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Valdés-Bango M, Gracia M, Rubio E, Vergara A, Casals-Pascual C, Ros C, Rius M, Martínez-Zamora MÁ, Mension E, Quintas L, Carmona F. Comparative analysis of endometrial, vaginal, and gut microbiota in patients with and without adenomyosis. Acta Obstet Gynecol Scand 2024. [PMID: 38661227 DOI: 10.1111/aogs.14847] [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: 01/10/2024] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Alterations in microbiota composition have been implicated in a variety of human diseases. Patients with adenomyosis present immune dysregulation leading to a persistent chronic inflammatory response. In this context, the hypothesis that alterations in the microbiota may be involved in the pathogenesis of adenomyosis, by affecting the epigenetic, immunologic, and biochemical functions of the host, has recently been postulated. The aim of the present study was to compare the microbiota composition in the vagina, endometrium, and gut of individuals with and without adenomyosis. MATERIAL AND METHODS Cross-sectional study including 38 adenomyosis patients and 46 controls, performed between September 2021 and October 2022 in a university hospital-based research center. The diagnosis of adenomyosis was based on sonographic criteria. Fecal, vaginal, and endometrial samples were collected. Study of the microbiota using 16S rRNA gene sequencing. RESULTS Patients with adenomyosis exhibited a significant reduction in the gut microbial alpha diversity compared with healthy controls (Chao1 p = 0.012, Fisher p = 0.005, Observed species p = 0.005). Beta-diversity analysis showed significant differences in the compositions of both gut and vaginal microbiota between adenomyosis patients and the control group (Adonis p-value = 0.001; R2 = 0.03 and Adonis p-value = 0.034; R2 = 0.04 respectively). Specific bacterial taxa were found to be either overrepresented (Rhodospirillales, Ruminococcus gauvreauii group, Ruminococcaceae, and Actinomyces) or underrepresented in the gut and endometrial microbiota of adenomyosis patients compared with controls. Distinct microbiota profiles were identified among patients with internal and external adenomyosis phenotypes. CONCLUSIONS The study revealed reduced gut microbiota diversity in adenomyosis patients, accompanied by distinct compositions in gut and vaginal microbiota compared with controls. Overrepresented or underrepresented bacterial taxa were noted in the gut and endometrial microbiota of adenomyosis patients, with variations in microbiota profiles among those with internal and external adenomyosis phenotypes. These findings suggest a potential association between microbiota and adenomyosis, indicating the need for further research to comprehensively understand the implications of these differences.
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Affiliation(s)
- Marta Valdés-Bango
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Elisa Rubio
- Department of Clinical Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Andrea Vergara
- Department of Clinical Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto Salud Carlos III, Madrid, Spain
| | - Climent Casals-Pascual
- Department of Clinical Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto Salud Carlos III, Madrid, Spain
| | - Cristina Ros
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Mariona Rius
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Maria Ángeles Martínez-Zamora
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Eduard Mension
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lara Quintas
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
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Rius M, Gracia M, Carmona F. Symptoms and clinical impact. Med Clin (Barc) 2023; 161 Suppl 1:S5-S7. [PMID: 37923513 DOI: 10.1016/j.medcli.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Mariona Rius
- Departamento de Ginecología. Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España.
| | - Meritxell Gracia
- Departamento de Ginecología. Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - Francisco Carmona
- Departamento de Ginecología. Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España
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Gracia M, Rius M, Carmona F. Clinical relevance of uterine fibroids: Epidemiology, risk and protective factors, and pathophysiology. Med Clin (Barc) 2023; 161 Suppl 1:S1-S4. [PMID: 37923508 DOI: 10.1016/j.medcli.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Meritxell Gracia
- Departamento de Ginecología. Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Facultad de Medicina, Universidad de Barcelona, Barcelona, España.
| | - Mariona Rius
- Departamento de Ginecología. Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - Francisco Carmona
- Departamento de Ginecología. Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Facultad de Medicina, Universidad de Barcelona, Barcelona, España
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Costa-Borges N, Munné S, Albó E, Mas S, Castelló C, Giralt G, Lu Z, Chau C, Acacio M, Mestres E, Matia Q, Marquès L, Rius M, Márquez C, Vanrell I, Pujol A, Mataró D, Seth-Smith M, Mollinedo L, Calderón G, Zhang J. First babies conceived with Automated Intracytoplasmic Sperm Injection. Reprod Biomed Online 2023; 47:103237. [PMID: 37400320 DOI: 10.1016/j.rbmo.2023.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/17/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 07/05/2023]
Abstract
RESEARCH QUESTION Can an automated sperm injection robot perform Automated Intracytoplasmic Sperm Injection (ICSIA) for use in human IVF? DESIGN The ICSIA robot automated the sperm injection procedure, including injection pipette advancement, zona pellucida and oolemma penetration with piezo pulses, and pipette removal after sperm release. The robot was first tested in mouse, hamster and rabbit oocytes, and subsequently using discarded human oocytes injected with microbeads. A small clinical pilot trial was conducted with donor oocytes to study the feasibility of the robot in a clinical setting. The ICSIA robot was controlled by engineers with no micromanipulation experience. Results were compared with those obtained with manual ICSI conducted by experienced embryologists. RESULTS The ICSIA robot demonstrated similar results to the manual procedure in the different animal models tested as well as in the pre-clinical validations conducted in discarded human oocytes. In the clinical validation, 13 out of 14 oocytes injected with ICSIA fertilized correctly versus 16 out of 18 in the manual control; eight developed into good-quality blastocysts versus 12 in the manual control; and four were diagnosed as chromosomally normal versus 10 euploid in the manual control. Three euploid blastocysts from the ICSIA robot group have been transferred into two recipients, which resulted in two singleton pregnancies and two babies born. CONCLUSIONS The ICSIA robot showed high proficiency in injecting animal and human oocytes when operated by inexperienced personnel. The preliminary results obtained in this first clinical pilot trial are within key performance indicators.
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Affiliation(s)
| | | | | | | | | | | | - Zhuo Lu
- New Hope Fertility Center, NY, USA
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Quintas-Marquès L, Martínez-Zamora MÁ, Camacho M, Gràcia M, Rius M, Ros C, Carrión A, Carmona F. Central sensitization in patients with deep endometriosis. Pain Med 2023; 24:1005-1007. [PMID: 36708006 DOI: 10.1093/pm/pnad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/27/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Affiliation(s)
- Lara Quintas-Marquès
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria-Ángeles Martínez-Zamora
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Camacho
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Meritxell Gràcia
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariona Rius
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Ros
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana Carrión
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Carmona
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Affiliation(s)
- Mariona Rius
- From the Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Barcelona, Spain (Rius, Carmona)
| | - José Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, FL (Carugno)
| | - Maurico S Abrao
- Endometriosis Section, Gynecologic Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, and Department of Obstetrics and Gynaecology, Universidade de São Paulo, São Paulo, Brazil (Abrao)
- Gynecologic Division, BP - A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil (Abrao)
| | - Francisco Carmona
- From the Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Barcelona, Spain (Rius, Carmona)
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Martínez-Zamora MA, Mensión E, Martínez-Egea J, Peri L, Franco A, Gracia M, Ros C, Rius M, Carmona F. Risk factors for irreversible unilateral loss of renal function in patients with deep endometriosis. Sci Rep 2023; 13:11940. [PMID: 37488122 PMCID: PMC10366200 DOI: 10.1038/s41598-023-38728-z] [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: 04/22/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023] Open
Abstract
Deep endometriosis (DE) can be more aggressive than other types of endometriosis, and may even lead to irreversible severe complications such as complete unilateral loss of renal function. We aimed to describe the clinical and radiologic characteristics of DE patients diagnosed with irreversible unilateral loss of renal function due to unilateral ureteral stenosis and evaluate risk factors for developing this loss. This retrospective cohort study included 436 patients who underwent laparoscopic DE surgery. We evaluated two groups of patients according to preserved (Non-Renal Loss Group; n = 421) or irreversible unilateral damaged renal function (Renal Loss Group; n = 15). Preoperative epidemiologic variables, clinical characteristics, radiologic findings and surgical treatments of all the patients were collected. The Renal Loss Group had a higher infertility rate and a higher proportion of asymptomatic patients. The following radiological variables showed statistically significant differences between the two groups: mean endometrioma diameter, the presence of intestinal DE and negative sliding sign. Multivariate analysis showed that infertility, being asymptomatic, having intestinal DE or torus uterinus/uterosacral ligament DE and a negative sliding sign significantly increased the risk of loss of renal function. Therefore, among patients with these clinical and/or radiological variables, severe urinary tract obstruction should be specifically ruled out.
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Affiliation(s)
- María-Angeles Martínez-Zamora
- Department of Gynecology. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona. Faculty of Medicine, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel St., 170, 08036, Barcelona, Spain.
| | - Eduard Mensión
- Department of Gynecology. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona. Faculty of Medicine, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel St., 170, 08036, Barcelona, Spain
| | - Judith Martínez-Egea
- Department of Gynecology. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona. Faculty of Medicine, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel St., 170, 08036, Barcelona, Spain
| | - Lluis Peri
- Urology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Agustín Franco
- Urology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Department of Gynecology. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona. Faculty of Medicine, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel St., 170, 08036, Barcelona, Spain
| | - Cristina Ros
- Department of Gynecology. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona. Faculty of Medicine, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel St., 170, 08036, Barcelona, Spain
| | - Mariona Rius
- Department of Gynecology. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona. Faculty of Medicine, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel St., 170, 08036, Barcelona, Spain
| | - Francisco Carmona
- Department of Gynecology. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona. Faculty of Medicine, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel St., 170, 08036, Barcelona, Spain
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Ros C, Mension E, Rius M, Munmany M, De Guirior C, Espuña-Pons M, Anglès-Acedo S, Castelo-Branco C. Assessing vaginal wall thickness by transvaginal ultrasound in breast cancer survivors: A pilot study. Maturitas 2023; 171:7-12. [PMID: 36863187 DOI: 10.1016/j.maturitas.2023.02.001] [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: 09/29/2022] [Revised: 01/17/2023] [Accepted: 02/03/2023] [Indexed: 03/04/2023]
Abstract
AIM There is need for a straightforward objective measure to evaluate vaginal wall changes related to hypoestrogenism. The aim of this pilot study was to evaluate a transvaginal ultrasound procedure for the quantification of vaginal wall thickness in order to differentiate between healthy premenopausal women and postmenopausal women with genitourinary syndrome of menopause using ultra-low-level estrogen status as a model. METHODS We performed a prospective, two-arm, cross-sectional pilot study comparing vaginal wall thickness measured by transvaginal ultrasound in postmenopausal breast cancer survivors using aromatase inhibitors with genitourinary syndrome of menopause (GSM group) and healthy premenopausal women (control or C group) from October 2020 to March 2022. After intravaginal introduction of 20 cm3 of sonographic gel, vaginal wall thickness was measured by transvaginal ultrasound in the anterior, posterior, and right and left lateral walls (four quadrants). The study methods followed the STROBE checklist. RESULTS According to the results of a two-sided t-test, the mean vaginal wall thickness of the four quadrants in the GSM group was significantly less than that of the C group (2.25 mm vs 4.17 mm, respectively; p < 0.001). Likewise, the thickness of each of the vaginal walls (anterior, posterior, right and left lateral) statistically differed between the two groups (p < 0.001). CONCLUSION Transvaginal ultrasound with intravaginal gel may be a feasible objective technique to assess genitourinary syndrome of menopause, showing clear differences in vaginal wall thickness between breast cancer survivors using aromatase inhibitors and premenopausal women. Possible correlations with symptoms or treatment response should be assessed in future studies.
