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Endometriosis: Ancient disease, ancient treatments
... Thanks to the works of Knapp and that of Nezhat, the phases in the discovery and characterization of endometriosis in the history of medicine are now very well-defined (14,15). Although the symptoms of the disease are described from over 2000 years ago, it is only in the last century that the pathology has been clearly defined. ...
... This pathogenetic mechanism was proposed by pioneer researchers of this disease in the late 19th and 20th century, but mysteriously forgotten after the affirmation of Sampson's retrograde menstruation theory (14,15). Further supporting the theory of the fetal origin is the observation that in adolescent patients, the cells of the endometriosis structures preserve some distinctive characteristics of fetal endometrium cells, such as ontogenic resistance to progesterone (40). ...
Endometriosis is a gynecological disease characterized by the growth of endometrial glands and stroma outside the uterine cavity. The incidence of the disease is very high, there are currently no reliable early diagnostic tests, the therapies are only symptomatic and, consequently, the social impact of endometriosis is very important, also considering the related fertility problems. Despite this, the pathogenesis of endometriosis is still not fully defined. Retrograde menstruation and coelomic metaplasia are currently the most recognized pathogenetic hypotheses. Recent experimental evidences generated by our research group and by others have indicated an alteration of the fine-tuning of the female genital system developmental program during a critical window of time in the fetal life as the pathogenetic event prompting to the development of endometriosis later in life. Goal of this article is to present a revision of the recent literature about the different pathogenetic mechanisms proposed for endometriosis with particular emphasis on the embryologic theory. The possible clinical and pathological implications of these findings will be discussed.
... With the discovery of video -assisted Laparoscopy by Dr Nezhat C, has modelled minimally invasive surgery with/ without any robotic aid in the form of standard of care amongst different surgical branches inclusive of Gynaecological oncology [5] . The initial video -assisted Laparoscopyic radical hysterectomy with paraaortic and pelvic node dissection was conducted by the team of Nezhats in 1989 [6] . ...
Abstract
Having reviewed earlier the significance of fertility preservation in cancer survivors in the context of ovarian tumors management with those in particular who receive alkylating agents,like Cyclophosphamide chemotherapy here we further emphasize on collaboration amongst the treating reproductive endocrinologist in addition to Gynaecological oncologists.Here we discuss the reproductive and oncological results following fertility sparing surgery for early stage cervical cancer [ESCC] (specifically stage IA1 -1B1) which was inclusive of cold knife conisation/simple trachelectomy, laparoscopic radical trachelectomy with/ without Robotic assistance as reviewed by Nezhat etal.for the first time ina systematic review with highlighting the role of fertility sparing surgery in early stage cervical cancer with a correlation of the fertility outcomes including clinical pregnancies rates,spontaneous/by assisted reproductive technology(ART),rather than the earlier canonical gold standard therapy for of inclusive of total hysterectomy, radical hysterectomy with/ without lymph node removal radical hysterectomyeven for ESCC.He initially started Laparoscopic strategy&finally cold knife conisation/simple trachelectomy. Further the incidence of preterm birthswasfound to be higher.Here we further updated on the future work by others workers keeping that study as a reference with role of conization , radical trachelectomy by abdominal vaginal trachelectomyor simple conisation.For preterm birth it has been confirmed that the cone dimensions make a big difference with regards to preterm delivery with cervix <10mm at greater risk ,however role of iatrogenic pretermdelivery with obstetricians performing elective LSCS with removal of cerclage.Furthermore certain HPV phenotypes might be associated with greater recurrence rates.Thus multiInstitutonal, Interdisciplinary team work is needed amongst, various specialities toobtain maximum outcomes with most experienced Gynaecological oncologists having high volume of work for most effective trachelectomy with avoidance of spillage,proper margins tumor free left back.However shifting from the gold standard radical hysterectomy to more fertility sparing surgery in early stage cervical cancer needs to be highlighted with referral in expert hands will pave a way towards fertility in young cervical cancer patients.
Key Words; early stage cervical Cancer; fertility sparing surgery; future fertility; Obstetric outcomes.
... Endometriosis is a disease that can affect all women of reproductive age, regardless of race, ethnicity, or socioeconomic status [1,2]. The literature defines endometriosis as the presence of the tissues of the endometrial lining outside the uterus inflaming areas of the body such as the ovaries, pelvis, abdominal cavity, and even the thorax and skin [2][3][4][5]. The disease imposes both clinical and economic burdens and concerns individuals and society. ...
Background: Endometriosis is a chronic and incurable gynecological disease that mainly affects women of reproductive age worldwide. It imposes clinical and economic burdens on patients, families, and society. A better understanding of the determinants of preferences towards early diagnosis of endometriosis may help develop programs and interventions to reduce the risk of more severe illness. We quantified patient preferences for early endometriosis diagnosis and explored whether preferences vary on the patient characteristics and pre-established social determinants of health. Methods: A discrete choice experiment (DCE) was designed to elicit women's preferences and willingness to pay for early diagnosis of endometriosis. Women ages 18 and older were eligible to participate in the study. The attributes (and levels) considered to describe hypothetical scenarios included diagnosis (immediate/postponed), the chance of advanced endometriosis and more severe illness (low/ high), time away from living, and professional activities (8 days, 15 days, 22 days and 30 days), and possible out-of pocket costs (0, 15, 210). The effects of participants' characteristics and social determinants of health on the preference for early diagnosis were modeled using a Tobit model. Results: A total of 66 women with (2) or at-risk (64) of endometriosis completed the experiment. The respondents' age and insurance statuses significantly influenced their preference or choice for early diagnosis. On average, respondents were willing to give up $61.55 out-of-pocket cost to have a low risk of advanced endometriosis and more severe disease. The Tobit model indicates only age and insurance variables significantly affected early diagnosis preference. The results suggest that older ages and not having insurance increase the likelihood of respondents choosing early diagnosis than the younger age group and having insurance. Conclusions: This study indicates the importance of considering the patient characteristics and social determinants of health when designing and implementing health programs and interventions for endometriosis.
... 19). In traditional Chinese medicine, they are prescribed in the treatment of gynaecological disorders and male impotence (Rehman et al. 2013), a clinical study suggesting that antler velvet products may "produce anti-inflammatory compounds that assist in the regulation of prostaglandins" (Rehman et al. 2013, p. 90;Nezhat et al. 2012). It has been proposed that the deer's close bond with Artemis-often identified with Eileithyia-explains its relevance in the Hippocratic treatment of uterine disorders (Von Staden 2008, p. 186). ...
The Minoan peak sanctuaries call for systematic comparative research as an island-bound phenomenon whose significance to the (pre)history of medicine far transcends the Cretan context: they yield clay anatomical offerings attesting to the earliest known healing cult in the Aegean. The peak sanctuary of Petsophas produced figurines of weasels, which are usually interpreted as pests, ignoring their association with votives that express concerns about childbirth, traditionally the first single cause of death for women. The paper draws from primary sources to examine the weasel’s puzzling bond with birth and midwives, concluding that it stems from the animal’s pharmacological role in ancient obstetrics. This novel interpretation then steers the analysis of archaeological evidence for rituals involving mustelids beyond and within Bronze Age Crete, revealing the existence of a midwifery koine across the Near East and the Mediterranean, a net of interconnections relevant to female therapeutics which brings to light a package of animals and plants bespeaking of a Minoan healing tradition likely linked to the cult of the midwife goddess Eileithyia. Challenging mainstream accounts of the beginnings of Western medicine as a male accomplishment, this overlooked midwifery tradition characterises Minoan Crete as a unique crucible of healing knowledge, ideas, and practices.
... Endometriosis is a gynecological disease first identified in 1860, following the microscopic findings of the Austrian pathologist Karl von Rokitansky, characterized by the presence of endometrial stroma and dysfunctional glands of the endometrial type, often accompanied by reactive fibrosis and muscle metaplasia outside the cavity 1,2 . ...
