Pelvic inflammatory disease (or disorder) (PID) is a generic term for inflammation of the female uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to tissue necrosis with/or without abscess formation. Pus can be released into the peritoneum. Two thirds of patients with laparoscopic evidence of previous PID were not aware they had had PID.[1] PID is often associated with sexually transmitted diseases, as it is a common result of such infections. PID is a vague term and can refer to viral, fungal, parasitic, though most often bacterial infections. PID should be classified by affected organs, the stage of the infection, and the organism(s) causing it. Although an STD is often the cause, other routes are possible, including lymphatic, postpartum, postabortal (either miscarriage or abortion) or intrauterine device (IUD) related, and hematogenous spread.
Epidemiology
In the United States, more than one million women are affected by PID each year, and the rate is highest with teenagers. Over 100,000 women become infertile in the US each year from PID.[2] N. gonorrhoea is isolated in only 40-60% of women with acute salpingitis.[3] C. trachomatis was estimated by current obgyn 9th ed to be the cause in about 60% of cases of salpingitis, which may lead to PID. It is unsure how much is due to a single organism and how much is due to multiple organisms; many other pathogens that are in normal vaginal flora become involved in PID. 10% of women in one study had asymptomatic Chlamydia trachomatis infection and 65% had asymptomatic infection with Neisseria gonorrhoeae.[3] It was noted in one study that 10-40% of untreated women with N. gonorrhoea develop PID and 20-40% of women infected with C. trachomitis developed PID.[1] PID is the leading cause of infertility. "A single episode of PID results in infertility in 13% of women."[1] This rate of infertility increases with each infection.
Diagnosis
There may be no actual symptoms of PID. If there are symptoms then fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, or irregular menstrual bleeding may be noted. It is important to note that PID can occur and cause serious harm without causing any noticeable symptoms. Laparoscopic identification is helpful in diagnosing tubal disease, 65-90% positive predictive value in patients with presumed PID.[3] Regular Sexually transmitted disease (STD) testing is important for prevention. Treatment is usually started empirically because of the terrible complications. Definitive criteria include: histopathologic evidence of endometritis, thickened filled fallopian tubes, or laparoscopic findings. Gram-stain/smear becomes important in identification of rare and possibly more serious organisms.[1]
Differential diagnosis
Appendicitis, ectopic pregnancy, septic abortion, hemorrhagic or ruptured ovarian cysts or tumors, twisted ovarian cyst, degeneration of a myoma, and acute enteritis must be considered. Pelvic inflammatory disease is more likely to occur when there is a history of pelvic inflammatory disease, recent sexual contact, recent onset of menses, or an IUD in place or if the partner has a sexually transmitted disease.
Acute pelvic inflammatory disease is highly unlikely when recent intercourse has not taken place or an IUD is not being used. A sensitive serum pregnancy test should be obtained to rule out ectopic pregnancy. Culdocentesis will differentiate hemoperitoneum (ruptured ectopic pregnancy or hemorrhagic cyst) from pelvic sepsis (salpingitis, ruptured pelvic abscess, or ruptured appendix).
Pelvic and vaginal ultrasounds are helpful in the differential diagnosis of ectopic pregnancy of over six weeks. Laparoscopy is often utilized to diagnose pelvic inflammatory disease, and it is imperative if the diagnosis is not certain or if the patient has not responded to antibiotic therapy after 48 hours.
No single test has adequate sensitivity and specificity to diagnose pelvic inflammatory disease. A large mulitsite U.S. study found that cervical motion tenderness as a minimum clinical criterion increases the sensitivity of the CDC diagnostic criteria from 83% to 95%. However, even the modified 2002 CDC criteria does not identify women with subclinical disease.[4]
Prognosis
Although the PID infection itself may be cured, effects of the infection may be permanent. This makes early identification by someone who can prescribe appropriate curative treatment so important in the prevention of damage to the reproductive system. Since early gonococcal infection may be asymptomatic, regular screening of individuals at risk for common agents (history of multiple partners, history of any unprotected sex, or people with symptoms) or because of certain procedures (post pelvic operation, postpartum, miscarriage or abortion). Prevention is also very important in maintaining viable reproduction capabilities.
If the initial infection is mostly in the lower tract, after treatment the person may have few difficulties. If the infection is in the fallopian tubes or ovaries, more serious complications are more likely to occur.
Complications
PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, infertility (difficulty becoming pregnant), ectopic pregnancy (the leading cause of pregnancy-related deaths in adult females), and other dangerous complications of pregnancy. Multiple infections and infections that are treated later are more likely to result in complications.
Infertile women may wish to see a specialist, because there may be a possibility in restoring fertility after scarring. Traditionally tuboplastic surgery was the main approach to correct tubal obstruction or adhesion formation, however success rates tended to be very limited. In vitro fertilization (IVF) was developed to bypass tubal problems and has become the main treatment for patients who want to become pregnant.
Treatment
Treatment depends on the cause and generally involves use of antibiotic therapy. If the patient has not improved within two to three days after beginning treatment with the antibiotics, they should return to the hospital for further treatment. Drugs should also be given orally and/or intravaneously to the patient while in the hospital to begin treatment immediately to increase the effectiveness of antibiotic treatment. Hospitalization may be necessary if Tubo-ovarian abscess, very ill, immunodeficient, pregnancy, incompetence, or because this or something else life threatening can not be ruled out. Treating partners for STD's is a very important part of treatment and prevention. Anyone with PID and partners of patients with PID since six months prior to diagnosis should be treated to prevent reinfection. Psychotherapy is highly recommended to women diagnosed with PID as the fear of redeveloping the disease after being cured may exist. It is important for a patient to communicate any issues and/or uncertainties they may have to a doctor, especially a specialist such as a gynecologist, and in doing so, to seek follow-up care.
A systematic review of the literature related to PID treatment was performed prior to the 2006 CDC sexually transmitted diseases treatment guidelines. Strong evidence suggests that neither site nor route of antibiotic administration affects the short or long-term major outcome of women with mild or moderate disease. Data on women with severe disease was inadequate to influence the results of the study. [5]
Prevention
Risk reduction against sexually transmitted diseases through abstinence or barrier methods such as condoms, see human sexual behavior for other listings.