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Affiliation(s)
- Cristina Ros
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Mension
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Mariona Rius
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Meritxell Munmany
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristian De Guirior
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Espuña-Pons
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sònia Anglès-Acedo
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Camil Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Carrillo Torres P, Martínez-Zamora MÁ, Ros C, Rius M, Mensión E, Gracia M, Carmona F. Clinical and sonographic impact of oral contraception in patients with deep endometriosis and adenomyosis at 2 years of follow-up. Sci Rep 2023; 13:2066. [PMID: 36739298 PMCID: PMC9899265 DOI: 10.1038/s41598-023-29227-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/31/2023] [Indexed: 02/06/2023] Open
Abstract
Nowadays, combined oral contraceptives (COCs) are successfully employed for the treatment of endometriosis (END) and adenomyosis (AD) in a large proportion of patients. However, literature focusing on the clinical and sonographic response to treatment in the long-term follow-up of patients with deep endometriosis (DE) and AD is scarce. The aim of this study was to evaluate the changes in the symptoms and the sonographic exams at 12 and 24 months of follow-up in patients who had received a flexible extended COC regimen containing 2 mg of dienogest/30 μg ethinyl estradiol. This prospective, longitudinal, observational study included women diagnosed with DE and AD presenting no surgical indication and were candidates to treatment with COCs. The presence and severity of dysmenorrhea, non-menstrual pelvic pain, deep dyspareunia, dyschezia and dysuria were evaluated using the Numerical Rating Scale (NRS) at baseline, and at 12 and 24 months of treatment. Transvaginal ultrasound was also performed at these check points searching for criteria of AD and reporting the size of the DE nodules and ovarian endometriomas (OE). Sixty-four patients were included. A significant decrease in the number of patients with severe dysmenorrhea and non-menstrual pelvic pain was reported during follow-up. The mean NRS score for dysmenorrhea, non-menstrual pelvic pain, deep dyspareunia, dyschezia and dysuria was also significantly lower at follow-up. There was a significant reduction in the sonographic number and type of AD criteria during follow-up after treatment. Similarly, a significant decrease in the size of OE and uterosacral ligament involvement in DE was observed at the 12-month follow-up, with a further, albeit not statistically significant, decrease in the 12- to 24-month follow-up. Additionally, torus and rectosigmoid DE decreased in size, although the reduction was not statistically significant at any study point. This prospective study suggests a clinical and sonographic improvement after a flexible extended COC regimen in DE and AD patients, which was significant at 12 months of follow-up. The improvement was more evident in AD and OEs compared with DE. Further research with a longer follow-up, larger sample size and comparison with other treatments is needed.
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Affiliation(s)
- Pilar Carrillo Torres
- Gynaecology Department Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M Ángeles Martínez-Zamora
- Gynaecology Department Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Universitat de Barcelona, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Villarroel 170, 08036, Barcelona, Spain.
| | - Cristina Ros
- Gynaecology Department Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Mariona Rius
- Gynaecology Department Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Eduard Mensión
- Gynaecology Department Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Gynaecology Department Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Gynaecology Department Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Universitat de Barcelona, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Villarroel 170, 08036, Barcelona, Spain
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Martínez-Zamora MÁ, Feixas G, Gracia M, Rius M, Quintas L, de Guirior C, Carmona F. Evaluation of menstrual symptoms after Coronavirus disease 2019 vaccination in women with endometriosis. Womens Health (Lond) 2023; 19:17455057231176751. [PMID: 37282979 DOI: 10.1177/17455057231176751] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Vaccination can have an impact on menstruation, and this impact may be more notable in women with inflammatory gynecological pathologies such as endometriosis. OBJECTIVES We aimed to investigate the impact of mRNA-based SARS-CoV-2 vaccines on menstrual cycle-related symptoms in women with endometriosis and assess the effect of hormonal therapy on potential SARS-CoV-2 vaccination-induced menstrual changes. DESIGN A total of 848 women who received at least two doses of mRNA-based COVID-19 vaccines were prospectively recruited: 407 with endometriosis (endometriosis group) and 441 healthy controls (non-endometriosis group). METHODS Data regarding demographics, clinical characteristics, hormonal treatment, and menstrual-associated symptoms in the first and second cycle after vaccination were collected through an online survey. RESULTS A similar percentage of patients in both the endometriosis and the non-endometriosis group self-reported menstrual-associated changes the first (52.6% versus 48.8%, respectively) and second cycle after vaccination (29.0% versus 28.1%, respectively). Although the total symptoms recorded were not different between the two groups, several specific symptoms were statistically more frequent in the endometriosis group. These were pain disorders and fatigue in the first cycle after vaccination and pain disorders, menstrual headache and fatigue in the second cycle after vaccination. Bleeding frequency/regularity disorders were found to be more frequent in the non-endometriosis group in the first cycle after vaccination. Patients under hormonal treatment reported fewer changes in menstrual symptoms in the first and second cycle after vaccination compared with those not receiving this treatment. Similarly, patients in the endometriosis group receiving hormonal treatment reported fewer changes in menstrual-associated symptoms compared with those not following any hormonal treatment in the first and second menstrual cycle after the last vaccination. CONCLUSION Women with endometriosis immunized with mRNA-based SARS-CoV-2 vaccines did not perceive greater worsening or new menstrual-associated symptoms after complete COVID-19 vaccination compared with healthy controls. Hormonal treatment may have a protective effect against worsened or new menstrual symptoms induced by COVID-19 vaccination.
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Affiliation(s)
- María Ángeles Martínez-Zamora
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Georgina Feixas
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Lara Quintas
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Cristian de Guirior
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Abrao MS, Andres MP, Gingold JA, Rius M, Neto JS, Goncalves MO, Giovanni AD, Malzoni M, Carmona F. Preoperative Ultrasound Scoring of Endometriosis by AAGL 2021 Endometriosis Classification Is Concordant with Laparoscopic Surgical Findings and Distinguishes Early from Advanced Stages. J Minim Invasive Gynecol 2022; 30:363-373. [PMID: 36403696 DOI: 10.1016/j.jmig.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To compare the accuracy of preoperative ultrasound (US) in predicting the laparoscopically defined 2021 American Association of Gynecologic Laparoscopists (AAGL) Endometriosis Staging. DESIGN Retrospective multicenter study of patients treated at 3 specialized endometriosis centers. SETTING Three specialized endometriosis surgical centers in São Paulo (Brazil), Barcelona (Spain), and Avellino (Italy) participated. PATIENTS A total of 878 patients aged 15 to 45 years with no history of pelvic malignancy underwent laparoscopic (LPS) treatment for suspected endometriosis. INTERVENTIONS Retrospective review of preoperative transvaginal and transabdominal US (index test) assessed for endometriosis at all sites used in the 2021 AAGL Endometriosis Classification and classified patients into AAGL-US stages 1 to 4. Results were compared with reference-standard LPS (AAGL-LPS) staging. MEASUREMENTS AND MAIN RESULTS The AAGL-US and AAGL-LPS stage were concordant in 586 cases (66.7%) (weighted kappa [WK] 0.759; intraclass correlation = 0.906), with the highest agreement observed in patients with no endometriosis (n = 70, 75.3% concordance), AAGL-LPS stage 1 (104, 50.7%) and stage 4 disease (358, 88.2%). Endometriosis was most accurately diagnosed in the rectum/sigmoid colon (WK 0.862), bladder (WK 0.911), and ovaries (WK 0.835/0.795 for right/left, respectively) and least accurately diagnosed at superficial peritoneal (WK 0.442), tubal (WK 0.391/0.363 for right/left, respectively), and retrocervical/uterosacral ligament (WK 0.656) sites. CONCLUSION Sonographic estimation of the 2021 AAGL Endometriosis Staging is greatest in AAGL-LPS stages 1 and 4 and among patients with no endometriosis. US best identifies endometriosis of the ovaries, bladder, and bowel but is more limited for the tubes and superficial peritoneum.
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Borges NC, Zhang J, Plandiura, Eng. EA, LU Z, Sabatés, Eng. SM, Castello C, Giralt G, Acacio M, Mestres E, Matia-Algué Q, Marquès L, Rius M, Marquez C, Vanrell I, Masana AP, Mollinedo L, Calderon G, Munne S. FIRST PRE-CLINICAL AND CLINICAL VALIDATION OF AN AUTOMATED SPERM INJECTION ROBOT (ICSI-A) IN HUMAN OOCYTES. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.031] [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: 11/04/2022]
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Hudson J, Bourne SD, Seebens H, Chapman MA, Rius M. The reconstruction of invasion histories with genomic data in light of differing levels of anthropogenic transport. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210023. [PMID: 35067090 PMCID: PMC8784929 DOI: 10.1098/rstb.2021.0023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 12/22/2022] Open
Abstract
Unravelling the history of range shifts is key for understanding past, current and future species distributions. Anthropogenic transport of species alters natural dispersal patterns and directly affects population connectivity. Studies have suggested that high levels of anthropogenic transport homogenize patterns of genetic differentiation and blur colonization pathways. However, empirical evidence of these effects remains elusive. We compared two range-shifting species (Microcosmus squamiger and Ciona robusta) to examine how anthropogenic transport affects our ability to reconstruct colonization pathways using genomic data. We first investigated shipping networks from the 18th century onwards, cross-referencing these with regions where the species have records to infer how each species has potentially been affected by different levels of anthropogenic transport. We then genotyped thousands of single-nucleotide polymorphisms from 280 M. squamiger and 190 C. robusta individuals collected across their extensive species' ranges and reconstructed colonization pathways. Differing levels of anthropogenic transport did not preclude the elucidation of population structure, though specific inferences of colonization pathways were difficult to discern in some of the considered scenario sets. We conclude that genomic data in combination with information of underlying introduction drivers provide key insights into the historic spread of range-shifting species. This article is part of the theme issue ‘Species’ ranges in the face of changing environments (part I)’.