Endometriosis is a gynecological pathology with chronic symptoms, which negatively affects the patient’s quality of life. The prevalence of endometriosis in asymptomatic women is between 2% and 50%, depending on the populations studied and the method of diagnosis. The severity of the symptoms as well as the probability of diagnosing endometriosis increases with age9. Because endometriosis is a gynecological condition with a nonspecific clinical picture, sometimes even asymptomatic, imaging technology can be considered the first line of diagnosis for this pathology. The main objective of this study is to evaluate the sensitivity and specificity of nuclear magnetic resonance imaging (MRI) used in the diagnosis of endometriotic lesions depending on their location, and compare the results obtained with the intraoperative appearance considered a reference standard in the diagnosis of endometriosis. Our study revealed the highest specificity for MRI in the case of endometriotic bladder invasion, respectively the highest sensitivity for endometriotic rectal nodules.
Endometriosis is an enigmatic disease whose diagnosis and management are being transformed through innovative surgical, molecular, and computational technologies. Integrating single-cell and other omic disease data with clinical and surgical metadata can identify multiple disease subtypes with translation to novel diagnostics and therapeutics. Herein, we present real-world perspectives on endometriosis and the importance of multidisciplinary collaboration in informing molecular, epidemiologic, and cell-specific data in the clinical and surgical contexts.
Bowel endometriosis is a complex condition predominantly impacting women in their reproductive years, which may lead to chronic pain, gastrointestinal symptoms, and infertility. This review highlights current approaches to the diagnosis and management of bowel endometriosis, emphasizing a multidisciplinary strategy. Diagnostic methods include detailed patient history, physical examination, and imaging techniques like transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), which aid in preoperative planning. Management options range from hormonal therapies for symptom relief to minimally invasive surgical techniques. Surgical interventions, categorized as shaving excision, disc excision, or segmental resection, depend on factors such as lesion size, location, and depth. Shaving excision is preferred for its minimal invasiveness and lower complication rates, while segmental resection is reserved for severe cases. This review also explores nerve-sparing strategies to reduce surgical morbidity, particularly for deep infiltrative cases close to the rectal bulb, anal verge, and rectosigmoid colon. A structured, evidence-based approach is recommended, prioritizing conservative surgery to avoid complications and preserve fertility as much as possible. Comprehensive management of bowel endometriosis requires expertise from both gynecologic and gastrointestinal specialists, aiming to improve patient outcomes while minimizing long-term morbidity.
Background: Endometriosis is a systemic, inflammatory, estrogen-dependent condition characterized by endometrial stroma and gland-like lesions outside of the uterus. It causes a range of symptoms, notably chronic pelvic pain, infertility and organ dysfunction. Thoracic endometriosis syndrome (TES) has been described as endometriosis that is found in the lung parenchyma, pleura and diaphragm. It may be asymptomatic or present with symptoms of catamenial pneumothorax, hemothorax, hemoptysis, isolated chest pain, shoulder pain or findings of lung nodules. Aim: The aim of this review is to provide a comprehensive overview of thoracic endometriosis syndrome (TES), including its clinical presentation, diagnostic challenges, and current management strategies. This review aims to highlight the importance of a multidisciplinary approach in the treatment of TES, emphasizing conservative management and the role of minimally invasive surgical techniques for refractory cases. Conclusions: Thoracic endometriosis syndrome appears to be a marker of severe endometriosis. As much as possible, the patient with TES is managed conservatively, with surgery reserved for refractory cases. When surgery is recommended, the procedure is conducted through a multidisciplinary minimally invasive approach, with video-assisted thoracoscopic surgery (VATS) and video-assisted laparoscopy. Meticulous intraoperative survey, the removal of endometriosis implants with and without robotic assistance and post-operative hormonal therapy may be recommended to prevent recurrence.
Endometriosis is a chronic, progressive inflammatory disease that occurs in approximately 10% of women of reproductive age, resulting in a decreased quality of life due to dysmenorrhea, chronic pain, and other problems. The primary treatment is pain control and fertility preservation, and while preserving ovarian function through drug therapy and surgery, assisted reproductive technology (ART), including in vitro fertilization (IVF), is also utilized. Hormonal therapies such as low-dose estrogen/progestin (LEP), progestins, and GnRH analogs are often the drug of choice. We presented that IAP (inhibitor of apoptotic protein) inhibitors can potentially be novel agents for treating endometriosis. Our studies using cultured cells derived from human endometriotic lesions and mouse models have revealed that inflammatory cytokines and antiapoptotic factors (IAPs) produced by peritoneal macrophages or endometriosis cells are crucial and that NF-κB (nuclear factor-kappa B) plays a central role in the pathogenesis of endometriosis. The high expression of IAPs in human endometriotic tissues, its facilitative role in ectopic survival, and the effect of IAPs on drug-resistant apoptosis of human endometriotic cells indicate its potential as a novel drug for IAP inhibitors. We found that the medicinal herb parthenolide and selective estrogen receptor modulators (SERM) can reduce lesions through NF-κB inhibition. Recently, new findings were obtained by non-invasive observation of early lesions using bioluminescence technology and by applying knockout mouse models. We will show the possibility of new therapeutic agents for endometriosis.
Background
Endometriosis is a common gynecological disease affecting women of reproductive age. Patients with endometriosis frequently experience severe chronic pain and have higher chances to experience infertility. Progesterone resistance is a major problem that develops during the medical treatment of endometriosis, which often leads to treatment failure of hormonal therapies. Previous studies indicated that the dysregulation of progesterone receptors (PR) is the primary factor leading to progesterone resistance in endometriosis.
Methods
This review article systematically reviewed and summarized findings extracted from previously published papers available on PubMed, encompassing both experimental studies and clinical trials.
Main findings
Various determinants influencing PR expression in endometriosis have been identified, including the environmental toxins, microRNAs, cell signaling pathways, genetic mutations, and the pro‐inflammatory cytokines. The selective estrogen/progesterone receptor modulators have emerged as novel therapeutic approaches for treating endometriosis, offering potential improvements in overcoming progesterone resistance.
Conclusion
Concerns and limitations persist despite the newly developed drugs. Therefore, studies on unraveling new therapeutic targets based on the molecular mechanisms of progesterone resistance is warranted for the development potential alternatives to overcome hormonal treatment failure in endometriosis.
Adenomyosis refers to the presence of endometrial stroma and glands within the myometrium, whereas the ectopic location of endometrium outside the uterus identifies the condition of endometriosis. Both benign and gynecological conditions originate from a menstruation-related dysfunction, and they are typically observed in reproductive age women. Common pathogenetic mechanisms, shared risk factor profile, and their frequent coexistence support their similarities, despite each disease has its own features. Dysmenorrhea, dyspareunia, pelvic pain, and infertility resulting from relative hyperestrogenism, progesterone resistance, and inflammation are frequently observed in both diseases. Conversely, abnormal uterine bleeding (AUB) and heavy menstrual bleeding (HMB) are mostly associated with adenomyosis, and resulting iron deficiency anemia is commonly reported. Endometriosis, instead, is a disease often accompanied by systemic comorbidities, along with a chronic pain syndrome. However, common pathogenetic mechanisms and factors support the use of similar hormonal treatment approaches.
Ovarian endometriomas affect many patients with endometriosis and have significant effects on quality of life, fertility, and risk of malignancy. Endometriomas range from small (1–3 cm), densely fibrotic cysts to large (20 cm or greater) cysts with varying degrees of fibrosis. Endometriomas are hypothesized to form from endometriotic invasion or metaplasia of functional cysts or alternatively from ovarian surface endometriosis that bleeds into the ovarian cortex. Different mechanisms of endometrioma formation may help explain the phenotypic variability observed among endometriomas. Laparoscopic surgery is the preferred first-line modality of diagnosis and treatment of endometriomas. Ovarian cystectomy is preferred over cyst ablation or sclerotherapy for enabling pathologic diagnosis, improving symptoms, preventing recurrence, and optimizing fertility outcomes. Cystectomy for small, densely adherent endometriomas is made challenging by dense fibrosis of the cyst capsule obliterating the plane with normal ovarian cortex, whereas cystectomy for large endometriomas can carry unique challenges as a result of adhesions between the cyst and pelvic structures. Preoperative and postoperative hormonal suppression can improve operative outcomes and decrease the risk of endometrioma recurrence. Whether the optimal management, fertility consequences, and malignant potential of endometriomas vary on the basis of size and phenotype remains to be fully explored.
