Pagina 6

Pag. 6Eur Radiol. 2007 Jan;17(1):211-9. Epub 2006 Aug 26.Multislice CT enteroclysis in the diagnosis of bowel endometriosis.Biscaldi E, Ferrero S, Fulcheri E, Ragni N, Remorgida V, Rollandi GA.Department of Radiology, Duchesse of Galliera-Hospital, Via Mura delle Cappuccine 14, 16128 Genoa, Italy. ennio.biscaldi@fastwebnet.itThis prospective study aims to evaluate the efficacy of multislice computed tomography combined with colon distension by water enteroclysis (MSCTe) in determining the presence and depth of bowel endometriotic lesions. Ninety-eight women with symptoms suggestive of colorectal endometriosis underwent MSCTe; locations, number of nodule/s, size of the nodule/s and depth of bowel wall infiltration were determined. Independently from the findings of MSCTe, all women underwent laparoscopy. MSCTe findings were compared with surgical and histological results. Abnormal findings suggestive of bowel endometriotic nodules were detected by MSCTe in 75 of the 76 patients with bowel endometriosis. MSCTe identified 110 (94.8%) of the 116 bowel endometriotic nodules removed at surgery; 6 nodules missed at MSCTe were located on the rectum. MSCTe correctly determined the degree of infiltration of the bowel wall in all of the 34 serosal bowel nodules identified at MSCTe. In six nodules reaching the submucosa, the depth of infiltration was underestimated by MSCTe. MSCTe had a sensitivity of 98.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.7% in identifying women with bowel endometriosis. MSCTe is effective in determining the presence and depth of bowel endometriotic lesions.Fertil Steril. 2006 Sep;86(3):543-7. Epub 2006 Jul 28.Deeply infiltrating endometriosis affecting the rectum and lymph nodes.Abrao MS, Podgaec S, Dias JA Jr, Averbach M, Garry R, Ferraz Silva LF, Carvalho FM.Obstetrics and Gynecology Department, Hospital das Clínicas, São Paulo Medical School, São Paulo, Brazil. msabrao@attglobal.netOBJECTIVE: To analyze morphologic aspects of bowel endometriosis. DESIGN: Prospective study of 35 consecutive cases of bowel endometriosis. SETTING: Multidisciplinary group practice and teaching hospital. PATIENT(S): Thirty-five patients with bowel endometriosis were assessed between September 2003 and June 2005. INTERVENTION(S): Histologic analysis of 35 tissue samples removed at laparoscopic rectosigmoidectomy. MAIN OUTCOME MEASURE(S): We performed an evaluation of lesion size, number of lesions present in the bowel, intestinal wall layers affected by the endometriotic lesion, circumference of the intestinal loop affected by the endometriotic lesion, and presence of lymph nodes with foci of endometriosis. RESULT(S): Analysis of the surgical samples revealed lymph nodes in the pericolic adipose tissue of 19 (54%), cases and in 5 of these cases (26.3%), endometriosis had affected the lymph nodes. When the thickness of the endometriotic lesion reached 1.75 cm, lymph nodes of all patients were affected, and all patients in whom more than 80% of the circumference of the intestinal loop was affected by endometriosis presented with positive lymph nodes. CONCLUSION(S): This study raises doubts about whether this form of the disease can still be considered a clinically benign disease.Fertil Steril. 2006 Aug;86(2):298-303. Epub 2006 Jul 7.Endometriosis and the appendix: a case series and comprehensive review of the literature.Gustofson RL, Kim N, Liu S, Stratton P.Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.OBJECTIVE: To report the prevalence of appendiceal disease in women with chronic pelvic pain undergoing laparoscopy for possible endometriosis, summarize the literature, and more accurately estimate the prevalence of endometriosis of the appendix. DESIGN: Prospective case series and literature review. SETTING: Academic research institute. PATIENT(S): One hundred thirty-three patients with chronic pelvic pain and possible endometriosis undergoing laparoscopy. INTERVENTION(S): History, physical exam, and abdominopelvic laparoscopy. Endometriosis and adhesions were excised using selective Nd:YAG contact laser trabeculoplasty and pathologically evaluated. Only patients with visible abnormalities involving the appendix were treated via concurrent laparoscopic appendectomy. MAIN OUTCOME MEASURE(S): Appendiceal abnormalities at laparoscopy. RESULT(S): Of 133 patients, 13 had a previous appendectomy with unknown pathology. Of the remaining 120 patients, 109 reported right lower quadrant pain. Of this subgroup, six patients had appendiceal pathology: four with pathology-confirmed endometriosis, one with Crohn’s disease suspected at laparoscopy, and one with chronic appendicitis. The prevalence of appendiceal endometriosis in patients with biopsy-proven endometriosis (n = 97) or with right lower quadrant pain (n = 109) was 4.1% and 3.7%, respectively. This rate was similar to the 2.8% prevalence confirmed by literature review in patients with endometriosis but was much higher than that reported in all patients (0.4%). CONCLUSION(S): Appendiceal endometriosis, while relatively uncommon in patients with endometriosis, is rare in the general population. In patients with right lower quadrant or pelvic pain, the appendix should be inspected for endometriosis and evidence of nongynecologic disease.Publication Types: Research Support, N.I.H., IntramuralReviewJ Minim Invasive Gynecol. 2006 Jul-Aug;13(4):281-8.Recurrence of endometriomas after laparoscopic removal: sonographic and clinical follow-up and indication for second surgery.Exacoustos C, Zupi E, Amadio A, Amoroso C, Szabolcs B, Romanini ME, Arduini D.Obstetrics and Gynecology Department, Università degli Studi di Roma Tor Vergata, Rome, Italy.STUDY OBJECTIVE: This study involved patients who, after laparoscopic surgery, had recurrence of endometriomas detected by sonography. The aim of this study was to evaluate the role of transvaginal sonography (TVS) in the management of recurrent endometriomas and to establish ultrasonographic criteria that would direct the therapy toward additional surgery versus medical or expectant management. DESIGN: Retrospective analysis of 62 reproductive-age women who showed recurrence of endometriomas on TVS after laparoscopic removal of an ovarian endometrioma by the stripping technique (Canadian Task Force classification II-1). SETTING: Obstetrics and Gynecology Department, University of Rome Tor Vergata. PATIENTS: Sixty-two patients with recurrent endometriomas after first-line treatment with laparoscopy. INTERVENTIONS: Ultrasonographic follow-up and/or second surgery. MEASUREMENTS AND MAIN RESULTS: Recurrence of an ovarian endometrioma was defined as the presence of ovarian cysts with the typical sonographic criteria of endometriomas and a diameter of more than 10 mm. The clinical and sonographic postoperative follow-up period lasted from 6 to 97 months (median 24.6) after the first procedure. Of 62 patients with recurrent endometriomas, 50 had recurrence on the treated ovary, 7 on the contralateral untreated ovary, and 5 on both the treated and untreated ovaries. Recurrence of endometriomas was associated with symptoms (pain or infertility) in 47 patients (76%), while the remaining 15 (24%) were asymptomatic. Of the 47 symptomatic patients with recurrence detected by TVS, a second procedure was performed in 15. Second surgery in these patients was indicated by the larger size of the recurrent cysts, a poor response to medical treatment, the presence on TVS of pelvic adhesions and nodules of deep endometriosis, and overall progression of the disease. Symptomatic patients who did not undergo a second procedure (32) had smaller recurrent endometriomas. However of the 31 symptomatic patients with large recurrent endometriomas (>3 cm), only 45% had repeat surgery. CONCLUSION: Recurrent endometriomas, as detected by TVS, can remain asymptomatic and do not necessarily progress in size with or without medical treatment. The decision to reoperate depends less on the endometrioma’s size than on symptoms, in particular severe pain, and failure of medical treatment. However such patients are also more likely to have signs of deep nodules and adnexal/bowel adhesions and larger endometriomas on TVS scan, thus predisposing them to require a second procedure.Gynecol Obstet Fertil. 