Angiogenesis. 2006 Nov 16; [Epub ahead of print]Image analysis measurements of the microvascularisation in endometrium, superficial and deep endometriotic tissues.
Jondet M, Vacher-Lavenu MC, Chapron C.
Cabinet de pathologie, 34 rue Ducouedic, 75014, Paris, France, email@example.com.
The aim of this study was to evaluate precisely the microvascularisation of endometrium, superficial and deep endometriotic lesions, in progestin-treated and non-treated patients suffering from endometriosis. Methods: A population of 66 women was constituted. Immunohistochemistry was carried out with a specific marker of the endothelial cells (CD31). The number of vessels and the vessel area were assessed by a computer image analysis system. Results: The number of vessels per mm(2) were 211, 216, 225 and the vessel area was 270, 141 and 194 mum(2), respectively in endometria, superficial and deep endometriotic lesions of untreated women. In endometria, superficial and deep endometriotic lesions of progestin-treated women the number of vessels were respectively 129, 149, and 181 per mm(2) and the vessel area was 369, 474 and 254 mum(2). Conclusion: Statistically significant data indicate that endometriotic lesions are heterogeneous and suggest that progestin treatment induces a reduction in number and a concomitant dilation of microvessels with more microvascular changes in endometrium and superficial endometriotic lesions than in deep endometriotic lesions.
PMID: 17109198 [PubMed – as supplied by publisher] ________________________________________
Minerva Ginecol. 2006 Dec;58(6):527-551Serum and peritoneal abnormalities in endometriosis: potential use as diagnostic markers.
Gupta S, Agarwal A, Sekhon L, Krajcir N, Cocuzza M, Falcone T.
Reproductive Research Center, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA.
Endometriosis is an ambiguous disease and its exact pathogenesis still remains elusive to clinicians and scientists. Local and systemic aberrations in immune response are associated with endometriosis. This article reviews the literature regarding various immunological factors such as cytokines, growth factors, adhesion molecules and angiogenic factors involved in the etiopathogenesis of this disease. Our review summarizes the literature regarding biomarkers, which may be reliable nonsurgical tools used in the diagnosis of endometriosis. Superior biomarkers characterized by high sensitivity, specificity and predictive value can help in the early detection and monitoring of disease progression as well as its response to therapeutic treatments critical for its management. A combination predictive model utilizing multiple biomarkers rather then individual markers alone is proposed to improve the diagnostic performance for identifying women with a high likelihood of having endometriosis. Immunomodulators and angiogenic factor blockers have a potential for endometriosis treatment and also to alleviate the pain or infertility associated with the disease. Potential new therapeutic agents include modulators, such as cytokine receptor blockers and angiogenic receptor blockers, presently used for treating endometriosis.
PMID: 17108882 [PubMed – as supplied by publisher] ________________________________________Minerva Ginecol. 2006 Dec;58(6):511-526.Endometrial stem/progenitor cells and proliferative disorders of the endometrium.
Gargett BE, Chan RW.
Center for Women’s Health Research, Monash Institute of Medical Research, Melbourne, Australia.
The human endometrium undergoes cyclical processes of regeneration, differentiation and shedding as part of the menstrual cycle. In non-menstruating species, there are cycles of endometrial growth and apoptosis rather than physical shedding. It was hypothesized many years ago that endometrial stem cells are responsible for the remarkable regenerative capacity of endometrium. In this review, we summarize the first data providing evidence for the presence of adult stem/progenitor cells in human and mouse endometrium using functional assays. This is because adult stem cells are defined by their functional properties rather than by marker expression, and there are no known markers of endometrial stem/progenitor cells. Evidence will be presented which demonstrates that the endometrium contains rare populations of both and epithelial and stromal stem/progenitor cells. These fundamental studies on endometrial stem/progenitor cells will provide new insights into the pathophysiology of various gynecological disorders associated with abnormal endometrial proliferation, including endometriosis, endometrial cancer, endometrial hyperplasia, and adenomyosis. The possible use of endometrial stem/progenitor cells in tissue engineering applications relevant to urogynecology will also be mentioned.
PMID: 17108881 [PubMed – as supplied by publisher] ________________________________________Minerva Ginecol. 2006 Dec;58(6):499-510Progestogens and estroprogestins in the treatment of pelvic pain associated with endometriosis.
Daguati R, Somigliana E, Vigano P, Vercellini P.
Clinica Ostetrica e Ginecologica, Istituto ”Luigi Mangiagalli”, Universita degli Studi di Milano, Milano, Italy.
We performed a MEDLINE and EMBASE search to identify all studies published in the English language literature on the use of progestogens for the treatment of endometriosis. The aim of our review was to clarify the biological rationale for treatment and define the drugs that can be used. It has been demonstrated that progestogens may prevent implantation and growth of regurgitated endometrium by inhibiting the expression of matrix metalloproteinases and angiogenesis, and they have several anti-inflammatory in vitro and in vivo effects that may reduce the inflammatory state generated by the metabolic activity of the ectopic endometrium. Oral contraceptives increase the abnormally low apoptotic activity of the endometrium of patients with endometriosis. Moreover, anovulation, decidualization, amenorrhoea and the establishment of a steady estrogen-progestogen milieu contribute to disease quiescence. Progestogens are able to control pain symptoms in approximately three out of four women with endometriosi. Different compounds can be administered by the oral, intramuscular, subcutaneous, intravaginal or intrauterine route, each with specific advantages or disadvantages. Medical treatment plays a role in the therapeutic strategy only if administered over a prolonged period of time. Given their good tolerability, minor metabolic effects and low cost, progestogens must therefore be considered drugs of choice and are currently the only safe and economic alternative to surgery. However, their contraceptive effectiveness limits their use to women who do not wish to have children in the short-term.
PMID: 17108880 [PubMed – as supplied by publisher] ________________________________________
Surg Endosc. 2006 Nov 14; [Epub ahead of print]Impact of diagnostic laparoscopy on the management of chronic pelvic pain.
Kang SB, Chung HH, Lee HP, Lee JY, Chang YS.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea, firstname.lastname@example.org.
BACKGROUND: Diagnostic laparoscopy is a useful tool, especially when there is no definite anatomical abnormality visible on imaging modalities. We assess the role and clinical impact of diagnostic laparoscopy in the management of women with chronic pelvic pain. METHODS: Clinical data of 3,068 cases of diagnostic laparoscopy performed for chronic pelvic pain from June 1994 to August 2005 were analyzed. We compared the diagnoses after diagnostic laparoscopy and those after pelvic examination and imaging modalities such as ultrasound or computed tomography (CT), and we then checked the final pathologic diagnoses after operation. RESULTS: Pelvic endometriosis was the most common (60.2%) laparoscopic finding in patients with chronic pelvic pain in this study, followed by normal pelvic findings (21.2%) and pelvic congestion (13.0%). Diagnostic laparoscopy had an influence on correcting previous plans based on imaging modalities in 42.7% of patients such as discarding unnecessary procedures or introducing new diagnostic or therapeutic plans. There were 3 cases of major complications requiring immediate correction. CONCLUSIONS: Diagnostic laparoscopy is a useful diagnostic tool for of women with chronic pelvic pain and can be used as a guideline for individualized treatment.