Endometriosis is a debilitating gynecologic disorder characterized by chronic pelvic pain, pelvic adhesions and infertility. The gold standard diagnostic modality is histologically by tissue biopsy, although it can be diagnosed empirically if symptoms improve with medical treatment. A delayed diagnosis of endometriosis often leads to a significant impairment in quality of life and work productivity; hence, significant morbidity has been shown to bear a detrimental impact on society and the economy. The ongoing novel investigation into biomarkers for diagnostic or prognostic evaluation of endometriosis may aid in earlier detection, and thereby, improve patient quality-of-life as well as minimize morbidity. Currently, no single biomarker has been validated for endometriosis; however, there are emerging data on the utility of microRNA for diagnosis and prognosis of disease activity. In this brief review, we will identify and categorize the novel biomarkers for endometriosis.
Background
Endometriosis frequently results in pain and infertility. While conservative surgery offers some relief, it often falls short of ensuring satisfactory pregnancy outcomes. Adjuvant GnRH-a is administered post-surgery to mitigate recurrence; however, its impact on pregnancy outcomes remains debated. This study endeavors to assess the efficacy of adjuvant GnRH-a in enhancing pregnancy outcomes post-conservative surgery in endometriosis patients.
Methods
Databases including PubMed, Embase, the Cochrane Library, Medline (Ovid), Web of Science, and Scopus were rigorously searched up to 02 August 2023, without linguistic constraints. Identified articles were screened using strict inclusion and exclusion criteria. Evaluated outcomes encompassed pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, multiple pregnancy rate, mean postoperative pregnancy interval, recurrence rate, and adverse reaction rate. The Cochrane risk of bias tool and the Jadad score evaluated the included studies’ quality. Subgroup and sensitivity analysis were implemented to analyze the pooled results. A meta-analysis model expressed results as standardized mean difference (SMD) and Risk ratio (RR).
Results
A total of 17 studies about 2485 patients were assimilated. Meta-analysis revealed that post-surgery, the GnRH-a cohort experienced a marginally elevated pregnancy rate (RR = 1.20, 95% CI = 1.02–1.41; P = 0.03) and a reduced mean time to conceive (RR = -1.17, 95% CI = -1.70- -0.64; P < 0.0001). Contrarily, other evaluated outcomes did not exhibit notable statistical differences.
Conclusions
Incorporating adjuvant GnRH-a following conservative surgery may be deemed beneficial for women with endometriosis, especially before Assisted Reproductive Technology (ART). Nonetheless, owing to pronounced heterogeneity, subsequent research is warranted to substantiate these potential advantages conclusively.
Registration number
CRD42023448280.
Endometriosis is one of the most common gynecologic diseases. Women with endometriosis display with subfertility per se. Inflammatory reactions in the pelvis and endometriomas/endometriotic cysts damage the ovaries and reduce the quality of egg cells. Miscarriage rates are elevated. Precision surgery and assisted reproductive techniques (ART; in vitro fertilization/intracytoplasmic sperm injection [IVF/ICSI]) are the predominant therapeutic strategies to improve the chance of conceiving. By better understanding the pathophysiology of endometriosis, less invasive medical treatment options are to be expected in the future.
Endometriosis is a common, underdiagnosed, systemic inflammatory, and endocrine pain disorder that impacts the quality of life of millions of persons with a uterus globally. It is associated with chronic pelvic pain and an increased risk of subfertility. It has also been associated with cardiovascular disease, depression, thyroid and autoimmune disorders, ovarian and breast cancers, and poor pregnancy outcomes. Treatment of endometriosis-related pain and infertility can be medical and/or surgical, although misdiagnosis due to symptoms that overlap with other conditions and reliance on definitive diagnosis by histologic confirmation of endometriosis at surgery have contributed to a prolonged diagnosis-to-treatment timeline. A paradigm shift in endometriosis diagnosis is underway, with greater reliance on clinical and family history, physical examination, and imaging, without surgical confirmation, and then proceeding with medical and/or surgical therapies, although any one diagnostic approach alone is insufficient. Although there are no validated, specific molecular biomarkers for endometriosis, recent candidates have promise for diagnosing the disease and facilitating symptom management. This review presents current and evolving approaches to diagnose endometriosis with the goal of expediting the diagnosis-to-treatment timeframe, so patients can have confidence in a diagnosis for their symptoms, expectations set about disease management across the lifespan, and a patient-centered treatment plan promptly initiated. To provide context, the review begins with a summary of disease characteristics, followed by genetic and environmental risks for developing endometriosis, the central role of estrogen and inflammation in the pathophysiology of pain and infertility relevant to the disease and biomarker discovery, and nonsurgical approaches that are increasingly being acknowledged by professional organizations across the globe to be of value in the diagnosis of this enigmatic disease with diverse manifestations.
Endometriosis, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.
Endometriosis is a challenging gynecological disorder that causes pelvic pain and infertility attributed to the prevalence of ectopic endometrial tissue outside the uterine tract. Based on the patient’s histology findings, it is typically identified by pathological lesions, endometritis, pyometra, and glandular cystic hyperplasia. Traditional medicines are thought to be the most reliable sources for the discovery of novel pharmaceuticals, notwithstanding recent developments in computational and chemical techniques. Endometriosis and other gynecological illnesses have been tested against a variety of therapeutic herbs and chemicals derived from plants. In healthcare areas with few resources, traditional medicine is still seen as the main treatment option, regardless of recent scientific progress and globalization. Plant-derived compounds were once thought to be a key source of modern medications and play a crucial biological role against some pathogenic organisms. Ever since the dawn of humanity, an increasing number of plants have been utilized as remedies. In communities all across the world, traditional medicine has been an essential resource for health for centuries, and it is still a cornerstone for some people who have unequal access to mainstream treatment, according to research conducted by the World Health Organization (WHO). This book chapter presents the activity profile of medicinal plants and their active components while highlighting the development of multitargeted endometriosis medicinal compounds.
Endometriosis is a prevalent condition that affects millions of individuals globally, leading to various symptoms and significant disruptions to their quality of life. However, the diagnosis of endometriosis often encounters delays, emphasizing the pressing need for non-invasive screening. This retrospective cross-sectional study aimed to evaluate the utility of the Endometriosis Risk Advisor (EndoRA) mobile application in screening for endometriosis in patients with chronic pelvic pain and/or unexplained infertility. The study consisted of 293 patients who met specific criteria: they were English-speaking individuals with chronic pelvic pain and/or unexplained infertility, owned smartphones, and had no prior diagnosis of endometriosis. The results demonstrated that the EndoRA score exhibited a high sensitivity of 93.1% but a low specificity of 5.9% in detecting endometriosis. The positive predictive value was 94.1%, while the negative predictive value was 5.0%. Although the study had limitations and potential selection bias, its findings suggest that EndoRA can serve as a valuable screening tool for high-risk individuals, enabling them to identify themselves as being at an increased risk for endometriosis. EndoRA’s non-invasive nature, free access, and easy accessibility have the potential to streamline evaluation and treatment processes, thereby empowering individuals to seek timely care and ultimately improving patient outcomes and overall well-being.
For years, reproductive surgery was the mainstay of reproductive care. As the evolution and ultimate success of in vitro fertilization (IVF) took hold, reproductive surgery became an adjuvant therapy, indicated mainly for severe symptoms or to enhance success rates with assisted reproductive technologies. As success rates for IVF have plateaued, and emerging data rekindles the enormous benefits of surgically correcting reproductive pathologiesthere is renewed interest amongst reproductive surgeons, in reviving research and surgical expertise in this area. In addition, new instrumentation and surgical techniques to preserve fertility have gained traction and will solidify the need to have skilled REI surgeons in our practice.
