300: J Obstet Gynaecol. 2002 Jul;22(4):453-4. Related Articles, Links
Exclusion of abnormal endometrial histology before balloon endometrial ablation: lessons to be learnt.
Onyeka BA, Arthur ID, Wilcox FL.
Sharoe Green Hospital NHS Trust, Preston, UK.
PMID: 12521488 [PubMed – indexed for MEDLINE]
301: J Obstet Gynaecol. 2002 Jul;22(4):448-9. Related Articles, Links
Isolated vesical endometriosis in the absence of previous surgery.
Thijs I, Bhal PS, Shaw R, Kynaston H.
Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK.
PMID: 12521483 [PubMed – indexed for MEDLINE]
302: J Obstet Gynaecol. 2002 Sep;22(5):561-2. Related Articles, Links
Uterine fibroids and adenomyosis in a woman with Rokitansky-Kuster-Hauser syndrome.
Yan CM, Mok KM.
Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong.
PMID: 12521437 [PubMed – indexed for MEDLINE]
303: J Obstet Gynaecol. 2002 Sep;22(5):553-4. Related Articles, Links
Cutaneous endometriosis and its association with caesarean section and gynaecological procedures.
Scholefield HJ, Sajjad Y, Morgan PR.
Whiston Maternity and Gynaecology Unit, Whiston Hospital, Merseyside, UK.
PMID: 12521430 [PubMed – indexed for MEDLINE]
304: Cochrane Database Syst Rev. 2002;(4):CD001398. Related Articles, Links
Laparoscopic surgery for subfertility associated with endometriosis.
Jacobson TZ, Barlow DH, Koninckx PR, Olive D, Farquhar C.
Barts and the London NHS Trust Fertility Centre, 2nd Floor, KGV Block, St Bartholomew’s Hospital, West Smithfield, London, UK, EC1A 7BE. tal.jacobson@virgin.net
BACKGROUND: Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity. It is variable in both its surgical appearance and clinical manifestation often with poor correlation between the two. Surgical treatment of endometriosis aims to remove visible areas of endometriosis and restore anatomy by division of adhesions. OBJECTIVES: To assess the efficacy of laparoscopic surgery in the treatment of subfertility associated with endometriosis. The review aims to compare outcomes of laparoscopic surgical interventions compared to no treatment or medical treatment with regard to improved fertility. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group’s specialised register of trials (searched Feb 2000), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2000), MEDLINE (1966-July 2001), EMBASE (1980-July 2001), the National Research Register (Issue 1, 2000) and reference lists of articles. SELECTION CRITERIA: Trials were selected if they were randomised and compared the effectiveness of laparoscopic surgery in the treatment of subfertility associated with endometriosis versus other treatment modalities or placebo. DATA COLLECTION AND ANALYSIS: Two studies had data appropriate for inclusion within the review. These studies compared laparoscopic surgical treatment of minimal and mild endometriosis compared with diagnostic laparoscopy only. The recorded outcomes included live birth, pregnancy, fetal losses and complications of surgery. MAIN RESULTS: Meta-analysis of the two randomised trials show improvement in infertility associated with endometriosis with laparoscopic surgery. The largest trial (Marcoux 1997) clearly supports this outcome with an increased chance of pregnancy (OR 2.03, 95% CI 1.28 to 3.24) and ongoing pregnancy rate after 20 weeks (OR 1.95, 95% CI 1.18 to 3.22) but the smaller trial (Gruppo Italiano 1999) does not show benefit (pregnancy OR 0.76, 95% CI 0.31 to 1.88; livebirth OR 0.85, 95% CI 0.32 to 2.28). Combining ongoing pregnancy and live birth rates there was a statistically significant increase with surgery (OR 1.64, 95% CI 1.05 to 2.57). REVIEWER’S CONCLUSIONS: The use of laparoscopic surgery in the treatment of minimal and mild endometriosis may improve success rates. The relevant trials have some methodological problems and further research in this area is needed.
Publication Types: · Meta-Analysis · Review · Review, Academic
PMID: 12519555 [PubMed – indexed for MEDLINE]
305: Clin Exp Obstet Gynecol. 2002;29(3):217-8. Related Articles, Links
Early diagnosed intramural ectopic pregnancy associated with adenomyosis: report of an unusual case.
Karakok M, Balat O, Sari I, Kocer NE, Erdogan R.
Department of Pathology, University of Gaziantep, School of Medicine, Gaziantep, Turkey.
Intramural pregnancy is the rarest type of ectopic pregnancy and almost always is diagnosed intraoperatively. It constitutes less than 1% of ectopic pregnancies and the world literature contains only 33 cases. We present an additional case of an uncomplicated intramural pregnancy in a patient with extensive adenomyosis, which is the earliest preoperatively diagnosed (sixth week of gestation) case in the literature.
PMID: 12519047 [PubMed – indexed for MEDLINE]
306: Obstet Gynecol. 2003 Jan;101(1):164-6. Related Articles, Links
Left lateral predisposition of endometriosis and endometrioma.
Al-Fozan H, Tulandi T.
Department Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
To evaluate lateral distribution of endometriosis and ovarian endometrioma in women with endometriosis.We evaluated operative reports of women who underwent laparoscopic treatment of endometriosis (n = 330) and ovarian endometrioma (n = 185) from January 1996 to January 2002. Data on all operative findings consisted of a written report, a diagram, the revised American Fertility Society classification of endometriosis, and a printout of the dictated report.Endometriotic implants were confined to one side of the pelvis in 143 women and bilaterally in 187 others. Endometriosis was significantly more frequent in the left (64.3%) than in the right hemipelvis (P <.001, odds ratio 3.3, 95% confidence interval 2.0, 5.3). Of those with bilateral lesions, adhesions were also more frequently found on the left than on the right hemipelvis (16.6% versus 6.9%, P <.01, odds ratio 2.6, 95% confidence interval 1.3, 5.2). Endometrioma was found in the left ovary (n = 90), in the right ovary (n = 59), and bilaterally (n = 36). Left ovarian endometrioma was found more frequently (60.4%) than right endometrioma (P <.001, odds ratio 2.3, 95% confidence interval 1.5, 3.7). This trend was not related to the size of the endometrioma.Our results confirm a left lateral predisposition of endometriosis and ovarian endometrioma. It is possible that this is related to decreased fluid movement in the left side of the pelvis because of the presence of sigmoid colon. These findings may support the theory that the origin of endometriosis is from the regurgitated endometrial cells.
PMID: 12517662 [PubMed – indexed for MEDLINE]
307: J Soc Gynecol Investig. 2003 Jan;10(1):32-6. Related Articles, Links
Analysis of an interleukin-6 gene promoter polymorphism in women with endometriosis by pyrosequencing.
Wieser F, Fabjani G, Tempfer C, Schneeberger C, Sator M, Huber J, Wenzl R.
Department of Obstetrics and Gynecology, Division of Gynecological Endocrinology and Reproductive Medicine, Vienna, Austria.
