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Charles Chapron - One of the best experts on this subject based on the ideXlab platform.
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diagnosis of endometriosis with imaging a review
European Radiology, 2006Co-Authors: Karen Kinkel, Kathrin A Frei, C Balleyguier, Charles ChapronAbstract:Endometriosis corresponds to ectopic endometrial glands and stroma outside the uterine cavity. Clinical symptoms include dysmenorrhoea, dyspareunia, infertility, Painful Defecation or cyclic urinary symptoms. Pelvic ultrasound is the primary imaging modality to identify and differentiate locations to the ovary (endometriomas) and the bladder wall. Characteristic sonographic features of endometriomas are diffuse low-level internal echos, multilocularity and hyperchoic foci in the wall. Differential diagnoses include corpus luteum, teratoma, cystadenoma, fibroma, tubo-ovarian abscess and carcinoma. Repeated ultrasound is highly recommended for unilocular cysts with low-level internal echoes to differentiate functional corpus luteum from endometriomas. Posterior locations of endometriosis include utero-sacral ligaments, torus uterinus, vagina and recto-sigmoid. Sonographic and MRI features are discussed for each location. Although ultrasound is able to diagnose most locations, its limited sensitivity for posterior lesions does not allow management decision in all patients. MRI has shown high accuracies for both anterior and posterior endometriosis and enables complete lesion mapping before surgery. Posterior locations demonstrate abnormal T2-hypointense, nodules with occasional T1-hyperintense spots and are easier to identify when peristaltic inhibitors and intravenous contrast media are used. Anterior locations benefit from the possibility of MRI urography sequences within the same examination. Rare locations and possible transformation into malignancy are discussed.
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endometriosis and pelvic pain epidemiological evidence of the relationship and implications
Human Reproduction Update, 2005Co-Authors: Arnaud Fauconnier, Charles ChapronAbstract:The relationship between chronic pelvic pain symptoms and endometriosis is unclear because Painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic micro-bleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the sub-peritoneal pelvic space by the implants. The Painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, Painful Defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as location indicating pain. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic management of endometriosis in a context of pain.
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endometriosis and pelvic pain epidemiological evidence of the relationship and implications
Human Reproduction Update, 2005Co-Authors: Arnaud Fauconnier, Charles ChapronAbstract:The relationship between chronic pelvic pain symptoms and endometriosis is unclear because Painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic micro-bleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the sub-peritoneal pelvic space by the implants. The Painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, Painful Defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as location indicating pain. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic management of endometriosis in a context of pain.
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relation between pain symptoms and the anatomic location of deep infiltrating endometriosis
Fertility and Sterility, 2002Co-Authors: Arnaud Fauconnier, Charles Chapron, Jeanbernard Dubuisson, Marco Vieira, Bertrand Dousset, G BreartAbstract:Abstract Objective: To investigate whether specific types of pelvic pain are correlated with the anatomic locations of deeply infiltrating endometriosis (DIE). Design: Retrospective data analysis. Setting: University tertiary referral center. Patient(s): Two hundred and twenty-five women with pelvic pain symptoms and DIE. Intervention(s): During surgery, we recorded the anatomic locations of DIE implants and associated endometriosis. Main Outcome Measure(s): We studied the incidence of pelvic pain symptoms including severe dysmenorrhea, deep dyspareunia, noncyclic chronic pelvic pain, Painful Defecation during menstruation, urinary tract symptoms, and gastrointestinal symptoms as related to the location of DIE. Result(s): The frequency of severe dysmenorrhea increased with Douglas pouch adhesions and decreased with parity. The frequency of dyspareunia increased with a uterosacral ligament DIE location and decreased when it involved the bladder. The frequency of noncyclic chronic pelvic pain was higher when it involved the bowel and was lower for women who were treated for infertility. The frequency of Painful Defecation during menstruation was higher when DIE involved the vagina; lower urinary tract symptoms were more frequent when DIE involved the bladder and less frequent in women with a lower body mass index. Gastrointestinal symptoms were associated with bowel or vaginal DIE locations. Conclusion(s): The types of pelvic pain are related to the anatomic location of DIE. Knowledge of the characteristics of pelvic pain symptoms is important in the preoperative assessment of patients with suspected DIE.
