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Sample records for endometriosis perineal malignizada

  1. Endometriosis

    Garcia-Manero, M. (Manuel); Olartecoechea, B. (Begoña); Royo, P. (Pedro); Auba, M. (M.); López-García, G. (Guillermo)

    2008-01-01

    Endometriosis is a common gynaecological disease of unknown aetiology which affects an estimated 10% to 15% of all premenopausal women. It is defined as the presence of endometrial tissue, consisting of both glandular epithelium and stroma, outside the uterine cavity. Three different clinical entities of endometriosis can be distinguished: peritoneal endometriosis, ovarian endometriosis and deep invasive endometriosis. There are several theories to explain their pathogenesis: metaplasia of th...

  2. Endometriosis

    ... can be done to relieve pain and improve fertility. During surgery, endometriosis implants can be removed. Does surgery cure endometriosis? After surgery, most women have relief from pain. However, about 40–80% of women have pain again within 2 years of surgery. The more severe the disease, the ...

  3. Endometriosis

    Available treatment options include medical, surgical and ... with other medical treatment options. ... Gestrinone is a 19-notestosterone derivative .... There are some experimental drugs that in future might alter the treatment of endometriosis.

  4. Perineal massage

    Laura Duarte González

    2013-01-01

    Full Text Available Most women want to give birth without perineal tears, cuts or sutures, because these often cause back pain and discomfort and may have a negative impact on sexual functioning. It is suggested that perineal massage during the last month of pregnancy as a possible way of allowing the perineal tissue to expand more easily during birth. Perineal massage, which makes the woman or her partner (for only one or two times a week from 35 weeks reduces the likelihood of perineal trauma (mainly episiotomies and perineal pain during and after birth.The FAME (Federation of Associations for Midwives in Spain recognizes that perineal massage during pregnancy reduces perineal trauma (episiotomy and tears during childbirth.

  5. Episiotomy scar endometriosis diagnosed on cytology - a case report

    Endometriosis, the presence of functioning endometrial tissue outside the uterus, is a common gynaecological condition. Perineal endometriosis is a rare disease characterized by the presence of ectopic endometrial stroma and glands in the perineum. Most commonly observed in the episiotomy scar after normal vaginal ...

  6. Endometriosis (For Teens)

    ... Staying Safe Videos for Educators Search English Español Endometriosis KidsHealth / For Teens / Endometriosis What's in this article? ... doctor thought Anne might have endometriosis. What Is Endometriosis? When a woman has endometriosis, tissue that looks ...

  7. Living with endometriosis

    Pelvic pain - living with endometriosis; Endometrial implant - living with endometriosis; Endometrioma - living with endometriosis ... counter pain relievers can reduce the pain of endometriosis. These include: Ibuprofen (Advil) Naproxen (Aleve) Acetaminophen (Tylenol) ...

  8. Masaje perineal en gestantes

    Muros Naranjo, Maria Carmen; Luque López, Eva; Sánchez Pascual, María José

    2015-01-01

    Cartel presentadaoen la Segunda Conferencia Internacional de Comunicación en Salud, celebrada el 23 de octubre de 2015 en la Universidad Carlos III de Madrid Introducción: el trauma perineal es una de las complicaciones más frecuentes tras un parto vaginal, que puede estar asociado a una morbilidad a corto y medio plazo; el masaje perineal aumenta la flexibilidad de los músculos perineales, lo que permite extenderse durante el proceso del parto sin que se produzcan desgarros. Objetivos...

  9. What Is Endometriosis?

    ... About Share Facebook Twitter Pinterest Email Print About Endometriosis Endometriosis is a disease in which tissue similar ... to get pregnant. 4 , 5 How common is endometriosis? It is difficult to know exactly how many ...

  10. Perineal Massage in Pregnancy

    ... the perineal tissues. Use a lubricant such as vitamin E oil or almond oil, or any vegetable oil used for cooking— like olive oil. You may also try a water-soluble jelly, such as K-Y jelly, or your ...

  11. Endometriosis mimicking the perianal fistula tract: Case report

    Gül Türkcü

    2014-09-01

    Full Text Available Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. Nowadays, in many cases, although routine use of episiotomy perineal endo metriosis is extremely rare. A 36 year old female patient was referred to our hospital with complaints of pain in the perianal region for five months. On physical examination, stiffness was palpated and then magnetic resonance im aging (MRI was performed. MRI is compatible with fistula tract. The lesion was excised and the histopathological appearance correspond to endometriosis. Perianal endo metriosis is rare in the perianal region and in the clinic mimicking perianal fistulas and malignancy should be kept in mind in the differential diagnosis

  12. Vesical endometriosis

    Akhter, N.; Sohail, I.; Farouk, K.

    2007-01-01

    Endometriosis affecting the urinary tract is very rare and the most common site of involvement is urinary bladder. The clinical features are urgency and frequency, hypo gastric pain and hematuria. Cystoscopic examination is the most valuable diagnostic test but definitive diagnosis requires histological confirmation. A 21-year-old unmarried female presented with lower urinary tract symptoms and blood in urine, more during menstruation. She gave history of left salpingo-oophorectomy. Ultrasonography revealed a mass in the bladder 2 x 3 cm on the posterior wall. Intravenous urography showed a filling defect in the bladder. Urethrocystoscopy performed and growth was resected and sent for histopathology. Histopathology confirmed the diagnosis of vesical endometriosis. She was advised Luteinizing hormone-releasing hormone (LHRH) but she refused as she could not afford it. She was managed on Tab 17-aethinyl testosterone. (author)

  13. Laparoscopic diagnosis of endometriosis.

    Wood, Carl; Kuhn, Raphael; Tsaltas, Jim

    2002-08-01

    To consider and explain the possibility of difficulties in diagnosis of endometriosis at previous laparoscopy Retrospective patient record review. The Endometriosis Care Centre of Australia and the private practices of authors. Two hundred and fifteen patients with clinical evidence of endometriosis examined laparoscopically between March 1999 and May 2001. Confirmation of endometriosis by histological biopsy. Endometriosis was confirmed in 168 of the 215 women. Of these women 38 had a previous negative laparoscopy within 12 months of the current laparoscopy. It is possible that in some of the patients, who previously had a negative laparoscopy, endometriosis was not recognised. Possible reasons for difficulty in diagnosis have been identified and techniques to improve diagnosis suggested. This retrospective study was performed to consider and explain the possibility of difficulties in diagnosis of endometriosis at previous laparoscopy.

  14. [Pseudocontinent perineal colostomy].

    Berrada, S; Khaiz, D; Alloubi, I

    2005-01-01

    This prospective study was designed to evaluate functional results of a pseudocontinent perineal colostomy (PCPC) using Schmidt's technique. Functional results in eight patients whose rectum were resected due to cancer or anal epidermoid carcinoma and reconstructed by PCPC between January 1995 and July 2002 in our institution were evaluated. Surgical technique and post-operative care were described. Morbidity, functional results and degree of patient satisfaction were reported. Median follow-up was 40 months (18-70 months) and was completed in 100% of patients. There were no operative deaths. Four patients had post-operative complications, whose two patients had partial disunion of sutures, and two patients had urinary infection that was treated by adequate antibiotherapy. No conversion to a definitive abdominal colostomy was performed. On a functional level, one patient has normal continence, six had gas incontinence, and one has occasional minimal soiling. Seventy-five percent of patients were either highly satisfied with their continence. PCPC is a reliable technique, which can be proposed as an alternative to a left iliac colostomy following amputation of the rectum due to cancer, provided that certain requirements are met: careful selection of patients, informed consent, flawless surgical technique and lifetime daily colic irrigation.

  15. Endometriosis: Does It Cause Infertility?

    ... Website of the American Society for Reproductive Medicine Endometriosis: Does It Cause Infertility? This fact sheet was ... with The Society of Reproductive Surgeons What is endometriosis? Endometriosis is when tissue is found outside the ...

  16. Perineal evisceration secondary to a bite injury in a dog with an untreated perineal hernia.

    McCarthy, Daniel; Lux, Cassie; Seibert, Rachel

    2016-10-01

    Emergency surgery was performed on a 6-year-old castrated male springer spaniel dog with evisceration of most of the small intestinal tract through the perineal region, secondary to a dog attack. This is the first report describing successful treatment of perineal evisceration secondary to dog attack at an untreated perineal hernia, employing abdominal and perineal approaches.

  17. Anterior perineal hernia after anterior exenteration

    Ka Wing Wong

    2017-10-01

    Full Text Available Perineal hernia is a rare complication of anterior exenteration. We reported this complication after an anterior exenteration for bladder cancer with bleeding complication requiring packing and second-look laparotomy. Perineal approach is a simple and effective method for repair of perineal hernia.

  18. Interleukin-37 in endometriosis.

    Kaabachi, Wajih; Kacem, Olfa; Belhaj, Rafik; Hamzaoui, Agnes; Hamzaoui, Kamel

    2017-05-01

    Interleukin-37 (IL-37) has been identified as a novel anti-inflammatory cytokine. The present study aimed to evaluate the expression of IL-37 in serum and in peritoneal fluid to determine its clinical significance in endometriosis. Enzyme-linked immunosorbent assay (ELISA) was performed to examine serum IL-37 levels in patients with endometriosis and healthy controls. Peritoneal fluid IL-37 mRNA and NFκB expression were quantified by real-time reverse transcription polymerase chain reaction assays. The association of IL-37 levels with clinical factors and prognosis of endometriosis was analysed. We found that IL-37 levels in PF and in serum were significantly higher in patients with endometriosis compared to women without endometriosis (P=0.0005). IL-37 levels were highly expressed in PF [132.38±34.62pg/mL; Pendometriosis patients. IL-37 mRNA expression contrasted with NFκB mRNA expression in PF from patients with endometriosis. A significant inverse correlation was observed between IL-37 mRNA and NFκB mRNA expression. IL-37 expression correlates with endometriosis severity. The affected NFκB mRNA expression in endometriosis contributed the to exhibited increase of IL-37. The increased levels of IL-37 may dampen NFκB activation in endometriosis patients. Copyright © 2017. Published by Elsevier B.V.

  19. Pathogenesis of deep endometriosis.

    Gordts, Stephan; Koninckx, Philippe; Brosens, Ivo

    2017-12-01

    The pathophysiology of (deep) endometriosis is still unclear. As originally suggested by Cullen, change the definition "deeper than 5 mm" to "adenomyosis externa." With the discovery of the old European literature on uterine bleeding in 5%-10% of the neonates and histologic evidence that the bleeding represents decidual shedding, it is postulated/hypothesized that endometrial stem/progenitor cells, implanted in the pelvic cavity after birth, may be at the origin of adolescent and even the occasionally premenarcheal pelvic endometriosis. Endometriosis in the adolescent is characterized by angiogenic and hemorrhagic peritoneal and ovarian lesions. The development of deep endometriosis at a later age suggests that deep infiltrating endometriosis is a delayed stage of endometriosis. Another hypothesis is that the endometriotic cell has undergone genetic or epigenetic changes and those specific changes determine the development into deep endometriosis. This is compatible with the hereditary aspects, and with the clonality of deep and cystic ovarian endometriosis. It explains the predisposition and an eventual causal effect by dioxin or radiation. Specific genetic/epigenetic changes could explain the various expressions and thus typical, cystic, and deep endometriosis become three different diseases. Subtle lesions are not a disease until epi(genetic) changes occur. A classification should reflect that deep endometriosis is a specific disease. In conclusion the pathophysiology of deep endometriosis remains debated and the mechanisms of disease progression, as well as the role of genetics and epigenetics in the process, still needs to be unraveled. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  20. Endometriosis Abdominal wall

    Alvarez, M.; Carriquiry, L.

    2003-01-01

    Endometriosis of abdominal wall is a rare entity wi ch frequently appears after gynecological surgery. Case history includes three cases of parietal endometriosis wi ch were treated in Maciel Hospital of Montevideo. The report refers to etiological diagnostic aspects and highlights the importance of total resection in order to achieve definitive healing

  1. What Are the Symptoms of Endometriosis?

    ... Pinterest Email Print What are the symptoms of endometriosis? The primary symptoms of endometriosis are pain and ... symptoms, may cause these endometriosis symptoms to continue. Endometriosis-Related Pain Researchers know that pain is a ...

  2. Endometriosis, a modern syndrome

    Brosens, Ivo; Benagiano, Giuseppe

    2011-01-01

    The identification of endometriosis has been a subject of intense debate over the last decade. There is, however, no doubt that Thomas Cullen was the first to describe endometriosis and adenomyosis as one disease characterized by the presence of endometrium-like tissue outside the uterine cavity. With the introduction of laparoscopy in the early 1960s three different clinical presentations of endometriosis were distinguished: peritoneal, deep adenomyotic and cystic ovarian. As soon as synthetic steroids became available, pioneer clinicians started utilizing these in an attempt to replace radical surgery by a medical treatment. While medical therapy may resort in relief, in most cases the current approach consists of a combination of medical and surgical therapy. While the pathogenesis of endometriosis is still enigmatic and complex, there is increasing evidence that endometriosis is part of a uterine reproductive dysfunction syndrome. For prevention of complications, it is very important that diagnosis is made as early as possible in a woman's life. PMID:21727656

  3. Bowel Endometriosis Syndrome

    Riiskjær, M; Egekvist, A G; Hartwell, D

    2017-01-01

    STUDY QUESTION: Is it possible to develop a validated score that can identify women with Bowel Endometriosis Syndrome (BENS) and be used to monitor the effect of medical and surgical treatment? SUMMARY ANSWER: The BENS score can be used to identify women with BENS and to monitor the effect...... of medical and surgical treatment of women suffering from bowel endometriosis. WHAT IS KNOWN ALREADY: Endometriosis is a heterogeneous disease with extensive variation in anatomical and clinical presentation, and symptoms do not always correspond to the disease burden. Current endometriosis scoring systems...... are mainly based on anatomical and surgical findings. STUDY DESIGN, SIZE, DURATION: The score was developed and validated from a cohort of 525 women with medically or surgically treated bowel endometriosis from Aarhus and Copenhagen University Hospitals, Denmark. PARTICIPANTS/MATERIALS, SETTING AND METHODS...

  4. Reproductive prognosis in endometriosis

    Hjordt Hansen, Maj V; Dalsgaard, Torur; Hartwell, Dorthe

    2014-01-01

    OBJECTIVE: To assess the reproductive long-term prognosis of women with and without endometriosis, to explore changes over time, and to quantify the contribution of artificial reproductive techniques. DESIGN: Cohort study. SETTING: Denmark 1977-2009. SAMPLE: Data retrieved from four national...... registries. Among 15-49-year-old women during the period 1977-82, 24 667 were diagnosed with endometriosis and 98 668 (1:4) women without endometriosis were age-matched. METHODS: To assess long-term reproductive prognosis, all pregnancy outcomes were identified among the women with and without endometriosis...... until the end of 2009. To explore changes over time, the endometriosis cohorts were followed for 15 years from the years 1980, 1986, 1992 and 1998, with the corresponding control cohorts. All pregnancy outcomes were categorized into naturally or artificially conceived pregnancies. MAIN OUTCOME MEASURES...

  5. The management of perineal wounds

    Ramesh k Sharma

    2012-01-01

    Full Text Available Management of perineal wounds can be very frustrating as these invariably get contaminated from the ano-genital tracts. Moreover, the apparent skin defect may be associated with a significant three dimensional dead space in the pelvic region. Such wounds are likely to become chronic and recalcitrant if appropriate wound management is not instituted in a timely manner. These wounds usually result after tumor excision, following trauma or as a result of infective pathologies like hideradenitis suppurativa or following thermal burns. Many options are available for management of perineal wounds and these have been discussed with illustrative case examples. A review of literature has been done for listing commonly instituted options for management of the wounds in perineum.

  6. Endometriosis e infertilidad = Endometriosis and infertility

    Restrepo Cano, Gustavo Adolfo

    2012-01-01

    Objetivo: revisar la literatura sobre endometriosis en cuanto se relaciona con la infertilidad.Metodología: búsqueda en PubMed / Medline, Hinari y Cochrane con los términos Infertilidad, Endometriosis, Endometrioma, Laparoscopia y Cistectomía. Se seleccionaron investigaciones originales, artículos de revisión y meta-análisis, en inglés, francés y español, publicados entre enero de 2000 y diciembre de 2010. Se eligieron los que evaluaban la fisiopatología, etiología, diagnóstico y tratamiento ...

  7. Laparoscopic repair of postoperative perineal hernia.

    Ryan, Stephen

    2010-01-01

    Perineal hernias are infrequent complications following abdominoperineal operations. Various approaches have been described for repair of perineal hernias including open transabdominal, transperineal or combined abdominoperineal repairs. The use of laparoscopic transabdominal repair of perineal hernias is not well-described. We present a case report demonstrating the benefits of laparoscopic repair of perineal hernia following previous laparoscopic abdominoperineal resection (APR) using a nonabsorbable mesh to repair the defect. We have demonstrated that the use of laparoscopy with repair of the pelvic floor defect using a non absorbable synthetic mesh offers an excellent alternative with many potential advantages over open transabdominal and transperineal repairs.

  8. The epidemiology of endometriosis.

    Cramer, Daniel W; Missmer, Stacey A

    2002-03-01

    Advances in understanding the epidemiology of endometriosis have lagged behind other diseases because of methodologic problems related to disease definition and control selection. Nevertheless, a better picture of the epidemiology of endometriosis has emerged over the past few decades. Prevalence estimates of the disease in clinic populations vary from about a 4% occurrence of largely asymptomatic endometriosis found in women undergoing tubal ligation to 50% of teenagers with intractable dysmenorrhea. General population incidence during the 1970s in this country has been suggested to be 1.6 per 1000 white females aged 15-49, while a more current study based upon hospital discharges finds endometriosis as a first listed diagnosis in 1.3 per 1000 discharges in women aged 15-44. There is a clinical impression that blacks have lower rates of endometriosis and Orientals have higher rates than whites. A variety of personal risk factors for endometriosis have also been described. Women with endometriosis may be taller and thinner. Menstrual factors reported to increase risk include dysmenorrhea, early menarche, and shorter cycle lengths. There is support for the idea that lifestyle exposures that might raise or lower estrogen levels could affect risk, including a decreased risk associated with smoking and exercise and an increased risk associated with caffeine or alcohol use. These risk factors appear to be compatible with the central importance of retrograde menstruation influenced by outflow obstruction that might affect its amount, immune factors that might affect its ability to be cleared, or hormonal stimuli that might affect its growth. In this model, dysmenorrhea could be either a disease symptom or a manifestation of outflow obstruction. Nulliparity could be either a consequence of disease or a cause since nulliparous women would not have the benefit of cervical dilation associated with labor and delivery. Since there is evidence that family history is a risk

  9. Endometriosis e infertilidad = Endometriosis and infertility

    Restrepo Cano, Gustavo Adolfo

    2012-01-01

    Full Text Available Objetivo: revisar la literatura sobre endometriosis en cuanto se relaciona con la infertilidad.Metodología: búsqueda en PubMed / Medline, Hinari y Cochrane con los términos Infertilidad, Endometriosis, Endometrioma, Laparoscopia y Cistectomía. Se seleccionaron investigaciones originales, artículos de revisión y meta-análisis, en inglés, francés y español, publicados entre enero de 2000 y diciembre de 2010. Se eligieron los que evaluaban la fisiopatología, etiología, diagnóstico y tratamiento de la endometriosis en relación con la infertilidad.Resultados: la endometriosis es responsable hasta del 15% de los casos de infertilidad femenina. Los mecanismos comprobados son: obstrucción tubárica, adherencias y endometriomas. La sobreproducción de prostaglandinas y citocinas podría afectar la función del ovario, las trompas y el endometrio. En los estadios I y II es superior el tratamiento quirúrgico frente al farmacológico; este último comprende tres ciclos de clomifeno más inseminación intrauterina (IIU; de no lograrse el embarazo, se debe proceder a administrar gonadotropinas más IIU y por último a la fertilización in vitro (FIV.Conclusiones: la endometriosis afecta la fertilidad por mecanismos comprobados pero puede haber otros aún no bien esclarecidos. Se deben tener en cuenta los avances recientes para ofrecer el mejor tratamiento posible.

  10. A Novel Endometriosis Inducing Factor In Women with Endometriosis

    Ramzy A,; Bibars M; El-Sawaf A; Selim M; Sabry D; Azmy O; Taha TF; Atta H; Rasheed K; El-Garf W; Anwar M

    2010-01-01

    Aim: To confirm the hypothesis of the presence of a possible endometriosis inducing factor(s) (EIF) in the blood of women with endometriosis. Patients and Methods: Forty infertile women were studied. The study group compromised of fifteen women of each three different degrees of endometriosis and fifteen women without endometriosis as a control group. Stem cells are characterized by being spindle shaped and proliferate in appropriate culture indefinitely. The women sera were co-cultured with ...

  11. Endometriosis in Adolescence

    Dessole, Margherita; Melis, Gian Benedetto; Angioni, Stefano

    2012-01-01

    Endometriosis is a common cause of pelvic pain and infertility. The majority of women report symptoms since adolescence, and there are rare cases of endometriosis in premenarchal age patients. Symptoms in adolescence are similar to those in adulthood. Treatment usually consists of oral contraceptives and nonsteroidal anti-inflammatory drugs. In cases where this treatment is not successful, laparoscopy and biopsy of the lesions are necessary for diagnosis. However, emerging new technologies pr...

  12. Endometriosis in adolescence

    Steenberg, Christine Krohn

    2012-01-01

    Endometriosis is a chronic disease with endometrial-like tissue located outside the uterus, resulting in inflammation, pelvic pain and infertility. Laparoscopic exploration is the only accurate diagnostic aid for disease recognition, and the time between symptom onset and final diagnosis can be up to 10 years. Endometriosis can already start in adolescence, and in order to make an earlier diagnosis, researchers are beginning to look for an association between specific characteristics, or mark...

  13. [Endometriosis Update 2016].

    Imesch, Patrick; Fink, Daniel

    2016-03-02

    Endometriosis is a common gynecologic benign disease, affecting 6–10% of women of reproductive age. The disease is often associated with dysmenorrhea, dyspareunia, chronic pelvic pain and infertility. The exact mechanism of the pathogenesis of endometriosis has not yet been fully elucidated, therefore, current medical therapeutic options are more symptom-oriented than causal. The aim of the present work is to summarize the current diagnostic and therapeutic options.

  14. The history of endometriosis.

    Benagiano, Giuseppe; Brosens, Ivo; Lippi, Donatella

    2014-01-01

    A dispute has recently emerged whether early descriptions exist of the condition we name endometriosis. A first question is: 'Who identified endometriosis?' To respond, two non-complementary methods have been employed: searching for ancient descriptions of symptoms associated with endometriosis or, alternatively, identifying researchers who described pathological features we associate with the presence of endometriosis in its various forms. We opted for the latter and found no evidence that in older times anyone delineated the macroscopic features of endometriosis; descriptions of menstrual or cyclic pain cannot be taken as proof of knowledge of what caused it. During the mid-part of the 19th century, Rokitansky had a great intuition: endometrial glands and stroma can be present in ovarian and uterine neoplasias. However, using histological parameters of endometrial structure and activity, the first scientist to delineate peritoneal endometriosis under the name 'adenomyoma' was Cullen. On the other hand, Rokitansky was the first to describe a form of adenomyosis (an adenomatous polyp). Early descriptions of ovarian endometrioma as 'haematomas of the ovary' or 'chocolate cysts' date back to the end of the 19th century. The first mention of an 'ovary containing uterine mucosa' was published in 1899 by Russel, but Sampson was the first to demonstrate specific endometrial activities, such as desquamation at the time of menstruation and decidualization in pregnancy; subsequently, he presented a theory on its pathogenesis. © 2014 S. Karger AG, Basel.

  15. Endometriosis and possible inflammation markers

    Meng-Hsing Wu

    2015-08-01

    Full Text Available Inflammation plays an important role in the pathogenesis of endometriosis. Infiltration of peritoneal macrophages and local proinflammatory mediators in the peritoneal microenvironment affect ovarian function and pelvic anatomy leading to the symptoms and signs of endometriosis. The identification of a noninvasive marker for endometriosis will facilitate early diagnosis and treatment of this disease. This review provides an overview of local microenvironmental inflammation and systemic inflammation biomarkers in endometriosis.

  16. DEEP INFILTRATING ENDOMETRIOSIS

    Martina Ribič-Pucelj

    2018-02-01

    Full Text Available Background: Endometriosis is not considered a unified disease, but a disease encompassing three differ- ent forms differentiated by aetiology and pathogenesis: peritoneal endometriosis, ovarian endometriosis and deep infiltrating endometriosis (DIE. The disease is classified as DIE when the lesions penetrate 5 mm or more into the retroperitoneal space. The estimated incidence of endometriosis in women of reproductive age ranges from 10–15 % and that of DIE from 3–10 %, the highest being in infertile women and in those with chronic pelvic pain. The leading symptoms of DIE are chronic pelvic pain which increases with age and correlates with the depth of infiltration and infertility. The most important diagnostic procedures are patient’s history and proper gynecological examination. The diagnosis is confirmed with laparoscopy. DIE can affect, beside reproductive organs, also bowel, bladder and ureters, therefore adi- tional diagnostic procedures must be performed preopertively to confirm or to exclude the involvement of the mentioned organs. Endometriosis is hormon dependent disease, there- fore several hormonal treatment regims are used to supress estrogen production but the symptoms recurr soon after caesation of the treatment. At the moment, surgical treatment with excision of all lesions, including those of bowel, bladder and ureters, is the method of choice but requires frequently interdisciplinary approach. Surgical treatment significantly reduces pain and improves fertility in inferile patients. Conclusions: DIE is not a rare form of endometriosis characterized by chronic pelvic pain and infertility. Medical treatment is not efficient. The method of choice is surgical treatment with excision of all lesions. It significantly reduces pelvic pain and enables high spontaneus and IVF preg- nacy rates.Therefore such patients should be treated at centres with experience in treatment of DIE and with possibility of interdisciplinary approach.

  17. Perineal colostomy prolapse: a novel application of mesh sacral pexy.

    Landen, S; Ursaru, D; Delugeau, V; Landen, C

    2018-01-01

    Full thickness colonic prolapse following pseudocontinent perineal colostomy has not been previously reported. Possible contributing factors include a large skin aperture at the site of the perineal stoma, the absence of anal sphincters and mesorectal attachments and the presence of a perineal hernia. A novel application of sacral pexy combined with perineal hernia repair using two prosthetic meshes is described.

  18. Obstetrical complications of endometriosis, particularly deep endometriosis.

    Leone Roberti Maggiore, Umberto; Inversetti, Annalisa; Schimberni, Matteo; Viganò, Paola; Giorgione, Veronica; Candiani, Massimo

    2017-12-01

    Over the past few years, a new topic in the field of endometriosis has emerged: the potential impact of the disease on pregnancy outcomes. This review aims to summarize in detail the available evidence on the relationship between endometriosis, particularly deep endometriosis (DE), and obstetrical outcomes. Acute complications of DE, such as spontaneous hemoperitoneum, bowel perforation, and uterine rupture, may occur during pregnancy. Although these events represent life-threatening conditions, they are rare and unpredictable. Therefore, the current literature does not support any kind of prophylactic surgery before pregnancy to prevent such complications. Results on the impact of DE on obstetrical outcomes are debatable and characterized by several limitations, including small sample size, lack of adjustment for confounders, lack of adequate control subjects, and other methodologic flaws. For these reasons, it is not possible to draw conclusions on this topic. The strongest evidence shows that DE is associated with higher rates of placenta previa; for other obstetrical outcomes, such as miscarriage, intrauterine growth restriction, preterm birth and hypertensive disorders, results are controversial. Although it is unlikely that surgery of DE may modify the impact of the disease on the course of pregnancy, no study has yet investigated this issue. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. Immune interactions in endometriosis

    Herington, Jennifer L; Bruner-Tran, Kaylon L; Lucas, John A; Osteen, Kevin G

    2011-01-01

    Endometriosis is a common, complex gynecologic disorder characterized by the presence of endometrial glands and stroma at extrauterine (ectopic) sites. In women who develop this disease, alterations in specific biological processes involving both the endocrine and immune systems have been observed, which may explain the survival and growth of displaced endometrial tissue in affected women. In the past decade, a considerable amount of research has implicated a role for alterations in progesterone action at both eutopic and ectopic sites of endometrial growth which may contribute to the excessive inflammation associated with progression of endometriosis; however, it remains unclear whether these anomalies induce the condition or are simply a consequence of the disease process. In this article, we summarize current knowledge of alterations within the immune system of endometriosis patients and discuss how endometrial cells from women with this disease not only have the capacity to escape immunosurveillance, but also use inflammatory mechanisms to promote their growth within the peritoneal cavity. Finally, we discuss evidence that exposure to an environmental endocrine disruptor, such as 2,3,7,8-tetrachlorodibenzo-p-dioxin, can mediate the development of an endometrial phenotype that exhibits both reduced progesterone responsiveness and hypersensitivity to proinflammatory stimuli mimicking the endometriosis phenotype. Future studies in women with endometriosis should consider whether a heightened inflammatory response within the peritoneal microenvironment contributes to the development and persistence of this disease. PMID:21895474

  20. Racial/ethnic variations in perineal length and association with perineal lacerations: a prospective cohort study.

    Yeaton-Massey, Amanda; Wong, Luchin; Sparks, Teresa N; Handler, Stephanie J; Meyer, Michelle R; Granados, Jesus M; Stasenko, Marina; Sit, Anita; Caughey, Aaron B

    2015-02-01

    To examine the association between race/ethnicity, perineal length and the risk of perineal laceration. This is a prospective cohort study of a diverse group of women with singleton gestations in the third trimester of pregnancy. Perineal length was measured and mean values calculated for several racial/ethnic groups. Chi-squared analyses were used to examine rates of severe perineal laceration (third or fourth degree laceration) by race/ethnicity among women considered to have a short perineal length. Further, subgroup analyses were performed comparing nulliparas to multiparas. Among 344 study participants, there was no statistically significant difference in mean perineal length by race/ethnicity (White 4.0 ± 1.1 cm, African-American 3.7 ± 1.0 cm, Latina 4.1 ± 1.1 cm, Asian 3.8 ± 1.0 cm, and other/unknown 4.0 ± 0.9 cm). Considering parity, more multiparous Asian and African-American women had a short perineal length (20.7 and 23.5%, respectively, p = 0.05). Finally, the rate of severe perineal lacerations in our cohort was 2.6% overall, but was 8.2% among Asian women (p = 0.04). We did not find a relationship between short perineal length and risk of severe perineal laceration with vaginal delivery, or a difference in mean perineal length by maternal race/ethnicity. However, we did find that women of different racial/ethnic groups have varying rates of severe perineal laceration, with Asian women comprising the highest proportion.

  1. Progesterone resistance in endometriosis

    Patel, Bansari G; Rudnicki, Martin; Yu, Jie

    2017-01-01

    Endometriosis is a common cause of pelvic pain and affects up to 10% of women of reproductive age. Aberrant progesterone signaling in the endometrium plays a significant role in impaired decidualization and establishment of ectopic endometrial implants. Eutopic endometrial cells from women...... with endometriosis fail to downregulate genes needed for decidualization, such as those involved in cell cycle regulation, leading to unbridled proliferation. Several causes of progesterone resistance in the endometrium have been postulated, including congenital "preconditioning", whereby the in utero environment...... renders infants susceptible to neonatal uterine bleeding and endometriosis. Progesterone action is crucial to decreasing inflammation in the endometrium, and deviant progesterone signaling results in a proinflammatory phenotype. Conversely, chronic inflammation can induce a progesterone resistant state...

  2. Intrinsic endometriosis of ureter: a case report

    Hong, Myung Sun; Kim, Ho Chul; Yun, Ku Sup; Choi, Chul Soon; Bae, Sang Hoon; Kim, Sung Yong; Shin, Hyung Sik

    1995-01-01

    Endometriosis is a rare cause of an ureteral obstruction. We report a case of intrinsic ureteral endometriosis resulting in severe hydroureteronephrosis. The diagnosis of ureteral endometriosis may be considered in women with flank pain and ureteric obstruction within true pelvis

  3. Intrinsic endometriosis of ureter: a case report

    Hong, Myung Sun; Kim, Ho Chul; Yun, Ku Sup; Choi, Chul Soon; Bae, Sang Hoon; Kim, Sung Yong; Shin, Hyung Sik [College of Medicine, Hallym University, Seoul (Korea, Republic of)

    1995-07-15

    Endometriosis is a rare cause of an ureteral obstruction. We report a case of intrinsic ureteral endometriosis resulting in severe hydroureteronephrosis. The diagnosis of ureteral endometriosis may be considered in women with flank pain and ureteric obstruction within true pelvis.

  4. Proton irradiation and endometriosis

    Wood, D.H.; Yochmowitz, M.G.; Salmon, Y.L.; Eason, R.L.; Boster, R.A.

    1983-01-01

    It was found that female rhesus monkeys given single total-body exposures of protons of varying energies developed endometriosis at a frequency significantly higher than that of nonirradiated animals of the same age. The minimum latency period was determined to be 7 years after the proton exposure. The doses and energies of the radiation received by the experimental animals were within the range that could be received by an aircrew member in near-earth orbit during a random solar flare event. It is concluded that endometriosis should be a consideration in assessing the risk of delayed radiation effects in female crew members. 15 references

  5. Proton irradiation and endometriosis

    Wood, D.H.; Yochmowitz, M.G.; Salmon, Y.L.; Eason, R.L.; Boster, R.A.

    1983-01-01

    Female rhesus monkeys given single total-body exposures of protons of varying energies developed endometriosis at a frequency significantly higher than that of nonirradiated animals of the same age. The minimum latency period was 7 years after exposure. The doses and energies of the radiation received were within the range that could be received by an aircrew member in near-earth orbit during a random solar flare event, leading to the conclusion that endometriosis should be a consideration in assessing the risk of delayed radiation effects in female crewmembers

  6. Rectus abdominis muscle endometriosis

    Goker, A.

    2014-01-01

    Endometriosis is characterized by an abnormal existence of functional endometrial tissue outside the uterine cavity, typically occuring within the pelvis of women in reproductive age. We report two cases with endometriosis of the abdominal wall; the first one in the rectus abdominis muscle and the second one in the surgical scar of previous caesarean incision along with the rectus abdominis muscle. Pre-operative evaluation included magnetic resonance imaging. The masses were dissected free from the surrounding tissue and excised with clear margins. Diagnosis of the excised lesions were verified by histopathology. (author)

  7. Endometriosis in Adolescence

    Margherita Dessole

    2012-01-01

    Full Text Available Endometriosis is a common cause of pelvic pain and infertility. The majority of women report symptoms since adolescence, and there are rare cases of endometriosis in premenarchal age patients. Symptoms in adolescence are similar to those in adulthood. Treatment usually consists of oral contraceptives and nonsteroidal anti-inflammatory drugs. In cases where this treatment is not successful, laparoscopy and biopsy of the lesions are necessary for diagnosis. However, emerging new technologies provide new options, in particular the use of serological markers.

  8. Perineal Sensation Predictive of Spina Bifida Outcome

    J Gordon Millichap

    2007-01-01

    Full Text Available Neurologic examination, including perineal sensation, was conducted in a prospective cohort study of 117 consecutive patients with open spina bifida at St George's, University of London, and Addenbrooke's Hospital, Cambridge, UK.

  9. Art and Endometriosis.

    Berstein, Jane C.

    1995-01-01

    Relation of an art therapist's personal story concerning her struggle to overcome endometriosis, and how her artwork has played a vital role in coping with the disease. Illustrated with a chronology of artwork produced during a bout with the illness. (JPS)

  10. Perineal recurrence of prostate cancer six years after trans-perineal brachytherapy

    Eppinga, Wietse; Vijverberg, Peter; Moerland, Rien; Brand, Eric; van der Voort van Zyp, Jochem; Noteboom, Juus; van Vulpen, Marco

    We report a case of perineal recurrence of prostate cancer 6 years after low-dose-rate (LDR) brachytherapy for localized prostate cancer. The most common approach to treat such perineal masses, including those occurring after prior biopsy or surgery, is local excision. We report the use of

  11. Endometriosis and possible inflammation markers

    Meng-Hsing Wu; Kuei-Yang Hsiao; Shaw-Jenq Tsai

    2015-01-01

    Inflammation plays an important role in the pathogenesis of endometriosis. Infiltration of peritoneal macrophages and local proinflammatory mediators in the peritoneal microenvironment affect ovarian function and pelvic anatomy leading to the symptoms and signs of endometriosis. The identification of a noninvasive marker for endometriosis will facilitate early diagnosis and treatment of this disease. This review provides an overview of local microenvironmental inflammation and systemic inflam...

  12. Angiogenesis and Endometriosis

    Ana Luiza L. Rocha

    2013-01-01

    Full Text Available A comprehensive review was performed to survey the role of angiogenesis in the pathogenesis of endometriosis. This is a multifactorial disease in which the development and maintenance of endometriotic implants depend on their invasive capacity and angiogenic potential. The peritoneal fluid of patients with endometriosis is a complex suspension carrying inflammatory cytokines, growth factors, steroid hormones, proangiogenic factors, macrophages, and endometrial and red blood cells. These cells and their signaling products concur to promote the spreading of new blood vessels at the endometriotic lesions and surroundings, which contributes to the endometriotic implant survival. Experimental studies of several antiangiogenic agents demonstrated the regression of endometriotic lesions by reducing their blood supply. Further studies are necessary before these novel agents can be introduced into clinical practice, in particular the establishment of the safety of anti-angiogenic medications in women who are seeking to become pregnant.

  13. Emerging treatment of endometriosis

    Aboubakr Elnashar

    2015-06-01

    Full Text Available Current treatment of endometriosis is mainly based on surgery and ovarian suppressive agents (oral contraceptives, progestins, GnRh agonist and androgenic agents. Hormonal treatments are often associated with unwanted effects, delayed conception and recurrence of disease and symptoms when stopped. For these reasons, new drugs that aim new targets are required to cause regression of the disease & symptoms without adverse hypo-estrogenic effects. This review aims to provide an update on the new drugs used for treatment of endometriosis. These include the levonorgestrel-releasing intrauterine device, GnRH antagonists, aromatase inhibitors, selective estrogen-receptor modulators, progesterone antagonist, selective progesterone receptor modulators, angiogenesis inhibitors, and immunomodulatory drugs.

  14. Endometriosis | Matebese | Continuing Medical Education

    Endometriosis is a benign disease defined as the presence of endometrial glands and stroma outside the uterus. Its pathogenesis and optimal management remain controversial, and its true prevalence is unknown. Endometriosis can be debilitating and can affect the psychosocial functioning of women. It is estimated to ...

  15. Conservative approach to rectosigmoid endometriosis

    Egekvist, Anne G; Marinovskij, Edvard; Forman, Axel

    2017-01-01

    INTRODUCTION: The aim of the study was to assess the risk of surgery after initial conservative treatment of rectosigmoid endometriosis in relation to demographic data. MATERIAL AND METHODS: The study was conducted on the tertiary endometriosis referral unit, Aarhus University Hospital. Medical...

  16. Ovarian irradiation in recurrent endometriosis

    Kochbati, L.; Chaari, N.; Besbes, M.; Maalej, M.; Neji, K.; Ben Amara, F.; Ben Romdhane, N.K.

    2005-01-01

    We describe a case of a young woman with a history of an aplastic anaemia in which pelvic radiotherapy was used successfully in the management of a recurrent and inoperable endometriosis. The use of therapeutic pelvic or ovarian irradiation in endometriosis may be considered, when surgical and medical treatments have been exhausted and have failed. (authors)

  17. Endometriosis e infertilidad

    O. Emilio Fernández, Dr.

    2010-05-01

    Full Text Available Este artículo revisa la evidencia reciente relacionada con el impacto de la endometriosis sobre la fertilidad. La endometriosis se presenta durante la vida reproductiva y es diagnosticada frecuentemente en mujeres en estudio de infertilidad. Tiene múltiples formas de presentación: peritoneal, infiltración profunda, ovárica y/o nódulo rectovaginal. En las etapas avanzadas la infertilidad se explica por la distorsión anatómica de los órganos reproductivos, y en las etapas iniciales, sin distorsión anatómica, se debería a la presencia una de reacción inflamatoria peritoneal, que compromete eventos reproductivos claves como el desarrollo folicular, la ovulación, el desarrollo embrionario y la implantación. El tratamiento de la endometriosis es quirúrgico y consiste en la resección tumoral máxima que permite restablecer la fecundidad natural. Tratamientos complementarios como IO, IIU e IVF, resultan apropiados cuando la cirugía no logra recuperar la fertilidad, en estadios avanzados y/o frente a la presencia de otros factores asociados de infertilidad.

  18. Prevención del trauma perineal intraparto mediante el masaje perineal

    González Casillas, María Jesús

    2014-01-01

    El trauma perineal es una de las complicaciones más frecuentes en el periodo expulsivo del parto. El masaje perineal se plantea como una intervención para prevenir y evitar dicho trauma. Objetivo: realizar una revisión bibliográfica en los últimos doce años, para dar a conocer los beneficios de la aplicación del masaje perineal durante el embarazo. Método: búsqueda bibliográfica en las bases de datos Pubmed, Cochrane, Cinahl y Cuiden plus, utilizando como palabras clave: masaje...

  19. Endometriosis and uterine malformations: infertility may increase severity of endometriosis.

    Boujenah, Jeremy; Salakos, Eleonora; Pinto, Mélodie; Shore, Joanna; Sifer, Christophe; Poncelet, Christophe; Bricou, Alexandre

    2017-06-01

    The aim of our study was to compare the stage and severity of endometriosis in fertile and infertile women with congenital uterine malformations. We performed an observational study from September 2007 to December 2015 in a tertiary care university hospital and assisted reproductive technology center. A total of 52 patients with surgically proven uterine malformations were included. We compared 41 infertile patients with uterine malformations with 11 fertile patients with uterine malformation. The main outcome was the stage, score and type of endometriosis in regard to infertility and class of uterine malformation. The rate of endometriosis did not differ between the two groups (43.9 vs. 36.4%). The mean revised American Fertility Society score was higher in infertile patients with uterine malformations (19.02 vs. 6, p endometriosis (43.9 vs. 37.5%). Endometrioma and deep infiltrating endometriosis were associated with uterine malformations in infertile women, respectively 14.6 and 0%. No difference in the characteristics of endometriosis was found regarding the class of malformation. The association of uterine malformations and infertility may increase the severity of endometriosis and raise the issue of their diagnosis and management. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  20. Paracetamol vs dexketoprofen for perineal pain relief after episiotomy or perineal tear.

    Akil, A; Api, O; Bektas, Y; Yilmaz, A Onan; Yalti, S; Unal, O

    2014-01-01

    A randomised controlled trial was conducted to investigate efficacy of paracetamol and dexketoprofen trometamol for perineal pain relief after perineal repair. Subjects were randomly assigned to receive two doses of either 50 mg of intravenous dexketoprofen trometamol via slow i.v. infusion (Group I, n = 49) or 1,000 mg of paracetamol via intravenous infusion (Group II, n = 46). The main outcome measure was a VAS (visual analogue scale) for pain recorded at 1 h (VAS 1). A total of 82 patients were included in the final analysis (Group I, n = 41; Group II, n = 41). There was no difference among groups in terms of pain scores at the beginning (VAS 0). The pain was decreased in 70% of the patients in Group I and in 62% of the patients in Group II (p = 0.502). Both paracetamol and dexketoprofen are effective in perineal pain relief after episiotomy or perineal tear repair.

  1. Reproductive prognosis in daughters of women with and without endometriosis

    Dalsgaard, T; Hansen, Maj Vadskjær Hjordt; Hartwell, D

    2013-01-01

    Do daughters of women with endometriosis exhibit an increased risk of endometriosis and impaired long-term reproductive prognosis when compared with daughters of women without endometriosis?......Do daughters of women with endometriosis exhibit an increased risk of endometriosis and impaired long-term reproductive prognosis when compared with daughters of women without endometriosis?...

  2. Perineal Ectopic Testis in an Adult

    in an ectopic site outside the scrotum; such as the perineum, pubic region, dorsum of the penis, femoral region, anterior abdominal wall and the contralateral scrotum. Management is orchidopexy through an inguinal crease incision as the length of the spermatic cord is normal. We report a 26 year old man with a left perineal ...

  3. Endometriosis in an episiotomy scar

    Mine islimye Taskin

    2016-03-01

    Full Text Available Endometriosis that is defined as the presence of functional endometrial tissue outside the uterine cavity is seen 5-10% of reproductive age women. Endometriosis can be seen any other site of the body; but the most frequently affected areas are ovaries, pelvic peritoneum, uterosacral ligament and Douglas pouche. Several teories exist for the development of endometriosis including retrograde menstruation, venous or lymphatic metastasis and immun dysfunction. Endometriosis of the perineum and vulva are extremely rare with the most common sites being episiotomy scars. Scar endometriosis is likely to be caused by mechanical transplantation of endometrium from the uterine cavity into the wound at the time of the surgery. The primary treatment for scar endometriosis is total surgical excision of the lesion. It is important not to leave residual tissue during surgery to prevent the recurrence. Here we present a patient who had her vaginal delivery 5 years ago, have a complaint of painful vulvar lump at the right mediolateral episiotomy scar since 1 year during her every menstruation period and whose final diagnosis was endometriosis after surgical removal and histopathologic examination. Althought vulvar endometrosis is rare, it should be considered in the patients who had a vaginal delivery and complaining painful vulvar lump with swelling in her mestrual cycle. [Cukurova Med J 2016; 41(1.000: 164-166

  4. Scar Endometriosis Following Cesarean Section

    Rüya Deveer

    2012-04-01

    CONCLUSION: Abdominal wall endometriosis frequently presents with cyclical pain during menstruation which is localised to a palpable mass in the abdominal wall especially in those who have had previous cesarean section. Complete surgical excision is curative.

  5. Transvaginal ultrasonography of rectal endometriosis

    Egekvist, Anne Gisselmann; Seyer-Hansen, Mikkel; Forman, Axel

    Objectives: The aim of this present study was to evaluate the interobserver variation of transvaginal ultrasonographic measurements of endometriosis infiltrating the rectosigmoid wall. Methods: Transvaginal ultrasonography was performed independently by two observers. Observer 1 had several years...... of experience in ultrasonography while observer 2 was a medical student with no prior experience in ultrasonography or endometriosis. In 24 patient length, width and depth of endometriosis infiltrating the rectosigmoid bowel was measured. The differences between the observers were analysed by Bland and Altman...... for a relatively short period gives comparable scanning results between the two observers. It seems that transvaginal ultrasound could be used as a diagnostic tool for rectal endometriosis in most departments. However, the irregular morphology of the lesions makes the measurements very complex, and a strict...

  6. Intussusception secondary to endometriosis of the cecum

    Hideki Katagiri

    2014-01-01

    CONCLUSION: Intussusception in an adult is a rare cause of bowel obstruction and intussusception caused by endometriosis is also rare. Although rare, the diagnosis of endometriosis as a cause of intussusception must be considered as part of the differential diagnosis.

  7. Surgical treatment of endometriosis before gamete intrafallopian ...

    Abstract. Objective. To determine whether active pelvic endometriosis impairs the efficacy of GIFT (gamete intrafallopian transfer) and whether prior surgical treatment of endometriosis improves the efficacy of GIFT. Design. Matched controlled retrospective study. Setting. University-based assisted reproduction programme.

  8. Researchers Realize Major Breakthrough in Understanding Endometriosis

    ... 16, 2014 Researchers Realize Major Breakthrough in Understanding Endometriosis For a disease that affects an estimated 6 ... 10% of women, surprisingly little is known about endometriosis — a disorder that causes uterine tissue to grow ...

  9. Autophagy in endometriosis: Friend or foe?

    Zhan, Lei; Li, Jun; Wei, Bing

    2018-01-01

    Endometriosis is a chronic, estrogen-dependent disease and characterized by the implantation of endometrial glands and stroma deep and haphazardly into the outside the uterine cavity. It affects an estimated 10% of the female population of reproductive age and results in obvious reduction in health-related quality of life. Unfortunately, there is no a consistent theory for the etiology of endometriosis. Furthermore, the endometriosis is hard to diagnose in early stage and the treatment methods are limited. Importantly, emerging evidence has investigated that there is a close relationship between endometriosis and autophagy. However, autophagy is a friend or foe in endometriosis is puzzling, the precise mechanism underlying autophagy in endometriosis has not been fully elucidated yet. Here, we provide an integrated view on the acquired findings of the connections between endometriosis and autophagy. We also discuss which may contribute to the abnormal level of autophagy in endometriosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. ENVIRONMENTAL PCB EXPOSURE AND RISK OF ENDOMETRIOSIS

    BACKGROUND: Hormonally active environmental agents recently have been associated with the development of endometriosis. METHODS: We undertook a study to assess the relation between endometriosis, an estrogen dependent gynecologic disease, and 62 individual polychlorinated biphe...

  11. Primary posterior perineal herniation of urinary bladder

    Kurumboor Prakash

    2013-01-01

    Full Text Available Primary perineal hernia is a rare clinical condition wherein herniation of viscera occurs through pelvic diaphragm. They are usually mistaken for sciatic hernia, rectal prolapse or other diseases in the perineum. Correct identification of the type of hernia by imaging is crucial for planning treatment. We present a case of primary posterior herniation of urinary bladder and rectal wall through levator ani repaired laparoscopically using a mesh repair.

  12. Delayed Single Stage Perineal Posterior Urethroplasty

    Ali, S.; Shahnawaz; Shahzad, I.; Baloch, M. U.

    2015-01-01

    Objective: To determine the delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture/distraction defect. Study Design: Descriptive case series. Place and Duration of Study: Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2009 to December 2011. Methodology: Patients were selected for delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture / distraction defect. All were initially suprapubically catheterized followed by definitive surgery after at least 3 months. Results: Thirty male patients were analyzed with a mean follow-up of 10 months, 2 patients were excluded as they developed failure in first 3 months postoperatively. Mean patients age was 26.25 ± 7.9 years. On follow-up, 7 patients (23.3 percentage) experienced recurrent stricture during first 10 months. Five (16.6 percentage) patients were treated successfully with single direct visual internal urethrotomy. Two patients (6.6 percentage) had more than one direct visual internal urethrotomy and considered failed. Re-do perineal urethroplasty was eventually performed. The overall success rate was 93.3 percentage with permissive criteria allowing single direct visual internal urethrotomy and 76.6% with strict criteria allowing no more procedures postoperatively. Conclusion: Posterior anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and distraction defect even after multiple prior procedures. (author)

  13. Delayed Single Stage Perineal Posterior Urethroplasty.

    Ali, Shahzad; Shahnawaz; Shahzad, Iqbal; Baloch, Muhammad Umar

    2015-06-01

    To determine the delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture/distraction defect. Descriptive case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2009 to December 2011. Patients were selected for delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture / distraction defect. All were initially suprapubically catheterized followed by definitive surgery after at least 3 months. Thirty male patients were analyzed with a mean follow-up of 10 months, 2 patients were excluded as they developed failure in first 3 months postoperatively. Mean patient's age was 26.25 ± 7.9 years. On follow-up, 7 patients (23.3%) experienced recurrent stricture during first 10 months. Five (16.6%) patients were treated successfully with single direct visual internal urethrotomy. Two patients (6.6%) had more than one direct visual internal urethrotomy and considered failed. Re-do perineal urethroplasty was eventually performed. The overall success rate was 93.3% with permissive criteria allowing single direct visual internal urethrotomy and 76.6% with strict criteria allowing no more procedures postoperatively. Posterior anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and distraction defect even after multiple prior procedures.

  14. Perineal hernia with bladder retroflexion in a female cocker spaniel

    Niles, J.D.; Williams, J.M.

    1999-01-01

    Perineal herniation in the bitch is rare and its complication by bladder retroflexion in the bitch has not been previously reported in the literature. This case report describes a multigravid, five-year-old female cocker spaniel with bilateral perineal hernias, complicated by marked rectal sacculation and ventral bladder retroflexion. The case was managed initially by cystopexy and colopexy, followed seven days later by bilateral perineal herniorrhaphy. There was no recurrence of the problem by 12 months postsurgery

  15. A young woman with endometriosis of kidney

    Dutta, P.; Bhat, M. H.; Bhansali, A.; Kumar, V.

    2006-01-01

    Endometriosis of kidney is a rare manifestation of a relatively common disease. We report a case in which ovarian and renal endometriosis were diagnosed concurrently. The disease was probably silent for a long time due to coexistent thyrotoxicosis modifying estrogen metabolism. Fine needle aspiration cytology clinched the diagnosis of endometriosis and avoided unnecessary nephrectomy. (author)

  16. Midwives conducting perineal repair: The Danish Suture Trial

    Kindberg, Sara

    2007-01-01

    Midwives conducting perineal repair: The Danish Suture Trial.     Background Suture techniques and materials for repair of 2nd degree perineal lacerations and episiotomies have been tested in several clinical trials. Danish midwives and obstetricians have developed a new, simple and time-efficien......Midwives conducting perineal repair: The Danish Suture Trial.     Background Suture techniques and materials for repair of 2nd degree perineal lacerations and episiotomies have been tested in several clinical trials. Danish midwives and obstetricians have developed a new, simple and time...

  17. Endometriosis in the male.

    Martin, J D; Hauck, A E

    1985-07-01

    An 83-year-old man with an endometrioma of the lower abdominal wall has been reported. This occurred following the administration of 25 mg of TACE for a period of about 10 years for what was thought to be carcinoma of the prostate. A second transurethral resection done by Dr. R. C. Thompson proved to be adenocarcinoma. Subsequent to this he was continued on TACE. A review of the more commonly accepted theories of the development of endometriosis in the female has been presented. It is pointed out that the separation between the male and female urogenital systems occurs in the embryo between the eighth week and the fourth month. There is always a possibility for remnants of the opposite sex to remain in individuals. No such was seen in the case which is herein reported. Normal phenotype male was demonstrated in the chromosomal evaluation. A review of the literature on endometriosis in the male reveals several cases which have occurred; the origin of which is though to be from the prostatic utricle which is a remnant of the uterus existing in the male. After a prolonged course the patient reported was followed until he died in 1979. There was no recurrence of the abdominal wall mass but persistent low grade carcinoma of the prostate remained. The terminal process was related to cardiovascular disease and not carcinoma of the prostate. There was delay in publication of this unusual case. The original plan was to await final confirmation of the exact pathologic nature of this condition; unfortunately this was never done since a postmortem examination was not performed.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Laparoscopic Management of Ureteral Endometriosis and Hydronephrosis Associated With Endometriosis.

    Alves, João; Puga, Marco; Fernandes, Rodrigo; Pinton, Anne; Miranda, Ignacio; Kovoor, Elias; Wattiez, Arnaud

    STUDY OBJECTIVE: To evaluate if laparoscopic treatment of ureteral endometriosis is feasible, safe, and effective and to determine if ureteral dilatation and/or the number of incisions increases complications. An institutional review board-approved retrospective cohort study of consecutive patients who underwent surgery for deep infiltrating endometriosis involving the ureter with hydronephrosis (Canadian Task Force classification III). A university hospital. Of 658 patients who had surgery for deep infiltrating endometriosis between November 2004 and December 2013, 198 of the 658 patients had ureteral endometriosis and required ureterolysis, and 28 of the 198 patients were identified with ureteral dilatation and hydronephrosis associated with endometriosis. Of these 28 cases, 15 ureterolyses, 12 reanastomoses, and 1 reimplantation were performed. Medical, operative, and pathological data on the evolution of pain, urinary complaints, fertility, complications, and recurrences were collected from clinical records. Additionally, telephone interviews were performed for the follow-up of long-term outcomes. All 28 patients had concomitant surgical procedures because of endometriosis elsewhere in the pelvis or abdomen; 12 (42.9%) underwent surgery of the bowel, whereas 5 (17.9%) had bladder surgery. The evolution of pain after surgery showed a positive response (mean dysmenorrhea evaluation measured by the Numeric Pain Rating Scale from 0-10 preoperatively at the short-term follow-up and the long-term follow-up: 7.25-1.73 and 0.25, respectively). Three complications were noted in the group of 28 patients with ureterohydronephrosis; 1 required surgical reintervention. Logistic regression analyses found vaginal incision (odds ratio = 2.08; 95% CI 0.92-4.73), bladder incision (odds ratio = 8.77; 95% CI 3.25-23.63), number of incisions (odds ratio = 2.12; 95% CI 1.29-3.47), and number of previous surgeries (odds ratio = 1.26; 95% CI 0.93-1.71) as independent risk

  19. Bladder Involvement in Stage I Endometriosis.

    Brady, Paula C; Missmer, Stacey A; Laufer, Marc R

    2017-08-01

    Endometriosis-the ectopic implantation of endometrial-like tissue-affects 10% of adolescent females and adults. Bladder involvement, causing dysuria and hematuria, occurs in a very small number of endometriosis patients. The patient presented at age 12 years with dysuria and pelvic pain. Laparoscopy revealed stage I endometriosis. Postoperatively, she reported persistent dysuria and passage of tissue in her urine. Cystoscopy showed diffuse erythema; urine cytology revealed glandular and spindle cells suggestive of endometriosis. She was transitioned from oral contraceptives to an intranasal gonadotropin-releasing hormone agonist, with symptom resolution. Intravesicular endometriosis coinciding with stage I disease supports a mechanism of endometriosis dissemination other than direct bladder infiltration. Patients with endometriosis who complain of urinary symptoms warrant assessment, because intravesicular bladder involvement cannot be excluded using pelviscopy. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  20. World Endometriosis Society consensus on the classification of endometriosis.

    Johnson, Neil P; Hummelshoj, Lone; Adamson, G David; Keckstein, Jörg; Taylor, Hugh S; Abrao, Mauricio S; Bush, Deborah; Kiesel, Ludwig; Tamimi, Rulla; Sharpe-Timms, Kathy L; Rombauts, Luk; Giudice, Linda C

    2017-02-01

    What is the global consensus on the classification of endometriosis that considers the views of women with endometriosis? We have produced an international consensus statement on the classification of endometriosis through systematic appraisal of evidence and a consensus process that included representatives of national and international, medical and non-medical societies, patient organizations, and companies with an interest in endometriosis. Classification systems of endometriosis, developed by several professional organizations, traditionally have been based on lesion appearance, pelvic adhesions, and anatomic location of disease. One system predicts fertility outcome and none predicts pelvic pain, response to medications, disease recurrence, risks for associated disorders, quality of life measures, and other endpoints important to women and health care providers for guiding appropriate therapeutic options and prognosis. A consensus meeting, in conjunction with pre- and post-meeting processes, was undertaken. A consensus meeting was held on 30 April 2014 in conjunction with the World Endometriosis Society's 12th World Congress on Endometriosis. Rigorous pre- and post-meeting processes, involving 55 representatives of 29 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement. A total of 28 consensus statements were made. Of all, 10 statements had unanimous consensus, however none of the statements was made without expression of a caveat about the strength of the statement or the statement itself. Two statements did not achieve majority consensus. The statements covered women's priorities, aspects of classification, impact of low resources, as well as all the major classification systems for endometriosis. Until better classification systems are developed, we propose a classification toolbox (that includes the revised American Society for Reproductive Medicine and, where appropriate, the

  1. Hérnia perineal primária: relato de caso Primary perineal hernia: case report

    Hernán Augusto Centurión Sobral

    2009-03-01

    Full Text Available As hérnias perineais primárias resultam de um defeito no assoalho pélvico que permite a passagem de conteúdo abdominal para a região pelve-perineal. É uma enfermidade rara, tendo sido descritos menos de cem casos até hoje. Apresentamos o caso de uma paciente jovem com queixa recente de tumoração glútea dolorosa que, mesmo após o exame físico e tomográfico, não teve sua etiologia esclarecida. Foi então submetida à ressecção cirúrgica da lesão via perineal, quando se confirmou tratar-se de saco herniário isquiorretal esquerdo transpondo defeito no músculo elevador do ânus. Evoluiu sem intercorrências no pósoperatório e sem indícios de recidiva.Primary perineal hernias result from a defect in the pelvic floor. It is a rare disease, having been described less than one hundred cases until today. We present a case of a young patient with recent complaint of painful gluteal tumor that even after the physical examination and CT did not clarified its etiology. She was submitted to a perineal resection of the lesion that confirmed being a hernia. She is going well without recurrence.

  2. An Audit of Perineal Trauma and Vertical Transmisson Of HIV

    USER

    episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on ... The incidence of episiotomy was more in the HIV negative group (p=0.0000) while that of perineal tear was not affected .... median CD4 cell count was 458.0686 (26-1538) and the ...

  3. Postpartum perineal repair performed by midwives

    Kindberg, S; Stehouwer, M; Hvidman, L

    2008-01-01

    OBJECTIVE: To compare a continuous suture technique with interrupted stitches using inverted knots for postpartum perineal repair of second-degree lacerations and episiotomies. DESIGN: A double-blind randomised controlled trial. SETTING: A Danish university hospital with more than 4800 deliveries...... months postpartum. Pain was evaluated using a visual analogue scale and the McGill Pain Questionnaire. Wound healing was evaluated using the REEDA scale and by assessment of gaping wounds >0.5 cm. Analysis complied with the intention-to-treat principle. MAIN OUTCOME MEASURES: The primary outcome...

