Dr. Redwine made a pelvic map for each woman and carefully marked on it where he had taken the biopsy and which biopsies turned out to be endo.
He found that the most common site of endo was the peritoneum, especially behind the uterus in the "cul de sac" or the bottom most part of the pelvis. The ovaries and the fallopian tube were found to be uncommon sites for endo.
When he biopsied all suspicious lesions (abnormalities) in the pelvis, things that didn't look like endo (clear, white, red and yellow in colour called atypical implants) turned out to be endo when examined under the microscope by a pathologist.
Only 36 percent of women had the typical blue or black implants that doctors are always looking for but more 43 percent had atypical implants only. These 43 percent of women would have their endo completely missed by a doctor looking only for the blue or black implants.
This was the case with a 26-year-old surgical nurse with severe pelvic pain that was interfering with her work. After a laparoscopic examination of her pelvis, her gynecologist told her she had a normal pelvis and perhaps the pain was in her head. Another one and a half years of pain later and she finally saw Dr. Redwine. He found that the back of her pelvis was riddled with endo that had predominantly a white colour.
Reoccurrences after surgery, he believes, are most often "simply disease the surgeon missed." And the surgeon is likely to miss quite a lot if he or she only removes the classic blue-black abnormalities.
In fact, Dr. Redwine's rule is that "any suspicious area of the pelvic peritoneum is endo until proven otherwise by biopsy." The final diagnosis of endo, he stresses, should by made by the pathologist and not by the gynecologist.
Dr. Redwine also found that endo was hidden in two thirds of peritoneal pockets that he found. These are folds or defects in the peritoneum that must be turned inside out and examined.
In the microscopic study of biopsied tissue, Dr. Redwine found few or no blood or blood vessels. From this he concluded that misplaced endometrial tissue does not bleed in the way he had been taught.
Instead, he believes that the endo tissue secretes a chemical that causes nearby blood vessels to bleed. The blood becomes trapped under the peritoneum and as it ages, turns from clear, white and yellow to red and blue and finally black. He found that women under 30 were more likely to have clear, yellow, or red lesions and women over 30, the characteristic black powder burn lesions.
Endo Does Not Progress
Dr. Redwine found no evidence that the disease is highly recurrent or progressively spreading.
From all these observations, Dr. Redwine concluded that endo is a static disease, persistent but not recurrent, in women of all ages, with pain as the most common problem. It also occurs independent of periods and most of the growths are atypical in appearance.
Dr. Redwine has come up with a theory that explains all of his findings which he calls Mulleriosis.
The Mullerian duct system of the fetus gives rise to the cells of the uterus, tubes, ovaries and peritoneum of the adult. Dr. Redwine believes as these Mullerian cells migrate along the back of the pelvic wall, some cells get left behind. If these cells are endometrial cells, endometriosis may result. Other types of cells can be left behind as well. This may explain why ovarian, cervical and tubal cells are found in odd places in the pelvises of some women have endo.
Dr. Redwine believes that drug therapy of endo with danazol or newer drugs like synarel and lupron is expensive, has serious side effects, does not destroy endo and has a high rate of pain reoccurrence as soon as treatment is stopped.
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