Pag. 10

Eur J Gynaecol Oncol. 2011;32(2):182-4.

Malignant changes in adenomyosis in patients with endometrioid adenocarcinoma.

Kucera E, Hejda V, Dankovcik R, Valha P, Dudas M, Feyereisl J.

Source

Institute for the Care of Mother and Child, Prague, Czech Republic. ekucera@seznam.cz

Abstract

OBJECTIVE:

The aim of our retrospective study was to evaluate pathological changes in adenomyotic foci in hysterectomy specimens, and point out a possible mechanism of carcinogenesis in adenomyotic foci inside the myometrium.

METHODS:

Retrospective analysis of clinical data; 219 patients were operated at our departments from 2003-2008 with the diagnosis of early endometrial cancer. Standard staging operation was used in all cases and all hysterectomy specimens were afterwards routinely analyzed.

RESULTS:

Adenomyosis was found in 88 of a total of 219 hysterectomy specimens, while 205 of these 219 were affected by endometrioid adenocarcinoma, ten with clear cell carcinoma and four with papillary serous carcinoma. Within these subgroups adenomyosis was documented in 87 of 205 specimens with endometrioid adenocarcinoma (42.4%) and in one specimen of ten with clear cell carcinoma (2.2%), all found in the eutopic endometrium. All cases of malignant changes (n = 6) in adenomyosis were found exclusively with coexisting endometrioid adenocarcinoma: adenocarcinoma in adenomyosis was well or moderately differentiated in five cases, and poorly differentiated in just one case. Differentiation of the tumor in adenomyosis correlated with differentiation of the eutopic endometrial cancer in 50%. Hyperplastic changes like benign glandular hyperplasia, or atypical complex hyperplasia (ACH) were identified simultaneously in all cancer-positive adenomyotic foci.

CONCLUSION:

Malignant changes in adenomyosis were present in 6.8% of patients with endometrial cancer. All malignancy-positive cases of adenomyosis were associated with endometrioid adenocarcinoma of the eutopic endometrium. Interestingly, in all these cases, different stages of hyperplastic changes were also simultaneously identified. This observation suggests a similar pathway of carcinogenesis in adenomyosis as is known in estrogen-responsive endometrial cancer type I.

J Assist Reprod Genet. 2011 May 26. [Epub ahead of print]

Identification of common mechanisms between endometriosis and ovarian cancer.

Meng Q, Sun W, Jiang J, Fletcher NM, Diamond MP, Saed GM.

Source

Department of Clinical Laboratory, Qianfo Shan Hospital, Shandong University, Jinan, Shandong, People’s Republic of China.

Abstract

PURPOSE:

To determine common molecular markers between endometriosis and ovarian cancer.

METHODS:

Patients included women who underwent laparoscopic excision of ovarian endometriotic lesions (n = 7), healthy non-pregnant women with normal pelvises, who underwent excision of normal peritoneum (n = 7). Two epithelial ovarian cancer (EOC) cell lines were also utilized. Expression of transforming growth factor (TGF)-β1, cyclooxygenase (COX)-2, vascular endothelial growth factor (VEGF), estrogen receptor (ER)-1α, progesterone receptor (PR), androgen receptor (AR), and aromatase was evaluated by real-time RT-PCR.

RESULTS:

Endometriosis and EOC cells manifested significantly higher mRNA levels of TGF-β1, COX-2, VEGF, ER-1α, AR, and aromatase, while they expressed significantly lower mRNA levels of PR.

CONCLUSIONS:

Increased TGF-β1, COX-2, VEGF, ER-1α, AR, and aromatase and decreased PR in endometriotic as well as EOC cells suggests a potential association between these two disease processes. This association is important, as it may reveal common mechanisms for both diseases.

Mol Hum Reprod. 2011 May 25. [Epub ahead of print]

Hypoxia induces expression of COX-2 through the homeodomain transcription factor CDX1 and orphan nuclear receptor SHP in human endometrial cells.

