Causes of Bleeding
John C. Petrozza in Uterine Fibroids, 2020
The most compelling evidence supporting that differences in angiogenic factors between fibroids and normal myometrium can translate to gross changes such as blood vessel formation comes from studies by Hague et al. [19] and Di Lieto et al. [21, 22]. Hague et al. [19] assessed 52 fibroid uteri and 39 control uteri and found that ADM and VEGF were upregulated in the myometrium and endometrium of fibroid uteri. Despite the expectation that all angiogenic factors would be associated with blood vessel formation, the investigators concluded that only ADM levels correlated with higher vascular density and endothelial cell proliferation in adjacent myometrium. Di Lieto et al. [21, 22] also discovered that treatment of fibroid uteri with a gonadotropin-releasing hormone analogue (GnRH-a), a treatment often used for AUB associated with fibroids, reduced protein expression of PDGF, bFGF and VEGF, as well as vascular density and angiogenesis, demonstrating that hormone action, angiogenic factors and gross vascular changes are all interconnected. Notably, plasma iron levels and hemoglobin values improved in patients treated with GnRH-a, supporting the idea that inhibition of vascular growth can result in clinical outcomes associated with decreased bleeding.
Comparison of the ongoing pregnancy rate of in vitro fertilisation following tubal occlusion by microcoil placement versus laparoscopic tubal ligation for hydrosalpinges
Published in Human Fertility, 2022
Zhi Qin Chen, Ernest Hung Yu Ng, Miao Xin Chen, Mei Zhao, Jia Ping Pan, Hong Chen, Xiao Ming Teng
Women started their IVF with ovarian stimulation using either the long agonist or antagonist protocols 8–12 weeks after the treatment of their hydrosalpinges. For the long protocol, gonadotropin-releasing hormone analogue (GnRHa) was given for pituitary desensitisation. On Day 2–3 of the menstrual cycle and they underwent transvaginal ultrasound examination and serum oestradiol measurement. Human menopausal gonadotrophin (hMG) (Lebaode, Lizhu, china) or recombinant FSH (Puregon, Organon, Dublin, Ireland or Gonal F, Merck Serono S.p.A, Modugno, Italy) was given at 150–225 IU per day based on the AFC count, age of women and previous ovarian response, according to the standard operation procedures of the centre. Ovarian response was monitored by serial transvaginal scanning with or without hormonal monitoring. Further dosage adjustments were based on the ovarian response at the discretion of the clinicians in charge. For the antagonist protocol, antagonist 0.25mg daily (Orgalutran, Organon, Dublin, Ireland) was given from the 6th day of ovarian stimulation until the day of ovulation trigger.
Commentary on guidelines for the pharmacological treatment of paraphilic disorders
Published in The World Journal of Biological Psychiatry, 2020
Richard B. Krueger
Nevertheless, continuing efforts to evaluate the pharmacological treatment of these disorders continue. Uncontrolled open-label studies have suggested that androgen reduction treatment has been effective in reducing sexual offending (Rosler and Witztum 1998, 2009). Their reports concerned 100 males treated with triptorelin, a long-acting agonist analogue of gonadotropin-releasing hormone analogue, together with supportive psychotherapy followed for up to 15 years; as long as patients continued with pharmacological treatment, no recidivism was detected. Recently (Landgren et al. 2020) reported on a randomised clinical trial of dagarelix, a gonadotropin-releasing hormone antagonist that reduces testosterone. This was found to reduce the risk score of committing sexual abuse in men with paedophilic disorder 2 weeks after the initial injection. This study was considered to be a milestone (Briken 2020). Both studies, however, relied on outcome measures with very limited validation, especially given the reliance on self-report from a forensic population where such a report can be unreliable.
Evaluation of the timing and safety of hysteroscopic myomectomy of large submucosal fibroids pretreated by high intensity focused ultrasound
Published in International Journal of Hyperthermia, 2023
Kaiyin Qu, Min Zou, Zhi Wang, Chunmei Gong, Yu Xiong, Lian Zhang
Uterine myomas or fibroids are the most common benign tumors of the reproductive system in reproductive age women. The prevalence of uterine fibroids varies in different races with different ages. The highest prevalence was reported as 70% in African American reproductive age women [1]. Submucosal fibroids account for 5–10% in all types of uterine fibroids and are more likely to cause prolonged menstruation and increased menstrual volume as the fibroids protrude into the uterine cavity [2]. In addition, submucosal fibroids can lead to infertility or miscarriage because they affect the endometrial receptivity and the intrauterine environment. Currently, the standard treatment of submucosal fibroids is hysteroscopic myomectomy/transcervical resection of myoma (TCRM) [3–5]. However, it is difficult to completely resect the submucosal fibroids with size larger than 4 cm by hysteroscopic myomectomy in one session [6]. Pretreatment is usually performed before hysteroscopic myomectomy to reduce the size of the large submucosal fibroids. Gonadotropin-releasing hormone analogue (GnRH-a) is the most commonly used medication of pretreatment for hysteroscopic myomectomy. Recently, a study showed that high intensity focused ultrasound (HIFU) seemed to be superior to GnRH-a in the pretreatment for large submucosal fibroids before hysteroscopic myomectomy [7]. However, there was no study on the timing of hysteroscopic myomectomy after HIFU for submucosal fibroids. Therefore, this study intended to evaluate the timing and safety of HIFU followed by hysteroscopic myomectomy in patients with large submucosal fibroids through a retrospective analysis.
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