This study explores how endometriosis has been represented and framed historically in the Australian press. Analysis of 80 articles published between 1949 and 2011 was conducted. Articles were examined for their framing, themes, and voices in a decade-by-decade format. Results found that endometriosis was overwhelmingly framed as a comorbidity to infertility during this timeframe, and experts were commonly sourced compared to patients with the disease. Medical treatments for the disease were also published heavily. Little focus was put on endometriosis as a standalone medical issue until the 1980s. The ways in which this disease is presented in the media may have an impact on general knowledge and understanding of endometriosis, both for patients and the wider public.
In this review, we aim to evaluate the current literature on reproductive and oncologic outcomes after fertility-sparing surgery for early-stage cervical cancer (stage IA1-IB1). This is a systematic review of the existing literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist to report on fertility-sparing surgery and its outcomes in early-stage cervical cancer. Outcomes of interest were subsequent clinical pregnancy rate, reproductive outcomes, and cancer recurrence outcomes. Included in this systematic review were 68 studies encompassing 3,592 patients who underwent fertility-sparing surgery. Of these, reproductive outcomes were reported in 1096 pregnancies. The mean clinical pregnancy rate was 53.2%. Those who underwent vaginal radical trachelectomy had the highest clinical pregnancy rate (67.5%). The mean live birth rate was 67.8% in our study. Twenty-one percent of pregnancies after fertility-sparing surgery required assisted reproductive technology. The mean cancer recurrence rate was 3.2%, and the cancer death rate was 0.6% after a median follow-up period of 40.1 months with no statistically significant difference across surgical approaches. Offering fertility-sparing surgery in early-stage cervical cancer is reasonable. Highest clinical pregnancy rate is associated with vaginal radical trachelectomy. Moreover oncologic outcomes of minimally invasive approaches were comparable with abdominal approaches. We encourage detailed preoperative counseling and multidisciplinary approach to achieve best outcomes.
Despite the clinically recognized association between endometriosis and infertility, the mechanisms implicated in endometriosis-associated infertility are not fully understood. Endometriosis is a multifactorial and systemic disease that has pleiotropic direct and indirect effects on reproduction. A complex interaction between endometriosis subtype, pain, inflammation, altered pelvic anatomy, adhesions, disrupted ovarian reserve/function, and compromised endometrial receptivity as well as systemic effects of the disease define endometriosis-associated infertility. The population of infertile women with endometriosis is heterogeneous, and diverse patients’ phenotypes can be observed in the clinical setting, thus making difficult to establish a precise diagnosis and a single mechanism of endometriosis related infertility. Moreover, clinical management of infertility associated with endometriosis can be challenging due to this heterogeneity. Innovative non-invasive diagnostic tools are on the horizon that may allow us to target the specific dysfunctional alteration in the reproduction process. Currently the treatment should be individualized according to the clinical situation and to the suspected level of impairment. Here we review the etiology of endometriosis related infertility as well as current treatment options, including the roles of surgery and assisted reproductive technologies.
There is not a single true history of endometriosis because historians differ in how they process and synthesize past events. However, a history of endometriosis is distinct from that of symptoms such as pain or infertility which have multiple causes. Crucially, a history should focus on endometriosis as defined by its characteristic histological features. The origin of “mucosal invasions of peritoneal organs” was debated for a few decades under the collective term “adenomyoma.” Consensus was reached around the 1920s on the endometrial origin of the mucosa, yet ovarian endometriomas were considered separate. In the mid-1920s O Frankl and J Sampson distinguished adenomyosis from endometriosis. Sampson drew the link between peritoneal and ovarian lesions and related them to menstrual dissemination of endometrial tissue into the peritoneal cavity. Several phenotypes of endometriosis are currently recognized. Retrograde menstruation remains central to the most widely accepted of the many hypotheses proposed to explain its pathogenesis.
Endometriosis is an inflammatory chronic pain condition caused by uterine tissue growing outside of the uterus that afflicts at least 11% of women (and people assigned female at birth) worldwide. This condition results in a substantial burden to these women, and society at large. Although endometriosis was first identified over 160 years ago, substantial knowledge gaps remain, including confirmation of the disease's etiology. Research funding for endometriosis is limited, with funding from bodies like the National Institutes of Health (NIH) constituting only 0.038% of the 2022 health budget—for a condition that affects 6.5 million women in the US alone and over 190 million worldwide. A major issue is that diagnosis of endometriosis is frequently delayed because surgery is required to histologically confirm the diagnosis. This delay increases symptom intensity, the risk of central and peripheral sensitization and the costs of the disease for the patient and their nation. Current conservative treatments of presumed endometriosis are pain management and birth control. Both of these methods are flawed and can be entirely ineffective for the reduction of patient suffering or improving ability to work, and neither addresses the severe infertility issues or higher risk of certain cancers. Endometriosis research deserves the funding and attention that befits a disease with its substantial prevalence, effects, and economic costs. This funding could improve patient outcomes by introducing less invasive and more timely methods for diagnosis and treatment, including options such as novel biomarkers, nanomedicine, and microbiome alterations.
Endometriosis is a common chronic gynaecological disease causing various symptoms, such as infertility and chronic pain. The gold standard for its diagnosis is still laparoscopy and the biopsy of endometriotic lesions. Here, we aimed to compare the eutopic endometrium from women with or without endometriosis to identify proteins that may be considered as potential biomarker candidates. Eutopic endometrium was collected from patients with endometriosis (n = 4) and women without endometriosis (n = 5) during a laparoscopy surgery during the mid-secretory phase of their menstrual cycle. Total proteins from tissues were extracted and digested before LC-MS-MS analysis. Among the 5301 proteins identified, 543 were differentially expressed and enriched in two specific KEGG pathways: focal adhesion and PI3K/AKT signaling. Integration of our data with a large-scale proteomics dataset allowed us to highlight 11 proteins that share the same trend of dysregulation in eutopic endometrium, regardless of the phase of the menstrual cycle. Our results constitute the first step towards the identification of potential promising endometrial diagnostic biomarkers. They provide new insights into the mechanisms underlying endometriosis and its etiology. Our results await further confirmation on a larger sample cohort.
Endometriosis is a prevalent gynecologic condition associated with pelvic pain and infertility characterized by the implantation and growth of endometrial tissue displaced into the pelvis via retrograde menstruation. The mouse is a molecularly well-annotated and cost-efficient species for modeling human disease in the therapeutic discovery pipeline. However, as a non-menstrual species with a closed tubo-ovarian junction, the mouse poses inherent challenges as a preclinical model for endometriosis research. Over the past three decades, numerous murine models of endometriosis have been described with varying degrees of fidelity in recapitulating the essential pathophysiologic features of the human disease. We conducted a search of the peer-reviewed literature to identify publications describing preclinical research using a murine model of endometriosis. Each model was reviewed according to a panel of ideal model parameters founded on the current understanding of endometriosis pathophysiology. Evaluated parameters included method of transplantation, cycle phase and type of tissue transplanted, recipient immune/ovarian status, iterative schedule of transplantation, and option for longitudinal lesion assessment. Though challenges remain, more recent models have incorporated innovative technical approaches such as in vivo fluorescence imaging and novel hormonal preparations to overcome the unique challenges posed by murine anatomy and physiology. These models offer significant advantages in lesion development and readout toward a high-fidelity mouse model for translational research in endometriosis.
