Explaining Brazil as a rising state, 2003‒2014: the role of policy diffusion as an international regulatory instrument.

In this paper, we examine Brazil's international activism and ascent to the status of rising state during the presidencies of Luiz Inácio Lula da Silva (2003-2010) and his chosen successor, Dilma Rousseff (2011-2014). We focus on the dissemination of social policies under an innovative model of development that reflected the political and economic context of a developing country. We argue that this activism was framed in terms of Brazil's socio-economic and cultural peculiarities, whereby these were treated not as obstacles but as positive contributions to developing states' attempts to reform global governance structures. We argue that this reflects an alternative form of foreign policy politicisation in which the social dilemmas, particularities and contradictions of the Brazilian experience are incorporated in the foreign policy agenda to leverage its international stature as a rising state. We explain how Brazil's international cooperation through transferring its public policies and development models (policies for fighting hunger and poverty, agrarian development and income generation) to its Southern partners has been discursively articulated as representing Brazil's normative potential to contribute to political and institutional solutions, and rebuild norms and standards that affect the distribution of international power and wealth.

Comparative study of the environmental footprints of marinas on European Islands.

Ports have been key elements in Europe's economic development. This situation is even more relevant on islands, which are highly dependent on the maritime sector. Consequently, over the years, ports with diverse functionalities have been established both in mainland Europe and on its outlying islands. This article discusses the environmental impact of leisure marinas on European islands, especially as they are closely linked to economic development through tourism. The aim is to study the environmental impact of these infrastructures by determining the carbon and water footprints of marinas on European islands in the Atlantic and the Mediterranean. The results obtained enable the authors to make recommendations in order to reduce the overall environmental footprint of marinas on islands, considering that these territories are much more vulnerable to climate change than mainland locations in Europe.

Perception and impact of pain on patients with fibromyalgia

BACKGROUND: Fibromyalgia is a disabling disease. One of the characteristics of FM is the absence of swelling associated with the pain. The other is the existence of tender points. A deep understanding of what is this painful and debilitating condition is therefore essential. OBJECTIVE: to characterize the pain in patients with fibromyalgia. To realize the impact this pain has on the lives of patients who suffer from fibromyalgia MATERIAL AND METHOD: It is a descriptive correlational study. The sample consists of 221 individuals, 4 males and 217 female(98,2%). Hypothesis: The perception of pain intensity, the way pain manifests itself, the evolution of pain intensity and widespread pain index influence FM patients. The instruments used were the Visual Analogue Scale for pain (VAS), the Manifestation of Pain and the Generalized Pain Index questionnaire. RESULTS: The sample is mostly formed by females (98.2%), with an average age of about 45 (± 10,587), who live in urban areas (79.6%), who are married or living with a partner (71.9%), are living with relatives or others (89.1%), have completed secondary education (49.3%) and are currently employed (42.1%). Pain intensity displayed by fibromyalgia patients has an average value of 7.59, the Generalized Pain Index shows an average value of 11.84. The intensity of pain perception and the manifestation of pain condition the way a patient with FM will be able to live. CONCLUSION: The intensity of perceived pain by this study patients is, on VAS's average ratings, equal to 7.59. Most subjects with FM reported moderate or severe pain. The Generalized Pain Index has an average value of 11.84, the majority of these individuals feel pain in approximately 12 to 19 corporal regions and their pain is long-lasting

No disponible

Optical coherence tomography study of peripapillary retinal nerve fiber layer and choroidal thickness in eyes with tilted optic disc.

