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1.
Artigo em Inglês | MEDLINE | ID: mdl-32387567

RESUMO

STUDY OBJECTIVE: To assess if women with obesity have increased complication rates compared with women with normal weight undergoing hysterectomy for benign reasons and if the mode of hysterectomy affects the outcomes. DESIGN: Cohort study. SETTING: Prospectively collected data from 3 Swedish population-based registers. PATIENTS: Women undergoing a total hysterectomy for benign indications in Sweden between January 1, 2015, and December 31, 2017. The patients were grouped according to the World Health Organization's classification of obesity. INTERVENTIONS: Intraoperative and postoperative data were retrieved from the surgical register up to 1 year after the hysterectomy. Different modes of hysterectomy in patients with obesity were compared, such as open abdominal hysterectomy (AH), traditional laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and robot-assisted laparoscopic hysterectomy (RTLH). MEASUREMENTS AND MAIN RESULTS: Out of 12,386 women who had a total hysterectomy during the study period, we identified 2787 women with normal weight and 1535 women with obesity (body mass index ≥30). One year after the hysterectomy, the frequency of complications was higher in women with obesity than in women with normal weight (adjusted odds ratio [aOR]) 1.4; 95% confidence interval [CI], 1.1-1.8). In women with obesity, AH was associated with a higher overall complication rate (aOR 1.8; 95% CI, 1.2-2.6) and VH had a slightly higher risk of intraoperative complications (aOR 4.4; 95% CI, 1.2-15.8), both in comparison with RTLH. Women with obesity had a higher rate of conversion to AH with conventional minimally invasive hysterectomy (TLH: aOR 28.2; 95% CI, 6.4-124.7 and VH: 17.1; 95% CI, 3.5-83.8, respectively) compared with RTLH. AH, TLH, and VH were associated with a higher risk of blood loss >500 mL than RTLH (aOR 11.8; 95% CI, 3.4-40.5; aOR 8.5; 95% CI, 2.5-29.5; and aOR 5.8; 95% CI, 1.5-22.8, respectively) in women with obesity. CONCLUSION: The use of RTLH may lower the risk of conversion rates and intraoperative bleeding in women who are obese compared with other modes of hysterectomy.

2.
J Sex Med ; 11(12): 3064-71, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25174699

RESUMO

INTRODUCTION: Provoked vestibulodynia (PVD) is a common type of dyspareunia among young women. The patho-physiology remains largely unclear. Women with PVD have general pain hypersensitivity and often report additional pain symptoms. Signs point towards PVD being a chronic pain disorder similar to other syndromes of longstanding pain, including a common comorbidity of anxiety and depression. Polymorphism in the serotonin receptor gene, 5HT-2A, has been associated with other chronic pain disorders such as fibromyalgia but has not been investigated in PVD patients. AIM: We aimed to investigate a possible contribution of polymorphism in the 5HT-2A gene to the etiology of PVD as well as a potential influence on pain sensitivity. METHODS: In this case-control study 98 women with PVD and 103 healthy controls between 18 and 44 years and in the same menstrual cycle phase completed questionnaires and underwent quantitative sensory testing. Venous blood samples were collected for DNA isolation. MAIN OUTCOME MEASURES: Concomitant pain was reported, a bodily pain score was created and pressure pain thresholds (PPTs) on the arm, leg, and in the vestibule were measured. Intensity of coital pain was rated on a visual analog scale, range 0-100. The T102C (rs6313) and A-1438G (rs6311) single nucleotide polymorphisms (SNPs) in the 5HT-2A gene were analyzed. RESULTS: The probability of PVD was elevated in participants carrying the 1438G- and 102C-alleles of the 5HT-2A gene (OR 2.9). The G-/C- genotypes were also associated with more concomitant bodily pain in addition to the dyspareunia, but not with experimental PPTs or coital pain ratings. PVD patients reported more concomitant bodily pain and had lower PPTs compared with controls. CONCLUSION: The results indicate a contribution of alterations in the serotonergic system to the patho-genesis of PVD and gives further evidence of PVD being a general pain disorder similar to other chronic pain disorders.