PMID: 17103271 [PubMed – as supplied by publisher] ________________________________________
Radiographics. 2006 Nov-Dec;26(6):1847-68 From the Archives of the AFIP: Inflammatory and Nonneoplastic Bladder Masses: Radiologic-Pathologic Correlation.
Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ.
Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201-1595.
Although the vast majority of bladder tumors are epithelial neoplasms, a variety of nonneoplastic disorders can cause either focal bladder masses or diffuse mural thickening and mimic malignancy. Some of these entities are rare and poorly understood such as inflammatory pseudotumor, which produces ulcerated, bleeding polypoid bladder masses. These masses may be large and have an extravesical component. Bladder endometriosis manifests as submucosal masses with characteristic magnetic resonance imaging features consisting of hemorrhagic foci and reactive fibrosis. Nephrogenic adenoma has no typical features, and pathologic evaluation is required for diagnosis. Although imaging features of malacoplakia are also nonspecific, characteristic Michaelis-Gutmann bodies are found at pathologic evaluation. The various types of cystitis (cystitis cystica, cystitis glandularis, and eosinophilic cystitis) require pathologic diagnosis. Bladder infection with tuberculosis and schistosomiasis produces nonspecific bladder wall thickening and ulceration in the acute phase and should be suspected in patients who are immunocompromised or from countries where these infections are common. The diagnosis of chemotherapy cystitis and radiation cystitis should be clinically evident, but imaging may be used to determine severity and to assess complications. Extrinsic inflammatory diseases such as Crohn disease and diverticulitis may be associated with fistulas to the bladder and focal bladder wall abnormality. The extravesical findings allow the diagnosis to be made easily. Finally, extrinsic masses arising from the prostate or distal ureter may cause filling defects, which can be confused with intrinsic bladder masses.
PMID: 17102055 [PubMed – in process] ________________________________________
Radiographics. 2006 Nov-Dec;26(6):1705-18.Deep Retroperitoneal Pelvic Endometriosis: MR Imaging Appearance with Laparoscopic Correlation.
Del Frate C, Girometti R, Pittino M, Del Frate G, Bazzocchi M, Zuiani C.
Department of Radiology, University of Udine, Via Colugna 50, 33100 Udine, Italy.
Deep pelvic endometriosis is defined as subperitoneal infiltration of endometrial implants in the uterosacral ligaments, rectum, rectovaginal septum, vagina, or bladder. It is responsible for severe pelvic pain. Accurate preoperative assessment of disease extension is required for planning complete surgical excision, but such assessment is difficult with physical examination. Various sonographic approaches (transvaginal, transrectal, endoscopic transrectal) have been used for this purpose but do not allow panoramic evaluation. Furthermore, exploratory laparoscopy has limitations in demonstrating deep endometriotic lesions hidden by adhesions or located in the subperitoneal space. Despite some limitations, magnetic resonance (MR) imaging is able to directly demonstrate deep pelvic endometriosis. The MR imaging features depend on the type of lesions: infiltrating small implants, solid deep lesions mainly located in the posterior cul-de-sac and involving the uterosacral ligaments and torus uterinus, or visceral endometriosis involving the bladder and rectal wall. Solid deep lesions have low to intermediate signal intensity with punctate regions of high signal intensity on T1-weighted images, show uniform low signal intensity on T2-weighted images, and can demonstrate enhancement on contrast-enhanced images. MR imaging is a useful adjunct to physical examination and transvaginal or transrectal sonography in evaluation of patients with deep infiltrating endometriosis. (c) RSNA, 2006.
PMID: 17102045 [PubMed – in process] ________________________________________
J Obstet Gynaecol Res. 2006 Dec;32(6):613-4.Supernumerary ovary on sigmoid colon resembling an endometriotic lesion.
Imir G, Arici S, Cetin M, Kivanc F.
Cumhuriyet University, Department of Obstetrics and Gynecology, Sivas, Turkey.
A 30-year-old woman with a history of endometriosis and chronic pelvic pain had right-sided pain and sonographic evaluation demonstrated a right ovarian cyst 5 cm in diameter. Laparotomy revealed a right ovarian cystic mass and the cystic mass was found on the sigmoid colon. After excision, histopathologic study revealed endometrioma for the ovarian cyst and a supernumerary ovary for the cystic mass on the sigmoid colon.
PMID: 17100826 [PubMed – in process] ________________________________________
Aust Fam Physician. 2006 Nov;35(11):887-8. Cutaneous endometriosis – Surgical presentations of a gynaecological condition.
Chiang DT, Teh WT.
MBBS, MS, is a general surgical registrar, Department of General Surgery, Casey Hospital, Southern Health, Victoria.
Endometriosis is a common gynaecological condition; cutaneous endometriosis is a subtype of endometriosis. Although cutaneous endometriosis involving the abdominal wall is not common, preoperative diagnosis of cutaneous endometriosis can be easily mistaken for a suture granuloma, lipoma, abscess, cyst or hernia. We report two common surgical presentations of this gynaecological condition.
PMID: 17099809 [PubMed – in process]
Aust Fam Physician. 2006 Nov;35(11):864-7.Endometriosis – An update.
MBBS, FRANZCOG, MRCOG, is a gynaecologist, Endosurgery Unit, Mercy Hospital for Women, Victoria.
BACKGROUND: Endometriosis is one of the major causes of pelvic pain and subfertility in women. OBJECTIVE: This article discusses the diagnosis and treatment of endometriosis. DISCUSSION: Empiric treatment in women presenting with pain symptoms suggestive of endometriosis is the usual first option. Ultrasound does not diagnose peritoneal disease but will recognise endometriomas. Laparoscopy remains the gold standard for diagnosis and surgical removal at that time should be first line treatment. Medical treatment is proven effective for superficial disease. It is most frequently used where surgical skills do not allow removal of the endometriosis or where incomplete removal is suspected in severe disease. Long term treatment after surgical removal with diet, exercise and hormones provides long term pain control and may reduce the risk of recurrence. Medical treatment has no place in infertility treatment, however surgical removal of milder disease enhances pregnancy rates. Early referral for assisted reproduction treatment is suggested with severe disease.
PMID: 17099804 [PubMed – in process] ________________________________________
Fertil Steril. 2006 Nov 9; [Epub ahead of print]Effect of a statin on an in vitro model of endometriosis.
Esfandiari N, Khazaei M, Ai J, Bielecki R, Gotlieb L, Ryan E, Casper RF.
Toronto Centre for Advanced Reproductive Technology; Department of Obstetrics and Gynecology, Division of Reproductive Sciences, Samuel Lunenfeld Research Institute, Mount Sinai Hospital; and University of Toronto, Toronto, Ontario, Canada.
