Morbidity, fertility and pregnancy outcomes after myoma enucleation by laparoscopy versus laparotomy.

OBJECTIVES: Myomas are defined as benign tumours that arise from smooth muscle cells of the uterus. Clinically, they are found in 5-77% of women of reproductive age. The prevalence rate varies considerably in the literature and a large number of fibroids do not cause symptoms. The lifetime risk of acquiring myomas is 70% for Caucasian women and ≥ 80% for African American women. MATERIALS/METHODS: The data of 265 patients undergoing surgery for symptomatic myomas by laparoscopy or laparotomy, performed in the gynaecological department of Hannover Medical School, Hannover, Germany, between 2009 and 2013, were retrospectively analysed in this retrospective design study. RESULTS: High pregnancy rates (up to 70%) and birth rates (up to 86%) after myomectomy, regardless of the surgical approach adopted, were found in the current study. The trend was that ≥ 3 myomas and those that were ≥ 6 cm in size were almost always removed by laparotomy in our clinic. It was possible to remove up to 42 myomas without having to perform a hysterectomy. A statistically significant negative correlation was observed in relation to the association between the size of the largest myoma extracted and the pregnancy rate (p = 0.02). A statistically significant correlation between the number of removed myomas and the pregnancy rate was observed for patients who wished to bear children (p = 0.010). Elevated complication rates (of up to 50%) were reported for more than three extracted myomas with a statistically significance (p = 0.0471). CONCLUSIONS: It is necessary to ensure sound preoperative selection of the surgical approach in order to achieve the most optimal results, especially for those patients who wished to bear children.

Alcohol consumption and risk of uterine myoma: A systematic review and meta analysis.

BACKGROUND: The published data about alcohol consumption and uterine myoma are scanty and controversial: some studies found positive association whereas other studies showed no association. OBJECTIVES: To conduct a systematic review and meta-analysis to determine whether alcohol is a risk factor for myoma. SEARCH STRATEGY: A MEDLINE/EMBASE search was carried out, supplemented by manual searches of bibliographies of the selected studies. SELECTION CRITERIA: Articles published as full-length papers in English. In the review we included all identified studies. Otherwise, the inclusion criteria for studies included in the meta-analysis were: a) case-control or cohort studies, reporting original data; b) studies reporting original data on the association between alcohol consumption and myoma; c) diagnosis of myoma was ultrasound or histological confirmed and/or clinically based. DATA COLLECTION AND ANALYSIS: A total of 6 studies were identified for the review and 5 studies were included in the meta-analysis. The primary outcome was the incidence of uterine myoma in ever versus never alcohol drinkers and when data were available, we also analyzed categories of alcohol intake. We assessed the outcomes in the overall population and then we performed a subgroup analysis according to study design. Pooled estimates of the odds ratios (OR) with 95% confidence interval (CI) were calculated using random effects models. MAIN RESULTS: The summary OR (95%CI) of myoma forever versus never alcohol intake was 1.12 (0.94-1.34) with significant heterogeneity. The summary OR for current versus never drinking was 1.33 (1.01-1.76) with no heterogeneity. CONCLUSIONS: Ever alcohol consumption is not associated with myoma risk. Based on the data of two studies, current alcohol drinkers had a slightly borderline increased risk of diagnosis of myoma. In consideration of the very limited number of studies and the suggestion of a potential increased risk among current drinkers, further studies are required.

Safety of Manual Morcellation After Vaginal or Laparoscopic-assisted Vaginal Hysterectomy.

UNLABELLED: STUDY OBJECTIVE: To determine the safety of manual vaginal morcellation by evaluating the rates of incidental uterine malignancy and manual vaginal morcellation after vaginal or laparoscopic-assisted vaginal hysterectomy. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University of Texas Southwestern Medical Center, Dallas, TX. PATIENTS: Women (n = 1,629) undergoing vaginal or laparoscopic-assisted vaginal hysterectomy. INTERVENTIONS: Vaginal hysterectomy (n = 1,091) or laparoscopic-assisted vaginal hysterectomy (n = 538) with and without scalpel morcellation. MEASUREMENTS AND MAIN RESULTS: The number of uterine malignancies, rate of vaginal morcellation, surgical indications, pathology diagnoses, and uterine weights were evaluated. Chi-square analysis was used to compare categoric data, and analysis of variance was used to compare uterine weights. There were no cases of leiomyosarcomas. There were 2 other sarcomas, 4 smooth muscle tumors of uncertain malignant potential, and 8 endometrial adenocarcinomas. The vaginal morcellation rate was 19.4%, but no malignancy was morcellated. Myomas were more common preoperatively and histologically in morcellated specimens. Mean (± standard deviation) uterine weights for morcellated versus nonmorcellated laparoscopic-assisted vaginal hysterectomy specimens were 285.5 ± 159.3 versus 140.1 ± 83.6 g (p < .001), respectively, and 199.9 ± 92.8 versus 111.9 ± 61.4 (p < .001), respectively, for vaginal hysterectomy. CONCLUSION: Vaginal manual morcellation is safe with a low risk of incidental malignancy. Variables that influence the decision for the vaginal approach may also affect malignancy risk and morcellation decisions. Thus, all patients undergoing vaginal or laparoscopic-assisted vaginal hysterectomy should be counseled regarding incidental malignancy, risk of morcellation, and alternatives for intact specimen removal.

