Pag. 18

Am J Reprod Immunol.2012 Feb;67(2):160-8. doi: 10.1111/j.1600-0897.2011.01077.x. Epub 2011 Oct 21.

Polymorphisms of dioxin receptor complex components and detoxification-related genes jointly confer susceptibility to advanced-stage endometriosis in the taiwanese han population.

Wu CH, Guo CY, Yang JG, Tsai HD, Chang YJ, Tsai PC, Hsu CC, Kuo PL.

Source

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.

Abstract

PROBLEM:

To establish a multilocus model for studying the effect of dioxin receptor complex components and detoxification-related enzymes on advanced endometriosis.

METHOD OF STUDY:

Six single-nucleotide polymorphisms (SNPs) and two deletion polymorphisms from eight genes (CYP1A1, CYP1B1, GSTM1, GSTT1, GSTP1, AhR, ARNT, and AhRR) were genotyped.

RESULTS:

In the single SNP analysis, GSTM1 null type and AhRR variant type were associated with a significantly increased risk of endometriosis [odds ratio (OR)=2.38 and 2.45, respectively]. Using multiple SNPs in the logistic regression for covariates, wild-type AhR and mutant AhRR combination was significantly higher in patients (67.8%) than in controls (48.0%) (OR=2.76). On the other hand, mutant AhRR in combination with GSTM1 null genotype was significantly higher in patients (35.5%) than in controls (19.3%) (OR=6.12).

CONCLUSION:

Polymorphisms of dioxin receptor complex components and detoxification-related genes jointly confer susceptibility to advanced-stage endometriosis in the Taiwanese Han population.

Anal Quant Cytol Histol.2012 Feb;34(1):23-7.

Evaluation of peritoneal fluid hemosiderin-laden macrophages in biopsy-proven endometriosis.

Bedaiwy MA, Noriega J, Abdel Aleem M, Gupta S, AbulHassan AM, Brainard J, Ismail AM, Falcone T.

Source

Reproductive Research Center, Minimally Invasive Surgery Center, Department of Obstetrics-Gynecology, Cleveland Clinic, 9500 Euclid Avenue, A-81, Cleveland, Ohio 44195, USA.

Abstract

OBJECTIVE:

To evaluate peritoneal fluid hemosiderin-laden macrophages (H-LMs) in patients with endometriosis compared to controls.

STUDY DESIGN:

Consecutive series of 46 patients during a year undergoing laparoscopy for benign gynecologic conditions were included. The presence of H-LMs in peritoneal fluid was evaluated. We compared clinical factors in patients with or without endometriosis in respect to H-LM status. To assess the potential of H-LMs to diagnose endometriosis, the sensitivity and specificity were calculated.

RESULTS:

Patients with endometriosis were significantly more likely to have positive H-LM test results than controls (p = 0.0013). The presence of H-LM has a low sensitivity of 52% but an acceptable specificity of 87% in diagnosing endometriosis. The presence of H-LMs was not related with any other of the clinical factors studied.

CONCLUSION:

The presence of specific findings of H-LMs related to endometriosis strongly suggests abnormalities in peritoneal iron metabolism.

Ann Thorac Surg.2012 Feb;93(2):696-7; author reply 697-8.

Pleural endometriosis and recurrent pneumothorax: the role of magnetic resonance imaging.

Marchiori E, Zanetti G, Rafful PP, Hochhegger B.

Comment on

Arch Gynecol Obstet.2012 Feb;285(2):387-96. Epub 2011 Dec 8.

The management of stage III and IV endometriosis.

Elbiss HM, Thomson AJ.

Source

Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, PO Box 17666, United Arab Emirates. hasa444@hotmail.com

Abstract

The clinical manifestations of severe endometriosis are variable and unpredictable in both presentation and course. There are also a proportion of women with severe endometriosis who remain asymptomatic. The treatment of severe endometriosis must be individualised, taking into account the impact of the disease and treatment on pain, fertility and quality of life. Surgery is usually required and multiple organs are sometimes involved. Therefore, if endometriosis is severe, referral to a center with the expertise to offer all available treatments in a multidisciplinary team, including advanced laparoscopic surgery and laparotomy, is strongly recommended. It is also important to involve the woman in all decisions, to be flexible in diagnostic and therapeutic thinking, to maintain a good relationship with the woman and to seek advice where appropriate.

Arch Gynecol Obstet.2012 Feb;285(2):427-33. Epub 2011 Jul 21.

Ovarian interstitial blood flow changes assessed by transvaginal colour Doppler sonography: predicting ovarian endometrioid cyst-induced injury to ovarian interstitial vessels.

Qiu JJ, Liu YL, Liu MH, Chen LP, Xu DW, Zhang ZX, Yang QC, Liu HB.

Source

Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China.

