John Jarrell - Academia.edu (original) (raw)
Papers by John Jarrell
Science of The Total Environment, 2012
The developing foetus is thought to be at increased risk from exposure to environmental contamina... more The developing foetus is thought to be at increased risk from exposure to environmental contaminants; however, developmental exposure data is notably lacking for many contaminants. Moreover, potential regional differences or effect of place of birth on residue levels measured in pregnant women is also unknown. Therefore, as part of a multinational biomonitoring study, 125 primiparous pregnant Canadian women were recruited from five Canadian centres (Vancouver, Calgary, Hamilton, Ottawa, and Halifax). Metals in whole blood and persistent organic pollutants (POPs) in plasma were measured by inductively coupled plasma mass spectrometry (ICPMS) and gas chromatography-mass spectrometry (GCMS), respectively. Of the 125 women recruited to this study, complete data sets were available for 123 of which 103 were Canadian born. Data were analysed by analysis of covariance and linear mixed models using age and body mass index as covariates. The metals cadmium (Cd), cobalt (Co), lead (Pb), nickel (Ni), selenium (Se), and total mercury (Hg) were detected in more than 93% of the samples tested. β-Hexachlorohexane (β-HCH), oxychlordane, trans-nonachlor, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p'-DDE), polybrominated diphenyl ether (PBDE) congeners (PBDE-153, PBDE-47), polychlorinated biphenyl (PCB) congeners (PCB-138, -153, and -180), and the dioxin-like PCB congener PCB-118 were quantified in greater than 70% of the samples tested. Significant differences in the concentrations of Cd, Ni, PCB-153, and p,p'-DDE were found between the centres studied. Furthermore, foreign-born pregnant women had significantly higher concentrations of Cd, β-HCH, PBDE-47, PCB-138, -153, -180, and p,p'-DDE compared to Canadian born pregnant women. Taken together, the data suggest that there are potential regional differences in contaminant body burden and place of birth may also contribute to differences in maternal residue concentrations.
Journal of Gynecology and Womens Health, 2017
Acta Obstetricia et Gynecologica Scandinavica, 2020
The therapeutic benefits of botulinum toxin (BTX) in alleviating pain in several myofascial disor... more The therapeutic benefits of botulinum toxin (BTX) in alleviating pain in several myofascial disorders such as focal dystonia and spasticity are well established. There is an expanding potential for benefits in chronic pelvic pain (CPP). A case report published in 1997 first described use of BTX injection for refractory vaginismus. Subsequently, other case reports also reported its success in CPP. At present, management of noncyclical myofascial CPP is multimodal. Botulinum toxin injections are generally reserved for refractory cases. In guidelines, this agent is considered a treatment option for CPP secondary to myofascial dysfunction. Given the lack of supporting evidence, however, BTX injections are not considered 602 Obstetrical and Gynecological Survey Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. to be a first-line treatment option. The authors of 2 systematic reviews and a randomized controlled trial (RCT) published between 2014 and 2019 concluded that the injections did not significantly reduce pain in women with CPP compared with placebo. This systematic review was designed to evaluate the efficacy and safety of BTX injection as an off-label treatment for adult women with CPP. A search was conducted of MEDLINE, EBM Reviews, PubMed, CINAHL, TRIP Database, EMBASE, Web of Science, and gray literature to identify relevant articles published in English up to January 13, 2020. PRISMA guidelines were followed. Relevant studies were those assessing efficacy of BTX for CPP in adult females. Only studies with more than 10 women were included. Two authors independently reviewed all eligible studies and extracted data using a standardized form. Quality of evidence was evaluated and graded using the Cochrane Risk of Bias 2 tool for RCTs and the Ottawa-Newcastle Scale for observational studies. Of the 773 articles identified and screened, 17 met eligibility criteria and were included; 5 were RCTs and 12 were observational studies. There was a wide range in quality of evidence (from low to high), and few of the studies were of high quality. Given the great degree of heterogeneity in study designs, the data could not be pooled, and a meta-analysis was not feasible. All observational studies reported that BTX was an effective treatment for CPP; the greatest change in 11-point (0–10) visual analog scale before and after treatment was from 8.69 at baseline to 3.07 at 24 months postinjection; P < 0.0001. The smallest change at 24 months postinjection was from 7.8 at baseline to 5.4; P = 0.004. In contrast, only 1 of the 5 RCTs found statistically significant differences favoring BTX in the reporting of the quality-of-life measure, EuroQOL-5D (botulinum: 0.78; 95% confidence interval, 0.69–1.00; control: 0.69; 95% confidence interval, 0.25–0.81; P = 0.03), and frequency of intercourse (botulinum: 1; 95% confidence interval, 1–1.75; placebo: 1; 95% confidence interval, 0–1; P = 0.025). There were no serious adverse events. Transient localized pain at injection site (6%–88%) was the most common adverse effect. Based on these data, there is currently insufficient high-quality evidence to recommend use of BTX injection as a first-line agent for CPP. However, its safety was demonstrated. Future high-quality studies are needed to establish its treatment efficacy.
