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1.
PLoS One ; 15(1): e0227695, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31951599

RESUMO

BACKGROUND: Endometriosis is defined by the presence of endometrial-like tissue (lesions) outside the uterus, commonly on the pelvic peritoneum. It affects 6-10% of women and is associated with debilitating pelvic pain. Current management options are often unsatisfactory. Omega-3 polyunsaturated fatty acids (O-PUFA) have the potential to reduce the painful symptoms associated with endometriosis, reduce lesion size, preserve the patient's ability to conceive, and have minimal side effects. We performed a two-arm, parallel double-blinded randomised controlled trial to inform the planning of a future multicentre randomised controlled trial to evaluate the efficacy of O-PUFA for endometriosis-associated pain. OBJECTIVES: The primary objectives of the trial were to assess recruitment and retention rates. The secondary objectives were to determine the acceptability to women of the proposed methods of recruitment, randomisation, treatments and questionnaires, to estimate the variability in the proposed primary endpoints to inform the sample size calculation and to refine the research methodology for the future definitive trial. METHODS: We recruited women with endometriosis from June 2016 to June 2017 and randomised them to eight weeks of treatment with O-PUFA or olive oil. Pain scores and quality of life questionnaires were collected at baseline and eight weeks. We calculated the proportion of eligible women randomised, and of randomised participants who were followed up to eight weeks. Acceptability questionnaires were used to evaluate women's experiences of the trial. RESULTS: The proportion of eligible participants who were randomised was 45.2% (33/73) and 81.8% (27/33) completed the study. The majority of participants described their overall trial experience favourably and there were no adverse events in either group. CONCLUSION: Our pilot trial supports the feasibility of a future larger trial to definitively evaluate the efficacy of O-PUFA for endometriosis-associated pain. TRIAL REGISTRATION: The trial was registered on the ISRCTN registry (registration number ISRCTN44202346).


Assuntos
Endometriose/tratamento farmacológico , Endometriose/fisiopatologia , Ácidos Graxos Ômega-3/uso terapêutico , Dor Pélvica/tratamento farmacológico , Adulto , Método Duplo-Cego , Endometriose/complicações , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente , Seleção de Pacientes , Dor Pélvica/etiologia , Dor Pélvica/fisiopatologia , Projetos Piloto , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
2.
Ceska Gynekol ; 84(5): 331-336, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826628

RESUMO

OBJECTIVE: The aim of this prospective, unicentric, cohort study was to evaluate the effect of dienogest use in the therapy of symptomatic endometriosis of rectovaginal septum in patients of fertile age. STUDY DESIGN: Prospective, unicentric, cohort study. SETTING: Department of Obstetrics and Gynaecology, Brno University Hospital and Masaryk University Medical School, Brno. MATERIAL AND METHODS: Prospective analysis of the group of 32 patients in reproductive age who have previously been diagnosed with endometriosis of rectovaginal septum. These patients were treated conservatively with dienogest 2 mg per day during a 24-week period. Through questionnaires and clinical assessment, we have studied the presence of symptoms like dyspareunia, diffuse pelvic pain, Biberoglu-Behrman(B-B) score assessment and subjective pain perception using Visual Analogue Scale (VAS) of pain. Data were collected at the beginning of therapy, after 4, 12 and 24 weeks of dienogest use. RESULTS: Continual use of dienogest during the 24-week period diminishes symptoms of dyspareunia by 62% (p.


Assuntos
Endometriose/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Nandrolona/análogos & derivados , Dor Pélvica/etiologia , Estudos de Coortes , Endometriose/patologia , Feminino , Humanos , Nandrolona/uso terapêutico , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Reto/patologia , Resultado do Tratamento , Vagina/patologia
3.
Pan Afr Med J ; 33: 240, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692748

RESUMO

Ovarian torsion is a rare cause of pelvic pain during the postpartum period. The absence of specific clinical and radiological signs makes suspicion and preoperative diagnosis difficult. Delayed management can compromise ovarian viability. We report the case of a 24-year patient presenting to the Emergency Department five days after delivery with severe pelvic pain. The diagnosis of ovarian torsion associated with cystic mass was made on the basis of ultrasound images. The patients underwent cystectomy and a conservative treatment.


