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1.
Anticancer Res ; 40(5): 2429-2438, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366386

RESUMO

Endometriosis is an estrogen-dependent disease, which affects 10% of women in the reproductive age. Malignant transformation is an uncommon event, which affects approximately 0.7-2.5% of women, and, when it occurs, it involves ovarian and extraovarian sites in 75% and 25% of the cases, respectively. Endometriosis correlates with presentation of clear cell and endometrioid carcinoma of the ovary. Activation of phosphatidylinositol 3-kinase (PIK3) - protein kinase B (AKT) - mammalian target of rapamycin (mTOR) pathway, aberrant chromatin remodeling due to AT-rich interactive domain-containing protein 1A (ARID1A) mutation and inactivation of estrogen receptor-α signaling seem to play a major role in the carcinogenesis. To date, little data are available regarding endometriosis-associated extraovarian malignancies. The aim of the present study was to review the clinical, pathological and prognostic features of endometriosis-related neoplasms arising from extraovarian sites, with particular focus on intestinal malignancies, urinary tract malignancies and tumors arising from surgical scars.


Assuntos
Carcinoma Endometrioide/diagnóstico , Carcinoma Endometrioide/etiologia , Transformação Celular Neoplásica , Endometriose/complicações , Endometriose/patologia , Biópsia , Carcinoma Endometrioide/terapia , Estudos de Casos e Controles , Progressão da Doença , Endometriose/etiologia , Endometriose/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Gradação de Tumores , Estadiamento de Neoplasias , Patologistas
2.
Zhonghua Fu Chan Ke Za Zhi ; 55(1): 15-20, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32074768

RESUMO

Objective: To explore the importance of the diagnosis and treatment value of laparoscopy and hysteroscopy in patients with unexplained infertility. Methods: A total of 519 cases diagnosed as unexplained infertility, received laparoscopy and hysteroscopy in Peking Union Medical College Hospital from May 2012 to December 2015. The causes of infertility were evaluated, and the subjects were followed up to observe the nature pregnancy rate. Results: Among 519 unexplained infertility patients, pelvic abnormalities had been explored in 466 (89.8%, 466/519) cases. Pelvic endometriosis combined with adhesions, pelvic adhesion alone, uterine leiomyoma and uterine cavity polyp were 72.4% (376/519), 12.3% (64/519), 3.7% (19/519) and 1.3% (7/519) respectively. The total natural pregnancy rate within the 3 years of follow up was 53.9% (208/386), and the natural pregnancy rate was 29.8% (31/104) in patients aged 35 years and over. Conclusions: The patients with clinical diagnosis of unexplained infertility should be examined by hysteroscopy and laparoscopy. Under the examination, the causes of infertility could be found more intuitively, and targeted treatment could be carried out to improve the pregnancy rate. The natural pregnancy rate of the elderly patients decrease obviously after operation, and the time of natural trying pregnancy should not be too long.


Assuntos
Histeroscopia , Infertilidade Feminina/diagnóstico por imagem , Infertilidade Feminina/terapia , Laparoscopia , Adulto , Endometriose/complicações , Endometriose/diagnóstico por imagem , Feminino , Humanos , Leiomioma/complicações , Leiomioma/diagnóstico por imagem , Gravidez , Aderências Teciduais/complicações , Aderências Teciduais/diagnóstico por imagem
3.
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
4.
BJOG ; 127(1): 107-114, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31319445

