Evaluación clínica y manejo de la endometriosis: resumen de la orientación técnica MINSAL para el manejo de personas con endometriosis / Clinical evaluation and management of endometriosis: summary of the national ministry of health guidance for the management of people with endometriosis

La endometriosis es una de las enfermedades más comunes en las edades reproductivas y afecta la calidad de vida y la fertilidad de las pacientes. A la fecha, no existen guías clínicas nacionales disponibles para la evaluación y el manejo de esta patología. El presente corresponde a una síntesis del trabajo liderado por la Sociedad Chilena de Obstetricia y Ginecología y el Ministerio de Salud para la conformación de una Orientación Técnica que sirva a los profesionales de salud para el mejor manejo de las personas con esta dolencia. Esta revisión presenta pautas para el diagnóstico y el manejo de la endometriosis en el ciclo de vida de la persona, incluyendo la adolescencia y la menopausia, y en personas infértiles. De igual manera, da directrices para el manejo médico, terapias complementarias y tratamiento quirúrgico, junto con el seguimiento en el tiempo y la estructuración en red del manejo de las personas con endometriosis.

Endometriosis is one of the most common diseases in reproductive ages and affects the quality of life and fertility of patients. To date, there are no national clinical guidelines available for the evaluation and management of this pathology. This paper corresponds to a synthesis of af effort led by the Chilean Society of Obstetrics and Gynecology and the Ministry of Health to create a national Guideline that serves health professionals for the better management of people with this condition This review presents recommendations for the diagnosis and management of endometriosis in the life cycle of the person with endometriosis including adolescence, menopause and in infertile persons. Moreover, provides guidelines for medical management, complementary therapies and surgical management, along with monitoring over time and network structuring of the management of people with this disease.

Analysis of the relationship between MRI imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients / 中华妇产科杂志

Objective: To investigate the relationship between magnetic resonance imaging (MRI) imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients. Methods: The clinical characteristics of the adenomyosis questionnaire was self-designed. This was a retrospective study. From September 2015 to September 2020, totally 459 patients were diagnosed with adenomyosis and underwent pelvic MRI examination at Peking University Third Hospital. Clinical characteristics and treatment were collected, MRI was used to determine the lesion location, and to measure the maximum lesion thickness, the maximum myometrium thickness, uterine cavity length, uterine volume, the minimum distance between the lesion and serosa or endometrium, and whether combined with ovarian endometrioma. The difference of MRI imaging characteristics in patients with adenomyosis and its relationship with clinical symptoms and therapeutic efficacy were analyzed. Results: (1) Among the 459 patients, the age was (39.1±6.4) years. There were 376 patients (81.9%, 376/459) with dysmenorrhea. Whether patients had dysmenorrhea were related to uterine cavity length, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness, and whether patients had ovarian endometrioma (all P<0.001). Multivariate analysis suggested that ovarian endometrioma was the risk factor for dysmenorrhea (OR=0.438, 95%CI: 0.226-0.850, P=0.015). There were 195 patients (42.5%, 195/459) with menorrhagia. Whether patients had menorrhagia were related to age, whether patients had ovarian endometrioma, uterine cavity length, the minimum distance between lesion and endometrium or serosa, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness (all P<0.001). Multivariate analysis suggested that ratio of the maximum lesion thickness to the maximum myometrium thickness was the risk factor for menorrhagia (OR=774.791, 95%CI: 3.500-1.715×105, P=0.016). There were 145 patients (31.6%, 145/459) with infertility. Whether the patients had infertility were related to age, the minimum distance between lesion and endometrium or serosa, and whether patients had ovarian endometrioma (all P<0.01). Multivariate analysis suggested that young and large uterine volume were risk factors for infertility (OR=0.845, 95%CI: 0.809-0.882, P<0.001; OR=1.001, 95%CI: 1.000-1.002, P=0.009). (2) The success rate of in vitro fertilization-embryo transfer (IVF-ET) was 39.2% (20/51). Dysmenorrhea, high maximum visual analogue scale score and large uterine volume affected the success rate of IVF-ET (all P<0.05). The smaller the maximum lesion thickness, the smaller the distance between the lesion and serosa, the larger the distance between the lesion and endometrium, the smaller the uterine volume, and the smaller the ratio of the maximum lesion thickness to the maximum myometrium thickness, the better the therapeutic efficacy of progesterones (all P<0.05). Conclusions: Concomitant ovarian endometrioma increases the risk of dysmenorrhea in patients with adenomyosis. The ratio of the maximum lesion thickness to the maximum myometrium thickness is an independent risk factor for menorrhagia. Young and large uterine volume may increase the risk of infertility. Severe dysmenorrhea and large uterine volume affect the success rate of IVF-ET. The therapeutic efficacy of progesterones is relatively better when the lesion is small and far away from the endometrium.

