Angiogenesis. 2006;8(4):373-9. Epub 2006 Jan 7.
PPAR[Formula: see text] represses VEGF expression in human endometrial cells: Implications for uterine angiogenesis.
Peeters LL, Vigne JL, Tee MK, Zhao D, Waite LL, Taylor RN.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA, l.peeters@og.unimaas.nl.
Endometrial vasculature supports physiological uterine growth, embryonic implantation and endometrial pathology. Vascular endothelial growth factor (VEGF) is regulated by diverse developmental and hormonal signals, including eicosanoid ligands of PPAR[Formula: see text]. The action of natural and synthetic PPAR[Formula: see text] ligands on VEGF expression in primary and transformed human endometrial cell cultures was established by quantifying endogenous gene expression and transfected VEGF gene reporters. VEGF promoter-luciferase constructs were truncated and mutated to map functional sequences. Endometrial tissues and cells express PPAR[Formula: see text] protein. Treatment of transformed and primary endometrial cells with rosiglitazone, a synthetic PPAR[Formula: see text] agonist, or prostaglandin 15-deoxy-Delta12-14 J(2), a naturally occurring eicosanoid ligand, decreased VEGF protein secretion. In transiently transfected Ishikawa cells, rosiglitazone repressed VEGF gene promoter-luciferase activation with an IC(50) approximately approximately 50 nM. Truncated and mutated VEGF promoter constructs revealed that the PPAR[Formula: see text]-regulated domain is a direct repeat (DR)-1 motif -443 bp upstream of the transcriptional start site. Conclusions: PPAR[Formula: see text] ligands repress VEGF gene expression via a PPAR[Formula: see text]-responsive element (PPRE) in the VEGF gene promoter. Agonists of this nuclear receptor might be exploited pharmacologically to inhibit pathological vascularization in complications of pregnancy, endometriosis and endometrial adenocarcinoma.
PMID: 16400517 [PubMed – in process]
Kathmandu Univ Med J (KUMJ). 2003 Apr-Jun;1(2):124-7.
Hysterectomy: an analysis of perioperative and post operative complication.
Saha R, Sharma M, Padhye S, Karki U, Pandey S, Thapa J.
Department of Obstetrics and Gynaecology, KMCTH, Sinamangal.
OBJECTIVE: To document peri operative and post operative complication observed after hysterectomy, regardless of route on the operator. MATERIAL AND METHODS: A hospital based prospective study was carried out in department of obstetrics and gynaecology, KMCTH Sinamangal for six months. The study was carried out in patients undergoing hysterectomy who were followed from the time of admission to the time of discharge and two weeks thereafter. And followings were noted–Indication; route of hysterectomy, intraoperative and postoperative morbidities during hospital stay and after two weeks of discharge was noted. RESULT: Total number of hysterectomy carried out was 50. 31 (62%) were Total abdominal hysterectomy, and 19 (38%) were vaginal hysterectomy. Indication for total abdominal hysterectomy were fibroid uterus 12 (24%), DUB 8 (16%), CIN 4 (8%), chronic cervicitis 1 (2%). II U-V prolapse with previous LSCS 1 (2%), endometriosis 1 (2%). Prophylactic for Ca breast 1 (2%), Postmenopausal bleeding 1 (2%). All cases of vaginal hysterectomy were performed for 2nd degree U-V prolapse. Intra operative complication during surgery were two cases of haemorrhage (4%) each in both total abdominal hysterectomy and vaginal hysterectomy. There was one case of bladder injury during abdominal hysterectomy. Postoperative complication noted were febrile morbidity 1 (2%) in abdominal hysterectomy. Urinary tract infection remains the single most common febrile morbidity. There was one case of secondary haemorrhage in both type of hysterectomy. One was managed conservatively and other required laparotomy. There were three (6%) cases of wound infection in abdominal hysterectomy of two which were sanguineous discharge and one was frank pus which required secondary suture.
PMID: 16388212 [PubMed – indexed for MEDLINE]
Reproduction. 2006 Jan;131(1):153-61.
Evaluation of clinical parameters and estrogen receptor alpha gene polymorphisms for patients with endometriosis.
Renner SP, Strick R, Oppelt P, Fasching PA, Engel S, Baumann R, Beckmann MW, Strissel PL.
Department of Gynecology and Obstetrics, University-Clinics Erlangen, Laboratory for Molecular Medicine, Universitaetsstr. 21-23, D-91054 Erlangen, Germany.
Endometriosis is a chronic inflammatory disease, which is especially found in women with subfertility problems with an incidence of up to 30%. The disease is considered an estrogen-dependent disorder, where DNA polymorphisms of the estrogen receptor alpha (ERalpha) in connection with endometriosis are controversially discussed. From a German population of women, clinical data associated with the disease, including the American Fertility Society (AFS) I-IV classification, and non-clinical parameters were evaluated statistically in endometriosis patients (n = 98) and in control women (n = 98) without endometriosis. Using a multivariate statistical analysis, significant associations of endometriosis with dysmenorrhea (P < 0.001) and allergies against medicaments (P = 0.042) were found. A positive trend between first grade family history of endometriosis and allergies against medicaments was also observed, suggesting a genetic relationship. From both collectives, DNA from peripheral blood was analyzed for the frequency of the ERalpha DNA polymorphisms Xba1 (A/G) and PvuII (T/C) in intron 1 and the ERalpha exonic DNA polymorphism (G229A) with an amino acid exchange (Gly77Ser) in the transactivation domain. DNA samples from endometriosis lesions and control tissues from the same collectives were also analyzed for the exonic G229A polymorphism. Only homozygote wild-type alleles for the polymorphism G229A were found, making it a rare polymorphism in mid-European individuals. Allele types for the PvuII and Xba1 polymorphisms were analyzed with the observed statistically significant clinical parameters and showed no significant association with endometriosis; however a trend with AFS IV was noted, which could contribute to lesion severity. In conclusion, the analyzed polymorphisms in the ERalpha do not have a functional role concerning specific clinical parameters associated with endometriosis.
