Curr Opin Obstet Gynecol. 2012 Aug;24(4):210-4. doi: 10.1097/GCO.0b013e3283558539. Review.

Ovarian remnant syndrome: etiology, diagnosis, treatment and impact of endometriosis.

Kho RM1Abrao MS.

Abstract

PURPOSE OF REVIEW:

Ovarian remnant syndrome (ORS), a rare condition in which remnant ovarian tissue presents as a pelvic mass and/or pain after previous oophorectomy, poses a diagnostic and treatment challenge. This study reviews the recent studies in the past 5 years on the subject.

RECENT FINDINGS:

Incomplete removal of ovarian tissue at the time of initial oophorectomy from inability to obtain adequate surgical margins or inappropriate extraction from the pelvic cavity during laparoscopy can cause ORS. Excision of ovarian remnant tissue is increasingly approached minimally invasively. Cases of malignant involvement of the remnant ovary have been reported. Endometriosis, recently suggested to increase the risk for ovarian cancer, predisposes to ORS and is associated with 50% of patients with ovarian carcinoma in ORS patients.

SUMMARY:

Surgical excision remains the treatment of choice in ORS as malignancy can be associated with the remnant tissue. In cases of endometriosis, complete excision of endometriosis and ovarian tissue at the time of initial surgery prevents recurrence of endometriosis, subsequent development of ORS and possible ovarian malignant transformation.

 

 

Rom J Morphol Embryol. 2012;53(2):433-7.

Ureteral stenosis due to endometriosis.

Traşcă ET1Traşcă ETiţu ARiza MLBusuioc I.

 

Abstract

Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, with potential to undergo malignant transformation. We report the case of a 36-year-old patient with a clinical and imagistic diagnosis of left vaginal pouch and left parametrium tumor. The patient presented lumbar and pelvic pain, dysuria and polakyuria. Ultrasound revealed changes in the left kidney confirmed by the CT scan, which also revealed the presence of a tumor in the left parametrium infiltrating the bladder, juxtavesical ureter, uterus and cervix. Laboratory tests were within normal limits. Surgery consisted of interadnexal hysterectomy, proximal colpectomy, left distal ureterectomy with ureterocystoneostomy. Pathological examination established the final diagnosis of infiltrative deep endometriosis involving the urinary tract. In the case of a young fertile patient with gynecological symptoms and morphofunctional changes of the urinary system, urinary tract endometriosis should always be a diagnostic option.

 

 

Gastrointest Endosc. 2012 Sep;76(3):672-4. doi: 10.1016/j.gie.2012.04.468. Epub 2012 Jun 23. No abstract available.

Evaluation of a panel of 28 biomarkers for the non-invasive diagnosis of endometriosis.

Vodolazkaia A1El-Aalamat YPopovic DMihalyi ABossuyt XKyama CMFassbender ABokor ASchols DHuskens DMeuleman CPeeraer KTomassetti CGevaert OWaelkens EKasran ADe Moor BD’Hooghe TM.

Abstract

BACKGROUND:

At present, the only way to conclusively diagnose endometriosis is laparoscopic inspection, preferably with histological confirmation. This contributes to the delay in the diagnosis of endometriosis which is 6-11 years. So far non-invasive diagnostic approaches such as ultrasound (US), MRI or blood tests do not have sufficient diagnostic power. Our aim was to develop and validate a non-invasive diagnostic test with a high sensitivity (80% or more) for symptomatic endometriosis patients, without US evidence of endometriosis, since this is the group most in need of a non-invasive test.

METHODS:

A total of 28 inflammatory and non-inflammatory plasma biomarkers were measured in 353 EDTA plasma samples collected at surgery from 121 controls without endometriosis at laparoscopy and from 232 women with endometriosis (minimal-mild n = 148; moderate-severe n = 84), including 175 women without preoperative US evidence of endometriosis. Surgery was done during menstrual (n = 83), follicular (n = 135) and luteal (n = 135) phases of the menstrual cycle. For analysis, the data were randomly divided into an independent training (n = 235) and a test (n = 118) data set. Statistical analysis was done using univariate and multivariate (logistic regression and least squares support vector machines (LS-SVM) approaches in training- and test data set separately to validate our findings.

RESULTS:

In the training set, two models of four biomarkers (Model 1: annexin V, VEGF, CA-125 and glycodelin; Model 2: annexin V, VEGF, CA-125 and sICAM-1) analysed in plasma, obtained during the menstrual phase, could predict US-negative endometriosis with a high sensitivity (81-90%) and an acceptable specificity (68-81%). The same two models predicted US-negative endometriosis in the independent validation test set with a high sensitivity (82%) and an acceptable specificity (63-75%).

CONCLUSIONS:

In plasma samples obtained during menstruation, multivariate analysis of four biomarkers (annexin V, VEGF, CA-125 and sICAM-1/or glycodelin) enabled the diagnosis of endometriosisundetectable by US with a sensitivity of 81-90% and a specificity of 63-81% in independent training- and test data set. The next step is to apply these models for preoperative prediction of endometriosis in an independent set of patients with infertility and/or pain without US evidence of endometriosis, scheduled for laparoscopy.

 

 

Virchows Arch. 2012 Aug;461(2):227-9. doi: 10.1007/s00428-012-1264-5. Epub 2012 Jun 27. No abstract available.

Deep pelvic endometriosis: accuracy of pelvic MRI completed by MR colonography.

Scardapane A1Lorusso FBettocchi SMoschetta MFiume MVimercati APepe MLAngelelli GStabile Ianora AA.

Abstract

PURPOSE:

This study assessed the diagnostic accuracy of pelvic magnetic resonance (MR) imaging completed by MR colonography for the preoperative evaluation of deep pelvic endometriosis in patients undergoing laparoscopic surgery.

MATERIALS AND METHODS:

A total of 143 patients (mean age 34.3 ± 5.1 years) with a clinical suspicion of deep pelvic endometriosis were assessed by pelvic MR and MR colonography. All patients underwent laparoscopic surgery 3-10 weeks after the MR examination. The presence, location, number and extent of endometriotic lesions were evaluated. Data obtained with MR were compared with surgical findings. MR sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy values were calculated for each site by considering the laparoscopic and histological findings as the reference standard.

RESULTS:

Laparoscopy confirmed the presence of endometriosis in 119/143 patients (83%); in 76/119 (64%) deep pelvic endometriosis was diagnosed, whereas in the remaining 43/119 (36%), superficial peritoneal implants and endometriomas were found. In 32/119 (27%) patients, intestinal lesions were detected. MR had sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 67-100%, 85-100%, 83-100%, 84-100% and 84-100%, respectively, in recognising lesions located in different pelvic sites.

CONCLUSIONS:

MR imaging combined with colonography is a highly accurate tool for characterising deep endometriotic lesions in patients scheduled for laparoscopic surgery. In particular, MR colonography has very high accuracy in detecting colorectal involvement.

 

Hum Reprod. 2012 Sep;27(9):2698-711. doi: 10.1093/humrep/des234. Epub 2012 Jun 26.

Reproducibility of assessment of severity of pelvic endometriosis using transvaginal ultrasound.

Holland TK1Hoo WLMavrelos DSaridogan ECutner AJurkovic D.

Abstract

OBJECTIVE:

To examine the reproducibility of assessment of severity of pelvic endometriosis by transvaginal sonography (TVS).

METHODS:

This was a prospective observational study conducted from August 2006 to July 2009 in two academic departments of obstetrics and gynecology. Women with clinically suspected or proven pelvic endometriosis were invited to join the study. All patients included underwent TVS performed by two observers and a laparoscopic assessment of pelvic endometriosis. The ultrasound observers were blinded to each other’s results. The reproducibility of TVS was examined by evaluation of interobserver agreement for the American Society of Reproductive Medicine (ASRM) score by Bland-Altman analysis and the stage and the diagnosis of deeply infiltrating endometriosis (DIE) by calculation of kappa coefficients. Agreement between the findings on TVS for each observer and those on laparoscopy was also evaluated.

