Our findings strongly suggest that endometriosis involving the bladder might disturb storage function, whereas endometriosis in the parametrium disturbs the voiding phase.
We report the case of a 29‐year‐old woman with deep infiltrating endometriosis who underwent robotic nerve‐sparing surgery for resection of all visible lesions infiltrating pelvic and extrapelvic sites. Painful symptoms included severe dysmenorrhea, menstrual dyschezia and stranguria, with no improvement in response to hormonal treatment. The location on physical examination of a painful retrocervical nodule was identified by magnetic resonance imaging to be infiltrating the right parametrium/paracervix. During surgery, this nodule was recognized as an important retrocervical/rectovaginal lesion infiltrating the pelvic floor (i.e. levator ani and coccygeus), and was histopathologically confirmed as endometriosis infiltrating the skeletal pelvic floor muscles. A Pubmed search of the MEDLINE database in March (2019) found no publication reporting histopathologic confirmation of endometriosis infiltrating the pelvic floor muscles.
Aim: Glioblastoma multiforme (GBM), the most common and lethal primary brain tumor in adults, inevitably recurs despite standard of care, consisting of surgical resection, radiotherapy (RT), and alkylating temozolomide (TMZ). High content of the repair enzyme MGMT (O 6 -methylguanine-DNA methyltransferase) contributes to drug resistance and tumor recurrence. The monoterpene perillyl alcohol (POH) induces apoptosis and cytotoxicity of TMZ-resistant and TMZ-sensitive glioma cells independently of MGMT expression. Case presentation: We report the case of an adult patient with non-resected inoperable recurrent GBM that was successfully treated with POH inhalation in combination with oral TMZ, after failing to respond to standard treatment. A 51-year-old white woman with a sudden, intense and refractory headache with no underlying cause showed brain image (MRI) with diffusely infiltrating lesion, prominent edema, and marked mass effect with midline shift, consistent with inoperable high-grade malignant glioma in the right temporal lobe. A complex histological feature, characterized by ischemic necrosis and glomeruloid microvascular proliferation, confirmed the diagnosis of malignant glioma. Immunohistochemical evaluation showed marked EGFR (epidermal growth factor receptor) staining; active proliferative status was confirmed by high Ki67 and p21 expression; there was strong p53 tumor suppressor labeling but faint cytoplasmic PTEN staining; expression of MLH1 and MSH6, two proteins associated with mismatch DNA repair and resistance to TMZ, was elevated. Indeed, 6 months after onset and despite specific treatment (RT+TMZ), this patient had tumor recurrence at same site. She developed adverse reactions including thrombocytopenia and resistance to alkylating TMZ, and was indicated for palliative treatment. The patient was then enrolled (December 2012) in the clinical trial for treatment with POH inhalation concomitant with 300 mg TMZ oral schedule during 5 days. MRI scans performed 3, 7, 12 and 24 months later (December 2012 to December 2014) revealed marked reduction of enhancing lesion without further recurrences. Conclusion: Despite increased expression of DNA repair proteins supporting drug resistance, combined POH+TMZ therapy reduced tumor mass, halted tumor recurrence, and increased patient's survival. This case highlights the therapeutic efficacy of combined POH intranasal administration with systemic TMZ in a patient with non-resected inoperable GBM, who failed prior therapy and was under supportive treatment.
38Infertility has been a common postoperative problem caused by peritoneal adhesions. Since several 39 prophylactic agents have recently shown promising preliminary results, more complete studies comparing 40 their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe 41 practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 42 healthy 5½ months old female pigs (24.3 -31.3 Kg) underwent a standardized laparoscopy to provoke 43 peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was 44 performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions 45 at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very 46 strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of 47 the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were 48 compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples 49 were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were 50 small (but significant) changes in serum albumin (P=0.07), globulin (P=0.07), C-reactive protein 51 (P=0.011), fibrinogen (P=0.023) and bilirubin (P<0.01) after 30 days, but all values were within the normal 52 range. No inflammation or abscess formation was observed, but different degrees of adhesion were 53 identified. The estimated occurrence of adhesion (scores >0) and of strong / very strong adhesion (scores 54 >1) was 75% (95% CI: 55 -94.9) and 65% (95% CI: 45 -85), respectively. The porcine model represents 55 a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents 56 intended to prevent postoperative peritubal adhesions formation. We present several practical 57 considerations and measures that can help to minimize animal suffering and avoid problems during such 58 experiments. 59 60 61 62 63 3 64 128 Suprema; Protocol Number 004/2017). Besides the health certificate issued by a veterinarian provided by 129 the supplier (Fazenda Penalva, Juiz de Fora, MG), the veterinarian responsible for the study (F.L.F.M.) 130 clinically evaluated all the animals before and during this study.
132In order to optimize the sample size, we considered as realistic an experimental model in which 133 adhesion formation would occur in 90% rather than all of the animals [10,18,19,20]. Assuming a 20%
Funding: This study was supported by DMC Importação e Exportação de Equipamentos Ltda which provided advanced medical devices and equipment for surgical procedures through its product development centers and manufacturing facilities in São Carlos-SP, Brazil, and by Instituto Crispi de Cirurgias Minimamente Invasivas (Rio de and measures that can help to minimize animal suffering and avoid problems during such experiments.
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