Arnaud Fauconnier - One of the best experts on this subject based on the ideXlab platform.
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endometriosis and pelvic pain epidemiological evidence of the relationship and implications
Human Reproduction Update, 2005Co-Authors: Arnaud Fauconnier, Charles ChapronAbstract:The relationship between chronic pelvic pain symptoms and endometriosis is unclear because Painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic micro-bleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the sub-peritoneal pelvic space by the implants. The Painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, Painful Defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as location indicating pain. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic management of endometriosis in a context of pain.
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endometriosis and pelvic pain epidemiological evidence of the relationship and implications
Human Reproduction Update, 2005Co-Authors: Arnaud Fauconnier, Charles ChapronAbstract:The relationship between chronic pelvic pain symptoms and endometriosis is unclear because Painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic micro-bleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the sub-peritoneal pelvic space by the implants. The Painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, Painful Defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as location indicating pain. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic management of endometriosis in a context of pain.
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relation between pain symptoms and the anatomic location of deep infiltrating endometriosis
Fertility and Sterility, 2002Co-Authors: Arnaud Fauconnier, Charles Chapron, Jeanbernard Dubuisson, Marco Vieira, Bertrand Dousset, G BreartAbstract:Abstract Objective: To investigate whether specific types of pelvic pain are correlated with the anatomic locations of deeply infiltrating endometriosis (DIE). Design: Retrospective data analysis. Setting: University tertiary referral center. Patient(s): Two hundred and twenty-five women with pelvic pain symptoms and DIE. Intervention(s): During surgery, we recorded the anatomic locations of DIE implants and associated endometriosis. Main Outcome Measure(s): We studied the incidence of pelvic pain symptoms including severe dysmenorrhea, deep dyspareunia, noncyclic chronic pelvic pain, Painful Defecation during menstruation, urinary tract symptoms, and gastrointestinal symptoms as related to the location of DIE. Result(s): The frequency of severe dysmenorrhea increased with Douglas pouch adhesions and decreased with parity. The frequency of dyspareunia increased with a uterosacral ligament DIE location and decreased when it involved the bladder. The frequency of noncyclic chronic pelvic pain was higher when it involved the bowel and was lower for women who were treated for infertility. The frequency of Painful Defecation during menstruation was higher when DIE involved the vagina; lower urinary tract symptoms were more frequent when DIE involved the bladder and less frequent in women with a lower body mass index. Gastrointestinal symptoms were associated with bowel or vaginal DIE locations. Conclusion(s): The types of pelvic pain are related to the anatomic location of DIE. Knowledge of the characteristics of pelvic pain symptoms is important in the preoperative assessment of patients with suspected DIE.
Marc A. Benninga - One of the best experts on this subject based on the ideXlab platform.
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functional constipation in childhood current pharmacotherapy and future perspectives
Expert Opinion on Pharmacotherapy, 2013Co-Authors: Daniel R Hoekman, Marc A. BenningaAbstract:Introduction: Childhood constipation is a common problem, varying from mild and short-lived to severe and chronic. In the majority of children, no organic cause can be identified and complaints are, thus, referred to as functional constipation. Infrequent Painful Defecation in combination with fecal incontinence has a significant impact on a child's quality of life. Pharmacological treatment often consists of fecal disimpaction and maintenance therapy. With current treatment options, results are often disappointing. Areas covered: The aim of this review is to provide an overview of current and future pharmacological therapies for functional constipation in childhood. Expert opinion: Despite the widespread use of laxatives, there is a paucity of evidence to support this practice. No strong conclusions can be drawn on which laxative to prefer over the other. However, polyethylene glycol appears to be a reasonable first choice for maintenance therapy. Due to advances in our understanding of intestinal (patho...