Interleukin (IL)-6 has been implicated in the etiology of endometriosis. A single nucleotide polymorphism (SNP) at position -174 in the IL-6 gene promoter appears to influence IL-6 transcription rates in vitro and basal IL-6 levels in vivo. We determined the genotype and the allele frequencies of the -174 IL-6 promoter polymorphism and the corresponding IL-6 serum levels in women with endometriosis.The pyrosequencing technique was used to assess the IL-6 genotypes in 94 women with histologically confirmed endometriosis (study group). A series of 70 healthy women without history of uterine disease served as clinical controls (control group).Allele frequencies for the G allele among women with and without endometriosis were 59.6% and 55.0%, respectively (P =.430; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.53, 1.29). Homozygotes for the protective allele C were present in 17.0% of women with endometriosis and in 18.6% of controls were homozygous for the protective allele C (P =.797; OR 0.90, 95% CI 0.40, 2.02). When patients with various disease manifestations were compared, we found an association between the -174 G allele and chocolate cysts (P =.037). Serum levels of IL-6 were significantly higher in women with endometriosis than in controls (P <.001), with highest levels in women with chocolate cysts. There was no association between serum IL-6 levels and IL-6 genotype.The IL-6 promoter polymorphism -174 G/C does not contribute significantly to overall disease susceptibility but does predispose the carrier to distinct endometriosis with chocolate cysts. A genetically determined high IL-6 response might play a pathogenic role in this disease condition.
PMID: 12517591 [PubMed – indexed for MEDLINE]
308: Expert Opin Pharmacother. 2003 Jan;4(1):67-82. Related Articles, Links
Diagnosis and treatment of endometriosis.
Frackiewicz EJ, Zarotsky V.
California Clinical Trials, 8501 Wilshire Boulevard, Main Floor, Beverly Hills, CA 90211, USA. edyta.frackiewicz@cctrials.com
Endometriosis is a chronic and progressive disease that affects ~ 10% of women of reproductive age. Its aetiology remains unknown, however, factors such as retrograde menstruation, heredity, impaired immune function and environmental toxins have been implicated. Laparoscopy is still considered the mainstay for diagnosis, however non-invasive diagnostic methods such as transvaginal ultrasound and MRI may also be complementary. Treatment should be individualised and current treatment options include medical treatment and surgery, however, disease recurrence is common following treatment. Hormonal therapy induces atrophy of endometriotic lesions. Conservative surgery may be successful in removing visible lesions, however in cases of severe or incapacitating illness, removal of the uterus and ovaries may be necessary. In such cases, extreme care must be taken to remove all traces of disease. Experimental treatments for endometriosis show promising preliminary results and include GnRH antagonists, aromatase inhibitors, selective oestrogen receptor modulators and mifepristone.
PMID: 12517244 [PubMed – in process]
309: J Reprod Med. 2002 Dec;47(12):1038-40. Related Articles, Links
Live birth after treatment of a heterotopic cornual pregnancy with fetal intrathoracic KCI. A case report.
Ghazeeri GS, Phillips OP, Emerson DS, Kutteh WH, Ke RW.
Division of Reproductive Endocrinology, Infertility and Genetics, Department of Obstetrics and Gynecology, Department of Radiology, University of Tennessee Health Sciences Center, Memphis, USA.
BACKGROUND: Heterotopic pregnancy, in which an ectopic gestation coexists with an intrauterine one, occurs more frequently following in vitro fertilization than with spontaneous conception. However, it is rare to find an ectopic gestation in the interstitial (or cornual) portion of the fallopian tube. This scenario poses challenges in diagnosis as well as difficulties in managing the cornual pregnancy while maintaining the viability of the intrauterine gestation. CASE: A 29-year-old nulligravida with stage IV endometriosis completed in vitro fertilization for primary infertility. A heterotopic pregnancy involving the right interstitial portion of the fallopian tube as well as a viable singleton intrauterine pregnancy was diagnosed using serial ultrasound. Successful termination of the cornual pregnancy was accomplished by transabdominal fetal intrathoracic injection of KCl under ultrasound guidance. CONCLUSION: Pregnancy reduction of a heterotopic cornual gestation using KCl is a treatment alternative for this uncommon but potentially devastating complication of in vitro fertilization.
PMID: 12516325 [PubMed – indexed for MEDLINE]
310: Thorax. 2003 Jan;58(1):89-90. Related Articles, Links
Catamenial haemoptysis and clomiphene citrate therapy.
Hope-Gill B, Prathibha BV.
Respiratory Unit, Morriston Hospital, Swansea SA6 6NL, UK. bhopegill@netscape.net
Case reports of catamenial haemoptysis are uncommon. We report the first case of thoracic endometriosis associated with clomiphene citrate therapy and previously unpublished endobronchial and angiographic findings.
PMID: 12511729 [PubMed – indexed for MEDLINE]
311: Saudi Med J. 2002 Nov;23(11):1402-4. Related Articles, Links
Uterine didelphus with obstructed hemivagina.
Al-Hakeem MM, Ghourab SA, Gohar MR, Khashoggi TY.
Department of Obstetrics & Gynecology, King Khalid University Hospital, PO Box 8413, Riyadh 11662, Kingdom of Saudi Arabia. Tel. +966 (1) 4670818. Fax. +966 (1) 4679347. E-mail: kmmtmm@hotmail.com
Complex congenital anomalies of the mullerian ducts can occur in isolation or in association with other developmental disorders. They result from non-development or non-fusion of the mullerian ducts or the failure of reabsorption of the uterine septum. Early diagnosis is necessary to relieve symptoms, optimize preservation of the genital organs and prevent the development of endometriosis. We present a case report to highlight this phenomenon.
PMID: 12506305 [PubMed – in process]
312: BJOG. 2003 Jan;110(1):85-6. Related Articles, Links
Comment on: · BJOG. 2001 Oct;108(10):1021-4.
The aetiology of parous endometriosis.
Quinn M.
Publication Types: · Comment · Letter
PMID: 12504948 [PubMed – indexed for MEDLINE]
313: Am J Obstet Gynecol. 2002 Dec;187(6):1723-5. Related Articles, Links
Sigmoid endometriosis in a postmenopausal woman.
Deval B, Rafii A, Felce Dachez M, Kermanash R, Levardon M.
Department of Gynecology, Hopital Beaujon, Clichy, France.
Bowel obstruction resulting from endometriosis is an infrequently observed phenomenon in postmenopausal women. A 69-year-old woman without hormone replacement had clinical and radiologic findings consistent with a pelvic tumor invasive into the wall of the sigmoid colon. The patient underwent resection of the sigmoid colon and total hysterectomy. Histologic examination revealed endometrioma. This case documents the possible occurrence of symptomatic bowel endometriosis after years of a hormonally castrated state.
PMID: 12501094 [PubMed – indexed for MEDLINE]
314: Am J Obstet Gynecol. 2002 Dec;187(6):1709-10. Related Articles, Links
Endometrioma of the abdominal wall.
Bumpers HL, Butler KL, Best IM.
Department of Surgery, Morehouse School of Medicine, Atlanta, Ga 30310, USA. bumperh@msm.edu
We describe a case of a large endometrioma in an abdominal scar and the approach to evaluation and therapy.
PMID: 12501087 [PubMed – indexed for MEDLINE]
315: Am J Obstet Gynecol. 2002 Dec;187(6):1515-9; discussion 1519-20. Related Articles, Links
Differences in uterine innervation at hysterectomy.
Quinn MJ, Kirk N.
