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1.
FEMINA ; 50(3): 178-183, 20220331. graf
Article in Portuguese | LILACS | ID: biblio-1367572

ABSTRACT

Objetivo: Analisar o perfil epidemiológico e clínico e a assistência médica fornecida às pacientes acompanhadas no ambulatório específico para endometriose em um hospital universitário público brasileiro. Métodos: Trata-se de um estudo transversal retrospectivo. Foram incluídos os prontuários médicos de 153 pacientes com endometriose acompanhadas em nosso ambulatório desde sua criação, em fevereiro de 2017, até abril de 2020. Os dados coletados foram utilizados para estabelecer os sintomas mais prevalentes, os métodos diagnósticos utilizados, os locais acometidos com maior frequência, o tratamento clínico estabelecido e as características epidemiológicas da população estudada. Resultados: A idade média das pacientes foi de 35,2 ± 7,23 anos. Os sintomas mais prevalentes foram dismenorreia (88,2%), dispareunia (65,4%) e infertilidade (52,9%). O ovário foi o local mais acometido (60,1%). A coexistência de doenças autoimunes foi identificada em 7,2% das pacientes. Cerca de 47,7% das pacientes foram diagnosticadas com ressonância magnética pélvica e 45% foram tratadas com dienogeste. Conclusão: O reconhecimento da epidemiologia da endometriose, os sintomas mais frequentes e as comorbidades associadas à doença podem permitir aos profissionais de saúde melhorar sua capacidade diagnóstica e realizar uma assistência clínica individualizada e eficiente.(AU)


Objective: To analyze the epidemiological and clinical profile and the medical assistance provided to patients followed up in the specific outpatient clinic of endometriosis in a Brazilian public university hospital. Methods: It was a cross-sectional retrospective study. Medical records of 153 patients with endometriosis followed up in our specific outpatient clinic, since its creation, in February 2017, until April 2020 were included. Data collected was used to establish the most prevalent symptoms, diagnostic methods used, most frequent sites of involvement, clinical treatment and epidemiological characteristics of the study population. Results: The mean age of patients was 35.2 ± 7.23 years old. The most prevalent symptoms were dysmenorrhea (88.2%), dyspareunia (65.4%) and infertility (52.9%). Ovary was the most affected site (60.1%). The coexistence of autoimmune disease was identified in 7.2% patients. About 47.7% were diagnosed by pelvic magnetic resonance imaging (MRI) and 45% were treated with dienogest. Conclusion: The recognition of endometriosis epidemiology, the most frequent symptoms and the comorbidities associated with the disease may enable health care professionals to improve the diagnostic capacity and to perform an individualized and efficient clinical assistance.(AU)


Subject(s)
Humans , Female , Endometriosis/drug therapy , Endometriosis/epidemiology , Health Profile , Brazil/epidemiology , Medical Records , Cross-Sectional Studies , Endometriosis/diagnosis , Endometriosis/diagnostic imaging
2.
Femina ; 49(3): 134-141, 20210331. ilus
Article in Portuguese | LILACS | ID: biblio-1224073

ABSTRACT

A suspeita clínica de endometriose geralmente envolve a história clínica da paciente e exame físico, abordando sua sintomatologia e história pessoal e familiar. Entretanto, a apresentação clínica da doença varia consideravelmente, sem características clínicas patognomônicas, fato que dificulta o seu diagnóstico. Um diagnóstico presuntivo de endometriose pode ser fortemente sugerido pela ultrassonografia transvaginal e pela ressonância magnética em casos de endometrioma ou endometriose infiltrativa profunda. No entanto, esses exames de imagem não possuem a sensibilidade e a especificidade necessárias quando se trata de endometriose peritoneal superficial. O biomarcador sérico mais utilizado na investigação da endometriose foi o CA-125, que não apresenta sensibilidade (70%-75%) suficiente para sua indicação na prática clínica. Portanto, apesar de seu risco e alto custo, a videolaparoscopia e a análise anatomopatológica subsequente ainda se apresentam como o procedimento padrão-ouro para o diagnóstico definitivo de endometriose. Assim, com o objetivo de demonstrar quais exames seriam necessários para o diagnóstico dessa doença, realizamos uma revisão sistemática da literatura, cujos dados estão descritos a seguir.(AU)


Subject(s)
Humans , Female , Video-Assisted Surgery , Endometriosis/surgery , Endometriosis/etiology , Endometriosis/diagnostic imaging , Progestins/therapeutic use , Contraceptives, Oral, Combined/therapeutic use , Endometriosis/drug therapy , Gonadotropins/agonists
3.
Rev. argent. coloproctología ; 31(2): 54-63, jun. 2020. ilus
Article in English, Spanish | LILACS | ID: biblio-1117010