2006 Jul-Aug;34(7-8):583-92. Epub 2006 Jul 5.Comment in:Gynecol Obstet Fertil. 2006 Nov;34(11):1099-100; author reply 1100. Gynecol Obstet Fertil. 2007 Jan;35(1):77-8. Gynecol Obstet Fertil. 2007 Jan;35(1):78-9. Laparoscopic surgery of deep endometriosis. About 118 cases.[Article in French]Panel P, Chis C, Gaudin S, Letohic A, Raynal P, Mikhayelyan M, Fraleu B, Sangana G, Almeras C, Dufour C, Boidart F.Service de gynécologie-obstétrique, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay cedex, France. ppanel@ch-versailles.frOBJECTIVE: To evaluate risks and benefits of laparoscopic surgery of deep endometriosis, especially with bowel involvement with the aim of improve the inform consent of patients and choice of adequate management. PATIENTS AND METHODS: Observational continuous study on 118 patients suffering from deep endometriosis (48 with bowel endometriosis) treated by laparoscopic surgery. RESULTS: 95.6% of the patients improved their symptoms (93.7% for dyspareunia). Upon the 29 infertile patients, 21 (72%) got pregnant, including 14 (66%) spontaneously. During operative time, 3 laparotomies occurred, two of them for haemorrhage. During postoperative time, 4 major complications (2 rectal fistulas and 2 ureteral necrosis) and minor complications occurred. DISCUSSION AND CONCLUSIONS: Those data confirm the efficiency of laparoscopic treatment of deep endometriosis especially for pain relief and fertility. Nevertheless, few but severe complications may occur. Therefore, it is imperative to deliver clear, loyal and appropriate information before to proceed to such a treatment.Publication Types: English AbstractEur J Pain. 2007 May;11(4):415-20. Epub 2006 Jul 11.Generalized deep-tissue hyperalgesia in patients with chronic low-back pain.O’Neill S, Manniche C, Graven-Nielsen T, Arendt-Nielsen L.Human Locomotion Science, University of Southern Denmark, Odense, Denmark.Some chronic painful conditions including e.g. fibromyalgia, whiplash associated disorders, endometriosis, and irritable bowel syndrome are associated with generalized musculoskeletal hyperalgesia. The aim of the present study was to determine whether generalized deep-tissue hyperalgesia could be demonstrated in a group of patients with chronic low-back pain with intervertebral disc herniation. Twelve patients with MRI confirmed lumbar intervertebral disc herniation and 12 age and sex matched controls were included. Subjects were exposed to quantitative nociceptive stimuli to the infraspinatus and anterior tibialis muscles. Mechanical pressure (thresholds and supra-threshold) and injection of hypertonic saline (pain intensity, duration, distribution) were used. Pain intensity to experimental stimuli was assessed on a visual analogue scale (VAS). Patients demonstrated significantly higher pain intensity (VAS), duration, and larger areas of pain referral following saline injection in both infraspinatus and tibialis anterior. The patients rated significantly higher pain intensity to supra-threshold mechanical pressure stimulation in both muscles. In patients, the pressure pain-threshold was lower in the anterior tibialis muscle compared to controls. In conclusion, generalized deep-tissue hyperalgesia was demonstrated in chronic low-back pain patients with radiating pain and MRI confirmed intervertebral disc herniation, suggesting that this central sensitization should also be addressed in the pain management regimes.Niger J Med. 2006 Apr-Jun;15(2):165-6.Chronic intestinal obstruction due to rectosigmoid endometriosis: a case report.Tade AO.Department of Surgery, Olabisi Onabanjo University, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.BACKGROUND: Intestinal endometriosis is not commonly reported in Nigeria and Africa. This paper presents a case of chronic intestinal endometriosis in a young Nigerian woman presenting with features of chronic intestinal obstruction. METHOD: The case records of a 29-year old Nigerian female, who presented with chronic intestinal obstruction secondary to endometriosis at the Olabisi Onabanjo University Teaching Hospital (OOUTH) Sagamu, Nigeria and literature review on the subject using medline and manual library search is presented. RESULT: A young woman presented with a three- month history of progressive abdominal distension and worsening constipation. Examination revealed a grossly distended abdomen, slightly tense but no area of tenderness. Bowel sounds were slightly exaggerated. A plain radiograph of the abdomen showed features of small and large bowel obstruction. A diagnosis of chronic large bowel obstruction was made. She was found to have a stricture in the rectosigmoid at laparotomy. Hartmann’s resection was done. Histologically, the stricture was due to endometriosis. Subsequent closure of colostomy and re-establishment of intestinal continuity gave excellent results. CONCLUSION: A young Nigerian female diagnosed with chronic intestinal obstruction due to rectosigmoid endometriosis was successfully treated. Though this condition is believed to be relatively uncommon in Nigeria, there is a need for a high index of suspicion, to ensure early diagnosis.Publication Types: Case ReportsJ Laparoendosc Adv Surg Tech A. 2006 Jun;16(3):251-5.Simultaneous laparoscopic treatment for rectosigmoid and ileal endometriosis.Sakamoto K, Maeda T, Yamamoto T, Takita N, Suda S, Watanabe T, Sakamoto S, Kamano T, Takeuchi H, Kinoshita K.Department of Coloproctological Surgery, Juntendo University School of Medicine, Tokyo, Japan. kazusaka@med.juntendo.ac.jpEndometriosis is common in women of childbearing age, while severe intestinal endometriosis requiring bowel resection is relatively rare. Intestinal endometriosis has recently been managed laparoscopically. We report the case of a 38-year-old patient with rectosigmoid and ileal endometriosis who was successfully treated by laparoscopic bowel resections. The patient had first presented at age 34 years with a chief complaint of rectal bleeding and lower abdominal pain related to the menstrual cycle. She underwent laparoscopic surgery and was diagnosed with severe endometriosis involving the rectosigmoid colon. Although an additional laparoscopic surgery had been planned, she did not return to the hospital. When she was 38 years old, she presented again with the same symptoms. Magnetic resonance imaging revealed a low intensity mass between the uterus and the rectosigmoid colon. A barium enema showed a stenotic site in the rectosigmoid colon. After hormone therapy, she underwent laparoscopic surgery. The anterior wall of the rectosigmoid colon adhered firmly to the corpus of the uterus, and another stenotic site was identified at the terminal ileum. The rectosigmoid colon and ileum were partially resected under laparoscopy. The postoperative course was uneventful and she was freed of symptoms. Laparoscopic treatment for patients with severe endometriosis of the bowel has becomes feasible and safe.Publication Types: Case ReportsAm J Gastroenterol. 