Cure for Uterine Fibroids Discovered
Family history data are graphically represented on a pedigree, which follows standard nomenclature to illustrate family relationships and disease information17 (Figure 25.1). Factors that limit the informativeness of the pedigree are small family size, early deaths in family members precluding the possibility of developing adult diseases, prophylactic surgeries that remove an organ from subsequent risk of cancer (e.g., total hysterectomy for uterine fibroids where the ovaries are also removed), and incomplete information about the health of family members. The degree of accuracy of reporting cancer diagnoses in relatives varies by how close the relatives are to the proband, with lack of information about specific cancer diagnoses in older second and or third generations being a particularly common problem encountered in pedigree generation.
Dysmenorrhea uterine bleeding VEGF mediates normal estrogen-induced endometrial development and vasculariza-tion 7, 8, 10 . Imbalances in VEGF expression or activity, therefore, could contribute to abnormal uterine bleeding. This is supported by the results of a recent clinical trial of the protein hormone relaxin for the treatment of progressive systemic sclerosis 20 . Relaxin, like estrogen, is an ovarian hormone that stimulates VEGF expression in the uterus (although its role in uterine physiology is less well understood at this time). The most frequent adverse event reported during the trial was heavier-than-usual or irregular menstrual bleeding. The authors of the study attributed this effect to relaxin-induced overexpression of VEGF in the uterus. VEGF is also implicated in the formation of uterine fibroids (below), which are also a frequent cause of abnormal uterine bleeding. Leiomyoma Uterine leiomyomas (fibroids) are benign tumors of the uterus that occur in one third of...
Magnetic resonance imaging findings were compared to physical examination and intraoperative findings. HASTE-sequence MRI was more accurate than physical examination in identifying cystoceles, enteroceles, vault prolapse, and pelvic organ pathology such as uterine fibroids, ure-thral diverticula, ovarian cysts, and Nabothian and Bartholin's gland cysts.5 Comiter et al.6 found that with dynamic MRI, surgical planning was altered in more than 30 of cases, most often because of occult enterocele not appreciated on physical examination.
Far, neurosurgery has benefited most from intraoperative MRI guidance. The introduction of real-time volumetric image updates has improved localization, and targeting and, most importantly, has resulted in complete tumor resections. Following this success in neurosurgery, new MRI-guided applications have been introduced for tumor treatment in the breast, liver, and prostate, as well as in the musculoskeletal system. Several percutaneous treatment methods like prostate brachytherapy have emerged. Thermal ablations in the brain (laser, RF), liver (laser, RF, and cryotherapy), and pelvis (laser treatment of fibroids) have been performed at multiple institutions. Today, among the thermal ablation methods, noninvasive image-guided focused ultrasound treatment has the most potential for tumor ablation but is also applicable to occlusion of blood vessels and to targeted drug delivery and gene therapy.
Uterine atony is responsible for the majority of primary postpartum hemorrhages originating from the placental bed. The main predisposing factors are prolonged labor followed by operative vaginal or abdominal delivery, uterine overdistension from polyhydramnios or multifetal pregnancy, and delivery following antepartum hemorrhage from either placenta praevia or abruption. Failure of the uterus to contract may also be due to retained placental fragments, either as disrupted portions or, more rarely, a succenturiate lobe. Fibroids may promote primary postpartum hemorrhage in a similar fashion. These factors should be considered if the uterus relaxes following normal uterotonic measures.
Endometriosis develops when cells from the lining of the uterus migrate outside the uterus. These cells still respond to the monthly hormonal cycles and release blood during menses. However, the blood has nowhere to go and so the area becomes inflamed and painful. Uterine fibroids are benign muscle tumors produced when estrogen activity is high as they depend on estrogen for growth. They appear in pre-menopausal women and shrink at menopause and in the absence of estrogen replacement therapy. They do not turn malignant. Birth control pills add to estrogen levels in the body. Symptoms of uterine fibroids include a feeling of fullness, frequent urination, and heavy and cramping menstruation.
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