OBJECTIVE: To determine the inhibitory effect of a statin on angiogenesis in a three-dimensional (3-D) culture of human endometrial fragments in vitro. Angiogenesis has been proposed as an important mechanism in the pathogenesis of endometriosis, and statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) have been shown to have anti-inflammatory and anti-angiogenic activity. DESIGN: Experimental in vitro study of human endometrial biopsies and 3-D culture in fibrin matrix. SETTING: Research laboratory at a university-affiliated infertility center. PATIENT(S): Forty-six normal ovulating women undergoing infertility treatment. INTERVENTION(S): Endometrial samples obtained from the fundus of the uterine cavity were minced, and the fragments were placed in a three-dimensional fibrin matrix culture system. MAIN OUTCOME MEASURE(S): Presence or absence of proliferation of stromal cells and invasion of the fibrin matrix, presence or absence of vessel sprouting, and immunohistochemical characterization of cellular components. RESULT(S): During the 1st week of culture, invasion of stromal cells into the fibrin matrix occurred in the control group and in some wells outgrowths were observed. After 2 weeks, endometrial glands were observed in the outgrowths at a distance from the main tissue and were growing in conjunction with new vessel formation until the end of culture period. A concentration-dependent effect of lovostatin was seen on cell growth and angiogenesis in the experimental groups. In the presence of 5 and 10 muM of statin, angiogenesis was abolished, and cell proliferation was inhibited. In the presence of 1 muM of lovastatin, angiogenesis was reduced, but cell proliferation was not affected. CONCLUSION(S): The statins were shown to be effective in inhibiting the mechanisms of cell proliferation and angiogenesis in an experimental model for the development of endometriosis-like tissue.
PMID: 17097652 [PubMed – as supplied by publisher]
J Minim Invasive Gynecol. 2006 Nov-Dec;13(6):576-7.Challenges to our understanding of endometriosis pain.
Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, Ohio.
Endometriosis remains a diagnostic and therapeutic challenge despite decades of clinical experience and research. The multiple treatment options for endometriosis described in this symposium clearly indicate how difficult it can be to diagnose and effectively treat endometriosis with our current understanding of the disease. At least 3 major challenges to our understanding can be identified: (1) endometriosis does not always cause pain; (2) other causes of pelvic pain often coexists in patients with endometriosis; and (3) common medical and surgical treatments for endometriosis are relatively nonspecific. Insights from the articles in this symposium can help clinicians reach a new level of understanding of endometriosis and perhaps lead to more effective methods for diagnosing and treating this perplexing condition.
PMID: 17097582 [PubMed – in process] ________________________________________
J Minim Invasive Gynecol. 2006 Nov-Dec;13(6):566-72.Hysterectomy for treatment of pain associated with endometriosis.
Department of Obstetrics and Gynecology, University of Tennessee Health Sciences Center, Memphis, Tennessee.
The literature was searched for endometriosis and hysterectomy on PubMed and the individual search engines of the Journal of Minimally Invasive Surgery, Fertility and Sterility, BJOG, Obstetrics and Gynecology, the American Journal of Obstetrics and Gynecology, and Human Reproduction. Eighty references of interest were identified and included in this review. Analysis of hysterectomy for pain associated with endometriosis is difficult for many reasons. These include a lack of differentiation of various forms of cyclic pain from other forms of non-cyclic pain, the retrospective nature of much of the literature, and a low specificity for identifying pain. Hysterectomy for chronic non-specified pelvic pain associated with endometriosis is a successful approach in many women. It can not be determined whether this is due to intermingling of patients with and without cyclic pain or if both of these respond equally well. Focused prospective research is needed to determine whether symptoms, signs, or laboratory findings might be useful in determining more specific response patterns.
PMID: 17097580 [PubMed – in process] ________________________________________
J Minim Invasive Gynecol. 2006 Nov-Dec;13(6):559-65.Treatment of urinary tract endometriosis.
Gustilo-Ashby AM, Paraiso MF.
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, Ohio.
Endometriosis involving the urinary tract, although infrequent, can have significant impact on patients’ symptoms, response to treatment, and urologic function. The purpose of this article is to review the epidemiology, pathophysiology, diagnosis, and management of endometriosis that affects the urinary tract.
PMID: 17097579 [PubMed – in process] ________________________________________
J Minim Invasive Gynecol. 2006 November – December;13(6):546-558. Conservative surgical management of endometriosis in women with pelvic pain.
Frishman GN, Salak JR.
Department of Obstetrics and Gynecology, Women & Infants’ Hospital, Brown Medical School, Providence, Rhode Island.
Endometriosis is a common cause of pelvic pain in women. This article addresses the conservative surgical treatment of endometriosis for this indication.
PMID: 17097578 [PubMed – as supplied by publisher] ________________________________________
J Minim Invasive Gynecol. 2006 Nov-Dec;13(6):539-45.GnRH analogs: Options for endometriosis-associated pain treatment.
Department of Obstetrics and Gynecology, Thomas Jefferson Medical College, Philadelphia, Pennsylvania.
While none of the currently available treatment options for endometriosis pain resolved the underlying disease process, there are growing numbers of medical alternatives available. Medical options include the GnRH agonists and antagonists. Review of these treatments in the management of endometriosis pain and the insight often to the etiology of endometriosis are presented for discussion.
PMID: 17097577 [PubMed – in process] ________________________________________
J Minim Invasive Gynecol. 2006 Nov-Dec;13(6):535-8. Medicated intrauterine systems for treatment of endometriosis-associated pain.
Department of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy.
Medicated intrauterine systems (IUSs) are intrauterine devices that act by means of the local release of a medication. The levonorgestrel (LNG)-IUS is a T-shaped device that releases the progestogen LNG directly into the uterine cavity. The LNG-IUS can be used with noncontraceptive, therapeutic intent for idiopathic menorrhagia, hormonal replacement therapy in conjunction with oral or transdermal estrogens, and endometriosis or adenomyosis-associated pain. For this last indication, however, the use of the LNG-IUS is still under clinical investigation.
PMID: 17097576 [PubMed – in process] ________________________________________ J Minim Invasive Gynecol. 2006 Nov-Dec;13(6):528-34.The role of progestins in treating the pain of endometriosis.
Colorado Center for Reproductive Medicine, Englewood, Colorado.
Progestins, synthetic progestational agents, have been used in the management of symptomatic endometriosis both as primary therapy and as an adjunct to surgical resection. A variety of oral agents have been employed in this regard with investigators demonstrating differing degrees of benefit. Unfortunately, due to the lack of large-scale, appropriately controlled, randomized trials, or dose-ranging studies, no single agent can be demonstrated to be truly efficacious. The lack of a standardized instrument to evaluate painful symptoms makes comparative analysis more difficult. Injectable administration of long-acting depot medroxyprogesterone acetate preparations intramuscularly or subcutaneously has been investigated in three randomized trials. The lower dose subcutaneous injection holds promise with an apparent reduction in side effects. Issues of reversible bone mineral density loss, breakthrough bleeding, and return of menses have not been completely resolved. Selective progesterone receptor modulators represent an intriguing alternative. These orally administered agents have been shown in preliminary investigations to be not only efficacious in reducing symptoms but also associated with minimal side effects. Further investigation of these agents is clearly required.
PMID: 17097574 [PubMed – in process]
Endocrinology. 2006 Nov 9; [Epub ahead of print]Pharmacological Characterization of a Novel Nonpeptide Antagonist of the Human GnRH Receptor, NBI-42902.