Body weight gain during adulthood and uterine myomas: Pró-Saúde Study.

This study intended to investigate whether body weight gain during adulthood is associated with uterine myomas. 1,560 subjects were evaluated in a Pró-Saúde Study. Weight gain was evaluated in a continuous fashion and also in quintiles. Odds ratios and 95% confidence intervals were estimated through logistic regression models that were adjusted for education levels, color/race, body mass indices at age 20, age of menarche, parity, use of oral contraceptive methods, smoking, health insurance, and the Papanicolaou tests. No relevant differences were observed regarding the presence of uterine myomas among weight gain quintiles in that studied population.

Perfil epidemiológico das pacientes inférteis com endometriose / Epidemiological profile of infertile patients with endometriosis

Objetivo: Descrever o perfil epidemiológico e clínico de pacientes inférteis com endometriose. Métodos: Estudo transversal que avaliou 450 prontuários de mulheres que procuraram tratamentos de reprodução assistida entre outubro de 2006 e maio de 2012. Analisaram-se sintomas como dismenorreia, intensidade da dor, alterações intestinais e doenças associadas. O software estatístico usado foi o Stata 11.0.Resultados: A mediana de idade foi 34 anos. A dismenorreia acometeu 84,2% das pacientes, de intensidade grave em 40,4%. Alterações intestinais presentes em 54,4%. Dentre as doenças ginecológicas associadas, destaca-se mioma em 23,3%. Em relação às doenças em tratamento, destaca-se a metabólica (8,4%). Discussão: Sabe-se que a dismenorreia é o sintoma mais prevalente nas mulheres com endometriose, assim como alterações intestinais, presente em 6% a 30% das mulheres com a endometriose profunda. Justifica-se a relação com outras doenc¸as também estrogênio-dependentes, como miomas e pólipos, devido ao endométrio dessas mulheres ter aromatases p450 e cyp19, que gerariam ambiente hiperestrogênico. No grupo estudado de mulheres brasileiras, o perfil de idade compreende a quarta década de vida, com infertilidade predominantemente primária, significativa prevalência de dismenorreia grave e associação com pólipos e mioma.

Aims: To describe epidemiological and clinical aspects of infertile patients with endometriosis. Methods: Cross section study of 450 medical records of infertile patients with endometriosis from October, 2006 to May, 2012. Symptoms such as dysmenorrhea, pain intensity, intestinal disorders where analyzed, as well as, associated diseases and treatments. The statistical software used was Stata 11.0. Results: The median age was 34 years. 84.2% of patients presented dysmenorrhea and 40.4% had severe pain intensity. Intestinal disorders was found in 54.4%. From the associated gynecologic diseases, 23.3% had myoma. Metabolic disease was found in 8.4% among the diseases in treatment. Discussion: It is known that dysmenorrhea is the most prevalent symptom in women with endometriosis, as well as intestinal disorders, that can be found between 6% and 30% women with severe endometriosis. Other studies have demonstrated the relationship of estrogen-dependent disease and women with endometrial endometriosis with aromatase enzyme P450 CYP19 mutations; which generate a hyperestrogenic environment, contributing to the development of polyps and myomas. The profile of these patients was traced as being inthe fourth decade of life, with predominantly primary infertility with prevalent symptoms of severe dysmenorrhea and association with polyps and myomas.

Effect of myomectomy on endometrial glutathione peroxidase 3 (GPx3) and glycodelin mRNA expression at the time of the implantation window.

