Many women deal with nauseating cramps and painful sex for decades. But, Dr. Iris Orbuch explains, they may be signs of endometriosis.
Full article:
Showing posts with label infertility. Show all posts
Showing posts with label infertility. Show all posts
Saturday, July 12, 2014
Friday, May 02, 2014
First Harry Reich Award presented at EFA’s Blossom Ball
First Harry Reich Award presented at EFA’s Blossom Ball
8 MARCH 2014
Professors Linda Giudice and Liselotte Mettler were honoured at EFA’s 6th Annual Blossom Ball with the inaugural Harry Reich Award.
Yesterday evening, the Endometriosis Foundation of America (EFA) awarded the inaugural Harry Reich Award to recognise two extraordinary healthcare professionals, Professors Linda Giudice and Liselotte Mettler, for the difference these two women have made in the lives of other women through their practice, research, and advocacy.
Tamer Seckin presenting Linda Giudice with her Award at the Blossom Ball
In announcing these two awards, co-founder of EFA, Dr Tamer Seckin, emphasised how the achievements of both Linda Giudice and Liselotte Mettler are an inspiration and encouragement for women (with and without endometriosis) to take charge of their health!
Professor Giudice is a biochemist, gynaecologist, and reproductive endocrinologist with a specific clinical interest in endometriosis, infertility, assisted reproduction, and implantation and ovulatory disorders.
Her research focuses on environmental impacts on reproductive health, steroid hormone signalling in human endometrium, endometrial-placental interactions, endometrium as a mucosal tissue, and translational applications of human embryonic and endometrial stem cells. She is distinguished professor and chair of the Department of Reproductive Sciences at the University of California San Francisco, immediate past-president of the ASRM, president-elect of the World Endometriosis Society, vice-president of the World Endometriosis Research Foundation, and a member of the Institute of Medicine of the National Academy of Sciences.
Tamer Seckin presenting Liselotte Mettler with her Award at the Blossom Ball
Professor Emeritus Mettler has specialised in reproductive medicine, gynaecological endoscopy, endometriosis, and gynaecological endocrinology since 1981 when she became deputy director of the Department of Obstetrics and Gynaecology at the University of Kiel. Following her retirement she remains an honorary patron of the Kiel School of Gynaecological Endoscopy and Reproductive Medicine, where she still teaches up to a dozen international training courses each year.
She is also visiting professor to the German Medical Center and the Dubai Healthcare City. Professor Mettler is a former board member and current ambassador of the World Endometriosis Society, a board member of the German Foundation for Endometriosis Research (SEF), and the General Secretary of the International Academy of Human Reproduction.
The Harry Reich Award
The Harry Reich Award is awarded by EFA to recognise extraordinary healthcare professionals, who are making a difference in women’s lives (and their families) by their practice, research, and advocacy.
Harry Reich with honouree Linda Giudice at the Blossom Ball
The award is named for Dr Harry Reich, a pioneer in the field of laparoscopic surgery, who performed many “firsts”, including: the first laparoscopic hysterectomy, the first pelvic lymphadenectomy for cancer, and the first excision of cul-de-sac endometriosis that included rectal resection.
Dr Reich, who has operated in more than 60 countries, is an honorary professor in Russia and Romania, as well as a Fellow (ad eundem) of the Royal College of Obstetricians and Gynaecologists in the UK for his pioneering work in the field of endoscopy. Though retired, Dr Reich remains actively involved in many medical organisations and serves as a reviewer for multiple scientific journals.
Please visit Endometriosis.org for more news about endo.
Dr. Drew doesn’t understand your “garbage” diagnosis ~ Endometriosis and Interstitial Cystitis
Grrrrrrrrrr. All the work we do for awareness and then this schmuck comes along...
The "Loveline" cohost draws outrage for his comments on endometriosis
Dr. Drew Pinsky is a board certified internist and assistant clinical professor of psychiatry at USC, but most of us know him better as radio and cable television’s most tireless ambulance chaser. Over the years, he’s doled out a variety of less than sound and/or helpful ideas. But when he speculated recently to a “Loveline” caller about his fiancée’s endometriosis, he definitively made the case against getting medical advice from flippant talk show hosts.
As Erin Gloria Ryan first noted on Jezebel, Pinsky was fielding a call from a man who was concerned about his girlfriend’s “multitude of conditions,” including endometriosis, interstitial cystitis, lactose intolerance and what he described as “no stomach lining.” The good doctor quickly interjected before the listener could even pose his question, explaining, “These are what we call sort of functional disorders. Everything you mentioned, everything you mentioned, are things that actually aren’t discernibly pathological. They’re what we call ‘garbage bag diagnoses,’ when you can’t think of anything else, you go, ‘Eh, it’s that.’ So, it then makes me question why is she so somatically preoccupied that she’s visiting doctors all the time with pains and urinary symptoms and pelvic symptoms, and then that makes me wonder, was she sexually abused growing up?”
Though the caller did acknowledge that his fiancée had in fact survived abuse, let’s take a step back here and observe that he never said the woman was “preoccupied” and “visiting doctors all the time” – on the contrary, he said she almost always “refuses” to go to doctors, even when she’s “in so much pain.” But Dr. Drew had a handy explanation, stating, “Trust me, she saw lots of doctors before you.” He then went on to explain why her early abuse was causing her problems now. “When people have unexplained pain, pelvic pain, it’s called somatoform dissociation,” he said, “and the only way her body, which was suffering during those early experiences, can tell its tale of woe is with pain. And she really needs to see a trauma specialist, not a urologist. Know what I’m saying?” This was immediately segued with Pinksy’s colleague joking that an additional way someone could have unexplained pelvic pain was by having sex with the show’s guest, Alan Thicke. Charming.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Here is the link to the CNN contact form for Dr. Drew's show...also what I wrote. Please give them a piece of your mind. IC folks....go get him!
Dr Drews comments on endometriosis are outrageous. He is not educated in a disease that strikes more than one in ten women! Find another doctor! Chronic stage 4 endo with severe adhesions has almost killed me twice. It is real, incurable and I hope you devote air some time in spreading awareness about endometriosis to counteract the sad stereotype that has made the burden of this horrible disease even harder.
Friday, April 11, 2014
Vitamin D and female fertility
Curr Opin Obstet Gynecol. 2014 Apr 8. [Epub ahead of print]
Vitamin D and female fertility.
Abstract
PURPOSE OF REVIEW:
Apart from the well known effects of vitamin D on maintaining calcium homeostasis and promoting bone mineralization, there is some evidence suggesting that vitamin D also modulates human reproductive processes. We will review the most interesting and relevant studies on vitamin D and female fertility published over the past year.
RECENT FINDINGS:
In the past year, several observational studies reported a better in-vitro fertilization outcome in women with sufficient vitamin D levels (≥30 ng/ml), which was mainly attributed to vitamin D effects on the endometrium. One randomized controlled trial found an increased endometrial thickness in women with polycystic ovary syndrome (PCOS) receiving vitamin D during intrauterine insemination cycles. Further, vitamin D supplementation had a beneficial effect on serum lipids in PCOS women. Vitamin D treatment improved endometriosis in a rat model and increased vitamin D intake was related to a decreased risk of incident endometriosis. Vitamin D was also favorably associated with primary dysmenorrhea, uterine leiomyoma, and ovarian reserve in late reproductive aged women.
SUMMARY:
In women undergoing in-vitro fertilization, a sufficient vitamin D level (≥30 ng/ml) should be obtained. Vitamin D supplementation might improve metabolic parameters in women with PCOS. A high vitamin D intake might be protective against endometriosis.
- PMID:
- 24717915
- [PubMed - as supplied by publisher]
Wednesday, April 09, 2014
Author Hilary Mantel: 'It won’t all be novels now — it could be plays' ~ Writes with severe Endometriosis
"Mantel has written about the severe endometriosis that doctors failed to diagnose in her youth; how it caused the loss of her fertility and the doubling of her body weight in less than a year.
Now she says the condition defined her as a writer, indeed made her one. “You really live on the verge of panic because you don’t know what’s going on inside you. And when the pain isn’t there, you know it’s waiting for you. It’s why I became a writer in the first place. I don’t like to let people down and I couldn’t have gone into an office every day.
“Sometimes I’ve travelled [to author events] and gone on stage when any sensible person would have stayed at home. I have sat in car parks thinking, ‘Do I go in and do the talk or do I go to A&E?’"
Sunday, March 16, 2014
Transvaginal hydrolaparoscopy. as diagnostic tool Endometriosis Adhesions
JSLS. 2012 Jul-Sep;16(3):461-5. doi: 10.4293/108680812X13462882736295.
Transvaginal hydrolaparoscopy.
