Navegando por Palavras-chave "leiomyoma"
Agora exibindo 1 - 7 de 7
Resultados por página
Opções de Ordenação
- ItemSomente MetadadadosA comparative analysis of structure and spatial distribution of decorin inhuman leiomyoma and normal myometrium(Elsevier B.V., 2003-01-02) Berto, AGA; Sampaio, L. O.; Franco, CRC; Cesar, R. M.; Michelacci, Y. M.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Leiomyoma is a benign smooth muscle tumor of the uterus that affects many women in active reproductive life. It is composed by bundles of smooth muscle cells surrounded by extracellular matrix. We have recently shown that the glycosylation of extracellular matrix proteoglycans is modified in leiomyoma: increased amounts of galactosaminoglycans with structural modifications are present. the data here presented show that decorin is present in both normal myometrium and leiomyoma but tumoral decorin is glycosylated with longer galactosaminoglycan side chains. Furthermore, these chains contain a higher ratio D-glucuronate/L-iduronate, as compared to normal tissue. To determine if these changes in proteoglycan glycosylation correlates with modifications in the extracellular matrix organization, we compared the general structural architecture of leiomyoma to normal myometrium. By histochemical and immunofluorescence methods, we found a reorganization of muscle fibers and extracellular matrix, with changes in the distribution of glycoproteins, proteoglycans, and collagen. Thin reticular fibers, possibly composed by types I and III collagen, were replaced by thick fibers, possibly richer in type I collagen. Type I collagen colocalized with decorin both in leiomyoma and normal myometrium, in contrast to type IV collagen that did not. the relative amount of decorin was increased and the distribution of decorin and collagen was totally modified in the tumor, as compared to the normal myometrium. These findings reveal that not only decorin structure is modified in leiomyoma but also the tissue architecture changed, especially concerning extracellular matrix. (C) 2002 Elsevier Science B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Galactosaminoglycans from normal myometrium and leiomyoma(Associação Brasileira de Divulgação Científica, 2001-05-01) Berto, A.g.a. [UNIFESP]; Oba-Shinjo, Sueli Mieko [UNIFESP]; Michelacci, Yara Maria [UNIFESP]; Sampaio, L.o. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In many tumors, the amount of chondroitin sulfate in the extracellular matrix has been shown to be elevated when compared to the corresponding normal tissue. Nevertheless, the degree of chondroitin sulfate increase varies widely. In order to investigate a possible correlation between the amount of chondroitin sulfate and tumor size, several individual specimens of human leiomyoma, a benign uterine tumor, were analyzed. The glycosaminoglycans from eight tumors were extracted and compared with those from the respective adjacent normal myometrium. The main glycosaminoglycan found in normal myometrium was dermatan sulfate, with small amounts of chondroitin sulfate and heparan sulfate. In leiomyoma, both dermatan sulfate and chondroitin sulfate were detected and the total amounts of the two galactosaminoglycans was increased in all tumors when compared to normal tissue. In contrast, the heparan sulfate concentration decreased in the tumor. To assess the disaccharide composition of galactosaminoglycans, these compounds were incubated with bacterial chondroitinases AC and ABC. The amounts of L-iduronic acid-containing disaccharides remained constant, whereas the concentration of D-glucuronic acid-containing disaccharides increased from 2 to 10 times in the tumor, indicating that D-glucuronic acid-containing disaccharides are responsible for the elevation in galactosaminoglycan concentration. This increase is positively correlated with tumor size.
