Biomedical subjects

D Oosterlynck

Publications and source records attributed to D Oosterlynck.

5 recordsLinked to original sources

PubMed1996

Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentration.

OBJECTIVES: To evaluate a clinical examination during menstruation and plasma CA-125 concentrations to diagnose deep endometriosis. DESIGN: Prospective study in 61 women scheduled for a laparoscopy, a retrospective study in 140 women with deep endometriosis, and a clinical validation study in 16 women with painful pelvic nodularities during menstruation. SETTING: University Hospital Gasthuisberg, a tertiary referral center. RESULTS: In the retrospective study, deep endometriosis was detected by routine clinical examination in only 36% of women. Lesions infiltrating deeper than 15 mm were detected in 50%. In the prospective study pelvic nodularities were detected by routine clinical examination in 4 women but were detected in 22 by clinical examination during menstruation. The latter was highly reliable to diagnose deep endometriosis, cystic ovarian endometriosis, and cul-de-sac obliteration. CA-125 concentrations were higher during menstruation and correlated with deep endometriosis and with deep and cystic ovarian endometriosis. Nodularities at clinical examination or follicular phase CA-125 concentrations > 35 U/mL are useful to decide that a bowel preparation should be given, achieving a sensitivity of 87% and a specificity of 83%. In the clinical validation study, deep endometriosis was found in 14 of 16 women. CONCLUSION: Clinical examination during menstruation can diagnose reliably deep endometriosis, cystic ovarian endometriosis, or cul-de-sac adhesions. This test, preferentially combined with a follicular phase CA-125 assay, should be used to decide whether a preparation for bowel surgery should be given.

CA-125 Antigen↗

PubMed1994

Deeply infiltrating endometriosis is a disease whereas mild endometriosis could be considered a non-disease.

Deeply infiltrating endometriosis can be defined as endometriosis infiltrating deeper than 5 mm under the peritoneal surface. Type I is a conical lesion suggested to be caused by infiltration; type II is mainly caused by retraction of the bowel over the lesion; type III is the most severe lesion suggested to be caused by adenomyosis externa. Severe cases are clinically apparent by nodularities in the pouch of Douglas, whereas mild and subtle forms of deep endometriosis are easily missed. Clinical examination during menstruation and scrutiny at laparoscopy for indurations, followed, preferably, by CO2-laser-excision are the key features for diagnosis and treatment. It is important to realize that depth of infiltration and lateral spread cannot be evaluated by laparoscopic inspection but only during excision, that CA125 concentration but not ultrasound or nuclear magnetic resonance can be helpful in the diagnosis, and that in the most severe cases medical pretreatment is advocated. Results of excision, as evaluated by disappearance of pain in some 80% of women, by a cumulative pregnancy of some 70% and a low recurrence rate, are excellent. The peritoneal fluid is thought to play a key role in the physiopathology of deep endometriosis which is considered to be endometriosis which has escaped from the influence of the peritoneal fluid. This concept is clinically important for the medical treatment of endometriosis, which is suggested to shrink deep lesions and to bring them back under peritoneal fluid control. A model of endometriosis is proposed and discussed. Subtle lesions are considered a natural condition occurring intermittently in all women, whereas we question whether mild endometriosis is a disease. In some women endometriosis has an aggressive behavior and develops into cystic ovarian endometriosis or into deeply infiltrating endometriosis. In this model subtle and mild forms would be called "endometriosis," whereas deep and cystic ovarian forms could be called "endometriotic disease." It is stressed that deep and cystic ovarian endometriosis are two distinct entities, which is important for our understanding of endometriosis, for classification and for treatment of endometriosis.

Endometriosis↗

PubMed1991

Conservative laparoscopic treatment of ectopic pregnancies using the CO2-laser.

