***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Fifty premenopausal patients requiring hysterectomy as treatment for symptomatic uterine leiomyomas , which were the size of 14 to 18 weeks ' gestation , were r and omized into two groups to determine whether preoperative gonadotropin-releasing hormone agonist would increase the feasibility of vaginal rather than abdominal hysterectomy . The control group ( group A ; n = 25 ) did not receive preoperative gonadotropin-releasing hormone agonist , but patients in Group B ( n = 25 ) received 2 months of gonadotropin-releasing hormone agonist before undergoing hysterectomy . Patients in the two groups were similar with respect to age , gravidity , parity , pretreatment uterine size , and hemoglobin and hematocrit levels . Patients in group B had an increase in hemoglobin levels ( 10.75 to 12.12 gm/dl , p less than 0.05 ) and a decrease in uterine volume ( 1086.7 to 723.4 ml , p less than 0.05 ) after 8 weeks of agonist therapy and were more likely to undergo vaginal hysterectomy ( 76.0 % vs 16 % ) . Patients in group B also had shorter hospitalizations ( 5.2 vs 3.8 days , p less than 0.05 ) . We conclude that the administration of gonadotropin-releasing hormone agonist for 2 months followed by vaginal hysterectomy is preferable to abdominal hysterectomy in selected patients with uterine leiomyomas A. J. M. AUDEBERT , P. MADENELAT * , D. Q U E R L E U ? , G. P O N T O N N I E R ~ , C . R A C I N E T ~ , R.R E N A U D ~ , J.-Y. GILLET * * , D. R A U D R A N T ? ~ , J. LANSAC:~ , J.-P. B R E T T E ~ Cnbitiet Medical . Bordeaus : * Hdpital Bichat , Paris ; ? Centre Hospitalier , Roubai.r ; 1 Hdpital de la Grave , Toulouse ; $ Centre Hospiialier Sud , Ecliirolles : Hfipital Central , Strasbourg ; * * Hi?pital Saint Roch , Nice ; ttH6pital de I'Hdtel Dieu , Lyon ; : $ Hdpital de Tours , Tours ; and # Hipito1 Monwti . Brest . OBJECTIVE Our purpose was to examine the effects of RU 486 and leuprolide acetate on uterine artery blood flow and uterine volume . STUDY DESIGN Patients were r and omly assigned to group A ( eight patients ) receiving 25 mg of RU 486 daily for 3 months or group B ( six patients ) receiving 3.75 mg of leuprolide acetate monthly for 3 months .  Uterine artery blood flow change was determined by resistive index by means of vaginal color Doppler ultrasonography . Uterine volume was measured before and during the study with abdominal ultrasonography . RESULTS Both groups showed an increase in resistive index . Patients receiving RU 486 had uterine artery blood flow decreased by 40 % , and those receiving leuprolide acetate had a 21 % decrease . We noted a significant decrease in uterine volume compared with pretreatment in both groups at 3 months . There was no significant decrease between groups . CONCLUSION Both RU 486 ( 25 mg daily ) and leuprolide acetate ( 3.75 mg monthly ) are effective in decreasing blood flow to the uterus ( increasing resistive index ) and decreasing uterine volume at 3 months . A significant decrease in uterine artery blood flow may provide a mechanism for the decrease in uterine size and the decrease in uterine blood loss at the time of surgery Summary . Twenty‐four women with symptomatic multiple uterine myomas were allocated r and omly to treatment with buserelin , 1200μg/day intranasally , for 3 months followed by myomectomy ( n = 8) or to immediate myomectomy ( n = 16 ) . Pre‐operative treatment with buserelin  reduced the mean uterine volume from 432 ( SD 165 ) to 242 ( SD 82 ) ml ( P < 0.01 ) but intra‐operative blood loss and postoperative morbidity were not significantly less in this group . Six months after operation , pelvic examination was normal in all the patients . However , ultrasonography with transvaginal probe demonstrated the presence of myomas of < 1.5 cm in five women ( 63 % ) treated pre‐operatively with the analogue and in two women ( 13 % ) who underwent immediate surgery ( P < 0.05 ) . Induction of a period of hypo‐oestrogenism before myomectomy seems to favour short‐term recurrence of uterine myomas , limiting the efficacy of surgery OBJECTIVE Aims of our study were as follows : ( 1 ) to evaluate the therapeutic efficacy of the preoperative administration of a gonadotropin-releasing hormone analog before laparoscopic myomectomy and ( 2 ) to assess whether any ultrasonographic parameter of the fibroids ( number , size , Doppler velocimetry , or echogenicity ) was of prognostic value . STUDY DESIGN A prospect i ve r and omized study was performed on 67 patients with symptomatic uterine fibroids that were mainly intramural ; these patients were undergoing laparoscopic myomectomy .  