Kim KH, Kim HY, Kim HH, Lee KS, Cheong J.

Source

Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea;

Abstract

Endometriosis, the presence of ectopic endometrial tissue outside the uterine cavity, is a common disease affecting women during their reproductive years. The aim of this study was to identify the molecular mechanism of transcriptional regulation of inflammatory cyclooxygenase-2 (COX-2) gene during endometriosis by hypoxia. Hypoxia induced COX-2 expression in endometrial cells together with induction of the orphan nuclear receptor SHP and intestinal-specific transcription factor CDX1. Hypoxia-inducible factor (HIF)-1α was responsible for SHP induction mediated by hypoxia. In addition, we observed that ectopic expression of CDX1 enhanced COX-2 gene expression in hypoxia-dependent fashion. Additionally, we evaluated that induction of CDX1 by hypoxia was mediated by SHP. Expression of COX-2, CDX1, SHP and HIF-1α mRNA in hypoxia-treated human endometrial cells were significantly higher than normal control cells. These results suggest that the SHP and CDX1 expression increased by hypoxia play an active role in inducing inflammatory COX-2 expression in the pathogenesis of endometriosis.

N Engl J Med. 2011 May 26;364(21):e45.

Images in clinical medicine. Villar’s nodule–umbilical endometriosis.

Weng CS, Yang YC.

Source

Mackay Memorial Hospital, Taipei, Taiwan.

Zhonghua Yi Xue Za Zhi. 2011 Apr 19;91(15):1047-50.

Levonorgestrel-releasing intrauterine system and combined oral contraceptives as conservative treatments for recurrent ovarian endometriosis: a comparative clinical study.

[Article in Chinese]

Xu XW, Wang LD, Zhu XQ, Yan LZ, Guan YT, Zhu SC, Hu Y.

Source

Department of Obstetrics & Gynecology, Second Affiliated Hospital, Wenzhou Medical College, Wenzhou 325027, China.

Abstract

OBJECTIVE:

To evaluate and compare the efficiency and safety of levonorgestrel-releasing intrauterine system (LNG-IUS) and combined oral contraceptives (COC) in the treatment of recurrent ovarian endometriosis after conservative surgery or conservative surgery plus medical therapy.

METHODS:

A total of 48 patients with recurrent ovarian endometriosis underwent randomization. The regimens of LNG-IUS (n = 24) and COC (n = 24) were offered. The volume of ovarian endometriotic cysts was recorded before treatment and at 6, 12, 18 and 24 months. The volume of ovarian endometriotic cysts, pain score of visual analogue scale (VAS), menstrual pattern, body weight, serum CA125 and serum lipids were compared to the pretreatment level within each treatment group, as well as between two treatment groups during the same period.

RESULTS:

(1) At 18 months after LNG-IUS, the cysts in 2 subjects entirely disappeared. At 24 months, 18 patients had a disappearance of cysts. The overall size reduction was statistically significant (9.2 ± 3.0) vs (0.9 ± 1.5) cm(3) (P < 0.01). In the COC group, 12 subjects had a complete resolution of cysts at 24 months. The overall size reduction was statistically significant (9.4 ± 2.2) vs (2.9 ± 3.1) cm(3) (P < 0.01). At 18 & 24 months, the cyst size reduction was significantly larger in the LNG-INS group than the COC group (2.4 ± 1.5) vs (4.7 ± 2.6) cm(3) (P < 0.01) and (0.9 ± 1.5) vs (2.9 ± 3.1) cm(3) (P < 0.05); (2) There was a significant improvement of dysmenorrhea, chronic pelvic pain and dyspareunia at 6- & 12-month follow-up in both groups; (3) serum CA125 decreased at 6 & 12 months in both groups with statistical significance. It decreased more sharply in the LNG-IUS group and remained at low levels beyond 12 months; (4) within 6 months of LNS-IUS, irregular bleeding and spotting were the major side effects. Beyond that period the symptoms were significantly relieved. Weight gain and dyslipidemia were the major side effects of COC.

