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The Role of Oral Contraceptive Therapy in Women Wait-Listed for Surgery for Deep Infiltrating Endometriosis
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S1–S24 Design: Case control-study. Setting: University tertiary referral center. Patients: 476 women less than 42 years old operated for benign gynecological indications from February 2005 and October 2009. The study group included 238 patients with histologically proved endometriosis (superficial SUP n = 40; OMA n = 101; DIE n = 97). Cases were matched to 238 controls without endometriosis on age and smoking status, which are usually correlated to BMI. Intervention: Complete surgical excision of symptomatic endometriotic lesions. Measurements and Main Results: Mean BMI was compared for patients and controls, for the stages (rAFS classification) and for endometriosis subtypes (SUP, OMA and DIE). Adjusted odds ratios (OR) were computed using a multiple regression analysis taking into account all possible confounding variables (parity, infertility, oral contraceptive use and visual analog scale above 7 for pelvic pain). Patients with endometriosis have a significant lower BMI as compared to controls (21,703.7 vs. 23.29, p\0.001). Mean BMI is significantly lower for DIE and OMA as compared to their own controls (21,353.4 vs. 23.35, p\0.001 and 21.883.8 vs. 22.994, p\0.038, respectively) but not for SUP. Patients with BMI%20 have a higher risk of endometriosis (OR = 2.5, 95%CI 1.73.7), OMA (OR = 2.5 ; 95%CI 1.5-4) and DIE (OR = 3.1, 95%CI 1.85-6). Patients with BMI%22 have a higher risk of stages I/II endometriosis (OR = 2.40, 95%CI 1-4.4) and stages III/IV (OR = 2.80, 95%CI 1.8-4.3). There is no statistical significant difference for the BMI between the rAFS stages. Conclusion: BMI is associated with a higher risk of endometriosis, especially of DIE and OMA but not of SUP. Patients with a BMI below 20 have an increased risk of developing a DIE with an OR of 3.1, independently of the intensity of pain and other confounding variables.
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Open Communications 1dEndometriosis (12:29 PM d 12:34 PM)
Watching Endometriosis Grow? A New Animal Model Using Ovine Eyes Garry R. Retired Professor University of Western Australia, Guisborough, Yorkshire, United Kingdom Study Objective: To use the immunologically-privileged site of the anterior chamber of sheep eyes to observe the early stages of implantation and growth of human endometrium through the transparent cornea. Design: A prospective research study in which human endometrial curettings are transplanted into the anterior chamber of sheep eye. Setting: An approved animal research laboratory in Victoria, Australia. Patients: Material: A sub-group of 12 sheep from a larger group of 60 sheep who had endometrial curettings from human volenteer donors transplanted surgically into the anterior chamber of their eyes. Intervention: The fate of the implants after transplantation was continually documented for the first 8 days after transplantation. After sacrifice the eyes were examined with conventional histology and a number of immunohistochemical techniques. Measurements and Main Results: All transplants were easily observed through the transparent cornea. Initially they appeared pink and healthy but within 24 hours became blanched and ‘lifeless’. Within 2-3 days some began to shows signs of growth and increased colour. By 8 days post transplantation, the implants that were surviving had developed both new intrinsic and extrinsic blood supplies. They also developed a new surface epithelial lining. Some transplants showed evidence of new gland growth and invasion into both the iris and the cornea which in one case was very aggressive. Most surprising was that in one case new classic endometriosis developed within 8 days in the cornea where no macroscopic transplanted had been left. This case clearly demonstrates a full blown endometriosis arising from a single/very few endometrial cells within a very short time span. All specimens left for longer than 10 days were rejected by immunological processes. Conclusion: Human endometrium can be transplanted into the anterior chamber of large mammal eyes such Using this model the early stages of re-vascularisation and growth of endometrium/endometriosis can be observed on a continual or continuous basis.