BACKGROUND: In fertile women, glycodelin and glutathione peroxidase 3 (GPx3) genes expression rises during the luteal phase, with a peak occurring during the implantation window. The expression of these genes decreases in women with myomas. To determine whether myomectomy would reverse glycodelin and GPx3 expression, we evaluated the transcript levels of these genes in the endometrium of patients before and after myomectomy. METHODS: Expression of glycodelin and GPx3 genes were examined prospectively during the midluteal phase in the endometrium obtained from infertile women with myoma (n = 12) before and three months after myomectomy. Endometrial expression of these genes was evaluated using quantitative real-time RT-PCR. RESULTS: Endometrial glycodelin mRNA expression levels (normalized to 18S rRNA expression) were increased significantly in endometrium of patients after myomectomy (P = 0.02). GPx3 mRNA expression was increased insignificantly after myomectomy (P = 0.43). CONCLUSION: The results showed that myomectomy increased endometrial glycodelin (significantly) and GPx3 (not significantly) gene expression after 3 months. Study at different times and detecting expression of these genes can reveal more details.

Is uterine artery embolization for patients with large myomas safe and effective? A retrospective comparative study in 323 patients.

PURPOSE: To evaluate the effectiveness, safety, and complications of uterine artery embolization (UAE) in women with large fibroid tumors. MATERIALS AND METHODS: From January 2005 to February 2011, 323 patients underwent UAE for symptomatic uterine leiomyomas without adenomyosis and were included in this study. Patients were divided into two groups: those with a large tumor burden (group 1; n = 63), defined as a dominant tumor with a longest axis of at least 10 cm or a uterine volume of at least 700 cm(3); and the control group (group 2; n = 260). Tumor infarction and volume reduction were calculated based on magnetic resonance imaging findings. Symptom status was assessed with a visual analog scale. Postprocedure complications and repeat interventions were recorded. The data were analyzed with appropriate statistical tests. RESULTS: No significant differences were seen between the two groups in volume reduction of dominant tumors (46.5% in group 1 vs 52.0% in group 2; P = .082) or percentage volume reduction of the uterus (40.7% in group 1 vs 36.3% in group 2; P = .114). Also, no significant differences were seen between the two groups regarding satisfaction scores at immediate or midterm follow-up (P = .524 and P = .497) or in the presence of procedure-related complications (P = .193). CONCLUSIONS: UAE outcomes in large fibroid tumors were comparable to those in smaller tumors, without an increased risk of significant complications. Tumor size may not be a key factor in predicting successful outcomes of UAE.

[Gynecological emergencies: etiology and degree of gravity]. / Urgences gynécologiques : nature et degré de gravité

OBJECTIVE: To evaluate the type and the emergency degree of the pathologies met in gynecological emergencies. METHODS: prospective study including 205 patients presented to the Emergency department of a maternity level 3 between the 2011 January 4 and February 15. RESULTS: One hundred and ninety-four patients (95%) came from their own initiative. One hundred and eighty-one patients (88%) consulted for abdominal/pelvic or lumbar pain and or metrorragia. The mean age of the patients was of 31 ± 11 years and the average waiting time before being examined was of 84 ± 101 minutes. For 94 patients (46%), the diagnosis was an asymptomatic intra-uterine pregnancy in 41 cases or associated with minor symptoms. 21 patients (8.9%) consulted for menstruation with or without dysmenorrhea, 17 (8,3%) had a miscarriage, 14 (7%) a genital infection, 11 (5%) an ovarian pathology and eight (4%) an ectopic pregnancy or its follow-up. Seven patients had an axillary lymphocele or a breast tumor and four symptomatic myomas. Six patients presented with non-gynecological pathologies. In 23 cases (11%) no organic cause was found. Only 24 patients (12%) were hospitalized and nine (4.5%) operated. CONCLUSION: Most of the patients consulted for minor obstetrical or gynecological pathologies without relation with the function of Emergency department. Ectopic pregnancy remains a rare event. Better information of the users on the significance of the urgency is desirable. Consultation of a referent physician before emergency services should be privileged.