ABSTRACT

La endometriosis es una de las patologías ginecológicas benignas más frecuente, ocurre en un 7-10% de las mujeres en edad reproductiva y es causal de dolores crónicos e infertilidad. Se trata de una población joven y sana por lo demás. La sospecha diagnóstica de esta entidad debe ser alta y su manejo multidisciplinario.La endometriosis colorrectal representa una variable altamente incapacitante y es aquí donde se plantea la necesidad de un tratamiento más agresivo para su resolución. Frente a esto nos preguntamos, ¿qué rol tiene la cirugía?, ¿cuáles serían sus ventajas y desventajas?, ¿por qué deberíamos elegirla como método terapéutico?.La presente monografía fue inspirada en todas las pacientes que nos plantearon esta controversia. Que motivaron interconsultas, ateneos, búsqueda de bibliografía. Que generaron discusiones, dudas e incertidumbres y nos hicieron salir del rol de cirujanos al que estamos habituados y nos enseñaron a acompañar, cuando no pudimos curar


Subject(s)
Humans , Female , Digestive System Surgical Procedures/methods , Endometriosis/surgery , Intestinal Diseases/surgery , Patient Care Team , Diagnostic Imaging , Treatment Outcome , Laparoscopy/methods , Diet Therapy , Endometriosis/diagnosis , Endometriosis/drug therapy , Hormone Antagonists/therapeutic use , Intestinal Diseases/diagnosis , Intestinal Diseases/drug therapy
5.
Rev. Soc. Bras. Clín. Méd ; 17(2): 106-109, abr.-jun. 2019. ilus., tab.
Article in Portuguese | LILACS | ID: biblio-1026527

ABSTRACT

A endometriose torácica é uma forma de endometriose extrapélvica encontrada em tecidos pulmonares ou na pleura. Caracteriza- se clinicamente pela presença de pneumotórax catamenial, hemotórax catamenial, hemoptise e nódulos pulmonares. O pneumotórax catamenial é a manifestação mais frequente, sendo caracterizado pelo acúmulo recorrente de ar na cavidade torácica durante o período menstrual. Ocorre, geralmente, no hemitórax direito e possui maior incidência na faixa etária dos 30 aos 40 anos de idade. Nosso objetivo é descrever um caso de derrame pleural hemorrágico recorrente e pneumotórax espontâneo correlacionados ao período menstrual em paciente de 34 anos. (AU)


Thoracic endometriosis is a form of extrapelvic endometriosis found in pulmonary tissue or the pleura. Clinically, it is characterized by the presence of catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules. The most frequent clinical presentation is catamenial pneumothorax, which is typified by a recurrent collection of air in the thoracic cavity occurring in conjunction with menstrual periods. It occurs more commonly on the right side and its highest incidence is between 30 and 40 years of age. Our objective is to describe a case of recurrent hemorrhagic pleural effusion and spontaneous pneumothorax correlated to the menstrual period in a 34-year-old patient. (AU)


Subject(s)
Humans , Female , Adult , Endometriosis/diagnosis , Hemopneumothorax/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Pleural Effusion/diagnostic imaging , Progestins/therapeutic use , Thoracoscopy , Uterine Neoplasms/drug therapy , Uterine Neoplasms/diagnostic imaging , Radiography , Tomography, X-Ray Computed , Back Pain , Leiomyomatosis/drug therapy , Leiomyomatosis/diagnostic imaging , Pleurodesis , Contraceptives, Oral, Hormonal/therapeutic use , Cough , Diabetes Mellitus , Dyspnea , Endometriosis/drug therapy , Fever , Thoracentesis , Hemopneumothorax/drug therapy , Lung Neoplasms/drug therapy
6.
Einstein (Säo Paulo) ; 17(2): eAO4583, 2019. tab, graf
Article in English | LILACS | ID: biblio-1001910

ABSTRACT

ABSTRACT Objective: To evaluate clinical features and complications in patients with bowel endometriosis submitted to hormonal therapy. Methods: Retrospective study based on data extracted from medical records of 238 women with recto-sigmoid endometriosis treated between May 2010 and May 2016. Results: Over the course of follow-up, 143 (60.1%) women remained in medical treatment while 95 (39.9%) presented with worsening of pain symptoms or intestinal lesion growth (failure of medical treatment group), with surgical resection performed in 54 cases. Women in the Medical Treatment Group were older (40.5±5.1 years versus 37.3±5.8 years; p<0.0001) and had smaller recto sigmoid lesions (2.1±1.9 versus 3.1±2.2; p=0.008) compared to those who had failed to respond to medical treatment. Similar significant reduction in pain scores for dysmenorrhea, chronic pelvic pain, cyclic dyschezia and dysuria was observed in both groups; however greater reduction in pain scores for dyspareunia was noted in the Surgical Group. Subjective improvement in pain symptoms was also similar between groups (100% versus 98.2%; p=0.18). Major complications rates were higher in the Surgical Group (9.2% versus 0.6%; p=0.001). Conclusion: Patients with recto-sigmoid endometriosis who failed to respond to medical treatment were younger and had larger intestinal lesions. Hormonal therapy was equally efficient in improving pain symptoms other than dyspareunia compared to surgery, and was associated with lower complication rates in women with recto-sigmoid endometriosis. Medical treatment should be offered as a first-line therapy for patients with bowel endometriosis. Surgical treatment should be reserved for patients with pain symptoms unresponsive to hormonal therapy, lesion growth or suspected intestinal subocclusion.