Assuntos
Dispareunia/genética , Polimorfismo de Nucleotídeo Único/genética , Receptor 5-HT2A de Serotonina/genética , Vulvodinia/genética , Adolescente , Adulto , Ansiedade/genética , Estudos de Casos e Controles , Dor Crônica/genética , Feminino , Humanos , Dor/epidemiologia , Medição da Dor , Limiar da Dor , Pressão , Serotonina/fisiologia , Inquéritos e Questionários , Adulto Jovem
3.
Scand J Pain ; 5(1): 10-16, 2014 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29913664

RESUMO

Background and aims Provoked vestibulodynia (PVD) is the most common cause of dyspareunia among young women. The aetiology is largely unknown and treatment is often extensive and longstanding with varying outcomes. Patients display general pain hypersensitivity and there are correlations with other chronic pain syndromes such as fibromyalgia later in life. The A118G polymorphism in the µ-opioid receptor (OPRM1) gene influences endogenous pain regulation and pain sensitivity, but has not been studied in this patient group before. We aimed to investigate a possible association between A118G polymorphism and PVD, with correlation to plasma levels of ß-endorphin, and to explore relationships between this polymorphism and pain sensitivity among women with PVD and healthy controls. Methods This case-control study included 98 women with PVD and 103 controls. Participants filled out study-specific questionnaires and underwent quantitative sensory testing of pressure pain thresholds on the arm, leg and in the vestibular area. Levels of ß-endorphin were analyzed by radioimmunoassay using the EURIA-beta-endorphin kit, and the A118G single-nucleotide polymorphism (SNP; rs1799971) in the OPRM1 gene was analyzed using the TaqMan SNP genotyping assay. Results The 118G allele was more common in controls (44%) than in patients (30%) (p = 0.042). The odds ratio of having PVD was 1.8 in participants carrying the 118A allele compared to participants hetero- or homozygous for the 118G allele (OR = 1.846, CI: 1.03-3.31, p = 0.039). Pressure pain thresholds on the leg were higher for participants carrying the 118G allele (mean 480 kPa, SD 167.5) than for those carrying the 118A allele (mean 419, SD 150.4, p = 0.008). Levels of ß-endorphin were higher in patients (mean 17.9 fmol/ml, SD 4.71) than in controls (mean 15.8 fmol/ml, SD 4.03) (p < 0.001). Conclusion We found an association between the A118G polymorphism in the OPRM1 gene and an increased risk of PVD and increased pain sensitivity among participants carrying the 118A allele. PVD patients were more sensitive to pressure pain and had higher levels of plasma ß-endorphin than controls. The results indicate that differences in endogenous pain modulation involving the opioid system could contribute to the pathophysiology of PVD and the general pain hypersensitivity seen in these women. Implications The data support the conceptualization of PVD as part of a general pain disorder with a possible genetic predisposition. The age of onset of PVD is usually between 18 and 25 years and already at this age general pain hypersensitivity is present but rarely causing disability. We believe that early recognition and treatment, with the risk of further development of chronic pain taken into consideration, might prevent future aggravated pain problems in this patient group.

4.
Mol Pain ; 8: 68, 2012 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-22971341

RESUMO

BACKGROUND: Provoked vestibulodynia (PVD) is a pain disorder localized in the vestibular mucosa. It is the most common cause of dyspareunia among young women and it is associated with general pain hypersensitivity and other chronic pain conditions. Polymorphism in the guanosine triphosphate cyclohydrolase (GCH1) gene has been found to influence general pain sensitivity and the risk of developing a longstanding pain condition. The aim of this study was to investigate GCH1-polymorphism in women with PVD and healthy controls, in correlation to pain sensitivity. RESULTS: We found no correlation between the previously defined pain-protective GCH1-SNP combination and the diagnosis of PVD. Nor any correlation with pain sensitivity measured as pressure pain thresholds on the arm, leg and in the vestibule, coital pain scored on a visual analog scale and prevalence of other bodily pain conditions among women with PVD (n = 98) and healthy controls (n = 102). However, among patients with current treatment (n = 36), there was a significant interaction effect of GCH1-gene polymorphism and hormonal contraceptive (HC) therapy on coital pain (p = 0.04) as well as on pressure pain thresholds on the arm (p = 0.04). PVD patients carrying the specified SNP combination and using HCs had higher pain sensitivity compared to non-carriers. In non-HC-users, carriers had lower pain sensitivity. CONCLUSIONS: The results of this study gave no support to the hypothesis that polymorphism in the GCH1-gene contributes to the etiology of PVD. However, among patients currently receiving treatment an interaction effect of the defined SNP combination and use of hormonal contraceptives on pain sensitivity was found. This finding offers a possible explanation to the clinically known fact that some PVD patients improve after cessation of hormonal contraceptives, indicating that PVD patients carrying the defined SNP combination of GCH1 would benefit from this intervention.


