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1.
Facts Views Vis Obgyn ; 14(3): 245-253, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36206799

RESUMO

Background: Deep Endometriosis (DE) classification studies with Enzian never compared solitary compartments (A, B, C, F), and combinations of anatomical locations (A&B, A&C, B&C, A&B&C), in correlation to pain. Therefore, the results of these studies are challenging to translate to the clinical situation. Objectives: We studied pain symptoms and their correlation with the solitary and combinations of anatomical locations of deep endometriosis lesion(s) classified by the Enzian score. Materials and Methods: A prospective multi-centre study was conducted with data from university and non-university hospitals. A total of 419 surgical DE cases were collected with the web-based application called EQUSUM (www.equsum.org). Main Outcome Measures: Preoperative reported numeric rating scale (NRS) were collected along with the Enzian classification. Baseline characteristics, pain scores, surgical procedure and extent of the disease were also collected. Results: In general, more extensive involvement of DE does not lead to an increase in the numerical rating scale for pain measures. However, dysuria and bladder involvement do show a clear correlation AUC 0.62 (SE 0.04, CI 0.54-0.71, p< 0.01). Regarding the predictive value of dyschezia, we found a weak, but significant correlation with ureteric involvement; AUC 0.60 (SE 0.04, CI 0.53-0.67, p< 0.01). Conclusions: Pain symptoms poorly correlate with anatomical locations of deep endometriosis in almost all pain scores, with the exception of bladder involvement and dysuria which did show a correlation. Also, dyschezia seems to have predictive value for DE ureteric involvement and therefore MRI or ultrasound imaging (ureter and kidney) could be recommended in the preoperative workup of these patients. What's new?: Dyschezia might have a predictive value in detecting ureteric involvement.

2.
Facts Views Vis Obgyn ; 13(1): 27-34, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33889858

RESUMO

BACKGROUND: Subfertility occurs in 30-40% of endometriosis patients. Regarding the fertilisation rate with in vitro fertilisation (IVF) and endometriosis, conflicting data has been published. This study aimed to compare endometriosis patients to non-endometriosis cycles assessing fertilisation rates in IVF. METHODS: A population-based cohort study was conducted at the Leiden University Medical Center. IVF cycles of endometriosis patients and controls (unexplained infertility and tubal pathology) were analysed. The main outcome measurement was fertilisation rate. RESULTS: 503 IVF cycles in total, 191 in the endometriosis group and 312 in the control. The mean fertilisation rate after IVF did not differ between both groups, 64.1%±25.5 versus 63.9%±24.8 (p=0.95) respectively, independent of age and r-ASRM classification. The median number of retrieved oocytes was lower in the endometriosis group (7.0 versus 8.0 respectively, p=0.19) and showed a significant difference when corrected for age (p=0.02). When divided into age groups, the statistical effect was only seen in the group of ≤ 35 years (p=0.04). In the age group ≤35, the endometriosis group also showed significantly more surgery on the internal reproductive organs compared to the control group (p<0.001). All other outcomes did not show significant differences. CONCLUSION: Similar fertilisation rates were found in endometriosis IVF cycles compared to controls. The oocyte retrieval was lower in the endometriosis group, however this effect was only significant in the age group ≤ 35 years. All other secondary outcomes did not show significant differences. In general, endometriosis patients with an IVF indication can be counselled positively regarding the chances of becoming pregnant, and do not need a different IVF approach.

