Bleeding patterns in recent postmenopausal outpatients with uterine myomas: comparison between two regimens of HRT

Objectives: To evaluate and to compare the bleeding patterns obtained with two regimens of hormone replacement therapy given to early postmenopausal women with asymptomatic uterine leiomyomas. Methods: In this randomised prospective 1-year study 50 early postmenopausal women with one to four asymptomatic uterine leiomyomas were enrolled into two study-groups to take two regimens of hormone replacement therapy for 12 28-day cycles: (A) Tibolone, 2.5 mg/day; (B) conjugated equine estrogens (CEE), 0.625 mg/day plus medroxyprogesterone acetate (MPA), 5 mg/day. The bleeding patterns and the changes in uterine volume of the 47 outpatients who completed the study were evaluated and compared. Results: Amenorrhea incidence was higher in group A (75.0% of the cycles) than in group B (65.6% of the cycles), while irregular bleeding and irregular spotting incidences were higher in group B (29.7 and 4.7% of the cycles, respectively) compared to group A (22.6 and 2.4% of the cycles, respectively). The mean bleeding and spotting lengths were not statistically different between patients in group A and those in group B. Finally, at the end of the study period transvaginal ultrasonography showed no significant change in leiomyoma size. Conclusions: The results demonstrate that, in early postmenopausal patients with asymptomatic uterine leiomyomas, Tibolone treatment seems to be preferable compared to CEE–MPA continuous combined treatment in relation to the lesser occurrence of irregular bleeding. Furthermore, neither Tibolone nor CEE–MPA therapy, at the doses used here, promote fibroid growth.     

BCL—2和增殖细胞核抗原子在子宫肌瘤中的表达

目的：研究bcl-2蛋白和增殖细胞核抗原（PCNA）在子宫肌瘤和正常子宫肌层中的表达及其在肌瘤发生发展中的作用。方法：用免疫组织化学ABC法检测40例子宫肌瘤组织和正常子宫平滑肌组织中的bcl-2蛋白和PCNA的表达。结果：bcl-2和PCNA在肌瘤组织中表达均明显强于正常 子宫平滑肌组织（P＜0．001）。结论：bcl-2和PCNA在肌瘤中过度表达以及两者的共同作用,可能在子宫肌瘤的发生发展过程中起重要作用。     

子宫肌瘤的CT诊断

目的:探讨子宫肌瘤的CT特征。方法:回顾性分析42例经手术病理证实为子宫肌瘤的CT征象。结果:壁间子宫肌瘤32例,浆膜下子宫肌瘤6例,黏膜下子宫肌瘤4例。结论:CT对子宫肌瘤的诊断与分型有重要价值。     

Endometrial cavity-myoma fistula after uterine artery embolization diagnosed by pelvic MRI: case report

Uterine cavity-myoma fistula is a rare entity which has scarcely been reported in the literature. They are mainly secondary to a treatment and intervention. The reported options for patient evaluation and treatment are mainly invasive such as hysteroscopy. The case, described here, is a 26-year-old woman who had significant symptoms for myoma and went through uterine artery embolization. After few months of being asymptomatic, she complained of continuous spotting with minimal pain; subsequently, pelvic MRI was performed and a clear connection between endometrial cavity and myoma was shown resulting in the final treatment by radio-frequency ablation and the complete relief of the symptoms. The case highlights the importance of the necessity of the proper case selection in terms of size and the site of myoma and also the significance of imaging, mainly MRI, for rare complications corresponding to myoma treatments.     

