|
251: J Pediatr Adolesc Gynecol. 2003 Dec;16(6):337-47.
Related Articles, Links
Endometriosis from thelarche to midteens: pathogenesis and prognosis, prevention and
pedagogy.
Batt RE, Mitwally MF.
Department of Gynecology-Obstetrics, University at Buffalo, The State University of
New York, Buffalo, New York 14086, USA. rbatt@acsu.buffalo.edu
John Huffman, a founder of the subspecialty of pediatric and adolescent gynecology
in North America, first related the diagnosis of endometriosis to thelarche.
Subsequently, endometriosis was diagnosed in early puberty between thelarche and
menarche. Based on solid evidence, we suggest that the theory of embryonic mullerian
rests be added to currently accepted theories of pathogenesis of endometriosis. This
article argues for recognition of embryonic mullerian rests as the pathogenesis of
some cases of endometriosis not explained by accepted theories. Along with Huffman,
we propose that thelarche be recognized as a developmental benchmark, after which
endometriosis is included in the differential diagnosis of chronic pelvic pain.
Thus, in an effort to refocus research and patient care to early adolescence, this
review is limited to endometriosis occurring in young women from thelarche to their
sixteenth birthday. Relating endometriosis to thelarche has fundamental implications
for pathogenesis, early diagnosis, prognosis, treatment, education, and long-term
care of adolescents.
PMID: 14642954 [PubMed]
--------------------------------------------------------------------------------
252: Can Fam Physician. 2003 Nov;49:1465-72.
Related Articles, Links
Infertility evaluation and management. Strategies for family physicians.
Case AM.
Department of Obstetrics, Gynecology and Reproductive Sciences, Royal University
Hospital, University of Saskatchewan, Saskatoon. Allison.Case@usask.ca
OBJECTIVE: To review family physicians' role in investigation and management of
infertile couples. QUALITY OF EVIDENCE: MEDLINE and PubMed were searched using the
MeSH headings infertility, advanced maternal age, polycystic ovarian syndrome,
clomiphene citrate, and insulin sensitizers. Bibliographies of review articles and
textbooks were also searched. Review articles, randomized trials, observational
studies, and case series are cited. MAIN MESSAGE: Approximately 8% of Canadian
couples have difficulty conceiving. Mother's age significantly affects ability to
conceive. Infertility assessment focuses on ovulatory dysfunction, tubal factors,
sexual factors, and male factors. Women older than 35 years more than 12 months
infertile; women younger than 35 more than 18 months infertile; women likely to have
such problems as anovulation, tubal disease, or endometriosis; women whose partners'
semen tests abnormal; and women who request referral should be referred. Patients
treated with clomiphene citrate should be aware of its potential side effects.
CONCLUSION: Family physicians have an important role in preconception counseling.
Detailed and focused assessment facilitates initial investigations and treatment and
can identify couples who could benefit from referral for further assessment.
Publication Types:
· Review
· Review, Tutorial
PMID: 14649985 [PubMed]
--------------------------------------------------------------------------------
253: Curr Opin Investig Drugs. 2003 Oct;4(10):1209-12.
Related Articles, Links
Use of estrogen antagonists and aromatase inhibitors in endometriosis.
Vigano P, Mangioni S, Odorizzi MP, Chiodini A, Rocca S, Chiodo I.
II Department of Obstetrics and Gynecology, University of Milano, Via Commenda 12,
20122 Milano, Italy. paola.vigano@unimi.it
Endometriosis is an estrogen-dependent disorder mostly occurring in reproductive-age
women. Various therapies have been used in an attempt to treat endometriosis,
including ovarian suppression therapy, surgical treatment or a combination of these
strategies. However, in general, substantial surgery remains the primary treatment
option for endometriosis at all stages. Recently, aromatase inhibitors and
anti-estrogens have been proposed as novel potential candidates. The rationale for
the use of aromatase inhibitors is mostly related to the high aromatase expression
in endometriotic cysts and extra-ovarian endometriotic implants. Among
anti-estrogens, raloxifene has been investigated in animal models with good results,
but in premenopausal women, the compound does not seem to suppress estrogen
production.
Publication Types:
· Review
· Review, Tutorial
PMID: 14649213 [PubMed]
--------------------------------------------------------------------------------
254: Ann N Y Acad Sci. 2003 Nov;997:274-81.
Related Articles, Links
Laparoscopic management of peritoneal endometriosis, endometriotic cysts, and
rectovaginal adenomyosis.
Donnez J, Smets M, Jadoul P, Pirard C, Squifflet J.
Department of Gynecology, Universite Catholique de Louvain, Cliniques Universitaires
St Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium. donnez@gyne.ucl.ac.be
Peritoneal endometriosis is probably caused by the implantation of regurgitated
menstrual cells. The ovarian endometrioma is the consequence of
non-hormone-regulated bleeding from intraovarian epithelial inclusions after they
have undergone metaplasia into endometrial-like tissue. Rectovaginal adenomyosis is,
in fact, an adenomyotic lesion and can develop from Mullerian rests. In conclusion,
peritoneal endometriosis, ovarian endometriosis, and rectovaginal adenomyotic
nodules must be considered as three separate entities with different pathogeneses
that require a different therapeutic approach.
Publication Types:
· Review
· Review, Tutorial
PMID: 14644835 [PubMed]
--------------------------------------------------------------------------------
255: Ann N Y Acad Sci. 2003 Nov;997:269-73.
Related Articles, Links
Laparoscopic management of patients with endometriosis and chronic pelvic pain.
Milingos S, Protopapas A, Drakakis P, Liapi A, Loutradis D, Kallipolitis G, Milingos
D, Michalas S.
1st Department of Obstetrics and Gynecology, University of Athens, Alexandra
Maternity Hospital, 115 28 Athens, Greece.
Endometriosis has been traditionally included among the most important causes of
chronic pelvic pain (CPP) in women of reproductive age. The main clinical
manifestations of endometriosis are dysmenorrhea, dyspareunia, and chronic
nonmenstrual pain. Despite the high prevalence of endometriosis in women suffering
from CPP, controversy still exists regarding the true association between the stage
and extent of this peculiar disease and the severity of pain. Over the last decade,
advances in endoscopic technology have enabled gynecologic surgeons to recognize
many atypical appearances of the endometriotic implants not known to exist before,
thus allowing their complete excision or destruction. Laparoscopic surgery may offer
considerable relief in patients with endometriosis and CPP. Although cases with
advanced endometriosis seem to benefit the most, we also support surgical treatment
in patients with early endometriosis diagnosed using laparoscopy, as many will
experience improvement in their symptoms.
Publication Types:
· Review
· Review, Tutorial
PMID: 14644834 [PubMed]
--------------------------------------------------------------------------------
256: Ann N Y Acad Sci. 2003 Nov;997:229-39.
Related Articles, Links
Endometriosis: treatment strategies.
Valle RF, Sciarra JJ.