Abstract
Transvaginal hydrolaparoscopy (THL) is being performed regularly in Europe and China, but rarely in the United States. The reasons may be physicians' unfamiliarity with the procedure and their uneasiness over potential rectal puncturing due to the proximity of the rectum to the vaginal trocar insertion site. THL has the advantage over hysterosalpingography (HSG) in that it allows for direct visualization of the tubal mucosa in addition to determining tubal patency. THL has advantages over traditional laparoscopy in that it does not require an abdominal incision and has the capability of being conducted in an outpatient office setting with local anesthesia. Studies have shown that THL has comparable accuracy to laparoscopy with 96.1% concordance between THL and laparoscopic findings. THL may be combined with chromopertubation and salpingoscopy. In addition to diagnostic purposes, THL may be used for operative intervention including adhesiolysis, endometriosis ablation, and ovarian drilling. Studies from France and China report the occurrence of rectal injury from 0% to1%. Despite the advantages of THL and low reports of rectal injury, THL has not gained popularity in the United States. The purpose of this article is to familiarize gynecologists in the United States with THL.
- PMID:
- 23318074
- [PubMed - indexed for MEDLINE]
- PMCID:
- PMC3535799
Saturday, March 01, 2014
Endometriosis Awareness 2014
Endometriosis Awareness 2014
Endometriosis Awareness takes place across the globe during the month of March with a mission to raise awareness of “the invisible disease”, which affects an estimated 176 million women.
Read More about awareness across the world dor the month of March!
Thursday, December 26, 2013
Million Woman March for Endometriosis March 13, 2014
Find a group!
Million Woman March for Endometriosis©, is an internationally-coordinated awareness campaign that will occur worldwide in dozens of international capitals, including Amsterdam, Berlin, Buenos Aires, Copenhagen, Dublin, Helsinki, Kingston, Lisbon, London, Madrid, Rome, Stockholm, and Washington, D.C., just to name a few.
With an estimated 176 million women and girls throughout the world still living lives awash in anguish because of this devastating disorder, we believe that an internationally coordinated campaign is absolutely necessary to effect the changes that are needed to overturn the status quo.
Join us in this unprecedented worldwide peaceful demonstration to raise awareness about Endometriosis, Adenomyosis, Fibroids and other related chronic pelvic pain disorders in women…
Thank you
Shauna Fuller Clarke's B.A.S.E. Foundation
Promoting awareness and offering support
to victims of Endometriosis
Please visit them
Thursday, December 05, 2013
Pesticides Linked to Endometriosis Risk
Why some women and not others get endometriosis — the growth of uterine tissue outside the uterus that can cause pain and infertility — is not known, but researchers have come up with one possible contributing factor: pesticide poisoning.
Scientists studied 248 women with surgically confirmed endometriosis and 538 healthy controls. They measured blood levels of two pesticides, mirex and beta HCH, which persist in some fish and dairy products even though their use in the United States has been banned for decades. The studyappears online in Environmental Health Perspectives.
Friday, November 04, 2011
Massachusetts Adopts Groundbreaking Endometriosis Resolution
http://www.prweb.com/releases/2005/11/prweb306562.htm
Representative Elizabeth A. Poirier (R) introduces Endometriosis Awareness to Massachusetts with the resolution below urging increased awareness of endometriosis.
Email PDF Print .(PRWEB) November 5, 2005
Massachusetts House of Representatives
Urging Increased Awareness of Endometriosis
Whereas, Endometriosis is a painful, reproductive and immunological disease which is a leading cause of female infertility, chronic pelvic pain, and gynecological surgery, and accounts for nearly half the 600,000 hysterectomies performed annually, and endometriosis is more prevalent than Alzheimer's disease, Parkinson's disease and even Breast Cancer, that places significant costs for the individual, and the Commonwealth in medical bills and lost productivity; and
Whereas, Endometriosis can negatively affect a woman or teen's ability to work, attend school, social functions or care for herself and her family, and can frequently be misdiagnosed due to lack of awareness and understanding of the symptoms ; and
Whereas, Endometriosis symptoms include pelvic pain with or without menstruation, infertility, miscarriage, ectopic pregnancy, pain associated with sexual intercourse, gastrointestinal difficulties, fatigue, chronic pain, allergies and other immune system-related dysfunction and associations to diseases including multiple sclerosis, lupus, and fibromyalgia, and endometriosis can lead to painful internal scar tissue know as adhesions, resulting in a complex set of symptoms called Adhesion Related Disorder; and
Whereas, studies have also shown an elevated risk of certain cancers and autoimmune disorders in women with endometriosis and rarely, even malignant changes within the disease itself, thus researchers remain unsure as to the specific cause of endometriosis and there is no definitive cure, and current treatments are often accompanied by significantly negative side effects; and
Whereas, in recognition of the disabling effects endometriosis as a significant disabling disease in women, it is incumbent upon the citizens of the Commonwealth of Massachusetts to support the courageous individuals living and coping with this painful condition; therefore be it
Resolved, That the Massachusetts House of Representatives moves to promote Endometriosis Awareness Month every March and to encourage awareness of the Endometriosis Research Center, The Endometriosis Association, and The International Adhesion Society; and be it
Resolved, That a copy of these resolutions be forwarded by the clerk of the House of Representatives to the Endometriosis Association.
House of Representatives, adopted October 31, 2005
http://www.endometriosisassn.org/
http://www.endocenter.org/
http://www.adhesions.org/
http://endotimes.blogspot.com/
Our deepest gratitude to Representative Elizabeth A. Poirier for her continuing dedication to women's issues in the Commonwealth.
Representative Elizabeth A. Poirier (R) introduces Endometriosis Awareness to Massachusetts with the resolution below urging increased awareness of endometriosis.
Email PDF Print .(PRWEB) November 5, 2005
Massachusetts House of Representatives
Urging Increased Awareness of Endometriosis
Whereas, Endometriosis is a painful, reproductive and immunological disease which is a leading cause of female infertility, chronic pelvic pain, and gynecological surgery, and accounts for nearly half the 600,000 hysterectomies performed annually, and endometriosis is more prevalent than Alzheimer's disease, Parkinson's disease and even Breast Cancer, that places significant costs for the individual, and the Commonwealth in medical bills and lost productivity; and
Whereas, Endometriosis can negatively affect a woman or teen's ability to work, attend school, social functions or care for herself and her family, and can frequently be misdiagnosed due to lack of awareness and understanding of the symptoms ; and
Whereas, Endometriosis symptoms include pelvic pain with or without menstruation, infertility, miscarriage, ectopic pregnancy, pain associated with sexual intercourse, gastrointestinal difficulties, fatigue, chronic pain, allergies and other immune system-related dysfunction and associations to diseases including multiple sclerosis, lupus, and fibromyalgia, and endometriosis can lead to painful internal scar tissue know as adhesions, resulting in a complex set of symptoms called Adhesion Related Disorder; and
Whereas, studies have also shown an elevated risk of certain cancers and autoimmune disorders in women with endometriosis and rarely, even malignant changes within the disease itself, thus researchers remain unsure as to the specific cause of endometriosis and there is no definitive cure, and current treatments are often accompanied by significantly negative side effects; and
Whereas, in recognition of the disabling effects endometriosis as a significant disabling disease in women, it is incumbent upon the citizens of the Commonwealth of Massachusetts to support the courageous individuals living and coping with this painful condition; therefore be it
Resolved, That the Massachusetts House of Representatives moves to promote Endometriosis Awareness Month every March and to encourage awareness of the Endometriosis Research Center, The Endometriosis Association, and The International Adhesion Society; and be it
Resolved, That a copy of these resolutions be forwarded by the clerk of the House of Representatives to the Endometriosis Association.
House of Representatives, adopted October 31, 2005
http://www.endometriosisassn.org/
http://www.endocenter.org/
http://www.adhesions.org/
http://endotimes.blogspot.com/
Our deepest gratitude to Representative Elizabeth A. Poirier for her continuing dedication to women's issues in the Commonwealth.
Teen finds relief from debilitating endometriosis
BY CYNTHIA BILLHARTZ GREGORIAN • cbillhartz@post-dispatch.com > 314-340-8114 STLtoday.com |
Read more: http://www.stltoday.com/lifestyles/health-med-fit/fitness/article_aea7c10e-1f4f-5f7b-8353-1761f10c6d9e.html#ixzz1cjQpZ7fu
Endometriosis is a common disease by most standards. Between 6 percent and 10 percent of women of child-bearing age have the condition, which results when cells from the lining of the uterus grow in other parts of the body.
Yet many women, like Emily Ingargiola, endure intense and prolonged pain and the possibility of infertility because they're misdiagnosed or inadequately treated, says Dr. Patrick Yeung. He intends to change that.
In August, Yeung, one of a handful of OB-GYNs nationwide who call themselves "excisionists," joined SLUCare and formed the Center for Endometriosis at St. Mary's Health Center. Before that, he'd been practicing at Duke University, where he founded a similar center.
The main mission of the clinic, Yeung said, is to take seriously the women who come to him seeking pain relief. In those who prove to have endometriosis, he'll use a CO2 laser to excise it. All of it. No matter how big or small or where it is.
Most doctors only recognize some lesions as endometriosis and won't touch it on certain organs.
The center at St. Mary's also will study the value of excising endometriosis with CO2 lasers compared to more traditional removal methods such as cauterization and ablation, Yeung said. And it will become home to an endometrial tissue bank for further study.
Ingargiola, 19, of High Ridge, became Yeung's first patient shortly after he set up shop in St. Louis.
By then, she and her mother, Nancy Ingargiola, a registered nurse who has worked in obstetrics and gynecology, had grown frustrated with a medical system that initially refused to believe Emily had a problem.
