A pilot study on the effect of ulipristal acetate on myoma angiogenesis, measured by 2D ultrasound and VEGF serum levels

2020 ◽  
pp. 19-29
Author(s):  
Patricia Diaz Ortega ◽  
Manuel García Manero
Keyword(s):  
Pilot Study ◽  
Power Doppler ◽  
Uterine Fibroids ◽  
Premenopausal Women ◽  
Serum Levels ◽  
Ulipristal Acetate ◽  
Before And After ◽  
Angiogenesis Process ◽  
2D Ultrasound ◽  
Average Size

Introduction: Symptomatic uterine fibroids can cause symptoms that can be disabling. There are many treatments, including ulipristal acetate, whose role in reducing symptoms and decreasing the size of the fibroid is well known. With this preliminary study, we also try to evaluate the correlation between myoma vascularization measured by ultrasound (Power Doppler 2D) and serum VEGF levels, before and after treatment with ulipristal acetate; in patients diagnosed with symptomatic uterine fibroids. Materials and Methods: A preliminary, prospective observational pilot study was designed. Twenty-four premenopausal women, diagnosed with symptomatic uterine fibroids, were included and all of them completed the study. Four cycles of ulipristal acetate were administered according to the dose and indications specified in the data sheet. In order to assess the influence of this treatment on the angiogenesis process of the fibroids, measurements of VEGF serum levels were made and their vascularization was assessed by means of 2D power doppler ultrasound; at the beginning and the end of treatment. In addition, several determinations of the same parameters were made throughout the successive visits. Endpoints were defined as the decrease in VEGF levels from previous levels, the decrease in myoma vascularization on ultrasound, and the reduction in myoma size. Result: 24 patients who met the inclusion criteria were enrolled (n=24). The average size of myomas was reduced from 45,08 ? 24,02mm to 29?16,96mm after treatment. The average VEGF serum level significantly decreased after the first treatment cycle (from 147,17 ? 153,51 pg/ml to 102,04 ? 186,08pg/ml). Vascularization of myomas after treatment with ulipristal acetate was analyzed, and a significantly decrease was achieved in 83,3% of cases. Conclusion: There is a correlation between myoma vascularization and treatment with Ulipristal acetate. SPRMs may provide effective treatment for women with symptomatic fibroids by two ways: supports selective progesterone receptor modulators and reduced angiogenesis. Keywords: Angiogenesis; Ulipristal Acetate; Uterine fibroids; VEGF

scholarly journals Effect of a Selective Progesterone Receptor Modulator on Induction of Apoptosis in Uterine Fibroids In Vivo

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Petr Horak ◽  
Michal Mara ◽  
Pavel Dundr ◽  
Kristyna Kubinova ◽  
David Kuzel ◽  
...  
Keyword(s):  
Uterine Fibroids ◽  
Premenopausal Women ◽  
Hormonal Treatment ◽  
Control Groups ◽  
Ulipristal Acetate ◽  
Receptor Modulator ◽  
Positive Clinical Effect ◽  
The Mean ◽  
And Control

Aim. To determine if hormonal treatment induces apoptosis in uterine fibroids.Methods. Immunohistochemical examination of fibroid tissue, using avidin-biotin complex and cleaved caspase-3 antibody for detecting apoptosis, was performed in premenopausal women who underwent 12-week treatment with oral SPRM (6 patients with 5 mg and 5 patients with 10 mg of ulipristal acetate per day) or gonadoliberin agonist (GnRHa, 17 patients) and subsequent myomectomy or hysterectomy for symptomatic uterine fibroids. Ten patients with no presurgical hormonal treatment were used as controls.Results. Apoptosis was present in a significantly higher proportion of patients treated with ulipristal acetate compared to GnRHa (P=0.01) and to patients with no hormonal treatment (P=0.01). In contrast to an AI of 158.9 in SPRM patients, the mean AI was 27.5 and 2.0 in GnRHa and control groups, respectively. No statistical difference in the AI was observed between the two groups of patients treated with ulipristal acetate (5 mg or 10 mg).Conclusion. Treatment with ulipristal acetate induces apoptosis in uterine fibroid cells. This effect of SPRM may contribute to their positive clinical effect on uterine fibroids.

scholarly journals Fibroid vascularisation assessed with 3D Power Doppler as predictor for fibroid related symptoms and quality of life; a pilot study