3.
Hum Reprod Open ; 2020(4): hoaa053, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33409380

RESUMO

STUDY QUESTION: Is electronic digital classification/staging of endometriosis by the EQUSUM application more accurate in calculating the scores/stages and is it easier to use compared to non-digital classification? SUMMARY ANSWER: We developed the first digital visual classification system in endometriosis (EQUSUM). This merges the three currently most frequently used separate endometriosis classification/scoring systems (i.e. revised American Society for Reproductive Medicine (rASRM), Enzian and Endometriosis Fertility Index (EFI)) to allow uniform and adequate classification and registration, which is easy to use. The EQUSUM showed significant improvement in correctly classifying/scoring endometriosis and is more user-friendly compared to non-digital classification. WHAT IS KNOWN ALREADY: Endometriosis classification is complex and until better classification systems are developed and validated, ideally all women with endometriosis undergoing surgery should have a correct rASRM score and stage, while women with deep endometriosis (DE) should have an Enzian classification and if there is a fertility wish, the EFI score should be calculated. STUDY DESIGN SIZE DURATION: A prospective endometriosis classification proof of concept study under experts in deep endometriosis was conducted. A comparison was made between currently used non-digital classification formats for endometriosis versus a newly developed digital classification application (EQUSUM). PARTICIPANTS/MATERIALS SETTING METHODS: A hypothetical operative endometriosis case was created and summarized in both non-digital and digital form. During European endometriosis expert meetings, 45 DE experts were randomly assigned to the classic group versus the digital group to provide a proper classification of this DE case. Each expert was asked to provide the rASRM score and stage, Enzian and EFI score. Twenty classic forms and 20 digital forms were analysed. Questions about the user-friendliness (system usability scale (SUS) and subjective mental effort questionnaire (SMEQ)) of both systems were collected. MAIN RESULTS AND THE ROLE OF CHANCE: The rASRM stage was scored completely correctly by 10% of the experts in the classic group compared to 75% in the EQUSUM group (P < 0. 01). The rASRM numerical score was calculated correctly by none of the experts in the classic group compared with 70% in the EQUSUM group (P < 0.01). The Enzian score was correct in 60% of the classic group compared to 90% in the EQUSUM group (P = 0.03). EFI scores were calculated correctly in 25% of the classic group versus 85% in the EQUSUM group (P < 0.01). Finally, the usability measured with the SUS was significantly better in the EQUSUM group compared to the classic group: 80.8 ± 11.4 and 61.3 ± 20.5 (P < 0.01). Also the mental effort measured with the SMEQ was significant lower in the EQUSUM group compared to the classic group: 52.1 ± 18.7 and 71.0 ± 29.1 (P = 0.04). Future research should further develop and confirm these initial findings by conducting similar studies with larger study groups, to limit the possible role of chance. LIMITATIONS REASONS FOR CAUTION: These first results are promising, however it is important to note that this is a preliminary result of experts in DE and needs further testing in daily practice with different types (complex and easy) of endometriosis cases and less experienced gynaecologists in endometriosis surgery. WIDER IMPLICATIONS OF THE FINDINGS: This is the first time that the rASRM, Enzian and EFI are combined in one web-based application to simplify correct and automatic endometriosis classification/scoring and surgical registration through infographics. Collection of standardized data with the EQUSUM could improve endometriosis reporting and increase the uniformity of scientific output. However, this requires a broad implementation. STUDY FUNDING/COMPETING INTERESTS: To launch the EQUSUM application, a one-time financial support was provided by Medtronic to cover the implementation cost. No competing interests were declared. TRIAL REGISTRATION NUMBER: N/A.

4.
Eur J Neurol ; 25(11): 1313-e113, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29924481

RESUMO

BACKGROUND AND PURPOSE: Fatigue is a major consequence of subarachnoid hemorrhage (SAH), but the specific characteristics are unclear. Our objective was to investigate the nature of post-SAH fatigue (mental or physical) and to determine the relationship with functional outcome in the chronic stage. Also, the possible influence of mood disorders and acute SAH-related factors [SAH type and external cerebrospinal fluid (CSF) drainage] on the presence of fatigue was investigated. METHODS: Patients with an aneurysmal SAH (aSAH) or angiographically negative SAH (anSAH) were assessed 3-10 years post-SAH (N = 221). Questionnaires were used to investigate mental and physical fatigue and mood. Functional outcome was examined with the Glasgow Outcome Scale Extended. Between-group comparisons and binary logistic regression analysis were performed. RESULTS: Frequencies of mental and physical fatigue were 48.4% and 38.5%, respectively, with prevalence of mental fatigue being significantly higher. A two-way anova with SAH type and external CSF drainage as independent variables and mental fatigue as dependent variable showed a significant main effect of CSF drainage only (P < 0.001). Only mental fatigue explained a significant part of the variance in long-term functional outcome (model χ2 = 52.99, P < 0.001; Nagelkerke R² = 0.32). CONCLUSIONS: Mental fatigue after SAH is a serious burden to the patient and is associated with impaired long-term functional outcome. Distinguishing different aspects of fatigue is relevant as mental post-SAH fatigue might be a target for treatment aimed to improve long-term outcome.


