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 Posted: Wed Jun 14, 2006 12:28 pm
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Posted: Wed Jun 14, 2006 12:29 pm
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Posted: Wed Jun 14, 2006 12:32 pm
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Endometriosis Information
Taken from: http://en.wikipedia.org/wiki/Endometriosis
Endometriosis is a common medical condition where the tissue lining the uterus (the endometrium, from endo, "inside", and metrium, "mother") is found outside of the uterus, typically affecting other organs in the pelvis. The condition can lead to serious health problems, primarily pain and infertility. Endometriosis primarily develops in women of the reproductive age.
Symptoms
A major symptom of endometriosis is pain, mostly in the lower abdomen, lower back, and pelvic area. The amount of pain a woman feels is not necessarily related to the extent of endometriosis. Some women will have little or no pain despite having extensive endometriosis affecting large areas or endometriosis with scarring. On the other hand, women may have severe pain even though they have only a few small areas of endometriosis.
Symptoms of endometriosis can include (but are not limited to):
- Painful, sometimes disabling menstrual cramps (dysmenorrhea); pain may get worse over time (progressive pain)
- Chronic pain (typically lower back pain and pelvic pain, also abdominal)
- Painful intercourse (dyspareunia)
- Painful bowel movements or painful urination (dysuria)
- Heavy menstrual periods (menorrhagia)
- Premenstrual or intermenstrual spotting (bleeding between periods)
- Infertile Women present with endometriosis may lead to fallopian tube obstruction despite no history of "endometriotic type" pain.
In addition, women who are diagnosed with endometriosis may have gastrointestinal symptoms that may mimic irritable bowel syndrome, as well as fatigue.
Epidemiology
Endometriosis can affect any woman of reproductive age, from menarche (the first period) to menopause, regardless of her race, ethnicity, whether or not she has children or her socio-economic status. Most patients with endometriosis are in their 20s and 30s. Rarely, endometriosis persists after menopause; sometimes, hormones taken for menopausal symptoms may cause the symptoms of endometriosis to continue.
Current estimates place the number of women with endometriosis between 2 percent and 10 percent of women of reproductive age. About 30 percent to 40 percent of women with endometriosis are subfertile. Some women do not find out that they have endometriosis until they have trouble getting pregnant. While the presence of extensive endometriosis distorts pelvic anatomy and thus explains infertility, the relationship between early or mild endometriosis and infertility is less clear. The relationship between endometriosis and infertility is an active area of research.
Anecdotally, endometriosis has been observed in men taking high doses of estrogens for prostate cancer.
Patients who rupture an endometriotic cyst may present with an acute abdomen as a medical emergency.
Extent
Early endometriosis typically occurs on the surfaces of organs in the pelvic and intraabdominal areas. Health care providers may call areas of endometriosis by different names, such as implants, lesions, or nodules. Larger lesions may be seen within the ovaries as endometriomas or chocolate cysts (They are termed chocolate because they contain a thick brownish fluid, mostly old blood). Endometriosis may trigger inflammatory responses leading to scar formation and adhesions. Most endometriosis is found on structures in the pelvic cavity:
- Ovaries
- Fallopian tubes
- The back of the uterus and the posterior culdesac
- The front of the uterus and the anterior culedesac
- Uterine ligaments such as the broad or round ligament of the uterus
- Intestines
- Urinary bladder
Endometriosis may spread to the cervix and v****a or to sites of a surgical abdominal incision. In extremely rare cases, endometriosis areas can grow in the lungs or other parts of the body.
Surgically endometriosis can be staged I-IV ( Revised Classification of the American Society of Reproductive Medicine).
Causes
While the exact cause of endometriosis remains unknown, many theories have been presented to explain its development. These concepts do not necessarily exclude each other.
1) Endometriosis is an estrogen-dependent condition, as it is seen during the reproductive years and generally disappears after menopause. In experimental models, estrogen is necessary to induce or maintain endometriosis. Medical therapy is often aimed at lowering estrogen levels to control the disease.
2) "Retrograde menstruation", by which some of the menstrual debris of her period flows into her pelvis, may play an important role (John A. Sampson). While most women may have some retrograde menstrual flow, typically their immune system is able to clear the debris and prevents implantation and growth of cells from this occurrence. However, in some patients, endometrial tissue transplanted by retrograde menstruation is able to implant and establish itself as endometriosis. Factors that might cause the tissue to grow in some women, but not in others, need to be elucidated, and some of the possible causes below may provide some explanation, i.e. hereditary factors, toxins, or a compromised immune system. It can be argued that the uninterrupted occurrence of regular menstruation over decades month after month is a modern phenomenon, as in the past women had more frequently menstrual rest due to pregnancy or lactation.
