Mifepristona 5 mg frente a 10 mg diarios en el tratamiento del leiomioma. Ensayo clínico aleatorizado

Objective

To estimate the efficacy and safety of 5 mg or 10 mg mifepristone daily in the treatment of leiomyoma.

Material and methods

Ninety women with symptomatic uterine myomas were randomised to receive 5 mg or 10 mg of mifepristone (45 per group). Leiomyomata and uterine volumes were evaluated by ultrasonography. Efficacy was estimated by the reduction of the leiomyomata and uterine volumes and the prevalence of symptoms.

Results

After treatment, in the 5 mg group there was a 60.8%, (P < .001), reduction in the fibroid volume and it was 59.4%, (P < .001), in the 10 mg group. The prevalence of symptoms decreased significantly. After treatment, 93.8% subjects from the 10 mg mifepristone group and 86.4% subjects from the 5 mg group were amenorrheic, respectively.

Conclusions

Both treatments were effective for treating uterine fibroids.     

Uterine fibroid pseudocapsule studied by transmission electron microscopy

Objective

The fibroid pseudocapsule is a structure which surrounds the uterine fibroid, separates it from the uterine tissue and contains a vascular network rich in neurotransmitters like a neurovascular bundle. The authors examined the composition of the fibroid pseudocapsule using electron microscopy.

Study design

Twenty non-pregnant patients were submitted to laparoscopic myomectomy by the intracapsular method and samples of the removed pseudocapsules were analyzed using transmission electron microscopy.

Results

At the ultrastructural level the pseudocapsule cells have the features of smooth muscle cells similar to the myometrium. So, the pseudocapsules are part of the myometrium which compresses the leiomyoma.

Conclusion

This ultrastructural feature suggests that when removing fibroids their pseudocapsules should be preserved. This study confirms preliminary evidence that pseudocapsules contain neuropeptides together with their related fibers, as a neurovascular bundle. The surgeon's behavior should be directed to carefully control and spare this muscular surrounding tissue during fibroid excision, in order to preserve the myometrium as much as possible.     

环氧合酶-2在子宫肌瘤组织中的表达及其意义

目的观察环氧合酶-2（cyclooxygenase,COX-2）在子宫肌瘤与子宫平滑肌组织中的表达,探讨COX-2与子宫肌瘤发病机制的相关性。方法选择2010年1月至2010年8月在上海市杨浦区中心医院行腹腔镜下子宫肌瘤切除术的30例患者的子宫肌瘤组织为实验组,并取其邻近的正常平滑肌组织为对照组,采用免疫组化方法检测COX-2的表达;并采用蛋白印迹法及实时荧光定量逆转录聚合酶链反应分别在蛋白水平和基因转录水平检测标本中COX-2的表达。结果免疫组化检测实验组和对照组均有COX-2蛋白表达,平滑肌细胞阳性指数（MPI）为11．90,子宫肌瘤细胞阳性指数（FPI）为46．50,两者比较,差异有统计学意义（P〈O．05）。蛋白印迹法结果显示,COX-2在实验组（O．872±0．035）中的表达明显高于对照组（O．202土0．056）,两者比较,差异有统计学意义（P〈0．05）。COX-2mRNA在实验组（0．122±0．062）中的表达也高于对照组（0．025±0．009）,两者比较,差异有统计学意义（P〈0．05）。结论COX-2在子宫肌瘤的表达明显高于子宫平滑肌,COX-2可能在子宫肌瘤的发病机制中起重要作用。     

Magnetic resonance imaging-guided focused ultrasound surgery for symptomatic uterine fibroids: estimation of treatment efficacy using thermal dose calculations

Objective

To study the correlation between the predicted thermal dose volume (TDV) and the actual ablation volumes in MR-guided focused ultrasound surgery (MRgFUS) for symptomatic uterine fibroids, and to follow up the outcome for 12 months post-treatment.

Study design

Phase-difference fast spoiled gradient-echo MR images were used to analyze thermal change during the energy deliveries of MRgFUS in 60 consecutive patients treated for symptomatic uterine fibroids. The TDV obtained through analysis of these MR images was compared with the non-perfused volume (NPV) measured on post-treatment contrast enhanced T1-weighted images. Final values of TDV ratio and NPV ratio were obtained by dividing these values by original fibroid volume. Patients were followed for 12 months post-treatment to assess symptomatic relief using the symptom severity score (SSS).