Assuntos
Cistos Ovarianos/diagnóstico por imagem , Período Pós-Parto , Anormalidade Torcional/diagnóstico por imagem , Serviço Hospitalar de Emergência , Feminino , Humanos , Cistos Ovarianos/cirurgia , Dor Pélvica/etiologia , Gravidez , Anormalidade Torcional/cirurgia , Ultrassonografia , Adulto Jovem
4.
Ned Tijdschr Geneeskd ; 1632019 10 03.
Artigo em Holandês | MEDLINE | ID: mdl-31580035

RESUMO

A 16-year-old male patient with no known medical history presented at the Emergency Department (ED) with a 2-day history of pain and swelling in his right hemiscrotum. He was diagnosed with non-bacterial epididymitis and discharged home with medical advice. Six days after being diagnosed, the pain and swelling worsened and he was seen by a general practitioner who concluded that the symptoms were attributable to the previously diagnosed epididymitis. No further investigations were performed. Two days later he again presented at the ED, at which time colour Doppler echography revealed a testicular torsion of probably two days old. As after operative detorsion the testis was found to be non-vital, an orchidectomy was performed. This case illustrates that the diagnosis of epididymitis should always be reviewed in patients in whom the scrotum once again becomes painful. Early recognition and treatment of torsio testis gives a better chance of keeping the testis and therefore fertility.


Assuntos
Epididimite/diagnóstico , Dor Pélvica/diagnóstico , Torção do Cordão Espermático/diagnóstico , Adolescente , Diagnóstico Diferencial , Epididimite/complicações , Epididimite/cirurgia , Humanos , Masculino , Orquiectomia , Dor Pélvica/etiologia , Dor Pélvica/cirurgia , Escroto/cirurgia , Torção do Cordão Espermático/complicações , Torção do Cordão Espermático/cirurgia
5.
Int J Mol Sci ; 20(19)2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31561455

RESUMO

The effect of low energy shock wave (LESW) therapy on the changes of inflammatory molecules and pain reaction was studied in a capsaicin (10 mM, 0.1 cc) induced prostatitis model in rats. Intraprostatic capsaicin injection induced a pain reaction, including closing of the eyes, hypolocomotion, and tactile allodynia, which effects were ameliorated by LESW treatment. LESW therapy (2Hz, energy flux density of 0.12 mJ/mm2) at 200 and 300 shocks significantly decreased capsaicin-induced inflammatory reactions, reflected by a reduction of tissue edema and inflammatory cells, COX-2 and TNF-α stained positive cells, however, the therapeutic effects were not observed at 100 shocks treated group. Capsaicin-induced IL-1ß, COX-2, IL-6, caspase-1, and NGF upregulation on day 3 and 7, while NALP1 and TNF-α upregulation was observed on day 7. LESW significantly suppressed the expression of IL-1ß, COX-2, caspase-1, NGF on day 3 and IL-1ß, TNF-α, COX-2, NALP1, caspase-1, NGF expression on day 7 in a dose-dependent fashion. LESW has no significant effect on IL-6 expression. Intraprostatic capsaicin injection activates inflammatory molecules and induces prostatic pain and hypersensitivity, which effects were suppressed by LESW. These findings might be the potential mechanisms of LESW therapy for nonbacterial prostatitis in humans.


Assuntos
Capsaicina/efeitos adversos , Mediadores da Inflamação/metabolismo , Dor Pélvica/etiologia , Dor Pélvica/terapia , Prostatite/etiologia , Prostatite/metabolismo , Terapia por Ultrassom , Animais , Comportamento Animal , Biomarcadores , Ciclo-Oxigenase 2/metabolismo , Citocinas/metabolismo , Modelos Animais de Doenças , Hipersensibilidade/etiologia , Hipersensibilidade/terapia , Imuno-Histoquímica , Masculino , Modelos Biológicos , Limiar da Dor/efeitos da radiação , Prostatite/complicações , Ratos , Fator de Necrose Tumoral alfa/metabolismo , Terapia por Ultrassom/métodos
7.
Health Qual Life Outcomes ; 17(1): 123, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311560

