Pub Date : 2020-10-29DOI: 10.1177/2284026520966504
M. Antonio, A. Walter, Ranieri Giorgia, Civiletto Anna, A. Luigi, Incandela Domenico
The presence of catamenial epilepsy in patients diagnosed with endometriosis is the symptom that would direct towards a suspected cerebral endometriotic localization. However, data research of medical literature supporting this diagnosis shows a small number of studies and the specific research on medline led to the finding of only four case reports. Hence forward, we will report a case of a patient with the surgical diagnosis of ovarian endometriosis, whom had signs of catamenial epilepsy resistant to medical therapy, and with contraindication to hormone therapy because of cerebral ischemic episodes, subjected to laparoscopic bilateral ovarosalpingectomy.
{"title":"A surgical solution for a catamenial epilepsy medical therapy-resistant: A presumed case of cerebral endometriosis?","authors":"M. Antonio, A. Walter, Ranieri Giorgia, Civiletto Anna, A. Luigi, Incandela Domenico","doi":"10.1177/2284026520966504","DOIUrl":"https://doi.org/10.1177/2284026520966504","url":null,"abstract":"The presence of catamenial epilepsy in patients diagnosed with endometriosis is the symptom that would direct towards a suspected cerebral endometriotic localization. However, data research of medical literature supporting this diagnosis shows a small number of studies and the specific research on medline led to the finding of only four case reports. Hence forward, we will report a case of a patient with the surgical diagnosis of ovarian endometriosis, whom had signs of catamenial epilepsy resistant to medical therapy, and with contraindication to hormone therapy because of cerebral ischemic episodes, subjected to laparoscopic bilateral ovarosalpingectomy.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"66 - 68"},"PeriodicalIF":0.5,"publicationDate":"2020-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520966504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49234214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-25DOI: 10.1177/2284026520967865
B. Zizolfi, V. Foreste, A. Di Spiezio Sardo, P. Giampaolino, Annarita Gencarelli, J. Carugno, G. Bifulco
Endometriosis is the presence of endometrial tissue outside the uterine cavity. Rectovaginal infiltration is present in 5% to 25% of the patients diagnosed with endometriosis. Accurate diagnosis is imperative for adequate counseling. Hysteroscopic vaginoscopy allows the inspection of the posterior vaginal fornix, not only providing better visualization of the area due to image magnification, but also allowing to obtain biopsy providing pathologic confirmation. We report the case of a 49-year-old nulliparous patient with long history of severe dysmenorrhea, deep dyspareunia and debilitating chronic pelvic pain not responding to medical treatment. On physical exam, recto-vaginal tender nodularity was palpated. Vaginal ultrasound and magnetic resonance imaging confirmed the presence of the nodular formation extending up to the rectum. In-office vaginoscopy revealed a perforated bulge on the uterine cervix, mimicking a double cervix. A biopsy of the nodule confirmed the presence of endometrial tissue, confirming the diagnosis of endometriosis. Patient underwent total hysterectomy with excision of deep infiltrating endometriosis which required segmental bowel resection with diverting loop colostomy. The final pathology confirmed the diagnosis of deep infiltrating endometriosis.
