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EMAK
Century Club
Joined: 26 Nov 2006
Posts: 572
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 Posted: Tue Jan 16, 2007 8:51 am Post subject: UAE: uterine artery embolisation |
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I found this recently:
In treating patient with HMB, the use of GnRha should be stoped immediately if the pateint is scheduled for UAE.......
ref//NICE guidelineDraft/HMB/2006
I would like to ask please;is it for financial cause...??
or for another?! |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Wed Jan 17, 2007 9:39 pm Post subject: |
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Been looking for this for 15 minutes and cannot find what you are talking about. Give up!
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 |
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EMAK
Century Club
Joined: 26 Nov 2006
Posts: 572
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| Posted: Wed Jan 17, 2007 10:23 pm Post subject: |
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Hi Nick,
it is in :
Nice guidline
Draft for consultation, July 2006
page 19
1.8 interventions for uterine fibroids
1.8.1.3 (( use of GnRH-a should be stopped as soon as UAE has been scheduled)) |
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rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
Posts: 966
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| Posted: Wed Jan 17, 2007 11:08 pm Post subject: |
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hi,
had a look at the draft. it is not for the money aspect.
i would not worry about this as it is unlikely that the college is going to ask your about an obscure statement from a DRAFT guideline.
the reason you stop GnRHa is because they act thru uterine artery blood flow change i.e. increase in resistance index as well as thru it's anti oestrogen action. this = reduction of uterine artery blood flow and smaller caliber of the uterine vessels. hence UAE will be technically difficult. hence it is prudent to stop the analogues to have ok sized arteries at op.
this does not negate the preop GnRHa for size reduction though. hence
| Quote: | | the use of GnRha should be stoped immediately if the pateint is scheduled for UAE |
holds true.
reference --
Reinsch, Ronald C.; Murphy, Ana A.; Morales, Arlene J.; Yen, Samuel S. C. The Effects of RU 486 and Leuprolide Acetate on Uterine Artery Blood Flow in the Fibroid Uterus: A Prospective, Randomized Study. Transactions Of The Sixtieth Annual Meeting Of The Pacific Coast Obstetrical And Gynecological Society. American Journal of Obstetrics & Gynecology. 170(6):1623-1628, June 1994.
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Dr Miss. Raj Walavalkar MBBS MRCOG
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SR O&G Wessex Region |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Thu Jan 18, 2007 2:18 pm Post subject: |
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That's a very interesting observation and explanation. Thanks Raj - I could work out why this would be necessary but your explanation makes absolute sense.
Silly question - should all patients listed for UAE have some pre-treatment with GnRHa or are we saying they should have no down-regulation at all unles for other reasons? I guess the reduction in size would still be of benefit for 3 months after they have been stopped but the blood flow would have returned making the procedure more likely to be successful? Seems there could be a nice study here 
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Thu Jan 18, 2007 2:39 pm Post subject: |
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| rpwalavalkar wrote: | hi,
the reason you stop GnRHa is because they act thru uterine artery blood flow change i.e. increase in resistance index as well as thru it's anti oestrogen action. this = reduction of uterine artery blood flow and smaller caliber of the uterine vessels. hence UAE will be technically difficult.
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Raj.// Thanks a lot, very sophisticatd answer.. |
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