Department of Gynaecology, Hinchingbrooke Hospital, Huntingdon, United Kingdom. quinnobgyn@aol.com
OBJECTIVE: Our purpose was to identify patterns of uterine innervation in normal uteri and selected clinical conditions including adenomyosis and chronic pelvic pain. STUDY DESIGN: A retrospective survey was performed of stored uteri removed at hysterectomy for a variety of clinical conditions, including 8 uteri from nulliparous subjects (group 1, mean age 40.0 years, range 30-52 years), 21 uteri with no reported histologic abnormality from multiparous subjects (group 2, mean age 43.4 years, range 32-53 years; mean parity 2.0, range 1-4), 31 uteri reported with adenomyosis (group 3, mean age 42.4 years, range 29-54 years; parity 2.0, range 0-4), and 17 uteri from subjects with pelvic pain (group 4, mean age 39.1 years, range 30-52 years; parity 2.5, range 1-7). Sections were cut from paraffin blocks of the isthmus of stored uteri (in the majority of cases) and stained with protein gene product 9.5 to identify nerves. Sections of pancreas provided positive controls. Each section was reviewed by two unblinded observers. RESULTS: Group 1 (n = 8, nulliparous uteri) showed significant nerve bundles at the endometrial-myometrial interface and in the subserosal layers, with nerve fibers noted in intervening neurovascular bundles supplying the myometrial stroma. Group 2 (n = 21, histologically normal uteri from parous subjects) showed patterns of innervation similar to those of group 1 with the exception that 6 uteri demonstrated areas of nerve fiber proliferation (see below, group 4). In group 3 (n = 31, uteri with adenomyosis), 30 uteri (30/31) showed large areas of myometrium without nerves and absence of nerves in the neurovascular bundles supplying these areas. Five uteri showed areas of nerve fiber proliferation at the margins of the adenomyosis. Subserosal nerves were present in the majority of these uteri. In group 4 (n = 17), uteri were removed for chronic pelvic pain. Eleven uteri demonstrated proliferation of small-diameter nerve fibers throughout the myometrium; in 6 uteri there was asymmetry of nerve fiber proliferation. CONCLUSIONS: Variations in uterine innervation were noted in the isthmic region of uteri stored after hysterectomy. Uteri with adenomyosis frequently demonstrated large areas with absence of nerve fibers; uteri from subjects with chronic pelvic pain showed proliferation of small-diameter nerve fibers throughout the myometrial stroma. Nerve fiber proliferation was asymmetric in some of these specimens.
PMID: 12501055 [PubMed – indexed for MEDLINE]
316: JSLS. 2002 Oct-Dec;6(4):311-4. Related Articles, Links
The evil twins of chronic pelvic pain syndrome: endometriosis and interstitial cystitis.
Chung MK, Chung RR, Gordon D, Jennings C.
Midwest Regional Center for Chronic Pelvic Pain, The Medical Park of Lima Memorial Hospital, Lima, Ohio 45805, USA. Endosurgeon85@aol.com
OBJECTIVE: To determine the value in the initial laparoscopic and cystoscopic evaluation of avoiding the unnecessary delay in diagnosing the "evil twins" of chronic pelvic pain syndrome, endometriosis and interstitial cystitis. METHODS: We performed a retrospective review of 60 women ranging in age from 19 to 62. They underwent concurrent laparoscopy, cystoscopy, and hydrodistentions from January 1999 to October 2000. A gynecology and urology team performed these procedures in these 60 patients at a regional pelvic pain center in Northwest Ohio. RESULTS: Fifty-eight patients (96.6%) were diagnosed with interstitial cystitis by the presence of glomerulation and terminal hematuria according to National Institutes of Health criteria. A diagnosis of (active and inactive) endometriosis was found in 56 patients (93.3%). Biopsy-confirmed active endometriosis was found in 48 patients (80%). In the interstitial cystitis patient group (58), 54 patients had a diagnosis of (active and inactive) endometriosis (93.1%), and 47 patients had biopsy-confirmed active endometriosis (81%). In the group of 56 patients with a diagnosis of (active and inactive) endometriosis, 54 patients were found to have interstitial cystitis (96.4%). In the group of 48 patients with active biopsy-confirmed endometriosis, 47 have interstitial cystitis (97.7%). CONCLUSION: Patients with chronic pelvic pain syndrome are very difficult to manage. Eighty percent were found to have endometriosis and had numerous previous operations. Many patients failed to respond to multiple therapies. In many cases, pain persists even after a hysterectomy. Through our study, we showed the high prevalence and association of interstitial cystitis and endometriosis, the evil twins of chronic pelvic pain syndrome. It is absolutely necessary to perform both laparoscopic and cystoscopic examinations concurrently with the patient anesthetized in the initial evaluation and treatment of chronic pelvic pain syndrome to avoid unnecessary delay in making the diagnosis of the evil twins, because chronic pelvic pain syndrome can be caused by either or both of these entities. It is very important to have the gynecologists and urologists working as a team in making an early diagnosis to resolve these chronic debilitating diseases.
PMID: 12500828 [PubMed – indexed for MEDLINE]
317: J Clin Pathol. 2003 Jan;56(1):79. Related Articles, Links
Comment on: · J Clin Pathol. 2002 May;55(5):391-2.
CD10 is useful in demonstrating endometrial stroma at ectopic sites and in confirming a diagnosis of endometriosis.
Onda T, Ban S, Shimizu M.
Publication Types: · Comment · Letter
PMID: 12499444 [PubMed – indexed for MEDLINE]
318: Hum Reprod Update. 2002 Nov-Dec;8(6):591-7. Related Articles, Links
Management of ovarian endometriomas.
Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB.
Assistance Publique, Hopitaux de Paris (AP-HP), Clinique Universitaire Baudelocque, CHU Cochin-Saint Vincent-de-Paul, Paris, France. charles.chapron@cch.ap-hop-paris.fr
The efficiency of medical therapy as a unique treatment for endometrioma has not been demonstrated. Operative laparoscopic management is the ‘gold standard’ for surgical treatment, and there are no indications to prescribe medical treatment before cystectomy. Post-operative administration of low-dose cyclic oral contraceptives does not significantly affect the long-term recurrence of endometriosis after surgical treatment. In case of infertility, the management of endometriomas is controversial. Recurrent ovarian surgery is not recommended.
Publication Types: · Review · Review, Tutorial
PMID: 12498427 [PubMed – indexed for MEDLINE]
319: J Reprod Med. 2002 Nov;47(11):955-8. Related Articles, Links
Management of intramedullary endometriosis of the conus medullaris. A case report.
Erbayraktar S, Acar B, Saygili U, Kargi A, Acar U.
Departments of Neurosurgery, Obstetrics and Gynecology, and Pathology, School of Medicine, Dokuz Eylul University, Izmir, Turkey. serbayrakta@hotmail.com
BACKGROUND: Few data exist on treating spinal cord endometriosis. CASE: Total excision of the endometriotic lesion, followed by a bilateral oophorectomy and aromatase inhibitor therapy, led to a clinical improvement. CONCLUSION: Attempts at total removal of spinal cord endometriosis may be safer after achieving pharmacologic control.
PMID: 12497691 [PubMed – indexed for MEDLINE]
320: J Reprod Med. 2002 Nov;47(11):936-8. Related Articles, Links
Uterus didelphys with cervical agenesis associated with adenomyosis, a leiomyoma and ovarian endometriosis. A case report.