Abstract

PURPOSE:

To evaluate the blood flow changes and their relationships to microvessel density (MVD) and thrombospondin-1 (TSP-1) by transvaginal colour Doppler sonography (TV-CDS) in the ovarian interstitium to predict ovarian interstitial microvascular injury in the pathological process of ovarian endometrial cysts (OEC).

METHODS:

TV-CDS was preoperatively performed to detect blood flow changes in 60 patients with 76 ovarian endometrioid cysts, and flow classification and resistance indices (RI) values were recorded for analysis. Ovarian interstitial specimens with blood flow signals were collected for postoperative pathologic examination. TSP-1 protein was evaluated by immunohistochemistry and Western blot, TSP-1 mRNA by reverse transcriptase polymerase chain reaction, microvessels by CD34 antibody, and MVD by image analysis. Thirty age-matched patients with benign ovarian tumours served as controls.

RESULTS:

Blood flow, most of star-shaped, within ovarian interstitial arteries in the OEC group was diminished; however, arterial spectra exhibited a high-resistance flow manifesting a significantly higher RI compared with that of the control group (P < 0.01). In ovarian interstitial specimens, there were significantly (P < 0.01) lower CD34-MVD and higher TSP-1 protein and mRNA in the OEC group than in the controls. CD34-MVD and TSP-1 showed remarkably negative correlation (rs = -0.76, P < 0.01). RI values correlated negatively with MVD values (rs = -0.91, P < 0.01), but positively with TSP-1 (rs = 0.81, P < 0.01), while flow classification correlated positively with MVD values (rs = 0.66, P < 0.01), but negatively with TSP-1 (rs = -0.54, P < 0.01).

CONCLUSIONS:

Changes in CD34-MVD and TSP-1 reflected ovarian interstitial microvascular injury of OEC, pathologically supported the findings of blood flow changes within ovarian interstitial arteries, and prospectively predicted OEC-induced ovarian interstitial vessel injury. This has important clinical value: early treatment, instead of allowing the cyst to become bigger, is of great importance for OEC patients, because a greater number of functional tissue blood vessels would be destroyed as the disease progresses.

Arch Gynecol Obstet.2012 Feb;285(2):479-83. Epub 2011 Jun 30.

Clinicopathological characteristics of ovarian carcinomas associated with endometriosis.

Kondi-Pafiti A, Papakonstantinou E, Iavazzo C, Grigoriadis C, Salakos N, Gregoriou O.

Source

Pathology Laboratory, University of Athens, Athens, Greece.

Abstract

INTRODUCTION:

Substantial histopathology data provide evidence that endometriosis might be viewed as a precursor lesion of endometrioid and clear cell carcinoma of the ovary, via intermediary atypical borderline lesions. Also, genes involved in both endometriosis and epithelial ovarian cancer have been shown to play a role in the pathogenesis of endometriosis-associated ovarian carcinoma.

MATERIAL AND METHODS:

A retrospective study of 17 cases of ovarian carcinomas associated with endometriosis, diagnosed between 2000 and 2009, at Aretaieion Hospital of University of Athens, is presented. 10/17 cases in this study (58.8%) were clear cell carcinomas (CCC), 6/17 cases (35.3%) were endometrioid adenocarcinomas (EAC) and 1/17 cases (5.9%) was a serous carcinoma associated with ovarian endometriosis. Patients’s age was 27-76 years (mean age 58 years). Typical ovarian endometriosis was documented in 8/17 (47%) of the tumors. In 9/17 cases, areas of fibrosis or cystic lesions infiltrated by iron-laden macrophages and endometrial-like stroma, consistent with endometriosis, were observed.

CONCLUSION:

In comparison with common epithelial ovarian cancers, CCC and EACs of the ovary were presented at earlier stages. Cytoreductive surgical treatment is critical in order to plan appropriate post-operative management.

Best Pract Res Clin Endocrinol Metab.2012 Feb;26(1):105-16. doi: 10.1016/j.beem.2011.07.002.

Ovarian incidentaloma.

Solnik MJ, Alexander C.

Source

Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Geffen School of Medicine at UCLA, Los Angeles, CA 90048, USA. solnikm@cshs.org

Abstract

Incidental adnexal masses occur with relatively high frequency in post-menopausal women, with a prevalence rate of 3.3-18% in asymptomatic patients. Unilocular, benign-appearing ovarian cysts represent the vast majority of abnormal findings at transvaginal ultrasonography. As many as 80% will resolve over a period of several months; if persistent, unchanged, less than 10 cm, and with normal CA-125 values, the likelihood of an invasive cancer is sufficiently low that observation should be offered. More recent investigations support the use of secondary imaging modalities such as MRI, which may help differentiate benign from malignant masses. Surgical management plays a key role when patients are symptomatic regardless of age, menopausal and have documented changes in cyst characteristics, experience elevations in tumor markers or have symptoms suggestive of a hormone-producing neoplasm. High level, evidence-based screening guidelines have yet to be developed.

Breast Cancer Res Treat.2012 Feb;132(1):259-66. Epub 2011 Oct 30.

