J Assist Reprod Genet. 2014 Oct;31(10):1277-85

The gene expression profile of cumulus cells reveals altered pathways in patients with endometriosis.

Allegra A1Raimondo SVolpes AFanale DMarino ACicero GDe Leo GSammartano FAllegra GAlessandro R.

 

Abstract

PURPOSE:

The objective of this experimental study was to compare the global gene expression profile of CC of mature oocytes in 18 patients with severe endometriosis and CC in 18 control patients affected by a severe male factor.

METHODS:

For each group, the CC were pooled, RNA was extracted and a microarray performed. For validating the microarray, a quantitative real-time PCR was performed in the CC of an independent set of patients with endometriosis (n = 5) and controls (n = 7).

RESULTS:

595 differentially expressed genes (320 down-regulated, 275 up-regulated, p < 0.05, fold change ≥1.5) were identified. The most significant changes were observed in genes involved in the chemokine signaling and cell-cell or cell-extracellular matrix adhesion pathways. Several genes of these pathways were down-regulated in endometriosis. Individual RT-PCR assays confirmed the microarray for ten genes.

CONCLUSIONS:

Several genes involved in the chemokine mediated-signaling pathway and in the functional cross-talk between CC and the oocyte are down-regulated in endometriosis CC. The impairment of these processes could explain the reduction of oocyte competence in endometriosis. This preliminary knowledge could be the starting point for a more detailed elucidation of the relationship between endometriosis and oocyte competence.

 

 

Surg Today. 2015 Sep;45(9):1194-6.

Diaphragmatic hernia caused by heterotopic endometriosis in Chilaiditi syndrome: report of a case.

Haratake N1Yamazaki KShikada Y.

 

Abstract

A 50-year-old Japanese female was admitted to our hospital because of ileus due to Chilaiditi syndrome. Her symptoms did not improve with conservative therapy, so chest and abdominal computed tomography (CT) was performed on the fifth day after hospital admission. A diagnosis of incarceration of a right diaphragmatic hernia was established in the coronal view of CT, and emergency surgery was performed. A dilated loop of small intestine was seen in the right thoracic cavity, which was strangulated by the 2-cm defect in the diaphragm. Primary closure of the diaphragm was performed. Approximately 80 cm of the terminal ileum showed obvious ischemic changes, and it was cut and reconstructed. Postoperatively, the patient made an uneventful recovery and was discharged on the 15th postoperative day. A histological examination of the specimen of the diaphragm around the hernia orifice showed the presence of a small cystiform glandular system with hemorrhage and congestion. These findings indicated that heterotopic endometriosis was present in the diaphragm. This report describes the first known case of right diaphragmatic hernia secondary to heterotopic endometriosis in a patient with Chilaiditi syndrome. The clinical course and management of affected patients and a literature review of these three unusual conditions are discussed.

 

 

J Assist Reprod Genet. 2014 Oct;31(10):1337-47.

Tubal transport of gametes and embryos: a review of physiology and pathophysiology.

Ezzati M1Djahanbakhch OArian SCarr BR.

 

Abstract

With the advent of assisted reproductive technology in the past three decades, the clinical importance of fallopian tubes has been relatively overlooked. However, successful spontaneous conception requires normal function of the tube to provide not only a conduit for the gametes to convene and embryo to reach the uterine cavity, but also a physiologically optimized environment for fertilization and early embryonic development. In this review, after a brief description of normal human tubal anatomy and histology, we will discuss tubal transport and its principal effectors, including ciliary motion, muscular contractility and tubal fluid. Furthermore, we will discuss the ciliary ultrastructure and regulation of ciliary beat frequency by ovarian steroids, follicular fluid, angiotensin system, autonomic nervous system and other factors such as adrenomedullin and prostaglandins. In the last section, we describe the adverse impact of various pathological conditions, such as endometriosis, infection and smoking on tubal function and ciliary motility.

 

 

 

J Minim Invasive Gynecol. 2015 Jan;22(1):8-9.

Laparoscopic discoid anterior rectal excision with the circular stapler for rectosigmoid endometriosis, performed by the gynecologic surgeon.

Zanatta A1Sousa JS2Machado RL2Polcheira PA2.

 

Abstract

STUDY OBJECTIVE:

To demonstrate the technique of laparoscopic discoid anterior rectal wall resection using a circular stapler, feasible in the case of rectosigmoid endometriosis lesions measuring ≤ 3 cm.

DESIGN:

Case report (Canadian Task Force classification III).

SETTING:

Private practice hospital in São Paulo, Brazil.

PATIENT:

Thirty-four-year-old woman with pelvic deep endometriosis including a 2-cm lesion in the rectosigmoid situated 11 cm proximally to the anal border. She had chronic pelvic pain, dysmenorrhea, dyspareunia, and constipation. She had undergone no previous surgical procedures.

INTERVENTIONS:

Standard 4-puncture laparoscopy was performed, and all visible endometriosis lesions were first removed before proceeding to rectal resection. The avascular rectovaginal space was identified, and the rectosigmoid was mobilized cranially, releasing the vagina and increasing the final distance of the bowel anastomosis to the anal border. The rectosigmoid nodule was isolated in its entire circumference and remained restricted to the anterior wall of the bowel. It was then transfixed using a 2-0 polyglycolic suture, with the healthy proximal and distal limits of the bowel included in the suture. A 33-cm endoscopic circular stapler was introduced via the anus up to the distal limit of the lesion and opened inside the bowel lumen. By pulling the edges of the suture, the rectosigmoid nodule was introduced inside of the circular stapler. It was fired to resect the anterior rectal wall, and the anastomosis was situated at the anterior and lateral walls of the bowel. Integrity of the bowel was checked via infusion of saline solution with methylene blue dye. Gynecologic surgeons performed all of the procedures.

MEASUREMENTS AND MAIN RESULTS:

Bowel resection took 20 minutes, and the entire surgical procedure lasted 120 minutes. The patient was discharged after 48 hours. There were no intercurrent events, either early or late postoperatively. The patient was symptom-free at 2 years of follow-up.

CONCLUSION:

Laparoscopic discoid excision of an anterior rectal nodule using the circular stapler is an effective option for treating selected cases of rectosigmoid endometriosis. The technique might be reproducible by gynecologic surgeons after proper training.

 

 

Reproduction. 2014 Nov;148(5):R85-95

Expression, activation, and role of AKT isoforms in the uterus.

Fabi F1Asselin E2.

 

Abstract

The three isoforms of AKT: AKT1, AKT2, and AKT3, are crucial regulators of both normal and pathological cellular processes. Each of these isoforms exhibits a high level of homology and functional redundancy with each other. However, while being highly similar and structurally homologous, a rising amount of evidence is showing that each isoform possesses specific targets as well as preferential subcellular localization. The role of AKT has been studied extensively in reproductive processes, but isoform-specific roles are yet to be fully understood. This review will focus on the role of AKT in the uterus and its function in processes related to cell death and proliferation such as embryo implantation, decidualization, endometriosis, and endometrial cancer in an isoform-centric manner. In this review, we will cover the activation of AKT in various settings, localization of isoforms in subcellular compartments, and the effect of isoform expression on cellular processes. To fully understand the dynamic molecular processes taking place in the uterus, it is crucial that we better understand the physiological role of AKT isoforms as well as their function in the emergence of diseases.

 

 

Eur J Gynaecol Oncol. 2014;35(4):438-41.

Is HE4 a useful endometrioma marker?

Leggieri CD’Agostino GTommasi LPlebani MConte L.

 

Abstract

PURPOSE OF INVESTIGATION:

By the comparison between most used tumor marker trend (cancer antigen 125: CA 125 and human epididymal secretory protein E4: HE4) before and after laparoscopic surgery, the aim of the present study was to assess HE4 usefulness in ovarian benign cyst and endometrioma diagnosis.