Yang CC, Tseng JY, Chen P, Wang PH.
Departments of Obstetrics and Gynecology and of Medical Research, Cardinal Tien Hospital-Hsintien, 362 Chung Cheng Road, Hsintien, Taipei County, 23137 Taiwan, R.O.C. ato5566@ms42.hinet.net
BACKGROUND: Elevated level of serum CA-125 was detected in a 48-year-old woman who was diagnosed with a lateral fusion defect in association with congenital agenesis of the uterine cervix. This unusual case combined two developmental anomalies of the mullerian duct. CASE REPORT: A 48-year-old woman consulted our outpatient department due to persistent abdominal pain for six months. Bimanual pelvic examination showed absence of the cervix, an anteverted uterus and a 6-cm, left adnexal mass. Ultrasound and computed tomography revealed a uterus didelphys with a 3-cm cystic mass over the right ovary. Serum level of CA-125 was 641.4 U/mL. The patient underwent exploratory laparotomy, and total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathology confirmed adenomyosis and a leiomyoma of the uterus with functional endometrium in conjunction with endometriosis of the right ovary. CONCLUSION: Multiple mullerian anomalies associated with adenomyosis and endometriosis should be considered in patients presenting with primary amenorrhea. Thorough evaluation, careful planning, fertility preservation and postoperative outcomes should be reviewed.
PMID: 12497685 [PubMed – indexed for MEDLINE]
321: Int J Gynecol Pathol. 2003 Jan;22(1):83-8. Related Articles, Links
Analysis of p53 and c-erbB-2 expression in ovarian endometrioid carcinomas arising in endometriosis.
Prefumo F, Venturini PL, Fulcheri E.
UO di Ostetricia e Ginecologia, Instituto G Gaslini, Universita di Genova, Italy.
We assessed the immunohistochemical expression of p53 and c-erbB-2 oncoproteins in 13 ovarian endometrioid adenocarcinomas arising from endometriosis (group 1) and compared the findings with 15 otherwise similar cases without associated endometriosis (group 2). Tumors in group 1 showed a higher expression of both p53 and c-erbB-2 (p = 0.015 and p = 0.048, respectively). The expression of the two proteins was also significantly associated in group 1 (p = 0.013) but not in group 2 (p = 0.63) tumors. The different pattern of expression of p53 and c-erbB-2 in the two groups suggests that different molecular pathways may be involved in their pathogenesis.
PMID: 12496703 [PubMed – indexed for MEDLINE]
322: Int J Gynecol Pathol. 2003 Jan;22(1):42-51. Related Articles, Links
Ovarian mucinous and mixed epithelial carcinomas of mullerian (endocervical-like) type: a clinicopathologic analysis of four cases of an uncommon variant associated with endometriosis.
Lee KR, Nucci MR.
Division of Women’s and Perinatal Pathology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
The epithelial cells of ovarian mucinous carcinomas may sometimes appear similar to those of gastrointestinal or endocervical mucinous carcinomas, but most are composed of cells that do not suggest any particular derivation. We report four cases of mucinous ovarian carcinoma in which the cells were entirely or almost entirely endocervical-like. The patients’ ages were 34, 43, 44, and 50 years. Two patients had bilateral tumors confined to the ovaries at initial staging; both also had synchronous endometrial carcinomas of the mucinous type. The two other patients had unilateral tumors, both with invasive metastases in the pelvis and abdomen at initial staging. In one of the latter cases a mullerian (endocervical-like) mucinous borderline tumor (MMBT) of the opposite ovary had been removed 5 years earlier, and in this case and two other cases the ovarian carcinomas had foci resembling MMBT, suggesting that they may be an invasive counterpart to these tumors. The six tumors ranged from 4 to 19 cm; five were grossly cystic with papillary or solid areas, and one was entirely solid. They were composed of closely packed glands, cysts, and cysts containing complex papillae. There was abundant intraglandular and intracystic mucin. The epithelial cells were well differentiated with infrequent mitoses and most were tall with mucinous cytoplasm resembling normal endocervical glandular cells. In three tumors there also were round to polygonal cells with eosinophilic cytoplasm; endometrioid foci were present in three tumors and a squamous focus was present in one. One tumor had a focally infiltrative growth pattern with a desmoplastic stromal reaction; the remaining five tumors had an exclusively confluent (expansile) pattern of invasion. Endometriosis was present in residual ovarian tissue adjacent to four tumors in three patients and had marked epithelial proliferation in three. All patients were treated postoperatively with chemotherapy and were without clinical recurrence with follow-up intervals of 8 months, 1.2 years, 2.9 years, and 3.8 years. By immunohistochemical analysis the neoplastic epithelium was positive for estrogen and progesterone receptor proteins, vimentin, and cytokeratin 7, and negative or only focally positive for carcinoembryonic antigen and cytokeratin 20, a profile that differs from that of the usual mucinous ovarian carcinoma and is supportive of a mullerian derivation. As with MMBTs, there was a strong association with endometriosis, and these tumors likely arise from endometriosis, possibly through an MMBT precursor in some cases. To better understand their clinicopathologic features and pathogenesis, this uncommon variant should be separated from the usual type in future studies of mucinous carcinomas of the ovary.
PMID: 12496697 [PubMed – indexed for MEDLINE]
323: J Am Coll Surg. 2002 Dec;195(6):754-8. Related Articles, Links
Laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement.
Duepree HJ, Senagore AJ, Delaney CP, Marcello PW, Brady KM, Falcone T.
Department of Colorectal Surgery, and The Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
BACKGROUND: Adequate treatment of severe deep pelvic endometriosis requires complete excision of all implants, but formal bowel resection is not generally recommended. The purpose of this study was to describe our experience with planned complete laparoscopic management of deep pelvic endometriosis with bowel involvement. STUDY DESIGN: All patients presenting to the Department of Obstetrics and Gynecology and the Department of Colorectal Surgery at our institution with stage IV endometriosis and bowel involvement from February 1998 to December 2001 were identified from a prospective database and were retrospectively analyzed. Data analysis included age, previous history of endometriosis, previous pregnancies, operative procedure, body mass index, operating room time, intra- and postoperative complications, length of stay, 30-day readmission, and pain relief. Laparoscopic excision of all visible disease was planned. RESULTS: The series consisted of 51 patients with median age of 34 years (range, 32 to 39 years), with history of earlier abdominal operation in 66.7%. Preoperative symptoms were present as dysmenorrhea (85.3%), dyspareunia (55.9%), rectal pain (41.2%), constipation (44.1%), rectal bleeding (14.7%), bloating (29.4%), and tenesmus (8.8%). Management of the bowel disease included superficial excision of serosal endometriosis implants (n = 26), bowel resection (n = 18), and disc excision (n = 5). Five patients required management of disease other than rectosigmoid involvement. Median operating room time was 187 minutes (range, 145 to 277 minutes), and the median length of stay was 2 days (range, 1 to 4 days). Thirty-three percent of excisions were outpatient procedures. Postoperative complications occurred in 10.3%: four cases (7.8%) were converted to formal laparotomy, and three patients (7.7%) were readmitted within 30 days. Only 7 of 47 patients with a uterus (14.9%) required abdominal hysterectomy or bilateral salpingo-oophorectomy. Postoperatively, 87% of patients reported a clinically significant improvement of their symptoms. CONCLUSIONS: Though technically demanding, complete radical laparoscopic excision of endometriotic implants can be accomplished with preservation of the reproductive organs and appropriate use of bowel resection in the majority of patients. The surgeon or gynecologist who plans to perform laparoscopic excision of deep pelvic endometriosis should have the ability or access to expertise for laparoscopic partial or segmental bowel resection or plan to convert to laparotomy when faced with this disease location.