Department of Obstetrics and Gynecology, Northwestern University Medical School, 680
N. Lake Shore Drive, Suite 1015, Chicago, IL 60611, USA. rvalle@nmff.org
Endometriosis is often a perplexing medical condition for both the physician and the
patient. Accordingly, development of treatment strategies based on the needs of the
individual patient is highly desirable. Although endometriosis has been part of the
clinical practice for almost a century, many questions remain relating to the
relationship between endometriosis and infertility as well as endometriosis and
pelvic pain. Endometriosis is a disease of reproductive-age women, and it is now
well recognized that a genetic susceptibility appears probable. The prevalence in
the general population has never been clearly established. Factors to consider in
management include the age and reproductive desires of the patient, the stage of the
disease, and, most importantly, the symptoms. Therapeutic options include no
treatment, medical therapy, surgery, or combination therapy. Oral contraceptives,
androgenic agents, progestins, and gonadotropin releasing hormone (GnRH) analogs
have all been used successfully, although at the present time, the latter
preparations are the most popular medical therapy for endometriosis. Leuprolide
acetate, goserelin acetate, and nafarelin acetate are all effective agents. Surgical
therapy is appropriate, especially for advanced stages of the disease. Laparoscopy
is an effective surgical approach with the goal of excision of visible endometriosis
in a hemostatic fashion. Since endometriosis is a chronic condition, it is not
uncommon for recurrences to occur. While endometriosis remains an enigmatic disease,
the introduction of new pharmacologic agents, such as GnRH analogs and newer
endoscopic methods of surgical treatment, have facilitated and improved the overall
management of this disease.
Publication Types:
· Review
· Review, Tutorial
PMID: 14644830 [PubMed]
--------------------------------------------------------------------------------
257: Ann N Y Acad Sci. 2003 Nov;997:223-8.
Related Articles, Links
Urokinase-type plasminogen activator and insulin-like growth factor-binding protein
3 mRNA expression in endometriotic lesions and eutopic endometrium: implications for
the pathophysiology of endometriosis.
Lembessis P, Milingos S, Michalas S, Milingos D, Creatsas G, Sourla A, Koutsilieris M.
Department of Experimental Physiology, University of Athens Medical School, 75
Micras Athens, Goudi-Athens 115 27, Greece.
The peritoneal fluid of women with endometriosis contains an increased insulin-like
growth factor 1 (IGF-1) bioavailability, which is produced by limited hydrolysis of
urokinase-type plasminogen activator (uPA) on IGF-binding protein 3 (IGFBP-3).
Recently, IGF-1 was shown to inhibit apoptosis of endometrial-like cells in vitro,
suggesting that a microenvironment of increased IGF-1 bioavailability can optimize
the survival of endometrial cells grown ectopically. Here the expression of mRNA of
IGFBP-3 and uPA in tissue biopsies from eutopic endometrium and endometriotic
lesions obtained at laparoscopy from women with endometriosis have been analyzed,
and it is documented that both IGFBP-3 and uPA mRNA expression are increased from 3-
to 10-fold in endometriotic lesions versus eutopic endometrium. Consequently, the
necessary components (uPA and IGFBP-3 expression) of endocrine/autocrine/paracrine
enhancement of local IGF bioavailability mediated by uPA hydrolysis of the IGFBP-3
were present in endometriotic lesions. These data possibly explain the origin of the
increased content of uPA activity, IGF-1 bioavailability, and NH(2)-truncated forms
of IGFBP-3 in the peritoneal fluid of women with endometriosis.
PMID: 14644829 [PubMed]
--------------------------------------------------------------------------------
258: Ann N Y Acad Sci. 2003 Nov;997:93-104.
Related Articles, Links
Perimenopausal conception.
Tarlatzis BC, Zepiridis L.
1st Department of Obstetrics and Gynaecology, Unit for Human Reproduction, Aristotle
University of Thessaloniki, Thessaloniki, Greece. tarlatzis@hol.gr
Fertility, defined as the ability to achieve a pregnancy, declines gradually over
the woman's lifespan. Although this decline seems to begin from the age of 30 years,
it is more obvious between 35 and 40 and increases dramatically thereafter. The age
of 41 is considered to be the point when fertility stops and sterility starts. The
actual menopause occurs approximately 10 years after the substantial loss of
conception potential. Thus, the biological rather than the chronological age of the
woman can predict more accurately her fertility potential. This decline in female
reproductive potential correlates with ovarian factors, although a slight
contribution from the uterus itself and from the neuroendocrine axis cannot be
excluded. The ovarian reserve decreases with advancing age, while a parallel
decrease in the quality of the oocytes is present, as indicated by the increased
incidence of oocyte aneuploidy. The endocrine function of the ovary also declines
with age, the later becoming unable to sustain its normal function in the
neuroendocrine axis. Additionally, the role of the various endometrial factors
remains controversial. On the other hand, exposure to toxic factors and the
increased prevalence of infertility-related diseases like endometriosis and PID, may
also contribute. Spontaneous conception rates are minimal in perimenopausal women,
mainly due to a qualitative and quantitative loss of female gametes. In the rare
case of spontaneous conception achievement, complications are more likely. The
application of classic ovulation induction and IVF may serve some selected cases,
where the woman's ovarian biological age does not correspond to her chronological
one. However, the implantation, clinical pregnancy, and live birth rates in women of
advanced age undergoing IVF treatment, show very poor results. On the other hand,
preimplantation genetic diagnosis is an accurate diagnostic tool for exclusion of
genetically deficient embryos prior to embryo transfer. Oocyte donation seems to be
the most reliable option of the perimenopausal woman, since the cumulative birth
rates after four treatment cycles is approximately 80%. Cryopreservation of ovarian
tissue may be an alternative in nulliparas women <40 years of age who want to have
children in the future or women with the same desire who, unfortunately, have had
pelvic radiotherapy, chemotherapy, oophorectomy, or premature menopause. This
technique has given encouraging results in animals, but has not achieved pregnancies
in humans. In the future, the use of drugs to block oocyte depletion as well as
recent techniques, such as cytoplasmic or germinal vesicle transfer, will be more
widely tested and may offer an option to the perimenopausal woman who wishes to
conceive.
Publication Types:
· Review
· Review, Tutorial
PMID: 14644814 [PubMed]
--------------------------------------------------------------------------------
259: Arch Esp Urol. 2003 Oct;56(8):952-4.
Related Articles, Links
[A new case of bladder endometriosis in a patient with a history of Cesarean section]
[Article in Spanish]
Garcia Rodriguez J, Fernandez Gomez JM, Jalon Monzon A, Martin Benito JL, Rodriguez
Faba O, Rodriguez Martinez JJ, Martin Blanco AS, Martinez Gomez FJ, Sanchez Trilla
A, Regadera Sejas J.
Servicio de Urologia I, Hospital Central de Asturias, Oviedo, Asturias, Espana.
OBJECTIVES: To report one new case of endometriosis in a patient with history of
caesarean section. METHODS: It is the case of a female patient presenting with
voiding symptoms and hematuria, with a bladder tumor on ultrasound. RESULTS: After
TUR of a retro trigonal tumor pathology report showed bladder endometriosis.