The association between mammographic density measures and aspirin or other NSAID use.

Stone J, Willenberg L, Apicella C, Treloar S, Hopper J.

Source

Centre for Molecular, Environmental, Genetic and Analytical Epidemiology, Melbourne School of Population Health, The University of Melbourne, L3, 207 Bouverie Street, Melbourne, VIC 3010, Australia. stonej@unimelb.edu.au

Abstract

There is evidence that aspirin use reduces the risk of breast cancer. Increased mammographic density is known to be associated with increased breast cancer risk. Little is known about the association between mammographic density and aspirin or other non-steroidal anti-inflammatory drug (NSAID) use, but it is possible that the association between aspirin use and breast cancer risk might be due to the effect of aspirin on mammographic density. Multiple linear regression was used to investigate the association between measures of mammographic density and the use, frequency, and duration of aspirin and other NSAIDs such as paracetamol (acetaminophen), arthritis medication, and other over-the-counter or doctor-prescribed pain medications in 3286 women from the Australian Mammographic Density Twins and Sisters Study and the Genes Behind Endometriosis Study. We found no association between either dense area or percent dense area with any of the NSAIDs examined (all P > 0.06). If aspirin is reducing the breast cancer risk in women, it is likely doing so via a different pathway other than mammographic density measures that predict breast cancer risk.

Curr Treat Options Neurol.2012 Feb;14(1):1-14.

Menstrual migraine: update on pathophysiology and approach to therapy and management.

Calhoun AH.

Source

Carolina Headache Institute, 103 Market Street, Chapel Hill, NC, 27516, USA, calhouna@carolinaheadacheinstitute.com.

Abstract

OPINION STATEMENT: Menstrual migraine (MM) is often reported to be more severe and more resistant to treatment than other migraines. Nevertheless, initial treatment should be the same as for any migraine. When results of acute therapy are incomplete or unsatisfactory, preventive strategies are warranted, including both pharmacologic preventives and careful adherence to lifestyle modifications. Where MM differs from other attacks is in its predictable timing and discrete precipitants. These differences allow for unique preventive strategies that target either the timing of the attacks or their hormonal precipitants. Nonspecific MM strategies-those that do not address the hormonal mechanism-include scheduled dosing of nonsteroidal anti-inflammatory drugs (NSAIDs) or triptans throughout the menstrual window. NSAIDs are a good choice when there is comorbid dysmenorrhea and allow for treatment of breakthrough headaches with triptans. Both strategies require that the timing of MM is highly predictable. Specific strategies for MM are those that reduce or eliminate the premenstrual decline in estradiol that predictably precipitates attacks. These include continuous or extended-cycle dosing of combined hormonal contraceptives (CHCs). A number of common gynecologic comorbidities argue for early adoption of these treatments, as CHCs effectively treat dysmenorrhea, menorrhagia, ovarian cysts, endometriosis, and irregular cycles. In the author’s experience, hormonal preventives are the best approach for most women whose menstrual attacks are resistant to acute therapy. They afford the greatest therapeutic benefit in prevention while treating common comorbidities and allowing for acute treatment with triptans when needed.

Diagn Cytopathol.2012 Feb;40(2):159-62. doi: 10.1002/dc.21608. Epub 2011 Feb 9.

Endometriosis of sigmoid colon mimicking malignant tumor diagnosed by intraoperative imprint cytology.

Ohsaki H, Nakamura M, Arie K, Hirakawa E, Haba R, Norimatsu Y.

Source

Department of Medical Technology, Ehime Prefectural University of Health Sciences, Ehime, Japan. ohsaki@epu.ac.jp

Abstract

A case of endometriosis of the sigmoid colon on imprint cytology from an intraoperative biopsy is discussed. Cytologic specimens showed sheets or tubular epithelial clusters and stromal fragments. The epithelial cell nuclei were small and round to ovoid with finely granular chromatin and inconspicuous nucleoli. The background showed a few scattered spindle-type stromal cells without pigment-laden histiocytes. A definitive diagnosis of endometriosis can be based on cytology, provided that the cytologic findings are interpreted in the appropriate clinical context.

Eur J Obstet Gynecol Reprod Biol.2012 Feb;160(2):166-9.

Trans-abdominal ultrasound guided transvaginal hydrolaparoscopy is associated with reduced complication rate.

Ma C, Wang Y, Li TC, Qiao J, Yang Y, Song X, Yang S.

Source

Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, People’s Republic of China.

Abstract

OBJECTIVE:

To evaluate the feasibility and value of abdominal ultrasound guided access for transvaginal hydrolaparoscopy (THL).

STUDY DESIGN:

One hundred and ninety-three infertile women were retrospectively included. A total of 31 subjects were included in the study group, and 162 cases performed prior to the introduction of transabdominal ultrasound guidance constituted a comparison group. The indications for THL were: inconclusive hysterosalpingogram findings and ovarian drilling for clomiphene-resistant polycystic ovarian disease. The total of complications arising from trocar needle insertions are compared between the study (ultrasound guidance) and comparison (without ultrasound guidance) groups.

