UMLS:C0016382 - FACTA Search

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Query: UMLS:C0016382 (flushing)
6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Royal Army Medical Corps (RAMC) of the UK is considering offering women in the Army the option of inducing amenorrhea especially those in war. Logistics problems of supplying sufficient sanitary protection makes inducing amenorrhea in these women an advantage. It is important that the Royal Army not force servicewomen ready for war to agree to chemical induction of amenorrhea, however. A survey of civilian women shows that 80% liked the notion of eliminating menstruation. continuous combined oral contraceptive (COC) therapy induces amenorrhea, but it poses some side effects including bleeding and spotting, 2 kg weight gain, breast tenderness, depression, and headaches. 12 weeks of COC therapy costs range form 2 to 6 pounds. The synthetic androgen used to treat endometriosis, danazol, may also induce amenorrhea at daily doses of 800 mg. It causes various side effects including reduced breast size, flushing, sweating, loss of libido, acne, weight gain, edema, hirsutism, and voice change. 12-week danazol therapy costs about 200 pounds. Another drug with androgenic, antigonadotrophic, antiestrogenic, and antiprogestogenic properties which is also used to treat endometriosis, gestrinone, in another possible amenorrhea inducer at 2 doses of 2.5-5 mg/week. Side effects are similar to those of danazol. In 1 study, all 20 patients developed acne and seborrhea. Its 12 week costs are considerably more than danazol and COC therapy (450 pounds). Intermittent administration of 2 gonadotropin releasing hormone (GnRH) analogues, buserelin and goserelin, suppresses production of gonadotropins. Health workers need to inject 3.6 mg goserelin every 28 days while they administer buserelin subcutaneously or intranasally. the leading side effect on both GnRH analogues is not flushes. 12-week therapy is about 375 pounds. Fertility is restored after discontinuation of all the aforementioned therapies. The GnRH analogue goserelin is the most effective therapy, but the cost factor causes the Royal Army to favor COCs.
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PMID:The induction of amenorrhoea. 153 75

Cellular elements from the mucous membrane of the uterus and oviducts and from peritoneal washings were cultured. The in vitro behavior of these cells was compared to elucidate the histogenesis of endometriosis and the role of various diagnostic procedures. In 65% of the cultured material obtained by uterine-tubal flushing, proliferating cells of the uterine-tubal mucous membrane were present. Their morphology and behavior corresponded to those of cultured cells obtained by separate washing of the uterine cavity and the tubes, respectively, curetted material, and biopsies of endometriosis lesions. Epithelial and stromal cells were identified using phase contrast microscopy, electron microscopy, and immunohistochemical methods. These cell types did not occur in peritoneal washings before the flushing of uterus and tubes. It was therefore assumed that they were detached and transported to the pelvic cavity during the above-mentioned procedures. In view of their intensive proliferation they may form the basis in the development of nodules of endometriosis. This would support the implantation theory concerning the pathogenesis of endometriosis. Interactions between epithelial and mesothelial cells point to the possible role of the latter in encapsulating the endometrial elements.
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PMID:Cell of the mucous membrane of the female genital tract in culture: a comparative study with regard to the histogenesis of endometriosis. 354 50

In 77 of 115 cultures from uterine/tubal flushes performed in women undergoing diagnostic laparoscopy for reasons of infertility, epithelioid colonies of "tadpole-like" cells appeared. In cultured jet washings from the uterine cavities in women with ligated tubes, the same tadpole-like cells are present. These cells are also observed in vitro in laparoscopic biopsy specimens of active endometriosis nodules. Judged by the presence of cytokeratin in these cells, demonstrated by polyvalent or monoclonal antikeratin antibodies (the latter as a marker for glandular epithelia), there can be no doubt about their origin from the lining and glandular epithelium of part of the genital tract. Peritoneal washings not preceded by uterine/tubal flushing never contained the tadpole-like cells in culture. True epithelial cells were observed in the peritoneal cavity after flushing, and the proliferative capacity of these cells in vitro during the preovulatory phase was proven.
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PMID:Behavior of cultured glandular cells obtained by flushing of the uterine cavity. 389 26

