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200: Fertil Steril. 2004 Jan;81(1):149-53. Related Articles, Links
Prediction of the change in bone mineral density induced by gonadotropin-releasing hormone agonist treatment for endometriosis.
Matsuo H.
Department of Maternity Nursing, Faculty of Health Sciences, Kobe University School of Medicine, Kobe, Japan. matsuoh@ams.kobe-u.ac.jp
OBJECTIVE: To observe the long-term changes in bone metabolism induced by GnRH agonist (GnRHa) treatment and to determine the factor that affected the change in bone mineral density (BMD). DESIGN: Prospective observational study. SETTING: Department of obstetrics and gynecology in university and general hospitals. PATIENT(S): Fifty women with endometriosis treated with GnRHa between 1994 and 1996. INTERVENTION(S): Leuprolide acetate administered for 24 weeks. Bone mineral density measurement by dual energy x-ray absorptiometry and collection of blood and urine samples were conducted until 12 months of posttreatment. MAIN OUTCOME MEASURE(S): Spinal BMD and bone turnover markers. RESULT(S): Mean BMD percent changes from pretreatment were -4.9% and -3.4% at 6 months of treatment and at 12 months of posttreatment, respectively. When the patients were divided by the median pretreatment deoxypyridinoline (DP) level, recovery of BMD after GnRHa discontinuation was slower in the Low-DP group than in the High-DP group. A significant positive correlation was found between the pretreatment DP level and the percent change in BMD at 12 months of posttreatment. No significant relation between BMD and the other bone turnover markers was noted. CONCLUSION(S): Bone mineral density changes were diverse among patients who were administered GnRHa. The pretreatment DP level may be the predictive factor for GnRHa-induced BMD change.
PMID: 14711558 [PubMed]
201: Fam Med. 2004 Jan;36(1):8-9. Related Articles, Links
Effectiveness of leukotriene receptor antagonists for dysmenorrhea of endometriosis.
Konno R, Fujiwara H, Suzuki M.
Publication Types:
· Letter
PMID: 14710319 [PubMed]
202: Surg Endosc. 2003 Oct;17(10):1678 -9. Related Articles, Links
A laparoscopic approach to small bowel obstruction secondary to endometriosis.
Weizman DA, Sullivan P.
Department of General Surgery, Toronto East General Hospital, 840 Coxwell Avenue, Toronto, Ontario, M4C 5T2 Canada.
The complications of endometriosis are well recognized and extend beyond the pelvis. Gastrointestinal manifestations of this disease have been well described; however, reports of small bowel obstruction are rare. We describe the case of a 44 year-old-woman who presented with high-grade small bowel obstruction secondary to an endometrioma. We review the epidemiology and pathology associated with this condition and describe a laparoscopic approach to its management.
PMID: 14703632 [PubMed]
203: Int J Gynaecol Obstet. 2004 Jan;84(1):61-4. Related Articles, Links
Familial risk among Japanese patients with endometriosis.
Kashima K, Ishimaru T, Okamura H, Suginami H, Ikuma K, Murakami T, Iwashita M, Tanaka K.
Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. kashimak@med.niigata-u.ac.jp
OBJECTIVES: This study was designed to examine the prevalence of endometriosis among female siblings of patients with endometriosis in Japan. METHODS: A total of 339 patients with endometriosis were questioned about endometriosis in their sisters. The control group consisted of 284 Japanese healthy fertile women with no history of endometriosis. Similarly, the controls were interviewed about their sisters. RESULTS: We detected sisters with endometriosis in 8.8% of cases and 1.5% of the control population. The relative risk of endometriosis in female siblings was 5.7. However, a significant difference was not seen in age at diagnosis and clinical stage between patients with or without a family history of endometriosis. CONCLUSIONS: These data demonstrate a familial tendency for endometriosis and suggest that endometriosis has a genetic factor in the pathogenesis.
PMID: 14698831 [PubMed]
204: J Clin Anesth. 2003 Nov;15(7):545-8. Related Articles, Links
Massive pulmonary embolism presented as sudden cardiac arrest in the immediate postoperative period after laparoscopic hysterectomy.
Hsieh SW, Lan KM, Luk HN, Wang CS, Jawan B.
First Department of Anesthesiology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung Hsien, Chang Gung University, Taipei, Taiwan.
A rare case of postoperative cardiac arrest in an otherwise healthy, 49-year-old female patient who had a laparoscopic hysterectomy, is presented. The cause of cardiac arrest was due to massive pulmonary embolism, which was detected by transesophageal echocardiography. Laparoscopic surgery is regarded as a less invasive procedure and provides a lower risk for postoperative complications. However, our is a case reminer that pneumoperitoneum may interfere with venous flow of lower extremities and predispose one to deep vein thrombosis or pulmonary embolism.
Publication Types:
· Case Reports
PMID: 14698370 [PubMed]
205: An Med Interna. 2003 Dec;20(12):624-6. Related Articles, Links
[Pseudo-obstruction chronic disease, lymphoid hyperplasia of the gastrointestinal tract and intestinal endometriosis]
[Article in Spanish]
Blanco Barrios A, Zancada Diaz De Entre-Sotos F, Rodriguez Perez A.
Servicio de Medicina Interna, Hospital Virgen del Puerto, Plasencia, Caceres. blancobarrios@terra.es
Nodular lymphoid hyperplasia of the gastrointestinal tract associated to endometriosis is an uncommon cause of chronic pseudo-obstruction and malabsortion. The case of a 32-year-old woman who suffered from this syndrome for one a half years is described. Diagnosis was achieved by laparotomy, which disclosed swelling and inflammation of the 30 cm terminal yeyunal portion. Removal of the involved intestine and side-to-side anastomosis were performed. The pathological findings were: follicular lymphoid hyperplasia with mucosal ulcers an fissures inflammatory pseudo-polyps, chronic deep enteritis and areas of endometriosis. A favourable outcome followed surgery.
Publication Types:
· Case Reports
PMID: 14697083 [PubMed]
206: J Formos Med Assoc. 2003 Oct;102(10):701-6. Related Articles, Links
Uterine artery embolization for symptomatic uterine leiomyoma and adenomyosis.
Toh CH, Wu CH, Tsay PK, Yeow KM, Pan KT, Tseng JH, Hung CF.
Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan Hsien, Taiwan.
BACKGROUND AND PURPOSE: Uterine artery embolization (UAE) is increasingly accepted as an alternative treatment for symptomatic uterine leiomyoma and adenomyosis. The purpose of this study was to compare the outcomes of UAE in 3 diagnostic categories--submucosal leiomyoma, intramural leiomyoma, and adenomyosis--to assist in patient selection for this relative new form of therapy. METHODS: The medical records of 43 patients (aged 22 to 54 years) who underwent UAE for symptomatic uterine leiomyoma or adenomyosis were retrospectively reviewed. Magnetic resonance imaging (MRI) was used for categorization of the patients into the 3 diagnostic categories, and also for objective measurement of the uterine and leiomyoma size, and subsequent imaging follow-up. UAE was performed using polyvinyl alcohol particles. Symptom improvement and complications after treatment were evaluated at gynecologist clinics using monthly questionnaires. The group differences in complete symptom resolution, uterine and leiomyoma size reduction, incidence of complications, and subsequent surgeries were analyzed. RESULTS: The mean duration of follow-up was 10.9 months. Complete resolution of symptoms was achieved in 13 out of 16 patients with submucosal leiomyoma (81%), 3 out of 15 patients (20%) with intramural leiomyoma (p = 0.002) and 3 out of 12 patients (25%) with adenomyosis (p = 0.01). The average reduction of leiomyoma size in the submucosal and intramural groups was 56% and 29%, respectively (p = 0.02). None of the patients died. Severe complications occurred in 3 of 43 patients (7%), including permanent amenorrhea in 2 and pelvic actinomycosis in 1 patient. The incidence of complications (p = 0.17) and subsequent surgery (p = 0.67) did not differ significantly among the 3 groups. CONCLUSIONS: UAE is an effective treatment for patients with symptomatic leiomyoma or adenomyosis. In this study, patients with submucosal leiomyoma had the best treatment outcome.
