Fertil Steril. 2011 Apr;95(5):1787.e5-7. Epub 2010 Dec 23.

Cervical endometriosis associated with malignant pleural mesothelioma mimicking cervical cancer-Occam’s razor or the “third man”.

Engel JB, Heuer S, Segerer S, Rauthe S, Dietl J, Hönig A.

Source

Department of Obstetrics and Gynecology, Medical University of Würzburg, Würzburg, Germany.

Abstract

OBJECTIVE:

To illustrate pitfalls in the diagnosis of endometriosis and cervical cancer.

DESIGN:

Case report.

SETTING:

University hospital, department of obstetrics and gynecology.

PATIENT(S):

A 45-year-old woman with menorrhagia, pelvic mass, right-sided hydronephrosis, and unexplained weight loss.

INTERVENTION(S):

Cervical biopsies were suggestive of cervical endometriosis. Laparoscopy confirmed endometriosis. Associated pleural effusion, without cytologic signs of malignancy, was interpreted as caused by thoracic endometriosis. The patient had a transabdominal hysterectomy and unilateral salpingo-oophorectomy. Histopathologic examination confirmed endometriosis and revealed a residual tubo-ovarian abscess. After surgery, the patient developed spontaneous seropneumothorax. Pleural biopsies revealed a well-differentiated epithelial malignant pleural mesothelioma. The patient underwent hypofractionated radiation of drain sites. She is now observed in our outpatient clinic.

MAIN OUTCOME MEASURE(S):

Steps to the correct diagnosis.

RESULT(S):

The patient had an association of cervical and pelvic endometriosis, residual tubo-ovarian abscess, and malignant pleural mesothelioma.

CONCLUSION(S):

Usually, the simplest diagnosis explaining a complex of symptoms and clinical and diagnostic findings is the one most likely to be correct. This is an application of Occam’s razor to medicine. Our case illustrates that occasionally the simplest and therefore most probable diagnosis can be wrong, and on these occasions one should consider a “third man.”

Fertil Steril. 2011 Apr;95(5):1788.e15-9. Epub 2010 Dec 23.

A subserosal uterus-like mass presenting after a sliding hernia of the ovary and endometriosis: a rare entity with a discussion of the histogenesis.

Seki A, Maeshima A, Nakagawa H, Shiraishi J, Murata Y, Arai H, Kubochi K, Kuramochi S.

Source

The Pathology Division, Clinical Laboratories, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

Abstract

OBJECTIVE:

To report the first case of a subserosal uterus-like mass.

DESIGN:

Case report.

SETTING:

A community-based hospital.

PATIENT(S):

A 44-year-old nulliparous woman who complained of a left inguinal mass had a medical history that was notable for two features. One was left oophorectomy for a sliding hernia at 10 months of age; the other was endometriosis at the oophorectomy site at 26 years of age.

INTERVENTION(S):

Tumorectomy.

MAIN OUTCOME MEASURE(S):

Not applicable.

RESULT(S):

Pathologic examination demonstrated that this subserosal mass mimicked a miniature uterus with a leiomyomatous lesion.

CONCLUSION(S):

As of September 2010, 23 cases of uterus-like mass had been reported. Three pathologic theories of uterus-like mass have been proposed: [1] congenital anomaly theory, [2] metaplasia theory, and [3] heterotopia. The pathogenesis of this rare entity is currently under debate. Most uterus-like masses have been connected to the genital organs (75.0%) and associated with endometriosis (50.0%). In the present case, the uterus-like mass developed at the surgical scar site of oophorectomy for a sliding hernia and a tumorectomy for endometriosis. We review the literature and discuss the theories regarding the histogenesis of uterus-like mass.

Fertil Steril. 2011 Apr;95(5):1836-8. Epub 2010 Dec 10.

Peritoneal fluid of patients with endometriosis promotes proliferation of endometrial stromal cells and induces COX-2 expression.

Liu Y, Hu J, Shen W, Wang J, Chen C, Han J, Zai D, Cai Z, Yu C.

Source

Department of Chinese Traditional Medicine, Changhai Hospital, Second Military Medical University, Shanghai, People’s Republic of China; Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, People’s Republic of China.

Abstract

Cell proliferation of endometrial stromal cells treated with peritoneal fluid of women (aged 25 to 43 years) with endometriosis (n = 12) statistically significantly increased compared with the control treatment (peritoneal fluid of women without endometriosis, n = 8). Also, COX-2 gene expression and prostaglandin E(2) production were induced in those cells by increasing COX-2 promoter transcription activity, which could be attenuated by a specific p38MAPK inhibitor, suggesting a role for peritoneal fluid in the etiopathogenesis of endometriosis.

Fertil Steril. 2011 Apr;95(5):1863-5. Epub 2010 Dec 3.

