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Streuli I, de Ziegler D, Santulli P, Marcellin L, Borghese B, Batteux F, Chapron C. An update on the pharmacological management of endometriosis. Expert Opin Pharmacother 2013; 14:291-305. [PMID: 23356536 DOI: 10.1517/14656566.2013.767334] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Endometriosis is a common disease that causes pain symptoms and/or infertility in women in their reproductive years. The disease is characterised by the presence of endometrium-like tissue - glands and stroma - outside the uterine cavity. Different treatment options exist for endometriosis including medical and surgical treatments or a combination of the two approaches. The most commonly used medications are non-steroidal anti-inflammatory drugs, GnRH agonists, androgen derivatives such as danazol, combined oral contraceptive pills, progestogens and more recently the levonorgestrel intrauterine system. AREAS COVERED The authors review current medical treatments used for symptomatic endometriosis and also discuss new treatment approaches. The authors conducted a literature search for randomised controlled trials related to medical treatments of endometriosis in humans, searched the Cochrane library for reviews and also searched for registered trials that have not yet been published on ClinicalTrials.gov. EXPERT OPINION The medical treatment of endometriosis is effective at treating pain and preventing recurrence of disease after surgery. Remarkably, the oral contraceptive pill taken continuously is as effective as GnRH-a, while causing far less side-effects. Conversely, no treatment currently exists for enhancing fecundity in women whose infertility is associated with endometriosis. As all existing therapies of endometriosis are contraceptive, great efforts should be targeted at researching novel products that reduce the disease expression without shuttering ovulation.
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Affiliation(s)
- Isabelle Streuli
- Service de gynécologie, obstétrique et médecine de la reproduction, Groupe hospitalier du centre Cochin -- Broca -- Hôtel-Dieu, CHU Cochin, Paris, France
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Santulli P, Borghese B, Chouzenoux S, Streuli I, Borderie D, de Ziegler D, Weill B, Chapron C, Batteux F. Interleukin-19 and interleukin-22 serum levels are decreased in patients with ovarian endometrioma. Fertil Steril 2013; 99:219-226.e2. [PMID: 23025883 DOI: 10.1016/j.fertnstert.2012.08.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/25/2012] [Accepted: 08/27/2012] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the serum levels of interleukin (IL)-10 family ILs in women with ovarian endometriosis and investigate the correlation of these levels with disease activity. DESIGN A case-control laboratory study. SETTING Tertiary-care university hospital. PATIENT(S) Two hundred nineteen women, with (n = 112) and without (n = 107) endometriosis. INTERVENTION(S) Complete surgical excision with pathological analysis. MAIN OUTCOME MEASURE(S) Blood samples were obtained during surgical procedures. IL-10, -19, -20, and -22 were assayed by ELISA in sera, and the concentrations correlated with the extent and the severity of the disease. RESULT(S) IL-19 was detectable in 18.3% and IL-22 in 47.9% of sera samples from all 219 women studied. Serum IL-19 was lower in women with endometriosis (median, 292.7 pg/mL; range, 32.2-1,339.3) than in endometriosis-free women (median, 1,035.8 pg/mL; range, 32.2-2,000.0). In addition, serum IL-22 levels were decreased in women affected by endometriosis (median, 352.0 pg/mL; range, 31.2-1,392.2) as compared with endometriosis-free women (median, 709.2 pg/mL; range, 73.3-2,012.0). We found significant correlations between serum IL-22 concentrations and intensity of deep dyspareunia (r = -0.303) and noncyclic chronic pelvic pain (r = -0.212). IL-19 was correlated with the intensity of deep dyspareunia (r = -0.749). CONCLUSION(S) Serum IL-19 and IL-22 are decreased in women with ovarian endometrioma. IL-10 family ILs may be involved in the pathogenesis of endometriosis.
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Affiliation(s)
- Pietro Santulli
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Hôpital Cochin, Laboratoire d'immunologie, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Faculté de Médecine, Inserm, Institut Cochin, Centre National de la Recherche Scientifique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Bruno Borghese
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Faculté de Médecine, Inserm, Institut Cochin, Centre National de la Recherche Scientifique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sandrine Chouzenoux
- Hôpital Cochin, Laboratoire d'immunologie, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Isabelle Streuli
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Hôpital Cochin, Laboratoire d'immunologie, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Didier Borderie
- Faculté de Médecine, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Dominique de Ziegler
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Bernard Weill
- Hôpital Cochin, Laboratoire d'immunologie, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Hôpital Cochin, Laboratoire d'immunologie, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Faculté de Médecine, Inserm, Institut Cochin, Centre National de la Recherche Scientifique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Frederic Batteux
- Hôpital Cochin, Laboratoire d'immunologie, Assistance publique-Hôpitaux de Paris, Hôpital Cochin, Laboratory of Biochemistry, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Brockman R. Medication and transference in psychoanalytically oriented psychotherapy of the borderline patient. Psychiatr Clin North Am 1990; 28:1552-68. [PMID: 2352891 DOI: 10.1093/humrep/det050] [Citation(s) in RCA: 336] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The regressive potential of the borderline patient has been recognized ever since the term was first introduced by Adolph Stern in 1938. He believed these patients were "too ill for classical psychoanalysis," and indeed almost all who have written on this subject have supported Stern's view, recognizing the severe regressive potential of a borderline patient in unmodified psychoanalysis. Taking medication is not generally considered to be a particularly regressive experience. It should be remembered, however, that for many patients and especially for patients with borderline personality disorder, medication can be both an overvalued hope and a terrifying assault. Thus, although the pharmacologic action of the medication may help to integrate the patient's ego functioning, the very taking of the medication may at the same time initiate subtle and unanticipated regressive drives. Two forces are then set in motion with potentially different effects. In a treatment where the same physician is prescribing medication and doing psychotherapy, the common pathway of these forces is transference. Thus, pharmacologic action may modify transference. And more importantly, because it is less easily recognized, transference issues may affect the patient's subjective experience of the action of the medication. For this reason, it is particularly important that not only diagnostic issues but also transference issues be understood before medication is prescribed.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Brockman
- Columbia University College of Physicians and Surgeons, New York, New York
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