子宫肌瘤的CT诊断

目的：总结子宫肌瘤的ＣＴ特证，讨论其应用价值。材料与方法：分析３８例经手术病理证实为子宫肌瘤的ＣＴ征象，对横断面上显示病变大小、位置与宫腔关系及病变的强化进行评价。结果：３８例中除１例误诊为子宫内膜癌外，ＣＴ都确诊为子宫肌瘤，其ＣＴ诊断准确率为９７３％。其中浆膜下型１０例，壁间型１８例，粘膜下型２例，混合型８例。全部病例子宫均有不同程度增大；肌瘤表现为低密度或等密度的实质性肿块，边界清楚。较大的肌瘤可有低密度坏死灶。钙化灶３例，占７９％。增强扫描肌瘤与正常肌层相差５～１０ＨＵ。结论：ＣＴ在显示子宫肌瘤的大小、位置与宫腔关系上有较高的诊断价值，可作为Ｂ超检查的重要补充手段     

Comparison of complications of vaginal hysterectomy in patients with leiomyomas and in patients with adenomyosis

We reviewed 1246 vaginal hysterectomies performed at Handa City Hospital between January 1984 and December 1996. We divided the patients into 2 groups: those with leiomyomas (n=893) and those with adenomyosis (n=353). There was no difference in operative time and estimated blood loss between the 2 groups when analyzed by uterine weight. However, adenomyosis was associated with an increased risk of bladder injury. Accepted: 7 April 1998     

子宫肌瘤患者GH-ICF-I轴与性激素的变化

目的:探讨GH-IGF-Ⅰ轴及性激素的变化与子宫肌瘤生长的关系。方法:选择年龄在30～55岁子宫肌瘤患者41例,其中增殖期21例,分泌期20例;年龄在33～53岁健康妇女40例作为对照组,其中增殖期21例,分泌期19例。采用免疫放射法(IRMA)测定血清生长激素(GH)、胰岛素样生长因子-1(IGF-Ⅰ)、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平;放射免疫法(RIA)测定血清雌二醇(E_2)、孕酮(P)、睾酮(T)水平。结果:①肌瘤组分泌期GH、IGF-Ⅰ、IGFBP-3比对照组明显降低(P<0.01);而在增殖期肌瘤组的IGFBP-3比对照组也明显降低(P<0.05),但GH、IGF-Ⅰ则降低不明显;②增殖期肌瘤组的T水平较对照组明显降低(P<0.05);③子宫肌瘤组在增殖期IGF-Ⅰ与年龄呈显著的负相关关系(P<0.05),在分泌期IGF-Ⅰ与IGFBP-3呈显著的正相关(P<0.05),E_2与P无论在增殖期(P<0.01)还是分泌期均有显著的正相关(P<0.05)。与对照组明显不同的是T与E_2、与P的相关关系,及E_2与年龄的相关关系不存在了。而GH在增殖期与IGFBP-3呈正相关(P<0.05),与P也呈正相关(P<0.05),在分泌期GH与E_2则有非常显著的正相关关系(P<0.01)。结论:①GH轴的变化是由年龄决定的,随着年龄的增长,GH、IGF-Ⅰ、IGFBP-3相应的降低,在此过程中性激素,尤其E_2起主要调节作用。子宫肌瘤患者在增?     

Mesenchymale und neurogene Oesophagustumoren Eine Literaturübersicht von 203 histologisch gesicherten Fällen