PURPOSE: The tilted optic disc is associated with peripapillary choroidal and retinal nerve fiber layer (RNFL) changes as well as visual field defects, often leading to diagnostic difficulties due to similarities with glaucomatous discs. We studied the peripapillary RNFL of the tilted optic disc by comparing values obtained with spectral-domain (SD) and time-domain (TD) optical coherence tomography (OCT) in order to identify characteristic RNFL patterns verified by both OCT devices, and also to determine whether SD-OCT offers any diagnostic advantage over TD-OCT. METHODS: Prospective case-control study of 16 individuals with tilted optic discs (27 eyes) and an age-matched control group (10 individuals, 20 eyes). Each case was subjected to ophthalmological examination and automated perimetry. Tilt orientation was classified based on observation of optic disc photographs, and angle of disc torsion was calculated with image processing software. RNFL measurements were obtained with TD-OCT and SD-OCT. Peripapillary choroid thickness was measured with SD-OCT. The findings were related with optic disc morphology and automated perimetry results. RESULTS: Stratus OCT results showed significantly lower superior RNFL (P<0.001) on the tilted group, whereas Spectralis indicated significantly lower superotemporal (P<0.001), superonasal (P=0.001), temporal (P=0.01), and global (P=0.01) RNFL on the tilted disc group. A significant correspondence was found between elevated disc rim and location of RNFL defect on the Spectralis (P=0.004). On the tilted group, peripapillary choroidal thickness was significantly thicker adjacent to the elevated rim (P<0.001). No correspondence was found between tilt orientation, peripapillary RNFL, or choroidal thickness and location of perimetric defects. CONCLUSIONS: Our results provide a clinical characterization of the main tilted disc morphologies and are valuable for correctly differentiating a tilted disc from a myopic glaucomatous disc. RNFL assessment by Spectralis OCT seems to be more susceptible to altered disc morphologies. The peripapillary RNFL changes found on titled disc cases could not predict the location of visual field defects.

Possible role for fundus autofluorescence as a predictive factor for visual acuity recovery after epiretinal membrane surgery.

PURPOSE: To study the potential association between fundus autofluorescence, spectral-domain optical coherence tomography, and visual acuity in patients undergoing surgery because of epiretinal membranes. METHODS: Prospective, interventional case series including 26 patients submitted to vitrectomy because of symptomatic epiretinal membranes. Preoperative evaluation consisted of a complete ophthalmologic examination, autofluorescence, and spectral-domain optical coherence tomography. Studied variables included foveal autofluorescence (fov.AF), photoreceptor inner segment/outer segment (IS/OS) junction line integrity, external limiting membrane integrity, central foveal thickness, and foveal morphology. All examinations were repeated at the first, third, and sixth postoperative months. The main outcome measures were logarithm of minimal angle resolution visual acuity, fov.AF integrity, and IS/OS integrity. RESULTS: All cases showing a continuous IS/OS line had an intact fov.AF, whereas patients with IS/OS disruption could have either an increased area of foveal hypoautofluorescence or an intact fov.AF, with the latter being associated with IS/OS integrity recovery in follow-up spectral-domain optical coherence tomography imaging. The only preoperative variables presenting a significant correlation with final visual acuity were baseline visual acuity (P = 0.047) and fov.AF grade (P = 0.023). CONCLUSION: Recovery of IS/OS line integrity after surgery, in patients with preoperative IS/OS disruption and normal fov.AF, can be explained by the presence of a functional retinal pigment epithelium-photoreceptor complex, supporting normal photoreceptor activity. Autofluorescence imaging provides a functional component to the study of epiretinal membranes, complementing the structural information obtained with optical coherence tomography.

Spectral-domain optical coherence tomography of the choroid during valsalva maneuver.

PURPOSE: To evaluate the influence of Valsalva maneuver on the morphology and thickness of the choroid at the macular area. DESIGN: Prospective interventional case series. METHODS: Institutional setting. Nine healthy volunteers performed macular spectral-domain optical coherence tomography using enhanced-depth imaging at rest and during a Valsalva maneuver. Horizontal and vertical B-scans centered on the fovea were acquired. Subfoveal and average choroidal thickness in the central 3 mm were compared in the resting position and during the Valsalva maneuver using manual and semiautomatic measuring tools. Changes in choroidal thickness were evaluated. RESULTS: There was no statistically significant difference in choroidal thickness at rest or during Valsalva maneuver in any of the compared groups. The subfoveal thickness difference was -4.1 µm on horizontal scans (P = .28) and 1.4 µm on vertical scans (P = .75). The mean choroidal thickness difference in the central 3000 µm was 8.5 µm on horizontal scans (P = .73) and -5.3 µm on vertical scans (P = .41). CONCLUSIONS: Valsalva maneuver does not change choroidal thickness at the posterior pole. The increase in ocular pressure caused by this maneuver cannot be explained by an increase in choroidal thickness in this portion of the uveal tract.

Rapid thawing human sperm does not affect basic parameters in normozoospermic men: a double-blind prospective study.

