Degeneration of Leiomyoma in Patients Referred for Uterine Fibroid Embolization: Incidence, Imaging Features and Clinical Characteristics

PURPOSE: Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma. MATERIALS AND METHODS: Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated. RESULTS: Among the 276 patients who underwent MRI, 14 (5.1%) showed degenerated leiomyomas. Symptoms were abdominal pain (n=4, 26.7%), menorrhagia (n=5, 35.7%) and bulk-related symptoms (n=5, 35.7%) and no symptoms (n=5, 35.7%). Of the 14 patients with degenerated leiomyomas, 5 (42.9%) had a history of pregnancy in the past two years. For T1-weighted imaging (T1WI), a high signal intensity (SI) of the leiomyoma was the most common finding (n=9, 64.3%) and a hyperintense rim (n=4, 28.6%) was the second most common. On T2-weighted imaging (T2WI), a low SI of the leiomyoma was found in six patients (42.9%), a high SI in four (28.6%) and a heterogeneous SI in four (28.6%) patients. Conservative management was performed in 11 (78.6%) patients, surgery in 3 (21.4%) and uterine artery embolization in one (7.1%) patient. CONCLUSION: The incidence of degeneration of leiomyoma in patients referred for UFE was 5.1%. Patients presented with variable clinical symptoms with or without a history of pregnancy. MR imaging showed a high SI on T1WI and various SIs on T2WI without contrast enhancement. An understanding of the degeneration of leiomyomata is essential when considering UFE.

Sangramento uterino anormal / Abnormal uterine bleeding

O sangramento uterino anormal é um distúrbio frequente que pode ocorrer em qualquer idade entre a menarca e a menopausa, mas concentra-se principalmente em seus extremos, logo após a menarca e no período perimenopausa, quando ocorrem alterações no eixo hipotálamo-hipófise-ovário, que levam com muita frequência à anovulação. O sangramento uterino disfuncional, considerado diagnóstico de exclusão, pode ser ovulatório ou anovulatório. O manejo do quadro pressupõe que o sangramento agudo seja coibido e que se evite a recidiva; para tanto, é fundamental que se estabeleça o diagnóstico etiológico. Os autores fazem uma revisão objetiva sobre o assunto, dando ênfase ao diagnóstico e tratamento da doença.

Abnormal uterine bleeding is a clinical problem wich may occur at any time during the reproductive years; however, it is most prevalent during perimenarche and perimenopause, when women tend to have anovularoty cycles. Disfunctional uterine bleeding is a prevalent disease that affects women from adolescence to menopause. The treatment should control the acute bleeding and avoid the recidive. The etiological diagnosis is fundamental for this purpose. The authors make an objective review about dysfunctional uterine bleeding herein, focusing on the diagnosis and treatment of the disease.

Ultrasound location of misplaced levonorgestrel releasing intrauterine system [LNG-IUS] - is it easy?

The Levonorgestrel intrauterine device [LNG-IUD] is a hormone-containing device licensed for treatment of menorrhagia and contraception. Though complications such as perforation have been reported similar to other non-hormonal intrauterine devices, the diagnosis of such complications is difficult with this device because the LNG-IUD has a different ultrasound appearance compared to copper devices and these case reports are intended to emphasize this point

Treatment of menorrhagia associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

Menorrhagia is an increasingly common health problem. The Icvonorgestrel-releasing intrauterine system [LNG-IUS] has been advocated for the treatment of menorrhagia as an alicrnativc to surgery. Based on this established indication and theoretical potential of targeted endometrial solution of myoma-related bleeding, we evaluated the efficiency of LNG-IUS in treating selected cases presenting with menorrhagia in the presence uicrinc leiomyomas. This study included 68 patients with history of menorrhagia and U/S proved submucous uterine leiomyoma. Uterine bleeding was done by the semiquantitative pictorial blood loss assessment score [PBAC]. The 5-Dimensional EuroQol [EQ-5D] was chosen as the primary measure of effectiveness on health-related quality of life. Patients were re-evaluated at 3,6,9 and 12 month. Alter 12 months of follow-up, a significant reduction of menstrual flow was observed up to amenorrhea [in 11 cases]. No significant effect for the ENG-IUS on the volume of fibroids or the uterine volume was observed. A significant improvement of the quality of life [measured by EQ index] was observed. Side effects were reported in 10 cases. Eight eases required removal of the IUD for different reasons. So this study shows that in selected cases of uterine leiomyomas, LNG-IUS is an effective therapy directed towards the local steroid environment of the endometrium for control of the bleeding with no valuable effect on the myomas themselves

Non HFE-related hemochromatosis; a case report from Iran

Hemochromatosis, especially with cardiac and liver problem, is rare in Iran. We report a young female with pulmonary hypertension and abnormal liver function tests due to non HFE- related hemochromatosis

Fisiopatologia, diagnóstico e tratamento da menorragia na adolescência / Menorrhagia in adolescence: phisiopathology, diagnosis and treatment

A menorragia é um problema ginecológico comum em adolescentes. Os dois primeiros anos pós-menarca geralmente säo anovulatórios e a maioria dos casos de sangramento excessiva resulta da imaturidade do eixo hipotálamo-hipófise-ovário. Entretanto, o diagnóstico diferencial deve incluir coagulopatias, tireoidopatias e Síndrome de Ovários Policísticos, entre outros. A fisiopatologia do sangramento excessivo ainda näo está bem definida mas acredita-se que alteraçöes hemostáticas e hormonais estejam envolvidas. Para o diagnóstico da etiologia da menorragia, a história menstrual e a idade ginecológica (tempo decorrido desde a menarca) säo fundamentais. Um hemograma e uma ecografia transvaginal podem auxiliar bastante. O tratamento pode variar desde a tranqüilizaçäo e acompanhamento da adolescente, até a terapia medicamentosa agressiva. O tratamento cirúrgico é incomum

Comparative efficiency ibuprofen and ethamsylate in the treatment of IUD menorrhagia

One hundred and fifty women with device menorrhagia were the subject of this study. Cases received either Ibuprofen, etamsylate or combined Ibuprofen etamsylate therapy. The duration of menstrual flow, the daily number of towel usage and the hemoglobin concentration before and after the treatment were taken as criteria for estimation of drug efficacy. The results showed that combined Ibuprofen- etamsylate therapy was superior to either Ibuprofen or etamsylate therapy in treating device-related menorrhagia. Seven case [4.7 percent] reported side effects, which were not serious