PMID: 16388018 [PubMed – in process]
Yonsei Med J. 2005 Dec 31;46(6):812-7.
The effect of preoperative ketorolac on WBC response and pain in laparoscopic surgery for endometriosis.
Hong JY.
Department of Anesthesiology, Samsung Cheil Hospital, Jung-gu, Mukjeong-dong 1-19, Seoul 100-380, Korea. jenyhongg@hanmail.net
Surgical stress causes changes in the composition of white blood cells (WBCs). Ketorolac is believed to have analgesic effects and to reduce the stress response and may therefore improve postoperative outcomes. The aim of this study was to assess the effect of preoperative ketorolac on the WBC subsets in patients who had laparoscopic surgery for endometriosis. Fifty patients who had laparoscopic surgery for endometriosis were randomly assigned to one of two groups: the ketorolac group (n = 25) received ketorolac 0.5 mg/kg before the induction of anesthesia, and the control group (n = 25) received saline. White cell count, differential, and pathology studies were done immediately after surgery, on postoperative day 1, and on postoperative day 3. We compared the baseline values within and between the two groups. We also assessed postoperative pain and side effects. The time that elapsed before the first patient request for analgesia, total meperidine dose and VAS (Visual Analog Scale) for postoperative pain were significantly lower in the ketorolac group than in the control group. Compared to the pre- surgical values, there was an increase in total WBC count and percentage of neutrophils, but a decrease in percentages of lymphocytes, monocytes, eosinophils, basophils, and leucocytes. Total WBC count, neutrophils, monocytes, eosinophils and leucocytes showed significant differences between the two groups. The incidences of postoperative side effects, such as nausea, dizziness, headache, and shoulder pain were not different between the groups. Preoperative ketorolac reduced postoperative pain and influenced the WBC response in laparoscopic surgery for endometriosis.
Publication Types: ? Randomized Controlled Trial
PMID: 16385658 [PubMed – indexed for MEDLINE]
JSLS. 2005 Oct-Dec;9(4):488-90.
Colonoscopic diagnosis of appendiceal intussusception: case report and review of the literature.
Duncan JE, DeNobile JW, Sweeney WB.
Department of Surgery, National Naval Medical Center, Bethesda, Maryland, USA.
Intussusception of the appendix is an extremely rare condition. Although approximately 200 cases of appendiceal intussusception have been reported in the literature, very few have ever been diagnosed preoperatively. We report a case of appendiceal intussusception secondary to endometriosis in an otherwise healthy female. The case was diagnosed preoperatively by colonoscopy and treated surgically at laparoscopy. We review the literature of appendiceal intussusception and discuss the associated conditions, diagnosis, and a classification scheme for this unusual finding.
Publication Types: ? Case Reports
PMID: 16381375 [PubMed – indexed for MEDLINE]
JSLS. 2005 Oct-Dec;9(4):431-3.
Microlaparoscopy and a GnRH agonist: a combined minimally invasive approach for the diagnosis and treatment of occlusive salpingitis isthmica nodosa associated with endometriosis.
Almeida OD Jr.
Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, Mobile, USA. odalmeida@aol.com
OBJECTIVE: To evaluate whether occlusive salpingitis isthmica nodosa associated with endometriosis can be diagnosed by microlaparoscopy and managed with medical therapy using leuprolide acetate. METHODS: This was a prospective, nonrandomized study conducted at a university hospital and a private community hospital. It included women with occlusive salpingitis isthmica nodosa associated with endometriosis. Diagnosis of salpingitis isthmica nodosa was made via microlaparoscopy with chromotubation. Patients with occlusive salpingitis isthmica nodosa were treated with leuprolide acetate 3.75 mg administered monthly for 6 months. RESULTS: Tubal patency in occlusive salpingitis isthmica nodosa following medical therapy with leuprolide acetate was evaluated. Thirteen of 16 (81.3%) women with bilateral salpingitis isthmica nodosa achieved patency of both fallopian tubes following treatment with leuprolide acetate; 3 of 16 (18.8%) developed patency in one of the fallopian tubes. All 5 women with unilateral SIN demonstrated bilateral patency following medical therapy. CONCLUSION: Diagnosis of occlusive salpingitis isthmica nodosa can be made by microlaparoscopy. These preliminary results suggest that medical therapy with leuprolide acetate may be the first-line treatment modality for women with occlusive salpingitis isthmica nodosa associated with endometriosis, possibly avoiding a more invasive surgical procedure.
PMID: 16381361 [PubMed – indexed for MEDLINE]

JSLS. 2005 Oct-Dec;9(4):426-30.
Chronic pelvic pain: the occurrence of interstitial cystitis in a gynecological population.
Paulson JD, Delgado M.
