Endometrioza je kronična vnetna bolezen, ki prizadene 6–10 % žensk v rodnem obdobju. Njeni simptomi vplivajo tako na fizično kot tudi psihično in socialno življenje in so eden od glavnih vzrokov za ...odsotnost žensk z dela in od pouka. Uspešnost medikamentnega in kirurškega zdravljenja endometrioze je omejena, zato bolnice iščejo dodatne možnosti za lajšanje simptomov, ki med drugim pogosto vključujejo prilagoditev prehrane. Danes lahko prosto dostopno na spletu najdemo številne diete za bolnice z endometriozo, ki pa so jih pogosto zasnovale bolnice same in ne temeljijo na znanstvenih dokazih. Prehrana pri endometriozi je tako vse pogostejši predmet raziskovanja. Številne raziskave nakazujejo pozitiven vpliv določenih hranil na pojavnost in simptome, povezane z endometriozo. Da bi dobili boljši vpogled v vlogo prehrane pri endometriozi, smo pregledali literaturo, ki opisuje vpliv hranil ali prehrane na pojavnost endometrioze in na simptome, povezane z njo.
ENDOMETRIOZA INGHINALĂ Ana Mishina; Corina Șcerbatiuc-Condur; Igor Mishin
Arta medica,
04/2023, Letnik:
86, Številka:
1
Journal Article
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Obiective. Endometrioza inghinală reprezintă o formă de endometrioză extrapelviană rară, care frecvent este interpretată drept hernie inghinală. Actualmente mecanismul fiziopatologic nu este elucidat ...cu certitudine și presupune provocări atât diagnostice, cât și terapeutice. Scopul acestui review al literaturii este determinarea caracteristicilor fiziopatologice și clinice specifice și evaluarea posibilităților terapeutice actuale. Materiale și metode. Pentru realizarea acestui articol am studiat sursele bibliografice din bazele de date on-line Medline, PubMed, Google Scholar. Căutarea a fost efectuată după următoarele cuvinte cheie (MeSH Terms): endometrioza inghinală, formațiune inghinală. A fost colectată și procesată informația despre manifestările clinice caracteristice, metodele de diagnostic și posibilitățile de tratament, datele colectate fiind analizate, comparate și sintetizate. Rezultate și concluzii. Este o patologie rar diagnosticată preoperator. Pacientele acuză la prezența durerii catameniale și creșterea ciclică în dimensiuni. Identificarea preoperatorie implică și necesitatea utilizării imagisticii prin rezonanță magnetică. Tratamentul de elecție este excizia chirurgicală en-bloc.
Mikroorganizmi v prebavilih imajo glede na izsledke nedavnih raziskav vlogo pri uravnavanju fizioloških presnovnih procesov, energijskega ravnovesja, imunskega odgovora in ohranjanju celovitosti ...črevesnega epitela. Združbe mikroorganizmov, ki naseljujejo neko okolje oziroma ekološko nišo, imenujemo mikrobiom. S pomočjo estroboloma – bakterijskih genov, ki imajo sposobnost metaboliziranja konjugiranih estrogenov, ima mikrobiom črevesja zmožnost uravnavati ravni estrogenov v sistemskem krvnem obtoku. Estrogeni in drugi steroidni hormoni imajo pomembno vlogo pri uravnavanju sestave in funkcije mikroorganizmov, ki kolonizirajo rodila. Dosedanjim raziskavam je skupna ugotovitev, da je prevlada laktobacilov v ženskih rodilih povezana z ugodnim reproduktivnim in perinatološkim izidom. Motnje mikrobioma rodil kot tudi mikrobioma prebavil lahko tako preko delovanja estroboloma vplivajo na razvoj kroničnih vnetnih (endometrioza) kot tudi malignih ginekoloških bolezni (rak endometrija).
Obravnava endometrioze v pomenopavznem obdobju Belak Magdalenić, Urška; Frangež, Helena Ban; Korošec, Sara
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
12/2023, Letnik:
92, Številka:
11-12
Journal Article
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Endometrioza je bolezen, ki lahko prizadene 2–5 % vseh žensk v pomenopavznem obdobju. Gre za bolezen, pri kateri se endometrijske žleze in stroma nahajajo zunaj maternice. O pomenopavzni endometriozi ...je zaenkrat v literaturi še malo znanih podatkov. V sklopu diagnosticiranja je v tem obdobju v ospredju predvsem skrb, da gre morda za maligno bolezen. Poročila v literaturi opisujejo ponovitev endometrioze v pomenopavznem obdobju kot tudi nastanek endometrioze »de novo«. Zdravljenje izbire simptomatske endometrioze v pomenopavzi je kirurško z odstranitvijo vsega vidnega endometriotičnega tkiva zaradi višjega tveganja za ponovitev bolezni in preobrat v maligno bolezen. Hormonsko zdravljenje po menopavzi (MHZ) se pogosto uporablja za lajšanje simptomov in preprečevanje izgube kostne mase. Obstajajo raziskave, ki dokazujejo, da MHZ lahko ponovno aktivira endometriotična žarišča in celo spodbuja maligno preoblikovanje žarišč pri ženskah z anamnezo endometrioze. Glede na ne povsem razjasnjena tveganja MHZ pri tovrstnih bolnicah se svetuje dodatna previdnost.