Best Practice & Research Clinical Obstetrics & Gynaecology, 2018
Historically, the evolutionary origins of menstruation have been based two theories: the ability ... more Historically, the evolutionary origins of menstruation have been based two theories: the ability to eliminate infectious agents carried to the uterus with spermatozoa and the comparative conservation of energy with menstruation compared to its absence. In the menstruating species, more recent theories have identified spontaneous decidualization as the key adaptive mechanism. Spontaneous decidualization is seen as a mechanism to provide the mother with protection from the invasive characteristics of the embryo. Physiologically menstruation involves complex interactions of inflammation and vascular mechanisms to stabilize the endometrium and allow a regulated loss of endometrial tissues and blood. A variety of human illnesses can be better understood as vulnerabilities associated with these evolutionary developments including recurrent pregnancy loss, placenta accreta, ectopic pregnancy, endometriosis, adenomyosis, dysmenorrhea and chronic pelvic pain. While the evolutionary aspects of these diseases indicate why such illnesses can occur, in some instances they also provide a basis for treatment, prevention and future research direction.
Journal of Obstetrics and Gynaecology Canada, 2018
Objective: To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-base... more Objective: To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. Burden of Suffering: CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates. Outcomes: Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state. This guideline was developed by the Chronic Pelvic Pain Working Group and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.
Journal of Obstetrics and Gynaecology Canada, 2017
Journal of Obstetrics and Gynaecology Canada, 2017
Journal SOGC, 1996
This study presents reliability and validity data from a small sample of pelvic pain clinic patie... more This study presents reliability and validity data from a small sample of pelvic pain clinic patients on a self-repart rating scale, termed the Functional Pelvic Pain Scale (FPPS) , designed to measure pelvic pain intensity as it relates to functions of daily living (bladder and bowel function, intercourse, walking, running, lifting, working, and sleeping). Study design: in a preliminary study, the FPPS was completed by 24 patients from a pelvic pain clinic, and 27 female medical students not having a complaint of pelvic pain. In a subsequent study of reliability and validity, 20 women attending the pelvic pain clinic completed the FPPS during their visit, and completed Daily Pain Records (DPRS) for every day of their next menstrual cycle, as well as a second FPPS at the end of their cycle. Results: preliminary results demonstrate that the FPPS shows discriminant validity between women without a complaint of pelvic pain and those with pelvic pain (p< 0.000 1). Results in the second study demonstrate that the FPPS has satisfactory levels of test-retest reliability (r= 0.8048 p= 0.004) and construct validity. Functional pelvic pain scale scores showed statistically significant correlations with the highest monthly activity impairment (r= 0.5433 p= 0.007) and the average uterine pain intensity (r= 0.4436 p= 0.025).
Journal SOGC, 1995
Abstract We know that Endometriosis is associated with pelvic pain, the severity of which has bee... more Abstract We know that Endometriosis is associated with pelvic pain, the severity of which has been poorly correlated with disease stage. This review highlights fundamental difficulties in endometriosis research with the measurement of both pain and disease. In fact, none of the many pelvic pain questionnaires used to measure outcomes in clinical studies has been validated for use in endometriosis patients. It follows that the current pathological classification of endometriosis is inappropriate in addressing the important symptom of pain in endometriosis. In medical research, graded classification is an essential means of communication between researchers and clinicians, providing a simple way of describing the severity of cases and summarizing complex data. In this article, we outline the urgent need for the development of a valid classification system for endometrosis and pelvic pain.