Going to the doctor immediately if symptoms of PID, sexually transmitted diseases appear, or after learning that a current or former sex partner has, or might have had a sexually transmitted disease.
Getting regular gynecological (pelvic) exams with STD testing to screen for symptomless PID.[6]
Discussing sexual history with a trusted physician in order to get properly screened for sexually transmitted diseases.
Regularly scheduling STD testing with a physician and discussing which tests will be performed that session.
Getting a STD history from your current partner and insisting they be tested and treated before intercourse.
Understanding when a partner says that they have been STD tested they usually mean chlamydia and gonorrhea in the US, but that those are not all of the sexually transmissible diseases.
Treating partners to prevent reinfection or spreading the infection to other people.
Other diseases that can lead to or be involved in PID
Salpingitis, any infection of the fallopian tubes.
Tubo-ovarian abscess an abscess of the fallopian tube or ovary.
Endometritis
Pelvic peritonitis
The Dalkon Shield (withdrawn from the market in 1975 for this reason)
Bacterial Vaginosis
References
^ a b c d Loscalzo, Joseph; Andreoli, Thomas E.; Cecil, Russell L.; Carpenter, Charles A.; Griggs, Robert C. (2001). Cecil essentials of medicine. Philadelphia: W.B. Saunders. ISBN 0-7216-8179-4.
^ STD Facts - Pelvic inflammatory disease (PID). Retrieved on 2007-11-23.
^ a b c Lauren Nathan; DeCherney, Alan H.; Pernoll, Martin L. (2003). Current obstetric & gynecologic diagnosis & treatment. New York: Lange Medical Books/McGraw-Hill. ISBN 0-8385-1401-4.
^ Blenning CE, Muench J, Judkins DZ, Roberts KT (2007). "Clinical inquiries. Which tests are most useful for diagnosing PID?". J Fam Pract 56 (3): 216–20. PMID 17343812.
^ Walker CK, Wiesenfeld HC (2007). "Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines". Clin. Infect. Dis. 44 Suppl 3: S111–22. doi:10.1086/511424. PMID 17342664.
^ Smith KJ, Cook RL, Roberts MS (2007). "Time from sexually transmitted infection acquisition to pelvic inflammatory disease development: influence on the cost-effectiveness of different screening intervals". Value Health 10 (5): 358–66. doi:10.1111/j.1524-4733.2007.00189.x. PMID 17888100.
External links
NIH/Medline
CDC
Pelvic Inflammatory Disease (PID; Salpingitis, Endometritis)
Wednesday, February 27, 2008
Pelvic Pain? Solve the Mystery
Use this checklist to explore the possible reasons—and remedies.
Remember New Year’s Day when you decided to jump-start your weight-loss program—by doing 500 sit-ups? That robo-routine could be the reason for the chronic ache in your pelvis. Then again, maybe not. One in seven women suffers from chronic pelvic pain, and the cause is often a mystery. To get relief, your first step (after the totally legit complaining) should be figuring out what’s wrong. Talk to your doctor about these possibilities, and to rule out ovarian cancer (which is rare):
It’s gynecological. Endometriosis—when uterine tissue grows outside the uterus—could be the culprit; roughly 10 percent of women have it. Also, prolonged pushing, a difficult forceps delivery, or certain types of incisions or lacerations during a vaginal delivery could lead to chronic pain. But don’t just assume it’s a female problem, cautions OB-GYN Andrea Rapkin, MD, director of the University of California, Los Angeles, Pelvic Pain Clinic.
It’s physical. Maybe it sounds odd, but a size mismatch between you and your partner could be to blame. If his penis is big, sex can bruise your cervix or tear the opening of your vagina. An injury from a fall could be responsible, too.
It’s intestinal or urological. Chronic constipation may trigger pain in the muscles of the pelvic floor, and malfunctions such as colitis, irritable bowel syndrome (IBS), and diverticulitis might feel like something more gyno than gastro. IBS is more common in women than men and often includes pain with constipation or diarrhea. Then there’s interstitial cystitis, a chronic inflammation in the bladder that can lead to pain, pressure, and tenderness.
And remember: It’s fixable. The pain may be chronic, but you don’t have to suffer. Experts say all of these underlying problems are treatable. Remedies may include hormonal therapy, antibiotics, pain relievers, antidepressants, counseling, relaxation exercises, physical therapy, or even surgery. And exhale now if fear of a disease like ovarian cancer is keeping you from seeing a doctor; pelvic pain is rarely a symptom. In fact, Rapkin says the chances of cancer being the problem are very low among premenopausal women.
(Well......Sometimes it isn't)
http://www.tamilstar.com/news/health/article_5630.shtml
Remember New Year’s Day when you decided to jump-start your weight-loss program—by doing 500 sit-ups? That robo-routine could be the reason for the chronic ache in your pelvis. Then again, maybe not. One in seven women suffers from chronic pelvic pain, and the cause is often a mystery. To get relief, your first step (after the totally legit complaining) should be figuring out what’s wrong. Talk to your doctor about these possibilities, and to rule out ovarian cancer (which is rare):
It’s gynecological. Endometriosis—when uterine tissue grows outside the uterus—could be the culprit; roughly 10 percent of women have it. Also, prolonged pushing, a difficult forceps delivery, or certain types of incisions or lacerations during a vaginal delivery could lead to chronic pain. But don’t just assume it’s a female problem, cautions OB-GYN Andrea Rapkin, MD, director of the University of California, Los Angeles, Pelvic Pain Clinic.
It’s physical. Maybe it sounds odd, but a size mismatch between you and your partner could be to blame. If his penis is big, sex can bruise your cervix or tear the opening of your vagina. An injury from a fall could be responsible, too.
It’s intestinal or urological. Chronic constipation may trigger pain in the muscles of the pelvic floor, and malfunctions such as colitis, irritable bowel syndrome (IBS), and diverticulitis might feel like something more gyno than gastro. IBS is more common in women than men and often includes pain with constipation or diarrhea. Then there’s interstitial cystitis, a chronic inflammation in the bladder that can lead to pain, pressure, and tenderness.