RESUMO Objetivo: Avaliar características clínicas e complicações em pacientes com endometriose intestinal submetidos ao tratamento hormonal. Métodos: Dados de prontuários de 238 pacientes com endometriose de retossigmoide tratadas entre maio de 2010 e maio de 2016 foram coletados para este estudo retrospectivo. Resultados: Durante o período de acompanhamento, 143 (60,1%) mulheres mantiveram tratamento clínico, enquanto 95 (39,9%) tiveram piora dos sintomas de dor ou aumento da lesão intestinal (grupo falha de tratamento clínico), sendo 54 submetidas ao tratamento cirúrgico. As mulheres no Grupo Tratamento Clínico eram mais velhas (40,5±5,1 anos versus 37,3±5,8 anos; p<0,0001) e tinham lesões intestinais menores (2,1±1,9 versus 3,1±2,2; p=0,008) em comparação ao grupo falha de tratamento clínico. Redução significativa e semelhante do escore de dor na dismenorreia, dor pélvica crônica, disquezia cíclica e disúria cíclica foi observada nos Grupos Tratamento Clínico e Cirúrgico. Dispareunia, no entato, teve uma redução maior no Grupo Cirurgia. A redução subjetiva dos sintomas dolorosos também foi semelhante entre os Grupos Clínico e Cirúrgico (100% versus 98,2%; p=0,18). O Grupo Tratamento Cirúrgico foi relacionado a uma maior taxa de complicações graves (9,2% versus 0,6%; p=0,001) em comparação ao Grupo Tratamento Clínico. Conclusão: Falha no tratamento clínico em pacientes com endometriose de retossigmoide foi observada em mulheres mais jovens que tinham lesões intestinais maiores. O tratamento clínico hormonal foi igualmente eficaz na melhora dos sintomas de dor, exceto dispareunia, em comparação ao tratamento cirúrgico em mulheres com endometriose intestinal, mas com menor taxa de complicações. O tratamento clínico deve ser oferecido como primeira opção em pacientes com endometriose intestinal, enquanto o tratamento cirúrgico deve ser reservado para pacientes sem melhora nos sintomas de dor com tratamento hormonal, progressão das lesões ou suspeita de suboclusão intestinal.


Subject(s)
Humans , Female , Adult , Progestins/therapeutic use , Rectal Diseases/drug therapy , Sigmoid Diseases/drug therapy , Pelvic Pain/drug therapy , Contraceptives, Oral, Combined/therapeutic use , Endometriosis/drug therapy , Rectal Diseases/surgery , Sigmoid Diseases/surgery , Pain Measurement , Recombinant Fusion Proteins , Medical Records , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Pelvic Pain/surgery , Dysmenorrhea/drug therapy , Dyspareunia/drug therapy , Endometriosis/surgery , Chronic Pain
7.
Acta cir. bras ; 34(4): e201900405, 2019. graf
Article in English | LILACS | ID: biblio-1001089

ABSTRACT

Abstract Purpose: To evaluate the effects of the nutraceuticals omega-6/3 and omega-9/6 on endometriosis-associated infertility and pain. Methods: Controlled experimental study, with each group composed of eight female rats. Fertility groups: sham-operated control (0.9% saline solution); control with endometriosis (0.9% saline); omega-6/3 (1.2 g/kg/day); omega-9/6 (1.2 g/kg/day); and meloxicam (0.8 mg/kg/day). Pain groups: sham-operated control (0.9% saline); control with endometriosis (0.9% saline); omega-6/3 (1.2 g/kg/day); omega-9/6 (1.2 g/kg/day); medroxyprogesterone acetate (5 mg/kg/every 3 days); and meloxicam (0.8 mg/kg/day). Peritoneal endometriosis was surgically induced. Pain was evaluated with the writhing test. Fertility was evaluated by counting the number of embryos in the left hemi-uterus. Results: The mean number of writhings was as follows: sham-operated, 11.1 ± 2.9; control with endometriosis, 49.3 ± 4.4; omega-6/3, 31.5 ± 2.7; omega-9/6, 34.1 ± 4.5; medroxyprogesterone acetate, 2.1 ± 0.8; meloxicam, 1 ± 0.3. There was a significant difference between both controls and all drugs used for treatment. Regarding fertility, the mean values were as follows: sham-operated, 6.8 ± 0.6; control with endometriosis, 4.2 ± 0.7; omega-6/3, 4.7 ± 1; omega-9/6, 3.8 ± 0.9; and meloxicam, 1.8 ± 0.9. Conclusions: The omega-6/3 and omega-9/6 nutraceuticals decreased pain compared to the controls. There was no improvement in fertility in any of the tested groups.


