Cystoscopy-assisted laparoscopy for bladder endometriosis: modified light-to-light technique for bladder preservation.

INTRODUCTION: Endometriosis is a disease with causes still unclear, affecting approximately 15% of women of reproductive age, and in 1%-2% of whom it may involve the urinary tract. The bladder is the organ most frequently affected by endometriosis, observed around 85% of the cases. In such cases, the most effective treatment is partial cystectomy, especially via videolaparoscopy. Study Objective, Design, Size and Duration: In order to identify and delimit the extent of the intravesical endometriosis lesion, to determine the resection limits, as well as to perform an optimal reconstruction of the organ aiming for its maximum preservation, we performed a cystoscopy simultaneously with the surgery, employing a modified light-tolight technique in 25 consecutive patients, from September 2006 to May 2012. SETTING: Study performed at Campinas Medical Center - Campinas - Sao Paulo - Brazil. Participants/materials, setting and methods: Patients aged 27 to 47 (average age: 33.4 years) with deep endometriosis with total bladder involvement were selected for the study. The technique used was conventional laparoscopy with a transvaginal uterine manipulator and simultaneous cystoscopy (the light-to-light technique). A partial videolaparoscopic cystectomy was performed with cystoscopy-assisted vesical reconstruction throughout the entire surgical time. The lesions had an average size of 2.75cm (ranging from 1.5 to 5.5cm). The average surgical time was 137.7 minutes, ranging from 110 to 180 minutes. MAIN RESULTS: Postoperative follow-up time was 32.4 months (12-78 months), with clinical evaluation and a control cystoscopy performed every six months. No relapse was observed during the follow-up period. CONCLUSIONS: A cystoscopy-assisted partial laparoscopic cystectomy with a modified light-to-light technique is a method that provides adequate identification of the lesion limits, intra or extravesically. It also allows a safe reconstruction of the organ aiming for its maximum preservation.

Quality of life after segmental resection of the rectosigmoid by laparoscopy in patients with deep infiltrating endometriosis with bowel involvement.

STUDY OBJECTIVE: To estimate the quality of life of patients undergoing laparoscopic resection of a segment of the rectosigmoid for the treatment of deep infiltrating endometriosis with bowel involvement. DESIGN: Prospective application of the SF-36 Health Status Questionnaire to 151 women before and 1 year after surgical intervention (Canadian Task Force Design Classification II). SETTING: Department of Obstetrics and Gynecology, University of São Paulo Medical School, and Samaritano Hospital, São Paulo, Brazil. PATIENTS: A total of 151 women (mean age 34.05 ± 5.65 years) with deep infiltrating endometriosis underwent resection of a segment of the rectosigmoid by laparoscopy between 2002 to 2009. INTERVENTIONS: All the patients had historical data collected and underwent clinical examination and transvaginal ultrasonography with prior bowel preparation for resection of a segment of the rectosigmoid by laparoscopy indicated for patients with symptoms (pelvic pain) with 1 or more lesions of more than 3 cm in length or multifocal lesions. MEASUREMENTS AND MAIN RESULTS: Wilcoxon signed rank test verified differences between the degrees of the symptoms and the SF-36 scores before and 1 year after laparoscopic treatment. There was a significant improvement (p < .001) in all pain-related symptoms, as well as a significant increase (p < .001) in scores in all the SF-36 domains and in the sum of the components comprising both physical and mental health. CONCLUSION: Laparoscopic segmental resection of the rectosigmoid fulfills its essential objective of treating endometriosis with bowel involvement and improving patients' QoL to a significant extent.

[Evaluation of pain and depression in women with endometriosis after a multi- professional group intervention]. / Avaliação de dor e depressão em mulheres com endometriose após intervenção multiprofissional em grupo.

OBJECTIVE: Evaluate pain and depression scores before and after multi-professional group intervention in women with endometriosis as compared to those who did not participate in this activity. METHODS: A total of 128 women attended at the Endometriosis Outpatient Facility CAISM/UNICAMP, was assessed and distributed equally into two groups: women who received group intervention and those who did not. All women completed the Beck Depression Inventory and the Analogical Visual Scale. RESULTS: There was a significant decrease in pain and depression scores at the end of group intervention. Women who had not participated in the intervention had higher initial scores of pain when compared to those who had. On the other hand, in the group without intervention,depression scores were lower. A positive correlation was identified between pain and depression in both groups. CONCLUSION: Group intervention was efficient in diminishing pain and depression in women with endometriosis and may be included in the conventional treatment for patients affected by this disease.

Pulmonary benign metastasizing leiomyoma: a report of 2 cases with different outcomes.