RESULTS:

Thirty-four patients were recruited to the study, and TVS was performed by two ultrasound observers. Of these patients, one did not undergo laparoscopy and was therefore excluded from the final analysis. No endometriosis was found in 12 (36.4%) patients. One patient (3%) had minimal disease, one (3%) had mild disease, five (15.2%) had moderate disease and 14 (42.4%) had severe disease. Interobserver agreement was very good for disease classification on TVS (Cohen’s kappa, 0.931). Agreement between TVS and laparoscopy findings was also very good (Cohen’s kappa, 0.955 and 0.966 for the two examiners). For ASRM score on TVS, the interobserver 95% limits of agreement were -16.6 to 12.7, with a mean difference of -1.9 (95% CI, -4.35 to 0.71).

CONCLUSION:

TVS is a reproducible method for assessment of the severity of pelvic endometriosis and shows good agreement with findings on laparoscopy.

 

 

 

 

J Comp Eff Res. 2012 Jul;1(4):347-57. doi: 10.2217/cer.12.38. Review.

Comparing treatments for endometriosis-related pain symptoms in patients with migraine without aura.

Morotti M1Remorgida VBuccelli EVenturini PLFerrero S.

 

Abstract

Endometriosis is a gynecological disorder defined by the presence of endometrial-like tissue outside the uterus. Several studies have found an epidemiological correlation between endometriosis and migraine, probably due to the association of both diseases with female hormones. Progestins or combined oral contraceptives are the first-line medical therapy in women with endometriosis; however, it is well known that in some women the use of combined oral contraceptives could exacerbate migraine. This observation poses a challenge to clinicians who must concomitantly treat endometriosis-related symptoms and migraine. This review summarizes the available literature on the medical treatment of endometriosis in women suffering concomitant migraine without aura until March 2012. Due to the lack of available studies on this topic, it is difficult to draw definitive conclusions. Further studies evaluating hormonal therapies are needed; in particular, progestin therapy should be reconsidered in women with migraine and concomitant endometriosis.

 

 

Iran J Reprod Med. 2012 Jul;10(4):321-8.

Effect of polyunsaturated fatty acids on secretory phospholipase A2 type IIa in ectopic endometrial cells.

Khanaki K1Motavalizadeh Ardekani A2Ghassemzadeh A3Shahnazi V3Sadeghi MR2Darabi M4Mehdizadeh A4Saremi A5Soleimani-Rad J3Imani AR6Nouri M3Rahimipour A7.

Abstract

BACKGROUND:

Endometriosis is a common chronic inflammation which leads to infertility and chronic pelvic pain in affected women. Secretory phospholipase A2 type IIa (sPLA2IIa) is an acute phase reactant that is markedly increased in inflammatory disorders.

OBJECTIVE:

To assess the effects of ω-3 and ω-6 polyunsaturated fatty acids (PUFAs) administration in endometrial cells culture on sPLA2IIa level and cell survival comparing homolog ectopic versus eutopic endometrial cells from endometriosis patients.

MATERIALS AND METHODS:

In this experimental study, ectopic and eutopic endometrial tissue samples obtained from 15 endometriosis patients were immediately frozen. After thawing and tissue digestion, mixed stromal and endometrial gland cells were cultured for 8 days in three different culture media; balanced ω-3/ω-6, high ω-3 and high ω-6 PUFAs ratio. Cell survival was measured using 2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-(phenylamino) carbonyl-2H- tetrazolium hydroxide (XTT) method and sPLA2IIa level assessed with ELISA technique.

RESULTS:

The sPLA2IIa level was significantly higher in the ectopic endometrial cell culture compared to the eutopic group for each of the three matched treatments (balanced, high ω-3 and high ω-6). Also the sPLA2IIa level in the ectopic endometrial cell group was remarkably increased by each of the three PUFAs treatments compared to control condition (p<0.05, p<0.01, p<0.05 respectively). Cell survival in the eutopic group was significantly decreased by high ω-6 culturing compared to control medium (p<0.05).

CONCLUSION:

The increase in sPLA2IIa level in ectopic endometrial cells by fatty acid treatments (especially high ω-3), strengthens the hypothesis that PUFAs stimulate secretion of cytokines leading to increased sPLA2IIa level.

 

 

Reprod Biol Endocrinol. 2012 Jun 29;10:49. doi: 10.1186/1477-7827-10-49. Review.

The effects of oxidative stress on female reproduction: a review.

Agarwal A1Aponte-Mellado APremkumar BJShaman AGupta S.

 

Abstract

Oxidative stress (OS), a state characterized by an imbalance between pro-oxidant molecules including reactive oxygen and nitrogen species, and antioxidant defenses, has been identified to play a key role in the pathogenesis of subfertility in both males and females. The adverse effects of OS on sperm quality and functions have been well documented. In females, on the other hand, the impact of OS on oocytes and reproductive functions remains unclear. This imbalance between pro-oxidants and antioxidants can lead to a number of reproductive diseases such as endometriosis, polycystic ovary syndrome (PCOS), and unexplained infertility. Pregnancy complications such as spontaneous abortion, recurrent pregnancy loss, and preeclampsia, can also develop in response to OS. Studies have shown that extremes of body weight and lifestyle factors such as cigarette smoking, alcohol use, and recreational drug use can promote excess free radical production, which could affect fertility. Exposures to environmental pollutants are of increasing concern, as they too have been found to trigger oxidative states, possibly contributing to female infertility. This article will review the currently available literature on the roles of reactive species and OS in both normal and abnormal reproductive physiological processes. Antioxidant supplementation may be effective in controlling the production of ROS and continues to be explored as a potential strategy to overcome reproductive disorders associated with infertility. However, investigations conducted to date have been through animal or in vitro studies, which have produced largely conflicting results. The impact of OS on assisted reproductive techniques (ART) will be addressed, in addition to the possible benefits of antioxidant supplementation of ART culture media to increase the likelihood for ART success. Future randomized controlled clinical trials on humans are necessary to elucidate the precise mechanisms through which OS affects female reproductive abilities, and will facilitate further explorations of the possible benefits of antioxidants to treat infertility.

 

 

J Minim Invasive Gynecol. 2012 Jul-Aug;19(4):514-6. doi: 10.1016/j.jmig.2012.03.005.

A case report of nasal endometriosis in a patient affected by Behcet’s disease.

Mignemi G1Facchini CRaimondo DMontanari GFerrini GSeracchioli R.

Abstract

We present a case of nasal endometriosis, an uncommon extrapelvic implantation of endometriotic tissue. A woman with a history of pelvic endometriosis and Behcet’s syndrome was diagnosed with nasal endometriosis after episodes of perimenstrual epistaxis and nasal pain. Despite being rare, the presence of catamenial symptoms and the possibility of performing endoscopic biopsy allowed us to make the diagnosis of nasal endometriosis. The simultaneous presence of Behcet’s syndrome focused our attention on the pathogenesis and the therapeutic management of endometriosis.

 

 

J Minim Invasive Gynecol. 2012 Jul-Aug;19(4):521-3. doi: 10.1016/j.jmig.2012.03.011.

Endometriosis of the pancreas.

Monrad-Hansen PW1Buanes TYoung VSLangebrekke AQvigstad E.

 

Abstract

Endometrial cyst of the pancreas was first described in 1984. The condition is extremely rare, and only a few case reports have been described. Herein we present a case report of a peripancreatic endometriosiscyst in a perimenopausal woman. Computed tomography, magnetic resonance imaging, and regression of the cyst during an observation period of a few months made the diagnosis most likely before laparoscopic surgery. Awareness of the condition, optimal preoperative imaging, and clinical features are discussed.

 

 

Eur J Radiol. 2013 Aug;82(8):1192-200. doi: 10.1016/j.ejrad.2012.05.026. Epub 2012 Jun 27.

Current status on performance of CT colonography and clinical indications.

Laghi A1Rengo MGraser AIafrate F.