2021 ◽  
Vol 13 (4) ◽  
pp. 387-394
Author(s):  
A.L. Keizer ◽  
L.L. Niewenhuis ◽  
W.J.K. Hehenkamp ◽  
J.W.R. Twisk ◽  
H.A.M. Brölmann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Power Doppler ◽  
Uterine Fibroids ◽  
Expectant Management ◽  
Point Increase ◽  
3D Power Doppler ◽  
Fibroid Volume ◽  
Over Time

Background: Uterine fibroids present differently, from well vascularised up to calcified, with some causing heavy menstrual bleeding (HMB). Objectives: To investigate the association between fibroid vascularisation and HMB, other fibroid related symptoms and quality of life (QOL). Materials and Methods: A single centre pilot study was carried out in the Netherlands. Women with a maximum of two fibroids who chose expectant management were included. 3D sonography including power doppler was performed at baseline and at 3, 6 and 12 months follow up. Women were asked to complete the Pictorial Blood Assessment Chart (PBAC) and Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaires at every visit. Main outcome measure: The association between fibroid vascularisation and HMB. Results: 53 women were included in the study. Baseline fibroid vascularisation, measured as vascular index (VI) is associated with PBAC score; a 1% higher VI at baseline leads to an 11 point increase in PBAC score over time (RC 10.99, p=0.05, 95% CI -0.15 – 22.12). After correction for the baseline variables ethnicity and fibroid type the association becomes stronger (P<0.05). Fibroid volume at baseline and HMB are also associated: a 1 cm3 larger fibroid leads to 0.6 points increase in PBAC score over time (RC 0.56, p=0.03, 95% CI 0.05 – 1.07). Conclusions: This study highlights that both fibroid vascularisation and fibroid volume may be associated with an increase in menstrual blood loss, other fibroid related symptoms and QOL over time. What is new? We used 3D power doppler to predict symptomatic fibroids.

scholarly journals Influence of Ulipristal Acetate in 3D-PW-Doppler parameters of patients with uterine myomas: a prospective observational pilot study

2020 ◽  
pp. 11-18
Author(s):  
Patricia Diaz Ortega ◽  
García-Manero Manuel
Keyword(s):  
Power Doppler ◽  
Female Genital Tract ◽  
Uterine Fibroids ◽  
3D Ultrasound ◽  
Benign Tumors ◽  
Ulipristal Acetate ◽  
End Of Treatment ◽  
3D Power Doppler ◽  
Multiple Treatments ◽  
Vascularization Index

Introduction: uterine fibroids are the most common benign tumors of the female genital tract. They associate a varied symptomatology, from the absence of symptoms to more disabling bleeding or pain [1,2]. There are multiple treatments directed against different targets such as ulipristal acetate which has proven effective in reducing the size of the fibroids and their symptoms [7]. Our preliminary study seeks to find the relationship between ulipristal acetate and angiogenesis of uterine fibroids, by measuring ultrasound vascularization of the fibroid throughout the treatment. Material and Methods: A prospective observational study has been designed, in which 24 patients with symptomatic uterine fibroids have been included and given 4 cycles of Ulipristal Acetate. The size and vascularization of the fibroids were measured at the beginning and end of treatment; as well as on several occasions throughout the follow-up. Myoma vascularization was measured by power doppler 3D ultrasound through different parameters that define the vascularization in a more objective way: Vascularization Index (VI), Flow Rate (FR), Flow Vascularization Index (FVI). Result: A significant reduction in the size of the fibroids has been observed, as well as their vascularization in terms of vascularization indices measured by 3D PW ultrasound. These changes were evident at the end of treatment and were maintained over time. Conclusion: There is a correlation between myoma vascularization and treatment with Ulipristal Acetate. SPRMs may provide effective treatment for women with symptomatic fibroids by two ways: supports selective progesterone receptor modulators and reduced angiogenesis. In addition, the use of vascularization markers of 3DPW ultrasound and the colour map allow us to monitor the response to medical treatment of myomas in a non-invasive and easily reproducible way. Keywords: Ulipristal Acetate; Esmya®; Uterine fibroids; Angiogenesis; 3D Power Doppler Ultrasound

Serum Levels of Cytokines in Subjects With Generalized Chronic and Aggressive Periodontitis Before and After Non-Surgical Periodontal Therapy: A Pilot Study