MATERIALS AND METHODS:

Thirty-eight patients were enrolled in this prospective study: 25 women underwent unilateral endometriosis ovarian cyst excision, 13 underwent benign ovarian cyst incision, and 26 were healthy controls. CA 125 and HE4 serum levels were estimated before surgery (in the early proliferative phase of the cycle) and one month after surgery.

RESULTS:

A statistically significant decrease of CA 125 serum level was found after an endometrioma surgical excision but no decreases in HE4 serum level.

CONCLUSION:

In patients with endometrioma, no alteration was found in HE4 serum levels before and after surgery, while CA125 serum levels decreased after surgery. HE4 may better distinguish a malign cyst from benign one, but it is not useful in the diagnosis of low risk endometrioma.

 

 

Eur J Gynaecol Oncol. 2014;35(4):469-72.

Rupture of an endometrioma with extremely high serum CA-125 level (> 10,000 IU/ml) and ascites resembling ovarian cancer.

Park CMKim SY.

 

Abstract

Carbohydate antigen 125 (CA-125) is a type of cell surface glycoproteins present in more than 80% of non-mucinous epithelial ovarian carcinomas; however, benign gynecologic conditions commonly cause a smaller increase in CA-125 level. This report presents the details regarding a 44-year-old woman with extremely high serum CA-125 level and ascites. She complained of having abdominal pain and abdominal distension. Her serum CA-125 level had been markedly elevated (> 10,000 IU!ml) and computed tomograpgy (CT) revealed an ovarian tumor and massive ascites. The cytological analysis showed no evidence of malignancy, however, the positron emission CT (PET-CT) scan suggested ovarian malignancy with peritoneal carcinomatosis. Under the impression that the patient had ovarian cancer, the present surgical team carried out an explorative laparotomy and discovered the ruptured bilateral ovarian endometriomas. In this study, it is suggested that clinicians carrying out differential diagnosis of pelvic mass with high serum CA-125 level and ascites should consider not only ovarian cancer but also ruptured endometrioma.

 

 

 

Indian J Pathol Microbiol. 2014 Jul-Sep;57(3):447-9.

Primary extrauterine endometrial stromal sarcoma: Located in pelvic and abdominal tissue and arising in endometriosis.

Ghosal T1Roy AKurian S.

 

Abstract

Primary extrauterine endometrial stromal sarcoma is a rare tumor and it is infrequently associated with endometriosis. We are reporting a case of this unusual tumor in a 42-year-old female who presented with multiple nodules of tumor in the abdomen and pelvis and with metastases in para-aortic lymph nodes. The right parametrium, in addition, had a focus of endometriosis, which was contiguous with the tumor, confirming its origin.

 

 

Fertil Steril. 2014 Oct;102(4):1191-6.

Resolvins RvD1 and 17(R)-RvD1 alleviate signs of inflammation in a rat model of endometriosis.

Dmitrieva N1Suess G2Shirley R2.

 

Abstract

OBJECTIVE:

To study the effects of two resolvins of D series, RvD1 and 17(R)-RvD1, on inflammatory signs associated with endometriosis (ENDO).

DESIGN:

In vivo research study.

SETTING:

Research laboratory.

ANIMAL(S):

Female Sprague-Dawley rats.

INTERVENTION(S):

Intravenous or intraperitoneal injections of RvD1 (300 ng/kg) or 17(R)-RvD1 (300 and 900 ng/kg) in rats with surgically induced ENDO.

MAIN OUTCOME MEASURE(S):

Vascular permeability of ectopic endometrial growths was assessed by Evans Blue extravasation; vaginal hyperalgesia was assessed with telemetered visceromotor response.

RESULT(S):

Both resolvins, but not vehicle, significantly decreased vascular permeability in ectopic endometrial tissue. 17(R)-RvD1 also significantly alleviated severity of vaginal hyperalgesia.

CONCLUSION(S):

Our results suggest that RvD1 and 17(R)-RvD1 can be considered for further investigation of their therapeutic potential for treating ENDO.

 

 

Mater Sociomed. 2014 Jun;26(3):156-7.

Combined hysterolaparoscopy for the diagnosis of female infertility: a retrospective study of 132 patients in china.

Zhang E1Zhang Y1Fang L2Li Q2Gu J2.

 

Abstract

OBJECTIVES:

To evaluate the effects and safeness of combined hysterolaparoscopy on evaluation the causes of infertility.

METHODS:

This retrospective study was conducted at the Department of Gynecology (The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China) from January 2011 to April 2014. Patients aged 21-43 years with infertility were included in this study. The prevalence of different lesions was collected to analyze.

RESULTS:

132 infertile patients were included, 71 (53.8%) women had primary infertility and the rest 61 (46.2%) had secondary infertility. Laparoscopic abnormalites were more common than hysteroscopy abnormalites both in primary infertility group and secondary infertility group. Pelvic inflammatory disease (59.09 %) and endometriosis (29.55%) were the most common abnormalities in two groups. The most common intrauterine pathology was uterine polyps and the most common uterine malformation was uterine septum in two groups. Out of 12 patients having malformation uterus, only one was double uterus and double cervical with double vagina. There was no major surgical or anesthetic complication in any of our patients, other than mild abdominal pain.

CONCLUSION:

Hysterolaparoscopy is an effective and safe tool in comprehensive evaluation of infertility to diagnosis and treat the lesions of pelvic and uterus in the same time. Hysterolaparoscopy may be recommended as the first and final procedure for evaluation of female infertility.

 

 

nt J Clin Exp Med. 2014 Jul 15;7(7):1853-9.

Effect of lower than expected number of oocyte on the IVF results after oocyte-pickup.

Gonca S1Gün I2Ovayolu A1Silfeler D1Sofuoğlu K1Ozdamar O3Yilmaz A2Tunali G1.

 

Abstract

OBJECTIVES:

To investigate whether a lower than expected number of oocyte after ≥14 mm follicle aspiration during OPU has any effect on pregnancy outcomes Methods: This is a retrospective study done between 2010 and 2013 at the IVF Unit of the Zeynep Kamil Women and Children Diseases Education and Research Hospital, dealing with the medical records of infertile patients who underwent IVF cycle and controlled ovarian stimulation with long agonist or fix antogonist protocol. The patients included into the study were those diagnosed with a primary infertility, aged between 23 and 39, at a BMI of 22-28 kg/m(2) and having received the first or second IVF treatment. Male factor, presence of uterine anomaly, patients with serious endometriosis and patients with low ovarian reserve were all excluded from the study. Typically, oocyte pick-up was performed in all the patients 35.5 hours after the hCG implementation. Single or double embryo transfer was performed, where available. Patients were classified into two groups. Group 1 consisted of those with no difference between ≥14 mm aspirated follicle number and expected number of oocyte or with 1 missing number of oocyte at the most. Group 2 consisted of those with at least ≥2 missing number of oocyte between aspirated follicle number and expected number of oocyte. Statistical analysis was performed using Student’s t test for continuous variables and chi-square test for categorical variables. Additionally, a Linear regression analysis was conducted between the total number of oocyte and pregnancy.

RESULTS:

In total, 387 treatment cycles were included into the study. Group 1 consisted of 134 patients and Group 2 consisted of 252 patients. Antral follicle number (12.8 ± 4.3 and 14.5 ± 4.1, P = 0.0007), hCG day E2 value (1990.7 ± 1056.4 and 2515.2 ± 1332.7, P < 0.0001) and the the number of aspirated follicle during OPU (9.1 ± 4.4 and 13.7 ± 5.5, P < 0.0001) were significantly higher in Group 2; whereas on the other hand, daily gonadotropin dose (290.9 ± 79.9 and 273.4 ± 74.4, P = 0.034) and total gonadotropin doses (2545 ± 1031.8 and 2247.7 ± 901.9, P = 0.004) were significantly higher in Group 1. The pregnancy rate was significantly higher in Group 1 (29.1% and 19.4%, P = 0.041). No correlation was observed between the number of oocyte and pregnancy (r = 0.082, P = 0.107).