 

Abstract

CT colonography (CTC) is a robust and reliable imaging test of the colon. Accuracy for the detection of colorectal cancer (CRC) is as high as conventional colonoscopy (CC). Identification of polyp is size dependent, with large lesions (≥10mm) accurately detected and small lesions (6-9mm) identified with moderate to good sensitivity. Recent studies show good sensitivity for the identification of nonpolypoid (flat) lesions as well. Current CTC indications include the evaluation of patients who had undergone a previous incomplete CC or those who are unfit for CC (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation). CTC can also be efficiently used in the assessment of diverticular disease (excluding patients with acute diverticulitis, where the exam should be postponed), before laparoscopic surgery for CRC (to have an accurate localization of the lesion), in the evaluation of colonic involvement in the case of deep pelvic endometriosis (replacing barium enema). CTC is also a safe procedure in patients with colostomy. For CRC screening, CTC should be considered an opportunistic screening test (not available for population, or mass screening) to be offered to asymptomatic average-risk individuals, of both genders, starting at age 50. The use in individuals with positive family history should be discussed with the patient first. Absolute contraindication is to propose CTC for surveillance of genetic syndromes and chronic inflammatory bowel diseases (in particular, ulcerative colitis). The use of CTC in the follow-up after surgery for CRC is achieving interesting evidences despite the fact that literature data are still relatively weak in terms of numerosity of the studied populations. In patients who underwent previous polypectomy CTC cannot be recommended as first test because debate is still open. It is desirable that in the future CTC would be the first-line and only diagnostic test for colonic diseases, leaving to CC only a therapeutic role.

 

 

Proc (Bayl Univ Med Cent). 2012 Jul;25(3):293-5.

Malignant transformation of endometriosis within the urinary bladder.

Mann S1Patel PMatthews CMPinto KO’Connor J.

 

Abstract

Although endometriosis of the pelvic organs is common, endometriosis of the urinary bladder is extremely rare. Malignant transformation of atypical endometriotic foci is an uncommon but well-documented sequela, occurring in approximately 1% of cases. This article reports the fourth case in the English literature of clear cell carcinoma arising from foci of endometriosis within the posterior bladder wall.

 

 

Womens Health (Lond). 2012 Jul;8(4):427-35. doi: 10.2217/whe.12.19. Review.

Effects of surgical excision of endometriosis regarding quality of life and psychological well-being: a review.

Fritzer N1Tammaa ASalzer HHudelist G.

 

 

Abstract

The aim of the present work is to give a critical and detailed reflection on the effects of surgical resection of deep infiltrating endometriosis regarding reduction of symptoms, psychological well-being and quality of life. The current evidence strongly supports the effectiveness of radical laparoscopic resection in relieving endometriosis-associated symptoms and enhancing psychological well-being. In addition, studies suggest a general improvement of quality of life, however, further studies are needed to support this observation.

 

 

Am J Pathol. 2012 Sep;181(3):917-27. doi: 10.1016/j.ajpath.2012.05.018. Epub 2012 Jun 30.

Macrophage migration inhibitory factor is involved in a positive feedback loop increasing aromatase expression in endometriosis.

Veillat V1Sengers VMetz CNRoger TLeboeuf MMailloux JAkoum A.

 

Abstract

Immune-endocrine interplay may play a major role in the pathogenesis of endometriosis. In the present study, we have investigated the interaction between macrophage migration inhibitory factor (MIF), a major pro-inflammatory and growth-promoting factor markedly expressed in active endometriotic lesions, and estradiol (E(2)) in ectopic endometrial cells. Our data showed a significant increase of MIF protein secretion and mRNA expression in endometriotic cells in response to E(2). MIF production was blocked by Fulvestrant, an estrogen receptor (ER) antagonist, and induced by ERα and ERβ selective agonists propyl-pyrazole-triol (PPT) and diarylpropionrile (DPN), respectively, thus demonstrating a specific receptor-mediated effect. Cell transfection with MIF promoter construct showed that E(2) significantly stimulates MIF promoter activity. Interestingly, our data further revealed that MIF reciprocally stimulates aromatase protein and mRNA expression via a posttranscriptional mRNA stabilization mechanism, that E(2) itself can upregulate aromatase expression, and that inhibition of endogenous MIF, using MIF specific siRNA, significantly inhibits E(2)-induced aromatase. Thus, the present study revealed the existence of a local positive feedback loop by which estrogen acts directly on ectopic endometrial cells to upregulate the expression of MIF, which, in turn, displays the capability of inducing the expression of aromatase, the key and rate-limiting enzyme for estrogen synthesis. Such interplay may have a considerable impact on the development of endometriosis.

 

 

J Clin Endocrinol Metab. 2012 Sep;97(9):3224-30. doi: 10.1210/jc.2012-1538. Epub 2012 Jul 3.

Mullerian inhibiting substance induces apoptosis of human endometrial stromal cells in endometriosis.

Namkung J1Song JYJo HHKim MRLew YODonahoe PKMacLaughlin DTKim JH.

Abstract

CONTEXT:

Müllerian inhibiting substance (MIS) is produced in Sertoli cells of fetal testis and causes regression of müllerian ducts in male embryos. MIS also can induce the cell cycle arrest and apoptosis in müllerian duct-derived tumors in vivo and in vitro.

OBJECTIVE:

Our objective was to investigate the expression of MIS type II receptor (MISR II) and whether MIS can inhibit the proliferation and induce apoptosis in primary cultures of endometrial stromal cells (ESC) of endometriosis.

DESIGN AND SETTINGS:

In vitro experiments were performed in the university research laboratory.

PARTICIPANTS:

Tissue samples from 12 patients who had undergone evisceration for ovarian endometrial cysts were included in this study.

INTERVENTIONS AND MAIN OUTCOME MEASURES:

The expression of MISR II in ESC was investigated by immunohistochemistry. The cell viability and apoptosis in ESC treated with MIS was measured by methylthiazoletetrazolium assay and annexin V analysis. The expression of regulatory proteins in ESC treated with MIS was shown by Western blotting.

RESULTS:

ESC showed specific immunostaining for the MISR II. ESC treated with MIS exhibited 32% growth inhibition (P = 0.0001). The changes in cell cycle distribution after MIS exposure at 72 h demonstrated that S and G(2)M phases were decreased; G(0)G(1) and sub-G(0)G(1) phases were increased. ESC treated with MIS showed 13.72% annexin V-fluorescein isothiocyanate positivity. In the ESCs, which contain defective p16, MIS increased the expression of pocket proteins p107 and p130 and decreased E2F transcription factor 1.

CONCLUSIONS:

The results support a central role for MIS in endometriosis. Although the precise mechanism of MIS-mediated inhibition of ESC growth has not been fully defined, these data suggest that MIS has activity against ESC in vitro and may also be an effective targeted therapy for endometriosis.

 

 

Fertil Steril. 2012 Sep;98(3):556-63. doi: 10.1016/j.fertnstert.2012.06.023. Epub 2012 Jul 3. Review.

Surgical treatment of ovarian endometriomas: state of the art?

Jadoul P1Kitajima MDonnez OSquifflet JDonnez J.

 

Abstract

To define the role of surgery in the treatment of endometriomas, we review the literature available via PubMed and cross-reference the published data. We analyze the arguments in favor of and against surgical treatment of endometriomas and compare surgical techniques. Pain relief and pregnancy rates of more than 50% after surgery are the most important arguments in favor of surgery. Histologic and biologic markers of ovarian reserve show a risk of decreased ovarian reserve that should be taken into consideration, especially in cases of repeated surgery. Considerable surgical expertise is required, and the lack of comparative studies yields no conclusions on the best surgical technique. Despite the risk of decreased ovarian reserve due to the surgical procedure, surgery has an important role in the treatment of ovarian endometriomas, and more studies are required to define the most appropriate surgical technique.

 

 

 

Indian J Gastroenterol. 2012 Jul;31(4):195-7. Epub 2012 Jul 5.

Hemorrhagic ascites: are we missing endometriosis?