Institute for Advanced Endoscopic Training, Norfolk, Virginia, USA. endodoc11@aol.com
OBJECTIVE: The objective of this study was to determine what relationship exists between interstitial cystitis and chronic pelvic pain in patients. METHODS: A prospective study of 35 women with a complaint of chronic pelvic pain was performed between August 2002 and September 2003. These patients underwent a workup to exclude other causes of pelvic pain and underwent a laparoscopy and a cystoscopy with hydrodistention at 80 cm of hydrostatic water pressure. Results were obtained and quantified. RESULTS: Twenty-eight patients (80%) were diagnosed with interstitial cystitis, 28 were diagnosed with endometriosis (80%), 24 had both disease entities simultaneously (69%), and 32 (91%) had endometriosis, interstitial cystitis, or both. Three patients (9%) had neither and were diagnosed with other pathologies. CONCLUSIONS: Chronic pelvic pain is a major concern for many women in the United States. Patients with chronic pelvic pain have traditionally been difficult to manage. A large percentage of women presenting with chronic pelvic pain have been shown to have endometriosis, interstitial cystitis, or both. Therefore, an appropriate workup for those individuals with chronic pelvic pain involves not only obtaining a good history and performing a good physical examination, but the possibility of a cystoscopy being performed when a laparoscopy has been deemed necessary for diagnosis of the pain. These procedures can serve as both a means for diagnosis and short-term treatment of these problems when encountered.
PMID: 16381360 [PubMed – indexed for MEDLINE]
J Psychosom Res. 2006 Jan;60(1):109-12.
Coping with emotions and abuse history in women with chronic pelvic pain.
Thomas E, Moss-Morris R, Faquhar C.
Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
OBJECTIVE: The purpose of this study was to investigate whether past abuse and the tendency to repress or suppress unwanted thoughts and emotions contribute to the experience of pain in patients with chronic pelvic pain (CPP). METHODS: A group of CPP patients without endometriosis and a group with endometriosis were compared with a pain-free control group. Participants completed measures of pain, emotional repression, suppression of unwanted thoughts and emotions, and past abuse history. RESULTS: Both CPP groups were more likely to be emotional suppressors when compared with the control group and reported significantly higher levels of thought suppression and abuse. Endometriosis patients were also more likely to be repressors of emotions when compared with controls. Suppression but not repression was related to higher levels of abuse and pain. CONCLUSION: Suppression of unwanted thoughts and emotions and past abuse distinguishes CPP patients from healthy controls. Assisting patients to express distressing emotions may impact on pain levels.
PMID: 16380318 [PubMed – in process]
Clin Radiol. 2006 Feb;61(2):198-201.
Polypoid endometriosis and other benign gynaecological complications associated with Tamoxifen therapy-a case to illustrate features on magnetic resonance imaging.
Kraft JK, Hughes T.
Division of Radiology, The James Cook University Hospital, Middlesbrough, UK. jeannettekraft@aol.com
PMID: 16439226 [PubMed – in process]
Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004635.
Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis.
Sallam HN, Garcia-Velasco JA, Dias S, Arici A.
Alexandria University, Egypt, Obstetrics and Gynaecology, 22 Victor Emanuel Square, Smouha, Alexandria, Egypt, 21615. hnsallam@link.net
BACKGROUND: Women with endometriosis who are treated with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) have a lower pregnancy rate compared to women with tubal factor infertility. It has been suggested that the administration of gonadotrophin releasing hormone (GnRH) agonists for a few months prior to IVF or ICSI increases the pregnancy rate. OBJECTIVES: To determine the effectiveness of administering GnRH agonists for three to six months prior to IVF or ICSI in women with endometriosis. SEARCH STRATEGY: We used computer searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the National Research Register (NRR) and the MDSG Specialised Register of controlled trials. We handsearched proceedings of annual meetings of the American Society for Reproductive Medicine (ASRM) and the European Society for Human Reproduction and Embryology (ESHRE). We reviewed lists of references in original research and review articles. We contacted experts in various countries to identify unpublished trials. SELECTION CRITERIA: We included randomised controlled trials using any GnRH agonist prior to IVF or ICSI to treat women with any degree of endometriosis diagnosed by laparoscopy or laparotomy DATA COLLECTION AND ANALYSIS: Two independent review authors abstracted data (HNS and JGV). We sent e-mails to investigators to seek additional information. We assessed the validity of each study using the methods suggested in the Cochrane Handbook. The data were checked by the third review author (SD) and any disagreement was resolved by arbitration with the fourth review author (AA). We generated 2 x 2 tables for principal outcome measures. The Peto-modified Mantel-Haenszel technique was used to calculate odds ratios (OR) and assess statistical heterogeneity between studies. MAIN RESULTS: Three randomised controlled trials (with 165 women) were included. The live birth rate per woman was significantly higher in women receiving the GnRH agonist compared to the control group (OR 9.19, 95% CI 1.08 to 78.22). However, this was based on one trial reporting "viable pregnancy" only. The clinical pregnancy rate per woman was also significantly higher (three studies: OR 4.28, 95% CI 2.00 to 9.15). The information on miscarriage rates came from two trials with high heterogeneity and, therefore, results of the meta-analysis were doubtful. The included studies provided insufficient data to investigate the effects of administration of GnRH agonists on multiple or ectopic pregnancies, fetal abnormalities or other complications. AUTHORS’ CONCLUSIONS: The administration of GnRH agonists for a period of three to six months prior to IVF or ICSI in women with endometriosis increases the odds of clinical pregnancy by fourfold. Data regarding adverse effects of this therapy on the mother or fetus are not available at present.
Publication Types: ? Review
PMID: 16437491 [PubMed – in process]
Obstet Gynecol Surv. 2006 Feb;61(2):136-45.
Von Willebrand disease.
James AH.
