Pag. 11


Int J Immunogenet. 2011 Jun;38(3):259-62. doi: 10.1111/j.1744-313X.2011.01000.x. Epub 2011 Feb 16.

Analysis of CTLA4 gene variant in infertile Brazilian women with and without endometriosis.

Lerner TG, Bianco B, Teles JS, Vilarino FL, Christofolini DM, Barbosa CP.


Division of Pathological Gynecology and Human Reproduction, Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Avenida Príncipe de Gales 821, Santo André/SP, Brazil.


An autoimmune aetiology has been suggested for endometriosis mostly on the basis of an increased prevalence of autoimmune diseases in affected women. Cytotoxic T lymphocyte antigen (CTLA) 4 gene is recognized as a primary determinant for autoimmunity, since specific polymorphisms have been associated with predisposition to most autoimmune disorders. Thus, the objective of the study was to evaluate CTLA4 polymorphism (+49A/G) in a group of infertile women with and without endometriosis and controls. Case-control study comprising 244 infertile women (177 with endometriosis and 67 without endometriosis) and 172 fertile women as controls. CTLA4 polymorphism was identified by qPCR. The results were analysed statistically and a P-value <0.05 was considered significant. We found relatively similar CTLA4 polymorphisms genotype frequencies in women with and without endometriosis and controls (P=0.158 and P=0.262, respectively). When the patients with minimal/mild endometriosis and moderate/severe endometriosis were studied separately, no difference was also found related to controls (P=0.560 and P=0.11, respectively). The data suggest that the CTLA4 polymorphism is not associated with endometriosis and/or infertility in Brazilian women.

J Obstet Gynaecol Res. 2011 May 22. doi: 10.1111/j.1447-0756.2011.01551.x. [Epub ahead of print]

T-cell receptor beta polymorphism is not associated with endometriosis.

Tripputi P, Bignotto M, Cigognini D, Bianchi S, Fedele L.


Departments of Medicine, Surgery and Dentistry Human Morphology and Biomedical Sciences Obstetrics and Gynecology, San Giuseppe Hospital Department of Obstetrics and Gynecology, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.


We carried out an association study between T-cell receptor beta polymorphism (TCRB) and Aim: endometriosis to investigate the difference in allelic frequency. Polymorphisms in T-cell receptor genes can provide important information for the study of the immune response and autoimmune diseases; indeed, rs1800907, a very common single nucleotide polymorphism (SNP) of the TCRB, has been extensively studied in autoimmune diseases in the 1990s using Southern blot analysis and more recently polymerase chain reaction (PCR) and sequencing. An autoimmune etiology for endometriosis  We investigated 70 patients with has been strongly suggested for the presence of antibodies against endometrium, high rates of autoimmune disorders and associated atopic diseases. Material and Methods: endometriosis  We performed an association study of the SNP rs1800907 of TCRB between 70 patients with and 120 controls. DNA of patients and controls was studied by PCR followed by restriction digestion and sequencing to determine genotype and presence of linkage disequilibrium (LD). Statistical analysis was carried out using STATA Routine GENHW (StataCorp, College Station, TX, USA) for estimation of Hardy-Weinberg equilibrium and test power calculation. The difference of allele distribution between patients and controls was calculated according to Pearson’s and Fisher’s tests. Test power for the estimation of linkage disequilibrium is low (0.16). Results: endometriosis  Our study does not suggest an evidential and major involvement of TCRB in the pathogenesis of 0.87). Fisher’s test confirmed a P-value of 0.872. Conclusion: = 0.27 and P = and 120 controls, and did not find any significant difference (χ(2)  endometriosis in an Italian population in a small case control study.

Gynecol Obstet Fertil. 2011 Jun;39(6):339-45. Epub 2011 May 18.

Computed tomography-based virtual colonoscopy: an examination useful for the choice of the surgical management of colorectal endometriosis.

[Article in French]

Vassilieff M, Suaud O, Collet-Savoye C, Da Costa C, Marouteau-Pasquier N, Belhiba H, Tuech JJ, Marpeau L, Roman H.


Clinique gynécologique et obstétricale, CHU Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France.



To evaluate the use of computed tomography-based virtual colonoscopy in the preoperative assessment of colorectal endometriosis.


