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1.
Medicine (Baltimore) ; 100(40): e27456, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622869

RESUMO

RATIONALE: Dienogest is a type of progestin used for the treatment of endometriosis (EM). However, a significant adverse effect of dienogest is depression; therefore, assessing for a history of mood disorders is recommended before prescribing the drug. Herein, we present the case of a patient with no history of psychiatric disorders who was diagnosed with dienogest-induced major depressive disorder. This case emphasizes the importance of close monitoring for negative mood changes in patients taking dienogest. PATIENT CONCERNS: A 41-year-old woman underwent surgery for EM. Postoperatively, her gynecologist prescribed dienogest (2 mg/d) to control EM symptoms. Two months after the initiation of dienogest, she manifested insomnia almost daily, gradually became depressed, lost interest in all activities, had incessant cries, and repeatedly thought of death. She had no history of major physical or psychiatric disorders. DIAGNOSIS: Major depressive disorder, single episode, severe. INTERVENTIONS: A psychiatric consultation was recommended, an antidepressant was prescribed, and dienogest was discontinued. OUTCOMES: Two weeks later, there was significant improvement in the symptoms, and after 4 weeks, she remained in a stable mood with no suicidal thoughts. She was followed up for 13 months with a maintenance dose of escitalopram (5 -10mg/d), until the psychiatrist recommended treatment discontinuation, with a confirmed state of remission. LESSONS: This was a case of dienogest-induced depression in a patient with no history of mood disorders. Clinicians should be aware of the possibility of the occurrence of severe depression in progestin users regardless of their previous history.


Assuntos
Transtorno Depressivo Maior/etiologia , Endometriose/tratamento farmacológico , Antagonistas de Hormônios/efeitos adversos , Nandrolona/análogos & derivados , Ideação Suicida , Adulto , Endometriose/cirurgia , Feminino , Antagonistas de Hormônios/uso terapêutico , Humanos , Nandrolona/efeitos adversos , Nandrolona/uso terapêutico
2.
Medicine (Baltimore) ; 100(40): e27441, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622860

RESUMO

ABSTRACT: No studies have examined the issue of intraabdominal port-site adhesion following single-port access (SPA) laparoscopic surgeries. The purpose of the present study was to investigate the clinical effects of temperature-sensitive adhesion barrier solution in preventing periumbilical adhesion in SPA laparoscopy. This was a prospective, single-arm study in which patients were given GUARDIX-SGTM after SPA laparoscopic surgery for benign gynecologic diseases. One gram of GUARDIX-SGTM was applied on the abdominal viscera just below the umbilical port site and adjacent abdominal wall prior to fascia closure. The primary endpoint was the incidence of postoperative adhesion evaluated by visceral sliding technique through transabdominal sonography after three months. Between June 2019 and March 2020, a total of 37 healthy patients without any history of previous abdominal surgery received SPA laparoscopic surgery by a single surgeon. No postoperative complications such as wound dehiscence or surgical site infection occurred during the follow-up period of three months. No postoperative adhesion around the umbilicus was noted in all 37 patients. The mean visceral movement measured by transabdominal sonography during maximal respiration was 4.9 cm (4.9 ±â€Š1.9 cm). Using an adhesion barrier around the port site prior to fascia closure prevents postoperative adhesion in benign SPA laparoscopic gynecologic surgery.


Assuntos
Laparoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Aderências Teciduais/prevenção & controle , Adulto , Endometriose/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Estudos Prospectivos , Miomectomia Uterina/efeitos adversos , Miomectomia Uterina/métodos
3.
BMC Womens Health ; 21(1): 355, 2021 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627209

RESUMO

BACKGROUND: Endometriosis is a common benign gynecological disease that has the potential to debilitate due to pain and reduced quality of life. Treatment modalities such as hormones and surgery have limitations and do not treat all dimensions of the problems caused by endometriosis, and physical activity (PA) and exercise have been suggested as alternative treatments. Aim of this study was to perform a systematic review and meta-analysis to assess the effect of PA and exercise on endometriosis-associated symptoms. METHODS: Eleven databases were searched systematically. Study selection, quality assessment, and data extraction were carried out by two independent researchers in accordance with PRISMA guidelines. Eligibility criteria were women with diagnosed endometriosis receiving an intervention (PA and/or exercise). The primary outcome was pain intensity, but all outcomes were accepted. RESULTS: This study screened 1045 citations for eligibility. Four interventional studies were identified, of which one showed fatal design flaws and so was excluded. Three studies, two randomized controlled trials (RCT) and one pre-post study with no control group, involving 109 patients were included in a descriptive synthesis. The interventions included flexibility and strength training, cardiovascular fitness, and yoga, and were performed from one to four times per week for a total duration of 8-24 weeks, with or without supervision. Only one study found improvements in pain intensity. One study showed decreases in stress levels. Due to the heterogeneity of the study outcomes and measures, as well as confounding factors, a quantitative meta-analysis could not be performed. CONCLUSION: The effect of PA and exercise as treatments for endometrioses-associated symptoms could not be determined due to significant limitations of the included studies. Future research should be based on RCTs of high methodological quality, measuring and reporting relevant core outcomes such as pain, improvements in symptoms and quality of life, and acceptability and satisfaction from the perspectives of patients. Furthermore, these outcomes need to be measured using reliable and validated tools. TRIAL REGISTRATION NUMBER: CRD42021233138.