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA. andra.james@duke.edu
Von Willebrand disease (VWD), the most common inherited bleeding disorder, results from a deficiency of von Willebrand factor (VWF), a protein required for the normal adhesion of platelets to the site of injured endothelium and for preservation of factor VIII in the circulation. The prevalence of VWD has been reported to be as high as 1.3%. Among women with VWD, menorrhagia is the most common symptom, affecting 32% to 100%. Treatments that have been reported to control menorrhagia in these women include combined oral contraceptives, 1-deamino-8-D-arginine vasopressin (DDAVP), tranexamic acid, and the levonorgestrel-releasing intrauterine system. With the exception of nonsteroidal antiinflammatory drugs, any treatments effective in the treatment of menorrhagia, including hysterectomy, may be suitable. Besides menorrhagia, women with VWD appear to be at an increased risk of developing hemorrhagic ovarian cysts and possibly endometriosis. As they grow older, they may be more likely to manifest conditions that present with bleeding such as fibroids, endometrial hyperplasia, and polyps. During pregnancy, they may be at greater risk of miscarriage and bleeding complications, particularly delayed or secondary postpartum hemorrhage. Vaginal or vulvar hematomas, extremely rare in women without bleeding disorders, are not uncommon. Although women with VWD are at risk for the same obstetric and gynecologic problems that affect all women, they appear to be disproportionately affected by conditions that manifest with bleeding. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall that Von Willebrand Disease (VWD) is a common inherited disease, especially in women with menorrhagia; state that prophylaxis therapies against bleeding in pregnant and nonpregnant women are available; and explain that, despite prophylaxis, miscarriage and bleeding complications can still occur.
PMID: 16433937 [PubMed – in process]
Am J Reprod Immunol. 2006 Feb;55(2):106-14.
Killer immunoglobulin-like receptor and human leukocyte antigen expression as immunodiagnostic parameters for pelvic endometriosis.
Zhang C, Maeda N, Izumiya C, Yamamoto Y, Kusume T, Oguri H, Yamashita C, Nishimori Y, Hayashi K, Luo J, Fukaya T.
Department of Biology, Jiamusi University, HeiLong Jiang, China.
PROBLEM: We investigated host immunologic responses to endometriosis by comparing immune cell surface antigens in peripheral blood (PB) and peritoneal fluid (PF) from women with endometriosis with those in PB and PF from other patients. METHOD OF STUDY: Japanese women with endometriosis (n = 56) were compared with controls with other laparoscopic diagnoses (n = 68). PB and PF were collected at the time of laparoscopy for flow cytometry. RESULTS: No significant difference in phenotypic parameters of T cells (CD3, CD4, and CD8), B cells (CD19), natural killer (NK) cells (CD56), or monocytes/macrophages (CD14) was seen between women with and without endometriosis. However, increased killer immunoglobulin-like receptor (CD158a) expression by NK cells and decreased human leukocyte antigen (HLA)-ABC and -DR expression by macrophages, all suggesting decreased functional activation were found in endometriosis. These markers showed significant association with endometriosis by odds ratio, logistic regression, and decision tree analyses. CONCLUSIONS: Increased CD158a(+) NK cells in PB and PF indicated decreased NK cell cytotoxicity in endometriosis, while decreased HLA expression on PF macrophages suggested impaired antigen presentation. Thus, aberrant immune responses by NK cells and macrophages may represent risk factors for endometriosis.
PMID: 16433829 [PubMed – in process]
Hum Reprod. 2006 Jan 23; [Epub ahead of print] Endometriosis and the risk of cancer with special emphasis on ovarian cancer.
Melin A, Sparen P, Persson I, Bergqvist A.
Department of Obstetrics & Gynaecology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
BACKGROUND: Several observations of the coexistence of endometriosis and cancer have been published. One study concerning endometriosis patients from 1969 to 1986 showed an overall relative cancer risk of 1.2 and relative risks for breast cancer, ovarian cancer and non-Hodgkin’s lymphoma to be 1.3, 1.9 and 1.8, respectively. The aim of this study was to see whether these risk ratios stand in an extended study with longer follow-up. METHODS: Women discharged from a hospital, with a diagnosis of endome-triosis from 1969 to 2000, were identified using the National Swedish Inpatient Register. Data were linked to the National Swedish Cancer Register to identify cases of cancer. Data on hysterectomies and oophorectomies were available. Standardized incidence ratios (SIR) were calculated. RESULTS: 64 492 women entered the study. First year of follow-up was excluded, leaving 3349 cases of cancer. There was no increased overall risk of cancer [SIR 1.04, 95% CI 1.00-1.07]. Elevated risks were found for ovarian cancer (SIR 1.43, 95% CI 1.19-1.71), endocrine tumours (SIR 1.36, 95% CI 1.15-1.61), non-Hodgkin’s lymphoma (SIR 1.24, 95% CI 1.02-1.49) and brain tumours (SIR 1.22, 95% CI 1.04-1.41). Women with early diagnosed and long-standing endometriosis had a higher risk of ovarian cancer, with SIR of 2.01 and 2.23, respectively. The average age at endometriosis diagnosis was 39.4, indicating that there are the moderate/severe cases that are included in this study. Women who had a hysterectomy before or at the time of the endometriosis diagnosis did not show an increased risk of ovarian cancer. CONCLUSION: Women with endometrio-sis have an increased risk of some malignancies, particularly ovarian cancer, and the risk increases with early diagnosed or long-standing disease. Hysterectomy may have a preventive effect against ovarian cancer.
