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Løve US, Kasch H, Severinsen KE, Abrahamsen J, Høyer C, Forman A, Thomsen HH. The Laparoscopic Implantation of Neuroprosthesis Procedure Increases Leg Lean Mass in Individuals With Paraplegia Due To Traumatic Spinal Cord Injury. Neuromodulation 2023; 26:1802-1807. [PMID: 35690509 DOI: 10.1016/j.neurom.2022.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We hypothesized that the laparoscopic implantation of neuroprosthesis (LION) procedure would significantly alter the body composition of patients with chronic traumatic spinal cord injury (SCI). The objectives were to determine the effect of the LION procedure on lean mass (LM), fatty mass (FM), and bone mineral content (BMC) in patients with SCI. MATERIALS AND METHODS Five consecutive patients underwent dual-energy x-ray absorptiometry scans before the LION procedure and at the one-year postoperative follow-up to determine changes in LM, FM, and BMC. Student paired t-test was used to determine significance. RESULTS The patients gained 2506 ± 565 g of LM in the legs (p < 0.001), which was an 18% total increase in leg LM. Total body LM was significantly increased by 3523 ± 1048 g (p < 0.003). FM was unaffected, whereas total BMC showed a small but significant increase of 99 ± 42 g (p = 0.009). CONCLUSIONS The LION procedure and subsequent neurostimulation procedures resulted in substantial increases in leg LM in patients with chronic traumatic SCI and paraplegia. A possible incremental effect on total BMC also was observed. Further studies are needed to confirm and expand these promising results.
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Affiliation(s)
- Uffe Schou Løve
- Department of Surgery, Regional Hospital of Viborg, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Helge Kasch
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Spinal Cord Injury Center of Western Denmark, Department of Neurology, Regional Hospital of Viborg, Viborg, Denmark
| | - Kåre Eg Severinsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Spinal Cord Injury Center of Western Denmark, Department of Neurology, Regional Hospital of Viborg, Viborg, Denmark
| | - Jan Abrahamsen
- Department of Clinical Physiology, Regional Hospital of Viborg, Viborg, Denmark
| | - Christian Høyer
- Department of Clinical Physiology, Regional Hospital of Viborg, Viborg, Denmark
| | - Axel Forman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Holm Thomsen
- Research Unit of Multimorbidity, Regional Hospital of Viborg, Viborg, Denmark; Department of Internal Medicine, Clinic for Diabetes and Hormonal Diseases, Regional Hospital of Viborg, Viborg, Denmark
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Jacobsen S, Glavind-Kristensen M, Jensen AB, Forman A, Bor P. Vaginal CO 2 laser therapy for genitourinary syndrome in breast cancer survivors-VagLaser study protocol: a randomized blinded, placebo-controlled trial. BMC Cancer 2023; 23:1164. [PMID: 38031020 PMCID: PMC10685468 DOI: 10.1186/s12885-023-11656-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Vaginal CO2 laser therapy is a new treatment option for genitourinary syndrome of menopause. Its potential is particularly interesting in breast cancer survivors, where existing treatment options often are insufficient as hormonal treatment is problematic in these women. The objective of this study is to investigate the effectiveness of vaginal laser treatment for alleviation of genitourinary syndrome of menopause in breast cancer survivors treated with adjuvant endocrine therapy. The secondary objective is to explore the importance of repeated vaginal laser treatment and the long-term effects in this patient population. METHODS VagLaser consist of three sub-studies; a dose response study, a randomized, participant blinded, placebo-controlled study and a follow-up study. All studies include breast cancer survivors in adjuvant endocrine therapy, and are conducted at the Department of Obstetrics and Gynecology, Randers Regional Hospital, Denmark. The first participant was recruited on 16th of February 2023. Primary outcome is vaginal dryness. Secondary subjective outcomes are vaginal pain, itching, soreness, urinary symptoms and sexual function. Secondary objective outcomes are change in vaginal histology (punch biopsy), change in vaginal and urine microbiota, and change in vaginal pH. DISCUSSION More randomized controlled trials, with longer follow-up to explore the optimal treatment regimen and the number of repeat vaginal laser treatments for alleviation the symptoms of genitourinary syndrome of menopause in breast cancer survivors treated with endocrine adjuvant therapy, are needed. This study will be the first to investigate change in vaginal and urine microbiota during vaginal laser therapy in breast cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov: NCT06007027 (registered 22 August, 2023). PROTOCOL VERSION Version 1, Date 13.11.2023.
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Affiliation(s)
- Sine Jacobsen
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | | | - Anders Bonde Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Melgaard A, Vestergaard CH, Kesmodel US, Risør BW, Forman A, Zondervan K, Bech BH, Rytter D. Utilization of healthcare prior to endometriosis diagnosis: a Danish case-control study. Hum Reprod 2023; 38:1910-1917. [PMID: 37581901 PMCID: PMC10546074 DOI: 10.1093/humrep/dead164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/01/2023] [Indexed: 08/16/2023] Open
Abstract
STUDY QUESTION Do women with endometriosis have higher utilization of primary and secondary healthcare prior to diagnosis compared to women without endometriosis? SUMMARY ANSWER Women with a hospital-based diagnosis of endometriosis had an overall higher utilization of both primary and secondary healthcare in all 10 years prior to diagnosis. WHAT IS KNOWN ALREADY Endometriosis is associated with a diagnostic delay, but only a few studies have investigated the potential consequences of this delay with regard to the utilization of healthcare. To the best of our knowledge, no study has investigated it in a period corresponding to the estimated diagnostic delay. STUDY DESIGN, SIZE, DURATION This national Danish registry-based case-control study included 129 696 women. Cases were women with a first-time hospital-based diagnosis of endometriosis between 1 January 2000 and 31 December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS We identified 21 616 cases using density sampling. Each case was matched on age at the date of diagnosis (index date) to five women without diagnosed endometriosis (n = 108 080). The utilization of healthcare was assessed for the 10 years before the index. MAIN RESULTS AND THE ROLE OF CHANCE Cases had significantly higher use of healthcare in all 10 years preceding the index. The mean number of yearly contacts with the GP was 9.99 for cases and 7.85 for controls, with an adjusted incidence rate ratio of 1.28 (1.27; 1.29). For hospital contacts, the association increased slightly in the first 9 years and was most profound in the last year preceding index when the adjusted incidence rate ratio was 2.26 (95% CI 2.28; 2.31). LIMITATIONS, REASONS FOR CAUTION We were not able to include women with an endometriosis diagnosis from the general practitioner or private gynaecologist. Therefore, our results are only applicable to hospital-based diagnoses of endometriosis. We do not have information on the specific reasons for contacting the healthcare providers and we can therefore only speculate that the higher utilization of healthcare among cases was related to endometriosis. WIDER IMPLICATIONS OF THE FINDINGS This study is in agreement with the other known studies on the subject. Future studies should include specific reasons for contacting the healthcare system and thereby identify any specific contact patterns for women with endometriosis. With this knowledge, healthcare professionals could be better at relating certain healthcare seeking behaviour to endometriosis earlier and thereby reduce the time from onset of symptoms to diagnosis. STUDY FUNDING/COMPETING INTEREST(S) This study is supported by grants from the project 'Finding Endometriosis using Machine Learning' (FEMaLe/101017562), which has received funding from The European Union's Horizon 2020 research and innovation program and Helsefonden (21-B-0141). K.Z. report grants from Bayer AG, Roche Inc. and Volition, royalties from Oxford-Bayer scientific collaboration in gynaecological therapies, non-financial collaboration with the World Endometriosis Society and World Endometriosis Research Foundation and is a Wellbeing of Women research advisory committee member. All this is outside the submitted work. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Anna Melgaard
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus C, Denmark
| | - Claus Høstrup Vestergaard
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
| | | | - Bettina Wulff Risør
- DEFACTUM, Central Denmark Region, Aarhus N, Denmark
- Department of Clinical Medicine, Danish Centre for Health Services Research, Aalborg University, Gistrup, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Krina Zondervan
- Nuffield Department of Women’s and Reproductive Health, John Radcliffe Hospital, Oxford University, Oxford, UK
| | - Bodil Hammer Bech
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus C, Denmark
| | - Dorte Rytter
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus C, Denmark
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Brønd M, Breintoft K, Forman A, Henriksen TB, Ramlau-Hansen CH, Rytter D, Arendt LH. Measures of fetal growth and preterm birth and risk of endometriosis and adenomyosis in adult life: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2023. [PMID: 37475152 PMCID: PMC10378002 DOI: 10.1111/aogs.14594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Exposures in utero are suggested to play a role in the etiology of endometriosis and adenomyosis, although the current evidence is inconclusive. Knowledge about potential prenatal programming and early life exposures that may affect this risk is of high importance, to focus potential preventive strategies for the diseases already during pregnancy. The aim of this study was to review systematically the literature of the association between measures of fetal growth and preterm birth and endometriosis and adenomyosis in adult life. MATERIAL AND METHODS A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and by search on PubMed and EMBASE was carried out. We included published case-control and cohort studies. We excluded studies without a reference group, eg case series, case reports as well as commentaries, letters and editorials. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Meta-analyses using a random-effect inverse variance weighted model were performed. PROSPERO registration number is CRD42021249322. RESULTS A total of 11 studies were included. In general, the quality scores of the studies were moderate. We found that the risk of endometriosis was 26% higher in women born with a birthweight <2.5 kg (pooled odds ratio [pOR] 1.26, 95% confidence interval [CI] 1.05-1.52) and 32% higher in women born preterm (pOR 1.32, 95% CI 1.01-1.72) than in the reference groups. The studies on adenomyosis pointed towards no association, but a meta-analysis was unfeasible due to the small number of studies. CONCLUSIONS This systematic review and meta-analysis found that low birthweight and being born preterm were associated with endometriosis in adult life, but the results must be interpreted cautiously. No solid conclusion could be made regarding adenomyosis due to a limited number of published studies, but the studies included found no association. The results support the hypothesis of a potential early programming effect of endometriosis. However, the body of evidence is sparse and this hypothesis needs to be investigated further.