"A little monster inside me that comes out now and again": endometriosis and pain in Austria / "Um pequeno monstro dentro de mim que sai de vez em quando": endometriose e dor na Áustria / "Un pequeño monstruo dentro de mí que sale una y otra vez": endometriosis y dolor en Austria

Abstract: The topics of endometriosis and pain imply far-reaching problems for women's health. Using a qualitative research approach, this paper addresses the subjective experience and effects of pain, the methods for dealing with these issues, and the needs of affected women in Austria. Data were collected by problem-focused interviews conducted with ten women suffering from endometriosis, which were later transcribed and subjected to qualitative content analysis. Findings are therefore described using content-related categories. Results show that negative thoughts and feelings like fear, despair, and anger are associated with endometriosis and pain. Moreover, predominantly negative impacts and changes are found in various areas of life, such as the well-being and psyche of those affected, their attitude towards life in general, partnerships, social life, leisure time and work-life balance. In dealing with endometriosis and pain, both Western biomedicine and complementary medicine treatments are used. Support from one's inner circle of friends and exchange and interaction with others affected by the disease are seen to be invaluable. Attending physicians as well as patients themselves and their private, social, and working environment should encourage open communication about endometriosis and the related pain.

Resumo: O tema da endometriose e dor tem implicações relevantes para a saúde das mulheres. O artigo procura contextualizar a experiência subjetiva e os efeitos da dor, os métodos para lidar com essas questões e as necessidades das mulheres afetadas por essa condição na Áustria. Foi escolhida uma abordagem qualitativa para examinar esses temas. Foram realizadas entrevistas focadas em problemas com dez mulheres com história de endometriose. Após a transcrição do material, foi realizada a análise qualitativa do conteúdo. Assim, os achados são retratados com o uso de categorias relacionadas ao conteúdo. Os resultados mostram que pensamentos e sentimentos negativos como medo, desesperança e raiva estão associados com a endometriose e dor. Além disso, são encontrados impactos e mudanças predominantemente negativos em vários domínios da vida, tais como o bem-estar e o estado psicológicos das mulheres afetadas, a atitude geral em relação à vida, parcerias, vida social, tempo de lazer e equilíbrio entre trabalho e vida pessoal. Tanto a medicina ocidental quanto os tratamentos da medicina complementar são utilizados no manejo da endometriose e da dor. O apoio do círculo próximo de amigas e as trocas e interação com outras pessoas afetadas pela doença são vistos como extremamente úteis. Os médicos atendentes e as próprias pacientes e seus ambientes privados, sociais e laborais devem incentivar a comunicação aberta sobre a endometriose e a dor associada.

Resumen: La endometriosis y su dolor asociado implican problemas profundos para la salud de las mujeres. El objetivo de este trabajo es identificar la experiencia subjetiva y los efectos del dolor, los métodos para tratarlos, así como las necesidades de las mujeres afectadas en Austria. Para el examen de los temas mencionados anteriormente, se eligió un enfoque de investigación cualitativo. Las entrevistas enfocadas en los problemas se realizaron con diez mujeres que sufrían endometriosis. Tras la transcripción material de los datos, el análisis se realizó usando un análisis cualitativo de contenido. Por lo tanto, los resultados se describen usando categorías relacionadas con el contenido. Los resultados muestran que los pensamientos negativos y los sentimientos como miedo, desesperación, y enfado están conectados con la endometriosis y el dolor. Además, predominantemente se encontraron impactos negativos y cambios en varias áreas de la vida, tales como: bienestar, psique de quienes se veían afectadas, su actitud ante la vida en general, relaciones, vida social, equilibrio entre tiempo de ocio y trabajo. Para enfrentarse a la endometriosis y el dolor, se utilizan tratamientos biomédicos occidentales, así como medicina complementaria. El apoyo del círculo íntimo de los afectados, como son los amigos, así como el intercambio e interacción con otras personas afectadas por la enfermedad parecen ser muy útiles. Ir al médico, el entorno privado, social y laboral de las pacientes, así como ellas mismas, deben estar y ser animadas para una comunicación abierta sobre la endometriosis y el dolor relacionado con la misma.

