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with endometriosis and are often associated with the severe form of the disease. , While the pathognomonic mechanisms of endometriosis per se remain elusive, it is widely believed that most endometriotic lesions develop from retrograde menstruation and are possibly associated with immune dysfunction, which can interfere with endometrial implant clearance. Endometriotic ovarian cysts (known as ‘endometriomas’) are mostly thought to occur through invagination of endometriotic tissue/cells through the ovarian (...) distortion and reduced endometrial receptivity, leading to compromised oocyte and embryo quality, and ovarian reserve, but the precise mechanism has yet to be determined. 3 Potential mechanisms for endometrioma‐associated infertility 3.1 Chronic inflammation Endometriosis is associated with dysregulation of the immune system. Peritoneal fluid from women with endometriosis has been found to contain increased numbers of immune cells, including macrophages, and mast, natural killer and T cells, as well
Endometriosis: A Rare Cause of Large Bowel Obstruction Large bowel obstruction can result in significant morbidity and mortality, especially in cases of acute complete obstruction. There are many possible causes, the most common in adults being colorectal cancer. Endometriosis is a benign disease, and the most affected extragenital location is the bowel, especially the rectosigmoid junction. However, transmural involvement and acute occlusion are very rare events. We report an exceptional case (...) of acute large bowel obstruction as the initial presentation of endometriosis. The differential diagnosis of colorectal carcinoma may be challenging, and this case emphasizes the need to consider intestinal endometriosis in females at a fertile age presenting with gastrointestinal symptoms and an intestinal mass causing complete large bowel obstruction.
History of breast feeding and risk of incident endometriosis: prospective cohort study. Objective To investigate the association between lifetime breast feeding, exclusive breast feeding, postpartum amenorrhea, and incidence of endometriosis among parous women.Design Prospective cohort study.Setting Nurses' Health Study II, 1989-2011.Participants 72 394women who reported having one or more pregnancies that lasted at least six months, 3296 of whom had laparoscopically confirmed endometriosis (...) . For each pregnancy, women reported duration of total breast feeding, exclusive breast feeding, and postpartum amenorrhea. Main outcome measures Incident self reported laparoscopically confirmed endometriosis (96% concordance with medical record) in parous women. Multivariable Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals for diagnosis of endometriosis.Results Duration of total and exclusive breast feeding was significantly associated with decreased
Ultrasound-guided high-intensity focused ultrasound for endometriosis of the uterus? Assessment according to §137h Social Code Book V 1 Translation of the executive summary of the assessment according to §137h Social Code Book (SGB) V Sonografiegesteuerte hochfokussierte Ultraschalltherapie bei der Endometriose des Uterus (Version 1.0; Status: 30 January 2017). Please note: This translation is provided as a service by IQWiG to English-language readers. However, solely the German original text (...) is absolutely authoritative and legally binding. Executive Summary IQWiG Reports – Commission No. H16-02A Ultrasound-guided high- intensity focused ultrasound therapy for uterine endometriosis 1 Executive summary of assessment H16-02A according to §137h SGB V Version 1.0 USgHIFU for uterine endometriosis 30 January 2017 Institute for Quality and Efficiency in Health Care (IQWiG) - i - Publishing details Publisher: Institute for Quality and Efficiency in Health Care Topic: Ultrasound-guided high-intensity
in bone mineral density than did those who received placebo; there were no adverse endometrial findings.Both higher and lower doses of elagolix were effective in improving dysmenorrhea and nonmenstrual pelvic pain during a 6-month period in women with endometriosis-associated pain. The two doses of elagolix were associated with hypoestrogenic adverse effects. (Funded by AbbVie; Elaris EM-I and EM-II ClinicalTrials.gov numbers, NCT01620528 and NCT01931670 .). (...) Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist. Endometriosis is a chronic, estrogen-dependent condition that causes dysmenorrhea and pelvic pain. Elagolix, an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist, produced partial to nearly full estrogen suppression in previous studies.We performed two similar, double-blind, randomized, 6-month phase 3 trials (Elaris Endometriosis I and II [EM-I and EM-II]) to evaluate the effects of two doses
Cancer-Associated Mutations in Endometriosis without Cancer. Endometriosis, defined as the presence of ectopic endometrial stroma and epithelium, affects approximately 10% of reproductive-age women and can cause pelvic pain and infertility. Endometriotic lesions are considered to be benign inflammatory lesions but have cancerlike features such as local invasion and resistance to apoptosis.We analyzed deeply infiltrating endometriotic lesions from 27 patients by means of exomewide sequencing (24 (...) carried identical KRAS c.35G→A mutations in three distinct lesions.We found that lesions in deep infiltrating endometriosis, which are associated with virtually no risk of malignant transformation, harbor somatic cancer driver mutations. Ten of 39 deep infiltrating lesions (26%) carried driver mutations; all the tested somatic mutations appeared to be confined to the epithelial compartment of endometriotic lesions.