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Affiliation(s)
- Marie Brønd
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Gødstrup Regional Hospital, Herning, Denmark
| | - Kjerstine Breintoft
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Brink Henriksen
- Department of Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Dorte Rytter
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Linn Håkonsen Arendt
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
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Thomsen LH, Vexø LE, Schnack TH, Hansen KE, Forman A, Hartwell D, Nielsen HS, Hummelshoj L, Nyegaard M, Madsen ME. Danish translation, cross-cultural adaptation, and electronic migration of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project Endometriosis Patient Questionnaire. Front Glob Womens Health 2023; 4:1102006. [PMID: 36994241 PMCID: PMC10042231 DOI: 10.3389/fgwh.2023.1102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/01/2023] [Indexed: 03/16/2023] Open
Abstract
ObjectivesThis study aims to translate and cross-culturally adapt the standard version of the World Endometriosis Research Foundation (WERF) EPHect Endometriosis Patient Questionnaire (EPQ) into Danish and to ensure equivalence of a Danish electronic version.MethodsThe translation, cultural adaption, and electronic migration followed recommendations from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Critical Path Institute. Ten women with endometriosis were enrolled for cognitive debriefing of the paper version (pEPQ) after translation and back translation. The questionnaire was then migrated into an electronic version (eEPQ) and subsequently tested for usability and measurement equivalence by five women with endometriosis.ResultsCross-cultural alterations were needed for medical terms, response options for ethnicity, the educational system, and measurement units. Thirteen questions were altered after back translation, while 21 underwent minor changes after cognitive debriefing. After testing the eEPQ, 13 questions were altered. Questions tested for measurement equivalence across the two modes of administration were found comparable. The median time-to-complete the pEPQ and eEPQ was 62 min (range: 29–110) and 63 min (range: 31–88), respectively. General comments included the questionnaire being relevant but long and repetitive.ConclusionsWe find the the Danish pEPQ and eEPQ similar and comparable to the original English instrument. However, attention must be drawn to questions regarding measurement units, ethnicity, and educational systems before cross-country comparison. The Danish pEPQ and eEPQ are suitable for obtaining subjective data on women with endometriosis.
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Affiliation(s)
- Line Holdgaard Thomsen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Correspondence: Line Holdgaard Thomsen
| | - Laura Emilie Vexø
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | | | | | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Dorthe Hartwell
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Hummelshoj
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- Endometriosis.org, London, United Kingdom
| | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mette Elkjær Madsen
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hansen KE, Brandsborg B, Kesmodel US, Forman A, Kold M, Pristed R, Donchulyesko O, Hartwell D, Vase L. Psychological interventions improve quality of life despite persistent pain in endometriosis: results of a 3-armed randomized controlled trial. Qual Life Res 2023; 32:1727-1744. [PMID: 36797461 PMCID: PMC10172241 DOI: 10.1007/s11136-023-03346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Despite standard medical treatment endometriosis is often associated with disabling pain and poor quality of life (QoL). Studies indicate that psychological interventions (PIs) may improve pain and QoL, yet studies on the effects of PIs for women with endometriosis are sparse and limited by low-quality study designs. Therefore, this study aimed, in a rigorous three-armed design, to evaluate the effect of PIs on chronic pelvic pain (CPP) and QoL in women with endometriosis. METHODS This three-armed parallel, multi-center randomized controlled trial included fifty-eight endometriosis patients reporting severe CPP [≥ 5 for pain intensity measured on a 0-10-point numeric rating scale (NRS)]. Patients were randomly assigned to (1) Specific mindfulness- and acceptance-based psychological intervention (MY-ENDO), (2) Carefully matched non-specific psychological intervention (Non-specific), or (3) A wait-list control group (WL). The primary outcome was pelvic pain intensity/unpleasantness measured on NRS. Secondary outcomes included endometriosis-related quality of life, workability, pain acceptance, and endometriosis-related symptoms. Differences in outcomes between groups at post-treatment follow-up were analyzed using mixed linear models. Analyses were performed on an intention-to-treat basis. RESULTS Compared to WL, psychological intervention (MY-ENDO + Non-specific) did not significantly reduce pain. However, psychological intervention did significantly improve the QoL-subscales 'control and powerlessness', 'emotional well-being', and 'social support' as well as the endometriosis-related symptoms 'dyschezia' and 'constipation'. MY-ENDO was not superior to Non-specific. CONCLUSIONS Women with endometriosis may have significant and large effects of psychological intervention on QoL despite an ongoing experience of severe CPP. TRIAL REGISTRATION 12 April 2016, clinicaltrials.gov (NCT02761382), retrospectively registered.
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Affiliation(s)
- K E Hansen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark. .,Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, 8000, Aarhus, Denmark.
| | - B Brandsborg
- Department of Clinical Medicine, Aarhus University, 8210, Aarhus, Denmark
| | - U S Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark
| | - A Forman
- Department of Clinical Medicine, Aarhus University, 8210, Aarhus, Denmark.,Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8210, Aarhus, Denmark
| | - M Kold
- Department of Communication and Psychology, The Faculty of Social Sciences and Humanities (SSH), Aalborg University, 9000, Aalborg, Denmark
| | - R Pristed
- Department of Psychological Health, Agder University, Agder, Norway
| | - O Donchulyesko
- Department of Obstetrics and Gynaecology, North Denmark Regional Hospital, Hjørring, Denmark
| | - D Hartwell
- Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - L Vase
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, 8000, Aarhus, Denmark
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Marschall H, Forman A, Lunde SJ, Kesmodel US, Hansen KE, Vase L. Is laparoscopic excision for superficial peritoneal endometriosis helpful or harmful? Protocol for a double-blinded, randomised, placebo-controlled, three-armed surgical trial. BMJ Open 2022; 12:e062808. [PMID: 36328387 PMCID: PMC9639085 DOI: 10.1136/bmjopen-2022-062808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Placebo-controlled surgical designs are recommended to ascertain treatment effects for elective surgeries when there is genuine doubt about the effectiveness of the surgery. Some elective surgeries for pain have been unable to show an effect beyond sham surgery, suggesting contributions from contextual factors. However, the nature of contextual factors in elective surgery is largely unexplored. Further, methodological difficulties in placebo-controlled surgical trials impact the ability to estimate the effectiveness of a surgical procedure. These include an overall lack of testing the success of blinding, absence of comparison to a no-surgery control group and dearth of test for neuropathic pain.For women with peritoneal endometriosis, there is uncertainty regarding the pain-relieving effect of surgery. Surgery may put patients at risk of complications such as postsurgical neuropathic pain, without guarantees of sufficient pelvic pain relief. The planned placebo-controlled trial aims to examine the effect of surgery on pelvic pain, widespread pain and neuropathic pain symptoms in women with peritoneal endometriosis, and to test the contribution of contextual factors to pain relief. METHODS AND ANALYSIS One hundred women with peritoneal endometriosis will be randomised to either diagnostic laparoscopy with excision of endometrial tissue (active surgery), purely diagnostic laparoscopy (sham surgery) or delayed surgery (no-surgery control group). Outcomes include pelvic pain relief, widespread pain, neuropathic pain symptoms and quality of life. Contextual factors are also assessed. Assessments will be obtained at baseline and 1, 3 and 6 months postrandomisation. Mixed linear models will be used to compare groups over time on all outcome variables. ETHICS AND DISSEMINATION The trial is approved by the Regional Ethics Committee in the Central Denmark Region (1-10-72-152-20). The trial is funded by a PhD scholarship from Aarhus University, and supported by a grant from 'Helsefonden' (20-B-0448). Findings will be published in international peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER NCT05162794.