2006 Jun;101(6):1172-5.Functional versus organic: an inappropriate dichotomy for clinical care.Drossman DA.Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA.Publication Types: Case ReportsBest Pract Res Clin Obstet Gynaecol. 2006 Oct;20(5):695-711. Epub 2006 Jun 9.Chronic pelvic pain: aetiology and therapy.Cheong Y, William Stones R.School of Medicine and Biomedical Sciences, Academic Unit of Reproductive and Developmental Medicine, Level 4, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK. yingcheong@hotmail.comChronic pelvic pain (CPP) is a common condition in women and rates of consultation for CPP in general practice are similar to those for asthma and migraine. US and UK population-based studies, together with data from UK hospital settings demonstrate a substantial impact of CPP on health-related quality of life. In this review, we will examine the current evidence on the aetiology and management of CPP, focussing on the randomised controlled trials (RCTs) that are available to date. CPP is a heterogeneous condition and causation is often unclear. There are associations with specific pathological processes but a barrier to understanding is that many studies have data that are not comparable. In the community setting, as many as 60% of women with CPP have not received a specific diagnosis and up to 20% have not undergone any investigation. The factor most commonly associated with CPP in the community is irritable bowel syndrome, although in a tertiary setting with laparoscopy, pathology associated with CPP in ascending order of frequency is endometriosis (33%), adhesions (24%) and ‘no pathology’ (35%). Current RCT evidence provides some support for the use of ultrasound scanning as an aid to counselling and reassurance, progestogen (medroxyprogesterone acetate) or goserelin for pelvic congestion and a multidisciplinary approach to assessment and treatment. Adhesiolysis is not shown to be of benefit other than in women with extensive adhesions. While studied in relation to dysmenorrhoea rather than CPP, the short term results for presacral neurectomy (PSN) and laparoscopic utero-sacral nerve ablation (LUNA) seem to be similar, although PSN has better results in the long term. Selective serotonin reuptake inhibitor (SSRI) antidepressants have not been shown to be of benefit in CPP. Most of these conclusions are based on the outcome of single randomised trials and therefore need replication.Publication Types: ReviewMinim Invasive Ther Allied Technol. 2005;14(3):160-6.Deep endometriosis, including intestinal involvement–the interdisciplinary approach.Keckstein J, Wiesinger H.Department of Gynaecology and Obstetrics, County Hospital Villach, Austria. joerg.keckstein@lkh-vil.or.atDeep endometriosis is a disease which may involve all organs of the pelvis. The lesion is most often located at the backside of the uterus, involving the uterosacral ligaments and/or the rectovaginal septum. The involvement of adjacent organs, e.g. bowel, ureter, and bladder, makes an interdisciplinary approach necessary. There is a correlation between the radicalness of endometriosis resection and the postoperative improvement of complaints. In a series of 202 patients with deep endometriosis including the bowel we performed a segmental resection with anterior anastomosis including radical excision of all endometriotic lesions. The follow-up of 142 patients shows a significant improvement of pelvic pain (96%), dyschezia (88%), and dyspareunia (87%). Of 95 patients with a desire for children, 50% became pregnant. The postoperative complication rate was low. A leakage of anastomosis was seen in six cases (3%).Ther Umsch. 2006 May;63(5):327-32.Chronic gastrointestinal bleeding.[Article in German]Orlandi M, Inauen W.GastroenterologieZentrum, Bürgerspital Solothurn, Solothurn.Chronic gastrointestinal bleeding can occur as recurrent overt blood loss (hematochezia, melena or hematemesis) or as occult gastrointestinal bleeding. Occult bleeding from the gastrointestinal tract is typically identified by either a positive stool test for occult blood or by the presence of iron deficiency anemia. The major cause of iron deficiency anemia is blood loss from the gastrointestinal tract. In women, menstrual blood loss must also be considered. Approximately 5% of all patients with gastrointestinal bleeding do not have lesions identified by upper or lower endoscopy. In most of these patients, the bleeding source responsible for the chronic blood loss is located in the small bowel. The most common cause for gastrointestinal bleeding of small bowel origin is angiodysplasia, tumors of the small intestine (primary benign or malignant tumors or metastatic lesions) and various other causes (such as ulcers caused by nonsteroidal antiinflammatory drugs, aortoenteric fistula, diverticula, endometriosis and hemobilia). After negative upper and lower endoscopy, examination of the small bowel is warranted. Methods to evaluate the small bowel include enteroscopy, capsule endoscopy, small bowel radiographic studies and angiography. The role of each examination depends upon the clinical setting and available expertise. Explorative surgery with intraoperative enteroscopy is generally reserved for patients with ongoing transfusion requirement and in those under the age of 5O years (to rule out a small bowel neoplasm). This article reviews the concepts of evaluation and care of patients with chronic gastrointestinal bleeding.Publication Types: English AbstractReviewArch Gynecol Obstet. 2006 Jul;274(4):203-5. Epub 2006 May 12.Over one thousand patients with early stage endometriosis treated with the Helica Thermal Coagulator (HELICA): safety aspects.Hill N, McQueen J, Morey R, Hanna L, Chandakas S, El-Toukhy T, Erian J.Department of Obstetrics and Gynaecology, Princess Royal University Hospital, Farnborough Common, Kent, BR6 8ND, UK. hills@shirecot.fsnet.co.ukSTUDY OBJECTIVE: To assess the safety of the Helica Thermal Coagulator in the laparoscopic treatment of early stage endometriosis. DESIGN: Retrospective, observational. SETTINGS: The Princess Royal University Hospital, The Sloane and Chelsfield Park Hospitals, Kent, UK. PATIENTS: One thousand and sixty patients with early stage endometriosis. RESULTS: All patients were treated laparoscopically with the Helica Thermal Coagulator; a new laparoscopic device that combines electrical energy with helium for the treatment of endometriosis. No major bladder, ureteric or bowel injuries occurred. The only complication was a perforated vagina from the cutting probe during dissection of the cul-de-sac in a patient with a vaginal endometriotic nodule. CONCLUSION: The Helica Thermal Coagulator is a safe device for the laparoscopic treatment of endometriosis.Int Arch Occup Environ Health. 