  4. Nutritional aspects related to endometriosis

    Gabriela Halpern

    2015-12-01

    Full Text Available SUMMARY This literature review analyzed the evidence on nutritional aspects related to the pathogenesis and progression of endometriosis. Diets deficient in nutrients result in changes in lipid metabolism, oxidative stress and promote epigenetic abnormalities, that may be involved in the genesis and progression of the disease. Foods rich in omega 3 with anti-inflammatory effects, supplementation with Nacetylcysteine, vitamin D and resveratrol, in addition to the increased consumption of fruits, vegetables (preferably organic and whole grains exert a protective effect, reducing the risk of development and possible regression of disease. Dietary re-education seems to be a promising tool in the prevention and treatment of endometriosis.

  5. Reliability of visual diagnosis of endometriosis.

    Fernando, Shavi; Soh, Pei Qian; Cooper, Michael; Evans, Susan; Reid, Geoffrey; Tsaltas, Jim; Rombauts, Luk

    2013-01-01

    To determine whether accuracy of visual diagnosis of endometriosis at laparoscopy is determined by stage of disease. Prospective longitudinal cohort study (Canadian Task Force classification II-2). Tertiary referral centers in three Australian states. Of 1439 biopsy specimens, endometriosis was proved in at least one specimen in 431 patients. Laparoscopy with visual diagnosis and staging of endometriosis followed by histopathologic analysis and confirmation. Operations were performed by five experienced laparoscopic gynecologists. Histopathologic confirmation of visual diagnosis of endometriosis adjusted for significant covariates. Endometriosis was accurately diagnosed in 49.7% of American Society for Reproductive Medicine (ASRM) stage I, which was significantly less accurate than for other stages of endometriosis. Deep endometriosis was more likely to be diagnosed accurately than superficial endometriosis (adjusted odds ratio, 2.51; 95% confidence interval, 1.50-4.18; p < .01). Lesion volume was also predictive, with larger lesions diagnosed more accurately than smaller lesions. In general, lesion site did not greatly influence accuracy except for superficial ovarian lesions, which were more likely to be incorrectly diagnosed visually as endometriosis (adjusted odds ratio, 0.16; 95% confidence interval, 0.06-0.41; p < .01). There was no statistically significant difference in accuracy between the gynecologic surgeons. The accuracy of visual diagnosis of endometriosis was substantially influenced by American Society of Reproductive Medicine stage, the depth and volume of the lesion, and to a lesser extent the location of the lesion. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  6. Adenosarcoma arising in hepatic endometriosis

    N'Senda, P.; Dahan, H.; Tubiana, J.M.; Arrive, L.; Wendum, D.; Balladur, P.

    2000-01-01

    We report a case of adenosarcoma arising in hepatic endometriosis. Both CT and MR scans demontrated a huge heterogeneous mass containing septated, thick-walled cystic lesions. After enlarged right hepatectomy, the patient was asymptomatic with no abnormalities at liver and abdominal CT scan at 2-year follow-up. (orig.)

  7. MR diagnosis of diaphragmatic endometriosis

    Rousset, Pascal; Gregory, Jules; Coste, Joel; Rousset-Jablonski, Christine; Hugon-Rodin, Justine; Regnard, Jean-Francois; Chapron, Charles; Golfier, Francois; Revel, Marie-Pierre

    2016-01-01

    To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis. Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics. Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes. MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. (orig.)

  8. MR diagnosis of diaphragmatic endometriosis

    Rousset, Pascal [Lyon 1 Claude Bernard University, Villeurbanne (France); Centre Hospitalier Lyon Sud, Radiology Department, Pierre Benite (France); Gregory, Jules; Coste, Joel [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Biostatistics and Epidemiology department, Paris (France); Rousset-Jablonski, Christine [Centre Hospitalier Lyon Sud, Obstetric and Gynecologic Department, Pierre Benite (France); Hugon-Rodin, Justine [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Gynecology Endocrinology Department, Paris (France); Regnard, Jean-Francois [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Thoracic Surgery Department, Paris (France); Chapron, Charles [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Obstetric and Gynecologic Department, Paris (France); Golfier, Francois [Lyon 1 Claude Bernard University, Villeurbanne (France); Centre Hospitalier Lyon Sud, Obstetric and Gynecologic Department, Pierre Benite (France); Revel, Marie-Pierre [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Radiology Department, Paris (France)

    2016-11-15

    To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis. Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics. Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes. MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. (orig.)

  9. Adenosarcoma arising in hepatic endometriosis

    N' Senda, P.; Dahan, H.; Tubiana, J.M.; Arrive, L. [Service de Radiologie, Hopital Saint-Antoine, 75 - Paris (France); Wendum, D. [Service d' Anatomie Pathologie, Hopital Saint-Antoine, 75 - Paris (France); Balladur, P. [Service de Chirurgie Digestive et Generale, Hopital Saint-Antoine, 75 - Paris (France)

    2000-08-01

    We report a case of adenosarcoma arising in hepatic endometriosis. Both CT and MR scans demontrated a huge heterogeneous mass containing septated, thick-walled cystic lesions. After enlarged right hepatectomy, the patient was asymptomatic with no abnormalities at liver and abdominal CT scan at 2-year follow-up. (orig.)

  10. A novel method to determine perineal artery occlusion among male bicyclists

    Parthiban, Sujeeth; Hotaling, James M.; Kathrins, Martin; Baftiri, Amit P.; Freels, Sally; Niederberger, Craig S.

    2015-01-01

    Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs. Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce? sensors were affixed over the proximal and distal aspects ...

  11. Low back pain tied to spinal endometriosis.

    Dongxu, Zhao; Fei, Yin; Xing, Xiao; Bo-Yin, Zhang; Qingsan, Zhu

    2014-05-01

    Case report. We present a case of endometriosis of lumbar vertebrae. The literatures are reviewed with endometriosis of spine. Endometriosis is a common condition, which is defined as endometrial tissue lying outside the endometrial cavity. It is usually found within the peritoneal cavity, predominantly within the pelvis, commonly on the uterosacral ligaments. It can also be found in other sites such as umbilicus, abdominal scars, nasal passages and pleural cavity. But it is very rarely seen in the spine, with no report of endometriosis found in the lumbar vertebrae. A 33-year-old woman presented with severe low back pain. She had the low back pain periodically for 3 years, and the pain was associated with menstruation. Radiographs showed a lesion in the posterior L3 body. After surgery, tissue biopsy indicated the presence of endometrial tissue in the lesion and thus confirmed endometriosis. Most cases of spine endometriosis that have been reported are usually found inside spinal canal, endorachis or spinal cord. But spinal vertebrae can also be involved in endometriosis. Although endometriosis is a rare possible cause of periodical low back pain in women of childbearing age, we suggest that if a woman suffering from periodical low back pain is encountered, do not ignore the possibility of endometriosis in the spine.

  12. Full-thickness endometriosis of the bladder

    Kjer, Jens Jørgen; Kristensen, Jens; Hartwell, Dorthe

    2014-01-01

    referral centres in Denmark for surgical treatment of stage III and IV endometriosis. POPULATION: Thirty-one women with deep infiltrating bladder endometriosis. METHODS: All women presenting in the Department of Obstetrics and Gynaecology with deep infiltrating bladder endometriosis between March 2002...... and March 2011. We included only patients with symptomatic full-thickness bladder detrusor endometriosis and mucosal involvement. All patients had had bladder symptoms for two to seven years. MAIN OUTCOME MEASURES: Symptoms after surgery and recurrence rate. RESULTS: The main preoperative symptom...

  13. Infantile Perineal Protrusion in Two Monochorionic Twins

    Paola Cavicchioli

    2014-11-01

    Full Text Available Case Report - Two female monochorionic-monoamniotic twins showed the same kind of infantile perineal protrusion (IPP at birth. Lesions in both twins progressively healed until resolution in 6 weeks' time; none of the twins have manifested, till date, alvus disturbances. Discussion and Literature Review - A literature review numbers approximately 100 reports of IPP. This condition has been classically classified into three categories: congenital/familiar (i.e., female sex, positive parental history of IPP, acquired (mainly due to constipation, and associated with lichen sclerosus et atrophicus. Conclusions and Final Remarks - This case report describes, for the first time, the presence of IPP in monochorionic-monoamniotic twins, supporting the existence of hereditary/genetic factors in the developing of this condition.

  14. A Novel Endometriosis Inducing Factor In Women with Endometriosis

    Ramzy A,

    2010-01-01

    Full Text Available Aim: To confirm the hypothesis of the presence of a possible endometriosis inducing factor(s (EIF in the blood of women with endometriosis. Patients and Methods: Forty infertile women were studied. The study group compromised of fifteen women of each three different degrees of endometriosis and fifteen women without endometriosis as a control group. Stem cells are characterized by being spindle shaped and proliferate in appropriate culture indefinitely. The women sera were co-cultured with mesenchymal stem cells (MSCs which were followed up weekly to look for morphological changes and to detect Annexin 1 marker and ß-actin gene by reverse transcriptase polymerase chain reaction. Results: MSCs cultured with sera of cases with, mild, moderate and severe endometriosis, showed morphological changes to be columnar and cuboidal shaped cells -resembling endometrial cells and glands- by the 4th week in 60%, 60% & 100% respectively. These cells were detected from as early as the first week in women with moderate and severe types (20% for each group. The percentage of the change into endometrial like cells increased among the three groups where it was 30±25.8%, 45±29.9% and 75±37.9% respectively. Moreover, increasing number of endometrial like cells are detected weekly, the more severe the disease is. None of the cultures of serum of the control group had made such changes all over the study. Furthermore, with more differentiation there was a considerable decrease in number of stem cells. These differentiated cells expressed the Annexin-1 marker. Conclusion: It was evident that serum of women with endometriosis posses a factor(s that enables the MSCs to be transformed into endometrial like cells and glands in vitro. This finding supports a new theory for the etiology of endometriosis. This observation may have a tremendous effect on the therapeutic implications of this debilitating condition.Introduction: Endometriosis is a common condition that

  15. Perineal trauma in children: a standardized management approach

    management, postoperative wound infection or disruption, postoperative functional ... Pediatr Surg 7:55–60 c 2011 Annals of Pediatric Surgery. Annals of Pediatric .... abdominal and perineal trauma caused by a car accident. (Fig. 3). Both the ...

  16. Perineal Trauma in Port Harcourt, Souh-South Nigeria | Ojule ...

    ... uterine descent and incontinence to urine, stool or flatus as well as sexual, social ... The objective of the study was to determine the prevalence and predisposing factors of perineal trauma amongst women delivering at the University of Port ...

  17. Persistent perineal sinus. Incidence, pathogenesis, risk factors, and management

    Lohsiriwat, V.

    2009-01-01

    This review discusses the incidence, pathogenesis, risk factors, diagnosis, and therapeutic options for persistent perineal sinus (PPS), defined as a perineal wound that remains unhealed more than 6 months after surgery. The incidence of PPS after surgery for inflammatory bowel disease (IBD) ranges from 3% to 70% and after abdominoperineal resection (APR) for Low rectal cancer, it can be up to 30%. These unhealed wounds are frequently related to perioperative pelvic or perineal sepsis. Crohn's disease (CD) and neoadjuvant radiation therapy are also important risk factors. The management of PPS is based on an understanding of pathogenesis and clinical grounds. The advantages and disadvantages of the current therapeutic approaches, including the topical administration of various drugs, vacuum-assisted closure, and perineal reconstruction with a muscle flap or a myocutaneous flap are also discussed. (author)

  18. A comparison of surgical outcomes of perineal urethrostomy plus penile resection and perineal urethrostomy in twelve calves with perineal or prescrotal urethral dilatation

    M.A. Marzok

    2013-10-01

    Full Text Available The clinical diagnosis, ultrasonographic findings, surgical management, outcome, and survival rate of perineal or prescrotal urethral dilatation in 12 male calves are described. All calves were crossbred and intact males. The most noticeable clinical presentations were perineal (n= 10 or prescrotal (n= 2 swellings and micturition problems. The main ultrasonographic findings were oval shaped dilatation of the urethra in all animals with dimensions of 40-75 X 30-62 mm. The calves with perineal urethral dilatation were treated by perineal urethrostomy (n= 4 and partial penile transection including the dilated urethra and urethral fistulation (n= 6. Prescrotal urethral dilatations were treated by penile transection proximal to the dilatation site (n= 2. Cystitis and stricture of the urethra were recorded postoperatively for two of the calves that underwent perineal urethrostomy. Nine animals were slaughtered at normal body weight approximately 6-8 months after the surgical treatment. Three animals were slaughtered after approximately three to four months, two of them having gained insufficient body weight. Our study shows that ultrasonography is a useful tool for the diagnosis of urethral dilatation in bovine calves. Our study also shows that the partial penile transection may be a suitable and satisfactory choice of surgical treatment for correcting the urethral dilatation in bovine calves.

  19. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project: I. Surgical phenotype data collection in endometriosis research

    Becker, Christian M.; Laufer, Marc R.; Stratton, Pamela

    2014-01-01

    ObjectiveTo standardize the recording of surgical phenotypic information on endometriosis and related sample collections obtained at laparoscopy, allowing large-scale collaborative research into the condition.......ObjectiveTo standardize the recording of surgical phenotypic information on endometriosis and related sample collections obtained at laparoscopy, allowing large-scale collaborative research into the condition....

  20. World Endometriosis Research Foundation Endometriosis Phenome and biobanking harmonization project: II. Clinical and covariate phenotype data collection in endometriosis research

    Vitonis, Allison F.; Vincent, Katy; Rahmioglu, Nilufer

    2014-01-01

    ObjectiveTo harmonize the collection of nonsurgical clinical and epidemiologic data relevant to endometriosis research, allowing large-scale collaboration.......ObjectiveTo harmonize the collection of nonsurgical clinical and epidemiologic data relevant to endometriosis research, allowing large-scale collaboration....

  1. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: III. Fluid biospecimen collection, processing, and storage in endometriosis research

    Rahmioglu, Nilufer; Fassbender, Amelie; Vitonis, Allison F.

    2014-01-01

    ObjectiveTo harmonize standard operating procedures (SOPs) and standardize the recording of associated data for collection, processing, and storage of fluid biospecimens relevant to endometriosis.......ObjectiveTo harmonize standard operating procedures (SOPs) and standardize the recording of associated data for collection, processing, and storage of fluid biospecimens relevant to endometriosis....

  2. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project: IV. Tissue collection, processing, and storage in endometriosis research

    Fassbender, Amelie; Rahmioglu, Nilufer; Vitonis, Allison F.

    2014-01-01

    ObjectiveTo harmonize standard operating procedures (SOPs) and standardize the recording of associated data for collection, processing, and storage of human tissues relevant to endometriosis.......ObjectiveTo harmonize standard operating procedures (SOPs) and standardize the recording of associated data for collection, processing, and storage of human tissues relevant to endometriosis....

  3. Exceptional cause of bowel obstruction: rectal endometriosis ...

    Endometriosis with intestinal serosal involvement is not uncommon in women of childbearing age. However, endometriosis presenting as colon obstruction is rare and occurs in less than 1% of cases. The Lack of pathognomonic signs makes the diagnosis difficult, mostly because the main differential diagnosis is with ...

  4. Macrophages and nerve fibres in peritoneal endometriosis.

    Tran, Lu Vinh Phuc; Tokushige, Natsuko; Berbic, Marina; Markham, Robert; Fraser, Ian S

    2009-04-01

    Endometriosis is considered to be an inflammatory disease, and macrophages are the most numerous immune cells in endometriotic lesions. However, the mechanisms underlying the elevation of macrophages and their role in the pathogenesis and manifestations of endometriosis still remain unclear. The number of macrophages stained for CD68 in endometriotic lesions (n = 24) and in peritoneum distant from the lesions (n = 14) from women with endometriosis was compared with the number of macrophages in normal peritoneum from women without endometriosis (n = 18). Peritoneal lesions were also double-stained for CD68 and protein gene product 9.5 to study the relationship between macrophages and nerve fibres. The densities of macrophages in peritoneal endometriotic lesions and unaffected peritoneum from women with endometriosis were both significantly higher than that in normal peritoneum from women without endometriosis (P peritoneal lesions from women with endometriosis compared with normal peritoneum from women without endometriosis. These cells may well play roles in the growth and development of endometriotic lesions and in the generation of pain through interaction with nerve fibres.

  5. Vesical endometriosis: utility of imaging techniques

    Parra, M.; Cascon, E.; Robledo, R.; Perez, M.

    1999-01-01

    We present three cases of vesical endometriosis initially studied with ultrasound. One case was also studied with intravenous urography, computed tomography and magnetic resonance imaging. We discuss on the utility of these imaging methods in the diagnosis of vesical endometriosis. (Author) 9 refs

  6. Radiologic findings of pulmonary endometriosis

    Kim, Seon Bok; Lee, Eil Seong; Jung, Hae Kyoung; Kim, Uk Jung; Yi, Jeong Geun; Kang, Ik Won; Kook, Shin Ho; Park, Jae Sung; Ryu, Dae Sik

    1998-01-01

    To describe the radiologic findings of pulmonary endometriosis. This study involved five patients with catamenial hemoptysis diagnosed as pulmonary endometriosis. All cases were diagnosed on the basis of bronchoscopic abnormalities. In one patient, endometrial glandular cells were seen on transthoracic fine needle aspiration biopsy. In three, hemoptysis ceased after Danazol treatment. The pattern, location and number of parenchymal abnormalities and the presence or absence of pleural lesion were analyzed retrospectively on plain chest radiographs (n=3D5) and CT scans(n=3D5). Follow-up study for each menstrual period was performed in two cases and changes from the initial lesion were assessed. Plain chest radiographic findings showed focal ground-glass opacity in three cases;two were in the right lung and one in the left. CT findings included ground-glass attenuation (n=3D3) and a mixed pattern of ground-glass attenuations and consolidations(n=3D2). Sites were single in four cases, and in one case, there were two; thus there were in all six lesions. Five of these were located in the right lung and subpleural region, continving to the pleura. Pleural lesion was not detected on either chest radiographs or CT scans. Follow-up CT scans (n=3D2) showed a similar lesion at the same site. In patient with repeated catamenial hemoptysis, CT may be helpful for the diagnosis of pulmonary endometriosis by exclusion of other diseases.=20

  7. Radiologic findings of pulmonary endometriosis

    Kim, Seon Bok; Lee, Eil Seong; Jung, Hae Kyoung; Kim, Uk Jung; Yi, Jeong Geun; Kang, Ik Won [Hallym Univ. College of Medicine, Seoul (Korea, Republic of); Kook, Shin Ho [Kangbuk Samsung Hospital, Seoul (Korea, Republic of); Park, Jae Sung [Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of); Ryu, Dae Sik [Kangnung Hospital, Kangnung (Korea, Republic of)

    1998-12-01

    To describe the radiologic findings of pulmonary endometriosis. This study involved five patients with catamenial hemoptysis diagnosed as pulmonary endometriosis. All cases were diagnosed on the basis of bronchoscopic abnormalities. In one patient, endometrial glandular cells were seen on transthoracic fine needle aspiration biopsy. In three, hemoptysis ceased after Danazol treatment. The pattern, location and number of parenchymal abnormalities and the presence or absence of pleural lesion were analyzed retrospectively on plain chest radiographs (n=3D5) and CT scans(n=3D5). Follow-up study for each menstrual period was performed in two cases and changes from the initial lesion were assessed. Plain chest radiographic findings showed focal ground-glass opacity in three cases;two were in the right lung and one in the left. CT findings included ground-glass attenuation (n=3D3) and a mixed pattern of ground-glass attenuations and consolidations(n=3D2). Sites were single in four cases, and in one case, there were two; thus there were in all six lesions. Five of these were located in the right lung and subpleural region, continving to the pleura. Pleural lesion was not detected on either chest radiographs or CT scans. Follow-up CT scans (n=3D2) showed a similar lesion at the same site. In patient with repeated catamenial hemoptysis, CT may be helpful for the diagnosis of pulmonary endometriosis by exclusion of other diseases.=20.

  8. [Sigmoid endometriosis: a diagnostic dilemma on multidetector CT].

    Telegrafo, Michele; Lorusso, Valentina; Rubini, Giuseppe; Rella, Leonarda; Pezzolla, Angela; Stabile Ianora, Amato Antonio; Moschetta, Marco

    2013-01-01

    Intestinal endometriosis represents a common condition that occurs particularly in women of reproductive age. The gastrointestinal tract is the third most common localization of endometriosis, after the ovaries and the peritoneum, and recto-sigmoid tract is involved in 70% of cases. Recto-sigmoid endometriosis has to be differentiated from other diseases of large bowel, especially in patients without a history of endometriosis. We report a case of sigmoid endometriosis which represented a diagnostic dilemma on multidetector computed tomography.

  9. Endometriosis presenting like a psoas abscess

    Bhat, S.N.; Mohanty, S.P.; Kustagi, P.

    2007-01-01

    Endometriosis is the presence of ectopic endometrial tissue that responds to hormonal stimulation. Although endometriosis occurs most often in the pelvis, several unusual sites have been reported. We present a case of endometriosis mimicking, a psoas abscess. A 39-year-old lady presented around the right hip, of 5 years duration. Computed tomography (CT) scan showed a multi-loculated mass in the right iliopsoas muscle. On exploration, a hemorrhagic cystic mass was seen pressing on the femoral nerve. The lesion was excised and histological examination of the tissue showed features of endometriosis. The patient was treated by cyclic hormonal suppressive therapy for 3 months. Her pain and flexion deformity of the hip resolved completely. Retroperitoneal endometriosis presenting with deformity and pain in the hip may mimic a psoas abscess. If the possibility of this diagnosis is entertained, inappropriate treatment may be avoided. (author)

  10. Risk of appendiceal endometriosis among women with deep-infiltrating endometriosis.

    Moulder, Janelle K; Siedhoff, Matthew T; Melvin, Kathryn L; Jarvis, Elizabeth G; Hobbs, Kumari A; Garrett, Joanne

    2017-11-01

    To determine whether deep-infiltrating endometriosis (DE) carries an increased risk of appendiceal endometriosis (AppE) as compared with superficial endometriosis or no endometriosis. In a retrospective study, data were obtained by chart review of an internal database for women who underwent coincidental appendectomy during benign gynecologic surgery between July 2009 and February 2014 at a tertiary referral center in the USA. Univariate, bivariate, and regression analyses were performed. The primary exposure was surgically documented endometriosis (DE, superficial, or no endometriosis). The primary outcome was AppE. Endometriosis was diagnosed for 151 (38.2%) of 395 women; 82 (54.3%) had DE. The prevalence of AppE was 13.2% (52/395) overall; 8 (11.6%) of 69 women with superficial endometriosis and 32 (39.0%) of 82 with DE were affected. Frequency of AppE was increased among women with DE, abnormal appendix appearance, and surgical indication (all Pendometriosis, controlling for appendiceal appearance and surgical indication, and a 2.7-fold (95% CI 1.2-6.2) higher risk of AppE compared with those with superficial endometriosis. Women with DE have increased risk of AppE. Coincidental appendectomy should form part of complete endometriosis excision for these patients. © 2017 International Federation of Gynecology and Obstetrics.

  11. Association Between Endometriosis and Hypercholesterolemia or Hypertension.

    Mu, Fan; Rich-Edwards, Janet; Rimm, Eric B; Spiegelman, Donna; Forman, John P; Missmer, Stacey A

    2017-07-01

    An altered hormonal or chronic systemic inflammatory milieu characterizing endometriosis may result in a higher risk of hypercholesterolemia and hypertension. Conversely, elevated low-density lipoprotein in hypercholesterolemia and chronic systemic inflammation resulting from hypertension may increase the risk of endometriosis. We assessed the association of laparoscopically confirmed endometriosis with hypercholesterolemia and hypertension in a large prospective cohort study. In 1989, 116 430 registered female nurses aged 25 to 42 completed the baseline questionnaire and were followed for 20 years. Multivariable Cox proportional hazards models were applied. In 1989, there were 4244 women with laparoscopically confirmed endometriosis and 91 554 women without. After adjusting for demographic, anthropometric, family history, reproductive, dietary, and lifestyle risk factors prospectively, comparing women with laparoscopically confirmed endometriosis to women without, the relative risks were 1.25 (95% confidence interval, 1.21-1.30) for development of hypercholesterolemia and 1.14 (95% confidence interval, 1.09-1.18) for hypertension. Conversely, the relative risks of developing laparoscopically confirmed endometriosis were 1.22 (95% confidence interval, 1.15-1.31) comparing women with hypercholesterolemia to women without and 1.29 (95% confidence interval, 1.18-1.41) comparing women with hypertension to women without. The strength of associations of laparoscopically confirmed endometriosis with hypercholesterolemia or hypertension was strongest among women aged ≤40 and weakened as age increased ( P values for interaction hypertension could be accounted for by treatment factors after endometriosis diagnosis, including greater frequency of hysterectomy/oophorectomy and earlier age for this surgery. In this large cohort study, laparoscopically confirmed endometriosis was prospectively associated with increased risk of hypercholesterolemia and hypertension

  12. Perineal hygiene in patients with pelvic fractures.

    Hossain, Mohammad A; Pearce, Rachel; Bircher, Martin D

    2008-08-01

    At the tertiary referral Orthopaedic Unit of St. Georges Hospital, it was noted that there was an unacceptably high number of soiled perinea in patients transferred from Base Hospitals. This not only exposed the patients to increased infection [Jepsen O. The effectiveness of preoperative skin preparations: an integrated review of the literature. AORN J 1993;58:477-82; and Nix D, Ermer-Seltun J. A review of perineal skin care protocols and skin barrier product use. Ostomy Wound Manage 2004;50:59-67] but was also undignified and unacceptable for them. We decided to audit the problem with a view to finding out why this was happening and to improve the situation. A 2-year study was carried out over three distinct phases (phase 1: February-June 2004, phase 2: July-November 2004, phase 3: February-November 2005). Observations of soiling were recorded in a questionnaire by the surgeon prior to surgery. Key system and clinical guidelines were implemented during the second phase, and the audit process was repeated. The percentage of clean perinea in phase 1 was 32%, phase 2 68% and phase 3 99.5% indicating a clear improvement in the overall system.

  13. Management of Severe Perineal Injuries in Major Pelvic Fractures

    A Jangjoo

    2009-01-01

    Full Text Available Introduction: Significant perineal injuries and major pelvic fractures resulting from blunt trauma manifest a high-energy injury. Open pelvic fractures (with perineal injury are associated with higher mortality rates of 40 to 60 %. Methods: This study was a review of patients with multiple traumas comprising of major pelvic fracture and severe perineal injuries (Shahid Kamyab hospital in Mashhad from 2002- 2005. A total of 11 patients, with pelvic fracture and perineal injuries (injury to urethra and anal canal were entered in the study. The data was gathered by a checklist and analyzed with SPSS software. Results: The population under study included 11 patients (9 male, 2 female with a mean age of 35years. Cause of trauma in all patients was motor vehicle accidents. All of the patients in the first 6 hours of admission received at least 4 liters of serum ringer lactate and 3 units of packed cells. The mean of packed cell received was 8 units and one patient needed 21 units of packed cells. All of patients were taken to the operating room for diverting colostomy, distal rectal washout, cystostomy and radical debridment and irrigation of devitalized tissue. Good results were achieved in 9 patients and there was one case of mortality and one morbidity (ARF. Conclusion: Open pelvic fractures and perineal injuries are associated with higher mortality rates. Prompt diagnosis and proper treatment (reanimation, colostomy, cystostomy, debridment and irrigation is the key to success.

  14. Relevance of MRI for endometriosis diagnosis

    Krueger, Karsten; Behrendt, K.; Balzer, M.; Hoehn, S.; Ebert, A.D.

    2011-01-01

    Endometriosis is a disease of the uterus with displacement of endometrium-like tissue outside the endometrium. Endometriosis is a common benign chronic often debilitating disease that primarily affects young woman. The estimated prevalence is about 10 %. In addition to the uterus and ovaries, clinically important localisations are the rectovaginal space, rectum, sigmoid colon, urinary bladder, ureter and peritoneum. The most common localisation outside the pelvis is the abdominal wall. Today, MRI is one of the most important tools in the diagnosis of endometriosis. The detection of peritoneal manifestations and the exact definition of the depth of infiltration in the rectum, sigmoid colon and bladder walls are limitations of MRI. (orig.)

  15. MRI of cul-de-sac endometriosis

    Balestrini, Maria A.; Martin, Eduardo; Gomez Sanetta, Santiago; De Lucas, Federico; Bruno, Claudio; Sanchez Marull, Ricardo; Villamayor, Irene

    2000-01-01

    The endometriosis is a gynecological disorder characterized by the presence of ectopic functioning endometrial tissue. According to different studies, the incidence of endometriosis in fertile women oscillates between 10% and 15%. There are many theories (Sampson or menstrual blood transport, coelomic methaplasia, lymphatic dissemination, blood, etc.) that take part in the ethiopatogenic explanation of the disease. The findings obtained by excretory urography, computed tomography (CT), magnetic resonance imaging (MRI), cytology and histology in a 31 years old patient with cul-de-sac endometriosis is presented. MRI was the imaging method of choice for diagnosis and follow-up after treatment of this condition. (author)

  16. A case of multisystem endometriosis.

    Athwal, Pardeep; Patel, Krishna; Hassani, Cameron; Bahadori, Shapour; Nardi, Peter

    2013-10-01

    Catamenial pneumothorax is a rare complication secondary to pleural endometriosis. We present a case of a 37-year-old-female with a history of recurrent pneumothoraces with an associated temporal relationship to the onset of her menses. In addition to her recurrent pneumothoraces, on further evaluation, she was found to have multiple nodular masses within the omentum. A thoracoscopic biopsy was subsequently performed, which showed endometrial implants within the pleural space and within the omental cavity. The radiological features and pathogenesis of this rare disease are reviewed and discussed with reference to relevant literature.

  17. Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment.

    Andromanakos, Nikolaos P; Kouraklis, Grigorios; Alkiviadis, Kostakis

    2011-01-01

    Chronic perineal pain is the anorectal and perineal pain without underlying organic disease, anorectal or endopelvic, which has been excluded by careful physical examination, radiological and endoscopic investigations. A variety of neuromuscular disorders of the pelvic floor lead to the different pathological conditions such as anorectal incontinence, urinary incontinence and constipation of obstructed defecation, sexual dysfunction and pain syndromes. The most common functional disorders of the pelvic floor muscles, accompanied by perineal pain are levator ani syndrome, proctalgia fugax, myofascial syndrome and coccygodynia. In the diagnosis of these syndromes, contributing to a thorough history, physical examination, selected specialized investigations and the exclusion of organic disease with proctalgia is carried out. Accurate diagnosis of the syndromes helps in choosing an appropriate treatment and in avoiding unnecessary and ineffective surgical procedures, which often are performed in an attempt to alleviate the patient's symptoms.

  18. Perineal hernias in children: Case report and review of the literature ...

    Perineal hernias (pelvic floor hernias) are extremely rare occurring through defects in musculature of the pelvic floor. This report presents a successfully treated case of primary perineal hernia and takes a review of the existing literature. The case of a 14-month-old girl with a great perineal hernia is presented. Diagnosis was ...

  19. Anorectal malformation associated with a perineal protrusion of the rectal mucosa: case presentation.

    Shinkai, Masato; Mochizuki, Kyoko; Hirata, Yoshihiro; Honda, Shohei; Kitagawa, Norihiko; Take, Hiroshi; Ohhama, Youkatsu; Tanaka, Mio; Tanaka, Yukichi

    2009-09-01

    We present a rare case of a female neonate with an imperforate anus associated with a perineal mass which may correspond to an extrophied rectal duplication. Associated anomalies were thoracic hemivertebrae and a multicystic dysplastic kidney. Excision of the perineal lesion followed by anal transplantation and perineal reconstruction corrected the anomaly.

  20. Vacuum-assisted closure therapy for infected perineal wounds after abdominoperineal resection. A retrospective cohort study

    Walma, M S; Burbach, J P M; Verheijen, P M; Pronk, A; van Grevenstein, W M U

    INTRODUCTION: Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound

  1. BREAST MILK AS AN ALTERNATIVE FOR POSTPARTUM PERINEAL CARE

    Yuli Admasari

    2017-07-01

    Full Text Available Background: Perineal laceration during childbirth is very common among mothers; however some of them may suffer from its complication if not treated properly. Objective: To prove the effectiveness of breast milk as an alternative topical ingredient in the treatment of perineal wound in postpartum mothers. Methods: This was a quasi-experimental study with non-equivalent control group posttest only design. There were 30 respondents selected in this study, with 15 assigned in the intervention and control group. Accidental sampling was used to select the samples with the criteria that the respondents had perineal laceration in level 1 and 2. Data were analzed using Mann Whitney test. Results: Effective wound healing process can be seen in the intervention group from 80% of poor category in 6- 10 hours (1st period of postpartum became 86.7% of good category in 7 days of postpartum (4th period. Different from the control group that showed the slow progress of wound healing, which was 86.7% of poor category in the 1st period to only 33.3% of good category in the 4th period. Mann Whitney test showed that there was a significant mean difference of the perineal wound healing process between the intervention group (11.23 and the control group (19.77 with p-value 0.002 (<0.05. Conclusion: Breast milk was more effective than povidone iodine in the treatment of perineal wound. It is suggested for health workers, especially midwife to apply this intervention to accelerate the healing of perineal wound in midwifery care.

  2. Comprehensive study of angiogenic factors in women with endometriosis compared to women without endometriosis.

    Yerlikaya, Gülen; Balendran, Sukirthini; Pröstling, Katharina; Reischer, Theresa; Birner, Peter; Wenzl, Rene; Kuessel, Lorenz; Streubel, Berthold; Husslein, Heinrich

    2016-09-01

    Endometriosis is a benign gynaecological disease, affecting women during their reproductive years. Angiogenesis represents a crucial step in the pathogenesis of endometriosis, because endometriotic lesions require neovascularization. In this study several angiogenesis-related genes have been studied in the context of endometriosis. Some of the analyzed angiogenic factors as well as their interactions were studied the first time regarding a possible association with endometriosis. This case-control study consisted of 205 biopsies of 114 patients comprising 61 endometriosis patients and 53 control patients. Among them in 29 cases paired samples were obtained. VEGFA, VEGFR2, HIF1A, HGF, NRP1, PDGFB, FGF18, TNFα, TGFB2, EPHB4, EPO and ANG mRNA expression was analyzed by qRT-PCR in ectopic tissue samples, in eutopic endometrium of women with and without endometriosis, and in unaffected peritoneum of women with and without endometriosis. VEGFR2, HIF1A, HGF, PDGFB, NRP1 and EPHB4 are overexpressed in ectopic lesions compared to eutopic tissues. VEGFR2, HGF, PDGFB, NRP1, and EPHB4 showed highest mRNA levels in peritoneal implants, in contrast HIF1A showed the highest expression in ovarian endometriomas. Correlation analyses of angiogenic factors in ectopic lesions revealed the strongest associations between VEGFR2, PDGFB, and EPHB4. We further showed a significant upregulation of VEGFR2, HIF1A and EPHB4 in eutopic endometrium of women with endometriosis compared to that of controls and a trend towards upregulation of HGF. Additionally, a significant downregulation for HIF1A, HGF and EPHB4 was observed in unaffected peritoneal tissues of women with endometriosis compared to controls. We identified new genes (EPHB4 and NRP1) that may contribute to angiogenesis in endometriosis beside known factors (VEGFA, VEGFR2, HIF1A, HGF, and PDGFB). Correlation studies revealed the putative importance of EBHB4 in association with endometriosis. Our analyses support preliminary reports

  3. The effect of maneuvers for shoulder delivery on perineal trauma

    Aabakke, Anna J M; Willert, Hanne; Krebs, Lone

    2016-01-01

    -treated analysis. RESULTS: Between June 2013 and March 2015, 650 women were randomized, and 543 (posterior, n = 281; anterior, n = 262) were included in the final intention-to-treat analysis. Most group characteristics were similar. The frequency of any perineal trauma did not differ between the two groups......: This was a randomized single-blinded trial comparing primary delivery of either the anterior or posterior shoulder in women having their first vaginal delivery. Primary outcome was any perineal trauma. Results were analyzed according to the intention-to-treat principle and supplemented with a per-protocol and as...

  4. Perineal herniorrhaphy in dogs - analysis of 35 cases

    Alceu Gaspar Raiser

    1994-12-01

    Full Text Available During a twelve-year period, from January 1980 to December 1992, 35 male dogs with perineal hernia were managed by the author. These dogs were submitted to the Veterinary Teaching Hospital (VTH, Universidade Federal de Santa Maria. RS, Brazil. The prevalence of herniation represented 0.5% of the dogs and cats seen at VTH in this period. The complications diagnosed were as the follow: retroflexion of the urinary bladder, rectal dilatation or diverticulum, necrotic retroperitoneal fat and serum or serosanguineous effusion. The surgical efficiency are dependent of digestive and urinary patency, obliteration of the perineal opening and control of tenesmus and infection.

  5. Catamenial pneumothorax caused by thoracic endometriosis

    Paolo Maniglio, MD

    2018-02-01

    Conclusion: The diagnosis of thoracic endometriosis is challenging. The first line of treatment is medical, whereas the surgical treatment is performed secondly. Moreover, surgical treatment can lead to a significant rate of recurrence, often reduced by a coadjutant medical treatment.

  6. What Are the Treatments for Endometriosis?

    ... did not relieve pain any better than laparoscopy alone. For this reason, it is generally not recommended for treatment of endometriosis-associated pain. 2 , 6 , 8 The American College of Obstetricians and Gynecologists (ACOG) reports several clinical ...

  7. Thoracic endometriosis syndrome: CT and MRI features

    Rousset, P.; Rousset-Jablonski, C.; Alifano, M.; Mansuet-Lupo, A.; Buy, J.-N.; Revel, M.-P.

    2014-01-01

    Thoracic endometriosis is considered to be rare, but is the most frequent form of extra-abdominopelvic endometriosis. Thoracic endometriosis syndrome affects women of reproductive age. Diagnosis is mainly based on clinical findings, which can include catamenial pneumothorax and haemothorax, non-catamenial endometriosis-related pneumothorax, catamenial haemoptysis, lung nodules, and isolated catamenial chest pain. Symptoms are typically cyclical and recurrent, with a right-sided predominance. Computed tomography (CT) is the first-line imaging method, but is poorly specific; therefore, its main role is to rule out other pulmonary diseases. However, in women with a typical clinical history, some key CT findings may help to confirm this often under-diagnosed syndrome. MRI can also assist with the diagnosis, by showing signal changes typical of haemorrhage within diaphragmatic or pleural lesions

  8. Pain recurrence after shaving of rectovaginal endometriosis

    Heide, Mathias Gottschalck; Forman, Axel

    Background: Surgical treatment of rectovaginal endometriosis varies from shaving of the nodule off the rectal wall without perforation, over discoid excision to routine rectal resection. Of these methods, shaving involves the lowest rate of serious complications but leaves endometriosis tissue...... on the bowel with risk of recurrence. This could motivate a change into more radical surgery. In the present study we therefore assessed recurrence of pain after shaving of rectovaginal endometriosis performed 2001-2009. Methods: Retrospective follow-up study. Questionnaires were sent to 212 women of whom 174...... OCs and gestagen IUD showed a trend towards a protective effect against menstrual pain (p=0.06). There was found no significant association between recurrence of pain and anterior rectal wall involvement. Conclusion: Shaving of rectovaginal endometriosis shows a high risk of postoperative pain...

  9. Peripheral changes in endometriosis-associated pain

    Morotti, Matteo; Vincent, Katy; Brawn, Jennifer; Zondervan, Krina T.; Becker, Christian M.

    2014-01-01

    BACKGROUND Pain remains the cardinal symptom of endometriosis. However, to date, the underlying mechanisms are still only poorly understood. Increasing evidence points towards a close interaction between peripheral nerves, the peritoneal environment and the central nervous system in pain generation and processing. Recently, studies demonstrating nerve fibres and neurotrophic and angiogenic factors in endometriotic lesions and their vicinity have led to increased interest in peripheral changes in endometriosis-associated pain. This review focuses on the origin and function of these nerves and factors as well as possible peripheral mechanisms that may contribute to the generation and modulation of pain in women with endometriosis. METHODS We conducted a systematic search using several databases (PubMed, MEDLINE, EMBASE and CINAHL) of publications from January 1977 to October 2013 to evaluate the possible roles of the peripheral nervous system in endometriosis pathophysiology and how it can contribute to endometriosis-associated pain. RESULTS Endometriotic lesions and peritoneal fluid from women with endometriosis had pronounced neuroangiogenic properties with increased expression of new nerve fibres, a shift in the distribution of sensory and autonomic fibres in some locations, and up-regulation of several neurotrophins. In women suffering from deep infiltrating endometriosis and bowel endometriosis, in which the anatomical distribution of lesions is generally more closely related to pelvic pain symptoms, endometriotic lesions and surrounding tissues present higher nerve fibre densities compared to peritoneal lesions and endometriomas. More data are needed to fully confirm a direct correlation between fibre density in these locations and the amount of perceived pain. A better correlation between the presence of nerve fibres and pain symptoms seems to exist for eutopic endometrium. However, this appears not to be exclusive to endometriosis. No correlation between

  10. Exploring the impact of endometriosis on partners.

    Ameratunga, Devini; Flemming, Tina; Angstetra, Donald; Ng, Shu-Kay; Sneddon, Anne

    2017-06-01

    This study aimed to determine how endometriosis affects the quality of life of partners of women who suffer from this disease and how it impacts their relationships, finances, mental states, and daily living. This was a questionnaire-based cohort study that took place at a large tertiary hospital gynecology unit, which covered two sites. Fifty-one partners of women who had surgically diagnosed endometriosis agreed to participate in the study and returned completed surveys. Ninety-two percent (n = 46) of partners reported negative feelings about the diagnosis of endometriosis. Seventy percent (n = 35) reported that endometriosis affected their day-to-day life either moderately or severely. Over half (52%) also felt that their finances were affected. Only 34% (n = 17) of partners felt that health professionals had engaged them in decision-making processes and had been supportive of them. Eighty percent (n = 40) of partners reported that they had received no information about the impact of endometriosis on couples. Partners reported a significant affect on their sex life (74%) and their relationship as a whole (56%). Participants whose relationships had been affected by endometriosis had also more likely had their day-to-day life (P = 0.027), sex life (P = 0.001), and finances (P = 0.002) affected. Overall, our findings suggest that endometriosis can have a significant impact on partners with respect to day-to-day living, finances, sex lives, and relationships. Improvements can be made to engage partners in the treatment process, and to provide better education, support, and holistic management to women and families who suffer with endometriosis. © 2017 Japan Society of Obstetrics and Gynecology.

  11. Defining Future Directions for Endometriosis Research

    D’Hooghe, Thomas M.; Fazleabas, Asgerally; Giudice, Linda C.; Montgomery, Grant W.; Petraglia, Felice; Taylor, Robert N.

    2013-01-01

    Endometriosis, defined as estrogen-dependent lesions containing endometrial glands and stroma outside the uterus, is a chronic and often painful gynecological condition that affects 6% to 10% of reproductive age women. Endometriosis has estimated annual costs of US $12 419 per woman (approximately €9579), comprising one-third of the direct health care costs with two-thirds attributed to loss of productivity. Decreased quality of life is the most important predictor of direct health care and total costs. It has been estimated that there is a mean delay of 6.7 years between onset of symptoms and a surgical diagnosis of endometriosis, and each affected woman loses on average 10.8 hours of work weekly, mainly owing to reduced effectiveness while working. To encourage and facilitate research into this debilitating disease, a consensus workshop to define future directions for endometriosis research was held as part of the 11th World Congress on Endometriosis in September 2011 in Montpellier, France. The objective of this workshop was to review and update the endometriosis research priorities consensus statement developed following the 10th World Congress on Endometriosis in 2008.1 A total of 56 recommendations for research have been developed, grouped under 6 subheadings: (1) diagnosis, (2) classification and prognosis, (3) clinical trials, treatment, and outcomes, (4) epidemiology, (5) pathophysiology, and (6) research policy. By producing this consensus international research priorities statement, it is the hope of the workshop participants that researchers will be encouraged to develop new interdisciplinary research proposals that will attract increased funding support for work on endometriosis. PMID:23427182

  12. Endometriosis during adolescent’s period

    Ibrahim Esinler

    2006-12-01

    Full Text Available Although endometriosis is usually diagnosed in reproductive aged women, adolescents after menarche may also effected by endometriosis. Since the diagnosis of all asymptomatic cases is impossible, the exact incidence of adolescent’s endometriosis is not known. Chronic pelvic pain, dysmenorrhea, dyspareunia, pelvic mass and rarely infertility may be associated with adolescent’s endometriosis. The exact diagnosis was performed by directly seeing endometriosis lesions. The most preferred method for this is laparoscopy (L/S. The L/S should be performed to the patients in whom chronic pelvic pain and dysmenorrhea are persistent despite medical treatment. The main goal of treatment is to decrease the severity of symptoms and to preserve the fertility. Non-steroidal antiinflammatory drugs, oral contraceptives, progestins, cyproterone acetate, danazol and gonadotrophin releasing hormone agonists are used for medical treatment. If the symptoms are resistant to the medical treatment, surgical treatment with L/S should be considered. The endometriosis lesions should be coagulated with electrocautery or laser.

  13. Visible and occult microscopic lesions of endometriosis

    Khaleque Newaz Khan

    2014-11-01

    Full Text Available Endometriosis is a multifactorial disease mostly affecting women of reproductive age and is associated with chronic pelvic pain and infertility. Even after 300 years, most of the literature claims that pathogenesis and/or pathophysiology of endometriosis is still elusive. Recurrence of pain and lesion continues to occur after effective medical or surgical therapies. Once generated within the pelvis due to retrograde entry of menstrual debris, peritoneal endometriotic lesions time-dependently change their color appearance resulting from certain biochemical change within lesions. A variable pattern of endometriotic lesions within the pelvis can be detected by laparoscopy as visible peritoneal endometriosis. It is generally believed that besides ovarian steroid hormones, the growth of endometriosis can be regulated by the innate immune system in the pelvic microenvironment by their interaction with endometrial cells and immune cells. Even with the careful eyes of an expert surgeon, we may sometimes miss detecting peritoneal lesion within the peritoneal cavity or deep into the peritoneum. In such a case, random collection of normal peritoneum may carry the possibility to identify some hidden endometriotic lesions by microscopy and these lesions can be named as occult (invisible microscopic endometriosis (OME. Here, we discuss the color appearance of peritoneal lesions and activity of these lesions by analysis of a panel of activity markers. Finally we discuss our recent findings on OME, their biological and clinical significance, and try to make a possible link in the origin between visible endometriosis and OME.

  14. Radiation-induced endometriosis in Macaca mulatta

    Fanton, J.W.; Golden, J.G.

    1991-01-01

    Female rhesus monkeys received whole-body doses of ionizing radiation in the form of single-energy protons, mixed-energy protons, X rays, and electrons. Endometriosis developed in 53% of the monkeys during a 17-year period after exposure. Incidence rates for endometriosis related to radiation type were: single-energy protons, 54%; mixed-energy protons, 73%; X rays, 71%; and electrons, 57%. The incidence of endometriosis in nonirradiated control monkeys was 26%. Monkeys exposed to single-energy protons, mixed-energy protons, and X rays developed endometriosis at a significantly higher rate than control monkeys (chi 2, P less than 0.05). Severity of endometriosis was staged as massive, moderate, and minimal. The incidence of these stages were 65, 16, and 19%, respectively. Observations of clinical disease included weight loss in 43% of the monkeys, anorexia in 35%, space-occupying masses detected by abdominal palpation in 55%, abnormal ovarian/uterine anatomy on rectal examination in 89%, and radiographic evidence of abdominal masses in 38%. Pathological lesions were endometrial cyst formation in 69% of the monkeys, adhesions of the colon in 66%, urinary bladder in 50%, ovaries in 86%, and ureters in 44%, focal nodules of endometrial tissue throughout the omentum in 59%, and metastasis in 9%. Clinical management of endometriosis consisted of debulking surgery and bilateral salpingo-oophorectomy combined in some cases with total abdominal hysterectomy. Postoperative survival rates at 1 and 5 years for monkeys recovering from surgery were 48 and 36%, respectively

  15. High rate of allergies among women with endometriosis.

    Matalliotakis, I; Cakmak, H; Matalliotakis, M; Kappou, D; Arici, A

    2012-04-01

    Women with endometriosis frequently suffer from autoimmune inflammatory diseases, allergies and asthma. This study was conducted to examine whether the prevalence of allergies is higher in patients with endometriosis than in the control group, and to show potential correlation with endometriosis stages. We evaluated the medical files of 501 women with laparoscopically-diagnosed endometriosis and 188 women without endometriosis enrolled in Yale University Hospital. Main outcome measures used were allergy on medications, complaints of sinus or perennial allergic rhinitis, asthma, family history of allergic disease, and correlation with stages of endometriosis. Our results indicated that the overall risk of women with endometriosis and positive history of allergies was 4.28 (95% CI, 2.9-6.3) (p allergies. Overall, our study indicated a link between endometriosis and increased risk of allergic autoimmune disorders that should further be explored.

  16. The relation between endometriosis and ovarian cancer - a review

    Nyhøj Heidemann, Lene; Hartwell, Dorthe; Heidemann, Christian Hamilton

    2014-01-01

    Endometriosis is known to harbor characteristics substantiating that it is a possible precursor of ovarian cancer.......Endometriosis is known to harbor characteristics substantiating that it is a possible precursor of ovarian cancer....

  17. Phosphoproteomics Analysis of Endometrium in Women with or without Endometriosis

    Hong-Mei Xu

    2015-01-01

    Conclusions: That large-scale phosphoproteome quantification has been successfully identified in endometrium tissues of women with or without endometriosis will provide new insights to understand the molecular mechanisms of the development of endometriosis.

  18. Managing Endometriosis in sub-Saharan Africa: Emerging Concepts ...

    AJRH Managing Editor

    African Journal of Reproductive Health June 2015; 19 (2): 13. COMMENTARY ... to improve awareness of endometriosis on a designated ... global movements for endometriosis provides ... subcontinent as a medical tourist destination must be ...

  19. Nodular smooth muscle metaplasia in multiple peritoneal endometriosis

    Kim, Hyun-Soo; Yoon, Gun; Ha, Sang Yun; Song, Sang Yong

    2015-01-01

    We report here an unusual presentation of peritoneal endometriosis with smooth muscle metaplasia as multiple protruding masses on the lateral pelvic wall. Smooth muscle metaplasia is a common finding in rectovaginal endometriosis, whereas in peritoneal endometriosis, smooth muscle metaplasia is uncommon and its nodular presentation on the pelvic wall is even rarer. To the best of our knowledge, this is the first case of nodular smooth muscle metaplasia occurring in peritoneal endometriosis. A...

  20. Perineal anterior dislocation of the hip with avulsion fracture of ...

    Traumatic anterior dislocation of the hip is rare even in children. Very uncommon also is the perineal variant of the inferior type of anterior dislocation with concomitant avulsion fracture of the greater trochanter. We report such a case highlighting the peculiarity of its management. No similar case of triumvirate injury of the hip ...

  1. Pelvic floor muscle thickness measured by perineal ultrasonography

    Bernstein, Inge Thomsen; Juul, N; Grønvall, S

    1991-01-01

    Pelvic floor muscle thickness was assessed in nine healthy female physiotherapists by perineal sonography. All measurements were performed as triple-measurements. The aims were to assess the reliability of the measurements and to establish a reference material. The muscle thickness at rest...

  2. An Audit of Perineal Trauma and Vertical Transmisson Of HIV ...

    Restrictive episiotomy is recommended for the prevention of vertical transmission of HIV. The study compared the frequency of episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on Mother-to-child transmission (MTCT) of HIV. A total of ...

  3. [Clinical trial of aromatherapy on postpartum mother's perineal healing].

    Hur, Myung Haeng; Han, Sun-Hee

    2004-02-01

    This study was designed to verify the effect of aromatherapy on a postpartum mother's perineal healing. The research design was a clinical trial. The methods of aromatherapy were applied sitz bath or soap application using essential oils with Lavender, Myrrh, Neroli, Rose, Grapefruit, Mandarin, Orange, and Roman Chamomile. The subjects of this experiment were postpartum mothers who delivered vaginally with an episiotomy. They were allocated to one of three groups; the aroma-sitz bath group, aroma-soap application group or control group. To evaluate the effect of aromatherapy, the perineal healing status was measured using the REEDA scale and smears of episiotomy wound were obtained. The data were analyzed by repeated measures of ANOVA, ANCOVA, chi2-test, and multiple response analysis via SPSS program. The REEDA scale was significantly low in the experimental group at postpartum 5th and 7th days (P=.009, P=.003), respectively. Most were observed 'few'(5-10 bacteria per field) bacteria in the smears of episiotomy wound. The one bacteria was identified in the 50.8% of subjects in pretest and two bacteria in the 60.3% in posttest. Most frequently identified bacteria were Escherichia coli and Enterococcus faecalis. In conclusion, these findings indicate that postpartum aromatherapy for perineal care could be effective in healing the perineum perineal care could be effective in healing the perineum.

  4. Disintegrating perineal disease: A variant of watering-can perineum

    N. Abrol

    www.ees.elsevier.com/afju · www.sciencedirect.com. Case report. Disintegrating perineal disease: A variant of watering-can perineum. N. Abrol. ∗. , A. Devasia. Department of Urology, Christian Medical College, Vellore, India. Received 11 January 2014; received in revised form 11 January 2014; accepted 11 March 2014.

  5. [Pseudo-continent perineal colostomy. Results and techniques].

    Lasser, P; Dubé, P; Guillot, J M; Elias, D

    1997-09-01

    This prospective study was conducted to assess functional results obtained after pseudo-continent perineal colostomy using the Schmidt procedure. Functional outcome was assessed in 40 patients who had undergone amputation of the rectum for cancer and pseudo-continent perineal colostomy reconstruction between 1989 and 1995 in our institution. The cancer pathology, operative procedure and post-operative care were noted. Morbidity, functional outcome and degree of patient satisfaction were recorded. Mean follow-up was 45 months (18-87) in 100% of the patients. There were no operative deaths. Twenty patients had post-operative complications and 2 patients required early conversion to definitive abdominal colostomy due to severe perineal complications. Function outcome showed normal continence in 4 patients, air incontinence in 23, occasional minimal leakage in 9 and incontinence requiring iliac colostomy in 2. Eighty-six percent of the patients were highly satisfied or satisfied with their continence capacity. Pseudo-continent perineal colostomy is a reliable technique which can be proposed as an alternative to left iliac colostomy after amputation of the rectum for cancer if a rigorous procedure is applied: careful patient selection, informed consent, rigorous surgical procedure, daily life-long irrigation of the colon.

  6. Endometriosis and fertility: women's accounts of healthcare.

    Young, K; Fisher, J; Kirkman, M

    2016-03-01

    What do women with endometriosis recall being told about their fertility by their healthcare providers? Women recalled being given varied information and advice, and gave examples of empathic and individualized care from doctors but also reported opportunities for enhancing clinical practice. There is evidence of an association between endometriosis and infertility. However, the strength of this association and the mechanisms that underlie it are not yet known nor are the implications for optimum healthcare. This study used in-depth cross-sectional qualitative research methods. Women aged at least 18 years who lived in Victoria, Australia, and who had been surgically diagnosed with endometriosis were invited to participate in in-depth interviews about their experience of endometriosis. Twenty-six women of diverse backgrounds and experiences of endometriosis were interviewed from January to September 2014. Interviews were transcribed and analysed thematically using a data-driven approach. All women encountered medical professionals who were aware of the association between endometriosis and infertility, and who were proactive in ensuring fertility was addressed within endometriosis care. Women recalled being given varied, often conflicting, information about the consequences for their fertility of an endometriosis diagnosis. While some recounted positive experiences with the way their doctor communicated with them about endometriosis and fertility, all women reported adverse experiences such as receiving insufficient or inappropriate information or having their doctor prioritize their fertility over other aspects of their care, including quality of life and symptom relief, without first consulting them. The perspectives of the women's doctors were not sought. The findings may not translate to settings that differ from a predominantly Anglo-Saxon country with both universal public and private healthcare systems. Women's fertility needs and priorities differ for many

  7. Should hysterectomy be performed for the treatment of endometriosis?

    When there is a medical or surgical indication for a hysterectomy apart from endometriosis the following discussion is not really relevant. The question deals with the role of hysterectomy purely for the management of endometriosis. Women, who have pelvic pain due to endometriosis that is unresponsive to conventional ...

  8. Primary umbilical endometriosis: To scope or not to scope ...

    Background. Primary umbilical endometriosis (PUE) is a rare condition affecting 0.5 - 1% of all cases of extragenital endometriosis. The method of using routine laparoscopic inspection of the pelvis to exclude pelvic endometriosis has been applied extensively over the years. It has been demonstrated that even patients who ...

  9. Imaging modalities for the non-invasive diagnosis of endometriosis

    Nisenblat, Vicki; Bossuyt, Patrick M. M.; Farquhar, Cindy; Johnson, Neil; Hull, M. Louise

    2016-01-01

    About 10% of women of reproductive age suffer from endometriosis. Endometriosis is a costly chronic disease that causes pelvic pain and subfertility. Laparoscopy, the gold standard diagnostic test for endometriosis, is expensive and carries surgical risks. Currently, no non-invasive tests that can

  10. [Definition, description, clinicopathological features, pathogenesis and natural history of endometriosis: CNGOF-HAS Endometriosis Guidelines].

    Borghese, B; Santulli, P; Marcellin, L; Chapron, C

    2018-03-01

    Endometriosis and adenomyosis are histologically defined. The frequency of endometriosis cannot be precisely estimated in the general population. Endometriosis is considered a disease when it causes pain and/or infertility. Endometriosis is a heterogeneous disease with three well-recognized subtypes that are often associated with each other: superficial endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). DIE is frequently multifocal and mainly affects the following structures: the uterosacral ligaments, the posterior vaginal cul-de-sac, the bladder, the ureters, and the digestive tract (rectum, recto-sigmoid junction, appendix). The role of menstrual reflux in the pathophysiology of endometriosis is major and explains the asymmetric distribution of lesions, which predominate in the posterior compartment of the pelvis and on the left (NP3). All factors favoring menstrual reflux increase the risk of endometriosis (early menarche, short cycles, AUB, etc.). Inflammation and biosteroid hormones synthesis are the main mechanisms favoring the implantation and the growth of the lesions. Pain associated with endometriosis can be explained by nociception, hyperalgia, and central sensitization, associated to varying degrees in a single patient. Typology of pain (dysmenorrhea, deep dyspareunia, digestive or urinary symptoms) is correlated with the location of the lesions. Infertility associated with endometriosis can be explained by several non-exclusive mechanisms: a pelvic factor (inflammation), disrupting natural fertilization; an ovarian factor, related to oocyte quality and/or quantity; a uterine factor disrupting implantation. The pelvic factor can be fixed by surgical excision of the lesions that improves the chance of natural conception (NP2). The uterine factor can be corrected by an ovulation-blocking treatment that improves the chances of getting pregnant by in vitro fertilization (NP2). The impact of endometrioma exeresis on

  11. APPENDICULAR INVAGINATION DUE TO ENDOMETRIOSIS

    Vasja Kruh

    2003-12-01

    Full Text Available Background. Invagination of the vermiform appendix is a very rare occurrence. We summarize epidemiologic and etiologic factors, types of classification, symtomatology, diagnostic features and treatment.Patients and treatment. The authors present 49-years old female with long-standing abdominal pains, who came in our hospital due to acute exacerbation with sever abdominal pain. Because of progressive symptoms and sensitivity in the right-lower abdominal quadrant a diagnostic laparoscopy was performed. An anomaly of cecum and the absence of appendix vermiformis have forced us to proceed with laparotomy in McBurnay point. After cecotomy an invaginated gangrenous appendix was found. The histological examination revealed endometriosis.Conclusions. By presenting this extremely rare pathology we also want to emphasize the important role of diagnostic laparoscopy in front of acute abdomen.

  12. Endocannabinoids modulate apoptosis in endometriosis and adenomyosis.

    Bilgic, Elif; Guzel, Elif; Kose, Sevil; Aydin, Makbule Cisel; Karaismailoglu, Eda; Akar, Irem; Usubutun, Alp; Korkusuz, Petek

    2017-06-01

    Adenomyosis that is a form of endometriosis is the growth of ectopic endometrial tissue within the muscular wall of the uterus (myometrium), which may cause dysmenorrhea and infertility. Endocannabinoid mediated apoptotic mechanisms of endometriosis and adenomyosis are not known. We hypothesized that the down regulation of endocannabinoid receptors and/or alteration in their regulatory enzymes may have a direct role in the pathogenesis of endometriosis and adenomyosis through apoptosis. Endocannabinoid receptors CB1 and CB2, their synthesizing and catabolizing enzymes (FAAH, NAPE-PLD, DAGL, MAGL) and the apoptotic indexes were immunohistochemically assessed in endometriotic and adenomyotic tissues. Findings were compared to normal endometrium and myometrium. Endometrial adenocarcinoma (Ishikawa) and ovarian endometriosis cyst wall stromal (CRL-7566) cell lines were furthermore cultured with or without cannabinoid receptor agonists. The IC50 value for CB1 and CB2 receptor agonists was quantified. Cannabinoid agonists on cell death were investigated by Annexin-V/Propidium iodide labeling with flow cytometry. CB1 and CB2 receptor levels decreased in endometriotic and adenomyotic tissues compared to the control group (p=0,001 and p=0,001). FAAH, NAPE-PLD, MAGL and DAGL enzyme levels decreased in endometriotic and adenomyotic tissues compared to control (p=0,001, p=0,001, p=0,001 and p=0,002 respectively). Apoptotic cell indexes both in endometriotic and adenomyotic tissues also decreased significantly, compared to the control group (p=0,001 and p=0,001). CB1 and CB2 receptor agonist mediated dose dependent fast anti-proliferative and pro-apoptotic effects were detected in Ishikawa and ovarian endometriosis cyst wall stromal cell lines (CRL-7566). Endocannabinoids are suggested to increase apoptosis mechanisms in endometriosis and adenomyosis. CB1 and CB2 antagonists can be considered as potential medical therapeutic agents for endometriosis and adenomyosis. Copyright

  13. World Endometriosis Research Foundation Endometriosis Phenome and biobanking harmonization project: II. Clinical and covariate phenotype data collection in endometriosis research

    Vitonis, Allison F.; Vincent, Katy; Rahmioglu, Nilufer; Fassbender, Amelie; Buck Louis, Germaine M.; Hummelshoj, Lone; Giudice, Linda C.; Stratton, Pamela; Adamson, G. David; Becker, Christian M.; Zondervan, Krina T.; Missmer, Stacey A.