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clinical practice diagnosis and treatment of functional constipation
European Journal of Pediatrics, 2011Co-Authors: Merit M Tabbers, Marjolein Y Berger, Nicole Boluyt, Marc A. BenningaAbstract:Childhood functional constipation has an estimated prevalence of 3% in the Western world and is probably the most common gastrointestinal complaint in children. It is characterized by infrequent Painful Defecation, faecal incontinence and abdominal pain. Only less than 5% of children with constipation have an underlying disease. Only recently two evidence-based guidelines (the Netherlands and Great Britain) have been developed concerning the diagnostic and therapeutic approach for childhood constipation which we both discuss in this article. At present, a thorough medical history and complete physical exam are usually sufficient to confirm the diagnosis of functional constipation. Further laboratory or radiological investigations should only be performed in case of doubt, to exclude an underlying disease. Treatment of childhood constipation consists of four steps: (1) education, (2) disimpaction, (3) prevention of re-accumulation of faeces and (4) follow-up. Surprisingly, there is only limited evidence that laxative treatment is better than placebo in children with constipation. However, according to the available evidence, the Dutch guideline recommends lactulose for children <1 year as first-choice treatment. For children below the age of older than 1 year, both lactulose and polyethylene glycol (PEG) with or without electrolytes can be used as first-choice treatment. According to the National Institute for Health and Clinical Excellence guideline, PEG plus electrolytes is the first-choice treatment for all ages. Conclusion: Children with functional constipation should be diagnosed and treated according to recently developed evidence-based guidelines.
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The clinical effect of a new infant formula in term infants with constipation: a double-blind, randomized cross-over trial
Nutrition Journal, 2007Co-Authors: Marloes E J Bongers, Fleur De Lorijn, J A J M Taminiau, Michael Groeneweg, Johannes B Reitsma, Marc A. BenningaAbstract:BackgroundNutrilon Omneo (new formula; NF) contains high concentration of sn-2 palmitic acid, a mixture of prebiotic oligosaccharides and partially hydrolyzed whey protein. It is hypothesized that NF positively affects stool characteristics in constipated infants.MethodsThirty-eight constipated infants, aged 3–20 weeks, were included and randomized to NF (n = 20) or a standard formula (SF; n = 18) in period 1 and crossed-over after 3 weeks to treatment period 2. Constipation was defined by at least one of the following symptoms: 1) Defecation frequency < 3/week; 2) Painful Defecation; 3) abdominal or rectal palpable mass.ResultsPeriod 1 was completed by 35 infants. A significant increase in Defecation frequency (NF: 3.5 pre versus 5.6/week post treatment; SF 3.6 pre versus 4.9/week post treatment) was found in both groups, but was not significantly different between the two formulas (p = 0.36). Improvement of hard stool consistency to soft stool consistency was found more often with NF than SF, but did not reach statistical significance (90% versus 50%; RR, 1.8; 95% CI, 0.9–3.5; p = 0.14). No difference was found in Painful Defecation or the presence of an abdominal or rectal mass between the two groups. Twenty-four infants completed period 2. Only stool consistency was significantly different between the two formulas (17% had soft stools on NF and hard stools on SF; no infants had soft stools on SF and hard stools on NF, McNemar test p = 0.046).ConclusionThe addition of a high concentration sn-2 palmitic acid, prebiotic oligosaccharides and partially hydrolyzed whey protein resulted in a strong tendency of softer stools in constipated infants, but not in a difference in Defecation frequency. Formula transition to NF may be considered as treatment in constipated infants with hard stools.