Background. Many studies have shown significant reduction of fertility in endometriosis. Mechanisms of infertility are still not completely clear. The aim of our study is to obtain the effectiveness ...of laparoscopic treatment of infertility for different stages of endometriosis. Methods. The effectiveness of laparoscopic treatment of infertility in endometriosis was observed through a questionnaire that was sent to 281 patients (pts), who had laparoscopic treatment at the Department of Obstetrics and Gynecology Ljubljana during the period from 1999 to 2006 due to endometriosis as the only cause of infertility. 53.4 % (150/281) pts, who answered the questionnaire, were divided into group I (minimal and mild endometriosis) and group II (moderate and severe endometriosis). We established the rate of pregnancy (in total, spontaneous and ART) and compared the results between two groups. Relatively small percentage of answered questionnaires was most likely due to the fact that the questionnaires were sent to pts who were operated several years ago and did not respond or have changed their address. Because the study is still ongoing, we present partial results. Results. For 132 pts wanting to get pregnant the overall pregnancy rate was 76.5 % (101/132). The rate of pregnant pts depended on the stage of endometriosis. In group I 86.8 % (79/91) pts became pregnant – 58. 2 % (46/79) spontaneously, 41.8 % (33/79) with ART. In group II 53.6 % (22/41) pts became pregnant – 68.2 % (15/22) spontaneously, 31.8 % (7/22) with ART. The difference between groups was statistically significant (p < 0.05). Conclusions. Our results are comparable to the results found in the literature. Laparoscopic treatment of infertility is effective in all four stages of endometriosis. According to our results laparoscopic treatment has the primary role in the treatment of endometriosis-associated infertility
Background. Endometriosis is an estrogen dependent disease that affects 5 − 20 % of women of reproductive age. Course of the disease is progressive and leads to a variety of symptoms that range from ...pain complaints to infertility. Some symptoms depend on the location of the break out. The most frequent symptoms are dysmenorrhea, dyspareunia, chronic pelvic pain and infertility. Endometriosis is also found in asymptomatic women. Clinical signs and symptoms with extrapelvic endometriosis are based on the involved organ system. Dysmenorhea may progress and begin prior to the onset of menses or become chronic and be noted throughout most of the menstrual cycle. Pain during menstrual cycle is estimated on 60–80 % of women with endometriosis. Dyspareunia is estimated on 25–50 % of women with endometriosis. It is frequently associated with rectovaginal and uterosacral ligament disease. It was established that advanced endometriosis is more frequently related to dysmenorrhea and deep dyspareunia in comparison with early disease. Chronic pelvic pain is defined as the pain that lasts 6 months and is not cyclic. In women being evaluated for pelvic pain, the diagnosis of endometriosis is made in 40–60 %, especially when it comes to deep infiltrative endometriosis. Infertility can be the only presenting symptom. The incidence of infertility in women with endometriosis is hard to establish. Some women with mild endometriosis are able to conceive, however this mild endometriosis can cause infertility. There is estimation that 20–30 % of women with endometriosis are infertile. Conclusions. Medical history is very important in recognizing the disease. Endometriosis does not threaten life but is associated with significant morbidity of women. It has a major impact on women’s health and life quality and represents a significant public health issue. Because the clinical signs and symptoms are complex and there is sometimes lack of the association between the stage of the disease and intensivity of symptoms, the disease can be diagnosed too late.
U ovom retrospektivnom istraživanju analizirani su parametri vezani za nastanak i lečenje pelvične endometrioze (operativni zahvat, godine starosti, operativni pristup i konzervativnost ...operacije,rasprostranjenost endometrioze na okolne organe male karlice) na Ginekološko-akušerskoj klinici Kliničkog centra Kragujevac, tokom petogodišnjeg perioda. Od ukupno 88 pacijentkinja koje su imale cistu na jajniku i povišenu vrednost tumorskog markera Ca 125, te patohistološku verifikaciju endometrioze, najviše ih je bilo starosnedobi od 26 do 35 godina (56,8%). Najčešće je primenjivan radikalni hirurški zahvat, adneksektomija kod 53 (60,2%) i hosterektomija kod 24 (45,83%) pacijentkinje (p<0,01), a s gotovo podjednakomverovatnoćom primenjivane su laparotomija i laparoskopija (p>0,01). Endometrioza jajnika često je bila udružena i s endometriozomna drugim organima male karlice.