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Affiliation(s)
- J Hudson
- School of Ocean and Earth Science, University of Southampton, National Oceanography Centre, European Way, Southampton SO14 3ZH, UK
| | - S D Bourne
- School of Ocean and Earth Science, University of Southampton, National Oceanography Centre, European Way, Southampton SO14 3ZH, UK
| | - H Seebens
- Senckenberg Biodiversity and Climate Research Centre, Senckenberganlage 25, 60325 Frankfurt, Germany
| | - M A Chapman
- Department of Biological Sciences, University of Southampton, Life Sciences Building 85, Highfield Campus, Southampton SO17 1BJ, UK
| | - M Rius
- School of Ocean and Earth Science, University of Southampton, National Oceanography Centre, European Way, Southampton SO14 3ZH, UK.,Department of Zoology, Centre for Ecological Genomics and Wildlife Conservation, University of Johannesburg, Auckland Park 2006, South Africa.,Centre for Advanced Studies of Blanes (CEAB, CSIC), Accés a la Cala Sant Francesc 14, Blanes 17300, Spain
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14
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Nicolás I, Martínez-Zamora MÁ, Gracia M, Feixas G, Rius M, Carmona F. Impact of SARS-COV2 Pandemic on Patients with Endometriosis and Their Health Care. J Womens Health (Larchmt) 2022; 31:480-486. [PMID: 35148487 DOI: 10.1089/jwh.2021.0323] [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] [Indexed: 12/14/2022] Open
Abstract
Background: Endometriosis is a debilitating chronic inflammatory disease. The current SARS-COV2 pandemic has had an impact on the management of these patients. Tele-health care has been a relevant tool. The aim of this study was to analyze the impact of the SARS-COV2 pandemic on the perceived clinical health status and the type of care received in patients with endometriosis. Methods: We evaluated 945 premenopausal women treated at the Hospital Clinic of Barcelona between October 1 and December 31, 2020. Five hundred forty-nine women had endometriosis, and 396 had other benign gynecological diseases. An online health survey was sent to these patients. Clinicopathological features data were recorded. Results: Compared to patients with other benign gynecological diseases, a higher proportion of patients with endometriosis reported worsening of their symptoms (148/549, 27% vs. 85/396, 21.5%) and concern about their disease (515/549, 93.8% vs. 342/396, 86.4%), and more frequently received tele-health care (73.8% vs. 54.0%) during the pandemic. Patients with endometriosis and "significant" pelvic pain reported more concern and worsening than patients without "significant" pelvic pain, and evaluated the assistance received poorly. Multivariate analysis showed pelvic pain, limitation in usual activity, and sadness as risk factors of perception of disease worsening. Awaiting surgery and the feeling of sadness were risk factors of concern. Conclusions: Patients with endometriosis, and especially patients with "significant" pelvic pain, reported greater concern and the perception of worsening during the SARS-COV2 pandemic. Tele-health is a useful tool in patients with endometriosis, and face-to-face visit should be considered in those reporting "significant" pelvic pain. Clinical Trial Registration Number: HCB 1202011497.
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Affiliation(s)
- Inmaculada Nicolás
- Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Georgina Feixas
- Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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15
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Alcalde AM, Martínez-Zamora MÁ, Gracia M, Ros C, Rius M, Castelo-Branco C, Carmona F. Assessment of Quality of Life, Sexual Quality of Life, and Pain Symptoms in Deep Infiltrating Endometriosis Patients With or Without Associated Adenomyosis and the Influence of a Flexible Extended Combined Oral Contraceptive Regimen: Results of a Prospective, Observational Study. J Sex Med 2022; 19:311-318. [PMID: 34974988 DOI: 10.1016/j.jsxm.2021.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 02/18/2021] [Revised: 10/06/2021] [Accepted: 11/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The quality of life of women with deep infiltrating endometriosis (DIE) is impaired and may improve with combined oral contraceptives (COCs). AIM To compare the overall and sexual quality of life of patients diagnosed with DIE with or without associated adenomyosis (AD) with that of healthy controls and determine the influence of a COC containing 2 mg dienogest/30 μg ethinyl estradiol on these aspects. METHODS We enrolled 42 women diagnosed with DIE; 31 diagnosed with DIE + AD by transvaginal ultrasound, and 39 non-AD/DIE controls. All patients were interviewed regarding pain symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria), heavy menstrual bleeding using the Pictorial Blood Loss Assessment Chart, quality of life using the Short Form-36 questionnaire (SF-36), and sexual quality of life using the Sexual Quality of Life-Female questionnaire (SQOL-F) and the Brief Profile of Female Sexual Function (B-PFSF) before starting COCs and after 12 months of treatment. OUTCOMES There was significant improvement in overall and sexual quality of life after treatment in DIE and DIE + AD patients. RESULTS Non-AD/DIE controls showed significantly higher scores in the B-PFSF, the SQOL-F and the SF-36 questionnaires (P < .05) at baseline versus the other groups. DIE + AD patients showed poorer quality of sexual life and greater intensity in pain symptoms compared with DIE patients. After 12 months of treatment, there was a significant improvement in overall and sexual quality of life in the DIE and DIE + AD groups, with improvement in sexual quality of life being slightly greater in DIE + AD patients compared with DIE patients. Pain symptoms also decreased in both groups. CLINICAL IMPLICATIONS Patients with DIE + AD showed greater impairment in overall and sexual quality of life compared with patients with isolated DIE which seems to improve with a COC containing 2 mg dienogest/30 μg ethinyl estradiol. STRENGTHS & LIMITATIONS Strengths include the long-term follow up, assessment of the impact of two associated conditions, and administration of the same COC in all patients. Limitations include the relatively small sample size, and the fact that we did not assess the effectiveness of a flexible extended COC regimen containing 2 mg dienogest/30 μg ethinyl estradiol since the groups were different at baseline. CONCLUSION Patients diagnosed with DIE with or without AD have a decreased quality of life which may improve with a COC containing 2 mg dienogest/30 μg ethinyl estradiol. Further research is needed to confirm our results. Alcalde AM, Martínez-Zamora MÁ, Gracia M, et al. Assessment of Quality of Life, Sexual Quality of Life, and Pain Symptoms in Deep Infiltrating Endometriosis Patients With or Without Associated Adenomyosis and the Influence of a Flexible Extended Combined Oral Contraceptive Regimen: Results of a Prospective, Observational Study. J Sex Med 2022;19:311-318.
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Affiliation(s)
- Ana María Alcalde
- Gynaecology Department, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Gynaecology Department, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Meritxell Gracia
- Gynaecology Department, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Ros
- Gynaecology Department, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariona Rius
- Gynaecology Department, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Camil Castelo-Branco
- Gynaecology Department, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Carmona
- Gynaecology Department, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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16
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Díaz-Feijoo B, Rius M, Gracia M, Musquera M, Magaldi M, Peri L, Alcaraz A, Carmona F. Donor robotic-assisted laparoscopy for uterus transplantation. Fertil Steril 2022; 117:651-652. [DOI: 10.1016/j.fertnstert.2021.11.026] [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] [Received: 05/01/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
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17
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Abrao MS, Andres MP, Neto JS, Miller CE, Gingold JA, Rius M, Carmona F. Author's reply regarding AAGL 2021 Endometriosis Classification: An Anatomy-Based Surgical Complexity Score. J Minim Invasive Gynecol 2021; 29:450. [PMID: 34864208 DOI: 10.1016/j.jmig.2021.11.021] [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: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022]
Abstract
Many classifications proposed for this disease over the last decades. While most classification systems have been tailored to measure particular outcomes, all have limitations. In this study, we validated this new system's ability to predict pain and infertility symptoms using a prospective, multi-center study involving over 1,200 cases and compared it to the ASRM classification for endometriosis. Future improvements are necessary to the proposed classification and the development of a preoperative classification by imaging are the next steps.