Ingargiola's troubles started shortly after she reached puberty at age 14. At first she had extreme pain but just during menstruation.
Then she started urinating and defecating blood. Her periods were so heavy that she'd use a tampon and maxi-pad simultaneously and bleed through both. The pain started lasting all month, often leaving her doubled over, unable to go to school.
At first, she said, her doctors told her pain was normal. That she was being whiny. Then they said she had irritable bowel syndrome, most likely from stress.
She spent an entire month during her junior year of high school in the hospital. "It's really traumatic to have something going on in your body and having a lot of pain and having doctors not believe you and say that you're crazy," Emily Ingargiola said. "Not being listened to was the hardest part for me."
Finally, in March 2010, doctors at the Mayo Clinic suggested that maybe she had endometriosis. An ultrasound in St. Louis indicated that was likely. When hormone suppressants didn't work, doctors performed laparoscopic surgery and found severe endometriosis on her bladder, bowels, ureter, ovaries and pelvic lining. They ablated it twice. Ablation vaporizes endometrial lesions by either freezing, heating, microwaving or sending electrical currents through them.
It didn't work. The pain and endometriosis returned within weeks.
By this time, Ingargiola was enrolled at Bellarmine University in Louisville, Ky. Out of desperation, she began getting Lupron injections, which suppressed the endometriosis and induced menopause. The side effects were almost as bad as the pain.
"I turned into a different person," Ingargiola said. "I was getting hot flashes, I was completely unable to remember things or focus on school, and I had horrible mood swings."
She had been on Lupron for three months when her mother attended a medical conference and heard about Yeung.
Emily Ingargiola had the laparoscopic CO2 laser excision surgery Aug. 23.
THE TEXTBOOK PATIENT
Ingargiola is the type of patient Yeung hopes to help.
Many OB-GYNs have accepted that recurrences of pain and endometriosis after ablation and cauterization are normal, particularly in teenagers, he said.
But excisionists like Yeung who train at the Center for Endometriosis Care in Atlanta don't accept that.
They're taught to recognize subtle forms of the disease, including the slightest of spots, which other OB-GYNs either miss or dismiss as something else. Then they use a CO2 laser to cut out every last bit of it.
Most OB-GYNs only cauterize or ablate tissue on the surface of organs.
"You might be getting just the tip of the iceberg," Yeung said. "We know endometriosis can invade, and you can't tell which lesions are invading. I and others believe that excision, which is cutting out the entire implant down to healthy tissue, is the only way to 100 percent treat it."
Read more: http://www.stltoday.com/lifestyles/health-med-fit/fitness/article_aea7c10e-1f4f-5f7b-8353-1761f10c6d9e.html#ixzz1cjQa2nB i
Read more: http://www.stltoday.com/lifestyles/health-med-fit/fitness/article_aea7c10e-1f4f-5f7b-8353-1761f10c6d9e.html#ixzz1cjQpZ7fu
Endometriosis is a common disease by most standards. Between 6 percent and 10 percent of women of child-bearing age have the condition, which results when cells from the lining of the uterus grow in other parts of the body.
Yet many women, like Emily Ingargiola, endure intense and prolonged pain and the possibility of infertility because they're misdiagnosed or inadequately treated, says Dr. Patrick Yeung. He intends to change that.
In August, Yeung, one of a handful of OB-GYNs nationwide who call themselves "excisionists," joined SLUCare and formed the Center for Endometriosis at St. Mary's Health Center. Before that, he'd been practicing at Duke University, where he founded a similar center.
The main mission of the clinic, Yeung said, is to take seriously the women who come to him seeking pain relief. In those who prove to have endometriosis, he'll use a CO2 laser to excise it. All of it. No matter how big or small or where it is.
Most doctors only recognize some lesions as endometriosis and won't touch it on certain organs.
The center at St. Mary's also will study the value of excising endometriosis with CO2 lasers compared to more traditional removal methods such as cauterization and ablation, Yeung said. And it will become home to an endometrial tissue bank for further study.
Ingargiola, 19, of High Ridge, became Yeung's first patient shortly after he set up shop in St. Louis.
By then, she and her mother, Nancy Ingargiola, a registered nurse who has worked in obstetrics and gynecology, had grown frustrated with a medical system that initially refused to believe Emily had a problem.
Ingargiola's troubles started shortly after she reached puberty at age 14. At first she had extreme pain but just during menstruation.
Then she started urinating and defecating blood. Her periods were so heavy that she'd use a tampon and maxi-pad simultaneously and bleed through both. The pain started lasting all month, often leaving her doubled over, unable to go to school.
At first, she said, her doctors told her pain was normal. That she was being whiny. Then they said she had irritable bowel syndrome, most likely from stress.
She spent an entire month during her junior year of high school in the hospital. "It's really traumatic to have something going on in your body and having a lot of pain and having doctors not believe you and say that you're crazy," Emily Ingargiola said. "Not being listened to was the hardest part for me."
Finally, in March 2010, doctors at the Mayo Clinic suggested that maybe she had endometriosis. An ultrasound in St. Louis indicated that was likely. When hormone suppressants didn't work, doctors performed laparoscopic surgery and found severe endometriosis on her bladder, bowels, ureter, ovaries and pelvic lining. They ablated it twice. Ablation vaporizes endometrial lesions by either freezing, heating, microwaving or sending electrical currents through them.
It didn't work. The pain and endometriosis returned within weeks.
By this time, Ingargiola was enrolled at Bellarmine University in Louisville, Ky. Out of desperation, she began getting Lupron injections, which suppressed the endometriosis and induced menopause. The side effects were almost as bad as the pain.
"I turned into a different person," Ingargiola said. "I was getting hot flashes, I was completely unable to remember things or focus on school, and I had horrible mood swings."
She had been on Lupron for three months when her mother attended a medical conference and heard about Yeung.
Emily Ingargiola had the laparoscopic CO2 laser excision surgery Aug. 23.
THE TEXTBOOK PATIENT
Ingargiola is the type of patient Yeung hopes to help.
Many OB-GYNs have accepted that recurrences of pain and endometriosis after ablation and cauterization are normal, particularly in teenagers, he said.
But excisionists like Yeung who train at the Center for Endometriosis Care in Atlanta don't accept that.
They're taught to recognize subtle forms of the disease, including the slightest of spots, which other OB-GYNs either miss or dismiss as something else. Then they use a CO2 laser to cut out every last bit of it.
Most OB-GYNs only cauterize or ablate tissue on the surface of organs.
"You might be getting just the tip of the iceberg," Yeung said. "We know endometriosis can invade, and you can't tell which lesions are invading. I and others believe that excision, which is cutting out the entire implant down to healthy tissue, is the only way to 100 percent treat it."
Read more: http://www.stltoday.com/lifestyles/health-med-fit/fitness/article_aea7c10e-1f4f-5f7b-8353-1761f10c6d9e.html#ixzz1cjQa2nB i
Thursday, November 03, 2011
Saturday, October 08, 2011
Endometriosis.
Niger J Med. 2011 Apr-Jun;20(2):191-9.
Endometriosis.
Okeke TC, Ikeako LC, Ezenyeaku CC.
SourceDepartment of Obstetrics & Gynaecology University of Nigeria Teaching Hospital, Enugu, Nigeria. Ubabikctochukwu@iyahoo.comendometriosis
Abstract
BACKGROUND: Endometriosis is a common mysterious and fascinating gynaecological condition with diverse clinical manifestations, highly variable and unpredictable clinical course with decreased quality of life. Despite extensive research, endometriosis is fraught with controversies.
METHODS: Review of pertinent literature on endometriosis, selected references, internet services through gynaecological search which have been critical in the understanding of this puzzling gynaecologic condition were included in the review.
RESULTS: Endometriosis most commonly afflict women in there late 20s and 30s. The classic symptom complex include dysmenorrhoea, dyspareunia, menorrhagia and infertility. About 30% of the patients are asymptomatic. The incidence of infertility amongst women suffering from endometriosis ranges from 30%-40%. The factors implicated in causing endometriosis-associated infertility are multiple and its management is shrouded in controversy, complex and imperfectly understood.
CONCLUSION: Inspite of diverse clinical manifestations, variable and unpredictable clinical course, there is a chance to improve pregnancy rates with improvement in assisted reproductive technology.
PMID:21970227[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/21970227
Endometriosis.
Okeke TC, Ikeako LC, Ezenyeaku CC.
SourceDepartment of Obstetrics & Gynaecology University of Nigeria Teaching Hospital, Enugu, Nigeria. Ubabikctochukwu@iyahoo.comendometriosis
Abstract
BACKGROUND: Endometriosis is a common mysterious and fascinating gynaecological condition with diverse clinical manifestations, highly variable and unpredictable clinical course with decreased quality of life. Despite extensive research, endometriosis is fraught with controversies.
METHODS: Review of pertinent literature on endometriosis, selected references, internet services through gynaecological search which have been critical in the understanding of this puzzling gynaecologic condition were included in the review.
