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Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina

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  • article 46 Citação(ões) na Scopus
    Consensus on Recording Deep Endometriosis Surgery: the CORDES statement(aEuro)
    Which essential items should be recorded before, during and after endometriosis surgery and in clinical outcome based surgical trials in patients with deep endometriosis (DE)? A DE surgical sheet (DESS) was developed for standardized reporting of the surgical treatment of DE and an international expert consensus proposal on relevant items that should be recorded in surgical outcome trials in women with DE. Surgery is an important treatment for symptomatic DE. So far, data have been reported in such a way that comparison of different surgical techniques is impossible. Therefore, we present an international expert proposal for standardized reporting of surgical treatment and surgical outcome trials in women with DE. International expert consensus based on a systematic review of literature. Taking into account recommendations from Consolidated Standards of Reporting Trials (CONSORT), the Innovation Development Exploration Assessment and Long-term Study (IDEAL), the Initiative on Methods, Measurement and Pain Assessment in Clinical trials (IMMPACT) and the World Endometriosis Research Foundation Phenome and Biobanking Harmonisation Project (WERF EPHect), a systematic literature review on surgical treatment of DE was performed and resulted in a proposal for standardized reporting, adapted by contributions from eight members of the multidisciplinary Leuven University Hospitals Endometriosis Care Program, from 18 international experts and from audience feedback during three international meetings. We have developed the DESS to record in detail the surgical procedures for DE, and an international consensus on pre-, intra- and post-operative data that should be recorded in surgical outcome trials on DE. The recommendations in this paper represent a consensus among international experts based on a systematic review of the literature. For several items and recommendations, high-quality RCTs were not available. Further research is needed to validate and evaluate the recommendations presented here. This international expert consensus for standardized reporting of surgical treatment in women with DE, based on a systematic literature review and international consensus, can be used as a guideline to record and report surgical management of patients with DE and as a guideline to design, execute, interpret and compare clinical trials in this patient population. None of the authors received funding for the development of this paper. M.A. reports personal fees and non-financial support from Bayer Pharma outside the submitted work; H.T. reports a grant from Pfizer and personal fees for being on the advisory board of Perrigo, Abbvie, Allergan and SPD. N/A.
  • article 5 Citação(ões) na Scopus
    Structured MRI reporting increases completeness of radiological reports and requesting physicians' satisfaction in the diagnostic workup for pelvic endometriosis
    (2021) BARBISAN, Cinthia Callegari; ANDRES, Marina Paula; TORRES, Lucas R.; LIBANIO, Bruna B.; TORRES, Ulysses S.; D'IPPOLITO, Giuseppe; RACY, Douglas J.; ABRAO, Mauricio Simoes
    Purpose MRI plays an important role in the diagnosis and surgical planning of pelvic endometriosis (PE), and imaging reports should contain all relevant information (completeness). As structured reports are being increasingly utilized, we aimed to evaluate whether structured MRI reporting increases the quality of reports regarding completeness and, consequently, their perceived value by gynecologists, in comparison to free-text reports. We also aimed to compare the diagnostic performance of both formats. Methods We retrospectively included 28 consecutive women with histologically proven PE who underwent MRI within one month before surgery. Two abdominal radiologists (Rd1/Rd2, 3y/12y experience), blinded to clinical and surgical data, individually elaborated free-text reports and, four months later, structured reports. Completeness (defined as description of six key anatomical sites deemed essential for surgical planning in a consensus of four-blinded external experts) and diagnostic performance (sensitivity and specificity) by site (histology as reference) were compared between reports using the McNemar test. The satisfaction of gynecologists was compared using the marginal homogeneity test. Results Structured reporting increased completeness for both Rd1 (rectosigmoid, retrocervical/uterosacral ligament, vagina, and ureter) and Rd2 (vagina, ureter, and bladder) (p < 0.05), without compromising sensitivity or specificity at any of the evaluated sites. Gynecologists' satisfaction was superior with structured reports in most comparisons. Conclusion Structured MRI reports perform better in fully documenting essential features of PE and are similar in terms of diagnostic performance, therefore having higher potential for surgical planning. Gynecologists found them easier to assess and were more satisfied with the information provided by structured reports.