Shabeerali TU1Rajan RKuruvilla APNoronha SKrishnadas DShenoy KTManjula MShenoy SRaji NL.

 

Abstract

Peritoneal tuberculosis, carcinomatosis and pancreatic ascites are often considered as differential diagnosis of hemorrhagic ascites. Endometriosis can rarely present as hemorrhagic ascites and closely mimic these conditions. When this occurs without common clinical features of endometriosis, it can create a diagnostic challenge to the treating physician. We present three patients with endometriosis who presented with hemorrhagic ascites; two of them did not have gynecological symptoms or significant pelvic disease. These patients were evaluated several times in many centers and even received multiple courses of anti-tuberculous treatment. The diagnosis was made by histologic examination of parietal peritoneum obtained by laparoscopy or laparotomy. The diagnosis was missed possibly because of the atypical presentation, lack of clinical suspicion and incomplete assessment. In conclusion, this potentially treatable condition should be considered as a differential diagnosis for hemorrhagic ascites in a premenopausal woman.

 

 

 

Adolesc Med State Art Rev. 2012 Apr;23(1):178-91, xii. Review

Ovarian cysts in adolescents: medical and surgical management.

Kirkham YA1Kives S.

 

 

Abstract

Contemporary management of ovarian cysts in the adolescent consists of conservative management, whether expectant, medical, or surgical. An understanding of ovarian physiology in the perimenarcheal and postpubertal patient supports ovarian preservation surgery, as the rate of malignancy is low and the alternative can be devastating. The most common ovarian cysts in adolescents are functional and often regress without further treatment. Symptomatic ovarian cysts warrant further investigation. Endometriomas arising from endometriosis are extremely uncommon. Tubo-ovarian abscesses are managed medically and rarely by drainage or surgery. Ovarian torsion is a surgical emergency, and prompt conservative operative management is indicated. Consideration of additional imaging, tumor markers, and surgical management of persistent or complex masses with ultrasound findings suspicious for malignancy is appropriate. This article reviews all these conditions and conservative management using laparoscopy as the preferred method if surgical intervention is needed. Unilateral removal of malignancies is advocated when possible.

 

 

J Cutan Pathol. 2012 Aug;39(8):777-80. doi: 10.1111/j.1600-0560.2012.01907.x. Epub 2012 Jul 5.

Cutaneous deciduosis: a report of two cases of an unusual pseudomalignancy.

Natale KE1Royer MCRush WLLupton GP.

 

Abstract

Cutaneous deciduosis represents a rare manifestation of cutaneous endometriosis in which typical endometrial glands and stroma are morphologically and physiologically transformed under hormonal influence. The transformed glands and stroma usually take on the microscopic appearance of uterine decidua but may mimic malignancy. We describe two cases of cutaneous deciduosis that presented in the post-partum period, but biopsies were not performed until a much later date. The first lesion arose on the perineum of a 31-year-old female after vaginal delivery, but a biopsy was not performed until 6 years after presentation. The second lesion grew in a cesarean section scar of a 26-year-old female with a history of ovarian adnexal endometriosis. Clinically described as a persistent post-operative hematoma, the lesion throbbed in synchrony with her menstrual cycles; a biopsy was also performed 6 years after presentation. Histopathologically, both specimens showed similar findings. Sections showed a multinodular proliferation of pale-staining epithelioid cells without significant nuclear atypia or conspicuous mitotic figures. Both showed focal glands that ranged from slit-like to slightly dilated and that contained a flattened epithelial lining without atypia. These unusual cases are presented to instruct about the pathologic findings of this entity in order to prevent the unnecessary diagnosis of malignancy.

 

 

 

J Obstet Gynaecol Res. 2013 Jan;39(1):462-5. doi: 10.1111/j.1447-0756.2012.01933.x. Epub 2012 Jul 6.

Rectus abdominis muscle endometriotic mass in a woman affected by multiple sclerosis.

Marci R1Lo Monte GSoave IBianchi APatella AWenger JM.

 

Abstract

We report a case of a rectus abdominis muscle endometriotic mass in a woman affected by multiple sclerosis. The pathogenesis of endometriosis is poorly understood but an immune system alteration could play a role in its onset and development. To date few studies have investigated the connection between autoimmune diseases and endometriosis. Multiple sclerosis is an inflammatory, autoimmune, demyelinating disease of the central nervous system. An autoimmune background might contribute both in the establishment of extrapelvic endometriotic lesions and in the possible increased risk of women with endometriosis to develop autoimmune diseases.

 

 

Hum Reprod. 2012 Sep;27(9):2737-46. doi: 10.1093/humrep/des220. Epub 2012 Jul 4.

Expression of adhesion, attachment and invasion markers in eutopic and ectopic endometrium: a link to the aetiology of endometriosis.

Sundqvist J1Andersson KLScarselli GGemzell-Danielsson KLalitkumar PG.

Abstract

BACKGROUND:

Cell properties, such as attachment, adhesion and invasion, are important for the normal function of the endometrium. However, it is believed that the same properties may also be involved in the development of gynaecological diseases, such as endometriosis. Endometrial cells, shed by retrograde menstruation, may have an aberrant expression of molecules involved in these functions, leading to endometriosis. Therefore, the aim of this study was to investigate the expression of proteins involved in adhesion, attachment and invasion in eutopic and ectopic endometrium.

METHODS:

Endometrial biopsy specimens were collected from healthy volunteers (controls: proliferative phase, n = 10; secretory phase, n = 15) and from endometriosis patients (proliferative phase: n = 9, secretory phase: n = 10). Biopsy specimens from endometriomas were also collected (proliferative phase: n = 9, secretory phase: n = 10). Expression of apolipoprotein E (ApoE), integrin β-2 (ITGB2), integrin β-7 (ITGB7), Laminin γ-1 (LAMC1), CD24 molecule (CD24) and junctional adhesion molecule-1 (JAM-1) was evaluated with real-time reverse transcriptase polymerase chain reaction and immunohistochemistry.

RESULTS:

The endometrium from controls and women with endometriosis expressed ApoE, ITGB2, ITGB7, LAMC1, CD24 and JAM-1. Gene expression of ApoE and JAM-1 was decreased in both proliferative and secretory phase in the endometrium from women with endometriosis compared with control endometrium. Also, mRNA expression of LAMC1 was reduced in the endometrium from endometriosis patients compared with controls in the proliferative phase. An altered gene expression of CD24 was seen between the endometrium from endometriosis patients and endometriomas in the secretory phase. The ITGB2 protein expression was altered in epithelia cells between the endometrium from healthy volunteers and endometriosis patients in the secretory phase.

CONCLUSIONS:

We have shown differential expression of adhesion, attachment and invasion proteins in proliferative and secretory endometrium from controls and endometriosis patients and in endometriomas. This study suggests that molecules with these properties may have a role in the anchoring of endometrial cells at ectopic sites, thus initiating the development of endometriosis.

 

 

Expert Opin Pharmacother. 2012 Sep;13(13):1937-42. doi: 10.1517/14656566.2012.705832. Epub 2012 Jul 7. Review.

Ulipristal acetate as an emergency contraceptive agent.

Martinez AM1Thomas MA.

Abstract

INTRODUCTION:

Emergency contraceptive agents play a crucial role in preventing unplanned pregnancy. These agents and devices have been studied since the 1960s and have had varied results in terms of side effects and efficacy. A new oral tablet for emergency contraception (EC), ulipristal acetate (UPA) , is a selective progesterone receptor modulator and can be used up to 120 h following unprotected intercourse, without an increase in adverse effects or a decrease in efficacy.

AREAS COVERED:

This article reviews studies that evaluate the pharmacodynamics, pharmacokinetics, clinical efficacy, and safety profile of UPA as an emergency contraceptive agent.

EXPERT OPINION:

UPA, a selective progesterone receptor modulator, is administered as a single 30 mg dose for EC. This agent provides a comparable, if not better, efficacy and side effect profile than seen with levonorgestrel or mifepristone. Because it has both agonistic and antagonistic effects on the progesterone receptor, ongoing clinical trials are documenting UPA’s use for patients with endometriosis and as an extended use contraceptive.