Treatment was completed with hormone therapy, being the patient relapse free at one
year follow-up. CONCLUSIONS: History of caesarean section is one of the possible
etiologies of bladder endometriosis.
Publication Types:
· Case Reports
PMID: 14639854 [PubMed]
--------------------------------------------------------------------------------
260: Mayo Clin Womens Healthsource. 2001 Dec;5(12):8.
Related Articles, Links
One on one. Can I take hormone therapy for menopause if I have endometriosis?
[No authors listed]
PMID: 14639203 [PubMed]
--------------------------------------------------------------------------------
261: J Urol. 2003 Dec;170(6 Pt 1):2388-9.
Related Articles, Links
Umbilical endometriosis.
Schachter LR, Tash J, Olgac S, Bochner BH.
Department of Urology, SUNY Downstate Medical School, Brooklyn, New York, USA.
Publication Types:
· Case Reports
PMID: 14634427 [PubMed]
--------------------------------------------------------------------------------
262: Mod Pathol. 2004 Jan;17(1):104-8.
Related Articles, Links
Aromatase expression in low-grade endometrial stromal sarcomas: an
immunohistochemical study.
Reich O, Regauer S.
1Department of Obstetrics and Gynecology, University of Graz, Graz, Austria.
Aromatase expression has been described in stromal cells of endometriosis,
adenomyosis and endometrial cancer. We analyzed aromatase expression in a series of
23 low-grade endometrial stromal sarcomas. Archival formalin-fixed and
paraffin-embedded material was analyzed with immunohistochemistry. Aromatase
expression was evaluated with a monoclonal and a polyclonal antibody using the
peroxidase-antiperoxidase method. A score was calculated based on the percentage of
positive tumor cells and the staining intensity. Aromatase was seen in 19 (83%) of
23 tumors with monoclonal antibody and 20 (87%) of 23 tumors with polyclonal
antibody. Aromatase expression using the monoclonal antibody was scored as high in
five (22%), moderate in nine (39%) and low in five (22%) tumors. Four (17%)
low-grade endometrial stromal sarcomas did not stain for aromatase. Aromatase
expression with the polyclonal antibody was scored as high in seven (31%), moderate
in four (17%) and low in nine (39%) tumors. Three (13%) low-grade endometrial
stromal sarcomas did not stain for aromatase. Little or no aromatase expression
tended to correlate with stage I disease, while higher scores were more frequently
associated with advanced disease. Our results demonstrate that most low-grade
endometrial stromal sarcomas express aromatase. The staining pattern, however, is
heterogeneous. The high percentage of aromatase positivity in low-grade endometrial
stromal sarcomas may have implications in the management of these tumors and offer
new treatment modalities such as hormonal therapy with aromatase inhibitors.Modern
Pathology (2004) 17, 104-108, advance online publication, 19 November 2003;
doi:10.1038/modpathol.3800031
PMID: 14631363 [PubMed]
--------------------------------------------------------------------------------
263: Ann Clin Biochem. 2003 Nov;40(Pt 6):663-73.
Related Articles, Links
Clinical and technical evaluation of the ACS:OV serum assay and comparison with
three other CA125-detecting assays.
Davelaar EM, Schutter EM, von Mensdorff-Pouilly S, van Kamp GJ, Verstraeten RA,
Kenemans P.
Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, 1081 HV
Amsterdam, The Netherlands.
BACKGROUND: In this study the clinical and technical performance of the CA125-
detecting Bayer ACS:OV immunoluminometric serum assay was compared with three other
well-established CA125-detecting assays. METHODS: A total of 1112 serum samples was
included in this evaluation: 462 from apparently healthy women, 153 from patients
with benign ovarian disease, 163 from patients with malignant ovarian disease, 10
from patients with borderline ovarian malignancies and 78 samples from 12 ovarian
cancer patients during monitoring of disease. Serum samples from women with
malignant endometrial (n = 68) and colon (n = 32) diseases were also included.
Moreover, serum samples from women with benign uterine disease and endometriosis (n
= 136) plus 10 serum samples from men (n = 7) and women (n = 3) with human
anti-mouse antibodies (HAMA) after immunoscintigraphy were included. All samples
were tested in duplicate with the Bayer ACS:OV, the Centocor CA125 II, the Abbott
IMx CA125 and the Roche (formerly Boehringer Mannheim) Enzymun-Test CA125 II assays.
RESULTS: The clinical performance of the Bayer ACS:OV assay, assessed in various
patient groups, was similar to that of the two other automated assays. In serum from
patients with benign diseases the highest values were found in patients with benign
ovarian tumours. In the ovarian cancer patients followed during the course of
disease we found similar marker patterns with all four assays. In contrast to the
Roche Enzymun-CA125 II assay and to a lesser extent the Centocor CA125 II assay, the
Bayer ACS:OV assay was less sensitive to interference from HAMA. CONCLUSION: The
Bayer ACS:OV assay is a precise and reliable test for the quantification of CA125 in
serum.
PMID: 14629806 [PubMed]
--------------------------------------------------------------------------------
264: Abdom Imaging. 2003 Sep-Oct;28(5):733-42.
Related Articles, Links
Staging of pelvic endometriosis based on MRI findings versus laparoscopic
classification according to the American Fertility Society.
Zanardi R, Del Frate C, Zuiani C, Bazzocchi M.
Institute of Radiology, University of Udine, via Colugna 50, 33100 Udine, Italy.
BACKGROUND: Preoperative staging of pelvic endometriosis helps the gynecologist plan
therapy and offers a prognosis to patients. We compared a staging system of pelvic
endometriosis based on magnetic resonance imaging (MRI) findings with the American
Fertility Society (AFS) laparoscopic classification. METHODS: Forty-four consecutive
females with clinically suspected endometriosis underwent MRI examination to
demonstrate the presence of endometriomas and pelvic implants. Laparoscopy was
performed within 2 weeks. An MRI score was developed to classify endometriosis into
four classes comparable to those of AFS laparoscopic staging. Concordance between
MRI and laparoscopic classification was evaluated with kappa statistics. RESULTS:
Laparoscopy confirmed 60 of 61 endometriomas detected by MRI. Implants were
discovered in 20 of 44 patients with MRI and in 23 of 44 with laparoscopy. MRI
detected 50 endometrial implants of 65 detected by laparoscopy (76.9%). With regard
to endometriosis staging, we obtained a concordance between MRI and AFS
classification in 42 of 44 patients (kappa = 0.913). CONCLUSION: Although MRI has
limitations such as suboptimal depiction of small implants and adhesions, this
technique is very useful to guide laparoscopy. Moreover, the optimal concordance
(95%) between our proposed MRI staging and the AFS laparoscopic classification
demonstrated a new advantage of MRI in preoperative staging of endometriosis.