  • article 19 Citação(ões) na Scopus
    Endometriosis Classification, Staging and Reporting Systems: A Review on the Road to a Universally Accepted Endometriosis Classification † ‡
    (2021) VERMEULEN, N.; ABRAO, M. S.; EINARSSON, J. I.; HORNE, A. W.; JOHNSON, N. P.; LEE, T. T. M.; MISSMER, S.; PETROZZA, J.; TOMASSETTI, C.; ZONDERVAN, K. T.; GRIMBIZIS, G.; WILDE, R. L. De; WES, ESGE International working group of AAGL ESHRE and
    Objective: In the field of endometriosis, several classification, staging and reporting systems have been developed. Which endometriosis classification, staging and reporting systems have been published and validated for use in clinical practice? Data sources: A systematic PUBMED literature search was performed. Data were extracted and summarized. Methods of study selection: na Tabulation, integration and results: Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific, and different, purposes. There still is no international agreement on how to describe the disease. Studies evaluating the different systems are summarized showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the ENZIAN system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. Conclusion: Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated for the purpose for which they were developed. The literature search was limited to PUBMED. Unpublished classification, staging or reporting systems, or those published in books were not considered. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. This overview of existing systems is a first step in working towards a universally accepted endometriosis classification. © 2021
  • article 2 Citação(ões) na Scopus
    Endometriosis and its correlation with carcinoid tumor of the appendix: a systematic review
    (2021) VILLAESCUSA, Marina; ANDRES, Marina P.; AMARAL, Alexandre C.; BARBOSA, Rodrigo N.; ABRAO, Mauricio S.
    INTRODUCTION: The prevalence of appendiceal endometriosis ranges from 0.4% to 22%. The carcinoid tumor is the most common neoplasm of the appendix, with incidence ranging from 0.3% to 0.9%. Appendix lesions develop in up to 22% of women with deep infiltrative endometriosis. Even though these are most likely endometriosis, carcinoid tumors should always be considered. The aim of this review was to assess the prevalence of appendiceal carcinoid tumors and appendiceal endometriosis in patients undergoing gynecologic surgery', its association with endometriosis, and related symptoms. EVIDENCE ACQUISITION: We included retrospective and prospective studies that assessed women who underwent appendicectomy in the past 20 years for appendiceal endometriosis and/or appendix carcinoid tumor confirmed by histological analysis. Results were reported as relative and absolute frequencies. Due to the heterogeneity of included studies, a statistical analysis (meta-analysis) was not performed. EVIDENCE SYNTHESIS: The prevalence of appendiceal endometriosis was 15.2% in patients who underwent surgery for pelvic endometriosis and 11.4% i n those who underwent benign gynecological surgery. Conversely. carcinoid tumors of the appendix were present in 2.4% of endometriosis patients and 1.3% of other benign gynecological surgeries. CONCLUSIONS: The rates of carcinoid tumors in patients with endometriosis are the same as in the general population. Given the risk of a malignant appendiceal tumor, in all gynecological surgeries, especially those for endometriosis, the appendix should be inspected and removed if it has an abnormal appearance.
  • article 32 Citação(ões) na Scopus
    Strategies for Management of Colorectal Endometriosis
    (2017) ABRAO, Mauricio Simoes; BORRELLI, Giuliano Moyses; CLARIZIA, Roberto; KHO, Rosanne Marie; CECCARONI, Marcello
    Endometriosis has clearly three distinct clinical presentations and deep endometriosis, especially compromising the rectosigmoid is probably the most concerning one for both patients and surgeons. Currently, with the available tools, it is mandatory to have a precise diagnostic of this type of disease prior to indication of treatment. Strategies to manage this form of endometriosis will take into account several involved aspects, such as age of the patient, reproductive desire or infertility, clinical symptoms, as well as the extension and localization of the disease. Treatment could vary from more conservative to more radical depending on those aspects. As we pointed out in this article, the key to manage colorectal endometriosis is to start with a good diagnosis. Knowing exactly what is the extension and localization of the disease and knowing the patient's wishes as well as the clinical complaints, surgeons are able to define the best option for each patient. Critical points should always be discussed; for example, patients chosen to have clinical treatment should be aware of important issues regarding the follow-up, while patients undergoing surgery must be advised about all surgical possibilities and related complications.
