Clin Ter. 2010 Jan-Feb;161(1):77-85.

Tubo-peritoneal factor of infertility: diagnosis and treatment.

[Article in Italian]

Muzii L, Sereni MI, Battista C, Zullo MA, Tambone V, Angioli R.

Dipartimento di Ginecologia, Università Campus BioMedico, Roma, Italia. l.muzii@unicampus.it

Infertility, defined as the inability to conceive despite regular unprotected sexual intercourse over 12 years, affects approximately 10% of the fertile population. The commonest cause of tubal damage is pelvic inflammatory disease (PID), which in the developed world is caused mainly by Chlamydia trachomatis infection. The incidence of tubal damage after one episode of pelvic infection is approximately 12%, 23% after two episodes and 54% after three episodes. Other causes of tubal damage include postsurgical adhesions or endometriosis. Tubal patency can be diagnosed by hysterosalpingography (HSG) or laparoscopy with chromopertubation. Surgery represents the best therapeutic approach for tubal pathology, with a term pregnancy rate of 70% after surgery in selected patients, while the latest results in Italy of assisted reproductive technology (ART) report a live birth rate per cycle of 13.8%. In conclusion, tubal reconstructive surgery remains an important option for many couples and surgery should be the fi rst line approach for a correct diagnosis and treatment of tubal infertility.

Clin Obstet Gynecol. 2009 Dec;52(4):702-11.

Impact of rape on female sexuality: review of selected literature.

Weaver TL.

Department of Psychology, Saint Louis University, Saint Louis, Missouri 63103, USA. weavert@slu.edu

This article reviews the medical and psychologic literature on the impact of rape on female sexuality. Studies documented moderately high rates of genital injuries and moderate rates of sexually transmitted infections postrape and significantly greater difficulties with aspects of reproductive/sexual functioning, including dyspareunia, endometriosis, menstrual irregularities, and chronic pelvic pain for raped compared with nonraped women. Raped women also engaged in significantly more high-risk sexual behaviors. Posttraumatic stress disorder emerged as an important mediator of sexual victimization and sexual health. An integrative model outlining interrelated physical, psychologic, biologic, and behavioral factors postrape was presented to assimilate review findings.

Acta Cytol. 2010 Mar-Apr;54(2):214-6.

Abdominal wall endometriosis: a report of 2 cases with primary diagnosis by fine needle aspiration.

Raddaoui E, Ameeri S.

Department of Pathology, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. eraddaoui@yahoo.com

BACKGROUND: Abdominal wall endometriosis is usually preceded by obstetric operations and occasionally can be spontaneous. The diagnosis can be suspected clinically when there is systemic endometriosis or cyclic pain; otherwise it is difficult to differentiate it from other abdominal rumors and nonneoplastic conditions. Fine needle aspiration is an extremely valuable and safe tool for preoperative evaluation of abdominal wall endometriosis as the disease usually presents as a cutaneous/subcutaneous mass. CASES: Two cases of abdominal wall endometriosis occurred. One was associated with systemic endometriosis, an the second was spontaneous. The diagnosis was reached correctly and confirmed by the subsequent histologic examination. CONCLUSION: The cytopathologic diagnosis ofendometriosis is feasible, and we need to include endometriosis in the differential diagnosis of an abdominal wall mass in a females.

Genet Mol Res. 2010 Apr 6;9(2):629-36.

DNA repair genes in endometriosis.

Attar R, Cacina C, Sozen S, Attar E, Agachan B.

Department of Obstetrics and Gynecology, Yeditepe University Hospital, Istanbul, Turkey.

Several polymorphisms in the DNA repair gene are thought to have significant effects on cancer risk. We investigated the association of polymorphisms in the DNA repair genes XRCC1 Arg399Gln, XRCC3 Thr241Met, XPD Lys751Gln, XPG Asp1104His, APE1 Asp148Glu, and HOGG1 Ser326Cys with endometriosis risk. Genotypes were determined by PCR-RFLP assays in 52 patients with endometriosis and 101 age-matched healthy controls. Although there were no significant (P > 0.05) differences in the frequencies of genotypes or alleles of APE1, XRCC1, XPD, XPG, and HOGG1 genes between patients and controls, the frequency of the XRCC3 Thr/Thr genotype was significantly greater in endometriosis patients compared with controls (P = 0.005). XRCC3 Thr/Met genotypes (P = 0.022), and the Met allele (P = 0.005) seem to have a protective role against endometriosis. The distributions of genotypes and alleles of the genes APE1, XRCC1, XRCC3, XPD, XPG, and HOGG1 were not significantly associated with the different stages of endometriosis (P > 0.05). We conclude that the XRCC3 Thr/Thr genotype is associated with endometriosis in Turkish women.

Abdom Imaging. 2010 Apr 14. [Epub ahead of print]

Deep pelvic endometriosis: MR imaging.

Marcal L, Nothaft MA, Coelho F, Choi H.

Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA, leonardo.marcal@di.mdacc.tmc.edu.

OBJECTIVE: The purpose of the pictorial essay is to show the MR imaging (MRI) findings associated with deep pelvic endometriosis. CONCLUSION: MRI is an excellent imaging modality for the evaluation of patients with deep pelvic endometriosis, showing high accuracy in the diagnosis and prediction of disease extent. Its multiplanar capabilities and superior soft tissue contrast are extremely useful in the detection of deeply infiltrating endometriotic implants, even in the setting of intense desmoplastic response that may result in complete obliteration of the posterior cul-de-sac and fixed retroversion of the uterus, which limits the scope of laparoscopy. The use of endovaginal and rectal contrast is helpful to better delineate the anatomy of interest and map out the extent of disease, contributing to more effective treatment planning.

N Z Med J. 2010 Apr 9;123(1312):77-80.

Non-classic congenital adrenal hyperplasia due to 21-hydoxylase deficiency as a cause of infertility and miscarriages.

Falhammar H.

Department of Endocrinology, Cairns Base Hospital, PO Box 902, Cairns, QLD 4870, Australia. henrik.falhammar@ki.se

The extragonadal manifestations of intestinal endometriosis necessitating immediate abdominal surgical exploration are, to date, sparsely represented within the literature. We present two cases of acute complete small and large bowel obstruction secondary to endometriosis, requiring emergent laparotomy; and review the pertinent literature.

J Clin Neurol. 2010 Mar;6(1):38-40. Epub 2010 Mar 26.

Early Dorsal Midbrain Syndrome Mimicking an Adie’s Tonic Pupil.

Han SW, Ryu JH, Baik JS, Kim JY, Hwang YS, Park JH.

Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

BACKGROUND: While tonic pupils have been attributed to various diseases, including syphilis, herpes zoster, orbital trauma, temporal arteritis, endometriosis, and paraneoplastic syndromes, obstructive hydrocephalus has not been implicated. CASE REPORT: A 36-year-old woman visited a neurology department with a 7-day history of throbbing headache and blurred vision in both eyes. She had early dorsal midbrain syndrome mimicking an Adie’s tonic pupil, and cholinergic supersensitivity was demonstrated using topical 0.125% pilocarpine. Brain MRI revealed obstructive hydrocephalus at the level of the aqueduct of Sylvius, and her symptoms resolved 4 days after surgery. CONCLUSIONS: We report a patient with early dorsal midbrain syndrome that was initially believed to represent a tonic pupil on the basis of pharmacologic testing. The findings in our patient suggested that early dorsal midbrain syndrome mimicking an Adie’s tonic pupil can be caused by obstructive hydrocephalus compressing the Edinger-Westphal nucleus.

