vaso di pandora della therapia per endometriosi

vaso di pandora della therapia per endometriosi

Vaso di Pandora : la terapia dell'endometriosi Pandora’s box of endometriosis therapy Evidence based medicine Therapy in medicine should be based on evidence.  This is important to ascertain that a therapy is useful without side effects.  It protects the patient from practices without a proven benefit and reduces the cost of medicine. Evidence based medicine has developed a ranking of evidence known as the pyramid of evidence. This ranking is mathematically correct with the Randomised Controlled Trial on top. Randomisation avoid an allocation bias and ascertains that the 2 groups are identical. The limitations of a RCT A non blinded trial of pain therapy is not useful. The effect of a treatment should be evaluated without bias. This is obvious If the effect can be objectively measured as height or weight. For endpoints as pain or well being, there is the well know placebo effect and observer bias. RCT on pain and well being thus have to be double blinded to be valid. A RCT trial is not useful for complex multimorbidities. The results of a RCT are rue only for the group of women investigated and cannot be extrapolated. What can be a valid conclusion for 20 year old is not necessarily valid for a 60 year old. For this reason RCT are not suited for multi-morbidities. only Clinical observation can detect rare events. A RCT evaluates a group as a whole and cannot detect or exclude a (hidden) small subgroup with an opposite effect. Only after detection by clinical observation this can be evaluated by another RCT. The player Bias Treatment varies with the specialist in infertility...
Profssa Anastasia Ussia

Profssa Anastasia Ussia

News & Events   Profssa Ussia Anastasia Cari amici Ho il piacere di condividere con voi la mia soddisfazione e la mia emozione per aver ricevuto oggi a Mosca un importante ed ambito riconoscimento:il diploma di professore honoris causa per aver contribuito per oltre 25 anni di collaborazione allo sviluppo della medicina della riproduzione e alla diffusione della chirurgia laparoscopica in Russia.Ho dedicato la mia vita professionale allo studio dell’endometriosi e alla chirurgia laparoscopica della infertilità e delle patologie benigne ginecologiche ,non è stato facile ma oggi sono veramente felice di quello che ho realizzato in tutti questi anni!!Devo ringraziare soprattutto la professoressa Leila Adamyan della Università di Mosca per avermi dato la possibilità di crescere professionalmente e di confrontarmi con colleghi di tutto il mondo.In Mosca ho avuto la possibilità di conoscere i pionieri della chirurgia laparoscopica ginecologica quali il professor Harry Reich, il professor Philippe Koninckx , il professor Wattiez e tanti altri che per motivi di spazio non elenco tutti ma che ringrazio tutti dal profondo del cuore per l’esempio e l’insegnamento ricevuto. Anastasia...
Guidelines da chirurgi : diagnosi e trattamento dell’endometriosi profonda

Guidelines da chirurgi : diagnosi e trattamento dell’endometriosi profonda

Endometriosi profonda Guidelines da chirurgi Diagnosis of deep endometriosis The final diagnosis of a deep endometriosis nodule -defined as adenomyosis externa- is made during surgery. Confirmation by pathology is close to 100%. After previous surgery, however , it can be difficult to distinguish deep endometriosis from fibrosis. Deep endometriosis should be suspected in all women with severe menstrual pain, especially severe dyschesia, mictalgia , deep dyspareunea and pain with perineal radiation. The diagnostic accuracy of exams varies with the size and the localisation of the deep endometriosis nodule. Clinical exam will obviously diagnose 100% of vaginally visible nodules if the clinician has experience. Otherwise, clinical exam will diagnose only 50% (1) to 90% of recto-vaginal nodules . A clinical exam cannot exclude a deep endometriosis nodule. Although CA125 has a specificity and sensitivity of 90% when assayed during the first days after menstruation, it was not considered a useful clinical tool for the diagnosis of deep endometriosis (1). Ultrasound is reported to have a sensitivity and specificity of 90 to over 95% for recto-vaginal and recto-sigmoid nodules. Accuracy moreover is operator dependent. Although the accuracy for small nodules is not known the accuracy obviously is less. A negative ultrasound exam therefore cannot exclude a small and/or a high situated or sigmoid nodule. MRI has a similar sensitivity and specificity as ultrasound and is less operator dependent. Since the accuracy for small nodules and the lower detection limit has not been established a negative exam cannot exclude a deep endometriosis nodule. Approved by Surgeons. Stephan Gordts, Life Expert Centre, Leuven, Belgium, Errico Zupi Prof Univ Tor vergate, Rome Italy, Anastasia...