Patients were r and omized either to preoperative administration of two injections of a depot formulation of leuprolide acetate 28 days apart ( group A , n = 35 ) or to direct surgery ( group B , n = 32 ) . In each group we studied the number , volume , and echogenicity of the larger fibroids ; the resistance index of uterine arteries and of fibroid vessels ; hematologic parameters ; operative time ; and blood loss . RESULTS The two groups did not differ significantly in basal ultrasonographic parameters and hematologic data . Postoperatively , the red blood cell count and the serum hemoglobin and iron levels were significantly ( p < 0.05 ) lower in group B. Both blood loss ( p < 0.01 ) and operative time ( p < 0.05 ) were significantly lower in group A. However , the operative time was significantly longer when the main fibroid was markedly hypoechoic , probably because the increased softness of the tumor after leuprolide acetate pretreatment makes its enucleation much more cumbersome . CONCLUSION Our data confirm the therapeutic efficacy of preoperative administration of a gonadotropin-releasing hormone analog before laparoscopic myomectomy in reducing the blood loss and in decreasing the operative time . This preoperative course of leuprolide acetate in hypoechoic fibroids , because of the further reduction of the density of the myomas , causes a significant ( p < 0.05 ) increase in operative time Objective To investigate the effect of the gonadotrophin releasing hormone (GnRH)‐agonist goserelin , given by monthly subcutaneous injection for three months prior to total abdominal hysterectomy for uterine leiomyomata , on the pre‐operative symptoms , difficulty of operation and operative blood loss The present study was undertaken in order to evaluate the usefulness or otherwise of preoperative gonadotrophin-releasing hormone ( GnRH ) analogue treatment prior to laparoscopic myomectomy . From June 1993 through December 1996 , 60 premenopausal women aged between 25 and 42 years and with a sonographic diagnosis of intramural or subserous myomas were selected for laparoscopic myomectomy at the Department of Obstetrics and Gynaecology of the Catholic University of The Sacred Heart , Rome . According to a computer-generated sequence , 30 patients were su bmi tted to three cycles of GnRH analogue treatment prior to surgery , whereas no preoperative treatment was prescribed to the other 30 patients . Laparoscopic myomectomy was successfully performed in all patients for a total of 174 myomas excised laparoscopically . The patients ' mean age , the number of myomas per patient , the mean diameter of the myomas , parity and estimated blood loss were similar in both groups . The operative time was significantly longer in the group of patients su bmi tted to GnRH analogue treatment than that of the group of patients not su bmi tted to any preoperative medical therapy ( 157.5 + /- 74.71 versus 112.33 + /- 54.71 min ; P = 0.01 ) . No intra-operative complications occurred . In no case was blood transfusion necessary . Two patients developed post-operative fever ( temperature > 38 degrees C. ) . The mean length of hospital stay was 2.39 days and was similar in both groups . Thirteen spontaneous pregnancies occurred among 24 infertile patients ( 54.1 % ) . The pregnancy rate for these patients was similar in both groups . The viable term delivery rate was 45.8 % . The authors conclude that laparoscopic myomectomy is a feasible and safe procedure . The post-operative pregnancy rate for infertile patients is similar to that following laparotomic myomectomy . The present study suggests that preoperative GnRH analogue treatment does not offer any significant advantages for laparoscopic myomectomy Objective . To investigate the usefulness of a routine short term treatment with gonadotropin releasing hormone agonist ( D‐Trp‐6‐LHRH depot ) before abdominal hysterectomy for leiomyoma The recurrence of myomas and myoma-related symptoms was evaluated in women participating in a r and omized , double-blind , P-controlled study of the efficacy of LA depot before myomectomy .  After 27 to 38 months of follow-up , the recurrence of myomas was found to be greater when at least four myomas were resected . Myoma recurrence was not associated with pretreatment or preoperative uterine volume , resected myoma mass , or preoperative medical therapy To determine whether pre-operative treatment with gonadotrophin-releasing hormone ( GnRH ) analogue may have a beneficial effect on surgery outcome , 53 patients with symptomatic fibroid uteri awaiting myomectomy or transabdominal hysterectomy ( TAH ) , were r and omly divided into a study group ( n = 29 ) and a control group ( n = 24 ) . The study group of patients were treated by an i.m . injection of D-Trp6 LHRH microcapsules at 2 months and 1 month prior to surgery . The control group had no pre-operative treatment .  