Epidemiology. 2010 Apr 7. [Epub ahead of print]

Use of Multiple Assays Subject to Detection Limits With Regression Modeling in Assessing the Relationship Between Exposure and Outcome.

Albert PS, Harel O, Perkins N, Browne R.

From the aBiostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD; bDepartment of Statistics, University of Connecticut, Storrs, CT; cEpidemiology Branch, Division of Epidemiology, Statistics, and Prevention, Eunice Kennedy Shriver National Institute of Child Health, Rockville, MD; and dDepartment of Clinical Laboratory Sciences, University at Buffalo, State University of New York, Buffalo, NY.

BACKGROUND:: The goal of many studies in environmental epidemiology is to assess the relationship between chemical exposure and disease outcome. Often various assays can be used to measure a particular environmental exposure, with some assays being more invasive or expensive than others. METHODS:: We consider the situation in which 2 assays can be used to measure an environmental exposure. The first assay has measurement error and is subject to a lower detection limit (LOD), and the second assay has less measurement error and is not subject to a lower LOD. In this situation, the first assay is less invasive or less expensive and is measured in all study participants, whereas the second assay is more invasive or more expensive and is only measured in a subset of individuals. We develop a flexible class of regression models that incorporates both sets of assay measurements and allows for continuous or binary outcomes. We explore different design strategies for selecting the subset of patients in whom to measure the second assay. One design strategy is to measure the second more invasive or expensive assay only when the first assay is below LOD. We compare these designs with a simple design in which the second assay is measured in a random subset of patients without regard to the results of the first assay. RESULTS:: We develop estimation approaches for these regression models. We demonstrate through simulations that there are efficiency advantages of measuring the second assay in at least a fraction of cases in which the first assay is above LOD. We illustrate the methodology by using data from a study examining the effect of environmental polychlorinated biphenyl exposure on the risk of endometriosis. CONCLUSION:: The proposed methodology has good statistical properties and will be a useful methodological technique for studying the effect of exposure on outcome when exposure assays are subject to LOD.

Fertil Steril. 2010 Apr 10. [Epub ahead of print]

Elevated ghrelin levels in the peritoneal fluid of patients with endometriosis: associations with vascular endothelial growth factor (VEGF) and inflammatory cytokines.

Verit FF, Ayas S.

Department of Obstetrics and Gynecology, Harran University, Faculty of Medicine, Sanliurfa, Turkey.

Fertil Steril. 2010 Apr 10. [Epub ahead of print]

Immunohistochemical expression of matrix metalloproteinases, their tissue inhibitors, and cathepsin-D in ovarian endometriosis: correlation with severity of disease.

Protopapas A, Markaki S, Mitsis T, Milingos D, Athanasiou S, Haidopoulos D, Loutradis D, Antsaklis A.

1st Department of Obstetrics and Gynecology of the University of Athens, “Alexandra” Hospital, Athens, Greece.

In this study the immunohistochemical expression of matrix metalloproteinases 1, 2, 3, and 9, tissue inhibitors (TIMPs) 1 and 2, and cathepsin-D in ovarian endometriomas were correlated with the clinical severity of endometriosis (i.e., presence of chronic pelvic pain [CPP] and American Society of Reproductive Medicine [ASRM] scores). Positive expression of proteases and their inhibitors was found more frequently in cases with low ASRM scores, whereas presence of CPP correlated significantly with absence of expression of TIMPs 1 and 2, indicating, first, that production of these enzymes is more active during the initial phases of the evolution of ovarian endometriosis, declining as fibrosis develops, and second, that expression of TIMPs seems to play a role in the development of CPP. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Rev Med Brux. 2010 Jan-Feb;31(1):15-22.

Management of deep pelvic endometriosis.

[Article in French]

Larguèche K, Ben Aissia N, Gara F.

Service de Gynécologie-Obstétrique, C.H.U. Mongi Slim, La Marsa, Tunis, Tunisie. kamel_l80@hotmail.com

No symptom is pathognomonic for deep pelvic endometriosis. It presents essentially in the form of a painful syndrome dominated by deep dyspareunia and painful functional symptoms that recur according to the menstrual cycle. It is essential to investigate deep endometriosis lesions and draw up a precise map, which is the only way to be sure that exeresis will be complete. The treatment of first intention remains surgery, and medical treatment is only palliative in the majority of cases. Success of treatment depends on how radical surgical exeresis is. Patients should be aware of these specific major complications. Rating scales are recommended in diagnosis and therapeutic follow up. It is advisable to explain that pain improves, either partially or completely, in about 80% of patients.

Acta Radiol. 2010 Apr 12. [Epub ahead of print]

Agreement and reproducibility in identification of endometriosis using magnetic resonance imaging.

Saba L, Guerriero S, Sulcis R, Ajossa S, Melis G, Mallarini G.

Department of Science of the Images.

Background: Magnetic resonance imaging (MRI) is a promising technique in the study of endometriosis, allowing a complete mapping of lesions before surgery. However, the value of MRI in the diagnosis of endometriosis in the bladder, in superficial peritoneal lesions, and in ovarian foci and uterosacral ligaments is still under debate. Purpose: To assess inter- and intra-observer agreement in the evaluation of endometriosis in different anatomical locations using MRI. Material and Methods: From June 2006 to February 2008, 83 female patients (mean age 39, range 19-49 years) who had undergone MRI examination for suspected endometriosis were evaluated by two radiologists. MRI at 1.5 Tesla was performed with SE and TSE sequences, T1- and T2-weighted with and without fat suppression. Each examination was completed with gadolinium administration. Each dataset was independently evaluated by the radiologists for the presence or absence of endometriosis. The location (ovaries, uterosacral ligaments (USLs), pouch of Douglas, vagina, rectosigmoid, rectovaginal septum, and bladder) of suspected lesions was recorded. Cohen kappa statistical analysis was performed to calculate agreement between measurements. After 2 months the data were analyzed again by the two observers to assess intra-observer agreement. Results: Of the 83 MRI examinations performed, 12 patients demonstrated no evidence of endometriosis. In the remaining 71 studies, 157 endometriotic lesions ranging in size from 0.4 to 6.2 cm were detected. Of the 157 lesions, 53 (33.75% incidence) were smaller than 1 cm. In the ovaries, the inter-observer agreement was 92.77% and the kappa value was 0.802 (95% CI, 0.695-0.91). In the bladder the inter-observer agreement was 96.39% and the kappa value was 0.553 (95% CI 0.056-1). In the USLs the inter-observer agreement was 90.96% and the kappa value 0.583 (95% CI, 0.381-0.784). In the rectovaginal septum the inter-observer agreement was 94.58% and the kappa value 0.739 (95% CI, 0.572-0.905). In the rectovaginal pouch the inter-observer agreement was 88.55% and the kappa value 0.608 (95% CI, 0.443-0.774). In the vaginal fornix the inter-observer agreement was 94.58% and the kappa value 0.726 (95% CI, 0.552-0.901). In the rectosigmoid the inter-observer agreement was 89.76% and the kappa value 0.589 (95% CI, 0.389-0.768). Conclusion: The results of our study indicate that MRI has a high inter- and intra-observer agreement in the identification of endometriosis located in the ovary, rectosigmoid, and rectovaginal septum, whereas the agreement is suboptimal for the identification of endometriosis located in the USLs.