RESULTS: Endometriosis most commonly afflict women in there late 20s and 30s. The classic symptom complex include dysmenorrhoea, dyspareunia, menorrhagia and infertility. About 30% of the patients are asymptomatic. The incidence of infertility amongst women suffering from endometriosis ranges from 30%-40%. The factors implicated in causing endometriosis-associated infertility are multiple and its management is shrouded in controversy, complex and imperfectly understood.
CONCLUSION: Inspite of diverse clinical manifestations, variable and unpredictable clinical course, there is a chance to improve pregnancy rates with improvement in assisted reproductive technology.
PMID:21970227[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/21970227
Thursday, October 06, 2011
Neurocrine Wins $20M from Abbott Related to Elagolix for Endometriosis
Neurocrine Biosciences received a $20 million milestone payment from Abbott following a pre-Phase III meeting with FDA on the companies' treatment of endometriosis-related pain called elagolix. That brings the total milestone payments paid by Abbott in the third quarter of this year up to $30 million.
Last month Neurocrine received a $10 million milestone fee after Abbott started a Phase II trial to evaluate elagolix in the treatment of uterine fibroids. The firms' partnership, valued at $575 million, covers elagolix for endometriosis and all next-generation gonadotropin-releasing hormone (GnRH) antagonists for a variety of women’s and men’s health conditions.
Under the exclusive, worldwide collaboration, inked in June 2010, Abbott is responsible for all development, marketing, and commercialization costs and will be entitled to an undisclosed percentage of worldwide sales of GnRH compounds. Abbott made an up-front payment of $75 million.
Neurocrine could receive additional milestone payments of about $500 million from Abbott toward achievement of certain development, regulatory, and commercial milestones; funding for certain internal collaboration expenses; plus royalty payments on any future product sales.
http://www.genengnews.com/gen-news-highlights/neurocrine-wins-20m-from-abbott-related-to-elagolix-for-endometriosis/81245782/
http://www.genengnews.com/gen-news-highlights/neurocrine-wins-20m-from-abbott-related-to-elagolix-for-endometriosis/81245782/
Last month Neurocrine received a $10 million milestone fee after Abbott started a Phase II trial to evaluate elagolix in the treatment of uterine fibroids. The firms' partnership, valued at $575 million, covers elagolix for endometriosis and all next-generation gonadotropin-releasing hormone (GnRH) antagonists for a variety of women’s and men’s health conditions.
Under the exclusive, worldwide collaboration, inked in June 2010, Abbott is responsible for all development, marketing, and commercialization costs and will be entitled to an undisclosed percentage of worldwide sales of GnRH compounds. Abbott made an up-front payment of $75 million.
Neurocrine could receive additional milestone payments of about $500 million from Abbott toward achievement of certain development, regulatory, and commercial milestones; funding for certain internal collaboration expenses; plus royalty payments on any future product sales.
http://www.genengnews.com/gen-news-highlights/neurocrine-wins-20m-from-abbott-related-to-elagolix-for-endometriosis/81245782/
http://www.genengnews.com/gen-news-highlights/neurocrine-wins-20m-from-abbott-related-to-elagolix-for-endometriosis/81245782/
Wednesday, October 05, 2011
Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018
NEW YORK, Sept. 28, 2011 /PRNewswire/ -- Reportlinker.com announces that a new market research report is available in its catalogue:
Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018
http://www.reportlinker.com/p0648874/Endometriosis-Therapeutics--Pipeline-Assessment-and-Market-Forecasts-to-2018.html#utm_source=prnewswire&utm_medium=pr&utm_campaign=NoCategory
Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018
Summary
GlobalData, the industry analysis specialist, has released its new report, "Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018". The report is an essential source of information and analysis on the global endometriosis therapeutics market and identifies the key trends shaping and driving it. The report also provides insights on the prevalent competitive landscape and the emerging players expected to significantly alter the market positioning of the current market leaders. Most importantly, the report provides valuable insights on the pipeline products within the global endometriosis therapeutics sector. This report is built using data and information sourced from proprietary databases, primary and secondary research and in-house analysis by GlobalData's team of industry experts.
GlobalData estimates that the global endometriosis therapeutics market was valued at $785m in 2010 and will grow at a Compound Annual Growth Rate (CAGR) of 5.9% to reach $1,239m by 2018. This steady growth is primarily attributed to the recently launched product, Visanne (dienogest) and the expected launch of the pipeline product, Elagolix (NBI-56418) in 2015 in the US and Europe. Organizations, such as the Endometriosis Special Interest Group (EndoSIG), through their work are creating awareness about the disease among the general public. This increasing awareness and the resultant higher treatment seeking rates for the disease are also expectecd to contribute to the growth of the market. The current market is underserved due to the lack of specific as well as non-invasive diagnostic techniques, alongside low disease awareness and the poor safety and moderate efficacy profiles of the current marketed therapies. There is a high unmet need which is largely driven by the unavailability of products with adequate efficacy and safety profiles.
Scope
The report provides information on the key drivers and challenges of the endometriosis therapeutics market. Its scope includes -
- Annualized seven key markets (US, France, Germany, Italy, Spain, UK and Japan) endometriosis therapeutics market revenues data from 2005 to 2010, forecast for eight years to 2018.
- Pipeline analysis data providing a split across the different phases, mechanisms of action being developed and emerging trends. Pipeline candidates fall under major therapeutic classes of GnRH agonists, GnRH antagonists, Aromatase inhibitors and others.
- Analysis of the current and future competition in the global endometriosis therapeutics market. Key market players covered are Nobelpharma, Novartis AG and Neurocrine Biosciences/Abbott.
- Insightful review of the key industry drivers, restraints and challenges. Each trend is independently researched to provide a qualitative analysis of its implications.
- Key topics covered include strategic competitor assessment, market characterization, unmet needs and the implications for the endometriosis therapeutics market.
- Analysis of key recent licensing and partnership agreements in the endometriosis therapeutics market.
Reasons to buy
The report will enhance your decision making capability. It will allow you to -
- Develop and design your in-licensing and out-licensing strategies through a review of pipeline products and technologies and by identifying the companies with the most robust pipeline.
- Develop business strategies by understanding the trends shaping and driving the global endometriosis therapeutics market.
- Drive revenues by understanding the key trends, innovative products and technologies, market segments and companies likely to impact on the global endometriosis therapeutics market in the future.
- Formulate effective sales and marketing strategies by understanding the competitive landscape and by analyzing the performance of various competitors.
- Identify emerging players with potentially strong product portfolios and create effective counter-strategies to gain a competitive advantage.
- Organize your sales and marketing efforts by identifying the market categories and segments that present maximum opportunities for consolidations, investments and strategic partnerships.
- What's the next big thing in the global endometriosis therapeutics market landscape? – Identify, understand and capitalize.
To order this report:
: Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018
More Market Research Report
Check our Industry Analysis and Insights
Nicolas Bombourg
Reportlinker
Email: nbo@reportlinker.com
US: (805)652-2626
Intl: +1 805-652-2626
SOURCE Reportlinker
Back to top
RELATED LINKS
http://www.reportlinker.com/
http://www.prnewswire.com/news-releases/endometriosis-therapeutics--pipeline-assessment-and-market-forecasts-to-2018-130689453.html
Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018
http://www.reportlinker.com/p0648874/Endometriosis-Therapeutics--Pipeline-Assessment-and-Market-Forecasts-to-2018.html#utm_source=prnewswire&utm_medium=pr&utm_campaign=NoCategory
Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018
Summary
GlobalData, the industry analysis specialist, has released its new report, "Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018". The report is an essential source of information and analysis on the global endometriosis therapeutics market and identifies the key trends shaping and driving it. The report also provides insights on the prevalent competitive landscape and the emerging players expected to significantly alter the market positioning of the current market leaders. Most importantly, the report provides valuable insights on the pipeline products within the global endometriosis therapeutics sector. This report is built using data and information sourced from proprietary databases, primary and secondary research and in-house analysis by GlobalData's team of industry experts.
GlobalData estimates that the global endometriosis therapeutics market was valued at $785m in 2010 and will grow at a Compound Annual Growth Rate (CAGR) of 5.9% to reach $1,239m by 2018. This steady growth is primarily attributed to the recently launched product, Visanne (dienogest) and the expected launch of the pipeline product, Elagolix (NBI-56418) in 2015 in the US and Europe. Organizations, such as the Endometriosis Special Interest Group (EndoSIG), through their work are creating awareness about the disease among the general public. This increasing awareness and the resultant higher treatment seeking rates for the disease are also expectecd to contribute to the growth of the market. The current market is underserved due to the lack of specific as well as non-invasive diagnostic techniques, alongside low disease awareness and the poor safety and moderate efficacy profiles of the current marketed therapies. There is a high unmet need which is largely driven by the unavailability of products with adequate efficacy and safety profiles.
Scope
The report provides information on the key drivers and challenges of the endometriosis therapeutics market. Its scope includes -
- Annualized seven key markets (US, France, Germany, Italy, Spain, UK and Japan) endometriosis therapeutics market revenues data from 2005 to 2010, forecast for eight years to 2018.
- Pipeline analysis data providing a split across the different phases, mechanisms of action being developed and emerging trends. Pipeline candidates fall under major therapeutic classes of GnRH agonists, GnRH antagonists, Aromatase inhibitors and others.