CONCLUSIONS:

The number of aspirated follicles during IVF treatment being higher than the collected number of oocyte leads to a statistically significant fall in the pregnancy rates. There is no correlation between the number of oocyte and pregnancy.

 

 

Case Rep Surg. 2014;2014:519631.

Cecal endometriosis presenting as acute appendicitis.

Alizadeh Otaghvar H1Hosseini M1Shabestanipour G2Tizmaghz A1Sedehi Esfahani G1.

 

Abstract

The aim of our paper is to show the diagnosis of Coecal endometriosis as an infrequent reason of right iliac fossa pain. cecal endometriosis manifesting with right lower quadrant pain is difficult to diagnose, and it may even sometimes require laparotomy for diagnosis and treatment. We report here a case of cecal endometriosiscausing clinically resembled acute appendicitis. In our patient, a diagnosis of cecal endometriosis was made postoperatively by microscopic examination of excised right colon, and the patient symptoms and general condition were improved after the surgery (open right hemicolectomy and ileocolic anastomosis).

 

 

Nagoya J Med Sci. 2014 Feb;76(1-2):83-90.

Unexpected ovarian malignancy found after laparoscopic surgery in patients with adnexal masses–a single institutional experience.

Saito SKajiyama HMiwa YMizuno MKikkawa FTanaka SOkamoto T.

 

Abstract

Laparoscopy has become the standard surgery for the treatment of benign ovarian tumors. The aim of this study was to evaluate the appropriateness of laparoscopy for ovarian tumors, including those with malignant potential. A total of 487 patients with adnexal masses underwent laparoscopic surgery in Social Insurance Chukyo Hospital from January 2000 to December 2012. We reviewed 471 cases that fulfilled the criteria set for this study, and examined 10 cases with unexpected ovarian malignancy to analyze their preoperative diagnosis, second surgery, postoperative chemotherapy, and prognosis. The ages of the 471 patients ranged from 13 to 50 years, with a median of 31. Nulliparous patients numbered 321(68.1%). Of all, 436 patients mostly consisted of those with endometrioma, benign ovarian neoplasm or functional cyst. In all, we histologically identified 10 women with malignancy: 6 with borderline ovarian tumors (BOT), 2 with ovarian cancer, and 2 with histologically rare tumors (immature teratoma and granulosa cell tumor). All patients with BOT were diagnosed with a mucinous histology. Two patients underwent both second radical surgery (hysterectomy and contra- or bilateral salpingo-oophorectomy) and chemotherapies that consisted of CBDCA and PTX or DTX. Thus, 2 patients underwent staging procedures, but the remaining 8 cases did not. None of them had evidence of recurrences. With accurate staging and careful postoperative follow-up, laparoscopic surgery could be a feasible initial operation for patients with adnexal masses including early-stage ovarian malignancy.

 

 

J Obstet Gynaecol Res. 2014 Aug;40(8):1989-97.

Thalidomide affects experimental endometriosis: a randomized controlled study in the rat.

Azimirad A1Alborzi SKumar PVZolghadri JZarei ATavana ZAzimirad M.

 

Abstract

AIM:

This study aimed to assess the efficacy of thalidomide for treatment of experimental endometriosis.

METHODS:

This study was a parallel-group, double-blind, stratified, randomized controlled animal trial with 1:1 allocation ratio. Endometriosis was induced experimentally in 23 mature, nulligravid, female Sprague-Dawley rats, weighing approximately 200 g and aged 2 months. A checkpoint surgery was performed 6 weeks later. Then, the rats were randomly allocated into the thalidomide (22 mg/day p.o.) and control (0.5 mL saline 0.9%/day p.o.) groups of nine. After 6 weeks, they were killed. Before each laparotomy, blood for leukocyte and lymphocyte counts and during them, implants for histopathology and peritoneal fluid for interleukin (IL)-6, tumor necrosis factor-α and vascular endothelial growth factor (VEGF)-A concentrations (by enzyme-linked immunoassay) were collected. Allocation and stratified randomization were done using a computer, based on the obtained histopathology scores of the implants of the checkpoint surgery.

RESULTS:

The histopathology scores (the main outcome measure) were 2.00 ± 1.55 versus 0.44 ± 1.01 (P = 0.035). The comparisons of after-treatment counts of leukocytes, lymphocytes, VEGF-A and IL-6 between the two groups were statistically significant.

CONCLUSION:

The results of this study are in favor of therapeutic implication of thalidomide in experimental endometriosis in rats. This is the first time thalidomide has been evaluated on endometriosis in an animal model.

 

 

 

 

World J Gastroenterol. 2014 Aug 14;20(30):10470-7

Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms.

Chen HT1Xu GQ1Teng XD1Chen YP1Chen LH1Li YM1.

 

Abstract

AIM:

To investigate the diagnostic accuracy of endoscopic ultrasonography (EUS) for rectal neuroendocrine neoplasms (NENs) and the differential diagnosis of rectal NENs from other subepithelial lesions (SELs).

METHODS:

The study group consisted of 36 consecutive patients with rectal NENs histopathologically diagnosed using biopsy and/or resected specimens. The control group consisted of 31 patients with homochronous rectal non-NEN SELs confirmed by pathology. Epithelial lesions such as cancer and adenoma were excluded from this study. One EUS expert blinded to the histological results reviewed the ultrasonic images. The size, original layer, echoic intensity and homogeneity of the lesions and the perifocal structures were investigated. The single EUS diagnosis recorded by the EUS expert was compared with the histological results.

RESULTS:

All NENs were located at the rectum 2-10 cm from the anus and appeared as nodular (n = 12), round (n = 19) or egg-shaped (n = 5) lesions with a hypoechoic (n = 7) or intermediate (n = 29) echo pattern and a distinct border. Tumors ranged in size from 2.3 to 13.7 mm, with an average size of 6.8 mm. Homogeneous echogenicity was seen in all tumors except three. Apart from three patients (stage T2 in two and stage T3 in one), the tumors were located in the second and/or third wall layer without involvement of the fourth and fifth layers. In the patients with stage T1 disease, the tumors were located in the second wall layer only in seven cases, the third wall layer only in two cases, and both the second and third wall layers in 27 cases. Approximately 94.4% (34/36) of rectal NENs were diagnosed correctly by EUS, and 74.2% (23/31) of other rectal SELs were classified correctly as non-NENs. Eight cases of other SELs were misdiagnosed as NENs, including two cases of inflammatory lesions and one case each of gastrointestinal tumor, endometriosis, metastatic tumor, lymphoma, neurilemmoma, and hemangioma. The positive predictive value of EUS for rectal NENs was 80.9% (34/42), the negative predictive value was 92.0% (23/25), and the diagnostic accuracy was 85.1%.

CONCLUSION:

EUS has satisfactory diagnostic accuracy for rectal NENs with good sensitivity, but unfavorable specificity, making the differential diagnosis of NENs from other SELs challenging.

 

 

Clin Exp Obstet Gynecol. 2014;41(4):371-4.

Serum markers of oxidative stress and endometriosis.

Rosa e Silva JCdo Amara VFMendonça JLRosa e Silva ACNakao LSPoli Neto OBFerriani RA.