Struthers RS, Xie Q, Sullivan SK, Reinhart GJ, Kohout TA, Zhu YF, Chen C, Liu XJ, Ling N, Yang W, Maki RA, Bonneville AK, Chen TK, Bozigian HP.
Departments of Endocrinology, Pharmacology, Medicinal Chemistry, Peptide Chemistry, Molecular Biology, and Preclinical Development, Neurocrine Biosciences Inc., El Camino Real, San Diego, California 92130.
Suppression of the hypothalamic-pituitary-gonadal axis by peptides that act at the gonadotropin-releasing hormone (GnRH) receptor has found widespread use in clinical practice for the management of sex steroid dependent diseases (such as prostate cancer and endometriosis) and reproductive disorders. Efforts to develop orally available GnRH receptor antagonists have led to the discovery of a novel, potent nonpeptide antagonist, NBI-42902 that suppresses serum LH concentrations in postmenopausal women following oral administration. Here we report the in vitro and in vivo pharmacologic characterization of this compound. NBI-42902 is a potent inhibitor of peptide radioligand binding to the human GnRH receptor (Ki = 0.56 nM). Tritiated NBI-42902 binds with high affinity (Kd = 0.19 nM) to a single class of binding sites and can be displaced by a range of peptide and nonpeptide GnRH receptor ligands. In vitro experiments demonstrate that NBI-42902 is a potent functional, competitive antagonist of GnRH stimulated inositol phosphate accumulation, Ca(2+) flux, and ERK1/2 activation. It did not stimulate histamine release from rat peritoneal mast cells. Finally, it is effective in lowering serum LH in castrated male macaques following oral administration. Overall, these data provide a benchmark of pharmacologic characteristics required for a nonpeptide GnRH antagonist to effectively suppress gonadotropins in humans and suggest that NBI-42902 may have clinical utility as an oral agent for suppression of the hypothalamic-pituitary-gonadal axis.
PMID: 17095587 [PubMed – as supplied by publisher] ________________________________________
Fertil Steril. 2006 Nov 7; [Epub ahead of print]Histologic analysis of endometriomas: what the surgeon needs to know.
Muzii L, Bianchi A, Bellati F, Cristi E, Pernice M, Zullo MA, Angioli R, Panici PB.
Department of Obstetrics and Gynecology.
OBJECTIVE: To evaluate by thorough pathologic analysis the histologic features of the endometrioma wall excised at laparoscopy. DESIGN: Prospective series of consecutive patients. SETTING: Tertiary care, university hospital. PATIENT(S): Fifty-nine patients with ovarian endometriomas. A total of 70 cysts were examined. INTERVENTION(S): Patients underwent operative laparoscopy with the stripping technique for excision of the ovarian endometrioma. MAIN OUTCOME MEASURE(S): A thorough histologic examination was performed on the entire cyst wall specimen. RESULTS: Histologic examination confirmed the endometriotic nature of the cyst in 100% of the cases. The inner wall of the endometrioma was covered by endometriotic tissue on 60% of the surface. The mean cyst wall thickness was 1.4 mm. The mean value of maximal depth of endometriosis penetration in the endometrioma wall was 0.6 mm. In 99% of the cases the maximal penetration of the endometriotic tissue was <1.5 mm. CONCLUSION(S): In the present study, we demonstrate that the endometrioma wall contains endometriotic tissue in 100% of the cases. However, the endometriotic tissue may cover the inner cyst wall for a surface that varies between 10% and 98% of the entire wall (median value 60%). This tissue may reach a depth of 2 mm, but for most of the surface it does not penetrate >1.5 mm. These histologic data may help the gynecologic laparoscopist select the surgical approach that maximally preserves healthy ovarian tissue.
PMID: 17094980 [PubMed – as supplied by publisher] ________________________________________
Fertil Steril. 2006 Nov 7; [Epub ahead of printQuantitative expression of apoptosis-regulating genes in endometrium from women with and without endometriosis.
Braun DP, Ding J, Shaheen F, Willey JC, Rana N, Dmowski WP.
Cancer Institute, Departments of Surgery and Medicine, Medical University of Toledo, Toledo, Ohio; Institute for the Study and Treatment of Endometriosis, Chicago; and Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois.
OBJECTIVE: To quantitate antiapoptotic and proapoptotic gene expression in endometrial cells (ECs) of women with and without endometriosis. DESIGN: Determination of transcript abundance (TA) of apoptosis-regulating genes in eutopic and ectopic endometrial cells. SETTING: Institute for the Study and Treatment of Endometriosis, Chicago, Illinois, and university-based research laboratories. PATIENTS: Women with (n = 10) and without (n = 6) endometriosis. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Quantitative virtually multiplexed transcript abundance measurement (VMTA) of the BCL2, BCLxL, defender against cell death-1 (DAD-1), BCLxS, P53, Caspase-1, and proliferating cell nuclear antigen (PCNA) genes. RESULTS: The TA ratio of antiapoptotic to proapoptotic isoforms of the BCL-X gene favors survival in eutopic and ectopic ECs from women with endometriosis, but not control ECs. This was found throughout the menstrual cycle for ectopic ECs. Eutopic but not ectopic ECs also expressed increased TA of the antiapoptotic DAD-1 gene in endometriosis. Eutopic and ectopic ECs from women with endometriosis expressed decreased TA of p53 and Caspase-1 compared to ECs from women without endometriosis. Expression of these genes was not correlated with the proliferative state of ECs based on TA of the PCNA gene. CONCLUSIONS: Dysregulation in expression of pro- and antiapoptotic regulatory genes characterizes eutopic and ectopic ECs from women with endometriosis. These results are consistent with apoptotic resistance and enhanced survival of ECs in endometriosis.
PMID: 17094974 [PubMed – as supplied by publisher] ________________________________________
Kyobu Geka. 2006 Nov;59(12):1062-8.[Catamenial pneumothorax] [Article in Japanese] Sakurai H, Hada M, Chiba S.
Department of Surgery, Yamanashi Prefectural Central Hospital, Kofu, Japan.
We report 3 cases of catamenial pneumothorax, with review of the literatures. Case 1: A 38-year-old female had recurrent right-sided pneumothorax in February 2001. Videothoracoscopic visualization showed multiple small fenestrations in central tendon of diaphragm. A partial diaphragmatic resection including the lesions was performed. She received hormone therapy postoperatively. Case 2: A 40-year-old female with past history of ovarian endometriosis had recurrent right-sided pneumothorax in 1993. During the operation, multiple diaphragmatic fenestrations and bullae of right middle and lower lobes were identified. The lesions were resected and postoperative hormone therapy was performed for 6 months. In 1997, right-sided pneumothorax recurred. She underwent surgical procedure due to prolonged air leakage from the right lung. During the operation, a diaphragmatic fenestration and bulla of apex of right upper lobe of the lung were visualized. Diaphragm was reefed and bulla was resected. After that, she had no recurrence of pneumothorax. Case 3: A 39-year-old female had recurrent right-sided pneumothorax in 2003. Under video-assisted thoracoscopic surgery, multiple fenestrations of central tendinous diaphragm were identified. Diaphragmatic partial resection was performed. Postoperatively, she received hormone therapy for 6 months. After hormone therapy, she suffered from recurrent pneumothorax, and underwent an operation. During the operation, she had endometriosis of visceral pleura without diaphragmatic fenestration. Once again, she received postoperative hormone therapy. Catamenial pneumothorax is a rare disease, and the definite etiology has not been clarified. A combination of both surgical and hormone therapy is useful for treatment.