Journal of Obstetrics and Gynaecology Canada, 2004
American Journal of Obstetrics and Gynecology, 1982
Journal of Obstetrics and Gynaecology Canada, 2011
Advanced Gynecologic Endoscopy, 2011
Diagnostic and operative laparoscopy has added significantly to the management of many surgical c... more Diagnostic and operative laparoscopy has added significantly to the management of many surgical conditions 1-4. These have extended to improved management of certain gynecological conditions 5-7. In addition to diagnosis, laparoscopy has evolved to more invasive procedures to include ovarian cystectomy, oophorectomy, assisted hysterectomy, total hysterectomy, radical hysterectomy and pelvic and paraaortic lymph node dissection 8-15. There is general acceptance that the procedure has immense benefits for the management of acute pain conditions such as those related to the management of ovarian torsion, ovarian cyst hemorrhage and the diagnosis of pelvic inflammatory disease 16-18. Laparoscopic surgery has resulted in reduced hospital admissions, and operating time thereby increasing efficiencies in health service provision 19;20. 4. Laparoscopy for chronic pelvic pain Although marked benefits for some conditions are substantial the same cannot be said for its use in the diagnosis and treatment of chronic pelvic pain. This condition is very common www.intechopen.com Myofascial Dysfunction and Its Relationship to Laparoscopy
Pain Research and Treatment, 2011
Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain f... more Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), res...
Gynäkologisch-geburtshilfliche Rundschau, 1981
Reproductive Toxicology, 2002
Hexachlorobenzene (C 6 Cl 6 , HCB) is a chemical that has been associated with significant immedi... more Hexachlorobenzene (C 6 Cl 6 , HCB) is a chemical that has been associated with significant immediate and long term adverse health effects in humans. It has been associated with both porphyria cutanea tarda and spontaneous abortions among survivors of widespread exposure in the 1950s in southeastern Turkey. HCB binds to the Ah receptor, albeit with lower affinity than dioxin. Dioxin exposure has been reported to lower human secondary sex ratio, putatively through a male mediated effect. We therefore wished to evaluate the impact of the HCB environmental event on the sex ratio of the progeny of the survivors. We undertook an assessment of 1) the effects of HCB exposure on the proportion of male births of individual subjects who had survived, 2) variables that significantly predicted the proportion of males among these individuals, and 3) the trend of the population sex ratio born in Turkey from 1935 to 1990. Women known to have been exposed to HCB in the 1950s did not have offspring with a significantly different sex ratio when compared to control populations. However, subjects reporting exposure at the peak of the episode (1955-57) had a significantly lower lifetime proportion of males than those exposed at a later date. The lifetime reported spontaneous abortion rate of these women also significantly predicted the percent males per subject. The available national data demonstrated a significant reduction in the calculated proportion of males from 1935 to 1970 that stabilized from 1970 to 1990. These data indicate that HCB exposure that was sufficient to induce clinical porphyria cutanea tarda may also have reduced the proportion of males in subjects over their reproductive lifespan. The HCB episode does not explain the pattern of the national trend from a population perspective.
