David Redwine

The visual appearance of endometriosis is important because every intellectual and therapeutic process begins with a surgeon identifying disease. Inaccurate identification of disease can introduce selection bias at a firstorder level and confound all conclusions, leading to inaccurate concepts of epidemiology, natural history, disease origin and tr...

Intestinal endometriosis is commonly diagnosed in the setting of deeply infiltrating endometriosis. A multidisciplinary team that includes gynaecologists and general surgeons traditionally performs laparoscopic bowel resections for symptomatic patients. Recently, Pereira et al. has published the results of a series of patients who underwent laparos...

Products of at least five specific steroidogenic genes, including steroidogenic acute regulatory protein (StAR), which facilitates the entry of cytosolic cholesterol into the mitochondrion, side chain cleavage P450 enzyme, 3beta-hydroxysteroid-dehydrogenase-2, 17-hydroxylase/17-20-lyase, and aromatase, which catalyzes the final step, are necessary...

Introduction Endometriosis is one of the most common reproductive diseases affecting women of reproductive age. The most common symptoms of endometriosis are pelvic pain and infertility. Less commonly, endometriosis results in cyclic bleeding or pain in a wide variety of locations. An undetermined proportion of patients with endometriosis remain as...

Reduction of medical errors has become a mantra of organized medicine. Consequently, complication rates and their severity are of increasing importance in hospital credentialing, legal liability issues, and financial reimbursement. Procedure-specific credentialing outside of a core is common for most advanced laparoscopic procedures. A significant...

To determine the prevalence of chronic inflammation of the pelvic peritoneum, systemic inflammation and autoimmunity in chronic pelvic pain and to explore the significance of these findings and assess the response to treatment with immune modification. Prospective, observational clinical studies from 2 centers were performed on 3,238 women presenti...

Objective To investigate if a lateral asymmetry exists in the distribution of endometriotic lesions of the sciatic nerve.

Endometriosis can have very subtle visual appearances. All theories of origin imply some early and presumably tiny form of the disease which potentially cannot be detected by the unaided human eye. A review of the literature indicates that with increasing magnification at surgery, virtually all endometriosis can be visualized. Invisible microscopic...

Sampson's theory of reflux menstruation suggests that endometriosis is one form of a condition known as an autotransplant. This study seeks to characterize autotransplants as they are described in the literature and to determine whether endometriosis resembles an autotransplant. Literature review of published studies containing the following types...

Objective: Sampson's theory of reflux menstruation suggests that endometriosis is one form of a condition known as an autotransplant. This study seeks to characterize autotransplants as they are described in the literature and to determine whether endometriosis resembles an autotransplant. Design: Literature review of published studies containing t...

To describe symptoms, surgical diagnosis and treatment, and long-term outcome of patients with symptomatic diaphragmatic endometriosis. Observational follow-up study. American tertiary referral center for the surgical treatment of endometriosis. Eight patients with diaphragmatic endometriosis causing severe or disabling symptoms. Laparoscopic diagn...

Why Sampson's theory is not the origin of endometriosis

To evaluate symptom relief following a laparoscopic technique designed for treatment of complete obliteration of the cul-de-sac associated with endometriosis, with fertility preserved. Preoperative and postoperative questionnaire study of a cohort of patients with complete obliteration of the cul-de-sac undergoing a standardized laparoscopic surgic...

To describe a computerized pelvic mapping system for pelvic and intestinal endometriosis and preliminary insights gained from it with respect to the effects of ovarian disease. Contemporaneous computerized tabulation of pelvic and intestinal sites of biopsy-proved endometriosis. Tertiary referral center for the surgical treatment of endometriosis....

You now have the skeleton of a functional database system. With the help of the documentation that comes with FoxPro, you can add more of your own fields to your main DBF and the dummy DBF, increase the number of fields you edit at one time in the dummy file (remember to increase window sizes accordingly), and add other automatic calculations. If y...

The information in this and the two preceding columns provides only a superficial introduction to database management using FoxPro for the Macintosh. The capabilities of this program are endless because the user can create programs that will examine and display results in any usable format that can be conceived. We cannot possibly begin to explore...

Ovarian remnant syndrome is a rare complication of total abdominal hysterectomy and bilateral salpingo-oophorectomy (BSO). Ovarian enlargement and dense periovarian adhesions are the predisposing factors. Recurrent ovarian remnant syndrome was associated with recurrence of symptomatic endometriosis in a woman who underwent laparoscopic supracervica...

The four field types will allow even a novice to construct a customized data base using FoxPro. Users should become acquainted with your documentation manuals since they carry a lot more detail than can be presented here. Table 1 lists the important fields of my main data base all.dbf. Use it as a reference when creating your own data base. Next is...

To compare three methods of segmental lower colon resection for treatment of symptomatic intestinal endometriosis. Retrospective case study. Private practice patients in a rural community hospital. Patients with nodular, invasive rectosigmoid endometriosis requiring segmental resection and anastomosis for treatment. Laparotomy patients were matched...

Intestinal and urinary tract involvement by endometriosis may be symptomatic, particularly when invasive disease is present. Even in expert hands, complete excision of all invasive disease cannot be accomplished laparoscopically in every case. The practitioner must balance enthusiasm for the advantages of a laparoscopic approach with limitations of...

To compare costs of laparoscopic hysterectomy with those of abdominal and vaginal hysterectomies in a community hospital. Retrospective review. Study cases were controlled for severity of pathology and extent of surgery performed laparoscopically. Charges were corrected for inflation. Rural community hospital, fee for service practice. Women underg...

The cul-de-sac holds special importance in endometriosis treatment. It is the pelvic area most commonly involved by the disease (Table 12.1). Indeed, although Sampson’s original publications in the 1920s made it appear that the ovary was the most commonly involved pelvic site, two decades later he realized that peritoneal disease was more common an...