Assuntos
Fadiga/complicações , Fadiga Mental/complicações , Hemorragia Subaracnóidea/complicações , Adulto , Afeto , Idoso , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
6.
Neuroradiology ; 49(12): 997-1007, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17891387

RESUMO

INTRODUCTION: We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). METHODS: Over the period April 2003 to January 2006 in all patients presenting with a subarachnoid haemorrhage CTA was performed primarily. If CTA demonstrated an aneurysm, coiling or clipping was undertaken. IA-DSA was limited to patients with negative or inconclusive CTA findings. We compared CTA images with findings at surgery or coiling in patients with positive CTA findings and in patients with negative and inconclusive findings in whom IA-DSA had been performed. RESULTS: In this study, 224 consecutive patients (mean age 52.7 years, 135 women) were included. In 133 patients (59%) CTA demonstrated an aneurysm, and CTA was followed directly by neurosurgical (n = 55) or endovascular treatment (n = 78). In 31 patients (14%) CTA findings were categorized as inconclusive, and in 60 (27%) CTA findings were negative. One patient received surgical treatment on the basis of false-positive CTA findings. In 17 patients in whom CTA findings were inconclusive, IA-DSA provided further diagnostic information required for correct patient selection for any therapy. Five ruptured aneurysms in patients with a nonperimesencephalic SAH were negative on CTA, and four of these were also false-negative on IA-DSA. On a patient basis the positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CTA for symptomatic aneurysms were 99%, 90%, 96%, 98% and 96%, respectively. CONCLUSION: CTA should be used as the first diagnostic modality in the selection of patients for surgical or endovascular treatment of ruptured intracranial aneurysms. If CTA renders inconclusive results, IA-DSA should be performed. With negative CTA results the complementary value of IA-DSA is marginal. IA-DSA is not needed in patients with negative CTA and classic perimesencephalic SAH. Repeat IA-DSA or CTA should still be performed in patients with a nonperimesencephalic SAH.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Aneurisma Roto/cirurgia , Angiografia Digital , Meios de Contraste , Feminino , Humanos , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Sensibilidade e Especificidade , Ácidos Tri-Iodobenzoicos
7.
Neuroradiology ; 47(8): 622-9, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15983772

RESUMO

The purpose of this study was to evaluate time-of-flight magnetic resonance angiography (MRA) in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils (GDCs). From January 1998 to January 2002 27 MRA and intra-arterial digital subtraction angiography (IADSA) examinations were analyzed for residual aneurysms and arterial patency following GDC placement. A total number of 33 intracranial aneurysms was analyzed, including 18 located in the posterior circulation. The MRA analysis was based on source images in combination with maximum intensity projections. The IADSA was used as the reference standard. Two aneurysms were excluded from evaluation, because of susceptibility artefacts from other aneurysms, which were clipped. Sensitivity and positive predictive values of MRA in revealing residual aneurysms were, respectively, 89% and 80%. Specificity in ruling out remnant necks and residual flow around coils was, respectively, 91% and 97%, with a negative predictive value of, respectively, 95% and 100%. Specificity and negative predictive value of MRA for arterial occlusion were, respectively, 87% and 100% for the parent arteries and, respectively, 85% and 100% for the adjacent arteries. MRA is a reliable diagnostic tool in the follow-up of GDC treatment, and it may replace IADSA in excluding residual flow around coils and aneurysmal necks and in ruling out arterial occlusion.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética/métodos , Adulto , Idoso , Angiografia Digital , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Resultado do Tratamento
8.
Acta Neurochir (Wien) ; 147(8): 815-21, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15944811