PMID: 12495306 [PubMed – indexed for MEDLINE]
324: Aust N Z J Obstet Gynaecol. 2002 Nov;42(5):565-7. Related Articles, Links
Perineal endometriosis after vaginal delivery–clinical experience with 10 patients.
Zhu L, Wong F, Lang JH.
Peking Union Medical College, Peking, ROC.
PMID: 12495118 [PubMed – indexed for MEDLINE]
325: Ultrasound Obstet Gynecol. 2002 Dec;20(6):630-4. Related Articles, Links
A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis.
Moore J, Copley S, Morris J, Lindsell D, Golding S, Kennedy S.
Nuffield Department of Obstetrics and Gynecology, John Radcliffe Hospital, Oxford, UK. janemoore@btinternet.com
OBJECTIVE: To evaluate transvaginal and transabdominal ultrasound scanning, with or without Doppler, as a diagnostic test for the accurate diagnosis of pelvic endometriosis. METHODS: The MEDLINE (1966-2001) and EMBASE (1980-2001) databases were searched for relevant studies, published in English. Only studies fulfilling predefined criteria were selected. An assessment of quality was made for each study, and data were then reanalyzed using likelihood ratios to determine the usefulness of the test. RESULTS: In total, 67 papers were identified using the search strategy, of which 17 described relevant studies. Of these, seven fulfilled the inclusion criteria. All seven related to the use of transvaginal gray-scale imaging in the diagnosis of ovarian endometriomata specifically, rather than endometriosis. The positive likelihood ratios ranged from 7.6 to 29.8, and the negative likelihood ratios ranged from 0.1 to 0.4. Confidence intervals were wide. One paper addressed the use of conventional color Doppler with ultrasound: the positive likelihood ratio was 1.2, with a negative likelihood ratio of 0.4. One paper assessed the use of color Doppler energy imaging, and showed a positive likelihood ratio of 33.5 and a negative likelihood ratio of 0.1. CONCLUSIONS: Transvaginal ultrasound appears to be a useful test both to make and to exclude the diagnosis of an ovarian endometrioma.
Publication Types: · Review · Review, Academic
PMID: 12493057 [PubMed – indexed for MEDLINE]
326: Ultrasound Obstet Gynecol. 2002 Dec;20(6):605-11. Related Articles, Links
Limitations of transvaginal sonography for the diagnosis of adenomyosis, with histopathological correlation.
Bazot M, Darai E, Rouger J, Detchev R, Cortez A, Uzan S.
Department of Radiology, Hopital Tenon, Paris, France. marc.bazot@tnn.ap-hop-paris.fr
OBJECTIVES: To evaluate the accuracy of transabdominal sonography (TAS) and transvaginal sonography (TVS) for the diagnosis of adenomyosis, and to determine the diagnostic relevance of various sonographic criteria. SUBJECTS AND METHODS: A total of 129 women scheduled for hysterectomy were enrolled into this prospective study. Group 1 (n = 23) consisted of patients with menometrorrhagia who were free of myoma and endometrial disorders on TAS. Group 2 consisted of all the other patients (n = 106). TAS and TVS findings were compared to histopathological results. RESULTS: The prevalence of adenomyosis in Groups 1 and 2 was 91.3% and 24.5%, respectively. TAS had limited value for the diagnosis of adenomyosis in both groups. The sensitivity, specificity, and positive and negative predictive values of TVS in Groups 1 and 2 were 80.9% and 38.4%, 100% and 97.5%, 100% and 83.3%, and 40% and 82.9%, respectively. The accuracy of combined TAS and TVS in Groups 1 and 2 was 91.3% and 83%, respectively. The presence of myometrial cysts was the most specific ultrasound diagnostic criterion for adenomyosis. Hypoechoic linear myometrial striations related to the presence of myometrial hypertrophy correlated to hormonal status with a sensitivity of 66.6% and a specificity of 100% in Group 1. CONCLUSIONS: Our results show that TAS has a limited diagnostic capacity for adenomyosis but also that TVS alone was poor in patients with an enlarged uterus. In these cases a combination of TVS and TAS should be used.
PMID: 12493051 [PubMed – indexed for MEDLINE]
327: Thyroid. 2002 Nov;12(11):997-1001. Related Articles, Links
Thyroid dysfunction and autoimmunity in infertile women.
Poppe K, Glinoer D, Van Steirteghem A, Tournaye H, Devroey P, Schiettecatte J, Velkeniers B.
Departments of Endocrinology, and Reproductive Medicine, Vrije Universiteit Brussel, Brussels, Belgium. hemopek@az.vub.ac.be
A prospective study was undertaken in 438 women (ages, 32 +/- 5 years) with various causes of infertility, and in 100 age-matched (33 +/- 5 years) healthy parous controls with the aim of assessing the prevalence of autoimmune thyroid disease (AITD) and hitherto undisclosed alterations of thyroid function. Female origin of the infertility was diagnosed in 45% of the couples, with specific causes including endometriosis (11%), tubal disease (30%), and ovarian dysfunction (59%). Male infertility represented 38% and idiopathic infertility 17% of the couples. Overall, median thyrotropin (TSH) was significantly higher in patients with infertility compared to controls: 1.3 (0.9) versus 1.1 (0.8) mIU/L. Serum TSH above normal (>4.2 mIU/L) or suppressed TSH (<0.27 mIU/L) levels were not more prevalent in the infertile women than in controls. The prevalence of positive thyroid peroxidase antibody (TPO-Ab) was higher in all investigated women of infertile couples, compared to controls (14% vs. 8%), but the difference was not significant. However, in infertility of female origin, a significant higher prevalence of positive TPO-Ab was present, compared to controls: 18% versus 8%. Furthermore, among the female causes, the highest prevalence of positive antibodies was observed in women with endometriosis (29%). When thyroid antibodies were positive, both hypothyroidism and hyperthyroidism were more frequent in all women of infertile couples and in the women with a female infertility cause, compared to women in the same groups but without positive TPO-Ab. The present study shows that in infertile women, thyroid autoimmunity features are significantly more frequent than in healthy fertile controls and this was especially the case for the endometriosis subgroup.
PMID: 12490077 [PubMed – indexed for MEDLINE]
328: J Endourol. 2002 Nov;16(9):663-6. Related Articles, Links
Cystoscopy-assisted laparoscopic resection of extramucosal bladder endometriosis.
Seracchioli R, Mannini D, Colombo FM, Vianello F, Reggiani A, Venturoli S.
