May 8th, 2009
Sampson stated that menstrual blood containing viable fragments of endometrial tissue—the lining of the uterus was “regurgitated” through the fallopian tubes into the abdominal cavity. Later laboratory experiments and observations of patients during abdominal surgery disclosed that most women have retrograde menstruation, but only a percentage will become victims of endometriosis.
Recent probes into the theory of retrograde menstruation reveal that a great percentage of women show an increased amount of blood in the pelvic cavity around menstruation and after ovulation. Blood has even been present in the dialysate (liquid drawn from the abdominal cavity) of women undergoing kidney dialysis while they had their periods. What this proves, again and again, is that retrograde menstruation it common.
Earlier experiments, specifically those performed in the 1950s, were more aggressive. One team—doctors R. B. Scott, R. W. TeLinde, and L. R. Wharton, Jr., of Chicago’s Northwestern Medical Centers-created pelvic endometriosis in rhesus monkeys by inducing retrograde menstruation in an extreme manner. Basically, what they did was cot into the monkey’s uterus, opening it so that menstrual blood spilled directly into the pelvic cavity instead of being washed out through the vagina. Six of the ten experimental monkeys developed endometriosis—some within two and a half months, whereas others had no signs of it for nearly three years. In 1958 a number of women voluntarily submitted to an experiment wherein doctors injected endometrial cells into a laparotomy incision. This experiment also produced endometriosis in most women,
Sampson’s theory has found a few detractors, but most doctors agree that the backward spraying of menstrual blood places endometrial tissue on vulnerable organs. Even Sampson postulated that in all probability there is “more than one” avenue available for the development and spread of this disease. One conclusion was that, he wrote, “the invasion and dissemination of endometrial tissue employ the same channels as the invasion of cancer.” This meant that fragments of endometrial tissue reached other parts of the body through channels such as the blood and lymph systems. The actual process of tissue transference from one organ to another by blood or lymph glands is known as metastasis.
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May 8th, 2009
Specific treatment aimed at unblocking comedones (black-beads or whiteheads) involves the use of various topical preparations which may be applied to the skin. These include preparations containing salicylic acid or sulphur, which promote dryness of the skin and light scaling or peeling. The advantage of these preparations is that they may be gradually increased in strength to achieve the required effect. Other preparations which may be cosmetically more acceptable include retinoic acid. This is perhaps more effective in penetration, but is frequently irritating to the skin. Other preparations which are very useful in causing exfoliation of the skin and subsequent unblocking of comedones are the benzoyl peroxide gels. These may cause irritation but if used carefully are very helpful as an adjunct to treatment.
Ultraviolet light seems to have a similar exfoliating effect on the skin and is therefore most beneficial in the treatment of this condition. It appears to be further helped by salt water, due no doubt to its drying action.
Oral antibiotics, particularly tetracycline, have a most dramatic and beneficial effect. Their action appears to be threefold. They reduce comedone formation, resulting in less blockages of sebaceous gland ducts. Furthermore they reduce the acidity of the sebum, which then results in less tissue breakdown when the glands rupture. They also decrease the amount of propionibacterium acnes. This results in less chemical or enzyme being released into the skin when the glands rupture. The overall result of this is much less inflammation. It can be seen, therefore, that the antibiotics are used not so much for their anti-bacterial effect as for a side effect that they appear to have on the oil glands. Very small doses of these antibiotics may be used, in fact much smaller doses than those required for the treatment of normal mild infections of the skin. Consequently they may be used for prolonged periods, except of course with pregnant women or children under the age of 12 years, or if side-effects appear.
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May 8th, 2009
Summary of main points.
• A low-fat diet has an automatically high percentage of carbohydrate.
• Carbohydrate is most simply classified as either sugar, starch or fibre.
• More complex classifications are currently being developed.
• A high-carbohydrate intake has not been linked to obesity in populations.
• A reduction in sugar consumption may be wise for some individuals.
• Client education should involve:
— assessment of dietary carbohydrate intake and its specific components; sugar, starch and fibre
— recommended food selection for increasing dietary fibre
— information on how to read food labels and ingredient lists
— explanation of nutritional claims about carbohydrate in food
Until recently, carbohydrates have drawn far less scientific attention than dietary fat. Now there is ample evidence to show that specific components of carbohydrate are beneficial for both health and body fat management. In percentage terms, carbohydrate will replace fat in the diet if a lower-fat eating plan is adopted.
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May 8th, 2009
Prostaglandins are substances that are produced by many tissues throughout the body, including endometrial implants. One of their functions is to control the contraction and relaxation of the muscles in many of the internal organs of the body including the uterus and fallopian tubes.
It is thought that women with endometriosis have higher concentrations of prostaglandins in their peritoneal fluid and that these higher concentrations may contribute to infertility by hindering or preventing conception and implantation in a number of ways.
It is possible that prostaglandins interfere with the functioning of the ovaries and prevent the release of the ovum thereby preventing fertilisation.
Prostaglandins may affect the sperm as they move towards the ovum by slowing down their movement and thus reducing the number of healthy sperm that can reach the ovum in time for fertilisation.
Prostaglandins help the ovum move along the fallopian tube.
If the fertilised ovum is propelled too rapidly along the tube the ovum will reach the uterus too quickly. Therefore, when the fertilised ovum reaches the uterus it may not be mature enough to implant itself in the endometrium or the endometrium may not be ready to accept the fertilised ovum. If the fertilised ovum is propelled too slowly down the fallopian tube it may not reach the uterus in time to embed itself in the endometrium.
Prostaglandins may also affect the relaxation and contraction of the uterus. If they produce excessive contractions of the uterus they may prevent implantation of the fertilised ovum or they may cause it to be expelled soon after implantation.
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May 8th, 2009
There is no simple and accurate test which can be used to detect endometriosis. The only reliable way to diagnose the condition is by observing the implants during a minor operation known as a laparoscopy.
The diagnosis usually involves several stages which may include some or all of the following:
Reporting your symptoms to a doctor
Giving a history of your symptoms
Having a physical examination
Having an ultrasound
Having a laparoscopy
Taking a biopsy during a laparoscopy.
An early diagnosis is important as endometriosis is generally thought to be a progressive condition in which treatment is more effective in the early stages. If the progression of the condition can be stopped, or at least slowed down, then the likelihood of developing long-term complications such as infertility, adhesions and chronic pain is reduced.
For many women the road to a diagnosis is often long and it is not uncommon for women to see several doctors regarding their symptoms over a number of years before a diagnosis is made. In a survey conducted by the Endometriosis Association (Victoria), the average time between the onset of symptoms and diagnosis was over six years.
The long delay in diagnosis experienced by many women is partly due to the fact that endometriosis is often difficult to diagnose, especially in the early stages. The symptoms are easily confused with several other conditions and some doctors are not fully aware of the range of possible symptoms. In addition, a pelvic examination often appears normal.
Unfortunately, the diagnosis of endometriosis is also sometimes affected by doctors’ attitudes to the symptoms. Many doctors do not take women’s and teenager’s symptoms, such as period pain, seriously. Like many people in our community, they tend to assume that period pain is normal or psychological.
Doctors often do not consider a diagnosis in women and teenagers who do not conform to the traditional stereotype of women with endometriosis. Consequently teenagers and women under the age of 25, women who have had children and women from lower socio-economic backgrounds are often simply not considered for a diagnosis.
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