Influência da posição sócio-econômica ao longo da vida nas desigualdades de cor/raça na ocorrência de miomas uterinos: estudo pró- saúde / Influence of socioeconomic position lifelong inequalities in color / race in the occurrence of uterine fibroids: pro-health study

Os miomas uterinos (MU) são considerados os tumores mais comuns dosistema reprodutor feminino. Estudos norte-americanos demonstram que mulheres negras são mais acometidas pelos MU que as de outros grupos étnico-raciais. No entanto, as causas da desigualdade racial na ocorrência dos tumores permanecem desconhecidas e possíveis mecanismos são pouco explorados na literatura. Em outra direção, devido às características dos MU (crescimento lento e longo períodode latência) parte considerável dos estudos epidemiológicos utilizam umdelineamento transversal, o que pode gerar problemas metodológicos, como osrelacionados à utilização da idade coletada transversalmente (posteriormente a ocorrência dos MU) como proxy da idade do surgimento dos tumores. Assim, este trabalho de tese foi dividido em três partes, como se segue. A primeira, com características descritivas, teve por objetivo estimar a ocorrência de MU autorelatadossegundo categorias demográficas e sócio-econômicas na população deestudo (compôs o artigo 1). A segunda, com componente analítico, propôs-se aavaliar o papel da PSE ao longo da vida como mediadora do efeito da cor/raça naocorrência de MU auto-relatados (compôs o artigo 2). A terceira, com caráter metodológico, teve por objetivo comparar medidas de associação, entre variáveis aferidas transversalmente, em análises que incluem a co-variável idade no momento da coleta de dados e análises que consideram a idade ao diagnóstico dos MU (compôs o artigo 3). Para tanto, foram analisados dados transversais da população feminina participante das duas etapas da linha de base do Estudo Pró-Saúde, referentes à história auto-relatada de diagnóstico médico de MU e ainda a características sócio-demográficas, da vida reprodutiva e de acesso a serviços de saúde...

The effect of amniocentesis on preterm delivery rate in women with uterine myoma.

OBJECTIVES: To evaluate the effect of genetic amniocentesis on the preterm delivery rate in women with uterine myoma. METHODS: The volume of each fibroid and the relation to the placenta, myometrium and uterine corpus were recorded. Amniocentesis was performed by an experienced operator, if indicated. RESULTS: During the study 14,579 pregnant women were examined and 234 had complications of uterine myomas (1.61%). Forty-three women delivered prematurely (19.46%). The results revealed that multifocal fibroids in relation to the myometrium, uterine myoma subjacent to the placenta, total myoma volume greater than 150 cm3 are statistically significant independent risk factors for preterm delivery, while amniocentesis was not found to be an independent risk factor for preterm delivery. CONCLUSIONS: Although having uterine myoma is a fairly known cause of preterm delivery, second trimester genetic amniocentesis does not seem to have any additional adverse effect on the preterm delivery rate in women with uterine myomas.

Significant association between EGFR-mutated lung adenocarcinoma and past illness from gastric cancer or uterine myoma: its implication in carcinogenesis.

The present study investigated the potential difference between EGFR-mutated lung adenocarcinoma (ADC) and KRAS-mutated ADC in relation to past illness and family history. Among the 153 tumors examined, 33 (21.6%) were EGFR-mutated, and 22 (14.4%) were KRAS-mutated. The EGFR-mutated cases showed a significantly higher prevalence of past illness involving the gastric cancer in males (EGFR 3/8 (37.5%), KRAS 0/13 (0.0%), no mutation (NONE) 1/57 (1.8%); Fisher's exact test, P=0.0064) or uterine myoma in females (EGFR 8/25 (32.0%), KRAS 0/9 (0.0%), NONE 3/41 (7.3%); Fisher's exact test, P=0.0139). No association between the mutations and family history was found. The EGFR-mutated ADC is therefore likely to develop through a distinct carcinogenetic pathway from the others, but genetic backgrounds seemed unlikely to be determinant predisposing to the EGFR-mutated ADC.

The effect of myoma uteri and myomectomy on sexual function.

INTRODUCTION: This is a report about the effects of myoma uteri and myomectomy on sexual function in women. AIM: The aim of this article was to determine the effects of myoma uteri and myomectomy on sexual function in women. METHOD: The study was designed as a controlled clinical study in an academic clinical research center. The study patients consisted of 80 women with myoma uteri and 75 control women. Baseline characteristics and properties of the myomas were recorded. A validated questionnaire was used to determine pre- and postoperative sexual function in the patients. MAIN OUTCOME MEASURE: Female sexual function index (FSFI) scores of the women were recorded before and after surgery. RESULTS: Women with myoma uteri had lower FSFI pain and satisfaction scores than women without it, even after correction for possible confounders. Fundal and posterior myomas were associated with pain, whereas only posterior myomas were related to the overall FSFI scores. However, although there was no relation between the volume of the myomas and the FSFI scores, women with a uterine volume over 200 cm(3) had significantly lower mean FSFI satisfaction, pain, and total scores. The mean FSFI pain and total scores of the patients improved significantly after undergoing a myomectomy. CONCLUSIONS: The findings of this study suggest that a potential impairment of sexual function exists in women with myomas. This is mainly because of pain during sexual intercourse, although it does not seem to have an effect on either the arousal or orgasmic phases. Furthermore, the performance of a myomectomy may alleviate pain during intercourse, and thereby improve sexual function in the patients.