Center for Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, S. Orsola-Malpighi Hospital, University of Bologna, Massarenti 13, 40138 Bologna, Italy. seracchioli@med.unibo.it
BACKGROUND AND PURPOSE: Involvement of the bladder is seen in only 1% to 2% of patients with endometriosis. The diagnosis of vesical endometriosis is difficult to formulate, and it should be confirmed by cystoscopy with biopsy. However, this examination is often insufficient because of the submucosal-transmural location of the lesion. Therefore, laparoscopic examination represents the gold standard for the diagnosis of pelvic endometriosis. We describe a case of recurrent bladder endometriosis treated by a combined endoscopy technique. Case Report: A 43-year-old woman presented with pelvic pain, dysmenorrhea, and persistent cystitis. The endometriotic lesion on the posterior wall of the bladder consisted in a 2.5-cm nodule growing into the vesical muscularis and raising the overlying peritoneum. We performed laparoscopic resection employing a cystoscopy-assisted technique in order to preserve the integrity of the vesical mucosa. Resection was carried out and monitored from inside the bladder with the cystoscope and laparoscope lights turned on during the whole procedure ("light-to-light" technique). CONCLUSION: This minimally invasive combined endoscopic procedure could represent a good alternative to partial cystectomy for muscle-infiltrating bladder endometriosis that does not involve the vesical mucosa.
PMID: 12490020 [PubMed – indexed for MEDLINE]
329: Int J Exp Pathol. 2002 Aug;83(4):151-63. Related Articles, Links
Angiogenesis in the female reproductive organs: pathological implications.
Reynolds LP, Grazul-Bilska AT, Redmer DA.
Department of Animal and Range Sciences, North Dakota State University, Fargo, ND 58105-5727, USA. Larry.Reynolds@ndsu.nodak.edu
The female reproductive organs (ovary, uterus, and placenta) are some of the few adult tissues that exhibit regular intervals of rapid growth. They also are highly vascular and have high rates of blood flow. Angiogenesis, or vascular growth, is therefore an important component of the growth and function of these tissues. As with many other tissues, vascular endothelial growth factors (VEGFs) and fibroblast growth factors (FGFs) appear to be major angiogenic factors in the female reproductive organs. A variety of pathologies of the female reproductive organs are associated with disturbances of the angiogenic process, including dysfunctional uterine bleeding, endometrial hyperplasia and carcinoma, endometriosis, failed implantation and subnormal foetal growth, myometrial fibroids (uterine leiomyomas) and adenomyosis, ovarian hyperstimulation syndrome, ovarian carcinoma, and polycystic ovary syndrome. These pathologies are also associated with altered expression of VEGFs and/or FGFs. In the near future, angiogenic or antiangiogenic compounds may prove to be effective therapeutic agents for treating these pathologies. In addition, monitoring of angiogenesis or angiogenic factor expression may provide a means of assessing the efficacy of these therapies.
Publication Types: · Review · Review, Tutorial
PMID: 12485460 [PubMed – indexed for MEDLINE]
330: J Assist Reprod Genet. 2002 Nov;19(11):507-11. Related Articles, Links
Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation.
Ho HY, Lee RK, Hwu YM, Lin MH, Su JT, Tsai YC.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92, Sec. 2, Chung Shan North Road, Taipei 10449, Taiwan.
PURPOSE: To compare ovarian response to controlled ovarian hyperstimulation (COH) between normal ovaries and ovaries previously treated surgically for unilateral ovarian endometrioma. METHODS: From January 1996 to December 2001, 32 patients with unilateral ovarian endometrioma previously treated surgically underwent 38 cycles of COH. Their records were reviewed retrospectively. The number of dominant follicles observed on the day of hCG injection and the number of eggs retrieved from the diseased and the normal ovaries in each patient were compared. RESULTS: The numbers of dominant follicles from diseased and normal ovaries were 1.9 +/- 1.5 and 3.3 +/- 2.1, respectively (P < 0.001). During ovum pick up, the numbers of eggs retrieved from diseased and normal ovaries were 2.9 +/- 2.6 and 6.1 +/- 4.1, respectively (P < 0.0001). For diseased ovaries, 21.1% (8/38) had no dominant follicles, while only 7.9% (3/38) of normal ovaries lacked dominant follicles. The clinical pregnancy rate and the implantation rate per embryo transfer were 33.3 and 17.6%. CONCLUSIONS: Surgery for ovarian endometrioma may damage ovarian reserve. It potentially results in poor ovarian response to COH, compared to the response of the contralateral normal ovary in the same individual.
PMID: 12484492 [PubMed – indexed for MEDLINE]
331: Fertil Steril. 2002 Dec;78(6):1350-1; author reply 1351. Related Articles, Links
Comment in: · Fertil Steril. 2002 Dec;78(6):1352.
Comment on: · Fertil Steril. 2002 Jun;77(6):1148-55.
The use of "MOOSE".
Check JH.
Publication Types: · Comment · Letter
PMID: 12477548 [PubMed – indexed for MEDLINE]
332: Gynecol Oncol. 2002 Nov;87(2):231-4. Related Articles, Links
Ovarian endometrioid adenocarcinoma arising from an endometriotic cyst in a postmenopausal woman under tamoxifen therapy for breast cancer: a case report.
Okugawa K, Hirakawa T, Ogawa S, Kaku T, Nakano H.
Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. kokugawa@med.kyushu-u.ac.jp
BACKGROUND: Ovarian cancer arising from an endometriotic cyst in a postmenopausal woman under tamoxifen therapy is rare. CASE: We herein report the case of a 67-year-old woman with a history of breast cancer, taking tamoxifen citrate 20 mg/day for 4 years, who underwent an operation for left ovarian tumor. The postoperative histological diagnosis was endometrioid adenocarcinoma in an endometriotic cyst with a gradual transition of the degree of cellular atypia noted from typical endometriotic epithelium, to atypical endometriosis, and finally to adenocarcinoma. CONCLUSION: Tamoxifen may cause malignant transformation of endometriosis through atypical endometriosis even in the postmenopausal state. Atypical endometriosis may act as a precancerous lesion in the process of tamoxifen-induced malignant transformation of endometriosis.
Publication Types: · Review · Review of Reported Cases
PMID: 12477460 [PubMed – indexed for MEDLINE]
333: Urol Clin North Am. 2002 Aug;29(3):625-35. Related Articles, Links
Endometriosis of the urinary tract.
Comiter CV.
University of Arizona College of Medicine, P.O. Box 245077, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA. ccomiter@u.arizona.edu
Genitourinary endometriosis is a rare manifestation of a common disease. Ectopic endometrial tissue may extrinsically involve or intrinsically invade the bladder or ureter, and, less commonly, the urethra or kidney. Bladder involvement usually presents with irritative symptoms, whereas ureteral disease may present with asymptomatic renal failure. Therefore, a high index of suspicion is necessary, and genitourinary endometriosis should be considered in all symptomatic women with a history of cesarean delivery of other gynecologic surgery. In women beyond reproductive age, definitive surgical treatment is preferred, with removal of the ectopic tissue, relief of obstruction, and castration with or without hysterectomy. In those who desire future fertility, conservative surgery and/or hormonal therapy is often recommended.
Publication Types: · Review · Review, Academic
PMID: 12476526 [PubMed – indexed for MEDLINE]
334: Eur J Obstet Gynecol Reprod Biol. 2003 Jan 10;106(1):99-101. Related Articles, Links
What is the biblical attitude towards personal hygiene during vaginal bleeding?
Ben-Noun LL.