Quality of life in endometriosis: evaluation of the Dutch-version Endometriosis Health Profile-30 (EHP-30).

van de Burgt TJ, Hendriks JC, Kluivers KB.

Source

Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.

Abstract

The Dutch version of the Endometriosis Health Profile-30 (EHP-30) showed a high return rate and data completeness, low floor and ceiling effects, as well as good internal consistency, test-retest reliability and construct validity. The questionnaire is a reliable and valid instrument for the measurement of health-related quality of life in women with endometriosis.

Fertil Steril. 2011 Apr;95(5):1798-800. Epub 2010 Dec 3.

Decreased concentrations of pigment epithelium-derived factor in peritoneal fluid of patients with endometriosis.

Chen L, Fan R, Huang X, Xu H, Zhang X.

Source

Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China.

Abstract

To determine whether patients with endometriosis have altered levels of pigment epithelium-derived factor (PEDF) in peritoneal fluid, concentrations of PEDF in peritoneal fluid collected from 42 patients with endometriosis and 30 patients without endometriosis were measured with enzyme-linked immunosorbent assay. We detected significantly lower levels of peritoneal fluid PEDF in patients with endometriosis compared with patients without endometriosis, suggesting that peritoneal fluid PEDF plays a role in the pathogenesis of this disorder.

Hum Immunol. 2011 Apr;72(4):359-63. Epub 2011 Jan 26.

Analysis of vitamin D receptor gene polymorphisms in women with and without endometriosis.

Vilarino FL, Bianco B, Lerner TG, Teles JS, Mafra FA, Christofolini DM, Barbosa CP.

Source

Division of Pathological Gynecology and Human Reproduction, Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André/São Paulo, Brazil.

Abstract

An aberrant immunologic mechanism has been suggested to be involved in the pathogenesis of endometriosis. Genetic alterations in the vitamin D receptor gene (VDR) may lead to important defects in gene activation that principally affect immune function. We have hypothesized a possible relationship between endometriosis and/or infertility and the VDR polymorphisms (ApaI, TaqI, FokI, and BmsI). The study was a case-control study including 132 women with endometriosis-related infertility, 62 women with idiopathic infertility, and 133 controls. VDR polymorphisms were studied by restriction fragment length polymorphism. We found relatively similar VDR polymorphism genotype frequencies in cases and controls. When patients with minimal/mild and moderate/severe endometriosis were studied separately, no difference was found. When we compared infertile groups with and without endometriosis there was no statistically significant difference. The data suggest that VDR polymorphisms did not play an important role in the pathogenesis of endometriosis and/or infertility in the Brazilian women studied.

Hum Reprod. 2011 Apr;26(4):885-97. Epub 2011 Feb 7.

Abnormal activation of Ras/Raf/MAPK and RhoA/ROCKII signalling pathways in eutopic endometrial stromal cells of patients with endometriosis.

Yotova IY, Quan P, Leditznig N, Beer U, Wenzl R, Tschugguel W.

Source

Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

Abstract

BACKGROUND Enhanced proliferation and survival of eutopic endometrial cells from patients with endometriosis compared with healthy women is associated with abnormal activation of extra-cellular signal-regulated kinases 1 and 2 (ERK1/2). Given the role of Ras/Raf/mitogen-activated protein kinase (MAPK) and RhoA/ROCKII signalling pathways in the regulation of cell proliferation and migration, we analysed their possible roles in endometriosis. METHODS Primary eutopic endometrial stromal cells of patients with endometriosis (Eu-hESC, n= 16) and endometriosis-free controls (Co-hESC, n= 14) were harvested and subjected to proliferation and migration assays as well as kinase activity assays and immunoblot analysis of proteins from the Ras/Raf/MAPK and RhoA/ROCKII signalling pathways. Effects of ROCKII (Y-27632) and MAPK (U0126) inhibitors or siRNA knockdown of ROCKII, Raf-1 and B-Raf were analysed. RESULTS The proliferation rate of Eu-hESC was 54% higher than Co-hESC. Eu-hESC also displayed a 75% higher migration rate than Co-hESC. Eu-hESC displayed higher levels of ERK phosphorylation (83%) and p27 expression (61%) and lower levels of Raf-1 protein (47%) compared with controls. In addition to an inhibitory effect on cell proliferation, ROCKII knockdown led to significant down-regulation of cyclinD1 and p27 but did not affect ERK phosphorylation. Down-regulation of Raf-1 by siRNA was dispensable for cell proliferation control but led to an increase in ROCKII activity and a decrease in cell migration. B-Raf was shown to act as a regulator of hESC proliferation by modulating cellular ERK1/2 activity and cyclinD1 levels. Eu-hESC displayed 2.4-fold higher B-Raf activity compared with Co-hESC and therefore exhibit abnormally activated Ras/Raf/MAPK signalling. CONCLUSIONS We show that the same molecular mechanisms operate in Co- and Eu-hESC. The differences in cell proliferation and migration between both cell types are likely due to increased activation of Ras/Raf/MAPK and RhoA/ROCKII signalling pathways in cells from endometriosis patients.