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S13
Open Communications 1dEndometriosis (12:35 PM d 12:40 PM)
The Role of Oral Contraceptive Therapy in Women Wait-Listed for Surgery for Deep Infiltrating Endometriosis Frasca` C, Mabrouk M, Geraci E, Solfrini S, Montanari G, Facchini C, Di Donato N, Raimondo D, Ferrini G, Venturoli S, Seracchioli R. Gynecology and Reproductive Medicine Unit S. Orsola Malpighi Hospital, Bologna, Italy Study Objective: To evaluate if oral contraceptive therapy can reduce or contain symptoms and nodules’ dimensions in patients wait-listed for surgery for deep infiltrating endometriosis. Design: Retrospective analysis. Setting: Tertiary care university hospital. Patients: One hundred six patients affected by deep infiltrating endometriosis and scheduled for laparoscopic surgery from November 2004 to November 2009. Intervention: During the study period (from surgical scheduling to preoperative examination: mean time 5.8 months), 75 patients were submitted to oral contraceptive therapy (therapy group) while 31 did not take any hormonal therapy (control group). Measurements and Main Results: At the beginning and at the end of the study period patients underwent a transvaginal sonographic examination evaluating localization and dimensions of endometriotic nodules. Presence and intensity of dysmenorrhoea, dyspareunia, chronic pelvic pain, dyschezia and dysuria were evaluated by 10-points Visual Analogue Scale. In the therapy group the mean nodules’ dimensions at scheduling and preoperative examination were respectively 24.8115.13 mm and 26.6615.5 mm (p = ns); in the control group dimensions were respectively 23.0911.11 mm and 30.8919.1 mm (p = 0.007). In therapy group the Visual Analogue Scale scores for dysmenorrhoea, dyspareunia, chronic pelvic pain and dyschezia did not vary significantly during the study period (p = ns), while score for dysuria was higher at preoperative examination (p = 0.014). In the control group, the Visual Analogue Scale scores for dysmenorrhoea and dyspareunia were significantly higher at preoperative examination than at surgical scheduling (respectively p = 0.02 e p = 0.005), while scores for chronic pelvic pain, dyschezia and dysuria did not vary during the study period (p = ns). Conclusion: Preoperative oral contraceptive therapy can restrain the progression of deep infiltrating endometriosis and related symptoms in women wait-listed for surgery. 40
Open Communications 1dEndometriosis (12:41 PM d 12:46 PM)
Increased Expression of Aromatase in Uterosacral Ligaments Affected by Deeply Infiltrating Endometriosis (DIE): Targets for Medical Management Rossi LM, Ribeiro PAAG, Lancellotti CLP, Carmo BL, Batista FAR, Aoki T. Obstetrics and Gynecology, Faculty of Medical Sciences of Santa Casa Sa˜o Paulo, Sa˜o Paulo, Brazil Study Objective: The aim of this study was to assess and compare the immunoexpression of aromatase in surgical specimens of uterosacral ligaments (US) from women with deeply infiltrating endometriosis (DIE) versus patients without endometriosis (non-DIE). Design: Prospective study. Setting: Medical school hospital. Patients: Forty-five surgical specimens of US from patients with DIE (n = 24) and without DIE (n = 21) were included in this study. Table 1 ROD values: mean standard error Positive Score (%) ROD values *
c2 = 15.742 t test 95% CI
**
DIE
non-DIE
18 (75.0) 0.351 0.023
4 (19.0) 0.249 0.005
P value ) \ 0.001 )) \ 0.001
38
Open Communications 1dEndometriosis (12:29 PM d 12:34 PM)
Watching Endometriosis Grow? A New Animal Model Using Ovine Eyes Garry R. Retired Professor University of Western Australia, Guisborough, Yorkshire, United Kingdom Study Objective: To use the immunologically-privileged site of the anterior chamber of sheep eyes to observe the early stages of implantation and growth of human endometrium through the transparent cornea. Design: A prospective research study in which human endometrial curettings are transplanted into the anterior chamber of sheep eye. Setting: An approved animal research laboratory in Victoria, Australia. Patients: Material: A sub-group of 12 sheep from a larger group of 60 sheep who had endometrial curettings from human volenteer donors transplanted surgically into the anterior chamber of their eyes. Intervention: The fate of the implants after transplantation was continually documented for the first 8 days after transplantation. After sacrifice the eyes were examined with conventional histology and a number of immunohistochemical techniques. Measurements and Main Results: All transplants were easily observed through the transparent cornea. Initially they appeared pink and healthy but within 24 hours became blanched and ‘lifeless’. Within 2-3 days some began to shows signs of growth and increased colour. By 8 days post transplantation, the implants that were surviving had developed both new intrinsic and extrinsic blood supplies. They also developed a new surface epithelial lining. Some transplants showed evidence of new gland growth and invasion into both the iris and the cornea which in one case was very aggressive. Most surprising was that in one case new classic endometriosis developed within 8 days in the cornea where no macroscopic transplanted had been left. This case clearly demonstrates a full blown endometriosis arising from a single/very few endometrial cells within a very short time span. All specimens left for longer than 10 days were rejected by immunological processes. Conclusion: Human endometrium can be transplanted into the anterior chamber of large mammal eyes such Using this model the early stages of re-vascularisation and growth of endometrium/endometriosis can be observed on a continual or continuous basis.
