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Conservative management of fibroids with longterm combination of GnRH-a and low dose steroids
28
was explored in 35% of the cases with reconstruction and preservation of the endometrial surface. Pregnancy rate after myomectomy was the highest in between the single interstitial and subserous myomas. The lowest pregnancy rate in between the submucous myomas with exploration and reconstruction of the endometrial cavity. Closure of the serous layer after myomectomy and drainage of the pelvic peritoneal cavity for at least 48 hours after the operation have improved our results concerning the postoperative adhesions an the pregnancy outcome. Not a single case of rupture myomectomy scar was encountered during subsequent delivery after myomectomy. The highest pregnancy rate occurred during the first year after myomectomy.
FC3.07.07 DISTRIBUTION OF TWO PROGESTERONE RECEPTOR ISOFORMS IN UTERINE LEIMYOMA Lihui Wei, Z. To, .I. Wang. Dept. GYN, People’s Hospital, Beijing Medical University, Biejing, P.R. China, 100044. Objectives: Human progesterone receptor(hPR) has two isoforms, hPRA and hPR-B, and hPR-B has a longer NH2 terminus and function differently from hPR-A. Thus, the relative expression of hPR-B/hPR-A is likely to be important for the action of progesterone. To investigate the role of two isoforms in generation and progression of leiomyoma, their distribution and ratio of messenger ribonucleic acid and protein in leiomyoma and myometrium were detected. Methods: Leimyoma and adjacent normal myometrium from 30 uteri, which were excised for leiomyoma, were used for location and quantification of hPR-A and hPR-B protein. Immunohistochemistry and western blot were applied respectively. 23 pairs of mRNA out of the 30 cases were quantification by RT-PCR. Results: (1)Both hPR-A and hPR-B are nuclear receptors. (2)Concentrations of hPR-(A+B) and hPR-A in leiomyoma were higher than those in myometrium (P=O.O415, Pa=0.000563). (3)Both isoforms are presented in leiomyoma and myometrium , with a consistent dominance of hPR-B over hPR-A (P=2.97*10-12, P=1.19*10-15). (4)hPR-B to hPR-A ratio is much lower in leiomyoma than that in myometrium (P=O.O388). (5)More protein expression of hPR-A in secrete stage than that in proliferative stage, not only in leiomyoma but also in myometrium (P=O.O368, P=O.O236). (6)mRNA of hPR-B and mRNA of hPR-A are both more in leiomyoma than those in myometrium. Conclusions: Abnormal distribution of hPR isoforms may cause myometrium cell responds to progestin abnormally, that may be one mechanism of leiomyoma generation. hPR-A has a closer relationship with leiomyoma than hPR-B do, and may plays an important role in physiological change of myometrium.
FC3.07.08 CONSERVATIVE MANAGEMENT OF FIBROIDS WITH LONGTERM COMBINATION OF GnRH-a AND LOW DOSE STEROIDS M. Mamououlos, J.M. Tzafettas, D. Delkos, P.Petropolous, B. Karayiannis, G.Tektsides, G. Kalogeros, N. Klearchou, S. Anapliotis, Dept. OBIGYN, University of Thessaloniki, Thessaloniki, Greece. GnRH-a have been used for the measurement of estrogen dependent conditions like fibroids, endometriosos, dysfunctional uterine bleedings, endometrial hyperplasias and more recently for advanced stages of gynecological cancers. This treatment, though has been hampered by the associated unpleasant climacteric symptoms and its time limitation, due to the risk of osteoporosis. Objective: The aim of this study was to evaluate the beneficial effect of long-term use of GnRH-a on the size of a fibroid uterus and to assess the prevention of osteoporosis and the amelioration of the climacteric symptoms with the parallel use of HRT treatment, in view of the fact that complete down regulation of the ovaries is not necessary in such cases. Study Methods: In a prospective, randomized study, 36 patients (aged 34 - 51) with fibroids that required surgical treatment, due to their size or persistent bleeding, underwent treatment with leuproreline (Elityran, TAKEDA) and Trisequence (Nova-Nordisk) from the 3’d month onwards and for an indefinite period. Prior to the treatment all patients were subjected to clinical examination, serum bone metabolism tests and ultrasound assessment, repeated every 3 months. Radiological determination of bone mineral density was repeated every 12 months.
