Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 22
Filter
Add more filters










Publication year range
5.
Eur J Obstet Gynecol Reprod Biol ; 171(2): 329-32, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24103533

ABSTRACT

BACKGROUND: Uterine myomas are benign tumours affecting 20-40% women. Various medical and surgical therapeutic options are available but the search for an ideal medical option continues. Aromatase inhibitors have recently been reported to have a potential role in the management of oestrogen-dependent conditions like endometriosis and leiomyoma. OBJECTIVE: To evaluate the effect of letrozole on uterine myoma size and symptomatology in perimenopausal women. STUDY DESIGN: Prospective interventional study conducted on 30 premenopausal women aged between 30 and 55 years with menstrual or pressure symptoms and having a single intrauterine myoma of size 4 cm or more with or without one or more additional myomata each of size 2 cm or less. They received tablet letrozole 2.5 mg a day for 12 weeks, and the effect of the drug on myoma size and volume and symptomatology was studied along with the adverse effect profile and patient satisfaction. RESULTS: The mean myoma size reduced from 5.4±1.3 cm to 4.3±0.9 cm (p<0.05) and the myoma volume exhibited a reduction of 52.45% (p=0.00) at the end of 3 months. The symptomatology score showed a significant improvement that persisted up to 3 months after cessation of therapy. No significant effect was observed on lipid profile, serum estradiol, progesterone, testosterone and FSH and LH levels during the therapy. Nausea and hot flushes were the main adverse effects observed and were self-limiting. CONCLUSION: Letrozole significantly reduces myoma size and volume and also improves the associated symptoms. It has a good adverse effect profile and appears to be a promising medical option for management of uterine myomas.


Subject(s)
Aromatase Inhibitors/therapeutic use , Leiomyoma/drug therapy , Nitriles/therapeutic use , Triazoles/therapeutic use , Uterine Neoplasms/drug therapy , Adult , Female , Humans , Leiomyoma/pathology , Letrozole , Middle Aged , Premenopause , Prospective Studies , Uterine Neoplasms/pathology
7.
Front Biosci (Elite Ed) ; 5(1): 12-22, 2013 01 01.
Article in English | MEDLINE | ID: mdl-23276966

ABSTRACT

Uterine myomas, the most common benign solid pelvic tumors in women, occur in twenty percent of them in reproductive years and form the most common indication for hysterectomy. Various factors affect the choice of the best treatment modality for a given patient. Asymptomatic myomas may be managed by careful follow up. Medical therapy should be tried as a first line of treatment for symptomatic myomas while surgical treatment should be reserved only for appropriate indications. Myomectomy would be preferred over hysterectomy in those wishing subsequent childbearing. Preoperative GnRH-analogue treatment reduces the myoma size and vascularity but may render the capsule more difficult to resect. Poor surgical risk women with large symptomatic myomas or those wishing to avoid major surgical procedures may be offered uterine artery embolization. Serial follow-up for growth and symptoms may be appropriate for asymptomatic perimenopausal women. The present article reviews the available therapeutic modalities for uterine myomas.


Subject(s)
Gonadotropin-Releasing Hormone/therapeutic use , Hysterectomy/methods , Myoma/drug therapy , Myoma/surgery , Uterine Artery Embolization/methods , Uterine Myomectomy/methods , Uterine Neoplasms/drug therapy , Uterine Neoplasms/surgery , Antifibrinolytic Agents/therapeutic use , Disease Management , Female , Humans , Norpregnadienes/therapeutic use , Progestins/therapeutic use
9.
Arch Gynecol Obstet ; 285(4): 1019-23, 2012 Apr.
Article in English | MEDLINE | ID: mdl-21971575

ABSTRACT

BACKGROUND: Osteoporosis, a skeletal disorder that adversely affects bone strength , is common among postmenopausal women primarily due to reduced ovarian estrogens. PURPOSE: The present study was taken up to evaluate the role of isosorbide mononitrate (IMN) in the management of postmenopausal osteoporosis and to compare its efficacy with that of alendronate. METHODS: This prospective systematic randomized study was conducted on 90 postmenopausal women with lumbar spine BMD >2.5 SD below the young adult reference range. The participants received either Tab Alendronate 70 mg orally, once weekly (Group I) or Tab IMN 40 mg orally once daily (Group II) for 9 months, in addition to 500 mg of oral calcium daily. The BMD of the lumbar spine was measured using DEXA scan at enrolment and after 9 months. The data was analyzed by Student's t test and Chi-square test. RESULTS: The mean baseline BMD was 0.67 + 0.097 and 0.68 + 0.067 g/cm(2) in Group I and II, respectively. An increase of 11.94% in the mean BMD was noted after 9 months of treatment with alendronate as against 8.82% with IMN. Headache, flushing and palpitations in Group II and nausea, epigastric pain and heart burn in Group I were the most common adverse effects. CONCLUSION: IMN has a beneficial effect on bone turnover in cases of postmenopausal osteoporosis and that the effect is comparable to that of alendronate. IMN is a promising and safe alternative to alendronate for the management of postmenopausal osteoporosis.