RESULTS:

In the study group, two cases were transferred to standard laparoscopy without vaginal needle insertion because of no obvious fluid in the cul-de-sac. One of these cases was confirmed to have severe adhesions and the other had no pathology in the pelvic cavity. One further case was transferred due to severe adhesions found by THL. Twenty-nine patients had successful vaginal access including seven cases with a retroverted uterus (24.1%), as against only one case with retroverted uterus in the comparison group (0.6%). The difference was statistically significant (P<0.05). There were three cases of intestinal perforation and one case of uterine injury in the comparison group, but no case of complication in the study group. Fifteen cases were fully conducted by two novel medical doctors monitored by a senior doctor.

CONCLUSIONS:

Trans-abdominal ultrasound guided vaginal access increases the safety of THL, especially in patients with a retroverted uterus, by seeking out a better puncture spot, and making training more intuitive and safe.

Eur J Obstet Gynecol Reprod Biol.2012 Feb;160(2):239-40. Epub 2011 Dec 2.

Deep infiltrating endometriosis with obstructive uropathy secondary to ureteral endometriosis.

Wu CJ, Huang KH, Kung FT.

Eur J Obstet Gynecol Reprod Biol.2012 Feb;160(2):185-90. Epub 2011 Nov 25.

A study in vitro on differentiation of bone marrow mesenchymal stem cells into endometrial epithelial cells in mice.

Zhang WB, Cheng MJ, Huang YT, Jiang W, Cong Q, Zheng YF, Xu CJ.

Source

Obstetrics and Gynecology Hospital, Department of Obstetrics and Gynecology of Shanghai Medical School, and Institute of Biomedical Sciences, Fudan University, Shanghai, PR China.

Abstract

OBJECTIVE:

To investigate the differentiation conditions of bone marrow mesenchymal stem cells (BMSCs) into endometrial epithelial cells and to confirm the effect of 17β-estradiol in this process.

STUDY DESIGN:

BMSCs were cultured alone or co-cultured with endometrial stromal cells (EStCs) in control/differentiation medium (17β-estradiol, growth factors) and were co-cultured with EStCs in different concentrations of 17β-estradiol. Flow cytometry and immunocytochemistry were used to identify the isolated cells. Real-time RT-PCR and immunofluorescence were used to test the expression of epithelial cell markers.

RESULTS:

The epithelial markers cytokeratin-7, cytokeratin-18, cytokeratin-19, and epithelial membrane antigen were elevated in real-time RT-PCR (P<0.05), and cytokeratin was strongly positive in immunofluorescence analysis in the differentiated BMSCs. Cytokeratin-7 and cytokeratin-19 expression levels were highest in the 1 × 10⁻⁸ mol/L 17β-estradiol group, as shown in real-time RT-PCR (P<0.05).

CONCLUSION:

BMSCs could be differentiated in the direction of endometrial epithelial cells in appropriate conditions in vitro: 17β-estradiol may play a key role in stimulating BMSCs’ epithelial differentiation in the process of endometriosis.

CONDENSATION:

Bone marrow mesenchymal stem cells can differentiate in the direction of endometrial epithelial cells in a certain microenvironment and appropriate concentration of 17β-E can facilitate this differentiation.

Fertil Steril.2012 Feb;97(2):367-72. Epub 2011 Dec 15.

Deep infiltrating endometriosis is a determinant factor of cumulative pregnancy rate after intracytoplasmic sperm injection/in vitro fertilization cycles in patients with endometriomas.

Ballester M, Oppenheimer A, Mathieu d’Argent E, Touboul C, Antoine JM, Nisolle M, Daraï E.

Source

Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.

Abstract

OBJECTIVE:

To evaluate the cumulative pregnancy rate (CPR) per patient after in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles in patients with endometriomas and to evaluate the determinant factors of CPR per patient.

DESIGN:

Retrospective study from January 2007 to October 2008.

SETTING:

Tertiary care university hospital.

PATIENT(S):

103 patients who had undergone IVF treatment, comprising isolated endometriomas (n = 30) and endometriomas with associated deep infiltrating endometriosis (DIE) (n = 73).

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Clinical pregnancy rate after IVF-ICSI cycle.

RESULT(S):

The total number of cycles was 162, and the median number of cycles per patient was 1 (1 to 5). Fifty-eight women (56.3%) became pregnant. The total number of endometriomas and size of the largest endometrioma and bilateral endometriomas had no impact on the CPR per patient. Using multivariable analysis, the associated DIE and antimüllerian hormone serum level (≤ 1 ng/mL) were independent factors associated with a decrease in the pregnancy rate per patient. Overall, the CPR per patient was 73.7%, and it increased until the third cycle with no benefit for additional cycles. The CPR per patient for women with isolated endometriomas and women with endometriomas and associated DIE was 82.5% and 69.4%, respectively.