 

 

Eur J Obstet Gynecol Reprod Biol. 2012 Oct;164(2):196-9. doi: 10.1016/j.ejogrb.2012.06.004. Epub 2012 Jul 5.

Association of epidermal growth factor receptor gene polymorphisms with advanced endometriosis in a Korean population.

Lee GH1Choi YMKim JMShin JJKim JGMoon SY.

Abstract

OBJECTIVES:

To determine if specific single nucleotide polymorphisms (SNPs) in the Epidermal Growth Factor Receptor (EGFR) gene were meaningful markers for the risk of advanced stage endometriosis in a Korean population.

STUDY DESIGN:

Case-control study in a collective of 299 women with endometriosis and 285 controls. Three polymorphisms (151904 A>T [T628T] on exon 16 [rs 17337023], 162093 G>A [Q787Q] on exon 20 [rs 10251977], and 181946 C>T [D994D] on exon 25 [rs 2293347]) were assessed by a Minor Groove Binder (MGB) primer/probe Taqman assay. In-silico haplotypes were deduced using the Haploview (version 3.32) software package.

RESULTS:

There were no statistically significant differences in the genotype or haplotype frequencies of the three EGFR polymorphisms between subjects with endometriosis versus the control group. Even when the endometriosis cases were subdivided into stage III and IV based on the ASRM criteria, no statistically significant differences in genotype distribution or haplotype frequencies were observed between the three groups.

CONCLUSIONS:

Our results suggest that the 151904 A>T, 162093 G>A, and 181946 C>T polymorphisms in the EGFR gene are not associated with advanced stage endometriosis in a Korean population. Our results are in agreement with the results reported by Inagaki et al.

 

 

Fertil Steril. 2012 Sep;98(3):520-8. doi: 10.1016/j.fertnstert.2012.06.021. Epub 2012 Jul 6. Review.

Nuclear factor-kappaB: a main regulator of inflammation and cell survival in endometriosis pathophysiology.

González-Ramos R1Defrère SDevoto L.

Abstract

OBJECTIVE:

To update, analyze, and summarize the literature concerning nuclear factor-kappaB (NF-κB) participation in endometriosis pathophysiology.

DESIGN:

Review.

RESULT(S):

Nuclear factor-kappaB is physiologically activated in the human endometrium, showing variable activity. A cyclic p65-DNA binding pattern was shown in the endometrium of healthy women. This cyclic pattern was altered in the endometrium of patients with endometriosis. Nuclear factor-kappaB is basally activated in peritoneal endometriotic lesions, showing higher p65 activity in red endometriotic lesions than in black lesions. In vivo and in vitro studies show up-regulation of inflammation and cell proliferation and down-regulation of apoptosis by NF-κB activity. Iron overload has been shown in the pelvic cavity of endometriosispatients, and iron overload and oxidative stress activate NF-κB in macrophages, which have been shown to participate in the endometriosis-associated inflammatory reaction.

CONCLUSION(S):

Nuclear factor-kappaB activation dysregulation in the endometrium of endometriosispatients may explain some endometrial biological alterations associated with endometriosis. The scientific evidence strongly suggests that NF-κB activity in endometriotic cells stimulates inflammation and cell proliferation and inhibits apoptosis, favoring the development and maintenance of endometriosis. Iron overload in the pelvic cavity of endometriosis patients could be a main factor enhancing oxidative stress and activating NF-κB in a chronic manner, contributing to endometriosis establishment and growth.

 

 

 

J Gynecol Obstet Biol Reprod (Paris). 2012 Nov;41(7):668-71. doi: 10.1016/j.jgyn.2012.04.019. Epub 2012 Jul 6. French.

A case of digestive occlusion on an endometriosis lesion after treatment by GnRH agonist.

Vieille P1Masia FDonici ILaporte SMares Pde Tayrac R.

 

Abstract

Endometriosis concerns 10% of childbearing age women and frequently affects the digestive tract. We report here the case of a 31-year-old patient presenting a severe occlusive syndrome while being treated with GnRH agonist, within the framework of an in vitro fertilization. The surgical treatment will find a deep endometriosis affecting the sigmoid and colorectal junction and leading to a colorectal resection. These endometriosis lesion recurrences during ovarian stimulation or by GnRH flare up effect is rare and often debated. The surgical treatment of the lesions, before the medically assisted procreation, seems to prevent these complications.

 

 

Integr Biol (Camb). 2012 Sep;4(9):1090-5. doi: 10.1039/c2ib00172a. Epub 2012 Jul 6.

Co-cultured endometrial stromal cells and peritoneal mesothelial cells for an in vitro model of endometriosis.

Chen Z1Dai YDong ZLi MMu XZhang RWang ZZhang WLang JLeng JJiang X.

 

Abstract

This paper demonstrates an in vitro model to simulate the microenvironment of endometriosis. We used microfluidic channels with cover slips to pattern and release endometrial stromal cells (ESCs) and human peritoneal mesothelial cells (HPMCs) in a way that mimicked the pathophysiology of peritoneal endometriosis. This approach enabled observation in real time interactions between ESCs and HPMCs both in their normal and pathological states. HPMCs from control individuals were able to resist the invasion of ESCs from both control and endometriotic individuals. By contrast, HPMCs from endometriotic individuals were unable to resist the invasion of ESCs from both normal and endometriotic individuals. We further analyzed the dynamics between HPMCs and ESCs from endometriotic individuals. HPMCs from endometriotic individuals relaxed their adhesion to each other at the beginning of invasion of ESCs, lose their adhesion to the substrate and apoptosed when surrounded by ESCs. These data implicate that the peritoneal physiology may play an important role in endometriosis.

 

 

Asian J Endosc Surg. 2011 Nov;4(4):161-5. doi: 10.1111/j.1758-5910.2011.00104.x. Epub 2011 Sep 8.

Total abdominal hysterectomy versus laparoscopically-assisted vaginal hysterectomy versus total vaginal hysterectomy.

Shiota M1Kotani YUmemoto MTobiume TShimaoka MHoshiai H.

Abstract

INTRODUCTION:

While total abdominal hysterectomy (TAH) and total vaginal hysterectomy (TVH) are conventional procedures, we have actively introduced laparoscopically-assisted vaginal hysterectomy (LAVH) since its advent. This study was the first attempt to retrospectively compare the surgical results, including invasiveness, among the three methods of performing a hysterectomy.

METHODS:

The subjects included 1181 patients who underwent total hysterectomies (TAH, n=465; LAVH, n=629; TVH, n=87) due to uterine fibroids or uterine adenomyosis at our hospital between January 1995 and December 2009. The mean age, parity, weight of the removed uterus, operative time, blood loss, rates of intra- and post-operative complications, length of post-operative hospital stay, leukocyte count, and CRP and hemoglobin levels were compared.

RESULTS:

The operative time was significantly longer in the LAVH group than the other two groups. Blood loss was significantly greater in the TAH group than the LAVH and TVA groups. The rates of intra- and post-operative complications were significantly higher in the TAH group than the LAVH group. The CRP level and leukocyte count were significantly lower in the LAVH group than the TAH and TVH groups.

CONCLUSION:

LAVH can be applied to nulligravidas or patients with relatively large uteri and it is proved less invasive than TAH and TVH in this study. We recommend active application of LAVH.

 

 

Case Rep Med. 2012;2012:725498. doi: 10.1155/2012/725498. Epub 2012 Jun 12

Desmoid tumor of the anterior abdominal wall in female patients: comparison with endometriosis.

Krentel H1Tchartchian GDe Wilde RL.