Even if laparoscopy is awarded the status of a gold standard in the diagnosis of involuntary childlessness, assisted reproductive techniques (ART) have initiated a paradigm shift and many steps in the fertilization process are technically assisted. The question arises as to what evidence exists for the use of laparoscopy for the various causes of sterility. It is laparoscopy that keeps the proportion of so-called unexplained sterility low and that can be immediately expanded to include a surgical intervention. In the case of tubal pathology, laparoscopic salpingo-ovariolysis with preserved tubal patency leads to results that are superior to ART. Among the Fédération internationale de gynécologie et dʼobstétrique (FIGO) myoma types 0, 1, 2, 2–5, 3, 4, 5, 6, the myomas adjacent to the cavity of the uterus develop the highest fertility-blocking effects, which must also be assumed for the myoma types 3, 4, 5, 6, although the cavity is not distorted. Myoma types 0, 1, 2 are a domain of hysteroscopic surgical techniques, all others myomas can successfully be operated on laparoscopically as long as there is a sufficiently high plane between the optical trocar and the object for the insertion of the working trocars. For the various phenotypes of endometriosis, priority is given to laparoscopic intervention in cases of treatment-resistant pain. In particular, stenosing processes in the urinary tract and the intestines are indications for laparoscopy. In cases of hydrosalpinx, a benefit is ensured by laparoscopic salpingectomy before in vitro fertilization (IVF). There are subgroups of endometriosis that benefit from the principle of surgery first before ART.
Endometriosis is a pathology described since the 19th century that affects women in reproductive age. It is characterized as the presence of endometrial glandular or stromal cells outside the endometrial cavity, provoking a pathologic inflammatory response. The pathogenesis still remains uncertain. Endometriosis is a complex disease with heterogeneous phenotypic and clinical presentations. Until now, there are no noninvasive tests to make a diagnosis of endometriosis, and the gold standard is surgery, in which in addition to the procedure it is possible to treat, with risks inherent to the procedure. This chapter covers many biomarkers that have already been researched in an attempt to obtain a test with high sensitivity and specificity for noninvasive diagnosis of endometriosis.
Aims
Copper (Cu) is involved in the endometriosis progression. Herein, an experimental endometriosis model was used to evaluate whether its chelation with ammonium tetrathiomolybdate (TM) affects the proliferation and angiogenesis in endometriotic-like lesions and the participation of oxidative stress in these processes.
Main methods
Female C57BL/6 mice were divided into three groups: sham-operated mice, endometriosis-induced mice, and TM-treated endometriosis-induced mice. Each animal in the third group received 0.3 mg of TM/day in their drinking water from the postoperative 15th day. The samples were collected after one month of induced pathology. In peritoneal fluids, Cu and estradiol levels were determined by electrothermal atomic absorption spectrometry and electrochemiluminescence, respectively. Endometriotic-like lesions were processed for the analysis of cell proliferation by PCNA immunohistochemistry, the expression of angiogenic markers by RT-qPCR, the presence of endothelial cells by immunofluorescent staining, and oxidative stress applying spectrophotometric methods.
Key findings
TM treatment decreased Cu and estradiol levels, which were increased by this pathology. In lesions, TM induced: (a) a decrease in tissue weight and volume, (b) a decrease in PCNA-positive cells, (c) antiangiogenic effects by decreasing the number of blood vessels, the mRNA expression of fibroblast growth factor 2 (Fgf2) and platelet-derived growth factor subunit B (Pdgfb), and the presence of endothelial cells, (d) a decrease in antioxidant activity and an increase in lipid peroxidation.
Significance
TM is a highly effective antiproliferative and antiangiogenic agent, modulating oxidative imbalance in endometriosis. Its anti-endometriotic potential is an attractive feature of TM as a possible non-hormonal treatment.
Objective
Evidence for an association between uterine leiomyoma and increased risk of endometriosis is limited by small sample sizes and short follow-up periods. We assessed this association in a large nationwide sample with 14 years of data.
Design
Data were sourced from Taiwan’s Longitudinal Health Insurance Database 2000 (LHID2000).
Materials and methods
We identified 31,239 women aged ≥20 years diagnosed with uterine leiomyoma (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] code 218) between Jan 1, 2000 and Dec 31, 2012, who were matched with 124,956 controls (1:4) by 5-year age groups and year of diagnosis. Follow-up was from the date of LHID2000 entry to the first occurrence of endometriosis, loss to follow-up, insurance termination, or until December 31, 2013, whichever was earlier.
Results
In Cox regression analysis, the adjusted hazard ratio (aHR) for endometriosis in women with uterine leiomyoma was 6.44 (95% CI, 6.18, 6.72) compared with controls. The risk of endometriosis was significantly increased in women with uterine leiomyoma and comorbidities of tube-ovarian infection (aHR 2.86; 95% CI, 1.28, 6.36), endometritis (1.14; 1.06, 1.24), infertility (1.26; 1.16, 1.37), or allergic diseases (1.11; 1.05, 1.17). Having both uterine leiomyoma and endometritis significantly increased the risk of endometriosis (aHR 6.73; 95% CI, 6.07, 7.45) versus having only uterine leiomyoma (6.61; 6.33, 6.91) or endometritis (1.49; 1.31, 1.69). Similarly, having both uterine leiomyoma and infertility significantly increased the risk of endometriosis (aHR 6.95; 95% CI, 6.21, 7.78) versus having only uterine leiomyoma (6.66; 6.38, 6.96) or infertility (1.78; 1.57, 2.02).
Conclusions
A diagnosis of uterine leiomyoma appears to increase the risk of endometriosis. Patients presenting with uterine fibroids should be encouraged to give informed consent for possible simultaneous surgical treatment of endometriosis.
Endometriosis is a chronic gynaecological condition which has been referred to as the ‘missed disease’ due to its unclear aetiology and inconsistencies in its diagnosis and management. Unlike other long-term conditions such as diabetes and asthma, endometriosis has remained largely ignored in government policy and research funding globally. Drawing on scholarship from the growing field of ‘ignorance studies’, this paper considers how ambiguity around endometriosis is part of a wider constellation of discursive, material and political factors which enrol certain forms of knowledge whilst silencing, ignoring or marginalizing other forms of knowledge. It uses concepts of ‘undone science’ and ‘wilful ignorance’ to explore how an absence of knowledge on endometriosis is a result of structural, cultural and political processes and forces which privilege certain voices and communities. This paper suggests that the association of endometriosis with historically specific constructions of menstruation and women’s pain has informed contemporary imaginaries around the condition, including ideas about women being somehow accountable for their own illnesses. Applying an ignorance lens demonstrates how the legacy of invisibility of endometriosis shapes its place in the present political and social arena, and is reflective of a process of undone science. The paper concludes by arguing that the social and political significance of endometriosis as a chronic, life-limiting condition which affects millions of women globally continues to need attention, illumination and critique.
Objective: To investigate the difference of clinical features and outcomes between EM patients with and without AM after following up for at least 6 years after surgery.
Methods: We retrospectively analyzed 358 EM patients who had a minimum of 6 years follow-up after laparoscopic cystectomy, which was performed by one single doctor at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into AM group and non-AM group and analysis was performed in preoperative characteristics, surgical findings and postoperative outcomes during follow-up.
Results: A total of 358 EM patients were recruited, of which 142 (39.7%) were in the AM group and the rest 216 (60.3%) in the non-AM group. Between the two group, the mean age was 34.6 vs. 32.2 years ( P < 0.001). The mean operating time in the AM and non-AM group was 73.2 vs. 61.9 min ( P < 0.001). According to the revised AFS classification, the mean score of the two group were 60.3 vs. 45.5 ( P < 0.001). At the end of the follow-up, though the AM group was with higher rate of disease relapse, yet no significant difference was found between the two groups in statistical comparison (34/142 [23.9%] vs. 34/216 [15.7%], P = 0.053). With a minimum follow-up of 6 years after laparoscopic cystectomy, failed and successful pregnancy were seen in 107/142(75.4%) and 35/142 (24.6%) patients in the AM group vs. 114/216(52.8%) and 102/216 (47.2%) patients in the non-AM group ( P < 0.05). As for the successfully pregnant patients, live births, including spontaneous pregnancy and IVF-ET, were seen in 34/35 (97.1) vs. 99/102 (97.1) patients between AM and non-AM groups, while others ended in spontaneous abortion. No significant associations were found between the two groups in infertility, leiomyoma presence, the size of ovarian endometrioma, type of deep infiltrating endometriosis (DIE) or type of recurrence ( P > 0.05).
Conclusion: Compared with non-AM group, EM patients with concurrent AM may have higher age, longer mean operating time and higher mean AFS score. In terms of fertility outcomes, patients in the AM group were with lower likelihood of pregnancy after surgery during the long-time follow-up.
