Uterine fibroids: the elephant in the room

Uterine fibroids (leiomyomas) have historically been viewed as important chiefly as the major indication for hysterectomy. As new therapies are developed, the heterogeneity of this disease becomes therapeutically relevant. An awareness of the role of genetics, the extracellular matrix, and hormones in tumor etiology is key to understanding this disease.

Focal beam distortion and treatment planning in abdominal focused ultrasound surgery

Recent clinical trials show promising results in using MRI and MRI-based thermometry to guide focused ultrasound surgery to treat uterine fibroids. During treatment, large variation in the focal temperature distribution has been observed. It is possible that some of this variation is due to abdominal tissue inhomogeneity, which might be causing focal beam distortion, and might largely decrease the focusing ability in deep-seated tissues. The purpose of this study was to numerically demonstrate this effect and also show the feasibility of restoring the focal beam patterns by employing the phase correction procedure for phased arrays. Abdominal MR data from four uterine fibroid patients were obtained to reconstruct the three-dimensional meshes of interfaces used in simulations, and one patient was selected to perform the analysis of key parameters in focused ultrasound surgery. Results show that, without phase correction, the focused beam can be severely distorted while using a frequency above 1 MHz or delivering ring-shape focal patterns. Different focal positions at the same depth may require a different power to induce the same ultrasonic intensity level (up to 179% among the different focal patterns). After adding a phase correction procedure, the distorted focal beams can be restored, and the peak intensity can be largely recovered (up to 85% among the different focal patterns). This study may offer important implications and information for treatment planning toward optimizing focused ultrasound surgery in uterine fibroid or other abdominal tumor treatments.

Genes associated with the genesis of leiomyoma of the uterus in a commonly deleted chromosomal region at 7q22

Uterine leiomyoma occurs in about 20-30% of women over the age of 30, and is the most frequent benign tumor in gynecology. Despite its benign status, leiomyoma of the uterus has been reported to involve chromosomal abnormalities on chromosome 7. To search for genes associated with the genesis and development of this disease, we examined microsatellite alterations on chromosome 7 in 41 uterine leiomyomas, and identified a commonly-deleted region. Allelic imbalance on chromosome 7 was detected with an incidence of 7% (3/41), with the D7S501 locus being the most frequently affected (13%). The commonly deleted region was between D7S2545 and D7S2420. We examined alterations in the expression of genes located within this region by RT-PCR. Only the LAMB1 (Laminin beta1) gene showed a variable expression. Of the 21 cases, 12 showed an increase, and 5 (24%) a decrease in the expression of LAMB1 in the leiomyomatous region. These results suggested that alteration of LAMB1 expression is associated with the genesis and development of uterine leiomyoma.

[Leptin and its influence on the main gynecoobstetric diseases]

Leptin is a protein hormone synthesized and secreted by adipose tissue and also probably in other organs and systems in human body. It has multiple functions such as to regulate feed intake and energy balance, gonadal regulation, action in the hypothalamo-pituitary-gonadal axis, regulates the metabolism of the fetal-placental unit in the pregnancy, fertility and reproductive systems, actions in the endometrium, mammary gland with corresponding influences on important physiologic processes such as menstruation, pregnancy and lactation. In the gynecologic surgery the serum leptin concentration is also modified. The knowledge of serum leptin concentration in the oncological diseases is going-up. Leptin is modified in the choriocarcinoma, Meigs' syndrome and other tumors. A better understanding of regulatory mechanisms will have direct clinical significance, as leptin has been proposed to impact on those causes of human perinatal morbidity and mortality that are associated with abnormalities of fetal maturity and development, general concept growth, trophoblast endocrinology, and placental sufficiency. Further investigations in this area will be necessary to improve new knowledge and a better understanding of the actions about this hormone.

[Localization of leiomyoma with respect to the placenta--factor for complications during pregnancy?]

We are presenting two cases of pregnant women with leiomyoma of the uterus, diagnosed antepartum. In both cases the patients were admitted on an emergency basis due to premature uterine contractions. In both cases preterm hemorrhage and fetal malpresentations were observed. The complications of pregnancy in both of the cases were primarily based on the location of the leiomyoma with respect to the placenta--intramural or submucosal disposition of the leiomyoma, retroplacentarily situated.

