Traitement conservateur des fibromes utérins volumineux et/ou multiples (intérêts de l'embolisation des artères utérines par particules résorbables avant myomectomie)

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Complications and failure of uterine artery embolisation for intractable postpartum haemorrhage.

International audienc

Interest of uterine artery embolization with gelatin sponge particles prior to myomectomy for large and/or multiple fibroids.

International audiencePURPOSE: To evaluate the efficacy of pre-myomectomy uterine artery embolization with gelatin sponge particles to reduce operative blood loss and facilitate removal of fibroids. MATERIALS AND METHODS: This retrospective study included 33 women (mean age, 36 years; range, 24-45 years), of whom at least 18 wished to preserve fertility. They presented with at least one large myoma (mean diameter, 90mm; range, 50-150mm) and had undergone preoperative uterine artery embolization with resorbable gelatin sponge by unilateral femoral approach between December 2001 and November 2008. Clinical, radiological and surgical data were available for all patients. Mean haemoglobin levels before and after surgery were compared with Student's t-test. RESULTS: No complication or technical failure of embolization occurred. The myomectomies were performed during laparotomy (25 cases) or laparoscopy (8 cases). Dissection of fibroids was easier (mean, 3 per patient; range, 1-11), with a mean operating time of 108+/-50min (range, 30-260min). Bloodless surgery was the rule with a mean estimated peroperative blood loss of 147+/-249mL (range, 0-800mL). Mean pre-(12.9+/-1.3g/dL) and post-therapeutic (11.4+/-1.2g/dL) haemoglobin levels were not statistically different (p>0.05). There was no need for blood transfusion. None of the patients required hysterectomy. The mean duration of hospital stay was 7.5+/-1.3 days (range, 3-12 days). CONCLUSION: Preoperative uterine artery embolization is effective in reducing intraoperative blood loss and improves the chances of performing conservative surgery. It should be considered a useful adjunct to myomectomy in women at high hemorrhagic risk or who refuse blood transfusion

Isolation of a Highly Myogenic CD34-Negative Subset of Human Skeletal Muscle Cells Free of Adipogenic Potential.

International audienceThe differentiation of multipotent cells into undesirable lineages is a significant risk factor when performing cell therapy. In muscular diseases, myofiber loss can be associated with progressive fat accumulation that is one of the primary factors leading to decline of muscular strength. Therefore, to avoid any contribution of injected multipotent cells to fat deposition, we have searched for a highly myogenic but non-adipogenic muscle-derived cell population.We show that the myogenic marker CD56, which is the gold standard for myoblast-based therapy, was unable to separate muscle cells into myogenic and adipogenic fractions. Conversely, using the stem cell marker CD34, we were able to sort two distinct populations, CD34(+) and CD34(-), which have been thoroughly characterized in vitro as well as in vivo using an immunodeficient Rag2(-/-)gamma(c) (-/-) mouse model of muscle regeneration with or without adipose deposition. Our results demonstrate that both populations have equivalent capacities for in vitro amplification. The CD34(+) cells and CD34(-) cells exhibit equivalent myogenic potential, but only the CD34(-) population fails to differentiate into adipocytes in vitro as well as in vivo after transplantation into regenerative fat muscle.These data indicate that the muscle-derived cells constitute an heterogeneous population of cells with various differentiation potential. The simple CD34 sorting allows isolation of myogenic cells with no adipogenic potential and therefore could be of high interest for cell therapy when fat is accumulated in diseased muscle