39
S13
Open Communications 1dEndometriosis (12:35 PM d 12:40 PM)
The Role of Oral Contraceptive Therapy in Women Wait-Listed for Surgery for Deep Infiltrating Endometriosis Frasca` C, Mabrouk M, Geraci E, Solfrini S, Montanari G, Facchini C, Di Donato N, Raimondo D, Ferrini G, Venturoli S, Seracchioli R. Gynecology and Reproductive Medicine Unit S. Orsola Malpighi Hospital, Bologna, Italy Study Objective: To evaluate if oral contraceptive therapy can reduce or contain symptoms and nodules’ dimensions in patients wait-listed for surgery for deep infiltrating endometriosis. Design: Retrospective analysis. Setting: Tertiary care university hospital. Patients: One hundred six patients affected by deep infiltrating endometriosis and scheduled for laparoscopic surgery from November 2004 to November 2009. Intervention: During the study period (from surgical scheduling to preoperative examination: mean time 5.8 months), 75 patients were submitted to oral contraceptive therapy (therapy group) while 31 did not take any hormonal therapy (control group). Measurements and Main Results: At the beginning and at the end of the study period patients underwent a transvaginal sonographic examination evaluating localization and dimensions of endometriotic nodules. Presence and intensity of dysmenorrhoea, dyspareunia, chronic pelvic pain, dyschezia and dysuria were evaluated by 10-points Visual Analogue Scale. In the therapy group the mean nodules’ dimensions at scheduling and preoperative examination were respectively 24.8115.13 mm and 26.6615.5 mm (p = ns); in the control group dimensions were respectively 23.0911.11 mm and 30.8919.1 mm (p = 0.007). In therapy group the Visual Analogue Scale scores for dysmenorrhoea, dyspareunia, chronic pelvic pain and dyschezia did not vary significantly during the study period (p = ns), while score for dysuria was higher at preoperative examination (p = 0.014). In the control group, the Visual Analogue Scale scores for dysmenorrhoea and dyspareunia were significantly higher at preoperative examination than at surgical scheduling (respectively p = 0.02 e p = 0.005), while scores for chronic pelvic pain, dyschezia and dysuria did not vary during the study period (p = ns). Conclusion: Preoperative oral contraceptive therapy can restrain the progression of deep infiltrating endometriosis and related symptoms in women wait-listed for surgery. 40
Open Communications 1dEndometriosis (12:41 PM d 12:46 PM)
Increased Expression of Aromatase in Uterosacral Ligaments Affected by Deeply Infiltrating Endometriosis (DIE): Targets for Medical Management Rossi LM, Ribeiro PAAG, Lancellotti CLP, Carmo BL, Batista FAR, Aoki T. Obstetrics and Gynecology, Faculty of Medical Sciences of Santa Casa Sa˜o Paulo, Sa˜o Paulo, Brazil Study Objective: The aim of this study was to assess and compare the immunoexpression of aromatase in surgical specimens of uterosacral ligaments (US) from women with deeply infiltrating endometriosis (DIE) versus patients without endometriosis (non-DIE). Design: Prospective study. Setting: Medical school hospital. Patients: Forty-five surgical specimens of US from patients with DIE (n = 24) and without DIE (n = 21) were included in this study. Table 1 ROD values: mean standard error Positive Score (%) ROD values *
c2 = 15.742 t test 95% CI
**
DIE
non-DIE
18 (75.0) 0.351 0.023
4 (19.0) 0.249 0.005
P value ) \ 0.001 )) \ 0.001