- Analysis of the current and future competition in the global endometriosis therapeutics market. Key market players covered are Nobelpharma, Novartis AG and Neurocrine Biosciences/Abbott.
- Insightful review of the key industry drivers, restraints and challenges. Each trend is independently researched to provide a qualitative analysis of its implications.
- Key topics covered include strategic competitor assessment, market characterization, unmet needs and the implications for the endometriosis therapeutics market.
- Analysis of key recent licensing and partnership agreements in the endometriosis therapeutics market.
Reasons to buy
The report will enhance your decision making capability. It will allow you to -
- Develop and design your in-licensing and out-licensing strategies through a review of pipeline products and technologies and by identifying the companies with the most robust pipeline.
- Develop business strategies by understanding the trends shaping and driving the global endometriosis therapeutics market.
- Drive revenues by understanding the key trends, innovative products and technologies, market segments and companies likely to impact on the global endometriosis therapeutics market in the future.
- Formulate effective sales and marketing strategies by understanding the competitive landscape and by analyzing the performance of various competitors.
- Identify emerging players with potentially strong product portfolios and create effective counter-strategies to gain a competitive advantage.
- Organize your sales and marketing efforts by identifying the market categories and segments that present maximum opportunities for consolidations, investments and strategic partnerships.
- What's the next big thing in the global endometriosis therapeutics market landscape? – Identify, understand and capitalize.
To order this report:
: Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018
More Market Research Report
Check our Industry Analysis and Insights
Nicolas Bombourg
Reportlinker
Email: nbo@reportlinker.com
US: (805)652-2626
Intl: +1 805-652-2626
SOURCE Reportlinker
Back to top
RELATED LINKS
http://www.reportlinker.com/
http://www.prnewswire.com/news-releases/endometriosis-therapeutics--pipeline-assessment-and-market-forecasts-to-2018-130689453.html
Saturday, September 24, 2011
Surgical encounters in Endometriosis
From Ad-Lap surgical group
http://www.adlap.com/endoNodules.htm
Nodules, Cul-de-sac disease, endometriomas, Extensive endometriosis means bulky deep fibrotic endometriosis deposits that can often be palpated preoperatively as tender pelvic nodules. These nodules consist of endometriosis glands and stroma surrounded by fibromuscular tissue that has accumulated over many years in response to cyclic monthly activation of the endometriosis. They represent a longstanding chronic inflammatory response.
Cul-de-sac Obliteration
In the female without previous hysterectomy, the anterior peritoneal reflection on the rectum (rectouterine pouch or pouch of Douglas) folds at an average distance of 4 cm from the anal verge. The rectovaginal fascial septum separates the rectum from the vagina.
In 1921, Sampson defined cul-de-sac obliteration as “extensive adhesions in the cul-de-sac obliterating its lower portion and uniting the cervix or the lower portion of the uterus to the rectum; with adenoma of the endometrial type invading the cervical and the uterine tissues and probably also (but to a lesser degree) the anterior wall of the rectum.” (7) Cul-de-sac obliteration secondary to endometriosis implies the presence of retrocervical deep fibrotic endometriosis beneath the peritoneum. This endometriosis is located on or in the anterior rectum, posterior vagina, posterior cervix (the cervical vaginal angle between the upper vagina and the cervix), the rectovaginal septum, or the uterosacral ligaments; often one area predominates.
Partial cul-de-sac obliteration (PCDSO) means that deep fibrotic endometriosis is severe enough to alter the course of the rectum, fusing it to a portion of posterior vagina. With complete cul-de-sac obliteration (CCDSO), fibrotic endometriosis and/or adhesions involve the entire cul-de-sac between the cervicovaginal junction (and sometimes above) and the rectum.
At laparoscopy, careful inspection of the cul-de-sac is necessary to evaluate the extent of upward tenting of the rectum. To determine if cul-de-sac obliteration is partial or complete, a sponge on a ring forceps is inserted into the posterior vaginal fornix (and a rectal probe in the rectum). The normal cul-de-sac will show a portion of vaginal wall between the cervix and rectum as a distinct and separate bulge. The utero-sacral ligaments will be of normal calibre and lateral. Partial cul-de-sac obliteration occurs when rectal tenting is visible but a protrusion from the sponge in the posterior vaginal fornix is noted between the rectum and the inverted “U” of the uterosacral ligaments. Complete cul-de-sac obliteration is diagnosed when the outline of the sponge in the posterior fornix cannot be visualised initially through the laparoscope: the rectum or fibrotic endometriosis nodules completely obscure the identification of the deep cul-de-sac.
Partial and complete cul-de-sac obliteration are the same disease, requiring the same surgical dissection. Both indicate that deep fibrotic endometriosis is present on the anterior rectum and the posterior vagina, areas from which it can be completely excised. Yet the American Society of Reproductive Medicine Classification makes partial obliteration Stage 1 and complete cul-de-sac obliteration Stage 4; go figure it!
Endometriomas
Preoperatively, transvaginal sonography is done to evaluate the ovaries in cases involving a pelvic mass, retrocervical nodules, or fibroids, and a CA 125 assay is obtained if persistent enlargement is documented. Ultrasound findings of a round shaped adnexal mass with thick wall and homogeneous, low-level echo pattern is highly suggestive of endometrioma. Another pattern has irregular margins with septations and an anechoic appearance. Intravenous pyelograms (IVP) are rarely necessary preoperatively, as ureteral dilation is readily evident at laparoscopic examination. An IVP is ordered postoperatively if abdominal pain persists after surgery on or near the ureter. Presently, there is no indication for CT scan or MRI prior to laparoscopic ovarian surgery.
In all cases careful inspection of the abdomen and pelvis is done. The ovaries are evaluated for visual evidence of malignancy. Washings are taken if indicated. Endometriomas are drained by mobilizing them from the pelvic sidewall.
Enlarged ovaries containing cysts are either free in the peritoneal cavity or attached to the pelvic sidewall, uterosacral ligament, or cul-de-sac. If attached to these structures, the cyst is frequently an endometrioma. An aquadissector is used to mobilize the ovaries by lifting them from the pelvic sidewall. Often this maneuver will result in drainage of chocolate-like hemosiderin filled fluid from the undersurface of the ovary. After this occurs, the ovary is completely mobilized from the pelvic sidewall to its hilum using aquadissection and careful blunt dissection to reduce pelvic sidewall peritoneal damage. If no endometrioma is readily identified, and the patient has “unexplained infertility” or pre- or postmenstrual spotting, a knife electrode connected to monopolar cutting current (70 W) is used to incise and drain areas on the ovary with superficial endometriosis and cysts suspicious for endometrioma. The clinical distinction between an endometrioma (pathology to be excised) and a corpus luteum cyst (normal, vascular tissue best left alone) may be difficult, and conservative discretion is advised to avoid the trauma and risk of removing normal tissue. An endometrioma has a thick white fibrotic capsule while a corpus luteum cyst capsule is yellow.
If an endometrioma is discovered by either of these two methods, the cyst cavity is rinsed with lactated Ringer’s solution and then excised using 5 mm biopsy forceps, grasping forceps, and sometimes scissors (Semm, Mettler 1980)(Reich, McGlynn 1986). Experience has proven that drainage is not enough. Ovarian endometriomas up to 15 cm are excised. The cyst wall is most firmly attached to the ovarian cortex in the area of cyst rupture during mobilization, i.e., the portion that was adhered to the pelvic sidewall or uterosacral ligament, and not to the portion near the ovarian hilum. To help create an initial plane between normal ovarian cortex and endometrioma cyst wall, cutting current (70 W) through a knife electrode tip is applied at the cyst wall-cortex junction to develop a dissection plane in this firmly attached area. This step is particularly useful near the utero-ovarian ligament as rough avulsion can lead to excessive bleeding. The laparoscope is brought close to the area of dissection, magnifying it to identify the cyst wall clearly. This incision is extended through the visible 360o opening if possible. The cutting current will destroy endometriosis at the ovarian cortex-endometrioma junction while making a divot of separation between the two structures. Thereafter, biopsy or grasping forceps are placed to stabilize the ovarian cortex and endometrioma cyst wall while traction is exerted on the endometrioma cyst wall to peel it from inside the ovary. If the cyst wall is felt to be incompletely excised, the cyst cavity can be desiccated or fulgurated to destroy any remaining endometrioma. Otherwise, the endometrioma may recur. Excision can be done with minimal bleeding from the cyst wall bed and the ovarian wall edges usually reapproximate quite well, though occasionally extracorporeal suturing is required, especially after removal of large endometriomas. Hemostasis is checked by underwater examination inside the ovary, and individual bleeders are identified using irrigation through an irrigating channel and coagulated with microbipolar forceps. When removal results in a large, asymmetrical defect, the ovary is suture repaired, usually with one purse-string absorbable suture, applied close to the utero-ovarian ligament in one direction and the infundibulopelvic ligament in the other. Although suturing is not thought to be necessary for reapproximation by many surgeons, anyone who has operated on many of these women realizes that the open ovary is very receptive to small and large bowel; I suspect that those who preach that all ovaries should not be suture repaired are not comfortable with suturing techniques.
