tailieunhanh - Obstetrics and Gynecology Clinics of North America by Dr. Aydin Arici,

Uterine myomas are the most common benign tumors in women, affecting 20%–50% of reproductive age population. Myomas cause significant morbidity and are the single most common indication for hysterectomy in the United States, representing a major personal and public health concern worldwide. Recent research on the cellular and molecular biology of myomas has enabled us to understand better the pathogenesis and pathophysiology of this tumor, but more remains to be done. In the clinical arena, novel methods of conservative treatments for myomas have been developed to allow many women to keep their reproductive capacity, and more novel treatments are available on the horizon | ELSEVIER VUADtRt OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA ELSEVIER SAUNDERS Obstet Gynecol Clin N Am 33 2006 xv-xvi OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA Foreword Myomas William F. Rayburn MD Consulting Editor This issue of the Obstetrics and Gynecology Clinics of North America guest edited by Dr. Aydin Arici is a comprehensive overview about uterine myomas. Myomas also known as fibroids or leiomyomas are the most common solid tumors in the pelvis. Myomas are clinically apparent in 25 -50 of women especially African American women and in up to 80 of select populations after careful examination of the uterus. This issue begins with presentations about the epidemiology genetic heterogeneity and cell biology of myomas. These tumors contain varying amounts of fibrous tissue that comprises proliferating and degenerated smoothmuscle cells. Myomas are usually multiple and grow by pushing borders with a pseudocapsule. Degeneration occurs from ischemia when the blood supply can no longer reach the myoma s center. Sarcomatous or malignant degeneration is rare regardless of the rapidity of tumor growth. Although very common myomas are often asymptomatic. Symptoms can include pelvic pressure and urinary frequency or ureteral obstruction from a mass effect. Abnormal bleeding results from either submucous myomas having a thin endometrium over the surface that may not respond normally to hormonal influences or from ulceration or necrosis with direct bleeding. Interstitial fibroids can cause an increase in the surface area of the endometrium as the uterus increases in size leading to menorrhagia and anemia. Infertility can result from impaired implantation or from occlusion of the cornual portion of the uterine 0889-8545 06 - see front matter 2006 Elsevier Inc. All rights reserved. doi xvi FOREWORD tube. Pregnancy complications can include preterm abortion labor abruptio placentae and dystocia. .