桃红四物汤加味治疗气滞血瘀子宫肌瘤80例临床观察

[目的]观察桃红四物汤加味治疗气滞血瘀子宫肌瘤(直径≤5cm)疗效。[方法]使用前瞻性设计方法,对80例住院患者,桃红四物汤加味(桃仁、红花各10g,当归、川芎、郁金各12g,白芍、赤芍、牡丹皮、半枝莲、川牛膝各15g,生地、白花蛇舌草各20g,天葵子、浙贝母、薏苡仁、黄芪各30g,穿山甲、甘草各8g。研粉,醋调成丸,6g/丸),1丸/次,2次/d。连续治疗3个月为1疗程。观测临床症状、肌瘤直径、不良反应。连续治疗4各疗程(1年),判定疗效。[结果]显效40例,有效32例,无效3例,退出实验5例,总有效率96.0%。[结论]桃红四物汤加味能有效消散或控制肌瘤的生长,值得推广。

Ampullary adenomyoma presenting as acute recurrent pancreatitis

Adenomyoma is a term generally applied to nodular lesions showing proliferation of both epithelial and smooth muscle components. Despite its benign nature,ampullary adenomyoma is usually presented as biliary obstruction. Most cases are misdiagnosed as carcinoma or adenoma by preoperative endoscopic or radiologic procedure. Therefore,it is frequently treated with extensive surgery. To our knowledge,this is the first reported case in English literature of adenomyoma located in the peripancreatic orifice resulting in intermittent pancreatic duct obstruction and recurrent pancreatitis diagnosed by the endoscopic piecemeal resection.

Identification of differentially expressed genes in human uterine leiomyomas using differential display

In searching of differentially expressed genes in human uterine leiomyomas, differential display was used with twelve pairs of primers to compare human uterine leiomyomas with matched myometrium. False positives were eliminated by reverse Northern analysis. Positives were confirmed by Northern blot analysis. RESULTS: Four of 69 cDNA fragments (3 up-regulated named L1, L2 and L3 and 1 down-regulated named M1 in leiomyoma) were confirmed by Northern analysis. Sequence comparison and Northern analysis proved that L1 is exactly the human ribosomal protein S19. It was present ubiquitously in 13 tissues tested but in various levels and even in different size. L1 was highly expressed in parotidean cystadenocarcinoma, pancreatic cancer and breast cancer examined. No mutations have been found in human uterine leiomyomas (n=6). CONCLUSIONS: hRPS19 overexpression might be a universal signal in rapid cell growth tissues.

Lower gastrointestinal bleeding secondary to a rectal leiomyoma

The occurrence of leiomyoma of the rectum is uncommon. Most of these lesions are clinically silent and are found incidentally during laparotomy or endoscopic procedures for unrelated conditions. Symptomatic leiomyomas of the rectum are encountered less frequently, with only sporadic reports in the literature. We describe a case of a leiomyoma of the rectum presenting as recurrent lower gastrointestinal hemorrhage and secondary anemia.

Effect of selective uterine artery embolization on symptomatic uterine fibroids

Objective： To evaluate the outcomes of selective uterine artery embolization （SUAE） in treatment of symptomatic uterine fibroids using Color Doppler ultrasonography （CDUS）. Methods： As the procedure SUAE for fibroids, prospective data of the initial 65 consecutive women treated from March 2007 to September 2009 were collected. The follow-up period from 1 week to 30 months, using questionnaires, we investigated the fibroid-related physical and psychological symptoms, and the cumulative rates of symptom control, gynecologic interventions, and complications. The volumes of uterine and uterine fibroids were calculated by CDUS pre- and post-SUAE for 6 months. And we tested the levels of internal hormone including FSH, LH and E2 before and after SUAE for 3, 6 months. Results： SUAE was performed successfully in all patients. There was no peri-operative morbidity in all procedures. Compared with pre-SUAE volumes of uterine [（322± 12） cm^3] and uterine fibroids [（125±46） cm^3], their volumes in post-SUAE were （144±72） cm^3 and （51 a：l 1） cm^3 （P〈0.01）, and reduction rate was 58% and 61%, respectively. At 3, 6 months after SUAE, levels of FSH, LH, and E2 were not decreased than that of in pre-SUAE （P〉0.05）. After SUAE for 24 months, the fibroids related physical and psychological symptoms such as bleeding, pain and quality of life were significantly improved （P〈0.01）. 90.8% （59/65） women had resolution of symptoms and no significant post-procedural symptoms. Parts of patients discharge necrotic fibroids. 86% （34/40） complications were minor, requiring no therapy. 9.2% （6/65） had significant post-procedural symptoms, requiring therapy in hospital or out-patient department. Conclusion： SUAE contributes to a long-term significant improvement of all investigated uterine fibroid-related symptoms and markedly improves women＇s health-related quality of life. SUAE that no impair on changes of internal hormone, under suitable conditions, represents an attractive alternative to hysterectomy for the treatment of symptomatic fibroids and is a minimally invasive, new method of good clinical prognosis. CDUS is an effective to investigate the outcome of SUAE.