We included in the study consecutive women undergoing surgical management of deep infiltrating endometriosis from August 2009 to April 2010, whose colorectal involvement had been assessed by magnetic resonance imaging (MRI) and rectal endoscopic sonography (RES). Prior to surgical procedure, a computed tomography-based virtual coloscopy was performed. Computed tomography was performed by insufflating air into the distal rectum, along with an intravenous injection of contrast agent. Then, 3D reconstruction of pictures was carried out, to allow visualization of the lumen of the rectum and the colon. Data provided by virtual colonoscopy were compared to those given by other imaging techniques and surgical exploration.


Twenty-seven patients were included in the study: 7 women underwent colorectal segmental resection, 2 full thickness excision, 15 shaving, while in 3 of them no digestive surgical step was performed. Virtual colonoscopy provided the measurement of the length and the diameter of colorectal stenosis due to infiltrating nodule through rectal and sigmoid wall, which was presenting as an endoluminal indentation. The number of patients presenting with endometriotic nodules arising on the rectum, sigmoid colon, or both of them, were respectively 13, 7 and 7. Ovarian endometriomas were responsible for extrinsic compression leading to digestive tract stenosis in nine cases. The number of lesions and their height reported to the anus were accurately assessed in 24 women out of 27 (sensitivity of 88%). The origin of the digestive tract stenosis, i.e. either infiltrating endometriotic nodules or extrinsic compression due to ovarian endometriomas, was accurately assessed in all cases, by combining information provided by virtual colonoscopy, IRM, RES and transvaginal ultrasonography.


Computed tomography-based virtual colonoscopy provides useful information about the degree and the height of digestive tract stenosis due to colorectal endometriosis. In our opinion, this information is of major interest to argue the choice of shaving or full thickness excision of nodules in a majority of women presenting with colorectal endometriosis.

Br J Pharmacol. 2011 May 19. doi: 10.1111/j.1476-5381.2011.01497.x. [Epub ahead of print]

Δ(9) -THC and N-arachidonyl glycine are full agonists at GPR18 and cause migration in the human endometrial cell line, HEC-1B.

McHugh D, Page J, Dunn E, Bradshaw HB.


Department of Psychological and Brain Sciences, Indiana University. Bloomington, IN Kinsey Institute for the Study of Sex, Gender and Reproduction.


Background and purpose: Endometriosis is a disorder in which the endometrium forms growths outside the uterus and is associated with chronic pain. Recent evidence suggests that endometrial motility may play a role in the eitology of the disease. The endogenous cannabinoid (eCB) system regulates cellular migration. Given the growing understanding of the involvement of the eCB system in reproduction, we investigated the specific role of eCB in endometrial cell migration. Experimental approach: Migration assays were performed on the human endometrial cell line, HEC-1B. Standard PCR techniques were used to determine the presence of GPR18 in HEC-1B cells, and p44/42 MAP kinase assays were performed using a stability transfected GPR18-HEK to determine receptor specificity for established cannabinoid agonists and antagonists. AEA metabolism assays were performed using HPLC/MS/MS for lipid analysis. Key results: AEA, delta 9-THC, and NAGly potently drive migration of HEC-1B cells through CB(1) -independent mechanisms. MAPK activation in GPR18-HEK cells reveal novel pharmacology for traditional CB(1) and CB(2) ligands at GPR18 receptors including delta 9-THC, which drives MAPK activation at nanomolar concentrations, whereas WIN 55212-2, CP55940, JWH-133 and JWH-015, and R1meth-AEA had no effect. Moreover, HEC-1B migration and MAPK activation by NAGly and delta 9-THC were antagonized by PTX, AM251 and CBD. Conclusions and implications: An understanding of the function and regulation of GPR18 and its molecular interactions with endogenous ligands, and how phytocannabinoids play a role with GPR18 signaling is vital if we are to comprehensively assess the function of the cannabinoid signaling system in human health and disease.

Arch Gynecol Obstet. 2011 May 19. [Epub ahead of print]

Clear cell adenocarcinoma of the ovary arising in atypical endometriosis: a report of eight cases.

Terada T.


Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231, Shimizu-Ku, Shizuoka, 424-8636, Japan,



Studies of clear cell adenocarcinoma of the ovary (CCAO) arising from endometriosis are scant.