RESUMO

OBJECTIVE: To evaluate the reproducibility of the Endometriosis Fertility Index (EFI). DESIGN: Single-cohort prospective observational study. SETTING: University hospital. POPULATION: Women undergoing laparoscopic resection of any rASRM-stage endometriosis. METHODS: Details of pre- and peroperative findings were collected into a coded research file. EFI scoring was performed en-bloc by three different raters (expert-1 [C.T.], expert-2 [C.M.], junior [C.B.]). Required sample size: 71. Definitions used for agreement: clinical (scores within same range: 0-4, 5-6, 7-10) and numerical (difference ≤1 EFI point). MAIN OUTCOME MEASURES: Primary outcome: rate of clinical agreement between two experts. SECONDARY OUTCOMES: expert numerical agreement, clinical and numerical agreement between expert-1 and junior, and within expert-1 (intra-observer), agreement of rASRM score and -stage. RESULTS: A near 'inter-expert' clinical agreement rate (1.000, 95% CI 0.956-1.000; P = 0.0149) was observed. The numerical agreement between two experts was also high (0.988, 95% CI 0.934-1.000); similarly, high agreement rates were observed for both 'junior-expert' comparisons (clinical 0 .963, 95% CI 0.897-0.992; numerical 0.988, 95% CI 0.934-1.000) and 'intra-expert' comparisons (clinical 0.988, 95% CI 0.934-1.000; numerical 1.000, 95% CI 0.956-1.000). Reasons for disagreements were different scoring of the least-function score and disagreements in rASRM scores. The reproducibility of the rASRM score was clearly inferior to that of the EFI for all comparisons. CONCLUSION: The EFI can be reproduced reliably by different raters, further supporting its use in daily clinical practice as the principal clinical tool for postoperative fertility counselling/management of women with endometriosis. TWEETABLE ABSTRACT: A study confirming the high reproducibility of the EFI substantiates its use in daily clinical practice.


Assuntos
Endometriose/complicações , Infertilidade Feminina/etiologia , Adolescente , Adulto , Endometriose/cirurgia , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto Jovem
5.
Ann Lab Med ; 40(1): 40-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31432638

RESUMO

BACKGROUND: Tumor markers are useful for detection and preoperative evaluation of ovarian tumors. We evaluated the clinical usefulness of cancer antigen (CA) 125, human epididymis 4 (HE4), and CA72-4 levels and Risk of Ovarian Malignancy Algorithm (ROMA) values for differential diagnosis of malignant and borderline tumors among suspected ovarian tumors, and the effects of endometriosis on these tumor markers. METHODS: In a total of 266 patients (213, 14, and 39 with benign, borderline and malignant tumors, respectively), CA125, HE4, and CA72-4 levels were measured, and ROMA values were calculated. Medians of each marker were compared among the three groups. The area under the ROC curve (AUC), sensitivity, and specificity were calculated to analyze the diagnostic performance of each marker. RESULTS: All markers were significantly higher in the malignant group than in the benign group. HE4 levels and ROMA values were significantly higher in the malignant group than in the borderline group. ROMA value had the highest AUC for distinguishing the malignant and borderline groups from the benign group in premenopausal (0.773) and postmenopausal (0.927) patients. CA125 level was significantly higher in patients with endometriosis than in those without (P<0.001), whereas HE4 and CA72-4 levels were not affected by endometriosis (P=0.128 and 0.271, respectively). CONCLUSIONS: ROMA value is the best marker to distinguish malignant and borderline tumors from benign tumors in pre- and postmenopausal patients. HE4 and CA72-4 levels provide information on possible CA125 elevation due to endometriosis.


Assuntos
Antígenos Glicosídicos Associados a Tumores/sangue , Antígeno Ca-125/sangue , Endometriose/patologia , Neoplasias Ovarianas/diagnóstico , Proteína 2 do Domínio Central WAP de Quatro Dissulfetos/análise , Adolescente , Adulto , Idoso , Algoritmos , Área Sob a Curva , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/sangue , Endometriose/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/complicações , Curva ROC , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
6.
Nat Commun ; 10(1): 5785, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31857578

RESUMO

Uterine adenomyosis is a benign disorder that often co-occurs with endometriosis and/or leiomyoma, and impairs quality of life. The genomic features of adenomyosis are unknown. Here we apply next-generation sequencing to adenomyosis (70 individuals and 192 multi-regional samples), as well as co-occurring leiomyoma and endometriosis, and find recurring KRAS mutations in 26/70 (37.1%) of adenomyosis cases. Multi-regional sequencing reveals oligoclonality in adenomyosis, with some mutations also detected in normal endometrium and/or co-occurring endometriosis. KRAS mutations are more frequent in cases of adenomyosis with co-occurring endometriosis, low progesterone receptor (PR) expression, or progestin (dienogest; DNG) pretreatment. DNG's anti-proliferative effect is diminished via epigenetic silencing of PR in immortalized cells with mutant KRAS. Our genomic analyses suggest that adenomyotic lesions frequently contain KRAS mutations that may reduce DNG efficacy, and that adenomyosis and endometriosis may share molecular etiology, explaining their co-occurrence. These findings could lead to genetically guided therapy and/or relapse risk assessment after uterine-sparing surgery.