3) A competing theory suggests that endometriosis does not represent transplanted endometrium but starts de novo from local stem cells. This process has been referred to as coelomic metaplasia. Triggers of various kind (including menses, toxins, or immune factors) may be necessary to start this process.
4) Hereditary factors play a role. It is well recognized that daughters or sisters of patients with endometriosis are at higher risk to develop endometriosis themselves. A recent study (2005) published in the American Journal of Human Genetics found a link between endometriosis and chromosome 10q26.[1]
5) It is accepted that in specific patients endometriosis can spread directly. Thus endometriosis has been found in abdominal incisional scars after surgery for endometriosis.
6) On rare occasions endometriosis may be transplanted by blood or by the lymphatic system into peripheral organs (i.e. lungs, brain).
7) Recent research is focusing on the immune system that may not be able to cope with the cyclic onslaught of retrograde menstrual fluid. In this context there is interest to study relationship to autoimmune disease, allergy reactions, and the impact of toxins.
Another area of research is the search for endometriosis markers. These markers are substances made by or in response to endometriosis that health care providers can measure in the blood or urine. If markers are found, health care providers could diagnose endometriosis by testing a woman's blood or urine, which might reduce the need for surgery. CA 125 is known to be elevated in many patients with endometriosis, but not specifically indicative of endometriosis.
Diagnosis
A history and a physical examination can in many patients lead the physician to suspect the diagnosis.
Use of imaging tests may identify larger endometriotic areas, such as nodules or endometriotic cysts. The two most common imaging tests are ultrasound and magnetic resonance imaging (MRI). Normal results on these tests do not eliminate the possibility of endometriosis - areas of endometriosis are often too small to be seen by these tests.
The only sure way to confirm an endometriosis diagnosis is by laparoscopy, or keyhole surgery. The diagnosis is based on the characteristic appearance of the disease, if necessary corroborated by a biopsy. Laparoscopy also allows for surgical treatment of endometriosis.
Generally endometriosis-directed drug therapy (other than the oral contraceptive pill) is utilized after a confirmed surgical diagnosis of endometriosis.
Cause of pain
How endometriosis causes pain is the topic of much research. Because many women with endometriosis feel pain during or related to their periods, and may spill further menstrual flow into the pelvis with each menstruation, some researchers are trying to reduce menstrual events in patients with endometriosis.
Endometriosic tissue reacts to hormonal stimulation and may "bleed" at time of menstruation. It accumulates locally, causes swelling, and triggers inflammatory responses with activation of cytokines. It is thought that this process may lead to pain perception.
Treatments
Currently, there is no cure for endometriosis although in most patients menopause (natural or surgical) will abate the process. Nevertheless, a hysterectomy or removal of the ovaries will not guarantee that the endometriosis areas and/or the symptoms of endometriosis will not come back. However, endometriosis can be effectively managed in a large majority of patients. Conservative treatments try to address usually pain or infertility issues.
The treatments for endometriosis pain include:
1) NSAIDs and other pain medication: They often work quite well as they not only reduce pain but also menstrual flow. They are commonly used in conjunction with other therapy. For more severe cases narcotic prescription drugs may have to be used.
2) Hormone suppression therapy: This approach tries to reduce or eliminate menstrual flow and estrogen support. Typically, it needs to be done for several months or even years.
-- Progesterone or Progestins: Progesterone counteracts estrogen and inhibits the growth of the endometrium. Such therapy can reduce or eliminate menstruation in a controlled and reversible fashion. Progestins are chemical variants of natural progesterone.
-- Avoiding products with xenoestrogens, which have a similar effect to naturally produced estrogen and can increase growth of the endometrium.
-- Continuous birth control pills consists of the use of birth control pills without the use of placebo pills. This eliminates monthly bleeding episodes.
-- Danocrine is a suppressive steroid with some androgenic activity. Oral -- Danocrine inhibits the growth of endometriosis but its use is limited as it may cause hirsutism. There has been some research done at Case Western Reserve University on a topical Danocrine, applied locally, which has not produced the hirsutism characteristics. The study has not yet been published in a medical journal.