{"title":"Hysteroscopic vaginoscopy. An additional diagnostic tool for recto-vaginal deep infiltrating endometriosis","authors":"B. Zizolfi, V. Foreste, A. Di Spiezio Sardo, P. Giampaolino, Annarita Gencarelli, J. Carugno, G. Bifulco","doi":"10.1177/2284026520967865","DOIUrl":"https://doi.org/10.1177/2284026520967865","url":null,"abstract":"Endometriosis is the presence of endometrial tissue outside the uterine cavity. Rectovaginal infiltration is present in 5% to 25% of the patients diagnosed with endometriosis. Accurate diagnosis is imperative for adequate counseling. Hysteroscopic vaginoscopy allows the inspection of the posterior vaginal fornix, not only providing better visualization of the area due to image magnification, but also allowing to obtain biopsy providing pathologic confirmation. We report the case of a 49-year-old nulliparous patient with long history of severe dysmenorrhea, deep dyspareunia and debilitating chronic pelvic pain not responding to medical treatment. On physical exam, recto-vaginal tender nodularity was palpated. Vaginal ultrasound and magnetic resonance imaging confirmed the presence of the nodular formation extending up to the rectum. In-office vaginoscopy revealed a perforated bulge on the uterine cervix, mimicking a double cervix. A biopsy of the nodule confirmed the presence of endometrial tissue, confirming the diagnosis of endometriosis. Patient underwent total hysterectomy with excision of deep infiltrating endometriosis which required segmental bowel resection with diverting loop colostomy. The final pathology confirmed the diagnosis of deep infiltrating endometriosis.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"149 - 151"},"PeriodicalIF":0.5,"publicationDate":"2020-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520967865","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49518916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-13DOI: 10.1177/2284026520960846
A. Weyl, Claire Illac, M. Delchier, B. Suc, E. Cuellar, E. Chantalat
Introduction: Splenic parenchymal endometriosis has never been described to date. We report here the case of real parenchymal endometriosis of the spleen. Case description: In this case, a 54-year-old female patient presented a histologically proven metastatic recurrence of breast cancer in the internal breast chain. The CT-scan also detected a large cystic structure developed from the spleen, but non-suspected to be metastasis. The patient was treated with chemotherapy (paclitaxel) and a combination of targeted therapies (everolimus and trastuzumab). While a complete radiological and biological response was noted at 2 months, the splenic cyst gradually decreased over the years. When targeted therapies were stopped, a reincrease of the splenic lesion and de novo significant hypermetabolism of the splenic parenchyma on 18F-FDG PET scan were observed. A splenectomy was finally performed and revealed splenic parenchymal endometriosis. Conclusion: This case once again highlights the complexity of endometriosis disease, from a pathophysiological point of view, but also the difficulties of radiological characterisation, and diagnostic management.
{"title":"Splenic lesion mimicking breast metastasis: The first description of splenic parenchymal endometriosis","authors":"A. Weyl, Claire Illac, M. Delchier, B. Suc, E. Cuellar, E. Chantalat","doi":"10.1177/2284026520960846","DOIUrl":"https://doi.org/10.1177/2284026520960846","url":null,"abstract":"Introduction: Splenic parenchymal endometriosis has never been described to date. We report here the case of real parenchymal endometriosis of the spleen. Case description: In this case, a 54-year-old female patient presented a histologically proven metastatic recurrence of breast cancer in the internal breast chain. The CT-scan also detected a large cystic structure developed from the spleen, but non-suspected to be metastasis. The patient was treated with chemotherapy (paclitaxel) and a combination of targeted therapies (everolimus and trastuzumab). While a complete radiological and biological response was noted at 2 months, the splenic cyst gradually decreased over the years. When targeted therapies were stopped, a reincrease of the splenic lesion and de novo significant hypermetabolism of the splenic parenchyma on 18F-FDG PET scan were observed. A splenectomy was finally performed and revealed splenic parenchymal endometriosis. Conclusion: This case once again highlights the complexity of endometriosis disease, from a pathophysiological point of view, but also the difficulties of radiological characterisation, and diagnostic management.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"69 - 73"},"PeriodicalIF":0.5,"publicationDate":"2020-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520960846","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43261795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-13DOI: 10.1177/2284026520960855
S. Singh, A. Soliman, Yasmine Rahal, C. Robert, I. Defoy, Paul Nisbet, N. Leyland
Introduction: We aimed to characterize the treatment patterns of women with a self-reported diagnosis of endometriosis in Canada. Methods: Between December 2018 and January 2019 an online cross-sectional survey was administered to women aged 18 to 49 who were members of the Survey Sampling International and two partner panels in Canada. The survey included a prevalence screener and an endometriosis-focused section. Self-reported treatment patterns among women reporting endometriosis diagnosis were analyzed descriptively. Results: Of 30,000 survey respondents, 2004 reported an endometriosis diagnosis (prevalence after weighting of 7%). Treatment status reported by these women was: 34.2% currently treated, 35.9% with prior but no current treatment, and 27.1% never treated. Among women with prior or current treatment, over-the-counter (OTC) medications, contraceptive pills/patches, and surgical procedures were used by 42.0%, 37.1%, and 26.4%, respectively, prior to diagnosis and by 39.9%, 33.0%, and 43.5%, respectively, following diagnosis. First treatments for endometriosis most commonly reported were OTC medications (28.9%) and surgical procedures (21.6%). Second treatments were reported by 46.5% of women, with surgical procedures (26.1%) being the most frequently reported. The most commonly reported endometriosis-associated surgeries were surgical ablation/excision (37.4%). Conclusion: A relevant proportion of women with endometriosis in Canada have multiple therapies with medical management as a first line followed by surgical options. These results emphasize the need to identify more effective and specific endometriosis treatment options and novel strategies.