Identification of up-regulated genes in human uterine leiomyoma by sup-pression subtractive hybridization

In searching for differentially expressed genes in human uterine leiomyomas (ULs), suppression sub-tractive hybridization was used to construct an UL up-regulated library, which turned out to represent 88genes. After two rounds of screening by reverse Northern analysis, twenty genes were proved to be up-regulated, including seventeen known genes and three genes with unknown function. All these genes werefirstly associated with UL. Three genes with notable difference were selected for Northern confirmationOur results proved the authenticity of the twenty genes. One gene named Phospholipase A2 (PLA2) showedup-regulation in 4/6 of the patients and investigation of tissue distribution indicated that it had obviousexpression in prostate, testis, liver, heart and skeletal muscle.

Effects of Fuke Qianjin Formula on hormones and their receptors and metabonomics study in uterine fibroids model rats

Objective To investigate the effects of different fractions from Fuke Qianjin Formula(妇科千金方,FKQJF)on uterine leiomyoma(UL)to determine the best fraction.Methods FKQJF was extracted and isolated to obtain polysaccharides(FKP),flavonoids(FKF),and grease(FKG).140 female SPF SD rats were divided into 14 groups[model(MOD),normal control(NC),Gouliuqing(GLQ),Mifepristone(MFST),FKQJF,low,medium,and high dose of polysaccharides(l-FKP,m-FKP,and h-FKP),low,medium,and high dose of flavonoids(l-FKF,m-FKF,and h-FKF),low,medium,and high dose of grease(l-FKG,m-FKG,and h-FKG)],and uterine fibroids model rats were treated with drugs for four weeks.Serum levels of estrogen and progesterone were measured using enzyme-linked immunoassay assay(ELISA)kits.The expression of estrogen receptor(ER-α,ER-β)and progesterone receptor(PR)in the uterus was observed using immunohistochemistry(IHC).Serum metabolite profiles and FKG were analyzed using gas chromatography-mass spectrometry(GC-MS).Results FKQJF,h-FKF,m-FKG,and h-FKG significantly downregulated the estrogen level in the uterine fibroid model rats(P<0.01).FKQJF,h-FKF,and h-FKG significantly reduced the level of progesterone in the uterine fibroid model rats(P<0.01).The levels of ER-α,ER-β,and PR in uterine fibroid model rats were significantly decreased by FKQJF and h-FKG(P<0.01).The levels of ER-α,ER-β,and PR in the fibroid model rats were decreased by m-FKG(P<0.05).Additionally,serum metabolism results revealed that h-FKG and FKQJF could regulate related endogenous metabolites and make the pathological indices of uterine fibroids in rats close to the normal group.Forty-six components were identified in the oil,accounting for 91.97%of the total oil components.Conclusion FKQJF and h-FKG showed a significant anti-myoma activity and significantly improved the pathological state of the uterus in rats with hysteromyoma.The mechanism of action may be related to the regulation of estrogen progesterone and its receptor in uterine fibroid model animals.These findings proved the effect of FKQJF on uterine leiomyoma and provided an experimental basis for its clinical research and application.