PMID: 14691595 [PubMed]
207: Vet Rec. 2003 Dec 6;153(23):708-10. Related Articles, Links
Mineralised deposits in the uterine glands of mares with chronic endometrial degeneration.
Walter I, Helmreich M, Handler J, Aurich C.
Institute of Histology and Embryology, University of Veterinary Medicine, Veterinarplatz 1, A-1210 Vienna, Austria.
Chronic degenerative disease of the mare's endometrium is characterised by changes in the uterine glands, including cystic dilation, hyperplasia and periglandular fibrosis. Endometrial biopsies were taken from 23 mares with different grades of endometrial degeneration. Solid structures were identified within the lumina of the uterine glands and shown to be calcified by histochemical staining. Most of them were not homogenous but composed of a mixture of mineral and organic substances. Further examinations of these mineralised structures by immunohistochemical methods revealed the presence of the non-collagenous matrix proteins osteopontin, osteonectin and bone sialoprotein, which are known to be involved in calcification processes such as urolithiosis. Osteopontin and bone sialoprotein were identified within the calculi, frequently arranged in concentric layers. Osteonectin was the only matrix protein that was also present in the glandular epithelium. Osteocalcin was not found in either the calculi or the glandular epithelial cells.
PMID: 14690074 [PubMed]
208: Reprod Biol. 2003 Nov;3(3):197-214. Related Articles, Links
The effect of ovarian steroid deficiency on regeneration of oviductal mucosa following reconstructive surgery.
Starczewski A, Glabowski W, Laszczynska M, Sluczanowska-Glabowska S.
Clinic for Reproduction and Gynecology, Pomeranian Medical University, Szczecin, Poland.
In patients with distal tubal occlusion a microsurgical oviductal reconstruction is, apart from the in vitro fertilization, the only treatment option. Unfortunately, the results of reconstructive surgery are often unsatisfactory. The effects of sex steroids on the regeneration process after reconstructive surgery have not been well investigated. This study was aimed to evaluate the effect of decreased concentrations of ovarian sex steroids (castration) on regeneration of the oviduct mucosa after the reconstructive surgery of distally occluded oviducts. The study was performed on 32 female rabbits that underwent unilateral oviduct ligature and resection of fimbriae. The occlusion lasted six (group I) or twelve weeks (group II). After this time the animals were re-operated, and allocated into 4 groups: castration with reconstructive surgery (IA, IIA), reconstructive surgery only (IB, IIB). After next six or twelve weeks the fallopian tubes were examined under light, scanning and transmission electron microscopes. An immunohistochemical reaction for Ki-67 proliferative antigen was also performed. Ovarian steroid levels were evaluated by radioimmunoassays. The castrated animals had significantly lower levels of estradiol, progesterone and 17-hydroxyprogesterone than the control groups. Long lasting tubal occlusion caused pronounced histological changes of tubal mucous membrane (group II). In the rabbits with preserved ovaries and twelve-week long oviductal occlusion (group IIB), the regeneration of the distal end and restoration of fimbria were not complete twelve weeks after microsurgical reconstruction. In castrated animals with long-lasting occlusion (group IIA) the destructive changes, found in the mucosa of tubal ampullas of occluded oviducts before reconstruction, were still present and even intensified twelve weeks following reconstructive surgery. The castration hampered proliferation of the mucosa cells, thus no fimbriae were restored. Low levels of ovarian steroids were found to have adverse effect on fallopian tube regeneration following reconstructive surgery. The effect was noted even in cases with minor preoperative fallopian tube damage. Therefore, the treatment of concomitant endometriosis or uterine fibroids with GnRH analogues should not be recommended simultaneously with microsurgical tubal reconstruction.
PMID: 14688821 [PubMed]
209: Hum Reprod. 2004 Jan;19(1):221. Related Articles, Links
Reply: Methological concerns regarding levels of vascular endothelial growth factor (VEGF) in serum of patients with endometriosis.
Gagne D, Page M, Robitaille G, Hugo P, Gosselin D.
Metriogene BioSciences (a subsidiary of PROCREA BioSciences), Montreal, Canada, H4P 2R2.
PMID: 14688194 [PubMed]
210: Hum Reprod. 2004 Jan;19(1):220-1; author reply 221. Related Articles, Links
Methodological concerns regarding levels of vascular endothelial growth factor (VEGF) in serum of patients with endometriosis.
Ferrero S, Gillott DJ, Anserini P, Remorgida V, Teisner B, Grudzinskas JG.
Publication Types:
· Comment
· Letter
PMID: 14688193 [PubMed]
211: Hum Reprod. 2004 Jan;19(1):179-84. Related Articles, Links
The evaluation of the effectiveness of an intrauterine-administered progestogen (levonorgestrel) in the symptomatic treatment of endometriosis and in the staging of the disease.
Lockhat FB, Emembolu JO, Konje JC.
Department of Obstetrics and Gynaecology, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, UK.
BACKGROUND: Medical treatment of endometriosis, a condition which significantly affects the quality of life in approximately 10-15% of women in the reproductive years, remains problematic. Although oral progestogens are effective and cheap, their efficacy is significantly influenced by poor compliance and systemic side effects. A progestogen (levonorgestrel) administered via an intrauterine system (Lng-IUS) has been demonstrated to improve symptoms of endometriosis; however, its effect on the staging of the disease has not been evaluated. The aims of this study were therefore to investigate the effectiveness of Lng-IUS in the symptomatic relief of minimal to moderate endometriosis and in the staging of the disease. METHODS: This was a prospective non-comparative observational study in which 34 women with clinically suspected and laparoscopically confirmed symptomatic minimal to moderate endometriosis had Lng-IUS inserted for 6 months. The symptom profile and stage of the disease before, during and after 6 months of treatment and patients' satisfaction with treatment and willingness to retain the device at the end of the study period were used to assess response to treatment. RESULTS: Of the 34 women recruited, 29 (85%) completed the study; five discontinued, for personal reasons (one), side effects of worsening of acne (one) and lower abdominal/ pelvic pain (three). Significant (P<0.05) improvements in severity and frequency of pain and menstrual symptoms as well as staging were achieved, with 68% (23) of cases electing to continue with the device after 6 months of therapy. CONCLUSION: The levonorgestrel intrauterine system is an effective hormonal option for treating symptomatic endometriosis (minimal to moderate). It also alters the American Fertility Society staging of disease. With a continuation rate of 68% after 6 months, it has the potential for providing long-term therapy in a substantial number of sufferers, although this would require further study and verification.