- ItemAcesso aberto (Open Access)Metanálise seguida de comparação indireta de tratamentos e modelo de custo-efetividade comparando embolização da artéria uterina e os métodos cirúrgicos para o tratamento de leiomiomas uterinos sintomáticos(Universidade Federal de São Paulo (UNIFESP), 2015-11-30) Fonseca, Marcelo Cunio Machado [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: Symptomatic uterine leiomyomas (SUL) impacts health, quality of life, and the working ability. Surgery is still the main therapeutic intervention. This study assessed the benefits and risks of uterine artery embolization (UAE) and its costeffectiveness in relation to the surgical interventions in the Brazilian healthcare system (SUS). Methods: We conducted a systematic search for randomised controlled trials of UAE versus any surgical therapy for SUL. We performed a meta-analysis comparing procedural, effectiveness, ovarian failure and patient experience outcomes. To compare the surgical procedures an indirect treatment comparison was performed anchored on the results of direct comparisons with a common control intervention, UAE. To evaluate the relative cost-effectiveness of UAE versus surgical procedures, a decision model simulating a SUL cohort receiving initially UAE or hysterectomy or myomectomy or laparoscopic occlusion of the uterine arteries (LOUA) was constructed from a SUS perspective over 5 years. We used effectiveness data from our meta-analysis and SUS data on resource use. The incremental cost expected for each additional quality adjusted life-year (QALY) gained and each avoided intervention was calculated and presented as the incremental cost-effectiveness ratio. Results: We identified 10 relevant RCTs for the meta-analysis. Length of hospital stay, recovery and the need for transfusions is lower in UAE. UAE have higher number of minor complications and reinterventions until two years after the procedure. Ovarian failure and patients? experiences did not differ between UAE and surgical procedures. In the indirect treatment comparison LOUA presents disadvantage compared to hysterectomy and myomectomy concerning the need for re-intervention within two years after the procedure and the need for re-intervention due to the persistence of symptoms; on the other hand it presents shorter hospital stay than them. Compared to hysterectomy, LOUA presents more re-interventions after two years and up to five years and lower resolution of menorrhagia after the first and second years of the initial procedure. Hysterectomy and myomectomy are equivalent in relation to the all studied outcomes. In the cost-effectiveness analysis, UAE compared to hysterectomy and myomectomy, was not a cost effective alternative, however, UAE is a cost-effective alternative compared to LOUA regarding the number of procedure avoided, but not QALYs. 176 Conclusion: Patients? experiences and ovarian failure appear to be similar among UAE and surgical procedures, whilst UAE offers an advantage with regards to a shorter hospital length of stay, a quicker recovery time and less need for transfusions. Conversely, UAE has a higher rate of minor complications and an increased likelihood of requiring surgical intervention within two years of the initial procedure. Concerning the other studied surgeries LOUA seems to present an increased rate of persistence of symptoms leading to an increased likelihood of requiring surgical procedure, mainly within two years after the initial intervention. Hysterectomy and myomectomy are equivalent in relation to the all studied outcomes although hysterectomy is not a uterus sparing procedure. UAE is not a cost-effective option in relation to hysterectomy and myomectomy in SUS.
- ItemSomente MetadadadosParaurethral leiomyoma in a female causing urinary obstruction(Springer, 2006-05-01) Bruschini, H.; Truzzi, J. C.; Simonetti, R.; Mesquita, R.; Delcelo, R.; Szenfeld, J.; Srougi, M.; Universidade Federal de São Paulo (UNIFESP)We report a case of paraurethral leiomyoma in a female patient, in which the first symptoms were dysuria and sensation of incomplete voiding. the physical examination revealed a mass in the anterior vaginal wall. the diagnosis was made through ultrasonography and pelvic MRI and confirmed by transvaginal ultrasound-guided needle biopsy. the surgical excision was accomplished without opening the urinary tract. A review of the relevant published studies and a suggestion for the appropriate management of these cases are included.