LAPAROSCOPIC MYOMECTOMY

Objective. To investigate the indications, surgical techniques and complications of laparoscopic myomectomy. Materials and methods. A retrospective study was carried out in 74 patients with fibroids >3cm from March, 1995 until May,2000 at PUMC Hospital. Indications for surgery were symptomatic fibroids（ 20 cases） , mainly pain or urine frequency； progressively increasing fibroid size (7 cases)； coexistent adnexal pathology（ 26 cases） and infertility（ 21 cases） . Results. The number of fibroids of each patient varied from 1 to 4 with single fibroid of 62 cases (83.7％ ).The fibroids were located in anterior wall (30 cases), posterior wall (23 cases) and fundus (21 cases). A total of 93 fibroids were removed from these patients including 16 intramural fibroids and 77 subserous fibroids. The size of dominant fibroids ranged from 3～ 8 cm (mean 4.8 cm). In 19 cases (25.6％ ),the uterine wall was sutured in one layer. Mean duration of operation was 73 minutes and mean blood loss was 82 ml. Longer operating time and more blood loss were observed in patients with fibroids≥ 4cm than those with fibroids < 4cm. The difference was statistically significant (P< 0.05). Mean postoperative hospital stay was 3.2 days and overall complication rate was 1.4％ . The average postoperative follow- up period was 22 months (1～ 62 months). All the patients with symptoms showed remission of their complaints at 2- month follow- up. Recurrence of fibroid occurred in 1 case 1 year after initial operation and second laparoscopic myomectomy was given to her successfully. Five patients became pregnant. The pregnancy was uneventful and proceeded to selective caesarean section at term pregnancy in 4 cases. One miscarriage occured at 8 weeks in the 5th case. No adhesions at myomectomy site were found in these 5 patients. Conclusions. Our study suggests the feasibility of laparoscopic myomectomy in selected patients, which leads to effectiveness, low complication rate and satisfactory remission of symptoms. Further study on recurrence and fertility must be continued.

The effects of vascular endothelial growth factor and microvessel density in the fibromyoma uteri

Objective： To investigate vascular endothelial growth factor （VEGF） expression and microvessel density （MVD） on the fibromyoma uteri treated with mifepristone. Methods： VEGF expression and MVD were counted on 60 cases of the fibromyoma uteri by SP method, including 40 cases of mifepristone treated and 20 cases of untreated patients as controlled group. Results： VEGF positive expression rate and MVD in treated group were 3715% and 9.90 ＋ 5.95, which were lower than those in controlled group （80% and 16.36 ＋ 2.07; P 〈 0.05）. Meanwhile, in treated group, those in marked shrink in tumor size sub-group were lower than in not obvious sub-group （12.0% and 7.89 ＋ 4.36 vs. 80% and 11,29 ＋ 3.10; P 〈 0.05）. Conclusion： VEGF and MVD expression decreases in the fibromyoma uteri after treatment with mifepristone, suggesting that mifepristone could inhibit angiogenesis and blood supply resulting in tumor shrink.

Pneumonic benign metastasizing leiomyoma:a case report and clinical treatment

Benign metastasizing leiomyoma （BML） is a rare entity usually occuring in females with history of uterus leiomyoma. It appears as a histopathologic benign smooth muscle tumors, distant from the uterus. It is hormone dependent and progresses slowly. Operation is the main clinical treatment. The article was reported one case who was a thirty-eight years old female. She was found to have bilateral lung nodules after hysterectomy of uterine leiomyoma seven years ago. An open lung biopsy revealed that the nodules consist of proliferating smooth muscle cells with a histopathologic feature which was similar to her uterus leiomyoma. Positive staining of estrogen and progesterone receptors were detected, which proved the turner originate from utedne. The patient did not accept operation, chemotherapy, radiotherapy or other treatment. We still follow up the development of the case.

Complete remission of leiomyosarcoma with lung and brain metastasis by chemoradiotherapy after surgery

Nowadays, leiomyosarcoma is stil dif icult to early diagnosis, has no standard treatment to fol ow, and the thera-peutic value of surgery, chemotherapy and radiotherapy haven’t been evaluated ef ectively. Here was a case, which was misdiagnosed as uterine myoma, and was found already to occur lung metastasis after surgery. Complete remission （CR） was achieved after four cycles of albupax-containing chemotherapy. But six months later brain metastases was found. Then the patient received semustine, local radiotherapy and surgery, once again, achieved CR.