The destiny of myomas: should we treat small submucous myomas in women of reproductive age?

OBJECTIVE: To carry out a thorough analysis aimed at demonstrating that a "wait-and-see" approach is no longer acceptable in women of reproductive age with small submucous myomas, even if they are asymptomatic. DESIGN: Review article. SETTING: University hospitals. PATIENT(S): Women of reproductive age with small (<1.5 cm) submucous myomas. INTERVENTION(S): "See-and-treat" hysteroscopy performed in an outpatient setting. MAIN OUTCOME MEASURES(S): a) The real endometrial surface and volume occupied by a submucous myoma; b) the high potential of a small myoma to grow during the reproductive age; c) its negative impact on reproduction through normal or assisted conception; d) the inability to perform a reliable and "safe" diagnosis, with respect to malignancy, without an eye-guided biopsy; and e) the effectiveness of "see-and-treat" hysteroscopy in removing small submucous myomas. RESULT(S): Small myomas, as hormone-dependent benign tumors, have a high potential to grow and either to become symptomatic or to cause complications during natural or assisted conception and pregnancy. Furthermore, not withstanding the risk of malignancy is rare, even the most experienced operator cannot replace the histological analysis to exclude malignancy or premalignant lesions. "See-and-treat" hysteroscopy has been demonstrated to be safe and effective in removing such small submucous myomas. CONCLUSION(S): A "wait-and-see" approach is no longer acceptable in women of reproductive age with small submucous myomas, especially if the lesion could be easily and safely removed in an outpatient setting with minimal patient's discomfort.

Treatment patterns for women with new episodes of uterine myomas in an insured population in the US.

INTRODUCTION: Uterine myomas are the most common benign tumors in reproductive-aged women and a leading reason for gynecologist visits and hysterectomies in the United States. This study examines the treatment patterns of insured women with new episodes of uterine myomas. MATERIALS AND METHODS: We used administrative claims from a proprietary research database to evaluate services (inpatient, outpatient, and prescription claims) incurred from January 1, 2001 to December 31, 2003. We identified women with CPT or ICD-9-CM codes suggestive of myoma and described treatment patterns for all women with a new episode of myoma and those with abnormal bleeding. RESULTS: The primary study group included 35 329 women with new episodes of care and at least three months of data before and after their index date for myoma. Most women (82.9%) had no code for diagnostic testing in the three months before or after the first myoma marker. Of 14 434 women with one year of follow-up, 26.1% had surgery and 24.7% were treated pharmacologically (oral contraceptives, progestins, or gonadotropin-releasing hormone agonists). Over half (55.1%) of women were untreated, including 45% of those with an ICD-9 code that indicated abnormal bleeding. CONCLUSIONS: Women with new myoma episodes rarely had codes for confirmatory diagnostic tests. Many women with myomas go untreated for at least a year. This is true even for those with evidence of abnormal bleeding. Myoma care may be improved through the introduction of new, safe, and effective therapies.

Selecting distending medium for out-patient hysteroscopy. Does it really matter?

BACKGROUND: The aim of this prospective randomized study was to evaluate the role of carbon dioxide (CO2) and normal saline for diagnostic accuracy in out-patient hysteroscopy. METHODS: Women admitted to our Department in order to undergo total abdominal hysterectomy also underwent diagnostic hysteroscopy, 12-24 h prior to surgery. The selection of distending medium was made after randomization. Two groups of patients were formed, group A (CO2; n=39) and group B (normal saline; n=35). More than half of the women in the study population were post-menopausal. Post-hysteroscopy, all women were asked to rank any symptom that they felt during the procedure on a 4-point scale (0=none; 1=mild; 2=severe; 3=inability to perform hysteroscopy). The hysteroscopic diagnosis was compared with the macroscopic findings and the histological examination of the surgical specimen after hysterectomy. RESULTS: The percentage who completed hysteroscopy was 89.74% within group A and 97.14% within group B. Most patients of both groups felt some pain of mild intensity. The diagnostic accuracy of hysteroscopy was similar for both media when major pathology [large polyps (group A 91.7%; group B 92.7%), myomas (group A 81.25%; group B 92.7%) and/or hyperplasia (group A 87.5%; group B 90.2%)] of the endometrial cavity was detected. In contrast, in cases of minor pathology (small polyps, mucosal elevations, crypts, hypervascularization), hysteroscopy with saline presented with significantly higher diagnostic accuracy (85.4%) compared with hysteroscopy with CO2 (64.6%). CONCLUSIONS: In out-patient hysteroscopy, CO2 and normal saline were comparable with regard to patient discomfort and for the detection of major pathology of the endometrial cavity. Normal saline seems to be the most appropriate medium for the detection of minor pathology of the endometrial cavity.