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18
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Ros C, de Guirior C, Mension E, Rius M, Valdés-Bango M, Tortajada M, Matas I, Martínez-Zamora MÁ, Gracia M, Carmona F. Transvaginal ultrasound for diagnosis of deep endometriosis involving uterosacral ligaments, torus uterinus and posterior vaginal fornix: prospective study. Ultrasound Obstet Gynecol 2021; 58:926-932. [PMID: 34090310 DOI: 10.1002/uog.23696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/20/2021] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the accuracy of transvaginal ultrasound (TVS) in diagnosing deep endometriosis (DE) involving the uterosacral ligaments (USLs), torus uterinus (TU) or posterior vaginal fornix (PVF) in women with suspected endometriosis scheduled for laparoscopic surgery. METHODS In this prospective study, consecutive women with clinically suspected pelvic endometriosis who were scheduled for laparoscopic surgery were invited to participate. TVS was performed before surgery. TVS findings were compared with those obtained at laparoscopy and confirmed histologically. The accuracy of TVS for diagnosing DE involving the USLs, TU or PVF was assessed. Additionally, the association of DE involving the USLs, TU or PVF on TVS with symptoms and with DE affecting other pelvic locations was assessed. RESULTS In total, 172 patients were included. The global sensitivity and specificity of TVS in diagnosing DE affecting the USLs, TU and/or PVF were 92% and 87%, respectively. For DE involving the USLs, the accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio and negative likelihood ratio of TVS were 89.5%, 96.6%, 82.1%, 85.0%, 95.8%, 5.41 and 0.04, respectively; the respective values for DE involving the TU were 86.6%, 83.9%, 89.4%, 89.0%, 84.4%, 7.92 and 0.18, and the respective values for DE involving the PVF were 93.6%, 87.0%, 94.6%, 71.4%, 97.9%, 16.20 and 0.14. Logistic regression analysis showed a significant association between DE affecting the USLs, TU and/or PVF and DE affecting the rectosigmoid (odds ratio, 5.43; P < 0.001). Dyschezia was associated strongly with DE involving the USLs, TU and PVF, while dysmenorrhea was associated significantly with DE involving the TU. CONCLUSION TVS has high accuracy, sensitivity, specificity, PPV and NPV for the detection of DE involving the USLs, TU and PVF in women with suspected endometriosis scheduled for laparoscopic surgery. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Ros
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - C de Guirior
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - E Mension
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - M Rius
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - M Valdés-Bango
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - M Tortajada
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - I Matas
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - M Á Martínez-Zamora
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - M Gracia
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - F Carmona
- Endometriosis Unit, ICGON, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
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Rius M, Gracia M, deGuirior C, Ros C, Martínez-Zamora M, Quintas L, Carmona F. Does the Presence of Adenomyosis Affect the Results of DEEP Infiltrating Endometriosis Surgery? J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.130] [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: 11/28/2022]
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Alcalde AM, Martínez-Zamora MÁ, Gracia M, Ros C, Rius M, Carmona F. Assessment of Sexual Quality of Life and Satisfaction in Couple Relationships Among Women With Deep Infiltrating Endometriosis and Adenomyosis. J Sex Marital Ther 2021; 48:263-272. [PMID: 34720061 DOI: 10.1080/0092623x.2021.1986444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Adenomyosis and endometriosis are similar gynecological diseases that decrease sexual quality of life and, in the case of endometriosis, satisfaction in couple relationships. This study aimed to assess sexual quality of life and couple satisfaction in women diagnosed with adenomyosis (AD) or deep infiltrating endometriosis (DIE). The study population included three groups of couples: one composed of 58 couples in which the woman was diagnosed with AD by transvaginal ultrasound (AD group), a second group comprising 55 couples in which the woman was diagnosed with isolated DIE by transvaginal ultrasound (DIE group), and a third group composed of 60 couples in which the women did not have AD or endometriosis (non-AD/DIE group). All women completed the Sexual Quality of Life-Female (SQOL-F) questionnaire, and all the couples completed the Dyadic Adjustment Scale (DAS). Sexual quality of life was significantly worse in women with AD or DIE compared with non-AD/DIE controls. Dyadic adjustment was significantly worse in the AD and DIE groups compared with the non-AD/DIE group. AD and DIE may impair quality of sexual life and couple relationships. Clinicians should be aware of this issue when treating women with AD or DIE.
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Affiliation(s)
- Ana M Alcalde
- Department of Gynaecology, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Department of Gynaecology, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Meritxell Gracia
- Department of Gynaecology, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Ros
- Department of Gynaecology, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariona Rius
- Department of Gynaecology, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Carmona
- Department of Gynaecology, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Rius M, Fusté P, Ros C, Martínez-Zamora Á, deGuirior C, Gracia M, Mension E, Carmona F. HE4 might be a more useful tumor biomarker to detect malignancy in patients with ovarian endometrioma when malignancy is suspected. J Int Med Res 2021; 49:3000605211047701. [PMID: 34590878 PMCID: PMC8489763 DOI: 10.1177/03000605211047701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 12/09/2022] Open
Abstract
Objective To analyze the utility of carbohydrate antigen (CA)125 and human epididymis protein 4 (HE4) to detect malignancy in women with ovarian endometriosis, when ovarian cancer is suspected and ultrasonography results are inconclusive. Methods Women who underwent surgery between 2015 and 2019 for ovarian endometriosis or for adnexal masses, with a final diagnosis of ovarian carcinoma (clear cell and endometrioid) were included in this retrospective study. The women were divided into three groups: ovarian endometriosis (OE), ovarian carcinoma without endometriosis (OC), and ovarian carcinoma with endometriosis (OC + E). Adnexal masses were assessed preoperatively by transvaginal ultrasonography according to the International Ovarian Tumor Analysis (IOTA) simple rules, and CA125 and HE4 blood levels were obtained. Results Of 208 women, 45 had malignancy, 16 in the OC + E group and 29 in the OC group. According to transvaginal ultrasonography, 13 were classified as undetermined risk of malignancy: OC group: 3, OE group: 3, and OC + E group: 7. When we compared the tumor biomarkers, significant differences in HE4 but not in CA125 levels were found between the groups. Conclusions When ovarian malignancy is suspected in patients with ovarian endometriosis, HE4 is a more useful tumor biomarker to diagnose OC when ultrasonography results are inconclusive.
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Affiliation(s)
- Mariona Rius
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Pere Fusté
- Gynecologic Oncology Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Ros
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ángeles Martínez-Zamora
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristian deGuirior
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Mension
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Abrao MS, Andres MP, Miller CE, Gingold JA, Rius M, Neto JS, Carmona F. AAGL 2021 Endometriosis Classification: An Anatomy-based Surgical Complexity Score. J Minim Invasive Gynecol 2021; 28:1941-1950.e1. [PMID: 34583009 DOI: 10.1016/j.jmig.2021.09.709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To develop a new endometriosis classification system for scoring intraoperative surgical complexity and to examine its correlation with patient-reported pain and infertility. DESIGN Multicenter study of patients treated at 3 recognized endometriosis centers. SETTING Three specialized endometriosis surgical centers in São Paulo, Brazil and Barcelona, Spain. PATIENTS Patients aged 15 to 45 years with histologically proven endometriosis and no history of pelvic malignancy underwent laparoscopic treatment of endometriosis. INTERVENTIONS Demographic data and clinical history, including dysmenorrhea, noncyclic pelvic pain, dyspareunia, dysuria and dyschezia, were prospectively recorded. All patients were staged surgically according to the new 2021 American Association of Gynecologic Laparoscopists (AAGL) and revised American Society of Reproductive Medicine (ASRM) classification systems. The staging for each system was compared against a 4-level surgical complexity scale defined by the most complex procedure performed. MEASUREMENTS AND MAIN RESULTS A total of 1224 patients undergoing surgery met inclusion criteria. The AAGL score discriminated between 4 stages of surgical complexity with high reproducibility (κ = 0.621), whereas the ASRM score discriminated between the complexity stages with poor reproducibility (κ = 0.317). The AAGL staging system correlated with dysmenorrhea, dyspareunia, dyschezia, total pain score, and infertility comparably with the ASRM staging system. CONCLUSION The AAGL 2021 Endometriosis Classification allows for identifying objective intraoperative findings that reliably discriminate surgical complexity levels better than the ASRM staging system. The AAGL severity stage correlates comparably with pain and infertility symptoms with the ASRM stage.
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Affiliation(s)
- Mauricio S Abrao
- Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs. Abrao, Andres, and Neto); Department of Obstetrics and Gynecology, Division of Gynecology, Faculty of Medicine, University of São Paulo (Drs. Abrao and Andres), São Paulo, São Paulo, Brazil; Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago (Dr. Miller); Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge (Dr. Miller), Illinois; Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Dr. Gingold); Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona (Drs. Rius and Carmona); Department of Gynecology, August Pi i Sunyer Biomedical Research Institute (Dr. Carmona), Barcelona, Spain.
| | - Marina Paula Andres
- Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs. Abrao, Andres, and Neto); Department of Obstetrics and Gynecology, Division of Gynecology, Faculty of Medicine, University of São Paulo (Drs. Abrao and Andres), São Paulo, São Paulo, Brazil; Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago (Dr. Miller); Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge (Dr. Miller), Illinois; Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Dr. Gingold); Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona (Drs. Rius and Carmona); Department of Gynecology, August Pi i Sunyer Biomedical Research Institute (Dr. Carmona), Barcelona, Spain
| | - Charles E Miller
- Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs. Abrao, Andres, and Neto); Department of Obstetrics and Gynecology, Division of Gynecology, Faculty of Medicine, University of São Paulo (Drs. Abrao and Andres), São Paulo, São Paulo, Brazil; Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago (Dr. Miller); Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge (Dr. Miller), Illinois; Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Dr. Gingold); Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona (Drs. Rius and Carmona); Department of Gynecology, August Pi i Sunyer Biomedical Research Institute (Dr. Carmona), Barcelona, Spain
| | - Julian A Gingold
- Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs. Abrao, Andres, and Neto); Department of Obstetrics and Gynecology, Division of Gynecology, Faculty of Medicine, University of São Paulo (Drs. Abrao and Andres), São Paulo, São Paulo, Brazil; Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago (Dr. Miller); Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge (Dr. Miller), Illinois; Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Dr. Gingold); Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona (Drs. Rius and Carmona); Department of Gynecology, August Pi i Sunyer Biomedical Research Institute (Dr. Carmona), Barcelona, Spain
| | - Mariona Rius
- Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs. Abrao, Andres, and Neto); Department of Obstetrics and Gynecology, Division of Gynecology, Faculty of Medicine, University of São Paulo (Drs. Abrao and Andres), São Paulo, São Paulo, Brazil; Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago (Dr. Miller); Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge (Dr. Miller), Illinois; Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Dr. Gingold); Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona (Drs. Rius and Carmona); Department of Gynecology, August Pi i Sunyer Biomedical Research Institute (Dr. Carmona), Barcelona, Spain
| | - Joao Siufi Neto
- Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs. Abrao, Andres, and Neto); Department of Obstetrics and Gynecology, Division of Gynecology, Faculty of Medicine, University of São Paulo (Drs. Abrao and Andres), São Paulo, São Paulo, Brazil; Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago (Dr. Miller); Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge (Dr. Miller), Illinois; Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Dr. Gingold); Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona (Drs. Rius and Carmona); Department of Gynecology, August Pi i Sunyer Biomedical Research Institute (Dr. Carmona), Barcelona, Spain
| | - Francisco Carmona
- Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs. Abrao, Andres, and Neto); Department of Obstetrics and Gynecology, Division of Gynecology, Faculty of Medicine, University of São Paulo (Drs. Abrao and Andres), São Paulo, São Paulo, Brazil; Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago (Dr. Miller); Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge (Dr. Miller), Illinois; Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Dr. Gingold); Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona (Drs. Rius and Carmona); Department of Gynecology, August Pi i Sunyer Biomedical Research Institute (Dr. Carmona), Barcelona, Spain
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Nicolás I, Martínez-Zamora MÁ, Gracia M, Carrion A, Feixas G, Bernal L, Quintas L, Rius M, Castelo-Branco C, Carmona F. Management of symptomatic uterine fibroids after ulipristal acetate suspension and identification of high risk patients for surgery at 6-months of follow-up. Gynecol Endocrinol 2021; 37:831-835. [PMID: 34044726 DOI: 10.1080/09513590.2021.1929152] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The use of ulipristal acetate (UPA) was indicated for the treatment of uterine fibroids. Following UPA suspension in March 2020, some patients presented worsening and required surgery. We aimed to identify patients at high-risk for undergoing surgery after UPA suspension. METHODS We evaluated 85 women receiving intermittent UPA treatment until March 2020. Following UPA suspension, patients received other medical treatments or surgery. The clinico-pathological features were recoded and a quality of life health survey was completed by patients at the time of UPA suspension and at 6-months thereafter. RESULTS After the suspension of UPA, 17 of the 85 patients receiving intermittent UPA (20%) required surgery, and 68 (80%) required other medical treatments. Patients who underwent surgery were younger and had greater fibroid volume. CONCLUSIONS In our series, 20% of clinically stable patients receiving intermittent UPA required surgery following UPA suspension. These women should be considered for future medical strategies.