Haemoglobin concentration and oestradiol , follicle-stimulating hormone and luteinizing hormone concentrations were measured at 2 months and 1 month prior to surgery , and at surgery . The duration of surgery was shorter in the study group ( 49 versus 70 min in the hysterectomy group ) and intra-operative blood loss was less ( 208 versus 309 ml in the hysterectomies and 320 versus 476 ml in the myomectomies ) . Pre-operative treatment with GnRH-agonists which induces shrinkage of the uterus and fibroids is therefore efficient in shortening the duration of surgery , and diminishing the intra-operative blood loss in surgery for fibroid uteri . Such pre-operative treatment is therefore a useful addition to surgery in cases with symptomatic fibroid uteri OBJECTIVE To compare the effects of goserelin acetate treatment with or without iron with iron alone . DESIGN Multinational , multicenter , prospect i ve , r and omized , double-blind study . PATIENTS Premenopausal women with menorrhagia or metrorrhagia and anemia associated with uterine leiomyomata awaiting hysterectomy . INTERVENTION Patients were r and omized to one of three 12-week treatment groups namely goserelin acetate 3.6 mg once monthly plus placebo iron ; 3.6 mg goserelin acetate once monthly plus 600 mg/d iron ; or sham injection once monthly plus 600 mg/d iron . MAIN OUTCOME MEASURE Preoperative hemoglobin concentration ; preoperative uterine and fibroid volumes and operative blood loss . RESULTS Considering the entry and preoperative hemoglobin concentrations , there was a difference in least square means of just over 1 g/dL between the goserelin acetate plus iron and iron only groups and 2.6 g/dL between the goserelin acetate plus iron and goserelin acetate only group . These differences were both statistically significant . Uterine and fibroid volumes were decreased in the goserelin acetate-treated patients by between 37 % and 40 % and 44 % and 47 % , respectively , compared with 7 % decreases for both in the iron only group . The differences in absolute changes were statistically significant for both the goserelin acetate-treated groups versus the iron-treated group . The least square geometric mean operative blood loss was greatest in the iron only group . CONCLUSION In the patient with uterine leiomyomata and anemia , goserelin acetate in combination with iron therapy has shown significant advantages over the iron alone in restoring hematologic normality , decreasing uterine and fibroid volumes , and reducing operative blood loss Objective To determine the effectiveness of leuprolide acetate depot plus iron compared with iron alone in the preoperative treatment of anemia 
    Output:
    
MAIN RESULTS Pre- and post-operative haemoglobin ( Hb ) and haematocrit ( HCT ) were significantly improved by GnRH analogue therapy prior to surgery , and uterine volume , uterine gestational size and fibroid volume were all reduced .
Pelvic symptoms were also reduced but some adverse events were more likely during GnRH analogue therapy .
Hysterectomy appeared to be easier after pre-treatment with GnRH analogue therapy ; there was reduced operating time and a greater proportion of hysterectomy patients were able to have a vaginal rather than an abdominal procedure .
Duration of hospital stay was also reduced .
Blood loss and rate of vertical incisions were reduced for both myomectomy and hysterectomy .
Evidence of increased risk of fibroid recurrence after GnRH analogue pre-treatment in myomectomy patients was equivocal and few data were available to assess change in post-operative fertility .
Lynestrenol did not offer any advantage over GnRH analogue therapy before fibroid surgery .
REVIEW ER 'S CONCLUSIONS The use of GnRH analogues for 3 to 4 months prior to fibroid surgery reduce both uterine volume and fibroid size .
They are beneficial in the correction of pre-operative iron deficiency anaemia , if present , and reduce intra-operative blood loss .
If uterine size is such that a mid-line incision is planned , this can be avoided in many women with the use of GnRH analogues .
For patients undergoing hysterectomy , a vaginal procedure is more likely following the use of these agents