Hum Reprod. 2010 Apr 8. [Epub ahead of print]

Rectal endometriosis and prolactinoma.

Kurt M, Ibis M, Karaman K, Bostanci EB, Temucin T.

Department of Gastroenterology, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Kizilay Sok. No: 2, 06100 Sihhiye Ankara, Turkey.

Fertil Steril. 2010 Apr 6. [Epub ahead of print]

Matrix metalloproteinases are elevated in the urine of patients with endometriosis.

Becker CM, Louis G, Exarhopoulos A, Mechsner S, Ebert AD, Zurakowski D, Moses MA.

Frauenklinik und Geburtshilfe, Charité, Universitätsklinikum Benjamin Franklin, Berlin, Germany; Vascular Biology Program, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts.

In a prospective, blinded, longitudinal study MMP-2, MMP-9, and MMP-9/neutrophil gelatinase-associated lipocalin were significantly more likely to be detected in the urine of patients with endometriosis than in controls. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Fertil Steril. 2010 Apr 6. [Epub ahead of print]

Effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization.

Almog B, Shehata F, Sheizaf B, Tan SL, Tulandi T.

Department of Obstetrics and Gynecology, McGill Reproductive Center, McGill University Health Center, Montreal, Quebec, Canada.

OBJECTIVE: To evaluate the effects of ovarian endometrioma on the number of oocytes retrieved for IVF. SETTING: University-based tertiary medical center. PATIENT(S): We studied 81 women with unilateral endometrioma who underwent their first IVF cycle. INTERVENTION(S): Oocyte collection. MAIN OUTCOME MEASURE(S): The numbers of antral follicles and the retrieved oocytes in the ovary that contained endometrioma were compared with those from the contralateral ovary. Antral follicle count and the total number of oocytes retrieved from these women then were compared with those in 162 age-matched women with no endometrioma or endometriosis, who also underwent the first IVF treatment cycle. RESULT(S): There was no significant difference in the number of antral follicles and oocytes retrieved in the endometrioma-containing ovary (6.0 +/- 0.4 and 7.7 +/- 1.0, respectively) and in the opposite ovary (6.1 +/- 0.5 and 8.5 +/- 0.9, respectively). There was no correlation between the size and the number of endometriomas with the number of retrieved oocytes. Antral follicle count and the number of retrieved oocytes in these women (15.0 +/- 1.6 and 11.9 +/- 0.8) were similar to those in women with no endometrioma (14.2 +/- 1.4 and 11.4 +/- 0.5, respectively). CONCLUSION(S): The presence of ovarian endometrioma in a controlled ovarian hyperstimulation cycle for IVF treatment is not associated with a reduced number of oocytes retrieved from the affected ovary. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Syst Biol Reprod Med. 2010 Apr;56(2):132-46.

Dioxin-like PCBs and endometriosis.

Bruner-Tran KL, Osteen KG.

Women’s Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN 37232-2519, USA.

A recent survey in the United States identified 287 different chemicals in human cord blood, demonstrating the significant exposure of women and their children to a wide array of environmental toxicants. While reducing contamination and exposure should be an international priority, it is equally appropriate to develop an understanding of the health consequences of increasing world-wide industrialization. Endometriosis, a disease of the female reproductive tract, has emerged as a disease potentially related to environmental exposures. While a number of population-based studies have suggested that a woman’s exposure to dioxin-like polychlorinated biphenyls may affect her risk of developing this disease, other studies have failed to find such evidence. In the current manuscript, we will review the limited data regarding polychlorinated biphenyl congeners and endometriosis with a focus on dioxin-like toxicants. We will also discuss the potential importance of early life exposures to these toxicants on the subsequent development of endometriosis.

J Obstet Gynaecol. 2010 Apr;30(3):277-80.

Fitz-Hugh-Curtis Syndrome: single centre experiences.

Hong DG, Choi MH, Chong GO, Yi JH, Seong WJ, Lee YS, Park IS, Cho YL.

Departments of Obstetrics and Gynecology.

This study was conducted to report 10 cases of Fitz-Hugh-Curtis Syndrome (FHCS) diagnosed with CT and 101 cases of FHCS-like lesion that suggested perihepatitis during laparoscopic surgery. We reviewed retrospectively the images of 3,674 laparoscopies for obstetrical and gynaecological diseases and analysed 10 cases of FHCS diagnosed by clinical patterns and CT. All the 10 cases showed liver capsular enhancement on CT. Among the 3,674 laparoscopies, we found 101 cases (2.7%) with FHCS like lesion. Among them, 23 cases were during laparoscopic procedure for endometriosis, 16 for gynaecological malignant tumours, 16 for benign adnexal diseases excluding endometriosis, 13 for uterine leiomyoma, 7 for pelvic inflammatory disease, 2 had peritoneal tuberculosis and 21 for other gynaecological diseases. Further consideration should be given for the causes of FHCS other than N. gonorrhoeae and C. trachomatis. Because FHCS may represent various clinical phases, other considerations and clinical classifications are necessary for treatment.

Oncol Rep. 2010 May;23(5):1193-203.

Clear cell carcinoma of the ovary: potential pathogenic mechanisms (Review).

Kajihara H, Yamada Y, Kanayama S, Furukawa N, Noguchi T, Haruta S, Yoshida S, Sado T, Oi H, Kobayashi H.

Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan.

Epithelial ovarian cancer (EOC) is the most common cause of gynecological cancer-related mortality. Clear cell EOC (cEOC) has a number of clinical features distinguishing it from other EOC because of frequent concurrence of endometriosis and highly chemoresistant nature resulting in a poor prognosis. Recent biochemical studies based on genome-wide expression analysis technology have noted specific expression of a transcription factor, hepatocyte nuclear factor-1beta (HNF-1beta), in cEOC and genetic alteration may be involved in oxidative stress. We describe the HNF-1beta-dependent pathophysiology of cEOC and discuss its role in oxidative stress-induced carcinogenesis. A systematic search was performed in the electronic databases PubMed and ScienceDirect up to July 2009, combining the keywords, genome-wide, microarray, epithelial ovarian cancer, clear cell carcinoma, oxidative stress, and detoxification, with specific expression profiles of genes. The catalog of cEOC-specificity might be a manifestation of six essential alterations in cell physiology: oxidative stress and detoxification, proteases, signal transduction, adhesion, transcription, and metabolism. Among 54 genes highly upregulated in cEOC, 47 genes (87.0%) were associated with the redox-related genes. Several important cEOC-related genes overlap with those known to be regulated by HNF-1beta. Twenty-two (40.7%) of the 54 genes predominantly identified in cEOC were involved in downstream targets of HNF-1beta. The HNF-1beta-dependent pathway might provide new insights into regulation of glycogen synthesis, detoxification and resistance to anticancer agents. This review summarizes recent advances in the understanding of oxidative stress and antioxidant mechanisms in pathogenesis of cEOC. A redox-sensitive subset of cEOC genes linked to oxidative and detoxification pathways was identified and associated with HNF-1beta-specific downstream targets.

Zhonghua Fu Chan Ke Za Zhi. 2010 Jan;45(1):45-50.

Human endostatin antiangiogenic gene therapy mediated by recombinant adeno-associated virus vector in nude mouse with endometriosis.

[Article in Chinese]

Sun JJ, Yin LR, Mi RR, Ma HD, Guo SJ, Shi Y, Gu YJ.

Department of Gynecology, Second Hospital, Tianjin Medical University, Tianjin 300211, China.