RESUMO

BACKGROUND: There is still lack of evidence on the optimal timing of surgery in patients with aneurysmal subarachnoid haemorrhage. Only one randomised clinical trial has been done, which showed no difference between early and late surgery. Other studies were observational in nature and most had methodological drawbacks that preclude clinically meaningful conclusions. We performed a retrospective observational study on the timing of aneurysm surgery in The Netherlands over a two-year period. METHOD: In eight hospitals we identified 1,500 patients with an aneurysmal subarachnoid haemorrhage. They were subjected to predefined inclusion criteria. We included all patients who were admitted and were conscious at any one time between admission and the end of the third day after the haemorrhage. We categorised the clinical condition on admission according the World Federation of Neurological Surgeons (WFNS) grading scale. Early aneurysm surgery was defined as operation performed within three days after onset of subarachnoid haemorrhage; intermediate surgery as performed on days four to seven, and late surgery as performed after day seven. Outcome was classified as the proportion of patients with poor outcome (death or dependent) two to four months after onset of subarachnoid haemorrhage. We calculated crude odds ratios with late surgery as reference. We distinguished between management results (reconstructed intention to treat analysis) and surgical results (on treatment analysis). The results were adjusted for the major prognosticators for outcome after subarachnoid haemorrhage. FINDINGS: We included 411 patients. There were 276 patients in the early surgery group, 36 in the intermediate surgery group and 99 in the late surgery group. On admission 78% were in good neurological condition (WFNS I-III). MANAGEMENT RESULTS: Overall, 93 patients (34%) operated on early had a poor outcome, 13 (36%) of those with intermediate surgery and 37 (37%) in the late surgery group had a poor outcome. For patients in good clinical condition on admission and planned for early surgery the adjusted odds ratio (OR) was 1.3 (95% CI 0.5 to 3.0). The adjusted OR for patients admitted in poor neurologicalcondition (WFNS IV-V) and planned for early surgery was 0.1 (95% CI 0.0 to 0.6). SURGICAL RESULTS: For patients in good clinical condition on admission who underwent early operation the adjusted OR was 1.1 (95% CI 0.4 to 3.2); it was 0.2 (95% CI 0.0 to 0.9) for patients admitted in poor clinical condition. CONCLUSIONS: In this observational study we found no significant difference in outcome between early and late operation for patients in good clinical condition on admission. For patients in poor clinical condition on admission outcome was significantly better after early surgery. The optimal timing of surgery is not yet settled. Ideally, evidence on this issue should come from a randomised clinical trial. However, such a trial or even a prospective study are unlikely to be ever performed because of the rapid development of endovascular coiling.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico , Estudos de Coortes , Feminino , Escala de Coma de Glasgow , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Fatores de Tempo , Resultado do Tratamento
9.
Neuroradiology ; 46(11): 867-75, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15502999

RESUMO

This study was aimed at establishing whether magnetic resonance angiography (MRA) can be applied to planning and performing surgery on ruptured intracranial aneurysms, especially in the early phase, without recourse to intra-arterial digital subtraction angiography (IA-DSA). From February 1998 to August 2001, in all patients presenting with a subarachnoid hemorrhage, MRA was performed first. A three-dimensional time-of-flight MRA protocol with T2-weighted coronal and axial images was used. If MRA demonstrated an aneurysm, surgery was undertaken. IA-DSA was limited to patients with negative or inconclusive MRA findings. We compared MRA images with operative findings in positive patients and with IA-DSA in negatives. IA-DSA was considered the gold standard when MRA findings were inconclusive. In this study, 205 consecutive patients (mean age 52.7 years, 69% women) were included. In 133 patients (64.9%) MRA demonstrated an aneurysm, directly followed by neurosurgical intervention. In 33 patients (16.1%) MRA findings were categorized as inconclusive. In 39 patients (19.0%) MRA results were negative. No false-negative ruptured aneurysms were selected by MRA. In only one patient surgical intervention was performed based on false-positive MRA findings. MRA can replace IA-DSA as a first diagnostic modality in the selection of patients suitable for surgical treatment of ruptured intracranial aneurysms.