PMID: 17094541 [PubMed – in process] ________________________________________
Hum Reprod. 2006 Nov 8; [Epub ahead of print]Effect of GnRH analogues on apoptosis and expression of Bcl-2, Bax, Fas and FasL proteins in endometrial epithelial cell cultures from patients with endometriosis and controls.
Bilotas M, Baranao RI, Buquet R, Sueldo C, Tesone M, Meresman G.
Instituto de Biologia y Medicina Experimental (IBYME), Buenos Aires, Argentina.
BACKGROUND: Our purpose was to evaluate the effect of the GnRH agonist (GnRHa), leuprolide acetate (LA), and the GnRH antagonist (GnRHant), Antide, on apoptosis and expression of apoptosis-related proteins in endometrial epithelial cell (EEC) cultures from patients with endometriosis and controls (infertile women without endometriosis). METHODS: Biopsy specimens of eutopic endometrium were obtained from 22 patients with endometriosis and from 14 women that served as controls. Apoptosis was examined in EEC after incubation with LA and Antide. Bax, Bcl-2, Fas and FasL expression was evaluated after exposure to LA, Antide or a combination of both. The percentage of apoptotic cells (%ApC) was assessed by the acridine orange-ethidium bromide technique, and protein expression was evaluated by western blot and immunocytochemistry. RESULTS: LA 100 and 1000 ng/ml increased the %ApC in EEC from patients with endometriosis (both P < 0.05) and controls (p < 0.05 and P < 0.01, respectively). Antide 10(-5) M increased the %ApC in EEC from patients with endometriosis and controls (P < 0.01). In EEC from women with endometriosis, Bax expression increased after treatment with LA, Antide and LA + Antide (P < 0.05, P < 0.001 and P < 0.001), whereas Bcl-2 expression decreased after exposure to LA and Antide (P < 0.001 and P < 0.01). FasL expression increased after LA, Antide and LA + Antide treatments (P < 0.01, P < 0.001 and P < 0.01). No significant changes were observed on Fas expression. CONCLUSIONS: GnRH analogues enhanced apoptosis in EEC, and this was accompanied by an increase in expression of the pro-apoptotic proteins Bax and FasL and a decrease in expression of the anti-apoptotic protein Bcl-2.
PMID: 17092985 [PubMed – as supplied by publisher] ________________________________________
J Thromb Haemost. 2006 Nov 9; [Epub ahead of print] The incidence of venous thromboembolism following gynecologic laparoscopy: a multicenter, prospective cohort study.
Ageno W, Manfredi E, Dentali F, Silingardi M, Ghezzi F, Camporese G, Bolis P, Venco A.
Department of Clinical Medicine, University of Insubria, Varese, Italy.
Background: Information on the incidence of venous thromboembolism (VTE) following laparoscopic procedures is inadequate and there is currently no solid evidence to guide the use of thromboprophylaxis in this setting. Gynecologic laparoscopy is a common procedure, and is frequently performed in low risk patients. To our knowledge, there are no clinical studies specifically designed to assess the incidence of VTE in this setting. Methods: In a prospective cohort study, consecutive patients undergoing gynecologic laparoscopy underwent compression ultrasonography (CUS) and clinical assessment to evaluate the incidence of clinically relevant VTE. CUS was performed 7 +/- 1 and 14 +/- 1 days postoperatively. A subsequent telephone contact was scheduled at 30 and 90 days. No patient received pharmacologic nor mechanical prophylaxis. Patients with malignancy or previous VTE were excluded from the study. Results: We enrolled 266 consecutive patients, mean age was 36.3 years, range 18-72. Most common indications to laparoscopy were ovarian cysts in 25.6% of patients, endometriosis in 21.0% of patients, unexplained adnexal masses in 12.4% of patients, and infertility in 7.5% of patients. Mean duration of the procedure was 60.5 minutes (range 10 to 300 minutes). In particular, in 55.6% of patients the duration exceeded 45 minutes. There were neither episodes of CUS detected DVT (0/247; 0%, 95% CI 0-1.51%) nor of clinically relevant VTE after follow up (0/256; 0%, 95% CI 0-1.48%). No patient died of fatal pulmonary embolism (0/266; 0%, 95% CI 0-1.42%). Conclusions: Gynecologic laparoscopy in non cancer patients is a low risk procedure for post-operative VTE.
PMID: 17092300 [PubMed – as supplied by publisher] ________________________________________
Acta Obstet Gynecol Scand. 2006;85(11):1375-1380.Relation between severity of dysmenorrhea and endometrioma.
Chopin N, Ballester M, Borghese B, Fauconnier A, Foulot H, Malartic C, Chapron C.
Unite de Chirurgie Gynecologique, Universite Rene Descartes (Paris V); Assistance Publique – Hopitaux de Paris (AP-HP); Groupe Hospitalier Universitaire Ouest; Service de Gynecologie Obstetrique et Medecine de la Reproduction (Pr Chapron). CHU Cochin, Paris. France.
Background. To evaluate the relationship between the severity of dysmenorrhea and endometrioma. Methods. Descriptive study with prospective design. Two hundred and thirty-nine women with histologically proved endometriomas. The severity of dysmenorrhea was assessed prospectively with a 10-cm visual analog scale. Various indicators concerning the endometrioma and the extent of deep infiltrating endometriosis were recorded during surgery in 239 patients. Correlations were sought with a multiple regression logistic model. Results. According to univariate analysis, the following variables were related to more severe dysmenorrhea: subperitoneal infiltration (uterosacral ligament and rectal infiltration) and R-AFS score of implants. None of the specific characteristics of endometriomas were associated with severe dysmenorrhea. After multiple regression analysis, rectal infiltration and R-AFS score of implants were the only factors that remained related to dysmenorrhea severity. Conclusions. When there is an endometrioma, severe dysmenorrhea is not directly related with the characteristics specific to these ovarian cysts. The associated deep infiltrating endometriotic lesions and in particular rectal infiltration could explain these symptoms.
PMID: 17091420 [PubMed – as supplied by publisher] ________________________________________
Zhong Xi Yi Jie He Xue Bao. 2006 Nov;4(6):634-8.Effects of Yiweining Recipe on expressions of metalloproteinase-2 and cyclooxygenase-2 mRNAs in ectopic endometrium of rats with endometriosis.
Qu F, Zhou J, Yang DX, Ma WG, Ma BZ.
Department of Gynecology and Obstetrics, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province 150040, China; E-mail: email@example.com.
