Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis.

AIM: Endometriosis is relatively common condition in fertile women and may affect the alimentary tract. Laparoscopic rectosigmoid resection for endometriosis has been found to be both feasible and safe. The aim of the present study was to prospectively evaluate the quality of life and sexual function of patients who have undergone rectosigmoid resection for endometriosis. METHOD: All patients undergoing rectal or sigmoid resection for endometriosis in two specialist hospitals were prospectively recruited in the study. Details regarding demography, endometriosis-related symptoms, procedure and postoperative recovery were collected. One year after the operation patients were sent a postal questionnaire asking about endometriosis-related symptoms, quality of life and sexual functioning. The 15D Questionnaire and McCoy Female Sexuality Questionnaire were used for this purpose. RESULTS: A total of 26 patients responded to the 15D questionnaire. Endometriosis-related bowel symptoms decreased significantly after the operation. The responses showed improvements in the overall score and scores for five different dimensions (usual activities, P = 0.04; discomfort and symptoms, P < 0.001; distress, P < 0.001; vitality, P < 0.001; sexual activity, P < 0.001). Sexual satisfaction was greater 1 year after the operation (P = 0.01). Sexual problems and partner satisfaction scores had not changed significantly. CONCLUSION: Laparoscopic rectal and sigmoid resection for endometriosis significantly reduce endometriosis-related symptoms and improve quality of life and sexual well-being.

The early outcome of laparoscopic sigmoid and rectal resection for endometriosis.

AIM: Deeply infiltrating endometriosis (DIE) is the most severe form of endometriosis and may affect the rectum and sigmoid colon. The most effective treatment is segmental resection. We report our results of rectal and sigmoid resection for this. METHOD: The study comprises all patients who have had laparoscopic bowel resection for rectal or sigmoid endometriosis in the Päijät-Häme Central Hospital between 1 January 2004 and 31 May 2007. Patient demographics, operative details, complications and early postoperative recovery were prospectively collected and analysed. RESULTS: A total of 31 patients were treated using a multidisciplinary approach. The mean age was 33.6 years (range 21.7-48.6) and body mass index 24.2 (17-40). The mean operation time was 253.5 min (range 56-484). There were three sigmoid and 28 rectal resections and 80 concomitant gynaecological procedures. Conversion to open surgery was not required. A total of 23 (74.2%) patients recovered without complications. There were two major complications, anastomotic leakage and rectovaginal fistula. Minor complications included transient urinary retention (2), wound infection (1), pneumonia (1) and undefined fever (2). The mean time to full peroral diet was 3.8 days (range 3-7), to first flatus 2.6 days (1-4), to first bowel movement 3.5 days (2-6) and to discharge 5.7 days (4-13). CONCLUSION: Laparoscopic rectal and sigmoid resection for deep intestinal endometriosis is safe with few severe complications and rapid recovery. The long-term outcome on symptoms requires further study.

Serum HE4 concentration differentiates malignant ovarian tumours from ovarian endometriotic cysts.

Human epididymal secretory protein E4 (HE4, also known as WAP four-disulphide core domain protein 2) is a new promising biomarker for ovarian cancer but its specificity against ovarian endometriotic cysts is only superficially known. We, thus, analysed serum HE4 concentrations together with a tumour marker CA125 in serum samples of women diagnosed with various types of endometriosis, endometrial cancer or ovarian cancer, and in samples from healthy controls. The mean serum concentration of HE4 was significantly higher in serum samples of patients with both endometrial (99.2 pM, P<0.001) and ovarian (1125.4 pM, P<0.001) cancer but not with ovarian endometriomas (46.0 pM) or other types of endometriosis (45.5 pM) as compared with healthy controls (40.5 pM). The serum CA125 concentrations were elevated in patients with ovarian cancer, advanced endometriosis with peritoneal or deep lesions, or ovarian endometriomas, but not in the patients with endometrial cancer. The microarray results revealed that the mRNA expression of the genes encoding HE4 and CA125 reflected the serum protein concentrations. Taken together, measuring both HE4 and CA125 serum concentrations increases the accuracy of ovarian cancer diagnosis and provides valuable information to discriminate ovarian tumours from ovarian endometriotic cysts.