Environmental Health Perspectives, 2008
Logistical considerations in the conduct of the clinical exam. The timing of the exam depends on ... more Logistical considerations in the conduct of the clinical exam. The timing of the exam depends on the research question, the measures to be taken, and the ability of the researchers to get the parent and infant into the clinic. In addition, researchers must be aware of developmental hormone changes
Biology of Reproduction, 1985
The ovarian enzyme 3a-hydroxysteroid dehydrogenase (3o-HSD) converts dihydrotestosterone (DHT) to... more The ovarian enzyme 3a-hydroxysteroid dehydrogenase (3o-HSD) converts dihydrotestosterone (DHT) to 5o-androstan-3a,173-diol (3-diol), a reduced androgen that does not bind to the granuloss cell androgen receptor. To determine BIOLOGY OF REPRODUCTION 33, 1207-1212 (1985)
Journal of the History of the Neurosciences
The peculiar therapeutic practice of "ovarian compression"-paradoxically, both in initiating and ... more The peculiar therapeutic practice of "ovarian compression"-paradoxically, both in initiating and in terminating hysterical activity-remains largely unexplained territory from both historical and medical perspectives. The gynecological indications of "hysteria" and "hystero-epilepsy" are now considered to be among similar questionable indications as contemporaneous "nymphomania" and "epilepsy." This article analyzes historical clinical observations, as well as surgical experiences of the time, to determine if there has been a uniform understanding of the ovarian contribution to "hystero-epilepsy." The respective findings are interpreted in light of the physiology of "chronic pelvic pain." Evidence for pain as a source of hystero-epileptic attacks is further represented through a series of clinical photographs suggesting a link to current problems, such as severe left-lower-quadrant pain. The emerging insights link more clearly to the functional role (le rôle fonctionnel) of the ovaries in relation to the "fits" of hystero-epileptic patients, while validating women's pain experiences during the latter part of the nineteenth century. Differences in the interpretation of disease concepts between Robert Battey (1828-1895) and Octave Terrillon (1844-1895) thereby permit an understanding of variations in the use of the removal of women's ovaries for pain. KEYWORDS Hysteria; hystero-epilepsy; neuropsychiatric patient experience; nineteenth century; ovaries; ovarian compression; pain theories Ovarian-based treatments of hysteria: Diseased ovaries Regarding the historical discussions about potential ovarian-based treatments of hysteria in the nineteenth century, Dr. Henri Gervis (1852-1941) of St Thomas Hospital in London provided a summary of the available information on ovaritis (an inflammatory condition of the ovaries) in 1883, and discussed the "Battey operation" "in the most guarded manner possible," as he was aware of its potential risk. His comments provide useful insights into what is now recognized as a representation of the onset phenomena of chronic pelvic pain: "It is probable that some central spinal lesion has occurred as the result of a long-lasting nerve irritation, and that the reason of surgical failure lies in the circumstance that the operation was too long delayed" (Gervis 1883, 195). Emile Chairou (1832-1870), chief of service at L'Asile Impérial du Vésinet in Paris, had published a thesis on the ovarian causes of hysteria, which was based on 26 detailed case studies and autopsy reports, incriminating ovarian pathologies as being associated with
Science of The Total Environment, 2012
The developing foetus is thought to be at increased risk from exposure to environmental contamina... more The developing foetus is thought to be at increased risk from exposure to environmental contaminants; however, developmental exposure data is notably lacking for many contaminants. Moreover, potential regional differences or effect of place of birth on residue levels measured in pregnant women is also unknown. Therefore, as part of a multinational biomonitoring study, 125 primiparous pregnant Canadian women were recruited from five Canadian centres (Vancouver, Calgary, Hamilton, Ottawa, and Halifax). Metals in whole blood and persistent organic pollutants (POPs) in plasma were measured by inductively coupled plasma mass spectrometry (ICPMS) and gas chromatography-mass spectrometry (GCMS), respectively. Of the 125 women recruited to this study, complete data sets were available for 123 of which 103 were Canadian born. Data were analysed by analysis of covariance and linear mixed models using age and body mass index as covariates. The metals cadmium (Cd), cobalt (Co), lead (Pb), nickel (Ni), selenium (Se), and total mercury (Hg) were detected in more than 93% of the samples tested. β-Hexachlorohexane (β-HCH), oxychlordane, trans-nonachlor, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-DDE), polybrominated diphenyl ether (PBDE) congeners (PBDE-153, PBDE-47), polychlorinated biphenyl (PCB) congeners (PCB-138, -153, and -180), and the dioxin-like PCB congener PCB-118 were quantified in greater than 70% of the samples tested. Significant differences in the concentrations of Cd, Ni, PCB-153, and p,p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-DDE were found between the centres studied. Furthermore, foreign-born pregnant women had significantly higher concentrations of Cd, β-HCH, PBDE-47, PCB-138, -153, -180, and p,p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-DDE compared to Canadian born pregnant women. Taken together, the data suggest that there are potential regional differences in contaminant body burden and place of birth may also contribute to differences in maternal residue concentrations.