PURPOSE: To compare sperm recovery from slow versus rapid thawing technique using thirty-eight normozoospermic human sperm samples, as follows. Twentyone samples from men taking part in routine infertility screening exams (infertile group) and seventeen from proven fertile volunteer men with at least one child (fertile group). MATERIALS AND METHODS: After analysis of motility, concentration, strict morphology and functional integrity of membranes, sperm was divided into two aliquots of 0.5 mL each and frozen in TyB-G medium. Samples were thawed at room temperature (25 ± 2° C) for 25 minutes (slow thaw) or in a water bath at 75° C for 20 seconds followed by water bath at 37° C for 3 minutes (rapid thaw). After thawing, motility, strict morphology and functional integrity of membranes were evaluated by a blinded investigator. The results were expressed as mean ± standard deviation for parametric variables and analyzed using Student's t-test. Data with unpaired non-parametric variables were expressed as median (interquartile range) and analyzed by the Mann-Whitney test. Wilcoxon test was used to analyze non-parametric paired variables. RESULTS: There was no significant difference between techniques for total and progressive motility, percentage of normal morphological forms, hypoosmotic swelling test. CONCLUSIONS: Although the rapid thawing protocol was completed in a shorter time (three minutes and 20 seconds versus 25 minutes, respectively), it wasn't harmful since both techniques showed comparable spermatozoa recovery. Additional research is needed to confirm its safety in clinical research before introducing this methodology in routine assisted reproduction.

Rapid thawing human sperm does not affect basic parameters in normozoospermic men: a double-blind prospective study

PURPOSE: To compare sperm recovery from slow versus rapid thawing technique using thirty-eight normozoospermic human sperm samples, as follows. Twenty-one samples from men taking part in routine infertility screening exams (infertile group) and seventeen from proven fertile volunteer men with at least one child (fertile group). MATERIALS AND METHODS: After analysis of motility, concentration, strict morphology and functional integrity of membranes, sperm was divided into two aliquots of 0.5 mL each and frozen in TyB-G medium. Samples were thawed at room temperature (25 ± 2º C) for 25 minutes (slow thaw) or in a water bath at 75º C for 20 seconds followed by water bath at 37º C for 3 minutes (rapid thaw). After thawing, motility, strict morphology and functional integrity of membranes were evaluated by a blinded investigator. The results were expressed as mean ± standard deviation for parametric variables and analyzed using Student's t-test. Data with unpaired non-parametric variables were expressed as median (interquartile range) and analyzed by the Mann-Whitney test. Wilcoxon test was used to analyze non-parametric paired variables. RESULTS: There was no significant difference between techniques for total and progressive motility, percentage of normal morphological forms, hypoosmotic swelling test. CONCLUSIONS: Although the rapid thawing protocol was completed in a shorter time (three minutes and 20 seconds versus 25 minutes, respectively), it wasn't harmful since both techniques showed comparable spermatozoa recovery. Additional research is needed to confirm its safety in clinical research before introducing this methodology in routine assisted reproduction.

Estudo das artérias dos úteros e tubas uterinas de gambá (Didelphis albiventris Lund, 1840) / Study of the uterus and uterine tuba arteries in opossum (Didelphis albiventris Lund, 1840)

Este trabalho tem como objetivo estabelecer o padrão anatômico da arquitetura vascular dos úteros e tubas uterinas de gambás (Didelphis albiventris). Para tal foram dissecados 10 fêmeas adultas, após injeção do sistema arterial, via aorta, com látex ALTAMIRA, corado com pigmento específico, e, fixados em solução aquosa de formol a 10%. Após dissecação observou-se: a) a artéria ovárica origina-se da aorta em todos os animais; b) em 4 casos (40,00%) as artérias ováricas esquerda e direita surgem da aorta através de um tronco comum; c) as artérias ováricas esquerda e direita emitem ramos tubários em 90,00% dos casos para as tubas uterinas; d) a artéria ovárica esquerda emite ramos uterinos em 60,00% das observações para o útero esquerdo; e) a artéria ovárica direita emite ramos uterinos em 90,00% dos casos para o útero direito; f) a artéria ovárica emite 1 ramo destinado a suprir a tuba uterina e o útero concomitantemente em 1 caso; g) a artéria uterina em todos os casos origina-se da artéria umbilical; h) a artéria uterina esquerda emite de 2 a 5 ramos destinados ao útero esquerdo; i) a artéria uterina direita emite 1 a 5 ramos destinados ao útero direito; j) ocorrem anastomoses entre os ramos uterinos da artéria ovárica e os ramos uterinos da artéria uterina e entre os ramos tubários da artéria ovárica e os ramos uterinos da artéria ovárica. Após análise, conclui-se que a artéria ovárica e a artéria uterina são destinadas a suprir os úteros e as tubas uterinas de gambás.