A series of 74 patients with endoscopically proven endometriosis were selected for evaluation of usefulness of peritoneal flushing and aspiration in the early diagnosis of pelvic endometriosis. Forty-three patients had either an ovarian or a peritoneal biopsy performed after peritoneal lavage. The results indicate that 25% of the washings performed were successful in demonstrating endometrial glands or stroma. On the other hand, 72% of the patients on whom biopsies were performed showed endometrial tissue, and biopsy failures were mainly related to the technical difficulties of the ovarian biopsy. In 46% of the histologically proven cases of endometriosis, peritoneal lavage failed to demonstrate endometrial tissue. Conversely, in 4.6% of the negative biopsy cases, peritoneal lavage showed endometrial glands. We conclude that exfoliative cytology is not a useful tool in the diagnosis of endometriosis. On the other hand, we were able to make the diagnosis by biopsy in more than 70% of the patients on whom biopsies were performed.
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PMID:Peritoneal flushing and biopsy in laparoscopically diagnosed endometriosis. 621 65

Gonadotropin-releasing hormone (GnRH) agonists are widely administered to treat endometriosis, but generally are not prescribed for more than 6 months since they are associated with vasomotor symptoms and bone loss. A GnRH agonist and steroid add-back therapy can be given for longer times without flare-up or significant hypoestrogenic symptoms. We examined the efficacy and safety of a weak estrogenic steroid, OD14, with prolonged goserelin treatment in seven regularly menstruating women (age 26-33 yrs) with laparoscopically diagnosed, symptomatic endometriosis. The women received goserelin 3.65 mg subcutaneously/month and 2.5 mg OD14 2.5 mg/day beginning in the fourth cycle for 18 to 20 months. The frequency and severity of hot flushes, sweating, irritability, loss of libido, nervousness, and sleeplessness were scored by the women on a scale of 0 to 6 and compared. Samples of blood and urine were obtained to measure serum estradiol (E2) levels, lipids, and urinary calcium:creatinine (Ca:Cr) ratios at the start of treatment and monthly thereafter. The vasomotor scores, serum E2 levels, and urine Ca:Cr ratios were consistent with the hypoestrogenism induced by goserelin (24.2 ± 3.1, 18.5 ± 7.2 pg/ml, and 0.063 ± 0.008, respectively). The decreases in vasomotor scoring with regard to hot flushing, sweating, and urinary Ca:Cr ratios were significant after adding OD14 (14.8 ± 2.2, 0.031 ± 0.005, p <0.05), whereas E2 levels remained below 40 pg/ml (23.1 ± 8.2 pg/ml, p >0.05) throughout therapy. The increased low-density:high-density lipoprotein ratio with goserelin improved with OD14, remaining at the lower limit of normal. Thus, OD14 add-back to GnRH agonist therapy enabled us to extend medical therapy of endometriosis longer than 6 months, preventing hypoestrogenic side effects, and with adequate suppression endometriosis symptoms.
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PMID:Effectiveness and Long-Term Safety of Prolonged Gosereline and Tibolone in Women with Endometriosis 907 53

There has been speculation for decades regarding the role of flushing women's fallopian tubes in improving the chance of pregnancy. More recent evidence has highlighted a possible specific role for lipiodol (ethiodized oil), an oil-soluble contrast medium, in the enhancement of fertility by these means. This systematic review was designed to assess the effectiveness of tubal flushing with various contrast media in improving the chance of pregnancy. The review was performed using Cochrane guidelines, including only data from randomized controlled trials. Results confirm the effectiveness of flushing with lipiodol in improving the chance of pregnancy and live birth. Although there was limited evidence to suggest a possible benefit of oil- over water-soluble contrast media, the answer to this question remains unclear. The specific groups who appear to benefit most from lipiodol flushing are couples with unexplained infertility, but particularly couples where the woman has endometriosis in the context of normal patent fallopian tubes. As a simple, low-cost, minimally invasive intervention that carries a low risk of complications and no increased risk of multiple pregnancy, lipiodol flushing may prove an appealing alternative to established fertility treatments for many couples.
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PMID:A review of the use of lipiodol flushing for unexplained infertility. 1605 40