Uterine contractions evaluated on cine MR imaging in patients with uterine leiomyomas

PURPOSE

Submucosal leiomyoma is one of the most recognized causes of infertility and habitual abortion. The purpose of this study is to evaluate uterine peristalsis, a cycle-related inherent contractility of uterus probably responsible for sperm transport and conservation of pregnancy, in patients with uterine leiomyomas using cine magnetic resonance (MR) imaging.

MATERIALS AND METHODS

Study population consisted of 26 female patients (age range: 19-51 years, mean: 41 years), in which 16 patients had submucosal leiomyomas and 10 patients had intramural or subserosal leiomyomas. We prospectively performed MR imaging of the midsagittal plane of uterus using 1.5 T magnet (Symphony, Siemens Medical Systems) with a body array coil, and obtained 60 half-Fourier acquisition single shot turbo spin echo (HASTE) images (Echo time=80 ms, FOV=300 mm, slice thickness 5 mm, matrix 256x256) within 2 min, and displayed them on cine mode at 12x faster than real speed. Evaluated were peristaltic movements at the endometral-myometrial junction and focal myometrial movements, adjacent to leiomyomas, regarding presence, direction, frequency, and conduction.

RESULTS

The peristaltic movements were identified in 12/16 patients with submucosal lesions and 10/10 with other leiomyomas. The frequency and direction were cycle-related. Loss of peristalsis was noted adjacent to submucosal myomas in 4/12 patients, but was not in others. Focal myometrial movements were noted in 9/16 patients with submucosal myomas, but not in others.

CONCLUSIONS

Uterine peristaltic movements were partly interrupted by submucosal leiomoymas, but not by myometrial or subserosal leiomyomas. Loss of peristalsis and focal myometrial movements was noted only adjacent to submucosal leiomyomas. These findings are considered to represent dysfunctional contractility, and may be related with pregnancy loss.

Assessment of ER-alpha and ER-beta expression levels in malicious tumors of the uterine corpus

PURPOSE

The purpose of this article is to present an assessment of the expression levels of estrogen receptors ER-alpha and ER-beta in malicious tumors of the uterine corpus.

MATERIAL AND METHODS

Estrogen receptor expression levels were tested using semiquantitative immunohistochemical methods. Paraffin-embedded sections of tissue from the corpus of the uterus from 171 patients were used in the research.

RESULTS

Analysis of the relation between ER-beta expression levels and the clinical grade of disease (based on FIGO classification) showed that these parameters are significantly related: p = 0.0099. There were no statistically significant relations between ER-alpha expression levels in tumors or clinical stages of tumors based on the FIGO criteria. The presence of high estrogen receptor beta expression levels is often accompanied by a low estrogen receptor alpha expression level and such arrangements allow the overt biological function of a dominant receptor.

CONCLUSION

The differences in tissue distribution of both estrogen receptors could indicate their different biological roles.

Erythropoietin and erythropoietin receptor system in a large uterine myoma of a patient with myomatous erythrocytosis syndrome: possible relationship with the pathogenesis of unusual tumor size

The rare condition of women with erythrocytosis and a concurrent myomatous uterus has been classified as "myomatous erythrocytosis syndrome". Substantial myoma size has been noted as a common denominator in this condition in which recent evidence have confirmed erythropoietin (Epo) production by myoma tissues themselves. Apart from its primary endocrine role in controlling erythropoiesis, Epo has been demonstrated to mediate several cellular processes such as angiogenesis, mitogenesis, and inhibition of apoptosis by autocrine and paracrine mechanisms. Recently, Epo and its receptor (Epo-R) have been shown to be involved in the growth, viability, and angiogenesis of several malignant tumors including human female reproductive organ malignancies. In this paper, we researched on Epo and, as a first in the literature, Epo-R immunoexpression in a large uterine myoma of a term pregnant patient suffering from the myomatous erythrocytosis syndrome. Eight nongravidic leiomyomas and 8 gravidic leiomyomas were used as control group samples. Apart from confirming Epo production by myoma smooth muscle cells in the myomatous erythrocytosis syndrome, we reveal in this pathologic condition a characteristic strong Epo-R expression in myoma endothelial cells and a weak and sporadic Epo-R expression in myoma smooth muscle cells. The striking presence of Epo-R within myoma tissues in the case of the myomatous erythrocytosis syndrome allows us to speculate that myoma Epo production, besides determining erythrocytosis through systemic effects, may contribute, acting by autocrine and paracrine mechanisms, in determining the large myoma size almost always observed in this condition. Finally, we confirm a less but specific immunostaining for Epo in uterine myomas of patients without erythrocytosis and, as a first in the literature, we prove a weak and sporadic Epo-R expression in these lesions. These last results may contribute to knowledge of the yet unclear etiopathogenesis of the most common human gynecologic neoplasm.