BACKGROUND: Benign metastasizing leiomyoma (BML) of the lung is a rare manifestation of metastasis from a uterine myoma, in which its benign characteristics are maintained. The majority of cases are asymptomatic. CASES: Case 1 responded to the classic treatment of oophorectomy, after which an improvement in symptoms was achieved. In case 2, however, symptoms appeared following oophorectomy and were treated with raloxifene. CONCLUSION: These cases show the uncertainty that exists with respect to the evolution and treatment of symptomatic BML. Raloxifene is a therapeutic agent that has not been widely studied for this purpose but should be considered for inclusion in the arsenal of therapeutic options available.

Evaluation of lipid profile in adolescents during long-term use of combined oral hormonal contraceptives.

The study evaluated the effects of the long-term use of a combined oral hormonal contraceptive containing 30 microg ethinyl estradiol and 75 microg gestodene in adolescents. Thirty-three volunteers, aged from 14 to 19 years, who used the oral contraceptive for three consecutive years, were studied. Evaluation of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides was made before use and after 1, 2 and 3 years. During the 3-year study period, total cholesterol, HDL-C, LDL-C and triglyceride levels were significantly higher than previous measurements, but average values did not exceed the normal range. Compared to the first year, the second- and third-year cholesterol, HDL-C, LDL-C and triglyceride levels were not significantly different.

Women's satisfaction with physicians' communication skills during an infertility consultation.

The purpose of this study was to assess women's satisfaction with the communication of medical residents, in a university tertiary service in Brazil. The follow-up visits of 124 women consulting with 7 physicians were observed. An exit interview was performed to assess women's perception of their interaction with physicians. Factor analysis was used to build a satisfaction score, which was then studied according to the presence or absence (yes/no) of physicians' communicative behaviors observed by the researcher during consultation. Median satisfaction score was 9.4 in a 0-10 scale. Four physicians' communicative behaviors showed significant differences in the general satisfaction score: introducing oneself, setting the main reason for the visit, providing information about treatment procedures and asking whether patient had other issues or concerns. No significant differences were found in satisfaction scores for women's socialdemographic characteristics, reproductive history or duration of consultation. These results are important in the development of educational strategies for doctors and patients.

Weight variation in a cohort of women using copper IUD for contraception.

The objective of this study was to assess weight changes over time in reproductive-age women using nonhormonal contraception [copper intrauterine device (IUD) users]. Baseline variables recorded included age, parity, decade when the IUD was inserted and the presence of hypertension. A total of 1697 IUD users were followed for 7 years of use. The mean age (+/- SD) of the women at the beginning of follow-up was 27.6 +/- 5.8 years and the mean height (+/- SD) was 150 +/- 10 cm. The mean weight (+/- SD) at the time of IUD insertion was 58.5 +/- 0.30 kg. After 5 and 7 years of follow-up, the mean weight (+/- SD) was 61.2 +/- 0.33 kg and 62.4 +/- 0.51 kg, respectively. At insertion, the body mass index mean (+/- SD) was 24.5 +/- 0.12 and after 3 years it was 25 +/- 0.14, remaining above 25 up to the 7th year of observation. During the 7 years of follow-up, older women gained more weight than younger women. Parity, decade of IUD insertion and hypertension were not noted to be significant determinants of weight variation. In conclusion, this cohort of lower and middle class Brazilian copper IUD users tended to gain weight during their reproductive life, independent of other factors. These observations may improve counseling of women regarding the prevention of age-related obesity.

Lipid profile in women over 35 years old using triphasic combined oral contraceptives.

Twenty-nine women aged 35 years old or more, using triphasic combined oral contraceptive (COC) were evaluated during six cycles for the following parameters: total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and its subfraction HDL2, triglycerides, apoproteins A and B, Castelli risk index I and II (cholesterol/HDL-C and LDL-C/HDL-C) and apoprotein ratio (apoprotein B/apoprotein A). The same laboratory measurements were done in a control group of 49 non-COC-user women. The results showed that there were no differences on most of the studied parameters between user and nonuser women. There was a significant reduction of HDL-C and HDL2-C, although within the normal range. In addition, it was observed a significant increment of triglycerides and apoprotein B at 6 months of follow-up only in user group (p < 0.05), although within the normal range. It is concluded that the use of levonorgestrel triphasic COC appeared to have no additional adverse impact when used by women aged over 35 years. Further studies are needed to obtain conclusive data.

Quality of life in Brazilian women with endometriosis assessed through a medical outcome questionnaire.

OBJECTIVE: To assess the quality of life in women with pelvic pain associated with endometriosis through the 36-item Short Form Health Survey (SF-36). STUDY DESIGN: The study was cross-sectional and conducted at a tertiary care center. Sixty women diagnosed surgically with endometriosis were interviewed during the first half of 2001. RESULTS: In general, a poor quality of life was observed among the women interviewed. No correlation was found between the quality of life and intensity of pain, use of medications and/or living with a partner. Women with moderate or severe endometriosis scored better on the emotional aspects of the questionnaire. Among those who exercised regularly, better scores on mental health were observed. CONCLUSION: According to the SF-36 questionnaire, this cohort study of Brazilian women with endometriosis showed a poor quality of life.