CONCLUSION(S):

Associated DIE has a negative impact on assisted reproduction results in patients with endometriomas. Moreover, our data show that after three IVF-ICSI cycles the CPR per patient is not improved and that surgery should be considered.

Fertil Steril.2012 Feb;97(2):373-80. Epub 2011 Dec 10.

Endometriosis-associated nerve fibers, peritoneal fluid cytokine concentrations, and pain in endometriotic lesions from different locations.

McKinnon B, Bersinger NA, Wotzkow C, Mueller MD.

Source

Department of Obstetrics and Gynecology, Inselspital, Berne University Hospital, University of Berne, Berne, Switzerland. brett.mckinnon@dkf.unibe.ch

Abstract

OBJECTIVE:

To assess the relationship between endometriotic lesions with associated nerve fibers with both pain and peritoneal fluid (PF) cytokine concentrations based on lesion location.

DESIGN:

An observational study.

SETTING:

University hospital.

PATIENT(S):

Premenopausal women undergoing laparoscopy.

INTERVENTION(S):

The pain experienced by patients was recorded before surgery and ectopic endometrial tissue excised and matching PF collected during laparoscopy. Immunohistochemistry was performed on endometriotic tissue sections to identify nerve fibers and PF cytokine concentrations determined.

MAIN OUTCOME MEASURE(S):

The pain experienced by women with endometriosis, the lesion locations, and the prevalence and proximity of nerve fibers to endometriotic lesions, as well as the PF concentrations of multiple cytokines.

RESULT(S):

Lesions from the rectovaginal septum were significantly more likely to be associated with a nerve fiber and report more menstrual pain than lesions from other regions. The PF glycodelin concentrations were also significantly higher in samples with an endometriotic-associated nerve. In peritoneal endometriotic lesions significantly more menstrual pain was reported when endometriotic lesions were associated with nerve fibers, although no difference was observed between the cytokine concentrations. Ovarian endometriotic lesions were rarely associated with nerve fibers.

CONCLUSION(S):

The presence of endometriosis-associated nerve fibers appear to be related to both the pain experienced by women with endometriosis and the concentration of PF cytokines; however, this association varies with the lesion location.

Fertil Steril.2012 Feb;97(2):477-82. Epub 2011 Nov 30.

Dienogest inhibits aromatase and cyclooxygenase-2 expression and prostaglandin E production in human endometriotic stromal cells in spheroid culture.

Yamanaka K, Xu B, Suganuma I, Kusuki I, Mita S, Shimizu Y, Mizuguchi K, Kitawaki J.

Source

Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.

Abstract

OBJECTIVE:

To determine the effect of dienogest (DNG) on the expression of aromatase and cyclooxygenase-2 (COX-2) and the production of prostaglandin E(2) (PGE(2)) in human endometriotic stromal cells (ESCs).

DESIGN:

Experimental study in vitro.

SETTING:

University hospital.

PATIENT(S):

Seventeen patients with ovarian endometrioma.

INTERVENTION(S):

ESCs from chocolate cyst linings of ovaries were treated with DNG.

MAIN OUTCOME MEASURE(S):

Expression of aromatase and COX-2 evaluated in spheroid cultures of human ESCs by real-time quantitative polymerase chain-reaction and immunocytochemistry, production of PGE(2) quantified by enzyme-linked immunosorbent assay (ELISA), and nuclear factor kappa B (NF-κB) DNA-binding examined by ELISA and immunocytochemistry.

RESULT(S):

The pharmaceutical actions of DNG on the expression of aromatase and COX-2 and the production of PGE(2) were examined using spheroid cultures of human ESCs. More aromatase, COX-2, and PGE(2) were expressed in spheroid cultures than in conventional ESCs monolayers. In the spheroid cultures, DNG (10(-7) M) and progesterone (10(-7) M) inhibited the expression of aromatase, COX-2, and PGE(2). DNG also inhibited NF-κB DNA-binding activity and reduced the immunocytochemical protein expression of aromatase, COX-2, and NF-κB p50 nuclear localization.

CONCLUSION(S):

Because DNG inhibits aromatase and COX-2 expression as well as PGE(2) production in ESCs, these pharmacologic features might contribute to a therapeutic effect of DNG on endometriosis.

Gynecol Endocrinol.2012 Feb;28(2):134-8. Epub 2011 Oct 17.

The role of prostaglandin E2 in endometriosis.

Sacco K, Portelli M, Pollacco J, Schembri-Wismayer P, Calleja-Agius J.

Source

Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida MSD, Malta.