Subject(s)
Animals , Female , Rats , Pain/drug therapy , Fatty Acids, Omega-3/administration & dosage , Medroxyprogesterone Acetate/administration & dosage , Endometriosis/drug therapy , Fertility/drug effects , Meloxicam/administration & dosage , Peritoneum/pathology , Disease Models, Animal , Endometriosis/pathology
8.
HU rev ; 43(2): 173-178, abr-jun 2017.
Article in Portuguese | LILACS | ID: biblio-946507

ABSTRACT

A endometriose consiste no alojamento de tecidos endometriais em certas regiões que ficam fora do útero. O número de casos dessa patologia é cada vez maior e é capaz de influenciar a fertilidade feminina. Os sinais e sintomas da patologia foram considerados no estudo, além de fatores biopsicossociais que envolvem as mulheres. Esse trabalho foi baseado em uma revisão bibliográfica a partir de uma seleção de artigos que relatam sobre endometriose e sobre a relação dessa enfermidade com infertilidade na população feminina. A partir da revisão de literatura, essa patologia pode causar modificação quimiotática e anatômica no aparelho de reprodução das mulheres, causando assim a infertilidade, dependendo do nível em que se encontra essa doença. Ademais, o tratamento dessa enfermidade, hormonal ou cirúrgico, é capaz de influenciar no processo saúde-doença da mulher, e ainda, possibilitar uma futura gravidez.


Endometriosis consists in endometrial tissues growth or adaptation outside of the uterus. The number of cases of this specific pathology has become more frequent and it may be capable influencing female fertility. Biopsychosocial factors as well as signs and symptoms that involve women are considered in this study. This work was based on a bibliographical review of selected articlesthat referred to endometriosis and its relationship with infertility in the female sex. According to this review, this pathology causes chemotactic and anatomic modification in the uterus, and consequently, infertility which depends on how advanced the disease is. Furthermore, the treatment of the disease, hormonal therapy or surgery, can influence the health-disease process as well as enable a future pregnancy.


Subject(s)
Endometriosis , Infertility , Pain , Health-Disease Process , Endometriosis/drug therapy
9.
Acta cir. bras ; 31(4): 227-234, Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-781325

ABSTRACT

PURPOSE: To investigate the efficacy of intralesional 20% aspirin injection for treatment of experimental peritoneal endometriosis. Methods: Peritoneal endometriosis was experimentally induced in forty adult nulligravid female rabbits. On day 30 post-endometriosis induction, rabbits were randomly divided to assess early (10 days) and late (20 days) effects of intralesional injection of physiological saline solution (control groups) in comparison to intralesional injection of 20% bicarbonate aspirin solution (experimental groups) as follows: control group 1 (10 days, n=10); control group 2 (20 days, n=10); experimental group 3 (10 days, n=10); experimental group 4 (20 days, n=10). Resected tissues, including endometriosis foci, were qualitatively (general morphology and signs of inflammatory cells infiltrate, necrosis and apoptosis) and quantitatively (remaining endometriosis area) assessed by histopathological analysis. Results: Extensive necrosis, hemorrhage, apoptosis, and fibrosis were observed in the experimental groups 3 and 4. Groups 1 and 2 presented typical endometrial tissue cysts, respectively. Groups 3 and 4 showed sparse endometrial tissue foci and no endometrial tissue, respectively. Quantitative analysis revealed that aspirin-treated groups 3 and 4 had significantly (p<0.05) smaller remaining endometriosis area, compared to control groups 1 and 2. Conclusion: Intralesional 20% aspirin injection caused total destruction of peritoneal endometriosis foci in rabbits.


Subject(s)
Animals , Female , Rabbits , Peritoneal Diseases/drug therapy , Injections, Intralesional , Aspirin/administration & dosage , Cyclooxygenase Inhibitors/administration & dosage , Endometriosis/drug therapy , Peritoneal Diseases/pathology , Peritoneum/drug effects , Peritoneum/pathology , Time Factors , Reproducibility of Results , Treatment Outcome , Apoptosis , Disease Models, Animal , Endometriosis/pathology , Endometrium/drug effects , Endometrium/pathology , Anti-Inflammatory Agents/administration & dosage
10.
Rev. Assoc. Med. Bras. (1992) ; 61(6): 507-518, Nov.-Dec. 2015. tab
Article in English | LILACS | ID: lil-771993

ABSTRACT

SUMMARY Endometriosis is a chronic gynecological disease characterized by sustained painful symptoms that are responsible for a decline in the quality of life of sufferers. Conventional treatment includes surgical and pharmacological therapy aiming at reducing painful symptoms. This study aimed to evaluate pain levels in women with endometriosis, focusing on the influence of conventional treatment in controlling this variable. To do so, a literature search was conducted in the Medline/Pubmed databases, with 119 scientific articles found. After applying the inclusion and exclusion criteria, 27 were selected for reading and elaboration of this review. Thus, 9 studies evaluated the contribution of surgery, 17 the use of drugs to reduce pain levels in patients with endometriosis and one assessed surgical and medical treatment. The main results of these searches are presented and discussed in this revision. Surgery and the use of drugs provided reduced pain scores in patients with endometriosis but nevertheless exhibit disadvantages, such as risk of recurrence and side effects, respectively. Treatment of endometriosis is, therefore, a challenge for gynecologists and patients, as they must select the best therapeutic approach for this disease. However, improved quality of life in these patients has been obtained with the use of conventional treatment.