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functional urinary and fecal incontinence in neurologically normal children symptoms of one functional elimination disorder
BJUI, 2007Co-Authors: An Bael, Marc A. Benninga, Hildegard Lax, Hannsjorg Bachmann, Ellen Janhsen, Tom P V M De Jong, Marianne A W Vijverberg, Jan D Van GoolAbstract:Authors from Belgium, the Netherlands and Germany tried to clarify the relationship between disordered Defecation and non-neuropathic bladder-sphincter dysfunction; they found few arguments for a casual relationship between these conditions. OBJECTIVE To clarify the relationship between disordered Defecation and non-neuropathic bladder-sphincter dysfunction (NNBSD) by comparing the prevalence of symptoms of disordered Defecation in children with NNBSD before and after treatment for urinary incontinence (UI), and assessing the effect of such symptoms on the cure rate for UI. PATIENTS AND METHODS In the European Bladder Dysfunction Study, a prospective multicentre study comparing treatment plans for children with NNBSD, 202 children completed questionnaires on voiding and on Defecation, at entry and after treatment for UI. Four symptoms of disordered Defecation were evaluated; low Defecation frequency, Painful Defecation, fecal soiling, and encopresis. RESULTS At entry, 17 of the 179 children with complete data sets had low Defecation frequency and/or Painful Defecation (9%), classified as functional constipation (FC). Of the 179 children, 57 had either isolated fecal soiling or soiling with encopresis (32%), classified as functional fecal incontinence (FFI). After treatment for UI, FFI decreased to 38/179 (21%) (statistically significant, P = 0.035); for FC there were too few children for analysis. After treatment for UI, 19 of the 179 children (11%) reported de novo FFI. Symptoms of disordered Defecation did not influence the cure rate of treatment for UI. CONCLUSIONS FFI improved significantly after treatment for UI only, but not in relation to the outcome of such treatment. FFI did not influence the cure rate for UI. There was little to support a causal relation between disordered Defecation and NNBDS (‘functional elimination syndrome’).
Zohoor Alireza - One of the best experts on this subject based on the ideXlab platform.
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botulinum toxin injection versus internal anal sphincterotomy for the treatment of chronic anal fissure
Annals of Saudi Medicine, 2005Co-Authors: Baghaiwadji Massoud, Vahedian Mehrdad, Tolooie Baharak, Zohoor AlirezaAbstract:BACKGROUND: Anal fissure is a chronic condition characterized by Painful Defecation and rectal bleeding. The aim of this study was to compare injection of botulinum toxin versus surgical sphincterotomy for treatment of chronic anal fissure. PATIENTS AND METHODS: In a quasi-experimental trial in a university hospital in Kerman, 50 patients diagnosed with chronic anal fissure received 20 units botulinum toxin (n=25) or underwent lateral internal sphincterotomy (n=25). All patients were evaluated for pain, bleeding and healing of the fissure from one to six months later by another surgeon. The data was analyzed by SPSS software with the Mann-Whitney and Fisher’s exact tests. RESULTS: One month after treatment, the rate of healing and bleeding in the operation group was better than in the toxin group (P<0.05), while pain was equal. After two months, none of the patients in either group had complications. After six months follow-up, bleeding, pain and healing were better in the operation group. CONCLUSION: In the clinical evaluation, botulinum toxin is an effective alternative nonsurgical modality for the treatment of chronic anal fissure. We recommend botulinum toxin as the first step in treatment because of the 60% chance of cure with an easily performed treatment.
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Botulinum toxin injection versus internal anal sphincterotomy for the treatment of chronic anal fissure.