-- Gonadotropin releasing hormone agonists (GnRH agonists) induce a profound hypoestrogenism by decreasing FSH and LH levels. While quite effective, they induce menopausal symptoms, and over time may lead to osteoporosis. To counteract such side effects some estrogen may have to be given back (add-back therapy).
3) Surgical treatment is usually a good choice if endometriosis is extensive, or very painful. Surgical treatments range from minor to major surgical procedures.
-- Laparoscopy is very useful not only to diagnose endometriosis, but to treat it. With the use of scissors, cautery, lasers, hydrodissection, or a sonic scalpel, endometriotic tissue can be ablated or removed in an attempt to restore normal anatomy.
-- Laparotomy can be used for more extensive surgery either in attempt to restore normal anatomy, or at least preserve reproductive potential, or, in severe cases, remove organs such as ovaries, tubes, and/or the uterus (hysterectomy). In extreme cases bowel surgery or surgery on the urinary tract may be necessary. For patients with extreme pain, a presacral neurectomy may be indicated where the nerves to the pelvis are cut.
4) A variety of alternative treatments are being used in patients with endometriosis, including acupuncture and nutrition.
Patients who are pregnant generally have less pain during pregnancy, and it is not unusual to have fewer symptoms after a pregnancy.
Infertility treatments
In-vitro fertilization (IVF) procedures are effective in improving fertility in many women with endometriosis. IVF makes it possible to combine sperm and eggs in a laboratory and then place the resulting embryos into the woman's uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.
Laparoscopy to remove or vaporize the growths in women who have mild or minimal endometriosis is also effective in improving fertility. Some studies show that surgery can double the pregnancy rate.
In patients with small amounts of endometriosis treatment with fertility medication (Clomiphene) may lead to success.
Relation to cancer
Endometriosis is not the same as endometrial cancer. Current research has not demonstrated an association between endometriosis and endometrial, cervical, uterine, or ovarian cancers. In very rare cases ( much less than one percent), endometriosis is seen with endometrioid cancer, but there is no evidence of a causative role between one and the other. Endometriosis often coexists with leiomyoma or adenomyosis.
External Links
- Endometriosis Association
- Government Publication on Endometriosis
- eMedicine Health
- Interview with Mary Lou Ballweg, President of the Endometriosis Association
~
And from Yi Min, some links:
*Opens her favorites and sets upon this thread a some more Linkage. ninja *
HealthyWomen.org
Endometriosis Association
Endo Facts
Endo Center - Has an Awesome Flash Presenation Explaining Endo.
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Posted: Wed Jun 14, 2006 12:34 pm
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Urinary Tract Infection (UTI) Information
Taken from: http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm
Alternative names
Bladder infection; Cystitis; UTI
Definition
A urinary tract infection, or UTI, is an infection that can happen anywhere along the urinary tract -- the kidneys, the ureters (the tubes that take urine from each kidney to the bladder), the bladder, or the urethra (the tube that empties urine from the bladder to the outside).
Causes, incidence, and risk factors
Cystitis, a common condition, is usually caused by a bacteria from the a**s entering the urethra and then the bladder. This leads to inflammation and infection in the lower urinary tract.
Certain people are more likely to get UTIs. Women tend to get them more often because their urethra is shorter and closer to the a**s. Elderly people (especially those in nursing homes) and people with diabetes also get more UTIs.
In addition, the following risk factors increase the chances of getting a UTI:
- Pregnancy and menopause
- Kidney Stones
- Sexual intercourse, especially if you have multiple partners or use a diaphragm for birth control
- Prostate inflammation or enlargement
- Narrowed urethra
- Immobility (for example, during recovery from a hip fracture)
- Not drinking enough fluids
- Bowel incontinence
- Catheterization
Some children develop UTIs. In boys, they are most common before the first birthday. UTIs are more common among uncircumcised boys. In young girls, UTIs are most common around age 3, overlapping with the toilet training period.
Cystitis in children can be promoted by abnormalities in the urinary tract. Therefore, children with cystitis, especially those under age 5, deserve special follow-up to prevent later kidney damage.
Symptoms
The symptoms of a UTI include:
- Pressure in the lower pelvis
- Pain or burning with urination
- Frequent or urgent need to urinate
- Need to urinate at night
- Cloudy urine
- Blood in the urine
- Foul or strong urine odor
Young children with UTIs may only have a fever, or even no symptoms at all.