Hum Reprod. 2011 Apr;26(4):904-10. Epub 2011 Feb 2.

The post-operative decline in serum anti-Mullerian hormone correlates with the bilaterality and severity of endometriosis.

Hirokawa W, Iwase A, Goto M, Takikawa S, Nagatomo Y, Nakahara T, Bayasula B, Nakamura T, Manabe S, Kikkawa F.

Source

Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.

Abstract

BACKGROUND To assess the impact of ovarian cystectomy for endometriomas on the ovarian reserve, we evaluated the pre- and post-operative levels of serum anti-Müllerian hormone (AMH). We also analyzed the correlations between factors related to endometriosis and surgery for endometriomas and the serum AMH levels to investigate which factors affect ovarian reserve. METHODS Thirty-eight patients who were undergoing ovarian cystectomy for unilateral endometrioma (n = 20) and bilateral endometriomas (n = 18) participated. Preoperative and post-operative serum samples were collected and assayed for AMH levels, and changes between the two samples were analyzed in association with parameters of endometriosis and surgery for endometriomas. RESULTS The mean AMH level was 3.9 ng/ml prior to surgery, and was reduced to 2.1 ng/ml at 1 month post-surgery. The rate of decline of the serum AMH level was significantly higher in the bilateral group than the unilateral group (62.8 ± 29.6 versus 24.7 ± 32.5%, P < 0.001). The rate of decline in the serum AMH levels showed a significant correlation to the revised American Society for Reproductive Medicine (rASRM) score (P = 0.003), but not age, cyst diameter, blood loss during the operation or the number of follicles removed in the specimens. CONCLUSIONS Our results suggest that the decrease in ovarian reserve should be taken into account in patients indicated for cystectomy for bilateral endometriomas or unilateral endometrioma with high rASRM scores.

Int J Epidemiol. 2011 Apr;40(2):513-4. Epub 2009 Nov 3.

On the roles of skin type and sun exposure in the risk of endometriosis and melanoma.

Grant WB.

Int J Gynaecol Obstet. 2011 Apr;113(1):76-80. Epub 2011 Jan 17.

Magnetic resonance imaging findings among women with tubercular tubo-ovarian masses.

Sharma JB, Karmakar D, Hari S, Singh N, Singh SP, Kumar S, Roy KK.

Source

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Abstract

OBJECTIVE:

To assess the usefulness of magnetic resonance imaging (MRI) in women with tubercular tubo-ovarian masses.

METHODS:

Twenty-four women with a confirmed diagnosis of tubercular tubo-ovarian masses underwent MRI. The findings were compared with laparotomy/laparoscopy results wherever possible.

RESULTS:

The mean age was 30.7years and the mean parity was 1.5. The main symptom in 37.5% of patients was infertility. The MRI findings included unilateral definitive tubo-ovarian masses (n=4 [16.7%]); bilateral definitive tubo-ovarian masses (n=4 [16.7%]); unilateral hydrosalpinx (n=8 [33.3%]); bilateral hydrosalpinx (n=4 [16.7%]); unilateral adnexal cyst (n=4 [16.7%]), tuberculous deposits on the liver (n=1 [4.2%]); and cervical growth (n=1 [4.2%]). Other associated findings were endometriosis (n=2 [8.3%]), inclusion cyst (n=1 [4.2%]), subserous fibroid (n=1 [4.2%]), sacroiliac joint arthritis (n=1 [4.2%]), and enteritis (n=1 [4.2%]).

CONCLUSION:

MRI seems to be a useful modality for the diagnosis of tubercular tubo-ovarian masses.

Int J Surg Pathol. 2011 Apr;19(2):259-62. Epub 2010 Nov 17.

Colonization of intestinal endometriosis by benign colonic mucosa: a pattern potentially misdiagnosed as invasive mucinous carcinoma.

Ponsford Tipps AM, Weidner N.

Source

University of California, San Diego, CA, USA.

Abstract

Endometriosis is well known for creating diagnostic pitfalls for pathologists. It may produce masses mimicking neoplasms or cause diagnostic quandaries, particularly when the patient age, location, and/or epithelial appearance are atypical. This study reports a patient with endometriosis causing rectal bleeding and involving the cecum. It produced a mass clinically considered appendiceal. The endometriosis was focally lined by intestinal epithelium including Paneth cells. In the deep endometriotic glands embedded within intestinal wall, direct fusion of the intestinal and the endometrial epithelium-the benign intestinal epithelium apparently colonizing the endometriotic foci-was found. The mass effect, plus deep-seated intestinal epithelium, closely mimicked invasive well-differentiated mucinous carcinoma. This is yet another peculiar presentation of endometriosis with potential for misinterpretation as a more serious condition, specifically well-differentiated mucinous carcinoma of the cecum or appendix.