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Affiliation(s)
- Inmaculada Nicolás
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ana Carrion
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Georgina Feixas
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Laura Bernal
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lara Quintas
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Camil Castelo-Branco
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Ros C, de Guirior C, Rius M, Escura S, Martínez-Zamora MÁ, Gracia M, Peri L, Franco A, Carmona F. Accuracy of Transvaginal Ultrasound Compared to Cystoscopy in the Diagnosis of Bladder Endometriosis Nodules. J Ultrasound Med 2021; 40:1571-1578. [PMID: 33085096 DOI: 10.1002/jum.15537] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/30/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the accuracy of transvaginal ultrasound (TVUS) in predicting detrusor infiltration and ureteral meatus involvement in patients with bladder endometriosis (BE) to select which cystoscopic procedures could be avoided and, secondarily, to assess the relationship between symptoms and the characteristics of nodules and the association of BE with other forms of endometriosis. METHODS Patients with BE diagnosed by TVUS were classified according to detrusor infiltration: BE with partial involvement of the muscular layer (group 1) and total muscular layer involvement with bladder protrusion (group 2). We analyzed the accuracy of TVUS compared with subsequently performed cystoscopy, the correlation with symptoms, and the association with other forms of endometriosis. RESULTS Among the 22 patients included, TVUS showed 9 patients with BE nodules partially affecting the detrusor (group 1) with normal cystoscopic findings (TVUS negative predictive value, 100%). Transvaginal ultrasound detected 13 nodules with total involvement, all visible by cystoscopy (TVUS positive predictive value, 100%). Transvaginal ultrasound also identified ureteral orifices that were free of involvement at greater than 10 mm from the BE nodule in 21 of 22 women (TVUS sensitivity, 95%). Ultrasound criteria for adenomyosis and endometriosis in other locations were present in 20 of 22 patients. CONCLUSIONS Transvaginal ultrasound can identify the infiltration of BE nodules in the bladder wall and predict cystoscopic findings with great accuracy. Nodules that partially affect the muscular layer have normal cystoscopic findings, thereby obviating the need for this procedure. Bladder endometriosis nodules are commonly associated with other forms of endometriosis and do not usually affect the ureteral meatus.
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Affiliation(s)
- Cristina Ros
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Cristian de Guirior
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Silvia Escura
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Lluís Peri
- Urologic Diagnosis Unit, Institut Clinic de Nefrologia i Urologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Agustín Franco
- Urologic Diagnosis Unit, Institut Clinic de Nefrologia i Urologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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Abstract
This study aimed to assess the impact of adenomyosis (AD) on different domains of sexual life. The study population included three groups: one composed of 68 women diagnosed with AD by transvaginal ultrasound, a second group comprised by 65 women diagnosed with isolated deep infiltrating endometriosis by transvaginal ultrasound and a third group including 70 women without AD or/and endometriosis. All participants completed the Brief Profile of Female Sexual Function (B-PFSF), the Female Sexual Distress Scale (FSDS), and the Sexual Quality of Life-Female (SQOL-F) questionnaire. Compared with non-AD/DIE controls, women with AD present significantly lower scores of the B-PFSF and the SQOL-F questionnaires and higher FSDS questionnaire scores (p < .0001). There were no differences between the groups of AD and deep infiltrating endometriosis. Clinicians should be aware that the quality of sexual life may be affected in patients with AD. Early diagnosis and multidisciplinary management would contribute to preventing impairment of sexual quality of life in these patients.
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Affiliation(s)
- Ana María Alcalde
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Meritxell Gracia
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Ros
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariona Rius
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Carmona
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Díaz-Feijoo B, Rius M, Gracia M, Agusti N, Carmona F. Pelvic anatomy for gynecologic oncologists: autonomic bladder plexus. Int J Gynecol Cancer 2021; 31:936-937. [PMID: 33782088 DOI: 10.1136/ijgc-2021-002411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Mariona Rius
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Nuria Agusti
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Ros C, Rius M, Abrao MS, deGuirior C, Martínez-Zamora MÁ, Gracia M, Carmona F. Bowel preparation prior to transvaginal ultrasound improves detection of rectosigmoid deep infiltrating endometriosis and is well tolerated: prospective study of women with suspected endometriosis without surgical criteria. Ultrasound Obstet Gynecol 2021; 57:335-341. [PMID: 32349172 DOI: 10.1002/uog.22058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/21/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To analyze the effect of bowel preparation prior to transvaginal ultrasound (TVS) examination on the detection of bowel involvement and the description of rectosigmoid nodules of deep infiltrating endometriosis (DIE), and to evaluate patient tolerance of bowel preparation. METHODS This was a prospective study of paired data obtained between September 2015 and March 2016 from a cohort of women referred, on suspicion of DIE but without surgical criteria, to the endometriosis unit of a tertiary university hospital. In all patients, the wall of the rectum and lower sigmoid colon was evaluated by two TVS examinations: the first was performed without bowel preparation and the second was done after the patient had followed a 3-day low-residue diet and received two 250-mL enemas, one the night before TVS and the second 1-3 h before the examination. The presence of adhesions, number and size of rectosigmoid nodules, deepest layer of the rectum affected, percentage of the circumference of the bowel affected and distance from the most caudal part of the bowel nodule to the anal verge were determined. Patient tolerance to bowel preparation was assessed using a 5-point Likert scale, in which 1 represented 'very well tolerated' and 5 represented 'very poorly tolerated'. RESULTS The mean ± SD age of the 110 patients included in the study was 36.8 ± 5.07 years. As many as 55% of those identified during the first examination (TVS alone) as having adhesions were identified at the second examination (TVS with prior bowel preparation) as having rectosigmoid nodules, and 22 additional nodules were observed on TVS following bowel preparation. These newly detected rectosigmoid nodules, initially assessed mainly as adhesions, were smaller and more superficial compared with the nodules detected on TVS alone, or located in the anterior sigmoid wall. Patient tolerance overall to bowel preparation scored a mean of 1.81 on the 5-point Likert scale. CONCLUSIONS Bowel preparation is well tolerated by patients. When bowel preparation is performed before TVS, the detection of small and superficial nodules and those in the anterior sigmoid wall is improved, allowing more detailed description of these nodules in patients with suspected endometriosis. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Ros
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Rius
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M S Abrao
- Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Obstetrics and Gynaecology, São Paulo University, São Paulo, Brazil
- Gynecologic Division, BP - A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
| | - C deGuirior
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M Á Martínez-Zamora
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Gracia
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - F Carmona
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Alcalde AM, Martínez-Zamora MÁ, Gracia M, Ros C, Rius M, Nicolás I, Carmona F. Impact of Adenomyosis on Women's Psychological Health and Work Productivity: A Comparative Cross-Sectional Study. J Womens Health (Larchmt) 2021; 30:1653-1659. [PMID: 33464159 DOI: 10.1089/jwh.2020.8789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Quality of life in adenomyosis (AD) patients has been poorly investigated. Previous data suggest that AD has negative impact on the quality of life in these women. Methods: From September 2018 to December 2019, all consecutive female premenopausal patients aged ≥18 years diagnosed with AD by transvaginal ultrasound (TVU) were invited to participate in a comparative cross-sectional study. The Short Form-36-item (SF-36) health questionnaire and the Hospital Anxiety and Depression Scale (HADS) were administered. Work productivity and activity impairment were assessed using the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH). Data obtained from these patients were compared with women with normal-appearing myometrium in the TVU recruited during routine gynecological visits. The study was approved by the Clinical Research Ethics Committee of the Hospital Clinic (reference HCB/2018/0919). Results: One hundred three patients with AD and 214 without AD were analyzed. Patients with AD compared to those without AD showed significantly lower scores in all domains of the SF-36 questionnaire and mean (SD) higher scores in the HADS questionnaire for anxiety (10.06 [3.04] vs. 6.92 [2.98], p < 0.001) and depression (6.39 [3.89] vs. 2.74 [2.01], p < 0.002). Significant differences (p < 0.001) were also found for the percentages of absenteeism (12.2% vs. 1.1%), presenteeism (31.1% vs. 11.4%), overall work productivity loss (38.2% vs. 12.4%), and activity impairment (55.7% vs. 9.9%). The presence of AD was associated with higher yearly estimated indirect costs of €5161.32 (€7928.0 vs. €2460.8, p < 0.001). Conclusions: AD negatively affects women's health-related quality of life, psychological health, and work productivity, with impairment at work and daily activities, and higher risk for anxiety and depression.
