宫腔镜手术治疗子宫黏膜下肌瘤248例分析

目的探讨宫腔镜手术治疗子宫黏膜下肌瘤的疗效及安全性。方法对威海市妇女儿童医院1999年1月至2006年10月248例子宫黏膜下肌瘤接受宫腔镜电切术后的治疗效果进行回顾性分析。子宫黏膜下肌瘤中0型62例,Ⅰ型116例,Ⅱ型70例。结果248例子宫黏膜下肌瘤患者均顺利完成手术,无一例发生子宫穿孔。切除肌瘤最重248g,术前超声测量肌瘤最大直径95mm。术后随访3个月至5年。术后满意率为94.4%,0型、Ⅰ型术后满意率达100%。27例有生育要求者,18例妊娠,14例已分娩。结论宫腔镜手术是治疗子宫黏膜下肌瘤的首选方式。正确选择适应证,提高操作技巧,严格超声监测,是保障手术安全性和疗效的关键措施。     

弥漫性子宫平滑肌瘤病诊治的临床分析

目的探讨弥漫性子宫平滑肌瘤病(DUL)的临床症状、影像学检查、病理特征和手术方式,以期提高对该病的认识。方法回顾性分析14例术后经病理证实的非妊娠期弥漫性子宫平滑肌瘤病的患者的临床资料,分析患者的症状、影像学检查、术前诊断、手术方式、术中所见及术后随访情况。结果 14例患者中,月经量增多至贫血13例,无症状1例。彩超提示为多发子宫肌瘤13例,单发子宫肌瘤1例。术前均被误诊为子宫肌瘤。7例行子宫肌瘤切除术,7例行全子宫切除术。术中仅1例见边界欠清的单发结节,余13例均见子宫肌层、宫腔布满结节。肌瘤切除术后患者月经量恢复正常,2例足月妊娠分娩。结论 DUL临床表现以月经增多为主,术前诊断率低,手术是最主要的治疗方法,多采用全子宫切除术,对于要求保留生育功能的年轻患者,可以选择经腹子宫肌瘤切除术。     

33例弥漫性子宫平滑肌瘤病临床分析

目的：提高对弥漫性子宫平滑肌瘤病（diffuse uterine leiomyomatosis,DUL）的诊断及治疗水平。方法：回顾性分析2009年1月—2022年10月首都医科大学附属北京妇产医院收治的33例确诊DUL患者的病例资料,分析其临床特点、诊治方法及术后妊娠情况。结果：33例患者的平均发病年龄为（38.4±6.9）岁（24～52岁）。19例（57.6%）表现为月经量增多,7例（21.2%）表现为尿频或下腹胀痛,余7例（21.2%）无明显临床症状,仅为查体发现子宫肌瘤逐渐增大就诊。33例患者均行超声检查,15例（45.5%）患者提示子宫肌层布满或弥漫性分布的低回声结节。7例患者行盆腔磁共振成像（magnetic resonance imaging,MRI）检查,3例提示子宫肌层弥漫分布大小不等的类圆形结节或团块。33例患者均行手术治疗,19例行开腹/腹腔镜全子宫切除术,另14例有生育要求患者,其中11例行经腹子宫肌瘤剔除术,3例行宫腔镜子宫肌瘤切除术。术后病理及免疫组织化学检查均提示平滑肌瘤。14例有生育要求患者（2例失访）术后平均随访时间（67.8±36.3）个月,3例患者...     

宫腔镜电切术治疗子宫黏膜下肌瘤预后相关因素分析

目的探讨宫腔镜电切术治疗子宫黏膜下肌瘤的临床效果及影响预后的相关因素。方法1999年1月至2004年11月,威海市妇女儿童医院对146例经宫腔镜联合超声检查发现子宫黏膜下肌瘤行宫腔镜肌瘤电切手术。其中0型40例,Ⅰ型55例,Ⅱ型51例。术前排除恶性病变。术中超声全程监护。术后连续随访。结果146例患者手术均顺利完成,所有0型、Ⅰ型黏膜下肌瘤均一次切净,Ⅱ型中有11例未能全部切除,切除范围≥70%。手术满意率达96·6%,无一例发生子宫穿孔。行米非司酮药物预处理2个月后子宫平均缩小25·3%,最大肌瘤平均缩小34·6%。14例有生育要求者,10例妊娠(71·4%),其中8例已足月分娩。结论宫腔镜电切术是治疗子宫黏膜下肌瘤的最佳方法。严格选择手术适应证,严格遵守操作规范是提高手术成功率,提高安全性及手术预后的关键因素。     