PMID: 16431901 [PubMed – as supplied by publisher]
J Minim Invasive Gynecol. 2006 Jan-Feb;13(1):80; author reply 80-1.
Nezhat et al. laparoscopic management of hepatic endometriosis: report of two cases and review of the literature.
Batt RE, Lele SB, Mitwally MF, Yeh J.
Publication Types: ? Comment ? Letter
PMID: 16431330 [PubMed – in process]
J Minim Invasive Gynecol. 2006 Jan-Feb;13(1):49-54.
Adhesions and pain in women with first diagnosis of endometriosis: results from a cross-sectional study.
Parazzini F, Mais V, Cipriani S; Gruppo Italiano per lo Studio dell’Endometriosi.
garimoldi@marionegri.it
OBJECTIVE: To analyze the relationship between pain and presence, site, and type of adhesions in women with endometriosis. METHODS: This was a multicenter, observational cross-sectional study. Eligible for the study were women with endometriosis and pelvic pain, consecutively observed during the study period at the collaborating centers. A total of 574 women entered the study. RESULTS: Adhesions were observed in 81.9% of cases (470 women). The frequency was lower in women with endometriosis at stage I-II (65%) and higher in women with stage III-IV (88%); this difference was statistically significant (p < .01). The frequency of adhesions was lower in women with ovarian endometriosis (74%) and higher in those with ovarian and peritoneal endometriosis (87%) or other sites (96%) (p < .01). The presence of adhesions was associated with higher mean visual analog scale (VAS) scores and median multidimensional scale ratings in women with ovarian disease and with stage I-II disease. Women with ovarian adhesions reported higher VAS and multidimensional scale scores (p < .05) than women with peritoneal adhesions or adhesions in other sites. CONCLUSIONS: The results of this study suggest that there is no overall association between the presence of adhesions and the degree of pain in women with endometriosis. The data suggests that there may be an association between adhesions and pain in women with ovarian and Type I-II endometriosis. However, these associations were no longer significant after correction for multiple comparisons. Further research is indicated to test these associations.
PMID: 16431323 [PubMed – in process]
J Minim Invasive Gynecol. 2006 Jan-Feb;13(1):20-5.
Total laparoscopic radical hysterectomy and pelvic lymphadenectomy using harmonic shears.
Nezhat F, Mahdavi A, Nagarsheth NP.
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Medical Center, New York, New York 10029-6574, USA. farr.nezhat@mssm.edu
STUDY OBJECTIVE: To describe the feasibility and outcome of total laparoscopic radical hysterectomy with or without pelvic lymphadenectomy for patients with stage I cervical cancer or severe pelvic endometriosis using harmonic shears as the sole instrument for dissection, division, and maintenance of hemostasis of all major surgical pedicles. DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University hospital and affiliate institutions. PATIENTS: Seven patients who underwent total laparoscopic radical hysterectomy using harmonic shears for International Federation of Gynecology and Obstetrics stage IA2 to IB1 cervical cancer and pelvic endometriosis at our institution or affiliate hospital from January 2004 through February 2005. INTERVENTION: A retrospective review of patients that underwent total laparoscopic radical hysterectomy with or without pelvic lymphadenectomy at our institution using harmonic shears was performed. Information regarding preoperative, intraoperative, and postoperative events was recorded and analyzed. MEASUREMENTS AND MAIN RESULTS: Pelvic lymphadenectomy was performed in all cancer cases. Mean patient age was 40 years (range 30-53 years). Mean estimated blood loss was 143 mL (range 100-200 mL). Mean operating time was 293 minutes (range 255-385 minutes). Mean pelvic node count was 27.8 (range 24-34) for cancer cases. Mean hospital stay was 3.2 days (range 2-7 days). One patient developed a vaginal cuff abscess postoperatively that was managed conservatively with drainage in the office setting followed by intravenous antibiotics. Another patient developed urinary retention for 2 weeks after surgery. There were no other intraoperative or postoperative complications. CONCLUSION: Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using harmonic shears is a technically feasible and safe procedure. Larger studies and long-term follow-up are required to determine the oncologic outcomes of these patients.
PMID: 16431319 [PubMed – in process]

Arch Gynecol Obstet. 2006 Mar;273(6):370-373. Epub 2006 Jan 22.
Post-coital bleeding: a rare and unusual presentation of cervical endometriosis.
Selo-Ojeme D, Freeman-Wang T, Khan NH.
Women’s Health Department, Whittington Hospital NHS Trust, Highgate Hill, London, UK.
Introduction: Often due to benign conditions such as cervical ectopy, post-coital bleeding is a distressing symptom for the patient. However, for the clinician, the identification of the etiology is important in order to effect proper treatment. Case report: We present a case referred to the colposcopy clinic because of post-coital bleeding and a smear report of ‘groups of benign glandular cells of endometrial origin’. Colposcopy was normal but histology of an excised haemorrhagic nodule revealed endometriosis with resolution of symptoms. Conclusion: Cervical endometriosis should be considered in the differential diagnosis of post-coital bleeding with no obvious ectopy or malignancy.
PMID: 16429321 [PubMed – as supplied by publisher]
Gastrointest Endosc. 2006 Feb;63(2):331-5.
Role of EUS and EUS-guided FNA in the diagnosis of symptomatic rectosigmoid endometriosis.
Pishvaian AC, Ahlawat SK, Garvin D, Haddad NG.
Division of Gastroenterology and Department of Pathology, Georgetown University Hospital, Washington DC, USA.