Abdominal wall endometriosis: differentiation from other masses using CT features To assess the utility of morphologic and quantitative CT features in differentiating abdominal wall endometriosis (AWE) from other masses of the abdominal wall.Retrospective IRB-approved study of 105 consecutive women from two institutions who underwent CT and biopsy/resection of abdominal wall masses. CTs were independently reviewed by two radiologists blinded to final histopathologic diagnoses. Associations (...) between CT features and pathology were tested using Fisher's Exact Test. Sensitivity, specificity, positive, and negative predictive values were calculated. P values were adjusted for multiple variable testing.24.8% (26/105) of patients had histologically proven abdominal wall endometriosis. The other most common diagnoses included adenocarcinoma NOS (21%; 22/105), desmoid (14.3%; 15/105), and leiomyosarcoma (8.6%; 9/105). CT features significantly associated with endometriosis for both readers were
Ultrasound-guided high-intensity focused ultrasound for endometriosis of the uterus: Assessment according to õ137h Social Code Book V Sonografiegesteuerte hochfokussierte Ultraschalltherapie bei der Endometriose des Uterus: Bewertungen gemäß § 137h SGB V; Auftrag: H16-02A [Ultrasound-guided high-intensity focused ultrasound for endometriosis of the uterus: Assessment according to §137h Social Code Book V] Sonografiegesteuerte hochfokussierte Ultraschalltherapie bei der Endometriose des Uterus (...) : Bewertungen gemäß § 137h SGB V; Auftrag: H16-02A [Ultrasound-guided high-intensity focused ultrasound for endometriosis of the uterus: Assessment according to §137h Social Code Book V] Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Institut für Qualität und Wirtschaftlichkeit im
A Qualitative Study on the Practice of Yoga for Women with Pain-Associated Endometriosis. To understand the meaning women with pain-associated endometriosis attribute to yoga practice regarding their physical and emotional state at the beginning of the practice; pain management by integrating body and mind; secondary benefits of the practice of yoga, such as self-knowledge, self-care, and autonomy; and the role of the yoga group as psychosocial support.Qualitative study conducted simultaneously (...) with a randomized clinical trial.Public university hospital in southeastern Brazil between August 2013 and December 2014.Fifteen women with pain-associated endometriosis who practiced yoga for 8 weeks.After completing the twice-a-week program, all women participated in a single, semi-structured interview. Interviews were recorded and transcribed verbatim, and thematic analyses were performed.The main themes of analysis were women's expectations regarding the practice of yoga, physical and emotional state
The Use of Resveratrol as an Adjuvant Treatment of Pain in Endometriosis: A Randomized Clinical Trial Resveratrol has been used for the treatment of endometriosis.To compare resveratrol (40 mg/d) with monophasic contraceptive pill (COC) to COC with placebo for the reduction of pain scores.A randomized clinical trial.University Hospital.Women (ages 20 to 50) with laparoscopic diagnosis of endometriosis were eligible for the study. Exclusion criteria: pregnancy, allergy to resveratrol (...) in endometriosis.
Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Endometriosis is a common gynaecological condition that affects women and can lead to painful symptoms and infertility. It greatly affects women's quality of life, impacting their careers, everyday activities, sexual and nonsexual relationships and fertility. Nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used as first-line treatment for women with pain associated with endometriosis.To assess effects (...) of NSAIDs used for management of pain in women with endometriosis compared with placebo, other NSAIDs, other pain management drugs or no treatment.We searched the Cochrane Gynaecology and Fertility Group Specialised Register of Controlled Trials (October 2016), published in the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, as well as MEDLINE (January 2008 to October 2016), Embase (date limited from 1 January 2016 to 19 October 2016, as all earlier references
and/or abdominal examination is normal To identify endometriomas and deep endometriosis involving the bowel, bladder or ureter. If a transvaginal scan is not appropriate, consider a transabdominal ultrasound scan of the pelvis. Serum Cancer Antigen 125 (CA125) Do not use serum CA125 to diagnose endometriosis. If a coincidentally reported serum CA125 level is available, be aware that: A raised serum CA125 (that is, 35 IU/ml or more) may be consistent with having endometriosisEndometriosis may be present (...) , consider taking a biopsy of suspected endometriosis: To confirm the diagnosis of endometriosis (be aware that a negative histological result does not exclude endometriosis) To exclude malignancy if an endometrioma is treated but not excised. If a full, systematic laparoscopy is performed and is normal, explain to the woman that she does not have endometriosis, and offer alternative management. Staging Systems Offer endometriosis treatment according to the woman's symptoms, preferences and priorities
Psychotherapy With Somatosensory Stimulation for Endometriosis-Associated Pain: A Randomized Controlled Trial To evaluate whether psychotherapy with somatosensory stimulation is effective for the treatment of pain and quality of life in patients with endometriosis-related pain.Patients with a history of endometriosis and chronic pelvic pain were randomized to either psychotherapy with somatosensory stimulation (ie, different techniques of acupuncture point stimulation) or wait-list control (...) ), and mental quality of life (5.9, 95% CI 0.6-11.3; P=.031); dyspareunia improved nonsignificantly (-1.8, 95% CI -4.4 to 0.7; P=.150). Improvements in the intervention group remained stable at 6 and 24 months, and control patients showed comparable symptom relief after delayed intervention.Psychotherapy with somatosensory stimulation reduced global pain, pelvic pain, and dyschezia and improved quality of life in patients with endometriosis. After 6 and 24 months, when all patients were treated, both groups
and a specificity of 0.50 and above, which 'rules out' the diagnosis with high accuracy if there is a negative test result (SnOUT test), or a sensitivity of 0.50 and above and a specificity of 0.95 and above, which 'rules in' the diagnosis with high accuracy if there is a positive result (SpIN test).Eleven eligible studies included 1339 participants. All the studies were of poor methodological quality. Seven studies evaluated pelvic endometriosis, one study considered DIE and/or ovarian endometrioma, two (...) studies differentiated endometrioma from other ovarian cysts and one study addressed mapping DIE at specific anatomical sites. Fifteen different diagnostic combinations were assessed, including blood, urinary or endometrial biomarkers, transvaginal ultrasound (TVUS) and clinical history or examination. We did not pool estimates of sensitivity and specificity, as each study analysed independent combinations of the non-invasive tests.Tests that met the criteria for a replacement test were: a combination
Intussusception of the Appendix and Ileum Endometriosis: A Case Report Intussusception of the appendix is a very rare condition. It may clinically mimic acute or chronic abdominal diseases or can be asymptomatic.This paper describes our experience with intussusception of the appendix. We report a case of a female with appendiceal intussusception and ileum endometriosis.It is important to know about such a rare condition in order to avoid mistaking it with other abdominal diseases. However
Practices and Attitudes Concerning Endometriosis Among Nurses Specializing in Gynecology Endometriosis is a chronic disease affecting approximately 10% of fertile women. These women often have negative health care experiences. This study adds new knowledge about endometriosis care in a hospital setting and nurses' attitudes toward the disease. To explore how the personal attitudes of gynecological nurses, their specialized knowledge, and their clinical experiences influenced the way (...) they conceptualized and cared for women with endometriosis, participant observations and semistructured interviews were conducted. Categorization of patients into certain kinds, with more or less legitimate needs, provided an important framework for practice. Specialized knowledge qualified the nurses' views of their patients and seemed to be conducive to sustained patient involvement. However, the organization of care based solely on medical specialization restricted a holistic approach. An important goal
Heavy menstrual bleeding and dysmenorrhea are improved by Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) of adenomyosis To assess reduction in heavy menstrual bleeding and dysmenorrhea following MRI guided Focused Ultrasound Surgery (MRgFUS) of focal and diffuse adenomyosis up to 12 months post-treatment a retrospective cohort study was done at a tertiary care academic medical center for obstetrics, gynecology and infertility.MRgFUS for adenomyosis uterus was done for thirty (...) -seven patients presenting with symptoms of heavy menstrual bleeding and dysmenorrhea with MRI-suspected adenomyosis. The main outcome measure, was reduction in heavy menstrual bleeding, dysmenorrhea and Symptom Severity Scoring (SSS) over a 3, 6 and 12 month period. Secondary outcome was evidence of fertility preservation post procedure. D'Agostino & Pearson omnibus normality test, one-way Ananova, Pearson's correlation coefficient analysis was performed on the data. Statistical significances, p