RESUMO

BACKGROUND: This exploratory study sought to establish the relationship between endometriosis-related pelvic pain, endometriosis symptom-frequency, and women's subjective wellbeing (SWB). METHODS: A purposive sample (N = 2061) of women with endometriosis aged between 18 and 62 years (M = 30.49 ± 7.45) completed an online questionnaire containing a measure of pelvic pain (Biberoglu & Behrman Scale; B&B), endometriosis symptom frequency, and an established measure of SWB (Personal Wellbeing Index: PWI). RESULTS: Mean SWB total scores (58.35 ± 17.90) were considerably lower than those of women in the general population (western normative range = 70-80; mean = 76). On average, women reported moderate levels of pelvic pain (B&B mean = 5.96 ± 1.84), with a mean of 10.87 (± 4.81) endometriosis-related symptoms across the sample. Significant relationships were found between pelvic pain and SWB dimension and total scores (r's = - 0.20 to - 0.43, all p's < .001), and significant small to medium associations between symptom frequency and all but one of the dimensions of SWB (r's = - 0.12 to - 0.23, all p's < .007). In multivariate regression models accounting for age and delay in diagnosis, higher levels of pelvic pain were significantly associated with lower SWB scores across all eight dimensions of the PWI and total score (all p's < .002). Greater symptom frequency was significantly associated with lower levels of SWB for the dimensions of health, future security, life as a whole, and total scores (all p's < .002). CONCLUSIONS: SWB was lower in women with endometriosis than SWB in women from the general population, and endometriosis related symptoms and pelvic pain explain significant proportions of the unique variance in women's SWB scores. Psychosocial support is needed for women dealing with endometriosis-related symptoms and pain in order to improve their wellbeing and quality of life.


Assuntos
Endometriose/psicologia , Dor Pélvica/psicologia , Qualidade de Vida , Adolescente , Adulto , Endometriose/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
8.
Pan Afr Med J ; 33: 20, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312336

RESUMO

Giant lipoma (GL) is a rare ubiquitous tumor. Pelvic lipoma is rare with less than 10 cases reported in the literature. The main differential diagnosis is lipoma-like well differentiated liposarcoma. We report the case of a 50-year old female patient, with a 3-month history of pelvic discomfort, presenting with a mass in the left ischiorectal fossa. Abdominopelvic CT scan showed presacral hypodense homogeneous lipomatous mass measuring 10x18 cm. MRI showed hyperintense lesion on T1 and T2 -weighted images with fine partition walls reaching the 2nd sacral vertebra. Total abdominoperineal resection was performed without rupture of tumor capsule. Anatomo-pathological examination confirmed the diagnosis of GL. This study aims to report a new case of giant presacral pelvic lipoma which extends into the left ischiorectal fossa.


Assuntos
Lipoma/diagnóstico , Lipossarcoma/diagnóstico , Neoplasias Pélvicas/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lipoma/patologia , Lipoma/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Pélvicas/patologia , Neoplasias Pélvicas/cirurgia , Dor Pélvica/etiologia , Tomografia Computadorizada por Raios X
9.
Urologiia ; (3): 31-35, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356010

