Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For better hemostasis in cases of operative pelviscopy in 60 patients Ornithine-8 Pitressin (POR 8) was applied locally as a vasoconstrictive agent in quantities of up to 50 ml at a concentration of 0.05 IU/ml. From the broad spectrum of indications for operative pelviscopy, the following procedures employing local application of a 5% POR 8 solution to produce intraoperative ischemia are described: Myoma enucleation, longitudinal salpingotomy with conception product extraction in the conservative treatment of a tubal pregnancy, ovarian cystectomy and salpingostomy. The tolerance was optimal no side effects were observed.
 ...
PMID:Local infiltration of ornithine 8-vasopressin (POR 8) as a vasoconstrictive agent in surgical pelviscopy (applied to myoma enucleation, salpingotomy in cases of tubal pregnancy and peripheral salpingostomy). 322 89

Using continuous administration of gonadotropin releasing hormone analogues (GnRH-analogue) to induce a hypoestrogenic state and amenorrhea, leading to uterine fibroid volume reduction, has been reported to be successful and acceptable. Only a few adverse effects related to the therapy have been reported. We report a case of acute onset of abdominal pain, increased sedimentation rate and low grade fever during treatment with intranasal administration of Buserelin acetate. An emergent myomectomy was performed to remove an infarcted intramural myoma. We propose that acute ischemia of a large leiomyoma, especially during the postpartum period, is a noticeable complication during medical treatment with buserelin acetate for uterine leiomyoma.
 ...
PMID:Infarcted intramural uterine leiomyomata during buserelin acetate treatment. 833 56

Although most myocardial infarctions are caused by either obstruction or spasm of the coronary arteries, severe anemia can lower oxygen carrying capacity and damage the myocardium. We report a case of leiomyoma-induced menorrhagia of such severity that myocardial infarction ensued. Hysterectomy was indicated to avoid further anemia. While delaying elective surgery until the heart has had time to recover from infarction is the usual practice, the fact that myoma-induced menorrhagia contributed to ischemia in this patient prompted us to perform hysterectomy shortly after infarction.
 ...
PMID:Management of leiomyoma causing myocardial infarction. 873 Jun 31

When the uterine arteries are bilaterally occluded, either by uterine artery embolization or by laparoscopic obstruction, women with myomas experience symptomatic relief. After the uterine arteries are occluded, most blood stops flowing in myometrial arteries and veins, and the uterus becomes ischemic. It is postulated that myomas are killed by the same process that kills trophoblasts: transient uterine ischemia. When the uterine arteries are bilaterally occluded, either by uterine artery embolization (UAE) or by laparoscopic obstruction, women with myomas experience symptomatic relief. After the uterine arteries are occluded, most blood stops flowing in myometrial arteries and veins, and the uterus becomes ischemic. Over time, stagnant blood in these arteries and veins clots. Then, tiny collateral arteries in the broad ligament (including communicating arteries from the ovarian arteries) open, causing clot within myometrium to lyse and the uterus to reperfuse. Myomas, however, do not survive this period of ischemia. This is unique organ response to clot formation and ischemia. What allows the uterus to survive a relatively long period of ischemia while myomas perish? Childbirth appears to be the predicate biology. Following placental separation, the uteroplacental arteries and the draining veins of the placenta are torn apart at their bases in the junctional zone of the myometrium and bleed directly into the uterine cavity. Left unchecked, every woman would bleed to death in less than 10 minutes after placental delivery. Most women do not bleed to death because vessels in the uterus clot after placental delivery. During pregnancy, clotting and lytic factors in blood increase many fold. Following delivery, uterine contractions continue, intermittently, periodically slowing the velocity of flowing blood through myometrium. The combination of slowed blood flow, elevated clotting proteins, and torn placental vessels (known as Virchow's triad) causes blood in myometrial arteries and veins to clot. Fibrinolytic enzymes later lyse clot in arteries and veins not associated with placenta perfusion, and the uterus is reperfused. Remnant placental tissue - primarily uteroplacental arteries and veins - does not survive this period of ischemia. Placental tissue dies and over weeks is sloughed into the uterine cavity. At the same time, residual endometrial tissue grows under the sloughing placental tissue thus re-establishing the endometrial lining. It is postulated that myomas are killed by the same process that kills trophoblasts - transient uterine ischemia.
 ...
PMID:Childbirth and myoma treatment by uterine artery occlusion: do they share a common biology? 1520 Jul 65

The diagnosis and treatment of uterine leiomyoma are topical problems of modern gynecology and radiodiagnosis. Organ-saving treatments for uterine myoma, one of which is uterine artery embolization, are gaining wide acceptance now. The objective of the study was to increase the informative value of ultrasound study to predict the uterine myoma after uterine artery embolization. One hundred uterine myoma patients aged 20 to 52 years were examined. Small pelvic Doppler ultrasonography was carried out in all the patients. The reduction of myomatous nodules was estimated after uterine artery embolization. The decrease in uterine myoma sizes was found to be due to the reduction in their vascularization and the occurrence of ischemia with degeneration in the myoma. Ultrasonography was found to be most accessible and informative in the prognostic and postoperative evaluation of the efficiency of X-ray endovascular treatment for uterine myoma.
 ...
PMID:[Ultrasound characteristics of uterine myoma before and after uterine artery embolization]. 2159 67