Objective: To explore the effects of Yiweining Recipe (YWNR), a compound Chinese herbal medicine, on expressions of metalloproteinase-2 (MMP-2) and cyclooxygenase-2 (COX-2) mRNAs in rats with endometriosis (EM). Methods: Operational self-transplantation was applied in establishing the rat models. Detection of MMP-2 and COX-2 mRNAs was conducted with hybridization in situ. Results: There were significant differences in the expressions of MMP-2 and COX-2 mRNAs between the untreated group and the high-dose YWNR-treated group. YWNR could reduce the expressions of MMP-2 and COX-2 mRNAs. Conclusion: YWNR can treat EM through reducing the positive expressions of MMP-2 and COX-2 mRNAs.
PMID: 17090383 [PubMed – in process] ________________________________________
Curr Opin Investig Drugs. 2006 Oct;7(10):882-90.Progesterone receptor antagonists.
Institute of Hormone Research, 14 Nili Street, Jerusalem 92548, Israel. Irving@spitz.com
Since the discovery of the progesterone receptor antagonist mifepristone, numerous additional compounds, which display a spectrum of biological actions ranging from full antagonist to those with mixed agonist/antagonist activity, have been synthesized. The latter are referred to as selective progesterone receptor modulators. Long-term administration of these agents is associated with an antiproliferative action on the endometrium as well as amenorrhea and often inhibition of ovulation. Thus far, the majority of clinical data have been obtained with mifepristone but studies are currently underway with other compounds. These compounds have application in the treatment of uterine myoma, endometriosis, dysfunctional uterine bleeding, as potential contraceptives and in steroid responsive tumors.
PMID: 17086932 [PubMed – in process] ________________________________________
Sao Paulo Med J. 2006 00;124(4):223-227. Positive correlation between serum and peritoneal fluid CA-125 levels in women with pelvic endometriosis.
Amaral VF, Ferriani RA, Sa MF, Nogueira AA, Silva JC, Silva AC, Moura MD.
Gynecology and Obstetrics Department, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
CONTEXT AND OBJECTIVE: One of the diagnostic markers of endometriosis is CA-125, and elevated levels of this are caused by high concentrations in the ectopic endometrium. The objective of this study was to correlate CA-125 levels in serum and peritoneal fluid from women with and without pelvic endometriosis. DESIGN AND SETTING: This was a prospective, cross-sectional, controlled study of consecutive pa-tients undergoing laparoscopy for infertility, pelvic pain or tubal ligation, during early follicular phase, at the university hospital of Faculdade de Medicina de Ribeirao Preto. METHODS: Fifty-two patients were divided into two groups: endometriosis group, consisting of 35 patients with biopsy-confirmed pelvic endometriosis, and control group, consisting of 17 patients without endometriosis. CA-125 levels in serum samples and peritoneal fluid were determined by chemiluminescence. RESULTS: CA-125 levels in serum and peritoneal fluid were higher in patients with advanced pelvic endometriosis (means of 39.1 &plusmn; 45.8 U/ml versus 10.5 &plusmn; 5.9 U/ml in serum, p < 0.005; 1,469.4 &plusmn; 1,350.4 U/ml versus 888.7 &plusmn; 784.3 U/ml in peritoneal fluid, p < 0.05), and showed a positive correlation between each other (correlation coefficient (r) = 0.4880). Women with more advanced degrees of endometriosis showed higher CA-125 levels in both serum and peritoneal fluid (p = 0.0001). CONCLUSION: There is a positive correlation between serum and peritoneal fluid values of CA-125 in women with and without endometriosis, and their levels are higher in peritoneal fluid. Advanced endometriosis is related to higher levels in both serum and peritoneal fluid.
PMID: 17086305 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2006 Oct 31; [Epub ahead of print] Selective cyclo-oxygenase-2 inhibition induces regression of autologous endometrial grafts by down-regulation of vascular endothelial growth factor-mediated angiogenesis and stimulation of caspase-3-dependent apoptosis.
Laschke MW, Elitzsch A, Scheuer C, Vollmar B, Menger MD.
Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/SaarGermany.
OBJECTIVE: To investigate the effects of selective cyclo-oxygenase-2 (COX-2) inhibition on the angiogenesis and proliferation of endometrial grafts. DESIGN: Intravital fluorescence microscopic study. SETTING: Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany. ANIMALS: Syrian golden hamsters. INTERVENTIONS: Endometrial fragments were transplanted into dorsal skinfold chambers of Syrian golden hamsters. Animals were treated daily with the selective COX-2-inhibitor NS398; controls received the vehicle dimethyl sulfoxide only. MAIN OUTCOME MEASURES: Angiogenesis was analyzed for 2 weeks with the use of intravital fluorescence microscopy. Protein expression of vascular endothelial growth factor, proliferating cell nuclear antigen, caspase-3, and activated caspase-3 was measured by Western blot analysis. Histological sections were scanned for local microthrombosis. RESULTS: COX-2 inhibition induced a marked regression of endometrial grafts due to inhibition of angiogenesis, as indicated by significantly reduced microvessel density within grafts compared to controls. This effect was associated with a decreased expression of vascular endothelial growth factor. Moreover, COX-2 inhibition suppressed cell proliferation and induced apoptosis-associated caspase-3 expression. Interestingly, microthrombus formation could not be observed. CONCLUSIONS: Our study demonstrates that selective COX-2 inhibition induces regression of endometrial grafts by suppression of angiogenesis and stimulation of apoptosis. Accordingly, COX-2 inhibition may represent a novel therapeutic strategy for the treatment of endometriosis.
PMID: 17081538 [PubMed – as supplied by publisher] ________________________________________
Fertil Steril. 2006 Oct 31; [Epub ahead of print]Aberrant expression of deoxyribonucleic acid methyltransferases DNMT1, DNMT3A, and DNMT3B in women with endometriosis.
Wu Y, Strawn E, Basir Z, Halverson G, Guo SW.
Department of Pediatrics.
OBJECTIVE: Since endometriosis is a persistent disease with substantial gene dysregulation, there must be cellular memory of some sort that constitutes a unique cell identity for endometriotic cells. Epigenetic regulation, especially through DNA methylation, is a flexible, yet stable, mechanism for maintaining such a cellular memory. The aim of this study was to determine gene expression levels of DNMT1, DNMT3A, and DNMT3B, the three genes coding for DNA methyltransferases that are responsible for methylation. DESIGN: Cross-sectional measurements of gene expression levels of DNMT1, DNMT3A, and DNMT3B on endometriotic tissue. SETTING: Academic. PATIENT(S): Seventeen patients with laparoscopically confirmed endometriosis and 8 healthy women who underwent tubal sterilization who were free of endometriosis were recruited for the study. INTERVENTION(S): Epithelial cells were harvested from tissue samples by laser capture microdissection and messenger RNA abundance was measured by quantitative real-time reverse transcription-polymerase chain reaction. MAIN OUTCOME MEASURE(S): The expression levels of these genes in epithelial cells from 13 ectopic endometrial tissue samples, 10 eutopic endometrial tissue samples taken from women with endometriosis, and 8 normal endometrial tissue samples from women without endometriosis. RESULT(S): The genes DNMT1, DNMT3A, and DNMT3B were over-expressed in the ectopic endometrium as compared with normal control subjects or the eutopic endometrium of women with endometriosis, and their expression levels were correlated positively with each other. CONCLUSION(S): The aberrant expression of these genes suggests that aberrant methylation may be rampant in endometriosis. This also provides a strong piece of evidence that endometriosis ultimately may be an epigenetic disease.