J Clin Endocrinol Metab. 2011 Apr;96(4):1145-50. Epub 2011 Feb 2.

Impaired CRH and Urocortin Expression and Function in Eutopic Endometrium of Women with Endometriosis.

Novembri R, Borges LE, Carrarelli P, Rocha AL, De Pascalis F, Florio P, Petraglia F.

Source

Obstetrics and Gynecology, Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Policlinico “Le Scotte” Viale Bracci, 53100 Siena, Italy. petraglia@unisi.it.

Abstract

Context: Women with endometriosis have altered endometrial function. CRH and urocortin (Ucn) are neuropeptides produced by human endometrium and modulate endometrial decidualization. Objective: To evaluate endometrial mRNA expression of CRH and Ucn, their role in in vitro decidualization of cultured human endometrial stromal cells (HESCs) in patients with endometriosis, and the role of CRH receptors (CHR-Rs). Design: Obstetrics and Gynecology, University of Siena. Patients: Endometrial specimens were obtained from patients with and without endometriosis. Interventions: Endometrial biopsy obtained at both phases of menstrual cycle. In vitro decidualization of HESCs collected from endometriosis or control was done in the presence of CRH, Ucn, or CRH receptor type 1 (CRH-R1, antalarmin) or type 2 (CRH-R2, astressin 2b) antagonists. Outcome Measures: Endometrial mRNA expression of CRH and Ucn during endometrial cycle; prolactin, CRH-R1, and CRH-R2 mRNA expression during in vitro decidualization. Results: In healthy women CRH and Ucn expression were significantly higher (P < 0.05) in secretory than in proliferative phase; no differences were observed in endometriotic women. During in vitro decidualization, prolactin mRNA expression and release in endometriosis was lower than in control (P < 0.001). CRH and Ucn were able to significantly increase (P < 0.01) prolactin release only in control group; moreover, in this group antalarmin reduced prolactin release (P < 0.01). CRH-R1 mRNA expression increased during in vitro decidualization of HESCs in control (P < 0.01) but not in endometriosis. Conclusions: Women with endometriosis show an impaired endometrial expression of CRH and Ucn mRNA, and these neuropeptides are no more active in modulating the in vitro decidualization of HESCs, associated with a reduced expression of CRH-R1 mRNA.

J Clin Pathol. 2011 Apr;64(4):313-8.

Peritoneal mesothelial hyperplasia associated with gynaecological disease: a potential diagnostic pitfall that is commonly associated with endometriosis.

Oparka R, McCluggage WG, Herrington CS.

Source

Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK.

Abstract

Aims To describe the clinicopathological features of florid peritoneal mesothelial hyperplasia associated with gynaecological disease. Methods Review of a series of 44 cases where there was significant peritoneal mesothelial proliferation, usually on the surface of the ovary, which resulted in diagnostic problems, often including a consideration of malignancy. Results Florid mesothelial proliferation was associated with a variety of benign and malignant lesions, most commonly endometriosis. The most characteristic morphological appearance was that of small bland tubules and nests and cords of cells often embedded in fibrous tissue, sometimes with a linear arrangement. In a minority of cases, there were closely packed small glands and papillae resulting in mimicry of a serous proliferation; psammoma bodies were present in one such case. In several cases, the groups of mesothelial cells either exhibited true lymphovascular invasion or were surrounded by spaces closely simulating lymphovascular invasion. Although most cases were appreciated to represent a reactive mesothelial proliferation, several were referred with a presumed or possible diagnosis of mesothelioma, low-grade serous carcinoma, adenocarcinoma, adenomatoid tumour or Sertoli cell tumour. Positive staining with calretinin and negative staining with Ber-EP4 often helped to identify the cells as mesothelial rather than epithelial. Conclusions Florid peritoneal mesothelial hyperplasia can occur in association with a variety of gynaecological disorders. Recognition of this phenomenon and appreciation that it can produce worrisome histological patterns, particularly when associated with endometriosis, is key to reaching the correct diagnosis.

J Med Libr Assoc. 2011 Apr;99(2):127-34.

Putting the pieces together: endometriosis blogs, cognitive authority, and collaborative information behavior.

Neal DM, McKenzie PJ.

Source

Assistant Professor dneal2@uwo.ca.

Abstract

OBJECTIVE:

A discourse analysis was conducted of peer-written blogs about the chronic illness endometriosis to understand how bloggers present information sources and make cases for and against the authority of those sources.