Annals of Saudi Medicine, 2005Co-Authors: Baghaiwadji Massoud, Vahedian Mehrdad, Tolooie Baharak, Zohoor AlirezaAbstract:BACKGROUND: Anal fissure is a chronic condition characterized by Painful Defecation and rectal bleeding. The aim of this study was to compare injection of botulinum toxin versus surgical sphincterotomy for treatment of chronic anal fissure. PATIENTS AND METHODS: In a quasi-experimental trial in a university hospital in Kerman, 50 patients diagnosed with chronic anal fissure received 20 units botulinum toxin (n=25) or underwent lateral internal sphincterotomy (n=25). All patients were evaluated for pain, bleeding and healing of the fissure from one to six months later by another surgeon. The data was analyzed by SPSS software with the Mann-Whitney and Fisher’s exact tests. RESULTS: One month after treatment, the rate of healing and bleeding in the operation group was better than in the toxin group (P
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botulinum toxin injection versus internal anal sphincterotomy for the treatment of chronic anal fissure
Annals of Saudi Medicine, 2005Co-Authors: Baghaiwadji Massoud, Vahedian Mehrdad, Tolooie Baharak, Zohoor AlirezaAbstract:BACKGROUND: Anal fissure is a chronic condition characterized by Painful Defecation and rectal bleeding. The aim of this study was to compare injection of botulinum toxin versus surgical sphincterotomy for treatment of chronic anal fissure. PATIENTS AND METHODS: In a quasi-experimental trial in a university hospital in Kerman, 50 patients diagnosed with chronic anal fissure received 20 units botulinum toxin (n=25) or underwent lateral internal sphincterotomy (n=25). All patients were evaluated for pain, bleeding and healing of the fissure from one to six months later by another surgeon. The data was analyzed by SPSS software with the Mann-Whitney and Fisher’s exact tests. RESULTS: One month after treatment, the rate of healing and bleeding in the operation group was better than in the toxin group (P<0.05), while pain was equal. After two months, none of the patients in either group had complications. After six months follow-up, bleeding, pain and healing were better in the operation group. CONCLUSION: In the clinical evaluation, botulinum toxin is an effective alternative nonsurgical modality for the treatment of chronic anal fissure. We recommend botulinum toxin as the first step in treatment because of the 60% chance of cure with an easily performed treatment.
Mohammad Mahdi Parvizi - One of the best experts on this subject based on the ideXlab platform.
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A randomized clinical trial on treatment of chronic constipation by traditional persian medicine recommendations compared to allopathic medicine: A pilot study
Wolters Kluwer Medknow Publications, 2017Co-Authors: Mohammad Reza Fattahi, Seyed Morteza Emami Alorizi, Majid Nimrouzi, Mohammad M Zarshenas, Mohammad Mahdi ParviziAbstract:Background: The aim of this study was to compare the efficacy and side effects of lactulose plus traditional Persian medicine with only lactulose on the functional chronic constipation. Methods: Participants included 20 patients (10 in each group) aged 18–80 years, with major inclusion criteria of ROME III. They were assigned into two parallel therapeutic groups, including the intervention group (lactulose plus traditional Persian medicine [TPM] advices) and control group (only lactulose) through a block randomization. Weekly follow-up was done for 1 month for both groups. Results: After the intervention, the frequency of bowel habit increased significantly in patients of both groups (P = 0.001), and the frequency of hard stool Defecation, sensation of Painful Defecation, sensation of incomplete evacuation, sensation of anorectal obstruction, and manual maneuver for evacuation were decreased significantly in patients of both groups (P < 0.001 for all comparisons and 0.025 for manual maneuver). However, the only significant difference between the two groups was more reduction in the sensation of Painful Defecation in the lactulose group versus lactulose plus TPM advices (P = 0.014). Conclusions: Based on the pilot study, no significant difference was shown between TPM with lactulose and lactulose only in the management of chronic functional constipation. However, the easy recommendations of TPM can be useful in improving chronic constipation
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a randomized clinical trial on treatment of chronic constipation by traditional persian medicine recommendations compared to allopathic medicine a pilot study
International Journal of Preventive Medicine, 2017Co-Authors: Mohammad Reza Fattahi, Seyed Morteza Emami Alorizi, Majid Nimrouzi, Mohammad M Zarshenas, Mohammad Mahdi ParviziAbstract:Background: The aim of this study was to compare the efficacy and side effects of lactulose plus traditional Persian medicine with only lactulose on the functional chronic constipation. Methods: Participants included 20 patients (10 in each group) aged 18–80 years, with major inclusion criteria of ROME III. They were assigned into two parallel therapeutic groups, including the intervention group (lactulose plus traditional Persian medicine [TPM] advices) and control group (only lactulose) through a block randomization. Weekly follow-up was done for 1 month for both groups. Results: After the intervention, the frequency of bowel habit increased significantly in patients of both groups (P = 0.001), and the frequency of hard stool Defecation, sensation of Painful Defecation, sensation of incomplete evacuation, sensation of anorectal obstruction, and manual maneuver for evacuation were decreased significantly in patients of both groups (P