Assuntos
Endometriose , Endometriose/complicações , Endometriose/terapia , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
BMC Womens Health ; 21(1): 336, 2021 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544404

RESUMO

BACKGROUND: To date, there is no reliable non-invasive marker for the early detection and diagnosis of endometriosis available possibly resulting in a delayed diagnosis and consequently an unnecessary long ordeal for the individual woman. Therefore, the primary objective of the current study was to evaluate whether the combination of a thyroid-stimulating hormone (TSH) level > 2.5 µlU/ml and premenstrual spotting could serve as non-invasive markers of endometriosis. A secondary objective was to determine whether typical symptoms of endometriosis like dysmenorrhea and/or dyspareunia could increase the diagnostic reliability. METHODS: We conducted a retrospective, case-control study with 167 female patients at the Department of OB/GYN and REI (UniKiD) of the medical center of the University of Düsseldorf, between January 2015 and December 2016. 107 women with surgically confirmed endometriosis were compared to 60 without endometriosis (controls). To evaluate the diagnostic accuracy, we considered sensitivity, specificity and predictive values. In order to assess the association between the non-invasive markers and endometriosis an odds ratio (OR) with a 95% confidence interval was calculated. RESULTS: In our cohort, diagnosis of endometriosis with non-invasive markers according to their sensitivity yielded the following ranking: increased TSH level, premenstrual spotting, combination of both previous parameters, addition of dysmenorrhea, addition of dyspareunia and combination of all parameters. CONCLUSION: The existence of endometriosis should be taken into consideration when a patient suffers from thyroid dysfunction and premenstrual spotting. Apart from an increased TSH level, the presence of premenstrual spotting underlines the possible diagnosis of endometriosis with non-invasive markers and therefore, the patient´s history needs to be taken into account carefully. Trial registration The retrospective study was approved by the Ethics Committee of the medical faculty of the Heinrich-Heine University, Düsseldorf, Germany, Registration number Düsseldorf: 5371R (approved: April 04th, 2016). Since the design of the study was retrospective no written informed consent was necessary.


Assuntos
Dispareunia , Endometriose , Estudos de Casos e Controles , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Endometriose/diagnóstico , Feminino , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos
5.
Ther Umsch ; 78(8): 441-446, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34555977

RESUMO

Endometriosis and Menopause Abstract. Endometriosis is supposed to affect only women in their reproductive years, but endometriotic lesions can reactivate in menopause and cause significant complaints in these patients. Altered needs and co-morbidities of the women request a different approach in therapy than in the younger ages. Reduction in chronic pain on the one hand and alleviation of climacteric symptoms, like hot-flushes and vaginal dryness, on the other hand, are main concerns to the physician in charge. Consequently, keeping the balance between the hypoestrogenic state, which is necessary to reduce activity and size of endometriotic lesions, and hormone replacement therapy (HRT) to relief menopausal complaints, depicts the key in treating these women. Progesterons, GnRH-analoga (with addback) and intrauterine devices depict the basic therapeutic strategy in perimenopausal women. In case of uncertain sonographic findings or intractable symptoms, a surgical approach (and histology) should be performed. Aromatase inhibitors, melatonin, oral GnRH-antagonists and ablation of the endometrium (in bare dysmenorrhea) represent promising alternatives to the established therapy. Requesting an HRT, it is important to add progesterone for at least two years, even in the patients with a prior hysterectomy to avoid a recurrence of residual lesions.


