Showing posts with label adenomyosis. Show all posts
Showing posts with label adenomyosis. Show all posts

Monday, April 30, 2018

In case you missed it: Here are the top 5 posts this month


FDA approves a bedside test for assessing the risk of spontaneous preterm birth

QIAGEN won FDA approval for marketing its Novel PartoSure® point of care test for estimating the risk of spontaneous preterm birth in patients who present with symptoms of preterm labor. PartoSure represents a breakthrough in research and development of diagnostic tests for preterm birth.

Predicting preterm birth is a diagnostic challenge and nearly 85% of patients admitted to the hospital for threatened preterm labor (PTL) do not deliver within the next 7 days, resulting in unnecessary interventions.

Medical management of adenomyosis: current and future therapies
The current issue of Journal of Fertility and Sterility has focused exclusively on etiology, pathophysiology, and medical and surgical treatment of adenomyosis. Adenomyosis has long been the source of controversy and its only with the recent advent of Transvaginal sonography (TVS) and MRI that its etiology and pathophysiology been better understood.

Adenomyosis is a uterine pathology in which the endometrial glands and stroma invaginate within the uterine myometrium. This ectopic endometrium induces hypertrophy and hyperplasia of the myometrium resulting in the typical ‘globular” enlargement of the uterus.

Significant rise in hysterectomy complications observed following the FDA’s warning against power morcellator
A significant increase in major and minor complications following hysterectomy was noted in a large retrospective cohort study that was conducted after the US Food and Drug Administration (FDA) warned against the use of laparoscopic power morcellation during a hysterectomy in November 2014.

The study was published today April 11 in JAMA Surgery.

The warning was issued because of fear of dissemination of undiagnosed occult leiomyosarcoma in the benign fibroid mass.   

Addition of 24-chromosome microarray analysis to standard testing identifies a probable or definitive cause in over 90% of recurrent miscarriages
The new method of 24 Chromosome Microarray, or comprehensive chromosomal screening when added to the standard Recurrent Pregnancy Loss (RPL) evaluation of American Society for Reproductive Medicine (ASRM) could provide a probable or definitive cause in over 90% of patients reports the result of a small prospective cohort study published 1 April 2018 in Journal of Human Reproduction.

In the absence of definitive etiologies and treatment strategies, RPL is one of the most frustrating and difficult to treat entity in reproductive medicine. It affects 2%-5% of couples and a cause can be found only in 50% of the couples after undergoing the standard ASRM workup.

A novel, single-use Foley’s catheter fixation device protects from accidental removal and trauma
Indwelling urinary catheters are very commonly used for inpatients in hospitals and people confined to bed in hospice and nursing homes. It is estimated that 25% of hospitalized patients have catheters placed during their hospital stay.

They are also associated with Urinary Tract Infections (UTI) and account for 70-80% of iatrogenic UTI in hospital and inpatient settings. But, genitourinary trauma is also common because of the inflated balloon during accidental pulling of Foley’s catheter.


Tuesday, April 10, 2018

Medical management of adenomyosis: current and future therapies


The current issue of Journal of Fertility and Sterility has focused exclusively on etiology, pathophysiology, and medical and surgical treatment of adenomyosis. Adenomyosis has long been the source of controversy and its only with the recent advent of Transvaginal sonography (TVS) and MRI that its etiology and pathophysiology been better understood.

Adenomyosis is a uterine pathology in which the endometrial glands and stroma invaginate within the uterine myometrium. This ectopic endometrium induces hypertrophy and hyperplasia of the myometrium resulting in the typical ‘globular” enlargement of the uterus.

It is also now known that endometriosis and adenomyosis are two different phenotypes of the disorder characterized by impaired cellular response to ovarian hormone. This concept has to lead to the use of common treatment modalities for both the diseases.



Transvaginal sonography (TVS) and MRI are now the gold standards for diagnosing adenomyosis. Adenomyosis requires a lifelong treatment plan that depends upon patient’s age, desire for children and symptoms. Medical management is the treatment of choice for women who want to preserve fertility, while hysterectomy is preferable in older women who have completed the childbearing.

No new drug has been developed in recent years for the treatment of adenomyosis although many new drugs are under development and undergoing clinical trials.  

Medical management includes minimally invasive procedures as well as medication to treat the symptoms.

Minimally invasive surgical procedures help preserve fertility as well as reduce the pain and abnormal uterine bleeding (AUB) and include endometrial ablation and resection, laparoscopic as well as open excision of adenomyosis and MRI-guided focused ultrasound. They are offered to patients who have not responded to medical drug treatments. 

The medical treatment is mainly aimed at easing the symptoms, improving quality of life and promote fertility. The rationale behind using these drugs is based on the pathophysiology of the disease which includes aberrant response to the ovarian hormone, inflammation, and impaired apoptosis.

http://journals.sagepub.com/doi/full/10.5301/je.5000261


The class of drugs includes:

Current Medical Treatments: 


GnRH agonist: These group of drugs cause a downregulation of GnRH activity and induce a reversible state of medical menopause. Goserelin, leuprolide, and nafarelin are commonly used in clinical practice before fertility treatments to improve the chances of pregnancy in infertile women with adenomyosis.

Progestins: Drugs such as danazol, norethindrone acetate (NETA), Levonorgestrel-releasing intrauterine system (LNG-IUS), and Dienogest are mainly used because of anti-inflammatory properties to relieve pain and reduce the amount of abnormal uterine bleeding.

The Levonorgestrel-releasing intrauterine system (LNG-IUS) has been found extremely effective in reducing menorrhagia and decrease the uterine volume over a period of 12 months use.

Combined oral contraceptives (COC): They are effectively used to reduce pain and control bleeding with the additional advantage of long-term use with minimal side effects.

Future Medical treatments:

Selective estrogen receptor modulators (SERMs)
Aromatase inhibitors (AIs)
Selective progesterone receptor modulators (SPRMs)
Valproic acid
Anti-platelets therapy
NSAIDs

Thus, the medical treatment of adenomyosis comprises many current and future drugs. No double-blind, RCTs have yet been conducted in the management of adenomyosis and the drugs are solely used based on results of observational studies.



Monday, November 6, 2017

Enjoy the latest issue of Hysteroscopy Newsletter: Nov-Dec 2017



The use of hysteroscopy is increasing throughout the world and is currently considered the gold standard for the diagnosis and treatment of pathologies of the uterine cavity and more recently for some pathologies of the cervix and vagina. Technological progress is opening new horizons for hysteroscopy allowing the gynecologist to perform many surgical procedures safely and effectively in an outpatient setting without significant inconvenience to the patient based on the concept of "see and treat".

Enjoy and update yourself on some interesting topics in Hysteroscopy in this latest newsletter:

Adenomyosis
INTERVIEW WITH... Prof. Mark Hans Emanuel.
CASE REPORT Uterine Malformation
HYSTEROSCOPY Devices -Harpoon
Hysteroscopy Conundrums Is the uterine septum "mostly" avascular?
WHAT'S YOUR DIAGNOSIS?
Brief Review Hysteroscopy complication: false passage
Brief Review: Chronic Endometritis (I)

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