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Uterine fibroids are common benign tumours that arise from the uterine myometrium or, less commonly, from the cervix (West, 1998). The prevalence of fibroids is 20 per cent in the Caucasian population and 50 per cent in the Afro-Caribbean and Afro-American population (West, 1998). Fibroids are derived from single myometrial cells, though G - 6 PD type may vary between individual fibroids within the same uterus (West, 1998). It is thought that fibroid growth is dependent on ovarian hormones, as they do not occur prior to menarche and normally reduce in size following menopause. Fibroids appear to develop and be maintained in response to oestrogen, and progesterone may have a major role to play in the control of fibroid growth. Fibroids may be single, but are more commonly multiple and at varying sites and sizes. They are named depending on where they are located within the muscle of the uterus. They include Intramural fibroids within the muscle layer of the uterus. Between 30 and 50...
Uterine leiomyomas, or fibroids, are the most common type of solid tumors in adult women, clinically apparent in at least 25 of those of reproductive age 24-26 . Abnormal menstrual bleeding, pelvic pain, and infertility are the most commonly experienced symptoms in these women. Uterine fibroids are the leading cause of hysterectomies performed in the United States, accounting for over 200,000 of these procedures each year. Other invasive surgical interventions for the treatment of uterine fibroids include myomectomy and uterine artery embolization. Leiomyomas are estrogen-responsive tumors that can be treated Along these lines, SERMs such as tamoxifen 1 and raloxifene 2 have been clinically evaluated for the treatment of leiomyoma. Tamoxifen lacks sufficient efficacy to reduce tumor size in pre-menopausal women due, in part, to the uterine agonist characteristics exhibited by this SERM 28,29 . In addition, treatment with tamoxifen has resulted in ovarian cysts, an undesired...
Menorrhagia is thought to be associated with uterine fibroids, adenomyosis, pelvic infection, endometrial polyps and the presence of a foreign body such as an intrauterine contraceptive device. Lumsden and Norman (1998) state that in women with menstrual blood loss greater than 200 ml, over half will have fibroids, although only 40 per cent of those with adenomyosis actually have menstrual blood loss in excess of 80ml. According to Hurskainen et al., (1999) approximately half of the cases who present with menorrhagia show no underlying pathology. It is thought that vascular changes may play an important role, but the condition remains poorly understood. Hysteroscopic removal of submucous fibroids or polyps.
TOA is generally a consequence of salpingitis or PID of acute or chronic nature. Other conditions associated with pelvic abscess formation include endometritis, pyelonephritis, uterine fibroids, and malignancy in the pelvic area. Most pelvic abscesses are polymicrobial with preponderance of anaerobic bacteria, with Bacteroides spp. predominating, followed by peptostreptococci and rarely, clostridia. P. bivia and P. disiens are major pathogens in these infections (51) these pathogens possess virulence characteristics similar to the B. fragilis group (35).
And stretched laterally and the peritoneum incised. The uterus is incised transversely in its thin lower segment. A 'classical' CS involves a midline incision, and the uterus is incised longitudinally in its upper segment. Classical CS is associated with a greater risk of haemorrhage, infection and ileus but is quicker to perform and easier than lower segment CS. It may be indicated if the lower segment is poorly formed (e.g. in premature delivery), or in placenta praevia, transverse unstable lie or uterine fibroids.
It is estimated that infertility is a major presenting factor or secondary feature in 27 per cent of women with fibroids. The most useful diagnostic tool for fibroids is pelvic ultrasound, with a full blood count and an iron study to assess anaemia. Computerised tomography (CT) scans or magnetic resonance imaging (MRI) can also be used to image fibroids, but are thought to be too expensive and show little added benefit over ultrasonography. Submucous fibroids can be found following hysterectomy. MANAGEMENT FOLLOWING FIBROIDS SUSPECTED ON EXAMINATION Table 16 Treatment of fibroids Table 16 Treatment of fibroids
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