{"title":"Treatment patterns of women with endometriosis in Canada","authors":"S. Singh, A. Soliman, Yasmine Rahal, C. Robert, I. Defoy, Paul Nisbet, N. Leyland","doi":"10.1177/2284026520960855","DOIUrl":"https://doi.org/10.1177/2284026520960855","url":null,"abstract":"Introduction: We aimed to characterize the treatment patterns of women with a self-reported diagnosis of endometriosis in Canada. Methods: Between December 2018 and January 2019 an online cross-sectional survey was administered to women aged 18 to 49 who were members of the Survey Sampling International and two partner panels in Canada. The survey included a prevalence screener and an endometriosis-focused section. Self-reported treatment patterns among women reporting endometriosis diagnosis were analyzed descriptively. Results: Of 30,000 survey respondents, 2004 reported an endometriosis diagnosis (prevalence after weighting of 7%). Treatment status reported by these women was: 34.2% currently treated, 35.9% with prior but no current treatment, and 27.1% never treated. Among women with prior or current treatment, over-the-counter (OTC) medications, contraceptive pills/patches, and surgical procedures were used by 42.0%, 37.1%, and 26.4%, respectively, prior to diagnosis and by 39.9%, 33.0%, and 43.5%, respectively, following diagnosis. First treatments for endometriosis most commonly reported were OTC medications (28.9%) and surgical procedures (21.6%). Second treatments were reported by 46.5% of women, with surgical procedures (26.1%) being the most frequently reported. The most commonly reported endometriosis-associated surgeries were surgical ablation/excision (37.4%). Conclusion: A relevant proportion of women with endometriosis in Canada have multiple therapies with medical management as a first line followed by surgical options. These results emphasize the need to identify more effective and specific endometriosis treatment options and novel strategies.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"25 - 31"},"PeriodicalIF":0.5,"publicationDate":"2020-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520960855","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49141366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1177/2284026521990201
O. Mutter, S. Ackroyd, G. A. Taylor, J. Diaz
Introduction: To evaluate differences in surgical outcomes of minimally invasive hysterectomy performed for endometriosis between general gynecologists and gynecologic oncologists. Methods: Utilizing the 2016–2018 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) hysterectomy dataset, we evaluated baseline characteristics and surgical outcomes for patients who underwent a minimally invasive hysterectomy for endometriosis between general gynecology and gynecologic oncology groups. Results: From 2016 to 2018, a total of 3751 minimally invasive hysterectomies were performed for the primary diagnosis of endometriosis. Of these cases, 3129 (83.4%) were performed by general gynecologists and 622 (16.6%) by gynecologic oncologists. There were several differences in baseline characteristics between the groups. Notably, general gynecologists performed a higher proportion of vaginal hysterectomies (7.9% vs 0.6%, p < 0.01). There were no statistically significant differences in overall 30-day complications or mortality between general gynecology and oncology groups, with the exception of a higher rate of postoperative sepsis (0.8% vs 0.2%, p = 0.01) in hysterectomies performed by oncologists. Compared to general gynecologists, oncologists had a longer operative time (134.9 ± 65.4 min vs 129 ± 60.9 min, p = 0.05). Multivariate regression of multiple tracked and composite outcomes revealed no consistent confounding variables other than race. In fact, African American race was a statistically significant predictive factor of composite complications (OR 1.80, p < 0.01), morbidity (OR 1.84, p < 0.05), and unplanned readmission (OR 2.30, p < 0.01). Surgeon specialty was not associated with composite complications, hysterectomy-specific complications, or readmission. Conclusion: There are no significant differences in surgical outcomes for minimally invasive hysterectomy for endometriosis between these two surgical subspecialties.