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Affiliation(s)
- Henrik Marschall
- School of Business and Social Sciences, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sigrid Juhl Lunde
- School of Business and Social Sciences, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lene Vase
- School of Business and Social Sciences, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Illum LRH, Forman A, Melgaard A, Hansen KE, Hansen SN, Nyegaard M, Hummelshoj L, Rytter D. Temporal and regional differences in the incidence of hospital-diagnosed endometriosis: a Danish population-based study. Acta Obstet Gynecol Scand 2022; 101:737-746. [PMID: 35434780 DOI: 10.1111/aogs.14364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Due to diagnostic challenges, normalization of symptoms and an overall lack of awareness among both patients and physicians, endometriosis is an underdiagnosed disease. This can result in delayed treatment and potentially worsening of the disease. Despite initiatives, such as patients' support organizations and specialized endometriosis referral centers, differences in awareness, socioeconomic factors and lifestyle, combined with varying distances to specialized referral centers, could result in regional differences in the degree of underdiagnosing. This study aims to explore temporal and regional variations in the incidence of endometriosis based on the Danish hospital discharge register, and shed light on the degree of underdiagnosing of endometriosis in Denmark. MATERIAL AND METHODS This registry-based cohort study included all women aged 15-55 living in Denmark from 1990-2017. Participants were identified through the Danish Civil Registration system and endometriosis diagnoses received at a hospital were obtained from the Danish National Patient Registry. Incidence rates of diagnosed endometriosis were calculated for each year of the study period and for each municipality in Denmark. A Cox regression analysis, stratified by calendar time and adjusted for ethnic origin, household composition, highest educational level and family socioeconomic status, was performed to estimate the association between residence and likelihood of receiving a hospital-based diagnosis of endometriosis. RESULTS The nationwide incidence rate of hospital-diagnosed endometriosis was 7.89 (95% confidence interval [CI] 7.80-7.99) per 10 000 person-years and the prevalence in 2017 was 1.63%. The results showed an overall increase in the incidence of diagnosed endometriosis of 46.8% (95% CI 32.9-62.2) during the study period and also displayed significant regional differences. After adjustments, women living in northern Jutland had the highest probability of receiving a hospital-based diagnosis of endometriosis (hazard ratio 1.13, 95% CI 1.09-1.18), whereas women living in northern Zealand had the lowest probability (hazard ratio 0.63, 95% CI 0.60-0.67) compared with eastern Jutland. These regional differences have become more evident over time. CONCLUSIONS Our results reveal significant regional differences in the incidence of hospital-diagnosed endometriosis, suggesting that a significant number of women may be left behind without a diagnosis. Further studies are needed to assess the underlying reasons for the significant regional differences.
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Affiliation(s)
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anna Melgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Karina E Hansen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Stefan N Hansen
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Dorte Rytter
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Breintoft K, Arendt LH, Uldbjerg N, Glavind MT, Forman A, Henriksen TB. Endometriosis and preterm birth: A Danish cohort study. Acta Obstet Gynecol Scand 2022; 101:417-423. [PMID: 35218204 DOI: 10.1111/aogs.14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Emerging evidence shows that women with endometriosis face a higher risk of preterm birth. However, the pathways are unclear. The objective of this study is to further investigate at different gestational ages the association between endometriosis and different pathways of preterm birth including, medically indicated preterm birth, premature pre-labor rupture of membranes (PPROM), and spontaneous labor contractions. MATERIAL AND METHODS In this population-based cohort study we linked singleton pregnancies from the Aarhus Birth Cohort to the Danish National Patient Registry, the Danish Medical Birth Registry, the Danish National Pathology Registry and Data Bank, and the Danish in vitro fertilization registry to gather information on endometriosis status, outcomes and maternal characteristics. We investigated preterm birth before 37 completed weeks of gestation and very preterm birth before 32 completed weeks of gestation. We explored different pathways including medically indicated preterm birth defined as induction of labor with intact membranes and no prior labor contractions, PPROM defined as rupture of membranes, and spontaneous labor contractions defined as contractions with intact membranes resulting in labor. RESULTS We found that women with endometriosis had an increased risk of preterm birth before 37 gestational weeks overall (adjusted hazard rate [aHR] 1.6, 95% confidence interval [CI] 1.3-1.9) and very preterm birth before 32 gestational weeks (aHR 1.8, 95% CI 1.1-2.9) compared with women without endometriosis. Medically indicated preterm birth was more prominent in women with endometriosis in deliveries before 37 gestational weeks (aHR 2.4, 95% CI 1.8-3.2) whereas spontaneous labor contractions were more common before 32 gestational weeks (aHR 2.2, 95% CI 1.1-4.5) in women with endometriosis compared with women without endometriosis. Further, in the analyses restricted to women with a histologically verified diagnosis of endometriosis, the results were strengthened overall and showed that women with endometriosis had an increased risk of PPROM before 32 gestational weeks (aHR 3.49, 95% CI1.36-8.98). CONCLUSIONS Endometriosis was associated with both preterm and very preterm birth; however, apparently through different pathways. Women with endometriosis were more prone to have medically indicated preterm births before 37 gestational weeks and spontaneous preterm births before 32 gestational weeks compared with women without endometriosis.
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Affiliation(s)
- Kjerstine Breintoft
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Linn Håkonsen Arendt
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Tølbøll Glavind
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Brink Henriksen
- Department of Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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10
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Kasch H, Løve US, Jønsson AB, Severinsen KE, Possover M, Elmgreen SB, Forman A. Effect of pelvic laparoscopic implantation of neuroprosthesis in spinal cord injured subjects: a 1-year prospective randomized controlled study. Spinal Cord 2022; 60:251-255. [PMID: 34429511 PMCID: PMC8904257 DOI: 10.1038/s41393-021-00693-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN 1-year prospective RCT. OBJECTIVE Examine the effect of implantable pulse generator and low-frequency stimulation of the pelvic nerves using laparoscopic implantation of neuroprosthesis (LION) compared with neuromuscular electrical stimulation (NMES) in SCI. METHODS Inclusion criteria: traumatic spinal cord injury (SCI), age 18-55 years, neurological level-of-injury Th4-L1, time-since-injury >1 year, and AIS-grades A-B. Participants were randomized to (A) LION procedure or (B) control group receiving NMES. PRIMARY OUTCOME MEASURE Walking Index for Spinal Cord Injury (WISCI-II), which is a SCI specific outcome measure assessing ability to ambulate. SECONDARY OUTCOME MEASURES Spinal Cord Independence Measure III (SCIM III), Patient Global Impression of Change (PGIC), Penn Spasm Frequency Scale (PSFS), severity of spasticity measured by Numeric Rating Scale (NRS-11); International Spinal Cord Injury data sets-Quality of Life Basic Data Set (QoLBDS), and Brief Pain Inventory (BPI). RESULTS Seventeen SCI individuals, AIS grade A, neurological level ranging from Th4-L1, were randomized to the study. One individual was excluded prior to intervention. Eight participants (7 males) with a mean age (SD) of 35.5 (12.4) years were allocated to the LION procedure, 8 participants (7 males) with age of 38.8 (15.1) years were allocated to NMES. Significantly, 5 LION group participants gained 1 point on the WISCI II scale, (p < 0.013; Fisher´s exact test). WISCI II scale score did not change in controls. No significant changes were observed in the secondary outcome measures. CONCLUSION The LION procedure is a promising new treatment for individuals with SCI with significant one-year improvement in walking ability.
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Affiliation(s)
- Helge Kasch
- grid.416838.00000 0004 0646 9184Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Uffe Schou Løve
- grid.416838.00000 0004 0646 9184Department of Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Anette Bach Jønsson
- grid.416838.00000 0004 0646 9184Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Eg Severinsen
- grid.416838.00000 0004 0646 9184Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marc Possover
- Possover International Medical Centre, Zürich, Switzerland
| | | | - Axel Forman
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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11
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Kloeve-Mogensen K, Rohde PD, Twisttmann S, Nygaard M, Koldby KM, Steffensen R, Dahl CM, Rytter D, Overgaard MT, Forman A, Christiansen L, Nyegaard M. Polygenic Risk Score Prediction for Endometriosis. Front Reprod Health 2021; 3:793226. [PMID: 36303976 PMCID: PMC9580817 DOI: 10.3389/frph.2021.793226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/09/2021] [Indexed: 12/19/2022] Open
Abstract
Endometriosis is a major health care challenge because many young women with endometriosis go undetected for an extended period, which may lead to pain sensitization. Clinical tools to better identify candidates for laparoscopy-guided diagnosis are urgently needed. Since endometriosis has a strong genetic component, there is a growing interest in using genetics as part of the clinical risk assessment. The aim of this work was to investigate the discriminative ability of a polygenic risk score (PRS) for endometriosis using three different cohorts: surgically confirmed cases from the Western Danish endometriosis referral Center (249 cases, 348 controls), cases identified from the Danish Twin Registry (DTR) based on ICD-10 codes from the National Patient Registry (140 cases, 316 controls), and replication analysis in the UK Biobank (2,967 cases, 256,222 controls). Patients with adenomyosis from the DTR (25 cases) and from the UK Biobank (1,883 cases) were included for comparison. The PRS was derived from 14 genetic variants identified in a published genome-wide association study with more than 17,000 cases. The PRS was associated with endometriosis in surgically confirmed cases [odds ratio (OR) = 1.59, p = 2.57× 10−7] and in cases from the DTR biobank (OR = 1.50, p = 0.0001). Combining the two Danish cohorts, each standard deviation increase in PRS was associated with endometriosis (OR = 1.57, p = 2.5× 10−11), as well as the major subtypes of endometriosis; ovarian (OR = 1.72, p = 6.7× 10−5), infiltrating (OR = 1.66, p = 2.7× 10−9), and peritoneal (OR = 1.51, p = 2.6 × 10−3). These findings were replicated in the UK Biobank with a much larger sample size (OR = 1.28, p < 2.2× 10−16). The PRS was not associated with adenomyosis, suggesting that adenomyosis is not driven by the same genetic risk variants as endometriosis. Our results suggest that a PRS captures an increased risk of all types of endometriosis rather than an increased risk for endometriosis in specific locations. Although the discriminative accuracy is not yet sufficient as a stand-alone clinical utility, our data demonstrate that genetics risk variants in form of a simple PRS may add significant new discriminatory value. We suggest that an endometriosis PRS in combination with classical clinical risk factors and symptoms could be an important step in developing an urgently needed endometriosis risk stratification tool.