The aim of this study was to establish the anatomical pattern in the vascular architecture of the uterus and uterine tuba arteries in opossum (D. albiventris). In this study ten adult females were dissected after injection of the vascular system, through aorta, with specially tinted Altamira latex, and fixed in 10% formalin aqueous solution. It was noticed that: a) the ovarian artery extends from the aorta in all of the animals studied; b) the left and right ovarian arteries extends from the same trunk of the aorta which means 40,00% of the studied cases; c) the left and right ovarian arteries extends tubal branches for the uterine tuba, in 90,00% of the studied cases; d) the left ovarian artery extends one uterine branch for the left uterus in 60,00% of the animals studied; e) the right ovarian artery extends uterine branch for the right uterus in 90,00% of the animals; f) in one studied case the uterine tuba andthe uterus receive one branch of the ovarian artery, which supplies both structures at the same time; g) the uterine artery extends itself from the umbilical artery in every animal studied; h) the left uterine artery extends from two to five branches to the left uterus; i) the right uterine artery extends from one to five branches to the right uterus; j) anastomoses were found among the ovarian artery’s uterine branches, the uterine artery’s uterine branches, the ovarian artery’s tubal branches and the ovarian artery uterine branches. After the analyses the conclusions was: the arteries destinated to supply the uterus and uterine tuba are ovarian and uterine artery in opossum.

Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution.

BACKGROUND: To investigate whether knowledge of the anatomical distribution of histologically proven deeply infiltrating endometriosis (DIE) lesions contributes to understanding the pathogenesis. METHODS: Observational study between June 1992 and December 2004 (retrospective study between 1992 and 2000; prospective study between 2001 and 2004). Continuous series of 426 patients suffering from pelvic pain who underwent complete surgical exeresis of DIE. DIE lesions were classified according to four different possibilities: (i) Firstly, DIE lesions were classified as located in the anterior or posterior pelvic compartment. (ii) Secondly, DIE were classified as left, median and right. (iii) Thirdly, DIE lesions were classified as pelvic or abdominal. (iv) Fourthly, DIE lesions that could present in a right and/or left location were classified as unilateral or bilateral. RESULTS: These 426 patients presented 759 histologically proven DIE lesions: bladder (48 lesions; 6.3%); uterosacral (USL) (400 lesions; 52.7%); vagina (123 lesions; 16.2%); ureter (16 lesions; 2.1%) and intestine (172, 22.7%). DIE lesions are significantly more often located in the pelvis (n=730 lesions) than in the abdomen (n=29 lesions) (P<0.0001). Pelvic DIE lesions are significantly more often located in the posterior compartment of the pelvis [682 DIE lesions (93.4%) versus 48 DIE lesions (6.6%); P<0.0001]. Pelvic DIE lesions are significantly more frequently located on the left side. For patients with unilateral pelvic DIE lesions, the anatomical distribution is significantly different in the three groups: left (172 lesions; 32.0%), median (284 lesions; 52.8%) and right (82 lesions; 15.2%) (P<0.0001). For patients with lateral lesions, left DIE lesions (172 lesions; 67.8%) were found significantly more frequently than right DIE lesions (82 lesions; 32.2%) (P<0.0001). A similar predisposition was observed when we included patients with bilateral pelvic DIE lesions (P=0.0031). The same significantly asymmetric distribution is observed for total (pelvic and abdominal) DIE lesions. CONCLUSIONS: Our results demonstrate that distribution of DIE lesions is asymmetric. It is possible that this is related to the anatomical difference between the left and right hemipelvis and to the flow of peritoneal fluid. These findings support the hypothesis that retrograde menstruation of regurgitated endometrial cells is implicated in the pathogenesis of DIE.

Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification.