前言:评价微创子宫切除术治疗子宫内膜异位症在普通妇科医生和妇科肿瘤医生之间的手术效果差异。方法:利用2016-2018年美国外科医师学会国家手术质量改进计划(NSQIP)子宫切除术数据集，我们评估了普通妇科和妇科肿瘤组接受微创子宫切除术治疗子宫内膜异位症患者的基线特征和手术结果。结果:2016年至2018年共行微创子宫切除术3751例，初步诊断为子宫内膜异位症。其中，3129例(83.4%)由普通妇科医生执行，622例(16.6%)由妇科肿瘤科医生执行。两组之间的基线特征存在一些差异。值得注意的是，普通妇科医生进行阴道子宫切除术的比例更高(7.9%比0.6%，p < 0.01)。妇科组和肿瘤组在30天总并发症和死亡率方面无统计学差异，但肿瘤组子宫切除术后脓毒症发生率较高(0.8% vs 0.2%， p = 0.01)。与普通妇科医生相比，肿瘤科医生的手术时间更长(134.9±65.4 min vs 129±60.9 min, p = 0.05)。多径和复合结果的多元回归显示除种族外没有一致的混杂变量。事实上，非裔美国人种族是综合并发症(OR 1.80, p < 0.01)、发病率(OR 1.84, p < 0.05)和意外再入院(OR 2.30, p < 0.01)的统计学显著预测因素。外科医生专业与复合并发症、子宫切除术特异性并发症或再入院无关。结论:微创子宫切除术治疗子宫内膜异位症的手术效果在这两个外科亚专科间无显著差异。
{"title":"Minimally invasive hysterectomy for endometriosis: Surgical outcomes based on surgeon specialty","authors":"O. Mutter, S. Ackroyd, G. A. Taylor, J. Diaz","doi":"10.1177/2284026521990201","DOIUrl":"https://doi.org/10.1177/2284026521990201","url":null,"abstract":"Introduction: To evaluate differences in surgical outcomes of minimally invasive hysterectomy performed for endometriosis between general gynecologists and gynecologic oncologists. Methods: Utilizing the 2016–2018 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) hysterectomy dataset, we evaluated baseline characteristics and surgical outcomes for patients who underwent a minimally invasive hysterectomy for endometriosis between general gynecology and gynecologic oncology groups. Results: From 2016 to 2018, a total of 3751 minimally invasive hysterectomies were performed for the primary diagnosis of endometriosis. Of these cases, 3129 (83.4%) were performed by general gynecologists and 622 (16.6%) by gynecologic oncologists. There were several differences in baseline characteristics between the groups. Notably, general gynecologists performed a higher proportion of vaginal hysterectomies (7.9% vs 0.6%, p < 0.01). There were no statistically significant differences in overall 30-day complications or mortality between general gynecology and oncology groups, with the exception of a higher rate of postoperative sepsis (0.8% vs 0.2%, p = 0.01) in hysterectomies performed by oncologists. Compared to general gynecologists, oncologists had a longer operative time (134.9 ± 65.4 min vs 129 ± 60.9 min, p = 0.05). Multivariate regression of multiple tracked and composite outcomes revealed no consistent confounding variables other than race. In fact, African American race was a statistically significant predictive factor of composite complications (OR 1.80, p < 0.01), morbidity (OR 1.84, p < 0.05), and unplanned readmission (OR 2.30, p < 0.01). Surgeon specialty was not associated with composite complications, hysterectomy-specific complications, or readmission. Conclusion: There are no significant differences in surgical outcomes for minimally invasive hysterectomy for endometriosis between these two surgical subspecialties.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"89 - 97"},"PeriodicalIF":0.5,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026521990201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42296624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-07DOI: 10.1177/2284026520946207
A. Yorgancı, N. Kadıoğlu, Harika Gümgümcü, Ş. Özyer, Y. Engin-Ustun
Objective: It is suggested that prolactin has a role in the pathogenesis of uterine adenomyosis. Besides, it is also reported that elevated cancer antigen 125 levels are related with this benign disorder. The aim of the study was to investigate serum prolactin and cancer antigen 125 levels in patients with adenomyosis. Methods: In this retrospective chart review study, data of patients with clinically diagnosed and histopathologically proven adenomyosis in hysterectomy specimens were analyzed. Patients were divided into two groups according to the ultrasonographically calculated preoperative uterine volume: Group 1 (n = 62): uterine volume ⩽240 cm3 (⩽12 gestational weeks) and