CONCLUSION:

For patients with recurrent ovarian endometriosis after conservative surgery or conservative surgery plus medical therapy, LNG-IUS and COC may be used to control and reduce endometriotic cysts, relieve pain and reduce the level of CA125. LNG-IUS has the advantages of a greater convenience and minor systemic side effects.

Zhonghua Fu Chan Ke Za Zhi. 2011 Apr;46(4):304-6.

Role of microRNA in the occurrence and development of endometriosis.

[Article in Chinese]

Dai L, Di W.

 

Zhonghua Fu Chan Ke Za Zhi. 2011 Apr;46(4):266-70.

Diagnosis and treatment of ureter endometriosis.

[Article in Chinese]

Li L, Leng JH, Lang JH, Liu ZF, Sun DW, Zhu L, Fan QB, Shi JH.

Source

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.

Abstract

OBJECTIVE:

To investigate strategies of diagnosis and treatment of ureter endometriosis.

METHODS:

From 1983 to 2010, the cases registered in Peking Union Medical College Hospital and confirmed as ureter endometriosis by surgery were enrolled in this study. Clinical manifestations, pre-operative examinations, surgical categories and routes, surgical and pathological findings, post-operative medical treatment, relapse and relating factors were collected and studied.

RESULTS:

Totally 46 patients with ureter endometriosis underwent one or two surgeries. Forty-eight per cent (22/46) of patients were not be diagnosed with ureter endometriosis pre-operatively, and 46% (21/46) only presented dysmenorrhea or even no symptoms. Ureterolysis (72%, 33/46) and laparotomy (63%, 29/46) were the most common surgical category and surgical approach. There were 64% (25/39) of patients had left ureter involved and 80% (37/46) had extrinsic ureter endometriosis. Fifteen per cent (7/46) of patients had relapsed disease with median recurrent time of 24 months (13-49 months), and they all received second surgeries. Logistic regression analysis showed that only gonadotropin releasing hormone analogue agents were related with recurrence when compared with those patients without medical treatment post-operatively significantly (OR=23.2, 95%CI: 2.4-221.7, P=0.002).

CONCLUSIONS:

Ureter endometriosis was related with reproductive tract endometriosis. It has insidious process resulting in difficulty for early diagnosis. It’s important to treat pelvic deep infiltrating endometriosis and ovarian endometrioma to prevent ureter from further involvement. Post-operative treatment of pelvic endometriosis is the key point of preventing relapse of ureter endometriosis.

Zhonghua Fu Chan Ke Za Zhi. 2011 Apr;46(4):250-4.

Evaluation of levonorgestrel-releasing intrauterine system in treatment of recurrent endometriosis after conservative surgery.

[Article in Chinese]

Xu XW, Zhang YW, He FF, Wang LD, Guan YT, Sun J, Lin M, Hu Y.

Source

Department of Obstetrics and Gynecology, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou 325027, China.

Abstract

OBJECTIVE:

To evaluate the efficiency of levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment.

METHODS:

Twenty-three patients with recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment were treated by LNG-IUS. All patients rejected further operation and had no desire of fertility. The visual analogue scale (VAS) scores of pain, menstrual model, weight and serum CA125 level and the volume of ovarian endometriotic cysts before and after 3, 6, 12, 24 and 36 months of treatment were recorded and compared.