PMID: 14688179 [PubMed]
212: Hum Reprod. 2004 Jan;19(1):172-8. Related Articles, Links
Concentration of soluble intercellular adhesion molecule-1 in serum samples from patients with endometriosis collected during the luteal phase of the menstrual cycle.
Steff AM, Gagne D, Page M, Hugo P, Gosselin D.
MetrioGene BioSciences, Inc (a subsidiary of Procrea BioSciences, Inc), 6100 Royalmount Avenue, Montreal (Quebec) H4P 2R2, Canada.
BACKGROUND: Soluble intercellular adhesion molecule-1 (sICAM-1), released by endometriotic lesions, is involved in the regulation of cytotoxic processes. Altered levels of sICAM-1 in the circulation could parallel its deregulation in the peritoneal cavity. We therefore investigated whether sICAM-1 could represent a serum marker for endometriosis. METHODS: sICAM-1 levels were measured by enzyme-linked immunosorbent assay in serum samples from 176 subjects with surgically confirmed endometriosis (134 patients with stage I-II and 42 patients with stage III-IV) and 198 controls with no surgical evidence of the disease. All serum samples were collected during the luteal phase of the menstrual cycle. Detailed information about demographics, symptoms and clinical profile were collected. RESULTS: Mean levels of sICAM-1 appeared significantly reduced in patients with stage III-IV endometriosis in a crude comparison of means. However, when means were adjusted for potential confounders such as the pre-operative indication or fertility status, no significant difference between cases with stage III-IV disease and controls was observed. CONCLUSIONS: Serum levels of sICAM-1 during the luteal phase of the cycle are not able to discriminate women suffering from endometriosis from controls when confounders are taken into account. These results underline the importance of careful identification of confounders, based on patients' demographic and clinical data in studies aiming at discovering diagnostic markers for endometriosis.
PMID: 14688178 [PubMed]
213: Hum Reprod. 2004 Jan;19(1):168-71. Related Articles, Links
Association rate between deep peritoneal endometriosis and other forms of the disease: pathogenetic implications.
Somigliana E, Infantino M, Candiani M, Vignali M, Chiodini A, Busacca M, Vignali M.
II Department of Obstetrics and Gynecology, Clinica L.Mangiagalli, University of Milan, Milan, Italy. dadosomigliana@yahoo.it
BACKGROUND: It has been suggested recently that deep endometriosis and the other forms of the disease do not share a common pathogenetic mechanism. In this study, we hypothesize that, if this is true, deep peritoneal endometriosis and the other forms should not be significantly associated. METHODS: Clinical and surgical records of all women who were referred to the Department of Obstetrics and Gynecology, Clinica 'L.Mangiagalli' between January 1995 and June 2002 and who were diagnosed with deep peritoneal pelvic endometriosis at the time of surgery were retrieved. The concomitant presence of superficial endometriotic implants, endometriomas and pelvic adhesions was evaluated. A binomial probability distribution model was used to calculate the 95% confidence interval (95% CI) of the association rates. RESULTS: Ninety-three women with deep peritoneal endometriosis were identified. The presence of superficial endometriotic implants, endometriomas and pelvic adhesions was documented in 61.3% (95% CI 51.4-71.2%), 50.5% (95% CI 40.3-60.7%) and 74.2% (95% CI 65.3-83.1%) of patients with deep endometriotic nodules, respectively. Overall, deep peritoneal endometriosis was the only form of the disease in only 6.5% (95% CI 2.8-12.3%) of cases. No relevant differences regarding these associations were observed according to the location and the size of the deep endometriotic nodules. CONCLUSIONS: Results from this study do not support the hypothesis that deep endometriosis should be considered as a distinct entity of the disease.
PMID: 14688177 [PubMed]
214: Hum Reprod. 2004 Jan;19(1):160-7. Related Articles, Links
The effects of post-surgical administration of goserelin plus anastrozole compared to goserelin alone in patients with severe endometriosis: a prospective randomized trial.
Soysal S, Soysal ME, Ozer S, Gul N, Gezgin T.
Department of Obstetrics and Gynecology, Pamukkale University Medical Center, 20100 Denizli, Turkey. msoysal@superonline.com
BACKGROUND: Among patients using GnRH analogues for endometriosis it has been postulated that peripheral and inflammation-induced in-situ aromatization of adrenal androgens are probably the main reasons for the high rates of failure during follow-up. We hypothesized that in cases with premenopausal severe endometriosis, use of a combination of anastrozole and goserelin to achieve almost maximal endocrine blockade of estrogen synthesis after conservative surgery may increase the pain-free interval and reduce the recurrence rates as compared to goserelin alone. METHODS: In a prospective randomized trial, we evaluated the efficacy of using either a combination of anastrozole and goserelin for 6 months or goserelin alone for 6 months after conservative surgery for severe endometriosis. The primary outcome measures were the symptom recurrence rates and the impact of treatment on endometriosis-related multidimensional score. The secondary outcome measures were the impact of allocated treatment regimens on menopausal quality of life and on lumbar spine bone mineral density (BMD). RESULTS: When we analyzed the Kaplan-Meier survival curves, we detected a statistically significant advantage of goserelin plus anastrozole as compared to goserelin only, in terms of the median time to detect symptom recurrence (>2.4 versus 1.7 months; log-rank test; P=0.0089). This statistically significant advantage occurred with a relative risk of 4.3 [95% confidence interval (CI) 1.3-9.8]. Three cases out of 40 recurred in the goserelin plus anastrozole arm (7.5%), whereas we detected recurrences in 14 cases out of 40 cases in the goserelin-only arm (35%) during the follow-up period of 24 months. Based on these data, the interpretation of Kaplan-Meier curves indicates that at the end of follow-up, 54.7 versus 10.4%, respectively, of the patients were free of recurrence. The mean of the differences in terms of Deltabaseline-24 months post-medical therapy multidimensional score were statistically significant in favour of goserelin and anastrozole (9.2 +/- 2.1 versus 6.7 +/- 2.8; paired t-test; P<0.0001; 95% CI 1.5-4.0). We observed a statistically significant difference in suppression of estradiol concentrations and a significantly greater BMD loss at the end of treatment in the goserelin and anastrozole arm as compared to goserelin-only arm. However, this did not elicit deterioration in menopausal quality of life and the observed bone loss was not significant in terms of DeltaBMD between the groups at 2 years of treatment withdrawal. CONCLUSIONS: Six months of treatment with anastrozole and goserelin as compared to goserelin alone increased the pain-free interval and decreased symptom recurrence rates in patients following surgery for severe endometriosis. Furthermore, menopausal quality of life and BMD at 2 years after medical therapy remained unaffected.
PMID: 14688176 [PubMed]
215: Hum Reprod. 2004 Jan;19(1):96-103. Related Articles, Links
Differences in time to natural conception between women with unexplained infertility and infertile women with minor endometriosis.
Akande VA, Hunt LP, Cahill DJ, Jenkins JM.