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Affiliation(s)
- Ana María Alcalde
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Cristina Ros
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Mariona Rius
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Inmaculada Nicolás
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Carmona F, Rius M, Díaz-Feijoo B, Musquera M, Tort J, Alcaraz A. Uterine transplantation. First viable case in Southern Europe. Med Clin (Barc) 2020; 156:297-300. [PMID: 33380366 DOI: 10.1016/j.medcli.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/24/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES To describe the development and characteristics living donor uterine transplantation program of the Hospital Clínic (Barcelona, Spain) and to report the first successful procedure in Southern Europe. PATIENTS AND METHODS A 31-year-old female suffering of Rokitansky Syndrome underwent uterus transplant from her living sister, as a part of our research protocol. Before the transplant, the patient underwent an in vitro fertilization procedure and twelve embryos were obtained and cryopreserved. The uterus obtention procedure was performed entirely by robotic surgery and lasted 10h, being the main objective to obtain arterial and venous pedicles of good quality in order to ensure the vitality of the graft. The surgical procedure in the recipient was performed by laparotomy and the vascular anastomoses were performed in a terminolateral fashion, with polypropylene 8-0, the vaginal cuff of the graft was sutured to the recipient vaginal vault and the round and utero-sacral ligaments were fixed to the remaining recipient ligaments. Immunosuppressive treatment was prescribed following the protocols from other groups modified according to the solid organ transplantation protocols from our center. RESULTS The donor and recipient were discharged without any major complications. The recipient ultrasound scan showed a normal flow in both uterine arteries and veins. A grade II rejection was treated with high dose corticoids with subsequent normal biopsies and a vaginal stricture was treated with the placement of an esophageal stent for 4 weeks. The patient had her first menstrual period 47 days after the surgery. CONCLUSIONS The case reported here open new options in Spain for a wide group of patients that had no medical solution for a disease that deeply impairs their quality of life.
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Affiliation(s)
- Francisco Carmona
- Service of Gynecology, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Mariona Rius
- Service of Gynecology, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Berta Díaz-Feijoo
- Service of Gynecology, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
| | - Mireia Musquera
- Service of Urology, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
| | - Jaume Tort
- Organització Catalana de Trasplantaments (OCATT), Passeig del Taulat, 106-116, 08005 Barcelona, Spain
| | - Antonio Alcaraz
- Service of Urology, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
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Carreras N, de Guirior C, Munmany M, Rius M, Nonell R, Carmona F, Castelo-Branco C. Diagnosis and Surgical Treatment of Uterine Isthmus Atresia: A Case Report and Review of the Literature. J Minim Invasive Gynecol 2020; 28:137-141. [PMID: 32841753 DOI: 10.1016/j.jmig.2020.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/06/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/15/2022]
Abstract
Uterine isthmus atresia is a rare Müllerian duct anomaly occasionally diagnosed in adolescents with primary amenorrhea and cyclic abdominal pain. A case is presented of a 14-year-old female with monthly cyclic lower abdominal pain of a 2-year duration. Magnetic resonance imaging and 3-dimensional ultrasound showed separation of a 10-mm fibrotic tissue between the cervical canal and the endometrial cavity. In an attempt to preserve reproductive ability, an end-to-end anastomosis was laparoscopically performed between the cervical canal and uterine cavity. A platinol stent (WallFlex Biliary RX; Boston Scientific, Boston, MA) was placed by hysteroscopy to avoid stenosis after surgery. Laparoscopic end-to-end anastomosis is proposed to treat congenital uterine isthmus atresia.
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Affiliation(s)
- Núria Carreras
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain (all authors)
| | - Cristian de Guirior
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain (all authors)
| | - Meritxell Munmany
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain (all authors)
| | - Mariona Rius
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain (all authors)
| | - Roser Nonell
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain (all authors)
| | - Francisco Carmona
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain (all authors)
| | - Camil Castelo-Branco
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain (all authors).
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Gracia M, Rius M, Carmona F. [Laparoscopic surgery in the COVID-19 era]. Clin Invest Ginecol Obstet 2020; 47:106-110. [PMID: 32834307 PMCID: PMC7256506 DOI: 10.1016/j.gine.2020.05.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/12/2022]
Abstract
Coexistence with COVID-19 infection (coronavirus disease 2019) in all hospital and health care settings is a current challenge of adaptation, as well as the creation of new protocols and care models. At present, there are still many unknowns about this infection, and much more unknown is the impact into the surgical field. Although evidence regarding the effect of SARS-CoV-2 and laparoscopic surgery is scarce, laparoscopy has been considered the method of choice by different scientific societies for most indications in gynaecology during the COVID-19 pandemic. This is due to the advantages over the open route. There is less morbidity and hospital stay, and in addition, as it involves autonomous and contained surgical procedures with respect to smoke release. Moreover, the instruments and the setting in the operating room mean that there can be safe distance from the surgeon and other staff to the patient. Overall, the main recommendations in laparoscopic surgery during the COVID era include: the use of Personal Protective Equipment for operating room personnel, and the adoption of safety measures to reduce CO2 exposure and surgical smoke release.
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Affiliation(s)
- M. Gracia
- Servicio de Ginecología, Institut Clínic de Ginecologia Obstetrícia i Neonatologia, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - M. Rius
- Servicio de Ginecología, Institut Clínic de Ginecologia Obstetrícia i Neonatologia, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - F. Carmona
- Servicio de Ginecología, Institut Clínic de Ginecologia Obstetrícia i Neonatologia, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina, Universitat de Barcelona, Barcelona, España
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Rius M, Gracia M, Ros C, Martínez-Zamora MÁ, deGuirior C, Quintas L, Carmona F. Impact of endometrioma surgery on ovarian reserve: a prospective, randomized, pilot study comparing stripping with CO 2 laser vaporization in patients with bilateral endometriomas. J Int Med Res 2020; 48:300060520927627. [PMID: 32527167 PMCID: PMC7294500 DOI: 10.1177/0300060520927627] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To assess ovarian reserve through antral follicle count (AFC) and ovarian volume (OV) determination after decapsulation (stripping technique) or CO2 laser vaporization in the surgical treatment of patients with bilateral ovarian endometriomas. Methods This prospective, randomized, blinded, self-controlled pilot study was set in a tertiary university hospital between January 2017 and December 2017, and included consecutive patients with bilateral ovarian endometriomas ≥3 cm. The study was registered with ClinicalTrials.gov under the title ‘Impact on ovarian reserve according to the type of ovarian endometrioma excision: laser versus conventional cystectomy’; NCT 03826355. For each patient, the endometrioma on one side was randomly selected to undergo CO2 laser vaporization and the contralateral endometrioma to undergo laparoscopic decapsulation. Results A total of 16 patients were included. There were no statistically significant between-group differences in OV and AFC levels at baseline. At the 6-month follow-up, OV and AFC levels were significantly higher in the laser-treated group versus the stripping technique. Conclusion Lower OV and AFC levels following excisional surgery for endometrioma versus CO2 laser vaporization suggest a higher impact on ovarian reserve after the stripping procedure.
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Affiliation(s)
- Mariona Rius
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Ros
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Cristian deGuirior
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lara Quintas
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Rius M, Ros C, Escura S, deGuirior C, Gracia M, Martínez-Zamora MÁ, Carmona F. 2908 Ultrasound Findings in Patients Referred to an Endometriosis Unit in a Tertiary Centre: Does Previous Surgery Matter? J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.361] [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: 11/30/2022]
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Coloma JL, Martínez‐Zamora M, Collado A, Gràcia M, Rius M, Quintas L, Carmona F. Prevalence of fibromyalgia among women with deep infiltrating endometriosis. Int J Gynaecol Obstet 2019; 146:157-163. [DOI: 10.1002/ijgo.12822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 01/21/2019] [Accepted: 04/10/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Jose Luis Coloma
- Department of GynecologyInstitut Clínic of Gynecology, Obstetrics and NeonatologyHospital Clínic of Barcelona Barcelona Spain
| | - Maria‐Angeles Martínez‐Zamora
- Department of GynecologyInstitut Clínic of Gynecology, Obstetrics and NeonatologyHospital Clínic of Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Faculty of MedicineUniversity of Barcelona Barcelona Spain
| | - Antonio Collado
- Service of RheumatologyInstitut Clínic d'Especialitats Mèdiques i QuirúrgiquesHospital Clínic of Barcelona Barcelona Spain
| | - Meritxell Gràcia
- Department of GynecologyInstitut Clínic of Gynecology, Obstetrics and NeonatologyHospital Clínic of Barcelona Barcelona Spain
| | - Mariona Rius
- Department of GynecologyInstitut Clínic of Gynecology, Obstetrics and NeonatologyHospital Clínic of Barcelona Barcelona Spain
| | - Lara Quintas
- Department of GynecologyInstitut Clínic of Gynecology, Obstetrics and NeonatologyHospital Clínic of Barcelona Barcelona Spain
| | - Francisco Carmona
- Department of GynecologyInstitut Clínic of Gynecology, Obstetrics and NeonatologyHospital Clínic of Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Faculty of MedicineUniversity of Barcelona Barcelona Spain
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Seijas R, Rius M, Barastegui D, Ares O, Rivera E, Alvarez-Diaz P. Sonographic Measurement of the Patellar Tendon Should Predict Autograft Bone Patellar Tendon Bone (BPTB) Size: Comparison of Anatomical and Clinical Findings. J INVEST SURG 2019; 33:621-626. [PMID: 30730225 DOI: 10.1080/08941939.2018.1551949] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The use of BPTB autograft is frequently used in ACL reconstruction, however, the risk of potential failure in patients with an anatomically unfavorable patellar tendon may predispose to reconstruction failure. Anatomical study of the extensor apparatus of the knee can provide knowledge about the best option obtain the graft and perform a better preoperative planning. Musculoskeletal ultrasound is a simple, reproducible, affordable technique that could be valid for patellar tendon evaluation. The objective of this study is to evaluate the reproducibility of the patellar tendon measurements by ultrasound and compare them with anatomical measurements, both in cadaver and patients undergoing ACLR. The study consists of two phases; first anatomical study in cadaver. The ultrasound measurement was performed by determining the length, width and thickness of the patellar tendon, both by ultrasound and anatomical dissection. The second phase is a cohort of 42 patients pending surgical ACLR. Previous ultrasound and intraoperative measurements were obtained. Regarding the anatomical study, statistical analysis did not show any differences comparing the measurements in length (p = ns) and thickness (p = ns) of the patellar tendon, although differences were obtained when comparing the results obtained for the width of the tendon after the ultrasound and anatomical measurement (p < 0.001). Same results were obtained in second phase of the study. The reproducibility of ultrasound measurements of the PT is comparable to intraoperatively measurements (without width measurement). These findings can be useful for preoperative planning in the reconstruction of ACL with BPTB Graft and to assess technical modifications prior to surgery.