Assuntos
Endometriose , Endometriose/diagnóstico , Endometriose/terapia , Feminino , Humanos , Menopausa
6.
Wiad Lek ; 74(8): 1939-1944, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34537747

RESUMO

OBJECTIVE: The aim: To assess the CSF - 1 level in peritoneal fluid and menstrual blood of women with endometrioid disease and to investigate its diagnostic and prognostic specificity. PATIENTS AND METHODS: Materials and methods: The study included 80 women of child-bearing age (mean age 30.95 ± 6.49 years) with benign gynaecological pathology of the ovaries and / or fallopian tubes. The women included in the study were divided into two groups: study group (n = 50, mean age 31.04 ± 6.3 years), consisting of patients with confirmed endometrioid disease, and control group (n = 30, mean age 30.8 ± 6.8 years), involving individuals without signs of endometriosis (p> 0.05). RESULTS: Results: We have found significantly higher level of CSF-1 content in the peritoneal fluid in the subjects of the study group (2027.05 ± 732.64 pg / ml) compared with those in the control group (1725.62 ± 466.06 pg / ml) (p = 0.029). There is a tendency towards an increase in CSF-1 level in women with endometriosis in its more severe stages and more severe and extended adhesions. The investigation of CSF-1 content in menstrual blood has demonstrated significant increase in its values in the women of the study group (9431.6 ± 2866.22 pg / ml) compared with the values in the control group (6637.12 ± 954.05 pg / ml), (p = 0.00004). Thus, there is a tendency towards the growth in CSF-1 level in peritoneal fluid and menstrual blood in women with endometriosis and concurrent increase in severity of the disease. CONCLUSION: Conclusions: There has been found significant increase in CSF-1 content in women with endometrioid disease in both peritoneal fluid and menstrual blood (1.2 and 1.4 times, respectively). Thus, macrophage growth factor (CSF-1) can be used as a diagnostic and prognostic criterion in evaluating the progression of endomertioid disease.


Assuntos
Endometriose , Doenças Uterinas , Adulto , Líquido Ascítico , Feminino , Humanos , Fator Estimulador de Colônias de Macrófagos , Aderências Teciduais , Adulto Jovem
7.
J Int Med Res ; 49(9): 3000605211047701, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34590878

RESUMO

OBJECTIVE: To analyze the utility of carbohydrate antigen (CA)125 and human epididymis protein 4 (HE4) to detect malignancy in women with ovarian endometriosis, when ovarian cancer is suspected and ultrasonography results are inconclusive. METHODS: Women who underwent surgery between 2015 and 2019 for ovarian endometriosis or for adnexal masses, with a final diagnosis of ovarian carcinoma (clear cell and endometrioid) were included in this retrospective study. The women were divided into three groups: ovarian endometriosis (OE), ovarian carcinoma without endometriosis (OC), and ovarian carcinoma with endometriosis (OC + E). Adnexal masses were assessed preoperatively by transvaginal ultrasonography according to the International Ovarian Tumor Analysis (IOTA) simple rules, and CA125 and HE4 blood levels were obtained. RESULTS: Of 208 women, 45 had malignancy, 16 in the OC + E group and 29 in the OC group. According to transvaginal ultrasonography, 13 were classified as undetermined risk of malignancy: OC group: 3, OE group: 3, and OC + E group: 7. When we compared the tumor biomarkers, significant differences in HE4 but not in CA125 levels were found between the groups. CONCLUSIONS: When ovarian malignancy is suspected in patients with ovarian endometriosis, HE4 is a more useful tumor biomarker to diagnose OC when ultrasonography results are inconclusive.


Assuntos
Endometriose , Neoplasias Ovarianas , Algoritmos , Biomarcadores Tumorais , Antígeno Ca-125 , Carcinoma Epitelial do Ovário , Endometriose/diagnóstico por imagem , Endometriose/cirurgia , Feminino , Humanos , Neoplasias Ovarianas/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade , Proteína 2 do Domínio Central WAP de Quatro Dissulfetos
8.
Am J Case Rep ; 22: e932493, 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34547012