Group 2 (n = 42): uterine volume >240 cm3 (>12 gestational weeks). Age, obstetric history, body mass index, preoperative hemoglobin, thyroid stimulating hormone, prolactin and cancer antigen 125 levels, and ultrasonographic findings were recorded. Preoperative prolactin and cancer antigen 125 values were compared between the two groups. Results: A total of 104 patients were included in the study. No differences in the baseline characteristics were observed between the groups, except the number of pregnancies and miscarriages. Furthermore, no significant differences were observed in terms of serum prolactin and cancer antigen 125 levels between the groups. Conclusion: Serum prolactin and cancer antigen 125 levels were not associated with uterine volume in patients with uterine adenomyosis.
{"title":"Serum prolactin and CA 125 levels in uterine adenomyosis","authors":"A. Yorgancı, N. Kadıoğlu, Harika Gümgümcü, Ş. Özyer, Y. Engin-Ustun","doi":"10.1177/2284026520946207","DOIUrl":"https://doi.org/10.1177/2284026520946207","url":null,"abstract":"Objective: It is suggested that prolactin has a role in the pathogenesis of uterine adenomyosis. Besides, it is also reported that elevated cancer antigen 125 levels are related with this benign disorder. The aim of the study was to investigate serum prolactin and cancer antigen 125 levels in patients with adenomyosis. Methods: In this retrospective chart review study, data of patients with clinically diagnosed and histopathologically proven adenomyosis in hysterectomy specimens were analyzed. Patients were divided into two groups according to the ultrasonographically calculated preoperative uterine volume: Group 1 (n = 62): uterine volume ⩽240 cm3 (⩽12 gestational weeks) and Group 2 (n = 42): uterine volume >240 cm3 (>12 gestational weeks). Age, obstetric history, body mass index, preoperative hemoglobin, thyroid stimulating hormone, prolactin and cancer antigen 125 levels, and ultrasonographic findings were recorded. Preoperative prolactin and cancer antigen 125 values were compared between the two groups. Results: A total of 104 patients were included in the study. No differences in the baseline characteristics were observed between the groups, except the number of pregnancies and miscarriages. Furthermore, no significant differences were observed in terms of serum prolactin and cancer antigen 125 levels between the groups. Conclusion: Serum prolactin and cancer antigen 125 levels were not associated with uterine volume in patients with uterine adenomyosis.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"12 1","pages":"165 - 169"},"PeriodicalIF":0.5,"publicationDate":"2020-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520946207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42090464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-24DOI: 10.1177/2284026520942432
Tesia G Kim, L. Sudhof, Fong W Liu, S. Shainker
Background: Hemoperitoneum in pregnancy requires urgent evaluation. While spontaneous intraperitoneal bleeding is rare, ectopic endometrial tissue is a frequent cause of this event. Case: A 38-year-old woman with a history of endometriosis presented at 26 weeks gestation with 1 week of vague abdominal pain. Vital signs were within normal limits, and physical exam was notable for left-sided abdominal tenderness. Imaging demonstrated simple free fluid in her pelvis, concern for a uterine fundal defect and an adjacent hematoma. Exploratory laparotomy revealed hemoperitoneum secondary to highly vascularized stage 4 endometriosis. After classical cesarean delivery, a supracervical hysterectomy with bilateral oophorectomy was performed due to ongoing global pelvic hemorrhage. Conclusion: Consider endometriosis as a cause of spontaneous hemoperitoneum in pregnancy. Obstetricians should be prepared for significant maternal morbidity when encountering such pathology.
