Safety and Efficacy of Ultrasound-Guided High-Intensity Focused Ultrasound Treatment for Uterine Fibroids and Adenomyosis.

The objective of this study was to assess the tolerability and efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation using a Haifu JC Focused Ultrasound Tumor Therapeutic System (operating transducer frequency: 0.8 MHz, 300-400 W/cm2) under real-time ultrasound guidance (2.5- to 5.0-MHz imaging probe) for uterine fibroids and adenomyosis in 1807 patients (928 with fibroids and 889 with adenomyosis). Volume change and clinical symptom improvement after treatment were evaluated based on symptom severity scores and health-related quality of life scores using the Uterine Fibroid Symptom and Quality of Life questionnaires. At 3, 6 and 12 mo after treatment, symptom severity scores and health-related quality of life scores and reductions in volumes of uterine adenomyosis and fibroids all revealed good effects. The complication rate was 4.6% (84/1807). With supportive care, all complications resolved without any permanent adverse effects. Thus, USgHIFU is an effective, non-invasive modality for treating uterine fibroids and adenomyosis with manageable complications.

Abdominal wall endometriosis treatment by ultrasound-guided high-intensity focused ultrasound ablation: a case report.

Abdominal wall endometriosis (AWE) occurs in about 0.1% of people with endometriosis, and is often diagnosed postoperatively. Surgical resection is generally used to treat AWE. We successfully treated AWE with ultrasound-guided high-intensity focused ultrasound therapy (USgHIFU). A 37-year-old Korean female presented with a palpable subcutaneous nodule associated with cyclic pain and swelling during menstruation. She was recommended surgical excision three months ago. She had a history of laparoscopic surgery for endometriosis 4 years ago and was interested in less invasive methods of treatment. The 0.9 cm painful nodule was observed as a low-echoic shadow in transabdominal ultrasonography and as an iso-signal in T1 MRI images. USgHIFU treatment was performed under light sedation and completed when the hyperechoic area covered the entire lesion. HIFU treatment was effective without any postoperative complications such as blisters or skin burns. The lesion showed changes in hyper-intensity signal on T1 MRI images. Physical examination showed absence of pain or tenderness and three months later, the painful nodule shrunk, and the menstrual cyclic pain associated with the nodule disappeared. In conclusion, USgHIFU may represent an effective therapy for AWE.

High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta.

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

Randomized controlled trial of the efficacy and safety of self-adhesive low-level light therapy in women with primary dysmenorrhea.

OBJECTIVE: To evaluate the efficacy and safety of low-level light therapy in women with primary dysmenorrhea. METHOD: A multicenter prospective, randomized, double-blind, placebo-controlled clinical trial including patients 18-35 years of age with primary dysmenorrhea was undertaken at two university hospitals in South Korea between October 2011 and September 2012. Patients were randomized using a computer-generated sequence to receive low-level light therapy using the Color DNA-WSF device or to receive placebo treatment with a dummy device. The severity of menstrual pain, assessed using a visual analog scale, was the primary outcome and was evaluated at baseline and during every menstrual cycle for 3 months following treatment. Patients who received more than one application of treatment (with a Color DNA-WSF or placebo device) were included in analyses. Patients and investigators were masked to the treatment assignments. RESULTS: Overall, 44 patients were assigned to each group. At the final study visit, the reduction in scores using a visual analog scale was significantly greater in patients who received low-level light therapy (n=41; 4.34±2.22) than among those in the control group (n=38; 1.79±1.73; P<0.001 when adjusted for age) No serious adverse events occurred. CONCLUSION: Low-level light therapy could be an effective, safe treatment modality for women with primary dysmenorrhea. Clinical Trials.gov: NCT02026206.

Ultrasound-guided high-intensity focused ultrasound treatment for uterine fibroid & adenomyosis: A single center experience from the Republic of Korea.