Additional symptoms may include:
- Painful sexual intercourse
- p***s pain
- Flank (side) pain, vomiting, or fever and chills (may be a sign of kidney involvement)
- Mental changes or confusion (in the elderly, mental changes or confusion often are the only signs of a urinary tract infection; possible spread to the blood should be considered)
Signs and tests
Tests generally include taking a urine sample:
- A urinalysis commonly reveals white blood cells (WBC) or red blood cells (see also RBC - urine).
- A urine culture (clean catch) or catheterized urine specimen may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment.
TESTING IN CHILDREN
Because many children with cystitis have something abnormal about their anatomy that predispose them to infections, because these infections are usually preventable, and because the long-term consequences of repeated urinary tract infections in children can be quite serious, many children with cystitis need special imaging studies to determine why they got a urinary tract infection.
These studies usually include both an ultrasound of the kidneys and an x-ray taken during urination (called a voiding cystourethrogram or VCUG).
Most experts recommend this evaluation for:
- Girls over age 5 with 2 or more urinary tract infections
- All boys with their first urinary tract infection
- All children who have a fever along with their urinary tract infection
- All children under age 5 with their first urinary tract infection
Treatment
A mild case of cystitis may resolve on its own without treatment. Because of the risk of the infection spreading to the kidneys, however, antibiotics are usually recommended. It is important that you finish the entire course of prescribed antibiotics.
In children, cystitis should be treated promptly with antibiotics to protect their developing kidneys. In the elderly, prompt treatment is recommended due to the greater chances of fatal complications.
Commonly used antibiotics include:
- Nitrofurantoin
- Cephalosporins
- Sulfa drugs (sulfonamides)
- Amoxicillin
- Trimethoprim-sulfamethoxazole
- Doxycycline (should not be used under age cool
- Quinolones (should not be used in children)
Most non-elderly adult women only need 3 days of antibiotics. If the infection has spread to one of the kidneys, you may need hospitalization to receive hydration and antibiotics through a vein.
A chronic or recurrent UTI should be treated thoroughly because of the chance of kidney infection. Antibiotics may need to be given for a long period of time (as long as 6 months to 2 years), or stronger antibiotics may be needed than for single, uncomplicated episodes of cystitis.
Use of low-dose antibiotics on a daily basis may be recommended to prevent UTIs if you get frequent infections.
Phenazopyridine hydrochloride (pyridium) may be used to reduce the burning and urgency associated with cystitis. In addition, acidifying medications such a ascorbic acid may be recommended to decrease the concentration of bacteria in the urine.
If an anatomical abnormality is present, surgery to correct the problem may be recommended.
Expectations (prognosis)
Cystitis is uncomfortable, but usually responds well to treatment.
Complications
- Chronic or recurrent urinary tract infection -- defined as at least two infections in 6 months or at least three in 1 year
- Complicated UTI
- Kidney infection
Calling your health care provider
Call your doctor if you, or your child, have symptoms of a UTI. Call right away if there is fever or chills, back or side pain, or vomiting. These symptoms suggest a possible kidney infection.
Also call if:
- You have diabetes or are pregnant.
- There is discharge from the p***s or v****a.
- The p***s or v****a is painful, or sexual intercourse is painful.
- You suspect a child may have been sexually abused.
- There is blood or pus in the urine.
The symptoms come back a short time after treatment with antibiotics.
Prevention
- Keep your genital area clean.
- Wipe from front to back.
- Drink plenty of fluids.
- Urinate after sexual intercourse.
- Avoid fluids that irritate the bladder, like alcohol and caffeine.
- Drink cranberry juice, but NOT if you have a personal or family history of kidney stones.
- DO NOT douche or use similar feminine hygiene products.
- Wear cloth undergarments.
- If you are prone to UTIs, your doctor may recommend taking antibiotics more regularly to prevent infection.
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Posted: Wed Jun 14, 2006 12:35 pm
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Ovarian Cancer Information
Taken from: http://www.nlm.nih.gov/medlineplus/ency/article/000889.htm
Alternative names
Cancer - ovaries
Definition
Ovarian cancer is a malignant neoplasm (abnormal growth) located on the ovaries.
Causes, incidence, and risk factors
Ovarian cancer is fairly uncommon, yet it is the 5th leading cause of cancer death in women. It is also the leading cause of death from gynecologic cancers. The cause is unknown. The disease is more common in industrialized nations, with the exception of Japan. In the United States, the lifelong chance of developing ovarian cancer is 1 out of 40-60 women.