OBJECTIVE: To study the therapeutic effect of recombinant adeno-associated virus carrying human endostatin gene therapy on endometriosis in mice model. METHODS: Recombinant adeno-associated virus vector carrying human endostatin gene and enhanced green fluorescent proteins gene (rAAV2-endostatin-EGFP) was constructed. Endometrium was from 12 patients with leiomyoma undergoing hysterectomy in Second Hospital, Tianjin Medical University between November and December 2008. Endometriosis models of nude mice were established by transplanting human endometrial fragments intooperitoneal surface. After 1 week, those 60 mice were divided into 3 groups: treatment group including 20 mice injected with rAAV2-endostatin-EGFP to ectopic lesion, control group including 20 mice injected with rAAV2-EGFP to ectopic lesion and blank control group including 20 mice injected with phosphate buffered saline (PBS) to the ectopic lesion. At 1, 2 and 3 weeks after treatment, those mice underwent laparotomy to observe the location and size of ectopic lesion in abdominal cavity. The expression of endostain protein, number of gland, microvessel density (MVD) and vascular endothelial growth factor (VEGF) were measured in ectopic lesions. The serum level of estradiol and progesterone were detected in nude mice among every groups. RESULTS: (1) All endometriosis of nude mice models were established successfully through peritoneum transplanting. After 1 week’s treatment, flat lesion nodes, decreased gland number and narrow and atrophy glandular cavity were observed by light microscope. (2) The endostatin gene was transferred into nude mice successfully and expressed effectively. It was observed that endostatin protein expression was shown with enhanced green fluorescent proteins in ectopic lesion. (3) Glands number of ectopic lesion in rAAV2-endostatin-EGFP group (7.8 +/- 1.9, 7.0 +/- 1.5 and 5.5 +/- 1.7) were significantly less than 10.1 +/- 1.7, 10.2 +/- 2.0 and 9.8 +/- 2.4 in rAAV2-EGFP control group and 10.2 +/- 2.2, 10.0 +/- 2.0 and 9.7 +/- 2.2 in PBS control group at 1, 2 and 3 weeks after treatment (all P < 0.05). Glands number of ectopic lesion in rAAV2-endostatin-EGFP group at 3 weeks was significantly less than those at 1 and 2 weeks after treatment (P < 0.05). (4) MVD of ectopic lesion in rAAV2-endostatin-EGFP group (12.2 +/- 1.5, 11.4 +/- 2.1 and 9.0 +/- 1.4) was significantly less than those at rAAV2-EGFP control group (16.5 +/- 1.7, 16.5 +/- 1.9 and 16.9 +/- 1.9) and PBS control group (16.2 +/- 1.6, 16.0 +/- 1.6 and 16.3 +/- 1.7) at 1, 2 and 3 weeks after treatment (all P < 0.05). MVD of ectopic lesion in rAAV2-endostatin-EGFP group at 3 weeks was significantly less than those at 1 and 2 weeks after treatment (P < 0.05). (5) The rate and density of VEGF expression at ectopic lesion in rAAV2-endostatin-EGFP group (35%, 30%, 25% and 1.60 +/- 0.43, 1.33 +/- 0.30, 1.03 +/- 0.36) were significantly less than those at rAAV2-EGFP control group (80%, 75%, 85% and 2.43 +/- 0.53, 2.43 +/- 0.29, 2.66 +/- 0.45) and PBS control group (85%, 90%, 90% and 2.36 +/- 0.53, 2.64 +/- 0.57, 2.53 +/- 0.52) at one 1, 2 and 3 weeks after treatment (all P < 0.05). The expression of VEGF at ectopic lesion in rAAV2-endostatin-EGFP group at 3 weeks was significantly less than those at 1 and 2 weeks after treatment (P < 0.05). (6) The level of estradial and progesterone in serum of nude mice of rAAV2-endostatin-EGFP group [E(2): (48 +/- 7) pmol/L, P: (61 +/- 8) nmol/L] did not reach statistical difference when compared with those at rAAV2-EGFP control group [E(2): (50 +/- 9) pmol/L, P: (60 +/- 10) nmol/L] and PBS control group [E(2): (48 +/- 7) pmol/L, P: (58 +/- 10) nmol/L, P > 0.05]. CONCLUSIONS: The recombinant adeno-associated virus carrying human endostatin gene therapy could inhibit angiogenesis at endometriotic lesions and not influence steroid level. The antiangiogenic gene therapy might become a novel option for endometriosis.

Minim Invasive Ther Allied Technol. 2010 Apr 5. [Epub ahead of print]

Diagnosis and laparoscopic management of a rudimentary uterine horn in a teenage girl, presenting with haematometra and severe endometriosis: Our experience and review of literature.

Liatsikos SA, Tsikouras P, Souftas V, Ammari A, Prassopoulos P, Maroulis G, Liberis V.

Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece.

Summary A unicornuate uterus is a rare congenital malformation of the female genital tract, which appears in about 1/1000 women and is characterized by significant anatomic variability. In the most common type, a noncommunicating rudimentary horn coexists with the unicornuate uterus. The diagnosis of this anomaly is usually delayed, as it remains asymptomatic until adolescence and its initial symptoms are atypical. As a result, it is often diagnosed after the appearance of severe complications, such as haematometra, endometriosis, infertility and ectopic pregnancy. We report a case of a teenage girl presenting with dysmenorrhoea, endometriosis and haematometra secondary to a noncommunicating rudimentary horn. The diagnosis of the anomaly was based on magnetic resonance imaging (MRI) and laparoscopy. The excision of the symptomatic rudimentary horn and the ipsilateral fallopian tube was also performed laparoscopically. A review of the literature follows, focusing mainly on the diagnosis and laparoscopic management of a unicornuate uterus and its complications in adolescence. Laparoscopy is an accurate diagnostic tool, which also carries significant advantages in effective surgical management of congenital uterine anomalies, especially in young women.

Qual Life Res. 2010 Apr 3. [Epub ahead of print]

Development and psychometric evaluation of the Endometriosis Treatment Satisfaction Questionnaire.

Deal LS, Williams VS, Dibenedetti DB, Fehnel SE.

Pfizer, Patient-reported Outcomes, Primary Care, 500 Arcola Rd, Collegeville, PA, 19426, USA, linda.deal@Pfizer.com.

PURPOSE: To develop and psychometrically evaluate the Endometriosis Treatment Satisfaction Questionnaire, a patient-reported assessment of satisfaction with endometriosis treatment. METHODS: The Endometriosis Treatment Satisfaction Questionnaire was developed based on the results of five focus groups and three iterative sets of cognitive interviews along with expert opinion and a review of the literature. The psychometric properties were assessed using data collected during a multicenter, randomized, proof-of-concept trial. The development and validation processes followed the guidance recommended by the United States FDA for patient-reported outcome instruments. RESULTS: The Endometriosis Treatment Satisfaction Questionnaire’s reliability, validity, and utility as a measure of patient satisfaction with their endometriosis treatment were supported. The results of the item-level analyses showed no evidence of distributional anomalies or response scale biases. The Endometriosis Treatment Satisfaction Questionnaire is unidimensional, has excellent internal consistency reliability, and discriminates well between known groups. Scores correlated well with other patient-reported outcome measures of endometriosis without being redundant. CONCLUSIONS: The Endometriosis Treatment Satisfaction Questionnaire has utility for assessing patient satisfaction with endometriosis treatment and may be useful in clinical trials that are assessing new treatments for endometriosis, especially when deciding between competing treatments or regimens that are found to have similar tolerability and efficacy.