Assuntos
GTP Cicloidrolase/genética , Predisposição Genética para Doença , Limiar da Dor , Polimorfismo de Nucleotídeo Único/genética , Vulvodinia/enzimologia , Vulvodinia/genética , Adolescente , Adulto , Anticoncepcionais Orais Hormonais/uso terapêutico , Feminino , Frequência do Gene/genética , Heterozigoto , Humanos , Modelos Lineares , Medição da Dor , Vulvodinia/tratamento farmacológico , Vulvodinia/fisiopatologia , Adulto Jovem
5.
J Sex Med ; 9(5): 1400-6, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22376009

RESUMO

INTRODUCTION: Provoked vestibulodynia (PVD) is the most common cause of dyspareunia in young women. The etiology is unclear, and there is little knowledge of how to predict treatment outcome. AIM: The aim of this study was to identify medical factors associated with treatment outcome and coital pain in women with PVD. METHODS: Seventy women previously treated for PVD at a vulvar open care unit completed questionnaires and a quantitative sensory testing session. MAIN OUTCOME MEASURES: Concomitant bodily pain and treatment outcome were surveyed using a study specific questionnaire. Coital pain was rated on a visual analog scale (VAS), range 0-100. Psychometric screening was carried out using the Hospital Anxiety and Depression Scale. Pressure pain thresholds on the arm, leg, and in the vestibulum were measured using pressure algometers. RESULTS: Major improvement/complete recovery was more likely in PVD patients with a maximum of one other concomitant pain disorder compared with patients with four or more (odds ratio = 7.8, confidence interval: 1.2-49.4, P = 0.03). In a multiple linear regression model, the number of other pain disorders (P < 0.01) and a diagnosis of primary PVD (P = 0.04) were positively associated with the coital VAS pain score. Women with secondary PVD reported major improvement/complete recovery to a higher extent than women with primary PVD (z = 2.11, P = 0.04). CONCLUSION: A successful treatment outcome was more likely in PVD patients with fewer other concomitant pain conditions. The number of other bodily pain conditions was also associated to the intensity of the coital pain. Additionally, the results indicate higher incomplete response rates to treatment in women with primary PVD compared with secondary PVD.


Assuntos
Vulvodinia/terapia , Adulto , Coito/fisiologia , Comorbidade , Feminino , Humanos , Dor/epidemiologia , Medição da Dor , Inquéritos e Questionários , Resultado do Tratamento , Vulva/fisiopatologia , Vulvodinia/diagnóstico , Vulvodinia/epidemiologia , Vulvodinia/fisiopatologia , Adulto Jovem
6.
Microbes Infect ; 12(10): 691-9, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20472091

RESUMO

This randomized double-blind placebo controlled study assessed the vaginal colonization of lactic acid bacteria and clinical outcome. Vaginal capsules containing L gasseri LN40, Lactobacillus fermentum LN99, L. casei subsp. rhamnosus LN113 and P. acidilactici LN23, or placebos were administered for five days to 95 women after conventional treatment of bacterial vaginosis and/or vulvovaginal candidiasis. Vulvovaginal examinations and vaginal samplings were performed before and after administration, after the first and second menstruation, and after six months. Presence of LN strains was assessed using RAPD analysis. LN strains were present 2-3 days after administration in 89% of the women receiving LN strains (placebo: 0%, p < 0.0001). After one menstruation 53% were colonized by at least one LN strain. Nine percent were still colonized six months after administration. Ninety-three percent of the women receiving LN strains were cured 2-3 days after administration (placebo: 83%), and 78% after one menstruation (placebo: 71%) (ns). The intervention group experienced less malodorous discharge 2-3 days after administration (p = 0.03) and after the second menstruation (p = 0.04), compared with placebo. In summary, five days of vaginal administration of LN strains after conventional treatment of bacterial vaginosis and/or vulvovaginal candidiasis lead to vaginal colonization, somewhat fewer recurrences and less malodorous discharge.


