$100 reward for help on looking at "blind spots"

Dan Martin MD is seeking help in looking at "Blind Spots" in his data base on literature needed for clinical decisions. There is a US$100 reward for peer reviewed, published articles that are abstracted in PubMed, which show statistically significant difference in outcomes (pain, tenderness, fertility, change in appearance or other outcomes) of surgery or medical therapy based on histology that is positive as compared with histology that is negative for endometriosis.

Decisions on endometriosis therapy are based on several definitions that are not always related. This can lead to application of data based on any appearance definition to patients who have a specific appearance or a histologic definition.

a) This is not an evidence based or scientific based approach.
b) It may lead to inappropriate therapy.
c ) A concentration on biopsy positive patients implies that we can ignore or discount patients who have a laparoscopic diagnosis of endometriosis but have histologically negative biopsies.

There is a large body of literature on accuracy of confirmation of endometriosis but not a corresponding literature on histologic diagnosis of peritoneal and pelvic abnormalities. This leads to:

a) Identification of psammoma bodies, endosalpingiosis, Walthard Rests, low malignant potential tumor and other pathology as endometriosis.
b) An assumption that if we think it is endometriosis then other significant pathology is not present.
c) Possibly diagnosing cancer as endometriosis and not doing biopsies.

The use of biopsy results is pleasing from a theoretical level regarding accuracy. But there is no data to support the theoretical use of biopsy results for patient management.

Dr Martin needs peer reviewed, published articles that are abstracted in PubMed. These need to show statistically significant difference in outcomes (pain, tenderness, fertility, change in appearance or other outcomes) of surgery or medical therapy based on histology that is positive as compared with histology that is negative for endometriosis.

There is a $100 reward to the first physician to send any paper that is not listed on Dr Martin's website (www.memfert.com/reward.htm). There will be as many rewards as there are papers.

Dr Martin also needs additional articles that study endometriosis histology and include the histology for both endometriosis and other lesions in the same article. The only reward for those will be his thanks.

If the article is not in English, an English translation of the abstract and of the statistical analysis is needed.

The citation for the articles and the names of those who win the money will be posted on his website: www.memfert.com/reward.htm, which also carries a list of papers already recognised.

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