METHODS:

Eleven blogs that were authored by endometriosis patients and focused exclusively or primarily on the authors’ experiences with endometriosis were selected. After selecting segments in which the bloggers invoked forms of knowledge and sources of evidence, the text was discursively analyzed to reveal how bloggers establish and dispute the authority of the sources they invoke.

RESULTS:

When discussing and refuting authority, the bloggers invoked many sources of evidence, including experiential, peer-provided, biomedical, and intuitive ones. Additionally, they made and disputed claims of cognitive authority via two interpretive repertoires: a concern about the role and interests of the pharmaceutical industry and an understanding of endometriosis as extremely idiosyncratic. Affective authority of information sources was also identified, which presented as social context, situational similarity, or aesthetic or spiritual factors.

CONCLUSIONS:

Endometriosis patients may find informational value in blogs, especially for affective support and epistemic experience. Traditional notions of authority might need to be revised for the online environment. Guidelines for evaluating the authority of consumer health information, informed by established readers’ advisory practices, are suggested.

J Pediatr Adolesc Gynecol. 2011 Apr;24(2):e21-3. Epub 2010 Dec 3.

Progression of endometriosis in non-medically managed adolescents: a case series.

Unger CA, Laufer MR.

Source

Children’s Hospital Boston, Division of Gynecology, Boston, Massachusetts, USA.

Abstract

BACKGROUND:

Endometriosis is considered a progressive disease that can cause chronic pelvic pain and infertility. A combined medical-surgical approach is the best method to slow the progression of endometriosis. Adolescents who are not maintained on a medical regimen postoperatively may be at risk for disease progression.

CASES:

This is a case series of three adolescent patients who presented at 13 to 16 years of age with complaint of severe pelvic pain and were diagnosed with stage 1 endometriosis at the time of laparoscopy. They were then prescribed menstrual suppressive therapy but did not remain compliant with their regimens.

RESULTS AND CONCLUSIONS:

Each patient returned to the operating room and underwent a second laparoscopy which revealed that each patient’s disease had progressed to a higher stage. Without combined surgical-medical management, disease worsens, and places patients at risk for severe chronic pelvic pain as well as infertility.

Med Hypotheses. 2011 Apr;76(4):560-3. Epub 2011 Jan 26.

Regional lymphatic spread in women with pelvic endometriosis.

Gong Y, Tempfer CB.

Source

Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.

Abstract

Endometriosis is defined by the presence of endometrial tissue outside the uterine cavity and is associated with chronic pelvic pain and infertility. After surgical and/or medical treatment, endometriosis has a high recurrence rate which increases with the length of follow-up. To delay or to eliminate recurrence is a main task in the control of this disease. To date, little is known about the mechanism of recurrence and its management is not efficacious. Recently, it has been observed that regional lymph node involvement by endometriosis is a common phenomenon in women with endometriosis. Endometriotic cells in regional lymph node are a potential target of hormonal stimulation in the postoperative period and may be a major source of disease recurrence. We hypothesize that the resection of regional lymph nodes can decrease the recurrence rate of endometriosis and hence should become part of the surgical treatment of this disease.

Med Sci Monit. 2011 Apr 1;17(4):RA92-99.

Is abnormal eutopic endometrium the cause of endometriosis? The role of eutopic endometrium in pathogenesis of endometriosis.

Liu H, Lang JH.

Source

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, P.R. China.

Abstract

Endometriosis (EM) is one of the most common diseases which severely affect the health and reproductive function of women of childbearing age. There are fundamental abnormal changes within the eutopic endometrium of women with endometriosis compared to normal endometrium of women without endometriosis. Eutopic endometrium shows enhanced ability of proliferation, implantation and angiogenesis, and greater probability of escaping the unfavorable conditions of the ectopic environment. Therefore, the character of eutopic endometrium determines the fate of the backward-flowing endometrial tissue – to live or to die. The abnormal endometrial tissue in EM patients flows backward to the pelvic cavity, completing a 3-step procedure of pathogenesis (attachment-aggression-angiogenesis), and ultimately develops into EM. Abnormal eutopic endometrium may also play important roles in endometriosis-associated infertility. This recognition regarding the pathogenesis of endometriosis ultimately will help to discover new methods for diagnosis and treatment. Endometrial markers for micro-invasive diagnosis and direct treatment of eutopic endometrium as the origin of the disease should be further investigated.<br />

Minerva Ginecol. 2011 Apr;63(2):195-201.

The presence of CD40, CD40L and ADAM8 among endometriotic patients.

Panoulis K, Nieri E, Kaparos G, Augoulea A, Logothetis E, Creatsa M, Fotiou S.

Source

nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece – aretiaugoulea@yahoo.gr.