{"title":"Spontaneous hemoperitoneum in pregnancy due to endometriosis","authors":"Tesia G Kim, L. Sudhof, Fong W Liu, S. Shainker","doi":"10.1177/2284026520942432","DOIUrl":"https://doi.org/10.1177/2284026520942432","url":null,"abstract":"Background: Hemoperitoneum in pregnancy requires urgent evaluation. While spontaneous intraperitoneal bleeding is rare, ectopic endometrial tissue is a frequent cause of this event. Case: A 38-year-old woman with a history of endometriosis presented at 26 weeks gestation with 1 week of vague abdominal pain. Vital signs were within normal limits, and physical exam was notable for left-sided abdominal tenderness. Imaging demonstrated simple free fluid in her pelvis, concern for a uterine fundal defect and an adjacent hematoma. Exploratory laparotomy revealed hemoperitoneum secondary to highly vascularized stage 4 endometriosis. After classical cesarean delivery, a supracervical hysterectomy with bilateral oophorectomy was performed due to ongoing global pelvic hemorrhage. Conclusion: Consider endometriosis as a cause of spontaneous hemoperitoneum in pregnancy. Obstetricians should be prepared for significant maternal morbidity when encountering such pathology.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"12 1","pages":"124 - 127"},"PeriodicalIF":0.5,"publicationDate":"2020-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520942432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42146905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-20DOI: 10.1177/2284026520932468
A. Costa, A. P. Carvalho, D. Martins, M. J. Carvalho, P. T. Silva, Sílvia C Roque, Daniel P Silva
Introduction: Treatment with ulipristal acetate effectively controls excessive bleeding due to uterine fibroids and reduces their size. Uterine fibroid size reduction is expected to improve the results of the myomectomy and the reproductive prospects of the patient. Methods: Retrospective and descriptive analysis of a series of 53 patients who achieved pregnancy after being treated for symptomatic uterine fibroids. The primary endpoints were pregnancy and birth outcomes in women with symptomatic uterine fibroids that conceived following at least one course of therapy with ulipristal acetate 5 mg/day. The secondary endpoints were time until pregnancy, reasons for ulipristal acetate treatment, number of treatment courses completed, hemorrhagic control achievement, hemoglobin levels, fibroid FIGO classification, largest fibroid diameter, and type of myomectomy (if any). Results: Fifty-five pregnancies were registered in 53 patients following ulipristal acetate therapy (43 live births, 9 miscarriages, and 3 ongoing pregnancies). Half of the patients became pregnant without interval surgery. Bleeding control was achieved in 96% of the cases. A significant increase (p < 0.001) in hemoglobin levels and a reduction (p < 0.001) in uterine fibroid size was observed after treatment. No malformations were reported among newborns after ulipristal acetate therapy. Conclusion: So far, this is the largest case series reporting both pregnancy and birth outcomes following ulipristal acetate therapy for uterine fibroids. Our data support favorable outcomes after therapy for this population subset.