  • article 11 Citação(ões) na Scopus
    Uterine tumors resembling ovarian sex-cord tumor: A case-report and a review of literature
    (2016) GOMES, Jessica Ribeiro; CARVALHO, Filomena M.; ABRAO, Mauricio; MALUF, Fernando Cotait
  • article 342 Citação(ões) na Scopus
    Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist
    BACKGROUND Endometriosis is a chronic, estrogen-dependent condition that causes dysmenorrhea and pelvic pain. Elagolix, an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist, produced partial to nearly full estrogen suppression in previous studies. METHODS We performed two similar, double-blind, randomized, 6-month phase 3 trials (Elaris Endometriosis I and II [EM-I and EM-II]) to evaluate the effects of two doses of elagolix - 150 mg once daily (lower-dose group) and 200 mg twice daily (higher-dose group) - as compared with placebo in women with surgically diagnosed endometriosis and moderate or severe endometriosis-associated pain. The two primary efficacy end points were the proportion of women who had a clinical response with respect to dysmenorrhea and the proportion who had a clinical response with respect to nonmenstrual pelvic pain at 3 months. Each of these end points was measured as a clinically meaningful reduction in the pain score and a decreased or stable use of rescue analgesic agents, as recorded in a daily electronic diary. RESULTS A total of 872 women underwent randomization in Elaris EM-I and 817 in Elaris EM-II; of these women, 653 (74.9%) and 632 (77.4%), respectively, completed the intervention. At 3 months, a significantly greater proportion of women who received each elagolix dose met the clinical response criteria for the two primary end points than did those who received placebo. In Elaris EM-I, the percentage of women who had a clinical response with respect to dysmenorrhea was 46.4% in the lower-dose elagolix group and 75.8% in the higher-dose elagolix group, as compared with 19.6% in the placebo group; in Elaris EM-II, the corresponding percentages were 43.4% and 72.4%, as compared with 22.7% (P< 0.001 for all comparisons). In Elaris EM-I, the percentage of women who had a clinical response with respect to nonmenstrual pelvic pain was 50.4% in the lower-dose elagolix group and 54.5% in the higher-dose elagolix group, as compared with 36.5% in the placebo group (P < 0.001 for all comparisons); in Elaris EM-II, the corresponding percentages were 49.8% and 57.8%, as compared with 36.5% (P = 0.003 and P < 0.001, respectively). The responses with respect to dysmenorrhea and nonmenstrual pelvic pain were sustained at 6 months. Women who received elagolix had higher rates of hot flushes (mostly mild or moderate), higher levels of serum lipids, and greater decreases from baseline in bone mineral density than did those who received placebo; there were no adverse endometrial findings. CONCLUSIONS Both higher and lower doses of elagolix were effective in improving dysmenorrhea and nonmenstrual pelvic pain during a 6-month period in women with endometriosis-associated pain. The two doses of elagolix were associated with hypoestrogenic adverse effects. (Funded by AbbVie; Elaris EM-I and EM-II numbers, NCT01620528 and NCT01931670.)
  • article 69 Citação(ões) na Scopus
    Role of Eutopic Endometrium in Pelvic Endometriosis
    (2011) CARVALHO, Luiz; PODGAEC, Sergio; BELLODI-PRIVATO, Marta; FALCONE, Tommaso; ABRAO, Mauricio Simoes
    Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity and is considered a benign gynecologic condition; however, in some cases, it may be aggressive. The pathogenesis of endometriosis is complex and multifactorial. Despite being one of the most widely studied gynecologic diseases, its pathogenesis remains uncertain. The intrinsic endometrial abnormalities thought lobe associated with endometriosis include abnormal expression of genes, modification of endometrial response to hormones such as progesterone; increased nerve density, and oxidative stress. Evaluation of the endometrium in patients with endometriosis is an important line of investigation in the pathophysiology of the disease. It has been suggested that investigation of eutopic endometrium may help to achieve this goal. Presented herein is a literature review and a comprehensive evaluation of the role of eutopic endometrium in pelvic endometriosis. Clinical correlations of the disease are highlighted, with the objective of understanding the role of eutopic endometrium in endometriosis. Journal of Minimally Invasive Gynecology (2011) 18, 419-427 (C) 2011 AAGL. All rights reserved.