Effect of inner myometrium fibroid on reproductive outcome after IVF

To evaluate the influence of inner myometrium fibroids (myomas) on the outcome of IVF cycles, a retrospective agematched controlled study was performed at SISMeR Reproductive Medicine Unit. The study group included 129 IVF/intracytoplasmic sperm injection cycles in 75 patients with one or more intramural and/or submucosal fibroids, while the control group consisted of 129 cycles in 127 patients without fibroids. The two groups were similar for mean oestradiol concentration at human chorionic gonadotrophin administration (1205.16 +/- 874 versus 1395 +/- 821 pg/ml), mean number of transferred embryos (2.02 +/- 0.4 versus 2.14 +/- 0.6) and clinical pregnancy rate (34.9 versus 41.1%). Conversely, the implantation rate was significantly lower in the study group (18.0%) than in the control group (26.5%; chi(2) = 4.81, P < 0.05), whereas the rate of spontaneous abortion demonstrated an opposite trend (40 versus 18.9%; chi(2) = 4.34, P < 0.05). Further research should be aimed at classifying fibroids on the basis of their location, especially when they are positioned in the junctional zone of the myometrium. Whether this classification will be superior in predicting the impact of fibroids on the reproductive outcome should be elaborated in a large multicentric study.

Malignant mixed mullerian sarcomas of the uterus--the LSUHSC Shreveport experience

OBJECTIVE

To evaluate our experience with malignant mixed mullerian sarcomas of the uterus (MMMT) and the clinical factors affecting survival.

STUDY DESIGN

The records of 18 women with MMMT who received treatment at our hospital between 1989-2002 were reviewed. We analyzed factors influencing survival such as stage, presence of heterologous components, and post-operative radiation. Survival analysis was performed using Kaplan-Meier survival curve.

RESULTS

All women underwent surgical tumor debulking. Eleven women were Stage I, three were Stage II, two were Stage III, and two were Stage IV. Five women had tumors with heterologous elements. As expected, survival was most influenced by stage of disease, with the best overall survival in women with Stage I tumors, P < 0.001. Cumulative 5-year survival was 60% for Stage I disease, for Stage II, 34%, and 0% for Stage III and Stage IV.

CONCLUSIONS

The initial stage of women presenting with MMMTs is the most important predictive factor for survival.

Advances in uterine protein research: reproduction and cancer

Uterine protein research has advanced from the measurements of specific compounds to detailed analysis of the genes that regulate protein synthesis and build up the complex carbohydrate structures that play important functional roles. Some 80% of all human proteins are glycoproteins. Functional glycomics highlights the importance of glycosylation in glycoprotein function. Glycodelin is a representative example of functional glycomics because its various glycoforms have different functions. In the uterus, synthesis of glycodelin-A is temporally regulated by progesterone. During the estrogen-dominated fertile window, absence of glycodelin synthesis is significant because uterine glycodelin-A potently and dose-dependently inhibits sperm-egg binding, the initial step in fertilization. The anti-fertilization propensity of glycodelin-A during the luteal phase of the cycle is highly glycosylation-dependent, and there is an intricate functional interplay between spermatozoa, zona pellucida and the various glycodelin isoforms present in the uterine fluid, seminal plasma and follicular fluid, respectively. Endometrial glycodelin synthesis can be induced during the fertile window by administration of progestagens, such as in levonorgestrel hormone-releasing IUD and contraceptive implants. Glycodelin can be chemically modified in such a fashion that it blocks the binding site on CD4 for the HIV surface glycoprotein, synthesis of viral gp 120, and infection of peripheral blood mononuclear cells by the primary HIV isolate THA/93/051, thus potentially inhibiting HIV transmission. Now that a cell line producing the contraceptive isoform has been identified by recombinant technology, these findings may have application for locally applied antiviral contraception. Glycodelin also has immunosuppressive properties, suggesting that the recognition mechanisms in immune and reproductive systems may have converged. Given its inhibitory activity on natural killer cells, abundant at the fetomaternal interphase, the high glycodelin concentration at the same site suggests a role in fetomaternal defense mechanisms. This may be relevant in women with recurrent miscarriage, in whom both the serum and uterine fluid glycodelin concentrations are decreased. Experiments on cancer cell lines have demonstrated increased epithelial differentiation by glycodelin cDNA transfection, and also by co-culture of cancer cells with normal stromal cells in the presence of basement membrane components. Both approaches result in glycodelin expression concomitant with decreased cell proliferation and reversion of the malignant phenotype. These results suggest an active role of normal stromal cells, basement membrane components and glycodelin in epithelial differentiation and glandular morphogenesis. This disposition of glycodelin is significant in patients with certain carcinomas, in which glycodelin-expressing tumors carry better prognosis than glycodelin-negative tumors of the same clinical stage and histological grade. Research on functional glycomics continues to produce significant information on fundamental aspects of fertilization, implantation, pregnancy and cancer.