Assuntos
Candidíase Vulvovaginal/terapia , Lactobacillus/fisiologia , Pediococcus/fisiologia , Probióticos/administração & dosagem , Vaginose Bacteriana/terapia , Adolescente , Adulto , Anti-Infecciosos/administração & dosagem , Candidíase Vulvovaginal/tratamento farmacológico , Candidíase Vulvovaginal/patologia , Impressões Digitais de DNA , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Método Duplo-Cego , Feminino , Humanos , Lactobacillus/classificação , Lactobacillus/crescimento & desenvolvimento , Lactobacillus/isolamento & purificação , Pessoa de Meia-Idade , Pediococcus/classificação , Pediococcus/crescimento & desenvolvimento , Pediococcus/isolamento & purificação , Técnica de Amplificação ao Acaso de DNA Polimórfico , Prevenção Secundária , Resultado do Tratamento , Vagina/microbiologia , Vaginose Bacteriana/tratamento farmacológico , Vaginose Bacteriana/patologia , Vulva/microbiologia , Adulto Jovem
7.
Am J Obstet Gynecol ; 198(3): 311.e1-6, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18177837

RESUMO

OBJECTIVE: This study was undertaken to survey the steroid receptor expression and morphology in the vulvar vestibular mucosa in women with provoked vestibulodynia. STUDY DESIGN: Fourteen patients and 25 controls without oral contraceptives were included. Vestibular biopsy specimens were obtained and analyzed by using immunohistochemistry, followed by computerized image analysis of estrogen receptors alpha and beta, progesterone receptors A and B, glucocorticoid receptor, androgen receptor, and the proliferation marker Ki67. The morphology was estimated by measuring 4 parameters in the epithelium. RESULTS: There was a significantly higher expression of estrogen receptor alpha in both the epithelium (P = .04) and the stroma (P = .02) in the patient specimens compared with the controls. There were no significant differences in the other analyses performed. CONCLUSION: There is an increased expression of estrogen receptor alpha in the vestibular mucosa but the epithelial morphology seems unaffected in women with provoked vestibulodynia. Further studies regarding plausible associations to neurogenic inflammation are needed.


Assuntos
Dispareunia/metabolismo , Dispareunia/patologia , Receptores de Esteroides/biossíntese , Vulva/metabolismo , Vulva/patologia , Adulto , Feminino , Humanos , Membrana Mucosa/metabolismo
8.
Contraception ; 76(4): 319-25, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17900445

RESUMO

BACKGROUND: The objective was to evaluate the influence of combined oral contraceptives (COC) and of the menstrual cycle on the steroid receptor expression in the vulvar vestibular mucosa of healthy women. STUDY DESIGN: Forty-five healthy women (20 with COC and 25 without) were included. Vestibular biopsies were obtained during the menstrual cycle. Estrogen receptors (ER) alpha and beta, progesterone receptors (PR) A and B, glucocorticoid receptor and androgen receptor as well as the proliferation marker Ki67 were analyzed using immunohistochemistry followed by computerized image analysis. RESULTS: The vestibular stromal tissue of women using COC expressed more ERbeta (p=.024) than that of women without COC. In the follicular phase, PRB was more abundant in the stromal tissue than in the luteal phase (p=.01). CONCLUSIONS: ERbeta is more abundant in the vulvar vestibular mucosa of women using COC than in that of women without COC. There is a cyclic variation in PRB in the vestibular mucosa in healthy women without COC.


Assuntos
Anticoncepcionais Orais Combinados/farmacologia , Receptor beta de Estrogênio/metabolismo , Fase Folicular/metabolismo , Membrana Mucosa/metabolismo , Receptores de Progesterona/metabolismo , Vulva/metabolismo , Adolescente , Adulto , Estudos de Casos e Controles , Receptor alfa de Estrogênio/metabolismo , Feminino , Humanos
9.
Pain ; 130(1-2): 31-9, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17169489