Abstract

Endometriosis is a leading cause of infertility in women of reproductive age. It involves the occurrence of endometrial tissue outside the uterine endometrium, mainly in the peritoneal cavity. Prostaglandin E(2) is up regulated in the peritoneal cavity in endometriosis and is produced by macrophages and ectopic endometrial cells. This prostaglandin is involved in the pathophysiology of the disease and elicits cell signals via four receptor types. Prostaglandin E(2) increases estrogen synthesis by up regulating steroidogenic acute regulatory protein (StAR) and aromatase. It inhibits apoptosis and up regulates fibroblast growth factor-9 (FGF-9) promoting cell proliferation. Prostaglandin E(2) affects leukocyte populations and promotes angiogenesis through its effect on estrogen and up regulation of vascular endothelial growth factor (VEGF). Dienogest is a synthetic progestin targeting expression of genes involved in prostaglandin synthesis.

Gynecol Obstet Fertil.2012 Feb;40(2):116-20. Epub 2012 Jan 26.

Segmental resection for colorectal endometriosis: are there alternatives?

[Article in French]

Daraï E, Touboul C, Chéreau E, Bazot M, Ballester M.

Source

Service de gynécologie-obstétrique, université Pierre et Marie Curie, hôpital Tenon, AP-HP, Paris 6, 4, rue de la Chine, 75020 Paris, France. emile.darai@tnn.aphp.fr

Abstract

Colorectal surgery for endometriosis is increasingly performed, but its assessment is still incomplete, especially regarding its impact on quality of life, the recurrence rate and subsequent fertility. Segmental resection is the technique most often performed and best evaluated with a proven efficacy but associated with significant morbidity. Alternatives to segmental resection consisting of shaving rectal resection, discoid resection or superficial resection have recently been proposed to provide equivalent efficacy while decreasing morbidity. To date, data are insufficient to clarify the respective indications of segmental resection and alternatives. Only randomized trials will resolve the existing controversy.

Hum Pathol.2012 Feb 1. [Epub ahead of print]

KRAS mutations in ovarian low-grade endometrioid adenocarcinoma: association with concurrent endometriosis.

Stewart CJ, Leung Y, Walsh MD, Walters RJ, Young JP, Buchanan DD.

Source

Department of Histopathology, King Edward Memorial Hospital, Perth 6008, Western Australia.

Abstract

The association between ovarian endometrioid adenocarcinoma and endometriosis is well established. However, not all endometrioid adenocarcinomas are directly related to endometriosis, and it has been suggested that there may be clinicopathologic differences between endometriosis-positive and endometriosis-negative tumors. Molecular alterations in endometrioid adenocarcinoma include KRAS and BRAF mutations, but the incidence of these abnormalities in previous reports has been highly variable (0%-36% and 0%-24%, respectively). This may be explained by relatively small sample sizes in earlier studies but could also reflect difficulties in accurately classifying high-grade ovarian malignancies. In the current study, we investigated KRAS and BRAF mutations in 78 low-grade (FIGO grade 1 and 2) endometrioid adenocarcinomas and compared the results with the presence of endometriosis in the tumor-associated ovary and/or in other pelvic sites. KRAS mutations were identified in 12 (29%) of 42 endometriosis-associated endometrioid adenocarcinomas with satisfactory analysis but in only 1 (3%) of 29 tumors in which endometriosis was not identified. BRAF mutation was identified only in a single endometriosis-associated case. These findings support the hypothesis that endometriosis-associated and independent endometrioid adenocarcinoma may develop via different molecular pathways and that KRAS mutations have an important role only in the former tumors. In contrast, BRAF mutations do not appear to have a significant role in either endometrioid adenocarcinoma subgroup. This may be relevant to future targeted therapies in patients with high-stage or recurrent disease and indicate that histopathologists should carefully examine endometrioid adenocarcinoma specimens, including nonneoplastic tissues, for the presence of endometriosis.

Hum Reprod.2012 Feb;27(2):418-26. Epub 2011 Dec 8.

Combined transanal and laparoscopic approach for the treatment of deep endometriosis infiltrating the rectum.

Bridoux V, Roman H, Kianifard B, Vassilieff M, Marpeau L, Michot F, Tuech JJ.

Source

Department of Digestive Surgery, Rouen University Hospital, Rouen, France.

Abstract

BACKGROUND:

Two surgical approaches are employed in the treatment of deep infiltrating endometriosis of the rectum (DIER): colorectal resection and nodule excision. In 2009, we introduced a new technique for transanal full thickness disc excision of endometriotic nodules infiltrating the low and middle rectum, using the Contour® Transtar™ stapler (Ethicon Endo-Surgery inc., Cincinnati, OH, USA). The aim of this retrospective study was to describe the technique and to present data on the feasibility of this technique.

METHODS:

From April 2009 to October 2010, all patients presenting with DIER and undergoing full thickness excision using the Contour® Transtar™ stapler were enrolled in the study. Pre-, intra- and post-operative data were collected and reported.

RESULTS:

Six nulliparous women were managed using this technique during the study period. The rectal wall discs removed measured from 40 × 45 to 60 × 50 mm. In two cases, microscopic foci were noted on one of the margins but in four cases the limits were clear. Operating time varied from 180 to 450 min. Four women were completely free of post-operative digestive complaints.