And remember: It’s fixable. The pain may be chronic, but you don’t have to suffer. Experts say all of these underlying problems are treatable. Remedies may include hormonal therapy, antibiotics, pain relievers, antidepressants, counseling, relaxation exercises, physical therapy, or even surgery. And exhale now if fear of a disease like ovarian cancer is keeping you from seeing a doctor; pelvic pain is rarely a symptom. In fact, Rapkin says the chances of cancer being the problem are very low among premenopausal women.
(Well......Sometimes it isn't)
http://www.tamilstar.com/news/health/article_5630.shtml
Tuesday, February 26, 2008
How to look good
Kudo's from EndoTimes!
23.02.2008
MIRANDA Bond believes her organic make-up company, which has been operating for just over a year, will soon be the biggest of its kind in the world.
These are not modest aims but she's confident she's on track. After all, she says the company is doubling its sales every three months and is adding one or two people a month to the staff. The growth has been phenomenal, something most companies can only dream of. But contrary to popular wisdom, Ms Bond and her partner Jenni Williams are now pulling the reins in on their growth, slowing things down so they're only taking baby steps. It's a strategy they believe will eventually make their company formidable. Inika, headquartered in Thirroul south of Sydney, makes cosmetics, but it stands out from mainstream cosmetic companies by making them out of Australian minerals, 100 per cent certified vegan and 100 per cent organic. The products were born out of the website Ms Bond established with Ms Williams, called www.thrivinghealthywomen.com.au. The women had come together because of health issues both had experienced. Ms Bond had been diagnosed with endometriosis and was told she couldn't have any children. When she was also told hormone levels can affect fertility and that chemicals in some cosmetics can affect a body's hormone balance, she got some progesterone cream, threw out all her cosmetics and changed her diet. Three months later she was pregnant. Ms William's son is allergic to dairy, nuts, fish, eggs and is chronically sensitive to chemicals, so much so that if she touched his skin while she was wearing certain cosmetics he would have a drastic reaction. As both women embarked on their toxic-free lifestyle, they set up the website as a database of articles that related to women's health. Soon they were fielding emails from women around the world looking for organic make-up, many because they had sensitive skins or allergies. After doing some research into organic make-up suppliers, they decided to have a go at making it themselves. "Within two weeks we'd found the best natural formulators in Australia,'' Ms Ward said. Inika, which means "small earth'' in Hindi, was formed in March 2006 and by the middle of the year they had products in shops. As factories in Western Australia and South Australia churned out their foundations, lipsticks, mascaras and eye-shadows, the pace at which the company moved was extraordinary. Their big break, Ms Ward said, was exhibiting at the 2006 Organic Expo in Sydney. "We signed up so many accounts with shops and salons. And within three to four months we were in 21 David Jones stores around the country. "We had no strategy really. Everything just fell into place. The strategy came later.'' Part of that was to make the move overseas, a bold step considering the products weren't very established in Australia. The main reason, Ms Bond said, was that the population in Australia wasn't big enough for their company to be sustainable. And the need for a wider market was because of perceptions, Ms Bond said. "A lot of people think that because a product is 'natural' it's not as good, but our products are up there with the global make-up houses,'' she said. With the help of Austrade, the products are now being sold in New Zealand, Slovenia, Thailand, the UK and Canada, and are considered good enough to take on more established global natural cosmetics companies such as Jane Iredale and Dr Hauschka. It's in the UK that Inika is achieving great success, so much so the company has opened offices in London and a UK website. And this is where their new growth strategy comes in. Europe promises to be a huge market, but at the moment the products are sold only in Slovenia. Likewise Asia, but at the moment they're sold only in Thailand. North America will also be lucrative, but they're sold at the moment only in Canada. "The product is sought after in China and Japan, but Austrade said don't do it, you'll implode,'' Ms Bond said. Likewise with North America. The company is leaving the US push until last. "Now that we've got a team in the UK, it's easier to manage growth,'' she said. "Now we can continue to build in the UK and Europe. "Our strategy is to keep a handle on things, to not lose control.'' And one of the challenges of growth is maintaining the company's independence. "We'd like to keep the autonomy we have now, and keep the intimacy,'' Ms Bond said.
Go to www.inika.com.au
23.02.2008
MIRANDA Bond believes her organic make-up company, which has been operating for just over a year, will soon be the biggest of its kind in the world.
These are not modest aims but she's confident she's on track. After all, she says the company is doubling its sales every three months and is adding one or two people a month to the staff. The growth has been phenomenal, something most companies can only dream of. But contrary to popular wisdom, Ms Bond and her partner Jenni Williams are now pulling the reins in on their growth, slowing things down so they're only taking baby steps. It's a strategy they believe will eventually make their company formidable. Inika, headquartered in Thirroul south of Sydney, makes cosmetics, but it stands out from mainstream cosmetic companies by making them out of Australian minerals, 100 per cent certified vegan and 100 per cent organic. The products were born out of the website Ms Bond established with Ms Williams, called www.thrivinghealthywomen.com.au. The women had come together because of health issues both had experienced. Ms Bond had been diagnosed with endometriosis and was told she couldn't have any children. When she was also told hormone levels can affect fertility and that chemicals in some cosmetics can affect a body's hormone balance, she got some progesterone cream, threw out all her cosmetics and changed her diet. Three months later she was pregnant. Ms William's son is allergic to dairy, nuts, fish, eggs and is chronically sensitive to chemicals, so much so that if she touched his skin while she was wearing certain cosmetics he would have a drastic reaction. As both women embarked on their toxic-free lifestyle, they set up the website as a database of articles that related to women's health. Soon they were fielding emails from women around the world looking for organic make-up, many because they had sensitive skins or allergies. After doing some research into organic make-up suppliers, they decided to have a go at making it themselves. "Within two weeks we'd found the best natural formulators in Australia,'' Ms Ward said. Inika, which means "small earth'' in Hindi, was formed in March 2006 and by the middle of the year they had products in shops. As factories in Western Australia and South Australia churned out their foundations, lipsticks, mascaras and eye-shadows, the pace at which the company moved was extraordinary. Their big break, Ms Ward said, was exhibiting at the 2006 Organic Expo in Sydney. "We signed up so many accounts with shops and salons. And within three to four months we were in 21 David Jones stores around the country. "We had no strategy really. Everything just fell into place. The strategy came later.'' Part of that was to make the move overseas, a bold step considering the products weren't very established in Australia. The main reason, Ms Bond said, was that the population in Australia wasn't big enough for their company to be sustainable. And the need for a wider market was because of perceptions, Ms Bond said. "A lot of people think that because a product is 'natural' it's not as good, but our products are up there with the global make-up houses,'' she said. With the help of Austrade, the products are now being sold in New Zealand, Slovenia, Thailand, the UK and Canada, and are considered good enough to take on more established global natural cosmetics companies such as Jane Iredale and Dr Hauschka. It's in the UK that Inika is achieving great success, so much so the company has opened offices in London and a UK website. And this is where their new growth strategy comes in. Europe promises to be a huge market, but at the moment the products are sold only in Slovenia. Likewise Asia, but at the moment they're sold only in Thailand. North America will also be lucrative, but they're sold at the moment only in Canada. "The product is sought after in China and Japan, but Austrade said don't do it, you'll implode,'' Ms Bond said. Likewise with North America. The company is leaving the US push until last. "Now that we've got a team in the UK, it's easier to manage growth,'' she said. "Now we can continue to build in the UK and Europe. "Our strategy is to keep a handle on things, to not lose control.'' And one of the challenges of growth is maintaining the company's independence. "We'd like to keep the autonomy we have now, and keep the intimacy,'' Ms Bond said.