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Affiliation(s)
- Kirstine Kloeve-Mogensen
- Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Palle Duun Rohde
- Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Simone Twisttmann
- The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marianne Nygaard
- The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Rudi Steffensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Møller Dahl
- Department of Business and Economics, University of Southern Denmark, Odense, Denmark
| | - Dorte Rytter
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Skejby, Denmark
| | - Lene Christiansen
- The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Mette Nyegaard
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12
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Hansen KE, Lambek R, Røssaak K, Egekvist AG, Marschall H, Forman A, Kesmodel US. Health-related quality of life in women with endometriosis: psychometric validation of the Endometriosis Health Profile 30 questionnaire using confirmatory factor analysis. Hum Reprod Open 2021; 2022:hoab042. [PMID: 34993353 PMCID: PMC8725642 DOI: 10.1093/hropen/hoab042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Which of the competing models of the Endometriosis Health Profile 30 Questionnaire (EHP-30) factor structure is best supported by confirmatory factor analysis (CFA)? SUMMARY ANSWER Findings support a five-factor first-order model of the EHP-30, thereby lending support to the model originally suggested by the questionnaire developers. WHAT IS KNOWN ALREADY Endometriosis has a negative impact on quality of life, and measures specifically developed to address this impact, such as the EHP-30, are vital in research and disease management. Previous studies have found different models of the EHP-30 factor structure, and generated uncertainty regarding how to use the questionnaire. CFA can be applied to compare competing factor models and determine the underlying structure of a questionnaire. STUDY DESIGN SIZE DURATION This cross-sectional multicenter study included 304 women with endometriosis recruited from three different public health service endometriosis clinics (referral centers for treatment of severe endometriosis) and the Danish Endometriosis Patients Association from 2014 to 2015. PARTICIPANTS/MATERIALS SETTING METHODS Diagnosis of endometriosis was confirmed in medical records for 84.2% and by histology for 66.8% of participants. Questionnaires (the licensed Danish version of the EHP-30) were sent by post two times with a 6- to 12-week interval. CFA was used to examine construct validity and Bland-Altman plots to examine test-retest reliability and the convergent validity with the Short Form 36 version 2. MAIN RESULTS AND THE ROLE OF CHANCE Response rate was high (87.6%). CFA supported the original first-order five-factor structure of the EHP-30, and thereby, the use of five separate scale-scores in clinical and research practice. Visual inspection of Bland-Altman plots suggested excellent test-retest reliability of the EHP-30 and supported the use of a disease specific quality of life instrument for women with endometriosis. LIMITATIONS REASONS FOR CAUTION Diagnosis could not be confirmed through histology data in 33.2% of participants. However, subgroup analyses based on women with confirmed histology only, yielded similar results. Data related to menstrual cycle stage and the use of hormonal and pain medication during questionnaire completion were not collected. A larger study, including data from different countries on different continents, would be better designed to exclude potential population bias. WIDER IMPLICATIONS OF THE FINDINGS EHP-30, with its original five-factor structure, appears to be a valid, stable, and specific quality of life measure for women with endometriosis. It seems easy to understand, quick to administer, and importantly, scoring might be unaffected by cyclical/menstrual pain symptoms related to endometriosis. The finding of a five-factor model from different studies across several countries supports the crosscultural validity of the EHP-30. STUDY FUNDING/COMPETING INTERESTS This work was supported by the Danish Endometriosis Association, which is a nongovernmental organization run by women with endometriosis and by a scholarship from the Health Research Fund of Central Denmark Region. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER The Danish Data Protection Agency (J.nr: 2013-41-2264).
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Affiliation(s)
- K E Hansen
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - R Lambek
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - K Røssaak
- Department of Obstetrics and Gynaecology, Rigshospitalet, Copenhagen, Denmark
| | - A G Egekvist
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - H Marschall
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - A Forman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - U S Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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13
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Hjorth S, Rytter D, Forman A, Kirkegaard H, Olsen J, Nohr EA. Menstrual pain and sexual health in mothers-A cross-sectional study in the Danish National Birth Cohort. Acta Obstet Gynecol Scand 2021; 100:2157-2166. [PMID: 34647618 DOI: 10.1111/aogs.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Prevalence and consequences of menstrual pain have mainly been studied in younger women. We aimed to describe the prevalence of menstrual pain in mothers and its association with sexual problems. MATERIAL AND METHODS A cross-sectional study using questionnaire data from the Maternal Follow Up (2013-2014) in the Danish National Birth Cohort (1996-2002). Of 82 569 eligible mothers, 43 639 (53%) completed the follow up. Of these, 24 000 women had a partner, and answered the questions on menstrual pain. Log binomial regression was used to calculate prevalence proportion ratios (PPR) with 95% CI for the association between menstrual pain and specific sexual problems. RESULTS Menstrual pain was reported by 16 464 women (69%), and severe menstrual pain by 19%. Treatment had previously been requested by 19% of women with menstrual pain. The most common treatment was oral contraceptives, but for 18% of women seeking treatment, no treatment was given. Women with menstrual pain were more likely to report reduced sexual desire (PPR 1.22, 95% CI 1.15-1.29), vaginismus (PPR 1.31, 95% CI 0.96-1.78), and dyspareunia (PPR 1.63, 95% CI 1.47-1.81), in particular deep dyspareunia (PPR 1.92, 95% CI 1.67-2.20). CONCLUSIONS A majority of Danish mothers in mid-life experienced menstrual pain, and these women more often reported reduced sexual desire, vaginismus, and deep dyspareunia. Few women sought and received treatment for menstrual pain. Healthcare practitioners should be aware that menstrual pain can affect parous women and co-occurs with sexual problems. Future studies should identify barriers to seeking and receiving adequate treatment for menstrual pain.
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Affiliation(s)
- Sarah Hjorth
- Research Unit for Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorte Rytter
- Research Unit of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Helene Kirkegaard
- Research Unit for Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen A Nohr
- Research Unit for Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center of Women's, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
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14
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Marschall H, Hansen KE, Forman A, Thomsen DK. Storying endometriosis: Examining relationships between narrative identity, mental health, and pain. Journal of Research in Personality 2021. [DOI: 10.1016/j.jrp.2020.104062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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15
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Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe KW, Krentel H, Janschek E, Exacoustos C, Malzoni M, Mueller M, Roman H, Condous G, Forman A, Jansen FW, Bokor A, Simedrea V, Hudelist G. The #Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand 2021; 100:1165-1175. [PMID: 33483970 DOI: 10.1111/aogs.14099] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/09/2020] [Accepted: 01/11/2021] [Indexed: 12/25/2022]
Abstract
Advances in preoperative diagnostics as well as in surgical techniques for the treatment of endometriosis, especially for deep endometriosis, call for a classification system, that includes all aspects of the disease such as peritoneal endometriosis, ovarian endometriosis, deep endometriosis, and secondary adhesions. The widely accepted revised American Society for Reproductive Medicine classification (rASRM) has certain limitations because of its incomplete description of deep endometriosis. In contrast, the Enzian classification, which has been implemented in the last decade, has proved to be the most suitable tool for staging deep endometriosis, but does not include peritoneal or ovarian disease or adhesions. To overcome these limitations, a comprehensive classification system for complete mapping of endometriosis, including anatomical location, size of the lesions, adhesions and degree of involvement of the adjacent organs, that can be used with both diagnostic and surgical methods, has been created through a consensus process and will be described in detail-the #Enzian classification.