Laparoscopy has come to dominate the management of endometriosis because it allows easy access to the dependent aspects of the pelvis, where endometriosis is most frequently found, and because it provides magnification, which allows subtle lesions to be detected. Pain management dominates fertility concerns during that portion of adolescence prior...

It has been postulated that laparoscopic electrosurgery may be a less predictable surgical method than lasers and substantial tissue injury may occur unbeknownst to the surgeon. We proposed to evaluate the correlation of histologic injury to visual estimated injury in a porcine model undergoing laparoscopic electrosurgery. A 25 kg female pig underw...

To identify the clinical characteristics and response to surgical treatment of endometriosis-associated pain in castrated women. In a prospective, longitudinal observational study, 75 patients with previous castration had biopsy-proven endometriosis excised surgically. Anatomical characteristics of disease were studied using pelvic mapping and comp...

To determine the accuracy of postoperative recall of preoperative pain, this prospective, longitudinal study was conducted by a general gynecologist in private practice at a referral center. Before excision of endometriosis at laparoscopy or laparotomy and again at 6 to 18 months after surgery, 168 patients completed a 5-point scale assessing 11 sy...

To determine if laparoscopic excision of endometriosis by electrosurgery is more rapid than by sharp dissection, a retrospective comparative study was made of operative times for the two procedures. Median operating times for laparoscopic electro-excision of endometriosis were 26% to 49% faster than excision by sharp dissection. A chi2 analysis of...

In endometriosis patients with obliteration of the cul-de-sac, laparoscopic en block resection of the uterosacral ligaments, posterior cervix, cul-de-sac, and bowel wall efficiently removes invasive disease.

Patients with symptomatic endometriosis of the colon and distal small bowel usually present with crampy abdominal pain, pelvic and rectal pain, constipation, and dyspareunia. Superficial disease can be easily resected laparoscopically with scissors. Deeper lesions require full-thickness resection and closure of the bowel. Occasionally deep, large,...

To determine the long-term outcome after laparoscopic excision of endometriosis. This longitudinal unmatched study evaluated surgical outcome using follow-up questionnaires and evaluation of reoperations with results presented in life table format. Surgery was performed by a private practitioner at a referral center. All 359 patients undergoing lap...

We report a technique for laparoscopic segmental resection of the sigmoid colon. A 30.73-year-old nulligravida complained of pelvic pain, abdominal bloating, intestinal cramping, and painful bowel movements. Examination revealed significant nodularity of the posterior pelvis, so a preoperative bowel prep was given. At laparoscopy, a 5 cm diameter m...

Defined criteria were used to select small samples of visually normal study peritoneum for serial section light microscopy in 45 patients with biopsy-proven endometriosis and 10 patients without endometriosis. A glandular element compatible with possible endometriosis was found in only 1 patient. Visually normal peritoneum does not harbor a high pr...

A 33-year-old woman, para 1001, had pain in the inner right thigh and proximal right leg weakness. At surgery a locally invasive, fibrotic lesion was found encircling the right ureter, right internal iliac vein and obturator nerve. It extended to the periosteum of the ilium. The lesion was dissected successfully without damage to vital structures,...

Visual identification of endometriosis is important, identification of very subtle manifestations of disease has recently received increased attention. Colorless and other subtle manifestations of peritoneal disease can be seen more easily by painting the peritoneal surface with bloody peritoneal fluid.

Of 132 women with endometriosis, almost one-fifth had peritoneal pockets. Two-thirds of the structures had endometriosis either around the rim or inside. Since one-third of the pockets lacked endometriosis and fibrosis was not present as a possible cause, endometriosis does not seem to have been the likely primary cause. Rather, such peritoneal inv...

A 31-year-old nulligravid woman had had two previous laparoscopies for endometriosis. Disease of the right broad ligament was treated by electrocoagulation at the first surgery, but pain persisted despite postoperative danazol therapy. At her second laparoscopy, a large defect of the right broad ligament was noted, but not treated. At her third ope...

This study fails to uphold the concept of invisible, microscopic endometriosis. Peritoneum devoid of disease exists, can be described, and can be consistently found.

Endometriosis presents a large variety of color manifestations, most nonblack, and many easily missed unless meticulous inspection is used to identify small or nonhemorrhagic lesions. An evolution in appearance with age may occur, with resultant spurious effects on conclusions regarding the natural history of the disease. This study confirms and ex...

The histogenesis of endometriosis remains controversial. It is thought that no one theory can explain all cases. Because of new basic knowledge, we must continuously scrutinize conventional wisdom related to the disease. Modern studies and reinterpretation of historic evidence lead inevitably to a single model of the origin of endometriosis that is...

In this series of patients, endometriosis does not involve more pelvic areas in older age groups. Exposure to pregnancy is associated with slightly less pelvic involvement, although this effect is inconstant when age groups are studied individually.

To the Editor.— I would appreciate it if Cramer et al1 could clarify some points regarding the methodology and conclusions of their case-control study on endometriosis. The first question concerns their use of infertility as the main symptom to select cases, since pain may actually be a more common symptom.2 Second, since cases were older than con...

The data indicated that young women who weigh less than 115 lb and who lose more than 10 lb after they start running are most likely to develop menstrual irregularity and amenorrhea. Thirty-three percent of women who lost more than 10 lb while running developed secondary amenorrhea. There was no apparent correlation with the number of miles run per...

Tumors metastatic to the heart are not rare, but complete heart block due to heart metastasis is. There have only been 16 cases of complete atrioventricular block due to solid tumors metastasizing to the heart reported thus far. In addition, there are several other reports of complete heart block due to leukemic infiltrates as well as reports of le...