Uterine leiomyoma and menstrual cycle characteristics in a population-based cohort study

BACKGROUND

We examined the association of uterine leiomyoma with menstrual cycle characteristics in a population of non-care-seeking women.

METHODS

This cross-sectional study uses data from the Seveso Women's Health Study (SWHS), a population-based cohort in Italy. Participants included 341 premenopausal women, 30-60 years old, who had an intact uterus and were not pregnant, lactating, or using oral contraception or intra-uterine devices. We examined the presence of any ultrasound-detected uterine leiomyoma in relation to self-reported menstrual cycle length, flow length and heaviness of flow. The association of leiomyoma number, volume, tissue layer location and axial position with menstrual cycle characteristics was also examined.

RESULTS

Uterine leiomyomata were detected in 73 women (21.4%). After adjustment for covariates, the presence of a leiomyoma was not significantly related to menstrual cycle length, flow length or heaviness of flow [odds ratio (OR) for scanty flow =1.9, 95% confidence interval (CI) 0.8-4.3; OR for heavy flow =1.3, 95% CI 0.7-2.5; relative to moderate flow]. Number, volume, tissue layer location (subserosal or intramural) and axial position (anterior or posterior) of the leiomyoma were also not related to menstrual cycle characteristics.

CONCLUSION

In this Italian population of women not seeking gynaecological care, menstrual characteristics are not related to leiomyoma.

Sex steroidal regulation of uterine leiomyoma growth and apoptosis

Uterine leiomyomas develop during the reproductive years and regress after menopause, indicating ovarian steroid-dependent growth potential. Although the clinical and biochemical observations have traditionally supported an important role for estrogen in the promotion of leiomyoma growth, there is also increasing evidence to suggest the involvement of progesterone in the pathogenesis of leiomyoma. In this review, much attention has been paid to characterizing the molecular mechanisms of sex steroidal regulation of leiomyoma growth and apoptosis by evaluating the effects of sex steroids on the expression of growth factors and apoptosis-related factors. The effects of GnRH agonist on the expression of these factors in leiomyoma are also described. 17beta-Estradiol up-regulates epidermal growth factor (EGF) receptor, but down-regulates p53 protein in leiomyoma cells, whereas progesterone augments EGF and Bcl-2 protein, but inhibits insulin-like growth factor (IGF-I) and tumour necrosis factor (TNFalpha). Since it is now evident that EGF and IGF-I act as local factors which stimulate leiomyoma growth, these findings suggest that progesterone may have dual actions, stimulatory and inhibitory, on leiomyoma cell growth and survival, depending on the local growth factor conditions around each leiomyoma. This may explain why the size of uterine leiomyomas during the use of levonorgestrel-releasing intrauterine system (LNG-IUS) increases in some but decreases in other instances. This may also explain why the size of leiomyomas during pregnancy does not increase despite the overwhelming increase in circulating concentrations of sex steroid hormones. Moreover, there is further evidence to suggest that the interactions between estrogen receptors and progesterone receptors may be involved in the modulation of gene transcription activity in leiomyoma. This review demonstrates that leiomyoma growth is integrally regulated by the complex cross-talk between sex steroid hormones and growth factors.

