Attitudes and perceptions of affected women towards endocrine endometriosis therapy: an international survey based on free-word association networks.

STUDY QUESTION: What are the attitudes and perceptions towards endocrine endometriosis therapy? SUMMARY ANSWER: Among the study population, endocrine endometriosis therapies are associated with negative mental images and emotions and there seems to be a pre-therapeutic information deficit on the part of physicians. WHAT IS KNOWN ALREADY: Endocrine therapies, as the current standard of conservative endometriosis treatment, have good efficacy and improve symptoms and quality of life in most patients. Nevertheless, clinical practice repeatedly shows rejection on the part of patients, which may result in reduced compliance and discontinuation of therapy. STUDY DESIGN, SIZE, DURATION: Cross-sectional study among endometriosis patients using a multilingual questionnaire distributed via the most popular social media channels between November 2020 and February 2021. A total of 3348 women participated in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS: Based on a pilot phase, an international, multilingual online survey was conducted among women affected by endometriosis. The questionnaire included free-word associations and questions about personal medical history, source of information, and demographic data. Mental representations were detected based on modules of the co-occurrence network of associations. MAIN RESULTS AND THE ROLE OF CHANCE: Six modules with different dominant emotional labels emerged from the confluence of associations to endocrine endometriosis therapy mentioned by participants. Five modules reflected negative mental associations, with the most frequently mentioned words being 'side effects', 'pain', 'ineffective', 'depression', and 'uncertainty'. Of the 12 most frequently selected emotions, only 'optimistic' was positive. Side effects affecting mental health are the most important reason for deciding against endocrine therapy in our survey population. Twenty-seven percent of respondents reported knowing little about endocrine therapies for endometriosis. Social media are the most frequently used sources of information and were rated as the most useful. LIMITATIONS, REASONS FOR CAUTION: By translating the questionnaire, questions might have been understood differently depending on the language. By using social media channels for distribution, digitally literate patients were targeted. The survey population might not be representative as patients who are critical/unhappy with therapy are more likely to seek advice from peer groups. WIDER IMPLICATIONS OF THE FINDINGS: The findings of this study replicate the findings of a recent survey in three European countries. Given the prevalence of endometriosis and the few emerging pharmaceutical alternatives, these data point to a growing need for further research and development of non-hormonal drugs for treating endometriosis. Most endometriosis patients are young and digitally literate, and much information is obtained from alternative sources, such as social media. Careful education before starting therapy should be taken seriously, and patients' concerns should be addressed individually by health care providers. This could help reduce misunderstanding and misinformation and improve treatment adherence and satisfaction. STUDY FUNDING/COMPETING INTEREST(S): There is no funding or conflict of interest to declare. TRIAL REGISTRATION NUMBER: The trial is not registered at any trial registry.

[Double-blind study on the influence of difenoxin hydrochloride on intestinal passage time in healthy volunteers (author's transl)]. / Doppelblindstudie zur Prüfung des Einflusses von Difenoxin-hydrochlorid auf die intestinale Passagezeit am gesunden Probanden.

The effect on the intestinal passage of 3 X 1 mg difenoxin hydrochloride (Lyspafen) was tested in a randomised double-blind study; the trial included 10 healthy volunteers and lasted one week. The time until elimination of both the first and twentieth of the total of 30 applied radiopaque stool markers was measured. The total weekly weight and number of stools served as further test criteria. The treatment with difenoxin and that without placebo were compared with the standard treatment using placebo. The extensive statistical evaluation failed to reveal significant differences in the criteria observed.

[Prospective study of the 1st 197 endoscopic retrograde cholangio-pancreatographies (ERCP) in Basel (1973-1975)]. / Prospektive Studie der ersten 197 endoskopische-retrograden Cholangio-Pankreatikographien (ERCP) in Basel (1973-1975).

Cannulation of the papilla has been successful in 144 out of 197 ERCPs. The rate of success increases with the experience of the endoscopist. The intended filling of the pancreatic duct was successful in 87%, of the bile ducts in 64% and of both duct systems in 28%. The correct diagnosis was made in 77% of pancreatic affections, 71% of biliary diseases and in 43% when both duct systems had to be evaluated. 10 ERCP findings disagreed with the final diagnosis, mainly because the distinction between acute and chronic pancreatitis was not correct. The differentiation of chronic pancreatitis from pancreatic carcinoma is not easy and the evaluation of processes localized to the papilla may be difficult. Complications occurred in 6.6%. It is concluded that the ERCP should be limited to regional hospital centers and should be performed only in cases with well defined indications.

[Induction of colonic carcinoma in mice using 1,2-dimethylhydrazine hydrochloride]. / Induktion von Kolonkarzinomen mit 1,2-Dimethylhydrazin-Hydrochlorid bei der Maus

Weekly injections of 1,2-dimethylhydrazine-HC1 were given to female NMRI mice (Versuchstierfarm Tuttlingen, Germany). The earliest histological changes are those of focal hyperplasia and focal atypias confined to single crypts. These changes are observed as early as 5 weeks after the first injection. Serial sections of the whole colon were analyzed for localization and incidence of these lesions. Whereas after 12 weeks the number of small lesions was greater than after 36 weeks of exposure, at 36 weeks there were in situ carcinomas and carcinomas with infiltration. It appears that the focal atypias confined to single crypts may heal. With H-3-TdR labelling, it could be demonstrated that before generalized changes are observed histologically, there is a widening of the proliferative compartment. After cessation of DMH exposure, these changes continue for many weeks.