RESUMO
OBJECTIVE: In women presenting to gynaecological clinics with lower abdominal pain, the cause is frequently attributed to endometriosis irrespective of whether it is found to be minimal or extensive at laparoscopy. Irritable bowel syndrome (IBS) is also common in this setting, and it was speculated that the visceral hypersensitivity associated with this condition might be amplifying the symptoms of endometriosis. METHODS: Visceral sensitivity to balloon distension, symptoms and psychological status were assessed following laparoscopy in 20 women with minimal to mild endometriosis, 20 with moderate to severe endometriosis, 20 with laparoscopy negative abdominal pain and 20 asymptomatic women undergoing laparoscopic sterilisation who acted as controls, and compared with 20 women with IBS. RESULTS: Compared with controls, patients with minimal to mild and moderate to severe endometriosis had a higher prevalence of symptoms consistent with IBS (0% vs 65% and 50%, respectively, p<0.001) with significantly lower mean pain thresholds (39.5 mm Hg (95% CI 36.0 to 43.0) vs 28.1 mm Hg (95% CI 24.5 to 31.6), p=0.001 and 28.8 mm Hg (95% CI 24.9 to 32.6), p=0.002) not explained by differences in rectal compliance. Patients with laparoscopy negative pain had symptoms and visceral sensitivity similar to patients with IBS. Controls undergoing laparoscopy had normal sensitivity, indicating that the laparoscopic procedure was not inducing hypersensitivity. CONCLUSION: Visceral hypersensitivity is extremely common in endometriosis and could be intensifying the pain. This finding might explain why mildly affected individuals often complain of severe symptoms out of proportion to the extent of their disease. This study has introduced a completely new concept into the understanding of pain in endometriosis and could open up new opportunities for treatment.
Assuntos
Endometriose/complicações , Hiperalgesia/etiologia , Vísceras/inervação , Adulto , Estudos de Casos e Controles , Dilatação/efeitos adversos , Endometriose/psicologia , Feminino , Humanos , Hiperalgesia/psicologia , Síndrome do Intestino Irritável/complicações , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor/métodos , Limiar da Dor , Limiar Sensorial , Adulto JovemRESUMO
Invasive group B streptococcus (GBS) disease is a leading cause of neonatal death. There is no UK national screening programme for GBS in pregnancy, hence colonisation rates are unknown. Intrapartum antibiotic prophylaxis is given during labour to colonised women to reduce neonatal GBS transmission and subsequent invasive infection. Data about prevalence of other haemolytic streptococci in pregnancy, including group A streptococcus (GAS), are uncommon despite increasing importance. This study investigated colonisation in 100 pregnant women using conventional culture methods; 19% had GBS. This suggests that GBS carriage is common in the UK. The role of other ß-haemolytic streptococci remains undefined.
Assuntos
Portador Sadio/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/isolamento & purificação , Streptococcus/isolamento & purificação , Adolescente , Adulto , Antibioticoprofilaxia , Dermatan Sulfato , Feminino , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Trabalho de Parto , Faringe/microbiologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Reto/microbiologia , Sorotipagem , Infecções Estreptocócicas/prevenção & controle , Infecções Estreptocócicas/transmissão , Streptococcus/classificação , Streptococcus pyogenes/isolamento & purificação , Reino Unido/epidemiologia , Vagina/microbiologiaAssuntos
Aborto Retido , Gravidez Ectópica , Útero/anormalidades , Adulto , Feminino , Humanos , GravidezRESUMO
HPV types are carcinogenic agents in cervical cancer. This view is supported by epidemiological and biological evidence. The oncogenic products and capsid proteins of high risk HPV types are potential targets against which effective immunity may be generated by vaccination. Both therapeutic and prophlylactic immunisation are potential strategies to deal with the widespread problem of HPV infection and possibly established cervical neoplasia. Clinical trials are now underway to evaluate candidate vaccines.
Assuntos
Doenças dos Anexos/diagnóstico , Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Complicações Neoplásicas na Gravidez/terapia , Neoplasias Retroperitoneais/diagnóstico , Nervo Isquiático , Doenças dos Anexos/terapia , Adulto , Cesárea/métodos , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Laparotomia/métodos , Imageamento por Ressonância Magnética , Monitorização Fisiológica/métodos , Neurilemoma/diagnóstico por imagem , Neurilemoma/terapia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/terapia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Neoplasias Retroperitoneais/terapia , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Pré-NatalRESUMO
1. The respiratory and psychomotor effects of two benzodiazepines used mainly as anticonvulsants were compared in healthy volunteers, using a double-blind placebo controlled design. 2. Clobazam (10 and 20 mg) produced significantly fewer psychomotor side effects than clonazepam (0.5 and 1 mg). Neither drug at either dose affected the ventilatory response to CO2. 3. Although clonazepam produced significant effects on psychomotor performance, these did not correlate with plasma drug concentration. 4. Our studies provide further evidence that at the doses chosen clobazam is considerably less sedating than clonazepam. Further investigation is required into the tolerance profile of both drugs in patients.