18例静脉内平滑肌瘤病临床病理分析

目的探讨静脉内平滑肌瘤病的临床病理特点和治疗策略。方法回顾性分析北京大学人民医院收治的18例静脉内平滑肌瘤病患者临床病理资料。结果 18例患者中,12例就诊于妇科,6例就诊于血管外科;中位数年龄为45岁,主诉以月经改变、腹痛及运动后黑朦为主。术前影像学检查如彩色超声、MRI、CT、血管造影等检查可初步提示该疾病,8例术前提示此诊断。18例患者均接受手术治疗,在血管外科就诊的患者中2例行盆腔肿物切除术,4例行下腔静脉(心房)病变切除术,妇科手术范围包括7例行全子宫双侧输卵管卵巢切除术,7例行全子宫切除术,2例既往曾行全子宫切除术的患者,术中切除子宫外病灶后切除双侧输卵管卵巢,1例行子宫肌瘤切除术。术中均尽可能切除肿瘤组织,术后经病理明确诊断。术后均未药物治疗,平均随访34.7个月,一例患者术后1年复发,再次手术切除复发病灶并切除双侧输卵管卵巢后随访无复发。结论静脉内平滑肌瘤病术前诊断较困难,影像学检查有辅助诊断价值。手术为主要治疗方式,无生育要求者建议切除全子宫及双侧附件。     

子宫内膜去除-输卵管绝育术后综合征1例张奇;杨保军;刘钰;冯力民;559-560

<正>1 临床资料患者,46岁,因子宫内膜剥除术后4年,下腹痛1个月,加重1周于2018年5月18日入北京天坛医院。8年前因异常子宫出血于我院行宫腔镜检查首都医科大学附属提示:子宫内膜息肉及Ⅱ型子宫黏膜下肌瘤,同时行子宫内膜息肉及子宫肌瘤电切术;5年前再次因异常子宫出血,宫腔镜检查提示Ⅱ型子宫黏膜下肌瘤,我院宫腔镜下行子宫黏膜下肌瘤电切除;4年前患者B超检查提示子宫肌壁间肌瘤,并出现经期缩短的症状。考虑患者无生育需求,     

子宫内膜去除-输卵管绝育术后综合征1例

正1 临床资料患者,46岁,因子宫内膜剥除术后4年,下腹痛1个月,加重1周于2018年5月18日入北京天坛医院。8年前因异常子宫出血于我院行宫腔镜检查首都医科大学附属提示:子宫内膜息肉及Ⅱ型子宫黏膜下肌瘤,同时行子宫内膜息肉及子宫肌瘤电切术;5年前再次因异常子宫出血,宫腔镜检查提示Ⅱ型子宫黏膜下肌瘤,我院宫腔镜下行子宫黏膜下肌瘤电切除;4年前患者B超检查提示子宫肌壁间肌瘤,并出现经期缩短的症状。考虑患者无生育需求,     

子宫动脉栓塞联合宫腔镜治疗巨大子宫黏膜下肌瘤36例临床分析

目的:探讨子宫动脉栓塞联合宫腔镜治疗巨大子宫黏膜下肌瘤(直径≥5.0 cm)的治疗效果。方法:选择我院收治的巨大子宫黏膜下肌瘤36例,先用子宫动脉栓塞治疗,1月后行经阴道子宫黏膜下肌瘤套圈结扎切除术和宫腔镜下子宫黏膜下肌瘤切除术。结果:36例患者均子宫动脉栓塞治疗成功,11例阴道大流血患者栓塞治疗后阴道流血明显减少,1月后平均经期明显缩短,平均血红蛋白明显升高,差异有统计学意义(P0.01)。栓塞治疗后出现腹痛、腰痛、会阴痛24例,发热3例,恶心、呕吐5例,经对症治疗后好转。栓塞治疗后1月均在宫腔镜下切除肌瘤。联合治疗后较治疗前平均经期明显缩短,平均血红蛋白明显升高,差异均有统计学意义(P0.01)。均无肌瘤复发。结论:子宫动脉栓塞联合宫腔镜治疗巨大子宫黏膜下肌瘤创伤小,效果明显,是一种疗效确切的治疗方法。     

