Predicting the Fibroid-Migratory Impact of UAE: Role of Pre-embolization MRI Characteristics

Abstract Aim To investigate potential factors on MR imaging that could be used to predict migration of uterine fibroids post-UAE. Methods and Materials We retrospectively reviewed patients referred for UAE having pre-procedural and 6 months post-procedural MRI, at a tertiary centre, over a 1-year period. Pre- and post-UAE images were reviewed in 64 women by two radiologists to identify the sub-type, dimensions, and infarction rate of each dominant fibroid. The shortest distance between the fibroid and the endometrial wall was measured to determine intramural fibroid movement. Paired sample T tests and two-sample T tests were used to compare between pre- and post-embolization variations and between migrated and non-migrated intramural fibroids, respectively. After preliminary results suggested potential predictors of intramural fibroids migration, we tested our findings against the non-dominant intramural fibroids in the same patients. Results Review of images revealed 35 dominant intramural fibroids, of which eight migrated to become submucosal fibroids, while five were either partially or completely expelled. These 13 migrated fibroids had a shorter pre-procedural minimum endometrial distance (range 1–2.4 mm) and greater maximum fibroid diameter (range 5.1–18.1 cm), when compared to non-migrating fibroids. On image reassessment, the migrated non-dominant intramural fibroids had a minimum endometrial distance and maximum fibroid diameter within the same range. Conclusion Intramural fibroids with a minimum endometrial distance less than 2.4 mm and a maximum fibroid diameter greater than 5.1 cm have a high likelihood of migrating towards the endometrial cavity after UAE.

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Fibroids and Infertility

10.5772/intechopen.98402 ◽

2021 ◽

Author(s):

Juan Luis Giraldo Moreno ◽

Susana Salazar López

Keyword(s):

Negative Impact ◽

Embryo Implantation ◽

Uterine Fibroids ◽

Abnormal Uterine Bleeding ◽

Open Approach ◽

Pelvic Tumors ◽

Increased Risk ◽

Submucosal Fibroids ◽

Intramural Fibroids

Uterine fibroids (also known as leiomyomas or myomas) are the most common pelvic tumors, affecting more than 70% of women over 70 years of age and although most are asymptomatic, some women may experience symptoms, depending on their location and size, which can alter your quality of life, such as abnormal uterine bleeding, anemia, pelvic pain and pressure, dyspareunia, increased urinary frequency and constipation. Its relationship with infertility has been controversial and, although insignificant for subserous fibroids, it appears that submucosal and intramural fibroids that distort the endometrial cavity can affect embryo implantation and are associated with an increased risk of early pregnancy loss. Its treatment will depend on the patient’s symptoms, size, location, whether it is one or multiple, and whether or not she suffers from infertility. It is clear that submucosal fibroids have a negative impact on fertility and with respect to intramural fibroids it is known that fibroids larger than 4 cm alter the probability of pregnancy, however there are studies that show that even smaller or multiple fibroids could affect pregnancy rates. There are multiple options for the treatment of fibroids; however, patients who are candidates for expectant, medical or surgical management should be individualized, and especially if they are going to be taken to surgery, an excellent mapping of fibroids prior to surgical intervention is recommended. Minimally invasive surgery continues to be the approach of choice, it should be left for the open approach in cases in which Laparoscopy is contraindicated or the patient with multiple myomatosis.

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Uterine Fibroids and Infertility

Diagnostics ◽

10.3390/diagnostics11081455 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1455

Author(s):

Damaris Freytag ◽

Veronika Günther ◽

Nicolai Maass ◽

Ibrahim Alkatout

Keyword(s):

Pregnancy Loss ◽

Recurrent Pregnancy Loss ◽

Uterine Fibroids ◽

Clinical Pregnancy ◽

Bleeding Disorders ◽

Indication For Surgery ◽

Unprotected Sexual Intercourse ◽

Live Birth Rates ◽

Submucosal Fibroids ◽

Intramural Fibroids

Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Uterine fibroids are the most common tumor in women, and their prevalence is high in patients with infertility. Fibroids may be the sole cause of infertility in 2–3% of women. Depending on their location in the uterus, fibroids have been implicated in recurrent pregnancy loss as well as infertility. Pregnancy and live birth rates appear to be low in women with submucosal fibroids; their resection has been shown to improve pregnancy rates. In contrast, subserosal fibroids do not affect fertility outcomes and their removal does not confer any benefit. Intramural fibroids appear to reduce fertility, but recommendations concerning their treatment remain unclear. Myomectomy should be discussed individually with the patient; other potential symptoms such as dysmenorrhea or bleeding disorders should be included in the indication for surgery.