RESUMO

BACKGROUND: chronic prostatitis is a common disease that significantly influence on the quality of life. AIM: Our aim was to assess the prevalence of particular domains of UPOINT classification and determine the efficiency of prostate-selective cytomedins in complex therapy of chronic prostatitis with the predominance of organic component. MATERIALS AND METHODS: a total of 96 patients aged from 24 to 48 years were treated in City clinical hospital named after D.D. Pletnev in 2017-2018 yy. with a previously diagnosed chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The mean duration of the disease was 18.0+/-6.2 months. The total NIH-CPSI score was 24+/-7.3 (pain score 9+/-4.9, urinary score 7+/-2,7, quality of life 8+/-2.3), Qmax was 16+/-4.2 ml/s, prostate volume - 34+/-12 cc. Leukocyturia in post-massage urine was found in 52 patients (54%). Positive urine culture after prostate massage or positive bacterial semen study were found in 22 patients (23%). Prostate-specific therapy consisted of 20 days of rectal suppositories Vitaprost-forte followed by oral therapy by Vitaprost tablet of the same duration. RESULTS: Follow-up examination of 72 patients (75%) was performed after 3 months of therapy. The total NIH-CSPI score decreased to 15.6+/-5.1 (pain score 6.3+/-3.8, urinary score 4.6+/-2.2, quality of life 4.7+/-2), Qmax was 16+/-3.8 ml/s and mean prostate volume was 24+/-6 cc. The normalization of laboratory parameters was achieved in all cases. CONCLUSION: using the UPOINT classification allows to optimize the treatment of patients with chronic prostatitis. Use of prostate-specific cytomedins (Vitaprost) is highly effective in case of prostatic involvement according to the UPOINT classification.


Assuntos
Peptídeos , Prostatite , Adulto , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Peptídeos/uso terapêutico , Prostatite/complicações , Prostatite/tratamento farmacológico , Qualidade de Vida , Síndrome , Adulto Jovem
10.
Medicine (Baltimore) ; 98(29): e16473, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335707

RESUMO

BACKGROUND: Endometriosis is a common disease of women of childbearing age. In recent years, the incidence of endometriosis has been on the rise. The main clinical manifestations are pelvic pain and infertility. In recent years, traditional Chinese patent medicine (TCMP) has played an important role in the treatment of endometriosis. So far, there is a lack of comparison among all the current common TCPMs for endometriosis. Consequently, it is indispensable to propose a network meta-analysis (NMA) protocol to discuss the strengths and weaknesses of different TCMPs. METHODS: We will comprehensively and systematically retrieve the relevant Chinese and English databases from their inceptions to the May 2019. All randomized controlled trials (RCTs) of TCMPs for Endometriosis will be included. Two researchers will independently screen literature, extract data and assess the risk of bias of included studies. We will conduct pairwise meta-analyses and Bayesian network meta-analyses to assess all the available evidence. Data will be analyzed using STATA and WinBUGS software. RESULTS: This work will compare and rank the relative efficacy of different TCPMs in the treatment of endometriosis in detail. CONCLUSION: The results of this study will provide reliable evidence for the selection of clinical treatment program and guideline development. PROSPERO REGISTRATION NUMBER: CRD42019127781.


Assuntos
Endometriose/terapia , Medicina Tradicional Chinesa , Teorema de Bayes , Endometriose/complicações , Feminino , Humanos , Infertilidade Feminina/etiologia , Medicina Tradicional Chinesa/efeitos adversos , Metanálise em Rede , Dor Pélvica/etiologia , Projetos de Pesquisa
11.
Ceska Gynekol ; 84(3): 240-246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324117

RESUMO

OBJECTIVE: To summarize the current knowledge about pathogenesis, diagnostics, symptomatology and the treatment of adenomysis. DESIGN: Review article. SETTING: The Centre of Assisted Reproduction, ISCARE I.V.F., Prague. METHODS: Analysis of literature and current studies. RESULTS: This article reviews etiology, diagnostics and classification of adenomyosis, medical and surgical management options and the fertility implication of adenomyosis. CONCLUSION: Uterine adenomyosis is characterized by the presence of endometrial glands in myometrium and usually manifests by pelvic pain, abnormal uterine bleeding or infertility. Although adenomyosis and endometriosis share a number of features, they are considered to be two different entities. Recent improvements of imaging techniques such as transvaginal ultrasound and magnetic resonance imaging have affected the detection of adenomyosis. Adenomyosis has a negative impact on IVF results.