Assuntos
Adenomiose/genética , Endometriose/genética , Nandrolona/análogos & derivados , Proteínas Proto-Oncogênicas p21(ras)/genética , Adenomiose/complicações , Adenomiose/terapia , Adulto , Proliferação de Células/efeitos dos fármacos , Proliferação de Células/genética , Análise Mutacional de DNA , Endometriose/complicações , Endometriose/terapia , Endométrio/patologia , Endométrio/cirurgia , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Histerectomia , Pessoa de Meia-Idade , Mutação , Miométrio/patologia , Miométrio/cirurgia , Nandrolona/farmacologia , Nandrolona/uso terapêutico , Receptores de Progesterona/genética , Receptores de Progesterona/metabolismo , Resultado do Tratamento , Adulto Jovem
7.
Presse Med ; 48(11 Pt 1): 1249-1256, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31727491

RESUMO

Cardiovascular diseases are become the primary cause of death in women. The cardiovascular risk of the woman has unknown specificities and remains underestimated. At equal age, women have more cardio vascular risk factors than men. All these specificities must be taken into account for an optimized evaluation of cardiovascular risk and for improvement of CV management in women. Some traditional risk factors are more deleterious in women such as hypertension, tobacco, diabetes or psycho-social stress and they are less well controlled compared to men. Women are also exposed to hormonal risk factors (contraception, pregnancy and menopause) or to emergent risk situations (migraine with aura, endometriosis, polycystic ovary syndrome, auto-immune diseases…). Conversely, lifestyle measures (regular physical activity, no smoking, healthy diet, stress management) are extremely effective in primary and secondary prevention in women. Predicting the risk of cardiovascular events in women is difficult because the classic risk scores (SCORE, Framingham…) do not take into account hormonal CV specificities and underestimate the women CV risk. Until then, only the specific women AHA stratification of CVR allowed for appropriate care for them. Recently, at the initiative of the French Society of hypertension, a consensus of experts proposed a stratification of CVR adapted to French women, to help practitioners in their care, especially for the two hormonal periods as contraception and menopause.


Assuntos
Doenças Cardiovasculares/etiologia , Cardiologia , Doenças Cardiovasculares/prevenção & controle , Anticoncepção/efeitos adversos , Angiopatias Diabéticas/etiologia , Endometriose/complicações , Feminino , França , Ginecologia , Humanos , Hipertensão/complicações , Menopausa , Equipe de Assistência ao Paciente , Síndrome do Ovário Policístico/complicações , Gravidez , Prevenção Primária , Medição de Risco , Fatores de Risco , Prevenção Secundária , Fatores Sexuais , Fumar/efeitos adversos , Sociedades Médicas , Estresse Psicológico/complicações
8.
J Comput Assist Tomogr ; 43(6): 976-980, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31688247

RESUMO

Endometriosis (EN) is a common gynecological condition characterized by the presence of functional endometrium located outside the uterine cavity. Sciatic nerve (SN) is rarely affected by EN. Magnetic resonance imaging allows a direct visualization of the spinal and SN, and it is the modality of choice for the study of SN involvement in extrapelvic EN. We report a case of an endometrioma located in the right SN with a systematic review of the literature.