OBJECTIVES: This study aimed to assess the therapeutic outcomes of patients with uterine fibroid or adenomyosis treated by ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation at Incheon Christian Hospital, Korea. METHODS: This study included 618 patients, of which 272 suffered from uterine fibroid and 346 suffered from adenomyosis. Treatment was administrated using the Model Haifu JC Focused Ultrasound Tumor Therapeutic System (Chongqing Haifu Technology, Chongqing, China) under real-time ultrasound guidance. A follow-up was conducted on volume change as well as on symptom improvement using the Symptom Severity Score (SSS) and Uterine Fibroid Symptom and Quality of Life (UFS-QOL) after treatment. RESULT: The uterine fibroid volume reduction rates (%) were 58.08%, 66.18%, and 77.59% at 3, 6, and 12 months after treatment, respectively. The SSS reduction rates (%) were 55.58%, 52.76%, and 50.39% by 3, 6, and 12 months, respectively. The UFS-QOL score increasing rates (%) were 42.66%, 43.50%, and 43.45% by 3, 6, and 12 months, respectively. The uterine volume reduction rates (%) for adenomyosis were 43.99%, 47.01%, and 53.98% by 3, 6, and 12 months, respectively. The SSS reduction rates (%) for adenomyosis were 55.61%, 52.38%, and 57.98% by 3, 6, and 12 months, respectively. The UFS-QOL score increasing rates (%) for adenomyosis UFS-QOL score were 80.06%, 69.39%, and 85.07% by 3, 6, and 12 months, respectively. CONCLUSION: We conclude that USgHIFU treatment for uterine fibroid and adenomyosis is an effective non-invasive therapy via the assessment of fibroid volume reduction, symptom improvement, UFS-QOL score increase, and acceptable level of side effects. Although preliminary experience of HIFU is encouraging, well-designed prospective trials and more clinical experiences are needed to ascertain the efficacy and safety of this new treatment.

Effects of menopausal hormone therapy on uterine myoma in menopausal women.

OBJECTIVES: The aim of the present study is to evaluate the long term effects of estrogen-progestogen therapy (EPT) on uterine myomas volume in postmenopausal women. METHODS: We performed a retrospective analysis on postmenopausal women with asymptomatic uterine myoma during the period between April, 2008 and September, 2012. Postmenopause was defined as amenorrhea for longer than a year or serum follicle stimulating hormone levels higher than 40 IU/L. The volume of the myoma was assessed by transvaginal ultrasonography for every 6 months after administration of EPT. RESULTS: Thirty-eight women were included in the study, with 32 in the EPT group and 6 in the control group. Overall, uterine myoma volume (mean ± standard deviation, cm(3)) in the EPT group was 19.5 ± 24.6 at baseline, and those at 6 and 12 months were 24.7 ± 35.1 and 28.5 ± 56.4, respectively. Myoma volume did not change significantly with EPT, and these changes were not significantly different from the control group. Myoma volume changes were not significantly different in the subgroups according to the route of estrogen administrations and the method of progestogen administrations. Clinically significant volume increases during one year of EPT was noted in 28.1% (9/32), however, only one showed transient increases. CONCLUSION: Our results suggest that treating postmenopausal woman with EPT on a long-term basis does not increase the volume of uterine myomas.

The Relationship between Uterine Myoma Growth and the Endocrine Disruptor in Postmenopausal Women.

OBJECTIVES: To investigate the number of leiomyoma patients-exposed to bisphenol A (BPA) and to observe whether the serum concentration of BPA is related to leiomyoma growth. METHODS: A total of 158 patients were recruited for this study. Leiomyoma patients were divided into three groups, mild (n = 48), moderate (n = 32) and severe (n = 28), according to the size of leiomyomas. The control (n = 30) group was defined as having no leiomyomas. Transvaginal ultrasonography was used to identify and measure the leiomyomas. Serum BPA concentrations were measured by enzyme-linked immunosorbent assay. RESULTS: BPA was detected in 87.0% out of a total of 158 samples, and in 86.0% out of 108 leiomyoma patients. In detail, the detection rates of serum BPA were 88.0% in the control group, 77.2% in the mild group, 90.0% in the moderate group and 96.0% in the severe group. The mean BPA concentration in the control group was 0.558 ± 0.097 ng/mL, the leiomyoma groups, the mean BPA concentrations were 0.274 ± 0.063 ng/mL (mild), 0.346 ± 0.064 ng/mL (moderate) and 0.647 ± 0.039 ng/mL (severe) (P = 0.0003). Values represent the mean ± standard error. CONCLUSION: The detection rates of serum BPA in the control and leiomyoma groups were 88.0% and 86.0%, respectively. However, there was no significant difference in the serum BPA concentrations between the control and leiomyoma groups. To verify the effect of BPA on leiomyoma growth, a close and sequential monitoring is recommended for people who are at risk for uterine leiomyoma.