Go to www.inika.com.au
Monday, February 25, 2008
Repros’ IND for the Commencement of Phase III Studies of Proellex ...
Repros’ IND for the Commencement of Phase III Studies of Proellex ...Business Wire (press release), CA - Feb 22, 2008Our lead drug, Proellex®, is a selective blocker of the progesterone receptor and is targeted for the treatment of uterine fibroids, endometriosis and ...RPRX
Many inflammatory bowel disease mimic gynecological disorders in its clinical presentation
Endometriosis is a condition of unknown etiology in which endometrial tissue occurs at extra-uterine sites, including ovaries, fallopian tubes, and gastrointestinal tract. It usually occurs between 30 and 40 years of age. Four to 17% of menstruating women develop endometriosis. When the disease involves the small bowel, it usually has a benign course, but in rare circumstances, it may present as abdominal emergency. Invasive bowel endometriosis can present as bowel obstruction. The major cause of obstruction is stricture formation and adhesions, which occasionally mimic Crohn's disease or a malignancy in its clinical presentation.
Gastrointestinal endometriosis is suggested by dysmenorrhea, menorrhagia or perimenstrual symptoms. Frank intestinal symptoms are usually associated with intestinal obstruction. While intestinal symptoms may occur during or be exacerbated by the menses, this association may not always be present. The symptoms coincide with menstruation in only 18-40% of the cases. A recurring crampy lower or mid-abdominal pain is the most common presenting symptom for both intestinal endometriosis and Crohn's disease. Other symptoms which may occur in both entities include diarrhea, constipation, nausea, vomiting, fever, anorexia, and weight loss.
A case report published on January 7, 2008 in the World Journal of Gastroenterology describes a desperate patient who presented to Dr. Zafer Teke of Pamukkale University Hospital, Turkey, in 2006. This patient was quite a challenge for Dr. Teke. She was 31 years old with perimenstrual lower and mid-abdominal pain irradiating to the back, and lower abdominal fullness for 3 years, at first monthly, but later continuous, and gradually increasing in severity. She gave a history of moderate dysmenorrhea and menorrhagia, but no dyspareunia. Her only medication was an oral contraceptive. She had delivered a healthy baby.
Her gynecologist at a women's health clinic had diagnosed her with small bowel endometriosis, based on interviews and her clinical course. As only oral contraceptive therapy was started, the symptoms due to partial mechanical bowel obstruction had gradually improved. The lack of response to oral contraceptive therapy had encouraged her gynecologist to perform an exploratory laparotomy. The gynecologist was only able to perform a biopsy from the highly inflamed areas. Biopsy results were non-specific inflammation. The patient was then referred to Dr. Teke's institution to identify the underlying pathology.
In an effort to improve the condition of the patient, Dr. Teke initially decided to treat the patient with conservative measures, and the patient responded to this treatment. However, after ingesting a small amount of food she again complained of abdominal pain, and plain abdominal radiography once more showed mechanical bowel obstruction. After improvement with conservative management and obtaining adequate informed consent, the patient was operated on by Dr. Teke. The operative appearance was thought to indicate Crohn's disease, but in view of the close relationship of the ovaries, tubes and uterus, an immediate gynecological opinion was obtained. The on-call gynecology registrar did not consider the appearance to be due to primary gynecological pathology. An approximately 40 cm segment of distal small bowel had four strictures and three internal fistulas. Histopathological examination of the resected specimen was consistent with Crohn's disease. The surgical treatment led to rapid resolution of the symptoms.
The differential diagnosis of Crohn's disease with intestinal endometriosis may be difficult pre-operatively. Dr. Teke noted that even lower gastrointestinal flexible endoscopy may show no findings suggestive of Crohn's disease, as in his patient. Indeed, there may be a similarity between the two entities in terms of clinical presentation, symptomatology, radiological appearances, surgical and pathological findings. Due to a relatively high percentage of endometriosis among the female population of child-bearing age globally, and the unavailability of a precise test differentiating Crohn's disease from bowel endometriosis, this case reported by Dr. Teke is surely worth the attention of both doctors and women at large.
###
Reference: Teke Z, Aytekin FO, Atalay AO, Demirkan NC. Crohn's Disease Complicated by Multiple Stenoses and Internal Fistulas Clinically Mimicking Small Bowel Endometriosis. World J Gastroenterol 2008, January 7; 14(1): 146-151 http://www.wjgnet.com/1007-9327/14/146.asp
Correspondence to: Zafer Teke, MD, Department of General Surgery, Pamukkale University, School of Medicine, Kuspinar Mah. Emek Cad. Oyku Sitesi, A-Blok, No:121, K:4, D:10, 20020, Denizli, Turkey. zteke_md@yahoo.com Telephone: +90-542-2644046 Fax: +90-258-2134922
Gastrointestinal endometriosis is suggested by dysmenorrhea, menorrhagia or perimenstrual symptoms. Frank intestinal symptoms are usually associated with intestinal obstruction. While intestinal symptoms may occur during or be exacerbated by the menses, this association may not always be present. The symptoms coincide with menstruation in only 18-40% of the cases. A recurring crampy lower or mid-abdominal pain is the most common presenting symptom for both intestinal endometriosis and Crohn's disease. Other symptoms which may occur in both entities include diarrhea, constipation, nausea, vomiting, fever, anorexia, and weight loss.