Abdom Imaging. 2010 Apr 3. [Epub ahead of print]

Preoperative assessment of intestinal endometriosis: a comparison of Transvaginal Sonography with Water-Contrast in the Rectum, Transrectal Sonography, and Barium Enema.

Bergamini V, Ghezzi F, Scarperi S, Raffaelli R, Cromi A, Franchi M.

Department of Obstetrics and Gynecology, University of Verona, Policlinico “G.B. Rossi”, 37134, Verona, Italy, valentino.bergamini@gmail.com.

To evaluate the accuracy of Transrectal Sonography (TRS) and a new technique, Transvaginal Sonography with Water-Contrast in the Rectum (RWC-TVS), in the diagnosis of rectosigmoid endometriosis, and the accuracy of Barium Enema (BE) and RWC-TVS in the detection of intestinal stenosis due to endometriosis. In a prospective study, we compared the findings of TRS and RWC-TVS performed before surgery with the operative and pathologic findings in 61 consecutive patients who underwent laparoscopy or laparotomy for suspected rectosigmoid endometriosis. The accuracy of BE and RWC-TVS in the detection of intestinal stenosis was evaluated comparing the radiologic and ultrasonographic results with the macroscopic findings at surgery and pathology. RWC-TVS diagnosed rectosigmoid endometriosis with the same accuracy of TRS and was equally efficient as BE in the detection of a significant intestinal lumen stenosis. For the diagnosis of rectosigmoid endometriosis the sensitivity, specificity, positive and negative predictive values of TRS and RWC-TVS were 88.2% and 96%, 80%, and 90%, 95.7%, and 98%, and 57.1% and 81.8%, respectively. For the detection of intestinal stenosis the sensitivity, specificity, positive and negative predictive values of BE and RWC-TVS were 93.7% and 87.5%, 94.2% and 91.4%, 88.2% and 82.3%, and 97% and 94.1%, respectively. RWC-TVS is a new, simple technique for a single-step and accurate preoperative assessment of rectosigmoid endometriosis.

J Clin Invest. 2010 Apr;120(4):1004-15. doi: 10.1172/JCI41210. Epub 2010 Apr 1.

Uterine disorders and pregnancy complications: insights from mouse models.

Lim HJ, Wang H.

Department of Biomedical Science and Technology, IBST, RCTC, Konkuk University, 1 Hwayang-dong, Kwangjin-gu, Seoul 143-701, Korea. hlim@konkuk.ac.kr

Much of our knowledge of human uterine physiology and pathology has been extrapolated from the study of diverse animal models, as there is no ideal system for studying human uterine biology in vitro. Although it remains debatable whether mouse models are the most suitable system for investigating human uterine function(s), gene-manipulated mice are considered by many the most useful tool for mechanistic analysis, and numerous studies have identified many similarities in female reproduction between the two species. This Review brings together information from studies using animal models, in particular mouse models, that shed light on normal and pathologic aspects of uterine biology and pregnancy complications.

Reprod Biomed Online. 2010 May;20(5):602-609. Epub 2010 Feb 1.

Fertility and clinical outcome after bowel resection in infertile women with endometriosis.

Stepniewska A, Pomini P, Scioscia M, Mereu L, Ruffo G, Minelli L.

Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Via Don Sempreboni 5, 37024 Negrar, Verona, Italy.

Bowel resection for endometriosis improves pain symptoms and quality of life in symptomatic women. However, little is known about fertility after surgery, particularly after such treatment in women suffering from infertility. The aim of the present study was to evaluate post-operative fertility and long-term clinical outcome after laparoscopic colorectal resection for endometriosis in infertile women. This study reports clinical outcomes in 62 infertile women who underwent laparoscopic excision of endometriosis with segmental bowel resection performed for severe intestinal symptoms. Among women younger than 30years trying to conceive spontaneously, the cumulative pregnancy rate was 58% and the cumulative pregnancy rate was 45% in those aged 30-34 years. The total pain recurrence was 9.7% (six cases) and endometriosis recurrence was diagnosed by ultrasound in 14.5% (nine cases) during the follow-up period. Four of these patients needed further surgery because of severe symptoms. The surgical treatment of bowel endometriosis seems to improve pain symptoms and patients’ satisfaction rates, and it could also be indicated in infertile women. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Med Sci Monit. 2010 Apr 1;16(4):MT45-50.

Laparoscopic surgery for the management of ovarian endometriomas.

Mossa B, Ebano V, Tucci S, Rega C, Dolce E, Frega A, Marziani R.

Department of Gynaecology, Perinatology and Child Health, Sapienza University of Rome, Rome, Italy.

BACKGROUND: Treatment for mild and moderate endometriosis is controversial, whereas ovarian endometriomas of diameter > 3 cm must be treated surgically. A minimally invasive and inexpensive surgical approach should be always preferred. The objective of this randomized, prospective, clinical trial was to assess operative time, hemostasis, accuracy, recurrence rates, and pregnancy outcomes of 2 different laparoscopic techniques for management of ovarian endometriomas. MATERIAL/METHODS: Ninety-two patients with ovarian endometriomas were randomized to undergo direct stripping of cystic wall from the initial adhesion site (group A), or circular excision of ovarian tissue around the initial adhesion site and then stripping (group B). Pregnancy outcome results were retrieved at 36 months after surgery. Recurrence rate corresponded to evaluation at 4 and 12 months after surgery performed by transvaginal ultrasound and Ca125 serum level. RESULTS: Direct stripping leads to bleeding more frequently than does circular excision. Hemostasis at the ovarian hilus does show differences between groups; an easy exposure of damage after circular excision reduces execution time. Cumulative pregnancy outcomes at 36 months, and recurrence rates during follow-up, did not significantly differ among techniques. CONCLUSIONS: Circular excision of endometrioma cystic wall reduces surgical time, and results in better hemostasis. In addition, excision techniques allow complete removal of the cystic wall in 93% of cases (compared to 74.5% for direct stripping technique), showing differences in recurrence rate, and bringing about a better pregnancy. Data are not statistically significant owing to the small number of collected cases.

Fertil Steril. 2010 Mar 30. [Epub ahead of print]

Hyaluronic acid reagent suppressed endometriotic lesion formation in a mouse model.

Hasegawa A, Yoshino O, Osuga Y, Kodama A, Takamura M, Nishii O, Taketani Y.

Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan.

In an animal endometriosis model, the administration of hyaluronic acid (HA) reagent significantly suppressed the formation of endometriotic lesions in both number and weight. This effect was found when HA treatment was conducted at the time of endometrial fragment inoculation. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Fertil Steril. 2010 Mar 30. [Epub ahead of print]

Surgical treatment of endometriosis: a prospective randomized double-blinded trial comparing excision and ablation.

Healey M, Ang WC, Cheng C.

Royal Women’s Hospital, Melbourne, Victoria, Australia.