OBJECTIVE: To assess the feasibility of CO2-laser-endoscopic surgical treatment for large and/or ruptured ectopic pregnancies, and to compare the results with those of microsurgical salpingotomy. DESIGN: A retrospective review of all women treated for an ectopic pregnancy during a 6-year period, 1984-1989. During 1988 and 1989 treatment was randomized by the day of admission, depending only upon the surgeon in charge, some performing a linear salpingotomy (n = 42) and some a CO2-laser laparoscopy (n = 34) in all women haemodynamically stable. SETTING: Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven. SUBJECTS: 135 women with ectopic pregnancies of whom 76 were included in the randomized series between 1988 and 1989. Overall 11 were treated by pelvic lavage, 78 by laparotomy and 46 by laparoscopic procedures. MAIN OUTCOME MEASURES: Postoperative complications, duration of hospital stay. Cumulative pregnancy rates after the procedures. RESULTS: The two groups of women analysed in the randomized series were comparable for duration of amenorrhoea, diameter of the ectopic pregnancy and prevalence of 'ruptured' ectopics, but the duration of stay in hospital was much shorter (mean 2.9, SD 1.8 days) for the 34 women treated by laparoscopy than for the 42 women treated by laparotomy (mean 6.8, SD 1.6 days). The postoperative cumulative pregnancy rate was higher in nulliparous women with a history of infertility or pelvic inflammatory disease (PID), when treated with CO2-laser-laparoscopy (P = 0.009). The recurrency rate was low (less than 5% in both groups). Overall in the women treated by laparotomy, postoperative cumulative pregnancy rates were lower following excision or adnexectomy than after a microsurgical linear salpingotomy (P = 0.01). Four women treated by laparoscopy required a second procedure. CONCLUSION: Endoscopic treatment of large and/or ruptured ectopic pregnancies is feasible and resulted in a shorter hospital stay and, in nulliparous women with a history of PID or infertility, in higher cumulative pregnancy rates, than after microsurgical salpingotomies.

Endoscopy↗

PubMed1990

Deeply infiltrating pelvic endometriosis: histology and clinical significance.

In 179 consecutive laparoscopies for infertility (n = 105), pain (n = 60), or both problems (n = 14), endometriosis was diagnosed in 77%, 82%, and 86%, respectively. Eighty implants with positive histology and with careful assessment of depth were sampled by CO2 laser excision from 53 patients. Deep (greater than or equal to 5 mm), intermediate (2 to 4 mm), and superficial (less than 1 mm) infiltration was found in 48%, 35%, and 17% of implants, respectively. Deep infiltration was observed in the pouch of Douglas (55%) and at the uterosacrals (34%), but was absent from the ovarian fossas. Deep implants were found to be active in 68%. At an intermediate depth, however, only 25% of implants were active, whereas 58% of superficial foci showed activity. Deep implants were in phase with the endometrium in 74%. At an intermediate depth, however, only 38% showed regular cyclicity, whereas 57% of superficial implants were in phase with the cycle. Deep infiltration occurred through loose connective tissue septa into the fibromuscular tissue and was always stopped at the underlying fat tissue. Very deep implants (greater than 10 mm) were found exclusively in patients with pain; superficial implants, on the contrary, were found most frequently in patients with infertility (83%).

Age Factors↗

PubMedDate not supplied

Immunological aspects of endometriosis.

The immune system probably plays a role in the onset and development of endometriosis. A general picture can be proposed. In some women refluxing endometrial cells are not destroyed, either because the patient is genetically programmed not to respond to endometrial antigens, or because the reflux is so abundant that the scavenging capacity of the peritoneal immune cells is overloaded. Refluxing cells could be protected due to an abnormal adherence to the mesothelium which exceptionally expresses certain adhesive molecules. Undestroyed, these endometrial cells would cause an inflammation with activation of macrophages. Not only does the peritoneum protect these endometrial cells, but it also produces abnormal quantities of chemotactic and angiogenic cytokines (interleukin-8). Macrophages facilitate development via growth factors such as transforming growth factor P. Immunosuppressive factors block the cytotoxic activity of natural killer (NK) cells. Activated macrophages present antigens of endometrial cells to T cells which will co-operate with B cells to synthesize autoantibodies. Synthesized antibodies protect the ectopic endometrium and could worsen the dysfunction of local NK cells. A vicious circle is set up involving all the partners of the immune system. It is as yet impossible to pinpoint the triggering mechanism. The primary defect could be localized on the endometrium, macrophages already activated by an extrinsic factor (infection, spermatozoa, chemical substances), the uterus or the tubo-uterine junction. The two pathophysiological theories put forward to explain endometriosis are linked by a defective immune system. Indeed, once the vicious circle is set up, growth and angiogenic factors could induce metaplasia of the already irritated mesothelium.

Antibody Formation↗