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Affiliation(s)
- Jörg Keckstein
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Endometriosis Clinic Dres. Keckstein, Villach, Austria.,University of Ulm, Germany
| | - Ertan Saridogan
- Department of Obstetrics and Gynaecology, University College Hospital, London, UK
| | - Uwe A Ulrich
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Obstetrics and Gynecology, Endometriosis Center, Martin Luther Hospital, Berlin, Germany
| | - Martin Sillem
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Praxisklinik am Rosengarten, Mannheim, Germany.,Department of Obstetrics and Gynecology, Saarland University Medical School, Homburg, Germany
| | - Peter Oppelt
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department for Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Austria
| | - Karl W Schweppe
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany
| | - Harald Krentel
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Obstetrics and Gynecology, Bethesda Hospital, Duisburg, Germany
| | - Elisabeth Janschek
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Obstetrics and Gynecology, Villach General Hospital, Villach, Austria
| | - Caterina Exacoustos
- Department of Obstetrics and Gynecology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Malzoni
- Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Michael Mueller
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Sydney Medical School Nepean, University of Sydney Nepean Hospital, Sydney, Australia
| | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Frank W Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Attila Bokor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Voicu Simedrea
- Department of Obstetrics and Gynecology, Regina Maria Clinic, Timisoara, Romania
| | - Gernot Hudelist
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Gynaecology, Center for Endometriosis, Hospital St. John of God, Vienna, Austria
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16
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Kruse AR, Lauszus FF, Forman A, Kesmodel US, Rugaard MB, Knudsen RK, Persson EK, Uldbjerg N, Sundtoft IB. Effect of early discharge after planned cesarean section on recovery and parental sense of security. A randomized clinical trial. Acta Obstet Gynecol Scand 2020; 100:955-963. [PMID: 33179268 DOI: 10.1111/aogs.14041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/08/2020] [Accepted: 10/29/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION In some European countries, discharge the day after planned cesarean section has become an accepted procedure. However, little is known about the patients' perception of early discharge. The aim of this study was to compare early discharge with standard care in relation to parental sense of security. Further, we evaluated postoperative pain, mobilization, and readmission. MATERIAL AND METHODS We performed a randomized clinical trial including parous, singleton pregnant women with a planned cesarean section at term. The women were allocated to either discharge within 28 hours (intervention group) or after 48 hours (standard care group) following the cesarean section. Women discharged within 28 hours after cesarean section were offered a home visit by a midwife the following day. The primary outcome was the postnatal sense of security, which was reported by the woman and her partner in the "Parents' Postnatal Sense of Security" questionnaire 1 week postpartum. Secondary outcomes were pain score, use of analgesics, mobilization, readmission, and contacts with the healthcare system in the postoperative period. RESULTS We included 143 women, of whom 72 were allocated to the intervention group and 71 were allocated to the standard care group. There were no differences in baseline characteristics. The two groups did not differ concerning the postnatal sense of security for the women (P = .98) or the postnatal sense of security for the partners (P = .38). We found no difference in pain scores, step count, use of analgesics, or number of contacts with the health-care system between the groups. CONCLUSIONS Parental postnatal sense of security is not compromised by discharge within 28 hours followed by a home visit compared with discharge after 48 hours after planned cesarean section among parous women.
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Affiliation(s)
- Anne R Kruse
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Finn F Lauszus
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Marie B Rugaard
- Department of Obstetrics and Gynecology, Regional Hospital Horsens, Horsens, Denmark
| | - Randi K Knudsen
- Department of Obstetrics and Gynecology, Regional Hospital Horsens, Horsens, Denmark
| | | | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Iben B Sundtoft
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
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17
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Marschall H, Kesmodel US, Forman A, Vase L. Re: Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink? BJOG 2020; 127:1578. [DOI: 10.1111/1471-0528.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Henrik Marschall
- Department of Psychology and Behavioural Sciences School of Business and Social Sciences Aarhus University Aarhus Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Axel Forman
- Department of Obstetrics and Gynaecology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Lene Vase
- Department of Psychology and Behavioural Sciences School of Business and Social Sciences Aarhus University Aarhus Denmark
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18
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Kruse AR, Arendt LH, Jakobsen DH, Kehlet H, Lauszus FF, Forman A, Uldbjerg N, Sundtoft IB, Kesmodel US. Length of hospital stay after cesarean section in Denmark from 2004 to 2016: A national register-based study. Acta Obstet Gynecol Scand 2020; 100:244-251. [PMID: 32979215 DOI: 10.1111/aogs.14000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Length of hospital stay after birth has decreased during the last decades, but nationwide data on length of hospital stay after cesarean section are lacking. Elements of Enhanced Recovery Programs were reported to reduce the length of hospital stay. The aim of this nationwide study was to describe the length of hospital stay after cesarean section in Denmark from 2004 to 2016 taking into account birth- and health-related factors as well as demographic changes and, further, to assess potential differences between the five Danish regions. MATERIAL AND METHODS Length of hospital stay was assessed in 164 209 deliveries by cesarean section in Denmark from 2004 to 2016. Data were obtained from the Danish National Patient Register. All deliveries by cesarean section at gestational age <22 weeks were excluded. Median length of hospital stay was reported based on crude and adjusted analyses. RESULTS The median length of hospital stay was significantly reduced by 39 hours (95% confidence interval [CI] 37.9-40.1), from 97 hours (4.0 days) in 2004 to 58 hours (2.4 days) in 2016. Reductions were observed among both planned and emergency cesarean sections. When birth- and health-related factors as well as demographic changes were accounted for, median length of hospital stay was reduced by 30 hours (95% CI 29.3-30.8) in the period. The decrease in length of hospital stay from 2004 to 2016 varied between the five Danish regions, with adjusted reductions between 19 and 46 hours. CONCLUSIONS A nationwide decrease in length of hospital stay after cesarean section was observed from 2004 to 2016 across all five regions but with significant regional variations. Further studies on the optimal length of hospital stay are needed, especially with regard to implementation of enhanced recovery programs.
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Affiliation(s)
- Anne R Kruse
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Linn H Arendt
- Department of Obstetrics and Gynecology, Regional Hospital Horsens, Horsens, Denmark
| | | | - Henrik Kehlet
- Surgical Pathophysiology Unit, Rigshospitalet, Copenhagen, Denmark
| | - Finn F Lauszus
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Iben B Sundtoft
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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Olesen MS, Hauge B, Ohrt L, Olesen TN, Roskær J, Bæk V, Elbæk HO, Nøhr B, Nyegaard M, Overgaard MT, Humaidan P, Forman A, Agerholm I. Therapeutic endometrial scratching and implantation after in vitro fertilization: a multicenter randomized controlled trial. Fertil Steril 2020; 112:1015-1021. [PMID: 31843072 DOI: 10.1016/j.fertnstert.2019.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study whether endometrial scratching in the luteal phase before ovarian stimulation increases clinical pregnancy rates in women with one or more previous implantation failures. DESIGN A nonblinded multicenter randomized clinical trial. SETTING Fertility clinics. PATIENT(S) Three hundred four eligible patients scheduled for IVF/intracytoplasmic sperm injection were randomized. The intervention group (n = 151) underwent endometrial scratching in the luteal phase before controlled ovarian stimulation, while no intervention was performed in the control group (n = 153). INTERVENTION(S) Endometrial scratching with a Pipelle de Cornier catheter in the luteal phase before ovarian stimulation. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate and prenatal and birth data. RESULT(S) There was no overall significant improvement in clinical pregnancy rates between the control and intervention groups (38.5% vs. 44.4%; relative risk = 1.15; confidence interval [0.86-1.55]). However, subgroup analyses revealed that women with three or more previous implantation failures had a significant increase in clinical pregnancy rate (31.1% vs. 53.6%; relative risk = 1.72; confidence interval [1.05-2.83]) after scratching. No difference was seen as regards prenatal and birth data between the two groups. CONCLUSION(S) Endometrial scratching in the luteal phase before ovarian stimulation significantly enhances the clinical pregnancy rate in women with three or more prior implantation failures. This result seems to corroborate previous reports, which found that particularly women with repeated implantation failure seem to gain a positive effect from endometrial scratching. Importantly, there were no significant differences in prenatal data and birth data between the groups. CLINICAL TRIAL REGISTRATION NUMBER NCT01963819.
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Affiliation(s)
| | - Benedicte Hauge
- Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
| | - Lisbeth Ohrt
- Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
| | | | - Janne Roskær
- Fertility Clinic, Aalborg University Hospital, Aalborg, Denmark
| | - Vibeke Bæk
- Fertility Clinic, Aalborg University Hospital, Aalborg, Denmark
| | | | - Bugge Nøhr
- Fertility Clinic, Department of Obstetrics and Gynecology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Mette Nyegaard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | | | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Inge Agerholm
- Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
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20
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Schmidt GB, Knudsen U, Forman A, Aalkjaer C, Brøgger T. Does the oxygen level affect the contractility in human fetal stem villous arteries? Pregnancy Hypertens 2019. [DOI: 10.1016/j.preghy.2019.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Christiansen UJ, Kruse AR, Olesen PG, Lauszus FF, Kesmodel US, Forman A. Outpatient vs inpatient total laparoscopic hysterectomy: A randomized controlled trial. Acta Obstet Gynecol Scand 2019; 98:1420-1428. [PMID: 31148146 DOI: 10.1111/aogs.13670] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/27/2019] [Accepted: 05/13/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Ulla J. Christiansen
- Department of Obstetrics and Gynecology the Regional Hospital West Jutland Herning Denmark
| | - Anne R. Kruse
- Department of Obstetrics and Gynecology the Regional Hospital West Jutland Herning Denmark
| | - Peter G. Olesen
- Department of Obstetrics and Gynecology the Regional Hospital West Jutland Herning Denmark
| | - Finn F. Lauszus
- Department of Obstetrics and Gynecology the Regional Hospital West Jutland Herning Denmark
| | - Ulrik S. Kesmodel
- Department of Obstetrics and Gynecology Aalborg University Hospital Aalborg Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology Aarhus University Hospital Aarhus Denmark
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22
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Elmgreen SB, Krogh S, Løve US, Forman A, Kasch H. [Neuromodulation in spinal cord injury rehabilitation]. Ugeskr Laeger 2019; 181:V02190104. [PMID: 31267931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Suffering a spinal cord injury is a devastating event often entailing a significant and demanding inpatient rehabilitation regime to improve the level of functioning post-injury. Neuromodulation has been applied in spinal cord injury rehabilitation for decades and carries promise for ameliorating the chronic complications associated with lesions of the spinal cord. Conventional methods of rehabilitation may be augmented by different modes of neuromodulation offering better rehabilitation outcomes, and combining techniques not currently in clinical use may convey additional benefits.