WEDNESDAY,
SEPTEMBER
6
Results: The duration of the treatment so far, has been 16*9 months (7. 26). Significant reduction of the uterine size was noticed within three months and remained for the rest of the treatment. Except for five patients for whom the treatment had to be discontinued due to resistant menorrhagia, this was well tolerated by the rest. The bone metabolism markers, after an initial deterioration around the 3’d month of the therapy, showed a definite improvement afterwards. The same was recorded for the BMD in the lumbar spine. There was no significant change in the HDL levels. Conclusions: The creation of a well balanced combination treatment with GnRH-a and the parallel use of low dose estrogen in the form of HRT treatment might be a successful alternative to the surgical management of fibroids and other estrogen dependent conditions, especially in women of relatively younger age or those patients not suitable for surgical management.
FC3.08 CURRENT
TOPICS
IN GENERAL
GYNECOLOGY
FC3.08.01 TISSUE RESPONSE TO THE STOP’” DEVICE: A NEW APPROACH TO TRANSCERVICAL STERILIZATION C.S. Carinnan, Stanwood Associates, 392 Stablers Church Road, Parkton, MD USA 21120; T.C. Wright, Dept. OB/GYN Pathology, Columbia University, 630 W 16gth St., NY, NY USA 10032; STOP’” Investigator Group, Conceptus, 1021 Howard Ave., San Carlos, CA USA 94070 Objective: To examine the histological response to the new STOP’” transcervical intrafallopian device in a multi-center prehysterectomy study to evaluate the likelihood of the device remaining in the tube and to support its proposed mechanisms of action: loss of normal tubal architecture and occlusion of the tube. Study Methods: The STOP’” device was inserted hysteroscopically in 50 fallopian tubes of 28 women who were scheduled to undergo a hysterectomy. The women wore the devices from 8-99 days. At the time of hysterectomy, the fallopian tubes were removed, embedded in methyl methacrylate and sectioned to observe the resulting local tissue response to the device. Results: All devices that were properly placed remained in the tube. On histological examination, acute and chronic inflammatory cells; loose and dense fibrosis; and smooth muscle cells, migrating in between the coils of the device and the PET fibers, characterize the reaction with properly placed devices. In women who wore the devices for a longer time, the response is more marked with denser fibrosis, migration of smooth muscle cells, and signs of early neovascularization. In all cases the reaction is limited to the area immediately surrounding the device and does not extend past the distal end of the device nor deep into the wall of the tube. Conclusion: The localized tissue response and notable absence of any normal tubal architecture at the site of implantation is believed to contribute to the contraceptive effectiveness the STOP’” device and to the long-term anchoring of the device.
FC3.08.02 PREGNANCY AFTER FAILED TUBAL STERILIZATION IN TEHRAN, IRAN A.Mehdizadeh. A. Akbarian, H. Movahedi, E. Shirazi, R. Alaghehbandan, Dept. OBIGYN, Iran University of Medical Sciences, Nyayesh Street, Sattarkhan Avenue, Tehran, Iran Objectives: Worldwide, tubal sterilization is the most commonly chosen form of contraception by women who have completed their desired childbearing. Also this method is accepted by most of married women in Iran. Although pregnancy after tubal sterilization is uncommon, it can occur. This study was carried out to determine the incidence of pregnancy after tubal sterilization in Tehran, Iran. Study Methods: A register-based retrospective study was conducted in the teaching hospitals affiliated to Iran University of Medical Sciences in Tehran during 1992-98. A total of 2000 tubal sterilization were performed during the period of study. We entered all information regarding the number of sterilization failure and type of procedure. Results: The patients’ age ranged from 22 to 49 years (mean, 33.8). Their parity ranged from 1 to 14 (mean, 4.7). Of 2000 patients 1900 (95%) had tubal sterilization by laparatomy and 100 (5%) by
was explored in 35% of the cases with reconstruction and preservation of the endometrial surface. Pregnancy rate after myomectomy was the highest in between the single interstitial and subserous myomas. The lowest pregnancy rate in between the submucous myomas with exploration and reconstruction of the endometrial cavity. Closure of the serous layer after myomectomy and drainage of the pelvic peritoneal cavity for at least 48 hours after the operation have improved our results concerning the postoperative adhesions an the pregnancy outcome. Not a single case of rupture myomectomy scar was encountered during subsequent delivery after myomectomy. The highest pregnancy rate occurred during the first year after myomectomy.