[Evaluation of the frequency of depression in patients with endometriosis and pelvic pain]. / Avaliação da freqüência de depressão em pacientes com endometriose e dor pélvica.

OBJECTIVE: Evaluate the frequency of depression in women with endometriosis and actual symptom of pelvic pain to determine the necessity of psychological support. METHODS: A total of 50 women aged 24 to 48 with endometriosis and referring pelvic pain. The prevalence of depression was evaluated by Beck's Depression Inventory adapted to the Brazilian population. RESULTS: It was found that 92% of the subjects presented depressive symptoms, being 56% from moderate to high levels. Although 66% of the women were using hormonal medication to treat endometriosis, there was no significant correlation between the presence of depression and the use of these medications. CONCLUSION: The results showed a high prevalence of depression symptoms in these patients confirming the necessity of psychological support.

Up-regulation of DNAM-1 and NKp30, associated with improvement of NK cells activation after long-term culture of mononuclear cells from patients with ovarian neoplasia.

This study aimed at evaluating the functional activation and activating receptors expression on resting, short- and long-term NK and NK-like T cells from blood of ovarian neoplasia patients. Blood from patients with adnexal benign alterations (n = 10) and ovarian cancer (grade I-IV n = 14) were collected after signed consent. Effector cells activation was evaluated by the expression of the CD107a molecule. Short-term culture was conducted overnight with IL-2 and long-term culture for 21 days, by a method designed to expand CD56(+) lymphocytes. Short-term culture significantly increased NK cells activation compared to resting NK cells (p<0.05), however, the long-term procedure supported an even higher increase (p<0.001). Resting NK-like T cells showed poor activation, which was not altered by the culture procedures. The long-term culture effectively increased the expression of the activating receptors on NK and NK-like T cells, either by increasing the number of cells expressing a given receptor and/or by up-regulating their expression intensity. As a conclusion, the long-term culture system employed, resulted in a high number of functional NK cells. The culture system was particularly efficient on the up-regulation of NKp30 and DNAM-1 receptors on NK cells.

Cystoscopy-assisted laparoscopy for bladder endometriosis: modified light-to-light technique for bladder preservation

ABSTRACT Introduction Endometriosis is a disease with causes still unclear, affecting approximately 15% of women of reproductive age, and in 1%-2% of whom it may involve the urinary tract. The bladder is the organ most frequently affected by endometriosis, observed around 85% of the cases. In such cases, the most effective treatment is partial cystectomy, especially via videolaparoscopy. Study Objective, Design, Size and Duration In order to identify and delimit the extent of the intravesical endometriosis lesion, to determine the resection limits, as well as to perform an optimal reconstruction of the organ aiming for its maximum preservation, we performed a cystoscopy simultaneously with the surgery, employing a modified light-to-light technique in 25 consecutive patients, from September 2006 to May 2012. Setting Study performed at Campinas Medical Center – Campinas – Sao Paulo – Brazil.Participants/materials, setting and methods: Patients aged 27 to 47 (average age: 33.4 years) with deep endometriosis with total bladder involvement were selected for the study. The technique used was conventional laparoscopy with a transvaginal uterine manipulator and simultaneous cystoscopy (the light-to-light technique). A partial videolaparoscopic cystectomy was performed with cystoscopy-assisted vesical reconstruction throughout the entire surgical time. The lesions had an average size of 2.75cm (ranging from 1.5 to 5.5cm). The average surgical time was 137.7 minutes, ranging from 110 to 180 minutes. Main Results Postoperative follow-up time was 32.4 months (12-78 months), with clinical evaluation and a control cystoscopy performed every six months. No relapse was observed during the follow-up period. Conclusions A cystoscopy-assisted partial laparoscopic cystectomy with a modified light-to-light technique is a method that provides adequate identification of the lesion limits, intra or extravesically. It also allows a safe reconstruction of the organ aiming for its maximum preservation.

Physical therapy and psychological intervention normalize cortisol levels and improve vitality in women with endometriosis.