    2014-01-01

    Objective To harmonize the collection of nonsurgical clinical and epidemiologic data relevant to endometriosis research, allowing large-scale collaboration. Design An international collaboration involving 34 clinical/academic centers and three industry collaborators from 16 countries on five continents. Setting In 2013, two workshops followed by global consultation, bringing together 54 leaders in endometriosis research. Patients None. Intervention(s) Development of a self-administered endometriosis patient questionnaire (EPQ), based on [1] systematic comparison of questionnaires from eight centers that collect data from endometriosis cases (and controls/comparison women) on a medium to large scale (publication on >100 cases); [2] literature evidence; and [3] several global consultation rounds. Main Outcome Measure(s) Standard recommended and minimum required questionnaires to capture detailed clinical and covariate data. Result(s) The standard recommended (EPHect EPQ-S) and minimum required (EPHect EPQ-M) questionnaires contain questions on pelvic pain, subfertility and menstrual/reproductive history, hormone/medication use, medical history, and personal information. Conclusion(s) The EPQ captures the basic set of patient characteristics and exposures considered by the WERF EPHect Working Group to be most critical for the advancement of endometriosis research, but is also relevant to other female conditions with similar risk factors and/or symptomatology. The instruments will be reviewed based on feedback from investigators, and–after a first review after 1 year–triannually through systematic follow-up surveys. Updated versions will be made available through http://endometriosisfoundation.org/ephect. PMID:25256930

  14. Incisional endometriosis: A rare cause for a painful scar – A report ...

    Endometriosis is the presence of endometrial tissue outside the Uterus. The true incidence of endometriosis is not really known, but it is believed that 10‑15% of all women in their reproductive age will develop endometriosis and 25‑35% of all women who are infertile have endometriosis. Incisional endometriosis (IE) is a ...

  15. Vacuum-assisted closure for open perineal wound after abdominoperineal resection.

    Fujino, Shiki; Miyoshi, Norikatsu; Ohue, Masayuki; Noura, Shingo; Fujiwara, Yoshiyuki; Yano, Masahiko; Higashiyama, Masahiko; Sakon, Masato

    2015-01-01

    In colorectal cancer surgery, surgical site infection (SSI) is a common complication, and especially, perineal wound complications after abdominoperineal resection (APR) remain to be serious clinical problems. Vacuum-assisted closure (VAC) therapy was first reported in another surgical field in 1997, and it is useful for treating complex wounds because it promotes granulation. VAC therapy has been recently used for open abdominal wounds. We introduced VAC for treating open perineal wound of APR and report the usefulness of it. We treated four patients. Firstly, in cases 1 and 2, we introduced VAC therapy to the management of SSI of the perineal wound after APR, and it was useful to control postoperative perineal wound infection. And also, in cases 3 and 4, we introduced VAC therapy to prevent perineal wound infection. Perineal wound infection did not happen. A vertical rectus abdominis myocutaneous flap has been reported to decrease perineal wound complications including pelvic abscess and open perineal wound; however it results in significant operative blood loss, increased operative time, and additional surgical complications. In our cases, there were no complications relating to VAC therapy and it promoted rapid wound healing. Our results suggested that it is an effective treatment for APR in a high-risk case of an open perineal wound. VAC therapy is a less invasive method and a useful treatment for open perineal wound of APR. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Pain and endometriosis: Etiology, impact, and therapeutics

    Robert N. Taylor

    2012-12-01

    Full Text Available The association of pain and endometriosis was recognized with the first definitive published reports of this disorder. Unfortunately, the precise etiologies and pathways leading to nociception and pain symptoms in endometriosis remain poorly understood, and as a result, effective therapeutic interventions are lacking with consequent profound effects on affected women’s quality of life. In this opinion paper we summarize selected proceedings presented at the 28th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE in Istanbul, Turkey, and review the clinical and translational evidence of chronic pain, neurogenesis, and the pernicious impact of dyspareunia on women with symptomatic endometriosis. The effectiveness of medical treatments is critically assessed and the findings indicate that good therapeutic options are available with extant medications effective in some sub-groups of women with endometriosis, many of which are affordable globally. Nevertheless, new management strategies and drugs need to be developed to increase the options of all afflicted women to minimize and ideally eradicate painful symptoms of endometriosis. However, only by elucidating distinctions among sub-groups with specific symptoms, suggesting different mechanisms, are we likely to derive truly successful therapeutic strategies.

  17. Spontanous Vulvar Endometriosis: Report of A Case

    Coşkun Ümit

    2016-04-01

    Full Text Available Endometriosis is an ectopic occurrence of tissue morphologically and functionally resembling endometrial tissue outside the uterine cavity. Vulva is one of the rarest location of extrapelvic endometriozis. We report a case of a 44-year-old multiparous woman, referred to our clinic with the complaints of having a vulvar mass and cyclic swelling of the mass during menstruation. She had a history of 2 previous cesarean delivery and no history of previous vulvar or vaginal surgery. The mass was 3-4cm in diameter and localized on the upper-portion of the right labium minus. Complete surgical excision was performed with the suspicion of endometriosis. Final histopathology report confirmed the diagnosis of endometriosis. Three weeks after surgery there was no evidence of endometriosis. In conclusion whether or not having a history of a previous vulvar surgery, vulvar endometriosis should be considered as a part of differential diagnosis in evaluation of vulvar masses.

  18. Pathophysiology and Immune Dysfunction in Endometriosis

    Ahn, Soo Hyun; Monsanto, Stephany P.; Miller, Caragh; Singh, Sukhbir S.; Thomas, Richard; Tayade, Chandrakant

    2015-01-01

    Endometriosis is an estrogen-dependent, chronic, proinflammatory disease prevalent in 10% of women of reproductive age worldwide. Characterized by the growth of endometrium-like tissue in aberrant locations outside of the uterus, it is responsible for symptoms including chronic pelvic pain, dysmenorrhea, and subfertility that degrade quality of life of women significantly. In Canada, direct and indirect economic cost of endometriosis amounts to 1.8 billion dollars, and this is elevated to 20 billion dollars in the United States. Despite decades of research, the etiology and pathophysiology of endometriosis still remain to be elucidated. This review aims to bring together the current understanding regarding the pathogenesis of endometriosis with specific focus on mechanisms behind vascularization of the lesions and the contribution of immune factors in facilitating lesion establishment and development. The role of hormones, immune cells, and cytokine signaling is highlighted, in addition to discussing the current pharmaceutical options available for management of pain symptoms in women with endometriosis. PMID:26247027

  19. Pathophysiology and Immune Dysfunction in Endometriosis

    Soo Hyun Ahn

    2015-01-01

    Full Text Available Endometriosis is an estrogen-dependent, chronic, proinflammatory disease prevalent in 10% of women of reproductive age worldwide. Characterized by the growth of endometrium-like tissue in aberrant locations outside of the uterus, it is responsible for symptoms including chronic pelvic pain, dysmenorrhea, and subfertility that degrade quality of life of women significantly. In Canada, direct and indirect economic cost of endometriosis amounts to 1.8 billion dollars, and this is elevated to 20 billion dollars in the United States. Despite decades of research, the etiology and pathophysiology of endometriosis still remain to be elucidated. This review aims to bring together the current understanding regarding the pathogenesis of endometriosis with specific focus on mechanisms behind vascularization of the lesions and the contribution of immune factors in facilitating lesion establishment and development. The role of hormones, immune cells, and cytokine signaling is highlighted, in addition to discussing the current pharmaceutical options available for management of pain symptoms in women with endometriosis.

  20. [Peritoneal fluid iron levels in women with endometriosis].

    Polak, Grzegorz; Wertel, Iwona; Tarkowski, Rafał; Kotarski, Jan

    2010-01-01

    Endometriosis is characterized by a cyclic hemorrhage within the peritoneal cavity. Accumulating data suggests that iron homeostasis in the peritoneal cavity may be disrupted by endometriosis. The aim of our study was to evaluate iron levels in peritoneal fluid (PF) of women with and without endometriosis. Seventy-five women were studied: 50 women with endometriosis and, as a reference group, 25 patients with functional follicle ovarian cysts. Iron concentrations in the PF were measured using a commercially available colorimetric assay kit. Iron concentrations were significantly higher in PF from women with endometriosis as compared to the reference group. Patients with stages III/IV endometriosis had significantly higher PF iron concentrations than women with stages I/II of the disease. Disrupted iron homeostasis in the peritoneal cavity of women with endometriosis plays a role in the pathogenesis of the disease.

  1. Endometriosis

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  2. Endometriosis

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  6. Endometriosis

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  16. SURGICAL TREATMENT OF ENDOMETRIOSIS IN INFERTILE PATIENTS

    Andrej Vogler

    2003-12-01

    Full Text Available Background. Endometriosis is nowadays probably the most frequent cause of infertility or subfertility and is revealed in approximately 30–40% of infertile women. The association between fertility and minimal or mild endometriosis remains unclear and controversial. Moderate and severe forms of the disease distort anatomical relations in the minor pelvis, resulting in infertility. The goals of endometriosis treatment are relief of pain symptoms, prevention of the disease progression and fertility improvement. Treatment of stages I and II endometriosis (according to the R-AFS classification may be expectative, medical or surgical. In severely forms of the disease (stage III and IV the method of choice is surgical treatment. Combined medical and surgical treatment is justified only in cases, in which the complete endometriotic tissue removal is not possible or recurrence of pain symptoms occur. Nowadays, laparoscopic surgical treatment is the golden standard being the diagnostic and therapeutic tool during the same procedure. The aim of this study was to evaluate the fertility rate after surgical treatment of different stages of endometriosis.Patients and methods. In prospectively designed study 100 infertile women were included. The only known cause of infertility was endometriosis. In group A there were 51 patients with stage I and II endometriosis, whereas in group B there were 49 patients with stage III and IV of the disease. Endometriosis was diagnosed and treated laparoscopically. Endometriotic implants were removed either with bipolar coagulation or CO2 laser vaporisation, whereas adhesions were sharp or blunt dissected, and endometriomas stripped out of ovaries. Pregnancy rates were calculated for both groups of patients, and statistically compared between the groups.Results. Mean age of patients was 29.25 (SD ± 4.08 years and did not significantly differ between the groups of patients (29.5 years in group A and 29 years in group B. In

  17. Endometriosis of the rectum: CT findings

    Guo Yan; Huang Zhaomin; Liu Mingjuan; Zhong Juemin

    2004-01-01

    Objective: To investigate the CT manifestations of recto-endometriosis. Methods: Three pathologically proved cases of recto-endometriosis were reported, the CT features and clinical manifestations were investigated retrospectively with review of literatures. Results: The patients were all menstruating females (28, 34, and 45 years old, respectively), and anal pain emerged during menses in one case. Rectal examination revealed stiff immobile mass along the rectal wall in all three cases. All the cases showed solid masses on CT scan with moderate enhancement after contrast administration. Two of them confined to the rectal walls, another involved the rectum and peri-rectal aspect. One case was misdiagnosed as well-differentiated adenocarcinoma of rectum in frozen section by biopsy specimen. Conclusion: A solid mass was always found in recto-endometriosis. No characteristic CT feature was manifested. Attention should be paid to the differentiation from rectal tumors when making the diagnosis

  18. X-ray diagnosis of colorectal endometriosis

    Runte, F.; Majewski, A.; Reichert, B.

    1987-05-01

    Preoperative diagnosis of symptomatic colorectal endometriosis is often difficult. Hence, the X-ray findings of eight woman patients with confirmed affection of the colon with endometriosis foci were evaluated together with the clinical, surgical and histological findings. In 50 % of the cases rectal haemorrhages were the most frequently occurring sign. In three-quarters of the cases the colon sigmoideum was involved. Radiologically it was possible to prove in 37,5 % each of the cases that there was a polypoid lesion and an irregular concentric stenosis of the intestinal lumen. In 25 % of the cases we found a complete stenosis of the intestinal lumen combined with ileus. X-ray sign pattern of colorectal endometriosis, however, is not pathognomonic.

  19. X-ray diagnosis of colorectal endometriosis

    Runte, F.; Majewski, A.; Reichert, B.

    1987-01-01

    Preoperative diagnosis of symptomatic colorectal endometriosis is often difficult. Hence, the X-ray findings of eight woman patients with confirmed affection of the colon with endometriosis foci were evaluated together with the clinical, surgical and histological findings. In 50 % of the cases rectal haemorrhages were the most frequently occurring sign. In three-quarters of the cases the colon sigmoideum was involved. Radiologically it was possible to prove in 37,5 % each of the cases that there was a polypoid lesion and an irregular concentric stenosis of the intestinal lumen. In 25 % of the cases we found a complete stenosis of the intestinal lumen combined with ileus. X-ray sign pattern of colorectal endometriosis, however, is not pathognomonic. (orig.) [de

  20. [Combined treatment of endometriosis: radical yet gentle].

    Alkatout, Ibrahim; Wedel, Thilo; Maass, Nicolai

    2018-02-01

    Endometriosis is the second most common benign female genital disease after uterine myoma. This review discusses the management of individual patients. This should take into account the severity of the disease and whether the patient desires to have children. Particular emphasis is laid on the anatomical intersections which, when injured, can lead to persistent damage of the anterior, middle or posterior compartment and are not infrequently the cause of urological and urogynaecological follow-up measures. Typical symptoms of endometriosis include chronic pelvic pain, subfertility, dysmenorrhoea, deep dyspareunia, cyclical bowel or bladder symptoms (e. g. dyschezia, bloating, constipation, rectal bleeding, diarrhoea and haematuria), abnormal menstrual bleeding, chronic fatigue and low back pain. Approx. 50 % of all female teenagers and up to 32 % of all women of reproductive age who have been operated for chronic pelvic pain or dysmenorrhoea suffer from endometriosis. The time interval between the first unspecific symptoms and the medical diagnosis of endometriosis is about 7 years. This is caused not only by the non-specific nature of the symptoms but also by the frequent lack of awareness on the part of the cooperating disciplines with which the patients have first contact. As the pathogenesis of endometriosis is not clearly understood, causal treatment is still impossible. Treatment options include expectant management, analgesia, hormonal medical therapy, surgical intervention and the combination of medical treatment before and/or after surgery. The treatment should be as radical as necessary and as minimal as possible. The recurrence rate among treated patients lies between 5 % and > 60 % and is very much dependent on integrated management and surgical skills. Consequently, to optimise the individual patient's treatment, a high degree of interdisciplinary cooperation in diagnosis and treatment is crucial and should be reserved to appropriate

  1. Hormonal treatment for endometriosis associated pelvic pain

    Wu Shun Felix Wong

    2011-01-01

    Full Text Available AbstractBackground: Endometriosis is a common gynecological problem associated with chronic pelvic pain. Objective: To evaluate the effectiveness of current hormonal treatments of endometriosis associated pain.Materials and Methods: Randomized Controlled studies identified from databases of Medline and Cochrane Systemic Review groups were pooled. 7 RCTs were recruited for evaluation in this review. Data from these studies were pooled and meta-analysis was performed in three comparison groups: 1 Progestogen versus GnRHa; 2 Implanon versus Progestogen (injection; 3 Combined oral contraceptive pills versus placebo and progestogen. Response to treatment was measured as a reduction in pain score. Pain improvement was defined as improvement ≥1 at the end of treatment. Results: There was no significant difference between treatment groups of progestogen and GnRHa (RR: 0.036; CI:-0.030-0.102 for relieving endometriosis associated pelvic pain. Long acting progestogen (Implanon and Mirena are not inferior to GnRHa and depot medroxy progesterone acetate (DMPA (RR: 0.006; CI:-0.142-0.162. Combined oral contraceptive pills demonstrated effective treatment of relieving endometriosis associated pelvic pain when compared with placebo groups (RR:0.321CI-0.066-0.707. Progestogen was more effective than combined oral contraceptive pills in controlling dysmenorrhea (RR:-0.160; CI:-0.386-0.066, however, progestogen is associated with more side effects like spotting and bloating than the combined contraceptive pills. Conclusion: Combined oral contraceptive pills (COCP, GnRHa and progestogens are equally effective in relieving endometriosis associated pelvic pain. COCP and progestogens are relatively cheap and more suitable for long-term use as compared to GnRHa. Long-term RCT of medicated contraceptive devices like Mirena and Implanon are required to evaluate their long-term effects on relieving the endometriosis associated pelvic pain

  2. Effects of Previous Laparoscopic Surgical Diagnosis of Endometriosis on Pregnancy Outcomes

    Hui Li

    2017-01-01

    Conclusions: Endometriosis may affect obstetric outcomes. Women with endometriosis have a higher risk of postpartum hemorrhage. Women with endometriosis who conceived by ART may have a higher risk of postpartum hemorrhage and preterm birth than those conceived naturally.

  3. Magnetic resonance imaging of pelvic endometriosis

    Vieira, G.P.; Martin, B.; Tubiana, J.M.

    1994-01-01

    Twenty-five magnetic resonance imaging (MRI) studies were performed in 18 patients with proven endometriosis. MRI findings were analyzed and compared with laparoscopic or surgical findings; MRI accurately demonstrated ovarian endometrial cysts as well as ectopic foci of endometriosis. Adhesions may be also suggested. Contrary to laparoscopy, MRI easily depicts both deep lesions and endometrial implants under the peritoneum. Consequently, MRI appears as an useful adjunct to laparoscopy for initial diagnosis before starting a medical treatment and above all as the imaging modality of choice for evaluation of the answer to treatment, avoiding iterative and often adhesions limited laparoscopies. (author). 7 refs.; 9 figs

  4. Characteristics of female patients with sexual dysfunction who also had a history of blunt perineal trauma.

    Munarriz, Ricardo; Talakoub, Lily; Somekh, Nir N; Lehrfeld, Todd; Chudnovsky, Aleksander; Flaherty, Elizabeth; Goldstein, Irwin

    2002-01-01

    Perineal trauma can occur in both genders, however, data supporting the relationship between sexual dysfunction and blunt perineal trauma in women is lacking. This study reviewed the patient characteristics of women with sexual dysfunction who also had a history of blunt perineal trauma. A neurogenic form of sexual dysfunction has been implicated, with primary complaints of orgasm disorder and abnormalities noted on genital sensory testing. Further research in this area is needed.

  5. BIRD’S NEST EXTRACT CREAM: TREATMENT FOR PERINEAL WOUND IN RATTUS NORVEGICUS

    Herlina Ofiwijayanti; Syarief Thaufik Hidayat; Nur Khafidhoh

    2017-01-01

    Background: Perineal rupture occurs almost in all the first labor and not infrequently in the next labor. Complex perineal wounds are at risk for non healing and infection. Objective: This study aims to determine the effect of bird’s nest extract on perineal wound healing on rattus norvegicus. Methods: This was a randomised posttest only group design conducted in October 2016 at Animal Laboratory Unit of Diponegoro University, Semarang. There were 30 samples recruited in this study, div...

  6. Postpartum perineal reapir performed by midwives: A randomised trial comparing two suture techniques for perineal repair leaving the skin unsutured

    Kindberg, Sara; Misan, Stehouwer; Hvidman, Lone

    2008-01-01

    Postpartum perineal repair performed by midwives: A randomised trial comparing two suture techniques leaving the skin unsutured. Objective      To compare a continuous suture technique to interrupted stitches using inverted knots for postpartum perineal repair of second-degree lacerations...... and episiotomies.   Design          A double blind randomised controlled trial.   Setting          A Danish university hospital with more than 4800 deliveries annually.   Population   400 healthy primiparous women with a vaginal delivery at term.   Method         Randomisation was computer-controlled. Structured...... healing, patient satisfaction, dyspareunia or need for resuturing. The continuous suture technique was significantly faster (15 min. vs. 17 min, p=0.03) and less suture material was used (1 vs. 2 packets, pskin unsutured...

  7. Evaluation of Risk Factors Associated with Endometriosis in Infertile Women

    Mahnaz Ashrafi

    2016-05-01

    Full Text Available Background: Endometriosis affects women’s physical and mental wellbeing. Symptoms include dyspareunia, dysmenorrhea, pelvic pain, and infertility. The purpose of this study is to assess the correlation between some relevant factors and symptoms and risk of an endometriosis diagnosis in infertile women. Materials and Methods: A retrospective study of 1282 surgical patients in an infertility Institute, Iran between 2011 and 2013 were evaluated by laparoscopy. Of these, there were 341 infertile women with endometriosis (cases and 332 infertile women with a normal pelvis (comparison group. Chi-square and t tests were used to compare these two groups. Logistic regression was done to build a prediction model for an endometriosis diagnosis. Results: Gravidity [odds ratio (OR: 0.8, confidence interval (CI: 0.6-0.9, P=0.01], parity (OR: 0.7, CI: 0.6-0.9, P=0.01, family history of endometriosis (OR: 4.9, CI: 2.1-11.3, P0.05. Fatigue, diarrhea, constipation, dysmenorrhea, dyspareunia, pelvic pain and premenstrual spotting were more significant among late-stage endometriosis patients than in those with early-stage endometriosis and more prevalent among patients with endometriosis than that of the comparison group. In the logistic regression model, gravidity, family history of endometriosis, history of galactorrhea, history of pelvic surgery, dysmenorrhoea, pelvic pain, dysparaunia, premenstrual spotting, fatigue, and diarrhea were significantly associated with endometriosis. However, the number of pregnancies was negatively related to endometriosis. Conclusion: Endometriosis is a considerable public health issue because it affects many women and is associated with the significant morbidity. In this study, we built a prediction model which can be used to predict the risk of endometriosis in infertile women.

  8. Inguinal endometriosis attaching to the round ligament

    Hagiwara, Y.; Hatori, M.; Kokubun, S.; Moriya, T.; Terada, Y.; Yaegashi, N.; Ehara, S.

    2007-01-01

    We report a case of endometriosis in the right inguinal region, attached to the right round ligament in a 28-year-old woman. At the age of 20, laparoscopic left ovarian cystectomy and pelvic adhesiolysis for endometriosis was carried out. She noticed a right tender groin mass 7 months previously, and the tumour size fluctuated with the menstrual cycle. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpated in her right inguinal region. Magnetic resonance imaging showed a 2.5 cm x 2.5 cm mass in the right inguinal canal and a 5.4 cm x 6.8 cm mass was seen in the left ovary. The mass enlarged during menstruation. The groin mass was removed, in addition to carrying out laparoscopic ovarian cystectomy. At operation, the groin mass was found to be in continuity with the round ligament of extraperitoneal portion. Histological diagnosis of endometriosis was made in both ovarian and inguinal tumours. After surgery, the pain disappeared completely. Worth mentioning is that MRI clearly showed the change of tumour size depending on the menstrual cycle, which aided in arriving at the correct diagnosis of endometriosis in an unusual location

  9. Thoracic endometriosis syndrome: Current concept in ...

    Background: Thoracic endometriosis is a rare pathology. The diagnosis is often delayed or missed, however recently, there has been significant advances in the knowledge of this condition and hence, an improvement in the diagnosis and treatment. Objective: To review the current concepts in the pathophysiology and ...

  10. Post caesarean section anterior abdominal wall endometriosis ...

    Abdominal wall endometriosis is a likely sequelae of caesarean section as viable endometrial tissue are deposited in the peritoneal cavity or anterior abdominal wall. One such case to sensitize clinicians of this rare presentation of the disease is presented. The patient was a 48 year old woman who presented with a lesion ...

  11. Low-Density Lipoproteins Oxidation and Endometriosis

    Grzegorz Polak

    2013-01-01

    Full Text Available The etiopathogenesis of endometriosis still remains unknown. Recent data provide new valuable information concerning the role of oxidative stress in the pathophysiology of the disease. It has been proved that levels of different lipid peroxidation end products are increased in both peritoneal fluid (PF and serum of endometriotic patients. We assessed the concentration of oxidized low-density lipoproteins (oxLDL in PF of 110 women with different stages of endometriosis and 119 women with serous ( or dermoid ( ovarian cysts, as the reference groups. PF oxLDL levels were evaluated by ELISA. We found that concentrations of oxLDL in PF of endometriotic women were significantly higher compared to women with serous but not dermoid ovarian cysts. Interestingly, by analyzing concentrations of oxLDL in women with different stages of the disease, it was noted that they are significantly higher only in the subgroup of patients with stage IV endometriosis as compared to women with ovarian serous cysts. In case of minimal, mild, and moderate disease, PF oxLDL levels were similar to those noted in reference groups. Our results indicate that disrupted oxidative status in the peritoneal cavity of women with endometriosis may play a role in the pathogenesis of advanced stages of the disease.

  12. DIOXINS AND ENDOMETRIOSIS: A PLAUSIBLE HYPOTHESIS

    A potential connection exists between the increasing prevalence of endometriosis and exposure to organochlorine chemicals. There is evidence that dioxin (2,3,7,8-TCDD) can increase the incidence and severity of the disease in monkeys and can promote the growth or survival of end...

  13. Hormonal Treatment for Severe Hydronephrosis Caused by Bladder Endometriosis

    Erkan Efe

    2014-01-01

    Full Text Available The incidence of endometriosis cases involving the urinary system has recently increased, and the bladder is a specific zone where endometriosis is most commonly seen in the urinary system. In the case presented here, a patient presented to the emergency department with the complaint of side pain and was examined and diagnosed with severe hydronephrosis and bladder endometriosis was determined in the etiology. After the patient was pathologically diagnosed, Levonorgestrel-Releasing Intrauterine System (LNG-IUS was administered to the uterine cavity. At the 12-month follow-up, endometriosis was not observed in the cystoscopy and symptoms had completely regressed. Hydronephrosis may be observed after exposure of the ureter, and silent renal function loss may develop in patients suffering from endometriosis with bladder involvement. For patients with moderate or severe hydronephrosis associated with bladder endometriosis, LNG-IUS application may be separately and successfully used after conservative surgery.

  14. Descending colon endometriosis misdiagnosis as diverticulitis: A case report

    Kim, Ji Hyun; Kim, Min Jeong; Ha, Hong Il; Lee, Kwan Seop; Min, Soo Kee [Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of)

    2016-09-15

    Endometriosis is defined as the presence of ectopic endometrial tissue outside the uterus. It is a common disease in menstruating females and intestinal involvement is not uncommon. Intestinal endometriosis most commonly involves the sigmoid colon, rectum, ileum, appendix, and cecum. However, the descending colon is a rare site of intestinal endometriosis. Although computed tomography (CT) findings of bowel endometriosis have been presented in several articles, there has been no report describing the CT findings of descending colon endometriosis above the pelvic cavity. Here, we report a rare case of descending colon endometriosis located in the retroperitoneal space, in which the initial impression was acute colonic diverticulitis with a small abscess on preoperative multidetector CT.

  15. Descending colon endometriosis misdiagnosis as diverticulitis: A case report

    Kim, Ji Hyun; Kim, Min Jeong; Ha, Hong Il; Lee, Kwan Seop; Min, Soo Kee

    2016-01-01

    Endometriosis is defined as the presence of ectopic endometrial tissue outside the uterus. It is a common disease in menstruating females and intestinal involvement is not uncommon. Intestinal endometriosis most commonly involves the sigmoid colon, rectum, ileum, appendix, and cecum. However, the descending colon is a rare site of intestinal endometriosis. Although computed tomography (CT) findings of bowel endometriosis have been presented in several articles, there has been no report describing the CT findings of descending colon endometriosis above the pelvic cavity. Here, we report a rare case of descending colon endometriosis located in the retroperitoneal space, in which the initial impression was acute colonic diverticulitis with a small abscess on preoperative multidetector CT

  16. Role of Interleukin-6 and Its Receptor in Endometriosis

    Li, Shihui; Fu, Xiaoxia; Wu, Tingting; Yang, Liwei; Hu, Changchang; Wu, RuiJin

    2017-01-01

    Background Studies have shown that the concentration of interleukin (IL)-6 in peritoneal fluid is increased in patients with endometriosis; however, whether the disorders involving IL-6 contribute to the development of endometriosis is still unclear. In the present study, we evaluated the potential role of IL-6 and IL-6 receptor (IL-6R) in the pathogenesis of endometriosis. Material/Methods We examined activated macrophages and the expression of membrane-binding receptor (mIL-6R) in peritonea...

  17. The role of the peritoneum in the pathogenesis of endometriosis.

    Young, Vicky J; Brown, Jeremy K; Saunders, Philippa T K; Horne, Andrew W

    2013-01-01

    BACKGROUND Endometriosis affects 6-10% of women of reproductive age and is associated with chronic pelvic pain, dysmenorrhoea, dyspareunia and infertility. Endometriosis is defined by the presence of endometrial tissue outside the uterus, most commonly attached to the pelvic peritoneum. The endometrium in women with endometriosis is reported to be altered and there is increasing evidence that the phenotype of the pelvic peritoneum may also play a role in the establishment and maintenance of the disease. The aim of this review is to discuss the putative role of the pelvic peritoneum in the pathophysiology of peritoneal endometriosis. METHODS A review was undertaken of the published literature on (i) the anatomy and physiology of the peritoneum and (ii) the potential roles played by peritoneal cells in the establishment and maintenance of peritoneal endometriosis. The current understanding of the biology of peritoneal endometriosis is summarized and the potential interaction of the peritoneum with ectopic endometrial cells in endometriosis is highlighted. RESULTS Several studies indicate that differential expression of peritoneal mesothelial adhesion factors occurs in women with endometriosis, providing potential ectopic endometrial cell attachment sites for the establishment of endometriosis lesions. Changes in the peritoneal mesothelial cell phenotype, including loss of tight junctions, may allow ectopic cells to bind to, or early lesions to invade into, the extracellular matrix. Epithelial-to-mesenchymal transition of peritoneal mesothelial cells may also lead to an increase in lesion invasion and formation of fibrotic tissue in and around the lesion. There is evidence that the peritoneal mesothelium may also play a role in the invasion potential of ectopic cells by production of MMPs increasing local tissue remodelling. Peritoneal immune scavenging function may be lowered in women with endometriosis; for example there is a notable increase in macrophage

  18. Cyclic sciatica caused by infiltrative endometriosis: MRI findings

    Yekeler, Ensar; Kumbasar, Basak; Tunaci, Atadan; Barman, Ahmet; Tunaci, Mehtap [Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, 34390, Capa, Istanbul (Turkey); Bengisu, Ergin [Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul (Turkey); Yavuz, Ekrem [Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, 34390, Capa, Istanbul (Turkey)

    2004-03-01

    Endometriosis, an important gynecological disorder of reproductive women, affects most commonly the ovaries and less frequently the gastrointestinal tract, chest, urinary tract, and soft tissues. Endometriosis classically appears on MRI as a mass with a large cystic component and variable signal intensities on T1- and T2-weighted images due to the presence of variable degradation of hemorrhagic products. Endometriosis in an atypical location, an infiltrative appearance and without cystic-hemorrhagic components has rarely been described. We report on a 33-year-old woman with cyclic sciatica due to histologically documented infiltrative endometriosis involving the area of the left sciatic notch. (orig.)

  19. Cyclic sciatica caused by infiltrative endometriosis: MRI findings

    Yekeler, Ensar; Kumbasar, Basak; Tunaci, Atadan; Barman, Ahmet; Tunaci, Mehtap; Bengisu, Ergin; Yavuz, Ekrem

    2004-01-01

    Endometriosis, an important gynecological disorder of reproductive women, affects most commonly the ovaries and less frequently the gastrointestinal tract, chest, urinary tract, and soft tissues. Endometriosis classically appears on MRI as a mass with a large cystic component and variable signal intensities on T1- and T2-weighted images due to the presence of variable degradation of hemorrhagic products. Endometriosis in an atypical location, an infiltrative appearance and without cystic-hemorrhagic components has rarely been described. We report on a 33-year-old woman with cyclic sciatica due to histologically documented infiltrative endometriosis involving the area of the left sciatic notch. (orig.)

  20. Endometriosis-Associated Ovarian Cancer: A Review of Pathogenesis

    Shu-Wing Ng

    2013-03-01

    Full Text Available Endometriosis is classically defined as the presence of endometrial glands and stroma outside of the endometrial lining and uterine musculature. With an estimated frequency of 5%–10% among women of reproductive age, endometriosis is a common gynecologic disorder. While in itself a benign lesion, endometriosis shares several characteristics with invasive cancer, has been shown to undergo malignant transformation, and has been associated with an increased risk of epithelial ovarian carcinoma (EOC. Numerous epidemiologic studies have shown an increased risk of EOC among women with endometriosis. This is particularly true for women with endometrioid and clear cell ovarian carcinoma. However, the carcinogenic pathways by which endometriosis associated ovarian carcinoma (EAOC develops remain poorly understood. Current molecular studies have sought to link endometriosis with EAOC through pathways related to oxidative stress, inflammation and hyperestrogenism. In addition, numerous studies have sought to identify an intermediary lesion between endometriosis and EAOC that may allow for the identification of endometriosis at greatest risk for malignant transformation or for the prevention of malignant transformation of this common gynecologic disorder. The objective of the current article is to review the current data regarding the molecular events associated with EAOC development from endometriosis, with a primary focus on malignancies of the endometrioid and clear cell histologic sub-types.

  1. Effect of imatinib on growth of experimental endometriosis in rats.

    Yildiz, Caglar; Kacan, Turgut; Akkar, Ozlem Bozoklu; Karakus, Savas; Seker, Metin; Kacan, Selen Baloglu; Ozer, Hatice; Cetin, Ali

    2016-02-01

    Currently, medical and surgical treatment options for endometriosis are limited due to suboptimal efficacy, and also safety and tolerance issues. Long-term use of gonadotrophin-releasing hormone analogs, androgenes, and the danazol, which are widely used drugs for endometriosis, is usually not possible due to their suboptimal safety and tolerance profile. The lack of an effective, tolerable and safe treatment option for endometriosis makes animal models of experimental endometriosis necessary to study candidate drugs. The aim of this study was to investigate the efficacy of imatinib on the experimental endometriosis in a rat model. Endometriosis was induced by autotransplantation of uterine tissue into the peritoneal cavity. Twenty-four rats, which had visually confirmed endometriotic implants on subsequent laparotomy, were randomized into three groups to receive imatinib (25mg/kg/day, p.o.), anastrozole (0.004 mg/day, p.o.), or normal saline (0.1 mL, i.p.) for 14 days. After removal of endometriotic tissue and H & E staining, endometriosis score was determined according to a semiquantitative histological classification. Also, immunostaining with primary antibodies including VEGF, CD117, and Bax were used for immunohistochemical (IHC) examination. Both anastrozole and imatinib suppressed the growth of endometriotic tissue and reduced the number of ovarian follicles. Although the difference was not statistically significant, imatinib was less effective than anastrozole for treatment of endometriosis. Imatinib effectively treats experimental endometriosis by its inhibitor effects on angiogenesis and cell proliferation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Urinary phthalate monoesters and endometriosis in infertile Japanese women

    Itoh, Hiroaki; Iwasaki, Motoki; Hanaoka, Tomoyuki; Sasaki, Hiroshi; Tanaka, Tadao; Tsugane, Shoichiro

    2009-01-01

    Phthalates may act as an estrogen and are a potential risk factor for estrogen-related diseases such as endometriosis. We assessed the association between phthalate exposure and endometriosis in 166 consecutive women who presented at a university hospital for consultation regarding infertility. The subjects were interviewed and provided a urine specimen prior to a laparoscopic diagnosis of endometriosis. They were then categorized by the severity of endometriosis as controls (stages 0-I) and cases (stages II-IV). Urinary concentrations of the phthalate metabolites monoethyl phthalate, mono-n-butyl phthalate, monobenzyl phthalate, mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-oxohexyl) phthalate, and mono(2-ethyl-5-hydroxyhexyl) phthalate were measured in 57 cases and 80 controls using high-performance liquid chromatography isotope-dilution tandem mass spectrometry. Adjusted odds ratios for endometriosis in relation to dichotomized individual phthalate metabolites (standardized for creatinine) were calculated. No significant association between endometriosis and any urinary creatinine-adjusted phthalate monoester was seen. Adjusted odds ratio (95% confidence interval) for higher dichotomized MEHP by endometriosis was 1.57 (0.74-3.30). No monotonic trend was seen in urinary creatinine-adjusted concentration of phthalate metabolites by endometriosis stage (p = 0.23-0.90). Our results do not support the hypothesis that higher urinary concentrations of phthalate metabolites are associated with the risk of endometriosis in infertile Japanese women.

  3. Urinary phthalate monoesters and endometriosis in infertile Japanese women

    Itoh, Hiroaki [Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 (Japan); Iwasaki, Motoki, E-mail: moiwasak@ncc.go.jp [Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 (Japan); Hanaoka, Tomoyuki [Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 (Japan); Sasaki, Hiroshi; Tanaka, Tadao [Department of Obstetrics and Gynecology, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo 105-8461 (Japan); Tsugane, Shoichiro [Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 (Japan)

    2009-12-15

    Phthalates may act as an estrogen and are a potential risk factor for estrogen-related diseases such as endometriosis. We assessed the association between phthalate exposure and endometriosis in 166 consecutive women who presented at a university hospital for consultation regarding infertility. The subjects were interviewed and provided a urine specimen prior to a laparoscopic diagnosis of endometriosis. They were then categorized by the severity of endometriosis as controls (stages 0-I) and cases (stages II-IV). Urinary concentrations of the phthalate metabolites monoethyl phthalate, mono-n-butyl phthalate, monobenzyl phthalate, mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-oxohexyl) phthalate, and mono(2-ethyl-5-hydroxyhexyl) phthalate were measured in 57 cases and 80 controls using high-performance liquid chromatography isotope-dilution tandem mass spectrometry. Adjusted odds ratios for endometriosis in relation to dichotomized individual phthalate metabolites (standardized for creatinine) were calculated. No significant association between endometriosis and any urinary creatinine-adjusted phthalate monoester was seen. Adjusted odds ratio (95% confidence interval) for higher dichotomized MEHP by endometriosis was 1.57 (0.74-3.30). No monotonic trend was seen in urinary creatinine-adjusted concentration of phthalate metabolites by endometriosis stage (p = 0.23-0.90). Our results do not support the hypothesis that higher urinary concentrations of phthalate metabolites are associated with the risk of endometriosis in infertile Japanese women.

  4. Nonsuturing or Skin Adhesives versus Suturing of the Perineal Skin After Childbirth: A Systematic Review

    Seijmonsbergen-Schermers, A.E.; Sahami, S.; Lucas, C.; de Jonge, A.

    2015-01-01

    Background: Suturing of perineal trauma after childbirth can cause problems such as pain, discomfort because of tight sutures, the need for suture removal, and dyspareunia. It is unclear whether leaving the perineal skin unsutured or using skin adhesives might prevent these problems. Methods:

  5. Nonsuturing or Skin Adhesives versus Suturing of the Perineal Skin After Childbirth: A Systematic Review

    Seijmonsbergen-Schermers, Anna E.; Sahami, Saloomeh; Lucas, Cees; Jonge, Ank de

    2015-01-01

    Suturing of perineal trauma after childbirth can cause problems such as pain, discomfort because of tight sutures, the need for suture removal, and dyspareunia. It is unclear whether leaving the perineal skin unsutured or using skin adhesives might prevent these problems. CENTRAL, MEDLINE, EMBASE,

  6. New perineal injection technique for pudendal nerve infiltration in diagnostic and therapeutic procedures

    Weinschenk, Stefan; Hollmann, Markus W.; Strowitzki, Thomas

    2016-01-01

    Pudendal nerve injection is used as a diagnostic procedure in the vulvar region and for therapeutic purposes, such as in vulvodynia. Here, we provide a new, easy-to-perform perineal injection technique. We analyzed 105 perineal injections into the pudendal nerve with a local anesthetic (LA),

  7. Correction of rectal sacculation through lateral resection in dogs with perineal hernia - technique description

    P.C. Moraes

    2013-06-01

    Full Text Available The occurrence of perineal hernias in dogs during routine clinical surgery is frequent. The coexistence of rectal diseases that go undiagnosed or are not correctly treated can cause recurrence and postoperative complications. The objective of this report is to describe a surgical technique for treatment of rectal sacculation through lateral resection in dogs with perineal hernia, whereby restoring the rectal integrity.

  8. Correction of rectal sacculation through lateral resection in dogs with perineal hernia - technique description

    P.C. Moraes; N.M. Zanetti; C.P. Burger; A.E.W.B. Meirelles; J.C. Canola; J.G.M.P. Isola

    2013-01-01

    The occurrence of perineal hernias in dogs during routine clinical surgery is frequent. The coexistence of rectal diseases that go undiagnosed or are not correctly treated can cause recurrence and postoperative complications. The objective of this report is to describe a surgical technique for treatment of rectal sacculation through lateral resection in dogs with perineal hernia, whereby restoring the rectal integrity.

  9. A novel method to determine perineal artery occlusion among male bicyclists.

    Parthiban, Sujeeth; Hotaling, James M; Kathrins, Martin; Baftiri, Amit P; Freels, Sally; Niederberger, Craig S

    2015-01-01

    Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs. Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce(®) sensors were affixed over the proximal and distal aspects of the perineal arteries bilaterally. Individuals completed bicycle rides in the road- and stationary-settings with six distinct seat designs, including those with and without an anterior "nose." Results. The occlusion time proportion of the total ride time was calculated for each trial. The overall occlusion time proportion was 0.59 (95% CI [0.45-0.73]) across all seats and settings. The "no-nose" bicycle seat and the stationary-setting demonstrated significantly lower occlusion proportion times than the traditional nose bicycle seat and road-setting, respectively. However, all bicycle seats yielded an occlusion time proportion of 0.41 or greater. Discussion. Our method of real-time, non-invasive force measurement localized to the perineal arteries may be used to validate future bicycle seat design. It also underscores the significant risk of perineal artery insufficiency in men who are avid bicyclists. This risk may be minimized by using newer "no-nose" bicycle seats.

  10. Pelvic floor muscle thickness measured by perineal ultrasonography

    Bernstein, Inge Thomsen; Juul, N; Grønvall, S

    1991-01-01

    Pelvic floor muscle thickness was assessed in nine healthy female physiotherapists by perineal sonography. All measurements were performed as triple-measurements. The aims were to assess the reliability of the measurements and to establish a reference material. The muscle thickness at rest...... and at contraction was 9.4 +/- 0.8 mm and 11.5 +/- 1.1 mm respectively (mean +/- SD). Contraction increased the thickness by 2.2 +/- 0.8 mm or 23 +/- 8%. The intra- and inter observer standard deviation of the estimate was in the range of 4-6%. In conclusion, we find the reliability of the measurements acceptable....

  11. Length of perineal pain relief after ice pack application: A quasi-experimental study.

    de Souza Bosco Paiva, Caroline; Junqueira Vasconcellos de Oliveira, Sonia Maria; Amorim Francisco, Adriana; da Silva, Renata Luana; de Paula Batista Mendes, Edilaine; Steen, Mary

    2016-04-01

    Ice pack is effective for alleviating postpartum perineal pain in primiparous women while multiparous women's levels of perineal pain appear to be poorly explored. Ice pack is a low-cost non-invasive localised treatment that can be used with no impact on breastfeeding. However, how long perineal analgesia persists after applying an ice pack is still unknown. To evaluate if perineal analgesia is maintained up to 2h after applying an ice pack to the perineum for 20min. A quasi-experimental study, using a pre and post-test design, was undertaken with a sample size of 50 multiparous women in Brazil. Data was collected by structured interview. The intervention involved a single application of an ice pack applied for 20min to the perineal area of women who reported perineal pain ≥3 by use of a numeric rating scale (0-10), with intact perineum, 1st or 2nd degree lacerations or episiotomy, between 6 and 24h after spontaneous vaginal birth. Perineal pain was evaluated at three points of time: before, immediately after and 2h after applying an ice pack. Immediately after applying an ice pack to the perineal area, there was a significant reduction in the severity of perineal pain reported (5.4 vs. 1.0, p<0.0005), which continued for 1h 35min up to 2h after the local application. Ice pack application for 20min is effective for alleviating postpartum perineal pain and continues to be effective between 1h 35min for up to 2h. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  12. [Serum markers of oxidative stress in infertile women with endometriosis].

    Andrade, Aline Zyman de; Rodrigues, Jhenifer Kliemchen; Dib, Luciana Azôr; Romão, Gustavo Salata; Ferriani, Rui Alberto; Jordão Junior, Alceu Afonso; Navarro, Paula Andrea de Albuquerque Salles

    2010-06-01

    to compare serum markers of oxidative stress between infertile patients with and without endometriosis and to assess the association of these markers with disease staging. this was a prospective study conducted on 112 consecutive infertile, non-obese patients younger than 39 years, divided into two groups: Endometriosis (n=48, 26 with minimal and mild endometriosis - Stage I/II, and 22 with moderate and severe endometriosis - Stage III/IV) and Control (n=64, with tubal and/or male factor infertility). Blood samples were collected during the early follicular phase of the menstrual cycle for the analysis of serum malondialdehyde, glutathione and total hydroxyperoxide levels by spectrophotometry and of vitamin E by high performance liquid chromatography. The results were compared between the endometriosis and control groups, stage I/II endometriosis and control, stage III/IV endometriosis and control, and between the two endometriosis subgroups. The level of significance was set at 5% (p Control Group (8.0 ± 2 µMol/g protein) and among patients with stage III/IV disease (9.7 ± 2.3 µMol/g protein) compared to patients with stage I/II disease (8.2 ± 1.0 µMol/g protein). No significant differences in serum malondialdehyde levels were observed between groups. we demonstrated a positive association between infertility related to endometriosis, advanced disease stage and increased serum hydroxyperoxide levels, suggesting an increased production of reactive species in women with endometriosis. These data, taken together with the reduction of serum vitamin E and glutathione levels, suggest the occurrence of systemic oxidative stress in women with infertility associated with endometriosis. The reproductive and metabolic implications of oxidative stress should be assessed in future studies.

  13. Surgical Outcomes of Urinary Tract Deep Infiltrating Endometriosis.

    Darwish, Basma; Stochino-Loi, Emanuela; Pasquier, Geoffroy; Dugardin, Fabrice; Defortescu, Guillaume; Abo, Carole; Roman, Horace

    To report the outcomes of surgical management of urinary tract endometriosis. Retrospective study based on prospectively recorded data (NCT02294825) (Canadian Task Force classification II-3). University tertiary referral center. Eighty-one women treated for urinary tract endometriosis between July 2009 and December 2015 were included, including 39 with bladder endometriosis, 31 with ureteral endometriosis, and 11 with both ureteral and bladder endometriosis. Owing to bilateral ureteral localization in 8 women, 50 different ureteral procedures were recorded. Procedures performed included resection of bladder endometriosis nodules, advanced ureterolysis, ureteral resection followed by end-to-end anastomosis, and ureteroneocystostomy. The main outcome measure was the outcome of the surgical management of urinary tract endometriosis. Fifty women presented with deep infiltrating endometriosis (DIE) of the bladder and underwent either full-thickness excision of the nodule (70%) or excision of the bladder wall without opening of the bladder (30%). Ureteral lesions were treated by ureterolysis in 78% of the patients and by primary segmental resection in 22%. No patient required nephrectomy. Histological analysis revealed intrinsic ureteral endometriosis in 54.5% of cases. Clavien-Dindo grade III complications were present in 16% of the patients who underwent surgery for ureteral nodules and in 8% of those who underwent surgery for bladder endometriosis. Overall delayed postoperative outcomes were favorable regarding urinary symptoms and fertility. Patients were followed up for a minimum of 12 months and a maximum of 7 years postoperatively, with no recorded recurrences. Surgical outcomes of urinary tract endometriosis are generally satisfactory; however, the risk of postoperative complications should be taken into consideration. Therefore, all such procedures should be managed by an experienced multidisciplinary team. Copyright © 2017 AAGL. Published by Elsevier Inc

  14. Endometriosis: a high-risk population for major chronic diseases?

    Kvaskoff, Marina; Mu, Fan; Terry, Kathryn L.; Harris, Holly R.; Poole, Elizabeth M.; Farland, Leslie; Missmer, Stacey A.

    2015-01-01

    BACKGROUND Despite an estimated prevalence of 10% in women, the etiology of endometriosis remains poorly understood. Over recent decades, endometriosis has been associated with risk of several chronic diseases, such as cancer, autoimmune diseases, asthma/atopic diseases and cardiovascular diseases. A deeper understanding of these associations is needed as they may provide new leads into the causes or consequences of endometriosis. This review summarizes the available epidemiological findings on the associations between endometriosis and other chronic diseases and discusses hypotheses for underlying mechanisms, potential sources of bias and methodological complexities. METHODS We performed a comprehensive search of the PubMed/Medline and ISI Web of Knowledge databases for all studies reporting on the associations between endometriosis and other diseases published in English through to May 2014, using numerous search terms. We additionally examined the reference lists of all identified papers to capture any additional articles that were not identified through computer searches. RESULTS We identified 21 studies on the associations between endometriosis and ovarian cancer, 14 for breast cancer, 8 for endometrial cancer, 4 for cervical cancer, 12 for cutaneous melanoma and 3 for non-Hodgkin's lymphoma, as well as 9 on the links between endometriosis and autoimmune diseases, 6 on the links with asthma and atopic diseases, and 4 on the links with cardiovascular diseases. Endometriosis patients were reported to be at higher risk of ovarian and breast cancers, cutaneous melanoma, asthma, and some autoimmune, cardiovascular and atopic diseases, and at decreased risk of cervical cancer. CONCLUSIONS Increasing evidence suggests that endometriosis patients are at higher risk of several chronic diseases. Although the underlying mechanisms are not yet understood, the available data to date suggest that endometriosis is not harmless with respects to women's long-term health. If

  15. PROCTOSSIGMOIDECTOMIA VIA PERINEAL NO TRATAMENTO DO PROLAPSO RETAL

    Bueno R. N.

    2001-01-01

    Full Text Available A técnica cirúrgica mais utilizada no tratamento do prolapso retal é a sacropromontofixação do reto por via abdominal, porém nos últimos anos a proctossigmoidectomia via perineal tem sido retomada como alternativa para pacientes idosos com comorbidades. Revisamos 14 casos operados pela proctossigmoidectomia via perineal (cirurgia de Altemeier, sendo 13 mulheres e 1 homem. Destes pacientes havia 50% de obstipados, 14,2% tinham diarréia crônica e 64,2% eram previamente incontinentes. Idade média de 72,2 anos, 64,2 % com anastomose manual e 35,8% mecânica, além de 42,9% com reparo anal posterior no mesmo tempo operatório. O tempo médio de internação foi de 3,8 dias, não houve complicações imediatas ou precoces e apenas ocorreu recidiva em 01 paciente, 7,1%. Pelos bons resultados, baixa morbi-mortalidade e recidiva aceitável e de acordo com a literatura nos encorajamos à utilização desta técnica para correção do prolapso retal .

  16. [Quality assurance program for pain management after obstetrical perineal injury].

    Urion, L; Bayoumeu, F; Jandard, C; Fontaine, B; Bouaziz, H

    2004-11-01

    A quality insurance program has been set up in order to improve the relief of pain in patients with perineal injury after childbirth. The program has been developed according to the French standards of accreditation. After elaboration of a referential, a first study (103 patients) allowed to evaluate the ongoing practices and to appreciate the pain intensities. After analysis of the results, an action strategy has been elaborated, with a brand new therapeutic standard and a pain-monitoring program for nurses. Six months later, a second study (105 patients) measured the efficiency of the accomplished actions. The statistic analysis used chi2 and Kruskal-Wallis tests and a multivariate analyse (p NSAI, decrease of the analgesics requests, improvement of the satisfaction referred to the relief of pain. The multivariate analyse showed a risk twice as little as in the second study to have a 36th hour VAS score superior to four (p =0.03). The apply of this quality insurance program allowed to improve the analgesia after obstetric perineal injuries. A few adaptations are needed, and also more formations of the medical and paramedical staff. The durability of the accomplished actions shall be evaluated in the future.

  17. Spontaneous endometriosis in a mandrill (Mandrillus sphinx).

    Nakamura, S; Ochiai, K; Ochi, A; Ito, M; Kamiya, T; Yamamoto, H

    2012-01-01

    A 25-year-old female mandrill (Mandrillus sphinx) died after exhibiting weakness and recumbency with serosanguineous ascites. Gross findings included haemoperitoneum and multifocal to diffuse serosal thickening with petechiae and ecchymoses throughout the peritoneum. The uterus was covered entirely with large blood clots and was adherent to the ovaries and pelvic wall. Microscopical and immunohistochemical examination revealed extra- and intra-uterine growth of ectopic endometrial tissue with marked fibrosis. The ectopic endometrial tissues predominantly consisted of stromal cells expressing CD10 and progesterone receptor and variably-sized glands lined by the epithelium with occasional slight expression of oestrogen receptor α. A diagnosis of endometriosis was made. This is the first report of naturally occurring endometriosis in a mandrill. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Malignant transformation of superficial peritoneal endometriosis lesion.

    Marchand, Eva; Hequet, Delphine; Thoury, Anne; Barranger, Emmanuel

    2013-08-26

    A 63-year-old woman with no medical history underwent an abdominal surgery with hysterectomy and bilateral salpingo-oophorectomy for a 10 cm peritoneal cyst with increased cancer antigene-125. A large suspicious tumour of the Douglas space, with contact to the uterus and the rectal wall was described. The rest of the exploration was normal, specially the rest of the peritoneum. Histopathology revealed a malignant transformation of a superficial peritoneal endometriosis. Secondary surgery was thus completed by laparoscopy with bilateral pelvic and para-aortic lymph node dissections, omentectomy and multiple peritoneal biopsies. All staging samples were free of cancer; therefore no complementary therapy was administered. After 18 months of follow-up, consisting of clinical examination and pelvis magnetic resonance imaging every 6 months, we did not observe any recurrence. Malignant transformation of superficial peritoneal endometriosis is a rare disease and surgical management seems to be the main treatment.

  19. Theories on the Pathogenesis of Endometriosis

    Samer Sourial

    2014-01-01

    Full Text Available Endometriosis is a common, chronic inflammatory disease defined by the presence of extrauterine endometrial tissue. The aetiology of endometriosis is complex and multifactorial, where several not fully confirmed theories describe its pathogenesis. This review examines existing theories on the initiation and propagation of different types of endometriotic lesions, as well as critically appraises the myriad of biologically relevant evidence that support or oppose each of the proposed theories. The current literature suggests that stem cells, dysfunctional immune response, genetic predisposition, and aberrant peritoneal environment may all be involved in the establishment and propagation of endometriotic lesions. An orchestrated scientific and clinical effort is needed to consider all factors involved in the pathogenesis of this multifaceted disease and to propose novel therapeutic targets to reach effective treatments for this distressing condition.

  20. Tension Hydrothorax Related to Disseminated Endometriosis

    AnnaKate Deal, MD

    2016-01-01

    Full Text Available We present the case of a 34-year-old woman presenting to the emergency department (ED with dyspnea, cough, and fever. She was found to have a tension hydrothorax and was treated with ultrasound-guided thoracentesis in the ED. Subsequent inpatient evaluation showed the patient had disseminated endometriosis. Tension hydrothorax has not been previously described in the literature as a complication of this disease.

  1. Endometriosis-related spontaneous diaphragmatic rupture.

    Triponez, Frédéric; Alifano, Marco; Bobbio, Antonio; Regnard, Jean-François

    2010-10-01

    Non-traumatic, spontaneous diaphragmatic rupture is a rare event whose pathophysiology is not known. We report the case of endometriosis-related spontaneous rupture of the right diaphragm with intrathoracic herniation of the liver, gallbladder and colon. We hypothesize that the invasiveness of endometriotic tissue caused diaphragm fragility, which finally lead to its complete rupture without traumatic event. The treatment consisted of a classical management of diaphragmatic rupture, with excision of the endometriotic nodule followed by medical ovarian suppression for six months.

  2. Urinary biomarkers for the non-invasive diagnosis of endometriosis

    Liu, Emily; Nisenblat, Vicki; Farquhar, Cindy; Fraser, Ian; Bossuyt, Patrick M. M.; Johnson, Neil; Hull, M. Louise

    2015-01-01

    About 10% of reproductive-aged women suffer from endometriosis which is a costly chronic disease that causes pelvic pain and subfertility. Laparoscopy is the 'gold standard' diagnostic test for endometriosis, but it is expensive and carries surgical risks. Currently, there are no simple non-invasive

  3. Blood biomarkers for the non-invasive diagnosis of endometriosis

    Nisenblat, Vicki; Bossuyt, Patrick M. M.; Shaikh, Rabia; Farquhar, Cindy; Jordan, Vanessa; Scheffers, Carola S.; Mol, Ben Willem J.; Johnson, Neil; Hull, M. Louise

    2016-01-01

    About 10% of reproductive-aged women suffer from endometriosis, a costly chronic disease causing pelvic pain and subfertility. Laparoscopy is the gold standard diagnostic test for endometriosis, but is expensive and carries surgical risks. Currently, there are no non-invasive or minimally invasive

  4. Primary umbilical endometriosis: To scope or not to scope?

    only partially understood. Endometriosis usually occurs within the pelvic cavity. Common locations are the uterine wall, the fallopian tubes, the ovaries and the pelvic peritoneum.[3-5] Pelvic endometriosis presents clinically with a triad of symptoms: pain (chronic pelvic pain and dysmenorrhea), menorrhagia and infertility.

  5. Involvement of immune cells in the pathogenesis of endometriosis.

    Izumi, Gentaro; Koga, Kaori; Takamura, Masashi; Makabe, Tomoko; Satake, Erina; Takeuchi, Arisa; Taguchi, Ayumi; Urata, Yoko; Fujii, Tomoyuki; Osuga, Yutaka

    2018-02-01

    Endometriosis is characterized by the implantation and growth of endometriotic tissues outside the uterus. It is widely accepted the theory that endometriosis is caused by the implantation of endometrial tissue from retrograde menstruation; however, retrograde menstruation occurs in almost all women and other factors are required for the establishment of endometriosis, such as cell survival, cell invasion, angiogenesis, and cell growth. Immune factors in the local environment may, therefore, contribute to the formation and progression of endometriosis. Current evidence supports the involvement of immune cells in the pathogenesis of endometriosis. Peritoneal neutrophils and macrophages secrete biochemical factors that help endometriotic cell growth and invasion, and angiogenesis. Peritoneal macrophages and NK cells in endometriosis have limited capability of eliminating endometrial cells in the peritoneal cavity. An imbalance of T cell subsets leads to aberrant cytokine secretions and inflammation that results in the growth of endometriosis lesions. It is still uncertain whether these immune cells have a role in the initial cause and/or stimulate actions that enhance disease; however, in either case, modulating the actions of these cells may prevent initiation or disease progression. Further studies are needed to deepen the understanding of the pathology of endometriosis and to develop novel management approaches of benefit to women suffering from this disease. © 2018 Japan Society of Obstetrics and Gynecology.

  6. MANAGEMENT OF ENDOMETRIOSIS IN TWO CAPTIVE MANDRILLS (MANDRILLUS SPHINX).

    Okeson, Danelle M; Higbie, Christine T; Mylniczenko, Natalie D; Haynes, April; Bennett, Suzanne; Klocke, Emily; Carpenter, James W

    2016-06-01

    Endometriosis has been reported in humans, great apes, and Old World monkeys. Although cases are noted anecdotally in Mandrillus spp., and a previously reported case was noted on postmortem examination, to the authors' knowledge, no previous reports of case management have been published in the peer-reviewed literature. This paper describes the medical and surgical management of endometriosis in two mandrills (Mandrillus sphinx).

  7. The association between endometriosis and survival outcomes of ...

    Background: Although it is generally recognized that endometriosis was significantly associated with higher risk of ovarian cancer, the association between endometriosis and the cancer survival outcomes is still not clear. This meta‑analysis aims to pool previous studies and to make an update estimate. Methods: Relevant ...

  8. Primary umbilical endometriosis: a case report | Muluka | Journal of ...

    Umbilical endometriosis is a rare presentation especially in the absence of prior pelvic surgery. This report presents a rare case of symptomatic primary umbilical endometriosis in a 28 year old female who presented with a 2 year history of umbilical mass associated with cyclical bleeding at the time of her menses.

  9. Case Report: Endometriosis of the Appendix | Al Oulaqi | African ...

    Endometriosis is a well known cause of infertility. Endometriosis of the appendix is a very rare condition. To highlight this rare entity, we are reporting a case of a young lady who was admitted with recurrent attacks of lower abdominal pain associated with primary infertility. Preoperative diagnosis was acute appendicitis.

  10. Menstruation in an unusual place: A case of thoracic endometriosis ...

    While pelvic endometriosis is relatively common, thoracic menstruation is rare. A report of what is believed to be the first case of thoracic endometriosis in Uganda is given. A 34 year old female was complaining of on and off chest pain mainly on the right side. Clinically she had signs of pleural effusion and 500 mls of altered ...