Results

Treatments in which we managed to reach a TDV ratio larger than 27% of the treated fibroid yielded a ratio of NPV to TDV of 1.1 ± 0.5, indicating accurate control of the non-invasive procedure. Patient symptoms, as measured by the SSS, continuously decreased from a mean baseline score of 50 ± 22 to 19 ± 12 (P < 0.0001) 12 months post-treatment.

Conclusions

At large treatment volumes (exceeding 27% TDV ratio), thermal dose estimates correspond very closely to non-perfused volumes measured immediately post treatment. These large treatment volumes result in continuous clinical improvement throughout the first 12 months after MRgFUS.     

Hysteroscopic myomectomy for menorrhagia using Versascope™ bipolar system: Efficacy and prognostic factors at a minimum of one year follow up

Objective

To evaluate the effectiveness of hysteroscopic submucous myomectomy for women with heavy menstrual bleeding (HMB) over a minimum 1-year period and assess prognostic factors associated with treatment success.

Study design

Prospective observational study set in a university teaching hospital in UK involving 92 women symptomatic of HMB with submucous myomas consecutively recruited between June 2003 and November 2006. Hysteroscopic myomectomy was performed under outpatient local anaesthetic (n = 35, 38%) or daycase general anaesthesia (n = 57, 62%) using Gynecare Versascope™ bipolar system. The main outcome measures were: the need for secondary surgical or medical re-intervention, menstrual improvement and patient satisfaction. Other outcome measures include: successful completion of primary resection, type of secondary treatment.

Result

Mean follow up was 2.6 years (95% CI 2.3–2.9). Complete fibroid excision was achieved in 66%. Secondary surgical re-intervention was required in 27 (29%) of which 11 (12%) were repeat hysteroscopic myomectomy and 10 (11%) were hysterectomy procedures. Multiple uterine fibroids and adenomyosis were identified in 80% of hysterectomies. At follow up, improved menstrual symptoms and patient satisfaction were reported by 91% and 86%, respectively. Irregular cycle HMB and incomplete fibroid excision were associated with secondary retreatment. Size of the submucous fibroid resected, presence of intramural and subserosal fibroids, or LA vs. GA setting were unrelated to treatment success.

Conclusion

HMB with submucous myomas may be successfully treated by completely removing the intracavity myoma component, irrespective of co-existent intramural or subserosal fibroids or size of fibroid resected. This effect remains sustained over at least a 1–2 year period.     

Peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri

Objective

To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the effect of relevant confounding variables on the occurrence of major peri-operative complications.

Study design

A cohort study of 200 abdominal myomectomies for fibroid uteri of 16 gestational weeks or greater. Logistic regression analysis was used to examine the influence of important clinical variables on the risk of complications. A systematic literature search was conducted for evidence related to peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri.

Results

The mean (±standard deviation) uterine size was 21 ± 5 weeks. The overall rate of major complications was 30%. Peri-operative bleeding necessitating blood transfusion occurred in 49 (24.5%) cases. During surgery, two patients had bowel injury, two had bladder injury, seven women returned to theatre and two (1%) had hysterectomy. Four patients were re-admitted within 14 days of surgery. Multivariable logistic regression analysis showed that the risk of major complications was significantly higher in cases with a uterine size of 20 gestational weeks or more [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.1–10.2; p = 0.03], where 10 or more fibroids were removed (OR 3.5, 95% CI 1.1–10.8; p = 0.05) and where midline skin incision was required (OR 6.1, 95% CI 1.7–22.3; p = 0.006). On comparison of primary vs repeat abdominal myomectomy, there was significantly higher blood loss (mean 1023 ± 1112 ml vs 579 ± 787 ml; p = 0.02) and risk of major complications in the repeat myomectomy group (40% vs 5%; p < 0.001). The systematic review identified only one study that reported a comparable risk of major complications related to abdominal myomectomy for very large fibroid uteri.

Conclusion

The risk of organ injury, hysterectomy, re-operation or hospital re-admission after abdominal myomectomy for very large fibroid uteri is low, but the procedure is associated with a significant risk of bleeding necessitating blood transfusion. This risk is increased after repeat myomectomy, and in patients with a uterine size of 20 gestational weeks or larger, requiring removal of 10 or more fibroids, and requiring a midline skin incision.     

Evolución del leiomioma uterino después del tratamiento con mifepristona. Ensayo clínico aleatorizado

Objectives

To evaluate the extent in time of the reduction of uterine and fibroids size in women treated with mifepristone.

Patients and methods

One-hundred women who received mifepristone 10 or 5 mg for three months were followed-up for six months after treatment termination.