RESUMO A endometriose é uma doença ginecológica crônica caracterizada por quadros álgicos constantes responsáveis pela redução da qualidade de vida das portadoras. O tratamento convencional, que inclui o cirúrgico e farmacológico, tem por finalidade reduzir os sintomas de dor. Este estudo teve por objetivo avaliar os níveis de dor nas mulheres com endometriose, com enfoque na influência do tratamento convencional no controle dessa variável. Para isso, foi realizada uma pesquisa bibliográfica no Medline/PubMed e foram encontrados 119 artigos científicos, sendo que, após a aplicação dos critérios de inclusão e exclusão, 27 foram selecionados para leitura e elaboração desta revisão. Desse modo, nove estudos avaliaram a contribuição da cirurgia; dezessete, o uso de medicamentos para redução nos níveis de dor em pacientes com endometriose; e um, o tratamento cirúrgico e medicamentoso. Os principais resultados dessas pesquisas estão apresentados e discutidos nesta revisão. A cirurgia e o uso de medicamentos proporcionaram redução nos escores de dor nas pacientes com endometriose, no entanto, exibem desvantagens como risco de recorrência e efeitos colaterais, respectivamente. Assim, o tratamento para endometriose é um desafio para ginecologistas e pacientes, uma vez que é necessário selecionar a melhor abordagem terapêutica para essa doença. Entretanto, melhora na qualidade de vida das pacientes foi obtida com o emprego do tratamento convencional.


Subject(s)
Female , Humans , Endometriosis/drug therapy , Estrogens/therapeutic use , Pain Measurement/methods , Pelvic Pain/drug therapy , Progestins/therapeutic use , Chronic Disease , Drug Therapy, Combination , Endometriosis/complications , Endometriosis/surgery , Laparoscopy/adverse effects , Laparoscopy/standards , Pelvic Pain/etiology , Pelvic Pain/surgery , Quality of Life
11.
Rev. Assoc. Med. Bras. (1992) ; 61(6): 519-523, Nov.-Dec. 2015.
Article in English | LILACS | ID: lil-771998

ABSTRACT

SUMMARY This literature review analyzed the evidence on nutritional aspects related to the pathogenesis and progression of endometriosis. Diets deficient in nutrients result in changes in lipid metabolism, oxidative stress and promote epigenetic abnormalities, that may be involved in the genesis and progression of the disease. Foods rich in omega 3 with anti-inflammatory effects, supplementation with Nacetylcysteine, vitamin D and resveratrol, in addition to the increased consumption of fruits, vegetables (preferably organic) and whole grains exert a protective effect, reducing the risk of development and possible regression of disease. Dietary re-education seems to be a promising tool in the prevention and treatment of endometriosis.


RESUMO Esta revisão de literatura analisou as evidências sobre aspectos nutricionais relacionados com a etiopatogenia e a progressão da endometriose. Dietas deficientes em nutrientes refletem-se em alterações no metabolismo lipídico, estresse oxidativo e favorecem anormalidades epigenéticas que podem estar envolvidas na gênese e na progressão da doença. Alimentos ricos em ômega-3, com efeito anti-inflamatório, suplementação com N-acetilcisteína, vitamina D e resveratrol, além do maior consumo de frutas, verduras (preferencialmente orgânicas) e cereais integrais, exercem efeito protetor, com redução no risco de desenvolvimento e possível regressão da doença. A reeducação alimentar parece ser uma ferramenta promissora na prevenção e no tratamento da endometriose.


Subject(s)
Female , Humans , Diet , Endometriosis/etiology , Epigenesis, Genetic/physiology , Inflammation/complications , Oxidative Stress/physiology , Dietary Supplements , Endometriosis/drug therapy , Fruit , /therapeutic use , Vegetables , Vitamin D/therapeutic use
13.
Acta cir. bras ; 30(1): 6-12, 01/2015. tab, graf
Article in English | LILACS | ID: lil-735705

ABSTRACT

PURPOSE: To present a rat model of subcutaneous endometriosis for the study of pathophysiology and the effects of drugs. METHODS: Fifty three-month-old female Wistar rats (Rattus norvergicus) were distributed into one control group and four treatment groups: estradiol (2.5; 5; 10mg/kg sc), medroxyprogesterone acetate (0.5; 2; 5mg/kg sc), triptorelin pamoate (0.18; 0.56mg/kg sc) and acetylsalicylic acid (3mg/kg per os). The animals were autoimplanted subcutaneously with 4x4-mm uterine fragments to induce endometriosis. The endometriomas were measured on days 1, 7, 14 and 21. The relative dry and wet weights of the endometrioma were used to evaluate response to the drug. Endometrial -like tissue was confirmed by histology. The greatest weight gain was observed on day 14 (relative wet weight: 29.1 ± 6.7mg%, relative dry weight: 5.3 ± 0.9mg %). Treatments were administered between day 5 and day 14. RESULTS: The relative wet weight of the hemiuterus in the 10mg/kg estradiol group differed significantly from control and the other two estradiol groups (p=0.0001). In the medroxyprogesterone acetate group the weight decreased significantly but this decrease was not dose-dependent. Weight reduction was also significant in the triptorelin pamoate and the acetylsalicylic acid groups. CONCLUSION: The model of subcutaneous endometriosis is reproducible, low-cost and easy to perform, and suitable for the study of pathophysiology and the effects of drugs. .