  11. Appendiceal Endometriosis: A case Report and Literature Review ...

    Appendiceal endometriosis is a very rare and usually asymptomatic condiction, but can result in severe complications such as intestinal perforation, massive gastrointestinal bleeding or intussusception. We report a case of endometriosis of the appendix presenting as acute appendicitis. The patient was a 36 year old ...

  12. What Is Endometriosis? | NIH MedlinePlus the Magazine

    ... risk about six times) Periods started at an early age (before age 11) Monthly cycles are short (less than 27 days) Menstrual cycles are heavy and last more than 7 days What are the symptoms of endometriosis? While the primary symptoms of endometriosis are pain and infertility, other ...

  13. Intestinal Obstruction Due to Rectal Endometriosis: A Surgical Enigma

    Razman Jarmin

    2006-07-01

    Full Text Available Obstructed rectal endometriosis is an uncommon presentation. The clinical and intraoperative presentation may present as malignant obstruction. The difficulty in making the diagnosis may delay the definitive management of the patient. We report a unique case of rectal endometriosis mimicking malignant rectal mass causing intestinal obstruction and discuss the management of the case.

  14. Endometriosis of the appendix presenting as acute appendicitis: A ...

    Endometriosis is a common disease generally, but appendiceal endometriosis causing acute appendicitis is a very uncommon clinical phenomenon and a few cases have been reported. The authors aim to highlight the rarity of such clinical entity in Nigeria. A 29 year old nulliparous woman presented with severe right iliac ...

  15. Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series

    Lier, M. van; Malik, R.F.; Waesberghe, J. van; Maas, J.W.; Rumpt-van de Geest, D.A. van; Coppus, S.F.P.J.; Berger, J.P.; Rijn, B.B. van; Janssen, P.F.; Boer, M.A. de; Vries, J.I.P. de; Jansen, F.W.; Brosens, I.A.; Lambalk, C.B.; Mijatovic, V.

    2017-01-01

    OBJECTIVE: To report pregnancy outcomes of SHiP (spontaneous haemoperitoneum in pregnancy) and the association with endometriosis. DESIGN: Retrospective case note review. SETTING: Dutch referral hospitals for endometriosis. SAMPLE: Eleven women presenting with 15 events of SHiP. METHODS: In

  16. Endoglin concentration in peritoneal fluid of patients with endometriosis

    Nusratuddin Abdullah

    2013-05-01

    Full Text Available Background: Endoglin is a specific angiogenic factor suspected to involve in the pathogenesis of endometriosis. The aim of this study was to evaluate the significance of endoglin concentration in the peritoneal fluid of patients with endometriosis.Methods: This pilot study was performed between March 2011 and July 2012 at Dr. Wahidin Sudirohusodo Hospital and another private hospital in Makassar, Indonesia. This was an observational, cross-sectional study. All patients undergoing laparoscopy for infertility and other cases with suitable inclusion criteria were asked to answer a questionnaire and had a 5 cc peritoneal fluid sample taken for measurement of peritoneal endoglin concentration using ELISA. Endometriosis stage was classified using ASRM criteria and divided into two groups, mild and severe. All data were analyed using Excel and Spearman correlation analysis.Results: In the endometriosis group peritoneal endoglin concentration ranged between 14.43- 15.65 ng/mL (median 15.04 ng/mL which is higher than control group 7.42-10.26 ng/mL (median 8.84 ng/mL. A peritoneal endoglin concentration equal to or higher than 11 ng/mL could be used to predict endometriosis.Conclusion: Endoglin concentrations increased proportionally with the severity of endometriosis, and many be used as predictive factor of endometriosis cases. (Med J Indones. 2013;22:88-91Keywords: Endoglin, endometriosis, peritoneum

  17. Nodular smooth muscle metaplasia in multiple peritoneal endometriosis.

    Kim, Hyun-Soo; Yoon, Gun; Ha, Sang Yun; Song, Sang Yong

    2015-01-01

    We report here an unusual presentation of peritoneal endometriosis with smooth muscle metaplasia as multiple protruding masses on the lateral pelvic wall. Smooth muscle metaplasia is a common finding in rectovaginal endometriosis, whereas in peritoneal endometriosis, smooth muscle metaplasia is uncommon and its nodular presentation on the pelvic wall is even rarer. To the best of our knowledge, this is the first case of nodular smooth muscle metaplasia occurring in peritoneal endometriosis. As observed in this case, when performing laparoscopic surgery in order to excise malignant tumors of intra-abdominal or pelvic organs, it can be difficult for surgeons to distinguish the metastatic tumors from benign nodular pelvic wall lesions, including endometriosis, based on the gross findings only. Therefore, an intraoperative frozen section biopsy of the pelvic wall nodules should be performed to evaluate the peritoneal involvement by malignant tumors. Moreover, this report implies that peritoneal endometriosis, as well as rectovaginal endometriosis, can clinically present as nodular lesions if obvious smooth muscle metaplasia is present. The pathological investigation of smooth muscle cells in peritoneal lesions can contribute not only to the precise diagnosis but also to the structure and function of smooth muscle cells and related cells involved in the histogenesis of peritoneal endometriosis.

  18. Spontaneous haemoperitoneum in pregnancy and endometriosis : a case series

    Lier, McI; Malik, R F; van Waesberghe, Jhtm; Maas, J W; van Rumpt-van de Geest, D A; Coppus, S F; Berger, J P; van Rijn, B B; Janssen, P F; de Boer, M. A; de Vries, Jip; Jansen, F. W.; Brosens, I A; Lambalk, C B; Mijatovic, V

    OBJECTIVE: To report pregnancy outcomes of SHiP (spontaneous haemoperitoneum in pregnancy) and the association with endometriosis. DESIGN: Retrospective case note review. SETTING: Dutch referral hospitals for endometriosis. SAMPLE: Eleven women presenting with 15 events of SHiP. METHODS: In

  19. Managing Endometriosis in sub-Saharan Africa: Emerging Concepts ...

    AJRH Managing Editor

    . Obstet 1987; 25: 47 – 52. 8. Kyama CM, Mwenda JM, Machoki J, Mihalyi A,. Simsa P, Chai DC, D'Hoodge TM. Endometriosis in African women. Women's. Health 2007; 3(5): 629 – 635. 9. D' Hoodge TM. The challenge of Endometriosis: A.

  20. Characteristics, expectations and needs of the dutch endometriosis society members

    Roos-Eysbouts, Y.K.; Bie-Rocks, B. De; Dijk, J. van; Nap, A.W.

    2015-01-01

    Background/Aim Study Question: Endometriosis is associated with a significant reduction in the quality of life and higher depression and anxiety rates. The Dutch Endometriosis Society (ES) was founded to increase the recognition and knowledge in patients and health care professionals, stimulate

  1. Role of Oxidative Stress in Epigenetic Modification in Endometriosis.

    Ito, Fuminori; Yamada, Yuki; Shigemitsu, Aiko; Akinishi, Mika; Kaniwa, Hiroko; Miyake, Ryuta; Yamanaka, Shoichiro; Kobayashi, Hiroshi

    2017-11-01

    Aberrant DNA methylation and histone modification are associated with an increased risk of reproductive disorders such as endometriosis. However, a cause-effect relationship between epigenetic mechanisms and endometriosis development has not been fully determined. This review provides current information based on oxidative stress in epigenetic modification in endometriosis. This article reviews the English-language literature on epigenetics, DNA methylation, histone modification, and oxidative stress associated with endometriosis in an effort to identify epigenetic modification that causes a predisposition to endometriosis. Oxidative stress, secondary to the influx of hemoglobin, heme, and iron during retrograde menstruation, is involved in the expression of CpG demethylases, ten-eleven translocation, and jumonji (JMJ). Ten-eleven translocation and JMJ recognize a wide range of endogenous DNA methyltransferases (DNMTs). The increased expression levels of DNMTs may be involved in the subsequent downregulation of the decidualization-related genes. This review supports the hypothesis that there are at least 2 distinct phases of epigenetic modification in endometriosis: the initial wave of iron-induced oxidative stress would be followed by the second big wave of epigenetic modulation of endometriosis susceptibility genes. We summarize the recent advances in our understanding of the underlying epigenetic mechanisms focusing on oxidative stress in endometriosis.

  2. Extrapelvic endometriosis: a rare entity or an under diagnosed condition?

    2013-01-01

    Endometriosis is a clinical entity characterized by the presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. Endometriosis can be either endopelvic or extrapelvicdepending on the location of endometrial tissue implantation. Despite the rarity of extrapelvic endometriosis, several cases of endometriosis of the gastrointestinal tract, the urinarytract, the upper and lower respiratory system, the diaphragm, the pleura and the pericardium, as well as abdominal scars loci have been reported in the literature. There are several theories about the pathogenesis and the pathophysiology of endometriosis. Depending on the place of endometrial tissue implantation, endometriosis can be expressed with a wide variety of symptoms. The diagnosis of this entity is neither easy nor routine. Many diagnostic methods clinical and laboratory have been used, but none of them is the golden standard. The multipotent localization of endometriosis in combination with the wide range of its clinical expression should raise the clinical suspicion in every woman with periodic symptoms of extrapelvic organs. Finally, the therapeutic approach of this clinical entity is also correlated with the bulk of endometriosis and the locum that it is found. It varies from simple observation, to surgical treatment and treatment with medication as well as a combination of those. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1968087883113362. PMID:24294950

  3. Clinical predictive factors for endometriosis in a Portuguese infertile population

    Calhaz-Jorge, C.; Mol, Ben W.; Nunes, J.; Costa, A. P.

    2004-01-01

    BACKGROUND: Endometriosis is an important clinical situation associated with subfertility. It would be very useful to identify patients at increased risk for endometriosis prior to laparoscopy. In the present study, we evaluate the demographic and clinical characteristics in a cohort of Portuguese

  4. Risk for breast cancer among women with endometriosis

    Bertelsen, Lisbeth; Mellemkjaer, Lene; Frederiksen, Kirsten; Kjaer, Susanne K.; Brinton, Louise A.; Sakoda, Lori C.; van Valkengoed, Irene; Olsen, Jørgen H.

    2007-01-01

    Although several risk factors are common to endometriosis and breast cancer, the results of observational studies of an association have so far been inconsistent. We evaluated the relationship between endometriosis and breast cancer on the basis of data on selected cancers and medical histories from

  5. Endometrial biomarkers for the non-invasive diagnosis of endometriosis

    Gupta, Devashana; Hull, M. Louise; Fraser, Ian; Miller, Laura; Bossuyt, Patrick M. M.; Johnson, Neil; Nisenblat, Vicki

    2016-01-01

    About 10% of reproductive-aged women suffer from endometriosis, which is a costly, chronic disease that causes pelvic pain and subfertility. Laparoscopy is the gold standard diagnostic test for endometriosis, but it is expensive and carries surgical risks. Currently, there are no non-invasive tests

  6. Blood biomarkers for the non-invasive diagnosis of endometriosis

    Nisenblat, Vicki; Bossuyt, Patrick M. M.; Shaikh, Rabia; Farquhar, Cindy; Jordan, Vanessa; Scheffers, Carola S.; Mol, Ben Willem J.; Johnson, Neil; Hull, M. Louise

    2016-01-01

    Background About 10% of reproductive-aged women suffer from endometriosis, a costly chronic disease causing pelvic pain and subfertility. Laparoscopy is the gold standard diagnostic test for endometriosis, but is expensive and carries surgical risks. Currently, there are no non-invasive or minimally

  7. Dienogest in the treatment of endometriosis.

    Bizzarri, Nicolò; Remorgida, Valentino; Leone Roberti Maggiore, Umberto; Scala, Carolina; Tafi, Emanuela; Ghirardi, Valentina; Salvatore, Stefano; Candiani, Massimo; Venturini, Pier Luigi; Ferrero, Simone

    2014-09-01

    Dienogest (DNG) is an oral progestin, derivative of 19-nortestosterone, that has recently been introduced for the treatment of endometriosis. This review examines the clinical efficacy, safety and tolerability of DNG in the treatment of endometriosis. The material included in the current manuscript was searched and obtained via Medline, Pubmed and EMBASE, from inception until February 2014. The term 'dienogest' was associated with the following search terms: 'endometriosis', 'pharmacokinetics', 'safety' and 'efficacy'. Several trials demonstrated the clinical efficacy, safety and tolerability of DNG. However the use of DNG is associated with some limitations. So far, no study investigated the potential of contraceptive effect of this treatment and therefore, it should be recommended with other methods of contraception (e.g., barrier methods). A further limitation of the use of DNG as daily therapy in the long term is that the cost of the therapy is higher than other progestins available on the market and combined oral contraceptives. Therefore, future studies should be designed to compare the efficacy and safety of DNG with other progestins.

  8. Diagnosis of endometriosis with imaging: a review

    Kinkel, Karen; Frei, Kathrin A.; Balleyguier, Corinne; Chapron, Charles

    2006-01-01

    Endometriosis corresponds to ectopic endometrial glands and stroma outside the uterine cavity. Clinical symptoms include dysmenorrhoea, dyspareunia, infertility, painful defecation or cyclic urinary symptoms. Pelvic ultrasound is the primary imaging modality to identify and differentiate locations to the ovary (endometriomas) and the bladder wall. Characteristic sonographic features of endometriomas are diffuse low-level internal echos, multilocularity and hyperchoic foci in the wall. Differential diagnoses include corpus luteum, teratoma, cystadenoma, fibroma, tubo-ovarian abscess and carcinoma. Repeated ultrasound is highly recommended for unilocular cysts with low-level internal echoes to differentiate functional corpus luteum from endometriomas. Posterior locations of endometriosis include utero-sacral ligaments, torus uterinus, vagina and recto-sigmoid. Sonographic and MRI features are discussed for each location. Although ultrasound is able to diagnose most locations, its limited sensitivity for posterior lesions does not allow management decision in all patients. MRI has shown high accuracies for both anterior and posterior endometriosis and enables complete lesion mapping before surgery. Posterior locations demonstrate abnormal T2-hypointense, nodules with occasional T1-hyperintense spots and are easier to identify when peristaltic inhibitors and intravenous contrast media are used. Anterior locations benefit from the possibility of MRI urography sequences within the same examination. Rare locations and possible transformation into malignancy are discussed. (orig.)

  9. Endometriosis, a disease of the macrophage

    Annalisa eCapobianco

    2013-01-01

    Full Text Available Endometriosis, a common cause of pelvic pain and female infertility, depends on the growth of vascularised endometrial tissue at ectopic sites. Endometrial fragments reach the peritoneal cavity during the fertile years: local cues decide whether they yield endometriotic lesions. Macrophages are recruited at sites of hypoxia and tissue stress, where they clear cell debris and heme-iron and generate pro-life and pro-angiogenesis signals. Macrophages are abundant in endometriotic lesions, where are recruited and undergo alternative activation. In rodents macrophages are required for lesions to establish and to grow; bone-marrow derived Tie-2 expressing macrophages specifically contribute to lesions neovasculature, possibly because they concur to the recruitment of circulating endothelial progenitors, and sustain their survival and the integrity of the vessel wall. Macrophages sense cues (hypoxia, cell death, iron overload in the lesions and react delivering signals to restore the local homeostasis: their action represents a necessary, non-redundant step in the natural history of the disease. Endometriosis may be due to a misperception of macrophages about ectopic endometrial tissue. They perceive it as a wound, they activate programs leading to ectopic cell survival and tissue vascularization. Clearing this misperception is a critical area for the development of novel medical treatments of endometriosis, an urgent and unmet medical need.

  10. PPAR–gamma: a dagger in endometriosis

    Amberkar MV

    2010-12-01

    Full Text Available Endometriosis is a debilitating gynecological disorder with an enigmatic pathogenesis. Current treatment strategy mainly involves surgery and medications, which provide only temporary relief. Endometriosis is associated with an abnormal inflammatory response, one of the recent pathogenesis is RANTES (regulated upon activation normal T-cell expressed and secreted in endometriotic stromal cells, which is responsible for 70% of monocyte migration in the peritoneal fluid. This RANTES can be inhibited by the peroxisome proliferator activated receptor system. Thiazolidinediones (PPAR Gamma Agonists exhibited the ability shown to suppress existing endometriotic lesions without suppressing ovulation. In vivo studies have shown some promising results which could be incorporated in humans. These results have promised new avenues of treatment emerging from older drugs. Since the existing conventional drugs have undesirable side effects, there is always a need for highly efficacious and better tolerated drugs acting through novel mechanisms of action. Hence, in this review we have highlighted the usage of a class of drugs commonly used to treat diabetes mellitus, which could also be used to treat endometriosis.

  11. Radiologic findings of abdominal wall endometriosis

    Seo, Jung Wook [Inje Univ. Ilsan Paik Hospital, Goyang (Korea, Republic of)

    2003-12-01

    To evaluate the imaging findings of abdominal wall endometriosis. In seven of 17 patients with surgically proven endometriosis of the abdominal wall, we retrospectively reviewed the findings of radiologic studies such as abdominal US (n=3), CT (n=4), and MRI (n=1). One patient under went more than one type of imaging, apparently. The surgical history of the seven, and their symptoms and preoperative diagnosis were reviewed, and the size, location, margin and nature of the mass, and the contrast enhancement patterns observed at radiologic studies, were assessed. The chief symptoms were palpable abdominal wall mass (n=5) and lower abdominal pain (n=2) around a surgical scar. Previous surgery included cesarean section (n=5), cesarean section with oophorectomy (n=1) and appendectomy (n=1). Masses were located in the subcutaneous fat layer (n=5) or rectus abdominis muscle (n=2), and their maximum diameter was 2.6 cm. Imaging findings, which correlated closely with the pathologic findings, included a well (n=5) or poorly marginated (n=2) solid mass, with a focal cystic area apparent in two cases. Although imaging findings of abdominal wall endometriosis may not be specific for diagnosis, the presence of a solid abdominal mass in female patients of reproductive age with a history of surgery is a diagnostic pointer.

  12. Radiologic findings of abdominal wall endometriosis

    Seo, Jung Wook

    2003-01-01

    To evaluate the imaging findings of abdominal wall endometriosis. In seven of 17 patients with surgically proven endometriosis of the abdominal wall, we retrospectively reviewed the findings of radiologic studies such as abdominal US (n=3), CT (n=4), and MRI (n=1). One patient under went more than one type of imaging, apparently. The surgical history of the seven, and their symptoms and preoperative diagnosis were reviewed, and the size, location, margin and nature of the mass, and the contrast enhancement patterns observed at radiologic studies, were assessed. The chief symptoms were palpable abdominal wall mass (n=5) and lower abdominal pain (n=2) around a surgical scar. Previous surgery included cesarean section (n=5), cesarean section with oophorectomy (n=1) and appendectomy (n=1). Masses were located in the subcutaneous fat layer (n=5) or rectus abdominis muscle (n=2), and their maximum diameter was 2.6 cm. Imaging findings, which correlated closely with the pathologic findings, included a well (n=5) or poorly marginated (n=2) solid mass, with a focal cystic area apparent in two cases. Although imaging findings of abdominal wall endometriosis may not be specific for diagnosis, the presence of a solid abdominal mass in female patients of reproductive age with a history of surgery is a diagnostic pointer

  13. Diagnosis of endometriosis with imaging: a review

    Kinkel, Karen [Clinique et fondation des Grangettes, Institut de Radiologie, Chene-Bougeries/Geneva (Switzerland); Frei, Kathrin A. [University Hospital Bern, Department of Obstetrics and Gynaecology, Bern (Switzerland); Balleyguier, Corinne [Institut Gustave Roussy, Radiology Department, Villejuif (France); Chapron, Charles [Hopitaux de Paris, Service de Gynecologie Obstetrique II, Unite de Chirurgie, Paris (France)

    2006-02-01

    Endometriosis corresponds to ectopic endometrial glands and stroma outside the uterine cavity. Clinical symptoms include dysmenorrhoea, dyspareunia, infertility, painful defecation or cyclic urinary symptoms. Pelvic ultrasound is the primary imaging modality to identify and differentiate locations to the ovary (endometriomas) and the bladder wall. Characteristic sonographic features of endometriomas are diffuse low-level internal echos, multilocularity and hyperchoic foci in the wall. Differential diagnoses include corpus luteum, teratoma, cystadenoma, fibroma, tubo-ovarian abscess and carcinoma. Repeated ultrasound is highly recommended for unilocular cysts with low-level internal echoes to differentiate functional corpus luteum from endometriomas. Posterior locations of endometriosis include utero-sacral ligaments, torus uterinus, vagina and recto-sigmoid. Sonographic and MRI features are discussed for each location. Although ultrasound is able to diagnose most locations, its limited sensitivity for posterior lesions does not allow management decision in all patients. MRI has shown high accuracies for both anterior and posterior endometriosis and enables complete lesion mapping before surgery. Posterior locations demonstrate abnormal T2-hypointense, nodules with occasional T1-hyperintense spots and are easier to identify when peristaltic inhibitors and intravenous contrast media are used. Anterior locations benefit from the possibility of MRI urography sequences within the same examination. Rare locations and possible transformation into malignancy are discussed. (orig.)

  14. Perineal pseudocontinent colostomy is safe and efficient technique for perineal reconstruction after abdominoperineal resection for rectal adenocarcinoma.

    Souadka, Amine; Majbar, Mohammed Anass; El Harroudi, Tijani; Benkabbou, Amine; Souadka, Abdelilah

    2015-04-10

    The aim of this study was to evaluate oncologic results and satisfaction rate results of pseudocontinent perineal colostomy (PCPC) using Schmidt's technique in patients undergoing abdominoperineal resection (APR) for managing low rectal adenocarcinoma. From January 1993 and December 2007, One hundred and forty six patients underwent successfully PCPC after abdominoperineal resection for lower rectal adenocarcinoma. There were 75 women, with an average age of 47 years old. All patients received neoadjuvant radiotherapy with or without chemotherapy. Long-term oncological results and satisfaction rate were evaluated. After a median follow up of 36 months (range 12-156) months, the five-year overall survival and disease free survival rate were 74.6% and 60.3% respectively. Local and distant recurrences occurred respectively in 10 (6,8%) and 29 (20%) patients. Seventy-seven percent (77%) of the patients were highly satisfied with this technique and only one patient was unsatisfied. However, none of them accepted the conversion to an abdominal colostomy neither would have changed PCPC for an iliac colostomy at first intent. This study showed that pseudocontinent perineal colostomy is a safe and reliable pelvic reconstruction technique after abdominoperineal resection for low rectal adenocarcinoma. It provides high degree of patient satisfaction without compromising oncological results. It is a good option in selected patients, especially in Muslim countries.

  15. Implications of immune dysfunction on endometriosis associated infertility.

    Miller, Jessica E; Ahn, Soo Hyun; Monsanto, Stephany P; Khalaj, Kasra; Koti, Madhuri; Tayade, Chandrakant

    2017-01-24

    Endometriosis is a complex, inflammatory disease that affects 6-10% of reproductive-aged women. Almost half of the women with endometriosis experience infertility. Despite the excessive prevalence, the pathogenesis of endometriosis and its associated infertility is unknown and a cure is not available. While many theories have been suggested to link endometriosis and infertility, a consensus among investigators has not emerged. In this extensive review of the literature as well as research from our laboratory, we provide potential insights into the role of immune dysfunction in endometriosis associated infertility. We discuss the implication of the peritoneal inflammatory microenvironment on various factors that contribute to infertility such as hormonal imbalance, oxidative stress and how these could further lead to poor oocyte, sperm and embryo quality, impaired receptivity of the endometrium and implantation failure.

  16. Endometriosis and risks for ovarian, endometrial and breast cancers

    Mogensen, Julie Brøchner; Kjær, Susanne K.; Mellemkjær, Lene

    2016-01-01

    Objective A growing body of evidence suggests that endometriosis increases the risk for ovarian cancer, but it is less well studied whether the excess risk is confined to certain histotypes. Furthermore, it is not fully resolved if endometriosis is associated with endometrial- and breast cancer....... The aim was to study overall- and histotype-specific risks for these hormone-dependent cancers in women with endometriosis. Methods In the Danish National Patient Register, we identified 45,790 women with a clinical diagnosis of endometriosis during 1977–2012. We linked the cohort to the Danish Cancer...... Register and calculated standardized incidence ratios (SIRs) with corresponding 95% confidence intervals (CIs). Results Endometriosis was associated with increased risks for ovarian cancer (SIR 1.34; 95% CI: 1.16–1.55), due primarily to endometrioid (SIR 1.64; 95% CI: 1.09–2.37) and clear-cell types (SIR 3...

  17. A case of bifocal endometriosis involving a pfannenstiel incision.

    Evsen, Mehmet Sidik; Sak, Muhammet Erdal; Yalinkaya, Ahmet; Firat, Ugur; Caca, Fatma Nur

    2011-01-01

    A 25-year-old woman was referred to our clinic for atypical cyclic pain and masses at both ends of a Pfannenstiel incision scar. Ultrasound of the anterior abdominal wall showed two masses. Both masses were hypoechoic, heterogeneous lesions located at opposite ends of the scar. The lesions were surgically excised with. Microscopic examination revealed endometrial gland structures with endometrial stroma in fibroadipose tissue in sections of both specimens indicative of endometriosis. Incisional endometriosis (IE) is a form of extrapelvic endometriosis especially in scars of obstetric or gynecologic surgery IE may be multifocal at surgical scars. We report the a case of bifocal incisional endometriosis in Pfannesteil scar. Whole scar evaluation should be done for incisional endometriosis and surgical excision should be performed for treatment.

  18. Retrospective Study (2009-2014): Perineal Hernias and Related Comorbidities in Bitches.

    Hayashi, Ayne Murata; Rosner, Sandra Aparecida; de Assumpção, Thais Cristine Alves; Stopiglia, Angelo João; Matera, Julia Maria

    2016-12-01

    Retrospective study based on data extracted from medical records of dogs diagnosed with perineal hernia between 2009 and 2014; medical records of bitches were selected for further analysis to determine the prevalence of perineal hernias in bitches and to investigate potential comorbidities. Perineal hernia was diagnosed in 182 dogs (174 males and 8 females; 96% and 4%, respectively). Surgical correction was performed in 6 bitches. Surgical procedures corresponded to internal obturator muscle transposition with or without polypropylene mesh reinforcement (n = 5) and semitendinosus muscle transposition flap (n = 1). Major comorbidities associated with perineal hernias in adult bitches were trauma (n = 3; 7.3 ± 1.5 years; 7.1 ± 8.5kg) and persistent cough secondary to conditions such as bronchitis, tracheal collapse, and cardiopathy in aged, small-sized patients (n = 3; 13.6 ± 2.0 years; 2.3 ± 0.1kg). Perineal hernias are uncommon in bitches and tend to be associated with comorbidities in these patients. Aged female dogs suffering from uncontrolled chronic cough secondary to cardiopathy or bronchitis are at risk of developing perineal hernia. Previous trauma to the pelvis is another potential risk factor for perineal hernia development in female dogs. Copyright © 2016. Published by Elsevier Inc.

  19. Modified semitendinosus muscle transposition to repair ventral perineal hernia in 14 dogs.

    Morello, E; Martano, M; Zabarino, S; Piras, L A; Nicoli, S; Bussadori, R; Buracco, P

    2015-06-01

    To describe a modified technique of semitendinosus muscle transposition for the repair of ventral perineal hernia. Retrospective review of case records of dogs with ventral perineal hernia that were treated by transposing the medial half of the longitudinally split semitendinosus muscle of one limb. The transposition of the internal obturator muscle was used when uni- or bilateral rectal sacculation was also present in addition to ventral perineal hernia; colopexy and vas deferens pexy were also performed. Fourteen dogs were included. In addition to ventral perineal hernia, unilateral and bilateral perineal hernia was also present in five and six of the dogs, respectively. The mean follow-up time was 890 days. Ventral perineal hernia was successfully managed by the modified semitendinosus muscle transposition with minor complications in all the dogs included in the study. Despite the small number of dogs included, the unilateral transposition of the medial half of the longitudinally split semitendinosus muscle consistently supported the ventral rectal enlargement in perineal hernia without obvious adverse effects. © 2015 British Small Animal Veterinary Association.

  20. Abscesso perineal por ingestão acidental de palito de dente

    Roberto Iglesias Lopes

    2006-06-01

    Full Text Available Palitos de dente são itens domésticos comuns e a maioria das pessoas subestima a gravidade das lesões que podem ocorrer com a ingestão acidental de palitos. Nós apresentamos um caso de abscesso perineal causado pela ingestão de um palito de dente. Um homem de 55 anos apresentou-se com quadro de dor perianal há um mês. Ao exame físico, notou-se abscesso perineal. Leucocitose com desvio à esquerda foi observada e a tomografia pélvica demonstrou um corpo estranho na região perineal. A remoção cirúrgica do corpo estranho e a drenagem adequada do abscesso foram realizadas, revelando um palito de dente. O paciente evoluiu bem após a abordagem cirúrgica. O abscesso perineal pode progredir para gangrena de Fournier e, portanto, a abordagem de abscessos perineais deve ser agressiva, com drenagem adequada e remoção do corpo estranho (sempre que presente.Toothpicks are a common household item and most people underestimate the seriousness of injuries that can occur with accidental ingestion. We report a case of a perineal abscess caused by an ingested toothpick. A 55-year-old man was admitted to the hospital with a 30-day history of perianal pain. Physical examination was unremarkable, except for a perineal abscess. Leucocytosis with 10% bands was present and pelvic tomography demonstrated a foreign body located in the perineal area. Surgical removal of the foreign body with adequate abscess drainage was performed revealing a toothpick. Perineal abscess may progress to Fournier's gangrene and as a consequence the management of a perineal abscess should be aggressive with adequate drainage and removal of the foreign body (if present.

  1. Vacuum-assisted closure therapy for infected perineal wounds after abdominoperineal resection. A retrospective cohort study.

    Walma, M S; Burbach, J P M; Verheijen, P M; Pronk, A; van Grevenstein, W M U

    2016-02-01

    Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound infections after APR. Patients undergoing APR for malignant disease between January 2007 and January 2013 were identified retrospectively. Data regarding occurrence and management of perineal wound complications were collected. Perineal wound infections were classified into minor or major complications and time to wound healing was measured. Time to wound healing was compared between patients receiving routine care or with additional VAC therapy. Of 171 included patients, 76 (44.4%) had minor and 36 (21.1%) major perineal wound infections. Management of major infected perineal wounds consisted of drainage (n = 16), debridement (n = 4), drainage combined with debridement (n = 4), VAC therapy alone (n = 5), or VAC therapy combined with other treatments (n = 7). Median duration of perineal wound healing in major infected wounds was 141 days (range 17-739). Median time to wound healing was not different in patients treated with (172 days, range 23-368) or without VAC therapy (131 days, range 17-739). In this study, VAC therapy did not shorten time to wound healing. However, prospective studies are required to investigate the role of VAC therapy in management of infected perineal wounds after APR. Up to then, wound management will remain to be based on clinical perception and 'gut-feeling'. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  2. Dioxins and endometriosis: cohort study of women in West Virginia

    Diliberto, J.; Birnbaum, L. [U.S. Environmental Protection Agency, NHEERL, ETD, Research Triangle Park, NC (United States); Staats, D.A. [West Virginia Dept. of Environmental Protection, Charleston, WV (United States); Staats, D.A.; Becker, J.; Jude, D.; Chouinard, S.C.; Smith, T. [Marshall Univ. Medical Center, Huntington, WV (United States); Sirinek, L. [West Virginia Dept. of Environmental Protection, Wheeling, WV (United States); Clark, G. [Xenobiotic Detection Systems Inc., Durham, NC (United States); Landy, R. [U.S. Environmental Protection Agency, Region 3, ESC, Ft. Meade, MD (United States)

    2004-09-15

    The women in this endometriosis/dioxin health study reside in the Kanawha/Ohio River Valley area of West Virginia and comprise a potential cluster (cohort) of individuals who have been exposed to dioxins (dioxin and dioxin-like chemicals) at background levels higher than those seen in other areas of the United States. The emissions from an unique constellation of chemical industries appear to have led to high levels of environmental dioxin contaminants. In addition, this area has a high incidence of endometriosis. Previous animal studies, both in nonhuman primates and rodents, have demonstrated a correlation between dioxin exposure and endometriosis. Human epidemiology studies have suggested an association but have not demonstrated a statistically significant correlation, possibly due to limitations in study design such as insufficient numbers, measurement of only TCDD rather than total equivalents to TCDD (TEQs), and/or lack of surgical ascertainment of endometriosis. The present study is addressing these issues. Thus, we have the unusual congruence of identified emission sources and high background levels of dioxins and a potentially related elevation of endometriosis. Endometriosis is a condition suffered by women in which the endometrial tissue, that usually lines the uterus, migrates to other areas. Most commonly it is found in the abdomen, bladder, ovaries or bowel. Patients with endometriosis experience pelvic pain, irregular bleeding, infertility and other problems. Immune suppression has been associated with severe endometriosis. This debilitating condition is a poorly understood disease. In the United States, this condition affects millions of women in their reproductive years and is showing up more frequently in very young women. Endometriosis will seriously impact future fertility and health care utilization. Data suggest that the rate of endometriosis in the Kanawha and Ohio River valleys is higher than is seen in other regions of the United States.

  3. Prolactin and cortisol levels in women with endometriosis

    A.P. Lima

    2006-08-01

    Full Text Available Endometriosis is a progressive estrogen-dependent disease affecting women during their reproductive years. The objective of the present study was to investigate whether endometriosis is associated with stress parameters. We determined cortisol and prolactin levels in serum, peritoneal and follicular fluid from infertile women with endometriosis and fertile women without the disease. The extent of the disease was staged according to the revised American Fertility Society classification (1997. Serum and peritoneal fluid were collected from 49 women aged 19 to 39 years undergoing laparoscopy. Eighteen women had stage I-II endometriosis and 10 had stage III-IV. Controls were 21 women undergoing laparoscopy for tubal sterilization. Follicular fluid was obtained from 39 women aged 25-39 years undergoing in vitro fertilization (21 infertile women with endometriosis and 18 infertile women without endometriosis. Serum prolactin levels were significantly higher in infertile women with stage III-IV endometriosis (28.9 ± 2.1 ng/mL than in healthy controls (13.2 ± 2.1 ng/mL. Serum cortisol levels were significantly higher in infertile women with stage III-IV endometriosis (20.1 ± 1.3 ng/mL than in controls (10.5 ± 1.4 ng/mL. Cortisol and prolactin levels in follicular fluid and peritoneal fluid did not differ significantly between groups. The high levels of cortisol and prolactin in the serum from women with endometriosis might contribute to the subfertility frequently associated with the disease. Moreover, since higher levels of cortisol and prolactin are often associated with stress, it is probable that stress might contribute to the development of endometriosis and its progression to advanced stages of the disease.

  4. Morphologic Features Suggestive of Endometriosis in Nondiagnostic Peritoneal Biopsies.

    Harrison, Beth T; Mittal, Khush

    2015-11-01

    Endometriosis is a common disorder that causes significant morbidity from dysmenorrhea, pelvic pain, and subfertility. Establishment of a definitive diagnosis has important therapeutic implications; however, only approximately 50% of biopsies of laparoscopically suspicious areas provide a diagnosis of endometriosis. Histologic criteria for diagnosis require the presence of endometrial glands or endometrial-type stroma. We hypothesize that other frequently present, but nondiagnostic, histologic features of endometriosis suggest its presence in patients with nondiagnostic peritoneal biopsies. We performed a retrospective clinicopathologic study of morphologic and immunohistochemical features that may improve the histologic diagnosis of endometriosis on laparoscopic peritoneal biopsies. We compared diagnostic (n=88) and nondiagnostic (n=54) peritoneal biopsies from pathologically confirmed endometriosis cases with negative peritoneal biopsies (n=84) from early-stage gynecologic cancer cases. Statistical analysis utilized the Fisher exact test. Multiple morphologic features were significantly increased in nondiagnostic biopsies from patients with endometriosis in comparison with those from negative controls, including foamy macrophages (P=0.0001) and submesothelial stromal clusters (SSCs) (P=0.0008). SSCs ranged from subtle aggregates of spindle cells to nodules of whorled spindle cells with small vessels and extravasated red blood cells resembling stromal endometriosis. Immunohistochemical studies confirmed that ER and CD10-positive SSCs were present in a greater proportion of both nondiagnostic and diagnostic peritoneal biopsies and at a greater number of lesions per biopsy. The overall histologic detection rate of peritoneal biopsies for endometriosis was 62.0%, and inclusion of SSCs with or without foamy macrophages in the diagnostic criteria appreciably increased this rate to between 72.5% and 76.8%. We describe SSCs, which appear to be an early or less developed

  5. Methods of reconstruction of perineal wounds after abdominoperineal resection. Literature review

    S. S. Gordeev

    2017-01-01

    Full Text Available The problem of wound closure after abdominoperineal resection to treat oncological diseases remains unsolved. Formation of a primary suture in the perineal wound can lead to multiple postoperative complications: seroma, abscess, wound disruption with subsequent perineal hernia. Chemoradiation therapy as a standard for locally advanced rectal or anal cancer doesn’t improve results of treatment of perineal wounds and increases duration of their healing. Currently, surgeons have several reconstructive and plastic techniques to improve both direct and long-term functional treatment results. In the article, the most common methods of allo- and autotransplantation are considered, benefits and deficiencies of various techniques are evaluated and analyzed.  

  6. Non-coding RNAs in endometriosis: a narrative review.

    Panir, Kavita; Schjenken, John E; Robertson, Sarah A; Hull, M Louise

    2018-04-25

    Endometriosis is a benign gynaecological disorder, which affects 10% of reproductive-aged women and is characterized by endometrial cells from the lining of the uterus being found outside the uterine cavity. However, the pathophysiological mechanisms causing the development of this heterogeneous disease remain enigmatic, and a lack of effective biomarkers necessitates surgical intervention for diagnosis. There is international recognition that accurate non-invasive diagnostic tests and more effective therapies are urgently needed. Non-coding RNA (ncRNA) molecules, which are important regulators of cellular function, have been implicated in many chronic conditions. In endometriosis, transcriptome profiling of tissue samples and functional in vivo and in vitro studies demonstrate that ncRNAs are key contributors to the disease process. In this review, we outline the biogenesis of various ncRNAs relevant to endometriosis and then summarize the evidence indicating their roles in regulatory pathways that govern disease establishment and progression. Articles from 2000 to 2016 were selected for relevance, validity and quality, from results obtained in PubMed, MEDLINE and Google Scholar using the following search terms: ncRNA and reproduction; ncRNA and endometriosis; miRNA and endometriosis; lncRNA and endometriosis; siRNA and endometriosis; endometriosis; endometrial; cervical; ovary; uterus; reproductive tract. All articles were independently screened for eligibility by the authors. This review integrates extensive information from all relevant published studies focusing on microRNAs, long ncRNAs and short inhibitory RNAs in endometriosis. We outline the biological function and synthesis of microRNAs, long ncRNAs and short inhibitory RNAs and provide detailed findings from human research as well as functional studies carried out both in vitro and in vivo, including animal models. Although variability in findings between individual studies exists, collectively, the

  7. Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis.

    Alharbi, Badr; Shlash, Ahmed; Bedaiwi, Khaled; Hooti, Qais Al; Almohaisen, Abdulrahman; Shlash, Saud; Said, Mohammad

    2015-01-01

    Scrotal elephantiasis has been a recognized complication of inguinal node irradiation, filarial infection, tumor involvement and surgical lymphatic destruction, but has rarely been reported in association with hidradenitis suppurativa (HS). HS, also known as acne inversa, is a chronic and often debilitating disease primarily affecting the axillae, inframammary regions and perineum. The location of the lesions may lead to social embarrassment and failure to seek medical treatment. Scroto-preineal HS complicated by scrotal elephantiasis is a distressing disease. Excisional surgery with reconstruction is the recommended treatment with a high likelihood of good outcome. We present a 38-year-old male patient with long-standing scroto-perineal HS complicated by giant scrotal elephantiasis.

  8. Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis

    Badr Alharbi

    2015-01-01

    Full Text Available Scrotal elephantiasis has been a recognized complication of inguinal node irradiation, filarial infection, tumor involvement and surgical lymphatic destruction, but has rarely been reported in association with hidradenitis suppurativa (HS. HS, also known as acne inversa, is a chronic and often debilitating disease primarily affecting the axillae, inframammary regions and perineum. The location of the lesions may lead to social embarrassment and failure to seek medical treatment. Scroto-preineal HS complicated by scrotal elephantiasis is a distressing disease. Excisional surgery with reconstruction is the recommended treatment with a high likelihood of good outcome. We present a 38-year-old male patient with long-standing scroto-perineal HS complicated by giant scrotal elephantiasis.

  9. Extralevator Abdominal Perineal Excision Versus Standard Abdominal Perineal Excision: Impact on Quality of the Resected Specimen and Postoperative Morbidity.

    Habr-Gama, Angelita; São Julião, Guilherme P; Mattacheo, Adrian; de Campos-Lobato, Luiz Felipe; Aleman, Edgar; Vailati, Bruna B; Gama-Rodrigues, Joaquim; Perez, Rodrigo Oliva

    2017-08-01

    Abdominal perineal excision (APE) has been associated with a high risk of positive circumferential resection margin (CRM+) and local recurrence rates in the treatment of rectal cancer. An alternative extralevator approach (ELAPE) has been suggested to improve the quality of resection by avoiding coning of the specimen decreasing the risk of tumor perforation and CRM+. The aim of this study is to compare the quality of the resected specimen and postoperative complication rates between ELAPE and "standard" APE. All patients between 1998 and 2014 undergoing abdominal perineal excision for primary or recurrent rectal cancer at a single Institution were reviewed. Between 1998 and 2008, all patients underwent standard APE. In 2009 ELAPE was introduced at our Institution and all patients requiring APE underwent this alternative procedure (ELAPE). The groups were compared according to pathological characteristics, specimen quality (CRM status, perforation and failure to provide the rectum and anus in a single specimen-fragmentation) and postoperative morbidity. Fifty patients underwent standard APEs, while 22 underwent ELAPE. There were no differences in CRM+ (10.6 vs. 13.6%; p = 0.70) or tumor perforation rates (8 vs. 0%; p = 0.30) between APE and ELAPE. However, ELAPE were less likely to result in a fragmented specimen (42 vs. 4%; p = 0.002). Advanced pT-stage was also a risk factor for specimen fragmentation (p = 0.03). There were no differences in severe (Grade 3/4) postoperative morbidity (13 vs. 10%; p = 0.5). Perineal wound dehiscences were less frequent among ELAPE (52 vs 13%; p < 0.01). Despite short follow-up (median 21 mo.), 2-year local recurrence-free survival was better for patients undergoing ELAPE when compared to APE (87 vs. 49%; p = 0.04). ELAPE may be safely implemented into routine clinical practice with no increase in postoperative morbidity and considerable improvements in the quality of the resected specimen of patients with low rectal

  10. Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study

    Byrne, Dominic; Curnow, Tamara; Smith, Paul; Cutner, Alfred; Saridogan, Ertan; Clark, T Justin

    2018-01-01

    Objective To estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis. Design A multicentre, prospective cohort study. Setting 51 hospitals accredited as specialist endometriosis centres. Participants 5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision. Interventions Laparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space. Main outcome measures Standardised symptom questionnaires enquiring about chronic pelvic pain, bladder and bowel symptoms, analgesia use and quality of life (EuroQol) completed prior to surgery and at 6, 12 and 24 months postoperatively. Serious perioperative and postoperative complications including major haemorrhage, infection and visceral injury were recorded. Results At 6 months postsurgery, there were significant reductions in premenstrual, menstrual and non-cyclical pelvic pain, deep dyspareunia, dyschezia, low back pain and bladder pain. In addition, there were significant reductions in voiding difficulty, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions were maintained at 2 years, with the exception of voiding difficulty. Global quality of life significantly improved from a median pretreatment score of 55/100 to 80/100 at 6 months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2 years. All analgesia use was reduced and, in particular, opiate use fell from 28.1% prior to surgery to 16.1% at 6 months. The overall incidence of complications was 6.8% (321/4721). Gastrointestinal complications (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder injury or leak) in 49 (1.0%) procedures. Conclusion Laparoscopic surgical excision of rectovaginal endometriosis

  11. [Performances and place of sonography in the diagnostic of endometriosis: CNGOF-HAS Endometriosis Guidelines].

    Philip, C-A; Dubernard, G

    2018-03-01

    Endometriosis is difficult to diagnose clinically. Transvaginal sonography (TVS) is a procedure that is known to be operator-dependent, which mean that published evidences has to be balanced with the level of the sonographer that produced the data. The objective of this publication was to assess the performances of the sonography in the diagnosis of endometriosis in order to establish the French national recommendations. We searched the MEDLINE database for publication from January 2000 to September 2017 using keywords associated with endometriosis and sonography. Eighty-four trial and reviews published in English or French were included. Ovarian endometrioma can usually be diagnosed by a non-expert sonographer, especially when its aspect is typical. In case of an ovarian cyst with atypical presentation, it is recommended to control the sonography by a referent or to perform an MRI. In menopaused women, any ovarian cyst should be considered as a cancer until proven otherwise. In the diagnosis of posterior deep invasive endometriosis (DIE), TVS with sensitivity and specificity of 96 and 99% respectively, seems at least equivalent if not superior to MRI. However, these performances are related to expert sonographers. To reach sufficient efficiency in posterior DIE, the estimated learning curve for a sonographer is 44 cases. When posterior DIE is suspected, we recommend proposing a TVS "performed by an expert" or a MRI "at least interpreted by an expert". In anterior DIE, TVS has a good specificity (100%), but its sensitivity is poor in the literature (64%). TVS is therefore not able to eliminate the diagnosis. However a renal ultrasound should be proposed each time a urinary endometriosis is confirmed, and should be considered whenever posterior DIE is diagnosed especially the lesion is superior to 3cm. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  12. The Many Guises of Endometriosis: Giant Abdominal Wall Endometriosis Masquerading as An Incisional Hernia

    Chiara Petrosellini

    2017-10-01

    Full Text Available Endometriosis is defined by the presence of ectopic endometrial tissue outside the uterine cavity. Although it is a leading cause of chronic pelvic pain and infertility, its clinical presentation can vary, resulting in diagnostic and therapeutic challenges. Extrapelvic endometriosis is particularly difficult to diagnose owing to its ability to mimic other conditions. Endometrial tissue in a surgical scar is uncommon and often misdiagnosed as a granuloma, abscess, or malignancy. Cyclical hemorrhagic ascites due to peritoneal endometriosis is exceptionally rare. We report the case of a pre-menopausal, nulliparous 44-year-old woman who presented with ascites and a large abdominal mass that arose from the site of a lower midline laparotomy scar. Five years previously, she had undergone open myomectomy for uterine fibroids. Soon after her initial operation she developed abdominal ascites, which necessitated percutaneous drainage on multiple occasions. We performed a laparotomy with excision of the abdominal wall mass through an inverted T incision. The extra-abdominal mass consisted of mixed cystic and solid components, and weighed 1.52 kg. It communicated with the abdominopelvic cavity through a 2 cm defect in the linea alba. The abdomen contained a large amount of odourless, brown fluid which drained into the mass. There was a large capsule that covered the small and large bowel, liver, gallbladder, and stomach. Final histology reported a 28×19×5 cm mass of endometrial tissue with no evidence of malignant transformation. The patient recovered well post-operatively and has remained asymptomatic. Our case illustrates that, despite being a common disease, endometriosis can masquerade as several other conditions and be missed or diagnosed late. Delay in diagnosis will not only prolong symptoms but can also compromise reproductive lifespan. It is therefore paramount that endometriosis is to be considered early in the management of premenopausal women

  13. Medical Therapies for Endometriosis Differentially Inhibit Stem Cell Recruitment.

    Ersoy, Gulcin Sahin; Zolbin, Masoumeh Majidi; Cosar, Emine; Mamillapalli, Ramanaiah; Taylor, Hugh S

    2017-06-01

    To determine the effect of the 3 well-known endometriosis treatments on stem cell recruitment to endometriotic lesions. C57BL/6 mice (aged 8 weeks, n = 20) underwent bone marrow transplant following submyeloablation with 5-fluorouracil using 20 × 10 6 bone marrow stem cells from green fluorescent protein (GFP) mice. Two weeks after transplantation, experimental endometriosis was created in mice by suturing segments of the uterine horn into the peritoneal cavity. Mice were then randomized to receive treatment with medroxyprogesterone acetate (MPA), leuprolide acetate (Gonadotrophin-Releasing Hormone Analogue [GnRHa]), letrozole, or vehicle control (dimethyl sulfoxide). After 3 weeks of treatment, the mice were killed and the endometriosis lesions evaluated. All 3 treatments resulted in a significant reduction in lesion volume and weight. Estrogen deprivation using GnRHa or letrozole resulted in greater lesion regression than the progestin MPA. The GFP + /CD45 - bone marrow-derived stem cells (BMDSCs) engrafted the lesions of endometriosis. Estrogen deprivation using GnRHa or letrozole significantly reduced BMDSC engraftment in the endometriosis lesions. MPA failed to significantly reduce stem cell number in endometriosis. The superiority of estrogen deprivation over progestin therapy in depriving the lesions of stem cells may have implications for the long-term treatment of endometriosis. Reduced stem cell engraftment is likely to result in long-term regression of the lesions, whereas progestins may only prevent their growth acutely.

  14. Bacterial contamination hypothesis: a new concept in endometriosis.

    Khan, Khaleque N; Fujishita, Akira; Hiraki, Koichi; Kitajima, Michio; Nakashima, Masahiro; Fushiki, Shinji; Kitawaki, Jo

    2018-04-01

    Endometriosis is a multifactorial disease that mainly affects women of reproductive age. The exact pathogenesis of this disease is still debatable. The role of bacterial endotoxin (lipopolysaccharide, LPS) and Toll-like receptor 4 (TLR4) in endometriosis were investigated and the possible source of endotoxin in the pelvic environment was examined. The limulus amoebocyte lysate test was used to measure the endotoxin levels in the menstrual fluid and peritoneal fluid and their potential role in the growth of endometriosis was investigated. Menstrual blood and endometrial samples were cultured for the presence of microbes. The effect of gonadotrophin-releasing hormone agonist (GnRHa) treatment on intrauterine microbial colonization (IUMC) and the occurrence of endometritis was investigated. Lipopolysaccharide regulates the pro-inflammatory response in the pelvis and growth of endometriosis via the LPS/TLR4 cascade. The menstrual blood was highly contaminated with Escherichea coli and the endometrial samples were colonized with other microbes. A cross-talk between inflammation and ovarian steroids or the stress reaction also was observed in the pelvis. Treatment with GnRHa further worsens intrauterine microbial colonization, with the consequent occurrence of endometritis in women with endometriosis. For the first time, a new concept called the "bacterial contamination hypothesis" is proposed in endometriosis. This study's findings of IUMC in women with endometriosis could hold new therapeutic potential in addition to the conventional estrogen-suppressing agent.

  15. New knowledge and insights about the malignant transformation of endometriosis.

    Taniguchi, Fuminori

    2017-07-01

    Endometriosis may be a definitive risk factor for ovarian cancer, the most fatal gynecological cancer. The ability of endometriosis to transform into malignancy, first described by Dr. Sampson in 1925, is considered a rare occurrence, affecting approximately 1% of ovarian endometriomas. Recently we conducted a retrospective study regarding the malignant transformation of endometriosis in Japanese women. Many studies have reported a consistent correlation between endometriosis and ovarian cancer according to histological subtypes. However, the existing epidemiological evidence linking this association is insufficient to define the role of endometriosis as a cause of ovarian cancer and to influence changes to current clinical practice. Prospective cohort studies are therefore needed to clarify this issue. Additionally, the results of many molecular studies are conflicting, and earlier studies showing the molecular aberrations involved in genomic instability and mutation that enable malignant transformation have not been replicated in later studies. Careful long-term observation of a patient with endometrioma is required to detect possible subsequent incidence of malignant transformation. More importantly, a precise strategy should be set up for better prevention, early detection, specific diagnosis and treatment targeting molecular pathogenesis to understand the mechanisms of endometriosis-associated ovarian cancer. Clinicians need to be aware of the increased ovarian cancer risk in women with endometriosis. © 2017 Japan Society of Obstetrics and Gynecology.

  16. Endometriosis: Where are We and Where are We Going?

    Greene, Alexis D.; Lang, Stephanie A.; Kendziorski, Jessica A.; Sroga-Rios, Julie M.; Herzog, Thomas J.; Burns, Katherine A.

    2016-01-01

    Endometriosis currently affects ∼5.5 million reproductive-aged women in the U.S. with symptoms such as painful periods (dysmenorrhea), chronic pelvic pain, pain with intercourse (dyspareunia), and infertility. It is defined as the presence of endometrial tissue outside the uterine cavity and is found predominately attached to sites within the peritoneal cavity. Diagnosis for endometriosis is solely made through surgery as no consistent biomarkers for disease diagnosis exist. There is no cure for endometriosis and treatments only target symptoms and not the underlying mechanism(s) of disease. The nature of individual predisposing factors or inherent defects in the endometrium, immune system, and/or peritoneal cavity of women with endometriosis remains unclear. The literature over the last 5 years (2010-2015) has advanced our critical knowledge related to hormones, hormone receptors, immune dysregulation, hormonal treatments, and the transformation of endometriosis to ovarian cancer. In this review, we cover the aforementioned topics with the goal of providing the reader an overview and related references for further study to highlight the progress made in endometriosis research, while concluding with critical areas of endometriosis research that are urgently needed. PMID:27165051

  17. Y-type urethral duplication with posterior perineal fistula: A new variant

    Sandesh V Parelkar

    2017-05-01

    Full Text Available 13 months old boy presented with constipation and straining during micturition with poor urinary stream and voiding of urine per rectum. Perineal examination revealed posterior perineal fistula. Voiding cysto-urethrogram showed bilateral vesicoureteral reflux with bladder diverticuli, normal dorsal urethra and dye going from urethra to rectum suggestive of Y type urethral duplication. Under stoma cover, he underwent excision of posterior perineal fistula with accessory ventral urethra and anorectoplasty was done. At present patient is passing urine in good stream without straining. The uniqueness of our case is the presence of Y type of urethral duplication with normal calibre dorsal urethra and presence of posterior perineal fistula. Therefore, we consider our case to be an unusual variant of Y type of urethral duplication that has not been described before.

  18. Relaxin of prostatic origin might be linked to perineal hernia formation in dogs.

    Niebauer, Gert W; Shibly, Sarina; Seltenhammer, Monika; Pirker, Armin; Brandt, Sabine

    2005-05-01

    Perineal hernia occurs spontaneously in older male dogs after idiopathic weakening of the pelvic diaphragm. Hernias invariably contain cystic paraprostatic tissues. Castration reduces incidence and recurrence after surgical repair. Although cystic prostatic hypertrophy is a consistent feature in patients with perineal hernia, an endocrine link of the disease to steroid sex hormones has not been demonstrated. Employing immunohistochemistry, we found intense relaxin immunoreactivity in dogs with perineal hernia within the epithelia of hypertrophic prostates and in periprostatic tissues. The prostate of normal dogs exhibited similar but less intense relaxin staining. In neutered dogs with prostatic atrophy, relaxin immunostaining was weak or absent. Periprostatic cysts highly expressed relaxin precursors in the fluid phase as shown by SDS-gel electrophoresis. Relaxin of prostatic origin, therefore, is possibly a local factor in connective tissue weakening and subsequently in perineal hernia formation.

  19. Stress Urinary lncontinence : Comparative Study of Perineal Sonography in Erect Position and Chain Cystourethrograpy

    Han, Gi Seok; Kim, Seung Hyup; Yeon, Kyung Mo; Han, Man Chung; Paick, Jae Seung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1995-06-15

    Authors investigated the diagnostic value of perineal sonography in erect position for patients with stress urinary incontinence. Perineal sonography and chain cystourethrography were performed in 18 female patients(mean age 51.2) with stress urinary incontinence. The posterior are throvesical angles in stress and rest states were measured in both studies and compared with each other. Mean posteriorurethrovesical angles({+-}2 standard error) in rest and stress states were 136.3({+-}7.2) .deg. , and 145.9({+-}7.0) .deg. for chain cystourethrography and 131.4({+-}5.6) .deg. and 143.4({+-}5.9) .deg. for perineal sonography, respectively. The data frorm both studies correlated well with cach other. Perineal sonography inerect position is easy,non-invasive technique and may substitute the chain cystourethrography in the evaluation of the patients with stress urinary in continece

  20. Stress Urinary lncontinence : Comparative Study of Perineal Sonography in Erect Position and Chain Cystourethrograpy

    Han, Gi Seok; Kim, Seung Hyup; Yeon, Kyung Mo; Han, Man Chung; Paick, Jae Seung

    1995-01-01

    Authors investigated the diagnostic value of perineal sonography in erect position for patients with stress urinary incontinence. Perineal sonography and chain cystourethrography were performed in 18 female patients(mean age 51.2) with stress urinary incontinence. The posterior are throvesical angles in stress and rest states were measured in both studies and compared with each other. Mean posteriorurethrovesical angles(±2 standard error) in rest and stress states were 136.3(±7.2) .deg. , and 145.9(±7.0) .deg. for chain cystourethrography and 131.4(±5.6) .deg. and 143.4(±5.9) .deg. for perineal sonography, respectively. The data frorm both studies correlated well with cach other. Perineal sonography inerect position is easy,non-invasive technique and may substitute the chain cystourethrography in the evaluation of the patients with stress urinary in continece

  1. Ascertaining severe perineal trauma and associated risk factors by comparing birth data with multiple sources.

    Ampt, Amanda J; Ford, Jane B

    2015-09-30

    Population data are often used to monitor severe perineal trauma trends and investigate risk factors. Within New South Wales (NSW), two different datasets can be used, the Perinatal Data Collection ('birth' data) or a linked dataset combining birth data with the Admitted Patient Data Collection ('hospital' data). Severe perineal trauma can be ascertained by birth data alone, or by hospital International Classification of Diseases Australian Modification (ICD-10-AM) diagnosis and procedure coding in the linked dataset. The aim of this study was to compare rates and risk factors for severe perineal trauma using birth data alone versus using linked data. The study population consisted of all vaginal births in NSW between 2001 and 2011. Perineal injury coding in birth data was revised in 2006, so data were analysed separately for 2001-06 and 2006-11. Rates of severe perineal injury over time were compared in birth data alone versus linked data. Kappa and agreement statistics were calculated. Risk factor distributions (maternal age, primiparity, instrumental birth, birthweight ≥4 kg, Asian country of birth and episiotomy) were compared between women with severe perineal trauma identified by birth data alone, and those identified by linked data. Multivariable logistic regression was used to calculate the adjusted odds ratios (aORs) of severe perineal trauma. Among 697 202 women with vaginal births, 2.1% were identified with severe perineal trauma by birth data alone, and 2.6% by linked data. The rate discrepancy was higher among earlier data (1.7% for birth data, 2.4% for linked data). Kappa for earlier data was 0.78 (95% CI 0.78, 0.79), and 0.89 (95% CI 0.89, 0.89) for more recent data. With the exception of episiotomy, differences in risk factor distributions were small, with similar aORs. The aOR of severe perineal trauma for episiotomy was higher using linked data (1.33, 95% CI 1.27, 1.40) compared with birth data (1.02, 95% CI 0.97, 1.08). Although discrepancies

  2. PErineal Assessment and Repair Longitudinal Study (PEARLS: protocol for a matched pair cluster trial

    Thomas Peter W

    2010-02-01

    Full Text Available Abstract Background The Perineal Assessment and Repair Longitudinal Study (PEARLS is a national clinical quality improvement initiative designed to improve the assessment and management of perineal trauma. Perineal trauma affects around 85% of women who have a vaginal birth in the UK each year and millions more world-wide. Continuous suturing techniques compared with traditional interrupted methods are more effective in reducing pain and postnatal morbidity, however they are not widely used by clinicians despite recommendations of evidence based national clinical guidelines. Perineal suturing skills and postnatal management of trauma remain highly variable within and between maternity units in the UK as well as worldwide. Implementation of a standardised training package to support effective perineal management practices could reduce perineal pain and other related postnatal morbidity for a substantial number of women. Methods/Design PEARLS is a matched pair cluster trial, which is being conducted in maternity units across the UK. Units within a matched pair will be randomised to implement the study intervention either early or late in the study period. The intervention will include the cascading of a multi-professional training package to enhance midwifery and obstetric skills in the assessment, repair and postnatal management of perineal trauma. Women who have had an episiotomy or second degree perineal tear will be eligible for recruitment. Prior to developing the intervention and deciding on study outcomes, a Delphi survey and a consensus conference were held to identify what women, who previously suffered perineal trauma during childbirth, considered to be important outcomes for them. Findings from this preliminary work (which will be reported elsewhere and other outcomes including women's experiences of perineal pain and pain on activity, breastfeeding uptake and duration and psychological well-being as assessed using the Edinburgh

  3. Dienogest in long-term treatment of endometriosis

    Schindler AE

    2011-07-01

    Full Text Available Adolf E SchindlerInstitute for Medical Research and Education, Essen, GermanyAbstract: Endometriosis is a chronic disease primarily affecting women of childbearing age, in which endometriotic lesions form outside the uterus, typically leading to painful symptoms, fatigue, and infertility. The symptoms of endometriosis may cause significant impairment in quality of life and represent a substantial economic burden to patients, families, and society. There is no cure for endometriosis; management consists of alleviating pain and other symptoms, reducing endometriotic lesions, and improving quality of life. Recurrence after surgical intervention is common, while the clinical evidence to support the efficacy and safety of many medications currently used in endometriosis is limited. Dienogest is an oral progestin that has been investigated extensively in the treatment of endometriosis in two clinical programs performed in Europe and Japan, including dose-ranging, placebo-controlled, active comparator-controlled, and long-term (up to 65 weeks studies. These studies demonstrated that dienogest 2 mg daily effectively alleviates the painful symptoms of endometriosis, reduces endometriotic lesions, and improves indices of quality of life. Dienogest showed a favorable safety and tolerability profile in these studies, with predictable adverse effects, high rates of patient compliance, and low withdrawal rates. This review article describes the clinical trial evidence that characterizes the efficacy and safety of dienogest in endometriosis, including two studies characterizing dienogest in long-term use. The relevance of these findings to the management of endometriosis in clinical practice is discussed.Keywords: dienogest, endometriosis, progestins, long-term treatment, quality of life, symptoms, pain

  4. Differentiation of tuboovarian abscess from endometriosis: CT indicators

    Eo, Hong; Choi, Hyuck Jae; Kim, Sun Ho; Jung, Seong Il; Park, Byung Kwan; Kim, Seung Hyup

    2005-01-01

    To assess and compare CT findings of surgically confirmed cases of tuboovarian abscesses (TOA) and endometriosis in order to identify indicators which may be helpful in making correct preoperative diagnoses. Of the 35 consecutive patients with surgically confirmed TOA, CT images were available for 11 of those patients. As a comparative group, 36 patients with surgically confirmed endometriosis with CT images were selected. CT images of TOA were compared with those of endometriosis. A retrospective analysis of the CT images of both groups was performed without knowledge of the pathologic diagnosis. The analysis compared the thickness and enhancement pattern of the cyst wall, attenuation of the cyst content, size and shape of the cyst, and paraaortic lymphadenopathy. Mean thickness of the cyst wall was 6.2 ± 2.0 mm in TOA and 4.5 ± 2.4 mm in endometriosis. Multilayered appearance in both diseases was seen on enhanced CT in 91% (10/11) of TOA cases and in 25% (9/36) of endometriosis cases. Hounsefield units of the cyst contents were 20.0 ± 5.5 HU and 24.7 ± 10.0 HU for TOA and endometriosis, respectively. Mean diameter of the cysts was 7.5 ± 1.7 cm in TOA and 7.9 ± 3.1 in endometriosis. Shape of the cyst was multilocular in 82% (9/11) of TOA cases and in 75% (27/36) of endometriosis cases. Paraaortic lymphadenopathy was present in 73% (8/11) and 44% (16/36) for TOA and endometriosis, respectively. TOA should be suspected on CT when a multilocular cystic ovarian mass is observed, especially if the lesion has a thick wall and has a multilayered appearance, and is accompanied by paraaortic lymphadenopathy

  5. Differentiation of tuboovarian abscess from endometriosis: CT indicators

    Eo, Hong; Choi, Hyuck Jae; Kim, Sun Ho; Jung, Seong Il; Park, Byung Kwan; Kim, Seung Hyup [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2005-10-15

    To assess and compare CT findings of surgically confirmed cases of tuboovarian abscesses (TOA) and endometriosis in order to identify indicators which may be helpful in making correct preoperative diagnoses. Of the 35 consecutive patients with surgically confirmed TOA, CT images were available for 11 of those patients. As a comparative group, 36 patients with surgically confirmed endometriosis with CT images were selected. CT images of TOA were compared with those of endometriosis. A retrospective analysis of the CT images of both groups was performed without knowledge of the pathologic diagnosis. The analysis compared the thickness and enhancement pattern of the cyst wall, attenuation of the cyst content, size and shape of the cyst, and paraaortic lymphadenopathy. Mean thickness of the cyst wall was 6.2 {+-} 2.0 mm in TOA and 4.5 {+-} 2.4 mm in endometriosis. Multilayered appearance in both diseases was seen on enhanced CT in 91% (10/11) of TOA cases and in 25% (9/36) of endometriosis cases. Hounsefield units of the cyst contents were 20.0 {+-} 5.5 HU and 24.7 {+-} 10.0 HU for TOA and endometriosis, respectively. Mean diameter of the cysts was 7.5 {+-} 1.7 cm in TOA and 7.9 {+-} 3.1 in endometriosis. Shape of the cyst was multilocular in 82% (9/11) of TOA cases and in 75% (27/36) of endometriosis cases. Paraaortic lymphadenopathy was present in 73% (8/11) and 44% (16/36) for TOA and endometriosis, respectively. TOA should be suspected on CT when a multilocular cystic ovarian mass is observed, especially if the lesion has a thick wall and has a multilayered appearance, and is accompanied by paraaortic lymphadenopathy.

