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Benign cancer of blood vessels. Modificările funcţionale ale celulelor canceroase în raport cu celulele normale

Horhoianu, M. Abstract Since the first description of uterine artery embolisation for the treatment of symptomatic fibroids of the uterus inthis minimally invasive procedure has been increasingly performed in many countries.

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Transcatheter embolisation of the uterine arteries feeding large fibroids is a minimally invasive technique. This paper presents the combined endovascular and surgical therapy in the treatment of uterine fibroma.

The purpose of this therapy is saving the reproductive function of the uterus even in cases with very large fibromas or located in areas with difficult access, in benign cancer of blood vessels hysterectomy would have been needed.

The therapy has a high rate of success, it is accompanied by disappearance of the symptoms and it has a low risk of intra- and post-operatory complications.

The first step is the embolisation of uterine arteries — a safe therapy of uterine fibroma. The procedure eliminates the risk of post-miomectomy relapse through the symultaneous devascularisation of all fibroma nodules, even of the very small ones which are unapparent clinically or imagistically. The post-embolisation surgical intervention is undertaken in conditions of operative comfort, with minimal bleeding; it eliminates the need for blood transfusions and diminishes the duration of intervention.

Three representative cases where this therapy has been successfully applied are presented in this article.

Hemangiom sau varicelor They often develop on the face and neck, and can vary greatly in color, shape, and size. În prezent, există soluţii moderne şi eficiente pentru prevenirea şi tratarea varicelor.

The embolisation of the uterine arteries represents an efficient therapy of the uterine fibroma, with very good results benign cancer of blood vessels in the speciality literature.

In many cases it is asymptomatic and it is discovered incidentally by a pelvic ultrasound imaging. In time, single or multiple fibromas may grow and become symptomatic by abundant, long and painful menstruations, a sensation of pressure in the abdomen, urinary frequency and back pain. These symptoms may respond initially to medical therapy including gonadotropin-releasing hormone agonistsbut often this therapy is not enough and they require surgical treatment. It often causes infertility or miscarriage.

COMBINED ENDOVASCULAR AND SURGICAL THERAPY OF UTERINE FIBROMA

The standard approach of treatment of fibroid uteri includes as well surgical therapy which consists of uterus resection hysterectomy either transabdominal or transvaginal and sometimes resection of the ovaries. Following that intervention, the woman loses her gestational function.

Therefore, for young women who whish to preserve their fertility, hysterectomy is not an acceptable therapeutical solution. More recently, hormone benign cancer of blood vessels and operative endoscopy laparoscopy and hysteroscopy have been introduced as alternatives, together with uterine embolisation previously applied preoperatively in extensive bleeding neoplasms or to control post-partum hemorrhage. Segmentary myomectomy Segmentary myomectomy is a conservative surgical intervention which consists in the resection of tumor, the preservation the uterus and, therefore, the reproductive function.

Modificările funcţionale ale celulelor canceroase în raport cu celulele normale

In some cases, however, the intervention is difficult or impossible because of the dimension, position or number of existing fibromas. Myomectomy is associated with increased blood loss, pain and prolonged operative time. It also has higher morbidity and mortality rates than hysterectomy. Furthermore, a significant number of patients undergoing myomectomy will need further surgical intervention.

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After intervention, a relapse of fibromatosis is likely to occur if there are small fibromas which have not been diagnosed clinically or imagistically before or during surgery and which continue to grow, eventually becoming symptomatic.

Pre-surgery preoperatively arterial embolisation The embolisation of uterine arteries causes the devascularisation of all fibroma structures in the uterus, which ensures optimal conditions for surgery. The procedure consists in supraselective percutaneous catheterization of both uterine arteries followed by their embolisation with Polivinil alcohol particles PVA or Tachocomb fragments.

The normal uterine structures are not affected, while the fibroma suffers an ischemy, papillomas soft tissue and resorbtion process. Ideally, embolisation of large uterine fibroma must be followed by myomectomy.

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In case of pedunculated, subserosal fibromas, it is better that the embolisation be followed by myomectomy. The advantages of pre-surgery embolisation The embolisation performed a few days before surgery has numerous advantages: - Minimal surgery bleeding; - Benign cancer of blood vessels the necessity for blood transfusion; - Surgical comfort; - Diminishes the duration of the surgery; - Allows resection of very large fibroma or of those positioned in areas difficult to reach the posterior side of the uterus, the inferior side close to the cervix.

Through embolization, all the existing fibromas papillomavirus peut on benign cancer of blood vessels guerir devascularised, regardless of their dimensions hpv nose symptoms position.

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The fibroma structures which remain after surgery become necrotic and are resorbed during a period of several months. The advantages of combined therapy Embolisation of uterus arteries followed by segmentary miomectomy is a conservative therapy, allowing the preservation of gestational function in cases where the usual treatment would have been hysterectomy.

It is therefore, an important therapeutical option for young women, especially for those who wish to have children. The experience of our clinic: At the Benign cancer of blood vessels Universitary Emergency Hospital, through the collaboration between the Obstetrics-Gynecology Clinic and the Angiography Laboratory of the Radiology Clinic from July until present, a number of embolisations were performed.

Therefore, it is the only clinic in Romania where the uterine arteries embolisation is performed.

Functional changes of cancerous cells in relation to normal cells

In this paper we describe three representative cases: - Case 1: large fibroma 9cm ; patient age: 20 years - Case 2: 4cm fibroma on the posterior side of the uterus, close to the cervix, with secondary infertility; patient age: 32 years - Case 3: uterine fibromatosis with numerous intramural and subserosal fibromas and a large nodule 10cm situated subserosal, with infertility.

Case 1: single large uterine fibroma Patient M.

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Anamnesis: abundant and painful metroragies, urinary frequency, intraabdominal pressure. The patient underwent: a clinical gynaecological exam, pelvic ultrasound imaging, laboratory analysis, MRI.

Introduction

Therapy: supraselective embolisation of blood vessels supplying blood to the fibroma, followed by segmentary myomectomy. Embolisation of left-side uterine artery with Tachocomb fragments. During the first day after embolisation, myomectomy and drainage surgical intervention was decided and performed.

In this case, a median pubo-subombilical incision was performed. The intraoperative histopathology exam result indicated an benign cancer of blood vessels transformed leiomyofibroma.