Assuntos
Endometriose/diagnóstico por imagem , Nervo Isquiático/patologia , Ciática/diagnóstico por imagem , Adulto , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Laparoscopia , Imagem por Ressonância Magnética/métodos , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/cirurgia , Ciática/etiologia , Ciática/cirurgia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(39): e16965, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574795

RESUMO

This study presents the postoperative pregnancy rate of women with recurrent endometriosis and evaluates the predictive value of the endometriosis fertility index (EFI) for the pregnancy.A total of 107 women who wished to conceive after surgery for recurrent endometriosis from January 2007 to December 2016 were included. The EFI score was calculated postoperatively. The receiver operator characteristic (ROC) curve was plotted to determine the most promising contributor to predicting pregnancy, and Kaplan-Meier (K-M) analysis was used to estimate the cumulative pregnancy rate (CPR).A total of 61 pregnancies were registered in 58 women and the remaining 49 patients failed to become pregnant. The EFI score was strongly associated with the postoperative fertility prognosis. The CPRs during the first 2 and 3 years postoperatively were 51.86% and 66.38%, respectively, and increased to 71.98% within the first 5 years postoperatively in patients with EFI scores ≥5. However, the CPR was 26.00% during the first 2 years after surgery in individuals with EFI scores <5, and there was no increase in the CRP thereafter.Women suffering from recurrent endometriosis still experienced a probability of natural pregnancy, especially patients with EFI scores ≥5. The EFI score had good predictive power for postoperative pregnancy in these patients.


Assuntos
Endometriose/cirurgia , Fertilização , Índice de Massa Corporal , Endometriose/complicações , Feminino , Seguimentos , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Estimativa de Kaplan-Meier , Valor Preditivo dos Testes , Gravidez , Taxa de Gravidez , Curva ROC , Recidiva , Técnicas de Reprodução Assistida , Estudos Retrospectivos
10.
Rev Med Suisse ; 15(668): 1941-1944, 2019 Oct 23.
Artigo em Francês | MEDLINE | ID: mdl-31643155

RESUMO

Endometriosis can negatively affects many aspects of womens'life, including their sexuality. Deep or superficial dyspareunia is reported by nearly half of women with endometriosis. The pain has chronic inflammatory, neuropathic or muscular components. Repetition of painful experiences, but also treatments for endometriosis can lead to other sexual disorders such as lack of desire and arousal. We present a narrative review exploring the causes of sexual pain in endometriosis patients and how they could deteriorate quality of sexual life if unrecognized.


Assuntos
Dispareunia/complicações , Endometriose/complicações , Inquéritos Epidemiológicos , Feminino , Humanos , Comportamento Sexual
11.
Medicina (Kaunas) ; 55(9)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31480321

RESUMO

Background and objective: Previous studies did not draw a definitive conclusion about the influence of the role of deep endometriosis (DE) and ovarian endometrioma (OE) as risk factor for developing adverse perinatal outcomes in patients affected by endometriosis. This study aimed to investigate if adverse fetal and maternal outcomes, and in particular the incidence of small for gestational age (SGA) infants, are different in pregnant women with OE versus pregnant women with DE without OE. Material and methods: This study was based on a retrospective analysis of a database collected prospectively. The population included in the study was divided into three groups: patients with OE, patients with DE without concomitant OE, and patients without endometriosis (controls). The controls were matched on the basis of age and parity. Demographic data at baseline and pregnancy outcomes were recorded. Results: There was no statistically significant difference in first trimester levels of PAPP-A, first and mid-pregnancy trimester mean Uterine Artery Doppler pulsatile index, estimated fetal weight centile, and SGA fetuses' prevalence for patients with OE, and those with DE without OE in comparison to health women; moreover, there was no statistically significant difference with regard to SGA birth prevalence, prevalence of preeclampsia, and five-minute Apgar score between these three groups. Conclusions: The specific presence of OE or DE in pregnant women does not seem to be associated with an increased risk of delivering an SGA infant. These data seem to suggest that patients with endometriosis should be treated in pregnancy as the general population, thus not needing a closer monitoring.