Higher rates of tachysystole among patients with clinically apparent uterine leiomyomas

OBJECTIVE

This study was undertaken to determine uterine and fetal heart rate (FHR) tracing patterns associated with clinically apparent uterine leiomyomas.

STUDY DESIGN

Uterine and FHR patterns of 44 women with diagnosed uterine leiomyomas were compared with 601 tracings of controls. Tracings were interpreted during the first stage of labor, using the National Institute of Child Health and Human Development Research Planning Workshop guidelines. Stratified analysis that used the Mantel-Haenszel technique was performed to control for confounders.

RESULTS

Patients with leiomyomas had higher rates of uterine tachysystole as compared with those without leiomyomas (22.7% vs 1.3%; odds ratio [OR] = 21.8, 95% CI 7.4-65.6; P < .001). No significant differences were noted between the groups regarding FHR patterns. Higher rates'of prostaglandin induction and oxytocin augmentation were noted in the uterine leiomyomas group (6.8% vs 0.8%; P = .005 and 52.3% vs 10.5%; P < .001, respectively). However, controlling for prostaglandin induction and oxytocin augmentation, with the use of the Mantel-Haenszel procedure, did not change the significant association between uterine leiomyomas and tachysystole (weighted OR 12.5, 95% CI 6.2-75.1, and weighted OR 8.7, 95% CI 3.6-43.1, respectively).

CONCLUSION

Clinically apparent uterine leiomyomas, although not coupled with abnormal FHR patterns, are associated with higher rates of tachysystole.

Analysis of a candidate gene associated with growth suppression of choriocarcinoma and differentiation of trophoblasts

OBJECTIVE

To isolate a choriocarcinoma suppressor gene and analyze its structure and function.

STUDY DESIGN

We constructed a polymerase chain reaction-based subtracted fragmentary cDNA library between normal placental villi and choriocarcinoma cell line CC1. A novel homeobox gene, designated NECC1 (not expressed in differ choriocarcinoma clone 1), is included in this library. We analyzed the structure and function of NECC1 with molecular biology.

RESULTS

NECC1 comprises an open reading frame of 219 nucleotides encoding 73 amino acids and contains a homeodomain as a consensus motif. NECC1 is located on human chromosome 4q11-q12, and its expression is ubiquitous in the brain, placenta, lung, smooth muscle, uterus, bladder, kidney and spleen. Normal placental villi abundantly expressed NECC1, but all choriocarcinoma cell lines examined and most surgically removed choriocarcinoma tissue samples failed to express it. We transfected this gene into choriocarcinoma cell lines and observed remarkable alterations in cell morphology and suppression of in vivo tumorigenesis. Induction of chorionic somatomammotropin hormone 1 by NECC1 transfection suggested differentiation of choriocarcinoma cells to syncytiotrophoblast-like cells.

CONCLUSION

Our results suggest that loss of NECC1 expression is involved in malignant conversion of placental trophoblasts.

Increased gestational age at evacuation of a complete hydatidiform mole: does it correlate with increased risk of requiring chemotherapy?

OBJECTIVE

To assess whether a complete hydatidiform mole (CHM) carries an increased risk of later requiring chemotherapy in pregnancies continued to term.

STUDY DESIGN

The Charing Cross gestational trophoblastic neoplasia (GTN) database was screened between 1973 and 2002 to identify registered singleton CHMs with a known gestational age at the time of evacuation. Of the 8,313 cases 2,800 were centrally histopathologically reviewed by us and confirmed as CHM. The proportion of patients requiring chemotherapyfor both total registered and centrally reviewed patients was analyzed by trimester of evacuation (< 13, 13-24, > 24 weeks). Statistical significance was assessed by the chi2 test.

RESULTS

For the total population, including non-centrally reviewed patients, evacuation occurring in the first, second or third trimester was associated with a treatment rate of 13.9% (601 of 4,333), 10.8% (412 of 3,803) and 5.1% (9 of 177), respectively. In patientsfor whom a central pathologic review had been performed to confirm the diagnosis, the treatment rates were 27.7% (525 of 1,897), 27% (241 of 893) and 20% (2 of 10). The higher apparent treatment rates reflect an error in the denominator as we do not review all nontreated cases. In the total population, evacuation in the third trimester correlated with a reduction in risk of subsequent treatment (P<.001). Most of these late deliveries were induced (before adequate ultrasound), whereas the earlier pregnancies were mostly terminated via suction dilatation and curettage.