RESUMO

BACKGROUND Endometriosis is a unique entity described in ample literature as the decidualization of endometrial tissues under the influence of gynecological hormones outside the uterine cavity. The post-surgical presence of ectopic endometrial tissue on the skin is known as abdominal wall endometriosis, cutaneous endometriosis, or scar endometriosis. Iatrogenic implantation of detached endometrial tissues at the incision site is the most widely accepted theory for this rare monad. The unspecific scar endometriosis presentation makes it challenging to diagnose. Moreover, it can easily be confused with hematoma, hernia, lipoma, abscess, scar granuloma, and tumor. Here, we report and discuss a rare case of scar endometriosis with various available treatment modalities. CASE REPORT We delineate a case of a 39-year-old woman with abdominal wall cutaneous endometriosis. An "inverted T" incision opened the abdominal and uterine cavity as it was a problematic preterm breech in labor. After an uneventful postoperative and postpartum period, she presented with a painful, discolored nodular mass of approximately 3 cm in diameter at the left border of the cesarian scar, developed over 1.5 years, often accompanied by drainage of brownish discharge. Ultrasonography with color Doppler showed a hypoechoic lesion with internal vascularity, corroborated our preliminary diagnosis of scar endometriosis, which was further confirmed by surgical excision and histopathology. CONCLUSIONS A proper surgical resection is the standard treatment line for scar endometriosis. However, patients need regular follow-up to look for recurrences, even after treatment. Further studies are recommended to establish factors associated with cutaneous endometriosis recurrence.


Assuntos
Parede Abdominal , Endometriose , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adulto , Cesárea , Cicatriz , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Recém-Nascido , Recidiva Local de Neoplasia/patologia , Gravidez
9.
Zhongguo Zhong Yao Za Zhi ; 46(12): 3087-3090, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34467699

RESUMO

Endometriosis(EMs) is a stubborn gynecological disease caused by persistent immune-inflammatory effects, and is known as "benign tumor" because of its similar characteristics to malignant tumors. National physician master Professor BAN Xiu-wen believes that the spread of damp-evil is the pathologic foundation for inflammatory response of ectopic endometrium; accumulation of blood stasis is the pathological product of continuous inflammatory attacks, and the combination of dampness and stasis is the main pathogenesis for refractory EMs. Modern researches have shown that immune-inflammatory effect is the key mechanism for development of EMs, and is closely related to cell autophagy, all of which have made it become the hot spots in research of the pathogenesis, diagnosis and treatment of EMs. Therefore, with immune-inflammatory effect as the breakthrough point in this research, and with reference to the related research of autophagy, the correlation between "combination of dampness and stasis" and abnormal autophagy-induced immune inflammatory response in ectopic endometrium was discussed, to provide guidance for the clinical application of traditional Chinese medicine and modern research.


Assuntos
Endometriose , Autofagia , Endométrio , Feminino , Humanos , Medicina Tradicional Chinesa
10.
J Bodyw Mov Ther ; 27: 165-168, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391229

RESUMO

Secondary dysmenorrhea is frequently associated with dyspareunia. When the diagnostic workup is negative, its clinical management could be complex and a cause for concerned for the patient. We reported a case of a young woman who suffered from dyspareunia, dysmenorrhea and chronic pelvic pain. After symptoms progression and pharmacological therapy unresponsiveness, the gynaecologist referred the patient to an osteopath for the functional evaluation of the abdominal pevic area. The examination revealed the presence of pelvic, lumbosacral, and sacrococcygeal dysfunctions which, once treated, significatively reduced the severity of dysmenorrhea and dyspareunia. A multidisciplinary approach might be considered in case of suspected functional impairment. This should be carefully evaluated, considering the previous trauma history and the somatic dysfunctions on abdominal-pelvic fascia.


Assuntos
Dor Crônica , Dispareunia , Endometriose , Dismenorreia , Feminino , Humanos , Dor Pélvica/etiologia , Pelve
11.
Acta Obstet Gynecol Scand ; 100(10): 1840-1848, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34396512

RESUMO

INTRODUCTION: The transfusion rate in hysterectomies for benign pathology is almost 3%. However, despite the strong interest in reducing intraoperative bleeding, limited evidence is available regarding the technical aspects concerning uterine vessel management during a total laparoscopic hysterectomy (TLH). Uterine artery (UA) closure in TLH can be performed at the origin from the internal iliac artery or at the uterus level (UL). However, low-quality evidence is available regarding the superiority of one method over the other. MATERIAL AND METHODS: We performed a single-blind randomized (1:1) controlled trial (NCT04156932) between December 2019 and August 2020. One hundred and eighty women undergoing TLH for benign gynecological diseases were randomized to TLH with UA closure at the origin from the internal iliac artery (n = 90), performed at the beginning of the procedure by putting two clips per side at the origin, vs closure at the UL (n = 90). Intraoperative blood loss estimated from suction devices was the primary outcome. Secondary end points were perioperative outcomes, the conversion rate from one technique to the other, and complication rates with 4 months of follow up. RESULTS: Uterine artery closure at the origin was completed in all 90 patients (0%), whereas closure at the UL was converted to closure at the origin in 11 cases (12.2%; p < 0.001); failures were mainly associated with the presence of endometriosis (81.8% [9/11] vs 10.1% [8/79]; p < 0.001). In the intention-to-treat analysis, the intraoperative blood loss was higher in the group assigned to the closure at the UL (108.5 mL) than in the group with closure at the origin (69.3 mL); the mean difference was 39.2 mL (95% CI 13.47-64.93 mL; p = 0.003). Other perioperative outcomes and complications rates did not differ. CONCLUSIONS: Uterine artery closure at the origin reduces intraoperative blood loss during a TLH and appears to be more reproducible than closure at the UL without higher complication rates. However, the absent translation in clinical benefits impedes the support of a clinical superiority in all women. Closure at the origin may provide clinical advantages in the presence of severe preoperative anemia or pelvic anatomic distortion.