Subject(s)
Alendronate/therapeutic use , Bone Density Conservation Agents/therapeutic use , Bone Remodeling/drug effects , Isosorbide Dinitrate/analogs & derivatives , Osteoporosis, Postmenopausal/drug therapy , Absorptiometry, Photon , Aged , Alendronate/pharmacology , Bone Density Conservation Agents/pharmacology , Female , Humans , Isosorbide Dinitrate/pharmacology , Isosorbide Dinitrate/therapeutic use , Middle Aged , Osteoporosis, Postmenopausal/diagnosis , Prospective Studies
10.
Arch Gynecol Obstet ; 285(4): 1055-8, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22009509

ABSTRACT

OBJECTIVES: To evaluate the efficacy and safety of mifepristone and buccal misoprostol versus buccal misoprostol alone in medical abortion of ≤56 days. STUDY DESIGN: One hundred pregnant women having gestational age ≤56 days were randomized to group A and group B. In group A, patients received 200 mg mifepristone on day 1, followed by buccal misoprostol 800 µg on day 2, and in group B patients received 800 µg buccal misoprostol only on day 1. MAIN OUTCOME MEASURES: Complete abortion was the principal outcome measure. Secondary outcome measures were side-effects and acceptability. RESULTS: Forty-six (92%) patients in group A and 37 (74%) patients in group B aborted successfully (p value 0.017). Four (8%) patients in group A and eight (16%) patients in group B had incomplete abortion with retained products of conception. In group B, three (6%) patients had missed abortion and two (4%) patients had continued pregnancy whereas none of the patients in group A had missed abortion or continued pregnancy. The overall method acceptance was 100% whereas the overall route acceptance was 83%. CONCLUSION: Misoprostol-alone regimen is a low-cost regimen as compared to mifepristone/misoprostol regimen. Though the efficacy of mifepristone followed by buccal misoprostol is better, buccal misoprostol alone can be used for termination of pregnancy in patients where mifepristone is either unavailable or contraindicated.


Subject(s)
Abortifacient Agents/administration & dosage , Abortion, Induced/methods , Mifepristone/administration & dosage , Misoprostol/administration & dosage , Abortion, Legal , Administration, Oral , Adult , Female , Gestational Age , Humans , Pregnancy , Treatment Outcome , Young Adult
12.
Int J Womens Health ; 3: 231-41, 2011.
Article in English | MEDLINE | ID: mdl-21892334

ABSTRACT

Uterine myomas, the most common benign, solid, pelvic tumors in women, occur in 20%-40% of women in their reproductive years and form the most common indication for hysterectomy. Various factors affect the choice of the best treatment modality for a given patient. Asymptomatic myomas may be managed by reassurance and careful follow up. Medical therapy should be tried as a first line of treatment for symptomatic myomas, while surgical treatment should be reserved only for appropriate indications. Hysterectomy has its place in myoma management in its definitiveness. However, myomectomy, rather than hysterectomy, should be performed when subsequent childbearing is a consideration. Preoperative gonadotropin-releasing hormone analog treatment before myomectomy decreases the size and vascularity of the myoma but may render the capsule more fibrous and difficult to resect. Uterine artery embolization is an effective standard alternative for women with large symptomatic myomas who are poor surgical risks or wish to avoid major surgery. Its effects on future fertility need further evaluation in larger studies. Serial follow-up without surgery for growth and/or development of symptoms is advisable for asymptomatic women, particularly those approaching menopause. The present article is incorporated with multiple clear clinical photographs and simplified elaboration of the available management options for these tumors of uterine smooth muscle to facilitate clear understanding.