A case report published on January 7, 2008 in the World Journal of Gastroenterology describes a desperate patient who presented to Dr. Zafer Teke of Pamukkale University Hospital, Turkey, in 2006. This patient was quite a challenge for Dr. Teke. She was 31 years old with perimenstrual lower and mid-abdominal pain irradiating to the back, and lower abdominal fullness for 3 years, at first monthly, but later continuous, and gradually increasing in severity. She gave a history of moderate dysmenorrhea and menorrhagia, but no dyspareunia. Her only medication was an oral contraceptive. She had delivered a healthy baby.
Her gynecologist at a women's health clinic had diagnosed her with small bowel endometriosis, based on interviews and her clinical course. As only oral contraceptive therapy was started, the symptoms due to partial mechanical bowel obstruction had gradually improved. The lack of response to oral contraceptive therapy had encouraged her gynecologist to perform an exploratory laparotomy. The gynecologist was only able to perform a biopsy from the highly inflamed areas. Biopsy results were non-specific inflammation. The patient was then referred to Dr. Teke's institution to identify the underlying pathology.
In an effort to improve the condition of the patient, Dr. Teke initially decided to treat the patient with conservative measures, and the patient responded to this treatment. However, after ingesting a small amount of food she again complained of abdominal pain, and plain abdominal radiography once more showed mechanical bowel obstruction. After improvement with conservative management and obtaining adequate informed consent, the patient was operated on by Dr. Teke. The operative appearance was thought to indicate Crohn's disease, but in view of the close relationship of the ovaries, tubes and uterus, an immediate gynecological opinion was obtained. The on-call gynecology registrar did not consider the appearance to be due to primary gynecological pathology. An approximately 40 cm segment of distal small bowel had four strictures and three internal fistulas. Histopathological examination of the resected specimen was consistent with Crohn's disease. The surgical treatment led to rapid resolution of the symptoms.
The differential diagnosis of Crohn's disease with intestinal endometriosis may be difficult pre-operatively. Dr. Teke noted that even lower gastrointestinal flexible endoscopy may show no findings suggestive of Crohn's disease, as in his patient. Indeed, there may be a similarity between the two entities in terms of clinical presentation, symptomatology, radiological appearances, surgical and pathological findings. Due to a relatively high percentage of endometriosis among the female population of child-bearing age globally, and the unavailability of a precise test differentiating Crohn's disease from bowel endometriosis, this case reported by Dr. Teke is surely worth the attention of both doctors and women at large.
###
Reference: Teke Z, Aytekin FO, Atalay AO, Demirkan NC. Crohn's Disease Complicated by Multiple Stenoses and Internal Fistulas Clinically Mimicking Small Bowel Endometriosis. World J Gastroenterol 2008, January 7; 14(1): 146-151 http://www.wjgnet.com/1007-9327/14/146.asp
Correspondence to: Zafer Teke, MD, Department of General Surgery, Pamukkale University, School of Medicine, Kuspinar Mah. Emek Cad. Oyku Sitesi, A-Blok, No:121, K:4, D:10, 20020, Denizli, Turkey. zteke_md@yahoo.com Telephone: +90-542-2644046 Fax: +90-258-2134922
Wednesday, February 13, 2008
Anguish for new victims of disgraced surgeon
By Grainne CunninghamWednesday February 13 2008
A VICTIM of Dr Michael Neary last night spoke of the "devastation" the disgraced surgeon has caused to a newly identified group of women.
Mother-of-two Caitriona Molloy, whose womb was removed after the birth of her second child Seamus, said the unnecessary surgery performed on these patients was "totally cruel".
Many of the women covered by the Porter/Clements investigation were relatively young and should have been able to look forward to having more children if they wished to do so.
Instead, women as young as 31 had both their ovaries removed, a procedure Ms Molloy described as "radical".
Menopause
"They had surgery that was totally unnecessary," she said.
As a result of having their ovaries removed, they were plunged into an early menopause, with all the physical and emotional complications that can present with that.
They were at a higher risk of osteoporosis and exposed to other negative effects, earlier and possibly for longer than the average woman.
In other cases, Dr Neary had told them that the surgery he was proposing was essential because they had endometriosis, a disease that causes the lining of the uterus to grow abnormally.
In many cases, his diagnosis was incorrect and their reproductive organs were healthy.
But Dr Neary told them that not only was the operation necessary, but that if they did not have it, the endometriosis would damage them irreparably, could become malignant and ultimately cause their death.
This was completely untrue. Endometriosis always improves at the menopause and is not a pre-malignant condition.
After the surgery, the women were told they should not take hormonal replacement therapy.
"It was totally cruel, what they were put through, they did not deserve this," Ms Molloy, of Patient Focus, said.
For years after they were subject to this surgery, many of these women continued to believe that they had nearly died.
Apart from the fear of an early death, they had to live with the knowledge that they would never again conceive or carry a child, which in itself, is a significant psychological burden for many women.
These already distressed women also had to cope with the discomfort of early menopause and were forbidden the drugs which could have helped them to endure it.
And if they had managed to come to terms with their loss and move on with their lives, they were then faced with fresh emotional turmoil when the disturbing facts about Dr Neary began to emerge.
"It was completely devastating, given the trust they put into that doctor," Ms Molloy explained. These women had trusted Dr Neary with their lives and he had responded by mutilating them unnecessarily and by presenting them with a future devoid of the joy of more children.
Sheila O'Connor of Patient Focus, which represents many of the women affected by Dr Neary, said: "They were left changed, they were different people, they will need counselling, and for a long time to come."
http://www.independent.ie/national-news/anguish-for-new-victims-of-disgraced-surgeon-1288395.html
A VICTIM of Dr Michael Neary last night spoke of the "devastation" the disgraced surgeon has caused to a newly identified group of women.