Assuntos
Adenomiose , Endometriose/patologia , Doenças Uterinas , Útero/patologia , Adenomiose/classificação , Adenomiose/complicações , Adenomiose/diagnóstico , Adenomiose/terapia , Feminino , Humanos , Infertilidade Feminina/etiologia , Dor Pélvica/etiologia , Doenças Uterinas/classificação , Doenças Uterinas/complicações , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia , Hemorragia Uterina/etiologia
12.
Pain Physician ; 22(4): E333-E344, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337177

RESUMO

BACKGROUND: Magnetic resonance neurography (MRN) has an increasing role in the diagnosis and management of pudendal neuralgia, a neurogenic cause of chronic pelvic pain. OBJECTIVE: The objective of this research was to determine the role of MRN in predicting improved pain outcomes following computed tomography (CT)-guided perineural injections in patients with pudendal neuralgia. STUDY DESIGN: This study used a retrospective cross-sectional study design. SETTING: The research was conducted at a large academic hospital. METHODS: Patients: Ninety-one patients (139 injections) who received MRN and CT-guided pudendal blocks were analyzed. INTERVENTION: A 3Tesla (T) scanner was used to evaluate the lumbosacral plexus for pudendal neuropathy. Prior to receiving a CT-guided pudendal perineural injection, patients were given pain logs and asked to record pain on a visual analog scale. MEASUREMENT: MRN findings for pudendal neuropathy were compared to the results of the CT-guided pudendal nerve blocks. Injection pain responses were categorized into 3 groups - positive block, possible positive block, and negative block.Statistical Tests: A chi-square test was used to test any association, and a Cochran-Armitage trend test was used to test any trend. Significance level was set at .05. All analyses were done in SAS Version 9.4 (SAS Institute, Inc., Cary, NC). RESULTS: Ninety-one patients (139 injections) who received MRN were analyzed. Of these 139 injections, 41 were considered positive (29.5%), 52 of 139 were possible positives (37.4%), and 46 of 139 were negative blocks (33.1%). Of the patients who had a positive pudendal block, no significant difference was found between the MRN result and the pudendal perineural injection response (P = .57). Women had better overall response to pudendal blocks, but this response was not associated with MRN findings (P = .34). However, positive MRN results were associated with better pain response in men (P = .005). Patients who reported bowel dysfunction also had a better response to pudendal perineural injection (P = .02). LIMITATIONS: Some limitations include subjectivity of pain reporting, reporting consistency, absence of a control group, and the retrospective nature of the chart review. CONCLUSION: Pudendal perineural injections improve pain in patients with pudendal neuralgia and positive MRN results are associated with better response in men. KEY WORDS: MRI, MRN, CT injection, pudendal neuralgia, pudendal nerve, pelvic pain, chronic pelvic pain, pudendal neuropathy.


Assuntos
Bloqueio Nervoso/métodos , Neuralgia do Pudendo/diagnóstico , Neuralgia do Pudendo/tratamento farmacológico , Radiografia Intervencionista/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/tratamento farmacológico , Dor Pélvica/etiologia , Nervo Pudendo/diagnóstico por imagem , Nervo Pudendo/efeitos dos fármacos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
13.
Medicine (Baltimore) ; 98(21): e15741, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124955

RESUMO

RATIONALE: The purpose of this case report was to raise awareness regarding endometriosis on the surface of the uterus mimicking malignant tumor and thus manage it accurately. PATIENT CONCERNS: A 40-year-old Asian woman with a 2-year history of lower abdomen pain was admitted to our department with elevated serum cancer antigen (CA) 125 level, weight loss, and pelvic mass from 20 days previously. Magnetic resonance imaging revealed a high volume of effusion in the pelvic cavity, an irregular occupying lesion on the surface of the fundus of the uterus, and multiple nodules. DIAGNOSES: Postoperative pathology confirmed the diagnosis of endometriosis. INTERVENTIONS: Diagnostic laparoscopy revealed large crunchy tissue and soft nodules on the surface of the posterior wall of the uterus and approximately 2000 mL of bloody ascites. The result of the frozen-section analysis of the tissue on the surface of the uterus indicated endometriosis. The surgical procedure was converted to laparotomy due to bleeding after biopsy. OUTCOMES: The patient's recovery was uneventful. Three months after the operation, the patient had a good general state without periodic pain, and the CA125 level returned to normal. LESSONS: A large mass occurring in the pelvic cavity could be indicative of endometriosis, especially if accompanied by a history of period pain. Preoperative positron emission tomography may increase the accuracy of the diagnosis.