2006 Nov;80(2):149-53. Epub 2006 May 11.Cadmium, lead and endometriosis.Heilier JF, Donnez J, Verougstraete V, Donnez O, Grandjean F, Haufroid V, Nackers F, Lison D.Industrial Toxicology and Occupational Medicine Unit, Faculty of Medicine, Université Catholique de Louvain, 30.54 Clos Chapelle aux Champs, 1200, Brussels, Belgium. jean-francois.heilier@toxi.ucl.ac.beOBJECTIVES: Cadmium (Cd) and lead (Pb) have been demonstrated to exert endocrine disrupting activities. Their possible role in endometriosis, an oestrogen-dependent disease, is unknown. METHODS: We compared cadmium urinary excretion (CdU) and blood concentration of cadmium (CdB) and lead (PbB) in 119 patients with peritoneal endometriosis and/or deep endometriotic (adenomyotic) nodules of the rectovaginal septum and 25 controls. RESULTS: The mean levels of cadmium in urine and blood did not differ among the groups. Women suffering from endometriotic diseases showed lower levels of PbB than controls. CONCLUSIONS: These data do not support a role for cadmium in the onset or the growth of endometriotic diseases but suggest a possible relationship with lead.Publication Types: Research Support, Non-U.S. Gov’tFertil Steril. 2006 Apr;85(4):1060.e1-2.Bowel endometriosis and schistosomiasis: a rare but possible association.Abrao MS, Dias JA Jr, Podgaec S, Carvalho FM, Averbach M.Department of Obstetrics and Gynecology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil. msabrao@attglobal.netOBJECTIVE: To report the case of a patient submitted to laparoscopic bowel resection in whom histology revealed endometriosis and schistosomiasis. DESIGN: Case report. SETTING: Multidisciplinary group practice and teaching hospital. PATIENT(S): A 31-year-old patient with pelvic pain. INTERVENTION(S): Laparoscopic bowel resection. MAIN OUTCOME MEASURE(S): Laparoscopic treatment of endometriosis affecting the sigmoid. RESULT(S): Histology performed on tissue removed at surgery revealed epithelioid granulomas with birefringent and partially calcified eggs characteristic of Schistosoma mansoni within an endometriotic lesion affecting the entire width of the sigmoid. CONCLUSION(S): Endometriosis and schistosomiasis may be present simultaneously in patients with bowel symptoms and pelvic pain.Publication Types: Case ReportsCurr Med Res Opin. 2006 Mar;22(3):495-500.A retrospective claims database analysis to assess patterns of interstitial cystitis diagnosis.Wu EQ, Birnbaum H, Kang YJ, Parece A, Mallett D, Taitel H, Evans RJ.Analysis Group, Inc., Boston, MA 02199, USA. ewu@analysisgroup.comOBJECTIVE: Interstitial cystitis (IC) is often misdiagnosed as one of several other conditions manifesting similar symptoms. This analysis assesses the potential extent of IC misdiagnosis while considering concomitant conditions in a managed care population and identifies predictors of IC diagnosis. RESEARCH DESIGN AND METHODS: Administrative insurance claims data covering 1.7 million lives (1999-2003) were analyzed. Insurance enrollees with >or= 1 IC diagnosis (ICD-9-CM of 595.1x) were identified as IC patients. A random sample of non-IC controls was selected using a 10:1 matching ratio. Six-month incidence rates of ‘commonly misdiagnosed conditions’, (overactive bladder, urinary tract infection, chronic pelvic pain, endometriosis, prostatitis) were compared before and after patients’ initial IC diagnosis and the reduction in incidence rate of commonly misdiagnosed conditions was used as a suggestive measure of the extent of IC misdiagnosis. The Kaplan-Meier method was used to assess the extent that commonly misdiagnosed conditions were predictors of subsequent IC. A Cox Proportional Hazards regression model (that adjusts for patient demographics, concomitant and misdiagnosed conditions) was used to estimate the hazard ratio (HR) of these conditions. Similar analyses were performed for the ‘commonly concomitant conditions’ (fibromyalgia, irritable bowel syndrome, vulvodynia). RESULTS: There were 992 IC patients and 9920 controls identified. The reduced incidence of commonly misdiagnosed conditions after initial IC diagnosis suggests that the misdiagnosis rate could be as high as 38% within the 6-month period before initial IC diagnosis. CONCLUSIONS: Diagnoses of commonly misdiagnosed conditions are significant predictors of future IC diagnosis. When overlooked, potential misdiagnosis of IC can lead to underestimation of the true prevalence of IC. Similarly, diagnoses of commonly concomitant conditions are significant predictors of future IC diagnosis. These initial findings based on claims data suggest hypotheses for further investigation with clinical data. These results suggest more consideration of IC as a diagnosis is warranted, especially when certain diagnoses are repeatedly made and the resulting treatments do not alleviate the patient’s symptoms.Publication Types: Research Support, Non-U.S. Gov’tJ Trauma Stress. 2006 Feb;19(1):45-56.PTSD and physical comorbidity among women receiving Medicaid: results from service-use data.Seng JS, Clark MK, McCarthy AM, Ronis DL.Department of Obstetrics and Gynecology, School of Nursing, University of Michigan Institute for Research on Women and Gender, Ann Arbor, 48109-1290, USA. jseng@umich.eduPatterns of physical comorbidity among women with posttraumatic stress disorder (PTSD) were explored using Michigan Medicaid claims data. PTSD-diagnosed women (n = 2,133) were compared with 14,948 randomly selected women in three health outcome areas: ICD-9 categories of disease, chronic conditions associated with sexual assault history in previous research, and reproductive health conditions. PTSD was associated with increased risk of all categories of diseases (OR range = 1.3-4.8), endometriosis (OR = 2.7), and dyspareunia (OR = 3.4). When PTSD was not complicated by other mental health conditions, odds ratios for chronic conditions ranged from 1.9 for fibromyalgia to 4.3 for irritable bowel. Comorbidity with depression or a dissociative or borderline personality disorder raised risk in a dose-response pattern.Mol Endocrinol. 2007 Jan;21(1):1-13. Epub 2006 Mar 23.Estrogen receptor-beta: recent lessons from in vivo studies.Harris HA.Women’s Health and Musculoskeletal Biology, Wyeth Research, Collegeville, Pennsylvania 19426, USA. harrish@wyeth.comThe unexpected discovery of a second form of the estrogen receptor (ER), designated ERbeta, surprised and energized the field of estrogen research. In the 9 yr since its identification, the remarkable efforts from academic and industrial scientists of many disciplines have made significant progress in elucidating its biology. A powerful battery of tools, including knockout mice as well as a panel of receptor-selective agonists, has allowed an investigation into the role of ERbeta. To date, in vivo efficacy studies are limited to rodents. Current data indicate that ERbeta plays a minor role in mediating estrogen action in the uterus, on the hypothalamus/pituitary, the skeleton, and other classic estrogen target tissues. However, a clear role for ERbeta has been established in the ovary, cardiovascular system, and brain as well as in several animal models of inflammation including arthritis, endometriosis, inflammatory bowel disease, and sepsis. The next phase of research will focus on elucidating, at a molecular level, how ERbeta exerts these diverse effects and exploring the clinical utility of ERbeta-selective agonists.Publication Types: ReviewJ Minim Invasive Gynecol. 