Mother-of-two Caitriona Molloy, whose womb was removed after the birth of her second child Seamus, said the unnecessary surgery performed on these patients was "totally cruel".
Many of the women covered by the Porter/Clements investigation were relatively young and should have been able to look forward to having more children if they wished to do so.
Instead, women as young as 31 had both their ovaries removed, a procedure Ms Molloy described as "radical".
Menopause
"They had surgery that was totally unnecessary," she said.
As a result of having their ovaries removed, they were plunged into an early menopause, with all the physical and emotional complications that can present with that.
They were at a higher risk of osteoporosis and exposed to other negative effects, earlier and possibly for longer than the average woman.
In other cases, Dr Neary had told them that the surgery he was proposing was essential because they had endometriosis, a disease that causes the lining of the uterus to grow abnormally.
In many cases, his diagnosis was incorrect and their reproductive organs were healthy.
But Dr Neary told them that not only was the operation necessary, but that if they did not have it, the endometriosis would damage them irreparably, could become malignant and ultimately cause their death.
This was completely untrue. Endometriosis always improves at the menopause and is not a pre-malignant condition.
After the surgery, the women were told they should not take hormonal replacement therapy.
"It was totally cruel, what they were put through, they did not deserve this," Ms Molloy, of Patient Focus, said.
For years after they were subject to this surgery, many of these women continued to believe that they had nearly died.
Apart from the fear of an early death, they had to live with the knowledge that they would never again conceive or carry a child, which in itself, is a significant psychological burden for many women.
These already distressed women also had to cope with the discomfort of early menopause and were forbidden the drugs which could have helped them to endure it.
And if they had managed to come to terms with their loss and move on with their lives, they were then faced with fresh emotional turmoil when the disturbing facts about Dr Neary began to emerge.
"It was completely devastating, given the trust they put into that doctor," Ms Molloy explained. These women had trusted Dr Neary with their lives and he had responded by mutilating them unnecessarily and by presenting them with a future devoid of the joy of more children.
Sheila O'Connor of Patient Focus, which represents many of the women affected by Dr Neary, said: "They were left changed, they were different people, they will need counselling, and for a long time to come."
http://www.independent.ie/national-news/anguish-for-new-victims-of-disgraced-surgeon-1288395.html
Tuesday, February 12, 2008
Stephanie St. James raises awareness for Endometriosis
About This Video
Stephanie St. James raises awareness for Endome... (more)
Added: September 28, 2007
Stephanie St. James raises awareness for Endometriosis on NBC's iVillage Live
Added: September 28, 2007
Category: People & Blogs
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Stephanie St. James Endometriosis oprah the color purple jeanette bayardelle michelle williams fantasia
...And Oprah is her boss!
Thx Glynis
Female sexual dysfunction fast facts
Saturday, February 9th 2008
Reviewed By: Steven A King, MD
- According to the American Medical Association, approximately 43 per cent of US women (and 31 per cent of men) have experienced some form of sexual dysfunction at some time.
- Any persistent, pervasive problem that routinely interferes with a woman's ability to achieve sexual gratification and causes her distress is female sexual dysfunction.
- The normal stages of sexual response include excitement, plateau, orgasm and resolution.
- Sexual desire disorders involve an absence of sexual fantasy or desire.
- Sexual arousal disorders involve problems with any of the body's normal mechanisms of arousal, including the erection of nipples and vaginal lubrication.
- Orgasmic disorders involve a lack or delay in orgasm.
- Sexual pain disorders involve any source of pain in the vagina, clitoris or labia.
- Smoking and/or drinking alcohol can affect not only the prognosis or treatment of a medical condition, but also your sexual function.
- During menopause, sexual response and a general interest in sex may diminish.
- Underlying medical and psychological conditions that can lead to female sexual dysfunction include diabetes, heart disease, endometriosis and arthritis.
- Sexual dysfunction may also occur due to a serious illness that physically alters a woman's body and body image, such as breast or gynaecologic cancer.
- As many as half of all breast cancer patients experience some form of long-term sexual difficulties, according to the National Cancer Institute.
- Following a diagnosis of cancer or chronic disease, it is normal for a woman to experience anxieties that can impede her ability to express her sexuality and trigger concerns about her sexual desirability.
- Hormonal changes, often related to pregnancy, menopause or female cancers, can lead to vaginal dryness or vaginal atrophy, in which the shape and flexibility of the vagina gradually decline.
- Psychological reasons may be expressed as anxieties or fears that cause a woman difficulty with one or more of the aspects of sexual intimacy.
- Patient education and reassurance, combined with early diagnosis and treatment, are the keys to effective treatment of female sexual dysfunction.
- If the underlying cause of the sexual dysfunction is medical, then effective treatment must first address the condition or disease.
- It is helpful for a woman to communicate her feelings about any physical changes, such as the loss of a breast due to breast cancer, with her partner.
- There are many over-the-counter creams, gels and lubricants that work well to alleviate vaginal dryness.
Reviewed By: Steven A King, MD
- According to the American Medical Association, approximately 43 per cent of US women (and 31 per cent of men) have experienced some form of sexual dysfunction at some time.
- Any persistent, pervasive problem that routinely interferes with a woman's ability to achieve sexual gratification and causes her distress is female sexual dysfunction.
- The normal stages of sexual response include excitement, plateau, orgasm and resolution.
- Sexual desire disorders involve an absence of sexual fantasy or desire.
- Sexual arousal disorders involve problems with any of the body's normal mechanisms of arousal, including the erection of nipples and vaginal lubrication.
- Orgasmic disorders involve a lack or delay in orgasm.
- Sexual pain disorders involve any source of pain in the vagina, clitoris or labia.
- Smoking and/or drinking alcohol can affect not only the prognosis or treatment of a medical condition, but also your sexual function.
- During menopause, sexual response and a general interest in sex may diminish.
- Underlying medical and psychological conditions that can lead to female sexual dysfunction include diabetes, heart disease, endometriosis and arthritis.
- Sexual dysfunction may also occur due to a serious illness that physically alters a woman's body and body image, such as breast or gynaecologic cancer.
- As many as half of all breast cancer patients experience some form of long-term sexual difficulties, according to the National Cancer Institute.
- Following a diagnosis of cancer or chronic disease, it is normal for a woman to experience anxieties that can impede her ability to express her sexuality and trigger concerns about her sexual desirability.
