Zhonghua Yi Xue Za Zhi. 2016 Sep 6;96(33):2675-2677.
Establishment of endometriosis subcutaneous model in immunodeficient nude mice.
Objective: To establish a model of endometriosis in immunodeficient nude mice and compare the outcome of the model construction between two different techniques. Methods: Eighteen nude mice were divided into 2 groups, with 9 mice in each group. All nude mice received a subcutaneous transplantation of endometrial fragments, followed by sutured the wounded skin (sutured group) or not (no-sutured group). Then the success rate of the model construction, inflammation of the wounds and the animal survival rate in the two groups were analyzed. Result: In no-sutured group, the survival rate of animal and the success rate of the model construction were 9/9 and 8/9 respectively, with 8/9 survival rate and 7/9 success rate in sutured group. No significant difference was found between the two groups. And no obvious inflammation was presented in the wounds for both groups. Conclusion: It is an effective method to establish animal model of endometriosis by subcutaneous transplantation in nude mice. After transplantation, it does not affect the outcome of the survival rate of the animal and the success rate of the model construction whether we suture the wounded skin. Considering the shorter operation time, we found it’s a simpler and time saving method to establish endometriosis by subcutaneously transplanting endometrial fragments in nude mice with no skin-sutured. And this model is worth of promotion.
Geburtshilfe Frauenheilkd. 2016 Apr;76(4):350-364.
Indications and Route of Hysterectomy for Benign Diseases. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry No. 015/070, April 2015)
Neis KJ1, Zubke W2, Römer T3, Schwerdtfeger K4, Schollmeyer T5, Rimbach S6, Holthaus B7, Solomayer E1, Bojahr B8, Neis F2, Reisenauer C2, Gabriel B9, Dieterich H10, Runnenbaum IB11, Kleine W12, Strauss A13, Menton M14, Mylonas I15, David M16, Horn LC17, Schmidt D18, Gaß P19, Teichmann AT20, Brandner P21, Stummvoll W22, Kuhn A23, Müller M23, Fehr M24, Tamussino K25.
Background: Official guideline “indications and methods of hysterectomy” to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated. Methods: The guideline group consisted of 26 experts from Germany, Austria and Switzerland. Recommendations were developed using a structured consensus process and independent moderation. A systematic literature search and quality appraisal of benefits and harms of the therapeutic alternatives for symptomatic fibroids, dysfunctional bleeding and adenomyosis was done through MEDLINE up to 6/2014 focusing on systematic reviews and meta-analysis. Results: All types of hysterectomy led in studies to high rates of patient satisfaction. If possible, vaginal instead of abdominal hysterectomy should preferably be done. If a vaginal hysterectomy is not feasible, the possibility of a laparoscopic hysterectomy should be considered. An abdominal hysterectomy should only be done with a special indication. Organ-sparing interventions also led to high patient satisfaction rates, but contain the risk of symptom recurrence. Conclusion: As an aim, patients should be enabled to choose that therapeutic intervention for their benign disease of the uterus that convenes best to them and their personal life situation.
World J Gastrointest Endosc. 2016 Sep 16;8(17):623-7
Transanal endoscopic microsurgery as optimal option in treatment of rare rectal lesions: A single centre experience.
To analyze the outcomes of transanal endoscopic microsurgery (TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma.
We retrospectively reviewed a twenty-three years database. Fifty-two patients were enrolled in this study. The lesions were considered suitable for TEM if they were within 20 cm from the anus. All of them underwent an accurate preoperative workup consisting in clinical examination, total colonoscopy with biopsies, endoscopic ultrasonography, and pelvic computerized tomography or pelvic magnetic resonance imaging. Operative time, intraoperative complications, rate of conversion, tumor size, postoperative morbidity, mortality, the length of hospital stay, local and distant recurrence were analyzed.