Skin adhesive low-level light therapy for dysmenorrhoea: a randomized, double-blind, placebo-controlled, pilot trial.

PURPOSE: The cause of dysmenorrhoea is an abnormal function of smooth muscles in the uterus due to long-term deficient blood supply into smooth muscle tissue. The purpose of this study was to evaluate the effectiveness of skin adhesive low-level light therapy (LLLT) in participants with dysmenorrhoea. METHODS: Thirty-one women were included in this randomized, double-blind, placebo-controlled, pilot trial. Twenty-one women were treated with active LLLT and ten women were treated with placebo one. The therapy was performed in a laboratory room for 20 min a day over a period of 5 days prior to the expected onset of menstruation. The outcome was measured using a visual analog scale (VAS) for each participant's dysmenorrhoeal pain severity. VAS of each subject was measured every month for 6 months. RESULTS: In the active LLLT group, 16 women reported successful results during their first menstrual cycle just after active LLLT and 5 women had successful results from the second menstrual cycle after active LLLT. The pain reduction rate was 83 % in the active LLLT group, whereas there was only a slight and temporary reduction in pain in the placebo LLLT group. Changes of VAS within 6 months of LLLT showed statistical significance (p = 0.001) over placebo control. CONCLUSIONS: Our study suggests that skin adhesive LLLT on acupuncture points might be an effective, simple and safe non-pharmacological treatment for dysmenorrhoea.

Risedronate directly inhibits osteoclast differentiation and inflammatory bone loss.

Risedronate, a nitrogen-containing bisphosphonate, is widely used in the clinical field for the treatment of osteoporosis. Risedronate is known to exert its effects through binding to hydroxyapatite in bone tissue, inhibiting osteoclastic activity, and inducing apoptosis of osteoclasts. The purpose of this study was to determine the effects of risedronate on osteoclast differentiation in vitro and on an inflammatory bone loss model in vivo. Risedronate inhibited osteoclast differentiation in co-culture of bone marrow cells (BMCs) and osteoblasts, and suppressed receptor activator of nuclear factor (NF)-kappaB ligand (RANKL)-mediated osteoclast differentiation from bone marrow-derived macrophages (BMMs) in a dose-dependent manner without toxicity. Risedronate significantly inhibited expression of c-Fos and nuclear factor of activated T cells (NFAT) c1 induced by RANKL. To examine the effect of risedronate on bone loss in vivo, we used a mouse model of lipopolysaccharide (LPS)-mediated bone loss. Micro-CT analysis of the femurs showed that LPS treatment caused bone loss. However, bone loss was significantly attenuated in mice administered with risedronate. Taken together, we conclude that risedronate exerts beneficial effects on osteoporosis by inhibiting osteoclast differentiation both directly and indirectly. In infectious conditions, the inhibitory effect of risedronate on bone erosion was excellent. Thus risedronate could be a treatment option for osteoporosis caused by inflammatory and infectious conditions.

Refractory uraemic pleuropericarditis treated successfully with corticosteroid therapy.

Uraemic pleuritis and pericarditis are frequently observed in chronic renal failure patients and tend to improve with continued haemodialysis. However, certain cases have been reported that do not respond to continued haemodialysis alone. A 67-year-old female on long-term haemodialysis was diagnosed with uraemic pleuropericarditis and treated with intensive haemodialysis and given a non-steroidal anti-inflammatory drug to which she showed no response. We report a case of uraemic pleuropericarditis refractory to traditional therapy, which was treated successfully with corticosteroid therapy.