PMID: 14628887 [PubMed]
--------------------------------------------------------------------------------
265: Zhonghua Fu Chan Ke Za Zhi. 2003 Aug;38(8):478-80.
Related Articles, Links
[[Study and opinion on endometriosis]
[Article in Chinese]
Lang JH.
PMID: 14627033 [PubMed]
--------------------------------------------------------------------------------
266: JSLS. 2003 Oct-Dec;7(4):371-5.
Related Articles, Links
Extraperitoneal endometriosis with catamenial pneumothoraces: a review of the
literature.
Roberts LM, Redan J, Reich H.
Advanced Gynecology Endoscopic Surgery, Kingston, Pennsylvania, USA.
OBJECTIVE: To present a case of recurrent catamenial pneumothorax and diaphragmatic
endometriosis that was managed thoracoscopically. A review of the literature is also
presented. METHODS: A-28-year-old woman presented with bloody stools, chronic
constipation, and chest pain. A review of systems was positive for monthly chest
pain associated with her menses. A preoperative chest x-ray revealed a right
pneumothorax. Colonoscopy revealed biopsy proven endometriosis of the sigmoid colon.
A pelvic computed tomography scan revealed bilateral complex, cystic and solid
adenexal lesions. RESULTS: A right thoracoscopy was performed. A lesion on the right
hemidiaphragm was excised and confirmed to be endometriosis. A wedge section of lung
tissue containing a bleb was resected and also contained endometriosis. Three months
later, the patient underwent laparoscopic excision of her pelvic endometriosis,
including a low anterior rectal resection. Five months later, she presented again
with right-sided chest pain. A thoracoscopic right total pleurectomy was performed
for recurrent pneumothorax. CONCLUSION: Pullmonary endometriosis may present as
chest pain, shortness of breath, or hemoptysis associated with menstrual cycles.
This case emphasizes the importance of a careful review of systems in patients with
known endometriosis. Management now includes an endoscopic alternative and all of
its known benefits.
Publication Types:
· Case Reports
· Review
· Review Literature
PMID: 14626406 [PubMed]
--------------------------------------------------------------------------------
267: Semin Arthritis Rheum. 2003 Oct;33(2):72-82.
Related Articles, Links
Estrogen and other female reproductive risk factors are not strongly associated with
the development of rheumatoid arthritis in elderly women.
Merlino LA, Cerhan JR, Criswell LA, Mikuls TR, Saag KG.
College of Public Health, University of Iowa, Iowa City, IA, USA.
OBJECTIVE: Endogenous and exogenous reproductive hormones have been associated with
rheumatoid arthritis (RA) in women, but data are inconsistent and no studies have
assessed RA risk factors exclusively in elderly women. METHODS: The authors examined
the association between reproductive factors, exogenous hormone exposure, and RA in
a prospective cohort study of 31,336 Iowa women who were aged 55 to 69 years at
cohort baseline in 1986. RESULTS: During 11 years of follow-up, 158 incident cases
of RA were identified and validated. Age at last pregnancy (P trend =.01) and age at
menopause (P trend =.03) were inversely associated with RA, whereas a history of
polycystic ovary syndrome (relative risk [RR], 2.58; 95% confidence interval [CI],
1.06 to 6.30), endometriosis (RR, 1.72; 95% CI, 0.93 to 3.18), and former use of
hormone replacement therapy (RR, 1.47; 95% CI, 1.04 to 2.06) were positively
associated with RA. In multivariate analysis models, a history of polycystic ovary
syndrome remained the most consistent predictor of RA, whereas the RRs for other
factors attenuated. CONCLUSION: Few reproductive factors showed a strong or
statistically significant association with RA in elderly women. The association of
polycystic ovary syndrome may be indicative of perturbations of endocrine-immune
activity that may influence the development of RA. This prospective cohort study
adds to the understanding of the potential contribution of hormonal factors to the
cause of RA in older women.
PMID: 14625816 [PubMed]
--------------------------------------------------------------------------------
268: Surg Endosc. 2004 Jan;18(1):87-91. Epub 2003 Nov 21.
Related Articles, Links
Role of laparoscopy in vaginal malformation.
Philbois O, Guye E, Richard O, Tardieu D, Seffert P, Chavrier Y, Varlet F.
Department of Pediatric Surgery, Centre Hospitalier Universitaire, 42055
Saint-Etienne Cedex 2, France.
BACKGROUND: The aim of this study was to assess the role of laparoscopy in the
management of vaginal malformations in children, a subject not often discussed in
the literature. METHODS: Between 1980 and 2002, we treated 22 children for vaginal
malformations. Two main patient populations were distinguished: younger children
with asymptomatic hymenal imperforation and hydrocolpos, and adolescents with
hematocolpos. A third of the malformations were identified on systematic clinic
examination, a third on the basis of abdominal pain, and a third due to various
other symptoms. Nine of the girls had associated malformations of the uterus,
external genital organs, or urinary tract. Eight patients underwent laparoscopy,
either to look for endometriosis in cases of hematocolpos, to make an accurate
determination of malformations in cases where clinical and paraclinical methods
failed, or to manage an abnormality. RESULTS: Eleven laparoscopic procedures were
performed in eight patients. Three diagnostic laparoscopies enabled us to determine
the exact nature of the malformations. One newborn underwent two laparoscopic
procedures to treat peritoneal fibrous bands that had caused repeated episodes of
obstruction. Six patients underwent exploratory laparoscopy to look for
endometriosis, but none was found. CONCLUSION: Laparoscopy is not applied
systematically in the management of any malformation, but it can be useful when
complementary exams fail to make an accurate diagnosis of the anomaly or for the
management of the rare complication of adhesions and bands. When used to search for
endometriosis, MRI detects ~50% of lesions, but laparoscopy is certainly still
appropriate for that purpose. However, the optimal timing of the procedure still
needs to be established.
PMID: 14625756 [PubMed]
--------------------------------------------------------------------------------
269: Curr Opin Obstet Gynecol. 2003 Dec;15(6):519-522.
Related Articles, Links
Non-invasive methods of diagnosis of endometriosis.
Brosens I, Puttemans P, Campo R, Gordts S, Brosens J.
Leuven Institute for Fertility and Embryology, Leuven, Belgium and Institute of
Reproductive and Developmental Biology, Wolfson and Weston Research Centre for
Family Health, Faculty of Medicine, Imperial College School of Medicine, Hammersmith
Hospital, London, UK.