BACKGROUND: Rectosigmoid endometriosis is an underrecognized cause of GI symptoms in women. Pelvic magnetic resonance imaging and CT have a low sensitivity in making this diagnosis. The role of EUS and EUS-guided FNA (EUS-FNA) in the diagnosis of rectosigmoid endometriosis in symptomatic patients is not well studied. METHODS: A review of medical records identified 5 women who were diagnosed with rectosigmoid endometriosis by EUS and EUS-FNA over a period of 1 year. OBSERVATIONS: Five women with nonspecific GI complaints underwent EUS examination of a rectosigmoid subepithelial mass found on colonoscopy. EUS revealed a hypoechoic lesion infiltrating the muscularis propria and the serosa of the rectal wall, and extending outside the rectal wall, findings consistent with rectosigmoid endometriosis. This diagnosis was confirmed by EUS-FNA, surgical exploration, and/or the patient’s clinical course. CONCLUSIONS: EUS and EUS-FNA are noninvasive, sensitive techniques for the diagnosis of rectosigmoid endometriosis in symptomatic patients.
PMID: 16427951 [PubMed – in process]
Ann Thorac Surg. 2006 Feb;81(2):761-9.
Thoracic endometriosis: current knowledge.
Alifano M, Trisolini R, Cancellieri A, Regnard JF.
Department of Thoracic Surgery, Hotel-Dieu, AP-HP, Paris, France. marcoalifano@yahoo.com
Thoracic endometriosis syndrome includes four well-recognized clinical entities, namely catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis and lung nodules, as well as some exceptional presentations. The etiological mechanisms of this syndrome are not well understood, and different theories have been proposed. Controversies exist about optimal management, as experience has been drawn from case reports and small clinical series. Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome.
PMID: 16427904 [PubMed – in process]
Cir Esp. 2006 Jan;79(1):64-6.
[Primary endometriosis of the abdominal wall: an entity to be included in the differential diagnosis of abdominal wall masses] [Article in Spanish] Parra PA, Caro J, Torres G, Malagon FJ, Tomas F.
Servicio de Cirugia General y Aparato Digestivo, Fundacion Hospital de Cieza, Cieza, Murcia, Spain. pedroapb@yahoo.es
Endometriosis consists of the presence of extrauterine endometrial tissue. It is usually localized in the pelvis, although it can also be found in other sites. Cutaneous localization is unusual and the most frequent form appears on scars from obstetric or gynecological interventions. It can, however, develop spontaneously, especially in umbilical or inguinal areas and can be confused with irreducible hernias or granulomas. We present the cases of three patients with spontaneous endometriotic nodules of the abdominal wall. The lesions were located in the umbilical region in two patients and in the suprapubic area in one. In two patients clinical suspicion led to preoperative diagnosis, although diagnosis is usually established after histopathological analysis of the surgical specimen.
PMID: 16426536 [PubMed – in process]
Adv Nurse Pract. 2006 Jan;14(1):43-5.
Endometriosis: clinical assessment and medical management.
Stockwell J.
Gabert Clinic Urgent Care in Glendive, Mont., USA.
PMID: 16425515 [PubMed – indexed for MEDLINE]

Nervenarzt. 2006 Apr;77(4):474-7.
[Extragenital endometriosis leading to piriformis syndrome.] [Article in German] Hettler A, Bohm J, Pretzsch M, von Salis-Soglio G.
Neurologische Abteilung, Kreiskrankenhaus Freiberg gGmbH, .
We report on a 44-year-old woman with a history of sciatica fluctuating with her menstrual cycle and going back over 10 years; ultimately it was present continuously and became disabling. Over the years the patient developed ipsilateral foot-drop, a sensory disorder in the lateral aspect of the lower limb and back of the foot, and atrophy of the gluteus muscle. MRI confirmed the suspicion of extragenital endometriosis, which had caused piriformis syndrome by compression with consequent damage to the sciatic and inferior gluteal nerves. After hormonal therapy had been tried without success, the endometrioma was excised to relieve the pressure on the nerves, and the diagnosis was confirmed histopathologically. The motor deficit remained up to the 15 months since surgery, but the patient is now free of pain.
PMID: 16425055 [PubMed – in process]
J Clin Endocrinol Metab. 2006 Jan 17; [Epub ahead of print] Down-regulation of Endometrial MMP-3 and MMP-7 Expression in vitro and Therapeutic Regression of Experimental Endometriosis in vivo by a Novel Nonsteroidal Progesterone Receptor Agonist, Tanaproget.
Bruner-Tran KL, Zhang Z, Eisenberg E, Winneker RC, Osteen KG.
Women’s Reproductive Health Research Center (KB-T, EE, KO), Department of Obstetrics and Gynecology,Vanderbilt University School of Medicine, Nashville, Tennessee 37232; and Division of Endocrinology and Reproductive Disorders (ZZ, RCW), Women’s Health Research Institute, Wyeth Research, Collegeville, Pennsylvania 19426.