2006 Mar-Apr;13(2):164-5.Laparoscopic approach to an endometriotic vault fistula causing posthysterectomy "menstruation".Oliver R, Coker A, Khoo D.Department of Obstetrics and Gynaecology, Harold Wood Hospital, Romford, United Kingdom. oliverreebs@aol.comEndometriosis is a commonly prevalent disease but can include rare complaints posing a challenge to surgical treatment. We describe an unreported cause of menstruation after hysterectomy, which was revealed as an endometriotic tubo-ovarian mass that fistulated into the vaginal vault. A 37-year-old woman experienced monthly vaginal bleeding after hysterectomy. At laparoscopy a tubo-ovarian endometriotic mass was revealed with a fistula into the vaginal vault. The mass was adherent to the left ureter and the sigmoid colon. Laparoscopic excision of the mass and fistula after ureterolysis and bowel dissection was performed. This case describes an unreported cause of posthysterectomy menstruation. The management outlines the optimal surgical management of laparoscopic techniques combined with vaginal access to achieve complete excision with minimal patient morbidity.Publication Types: Case ReportsGastroenterol Clin Biol. 2005 Nov;29(11):1157-9.Exclusive ileal endometriosis.[Article in French]Roger N, Munoz-Bongrand N, Vila A, Allez M, Gornet JM, Cattan P, Lemann M, Sarfati E.Services de Chirurgie Générale, Digestive et Endocrinienne, Hôpital Saint-Louis, AP-HP, Paris.Endometriosis is a common condition, but its exclusive localization on the ileum is very rare. Unless there is catamenial exacerbation of symptoms, and considering the lack of specificity of results, diagnosis can be difficult. We report the case of a 50 year-old woman presenting with chronic pain in the right lower quadrant. Initial explorations revealed an ileal tumor which was not characterized before the occurrence of acute small bowel obstruction. Ileo-caecal resection by laparotomy relieved the symptoms and alllesions were removed. Diagnosis of ileal endometriosis was made by pathological examination of the resected specimen.Publication Types: Case ReportsEnglish AbstractHum Reprod. 2006 Mar;21(3):774-81. Epub 2006 Jan 31.Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible?Landi S, Ceccaroni M, Perutelli A, Allodi C, Barbieri F, Fiaccavento A, Ruffo G, McVeigh E, Zanolla L, Minelli L.Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Via Don A.Sempreboni 5, 37024 Negrar (Verona), School of Medicine, University of Bologna, Italy.BACKGROUND: Little is known about the morbidity associated with laparoscopic complete excision of endometriosis in terms of urinary, digestive and sexual function. METHODS: We performed a prospective non-randomized study in 45 patients with laparoscopic complete excision of all detectable foci of endometriosis with segmental bowel resection using a non nerve-sparing technique (control group-group A n=20) and a nerve-sparing technique (case group-group B n=25). At initial gynaecological evaluation, and at follow-up details on dysmenorrhoea, pelvic pain, dyspareunia and dyschezia were evaluated using an interview-based questionnaire (10-point analogue rating scale: 0=absent, 10=unbearable). RESULTS: The mean (+/-SD) follow-up period was 15.3+/-10 months (range, 8.8-23 months) for group A and 3.5+/-2.1 months (range, 0.3-5.2 months) for group B. In the immediate postoperative course, in group A three women required blood transfusion vs seven women in group B (P=0.003). The median time to resume the voiding function was significantly shorter in group B (12.5 vs 3.0 days; P<0.01). At the time of follow-up a higher proportion of patients in group B were ‘very satisfied’ than those in group A (87.7% vs 59.0%, P=0.013). CONCLUSIONS: Laparoscopic nerve-sparing complete excision of endometriosis seems to be feasible and offers good results in terms of bladder morbidity reduction with apparently higher satisfaction than classical technique. Larger series with longer follow-up are needed to confirm our results.Publication Types: Comparative StudyObstet Gynecol. 2006 Feb;107(2 Pt 2):451-3.Colouterine fistula secondary to endometriosis with associated chorioamnionitis.Sriganeshan V, Willis IH, Zarate LA, Howard L, Robinson MJ.Arkadi M. Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA. vathanysri@yahoo.comBACKGROUND: Intestinal endometriosis may be complicated by bowel obstruction, colonic rupture, sepsis, and rarely, malignant transformation. Fistula formation is extremely rare. CASE: A 26-year-old woman presented at 16 weeks of gestation with an acute abdomen suggestive of ruptured appendicitis. Blood cultures were positive for Bacteroides fragilis. At laparotomy, she was found to have a colouterine fistula with pelvic sepsis. The resected specimens demonstrated extensive uterine adenomyosis and endometriosis of the cecum, with a fistulous tract lined by endometriosis and suppurative inflammation extending from the cecum to the uterine endometrial cavity associated with severe chorioamnionitis and endomyometritis. CONCLUSION: This case illustrates a rare complication of colouterine fistula secondary to intestinal endometriosis.Publication Types: Case ReportsArq Gastroenterol. 2005 Oct-Dec;42(4):226-32. Epub 2006 Jan 19.Importance of the tridimensional ultrasound in the anorectal evaluation.[Article in Portuguese]Regadas SM, Regadas FS, Rodrigues LV, Silva FR, Lima DM, Regadas-Filho FS.Centro de Coloproctologia e Gastroenterologia, Hospital São Carlos, Fortaleza, CE. smregadas@hospitalsaocarlos.com.brBACKGROUND: Anorectal endosonography is actually the main image exam to evaluate some anorectal diseases. AIM: To show the three-dimensional endosonography importance in the anal canal anatomic evaluation and the anorectal diseases diagnosis. METHODS: Seventy four anorectal ultrasound were performed, 23 normal individuals (13 women) and 51 patients (33 women) with benign and malignant diseases. All the patients were examined with a 3-D equipment with 360 degrees transducer. Normal individuals were evaluated in midline sagittal plane concerning to the length of the anal canal, the internal anal sphincter, the external anal sphincter and the anatomic defect in the anterior quadrant. RESULTS: There were no differences in the anal canal and the internal anal sphincter length between men and women. Otherwise, the external anal sphincter length is longer in men and the anatomic defect is longer in women. In those with anorectal diseases, 11 sphincter injuries, 8 anal fistulas, 7 abscess, 1 perirectal endometriosis, 1 pre-sacral cyst, 3 anal canal and 10 rectal malignant neoplasias were diagnosed. The surgical findings confirmed the ultrasound diagnosis in all the patients. CONCLUSION: Three-dimensional endosonography demonstrated the anatomic differences between male and female anal canal, justifying the larger incidence of pelvic floor disorders in female patients. It was possible to diagnose the anorectal diseases, in multi-plane, with high spatial resolution, adding also important informations about the therapeutic decision. Such characteristics become it similar to nuclear magnetic resonance with intra-rectal coil, with the advantages to be easier, quicker, low cost and better tolerated.Publication Types: English AbstractHum Reprod. 2006 May;21(5):1243-7. Epub 2006 Jan 26.Comment in:Hum Reprod. 2006 Jul;21(7):1941-2; author reply 1942-3. Quality of life after laparoscopic colorectal resection for endometriosis.Dubernard G, Piketty M, Rouzier R, Houry S, Bazot M, Darai E.Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Université Saint-Antoine Paris VI, Assistance Publique des Hôpitaux de Paris, France.BACKGROUND: Indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. Therefore, the aims of the current study were to evaluate the efficacy of laparoscopic segmental colorectal resection for endometriosis on quality of life and gynaecologic and digestive symptoms, and its complications. METHODS: After magnetic resonance imaging and rectal endoscopic sonographic evaluation of symptomatic colorectal endometriosis, 58 consecutive women requiring colorectal resection were included in this study. Symptom questionnaires and the short-form (SF)-36 Health Status and the quality of life score were completed. Linear intensity scores for several gynaecologic and digestive symptoms and perioperative complications were also recorded. RESULTS: Fifty-one women (88%) underwent laparoscopic segmental colorectal resection and seven required laparoconversion. Major complications occurred in nine cases (15.5%), including six rectovaginal fistulae (10.3%), and the three remaining complications corresponded to a haemoperitoneum, a uroperitoneum and a pelvic abscess. Median follow-up after colorectal resection was 22.5 months (2-55 months). A significant improvement in dysmenorrhoea (P < 0.0001), dysparaeunia (P < 0.0001), bowel movement pain or cramping (P < 0.0001), pain on defecation (P < 0.0001), diarrhoea (P < 0.016), lower back pain (P < 0.0001) and asthaenia (P < 0.0002) was observed. Tenesmus, rectorrhagia and constipation were not improved. All the items of the SF-36 Health Status and the quality of life score were improved after colorectal resection for endometriosis. CONCLUSION: Laparoscopic segmental colorectal resection for endometriosis significantly improves quality of life and gynaecologic and digestive symptoms. However, women have to be informed on the risk of complications including rectovaginal fistula.Colorectal Dis. 2006 Feb;8(2):102-11.Self-expanding metallic stents in the treatment of benign colorectal disease: indications and outcomes.Forshaw MJ, Sankararajah D, Stewart M, Parker MC.Department of Surgery, Darent Valley Hospital, Dartford, UK.OBJECTIVE: The use of stents for benign colorectal obstruction is considered controversial because of a lack of data and perceived high failure and complication rates. The aim of this study was to evaluate the indications and outcomes following stent placement for benign colorectal disease in a UK district general hospital and to review the published literature. PATIENTS AND METHODS: Between 1997 and 2004, 11 of 90 attempted stent insertions were performed for benign colorectal disease (diverticular disease, 4; anastomotic strictures, 4; idiopathic rectal stricture, 1; rectal endometriosis, 1; caecal volvulus, 1). Complications and outcomes were analysed from a prospective database. RESULTS: Stent insertion was successful in nine patients. Early complications occurred in two patients (both with diverticular disease): one patient failed to decompress and needed a colostomy and laparotomy was performed in a second patient who developed peritonitis after five days although no stent perforation of the bowel was identified. Two patients were successfully decompressed and underwent subsequent elective surgery with full bowel preparation. Stent placement resulted in symptomatic improvement in three out of four patients with anastomotic strictures (allowing closure of defunctioning stomas) and in the one patient with an idiopathic rectal stricture. Stent migration occurred in two of these patients without recurrence of symptoms. Stent fracture occurred in one patient, who remained symptomatic. CONCLUSIONS: Self-expanding metallic stents are an effective treatment for benign colorectal obstructions, especially anastomotic strictures with long-term patency. Stents should be avoided in acute diverticular disease because of a higher incidence of complications.Publication Types: ReviewJSLS. 2005 Oct-Dec;9(4):488-90.Colonoscopic diagnosis of appendiceal intussusception: case report and review of the literature.Duncan JE, DeNobile JW, Sweeney WB.Department of Surgery, National Naval Medical Center, Bethesda, Maryland, USA.Intussusception of the appendix is an extremely rare condition. Although approximately 200 cases of appendiceal intussusception have been reported in the literature, very few have ever been diagnosed preoperatively. We report a case of appendiceal intussusception secondary to endometriosis in an otherwise healthy female. The case was diagnosed preoperatively by colonoscopy and treated surgically at laparoscopy. We review the literature of appendiceal intussusception and discuss the associated conditions, diagnosis, and a classification scheme for this unusual finding.Publication Types: Case ReportsMt Sinai J Med. 2005 Nov;72(6):405-8.Intestinal obstruction due to rectal endometriosis.Paksoy M, Karabiçak I, Ayan F, Aydoğan F.Department of General Surgery, Cerrahpasa Medical Facility, Istanbul University, Istanbul, Turkey.We report a case of a premenopausal woman with severe constipation causing intermittent obstruction. Colonoscopy revealed a tight rectal stricture; however, mucosal biopsies were normal. Exploratory surgery revealed an intense fibrotic reaction involving the rectum and uterus, necessitating a simultaneous low anterior resection and hysterectomy. Pathology established a diagnosis of endometriosis. Preoperative diagnosis of rectal endometriosis can be difficult to establish. Endometrial deposits do not invade the mucosa; therefore, colonoscopy with biopsies are frequently non-diagnostic. Surgery may be the only definitive way to obtain a certain diagnosis. In cases involving rectal strictures of unknown etiology in premenopausal women, rectal endometriosis must be included in the differential diagnosis.Publication Types: Case ReportsJ Pediatr Adolesc Gynecol. 2005 Dec;18(6):371-7.Adolescent chronic pelvic pain.Song AH, Advincula AP.Department of Obstetrics & Gynecology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA.The presentation of chronic pelvic pain in the adolescent can at times be quite daunting. A careful and insightful approach to obtaining the history and physical examination must be implemented while maintaining an appreciation of the various stages of adolescent development. The etiologies can range from gynecologic to nongynecologic causes. The ability to render an early diagnosis and appropriate treatment in this population of patients can significantly improve future reproductive health outcomes. The following minireview will outline a systematic approach to the adolescent with chronic pelvic pain.Publication Types: ReviewArch Pathol Lab Med. 2005 Dec;129(12):e218-21.A 42-year-old woman with a 7-month history of abdominal pain. A, endometriosis involving ileocecal junction and 2 pericolonic lymph nodes; B, intranodal benign glandular inclusions.Sheikh HA, Krishnamurti U, Bhat Y, Rajendiran S.Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. cheikhha@msx.upmc.eduPublication Types: Case ReportsAm J Obstet Gynecol. 2005 Dec;193(6):2062-6.Ovarian remnant syndrome.Magtibay PM, Nyholm JL, Hernandez JL, Podratz KC.Division of Gynecologic Surgery, Mayo Clinic, Scottsdale, AZ 85259, USA. magtibay.paul@mayo.eduOBJECTIVE: This study was undertaken to examine surgical management of patients with ovarian remnant syndrome. STUDY DESIGN: Data were abstracted from records of patients with a history of bilateral salpingo-oophorectomy who were treated surgically at Mayo Clinic between 1985 and 2003 for pathologically confirmed residual ovarian tissue. A follow-up questionnaire was also mailed. RESULTS: Records review identified 186 patients (mean age, 37.6 years; mean follow-up, 1.2 years). Of 180 patients with available data, 153 (85%) underwent oophorectomy by laparotomy, 13 (7%) by laparoscopy, and 14 (8%) by transvaginal approach, mostly for endometriosis (56.8%). Of 186 patients, 105 (57%) presented with pelvic masses and 89 (48%) with pelvic pain. Remnant ovarian tissue was associated with a corpus luteum in 78 (42%) and endometriosis in 54 (29%). The intraoperative complication rate was 9.6%. Of 142 patients, 12 (9%) required subsequent re-exploration (1 ovarian remnant identified). CONCLUSION: This heavily pretreated population has modest risk of bowel, bladder, or ureteral trauma with definitive pelvic sidewall stripping and apical vaginal excision. However, subsequent recurrence is minimal (<1%). More than 90% of patients reported resolution or marked improvement of symptoms.Gastrointest Endosc. 