Journal of Gynecology and Womens Health, 2017
Acta Obstetricia et Gynecologica Scandinavica, 2020
The therapeutic benefits of botulinum toxin (BTX) in alleviating pain in several myofascial disor... more The therapeutic benefits of botulinum toxin (BTX) in alleviating pain in several myofascial disorders such as focal dystonia and spasticity are well established. There is an expanding potential for benefits in chronic pelvic pain (CPP). A case report published in 1997 first described use of BTX injection for refractory vaginismus. Subsequently, other case reports also reported its success in CPP. At present, management of noncyclical myofascial CPP is multimodal. Botulinum toxin injections are generally reserved for refractory cases. In guidelines, this agent is considered a treatment option for CPP secondary to myofascial dysfunction. Given the lack of supporting evidence, however, BTX injections are not considered 602 Obstetrical and Gynecological Survey Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. to be a first-line treatment option. The authors of 2 systematic reviews and a randomized controlled trial (RCT) published between 2014 and 2019 concluded that the injections did not significantly reduce pain in women with CPP compared with placebo. This systematic review was designed to evaluate the efficacy and safety of BTX injection as an off-label treatment for adult women with CPP. A search was conducted of MEDLINE, EBM Reviews, PubMed, CINAHL, TRIP Database, EMBASE, Web of Science, and gray literature to identify relevant articles published in English up to January 13, 2020. PRISMA guidelines were followed. Relevant studies were those assessing efficacy of BTX for CPP in adult females. Only studies with more than 10 women were included. Two authors independently reviewed all eligible studies and extracted data using a standardized form. Quality of evidence was evaluated and graded using the Cochrane Risk of Bias 2 tool for RCTs and the Ottawa-Newcastle Scale for observational studies. Of the 773 articles identified and screened, 17 met eligibility criteria and were included; 5 were RCTs and 12 were observational studies. There was a wide range in quality of evidence (from low to high), and few of the studies were of high quality. Given the great degree of heterogeneity in study designs, the data could not be pooled, and a meta-analysis was not feasible. All observational studies reported that BTX was an effective treatment for CPP; the greatest change in 11-point (0–10) visual analog scale before and after treatment was from 8.69 at baseline to 3.07 at 24 months postinjection; P < 0.0001. The smallest change at 24 months postinjection was from 7.8 at baseline to 5.4; P = 0.004. In contrast, only 1 of the 5 RCTs found statistically significant differences favoring BTX in the reporting of the quality-of-life measure, EuroQOL-5D (botulinum: 0.78; 95% confidence interval, 0.69–1.00; control: 0.69; 95% confidence interval, 0.25–0.81; P = 0.03), and frequency of intercourse (botulinum: 1; 95% confidence interval, 1–1.75; placebo: 1; 95% confidence interval, 0–1; P = 0.025). There were no serious adverse events. Transient localized pain at injection site (6%–88%) was the most common adverse effect. Based on these data, there is currently insufficient high-quality evidence to recommend use of BTX injection as a first-line agent for CPP. However, its safety was demonstrated. Future high-quality studies are needed to establish its treatment efficacy.
Best Practice & Research Clinical Obstetrics & Gynaecology, 2018
Historically, the evolutionary origins of menstruation have been based two theories: the ability ... more Historically, the evolutionary origins of menstruation have been based two theories: the ability to eliminate infectious agents carried to the uterus with spermatozoa and the comparative conservation of energy with menstruation compared to its absence. In the menstruating species, more recent theories have identified spontaneous decidualization as the key adaptive mechanism. Spontaneous decidualization is seen as a mechanism to provide the mother with protection from the invasive characteristics of the embryo. Physiologically menstruation involves complex interactions of inflammation and vascular mechanisms to stabilize the endometrium and allow a regulated loss of endometrial tissues and blood. A variety of human illnesses can be better understood as vulnerabilities associated with these evolutionary developments including recurrent pregnancy loss, placenta accreta, ectopic pregnancy, endometriosis, adenomyosis, dysmenorrhea and chronic pelvic pain. While the evolutionary aspects of these diseases indicate why such illnesses can occur, in some instances they also provide a basis for treatment, prevention and future research direction.
Journal of Obstetrics and Gynaecology Canada, 2018
Objective: To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-base... more Objective: To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. Burden of Suffering: CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates. Outcomes: Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state. This guideline was developed by the Chronic Pelvic Pain Working Group and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.