FC3.07.07 DISTRIBUTION OF TWO PROGESTERONE RECEPTOR ISOFORMS IN UTERINE LEIMYOMA Lihui Wei, Z. To, .I. Wang. Dept. GYN, People’s Hospital, Beijing Medical University, Biejing, P.R. China, 100044. Objectives: Human progesterone receptor(hPR) has two isoforms, hPRA and hPR-B, and hPR-B has a longer NH2 terminus and function differently from hPR-A. Thus, the relative expression of hPR-B/hPR-A is likely to be important for the action of progesterone. To investigate the role of two isoforms in generation and progression of leiomyoma, their distribution and ratio of messenger ribonucleic acid and protein in leiomyoma and myometrium were detected. Methods: Leimyoma and adjacent normal myometrium from 30 uteri, which were excised for leiomyoma, were used for location and quantification of hPR-A and hPR-B protein. Immunohistochemistry and western blot were applied respectively. 23 pairs of mRNA out of the 30 cases were quantification by RT-PCR. Results: (1)Both hPR-A and hPR-B are nuclear receptors. (2)Concentrations of hPR-(A+B) and hPR-A in leiomyoma were higher than those in myometrium (P=O.O415, Pa=0.000563). (3)Both isoforms are presented in leiomyoma and myometrium , with a consistent dominance of hPR-B over hPR-A (P=2.97*10-12, P=1.19*10-15). (4)hPR-B to hPR-A ratio is much lower in leiomyoma than that in myometrium (P=O.O388). (5)More protein expression of hPR-A in secrete stage than that in proliferative stage, not only in leiomyoma but also in myometrium (P=O.O368, P=O.O236). (6)mRNA of hPR-B and mRNA of hPR-A are both more in leiomyoma than those in myometrium. Conclusions: Abnormal distribution of hPR isoforms may cause myometrium cell responds to progestin abnormally, that may be one mechanism of leiomyoma generation. hPR-A has a closer relationship with leiomyoma than hPR-B do, and may plays an important role in physiological change of myometrium.
FC3.07.08 CONSERVATIVE MANAGEMENT OF FIBROIDS WITH LONGTERM COMBINATION OF GnRH-a AND LOW DOSE STEROIDS M. Mamououlos, J.M. Tzafettas, D. Delkos, P.Petropolous, B. Karayiannis, G.Tektsides, G. Kalogeros, N. Klearchou, S. Anapliotis, Dept. OBIGYN, University of Thessaloniki, Thessaloniki, Greece. GnRH-a have been used for the measurement of estrogen dependent conditions like fibroids, endometriosos, dysfunctional uterine bleedings, endometrial hyperplasias and more recently for advanced stages of gynecological cancers. This treatment, though has been hampered by the associated unpleasant climacteric symptoms and its time limitation, due to the risk of osteoporosis. Objective: The aim of this study was to evaluate the beneficial effect of long-term use of GnRH-a on the size of a fibroid uterus and to assess the prevention of osteoporosis and the amelioration of the climacteric symptoms with the parallel use of HRT treatment, in view of the fact that complete down regulation of the ovaries is not necessary in such cases. Study Methods: In a prospective, randomized study, 36 patients (aged 34 - 51) with fibroids that required surgical treatment, due to their size or persistent bleeding, underwent treatment with leuproreline (Elityran, TAKEDA) and Trisequence (Nova-Nordisk) from the 3’d month onwards and for an indefinite period. Prior to the treatment all patients were subjected to clinical examination, serum bone metabolism tests and ultrasound assessment, repeated every 3 months. Radiological determination of bone mineral density was repeated every 12 months.