- ItemAcesso aberto (Open Access)Tradução e validação do questionário UFS-QoL para lingua portuguesa em mulheres com leiomioma uterino(Universidade Federal de São Paulo (UNIFESP), 2016-08-30) Silva, Rita Oliveira da [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The purpose of this study was to translate into Portuguese, adapt culturally and validate the Uterine Fibroid Symptom - Quality of Life Questionnaire (UFS-QoL) for Brazilian women with uterine leiomyoma. Sixty-nine patients with uterine leiomyoma, confirmed by examination abdominal pelvic ultrasound and / or transvaginal, were selected in the outpatient clinics of the Department of Gynecology. Initially, the UFS-QoL questionnaire was translated into Portuguese (from Brazil) in accordance with international standards, with subsequent cultural adaptation, structural, conceptual and semantics, so that patients understand the issues. All women responded twice the UFS-QoL, the same day, with two different interviewers, with an interval of 15 minutes between interviews. After 15 days, the instrument was applied again by the first interviewer. To validate the questionnaire were tested reliability (internal consistency and test-retest), validity of the construct and discriminant. The reliability of the instrument was assessed by Cronbach's ? Coefficient with the overall result of 0.97, showing high reliability. The intraclass correlation coefficients(ICC) interobserver were 0.928 (control group) and 0.972(case group), and ICC intraobserver were 0.847(control) and 0.974(case) respectively. The survey results showed a high correlation (p=0.942 p?0.001). This study conclued that the UFS-QoL was adapted to the Brazilian Portuguese language and Brazilian culture, showing great reliability and validity.
- ItemSomente MetadadadosUterine Artery Embolization and Surgical Methods for the Treatment of Symptomatic Uterine Leiomyomas: A Systemic Review and Meta-analysis Followed by Indirect Treatment Comparison(Elsevier, 2017) Fonseca, Marcelo C. M. [UNIFESP]; Castro, Rodrigo [UNIFESP]; Machado, Marcio; Conte, Tania; Girao, Manoel J. B. C. [UNIFESP]Purpose: There is significant discussion and uncertainty about the optimal management of symptomatic uterine leiomyomas (SULs). Nonsurgical procedures such as uterine artery embolization (UAE) have been developed. The goal of this study was to conduct a meta-analysis and an indirect treatment comparison to examine the comparative efficacy and safety of the surgical procedures to treat SULs compared with UAE. Methods: MEDLINE, EMBASE, Lilacs, and the Cochrane Central Register of Controlled Trials data-bases were searched from inception to February 2016. Ten randomized controlled trials comparing UAE versus hysterectomy, myomectomy, and laparoscopic occlusion of the uterine arteries in patients with SUL published in a peer-reviewed journal were included. Two reviewers independently selected studies, assessed quality, and extracted data. Discrepancies were resolved through consensus. Findings: Data from 986 patients submitted to UEA (n = 527) or surgery (n = 459) were analyzed. UAE had a lower risk of major complications (risk ratio [RR], 0.45 [95% CI, 0.22-0.95]
- ItemAcesso aberto (Open Access)Uterine Fibroid Symptom - Quality of Life questionnaire translation and validation into Brazilian Portuguese(Federacao Brasileira Soc Ginecologia & Obstetricia-Febrasgo, 2016) Silva, Rita Oliveira da [UNIFESP]; Gomes, Mariano Tamura Vieira [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Bonduki, Claudio Emilio [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]Purpose To translate into Portuguese, culturally adapt and validate the Uterine Fibroid Symptom-Quality of Life (UFS-QoL) questionnaire for Brazilian women with uterine leiomyoma. Methods Initially, the UFS-QoL questionnaire was translated into Brazilian Portuguese in accordance with international standards, with subsequent cultural, structural, conceptual and semantic adaptations, so that patients were able to properly answer the questionnaire. Fifty patients with uterine leiomyoma and 19 patients without the disease, confirmed by abdominal pelvic examination and/ or transvaginal ultrasound, were selected at the outpatient clinics of the Department of Gynecology of the Universidade Federal de Sao Paulo (Unifesp). The UFS-QoL questionnaire was administered to all women twice on the same day, with two different interviewers, with an interval of 15 minutes between interviews. After 15 days, the questionnaire was readministered by the first interviewer. Reliability (internal consistency and test-retest), construct and discriminative validity were tested to ratify the questionnaire. Results The reliability of the instrument was assessed by Cronbach's a coefficient with an overall result of 0.97, indicating high reliability. The survey results showed a high correlation (p = 0.94