, Hill MC, Schectman JM, Hollis BW. Vitamin D and the risk of uterine fibroids. Epidemiology. 2013 May;24(3):447-53. 23. Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev 2014;10:CD004638. 24. Donnez J, Donnez O, Dolmans MM. With the advent of selective progesterone receptor modulators, what is the place of myoma surgery in current practice. Fertil Steril 2014. a;102:640-648. 25. Segars JH, Parrott EC, Nagel JD, Guo XC, Gao X, Birnbaum LS, Pinn VW, Dixon D
, H., Mandelbrot, L., Aubriot, F.X. & Mouly, M. (1991). Myomectomy by laparoscopy: A preliminary report of 43 cases. Fertil Steril. 56, 827-830 5. Abbas, A. & Irvine, L. (1997). Uterine rupture during labour after hysteroscopic myomectomy. Gynaecol Endosc. 6, 245-246 6. Babaknia, A., Rock, J.A. & Jones, H.W.J. (1978). Pregnancy success following abdominal myomectomy for infertility. Fertil Steril. 30, 644-647 7. Eldar-Geva, T., Meagher, S. & Healy, D.L. et al. (1998). Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted
Since 1994, alcohol septal ablation (ASA) has been used as a minimally invasive treatment of patients with hypertrophic obstructive cardiomyopathy, resistant to conservative medical therapy. This catheter-based intervention consists of injecting absolute alcohol in a septal perforator to induce infarction of the hypertrophied septum and thus diminish the left ventricle outflow tract obstruction. This reduction of the gradient is associated with reduction of symptoms and left ventricle remodeling. The procedure was improved after the introduction of myocardial contrast echocardiography for visualization of the area at risk of infarction and reduction of the alcohol amount. Major complications of ASA are rare but centers with experience have reported conduction disorders - about 10% of patients needed permanent pacing because of complete AV block. Large randomized prospective studies have not yet compared alcohol septal ablation to the gold standard for treatment of hypertrophic obstructive cardiomyopathy - surgical myomectomy.
Introduction. Hypertrophic cardiomyopathy (HCM) is a disease with increased left ventricular (LV) wall thickness not solely explained by abnormal loading conditions, with great heterogeneity regarding clinical expression and prognosis. The aim of the present study was to collect data on HCM patients from different centres across the country, in order to assess the general characteristics and therapeutic choices in this population.
Methods. Between December 2014 and April 2017, 210 patients from 11 Romanian Cardiology centres were enrolled in the National Registry of HCM. All patients had to fulfil the diagnosis criteria for HCM according to the European Society of Cardiology guidelines. Clinical, electrocardiographic, imaging and therapeutic characteristics were included in a predesigned online file.
Results. Median age at enrolment was 55 ± 15 years with male predominance (60%). 43.6% of the patients had obstructive HCM, 50% non-obstructive HCM, while 6.4% had an apical pattern. Maximal wall thickness was 20.3 ± 4.8 mm (limits 15-37 mm) while LV ejection fraction was 60 ± 8%. Heart failure symptoms dominated the clinical picture, mainly NYHA functional class II (51.4%). Most frequent arrhythmias were atrial fibrillation (28.1%) and non-sustained ventricular tachycardia (19.9%). Mean sudden cardiac death risk score (SCD-RS) was 3.0 ± 2.3%, with 10.4% of the patients with high risk of SCD. However, only 5.7% received an ICD. Patients were mainly treated with beta-blockers (72.9%), diuretics (28.1%) and oral anticoagulants (28.6%). Invasive treatment of LVOT obstruction was performed in a small number of patients: 22 received myomectomy and 13 septal ablation. Cardiac magnetic resonance was reported in only 14 patients (6.6%).
Conclusions. The Romanian registry of HCM illustrates patient characteristics at a national level as well as the gaps in management which need improvement – accessibility to high-end diagnostic tests and invasive methods of treatment.
, NY: Springer Verlag, Inc; 1994. p. 487-528. 10. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94:435-8. (Level II-3). 11. Reroń A, Huras H. Etiopatogeneza mięśniaków macicy i ich wpływ na płodność i przebieg ciąży. Ginekol Położ. 2008;2(8):49-57. 12. Ross RK, Pike MC, Vessey MP, et al. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives BMJ. 1986;293(6543):359-62. 13. Stewart EA. Uterine fibroids. Lancet. 2001;357:293-8. 14. Buttram VC Jr, Snabes MC. Indications for myomectomy. Semin Reprod
reproduction: a critical analysis of the evidence. Hum Reprod Update 2007;13:465-76. 9. Kolankaya A, Arici A. Myomas and assisted reproductive technologies: when and how to act? Obstet Gynecol Clin North Am 2006;33:145-52. 10. Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for a debate? Hum Reprod 2002;17:1424-30. 11. Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fi broids. Cochrane Database Syst Rev 2001;CD000547. 12. Donnez J, Schrurs B, Gillerot S, et al. Treatment of
.39-3-379 PMid:12014502 14. Verkauf, B.S. (1992). Myomectomy for fertility enhancement and preservation. Fertil Steril. 58(1): 1-15. https://doi.org/10.1016/S0015-0282(16)55128-0 15. Moody, K.D., Weir, E.C., Morgenstern, S.E., Barthold S.W. (1996). Resumption of fertility after myomectomy for uterine leiomyoma in a rhesus macaque. Lab Anim Sci. 46(1): 120-122. 16. Santschi, E.M., Slone, D.E. (1994). Successful pregnancy after partial hysterectomy in two mares. J Am Vet Med Assoc. 205(8): 1180-1182. 17. Joel, R. L., Micheal, P. J. (1990). Oviduct, uterus, and
: plasma ropivacaine concentrations after ultrasound-guided rectus sheath block in patients undergoing lower abdominal surgery. Anesth Analg. 2012; 114(1):230–2. Doi: 10.1213/ANE.0b013e3182367a68. 20. Mukesh Kumar Shah, Sandeep S Kulkarni, Wendy Fun. The analgesic efficacy of ultrasound-guided modified rectus sheath block compared with wound infiltration in reduction of postoperative morphine consumption in women undergoing open hysterectomy or myomectomy: A randomized controlled trial 14/09/2012 trial. Journal of Obstetric Anesthesia and Critical Care 21. Smith BE
T., Mori T.: Interleukin-6 as a new indicator of inflammatory status:detection of serum levels of interleukin-6 and c-reaction protein after surgery. Surgery 1992, 111, 201-209. 29. Sesti F., Melgrati L., Damiani A., Piccione E.: Isobaric (gasless) laparoscopic uterine myomectomy an overview. Eur J Obstet Gynecol Reprod Biol 2006, 129 , 9-14. 30. Stone E.A., Cantrell C.G., Sharp N.J.: Ovary and uterus. In: Textbook of small animal surgery , edited by D.Slatter, Philadelphia, W.B. Saunders, 1993, pp. 1293-1308. 31. Van Goethem B.E.B.J., Rosenveldt K
through all the stressful procedures or events they underwent As we found later, the control group mothers did conceive spontaneously, but some after surgical treatment on the reproductive tract (1 myomectomy, 3 resections of the septum, and 4 surgeries on ovaries). These women might have carried some of the characteristics of IVF mothers. Namely, the inclusion criterion depended on the mode of conception: either IVF or spontaneous, whereas the anamnestic questionnaire was more specific about conception problems. Interestingly, 8.2% of IVF mothers reported sexual