2005 Dec;62(6):978-9; discussion 979.Erratum in:Gastrointest Endosc. 2006 Jan;63(1):198. Abrao, Mauricio [corrected to Abrao, Mauricio S]. Rectal endometriosis.Averbach M, Abrao MS, Podgaec S, Correa P.Endoscopy Unit, Hospital Sirio Libanes, Sao Paulo, Brazil.Publication Types: Case ReportsGastroenterol Clin Biol. 2005 Aug-Sep;29(8-9):942-4.Peritonitis by sigmoid perforation in two patients with endometriosis: report of 2 cases.[Article in French]Vialle R, Pietin-Vialle C, Burdy G, Drain O, Gillot V, Bernier M, Frileux P.Publication Types: Case ReportsLetterReprod Biomed Online. 2005 Oct;11(4):455-7.Successful treatment of an aggressive recurrent post-menopausal endometriosis with an aromatase inhibitor.Fatemi HM, Al-Turki HA, Papanikolaou EG, Kosmas L, De Sutter P, Devroey P.Centre of Reproductive Medicine, AZ-VUB, University Hospital, Dutch-speaking Free University of Brussels, Laarbeeklaan 101, 1090-Brussels, Belgium. hmousavi@az.vub.ac.beThe current case report describes the development and medical treatment of an aggressive pelvic endometrioma in a post-menopausal patient, who had undergone abdominal hysterectomy and salpingo-oophorectomy a decade earlier. The patient was referred to the authors’ centre because of right-sided sciatic pain. Three months before her admission she was hospitalized elsewhere due to subacute bowel obstruction. She was operated on and a resection of a part of sigmoid colon and an endometrioma, which was the cause of the subobstruction, was carried out. During the clinical investigation for the right-sided sciatic pain, an intrapelvic mass was found, which was compressing the lumbo-sacral plexus mimicking sciatica. The diagnosis of recurrent endometrioma was confirmed by a computerized tomography-guided biopsy and the decision was made to treat it with an aromatase inhibitor (letrozole). Eighteen months later, the endometrioma was almost completely regressed and the patient was free of symptoms. Medical management of recurrent post-menopausal endometriosis with aromatase inhibitors seems to be an effective alternative treatment to surgery.Publication Types: Case ReportsTurk J Gastroenterol. 2005 Mar;16(1):48-51.Colonic obstruction due to rectal endometriosis: report of a case.Yildirim S, Nursal TZ, Tarim A, Torer N, Bal N, Yildirim T.Department of General Surgery, Adana Teaching and Medical Research Center, Başkent University, Adana, Turkey. ysedat@hotmail.comAlthough endometriosis is a common disease in women of childbearing age, intestinal endometriosis is unusual and may cause clinically significant complications. We report a 46-year-old woman with rectal endometriosis who presented with intestinal obstruction. She was operated on with a preoperative diagnosis of malignancy. The diagnosis of endometriosis was made only after histological examination of the resected specimen. Intestinal endometriosis has a diverse clinical spectrum, with nonspecific features in many patients. In female patients who have unexplained digestive complaints, endometriosis should also be considered in the differential diagnosis.Publication Types: Case ReportsInt Urogynecol J Pelvic Floor Dysfunct. 2006 Nov;17(6):646-9. Epub 2006 Jul 13.Perineal endometriosis in episiotomy scar with anal sphincter involvement: report of two cases and review of the literature.Barisic GI, Krivokapic ZV, Jovanovic DR.First Surgical Clinic, Clinical Center of Serbia, Institute for Digestive Diseases, Koste Todorovica 6, 11000 Belgrade, Serbia and Montenegro. scpy@beotel.yuPerineal endometriosis with anal sphincter involvement is a rare occurrence with only nine cases reported so far. Two such cases are presented, and the literature is reviewed. In presented cases, diagnosis was suspected at clinical exam. Anal manometry was performed in both cases and endoanal ultrasound in one case. Wide surgical excision of endometriotic mass together with part of external anal sphincter was carried out in both cases. The procedure was followed by anal sphincter reconstruction in an "overlapping" fashion in the first and "apposition" technique in the second case. Histopathologic tests confirmed endometriosis. The recovery was uneventful in both cases with excellent functional results. Two years after the operation, patients are asymptomatic and fully continent. According to the literature and our own experience, wide excision of endometrioma with primary sphincteroplasty seems to be the best chance of cure with satisfactory functional results and should be recommended.Publication Types: Case ReportsSaudi Med J. 2005 Oct;26(10):1546-50.Unusual causes of mechanical small bowel obstruction.Shatnawi NJ, Bani-Hani KE.Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan.OBJECTIVES: We herein report our experience regarding unusual causes of bowel obstruction to increase the awareness of surgeons regarding this disease. METHODS: From 1991 to 2003, we had experience at the University affiliated hospitals, northern Jordan with 24 patients with small bowel obstruction resulting from unusual causes. We retrospectively reviewed the medical records of these patients with regards to the mode of presentation, cause of obstruction, radiological and operative findings, management and outcome. RESULTS: We recorded 15 patients who underwent previous abdominal surgery. Preoperative diagnosis was correct in only one patient with an internal hernia, but the abdominal CT scan suggested the diagnosis in 5 of the 9 patients who had the scan. The final diagnosis was internal hernias in 11 patients, foreign bodies in 5, ischemic strictures in 3, carcinoid tumors in 2, endometriosis in 2, and metastatic deposit from interstitial bladder carcinoma in one patient. Nine of the 12 patients with recurrent obstruction had either short course or recurrence obstruction during the same hospital admission. W carried out bowel resections in 15 patients (5 resections were due to bowel strangulation). Post operative death occurred in 4 patients. CONCLUSIONS: Awareness of these rare causes of intestinal obstruction even in patients with previous abdominal operation might improve the outcome. The tentative diagnosis of adhesion obstruction in patients with unusual obstructive etiology might lead to a higher rate of gangrenous complications. Rigorous preoperative evaluation including careful history and early abdominal CT may show the obstructive cause.Publication Types: Comparative StudyUgeskr Laeger. 2005 Sep 19;167(38):3604-5.Colon ileus caused by endometriosis.[Article in Danish]Andersen NS, Pedersen MD, Filtenborg-Barnkob BE.Roskilde Amts Sygehus Køge, Organkirurgisk Afdeling A.stevnbak@yahoo.dkA case history of acute obstruction of the sigmoid colon caused by endometriosis in a 35-year-old woman is described. Endometriosis occasionally causes relative stenoses of the bowel, whereas total obstruction is rarely seen. Obstruction of the sigmoid colon is often caused by malignancy, but sometimes other causes must be considered.Publication Types: Case ReportsEnglish AbstractFertil Steril. 