SUMMARY: PURPOSE OF REVIEW Laparoscopy is the gold standard for the diagnosis of
endometriosis but the need for visual evidence of the disease is a major
stumbling-block for both effective clinical management of affected patients as well
as for research into this common and debilitating reproductive disease. Laparoscopy
is invasive and often causes a delay in diagnosis and treatment, especially in
symptomatic teenagers and young women. Moreover, the visual inspection of the pelvis
has major limitations, particularly for the diagnosis of retroperitoneal lesions. It
is therefore not surprising that considerable efforts are being made to improve
imaging techniques and to evaluate the diagnostic value of potential molecular
markers of disease.RECENT FINDINGS High-resolution transvaginal ultrasonography and,
in selected cases, magnetic resonance imaging improve the diagnosis of
retroperitoneal pelvic endometriosis as well as the identification of lesions that
involve pelvic organs. A variety of serum and endometrial markers are being
evaluated for their diagnostic potential, particularly in endometriosis associated
infertility. The first gene profiling studies are showing positive results and
proteomic technology is being applied to identify novel diagnostic protein
expression patterns.SUMMARY Current imaging techniques, such as transvaginal
ultrasonography, are useful to screen the pelvis for the presence of retroperitoneal
endometriosis but fail to diagnose peritoneal lesions, small ovarian endometriomas
and adhesions. Postgenomic technologies and identification of novel serum and
endometrial markers are likely to revolutionize future diagnosis of endometriosis.
PMID: 14624220 [PubMed]
--------------------------------------------------------------------------------
270: Curr Opin Obstet Gynecol. 2003 Dec;15(6):507-12.
Related Articles, Links
Pain in endometriosis: effectiveness of medical and surgical management.
Davis CJ, McMillan L.
The Fertility Centre, St Bartholomews Hospital, Barts and The London NHS Trust and
Consultant Gynaecologist, Wimpole Street, London, UK.
SUMMARY: PURPOSE OF REVIEW Endometriosis is a common cause of chronic pelvic pain
and has a detrimental effect on the quality of life for women affected with the
condition. It is also clear that early diagnosis with prompt effective management
does not always occur. This review will discuss the medical and surgical treatment
options and support conclusions with randomized double blind placebo-controlled
studies where possible.RECENT FINDINGS Assessment of the pelvic pain associated with
endometriosis can be categorized according to its relation to the menstrual cycle.
Dysmenorrhoea and ovulatory pain occur with cyclical changes, as compared with
chronic non-cyclic pain and deep dyspareunia. Dyskesia and urinary pain may have a
relation to the menstrual cycle. The severity of pain symptoms, as well as the
effect on the woman's quality of life, should be quantified. The preoperative
symptoms can be compared with the operative findings and the stage of endometriosis
according to the revised American Fertility Score.SUMMARY Review of the current
literature demonstrates that a combined medical and conservative surgical approach
is beneficial for most women with endometriosis associated pelvic pain.
PMID: 14624218 [PubMed]
--------------------------------------------------------------------------------
271: Gynecol Obstet Fertil. 2003 Nov;31(11):986; author reply 987-8.
Related Articles, Links
Comment on:
· Gynecol Obstet Fertil. 2003 Apr;31(4):337-42.
[Laser vaporization of ovarian endometriomas: the impact on the response to
gonadotrophin stimulation. Gynecol Obstet Fertil 2003; 31 : 337-342]
[Article in French]
Pouly JL.
Publication Types:
· Comment
· Letter
PMID: 14623566 [PubMed]
--------------------------------------------------------------------------------
272: Gynecol Obstet Fertil. 2003 Nov;31(11):893-4.
Related Articles, Links
[Deeply infiltrating endometriosis: a plea for listening to patients and for vaginal
manual examination!]
[Article in French]
Canis M.
Publication Types:
· Editorial
PMID: 14623551 [PubMed]
--------------------------------------------------------------------------------
273: Bone. 2003 Nov;33(5):860-6.
Related Articles, Links
Circulating osteoprotegerin in women during GnRH-agonist treatment and their
relationships with mineral components and biomarkers of bone turnover.
Uemura H, Yasui T, Umino Y, Niki H, Takikawa M, Saito S, Furumoto H, Irahara M.
Department of Obstetrics and Gynecology, School of Medicine, University of
Tokushima, Tokushima 770-8503, Japan. uemura@clin.med.tokushima-u.ac.jp
A novel cytokine termed osteoprotegerin (OPG) that is also called
osteoclastogenesis-inhibitory factor, which inhibits osteoclast maturation and
activity, was recently isolated. In order to determine the influence of estrogen
deficiency on the levels of circulating OPG in women, we studied the changes in the
levels of circulating OPG in 10 Japanese women ages 25-49 (mean +/- SD, 34.0 +/-
6.9) years with endometriosis receiving gonadotropin-releasing hormone agonists
(GnRH-a) therapy. We further analyzed whether the levels of circulating OPG have
relations with the levels of the biomarkers of bone turnover or those of circulating
mineral components in these patients during GnRH-a treatment. The patients were
treated with a monthly injection of 3.75 mg leuprolide acetate depot for 6 months.
In all patients, the concentrations of serum estradiol decreased after 6 months of
GnRH-a treatment. The bone mineral density of the lumber spines in these patients
significantly (P < 0.01) decreased (percentage change: mean +/- SD, -5.4 +/- 2.1%),
while circulating OPG levels significantly (P < 0.01) increased after 6 months of
treatment. The values of circulating OPG had significant correlations with those of
urinary pyridinoline (r = 0.59, P < 0.01), urinary deoxypylridinoline (Dpd) (r =
0.46, P < 0.05), and serum alkaline phosphatase (r = 0.66, P < 0.01) but not with
those of serum carboxy-terminal propeptide of type I procollagen during GnRH-a
treatment. The values of circulating OPG also correlated significantly with those of
serum calcium (Ca) and phosphorus (P) (r = 0.65 and 0.72, P < 0.01). Further
analyses revealed that the percentage change in the value of circulating OPG had a
significant correlation with that of urinary Dpd (r = 0.84, P < 0.01). These results
suggest that circulating OPG levels rise against the increase in osteoblastic bone
resorption and circulating Ca levels in the case of estrogen deficiency, possibly as
a compensatory mechanism serving to limit circulating Ca levels and bone density.
PMID: 14623063 [PubMed]
--------------------------------------------------------------------------------
274: J Pain. 2003 Sep;4(7):372-80.
Related Articles, Links
Endometriosis is associated with central sensitization: a psychophysical controlled
study.
Bajaj P, Bajaj P, Madsen H, Arendt-Nielsen L.
Laboratory For Experimental Pain Research, Department Of Health Science And
Technology, Centre For Sensory-Motor Interaction, Aalborg University, Aalborg,
Denmark. pba@smi.auc.dk
Endometriosis is a pain syndrome representing a major cause of pelvic pain in women
of reproductive age. The aim of this study was to test the hypothesis that
persistent nociceptive input from endometriotic tissues leads to central
sensitization manifested by somatic hyperalgesia and increased referred pain areas
to experimental saline-induced muscle pain in patients with endometriosis, compared
to healthy control subjects. Ten women with laparoscopically confirmed endometriosis
and 10 healthy, age-matched women participated in the study. Hypertonic saline (0.5
mL, 5.8%) was injected intramuscularly, in random succession, into 1 site of
menstrual pain referral (the multifidus muscle at the low back) and into 1 non-pain
control site (first dorsal interosseous muscle [FDI] of the hand). The post-saline
pain intensity and pain areas at the FDI were significantly greater in patients with
endometriosis than in control subjects (P <.05) but were not different between the
groups for the back. An absence of enhancement of post-saline pain responses at the
back in the endometriosis group suggests that saline-induced pain at the back
appears to activate segmental inhibitory systems in patients with endometriosis.
