Prise en charge de l'endométriose: évaluation clinique et biologique

The Emotional Dimension of Value: A Proposal for Its Quantitative Measurement

The first goal of this paper is to develop a theoretical and practical framework which can help to measure the emotional value generated by organizations in quantitative terms. Its second goal is to use data obtained from the UCAN (Union of Food and Agriculture Cooperatives of Navarre) in Spain as a case study to illustrate the quantification of the emotional value generated, with a view to factoring that value into a social accounting system. Ever greater recognition of the social role of organizations in recent years has led to a need for a consistent definition of the concept of socio-emotional value, and for instruments that can be used to measure that value in terms of generic social accounting. Taking the current lack of standardization in such models and instruments, especially those that deal with emotional value as its starting point, the paper proposes a new instrument for measuring that value quantitatively in such a way as to overcome some of the limitations of earlier proposals. The underlying perspective is that the monetary values identified in market and non-market transactions do not accurately account for all the value generated for different stakeholders, and that adjustments are required through a correction factor applied to the value variables identified. The quantification of the socio-emotional value generated by an organization is seen as a more comprehensive indicator of its performance, given that it provides more information and takes into account the value generated for stakeholders as a whole in all dimensions.

Deep infiltrating endometriosis: Interest of the robotic approach for a fledgling team

Introduction:

Mini-invasive surgery of deep endometriosis is challenging. Surgical difficulties related to the technical limitations of classical laparoscopic approach might be overcome with the use of robotic assistance. The aim of this study was to evaluate the safety and feasibility of robotic surgery for deep infiltrating endometriosis in the learning phase of our team.

Methods:

The 20 first cases of robotic-assisted laparoscopies for endometriosis were included over a 2-year period. Baseline characteristics of patients and surgical data were reviewed. Surgical outcomes and follow-up information of the patients were analyzed.

Results:

Twenty women were included. The mean age was 31.9 years (range: 25–44) and mean body mass index was 23 kg/m2 (range: 16–35). Ten patients had rectovaginal or uterosacral location only (50%) and nine women had deep infiltrating endometriosis with digestive or urinary tract lesions (45%). In addition to the gynecologic surgeon, urologic or visceral surgeons were required in 10 cases, and there were 3 cases where the three specialties were needed. The mean operative time was 183.9 min (range: 85–398) and no difference was observed between the first five cases and the last five cases. There was one laparoconversion, and only two urologic postoperative complications occurred.

Conclusion:

Thanks to the use of robotic surgical assistance and a multidisciplinary approach, and despite the start of the team for deep endometriosis care, no learning curve effect was observed regarding surgical procedures’ success, safety, or duration. The use of robotic assistance might improve the quality of care for women facing deep endometriosis.

[Specific clinical signs suggestive of endometriosis (excluding adenomyosis) and questionnaires of symptoms, pain and quality of life: CNGOF-HAS Endometriosis Guidelines]

In case of consultation for chronic pelvic pain or suspicion of endometriosis, it is recommended to evaluate the pain (intensity, resonance) and to search out the evocative and localizing symptoms of endometriosis (Grade B). The main symptoms suggestive of endometriosis are: severe dysmenorrhea (NP2), deep dyspareunia (NP2), painful defecation during menstruation (NP2), urinary tract symptoms during menstruation (NP2) and infertility (NP2). In patients with chronic pelvic pain, it is recommended to search deep infiltrating endometriosis in patients with painful defecation during menstruation or severe deep dyspareunia (Grade B). It is recommended to search symptoms suggestive of sensitization in painful patients with endometriosis (Grade B). When suggestive symptoms of endometriosis are present, a directed gynecological examination is recommended, where possible, including examination of the posterior vaginal cul-de-sac (Grade C). In assessing pain intensity or evaluating analgesic effectiveness of a treatment, it is recommended to use a scale to measure the intensity of pain (Grade A). In the management of symptomatic endometriosis, it is recommended to evaluate the quality of life (Grade C).

[Linguistic adaptation of the endometriosis health profile 5: EHP 5]

OBJECTIVES

The aim of this work was to develop a French version of an English quality of life questionnaire specific of endometriosis: endometriosis health profile 5.

MATERIALS AND METHODS

After many translations and reverse translations, we got a first French version of EHP 5. This scale was then distributed in two centres: Poissy and Versailles. This questionnaire was completed by women with endometriosis proven and chronic pain. We studied acceptability and feasibility.

RESULTS

Eighteen patients were included. All items have been completed satisfactorily. Our version was described as understandable and easy to complete.

CONCLUSION

Our work consisted in developing a French version of EHP 5 which was very well received by the patient. However, the psychometric and clinical validation remains to be done.

Circulating cell-free DNA as a potential biomarker for minimal and mild endometriosis

It has recently been reported that high concentrations of circulating cell-free (ccf) nucleic acids in plasma and serum could be used as biomarkers for non-invasive monitoring a wide variety of malignant and benign proliferations and inflammatory conditions. Endometriosis is one of the most common benign gynaecological proliferations with inflammatory activation in premenopausal women. Real-time multiplex polymerase chain reaction was used for synchronized quantification of the glyceraldehyde-3-phosphate dehydrogenase gene sequence in nuclear DNA (nDNA) and the ATP synthase-8 gene sequence in mitochondrial DNA (mtDNA). DNA was extracted from 500 microl serum and plasma of 19 cases with endometriosis to measure the total amount of ccf nDNA and ccf mtDNA. The concentration of ccf nDNA in plasma was significantly higher in the endometriosis group than in the control group (P = 0.046). The cut-off value selected by a receiver operating characteristic curve could provide a sensitivity of 70% and a specificity of 87% to discriminate between the minimal or mild cases and normal controls. The finding of significantly increased concentrations of ccf nDNA in plasma of patients with endometriosis suggests that ccf nDNA might be a potential biomarker for developing non-invasive diagnostic test in endometriosis.