Department of Family Medicine, Faculty for Health Sciences, Ben-Gurion University of the Negev, Family Physician Specialist, P.O. Box 572, 82104, Kiryat-Gat, Israel. lbennun@zahav.net.il
OBJECTIVE: To analyze biblical passages associated with personal hygiene during vaginal bleeding. According to the Bible, a woman who is menstruating or who has pathological vaginal bleeding is unclean. Anybody who touches such a woman’s bed or her personal things is also regarded as unclean and should therefore, wash carefully. Sexual relations are forbidden within 7 days from the beginning of menstruation and during pathological vaginal bleeding. Seven days after the cessation of vaginal bleeding, a woman is considered as clean, and therefore, sexual contacts are permitted. From a modern perspective sexual contacts during menses are associated with the development of chlamydial and gonococcal diseases, the risk of transmission of the human immunodeficiency virus infection, endometriosis and subsequent infertility.This report indicates that the roots of contemporary obstetric preventive medicine can be traced to Biblical times.
PMID: 12475597 [PubMed – in process]
335: Best Pract Res Clin Obstet Gynaecol. 2002 Oct;16(5):685-702. Related Articles, Links
Molecular approach to common causes of female infertility.
Simpson JL.
Baylor College of Medicine, Houston, Texas, USA.
Pivotal genetic information has been derived for a host of rare genetic disorders, but progress has been much slower in relation to the common causes of female infertility. In this chapter, we shall illustrate the approaches being applied in elucidating conditions causing infertility that are inherited in a polygenic/multifactorial fashion. The task is to determine the number of genes responsible and their chromosomal location(s). The first approach is to use genome-wide quantitative linkage analysis, searching throughout the genome with no prior expectation that a given gene or chromosomal region is casually involved. A second approach is to search across the genome for altered gene expression, for example comparing endometriosis and normal (non-endometriosis)cells. The third approach is less indiscriminate and more focused, depending upon identifying specific candidate genes. Aromatase, calhedrin, oestrogen receptor, galactose-1-phosphate uridyl transferase (GALT) and tumour suppressor genes such as p53 are attractive candidate genes for endometriosis. Endometriosis, which has long been suspected to possess a familial tendency, has been subjected to genome-wide linkage analysis in Oxford, UK, where sib-pair analysis uses polymorphic DNA markers and fluorescence-based automated analysis. Several regions of exclusion have been found, but no linkages have so far been reported. A candidate gene approach focuses on the presence of chromosomal aberrations, the assumption being that endometriosis parallels neoplasia. At Baylor College of Medicine, we thus began by showing chromosome alterations involving trisomy 11, monosomy 16 and monosomy 17 in late-stage endometriosis. A loss of only the p53 tumour suppressor gene, rather than a loss (monosomy) of chromosome 17 per se, however, seems to be the pivotal event. A second representative polygenic/multifactorial disorder causing female infertility is polycystic ovarian syndrome. Both quantitative linkage analysis and candidate gene approaches are being pursued. In the far more commonly observed ‘idiopathic’ variety (non-adrenal polycystic ovarian syndrome and hirsutism), consensus has long existed that one or more dominant genes causes the condition. Although the mode of inheritance in ‘essential’ polycystic ovarian syndrome remains uncertain, dominant tendencies are clearly more pertinent than recessive ones. Genes for adrenal biosynthetic enzymes, insulin receptors, leptin and leptin receptors, follistatin, activin and inhibins are attractive candidates for polycystic ovarian disease. A linkage to 37 candidate genes was sought using affected sib-pair analysis and transmission/disequilibrium methods.
Publication Types: · Review · Review, Tutorial
PMID: 12475548 [PubMed – indexed for MEDLINE]
336: Magy Seb. 2002 Oct;55(5):307-12. Related Articles, Links
[Intestinal endometriosis causing subacute ileus. Experience in three cases] [Article in Hungarian] Szendei G, Mathe Z, Hernadi Z, Antal P, Devenyi N.
Semmelweis Egyetem I. sz. Szuleszeti es Nogyogyaszati Klinika, 1088 Budapest, Baross u. 27. szendei@noi1.sote.hu
We present three rare cases of intestinal endometriosis. The patients were treated at the Endometriosis Clinic of the 1st Dept. of Obstetrics and Gynecology of the Semmelweis University, Budapest. Their main symptom besides the classic symptoms of endometriosis (dysmenorrhea, dyspareunia, pelvic pain) was the catamenial haematochesia–a subacute obstruction which became more intensive in the perimenstrum and needed medical treatment but no surgical intervention. Because of the recurrent complaints, after detailed check-up and biopsy of the obstructing intestinal endometriosis, anterior resection of the rectum was performed with endocoagulation or extirpation of other endometriosis implants of the pelvis. Depending on the severity of pre or postoperative complaints patients underwent a GnRH-analogue therapy for six months. In one patient because of the patient’s age, and extensive retrocervical-deep endometriosis causing serious dyspareunia–the resection was performed with additional hysterectomy and adnexectomy (TAH). Recently the patient is on monophasic hormone replacement therapy. In the two other patients after a second-look laparoscopy with testing the lumen of the tubes treatment was started for the induction–because of infertility. We give an overview of the frequency, incidence and possible pathomechanism of pelvic endometriosis. We describe the modern diagnostic and therapeutic tools of pelvic endometriosis.
Publication Types: · Review · Review, Tutorial
PMID: 12474516 [PubMed – indexed for MEDLINE]
337: Reprod Biomed Online. 2002;4 Suppl 3:72-5. Related Articles, Links
Experience with transvaginal hydrolaparoscopy for reconstructive tubo-ovarian surgery.
Gordts S, Campo R, Brosens I.
Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000 Leuven, Belgium. life@lifeleuven.be
The transvaginal approach to tubo-ovarian surgery allows easy and direct access to the tubo-ovarian structures and the fossa ovarica without additional manipulation. In the absence of a panoramic view, the proximity of the tubo-ovarian structures allows operative procedures for treatment of superficial and cystic ovarian endometriosis, drilling of the ovarian capsule, adhesiolysis and salpingostomy. Operative procedures were performed in 78 patients. No conversion to standard laparoscopy was necessary, and no complications occurred. All procedures were carried out on an ambulatory basis with a very low morbidity.
Publication Types: · Review · Review, Tutorial
PMID: 12470570 [PubMed – indexed for MEDLINE]
338: Reprod Biomed Online. 2002;4 Suppl 3:59-63. Related Articles, Links
Reproductive disorders affecting fertility in endometriosis.
Brosens I, Campo R, Gordts S.
Leuven Institute for Fertility and Embryology, Tiensevest 168, B-3000 Leuven, Belgium. ivo.brosens@kuleuven.ac.be
The classical concept of endometriosis as a cause of infertility is challenged. Traditionally, both surgical and medical therapy of endometriosis-associated infertility has focused on eliminating or reducing the visible implants. The classic 6-month medical approach has been a failure, and surgery may moderately enhance fertility, but its benefit in the absence of adhesions is still doubtful. Recent studies have shown that endometriosis is characterized by an aberrant response to sex steroid hormones, resulting in pleiotropic dysfunctions of the reproductive system involving the uterine, peritoneal and ovarian micro-environment. Studies on endometriosis and IVF have been highly relevant in revealing the pleiotropic dysfunctions in patients with endometriosis, although the results should be interpreted with caution. The conclusion seems to support the view that infertility in patients with endometriosis is primarily dysfunctional, rather than lesional, in origin. It is concluded that the place of medical therapy in endometriosis should be reviewed and that the surgical approach needs to be complemented by appropriate medical therapy to restore fertility.