 

Abstract

PURPOSE OF INVESTIGATION:

To assess the changes secondary to chronic inflammation in women with and without pelvic endometriosis by the determination of serum thiols and carbonyls.

MATERIALS AND METHODS:

Sixty-seven women with endometriosis consecutively submitted to laparoscopy and 41 women without endometriosis consecutively submitted to tubal ligation (control group) were selected. Serum levels of total thiols and carbonyls were determined in both groups.

RESULTS:

Patients with endometriosis had significantly lower thiol levels than controls (342.37 +/- 142.09 microM vs 559.60 +/- 294.05 microM) (p < 0.001), as well as significantly lower carbonyl levels (8.97 +/- 3.76 microM vs 16.40 +/- 9.26 microM) (p < 0.001). Other clinical characteristics were not associated with changes in marker levels. The cutoff point established by the ROC curve was 396.44 microM for the thiols, with 73.1% sensitivity and 80.5% specificity, and 14.9 microM for the carbonyls, with 94% sensitivity and 51.2% specificity.

CONCLUSIONS:

The serum thiol levels revealed an increase in oxidative stress related to the development of pelvic endometriosis.

 

 

Clin Exp Obstet Gynecol. 2014;41(4):423-5.

Increased platelet count in severe peritoneal endometriosis.

Evsen MSSoydinc HESak MEOzler ATurgut ACelik YTunc SYGul T.

 

Abstract

OBJECTIVE:

Platelet count (PC) is higher in chronic inflammatory diseases. The aim of this study was to evaluate the PC in patients with severe pelvic endometriosis.

MATERIALS AND METHODS:

Patients with advanced stage pelvic endometriosis were retrospectively evaluated in a tertiary center between January 2009 and December 2011. Patients with pelvic endometriosiswere divided into two groups; advanced stage peritoneal endometriosis were classified as Group 1 (n = 28). Group 2 consisted of 29 patients which had ovarian endometrioma without clinically apparent peritoneal endometriosis foci. Group 3 included 51 women as control subjects. PC between the groups was tested by Student’s t test. The mean values of three groups were analyzed by using one way ANOVA test followed post-hoc test Bonferroni.

RESULTS:

PC in patients with pelvic endometriosis were found to be higher from the control group (290 +/- 67 10(9)/1; 264 +/- 63 10(9)/1, respectively; p = 0.038). Patients with peritoneal endometriosis (Group 1) had significantly higher PCs compared with the healthy controls (309 +/- 65 10(9)/1; 264 +/- 63 10(9)/1; respectively; p = 0.011).

CONCLUSION:

Increased PC in advanced stage pelvic endometriosis may be a sign of increased systemic inflammation. The systemic inflammation may be more apparent in advanced stage peritoneal endometriosis.

 

 

Clin Exp Obstet Gynecol. 2014;41(4):432-5.

Serum levels of androgens and prostate-specific antigen in endometriosis.

Evsen MSSak MESoydinc HEGuven SBasaranoglu SHatipoglu NKEvliyaoglu OGul T.

 

Abstract

OBJECTIVE:

The aim of the present study was to evaluate the levels of serum androgens and prostate-specific antigen (PSA) levels in patients with endometriosis.

MATERIALS AND METHODS:

Patients with Stage III/IV (advanced stage) endometriosis were compared to controls with respect to basal serum levels of total testosterone (T), free testosterone (fT), androstenedion (A), dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulphate (DHEA-S), and PSA in the early follicular phase of menstrual cycle for this prospective case control study.

RESULTS:

Level of T, fT, A, DHEA, and DHEA-S were higher in patients with endometriosis when compared to control subjects, but the difference was not statistically significant. The mean PSA level was 0.0074 +/- 0.0120 ng/ml in patients with endometriosis and 0.0059 +/- 0.0056 ng/ml in control group and there was no statistically significant difference between groups (p = 0.58).

CONCLUSION:

Serum basal androgens and PSA levels are higher in endometriosis group with respect to control but the differences are not statistically significant.

 

 

Clin Exp Obstet Gynecol. 2014;41(4):455-9.

Effects of natural progesterone on endometriosis in an experimental rat model: is it effective?

Narin RNazik HAytan HNarin MAApi MDağlioğlu KBüyüknacar SSatar DAAdamhasan F.

 

Abstract

To assess the effects of the natural progesterone on the endometriosis in a rat model.

MATERIALS AND METHODS:

Endometriosis was surgically induced in 20 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Rats in control group had no medication but 2.5 mg/kg/weekly natural progesterone was administered to rats in study group for four weeks. After that, all rats were sacrificed and dimensions of endometriosis were measured and they were evaluated morphologically and histologically. Scoring systems were used to evaluate preservation of epithelia.

RESULTS:

Two rats in the study group and one rat in the control group died of complications related to surgery. At the end of the treatment, there was a reduction in the size of the endometriotic lesions in the study group (p < 0.01). According to histological evaluation, the study group had lower score than control goup which was statistically significant (p = 0.014).

CONCLUSIONS:

Natural progesterone is effective against endometriosis in rat model.

 

 

Clin Exp Obstet Gynecol. 2014;41(4):486-8.

Spontaneous cutaneous umbilical endometriosis: a rare variant of extragenital endometriosis.

Nguessan KLNguessan EMian DBGuie PBoni S.

 

Abstract

Umbilical endometriosis is a very uncommon condition which presents as a pigmented umbilical nodule, papular or cystic, with symptoms punctuated rhythmed by menses. The authors report the case of a 32-year-old with spontaneous umbilical endometriosis. Surgical resection was performed with a good cosmetic result and no recurrence at six months. A review of the literature allowed the authors to discuss the diagnosis difficulties and treatment in a underdeveloped country.

 

 

Sci Rep. 2014 Aug 19;4:6116.

Ovulation and extra-ovarian origin of ovarian cancer.

Yang-Hartwich Y1Gurrea-Soteras M1Sumi N1Joo WD2Holmberg JC1Craveiro V1Alvero AB1Mor G1.

 

Abstract

The mortality rate of ovarian cancer remains high due to late diagnosis and recurrence. A fundamental step toward improving detection and treatment of this lethal disease is to understand its origin. A growing number of studies have revealed that ovarian cancer can develop from multiple extra-ovarian origins, including fallopian tube, gastrointestinal tract, cervix and endometriosis. However, the mechanism leading to their ovarian localization is not understood. We utilized in vitro, ex vivo, and in vivo models to recapitulate the process of extra-ovarian malignant cells migrating to the ovaries and forming tumors. We provided experimental evidence to support that ovulation, by disrupting the ovarian surface epithelium and releasing chemokines/cytokines, promotes the migration and adhesion of malignant cells to the ovary. We identified the granulosa cell-secreted SDF-1 as a main chemoattractant that recruits malignant cells towards the ovary. Our findings revealed a potential molecular mechanism of how the extra-ovarian cells can be attracted by the ovary, migrate to and form tumors in the ovary. Our data also supports the association between increased ovulation and the risk of ovarian cancer. Understanding this association will lead us to the development of more specific markers for early detection and better prevention strategies.

 

 

J Clin Endocrinol Metab. 2014 Nov;99(11):E2188-97.

Intra-tissue steroid profiling indicates differential progesterone and testosterone metabolism in the endometrium and endometriosis lesions.

Huhtinen K1Saloniemi-Heinonen TKeski-Rahkonen PDesai RLaajala DStåhle MHäkkinen MRAwosanya MSuvitie PKujari HAittokallio THandelsman DJAuriola SPerheentupa APoutanen M.

 

Abstract

CONTEXT:

Aberrant sex steroid signaling is suggested to promote endometriosis growth by several mechanisms, and the tissue concentrations of sex steroids are key determinants of the hormone action. However, their concentrations are only superficially known in the endometrium and endometriosis lesions.