OBJECTIVE: To compare reduction of pain following laparoscopy after ablation or excision of endometriosis. DESIGN: A prospective, randomized, double-blind study. SETTING: Endometriosis and pelvic pain clinic at a university teaching hospital. PATIENT(S): Women of reproductive age presenting with pelvic pain and visually proved endometriosis. INTERVENTION(S): Subjects completed a questionnaire rating their various pains using visual analogue scales (VASs). After visual identification subjects were assigned randomly to treatment with ablation or excision by supervised training gynecologists as primary surgeon. Follow-up questionnaires at 3, 6, 9, and 12 months documented pain levels. MAIN OUTCOME MEASURE(S): Change in overall pain VAS score at 12 months after operation. RESULT(S): There was no significant difference in reduction in overall pain VAS scores at 12 months when comparing ablation and excision. CONCLUSION(S): This study has not been able to demonstrate a significant difference in pain reduction between ablation and excisional treatments. Nonsignificant trends suggest that a larger study may find a difference in outcomes looking at dyspareunia or dyschezia. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Fertil Steril. 2010 Mar 30. [Epub ahead of print]

Diagnosis of endometriosis of the rectovaginal septum using introital three-dimensional ultrasonography.

Pascual MA, Guerriero S, Hereter L, Barri-Soldevila P, Ajossa S, Graupera B, Rodriguez I.

Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, University of Barcelona, Barcelona, Spain.

OBJECTIVE: To evaluate the diagnostic accuracy of introital three-dimensional (3D) transvaginal sonography for preoperative detection of rectovaginal septal endometriosis. DESIGN: Ultrasonographic results were compared with surgical and histologic findings. SETTING: University Department of Obstetrics and Gynecology. PATIENT(S): This prospective study included 39 women with suspected rectovaginal endometriosis. INTERVENTION(S): All patients underwent 3D transvaginal sonography for the evaluation of the rectovaginal septum, before undergoing laparoscopic radical resection of endometriosis. Rectovaginal endometriosis was defined as hypoechoic areas, nodules, or anatomic distortion of this specific location. MAIN OUTCOME MEASURE(S): Sensitivity, specificity, and likelihood ratios (positive or negative) were calculated with 95% confidence intervals (CIs). RESULT(S): Surgery associated with histopathologic evaluation revealed deep endometriosis in the rectovaginal septum in 19 patients. The specificity, sensitivity, positive likelihood ratio, and negative likelihood ratio were 94.7% (95% CI, 78.6%-99.7%), 89.5% (95% CI, 73.3%-94.5%), 17.2 (95% CI, 2.51-115), and 0.11 (95% CI, 0.03-0.41), respectively. CONCLUSION(S): Introital 3D ultrasonography seems to be an effective method for the diagnosis of endometriosis of the rectovaginal septum and should be included in the preoperative evaluation of patients with clinical suspicion of deep endometriosis. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Amino Acids. 2010 Mar 31. [Epub ahead of print]

Structural elucidation of Leuprolide and its analogues in solution: insight into their bioactive conformation.

Laimou DK, Katsara M, Matsoukas MT, Apostolopoulos V, Troganis AN, Tselios TV.

Department of Chemistry, University of Patras, Patras, 26500, Greece.

Leuprolide [D: Leu(6), NHEt(10)]GnRH, a potent gonadotropin-releasing hormone (GnRH) agonist, is used in a wide variety of hormone-related diseases like cancer and endometriosis. In this report, the conformational behaviour of Leuprolide and its linear synthetic analogues, namely [Tyr(5)(OMe), D: Leu(6), Aze(9), NHEt(10)]GnRH (1) and [Tyr(5)(OMe), D: Leu(6), NHEt(10)]GnRH (2) have been studied in DMSO and H(2)O solutions by means of 2D nuclear magnetic resonance (NMR) experiments and detailed molecular dynamics (MD) simulations. The aim was to identify the conformational requirements of GnRH analogues for agonistic activity. This approach is of value as no crystallographic data are available for the GnRH receptor (G protein-coupled receptor, GPCR). The NOE data indicate the existence of a beta-turn type I in the 2-5 segments of Leuprolide and its linear analogues in the case of using DMSO-d(6) as solvent, whereas a beta-turn type II in the 3-6 segments is indicated using D(2)O as solvent. The final structures fulfil the conformational requirements that are known, in the literature, to play a significant role in receptor recognition and activation. Finally, the linear analogues (1) and (2) are biologically active when tested against the human breast cancer cell line, MCF-7.

Semin Reprod Med. 2010 Mar;28(2):118-25. Epub 2010 Mar 29.

Intrauterine contraceptives: a review of uses, side effects, and candidates.

Shimoni N.

Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York 10032, USA. ns2476@columbia.edu

This article reviews the two intrauterine devices (IUDs) available in the United States: the TCu380A, marketed as ParaGard (Duramed Pharmaceuticals, Inc. Pomona, NY), and the levonorgestrel-releasing intrauterine system (LNG-IUS), marketed as Mirena (Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ). The properties of the two devices are detailed, as well as noncontraceptive indications and appropriate candidates for use. Studies consistently demonstrate that the devices are safe, effective, and provide cost savings when compared with other reversible methods. The TCu380A may be used as postcoital contraception with close to 100% effectiveness. Menstrual blood loss is likely to increase with the TCu380A and decrease with the LNG-IUS. Reduction in menstrual blood loss and endometrial suppression make the LNG-IUS an increasingly popular treatment for menorrhagia, endometriosis, adenomyosis, and as an adjunct to estrogen therapy. IUDs may be inserted immediately after a first- or second-trimester abortion, immediately postpartum, and >or=4 weeks postpartum. Candidacy for IUDs has expanded, and includes nulliparous women, adolescents, and women with immunocompromised conditions including HIV. Thieme Medical Publishers.

Gen Comp Endocrinol. 2010 Mar 27. [Epub ahead of print]

Pre-natal exposure of mice to bisphenol A elicits an endometriosis-like phenotype in female offspring.

Signorile PG, Spugnini EP, Mita L, Mellone P, D’Avino A, Bianco M, Diano N, Caputo L, Rea F, Viceconte R, Portaccio M, Viggiano E, Citro G, Pierantoni R, Sica V, Vincenzi B, Mita DG, Baldi F, Baldi A.

Fondazione Italiana Endometriosi, Rome, Italy.

Endometriosis is a chronic gynecological disease characterized by the growth of endometrial tissue outside the uterine cavity. Exposure to endocrine disruptors during critical period of development causes long-lasting effects, being the genital system one of the targets. This study describes the effects on female genital system caused by developmental exposure to the endocrine-disrupting chemical bisphenol A (BPA) during pre- and peri-natal development in mice. To this end, timed pregnant Balb-C mice were treated from day 1 of gestation to 7days after delivery with BPA (100, or 1000mug/kg/day). After delivery, pups were held for 3 months; then, pelvic organs were analyzed in their entirety and livers of both pups and moms were studied for the presence of BPA. We found in the adipose tissue surrounding the genital tracts of a consistent number of treated animals, endometriosis-like structure with the presence of both glands and stroma and expressing both estrogen receptor and HOXA-10. Moreover, cystic ovaries, adenomatous hyperplasia with cystic endometrial hyperplasia and atypical hyperplasia were significantly more frequent in treated animals respect to the controls. Finally, BPA was found in the livers of exposed moms and female offspring. In conclusion, we describe for the first time an endometriosis-like phenotype in mice, elicited by pre-natal exposition to BPA. This observation may induce to thoroughly reconsider the pathogenesis and treatment of endometriosis, considering the high incidence of endometriosis and the problems caused by associated infertility. Copyright © 2010. Published by Elsevier Inc.

J Med Primatol. 2010 Mar 15. [Epub ahead of print]

Ovarian pathology in rhesus macaques: a 12-year retrospective.

Marr-Belvin AK, Bailey CC, Knight HL, Klumpp SA, Westmoreland SV, Miller AD.