  6. Perineal burn contractures: An experience in tertiary hospital of a Himalayan state

    Thakur Jagdeep

    2008-01-01

    Full Text Available Perineal burn contracture is a rare burn sequel. We conducted a retrospective analysis of cases with perineal burn contractures managed in a tertiary care centre of a Himalayan state. We found that all cases sustained burn injury from burning firewood and the time of presentation was two to six years after the burn injury. We analyzed our treatment method and have classified these contractures into two types.

  7. Symptomatic endometriosis of the colon - a case report

    Leutloff, U.C.; Roeren, T.; Feldmann, K.; Sillem, M.; Rabe, T.; Kauffmann, G.

    1996-01-01

    The intestinal endometriosis in need of treatment is a rare case in the surgical department. Preoperative diagnosis is very difficult and in any case must be based on histologic findings; endoscopy-guided biopsy very frequently yields negative results. Dual-contrast scanning of the colon still is a major examination method, but the findings make it difficult to rule out malignomas. Cyclic, recurrent abdominal complaints reported in the case history strongly indicate the possibility of endometriosis. Typing can be done in general only after surgery. The article reports the clinical and diagnostic parameters of a symptomatic endometriosis of the colon. (orig.) [de

  8. Rediscovering peritoneal macrophages in a murine endometriosis model.

    Yuan, Ming; Li, Dong; An, Min; Li, Qiuju; Zhang, Lu; Wang, Guoyun

    2017-01-01

    What are the features of peritoneal macrophage subgroups and T helper cells in the development of murine endometriosis? During the development of endometriosis in a murine model, large peritoneal macrophages (LPMs) and small peritoneal macrophages (SPMs) are polarized into M1 and M2 cells, respectively, and the proportions of T helper (Th) 1, Th17 and T regulatory (T reg ) cells are increased. Numerous studies investigating the etiology and pathogenesis of endometriosis have focused on the polarization states of peritoneal macrophages in endometriosis models and patients, but the results are inconclusive. Further studies indicate that peritoneal macrophages are composed of two distinct subsets: LPMs and SPMs, although their roles in endometriosis are unknown. This study involves a prospective and randomized experiment. Fifty C57BL/6 female mice were randomly allocated to five control and five experimental groups (n = 5/group) according to the presence or absence of transplantation. The transplant periods are 0.25, 3, 14, 28 and 42 days. C57BL/6 mice were utilized to establish an endometriosis model by i.p. injection of allogeneic endometrial segments. Dynamic changes of peritoneal macrophage subsets and polarization profiles were evaluated by flow cytometry (FCM). Macrophage morphology and density were assessed by cell counting under a microscope. Dynamic changes of Th1, Th2, Th17 and T reg cells were estimated by FCM. Peritoneal macrophages are composed of two distinct subsets: LPMs and SPMs. The proportion of SPMs increased immediately after peritoneal injection of endometrial tissues, whereas LPMs showed an opposite trend. Peritoneal macrophages differentiated into both M1 and M2 macrophages. The bidirectional polarization of macrophages was caused by the inverse trends of polarization of LPMs and SPMs. Consistently, the proportions of Th1, Th17 and T reg cells were all increased in mice with endometriosis. N/A. In this study, detection was only performed in a

  9. APPEARANCE OF AUTOIMMUNE DISEASES IN PATIENTS WITH ENDOMETRIOSIS

    Nina Slabe

    2018-02-01

    Full Text Available Background. Endometriosis is a comon, complex gynecological syndrom defined as the growth of endometrial glands and stroma in an extra-uterine location. It affects 5 – 20 % of women of reproductive age.1 Nowadays, prevailing opinion about endometriosis is based on presumption, that endometriosis is a result of changed immune system, according to autoimmune theory.2, 3 Characteristics of autoimmune disease that are also found in endometriosis are female preponderance, multiorgan involvement, family occurence, possible genetic basis, response to hormonal manipulation, tissue damage, polyclonal B lymphocite activation, immunological abnormalities in T lymphocite and B lymphocite function and associated autoimmune disease. Women with endometriosis are more frequently affected by asthma, rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrom and Hashimoto’s thyroiditis. Autoimmune disease is characterized by the production of autoantibodies against components of apoptotic cells. Anti-endometrial antibodies of IgG and IgM classes could be detected in 60 % of endometriosis patients. They show reactivity in glandular epithelium and stroma. Anti-endothelial antibodies specifically react with vascular endothelium and might be with anti-endometrial antibodies partially responsible for failure of implantation leading to infertility, wich is common in endometriosis patients. Anti-nuclear antibodies are frequent serological findings in patients with autoimmune disease, and could be detected in 29–47 % of women with endometriosis.4 Generation of anti-nuclear antibodies is a risk factor for development of other autoimmune disease in women of reproductive age. Studies have shown conflicting results on the presence of anti-ovarian antibodies in the serum of endometriosis patients and in the peritoneal fluid. Their presence is one of the possible causes of infertility. Conclusions. Ethiopathogenesis of endometriosis still remains uncelar but

  10. Progress on macrophage's proinflammatory products as markers of acute endometriosis

    Alicja Ziętek

    2015-08-01

    Full Text Available To provide the review of the macrophage activity products as pathophysiological markers of endometriosis by literature survey (PubMed, Cochrane. Immunoreactive cells and several of their synthesis products concentrations are elevated in the serum and peritoneal fluid in patients with endometriosis. The enhanced reactive proteins contributed to local inflammation and aggregation of endometriotic lesions. Immune response and immune surveillance of tissue play an important role in pathogenesis of endometriosis. Activated macrophages in peritoneal environment secrete immunoreactive cytokines which are responsible for inflammatory cascade of reactions. The immunoreactive cytokines should be a target not only as a disease marker but also as a part of therapeutic protocol.

  11. Endometriosis After Surgical Menopause Mimicking Pelvic Malignancy: Surgeons’ Predicament

    Rani A. Bhat

    2014-05-01

    Full Text Available Prevalence of persistent endometriosis in women after menopause without any hormonal replacement therapy is very rare. This is a case of a woman with previous history of total hysterectomy and bilateral salpingo-oophorectomy for endometriosis who presented with hemoperitoneum, vaginal bleeding, pelvic mass, and pulmonary thromboembolism mimicking as rectovaginal septum carcinoma. This is the first case report with a unique mode of presentation wherein the patient presented with hemoperitoneum requiring emergency embolization of the vessel to stabilize the patient. She underwent en bloc resection of the tumor with high anterior resection of the rectum. Histopathology confirmed endometriosis.

  12. Magnetic resonance imaging in lower urinary tract endometriosis: iconographic essay

    Lima, Claudio Marcio Amaral de Oliveira; Coutinho, Elisa Pompeu Dias; Ribeiro, Erica Barreiros; Domingues, Marisa Nassar Aidar; Junqueira, Flavia Pegado; Coutinho Junior, Antonio Carlos

    2009-01-01

    Endometriosis is defined as the presence of functional endometrial tissue outside the endometrial cavity and myometrium. Although this is a frequent disease with multifactorial causes, involvement of the lower urinary tract is rare. Magnetic resonance imaging is highly sensitive, specific and accurate in the diagnosis of endometriosis in the lower urinary tract, especially for allowing the identification of lesions obscured by adhesions or with subperitoneal extension. The present iconographic essay presents the main magnetic resonance imaging findings of the lower urinary tract involvement by endometriosis. (author)

  13. Effectiveness of nitrous oxide for postpartum perineal repair: a randomised controlled trial.

    Berlit, Sebastian; Tuschy, Benjamin; Brade, Joachim; Mayer, Jade; Kehl, Sven; Sütterlin, Marc

    2013-10-01

    To compare the effectiveness of self-administered 50% nitrous oxide and conventional infiltrative anaesthesia with 1% prilocaine hydrochloride in postpartum perineal repair. A total of 100 women were prospectively enrolled and randomised to receive either infiltrative anaesthesia or a self-administered nitrous oxide mixture (Livopan(©)) for pain relief during postpartum perineal suturing. Besides data concerning anaesthesia, characteristics of patients and labour were documented for statistical analysis. Pain experienced during perineal repair was assessed using the short form of the McGill Pain Questionnaire (SF-MPQ). Forty-eight women received nitrous oxide and 52 underwent perineal suturing after infiltrative anaesthesia. There were no statistically significant differences regarding maternal age, body mass index (BMI), duration of pregnancy and suturing time between the groups. The most frequent birth injury was second-degree perineal laceration in the study group [22/48; 46%] and episiotomy in the control group [18/52; 35%]. Pain experienced during genital tract suturing and patients' satisfaction showed no statistically significant differences between the groups. Thirty-seven women in the study group and 47 in the control group were satisfied with the anaesthesia during perineal repair and would recommend it to other parturients [37/48, 77% vs. 47/52, 90%; p=0.0699). Nitrous oxide self-administration during genital tract suturing after vaginal childbirth is a satisfactory and effective alternative to infiltrative anaesthesia. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. Temporary Rectal Stenting for Management of Severe Perineal Wounds in Two Dogs.

    Skinner, Owen T; Cuddy, Laura C; Coisman, James G; Covey, Jennifer L; Ellison, Gary W

    Perineal wounds in dogs present a challenge due to limited local availability of skin for closure and constant exposure to fecal contaminants. This report describes temporary rectal stenting in two dogs following severe perineal wounds. Dog 1 presented with a 4 × 4 cm full-thickness perineal slough secondary to multiple rectal perforations. A 12 mm internal diameter endotracheal tube was placed per-rectum as a temporary stent to minimize fecal contamination. The stent was removed 18 days after placement, and the perineal wound had healed at 32 days post-stent placement, when a minor rectal stricture associated with mild, intermittent tenesmus was detected. Long-term outcome was deemed good. Dog 2 presented with multiple necrotic wounds with myiasis, circumferentially surrounding the anus and extending along the tail. A 14 mm internal diameter endotracheal tube was placed per-rectum. The perineal and tail wounds were managed with surgical debridement and wet-to-dry and honey dressings prior to caudectomy and negative pressure wound therapy (NPWT). Delayed secondary wound closure and stent removal were performed on day six without complication. Long-term outcome was deemed excellent. Temporary rectal stenting may be a useful technique for fecal diversion to facilitate resolution of complex perineal injuries, including rectal perforation.

  15. [Exstrophy of rectal duplication associated with anorectal malformation and penoscrotal transposition with perineal hypospadias. A case report].

    Fernández Fernández, Jesús Angel; Parodi Hueck, Luis; Carrasco Fermín, Joanna

    2014-06-01

    We present the case of a male patient who required treaatment due to anorectal agenesis with recto urethral fistula and penoscrotal transposition with perineal hypospadias, associated with a perineal tumor. The perineal tumor was found strongly adhered and contiguous to the rectum which makes it compatible with an exstrophy of rectal duplication. Surgical reconstruction of the birth defect was performed in stages until acceptable biological function and esthetic results were obtained.

  16. Efficacy of letrozole in treatment of endometriosis-related pain

    Elham Hussein Madny

    2014-03-01

    Conclusion: Letrozole (aromatase inhibitor has shown to be effective in the treatment of endometriosis-related pain with substantial improvement of pain with no recurrence of pain for 6 months after completion of treatment.

  17. Clear Cell Adenocarcinoma Arising from Abdominal Wall Endometriosis

    Thouraya Achach

    2008-01-01

    Full Text Available Endometriosis is a frequent benign disorder. Malignancy arising in extraovarian endometriosis is a rare event. A 49-year-old woman is presented with a large painful abdominal wall mass. She underwent a myomectomy, 20 years before, for uterus leiomyoma. Computed tomography suggested that this was a desmoid tumor and she underwent surgery. Histological examination showed a clear cell adenocarcinoma associated with endometriosis foci. Pelvic ultrasound, computed tomography, and endometrial curettage did not show any malignancy or endometriosis in the uterus and ovaries. Adjuvant chemotherapy was recommended, but the patient was lost to follow up. Six months later, she returned with a recurrence of the abdominal wall mass. She was given chemotherapy and then she was reoperated.

  18. Genital endometriosis rate dynamics before and after Chernobyl accident

    Al-Shbul', I.; Suprun, L.Ya.

    2000-01-01

    The necessity of endometriosis dynamics evaluation is caused by worse ecological situation on the area of Belarus. Genital endometriosis frequency was studied considering the outcomes of surgeries fulfilled in hospitals of Gomel, Mogilev and Vitebsk in 1981-1995. At this time 1254 women underwent an operation and 19% of patients (235 persons) were operated before the Chernobyl accident. In the first 5 years after the accident endometriosis frequency increased nearly 2 times. The next 5 years (1991-1995) the number of operated patients was 565, i.e. 45% from the whole number. Uterus was extirpated or amputated in 898 patients, ovaries at both sides were removed in 36 ones. As the analysis showed the endometriosis frequency grew in 2,5 times for last 15 years, the most significant increase of this pathology was observed during the first five years after the accident

  19. Serum CA 125 concentrations in women with endometriosis or ...

    releasing hormone (GnRH) agonist analogue therapy in women with endometriosis and uterine fibroids. Serum concentrations of this cell surface antigen did not correlate with uterine volume and appeared to have no value in the assessment of ...

  20. Endometriosis presenting as carcinoma colon in a perimenopausal woman

    Tanuja Muthyala

    2015-01-01

    Full Text Available Endometriosis is a common benign disease of reproductive age women, and can involve the intestinal tract. Inconsistent clinical presentation, similar features on radiological imaging and colonoscopy with other inflammatory and malignant lesions of the bowel makes the preoperative diagnosis of bowel endometriosis difficult. We present a case of a 42-year-old perimenopausal female clinically presented, investigated and managed in the lines of carcinoma of sigmoid colon. She underwent terminal ileac resection with end to end anastomoses, Hartmann′s procedure and total hysterectomy with bilateral salpingoophorectomy. The histopathological report revealed endometriosis of small intestine, large intestine, mesentery, right ovary and adenomyoma of uterus. Thus, bowel endometriosis should also be considered as differential diagnosis in reproductive age women with gastrointestinal symptoms or intestinal mass of uncertain diagnosis.

  1. Endometriosis and the subsequent risk of epithelial ovarian cancer

    Wen-Hsun Chang

    2014-12-01

    Conclusion: Taiwanese women with endometriosis really had a risk of newly developed EOC, especially those who had a surgical diagnosis, and this three-fold increase of risk was neither influenced by exposure time nor biased by surveillance.

  2. Endometriosis, dysmenorrhea and diet--what is the evidence?

    Fjerbaek, Agnete; Knudsen, Ulla B

    2007-01-01

    between diet and endometriosis/dysmenorrhea was performed. Data on diet and endometriosis were limited to four trials of which two were animal studies. The articles concerning human consumption found some relation between disease and low intake of vegetable and fruit and high intake of vegetarian...... between diet and endometriosis/dysmenorrhea was performed. Data on diet and endometriosis were limited to four trials of which two were animal studies. The articles concerning human consumption found some relation between disease and low intake of vegetable and fruit and high intake of vegetarian....... Further research is recommended on both subjects.ke of vegetarian polyunsaturated fat, ham, beef and other red meat. Results concerning fish intake were not consistent. Eight trials of different design, with a total of 1097 women, investigated the relationship between diet and dysmenorrhea. Intake of fish...

  3. Abnormal pathways in endometriosis in relation to progesterone resistance

    Lode, Lise; Sveen, Magnhild Often; Rudnicki, Martin

    2017-01-01

    Introduction: Endometriosis is an estrogen-dependent disorder, and recent studies suggest that progesterone resistance may contribute to the development and pathophysiology of the disorder. Based on this, identification of genetic and molecular perturbations in the endometrium of women...

  4. The association between endometriosis and survival outcomes of ...

    2015-03-02

    Mar 2, 2015 ... Key words: Endometriosis, meta‑analysis, ovarian cancer, survival ..... Sainz de la Cuesta R, Eichhorn JH, Rice LW, Fuller AF Jr, Nikrui N, Goff BA. .... adenocarcinomas/adenosquamous carcinomas of the uterine cervix. Int J.

  5. Prevalence of Endometriosis Among Women Undergoing Laparoscopic Procedures

    K. K. Chu

    1995-01-01

    Full Text Available We evaluated 752 patients for endometriosis in consecutive laparoscopic procedures over a one year period. Six hundred eighty patients underwent laparoscopy for indications unrelated to symptoms of endometriosis and 72 patients were diagnosed clinically to have endometriosis before the procedures. In the 72 patients with clinical indications of endometriosis, 59 patients had disease confirmed at surgery (82%. Out of 680 asymptomatic patients, 186 patients (24.7% were documented to have the disease of various characteristics or appearances in which the typical lesions accounted for 42%. The overall prevalence among these women undergoing laparoscopy was 32.5%. However, a prevalence of 12% was shown in a subset of asymptomatic patients indicated for sterilization. This may reflect the appropriate prevalence in reproductive age population.

  6. Update on Biomarkers for the Detection of Endometriosis

    Fassbender, Amelie; Burney, Richard O.; O, Dorien F.; D'Hooghe, Thomas; Giudice, Linda

    2015-01-01

    Endometriosis is histologically characterized by the displacement of endometrial tissue to extrauterine locations including the pelvic peritoneum, ovaries, and bowel. An important cause of infertility and pelvic pain, the individual and global socioeconomic burden of endometriosis is significant. Laparoscopy remains the gold standard for the diagnosis of the condition. However, the invasive nature of surgery, coupled with the lack of a laboratory biomarker for the disease, results in a mean latency of 7–11 years from onset of symptoms to definitive diagnosis. Unfortunately, the delay in diagnosis may have significant consequences in terms of disease progression. The discovery of a sufficiently sensitive and specific biomarker for the nonsurgical detection of endometriosis promises earlier diagnosis and prevention of deleterious sequelae and represents a clear research priority. In this review, we describe and discuss the current status of biomarkers of endometriosis in plasma, urine, and endometrium. PMID:26240814

  7. Magnetic resonance imaging in deep pelvic endometriosis: iconographic essay

    Coutinho Junior, Antonio Carlos; Coutinho, Elisa Pompeu Dias; Lima, Claudio Marcio Amaral de Oliveira; Ribeiro, Erica Barreiros; Aidar, Marisa Nassar; Gasparetto, Emerson Leandro

    2008-01-01

    Endometriosis is characterized by the presence of normal endometrial tissue outside the uterine cavity. In patients with deep pelvic endometriosis, uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder may be involved. Clinical manifestations may be variable, including pelvic pain, dysmenorrhea, dyspareunia, urinary symptoms and infertility. Complete surgical excision is the gold standard for treating this disease, and hence the importance of the preoperative work-up that usually is limited to an evaluation of sonographic and clinical data. Magnetic resonance imaging is of paramount importance in the diagnosis of endometriosis, considering its high accuracy in the identification of lesions intermingled with adhesions, and in the determination of peritoneal lesions extent. The present pictorial review describes the main magnetic resonance imaging findings in deep pelvic endometriosis. (author)

  8. Endometriosis of the mesoappendix mimicking appendicitis: A case report

    Suman Mewa Kinoo

    2016-09-01

    Full Text Available Although appendicitis is largely a clinical diagnosis, on occasions diagnostic modalities may be needed to aid with the diagnosis. Despite the use of adjuncts and exploratory surgery, the diagnosis may not be clear until a histological diagnosis is achieved. Endometriosis of the appendix mimicking appendicitis is one of these diagnoses described in several case reports. Endometriosis of the meso-appendix has been described in association with intussusception of the appendix in several case reports. However, to our knowledge, endometriosis of the meso-appendix mimicking appendicitis has not been reported to date. We present the case of a 33-year-old woman with classic clinical signs and symptoms of appendicitis endorsed on computed tomography imaging. The patient underwent a laparoscopic appendicectomy with the postoperative histology demonstrating a normal appendix with endometriosis of the meso-appendix.

  9. Update on Biomarkers for the Detection of Endometriosis

    Amelie Fassbender

    2015-01-01

    Full Text Available Endometriosis is histologically characterized by the displacement of endometrial tissue to extrauterine locations including the pelvic peritoneum, ovaries, and bowel. An important cause of infertility and pelvic pain, the individual and global socioeconomic burden of endometriosis is significant. Laparoscopy remains the gold standard for the diagnosis of the condition. However, the invasive nature of surgery, coupled with the lack of a laboratory biomarker for the disease, results in a mean latency of 7–11 years from onset of symptoms to definitive diagnosis. Unfortunately, the delay in diagnosis may have significant consequences in terms of disease progression. The discovery of a sufficiently sensitive and specific biomarker for the nonsurgical detection of endometriosis promises earlier diagnosis and prevention of deleterious sequelae and represents a clear research priority. In this review, we describe and discuss the current status of biomarkers of endometriosis in plasma, urine, and endometrium.

  10. Magnetic resonance imaging in deep pelvic endometriosis: iconographic essay

    Coutinho Junior, Antonio Carlos; Coutinho, Elisa Pompeu Dias; Lima, Claudio Marcio Amaral de Oliveira; Ribeiro, Erica Barreiros; Aidar, Marisa Nassar [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil); Clinica Multi-Imagem, Rio de Janeiro, RJ (Brazil); E-mail: cmaol@br.inter.net; Gasparetto, Emerson Leandro [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Dept. de Radiologia

    2008-03-15

    Endometriosis is characterized by the presence of normal endometrial tissue outside the uterine cavity. In patients with deep pelvic endometriosis, uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder may be involved. Clinical manifestations may be variable, including pelvic pain, dysmenorrhea, dyspareunia, urinary symptoms and infertility. Complete surgical excision is the gold standard for treating this disease, and hence the importance of the preoperative work-up that usually is limited to an evaluation of sonographic and clinical data. Magnetic resonance imaging is of paramount importance in the diagnosis of endometriosis, considering its high accuracy in the identification of lesions intermingled with adhesions, and in the determination of peritoneal lesions extent. The present pictorial review describes the main magnetic resonance imaging findings in deep pelvic endometriosis. (author)

  11. [Pictures balance for optimal surgical management of pelvic endometriosis. Imaging and surgery of endometriosis].

    Leroy, A; Garabedian, C; Fourquet, T; Azaïs, H; Merlot, B; Collinet, P; Rubod, C

    2016-03-01

    Endometriosis is a frequent benign pathology that is found in 10-15% of women and in 20% of infertile women. It has an impact on fertility, but also in everyday life. If medical treatment fails, surgical treatment can be offered to the patient. To provide adequate treatment and give clearer information to patients, it seems essential to achieve an optimal preoperative imaging assessment. Thus, the aim of this work is to define the information expected by the surgeon and the indications of each imaging test for each compartment of the pelvis, allowing an ideal surgical management of pelvic endometriosis. We will not discuss imaging techniques' principles and we will not develop the indications and surgical techniques. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Elephantiasis Nostras Verrucosa. Excision with full-thickness skin grafting of the penis, scrotum, and perineal area.

    Judge, Nathan; Kilic, Ali

    2016-11-13

    Elephantiasis nostras verrucosa is a rare cutaneous complication of chronic lymphatic obstruction. It is most commonly caused by bacterial infection, trauma, neoplasia, obesity, and venous stasis. In this report, we describe a case of elephantiasis nostras verrucosa involving the scrotum and perineal area in a 32-year-old. The lesions were excised, and full-thickness skin grafting of the penis, scrotum, and perineal skin was performed. This case demonstrates the efficacy of excision with full-thickness skin grafting of the penis, scrotum, and perineal area in a patient with elephantiasis nostras verrucosa confined to the scrotum and perineal region.

  13. Intraperitoneal inflammation decreases endometriosis in a mouse model

    Nowak, N.M.; Fischer, O.M.; Gust, T.C.; Fuhrmann, U.; Habenicht, U.-F.; Schmidt, A.

    2008-01-01

    BACKGROUND The role of the immune system in the pathogenesis of endometriosis remains elusive. It has been shown that patients have an altered peritoneal environment with increased levels of inflammatory cytokines, activated macrophages and reduced clearance of retrogradely transported endometrial fragments. However, it is not known if this unique inflammatory situation is cause or consequence of endometriosis. This study investigates the impact of a pre-existing peritoneal inflammation on en...

  14. Imbalance between sympathetic and sensory innervation in peritoneal endometriosis.

    Arnold, Julia; Barcena de Arellano, Maria L; Rüster, Carola; Vercellino, Giuseppe F; Chiantera, Vito; Schneider, Achim; Mechsner, Sylvia

    2012-01-01

    To investigate possible mechanisms of pain pathophysiology in patients with peritoneal endometriosis, a clinical study on sensory and sympathetic nerve fibre sprouting in endometriosis was performed. Peritoneal lesions (n=40) and healthy peritoneum (n=12) were immunostained and analysed with anti-protein gene product 9.5 (PGP 9.5), anti-substance P (SP) and anti-tyrosine hydroxylase (TH), specific markers for intact nerve fibres, sensory nerve fibres and sympathetic nerve fibres, respectively, to identify the ratio of sympathetic and sensory nerve fibres. In addition, immune cell infiltrates in peritoneal endometriotic lesions were analysed and the nerve growth factor (NGF) and interleukin (IL)-1β expression was correlate with the nerve fibre density. Peritoneal fluids from patients with endometriosis (n=40) and without endometriosis (n=20) were used for the in vitro neuronal growth assay. Cultured chicken dorsal root ganglia (DRG) and sympathetic ganglia were stained with anti-growth associated protein 43 (anti-GAP 43), anti-SP and anti-TH. We could detect an increased sensory and decreased sympathetic nerve fibres density in peritoneal lesions compared to healthy peritoneum. Peritoneal fluids of patients with endometriosis compared to patients without endometriosis induced an increased sprouting of sensory neurites from DRG and decreased neurite outgrowth from sympathetic ganglia. In conclusion, this study demonstrates an imbalance between sympathetic and sensory nerve fibres in peritoneal endometriosis, as well as an altered modulation of peritoneal fluids from patients with endometriosis on sympathetic and sensory innervation which might directly be involved in the maintenance of inflammation and pain. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Abdominal Wall Endometriosis: An Overlooked but Possibly Preventable Complication

    Chen-Chih Teng

    2008-03-01

    Conclusion: Abdominal wall endometriosis may be caused by iatrogenic inoculation of the endometrium into the surgical wound. It is strongly recommended that, at the conclusion of the surgical procedure, the abdominal wound be cleaned thoroughly, particularly at both corner sites (especially the operator's side. If an abdominal wall endometriosis is encountered after CS but the patient plans to have future pregnancy and the symptoms are mild, excision of the endometrioma may be deferred until the next indicated CS.

  16. Interplay between Endometriosis and Pregnancy in a Mouse Model.

    Mariela Andrea Bilotas

    Full Text Available To evaluate the effect of endometriosis on fertility and the levels of the IL-2 and IFN-γ in the peritoneal fluid in a mouse model; to evaluate the effect of pregnancy on endometriotic lesion growth, apoptosis and cell proliferation.Two month old C57BL/6 female mice underwent either a surgical procedure to induce endometriosis or a sham surgery. Four weeks after surgery mice were mated and sacrificed at day 18 of pregnancy. Number of implantation sites, fetuses and fetal weight were recorded. Endometriotic lesions were counted, measured, excised and fixed. Apoptosis and cell proliferation were evaluated in lesions by TUNEL and immunohistochemistry for PCNA respectively. Levels of IL-2 and IFN-γ were assessed by ELISA in the peritoneal fluid.Pregnancy rate (i.e. pregnant mice/N decreased in mice with endometriosis. However there were no significant differences in resorption rate, litter size and pup weight between groups. IFN-γ augmented in endometriosis mice independently of pregnancy outcome. Additionally IFN-γ increased in pregnant endometriosis mice compared to pregnant sham animals. While IFN-γ increased in non pregnant versus pregnant mice in the sham group, IL-2 was increased in non pregnant mice in the endometriosis group. The size of endometriotic lesions increased in pregnant mice while apoptosis increased in the stroma and cell proliferation decreased in the epithelium of these lesions. Additionally, leukocyte infiltration, necrosis and decidualization were increased in the same lesions.Pregnancy rate is reduced in this mouse model of endometriosis. Levels of IL-2 are increased in the peritoneal fluid of mice with endometriosis suggesting a role of this cytokine in infertility related to this disease. The size of endometriotic lesions is increased in pregnant mice; however pregnancy has a beneficial effect on lesions by decreasing cell proliferation and by increasing apoptosis, decidualization and necrosis.

  17. Interplay between Endometriosis and Pregnancy in a Mouse Model.

    Bilotas, Mariela Andrea; Olivares, Carla Noemí; Ricci, Analía Gabriela; Baston, Juan Ignacio; Bengochea, Tatiana Soledad; Meresman, Gabriela Fabiana; Barañao, Rosa Inés

    2015-01-01

    To evaluate the effect of endometriosis on fertility and the levels of the IL-2 and IFN-γ in the peritoneal fluid in a mouse model; to evaluate the effect of pregnancy on endometriotic lesion growth, apoptosis and cell proliferation. Two month old C57BL/6 female mice underwent either a surgical procedure to induce endometriosis or a sham surgery. Four weeks after surgery mice were mated and sacrificed at day 18 of pregnancy. Number of implantation sites, fetuses and fetal weight were recorded. Endometriotic lesions were counted, measured, excised and fixed. Apoptosis and cell proliferation were evaluated in lesions by TUNEL and immunohistochemistry for PCNA respectively. Levels of IL-2 and IFN-γ were assessed by ELISA in the peritoneal fluid. Pregnancy rate (i.e. pregnant mice/N) decreased in mice with endometriosis. However there were no significant differences in resorption rate, litter size and pup weight between groups. IFN-γ augmented in endometriosis mice independently of pregnancy outcome. Additionally IFN-γ increased in pregnant endometriosis mice compared to pregnant sham animals. While IFN-γ increased in non pregnant versus pregnant mice in the sham group, IL-2 was increased in non pregnant mice in the endometriosis group. The size of endometriotic lesions increased in pregnant mice while apoptosis increased in the stroma and cell proliferation decreased in the epithelium of these lesions. Additionally, leukocyte infiltration, necrosis and decidualization were increased in the same lesions. Pregnancy rate is reduced in this mouse model of endometriosis. Levels of IL-2 are increased in the peritoneal fluid of mice with endometriosis suggesting a role of this cytokine in infertility related to this disease. The size of endometriotic lesions is increased in pregnant mice; however pregnancy has a beneficial effect on lesions by decreasing cell proliferation and by increasing apoptosis, decidualization and necrosis.

  18. Abdominal endometriosis: Ultrasonographic findings (report of two cases)

    Lee, Jong Beum; Kim, Yong Goo; Lee, Yong Chul; Kim, Kun Sang [Chung Ang University Hospital, Seoul (Korea, Republic of)

    1993-12-15

    Endometriosis in the abdominal wall is a rare condition that most commonly occurs in the physiological scar of the umbilicus and in surgical scars of pelvic operation. The ultrasonographic findings are often non-specific, but with scrutinized physical examination and history, correct diagnosis can be made. We report ultrasonographic findings of abdominal wall endometriosis in two cases, both of which were related to previous cesarian section scar

  19. Female sexual dysfunction in patients with endometriosis: Indian scenario

    Vineet V Mishra

    2016-01-01

    Full Text Available Background: Female sexual dysfunction (FSD in Indian women is often overlooked due to cultural beliefs and considered as social taboos. Sexuality is an important and integral part of life. There are many causes of sexual dysfunction, but the prevalence of FSD in endometriotic patients is still underdiagnosed. Materials and Methods: Study design - Cross-sectional observational study conducted at tertiary care center, from June 2015 to March 2016. Sample size - Fifty-one patients in reproductive age group (18-47 years who were diagnosed with endometriosis on diagnostic laparoscopy were included. Methods - FSD was assessed with a detailed 19-item female sexual function index questionnaire. All six domains of sexual dysfunction, i.e., desire, arousal, lubrication, orgasm, satisfaction, and pain were studied. Exclusion - Patients with other gynecological, medical or surgical history were excluded. Results: Out of 51 patients with endometriosis, 47.06% of patients had sexual dysfunction. With the increase in staging of endometriosis, sexual dysfunction prevalence is also rising. FSD was 100% in patients with severe endometriosis as compared to 33.33% in minimal endometriosis. Conclusion: Every individual deserves good sexual life. The sexual dysfunction associated with endometriosis should also be taken into consideration while managing these patients.

  20. Conservative approach to rectosigmoid endometriosis: a cohort study.

    Egekvist, Anne G; Marinovskij, Edvard; Forman, Axel; Kesmodel, Ulrik S; Riiskjaer, Mads; Seyer-Hansen, Mikkel

    2017-06-01

    The aim of the study was to assess the risk of surgery after initial conservative treatment of rectosigmoid endometriosis in relation to demographic data. The study was conducted on the tertiary endometriosis referral unit, Aarhus University Hospital. Medical records, from patients seen from January 2009 onwards with a diagnosis of rectosigmoid endometriosis and more than 6 months' follow up were audited. Demographic data, results of magnetic resonance imaging and time to secondary surgery for rectosigmoid endometriosis were registered. Data on 238 patients diagnosed with rectosigmoid endometriosis were included. In all, 78 (32.8%) patients had primary surgery, 27 (11.3%) had secondary surgery and 133 (55.9%) continued conservative treatment throughout the observation period. Patients who underwent primary or secondary surgery were younger than patients continuing conservative treatment. In a tertiary referral center where about half of patients with rectosigmoid endometriosis were scheduled for conservative treatment, more than 80% of these avoided surgery. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. Cine MR imaging of uterine peristalsis in patients with endometriosis

    Kido, Aki; Togashi, Kaori; Koyama, Takashi; Fujimoto, Ryota; Nishino, Mizuki; Miyake, Kanae; Hayakawa, Katsumi; Iwasaku, Kazuhiro; Fujii, Shingo

    2007-01-01

    Endometriosis is one of the most important causes of infertility; however the precise mechanism by which it affects female fertility is unclear. The objective of this study was to study the functional aspects of the uterus by evaluating uterine contractility in patients with endometrial cysts of the ovary. The study population was recruited from two institutes and consisted of 26 women (periovulatory (10), luteal (13), and menstrual phase (3); age range: 19-51 years) with untreated endometriosis; the control group consisted of 12 healthy women (age range: 22-41 years). Cine MR imaging obtained by a 1.5T magnet was visually evaluated at 12 x faster than real speed, focusing on the presence of uterine peristalsis, the direction and frequency of peristalsis, and the presence of sustained uterine contractions. Uterine peristalsis was identifiable in 3/10, 3/13, and 3/3 of the endometriosis patients in each menstrual cycle, respectively, and in 11/12, 3/12, and 5/12 of their control subjects. Peristaltic detection rate and frequency were significantly less for the endometriosis group than for the controls in the periovulatory phase only (p<0.05). Sustained contractions were recognized in 19/36 control subjects and in 13/26 endometriosis patients, but the difference was not significant. Uterine peristalsis appears to be suppressed during the periovulatory phase in patients with endometriosis, which may have an adverse effect on sperm transport. (orig.)

  2. Kadar TNF-α dalam Zalir Peritoneal Penderita Endometriosis

    TEDJA DANUDJA OEPOMO

    2005-11-01

    Full Text Available The aim of this research was to expose the role of tumor necrotic factor alpha (TNF-α in the pathogenetic endometriosis. This research had been done in dr. Muwardi Hospital Surakarta. Twenty patients undergoing laparoscopic operation because of endometriosis indication (Group I, 20 women (aged 23 to 40 who undergo interval sterilization by means of laparoscopic technique (Group II. During laparoscopic operation, peritoneal fluid is taken to examine TNF-α by ELISA technique. The results indicated that by independent t-test, a significant difference of concentration of TNF-α in the peritoneal fluid is found between endometriosis patients and normal women (who are sterilized (P=0.00. By chi-square test, the Ratio Odds value 171 shows that the high concentration of TNF-α will increase the possibility of endometriosis 171 times rather than the low TNF-α. It could be concluded the high concentration of TNF-α is the risk factor of endometriosis in comparison with the low TNF-α. It shows that quite possibly TNF-α has a role in the pathogenic endometriosis.

  3. Potential involvement of iron in the pathogenesis of peritoneal endometriosis.

    Defrère, S; Lousse, J C; González-Ramos, R; Colette, S; Donnez, J; Van Langendonckt, A

    2008-07-01

    The aim of this study is to review the current literature associating endometriosis with iron and to discuss the potential causes and consequences of iron overload in the pelvic cavity. Indeed, iron is essential for all living organisms. However, excess iron can result in toxicity and is associated with pathological disorders. In endometriosis patients, iron overload has been demonstrated in the different components of the peritoneal cavity (peritoneal fluid, endometriotic lesions, peritoneum and macrophages). Animal models allow us to gather essential information on the origin, metabolism and effect of iron overload in endometriosis, which may originate from erythrocytes carried into the pelvic cavity mainly by retrograde menstruation. Peritoneal macrophages play an important role in the degradation of these erythrocytes and in subsequent peritoneal iron metabolism. Iron overload could affect a wide range of mechanisms involved in endometriosis development, such as oxidative stress or lesion proliferation. In conclusion, excess iron accumulation can result in toxicity and may be one of the factors contributing to the development of endometriosis. Treatment with an iron chelator could thus be beneficial in endometriosis patients to prevent iron overload in the pelvic cavity, thereby diminishing its deleterious effect.

  4. Caesarean section greatly increases risk of scar endometriosis.

    Nominato, Nilo Sérgio; Prates, Luis Felipe Victor Spyer; Lauar, Isabela; Morais, Jaqueline; Maia, Laura; Geber, Selmo

    2010-09-01

    To estimate the incidence of scar endometriosis after different surgical procedures. A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated. Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p<0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years. Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  5. Cine MR imaging of uterine peristalsis in patients with endometriosis

    Kido, Aki; Togashi, Kaori; Koyama, Takashi; Fujimoto, Ryota [Kyoto University, Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto (Japan); Nishino, Mizuki [Beth Israel Deaconess Medical Center, Department of Radiology, Kyoto (Japan); Miyake, Kanae; Hayakawa, Katsumi [Kyoto City Hospital, Department of Radiology, Kyoto (Japan); Iwasaku, Kazuhiro [Kyoto City Hospital, Department of Obstetrics and Gynecology, Kyoto (Japan); Fujii, Shingo [Kyoto University, Department of Gynecology and Obstetrics, Kyoto (Japan)

    2007-07-15

    Endometriosis is one of the most important causes of infertility; however the precise mechanism by which it affects female fertility is unclear. The objective of this study was to study the functional aspects of the uterus by evaluating uterine contractility in patients with endometrial cysts of the ovary. The study population was recruited from two institutes and consisted of 26 women (periovulatory (10), luteal (13), and menstrual phase (3); age range: 19-51 years) with untreated endometriosis; the control group consisted of 12 healthy women (age range: 22-41 years). Cine MR imaging obtained by a 1.5T magnet was visually evaluated at 12 x faster than real speed, focusing on the presence of uterine peristalsis, the direction and frequency of peristalsis, and the presence of sustained uterine contractions. Uterine peristalsis was identifiable in 3/10, 3/13, and 3/3 of the endometriosis patients in each menstrual cycle, respectively, and in 11/12, 3/12, and 5/12 of their control subjects. Peristaltic detection rate and frequency were significantly less for the endometriosis group than for the controls in the periovulatory phase only (p<0.05). Sustained contractions were recognized in 19/36 control subjects and in 13/26 endometriosis patients, but the difference was not significant. Uterine peristalsis appears to be suppressed during the periovulatory phase in patients with endometriosis, which may have an adverse effect on sperm transport. (orig.)

  6. How Many People Are Affected by or at Risk for Endometriosis?

    ... Share Facebook Twitter Pinterest Email Print How many people are affected by or at risk for endometriosis? ... Gynecology, 202 , 534.e1–534.e6. How many people are affected by or at risk for endometriosis? ...

  7. Immunohistochemical Evaluation of TGF-ß Isoforms in Cases with Ovarian Endometriosis and Follicular Cyst

    Abdulmuttalip Şentaş

    2007-04-01

    CONCLUSION: Ovarian tissue TGF-ß1 immunoreactivity was significantly increased in endometriosis cases when compared with follicular cyst. There are needed further studies to elucidate the importance of this finding in the pathogenesis of endometriosis.

  8. Association between endometriosis and risk of histological subtypes of ovarian cancer

    Pearce, Celeste Leigh; Templeman, Claire; Rossing, Mary Anne

    2012-01-01

    Endometriosis is a risk factor for epithelial ovarian cancer; however, whether this risk extends to all invasive histological subtypes or borderline tumours is not clear. We undertook an international collaborative study to assess the association between endometriosis and histological subtypes...

  9. Endometriosis and Ovarian Cancer: A Review of Clinical, Pathologic, and Molecular Aspects

    Wei, Jian-Jun; William, Josette; Bulun, Serdar

    2014-01-01

    Summary Endometriosis is a chronic disease that affects millions of reproductive-age women. Despite the destructive and invasive nature of endometrioses, most cases are perpetually benign or eventually regress; however, atypical endometriosis is a precursor lesion and can lead to certain types of ovarian cancer. Endometriosis induced inflammation and auto- and paracrine production of sex steroid hormones contribute to ovarian tumorigenesis. These changes provide microenvironment necessary to accumulate enough genetic alterations for endometriosis associated malignant transformation. It takes years for endometriosis to undergo the pathophysiological progression that begins with atypical epithelial proliferation (atypical endometriosis and metaplasia), and then is followed by the formation of well-defined borderline tumors, and finally culminates in fully malignant ovarian cancer. This study is a review of the natural history of endometriosis and the role of microenvironments that favor the accumulation of genetic alterations and endometriosis-associated ovarian cancer progression. PMID:21979592

  10. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres.

    Simoens, Steven; Dunselman, Gerard; Dirksen, Carmen; Hummelshoj, Lone; Bokor, Attila; Brandes, Iris; Brodszky, Valentin; Canis, Michel; Colombo, Giorgio Lorenzo; DeLeire, Thomas; Falcone, Tommaso; Graham, Barbara; Halis, Gülden; Horne, Andrew; Kanj, Omar; Kjer, Jens Jørgen; Kristensen, Jens; Lebovic, Dan; Mueller, Michael; Vigano, Paola; Wullschleger, Marcel; D'Hooghe, Thomas

    2012-05-01

    This study aimed to calculate costs and health-related quality of life of women with endometriosis-associated symptoms treated in referral centres. A prospective, multi-centre, questionnaire-based survey measured costs and quality of life in ambulatory care and in 12 tertiary care centres in 10 countries. The study enrolled women with a diagnosis of endometriosis and with at least one centre-specific contact related to endometriosis-associated symptoms in 2008. The main outcome measures were health care costs, costs of productivity loss, total costs and quality-adjusted life years. Predictors of costs were identified using regression analysis. Data analysis of 909 women demonstrated that the average annual total cost per woman was €9579 (95% confidence interval €8559-€10 599). Costs of productivity loss of €6298 per woman were double the health care costs of €3113 per woman. Health care costs were mainly due to surgery (29%), monitoring tests (19%) and hospitalization (18%) and physician visits (16%). Endometriosis-associated symptoms generated 0.809 quality-adjusted life years per woman. Decreased quality of life was the most important predictor of direct health care and total costs. Costs were greater with increasing severity of endometriosis, presence of pelvic pain, presence of infertility and a higher number of years since diagnosis. Our study invited women to report resource use based on endometriosis-associated symptoms only, rather than drawing on a control population of women without endometriosis. Our study showed that the economic burden associated with endometriosis treated in referral centres is high and is similar to other chronic diseases (diabetes, Crohn's disease, rheumatoid arthritis). It arises predominantly from productivity loss, and is predicted by decreased quality of life.

  11. Bronchial Artery Embolization in the Management of Pulmonary Parenchymal Endometriosis with Hemoptysis

    Kervancioglu, Selim; Andic, Cagatay; Bayram, Nazan; Telli, Cumali; Sarica, Akif; Sirikci, Akif

    2008-01-01

    Pulmonary parenchymal endometriosis is extremely rare and usually manifests itself with a recurrent hemoptysis associated with the menstrual cycle. The therapies proposed for women with endometriosis consist of medical treatments and surgery. Bronchial artery embolization has become a well-established and minimally invasive treatment modality for hemoptysis, and to the best of our knowledge, it has not been reported in pulmonary endometriosis. We report a case of pulmonary parenchymal endometriosis treated with embolotheraphy for hemoptysis.

  12. Perineal hernia in sheep containing pregnancy uterus / Hérnia perineal em ovino com útero gravídico como conteúdo

    Augusto José Savioli de Almeida Sampaio

    2010-09-01

    Full Text Available Herniations and eventrations are ordinary events of buiatric clinic. Umbilical and inguinal hernias are well described, but perineal hernias in small ruminant animals are not so mentioned. Even though being the perineal hernia more common in cats and dogs, it might be occasionally observed in pregnant sheep close to delivery, being the gravid uterus rarely as content. The present study describes the event of perineal hernia with gravid uterus as content in a sheep of approximately one year old with no breed defined with a pregnancy period about 120 days. The adopted procedure included surgical reduction of the hernia, but without the closure of the hernial ring. The animal presented excellent recovery without post-surgery complications. Herniações e eventrações são ocorrências comuns na clinica buiátrica. Hérnia umbilical e inguino-escrotal são bem descritas, porém hérnias perineais em pequenos ruminantes são pouco relatadas. Apesar de a hérnia perineal ser mais comum em cães e gatos, pode ser ocasionalmente observada em ovelhas gestantes próximas ao parto sendo que raramente apresenta o útero como conteúdo. O presente relato descreve a ocorrência de hérnia perineal com útero gravídico como conteúdo em uma ovelha de aproximadamente um ano de idade sem raça definida com tempo de gestação aproximado de 120 dias. A terapêutica adotada incluiu a redução cirúrgica da hérnia, porém, sem a síntese do anel herniário. O animal apresentou excelente recuperação sem complicações pós-operatórias.

  13. Occult microscopic endometriosis: undetectable by laparoscopy in normal peritoneum.

    Khan, Khaleque Newaz; Fujishita, Akira; Kitajima, Michio; Hiraki, Koichi; Nakashima, Masahiro; Masuzaki, Hideaki

    2014-03-01

    Is there any occurrence of hidden (occult) endometriotic lesions in normal peritoneum of women with and without visible endometriosis? We detected a slightly higher occurrence of occult microscopic endometriosis (OME) in normal peritoneum of women with visible endometriosis than in control women. Based on a small number of cases, the concept of invisible microscopic endometriosis in visually normal peritoneum has been reported for more than a decade but there is controversy regarding their tissue activity and clinical significance. This case-controlled research study was conducted with prospectively collected normal peritoneal samples from 151 women with and 62 women without visible endometriosis. Normal peritoneal biopsy specimens from different pelvic sites of were collected during laparoscopy. A histological search of all peritoneal biopsy specimens for the detection of invisible endometriosis was done by immunoreaction to Ber-EP4 (epithelial cell marker), CD10 (stromal cell marker) and Calretinin (mesothelial cell marker). Tissue expression of estrogen/progesterone receptors (ER/PR) and cell proliferation marker, Ki-67, was performed by immunohistochemistry to identify tissue activity. Three different patterns of OME were detected based on (I) the presence of typical gland/stroma, (II) reactive hyperplastic change of endometrioid epithelial cells with surrounding stroma and (III) single-layered epithelium-lined cystic lesions with surrounding stroma. A higher tendency toward the occurrence of OME was found in women with visible endometriosis (15.2%, 23/151) compared with control women (6.4%, 4/62) (P = 0.06, χ(2) test). The epithelial cells and/or stromal cells of OME lesions were immunoreactive to Ber-EP4 and CD10 but not reactive to Calretinin. ER and PR expression was observed in all patterns of OME lesions. Ki-67 index was significantly higher in pattern I/II OME lesions than in pattern III OME lesions (Pendometriosis due to the presence of adhesions in

  14. Stages of endometriosis: Does it affect in vitro fertilization outcome

    Sonja Pop-Trajkovic

    2014-06-01

    Conclusion: The American Society for Reproductive Medicine classification of endometriosis is useful in predicting IVF outcome. Advanced endometriosis means a worse prognosis for IVF treatment compared to milder stages or tubal factor infertility. The decreased fertilization rate in Stage I/II endometriosis might be a cause of subfertility in these women, as a result of a hostile environment caused by the disease.

  15. Mannan-binding lectin polymorphisms and serum levels in patients with endometriosis

    Kruse, Christina; Steffensen, Rudi; Nielsen, Hans J

    2014-01-01

    OBJECTIVE: To investigate a possible association between endometriosis and low levels of mannan-binding lectin (MBL). STUDY DESIGN: Case-control study of blood samples from 100 patients with endometriosis compared with results from a group of 350 blood donors. RESULT: The frequency of MBL levels...... endometriosis and low levels of MBL....

  16. Increased risk for ovarian cancer and borderline ovarian tumours in subfertile women with endometriosis

    Buis, C. C. M.; van Leeuwen, F. E.; Mooij, T. M.; Burger, C. W.; Lambalk, Cornelis B.; Kortman, Marian; Laven, Joop S. E.; Jansen, Cees A. M.; Helmerhorst, Frans M.; Cohlen, Ben J.; Willemsen, Wim N. P.; Smeenk, Jesper M. J.; Simons, Arnold H. M.; van der Veen, Fulco; Evers, Johannes L. H.; van Dop, Peter A.; Macklon, Nicholas S.

    2013-01-01

    Is ovarian or extra-ovarian endometriosis associated with an increased risk of ovarian cancer and borderline ovarian tumours (BOT)? We found a 3- to 8-fold increased risk of ovarian tumours associated with endometriosis: the magnitude of the risk increase depended on the definition of endometriosis.

  17. Internal obturator muscle transposition for treatment of perineal hernia in dogs: 34 cases (1998-2012).

    Shaughnessy, Magen; Monnet, Eric

    2015-02-01

    To evaluate the outcome of dogs with perineal hernia treated with transposition of the internal obturator muscle. Retrospective case series. 34 dogs. Medical records of dogs with perineal hernia surgically treated from 1998 to 2012 were reviewed. Diagnostic methods and surgical techniques were recorded. Dogs were assigned preoperative and postoperative clinical sign scores. Complication and recurrence rates were evaluated over time. Risk factors were determined. Median follow-up time was 345 days (range, 22 to 1,423 days). Complications were observed in 10 dogs. Tenesmus (n = 9), dyschezia (7), fecal impaction (3), stranguria (4), hematochezia (2), urinary incontinence (2), diarrhea (1), urinary tract infection (1), and megacolon (1) occurred following surgery. Bladder retroflexion at the time of initial evaluation or surgery was not a risk factor for complication (hazard ratio, 1.72). One year after surgery, 51.2% dogs were free of complications. Three dogs developed a perineal hernia on the contralateral side between 35 and 95 days after surgery. The 1-year recurrence rate was 27.4%. Median time for recurrence was 28 days after surgery (range, 2 to 364 days). Postoperative tenesmus was a risk factor for the development of recurrence (hazard ratio, 2.29). Internal obturator muscle transposition was used for primary repair of perineal hernia in dogs. Recurrence was recorded as long as 1 year after surgery. Tenesmus was a risk factor for the development of recurrence after treatment of perineal hernia with internal obturator muscle transposition.

  18. A Review of the Surgical Management of Perineal Hernias in Dogs.

    Gill, Sukhjit Singh; Barstad, Robert D

    2018-05-14

    Perineal hernia refers to the failure of the muscular pelvic diaphragm to support the rectal wall, resulting in herniation of pelvic and, occasionally, abdominal viscera into the subcutaneous perineal region. The proposed causes of pelvic diaphragm weakness include tenesmus associated with chronic prostatic disease or constipation, myopathy, rectal abnormalities, and gonadal hormonal imbalances. The most common presentation of perineal hernia in dogs is a unilateral or bilateral nonpainful swelling of the perineum. Clinical signs do occur, but not always. Clinical signs may include constipation, obstipation, dyschezia, tenesmus, rectal prolapse, stranguria, or anuria. The definitive diagnosis of perineal hernia is based on clinical signs and findings of weak pelvic diaphragm musculature during a digital rectal examination. In dogs, perineal hernias are mostly treated by surgical intervention. Appositional herniorrhaphy is sometimes difficult to perform as the levator ani and coccygeus muscles are atrophied and unsuitable for use. Internal obturator muscle transposition is the most commonly used technique. Additional techniques include superficial gluteal and semitendinosus muscle transposition, in addition to the use of synthetic implants and biomaterials. Pexy techniques may be used to prevent rectal prolapse and bladder and prostate gland displacement. Postoperative care involves analgesics, antibiotics, a low-residue diet, and stool softeners.

  19. Endometriosis increases the risk of obstetrical and neonatal complications.

    Berlac, Janne Foss; Hartwell, Dorthe; Skovlund, Charlotte Wessel; Langhoff-Roos, Jens; Lidegaard, Øjvind

    2017-06-01

    The objective of this study was to assess obstetrical complications and neonatal outcomes in women with endometriosis as compared with women without endometriosis. National cohort including all delivering women and their newborns in Denmark 1997-2014. Data were extracted from the Danish Health Register and the Medical Birth Register. Logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI). Sub-analyses were made for primiparous women with a singleton pregnancy and for women with endometriosis who underwent gynecological surgery before pregnancy. In 19 331 deliveries, women with endometriosis had a higher risk of severe preeclampsia (OR 1.7, 95% CI 1.5-2.0), hemorrhage in pregnancy (OR 2.3, 95% CI 2.0-2.5), placental abruption (OR 2.0, 95% CI 1.7-2.3), placenta previa (OR 3.9, 95% CI 3.5-4.3), premature rupture of membranes (OR 1.7, 95% CI 1.5-1.8), and retained placenta (OR 3.1, 95% CI 1.4-6.6). The neonates had increased risks of preterm birth before 28 weeks (OR 3.1, 95% CI 2.7-3.6), being small for gestational age (OR 1.5, 95% CI 1.4-1.6), being diagnosed with congenital malformations (OR 1.3, 95% CI 1.3-1.4), and neonatal death (OR 1.8, 95% CI 1.4-2.1). Results were similar in primiparous women with a singleton pregnancy. Gynecological surgery for endometriosis before pregnancy carried a further increased risk. Women with endometriosis had a significantly higher risk of several complications, such as preeclampsia and placental complications in pregnancy and at delivery. The newborns had increased risk of being delivered preterm, having congenital malformations, and having a higher neonatal death rate. Pregnant women with endometriosis require increased antenatal surveillance. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  20. Revisiting the wandering womb: Oxytocin in endometriosis and bipolar disorder.

    Dinsdale, Natalie L; Crespi, Bernard J

    2017-11-01

    Hippocrates attributed women's high emotionality - hysteria - to a 'wandering womb'. Although hysteria diagnoses were abandoned along with the notion that displaced wombs cause emotional disturbance, recent research suggests that elevated levels of oxytocin occur in both bipolar disorder and endometriosis, a gynecological condition involving migration of endometrial tissue beyond the uterus. We propose and evaluate the hypothesis that elevated oxytocinergic system activity jointly contributes to bipolar disorder and endometriosis. First, we provide relevant background on endometriosis and bipolar disorder, and then we examine evidence for comorbidity between these conditions. We next: (1) review oxytocin's associations with personality traits, especially extraversion and openness, and how they overlap with bipolar spectrum traits; (2) describe evidence for higher oxytocinergic activity in both endometriosis and bipolar disorder; (3) examine altered hypothalamic-pituitary-gonadal axis functioning in both conditions; (4) describe data showing that medications that treat one condition can improve symptoms of the other; (5) discuss fitness-related impacts of endometriosis and bipolar disorder; and (6) review a pair of conditions, polycystic ovary syndrome and autism, that show evidence of involving reduced oxytocinergic activity, in direct contrast to endometriosis and bipolar disorder. Considered together, the bipolar spectrum and endometriosis appear to involve dysregulated high extremes of normally adaptive pleiotropy in the female oxytocin system, whereby elevated levels of oxytocinergic activity coordinate outgoing sociality with heightened fertility, apparently characterizing, overall, a faster life history. These findings should prompt a re-examination of how mind-body interactions, and the pleiotropic endocrine systems that underlie them, contribute to health and disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Vitamin D in endometriosis: a causative or confounding factor?

    Sayegh, Lamia; Fuleihan, Ghada El-Hajj; Nassar, Anwar H

    2014-01-01

    The aim of this paper is to review the evidence from studies that evaluated the relationship between vitamin D and endometriosis. Comprehensive review. Systematic literature search in Medline for relevant publications from 1946 until June 2013. Endometriosis risk may be influenced by dietary vitamin D intake and plasma hydroxyvitamin D concentration. Vitamin D receptor and vitamin D metabolizing enzymes, 24-hydroxylase and 1-α hydroxylase, are found in the normal cycling endometrium and also in the eutopic and ectopic endometrium of women with endometriosis. The endometrium is a target of 1, 25 dihydroxyvitamin D actions through regulation of specific genes and via immunomodulation. The endometrium in endometriosis expresses dysregulation of some vitamin D enzymes and receptors. If vitamin D and its metabolites are implicated in endometriosis-associated infertility, it is likely through interference with HOXA10 gene expression. The Gc2 phenotype of vitamin D binding protein is prevalent in women with endometriosis and may be implicated in its pathogenesis. In a mouse model, Elocalcitol, a VDR-agonist was shown to reduce the development of endometriotic lesions and recurrence. A biological plausibility for a role of vitamin D, as an immunomodulator and anti-inflammatory agent, in the pathogenesis and treatment of endometriosis is suggested in this article, but is difficult to illustrate due to sparse evidence from human studies limited primarily to case-control studies. A significant knowledge gap precludes the establishment of a clear cause-effect relationship. The intriguing leads presented herein need to be investigated further with placebo-controlled supplementation trials. © 2013.