In most cases of ovarian endometrioma, endometriosis of the pelvic sidewall and/or uterosacral ligament is present. These lesions should be excised after enucleation of the endometrioma to prevent recurrence. Pelvic sidewall endometriosis peritoneal excision usually requires ureterolysis to free the underlying ureter from the lesion.
Oophorectomy can also be considered for pain or mass arising from ovarian endometrioma in women not desiring future fertility. This is especially indicated for left pelvic pain if the left ovary is enmeshed in rectosigmoid adhesions because they tend to recur.
Before removal, the ovary is released from all pelvic sidewall and bowel adhesions. It is imperative that the surgeon visualize the course of the ureter. The peritoneum above the ureter is opened with sharp scissors. Smooth grasping forceps are then opened parallel and perpendicular to the retroperitoneal structures until the ureter is identified. Scissors can be used to further dissect the ureter throughout its course along the pelvic sidewall.
The uterus is anteverted and displaced to the contralateral side. The fallopian tube is grasped and pulled medially to stretch out the infundibulopelvic ligament containing the ovarian vessels. The anterior and posterior leaves of the broad ligament are opened with scissors lateral and medial to the infundibulopelvic ligament and a free ligature (2-0 Vicryl) passed through the window thus created and tied extracorporeally using the Clarke-Reich knotpusher. This is repeated twice until two proximal ties and one distal one are placed, and the ligament then divided. While applying traction to the cut distal pedicle, the broad ligament is divided to the round ligament just lateral to the uteroovarian artery anastomosis using cutting current through a spoon electrode. Two free ligatures are placed around the uteroovarian ligament, which is then divided.
Alternatively, Kleppinger bipolar forceps are used to compress and desiccate the infundibulopelvic ligament, the broad ligament, the fallopian tube isthmus, and the utero-ovarian ligament with bipolar cutting current (25-35 W). In most cases, 3 contiguous areas are desiccated. Laparoscopic scissors are used to divide the pedicle. (Reich H, 1987)
The free ovary is removed through the umbilicus or cul-de-sac. Large endometriomas are usually sufficiently cystic and pliable that, once separated from the pelvic sidewall, they can be removed through the umbilical incision.
When the ovary is retroperitoneal, embedded in the pelvic sidewall, a lateral approach is advocated. The peritoneum lateral to the ovary and the infundibulopelvic ligament where it crosses the iliac vessels is incised with dissecting scissors and the broad ligament opened by bluntly separating the extraperitoneal areolar tissues. The peritoneal incision is extended to the round ligament, lateral to the infundibulopelvic ligament. The infundibulopelvic ligament is pulled medially with grasping forceps to expose the ureter at the pelvic brim where it crosses the common or external iliac artery. It may be necessary to reflect the ureter off the medial leaf of the broad ligament for a short distance to aid in its identification, although this is not always required. The infundibulopelvic ligament is ligated, divided, and its distal cut end put on traction with traumatic grasping forceps for the rest of the oophorectomy. The medial leaf of the broad ligament with its contained ovary is freed from the pelvic sidewall vessels and areolar tissue. The ureter is peeled off the retroperitoneal ovary for most of its pelvic course until the uteroovarian ligament can be isolated and divided.
--------------------------------------------------------------------------------
References
Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil.Steril. 1990;53:978-983.
Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil.Steril. 1991;55:759-765.
Koninckx PR, Barlow D, Kennedy S. Implantation versus infiltration: The Sampson versus the endometriotic disease theory. GYNECOLOGIC.AND.OBSTETRIC.INVESTIGATION. 1999;47
Martin DC, Hubert G D, Levy B S. Depth of infiltration of endometriosis. Journal of Gynecologic Surgery, 5:55-60, 1989.
Reich H, McGlynn F: Treatment of ovarian endometriomas using laparoscopic surgical techniques. J of Reprod Med 1986;31:577-84.
Reich H, McGlynn F: Laparoscopic oophorectomy and salpingo-oophorectomy in the treatment of benign tuboovarian disease. J Reprod Med 1986; 31:609.
Reich H: Laparoscopic oophorectomy and salpingo-oophorectomy in the treatment of benign tubo-ovarian disease. Int J Fertil 1987; 32:233-236
Reich H: Laparoscopic oophorectomy without ligature or morcellation. Contemp Ob Gyn 1989;9:34-46
Reich H. New techniques in advanced laparoscopic surgery. In Laparoscopic surgery. Sutton C, ed. Bailliere’s Clinical Obstetrics and Gynecology. WB Saunders, Philadelphia London. 1989;3:655-81.
Semm K, Mettler L: Technical progress in pelvic surgery via operative laparoscopy. Am J Obstet Gynecol 1980; 138:121
http://www.adlap.com/endoNodules.htm
Nodules, Cul-de-sac disease, endometriomas, Extensive endometriosis means bulky deep fibrotic endometriosis deposits that can often be palpated preoperatively as tender pelvic nodules. These nodules consist of endometriosis glands and stroma surrounded by fibromuscular tissue that has accumulated over many years in response to cyclic monthly activation of the endometriosis. They represent a longstanding chronic inflammatory response.
Cul-de-sac Obliteration
In the female without previous hysterectomy, the anterior peritoneal reflection on the rectum (rectouterine pouch or pouch of Douglas) folds at an average distance of 4 cm from the anal verge. The rectovaginal fascial septum separates the rectum from the vagina.
In 1921, Sampson defined cul-de-sac obliteration as “extensive adhesions in the cul-de-sac obliterating its lower portion and uniting the cervix or the lower portion of the uterus to the rectum; with adenoma of the endometrial type invading the cervical and the uterine tissues and probably also (but to a lesser degree) the anterior wall of the rectum.” (7) Cul-de-sac obliteration secondary to endometriosis implies the presence of retrocervical deep fibrotic endometriosis beneath the peritoneum. This endometriosis is located on or in the anterior rectum, posterior vagina, posterior cervix (the cervical vaginal angle between the upper vagina and the cervix), the rectovaginal septum, or the uterosacral ligaments; often one area predominates.
Partial cul-de-sac obliteration (PCDSO) means that deep fibrotic endometriosis is severe enough to alter the course of the rectum, fusing it to a portion of posterior vagina. With complete cul-de-sac obliteration (CCDSO), fibrotic endometriosis and/or adhesions involve the entire cul-de-sac between the cervicovaginal junction (and sometimes above) and the rectum.
At laparoscopy, careful inspection of the cul-de-sac is necessary to evaluate the extent of upward tenting of the rectum. To determine if cul-de-sac obliteration is partial or complete, a sponge on a ring forceps is inserted into the posterior vaginal fornix (and a rectal probe in the rectum). The normal cul-de-sac will show a portion of vaginal wall between the cervix and rectum as a distinct and separate bulge. The utero-sacral ligaments will be of normal calibre and lateral. Partial cul-de-sac obliteration occurs when rectal tenting is visible but a protrusion from the sponge in the posterior vaginal fornix is noted between the rectum and the inverted “U” of the uterosacral ligaments. Complete cul-de-sac obliteration is diagnosed when the outline of the sponge in the posterior fornix cannot be visualised initially through the laparoscope: the rectum or fibrotic endometriosis nodules completely obscure the identification of the deep cul-de-sac.
Partial and complete cul-de-sac obliteration are the same disease, requiring the same surgical dissection. Both indicate that deep fibrotic endometriosis is present on the anterior rectum and the posterior vagina, areas from which it can be completely excised. Yet the American Society of Reproductive Medicine Classification makes partial obliteration Stage 1 and complete cul-de-sac obliteration Stage 4; go figure it!
Endometriomas
Preoperatively, transvaginal sonography is done to evaluate the ovaries in cases involving a pelvic mass, retrocervical nodules, or fibroids, and a CA 125 assay is obtained if persistent enlargement is documented. Ultrasound findings of a round shaped adnexal mass with thick wall and homogeneous, low-level echo pattern is highly suggestive of endometrioma. Another pattern has irregular margins with septations and an anechoic appearance. Intravenous pyelograms (IVP) are rarely necessary preoperatively, as ureteral dilation is readily evident at laparoscopic examination. An IVP is ordered postoperatively if abdominal pain persists after surgery on or near the ureter. Presently, there is no indication for CT scan or MRI prior to laparoscopic ovarian surgery.
In all cases careful inspection of the abdomen and pelvis is done. The ovaries are evaluated for visual evidence of malignancy. Washings are taken if indicated. Endometriomas are drained by mobilizing them from the pelvic sidewall.
Enlarged ovaries containing cysts are either free in the peritoneal cavity or attached to the pelvic sidewall, uterosacral ligament, or cul-de-sac. If attached to these structures, the cyst is frequently an endometrioma. An aquadissector is used to mobilize the ovaries by lifting them from the pelvic sidewall. Often this maneuver will result in drainage of chocolate-like hemosiderin filled fluid from the undersurface of the ovary. After this occurs, the ovary is completely mobilized from the pelvic sidewall to its hilum using aquadissection and careful blunt dissection to reduce pelvic sidewall peritoneal damage. If no endometrioma is readily identified, and the patient has “unexplained infertility” or pre- or postmenstrual spotting, a knife electrode connected to monopolar cutting current (70 W) is used to incise and drain areas on the ovary with superficial endometriosis and cysts suspicious for endometrioma. The clinical distinction between an endometrioma (pathology to be excised) and a corpus luteum cyst (normal, vascular tissue best left alone) may be difficult, and conservative discretion is advised to avoid the trauma and risk of removing normal tissue. An endometrioma has a thick white fibrotic capsule while a corpus luteum cyst capsule is yellow.