Dextran uterine artery embolization to treat fibroids

OBJECTIVES: To analyze the technical aspects of uterine artery embolization with dextran microspheres and to evaluate the effectiveness of this technique as the primary treatment of uterine fibroids in a series of 38 patients. METHODS: Thirty-eight volunteers (age range, 24-48 years; mean, 37.2 years) with symptoms caused by uterine fibroids (menorrhagia, mass-related symptoms, and pelvic pain) were randomly included in this study. The fibroids were single in 32 patients and multiple in 6 patients. According to the tumor location, subserous fibroids were found in 4 patients and interstitial or submucosal fibroids in 34. Tumor size was from 2 to 10.9 cm in diameter. We performed embolization with a single Headhunter catheter using the right-femoral artery approach, injection of dextran microspheres (225-450 micro m), and an absorbable gelatin sponge. Follow-up included clinical and sonographic examinations at one-month intervals for 6 months. RESULTS: Embolization was successfully performed in all patients. Post-procedural pain control was good in 35 (92%) patients. In most patients, symptoms were improved at 3 months (36/38, 95%). Clinical failure of the treatment occurred in only 2 patients (2/38, 5%). Progressive reduction in leiomyoma size was revealed during sonographic follow-up, and the reduction rate at the sixth month after embolization was 68%. The tumor had vanished in five submucosal fibroid patients. Histopathological tests showed that the tumor was degenerative as fibrosis and hyalinosis. CONCLUSIONS: Uterine artery embolization with dextran microspheres is a micro-invasive method for the treatment of uterine fibroids. It is clinically effective in most patients and induces a progressive reduction in the size of fibroids. Based on this study, we believe that this new technique is much more suitable for submucosal fibroids with massive menorrhagia.

Effect of Lichong decoction on expression of Bcl-2 and Bcl-2-associated X protein mRNAs in hysteromyoma model rat

OBJECTIVE:To study on effects of Lichong decoction on expression of apoptosis-controlling genes,Bcl-2 and Bcl-2-associated X protein(Bax) mRNAs in hysteromyoma tissue of the hysteromyoma model rat.METHODS:Fifty Wistar female rats were randomly divided into a normal group,a model group,a Lichong decoction group,a Guizifuling capsule group and a Mifepristone group.The hysteromyoma rat model was established by intraperitoneal injection of exogenous estrin and progestogens.Pathological examination of uterine tissue,uterine coefficient and uterine transverse diameter were made under optic microscope and expressions of Bcl-2 and Bax mRNAs in uterine tissue in the groups were detected with real-time fluorescent quantitative polymerase chain reaction(PCR) technique.RESULTS:After treatment,under microscope it was found that in the Lichong decoction group myometrium thinned,muscle fiber slightly overgrowth or long and thin,regular arrangement,inserting phenomenon of inner circular muscle and external longitudinal muscle was occasionally or not seen in the Lichong decoction group.The uterine coefficient and the uterine transverse diameter significantly decreased(P<0.01),and Bcl-2 mRNA expression significantly decreased(P<0.01) and Bax mRNA expression significantly increased in hysteromyoma tissue(P<0.01) in the Lichong decoction group as compared with the model group.CONCLUSION:Therapeutic effects of Lichong decoction on hysteromyoma is related with decrease of Bcl-2 mRNA expression and increase of Bax mRNA expression.

Effect of Lichong Decoction on expression of IGF-I and proliferating cell nuclear antigen mRNA in rat model of uterine leiomyoma

OBJECTIVE:To study the effect of Lichong Decoction(Lichong Decoction for strengthening anti-pathogenic Qi and eliminating blood stasis) on the expression of insulin-like growth factor-I(IGF-I) and proliferating cell nuclear antigen(PCNA) mRNA in a rat model of uterine leiomyoma.METHODS:Fifty female Wistar rats were randomized into a normal control group,model group,Lichong Decoction group,Guizhifuling Capsule(Capsule containing Cassia Twig and Poria) group,and Mifepristone group.The uterine leiomyoma model was established by peritoneal injections of exogenous estrogen and progesterone hormone.The ultrastructural changes in cells of rat uterine tissues were observed with transmission electron microscopy,and the expression of IGF-I and PCNA mRNA was detected by real-time fluorescent quantitative PCR.RESULTS:Following treatment,cells in the Lichong Decoction group appeared to be arranged normally,the cellular morphology were almost in a normal state,hyperplasia and hypertrophy of the chondriosome was reduced,collagen fibers were arranged in a regular manner,without obvious hyperplasia,and the expression of IGF-I and PCNA mRNA was significantly decreased compared with the model group(P<0.01).CONCLUSIONS:The effect of Lichong Decoction on uterine leiomyoma is related to its function in reducing the expression of IGF-I and PCNA mRNA.