University Division of Obstetrics and Gynaecology, University of Bristol, St Michael's Hospital, Bristol BS2 8EG, UK. valentine.akande@bristol.ac.uk
BACKGROUND: Opinion remains divided as to whether finding endometriotic lesions in the absence of adhesions has an adverse effect on the likelihood of conception. METHODS: This was a retrospective study of 192 fully investigated infertile couples, followed up for up to 3 years following laparoscopy. Women studied were ovulating, <40 old years and their partners had normal sperm parameters. All 117 women with unexplained infertility and 75 with minimal/mild endometriosis without adhesive disease were managed conservatively. RESULTS: Women with endometriosis were found to have a lower probability of pregnancy compared with women with unexplained infertility (36% versus 55%; P<0.05). Other factors adversely associated with pregnancy were primary infertility, smoking and longer duration (>3 years) of infertility. However, the effects of duration of infertility and primary infertility were not observed to be statistically significant for women with endometriosis. CONCLUSIONS: The findings, although undertaken in a select population undergoing laparoscopy, suggest the likelihood of pregnancy is reduced in infertile women with minimal/mild endometriosis compared with those infertile women with a normal pelvis. Duration of infertility and a previous history of pregnancy are important in predicting the likelihood of pregnancy in women with no obvious cause for their infertility (unexplained), whilst the relationship may be more complex in women with minor endometriosis
PMID: 14688164 [PubMed]
216: Appl Psychophysiol Biofeedback. 2003 Dec;28(4):279-89. Related Articles, Links
The use of thermal biofeedback in the treatment of pain associated with endometriosis: preliminary findings.
Hawkins RS, Hart AD.
Graduate School of Psychology, Fuller Theological Seminary, Pasadena, California, USA. drrebeccahawkins@hotmail.com
Endometriosis is a common gynecological disease that causes marked physical and emotional distress in lives of women, resulting in dysmenorrhea, pain, or both throughout the menstrual cycle in over 96% of cases. A multiple case study design (N = 5) was employed to investigate the use of thermal biofeedback in the treatment of pain associated with endometriosis. The majority of participants (4 out of 5) were able to demonstrate mastery over hand temperature through thermal biofeedback. Of those participants, significant reductions in various aspects of pain were observed by the end of the study; one had a significant increase in Life Control; two had reductions in Pain Severity; three had a decrease in Affective Distress; and all 4 demonstrated reduction in Life Interference, as measured by the West Haven-Yale Multidimensional Pain Inventory. This is a preliminary study with a small sample size and without a control sample; hence, the results are considered only as suggestive of the potential use of biofeedback therapy in alleviating pain and associated symptomatology related to endometriosis. Further research is warranted.
PMID: 14686081 [PubMed]
217: Ginecol Obstet Mex. 2003 Sep;71:455-9. Related Articles, Links
[Influence of sperm morphology on results of intrauterine insemination]
[Article in Spanish]
Saucedo de la Llata E, Moraga Sanchez MR, Batiza Resendiz V, Galache Vega P, Santos Haliscak R, Hernandez Ayup S.
Instituto para el Estudio de la Concepcion Humana (IECH), Monterrey, N.L.-Centro de Ginecologia y Obstetricia de Monterrey, S.A. (CGOMSA).
OBJECTIVE: To determine the influence of sperm morphology, according to WHO criteria, on pregnancy rates of couples who were submitted to intra-uterine insemination (IUI). MATERIAL AND METHODS: Retrospective study that included 787 IUI cycles performed in the Instituto para el Estudio de la Concepcion Humana in Monterrey, Mexico, from January to December 2002. Main diagnosis were anovulation, male factor, endometriosis, and cervical factor. All patients were allocated into a controlled ovarian hyperstimulation protocol with either clomiphene citrate, menotropins and/or recombinant FSH. RESULTS: A total of 115 pregnancies were achieved (pregnancy rate per cycle of 14.61%). When seminal parameters were analyzed as independent factors it was found that a motility less than 10%, total motile count after sperm preparation less than 1 million/ml and sperm motility less than 20% had a pregnancy rate of zero. CONCLUSIONS: Patients with normal sperm forms less than 20% according to WHO criteria have no benefit with the IUI and these patients should be canalized to ART.
PMID: 14686057 [PubMed]
218: Pharmacogenomics. 2004 Jan;5(1):57-65. Related Articles, Links
Applications of polymorphisms and pharmacogenomics in obstetrics and gynecology.
Tempfer CB, Schneeberger C, Huber JC.
Department of Obstetrics & Gynaecology, University of Freiburg Medical School, Freiburg, Germany. clemens.tempfer@akh-wien.ac.at
The number of reports investigating disease susceptibility based on the carriage of low-penetrance, high-frequency polymorphisms has steadily increased over the last years. Evidence based on meta-analyses of individual case-control studies is accumulating, defining specific individual variations in disease susceptibility. For example, genetic variations of the estradiol metabolism have been described as significant contributors to disease susceptibility with variations depending on ethnic background. In the field of obstetrics and gynecology, the genetic contribution of polymorphic markers to a series of disorders has been characterized. These disorders include recurrent pregnancy loss, pre-eclampsia, endometriosis, breast cancer, and hormone replacement therapy (HRT)-related complications such as thrombosis. Among other genetic markers, thrombophilic genetic variants, such as the Factor V Leiden and prothrombin G20210A polymorphisms, as well as genetic variants of cytochrome P450 (CYP) enzymes, for example, CYP19 and CYP1B1, have been established as genetic risk markers and disease modifiers of recurrent and sporadic pregnancy loss and HRT-independent and -dependent breast cancer, respectively. In addition, meta-analyses of data in the literature established the TGFBR1*6A, GSTP I105V, and TP53 R72P polymorphisms, as well as the GSTM1 gene deletion as low-penetrance genetic risk factors of sporadic breast cancer. With respect to genetic modulation of therapeutic effects, beneficial effects of estrogen replacement therapy and HRT are modulated by the carriage of single nucleotide polymorphisms, for example, osteoprotection and blood lipid changes by the estrogen receptor-alpha (ER-a) PvuII polymorphism. Polymorphisms of the catechol-O-methyltransferase (COMT), ER-alpha, IL-1 receptor antagonist, and Factor V genes have been demonstrated to modulate the timing of natural menopause. Lastly, a strong genetic contribution of polymorphisms to the development and the clinical course of endometriosis has been established with data pointing to polymorphisms of the COMT, GST, NAT-2, and ER-alpha genes as susceptibility markers. In summary, the available evidence points to a number of polymorphisms of a wide variety of genes as strong hereditary determinants of the susceptibility to benign and malignant gynecologic and obstetric conditions.
PMID: 14683420 [PubMed]
219: Reprod Biol Endocrinol. 2003 Dec 16;1(1):125. Related Articles, Links
Gonadotropin releasing hormone analogue (GnRHa) alters the expression and activation of Smad in human endometrial epithelial and stromal cells.
Luo X, Xu J, Chegini N.
Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA. cheginin@obgyn.ufl.edu
Gonadotropin releasing hormone analogues (GnRHa) are often used to regress endometriosis implants and prevent premature luteinizing hormone surges in women undergoing controlled ovarian stimulation. In addition to GnRH central action, the expression of GnRH and receptors in the endometrium implies an autocrine/paracrine role for GnRH and an additional site of action for GnRHa. To further examine the direct action of GnRH (Leuprolide acetate) in the endometrium, we determined the effect of GnRH on endometrial stromal (ESC) and endometrial surface epithelial (HES) cells expression and activation of Smads (Smad3, -4 and -7), intracellular signals activated by transforming growth factor beta (TGF-beta), a key cytokine expressed in the endometrium. The results show that GnRH (0.1 microM) increased the expression of inhibitory Smad7 mRNA in HES with a limited effect on ESC, while moderately increasing the common Smad4 and Smad7 protein levels in these cells (P < 0.05). GnRH in a dose- (0.01 to 10 microM) and time- (5 to 30 min) dependent manner decreased the rate of Smad3 activation (phospho-Smad3, pSmad3), and altered Smad3 cellular distribution in both cell types. Pretreatment with Antide (GnRH antagonist) resulted in further suppression of Smad3 induced by GnRH, with Antide inhibition of pSmad3 in ESC. Furthermore, co-treatment of the cells with GnRH + TGF-beta, or pretreatment with TGF-beta type II receptor antisense to block TGF-beta autocrine/paracrine action, in part inhibited TGF-beta activated Smad3. In conclusion, the results indicate that GnRH acts directly on the endometrial cells altering the expression and activation of Smads, a mechanism that could lead to interruption of TGF-beta receptor signaling mediated through this pathway in the endometrium.
PMID: 14678567 [PubMed]
220: J Obstet Gynaecol. 2004 Jan;24(1):64-6. Related Articles, Links
The effect of a gonadotrophin-releasing hormone analogue as first-line management in cyclical pelvic pain.
Baxter N, Black J, Duffy S.
University Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds, UK.
One of the most common gynaecological causes of chronic pelvic pain is endometriosis. A lack of correlation between laparoscopic findings and pelvic pain has been reported. As endometriotic lesions are under hormonal influence, the effects of the gonadotrophin-releasing hormone (GnRH) analogues cause shrinkage of the deposits, reducing symptoms caused by them. We carried out a longitudinal, interventional pilot study, examining the effect of leuprorelin acetate 3.75 mg (Prostap SR, Wyeth) on pelvic pain prospectively. Preliminary data shows a decrease in pain scores from before to after treatment which is statistically significant (P<0.0001) as well as a general improvement in other symptoms. Laparoscopy showed that symptom intensity is not always related to severity of endometriosis and the worst symptoms may not necessarily be due to pathology. Therefore, it is beneficial to treat women with CPP with GnRH analogues as first-line management to relieve painful symptoms, avoid surgical risks and save money.
PMID: 14675984 [PubMed]
221: Gynecol Oncol. 2003 Dec;91(3):643-7. Related Articles, Links
Ovarian endometrioid adenocarcinoma arising from endometriosis in a young woman.
Tagashira Y, Shimada M, Kigawa J, Iba T, Terakawa N.
Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishimachi Yonago, 6838504, Japan.
BACKGROUND: The risk of ovarian cancer increases in women with a long history of ovarian endometriosis, particularly in postmenopausal women. We present here a case of malignant transformation of endometriosis occurring over a short time in a young woman. CASE: The 27-year-old woman underwent laparoscopic cystectomy and was diagnosed with left ovarian endometrioma with an accompanying high level of serum CA125 (734.6 U/mL). Fourteen months later, she underwent cytoreductive surgery for her ovarian cancer. Histological examination revealed endometrioid adenocarcinoma with transitions between endometriosis and adenocarcinoma. She was diagnosed as having stage IIIc of ovarian cancer with paraaortic lymphnode involvement. CONCLUSION: We suggest that endometrial cyst of the ovary associated with high levels of serum CA125 should be managed with special care even in a young woman.
Publication Types:
· Case Reports
PMID: 14675692 [PubMed]
222: Ginekol Pol. 2003 Sep;74(9):1014-7. Related Articles, Links
[Comparison of assessing the patency of the Fallopian tubes during laparoscopy and during hysterosalpingography on television in infertile women with endometriosis]
[Article in Polish]
Salata I, Gottwald L, Sobkiewicz S.
II Kliniki Ginekologi, Instytutu Ginekologii i Poloznictwa UM w Lodzi.
OBJECTIVES: Sterility become nowadays not only medical, but as well socio-economic problem. One of its major causes is endometriosis. Recurrent adnexitis--one of the most common symptoms of endometriosis might be the cause of fallopian tubes occlusion. The hysterosalpingography (HSG) can be helpful to diagnose this tubal pathology. DESIGN: To compare the assessment of fallopian tubes patency during HSG with the results of laparoscopy in infertile women with endometriosis. MATERIAL AND METHODS: 331 women with endometriosis who were diagnosed during laparoscopy examination between 1998-2002 due to sterility. The presence of endometriosis was confirmed during laparoscopy. In each patient the control of the patency of both fallopian tubes was performed. These data were confirmed with those from HSG performed during follicular phase on the television path. The absence of the contrast passage through fallopian tubes as well as the only trace contrast passage into abdominal cavity were classified as tubal obstruction. RESULTS: In patients during the HSG physiological uterine shape and size in 91.3%, the bicornis uterus in 6.6%, and the unicornis uterus in 2.1% were observed. During laparoscopy we diagnosed the physiological uterine shape and size in 88.8%, the bicornis uterus in 8.2%, and the unicornis uterus in 3.0%. The diagnostic compatibility of these both examinations was 90.6%. In HSG the correct anatomical course of both fallopian tubes without occlusions in 51.7%, the only unilateral patency in 36.7%, and bilateral occlusions in 11.6% were found. During laparoscopy we diagnosed the anatomical course of both fallopian tubes without occlusions in 36.7%, the only unilateral patency in 33.3%, and bilateral occlusions in 30.0%. The diagnostic compatibility of these both examinations was 49.6% for both fallopian tubes, and 34.2% for the only one fallopian tube. In 16.2% both results were incompatible. CONCLUSIONS: The incorrect contrast passage through the fallopian tubes and its increased pressure during HSG in women with the characteristic history and clinical symptoms can suggest endometriosis. In these cases laparoscopy is necessary as the additional examination in the diagnostics of fallopian tubes patency, but the only objective method in diagnosis of endometriosis.
PMID: 14674161 [PubMed]
223: Ginekol Pol. 2003 Sep;74(9):992-6. Related Articles, Links
[Tumor necrosis factor alpha and interferon gamma levels in peritoneal fluid of infertile women]
[Article in Polish]
Polak G, Koziol-Montewka M, Tarkowski R, Kotarski J.
I Katedry i Kliniki Ginekologii AM w Lublinie.
Changes in the peritoneal fluid environment have been implicated in the pathogenesis of endometriosis as well as in the decrease of fertility. Tumor necrosis factor alpha (TNF alpha) and interferon gamma (IFN gamma) play a critical role in the generation of the immune response, leading to the enhanced proinflammatory cytokines and free radicals production. MATERIALS AND METHODS: 59 women were studied, including 24 patients with unexplained infertility, 10 infertile women with endometriosis (Io or IIo rAFS), 11 patients with PCOS and 14 patients with tubal occlusion. TNF alpha and IFN gamma concentrations were measured in the PF using commercially available ELISA kits. RESULTS: Peritoneal fluid IFN gamma concentrations did not differ significantly between the studied groups. TNF alpha levels were significantly (p = 0.02) higher in the PF of endometriotic patients compared to women with tubal infertility. The positive correlation (R = 0.83; p < 0.01) has been found between TNF alpha and IFN gamma levels. CONCLUSIONS: Increased PF TNF alpha levels observed in patients with endometriosis may play a role in activation of peritoneal macrophages. Positive correlation between TNF alpha and IFN gamma suggests their synergistic stimulatory effect on the immunocompetent PF cells.