RESUMO

Provoked vestibulodynia is a common cause of superficial dyspareunia in young women. Recent evidence has pointed out the importance of studying endogenous pain modulation in these women. An impairment of diffuse noxious inhibitory controls (DNIC) has been suggested in chronic pain conditions with a female predominance such as fibromyalgia and temporomandibular disorder. Our aim was to examine whether patients with provoked vestibulodynia and healthy women with or without combined oral contraceptives (COC) display a DNIC response to cold noxious stimulation. Twenty patients with provoked vestibulodynia not using COC, 20 healthy women on COC and 20 healthy women without COC were included and tested days 7-11 of their menstrual cycle. Pressure pain thresholds (PPTs) and pain ratings using VAS were measured on the arm and leg before and during a cold pressor test. A socio-medical questionnaire, the Hospital and Anxiety Depression Scale and the Short Form-36 were completed. The majority of the subjects in all three study groups significantly increased their PPTs during cold noxious stimulation indicating a DNIC response. The patients displayed lower PPTs compared to the healthy women. Depression, anxiety and bodily pain were more often reported by the patients. No differences related to the intake of COC were observed between the healthy women. In conclusion, women with provoked vestibulodynia as well as healthy women irrespective of COC status display a DNIC response indicating an endogenous pain inhibition. However, the results imply a systemic hypersensitivity in women with vestibulodynia with low general pain thresholds as compared to healthy women.


Assuntos
Temperatura Baixa , Inibição Neural/fisiologia , Limiar da Dor/fisiologia , Doenças da Vulva/fisiopatologia , Adolescente , Adulto , Braço , Anticoncepcionais Orais Combinados/administração & dosagem , Dispareunia/fisiopatologia , Feminino , Humanos , Perna (Membro) , Nociceptores/fisiologia , Pressão
10.
J Reprod Med ; 49(11): 888-92, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15603099

RESUMO

OBJECTIVE: To analyze possible differences in somatosensory perception in the vestibular mucosa in healthy women associated with the use of oral contraceptives. STUDY DESIGN: Quantitative sensory tests were performed on the vestibular mucosa in 39 healthy women. Twenty women were using oral contraceptives containing 30-40 microg ethinyl estradiol combined with various progestins; 19 women with regular menstrual periods not using oral contraceptives served as controls. The testing included mechanical and heat pain thresholds and detection thresholds of warmth and cold in the anterior and posterior part of the vestibule. RESULTS: Significant lower mechanical pain thresholds were observed in both areas tested in women using oral contraceptives. The most sensitive area was the posterior vestibule in the group using oral contraceptives with a mechanical pain threshold of 72 +/- 10 ( +/-SEM) mN as compared to 161 +/- 3 mN (p < 0.01), in the controls. The result of the thermotest showed no significant differences between the groups. CONCLUSION: Oral contraceptives may induce increased sensitivity in the vestibular mucosa in healthy women and might be one contributingfactor in the development of vulvar vestibulitis.


Assuntos
Anticoncepcionais Orais/efeitos adversos , Limiar da Dor , Dor/etiologia , Doenças da Vulva/etiologia , Adulto , Feminino , Humanos , Membrana Mucosa , Dor/patologia , Fatores de Risco , Doenças da Vulva/patologia
11.
Micron ; 35(5): 319-29, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15006358

RESUMO

OBJECTIVE: To develop and evaluate a standardised method for unbiased measurements of epithelial thickness taking the variability of the dermal papillae in consideration. METHODS: A computer-assisted measurement program suitable for haematoxylin and eosin routine stained specimens has been developed. RESULTS: The developed program was designed to measure four different distance parameters, taking the number, height and width of dermal papillae into account. The measurement program gave very accurate results compared with manual measurements. The measurement results can be presented as tables or star graphs, and the results can be further processed by multivariate analysis. CONCLUSION: The computer-assisted measurement program is considered to be a valuable and reliable tool for measurements of epithelial thickness, irrespectively of the variability of the epithelial morphology. Since length, size and number of the papillae may change with certain pathological conditions, age and also under hormonal influence, this method can be a helpful diagnostic tool.


Assuntos
Epitélio/anatomia & histologia , Processamento de Imagem Assistida por Computador/métodos , Software , Adulto , Idoso , Idoso de 80 Anos ou mais , Derme/anatomia & histologia , Epiderme/anatomia & histologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Pessoa de Meia-Idade , Membrana Mucosa/anatomia & histologia , Vagina/anatomia & histologia
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