Manifestation of central sensitization in women with endometriosis is demonstrated
by increased muscle nociceptor input in the form of increased post-saline pain
intensity, pain areas at the FDI, and hypersensitivity to pressure stimulation.
These findings provide new insights into the complex pain mechanisms associated with
endometriosis.
Publication Types:
· Clinical Trial
PMID: 14622679 [PubMed]
--------------------------------------------------------------------------------
275: J Reprod Med. 2003 Oct;48(10):761-6.
Related Articles, Links
Alendronate for the prevention of bone mineral loss during gonadotropin-releasing
hormone agonist therapy.
Ripps BA, VanGilder K, Minhas B, Welford M, Mamish Z.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and
Gynecology, University of Florida College of Medicine, 5147 North Ninth Avenue,
Suite 315, Pensacola, FL 32504, USA.
OBJECTIVE: To evaluate alendronate as a prophylactic measure against bone mineral
density (BMD) loss in reproductive-aged women receiving gonadotropin-releasing
hormone agonist (GnRHa) therapy for 6 months. STUDY DESIGN: A randomized,
double-blind, placebo-controlled, pilot trial at a university-affiliated community
hospital. Subjects were 11 premenopausal women with indications for GnRHa therapy
who were randomized to receive alendronate, 10 mg, or placebo, by mouth daily during
6 months of GnRHa use. Both groups received intramuscular depot leuprolide acetate,
3.75 mg every 28 days for a total of 24 weeks. BMD at the lumbar spine and femur was
determined by dual energy x-ray absorptiometry at baseline and at the conclusion of
treatment. Lipids and urinary N-telopeptide were measured before and during
treatment. RESULTS: Alendronate-exposed subjects experienced a mean gain of 1.0% (P
= .35) in lumbar BMD as compared to a significant mean loss in the control group
3.8% (P = .01). Subjects in the placebo group experienced a significant reduction in
mean femur BMD of 3.4% (P = .02), while alendronate-exposed subjects had a loss of
0.4% (P = .65). Bone turnover, as evidenced by urinary N-telopeptide, increased over
baseline for both groups. Neither group experienced significant changes in lipids
during the study period. CONCLUSION: Alendronate appears to offer some degree of
protection against BMD loss in young women during transient, induced
hypoestrogenemia. Alendronate was associated with a gain in lumbar (trabecular) BMD
but less than expected from studies of postmenopausal women. With the expectation
that young women gain BMD, extending the safe and effective duration of GnRHa
therapy in this population may require additional measures.
Publication Types:
· Clinical Trial
· Randomized Controlled Trial
PMID: 14619641 [PubMed]
--------------------------------------------------------------------------------
276: Sichuan Da Xue Xue Bao Yi Xue Ban. 2003 Oct;34(4):727-9.
Related Articles, Links
[A case-control study on risk factors of endometriosis in Chengdu]
[Article in Chinese]
Wang H, Wu Y, Chen X, Guo Y, Song X, Tian C, Wang J.
Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan
University, Chengdu 610041, China.
OBJECTIVE: To identify the possible risk factors of endometriosis in Chengdu.
METHODS: A hospital-based pair matched case-control study was carried out in 100
pair of female patients with endometriosis and their controls. The data were
analysed by univariate analysis, multi-variate conditional logistic regression and
ANOVA. RESULTS: Univariate analysis showed that the positive response rates for
"high educational level, history of ectopic pregnancy, short menstrual cycle,
menorrhagia, dysmenorrhea, not warmly dressed during menses, depression, history of
coitus during menstruation or puerperium and heavy pungent food" in the
endometriosis group were much higher than those in the control group (P < 0.05). The
multivariate analysis confirmed that the risk factors associated with endometriosis
were menorrhagia, not warmly dressed during menses, depression during menstruation,
heavy pungent food, and history of ectopic pregnancy (OR = 0.388, 3.066, 4.292,
2.742, 3.612, respectively). CONCLUSION: The above findings suggest that
endometriosis may be associated with menorrhagia, negligence in menstrual hygiene,
and certain behavioral and psychological factors.
PMID: 14619594 [PubMed]
--------------------------------------------------------------------------------
277: Vestn Rentgenol Radiol. 2003 Jul-Aug;(4):45-59.
Related Articles, Links
[Magnetic resonance imaging in the diagnosis of different forms of endometriosis]
[Article in Russian]
Kulakov VI, Adamian LV, Volobuev AI, Demidov VN, Panov VO, Gavrilova TI, Kulabukhova
EN, Panova MM, Stashuk GA.
The present paper examines the capacities of non-invasive MRI in the diagnosis of
endometriosis. A standardized study algorithm is proposed, indications and
methodology for MRI in different forms of endometriosis (EM) are specified. It is
shown that in the diagnosis of different types of EM there are specific changes in
the MR pattern of small pelvic organs, which allow one to make a differential
diagnosis of this disease with a higher sensitivity (96%) and specificity (87%) as
compared with ultrasound study. MRI makes it possible to assess the degree of
invasion of endometrioid heterotopies into the wall of the intestine and cervix
uteri with a high degree of accuracy and to judge the degree and extent of
intestinal luminal narrowing. Diagnostic errors in solving these problems (as well
as those associated with the detection of extragenital foci of EM in the small
pelvis) are due first of all to movement artefacts a (respiration and intestinal
motility) particularly in the presence of a significant adhesive process and/or
after surgical intervention. MRI does not virtually yield false-negative conclusions
in the diagnosis of different forms of genital endometriosis (less than 3%), which,
in the authors' opinion, rather justifies some hyperdiagnosis (about 11%) made by
this method in the diagnosis of endometriosis of the rectovaginal septum. MRI is a
closing, specifying stage of instrumental diagnosis of not only EM, but also other
small pelvic diseases.
PMID: 14619398 [PubMed]
--------------------------------------------------------------------------------
278: Int Urogynecol J Pelvic Floor Dysfunct. 2003 Nov;14(5):358-9. Epub 2003
Aug 29.
Related Articles, Links
Persistent vesicovaginal fistula associated with endometriosis.
Lovatsis D, Drutz HP.
Department of Obstetrics and Gynecology, University of Toronto, Division of
Urogynecology and Reconstructing Pelvic Surgery, Mount Sinai Hospital, 700
University Ave., Room 3099, Toronto, Ontario, M5G 1Z5, Canada.
dlovatsis@mtsinai.on.ca
Vesicovaginal fistula with endometriosis is an extremely rare scenario. A case of a
50-year-old woman with persistent vesicovaginal fistula associated with
endometriosis is described.
Publication Types:
· Case Reports
PMID: 14618317 [PubMed]
--------------------------------------------------------------------------------
279: J Obstet Gynaecol. 2003 Nov;23(6):682.
