Objective: To evaluate the long-term clinical effect of high-intensity focussed ultrasound (HIFU) as a non-invasive modality for ablation of abdominal wall endometriosis (AWE) foci.
Methods: All women who were diagnosed with cutaneous endometriosis and underwent HIFU ablation and 4-year follow-up were included. Patient symptoms, imaging performed, HIFU ablation, recurrence, lesion location, size and number were collected and analyzed.
Results: A total of 51 women with 57 painful abdominal wall masses with a median volume of 4.00?cm3 and a mean age of 30.5±2.12 years were treated with HIFU. The main symptoms were a palpable painful abdominal mass (93%), protrusion of the skin (28.1%, 16) or lack of protrusion of the skin (71.9%, 41). Ultrasound was initially performed in 100% (51) of women, whereas 6% (3) required MRI examinations to distinguish the features and range of the masses. Ablation was performed with a median 300?s of sonication time, 40?min treatment time, 150?W of power and 41800?J of total energy to treat lesions that were a median volume of 3.83?cm3. No severe complications occurred, except in one patient with a first-degree skin burn, during the 48-month follow-up period. The pooled recurrence of cutaneous endometriosis occurred in 3.9% (2) of women.
Conclusion: The diagnosis of AWE should be confirmed with imaging of the lesion number, location, size and features before HIFU ablation. HIFU should be the first choice for the treatment of AWE as it is a non-invasive method, with high efficiency and safety and rapid postoperative recovery. 相似文献
Summary BACKGROUND: Endometriosis is a relatively common pathology in women of childbearing age and of low parity but rarely shows
extraperitoneal involvement. The main aim of this paper is to raise the attention of specialists to the necessity of carrying
out penetrating diagnosis of nonspecific extraperitoneal masses occurring in women of reproductive age. METHODS: We performed
a retrospective review of six patients diagnosed with extraperitoneal endometriosis who were treated at the Vega Baja University
Hospital (Spain) during the last 5 years. RESULTS: Surgical treatment had positive results in five patients. The preoperative
diagnosis was correctly made in only two patients. The accurate aetiology of endometriosis remains unknown and diagnosis is
based on clinical and cytopathological findings. CONCLUSIONS: Surgical treatment of extraperitoneal endometriosis is recommended.
However, postoperative follow-up is obligatory and hormonal suppressive therapy may be necessary. Medical treatment with gestagens,
Danazol, or agonists of the gonadotropin-releasing hormone are ineffective in endometriomas which are bigger than 2 cm.
相似文献
Endometriosis and infertility are commonly associated. Thisstudy investigated the role of accelerated lipid peroxidationof spermatozoa by the peritoneal fluid of patients with endometriosisas a cause for this association. It proposes that the increasediron concentration present in the fluid of these patients actsas a catalyst for the process. Peritoneal fluid from 25 patientswith endometriosis and 25 matched controls was obtained at laparoscopy.Spermatozoa were incubated in the fluid from both groups andthe subsequent acrosome reaction rates analysed. The relationshipbetween these results and iron concentration in the fluid wasexamined. A significant decrease in the acrosome reaction ratewas seen in the endometriotic group(P = 0.034). Overall, a decreasein the acrosome reaction rate was associated with an increasediron concentration in the fluid(18 of the 25 pairs). In milddisease, (six of 11 pairs), the relationship was not as markedas that in severe disease (12 of 14 pairs). These results suggestthat the peritoneal fluid in patients with endometriosis hasa detrimental action on the acrosome reaction of spermatozoain vitro. 相似文献
Introduction Scar endometriosis develops in and is adjacent to surgical scars at the site of previous abdominal operations. The most frequent
clinical presentation of the disease is that of a palpable subcutaneous mass near surgical scars associated with cyclic pain
and swelling during menses. Endometriosis of the surgical scar is often referred to the general surgeons because the clinical
presentation suggests an incisional hernia or other conditions related to the general surgery. Cyclical symptoms such as pain
and swelling, in relation to surgical scars, which worsen at the time of menstruation, are nearly pathognomonic of scar endometriosis.
However, often the diagnosis of endometriosis is not suggested until after histology has been performed.
Case report We present two cases of cutaneous endometriosis that has occurred on the site of previous cesarean section scar area. 相似文献
Although treatment of one unusually aggressive case of postmenopausal endometriosis with an aromatase inhibitor has been strikingly successful, large clinical trials are required to establish whether aromatase inhibitors will have a significant role in the medical management of endometriosis. Introduction of aromatase inhibitors into the treatment of endometriosis underscores the importance of basic research leading to the development of novel strategies in reproductive disorders. It was shown earlier that aromatase activity was not detectable in normal endometrium. Aromatase, however, is expressed inappropriately in endometriosis and stimulated by prostaglandin E2. Aromatase activity gives rise to local biosynthesis of oestrogen, which, in turn, stimulates prostaglandin E2 production, thus establishing a positive feedback cycle. This favours accumulation of oestrogen and prostaglandins in endometriosis, which is an inflammatory disorder dependent on oestrogen for growth. 相似文献
BACKGROUND: Inflammation has been proposed to play essential roles in the pathophysiology of endometriosis, in which neutrophils and mast cells have been suggested to be involved. We studied whether the protease-activated receptor 2 (PAR2), which is activated by enzymes from neutrophils and mast cells, in endometriotic stromal cells (ESC) has any implication in the development of the disease. METHODS: Cultured ESC were stimulated with various concentrations of a specific PAR2 agonist peptide. Proliferating activity of the cells was determined using immunostaining of proliferating cell nuclear antigen (a cell proliferation marker), 5-bromo-2'-deoxyuridine incorporation into DNA and cell count. The concentrations of interleukin (IL)-6 and IL-8 were measured using specific enzyme-linked immunosorbent assay kits. The phosphorylation of three mitogen-activated protein kinases (MAPK), i.e. p38 MAPK, p42/44 MAPK and stress-activated protein Kinase/c-jun N terminal Kinase, in ESC was examined with Western blot analysis. RESULTS: Activation of PAR2 stimulated the proliferation of ESC and the secretion of IL-6 and IL-8 from ESC in a dose-dependent manner. Activation of PAR2 stimulated the phosphorylation of all three MAPK, and inhibitors of each MAPK suppressed the PAR2 activation-induced proliferation of ESC. CONCLUSIONS: The activation of PAR2 in ESC may be involved in the pathophysiology of endometriosis by inducing the growth and inflammation of endometriotic lesions. 相似文献