Gravidez e parto após embolização arterial para tratamento de leiomioma uterino

Bonduki, Cláudio Emílio; Gonçalves, Patrícia; Yokohama, Cláudio; Costa, O. F.; Baracat, Edmund Chada; Lima, Geraldo Rodrigues de; Girão, Manoel Joâo Batista Castello

doi:10.1590/s0100-72032006001000005

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…Despite the many studies reporting normal and uncomplicated pregnancies in patients who received this treatment [2]- [4], the main discussion around the use of AEM is about its possible effects on the endometrium that could lead to infertility. These controversies weights heavy on the decision making process that doctors and patients have to walk through; candidates for the procedure must be carefully evaluated, couples must be informed of risks, and informed voluntary consent statements must be signed before a decision is made to proceed to treatment.…”

Section: Introductionmentioning

confidence: 99%

Gene Expression Analysis of Extracellular Matrix and Cytokines after Uterine Artery Embolization

Bernardo¹,

Bonetti²,

Silva³

et al. 2014

OJOG

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Arterial embolization of myomas (AEM) is an established option for the conservative treatment of uterine leio-myomas; it treats all present uterine nodules at once, is less invasive than other procedures and effective in controlling symptoms, and does not require long term hospitalizations. Nevertheless, the potential impact on endometrial morphological and functional outcomes after the procedure is still controversial based on reports of endometritis or eventual transient ischemia. This study evaluated endometrial reorganization in uterine leiomyoma patients, before and after AEM, through gene expression analyses of extracellular matrix and cytokines genes in the endometrial tissue. Eight patients with leiomyomas were evaluated before AEM and 6 months after. The examinations included transvaginal pelvic ultrasonography, dosing of the follicle-stimulating hormone, and endometrial biopsy during the second phase of the menstrual cycle. RNA was extracted from endometrial samples, cDNA was synthesized, and applied on PCR array™ plates to evaluate the expression of extracellular matrix (ECM) genes and cytokines and their receptors' genes (CYT). The ECM overexpressed genes were MMP (1, 3, 10, 11, and 14), CTGF1, ICAM1, TBHS1, ITGA2, ITGA3, ITGB3, COL7A1, COL12A, SPP1, and TNC; ADAMTS8 was underexpressed. The CYT overexpressed genes were SPP1, BCL6, CXCL12, IL-8, and CEBPB; CXCL13 and CCL21 were underexpressed. The ECM results showed overexpression of proteases that are responsible for dysfunctions in the ECM, and of genes responsible for adhesion and membrane components. The CYT results showed overexpression of chemokines responsible for endometrial repair, and underex-* Corresponding author. A. Bernardo et al. 936pression of cytokines involved in inflammatory processes in the endometrial tissue. AEM treatment did not negatively affect the endometrial function at 6 months after embolization. This study broadens the knowledge about using a procedure that is relevant to the treatment of leiomyomas and contributes to the establishment of future guidelines for the decision making process for physicians and patients.

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Section: Introductionmentioning

confidence: 99%

Gene Expression Analysis of Extracellular Matrix and Cytokines after Uterine Artery Embolization

Bernardo¹,

Bonetti²,

Silva³

et al. 2014

OJOG

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“…Some hypotheses suggest that leiomyomas determine dysfunctional uterine contractility, which can interfere in the migration of the sperm, in transportation of the ovule, or in nidation ( 10 ) . Leiomyomas may also be related to failures of implantation or miscarriage due to focal vascular endometrial disorders, endometrial inflammation, and secretion of vasoactive substances ( 10 – 12 ) .…”

Section: Introductionmentioning

confidence: 99%

Alterações endometriais após embolização de leiomiomas uterinos avaliadas por ressonância magnética de alto campo (3 Tesla)

Jacobs

Nasser

Zlotnik

et al. 2013

Einstein (São Paulo)

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Objective:To evaluate the endometrial alterations related to embolization of uterine arteries for the treatment of symptomatic uterine leiomyomatosis (pelvic pain and/or uterine bleeding) by means of high-field (3-Tesla) magnetic resonance.Methods:This is a longitudinal and prospective study that included 94 patients with a clinical and imaging diagnosis of symptomatic uterine leiomyomatosis, all of them treated by embolization of the uterine arteries. The patients were submitted to evaluations by high-field magnetic resonance of the pelvis before and 6 months after the procedure. Specific evaluations were made of the endometrium on the T2-weighted sequences, and on the T1-weighted sequences before and after the intravenous dynamic infusion of the paramagnetic contrast. In face of these measures, statistical analyses were performed using Student's t test for comparison of the results obtained before and after the procedure.Results:An average increase of 20.9% was noted in the endometrial signal on T2-weighted images obtained after the uterine artery embolization procedure when compared to the pre-procedure evaluation (p=0.0004). In the images obtained with the intravenous infusion of paramagnetic contrast, an average increase of 18.7% was noted in the post-embolization intensity of the endometrial signal, compared to the pre-embolization measure (p<0.035).Conclusion:After embolization of the uterine arteries, there was a significant increase of the endometrial signal on the T2-weighted images and on the post-contrast images, inferring possible edema and increased endometrial flow. Future studies are needed to assess the clinical impact of these findings.

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Gravidez e parto após embolização arterial para tratamento de leiomioma uterino

Cited by 2 publications

References 16 publications

Gene Expression Analysis of Extracellular Matrix and Cytokines after Uterine Artery Embolization

Gene Expression Analysis of Extracellular Matrix and Cytokines after Uterine Artery Embolization

Alterações endometriais após embolização de leiomiomas uterinos avaliadas por ressonância magnética de alto campo (3 Tesla)

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