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23
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Egekvist AG, Marinovskij E, Forman A, Kesmodel US, Graumann O, Seyer-Hansen M. Conservative treatment of rectosigmoid endometriosis: A prospective study. Acta Obstet Gynecol Scand 2019; 98:1139-1147. [PMID: 30970147 DOI: 10.1111/aogs.13619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/27/2019] [Accepted: 04/04/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Deep infiltrating endometriosis is a common cause of pelvic pain. However, some patients have limited problems that may be controlled by medical treatment, so avoiding the potentially severe complications of major surgery. This approach requires detailed knowledge on quality of life and clinical symptoms over time. The aim of the study was to monitor these parameters in patients with rectosigmoid endometriosis treated with oral contraceptives, oral gestagens, and/or the levonorgestrel-releasing intrauterine device. Moreover, nodule size measurements performed with transvaginal sonography were correlated to severity of symptoms. MATERIAL AND METHODS Conservatively treated patients on oral contraceptives, oral gestagens, or the levonorgestrel-releasing intrauterine device underwent transvaginal sonography and answered a self-administered questionnaire regarding clinical symptoms and quality of life (Short Form 36 and Endometriosis Health Profile 30) at baseline, and 6 and 12 months later. RESULTS Eighty women completed the follow up. Scores of quality of life were comparable to normative data for Danish women of similar age and did not change with time. No association between change in size of the rectosigmoid nodule and change in symptoms was seen. CONCLUSIONS This study supports that simple treatment with oral contraceptives, oral gestagens, or the levonorgestrel-releasing intrauterine device represents a viable therapeutic approach to rectosigmoid Deep infiltrating endometriosis, provided that proper selection of patients in need of surgery exists.
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Affiliation(s)
- Anne G Egekvist
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Mikkel Seyer-Hansen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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24
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Schomacker ML, Hansen KE, Ramlau-Hansen CH, Forman A. Is endometriosis associated with irritable bowel syndrome? A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2018; 231:65-69. [DOI: 10.1016/j.ejogrb.2018.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 01/22/2023]
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25
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Monten L, Forman A, Andersson KE. Pelvic organ cross-talk: A new paradigm for endometriosis-related pelvic pain? Journal of Endometriosis and Pelvic Pain Disorders 2018. [DOI: 10.1177/2284026518810573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endometriosis patients often complain about pelvic and abdominal pain with varying bowel and bladder symptoms unrelated to the location and extent of the disease. The pathophysiology can be multifactorial, but one possibility is that pelvic organ cross-talk may play a role. The aim of this review was to evaluate the scientific support for this hypothesis. A search was performed in PubMed to identify relevant experimental and clinical studies. Data achieved in animal models and clinical evidence suggest that endometriosis-related pain may implicate interactions between pelvic structures like the urinary tract, the bowel and the vagina, mediated by the autonomous nervous system. Such pelvic organ cross-talk with involvement of nerve fibre outgrowth into endometriosis lesions, peripheral sensitisation and convergence of afferent nerve fibres could be an explanation for the varying pain problems in endometriosis, but the precise mechanisms are still poorly understood. Some patients with chronic pelvic pain, including those with endometriosis, also seem to have a more general somatic, musculoskeletal hyperalgesia, indicating a potential viscero-somatic convergence. This might be due to continuous nociceptive input to the brain, resulting in changes in brain structures and finally leading to central sensitisation. Thus, pelvic organ cross-talk seems to represent a new paradigm for endometriosis-related pain with novel possibilities for the development of therapeutic strategies.
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Affiliation(s)
- Lina Monten
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Axel Forman
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Karl-Erik Andersson
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
- Wake Forest Institute for Regenerative Medicine, School of Medicine, Wake Forest University, Winston Salem, NC, USA
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26
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Glavind MT, Møllgaard MV, Iversen ML, Arendt LH, Forman A. Obstetrical outcome in women with endometriosis including spontaneous hemoperitoneum and bowel perforation: a systematic review. Best Pract Res Clin Obstet Gynaecol 2018; 51:41-52. [DOI: 10.1016/j.bpobgyn.2018.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/23/2018] [Indexed: 12/29/2022]
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27
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Bruun MR, Arendt LH, Forman A, Ramlau-Hansen CH. Endometriosis and adenomyosis are associated with increased risk of preterm delivery and a small-for-gestational-age child: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018; 97:1073-1090. [PMID: 29753309 DOI: 10.1111/aogs.13364] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/25/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this systematic review and meta-analysis was to evaluate the risk of preterm delivery and having a small-for-gestational-age (SGA) child in women with endometriosis and adenomyosis compared with women without these two diseases. MATERIAL AND METHODS Studies on endometriosis or adenomyosis and risk of preterm delivery and/or SGA infant were included. The systematic search was conducted for all published articles in PubMed and Embase published from 1950 to 2017 using specific search terms. After duplicates were removed, two authors independently reviewed all studies, initially based on title and subsequently based on abstract. Studies considered relevant were read in full text by both reviewers to identify if studies met the inclusion criteria. RESULTS The search found 21 studies on a total of 2 517 516 women meeting the inclusion criteria. Women with endometriosis had an increased odds of preterm delivery [odds ratio (OR) 1.47, 95% CI 1.28-1.69] and SGA infant (OR 1.26, 95% CI 1.04-1.549). Compared with endometriosis, adenomyosis implied an even higher odds of both preterm delivery (OR 3.09, 95% CI 1.88-5.09) and SGA infant (OR 3.23, 95% CI 1.71-6.09) as well. CONCLUSIONS Women with endometriosis or adenomyosis had a higher odds of preterm delivery and having a child that was SGA compared with women without endometriosis or adenomyosis. The odds of both adverse birth outcomes was highest among women with adenomyosis. The results suggest a closer prenatal monitoring among pregnant women with endometriosis or adenomyosis.
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Affiliation(s)
- Mette R Bruun
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Linn H Arendt
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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28
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Egekvist AG, Forman A, Riiskjaer M, Kesmodel US, Mathiasen M, Seyer-Hansen M. Intra- and interobserver variability in nodule size of rectosigmoid endometriosis measured by two- and three-dimensional transvaginal sonography. Acta Obstet Gynecol Scand 2018. [DOI: 10.1111/aogs.13343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anne G. Egekvist
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Axel Forman
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Mads Riiskjaer
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ulrik S. Kesmodel
- Department of Obstetrics and Gynecology; Herlev and Gentofte University Hospital; Herlev Denmark
- Institute for Clinical Medicine; University of Copenhagen; Copenhagen Denmark
| | - Mie Mathiasen
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Mikkel Seyer-Hansen
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
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29
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Seyer-Hansen M, Egekvist A, Forman A, Riiskjaer M. Risk of bowel obstruction during in vitro fertilization treatment of patients with deep infiltrating endometriosis. Acta Obstet Gynecol Scand 2017; 97:47-52. [DOI: 10.1111/aogs.13253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 10/10/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anne Egekvist
- Department of Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Axel Forman
- Department of Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Mads Riiskjaer
- Department of Gynecology; Aarhus University Hospital; Aarhus Denmark
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30
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Olesen MS, Starnawska A, Bybjerg-Grauholm J, Bielfeld AP, Agerholm I, Forman A, Overgaard MT, Nyegaard M. Biological age of the endometrium using DNA methylation. Reproduction 2017; 155:167-172. [PMID: 29162648 DOI: 10.1530/rep-17-0601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/15/2017] [Accepted: 11/21/2017] [Indexed: 12/19/2022]
Abstract
Age has a detrimental effect on reproduction and as an increasing number of women postpone motherhood, it is imperative to assess biological age in terms of fertility prognosis and optimizing fertility treatment individually. Horvath's epigenetic clock is a mathematical algorithm that calculates the biological age of human cells, tissues or organs based on DNA methylation levels. The clock, however, was previously shown to be highly inaccurate for the human endometrium, most likely because of the hormonal responsive nature of this tissue. The aim of this study was to determine if epigenetically based biological age of the human endometrium correlated with chronological age, when strictly timed to the same time point in the menstrual cycle. Endometrial biopsies from nine women were obtained in two consecutive cycles, both strictly timed to the LH surge (LH + 7) and additionally, peripheral whole blood samples were analyzed. Using the Illumina HumanMethylation 450 K array and Horvath's epigenetic clock, we found a significant correlation between the biological age of the endometrium and the chronological age of the participants, although the endometrial biological age was accelerated by comparison with blood and chronological age. Moreover, similar biological ages were found in pairs of consecutive biopsies, indicating that an endometrial biopsy does not alter the biological age in the following cycle. In conclusion, as long as endometrial samples are timed to the same time point in the menstrual cycle, Horvath's epigenetic clock could be a powerful new biomarker of reproductive aging in the human endometrium.