RESULTS:

(1) VAS score:after 12 months of using LNG-IUS, dysmenorrheal, chronic pelvic pain or dyspareunia were relieved significantly. VAS score were dropped from 5.9±2.3, 4.3±2.0 to 1.0±0.7, 1.4±1.1 (P<0.01). (2) Volum of cysts:after 6 months of using LNG-IUS, the volume of recurrent ovarian endometriotic cysts in 11 patients were reduced from (11.4±6.1) cm3 to (5.5±3.4) cm3 significantly (P<0.01). At 12 months of follow-up, it suggested that 2 patients’ ovarian endometriotic cysts disappeared. At 24 months follow-up, 9 patients ovarian endometriotic cysts disappeared (3) CA125: serum CA125 decreased from (65.5±19.6) kU/L to (42.1±13.6) kU/L at 6 months after treatment remarkably (P<0.01). Continued to decrease after 12 months and then become steady. Irregular bleeding and spotting was the main side effects, weight gain was also observed in few patients.

CONCLUSIONS:

LNG-IUS could be used in treatment of recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment effectively. It could relieve pain, reduce the level of CA125 and decrease the size of ovarian endometriotic cysts. LNG-IUS seems to be an effective, safe, and long term treatment for endometriosis with fewer side effects and better compliance.

Pathologe. 2011 Jul;32(4):297-302.

Polyps of the colorectum : Non-neoplastic and non-hamartomatous.

[Article in German]

Aust DE, Rüschoff J.

Source

Institut für Pathologie, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Fetscherstr. 74, 01309, Dresden, Deutschland, Daniela.Aust@uniklinikum-dresden.de.

Abstract

Non-neoplastic and non-hamartomatous colorectal polyps or tumor-like lesions comprise a very heterogeneous group of changes in the colorectal mucosa or the colon wall. Mucosal prolapse-associated lesions and inflammatory polyps, which are predominantly associated with chronic inflammatory bowel disease, are the most prominent examples for polypoid lesions difficult to distinguish from neoplastic lesions such as adenomas, hyperplastic/serrated polyps/adenomas and invasive carcinomas. The considerably less frequent tumor-like lesions like heterotopias, endometriosis, amyloid tumors and pseudolipomatous changes are histologically often well defined and should be considered in the differential diagnosis of colorectal lesions. The etiology, endoscopic and histological appearance of these entities and their most important differential diagnoses are discussed.

Gynecol Obstet Invest. 2011 May 21. [Epub ahead of print]

Psychological Factors in Chronic Pelvic Pain due to Endometriosis: A Comparative Study.

Roth RS, Punch M, Bachman JE.

Source

Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Mich., USA.

Abstract

Background/Aims: This study compared women suffering chronic pelvic pain (CPP) secondary to endometriosis (n = 30) with women experiencing CPP due to either myofascial abdominal/pelvic pain (n = 70) or pelvic adhesions (n = 38) to determine if there are specific psychological variables uniquely associated with endometriosis. Methods: This is a cross-sectional study of 138 women drawn from a convenience sample of 192 consecutive women with CPP presenting for evaluation to a university hospital chronic pain clinic. Subjects were categorized into groups based on their CPP diagnosis. Each subject completed a battery of validated inventories assessing demographic status, pain experience and other pain-related symptoms, pain disability, frequency of depressive symptoms, level of affective distress, satisfaction with pain treatment and satisfaction with their marital relationship. Results: No differences were obtained across the three groups for any of the outcome measures. Effect size computation supported the absence of clinical differences across the groups for these measures. Conclusion: These findings fail to support the presence of a unique psychological profile or disproportionate psychological disturbance for women with CPP due to endometriosis. These data illustrate the importance of considering control groups that include chronic pain when exploring psychological contributions to specific chronic pain conditions.

Maturitas. 2011 Jul;69(3):279-83. Epub 2011 May 24.

Association of endometriosis-related infertility with age at menopause.

Yasui T, Hayashi K, Mizunuma H, Kubota T, Aso T, Matsumura Y, Lee JS, Suzuki S.

Source

Department of Reproductive Technology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan. yasui@medsci.tokushima-u.ac.jp

Abstract

OBJECTIVE:

The influence of past history of infertility, which is closely associated with reproductive factors, on menopause has not been clarified. The purpose of this study was to clarify the association of reproductive factors, including past history of infertility, with menopause in Japanese women.