CONCLUSIONS:

Despite the small numbers in this series, our data suggest that the new technique of transanal rectal disc excision using the contour stapler may be applied in patients with infiltrating endometrial nodules of the rectum up to 10 cm from the anal margin and up to 5 cm in diameter. This new procedure promises to be a useful addition to the surgeon’s armamentarium in a multidisciplinary approach to deep pelvic endometriosis.

Hum Reprod.2012 Feb;27(2):408-17. Epub 2011 Dec 8.

Identification and validation of novel serum markers for early diagnosis of endometriosis.

Gajbhiye R, Sonawani A, Khan S, Suryawanshi A, Kadam S, Warty N, Raut V, Khole V.

Source

Department of Reproductive Endocrinology & Infertility, National Institute for Research in Reproductive Health, Indian Council of Medical Research, J. M. Street, Parel, Mumbai 400 012, India.

Abstract

BACKGROUND:

Non-invasive diagnosis of endometriosis is urgently required to prevent the long delay between the onset of symptoms and diagnosis. A biomarker that possesses both high sensitivity and specificity is greatly required. Here, we describe the use of a proteomic approach to identify potential novel endometrial antigens using sera from endometriosis patients and healthy controls, with evaluation of biomarkers for non-invasive diagnosis of endometriosis.

METHODS:

A cross-sectional study was conducted to identify specific endometrial antigens using 1D and 2D western blots in women with early endometriosis (n = 17), advanced endometriosis (n = 23) and without endometriosis (n = 30). Five immunoreactive spots were analyzed using matrix-assisted laser desorption/ionization-time-of-flight/mass spectrometry with MASCOT analysis. ELISAs were established for specific epitopes and autoantibody titres were estimated in an independent cohort comprising women with early endometriosis (n = 18), advanced endometriosis (n = 32) and without endometriosis (n = 27) for validation.

RESULTS:

The 2D western blot analysis resulted in the identification of three endometrial antigens, tropomyosin 3 (TPM3), stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3). Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3, SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls. Sensitivity and specificity of serum anti-TPM3a-autoAb (61%, 93%), anti-TPM3c-autoAb (44%, 93%), anti-TPM3d-autoAb (78%, 89%), anti-SLP2a-autoAb (50%, 96%), anti-SLP2c-autoAb (61%, 93%), anti-TMOD3b-autoAb (61%, 96%), serum anti-TMOD3c-autoAb (78%, 93%) and anti-TMOD3d-autoAb (78%, 96%) were better than those of serum CA125 levels (21%, 89%) in the detection of early stages of endometriosis.

CONCLUSIONS:

Serum anti-TPM3a-autoAb, anti-TPM3c-autoAb, anti-TPM3d-autoAb, anti-SLP2a-autoAb, anti-SLP2c-autoAb, anti-TMOD3b-autoAb, anti-TMOD3c-autoAb and anti-TMOD3d-autoAb could be new markers for the early diagnosis of endometriosis.

Hum Reprod.2012 Feb;27(2):515-22. Epub 2011 Dec 8.

Urinary vitamin D-binding protein is elevated in patients with endometriosis.

Cho S, Choi YS, Yim SY, Yang HI, Jeon YE, Lee KE, Kim H, Seo SK, Lee BS.

Source

Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, 146-92 Dogok-dong, Gangnam-gu, Seoul 135-720, Korea.

Abstract

BACKGROUND:

Recently, proteomic technologies have demonstrated that several proteins are differently expressed in various body fluids of patients with endometriosis compared with those without this condition. The aim of this study was to investigate proteins secreted in urine of patients with endometriosis using proteomic techniques in order to identify potential markers for the clinical diagnosis of endometriosis.

METHODS:

Urine samples were collected from women undergoing laparoscopy for different indications including pelvic masses, pelvic pain, suspicious endometriosis, infertility and diagnostic evaluation. Proteomic techniques and mass spectrometry were used to identify proteins secreted in the urine of the patients with and without endometriosis and quantification of identified protein was performed using western blot and specific commercial sandwich enzyme-linked immunosorbent assays (ELISA).

RESULTS:

Twenty-two protein spots were differentially expressed in the urine of patients with and without endometriosis, one of which was identified as urinary vitamin D-binding protein (VDBP). ELISA quantification of urinary VDBP corrected for creatinine expression (VDBP-Cr) revealed that urinary VDBP-Cr was significantly greater in patients with endometriosis than in those without (111.96 ± 74.59 versus 69.90 ± 43.76 ng/mg Cr, P = 0.001). VDBP-Cr had limited value as a diagnostic marker for endometriosis (Sensitivity 58%, Specificity 76%). When combined with serum CA-125 levels (the product of serum CA-125 and urinary VDBP-Cr), it did not significantly increase the diagnostic power of serum CA-125 alone.