Context: Endometriosis, the growth of endometrial tissue outside the uterus, is principally an estrogen-dependent disease. In contrast, exposure to progesterone during pregnancy or therapeutically has been shown to provide benefit to some women with this disease. However, recent research suggests that the presence of endometriosis impairs the capacity of the eutopic endometrium to respond to endogenous progesterone. Objective: Reduced progesterone responsiveness results in an elevated endometrial expression of matrix metalloproteinases (MMPs) during the secretory phase of the menstrual cycle in women with endometriosis. Although cyclic MMP expression is critical for endometrial growth and remodeling, the failure of progesterone to down-regulate MMPs may impair nidation and promote the invasive establishment of endometriosis. In the current study, we examined the ability of a newly developed progesterone receptor (PR) agonist, tanaproget (TNPR), to down-regulate endometrial MMP expression in vitro and regress experimental endometriosis in vivo. Setting: University-based Medical Center Participants: Asymptomatic volunteers and patients with endometriosis. Intervention: None Main Outcome Measures: We examined the ability of TNPR to down-regulate endometrial MMP expression in vitro compared with natural progesterone and two currently marketed synthetic steroidal progestins. Using a human/mouse model of endometriosis, we also tested the in vivo ability of TNPR to regress ectopic lesions established by tissues with reduced progesterone sensitivity. Results: TNPR effectively down-regulates MMP expression in vitro and induced significant reduction of lesions in mice with disease established by tissues from endometriosis patients. Conclusion: Given the positive preclinical pharmacological profile of TNPR which has recently been reported, further development of this compound for the treatment of endometriosis is warranted.
PMID: 16418212 [PubMed – as supplied by publisher]
Ginekol Pol. 2005 Oct;76(10):770-81.
[Is glycodelin an important marker of endometrial receptivity?] [Article in Polish] Skrzypczak J, Wirstlein P, Mikolajczyk M.
Klinika Rorodczosci Katedry Ginekologii i Poloznictwa Akademii Medycznej im Karola Marcinkowskiego Poznaniu.
OBJECTIVE: Glycodelin A (GdA) is viewed as a uterine endometrium receptivity marker. The expression of GdA in the endometrium is mirrored in uterine fluid and in the serum. Thanks to its immunosuppressive properties GdA might regulate mechanisms of fertilization, implantation and further development of the embryo. DESIGN: The authors assessed the GdA concentration during implantation window of nonconceptional cycles in women with impaired reproduction. MATERIAL AND METHODS: Fluid from uterine cavity, serum and endometrial samples were obtained from 116 women, among them 43 have had 2 or more miscarriages, while 52 were infertile. Control constituted 21 fertile women. In uterine fluid and serum the GdA concentration was assessed with ELISA Bioserv Diagnostic kits, and progesterone with electrochemiluminescence. Endometria obtained during hysteroscopy were evaluated in terms of conformity with the cycle dating. RESULTS: Statistically lower (p < 0,0001) compared to control GdA concentration in uterine fluid was found in infertile women. The lowest GdA values were obtained in women with idiopathic infertility and infertile women with endometriosis. GdA level of women with 2 or more miscarriages was no statistically significant different compared to control. The lowest concentration of GdA in this group of patients was found in women with luteal phase deficiency. The GdA concentration in the serum was three times lower compared to values noted in uterine fluid, and there was no difference between studied groups. CONCLUSION: Based on our research we might conclude that GdA has a more important role during implantation than in further development of the embryo.
PMID: 16417092 [PubMed – indexed for MEDLINE]
Environ Mol Mutagen. 2006 Jan 13; [Epub ahead of print] No association of endometriosis with galactose-1-phosphate uridyl transferase mutations in a Chinese population.
He C, Song Y, He X, Zhang W, Liao L.
Department of Obstetrics and Gynecology, Fuzhou General Hospital, Fuzhou, People’s Republic of China.
The linkage between endometriosis and galactose-1-phosphate uridyl transferase gene (GALT) mutations is controversial. In this study, the prevalence of the most common GALT mutations, Q188R and N314D, was assessed in women with endometriosis in a Chinese population. Three hundred twenty five unrelated women with endometriosis were enrolled. Samples of umbilical cord blood obtained from 310 female newborn infants were used as population controls. Genomic DNA isolated from endometriosis patients and controls were subjected to multiple polymerase chain reactions to determine the Q188R and N314D mutations. There was no significant difference in the frequencies of the Q188R and N314D mutations between endometriosis patients and controls. The endometriosis patients were further divided into subgroups of stage III and IV disease, but still no statistically significant differences were observed in the frequency of the Q188R and N314D mutations between any of these groups and the controls. These findings suggest that Q188R and N314D mutations are not likely to be associated with an increased risk of endometriosis among Chinese Women. Environ. Mol. Mutagen., 2006 (c) 2006 Wiley-Liss, Inc.
PMID: 16416427 [PubMed – as supplied by publisher]
: Mol Cell Endocrinol. 2006 Mar 27;248(1-2):192-8. Epub 2006 Jan 18.
New inhibitors of 17beta-hydroxysteroid dehydrogenase type 1.
Messinger J, Hirvela L, Husen B, Kangas L, Koskimies P, Pentikainen O, Saarenketo P, Thole H.
Solvay Pharmaceuticals Research Laboratories, Hannover, Germany.
The estradiol-synthesizing enzyme 17beta-hydroxysteroid dehydrogenase type 1 (17betaHSD1) is mainly responsible for the conversion of estrone (E1) to the potent estrogen estradiol (E2). It is a key player to control tissue levels of E2 and is therefore an attractive target in estradiol-dependent diseases like breast cancer or endometriosis. We selected a unique non-steroidal pyrimidinone core to start a lead optimization program. We optimized this core by modulation of R1-R6. Its binding mode at the substrate-binding site of 17betaHSD1 is complex and difficult to predict. Nevertheless, some basic structure-activity relationships could be identified. In vitro, the most active pyrimidinone derivative showed effective inhibition of recombinant human 17betaHSD1 at nanomolar concentrations. In intact cells overexpressing the human enzyme, IC50 values in the lower micromolar range were determined. Furthermore, the pyrimidinone proved its use in vivo by significantly reducing 17betaHSD1-dependent tumor growth in a new nude mouse model.