Older women are at highest risk. More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age. About 25% of ovarian cancer deaths occur in women between 35 and 54 years of age.
Ovarian cancer symptoms are often vague and non-specific, so women and their physicians frequently attribute them to more common conditions. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries.
Also, ovarian cancers shed cancer cells that often implant on the uterus, bladder, bowel, and lining of the bowel wall. These cells can begin forming new tumor growths before cancer is even suspected.
No cost-effective screening test for ovarian cancer exists, so more than 50% of women with ovarian cancer are diagnosed in the advanced stages of the disease.
The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovarian cancer. Early age at first pregnancy and the use of some oral contraceptive pills have also been shown to have a protective effect. In contrast, the use of fertility drugs may be associated with an increased chance of developing this cancer, although there is ongoing controversy over this.
Certain genes may also increase risk, including BRCA1 and BRCA2, which also increase breast cancer risk and the chances that a woman will be affected by either cancer at a younger age. Patients with a personal history of breast cancer, or a family history of breast or ovarian cancer, may have an elevated risk. A strong family history of uterine, colon, or other gastrointestinal cancers may indicate the presence of a syndrome known as hereditary non-polyposis colon cancer (HNPCC), which confers a higher risk for developing ovarian cancer.
Other factors that have been investigated, such as talc use, asbestos exposure, high dietary fat content, and childhood mumps infection, are controversial and have not been definitively proven.
Symptoms
- Sense of pelvic heaviness
- Vague lower abdominal discomfort
- Vaginal bleeding
- Weight gain or loss
- Abnormal menstrual cycles
- Unexplained back pain that worsens over time
- Increased abdominal girth
- Non-specific gastrointestinal symptoms:
- Increased gas
- Indigestion
- Lack of appetite
- Nausea and vomiting
- Inability to ingest usual volumes of food
- Bloating
- Additional symptoms that may be associated with this disease:
- Increased urinary frequency or urgency
- Excessive hair growth
There may be no symptoms until late in the disease.
Signs and tests
A physical examination may reveal increased abdominal girth and ascites (fluid within the abdominal cavity). A pelvic examination may reveal an ovarian or abdominal mass.
Tests include:
- CBC
- Blood chemistry
= CA125
- Quantitative serum HCG (blood pregnancy test)
- Alpha fetoprotein
- Urinalysis
- GI series
- Exploratory l aparotomy
- Ultrasound
- An abdominal CT scan or MRI of abdomen
Treatment
Surgery is the preferred treatment and is frequently necessary for diagnosis. Studies have shown that surgery performed by a specialist in gynecologic oncology results in a higher rate of cure. Chemotherapy is used as after surgery to treat any residual disease. Chemotherapy can also be used to treat women who have a recurrence. Radiation therapy is rarely used in ovarian cancer in the United States.
Support Groups
For additional information and resources, cancer support group.
(http://www.nlm.nih.gov/medlineplus/ency/article/002166.htm)
Expectations (prognosis)
Ovarian cancer is rarely diagnosed in its early stages. It is usually quite advanced by the time diagnosis is made. The outcome is often poor. The 5-year survival rate for all stages is only 35% to 38%. If, however, diagnosis is made early in the disease, 5-year survival rates can reach 90% to 98%.
Complications
- Metastasis spread of the cancer to other organs
- Progressive function loss of various organs
- Ascites (fluid in the abdomen)
- Blockage of the intestines
Calling your health care provider
Call for an appointment with your health care provider if you are a woman over 40 years old who has not recently had a Pap smear and pelvic examination (routine Pap smears and pelvic examinations are recommended for all women over 20 years old).
Call for an appointment with your provider if symptoms appear which may be associated with this disease.
Prevention
Having regular pelvic examinations may decrease the overall risk. However, no definitive prevention strategy is known. Screening tests for ovarian cancer remains a very active research area.
Studies have shown that there may be a lower risk of ovarian cancer in patients who have used the oral contraceptive pill, although certain types are of more benefit than others. Recent research has shown that for women with mutation in BRCA1 and BRCA2 (the genes that are related to the breast-ovarian cancer syndrome), surgery to remove the ovaries can dramatically reduce the risk of developing ovarian cancer.
~
Other Helpful Links
- http://www.acor.org/Cancerlist/ovarian.html
- http://cdmrp.army.mil/ocrp/default.htm
- http://www.meds.com/cancerlinks.html
- http://news.bbc.co.uk/1/hi/health/medical_notes/c-d/629665.stm
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