STUDY DESIGN:

This study was a cross-sectional analysis of the Japan Nurses’ Health Study (JNHS) baseline survey. The JNHS is a nationwide prospective cohort study on the health of Japanese women, and the baseline survey was conducted between 2001 and 2007.

MAIN OUTCOME MEASURE:

We analyzed data for 24,153 pre- and postmenopausal women who were enrolled in the JNHS at the ages 40-59 years. The main outcome measure was menopause.

RESULTS:

Reproductive factors influencing the onset of natural menopause were past history of infertility [relative risk (RR) (age-adjusted odds ratio and 95% confidence interval): 1.28 (1.10-1.48)], past history of endometriosis: 1.32 (1.07-1.64), age at menarche: 0.919 (0.886-0.953) and number of pregnancies: 0.943 (0.911-0.976). Endometriosis as the cause of infertility was significantly associated with earlier onset of menopause (3.43 [2.17-5.44]) after adjustment for age. The strong association of past history of infertility related to endometriosis was still significant after multivariate adjustment.

CONCLUSION:

Menopause in women who have a past history of infertility, especially in those who have suffered from endometriosis, is significantly earlier than that in women without such a history.

Fertil Steril. 2011 Jul;96(1):e39-41. Epub 2011 May 24.

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome with a single uterus.

Shah DK, Laufer MR.

Source

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts.

Abstract

OBJECTIVE:

To describe an unusual case of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome with a single uterus.

DESIGN:

Case report.

SETTING:

Major academic medical center.

PATIENT(S):

A 12-year-old girl with OHVIRA syndrome.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

None.

RESULT(S):

A 12-year-old girl presented with presumed OHVIRA syndrome and had surgical correction of the obstructed hemivagina. Two years later she presented with increasing pelvic pain and underwent laparoscopy for presumed endometriosis. A single uterus with a broad flat fundus was found as well as endometriosis.

CONCLUSION(S):

OHVIRA syndrome is typically associated with a didelphys uterus with two cervices and two vaginas, one of which is obstructed. The obstruction usually occurs on the same side as the renal anomaly. We report a rare congenital anomaly of the female reproductive tract: OHVIRA syndrome with a single uterus. From a fertility standpoint, cases of a single uterus with two cervices are managed differently than two uteri with two cervices. Healthcare providers managing complex reproductive tract anomalies should be aware of this potential variant.

Nan Fang Yi Ke Da Xue Xue Bao. 2011 May 20;31(5):796-800.

Differential expression of the anti-oncogene ARHI between patients with and without endometriosis.

[Article in Chinese]

Li J, Wang SJ, Sun L, Li YL.

Source

Department of Gynecolgy and Obstetrics, General Hospital of PLA, Beijing 100853, China.E-mail:gengjieli@126.com.

Abstract

OBJECTIVE:

To investigate the expression of the anti-oncogene ARHI in the endometriotic tissue and explore its clinical significance.

METHODS:

A semiquantitative analysis of the expression of ARHI mRNA and protein in the ectopic and eutopic endometrium of women with endometriosis was conducted using RT-PCR and Western blotting in comparison with that in the endometrium of women without endometriosis. Immunohistochemisty and in situ hybridization were performed for semiqualitative analysis and localization of ARHI expression.

RESULTS:

The expression levels of ARHI mRNA and protein differed significantly between the groups. ARHI was expressed at significantly higher levels in ectopic endometrium than in eutopic and normal endometrium (P<0.005), but showed no significant difference between the latter two tissues (Pgt;0.05). The positivity rate ARHI DNA was 97.3% in the endometrium of women without endometriosis, 100% in the ectopic endometrium and 93.8% in the eutopic endometrium of women with endometriosis. mmunohistochemisty showed an ARHI positivity of 93.2% in the endometrium of women without endometriosis, 100% in the ectopic endometrium and 92.3% in the eutopic endometrium of women with endometriosis. The expression patterns of ARHI DNA and protein were consistent. Immunohistochemisty in 5 cases of malignant endometriosis showed negative ARHI expression in 4 cases and weak positivity in 1 case. CONCLUISON: ARHI expressions are present in the endometrium and up-regulated in ectopic endometrium, whereas in the ectopic endometrium of patients with malignant endometriosis its expression is often negative, suggesting a role of ARHI in infertility and tumorigenesis of endometriosis.