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Affiliation(s)
- Mia S Olesen
- The Fertility ClinicHorsens Regional Hospital, Horsens, Denmark
| | - Anna Starnawska
- Department of BiomedicineAarhus University, Aarhus C, Denmark.,iPSYCH: The Lundbeck Foundation Initiative for Integrative Psychiatric ResearchAarhus, Denmark
| | | | - Alexandra P Bielfeld
- Department of GynaecologyObstetrics and REI (UniKiD), Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Inge Agerholm
- The Fertility ClinicHorsens Regional Hospital, Horsens, Denmark
| | - Axel Forman
- Department of Gynaecology and ObstetricsAarhus University Hospital, Skejby, Denmark
| | - Michael T Overgaard
- Department of Chemistry and BioscienceAalborg University, Aalborg E, Denmark
| | - Mette Nyegaard
- Department of BiomedicineAarhus University, Aarhus C, Denmark
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31
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Riiskjær M, Egekvist A, Hartwell D, Forman A, Seyer-Hansen M, Kesmodel U. Bowel Endometriosis Syndrome: a new scoring system for pelvic organ dysfunction and quality of life. Hum Reprod 2017; 32:1812-1818. [DOI: 10.1093/humrep/dex248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/01/2017] [Indexed: 11/13/2022] Open
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32
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Iversen ML, Seyer-Hansen M, Forman A. Does surgery for deep infiltrating bowel endometriosis improve fertility? A systematic review. Acta Obstet Gynecol Scand 2017; 96:688-693. [DOI: 10.1111/aogs.13152] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maja L. Iversen
- Department of Gynecology; Aarhus University Hospital; Aarhus Denmark
| | | | - Axel Forman
- Department of Gynecology; Aarhus University Hospital; Aarhus Denmark
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33
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Possover M, Forman A. Recovery of supraspinal control of leg movement in a chronic complete flaccid paraplegic man after continuous low-frequency pelvic nerve stimulation and FES-assisted training. Spinal Cord Ser Cases 2017; 3:16034. [PMID: 28503316 DOI: 10.1038/scsandc.2016.34] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 08/28/2016] [Accepted: 10/18/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION More than 30 years ago, functional electrical stimulation (FES) was developed as an orthotic system to be used for rehabilitation for SCI patients. In the present case report, FES-assisted training was combined with continuous low-frequency stimulation of the pelvic somatic nerves in a SCI patient. CASE PRESENTATION We report on unexpected findings in a 41-year-old man with chronic complete flaccid paraplegia, since he was 18 years old, who underwent spinal stem cell therapy and a laparoscopic implantation of neuroprosthesis (LION procedure) in the pelvic lumbosacral nerves. The patient had complete flaccid sensomotoric paraplegia T12 as a result of a motor vehicle accident in 1998. In June 2011, he underwent a laparoscopic implantation of stimulation electrodes to the sciatic and femoral nerves for continuous low-frequency electrical stimulation and functional electrical stimulation of the pelvic nerves. Neither intraoperative direct stimulation of the pelvic nerves nor postoperative stimulation induced any sensation or muscle reactions. After 2 years of passive continuous low-frequency stimulation, the patient developed progressive recovery of electrically assisted voluntary motor functions below the lesions: he was first able to extend the right knee and 6 months later, the left. He is currently capable of voluntary weight-bearing standing and walking (with voluntary knee movements) about 50 m with open cuff crutches and drop foot braces. DISCUSSION Our findings suggest that continuous low-frequency pelvic nerve stimulation in combination with FES-assisted training might induce changes that affect both the upper and the lower motor neuron and allow supra- and infra-spinal inputs to engage residual spinal and peripheral pathways.
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Affiliation(s)
- Marc Possover
- Department of Gynecology & Neuropelveology, Possover International Medical Center, Zurich, Switzerland.,Department of Gynecology & Neuropelveology, University of Aarhus, Aarhus, Denmark
| | - Axel Forman
- Department of Gynecology & Neuropelveology, University of Aarhus, Aarhus, Denmark
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34
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Glindtvad C, Chen M, Vinge Nygaard J, Wogensen L, Forman A, Danielsen CC, Taskin MB, Andersson KE, Axelsen SM. Electrospun biodegradable microfibers induce new collagen formation in a rat abdominal wall defect model: A possible treatment for pelvic floor repair? J Biomed Mater Res B Appl Biomater 2017; 106:680-688. [DOI: 10.1002/jbm.b.33875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 01/15/2017] [Accepted: 02/20/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Cecilie Glindtvad
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Denmark
| | - Menglin Chen
- iNANO, Department of Engineering - Nano Fiber Technology and Cellular Engineering; Aarhus University; Denmark
| | - Jens Vinge Nygaard
- Department of Engineering - Biomechanics and Mechanobiology; Aarhus University; Denmark
| | - Lise Wogensen
- Faculty Secretariat, Faculty of Health Sciences; Aarhus University; Denmark
| | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital; Denmark
| | | | - Mehmet Berat Taskin
- iNANO Department of Engineering - Nano Fiber Technology and Cellular Engineering; Aarhus University; Denmark
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35
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Egekvist AG, Marinovskij E, Forman A, Kesmodel US, Riiskjaer M, Seyer-Hansen M. Conservative approach to rectosigmoid endometriosis: a cohort study. Acta Obstet Gynecol Scand 2017; 96:745-750. [DOI: 10.1111/aogs.13094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/22/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Anne G. Egekvist
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | | | - Axel Forman
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ulrik S. Kesmodel
- Department of Obstetrics and Gynecology; Herlev and Gentofte University Hospital; Herlev Denmark
- Institute for Clinical Medicine; University of Copenhagen; Copenhagen Denmark
| | - Mads Riiskjaer
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Mikkel Seyer-Hansen
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
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Glavind MT, Forman A, Arendt LH, Nielsen K, Henriksen TB. Endometriosis and pregnancy complications: a Danish cohort study. Fertil Steril 2017; 107:160-166. [DOI: 10.1016/j.fertnstert.2016.09.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/05/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
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Abstract
The vascular supply to the human bladder is derived mainly from the superior and inferior vesical arteries, the latter being directly connected to the internal iliac artery. Aging is associated with an impairment of blood vessel function and changes may occur in the vasculature at the molecular, cellular and functional level. Pelvic arterial insufficiency may play an important role in the development of bladder dysfunctions such as detrusor overactivity (DO) and the overactive bladder syndrome. Chronic ischemia-related bladder dysfunction may progress to bladder underactivity and it would be desirable to treat not only lower urinary tract symptoms (LUTS) induced by chronic ischemia, but also the progression of the morphological bladder changes. Studies in experimental models in rabbits and rats have shown that pelvic arterial insufficiency may result in significant bladder ischemia with reduced bladder wall oxygen tension. In turn, this will lead to oxidative stress associated with upregulation of oxidative stress-sensitive genes, increased muscarinic receptor activity, ultrastructural damage, and neurodegeneration. The phosphodiesterase type 5 (PDE5) inhibitor tadalafil, the α1-adrenoceptor (AR) blocker silodosin, the β3-AR agonist mirabegron, and the free radical scavenger melatonin, exerted a protecting effect on urodynamic parameters, and on functional and morphological changes of the bladder demonstrable in vitro. Since the agents tested are used clinically for relieving LUTS, the results from the animal models seem to have translational value, and may be of relevance for designing clinical studies to demonstrate if the drugs may prevent progression of ischemia-related functional and morphological bladder changes.
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Affiliation(s)
- Karl-Erik Andersson
- Institute of Clinical Medicine, Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200 Aarhus N, Denmark
| | | | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark
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Mieritz RM, Thorhauge K, Forman A, Mieritz HB, Hartvigsen J, Christensen HW. Musculoskeletal Dysfunctions in Patients With Chronic Pelvic Pain: A Preliminary Descriptive Survey. J Manipulative Physiol Ther 2016; 39:616-622. [DOI: 10.1016/j.jmpt.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/27/2016] [Accepted: 04/25/2016] [Indexed: 11/25/2022]
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Thomsen LH, Schnack TH, Buchardi K, Hummelshoj L, Missmer SA, Forman A, Blaakaer J. Risk factors of epithelial ovarian carcinomas among women with endometriosis: a systematic review. Acta Obstet Gynecol Scand 2016; 96:761-778. [DOI: 10.1111/aogs.13010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Line H. Thomsen
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Tine H. Schnack
- Gynecologic and Obstetric Department; Rigshospitalet University Hospital of Copenhagen; Copenhagen Denmark
| | | | | | - Stacey A. Missmer
- Department of Obstetrics; Gynecology and Reproductive Biology College of Human Medicine; Michigan State University; Boston MA USA
- Department of Epidemiology; Harvard T.H. Chan School of Public Health; Boston MA USA
| | - Axel Forman
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
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Riiskjaer M, Greisen S, Glavind-Kristensen M, Kesmodel US, Forman A, Seyer-Hansen M. Authors' reply. BJOG 2016; 123:1871-2. [PMID: 27653330 DOI: 10.1111/1471-0528.14230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Mads Riiskjaer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Greisen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel Seyer-Hansen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Riiskjær M, Forman A, Kesmodel US, Andersen LM, Ljungmann K, Seyer-Hansen M. Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis. Gynecol Obstet Invest 2016; 82:410-416. [DOI: 10.1159/000447513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022]
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Hansen KE, Kesmodel US, Kold M, Forman A. Long-term effects of mindfulness-based psychological intervention for coping with pain in endometriosis: A six-year follow-up on a pilot study. Nordic Psychology 2016. [DOI: 10.1080/19012276.2016.1181562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Riiskjaer M, Greisen S, Glavind-Kristensen M, Kesmodel US, Forman A, Seyer-Hansen M. Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG 2016; 123:1360-7. [PMID: 26956803 DOI: 10.1111/1471-0528.13975] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess urinary, sexual, and bowel function before and after laparoscopic bowel resection for rectosigmoid endometriosis. DESIGN Prospectively collected data regarding the function of the pelvic organs. SETTING Tertiary endometriosis referral unit, Aarhus University Hospital. SAMPLE A cohort of 128 patients who underwent laparoscopic bowel resection for endometriosis. METHODS The International Consultation on Incontinence Questionnaire (ICIQ), Sexual Function-Vaginal Changes Questionnaire (SVQ), and the Low Anterior Resection Syndrome (LARS) questionnaire were answered before and after surgery. Non-invasive urodynamic testing was performed. MAIN OUTCOME MEASURES Pre- and postoperative function of the pelvic organs was compared, and risk factors for improved/impaired function were identified. RESULTS A total of 96.1% of the women completed the 1-year follow-up. A significant decrease (P = 0.002) in bladder filling problems (F-score) was observed 1 year after surgery, primarily caused by a significant decrease in bladder pain (P = 0.0001). No change for urodynamic parameters was observed. A significant increase in overall sexual satisfaction (P = 0.0001) and decrease in worries about sexual life (P = 0.001) was seen 1 year after surgery. Frequency of defecation was significantly increased 1 year after surgery (P = 0.0001), but the overall bowel function measured by LARS score was unchanged. Patients with anastomotic leakage had a significantly higher risk (odds ratio, OR 5.40; P = 0.002) of increased incontinence problems (I-score) 1 year after surgery. CONCLUSION A significant and clinically relevant improvement in urinary and sexual function 1 year after laparoscopic bowel resection for endometriosis was found. Except for anastomotic leakage, this could be observed independent of any patient- or treatment-related factor. Apprehension about impairment of urinary and sexual function should not be a contraindication for bowel resection in endometriosis patients. TWEETABLE ABSTRACT Rectal resection for endometriosis does not impair urinary and sexual function 1 year after surgery.