Journal of Obstetrics and Gynaecology Canada, 2017
Journal of Obstetrics and Gynaecology Canada, 2017
Journal SOGC, 1996
This study presents reliability and validity data from a small sample of pelvic pain clinic patie... more This study presents reliability and validity data from a small sample of pelvic pain clinic patients on a self-repart rating scale, termed the Functional Pelvic Pain Scale (FPPS) , designed to measure pelvic pain intensity as it relates to functions of daily living (bladder and bowel function, intercourse, walking, running, lifting, working, and sleeping). Study design: in a preliminary study, the FPPS was completed by 24 patients from a pelvic pain clinic, and 27 female medical students not having a complaint of pelvic pain. In a subsequent study of reliability and validity, 20 women attending the pelvic pain clinic completed the FPPS during their visit, and completed Daily Pain Records (DPRS) for every day of their next menstrual cycle, as well as a second FPPS at the end of their cycle. Results: preliminary results demonstrate that the FPPS shows discriminant validity between women without a complaint of pelvic pain and those with pelvic pain (p< 0.000 1). Results in the second study demonstrate that the FPPS has satisfactory levels of test-retest reliability (r= 0.8048 p= 0.004) and construct validity. Functional pelvic pain scale scores showed statistically significant correlations with the highest monthly activity impairment (r= 0.5433 p= 0.007) and the average uterine pain intensity (r= 0.4436 p= 0.025).
Journal SOGC, 1995
Abstract We know that Endometriosis is associated with pelvic pain, the severity of which has bee... more Abstract We know that Endometriosis is associated with pelvic pain, the severity of which has been poorly correlated with disease stage. This review highlights fundamental difficulties in endometriosis research with the measurement of both pain and disease. In fact, none of the many pelvic pain questionnaires used to measure outcomes in clinical studies has been validated for use in endometriosis patients. It follows that the current pathological classification of endometriosis is inappropriate in addressing the important symptom of pain in endometriosis. In medical research, graded classification is an essential means of communication between researchers and clinicians, providing a simple way of describing the severity of cases and summarizing complex data. In this article, we outline the urgent need for the development of a valid classification system for endometrosis and pelvic pain.
Journal of Obstetrics and Gynaecology Canada, 2004
American Journal of Obstetrics and Gynecology, 1982
Journal of Obstetrics and Gynaecology Canada, 2011
Advanced Gynecologic Endoscopy, 2011
Diagnostic and operative laparoscopy has added significantly to the management of many surgical c... more Diagnostic and operative laparoscopy has added significantly to the management of many surgical conditions 1-4. These have extended to improved management of certain gynecological conditions 5-7. In addition to diagnosis, laparoscopy has evolved to more invasive procedures to include ovarian cystectomy, oophorectomy, assisted hysterectomy, total hysterectomy, radical hysterectomy and pelvic and paraaortic lymph node dissection 8-15. There is general acceptance that the procedure has immense benefits for the management of acute pain conditions such as those related to the management of ovarian torsion, ovarian cyst hemorrhage and the diagnosis of pelvic inflammatory disease 16-18. Laparoscopic surgery has resulted in reduced hospital admissions, and operating time thereby increasing efficiencies in health service provision 19;20. 4. Laparoscopy for chronic pelvic pain Although marked benefits for some conditions are substantial the same cannot be said for its use in the diagnosis and treatment of chronic pelvic pain. This condition is very common www.intechopen.com Myofascial Dysfunction and Its Relationship to Laparoscopy
Pain Research and Treatment, 2011
Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain f... more Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), res...