  2. ZEB1 expression is a potential indicator of invasive endometriosis.

    Furuya, Masataka; Masuda, Hirotaka; Hara, Kanako; Uchida, Hiroshi; Sato, Kenji; Sato, Suguru; Asada, Hironori; Maruyama, Tetsuo; Yoshimura, Yasunori; Katabuchi, Hidetaka; Tanaka, Mamoru; Saya, Hideyuki

    2017-09-01

    Although endometriosis is a benign disease, it shares some features with cancers, such as invasiveness and the potential to metastasize. This study sought to investigate the epithelial-mesenchymal transition status in human endometriotic lesions. Thirteen endometriosis patients and 10 control women without endometriosis undergoing surgery for benign indications were recruited. We examined the expression of E-cadherin, vimentin, and epithelial-mesenchymal transition-induced transcriptional factors, such as Snail and ZEB1, by immunohistochemistry. We evaluated the expression of each marker in epithelial cells of both endometriotic lesions (ovarian endometrioma, deep infiltrating endometriosis, adenomyosis) and normal endometria. The correlation between ZEB1 expression and serum level of CA125 was also investigated. Immunohistochemical analysis revealed that although E-cadherin, vimentin, and Snail were expressed in epithelia of normal endometria and endometriotic lesions, ZEB1 expression was only expressed in epithelia of endometriotic lesions. Additionally, ZEB1 was most frequently observed in epithelial cells of invasive endometriosis. The endometriosis patients with high serum CA125 level were more likely to have ZEB1-positive lesions. This is the first observation of ZEB1 expression in epithelial cells of benign disease. The preferential expression of ZEB1 in epithelial cells of endometriotic lesions suggests that these cells may have, at least in part, a higher level of mesenchymal features possibly via ZEB1-driven epithelial-mesenchymal transition than normal endometria and that ZEB1 can be a potential indicator of invasiveness or severity of endometriosis. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. Extraperitoneal colostomy in laparoscopic abdominoperineal resection using a hand inserted from the perineal side.

    Shiraishi, Takuya; Tomizawa, Naoki; Ando, Tatsumasa; Arakawa, Kazuhisa; Kobayashi, Katsumi; Muroya, Ken; Kurosaki, Ryo; Sato, Hiroaki; Suto, Yuji; Kato, Ryuji; Ozawa, Naoya; Sunose, Yutaka; Takeyoshi, Izumi

    2014-01-01

    Extraperitoneal colostomy is considered to be more effective at preventing post-colostomy complications than intraperitoneal colostomy. However, this operation is difficult via laparoscopic surgery alone. We present an extraperitoneal colostomy technique using a hand inserted from the perineal side. Extraperitoneal colostomy was performed in five patients. After the rectum was resected, a hand was inserted into the abdominal cavity from the perineal side, and pneumoperitoneum was created. The peritoneum was dissected to make the extraperitoneal route, and the proximal colon was passed along this route with fingers and laparoscopic manipulation. All procedures were completed without tissue damage or hemorrhage. No patient developed a hernia or ileus postoperatively. Laparoscopic abdominoperineal resection for an extraperitoneal colostomy is difficult via laparoscopic ports only. It can be simplified by operating with manual assistance via the perineal wound. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  4. Crioterapia no pos-parto: tempo de aplicacao e mudancas na temperatura perineal

    Adriana Amorim Francisco; Sonia Maria Junqueira Vasconcellos de Oliveira; Lucila Coca Leventhal; Caroline de Souza Bosco

    2013-01-01

    Estudo descritivo com dados de dois ensaios clínicos realizados em 2008 e 2009 em uma maternidade de uma instituição filantrópica da cidade de São Paulo. Teve como objetivo descrever a temperatura perineal após a aplicação de bolsa de gelo no pós-parto normal. Três grupos com 38 puérperas cada (n=114) receberam aplicação perineal de bolsa de gelo entre 2 e 48h após o parto. Os achados indicaram que com 10 min de crioterapia as médias da temperatura perineal atingiram de 13,3 a 15,3oC, com peq...

  5. ENDOMETRIOSIS OF APPENDIX IN WOMEN PRESENTING WITH RIGHT LOWER ABDOMINAL PAIN

    Radha Bai Prabhu T, Velayudam DA, Jayalakshmi M

    2015-07-01

    Full Text Available Endometriosis is a well known gynaecological condition associated with infertility and chronic pelvic pain. Review of literature shows that endometriosis can affect any tissue in the body, including the appendix. Here we report a case of pelvic endometriosis involving the vermiform appendix in a 45 years old multiparous woman. When women of the reproductive age present with recurrent lower abdominal pain on the right side, endometriosis of the appendix should also be considered. At the time of surgery appendix should be inspected and removed; especially in the presence of pelvic endometriosis.

  6. Endometriosis fertility index predicts live births following surgical resection of moderate and severe endometriosis.

    Maheux-Lacroix, S; Nesbitt-Hawes, E; Deans, R; Won, H; Budden, A; Adamson, D; Abbott, J A

    2017-11-01

    Can live birth be accurately predicted following surgical resection of moderate-severe (Stage III-IV) endometriosis? Live births can accurately be predicted with the endometriosis fertility index (EFI), with adnexal function being the most important factor to predict non-assisted reproductive technology (non-ART) fertility or the requirement for ART (www.endometriosisefi.com). Fertility prognosis is important to many women with severe endometriosis. Controversy persists regarding optimal post-operative management to achieve pregnancy and the counselling of patients regarding duration of conventional treatments before undergoing ART. The EFI is reported to correlate with expectant management pregnancy rate, although external validation has been performed without specifically addressing fertility in women with moderate and severe endometriosis. Retrospective cohort study of 279 women from September 2001 to June 2016. We included women undergoing laparoscopic resection of Stage III-IV endometriosis who attempted pregnancy post-operatively. The EFI was calculated based on detailed operative reports and surgical images. Fertility outcomes were obtained by direct patient contact. Kaplan-Meier model, log rank test and Cox regression were used for analyses. The follow-up rate was 84% with a mean duration of 4.1 years. A total of 147 women (63%) had a live birth following surgery, 94 of them (64%) without ART. The EFI was highly associated with live births (P years was 0% and steadily increased up to 91% with an EFI of 9-10, while the proportion of women who attempted ART and had a live birth, steadily increased from 38 to 71% among the same EFI strata (P = 0.1). A low least function score was the most significant predictor of failure (P = 0.003), followed by having had a previous resection (P = 0.019) or incomplete resection (P = 0.028), being older than 40 compared to years of age (P = 0.027), and having leiomyomas (P = 0.037). The main limitation of this study is its

  7. Chemotherapy-induced enterocutaneous fistula after perineal hernia repair using a biological mesh

    Eriksen, Mh; Bulut, O

    2014-01-01

    abdominoperineal resection. Nine months after the perineal hernia operation, the patient had multiple metastases in both lungs and liver. The patient underwent chemotherapy, including bevacizumab, irinotecan, calcium folinate, and fluorouracil. Six weeks into chemotherapy, the patient developed signs of sepsis...... and complained of pain from the right buttock. Ultrasound examination revealed an abscess, which was drained, guided by ultrasound. A computed tomography scan showed a subcutaneous abscess cavity located in the right buttock with communication to the small bowel. Operative findings confirmed a perineal fistula...

  8. Device and method to determine perineal artery occlusion during road bicycling.

    Parthiban, Sujeeth; Hotaling, James M; Ohlander, Samuel J; Baftiri, Amit P; Freels, Sally; Niederberger, Craig S

    2014-01-01

    Greater than 60 million American men who ride bicycles are at risk of developing erectile dysfunction. One possible reason is occlusion of the perineal arteries. Researchers relied on indirect methods and stationary models to study this problem. We developed a novel system to quantify occlusion among bicycle riders during a road bike ride. Our verification and validation activities show that this system can be safely used on human subjects to measure perineal artery occlusion. The method described in this paper provides a valuable tool to the researchers to study or to develop new solutions that alleviate this problem. The outcomes of these efforts will help millions of cyclists worldwide.

  9. Epithelial-to-mesenchymal transition in the development of endometriosis.

    Yang, Yan-Meng; Yang, Wan-Xi

    2017-06-20

    Endometriosis, an estrogen-dependent chronic gynecological disease, is common in reproductive-age women and profoundly affects their life quality. Although various pathogenic theories have been proposed, the origin of endometriosis remains unclear. Epithelial to mesenchymal transition (EMT) is a process that epithelial cells lose polarized organization of the cytoskeleton and cell-to-cell contacts, acquiring the high motility of mesenchymal cells. These changes are thought to be prerequisites for the original establishment of endometriotic lesions. However, no study exactly indicates which type of EMT occurs in endometriosis. In this review, we conclude that two different types of EMT may participate in this disease. Besides, two stimulating signals, hypoxia and estrogen, can through different pathways to activate the EMT process in endometriosis. Those pathways involve many cellular factors such as TGF-beta and Wnt, ultimately leading to cell proliferation and migration. As infertility is becoming a serious and intractable issue for women, EMT, during the implantation process, is gaining attention. In this review, we will describe the known functions of EMT in endometriosis, and suggest further studies that may aid in the development of medical therapy.

  10. Medical Treatments for Endometriosis-Associated Pelvic Pain

    Gabriella Zito

    2014-01-01

    Full Text Available The main sequelae of endometriosis are represented by infertility and chronic pelvic pain. Chronic pelvic pain causes disability and distress with a very high economic impact. In the last decades, an impressive amount of pharmacological agents have been tested for the treatment of endometriosis-associated pelvic pain. However, only a few of these have been introduced into clinical practice. Following the results of the controlled studies available, to date, the first-line treatment for endometriosis associated pain is still represented by oral contraceptives used continuously. Progestins represent an acceptable alternative. In women with rectovaginal lesions or colorectal endometriosis, norethisterone acetate at low dosage should be preferred. GnRH analogues may be used as second-line treatment, but significant side effects should be taken into account. Nonsteroidal anti-inflammatory drugs are widely used, but there is inconclusive evidence for their efficacy in relieving endometriosis-associated pelvic pain. Other agents such as GnRH antagonist, aromatase inhibitors, immunomodulators, selective progesterone receptor modulators, and histone deacetylase inhibitors seem to be very promising, but there is not enough evidence to support their introduction into routine clinical practice. Some other agents, such as peroxisome proliferator activated receptors-γ ligands, antiangiogenic agents, and melatonin have been proven to be efficacious in animal studies, but they have not yet been tested in clinical studies.

  11. Oxidative Stress and Endometriosis: A Systematic Review of the Literature

    Gennaro Scutiero

    2017-01-01

    Full Text Available Endometriosis is one of the most common gynaecologic diseases in women of reproductive age. It is characterized by the presence of endometrial tissue outside the uterine cavity. The women affected suffer from pelvic pain and infertility. The complex etiology is still unclear and it is based on three main theories: retrograde menstruation, coelomic metaplasia, and induction theory. Genetics and epigenetics also play a role in the development of endometriosis. Recent studies have put the attention on the role of oxidative stress, defined as an imbalance between reactive oxygen species (ROS and antioxidants, which may be implicated in the pathophysiology of endometriosis causing a general inflammatory response in the peritoneal cavity. Reactive oxygen species are intermediaries produced by normal oxygen metabolism and are inflammatory mediators known to modulate cell proliferation and to have deleterious effects. A systematic review was performed in order to clarify the different roles of oxidative stress and its role in the development of endometriosis. Several issues have been investigated: iron metabolism, oxidative stress markers (in the serum, peritoneal fluid, follicular fluid, peritoneal environment, ovarian cortex, and eutopic and ectopic endometrial tissue, genes involved in oxidative stress, endometriosis-associated infertility, and cancer development.

  12. Endometriosis is an important cause of pelvic pain in adolescence

    Marina de Paula Andres

    2014-12-01

    Full Text Available Objective: despite endometriosis being a common disease, where early detection is key to preventing its progression, it is a condition often overlooked in adolescents. The aim of this study was to report the clinical characteristics of adolescent patients with endometriosis monitored in a tertiary hospital. Methods: a retrospective study of 394 patients undergoing surgery with a histological diagnosis of endometriosis at the Endometriosis Division of the Gynecology Department at the Hospital das Clínicas of the University of São Paulo Medical School from 2008 to 2013. 21 adolescents were included (aged under 21 years. Results: the age ranged from 17.95 ± 1.48 years, the average time for diagnostic confirmation was 2.96 ± 2.93 years, and the age at the onset of symptoms was 15.28 ± 3.03 years on average. The sites affected were ovarian (38%, peritoneal (47.6% and retrocervical (23.8%. Dysmenorrhea was found in 80.9 % of adolescents (severe in 33.3% of cases and chronic pelvic pain in 66.6%. Conclusion: endometriosis in adolescents is an important differential diagnosis from pelvic pain and ovarian cysts, mainly among those with no response to conventional treatment. The main forms of involvement are peritoneal and ovarian. Despite the onset of symptoms in adolescence and advances in imaging methods, the diagnosis of this disease is still delayed.

  13. [IVF and endometriosis, oocyte donation and fertility preservation].

    d'Argent, Emmanuelle Mathieu; Antoine, Jean-Marie

    2017-12-01

    Endometriosis is a common condition, causing pain and infertility. In infertile woman with superficial peritoneal endometriosis and patent tubes, laparoscopy is recommended, followed by ovarian stimulation alone or in combination with intrauterine inseminations. In case of ovarian or deep endometriosis, the indications of surgery and assisted reproductive technologies remain to be defined precisely. In vitro fertilization is generally proposed after the failure of up to three inseminations, directly for ovarian or deep endometriosis, or in case of an associated factor of infertility, mainly male. Before ovarian stimulation in view to in vitro fertilization, a pretreatment by GnRH agonist for 2 to 6 months or combined contraceptive for 6 to 8 weeks would improve the pregnancy rate. Egg donation is effective in patients with advanced ovarian failure or lack of ovarian response to stimulation. Fertility preservation, especially by oocytes vitrified, must be proposed preventively to women with endometriosis at risk of ovarian failure, without close wish to be pregnant. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Diagnosis, management, and long-term outcomes of rectovaginal endometriosis

    Moawad NS

    2013-11-01

    Full Text Available Nash S Moawad,1 Andrea Caplin21Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Florida, 2University of Florida College of Medicine, Gainesville, FL, USAAbstract: Rectovaginal endometriosis is the most severe form of endometriosis. Clinically, it presents with a number of symptoms including chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, and rectal bleeding. The gold standard for diagnosis is laparoscopy with histological confirmation; however, there are a number of options for presurgical diagnosis, including clinical examination, transvaginal/transrectal ultrasound, magnetic resonance imagining, colonoscopy, and computed tomography colonography. Treatment can be medical or surgical. Medical therapies include birth control pills, oral progestins, gonadotropin-releasing hormone agonists, danazol, and injectable progestins. Analgesics are often used as well. Surgery improves up to 70% of symptoms. Surgery is either ablative or excisional, and is conducted via transvaginal, laparoscopic, laparotomy, or combined approaches. Common surgical techniques involve shaving of the superficial rectal lesion, laparoscopic anterior discoid resection, and low anterior bowel resection and reanastomosis. Outcomes are generally favorable, but postoperative complications may include intra-abdominal bleeding, anastomotic leaks, rectovaginal fistulas, strictures, chronic constipation, and the need for reoperation. Recurrence of rectal endometriosis is a possibility as well. Other outcomes are improved pain-related symptoms and fertility. Long-term outcomes vary according to the management strategy used. This review will provide the most recent approaches and techniques for the diagnosis and treatment of rectovaginal endometriosis.Keywords: pelvic pain, dyspareunia, bowel resection, endometriosis, rectovaginal

  15. Pelvic pain in endometriosis: painkillers or sport to alleviate symptoms?

    Koppan, A; Hamori, J; Vranics, I; Garai, J; Kriszbacher, I; Bodis, J; Rebek-Nagy, G; Koppan, M

    2010-06-01

    To assess potential individual factors influencing quality of life and pain scores of patients suffering from histologically confirmed endometriosis. Study using a questionnaire among patients of reproductive age undergoing laparoscopy with a presumed diagnosis of endometriosis. Details of fertility, previous treatments and quality of life, sexual activity, as well as linear pain scores for several symptoms, were recorded. Details of intraoperative findings were also collected and only those data were used where endometriosis was intraoperatively and histologically proven. A questionnaire before surgery gathered information from women on the following groups of variables: age, marital status, education, reproductive and medical history including previous pregnancies and parity, knowledge of accompanying pelvic disorders, regular sport activity, as well as general quality of life estimates including self-image. Pelvic pain was scored using a visual analogue scale. Data were statistically evaluated. Eighty-one patients complaining about persistent pelvic pain were later intraoperatively and histologically proven to have endometriosis. Thirty-one of them (38.2%) reported regular sport as part of their daily life schedule while 50 of them (61.8%) performed no physical activity at all. Fourteen patients among regular exercisers and 33 patients among those without physical activity reported the effectiveness of painkillers for pelvic pain, corresponding to 45.1% and 66% of these subgroups, respectively (difference statistically significant, ppainkillers might be less effective among endometriosis patients performing regular daily sport activities, and, thus it might impose them to an unnecessary burden of possible side-effects.

  16. Endometriosis: frequency and correlation between symptomatology and disease stage

    Mehmud, G.; Akhtar, T.; Sadia, S.

    2007-01-01

    To determine the frequency of endometriosis in general gynecological and infertile women presenting to hospital and to correlate symptomatology and stage of disease. Fifty patients with diagnosis of endometriosis on laparoscopy were included in the study. The degree of pain symptoms was graded according to 1-4 point verbal rating scale designed by Biberoglu and Behrman. Endometriosis was staged according to Revised American Fertility Society (R-AFS) scoring on laparoscopy. Correlation coefficient-Spearman rank order correlation test was applied to analyze data. The frequency of endometriosis in infertile women was 24% (33) and in women with general gynecological complaints, it was 23% (17). There was a significant positive correlation between chronic pelvic pain and R-AFS scoring. Increasing severity of pelvic pain was also positively correlated with presence of endometrioma and complete obliteration of pouch of Douglas. No correlation between dysmenorrhoea and R-AFS scoring could be detected. Dysmenorrhoea was strongly and positively correlated with the presence of superficial implants. Dyspareunia was found to have positive correlation with R-AFS score and also with complete obliteration of pouch of Douglas. The frequency of endometriosis in infertile women was 24% (33) and in women with general gynecological complaints, it was 23% (17). Chronic pelvic pain and dyspareunia had strong positive correlation with R-AFS score while dysmenorrhoea had no such correlation. (author)

  17. Deep infiltrating ureteral endometriosis with catamenial hydroureteronephrosis: a case report.

    Lee, Hyun Jung; Lee, Yoon Soon

    2017-12-13

    This aim of this case report is to raise awareness of ureteral endometriosis in women of reproductive age with hydronephrosis in the absence of urolithiasis to enable early diagnosis and prevent loss of renal function. A 44-year-old Asian woman presented with a 4-year history of cyclic right flank pain and right hydronephrosis during menstruation. Despite several evaluations by physicians, including gynecologists, the cause of her symptoms was not diagnosed. On transvaginal ultrasonography, the uterus was observed deviated to the right, with a nodular lesion at the right uterosacral ligament, and the right ovary was attached to the uterus with no apparent cystic lesion. Magnetic resonance imaging showed a mass in the right uterine wall and mild wall thickening with delayed enhancement of the right distal ureter. Right ureteral endometriosis was suspected. Diagnostic laparoscopy revealed narrowing of the distal right ureter between the right uterosacral ligament and the right ovary with adhesions caused by deep infiltrating endometriosis. The adhesion bands and infiltrating endometriosis around the right ureter were dissected. The nonspecific symptoms of ureteral endometriosis can result in incorrect diagnosis, with renal damage as a result of prolonged hydronephrosis. A high index of suspicion and use of imaging modalities enable earlier diagnosis and preservation of renal function.

  18. Molecular detection of Chlamydia Trachomatis and Mycoplasma Hominis in endometriosis lesions

    F. Azizvakili

    2016-12-01

    Full Text Available Background: Retrograde of menstrual blood into the peritoneal cavity is one of the accepted theories for initiation of endometriosis although indicated that other factors are involved in pathogenesis. Investigation of infectious agents is important in this regard. Objective: To investigate the presence of bacterial infections; Chlamydia trachomatis and Mycoplasma Hominis as risk factors in endometriosis lesions. Methods: This case-control study was conducted in Sarem Hospital in 2014. DNA was extracted from 90 paraffin-embedded blocks included 40 endometriosis tissue samples, 23 samples of endometrial tissue from the same patients and 27 samples of endometrial tissue of the patients without endometriosis, and molecular analysis were performed using polymerase chain reaction. Results were analyzed by Fisher Exact Test and McNemar Test. Findings: Chlamydia trachomatis infection was seen in 11 (27.5% endometriosis tissue, 3 (13% normal tissue from patients and 10 (37% in patient without endometriosis. Mycoplasma hominis was diagnosed in 11 (27.5% endometriosis tissue, 7 (30.4% of normal tissue from patients and one patient without endometriosis (3.7%. These differences show significant relations between infection with Mycoplasma hominis and endometriosis. Conclusion: The findings of this study did not show significant association between Chlamydia trachomatis infections and endometriosis. However; it seems Mycoplasma hominis infection can increase the risk of endometriosis incidence.

  19. Elevated peritoneal expression and estrogen regulation of nociceptive ion channels in endometriosis.

    Greaves, Erin; Grieve, Kelsey; Horne, Andrew W; Saunders, Philippa T K

    2014-09-01

    Ovarian suppression is a common treatment for endometriosis-associated pelvic pain. Its exact mechanism of action is poorly understood, although it is assumed to reflect reduced production/action of estrogens. The objective of the study was to measure the expression of mRNAs encoded by nociceptive genes in the peritoneum of women with chronic pelvic pain (CPP) with or without endometriosis and to investigate whether estrogens alter nociceptive gene expression in human sensory neurons. The study was performed using human tissue analysis and cell culture. The study was conducted at a university research institute. Peritoneal biopsies were obtained from women with CPP and endometriosis (n = 12), CPP and no endometriosis (n = 10), and no pain or endometriosis (n = 5). Endometriosis lesions were obtained from women with endometriosis (n = 18). mRNAs encoding ion channels (P2RX3, SCN9A, SCN11A, TRPA1, TRPV1) and the neurotransmitter TAC1 were measured in human tissue samples and in human embryonic stem cell-derived sensory neurons treated with estrogens. TRPV1, TRPA1, and SCN11A mRNAs were significantly higher in the peritoneum from women with endometriosis (P endometriosis lesions (P endometriosis (P endometriosis-associated pain. Strategies directly targeting ion channels may offer an alternative option for the management of CPP.

  20. Tratamento da endometriose Treatment of endometriosis

    Paula Andrea de Albuquerque Salles Navarro

    2006-10-01

    reduzir a dor e os riscos de recidiva. Por fim, é importante ressaltar que há muita controvérsia e que as recomendações acima descritas deverão ser revistas à medida que estudos clínicos randomizados, controlados e com casuística adequada gerarem evidências mais concretas e confiáveis.Despite a wide heterogeneity of clinical manifestations related to endometriosis, a high prevalence of the disease is observed in infertile women and in those with chronic pelvic pain. This enigmatic condition has a high socioeconomic impact, and the described data regarding efficacy of the therapeutic approaches are quite conflicting. Thus, the purpose of the present study was to describe the available scientific evidence about the applicable therapeutic modalities and to provide recommendations for the treatment of infertility and the chronic pelvic pain related to endometriosis. Although suppression of ovarian function in patients with minimal or mild endometriosis is not effective in improving fertility, ablation of the lesions associated with adhesiolysis seems to be more effective than exclusive diagnostic laparoscopy. There is no sufficient evidence to determine whether surgical excision in cases of moderate or severe disease would improve the pregnancy rates. In vitro fertilization seems to be an adequate approach, especially in cases of coexistence of infertility factors and/or failure of other treatments. The possibility of using GnRH for 3 to 6 months before in vitro fertilization should be considered. Regarding pain relief, suppression of ovarian function for 3 to 6 months in patients with laparoscopically-confirmed disease reduces the pain associated with endometriosis. All studied medication seem to have similar efficacy, differing only in terms of adverse effects and costs. Ablation of endometriotic lesion reduces the pain associated with endometriosis, being less effective in cases of minimal disease. Exeresis of endometriomas with diameter > 4 cm seems to improve

  1. Demographic, Clinical, and Prognostic Factors of Ovarian Clear Cell Adenocarcinomas According to Endometriosis Status

    Schnack, Tine H; Høgdall, Estrid; Thomsen, Lotte Nedergaard

    2017-01-01

    OBJECTIVES: Women with endometriosis carry an increased risk for ovarian clear cell adenocarcinomas (CCCs). Clear cell adenocarcinoma may develop from endometriosis lesions. Few studies have compared clinical and prognostic factors and overall survival in patients diagnosed as having CCC according...... to endometriosis status. METHODS: Population-based prospectively collected data on CCC with coexisting pelvic (including ovarian; n = 80) and ovarian (n = 46) endometriosis or without endometriosis (n = 95) were obtained through the Danish Gynecological Cancer Database. χ Test, independent-samples t test, logistic...... regression, Kaplan-Meier test, and Cox regression were used. Statistical tests were 2 sided. P values less than 0.05 were considered statistically significant. RESULTS: Patients with CCC and pelvic or ovarian endometriosis were significantly younger than CCC patients without endometriosis, and a higher...

  2. Perineal herpes simplex infection in bedridden geriatric patients.

    Nikkels, Arjen F; Piérard, Gérald E

    2007-01-01

    Herpes simplex virus (HSV) lesions are prone to reactivation and recurrence in response to various local or systemic triggering factors. To study the characteristics of five bedridden geriatric patients who presented with herpetic recurrences on the buttocks, gluteal cleft, and perianal region during hospitalization. Data were gathered regarding age, gender, reason for hospitalization, localization of lesions, clinical presentation, previous clinical diagnosis and topical treatments, immune status and immunosuppressant drug intake, as well as prior history of labial or genital herpes. A skin biopsy was taken for histologic examination and immunohistochemical viral identification. Viral culture and viral serology were performed and data regarding antiviral therapy were recorded. The five patients (three women, two men) were aged >80 years and hospitalized for either severe drug-induced renal insufficiency (one case), severe pneumonia (two cases), or stroke causing restricted mobility (two cases). Numerous well demarcated, painful ulcerations developed in the perianal region of these patients, and one patient also presented with some vesicular lesions. The lesions had been confused with mycotic and/or bacterial infections for 10-14 days. No inguinal lymphadenopathies were present and there was no fever. None of the patients had a previous history of recurrent labial or genital HSV infections or HIV infection. Histology was suggestive of HSV infection in two of five patients. Immunohistochemistry identified HSV type I (three patients) and HSV type II (two patients) infections. Viral culture with immunofluorescence viral identification revealed HSV type I in one of the four patients in whom a swab for viral culture was taken. Serology revealed past HSV infection. All lesions cured gradually after 10-14 days of intravenous acyclovir (aciclovir) treatment. Herpetic lesions of the perineal region represent a rare complication in bedridden geriatric patients in the absence

  3. Endometriosis: A Rare Cause of Large Bowel Obstruction

    Gonçalo Alexandrino

    2017-10-01

    Full Text Available Large bowel obstruction can result in significant morbidity and mortality, especially in cases of acute complete obstruction. There are many possible causes, the most common in adults being colorectal cancer. Endometriosis is a benign disease, and the most affected extragenital location is the bowel, especially the rectosigmoid junction. However, transmural involvement and acute occlusion are very rare events. We report an exceptional case of acute large bowel obstruction as the initial presentation of endometriosis. The differential diagnosis of colorectal carcinoma may be challenging, and this case emphasizes the need to consider intestinal endometriosis in females at a fertile age presenting with gastrointestinal symptoms and an intestinal mass causing complete large bowel obstruction.

  4. Colonoscopic tattoo dye spillage mimics endometriosis on laparoscopy.

    Stemmer, Shlomo M; Shurshalina, Anna

    2014-01-01

    Rare adverse effects of India ink injection spillage during colonoscopy have been reported. We present a case report in which prior colonoscopic India ink tattooing was found to mimic intraperitoneal endometriosis in a 48 year-old woman undergoing laparoscopic sterilization. Multiple black lesions suspicious for endometriosis involving the anterior and posterior cul-de-sac, left ovary, and omentum were found. A pathological assessment showed peritoneal tissue with focal dark pigment associated with mild chronic inflammation and deposition of tattoo pigment; there was no evidence of endometriosis in the specimens. Surgical recognition of tattoo ink spillage in the peritoneum is very important to prevent misinterpretation of peritoneal findings. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  5. Shared genetics underlying epidemiological association between endometriosis and ovarian cancer

    Lu, Yi; Cuellar-Partida, Gabriel; Painter, Jodie N

    2015-01-01

    Epidemiological studies have demonstrated associations between endometriosis and certain histotypes of ovarian cancer, including clear cell, low-grade serous and endometrioid carcinomas. We aimed to determine whether the observed associations might be due to shared genetic aetiology. To address...... this, we used two endometriosis datasets genotyped on common arrays with full-genome coverage (3194 cases and 7060 controls) and a large ovarian cancer dataset genotyped on the customized Illumina Infinium iSelect (iCOGS) arrays (10 065 cases and 21 663 controls). Previous work has suggested...... that a large number of genetic variants contribute to endometriosis and ovarian cancer (all histotypes combined) susceptibility. Here, using the iCOGS data, we confirmed polygenic architecture for most histotypes of ovarian cancer. This led us to evaluate if the polygenic effects are shared across diseases. We...

  6. Risk factors of epithelial ovarian carcinomas among women with endometriosis

    Thomsen, Line H.; Schnack, Tine H.; Buchardi, Kristina

    2017-01-01

    INTRODUCTION: To evaluate the published literature on epidemiologic risk factors for epithelial ovarian cancer among women with a diagnosis of endometriosis. MATERIAL AND METHODS: A systematic literature search was conducted in PubMed and Scopus. Studies comparing epidemiologic risk factors...... an elevated risk of epithelial ovarian cancer. However, due to the limited number and size of studies in this area we cannot draw definitive conclusions. Further research into a risk factor profile among women with endometriosis is needed before clear recommendations can be made....... of epithelial ovarian cancer among women with endometriosis were included. A quality assessment was conducted using the Newcastle-Ottawa Scale. RESULTS: Eight of 794 articles met the inclusion criteria. A lower risk of epithelial ovarian cancer was observed in women with documented complete surgical excision...

  7. Retreatment Rates Among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy.

    Soliman, Ahmed M; Du, Ella Xiaoyan; Yang, Hongbo; Wu, Eric Q; Haley, Jane C

    2017-06-01

    Hysterectomy and laparoscopy are the two most common surgical options used to treat women with endometriosis, yet the disease may still recur. This study aimed to determine the long-term retreatment rates among endometriosis patients in the United States who received either hysterectomy or laparoscopy. Patients aged 18-49 years with endometriosis who underwent hysterectomy or laparoscopy were identified in the Truven Health MarketScan claims database (2004-2013). The retreatment rate up to 8 years after the initial surgery was estimated using Kaplan-Meier survival analysis. The relative risk of retreatment among patients with hysterectomy versus laparoscopy was assessed using a Cox proportional hazard model. A total of 24,915 patients with endometriosis who underwent hysterectomy and 37,308 patients with endometriosis who underwent laparoscopy were identified. The estimated retreatment rates were 3.3%, 4.7%, and 5.4% in the 2nd, 5th, and 8th year following hysterectomy, respectively, while the rates following laparoscopy were 15.8%, 27.5%, and 35.2%, respectively. The hazard ratio of retreatment was 0.157 (95% confidence interval [CI]: 0.146-0.169) comparing hysterectomy to laparoscopy. In the sensitivity analysis, which expanded the definition of retreatment by including medical treatments, the retreatment rate increased by a factor of 11-14 for the hysterectomy cohort and by a factor of 2-4 for the laparoscopy cohort, and the hazard ratio of retreatment rate for hysterectomy versus laparoscopy was 0.490 (95% CI: 0.477-0.502). Our study results indicated that the disease retreatment rate after laparoscopy is high among patients with endometriosis; even hysterectomy does not guarantee freedom from retreatment.

  8. Progesterone resistance in endometriosis: origins, consequences and interventions.

    Patel, Bansari G; Rudnicki, Martin; Yu, Jie; Shu, Yimin; Taylor, Robert N

    2017-06-01

    Endometriosis is a common cause of pelvic pain and affects up to 10% of women of reproductive age. Aberrant progesterone signaling in the endometrium plays a significant role in impaired decidualization and establishment of ectopic endometrial implants. Eutopic endometrial cells from women with endometriosis fail to downregulate genes needed for decidualization, such as those involved in cell cycle regulation, leading to unbridled proliferation. Several causes of progesterone resistance in the endometrium have been postulated, including congenital "preconditioning", whereby the in utero environment renders infants susceptible to neonatal uterine bleeding and endometriosis. Progesterone action is crucial to decreasing inflammation in the endometrium, and deviant progesterone signaling results in a proinflammatory phenotype. Conversely, chronic inflammation can induce a progesterone-resistant state. Repetitive retrograde endometrial shedding begets chronic peritoneal inflammation, which further exacerbates progesterone resistance. Genetic causes of progesterone resistance include progesterone receptor gene polymorphisms, altered microRNA expression, and epigenetic modifications to progesterone receptors and their targets. Environmental toxins such as dioxin play a possible role in the genesis of endometriosis by permitting an inflammatory milieu. A consequence of impaired progesterone action is that hormonal therapy is rendered ineffective for a subset of women with endometriosis. Synthetic progestins, such as dienogest, may overcome this phenomenon by increasing progesterone receptor expression and decreasing proinflammatory cytokines. Other modalities include high dose depot formulations of progestins, medicated intrauterine devices and the likely advent of oral GnRH antagonists. Unearthing root causes of progesterone inaction in endometriosis will aid in the development of novel therapeutics geared toward prevention and treatment. © 2017 Nordic Federation of

  9. Endometriosis on the uterosacral ligament: a marker of ureteral involvement.

    Lima, Raquel; Abdalla-Ribeiro, Helizabet; Nicola, Ana Luisa; Eras, Aline; Lobao, Anna; Ribeiro, Paulo Ayroza

    2017-06-01

    To evaluate the association between ultrasound measurements of endometriosis nodules on the uterosacral ligament (USL) and the risk of ureteral involvement, as well as to assess whether associations with other ultrasound variables increase the sensitivity and specificity of the diagnosis of ureteral endometriosis. Cross-sectional, observational study. University hospital. Four hundred sixty-three women with deep infiltrating endometriosis (DIE). Patients diagnosed with DIE underwent transvaginal ultrasound endometriosis mapping before laparoscopic surgery for full excision of endometriotic lesions. Preoperative ultrasound evaluation, intra- and postoperative assessment, and anatomopathologic confirmation. Of the 463 patients who participated in the study, 111 (23.97%) presented with endometriosis nodules with USL involvement on ultrasound examination conducted by a single radiologist. Receiver operating characteristic curve analysis showed that the size of the USL nodule had a statistically significant association with ipsilateral ureteral involvement. After multivariate logistic regression, the variables reduction in ovarian mobility, ureteral changes on the right side, size of the USL nodule, and presence of endometrioma on the left side were significantly associated with a ureteral endometriosis nodule. However, the combined result for the variables cited was worse than the diagnostic analysis using only the size of the USL nodule. Uterosacral ligament nodules with ultrasound measurements of 1.75 cm and 1.95 cm on the right and left sides, respectively, significantly increase the risk of ureteral involvement. Even with the association of other ultrasound variables, there was no improvement in sensitivity. Therefore, USL nodule size is a key measure for therapeutic planning and consent of the patient. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  10. Expression of eicosanoid biosynthetic and catabolic enzymes in peritoneal endometriosis.

    Lousse, J-C; Defrère, S; Colette, S; Van Langendonckt, A; Donnez, J

    2010-03-01

    Increased peritoneal eicosanoid concentrations have been reported in endometriosis patients and might be important in disease-associated pain and inflammation. Here, we evaluated the expression of key biosynthetic and catabolic enzymes involved in this abnormal eicosanoid production in peritoneal macrophages and endometriotic lesions. Peritoneal macrophages, endometriotic lesions and matched eutopic endometrium were collected from endometriosis patients (n = 40). Peritoneal macrophages and eutopic endometrium samples were also collected from disease-free women (n = 25). Expression of type IIA secretory phospholipase A(2) (sPLA(2)-IIA), cyclooxygenase-2 (COX-2), microsomal prostaglandin E synthase-1 (mPGES-1), 15-hydroxyprostaglandin dehydrogenase (15-PGDH) and 5-lipoxygenase (5-LO) was quantified by real-time PCR, and these five key enzymes were localized by immunohistochemistry. sPLA(2)-IIA, COX-2 and mPGES-1 mRNA was significantly increased in peritoneal macrophages of endometriosis patients compared with controls (P = 0.006, P = 0.016 and P = 0.025, respectively). In endometriosis patients, sPLA(2)-IIA, mPGES-1 and 15-PGDH mRNA was significantly enhanced in peritoneal lesions compared with matched eutopic endometrium (P endometriosis group compared with controls (P = 0.023). Finally, sPLA(2)-IIA, COX-2, mPGES-1 and 15-PGDH immunostaining was found mainly in endometrial glands, whereas 5-LO was distributed throughout the glands and stroma. Our study highlights an imbalance between eicosanoid biosynthesis and degradation in endometriosis patients. Both peritoneal macrophages and endometriotic lesions may be involved. Research into new molecules inhibiting biosynthetic enzymes (such as sPLA(2)-IIA and mPGES-1) and/or activating catabolic enzymes (such as 15-PGDH) may prove to be a major field of investigation in the development of targeted medical therapies.

  11. A life shaped by pain: women and endometriosis.

    Huntington, Annette; Gilmour, Jean A

    2005-10-01

    The research aim was to explore women's perceptions of living with endometriosis, its effects on their lives and the strategies used to manage their disease. Symptomatic endometriosis significantly affects women's quality of life. Characteristically the condition causes severe pain and has a negative impact on the ability to work, on family relationships and self-esteem. There has been little discussion about women's experience of endometriosis in nursing literature. A qualitative research design informed by feminist research principles was chosen for this project. Eighteen women agreed to take part in the research. The individual, audio taped interviews were semi-structured and interactive. The interviews were analysed using a thematic analysis approach. The dominant feature of data from the interviews was the experience of severe and chronic pain impacting on all aspects of life. Analysis related to pain resulted in four themes: manifestations of pain, the pain trajectory, intractable pain and controlling pain. The diagnostic process typically took 5-10 years indicating that primary health care practitioners need higher levels of 'suspicion' for this condition. Case studies and problem-based scenarios focusing on endometriosis in health professional education programmes would enhance diagnostic skills and knowledge development. No formal pain management follow up after diagnosis and treatment meant women actively sought information from other sources as they made major lifestyle changes in the areas of activity and nutrition. Pain management services specifically for women with endometriosis would provide much needed support with this neglected aspect of the disease. This is a fertile area for the development of the Nurse Practitioner role which, also drawing on the considerable collective expertise of women with endometriosis, could provide significant information and support for women as they manage this highly complex condition.

  12. Assessment of pelvic floor muscles in women with deep endometriosis.

    Dos Bispo, Ana Paula Santos; Ploger, Christine; Loureiro, Alessandra Fernandes; Sato, Hélio; Kolpeman, Alexander; Girão, Manoel João Batista Castello; Schor, Eduardo

    2016-09-01

    To assess function and prevalence of spasms and trigger points of the pelvic floor muscles in women with deep endometriosis. One hundred and four (104) patients were assessed. Group 1 (G1) was composed of 52 subjects diagnosed with deep endometriosis proven by magnetic resonance imaging (MRI); Group 2 (G2) was composed of 52 women with no signs of endometriosis. Subjects from both G1 and G2 were seen at the Division of Pelvic Pain and Endometriosis and at Center for Prevention of Sexually Transmitted Diseases, both at Federal University of São Paulo (UNIFESP), respectively. A full physical therapy evaluation was carried out, including medical history, presence of dyspareunia and physical examination, which included detailed evaluation of pelvic floor muscles and occurrence of muscle spasm, trigger point and muscle function. The average age of the subjects in the study group was 36.4 and 30.9 years in the control group (p = 0.002). A greater prevalence of deep dyspareunia was found in the subjects in the endometriosis group when compared to the control group (p = 0.010). Women in G1 had higher prevalence of muscle spasms. In this group, 53.9 % had spasms-compared to only 17.3 % of women in G2 (p < 0.001). On the other hand, no significant difference between the groups (p = 0.153) was found while searching for the presence of trigger points. Women with deep endometriosis have increased prevalence of pelvic floor muscle spasms when compared to the control group.

  13. Endometriosis and Type I Interferon & Characterization of a Mammalian Flippase

    Vestergaard, Anna Lindeløv

    2010-01-01

    endometriosis lesion. Human papillomavirus (HPV) is the causative agent of cervix cancer, and DNA viruses might play a role in endometriosis. DNA purified from tissue samples were subjected to highly sensitive PCR tests detecting HPV types, the herpes family viruses HSV-1 and -2, CMV, and EBV......, and ERa, when analyzed by bisulfate PCR and melting curve analysis. Also, no mutations of BRAF, HRAS, NRAS, CTNNB1, CDK4, FGFR3, PIK3CA, P53, and PTEN were detected by PCR denaturing gradient gel electrophoresis analysis. A well-known cancer-associated mutation in KRAS was detected in a single...

  14. Estrogen signaling in the proliferative endometrium: implications in endometriosis

    Rita de Cássia Pereira da Costa e Silva

    2016-02-01

    Full Text Available SUMMARY Even though the physiological role of estrogen in the female reproductive cycle and endometrial proliferative phase is well established, the signaling pathways by which estrogen exerts its action in the endometrial tissue are still little known. In this regard, advancements in cell culture techniques and maintenance of endometrial cells in cultures enabled the discovery of new signaling mechanisms activated by estrogen in the normal endometrium and in endometriosis. This review aims to present the recent findings in the genomic and non-genomic estrogen signaling pathways in the proliferative human endometrium specifically associated with the pathogenesis and development of endometriosis.

  15. Potential role of aromatase inhibitors in the treatment of endometriosis

    Abu Hashim H

    2014-07-01

    Full Text Available Hatem Abu HashimDepartment of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, EgyptAbstract: Endometriosis is an estrogen-dependent chronic inflammatory disease affecting 5%–10% of reproductive-age women, with a prevalence of 5%–50% in infertile women and >33% of women with chronic pelvic pain. Third-generation aromatase inhibitors (AIs are approved adjuvants for the treatment of estrogen receptor-positive breast cancer. Molecular studies have revealed the presence of aromatase P450, the key enzyme in the biosynthesis of ovarian estradiol, inside the endometriotic tissue, indicating local synthesis of estradiol. Thereby, AIs represent an appealing medical option for the management of different aspects of this enigmatic disease, especially pelvic pain and infertility. Accordingly, this review aims to evaluate the potential role of AIs in the treatment of endometriosis-associated symptoms, mainly pain and infertility. Notably, several studies have demonstrated that the combination of AIs with conventional therapy as oral contraceptive pills, progestins, or gonadotropin-releasing hormone analogs can be used to control endometriosis-associated pain and pain recurrence in premenopausal women, particularly those with pain due to rectovaginal endometriosis refractory to other medical or surgical treatment. Some case reports have shown promising results in the treatment of postmenopausal endometriosis as first-line treatment, when surgery is contraindicated, or as second-line treatment in the case of postoperative recurrence. Third-generation AIs, especially letrozole, have challenged clomiphene citrate as an ovulation-induction agent in patients with polycystic ovary syndrome and in cases of unexplained infertility. However, few studies are available regarding the use of AIs to treat endometriosis-associated infertility. Therefore, larger multicenter randomized trials using AIs for the treatment of endometriosis

  16. High-field-strength MR imaging of endometriosis

    Zawin, M.; McCarthy, S.M.; Comite, F.

    1987-01-01

    Twelve women with proven endometriosis were evaluated with MR imaging, utilizing a 1.5-T system. Axial and sagittal T1, proton density, and T2-weighted images were acquired. Laparoscopies were performed within a 1-month interval of the study in all cases. MR imaging accurately identified seven endometriomas but missed lesions in two cases. Areas with endometriotic implants were accurately localized five cases. The authors conclude that MR imaging is extremely useful in identifying sites of endometriosis and, therefore, promises to obviate repeated laparoscopies to monitor patients' response to therapy

  17. Perineal colostomy: An option in the treatment of inferior rectal and anal canal cancer

    Luciano P. Nogueira da Gama

    2014-01-01

    Full Text Available Introduction: The surgical treatment of anorectal cancer is considered a challenging topic. Colostomy, temporary or permanent, can be a serious limiting factor with respect to the quality of life of cancer patients. Our goal is to study the clinical and surgical experience in patients with anorectal cancer, in whom we proceeded to abdominoperineal resection with a perineal colostomy at the anterior border of the incision resulting from the ampu- tation of the rectum. Methods: The medical records of patients undergoing abdominoperineal resection with perineal colostomy from January 1st, 1998 to July 1st, 2012 were analyzed retrospectively. Results: Twenty-seven patients were studied; 15 (55.56% were male and 12 (44.44% fe- males, with a mean age of 56.3 years. The average length of hospital stay was 7.4 days. Complications included four (14.8% prolapses of the perineal colostomy, which were surgically treated after the sixth month postoperatively, two (7.4% partial suture dehis- cences of the perineal colostomy, treated with hyperbaric oxygen therapy, two (7.4% ste- noses of the perineal colostomy, treated with dilation, two (7.4% incisional hernias and one (3.7% urinary incontinence. Conclusion: The perineal colostomy is a relatively new proposition, with acceptable mor- bidity rates. We understand that the perineal colostomy dismisses the use of a collection device, leaves no odor and allows the periodic application of enemas for colon cleansing, which prevents stoma incontinence. Another advantage is to enable the patient's return to a good social and work interaction; thus, it will be possible his (her reintroduction into society. Resumo: Introdução: O tratamento cirúrgico do câncer da região retoanal é considerado um tema de- safiador. A colostomia, temporária ou definitiva, pode ser um sério limitador da qualidade de vida de pacientes oncológicos. Nosso objetivo é estudar a experiência clínico-cirúrgica em pacientes portadores

  18. Crioterapia no pos-parto: tempo de aplicacao e mudancas na temperatura perineal

    Adriana Amorim Francisco

    2013-06-01

    Full Text Available Estudo descritivo com dados de dois ensaios clínicos realizados em 2008 e 2009 em uma maternidade de uma instituição filantrópica da cidade de São Paulo. Teve como objetivo descrever a temperatura perineal após a aplicação de bolsa de gelo no pós-parto normal. Três grupos com 38 puérperas cada (n=114 receberam aplicação perineal de bolsa de gelo entre 2 e 48h após o parto. Os achados indicaram que com 10 min de crioterapia as médias da temperatura perineal atingiram de 13,3 a 15,3oC, com pequena redução de temperatura ao final de aplicações de 15 e 20 minutos (2,4 e 2,7o, respectivamente. Após resfriamento por 10 min., as mulheres referiram frio e alívio e, depois de 15 a 20 min., dormência e anestesia local. Conclui-se que 10 minutos de aplicação foram suficientes para reduzir a temperatura perineal aos níveis recomendados para analgesia (10-15oC.

  19. Perineal hernia repair using an autologous tunica vaginalis communis in nine intact male dogs.

    Pratummintra, Kittiya; Chuthatep, Suwicha; Banlunara, Wijit; Kalpravidh, Marissak

    2013-01-01

    Perineal hernia in dogs is very problematic and mostly requires surgical reconstruction of the weak pelvic diaphragm. Tissue or synthetic grafts have been used for the correction after failure of the conventional herniorrhaphy. Aim of this clinical trial was to assess the possible use of the autologous tunica vaginalis communis as a free graft for perineal hernia repair in intact male dogs. Seven unilateral and 2 bilateral perineal hernias in nine intact male dogs free from testicular and scrotal neoplasms were included in this study. The median surgical time for unilateral herniorrhaphy was 75 min. The median follow-up time was 13 months. The success of the autografting, based on no recurrence and comfort of the animals during urination and defecation, was found in ten of 11 hernias; giving a success rate of 90.91%. One hernia (9.09%) recurred 10 days after surgery. Histopathological examination of the apposing area between the graft and the adjacent tissue, taken during the repair of the recurred case at day 20, revealed neovascularization and connective tissue ingrowth. In conclusion, the tunica vaginalis autograft can be used for perineal herniorrhaphy in intact male dogs.

  20. [Assessment of restrictive episiotomy use and impact on perineal tears in the Burgundy's Perinatal Network].

    Ginod, P; Khallouk, B; Benzenine, E; Desplanches, T; Dub, T; Schmutz, E; Douvier, S; Sagot, P

    2016-11-01

    To analyse episiotomy and perineal tears rates in Burgundy after French National College of Obstetricians and Gynecologists (CNGOF) guidelines in 2005. Multicenter retrospective study, between 2003-2005 (period 1) et 2012-2014 (period 2), conducted on singletons vaginal deliveries, in cephalic presentation from 37 weeks. We compared the episiotomy rate (ER), and perineal lesions in normal deliveries (ND) and instrumental deliveries (ID) between the two periods. A total of 74,268 women were included. The overall ER significantly decreased from 35.8 to 16.7% (Pdegree perineal tears (0.73% vs. 0.66%) or fourth degree (0.14% vs 0.14%). First degree perineal tears rose (42.1% vs 17.6%, Pdegree decreased (13.5% vs 20.5%, P<0.001). ER decreased whatever the level of motherhood, healthcare ward, vaginal delivery type, or the instrument used. Our study found a strong impact in Burgundy of the French guidelines for the practice of restrictive episiotomy for both ND and for ID without increasing sphincter tears and in decreasing spontaneous morbidity. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Methods of pushing during vaginal delivery and pelvic floor and perineal outcomes: a review.

    de Tayrac, Renaud; Letouzey, Vincent

    2016-12-01

    Over the past 20 years, several randomized studies have compared Valsalva and spontaneous pushing techniques during vaginal delivery. This review summarizes current medical knowledge concerning their maternal and fetal consequences, focusing on pelvic and perineal outcomes. We selected nine randomized controlled trials comparing Valsalva and spontaneous pushing, and a secondary analysis of a randomized controlled trial comparing different methods of perineal protection. Two trials showed that spontaneous pushing reduces the risk of perineal tears, but no firm conclusions can be drawn given the heterogeneity and inconsistent results of these studies. Conflicting results have been reported regarding the duration of the second stage of labor. Pushing technique does not seem to affect episiotomy, instrumental delivery or cesarean rates. Maternal satisfaction seems to be better after spontaneous pushing. Spontaneous pushing appears to have no adverse effects on neonatal well being, and one study showed a significant improvement in prenatal fetal parameters during the expulsive phase. Valsalva and spontaneous pushing techniques currently appear comparable in terms of duration, pelvic floor, perineal, and neonatal outcomes. In the absence of strong evidence in favor of either technique, the decision should be guided by patient preference and the clinical situation. Additional, well-designed randomized controlled trials are required.

  2. [Methods of pushing at vaginal delivery and pelvi-perineal consequences. Review].

    Ratier, N; Balenbois, E; Letouzey, V; Marès, P; de Tayrac, R

    2015-03-01

    The main objective of that review was to evaluate the pelvi-perineal consequences of the different methods of pushing at vaginal delivery. A review on PubMed, the Cochrane Library and EM-Premium was performed from 1984 to 2014. Among 29 manuscripts analysed, only nine randomised controlled trials (including one meta-analysis of three trials) comparing Valsalva and spontaneous pushing were selected. A 10 th study, secondary analysis of a randomized controlled trial comparing different methods of perineal protection (warm compresses, massage and manual protection), was also selected. Two trials have shown that spontaneous pushing reduces the risk of perineal tears, but studies were heterogeneous and discordant results do not allowed definitive conclusions. Results on the duration of the second stage of labour are conflicting. The method of pushing does not seem to affect the rate of episiotomy, instrumental delivery and cesarean section. Maternal satisfaction seems to be better after spontaneous pushing. It seems that there is no negative effect of spontaneous pushing on neonate well-being, and one study has shown a significant improvement of prenatal fetal parameters during the expulsive phase. According to current knowledge, both techniques of pushing during the expulsive phase at delivery seem comparable in terms of duration, risk of perineal tears and neonatal outcome. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  3. Implementation of care practices to prevent and repair perineal trauma in childbirth.

    Santos, Rafael Cleison Silva Dos; Riesco, Maria Luiza Gonzalez

    2017-04-06

    To implement care practices for perineal trauma prevention and repairing in normal birth. Quasi-experimental study conducted at Hospital da Mulher Mãe-Luzia, in Macapá, AP, Brazil. Seventy-four (74) nurses and obstetricians and 70 post-partum women were interviewed and the records of 555 patients were analyzed. The study was conducted in three stages: pre-audit and baseline audit (phase 1); educational intervention and implementation of best practices (phase 2); post-implementation audit (phase 3). Data was analyzed by comparison of the results of phases 1 and 3. Following the educational intervention, a lower number of health professionals encouraged directed pushing, performed episiotomies and repaired first-degree lacerations; more women reported lithotomy position; more patient records indicated the use of Vicryl™ to suture the perineal mucosa and skin. The educational intervention improved birth care and perineal outcomes. Nevertheless, gaps were identified in the implementation of evidence, as well as inappropriate perineal care management.

  4. Correlation between matrix metalloproteinase-9 and endometriosis.

    Liu, Haiping; Wang, Jianye; Wang, Haiyu; Tang, Ning; Li, Yunfei; Zhang, Yan; Hao, Tianyu

    2015-01-01

    Endometrial implantation is the major cause of endometriosis (EMS). Matrix metalloproteinase (MMPs) can degrade multiple extracellular matrix and has been postulated to be related with EMC occurrence. This study thus investigated serum and ascites levels of MMP-9 in EMS patients, in an attempt to discuss the correlation between MMP-9 and EMS. A total of 100 EMS patients, including eutopic endometrium and ectopic endometrium, were recruited in this study along with hysteromyoma patients as the control group. Peripheral blood and ascites samples were collected and tested for MMP-9 levels using gelatin zymogram and enzyme-linked immunosorbent assay (ELISA). In EMS patients, MMP-9 levels in serum and ascites were 6.24 ± 0.53 mM and 38.57 ± 4.93 mM, respectively. Both of them were significantly higher than those in control group (P<0.05). Eutopic endometrium group had higher MMP-9 levels compared to those in ectopic endometrium ones (P<0.05). With advancement of disease stage, EMS patients had progressively elevated MMP-9 levels (P<0.05). Patients at proliferative stage had higher MMP-9 secretion (P<0.05). In summary, site of endometrium, clinical stage and proliferative cycle were independent risk factors for EMS. The elevation of serum and ascites MMP-9 existed in EMS patients, of which those had ectopic endometrium, advanced stage and at proliferative stage had higher MMP-9 expression.

  5. [Surgical therapy of perineal hernia in dogs by the use of Small Intestinal Submucosa (SIS™): a retrospective study].

    Thiel, C; Fischer, A; Kramer, M; Lautersack, O

    2010-01-01

    Surgical therapy of perineal hernia in dogs by using Small Intestinal Submucosa (SIS™). Retrospective evaluation of pre-, intra-, and postoperative data of 15 dogs for which a total of 21 perineal hernias were surgically treated by implantation of SIS™ between July 2003 to January 2005 at the Hospital for Small Animals, Surgery, Justus Liebig University of Giessen. Eleven of the 15 dogs showed a large sized perineal hernia, whereas in four dogs the defect was of medium size. Preoperatively, 86.7% of the patients showed defecation problems and 40% had perineal swelling. Retroflexion of the bladder was observed in four dogs. Average operation time was 58.1 minutes (50-70 minutes). No intraoperative complications were observed. Postoperative complications were minor (seroma formation in six patients, minor wound dehiscence in three dogs), and only three cases required local therapy. Implant intolerance was not observed. Long-term results were obtained 6-36 months postoperatively (mean 25.2 months) by rectal examination and owner telephone questionnaire. The recurrence rate, based on clinical signs of perineal hernia, was 9.5% (two of 21 perineal hernias). Results were rated excellent to good in 19 of the 21 surgically treated perineal hernias. Implantation of SIS™ in the treatment of perineal hernia in dogs is an easy and safe treatment option. Long-term implant tolerance appears to be excellent. Recurrence rate of clinical signs is low. In cases where the defect can not be closed with endogenous tissue, either due to atrophic tissue or dimensions of perineal hernia do not allow such closure, the use of Small Intestinal Submucosa should be considered. The additional costs for the implant are however a disadvantage of this method.

  6. Urethroplasty, by perineal approach, for bulbar and membranous urethral strictures in children and adolescents.

    Shenfeld, Ofer Z; Gdor, Joshua; Katz, Ran; Gofrit, Ofer N; Pode, Dov; Landau, Ezekiel H

    2008-03-01

    To evaluate the safety and efficacy of urethroplasty for bulbar and membranous urethral strictures using the perineal approach in children and adolescents. Urethroplasty by the perineal approach is considered the best treatment for bulbar and membranous urethral strictures in adults. It is not as clear whether this also holds true in children, because the published data addressing this question are scant. We retrospectively reviewed our urethroplasty database to identify patients who had undergone urethroplasty using the perineal approach surgery at age 1 to 13 years (children) and 14 to 18 years (adolescents). A total of 14 patients who had undergone urethroplasty by the perineal approach were identified, including 5 children (mean age 10.8 years) and 9 adolescents (mean age 16.7 years). Of the 14 patients, 7 had membranous and 7 bulbar urethral strictures. The membranous strictures were all secondary to pelvic fractures. The bulbar strictures were "idiopathic" in 57%, traumatic in 29%, and secondary to hypospadias in 14%. All bulbar strictures had been previously treated for 2.5 years, on average, by repeated dilation or urethrotomy that failed. Anastomotic urethroplasty was used in 79% of the patients and tissue transfer techniques in the remainder. The mean follow-up was 30 months (range 12 to 54). Surgery was primarily successful in 93% of the patients, and subsequently successful in 100%. The mean maximal urinary flow increased from 2.65 mL/s preoperatively to 27.65 mL/s postoperatively. No significant complications occurred, and success was similar in both groups. In pediatric patients, as in adults, bulbar and membranous strictures can be treated successfully with urethroplasty using the perineal approach. These patients should probably not be treated "conservatively" with urethral dilation or endoscopic incision. Longer follow-up is needed to confirm that these good results are maintained as these patients cross into adulthood, especially for those who

  7. Progressive Perineal Urethroplasty for Pelvic Fracture Urethral Distraction Defect in Prepubertal Children: The Outcome.

    Pal, Bipin Chandra; Modi, Pranjal R; Qadri, Syed Javid Farooq; Modi, Jayesh; Kumar, Suresh; Nagarajan, Ramya; Safee, Yusuf

    2017-01-01

    Urethroplasty in pediatric patients is a challenging task. In this study, we have tried to assess the complexity and evaluate the outcome of progressive perineal anastomotic urethroplasty in prepubertal children. Retrospective data of all the prepubertal children who underwent progressive perineal urethroplasty between March 2009 and April 2014 were analyzed. Patients were evaluated with history, examination, essential laboratory investigations, retrograde urethrogram, and voiding cystourethrogram. Before subjecting the patients for definitive surgery, antegrade and retrograde endoscopic assessment was done. The surgery was performed by the transperineal route with the help of ×2.5 magnification. Patients were followed up with uroflowmetry for every 3 months in the 1 st year and for every 6 months in the subsequent years. Mean age of the patients was 7.3 (range 5-11) years. Mean urethral distraction defect was 1.7 (range 1-2.5) cm. All the patients were successfully managed by the perineal approach. Crural separation was performed in all the patients while additional inferior pubectomy was required in six patients. Mean operating time was 298 (range 180-400) min. Mean blood loss was 174 (range 100-500) ml. One patient had the left calf hematoma in the immediate postoperative period. Seven out of nine (77.7%) patients had successful urethroplasty. Two patients had failed urethroplasty who were successfully managed by redo-urethroplasty. Transient incontinence was observed in one patient. Erectile function could not be assessed in these patients. This study shows the feasibility of progressive perineal urethroplasty by the perineal route in prepubertal children. An endoscopic assessment should be performed before the definitive surgery. Use of loupe helps in performing better anastomosis and hence yielding a better result.