宫腔镜电切术治疗Ⅱ型子宫黏膜下肌瘤两种切除方法对生殖预后的影响

目的探讨宫腔镜电切术治疗Ⅱ型子宫黏膜下肌瘤两种切除方法对生殖预后的影响。方法选择威海市妇幼保健院妇科2001年1月至2016年1月63例有生育要求的Ⅱ型子宫黏膜下肌瘤的患者,分为研究组(35例)、对照组(28例),研究组采用开窗后切除法,对照组采用直接切除法。观察宫腔镜下Ⅱ型子宫黏膜下肌瘤两种切除方法对子宫内膜、子宫肌层及妊娠的影响。结果 63例中61例一次手术切除肌瘤,一次手术成功率96.8%,均未发生严重并发症。研究组与对照组在手术时间、术中出血、术后复发、膨宫液用量、术后子宫肌层恢复等方面差异均无统计学意义(P0.05)。研究组与对照组在子宫内膜恢复、宫腔粘连发生、术后妊娠分娩率方面差异均有统计学意义(P0.05)。结论宫腔镜电切术治疗Ⅱ型子宫黏膜下肌瘤采用开窗后切除法的患者其生殖预后明显优于直接切除法。     

宫腔镜电切术治疗异常子宫出血140例临床分析

目的 探讨宫腔镜电切术治疗异常子宫出血的疗效。方法 2000年1月～2004年5月应用连续灌流式宫腔镜对140例异常子宫出血患者行宫腔镜电切术治疗，对72例保守治疗无效、无生育要求的患者行子宫内膜电切术(TCRE)，其中12例同时行黏膜下子宫肌瘤电切术，59例行单纯黏膜下子宫肌瘤及内突壁间肌瘤切除术(直径≤5．0cm)，9例子宫内膜息肉切除术。结果 术后随访1个月～2年，月经改善率98．5％，TCRE后62例无月经，8例月经减少，68例月经正常。结论 宫腔镜电切术治疗功能性子宫出血、黏膜下子宫肌瘤及子宫内膜息肉引起的异常子宫出血，疗效满意。     

Successful Pregnancies in Women with Diffuse Uterine Leiomyomatosis after Hysteroscopic Management Using the Hysteroscopy Endo Operative System

Study ObjectiveTo evaluate the feasibility, effectiveness, and reproductive outcome of hysteroscopic management using the Hysteroscopy Endo Operative system (HEOS) in patients with diffuse uterine leiomyomatosis (DUL).DesignRetrospective study (Canadian Task Force classification III).SettingBeijing Tiantan Hospital, Capital Medical University, Beijing, China.PatientsEight women of reproductive age suffering from menorrhagia and anemia or infertility diagnosed with DUL by ultrasonography and hysteroscopy.InterventionsHysteroscopic surgery using cold graspers combined with electric loop by the HEOS was performed to excise submucous myomas (including types 0, I, and II), leaving other intramural myomas in place. The fenestration method is used in electrical hysteroscopic myomectomy. Postoperative endometrial repair and synechiae, menstrual improvement, conception, and pregnancy were recorded.Measurements and Main ResultsTwo patients underwent a single hysteroscopic myomectomy, whereas 6 patients underwent 2 to 3 myomectomies. No complications were observed. The mean follow-up period was 39.13 ± 17.01 months (range, 21–67). The endometrium recovered 2 to 3 months after the initial surgery, and 100% improvement in menstruation was observed. Two patients had mild synechia after the first hysteroscopic surgery. Seven patients conceived spontaneously (postoperative pregnancy rate, 87.5%), 6 of whom had a full-term pregnancy. One patient suffered a miscarriage in the second trimester (live birth rate, 75%).ConclusionHysteroscopic surgery using cold graspers combined with electric loop by the HEOS is a feasible and effective for treatment of DUL because it preserves the uterus and yields favorable reproductive outcomes. The cold surgery and fenestration method minimizes electrical and thermal damage to the endometrium surrounding the myoma, consequently reducing surgical risks.     