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Affiliation(s)
- M Riiskjaer
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - S Greisen
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - M Glavind-Kristensen
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - U S Kesmodel
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Copenhagen, Denmark
| | - A Forman
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - M Seyer-Hansen
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Broegger T, Andersson KE, Aalkjaer C, Forman A, Boedtkjer DB. Sensitivity to the thromboxane A 2 analog U46619 varies with inner diameter in human stem villous arteries. Placenta 2016; 39:111-5. [DOI: 10.1016/j.placenta.2016.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 11/29/2022]
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Bach AM, Risoer MB, Forman A, Seibaek L. Practices and Attitudes Concerning Endometriosis Among Nurses Specializing in Gynecology. Glob Qual Nurs Res 2016; 3:2333393616651351. [PMID: 28462341 PMCID: PMC5342857 DOI: 10.1177/2333393616651351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/29/2022] Open
Abstract
Endometriosis is a chronic disease affecting approximately 10% of fertile women. These women often have negative health care experiences. This study adds new knowledge about endometriosis care in a hospital setting and nurses' attitudes toward the disease. To explore how the personal attitudes of gynecological nurses, their specialized knowledge, and their clinical experiences influenced the way they conceptualized and cared for women with endometriosis, participant observations and semistructured interviews were conducted. Categorization of patients into certain kinds, with more or less legitimate needs, provided an important framework for practice. Specialized knowledge qualified the nurses' views of their patients and seemed to be conducive to sustained patient involvement. However, the organization of care based solely on medical specialization restricted a holistic approach. An important goal is, therefore, to investigate patients' perspectives of health and illness and to create participatory relationships with patients, regardless of their diagnosis.
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Possover M, Forman A. Pelvic Neuralgias by Neuro-Vascular Entrapment: Anatomical Findings in a Series of 97 Consecutive Patients Treated by Laparoscopic Nerve Decompression. Pain Physician 2015; 18:E1139-E1143. [PMID: 26606029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Some patients have pelvic, pudendal, or low lumbar pain radiating into the legs that is worse while sitting but differs from pudendal neuralgia. The purpose of this study was to present a new clinical entity of neuropathic pelvic pain by pelvic neuro-vascular entrapment. OBJECTIVES To report about the locations of predilection for pelvic neurovascular entrapment. STUDY DESIGN Prospective cohort pre- and post-intervention. SETTING University referral unit specializing in advanced gynecological surgery and neuropelveology. METHODS Patients, Intervention: In a prospective study, 97 patients presenting with intractable pelvic neuropathic pain (pudendal pain, gluteal pain, vulvodynia, coccygodynia, and sciatic pain) underwent laparoscopic exploration with decompression of compressed pelvic somatic nerves. The population included 76 (78.3%) women and 21 men. Indication for laparoscopic exploration of pelvic nerves suspected to be involved in pain has been indicated after neuropelveological work up, pelvic neuro-magnetic resonance imaging (MRI) and Doppler-sonography. Pain evolution was recorded over 2 years after the procedure. MEASUREMENTS AND MAIN RESULTS Three entities were isolated: pudendal neuralgie by compression at the less sciatic notch, sacral radiculopathy at S2-4 by compression at the infracardinal level of the sacral plexus, and sciatica L5-S1/2 by compression at the greater sciatic notch. Pain was worse sitting (98%), during menstrual bleeding in women, and during Valsalva maneuver, but the pain did not wake the patients up at night and was not accompanied by neurologic dysfunctions. A decrease in VAS scores (> 50%) at 2 years follow-up was observed in 86 patients (88.6%). CONCLUSIONS Neuro-vascular entrapment is a pathophysiologic phenomenon implicated in several pelvic neuropathies. The most common are L5-S1 sciatica, pudendal neuralgia, and sacral radiculopathy. After intraoperative confirmation, laparoscopic exploration of the entire sacral plexus is essential to diagnose conflict. Laparoscopic decompression is a treatment of choice, based on the separation of the offending vessel from the nerves. Those procedures are safe, with a high success rate; the neuropelveological approach is essential in order to obtain good treatment results. The laparoscopic approach gives the possibility of reducing morbidity and improving results by providing wider insight into the operating field with smaller intraoperative injury.
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Affiliation(s)
- Marc Possover
- Possover International Medical Center, Zürich, Switzerland; and Department for Gynecology and Neuropelveology, University of Aarhus, Aarhus, Denmark
| | - Axel Forman
- Department for Gynecology and Neuropelveology, University of Aarhus, Aarhus, Denmark
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Forman A, Green G, Kidd T, Colby S, Shelnutt K, Phillips B, Ruppert M, Sparks A. Differences in Health-Related Behavior of Normal Weight and Overweight/Obese College Females Trying to Lose Weight. J Acad Nutr Diet 2014. [DOI: 10.1016/j.jand.2014.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hansen KE, Kesmodel US, Baldursson EB, Kold M, Forman A. Visceral syndrome in endometriosis patients. Eur J Obstet Gynecol Reprod Biol 2014; 179:198-203. [PMID: 24999078 DOI: 10.1016/j.ejogrb.2014.05.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/03/2014] [Accepted: 05/23/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Pain related to bowel and bladder function is seen more often in endometriosis. This study explored whether employed endometriosis patients experience multiple visceral symptoms more often than reference women without the disease. STUDY DESIGN In a cohort study, 610 patients with diagnosed endometriosis and 751 reference women completed an electronic survey based on the EHP-30 questionnaire. Percentages were reported for all data. Principal component analysis was used to find underlying structures of correlations among variables, and Cronbach's alpha reliability analysis was used to demonstrate internal consistency of each scale. The level of statistical significance was set at p<0.025 in all the analyses. RESULTS Principal component analysis pointed at a specific visceral symptom-complex relating to the abdominal organs. This correlation was called "visceral syndrome" and consisted of the seven symptoms; "abdominal pain with no relation to menstruation", "pain during urination", "pain during defecation", "constipation or diarrhea", "irregular bleeding", "nausea or vomiting" and "feeling tired/lack of energy", with a Cronbach's alpha value α=0.85. More women with endometriosis than reference women suffered between five and seven symptoms from the visceral syndrome (22.7% vs. 2.7%) and more women with endometriosis compared to women with pain from other conditions suffered between five and seven symptoms from the visceral syndrome (22.7% vs. 3.2%). CONCLUSION These data indicate that a significant number of endometriosis patients suffer from a specific symptom correlation, which is uncommon in women without the disease. These findings and previous data may suggest the occurrence of a visceral syndrome in endometriosis.
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Affiliation(s)
- Karina E Hansen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus 8210, Denmark.
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus 8210, Denmark
| | - Einar B Baldursson
- Department of Psychology, Institute of Communication, Aalborg University, Aalborg, Denmark
| | - Mette Kold
- Time2be, Vesterbro 18, 9000 Aalborg, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus 8210, Denmark
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Forman A, Renner M, Fujita E, Barkigia K, Evans M, Smith K, Fajer J. ESR and ENDOR Probes of Skeletal Conformations Implications for Conformations and Orientations of Chlorophylls In Vivo. Isr J Chem 2013. [DOI: 10.1002/ijch.198900009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Forman A, Davis MS, Fujita I, Hanson LK, Smith KM, Fajer J. Mechanisms of Energy Transduction in Plant Photosynthesis: ESR, ENDOR and MOs of the Primary Acceptors. Isr J Chem 2013. [DOI: 10.1002/ijch.198100049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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