[Show abstract][Hide abstract] ABSTRACT: Uterine leiomyomata (fibroids) are the leading cause of hysterectomy in the United States. Black women have a greater fibroid burden than whites, yet no study has systematically evaluated the growth of fibroids in blacks and whites. We prospectively tracked growth for 262 fibroids (size range: 1-13 cm in diameter) from 72 premenopausal participants (38 blacks and 34 whites). Fibroid volume was measured by computerized analysis of up to four MRI scans over 12 months. We used mixed effects models to identify factors that are associated with growth, and results were converted to percent change per 6 months for clinical relevance. The median growth rate was 9% (range: -89% to +138%). Seven percent of fibroids regressed (>20% shrinkage). Tumors from the same woman grew at different rates (within-woman component of variation was twice the component among women; both were significant, P < 0.001). Black and white women less than 35 years of age had similar fibroid growth rates. However, growth rates declined with age for whites but not for blacks (P = 0.05). The odds of a tumor growing more than 20% in 6 months also decreased with age for whites but not for blacks (P < 0.01). Growth rates were not influenced by tumor size, location, body mass index, or parity. We conclude that (i) spontaneous regression of fibroids occurs; (ii) fibroids from the same woman grow at different rates, despite a uniform hormonal milieu; (iii) fibroid size does not predict growth rate; and (iv) age-related differences in fibroid growth between blacks and whites may contribute to the higher symptom burden for black women.
Proceedings of the National Academy of Sciences 01/2009; 105(50):19887-92. DOI:10.1073/pnas.0808188105 · 9.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although essential for cell physiology, an increase or depletion of body iron has harmful effects on health. Apart from iron deficiency anemia and iron overload-related organ tissue damage, there are increasing evidences that body iron status is implicated in atherosclerotic cardiovascular diseases. The hypothesis formulated in 1981 that iron depletion may protect against cardiovascular events is intriguing and has generated a significant debate in the last two decades. Indeed, to study this phenomenon, several investigators have tried to design appropriate experimental and clinical studies and to identify useful biochemical and genetic markers of iron status. The results of the literature on the effect of iron deficiency and overload on vascular health are critically reviewed in this study from a pathogenic and clinical point of view.
Annals of Hematology 04/2008; 87(3):167-73. DOI:10.1007/s00277-007-0416-1 · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Disseminated intravascular coagulation (DIC) and acute renal failure are uncommon complications of multiple myomectomy. We report a case of DIC, microangiopathic hemolytic anemia, myoglobinemia, and acute renal failure following the removal of 52 uterine fibroids. We postulate that extensive myometrial dissection and the administration of hetastarch favored the development of DIC and microangiopathic hemolytic anemia. Acute renal failure ensued, necessitating hemodialysis. Proposed mechanisms and recommendations for future prevention are discussed.
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