Having period does not mean sex is not an option. It comes with some benefits and some side effects. This is the question of many people’s that having sex before, after and during menstruation is safe of not? People feel shy to discuss about this topic. Period is a part of the menstrual cycle when a woman bleeds from her vagina for a few days. You may feel more sexually aroused during your period time.
Endometriosis is the presence of tissue estrogen-dependent endometrial outside the uterine cavity. The two main symptoms are pain and infertility. It is a common disease, but the whole pathological mechanisms remain poorly understood. However, in addition to the two main pathological theories (implantation and metaplasia), new data have been added: inflammation and perinervous infiltration appear to be two major elements in the mechanism of pain. The basis of infertile process is not dependent on a mechanic cause, but also on disturbances in follicular generation and in fluid abnormality in the peritoneum
Endometriosis is a chronic benign disease that affects women of reproductive age. Medical therapy is often the first line of management for women with endometriosis in order to ameliorate symptoms or to prevent post-surgical disease recurrence. Currently, there are several medical options for the management of patients with endometriosis and long-term treatments should balance clinical efficacy (controlling pain symptoms and preventing recurrence of disease after surgery) with an acceptable safety-profile. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of chronic inflammatory conditions, being efficacious in relieving primary dysmenorrhea. Combined oral contraceptives and progestins, available for multiple routes of administration, are commonly administered as first-line hormonal therapies. Several studies demonstrated that they succeed in improving pain symptoms in the majority of patients; moreover, they are well tolerated and not expensive. Gonadotropin-releasing hormone-agonists are prescribed when first line therapies are ineffective, not tolerated or contraindicated. Even if these drugs are efficacious in treating women not responding to COCs or progestins, they are not orally available and have a less favorable tolerability profile (needing an appropriate add-back therapy). Because few data are available on long-term efficacy and safety of aromatase inhibitors they should be reserved only for women with symptoms who are refractory to other treatments only in a research environment. Almost all of the currently available treatment options for endometriosis suppress ovarian function and are not curative. For this reason, research into new drugs is unsurprisingly demanding. Amongst the drugs currently under investigation, gonadotropin-releasing hormone antagonists have shown most promise, currently in late-stage clinical development. There is a number of potential future therapies currently tested only in vitro, in animal models of endometriosis or in early clinical studies with a small sample size. Further studies are necessary to conclude whether these treatments would be of value for the treatment of endometriosis.
Through microscopy, early researchers identified the epithelium on the inner surfaces of the uterus, cervix and Fallopian tubes. The identification of ectopic epithelium was gradual, starting from the gross pathology study of unusual cystic lesions. Towards the end of the nineteenth century, attention focused on the epithelium as a critical component. The term ‘adenomyoma’ was coined around eighteen eighty to designate the majority of mucosa-containing lesions. Several theories were advanced to explain its aetiology. In the main, lesions were considered to arise from invasion from uterine epithelium; implantation of endometrium through retrograde menstruation; hematogenous or lymphatic spread; or from embryonic remnants. Although initially widely rejected, around 1920, an almost unanimous consensus formed on the endometrial nature of epithelial invasions. During the following years, adenomyosis and endometriosis came to be used to distinguished lesions within or outside the uterus. Adenomyosis was attributed to direct infiltration of uterine mucosa into the myometrium, and endometriosis to the implantation of endometrial cells and stroma into the peritoneal cavity through retrograde menstruation. Around the same time, ovarian lesions, initially described as ovarian hematomas or chocolate cysts, were regarded as a form of endometriosis. Three variants of endometriosis were thus described: superficial peritoneal, deep nodular and ovarian endometriomas. Ectopic epithelium has long been recognised as having similarities to tubal, or cervical epithelium. Lesions containing mixed epithelium are often termed Müllerianosis. This article demonstrates the stepwise evolution of knowledge, the role of the pioneers and the difficulties that needed to be overcome. It also demonstrates the value of collaboration and the inter-connected nature of the scientific endeavour.
Robotic platform, despite its limitations, has made surgeries to be performed more easily in a minimally invasive way. This platform is a reliable and durable way to be precise in dissection and reconstruction, enabling surgeons to bridge the gap between laparotomy and laparoscopy. Endometriosis is an enigmatic disease that exists in many forms, like peritoneal endometriosis, ovarian endometriosis, and extragenital endometriosis. The main goal of surgical treatment is restoration of anatomy and removal of all endometriotic implants, with the hope of alleviating pain and improving fertility.
Provides a social psychological interpretation of the interrelations among demonic possession, mesmerism, and hysteria. It is argued that the reciprocal role relationship of mesmerist and magnetized S in the 18th and 19th centuries involved the secularization of the role relation that had existed between exorcist and demonically possessed. The commonalities between these 2 sets of social roles are delineated, some of the variables leading an individual to learn and enact the possessed role are outlined, and several lines of historical evidence pertaining to the influence of the exorcist–demoniac relationship on the mesmeric relationship are outlined. The influence of the possessed role in shaping the role of the hysterical patient is also discussed. The use of hysteria as a modern explanatory concept in histories of possession and mesmerism, however, is criticized. (198 ref)
This collection of essays represents research currently being undertaken on women's lives and their representations in various ancient societies. It provides a forum for the exchange and development of ideas and methods at a crucial period in the growth of women's studies in the UK.
The year 2010 marked the sesquicentennial of the discovery and description of adenomyosis and endometriosis by Carl Rokitansky of Vienna. The intervening 150 years have seen intense basic scientific and clinical research, and the diagnosis and treatment of millions of women worldwide. Yet there has been no scholarly history, and little mention of endometriosis and adenomyosis in historical compendiums of disease.
Endometriosis must be understood as the dominant member of five closely related benign müllerian diseases: endometriosis, adenomyosis, endosalpingiosis, endocervicosis, and müllerianosis, and its history is intertwined within the tale of discovery of each of these diseases and their interrelatedness by a series of pioneering physicians. Possibly because endometriosis is an enigmatic disease best understood through increasingly sophisticated and reductionistic scientific research, historians of science and medicine have consequently not been forthcoming.
Faced with such a daunting task, A History of Endometriosis provides a stunning chronological and biographical history of endometriosis with a intellectual leitmotif to frame the history of these chronic diseases. A history of ideas has enabled the author to follow the intellectual development of physician-investigators as they identified and described endometriotic diseases and theories of pathogenesis as well as to trace their influence on one another, all revealed by a patient reading of primary and secondary sources.
Just the steps you need to get going with Windows 7!. Coming in day and date with Microsoft's exciting release of the new Window 7 operating system, this friendly, accessible book shows you the features and functions you need from this exciting new operating system. Presented in a series of numbered steps that are concise, visually clear, and easy to follow, you'll learn to navigate the Windows 7 desktop, create files, connect to the Internet, search the Web, use e-mail, and more with this fun and practical guide. Get quickly and easily up to speed on Microsoft's new operating system, Windows 7. Master Windows 7 through a list of steps and easy-to-follow visual elements. See how to set up your desktop, copy and delete files, connect to the Internet, create folders, and more. Discover what so many readers already know-fun, readable Dummies books are a great way to get the most out of your Windows technology in a non-intimidating way. Why waste time on extraneous information? Get this book and get just the steps!.