  • article
    Endometriosis classification systems: an international survey to map current knowledge and uptake
    (2022) ZONDERVAN, Krina T.; MISSMER, Stacey; ABRAO, Mauricio S.; I, Jon Einarsson; HORNE, Andrew W.; JOHNSON, Neil P.; LEE, Ted T. M.; PETROZZA, John; TOMASSETTI, Carla; VERMEULEN, Nathalie; GRIMBIZIS, Grigoris; WILDE, Rudy L. de
    Background: In the field of endometriosis, several classification, staging and reporting systems have been developed and published, but there are no data on the uptake of these systems in clinical practice. Objectives: The objective of the current study was to examine whether clinicians routinely use the existing endometriosis classification systems, which system do they use and what are the clinicians' motivations? Materials and Methods: A cross-sectional study was performed to gather data on the current use of endometriosis classification systems, problems encountered and interest in a new simple surgical descriptive system for endometriosis. Of particular focus were three systems most commonly used: the Revised American Society for Reproductive Medicine (rASRM) classification, the Endometriosis Fertility Index (EFI), and the ENZIAN classification. Data were analysed by SPSS. A survey was designed using the online SurveyMonkey tool consisting of 11 questions concerning three domains-participants' background, existing classification systems and intentions with regards to a new classification system for endometriosis. Replies were collected between 15 May and 1 July 2020. Main outcome measures: Uptake, feedback and future intentions. Results: The final dataset included the replies of 1178 clinicians, including surgeons, gynaecologists, reproductive endocrinologists, fertility specialists and sonographers, all managing women with endometriosis in their clinical practice. Overall, 75.5% of the professionals indicate that they currently use a classification system for endometriosis. The rASRM classification system was the best known and used system, the EFI system and ENZIAN system were known by a majority of the professionals but used by only a minority. The lack of clinical relevance was most often selected as a problem with using any system. The findings of the survey suggest that clinicians worldwide are open to using a new classification system for endometriosis that can achieve standardised reporting, and is clinically relevant and simple. Conclusions: Even with a high uptake of the existing endometriosis classification systems (rASRM, ENZIAN and EFI), most clinicians managing endometriosis would like a new simple surgical descriptive system for endometriosis. What is new? The findings therefore support future initiatives for the development of a new descriptive system for endometriosis and provide information on user expectations and conditions for universal uptake of such a system.
  • article 41 Citação(ões) na Scopus
    The Placenta as an Organ and a Source of Stem Cells and Extracellular Matrix: A Review
    (2015) LOBO, Sonja E.; LEONEL, Luciano Cesar P. C.; MIRANDA, Carla M. F. C.; COELHO, Talya M.; FERREIRA, Guilherme A. S.; MESS, Andrea; ABRAO, Mauricio S.; MIGLINO, Maria Angelica
    The placenta is a temporal, dynamic and diverse organ with important immunological features that facilitate embryonic and fetal development and survival, notwithstanding the fact that several aspects of its formation and function closely resemble tumor progression. Placentation in mammals is commonly used to characterize the evolution of species, including insights into human evolution. Although most placentas are discarded after birth, they are a high-yield source for the isolation of stem/progenitor cells and are rich in extracellular matrix (ECM), representing an important resource for regenerative medicine purposes. Interactions among cells, ECM and bioactive molecules regulate tissue and organ generation and comprise the foundation of tissue engineering. In the present article, differences among several mammalian species regarding the placental types and classifications, phenotypes and potency of placenta-derived stem/progenitor cells, placental ECM components and current placental ECM applications were reviewed to highlight their potential clinical and biomedical relevance. (C) 2016 S. Karger AG, Basel