Experiências das mulheres quanto às suas trajetórias até o diagnóstico de endometriose / Experiencias de mujeres en cuanto a sus trayectorias hasta el diagnóstico de endometriosis / Experiences of women regarding their pathways to the diagnosis of endometriosis

Resumo Objetivo descrever as experiências das mulheres sobre as suas trajetórias desde o início dos sintomas até o diagnóstico da endometriose. Método pesquisa descritiva, qualitativa, realizada com dez mulheres com diagnóstico de endometriose no município do Rio de Janeiro (RJ), Brasil. Coletaram-se entrevistas semiestruturadas áudio gravadas e posteriormente submetidas à Análise de Conteúdo por meio do software Atlas.ti 8. Resultados sem o diagnóstico de endometriose, as mulheres vivenciam sintomas fortes desde a menarca. Essa situação repercute negativamente em diferentes esferas da vida, inclusive pela desvalorização de suas queixas em seus círculos de convivência. Assim, entende-se a importância da rede de apoio perante essa situação. Diante desse contexto, as mulheres peregrinam por diversos profissionais até o diagnóstico definitivo. Considerações finais e implicações para a prática as trajetórias dessas mulheres são marcadas pela desvalorização de suas queixas por profissionais de saúde e pessoas próximas, pela naturalização da dor feminina e pela dificuldade em estabelecer um diagnóstico diferencial. No entanto, a capacidade individual de reconhecer a presença de uma patologia, o conhecimento sobre a endometriose e a experiência do profissional facilitaram o diagnóstico. No contexto da assistência de enfermagem, entender essa trajetória pode promover a escuta ativa, melhor valorização das queixas, avaliação clínica e o encaminhamento para o diagnóstico precoce.

Resumen Objetivo describir las vivencias de las mujeres en sus trayectorias desde el inicio de los síntomas hasta el diagnóstico de endometriosis. Método investigación descriptiva cualitativa realizada con diez mujeres diagnosticadas con endometriosis en la ciudad de Río de Janeiro (RJ), Brasil. Se recogieron entrevistas semiestructuradas grabadas en audio y posteriormente se sometieron a Análisis de Contenido utilizando el software Atlas.ti 8. Resultados sin el diagnóstico de endometriosis, las mujeres experimentan síntomas fuertes desde la menarquia. Esta situación tiene un impacto negativo en diferentes ámbitos de la vida, incluso por la devaluación de sus quejas en sus círculos de convivencia. Así, se comprende la importancia de la red de apoyo en esta situación. Ante este contexto, las mujeres deambulan por diferentes profesionales hasta el diagnóstico definitivo. Consideraciones finales e implicaciones para la práctica las trayectorias de estas mujeres están marcadas por la devaluación de sus quejas por parte de los profesionales de la salud y personas cercanas, por la naturalización del dolor femenino y por la dificultad para establecer un diagnóstico diferencial. Sin embargo, la capacidad del individuo para reconocer la presencia de una patología, el conocimiento sobre la endometriosis y la experiencia del profesional facilitaron el diagnóstico. En el contexto del cuidado de enfermería, comprender esta trayectoria puede promover la escucha activa, mejor valoración de las quejas, evaluación clínica y la derivación para diagnóstico precoz.

Abstract Objectives to describe the experiences of women on their trajectories from the beginning of symptoms to the diagnosis of endometriosis. Method descriptive, qualitative research, conducted with ten women diagnosed with endometriosis in the city of Rio de Janeiro (RJ), Brazil. Audio recorded semi-structured interviews were collected and later submitted to Content Analysis using Atlas.ti 8 software. Results without the diagnosis of endometriosis, women experience strong symptoms from the menarche. This situation has a negative impact on different spheres of life, including the devaluation of their complaints in their circles of coexistence. Thus, the importance of the support network in this situation is understood. Faced with this context, women wander through various professionals until the definitive diagnosis. Final considerations and implications for practice the trajectories of these women are marked by the devaluation of their complaints by health professionals and people close to them, by the naturalization of female pain and by the difficulty in establishing a differential diagnosis. However, the individual's ability to recognize the presence of a pathology, the knowledge about endometriosis and the professional's experience facilitated the diagnosis. In the context of nursing care, understanding this trajectory can promote active listening, better appreciation of complaints, clinical assessment and referral to early diagnosis.

Reconstrução de defeito de parede abdominal e vulva após ressecção de endometriomas extracavitários / Reconstruction of abdominal wall and vulvar defects after endometriosis resection

Introdução: Endometriose é a presença de tecido endometrial funcionante (glândulas endometriais e estroma) em localização fora da cavidade endometrial. Implantes endometrióticos extrapélvicos têm sido ocasionalmente descritos na literatura. Métodos: Este é um relato de caso de uma paciente do serviço de cirurgia plástica do autor, operada em setembro de 2013 em um hospital de Brasília-DF. O trabalho seguiu os princípios de Helsinque e o termo de consentimento livre e esclarecido foi realizado. Resultados: O trabalho se trata de uma paciente de 30 anos que apresentava dismenorreia, dor e parestesia em região inguinal direita, nódulo endurecido em grande lábio direito com cicatrizes de duas ressecções de focos de endometriose. A equipe de ginecologia realizou ressecção endoscópica das lesões cavitárias, do conteúdo do canal inguinal, do nódulo no grande lábio direito, da cicatriz umbilical e parte da aponeurose. Após se instalarem os defeitos de parede abdominal e vulva, a cirurgia plástica realizou a reconstrução com retalho de abdome inferior randômico, baseado lateralmente, como um dos vértices de uma zetaplastia. Conclusão: O retalho descrito no trabalho é uma alternativa na reconstrução da região inguinal e vulva, em casos de grandes defeitos, obtendo um resultado satisfatório.