Hysteroscopic management in submucous fibroids to improve fertility

Objective: To evaluate prospectively the reproductive performance following hysteroscopic myomectomy in women with submucous fibroids and wishing a pregnancy. Study design: Twenty-nine consecutive women wishing a pregnancy with a previously diagnosed submucous fibroid as a sole cause for reproductive failure were treated by hysteroscopic myomectomy. Fourteen women suffered from primary infertility and 15 women had previous pregnancies with a poor obstetric outcome. The myomas were intracavitary (n=25) and intramural class 1 (n=4). None of the patients had type 2 or multiple submucousal fibroids. Myoma size was not larger than 5 cm (the mean was 13.3 mm). Before myomectomy, the outcome reproductive data were recorded prospectively. Following myomectomy, the cumulative rate of first pregnancies, live birth rate and the hysteroscopic anatomical results were assessed and compared with that before surgery. Results: The mean duration of follow-up before and after myomectomy was comparable. Twenty-one women (72.4%) experienced 30 pregnancies after myomectomy. Thirteen women gave birth to16 live infants. Compared with previous pregnancies, the rate of deliveries increased from 3.8% to 63.2% and the abortion rate decreased from 61.6% to 26.3%. No complications occurred during myomectomy. The hysteroscopic anatomical results were good in the majority of cases. Conclusions: This prospective study demonstrates that hysteroscopic myomectomy at present is the method of choice to improve the cumulative pregnancy rate as well as the live birth rate in selected women with submucous myomas and a history of reproductive failure.     

Laparoscopic myomectomy and pregnancy outcome in infertile patients

OBJECTIVE: To assess outcomes and pregnancy-related complications after laparoscopic myomectomy in infertile patients. DESIGN: Retrospective analysis. SETTING: Tertiary care advanced laparoscopic center. PATIENT(S): Twenty-eight infertile patients with at least one uterine leiomyoma of >5 cm in diameter. INTERVENTION(S): Laparoscopic myomectomy. MAIN OUTCOME MEASURE(S): Occurrence of pregnancy, delivery rate, and pregnancy-related complications. RESULT(S): The average size of the myomas removed was 6 cm (range, 4-13.3 cm). None of the procedures were converted to laparotomy. The postoperative rate of intrauterine pregnancy was 64.3% (n = 18), including 1 of 2 patients who underwent concomitant hysteroscopic myomectomy. Four patients had spontaneous abortions and 14 delivered viable term neonates. Six women had a vaginal delivery without complications and 8 had a cesarean section. No antepartum or intrapartum complications were reported. CONCLUSION(S): Laparoscopic myomectomy can be offered to patients who want to have children and who refuse to undergo an abdominal myomectomy. Patient selection as well as meticulous surgical technique are the key factors in achieving a successful outcome.     

Pregnancy rates following hysteroscopic polypectomy,myomectomy, and a normal cavity in infertile patients

Objective: To assess the reproductive benefits of hysteroscopic myomectomy and polypectomy for infertility when compared to infertile couples with a normal cavity at hysteroscopy.Material and Methods: All patients with a diagnosis of infertility who underwent hysteroscopic evaluation by a single surgeon between 1975 and 1996 were sent a questionnaire as routine follow-up regarding their reproductive history. All 100 subjects who were located responded to the questionnaire, and 78 subjects met the inclusion criteria; age <45 years, 12 months of infertility, and 18 months of follow-up with attempts to conceive including in vitro fertilization in patients with bilateral tubal occlusion.Results: Of the 78 subjects, 36 had undergone a myomectomy, 23 a polypectomy, and 19 had a normal cavity. Among the three groups there was no significant difference in their ages, types of infertility, length of infertility, or follow-up after the procedure. Using the Cox proportional hazard model, and adjusting for age, polypectomy patients had a significantly higher pregnancy rate (RR 3.89, P < .01) and a higher live birth rate (RR 2.42, P = .06) than patients with a normal cavity. Patients who had undergone a myomectomy also had a higher pregnancy rate (RR 2.02, P = .11) and live birth rate, but this did not achieve statistical significance. Pregnancy following a hysteroscopic myomectomy was associated with a larger fibroid resection (3.15 cm vs 2.5 cm P = .05). The spontaneous abortion rate following the myomectomy, polypectomy, or a normal study was equivalent, 28.1%, 23.1%, and 29.2%, respectively.Conclusions: Both hysteroscopic polypectomy and hysteroscopic myomectomy appear to enhance fertility when compared to infertile patients with a normal cavity. Despite concern that hysteroscopic resection of a large myoma may ablate a large surface area of the endometrial cavity, patients with larger myomas were more likely to conceive following resection.     