Abstract

Clinical and molecular research data are still insufficient to determine the onset, etiology and progression of endometriosis. Recently, a number of studies have been investigating the role of the inflammatory-immune factor. The role of inflammation in tissue infiltration and staging of endometriosis is limited. The aim of this study is to investigate the presence of CD40, CD40L and ADAM8 among endometriotic patients. These three markers of inflammation were measured in the serum of each of 76 women participating in the study. Twenty-nine (29) women, of mean age 36.9, (±9.2 SD) years free of endometriosis served as the control group. Of the endometriotic women 15 had a stage I-II and 32 stage III-IV disease. We undertook the present investigation expecting that an increased expression of CD40, CD40L and ADAM8 would testify to the inflammatory-autoimmune character of endometriosis. No difference in the levels of CD40, ADAM 8, CD40L was detected between the two groups. The stage of endometriosis did not affect CD40, ADAM 8, CD40L serum concentrations. A difficulty in our study is the lack of data with which to compare our results. Further investigation is needed to elucidate the role of these inflammatory markers in endometriosis.

Minerva Ginecol. 2011 Apr;63(2):189-94.

Proposal for a systematic preoperative assessment of pelvic endometriosis.

Scioscia M, Speri C, Menegazzi F, Lamanuzzi M, Trivella G, Musola M, Spoto E, Mainardi P, Minelli L.

Source

Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria General Hospital, Negrar, Verona, Italy – marcoscioscia@gmail.com.

Abstract

AIM:

Severe endometriosis represents one of the most challenging clinical and surgical cases in gynecology. Preoperative assessment of the extension of the disease is of key relevance to opt for medical or surgical therapy and, sometimes, to plan a multidisciplinary approach.

METHODS:

A systematic diagnostic approach is proposed and evaluated in a tertiary referral centre. It is based on an initial clinical evaluation and a second level ultrasound of the pelvis. Further exams, whenever required, have to be aimed at demonstrating specific involvements of organs other than ovaries and peritoneum such as bowel, urinary tract and nerves.

RESULTS:

The application of the proposed protocol has led to a reduction of the number of non-radical surgical procedures due to incomplete consent associated with missed diagnosis over the years (P<0.001).

CONCLUSION:

Our findings support the efficacy of a systematic diagnostic approach to endometriosis. This allows a correct planning of therapy with a multidisciplinary approach when necessary.

Mol Hum Reprod. 2011 Apr;17(4):243-54. Epub 2010 Dec 14.

Transcriptional expression of type-I interferon response genes and stability of housekeeping genes in the human endometrium and endometriosis.

Vestergaard AL, Knudsen UB, Munk T, Rosbach H, Martensen PM.

Source

Department of Molecular Biology, Aarhus University, 8000 Aarhus C, Denmark.

Abstract

Endometriosis is a painful chronic female disease defined by the presence of endometrial tissue implants in ectopic (Ec) locations. The pathogenesis is much debated, and type-I interferons (IFNs) could be involved. The expression of genes of the type-I IFN response were profiled by a specific PCR array of RNA obtained from Ec and eutopic (Eu) endometrium collected from nine endometriosis patients and nine healthy control women. Transcriptional expression levels of selected IFN-regulated and housekeeping genes (HKGs) were investigated by real-time quantitative reverse transcriptase PCR (qRT-PCR). Stably expressed HKGs for valid normalization of transcriptional studies of endometrium and endometriosis have not yet been published. Here, seven HKGs were evaluated for stability using the GeNorm and NormFinder software. A normalization factor based on HMBS, TBP and YWHAZ expression was suitable for normalization of qRT-PCR studies of Eu versus Ec endometrium. In the endometrial cell lines HEC1A, HEC1B, Ishikawa and RL95-2, HMBS and HPRT1 were the most stably expressed. The IFN-specific PCR array indicated significantly different expression of the genes BST2, COL16A1, HOXB2 and ISG20 between the endometrial tissue types. However, by correctly normalized qRT-PCR, levels of BST2, COL16A1 and the highly type-I IFN-stimulated genes ISG12A and 6-16 displayed insignificant variations. Conversely, HOXB2 and ISG20 transcriptions were significantly reduced in endometriosis lesions compared with endometrium from endometriosis patients and healthy controls. In conclusion, appropriate HKGs for normalization of qRT-PCR studies of endometrium and endometriosis have been identified here. Abolished expression of ISG20 and HOX genes could be important in endometriosis.

Rehabilitation (Stuttg). 2011 Apr;50(2):111-117. Epub 2011 Apr 18.

General Conditions Concerning the Implementation of an Outpatient Education Programme – Characteristics and Distinctions from an Inpatient Training Programme.

[Article in German]

Brandes I, Wunderlich B, Niehues C.

Source

Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover.

Abstract

INTRODUCTION:

The aim of the EVA study was to develop an outpatient education programme for women with endometriosis with a view to permanent transfer into routine care. Implementation of the programme generated several problems and obstacles that are not, or not to this extent, present in the inpatient setting of a rehabilitation clinic.