- Hormonal changes, often related to pregnancy, menopause or female cancers, can lead to vaginal dryness or vaginal atrophy, in which the shape and flexibility of the vagina gradually decline.
- Psychological reasons may be expressed as anxieties or fears that cause a woman difficulty with one or more of the aspects of sexual intimacy.
- Patient education and reassurance, combined with early diagnosis and treatment, are the keys to effective treatment of female sexual dysfunction.
- If the underlying cause of the sexual dysfunction is medical, then effective treatment must first address the condition or disease.
- It is helpful for a woman to communicate her feelings about any physical changes, such as the loss of a breast due to breast cancer, with her partner.
- There are many over-the-counter creams, gels and lubricants that work well to alleviate vaginal dryness.
Scarring gel in spotlight
By JANINE RANKIN - Manawatu Standard
Tuesday, 12 February 2008
The one in five Palmerston North women and girls who suffer from endometriosis need not be alarmed at reports that a product used in surgical treatment could make their condition worse.
The surgical spray gel at the centre of a Wellington gynaecologist's concerns that it causes internal scarring isn't widely used in Palmerston North.
MidCentral Health and private specialist Digby Ngan Kee says he doesn't use the product and isn't aware of any other surgeons locally who use it."It is a very expensive product, and there is no good evidence that it is effective," he said.
Wellington gynaecologist Hanifa Koya says she's stopped using the gel since she's had endometriosis patients returning for repeat surgery after its use, to repair the sort of scarring the product was supposed to prevent.
Endometriosis New Zealand chief executive Deborah Bush, who originally set up the national support group in Palmerston North, said she didn't believe women should be alarmed.
The evidence that the gel actually caused scarring over and above the damage done by endometriosis was anecdotal rather than scientific, she said."It's a horrible disease, and we don't know what causes it. Surgeons can excise the disease, but that doesn't mean a woman won't develop more adhesions."In women with endometriosis the tissue that developed in the uterus each month also formed in other parts of the abdomen causing pain, scarring, and often damaging fertility.
Ms Bush said although some surgeons were reporting an increased rate of women coming back for repeat surgery, there was no good evidence the scarring was a result of the gel rather than a result of surgery or the disease.
Dr Ngan Kee said the numbers of women returning for surgery were still too small to give an accurate view. Women struggling with endometriosis will be able to attend a seminar at Palmerston North Hospital next month when Ms Bush, a gynaecologist, and an authority on nutrition and fertility will talk about latest treatments and self-help options.
Tuesday, 12 February 2008
The one in five Palmerston North women and girls who suffer from endometriosis need not be alarmed at reports that a product used in surgical treatment could make their condition worse.
The surgical spray gel at the centre of a Wellington gynaecologist's concerns that it causes internal scarring isn't widely used in Palmerston North.
MidCentral Health and private specialist Digby Ngan Kee says he doesn't use the product and isn't aware of any other surgeons locally who use it."It is a very expensive product, and there is no good evidence that it is effective," he said.
Wellington gynaecologist Hanifa Koya says she's stopped using the gel since she's had endometriosis patients returning for repeat surgery after its use, to repair the sort of scarring the product was supposed to prevent.
Endometriosis New Zealand chief executive Deborah Bush, who originally set up the national support group in Palmerston North, said she didn't believe women should be alarmed.
The evidence that the gel actually caused scarring over and above the damage done by endometriosis was anecdotal rather than scientific, she said."It's a horrible disease, and we don't know what causes it. Surgeons can excise the disease, but that doesn't mean a woman won't develop more adhesions."In women with endometriosis the tissue that developed in the uterus each month also formed in other parts of the abdomen causing pain, scarring, and often damaging fertility.
Ms Bush said although some surgeons were reporting an increased rate of women coming back for repeat surgery, there was no good evidence the scarring was a result of the gel rather than a result of surgery or the disease.
Dr Ngan Kee said the numbers of women returning for surgery were still too small to give an accurate view. Women struggling with endometriosis will be able to attend a seminar at Palmerston North Hospital next month when Ms Bush, a gynaecologist, and an authority on nutrition and fertility will talk about latest treatments and self-help options.
Monday, February 11, 2008
Scarring caused by surgical gel spray
Surgical treatment hurts women but is allowed to continueBy LANE NICHOLS - The Dominion Post Monday, 11 February 2008
ANDREW GORRIE/ Dominion Post
ANGRY AND AMAZED: Hanifa Koya has stopped using SprayGel after her patients required further surgery to remove scars. She says the product should be put on hold till surgeons and patients can be assured of its safety.
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• Subscribe to Archivestuff• Have your say
A surgical gel - containing a drug untested on humans - has caused excruciating internal scarring in dozens of women that could lead to infertility, claims a leading gynaecologist.
Many of the endometriosis patients have already forked out thousands of dollars for repeat surgery. Some are now pursuing compensation from ACC.
Endometriosis is a condition where abnormal growths develop in pelvic organs, causing inflammatory reactions leading to scarring and pain. It affects millions of women worldwide.
Though some gynaecologists have stopped using the anti-scarring gel because of concerns about its safety and effectiveness, others still use the treatment, Wellington specialist Hanifa Koya said.
Medsafe, the Government agency that approves medicines, has told the American manufacturer to add additional precautions to the instruction pamphlet.
But it maintains the product is safe, and refuses to ban its sale without conclusive evidence of harm - even though the gel is considered high risk under proposed legislation.
Dr Koya - who first raised concerns in December 2005 - was disillusioned at the response of health agencies, which she claimed had let Confluent SprayGel be used internally on thousands of Kiwi women since about 2002 without adequate clinical testing or ongoing monitoring of its effects.
She had spoken out because of concern for her patients and to highlight the need for immediate law changes to protect people.
"Confluent SprayGel is a product sprayed inside human beings and contains a section 29 drug (methylene blue) which has not been tested on human beings, and this product was allowed to be used ... [with] no quality assurance in terms of monitoring," she wrote to Medsafe in December.
"It's quite amazing - we're using it inside human beings," she told The Dominion Post. "I would have expected ... that they would have said, `Let's put this product on hold or start asking some questions', but that didn't happen."