PMID: 17081533 [PubMed – as supplied by publisher]
Fertil Steril. 2006 Oct 31; [Epub ahead of print]Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and postoperative administration of triptorelin.
Ferrero S, Abbamonte LH, Parisi M, Ragni N, Remorgida V.
Department of Obstetrics and Gynecology, San Martino Hospital, University of Genoa, Genoa, Italy.
This observational cohort study examined the effect of laparoscopic full excision of endometriosis combined with postoperative triptorelin treatment on deep dyspareunia (DD) and quality of sex life. One year after completing the postoperative treatment, 45.9% of the patients had no DD and 34.7% reported a decrease in DD intensity; an increase in the frequency of sexual intercourse was reported by 62.2% of the women; objective improvements in several aspects of sex life were observed.
PMID: 17081532 [PubMed – as supplied by publisher] ________________________________________
Tohoku J Exp Med. 2006 Nov;210(3):175-88.Management of the pain associated with endometriosis: an update of the painful problems.
Ozawa Y, Murakami T, Terada Y, Yaegashi N, Okamura K, Kuriyama S, Tsuji I.
Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine.
Endometriosis is a condition characterized by ectopic endometrial tissues located outside of the uterus, most commonly found on the pelvic peritoneum or ovary. Endometriosis, which occurs in 7-10% of women in the general population and 71-87% of women with chronic pelvic pain, is associated with dysmenorrhea, chronic pelvic pain, and infertility. There is considerable debate about the effectiveness of various interventions for endometriosis. This review discusses the benefits and drawbacks of pharmacologic and surgical treatments for the pain associated with endometriosis. Laparoscopic surgery has been demonstrated to relieve the pain associated with endometriosis. Hormonal therapies, such as gonadotropin-releasing hormone (GnRH) analogues or the weak androgen danazol, have also been effective at relieving the pain associated with endometriosis. Oral contraceptives appear to be as effective as GnRH analogues for pain relief. Although both surgical and pharmacologic treatments have been effective for relief of the pain associated with endometriosis, the recurrence rate remains significant. The management of pain associated with endometriosis has thus not been satisfied. Larger unified clinical trials are needed to evaluate the effectiveness of new treatments in managing the pain associated with endometriosis.
PMID: 17077594 [PubMed – in process] ________________________________________
J Reprod Dev. 2006 Nov 1; [Epub ahead of print]Effect of Danazol on NK Cells and Cytokines in the Mouse Uterus.
Kusakabe K, Morishima S, Li ZL, Otsuki Y.
Department of Anatomy and Cell Biology, Division of Basic Medicine 1, Osaka Medical College.
Danazol, which has been used as a medicine for endometriosis, has a valid effect in pretreatment of patients receiving in vitro fertilization and embryo transfer, although its reproductive mechanism remains unclear. BALB/c mice were subcutaneously injected with danazol for 2 weeks. Blood and uteri were collected and cytokines were assayed. Following danazol treatment, an increase in pregnancy ratio was evident that was accompanied by up-regulation in serum macrophage-colony stimulating factor (M-CSF). RT-PCR analysis revealed that expression of M-CSF and Ly49, a phenotypic marker of natural killer (NK) cells, was up-regulated in the uteri of the danazol-treated mice. In immunohistochemical analysis, M-CSF and Ly49, together with alpha5 integrin, were clearly detected in the endometrium of the danazol-treated mice with very similar pattern of localization. These results suggest that danazol has an effect to promote pregnancy that induces recruitment of NK cells and a concomitant increase in the expression of M-CSF and alpha5 integrin in the uterus.
PMID: 17077583 [PubMed – as supplied by publisher] ________________________________________
Hum Reprod. 2006 Oct 31; [Epub ahead of print] Increased telomerase activity and human telomerase reverse transcriptase mRNA expression in the endometrium of patients with endometriosis.
Kim CM, Oh YJ, Cho SH, Chung DJ, Hwang JY, Park KH, Cho DJ, Choi YM, Lee BS.
Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yongdong Severance Hospital, 146-92 Dogok-dong, Kangnam-ku, Seoul, Korea.
BACKGROUND: Endometriosis is considered a frequent, benign disease with the ability to undergo neoplastic processes. The aim of this study was to evaluate the limitless replication potential of the endometrium in patients with endometriosis by examining human telomerase reverse transcriptase (hTERT) mRNA expression and telomerase activity. METHODS: Endometrium samples from 30 endometriosis patients and 30 patients without endometriosis were obtained via endometrial biopsy. The expression of hTERT mRNA was determined by real-time RT-PCR assay, and telomerase activity was measured by telomerase repeat amplification protocol (TRAP) assay. RESULTS: The mean normalized hTERT (N hTERT) mRNA level was significantly higher in the endometriosis than in the control group (P = 0.013). The mean hTERT mRNA levels during the proliferative phase and during the secretory phase were higher in the endometriosis group than in the control group, although the difference was only significant for the secretory phase (P = 0.036). We found a prominent difference in endometrial telomerase activity between moderate-to-severe endometriosis and the control group (P = 0.048). The levels of hTERT mRNA and telomerase activity increased as the disease became more severe (P = 0.038, P = 0.016). CONCLUSIONS: This study showed the overex-pression of hTERT mRNA and telomerase activity in the endometrium of endometriosis patients. These finding suggest that replication potential of endometrial cells may have an important role in the pathogenesis of endometriosis.
PMID: 17077107 [PubMed – as supplied by publisher] ________________________________________
Am J Reprod Immunol. 2006 Nov;56(5-6):364-70.Controlled ovarian hyperstimulation changes the prevalence of serum autoantibodies in in vitro fertilization patients.
Haller K, Sarapik A, Talja I, Salumets A, Uibo R.
Department of Immunology, Institute of General and Molecular Pathology, Centre of Molecular and Clinical Medicine, University of Tartu, Tartu, Estonia.
Problem Autoimmune mechanisms are involved in etiology of female infertility, the medical problem frequently treated by in vitro fertilization (IVF). Controlled ovarian hyperstimulation (COH) with supraphysiological levels of sex hormones is achieved by IVF. Methods of study Anti-human-ovary and eight common autoantibodies [nuclear (ANA-H, ANA-R on human HEp-2 cell line and rodent antigen, respectively), smooth muscle (SMA), parietal cell, thyroid microsomal, mitochondrial, beta2-glycoprotein-I, cardiolipin antibodies] found in IVF patients (n = 129) were analyzed with regard to the number of previous IVF procedures and the age of the patient. The changes in autoimmune reactions caused by the COH were determined. Results Endometriosis and polycystic ovary syndrome were associated with a higher number of common serum autoantibodies compared with the tubal factor infertility (Proportion test, P < 0.05). ANA-R was associated with unexplained infertility [adjusted odds ratio (aOR) 8.79, P = 0.038]. SMA correlated with endometriosis (aOR 37.29, P = 0.008), male factor infertility (aOR 20.45, P = 0.018) and with the previous IVF procedures (aOR 2.87, P = 0.013). There was an overall decrease in the number of detectible autoantibodies after COH (Proportion test, P < 0.05). Conclusion COH may have a suppressive effect on the humoral immunity by the time of embryo transfer but more conclusive studies are needed.