Assuntos
Endometriose/diagnóstico , Endometriose/patologia , Adulto , Antígeno Ca-125/sangue , Diagnóstico Diferencial , Endometriose/complicações , Endometriose/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Dor Pélvica/etiologia , Neoplasias Uterinas/diagnóstico , Perda de Peso
14.
Urol Int ; 103(2): 211-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31129663

RESUMO

The objective is to observe if it could be possible to use the apoptosis test to distinguish different aetiologies in chronic pelvic pain syndrome (CPPS). A prospective study was done, 106 patients, 57 had previously been diagnosed with urological chronic pelvic pain (UCPP)/interstitial cystitis (IC) and 49 patients with gynaecological chronic pelvic pain (GCPP). Neoplastic cells cultures were exposed to the urine of patients with UCPP/IC and patients with GCPP. The urine ability to provoque apoptosis on them was analysed. The apoptosis degree was measured by quantifying the percentage of cells in phase subG0, determined by a flow cytometry analysis. It is observed that the cell cultures exposed to urine of patients with UCPP had a significantly higher sub-G1 peak and G2 phase than those of the cells exposed to urine from patient's GCPP. The average values of apoptosis in patients with UCPP were significantly higher to that obtained in -patients having GCPP. With the apoptosis tests having a value >10%, it is considered as positive as well. This means that when we are faced with a patient who has UCPP or non-bladder chronic pelvic pain, the probability of having an UCPP increases by 45% when the apoptosis test is positive for a value >10%. Urine from patients with UCPP has significantly higher apoptotic effect over than the effect produced by urine from patients with GCPP. The apoptosis test could be useful as an illness biomarker.


Assuntos
Apoptose , Dor Crônica/etiologia , Doenças dos Genitais Femininos/etiologia , Dor Pélvica/etiologia , Doenças Urológicas/etiologia , Adulto , Dor Crônica/patologia , Feminino , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Femininos/patologia , Humanos , Pessoa de Meia-Idade , Dor Pélvica/patologia , Estudos Prospectivos , Autorrelato , Doenças Urológicas/complicações , Doenças Urológicas/patologia , Adulto Jovem
15.
Obstet Gynecol ; 133(6): e363-e371, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135762

RESUMO

Obstructive uterovaginal anomalies may present after puberty with amenorrhea, dysmenorrhea, pelvic pain, recurrent vaginal discharge, or infertility. The evaluation of a patient with a suspected obstructive reproductive anomaly should include a detailed medical history, physical examination, and imaging. The genital examination is critical to differentiate a patient with an imperforate hymen from a patient with labial adhesions, urogenital sinus, transverse vaginal septum, or distal vaginal atresia. Pelvic ultrasonography is the initial imaging method recommended for a patient with cyclic pain and amenorrhea or a patient with persistent dysmenorrhea. It is important to note that diagnosis of a uterine or vaginal anomaly by imaging before puberty can be challenging and misleading because of the small size of the prepubertal uterus and the lack of endometrial stimulation and menstrual distention of the vagina. Consultation with a radiologist experienced with imaging of uterovaginal anomalies may be helpful to determine the most accurate diagnosis. In general, obstructive vaginal and uterine anomalies are not surgical emergencies, and the complexities of these conditions are best managed by gynecologic care providers familiar with the surgical management of these conditions. Given the high risk of stenosis and complications associated with transverse vaginal septum, distal vaginal atresia, and cervical atresia, referral to a center with expertise in the management of these anomalies is paramount. The best long-term outcome is achieved with a complete evaluation, clear understanding of the anomaly, mobilization of appropriate surgical resources, sufficient preoperative counseling, and planned surgical intervention.


