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Clinics+Myomas

Clinics+Myomas

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Published by felix campos

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Published by: felix campos on Jan 08, 2009
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05/09/2014

 
Foreword
Myomas
William F. Rayburn, MD
Consulting Editor 
This issue of the
Obstetrics and Gynecology Clinics of North America
, guest edited by Dr. Aydin Arici, is a comprehensive overview about uterine myomas.Myomas, also known as fibroids or leiomyomas, are the most common solidtumors in the pelvis. Myomas are clinically apparent in 25%–50% of women(especially African American women) and in up to 80% of select populationsafter careful examination of the uterus.This issue begins with presentations about the epidemiology, geneticheterogeneity, and cell biology of myomas. These tumors contain varyingamounts of fibrous tissue that comprises proliferating and degenerated smooth-muscle cells. Myomas are usually multiple and grow by pushing borders with a pseudocapsule. Degeneration occurs from ischemia when the blood supply canno longer reach the myoma’s center. Sarcomatous or malignant degeneration israre, regardless of the rapidity of tumor growth.Although very common, myomas are often asymptomatic. Symptoms caninclude pelvic pressure and urinary frequency or ureteral obstruction from a masseffect. Abnormal bleeding results from either submucous myomas having a thinendometrium over the surface that may not respond normally to hormonalinfluences or from ulceration or necrosis with direct bleeding. Interstitial fibroidscan cause an increase in the surface area of the endometrium as the uterusincreases in size, leading to menorrhagia and anemia. Infertility can result fromimpaired implantation or from occlusion of the cornual portion of the uterine
0889-8545/06/$ – see front matter 
D
2006 Elsevier Inc. All rights reserved.doi:10.1016/j.ogc.2006.01.002
obgyn.theclinics.com
Obstet Gynecol Clin N Am33 (2006) xv–xvi
 
tube. Pregnancy complications can include preterm abortion, labor, abruptio, placentae, and dystocia. Fibroids may grow rapidly (especially during pregnancy)and may infarct, leading to severe pain.The diagnosis of fibroids can be established based on physical examinationand diagnostic imaging. Refinement in ultrasonography described here may also be useful to diagnose small submucous fibroids. Laparoscopy may be needed todifferentiate a myoma in the broad ligament from a solid adnexal mass.This issue provides an excellent overview of current options for medical,radiologic, and conservative surgical therapies. Until recently, simple, inex- pensive, and safe medical treatment was not possible for most women withsymptomatic leiomyomas. Hysterectomy still remains the most common treat-ment, because it is curative and eliminates the possibility of recurrence.Conservative surgery is now available as alternatives to hysterectomy.Efficacies of these conservative treatments and the risk of potential problemsare delineated in this issue. Although these options may prove to be as effectiveas a hysterectomy, the number of patients treated at any center is often small,follow-up periods are relatively short, and the overall safety of the procedures hasnot yet been demonstrated. The authors attempt to describe both safety andefficacy criteria when selecting a surgical alternative to hysterectomy. Thesealternatives do not remove the myoma entirely, however, and pre-existingleiomyomas may be too small to be detected or may eventually exhibit significant growth, necessitating another procedure.The outstanding group of international experts in this issue addresses manyquestions of current clinical interest. For example, in women with leiomyomaswho are candidates for surgery, does the use of adjunctive medical treatment or uterine artery embolization result in improved outcomes? For women who areinfertile, does removal of myomas increase the pregnancy rate? When are assistedreproductive technologies to be chosen in the presence of myomas? For womenwho have undergone a myomectomy before pregnancy, does a planned cesareandelivery reduce the added risk of uterine rupture? What is the effect in menopausalwomen of hormone replacement therapy on leiomyoma growth, bleeding, and pain? And is malignant transformation of myomas a myth or reality?William F. Rayburn, MD
 Department of Obstetrics and GynecologyUniversity of New Mexico Health Science Center  MSC 10 55801 University of New Mexico Albuquerque, NM 87131-0001, USA E-mail address:
wrayburn@salud.unm.edu
foreword
xvi
 
Preface
Myomas
Aydin Arici, MD
Guest Editor 
Uterine myomas are the most common benign tumors in women, affecting20%–50% of reproductive age population. Myomas cause significant morbidityand are the single most common indication for hysterectomy in the United States,representing a major personal and public health concern worldwide. Recent research on the cellular and molecular biology of myomas has enabled us tounderstand better the pathogenesis and pathophysiology of this tumor, but moreremains to be done. In the clinical arena, novel methods of conservativetreatments for myomas have been developed to allow many women to keep their reproductive capacity, and more novel treatments are available on the horizon.This issue of the
Obstetrics and Gynecology Clinics of North America
isdevoted to myomas, covering both recent advances in our understanding of their  biology, and an overview of the current options for their medical, radiologic, andsurgical conservative treatments. As we learn more about the molecular andcellular biology of myomas, we will be able to develop more innovative treat-ments. For this issue, an outstanding group of international experts have cometogether to provide a detailed discussion of basic research and clinical aspectsof myomas. I would like to express my gratitude to all authors, who despitetheir other responsibilities have contributed their time, effort, and expertise tothis issue.
0889-8545/06/$ – see front matter 
D
2006 Elsevier Inc. All rights reserved.doi:10.1016/j.ogc.2006.01.001
obgyn.theclinics.com
Obstet Gynecol Clin N Am33 (2006) xvii–xviii

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