oxytocin and Leiomyomatosis

To assess the effectiveness and safety of interventions to reduce blood loss during myomectomy.. Electronic searches of the Cochrane Library, MEDLINE, and EMBASE, between 1966 and 2006 for randomized controlled trials (RCTs).. We found significant reductions in blood loss with vaginal misoprostol (weighted mean difference [WMD] -149.00 mL, 95% confidence interval [CI] -229.24 to -68.76); intramyometrial vasopressin and analogues (WMD -298.72 mL, 95% CI -593.10 to -4.34); intramyometrial bupivacaine plus epinephrine (WMD -68.60 mL, 95% CI -93.69 to -43.51); and pericervical tourniquet (WMD -1870.00 mL, 95% CI -2547.16 to -1192.84). There was no evidence of effect in blood loss with myoma enucleation by morcellation and oxytocin.. There is limited evidence from a few RCTs that some interventions may reduce bleeding during myomectomy. There is need for adequately powered RCTs to shed more light on the effectiveness, safety, and cost of different interventions to reduce blood loss during myomectomy.

Topics: Blood Loss, Surgical; Bupivacaine; Combined Modality Therapy; Female; Gynecologic Surgical Procedures; Humans; Leiomyomatosis; Misoprostol; Oxytocin; Randomized Controlled Trials as Topic; Tourniquets; Uterine Neoplasms; Vasopressins

The myoma pseudocapsule (MP) is a fibro-vascular network rich of neurotransmitters, as a neurovascular bundle, surrounding fibroid and separating myoma from myometrium. We investigated the distribution of the opioid neuropeptides, as enkephalin (ENK) and oxytocin (OXT), in the nerve fibers within MP and their possible influence in human reproduction in 57 women. An histological and immunofluorescent staining of OXT and ENK was performed on nerve fibers of MP samples from the fundus, corpus and isthmian-cervical regions, with a successive morphometric quantification of OXT and ENK. None of the nerve fibers in the uterine fundus and corpus MPs contained ENK and the nerve fibers in the isthmian-cervical region demonstrated an ENK value of up to 94 ± 0.7 CU. A comparatively lower number of OXT-positive nerve fibers were found in the fundal MP (6.3 ± 0.8 CU). OXT-positive nerve fibers with OXT were marginally increased in corporal MP (15.0 ± 1.4 CU) and were substantially higher in the isthmian-cervical region MP (72.1 ± 5.1 CU) (p < 0.01). The distribution of OXY neurofibers showed a slight into the uterine corpus, while are highly present into the cervico-isthmic area, with influence on reproductive system and sexual disorders manifesting after surgical procedures on the cervix.

Topics: Adult; Cervix Uteri; Enkephalins; Female; Humans; Hysterectomy; Immunohistochemistry; Leiomyomatosis; Menorrhagia; Neoplasm Proteins; Neovascularization, Pathologic; Nerve Fibers; Oxytocin; Pelvic Pain; Uterine Neoplasms; Uterus

Interaction of sex hormone-binding globulin (SHBG) and oxytocin (OT) is among the factors that control smooth muscle proliferation and tumor growth through the oxytocin receptor (OTR). Also, a close functional interaction of OTR and caveolin-1 has been shown to modulate cell growth and proliferation.. We studied surgical samples from 23 leiomyoma patients (aged 33-66 years) with immunocytochemistry. Specimens from five patients (34-76 years), who had hysterectomy for other reasons, served as controls. Tissue samples were cut into serial 1-microm thick sections for co-localization of SHBG, OTR, proliferation marker p21 and caveolin-1.. SHBG was found in smooth muscle cells in all samples. OTR staining occurred in most of these cells in myomas, while controls contained only scattered cells positive for OTR. There were no apparent differences in immunostaining for p21, while immunoreactivity for caveolin-1 was observed in most cells in myomas and in only few cells in controls. Caveolin-1 was mostly co-localized with SHBG and OTR in myoma samples whereas controls showed this co-localization only occasionally.. Our observations indicate an interaction of SHBG and OTR, associated with caveolin-1, which may account in part for known non-genomic actions of ovarian steroids. Growth of leiomyomas may be linked to these mechanisms.

Topics: Adult; Aged; Case-Control Studies; Caveolin 1; Cyclin-Dependent Kinase Inhibitor p21; Female; Humans; Immunohistochemistry; Leiomyomatosis; Middle Aged; Myometrium; Oxytocin; Receptors, Oxytocin; Sex Hormone-Binding Globulin; Uterine Neoplasms