STUDY OBJECTIVE: To assess the results of complete surgical excision for patients with painful functional symptoms in a context of histologically proven deeply infiltrating endometriosis (DIE). DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: One hundred thirty-two patients with pelvic pain symptoms and histologically proved DIE. The DIE lesions were classified according to surgical classification: uterosacral ligaments (USL), vagina, bladder, or intestine. INTERVENTION: Complete surgical excision of DIE lesions. MEASUREMENTS AND MAIN RESULTS: A retrospective analysis was made of medical, operative, and pathologic reports as well as of questionnaires mailed to patients. Efficiency of surgical excision was assessed according to two methods: objective evaluation (numerical rating scale) and subjective evaluation (patients were asked to classify the improvement after surgery with one of the following: excellent, satisfactory, slight, or no improvement). For each symptom, the mean scores according to the numerical rating scale were significantly lower postoperatively. The difference between the preoperative and postoperative scores was 5.2 points +/- 3.6 for dysmenorrhea, 4.6 points +/- 3.1 for deep dyspareunia, 4.4 points +/- 3.7 for painful defecation during menstruation, 4.9 +/- 3.2 for lower urinary tract symptoms during menses, and 4.6 points +/- 3.4 for noncyclic chronic pelvic pain. Comparable results were observed for patients in each group according to the surgical classification of their DIE lesions: USL (n = 78 patients); vagina (n = 25 patients); bladder (n = 13 patients); and intestine (n = 16 patients). Subjective evaluation showed that the improvement was considered to be excellent in 40.2% of women (53 patients), satisfactory in 42.4% (56 patients), slight in 14.4% (19 patients), and nonexistent in 3.0% (4 patients). The patients' characteristics (i.e., age, gravidity, parity, body mass index, preoperative medical treatment, follow-up after surgery, number and location of DIE lesions, revised American Fertility Society stage, associated endometrioma) did not differ significantly according to whether the improvement was considered to be excellent (Group A: 53 patients) or not (Group B: 79 patients). Among the infertile patients (n = 78; 59.1%), there was no difference in pain improvement if the patient was pregnant or not in the 42 women who achieved pregnancy after the surgery. CONCLUSION: Complete surgical excision of DIE lesions results in a statistically significant reduction in painful functional symptoms. These results are observed whatever the main location of DIE lesions. The patients' preoperative characteristics have no significant influence on the result.

Avaliação da aplicabilidade da técnica de maturaçäo in vitro de oócitos humanos e posterior fertilização / Evaluation of the usefulness of the in vitro maturation technique of human oocyte and subsequent fertilization

OBJETIVO: avaliar a aplicabilidade da técnica de maturaçäo in vitro de oócitos humanos e posterior fertilizaçäo. MÉTODOS: estudo prospectivo näo randomizado descritivo realizado no período de novembro de 1999 a março de 2001 no qual foram incluídas 15 pacientes com infertilidade tubária e 20 ciclos de fertilizaçäo in vitro. Todas assinaram o termo de consentimento livre e esclarecido antes de iniciar o estudo. As pacientes tinham idade entre 18 e 32 anos incompletos, obstruçäo tubária como causa exclusiva de infertilidade e índice de massa corporal inferior a 25 kg/m². As pacientes receberam 300 UI de hormônio folículo estimulante (FSH) recombinante por via intramuscular no segundo dia do ciclo e doses adicionais de 150 UI no quarto e no sexto dia do ciclo. A coleta ovular foi realizada no sétimo dia do ciclo. Os oócitos foram colocados em meio TCM 199 acrescido de antibióticos, piruvato, FSH, gonadotrofina coriônica humana e soro (Serum Substitute Supplement - Irvine Scientific®). Após 48 h de cultivo, os oócitos que atingiram o estágio de metáfase II foram inseminados e os fertilizados foram transferidos. RESULTADOS: foram puncionados 144 folículos com a coleta de 67 oócitos imaturos (46,5 por cento). Quarenta e três oócitos atingiram o estágio de metáfase II (64,2 por cento) e foram inseminados. Destes, 30 fertilizaram e 25 embriöes foram transferidos para 10 pacientes. Houve uma gravidez com nascimento de um bebê. CONCLUSÄO: concluiu-se que a técnica de maturar oócitos humanos in vitro previamente à fertilizaçäo in vitro é técnica exeqüível, capaz de gerar gravidez

Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease.