Introduction: Endometriosis is characterized by the presence of functional endometrial tissue (endometrial glands and stroma) outside the uterine cavity. However, only a few cases of extrapelvic endometriosis have been described in the literature. Methods: This study reports the case of a patient from the author's plastic surgery service who underwent surgery in September 2013 at a hospital in Brasília, Federal District, Brazil. The study was conducted according to the principles of the Declaration of Helsinki, and the patient signed an informed consent form. Results: A 30-year-old female patient presented with dysmenorrhea, pain, and paresthesia in the right inguinal region as well as a firm nodule in the labia majora with scars from two surgical resections of endometriosis. The gynecology team performed endoscopic resection of the uterine cavity lesions, inguinal canal content, nodules in the right labia majora, umbilical scar, and part of the aponeurosis. The abdominal wall and vulvar defects caused by the resection were repaired using a laterally based random lower abdominal flap as one of the vertices of a Z-plasty. Conclusion: The flap described in this study is an alternative and satisfactory method for repairing large defects in the inguinal and vulvar regions.

Nanotechnology for the treatment of deep endometriosis: uptake of lipid core nanoparticles by LDL receptors in endometriotic foci

OBJECTIVE: Rapidly dividing cells in multiple types of cancer and inflammatory diseases undergo high low density lipoprotein (LDL) uptake for membrane synthesis, and coupling an LDL-like nanoemulsion, containing lipid nanoparticles (LDE) to a chemotherapeutic agent efficiently targets these cells without significant systemic effects. This was a prospective exploratory study that evaluated the uptake of a radioactively labeled LDE emulsion by receptors of endometriotic foci and the capacity of the LDE for cellular internalization. METHODS: The lipid profile of each patient was determined before surgery, and labeled LDE were injected into fourteen patients with intestinal or nonintestinal endometriosis. The radioactivity of each tissue sample (intestinal endometriosis, nonintestinal endometriosis, healthy peritoneum, or topical endometrium) was measured. RESULTS: The group with intestinal endometriosis presented higher levels of plasma LDL but lower LDE uptake by foci than the nonintestinal group, suggesting less cell division and more fibrosis. The uptake of LDE was highest in the topical endometrium, followed by the healthy peritoneum, and lowest in the endometriotic lesion. Since the endometriotic foci showed significant LDE uptake, there was likely increased consumption of LDL by these cells, similar to cells in cancers and inflammatory diseases. Plasma cholesterol levels had no influence on LDE uptake, which showed that the direct delivery of the nanoemulsion to target tissues was independent of serum lipoproteins. There were no significant differences in the parameters (p>0.01) because of the small sample size, but the findings were similar to those of previous studies. CONCLUSION: Nanotechnology is a promising therapeutic option for surgery and hormonal blockage for deep endometriosis, with a lower complication rate and no systemic side effects.

Endometriosis: aspectos psicologicos / Endometriosis: psychological aspects

La endometriosis es la causa más común de dolor pélvico crónico femenino. A pesar del tratamiento médico, muchas mujeres no logran controlar el dolor, con la consecuencia de restricciones más o menos graves en la vida laboral, social, familiar, de pareja y sexual. En América Latina y específicamente en idioma español hay escasa información sobre las relaciones de la endometriosis con factores psicológicos que se encuentran enmarcados dentro de esta enfermedad. Por este motivo, el objetivo de este estudio es analizar esta patología estrógeno-dependiente y su asociación con diferentes aspectos psicológicos, así como su abordaje terapéutico. Para esto se realizó una búsqueda sistemática en base s de datos. Los resultados indican que la endometriosis es una enfermedad que genera como sintomatología, dolor crónico, el cual afecta de manera negativa la calidad de vida, relaciones de pareja, fertilidad, y estado emocional, generando ansiedad y depresión entre otros trastornos psiquiátricos. Los anteriores factores influyen de la misma forma, de manera negativa en la percepción del dolor, aumentando el ciclo. Debido a esto se concluye que el tratamiento psicológico podría ser un apoyo necesario para las mujeres que padecen endometriosis, en donde el manejo de dolor y los mecanismos de afrontamiento, deben ser los objetivos principales en el plan terapéutico.