PMID: 17076681 [PubMed – in process]
Ginekol Pol. 2006 Jul;77(7):566-70.[Catamenial pneumothorax] [Article in Polish] Maskey-Warzechowska M, Warzechowski S.
Katedra i Klinika Chorob Wewnetrznych, Pneumonologii i Alergologii AM w Warszawie. firstname.lastname@example.org
Catamenial pneumothorax (CP) is a specific type of secondary spontaneous pneumothorax. It is characterized by a temporal relationship with menses. CP is considered to be the most frequent symptom of thoracic endometriosis. It occurs mainly in women above 30 years of age and is typically right sided. The authors reviewed the current literature on this entity. The hypotheses on its pathogenesis and the diagnostic possibilities and therapeutic options are discussed.
PMID: 17076209 [PubMed – in process] ________________________________________
Ginekol Pol. 2006 Aug;77(8):582-8.[Laparoscopic evaluation following failure to achieve pregnancy after intrauterine inseminations in patients with normal hysterosalpingograms] [Article in Polish] Jedrzejczak P, Serdynska M, Brazert M, Pelesz M, Pawelczyk L.
Klinika Nieplodnosci i Endokrynologii Rozrodu, Katedra Ginekologii i Poloznictwa, Akademia Medyczna im K Marcinkowskiego w Poznaniu.
OBJECTIVES: To assess the diagnostic benefit of laparoscopy in infertile women thought to be at low risk for altered pelvic anatomy. DESIGN: Retrospective chart review. MATERIAL AND METHODS: Patients: 127 infertile patients who underwent laparoscopic evaluation of the pelvis failing to conceive after intrauterine inseminations (IUI) with normal hysterosalpingography (HSG). Intervention: Diagnostic and/or therapeutic laparoscopy. Main outcome measures: Presence of pelvic pathology and predictors of pelvic disease. RESULTS: Although the hysterosalpingograms were read as normal in all women, endometriosis stage I-II was found in 64 (50,4%) patients, stage III and stage IV in 4 (3,1%). Adhaesions were diagnosed laparoscopically in 22 (17%) patients and distal tubal disease in 26 (20%). All of this abnormalities were directly treated by laparoscopic intervention. The time between HSG and laparoscopy was positively correlated with appearance of distal tubal disease and pelvic adhaesions. CONCLUSION: Laparoscopic findings could lead to a change of treatment decisions in high number of infertile patients with normal hysterosalpingography.
PMID: 17076188 [PubMed – in process] ________________________________________
Fertil Steril. 2006 Oct 27; [Epub ahead of print]Umbilical endometriosis, a pathology that a gynecologist may encounter when inserting the Veres needle.
Teh WT, Vollenhoven B, Harris PI.
Department of General Surgery.
OBJECTIVE: To raise awareness between laparoscopists about umbilical endometriosis and to recommend the appropriate management measure for this rare but easily treatable condition. DESIGN: Case reports and literature review. SETTING: Women presented to general surgeon with umbilical masses. PATIENT(S): Women of reproductive age with histologic diagnosis of umbilical endometriosis. INTERVENTION(S): Excision with histopathologic examination. MAIN OUTCOME MEASURE(S): Definite diagnosis and clinical improvement. RESULT(S): Umbilical endometriosis is best diagnosed and cured with excisional biopsy. Other diagnostic methods have been proven to be nonspecific and unreliable in the literature. CONCLUSION(S): Clinical diagnosis of this condition can be difficult even with the aid of cytology and imaging. Surgical excision with removal and histopathology is recommended for both diagnostic and therapeutic purposes. Simultaneous laparoscopy should be recommended to the patient with suspected pelvic endometriosis.
PMID: 17074348 [PubMed – as supplied by publisher] ________________________________________
Fertil Steril. 2006 Nov;86(5):1504-10.Uterine myomas, dyspareunia, and sexual function.
Ferrero S, Abbamonte LH, Giordano M, Parisi M, Ragni N, Remorgida V.
Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Genoa, Italy. email@example.com
OBJECTIVE: To determine the prevalence of deep dyspareunia (DD) and characteristics of sexual life in women with uterine myomas. DESIGN: Cross-sectional survey. SETTING: University hospital. PATIENT(S): Three hundred seven sexually active premenopausal women who underwent surgery because of uterine myomas (group M, n = 132), uterine myomas and ovarian cysts (group MC, n = 84), ovarian cysts (group C, n = 67), and tubal sterilization (group S, n = 24). Exclusion criteria were as follows: endometriosis, pelvic inflammatory disease, interstitial cystitis, and preoperative treatment with GnRH analogues. INTERVENTION(S): Before surgery, patients underwent transvaginal ultrasound; number and characteristics of myomas were recorded. MAIN OUTCOME MEASURE(S): The presence and intensity of DD were determined. Patients completed a sexual-function questionnaire. RESULT(S): Patients included in the four groups had similar DD prevalence and DD intensity. No significant difference was observed in DD prevalence and pain intensity according to the number, position, and size of myomas. Deep dyspareunia intensity was higher in women with fundal and anterior myomas than in those with other myoma positions. No significant difference was observed in sexual function among the four study groups. CONCLUSION(S): Women with uterine myomas do not have increased prevalence or severity of DD; their sexual function is not impaired.
PMID: 17070199 [PubMed – in process] ________________________________________
Fertil Steril. 2006 Nov;86(5):1312-3; discussion 1317. Should a diagnosis of endometriosis be sought in all symptomatic women?
Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom. firstname.lastname@example.org
A tool is needed to enable clinicians to determine whether women wish to seek a pathology-based explanation for chronic pelvic pain or whether they just want symptom relief. Such an approach might reduce the number of unnecessary laparoscopies without adversely affecting outcomes.
PMID: 17070188 [PubMed – in process] ________________________________________ Fertil Steril. 2006 Nov;86(5):1310-1; discussion 1317.Too soon, too late, too often, too seldom?
Division of Advanced Laparoscopy and Pelvic Pain, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill 27599-7570, USA. email@example.com
Many variables determine the appropriate timing of diagnostic laparoscopy for suspected endometriosis. When initial treatments fail to relieve pain attributed to endometriosis, more detailed assessment is often indicated rather than escalation of treatment.
PMID: 17070187 [PubMed – in process] ________________________________________
Fertil Steril. 2006 Nov;86(5):1307-9; discussion 1317.Diagnosis of endometriosis and pelvic pain.
School of Women’s and Infants’ Health, King Edward Memorial Hospital, University of Western Australia, Perth, Western Australia, Australia. firstname.lastname@example.org
Both the American and the Royal Colleges of Obstetricians and Gynecologists have produced guidelines that recommend patients with chronic pelvic pain, including those suspected of having endometriosis, should receive empirical medical therapy without a preliminary diagnostic laparoscopy. This paper reviews the implications of this approach.
PMID: 17070186 [PubMed – in process]