In The Curse of Eve, the Wound of the Hero, Peggy McCracken explores the role of blood symbolism in establishing and maintaining the sex-gender systems of medieval culture. Reading a variety of literary texts in relation to historical, medical, and religious discourses about blood, and in the context of anthropological and religious studies, McCracken offers a provocative examination of the ways gendered cultural values were mapped onto blood in the Middle Ages. As McCracken demonstrates, blood is gendered when that of men is prized in stories about battle and that of women is excluded from the public arena in which social and political hierarchies are contested and defined through chivalric contest. In her examination of the conceptualization of familial relationships, she uncovers the privileges that are grounded in gendered definitions of blood relationships. She shows that in narratives about sacrifice a father's relationship to his son is described as a shared blood, whereas texts about women accused of giving birth to monstrous children define the mother's contribution to conception in terms of corrupted, often menstrual blood. Turning to fictional representations of bloody martyrdom and of eucharistic ritual, McCracken juxtaposes the blood of the wounded guardian of the grail with that of Christ and suggests that the blood from the grail king's wound is characterized in opposition to that of women and Jewish men. Drawing on a range of French and other literary texts, McCracken shows how the dominant ideas about blood in medieval culture point to ways of seeing modern values associated with blood in a new light, and how modern representations in turn suggest new perspectives on medieval perceptions. Copyright
Historic hypotheses regarding the pathogenesis of endometriosis and epithelial ovarian cancer are not entirely consistent with epidemiologic and biologic data. Alternatively, inflammation may also play an important role in the development of these conditions. Epidemiological, histopathological and molecular data suggest endometriosis may be a precursor lesion for the development of endometrioid or clear cell epithelial ovarian cancer. Endometriosis is more prevalent in patients with endometrioid and clear cell epithelial ovarian cancer. Hyperplastic and atypical endometriosis may be candidate lesions in the pathogenesis of these types of ovarian malignancies. Endometriosis also has neoplastic characteristics on a molecular level and it shares a common molecular lineage with endometrioid and clear cell ovarian cancer. Finally, the relationship between endometriosis and epithelial ovarian cancer has clinical implications in the diagnosis, treatment and prognosis of these conditions and in recommending hormone replacement therapy to women with endometriosis.
The serious, though unusual, hemorrhage of ovarian origin into the peritoneal cavity simulating ruptured tubal pregnancy is well known to every abdominal surgeon, even though he may have encountered but few such instances in his own practice. The literature on this subject has been recently reviewed by Novak¹ and by Smith.² The larger ovarian cysts, also with hemorrhagic contents due to twisting of the pedicle of the cyst or from other conditions, are so obvious as to make it impossible to overlook them. Ovarian hematomas due to various causes have been reported by Savage, ³ Wolf, ⁴ Hedley, ⁵ Novak ⁶ and others.
There is, however, one type of hemorrhagic ovarian cyst or ovarian hematoma which should receive more careful attention; not only on account of its frequency but because of the nature of the adhesions resulting from the escape of its contents into the peritoneal cavity. These
Ideas we associate with the 18th century are clearly seen in work published from the latter decades of the 17th century through the first decades of the 19th century. This is the "long 18th century", a period which exhibits multiple discourses in medicine, brain science and philosophy. The editors have deliberately adopted a "presentist" subtitle, "neuroscience", to emphasize that this collection of essays reflect a range of current thought about 18th century-studies of the nervous system in isolation and in context. There are six sections, each preceded by a short introduction. The opening section of Brain, Mind and Medicine: Neuroscience in the 18th Century sets forth a temporal chronology for the long 18th century. This is followed by a background section of essays on (a) brain and mind in the long 18th century, (b) the role of microscopes and microscopy in this period, (c) the nature of 18th century medical education and the place of voluntary hospitals and (d) an illustration of late-18th century medicine, discussing the early career of James Parkinson as an example. The third section contains a series of papers focusing on the nervous system, with (a) an exegesis of John Hunter's work, (b) the contributions of William Cullen and Robert Whytt, (c) a detailed analysis of the physiological and anatomical work of Pourfour du Petit, (d) the debate between Albrecht Haller and Robert Whytt concerning the mechanism of muscle contraction and two essays on developments in animal electricity during this epoch, (e) the early history starting with observations of the electric ray, and (f) the later contributions of Luigi Galvani, medical man and scientist. The fourth section on brain and behavior considers (a) William Porterfield's thoughts on vision, and three essays in speculative philosophy of neuroscience, (b) a discussion of David Hartley's vibration theory, (c) a discussion of Charles Bonnet's vibration theory and an analysis of Emanuel Swedenborg's century-too-soon thoughts on localization of brain function. The next section opens with an essay (a) on the neuroscientific ideas of Hermann Boerhaave and Albrecht Haller, then (b) a discussion of the evolution of our understanding of strokes in this epoch; these are followed by three essays on the development and applications of medical electricity, the first (c) on the contribution of Benjamin Franklin, the second (d) on how medical electricity was discussed in the popular publication, Gentleman's Magazine, and the third (e) on the application of medical electricity in physician's practices. The essays continue with (f) the medical opinions of the clergyman John Wesley, followed by (g) an essay on the best example of the power of suggestion in this era, Franz Anton Mesmer's notions of animal magnetism. The final essay in this section (h) discusses the evolution of the concept of hysteria well in advance of the well-known work of Jean Marie Charcot and Sigmund Freud. The final three essays in the last section capture some of the cultural consequences of 18th century interest in the nervous system: (a) in the context of French materialism, (b) in Jonathan Swift's literary treatment of brain and nervous system and, finally (c) in an analysis of the origin and development of the concept of temperament. © 2007 Springer Science+Business Media, LLC. All rights reserved.
In a recent article I stated that I 1 believed that perforating hemorrhagic (chocolate) cysts of the ovary were hematomas of endometrial type, and that at the time of the perforation of the cyst some of the epithelium lining it might be carried with the contents of the cyst into the peritoneal cavity. This epithelium might become lodged on the surface of the peritoneum, soiled by the contents of the cyst, and there develop into adenomas of endometrial type. The adenomas arising from the implantation of this epithelium might be small and quiescent, or they might become invasive, giving rise to so-called adenomyomas of the part invaded. I compared the conditions arising from the perforation of these cysts with the implantations of ovarian papilloma and cancer resulting from the rupture or perforation of an ovarian tumor containing these growths. These cysts were described as developing most frequently in women between
The oil derived from the seed of the Ricinus communis plant and its primary constituent, Ricinoleic Acid, along with certain of its salts and esters function primarily as skin-conditioning agents, emulsion stabilizers, and surfactants in cosmetics, although other functions are described. Ricinus Communis (Castor) Seed Oil is the naming convention for castor oil used in cosmetics. It is produced by cold pressing the seeds and subsequent clarification of the oil by heat. Castor oil does not contain ricin because ricin does not partition into the oil. Castor oil and Glyceryl Ricinoleate absorb ultraviolet (UV) light, with a maximum absorbance at 270 nm. Castor oil and Hydrogenated Castor Oil reportedly were used in 769 and 202 cosmetic products, respectively, in 2002; fewer uses were reported for the other ingredients in this group. The highest reported use concentration (81%) for castor oil is associated with lipstick. Castor oil is classified by Food and Drug Administration (FDA) as generally recognized as safe and effective for use as a stimulant laxative. The Joint Food and Agriculture Organization (FAO)/World Health Organization (WHO) Expert Committee on Food Additives established an acceptable daily castor oil intake (for man) of 0 to 0.7 mg/kg body weight. Castor oil is hydrolyzed in the small intestine by pancreatic enzymes, leading to the release of glycerol and Ricinoleic Acid, although 3,6-epoxyoctanedioic acid, 3,6-epoxydecanedioic acid, and 3,6-epoxydodecanedioic acid also appear to be metabolites. Castor oil and Ricinoleic Acid can enhance the transdermal penetration of other chemicals. Although chemically similar to prostaglandin E1, Ricinoleic Acid did not have the same physiological properties. These ingredients are not acute toxicants, and a National Toxicology Program (NTP) subchronic oral toxicity study using castor oil at concentrations up to 10% in the diet of rats was not toxic. Other subchronic studies of castor oil produced similar findings. Undiluted castor oil produced minimal ocular toxicity in one study, but none in another. Undiluted castor oil was severely irritating to rabbit skin in one study, only slightly irritating in another, mildly irritating to guinea pig and rat skin, but not irritating to miniature swine skin. Ricinoleic Acid was nonirritating in mice and in one rabbit study, but produced well-defined erythema at abraded and intact skin sites in another rabbit study. Zinc Ricinoleate was not a sensitizer in guinea pigs. Neither castor oil nor Sodium Ricinoleate was genotoxic in bacterial or mammalian test systems. Ricinoleic Acid produced no neoplasms or hyperplasia in one mouse study and was not a tumor promoter in another mouse study, but did produce epidermal hyperplasia. Castor oil extract had a strong suppressive effect on S180 body tumors and ARS ascites cancer in male Kunming mice. No dose-related reproductive toxicity was found in mice fed up to 10% castor oil for 13 weeks. Female rats injected intramuscularly with castor oil on the first day after estrus had suppressed ovarian folliculogenesis and anti-implantation and abortive effects. Castor oil used as a vehicle control in rats receiving subcutaneous injections had no effect on spermatogenesis. A methanol extract of Ricinus communis var. minor seeds (ether-soluble fraction) produced anti-implantation, anticonceptive, and estrogenic activity in rats and mice. Clinically, castor oil has been used to stimulate labor. Castor oil is not a significant skin irritant, sensitizer, or photosensitizer in human clinical tests, but patients with occupational dermatoses may have a positive reaction to castor oil or Ricinoleic Acid. The instillation of a castor oil solution into the eyes of nine patients resulted in mild and transient discomfort and minor epithelial changes. In another study involving 100 patients, the instillation of castor oil produced corneal epithelial cell death and continuity breaks in the epithelium. Because castor oil contains Ricinoleic Acid as the primary fatty acid group, the Cosmetic Ingredient Review (CIR) Expert Panel considered the safety test data on the oil broadly applicable to this entire group of cosmetic ingredients. The available data demonstrate few toxic effects. Although animal studies indicate no significant irritant or sensitization potential, positive reactions to Ricinoleic Acid in selected populations with identified dermatoses did suggest that sensitization reactions may be higher in that population. Overall, however, the clinical experience suggests that sensitization reactions are seen infrequently. In the absence of inhalation toxicity data on these ingredients, the Panel determined that these ingredients can be used safely in aerosolized cosmetic products because the particle sizes produced are not respirable. Overall, the CIR Expert Panel concluded that these cosmetic ingredients are safe in the practices of use and concentrations as described in this safety assessment.