13.
Arch Gynecol Obstet ; 283(2): 295-7, 2011 Feb.
Article in English | MEDLINE | ID: mdl-20072784

ABSTRACT

INTRODUCTION: Laparoscopy, because of its availability and safety, provides a valuable tool in the evaluation of undiagnosed chronic pelvic pain. It is a simple and definitive means of establishing the presence or absence of pelvic pathology without resorting to major abdominal surgery. OBJECTIVE: To evaluate the causes of chronic pelvic pain using laparoscopy and to correlate between clinical examination, ultrasonography, and laparoscopy. MATERIAL AND METHODS: The present prospective study was done in the Department of Obstetrics and Gynecology of Pt. BD Sharma, PGIMS Rohtak. Fifty cases of chronic pelvic pain attending gynae OPD were included in the study. After detailed history, examination, investigations, and ultrasonography, the patients were subjected to laparoscopy. RESULTS: The mean age and parity of the patients with CPP was 30.88 ± 7.71 years and 1.74 ± 1.38, respectively. The mean duration of pain was 2.8 years (6 months-8 years). The commonest finding on laparoscopy was adhesions in 40%, endometriosis in 18%, and pelvic congestion syndrome in 20%, while 10% of the patients had normal pelvis. Laparoscopic findings were taken as gold standard and pelvic examination and ultrasonographic findings were compared with it. CONCLUSION: Clinical examination and ultrasonography has a sensitivity of 8.1 and 2%, respectively. Laparoscopy helps in detecting many causes of CPP which clinical methods and ultrasonography fail to identify. This enforces the position of laparoscopy as a gold standard in evaluation of this condition.


Subject(s)
Genital Diseases, Female/diagnosis , Laparoscopy , Pelvic Pain/etiology , Adult , Chronic Disease , Female , Genital Diseases, Female/diagnostic imaging , Humans , Sensitivity and Specificity , Tissue Adhesions/complications , Tissue Adhesions/diagnosis , Ultrasonography
14.
Arch Gynecol Obstet ; 283(6): 1245-8, 2011 Jun.
Article in English | MEDLINE | ID: mdl-20549511

ABSTRACT

AIM: The present study was undertaken to compare the efficacy of isosorbide mononitrate (IMN) and misoprostol for cervical ripening in termination of pregnancy between 8 and 12 weeks. MATERIALS AND METHODS: This prospective randomized single blind study enrolled 40 women with singleton pregnancy seeking surgical termination of pregnancy between 8 and 12 weeks of gestation. They were divided into two groups--group I received IMN 40 mg while group II received misoprostol 40 mg vaginally, 3 h prior to suction and evacuation. All women were monitored for effects of cervical ripening and adverse effects. RESULTS: The mean sizes of dilators that could be negotiated without any resistance was 5.9 ± 1.33 in group I and 8.6 ± 0.94 in group II (p < 0.001, 95% CI 0.58, 0.41). The mean dilator sizes at which resistance was first encountered was 6.9 ± 1.37 in group I and 9.9 ± 1.23 in group II (p < 0.001, 95% CI 0.60, 0.54). The mean blood loss was 61.5 ± 13.86 ml in group I and 36.25 ± 12.80 ml in group II (p < 0.001, 95% CI 6.07, 5.63). Headache was the most common adverse effect seen with IMN use. CONCLUSION: The results show that IMN has a definite role and better safety profile than misoprostol in first trimester cervical ripening, although misoprostol is more effective and causes less blood loss.


Subject(s)
Abortifacient Agents, Nonsteroidal/administration & dosage , Abortion, Induced , Cervical Ripening , Isosorbide Dinitrate/analogs & derivatives , Misoprostol/administration & dosage , Abortifacient Agents, Nonsteroidal/adverse effects , Administration, Intravaginal , Adult , Blood Loss, Surgical , Female , Hospitals, Teaching , Humans , India , Isosorbide Dinitrate/administration & dosage , Isosorbide Dinitrate/adverse effects , Labor Stage, First , Misoprostol/adverse effects , Pregnancy , Pregnancy Trimester, First , Prospective Studies , Single-Blind Method , Treatment Outcome , Vacuum Curettage , Young Adult
15.
Arch Gynecol Obstet ; 283(5): 1145-8, 2011 May.
Article in English | MEDLINE | ID: mdl-20596716

ABSTRACT

BACKGROUND: Aggressive angiomyxoma is a rare locally aggressive mesenchymal tumor of unknown etiology usually affecting the vulva, perianal region, buttocks or pelvis of reproductive age women. MATERIAL: A series of three cases, one each of vaginal, vulval and labial angiomyxoma is being presented. The etiology, presentation, diagnosis and management of this rare genital tumor are outlined. CONCLUSION: Angiomyxoma of vulva and vagina refers to a rare disease; diagnosis is not at all clinical, thus, cases presenting as bartholin cyst, benign vulval lesions and vaginal wall cysts should have complete radiological work up before excision, as pre-diagnosis can change the treatment modality and prognosis of patient.


