Uterine artery embolization for symptomatic uterine fibroids

Uterine artery embolization for symptomatic uterine fibroids

BRIEF COMMUNICATIONS (3) remove the ectopic pregnancy totally in order to avoid persistence of the ectopic pregnancy; and (4) if the diameter of the i...

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BRIEF COMMUNICATIONS (3) remove the ectopic pregnancy totally in order to avoid persistence of the ectopic pregnancy; and (4) if the diameter of the interstitial pregnancy portion is bigger than 4 cm, we recommend cornual resection. This new use of an advanced laparoscopic technique can be safe, simple, effective, and feasible, and may improve the outcome of the intrauterine gestation in this challenging therapeutic dilemma.

References

81 [2] Fernandez H, Lelaidier C, Doumerc S, Fournet P, Olivennes F, Frydman R. Nonsurgical treatment of heterotopic pregnancy: a report of six cases. Fertil Steril 1993;60:428–32. [3] Chen SU, Ho HN, Chao KH, Chen HF, Chen CA, Yang YS. Successful treatment of a combined interstitial and intrauterine pregnancy after tubal embryo transfer (TET). Acta Obstet Gynecol Scand 1995;74:752–5. [4] Marcus SF, Macnamee M, Brinsden P. Heterotopic pregnancies after in-vitro fertilization and embryo transfer. Hum Reprod 1995;10:1232–6.

[1] Tummon IS, Whitmore NA, Daniel SA, Nisker JA, Yuzpe AA. Transferring more embryos increases risk of heterotopic pregnancy. Fertil Steril 1994;61:1065–7.

Uterine artery embolization for symptomatic uterine fibroids Maja Pakiz ⁎, Igor But Gynecologic Clinic, Maribor University Clinical Center, Maribor, Slovenia Received 13 September 2007; received in revised form 14 September 2007; accepted 14 September 2007

KEYWORDS Uterine artery embolization; Revascularization; Uterine fibroids

Uterine fibroids are common tumors occurring in 20% or more of women of reproductive age. In 1995, uterine artery embolization (UAE) was presented as a new method for the treatment of uterine fibroids, and it was introduced into our department in 2001. The present paper reports our experiences after 5 years follow-up of patients who underwent this procedure. A total of 60 women with symptomatic solitary uterine fibroids were referred for UAE. The diagnosis was based on history, clinical investigation, and ultrasound examination. We determined the position, number, size of fibroids, and their vascularization using ultrasound power Doppler flow. We measured fibroid volume using nuclear magnetic resonance (NMR) imaging. An experienced interventional radiologist performed the UAE using polyvinyl alcohol particles, embospheres, and occasionally microspirals. The women estimated pain using a visual-analogue scale (VAS) from 0 to 10 every 2 h for 12 h following the procedure, and once prior

⁎ Corresponding author. Tel.: +386 41 743 715; fax: +386 2 3312393. E-mail address: [email protected] (M. Pakiz). doi:10.1016/j.ijgo.2007.09.025

to being discharged the day after UAE. Vascularization of fibroids was excluded using ultrasound power Doppler flow prior to discharge. The women returned for follow-up ultrasound and NMR examinations at 3, 6, and 12 months after the procedure, and volume and vascularization of the fibroid were assessed. Fibroid revascularization was confirmed with NMR using contrast. Women were followed for up to 5 years after UAE. Data analysis was conducted with SPSS version 13.0 (SPSS Inc, Chicago, IL, USA) using descriptive statistics and Kaplan–Meier analysis. A P value b 0.05 was considered statistically significant. The average age of patients was 41.7 years. The average fibroid volume was 245.5 cm3 (median, 210 cm3). Pain after UAE was most intense 2 h after the procedure, amounting on average to 6.5 (median, 8.0) on the VAS, and decreased to 4.2 (median, 5.0) 10 h after UAE. The average fibroid volume had decreased by 53.4% (±26.9%) 3 months after UAE, by 63.7% (±28.2%) after 6 months, and by 71.8% (±26.8%) after 12 months. The average follow-up period after UAE was 46.9 months. In 18.2% of women fibroid revascularization was confirmed after the procedure (Fig. 1). Fibroid revascularization was present in 70.0% of women who underwent subsequent operation, and only in 6.5% of those who did not. According to Kaplan–Meier analysis, there is a 92.3% probability that patients will not require a second operation within 4 years after UAE if no revascularization is present. If revascularization is confirmed, this probability is significantly lower at 30.0% (χ2 = 28.9, P = 0.000). Following UAE, 18.2% of women required surgery.

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BRIEF COMMUNICATIONS not have fibroid revascularization were 3 times more likely not to require a second operation within 4 years after UAE compared with patients with fibroid revascularization. The major reason for surgery was the recurrence of the symptoms. This is consistent with the findings of Marret et al. [3] who found that recurrence was associated with the size and number of fibroids. In the present study, 18.2% of women required operation after UAE, which is consistent with the literature [4]. UAE can be a successful method for treating uterine fibroids. The most important immediate complication of the procedure is pelvic pain that is often resistant to therapy. An important long-term complication is fibroid revascularization, which due to recurrence of presenting symptoms, often requires another surgery.

References Figure 1 Kaplan–Meier analysis of fibroid revascularization after uterine artery embolization (UAE).

UAE is a successful therapy to treat fibroids and is associated with a high level of satisfaction [1]. In the present study the most important early complication was ischemic pain, which was resistant to intravenous analgesia and was as high as 5.0 on the VAS for as long as 10 h after UAE. This is consistent with the literature [2]. Fibroid revascularization was a very important factor connected to further surgical treatment. Patients who did

[1] Spies JB, Myers ER, Worthington-Kirsch R, Mulgund J, Goodwin S, Mauro M. The FIBROID Registry: symptom and quality-of-life status 1 year after therapy. Obstet Gynecol 2005;106:1309–18. [2] Worthington-Kirsch RL, Koller NE. Time course of pain after uterine artery embolization for fibroid disease. Medscape Women's Health 2002;7:4. [3] Marret H, Cottier JP, Alonso AM, Giraudeau B, Body G, Herbreteau D. Predictive factors for fibroids recurrence after uterine artery embolisation. BJOG 2005;112:461–5. [4] Spies JB, Bruno J, Czeyda-Pommersheim F, Magee ST, Ascher SA, Jha RC. Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol 2005;106:933–9.

Chronic myeloid leukemia presenting as vulvar hematoma Poonam Shivkumar, Surekha Tayade ⁎, Reddy Srujana Department of Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Maharashtra, India Received 15 September 2007; received in revised form 26 September 2007; accepted 3 October 2007

KEYWORDS Chronic myeloid leukemia; Vulvar hematoma

A 45-year-old woman (para 10) presented with a right-sided vulvar swelling associated with severe pain for 3 days' duration ⁎ Corresponding author. Tel.: +91 09850309320; fax: +91 07152 284333. E-mail address: [email protected] (S. Tayade). doi:10.1016/j.ijgo.2007.10.004

and no history of trauma. The patient's pregnancies had resulted in standard home deliveries; she had regular menstrual cycles, no significant past history, significant pallor, tachycardia, and gross splenomegaly. A swelling over the right labia majora measured 7 × 6-cm2 and was blue, ill-circumscribed, tense, and tender. The patient's uterus was normal size, anteverted, and a large mass occupied the posterior and right fornix. A provisional diagnosis of vulvar hematoma was made. The patient was investigated for anemia and her peripheral smear examination suggested chronic myeloid leukemia. Her hemoglobin concentration was 5.8 g/dL and