Division of Comparative Medicine and Pathology, New England Primate Research Center, Harvard Medical School, Southborough, MA, USA.

Abstract Background Ovarian pathology is an important cause of decreased fertility and reproductive capability and may impact multiple systems, particularly in aging rhesus macaques. Methods Retrospective histopathologic and immunohistochemical analysis of 458 female rhesus macaque necropsies over 12 years at the New England Primate Research Center in Southborough, MA. Results Degenerative and inflammatory changes in the ovaries included mineralization, infiltration by lymphocytes, macrophages and multinucleated giant cells, endometriosis, and arteriopathy. Cystic changes included follicular cysts, cystic rete, and mesonephric duct cysts with cystic rete the most common. Neoplasms included granulosa cell tumors, cystadenoma, cystadenocarcinoma, and teratoma. Conclusions Ovarian lesions of the rhesus macaque are similar to those of cynomolgus macaques and humans. These lesions are frequently incidental findings but may impact metabolic and neurocognitive studies.

Rev Assoc Med Bras. 2010 Jan-Feb;56(1):92-8.

Th1 and Th2 ummune responses related to pelvic endometriosis.

Podgaec S, Dias Junior JA, Chapron C, Oliveira RM, Baracat EC, Abrão MS.

Clínica Ginecológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP.

OBJECTIVE: This study analyzed the relationship between clinical characteristics of endometriosis and Th1/Th2 immune response patterns. METHODS: A prospective study was performed with 65 patients with endometriosis (Group A) and 33 without the disease (Group B). Measurement of IL 2, 4 and 10, TNF-alpha and IFN-gamma was carried out in peripheral blood and peritoneal fluid. RESULTS: Serum TNF-alpha was higher in patients with endometriosis who had deep dyspareunia compared to controls (mean 4.5 pg/ml and 2.3 pg/ml, p<0.05). Among these patients (n=32), 65.5% had deep endometriosis. Patients with endometriosis and infertility had higher IL-2 concentrations in peritoneal fluid than controls (mean 5.9 pg/ml and 0.2 pg/ml, p<0.05). Among these patients (n=22), 63.5% (n=14) had deep endometriosis. A higher concentration of IL-10 was also observed in patients with ovarian endometriosis when compared to those without this type of disease, as well as when compared to control group patients (mean 50pg/ml, 18.7pg/ml and 25.7pg/ml, p<0.05). CONCLUSIONS: These results suggest that when specific clinical data are associated with a higher production of certain cytokines, there is a Th1 response pattern that may be related to deep infiltrating endometriosis.

J Reprod Med. 2010 Jan-Feb;55(1-2):62-6.

A rare extrapelvic endometriosis: inguinal endometriosis.

Sun ZJ, Zhu L, Lang JH.

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 1 Shuaifuyuan Dongcheng District, Beijing 100730, China. sunzhj2001@sina.com

OBJECTIVE: To study the diagnosis and treatment of inguinal endometriosis. STUDY DESIGN: A retrospective study was made of 9 patients presenting with inguinal endometriosis between January 1986 and November 2008. RESULTS: The incidence of inguinal endometriosis was 0.07% among a total of 13,352 patients with endometriosis treated. Eight of 9 patients (88.9%) had lesions on the right side. The symptoms in 6 patients fluctuated with menses. Only in 3 of them with cyclic symptoms was inguinal endometriosis suspected preoperatively. Symptomatic complaints ranged from 3 months to 10 years, with an average interval of 3 years. Eight patients received complete excision of inguinal lumps. One patient with a lump of 5 cm in diameter underwent a wide excision including the extraperitoneal portion of the round ligament. Four cases underwent pelvic exploration at the same time, and it revealed the coexistence of ovarian endometriomas. No one showed recurrence in the groin on follow-up of 19-96 months. CONCLUSION: Inguinal endometriosis is rare and often diagnosed accidentally. It is mostly right-sided and concomitant with pelvic endometriosis. The surgical procedure is complete excision of the mass. Pelvic exploration should be performed if necessary.

Fertil Steril. 2010 Mar 22. [Epub ahead of print]

Endometriomas in adolescents.

Wright KN, Laufer MR.

Division of Gynecology, Children’s Hospital Boston, Boston, Massachusetts, USA; Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.

OBJECTIVE: To report a rare presentation of bilateral endometriomas in an adolescent and describe characteristics of endometriomas. DESIGN: Case report. SETTING: Major academic medical center. PATIENT(S): An 18-year-old G0 presented with an incidentally found 35-cm pelvic mass that was found to be bilateral endometriomas. INTERVENTION(S): Exploratory laparotomy with resection of endometrioma cyst walls and lysis of adhesions. MAIN OUTCOME MEASURE(S): The incidence, pathogenesis, fertility implications, and treatment options for endometriomas in adolescents. RESULT(S): Endometriomas are rare in adolescents. There are no case reports in the literature to date. CONCLUSION(S): Endometriosis should be considered in adolescents presenting with bilateral complex ovarian masses regardless of their size. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Arch Gynecol Obstet. 2010 Mar 24. [Epub ahead of print]

Efficacy of anti-tumor necrosis factor therapy on endometriosis in an experimental rat model.

Zulfikaroglu E, Kılıc S, Islimye M, Aydin M, Zergeroglu S, Batioglu S.

Department of Obstetrics and Gynecology, Ankara Dr Zekai Tahir Burak Women Health Teaching and Research Hospital, 7.Cadde 70 A/14, Bahcelievler, 06490, Ankara, Turkey, zebru33@hotmail.com.

OBJECTIVE: To show the efficacy of anti-tumor necrosis factor therapy (etanercept) for treating endometriosis in an experimental model. DESIGN: A randomized, placebo-controlled, blinded study using rat endometriosis model. SETTING: Experimental research center of Ankara Education and Research Hospital. ANIMAL(S): Twenty-two Wistar female rats. INTERVENTION(S): After peritoneal implantation of endometrial tissue, rats were randomized to two equal intervention groups: control and etanercept-treated groups. After measuring implant volume, blood and peritoneal fluid samples were obtained. Vehicle treatments of 2 mL saline to rats in control and 0.4 mg/kg etanercept SC once weekly were administered in treatment group. Four weeks later, a third laparotomy was performed to remeasure implant volumes, blood, and peritoneal fluid samples. MAIN OUTCOME MEASURE(S): To compare spherical volume, peritoneal fluid and serum levels of VEGF, IL-6, and TNF-alpha between groups. RESULT(S): There was a significant difference in spherical volume between control [131.0 (60.3-501.2)] and treatment groups [72.8 (31.2-149.6)] (p < 0.025). In etanercept-treated group, a significant difference was found between peritoneal fluid and serum levels of VEGF, IL-6, and TNF-alpha (p < 0.01). CONCLUSION(S): These results indicate that etanercept was found to effectively reduce the development of endometriosis.

Hum Reprod. 2010 Mar 23. [Epub ahead of print]

A prospective study of dietary fat consumption and endometriosis risk.

Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Willett WC, Hankinson SE.

Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115-5804, USA.