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The Role of Relaparoscopy in the Management of Early Bariatric Surgery Complications and 30-Day Outcome: a Tertiary Centre Experience

Obesity Surgery ◽

10.1007/s11695-021-05401-1 ◽

2021 ◽

Author(s):

Mohammed Al-Rashedy ◽

Anirban Ghosh ◽

Tanmoy Mukherjee ◽

Sonal Halai ◽

Ruba A. Mahmood ◽

...

Keyword(s):

Bariatric Surgery ◽

Surgery Complications ◽

Tertiary Centre ◽

Bariatric Surgery Complications

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Role of Laparoscopy in Infertility : Review Article

BIRDEM Medical Journal ◽

10.3329/birdem.v2i2.12324 ◽

2012 ◽

Vol 2 (2) ◽

pp. 99-103 ◽

Cited By ~ 1

Author(s):

S Jahan

Keyword(s):

Fiber Optics ◽

Semen Analysis ◽

Uterine Fibroids ◽

Scar Tissue ◽

Direct Visualization ◽

Male Factor ◽

Operative Laparoscopy ◽

Pelvic Organs ◽

Carbon Dioxide Co2

Infertility is defined as failure to conceive during one year of unprotected frequent intercourse. Leading causes of infertility include tubal disease, ovulatory disorders, uterine or cervical factors, endometriosis and male factor infertility. A laparoscope is a thin fiber optic telescope that is inserted into the abdomen usually through the belly button. The fiber optics allow a light to used to see inside the abdomen. Carbon dioxide (CO2) gas is placed into the abdomen prior to inserting the laparoscope. Generally, laparoscopy should be reserved for couples who have already completed a more basic infertility evaluation including assessing for ovulation, ovarian reserve, ultrasound and hysterosalpingogram for the female and semen analysis for the male. Laparoscopy can help physicians diagnose many gynecological problems including endometriosis, uterine fibroids and other structural abnormalities, ovarian cysts, adhesions (scar tissue), and ectopic pregnancy. Robotic assisted laparoscopic surgery (RAL) is a more recent development and a form of operative laparoscopy. In RAL, the instruments and telescope are very similar to conventional laparoscopy, but they are attached to a robot which in turn is controlled by the surgeon who is seated at a viewing console. Women who have been diagnosed with endometriosis are more likely to experience infertility, and observational studies have shown that the monthly probability of pregnancy in women with endometriosis is about half of the probability in normal women. In spite of this well-documented association, a true cause and effect relationship has not been established. Laparoscopy is used world-wide to investigate infertility. It is an essential part of full assessment and treatment of infertility. It provides direct visualization of the pelvic organs, ovarian and tubal status and can elucidate the site of tubal obstruction. It has got an advantage of direct visualization of the pelvic organs and the peri-tubal status resulting in greater information as compared to hysterosalpingography and ultrasonography. The advance in instrument technology has made this procedure more productive and less hazardous. Laparoscopy is the most dependable tool to investigate pelvic pathology. The role of laparoscopy in diagnosis of infertility both primary as well as secondary is established beyond any doubt.DOI: http://dx.doi.org/10.3329/birdem.v2i2.12324 (Birdem Med J 2012; 2(2): 99-103)

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Factors affecting the amplitude of the τ angle in proteins: a revisitation

Acta Crystallographica Section D Structural Biology ◽

10.1107/s2059798317007793 ◽

2017 ◽

Vol 73 (7) ◽

pp. 618-625 ◽

Cited By ~ 10

Author(s):

Nicole Balasco ◽

Luciana Esposito ◽

Luigi Vitagliano

Keyword(s):

Protein Structures ◽

Factors Affecting ◽

X Ray ◽

Backbone Conformation ◽

Potential Factors ◽

The Stability ◽

Major Factors ◽

The Impact ◽

Open Issues

The protein folded state is the result of the fine balance of a variety of different forces. Even minor structural perturbations may have a significant impact on the stability of these macromolecules. Studies carried out in recent decades have led to the convergent view that proteins are endowed with a flexible spine. One of the open issues related to protein local backbone geometry is the identification of the factors that influence the amplitude of the τ (N—Cα—C) angle. Here, statistical analyses performed on an updated ensemble of X-ray protein structures by dissecting the contribution of the major factors that can potentially influence the local backbone geometry of proteins are reported. The data clearly indicate that the local backbone conformation has a prominent impact on the modulation of the τ angle. Therefore, a proper assessment of the impact of the other potential factors can only be appropriately evaluated when small (φ, ψ) regions are considered. Here, it is shown that when the contribution of the backbone conformation is removed by considering small (φ, ψ) areas, an impact of secondary structure, as defined byDSSP, and/or the residue type on τ is still detectable, although to a limited extent. Indeed, distinct τ-value distributions are detected for Pro/Gly and β-branched (Ile/Val) residues. The key role of the local backbone conformation highlighted here supports the use of variable local backbone geometry in protein refinement protocols.