{"title":"Series of 55 pregnancies following ulipristal acetate treatment of symptomatic uterine fibroids","authors":"A. Costa, A. P. Carvalho, D. Martins, M. J. Carvalho, P. T. Silva, Sílvia C Roque, Daniel P Silva","doi":"10.1177/2284026520932468","DOIUrl":"https://doi.org/10.1177/2284026520932468","url":null,"abstract":"Introduction: Treatment with ulipristal acetate effectively controls excessive bleeding due to uterine fibroids and reduces their size. Uterine fibroid size reduction is expected to improve the results of the myomectomy and the reproductive prospects of the patient. Methods: Retrospective and descriptive analysis of a series of 53 patients who achieved pregnancy after being treated for symptomatic uterine fibroids. The primary endpoints were pregnancy and birth outcomes in women with symptomatic uterine fibroids that conceived following at least one course of therapy with ulipristal acetate 5 mg/day. The secondary endpoints were time until pregnancy, reasons for ulipristal acetate treatment, number of treatment courses completed, hemorrhagic control achievement, hemoglobin levels, fibroid FIGO classification, largest fibroid diameter, and type of myomectomy (if any). Results: Fifty-five pregnancies were registered in 53 patients following ulipristal acetate therapy (43 live births, 9 miscarriages, and 3 ongoing pregnancies). Half of the patients became pregnant without interval surgery. Bleeding control was achieved in 96% of the cases. A significant increase (p < 0.001) in hemoglobin levels and a reduction (p < 0.001) in uterine fibroid size was observed after treatment. No malformations were reported among newborns after ulipristal acetate therapy. Conclusion: So far, this is the largest case series reporting both pregnancy and birth outcomes following ulipristal acetate therapy for uterine fibroids. Our data support favorable outcomes after therapy for this population subset.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"12 1","pages":"170 - 175"},"PeriodicalIF":0.5,"publicationDate":"2020-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520932468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41563265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-20DOI: 10.1177/2284026520940518
Razan Asally, R. Markham, F. Manconi
Introduction: Endometriosis is an inflammatory disease characterised by the presence of endometrial-like tissue outside the uterus and affects approximately 10%–15% of women in their reproductive years. Pain is one of the predominant symptoms of the disease. Oxidative stress is involved in the pathophysiology of endometriosis and develops when there is an imbalance between the reactive oxygen species and reactive nitrogen species production, and the elimination capacity of antioxidants in the reproductive tract. High levels of reactive oxygen species can induce pain indirectly through oxidative stress-associated inflammation or directly through sensitising the nociceptive neurons that transmit the signals to the cerebral sensory cortex which are perceived as a feeling of pain. Mitochondria are the main source of reactive oxygen species, which generate through oxidative phosphorylation. Given that the mitochondria are involved in reactive oxygen species formation and energy production, which are required for the activation and proliferation of peripheral lymphocytes, it has been suggested that mitochondrial DNA variants are involved in the pathogenesis of endometriosis. This study has provided a better understanding of maternally inherited risk factors which contribute to the pain mechanisms associated with endometriosis. Results: Mitochondrial DNA haplogroup H was found to be significantly higher in women with endometriosis. This study was the first to report the association between the European mitochondrial haplogroup H and the risk of pain associated with endometriosis. Discussion: The results suggest that there are maternally inherited risk factors in women with endometriosis causing high reactive oxygen species production and oxidative stress, which facilitate pain generation in women with endometriosis.
{"title":"Mitochondrial DNA haplogroup H association with endometriosis and possible role in inflammation and pain","authors":"Razan Asally, R. Markham, F. Manconi","doi":"10.1177/2284026520940518","DOIUrl":"https://doi.org/10.1177/2284026520940518","url":null,"abstract":"Introduction: Endometriosis is an inflammatory disease characterised by the presence of endometrial-like tissue outside the uterus and affects approximately 10%–15% of women in their reproductive years. Pain is one of the predominant symptoms of the disease. Oxidative stress is involved in the pathophysiology of endometriosis and develops when there is an imbalance between the reactive oxygen species and reactive nitrogen species production, and the elimination capacity of antioxidants in the reproductive tract. High levels of reactive oxygen species can induce pain indirectly through oxidative stress-associated inflammation or directly through sensitising the nociceptive neurons that transmit the signals to the cerebral sensory cortex which are perceived as a feeling of pain. Mitochondria are the main source of reactive oxygen species, which