Eur J Obstet Gynecol Reprod Biol. 2011 May 20. [Epub ahead of print]

Effectiveness of the association micronized N-Palmitoylethanolamine (PEA)-transpolydatin in the treatment of chronic pelvic pain related to endometriosis after laparoscopic assessment: a pilot study.

Cobellis L, Castaldi MA, Giordano V, Trabucco E, De Franciscis P, Torella M, Colacurci N.

Source

Department of Gynaecology, Obstetric and Reproductive Science, Second University of Studies of Naples, Largo Madonna delle Grazie 1, 80138 Naples, Italy.

Abstract

OBJECTIVE:

Aim of our study was to evaluate the effectiveness of the association between N-Palmitoylethanolamine and transpolydatin in the management of chronic pelvic pain related to EMS.

STUDY DESIGN:

This was a randomized, double-blind, parallel-group, placebo-controlled clinical trial involving 61 subjects, submitted to a first line laparoscopic conservative surgery, who were randomized into 3 groups receiving: group A (n=21) the association N-Palmitoylethanolamine-transpolydatin 400mg+40mg twice a day for 3 months; group B (n=20) the placebo for 3 months; group C (n=20) a single course of Celecoxib 200mg twice a day for 7 consecutive days. Assessments of the severity of pelvic endometriosis (pelvic pain, dysmenorrhoea and dyspareunia) were recorded before and after treatment on a questionnaire and a 10-point VAS. Differences between groups were verified with Kruskal-Wallis ANOVA for non-parametric multiple comparisons.

RESULTS:

A marked decrease in dysmenorrhoea, dyspareunia and pelvic pain was observed in all groups, and the association between N-Palmitoylethanolamine and transpolydatin resulted to be more effective than placebo (P<.001). Additionally, the treatment with Celecoxib resulted in a decrease in pelvic pain more effective either than the association N-Palmitoylethanolamine and transpolydatin or placebo.

CONCLUSION:

These preliminary results show that the association between micronized N-Palmitoylethanolamine and transpolydatin is effective in the management of pelvic pain related to endometriosis after laparoscopy. Additionally, this association seems to be safe, shows an optimal control of pain and can be used in patients who are unable to receive other therapies.

Eur J Obstet Gynecol Reprod Biol. 2011 May 20. [Epub ahead of print]

Clinical analysis of ovarian pregnancy: a report of 49 cases.

Choi HJ, Im KS, Jung HJ, Lim KT, Mok JE, Kwon YS.

Source

Department of Obstetrics and Gynecology, College of Medicine, University of Kwandong, Cheil General Hospital and Women’s Healthcare Center, 1-19 Mukjeong-dong, Jung-gu, Seoul 100380, Republic of Korea.

Abstract

OBJECTIVE:

To clinically analyze cases of ectopic ovarian pregnancy and to generate data regarding the evaluation and management of suspected ectopic ovarian pregnancies.

STUDY DESIGN:

We retrospectively analyzed 49 ovarian pregnancies that were surgically treated at Cheil General Hospital and Women’s Healthcare Center between January 1996 and December 2009. We analyzed patient age, parity, symptoms, risk factors, preoperative diagnosis, and ovarian pregnancy type.