Assuntos
Endometriose/complicações , Recém-Nascido Pequeno para a Idade Gestacional , Doenças Ovarianas/complicações , Placentação , Resultado da Gravidez , Adulto , Endometriose/patologia , Feminino , Humanos , Gravidade do Paciente , Fenótipo , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos
12.
Artigo em Inglês | MEDLINE | ID: mdl-31540449

RESUMO

BACKGROUND: Endometriosis has been associated with the subsequent development of ovarian and breast cancers. This study evaluated whether nurses were at increased risks of developing endometriosis and subsequent ovarian and breast cancers. METHODS: From Taiwan National Health Insurance Research Database during 2000 to 2011, we established 3 study cohorts, consisting of 23,801 nurses, 11,973 other hospital employees, and 143,096 general women free of endometriosis and cancer. Women in all cohorts were followed to the end of 2011 to measure the occurrences of endometriosis and subsequent ovarian and breast cancers. The incident endometriosis cases and related hazard ratio (HR) and 95% confidence interval (CI) were calculated. The incident cases of ovarian cancer and breast cancer and related odds ratio were calculated. RESULTS: The incidence of endometriosis was the highest in the nurse cohort (4.23 per 100, n = 966) followed by other health professionals (3.74 per 100, n = 427) and control cohort (3.06 per 100, n = 4193), with adjusted hazard ratios of 1.28 (95% CI = 1.20-1.38) and 1.13 (95% CI = 1.02-1.25), respectively, comparing to controls. Among those who developed endometriosis, nurses had higher subsequent ovarian cancer and lower breast cancer, but not significant. CONCLUSIONS: Nurses are at a higher risk of developing endometriosis. However, the link between endometriosis and subsequent cancers is weak.


Assuntos
Neoplasias da Mama/epidemiologia , Endometriose/epidemiologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Neoplasias Ovarianas/epidemiologia , Adulto , Neoplasias da Mama/etiologia , Estudos de Casos e Controles , Estudos de Coortes , Endometriose/complicações , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Neoplasias Ovarianas/etiologia , Modelos de Riscos Proporcionais , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
15.
Am J Case Rep ; 20: 1360-1363, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31519867

RESUMO

BACKGROUND Endometriosis is a chronic and benign condition in which endometrial glands and stroma are present outside the uterine cavity. The pathogenesis of endometriosis is not fully understood; however, several mechanisms have been hypothesized. Endometriosis is a common clinical presentation in gynecology, but affecting the urinary tract is a rare phenomenon, occurring in 0.3-12% of cases. In more severe forms, the initial presentation may be hydronephrosis or infertility. CASE REPORT We describe the case of a 25-year-old Saudi woman who presented with obstructive urinary tract symptoms and was diagnosed with urinary bladder endometriosis complicated with a right hydronephrosis. After thorough investigations and workups, the management was taken on by a multidisciplinary team approach. CONCLUSIONS This case report shows that hormonal therapy management resulted in a satisfactory outcome contrary to the surgical resection approach that is discussed in many articles.


Assuntos
Endometriose/complicações , Hidronefrose/etiologia , Doenças da Bexiga Urinária/complicações , Adulto , Feminino , Humanos
16.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439550

RESUMO

Abdominal wall endometriosis (AWE) is a rare entity presenting as a painful lump with a cyclical pattern, associated with previous caesarean section (CS). AWE is typically located at the site of the CS scar. The diagnosis is challenging in the rare instance when AWE presents at a location distant to the CS scar. A 37-year-old patient presented to a general surgeon with a 2-year history of left-sided, periumbilical pain exacerbated during her menstrual periods. A 3 cm firm and tender nodule was noted clinically. Intraoperatively, the nodule involved the rectus muscle and infiltrated the peritoneum. Histology confirmed endometriosis, and the patient recovered uneventfully. The rarity of this clinical entity and the fact that AWE mostly presents to non-gynaecologists make the diagnosis challenging prolonging its physical and psychological morbidity. Thorough history-taking with emphasis on the pattern of pain and a previous history of CS should raise suspicion of AWE.