Assuntos
Histerectomia/métodos , Laparoscopia/métodos , Artéria Uterina/cirurgia , Útero/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Endometriose/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Resultado do Tratamento
12.
Clinics (Sao Paulo) ; 76: e2981, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34406269

RESUMO

OBJECTIVE: To evaluate the association of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVUS) findings with adenomyosis symptoms. METHODS: This prospective study conducted between January and December 2018 enrolled 78 women aged 18 to 40 years with abnormal uterine bleeding (AUB), infertility, and/or pelvic pain. All patients underwent 2D and 3D TVUS. Signs of adenomyosis on TVUS were identified according to the consensus of the Morphological Uterus Sonographic Assessment group. RESULTS: The prevalence of adenomyosis on TVUS was 55.12%. Patients with adenomyosis were older (p=0.002) and had more dysmenorrhea, AUB, and endometriosis than those without adenomyosis. When comparing the presence of symptoms with each adenomyosis feature, on 2D TVUS, severe dyspareunia was significantly associated with the presence of a poorly defined junctional zone (JZ) (p=0.023) and on 3D TVUS, patients with AUB had a more irregular (p=0.003), poorly defined (p=0.028), and interrupted JZ (p=0.011). After logistic regression analysis, signs of adenomyosis on TVUS remained significantly associated only with age over 30 years (OR: 1.2; 95% CI: 1.0-1.2) and AUB (OR: 7.65; 95% CI: 2-29). Patients with diffuse adenomyosis were older and presented with more infertility and AUB than patients with focal or no adenomyosis. CONCLUSION: The findings of adenomyosis by 2D and 3D TVUS showed association with age and AUB. 3D TVUS alterations in the JZ were associated with AUB and dyspareunia. Diffuse adenomyosis was associated with older age, a greater prevalence of infertility, and AUB.


Assuntos
Adenomiose , Endometriose , Doenças Uterinas , Adenomiose/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Estudos Prospectivos , Ultrassonografia , Doenças Uterinas/diagnóstico por imagem , Doenças Uterinas/epidemiologia
13.
Environ Health ; 20(1): 96, 2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34452632

RESUMO

BACKGROUND: Endometriosis, which affects 10-15 % of women of reproductive age, is an estrogen-driven condition influenced by environmental and genetic factors. Exposition to estrogen-like endocrine-disrupting chemicals (EDCs) has been reported to contribute to the fetal origin of this disease. CASE PRESENTATION: We report here an informative family in which all prenatally DES-exposed daughters and subsequent granddaughters presented endometriosis, whereas the unexposed first daughter and her progeny presented no gynecological disorders. Moreover, the only post-pubertal great-granddaughter, who presents chronic dysmenorrhea that remains resistant to conventional therapy, is at risk of developing endometriosis. The mother (I-2) was prescribed DES (30 mg/day for 3 months) to inhibit lactation after each delivery. CONCLUSIONS: Although a direct causal link between the grandmother's treatment with DES and the development of endometriosis in possibly three exposed generations remains speculative, this report strengthens the suspicion that fetal exposition to DES contributes to the pathogenesis of adult diseases, such as endometriosis. It also highlights a multigenerational and likely transgenerational effect of EDCs.