Subject(s)
Animals , Female , Connective Tissue Diseases/drug therapy , Connective Tissue Diseases/physiopathology , Disease Models, Animal , Endometriosis/drug therapy , Endometriosis/physiopathology , Subcutaneous Tissue , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Antineoplastic Agents, Hormonal/administration & dosage , Aspirin/administration & dosage , Connective Tissue Diseases/pathology , Dose-Response Relationship, Drug , Endometriosis/pathology , Estradiol/administration & dosage , Estrogens/administration & dosage , Medroxyprogesterone Acetate/administration & dosage , Rats, Wistar , Reproducibility of Results , Time Factors , Triptorelin Pamoate/administration & dosage
15.
Acta cir. bras ; 26(supl.2): 15-19, 2011. ilus, tab
Article in English | LILACS | ID: lil-602638

ABSTRACT

PURPOSE: Evaluate the histological changes in parenchyma´s epithelial layer of the uterus and ovarian of rats with induced endometriosis, treated with Uncaria tomentosa extract. METHODS: 29 rats with experimental endometriosis, were selected and divided in three groups: The uncaria group received 32mg/ml of Uncaria tomentosa extract, 1ml administered daily and the placebo group received 1ml of saline 0.9 percent per day, during for 14 days (both groups); the leuprolide group received leuprolide acetate 1mg/kg body weight applied single subcutaneous dose. In the 15th day of treatment the uterine horn and ovaries were removed for histopathological analysis. RESULTS: The uncaria group presented nine samples (90 percent) with immature ovarian follicles, whereas the placebo group did not present any case and in the leuprolide group there were eight rats (88 percent) with the same change. The placebo group showed mature corpus luteum in all animals, occurring less frequent in uncaria (10 percent) and leuprolide (22 percent) groups. The uterine epithelium showed weak proliferative in nine (90 percent) samples of the uncaria group, in two (20 percent) animals in the placebo group and seven (77.8 percent) rats in the leuprolide group. CONCLUSIONS: The findings suggest that Uncaria tomentosa has contraceptive effect.


OBJETIVO: Avaliação histológica do útero e parênquima ovariano de ratas com endometriose induzida tratadas com extrato de Uncaria tomentosa. MÉTODOS: Foram selecionadas 29 ratas com endometriose experimental e formados três grupos: O grupo uncaria recebeu extrato de Uncaria tomentosa com 32mg/ml, administrado 1ml ao dia e o grupo placebo recebeu 1ml de solução salina a 0,9 por cento, ambos por 14 dias; o grupo leuprolida recebeu acetato de leuprolida 1mg/kg de peso corporal aplicado via subcutânea dose única. No 15° dia de tratamento realizou-se retirada de corno uterino e ovários para análise histopatológica. RESULTADOS: O grupo uncaria apresentou nove amostras (90 por cento) com maturação incompleta dos folículos ovarianos, já o grupo placebo não apresentou nenhum caso e no grupo leuprolida houve oito ratas (88 por cento) com a mesma alteração. O grupo placebo apresentou corpo lúteo maduro em todos os animais, acontecendo de forma menos freqüente nos grupos uncaria (10 por cento) e leuprolida (22 por cento). O epitélio uterino se mostrou fracamente proliferativo em nove (90 por cento) das amostras do grupo unacaria, em dois (20 por cento) casos do grupo placebo e sete (77.8 por cento) casos no grupo leuprolida. CONCLUSÃO: Os achados sugerem que a Uncaria tomentosa tem efeito anticoncepcional.


Subject(s)
Animals , Female , Rats , Cat's Claw/chemistry , Contraceptive Agents/therapeutic use , Endometriosis/drug therapy , Endometriosis/pathology , Phytotherapy , Plant Extracts/therapeutic use , Disease Models, Animal , Random Allocation , Rats, Wistar , Treatment Outcome , Uterus/drug effects , Uterus/pathology
16.
Acta cir. bras ; 26(supl.2): 20-24, 2011. ilus, tab
Article in English | LILACS | ID: lil-602639

ABSTRACT

PURPOSE: The aim of this study was to analyze the changes that occur in rats with experimental endometriosis after treatment with copaiba oil. METHODS: Experimental endometriosis was induced in rats. The experimental group received copaiba oil (Copaiferalangsdorffii) orally (0.63 mg/day), and the control group received a 0.9 percent sodium chloride solution orally (1 ml/100 g of body weight/day). Both groups were treated with gavage for 14 days. After this period, the animals were euthanized, and the implant volume was calculated. The autologous transplants were removed, dyed with hematoxylin-eosin, and analyzed by light microscopy. RESULTS: The average final volumes were significantly different between the groups (p=0.007). There was a significant increase (p=0.012) between the initial and final volumes in the control group, whereas treatment with Copaiferalangsdorffii caused a marked reduction in endometrial growth over time (p=0.016). Histologically, 6/11 (55.00 percent) rats in the experimental group had a well-preserved epithelial layer, and 3 (45.00 percent) had mildly preserved epithelium. The control group had seven cases (58.30 percent) of well-preserved epithelial cells and five cases (41.70 percent) of mildly preserved epithelial cells (p>0.05). CONCLUSION: Copaiba oil (Copaiferalangsdorffii) appears to be a promising alternative treatment for endometriosis.