Among the 1328 patients treated by TEM in our department, the 52 patients with rectal abnormalities other than adenoma or adenocarcinoma represented 4.4%. There were 30 males (57.7%) and 22 females (42.3%). Mean age was 55 years (median = 60, range = 24-78). This series included 14 (26.9%) gastrointestinal stromal tumors, 21 neuroendocrine tumors (40.4%), 1 ganglioneuroma (1.9%), 2 solitary ulcers in the rectum (3.8%), 6 cases of rectal endometriosis (11.5%), 6 cases of rectal condylomatosis (11.5%) and 2 rectal melanomas (3.8%). Mean lesion diameter was 2.7 cm (median: 4, range: 0.4-8). Mean distance from the anal verge was 9.5 cm (median: 10, range: 4-15). One patient operated for rectal melanoma developed distant metastases and died two years after the operation. We experienced 2 local recurrences (3.8%) with an overall survival equal to 97.6% (95%CI: 95%-99%) at the end of follow-up and a disease free survival of 98% (95%CI: 96%-99%).
We could conclude that TEM is an important therapeutical option for rectal rare conditions.
Reprod Sci. 2017 May;24(5):790-795.
Impact of Endometrioma Resection on Eutopic Endometrium Metabolite Contents: Noninvasive Evaluation of Endometrium Receptivity.
The aim of this study was to determine whether endometrioma resection alters most commonly defined endometrial metabolites, lactate (Lac), N-acetylaspartate (NAA), creatine 1 (Cr1), creatine 2 (Cr2), and choline (Cho) during the window of implantation. Twenty patients with uni- or bilateral endometrioma and 7 patients having nonendometriotic benign ovarian cyst were included. Midluteal phase magnetic resonance spectroscopy analysis of eutopic endometrium was performed before surgery. Second spectrum of endometrium was obtained 3 to 5 months after laparoscopic endometrioma resection. Pre- and postoperative endometrial peaks of Lac, NAA, Cr, and Cho were measured in units and denominated in parts per million (ppm). Compared to preoperative peak values, significantly decreased NAA, Lac, and Cr1 signals were noted in patients undergoing endometrioma surgery. Nearly 5-fold decline in the NAA signal occurred after endometrioma surgery (1.94 ± 3.24 vs 0.37 ± 0.55). Likewise, 2.5-fold decline in Lac signals was noted after endometrioma resection (2.81 ± 2.64 vs 1.06 ± 1.88). Both uni- and bilateral endometrioma affected endometrium signals the same. The peak intensity of Cho, Cr1, Cr2, NAA, and Lac did not alter significantly after nonendometriotic cyst surgery. Endometrioma surgery straightens endometrial NAA, Lac, and Cr1 peaks, suggesting improvement in endometrial receptivity.
Reprod Sci. 2017 May;24(5):773-782
Serum Osteopontin Levels Are Decreased in Focal Adenomyosis.
We investigated whether serum osteopontin (OPN) levels are different according to specific phenotypes of adenomyosis and endometriosis. We conducted a prospective laboratory study in a university referral center for endometriosis between May 2005 and May 2013 and included 148 nonpregnant women, younger than 42 years, undergoing surgery for a benign gynecological condition and who had a preoperative pelvic magnetic resonance imaging (MRI). The presence of focal and/or diffuse adenomyosis was determined by pelvic MRI, and women were classified into 3 groups: no-adenomyosis (No-AM), isolated diffuse adenomyosis (DIF-AM), and focal adenomyosis with or without diffuse adenomyosis (FOC-AM). After complete surgical exploration of the pelvic cavity, the presence and type of endometriosis was surgically determined and histologically confirmed. We distinguished 4 phenotypes: no endometriosis, superficial peritoneal endometriosis (SUP), ovarian endometrioma, and deep infiltrating endometriosis (DIE). Osteopontin levels were measured by enzyme-linked immunosorbent assay in serum samples obtained in all participants in the month preceding surgery. Our results show lower OPN levels in women with focal adenomyosis compared to adenomyosis-free controls. Our results also show a decrease in OPN levels in women with associated DIE and focal adenomyosis compared to women with SUP. Various serum biomarkers have been studied in the context of endometriosis severity and subtypes, whereas data on serum markers of adenomyosis are scarce. Both entities are often associated, and adenomyosis could be a confounding factor influencing results. Future research on serum biomarkers should describe subtypes of adenomyosis and endometriosis and analyze results according to well-defined subtypes.