Fertility rates after hysteroscopic treatment of submucous myomas depending on their type

The objective was too evaluate the pregnancy rate and the chance of term pregnancy following hysteroscopic myomectomy depending on the type of the myoma. Between February 2000 and October 2005, a total of 25 patients under 36 years of age (mean 30.1±5.8 SD) with a diagnosis of primary or secondary infertility and menstrual disorders due to submucous myoma underwent hysteroscopic myomectomy. The subgroups of the patients depending on the type of the myomas were: Type 0, 14 patients; type I, 7 patients; and type II, 4 patients. For the subgroup of patients with type II myomas there was a control group of 8 patients with infertility but without menstrual disorders who did not consent to undergoing operative hysteroscopic treatment and received expectant management. Mean myoma size was 22.6±14.7 mm, mean duration of the procedure was 28±17 min, and mean follow-up was 18±12.5 months. Menstrual pattern was reestablished in 84% of patients. Hysteroscopic myomectomy was associated with an increase in pregnancy rate: 57.1% for patients with type 0 myoma and 42.8% for patients with type I myoma. Patients with type II myoma, after hysteroscopic myomectomy, had a 25% pregnancy rate, while patients who received expectant management had a 50% rate. Delivery at term was achieved by 35.7% of patients with type 0 myoma, by 28.5% of patients with type I myoma, and by 25% of patients with type II myoma, after hysteroscopic myomectomy. Patients with type II myoma without menstrual disorders had a 37.5% term delivery rate receiving expectant management. Three patients had a spontaneous abortion during the first trimester (12%) and one patient had premature labor at 34 weeks’ gestation (4%). Fertility rates appear to increase after hysteroscopic myomectomy of type 0 and type I myomas in previously infertile patients. In patients with type II myomas fertility rates did not increase, in contrast with patients with type II myomas who received expectant management. No difference in fertility rates was observed between patients with different types of submucous myomas after myomectomy, while the complication rate for these procedures is low. Patients’ age and type of infertility (primary or secondary) are factors that do not affect fertility rates after hysteroscopic myomectomy.

Intrauterine adhesion prevention with Malecot catheter after hysteroscopic myomectomy: A novel approach

ObjectiveIntrauterine adhesion after hysteroscopic myomectomy contributes to infertility, recurrent miscarriages, menstrual irregularities, and hinders pregnancy outcomes. The aim of this study was to apply the indwelling Malecot catheter in prevention of intrauterine adhesion after hysteroscopic myomectomy and to further evaluate the effectiveness of this approach with reported live birth rates in infertile patients who underwent subsequent infertility treatment.Materials and methodsSeventeen patients with FIGO Classification System PALM-COIEN Type 0 or 1 submucous myoma that received hysteroscopic myomectomy were recruited in this retrospective analysis. Post-operative insertion of the Malecot catheter via the aid of the uterine sound was performed and the catheter was left in place for seven days.ResultsThe mean duration of TTP (time to pregnancy) was 15.6 months after hysteroscopy. Within three years after the operation, 10 out of 17 infertility patients achieved ongoing pregnancy over 12 weeks. Ongoing pregnancy rate was 58.8% (10/17). Eight patients achieved live birth (seven singletons, one twin pregnancy) with mean gestational age of 38 weeks. Live birth rate was 47.1% (8/17).ConclusionThe Malecot catheter is an inexpensive, easy-to-operate, and effective physical barrier method for preventing IUA in infertile patients undergoing hysteroscopic myomectomy with high live birth rate and no obvious visible post-operative adhesions.     