BACKGROUND: Little is known about the precise nature of the relationship between dysmenorrhoea (DM) and endometriosis. Our aim was to evaluate the relationship between the severity of DM in women with posterior deep infiltrating endometriosis (DIE) and indicators of the extent of their disease. METHODS: Various indicators of the extent of DIE were recorded during surgery in 209 women. The severity of their DM was assessed with a pain scale. The scale was retrospective for 155 women and prospective for 54. Correlations were sought with an ordinal logistic regression model with cumulative odds. RESULTS: On univariate analysis the following variables were related to the severity of DM: number of previous surgical procedures for endometriosis; revised American Fertility society classification; extensiveness of adnexal adhesion; Douglas obliteration; size of the posterior DIE implant; extent of the sub-peritoneal infiltration by the posterior DIE (rectal, vaginal or both versus sub-peritoneal only). Current infertility was associated with less severe DM. After multiple regression analysis, presence of a rectal or vaginal infiltration by the posterior DIE and extensiveness of adnexal adhesion were the only factors that remained related to DM severity. CONCLUSIONS: The concept of 'very deep infiltrating endometriosis', defined as implants invading the wall of the pelvic organ, should be tested in future classification systems specifically addressed to the prediction of endometriosis-related pain.

Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification.

BACKGROUND: Deeply infiltrating endometriosis (DIE) is recognized as a specific entity responsible for pain. The distribution of locations and their contribution to surgical management has not been previously studied. METHODS: Medical, operative and pathological reports of 241 consecutive patients with histologically proven DIE were analysed. DIE lesions were classified as: (i). bladder, defined as infiltration of the muscularis propria; (ii). uterosacral ligaments (USL), as DIE of the USL alone; (iii). vagina, as DIE of the anterior rectovaginal pouch, the posterior vaginal fornix and the retroperitoneal area in between, and (iv). intestine, as DIE of the muscularis propria. RESULTS: A total of 241 patients presented 344 DIE lesions: USL (69.2%; 238); vaginal (14.5%; 50); bladder (6.4%; 22); intestinal (9.9%; 34). The proportion of isolated lesions differed significantly according to the DIE location: 83.2% (198) for USL DIE; 56.0% (28) for vaginal DIE; 59.0% (13) for bladder DIE; 29.4% (10) for intestinal DIE (P < 0.0001). The total number of DIE lesions varied significantly according to the location (P < 0.0001). In 39.1% of cases (9/23) intestinal lesions were multifocal. Only 20.6% (seven cases) of intestinal DIE were isolated and unifocal. CONCLUSIONS: Multifocality must be considered during the pre-operative work-up and surgical treatment of DIE. We propose a surgical classification based on the locations of DIE. Operative laparoscopy is efficient for bladder, USL and vaginal DIE. However, indications for laparotomy still exist, notably for bowel lesions.

Management of ovarian endometriomas.

The efficiency of medical therapy as a unique treatment for endometrioma has not been demonstrated. Operative laparoscopic management is the 'gold standard' for surgical treatment, and there are no indications to prescribe medical treatment before cystectomy. Post-operative administration of low-dose cyclic oral contraceptives does not significantly affect the long-term recurrence of endometriosis after surgical treatment. In case of infertility, the management of endometriomas is controversial. Recurrent ovarian surgery is not recommended.

Histologic appearance of endometriosis infiltrating uterosacral ligaments in women with painful symptoms.

STUDY OBJECTIVE: To describe the histologic appearance of deep endometriosis infiltrating the uterosacral ligaments (USL). DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: One hundred forty-nine women with pain due to endometriosis. INTERVENTION: Resection of one or both USL. MEASUREMENTS AND MAIN RESULTS: One hundred seventy-two USL were examined by histology after unilateral resection in 126 patients (84.6%) and bilateral resection in 23 (15.4%). Two-thirds of women (122, 70.9%) had a classic appearance of endometriosis. Lesions of myoproliferative endometriosis with a histologic appearance of so-called adenomyotic nodules were observed in 25 (14.5%). Associated fibrosis was most frequent in patients with positive compared with negative histology (85, 69.7% vs 18, 36.0%). CONCLUSION: Anatomicopathologic lesions of deep endometriosis infiltrating the USL are heterogeneous. Adenomyotic nodules are not frequently observed.

Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis.