OBJECTIVE:

This study sought to evaluate whether the tissue steroid hormone concentrations in endometriosisdiffer from the endometrium or serum.

MAIN OUTCOME MEASURES:

Steroid analysis of serum and tissue specimens of women with endometriosis (n = 60) and healthy controls (n=16) was measured, and supporting data from quantitative RT-PCR for steroidogenic enzymes and explant cultures of a subset of specimens is provided.

RESULTS:

Endometrial tissue progesterone (P4) concentrations reflected the serum P4 levels during the menstrual cycle, whereas in endometriosis lesions, the cycle-dependent change was missing. Remarkably high tissue T concentrations were measured in endometriosis lesions independent of the cycle phase, being 5-19 times higher than the corresponding serum levels. Tissue/serum ratio of T was further increased in patients with contraceptive medication. The altered tissue steroid concentrations in endometriosis were in line with the expression of various steroidogenic enzymes in the lesions, of which HSD3B2 showed constantly high expression, whereas CYP11A1 expression was low. Furthermore, the high concentration of sex steroids detected in the ovarian lesions involves their production by the lesion and by the adjacent ovarian tissue.

CONCLUSIONS:

Endometriosis lesions present with progestin and androgen metabolism, which are different from that of the endometrium, and the lesions are characterized by high tissue T and a loss of cyclical changes in tissue P4 concentration.

 

 

Hum Reprod. 2014 Nov;29(11):2592-9.

Severe teenage acne and risk of endometriosis.

Xie J1Kvaskoff M2Li Y2Zhang M3Qureshi AA3Missmer SA4Han J5.

 

Abstract

STUDY QUESTION:

Is there a relationship between severe teenage acne and endometriosis?

SUMMARY ANSWER:

Endometriosis is positively associated with severe teenage acne.

WHAT IS KNOWN ALREADY:

No studies have specifically explored a possible association between severe acne in adolescence and risk of endometriosis.

STUDY DESIGN, SIZE, DURATION:

This prospective cohort study used data collected from 88 623 female nurses from September 1989 to June 2009 as part of the Nurses’ Health Study II (NHS II) cohort.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Regression models were used to calculate hazard ratios (HRs) and confidence intervals (CIs) for endometriosis among women with and without severe teenage acne. Multivariate models were adjusted for established risk factors of endometriosis.

MAIN RESULTS AND THE ROLE OF CHANCE:

A total of 4 382 laparoscopically confirmed endometriosis cases were documented during 1 132 272 woman-years of follow-up. Compared with women without a history of severe teenage acne, women who had severe teenage acne had a 20% increased risk of endometriosis (HR = 1.20, 95% CI: 1.08-1.32). The association was not affected by adjusting for use of tetracycline or isotretinoin.

LIMITATIONS AND REASONS FOR CAUTION:

The HR is likely to be underestimated since we only included endometriosis cases confirmed by laparoscopy. Although geographically diverse, the NHS II cohort is primarily Caucasian, which may limit generalization to more ethnically diverse populations.

WIDER IMPLICATIONS OF THE STUDY:

The results of this study suggest that severe teenage acne is associated with an increased risk of endometriosis. As a visible and non-invasive clinical indicator, severe teenage acne may be useful for early detection of endometriosis. We bring this counter-intuitive association to the attention of clinicians for the benefit of the patient and an early diagnosis of endometriosis.

STUDY FUNDING/COMPETING INTEREST:

This study was funded by research grant CA176726 from the National Institute of Health. M.K. is supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078). The funding agencies had no role in the design of the study, in the analysis and interpretation of the data, in the writing of the report or in the decision to submit the paper for publication.

 

 

J Clin Endocrinol Metab. 2014 Dec;99(12):E2610-9

mRNA-binding protein TIA-1 reduces cytokine expression in human endometrial stromal cells and is down-regulated in ectopic endometrium.

Karalok HM1Aydin ESaglam OTorun AGuzeloglu-Kayisli OLalioti MDKristiansson HDuke CMChoe GFlannery CKallen CBSeli E.

 

Abstract

BACKGROUND:

Cytokines and growth factors play important roles in endometrial function and the pathogenesis of endometriosis. mRNAs encoding cytokines and growth factors undergo rapid turnover; primarily mediated by adenosine- and uridine-rich elements (AREs) located in their 3′-untranslated regions. T-cell intracellular antigen (TIA-1), an mRNA-binding protein, binds to AREs in target transcripts, leading to decreased gene expression.

OBJECTIVE:

The purpose of this article was to determine whether TIA-1 plays a role in the regulation of endometrial cytokine and growth factor expression during the normal menstrual cycle and whether TIA-1 expression is altered in women with endometriosis.

METHODS:

Eutopic endometrial tissue obtained from women without endometriosis (n = 30) and eutopic and ectopic endometrial tissues from women with endometriosis (n = 17) were immunostained for TIA-1. Staining intensities were evaluated by histological scores (HSCOREs). The regulation of endometrial TIA-1 expression by immune factors and steroid hormones was studied by treating primary cultured human endometrial stromal cells (HESCs) with vehicle, lipopolysaccharide, TNF-α, IL-6, estradiol, or progesterone, followed by protein blot analyses. HESCs were engineered to over- or underexpress TIA-1 to test whether TIA-1 regulates IL-6 or TNF-α expression in these cells.

RESULTS:

We found that TIA-1 is expressed in endometrial stromal and glandular cells throughout the menstrual cycle and that this expression is significantly higher in the perimenstrual phase. In women with endometriosis, TIA-1 expression in eutopic and ectopic endometrium was reduced compared with TIA-1 expression in eutopic endometrium of unaffected control women. Lipopolysaccharide and TNF-α increased TIA-1 expression in HESCs in vitro, whereas IL-6 or steroid hormones had no effect. In HESCs, down-regulation of TIA-1 resulted in elevated IL-6 and TNF-α expression, whereas TIA-1 overexpression resulted in decreased IL-6 and TNF-α expression.

CONCLUSIONS:

Endometrial TIA-1 is regulated throughout the menstrual cycle, TIA-1 modulates the expression of immune factors in endometrial cells, and downregulation of TIA-1 may contribute to the pathogenesis of endometriosis.

 

 

Biol Reprod. 2014 Oct;91(4):84.

Retinoic acid biosynthesis is impaired in human and murine endometriosis.

Pierzchalski K1Taylor RN2Nezhat C3Jones JW1Napoli JL4Yang G5Kane MA6Sidell N7.

 

Abstract

Endometriosis is characterized by the presence of endometrial glands and stroma in extrauterine sites. Our objective was to determine whether endometriotic lesions (ELs) from women with endometriosis have altered retinoid levels compared with their eutopic endometrium, and to test the hypothesis that defects in all-trans retinoic acid (ATRA) biosynthesis in EL is related to reduced expression of cellular retinol-binding protein type 1 (RBP1). Retinoids were evaluated by liquid chromatography-tandem mass spectrometry and high-performance liquid chromatography in eutopic endometrial biopsies (EBs) and ELs from 42 patients with pathologically confirmed endometriosis. The ATRA levels were reduced, whereas the retinol and retinyl ester concentrations were elevated in EL compared with EB tissue. Similar results were found in a mouse model of endometriosisthat used green fluorescent protein-positive endometrial tissue injected into the peritoneum of syngeneic hosts to mimic retrograde menses. The ATRA biosynthesis in vitro in retinol-treated primary human endometrial stromal cell (ESC) cultures derived from ELs was reduced compared with that of ESCs derived from patient-matched EBs. Correspondingly, RBP1 expression was reduced in tissue and ESCs derived from EL versus EB. Rbp1(-/-) mice showed reduced endometrial ATRA concentrations compared with wild type, associated with loss of tissue organization and hypercellularity. These findings provide the first quantitative measurements of ATRA in human endometrium and endometriosis, demonstrating reduced ATRA in ectopic tissue and corresponding ESC cultures. Quantitation of retinoids in murine endometriosis and in Rbp1(-/-) mice supports the contention that impaired ATRA synthesis caused by reduced RBP1 promotes an “endometriosis phenotype” that enables cells to implant and grow at ectopic sites.