Assuntos
Aneurisma Roto/diagnóstico , Aneurisma Roto/cirurgia , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia , Angiografia por Ressonância Magnética , Seleção de Pacientes , Adolescente , Adulto , Idoso , Aneurisma Roto/complicações , Criança , Feminino , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
10.
Neurosurgery ; 34(6): 994-1002; discussion 1002, 1994 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8084410

RESUMO

Proton magnetic resonance spectroscopic imaging (1H-MRSI) and positron emission tomography with the tracer L-[1-11C]tyrosine (11C-TYR) were used to localize gliomas for biopsy or resection. This is especially helpful in cases of low-grade gliomas, if these lesions are not visualized by contrast-enhanced computed tomographic and magnetic resonance imaging scans. The clues to improved localization are provided by changes in tissue metabolite contents, such as elevation of phosphocholine, indicating cellular proliferation; decrease of N-acetylaspartate, denoting loss of neurons (as these are replaced by tumor cells); and elevation of lactate, pointing to the prevalence of glycolysis, as observed in many tumors. These data on tissue metabolite content have been obtained in vivo in the patient by proton magnetic resonance spectroscopy; metabolite maps derived from these data then visualize the distribution of the various metabolites over the section of the brain under investigation. Alternatively, localization of a tumor may be achieved by means of positron emission tomography depicting the pattern of uptake of the amino acid tracer 11C-TYR, as it tends to be incorporated in the process of cellular proliferation and protein biosynthesis. Five cases are presented as examples.


Assuntos
Neoplasias Encefálicas/patologia , Glioma/patologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada de Emissão , Adulto , Astrocitoma/patologia , Astrocitoma/cirurgia , Biópsia , Neoplasias Encefálicas/cirurgia , Radioisótopos de Carbono , Craniotomia , Feminino , Lobo Frontal/patologia , Lobo Frontal/cirurgia , Glioblastoma/patologia , Glioblastoma/cirurgia , Glioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas Estereotáxicas , Lobo Temporal/patologia , Lobo Temporal/cirurgia , Tirosina
11.
Acta Neurochir (Wien) ; 131(1-2): 74-9, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-7709788

RESUMO

Four patients aged 5 to 9 years with large tumours located in the posterior fossa (PNET, ependymoma or astrocytoma) are presented. Patients received standard neuropsychological assessments, including speech evaluation, prior to surgery. Following tumour resection, these 4 children developed transient mutism or different types of speech and cognitive disorders, associated with behavioural disturbances. We describe course and results of repeated postoperative neurological and neuropsychological evaluations. Full recovery of speech was seen in 3 out of 4 patients; the only child with persistent symptoms was the one who already had neuropsychological deficits before surgery. However, despite fast recovery of the speech disorders more persistent behavioural problems were found in 3 out of 4 patients. Possible pathogenesis anatomical location of this "cerebellar speech syndrome" are discussed, as well as the relevance of repeated neuropsychological assessments.


Assuntos
Neoplasias Cerebelares/cirurgia , Neoplasias do Ventrículo Cerebral/cirurgia , Ataque Isquêmico Transitório/etiologia , Mutismo/etiologia , Complicações Pós-Operatórias/etiologia , Distúrbios da Fala/etiologia , Astrocitoma/diagnóstico , Astrocitoma/cirurgia , Neoplasias Cerebelares/diagnóstico , Neoplasias do Ventrículo Cerebral/diagnóstico , Criança , Pré-Escolar , Ependimoma/diagnóstico , Ependimoma/cirurgia , Humanos , Ataque Isquêmico Transitório/diagnóstico , Masculino , Mutismo/diagnóstico , Tumores Neuroectodérmicos Primitivos/diagnóstico , Tumores Neuroectodérmicos Primitivos/cirurgia , Testes Neuropsicológicos , Complicações Pós-Operatórias/diagnóstico , Distúrbios da Fala/diagnóstico
12.
Acta Neurochir (Wien) ; 88(3-4): 75-8, 1987.
Artigo em Inglês | MEDLINE | ID: mdl-3687502

RESUMO

A series of 383 extracranial CSF shunts performed between Jan. 1980 and Jan. 1985 for hydrocephalus in children and adults is reviewed. Ventriculoatrial (VA) and ventriculoperitoneal (VP) shunts were compared with a special attention to infections. The difference between VA and VP shunts concerning indication of revision, operative mortality and infection related morbidity and mortality was not significant.


Assuntos
Derivações do Líquido Cefalorraquidiano , Hidrocefalia/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Átrios do Coração , Humanos , Lactente , Recém-Nascido , Masculino , Países Baixos , Cavidade Peritoneal , Estudos Retrospectivos
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