2010 ◽  
Vol 81 (7) ◽  
pp. 1056-1063 ◽  
Author(s):  
Poliana Mendes Duarte ◽  
Marcelo da Rocha ◽  
Eduardo Sampaio ◽  
Maria Josefa Mestnik ◽  
Magda Feres ◽  
...  
Keyword(s):  
Pilot Study ◽  
Serum Levels ◽  
Aggressive Periodontitis ◽  
Periodontal Therapy ◽  
Before And After

Treated and untreated anovulation associated with ovarian and uterine blood flow in Arabian mares (a case study)

2018 ◽  
Vol 14 (3) ◽  
pp. 21-34
Author(s):  
Amal M. Abo El-Maaty ◽  
Yehia El Baghdady ◽  
Khalid A. ElShahat ◽  
Mahmoud A. Helmy ◽  
Elshymaa A. Abdelnaby
Keyword(s):  
Blood Flow ◽  
Power Doppler ◽  
Serum Levels ◽  
Uterine Horn ◽  
Uterine Blood Flow ◽  
Before And After ◽  
Antral Area ◽  
Uterine Body ◽  
Area And Volume

To investigate the development of treated and untreated hormonal anovulatory follicles (AnOV) associated with uterine and ovarian vascularization, rectal Doppler ultrasound of seven Arabian mares was performed before and after the development of an AnOV. In addition to measuring the diameter, area and volume of the follicle, daily colour and power Doppler scans were analysed in order to measure red, blue and power blood flow areas in pixels. Serum levels of estradiol (E2), progesterone (P4), leptin, insulin-like growth factor-I (IGF-1) and nitric oxide (NO) were measured as well. The diameter (cm), area (cm2), volume (cm3), area in pixels, antral area in pixels, circumference, and percentage change in circulation of the AnOV progressively increased (P<0.0001) after the disappearance of uterine oedema compared to the values obtained during oedema. The blue, total colour and power areas of the AnOV increased after the disappearance of uterine oedema (P<0.0001). When the antral area was excluded, the percentage of the granulosa layer in the colour and power Doppler decreased after the disappearance of uterine oedema. The ipsilateral uterine horn and uterine body had significantly (P<0.0001) high blue and red blood flow vascularization areas in the presence of uterine oedema. The AnOV was associated with low P4, IGF-1 (P<0.001), and leptin (P<0.05). Treatment of the AnOV follicle with GnRH resulted in its luteinization and induced ovulation 9 and 30 days later. It can be concluded that an abrupt increase in blood flow due to decreased progesterone and E2 and increased IGF-1 causes anovulation. The absence of oestrous behaviour and high uterine-oedema-associated follicular and ipsilateral uterine horn vascularization are predictors of ovulation failure.

POSTOPERATIVE COMPLIANCE OF BARIATRIC SURGERY PATIENTS REGARDING THE ASSESSMENT OF SERUM LEPTIN LEVELS AND INSULIN RESISTANCE

2019 ◽  
Vol 49 (1/2019) ◽  
Keyword(s):  
Insulin Resistance ◽  
Bariatric Surgery ◽  
Serum Levels ◽  
Medical Laboratory ◽  
Leptin Resistance ◽  
Obese Patients ◽  
Laboratory Assessment ◽  
Serum Leptin ◽  
Before And After ◽  
Bariatric Patients

Background and aims: Overweight and obese patients who undergo bariatric surgery require a rigorous clinical and paraclinical assessment both before and after the surgery at 3, 6, and 12 months.The present study aims the assessment of serum leptin levels and insulin resistance status in compliant bariatric patients to scheduled medical laboratory assessment at 6 months after surgery. Material and Method: The study included 109 eligible patients selected for bariatric surgery, 48 of whom attended the scheduled visit at 6 months after the surgery. Laboratory assessing regarded the insulin resistance by determining before meal the serum levels of leptin, glucose and insulin, as well as HOMA 1 and HOMA 2 indexes. Results: Patients who underwent bariatric treatment experienced a significant decrease in insulin resistance status. A higher percentage in the preoperative group was recorded in women, feature which was also recorded in the postoperative group that attended the scheduled visit at 6 months after surgery. Age is also an important factor that significantly influences the behavioral adherence to postoperative visits. Conclusions: Insulin resistance status improved significantly in 6 months after bariatric surgery among the fully compliant patients. The percentage of attendance at scheduled visits is higher among women, and decreases with age. Keywords: obesity surgery, leptin resistance, insulin resistance, HOMA index, compliance

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