PMID: 16413669 [PubMed – in process]

Fertil Steril. 2006 Jan;85(1):267; author reply 267.
Comment on: ? Fertil Steril. 2005 Jul;84(1):60-6.
Variations in tubal configuration in endometriosis?
Redwine DB.
Publication Types: ? Comment ? Letter
PMID: 16412773 [PubMed – indexed for MEDLINE]
Fertil Steril. 2006 Jan;85(1):225-6.
Uterine adenomyoma presenting as a vesico-uterine endometrioma.
Xiromeritis P, Papanicolaou A, Traianos V, Makedos G.
Department of Gynecology, Catholic University of Louvain, Brussels, Belgium. panos.xiromeritis@tiscali.be
This is an image case report of a 5-cm uterine adenomyoma in a 38-year-old asymptomatic woman, presenting as a vesico-uterine endometrioma in both ultrasound scan and magnetic resonance imaging.
Publication Types: ? Case Reports
PMID: 16412758 [PubMed – indexed for MEDLINE]
Surgeon. 2006 Feb;4(1):55-6.
Post-caesarean incisional hernia or scar endometrioma?
Rao R, Devalia H, Zaidi A.
Department of Surgery, St Heliers Hospital NHS Trust, Carshalton, London, UK. rrao67@yahoo.co.uk
Scar endometrioma is an uncommon condition following caesarean section. It presents as a lump on the caesarean scar and can often be painful. Endometrioma is referred to the general surgeon as an incisional hernia. We present six such patients referred to the general surgical department by either the general practitioner or the gynaecologist. Scar endometrioma is believed to arise due to implantation of endometrial tissue during caesarean section. Cyclical pain, as in endometriosis, is characteristic but uncommon. Local wide excision remains the treatment of choice.
PMID: 16459501 [PubMed – indexed for MEDLINE]
Am J Obstet Gynecol. 2006 Feb;194(2):351-4.
Value of laparoscopic assistance for vaginal hysterectomy with prophylactic bilateral oophorectomy.
Agostini A, Vejux N, Bretelle F, Collette E, De Lapparent T, Cravello L, Blanc B.
Department of Obstetrics and Gynecology, La Conception University Hospital, Marseille, France.
OBJECTIVE: This study was undertaken to compare morbidity for women undergoing laparoscopy-assisted vaginal hysterectomy with bilateral oophorectomy (LAVHO) and vaginal hysterectomy with bilateral oophorectomy without laparoscopic assistance (VHO). STUDY DESIGN: Between April 1, 2002, and February 1, 2004, a prospective randomized study at Marseille University Hospital (La Conception) included 48 patients who underwent a hysterectomy with prophylactic bilateral oophorectomy for benign uterine conditions. These patients were allocated to 2 groups (LAVHO vs VHO). The study variables were duration of surgery and of hospitalization and surgical and postoperative complications. RESULTS: There was no significant difference in the duration of surgery between the LAVHO and VHO groups (100.2 +/- 27.9 vs 83.9 +/- 34.6, P = .08). The rate of complications was significantly higher in the LAVHO group (13/24 [54.1%] vs 6/24 [25%], P = .039). CONCLUSION: The overall complication rate was higher with LAVHO than VHO. It thus appears that laparoscopic assistance is not useful in performing vaginal hysterectomies with prophylactic bilateral oophorectomies in patients without other related disorders (endometriosis, adhesions, adnexal anomalies).
PMID: 16458628 [PubMed – in process]
Eur J Obstet Gynecol Reprod Biol. 2006 Jan 1;124(1):101-5.
Cyclooxygenase-2 expression is higher in ovarian cancer tissue adjacent to endometriosis than in ovarian cancer without comorbid endometriosis.
Chou YC, Chen YJ, Lai CR, Wang PH, Hsin-Chan, Yuan CC.
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201 Section 2, Shih-Pai Road, Taipei 11217, Taiwan.
OBJECTIVES: The purpose of this study was to examine if COX-2, CK7 and CK20 are involved in the malignant transformation of endometriosis. METHODS: We compared COX-2, CK7 and CK20 expressions between isolated endometriosis lesions and endometriosis lesions adjacent to ovarian carcinoma and between isolated ovarian carcinoma and ovarian carcinoma with implants of endometriosis. Immunoreactivity was quantified using an immunohistochemical scoring system that corresponds to an image analysis-based system. RESULTS: There was no difference in COX-2, CK7 and CK20 expressions between the isolated endometriosis lesions and the endometriosis lesions adjacent to ovarian carcinoma. Similarly, CK7 and CK20 were equally expressed between the isolated ovarian carcinoma and the ovarian carcinoma with implants of endometriosis. The COX-2 over-expression rate was greater in ovarian carcinoma that was associated with endometriosis than in isolated ovarian carcinoma (27.8% versus 5.6%, P = 0.083). In endometrioid type ovarian carcinoma, the difference in COX-2 expression was statistically significant (50% versus 0%, P = 0.023). CONCLUSIONS: COX-2 over-expression may be a result of the malignant transformation of endometriosis to endometrioid type ovarian cancer or may represent an interaction between the two cellular components. With respect to cytokeratins, neither CK7 nor CK20 appear to be involved in the malignant transformation of endometriosis.
PMID: 16456945 [PubMed – indexed for MEDLINE]

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