Assuntos
Dietilestilbestrol/efeitos adversos , Dismenorreia/induzido quimicamente , Disruptores Endócrinos/efeitos adversos , Endometriose/induzido quimicamente , Estrogênios não Esteroides/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Feminino , Humanos , Gravidez
14.
Int J Mol Sci ; 22(16)2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34445738

RESUMO

According to a rich body of literature, immune cell dysfunctions, both locally and systemically, and an inflammatory environment characterize all forms of endometriosis. Alterations in transcripts and proteins involved in the recruitment of immune cells, in the interaction between cytokines and their receptors, cellular adhesion and apoptosis have been demonstrated in endometriotic lesions. The objective of this narrative review is to provide an overview of the components and mechanisms at the intersection between inflammation and genetics that may constitute vanguard therapeutic approaches in endometriosis. The GWAS technology and pathway-based analysis highlighted the role of the MAPK and the WNT/ß-catenin cascades in the pathogenesis of endometriosis. These signaling pathways have been suggested to interfere with the disease establishment via several mechanisms, including apoptosis, migration and angiogenesis. Extracellular vesicle-associated molecules may be not only interesting to explain some aspects of endometriosis progression, but they may also serve as therapeutic regimens per se. Immune/inflammatory dysfunctions have always represented attractive therapeutic targets in endometriosis. These would be even more interesting if genetic evidence supported the involvement of functional pathways at the basis of these alterations. Targeting these dysfunctions through next-generation inhibitors can constitute a therapeutic alternative for endometriosis.


Assuntos
Endometriose/genética , Endometriose/imunologia , Endometriose/metabolismo , Endometriose/terapia , Vesículas Extracelulares/metabolismo , Feminino , Humanos , Inflamação/genética , Inflamação/metabolismo , Sistema de Sinalização das MAP Quinases , Terapia de Alvo Molecular , Via de Sinalização Wnt
15.
Curr Issues Mol Biol ; 43(2): 900-916, 2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34449536

RESUMO

Endometriosis is a chronic gynecological disease defined by the presence of endometrial-like tissue found outside the uterus, most commonly in the peritoneal cavity. Endometriosis lesions are heterogenous but usually contain endometrial stromal cells and epithelial glands, immune cell infiltrates and are vascularized and innervated by nerves. The complex etiopathogenesis and heterogenity of the clinical symptoms, as well as the lack of a specific non-invasive diagnostic biomarkers, underline the need for more advanced diagnostic tools. Unfortunately, the contribution of environmental, hormonal and immunological factors in the disease etiology is insufficient, and the contribution of genetic/epigenetic factors is still fragmentary. Therefore, there is a need for more focused study on the molecular mechanisms of endometriosis and non-invasive diagnostic monitoring systems. MicroRNAs (miRNAs) demonstrate high stability and tissue specificity and play a significant role in modulating a range of molecular pathways, and hence may be suitable diagnostic biomarkers for the origin and development of endometriosis. Of these, the most frequently studied are those related to endometriosis, including those involved in epithelial-mesenchymal transition (EMT), whose expression is altered in plasma or endometriotic lesion biopsies; however, the results are ambiguous. Specific miRNAs expressed in endometriosis may serve as diagnostics markers with prognostic value, and they have been proposed as molecular targets for treatment. The aim of this review is to present selected miRNAs associated with EMT known to have experimentally confirmed significance, and discuss their utility as biomarkers in endometriosis.


Assuntos
MicroRNA Circulante/sangue , Endometriose/sangue , Inflamação/patologia , Biomarcadores/sangue , MicroRNA Circulante/genética , Endometriose/diagnóstico , Endometriose/genética , Endometriose/patologia , Endométrio/metabolismo , Endométrio/patologia , Transição Epitelial-Mesenquimal , Feminino , Humanos , Inflamação/genética , Inflamação/metabolismo , Fatores de Risco , Útero/metabolismo , Útero/patologia
16.
Environ Int ; 157: 106819, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34391986

RESUMO

BACKGROUND: Perfluorinated substances (PFAS) are chemicals with endocrine disruptive properties that may interfere with the female reproductive system. However, few studies have explored the association between benign gynecological diseases and high PFAS exposure. OBJECTIVES: The aim of this study was to investigate the possible associations between PFAS exposure and subsequent diagnosis of polycystic ovarian syndrome (PCOS), uterine leiomyoma (fibroids), and endometriosis in a cohort exposed to PFAS through drinking water. MATERIAL AND METHODS: In 2013, high levels (with sum of PFAS above 10,000 ng/L), dominated by perfluorooctanesulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS), were found in the drinking water from one of the two waterworks in Ronneby, Sweden. The contamination came from firefighting foams used at a nearby airfield. Females of all ages (n = 29,106) who had ever resided in the municipality between 1985 and 2013 formed a cohort. Individual exposure was assessed based on municipality waterworks distribution data linked to annual residential address data; 27% of the females had ever lived at an address with PFAS-contaminated water. Gynecological health outcomes were retrieved from the Swedish National Patient Register. The Cox proportional hazards model was used to estimate the association between exposure and each diagnosis. RESULTS: There were in all 161 cases of PCOS, 1,122 cases of uterine leiomyoma, and 373 cases of endometriosis. In women aged 20-50 years (n = 18,503), those with the highest estimated PFAS exposure had increased hazard ratios (HR) for PCOS (HR = 2.18; 95% confidence interval (CI) 1.43, 3.34) and uterine leiomyoma (HR = 1.28; 95% CI 0.95, 1.74). No increased HR for endometriosis was found (HR = 0.74; 95% CI 0.42, 1.29). CONCLUSIONS: Exposure to high levels of PFAS in drinking water was associated with increased risk of PCOS and possibly uterine leiomyoma, but not endometriosis. The findings for PCOS are consistent with prior studies reporting positive associations between PCOS and PFAS exposure at background levels.