The endometriosis is the most common cause of chronic female pelvic pain. Despite medical treatment, many women are unable to control their pain, limiting their social, family, sexual life and couple sexual life. In Latin America and specifically in Spanish language, there is no much information on the relationships between endometriosis with psychological factors from this disease. The aim of this study was to analyze the different psychological aspects related and the therapeutic approach of this estrogen-dependent pathology. A systematic search on databases was carried out for this end. The results indicate that pain chronic is a factor important in this illness, which negatively affects quality of life, couple relationships, fertility, and emotional state, generating anxiety, depression and another psychiatric disorders. These factors increase negatively pain perception and get worse the course of the disease. Conclusion: psychological treatment could be a necessary support for women who suffering from endometriosis, where pain management and coping mechanisms could be the main aims at the therapeutic plan.

A experiência de adoecimento de mulheres com endometriose: narrativas sobre violência institucional / The experience of illness of women with endometriosis: narratives about institutional violence

Resumo O artigo evoca a centralidade ocupada pela categoria relacional de gênero, para iluminar as narrativas de vida de mulheres com uma doença crônica - a endometriose. O objetivo é discutir o significado da experiência de adoecimento de mulheres com endometriose na interface com a violência institucional. À luz do referencial de Bertaux, no método Narrativas de Vida, 20 foram as participantes desta pesquisa convidadas a partir de dois espaços virtuais de discussão e encontros sobre o viver com endometriose. As entrevistas foram realizadas pessoalmente no circuito RJ, SP e MG. A abordagem teórica foi abalizada por autores que tratam da experiência do adoecimento crônico enquanto fenômeno sociocultural, leituras metafóricas do problema e críticas à violência institucional. Os resultados identificam situações de violência de gênero/institucional perpetradas nos diversos espaços de atenção às mulheres. Expressam-se a partir da banalização dos discursos das mulheres; das tensões estabelecidas entre usuárias e médicos, onde o suposto saber leigo funciona como ultraje ao saber biomédico oficial e, precipuamente, na dificuldade de acesso aos serviços, levando as mulheres a uma peregrinação por cuidados e a se submeterem a formas de assistência não necessariamente baseadas em boas práticas.

Abstract This paper conjures up the centrality of the relational category of gender to shed a light on women's life narratives with a chronic disease named endometriosis. It aims to discuss the meaning of the illness experience of women with endometriosis in the interface with institutional violence. Based on Bertaux reference, in the Narratives of Life method, twenty women participated in this research. They were invited from two virtual spaces of discussion and gatherings about living with endometriosis. Interviews were conducted in person in the States of Rio de Janeiro, São Paulo and Minas Gerais circuit. Authors sustained the theoretical approach and addressed the experience of chronic illness as a sociocultural phenomenon, metaphorical readings of the problem and criticism of institutional violence. The results identify situations of gender/institutional violence perpetrated in various women care settings. They are expressed through the trivialization of women's discourses; user-physician tensions, where the supposed lay knowledge appears as an insult to official biomedical knowledge and, mainly, the difficult access to services, leading women to a care pilgrimage and to submit themselves to care types not necessarily based on best practices.

Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain / Pacientes com endometriose que utilizam estratégias positivas de enfrentamento apresentam menos depressão, estresse e dor pélvica

ABSTRACT Objective To determine the correlations between coping strategies, depression, stress levels and pain perception in patients with endometriosis. Methods This prospective and exploratory study included 171 women undergoing treatment for endometriosis between April and August 2014. The questionnaires used were Brief COPE, Beck Depression Inventory, Lipp’s Stress Symptom Inventory for Adults and Visual Analogue Scale. Clinical data were collected from electronic medical records. Results Patients with endometriosis who used positive coping strategies had better adaptation to stress (p<0.004) and less depression (p<0.004). The presence and intensity of depression, stress and acyclic pelvic pain were directly associated (p<0.05). The intensity of dysmenorrhea was associated with the degree of depression (p<0.001), whereas acyclic pelvic pain was associated with the degree of depression (p<0.001), stress level (p<0.001) and stress type (p<0.001). Conclusion We found a positive association between coping, depression levels, type and levels of stress and pain intensity in patients with endometriosis. The use of maladaptive coping strategies focused on emotion is correlated with increase in depression and stress.