Exercise capacity and hemodynamics in persons aged 20 to 50 years with systemic hypertension treated with diltiazem and atenolol.

Hemodynamic responses and exercise capacity were studied during maximal exercise in 25 young hypertensive persons (mean age 40 years) taking placebo, diltiazem (mean 216 mg/day) and atenolol (mean 80 mg/day). The study was a crossover, double-blind, randomized trial, each medication period lasting 2 months. Sitting blood pressure (BP) was 160 +/- 19/109 +/- 8 mm Hg after run-in. Both drugs decreased BP significantly, diltiazem by 10/ 11 mm Hg and atenolol by 16/14 mm Hg (difference not significant between drugs). During exercise there were no differences among patients taking placebo, diltiazem and atenolol in peak workload and rating of perceived exertion. Atenolol significantly attenuated the increase in heart rate, BP and heart rate-BP product at each workload. Diastolic BP during exercise was significantly lower (6 to 10 mm Hg) during diltiazem therapy than during placebo at each workload. Thus, both diltiazem and atenolol decrease rest BP significantly without impairing exercise capacity.

Oxygen delivery during endobronchial anaesthesia: a comparison of halothane-oxygen and nitrous oxide-oxygen.

Total oxygen delivery (cardiac output X arterial oxygen content) and oxygen consumption were determined in 22 patients undergoing one-lung ventilation (OLV) during thoracotomy. In 11 patients, anaesthesia was maintained with halothane-oxygen and in another 11 patients with nitrous oxide-oxygen-analgesic combination (FIO2 0.5). During OLV, oxygen delivery was greater in the halothane group and these patients tended to show a decrease in oxygen consumption compared with the patients of the nitrous oxide group. Therefore, as far as total oxygen balance (oxygen delivery/oxygen consumption) during OLV is concerned, halothane-oxygen maintenance provides a greater margin of safety than nitrous oxide-oxygen-analgesic combination. However, in spite of occasional hypoxaemic episodes, none of our patients receiving 50% nitrous oxide in oxygen showed an oxygen delivery coefficient (oxygen delivery/oxygen consumption) significantly smaller than the predicted normal value for an unanaesthetized patient. This finding may explain why this anaesthetic technique has been used without apparent harm during OLV in patients with unimpaired cardiovascular function.

Effects of intra-aortic balloon pumping on experimental acute myocardial ischaemia.

In an experimental study on dogs, effects of intra-aortic balloon pumping (IABP) on acute myocardial ischaemia without marked cardiac failure were analyzed. With the use of epicardial ST-segment recording IABP was shown to significantly reduce ischaemia when pumping was initiated 10 minutes after left anterior descending coronary artery ligation. Prior to coronary ligation the mean ST-segment height was 6.4 +/- 0.8 mV (mean +/- SE) and 10 minutes after the ligation it was 21.5 +/- 4.6 mV. During pumping ST-segment elevation increased to 6.9 +/- 0.7 mV. A dual-chambered intra-aortic balloon was used, and six dogs were treated with IABP. In the control dog no tendency to spontaneous ST-segment decrease was seen.

Cardiorespiratory function during thoracic anaesthesia: a comparison of two-lung ventilation and one-lung ventilation with and without PEEP5.

Previous studies have shown that, in patients undergoing thoracic surgery, a relatively high positive end-expiratory pressure (PEEP of 10 cmH2O = PEEP10) has no beneficial effect on oxygenation during one-lung ventilation (OLV). In the present investigation, cardiorespiratory function was examined in 11 patients intubated endobronchially and undergoing thoracotomy. Comparison was made between two-lung ventilation (TLV) and OLV and between zero end-expiratory pressure and PEEP5 during OLV. Cardiac output was determined to obtain information of the total oxygen delivery (cardiac output times arterial O2 content. The change from TLV to OLV was accompanied by a marked fall in PaO2 and a marked rise in shunt, whereas no significant change was observed in mean cardiac output. Oxygen delivery also remained unchanged due to relatively small decrease in SaO2 (arterial oxygen saturation) and maintenance of cardiac output. The application of PEEP5 during OLV produced no significant changes in these parameters. The findings in individual patients demonstrated the relative importance of cardiac output in determining oxygen delivery during OLV. A significant negative correlation was found between inspiratory airway pressure and cardiac index during OLV.