  8. Progressive perineal urethroplasty for pelvic fracture urethral distraction defect in prepubertal children: The outcome

    Bipin Chandra Pal

    2017-01-01

    Full Text Available Background: Urethroplasty in pediatric patients is a challenging task. In this study, we have tried to assess the complexity and evaluate the outcome of progressive perineal anastomotic urethroplasty in prepubertal children. Materials and Methods: Retrospective data of all the prepubertal children who underwent progressive perineal urethroplasty between March 2009 and April 2014 were analyzed. Patients were evaluated with history, examination, essential laboratory investigations, retrograde urethrogram, and voiding cystourethrogram. Before subjecting the patients for definitive surgery, antegrade and retrograde endoscopic assessment was done. The surgery was performed by the transperineal route with the help of ×2.5 magnification. Patients were followed up with uroflowmetry for every 3 months in the 1 st year and for every 6 months in the subsequent years. Results: Mean age of the patients was 7.3 (range 5-11 years. Mean urethral distraction defect was 1.7 (range 1-2.5 cm. All the patients were successfully managed by the perineal approach. Crural separation was performed in all the patients while additional inferior pubectomy was required in six patients. Mean operating time was 298 (range 180-400 min. Mean blood loss was 174 (range 100-500 ml. One patient had the left calf hematoma in the immediate postoperative period. Seven out of nine (77.7% patients had successful urethroplasty. Two patients had failed urethroplasty who were successfully managed by redo-urethroplasty. Transient incontinence was observed in one patient. Erectile function could not be assessed in these patients. Conclusion: This study shows the feasibility of progressive perineal urethroplasty by the perineal route in prepubertal children. An endoscopic assessment should be performed before the definitive surgery. Use of loupe helps in performing better anastomosis and hence yielding a better result.

  9. The Peritoneum Is Both a Source and Target of TGF-β in Women with Endometriosis

    Young, Vicky J.; Brown, Jeremy K.; Saunders, Philippa T. K.; Duncan, W. Colin; Horne, Andrew W.

    2014-01-01

    Transforming growth factor-β (TGF-β) is believed to play a major role in the aetiology of peritoneal endometriosis. We aimed to determine if the peritoneum is a source of TGF-β and if peritoneal TGF-β expression, reception or target genes are altered in women with endometriosis. Peritoneal fluid, peritoneal bushings and peritoneal biopsies were collected from women with and without endometriosis. TGF-β1, 2 and 3 protein concentrations were measured in the peritoneal fluid. TGF-β1 was measured in mesothelial cell conditioned media. Control peritoneum and peritoneum prone to endometriosis (within Pouch of Douglas) from women without disease (n = 16) and peritoneum distal and adjacent to endometriosis lesions in women with endometriosis (n = 15) and were analysed for TGF-β expression, reception and signalling by immunohistochemistry, qRT-PCR and a TGF-β signalling PCR array. TGF-β1 was increased in the peritoneal fluid of women with endometriosis compared to those without disease (Pendometriosis, peritoneum from sites adjacent to endometriosis lesions expressed higher levels of TGFB1 mRNA when compared to distal sites (Pendometriosis. In conclusion, the peritoneum, and in particular, the peritoneal mesothelium, is a source of TGF-β1 and this is enhanced around endometriosis lesions. The expression of TGF-β-regulated genes is altered in the peritoneum of women with endometriosis and this may promote an environment favorable to lesion formation. PMID:25207642

  10. Feasibility of 3.0 T pelvic MR imaging in the evaluation of endometriosis

    Manganaro, L.; Fierro, F.; Tomei, A.; Irimia, D.; Lodise, P.; Sergi, M.E.; Vinci, V.; Sollazzo, P.; Porpora, M.G.; Delfini, R.; Vittori, G.; Marini, M.

    2012-01-01

    Introduction: Endometriosis represents an important clinical problem in women of reproductive age with high impact on quality of life, work productivity and health care management. The aim of this study is to define the role of 3 T magnetom system MRI in the evaluation of endometriosis. Materials and methods: Forty-six women, with transvaginal (TV) ultrasound examination positive for endometriosis, with pelvic pain, or infertile underwent an MR 3.0 T examination with the following protocol: T2 weighted FRFSE HR sequences, T2 weighted FRFSE HR CUBE 3D sequences, T1 w FSE sequences, LAVA-flex sequences. Pelvic anatomy, macroscopic endometriosis implants, deep endometriosis implants, fallopian tube involvement, adhesions presence, fluid effusion in Douglas pouch, uterus and kidney pathologies or anomalies associated and sacral nervous routes were considered by two radiologists in consensus. Laparoscopy was considered the gold standard. Results: MRI imaging diagnosed deep endometriosis in 22/46 patients, endometriomas not associated to deep implants in 9/46 patients, 15/46 patients resulted negative for endometriosis, 11 of 22 patients with deep endometriosis reported ovarian endometriosis cyst. We obtained high percentages of sensibility (96.97%), specificity (100.00%), VPP (100.00%), VPN (92.86%). Conclusion: Pelvic MRI performed with 3 T system guarantees high spatial and contrast resolution, providing accurate information about endometriosis implants, with a good pre-surgery mapping of the lesions involving both bowels and bladder surface and recto-uterine ligaments.

  11. A higher prevalence of endometriosis among Asian women does not contribute to poorer IVF outcomes.

    Yamamoto, Ayae; Johnstone, Erica B; Bloom, Michael S; Huddleston, Heather G; Fujimoto, Victor Y

    2017-06-01

    The purpose of the study was to determine whether diagnosis of endometriosis or endometriosis with endometrioma influences in vitro fertilization (IVF) outcomes in an ethnically diverse population. Women undergoing a first IVF cycle (n = 717) between January 1, 2008 and December 31, 2009, at a university-affiliated infertility clinic, were retrospectively assessed for an endometriosis diagnosis. Differences in prevalence of endometriosis by ethnicity were determined, as well as differences in IVF success by ethnicity, with a focus on country of origin for Asian women. A multivariate model was generated to assess the relative contributions of country of origin and endometriosis to chance of clinical pregnancy with IVF. Endometriosis was diagnosed in 9.5% of participants; 3.5% also received a diagnosis of endometrioma. Endometriosis prevalence in Asian women was significantly greater than in Caucasians (15.7 vs. 5.8%, p Women of Filipino (p women, although there was no difference in endometrioma presence by race/ethnicity. Oocyte quantity, embryo quality, and fertilization rates did not relate to endometriosis. Clinical pregnancy rates were significantly lower for Asian women, specifically in Indian (p women, compared to Caucasian women, even after controlling for endometriosis status. The prevalence of endometriosis appears to be higher in Filipino, Indian, Japanese, and Korean women presenting for IVF treatment than for Caucasian women; however, the discrepancy in IVF outcomes was conditionally independent of the presence of endometriosis. Future research should focus on improving pregnancy outcomes for Asian populations whether or not they are affected by endometriosis, specifically in the form of longitudinal studies where exposures can be captured prior to endometriosis diagnoses and infertility treatment.

  12. Ear Acupuncture versus  local anaestethic for pain relief during perineal repair - a randomised controlled trial

    Kindberg, Sara

    2007-01-01

    ACUPUNCTURE OR LOCAL ANAESTETICS FOR PAIN RELIEF DURING PERINEAL REPAIR AFTER VAGINAL DELIVERY: A RANDOMISED CONTROLLED TRIAL.   By:  Sara Kindberg. Midwife and PhD student, Sønderborg Hospital, Denmark. Objective: To evaluate acupuncture as a new method of pain relief for postpartum perineal...... as photos of the acupuncture points. Perspectives:  Basic midwifery services such as providing sufficient pain relief during perineal repair still need improvement. Clinical practice should be improved continuously and thus produce reliable evidence on different pain relief methods. Website:        http...

  13. Chronic intestinal obstruction due to rectosigmoid endometriosis: a ...

    Chronic intestinal obstruction due to rectosigmoid endometriosis: a case report. AO Tade. Abstract. No Abstract. Nigerian Journal of Medicine Vol. 15(2) 2006: 165-166. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/njm.v15i2.37104.

  14. Episiotomy Scar Endometriosis Diagnosed on Cytology - A Case ...

    2017-06-30

    Jun 30, 2017 ... Dnyanada Kokode*, Anne Wilkinson, Sadhana Mahore and Trupti Dongre ... Endometriosis, the presence of functioning endometrial tissue outside the ... examination, a tender, irregular, raised nodule measuring .... hematoma, hypertrophic scar tissue, traumatic neuroma, ... CT and MRI seem to be useful in.

  15. Nerve fibers and menstrual cycle in peritoneal endometriosis.

    Wang, Guoyun; Tokushige, Natsuko; Fraser, Ian S

    2011-06-30

    There was no difference in the density of nerve fibers across the menstrual cycle in peritoneal endometriotic lesions. These findings may explain why patients with peritoneal endometriosis often have painful symptoms throughout the menstrual cycle. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  16. untranslated region *T/C polymorphism in endometriosis

    Administrator

    3Department of Family Medicine, China Medical University Hospital, ... 5Taichung Health Care and Management University, Taichung, Taiwan ... of endometriosis, CYP17 5'-UTR gene polymorphism might not be a useful marker for ... dometriosis are difficulty to approach due to the uncertainty ... Patients and Methods.

  17. Lag time between onset of symptoms and diagnosis of endometriosis

    Tânia Mara Vieira Santos

    2012-03-01

    Full Text Available Objective: To assess lag time between onset of symptoms anddiagnosis of endometriosis in patients followed up at the OutpatientsClinic of Endometriosis and Chronic Pelvic Pain, at the Hospitaldo Servidor Público Estadual de São Paulo “Francisco Moratode Oliveira”, from January 2003 to November 2009. Methods:In a retrospective analytical study, a total of 310 women withendometriosis confirmed by surgery and pathological examinationwere evaluated in the period from January 6, 2003 to November29, 2009. Data were gathered through revision of the follow-up visitforms at the specialized outpatients clinic and medical records. Thesoftware Epi-Info 3.3.2 was used for statistical analysis. Results: The mean lag time between onset of symptoms and confirming diagnosisof endometriosis was 46.16 months (3.84 years, ranging from 6 to324 months. Patients aged under 20 years had a mean time untildiagnosis of 2.8 years (33.6 months, range of 6 to 144 months. Inpatients aged 20-29 years, it was 3.51 years (42.18 months, range6-192 months. In those aged 30-40 years, the mean time was 4.14years (49.69 months, range 6-324 months. And in women age over40 years, it was 3.15 years (37.86 months, range 6-216 months.Conclusion: The lag time between onset of symptoms and diagnosisof endometriosis was shorter, as compared to other national andinternational evaluations.

  18. [Gestrinone in pelvic endometriosis. A one-year evaluation].

    Cervantes Villarreal, E; García Zamarripa, H R; Herrera Prado, E; Barrón Vallejo, J

    1995-08-01

    The therapeutical effectiveness of gestrinone in endometriosis treatment, as well as its long term side effects, were evaluated. Prospective, clinical trial. At "Dr. Alejandro Castanedo Kimball" Hospital (PEMEX). Salamanca, Guanajuato. México. Thirty women with laparoscopically confirmed endometriosis, were studied. Subjects received 2.5 mg. of gestrinone two times per week for 6 months. Laparoscopy was performed before treatment, and clinical response was determined by second laparoscopy after 6 months. The pregnancy rate, frequency of side effects and recurrence of symptoms were determined. Median total endometriosis scores and symptoms decreased significantly after treatment. Four pregnancies were observed after treatment. The principal side effects were: ponderal increase, changes in the voice and hirsutism. However, the side effects disappeared after one year of clinical survey. The results indicate that gestrinone is effective in the treatment of pelvic endometriosis. In despite of a clear benefic effect on stage of the disease and symptoms; the use of gestrinone should weigh the risk-benefit (cost versus metabolic side effects) of treatment.

  19. Social isolation in women with endometriosis and chronic pelvic pain.

    Mellado, Bruna H; Falcone, Ananda C M; Poli-Neto, Omero B; Rosa E Silva, Julio C; Nogueira, Antonio A; Candido-Dos-Reis, Francisco J

    2016-05-01

    To evaluate the perceptions of women with endometriosis and chronic pelvic pain regarding their social ties. A qualitative study was undertaken of women with chronic pelvic pain and endometriosis. Focus groups discussions among four to six participants were performed until saturation at the Clinics Hospital of Ribeirão Preto Medical School, Ribeirão Preto, southwest Brazil, between February 2013 and January 2014. Transcripts were analyzed according to the grounded theory approach and the emerging categories were coded using the WebQDA platform. Six focus group discussions took place, with a total of 29 patients. Social isolation was the main emerging theme. Social isolation was associated with a lack of understanding about endometriosis symptoms and with resignation in face of recurrent pain episodes. Avoiding partner intimacy and isolation from family and friends were components of social isolation. Women with endometriosis develop progressive social isolation after the onset of chronic pelvic pain. This finding is important for the multidisciplinary management of the disease. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  20. Effectiveness of laparoscopic surgeries in treating infertility related to endometriosis

    Aneta Słabuszewska-Jóźwiak

    2015-05-01

    Laparoscopy is a vital therapeutic method. Operative laparoscopy is an efficient method for treating infertility related to endometriosis, and the procedure seems to be the most effective particularly at stage III rAFS. The period for expectant management after a surgical procedure should last 6 months.

  1. Aromatase inhibitors in the treatment of deep endometriosis

    Simone Ferrero

    2009-09-01

    Full Text Available Recent case reports and pilot studies suggested that aromatase inhibitors might be effective in treating pain symptoms related to the presence of endometriosis. We present the case of a 32-year-old woman who suffered dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia caused by rectovaginal endometriosis. Pain symptoms recurred after treatment with the oral contraceptive pill; the patient refused surgery. Therefore a double-drug regimen including letrozole (2.5 mg/day and norethisterone acetate (2.5 mg/day was offered to the patient. The scheduled length of treatment was six months. This double-drug regimen determined a quick and significant improvement in all pain symptoms. During treatment, the patient complained mild arthralgia. After the interruption of treatment, pain symptoms quickly recurred and at 6-month follow-up their intensity was similar to baseline values. Operative laparoscopy was performed, the presence of rectovaginal endometriosis was confirmed and all visible endometriotic lesions were excised. Aromatase inhibitors might be offered when pain symptoms caused by endometriosis persist during the administration of other hormonal therapies and the patient refuses surgery. However, women must be informed that these drugs determine only a temporary relief of pain symptoms and might cause adverse effects (such as arthralgia.

  2. ENVIRONMENTAL PCB AND PESTICIDE EXPOSURE AND RISK OF ENDOMETRIOSIS

    Environmental PCB and Pesticide Exposure and Risk of EndometriosisGermaine M. Buck1, John M. Weiner2, Hebe Greizerstein3, Brian Whitcomb1, Enrique Schisterman1, Paul Kostyniak3, Danelle Lobdell4, Kent Crickard5, and Ralph Sperrazza51Epidemiology Branch, Division o...

  3. Endometriosis increases the risk of obstetrical and neonatal complications

    Berlac, Janne Foss; Hartwell, Dorthe; Skovlund, Charlotte Wessel

    2017-01-01

    Introduction: The objective of this study was to assess obstetrical complications and neonatal outcomes in women with endometriosis as compared with women without endometriosis. Material and methods: National cohort including all delivering women and their newborns in Denmark 1997–2014. Data were...... extracted from the Danish Health Register and the Medical Birth Register. Logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI). Sub-analyses were made for primiparous women with a singleton pregnancy and for women with endometriosis who underwent gynecological surgery...... before pregnancy. Results: In 19 331 deliveries, women with endometriosis had a higher risk of severe preeclampsia (OR 1.7, 95% CI 1.5–2.0), hemorrhage in pregnancy (OR 2.3, 95% CI 2.0–2.5), placental abruption (OR 2.0, 95% CI 1.7–2.3), placenta previa (OR 3.9, 95% CI 3.5–4.3), premature rupture...

  4. The dynamics of nuclear receptors and nuclear receptor coregulators in the pathogenesis of endometriosis

    Han, Sang Jun; O'Malley, Bert W.

    2014-01-01

    BACKGROUND Endometriosis is defined as the colonization and growth of endometrial tissue at anatomic sites outside the uterine cavity. Up to 15% of reproductive-aged women in the USA suffer from painful symptoms of endometriosis, such as infertility, pelvic pain, menstrual cycle abnormalities and increased risk of certain cancers. However, many of the current clinical treatments for endometriosis are not sufficiently effective and yield unacceptable side effects. There is clearly an urgent need to identify new molecular mechanisms that critically underpin the initiation and progression of endometriosis in order to develop more specific and effective therapeutics which lack the side effects of current therapies. The aim of this review is to discuss how nuclear receptors (NRs) and their coregulators promote the progression of endometriosis. Understanding the pathogenic molecular mechanisms for the genesis and maintenance of endometriosis as modulated by NRs and coregulators can reveal new therapeutic targets for alternative endometriosis treatments. METHODS This review was prepared using published gene expression microarray data sets obtained from patients with endometriosis and published literature on NRs and their coregulators that deal with endometriosis progression. Using the above observations, our current understanding of how NRs and NR coregulators are involved in the progression of endometriosis is summarized. RESULTS Aberrant levels of NRs and NR coregulators in ectopic endometriosis lesions are associated with the progression of endometriosis. As an example, endometriotic cell-specific alterations in gene expression are correlated with a differential methylation status of the genome compared with the normal endometrium. These differential epigenetic regulations can generate favorable cell-specific NR and coregulator milieus for endometriosis progression. Genetic alterations, such as single nucleotide polymorphisms and insertion/deletion polymorphisms of NR

  5. Pregnancy outcome in women with endometriosis achieving pregnancy with IVF.

    Benaglia, Laura; Candotti, Giorgio; Papaleo, Enrico; Pagliardini, Luca; Leonardi, Marta; Reschini, Marco; Quaranta, Lavinia; Munaretto, Maria; Viganò, Paola; Candiani, Massimo; Vercellini, Paolo; Somigliana, Edgardo

    2016-12-01

    Are women with endometriosis who conceive with IVF at increased risk of preterm birth? Women with endometriosis who conceive with IVF do not face an increased risk of preterm birth. The eutopic endometrium of women with endometriosis has been repeatedly shown to present molecular and cellular alterations. On this basis, it has been hypothesized that pregnancy outcome may be altered in affected women. However, to date, available evidence from epidemiological studies is scanty and conflicting. Data tended to be partly consistent only for an increased risk of preterm birth and placenta previa. Retrospective matched case-control study of women achieving an IVF singleton pregnancy progressing beyond 12 weeks' gestation. Women achieving IVF singleton pregnancies that progressed beyond 12 weeks' gestation at two infertility units were reviewed. Cases were women with a history of surgery for endometriosis and/or with a sonographic diagnosis of the disease at the time of the IVF cycle. Controls were women without current or past evidence of endometriosis who were matched to cases by age (± 6 months), type of cycle (fresh or frozen cycle) and study period. Male factor and unexplained infertility were the most common diagnoses in the control group. Two hundred and thirty-nine women with endometriosis and 239 controls were selected. The main outcome of the study was the rate of preterm birth (birth IVF pregnancies only, and specific data from properly designed studies are required to support any inference for natural pregnancies. The results of our study suggest that women with endometriosis conceiving with IVF can be reassured regarding the risk of preterm birth. The observed association with placenta previa requires further investigation and may open a new avenue of research. No external funding was used for this study. None of the authors have any conflict of interest to declare. © The Author 2016. Published by Oxford University Press on behalf of the European Society

  6. Endometriosis, especially mild disease: a risk factor for miscarriages.

    Kohl Schwartz, Alexandra Sabrina; Wölfler, Monika Martina; Mitter, Vera; Rauchfuss, Martina; Haeberlin, Felix; Eberhard, Markus; von Orelli, Stephanie; Imthurn, Bruno; Imesch, Patrick; Fink, Daniel; Leeners, Brigitte

    2017-11-01

    To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW). Cross-sectional analysis nested in a retrospective observational study (n = 940). Hospitals and associated private practices. Previously pregnant women (n = 268) within reproductive age in matched pairs. Retrospective analysis of surgical reports and self-administered questionnaires. Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis). The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%-42.0%]) compared with CW (22.0% [16.7%-27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41-2.75). This remained significant in subfertile WwE (50.0% [40.7%-59.4%]) vs. CW (25.8% [8.5%-41.2%]) but not in fertile WwE (24.5% [16.3%-31.6%]) vs. CW (21.5% [15.9%-26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%-51.4%] vs. rASRM III/IV 30.8% [22.6%-38.7%], compared with 22.0% [16.7%-27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%-53.9%]) compared with ovarian endometriosis (28.6% [17.7%-38.7%]) and deep infiltrating endometriosis (33.9% [21.2%-46.0%]) compared with CW (22.0% [16.7%-27.0%]). Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage. NCT02511626. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Does exist a correlation between endometriosis and thrombophilic disorders? A pilot study.

    Paradisi, Roberto; Ferrini, Giulia; Matteucci, Carlotta; Facchini, Chiara; Zannoni, Letizia; Seracchioli, Renato

    2017-06-01

    At present, there is growing evidence of the existence of a genetic predisposition in both thrombophilic disorders and endometriosis. The aim of our study was to evaluate for the first time the prevalence of some thrombophilic disorders in patients with endometriosis. We conducted a retrospective study on 138 patients with endometriosis and 278 healthy control women. All women were subjected to a blood examination testing for thrombophilic screening and the variables examinated were: hyperhomocysteinemia, factor V Leiden and factor II prothrombin G20210A mutations in heterozygosis and homozigosis. A significant reduced prevalence (p endometriosis patients was found, whereas no significant differences (p = NS) for factor II and hyperhomocysteinemia were observed. Our preliminary data do not show any association between thrombophilic condition and endometriosis. Before assuming hormonal therapies, a thrombophilic plasmatic screening seems to be unnecessary in patients affected by endometriosis. Copyright © 2017. Published by Elsevier B.V.

  8. Anti-Müllerian Hormone in Peritoneal Fluid and Plasma From Women With and Without Endometriosis.

    Hipp, Heather; Loucks, Tammy L; Nezhat, Ceana; Sidell, Neil; Session, Donna R

    2015-09-01

    Anti-Müllerian hormone (AMH) has potential local effects on ovarian function and endometrial tissue, including endometriosis, but its presence in peritoneal fluid is not fully understood. This is a cross-sectional study evaluating AMH in peritoneal fluid and plasma from women with endometriosis (N = 61) and from control women without endometriosis (N = 36). There was a significant correlation between AMH in plasma and peritoneal fluid from both patients with endometriosis (r(2) = .767 [P peritoneal fluid in women with and without endometriosis. There were no differences in the plasma or peritoneal fluid AMH in women with endometriosis versus control women. The strong relationship between plasma and peritoneal fluid may allow plasma AMH to be a marker for peritoneal AMH in studies evaluating the local effects of AMH. © The Author(s) 2015.

  9. Endometriosis and atherosclerosis: what we already know and what we have yet to discover.

    Santoro, Luca; D'Onofrio, Ferruccio; Flore, Roberto; Gasbarrini, Antonio; Santoliquido, Angelo

    2015-09-01

    The possible association between endometriosis and atherosclerosis represents an emerging topic in the field of women's health. In this Clinical Opinion paper, we analyze this theme focusing on the pathogenetic mechanisms of both diseases, deeply discussing about what is already known about this association and producing starting points about what we consider suitable to research in the near future with regard to cardiovascular involvement in women affected by endometriosis. We have identified 5 reports specifically carried out to investigate the relationship between atherosclerosis and endometriosis; these studies show the presence of subclinical atherosclerosis in women affected by endometriosis, susceptible of regression after surgical removal of endometriosis, with a possible prognostic relevance for variations of cardiovascular risk in these women. However, to date, no studies in literature have been carried out to investigate the real incidence of cardiovascular events in women with endometriosis. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Increased expression of resistin in ectopic endometrial tissue of women with endometriosis.

    Oh, Yoon Kyung; Ha, Young Ran; Yi, Kyong Wook; Park, Hyun Tae; Shin, Jung-Ho; Kim, Tak; Hur, Jun-Young

    2017-11-01

    Inflammation is a key process in the establishment and progression of endometriosis. Resistin, an adipocytokine, has biological properties linked to immunologic functions, but its role in endometriosis is unclear. Resistin gene expression was examined in eutopic and ectopic endometrial tissues from women with (n=25) or without (n=25) endometriosis. Resistin mRNA and protein levels were determined in endometrial tissue using quantitative real-time reverse transcription PCR and Western blotting, following adipokine profiling arrays. Resistin protein was detected in human endometrial tissues using an adipokine array test. Resistin mRNA and protein levels were significantly higher in ectopic endometrial tissue of patients with endometriosis than in normal eutopic endometrial tissue. Our results indicate that resistin is differentially expressed in endometrial tissues from women with endometriosis and imply a role for resistin in endometriosis-associated pelvic inflammation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. The influence of endometriosis-related symptoms on work life and work ability - a study of Danish endometriosis patients in employment

    Hansen, Karina Ejgaard; Kesmodel, Ulrik Schiøler; Baldursson, Einar B

    2013-01-01

    Abstract Objective Little is known about the implications of endometriosis on women's work life. This study aimed at examining the relation between endometriosis-related symptoms and work ability in employed women with endometriosis. Study design In a cohort study, 610 patients with diagnosed...... ability. The level of statistical significance was set at pwork disturbances due to symptoms, lower work ability and a wide number of other implications on work life in employed women...... endometriosis and 751 reference women completed an electronic survey based on the Endometriosis Health Profile 30-questionnaire and the Work Ability Index (short form). Percentages were reported for all data. Binary and multivariate logistic regression analyses were used to assess risk factors for low work...

  12. Role of Versican in the Pathogenesis of Peritoneal Endometriosis.

    Tani, Hirohiko; Sato, Yukiyasu; Ueda, Masashi; Miyazaki, Yumiko; Suginami, Koh; Horie, Akihito; Konishi, Ikuo; Shinomura, Tamayuki

    2016-11-01

    Sampson's theory cannot explain why only some cycling women develop peritoneal endometriosis. Few studies have focused on the pelvic peritoneum, which receives regurgitated endometrial tissues. We hypothesized that molecular alterations in the peritoneum are involved in the development of peritoneal endometriosis and conducted a microarray analysis to compare macroscopically normal peritoneum sampled from women with peritoneal endometriosis (endometriotic peritoneum) and those without (non-endometriotic peritoneum). Versican, a major proteoglycan component of the extracellular matrix, is one of the molecules up-regulated in endometriotic peritoneum. To investigate the role of versican in peritoneal endometriosis. Design, Patients, and Main Outcome Measure: Endometriotic peritoneum and non-endometriotic peritoneum were subjected to RT-PCR, immunostaining, and Western blotting. The versican V1 isoform was stably transfected into Chinese hamster ovary cells (CHO-V1), and the effects of CHO-V1-derived conditioned medium (V1-CM) on primary human endometrial stromal cells were investigated with attachment, invasion, and proliferation assays. The effects of peritoneal fluid collected from endometriotic women (endometriotic PF) or cytokines/growth factors, which were shown to be elevated in endometriotic PF, on versican expression in a human peritoneal cell line (HMrSV5) were also examined. Versican V1 expression levels were significantly higher in endometriotic peritoneum. In vitro, V1-CM promoted attachment to the HMrSV5 cell monolayer as well as the Matrigel invasion of endometrial stromal cells. Although versican V1 expression was up-regulated by TGF-β1 in HMrSV5 cells, it remained unchanged in endometriotic PF. Our results suggest the involvement of peritoneal versican in the development of peritoneal endometriosis.

  13. Correlation Between Echodefecography and 3-Dimensional Vaginal Ultrasonography in the Detection of Perineal Descent in Women With Constipation Symptoms.

    Murad-Regadas, Sthela M; Pinheiro Regadas, Francisco Sergio; Rodrigues, Lusmar V; da Silva Vilarinho, Adjra; Buchen, Guilherme; Borges, Livia Olinda; Veras, Lara B; da Cruz, Mariana Murad

    2016-12-01

    Defecography is an established method of evaluating dynamic anorectal dysfunction, but conventional defecography does not allow for visualization of anatomic structures. The purpose of this study was to describe the use of dynamic 3-dimensional endovaginal ultrasonography for evaluating perineal descent in comparison with echodefecography (3-dimensional anorectal ultrasonography) and to study the relationship between perineal descent and symptoms and anatomic/functional abnormalities of the pelvic floor. This was a prospective study. The study was conducted at a large university tertiary care hospital. Consecutive female patients were eligible if they had pelvic floor dysfunction, obstructed defecation symptoms, and a score >6 on the Cleveland Clinic Florida Constipation Scale. Each patient underwent both echodefecography and dynamic 3-dimensional endovaginal ultrasonography to evaluate posterior pelvic floor dysfunction. Normal perineal descent was defined on echodefecography as puborectalis muscle displacement ≤2.5 cm; excessive perineal descent was defined as displacement >2.5 cm. Of 61 women, 29 (48%) had normal perineal descent; 32 (52%) had excessive perineal descent. Endovaginal ultrasonography identified 27 of the 29 patients in the normal group as having anorectal junction displacement ≤1 cm (mean = 0.6 cm; range, 0.1-1.0 cm) and a mean anorectal junction position of 0.6 cm (range, 0-2.3 cm) above the symphysis pubis during the Valsalva maneuver and correctly identified 30 of the 32 patients in the excessive perineal descent group. The κ statistic showed almost perfect agreement (κ = 0.86) between the 2 methods for categorization into the normal and excessive perineal descent groups. Perineal descent was not related to fecal or urinary incontinence or anatomic and functional factors (sphincter defects, pubovisceral muscle defects, levator hiatus area, grade II or III rectocele, intussusception, or anismus). The study did not include a

  14. [First line management without IVF of infertility related to endometriosis: Result of medical therapy? Results of ovarian superovulation? Results of intrauterine insemination? CNGOF-HAS Endometriosis Guidelines].

    Boujenah, J; Santulli, P; Mathieu-d'Argent, E; Decanter, C; Chauffour, C; Poncelet, P

    2018-03-01

    Using the structured methodology of French guidelines (HAS-CNGOF), the aim of this chapter was to formulate good practice points (GPP), in relation to optimal non-ART management of endometriosis related to infertility, based on the best available evidence in the literature. This guideline was produced by a group of experts in the field including a thorough systematic search of the literature (from January 1980 to March 2017). Were included only women with endometriosis related to infertility. For each recommendation, a grade (A-D, where A is the highest quality) was assigned based on the strength of the supporting evidence. Management of endometriosis related to infertility should be multidisciplinary and take account into the pain, the global evaluation of infertile couple and the different phenotypes of endometriotic lesions (good practice point). Hormonal treatment for suppression of ovarian function should not prescribe to improve fertility (grade A). After laproscopy for endometriosis related to infertility, the Endometriosis Fertility Index should be used to counsel patients regarding duration of conventional treatments before undergoing ART (grade C). After laparoscopy surgery for infertile women with AFS/ASRM stage I/II endometriosis or superficial peritoneal endometriosis, controlled ovarian stimulation with or without intrauterine insemination could be used to enhance non-ART pregnancy rate (grade C). Gonadotrophins should be the first line therapy for the stimulation (grade B). The number of cycles before referring ART should not exceed up to 6 cycles (good practice point). No recommendation can be performed for non-ART management of deep infiltrating endometriosis or endometrioma, as suitable evidence is lacking. Non-ART management is a possible option for the management of endometriosis related to infertility. Endometriosis Fertilty Index could be a useful tool for subsequent postoperative fertility management. Controlled ovarian stimulation can be

  15. MR findings of extrauterine muellerian adenosarcoma associated with deep pelvic endometriosis

    Oh, Dae Kun; Kim, Chan Kyo; Park, Byung Kwan; Kim, Ji Young

    2008-01-01

    Extrauterine muellerian adenosarcoma is a very rare tumor and it is characterized by a benign glandular component and a low-grade sarcomatous stromal component. These tumors have been reported to arise from ovarian or extraovarian endometriosis. However, there are scant reports on the MR findings of extrauterine muellerian adenosarcoma arising from deep pelvic endometriosis. We describe here a case of a large infiltrating extrauterine muellerian adenosarcoma arising from recurrent deep pelvic endometriosis and we discuss its MR findings

  16. Risk Profiles for Endometriosis in Japanese Women: Results From a Repeated Survey of Self-Reports

    Yasui, Toshiyuki; Hayashi, Kunihiko; Nagai, Kazue; Mizunuma, Hideki; Kubota, Toshiro; Lee, Jung-Su; Suzuki, Shosuke

    2015-01-01

    Background The prevalence and risk factors for endometriosis may differ according to diagnosis methodologies, such as study populations and diagnostic accuracy. We examined risk profiles in imaging-diagnosed endometriosis with and without surgical confirmation in a large population of Japanese women, as well as the differences in risk profiles of endometriosis based on history of infertility. Methods Questionnaires that included items on sites of endometriosis determined by imaging techniques and surgical procedure were mailed to 1025 women who self-reported endometriosis in a baseline survey of the Japan Nurses’ Health Study (n = 15 019). Results Two hundred and ten women had surgically confirmed endometriosis (Group A), 120 had imaging-diagnosed endometriosis without a surgical procedure (Group B), and 264 had adenomyosis (Group C). A short menstrual cycle at 18–22 years of age and cigarette smoking at 30 years of age were associated with significantly increased risk of endometriosis (Group A plus Group B), while older age was associated with risk of adenomyosis (Group C). In women with a history of infertility, a short menstrual cycle was associated with a significantly increased risk of endometriosis in both Group A and Group B, but risk profiles of endometriosis were different between Group A and Group B in women without a history of infertility. Conclusions Women with surgically confirmed endometriosis and those with imaging-diagnosed endometriosis without surgery have basically common risk profiles, but these risk profiles are different from those with adenomyosis. The presence of a history of infertility should be taken into consideration for evaluation of risk profiles. PMID:25716280

  17. The peritoneum is both a source and target of TGF-β in women with endometriosis.

    Vicky J Young

    Full Text Available Transforming growth factor-β (TGF-β is believed to play a major role in the aetiology of peritoneal endometriosis. We aimed to determine if the peritoneum is a source of TGF-β and if peritoneal TGF-β expression, reception or target genes are altered in women with endometriosis. Peritoneal fluid, peritoneal bushings and peritoneal biopsies were collected from women with and without endometriosis. TGF-β1, 2 and 3 protein concentrations were measured in the peritoneal fluid. TGF-β1 was measured in mesothelial cell conditioned media. Control peritoneum and peritoneum prone to endometriosis (within Pouch of Douglas from women without disease (n = 16 and peritoneum distal and adjacent to endometriosis lesions in women with endometriosis (n = 15 and were analysed for TGF-β expression, reception and signalling by immunohistochemistry, qRT-PCR and a TGF-β signalling PCR array. TGF-β1 was increased in the peritoneal fluid of women with endometriosis compared to those without disease (P<0.05 and peritoneal mesothelial cells secrete TGF-β1 in-vitro. In women with endometriosis, peritoneum from sites adjacent to endometriosis lesions expressed higher levels of TGFB1 mRNA when compared to distal sites (P<0.05. The TGF-β-stimulated Smad 2/3 signalling pathway was active in the peritoneum and there were significant increases (P<0.05 in expression of genes associated with tumorigenesis (MAPK8, CDC6, epithelial-mesenchymal transition (NOTCH1, angiogenesis (ID1, ID3 and neurogenesis (CREB1 in the peritoneum of women with endometriosis. In conclusion, the peritoneum, and in particular, the peritoneal mesothelium, is a source of TGF-β1 and this is enhanced around endometriosis lesions. The expression of TGF-β-regulated genes is altered in the peritoneum of women with endometriosis and this may promote an environment favorable to lesion formation.

  18. CONTENTS OF CHEMOKINES AND CYTOKINES IN PERITONEAL FLUID FROM THE PATIENTS WITH ENDOMETRIOSIS OF VARIOUS SEVERITY

    D. I. Sokolov

    2007-01-01

    Full Text Available Abstract. Endometriosis is a disease accompanied by development of heterotopic endometrial foci at the peritoneum, proliferation of endothelial cells, and inflammatory reaction. Aiming to specify the dynamics of inflammatory process in endometriosis of different severity, as well as significance of chemokines and cytokines in angiogenesis and inflammation, we determined concentrations of RANTES, IL-8, IP-10, MIG, MCP-1 chemokines, as well as IL-4, IL-6 and IL-10 cytokines in peritoneal fluid from patients by endometriosis. Forty women at reproductive age with an endometriosis have been observed. Among them, endometriosis grade I-II was registered in 20 cases, whereas grade III-IV has been confirmed in 20 women. Twenty-two women without evidence of endometriosis referred to diagnostic laparoscopy for pregnancy planning, comprised a control group. Diagnosis of endometriosis was based upon endoscopic findings and results of histological research. Severity grade of endometriosis was estimated according to R-AFS classification. Sampling of peritoneal fluid was carried out when performing surgical laparoscopies. Concentrations of chemokines and cytokines were determined by flow cytometry techniques, using BD Cytometric Bead Array test kits and FACStrack flow cytometer. The amounts of RANTES in peritoneal fluid were higher in grade I-II endometriosis, in comparison with grade III-IV endometriosis and control samples. Concentrations of IP-10, IL-8, МСР-1, MIG, IL-6, and IL-4 were higher than in control group and correlated with severity of the disease. IL-10 was not detectable in peritoneal fluid of the patients with endometriosis. These results suggest a significant role of the mentioned cytokines and chemokines that may promote invasion of endometrial cells, growth of heterotopic endometrioid locuses, development of vascular bed and induction of inflammatory processes, in development and progression of endometriosis.

  19. Clinical outcomes of patients with clear cell and endometrioid ovarian cancer arising from endometriosis.

    Paik, E Sun; Kim, Tae Joong; Choi, Chel Hun; Kim, Byoung Gie; Bae, Duk Soo; Lee, Jeong Won

    2018-03-01

    The aim of this investigation is to compare outcomes of patients according to the presence of cancer arising from endometriosis in ovarian clear cell carcinoma (CCC) and endometrioid carcinoma (EC). This study retrospectively investigated 224 CCC and EC patients treated in Samsung Medical Center from 2001 to 2015 to identify cancer arising from endometriosis according to Sampson and Scott criteria. Propensity score matching was performed to compare patients arising from endometriosis to patients without endometriosis (ratio 1:1) according to stage, age, lymph node metastasis (LNM), cancer antigen (CA)-125 level, and residual status after debulking surgery. Forty-five cases arising from endometriosis were compared with 179 cases without endometriosis. CCC and EC arising from endometriosis tended to present with early age (mean, 45.2 vs. 49.2 years; p=0.003), early-stage (stages I and II, 92.7% vs. 62.3%; p<0.001), lower CA-125 level (mean, 307.1 vs. 556.7; p=0.041), higher percentages of no gross residual disease after surgery (87.8% vs.56.8%; p=0.001), and higher percentages of negative LNM (82.9% vs. 59.0%; p=0.008) compared to cases without endometriosis. Kaplan-Meier curves for progression-free survival (PFS) and overall survival (OS) showed better outcomes for groups with cancer arising from endometriosis (p=0.014 for PFS; and p=0.010 for OS). However, the association with endometriosis was not significant in multivariate analysis. Also, after propensity score matching, survival differences between the 2 groups were not significant. CCC and EC arising from endometriosis are diagnosed at an earlier age and stage. However, cancer arising from endometriosis was not a significant prognostic factor. Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

  20. Prediction of endometriosis by transvaginal ultrasound in reproductive-age women with normal ovarian size

    Tamer H. Said; Amal Z. Azzam

    2014-01-01

    Objective: To predict endometriosis by transvaginal ultrasound (TVS) in reproductive-age women with normal ovarian size. Design: Prospective study. Setting: El-Shatby Maternity Hospital, Alexandria University. Patients: 125 Women with symptoms suggestive of endometriosis and with normal ovarian size during TVS. Interventions: Patients were subjected to high frequency ultrasound and evaluated for the presence of ultrasound signs of endometriosis (TVS-based soft markers). All patien...

  1. Ultrasound and MR-imaging in preoperative evaluation of two rare cases of scar endometriosis

    Pados, George; Tympanidis, John; Zafrakas, Menelaos; Athanatos, Dimitrios; Bontis, John N

    2008-01-01

    Scar or incisional endometriosis is a rare, often misdiagnosed, pathologic condition of the abdominal wall. Two cases of incisional endometriosis are presented. Both patients presented with atypical cyclic pain and palpable nodules on scars of previous cesarean sections. In both cases, the mass was totally excised, after accurate preoperative evaluation with 2-D ultrasound, power Doppler and MRI. Microscopic examination confirmed the preoperatively presumed diagnosis of cutaneous endometriosi...

  2. Obstetrical Complications in Women with Endometriosis: A Cohort Study in Japan.

    Takashi Harada

    Full Text Available Endometriosis, which occurs in approximately 10% of women of reproductive age, is defined as the presence of endometrial tissue outside the uterus. Women with endometriosis are more likely to have difficulty conceiving and tend to receive infertility treatment, including assisted reproductive technology (ART therapy. There has not yet been a prospective cohort study examining the effects of endometriosis on pregnancy outcome in pregnant Japanese women.This was a prospective cohort study of the incidence of obstetrical complications in women with endometriosis using data of the Japan Environment & Children's Study (JECS. Included in this study were 9,186 pregnant women in the JECS with or without a history of endometriosis who gave birth or stillbirth or whose pregnancy was terminated with abortion between February and December 2011.The effects of endometriosis on pregnancy outcome.Of the 9,186 pregnant women in the JECS, 4,119 (44.8% had obstetrical complications; 330 participants reported a diagnosis of endometriosis before pregnancy, and these women were at higher risk for complications of pregnancy than those without a history of endometriosis (odds ratio (OR = 1.50; 95% confidence interval (CI 1.20 to 1.87. Logistic regression analyses showed that the adjusted OR for obstetrical complications of pregnant women who conceived naturally and had a history of endometriosis was 1.45 (CI 1.11 to 1.90. Among pregnant women with endometriosis, the ORs of preterm premature rupture of the membranes (PROM and placenta previa were significantly higher compared with women never diagnosed with endometriosis who conceived naturally or conceived after infertility treatment, except for ART therapy (OR 2.14, CI 1.03-4.45 and OR 3.37, CI 1.32-8.65.This study showed that endometriosis significantly increased the incidence of preterm PROM and placenta previa after adjusting for confounding of the data by ART therapy.

  3. US or MR Imaging Features of Polypoid Endometriosis: A Case Report

    Park, Jae Il; Cho, Jae Ho; Kim, Geum Rae; Kim, Mi Jin

    2009-01-01

    Polypoid endometriosis is a rare variant of endometriosis that is pathologically similar to an endometrial polyp. This lesion is frequently mistaken for a solid neoplasm in clinical, radiological and pathological examinations. The clinical and pathological features of the lesion have been well described in the English literature. However, its imaging features have not been reported in the Korean literature. We describe ultrasound and magnetic resonance imaging features of pathologically-confirmed polypoid endometriosis

  4. MR findings of extrauterine muellerian adenosarcoma associated with deep pelvic endometriosis

    Oh, Dae Kun; Kim, Chan Kyo; Park, Byung Kwan; Kim, Ji Young [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2008-02-15

    Extrauterine muellerian adenosarcoma is a very rare tumor and it is characterized by a benign glandular component and a low-grade sarcomatous stromal component. These tumors have been reported to arise from ovarian or extraovarian endometriosis. However, there are scant reports on the MR findings of extrauterine muellerian adenosarcoma arising from deep pelvic endometriosis. We describe here a case of a large infiltrating extrauterine muellerian adenosarcoma arising from recurrent deep pelvic endometriosis and we discuss its MR findings.

  5. US or MR Imaging Features of Polypoid Endometriosis: A Case Report

    Park, Jae Il; Cho, Jae Ho; Kim, Geum Rae; Kim, Mi Jin [Yeungnam University, Gyeongsan (Korea, Republic of)

    2009-12-15

    Polypoid endometriosis is a rare variant of endometriosis that is pathologically similar to an endometrial polyp. This lesion is frequently mistaken for a solid neoplasm in clinical, radiological and pathological examinations. The clinical and pathological features of the lesion have been well described in the English literature. However, its imaging features have not been reported in the Korean literature. We describe ultrasound and magnetic resonance imaging features of pathologically-confirmed polypoid endometriosis.

  6. Scar Endometriosis: A Case Report of This Uncommon Entity and Review of the Literature

    Cihangir Uzunçakmak

    2013-01-01

    Full Text Available Scar endometriosis is an infrequent type of extrapelvic endometriosis that is rather close together with obstetrical and gynecological surgeries. It is mostly confused with other dermatological or surgical conditions and delays the diagnosis. We report a case of a 50-year-old woman presenting with scar endometriosis 23 years after her last lower segment caesarean section. The epidemiology, diagnosis, pathogenesis, and treatment of the situation are discussed.

  7. Sequential imaging of intraneural sciatic nerve endometriosis provides insight into symptoms of cyclical sciatica.

    Capek, Stepan; Amrami, Kimberly K; Howe, Benjamin M; Collins, Mark S; Sandroni, Paola; Cheville, John C; Spinner, Robert J

    2016-03-01

    Endometriosis of the nerve often remains an elusive diagnosis. We report the first case of intraneural lumbosacral plexus endometriosis with sequential imaging at different phases of the menstrual cycle: during the luteal phase and menstruation. Compared to the first examination, the examination performed during the patient's period revealed the lumbosacral plexus larger and hyperintense on T2-weighted imaging. The intraneural endometriosis cyst was also larger and showed recent hemorrhage. Additionally, this case represents another example of perineural spread of endometriosis from the uterus to the lumbosacral plexus along the autonomic nerves and then distally to the sciatic nerve and proximally to the spinal nerves.

  8. Prevalence of fibromyalgia and quality of life in women with and without endometriosis.

    Nunes, Fabiana R; Ferreira, Jessica M; Bahamondes, Luis

    2014-04-01

    The objectives of the study were to assessed if there is any difference in the prevalence of fibromyalgia and in quality of life (QoL) between women with and without endometriosis. A cross-sectional study was conducted in 2011-2013, involving 257 women with surgically and histopathologically confirmed endometriosis and 253 women with no history of endometriosis and no endometriosis-related symptoms. Women were recruited both at the family planning and endometriosis clinic, Department of Obstetrics and Gynecology, University of Campinas, Brazil. The Short Form 36 questionnaire (SF-36) was used to assess QoL, while the 1990 and 2010 American College of Rheumatology (ACR) criteria were used to evaluate fibromyalgia. According to the 1990 ACR criteria, there were no cases of fibromyalgia in either group. Nevertheless, according to the 2010 ACR criteria, four women, two with endometriosis and two without the disease, were diagnosed with fibromyalgia. Scores were significantly lower in all the domains of the QoL questionnaire for the women with endometriosis compared to those without the disease. This study reports no difference in the prevalence of fibromyalgia between women with and without endometriosis; however QoL was poorer among women with endometriosis when compared to women without the disease.

  9. Factors Associated with Severity of Irritable Bowel Syndrome Symptoms in Patients with Endometriosis.

    Lee, Caroline E; Yong, Paul J; Williams, Christina; Allaire, Catherine

    2018-02-01

    This study sought to examine factors associated with severity of irritable bowel syndrome (IBS) by using the Birmingham IBS symptom scale in patients presenting with endometriosis to a tertiary referral centre. A prospective research cohort of patients presenting to a tertiary referral centre for endometriosis was evaluated for the presence and severity of IBS between December 2013 and April 2015. Patients with endometriosis had a diagnosis of IBS by using the Rome III criteria and were evaluated for severity of IBS symptoms by using the Birmingham IBS symptom scale. Multifactorial variables, including stage of endometriosis at the time of previous surgery, clinical examination findings, mood disorder questionnaire scores, and lifestyle factors, were evaluated using the t test and Spearman rank correlation test. A total of 194 of 373 (52%) women with confirmed endometriosis had a diagnosis of IBS. Factors associated with severity of IBS symptoms in patients with endometriosis included lower-stage endometriosis (P = 0.004), presence of mood disorders (P IBS symptom scale revealed a strong association between the previously identified factors and the pain subscale. Using the Birmingham IBS symptom scale, our study revealed more severe IBS symptoms in patients with lower-stage endometriosis and identified other variables highly associated with severity of IBS. Continued research is required to characterize further the clinical importance of IBS symptoms in patients with endometriosis-associated pelvic pain. Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  10. Umbilical Nodule with Cyclical Bleeding: A Case Report and Literature Review of Atypical Endometriosis

    Marlene Teixeira Andrade

    2016-01-01

    Full Text Available Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. It affects 3 to 10 percent of women of reproductive age. Umbilical endometriosis is rare, with an estimated incidence of 0.5–1.0% among all cases of endometriosis, and is usually secondary to prior laparoscopic surgery involving the umbilicus. In this report, we described a case of umbilical endometriosis treated with surgical resection and highlight the great importance of medical history compared to complementary diagnostic tests that can be sometimes inconclusive.

  11. Effect of induced peritoneal endometriosis on oocyte and embryo quality in a mouse model.

    Cohen, J; Ziyyat, A; Naoura, I; Chabbert-Buffet, N; Aractingi, S; Darai, E; Lefevre, B

    2015-02-01

    To assess the impact of peritoneal endometriosis on oocyte and embryo quality in a mouse model. Peritoneal endometriosis was surgically induced in 33 B6CBA/F1 female mice (endometriosis group, N = 17) and sham-operated were used as control (sham group, N = 16). Mice were superovulated 4 weeks after surgery and mated or not, to collect E0.5-embryos or MII-oocytes. Evaluation of oocyte and zygote quality was done by immunofluorescence under spinning disk confocal microscopy. Endometriosis-like lesions were observed in all mice of endometriosis group. In both groups, a similar mean number of MII oocytes per mouse was observed in non-mated mice (30.2 vs 32.6), with a lower proportion of normal oocytes in the endometriosis group (61 vs 83 %, p endometriosis group (21 vs 35.5, p = 0.02) without difference in embryo quality. Our results support that induced peritoneal endometriosis in a mouse model is associated with a decrease in oocyte quality and embryo number. This experimental model allows further studies to understand mechanisms of endometriosis-associated infertility.

  12. Low prevalence of DNA virus in the human endometrium og endometriosis

    Vestergaard, Anna Lindeløv; Knudsen, Ulla Breth; Munk, Torben

    2010-01-01

    The chronic female disease endometriosis causes debilitating pain and lowered fertility. The aetiology is unknown, but indications of an infectious agent are present. This study investigates the possible involvement of a pathogenic virus in endometriosis patients and controls. DNA was purified from......–10%). The virus prevalence was found to vary slightly when comparing the endometrium of healthy women and women with endometriosis. However, these were not significant differences, and no viruses were identified in endometriotic lesions. These results do not point towards any evidence that endometriosis is caused...

  13. [Minimal and mild endometriosis: Impact of the laparoscopic surgery on pelvic pain and fertility. CNGOF-HAS Endometriosis Guidelines].

    Ploteau, S; Merlot, B; Roman, H; Canis, M; Collinet, P; Fritel, X

    2018-03-01

    Minimal and mild endometriosis (stage 1 and 2 AFSR) can lead to chronic pelvic pain and infertility but can also exist in asymptomatic patients. The prevalence of asymptomatic patients with minimal and mild endometriosis is not clear but typical endometriosis lesions are found in about 5 to 10% of asymptomatic women and more than 50% of painful and/or infertile women. Laparoscopic treatment of minimal and mild endometriotic lesions is justified in case of pelvic pain because their destruction decrease significatively the pain compared with diagnostic laparoscopy alone. In this context, ablation and excision give identical results in terms of pain reduction. Moreover, literature shows no interest in uterine nerve ablation in case of dysmenorrhea due to minimal and mild endometriosis. Then, it is recommended to treat these lesions during a laparoscopy realised as part of pelvic pain. On the other hand, it is not recommended to treat asymptomatic patients. With regard to treatment of minimal and mild endometriosis in infertile patients, only two studies can be selected and both show that laparoscopy with excision or ablation and ablation of adhesions is superior to diagnostic laparoscopy alone in terms of pregnancy rate. However, it is not recommended to treat these lesions when they are asymptomatic because there is no evidence that they can progress with symptomatic disease. There is no study assessing the interest to treat these lesions when they are found fortuitously. Adhesion barrier utilisation permits to reduce post-operative adhesions, however literature failed to demonstrate the clinical profit in terms of reduction of the risk of pain or infertility. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  14. Kelp and dolphin gulls cause perineal wounds in South American fur seal pups (Arctocephalus australis) at Guafo Island, Chilean Patagonia.

    Seguel, Mauricio; Muñoz, Francisco; Montalva, Felipe; Perez-Venegas, Diego; Pavés, Héctor; Gottdenker, Nicole

    2017-07-01

    During five reproductive seasons, we documented the presence, extent and origin of perineal wounds in South American fur seal pups ( Arctocephalus australis ) on Guafo Island, Northern Chilean Patagonia. The seasonal prevalence of perineal wounds ranged from 5 to 9%, and new cases were more common at the end of the breeding season (February), when pups were on average two months old and were actively expelling hookworms ( Uncinaria sp). Histologically, wounds corresponded to marked ulcerative lymphoplasmacytic and histiocytic dermatitis with granulation tissue and mixed bacterial colonies. In 2015 and 2017, kelp gulls ( Larus dominicanus ) and dolphin gulls ( Leucophaeus scoresbii ) were observed picking and wounding the perineal area of marked pups. This behaviour occurred more frequently after the pups' defecation, when sea gulls engaged in consumption of pups' faeces. The affected pups usually had moderate to marked hookworm infections along with bloody diarrhoea and anaemia. Pups with severe wounds (23% of affected animals) had swollen perineal areas and signs of secondary systemic bacterial infection. We propose that seagulls on Guafo Island have learned to consume remains of blood and parasites in the faeces of pups affected by hookworm infection, causing perineal wounds during this process. We conclude that this perineal wounding is an unintentional, occasional negative effect of an otherwise commensal gull-fur seal relationship.

  15. Active delivery of the anterior arm and incidence of second-degree perineal tears: a clinical practice evaluation.

    Mottet, Nicolas; Bonneaud, Marine; Eckman-Lacroix, Astrid; Ramanah, Rajeev; Riethmuller, Didier

    2017-05-12

    Evaluate the feasibility of active delivery of the anterior arm during spontaneous delivery. This maneuver could decrease incidence of second-degree perineal tears because it reduces fetal biacromial diameter. An observational comparative prospective study was conducted at our teaching maternity from July 2012 to March 2013. The study included 199 nulliparous women ≥18 years, who met the following criteria: singleton pregnancy, vaginal delivery with occiput anterior presentation, on epidural analgesia, from 37 weeks of gestation onward. The distribution of rate and type of perineal tears were compared between two groups: a non-exposed group and a group exposed to the maneuver. A total of 101 patients were exposed to Couder's maneuver (CM) and 98 patients were not exposed. In the intervention group, 3 failures of the maneuver were reported. The maneuver was considered easy in 80% of cases, moderately easy in 12% and difficult in 8% of cases. There was a significant difference (p = 0.03) in the distribution of perineal tears between the two groups. There was a significant reduction (p tears in the patients exposed to CM. There was no significant difference in the rate of anterior perineal trauma between the exposed and non-exposed arms. CM in primiparous women at term is feasible with a low failure rate and influences the distribution of perineal tears by lowering second-degree perineal tears in a highly significant manner (p <0.01).

  16. Urinary biomarkers for the non-invasive diagnosis of endometriosis.

    Liu, Emily; Nisenblat, Vicki; Farquhar, Cindy; Fraser, Ian; Bossuyt, Patrick M M; Johnson, Neil; Hull, M Louise

    2015-12-23

    About 10% of reproductive-aged women suffer from endometriosis which is a costly chronic disease that causes pelvic pain and subfertility. Laparoscopy is the 'gold standard' diagnostic test for endometriosis, but it is expensive and carries surgical risks. Currently, there are no simple non-invasive or minimally-invasive tests available in clinical practice that accurately diagnoses endometriosis. 1. To provide summary estimates of the diagnostic accuracy of urinary biomarkers for the diagnosis of pelvic endometriosis compared to surgical diagnosis as a reference standard.2. To assess the diagnostic utility of biomarkers that could differentiate ovarian endometrioma from other ovarian masses.Urinary biomarkers were evaluated as replacement tests for surgical diagnosis and as triage tests to inform decisions to undertake surgery for endometriosis. The searches were not restricted to particular study design, language or publication dates. We searched the following databases to 20 April - 31 July 2015: CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, LILACS, OAIster, TRIP and ClinicalTrials.gov (trial register). MEDION, DARE, and PubMed were also searched to identify reviews and guidelines as reference sources of potentially relevant studies. Recently published papers not yet indexed in the major databases were also sought. The search strategy incorporated words in the title, abstract, text words across the record and the medical subject headings (MeSH) and was modified for each database. Published peer-reviewed, randomised controlled or cross-sectional studies of any size were considered, which included prospectively collected samples from any population of reproductive-aged women suspected of having one or more of the following target conditions: ovarian, peritoneal or deep infiltrating endometriosis (DIE). We included studies comparing the diagnostic test accuracy of one or more urinary biomarkers with surgical visualisation of endometriotic lesions. Two

  17. “Horrendoplasty” – A case of total perineal destruction by agricultural implement

    Pedro Simoes de Oliveira

    2017-01-01

    Full Text Available Although posterior urethral injury occurs almost always in association with pelvic fracture, it may result from severe trauma to the perineum with its associated potential lethality and severe morbidity. Early primary endoscopic realignment over a urethral catheter can be attempted, although an immediate suprapubic tube placement remains the standard of care. Definitive treatment consists of elective open posterior anastomotic urethroplasty through a perineal approach. The authors present a 53-year-old man who sustained total, massive perineal destruction resulting from work accident with an agricultural implement. Immediate suprapubic tube placement was performed followed by delayed elective transperineal anastomotic posterior urethroplasty. A major multidisciplinary approach was necessary in the management strategy, including orthopedic, general, plastic, vascular surgeries, and reconstructive urology teams. At a later stage, with the patient stabilized and recovered from major, life-threatening lesions dealt with by a multidisciplinary team, urethral reconstruction can be undertaken with ultimate good functional outcomes.

  18. Variations in rates of severe perineal tears and episiotomies in 20 European countries

    Blondel, Béatrice; Alexander, Sophie; Bjarnadóttir, Ragnheiður I

    2016-01-01

    INTRODUCTION: Rates of severe perineal tears and episiotomies are indicators of obstetrical quality of care, but their use for international comparisons is complicated by difficulties with accurate ascertainment of tears and uncertainties regarding the optimal rate of episiotomies. We compared...... rates of severe perineal tears and episiotomies in European countries and analysed the association between these two indicators. MATERIAL AND METHODS: We used aggregate data from national routine statistics available in the Euro-Peristat project. We compared rates of severe (third- and fourth......-degree) tears and episiotomies in 2010 by mode of vaginal delivery (n = 20 countries), and investigated time trends between 2004 and 2010 (n = 9 countries). Statistical associations were assessed with Spearman's ranked correlations (rho). RESULTS: In 2010 in all vaginal deliveries, rates of severe tears ranged...

  19. Deoti surgical flap and sphincteroplasty for treatment of severe perineal deformity

    Beatriz D.S. Rodrigues

    2017-04-01

    Full Text Available Purpose: Anal incontinence is a very stigmatizing condition, which affects biopsychosocially the patient. It is a neglected, but quite common complication of obstetric and anorectal surgery, however it has treatment options. None of the treatment options have exceptional efficacy rates and still associated with risk of recurrence. The surgery techniques known are: anterior and posterior shortening procedure; post-anal repair; anterior elevator plasty and external sphincter plication; total pelvic floor repair and sphincter repair. None of them use a flap rotation of adipose tissue. The purpose is to propose a new surgery technique of anal sphincteroplasty, which uses flap rotation, for severe perineal deformity associated with anal incontinence. Methods: Patient with severe perineal deformity and anal incontinence treated with a new surgery technique of sphincteroplasty with flap rotation. Results: The severe perineal deformity was corrected with both esthetic and functional results. Anal continence measured by Wexner and Jorge assessment in a follow-up period of 2 years after the intervention. Pictures and video show esthetic and functional aspects. Conclusion: This is the first time that a flap rotation is used to treat a severe perineal deformity. And the technique presented promising outcomes, which allows perineum reconstruction that is similar to the original anatomy. Therefore, this technique is justified to better evaluate its efficiency and the impact on patients’ prognosis. Resumo: Objetivo: A incontinência anal é uma condição muito estigmatizante, que afeta biopsicossocialmente o paciente. É uma complicação negligenciada, mas bastante comum da cirurgia obstétrica e anorretal, no entanto, tem opções de tratamento. Nenhuma das opções de tratamento tem taxas de eficácia excepcionais e ainda está associada ao risco de recorrência. As técnicas cirúrgicas conhecidas são: procedimento de encurtamento anterior e posterior

  20. The effect of primary delivery of the anterior compared with the posterior shoulder on perineal trauma

    Willer, Hanne; Aabakke, Anna J M; Krebs, Lone

    2014-01-01

    is that primary delivery of the posterior shoulder reduces the rate and degree of perineal trauma. METHODS/DESIGN: This is a single-centre, randomized controlled trial, with computer-generated randomization in a 1:1 allocation ratio. Women planning their first vaginal delivery (n = 650) are randomized to primary....... Recruitment started in January 2013 and the trial is planned to proceed for 24 months. DISCUSSION: Most delivery assistance techniques are based on tradition and heritage and lack objective evidence. This trial provides an example of how vaginal delivery techniques can be evaluated in a randomized controlled...... trial. The results of this trial will clarify the role that delivery of the shoulders has on perineal trauma and thereby provide knowledge to recommendations on birthing technique. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01937546....