Pregnancy outcomes and deliveries after laparoscopic myomectomy

STUDY OBJECTIVE: To assess pregnancy outcomes and deliveries after laparoscopic myomectomy. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: General hospital. PATIENTS: Three hundred fifty-nine women. INTERVENTIONS: Laparoscopic myomectomy and laparoscopic and/or hysteroscopic treatment of associated pathologies. MEASUREMENTS AND MAIN RESULTS: Five patients (1.39%) were lost to follow-up. Seventy-two women were pregnant at least once after laparoscopic myomectomy, for a total of 76 pregnancies. Four women conceived twice and four are pregnant as of this writing. One multiple pregnancy occurred. Twelve pregnancies resulted in first-trimester miscarriage, one in an ectopic pregnancy, one in a blighted ovum, and one in a hydatiform mole. One patient underwent elective first-trimester termination of pregnancy. Thirty-one women had vaginal delivery at term and 26 were delivered by cesarean section. No case of uterine rupture or dehiscence occurred. CONCLUSION: Our technique of laparoscopic myomectomy appears to allow safe vaginal delivery.     

Uterine myomectomy in pregnant women

OBJECTIVE: To determine whether myomectomy during pregnancy in selected patients improves outcome. METHODS: Retrospective analysis of 18 patients who underwent myomectomy between the 6th and 24th week of gestational age. Surgical management of tumors was required on the basis of the characteristics of the myomas and symptoms. The dimensions and site of myomas, symptoms of the patients, time and mode of delivery, and pregnancy outcome were analyzed. RESULTS: One woman was lost to follow-up, and one suffered a miscarriage. The remaining 16 patients delivered healthy babies between the 36th and 41st week; 14 delivered by cesarean section, and 2 vaginally. CONCLUSION: We suggest that myomectomy during pregnancy may be considered safe in selected patients. Moreover, it permits good pregnancy outcome with healthy babies delivered at term.     

Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women.

OBJECTIVE: To compare reproductive benefits of hysteroscopic myomectomy and polypectomy for infertility to outcomes in infertile couples with normal hysteroscopic findings. METHODS: Women with diagnoses of infertility who had hysteroscopic evaluations by a single surgeon between 1975 and 1996 were sent a routine follow-up questionnaire regarding their reproductive histories. All 92 subjects who were located responded to the questionnaire, and 78 met inclusion criteria: age under 45 years, at least 12 months of infertility, and at least 18 months of follow-up with attempts to conceive, including in vitro fertilization in women with bilateral tubal occlusion. RESULTS: Of the 78 subjects, 36 had myomectomies, 23 had polypectomies, and 19 had normal cavities. Among the three groups, there were no significant differences in age, type of infertility, length of infertility, or follow-up after the procedure. Polypectomy subjects had significantly higher pregnancy and live birth rates than women with normal cavities. Women who had myomectomies larger than 2 cm had significantly higher pregnancy and live birth rates, achieving statistical significance at a myoma size of 3 cm or greater for live births. Spontaneous abortion rates among first pregnancies after myomectomy, polypectomy, or normal study were similar: 31.5%, 27.7%, and 37.5%, respectively. CONCLUSION: Both hysteroscopic polypectomy and hysteroscopic myomectomy appeared to enhance fertility compared with infertile women with normal cavities. Despite concern that hysteroscopic resection of a large myoma might ablate a large surface area of the endometrial cavity, the reproductive benefit appears greater than the risk.     

Fertility after hysteroscopic myomectomy: effect of intramural myomas associated

OBJECTIVE: The aims of this retrospective study were to evaluate the subsequent fertility and outcome of pregnancies after hysteroscopic myomectomy according to (a) the characteristics of submucous myomas and (b) the association with intramural myomas. MATERIALS AND METHODS: From July 1994 to June 1997, 119 patients had hysteroscopic myomectomy including 31 infertile women. Among these 31 patients, the mean number of removed myomas by hysteroscopy was 1.4 (range 1-4) and the mean diameter of fibroid was 20 mm (range 10 to 50). RESULTS: Eleven out of 31 women (35.5%) became pregnant. Thirteen pregnancies were observed including nine term deliveries, three miscarriages and one premature labor at 24 weeks of amenorrhea. A difference in delivery rate was found between patients with one submucous myoma resected and those with two or more (p=0.02). No difference in pregnancy and in delivery rates was observed according to size and location of submucous myomas. In contrast, in patients without intramural myomas, the delivery rate (p<0.03) was significantly greater and the delay of conception (p=0.05) was significantly shorter than those found in patients with intramural myomas. CONCLUSION: Our study suggest that fertility after hysteroscopic myomectomy depend on (a) the number of submucous myomas resected and (b) the association with intramural fibroids.