PMID: 14674157 [PubMed]
224: Ginekol Pol. 2003 Sep;74(9):959-67. Related Articles, Links
[Innate immunity participation in the pathogenesis of endometriosis]
[Article in Polish]
Kamer-Bartosinska A, Szyllo K, Tchorzewski H, Lewy J.
Kliniki Ginekologii Operacyjnej Instytutu Centrum Zdrowia Matki Polki w Lodzi.
Endometriosis is a serious clinical problem among the women treated because of gynecological reasons. The frequency of its occurrence is estimated for 10-15% of all women at reproductive age. AIM: This study evaluates the chosen phenomenons participating in innate immunity and their role in the pathogenesis of endometriosis. MATERIALS AND METHODS: 42 patients aged 22 to 39 years old treated in Surgical Gynecology Department of Polish Mother Health Centre Research Institute were the study group. Comparative group consisted of 22 age-matched women with no clinical complains. We evaluated production of reactive oxygen intermediates by peripheral blood neutrophils in both groups of women (both spontaneous and stimulated with fMLP) using the chemiluminescence test. We used neutrophils, both resting and previously preactivated with TNF-alpha. The activity of C3 and C4 complement components and total antioxidant status were also measured. RESULTS: Showed that the chemiluminescence values were higher in patients with endometriosis than in comparative group. Preactivation of neutrophils with the use of TNF-alpha was significantly weakened. Both C3 and C4 complement components revealed higher activity in women with endometriosis as compared to those without this disease. Total antioxidant status values were significantly lower in patients with endometriosis than in women from the comparative group. CONCLUSION: Innate immunity may play a significant role in the pathogenesis of endometriosis due to changes in its components activity that are observed in the course of this disease.
PMID: 14674152 [PubMed]
225: Acta Cytol. 2003 Nov-Dec;47(6):1059-62. Related Articles, Links
Fine needle aspiration cytology of an ovarian luteinized follicular cyst mimicking a granulosa cell tumor. A case report.
Dejmek A.
Department of Clinical Pathology and Cytology, Lund University, Malmo University Hospital, S-205 02 Malmo, Sweden.
BACKGROUND: Fine needle aspiration is a valuable tool in the diagnosis of ovarian cysts, especially in the young and when a nonneoplastic cyst is suspected. High cellularity, epitheliallike clusters and cellular atypia in aspirates from functional cysts are known features that may lead to an erroneous diagnosis of malignancy. Granulosa cells in ovarian cystic fluids may originate in follicular cysts or cystic granulosa cell tumors. In luteinized follicular cysts the cells usually have ample cytoplasm and tend to form clusters. This report draws attention to a case where abundant, dispersed cells lacking cytoplasm led to the incorrect diagnosis of a granulosa cell tumor. CASE: In an ovarian cystic aspirate from a 34-year-old woman, the fluid was highly cellular, with a striking predominance of cells interpreted as granulosa cells. Granulosa cells are often found in aspirates from functional cysts, but striking cellularity, prominent nuclear grooves and lack of luteinization made us consider a granulosa cell tumor rather than a follicle-derived cyst. Surgery was performed, and histology revealed a benign serous cystadenoma but also numerous maturing follicles and follicular cysts with thick layers of granulosa cells. The aspirate obviously did not represent the cystadenoma but one of the prominent follicular cysts. CONCLUSION: An understanding of the cytologic features of functional ovarian cysts, including the pitfalls, is necessary to avoid a false diagnoses of a neoplastic lesion. For a correct interpretation of the cytologic findings, close communication with the clinician and with the radiologist performing the aspiration is of vital importance.
PMID: 14674080 [PubMed]
226: Gynecol Obstet Invest. 2004;57(2):90-2. Epub 2003 Dec 09. Related Articles, Links
Endometriotic uterocutaneous fistula after cesarean section. A case report.
Dragoumis K, Mikos T, Zafrakas M, Assimakopoulos E, Stamatopoulos P, Bontis J.
1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokrateio General Hospital, Thessaloniki, Greece.
Endometriosis outside the pelvis is rare and most cases occur in surgical scars after operations involving the female genital tract. Fistulae involving the uterus are also very rare, usually being the result of postpartum and postoperative complications. In the present report, a case of a 44-year-old patient with an endometriotic uterocutaneous fistula is described. The patient presented 6 years after her fourth cesarean section with a painful nodule on the cesarean scar, which was bleeding during menstruation. The lesion extended to the uterine fundus, connecting the endometrial cavity with the skin. This is merely the second case of a uterocutaneous fistula to be reported in the literature and the first case developed on grounds of endometriosis. Copyright 2004 S. Karger AG, Basel
PMID: 14671417 [PubMed]
227: Ginekol Pol. 2003 Oct;74(10):1379-85. Related Articles, Links
[Effect of combined surgical and pharmacologic treatment on peripheral blood cytokine concentrations in women with endometriosis]
[Article in Polish]
Szyllo K, Tchorzewski H, Kamer-Bartosinska A, Lewy J.
Kliniki Ginekologii Operacyjnej Instytutu Centrum Zdrowia Matki Polki w Lodzi.
Endometriosis is a disease causing the growth of endometrial tissue outside its proper localisation. The frequency of this disease occurrence is estimated for about 10% of women at reproductive age. More and more often scientific studies reveal the key role of immunological disorders as the factor contributing to the development of endometriosis. Investigators pay their attention not only on the composition of immunological cells, but on the amount and proportion of their products, including cytokines, as well. Aim of the study was the evaluation of cytokine generation by peripheral blood lymphocytes derived from women with endometriosis, as well as the estimation of combined surgical and pharmacological treatment influence on this production. MATERIAL AND METHODS: The study group consisted of 72 patients treated in Surgical Gynecology Department of Polish Mother Health Centre Research Institute in Lodz, in years 1998-2002. Endometriosis was diagnosed during laparoscopy or laparotomy in 60 of them. The diagnosis was confirmed in histopathological examination. 14 of those patients were qualified to 6 months long Zoladex therapy (AstraZeneca), following the operation. Zoladex was used in a dose of 3.6 mg per month. Evaluation of the cytokine generation was performed before the treatment and repeated after the full therapy. 12 women with no signs of endometriosis lesions existence were the comparison group. Immunofluorescence method ELISA and ENDOGEN commercial kits were used for evaluating the cytokine concentration levels. RESULTS: Significant decrease in IFN-gamma generation (p < 0.05) by peripheral blood lymphocytes was noted in women with endometriosis before the treatment as compared to women without this disease. Therapy caused its increase and the difference was statistically significant. Significantly higher levels of the IL-4 generation after PHA stimulation were also observed in women with endometriosis then in women from the comparative group. The therapy of endometriosis caused the decrease in IL-4 production, but the differences were not statistically significant (p < 0.05). Significant differences in IL-4 generation after the treatment as compared to the values noted before the treatment were observed only after using conkanavaline A as the lymphocyte stimulator. Generation levels of IL-2, IL-10 and IL-12 did not vary significantly after the combined surgical and pharmacological treatment of endometriosis. CONCLUSIONS: 1. Significant decrease in IFN-gamma concentration was shown in patients with endometriosis, which proves the role of this cytokine in the pathogenesis of this disease. 2. Combined surgical and pharmacological treatment causes the increase in IFN-gamma production by peripheral blood lymphocytes.