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Affiliation(s)
- R Seijas
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - M Rius
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Mutualitat Catalana de Futbolistes. FCF-RFEF, Barcelona, Spain.,Hospital Teknon Barcelona, Barcelona, Spain
| | - D Barastegui
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Mutualitat Catalana de Futbolistes. FCF-RFEF, Barcelona, Spain
| | - O Ares
- Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain.,Hospital Teknon Barcelona, Barcelona, Spain
| | - E Rivera
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Mutualitat Catalana de Futbolistes. FCF-RFEF, Barcelona, Spain
| | - P Alvarez-Diaz
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain.,Mutualitat Catalana de Futbolistes. FCF-RFEF, Barcelona, Spain
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Gracia M, Nonell R, Ros C, Rius M, Quintas L, Martínez-Zamora MÁ, Carmona F. Sonographic and hysteroscopic endometrial examination in women treated with ulipristal acetate: Exploratory findings at a tertiary referral center. Eur J Obstet Gynecol Reprod Biol 2018; 232:40-45. [PMID: 30468982 DOI: 10.1016/j.ejogrb.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/10/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Ulipristal acetate (UPA) is a progesterone receptor modulator (PRM) agent that has shown benefits in women with symptomatic uterine fibroids. However, its effects on the endometrium are complex and not fully understood. We describe exploratory findings on macroscopic observation of the endometrium at transvaginal sonography (TVS) and hysteroscopy. The aim of the study is to characterize endometrial patterns commonly observed after UPA treatment. STUDY DESIGN We performed a prospective longitudinal study at a tertiary referral center with 100 women with symptomatic uterine fibroids who received a 12-week treatment with UPA (5 mg/day). Patients underwent TVS before and after the treatment, and also a hysteroscopy examination was performed. Main outcome was to compare sonographic and hysteroscopic findings to histology after UPA treatment. RESULTS Twenty one out of 100 (21%) women showed PAEC confirmed by histology after UPA treatment. Ultrasound findings were normal in most women after UPA treatment, but 18/100 (18%) showed an endometrial pattern suggestive of PRM effects (non-uniform, homogeneous endometrium with regular cystic areas). Endometrial thickness ≥16 mm was detected in 6/100 patients (6%), and all of them also presented sonographic PRM pattern. No patient presented malignancy according to histology in this subgroup, and 100% of them had PAEC pattern at histology. Among total patient population showing PAEC at histology, only 33% of these were identified by hysteroscopy, while 57% were identified by TVS with the PRM suggestive pattern. Of note, visibility of endometrium was improved at TVS after UPA. CONCLUSION Identification of increased endometrial thickness together with the categorized endometrial PRM pattern at TVS may be correlated to benign lesions and may not be a cause of concern. This study is exploratory and further research is necessary to support these conclusions. Nevertheless, TVS seems to be feasible to plan adequate follow-up protocols by avoiding unnecessary interventional procedures such as hysteroscopy.
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Affiliation(s)
- Meritxell Gracia
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Roser Nonell
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Cristina Ros
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Lara Quintas
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Maria Ángeles Martínez-Zamora
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain.
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Gracia M, Alcalà M, Ferreri J, Rius M, Ros C, Saco MA, Martínez-Zamora MÁ, Carmona F. Ulipristal Acetate Improves Clinical Symptoms in Women with Adenomyosis and Uterine Myomas. J Minim Invasive Gynecol 2018; 25:1274-1280. [DOI: 10.1016/j.jmig.2018.04.002] [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: 12/28/2017] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
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Munrós J, Martínez-Zamora MA, Tàssies D, Reverter JC, Rius M, Gracia M, Ros C, Carmona F. Total Circulating Microparticle Levels After Laparoscopic Surgical Treatment for Endometrioma: A Pilot, Prospective, Randomized Study Comparing Stripping with CO 2 Laser Vaporization. J Minim Invasive Gynecol 2018; 26:450-455. [PMID: 29803597 DOI: 10.1016/j.jmig.2018.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/21/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 01/17/2023]
Abstract
STUDY OBJECTIVE To evaluate serial generation of microparticles (MPs) after laparoscopic stripping or CO2 laser vaporization in the surgical treatment of patients with ovarian endometrioma (OE). DESIGN A prospective, randomized, blinded, pilot study (Canadian Task Force classification I). SETTING Tertiary care university hospital from December 2014 to July 2016. PATIENTS Thirty women with unilateral OE undergoing laparoscopic surgery. INTERVENTION Patients were randomly selected to undergo either CO2 laser vaporization (L group) or laparoscopic stripping (S group) of OE. MEASUREMENTS AND MAIN RESULTS Blood samples were collected before surgery and at 2 hours, 24 hours, 1 month, and 3 months after surgery. An MP generation curve after OE surgery was created. MP generation was greater in the S group than in the L group at all time points evaluated. The MP generation curve showed a significantly higher area under the curve after excisional surgery (p <.05). CONCLUSION The higher MP levels in the S group suggest an increased inflammation and procoagulant response after this procedure.
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Affiliation(s)
- Jordina Munrós
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria-Angeles Martínez-Zamora
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dolors Tàssies
- Department of Hemotherapy and Hemostasis, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Juan Carlos Reverter
- Department of Hemotherapy and Hemostasis, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Meritxell Gracia
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Ros
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Carmona
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Bourne SD, Hudson J, Holman LE, Rius M. Marine Invasion Genomics: Revealing Ecological and Evolutionary Consequences of Biological Invasions. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/13836_2018_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rius M, Gracia M, Martinez-Zamora MA, Perez A, Carmona F. Treatment with Radiofrequency in Patients with Chronic Pelvic Pain and Endometriosis: Pilot Study. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.558] [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: 11/15/2022]
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Rius M, Munros J, Martinez-Zamora MA, Ros C, Carmona F. Impact on Ovarian Reserve According to the Type of Ovarian Endometrioma Excision: CO2 Fiber Laser Vaporization (AcuPulse DUO, Lumenis) versus Conventional Excision. Interim Analysis. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.624] [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: 11/27/2022]
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Giesel FL, Sterzing F, Schlemmer HP, Holland-Letz T, Mier W, Rius M, Afshar-Oromieh A, Kopka K, Debus J, Haberkorn U, Kratochwil C. Intra-individual comparison of (68)Ga-PSMA-11-PET/CT and multi-parametric MR for imaging of primary prostate cancer. Eur J Nucl Med Mol Imaging 2016; 43:1400-6. [PMID: 26971788 PMCID: PMC4906063 DOI: 10.1007/s00259-016-3346-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/16/2016] [Indexed: 12/01/2022]
Abstract
Purpose Multi-parametric magnetic resonance imaging (MP-MRI) is currently the most comprehensive work up for non-invasive primary tumor staging of prostate cancer (PCa). Prostate-specific membrane antigen (PSMA)-Positron emission tomography–computed tomography (PET/CT) is presented to be a highly promising new technique for N- and M-staging in recurrent PCa-patients. The actual investigation analyses the potential of 68Ga-PSMA11-PET/CT to assess the extent of primary prostate cancer by intra-individual comparison to MP-MRI. Methods In a retrospective study, ten patients with primary PCa underwent MP-MRI and PSMA-PET/CT for initial staging. All tumors were proven histopathological by biopsy. Image analysis was done in a quantitative (SUVmax) and qualitative (blinded read) fashion based on PI-RADS. The PI-RADS schema was then translated into a 3D-matrix and the euclidian distance of this coordinate system was used to quantify the extend of agreement. Results Both MP-MRI and PSMA-PET/CT presented a good allocation of the PCa, which was also in concordance to the tumor location validated in eight-segment resolution by biopsy. An Isocontour of 50 % SUVmax in PSMA-PET resulted in visually concordant tumor extension in comparison to MP-MRI (T2w and DWI). For 89.4 % of sections containing a tumor according to MP-MRI, the tumor was also identified in total or near-total agreement (euclidian distance ≤1) by PSMA-PET. Vice versa for 96.8 % of the sections identified as tumor bearing by PSMA-PET the tumor was also found in total or near-total agreement by MP-MRI. Conclusions PSMA-PET/CT and MP-MRI correlated well with regard to tumor allocation in patients with a high pre-test probability for large tumors. Further research will be needed to evaluate its value in challenging situation such as prostatitis or after repeated negative biopsies.
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Affiliation(s)
- F L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany.
- Unit of Radiopharmaceutic Chemistry, German Cancer Research Center, Heidelberg, Germany.