Assuntos
Anormalidades Múltiplas , Doenças Uterinas/cirurgia , Útero/anormalidades , Vagina/anormalidades , Doenças Vaginais/cirurgia , Amenorreia/etiologia , Constrição Patológica , Gerenciamento Clínico , Dismenorreia/etiologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Dor Pélvica/etiologia , Exame Físico , Sociedades Médicas , Ultrassonografia , Estados Unidos , Doenças Uterinas/congênito , Doenças Uterinas/diagnóstico , Doenças Vaginais/congênito , Doenças Vaginais/diagnóstico
17.
BMC Womens Health ; 19(1): 68, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096979

RESUMO

BACKGROUND: Dienogest has been shown to substantially improve endometriosis-associated symptoms such as debilitating chronic pelvic pain, and in turn, health-related quality of life (HRQoL). To date, there is no data on patient-reported outcomes reflecting the real-world practice in Asia where endometriosis is a relevant health, social and economic burden. This non-interventional, multi-center, prospective study aims to investigate the influence of dienogest on HRQoL. METHODS: Asian women received dienogest (2 mg/daily) and were followed for 24 months. The effectiveness of dienogest to improve HRQoL and endometriosis-associated pelvic pain (EAPP) was assessed by patient-reported outcomes. HRQoL, especially the "pain" domain as primary endpoint, was evaluated with the Endometriosis Health Profile-30 (EHP-30) questionnaire. The numeric rating scale served to determine changes in the severity of EAPP. Within the presented interim analysis (data cut-off: 2017-11-27), the mean changes in EHP-30 and EAPP scores from baseline to 6 months upon availability of the data were evaluated. Treatment-emergent adverse events (TEAEs) and bleeding profiles were documented. RESULTS: Dienogest therapy decreased EHP-30 scores in all assessed domains (score 0-100, lower scores indicate better HRQoL). Primarily, the "pain" domain was improved in 78.4% of patients. EAPP was reduced (score 0-10, lower scores reflect less pain), highlighted by a mean reduction of the pain score by - 4.5 points. Patients with a higher EAPP score at baseline had an increased response to dienogest (- 6.2 points mean change) compared to patients with low baseline EAPP severity (- 1.4 points mean change). Both surgically and clinically diagnosed patients described comparable pain reduction, as well as women with or without prior treatment. Drug-related TEAEs were documented for 31.5% of patients, with amenorrhoea (5.9%) and metrorrhagia (5.1%) being the most common events. The bleeding pattern was changed upon dienogest, characterized by decreased normal bleeding (84.2 to 28.8%) and increased amenorrhea (3.2 to 42.9%) at 6 months. CONCLUSION: The data indicate an amelioration of HRQoL and EAPP upon dienogest therapy. No new safety signals were observed. Therefore, its use as first-line therapy for long-term management of debilitating and chronic endometriosis-associated pain represents an interesting option that remains to be further investigated. TRIAL REGISTRATION: Name of registry: Clinical Trials Clinicaltrials.gov registration number: NCT02425462 Registration date: 2015-04-24. Registration timing: prospective.


Assuntos
Endometriose/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Nandrolona/análogos & derivados , Dor Pélvica/tratamento farmacológico , Qualidade de Vida/psicologia , Adulto , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Estudos de Coortes , Endometriose/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Nandrolona/uso terapêutico , Dor Pélvica/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
18.
Gynecol Endocrinol ; 35(9): 782-786, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30957578

RESUMO

Primary dysmenorrhea is a common gynecologic disorder and is one of the main causes for referral to the gynecology clinic. This study aimed to determine the effects of alpha-lipoic acid (ALA) and mefenamic acid and a combination compared with placebo on the girls with primary dysmenorrhea. This double-blind, placebo-controlled clinical trial done on population consisted of female students living in dormitories of Qazvin University of Medical Sciences who had moderate to severe dysmenorrhea using the Visual Analog Scale (VAS) questionnaire. Participants were randomly divided into four groups (n = 100): ALA, mefenamic acid, ALA + mefenamic acid and placebo groups. ALA and mefenamic acid were administrated in 600 mg and 250 mg, respectively. The severity of the pain was measured in the beginning and the end of the study. Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, IL). Our final results suggested that, although mefenamic acid significantly decreased the menstrual pain, ALA supplementation, 600 mg, would be more efficient than mefenamic acid in 250 mg. Also, the combination of ALA and mefenamic acid significantly has been far. Considering the ALA supplementation effect on pain relief in patients with primary dysmenorrhea, this antioxidant can be recommended for the healing of symptoms of these patients.