Assuntos
Ácidos Alcanossulfônicos , Água Potável , Endometriose , Poluentes Ambientais , Fluorcarbonetos , Leiomioma , Síndrome do Ovário Policístico , Poluentes Químicos da Água , Ácidos Alcanossulfônicos/análise , Estudos de Coortes , Água Potável/efeitos adversos , Água Potável/análise , Endometriose/induzido quimicamente , Endometriose/epidemiologia , Feminino , Fluorcarbonetos/análise , Fluorcarbonetos/toxicidade , Humanos , Leiomioma/induzido quimicamente , Leiomioma/epidemiologia , Síndrome do Ovário Policístico/induzido quimicamente , Síndrome do Ovário Policístico/epidemiologia , Suécia/epidemiologia , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/toxicidade
17.
BMJ Case Rep ; 14(8)2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429296

RESUMO

Bladder endometriosis accounts for 70%-85% cases of urinary tract endometriosis. A high index of suspicion is needed to diagnose this condition as most women have associated pelvic and menstrual complaints. The presence of cyclical haematuria along with tender anterior vaginal wall should alert the gynaecologist or urologist to consider this rare entity. Treatment is medical therapy followed by surgery when needed. Transurethral resection of endometriotic spot is the commonly used approach but to completely excise the endometriotic nodule, bladder resection at the site of nodule is needed along with repair of cut bladder margins. Herein, we describe a dual surgical approach where the margins of the endometriotic spot were delineated and cut using cystoscopy, followed by robotic approach to completely excise the nodule along with bladder repair. Robotic approach seems safer and easier in this complex surgery owing to dense adhesions in such cases.


Assuntos
Endometriose , Procedimentos Cirúrgicos Robóticos , Robótica , Cistectomia , Cistoscopia , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia
18.
PLoS One ; 16(8): e0256433, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34432847

RESUMO

BACKGROUND: Endometriosis is a chronic pain condition in premenopausal women. Pain is mainly characterized by pain intensity and may induce disability in all areas of daily life. Nevertheless, pain is influenced by emotional and social factors as well. Social distancing measures or quarantine, as reaction to rapidly rising infections with the COVID-19 virus due to the SARS-CoV-2 pandemic, were implemented across Europe to prevent the spread of the virus and social distancing measures were imposed by the German government by beginning of March 2020 with initiation of the lockdown by the end of March 2020. The objective of this study was to assess, how social distancing measures during the lockdown impacted the various aspects of pain perception in a group of chronic pain patients, such as women suffering from endometriosis. METHODS: Between 6th to 27th April 2020, an online questionnaire was activated at internet platforms of endometriosis patients support groups. Participants were asked retrospectively at one time point about their visual pain intensity measured by the visual analogue scale (VAS) and pain disability via pain disability index (PDI) prior to initiation of social distancing measures in Germany (VASP, PDIP), as well as the pain intensity and pain disability since implementation of social distancing measures (VASI, PDII). Differences of VAS and PDI previous and after implementation of social distancing measures were displayed as ΔVAS and ΔPDI. Pain experience and social support were assessed by a 5-point Likert scale. RESULTS: 285 participants completed at least one question regarding pain intensity, disability, pain experience or social support. Dysmenorrhea, the symptom with the highest level of pain assessed by VAS, decreased significantly during the SARS-CoV-2 pandemic compared to the time period prior to social isolation (45.30% respondents experienced improvemenet vs 40.50% who experienced worsening; p = 0.025). The global physical impairment improved significantly (improvement of pain induced disability in 48.20% vs 40.90% with worsening of pain symptoms; p = 0.032) after the implementation of social distancing measures. Pain experience was negatively affected by social distancing measures, since frequency of pain awareness increased in 43.6% (p<0.001) of participants and 30.0% (p<0.001) more participants experienced pain as a threat. Verbalization of pain experience was reduced in 36.6% (p = 0.001) of participants and 14.6% (p = 0.91), 21.9% (p<0.001) and 31.5% (p<0.001) of participants reported less social support from their partner, family and friends. CONCLUSIONS: Physical pain and disability on one hand and emotional and social pain experience on the other were differentially affected by the emerged emotional, social and health care constraints related to the SARS-CoV-2 pandemic.


