Deep Invasive Endometriosis Lesions of the Rectosigmoid May Be Related to Alterations in Cell Kinetics.

OBJECTIVES: The aim of this study was to analyze cell kinetics through expression and apoptosis of topoisomerase 2-α (TOP2A), p53, and c-erb2 in rectosigmoid endometriotic lesions and in healthy endometrial tissue and to establish correlations between such findings and clinical data in patients with rectosigmoid endometriosis. METHODS: Sixty patients with rectosigmoid endometriosis and 20 control women without endometriosis were included. Immunohistochemical assays were used to measure expression of TOP2A, p53, and c-erB-2. Apoptosis was quantified by directly counting the apoptotic bodies. FINDINGS: The number of lesions was positively correlated with expression of TOP2A in the lesion. There was also significant correlation between the lesions' size and number and cell turnover index. Apoptosis index (AI) was the same for endometriosis lesions and eutopic endometrium. Expression of TOP2A was significantly lower in the endometriosis group compared to the controls. CONCLUSIONS: Changes in cell proliferation but not in the AI in rectosigmoid endometriosis are indicative of an imbalance in cell kinetics that may lead to the development of the disease.

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.

[Bowel endometriosis: a benign disease?]. / Endometriose intestinal: uma doença benigna?

Endometriosis is generally assumed to be a benign disease, but it is estimated that 1% of cases are associated with cancer, especially when both conditions are present in the ovary. Extra-ovarian lesions in the rectovaginal septum, colon, bladder, vagina and peritoneum were already associated with malign neoplasia. Several characteristics of endometrial tissue are very similar to the neoplasia phenotype. Endometriosis itself typically behaves as a neoplasia process, spreading over adjacent stroma and being associated with distant lesions. This is an update on the diagnostic, clinical, and therapeutic knowledge of, management of bowel implants of endometrial tissue, as well as the relation with neoplastic processes to better understand its benign nature or eventual potential for malignancy.

Endometriose intestinal: uma doença benigna? / Bowel endometriosis: a benign disease?

A despeito do caráter benigno da endometriose, estima-se que 1 por cento dos casos esteja relacionado com câncer, especialmente quando ambas as condições ocorrem nos ovários. Lesões extra-ovarianas encontradas no septo retovaginal, cólon, bexiga, vagina e peritônio da região pélvica também já foram associadas com neoplasias malignas. Várias características do tecido endometrial ectópico o aproximam do fenótipo neoplásico, e a própria endometriose possui comportamento tipicamente neoplásico com capacidade de invasão do estroma adjacente e associação com lesões à distância. Esta revisão atualiza conhecimentos diagnósticos, clínicos e terapêuticos dos implantes intestinais de tecido endometriótico, bem como sua relação com processos neoplásicos para melhor compreensão de seu caráter benigno ou de seu eventual potencial para malignidade.

Endometriosis is generally assumed to be a benign disease, but it is estimated that 1 percent of cases are associated with cancer, especially when both conditions are present in the ovary. Extra-ovarian lesions in the rectovaginal septum, colon, bladder, vagina and peritoneum were already associated with malign neoplasia. Several characteristics of endometrial tissue are very similar to the neoplasia phenotype. Endometriosis itself typically behaves as a neoplasia process, spreading over adjacent stroma and being associated with distant lesions. This is an update on the diagnostic, clinical, and therapeutic knowledge of, management of bowel implants of endometrial tissue, as well as the relation with neoplastic processes to better understand its benign nature or eventual potential for malignancy.

Médicos e pacientes: vidas cruzadas / Doctor and patient: Journey companions

Num futuro próximo, a Associação Paulista de Medicina e o conjunto dos médicos do País esperam contabilizar importantes vitórias para que o Brasil tenha sistemas de saúde pública e privada que sirvam de exemplo para o restante do mundo. Queremos ver hospitais bem equipados, com recursos, pacientes bem atendidos e confiantes que estão recebendo o melhor tratamento possível. O reconhecimento, para nós, será acalentar, num silêncio de encher a alma, a satisfação de jamais ter calado perante as injustiças e de haver cumprido efetivamente o juramento de Hipocrátes, de dedicar cada ação, cada minuto de nossas vidas, àqueles que são o motivo de nossa existência: os pacientes...

Associaçäo entre prolapso uterino e incontinência istmocervical durante a gestaçäo / Association between prolapse of the uterus and incompetent cervix during pregnancy

Os autores descrevem um caso raro de associaçao entre prolapso uterino e incontinência istmocervical disgnosticado durante a gestaçao. Relatam as condutas adotadas durante a gravidez e o parto, o resultado final para a mae e o recém-nascido e fazem uma breve revisao da literatura a respeito.