PMID: 14669448 [PubMed]
228: Surg Today. 2003;33(12):944-7. Related Articles, Links
Acute small bowel obstruction secondary to ileal endometriosis: report of a case.
Ridha JR, Cassaro S.
Department of Surgery, Cabrini Medical Center, Mount Sinai School of Medicine, 227 East 19th Street, New York, NY 10003, USA.
We report a case of acute small bowel obstruction occurring secondary to endometriosis of the terminal ileum. Ileal endometriosis is a rare condition that can cause acute small bowel obstruction. As this case and others in the literature highlight, establishing a preoperative diagnosis is very difficult due to the vagueness of symptoms and similarity in presentation to other causes of obstruction, and is based on a high index of suspicion. However, this disorder should be considered in the differential diagnosis of women of child-bearing age who present with symptoms of obstruction. The definitive treatment includes resection of the involved segment with primary anastomosis, and adjuvant hormonal therapy may prevent recurrence.
PMID: 14669090 [PubMed]
229: Dis Colon Rectum. 2003 Dec;46(12):1667-73. Related Articles, Links
Rectal endometriosis: high sensitivity and specificity of endorectal ultrasound with an impact for the operative management.
Doniec JM, Kahlke V, Peetz F, Schniewind B, Mundhenke C, Lohnert MS, Kremer B.
Department for General and Thoracic Surgery, University of Kiel, Arnold-Heller-Strasse 7, 24105 Kiel, Germany.
PURPOSE: In patients with histopathologically proven or suspected endometriosis with possible involvement of the rectum, endorectal ultrasound was performed to determine the sensitivity and specificity of this method with regard to rectal wall involvement and the impact on the following operation. METHODS: In an historical cohort analysis, 85 females with histopathologically proven or suspected endometriosis with possible involvement of the rectum were treated between 1992 and 2001. Endorectal ultrasound was performed with a 7.5 MHz real-time unit, and results of endorectal ultrasound were compared with intraoperative findings and histopathologic diagnosis of 65 patients undergoing operation. A questionnaire was used to evaluate postoperative signs and symptoms. RESULTS: Of 65 patients undergoing surgery, 37 underwent laparotomy with 25 resections of the bowel and 28 laparoscopy. In 31 of 32 patients with suspected rectal wall infiltration, preoperative endorectal ultrasound diagnosis was confirmed. In patients in whom endorectal ultrasound showed no rectal wall involvement, histopathology revealed infiltration in one patient, leading to sensitivity of 97 percent and specificity of 97 percent with regard to rectal wall involvement. In terms of the deepness of rectal wall infiltration, endorectal ultrasound had a sensitivity of 76 percent with regard to infiltration of the muscularis propria and 66 percent for infiltration of the submucosa. Operations led to a significant (P < 0.05) reduction of preoperative symptoms by approximately 60 percent. CONCLUSIONS: Endorectal ultrasound is a useful, noninvasive technique for preoperative evaluation of possible rectal wall involvement in endometriosis. Based on the high sensitivity and specificity, recommendation for laparotomy and bowel resection in cases with suspected rectal involvement can be facilitated.
PMID: 14668593 [PubMed]
230: Steroids. 2003 Nov;68(10-13):1019-32. Related Articles, Links
Asoprisnil (J867): a selective progesterone receptor modulator for gynecological therapy.
DeManno D, Elger W, Garg R, Lee R, Schneider B, Hess-Stumpp H, Schubert G, Chwalisz K.
TAP Pharmaceutical Products Inc., 675 N. Field Drive, Lake Forest, IL 600452, USA.
Asoprisnil is a novel selective steroid receptor modulator that shows unique pharmacodynamic effects in animal models and humans. Asoprisnil, its major metabolite J912, and structurally related compounds represent a new class of progesterone receptor (PR) ligands that exhibit partial agonist and antagonist activities in vivo. Asoprisnil demonstrates a high degree of receptor and tissue selectivity, with high-binding affinity for PR, moderate affinity for glucocorticoid receptor (GR), low affinity for androgen receptor (AR), and no binding affinity for estrogen or mineralocorticoid receptors. In the rabbit endometrium, both asoprisnil and J912 induce partial agonist and antagonist effects. Asoprisnil induces mucification of the guinea pig vagina and has pronounced anti-uterotrophic effects in normal and ovariectomized guinea pigs. Unlike antiprogestins, asoprisnil shows only marginal labor-inducing activity during mid-pregnancy and is completely ineffective in inducing preterm parturition in the guinea pig. Asoprisnil exhibits only marginal antiglucocorticoid activity in transactivation in vitro assays and animal models. In male rats, asoprisnil showed weak androgenic and anti-androgenic properties. In toxicological studies in female cynomolgus monkeys, asoprisnil treatment abolished menstrual cyclicity and endometrial atrophy. Early clinical studies of asoprisnil in normal volunteers demonstrated a dose-dependent suppression of menstruation irrespective of the effects on ovulation, with no change in basal estrogen concentrations and no antiglucocorticoid effects. Unlike progestins, asoprisnil does not induce breakthrough bleeding. With favorable safety and tolerability profiles thus far, asoprisnil appears promising as a novel treatment of gynecological disorders, such as uterine fibroids and endometriosis.
PMID: 14667995 [PubMed]
231: Steroids. 2003 Nov;68(10-13):1005-11. Related Articles, Links
Pharmacologic properties of CDB(VA)-2914.
Gainer EE, Ulmann A.
HRA Pharma, 19, rue Frederick Lemaitre, Paris 75020, France. gainer@hra-pharma.com
CDB(VA)-2914 (17alpha-acetoxy-11beta-(4-N,N-dimethylaminophenyl)-19-norpregna-4,9-diene-3,20-dione) is a synthetic steroid that demonstrates potent progesterone antagonist activity in vitro and in vivo. Its binding and antagonist potency with respect to the glucocorticoid receptor is significantly reduced compared to that of mifepristone, indicating that CDB(VA)-2914 belongs to a new class of dissociated progesterone receptor modulators that have reduced antiglucorticoid activity. The pharmacological effects of CDB(VA)-2914 have been examined in a variety of animal models, the results of which are reviewed in this paper. CDB(VA)-2914 inhibits ovulation in rats in a dose-dependent manner upon single-dose oral administration and exhibits antifertility activity during continuous low-dose administration. CDB(VA)-2914 is also effective in animal models of postcoital contraception. This paper also presents the results of metabolism studies undertaken to link the results of the animal models to potential human applications. Because of its unique pharmacological profile, CDB(VA)-2914 is a promising candidate for use in contraception as well as treatment of uterine fibroids and endometriosis.
