26 research outputs found
Anti-TNF-α treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial
BACKGROUND: Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-TNF-alpha monoclonal antibody, might relieve pain. METHODS: A randomized placebo-controlled trial was designed with 21 women with severe pain and a rectovaginal nodule of at least 1 cm. After 1 month of observation, three infusions of infliximab (5 mg/kg) or placebo were given. Surgery was performed 3 months later and follow-up continued for 6 months. The primary end-point was pain (dysmenorrhea, deep dyspareunia and non-menstrual pain) rated at each visit by the clinician and on a daily basis by the patient who in addition scored pain by visual analog pain scale and analgesia intake. Secondary end-points included the volume of the endometriotic nodule, pelvic tenderness and the visual appearance of endometriotic lesions at laparoscopy. RESULTS: Pain severity decreased during the treatment by 30% in both the placebo (P < 0.001) and infliximab groups (P < 0.001). However, no effect of infliximab was observed for any of the outcome measures. After surgery, pain scores decreased in both groups to less than 20% of the initial value. CONCLUSIONS: Infliximab appears not to affect pain associated with deep endometriosis. Treatment is associated with an important placebo effect. After surgery, pain decreases to less than 20%. Trials registration number ClinicalTrials.gov: NCT00604864
The effect of training and duration of surgery on adhesion formation in the rabbit model
In order to evaluate the effect of training upon postoperative adhesions, standard bipolar and mechanical, nonopposing injuries were performed in the uterine horns and
side walls of 52 mature female rabbits using a conventional
three-puncture laparoscopy, by an endoscopic surgeon with
limited experience. An additional injury, either bipolar or
mechanical or both, was performed in the retro-uterine
space. With experience, the duration of surgery decreased
progressively from 12 K 2 to 8 K 1 min in the first and
last 10 animals respectively. The amount of perioperative
bleeding was not affected by experience. With experience
the postoperative adhesions decreased in extent (P J
0.0001), tenacity (P J 0.004), type (P J 0.002) and
inflammation (P J 0.003) and for total score (P J 0.0002).
These changes were correlated with the briefer duration
of surgery but not with the amount of perioperative
bleeding. The strong correlations of adhesion scores in the
pouch of Douglas, and around both uterine horns confirmed
the importance of the inter-animal variability in making
adhesions. By logistic regression, the adhesions in the pouch
of Douglas were explained simultaneously by the adhesions
on the uterine horns (P J 0.0004, thus correcting for interanimal variability) by the amount of bleeding (P J 0.01)
and the duration of surgery (P J 0.05). No major differences were found in adhesions following a mechanical or
a bipolar injury or following such a lesion in the pouch of
Douglas or at the uterine horns. In conclusion, experience,
expressed by the duration of surgery and to a lesser extent
perioperative bleeding, is a major co-factor in postoperative
adhesions, suggesting that duration of surgery should be
strictly standardized in endoscopic adhesion studies. The
important inter-animal variability can be circumvented by
using a standard control lesion, making each animal its
own control.Fil: Ordoñez, J.L. Centre for Surgical Technologies; BelgiumFil: Domínguez, J. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Evrard, V. Centre for Surgical Technologies; BelgiumFil: Koninckx, P.R. Centre for Surgical Technologies; Belgiu
Müllerianosis
Müllerianosis may be defined as an organoid
structure of embryonic origin; a choristoma composed of
müllerian rests - normal endometrium, normal
endosalpinx, and normal endocervix - singly or in
combination, incorporated within other normal organs
during organogenesis. A choristoma is a mass of
histologically normal tissue that is “not normally found
in the organ or structure in which it is located”
(Choristoma, 2006). Müllerian choristomas are a subset
of non-müllerian choristomas found throughout the
body.
Histologically, endometrial-müllerianosis and
endometriosis are both composed of endometrial glands
and stroma, but there the similarity ends. Their
pathogenesis is different. Sampson faced the same
difficulty with pathogenesis and nomenclature when he
wrote: “The nomenclature of misplaced endometrial or
müllerian lesions is a difficult one to decide upon.” “The
term müllerian would be inclusive and correct, but
unfortunately it suggests an embryonic origin.” Sampson
then divided “misplaced endometrial or müllerian tissue”
into “four or possibly five groups, according to the
manner in which this tissue reached its ectopic location”
(Sampson, 1925).
Sampson’s classification of heterotopic or misplaced
endometrial tissue is based on pathogenesis: 1) “direct or
primary endometriosis” [adenomyosis]; “a similar
condition occurs in the wall of the tube from its invasion
by the tubal mucosa” [endosalpingiosis]; 2) “peritoneal
or implantation endometriosis;” 3) “transplantation
endometriosis;” 4) “metastatic endometriosis;” and 5)
“developmentally misplaced endometrial tissue. (I admit
the possibility of such a condition, but have never been
able to appreciate it.)” (Sampson, 1925). It is precisely
this condition “developmentally misplaced endometrial
tissue,” [müllerianosis] that is the subject of this review