CONCLUSIONS:

Urinary VDBP levels are elevated in patients with endometriosis. They have limited value as a potential diagnostic biomarker for endometriosis but suggest it would be worthwhile to investigate other urinary proteins for this purpose.

Hum Reprod.2012 Feb;27(2):394-407. Epub 2011 Dec 6.

Aberrant expression of metastasis-inducing proteins in ectopic and matched eutopic endometrium of women with endometriosis: implications for the pathogenesis of endometriosis.

Hapangama DK, Raju RS, Valentijn AJ, Barraclough D, Hart A, Turner MA, Platt-Higgins A, Barraclough R, Rudland PS.

Source

Department for Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. dharani.hapangama@liverpool.ac.uk

Abstract

BACKGROUND:

Endometriosis is a metastatic disease without obvious tumorigenesis. Expression of S100P, S100A4, osteopontin (OPN) or anterior gradient homologue 2 (AGR2) proteins can induce metastasis but fail to induce tumorigenesis per se. We now explore whether this group of metastasis-inducing proteins (MIPs) are associated with the pathogenesis of endometriosis.

METHODS:

Eutopic endometrial biopsies were taken from 73 women (35 fertile women without endometriosis and 38 women with surgically diagnosed endometriosis). Ectopic endometriotic lesions were collected from eight of the women with endometriosis. The expression of MIPs at the cellular level was evaluated by immunohistochemistry and the presence of these proteins in the endometrial tissues was verified by western blotting and their gene expression was confirmed by RT-PCR.

RESULTS:

All four MIPs were immunolocated in the endometrium of control women and S100P, AGR2 and OPN showed a cyclical variation. Proliferative phase eutopic endometrium of both groups showed a similar staining pattern for all MIPs, whereas secretory phase endometrium showed a differential expression between controls and cases. The secretory phase endometrial immunostaining of controls showed weak stromal and perivascular AGR2, and decreased stromal and glandular S100P. In contrast, immunostaining for all MIPs was increased in the late secretory endometrial samples of women with endometriosis and intense immunostaining was seen for S100A4 in the stroma (P< 0.05) and for S100P (P< 0.001) and AGR2 (P< 0.0001) in both glands and stroma (P< 0.001). All active peritoneal endometriotic lesions showed strong immunostaining for each of the MIPs studied.

CONCLUSIONS:

We propose that these MIPs enhance endometrial cell invasiveness and contribute to the establishment of ectopic endometriotic deposits after retrograde menstruation.

Hum Reprod.2012 Feb;27(2):451-6. Epub 2011 Nov 23.

Nomogram to predict pregnancy rate after ICSI-IVF cycle in patients with endometriosis.

Ballester M, Oppenheimer A, d’Argent EM, Touboul C, Antoine JM, Coutant C, Daraï E.

Source

Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, 4 rue de la Chine, 75020 Paris, France. marcos.ballester@tnn.aphp.fr

Abstract

BACKGROUND:

Although several scoring systems have been published to evaluate the pregnancy rate after ICSI-IVF in infertile patients, none of them are applicable for patients with deep infiltrating endometriosis (DIE) nor can they evaluate the chances of pregnancy for individual patients. The aim of this study was to develop a nomogram based on an association of patients’ characteristics to predict the clinical pregnancy rate in patients with endometriosis.

METHODS:

This prospective longitudinal study was conducted from January 2007 to June 2010. The nomogram was built from a training cohort of 94 consecutive patients (141 ICSI-IVF cycles) and tested on an independent validation cohort of 48 patients (83 ICSI-IVF cycles). DIE was confirmed in all participants.

RESULTS:

The pregnancy rate (per patient) in women with and without DIE was 58 and 83%, respectively (P = 0.03). Increased patient age (P = 0.04), serum anti-Mullerian hormone (AMH) level ≤ 1 ng/ml (P = 0.03) and increased number of ICSI-IVF cycles (P = 0.03) were associated with a decreased clinical pregnancy rate. The presence of DIE was the strongest determinant factor of the clinical pregnancy rate in our model [odds ratio = 0.26, 95% confidence interval (CI): 0.07-0.9 (P = 0.006)], which also included patient age, serum AMH level and number of attempts at ICSI-IVF. The nomogram showed an area under the curve (AUC) of 0.76 for the training cohort (95% CI: 0.7-0.8) and was well calibrated. The AUC for the validation cohort was 0.68 (95% CI: 0.6-0.75) and calibration was good.

CONCLUSIONS:

Our nomogram provides realistic and precise information about ICSI-IVF success and can be used to guide couples and practitioners.

Lascia un commento

Cerca

Utilizzando il sito, accetti l'utilizzo dei cookie da parte nostra. maggiori informazioni

Questo sito utilizza i cookie per fornire la migliore esperienza di navigazione possibile. Continuando a utilizzare questo sito senza modificare le impostazioni dei cookie o cliccando su "Accetta" permetti il loro utilizzo.

Chiudi