PMID: 14667993 [PubMed]
232: Steroids. 2003 Nov;68(10-13):981-93. Related Articles, Links
Progesterone antagonists and progesterone receptor modulators: an overview.
Spitz IM.
Institute of Hormone Research, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel. spitz@rockefeller.edu
Since the original description of the structure of the antiprogestin, mifepristone, was published, numerous related compounds have been synthesized which may function as progesterone antagonists (PAs) or progesterone receptor modulators (PRMs). The latter are mixed agonists-antagonists. Both PAs and PRMs have therapeutic applications in female health care. Mifepristone is predominantly a PA and displays only minimum agonist activity in certain systems. Together with a prostaglandin, mifepristone can terminate pregnancies of less than 9 weeks duration, and it may also be used at later gestational ages. Mifepristone causes expulsion of the uterine contents following intrauterine fetal death. A mifepristone-prostaglandin combination has been shown to be very effective treatment in women with menses delay of 11 days or less. Many PAs and PRMs display antiproliferative effects in the endometrium. Serum estradiol levels however remain in the early to mid-follicular phase range. For this reason, they have application in the treatment of endometriosis and myoma without being associated with bone loss and hypoestrogenism. PRMs may also find application in the treatment of dysfunctional bleeding as well as an adjunct to estrogens in hormone replacement therapy in postmenopausal women. Many PAs have contraceptive potential by suppressing follicular development and blocking the LH surge. Low doses may also be potential contraceptives by retarding endometrial maturation without affecting ovulation or inducing bleeding. Mifepristone is an excellent agent for use as an emergency "postcoital" contraceptive. PAs may also be useful in IVF programs to prevent a premature LH surge and to delay the emergence of the implantation window. In addition to their use in women's health care, mifepristone and several other PAs are potent antiglucocorticoid agents and may be used to treat ACTH-independent Cushing's syndrome. They may also be used in the treatment of tumors containing steroid receptors and in other situations which require suppression of the ACTH-cortisol axis.
PMID: 14667991 [PubMed]
233: Steroids. 2003 Nov;68(10-13):801-7. Related Articles, Links
Paracrine regulation of endometrial function: interaction between progesterone and corticotropin-releasing factor (CRF) and activin A.
Florio P, Rossi M, Sigurdardottir M, Ciarmela P, Luisi S, Vigano P, Grasso D, Fiore G, Cobellis L, Di Blasio AM, Petraglia F.
Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Le Scotte, viale Bracci, Siena 53100, Italy.
Under the influence of ovarian steroid hormones, endometrial cells aer able to produce a wide variety of growth factors and peptide hormones that area believed to promote: (1) physiological growth and differentiation during the endometrial cycle; (2) decidualization, an essential preparative event for establishment of pregnancy; and (3) pathological growth and differentiation in endometriosis and cancer. Among the local factors produced by the human endometrium, corticotropin-releasing factor (CRF) and activin A have been evaluated in terms of localization and effects. CRF is a neuropeptide expressed by the epithelial and stromal cells of the human endometrium in increasing amounts from the endometrial proliferative to the secretory phase. CRF expression also increases in the pregnant endometrium, from early in the pregnancy until term. CRF-type 1 receptor mRNA is only expressed by stromal cells. Progesterone induces CRF gene expression and release from decidualized cells and CRF decidualizes cultured stromal endometrial cells. Urocortin, a CRF-related peptide, has been identified in endometrial epithelial and stromal cells, and its function is still under investigation. Activin A is a growth factor expressed in increasing amounts throughout endometrial phases by both epithelial and stromal cells. This growth factor is secreted into the uterine cavity with higher levels in the secretory phase. Maternal decidua expresses activin A mRNA in increasing amounts from early pregnancy until term. Human endometrium also expresses activin-A receptors and follistatin, its binding protein. Activin A decidualizes cultured human endometrial stromal cells (an effect reversed by follistatin) and modulates embryonic trophoblast differentiation and adhesion. Activin A is expressed in endometriosis and endometrial adenocarcinoma.
PMID: 14667971 [PubMed]
234: Fertil Steril. 2003 Dec;80(6):1524-5. Related Articles, Links
The Glu298-->Asp polymorphism of the endothelial nitric oxide synthase gene is associated with endometriosis.
Zervou S, Karteris E, Goumenou AG, Vatish M, Koumantakis EE, Hillhouse EW.
Publication Types:
· Letter
PMID: 14667898 [PubMed]
235: Fertil Steril. 2003 Dec;80(6):1518-20. Related Articles, Links
Increased concentration of vascular endothelial growth factor in the follicular fluid of patients with endometriosis does not affect the outcome of in vitro fertilization-embryo transfer.
Attar E, Genc S, Bulgurcuoglu S, Topuz S, Serdaroglu H.
Publication Types:
· Letter
PMID: 14667896 [PubMed]
236: Fertil Steril. 2003 Dec;80(6):1450-3. Related Articles, Links
Laparoscopic evaluation following failure to achieve pregnancy after ovulation induction with clomiphene citrate.
Capelo FO, Kumar A, Steinkampf MP, Azziz R.
Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
OBJECTIVE: To assess the value of laparoscopic evaluation of the pelvis after failure to achieve pregnancy with clomiphene citrate-induced ovulation and to determine whether predictors for significant pelvic pathology can be isolated. DESIGN: Retrospective study. SETTING: Tertiary care academic medical center. PATIENT(S): Ninety-two patients failing to conceive after four ovulatory cycles with clomiphene citrate with a normal hysterosalpingogram who underwent laparoscopic evaluation of the pelvis. INTERVENTION(S): Laparoscopy. MAIN OUTCOME MEASURE(S): Presence of pelvic pathology and predictors of pelvic disease. RESULT(S): Of the 92 patients studied, 32 patients (34.8%) had a "positive" laparoscopy (i.e., stages III and IV endometriosis, an endometrioma, pelvic adhesions, and/or tubal disease), 27 patients (29.3%) had stage I or II endometriosis, and 30 patients (32.6%) had a normal pelvis. The predictors for intrapelvic disease were a history of dyspareunia, no prior use of oral contraceptive pills, and no prior use of any form of contraception. Almost 40% of women with predictors had a "positive" laparoscopy, compared with only 12.5% of patients without predictors; however, the majority of patients (91.3%) had at least one predictor. CONCLUSION(S): More than one third of the patients failing to conceive after four ovulatory cycles of clomiphene citrate had significant intrapelvic pathology. Although predictors for intrapelvic disease were isolated, their high prevalence reduced their predictive value.
PMID: 14667882 [PubMed]
237: Fertil Steril. 2003 Dec;80(6):1371-5. Related Articles, Links
Uterine cavity findings and hysteroscopic interventions in patients undergoing in vitro fertilization-embryo transfer who repeatedly cannot conceive.
Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Nagy ZP, Abdelmassih R.
Clinica e Centro de Pesquisa em Reproducao Humana Roger Abdelmassih, Sao Paulo, SP, Brazil. flaviogo2@uol.com.br
OBJECTIVE: To assess hysteroscopic findings in patients undergoing IVF-ET who repeatedly failed to conceive despite transfer of good-quality embryos. DESIGN: Prospective, observational study. SETTING: Clinical research unit for reproductive medic
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