 

 

 

 

Washington (DC): National Academies Press (US); 1993.

Clinical Applications of Mifepristone (RU 486) and Other Antiprogestins: Assessing the Science and Recommending a Research Agenda.

Editors

Institute of Medicine (US) Committee on Antiprogestins: Assessing the Science; Donaldson MSDorflinger LBrown SSBenet LZ, editors.

Source

Washington (DC): National Academies Press (US); 1993.

Excerpt

Mifepristone (RU486), the first clinically available antiprogestin, has generated great interest since its discovery in the early 1980s. Today, it is recognized that mifepristone, along with other antiprogestins, has a potentially significant therapeutic role in human health and disease, with likely applicability to a variety of pregnancy-related conditions (e.g., management of labor) and to contraception, endometriosis, and cancer, among others. But because mifepristone has been studied and used most widely as a means of nonsurgical abortion, political issues have thus far limited research on the drug and prevented its introduction into the U.S. market. This book provides an unbiased evaluation of current knowledge about both the fundamental nature of antiprogestins as well as their possible use in treating numerous diseases and conditions, and it contains recommendations for future research.

 

 

Gynecol Endocrinol. 2014 Nov;30(11):769-73.

New trends of progestins treatment of endometriosis.

Angioni S1Cofelice VPontis ATinelli RSocolov R.

 

Abstract

The management of endometriosis with OC or progestins is generally safe, effective and well-tolerated and should constitute the first line of medical treatment in symptomatic patients who do not want to have children. Progestins, synthetic progestational agents, have been used in the management of symptomatic endometriosisboth as primary therapy and as an adjunct to surgical time. A variety of oral agents have been employed in this regard and investigators have demonstrated differing degrees of benefit. The lack of a standardized instrument to evaluate painful symptoms makes comparative analysis more difficult. Concern about efficacy and side effect has pushed the research on the development of new well-tolerated drugs and to develop new administration routes to minimize general side effects. Aim of the present review is to present the results of clinical studies on new trends of progestins in the treatment of endometriosis.

 

 

Complement Ther Med. 2014 Aug;22(4):632-9.

Reduction of surgery rate in endometriosis patients who take Chinese medicine: a population-based retrospective cohort study.

Su SY1Muo CH2Sung FC3Morisky DE4.

 

Abstract

OBJECTIVES:

Female patients have frequently utilized Chinese medicine (CM) to treat symptoms that could possibly be related to endometriosis. The objective of this population-based retrospective cohort study was to evaluate the relationship between CM use and subsequent surgery among patients with endometriosis.

DESIGN:

A total of 8,283 CM users were identified among the 22,488 endometriosis patients found in the National Health Insurance reimbursement database between 2000 and 2010. A control group was identified and consisted of 8,283 matched nonusers with the same disease. A Cox proportional regression analysis was performed in order to assess risk factors for surgery for the CM users and nonusers.

RESULTS:

When compared to nonusers, CM users were significantly less likely to undergo surgery, with a hazard ratio of 0.47 (95% CI=0.421, 0.534) after adjusting for age, occupation, childbirth status, hypermenorrhea, iron-deficient anemia, dysmenorrhea, and amount of conventional medications. Among patients who had undergone surgery, the follow-up time was longer for CM users than for CM nonusers (p<0.001). Moreover, the most frequently used CM single and formula were Cyperus rotundus and Gui-zhi-fu-ling-wan, respectively.

CONCLUSIONS:

These results suggest that whatever the underlying reason, CM provides an alternative option that reduces the incidence rate of surgery in endometriosis patients.

 

 

 

 

Gastroenterol Rep (Oxf). 2014 Nov;2(4):288-94.

Limited segmental rectal resection in the treatment of deeply infiltrating rectal endometriosis: 10 years’ experience from a tertiary referral unit.

English J1Sajid MS2Lo J1Hudelist G1Baig MK1Miles WA1.

 

Abstract

BACKGROUND:

The management of symptomatic rectal endometriosis is a challenging condition that may necessitate limited stripping or limited segmental anterior rectal resection (LSARR) depending upon the extent and severity of the disease.

OBJECTIVE:

To report the efficacy of LSARR in terms of pain, quality of life and short- and long-term complications-in particular, those pertaining to bowel function.

METHODS:

The case notes of all patients undergoing LSARR were reviewed. The analysed variables included surgical complications, overall symptomatic improvement rate, dysmenorrhoea, dyspareunia, and dyschezia. Chronic pain was measured using a visual analogue scale. Quality of life was measured using the EQ-5D questionnaire. Bowel symptoms were assessed using the Memorial Sloan Kettering Cancer Centre (MSKCC) questionnaire.

RESULTS:

Seventy-four women who underwent LSARR by both open and laparoscopic approaches were included in this study. Sixty-nine (93.2%) women reported improvement in pain and the same percentage would recommend the similar procedure to a friend with the same problem. Approximately 42% of women who wished to conceive had at least one baby. The higher frequency of defecation was a problem in the early post-operative period but this settled in later stages without influencing the quality of life score. Post-operative complications were recorded in 14.9% of cases.

CONCLUSIONS:

LSARR for rectal endometriosis is associated with a high degree of symptomatic relief. Pain relief achieved following LSARR does not appear to degrade with time. As anticipated, some rectal symptoms persist in few patients after long-term follow-up but LSARR is nonetheless still associated with a very high degree of patient satisfaction.

 

 

 

 

Chirurgia (Bucur). 2014 Jul-Aug;109(4):546-9.

Primary umbilical endometriosis (Villar’s nodule) – case study, literature revision.

Pariza GMavrodin CI.

 

Abstract

Spontaneous umbilical endometriosis, also known as Villar’s nodule, is an unusual location of the endometrial tissue.Whilst in the case of umbilical locations secondary to surgical procedures endometriosis occurs quite frequently,the frequency of the primary umbilical location is lower than 1% of all endometriosis locations. The authors present such a case diagnosed in a young, nulliparous patient with no history of surgical procedures, the diagnosis being suggested by the presence of an umbilical tumor mass whose symptomatology concurs with menstrual periods. The aspects regarding differential diagnosis and the therapeuticoptions for the surgical cure of this type of lesion are discussed.

 

 

Surg Endosc. 2015 May;29(5):1167-73.

Standardized laparoscopic NOSE-colectomy is feasible with low morbidity.

Wolthuis AM1de Buck van Overstraeten AFieuws SBoon KD’Hoore A.

 

Abstract

BACKGROUND:

In laparoscopic colorectal surgery, extraction site laparotomy can be avoided by natural orifice specimen extraction (NOSE) resulting in less postoperative pain, shorter length of stay, and less morbidity such as wound complications. To date, short-term outcome of a large prospective cohort of patients has not been studied. The aim of this prospective cohort study was to assess short-term outcome of laparoscopic left-sided NOSE-colectomy.

METHODS:

Prospectively collected data of patients who had undergone elective laparoscopic NOSE-colectomy between July 2009 and December 2013 were analyzed retrospectively. Primary endpoint was short-term morbidity.