| | - F Sterzing
- Department of RadioOncology, University Hospital Heidelberg, Heidelberg, Germany
| | - H P Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Holland-Letz
- Department of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - W Mier
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - M Rius
- Institute of Transuranium Elements, European Commission (EC), Karlsruhe, Germany
| | - A Afshar-Oromieh
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
- Unit of Radiopharmaceutic Chemistry, German Cancer Research Center, Heidelberg, Germany
| | - K Kopka
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J Debus
- Department of RadioOncology, University Hospital Heidelberg, Heidelberg, Germany
| | - U Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
- Unit of Radiopharmaceutic Chemistry, German Cancer Research Center, Heidelberg, Germany
| | - C Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
- Unit of Radiopharmaceutic Chemistry, German Cancer Research Center, Heidelberg, Germany
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Daina G, Ramos L, Obradors A, Rius M, del Rey J, Martinez-Pasarell O, Pujol A, Benet J, Navarro Ferreté J. Double-factor preimplantation genetic diagnosis: monogenic and cytogenetic diagnoses analyzing a single blastomere. Prenat Diagn 2015; 35:1301-7. [DOI: 10.1002/pd.4691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/07/2015] [Accepted: 09/14/2015] [Indexed: 01/02/2023]
Affiliation(s)
- Gemma Daina
- Unitat de Biologia Cel·lular i Genètica Mèdica, Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia; Universitat Autònoma de Barcelona; Barcelona Spain
- Càtedra de Recerca Eugin-UAB; Barcelona Spain
| | - Laia Ramos
- Unitat de Biologia Cel·lular i Genètica Mèdica, Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Albert Obradors
- Càtedra de Recerca Eugin-UAB; Barcelona Spain
- Clínica Eugin; Barcelona Spain
| | - Mariona Rius
- Unitat de Biologia Cel·lular i Genètica Mèdica, Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Javier del Rey
- Unitat de Biologia Cel·lular i Genètica Mèdica, Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia; Universitat Autònoma de Barcelona; Barcelona Spain
- Càtedra de Recerca Eugin-UAB; Barcelona Spain
| | | | | | - Jordi Benet
- Unitat de Biologia Cel·lular i Genètica Mèdica, Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia; Universitat Autònoma de Barcelona; Barcelona Spain
- Càtedra de Recerca Eugin-UAB; Barcelona Spain
| | - Joaquima Navarro Ferreté
- Unitat de Biologia Cel·lular i Genètica Mèdica, Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia; Universitat Autònoma de Barcelona; Barcelona Spain
- Càtedra de Recerca Eugin-UAB; Barcelona Spain
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Rius M, Cobo T, García-Posadas R, Hernández S, Teixidó I, Barrau E, Abad C, Palacio M. Emergency Cerclage: Improvement of Outcomes by Standardization of Management. Fetal Diagn Ther 2015. [PMID: 26202176 DOI: 10.1159/000433465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cervical dilatation followed by prolapse and ballooning of membranes into the vagina at mid-gestation is a critical situation. The aim of this study was to describe the outcome of emergency cerclage in a tertiary referral center during a 10-year period (2001-2010) in which a defined selection of women and standard protocol were introduced. SUBJECTS AND METHODS Thirty-nine cases of emergency cervical cerclage performed before 24 completed weeks were retrospectively reviewed. Data related to maternal history, diagnosis, procedure details, postoperative management and perinatal outcome were recorded. Maternal characteristics and perinatal outcomes are described. RESULTS Gestational age at cerclage (mean ± SD) was 22.1 ± 2.0 weeks with 61% (24/39) of women presenting bulging membranes. Gestational age at delivery and cerclage-to-delivery time (mean ± SD) were 28.6 ± 6.2 weeks and 49.1 ± 36.5 days, respectively. Only 38.5% (15/39) of the whole group and 44.1% (15/34) of those who reached 24.0 weeks delivered beyond 28 weeks of gestational age. Neonatal survival before discharge was 82.4% (28/34). DISCUSSION Perinatal outcomes after emergency cerclage are still poor with more than half of the cases delivering before 28 weeks. A standard protocol may help in the management of these rare cases.
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Affiliation(s)
- Mariona Rius
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clx00ED;nic and Hospital Sant Joan de Dx00E9;u), Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
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Giesel FL, Fiedler H, Stefanova M, Sterzing F, Rius M, Kopka K, Moltz JH, Afshar-Oromieh A, Choyke PL, Haberkorn U, Kratochwil C. PSMA PET/CT with Glu-urea-Lys-(Ahx)-[⁶⁸Ga(HBED-CC)] versus 3D CT volumetric lymph node assessment in recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2015; 42:1794-800. [PMID: 26162799 PMCID: PMC4589548 DOI: 10.1007/s00259-015-3106-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 06/02/2015] [Indexed: 11/25/2022]
Abstract
Purpose PET/CT with the PSMA ligand is a powerful new method for the early detection of nodal metastases in patients with biochemical relapse. The purpose of this retrospective investigation was to evaluate the volume and dimensions of nodes identified by Glu-urea-Lys-(Ahx)-[68Ga(HBED-CC)] (68Ga-PSMA-11) in the setting of recurrent prostate cancer. Methods All PET/CT images were acquired 60 ± 10 min after intravenous injection of 68Ga-PSMA-11 (mean dose 176 MBq). In 21 patients with recurrent prostate cancer and rising PSA, 49 PSMA-positive lymph nodes were identified. Using semiautomated lymph node segmentation software, node volume and short-axis and long-axis dimensions were measured and compared with the maximum standardized uptake values (SUVmax). Round nodes greater than or equal to 8 mm were considered positive by morphological criteria alone. The percentage of nodes identified by elevated SUVmax but not by conventional morphological criteria was determined. Results The mean volume of 68Ga-PSMA-11-positive nodes was 0.5 ml (range 0.2 – 2.3 ml), and the mean short-axis diameter was 5.8 mm (range 2.4 – 13.3 mm). In 7 patients (33.3 %) with 31 PSMA-positive nodes only 11 (36 %) were morphologically positive based on diameters >8 mm on CT. In the remaining 14 patients (66.7 %), 18 (37 %) of PSMA positive lymph nodes had short-axis diameters <8 mm with a mean short-axis diameter of 5.0 mm (range 2.4 – 7.9 mm). Thus, in this population, 68Ga-PSMA-11 PET/CT detected nodal recurrence in two-thirds of patients who would have been missed using conventional morphological criteria. Conclusion 68Ga-PSMA-11 PET/CT is more sensitive than CT based 3D volumetric lymph node evaluation in determining the node status of patients with recurrent prostate cancer, and is a promising method of restaging prostate cancers in this setting.
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Affiliation(s)
- Frederik L Giesel
- Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany.
- Cooperation Unit Nuclear Medicine, DKFZ, Heidelberg, Germany.
| | - H Fiedler
- Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany
| | - M Stefanova
- Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany
| | - F Sterzing
- Department of RadioOncology, University of Heidelberg, Heidelberg, Germany
| | - M Rius
- Institute for Transuranium Elements (ITU), European Commission, Karlsruhe, Germany
- Cooperation Unit Nuclear Medicine, DKFZ, Heidelberg, Germany
| | - K Kopka
- Radiopharmaceutical Chemistry, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - J H Moltz
- Radiopharmaceutical Chemistry, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - A Afshar-Oromieh
- Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany
| | - P L Choyke
- Molecular Imaging Program, National Cancer Institute, Bethesda, USA
| | - U Haberkorn
- Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany
- Cooperation Unit Nuclear Medicine, DKFZ, Heidelberg, Germany
| | - C Kratochwil
- Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany
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Rius M, Vilanova J, Cayuela E, Carmona F. Dissection of Hipogastric Plexus and Sacral Nerves on Unembalmed Female Cadaver. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.692] [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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Galán M, Seijas R, Ares O, Cuscó X, Rius M, Cugat R. [Adjuvant administration of plasma rich in growth factors for bilateral quadriceps tendon tear]. Acta Ortop Mex 2014; 28:310-314. [PMID: 26021096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Bilateral quadriceps tendon tears are infrequent conditions. Surgical repairs are the most appropriate treatments and they involve several months of recovery. METHODS We report the case of a patient with bilateral quadriceps tendon tear resulting from low energy trauma. He was treated with surgical transpatellar suturing reinforced with plasma rich in growth factors (PRGF-Endoret). RESULTS Short-term results showed functional and radiological recovery at the two-months follow-up. The use of PRGF together with usual surgery may contribute to early rehabilitation.
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Ramos L, del Rey J, Daina G, Martinez-Passarell O, Rius M, Tuñón D, Campillo M, Benet J, Navarro J. Does the S phase have an impact on the accuracy of comparative genomic hybridization profiles in single fibroblasts and human blastomeres? Fertil Steril 2013; 101:488-95. [PMID: 24314925 DOI: 10.1016/j.fertnstert.2013.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 08/01/2013] [Revised: 10/16/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate if there is an association between single-cell replicative stage and the segmental chromosome imbalances detected by comparative genomic hybridization (CGH). DESIGN First, 135 fibroblasts from cell-line GM03184 (Coriell) at three cell stages (G0/G1, S, and G2/M) were amplified by degenerate oligonucleotide-primed polymerase chain reaction (DOP-PCR) or Sureplex and blindly analyzed by CGH. Second, 85 human blastomeres at the interphase and the metaphase stages, from 30 donated human cryopreserved embryos, were amplified by Sureplex and analyzed by CGH. SETTING Academic center for reproductive medicine. PATIENT(S) None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Incidence of aneuploidy and segmental imbalances detected at the different cell stages. RESULT(S) In DOP-PCR amplifications of fibroblasts, an increased incidence of segmental abnormalities was detected in the S phase. In Sureplex amplifications of fibroblasts and blastomeres, no differences were detected between the different cell stages. A significantly increased incidence of structural abnormalities was seen in the aneuploid blastomeres. CONCLUSION(S) The segmental imbalances detected after Sureplex amplification in 73.3% of the cryopreserved embryos analyzed are mainly nontransitory. They correspond to segmental imbalances present in the cells due to chromosome instability, rather than to replicative DNA segments.
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Affiliation(s)
- Laia Ramos
- Unitat de Biologia Cel·lular i Genètica Mèdica. Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Javier del Rey
- Unitat de Biologia Cel·lular i Genètica Mèdica. Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Gemma Daina
- Unitat de Biologia Cel·lular i Genètica Mèdica. Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | | | | | - Mercedes Campillo
- Àrea de Medicina Preventiva i de Salut Pública. Facultat de Medicina. Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Benet
- Unitat de Biologia Cel·lular i Genètica Mèdica. Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Joaquima Navarro
- Unitat de Biologia Cel·lular i Genètica Mèdica. Facultat de Medicina, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Daina G, Ramos L, Obradors A, Rius M, Martinez-Pasarell O, Polo A, Del Rey J, Obradors J, Benet J, Navarro J. First successful double-factor PGD for Lynch syndrome: monogenic analysis and comprehensive aneuploidy screening. Clin Genet 2012; 84:70-3. [PMID: 22998423 DOI: 10.1111/cge.12025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
Abstract
Preimplantation genetic diagnosis (PGD) has been applied worldwide for a great variety of single-gene disorders over the last 20 years. The aim of this work was to perform a double-factor preimplantation genetic diagnosis (DF-PGD) protocol in a family at risk for Lynch syndrome. The family underwent a DF-PGD approach in which two blastomeres from each cleavage-stage embryo were biopsied and used for monogenic and comprehensive cytogenetic analysis, respectively. Fourteen embryos were biopsied for the monogenic disease and after multiple displacement amplification (MDA), 12 embryos were diagnosed; 5 being non-affected and 7 affected by the disease. Thirteen were biopsied to perform the aneuploidy screening by short-comparative genomic hybridization (CGH). The improved DF-PGD approach permitted the selection of not only healthy but also euploid embryos for transfer. This has been the first time a double analysis of embryos has been performed in a family affected by Lynch syndrome, resulting in the birth of two healthy children. The protocol described in this work offers a reliable alternative for single-gene disorder assessment together with a comprehensive aneuploidy screening of the embryos that may increase the chances of pregnancy and birth of transferred embryos.
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Affiliation(s)
- G Daina
- Càtedra de Recerca Eugin-UAB; Unitat de Biologia Cel·lular i Genètica Mèdica, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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