CONCLUSION

There is no evidence that delayed evacuation/delivery of singleton CHM increases the risk of subsequently requiring chemotherapy.

Leiomyoma uteri in Ethiopian women: a clinical study

A retrospective review of 588 patients with myoma surgically managed at Tikur Anbessa teaching hospital, Addis Ababa, Ethiopia, from February 1992-October 2000 is presented. The objectives of the study were to describe the sociodemographic profile, clinical parameters, indications for operation and outcome of management of myoma cases surgically managed at the hospital. Data was collected on sociodemographic, obstetric, gynecological and other relevant clinical variables from the patient's records. Mean age of patients was 35.8 (SD 7.5) years with a median parity of 1. Median uterine size was of 16 weeks pregnant uterus. Number of myomas removed at myomectomy ranged from 1-50 (Median 2). 98% of myomas were fundal and 2% cervical. 40 (6.8%) of the myomas were "delivered" myomas. The median duration of the presenting complaints reported by the patients was 1 year. Abnormal bleeding was the major presenting complaint (69.2%). In 101 (17.2%) of the patients other pelvic pathologies were identified, the majority being ovarian tumours. Three hundred sixteen (53.7%) of the patients had an additional medical condition encountered mainly anemia and hypertension. Intraoperative and postoperative complications were much higher following hysterectomy than myomectomy, but duration of operation, intraoperative blood loss and uterine size were not much different in the two operations. Reasons for the delay in presentation should be addressed by studies so that interventions leading to early presentation of patients can be sought. It is proposed that in all situations where it is feasible to do so, myomectomy should be performed in preference to hysterectomy irrespective of the need for future fertility.

Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid

Human chorionic gonadotropin (hCG) is a glycoprotein hormone that has structural similarity to TSH. At the time of the peak hCG levels in normal pregnancy, serum TSH levels fall and bear a mirror image to the hCG peak. This reduction in TSH suggests that hCG causes an increased secretion of T4 and T3. Women with hyperemisis gravidarum often have high hCG levels that cause transient hyperthyroidsm. In the vast majority of such patients, there will be spontaneous remission of the increased thyroid function when the vomiting stops in several weeks. When there are clinical features of hyperthyroidism, it is be reasonable to treat with antithyroid drugs or a beta-adrenergic blocker, but treatment is rarely required beyond 22 weeks of gestation. Hyperthyroidism or increased thyroid function has been reported in many patients with trophoblastic tumors, either hydatiditform mole or choriocarcinoma. The diagnosis of hydatidiform mole is made by ultrasonography that shows a 'snowstorm' appearance without a fetus. Hydatidiform moles secrete large amounts of hCG proportional to the mass of the tumor. The development of hyperthyroidism requires hCG levels of >200 U/ml that are sustained for several weeks. Removal of the mole cures the hyperthyroidism. There have been many case reports of hyperthyroidism in women with choriocarcinoma and high hCG levels. The principal therapy is chemotherapy, usually given at a specialized center. With effective chemotherapy, long-term survival exceeds 95%. A unique family with recurrent gestational hyperthyroidism associated with hyperemesis gravidarum was found to have a mutation in the extracellular domain of the TSH receptor that made it responsive to normal levels of hCG.

Molecular biology of gestational trophoblastic neoplasia: a review

Gestational trophoblastic diseases are interrelated conditions characterized by abnormal growth of chorionic tissues with varying propensitiesfor local invasion and metastases. These diseases are characterized by altered expression of several growth regulatory factors and oncogenes. On the basis of the expression of various oncogenes and growth factors, partial mole appears to be more like normal placenta, while complete mole seems to be more like choriocarcinoma. These results may have both prognostic and therapeutic consequences and provide insight into the relationship between normal placenta and gestational trophoblastic diseases.