 

 

Abstract

In female patients presenting a tumor of the lower abdominal wall especially after cesarian section, an endometriotic tumor as well as an aggressive desmoid tumor should be considered. Symptoms in correlation with the monthly period can facilitate the presurgical differentiation between endometriosis and fibromatosis. Ultrasound reveals the typical location of both tumors and its remarkable sonographic appearance. In the clinical practice, the desmoid fibromatosis of the lower abdominal wall is a very rare disease. We present a case of a 25-year-old pregnant and discuss diagnostic and therapeutic options by a PubMed literature review. With the knowledge of the prognosis of the desmoid fibromatosis and the respective treatment options including wait and see, complete surgical resection with macroscopically free margins and adjuvant approaches is essential to avoid further interventions and progression of the locally destructive tumor.

 

 

Ceska Gynekol. 2012 Jun;77(3):189-94.

Laparoscopic reconstructive management of cervical agenesis.

Bielik T1Baláž VRosova L.

Abstract

OBJECTIVE:

To asses the viability of laparoscopic management of cervical agenesis.

DESIGN:

Case report.

SETTING:

  1. Gynaecology and Obstetrics Dpt. at the University Hospital of F.D. Roosevelt, Banská Bystrica, Slovakia.

METHODOLOGY:

Diagnostic management and laparoscopic technique.

RESULTS:

Congenital agenesis of the cervix is a rare anomaly of the inner genital. It may be associated with vaginal aplasia and less frequently with other anomalies like an incomplete fusion of müllerian ducts. Hysterectomy was frequently used to resolve main symptoms with respect to frequent complications associated with reconstructive surgery. Recently we can see a comeback to reconstructive surgery as a result of new medical technologies (new antibiotics and antibacterial sutures). Laparoscopic surgery is considered to be the main approach. The treatment strategy is related to a detailed individual pre-surgery investigation. Success of the surgical treatment is measured by normal menstruation and restored fertility. In this article we report the laparoscopic approach in creating the uterovaginal anastomosis in 20-year old women with cervical agenesis and duplex uterine anomaly and review the treatment options.

CONCLUSION:

Laparoscopic treatment of cervical agenesis is eligible and might be considered as a first-line treatment option.

 

 

J Obstet Gynaecol. 2012 Aug;32(6):566-8. doi: 10.3109/01443615.2012.690786.

Outcome of IVF/ICSI referrals from the Royal Alexandra Hospital (level 2 infertility service) to Glasgow Royal Infirmary (level 3 infertility service).

May J1Gemmell JCrawford JLyall H.

 

Abstract

In a 2-year period (2004 and 2005), 117 couples with infertility were referred from secondary care for IVF/ICSI treatment. This study describes the age, waiting times, diagnostic categories and outcomes for all couples referred. A total of 59% (69) of all couples referred conceived. Of these, 25% (29 couples) conceived spontaneously or as a result of simpler treatments and 34% (40 couples) conceived following IVF/ICSI treatment. The twin pregnancy rate following IVF/ICSI was 25% and the average waiting time from referral to treatment was 13-18 months. Couples with female factor infertility (excluding endometriosis) and couples with unexplained infertility experienced a higher spontaneous pregnancy rate while awaiting IVF/ICSI treatment, than those couples with male factor or combined infertility. However, couples with male factor or combined infertility achieved much higher success rates with IVF/ICSI treatment.

Zhonghua Fu Chan Ke Za Zhi. 2012 Mar;47(3):179-84. Review. Chinese.

Vascular endothelial growth factor gene polymorphisms and the risk of endometriosis: a systematic review.

[Article in Chinese]

Jiang Y1Tang JYWu YZhao TF.

Abstract

OBJECTIVE:

To analyze the potential association between the single nucleotide polymorphisms (SNP) of the vascular endothelial growth factor (VEGF) gene with the risk of endometriosis by meta-analysis.

METHODS:

Published case-control studies about the influence of VEGF polymorphisms on endometriosiswere searched and screened in Medline, the Cochrane library, China National Knowledge Internet (CNKI), Chinese Biological Medicine Disk (CBM), data base of Wanfang and Foreign Medical Journal Full-Text Service (FMJS). RevMan 5.0 software was used for meta-analysis.

RESULTS:

Finally, there were 9 literatures including 1610 endometrisis patients and 1643 controls cases, which were eligible for the criteria to investigating the VEGF SNP about -460C/T, +405C/G and +936C/T. The results of meta-analysis showed that there was no evidence for association between endometriosisand the VEGF -460C/T SNP in the genotype or allele frequencies distribution (P > 0.05). Significant differences were found between the frequencies distribution of VEGF +405CC genotype (P = 0.009, OR = 1.45, 95%CI: 1.10 – 1.91) and +405C allele (P = 0.020, OR = 1.19, 95%CI: 1.03 – 1.38), also between the +936CC genotype (P = 0.050, OR = 0.81, 95%CI: 0.66 – 1.00) and +936T allele (P = 0.040, OR = 1.20, 95%CI: 1.01 – 1.43).

CONCLUSIONS:

The VEGF +405C/G and +936C/T SNP may be associated with the risk of endometriosis. Women carrying the +405C or the +936T allele could significantly increase the risk of developing endometriosis.

 

 

Zhonghua Fu Chan Ke Za Zhi. 2012 Apr;47(4):255-8. Chinese.

Clinical value of anti-adhesion agents used in laparotomy in obstetrics and gynecology.

[Article in Chinese]

Liu MM1Li PL.

Abstract

OBJECTIVE:

To investigate clinical value of anti-adhesion agent:chitosan in preventing adhesions followed by laparotomy surgery in obstetrics and gynecology.

METHODS:

From Jan. 2006 to Dec. 2009, 770 patients underwent laparotomy surgery at Department of Obstetrics and Gynecology in the Second Affiliated Hospital of Harbin Medical University. One hundred and twenty-five patients underwent secondary surgery due to disease recurrence or cesarean section, the previous surgery were 18 cases with myomectomy, 20 cases with endometriosis surgery, 5 cases with resection of pelvic abscess, 20 cases with ectopic pregnancy surgery, 27 cases with benign adnexal neoplasm resection, 9 cases with cyto-reductive surgery in ovarian cancer, 26 cases with variable infertility surgery. Those 125 patients were managed by different agents washing before abdomen closure, which were assigned into two groups, including 59 cases washed by saline in control group and 66 cases washed by chitosan in study group. The abdomen adhesion in secondary surgery was evaluated by adhesion classification system.

RESULTS:

In study group, 37 patients without adhesions, 20 patients with degree I adhesion, 6 patients with degree II adhesion, 3 patients with degree III adhesion, and no patients with degree IV adhesion were observed. While in control group, there were 11 patients without adhesions, 23 patients with degree I adhesion, 14 patients with degree II adhesion, 8 patients with degree III adhesion, and 3 patients with degree IV adhesion. The distribution of adhesion reached statistical significance between the two groups (χ(2) = 20.9999, P = 0.0003). Twenty-six patients in previous surgeries due to infertility included 17 cases in control group and 9 cases in study group. They all were managed by cesarean section in secondary surgery, it was found that 15 cases without adhesion and 2 cases with degree I adhesion were in study group and 2 cases without adhesion and 7 cases with degree I adhesion were in control group. It reached statistical difference (P = 0.0016).

CONCLUSION:

Anti-adhesion agent could prevent adhesion followed by surgery in obstetrics and gynecology effectively.

 

 

Genet Test Mol Biomarkers. 2012 Aug;16(8):865-73. doi: 10.1089/gtmb.2011.0295. Epub 2012 Jul 11.

p53 and risk of endometriosis in Indian women.

Govatati S1Chakravarty BDeenadayal MKodati VLManolla MLSisinthy SBhanoori M.

Abstract

AIM:

To investigate the role of loss of heterozygosity (LOH), single nucleotide polymorphisms (SNPs), and the expression of gene p53 in the pathogenesis of endometriosis.

METHODS:

LOH at the p53 gene locus (17p13.1) was examined in matched ectopic and eutopic endometrial tissues from 31 endometriosis patients by polymerase chain reaction (PCR)-GeneScan analysis. The genotyping of selected p53 SNPs (n=10) was carried out on genomic DNA of blood from endometriosis patients (n=720) and controls (n=500) by PCR sequencing. The p53 expression levels were analyzed in the endometrial tissues from endometriosis patients (n=5) and controls (n=4) by Western blot and immunohistochemical analysis.

