [42], and present with similar symptoms and radiologic presentations to that of benign disease... 

Prollius A, de Vries C et al (2004) Uterine artery embolisation for symptomatic fibroids the effect of the large uterus on outcome. BJOG 111 239-242... 

The anatomy of uterine fibroids and uterine artery embolization (UAE) consists of the fibroids, their position in the uterus, and the vasculature associated with the uterus. The vasculature of the ovarian arteries is also important because of the potential for collateral blood flow from the ovarian arteries supplying the fibroids. Communication between the uterine arteries and the ovarian arteries are also important because of the risk of embolization of the ovaries through uterine-ovarian anastomoses. 

The size, position, and number of fibroids in the uterus have a bearing on the success of the embolization procedure. The vascular anatomy also has a major impact on the success and complications of the embolization procedure. 

CiciNELLi et al. [5] described an interesting pattern of collateral flow between the uterine and ovarian arterial supply to the uterus. In doing measurements of blood flow in premenopausal women, this group found there is more blood flow to the uterus from the ovarian artery during the follicular phase, whereas in the luteal phase most of the uterus is supplied from the uterine artery. Whether this change in blood flow patterns is changed in patients with fibroids is not clear. No studies of the effect of the phase of the menstrual cycle on the effectiveness of uterine artery embolization have been performed at this point. 

Fibroid location within the uterus may correlate with outcome. Spies et al. [32] reported that smaller baseline leiomyoma size and submucosal location were more likely to result in a positive imaging outcome (Fig 10.4.2). Jha et al. [33] confirmed that... 

Fig. 10.4.1a,b. A 39-year-old woman with fibroid-related menorrhagia and pelvic pressure, a Pre-embolization sagittal T2-weighted MRI demonstrates a multifibroid uterus, b Post-embolization sagittal T2-weighted MRI obtained 6 months after embolization demonstrates a marked volume reduction of 55%. The patient s condition has also greatly improved... 

In addition to volume reduction, the detection of new fibroids should be a priority since it is very common with other uterus-sparing therapies [20]. The remaining question is the duration between UFE and clinical recurrence due to new fibroids and whether this interval is different from that seen after myomectomy. 

Fig. 10.4.10a,b. A 45-year-old woman with complete resolution of symptoms after embolization, a Pre-embolization sagittal T2-weighted MRI shows a small pedunculated submucosal fibroid (F). She underwent a failed attempt of hysteroscopic resection prior to embolization, b At 3-months post-embolization MRI shows that the whole fibroid has been spontaneously expelled. The uterus is virtually normal... 

The role of ovarian arteries as a cause of failure is well known. Ovarian arteries may feed the fibroids through different pathways. The visualization of an ovarian artery is not systematically associated with failure. In one study, 25% of patients had large ovarian arteries before embolization [8]. Only arteries that directly participate in feeding the uterus cause failure. In cases of a small uterine artery or absence of one or both arteries, the ovarian artery supply should be suspected (Fig. 10.5.3). However, additional supply to the fibroids may come from the ovarian arteries, even if large sized bilateral uterine arteries are present [9, 10]. 

Fig. 10.5.3a-e. A 37-year-old patient with symptomatic fibroids. She was offered a hysterectomy as the only alternative. a,b Left uterine artery catheterization and embolization. The final angiogram at the termination of the embolization demonstrates the left ovarian artery (b). c Right internal iliac angiogram shows the absence of righf ufer-ine artery, d Catheterization of fhe righf ovarian arfery demonstrafes the supply to the uterus by this artery, e Distal catheterization and embolization of fhe ovarian arfery wifh successftil clinical oufcome... 

Fig.10.5. 4a-f. A 37-year-old patient with heavy bleeding related to a 7-cm intramural fibroid. a,b Right uterine artery angiogram demonstrates spasm (arrow) due to catheterization, c Left uterine artery angiogram shows the feeding artery to the fibroid (arrow), d Embolization of the main feeding artery and patency of the myometrial arteries, e MRI obtained prior to the embolization shows a large intramural mass, f MRI obtained 10 months after the embolization shows an almost normal uterus... 

Fibroid location within the uterus may influence the outcome of embolization. Submucosal fibroids were more likely to respond to UFE [20]. Submucosal location was a positive predictor of fibroid volume reduction after UFE [21]. The subserosal fibroids are also believed to be associated with less volume reduction after embolization (Fig. 10.5.6). 

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