METHODS:

The patient education programme was developed in line with an existing inpatient programme, taking into account the criteria for evaluating such training programmes. Several adjustments to process, structure and content level had to be made to achieve the conditions of the outpatient setting.

RESULTS:

Since May 2008, 17 training courses took place in various outpatient and acute inpatient settings, and a total of 156 women with diagnosed endometriosis participated. The problems and obstacles that emerged affected similarly the process, structure and content of the training programme.

DISCUSSION:

On the structural level, especially problems with availability of rooms, technical equipment and trainers occurred, leading to significant time pressures. The main problem on the procedural level was the recruitment of participants, since – in contrast to the inpatient setting and to disease management programmes – no assignment by physicians or insurers takes place. Furthermore, gainful activity of the participants and the resulting shift of the training beyond the usual working and opening hours are important barriers for implementation. The unavailability of trainers in these settings requires creative solutions. Regarding the contents of the training it has to be taken into consideration that – unlike the inpatient setting – no aftercare intervention and no individual psychological consultation are possible. The training programme has to be designed in such a way that all problems that have occurred could be dealt with appropriately.

CONCLUSION:

In summary, the permanent implementation of an outpatient training programme is possible but is more time-consuming than inpatient trainings due to unfavourable conditions concerning recruitment, organization and procedure. It seems that “soft” factors such as motivation, integration into the clinic concept, well-defined acceptance of responsibility and experience in dealing with the disease and with patient groups are the critical success factors. Until now cost carriage by the health insurance funds has not been realized – except for disease management programmes; so there is still a need for action here.

Reprod Fertil Dev. 2011 Apr;23(3):403-16.

Negative impact of endocrine-disrupting compounds on human reproductive health.

Balabanič D, Rupnik M, Klemenčič AK.

Source

Pulp and Paper Institute, Bogišićeva ulica 8, SI-1000 Ljubljana, Slovenia.

Abstract

There is increasing concern about chemical pollutants that are able to mimic hormones, the so-called endocrine-disrupting compounds (EDCs), because of their structural similarity to endogenous hormones, their ability to interact with hormone transport proteins or because of their potential to disrupt hormone metabolic pathways. Thus, the effects of endogenous hormones can be mimicked or, in some cases, completely blocked. A substantial number of environmental pollutants, such as polychlorinated biphenyls, dioxins, polycyclic aromatic hydrocarbons, phthalates, bisphenol A, pesticides, alkylphenols and heavy metals (arsenic, cadmium, lead, mercury), have been shown to disrupt endocrine function. These compounds can cause reproductive problems by decreasing sperm count and quality, increasing the number of testicular germ cells and causing male breast cancer, cryptorchidism, hypospadias, miscarriages, endometriosis, impaired fertility, irregularities of the menstrual cycle, and infertility. Although EDCs may be released into the environment in different ways, the main sources is industrial waste water. The present paper critically reviews the current knowledge of the impact of EDCs on reproductive disorders in humans.

Surg Endosc. 2011 Apr;25(4):1257-62. Epub 2010 Sep 17.

Laparoscopic ileocecal resection for bowel endometriosis.

Ruffo G, Stepniewska A, Crippa S, Serboli G, Zardini C, Steinkasserer M, Ceccaroni M, Minelli L, Falconi M.

Source

Department of Surgery, Ospedale Sacro Cuore, Via Sempreboni, 5, 37024, Negrar, VR, Italy, giacomo.ruffo@sacrocuore.it.

Abstract

BACKGROUND:

Ileocecal endometriosis is a very rare entity, and its diagnosis is usually made during surgery for other endometriosis sites or, rarely, because of direct complications of ileal involvement. This study was designed to analyze perioperative and long-term outcomes after bowel resection for ileocecal endometriosis.

METHODS:

All patients who underwent surgery for ileocecal endometriosis between October 2004 and January 2008 were prospectively collected and analyzed.

RESULTS:

Thirty-one women (median age, 34 (range, 25-40) years) were identified. Ileocecal endometriosis was diagnosed during surgery in all patients, and it was associated with colorectal endometriosis in 29 patients (94%). All patients underwent laparoscopic ileocecal resection with no laparotomic conversion. Rectosigmoid or rectal resections was associated in 28 patients (90%) and nodulectomy for sigmoid endometriosis in 1 patient. Median duration of surgery was 301 (range, 90-480) min. Other associated surgical procedures included total hysterectomy (n = 3, 14%), ureterolysis (n = 7, 23%), excision of vesical (n = 4, 13%), vaginal (n = 8, 26%), and parametrial (n = 3, 14%) nodules. There was no mortality. Four patients (13%) required blood transfusions and one a reoperation for bleeding. In a patient who performed ureterolysis, a ureteral fistula occurred. The median hospital stay was 7 (range, 5-18) days. Long-term (>12 months) follow-up data were available for 18 patients. After a median follow-up of 27 months, in 12 of 18 patients (67%) defecation after surgery was normal. Only one patient developed recurrence, which is under medical treatment.