Assuntos
COVID-19/epidemiologia , Dor Crônica/etiologia , Endometriose/patologia , Apoio Social , Adulto , COVID-19/virologia , Estudos Transversais , Avaliação da Deficiência , Endometriose/complicações , Feminino , Alemanha/epidemiologia , Humanos , Internet , Medição da Dor , Percepção da Dor , Pandemias , Quarentena , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Isolamento Social , Inquéritos e Questionários
19.
Int J Mol Sci ; 22(16)2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34445100

RESUMO

Endometriosis is a common gynecological disorder characterized by ectopic growth of endometrium outside the uterus and is associated with chronic pain and infertility. We investigated the role of the long intergenic noncoding RNA 01133 (LINC01133) in endometriosis, an lncRNA that has been implicated in several types of cancer. We found that LINC01133 is upregulated in ectopic endometriotic lesions. As expression appeared higher in the epithelial endometrial layer, we performed a siRNA knockdown of LINC01133 in an endometriosis epithelial cell line. Phenotypic assays indicated that LINC01133 may promote proliferation and suppress cellular migration, and affect the cytoskeleton and morphology of the cells. Gene ontology analysis of differentially expressed genes indicated that cell proliferation and migration pathways were affected in line with the observed phenotype. We validated upregulation of p21 and downregulation of Cyclin A at the protein level, which together with the quantification of the DNA content using fluorescence-activated cell sorting (FACS) analysis indicated that the observed effects on cellular proliferation may be due to changes in cell cycle. Further, we found testis-specific protein kinase 1 (TESK1) kinase upregulation corresponding with phosphorylation and inactivation of actin severing protein Cofilin, which could explain changes in the cytoskeleton and cellular migration. These results indicate that endometriosis is associated with LINC01133 upregulation, which may affect pathogenesis via the cellular proliferation and migration pathways.


Assuntos
Endometriose/genética , Endométrio/patologia , Células Epiteliais/patologia , RNA Longo não Codificante/genética , Adulto , Linhagem Celular , Proliferação de Células , Endometriose/patologia , Endométrio/citologia , Endométrio/metabolismo , Células Epiteliais/citologia , Células Epiteliais/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Regulação para Cima , Adulto Jovem
20.
Eur J Obstet Gynecol Reprod Biol ; 264: 254-258, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34333367

RESUMO

OBJECTIVES: Endometriosis is a disease that significantly affects the quality of life of patients. Continuous pelvic pain seen in patients disrupts their well-being. The aim of this study is to examine the changes in depression and sleep disorders in patients with endometriosis before and after the operation. STUDY DESIGN: Forty-two women aged 18-49 with an indication for operation due to the diagnosis of stage 4 endometriosis and without a known psychiatric disorder were included in the study. Pittsburgh Sleep Quality Index and Beck Depression Inventory were used to compare sleep quality and mood of endometriosis patients before and after surgery. RESULTS: The mean age of the patients was 33.8 ± 7.6. The mean BMI of the patients was 24.6 ± 4.1. Endometrioma diameter was 248.42 ± 95.7 cm3 in patients with poor sleep quality, while it was 296.11 ± 271.53 cm3 in patients with good sleep quality, and a significant difference was observed (p < 0.05). Poor sleep quality and severe depression were significantly higher in patients with infertility complaints. It was observed that sleep quality was not significantly correlated with bilateral endometrioma, a nodule in the Douglas, sacrouterine tenderness and mean ASRM scores (p > 0.05). A significant decrease in depression complaints and a significant increase in sleep quality were observed in patients who underwent stage-4 endometriosis surgery (p < 0.05). CONCLUSION: We showed that there was a significant increase in sleep quality and a significant decrease in depression symptoms in patients who underwent stage-4 endometriosis surgery. Since endometriosis affects the social life of patients in many ways, it is necessary to increase the knowledge and experience about the treatment of endometriosis with larger studies to be done. We believe that surgical treatment can reduce social problems and increase the quality of life of endometriosis patients.


Assuntos
Endometriose , Transtornos do Sono-Vigília , Depressão/etiologia , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Período Pós-Operatório , Qualidade de Vida , Transtornos do Sono-Vigília/etiologia
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