2005 Oct;84(4):945-50.Fertility after laparoscopic colorectal resection for endometriosis: preliminary results.Daraï E, Marpeau O, Thomassin I, Dubernard G, Barranger E, Bazot M.Service de Gynécologie, Hôpital Tenon, AP-HP, Paris, France. emile.darai@tnn.ap-hop-paris.frOBJECTIVE: To examine fertility, reproductive outcomes, and determinants of fertility after laparoscopic segmental colorectal resection for endometriosis. DESIGN: Retrospective longitudinal study. SETTING: Tertiary university gynecology unit. PATIENT(S): The study population consisted of 34 women with colorectal endometriosis, of whom 22 wished to conceive. Demographic, surgical, and histological characteristics of 10 women who conceived were compared with those of 12 women who failed to conceive. INTERVENTION(S): Laparoscopic colorectal resection for endometriosis. MAIN OUTCOME MEASURE(S): Rates of pregnancy and live birth. RESULT(S): Mean follow-up after segmental colorectal resection was 24 months (range 6-42 months), and the pregnancy rate was 45.5%. The median time to conceive was 8 months (range 3-13 months). Twelve pregnancies occurred in 10 women, comprising nine spontaneous singleton pregnancies (7 vaginal deliveries, 1 cesarean section, and 1 ongoing pregnancy), and three pregnancies obtained by IVF (one miscarriage, one ongoing twin pregnancy, and one triplet pregnancy necessitating cesarean section at 29 weeks for premature rupture of the membranes, with two surviving infants). The live birth rate was 82%. The women who did and did not conceive did not differ in terms of mean follow-up, mean age, body mass index (BMI), parity, smoking, use and duration of oral contraception (OC), duration of infertility, or the length of the resected colorectal segment. Uterine adenomyosis was the main determinant of pregnancy after colorectal resection. CONCLUSION(S): These preliminary results suggest that extensive laparoscopic segmental colorectal resection for endometriosis can enhance fertility, with high rates of spontaneous pregnancy and live birth.Publication Types: Comparative StudyJ Minim Invasive Gynecol. 2005 Sep-Oct;12(5):391-5.Intraoperative sigmoidoscopy in gynecologic surgery.Nezhat C, de Fazio A, Nicholson T, Nezhat C.Atlanta Center for Special Pelvic Surgery, Atlanta, Georgia 30342, USA. info@nezhat.comIntraoperative sigmoidoscopy is underused by the majority of practicing gynecologists and is not widely taught in obstetrics and gynecology training programs. In this report, a step-by-step approach is provided in order to perform sigmoidoscopy. Indications for use, along with various intraoperative applications, are discussed. Results from our center’s experience with its use during laparoscopic treatment of adhesions, endometriosis, and associated disease of the bowel also are provided. Intraoperative sigmoidoscopy is a safe and efficacious procedure that can aid in the evaluation and treatment of pelvic pathology and facilitate identification and management of bowel injuries. It should be considered a valuable adjunct when such cases are encountered by gynecologic and pelvic surgeons.Publication Types: ReviewHum Reprod Update. 2005 Nov-Dec;11(6):595-606. Epub 2005 Sep 19.Republished in:Gynecol Obstet Fertil. 2009 Jan;37(1):57-69. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications.Fauconnier A, Chapron C.Unité Inserm 149, Recherches Epidémiologiques en Santé Périnatale et Santé des Femmes, Port-Royal, Paris, France.The relationship between chronic pelvic pain symptoms and endometriosis is unclear because painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic micro-bleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the sub-peritoneal pelvic space by the implants. The painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, painful defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as location indicating pain. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic management of endometriosis in a context of pain.Publication Types: ReviewEur Radiol. 2006 Feb;16(2):285-98. Epub 2005 Sep 10.Diagnosis of endometriosis with imaging: a review.Kinkel K, Frei KA, Balleyguier C, Chapron C.Institut de Radiologie, Clinique et fondation des Grangettes, 7, chemin des Grangettes, 1224, Chêne-Bougeries/Geneva, Switzerland. Karen.Kinkel@grangettes.chEndometriosis corresponds to ectopic endometrial glands and stroma outside the uterine cavity. Clinical symptoms include dysmenorrhoea, dyspareunia, infertility, painful defecation or cyclic urinary symptoms. Pelvic ultrasound is the primary imaging modality to identify and differentiate locations to the ovary (endometriomas) and the bladder wall. Characteristic sonographic features of endometriomas are diffuse low-level internal echos, multilocularity and hyperchoic foci in the wall. Differential diagnoses include corpus luteum, teratoma, cystadenoma, fibroma, tubo-ovarian abscess and carcinoma. Repeated ultrasound is highly recommended for unilocular cysts with low-level internal echoes to differentiate functional corpus luteum from endometriomas. Posterior locations of endometriosis include utero-sacral ligaments, torus uterinus, vagina and recto-sigmoid. Sonographic and MRI features are discussed for each location. Although ultrasound is able to diagnose most locations, its limited sensitivity for posterior lesions does not allow management decision in all patients. MRI has shown high accuracies for both anterior and posterior endometriosis and enables complete lesion mapping before surgery. Posterior locations demonstrate abnormal T2-hypointense, nodules with occasional T1-hyperintense spots and are easier to identify when peristaltic inhibitors and intravenous contrast media are used. Anterior locations benefit from the possibility of MRI urography sequences within the same examination. Rare locations and possible transformation into malignancy are discussed.Publication Types: ReviewJ Obstet Gynaecol. 2005 Jan;25(1):52-4.Safety of the Helica Thermal Coagulator in treatment of early stage endometriosis.Hill NC, El-Toukhy T, Chandakas S, Grigoriades T, Erian J.Minimal Access Unit, Department of Obstetrics and Gynaecology, The Princess Royal University Hospital, Orpington, Kent, UK. denise.Dalton@bromleyhospitals.nhs.ukThe objective of this prospective study was to assess the safety and short-term outcome of the Helica Thermal Coagulator in the laparoscopic treatment of early stage endometriosis. Two hundred and fifty consecutive women with chronic pelvic pain and stage I and II endometriosis (r-AFS classification) were treated laparoscopically with the Helica Thermal Coagulator. No bladder, ureteric or bowel injuries occurred. None of the procedures was converted to laparotomy and there were no major peri-operative complications. The only complication was a vaginal perforation during dissection of the cul-de-sac in a patient with a vaginal vault endometriotic nodule. We conclude that the Helica Thermal Coagulator is a safe alternative for the treatment of mild to moderate endometriosis. Long-term efficacy studies are required to better assess the role of the device in laparoscopic management of endometriosis.J Obstet Gynaecol. 2004 Nov;24(8):931-2.Widespread intraperitoneal and diaphragmatic endometriosis presenting with frequent bowel motions and chronic shoulder tip pain.Basama FM.Sharoe Green Hospital, Preston, Lancashire, UK. fbasama@hotmail.comPublication Types: Case Reports