RESULTS:

A total of 110 patients were included in this study. Median age was 38 years (IQR: 32-56), median BMI was 23 kg/m(2) (IQR: 21-25), and 88% of the patients were female. Sixty-three patients (57%) underwent resection for endometriosis, 29 patients (26%) for diverticular disease, 16 patients (15%) for a tumor, and 2 patients for other indications. Median operating time was 85 min (IQR: 70-100) and median length of the extracted specimen was 20 cm (IQR: 16-25). Overall, 14 patients had a postoperative complication (13%), of which 9 were Clavien-Dindo grade 1 or 2 (8%). Four patients (3.6%) had an intraluminal bleeding from the anastomosis, which was treated endoscopically. There was 1 anastomotic leak (1%), treated by emergency laparotomy and creation of a new colorectal anastomosis (grade 3b). The median hospital stay was 5 days (IQR: 4-6).

CONCLUSION:

Laparoscopic NOSE-colectomy is safe and feasible with good short-term outcome. This study concerning a standardized operative technique is the first in literature reporting on a large group of patients.

 

 

Fertil Steril. 2014 Nov;102(5):1213-22.

World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project: I. Surgical phenotype data collection in endometriosis research.

Becker CM1Laufer MR2Stratton P3Hummelshoj L4Missmer SA5Zondervan KT6Adamson GD7WERF EPHect Working Group.

 

Abstract

OBJECTIVE:

To standardize the recording of surgical phenotypic information on endometriosis and related sample collections obtained at laparoscopy, allowing large-scale collaborative research into the condition.

DESIGN:

An international collaboration involving 34 clinical/academic centers and three industry collaborators from 16 countries.

SETTING:

Two workshops were conducted in 2013, bringing together 54 clinical, academic, and industry leaders in endometriosis research and management worldwide.

PATIENT(S):

None.

INTERVENTION(S):

A postsurgical scoring sheet containing general and gynecological patient and procedural information, extent of disease, the location and type of endometriotic lesion, and any other findings was developed during several rounds of review. Comments and any systematic surgical data collection tools used in the reviewers’ centers were incorporated.

MAIN OUTCOME MEASURE(S):

The development of a standard recommended (SSF) and minimum required (MSF) form to collect data on the surgical phenotype of endometriosis.

RESULT(S):

SSF and MSF include detailed descriptions of lesions, modes of procedures and sample collection, comorbidities, and potential residual disease at the end of surgery, along with previously published instruments such as the revised American Society for Reproductive Medicine and Endometriosis Fertility Index classification tools for comparison and validation.

CONCLUSION(S):

This is the first multicenter, international collaboration between academic centers and industry addressing standardization of phenotypic data collection for a specific disease. The EndometriosisPhenome and Biobanking Harmonisation Project SSF and MSF are essential tools to increase our understanding of the pathogenesis of endometriosis by allowing large-scale collaborative research into the condition.

 

 

Fertil Steril. 2014 Oct;102(4):1149-1154

Genetic variation of the E-cadherin gene is associated with primary infertility in patients with ovarian endometriosis.

Kang S1Li Y2Li B3Wang N2Zhou RM2Zhao XW3.

 

Abstract

OBJECTIVE:

To explore the association between the genetic variant of E-cadherin gene and endometriosis-related infertility.

DESIGN:

Case-control study.

SETTING:

University hospital.

PATIENT(S):

Five hundred eighty-nine women with ovarian endometriosis including 127 patients with primary infertility and 589 female controls in northern China.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Single nucleotide polymorphisms (SNPs) in the promoter region, exons, and the 3′ untranslated region of the E-cadherin gene were identified by direct sequencing in patients with ovarian endometriosis and with polymerase chain reaction (PCR). Six candidate SNPs (rs16260, rs28372783, rs1801552, rs1801026, rs8049282, and rs13689) were genotyped by PCR and ligase detection reaction.

RESULT(S):

The results revealed a significant association of rs8049282 SNP on E-cadherin gene with endometriosis-related infertility. When compared with control women or endometriosis patients who had a history of successful fertility, the CC genotype of rs8049282 may significantly increase the risk of primary infertility in patients with ovarian endometriosis (adjusted odds ratio [OR] = 2.70, 95% confidence interval [CI] 1.45-5.00; OR = 2.54, 95% CI 1.45-4.44, respectively).

CONCLUSION(S):

Our results suggested that genetic variants on the E-cadherin gene may be involved in endometriosis-related infertility. The rs8049282 SNP of the E-cadherin gene may be a potential molecular marker for the development of primary infertility in northern Chinese women with ovarian endometriosis.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Oct;181:130-4

IVF outcome in women with accidental contamination of follicular fluid with endometrioma content.

Benaglia L1Cardellicchio L2Guarneri C3Paffoni A3Restelli L3Somigliana E3Fedele L2.

Abstract

OBJECTIVE:

To evaluate whether accidental contamination of follicular fluid with endometrioma content during oocytes retrieval affects IVF outcome.

STUDY DESIGN:

We set up a retrospective review of women undergoing IVF in our infertility unit during a four years period. Cases were 19 women with ovarian endometriomas who had an accidental aspiration of the endometrioma content during oocyte retrieval. Controls (n=38) were the two subsequent age-matched women with endometriomas who underwent an uncomplicated oocyte retrieval. The main outcome was to evaluate the clinical pregnancy rate in cases and in controls.

RESULTS:

Accidental aspiration of endometrioma content occurred in 19 out of 314 women (6.1%, 95%CI: 3.8-9.1%). The number of embryos and top quality embryos was significantly higher in exposed women (3.1±2.0 versus 1.7±1.2 and 1.9±1.5 versus 1.1±1.1, respectively) but the chances of pregnancy were lower. The adjusted RRs of clinical pregnancy and live birth were 0.63 (95%CI: 0.49-0.87, p=0.005) and 0.60 (95%CI: 0.51-086, p=0.003), respectively.

CONCLUSION:

Accidental contamination of the follicular fluid with endometrioma content is an uncommon but possible event. This situation may affect IVF outcome but does not justify systematic surgical removal before the cycle.

 

 

Arch Gynecol Obstet. 2015 Feb;291(2):363-70.

Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery.

Angioni S1Pontis ADessole MSurico DDe Cicco Nardone CMelis I.

 

Abstract

PURPOSE:

To evaluate the role of post-surgical medical treatment with GnRHa in patients with DIE (Deep Infiltrating Endometriosis) that received complete or incomplete surgery laparoscopic excision.

METHODS:

Hundred fifty-nine patients with deep infiltrating endometriosis of the cul-de-sac and of the rectovaginal septum with pelvic pain undergoing laparoscopic surgery in academic tertiary-care medical center. Eighty patients underwent complete laparoscopic excision of DIE (Arm A) while 79 patients underwent incomplete surgery (Arm B). After surgery each surgical arm was randomized in two groups: no treatment groups 1A [40 pts] and 1B [40 pts] and GnRHa treatment for 6 months groups 2A [40 pts] and 2B [39 pts]. Pain recurrence and quality of life were evaluated in follow-up of 12 months and compared between groups.

RESULTS:

No differences were observed between patient groups 1A and 2A. Groups 1A, 2A and 2B obtained significantly lower pain scores than those achieved by the group 1B undergoing incomplete surgical treatment and no post-surgical therapy. At 1-year follow-up patients treated with en-block resection (Groups 1A and 2A) showed the lowest pain scores and the highest quality of life in comparison with the other two groups (Group 1B and 2B).

CONCLUSION:

GnRHa administration is followed by a temporary improvement of pain in patients with incomplete surgical treatment. It seems that it has no role on post-surgical pain when the surgeon is able to completely excise DIE implants.

 

 

Case Rep Obstet Gynecol. 2014;2014:240596.

Vesicoovarian fistula on an endometriosis abscessed cyst.

Tran C1Even M1Carbonnel M1Preaux F1Isnard F1Rault A1Rouanne M1Ayoubi JM1.