If an endometrioma is discovered by either of these two methods, the cyst cavity is rinsed with lactated Ringer’s solution and then excised using 5 mm biopsy forceps, grasping forceps, and sometimes scissors (Semm, Mettler 1980)(Reich, McGlynn 1986). Experience has proven that drainage is not enough. Ovarian endometriomas up to 15 cm are excised. The cyst wall is most firmly attached to the ovarian cortex in the area of cyst rupture during mobilization, i.e., the portion that was adhered to the pelvic sidewall or uterosacral ligament, and not to the portion near the ovarian hilum. To help create an initial plane between normal ovarian cortex and endometrioma cyst wall, cutting current (70 W) through a knife electrode tip is applied at the cyst wall-cortex junction to develop a dissection plane in this firmly attached area. This step is particularly useful near the utero-ovarian ligament as rough avulsion can lead to excessive bleeding. The laparoscope is brought close to the area of dissection, magnifying it to identify the cyst wall clearly. This incision is extended through the visible 360o opening if possible. The cutting current will destroy endometriosis at the ovarian cortex-endometrioma junction while making a divot of separation between the two structures. Thereafter, biopsy or grasping forceps are placed to stabilize the ovarian cortex and endometrioma cyst wall while traction is exerted on the endometrioma cyst wall to peel it from inside the ovary. If the cyst wall is felt to be incompletely excised, the cyst cavity can be desiccated or fulgurated to destroy any remaining endometrioma. Otherwise, the endometrioma may recur. Excision can be done with minimal bleeding from the cyst wall bed and the ovarian wall edges usually reapproximate quite well, though occasionally extracorporeal suturing is required, especially after removal of large endometriomas. Hemostasis is checked by underwater examination inside the ovary, and individual bleeders are identified using irrigation through an irrigating channel and coagulated with microbipolar forceps. When removal results in a large, asymmetrical defect, the ovary is suture repaired, usually with one purse-string absorbable suture, applied close to the utero-ovarian ligament in one direction and the infundibulopelvic ligament in the other. Although suturing is not thought to be necessary for reapproximation by many surgeons, anyone who has operated on many of these women realizes that the open ovary is very receptive to small and large bowel; I suspect that those who preach that all ovaries should not be suture repaired are not comfortable with suturing techniques.
In most cases of ovarian endometrioma, endometriosis of the pelvic sidewall and/or uterosacral ligament is present. These lesions should be excised after enucleation of the endometrioma to prevent recurrence. Pelvic sidewall endometriosis peritoneal excision usually requires ureterolysis to free the underlying ureter from the lesion.
Oophorectomy can also be considered for pain or mass arising from ovarian endometrioma in women not desiring future fertility. This is especially indicated for left pelvic pain if the left ovary is enmeshed in rectosigmoid adhesions because they tend to recur.
Before removal, the ovary is released from all pelvic sidewall and bowel adhesions. It is imperative that the surgeon visualize the course of the ureter. The peritoneum above the ureter is opened with sharp scissors. Smooth grasping forceps are then opened parallel and perpendicular to the retroperitoneal structures until the ureter is identified. Scissors can be used to further dissect the ureter throughout its course along the pelvic sidewall.
The uterus is anteverted and displaced to the contralateral side. The fallopian tube is grasped and pulled medially to stretch out the infundibulopelvic ligament containing the ovarian vessels. The anterior and posterior leaves of the broad ligament are opened with scissors lateral and medial to the infundibulopelvic ligament and a free ligature (2-0 Vicryl) passed through the window thus created and tied extracorporeally using the Clarke-Reich knotpusher. This is repeated twice until two proximal ties and one distal one are placed, and the ligament then divided. While applying traction to the cut distal pedicle, the broad ligament is divided to the round ligament just lateral to the uteroovarian artery anastomosis using cutting current through a spoon electrode. Two free ligatures are placed around the uteroovarian ligament, which is then divided.
Alternatively, Kleppinger bipolar forceps are used to compress and desiccate the infundibulopelvic ligament, the broad ligament, the fallopian tube isthmus, and the utero-ovarian ligament with bipolar cutting current (25-35 W). In most cases, 3 contiguous areas are desiccated. Laparoscopic scissors are used to divide the pedicle. (Reich H, 1987)
The free ovary is removed through the umbilicus or cul-de-sac. Large endometriomas are usually sufficiently cystic and pliable that, once separated from the pelvic sidewall, they can be removed through the umbilical incision.
When the ovary is retroperitoneal, embedded in the pelvic sidewall, a lateral approach is advocated. The peritoneum lateral to the ovary and the infundibulopelvic ligament where it crosses the iliac vessels is incised with dissecting scissors and the broad ligament opened by bluntly separating the extraperitoneal areolar tissues. The peritoneal incision is extended to the round ligament, lateral to the infundibulopelvic ligament. The infundibulopelvic ligament is pulled medially with grasping forceps to expose the ureter at the pelvic brim where it crosses the common or external iliac artery. It may be necessary to reflect the ureter off the medial leaf of the broad ligament for a short distance to aid in its identification, although this is not always required. The infundibulopelvic ligament is ligated, divided, and its distal cut end put on traction with traumatic grasping forceps for the rest of the oophorectomy. The medial leaf of the broad ligament with its contained ovary is freed from the pelvic sidewall vessels and areolar tissue. The ureter is peeled off the retroperitoneal ovary for most of its pelvic course until the uteroovarian ligament can be isolated and divided.
--------------------------------------------------------------------------------
References
Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil.Steril. 1990;53:978-983.
Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil.Steril. 1991;55:759-765.
Koninckx PR, Barlow D, Kennedy S. Implantation versus infiltration: The Sampson versus the endometriotic disease theory. GYNECOLOGIC.AND.OBSTETRIC.INVESTIGATION. 1999;47
Martin DC, Hubert G D, Levy B S. Depth of infiltration of endometriosis. Journal of Gynecologic Surgery, 5:55-60, 1989.
Reich H, McGlynn F: Treatment of ovarian endometriomas using laparoscopic surgical techniques. J of Reprod Med 1986;31:577-84.
Reich H, McGlynn F: Laparoscopic oophorectomy and salpingo-oophorectomy in the treatment of benign tuboovarian disease. J Reprod Med 1986; 31:609.
Reich H: Laparoscopic oophorectomy and salpingo-oophorectomy in the treatment of benign tubo-ovarian disease. Int J Fertil 1987; 32:233-236
Reich H: Laparoscopic oophorectomy without ligature or morcellation. Contemp Ob Gyn 1989;9:34-46
Reich H. New techniques in advanced laparoscopic surgery. In Laparoscopic surgery. Sutton C, ed. Bailliere’s Clinical Obstetrics and Gynecology. WB Saunders, Philadelphia London. 1989;3:655-81.
Semm K, Mettler L: Technical progress in pelvic surgery via operative laparoscopy. Am J Obstet Gynecol 1980; 138:121
Thursday, July 28, 2011
Rectal endometriosis causing colonic obstruction and concurrent endometriosis of the appendix: a case report
Introduction Endometriosis is a clinical entity which presents with functioning endometrial tissue at sites outside the uterus. Bowel endometriosis is usually asymptomatic, but it may show non-specific symptoms.
Digital examination revealed an empty rectum and bowel obstruction was diagnosed. Our patient underwent exploratory laparotomy and rectum stenosis (almost complete obstruction) was observed.
The bowel stenosis was resected, and temporary colostomy and appendectomy were performed. The pathology report showed endometriosis of the colon and the appendix, and our patient received medical treatment for endometriosis.
Six months after this operation our patient had another surgery for restoration of large bowel continuity. No endometriosis was found.
Our patient was doing well at the one-year follow up.
Conclusion: Endometriosis of the bowel is a disease that may cause large bowel obstruction. In women of reproductive age, the surgeon should consider endometriosis as a differential diagnosis in case of various gastrointestinal symptoms.
Author: N. KatsikogiannisA. TsarouchaK. DimakisE. SivridisC. Simopoulos
Credits/Source: Journal of Medical Case Reports 2011, 5:320Endotimes blogger opinion: Yikes, I would never have an open surgery....if they can't do it laparoscoply then they aint good enough!
Saturday, June 18, 2011
DATA FROM DAISY PETAL STUDY WILL BE PRESENTED IN THREE SESSIONS
SAN DIEGO, June 16, 2011 /PRNewswire/ -- Neurocrine Biosciences, Inc. (NASDAQ: NBIX) today announced that three elagolix presentations have been accepted for the scientific program at 2011 World Congress on Endometriosis, to be held September 4-7, 2011 in Montpellier, France. This important meeting is sponsored by the World Endometriosis Society and occurs every three years, bringing together clinicians and basic scientists from all over the world to share the latest developments in endometriosis.