[Impact of man-made load on patients' life quality]. / Vliianie antropogennoi nagruzki na "kachestvo zhizni" bol'nykh.

The present prospective study included 70 females with uterine myoma indicated for surgery. The patients lived in the city districts having different industrial loads. Life quality was studied before and different periods after surgery. The poor environment was ascertained to affect life quality in patients with uterine myoma. Testing the life quality of a patient can significantly alter our views of preparation for surgery and of postoperative rehabilitation.

[Environmental factors and prevalence of uterine myoma]. / Faktory okruzhaiushchei sredy i rasprostranennost' miomy matki.

The hygienic assessment of the environment of development lands of an industrial town was made by the most priority factors. The working conditions at the enterprise that was one of the main sources of air pollution of the town were also examined. A significant relationship was found between the level of anthropogenic load in different districts and the mortality rates of benign uterine tumors. This relationship was confirmed by the establishment of that between the air concentrations of a number of metals and the female body's biosubstrates.

Esquistosomiasis tubárica: un sorprendente hallazgo / Tubal schistosomiasis: a surprising finding

Se describe el hallazgo casual de afección tubárica por esquistosoma en una paciente de 57 años, puesta de manifiesto en el estudio histopatológico de una pieza de histerectomía con salpingoooforectomía bilateral por mioma uterino. En el aspecto macroscópico se reveló como una lesión nodular de la trompa uterina izquierda, identificándose en el estudio microscópico las modificaciones compatibles con parasitosis por esquistosoma. Se discuten las distintas localizaciones, así como las características clínicas, epidemiológicas e histopatológicas de la afección genital por esta parasitosis (AU)

[Endometriosis as an unexpected finding during laparoscopy on sterile women]. / Endometriozata kato nepodozirana nakhodka po vreme na laparoskopiia pri sterilni zheni.

OBJECTIVES: Assessment of the laparoscopy as endoscope method at diagnosing as unsuspected finding at sterile women. MATERIALS AND METHODS: Studying is retrospective and includes 20 years period of time (1976-1996). We have examined the documentation of 912 patients on whom performed laparoscopy. 678 from them have been primary and 234 have been with secondary sterility. RESULTS: We have established the following findings: cases only with endometriosis--164 patients; endometriosis and polycystic disease of the ovaries--11 patients; endometriosis and tubal sterility--42 patients; endometriosis and pelvic inflammatory disease (PID)--56 patients; endometriosis and uterus myomatosus--6 patients. DISCUSSION: Diagnosis of endometriosis by laparoscopy effectively helps in the further treatment of sterile women.

Prevalence of uterine myoma detected by ultrasound examination in the atomic bomb survivors.

Benign tumors of several organs have been demonstrated to occur as late effects of atomic bomb exposure, and a recent addition to the list of affected organs is the uterus. The increased incidence of uterine myoma noted in Radiation Effects Research Foundation (RERF) Adult Health Study Report 7 (Wong et al., Radiat, Res. 135, 418-430, 1993), however, was based on self-reported information, optional gynecological examination and patient-requested ultrasound examination. Thus the possibility of dose-related bias in case detection was a serious concern. Therefore, the relationship between the prevalence of uterine myoma and dose to the uterus was examined after excluding as much bias as possible by asking all women who had undergone biennial examinations from December 1991 through December 1993 to undergo ultrasound examinations. Among 2506 female participants in Hiroshima, the uterus was visualized by ultrasound examination in 1190, and 238 were found to have uterine nodules. Multiple logistic analysis using Dosimetry System 1986 uterine doses revealed a significant dose response for the prevalence of uterine nodules. The odds ratio at 1 Gy was 1.61 (95% confidence interval: 1.12-2.31). It is unlikely that the observed relationship after adjusting for bladder filling, volume of the uterus, age and menopause status was the result of dose-related bias. These results support previous findings at RERF and provide further evidence that radiation exposure is one of the factors associated with uterine myoma.