Mimo wielu badań biochemicznych i molekularnych endometrioza należy do chorób, których etiopatogenezajest mało poznana i przysparza wiele trudności w postępowaniu leczniczym. Rozpoczynając terapię ...endometriozy,należy wziąć pod uwagę rodzaj i stopień nasilenia objawów oraz status prokreacyjny kobiety. Ponadto,klasyczna definicja endometriozy (obecność komórek gruczołowych i podścieliska) zakłada konieczność pobraniamateriału do badania histopatologicznego. Nie zawsze jednak laparoskopia jest pierwszym krokiem w rozpoznawaniui terapii endometriozy. Leczenie objawów, takich jak ból związany z endometriozą czy zaburzeniamiesiączkowania, rozpoczyna się od podania leków I rzutu – tabletek antykoncepcyjnych oraz niesteroidowychleków przeciwzapalnych (NLPZ). Dwuskładnikowe tabletki antykoncepcyjne najczęściej poleca się do stosowaniaw terapii ciągłej. Nieskuteczne leczenie bólu (min. 3 miesiące) daje podstawę do wdrożenia innej metodyleczniczej: laparoskopii lub terapii II rzutu, czyli zastosowania analogów GnRh, Danazolu i progestagenów. Dużenadzieje wiąże się inhibitorami aromatazy, inhibitorami czynnika martwicy nowotworów α (TNF-α), lekamihamującymi angiogenezę oraz inhibitorami metaloproteinaz tkankowych.
Background. Endometriosis is a comon, complex gynecological syndrom defined as the growth of endometrial glands and stroma in an extra-uterine location. It affects 5 – 20 % of women of reproductive ...age.1 Nowadays, prevailing opinion about endometriosis is based on presumption, that endometriosis is a result of changed immune system, according to autoimmune theory.2, 3 Characteristics of autoimmune disease that are also found in endometriosis are female preponderance, multiorgan involvement, family occurence, possible genetic basis, response to hormonal manipulation, tissue damage, polyclonal B lymphocite activation, immunological abnormalities in T lymphocite and B lymphocite function and associated autoimmune disease. Women with endometriosis are more frequently affected by asthma, rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrom and Hashimoto’s thyroiditis. Autoimmune disease is characterized by the production of autoantibodies against components of apoptotic cells. Anti-endometrial antibodies of IgG and IgM classes could be detected in 60 % of endometriosis patients. They show reactivity in glandular epithelium and stroma. Anti-endothelial antibodies specifically react with vascular endothelium and might be with anti-endometrial antibodies partially responsible for failure of implantation leading to infertility, wich is common in endometriosis patients. Anti-nuclear antibodies are frequent serological findings in patients with autoimmune disease, and could be detected in 29–47 % of women with endometriosis.4 Generation of anti-nuclear antibodies is a risk factor for development of other autoimmune disease in women of reproductive age. Studies have shown conflicting results on the presence of anti-ovarian antibodies in the serum of endometriosis patients and in the peritoneal fluid. Their presence is one of the possible causes of infertility. Conclusions. Ethiopathogenesis of endometriosis still remains uncelar but currently available data suggest that there are many similarites between endometriosis and such autoimmune diseases as rheumathoid arthritis, systemic lupus erythematosus, Sjögren syndrom etc. Important similarity is the presence of auto-antibodies. Autoimmune theory represents a challenge and at the same time opens the possibility of a new mode of treatement of endometriosis with immunomodulators.
DEEP INFILTRATING ENDOMETRIOSIS Martina Ribič-Pucelj
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Letnik:
78
Journal Article
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Background: Endometriosis is not considered a unified disease, but a disease encompassing three differ- ent forms differentiated by aetiology and pathogenesis: peritoneal endometriosis, ovarian ...endometriosis and deep infiltrating endometriosis (DIE). The disease is classified as DIE when the lesions penetrate 5 mm or more into the retroperitoneal space. The estimated incidence of endometriosis in women of reproductive age ranges from 10–15 % and that of DIE from 3–10 %, the highest being in infertile women and in those with chronic pelvic pain. The leading symptoms of DIE are chronic pelvic pain which increases with age and correlates with the depth of infiltration and infertility. The most important diagnostic procedures are patient’s history and proper gynecological examination. The diagnosis is confirmed with laparoscopy. DIE can affect, beside reproductive organs, also bowel, bladder and ureters, therefore adi- tional diagnostic procedures must be performed preopertively to confirm or to exclude the involvement of the mentioned organs. Endometriosis is hormon dependent disease, there- fore several hormonal treatment regims are used to supress estrogen production but the symptoms recurr soon after caesation of the treatment. At the moment, surgical treatment with excision of all lesions, including those of bowel, bladder and ureters, is the method of choice but requires frequently interdisciplinary approach. Surgical treatment significantly reduces pain and improves fertility in inferile patients. Conclusions: DIE is not a rare form of endometriosis characterized by chronic pelvic pain and infertility. Medical treatment is not efficient. The method of choice is surgical treatment with excision of all lesions. It significantly reduces pelvic pain and enables high spontaneus and IVF preg- nacy rates.Therefore such patients should be treated at centres with experience in treatment of DIE and with possibility of interdisciplinary approach.