The process of identifying the presence of epithelial invasions in the peritoneal cavity, but outside the uterine cavity, proceeded in steps over a period of 60 years until, in 1920, Cullen established that uterine adenomyoma, ovarian and deep endometriosis were one disease characterized by the presence of "adenomyomatous tissue" outside the uterine cavity. Sampson then gave the condition a name and provided the first theory on the pathogenesis of the disease, observing that the peritoneal lesions were bleeding at menstruation. A true revolution in the management of endometriosis occurred when, in the 1940s, new pelvic endoscopic techniques were introduced, allowing differentiation between causes of intra-abdominal bleeding, appendicitis, and salpingitis. The American Fertility Society stratified endometriosis into mild, moderate, severe, and extensive disease, using a weighted point score; this classification has now been revised twice and a "stage 5" proposed. The most important localization is in the peritoneum, with early lesions appearing and disappearing. In the ovary, endometriosis forms pseudocysts, the inside of which is constituted by invaginated ovarian cortex and a thin layer of endometriotic tissue. Hormonal treatment was started in the 1940s using, in sequence, androgens, estrogens, estrogen-progestins ("pseudo-pregnancy regimen"), antigonadotropic and antiprogestin agents. Conservative surgery gained popularity in the 1970s when laparoscopic techniques were introduced; in the 1980s the use of intraperitoneal adjuncts was added to reduce postoperative adhesion formation. Pathogenesis is still hotly debated: Sampson's retrograde menstruation theory remains valid, but the role of a modified peritoneal environment is today widely accepted, explaining reduced fecundability even in the presence of minimal endometriosis. Finally, the initial role of possible endometrial dysfunction is now being investigated.
At a meeting of the Johns Hopkins Hospital Medical Society in March, 1895, I reported my first case of adenomyoma of the uterus, and since then I have been on the lookout for tumors of this character. From time to time the results of my labors have been recorded either in book form or in the literature.
I have been amazed at the widespread distribution of these tumors consisting of nonstriped muscle with islands of uterine mucosa scattered throughout them. In May, 1919, I read a short paper on the subject before the New York State Medical Society at Syracuse. This fragmentary article was published¹ a few months later.
In the present paper I shall not attempt to cover the literature on the subject, but I shall confine my remarks to a description of the cases and of the pathologic material that I have personally observed since reporting my
The first laparoscopic hysterectomy is described. Surgical techniques included aquadissection to develop appropriate tissue planes and bipolar electrosurgery to achieve hemostasis. The 38-year-old woman who elected to undergo this procedure had persistent pelvic pain secondary to pelvic adhesions from previous endometriosis surgery and hypermenorrhea due to uterine myomas. She was discharged on the fourth postoperative day and returned to full activity within 3 weeks. This case illustrates that hysterectomy can be accomplished using laparoscopy as the mode of access. In the future, titanium laparoscopic staples may replace bipolar electrosurgery for hemostasis. In selected patients, the laparoscopic approach to hysterectomy may avoid the increased morbidity associated with abdominal surgery while retaining the surgical advantages of the abdominal approach, i.e., thorough visualization and easy access to the vascular pedicles.
Of the 600,000 hysterectomies performed each year, more than 60% are accomplished using an abdominal incision. Abdominal hysterectomy will probably become a rarely used procedure, however, because laparoscopy can be effectively used to accomplish a less invasive laparoscopie or vaginal hysterectomy in many cases.
INTRODUCTION 1. The Duchy of Nassau and the Eberbach Asylum SECTION I: RELIGION 2. Religious Madness in the Vormarz: Culture, Politics, and the Professionalization of Psychiatry 3. Religious Madness and the Formation of Patients SECTION II: SEXUALITY AND GENDER 4. Medical Representation of Sexual Madness: Nymphomania and Masturbatory Insanity 5. Doctors and Patients: The Practice(s) of Nymphomania 6. Women, Sex, and Rural Life SECTION III: DELINQUINCY AND CRIMINALITY 7. Masturbatory Insanity and Delinquincy 8. Jews and the Criminalization of Madness CONCLUSION
A reliable method to measure presence and quantity of the toxic factor in needles of ponderosa pine (Pinus ponderosa Laws.) was developed using embryo implantation and gestation in laboratory mice as the basis of the assay. The abortiofacient factor was present in both aqueous and acetone extracts of ponderosa pine needles. Control animals had significantly (P<0.1) greater number of viable embryos at 124, 148, and 172 hr post-coitum than mice fed pine needle extracts. A gestation study verified results from the implantation experiment, as few mice fed pine needle extracts delivered normal litters. Frequently, mice receiving the concentrated aqueous extract had diarrhea and decreased feed intake. Failure of implantation by 124 hr postcoitum in bred mice fed aqueous or acetone extracts of ponderosa pine can be used as an index of the risk involved in grazing ponderosa pine ranges, but cannot be used to predict losses.
This is a study of the nature and influence of Hippocratic gynecological medicine.
The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Maayan-Metzger A, Schushan-Eisen I, Todris L, et al. Maternal hypotension during elective cesarean section and short-term neonatal outcome. Am J Obstet Gynecol 2010;202:56.e1-5. The full discussion appears at www.AJOG.org, pages e12-e14.
The word ‘nymphomania’, the concept of ‘madness from the womb’ and the belief in the existence of a behaviour consisting in an abnormally high female sexual drive converged during the second half of the seventeenth century to give rise to a new clinical category which, with minor changes, has survived until the present (e.g., in ICD-10).
This Classic Text, an excerpt from the work of Lazare Rivière, provides a glimpse into the process whereby medical categories are constructed. According to Rivière (and many others) ‘madness from the womb’ was a disease which resulted from overheating and putrefaction of accumulated seed (female sperm) in the womb. Like all medical constructs, ‘madness from the womb’ (and soon nymphomania) included a symptomatology, natural history, aetiology, prognosis and cure. It is also clear that it was rehash of the earlier moral notion of ‘satyriasis’ (a male category applied to women) and the expression of seventeenth-century changing male attitudes towards, and fears of, female sexuality.