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LEIOMYOMAS

Leiomyomas or uterine fibroids are benign tumors of the uterus that consist of smooth muscle and extracellular matrix collagen and elastin.

Most common solid pelvic tumors and one of the most frequent clinical conditions encountered in gynecologic practice.

They tend to grow during the reproductive years and usually regress during menopause.

Leiomyomas Diagnosis

Diagnosis

Classification

Based on location, fibroids can be:
- Submucosal (protruding into the uterine cavity)
- Intramural (found within the myometrium)
- Subserosal (protruding outside the uterus)
Fibroid classification may use the European Society for Gynecological Endoscopy (ESGE) or the International Federation of Gynecology and Obstetrics (FIGO) classification wherein the degree of uterine cavity distortion and/or intramural extension are taken into account

Physical Examination

Pelvic exam may reveal a palpable enlarged, firm, and irregular uterus
- A pelvic mass that moves with the uterus is suggestive of fibroids

Myomatous uterus’ size is reported in menstrual week as is a pregnant uterus
- Size of >12 to 20 weeks may be palpated on abdominal exam

Diagnosis can be difficult in obese women

Laboratory Tests

A CBC to evaluate hemoglobin (Hb) will detect iron-deficiency anemia in patients with heavy menstrual bleeding

Imaging

Transvaginal ultrasound (TVS): Helpful in assessing the adnexae and growth of myoma
Transvaginal sonohysterography (TVSH): Should be considered if submucosal fibroids and polyps are suspected
- TVSH may avoid the need for diagnostic hysteroscopy in approximately 47% of women who can then proceed to planned operative hysteroscopy
Magnetic resonance imaging (MRI): May be considered in women in whom the location and nature of the fibroids remain unclear after TVS and TVSH
- May also be used in those who wish to avoid discomfort of TVSH
- MRI predictors of malignancy include age >45 years, menopausal status, thickening of the endometrium, presence of intratumoral hemorrhage, nonmyometrial origin, and T2-weighted signal heterogeneity

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Abemaciclib + fulvestrant survival benefit extends to Asians with HR+, HER- ABC

Pearl Toh, 12 Jan 2021

Adding the CDK4/6 inhibitor abemaciclib to an endocrine therapy of fulvestrant extends overall survival (OS) compared with fulvestrant alone in East Asian patients with hormone receptor-positive (HR+), HER2-negative advanced breast cancer (ABC) who have progressed on prior endocrine therapy, consistent with results from the overall population, updated analysis of the global, phase III MONARCH 2 study has shown.

Acute diarrhoea is the second leading cause of death in children aged younger than 5 years, accounting for approximately 1.9 million deaths worldwide each year; however, diarrhoea is a preventable and treatable condition. In Malaysia, acute gastroenteritis accounts for about 1.3% of all deaths in children aged younger than 5 years annually. Diarrhoea is defined as the passage of three or more loose or watery stools within 24 hours, and it may be clinically categorised as either acute watery diarrhoea (AWD), acute bloody diarrhoea, persistent diarrhoea or diarrhoea with severe malnutrition.

01 Sep 2020

Acute diarrhoea is the second leading cause of deathin children aged younger than 5 years, accounting forapproximately 1.9 million deaths worldwide each year;however, diarrhoea is a preventable and treatable condition.In Malaysia, acute gastroenteritis accounts for about 1.3%of all deaths in children aged younger than 5 years annually.Diarrhoea is defined as the passage of three or more looseor watery stools within 24 hours, and it may be clinicallycategorised as either acute watery diarrhoea (AWD), acutebloody diarrhoea, persistent diarrhoea or diarrhoea withsevere malnutrition.