Results

Six months after treatment the fibroids mean sizes were 19% and 23% lower than baseline values in 10 and 5 mg mifepristone groups, respectively, and mean uterine volumes were 8% and 17% lesser than before treatment in 10 and 5 mg groups, respectively. Prevalence of symptoms was still significantly lower than before treatment.

Conclusions

Six months after treatment termination the sizes of fibroids and uteri were near to the initial values but a clinical improvement was maintained.     

Uterine artery embolization versus laparoscopic occlusion of uterine vessels for management of symptomatic uterine fibroids

Objective

To evaluate the efficacy and complications of uterine artery embolization (UAE) versus laparoscopic occlusion of uterine vessels (LOUV) in the management of symptomatic fibroids.

Methods

A pilot randomized clinical trial in which 20 patients with symptomatic fibroids were randomly allocated into two groups. Ten women underwent UAE, and 10 women underwent LOUV. Symptomatic improvement in menorrhagia and reduction in the volumes of the uterus and the fibroid were assessed at 3 and 6 months.

Results

The patients were comparable with regard to age and parity. At 6 months, there was no significant difference in the mean reduction in menstrual blood loss, uterine volume, and volume of the dominant fibroid between the two groups (P = 0.436, P = 0.796, P = 1.00, respectively). However, higher pain scores were recorded on day 1 in the UAE group compared with the LOUV group (P = 0.0002).

Conclusions

The effects of UAE and LOUV in the management of symptomatic fibroids are comparable. The main advantage of LOUV is less postoperative pain compared with UAE.     

The role of the alcohol dehydrogenase-1 (ADH1) gene in the pathomechanism of uterine leiomyoma

Objective

To describe alterations of gene expression patterns of the alcohol dehydrogenase-1 (ADH1) gene in human leiomyoma tissue. We correlated changes in ADH1 gene activity with several clinical and demographic variables.

Study design

We compared gene expression patterns of ADH1 in leiomyoma tissue samples obtained from 101 hysterectomy cases to 110 cases of hysterectomy performed for non-oncological indications. Gene expression was determined by standard PCR technique. Clinical and epidemiological data were extracted from the computerized database of the 1st Department of Obstetrics and Gynecology of Semmelweis University and from patient questionnaires.

Results

Median age in the leiomyoma group was significantly lower than in the control group (47.5 ± 12.1 vs. 54.7 ± 10.2 years). The incidence of uterine leiomyoma was highest (48%) in the 41–50 year age group. In the obstetric history, cumulative gestational age in the leiomyoma group was significantly lower (105.1 ± 8.2 weeks) than in the control group (127.2 ± 9.1 weeks) and cumulative lactation length was also significantly shorter (2.4 ± 1.2 months vs. 5.1 ± 2.2 months). Surgical treatment of the fibroid was myomectomy in 39.6% of the cases and hysterectomy in 60.4%. The ADH1 gene was significantly underexpressed in the leiomyoma group compared to the control group. There was no significant association between ADH1 gene expression and family history. Within the leiomyoma group, there was no significant difference in ADH1 gene expression between subgroups of cases with different number of fibroid tumors found in the hysterectomy sample, but individual tumor number did correlate with the degree of underexpression of the ADH1 gene. There was no significant association between ADH1 gene expression and cumulative history of lactation.

Conclusions

Underexpression of the ADH1 gene, which influences the transformation of the extracellular matrix, plays a probable role in the etiology of uterine fibroid. Although significant differences in ADH1 gene activity were not seen, a negative correlation between tumor number and degree of ADH1 underexpression was found. Neither family history nor cumulative lactation length was a significant predictor of uterine leiomyoma.     

Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids – early experience

Objective

To describe early results regarding efficacy and safety of magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) for the treatment of uterine leiomyomas among a population of Japanese women.

Study design

In this single site study, 48 Japanese women, over 18 years of age, who were candidates for surgical intervention due to symptomatic fibroids, were recruited. Fifty-five uterine fibroids were treated by MRgFUS and followed up for 12 months.

Results

During the 12-month follow-up period, two patients (4%) required surgical interventions, and two patients required additional drug treatment for fibroids. The average reduction in fibroid volume determined by MR imaging at 6 months after treatment was 33%. This volume reduction is correlated with the fibroid's treated volume. No serious complications were recorded during the treatments or follow-up period.