The author reviewed 13 cases CCAO of our pathology laboratory for the presence of endometriosis within the tumor. Eight (61.5%) of the 13 tumors contained endometriosis within the tumor. Of the eight cases, seven were atypical endometriosis and one was ordinary endometriosis. The age of the eight patients with CCAO ranged from 35 to 82 years with a median of 52 years.


Grossly, the ovarian tumors of CCAO were characterized by unilocular cystic lesions containing solitary or multiple nodules in the inner surfaces. The outer surface was smooth and free of tumor. Histologically, the nodules showed typical features of pure CCAO with clear cells, hobnail cells, and hyalinized stroma. The non-nodular flat areas of the tumor were composed of a layer of atypical clear cells and endometriosis consisting of a layer of endometrial epithelium and endometrial stroma. Incipient foci of CCAO were occasionally recognized in the atypical clear cells. Seven cases with endometriosis showed atypia of the endometrial epithelium (atypical endometroiosis), and one case showed no atypia. There was contiguity between the CCAO and atypical clear cells and between atypical clear cells and endometriosis. Contiguity between atypical endometriosis and CCAO was also recognized in a few areas. The outer surface was devoid of tumor cells and endometriosis.


The author speculates as follows. An endometrial cyst develops in the ovary. Its epithelium undergoes initiation, thus giving rise to atypical endometriosis consisting of dysplastic or intraepithelial neoplastic epithelium. The atypical endometriosis further undergoes initiation, leading to the atypical clear cells, and ultimately leads to CCAO showing a unilocular cyst consisting of inner masses of CCAO and flat areas composed of a layer of atypical clear cells with incipient CCAO and atypical endometriosis.

Kyobu Geka. 2011 May;64(5):430-3.

Catamenial pneumothorax due to diaphragmatic endometriosis confirmed by histological examination; report of a case.

[Article in Japanese]

Segawa M, Touge M, Kusajima Y, Saito K.


Department of Respiratory and Vascular Surgery, Toyama City Hospital, Toyama, Japan.


We reported a case of catamenial pneumothorax caused by diaphragmatic endometriosis that was histologically confirmed. A 49-year-old female who had recurrent chest pain and cough appearing on the day preceding each menstruation from 5 years ago. These episode suggested catamenial pneumothorax. Thoracotomy revealed the characteristic appearances of catamenial pneumothorax such as blueberry spots and multiple small holes on the central tendon of the right diaphragm. But there were no lesions on the visceral pleura of the lung. Partial resection of the diaphragm including these lesions were performed. Histological examination showing positive for estrogen receptor and progesterone receptor confirmed the presence of endometrial tissue on the diaphragm. The patient has been well controlled by therapy with gonadotropin releasing hormone, without recurrence of catamenial pneumothorax.

J Pathol. 2011 Jul;224(3):328-33. doi: 10.1002/path.2911. Epub 2011 May 18.

Loss of BAF250a (ARID1A) is frequent in high-grade endometrial carcinomas.

Wiegand KC, Lee AF, Al-Agha OM, Chow C, Kalloger SE, Scott DW, Steidl C, Wiseman SM, Gascoyne RD, Gilks B, Huntsman DG.


The Center for Translational and Applied Genomics (CTAG) at the British Columbia (BC) Cancer Agency, Vancouver, BC, Canada.