WEDNESDAY,
SEPTEMBER
6
Results: The duration of the treatment so far, has been 16*9 months (7. 26). Significant reduction of the uterine size was noticed within three months and remained for the rest of the treatment. Except for five patients for whom the treatment had to be discontinued due to resistant menorrhagia, this was well tolerated by the rest. The bone metabolism markers, after an initial deterioration around the 3’d month of the therapy, showed a definite improvement afterwards. The same was recorded for the BMD in the lumbar spine. There was no significant change in the HDL levels. Conclusions: The creation of a well balanced combination treatment with GnRH-a and the parallel use of low dose estrogen in the form of HRT treatment might be a successful alternative to the surgical management of fibroids and other estrogen dependent conditions, especially in women of relatively younger age or those patients not suitable for surgical management.
FC3.08 CURRENT
TOPICS
IN GENERAL
GYNECOLOGY
FC3.08.01 TISSUE RESPONSE TO THE STOP’” DEVICE: A NEW APPROACH TO TRANSCERVICAL STERILIZATION C.S. Carinnan, Stanwood Associates, 392 Stablers Church Road, Parkton, MD USA 21120; T.C. Wright, Dept. OB/GYN Pathology, Columbia University, 630 W 16gth St., NY, NY USA 10032; STOP’” Investigator Group, Conceptus, 1021 Howard Ave., San Carlos, CA USA 94070 Objective: To examine the histological response to the new STOP’” transcervical intrafallopian device in a multi-center prehysterectomy study to evaluate the likelihood of the device remaining in the tube and to support its proposed mechanisms of action: loss of normal tubal architecture and occlusion of the tube. Study Methods: The STOP’” device was inserted hysteroscopically in 50 fallopian tubes of 28 women who were scheduled to undergo a hysterectomy. The women wore the devices from 8-99 days. At the time of hysterectomy, the fallopian tubes were removed, embedded in methyl methacrylate and sectioned to observe the resulting local tissue response to the device. Results: All devices that were properly placed remained in the tube. On histological examination, acute and chronic inflammatory cells; loose and dense fibrosis; and smooth muscle cells, migrating in between the coils of the device and the PET fibers, characterize the reaction with properly placed devices. In women who wore the devices for a longer time, the response is more marked with denser fibrosis, migration of smooth muscle cells, and signs of early neovascularization. In all cases the reaction is limited to the area immediately surrounding the device and does not extend past the distal end of the device nor deep into the wall of the tube. Conclusion: The localized tissue response and notable absence of any normal tubal architecture at the site of implantation is believed to contribute to the contraceptive effectiveness the STOP’” device and to the long-term anchoring of the device.
FC3.08.02 PREGNANCY AFTER FAILED TUBAL STERILIZATION IN TEHRAN, IRAN A.Mehdizadeh. A. Akbarian, H. Movahedi, E. Shirazi, R. Alaghehbandan, Dept. OBIGYN, Iran University of Medical Sciences, Nyayesh Street, Sattarkhan Avenue, Tehran, Iran Objectives: Worldwide, tubal sterilization is the most commonly chosen form of contraception by women who have completed their desired childbearing. Also this method is accepted by most of married women in Iran. Although pregnancy after tubal sterilization is uncommon, it can occur. This study was carried out to determine the incidence of pregnancy after tubal sterilization in Tehran, Iran. Study Methods: A register-based retrospective study was conducted in the teaching hospitals affiliated to Iran University of Medical Sciences in Tehran during 1992-98. A total of 2000 tubal sterilization were performed during the period of study. We entered all information regarding the number of sterilization failure and type of procedure. Results: The patients’ age ranged from 22 to 49 years (mean, 33.8). Their parity ranged from 1 to 14 (mean, 4.7). Of 2000 patients 1900 (95%) had tubal sterilization by laparatomy and 100 (5%) by