"We are very pleased to participate in this prestigious scientific event," said Chris O'Brien, MD, Chief Medical Officer at Neurocrine. "This Congress will highlight the marked increase in both the basic science and clinical research related to endometriosis that has occurred in recent years. Endometriosis profoundly impacts the lives of well over one hundred million women worldwide, and global efforts to improve our understanding of the disorder, its symptoms and treatment, are the highlights of this triennial meeting. We are excited to be an integral part of these initiatives and to provide a detailed update on our potential new therapy."
The acceptance of multiple abstracts and datasets from the development program of elagolix for endometriosis at the 2011 World Congress on Endometriosis is as follows:
Data from the recently completed Daisy Petal clinical study of elagolix for the treatment of endometriosis-associated pain will be presented in a speaking session:
•"Elagolix, A Novel Oral GnRH Antagonist, Significantly Reduced Endometriosis-Associated Pelvic Pain: Results For The Placebo-Controlled, Double-Blind Period Of A Randomized Phase 2 Study" on Wednesday, September 7, 2011 at 10:30 am
Data from the recently completed Daisy Petal clinical study of elagolix for the treatment of endometriosis-associated pain will also be presented in two distinct poster sessions:
•"Elagolix, A Novel Oral GnRH Antagonist Improves Quality Of Life In Women With Endometriosis-Associated Pelvic Pain" on Tuesday, September 6, 2011 at 8:00 am
•"Elagolix, A Novel Oral GnRH Antagonist, Maintained Reduction Of Endometriosis-Associated Pelvic Pain During 24 Weeks Of Treatment" on Wednesday, September 7, 2011 at 8:00 am
In addition, data from the extensive work undertaken to improve our understanding of endometriosis symptoms will be presented at the 11th World Congress on Endometriosis in two separate sessions:
•"A Qualitative Evaluation of Disease Severity and Bothersomeness of Symptoms In Patients with Endometriosis" on Tuesday, September 6, 2011 at 8:00 am
•"Perception of Pelvic Pain in Women with Endometriosis: A Focus Group Study" on Wednesday, September 7, 2011 at 11:30 am.
About Neurocrine Biosciences
Neurocrine Biosciences, Inc. is a biopharmaceutical company focused on neurological and endocrine diseases and disorders. Our product candidates address some of the largest pharmaceutical markets in the world, including endometriosis, stress-related disorders, pain, diabetes, insomnia, and other neurological and endocrine-related diseases and disorders. Neurocrine Biosciences, Inc. news releases are available through the Company's website via the internet at http://www.neurocrine.com
In addition to historical facts, this press release may contain forward-looking statements that involve a number of risks and uncertainties. Among the factors that could cause actual results to differ materially from those indicated in the forward-looking statements are risks and uncertainties associated with Neurocrine's business and finances in general, and Company overall. In addition, the Company faces risks and uncertainties with respect to the Company's R & D pipeline including risk that the Company's clinical candidates will not be found to be safe and effective; and the other risks described in the Company's report on Form 10-K for the year ended December 31, 2010 and report on Form 10-Q for the quarter ended March 31, 2011. Neurocrine undertakes no obligation to update the statements contained in this press release after the date hereof.
SOURCE Neurocrine Biosciences, Inc.
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RELATED LINKS
http://www.neurocrine.com
http://www.prnewswire.com/news-releases/neurocrine-biosciences-announces-elagolix-scientific-presentations-at-the-11th-world-congress-on-endometriosis-123989909.html
"We are very pleased to participate in this prestigious scientific event," said Chris O'Brien, MD, Chief Medical Officer at Neurocrine. "This Congress will highlight the marked increase in both the basic science and clinical research related to endometriosis that has occurred in recent years. Endometriosis profoundly impacts the lives of well over one hundred million women worldwide, and global efforts to improve our understanding of the disorder, its symptoms and treatment, are the highlights of this triennial meeting. We are excited to be an integral part of these initiatives and to provide a detailed update on our potential new therapy."
The acceptance of multiple abstracts and datasets from the development program of elagolix for endometriosis at the 2011 World Congress on Endometriosis is as follows:
Data from the recently completed Daisy Petal clinical study of elagolix for the treatment of endometriosis-associated pain will be presented in a speaking session:
•"Elagolix, A Novel Oral GnRH Antagonist, Significantly Reduced Endometriosis-Associated Pelvic Pain: Results For The Placebo-Controlled, Double-Blind Period Of A Randomized Phase 2 Study" on Wednesday, September 7, 2011 at 10:30 am
Data from the recently completed Daisy Petal clinical study of elagolix for the treatment of endometriosis-associated pain will also be presented in two distinct poster sessions:
•"Elagolix, A Novel Oral GnRH Antagonist Improves Quality Of Life In Women With Endometriosis-Associated Pelvic Pain" on Tuesday, September 6, 2011 at 8:00 am
•"Elagolix, A Novel Oral GnRH Antagonist, Maintained Reduction Of Endometriosis-Associated Pelvic Pain During 24 Weeks Of Treatment" on Wednesday, September 7, 2011 at 8:00 am
In addition, data from the extensive work undertaken to improve our understanding of endometriosis symptoms will be presented at the 11th World Congress on Endometriosis in two separate sessions:
•"A Qualitative Evaluation of Disease Severity and Bothersomeness of Symptoms In Patients with Endometriosis" on Tuesday, September 6, 2011 at 8:00 am
•"Perception of Pelvic Pain in Women with Endometriosis: A Focus Group Study" on Wednesday, September 7, 2011 at 11:30 am.
About Neurocrine Biosciences
Neurocrine Biosciences, Inc. is a biopharmaceutical company focused on neurological and endocrine diseases and disorders. Our product candidates address some of the largest pharmaceutical markets in the world, including endometriosis, stress-related disorders, pain, diabetes, insomnia, and other neurological and endocrine-related diseases and disorders. Neurocrine Biosciences, Inc. news releases are available through the Company's website via the internet at http://www.neurocrine.com
In addition to historical facts, this press release may contain forward-looking statements that involve a number of risks and uncertainties. Among the factors that could cause actual results to differ materially from those indicated in the forward-looking statements are risks and uncertainties associated with Neurocrine's business and finances in general, and Company overall. In addition, the Company faces risks and uncertainties with respect to the Company's R & D pipeline including risk that the Company's clinical candidates will not be found to be safe and effective; and the other risks described in the Company's report on Form 10-K for the year ended December 31, 2010 and report on Form 10-Q for the quarter ended March 31, 2011. Neurocrine undertakes no obligation to update the statements contained in this press release after the date hereof.
SOURCE Neurocrine Biosciences, Inc.
Back to top
RELATED LINKS
http://www.neurocrine.com
http://www.prnewswire.com/news-releases/neurocrine-biosciences-announces-elagolix-scientific-presentations-at-the-11th-world-congress-on-endometriosis-123989909.html
Friday, June 03, 2011
Team eyes infrared route to diagnose endometriosis
24 May 2011 | By Andrew Czyzewski
Infrared (IR) spectroscopy could greatly improve the diagnosis of endometriosis, bypassing the need for invasive surgical biopsy, according to a team from from Lancaster University
The team found that tissue from women with the condition carried a distinct IR signature — thus paving the way for routine assessment such as that done for cervical smears.
‘We use spectroscopy as a method of deriving what we call a biochemical cell fingerprint of a tissue sample — and from that we can get an absorption spectrum associated with the functionality of the tissue we’ve looked at,’ project lead Dr Francis Martin of Lancaster told The Engineer.
Read more: http://www.theengineer.co.uk/sectors/medical-and-healthcare/news/team-eyes-infrared-route-to-diagnose-endometriosis/1008781.article#ixzz1OEE8qLKt
Infrared (IR) spectroscopy could greatly improve the diagnosis of endometriosis, bypassing the need for invasive surgical biopsy, according to a team from from Lancaster University
The team found that tissue from women with the condition carried a distinct IR signature — thus paving the way for routine assessment such as that done for cervical smears.
‘We use spectroscopy as a method of deriving what we call a biochemical cell fingerprint of a tissue sample — and from that we can get an absorption spectrum associated with the functionality of the tissue we’ve looked at,’ project lead Dr Francis Martin of Lancaster told The Engineer.
Read more: http://www.theengineer.co.uk/sectors/medical-and-healthcare/news/team-eyes-infrared-route-to-diagnose-endometriosis/1008781.article#ixzz1OEE8qLKt
Sunday, April 24, 2011
Eggsploitation
04-06-11: Award-winning documentary, 'Eggsploitation', was shown at Boston College Law School. Risks of lupron, and the lack of data-tracking of women who undergo egg donation and IVF, were discussed. 'RESOLVE' (the organization that alleges to "educate, advocate, and support the infertile") had in attendance a Board Member who attempted to discredit 'Eggsploitation' as "biased" and 'not representative of the industry'. 'RESOLVE's' Board Member failed to inform the audience of 'RESOLVE's' conflicts of interest: RESOLVE has a history of receiving hundreds of thousands of dollars from the fertility drug manufacturers, fertility clinics, and fertility doctors.
From: http://www.lupronvictimshub.com/
From: http://www.lupronvictimshub.com/
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