bowel resections

Bowel resections 28-2-2009 :The debate concerning rectosigmoid endometriosis on AAGL-ENDO-EXCHANGE automatic digest system;LISTSERV@listserv.brown.edu We Wrote : Our overall approach to these patients is as follows 1. If less than 50% bowel occlusion on contrast enema - if asymptomatic and no desire to become pregnancy : do nothing (most I saw are not evolutive ; evolutivity anyway is not proven) - if symptomatic : indication depends on the severity of pain - if a pregnancy is planned I would be prudent since these nodules become bigger and might occasionally cause occlusion during pregnancy or ovulation induction. 2. If more than 50% bowel occlusion on contrast enema I would be prudent since a bowel obstruction means urgent surgery in less than good circumstances.  If a pregnancy is planned, I would definitively do surgery. This however is a partial academic discussion, since more than 50% occlusion at the level of the rectosigmoid or rectum is extremely rare and all of them can be treated by discoid/full thickness excision. For the sigmoid however 50% occlusion occurs in some 10-20% and we prefer to have a sigmoid resection done. Philippe R. Koninckx*,**  and Anastasia Ussia** *Dpt obstetrics and gynaecology, KULeuven Belgium, Univ Cattolica, Rome, Univ Oxford, UK ** Gruppo Italo-Belga, Villa del Rosario and l’Anunciatella, Rome,...
Chirurgia per l’endometriosi profonda senza resezione intestinale sara difficile in Belgio.

Chirurgia per l’endometriosi profonda senza resezione intestinale sara difficile in Belgio.

Chirurgia per l’endometriosi profonda senza resezione intestinale sarà difficile in Belgio. Relazioni il 10/9/12 a Ircad Strasburgo, il 12/9/12 la discussione con il Prof Keckstein durante il congresso dell’ ESGE meeting a Parigi e il 20-9-12 a Bruxelles quando il prof Donnez è diventato emeritus. click to start   La relazione e l’articolo completo sono a destra La storia 1990 Prof Koninckx ha iniziato la chirurgia per l’endometriosi profonda con il Prof em Penninckx ie poco dopo la prima pubblicazione. 1995 dopo alcune resezioni intestinali per l’endometriosi profonda , a Leuven noi siamo giunti all’accordo che la resezione del sigma sarebbe stata eseguita dai chirurghi colon/rettali, in parte per ridurre il nostro carico di lavoro ed inoltre non era un intervento estremamente difficile.Per capire ciò bisogna sapere che a quel momento i chirurghi generali erano all’inizio della loro esperienza in chirurgia laparoscopica e Koninckx insegnava la laparoscopia ai chirurghi. 2000 tanti ginecologi hanno iniziato la chirurgia per l’endometriosi profonda, ma quasi tutti fanno sempre la resezione intestinale, perché meno difficile e per motivi medico legali. Inoltre il rimborso del DRG della resezione intestinale è 5 volte più alto che quello della resezione discoide o della chirurgia consrvativa. Cosi il Prof koninckx (KULeuven) e Prof Donnez (UCL) in Belgio, e qualche gruppi in Stati Uniti (eg Charles Koh Milwaukee, Camran Nezhat Atlanta, David Redwine Oregon) ) erano una minoranza 2005 progressivamente con piu dati è divenuto chiaro che la resezione intestinale non è sempre necessaria, che i risultati della resezione intestinale non sono superiori, ed inoltre la resezione del retto bassa è associata a molte complicanze a lungo termine.Questo è...

Chirurgia per idronefrosi cronico

Chirurgia per idronefrosi cronico In response to a question : how to treat silent hydronefrosis (without pain) and a marked reduction in kidney function ? AAGL-ENDO-EXCHANGE Digest - 7 Aug 2011 to 8 Aug 2011 Date: Mon, 8 Aug 2011 15:50:26 -0400 From: Philippe Koninckx and Anastasia Ussia <Gary_Frishman@BROWN.EDU> Subject: Chronic hydronephrosis surgical management In all cases seen with hydronephrosis until today (around 100): strategy has been consistently the same * insert a stent if possible * dissect the ureter what will give the diagnosis of the cause of the hydronephrosis ie generally endometriosis, rarely compression only. Anyway this becomes apparent during dissection. * during dissection decide whether excision of surrounding endometriosis is sufficient or whether a resection anastomosis is necessary (a reimplantation almost always is a secondary option after failure as published) Since dissection of the ureter was not done, I would suggest repeat surgery. The prognosis of the kidney function is difficult to predict since the duration that the hydronephrosis existed is unknown. Sincerely Philippe Koninckx and Anastasia Ussia Gruppo Italo Belga, Belgium and...

Shiny Trinket

Shiny trinkets are shiny.