Assuntos
Dismenorreia/tratamento farmacológico , Ácido Mefenâmico/administração & dosagem , Ácido Tióctico/administração & dosagem , Adulto , Método Duplo-Cego , Quimioterapia Combinada , Dismenorreia/complicações , Feminino , Humanos , Irã (Geográfico) , Menstruação/efeitos dos fármacos , Manejo da Dor/métodos , Dor Pélvica/tratamento farmacológico , Dor Pélvica/etiologia , Placebos , Resultado do Tratamento , Adulto Jovem
19.
PLoS One ; 14(4): e0214195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31009470

RESUMO

OBJECTIVE: To assess the cost-effectiveness of acupuncture for pelvic girdle and low back pain (PGLBP) during pregnancy. DESIGN: Pragmatic-open-label randomised controlled trial. SETTING: Five maternity hospitals. POPULATION: Pregnant women with PGLBP. METHOD: 1:1 randomization to standard care or standard care plus acupuncture (5 sessions by an acupuncturist midwife). MAIN OUTCOME MEASURE: Efficacy: proportion of days with self-assessed pain by numerical rating scale (NRS) ≤ 4/10. Cost effectiveness (societal viewpoint, time horizon: pregnancy): incremental cost per days with NRS ≤ 4/10. Indirect non-healthcare costs included daily compensations for sick leave and productivity loss caused by absenteeism or presenteeism. RESULTS: 96 women were allocated to acupuncture and 103 to standard care (total 199). The proportion of days with NRS ≤ 4/10 was greater in the acupuncture group than in the standard care group (61% vs 48%, p = 0.007). The mean Oswestry disability score was lower in the acupuncture group than with standard care alone (33 versus 38, Δ = 5, 95% CI: 0.8 to 9, p = 0.02). Average total costs were higher in the control group (€2947) than in the acupuncture group (€2635, Δ = -€312, 95% CI: -966 to +325), resulting from the higher indirect costs of absenteeism and presenteeism. Acupuncture was a dominant strategy when both healthcare and non-healthcare costs were included. Costs for the health system (employer and out-of-pocket costs excluded) were slightly higher for acupuncture (€1512 versus €1452, Δ = €60, 95% CI: -272 to +470). CONCLUSION: Acupuncture was a dominant strategy when accounting for employer costs. A 100% probability of cost-effectiveness was obtained for a willingness to pay of €100 per days with pain NRS ≤ 4.


Assuntos
Terapia por Acupuntura/métodos , Dor Lombar/terapia , Dor Pélvica/terapia , Complicações na Gravidez/terapia , Terapia por Acupuntura/economia , Adolescente , Adulto , Análise Custo-Benefício , Terapia por Exercício/economia , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Dor Pélvica/etiologia , Dor Pélvica/fisiopatologia , Pelve/fisiopatologia , Gravidez , Complicações na Gravidez/fisiopatologia , Qualidade de Vida , Resultado do Tratamento , Adulto Jovem
20.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936334

RESUMO

A 52-year-old woman with a background of vaginal hysterectomy for heavy menstrual bleeding underwent an elective laparoscopic adhesiolysis, left salpingo-oophorectomy for left-sided pelvic pain, and a right salpingectomy. Despite a grossly normal appearance, histology revealed a rare presentation of mature teratoma with insular carcinoid tumour arising from the left fallopian tube. Even though the salpingectomy was thought to be curative, the patient underwent a second operation to remove her remaining right ovary as a precaution against malignant spread. In light of limited information in such rare cases, counselling on best management and discussion of risks to guide patient decision making remains challenging.


Assuntos
Tumor Carcinoide/diagnóstico , Tubas Uterinas/patologia , Neoplasias Ovarianas/diagnóstico , Teratoma/diagnóstico , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Feminino , Humanos , Histerectomia , Laparoscopia , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Dor Pélvica/etiologia , Cuidados Pré-Operatórios , Salpingo-Ooforectomia , Teratoma/patologia , Teratoma/cirurgia , Resultado do Tratamento
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