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Environment and Potential Affecting Investment Decision for Accommodation Business: Case of Less Visited Area in Samut Songkhram and Phatthalung Province

Psychology and Education Journal ◽

10.17762/pae.v58i2.2326 ◽

2021 ◽

Vol 58 (2) ◽

pp. 1706-1717

Author(s):

Krisada Sungkhamanee, Piyadhida Sungkhamanee

Keyword(s):

Financial Literacy ◽

Investment Decision ◽

Investment Decisions ◽

Business Case ◽

Potential Factors ◽

Short Term Investment ◽

The Impact ◽

Moderating Role

Investment decisions have great importance in different sectors of various countries and these decisions are the basis on which the outcomes of the investments are based. However, there might be certain factors that might lead to the incorrect long term and short term investment decisions. In this regard, the current study has been conducted with the core motive to explore the impact casted by the environment and potential factors i.e. salience and overconfidence on the long term investment decisions for accommodation business along with the moderation of a variable i.e. financial literacy. To fulfill this objective, the researcher has collected data from the investors of accommodation businesses in Thailand. The collected data has been subjected to different statistical techniques and tools for analysis purpose and the results have been obtained. The results obtained by the analysis of the collected data indicate that salience and overconfidence have significant impact on the long term investment decision. In addition, the moderating role of financial literacy has also been found as significant in the study. The results suggest that the investors of the accommodation business must consider the aspects of salience and overconfidence before taking any long term investment decision to avoid failure of the investment decision.

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Uterine submucosal leiomyomas: modern diagnosis and miniinvasive surgery

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/6.2.2 ◽

2021 ◽

Vol 6 (2) ◽

pp. 88-93

Author(s):

Oana Denisa Balalau ◽

◽

Mihai-George Loghin ◽

Sabin Vasilache ◽

Octavian Gabriel Olaru ◽

...

Keyword(s):

Recovery Time ◽

Uterine Fibroids ◽

Therapeutic Decision ◽

Common Complication ◽

Hysteroscopic Myomectomy ◽

Abdominal Myomectomy ◽

Pelvic Tumors ◽

Submucosal Fibroids ◽

Miniinvasive Surgery ◽

Vaginal Myomectomy

Uterine leiomyomatosis is one of the most common benign pelvic tumors diagnosed in women aged 25-44 years. Clinically, it is manifested by vaginal bleeding, pelvic pain, infertility, digestive and urinary symptoms. The diagnosis of uterine fibroids requires careful clinical and paraclinical evaluation. Based on these data, the therapeutic decision is conducted in most cases. The treatment of uterine leiomyomatosis involves several procedures, such as: total abdominal hystectomy, total vaginal hystectomy, abdominal myomectomy, vaginal, laparoscopic or hysteroscopic myomectomy. Hysteroscopic myomectomy is currently the preferred procedure for submucosal fibroids. It has multiple advantages: shorter recovery time, reduced pain related to movements, shorter duration procedure and fewer risks. The procedure has few contraindications. The most common complication is recurrence. The treatment of choice for prolapsed pedunculated submucous leiomyoma is vaginal myomectomy. As described, the procedure has multiple advantages and generally has a low recurrence rate.

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Introduction of triage. An experience of a triage nurse in a tertiary centre in Japan

Romanian Neurosurgery ◽

10.33962/roneuro-2019-018 ◽

2019 ◽

pp. 87-89

Author(s):

Shinobu Tsuge ◽

Takahiro Shinagawa ◽

Kumi Hara ◽

Akio Aihara

Keyword(s):

Medical Treatment ◽

Dynamic Process ◽

Fire Department ◽

Saving Rate ◽

Triage Nurse ◽

Emergency Patients ◽

Tertiary Centre ◽

Emergency Medical ◽

Life Saving

Emergency medical treatment in Japan is subject to jurisdiction by the Fire Department. Triage, by definition, is a dynamic process, as the patient's status can change rapidly. Triage is very important for Japan, where emergency patients are on the rise. The role of triage nurse is also important. That will improve the life-saving rate of emergency patients and improve the reversion to society.

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