OBJECTIVE: To investigate whether specific types of pelvic pain are correlated with the anatomic locations of deeply infiltrating endometriosis (DIE). DESIGN: Retrospective data analysis. SETTING: University tertiary referral center. PATIENT(S): Two hundred and twenty-five women with pelvic pain symptoms and DIE. INTERVENTION(S): During surgery, we recorded the anatomic locations of DIE implants and associated endometriosis. MAIN OUTCOME MEASURE(S): We studied the incidence of pelvic pain symptoms including severe dysmenorrhea, deep dyspareunia, noncyclic chronic pelvic pain, painful defecation during menstruation, urinary tract symptoms, and gastrointestinal symptoms as related to the location of DIE. RESULT(S): The frequency of severe dysmenorrhea increased with Douglas pouch adhesions and decreased with parity. The frequency of dyspareunia increased with a uterosacral ligament DIE location and decreased when it involved the bladder. The frequency of noncyclic chronic pelvic pain was higher when it involved the bowel and was lower for women who were treated for infertility. The frequency of painful defecation during menstruation was higher when DIE involved the vagina; lower urinary tract symptoms were more frequent when DIE involved the bladder and less frequent in women with a lower body mass index. Gastrointestinal symptoms were associated with bowel or vaginal DIE locations. CONCLUSION(S): The types of pelvic pain are related to the anatomic location of DIE. Knowledge of the characteristics of pelvic pain symptoms is important in the preoperative assessment of patients with suspected DIE.

Anatomopathological lesions of bladder endometriosis are heterogeneous.

OBJECTIVE: To present the anatomopathological characteristics of deep bladder endometriosis. DESIGN: Descriptive anatomapathological study. SETTING: A university hospital department of gynecological surgery. PATIENT(S): Eleven consecutive patients complaining of pelvic pain and painful urinary functional symptoms. INTERVENTION(S): Laparoscopic partial cystectomy. MAIN OUTCOME MEASURE(S): Macroscopic and microscopic characteristics of deep bladder endometriosis lesions. RESULT(S): Deep bladder endometriosis lesions were extremely heterogeneous, not only in any one patient but also from one patient to another. Bladder muscularis propria presented three aspects: [1] hyperplasia of the fibromuscular tissue (4/11); [2] simple dissociation of the smooth muscle fiber bundles with no veritable "disorganization" (4/11); [3] simple thickening of the interstitial collagen network, or sclerosis (3/11). A histological adenomyotic nodule aspect was only observed in one patient (9%). CONCLUSION(S): Bladder endometriosis is an enigmatic disease. No hypothesis can be proposed as a single explanation for its pathogenesis.

Magnetic resonance imaging and endometriosis: deeply infiltrating endometriosis does not originate from the rectovaginal septum.

The goal of this study was to describe the magnetic resonance (MR) imaging signs of deeply infiltrating endometriosis (DIE) lesions and above all to find out if MR imaging can pinpoint the location of these lesions. We made a retrospective study of 8 patients presenting with histologically proven DIE lesions. The MR imaging results were compared with intraoperative findings. Nodules revealed on T1-weighted images as isointense to myometrium with hyperintense spots remained visible on the fat-suppressed spin echo images. When there was no rectal involvement, the T1- and T2-weighted images showed a hypointense transition area between the nodule and the rectum. The DIE nodules were in identical locations in every case, lying below the torus uterinum, level with the posterior vaginal fornix and the upper third of the posterior vaginal wall. Without exception, the DIE nodules were located above the upper edge of the rectovaginal septum, with the latter appearing fine and regular with no image of any nodule. Our MR imaging results suggest that DIE lesions do not originate from the rectovaginal septum.

Routine clinical examination is not sufficient for diagnosing and locating deeply infiltrating endometriosis.

STUDY OBJECTIVE: To determine whether routine clinical examination is sufficient for the diagnosis and establishing the location of deeply infiltrating endometriosis (DIE). DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. Patients. One hundred sixty women with histologically proved deeply infiltrating endometriosis. MEASUREMENTS AND MAIN RESULTS: Speculum examination allowed endometriotic lesions to be viewed in only 14.4% (23) of patients, and a classic, painful, spheric nodule was palpated in only 43.1% (69). Results of routine clinical examination varied significantly with location of DIE. Whereas a nodule was found in 80.0% (24) of patients with vaginal endometriosis, this rate dropped to only 35.3% (6) and 33.3% (34) in those with DIE of the digestive tract and uterosacral ligaments, respectively (p <0.0001). CONCLUSION: High locations of DIE lesions at the level of uterosacral ligaments, bottom of the pouch of Douglas, and upper one-third of the posterior vaginal wall explain why results of routine clinical examination are so poor. The term "deep endometriosis infiltrating the rectovaginal septum" is generally incorrect in the true anatomic sense.