RESULTS:

LOH was observed at the 17p13.1 locus (38.7%) in the ectopic endometrium but not in the eutopic endometrium of patients. The genotype (p=0.909) and allele (p=0.729) distribution of the p53 codon Arg72Pro polymorphism was not significantly different between patients and controls. The polymorphism was not observed at codon 47 along the other SNPs studied. There was no preferential loss of either “Arg72” or “Pro72” alleles among the LOH-positive heterozygous cases. In addition, decreased p53 expression was observed more often in the endometrium of patients than in controls.

CONCLUSIONS:

p53 SNPs are not associated with endometriosis in Indian women. However, LOH and reduced expression of p53 are related with the risk of endometriosis in Indian women.

 

 

 

J Plast Reconstr Aesthet Surg. 2013 Jan;66(1):129-30. doi: 10.1016/j.bjps.2012.05.012. Epub 2012 Jul 10. Review.

Cutaneous endometriosis: a plastic surgery perspective.

Din AH1Verjee LSGriffiths MA.

 

 

Abstract

Cutaneous endometriosis is a rare skin pathology that may present to the gynaecologist, general surgeon, dermatologist, or plastic surgeon. It is often misdiagnosed due to its rarity and variable appearance. In the current literature recommendations for its management vary greatly. We present a case of cutaneous endometriosis presenting to a plastic surgery service, as well as a review of the literature. Cutaneous endometriosis should be considered as a differential in any female presenting with an umbilical lesion, and should be diagnosed histiologically following an excision biopsy with 2 mm margins.

 

 

 

Radiographics. 2012 Jul-Aug;32(4):971-85. doi: 10.1148/rg.324115184.

Tumorlike conditions of the pleura.

Walker CM1Takasugi JEChung JHReddy GPDone SLPipavath SNSchmidt RAGodwin JD 2nd.

 

 

Abstract

Tumorlike conditions of the pleura are rare, but diagnosis is facilitated by recognizing certain imaging patterns and interpreting them in the clinical context. A tumorlike condition of the pleura is any nonneoplastic lesion of the pleura itself, or within the pleural space, that resembles a tumor. An approach to diagnosis of the tumorlike conditions of the pleura is provided, and these conditions are grouped into focal or diffuse conditions, with an emphasis on specific imaging features. Focal tumorlike conditions of the pleura include pleural plaque, thoracic splenosis, thoracic endometriosis causing catamenial pneumothorax, and pseudotumor caused by pleural effusion. Thoracic splenosis should be considered in a patient who has a healed left lower rib fracture, an absent spleen, and left lower pleural nodules. Thoracic endometriosiswith catamenial pneumothorax should be considered in a woman of childbearing age who presents with right scapular pain and recurrent pneumothorax occurring at or around the onset of menses. Extrapleural hematoma is a nonpleural mimic of pleural tumor and shares some imaging features with focal tumorlike conditions of the pleura, despite residing in the extrapleural space. Diffuse tumorlike conditions of the pleura include diffuse pleural thickening and rare conditions such as Erdheim-Chester disease and diffuse pulmonary lymphangiomatosis. Erdheim-Chester disease should be considered when diffuse pleural thickening occurs with a perirenal soft-tissue halo or distal femoral sclerosis. Diffuse pulmonary lymphangiomatosis should be considered when findings include diffuse pleural thickening, interlobular septal and peribronchovascular interstitial thickening, and mediastinal fat infiltration limited to the thorax and when these findings persist despite diuretic therapy.

 

 

Fertil Steril. 2012 Oct;98(4):948-56.e1. doi: 10.1016/j.fertnstert.2012.06.009. Epub 2012 Jul 11.

Progesterone-dependent regulation of endometrial cannabinoid receptor type 1 (CB1-R) expression is disrupted in women with endometriosis and in isolated stromal cells exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD).

Resuehr D1Glore DRTaylor HSBruner-Tran KLOsteen KG.

Abstract

OBJECTIVE:

To examine the differentiation-related expression of cannabinoid receptor type 1 (CB1-R) messenger RNA (mRNA) and protein in endometrial tissue obtained from women with and without endometriosis and to determine the impact of acute 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure on CB1-R gene expression in isolated endometrial stromal cells.

DESIGN:

Laboratory-based study.

SETTING:

University-affiliated medical center.

PATIENT(S):

Women with and without endometriosis undergoing volunteer endometrial biopsies after informed consent.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Analysis of in vivo CB1-R mRNA and protein expression in human endometrial tissues and mRNA expression in isolated stromal cells after exposure to TCDD or a progesterone receptor antagonist (onapristone).

RESULT(S):

Expression of CB1-R mRNA and protein was highest during the progesterone-dominated secretory phase in control samples, but expression was minimal in the endometrial tissues acquired from women with endometriosis, regardless of the cycle phase. Although progesterone was found to induce CB1-R mRNA expression in endometrial stromal cells from control donors, steroid-induced expression of this gene was inhibited by cotreatment with either TCDD or onapristone.

CONCLUSION(S):

Our studies reveal a role for the anti-inflammatory actions of progesterone in regulating endometrial cannabinoid signaling, which is disrupted in women with endometriosis. We demonstrate for the first time that acute TCDD exposure disrupts cannabinoid signaling in the human endometrium.

 

 

 

Fukushima J Med Sci. 2012;58(1):74-7.

Incidental early lung adenocarcinoma after surgery for catamenial pneumothorax.

Higuchi M1Yamaura TKanno RSuzuki HAsano SGotoh M.

 

 

Abstract

A 40-year-old female patient underwent surgery at our hospital for recurrent pneumothorax. A defect on the right diaphragm was diagnosed as ectopic endometriosis. However, air leakage continued 2 days after surgery. Chest computed tomography identified a 5-mm ground glass opacity in the right S3 field, suggestive of lung cancer. Ten days after the initial surgery, she underwent curative surgery for both pneumothorax and the lung tumor. The tumor was diagnosed as bronchioloalveolar carcinoma, but no other endometriosis was identified. The patient has remained well with no recurrence of lung cancer or pneumothorax since the second surgery.

 

 

Arch Gynecol Obstet. 2012 Oct;286(4):1033-40. doi: 10.1007/s00404-012-2439-7. Epub 2012 Jul 12. Review.

Oxidative stress biomarkers in patients with endometriosis: systematic review.

Carvalho LF1Samadder ANAgarwal AFernandes LFAbrão MS.

Abstract

PURPOSE:

Since the first description about oxygen toxicity made by Joseph Priestley, the oxidative stress has been enrolled as a key factor in the pathogenesis of endometriosis. Our aim was to review oxidative stress biomarkers measured in patients with endometriosis.

METHODS:

Relevant studies were identified by searches of the MEDLINE database from 1990 to March 2011 using endometriosis, free radical and oxidative stress as mesh terms. We only included manuscripts in English, and review articles were excluded. In addition, free radical chemistry and oxidative stress history were discussed.

RESULTS:

After inclusion and exclusion criteria, 19 articles were selected to be included in this systematic review. A total of 36 oxidative stress biomarkers (20 different markers) were measured in patients with endometriosis. Some of the markers were measured in more than one manuscript. They were arranged in five subgroups: Enzymatic activity (n = 3), Anions/free radicals (n = 5), Lipoperoxidation markers (n = 7), DNA Damage markers (n = 1), and Protein oxidation (n = 4). Of those 36 markers, 23 were found to be significantly higher in patients with endometriosis comparing with control patients.

CONCLUSION:

Oxidative stress plays an important role in the pathogenesis and progression of endometriosis.

 

 

Gynecol Obstet Invest. 2012;74(4):261-4. doi: 10.1159/000339630. Epub 2012 Jul 10.

Endometrioma ≤3 cm in diameter per se does not affect ovarian reserve in intracytoplasmic sperm injection cycles.

Esinler I1Bozdag GArikan IDemir BYarali H.