Conclusion

MRgFUS can safely be used to non-invasively treat symptomatic uterine fibroids and avoid the need for surgical intervention in the short term. With large treatment volumes, MRgFUS also results in significant fibroid shrinkage in a relatively short time. Additional follow-up is needed to determine the long-term durability of this promising non-invasive approach.     

Laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy

Objective

To compare the mean hospital discharge times and perioperative outcomes for radiofrequency volumetric thermal ablation (RFVTA) of fibroids and laparoscopic myomectomy (LM).

Methods

The present postmarket, randomized, prospective, single-center, longitudinal, comparative study, conducted in Tübingen, Germany, evaluated the outcomes of RFVTA and the current standard of care (LM) for symptomatic uterine fibroids in women who desired uterine conservation. The surgeons were blinded to the treatment until all fibroids had been mapped by laparoscopic ultrasound.

Results

The mean hospitalization times were 10.0 ± 5.5 (median 7.8 [range 4.2–25.5]) hours for the RFVTA group and 29.9 ± 14.2 (median 22.6 [range 16.1–68.1]) hours for the LM group (P < 0.001, Wilcoxon test). Intraoperative blood loss was 16 ± 9 (median 20 [range: 0–30]) mL for the RFVTA procedures and 51 ± 57 (median 35 [range 10–300]) mL for the LM procedures. The percentage of fibroids imaged by laparoscopic ultrasound that were treated/excised was 98.6% for RFVTA and 80.3% for LM. Two complications were reported: vertigo (n = 1; RFVTA) and port site hematoma (n = 1; LM).

Conclusion

Radiofrequency volumetric thermal ablation resulted in the treatment of more fibroids, a significantly shorter hospital stay, and less intraoperative blood loss than laparoscopic myomectomy.ClinicalTrials.gov:NCT01750008     

Decreasing margins to the uterine serosa as a method for increasing the volume of fibroids ablated with magnetic resonance-guided focused ultrasound surgery

Objective

To demonstrate the safety of magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatments regardless of the distance between the treatment region and the uterine serosa.

Study design

83 pre-menopausal women with symptomatic uterine fibroids were treated with MRgFUS in 88 treatments. Treatment data was analyzed, measuring the distance between the treatment spots (sonications) and the serosa. Patients were followed up for 1 year and adverse events were collected.

Results

79% and 37% of the sonications were less than 15 mm and 10 mm from the serosa, respectively. Treatment was always confined to the fibroid capsule. There were no unexpected or serious adverse events.

Conclusion

Reducing the margin between the fibroid treatment area and the uterine serosa, when possible, enables MRgFUS treatment of greater fibroid volume, while maintaining a high safety profile. Special attention should be paid when the uterus lies adjacent to other sensitive organs to avoid unintentional heating of these organs, using the planning and real-time MR images.     

Prevalence and clinical relevance of cyclooxygenase-1 and -2 expression in stage IIB cervical adenocarcinoma

Objective

The objective of this study was to determine the relationship between cyclooxygenase (COX)-1 and -2 and prognosis in patients diagnosed with FIGO stage IIB cervical adenocarcinoma who underwent concurrent chemoradiotherapy.

Study design

Twenty-three patients diagnosed with stage IIB cervical adenocarcinoma and treated with concurrent chemoradiotherapy between 1990 and 1995 were included in this study. COX-1 and -2 expression and clinicopathologic features were evaluated. COX-1 and -2 expression was determined by immunohistochemistry.

Results

The prevalence of COX-1 and -2 expression was similar at 73.9%. Significant COX-1 and -2 expression was 47.8 and 60.9%, respectively. COX-2 expression was associated with poor response to treatment and cancer-related death (P = 0.043 and 0.012, respectively). Poor survival was identified in patients who showed high COX-2 expression (P = 0.016). There was no correlation between COX-1 expression and patient prognosis.

Conclusion

Only COX-2 was found to be a potent prognostic factor in patients treated with concurrent chemoradiotherapy for stage IIB cervical adenocarcinoma. However, further studies with more samples are needed to definitely demonstrate the relationship between COX expression and cervical adenocarcinoma.     

Uterine fibroids are characterized by an impaired antioxidant cellular system: potential role of hypoxia in the pathophysiology of uterine fibroids

Purpose

Fibroids are the most common smooth muscle overgrowth in women. This study determined the expression and the effect of hypoxia on two potent antioxidant enzymes, superoxide dismutase (SOD) and catalase (CAT) on human fibroid cells.