Leiomyomas are the most frequently solid tumors found in pregnancy. This kind of tumor has a wide incidence depending on the age, race, and type of population studied. Most of the cases have an asymptomatic course; however, they could develop different kinds of complications during the pregnancy such as severe abdominal pain, often due to degeneration or torsion with ischemia. In these cases, a surgical approach is required because these tumors do not respond to the conventional treatment. Very few of these cases are reported in the literature. We report the case of a 36-year-old woman pregnant 18 weeks, who experienced acute abdominal pain without initial reponse to regular analgesics. She was taken to the operating room, and under laparoscopic exploration, torsion of a subserosal myoma was observed. The fibroid was resected laparoscopically, and she was released from the hospital without complications. Unfortunately, she was readmitted 45 days later with signs of preterm labor because of a motorcycle accident. An emergency cerclage was performed, but the pregnancy was compromised with amnionitis and early fetal demise. We concluded that the laparoscopic approach could be a successful alternative treatment in selected cases.
...
PMID:Laparoscopic Approach for Fibroid Removal at 18 Weeks of Pregnancy. 2668 Mar 96

Studies have demonstrated that during hysteroscopic myomectomy with bipolar diathermy, carbon monoxide is produced and enters the patient's circulation. However, little is known regarding the immediate or long-term sequelae of transient rises in carboxyhemoglobin levels during hysteroscopic surgery. This paper aims to suggest recommendations for acute evaluation, management, patient counseling, and future research. We present a case of a 36-year-old woman (Gravida 0, Para 0) with abnormal uterine bleeding-leiomyoma and resultant anemia, undergoing hysteroscopic resection of a large submucous myoma. During surgery, the patient was found to have a critically elevated level of carboxyhemoglobin and accompanying electrocardiogram derangements. She was managed with prolonged intubation, 100% O2, and trending of her carboxyhemoglobin levels before extubation. This demonstrates the importance of being cognizant of the potentially toxic gaseous byproducts of bipolar resection and of including intravasation of these byproducts in one's consideration of patient safety during extensive resections. Bipolar hysteroscopic resection of large leiomyomas may result in critically high carboxyhemoglobin levels, which can impair end-organ oxygen delivery with resultant ischemia; the risks of myocardial ischemia should be discussed with the anesthesia team before attempting an extensive resection. Electrocardiogram changes indicative of ischemia should prompt discontinuation of the case. Finally, carboxyhemoglobin poisoning should be included in the differential diagnosis of patients who demonstrate longer-than-expected anesthesia recovery times after bipolar resection of large submucous leiomyomas, and they should be managed with repeat evaluation of carboxyhemoglobin levels, supplemental oxygen, and cardiac monitoring.
 ...
PMID:Critically High Carboxyhemoglobin Level following Extensive Hysteroscopic Myomectomy. 3157 14

Minimally invasive techniques for myomectomy are based on the rationale of preserving the myometrial integrity, in order to spare muscular and fibro-neurovascular myometrial fibers and ensure complete and bloodless myoma removal. Post-operative myometrial vascularization is crucial in injured muscle regeneration. The post-surgical myometrial healing is needful for uterine reproductive function. Neurotransmitters and neurofibers were analyzed in the myoma pseudocapsule surrounding fibroid. They activate signaling molecule synthesis and release which, in turn, promote cell activation and induce muscle regeneration and growth. Pseudocapsule damage during myomectomy may lead to a reduction of neuropeptides and neurofibers at the hysterotomic site, to a poor physiological myometrial healing, with more fibrosis due to hypoxia, ischemia and necrosis. These pathophysiological events cause deficit in myometrial neurotransmission, muscular impulse and contractility, with ultimately impaired uterine muscle function during pregnancy, labor and delivery. Hence, during myomectomy, all manipulations should be performed as precisely and bloodlessly as possible, avoiding extensive, high wattage diathermocoagulation or excessive tissue manipulation or muscular trauma. Any iatrogenic pseudocapsule damage may alter neurotransmitter function during successive myometrial healing, impacting negatively on uterine repair and on eventual pregnancies. Hence the reasoned myomectomy on a biological basis, the "intracapsular myomectomy", satisfied these surgical and physiological requirements. It was described precisely and firstly by the hysteroscopy, with the image magnification of the preservation of the myoma pseudocapsule. The "intracapsular hysteroscopic myomectomy" demonstrated the safe and effective removal of submucous myomas with intramural development. It allowed to completely remove the myoma in one or two surgical steps, saving the pseudocapsule and the surrounding healthy myometrium. The respect of the myometrium and the reduced thermal injury, a part the excellent outcomes in terms of surgical complications prevention, post-surgical fibrosis and intrauterine synechiae reduction, highlighted the physiological development of a successive pregnancy, without any myometrial complications during pregnancy, labor and delivery.
 ...
PMID:The importance of pseudocapsule preservation during hysteroscopic myomectomy. 3158 77