RESUMO Objetivo Observar a correlação entre estratégias de enfrentamento, depressão, níveis de estresse e percepção de dor em pacientes com endometriose. Métodos Estudo prospectivo e exploratório, que incluiu 171 mulheres em tratamento por endometriose entre abril e agosto de 2014. Foram utilizadas as escalas: COPE Breve, Inventário de Depressão de Beck, Inventário de Sintomas de Stress para Adultos de Lipp e a Escala Visual Analógica. Os dados clínicos foram coletados do prontuário eletrônico. Resultados Pacientes com endometriose que utilizaram estratégias positivas de enfrentamento apresentaram melhor adaptação ao estresse (p<0,004) e menos depressão (p<0,004). A presença e a intensidade da depressão, do estresse e da dor pélvica estiveram diretamente associadas (p<0,05). A intensidade da dismenorreia foi associada com o grau de depressão (p<0,001), enquanto a intensidade da dor pélvica acíclica esteve associada com o grau de depressão (p<0,001), nível de estresse (p<0,001) e tipo de estresse (p<0,001). Conclusão Houve associação positiva entre coping, níveis de depressão, tipo e níveis de estresse e intensidade da dor nas pacientes com endometriose. A utilização de estratégias de coping desadaptativa focada na emoção está correlacionada com o aumento da depressão e do estresse.

Avaliação da influência dos polimorfismos no gene do fator decrescimento endotelial vascular e seu receptor na etiologia da endometriose / Polymorphisms influence the evaluation of the factor gene vascular endothelial growth and its receptor in the etiology of endometriosis

A endometriose é considerada uma doença complexa, influenciada tanto por fatores genéticos como ambientais. A angiogênese via sinalização do fator de crescimento endotelial vascular (VEGF) e do seu receptor de domínio de inserção da quinase (KDR), é um processo crucialno estabelecimento e progressão da endometriose. Polimorfismos de um único nucleotídeo (SNP) nos genes VEGF e KDR podem influenciar no desenvolvimento da doença. O presente estudo teve como objetivo avaliar o papel dos SNPs do VEGF (...) na etiologia da endometriose. A população do estudo foi composta por 293 mulheres com diagnóstico histopatologico de endometriose (casos) e 223 mulheres sem a evidência laparoscópica da doença (controle). A genotipagem dos SNPs estudados foi realizada pela técnica de reação em cadeia da polimerase (PCR) em tempo real utilizando o sistema TaqMan. (...) Verificou-se um efeito protetor dos haplótipos de VEGF (CTGC, ATGG e CCGG) e KDR (TTT e CTA) com a susceptibilidade da endometriose; e um risco aumentado dos haplótipos de VEGF (ACAG) e KDR (TCA e CCA)com o desenvolvimento da doença. Uma associação negativa foi encontrada nos genótipos combinados de VEGF e KDR com o desenvolvimento da endometriose e com a presença dos sintomas (dismenorreia, dor pélvica, dispareunia e sintomas urinários). Realizou-se também uma revisão sistemática, utilizando o sistema STROBE, sobre a associação dos SNPs de VEGF e KDR no desenvolvimento da endometriose, além de descrever as diferenças metodológicas dos estudos caso controle. Como conclusão os SNPs de VEGF e KDR estão associados com o desenvolvimento da endometriose e seus sintomas, sugerindo que a via de sinalização, VEGF-KDR, é um importante fator na etiologia da doença. Este estudo serve como base de dados para futuras aplicações que visem o desenvolvimento de biomarcadores para o diagnóstico e/ou prognóstico da endometriose.

Endometriosis is considered a complex diseases influenced by both genetic and environmental factors. The angiogenesis via signaling vascular endothelial growth factor (VEGF) and its kinase insert domain receptor (KDR), is a crucial process in the establishment and progressionof endometriosis. Single nucleotide polymorphisms (SNPs) in VEGF and KDR genes can influence the development of the disease. (...) SNPs in the etiology of endometriosis. The study population consisted of 293women with histopathological diagnosis of endometriosis (cases) and 223 women without laparoscopic evidence of disease (controls). Genotyping of the studied SNPs was performed by polymerase chain reaction (PCR) in real time using the TaqMan system. Logistic regression was used, being obtained odds ratios (OR) and confidence intervals (95 percent CI) to evaluate the associations of the studied SNPs and the development of endometriosis, and the presence of symptoms. (...) It was found a protective effect of VEGF (CTGC, ATGG and GGCC) and KDR (TTT and CTA) haplotypes susceptibility to endometriosis; and an increased risk of VEGF (ACAG) and KDR (CCA and TCA) haplotypes with the development of the disease. Negative association was found in the combined genotypes of VEGF and KDR withthe development of endometriosis and the presence of symptoms (dysmenorrhea, pelvic pain, dyspareunia and urinary symptoms). It was also carried out a systematic review using the STROBE system on the association of VEGF and KDR SNPs in the development of endometriosis, and describes the methodological differences of case-control studies. In conclusion VEGF and KDR SNPs are associated with the development of endometriosis and its symptoms, suggesting that signaling pathway, VEGF-KDR, is an important factor in theetiology of the disease. This study serves as a database for future applications for thedevelopment of biomarkers for the diagnosis and / or prognosis of endometriosis.