BACKGROUND Endometriosis is a prevalent but enigmatic gynecologic disorder for which few modifiable risk factors have been identified. Fish oil consumption has been associated with symptom improvement in studies of women with primary dysmenorrhea and with decreased endometriosis risk in autotransplantation animal studies. METHODS To investigate the relation between dietary fat intake and the risk of endometriosis, we analyzed 12 years of prospective data from the Nurses’ Health Study II that began in 1989. Dietary fat was assessed via food frequency questionnaire in 1991, 1995 and 1999. We used Cox proportional hazards models adjusted for total energy intake, parity, race and body mass index at age 18, and assessed cumulatively averaged fat intake across the three diet questionnaires. RESULTS During the 586 153 person-years of follow-up, 1199 cases of laparoscopically confirmed endometriosis were reported. Although total fat consumption was not associated with endometriosis risk, those women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis compared with those with the lowest fifth of intake [95% confidence interval (CI) = 0.62-0.99; P-value, test for linear trend (Pt) = 0.03]. In addition, those in the highest quintile of trans-unsaturated fat intake were 48% more likely to be diagnosed with endometriosis (95% CI = 1.17-1.88; Pt = 0.001). CONCLUSION These data suggest that specific types of dietary fat are associated with the incidence of laparoscopically confirmed endometriosis, and that these relations may indicate modifiable risk. This evidence additionally provides another disease association that supports efforts to remove trans fat from hydrogenated oils from the food supply.

Reprod Sci. 2010 Mar 23. [Epub ahead of print]

Genistein Does Not Affect Vascularization and Blood Perfusion of Endometriotic Lesions and Ovarian Follicles in Dorsal Skinfold Chambers of Syrian Golden Hamsters.

Laschke MW, Schwender C, Vollmar B, Menger MD.

Genistein has previously been shown to cause regression of endometriotic lesions. In the current study, we investigated whether this observation is due to the antiangiogenic activity of genistein. Endometrial fragments and ovarian follicles were transplanted into dorsal skinfold chambers of hamsters, which were treated with genistein (50 and 200 mg/kg) or vehicle (control). Vascularization and blood perfusion of the grafts was analyzed over 14 days using intravital fluorescence microscopy and histology. Genistein inhibited angiogenesis neither in endometriotic lesions nor in ovarian follicles. This was indicated by a final microvessel density of the grafts, which was comparable to that of controls. Blood perfusion was not affected by genistein treatment. At day 14 after transplantation, the grafts of genistein- and vehicle-treated animals exhibited a histomorphology, which was typical for well-vascularized endometriotic lesions and ovarian follicles without any signs of regression. Thus, genistein may not be considered for the development of antiangiogenic treatment strategies in the therapy of endometriosis.

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2009 Nov;29(11):1001-4.

Effect of human follicular fluid from endometriosis patients treated with quyu jiedu granule on mouse embryonic development.

[Article in Chinese]

Li XL, Lian F, Liu YH.

Department of Gynecology, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan.

OBJECTIVE: To observe the effect of human follicular fluid (HFF) from endometriosis (EM) patients treated with Quyu Jiedu Granule (QJG) on mouse embryonic development. METHODS: Cultured 2-cell mouse embryos were divided into three groups. To the medium of Group A (70 embryos), HFF from endometriosis patients treated with QJG was added; to that of Group B (60 embryos), HFF from endometriosis patients untreated with QJG, and to Group C (59 embryos), HFF from patients with fallopian tube obstruction was added. The percentages of embryos developed to 8-cell stage, morula stage and blastula stage were counted, and the early stage number and rate of high-quality embryo were measured. RESULTS: Among the 70 embryos in Group A, 53 (75.71%) developed to 8-cell stage, 48 (68.57%) to morula stage and 45 (64.28%) to blastula stage; while in the 60 embryos of Group B, the corresponding number (percentage) were 34 (56.67%), 29 (48.33%), 21 (35.00%), respectively, showing significant differences between groups (P < 0.05). High-quality of embryo was 61 (87.14%) in Group A and 44 (73.3%) in Group B, the difference between groups also showed statistical significance (P < 0.05). CONCLUSION: HFF from endometriosis patients is toxic to 2-cell mouse embryos, but after treated by QJG, it could elevate the quality of cultured mouse embryo in the early stage.

Endoscopy. 2010;42 Suppl 2:E112-3. Epub 2010 Mar 19.

Intestinal endometriosis: an uncommon cause of rectal bleeding.

Kwok RM, Moawad FJ, Laczek JT, Horwhat JD.

Gastroenterology Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. Ryan.Kwok@amedd.army.mil

Psychiatr Danub. 2010 Mar;22(1):64-7.

Hamilton anxiety scale (HAMA) in infertile women with endometriosis and its correlation with magnesium levels in peritoneal fluid.

Garalejić E, Bojović-Jović D, Damjanović A, Arsić B, Pantić I, Turjacanin-Pantelić D, Perović M.

Institute of psychiatry, Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia, damal64@yahoo.com.

BACKGROUND: Endometriosis is a complex disease that can result in substantial morbidity, including chronic pain, dysmenorrhea and dyspareunia. There are contradictory reports regarding the connection between acute and chronic stress and magnesium levels in body fluids. SUBJECTS AND METHODS: A prospective study included 87 patients undergoing laparoscopy. The study group included 40 women with endometriosis and the control group consisted of 47 women with other causes of infertility. The levels of fright were determined using HAMA scale. The measurements of Mg levels were performed using biochemical analyzer “Monarch Plus”. RESULTS: One day before the operation, HAMA score was 9.54+/-7.34 in the women with endometriosis, and 6.69+/-5.51 in the women without endometriosis. The morning before the operation, HAMA score was 8.64 +/- 8.10 in the women with endometriosis, and 4.29+/-2.29 in the women without endometriosis. The second postoperative day, HAMA score was 8.96+/-7.60 in the women with endometriosis and 6.92+/-5.16 in the women without endometriosis. Higher HAMA score in the women with endometriosis, in comparison with the control group, in all three time periods has been found, but the differences were not statistically significant (p>0.05). A negative correlation between the concentration of Mg in peritoneal fluid and HAMA score was found in the control group (p<0.01). CONCLUSIONS: In infertile women without endometriosis a correlation between Mg concentration in peritoneal fluid and HAMA score was found. No such correlation was found in the women with endometriosis, possibly due to a systemic disorder in endometriosis that might affect Mg transport through the cell membrane.

Curr Opin Obstet Gynecol. 2010 Mar 18. [Epub ahead of print]

Stem cells and reproduction.

Du H, Taylor HS.

Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, USA bMolecular Cellular and Developmental Biology, Yale University, New Haven, Connecticut, USA.

PURPOSE OF REVIEW: To review the latest developments in reproductive tract stem cell biology. RECENT FINDINGS: In 2004, two studies indicated that ovaries contain stem cells which form oocytes in adults and that can be cultured in vitro into mature oocytes. A live birth after orthotopic transplantation of cyropreserved ovarian tissue in a woman whose ovaries were damaged by chemotherapy demonstrates the clinical potential of these cells. In the same year, another study provided novel evidence of endometrial regeneration by stem cells in women who received bone marrow transplants. This finding has potential for the use in treatment of uterine disorders. It also supports a new theory for the cause of endometriosis, which may have its origin in ectopic transdifferentiation of stem cells. Several recent studies have demonstrated that fetal cells enter the maternal circulation and generate microchimerism in the mother. The uterus is a dynamic organ permeable to fetal stem cells, capable of transdifferentiation and an end organ in which bone marrow stem cells may differentiate. Finally stem cell transformation can be an underlying cause of ovarian cancer. SUMMARY: Whereas we are just beginning to understand stem cells, the potential implications of stem cells to reproductive biology and medicine are apparent.

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