Endometriosis is an estrogen-dependent gynaecological disease associated with pain and infertility, which occurs in humans and menstruating primates. In this study, the marmoset monkey (Callithrix jacchus), which is a non-menstruating primate with high circulating estrogen levels, was used to test firstly the hypothesis that endometriosis is based on uterine shedding into the peritoneal cavity, secondly to study the pathogenesis of endometriosis due to its estrogenic situation. Female marmoset monkeys (n = 29) were exposed to two different experimental procedures (non-invasive versus invasive) for intrapelvic placement of endometrial cells by uterine flushing over an experimental period of 2-3 years. First endometriotic foci were detected by colour Doppler ultrasound at the bladder, the uterus and the ovaries at the earliest after 4 months of either treatments. However, invasive induction was more effective in terms of the time-course of induction and the number of resulting endometriotic foci. The analysis of the endometriotic foci by histology, immunohistochemistry and molecular techniques allowed a division into two distinct groups: an initial developing stage occurred, which under further treatment led to the second stage of established endometriosis. Both procedures showed a treatment-dependent increase of vascular supply to the endometriotic foci over the experimental period. The invasive method induced the final established stage of endometriosis more rapidly, with the expression of steroid receptors, aromatase, 17betaHSD1 and CD10. Altogether, 72% of the treated marmoset monkeys developed endometriosis under our endometrial reflux protocols. Our data support the theory that endometriosis can be induced artificially in a non-menstruating primate (C. jacchus) by endometrial shedding into the peritoneal cavity. Because the marmoset is a primate with very high peripheral estrogen levels, this offers an interesting model for studying the pathogenesis of this estrogen-dependent disease, as well as for therapeutic impacts on enzymes involved in steroid metabolism.
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PMID:Induction of endometriosis in the marmoset monkey (Callithrix jacchus). 1660 6

Treatment of endometriosis usually requires highly individualized management and varies depending on the presenting symptoms and the life stage of the patient. Surgical treatment of endometriosis starts with clinical recognition of the condition that may be enhanced by narrow band imaging. Surgery is effective in pain control and enhancing fertility. Tubal ligation or salpingectomy can be considered. Robotic surgery is unlikely to create a cure, but may assist surgery. Medical treatment including aromatase inhibitors may also be effective. Tubal flushing with lipiodol increases fecundity; other immunomodulators and neuromodulators may also be effective. Complementary therapies, however, have not been subjected to randomized clinical trials. Environmental factors, diet, and lifestyle modification may be effective.
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PMID:Potential cures for endometriosis. 2140 32

A lipiodol hysterosalpingogram was the routine test for tubal patency as recently as the 1970s. Observational studies, then randomised controlled trials, provided evidence of a fertility enhancing effect of lipiodol. It has been found to improve fertility for women with normal tubal patency, particularly where the woman has a history of endometriosis. Previous successful treatment for infertility with lipiodol is a marker of further successful treatment for infertility in a repeat procedure. Whilst lipiodol is probably effective at flushing debris that could hinder fertility from fallopian tubes, it also exerts immunobiological effects in pelvic peritoneum and on the endometrium that could be responsible for fertility enhancement. Effects of lipiodol on the endometrium that might be important at the time of the implantation window are a reduced expression of osteopontin and an increased number of uterine natural killer cells postlipiodol. The effect of lipiodol uterine bathing for women with endometriosis, repeat in vitro fertilisation (IVF) implantation failure and other reproductive disorders merits further investigation. Lipiodol presents a new, simple, low invasive, inexpensive treatment option for endometriosis-related infertility and might have wider applications.
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PMID:Review of lipiodol treatment for infertility - an innovative treatment for endometriosis-related infertility? 2447 42