Risk factors for low bone mineral density and the 6-year rate of bone loss among premenopausal and perimenopausal women

Risk factors that are associated with lower bone mineral density (BMD) may not necessarily be associated with increased bone loss among premenopausal and perimenopausal women. We determined risk factors for lower premenopausal and perimenopausal BMD while simultaneously determining risk factors for increased 6-year rate of bone loss among women aged 24-50 years within a population-based prospective cohort study. BMD of the lumbar spine and femoral neck, reported as t scores, were measured five times within the 6-year study among 614 women who were between the ages of 24 and 44 in 1992/1993. Rates of bone loss were calculated from the repeated BMD measurements. Risk factors for lower BMD over time at the lumbar spine included history of any fracture ( P=0.005). The major risk factor for lower BMD over time at the femoral neck was family history of osteoporosis ( P<0.002). The major protective factor for greater BMD over time at both skeletal sites was additional body weight ( P<0.0001). Other protective factors for greater BMD over time at the femoral neck were modest alcohol consumption ( P=0.0002) and high-school sports participation ( P=0.002). Risk factors for greater bone loss at either skeletal site included postmenopausal status ( P<0.0001 at the lumbar spine; P=0.01 at the femoral neck), and the reporting of a reproductive cancer ( P<0.0001 at the lumbar spine; P=0.0008 at the femoral neck). Body weight was protective against bone loss at both skeletal sites ( P<0.0001). Baseline age, calcium intake, smoking, and current physical activity were not associated with BMD or bone loss. The understanding of the relative importance of risk factors for both low BMD and bone loss may assist in the identification of women at greater risk for subsequent low postmenopausal BMD.

Potential regulation of PTH/PTHrP receptor expression in choriocarcinoma cells

OBJECTIVE

Parathyroid hormone-related peptide (PTHrP) have been found to be expressed in a variety of human tumors. Parathyroid hormone-related peptide is known as the major mediator of humoral hypercalcemia of malignancy, may also regulate placental calcium flux, uterine contraction and fetal tissue development. The purpose of this study is to evaluate the expression of PTH/PTHrP receptor in choriocarcinoma JAR cell line.

METHODS

This study was carried out at the Department of Biochemistry, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia, between November 2002 and August 2003. Choriocarcinoma JAR cell line treated for 12 and 72 hours with epidermal growth factor, (EGF) (20ng/ml), estradiol, E2 (10(-8) M), dexamethasone, (DEX) (10(-8) M) or 1,25 dihydroxycholecalciferol, 1,25 (DHCC) (10(-8) M). We investigated the expression of parathyroid hormone (PTH)/PTHrP receptor in JAR cell line with these treatments compared with untreated JAR cells. The PTH/PTHrP receptor expression were detected with 3.3nM 125I-PTHrP-34Tyrosine.

RESULTS

The expression of the receptors at 12 hours were increased following exposure to EGF, E2 or DEX, whereas 1,25 DHCC inhibited the receptor expression. In further experiments at 72 hours with the same treatments, the receptors expression were remarkably increased with EGF, E2 or DEX, whereas, 1,25 DHCC inhibited the receptor expression in these cells.

CONCLUSION

These data suggested that in JAR cells, The EGF, E2 and DEX upregulated the PTH/PTHrP receptor expression, whereas the 1,25 DHCC down-regulated the PTH/PTHrP receptor, and the 1,25 DHCC may play an important role as antiproliferative drug for choriocarcinoma.

Myomectomy and MRI-Directed Cryotherapy

The purpose of this study was to identify alternatives to hysterectomy by transabdominal interventional magnetic resonance imaging-guided cryoablation. This represents a report of a prospective institutional review board-approved protocol to study interventional magnetic resonance imaging-guided cryoablation of uterine fibroid tumors. Women were selected on the basis of symptoms that were related to uterine fibroid tumors (bleeding, uterine pain, pelvic congestion, compression symptoms) and the absence of any desire for childbearing. Magnetic resonance imaging was performed before the procedure to measure the size and number of fibroid tumors, and follow-up magnetic resonance imaging determined the reduction of the lesion. Ten patients were originally included, and nine were treated and had substantial reduction in the uterine size (average, 65% volume reduction). The primary symptoms have either improved or resolved in eight of the nine women. This is the first reported review of interventional magnetic resonance imaging-directed cryotherapy of uterine fibroid tumors. This minimally invasive therapy produced shrinkage of the tumor in nine of our first ten patients.