A interação de polimorfismos no gene CYP2C19 com fatores epidemiológicos e clínicos em mulheres diagnosticadas com endometriose na cidade do Rio de Janeiro, Brasil

A endometriose é um problema de saúde pública no mundo, acometendo principalmentemulheres entre 15 a 45 anos. É uma doença inflamatória estrogênio dependente, caracterizadapela presença de tecido endometrial em localização extra-uterina, entretanto, a etiologia aindanão está definida. O histórico familiar da doença já tem sido associado ao risco de endometriosesugerindo a influência dos fatores genéticos que, interagindo com os fatores ambientais,poderiam modular o risco de desenvolvimento da endometriose. Nesse contexto, estudarpolimorfismos no gene CYP2C19, que atua no catabolismo do estrogênio, e sua interação comos fatores ambientais poderia explicar, em parte, a suscetibilidade para o desenvolvimento daendometriose. Assim, o objetivo deste trabalho é avaliar o efeito da interação entre fatoresambientais selecionados e os polimorfismos no gene CYP2C19 (*2 e *17), em uma série decasos de endometriose. Metodologia: Um estudo observacional exploratório de uma série decasos, utilizando a abordagem case-only foi realizado em 155 mulheres diagnosticadas comendometriose foram classificadas para a “presença” e “ausência” de um fator genético e umfator ambiental. Para avaliar a interação entre a combinação de polimorfismos no geneCYP2C19 e fatores ambientais foi estimada a OR (OddsRatio) de interação e seus respectivosIC (Intervalo de Confiança) 95%. Resultados: A média de idade do diagnóstico foi de 31,23anos; 45,3% tinham nível superior ou pós-graduação; 73,2% união estável e 56,3% sobrepesoe obesidade...

Endometriosis is a public health problem in Brazil and worldwide, affecting womenbetween 15-45 years. It is an inflammatory estrogen dependent disease characterized by thepresence of endometrial tissue outside the uterine location however, the etiology is still notdefined. The family history of the disease has been associated with risk of endometriosissuggesting the influence of genetic factors that interact with environmental factors, couldmodulate the risk of developing endometriosis. In this context, study polymorphisms in theCYP2C19 gene, which operates in estrogen catabolism, and their interaction withenvironmental factors could explain, in part, the susceptibility to the development ofendometriosis. The objective of this study was to evaluate the effect of interaction betweenselected environmental factors and polymorphisms in the CYP2C19 gene (*2 and *17), in aseries of cases of endometriosis. Methodology: An exploratory observational study of a groupof cases, using a case-only approach was performed and 155 women diagnosed withendometriosis were classified to "presence" and "absence" of a genetic factor and anenvironmental factor. Then, to evaluate the interaction between the combination of thepolymorphisms CYP2C19 and environmental factors gene was estimated odds ratio (OR) andtheir interaction CI: 95%. Results: The average age of diagnosis was 31.23 years; 45.3% hadcollege or graduate; 73.2% married and 56.3% overweight and obesity...

Endometriosis tracto urinario: revisión de la literatura / Urinary tract endometriosis: review of the literature

Se define como endometriosis a la presencia de tejido endometrial fuera de la cavidad uterina. La endometriosis del tracto urinario (ETU) se refiere a la presencia de tejido endometrial en o alrededor de la vejiga, uréteres, uretra o riñones, lo que ocurre en alrededor de 1por ciento de los casos. El objetivo de esta revisión es realizar una puesta al día en los conceptos relativos a esta rara enfermedad. Se analiza clínica, fisiopatología y tratamiento.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Urinary tract endometriosis (ETU) refers to the presence of endometrial tissue in or around the bladder, ureters, urethra or kidneys, which occurs in about 1percent of cases. The objective of this review is to update the concepts concerning this rare disease. Clinic, pathophysiology and treatment are discussed.

Curcumin inhibits endometriosis endometrial cells by reducing estradiol production

Endometriosis is a complex estrogen-dependent disease that is defined as the presence of endometrial gland and stroma outside the uterine cavity. Although the exact mechanism for the development of endometriosis remains unclear, there is a large body of research data and circumstantial evidence that suggests a crucial role of estrogen in the establishment and maintenance of this disease. This study is an attempt to assess the effect of curcumin on inhibiting endometriosis endometrial cells and to investigate whether such an effect is mediated by reducing estradiol production. Endometriotic stromal cells, normal endometrial stromal cells, endometriotic epithelial cells and normal endometrial epithelial cells were isolated and cultured. E[2] value of cells and the effect of curcumin on cell proliferation were evaluated. Finally, effect of curcumin on E[2] assay was detected. Electrochemiluminescence immunoassay results showed that E[2] value of endometriotic epithelial cells was higher than the endometriotic stromal cells [p=0.037], while the expression of E[2] in normal endometrial stromal and epithelial cells was extremely low. WST-8 result showed, compared with endometrial stromal cells, ectopic endometriotic stromal cells had a higher growth rate. After intervene with curcumin [10micromol/L, 30micromol/L and 50micro mol/L] for 0-96h, the number of endometriotic stromal cells was reduced and cells growth slowed, compared with 0micromol/L group. Compared with 0micromol/L group, E[2] level was lower after treatment with curcumin, especially in 30micromol/L and 50micromol/L group. In summary, in this study we found that E[2] is important in ectopic endometrium, and epithelial cell is in dominant position with E[2] secretion. Curcumin was able to suppress the proliferation of endometrial cells by reducing the E2 value.

Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: a randomized clinical trial

Endometriosis is a common hormone-dependent gynecologic disease with a high recurrence. Laparotomy or laparoscopy is the standard surgery for the large endometrioma. Also, sclerotherapy is basically used to treat different diseases one of which is endometrioma. The study was designed to assess the value of transvaginal ultrasound-guided ethanol sclerotherapy in patients with a recurrent endometrioma. In a randomized clinical trial, an interventional group of 20 patients underwent transvaginal ethanol sclerotherapy for recurrent ovarian endometrioma. The patients were followed up first after one and two weeks and then after one, two, and three months. If the patients had no endometrioma, they were treated with in vitro fertilization [IVF] [standard long protocol]. A control group of 20 patients with endometrioma were enrolled for an IVF protocol. They had no treatment by ethanol sclerotherapy. IVF parameters, pregnancy rates, and implantation rates were compared in both groups. The demographic data showed no difference between the two groups. The initial mean endometria size was 41.45 +/- 15.9 cm, the recurrence rate after 6 months was 4 [20%], FSH before and after sclerotherapy was 6.97 +/- 2.25 IU/L and 6.78 +/- 1.88 IU/L [p=0.343]. The clinical pregnancy rate was 6 [33.3%] vs. 3 [15%], [p=0.616]. The fertilization rate emerged 63.06% in study group vs. 60.38%, [p=0.57]. The implantation rate turned out 12.9% in study group vs. 7.5%, [p=0.52]. None of these results were significant. However, the data pointed to a better trend toward the ethanol sclerotherapy group. Ethanol sclerotherapy could be an effective strategy for the treatment of recurrent endometrioma especially before IVF

Curcumin delays endometriosis development by inhibiting MMP-2 activity.

Endometriosis is a common reproductive disorder believed to be associated with matrix metalloproteinases (MMPs) activities for invasion and remodeling of endometrial tissues. Ectopic endometrium has higher capacity to produce proMMP-2 than eutopic tissues; however, the role of MMP-2 during early phase of endometriosis development is still unclear. In the present study, we investigated the role of MMP-2 in establishment and development of endometriosis in mouse model. The effect of curcumin on regression of endometriosis through protease/antiprotease balance between MMP-2 and TIMP-2 was also examined. After endometrial inoculation into peritoneum, we observed a significant elevation of proMMP-2 activity from day 2 onwards. This increased MMP-2 activity was associated with decreased expression of tissue inhibitor of MMP (TIMP)-2, while a significant up-regulation of active MMP-2 activity was observed from day 3 onwards. The activation of proMMP-2 to active MMP-2 was associated with increased expression of membrane type 1 matrix metalloproteinase (MT1MMP). Curcumin at a dose of 48 mg/kg b.w. repressed the MMP-2 activity via up-regulation of bound TIMP-2 expression, thus delayed endometriosis development. In addition, curcumin inhibited production of active MMP-2 by down-regulating MT1MMP expression. Moreover, endometriotic progression was directly linked with increased MMP-2/TIMP-2 ratio which was delayed by curcumin pretreatment. In summary, our study documents the regulation of MMP-2 activity by TIMP-2 during the early phase of endometriosis development and inhibitory action of curcumin thereon.

Endometriose cutânea / Cutaneous endometriosis

A endometriose é definida como a presença de glândulas endometriais e estroma fora da cavidade uterina. Essa doença, comum nas mulheres, é geralmente observada durante os anos reprodutivos. Embora a pelve seja o sítio mais comum da endometriose em mulheres, a localização extrapélvica é menos frequente e ainda mais difícil de diagnosticar, em decorrência das apresentações distintas. Neste artigo é descrito um caso de endometriose de cicatriz da parede abdominal.

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. This disease is commonly observed in women, particularly those of reproductive age. The pelvis is the most common location for endometriosis. On the other hand, extrapelvic endometriosis, which is less common, is more difficult to diagnose because of the extreme differences in its presentation. In this article, we describe our experience of a case of endometriosis in an abdominal wall scar.