Methods

Immortalized human leiomyoma (fibroid) and myometrial cells were subjected to hypoxia (2 % O₂, 24 h). Total RNA and cell homogenate were obtained from control and treated cells; CAT and SOD mRNA and activity levels were determined by real-time RT-PCR and ELISA, respectively.

Results

Fibroid cells have significantly lower antioxidant enzymes, SOD and CAT mRNA and activity levels than normal myometrial cells (p < 0.05). Hypoxia treatment significantly increased SOD activity in myometrial cells while significantly decreasing CAT activity in fibroid cells (p < 0.05). There was no significant difference in CAT mRNA levels or activity in response to hypoxia in myometrial cells. Also, there was no significant difference in SOD mRNA levels in response to hypoxia in myometrial cells.

Conclusion

This is the first report to show that uterine fibroids are characterized by an impaired antioxidant cellular enzymatic system. More importantly, our results indicate a role for hypoxia in the modulation of the balance of those enzymes in fibroid and myometrial cells. Collectively, these results shed light on the pathophysiology of fibroids thereby providing potential targets for novel fibroid treatment.     

Treatment of uterine myoma with 5 or 10mg mifepristone daily during 6 months, post-treatment evolution over 12 months: double-blind randomised clinical trial

Objectives

To evaluate the efficacy and safety of 5 and 10 mg doses of mifepristone for 6 months for the treatment of uterine fibroids and to check those results at 1 year post-treatment.

Study design

Randomised double-blind clinical study carried out at the “Eusebio Hernández” Hospital, Havana, Cuba. One hundred and seventy-six women with symptomatic uterine fibroids received one daily capsule of 10 mg mifepristone orally or one daily capsule of 5 mg mifepristone orally, over 6 months. Up to two endometrial biopsies were performed. Reduction in fibroid volume was used to evaluate efficacy.

Results

The 5 and 10 mg dose had a similar efficacy in reducing the fibroid volume, 48.1% and 39.1%, p = 0.07, and that of the uterus, 30.3% and 27.2%, p = 0.63, respectively. Twelve months after treatment the majority of the subjects were asymptomatic with symptom prevalence similar to that at the end of treatment, except for hypermenorrhea and metrorrhagia, although the intensity of hypermenorrhea was much less, p < 0.01.

Conclusions

(1) Both doses obtain similar results in reducing fibroid size. (2) Administering 6 months’ treatment achieves symptomatic improvement lasting 1 year in a high percentage of cases. (3) More studies need to be carried out with longer treatment and follow-up periods.     

Patient suitability for magnetic resonance guided focused ultrasound surgery of uterine fibroids

Objective

To assess selection criteria used to determine eligibility for magnetic resonance-guided focused ultrasound surgery (MRgFUS) for the treatment of symptomatic uterine fibroids; to assess the percentage of patients suitable for MRgFUS.

Study design

A retrospective analysis of 144 patients seeking minimally invasive treatment options for symptomatic uterine fibroids at a single treatment center. Clinical eligibility for MRgFUS was assessed at a gynecology clinic by a Gynecology research fellow trained in the procedure and suitability was assessed by magnetic resonance imaging. Several techniques were used to mitigate against factors that are contra-indications for MRgFUS.

Results

100% of patients interested in MRgFUS were deemed clinically eligible for the procedure and 74% were deemed technically suitable to proceed with treatment.

Conclusions

Mitigation techniques allow for less restrictive MRgFUS selection criteria for treatment for symptomatic uterine fibroids. These less restrictive criteria are expected to expand the pool of patients for whom MRgFUS is a viable treatment option for uterine fibroid symptoms.     

Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection

Objective

To further evaluate the effects of intramural and subserosal uterine fibroids on the outcome of IVF-ET, when there is no compression of the endometrial cavity.

Design

Retrospective, matched-control study from January 2000 to October 2001.

Setting

Private IVF center.

Patient(s)

Two hundred forty-five women with subserosal and/or intramural fibroids that did not compress the uterine cavity (fibroid group) and 245 women with no evidence of fibroids anywhere in the uterus (control group).

Intervention(s)

In vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) cycles.

Main outcome measure(s)

The type of fibroid (intramural, subserosal), number, size (cm), and location of intramural leiomyomas (fundal, corpus) were recorded. Outcomes of IVF-ICSI cycles were compared between the two groups.