 

Abstract

We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection of vesical fistula.

 

J Obstet Gynaecol. 2015 Apr;35(3):269-71.

Polymorphism of catalase gene (CAT C-262T) in women with endometriosis.

Zarafshan SS1Salehi ZSalahi ESabet EEShabanipour SZahiri Z.

 

Abstract

Endometriosis is defined as the presence of ectopic endometrial glands and stroma outside of the uterine cavity. Recent studies have shown that the oxidative stress causes irreparable damage, which leads to oxidative enzymopathies. Catalase gene encodes an antioxidant enzyme, detoxifying hydrogen peroxide to H2O and O2. The aim of this study was to determine whether the polymorphism at position -262 in the promoter region of catalase gene (C-262T), which alters the expression and enzyme blood levels, could have an impact on the risk of endometriosis. Extracted DNA from peripheral blood leucocytes was genotyped using allele-specific PCR (AS-PCR). The χ(2)-test was used for statistical analyses. In endometriosis subjects, the frequencies of the CAT CC/CT/TT were 67.5%, 32.5% and 0%, respectively, while in healthy women, they were 12%, 68% and 20%, respectively. Significant differences in allele and genotype distribution among controls and patients were found (OR, 178.76 95% CI, 10.11-3159.1202; p = 0.0004). This study indicates that catalase C-262T polymorphism is associated with the endometriosis. Randomised multicentre trials with greater sample sizes are still needed to clarify our results.

 

 

Fertil Steril. 2014 Nov;102(5):1393-7

Association of CDKN2B-AS and WNT4 genetic polymorphisms in Korean patients with endometriosis.

Lee GH1Choi YM2Hong MA3Yoon SH4Kim JJ5Hwang K6Chae SJ7.

 

Abstract

OBJECTIVE:

To investigate whether specific genetic polymorphisms in the cyclin-dependent kinase inhibitor 2B antisense RNA (CDKN2B-AS) gene and near the wingless-type MMTV integration site family member 4 (WNT4) gene are associated with endometriosis in a Korean population.

DESIGN:

Case-control genetic association study.

SETTING:

University.

PATIENT(S):

Surgically or histologically diagnosed cases of endometriosis (n=673) and controls (n=500) among a population of ethnic Koreans.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Genotype distribution and synergistic interaction.

RESULT(S):

Significant differences were found in the allele distributions of the CC genotype of the rs10965235 single-nucleotide polymorphism (SNP) of the CDKN2B-AS gene and the GG genotype of the rs16826658 SNP on chromosome 1p36 between the endometriosis cases and the controls (rs10965235: 69.7% CC, 26.9% CA, and 3.4% AA vs. 59.2% CC, 35.2% CA, and 5.6% AA; rs16826658: 33.7% GG, 48.4% GT, and 17.8% TT vs. 25.6% GG, 49.8% GT, and 24.6% TT, respectively). A significant interaction was not found between the CC genotype of the rs10965235 SNP and the GG genotype of the rs16826658 SNP after Bonferroni correction (32.8% of CC+GG and 67.2% of CC+non-GG in the endometriosis cases vs. 25.0% of CC+GG and 75.0% of CC+non-GG in the controls).

CONCLUSION(S):

Our results suggest that the rs10965235 SNP in the CDKN2B-AS gene and the rs16826658 SNP near the WNT4 gene were significantly associated with endometriosis in this Korean population.

 

 

Fertil Steril. 2014 Nov;102(5):1211-2.

Introduction: new tools for enhancing collaborative endometriosis research.

Casper RF1.

 

Abstract

This issue of Fertility and Sterility contains four articles by the World Endometriosis Research Foundation whose present objective is global standardization of the collection of phenotypic data and biological samples, designated as the Endometriosis Phenome and Biobanking Harmonisation Project. The aim is to facilitate large-scale international, multicenter trials that are robust, and will result in biomarker and treatment targets to advance research in endometriosis.

 

 

Obstet Gynecol Clin North Am. 2014 Sep;41(3):343-55.

The approach to chronic pelvic pain in the adolescent.

Powell J1.

 

Abstract

Adolescents present to outpatient and acute care settings commonly for evaluation and treatment of chronic pelvic pain (CPP). Primary care providers, gynecologists, pediatric and general surgeons, emergency department providers, and other specialists should be familiar with both gynecologic and nongynecologic causes of CPP so as to avoid delayed diagnoses and potential adverse sequelae. Treatment may include medications, surgery, physical therapy, trigger-point injections, psychological counseling, and complementary/alternative medicine. Additional challenges arise in caring for this patient population because of issues of confidentiality, embarrassment surrounding the history or examination, and combined parent-child decision making.

 

 

Obstet Gynecol Clin North Am. 2014 Sep;41(3):357-69.

Surgical evaluation and treatment of the patient with chronic pelvic pain.

Holloran-Schwartz MB1.

 

Abstract

Treatment of patients with chronic pelvic pain is assisted by detailed history, physical examination, pain diary, and ultrasonography. The possibility of other contributing systems (eg, gastrointestinal, genitourinary, musculoskeletal) should also be addressed and treatment initiated if present. A diagnostic surgical procedure is helpful in patients for whom medical management or whose severity of pain warrants an urgent diagnosis. Limited evidence exists to support adhesions, endometriosis, ovarian cysts, ovarian remnants, and hernias as being causes of chronic pelvic pain. In select patients, ovarian cystectomy, excision of endometriosis and ovarian remnants, adhesiolysis, hysterectomy, hernia repair, and presacral neurectomy may provide relief.

 

 

Obstet Gynecol Clin North Am. 2014 Sep;41(3):371-83.

The laparoscopic management of endometriosis in patients with pelvic pain.

Yeung P Jr1.

 

Abstract

Endometriosis, an underdiagnosed and undertreated condition, affects 1 in 10 women and is associated with pain and infertility. Preoperative evaluation should include testing and management of other causes of pelvic pain. Ultrasonography can aid in surgical planning. Hormonal suppression improves symptoms, but should not be used to diagnose endometriosis, and is not shown to be effective in preventing disease recurrence nor in improving fertility. The goal of surgical management should be optimal removal or treatment of disease and should include measures for adhesion prevention. Rates of recurrence of endometriosis depend on the surgical completeness of removing the disease.

 

 

Obstet Gynecol Clin North Am. 2014 Sep;41(3):491-501.

Opioid use and depression in chronic pelvic pain.

Steele A1.

 

Abstract

Opioid pain medications and antidepressants are commonly prescribed to patients for chronic non-cancer pain. However, little evidence exists for their effectiveness in most pain states, including chronic pelvic pain. Whenever possible, initiation of opioid pain medications in chronic non-cancer pain should be avoided. If patients present for evaluation of disease states such as endometriosis or interstitial cystitis already using regular narcotics, physicians should be aware of ways to mediate misuse and diversion. Women with chronic pain should be screened for depression as well as a history of prior sexual abuse, and treatment or referral initiated when indicated.

 

 

Obstet Gynecol Clin North Am. 2014 Sep;41(3):503-10

Complementary and alternative medications for chronic pelvic pain.

Leong FC1.

 

Abstract

Chronic pelvic pain is common, but rarely cured, thus patients seek both second opinions and alternative means of controlling their pain. Complementary and alternative medicine accounts for 11.2% of out-of-pocket medical expenditures for adults for all conditions in the United States. Although there are many treatments, rigorous testing and well-done randomized studies are lacking. Dietary changes and physical modalities such as physical therapy have often been included in the category of alternative medicine, but their use is now considered mainstream. This article concentrates on other sources of alternative and complementary medicine, such as dietary supplementation and acupuncture.

 

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