Subject(s)
Myxoma/diagnosis , Pregnancy Complications, Neoplastic/diagnosis , Vaginal Neoplasms/diagnosis , Vulvar Neoplasms/diagnosis , Adult , Cysts/diagnosis , Diagnosis, Differential , Female , Humans , Lipoma/diagnosis , Pregnancy
16.
Arch Gynecol Obstet ; 284(4): 1015-7, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21132312

ABSTRACT

Hidradenoma papilliferum (HP) is a rare, small, benign, cystic, papillary, slow growing tumor occurring in anogenital region of adult women. The authors describe a case of large, rapidly enlarging HP of vulva in a 25-year-old woman and review the literature available on this rare condition.


Subject(s)
Acrospiroma/diagnosis , Sweat Gland Neoplasms/diagnosis , Vulvar Neoplasms/diagnosis , Acrospiroma/pathology , Acrospiroma/surgery , Adult , Diagnosis, Differential , Female , Humans , Sweat Gland Neoplasms/pathology , Sweat Gland Neoplasms/surgery , Sweat Glands/pathology , Vulvar Neoplasms/pathology , Vulvar Neoplasms/surgery
17.
Eur J Obstet Gynecol Reprod Biol ; 152(2): 119-25, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20933150

ABSTRACT

The present study was planned to review the pathophysiology of uterine myomas and emphasize the principles of logical management on the basis of literature review and synthesis of the author's experience. The growth of uterine myomas, the most common solid pelvic tumors in women, is related to genetic predisposition, hormonal influences and growth factors. The treatment options include pharmacologic, surgical and radiographic interventions. Most asymptomatic myomas can be followed serially for progressive growth or development of symptoms. The various diagnostic and therapeutic advancements available today permit higher management flexibility with safe options, which must be tailored to the individual patients requirement.


Subject(s)
Leiomyoma/physiopathology , Uterine Neoplasms/physiopathology , Adult , Female , Humans , Leiomyoma/surgery , Leiomyoma/therapy , Middle Aged , Uterine Neoplasms/surgery , Uterine Neoplasms/therapy
18.
Arch Gynecol Obstet ; 280(4): 625-6, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19198865

ABSTRACT

Twenty-year-old para 1 presented with acute puerperal uterine inversion. Manual reposition and O'sullivan methods were tried but failed. She refused for any other corrective procedure. She again presented after 10 months with chronic puerperal inversion. Haultain operation was done. At laparotomy, inverted uterus was unicornuate, right kidney and ureter were absent.


Subject(s)
Puerperal Disorders , Uterine Inversion , Uterus/abnormalities , Female , Humans , Kidney/abnormalities , Ureter/abnormalities , Young Adult
19.
Arch Gynecol Obstet ; 280(2): 309-12, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19112577

ABSTRACT

The isthmus of uterus is different from the rest of uterus and cervix in anatomic as well as functional aspects. The tumors arising from it may be subjected to a different set of forces which may predispose to growth in a tangential or horizontal direction. A young woman who underwent myomectomy for a large isthmic myoma is presented and the growth dynamics are discussed.


Subject(s)
Leiomyoma/pathology , Uterine Neoplasms/pathology , Uterus/pathology , Female , Humans , Laparotomy , Leiomyoma/surgery , Pregnancy , Uterine Neoplasms/surgery , Uterus/surgery , Young Adult
20.
Arch Gynecol Obstet ; 279(5): 705-8, 2009 May.
Article in English | MEDLINE | ID: mdl-18777035

ABSTRACT

INTRODUCTION: Primary leiomyosarcoma of the broad ligament (LBL) is a very rare and highly malignant gynecological tumor. MATERIALS AND METHODS: A 45 year old hysterectomized woman with this rare tumor is presented. Treatment consisted of resection of the tumor along with omental and peritoneal sampling and adjuvant chemotherapy. No evidence of metastasis was present after 15 months of follow up. CONCLUSION: Complete surgery along with adjuvant chemotherapy or radiation and a close follow up for recurrence are advocated to optimize disease free survival.


Subject(s)
Broad Ligament/pathology , Leiomyosarcoma/pathology , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Combined Modality Therapy , Cyclophosphamide/administration & dosage , Dactinomycin/administration & dosage , Female , Gynecologic Surgical Procedures , Humans , Leiomyosarcoma/drug therapy , Leiomyosarcoma/surgery , Middle Aged , Vincristine/administration & dosage
SELECTION OF CITATIONS
SEARCH DETAIL
...