Publication Types: · Review · Review, Tutorial
PMID: 12470568 [PubMed – indexed for MEDLINE]
339: Reprod Biomed Online. 2002;4 Suppl 3:40-5. Related Articles, Links
Minimally invasive exploration of the female reproductive tract in infertility.
Campo R, Gordts S, Brosens I.
Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000 Leuven, Belgium. rd@pophost.eunet.be
Classically, invasive and non-invasive tests are performed to evaluate the causes of infertility. Transvaginal hydrolaparoscopy (THL) allows the exploration of the pelvic structures with a mini-endoscope, using a vaginal needle-guided trocar introduction technique and saline as a distension medium. A first study on 349 patients demonstrated the feasibility of the procedure and gave a high patient satisfaction. Access to the pouch of Douglas was achieved in 330 patients (94.5%) under local anaesthesia and in an ambulatory environment. The mean pain score measured on a visual analogue scale of 10 was 2.7, comparable to the score of mini-hysteroscopy only and significantly lower than the scores of hysterosalpingography with either metal cannula or balloon catheter. A total of 96% of the patients agreed to repeat the procedure under the same circumstances if required. The diagnostic accuracy of the technique was demonstrated in a prospective study, in which two independent endoscopists explored 10 patients with both THL and standard laparoscopy. The inter-observer agreement for ovarian adhesions was 75% for standard laparoscopy and 90% for THL. In addition, in patients with mild endometriosis, more peri-ovarian adhesions were detected with THL than with standard laparoscopy. A multinational survey to evaluate the risk and outcome of bowel injury during THL registered 24 (0.65%) cases in 3667 procedures. In all cases, the diagnosis was made immediately and the treatment was conservative without complications.
Publication Types: · Review · Review, Tutorial
PMID: 12470564 [PubMed – indexed for MEDLINE]
340: Reprod Biomed Online. 2002;4 Suppl 3:10-3. Related Articles, Links
Endoscopic visualization of oocyte release and oocyte retrieval in humans.
Gordts S, Campo R, Brosens I.
Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000 Leuven, Belgium. life@lifeleuven.be
Transvaginal hydrolaparoscopy (THL) allows the inspection of the tubo-ovarian structures in their natural position without supplementary manipulation. Saline is used at 37 degrees C as distension medium, which keeps the organs afloat. Using this technique it was possible to visualize and record for the first time the process of oocyte release and capture by the fimbriae in humans. THL was performed in the peri-ovulatory period, in order to collect data that would give a better insight into events at the moment of ovulation.
PMID: 12470558 [PubMed – indexed for MEDLINE]
341: Reprod Biomed Online. 2002;4 Suppl 3:5-9. Related Articles, Links
Uterine peristaltic activity during the menstrual cycle: characterization, regulation, function and dysfunction.
Kunz G, Leyendecker G.
Department of Obstetrics and Gynaecology and Reproductive Medicine, Klinikum Darmstadt, Academic Teaching Hospital to the Universities of Frankfurt and Heidelberg/Mannheim, Grafenstr. 9, 64283 Darmstadt, Germany. g_kunz@t.online.de
Unlike other smooth muscle organs, the uterine muscle was regarded to be normally functional for only a brief period, following a lengthy gestation. However, recently it has been shown that uterine peristalsis constitutes one of the fundamental functions of the non-pregnant uterus. Its morphological basis is the archimyometrium, which is the muscular component of the archimetra and which preserves a functional bipartition of the primarily unpaired uterus. Three types of uterine peristaltic contractions can be distinguished: cervico-fundal, fundo-cervical and isthmical peristaltic activity, which changes during the menstrual cycle and is controlled by the dominant ovarian structure via the secretion of sex steroids systemically and into the utero-ovarian vascular countercurrent system. Uterine peristalsis of the non-pregnant uterus is actively involved in very early reproductive processes, such as rapid and sustained directed sperm transport and high fundal implantation, as well as serving retrograde menstruation for the preservation of body iron content. Furthermore, it became apparent that hyper- and dysfunctions of this contractile activity, such as hyper- and dysperistalsis, might be causally involved in the development of pelvic endometriosis, uterine adenomyosis and infertility, as obtained from immunohistochemistry, vaginal sonography, hysterosalpingoscintigraphy and magnetic resonance imaging.
Publication Types: · Review · Review, Tutorial
PMID: 12470555 [PubMed – indexed for MEDLINE]
342: Reprod Biomed Online. 2002 Jul-Aug;5(1):12-6. Related Articles, Links
Use of GnRH antagonists in the treatment of endometriosis.
Kupker W, Felberbaum RE, Krapp M, Schill T, Malik E, Diedrich K.
Department of Obstetrics and Gynaecology, Medical University Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany. wkupker@hotmail.com
Endometriosis is an oestrogen-dependent disease that is treatable by oestrogen withdrawal, a therapy that has been effectively provided by the use of a gonadotrophin-releasing hormone (GnRH) agonist. Complete oestrogen withdrawal results in unacceptable side-effects, in particular in accelerated bone density loss. This problem has been effectively overcome with ‘add-back therapy’ using low-dose oestrogens and progestins in combination with a GnRH agonist to limit these side-effects, while still allowing regression of endometriotic lesions. The aim of this study was to determine the feasibility of using a subcutaneous injection of GnRH antagonist in the treatment of endometriosis. All patients (15/15; 100%) reported a symptom-free period during GnRH antagonist treatment, including mood changes, hot flushes, loss of libido, vaginal dryness and other symptoms. Serum oestradiol oscillated around a mean concentration of 50 pg/ml during therapy. Diagnostic laparoscopy before GnRH antagonist administration showed a mean stage III of disease. Regression occurred in 60% of cases (9/15) and the degree of endometriosis declined to stage II. Sequential administration of the GnRH antagonist cetrorelix (Cetrotide) in a 3 mg dosage once weekly over 8 weeks creates a new opportunity for medical treatment of symptomatic endometriosis. Preserving basic oestrogen production during the course of treatment apparently does not influence regression of disease, and has no major side-effects.
PMID: 12470539 [PubMed – indexed for MEDLINE]
343: Reprod Biomed Online. 2002 Jan-Feb;4(1):71-82. Related Articles, Links
Development of a miniature, low-dose, frameless intrauterine levonorgestrel-releasing system for contraception and treatment: a review of initial clinical experience.
Wildemeersch D, Schacht E, Wildemeersch P, Janssens D, Thiery M.
Contrel Research, Technology Park Zwijnaarde, Ghent, Belgium. dirk.wildemeersch@contrel.be
A low-dose levonorgestrel (LNG)-releasing intrauterine system (IUS) (FibroPlant) has been clinically developed since 1997 for endometrial suppression during hormone replacement therapy in peri- and postmenopausal women, for the treatment of menorrhagia in women with normal uteri or with uterine fibroids, for contraception, for the treatment of endometrial hyperplasia, and for alleviating primary and secondary dysmenorrhoea. Results of preliminary studies confirm the promising nature of this all-round drug delivery system. The low dose of LNG released accounts for the low hormonal side-effect rate and virtual absence of amenorrhoea in premenopausal women. The system has not yet been evaluated in tamoxifen users (to protect the endometrium), or in women with rectovaginal endometriosis. However, early indications suggest t

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