Related Articles, Links
Expanding intra-abdominal haematoma.
Pranesh N.
Doncaster Royal Infirmary, Doncaster, UK. npranesh@hotmail.com
Publication Types:
· Case Reports
PMID: 14617488 [PubMed]
--------------------------------------------------------------------------------
280: Radiographics. 2003 Nov-Dec;23(6):1423-39.
Related Articles, Links
Diffusely enlarged uterus: evaluation with MR imaging.
Kido A, Togashi K, Koyama T, Yamaoka T, Fujiwara T, Fujii S.
Department of Nuclear Medicine and Diagnostic Imaging, Graduate School of Medicine,
Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
akikido@kuhp.kyoto-u.ac.jp
Diffuse uterine enlargement is a common clinical finding. Because this abnormality
can represent a physiologic manifestation, benign tumor, or malignancy, the
diagnostic dilemma of a diffusely enlarged uterus can be challenging. Clinical
findings can provide valuable information in regard to physiologic effects,
pregnancy-related changes, and hormonal causes. Cytologic examination is essential
for identification of cervical and endometrial malignancies. However, since
preoperative histologic examination of myometrial lesions is not possible,
preoperative distinction between benign and malignant conditions is frequently
difficult. Imaging thus plays an important role in evaluation of myometrial lesions.
In particular, magnetic resonance (MR) imaging allows specific diagnosis of several
different lesions. Signal voids and prominent vessels at MR imaging are
characteristic of vascular lesions. Adenomyosis and leiomyomas can be distinguished
from other lesions with MR imaging, although a variety of unusual manifestations can
be seen. MR imaging findings that allow distinction between leiomyoma and
leiomyosarcoma have yet to be clearly established; however, invasion, hemorrhagic
necrosis, or rapid growth is suggestive of malignancy. Endometrial stromal sarcoma
tends to have distinct MR imaging features that allow differentiation from benign
lesions. Copyright RSNA, 2003
Publication Types:
· Review
· Review, Tutorial
PMID: 14615554 [PubMed]
--------------------------------------------------------------------------------
281: Radiographics. 2003 Nov-Dec;23(6):1401-21.
Related Articles, Links
MR imaging of disorders associated with female infertility: use in diagnosis,
treatment, and management.
Imaoka I, Wada A, Matsuo M, Yoshida M, Kitagaki H, Sugimura K.
Department of Radiology, Tenri Hospital, 200 Mishima, Tenri, Nara 632-8552, Japan.
iizumi@tenriyorozu-hp.or.jp
Magnetic resonance (MR) imaging has extended the usefulness of imaging in evaluation
of pelvic disorders associated with female infertility. The causes of female
infertility include ovulatory disorders (ie, pituitary adenoma and polycystic
ovarian syndrome), disorders of the fallopian tubes (ie, hydrosalpinx and pelvic
inflammatory disease), uterine disorders (ie, mullerian duct anomaly, adenomyosis,
and leiomyoma), and pelvic endometriosis. Although laparoscopy, hysteroscopy,
hysterosalpingography, and transvaginal ultrasonography are the most effective
techniques for evaluation of pelvic disorders related to female infertility, MR
imaging is used in a variety of clinical settings in diagnosis, treatment, and
management. The applications of MR imaging include evaluation of the functioning
uterus and ovaries, visualization of pituitary adenomas, differentiation of
mullerian duct anomalies, and accurate noninvasive diagnosis of adenomyosis,
leiomyoma, and endometriosis. In addition, MR imaging helps predict the outcome of
conservative treatment for adenomyosis, leiomyoma, and endometriosis and may lead to
selection of better treatment plans and management. Finally, MR imaging may serve as
an adjunct to diagnostic laparoscopy and hysterosalpingography in patients with
hydrosalpinx, peritubal adhesions, or pelvic adhesions related to endometriosis.
Copyright RSNA, 2003
Publication Types:
· Review
· Review, Tutorial
PMID: 14615553 [PubMed]
--------------------------------------------------------------------------------
282: Br J Health Psychol. 2003 Nov;8(Pt 4):465-76.
Related Articles, Links
Self-management training for people with chronic disease: an exploratory study.
Wright CC, Barlow JH, Turner AP, Bancroft GV.
Interdisciplinary Research Centre in Health, School of Health and Social Sciences,
Coventry University, UK.
OBJECTIVE: To determine the effectiveness of a community-based Chronic Disease
Self-management Course (CDC) for UK participants with a range of chronic diseases.
DESIGN: The study was a multiple baseline, pre-test post test design with a sample
of 185 participants who attended a CDC delivered in community settings by lay
tutors, in the UK. METHOD: Data were collected by self-completed questionnaires
before attendance and at four-month follow-up. RESULTS: The sample comprised 72%
women (mean age = 53 years, mean disease duration = 16 years). The main chronic
diseases included endometriosis, depression, diabetes, myalgic encephalomyelitis,
osteoporosis and polio. Adjusting for baseline values and gender, small to moderate
increases were found on cognitive symptom management, self-efficacy (disease and
symptoms) and communication with physician. A similar sized decrease was found on
fatigue, and small decreases were evident on anxious and depressed moods, and health
distress. There were no changes in the use of health care resources, or on
self-reported exercise behaviour. CONCLUSION: The results of this exploratory study
suggest that self-management training for people with chronic diseases can offer
benefits in terms of enhanced self-efficacy, greater use of cognitive behavioural
techniques, and improvement in some aspects of physical and psychological
well-being.
Publication Types:
· Evaluation Studies
· Multicenter Study
PMID: 14614793 [PubMed]
--------------------------------------------------------------------------------
283: Gynecol Obstet Invest. 2003;56(4):207-12. Epub 2003 Nov 11.
Related Articles, Links
Obstetric outcome in women with endometriosis--a matched case-control study.
Kortelahti M, Anttila MA, Hippelainen MI, Heinonen ST.
Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.
BACKGROUND: Immunological deficiencies, altered angiogenic activity, infiltrative
potential and growth factors are plausible factors behind endometriosis. The aim of
this study was to determine whether endometriosis interferes with the course or
outcome of pregnancy. STUDY DESIGN: In this matched case-control study, we analyzed
obstetric outcome among 137 women with endometriosis and 137 controls matched as
regards IVF procedures and parity who gave singleton births at Kuopio University
Hospital between January 1994 and December 2000. In affected women, the diagnosis
was histologically verified, whereas the controls were eligible for the study only
if they had undergone laparoscopy/tomy in connection with tubal sterilization, or
infertility unrelated to endometriosis. RESULTS: No statistically significant
differences were detected in reproductive risk factors in women with endometriosis,
with the exception of mean maternal age (31.2 years in the cases vs. 34 years in the
controls). The mean birth weight (+/-SD) among those delivering at term (>37
completed weeks) was 3,600 (+/-542) g in the control group and 3,547 (+/-456) g in
the study group. Placental weight was comparable in both groups. Overall pregnancy
characteristics and pregnancy outcome measures were similar in women affected by
endometriosis when compared with the control group. CONCLUSIONS: Any potential
negative effect of endometriosis on obstetric outcome was undetectable. Copyright
2003 S. Karger AG, Basel
PMID: 14614250 [PubMed]
--------------------------------------------------------------------------------
284: Hum Fertil (Camb). 2003 Nov;6(4):169-73.