Result(s)

There was no correlation between location and number of uterine fibroids and the outcomes of IVF-ICSI. Patients with subserosal or intramural fibroids <4 cm had IVF-ICSI outcomes (pregnancy, implantation, and abortion rates) similar to those of controls. Patients with intramural fibroids >4.0 cm had lower pregnancy rates than patients with intramural fibroids ≤4.0 cm. There were no statistical differences related to delivery rates (31.5% vs. 32%, respectively) between all patients with fibroids and controls. Premature delivery rates for singleton gestations were 10% vs. 8%, respectively, in all patients with fibroid and controls.

Conclusion(s)

Patients having subserosal or intramural leiomyomas of <4 cm not encroaching on the uterine cavity have IVF-ICSI outcomes comparable to those of patients without such leiomyomas. Therefore, they might not require myomectomy before being scheduled for assisted reproduction cycles. However, we recommend caution for patients with fibroids >4 cm and that such patients be submitted to treatment before they are enrolled in IVF-ICSI cycles. Whether or not women with fibroids > 4 cm would benefit from fibroid treatment remains to be determined.     

Improved quality of life is partly explained by fewer symptoms after treatment of fibroids with mifepristone

Objective

To examine mediators of mifepristone treatment on improvements in health-related quality of life (HRQOL) among women with symptomatic fibroids.

Methods

The study sample included women with symptomatic uterine fibroids who were treated with 5 mg or 2.5 mg of mifepristone or placebo. Assessments of uterine size (ultrasound), pain (McGill pain questionnaire), bleeding (diary), anemia (gm/dL), and HRQOL measured using the uterine fibroid symptom quality of life scale were done at baseline, 3 months, and 6 months. The improvements in HRQOL that could be explained by changes in these clinical factors were assessed.

Results

The final sample included 62 women. Treatment with mifepristone was associated with significant improvement in HRQOL, which was explained in part by reduction in pain (28%, P < 0.001) and bleeding (18%, P < 0.001). Reduction in uterine volume was of marginal significance (P = 0.05) and was associated with a decrease in HRQOL (7%). Much of the impact of treatment on HRQOL (61%) remained unexplained in this model.

Conclusions

Improvements in HRQOL after treatment with mifepristone are partly explained by improvements in pain and bleeding, but not uterine size. However, most of the improvement in HRQOL is not explained by improvements in these clinical parameters.     

Measurement of uterine fibroid volume: a comparative accuracy and validation of methods study

Objective

A range of measurement techniques have been described which may be used to calculate uterine fibroid volume. A commonly-reported method involves application of a formula for the volume of an ellipsoid sphere to three orthogonal axes of a fibroid as measured on cross-sectional images. We aimed to compare this method and a second method, that of software-computed parallel planimetric uterine fibroid computation on MRI images, to a gold standard: the volume of objects measured by water displacement. We also compared these methods in volume estimation of patient fibroids using MRI data.

Study design

Mixed observational study and blinded cross-sectional analysis of imaging data.

Results

Large inter-observer variability was noted when using the ellipsoid formula method, which was also inaccurate when compared to the gold standard. Conversely, the parallel planimetric method showed excellent interobserver correlation and a high degree of correlation with gold standard volume measurements.

Conclusion

We conclude that the parallel planimetric method, although a more complex and time consuming technique, is the more accurate and therefore preferred method for measuring uterine fibroid volume.     

Changes of nuclear factor kappa B (NF-κB), cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9) in human myometrium before and during term labor

Objective

To investigate the changes of nuclear factor kappa B (NF-κB), cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9) in human term myometrium before and during term labor.

Study design

Myometrium was obtained from women undergoing cesarean delivery at term before (n = 16) and after labor (n = 12). Immunostaining of NF-κB subunits (p65/p50) and Western blot analysis of NF-κB subunits, MMP-9 and COX-2 proteins were compared. Human term myocyte cultures were stimulated with IL-1β. Activation of NF-κB was assessed by evaluating changes in the inhibitory protein IκB; regulation of COX-2 and MMP-9 levels was studied using Western blot analysis and gelatin zymography.

Results

In contrast to a significant increase in the level of COX-2 and MMP-9 proteins, p65 and p50 decreased significantly in the after-labor group compared to the before-labor group. After treatment with IL-1β, IκB was degraded by almost 90% within 5 min and became undetectable by 15 min. IL-1β stimulation increased the levels of COX-2 protein and the gelatinolytic activities of MMP-9, both of which were inhibited by NF-κB inhibitors.

Conclusions

Human term labor is associated with changes in NF-κB and increased expression of COX-2 and MMP-9 in the myometrium. NF-κB pathway activation and subsequent increments of COX-2 and MMP-9 were observed in human term myocyte cultures.