Gynäkologisch-geburtshilfliche Rundschau, 1981
Reproductive Toxicology, 2002
Hexachlorobenzene (C 6 Cl 6 , HCB) is a chemical that has been associated with significant immedi... more Hexachlorobenzene (C 6 Cl 6 , HCB) is a chemical that has been associated with significant immediate and long term adverse health effects in humans. It has been associated with both porphyria cutanea tarda and spontaneous abortions among survivors of widespread exposure in the 1950s in southeastern Turkey. HCB binds to the Ah receptor, albeit with lower affinity than dioxin. Dioxin exposure has been reported to lower human secondary sex ratio, putatively through a male mediated effect. We therefore wished to evaluate the impact of the HCB environmental event on the sex ratio of the progeny of the survivors. We undertook an assessment of 1) the effects of HCB exposure on the proportion of male births of individual subjects who had survived, 2) variables that significantly predicted the proportion of males among these individuals, and 3) the trend of the population sex ratio born in Turkey from 1935 to 1990. Women known to have been exposed to HCB in the 1950s did not have offspring with a significantly different sex ratio when compared to control populations. However, subjects reporting exposure at the peak of the episode (1955-57) had a significantly lower lifetime proportion of males than those exposed at a later date. The lifetime reported spontaneous abortion rate of these women also significantly predicted the percent males per subject. The available national data demonstrated a significant reduction in the calculated proportion of males from 1935 to 1970 that stabilized from 1970 to 1990. These data indicate that HCB exposure that was sufficient to induce clinical porphyria cutanea tarda may also have reduced the proportion of males in subjects over their reproductive lifespan. The HCB episode does not explain the pattern of the national trend from a population perspective.
Environmental Health Perspectives, 2008
Logistical considerations in the conduct of the clinical exam. The timing of the exam depends on ... more Logistical considerations in the conduct of the clinical exam. The timing of the exam depends on the research question, the measures to be taken, and the ability of the researchers to get the parent and infant into the clinic. In addition, researchers must be aware of developmental hormone changes
Biology of Reproduction, 1985
The ovarian enzyme 3a-hydroxysteroid dehydrogenase (3o-HSD) converts dihydrotestosterone (DHT) to... more The ovarian enzyme 3a-hydroxysteroid dehydrogenase (3o-HSD) converts dihydrotestosterone (DHT) to 5o-androstan-3a,173-diol (3-diol), a reduced androgen that does not bind to the granuloss cell androgen receptor. To determine BIOLOGY OF REPRODUCTION 33, 1207-1212 (1985)
Journal of the History of the Neurosciences
The peculiar therapeutic practice of "ovarian compression"-paradoxically, both in initiating and ... more The peculiar therapeutic practice of "ovarian compression"-paradoxically, both in initiating and in terminating hysterical activity-remains largely unexplained territory from both historical and medical perspectives. The gynecological indications of "hysteria" and "hystero-epilepsy" are now considered to be among similar questionable indications as contemporaneous "nymphomania" and "epilepsy." This article analyzes historical clinical observations, as well as surgical experiences of the time, to determine if there has been a uniform understanding of the ovarian contribution to "hystero-epilepsy." The respective findings are interpreted in light of the physiology of "chronic pelvic pain." Evidence for pain as a source of hystero-epileptic attacks is further represented through a series of clinical photographs suggesting a link to current problems, such as severe left-lower-quadrant pain. The emerging insights link more clearly to the functional role (le rôle fonctionnel) of the ovaries in relation to the "fits" of hystero-epileptic patients, while validating women's pain experiences during the latter part of the nineteenth century. Differences in the interpretation of disease concepts between Robert Battey (1828-1895) and Octave Terrillon (1844-1895) thereby permit an understanding of variations in the use of the removal of women's ovaries for pain. KEYWORDS Hysteria; hystero-epilepsy; neuropsychiatric patient experience; nineteenth century; ovaries; ovarian compression; pain theories Ovarian-based treatments of hysteria: Diseased ovaries Regarding the historical discussions about potential ovarian-based treatments of hysteria in the nineteenth century, Dr. Henri Gervis (1852-1941) of St Thomas Hospital in London provided a summary of the available information on ovaritis (an inflammatory condition of the ovaries) in 1883, and discussed the "Battey operation" "in the most guarded manner possible," as he was aware of its potential risk. His comments provide useful insights into what is now recognized as a representation of the onset phenomena of chronic pelvic pain: "It is probable that some central spinal lesion has occurred as the result of a long-lasting nerve irritation, and that the reason of surgical failure lies in the circumstance that the operation was too long delayed" (Gervis 1883, 195). Emile Chairou (1832-1870), chief of service at L'Asile Impérial du Vésinet in Paris, had published a thesis on the ovarian causes of hysteria, which was based on 26 detailed case studies and autopsy reports, incriminating ovarian pathologies as being associated with