Related Articles, Links
Diagnosing infertility in a district general hospital: a case-note and cost analysis.
Ojha K, Philips Z, Darne FJ.
Department of Obstetrics and Gynaecology, St George's Hospital Medical School,
London SW17 0RE, UK.
This study aimed to observe diagnostic work-up and cost evaluation of infertile
couples to identify opportunities for improvement. One hundred and seventy-four new
referrals to the gynaecology clinic in a District General Hospital during 1996 and
1997 provided the cohort for analysis. Data from case notes were transferred on to
data collection sheets. Data were inputted into SPSS for analysis. Primary
infertility accounted for 62% of couples. One hundred and forty-two couples (81.6%)
had a definitive diagnosis, and the analyses relate to these couples only. There was
no single investigation performed on the whole cohort studied. Semen analysis was
undertaken in 80.3% of the couples; couples with suspected male infertility were
over four times more likely to have had more than two semen tests (P = 0.0005);
77.5% of couples had FSH and LH tests; and midluteal progesterone was tested in
76.1%. An increased intensity of FSH-LH hormone testing was associated with couples
with anovulation (chi(2) = 6.79, P = 0.03). Serial repeat progesterone tended to be
given to women with irregular or prolonged cycles (35 days or more), although this
tendency was not statistically significant. The most common test for tubal patency
was hysterosalpingography. Higher costs are generally associated with diagnosing
endometriosis and tubal factor because of the relatively high cost of laparoscopy.
The average cost of diagnosis for each patient was pound 365 and ranged from pound
64 to pound 851. In conclusion, a standard protocol of basic investigative
procedures should be offered in secondary centres to all couples. Avoiding
duplication and unnecessary investigations (for example, serial progesterone) may
reduce costs, although offering all couples a standard protocol of tests would
probably offset this observation.
PMID: 14614195 [PubMed]
--------------------------------------------------------------------------------
285: Clin Cancer Res. 2003 Nov 1;9(14):5142-4.
Related Articles, Links
Endometriosis and its treatment with danazol or lupron in relation to ovarian cancer.
Cottreau CM, Ness RB, Modugno F, Allen GO, Goodman MT.
University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
15261, USA.
PURPOSE: It has been hypothesized that circulating androgens may be involved in the
development of ovarian cancer. The androgenic medication, danazol, and the
antiandrogenic medications, leuprolide and nafarelin, are commonly used in the
treatment of endometriosis. We assessed the associations between the use of these
medications and ovarian cancer. EXPERIMENTAL DESIGN: We pooled information on
self-reported use of danazol and leuprolide/nafarelin from two population-based
case-control studies of incident ovarian cancer, comprising 1373 cases and 1980
controls. Odds ratios for the association between danazol and ovarian cancer, and
leuprolide/nafarelin and ovarian cancer were adjusted for age, parity, oral
contraceptive use, and family history of ovarian cancer. These analyses were
repeated among the 120 cases and 124 controls who reported having had endometriosis.
RESULTS: Danazol users (n = 19) were at a significantly elevated 3.2 fold (95%
confidence interval, 1.2-8.5) risk of developing ovarian cancer, whereas
leuprolide/nafarelin users (n = 23) were not at significantly elevated risk (odds
ratio, 1.0; 95% confidence interval, 0.4-2.4). Similar results were obtained among
the subset of women with endometriosis. CONCLUSIONS: Danazol, but not
leuprolide/nafarelin, increased the risk of ovarian cancer. This supports the
hypothesis that androgen excess may be associated with the development of ovarian
cancer.
PMID: 14613992 [PubMed]
--------------------------------------------------------------------------------
286: Reproduction. 2003 Nov;126(5):559-67.
Related Articles, Links
Cyclooxygenase enzymes and prostaglandins in pathology of the endometrium.
Sales KJ, Jabbour HN.
MRC Human Reproductive Sciences Unit, Center for Reproductive Biology, University of
Edinburgh Academic Center, 49 Little France Crescent, Old Dalkeith Road, Edinburgh,
EH16 4SB, UK.
Prostaglandins are bioactive lipids produced from arachidonic acid by cyclooxygenase
(COX) enzymes and specific terminal prostanoid synthase enzymes. After biosynthesis,
prostaglandins exert an autocrine-paracrine function by coupling to specific
prostanoid G protein-coupled receptors to activate intracellular signalling and gene
transcription. For many years, prostaglandins have been recognized as key molecules
in reproductive biology by regulating ovulation, endometrial physiology and
proliferation of endometrial glands and menstruation. More recently, a role for COX
enzymes and prostaglandins has been ascertained in reproductive tract pathology,
including carcinomas, menorrhagia, dysmenorrhoea and endometriosis. Although the
mechanism by which prostaglandins modulate these pathologies is still unclear, a
large body of evidence supports a role for COX enzymes, prostaglandins and
prostaglandin receptor signalling pathways in angiogenesis, apoptosis and
proliferation, tissue invasion and metastases and immunosuppression. Here, an
overview is provided of some of the findings from these studies with specific
emphasis on the role of COX enzymes, prostaglandin E(2) and F(2alpha) in disorders
of endometrial proliferation and menstruation in non-pregnant women.
Publication Types:
· Review
· Review, Academic
PMID: 14611628 [PubMed]
--------------------------------------------------------------------------------
287: Fertil Steril. 2003 Nov;80(5):1284; author reply 1284-5.
Related Articles, Links
Comment on:
· Fertil Steril. 2003 May;79(5):1234-6.
Isolated hepatic endometriosis: as rare as hens' teeth, but sometimes you can learn
a lot from a hen with teeth.
Batt RE, Lele SB, Mitwally MF, Yeh J.
Publication Types:
· Comment
· Letter
PMID: 14607592 [PubMed]
--------------------------------------------------------------------------------
288: Fertil Steril. 2003 Nov;80(5):1216-23.
Related Articles, Links
Effect of gonadotropin-releasing hormone agonist and medroxyprogesterone acetate on
calcium metabolism: a prospective, randomized, double-blind, placebo-controlled,
crossover trial.
Carr BR, Breslau NA, Peng N, Adams-Huet B, Bradshaw KD, Steinkampf MP.
Department of Obstetrics and Gynecology, The University of Texas Southwestern
Medical Center, Dallas, Texas 75390-9032, USA. bruce.carr@utsouthwestern.edu
OBJECTIVE: The purpose of this study was to prospectively compare the effectiveness
of administering medroxyprogesterone acetate (MPA; 20 mg/d) in either the first
(protocol A) or last (protocol B) 12-week period as well as a 6-month course of the
GnRH agonist (GnRH-a; leuprolide acet
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