Assuntos
Parede Abdominal , Cesárea , Cicatriz , Endometriose/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Diferencial , Endometriose/complicações , Endometriose/diagnóstico por imagem , Endometriose/cirurgia , Feminino , Humanos , Gravidez
17.
Medicine (Baltimore) ; 98(31): e16695, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374059

RESUMO

This study means to investigate a combination of noninvasive methods in diagnosis of minimal or mild endometriosis expecting to narrow down the range of laparoscopic exploration for female infertility.It is a retrospective case control study of totally 447 patients suspected unexplained infertility before surgery were eligible from May 2012 to February 2017. Of these, 299 patients were laparoscopy-proved minimal or mild endometriosis group, the remaining 148 patients served as control group (normal pelvis). Preoperative age, duration of infertility, type of infertility, body mass index, baseline follicle-stimulating hormone, anti-Müllerian hormone, serum CA125, clinical symptoms, findings on vagino-recto-abdominal examinations and pregnancy prognosis had been recorded. Every variable and their combinations were evaluated.Any single factor had limited diagnostic value. The cut-off value for CA125 was 19.25 IU/L. Parallel testing had a higher sensitivity at 81.3%. Serial tests of vagino-recto-abdominal examination combined with dysmenorrhea or positive CA125 got reasonable sensitivity (51.4% and 49%), remarkable high specificities (95.7% and100%) and Positive Predictive Value (96.4% and 100%). Multivariate logistic regression identified the following factors in decreasing order of importance: (1) vagino-recto-abdominal examinations, (2) CA125, (3) dysmenorrhea, their ORs being 16.148, 3.796, and 2.809, respectively. The spontaneous pregnancy rate (50.8%) in minimal or mild endometriosis was higher than control (35.6%, P = .043).A combination of noninvasive diagnostic methods had certain preoperative diagnostic value of minimal or mild endometriosis, which might benefit some patients from avoiding laparoscopic surgery.


Assuntos
Antígeno Ca-125/sangue , Endometriose/diagnóstico , Infertilidade Feminina/diagnóstico , Adulto , Estudos de Casos e Controles , China , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Endometriose/complicações , Feminino , Exame Ginecológico/estatística & dados numéricos , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/etiologia , Laparoscopia , Valor Preditivo dos Testes , Gravidez , Taxa de Gravidez , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
BMJ Case Rep ; 12(7)2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31337629

RESUMO

A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management.


Assuntos
Apêndice/cirurgia , Doenças do Ceco/cirurgia , Endometriose/cirurgia , Obstrução Intestinal/cirurgia , Aderências Teciduais/cirurgia , Adulto , Apendicectomia , Doenças do Ceco/complicações , Endometriose/complicações , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Intestino Delgado/diagnóstico por imagem , Laparoscopia , Aderências Teciduais/etiologia , Tomografia Computadorizada por Raios X
20.
Cir Cir ; 87(4): 385-389, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264985

RESUMO

Background: Abdominal wall endometriosis is a rare pathological entity. It presents as a tumor with pain, erythema, which worsens with Valsalva maneuvers. Objective: To show the experience and results in the management of the department of hernias and abdominal wall in a hospital of second level and to present review of the literature. Method: The files of patients treated in the department of hernias and abdominal wall, surgically treated with preoperative clinical and postoperative histopathological diagnosis of abdominal wall endometriosis were taken. The data was described using measures of central tendency and percentages. Results: Twenty-nine patients were identified, with an average age of 32.75 years, 68.9% reported cyclic catamenial pain associated with a tumor in the abdominal wall; a preoperative clinical diagnosis of abdominal wall endometriosis was made in 89.75%. Only one patient was reported with histopathological diagnosis of fibrolipoma. The totality of the patients referred cesarean section as previous surgery. No recurrences were reported. Conclusions: Abdominal wall endometriosis is the presence of ectopic endometrial tissue in any layer of the abdominal wall. Patients with this diagnosis are referred to the general surgeon presenting a tumor, however, the preoperative diagnosis rate is erroneous in most cases. Abdominal wall ultrasound is useful in diagnosis; tomography and magnetic resonance determine the extent of the disease. The treatment must be related to the extension of the disease and its recurrence is associated with the presence of positive margins.


Assuntos
Parede Abdominal , Endometriose/cirurgia , Parede Abdominal/diagnóstico por imagem , Adulto , Cesárea , Dismenorreia/etiologia , Endometriose/complicações , Endometriose/patologia , Feminino , Humanos , Lipoma/complicações , Lipoma/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários , Adulto Jovem
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