OBJETIVO: O objetivo deste estudo foi analisar as mudanças que ocorreram em ratas com endometrioses experimental tratadas com óleo de copaíba. MÉTODOS: Foi induzida a endometriose experimental nas ratas. O grupo experimental recebeu óleo de copaíba (Copaiferalangsdorffii) oralmente (0,63mg/dia) e o grupo controle recebeu oralmente solução salina 0,9 por cento (1mL/100g/dia). Ambos grupos foram tratados por gavagem por 14 dias. Depois desse período, foi realizada a eutanásia dos animais e calculado o volume do implante. Os transplantes autólogos foram removidos, corados com Hematoxilina-eosina e realizada a microscopia óptica. RESULTADOS: A média final dos volumes foi significativamente diferente entre os grupos (p=0,007). Houve um aumente significante (p=0,12) entre o volume inicial e final do grupo controle, enquanto no grupo tratado com Copaiferalangsdorffii causou uma redução acentuada no crescimento endometrial ao longo durante o período (p=0,016). Histologicamente,6 das 11 (55 por cento) ratas do grupo experimental tinha uma camada epitelial bem preservada e 3 (45 por cento) apresentaram epitélio levemente preservado. O grupo controle apresentou sete casos (58,3 por cento) de células epiteliais bem preservadas e cinco casos (41,7 por cento) de células epiteliais levemente preservadas (p>0,05). CONCLUSÃO: O óleo de copaíba (Copaiferalangsdorffii) parece ser um tratamento alternativo promissor para endometriose.


Subject(s)
Animals , Female , Rats , Endometriosis/drug therapy , Endometriosis/pathology , Plant Oils/therapeutic use , Plant Preparations/therapeutic use , Disease Models, Animal , Photomicrography , Random Allocation , Rats, Wistar , Time Factors , Treatment Outcome , Uterus/drug effects , Uterus/pathology
17.
Pakistan Journal of Medical Sciences. 2011; 27 (2): 365-370
in English | IMEMR | ID: emr-143928

ABSTRACT

To investigate the safety and therapeutic outcomes of conservative surgery combined with GnRH agonist for uterine adenomyosis. Eighteen women with symptomatic uterine adenomyosis were analyzed retrospectively at Cheil General Hospital and Women's Healthcare Center, Seoul, Korea, between March 2008 and November 2009. We used the mean numerical rating scale [MRS] for dysmenorrhea and the Mansfield-Voda-Jorgensen menstrual bleeding scale [MVJ] for menorrhagia before and after the treatment. The mean follow-up period was 9.7 months [6-16 months]. The mean surgical time was 92.5 min, the mean estimated blood loss was 238.9 ml, and the mean hospital stay after operation was 3.4 days. The mean decrease of hemoglobin was 2.0 g/dL After combination of surgery and GnRH agonist, the mean MRS of dysmenorrhea decreased significantly from 8.1 to 1.9 [P < 0.001], and the mean MVJ score also decreased from 4.3 to 3.2 [P < 0.05]. This conservative surgery should be considered as a therapeutic option for women with symptomatic adenomyosis who wish to preserve the uterus


Subject(s)
Humans , Female , Endometriosis/surgery , Endometriosis/drug therapy , Uterine Diseases , Gonadotropin-Releasing Hormone/agonists , Retrospective Studies , Dysmenorrhea , Menorrhagia
18.
Femina ; 38(5)maio 2010.
Article in Portuguese | LILACS | ID: lil-546436

ABSTRACT

A endometriose é uma desordem estrogênio-dependente definida pela presença de tecido endometrial fora da cavidade uterina, e é uma das principais causas de infertilidade feminina. A melhor escolha para seu tratamento, associado à infertilidade, ainda permanece obscura. As evidências científicas disponíveis indicam que a supressão da função ovariana, apenas com o tratamento hormonal, não melhora as taxas de gravidez. O tratamento cirúrgico é, entretanto, provavelmente eficaz em todos os estágios da doença. Nos casos de endometriose mínima e leve, corrigida cirurgicamente e com anatomia pélvica normal, a inseminação intrauterina (IIU), acompanhada de hiperestímulo ovariano controlado, é recomendada. Em casos de endometriose avançada, especialmente se estiver associada a alterações tubárias, fatores masculinos ou falha de tratamento prévio, após laparoscopia, a melhor opção é a Fertilização in vitro (FIV). O sucesso pode ser maior com o tratamento de análogos de gonadotropina (GnRH) de três a seis meses antes da FIV. Finalmente, é importante ressaltar que as recomendações acima deverão ser revistas à medida que estudos clínicos randomizados e controlados mostrarem evidências mais concretas e confiáveis dessa enigmática doença.