Abstract

BACKGROUND:

Our aim was to determine the effect of single endometriomas ≤3 cm in diameter per se on ovarian reserve in intracytoplasmic sperm injection (ICSI) cycles.

METHODS:

We enrolled 19 consecutive infertile patients (29 cycles) who had unilateral single endometriomas ≤3 cm in diameter and who underwent ICSI.

RESULTS:

The mean age of the patients was 33.3 ± 4.9 years. The mean diameter of endometriomas was 21.8 ± 4.9 mm. Left- and right-sided endometriomas were 34.5 and 65.5%, respectively. The number of oocytes retrieved from ovaries with endometriomas and contralateral normal ovaries was comparable (5.9 ± 4.3 vs. 5.4 ± 3.8).

CONCLUSION:

Endometriomas ≤3 cm in diameter per se did not have a deleterious effect on ovarian reserve in ICSI cycles.

 

 

J Assist Reprod Genet. 2012 Oct;29(10):1083-9. doi: 10.1007/s10815-012-9831-x. Epub 2012 Jul 14.

The relationship between pregnancy and oxidative stress markers on patients undergoing ovarian stimulations.

Younis A1Clower CNelsen DButler WCarvalho AHok EGarelnabi M.

Abstract

PURPOSE:

We investigated the activities and relevance of a validated panel of antioxidant enzymes, cytokines, specific lipid peroxidation end products and six fatty acids by correlational analyses with peak E(2) levels and pregnancy outcome after ovarian stimulation for IVF or IUI.

METHODS:

Blood samples obtained from 15 patients undergoing ovarian stimulation with rFSH or hMG were divided into two groups. Group-1 was baseline blood collected on day-2-3 of women cycle. Group-2 is blood collected at the end of FSH/hMG injection. Serum was collected and stored in liquid nitrogen at -196 °C until analysis. Standard IVF and IUI procedures were followed. The serum levels of Paraoxonase (PON1), Superoxide Dismutases (SOD), Interleukin-6 (IL-6), Glutathione Peroxidase (GPx), 8-Isoprostane, and fatty acids Arachidic, Palmitic, Stearic, Oleic, Linoleic & Linolenic were measured.

RESULTS:

With the exception of 8-Isoprostane, results showed a positive correlation between baseline and peak levels of E(2) and that of SOD, GPx, PON1, and IL-6. The PON1, IL-6 and SOD were significantly (p < 0.05) higher in pregnant than non-pregnant group. Fatty acid levels at baseline and peak E(2) were not different but pregnancy rates were found to be decreasing with higher palmitic, and stearic acid levels.

CONCLUSIONS:

Ovarian stimulation causes a significant increase in serum PON1, SOD, GPx and IL-6 activity in women undergoing IVF or IUI. The high levels of IL-6, SOD, and PON1 and lower levels of palmitic, and stearic acids in the pregnancy positive group indicate that these oxidative stress and nutritional factors may be used as a predictive marker in controlled ovarian stimulation success.

 

 

Zhonghua Wai Ke Za Zhi. 2012 Apr;50(4):349-52. Chinese.

Transurethral partial cystectomy with a 2 micron laser in diagnosis and treatment for bladder submucosal lesions in adults.

[Article in Chinese]

Wei ZT1Yang YSun DCXu YLu JSZu QZhang X.

Abstract

OBJECTIVE:

To investigate the characteristics of transurethral partial cystectomy with a 2 µm laser in diagnosis and treatment for the bladder submucosal lesions in adults.

METHODS:

Nine patients with suspected pathological diagnosed bladder submucosal lesions in out-patient department were diagnosed and treated transurethral with a 2 µm laser under sacral block between August 2009 and December 2010. The diameters of tumors were 1.5 – 2.5 cm. A 2 µm laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with bladder wall at the base were removed together and sent for pathological examination. The surgical procedures, intraoperative hemorrhage, intraoperative and postoperative complications were observed, pathological diagnosis and postoperative follow-up were performed.

RESULTS:

All operations were successful. Mean operative time was 36.4 minutes (range 25 to 47 minutes), perioperative blood loss was minimal. There was no obturator nerve reflection and no hemorrhage detected after surgery. Postoperative pathological diagnosis included leiomyoma in 3 cases, pheochromocytoma in 3 cases, endometriosis in 1 case and metastatic bladder cancer in 2 cases.

CONCLUSIONS:

Transurethral partial cystectomy with a 2 µm laser can diagnose and treat bladder submucosal lesions. The procedures are effective and safe. Patients could get accurate pathological diagnosis without further painful and some bladder tumors can be treated by minimally invasive surgery.

 

 

Chin Med J (Engl). 2012 May;125(9):1614-7.

Mini-abdominoplasty combined with mesh used for abdominal wall endometriosis.

Zhao R1Wang XJSong KXZhu LLi B.

Abstract

BACKGROUND:

Wide excision is considered the treatment of endometriosis. It is difficult to surgeon for reconstruction of a large full-thickness defect through the abdominal-wall. We introduce a method of mini-abdominoplasty combined with mesh that can be used for reconstruction of a large full-thickness defect through the abdominal-wall after wide excision of abdominal wall endometriosis.

METHODS:

This retrospective study includes a series of patients who underwent wide excision of abdominal wall endometriosis and reconstruction of a large full-thickness defect through the abdominal-wall over a 5-year period. Information obtained from chart reviews includes age, size of lesion and defect, complications and revisions.

RESULTS:

The method was used for 8 patients including 2 patients with recurrence. The mean size of the masses was (3.5 ± 2.0) cm. The mean size of the fascia defects was 7.1 cm × 8.6 cm. The mean length of follow-up was (24 ± 12) months. There was no recurrence, no hernia, and no other complications. The technique generated only a horizontal scar. The scar and contour of the lower abdomen provided a more pleasant appearance than the traditional procedure.

CONCLUSIONS:

Mini-abdominoplasty combined with mesh is a useful and acceptable reconstruction method for large full-thickness defects through the abdominal wall after endometriosis resection. It is feasible for wide excision with 1 cm normal tissues around the margin. It provides an aesthetically pleasing result.

 

 

Rev Bras Ginecol Obstet. 2012 Jun;34(6):278-84. Portuguese.

Deep infiltrating endometriosis: anatomical distribution and surgical treatment.

Kondo W1Ribeiro RTrippia CZomer MT.

Abstract

PURPOSE:

To evaluate the anatomical distribution of deep infiltrating endometriosis (DIE) lesions in a sample of women from the South of Brazil.

METHODS:

A prospective study was conducted on women undergoing surgical treatment for DIE from January 2010 to January 2012. The lesions were classified according to eight main locations, from least serious to worst: round ligament, anterior uterine serosa/vesicouterine peitoneal reflection, utero-sacral ligament, retrocervical area, vagina, bladder, intestine, ureter. The number and location of the DIE lesions were studied for each patient according to the above-mentioned criteria and also according to uni- or multifocality. The statistical analysis was performed using Statistica version 8.0. The values p<0.05 were considered statistically significant.

RESULTS:

During the study period, a total of 143 women presented 577 DIE lesions: uterosacral ligament (n=239; 41.4%), retrocervical (n=91; 15.7%), vagina (n=50; 8.7%), round ligament (n=50; 8,7%), vesico-uterine septum (n=41; 7.1%), bladder (n=12; 2.1%), and intestine (n=83; 14.4%), ureter (n=11; 1.9%). Multifocal disease was observed in the majority of patients (p<0.0001), and the mean number of DIE lesions per patient was 4. Ovarian endometrioma was present in 57 women (39.9%). Sixty-five patients (45.4%) presented intestinal infiltration on histological examination. A total of 83 DIE intestinal lesions were distributed as follows: appendix (n=7), cecum (n=1) and rectosigmoid (n=75). The mean number of intestinal lesions per patient was 1.3.

CONCLUSIONS:

DIE has a multifocal pattern of distribution, a fact of fundamental importance for the definition of the complete surgical treatment of the disease.

 

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