  1. Use of canine small intestinal submucosa allograft for treating perineal hernias in two dogs.

    Lee, A-Jin; Chung, Wook-Hun; Kim, Dae-Hyun; Lee, Kyung-Pil; Suh, Hyun Jung; Do, Sun Hee; Eom, Ki-Dong; Kim, Hwi-Yool

    2012-09-01

    Here, we describe two dogs in which canine small intestinal submucosa (SIS) was implanted as a biomaterial scaffold during perineal herniorrhaphy. Both dogs had developed severe muscle weakness, unilaterally herniated rectal protrusions, and heart problems with potential anesthetic risks. Areas affected by the perineal hernia (PH) located between the internal obturator and external anal sphincter muscles were reconstructed with naïve canine SIS sheets. In 12 months, post-operative complications such as wound infections, sciatic paralysis, rectal prolapse, or recurrence of the hernia were not observed. Symptoms of defecatory tenesmus also improved. Neither case showed any signs of rejection or specific immune responses as determined by complete and differential cell counts. Our findings demonstrate that canine SIS can be used as a biomaterial scaffold for PH repair in dogs.

  2. Application of the perineal ostomy in severe organophosphate poisoned patients after catharsis.

    Zhang, D-M; Xiao, Q

    2014-01-01

    To investigate the efficacy of the one-piece ostomy bags for severe organophosphate poisoned patients after catharsis. Sixty cases of severe organophosphate poisoned patients who were given rhubarb catharsis after thorough nasal lavage were divided into two groups. The observation group used the one-piece ostomy bags whilst the control group used the disposable changing mats. The perineal skin changes, average daily hours of care, and cost of care rates were compared between the two groups. The rates of perineal skin changes were lower in the observation group than the control group (p ostomy bag in poisoned patients after the catharsis can prevent the risk of nursing by protecting and promoting the care quality, reducing the nursing workload and improving their work efficiency. It can enhance the nurses' self-esteem, reduce patients' expenses and provide an objective basis for assessing the treatments.

  3. Imaging modalities for the non-invasive diagnosis of endometriosis.

    Nisenblat, Vicki; Bossuyt, Patrick M M; Farquhar, Cindy; Johnson, Neil; Hull, M Louise

    2016-02-26

    About 10% of women of reproductive age suffer from endometriosis. Endometriosis is a costly chronic disease that causes pelvic pain and subfertility. Laparoscopy, the gold standard diagnostic test for endometriosis, is expensive and carries surgical risks. Currently, no non-invasive tests that can be used to accurately diagnose endometriosis are available in clinical practice. This is the first review of diagnostic test accuracy of imaging tests for endometriosis that uses Cochrane methods to provide an update on the rapidly expanding literature in this field. • To provide estimates of the diagnostic accuracy of imaging modalities for the diagnosis of pelvic endometriosis, ovarian endometriosis and deeply infiltrating endometriosis (DIE) versus surgical diagnosis as a reference standard.• To describe performance of imaging tests for mapping of deep endometriotic lesions in the pelvis at specific anatomical sites.Imaging tests were evaluated as replacement tests for diagnostic surgery and as triage tests that would assist decision making regarding diagnostic surgery for endometriosis. We searched the following databases to 20 April 2015: MEDLINE, CENTRAL, EMBASE, CINAHL, PsycINFO, Web of Science, LILACS, OAIster, TRIP, ClinicalTrials.gov, MEDION, DARE, and PubMed. Searches were not restricted to a particular study design or language nor to specific publication dates. The search strategy incorporated words in the title, abstracts, text words across the record and medical subject headings (MeSH). We considered published peer-reviewed cross-sectional studies and randomised controlled trials of any size that included prospectively recruited women of reproductive age suspected of having one or more of the following target conditions: endometrioma, pelvic endometriosis, DIE or endometriotic lesions at specific intrapelvic anatomical locations. We included studies that compared the diagnostic test accuracy of one or more imaging modalities versus findings of surgical

  4. USE OF VACUUM-ASSISTED CLOSURE (VAC) IN COMPLICATED PERINEAL WOUNDS: ANALYSIS OF CASES

    Blaž Trotovšek; Danijela Semenič

    2015-01-01

    Treatment of perineal wounds has been one of the challenges of surgery since its inception. Vacuum-assisted closure provides a new option that can be used in concert with a wide variety of standard existing surgical techniques. It was originally developed for treatment of chronic wounds in patients with diabetes. It has rapidly evolved into a widely accepted treatment also for acute, contaminated and complicated wounds from failed operations. User-friendliness of the technique and a high rate...

  5. Perineal mass protrusion with rectal mucosa: a rectal duplication that underwent exstrophy.

    Sun, Junjie; Vongphet, Soulithone; Zhang, Zhichong; Mo, Jiacong

    2011-08-01

    We present a rare case of a male neonate with a perineal mass with rectal mucosa, diagnosed as an exstrophic duplication of the rectum. It was accompanied by a cord that was deeply invested in the pelvic diaphragm and was composed of smooth muscle, fibrous tissue, and some rectal glands. The association of exstrophic rectal duplication with a bifid scrotum, hypospadias, and normal anus has not been described previously in the literature. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Primary diffuse large B-cell lymphoma of the corpora cavernosa presented as a perineal mass

    González-Satué Carlos

    2012-01-01

    Full Text Available Primary male genital lymphomas may appear rarely in testis, and exceptionally in the penis and prostate, but there is not previous evidence of a lymphoma arising from the corpora cavernosa. We report the first case in the literature of a primary diffuse cell B lymphoma of the corpora cavernosa presented with low urinary tract symptoms, perineal pain and palpable mass. Diagnosis was based on trucut biopsy, histopathological studies and computed tomographic images.

  7. Androgen receptors in the pelvic diaphragm muscles of dogs with and without perineal hernia.

    Mann, F A; Nonneman, D J; Pope, E R; Boothe, H W; Welshons, W V; Ganjam, V K

    1995-01-01

    Levator ani and coccygeus muscle estrogen and androgen receptors were measured in 6, healthy, > or = 5-year-old, noncastrated, male Beagles (controls) and in 24 dogs with perineal hernia. Estrogen and androgen receptor analyses were performed on levator ani and coccygeus muscle specimens obtained from control dogs at the time of castration; contralateral levator ani and coccygeus muscle specimens were assayed 2 months after castration. During herniorrhaphy of dogs with perineal hernia, levator ani (non-castrated, n = 12; castrated, n = 7) and/or coccygeus (noncastrated, n = 5; castrated, n = 4) muscle biopsy specimens were obtained for estrogen and androgen receptor analyses. For estrogen and androgen receptor assays, each muscle biopsy specimen was homogenized in Tris-EDTA-glycerol buffer, and centrifuged at 30,000 x g; extracts were used for binding with ligands: [3H]methyltrienolone (3HR1881) for androgen receptors, and [3H]estradiol-17 beta for estrogen receptors. Extracts were incubated overnight at 0 to 4 C. Nonspecific binding was estimated, using 100-fold concentration of cold ligands. Bound and free hormones were separated, using hydroxylapatite batch assay. Receptor numbers for each tissue were calculated as femtomoles (fmol) per milligram of protein. Quantified data were compared between precastration and postcastration controls, using a paired t-test. One-way ANOVA and Bonferroni post-hoc test were used to compare values for precastration controls, postcastration controls, castrated dogs with perineal hernia, and noncastrated dogs with perineal hernia. Significance was set at P < 0.05.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy

    Danilo Souza Lima da Costa Cruz; Carlos Arturo Levi D’Ancona; Jamal Baracat; Marco Antonio Dionisio Alves; Marcelo Cartapatti; Ronaldo Damião

    2014-01-01

    Introduction Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period. Materials and Methods This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were includ...

  9. A study of laparoscopic extraperitoneal sigmoid colostomy after abdomino-perineal resection for rectal cancer

    Heiying, Jin; Yonghong, Du; Xiaofeng, Wang; Hang, Yao; Kunlan, Wu; Bei, Zhang; Jinhao, Zhang; Qiang, Leng

    2014-01-01

    Objective: To established a procedure for laparoscopic extraperitoneal ostomy after abdomino-perineal resection (APR) and study safety aspects and complications. Method: From July 2011 to July 2012, 36 patients with low rectal cancer undergoing APR were included in the study and divided into extraperitoneal ostomy group (n = 18) and intraperitoneal ostomy group (n = 18). Short- and long-term complications were compared between the two groups. All patients were followed up and the median durat...

  10. Cloacal reconstruction after a complex treatment of perineal haemangioma in a variant of PELVIS syndrome

    Žalimas, Algirdas; Pošiūnas, Gintas; Strupas, Sigitas; Raugalas, Ramūnas; Raistenskis, Juozas; Verkauskas, Gilvydas

    2015-01-01

    Background PELVIS is an acronym defining the association of perineal hemangioma, malformations of external genitalia, lipomyelomeningocele, vesicorenal abnormalities, imperforate anus and skin tag. Eleven cases have been reported according to the Orphanet data. Acronyms of LUMBAR and SACRAL syndrome have been used and most probably represent a spectrum of the same entity. Very little is known about the success and timing of cloacal reconstruction after the treatment of hemangioma. We present ...

  11. Combined laparoscopic abdomino-endoscopic perineal total mesorectal excision for anorectal malignant melanoma: A case report

    Ryo Ohta

    Full Text Available Introduction: This report presents a case of anorectal malignant melanoma treated with combined laparoscopic abdomino-endoscopic perineal total mesorectal excision. Presentation of case: An 82-year-old female presented with hematochezia. Colonoscopy revealed a 5-cm tumor in the anorectal junction, and biopsy specimen showed malignant melanoma. Modified ransanal total mesorectal excision was performed to get the sufficient surgical resection margins. After lymph node dissection in usual manner, mobilizing the rectum to the level of levator ani muscle. Then a skin incision was made around the anus and the transperineal access platform was placed. The fat tissue of the ischioanal fossa was divided until the levator ani muscle was exposed. The oral side of the colon was transected and specimen was extracted through the perineal incision site. Then stoma was placed laparoscopically. Discussion: This procedure provides not only better exposure of the extralevator surgical field, but also efficient resection margins compared with the conventional andominoperineal resection. Conclusion: To the best of our knowledge, this is the first report of combined laparoscopic abdomino-endoscopic perineal total mesorectal excision for anorectal malignant melanoma. Our experience showed safety and feasible option for anorectal malignant diseases. Keywords: Anorectal malignant melanoma, Transanal total mesorectal excision, Laparoscopic abdominoperineal resection, Case report

  12. Infrascrotal, perineal, femorofemoral bypass for arterial graft infection at the groin.

    Illuminati, Giulo; Caliò, Francesco G; D'Urso, Antonio; Giacobbi, Daniela; Papaspyropoulos, Vassilios; Ceccanei, Gianluca

    2004-12-01

    Infrascrotal, perineal, femorofemoral bypass is an acceptable procedure for treating infection of a prosthetic arterial graft limited to a unilateral groin. A consecutive sample clinical study with a mean follow-up of 29 months. The surgical department of an academic tertiary care center and an affiliated secondary care center. Nineteen patients with a mean age of 68 years with prosthetic graft infection at the outflow anastomosis on a femoral artery at the Scarpa triangle underwent an infrascrotal, perineal, femorofemoral bypass, with excision of the graft material limited at the groin. The recipient artery was the profunda femoris artery in 12 cases, the superficial femoral in 5, and the distal common femoral artery in 2. Cumulative survival, recurrence of sepsis, primary graft patency, and limb salvage rates expressed by standard life-table analysis. Postoperative mortality rate was 5%. Cumulative (SE) survival rate was 65% (11.6%) at 3 years. Cumulative (SE) rate of freedom from recurrent sepsis was 88% (8.6%) at 3 years. Cumulative (SE) primary patency and limb salvage rates were 86% (9.4%) and 91% (7.9%), respectively, at 3 years. Femorofemoral bypass with an infrascrotal perineal approach is a valuable procedure for the treatment of femoral arterial graft infection limited at a unilateral groin.

  13. Recurrent vulvar carcinoma: complex surgical treatment via perineal excision and reconstruction with musculocutaneous flap

    Dragoș Popa

    2018-04-01

    Full Text Available Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion. We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3 for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal sphincter, creating a delicate problem regarding a surgical approach. The size and the extent of the recurrent tumor required a complex surgical intervention using a mixed surgical team of general surgeons and plastic surgeons. Surgical intervention with a large excision of the recurrent cancer along with amputation of the inferior rectum via perineal route, and creation of a left iliac anus was performed. The perineal defect was covered via a musculocutaneous flap using the gracilis muscle. The immediate post-operative evolution was favorable.

  14. Single stage: dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures using perineal route

    Vikram Prabha

    2016-06-01

    Full Text Available ABSTRACT Objective To assess the outcome of single stage dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures (>4cm long using a perineal incision. Materials and Methods From August 2010 to August 2013, 20 patients underwent BMG urethroplasty. The cause of stricture was Lichen sclerosis in 12 cases (60%, Instrumentation in 5 cases (25%, and unknown in 3 cases (15%. Strictures were approached through a perineal skin incision and penis was invaginated into it to access the entire urethra. All the grafts were placed dorsolaterally, preserving the bulbospongiosus muscle, central tendon of perineum and one-sided attachement of corpus spongiosum. Procedure was considered to be failure if the patient required instrumentation postoperatively. Results Mean stricture length was 8.5cm (range 4 to 12cm. Mean follow-up was 22.7 months (range 12 to 36 months. Overall success rate was 85%. There were 3 failures (meatal stenosis in 1, proximal stricture in 1 and whole length recurrent stricture in 1. Other complications included wound infection, urethrocutaneous fistula, brownish discharge per urethra and scrotal oedema. Conclusion Dorsolateral buccal mucosal urethroplasty for long anterior urethral strictures using a single perineal incision is simple, safe and easily reproducible by urologists with a good outcome.

  15. Perineal pseudocontinent colostomy for ultra-low rectal adenocarcinoma: the muscular graft as a pseudosphincter.

    Souadka, Amine; Majbar, Mohammed Anass; Amrani, Laila; Souadka, Abdelilah

    2016-10-01

    The aim of this study was to analyze objectively the role of the muscular graft in the continence using manometric study in the patients who underwent pseudocontinent perineal colostomy after abdominoperineal resection for rectal adenocarcinoma. This was a retrospective study including all the patients from January 2002 to December 2009 who underwent an abdominoperineal resection followed by perineal pseudocontinent colostomy for ultra-low rectal adenocarcinoma and agreed to perform the manometric evaluation of the muscular graft. Fifteen patients were included, six males and nine females, with a mean age of 50 years. According to Kirwan's classification, 2 (13.3%) patients had normal continence (Stage A) had 10 (66.6%) no soiling (stage B) and 3 (20%) patients had minimal soiling (Stage C). The manometric evaluation was performed after a median period of 12 months post-surgery. The mean maximal resting and squeeze pressures were respectively 41 cmH2O and 59 cmH2O and the mean colonic sensory volume was 12 ml. This study showed that the musculae graft of Pseudocontinent Perineal colostomy acted as a hypotonic sphincter that pressure can increase during the voluntary squeeze. These data may help to clarify the functional outcomes of this technique after APR for ultra-low rectal adenocarcinoma.

  16. Perineal colostomy: an alternative to avoid permanent abdominal colostomy: operative technique, results and reflection.

    da Silva, Alcino Lázaro; Hayck, Johnny; Deoti, Beatriz

    2014-01-01

    The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life. To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy. Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010. The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis. The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer.

  17. Treatment outcomes of open pelvic fractures associated with extensive perineal injuries.

    Hasankhani, Ebrahim Ghayem; Omidi-Kashani, Farzad

    2013-12-01

    The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries. We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis. The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia. Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.

  18. [Perineal colostomy with antegrade continence enemas as an alternative after abdominoperineal resection for low rectal cancer].

    Penninckx, F; D'Hoore, A; Vanden Bosch, A

    2005-06-01

    Some young and active patients requiring abdominoperineal resection for rectum cancer ask for an alternative of an abdominal colostomy. We analysed the results after a combination of a perineal colostomy and antegrade continence enemas (ACE). Fifteen patients have been operated between 1999 and 2004. Follow-up was >six months in 12 patients with a mean of two years and with a maximum of 55 months. The QLQ-C30 (version 3) and CR 38 questionnaires of the EORTC have been used to evaluate quality of life aspects. Five out of 15 patients presented complications: infection of the caecal conduit (2), small bowel obstruction (1), prolapse of the perineal colostomy (1), eventration (1), urologic complications (2). ACE are still used by all patients. The volume needed was 400 ml and duration of irrigation was 30 minutes (15-45 minutes). The median score for faecal incontinence was 0 ; faecal pseudocontinence was obtained by 7/12 patients. The scores for all aspects of functioning were excellent, as well as the score for body image. The general health status and quality of life were estimated at 75% from normal value. The procedure is simple and can be performed in one operative session. A perineal colostomy with ACE seems to be a valuable and less expensive alternative for an abdominal colostomy, and certainly for total anorectal reconstruction.

  19. Abdominal and perineal approaches in the surgical treatment of rectal prolapse

    Mesut Gül

    2012-03-01

    Full Text Available Introduction: Rectal prolapse is a disease, which is an important cause of social and functional problems and has a continuing debate about the ideal surgical treatment of itself. In this study, we aimed to investigate the abdominal and perineal approaches with early and late postoperative result in the patients undergoing surgery for rectal prolapse.Materials and methods: Between 2006-2011, the records of 21 patients undergoing surgery with the diagnosis of rectal prolapse were reviewed, retrospectively. The demographic and physical examination findings, surgical procedures, early and late postoperative complications, recurrence and mortality rates were recorded.Results: The median age was 43 years and female/male ratio was 1.63/1. The most common presenting complaint was gas control failure and often wetting with mucus. Stage 1 and stage 3 rectal prolapses was detected in 19% and 81% of the patients, respectively. The most common surgical procedure was Notaras (54%. Early postoperative complications were seen in 14.3% of the patients. There were no postoperative recurrence, mortality and complication requiring re-exploration. Advanced age and shorter duration of hospital stay were determined and often performed under regional anesthesia in the patients undergoing perineal approach. No statistical differences were observed in terms of early postoperative complications and recurrence.Conclusion: Results of abdominal and perineal approaches were similar, when they were applied with taking into account the risk factors for surgical treatment, findings of the patients and the surgeon’s experience.

  20. The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

    Hinata, Nobuyuki; Murakami, Gen

    2014-01-01

    Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter. PMID:24877147

  1. The influence of endometriosis-related symptoms on work life and work ability: a study of Danish endometriosis patients in employment.

    Hansen, Karina E; Kesmodel, Ulrik S; Baldursson, Einar B; Schultz, Rikke; Forman, Axel

    2013-07-01

    Little is known about the implications of endometriosis on women's work life. This study aimed at examining the relation between endometriosis-related symptoms and work ability in employed women with endometriosis. In a cohort study, 610 patients with diagnosed endometriosis and 751 reference women completed an electronic survey based on the Endometriosis Health Profile 30-questionnaire and the Work Ability Index (short form). Percentages were reported for all data. Binary and multivariate logistic regression analyses were used to assess risk factors for low work ability. The level of statistical significance was set at pwork disturbances due to symptoms, lower work ability and a wide number of other implications on work life in employed women. Moreover, a higher pain level and degree of symptoms were associated with low work ability. Full regression analysis indicated that tiredness, frequent pain, a higher daily pain level, a higher number of sick days and feeling depressed at work were associated with low work ability. A long delay from symptom onset to diagnosis was associated with low work ability. These data indicate a severe impact of endometriosis on the work ability of employed women with endometriosis and add to the evidence that this disease represents a significant socio-economic burden. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  2. Expression of natural killer cell activity with CD107a on ectopic endometrium in woman with endometriosis compared with non-endometriosis

    Lubis, H. P.; Aldiansyah, D.; Siregar, H. S.; Rivany, R.; Hariadi, T. S.

    2018-03-01

    Some factors have an important role in endometriosis pathogenesis; there is an immune cell that plays an important role in endometrial cells that have reflux. Woman with endometriosis experienced the cellular immune disorder. It is suspected that decrease of NK cell in the peritoneal fluid caused by its qualitative defect with CD107a expression as the best marker. The aim of this study was to compare expression of NK Cell activity with CD107a between awoman with endometriosis and non-endometriosis. A case-control study from March until July 2015 in Haji Adam Malik General Hospital. The case group was ectopic endometrial tissue block paraffin and control group was normal endometrial tissue block paraffin. This study included 23 patients in endometriosis group and control group respectively. A majority proportion of CD107a expression in endometriosis group was +1 (16 patients (69.6%)), while the control group was +3 (9 patients (39.1%)). Expression of NK cell activity with CD107a in patients with endometriosis was lower than the control group (pendometriosis.

  3. The plasma and peritoneal fluid concentrations of matrix metalloproteinase-9 are elevated in patients with endometriosis.

    Liu, Haiping; Wang, Jianye; Wang, Haiyu; Tang, Ning; Li, Yunfei; Zhang, Yan; Hao, Tianyu

    2016-09-01

    Enzyme matrix metalloproteinase-9 is a member of the matrix metalloproteinase family, which is critical to normal tissue remodelling during embryogenesis and wound healing. In patients with endometriosis, increased expression and activity of matrix metalloproteinase-9 have been observed in ectopic endometrium, but the plasma and peritoneal fluid concentrations of matrix metalloproteinase-9 in patients with endometriosis and their relation to disease severity have not been clear. The aim of the study was to investigate the concentrations of matrix metalloproteinase-9 in plasma and peritoneal fluid of patients with endometriosis. A prospective case-control study was conducted in Jinan Military General Hospital between January 2010 and December 2013. Fifty patients with proven endometriosis and 26 endometriosis-free controls were enrolled in this study. Patients with endometriosis were evaluated and divided into moderate/severe endometriosis group (stage I-II, n = 26) and minimal/mild endometriosis group (stage III-IV, n = 24) according to the revised criteria of the American Society for Reproductive Medicine. Blood samples and peritoneal fluid were obtained from both patients and controls. Matrix metalloproteinase-9 was measured using enzyme-linked immunosorbent assay in plasma and peritoneal fluid. The concentration of matrix metalloproteinase-9 between different groups was compared and its correlation to disease severity was analysed. Plasma and peritoneal fluid concentrations of matrix metalloproteinase-9 in patients with endometriosis were higher than that in controls. In addition, those patients with moderate/severe endometriosis had significantly higher plasma and peritoneal fluid concentrations of matrix metalloproteinase-9 compared to those with minimal/mild endometriosis. Matrix metalloproteinase-9 concentrations in plasma and peritoneal fluid were both positively correlated with severity of endometriosis and plasma matrix metalloproteinase-9

  4. Risk factors of epithelial ovarian carcinomas among women with endometriosis: a systematic review.

    Thomsen, Line H; Schnack, Tine H; Buchardi, Kristina; Hummelshoj, Lone; Missmer, Stacey A; Forman, Axel; Blaakaer, Jan

    2017-06-01

    The objective of this review was to evaluate the published literature on epidemiologic risk factors for epithelial ovarian cancer among women with a diagnosis of endometriosis. A systematic literature search was conducted in PubMed and Scopus. Studies comparing epidemiologic risk factors of epithelial ovarian cancer among women with endometriosis were included. A quality assessment was conducted using the Newcastle-Ottawa Scale. Eight of 794 articles met the inclusion criteria. A lower risk of epithelial ovarian cancer was observed in women with documented complete surgical excision of endometriotic tissue and suggested among women with unilateral oophorectomy. The use of oral contraceptives (≥10 years) may be associated with a lower risk of epithelial ovarian cancer among women with endometriosis, whereas older age at endometriosis diagnosis (≥45 years, pre- or postmenopausal), nulliparity, hyperestrogenism (endogenous or exogenous), premenopausal status at endometriosis diagnosis, solid compartments as well as larger size of endometrioma (≥9 cm in diameter at endometriosis diagnosis) were all associated with an increased risk of ovarian cancer. A subgroup of women with endometriosis characterized by endometriosis observed through surgery or imaging after the age of 45 years, nulliparity, postmenopausal status at endometriosis diagnosis, larger size of endometrioma (>9 cm) at endometriosis diagnosis, hyperestrogenism (endogenous or exogenous) and/or cysts with solid compartments may have an elevated risk of epithelial ovarian cancer. However, due to the limited number and size of studies in this area we cannot draw definitive conclusions. Further research into a risk factor profile among women with endometriosis is needed before clear recommendations can be made. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Calcium-binding protein expression in peritoneal endometriosis-associated nerve fibres.

    Barcena de Arellano, M L; Münch, S; Arnold, J; Helbig, S; Schneider, A; Mechsner, S

    2013-11-01

    Recent studies demonstrated the potential involvement of nerve fibres in the chronic inflammatory process of endometriosis. We aimed to characterize nerve fibres in the proximal and distal areas of the peritoneal endometriotic lesions in order to understand the chronic inflammatory process in endometriosis. Peritoneal endometriotic lesions (proximal area) (n = 17), the matching unaffected peritoneum (distal area) and healthy peritoneum of patients without endometriosis (n = 15) were analysed with the neuronal markers PGP 9.5, calbindin, calretinin and parvalbumin. Peritoneal fluids of women with and without endometriosis were used for Western blot analysis and for the neuronal growth assay. The protein expression of neuronal PC-12 cells incubated with peritoneal fluids was analysed. The overall nerve fibre density was significantly reduced in the distal area of the lesion when compared with the proximal area or with healthy peritoneum. The density of calbindin-, calretinin- and parvalbumin-positive nerve fibres was significantly increased in the endometriosis group. Calretinin expression was elevated in the peritoneal fluid of women with symptomatic endometriosis when compared with women with asymptomatic endometriosis. Furthermore, PC-12 cells incubated with peritoneal fluid of women with endometriosis showed a higher proliferation rate and a stronger neurite outgrowth than the control group. PC-12 cells incubated in peritoneal fluids of women with endometriosis expressed less calretinin but more calbindin than the control group. Calcium-binding proteins seem to be increased in endometriosis-associated nerve fibres and might play an important role in the chronic inflammatory condition and the pain pathogenesis of endometriosis. © 2013 European Federation of International Association for the Study of Pain Chapters.

  6. The peritoneum is both a source and target of TGF-β in women with endometriosis.

    Young, Vicky J; Brown, Jeremy K; Saunders, Philippa T K; Duncan, W Colin; Horne, Andrew W

    2014-01-01

    Transforming growth factor-β (TGF-β) is believed to play a major role in the aetiology of peritoneal endometriosis. We aimed to determine if the peritoneum is a source of TGF-β and if peritoneal TGF-β expression, reception or target genes are altered in women with endometriosis. Peritoneal fluid, peritoneal bushings and peritoneal biopsies were collected from women with and without endometriosis. TGF-β1, 2 and 3 protein concentrations were measured in the peritoneal fluid. TGF-β1 was measured in mesothelial cell conditioned media. Control peritoneum and peritoneum prone to endometriosis (within Pouch of Douglas) from women without disease (n = 16) and peritoneum distal and adjacent to endometriosis lesions in women with endometriosis (n = 15) and were analysed for TGF-β expression, reception and signalling by immunohistochemistry, qRT-PCR and a TGF-β signalling PCR array. TGF-β1 was increased in the peritoneal fluid of women with endometriosis compared to those without disease (Pperitoneal mesothelial cells secrete TGF-β1 in-vitro. In women with endometriosis, peritoneum from sites adjacent to endometriosis lesions expressed higher levels of TGFB1 mRNA when compared to distal sites (Pendometriosis. In conclusion, the peritoneum, and in particular, the peritoneal mesothelium, is a source of TGF-β1 and this is enhanced around endometriosis lesions. The expression of TGF-β-regulated genes is altered in the peritoneum of women with endometriosis and this may promote an environment favorable to lesion formation.

  7. A cross-study gene set enrichment analysis identifies critical pathways in endometriosis

    Bai Chunyan

    2009-09-01

    Full Text Available Abstract Background Endometriosis is an enigmatic disease. Gene expression profiling of endometriosis has been used in several studies, but few studies went further to classify subtypes of endometriosis based on expression patterns and to identify possible pathways involved in endometriosis. Some of the observed pathways are more inconsistent between the studies, and these candidate pathways presumably only represent a fraction of the pathways involved in endometriosis. Methods We applied a standardised microarray preprocessing and gene set enrichment analysis to six independent studies, and demonstrated increased concordance between these gene datasets. Results We find 16 up-regulated and 19 down-regulated pathways common in ovarian endometriosis data sets, 22 up-regulated and one down-regulated pathway common in peritoneal endometriosis data sets. Among them, 12 up-regulated and 1 down-regulated were found consistent between ovarian and peritoneal endometriosis. The main canonical pathways identified are related to immunological and inflammatory disease. Early secretory phase has the most over-represented pathways in the three uterine cycle phases. There are no overlapping significant pathways between the dataset from human endometrial endothelial cells and the datasets from ovarian endometriosis which used whole tissues. Conclusion The study of complex diseases through pathway analysis is able to highlight genes weakly connected to the phenotype which may be difficult to detect by using classical univariate statistics. By standardised microarray preprocessing and GSEA, we have increased the concordance in identifying many biological mechanisms involved in endometriosis. The identified gene pathways will shed light on the understanding of endometriosis and promote the development of novel therapies.

  8. The Association between ABO and Rh Blood Groups and Risk of Endometriosis in Iranian Women.

    Malekzadeh, Farideh; Moini, Ashraf; Amirchaghmaghi, Elham; Daliri, Leila; Akhoond, Mohammad Reza; Talebi, Mehrak; Hosseini, Rihaneh

    2018-06-01

    Endometriosis is a common gynaecological disease that affects quality of life for women. Several studies have revealed that both environmental and genetic factors contribute to the development of endometriosis. The aim of this study was to investigate the distribution of ABO and Rh blood groups in Iranian women with endometriosis who presented to two referral infertility centers in Tehran, Iran. In this case-control study, women who referred to Royan Institute and Arash Women's Hospital for diagnostic laparoscopy between 2013 and 2014 were assessed. Based on the laparoscopy findings, we categorized the women into two groups: endometriosis and control (women without endometriosis and normal pelvis). Chi-square and logistic regression tests were used for data analysis. In this study, we assessed 433 women, of which 213 patients were assigned to the endometriosis group while the remaining 220 subjects comprised the control group. The most frequent ABO blood group was O (40.6%). The least frequent blood group was AB (4.8%). In terms of Rh blood group, Rh+ (90.1%) was more frequent than Rh- (9.9%). There was no significant correlation between ABO (P=0.091) and Rh (P=0.55) blood groups and risk of endometriosis. Also, there was no significant difference between the two groups with regards to the stage of endometriosis and distribution of ABO and Rh blood groups (P>0.05). Although the O blood group was less dominant in Iranian women with endometriosis, we observed no significant correlation between the risk of endometriosis and the ABO and Rh blood groups. Endometriosis severity was not correlated to any of these blood groups. Copyright© by Royan Institute. All rights reserved.

  9. Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link.

    Cicinelli, Ettore; Trojano, Giuseppe; Mastromauro, Marcella; Vimercati, Antonella; Marinaccio, Marco; Mitola, Paola Carmela; Resta, Leonardo; de Ziegler, Dominique

    2017-08-01

    To evaluate the association between endometriosis end chronic endometritis (CE) diagnosed by hysteroscopy, conventional histology, and immunohistochemistry. Case-control study. University hospital. Women with and without endometriosis who have undergone hysterectomy. Retrospective evaluation of 78 women who have undergone hysterectomy and were affected by endometriosis and 78 women without endometriosis. CE diagnosed based on conventional histology and immunohistochemistry with anti-syndecan-1 antibodies to identify CD138 cells. The prevalence of CE was statistically significantly higher in the women with endometriosis as compared with the women who did not have endometriosis (33 of 78, 42.3% vs. 12 of 78, 15.4% according to hysteroscopy; and 30 of 78, 38.5% vs. 11 of 78, 14.1% according to histology). The women were divided into two groups, 115 patients without CE and 41 patients with CE. With univariate analysis, parity was associated with a lower risk for CE, and endometriosis was associated with a statistically significantly elevated risk of CE. Using multivariate analysis, parity continued to be associated with a lower incidence of CE, whereas endometriosis was associated with a 2.7 fold higher risk. The diagnosis of CE is more frequent in women with endometriosis. Although no etiologic relationships between CE and endometriosis can be established, this study suggests that CE should be considered and if necessary ruled out in women with endometriosis, particularly if they have abnormal uterine bleeding. Identification and appropriate treatment of CE may avoid unnecessary surgery. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  10. Endometriosis in Adolescent and Young Girls: Report on a Series of 55 Cases.

    Matalliotakis, Michail; Goulielmos, George N; Matalliotaki, Charoula; Trivli, Alexandra; Matalliotakis, Ioannis; Arici, Aydin

    2017-10-01

    The aim of this retrospective study was to evaluate endometriosis in adolescent and young girls and further to review the menstrual, reproductive characteristics, and risk factors. We reviewed the medical records of adolescent and young girls with endometriosis from 2 different countries. Data were collected and analyzed from charts of 900 patients with endometriosis. Fifty-five female adolescents aged between 13 and 21 years (mean age 18.3 years) participated in our series. This study was conducted in the Obstetric and Gynecology Department of Venizeleio General Hospital of Crete and involved all patients diagnosed with endometriosis between 1996 and 2016. Statistical methods included χ 2 and Mann-Whitney U test. Of 900 patients with endometriosis we found 55 female adolescents (6.1%). The mean age was 18.3 ± 2.3 years, significantly younger compared with the advanced endometriosis patients (32.7 ± 7.2; P endometriosis group. The factors associated with an increased risk for young women include age at menarche, dysmenorrhea, history of asthma, and a positive family history of endometriosis. Additionally, we report on 16 of 55 (32%) adolescent women with endometriosis and congenital malformations (P endometriosis in adolescent and young women and risk factors including early menarche, early onset of dysmenorrhea, history of asthma, previous surgical procedures, obstructive genital anomalies, and family history of endometriosis. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  11. Feasibility of a Smartphone website to support antenatal Perineal massage in pregnant women.

    Takeuchi, Shoko; Horiuchi, Shigeko

    2017-10-16

    In Japan, 85% of pregnant women do not practice antenatal perineal massage. Therefore, we developed a smartphone website to support the practice of antenatal perineal massage. The purpose of the present study was to evaluate the feasibility of our smartphone website. Pregnant women were recruited at five hospitals or clinics in Tokyo, Japan. Participants assigned to the smartphone website group (n = 74) were asked to register on the smartphone website. After completing registration, they could login and use all the contents of the website. After giving birth, participants completed a 5-item questionnaire evaluating the acceptability of the smartphone website. Participants assigned to the leaflet group (n = 71) received a leaflet on antenatal perineal massage and completed a similar 4-item questionnaire evaluating the leaflet. Data were collected from April 2014 to November 2014. Data analysis was performed using chi-square and t-tests to analyze responses to close-ended questions, and content analysis was conducted to analyze responses of open-ended questions. In the smartphone website group, 9 women (12.2%) did not register on the smartphone website. Approximately 80% of the women who responded indicated that the smartphone site was easy to understand and useful for practicing antenatal perineal massage. In the smartphone website group, the reply rate for reporting the frequency of massage was 43.6%. Although the ratings and frequency at which the material was accessed tended to be higher in the smartphone website group than in the leaflet group, there were no significant differences. Most pregnant women in the smartphone website group provided a favorable evaluation for the smartphone website. However, some participants had suggestions for improvement, which need to be incorporated in a revised version of the website. Therefore, the present study's results demonstrate the feasibility of a smartphone website to support the practice of antenatal perineal

  12. Hipospadia perineal em um cão: relato de caso

    F.S. Valente

    2014-06-01

    Full Text Available A hipospadia é uma anomalia congênita da genitália externa, na qual a uretra peniana termina ventral e caudalmente à sua abertura normal. Pode ser classificada, com base na localização da abertura uretral, como glandular, peniana, escrotal, perineal e anal. O objetivo deste trabalho é relatar um caso raro de hipospadia perineal, em que são abordados seus aspectos clínicos e terapêuticos, em um cão macho, sem raça definida, com seis meses de idade. Um canino com histórico de suspeita de hermafroditismo e presença de um orifício, logo abaixo do ânus, pelo qual urinava foi atendido no Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul (UFRGS. Durante o exame físico, foi observado o meato uretral localizado ventralmente ao ânus, além de alterações no prepúcio, pênis e escroto. Foram realizados exames de triagem, tais como: hemograma completo, urinálise, ecografia abdominal e uretrocistografia. O cão foi encaminhado para a cirurgia, quando foi submetido à amputação peniana e prepucial total e também à orquiectomia. O canino recebeu antibioticoterapia, analgésicos, anti-inflamatório e limpezas diárias dos pontos e da região perineal e apresentou excelente recuperação pós-operatória. Após 30 dias da cirurgia, o paciente retornou ao hospital, e foi verificada completa cicatrização da ferida cirúrgica, sem sinais de infecção urinária e inflamação ou assaduras na região perineal. A hipospadia perineal é um caso raro de anomalia uretral congênita, ainda pouco documentada em medicina veterinária. O procedimento cirúrgico realizado demonstrou ser importante, uma vez que removeu toda a genitália externa defeituosa, onde, futuramente, poderiam desenvolver-se infecções e/ou inflamações. Com isso, minimizou as complicações dessa doença e melhorou a qualidade de vida do paciente.

  13. Radical perineal prostatectomy: cost efficient, outcome effective, minimally invasive prostate cancer management.

    Harris, Michael J

    2003-09-01

    Localized prostate cancer is a common disease for which minimally invasive treatment methods are being explored. Perineal prostatectomy, as a historical open procedure, is modified to incorporate contemporary surgical ideas. There is relatively little in the literature regarding modern adaptations of perineal prostatectomy. This method of anatomic radical perineal prostatectomy has been developed to accomplish a minimally invasive method of achieving goals of disease control and preservation of genito-urinary functions. Prospective outcome data is accumulated on 508 consecutive radical perineal prostatectomies by a single surgeon. Pathologic stage and PSA detectability are measures of cancer control. Pad use and ability to complete intercourse measure urinary and sexual function. General complications and other outcome measures are evaluated. Freedom from PSA detectability by pathologic stage is 96.3%, 79.4%, and 69.4% for organ confined, specimen confined and margin positive in the absence of seminal vesical invasion with an average 4 years follow up (3-114 months). Margins are positive in 18% of cases. The average cancer size is 9.4g and 36% of cases have extracapsular invasion. By the first, third, sixth months and one year, 38%, 65%, 88% and 96% are free of pad use and report being dry. While over 80% of nerve-spared patients enjoy the return of spontaneous erectile function, the men with bilateral nerve preservation note earlier and more complete return of function. There are no cardiopulmonary complications or deaths. Transfusions occurred in 1%, none in the past 400 cases. Average total hospital charges are USD$4889.00 in 1999 and 2000. Anterior urethral strictures, anastomotic strictures and fecal urgency/stress flatus occur 2%, 2% and 2-4%, respectively. This method of prostatectomy is able to achieve complete cancer resection while preserving urinary and sexual function as well as laparoscopic or retropubic prostatectomy. The simplicity and minimally

  14. Malignant Transformation of Endometriosis in the Ischioanal Fossa

    Jordan S. Klebanoff

    2018-01-01

    Full Text Available We present the case of a 28-year-old nulliparous female with malignant transformation of an ectopic focus of endometriosis in the right ischioanal fossa. A 28-year-old nulliparous patient with a past medical history of polycystic ovarian syndrome (PCOS was diagnosed with endometrioid adenocarcinoma in her right ischioanal fossa. Initially, patient presented to an emergency department and underwent a CT scan of the appendix to rule out appendicitis. A multiloculated cystic lesion adjacent to the right obturator internus muscle was found. She underwent surgical resection of the mass, which confirmed FIGO grade 2 endometrioid adenocarcinoma, followed by localized radiation therapy. Malignancy arising in endometriosis is rare, and the influence of PCOS on the rate of malignant transformation is not well established.

  15. The role of MR in the evaluation of endometriosis

    Worthington, B.S.; Powell, M.; Symonds, E.M.

    1986-01-01

    Thirty patients with endometriosis were studied by US and MR imaging performed using a 0.15-T resistive system. Imaging findings were compared with findings on laparoscopy. Spin-echo sequences with a long echo time and a short tau inversion-recovery sequence were the most useful in highlighting pelvic implants. The signal patterns associated with the altered blood products within endometriotic cysts allowed the age of the cysts to be estimated. The authors conclude that MR imaging is superior to US in the diagnosis of endometriosis and is useful for monitoring treatment by surgery and estrogen therapy, but laparoscopy is required staging to detect any implants beyond the range of imaging techniques

  16. Blood biomarkers for the non-invasive diagnosis of endometriosis.

    Nisenblat, Vicki; Bossuyt, Patrick M M; Shaikh, Rabia; Farquhar, Cindy; Jordan, Vanessa; Scheffers, Carola S; Mol, Ben Willem J; Johnson, Neil; Hull, M Louise

    2016-05-01

    About 10% of reproductive-aged women suffer from endometriosis, a costly chronic disease causing pelvic pain and subfertility. Laparoscopy is the gold standard diagnostic test for endometriosis, but is expensive and carries surgical risks. Currently, there are no non-invasive or minimally invasive tests available in clinical practice to accurately diagnose endometriosis. Although other reviews have assessed the ability of blood tests to diagnose endometriosis, this is the first review to use Cochrane methods, providing an update on the rapidly expanding literature in this field. To evaluate blood biomarkers as replacement tests for diagnostic surgery and as triage tests to inform decisions on surgery for endometriosis. Specific objectives include:1. To provide summary estimates of the diagnostic accuracy of blood biomarkers for the diagnosis of peritoneal, ovarian and deep infiltrating pelvic endometriosis, compared to surgical diagnosis as a reference standard.2. To assess the diagnostic utility of biomarkers that could differentiate ovarian endometrioma from other ovarian masses. We did not restrict the searches to particular study designs, language or publication dates. We searched CENTRAL to July 2015, MEDLINE and EMBASE to May 2015, as well as these databases to 20 April 2015: CINAHL, PsycINFO, Web of Science, LILACS, OAIster, TRIP, ClinicalTrials.gov, DARE and PubMed. We considered published, peer-reviewed, randomised controlled or cross-sectional studies of any size, including prospectively collected samples from any population of reproductive-aged women suspected of having one or more of the following target conditions: ovarian, peritoneal or deep infiltrating endometriosis (DIE). We included studies comparing the diagnostic test accuracy of one or more blood biomarkers with the findings of surgical visualisation of endometriotic lesions. Two authors independently collected and performed a quality assessment of data from each study. For each diagnostic test

  17. Rectosigmoid endometriosis: comparison between CT water enema and video laparoscopy.

    Stabile Ianora, A A; Moschetta, M; Lorusso, F; Lattarulo, S; Telegrafo, M; Rella, L; Scardapane, A

    2013-09-01

    To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard. Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen's weighted kappa (κ) test was used to evaluate the interobserver agreement. In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84). Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  18. Rectosigmoid endometriosis: Comparison between CT water enema and video laparoscopy

    Stabile Ianora, A.A.; Moschetta, M.; Lorusso, F.; Lattarulo, S.; Telegrafo, M.; Rella, L.; Scardapane, A.

    2013-01-01

    Aim: To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard. Materials and methods: Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen's weighted kappa (κ) test was used to evaluate the interobserver agreement. Results: In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84). Conclusion: Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated

  19. Potential Role of Semaphorin 3A and Its Receptors in Regulating Aberrant Sympathetic Innervation in Peritoneal and Deep Infiltrating Endometriosis.

    Liang, Yanchun; Wang, Wei; Huang, Jiaming; Tan, Hao; Liu, Tianyu; Shang, Chunliang; Liu, Duo; Guo, Luyan; Yao, Shuzhong

    2015-01-01

    Previous studies have demonstrated the involvement of nerve repellent factors in regulation of the imbalanced innervation of endometriosis. This prospective study aims to explore the role of Sema 3A in regulating aberrant sympathetic innervation in peritoneal and deep infiltrating endometriosis. Ectopic endometriotic lesion were collected from patients with peritoneal endometriosis (n = 24) and deep infiltrating endometriosis of uterosacral ligament (n = 20) undergoing surgery for endometriosis. Eutopic endometrial samples were collected from patients with endometriosis (n = 22) or without endometriosis (n = 26). Healthy peritoneum (n = 13) from the lateral pelvic wall and healthy uterosacral ligament (n = 13) were obtained from patients who had no surgical and histological proof of endometriosis during hysterectomy for uterine fibroids. Firstly, we studied the immunostaining of Sema 3A, Plexin A1 and NRP-1 in all the tissues described above. Then we studied the nerve fiber density (NFD) of endometriosis-associated (sympathetic) nerve and para-endometriotic (sympathetic) nerve by double immunofluorescence staining. Finally we analyzed the relationship between expression of Sema 3A in stromal cells of endometriotic lesion and the aberrant innervation of endometriosis. Semi-quantitative immunostaining demonstrated that (1) Higher immunostaining of Sema 3A were found in the eutopic endometrial glandular epithelial cells from patients with endometriosis (p = 0.041) than those without endometriosis; (2) Sema 3A immunostaining was higher in glandular epithelial cells of peritoneal endometriosis (Pendometriosis, while its expression in ectopic stormal cells in both groups were significantly lower than that from eutopic endometrium of women without endometirosis (Pendometriosis-associated sympathetic nerve of peritoneal endometriosis (pendometriosis of uterosacral ligament (pperitoneal and deep infiltrating endometriosis.

  20. Combination of the non-invasive tests for the diagnosis of endometriosis

    Nisenblat, Vicki; Prentice, Lucy; Bossuyt, Patrick M. M.; Farquhar, Cindy; Hull, M. Louise; Johnson, Neil

    2016-01-01

    Background About 10% of women of reproductive age suffer from endometriosis, a costly chronic disease causing pelvic pain and subfertility. Laparoscopy is the gold standard diagnostic test for endometriosis, but is expensive and carries surgical risks. Currently, there are no non-invasive tests

  1. Identification of Circular RNAs as a Novel Biomarker for Ovarian Endometriosis

    Xiao-Xuan Xu

    2018-01-01

    Conclusions: This study provides evidence that circRNAs are differentially expressed between eutopic and normal endometrium, which suggests that circRNAs are candidate factors in the activation of endometriosis. circ_0002198 and circ_0004712 may be potential novel biomarkers for the diagnosis of ovarian endometriosis.

  2. A Case with Severe Endometriosis, Ovarian Hyperstimulation Syndrome, and Isolated Unilateral Pleural Effusion after IVF

    Sopa, Negjyp; Larsen, Elisabeth Clare; Andersen, Anders Nyboe

    2017-01-01

    We present a very rare case of right-sided isolated pleural effusion in a patient with severe endometriosis who, in relation to in vitro fertilization (IVF), developed ovarian hyperstimulation syndrome (OHSS). Earlier laparotomy showed grade IV endometriosis including endometriotic implants...

  3. In vitro fertilization outcome in women with endometriosis & previous ovarian surgery

    Sonja Pop-Trajkovic

    2014-01-01

    Full Text Available Background & objectives: Women with endometriosis often need in vitro fertilization (IVF to concieve. There are conflicting data on the results of IVF in patients with endometriosis. This study was undertaken to elucidate the influence of endometriosis on IVF outcome to give the best counselling for infertile patient with this problem. Methods: The outcome measures in 78 patients with surgically confirmed endometriosis were compared with 157 patients with tubal factor infertility, all of whom have undergone IVF. The groups were matched for age and follicle stimulating hormone (FSH levels. Outcome measures included number of follicles, number of ocytes, peak oestradiol (E2 concentrations and mean number of ampoules of gonadotropins. Cumulative pregnancy, miscarriage and live birth rates were calculated in both the groups. Results: Higher cancelation rates, higher total gonadotropin requirements, lower peak E2 levels and lower oocyte yield were found in women with endometriosis and previous surgery compared with those with tubal factor infertility. However, no differences were found in fertilization, implantation, pregnancy, miscarriage, multiple births and delivery rates between the endometriosis and tubal factor infertility groups. Interpretation & conclusions: The present findings showed that women with endometriosis and previous surgery responded less well to gonadotropins during ovarian stimulation and hence the cost of treatment to achieve pregnancy was higher in this group compared with those with tubal factor infertility. However, the outcome of IVF treatment in patients with endometriosis was as good as in women with tubal factor infertility.

  4. Examining subjective wellbeing and health-related quality of life in women with endometriosis.

    Rush, Georgia; Misajon, RoseAnne

    2018-03-01

    The purpose of this study was to explore the subjective wellbeing, health-related quality of life and lived experience of women living with endometriosis. In 2015 five hundred participants between the ages of 18-63 (M = 30.5, SD = 7.46) were recruited through Endometriosis Australia and social media, completing an online questionnaire comprising the Personal Wellbeing Index, the Endometriosis Health Profile-30 and various open-ended questions. Results found that women with endometriosis reported low levels of subjective wellbeing (mean PWI total scores of 51.5 ± 2.03), considerably below the normative range of 70-80 for western populations. The mean Endometriosis Health Profile total score indicated a very low health-related quality of life amongst the women in this sample (78.9, ±13.14). There was also a significant relationship between scores on the Endometriosis Health Profile and Personal Wellbeing Index. The findings from the qualitative data suggest that endometriosis impacts negatively on women's lives in several areas such as; social life, relationships and future plans, this in turn affects women's overall life quality. The study highlights the strong negative impact that endometriosis can have on women's subjective wellbeing and health related quality of life, contributing to productivity issues, relationship difficulties and social dissatisfaction and increasing the risk of psychological comorbidities.

  5. How can macroscopically normal peritoneum contribute to the pathogenesis of endometriosis?

    Fassbender, Amelie; Overbergh, Lut; Verdrengh, Eefje; Kyama, Cleophas M; Vodolazakaia, Alexandra; Bokor, Attila; Meuleman, Christel; Peeraer, Karen; Tomassetti, Carla; Waelkens, Etienne; Mathieu, Chantal; D'Hooghe, Thomas

    2011-09-01

    This study indicates that the immunobiology of macroscopically normal peritoneum is relevant to understand the pathogenesis of endometriosis. Peritoneal interleukin 6, interleukin 12, and ferritin were differentially expressed in women with and without endometriosis. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  6. Epidemiology of Endometriosis in France: A Large, Nation-Wide Study Based on Hospital Discharge Data

    Peter von Theobald

    2016-01-01

    Full Text Available We aimed to assess the prevalence of hospitalization for endometriosis in the general population in France and in each French region and to describe temporal trends, rehospitalization rates, and prevalence of the different types of endometriosis. The analyses were carried out on French hospital discharge data and covered the period 2008–2012 and a population of 14,239,197 women of childbearing age. In this population, the prevalence of hospitalization for endometriosis was 0.9%, ranging from 0.4% to 1.6% between regions. Endometriosis affected 1.5% of hospitalized women of childbearing age, ranging from 1.0% to 2.4% between regions. The number of patients hospitalized for endometriosis significantly increased over the study period (p<0.01. Of these, 4.2% were rehospitalized at least once at one year: ranging from 2.7% to 6.3% between regions. The cumulative rehospitalization rate at 3 years was 6.9%. The types of endometriosis according to the procedures performed were as follows: ovarian (40–50%, peritoneal (20–30%, intestinal (10–20%, and ureteral or bladder (<10%, with significant differences between regions. This is the first detailed epidemiological study of endometriosis in France. Further studies are needed to assess the reasons for the increasing prevalence of endometriosis and for the significant differences in regional prevalence of this disease.

  7. Costs of endometriosis in Austria: a survey of direct and indirect costs.

    Prast, Johanna; Oppelt, Peter; Shamiyeh, Andreas; Shebl, Omar; Brandes, Iris; Haas, Dietmar

    2013-09-01

    The literature includes a wealth of medical data on endometriosis, but the economic significance of the condition has so far been neglected. An analysis of hospital costs for endometriosis in Austria was, therefore, carried out for economic purposes. Seventy-three patients with endometriosis were included in the study. A bottom-up approach was used to collect data on the average hospital costs of an endometriosis patient over a time period of 1 year. In addition, a prevalence approach was used that allows subsequent estimation of the total costs of endometriosis for the health-care system in Austria for that period. Retrospective questionnaire survey was conducted. The average annual costs of one case of endometriosis are 7,712, with 5,605.55 attributable to direct costs and 2,106.34 to indirect costs. This indicates an overall economic burden of 328 million. In-patient care (45 %) and loss of productivity (27 %) were identified as the major cost factors. The patients themselves pay for 13 % of the costs (through out-of-pocket payments). This study impressively demonstrates the financial burden on the economy and on each individually affected patient caused by the disease of endometriosis. The massive consumption of resources represents a high level of usage of the medical services provided. The question arises as to whether more timely diagnosis, followed by better-targeted treatment, might have the potential to reduce these costs. The overall economic burden of endometriosis in Austria is currently comparable with that of Parkinson's disease.

  8. Pelvic Pain and Quality of Life Before and After Laparoscopic Bowel Resection for Rectosigmoid Endometriosis

    Riiskjær, Mads; Forman, Axel; Kesmodel, Ulrik S

    2018-01-01

    BACKGROUND: Surgery for rectosigmoid endometriosis carries a substantial risk of short- and long-term complications, which has to be counterbalanced against the potential effect of the procedure. Prospective data are scarce in the field of deep infiltrating endometriosis surgery. OBJECTIVE...

  9. Polypoid endometriosis mimicking invasive cancer in an obese, postmenopausal tamoxifen user

    William T. Jaegle

    2017-11-01

    Précis: Endometriosis is a benign estrogen dependent condition rarely problematic in a postmenopausal patient. Tamoxifen use in the setting of an obese patient may contribute to a proliferation of pre-existing endometriosis which resembles an aggressive late-stage gynecological malignancy.

  10. The significant effect of endometriosis on physical, mental and social wellbeing

    De Graaff, A A; D'Hooghe, T M; Dunselman, G A J

    2013-01-01

    To what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease?......To what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease?...

  11. Ovarian irradiation in recurrent endometriosis; Irradiation ovarienne pour endometriose refractaire inoperable

    Kochbati, L.; Chaari, N.; Besbes, M.; Maalej, M. [Institut Salah-Azaiz, Service de Radiotherapie Carcinologique Tunis (Tunisia); Neji, K.; Ben Amara, F. [Centre de Maternite et de Neonatologie de Tunis, Service B (Tunisia); Ben Romdhane, N.K. [Hopital La-Rabta, Service d' Hematologie, Tunis (Tunisia)

    2005-09-15

    We describe a case of a young woman with a history of an aplastic anaemia in which pelvic radiotherapy was used successfully in the management of a recurrent and inoperable endometriosis. The use of therapeutic pelvic or ovarian irradiation in endometriosis may be considered, when surgical and medical treatments have been exhausted and have failed. (authors)

  12. Diagnosis of uterus endometriosis in women of reproductive age using magnetic resonance imaging

    Mertsalova, O.V.

    1997-01-01

    The results of complex clinical and magnetic resonance imaging (MRI) study of 103 women of reproductive age with uterus endometriosis are discussed. Uterus endometriosis and myoma can have similar clinical picture, which makes their differential diagnosis difficult. MRI is the method allowing to reveal significant difference between the diseases

  13. Induction of Endometriosis in Mice: A New Model Sensitive to Estrogen

    Endometriosis consists of the growth of endometrial tissue outside the uterus. A rat model of endometriosis is available to evaluate the potential for environmental chemicals to promote the disease but may he relatively insensitive for the evaluation of the hazard of certain comp...

  14. Therapeutically Targeting the Inflammasome Product in a Chimeric Model of Endometriosis-Related Surgical Adhesions.

    Stocks, Meredith M; Crispens, Marta A; Ding, Tianbing; Mokshagundam, Shilpa; Bruner-Tran, Kaylon L; Osteen, Kevin G

    2017-08-01

    Development of adhesions commonly occurs in association with surgery for endometriosis. Even in the absence of surgery, women with endometriosis appear to be at an enhanced risk of developing adhesions. In the current study, we utilized a chimeric mouse model of experimental endometriosis in order to examine the role of inflammasome activation in the development of postsurgical adhesions. Mice were randomized to receive peritoneal injections of human endometrial tissue fragments or endometrial tissue conditioned media (CM) from women with or without endometriosis 16 hours after ovariectomy and placement of an estradiol-releasing silastic capsule. A subset of mice receiving CM was also treated with interleukin (IL) 1 receptor antagonist (IL-1ra). Our studies demonstrate that peritoneal injection of endometrial tissue fragments near the time of surgery resulted in extensive adhesive disease regardless of tissue origin. However, adhesion scores were significantly higher in mice receiving CM from tissues acquired from patients with endometriosis compared to control tissue CM ( P = .0001). Cytokine bead array analysis of endometrial CM revealed enhanced expression of IL-1β from patients with endometriosis compared to controls ( P endometriosis as a potential causal factor in their increased susceptibility of developing postsurgical adhesions. Thus, targeting inflammasome activation may be an effective strategy for the prevention of surgical adhesions in patients with endometriosis.

  15. Differential expression of EWI-2 in endometriosis, its functional role and underlying molecular mechanisms.

    Zheng, Tingting; Yang, Jing

    2017-07-01

    We aimed to investigate EWI-2 expression in endometrium tissues collected from women with endometriosis at mRNA and protein levels, to evaluate its potential as a biomarker for endometriosis and to study its functional role via possible regulation of the PI3K/Akt signaling pathway. Endometrium tissues were collected from patients with endometriosis and healthy individuals. EWI-2 mRNA expression was evaluated using quantitative real-time PCR (qRT-PCR) while EWI-2 protein levels were determined by western blotting. For functional studies, EWI-2 shRNA was transfected in endometrial epithelial cells and the in vitro migration and invasion assays were performed using the Transwell chambers. EWI-2 was significantly downregulated in tissues obtained from patients with endometriosis compared with healthy individuals (P endometriosis diagnosis was 0.8942 (P = 0.003), 0.9643 (P = 0.0001), 0.9912 (P endometriosis in matched comparisons of data originated from the proliferative, early, middle, and late secretory phases. Over the menstrual cycle, the expression of EWI-2 was significantly decreased in the eutopic tissues compared to the ectopic tissues. Further cellular and molecular analyses showed that EWI-2 inhibited cell migration and invasion via the Akt signaling. Our findings suggested that downregulation of EWI-2 may contribute to endometriosis physiopathology and potentiate EWI-2 as a valuable diagnostic biomarker and therapeutic target for endometriosis. © 2017 Japan Society of Obstetrics and Gynecology.

  16. Progesterone receptor gene polymorphisms and risk of endometriosis: results from an international collaborative effort

    Near, Aimee M; Wu, Anna H; Templeman, Claire

    2011-01-01

    To investigate the association between self-reported endometriosis and the putative functional promoter +331C/T single nucleotide polymorphism and the PROGINS allele.......To investigate the association between self-reported endometriosis and the putative functional promoter +331C/T single nucleotide polymorphism and the PROGINS allele....

  17. The involvement of T lymphocytes in the pathogenesis of endometriotic tissues overgrowth in women with endometriosis

    Krzysztof Szyllo

    2003-01-01

    Full Text Available Background: Endometriosis, uncontrolled proliferation of ectopic and eutopic endometriotic tissues, is common in women at reproductive age, and may affect fertility. The role of macrophages in the pathogenesis is well proved, but engagement of T cells in the pathogenesis of endometriosis is a matter of controversy

  18. [The so-called "chocolate cyst"--frequently misinterpreted as ovarian endometriosis?].

    Christensen, B; Schindler, A E

    1996-09-01

    Limitation of morphological diagnostic and possible misinterpretations are shown in a patient with anamnestic ovarian endometriosis. In cases of "chocolate cysts" it is necessary to differentiate between ovarian endometriosis and functional cysts. Hints for the existence of a functional cyst are an atypical past history or perioperative findings. Biochemical analysis of the cyst fluid may lead to a correct diagnosis.

  19. Danazol: an antigonadotropic agent in the treatment of pelvic endometriosis.

    Lauersen, N H; Wilson, K H; Birnbaum, S

    1975-12-01

    Danazol, an antigonadotropic agent, was administered in a dosage of 800 mg. daily for six months to 32 patients with pelvic endometriosis. Twenty-eight patients (87.5 per cent) were found to have a marked improvement of both clinical and subjective symptoms of endometriosis. Furthermore, Danazol was found to be effective in three patients with chronic cystic mastitis and one patient with fibrocystic disease. There was no change in uterine size in two patients with uterine adenomyosis and one patient with uterine myomas during the treatment period. Danazol was ineffective in relieving the symptoms of the menopausal syndrome in one patient. The main side effects of Danazol treatment were weight gain and water retention which were maximal at four months of treatment and then decreased. Other side effects such as acne, oiliness of skin, and voice change were rare in this series. Danazol therapy was found to be very effective in this study for the treatment of pelvic endometriosis, and the drug was well tolerated by the patients.

  20. Peculiarities of immune effects in patients with genital endometriosis

    Gasanova Ch.A.

    2011-12-01

    Full Text Available The research goal is to study the immune effects in patients with external genital endometriosis. 126 patients with external genital endometriosis ages 22-44 years have been examined. CD3+, CD4+, CD8+, CD16+, CD19+, CD25+, immunoglobulin A, M, G are defined in peripheral blood and peritoneal liquid. Method of cytoflowmetry and radial immunodiffusion by Manchini has been used. Statistical processing of results has been spent by means of a package of the statistical program «Statgraphics», STSC (USA. Reliability of variability has been estimated by means of calculation of nonparametric criterion by Uilkokson — Mann — Uitni. Depression of cellular and increase of humoral immunity (IgG and IgA in peritoneal liquid have been revealed. Degree of expressiveness of immunity has been depended on presence of inflammatory diseases, duration of disease, localization of the pathology center. In peritoneal liquid the total amount of T-lymphocytes, CD4+ cells and CD8+ lymphocytes has been increased in patients with of external genital endometriosis of lll-IV degree. The immunoregulatory index has been also increased. These results have confirmed the presence of inflammatory process in peritoneal cavity