Endometrial changes associated with myomata of the uterus.
TL;DR: The endometrium of 30 uteruses with myomata was studied and glands at the margin of a myoma hyperplastic glands were frequently found, and distorted, elongated, or dilated glands were present at this site in half of all specimens.
Abstract: The endometrium of 30 uteruses with myomata was studied at four standard sites. Glandular atrophy over a myoma or opposite a myoma was the most constant finding. At the margin of a myoma hyperplastic glands were frequently found, and distorted, elongated, or dilated glands were present at this site in half of all specimens. Other changes included adenomyosis and the separation of glands by muscle fibres from the basal layer of the endometrium. The coexistence of many of these findings in endometrial curettings can lead to the histological diagnosis of uterine myomata. Two factors, mechanical and hormonal, may be responsible and their mechanisms are discussed.
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TL;DR: No studies have yet demonstrated that women on oral pills are at increased risk for growth of these tumors, and low-dose contraceptives should not be contraindicated in patients with leiomyomata if they desire to use this form of contraceptive.
1,455 citations
TL;DR: The purpose of this study was to compare, in infertile patients, the efficacy of laparoscopic myomectomy versus abdominal myomeCTomy, in restoring fertility and to evaluate the obstetric outcomes.
Abstract: The purpose of this study was to compare, in infertile patients, the efficacy of laparoscopic myomectomy versus abdominal myomectomy, in restoring fertility and to evaluate the obstetric outcomes. Between January 1993 and January 1998, 131 patients of reproductive age, with anamnesis of infertility, underwent myomectomy because of the presence of at least one large myoma (diameter greater than or = 5 cm). Patients were randomly selected for treatment by laparotomy (n = 65) or laparoscopy (n = 66). The two groups were homogeneous for number, size and position of large myomata. Significant differences were found in the post-operative outcome: febrile morbidity (> 38 degrees C) was more frequent in the abdominal than in the laparoscopic group (26.2 versus 12.1%; P < 0.05). Laparotomy caused a more pronounced haemoglobin drop (2.17 +/- 1.57 versus 1.33 +/- 1.23; P < 0.001); three patients received a blood transfusion after laparotomy and none after laparoscopy. The post-operative hospital stay was shorter in the laparoscopic group (142.80 +/- 34.60 versus 75.61 +/- 37.09 h; P < 0.001). No significant differences were found between the two groups as concerns pregnancy rate (55.9% after laparotomy, 53.6% after laparoscopy), abortion rate (12.1 versus 20%), preterm delivery (7.4 versus 5%) and the use of Caesarean section (77.8 versus 65%). No case of uterine rupture during pregnancy or labour was observed.
391 citations
TL;DR: In order to evaluate the relationship between leiomyomas and infertility, which remains a subject of debate, Medline research was conducted of publications appearing between January 1988 and August 2001 and their impact on fertility and pregnancy outcome in infertile women.
Abstract: In order to evaluate the relationship between leiomyomas and infertility, which remains a subject of debate, we have tried to evaluate the impact of myomas on fertility and pregnancy outcome in different conditions where myomas are implicated. Medline research was conducted of publications appearing between January 1988 and August 2001 on the subjects of myomas and myomectomy and their impact on fertility and pregnancy outcome in infertile women. A total of 106 manuscripts were consulted. The incidence of myomas in infertile women without any obvious cause of infertility is estimated to be 1-2.4%. The relationship between leiomyomas and infertility remains a subject of debate. The question is: do myomas influence fertility? We are obliged to conclude that the question remains. The absence of an answer to this crucial question is probably due to the fact that we have not yet conducted the appropriate prospective studies required to obtain any clear results.
340 citations
TL;DR: The current data suggest that only those fibroids with a submucosal or an intracavitary component are associated with decreased reproductive outcomes, and that hysteroscopic myomectomy may be of benefit.
Abstract: A systematic literature review was performed to determine whether leiomyomata are associated with decreased fertility rates, and whether surgical removal increases fertility rates postoperatively. Meta-analysis was conducted when multiple studies addressed a single issue and were sufficiently homoge
312 citations
TL;DR: Abdominal myomectomy is an appropriate alternative to hysterectomy for most women who wish to preserve childbearing potential or enhance it and by endoscopic techniques may hold similar potential.
290 citations
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TL;DR: Uterine fibroids are the commonest of pelvic neoplasms and therefore should command the interest of all gynecologists and the source of these tumors is a question that is asked daily and one which can be answered only in generalities.
Abstract: Uterine fibroids are the commonest of pelvic neoplasms and therefore should command the interest of all gynecologists. What is the source of these tumors is a question that is asked daily and one which can be answered only in generalities. In three former contributions (1, 2, 3) excessive stimulation of the myometrium by the ovarian follicular hormone has been suggested as a cause. That the action of this hormone is not specific for the endometrium, as demonstrated by the endometrial changes during the normal menstrual cycle, but that it affects the genital tract as a whole, is easily proved (4). When the action on the endometrium is abnormal, with resulting endometrial hyperplasia, there is an equally abnormal action upon the myometrium, which, if it is prolonged sufficiently, results in cellular metaplasia of the uterine muscle cell or cells, with the subsequent development of uterine fibroids. According to Meyer (5), the histogenetic study of fibroids does not reveal any distinctive myoma mother cells in the uterine muscle from which a proliferating myoma might develop. He reports that the earliest appearance of a myoma is represented by a thickening of the uterine muscle bundles which are directly connected with the normal musculature of the uterus. De Snoo (6), on the other hand, claims that the uterus is a very primitive special organ which contains many undifferentiated cells, genitoblasts. During embryonic life these cells form the uterus proper, while in later life they provide the means of gestational hyperplasia and of regeneration of the endometrium during the puerperium. Under pathological conditions, due to ovarian hormonal dysfunction, these genitoblasts can give rise to the formation of uterine fibroids, endometriomas, or adenomyomas.
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TL;DR: Meine Darstellung wird unter dem Gesichtspunkt der Pathogenese des Uterus myomatosus stehen, das fast alle wichtigen Forschungsrichtungen hier konvergieren, so das man immerhin einen gewissen Uberblick uber den Gegenstand erhalt.
Abstract: Meine Darstellung wird unter dem Gesichtspunkt der Pathogenese des Uterus myomatosus stehen. Dabei wird sich zeigen, das fast alle wichtigen Forschungsrichtungen hier konvergieren, so das man immerhin einen gewissen Uberblick uber den Gegenstand erhalt. — Vollstandigkeit ist nicht moglich. Das Schrifttum ist unubersehbar.
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Journal Article•
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