Dr Koya began using the gel in October 2002, but stopped in April 2006 after her rate of repeat laparoscopies - keyhole operations - jumped from less than 2 per cent to around 10 per cent.
Women who would usually have made swift recoveries developed severe pain or discomfort after their initial operations.
Dozens of the many hundred women she treated with the gel needed repeat surgery to remove scarring - which could cause infertility - even though their endometriosis had not returned. "It's only where I've sprayed the SprayGel. It's like sheets of scarring which I've never seen in my practice."
Dr Koya said she had not repeated any laparoscopies since using an alternative product.
She complained to American manufacturer Confluent Surgical and has written repeatedly to MedSafe and the Health Ministry asking them to investigate, but felt her concerns had been ignored.
New Zealand distributor Covidien Tyco did not return calls.
Medsafe interim manager Stewart Jessamine said SprayGel was classed as a device under the Medicines Act, not a medicine.
No clinical assessment was required before its sale, though manufacturers had to ensure the device was safe. Medical practitioners had the ultimate responsibility for its use on patients.
After a review, it it concluded the gel was safe "when used as intended".
There had been no other complaints and there were no plans to restrict its supply, it said.
http://www.stuff.co.nz/stuff/4395993a11.html
'I shouldn't have to pay for it'The Dominion Post, New Zealand - 21 hours agoTwo years after she had invasive surgery to treat her endometriosis, Anastasia Spallas-Blades has had to go back to have painful scarring caused by a ...
Expert: Surgical gel has injured womenUnited Press International - 14 hours agoKoya said these women now suffer from endometriosis, a medical condition in which abnormal growths appear in a woman's pelvic organs. ...
Gynaecologist calls for ban on surgical gelRadio New Zealand, New Zealand - 9 hours agoA Wellington gynaecologist is calling for a ban on a gel used in operations to treat endometriosis. Hanifa Koya, a surgeon at Wellington's Wakefield ...
IHRT.....the jury is out here. We will wait for science and not accusation before we give up hope on Spraygel.
As we all were told....Spraygel is only as effective as the surgeon using it.
The blue coloring in question is used to run the bowel and bladder all the time.
Maybe the were using too many kits ( like some surgeons we know)
Science please.
ANDREW GORRIE/ Dominion Post
ANGRY AND AMAZED: Hanifa Koya has stopped using SprayGel after her patients required further surgery to remove scars. She says the product should be put on hold till surgeons and patients can be assured of its safety.
Related Links
• Subscribe to Archivestuff• Have your say
A surgical gel - containing a drug untested on humans - has caused excruciating internal scarring in dozens of women that could lead to infertility, claims a leading gynaecologist.
Many of the endometriosis patients have already forked out thousands of dollars for repeat surgery. Some are now pursuing compensation from ACC.
Endometriosis is a condition where abnormal growths develop in pelvic organs, causing inflammatory reactions leading to scarring and pain. It affects millions of women worldwide.
Though some gynaecologists have stopped using the anti-scarring gel because of concerns about its safety and effectiveness, others still use the treatment, Wellington specialist Hanifa Koya said.
Medsafe, the Government agency that approves medicines, has told the American manufacturer to add additional precautions to the instruction pamphlet.
But it maintains the product is safe, and refuses to ban its sale without conclusive evidence of harm - even though the gel is considered high risk under proposed legislation.
Dr Koya - who first raised concerns in December 2005 - was disillusioned at the response of health agencies, which she claimed had let Confluent SprayGel be used internally on thousands of Kiwi women since about 2002 without adequate clinical testing or ongoing monitoring of its effects.
She had spoken out because of concern for her patients and to highlight the need for immediate law changes to protect people.
"Confluent SprayGel is a product sprayed inside human beings and contains a section 29 drug (methylene blue) which has not been tested on human beings, and this product was allowed to be used ... [with] no quality assurance in terms of monitoring," she wrote to Medsafe in December.
"It's quite amazing - we're using it inside human beings," she told The Dominion Post. "I would have expected ... that they would have said, `Let's put this product on hold or start asking some questions', but that didn't happen."
Dr Koya began using the gel in October 2002, but stopped in April 2006 after her rate of repeat laparoscopies - keyhole operations - jumped from less than 2 per cent to around 10 per cent.
Women who would usually have made swift recoveries developed severe pain or discomfort after their initial operations.
Dozens of the many hundred women she treated with the gel needed repeat surgery to remove scarring - which could cause infertility - even though their endometriosis had not returned. "It's only where I've sprayed the SprayGel. It's like sheets of scarring which I've never seen in my practice."
Dr Koya said she had not repeated any laparoscopies since using an alternative product.
She complained to American manufacturer Confluent Surgical and has written repeatedly to MedSafe and the Health Ministry asking them to investigate, but felt her concerns had been ignored.
New Zealand distributor Covidien Tyco did not return calls.
Medsafe interim manager Stewart Jessamine said SprayGel was classed as a device under the Medicines Act, not a medicine.
No clinical assessment was required before its sale, though manufacturers had to ensure the device was safe. Medical practitioners had the ultimate responsibility for its use on patients.
After a review, it it concluded the gel was safe "when used as intended".
There had been no other complaints and there were no plans to restrict its supply, it said.
http://www.stuff.co.nz/stuff/4395993a11.html
'I shouldn't have to pay for it'The Dominion Post, New Zealand - 21 hours agoTwo years after she had invasive surgery to treat her endometriosis, Anastasia Spallas-Blades has had to go back to have painful scarring caused by a ...
Expert: Surgical gel has injured womenUnited Press International - 14 hours agoKoya said these women now suffer from endometriosis, a medical condition in which abnormal growths appear in a woman's pelvic organs. ...
Gynaecologist calls for ban on surgical gelRadio New Zealand, New Zealand - 9 hours agoA Wellington gynaecologist is calling for a ban on a gel used in operations to treat endometriosis. Hanifa Koya, a surgeon at Wellington's Wakefield ...
IHRT.....the jury is out here. We will wait for science and not accusation before we give up hope on Spraygel.
As we all were told....Spraygel is only as effective as the surgeon using it.
The blue coloring in question is used to run the bowel and bladder all the time.
Maybe the were using too many kits ( like some surgeons we know)
Science please.
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