generate through oxidative phosphorylation. Given that the mitochondria are involved in reactive oxygen species formation and energy production, which are required for the activation and proliferation of peripheral lymphocytes, it has been suggested that mitochondrial DNA variants are involved in the pathogenesis of endometriosis. This study has provided a better understanding of maternally inherited risk factors which contribute to the pain mechanisms associated with endometriosis. Results: Mitochondrial DNA haplogroup H was found to be significantly higher in women with endometriosis. This study was the first to report the association between the European mitochondrial haplogroup H and the risk of pain associated with endometriosis. Discussion: The results suggest that there are maternally inherited risk factors in women with endometriosis causing high reactive oxygen species production and oxidative stress, which facilitate pain generation in women with endometriosis.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"12 1","pages":"158 - 164"},"PeriodicalIF":0.5,"publicationDate":"2020-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520940518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43065896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-06DOI: 10.1177/2284026520934272
A. Rajanbabu, Viral Patel
Introduction: The aim of this video is to show that ureteric injection of Indocyanine green dye in difficult gynecological operations is a useful tool to identify and safeguard ureters. Case description: A 56-year-old lady with a large 10.5 × 14.5 × 13 cm3 multiloculated endometriotic cyst in the right adnexa was scheduled for robotic-assisted hysterectomy with bilateral salphingooophorectomy. She had undergone a laparotomy and three laparoscopic surgeries for endometriosis and fibroid uterus. Before starting surgery, cystoscopy was performed and with 6 Fr ureteral catheter inserted into ureteral orifice, 5 mL of 0.5% Indocyanine green dye (Aurolab, Madurai, India) was injected into both ureters. Intraoperatively bilateral adnexal cysts were seen densely adherent to omentum, sigmoid colon, sigmoid mesocolon, bladder, and lateral pelvic wall. Bladder and rectosigmoid were pulled up both anteriorly and posteriorly, respectively, and densely adherent to uterus and to adnexal cysts. During surgery, the course of ureter was identified by the green fluorescence emitted by the Indocyanine green dye under near-infrared light on da Vinci Xi camera. During this difficult surgery, the real-time visualization of ureteric course helped to identify and safeguard ureter during adhesiolysis and surgery could be completed without any injury to ureter. Patient did not experience any side effects due to the ureteric Indocyanine green injection. Conclusion: Endometriosis can distort the pelvic anatomy making surgery very challenging. Identifying the course of ureter during surgery can help in avoiding injuries and reduce surgical morbidity.
{"title":"Ureteric mapping with Indocyanine green: A new tool to prevent ureteral injury in complex gynecological surgery","authors":"A. Rajanbabu, Viral Patel","doi":"10.1177/2284026520934272","DOIUrl":"https://doi.org/10.1177/2284026520934272","url":null,"abstract":"Introduction: The aim of this video is to show that ureteric injection of Indocyanine green dye in difficult gynecological operations is a useful tool to identify and safeguard ureters. Case description: A 56-year-old lady with a large 10.5 × 14.5 × 13 cm3 multiloculated endometriotic cyst in the right adnexa was scheduled for robotic-assisted hysterectomy with bilateral salphingooophorectomy. She had undergone a laparotomy and three laparoscopic surgeries for endometriosis and fibroid uterus. Before starting surgery, cystoscopy was performed and with 6 Fr ureteral catheter inserted into ureteral orifice, 5 mL of 0.5% Indocyanine green dye (Aurolab, Madurai, India) was injected into both ureters. Intraoperatively bilateral adnexal cysts were seen densely adherent to omentum, sigmoid colon, sigmoid mesocolon, bladder, and lateral pelvic wall. Bladder and rectosigmoid were pulled up both anteriorly and posteriorly, respectively, and densely adherent to uterus and to adnexal cysts. During surgery, the course of ureter was identified by the green fluorescence emitted by the Indocyanine green dye under near-infrared light on da Vinci Xi camera. During this difficult surgery, the real-time visualization of ureteric course helped to identify and safeguard ureter during adhesiolysis and surgery could be completed without any injury to ureter. Patient did not experience any side effects due to the ureteric Indocyanine green injection. Conclusion: Endometriosis can distort the pelvic anatomy making surgery very challenging. Identifying the course of ureter during surgery can help in avoiding injuries and reduce surgical morbidity.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"12 1","pages":"190 - 192"},"PeriodicalIF":0.5,"publicationDate":"2020-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520934272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47850224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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