Zusammenfassung Aus dem Zeitraum von 1944 bis 1969, der eine histologische Absicherung weitgehend garantiert, wird eine Übersicht über 155 benigne mesenchymale und neurogene Oesophagustumoren (14 eigene Beobachtungen) und über 43 Oesophagussarkome (4 eigene Fälle) gegeben. Der häufigste Befall der mesenchymalen Tumoren liegt im 3. bis 5. Lebensjahrzehnt (73 Fälle), bei den Sarkomen im 6. Lebensjahrzehnt (18 Patienten). Das Geschlechtsverhältnis der gutartigen Tumoren beträgt 85 Männer und 68 Frauen (2mal fehlende Angaben), bei den Sarkomen 28 Männer und 20 Frauen. Die Symptomatik der gutartigen Tumoren erstreckt sich über Jahre (Dysphagie, retrosternale Schmerzen usw.). Ein Teil wird erst bei der Autopsie entdeckt. Gelegentlich führen Röntgenreihenuntersuchungen (Mediastinaltumoren) zur Diagnose. Bei vorhandener Symptomatik führt die Dysphagie, gelegentlich auch einmal Haematemesis oder Melaena. Bei den Sarkomen ist die Symptomatik praktisch identisch, jedoch die Entwicklung auf Grund des raschen Wachs tums sehr viel schneller. Im Durchschnitt wird nach 8 Monaten der Arzt aufgesucht. Die Röntgenuntersuchung und Oesophagoskopie führen in der Diagnostik. Bei Verdacht auf gutartige Tumoren sollte keine Probeexcision entnommen werden. Die histologische Einteilung wird in Anlehnung an die UICC vorgenommen. Unter 155 gutartigen Tumoren führen die Leiomyome mit 117 Fällen (60% aller und 77% der benignen mesenchymalen Tumoren). Häufigster Sitz ist der distale Abschnit; dann folgen die Haemangiome (10 Fälle), Fibrome und Lipome (je 9 Fälle), neurogene Tumoren (8 Fälle) und Varia. Unter den 48 Sarkomen fallen 21 Erkrankungen auf das distale Drittel, 17 auf das mittlere und 8 auf das proximale. Hier führt das Leiomyosarkom (19 Fälle). Während die Prognose der 150 operierten gutartigen Tumoren sehr gut ist (operative Mortalität 2,6%), ist das Risiko der Operation und die Überlebenschance der Sarkome den Oesophaguscarcinomen praktisch gleichzusetzen. Nur bei 14 von den 48 Mitteilungen finden sich Angaben über den Verlauf. Immerhin haben 7 Patienten länger als 5 bis 15 Jahre zum Zeitpunkt der Mitteilungen gelebt. Für eine verbindliche Aussage sind die Zahlen zu klein.

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Mesenchymal and neurogenic oesophageal tumors

Summary This is a survey of 155 benign mesenchymal and neurogenic esophageal tumors (14 own cases) and of 48 esophageal sarcomas (4 own cases). All cases occured during the period between 1944 and 1969, so that histological control is largely guaranteed. Mesenchymal esophageal tumors manifest themselves predominantly during the 3rd and 5th decade of life (73 cases), while esophageal sarcomas develop during the 6th decade (18 cases). The ratio of male to female among the patients with benign tumors is 85 to 68 (in two cases sex is not reported), among the patients with sarcomas, there were 28 men and 20 women. The symptoms of benign tumors exist for years (dysphagia, retrosternal pain etc.). Some of the benign tumors are not detected before autopsy. Sometimes routine X-ray studies, which may reveal mediastinal tumors, lead to the diagnosis of an esophageal tumor. If symptoms are present, the main complaint is dysphagia and rarely hematemesis or melena. Symptoms of esophageal sarcomas are practically identical to those of benign tumors, but develop much more rapidly. Almost all patients with esophageal tumors see the doctor 8 months after the first onset of symptoms. X-ray examination and esophagoscopy are among the most important diagnostic procedures. A biopsy should not be undertaken if a benign tumor is suspected. The tumors are histologically classified according to the UICC. Among the 155 benign tumors, the leiomyomas occur most frequently, (117 cases — 60% of all and 77% of the benign mesenchymal tumors). Most of them are located in the lower part of the esophagus. The leiomyomas are followed by hemangiomas (10 cases), fibromas (9 cases), lipomas (9 cases), and neurogenic tumors (8 cases). In 2 cases, histological classification is not reported. 21 of the total number of 48 esophageal sarcomas are located in the lower, 17 in the middle, and 8 in the upper third of the esophagus. Quantitatively, leiomyosarcomas occurred most frequently (19 cases). While the prognosis of 150 operations on benign tumors is excellent (operative mortality 2,6%) sarcomas show the same risk of operation and chance of survival as esophageal carcinomas. We have complete information about the whole course of the disease for only 14 of the 48 sarcoma cases. Nevertheless, at the time the sarcoma cases were reported, 7 patients had lived more than 5 to 15 years. The small number of cases, however, does not allow a definitive statement on the prognosis of esophageal sarcomas.

Herrn Professor Linder zum 60, Geburtstag in dankbarer Verehrung gewidmet.