CONCLUSIONS:

Laparoscopic ileocecal resection is safe and feasible and should be considered as part of surgery for endometriosis with radical intent.

Ultrasound Obstet Gynecol. 2011 Apr;37(4):480-7. doi: 10.1002/uog.8935.

Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis.

Hudelist G, Ballard K, English J, Wright J, Banerjee S, Mastoroudes H, Thomas A, Singer CF, Keckstein J.

Source

Department of Obstetrics and Gynaecology, Endometriosis and Pelvic Pain Clinic, Wilhelminen Hospital, Vienna, Austria; Stiftung Endometriose-Forschung (SEF), University of Surrey, Guildford, UK. gernot_hudelist@yahoo.de.

Abstract

OBJECTIVE:

The aim of this study was to compare the diagnostic performance of clinical vaginal examination with that of transvaginal sonography (TVS) in the presurgical diagnosis of deep infiltrating endometriosis.

METHODS:

One-hundred and fifty-five women with symptoms suggestive of endometriosis were included. One-hundred and twenty-nine patients met the inclusion criteria and were prospectively and independently assessed by vaginal examination and TVS prior to a diagnostic laparoscopy and, where appropriate, radical resection and histological confirmation of endometriosis was performed. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and positive and negative likelihood ratios (LR+ and LR-) were calculated for each test method.

RESULTS:

In total, 83 (64%) women had histological confirmation of endometriosis, 52 (40%) of whom had deep infiltrating endometriosis. The prevalence of endometriosis on the uterosacral ligaments, pouch of Douglas, vagina, bladder, rectovaginal space and rectosigmoid was 23.3%, 16.3%, 8.5%, 3.1%, 6.9% and 24%. PPV, NPV, LR+ and LR- for vaginal examination were 92%, 87%, 41.56 and 0.60 for ovarian endometriosis; 43%, 84%, 2.48 and 0.63 for uterosacral ligament disease; 64%, 95%, 9.14 and 0.26 for involvement of the pouch of Douglas; 80%, 97%, 42.91 and 0.28 for vaginal endometriosis; 78%, 98%, 46.67 and 0.23 for endometriosis of the rectovaginal space; 100%, 98%, 75.60 and 0.75 for bladder involvement; 86%, 84%, 18.97 and 0.63 for rectosigmoidal endometriosis. Values for TVS were similar with regard to vaginal and rectovaginal space endometriosis, but were clearly superior to vaginal examination in cases of ovarian (87%, 99%, 24.56 and 0.04), uterosacral ligament (91%, 90%, 31.35 and 0.37) and rectosigmoidal (97%, 97%, 88.51 and 0.1) endometriosis.

CONCLUSIONS:

TVS is a more useful test than is vaginal examination in detecting endometriosis in the ovaries and rectosigmoid. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2011 Apr;28(2):195-8.

No association of AhR gene 1661G/A and ARNT gene 567G/C polymorphisms with endometriosis in southern Han Chinese women.

[Article in Chinese]

WANG YF, ZONG LL, ZHAO X, MAO T, FU YG, ZENG J, RAO XQ.

Source

Department of Gynecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 510282 P. R. China.

Abstract

OBJECTIVE:

To explore the association between the arylhydrocarbon receptor gene (AhR) 1661G/A or arylhydrocarbon nuclear translocatorgene (ARNT) 567G/C polymorphism and endometriosis in southern Han Chinese women.

METHODS:

The polymorphisms of AhR gene 1661G/Aand ARNT gene 567G/C in 431 cases of endometriosis and 499 healthy women were genotyped by fluorescence quantitative PCR-based high resolution melting.

RESULTS:

The frequencies of genotypes AA, AG, GG and alleles A and G in controls were 12.0%, 41.9%, 46.1%, 33.0% and 67.0%, respectively, which were not significantly different from those in patients with endometriosis (9.7%, 44.6%, 45.7%, 32.0% and 68.0%, respectively). The genotype frequencies of GG, GC, CC and alleles C and G in controls (15.6 %, 51.7%, 32.7%, 58.5%, 41.5%) were not significantly different from those in patients with endometriosis (13.5%, 47.8%, 38.7%, 62.6%, 37.4%), either. And no interaction of AhR 1661G/A and ARNT 567G/C on endometriosis was found.

CONCLUSION:

No association between AhR 1661G/A and ARNT 567G/C genetic polymorphisms and endometriosis was found in the southern Han Chinese women in this study.

Fertil Steril.

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