RESULTS:

During the study period, the incidence of ovarian pregnancy was 1.59% of all ectopic pregnancies (49/3081); 45/49 (91.8%) were primary ovarian pregnancies. At the time of diagnosis, mean age was 30.7 years (SD: ±4.4 years) and mean parity was 0.63 (SD: ±0.8). The most common presenting symptoms were abdominal pain (42.9%) and vaginal bleeding (28.6%). The most common sonographic findings were fluid surrounding the ovarian pregnancy and ovarian enlargement. In regard to surgical treatment, ovarian wedge resection was most often performed (85.7% of cases), followed by oophorectomy (8.2% of cases). The most common risk factors were endometriosis (16 patients) and a history of abdominal surgery (19 patients).

CONCLUSIONS:

Ovarian pregnancies are extremely rare and difficult to diagnose both pre- and intra-operatively. Our data may assist surgeons in understanding the clinical presentation of ovarian pregnancy and in counseling patients. Larger studies are warranted to gather more data on this rare form of ectopic pregnancy.

Fertil Steril. 2011 Jul;96(1):113-7. Epub 2011 May 20.

Interleukin-17F increases the secretion of interleukin-8 and the expression of cyclooxygenase 2 in endometriosis.

Hirata T, Osuga Y, Takamura M, Saito A, Hasegawa A, Koga K, Yoshino O, Hirota Y, Harada M, Taketani Y.

Source

Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan.

Abstract

OBJECTIVE:

To examine the effects of interleukin (IL)-17F on the secretion of IL-8 and the gene expression of cyclooxygenase 2 (COX2) in endometriotic stromal cells.

DESIGN:

In vitro experimental study using human samples.

SETTING:

University hospital.

PATIENT(S):

Endometriotic tissues were obtained from women with ovarian endometriomas undergoing laparoscopic surgery.

INTERVENTION(S):

Endometriotic stromal cells (ESCs) were cultured with IL-17F.

MAIN OUTCOME MEASURE(S):

Concentrations of IL-8 were measured by a specific ELISA, and messenger RNA levels of IL-8 and COX2 were measured by real-time reverse transcription-polymerase chain reaction (PCR).

RESULT(S):

IL-17F increased the secretion of IL-8 from ESCs, and the effect was inhibited by antibodies for IL-17 receptor A and IL-17 receptor C. Tumor necrosis factor α (TNF-α) synergistically enhanced IL-17F-induced increase in IL-8 secretion from ESCs. The IL-17F increased the gene expression of IL-8 and COX2 in ESCs.

CONCLUSION(S):

These findings suggest that IL-17F may stimulate the development of endometriosis by up-regulation of IL-8 and COX2.

Fertil Steril. 2011 Jul;96(1):e22-4. Epub 2011 May 19.

Massive hematuria with hemodynamic instability-complication of oocyte retrieval.

Jayakrishnan K, Raman VK, Vijayalakshmi VK, Baheti S, Nambiar D.

Source

K.J.K. Hospital Fertility Research and Gynaecology Centre, Kerala, India.

Abstract

OBJECTIVE:

To report a case of pseudoaneurysm causing massive hematuria with hemodynamic instability occurring after oocyte retrieval.

DESIGN:

Case report.

SETTING:

Tertiary care infertility clinic.

PATIENT(S):

A 34-year-old woman with endometriosis undergoing oocyte aspiration for IVF.

INTERVENTION(S):

Blood transfusion, cystoscopy, and resection and cauterization of pseudoaneurysm.

MAIN OUTCOME MEASURE(S):

Control of hematuria and hemodynamic stability.

RESULT(S):

Massive hematuria occurred after oocyte retrieval. Blood transfusion was given. Cystoscopy was done, and a bleeding pseudoaneurysm was seen. It was resected and cauterized.

CONCLUSION(S):

Pseudoaneurysm after oocyte retrieval has not been reported before. It resulted in massive hematuria causing hemodynamic instability. Immediate resuscitation and cystoscopy should be performed on all patients who present with persistent hematuria after oocyte retrieval. Injury to surrounding structures should always be kept in mind during oocyte retrieval.

 

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