Endometriosis is an estrogen-dependent disorder defined as the presence of endometrial tissue outside of the uterine cavity, and is a leading cause of female infertility. The optimal choice for its treatment associated with infertility remains obscure. The available scientific evidence indicates that suppression of ovarian function with hormonal treatment is not effective and should not be offered for this indication alone, and it does not get better pregnancy rates. Surgery treatment is probably efficacious for all stages of the disease. Intrauterine insemination (IUI) with controlled ovarian stimulation is effective in endometriosis minimal-mild and surgically corrected when the pelvic anatomy is normal. In advanced endometriosis cases, especially if tubal function is compromised, if there is also male factor infertility, and other treatments have failed, in vitro fertilization (IVF) is the appropriate treatment. The success may increase with gonadotropin-releasing hormone analog treatment (GnRH) for three to six months before IVF. Finally, it is important to emphasize that the recommendation above should be revised as randomized controlled clinical trials with more concrete and reliable evidence of this enigmatic disease.


Subject(s)
Humans , Female , Pregnancy , Combined Modality Therapy , Endometriosis/surgery , Endometriosis/drug therapy , Endometriosis/therapy , Fertilization in Vitro , Gonadotropin-Releasing Hormone/agonists , Infertility, Female/etiology , Laparoscopy , Pregnancy Rate , Reproductive Techniques, Assisted , Treatment Outcome
20.
J. bras. patol. med. lab ; 45(2): 147-153, abr. 2009. ilus, tab
Article in Portuguese | LILACS | ID: lil-522588

ABSTRACT

INTRODUÇÃO: A literatura relata que os implantes endometriais possuem receptores para hormônios esteroides, sendo estimulados principalmente pelo estrógeno, e que algumas estratégicas de tratamento têm sido propostas em modelos experimentais, tais como a utilização de glicocorticoides sintéticos, como a dexametasona. OBJETIVO: analisar histoquímica e morfometricamente lesões endometrióticas induzidas em ratas e tratadas com 0,8 mg/kg/dia de dexametasona. MATERIAL E MÉTODOS: Quarenta ratas albinas (linhagem Wistar) com 90 dias de vida, pesando aproximadamente 150 g, foram induzidas à endometriose e divididas em grupos: 1. ratas com endometriose e avaliadas após 34 dias (G1); 2. ratas com endometriose e avaliadas após 47 dias (G2); 3. ratas com endometriose e, após 21 dias do pós-operatório, tratadas com dexametasona por 13 dias (G3) e 4. ratas com endometriose e, após 21 dias do pós-operatório, tratadas com dexametasona por 13 dias e eutanasiadas após um período de 13 dias, contados a partir do término do tratamento com dexametasona (G4). Os fragmentos dos implantes endometriais foram fixados em Bouin, incluídos em paraplast e corados por hematoxilina-eosina e tricrômico de Mallory. As médias do número de glândulas foram submetidas ao teste não-paramétrico de Tukey-Kramer (p < 0,05). RESULTADOS: A dexametasona reduziu a inflamação nos implantes endometriais, o teor de colágeno no estroma e significativamente a área ocupada pelas glândulas (G1= 123,25 ± 6,44ª; G2= 113 ± 6,27ª; G3= 81,66 ± 3,05b; e G4= 94 ± 6,24b). CONCLUSÃO: A dexametasona, na dosagem utilizada, reduz os efeitos estrogênicos em implantes endometriais em ratas.


INTRODUCTION: The literature reports that endometrial implants have receptors for steroid hormones primarily stimulated by estrogen and that some treatment strategies have been proposed in experimental models such as the use of synthetic glucocorticoids, for example, dexamethasone. OBJECTIVE: to analyze histochemically and morphometrically endometriotic lesions induced in rats and treated with dexamethasone (0.8 mg/kg/day). MATERIAL AND METHODS: Forty albino female rats (Wistar strain), with 90 days of age, weighing approximately 150 g, were induced with endometriosis and divided into groups: I - rats with endometriosis and evaluated after 34 days, II - rats with endometriosis and evaluated after 47 days, III - rats with endometriosis and 21 days post-surgery treated with dexamethasone for 13 days and IV - rats with endometriosis and 21 days post-surgery treated with dexamethasone for 13 days and euthanized after a period of 13 days starting from the end of treatment. The fragments of endometrial implants were fixed in Bouin, embedded in Paraplast and stained with hematoxylin-eosin and Mallory trichrome. The mean number of glands was compared through nonparametric Tukey-Kramer test (p < 0,05). RESULTS: Dexamethasone reduced inflammation in the endometrial implants, the collagen content in the stroma and decreased significantly the area occupied by glands (GI - 123.25 ± 6.44ª; IGI - 113 ± 6.27ª; GIII - 81.66 ± 3.05b and GIV - 94 ± 6.24b). CONCLUSION: The applied dexamethasone dosage reduces estrogenic effects in endometrial implants in rats.


Subject(s)
Humans , Animals , Female , Mice , Dexamethasone/therapeutic use , Endometriosis/chemically induced , Endometriosis/drug therapy , Prostheses and Implants , Dexamethasone/administration & dosage , Endometriosis/surgery , Immunohistochemistry , Models, Animal , Rats, Wistar/surgery
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