There is as yet no effective treatment for endometriosis. The objective of this study was to evaluate the effectiveness of submitting women with endometriosis and chronic pelvic pain to a therapeutic protocol involving physical and psychological therapy. Twenty-six female volunteers were submitted to a treatment protocol consisting of 2.5-h sessions, once a week for 10 weeks. We applied a Visual Analogue Scale, the Perceived Stress Questionnaire (PSQ), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Morning, afternoon, and evening levels of cortisol were determined in saliva samples. The PSQ scores were significantly lower after treatment, whereas the scores for the SF-36 vitality and physical functioning domains were significantly higher. Salivary cortisol levels were higher after treatment in the samples collected in the morning, but not in those collected in the afternoon or evening. The post-treatment cortisol levels were similar to those reported for healthy women. There were positive correlations between vitality, role emotional, social functioning, and mental health, and negative correlations to perceived stress. In conclusion, the physical and psychological intervention protocol applied in this study to women suffering of endometriosis was effective in reducing perceived stress, normalizing cortisol levels, increasing vitality and improving physical functioning.

[Chlamydia trachomatis and Neisseria gonorrhoeae among women in a family planning clinic]. / Infecção por Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres atendidas em serviço de planejamento familiar.

PURPOSE: to study infection prevalence by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), among adolescent and young women in a family planning outpatient clinic. METHODS: a total of 230 women up to 24 years old and history of up to four sexual partners have been followed-up for 48 months, with urine collection to search CT and NG, by the polymerase chain reaction method at the 1st, 12nd, 24th, 36th and 48th months. The variables studied were age group, schooling, marital status, number of gestations, abortions and children alive, age at the onset of sexual life, previous and present use of condom, previous use of intrauterine device, number of sexual partners in the previous six months and follow-up time. Bivariate analysis of variables according to positive tests for CT and NG, and multiple analyses by logistic regression were done. RESULTS: the ratio of infections by CT was 13.5% and by NG, 3%. Two women presented both tests as positive. The previous intrauterine device use was associated with positive tests for NG. CONCLUSIONS: the prevalence of infections by CT and NG was higher among the age group studied and the screening of young women must be taken into consideration in our services, to control the dissemination of sexually transmitted diseases and prevention of sequels.

[Predictive factors for height gain in idiopathic central precocious puberty treated with GnRH analogues]. / Fatores determinantes do ganho na altura em meninas com puberdade precoce central idiopática tratadas com análogo de GnRH.

PURPOSE: to evaluate predictive factors of response to GnRHa treatment in girls with idiopathic central precocious puberty. METHODS: a retrospective cohort study was conducted involving 33 girls diagnosed with idiopathic central precocious puberty and treated with GnRHa. The following independent variables were assessed: age at the beginning of therapy and at the onset of symptoms, time elapsed since the appearance of pubertal characteristics and the beginning of treatment, bone age, bone age advance, duration of GnRHa treatment, actual height and Z-score, predicted height and Z-score and hormone measurements of FSH and LH after GnRH stimulation, which were correlated with gain in height as a dependent variable at treatment discontinuation, calculated by the difference between the predicted height at the end and beginning of treatment. For statistical analysis, Pearson's linear correlation was used, in addition to multiple linear regression analysis. RESULTS: the mean age at the beginning of treatment was 7.8+/-1.3 years, with a mean bone age of 10.1+/-1.6 years. Bone age advance was 2.3+/-1.1 years and was controlled during the treatment period. Gain in predicted height was 2.5+/-1.3cm. It was positively correlated with time elapsed since the beginning of symptoms and the beginning of treatment and with bone age advance, while negatively correlated with the Z-score of height at the beginning of treatment and predicted height at the beginning of treatment, and the latter was the main factor determining gain from treatment. CONCLUSIONS: girls who had the most significant compromise of predicted adult height, as detected by a larger deviation from the population (Z-score) and the most considerable advance in bone age, received benefit from GnRHa therapy, and they must not be excluded from the group to be treated.

Breast density in women with premature ovarian failure using hormone therapy.

BACKGROUND: Women with premature ovarian failure (POF) are treated with estrogen-progestin therapy; however, doubts remain regarding the effect of this therapy on the breasts of women with POF. OBJECTIVE: To evaluate the breast density of women with POF using estrogen-progestin therapy compared with normally menstruating women. METHODS: A cross-sectional study was performed in 31 women with POF using conjugated equine estrogens and medroxyprogesterone acetate and a control group of 31 normally menstruating women, paired by age. All underwent mammography, analyzed by digitization and Wolfe's classification, the latter defined as non-dense (N1 and P1) or dense (P2 and Dy). Parity, breastfeeding and body mass index were evaluated, as well as duration of hormone use and ovarian failure in the POF group. RESULTS: Digitization revealed no difference in mean breast density between the groups: 24.1+/-14.6% and 21.8+/-11.3% for POF and control groups, respectively. The Wolfe classification also failed to detect any significant difference between the groups, dense breasts being detected in 51.6% and 35.5% of cases in the POF and control groups, respectively. CONCLUSION: Periods of hypoestrogenism followed by hormone therapy resulted in no changes in breast density in women with POF, compared with normally menstruating women of the same age.