Mutation of the ARID1A gene and loss of the corresponding protein BAF250a has recently been described as a frequent event in clear cell and endometrioid carcinomas of the ovary. To determine whether BAF250a loss is common in other malignancies, immunohistochemistry (IHC) for BAF250a was performed on tissue microarrays (TMAs) in more than 3000 cancers, including carcinomas of breast, lung, thyroid, endometrium, kidney, stomach, oral cavity, cervix, pancreas, colon and rectum, as well as endometrial stromal sarcomas, gastrointestinal stromal tumours, sex cord-stromal tumours and four major types of lymphoma (diffuse large B cell lymphoma, primary mediastinal B cell lymphoma, mantle cell lymphoma and follicular lymphoma). We found that BAF250a loss is frequent in endometrial carcinomas but infrequent in other types of malignancies, with loss observed in 29% (29/101) of grade 1 or 2 and 39% (44/113) of grade 3 endometrioid carcinomas of the endometrium, 18% (17/95) of uterine serous carcinomas and 26% (6/23) of uterine clear cell carcinomas. Since endometrial cancers showed BAF250a loss, we stained whole tissue sections for BAF250a expression in nine cases of atypical hyperplasia and 10 cases of atypical endometriosis. Of the nine cases of complex atypical endometrial hyperplasia, all showed BAF250a expression; however, of 10 cases of atypical endometriosis (the putative precursor lesion for ovarian clear cell and endometrioid carcinoma), one case showed loss of staining for BAF250a in the atypical areas, with retention of staining in areas of non-atypical endometriosis. This was the sole case that recurred as an endometrioid carcinoma, indicating that BAF250a loss may be an early event in carcinogenesis. Since BAF250a loss is seen in endometrial carcinomas at a rate similar to that seen in ovarian carcinomas of clear cell and endometrioid type, and is uncommon in other malignancies, we conclude that loss of BAF250a is a particular feature of carcinomas arising from endometrial glandular epithelium.

Iran J Nurs Midwifery Res. 2010 Fall;15(4):167-71.

The effects of massage therapy on dysmenorrhea caused by endometriosis.

Valiani M, Ghasemi N, Bahadoran P, Heshmat R.


Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.



Studying women’s quality of life, we come across some harmful effects that factor such as dysmenorrhea caused by endometriosis leaves on their lives, their ability to work, their familial relations, and their self-confidence. Due to the repeated medical follow-ups and the side effects of medical therapies and endometriosis surgeries, many patients tend to use less expensive, nonmedical, and nonaggressive methods. The present study aimed to assess the effects of massage therapy, one of the aforementioned methods on endometriosis caused dysmenorrhea.


This was a semi-empirical clinical trial. Considering inclusion criteria, 23 patients suffering from endometriosis visited the Infertility Center of Isfahan, who were later confirmed by laparoscopy or laparotomy were picked as the sample through a simple method. The visual analog scale and McGill questionnaires were used once before and twice after the end of intervention for each patient. The data were analyzed using SPSS software.


There was a statistically significant difference between the intensity of pain before the intervention started, immediately after, and also six weeks after it (p < 0.001).


According to the results of this study and confirmations of other ones, it seems that massage therapy can be a fitting method to reduce the menstrual pain caused by endometriosis.

Endocrinology. 2011 Aug;152(8):3226-32. Epub 2011 May 17.

Treatment with bazedoxifene, a selective estrogen receptor modulator, causes regression of endometriosis in a mouse model.

Kulak J Jr, Fischer C, Komm B, Taylor HS.


Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, 333 Cedar Street, New Haven, Connecticut 06510.


Endometriosis is a common estrogen-dependent disorder. Medical treatments currently consist of progestins or GnRH agonists; however, neither is fully effective and both entail significant side effects. Selective estrogen receptor (ER) modulators (SERM) have tissue-selective actions, acting as an ER agonist in some tissues and ER antagonist in others. The SERM bazedoxifene (BZA) effectively antagonizes estrogen-induced uterine endometrial stimulation without countering estrogenic effects in bone or central nervous system. These properties make it an attractive candidate for use in the treatment of endometriosis. Experimental endometriosis was created in reproductive-age CD-1 mice. After 8 wk, 10 animals received ip injections of BZA (3 mg/kg·d) for 8 wk, whereas 10 received vehicle control. Mice were killed, and implant size was assessed. The mean size of the implants after treatment was 60 mm(2) in the control group and 21 mm(2) in the BZA treatment group (P = 0.03). Quantitative PCR and immunohistochemical analysis were used to determine the effect on endometrial gene expression. PCNA, ERα, and LIF mRNA and protein expression were significantly decreased in endometrium of the treated group. Caspase 3 mRNA expression was increased. Expression of PR and Hoxa10 were not significantly altered by treatment. There was no evidence of ovarian enlargement or cyst formation. Decreased PCNA and ER expression demonstrated that the regression of endometriosis likely involved decreased estrogen-mediated cell proliferation. BZA may be an effective novel agent for the treatment of endometriosis due to greater endometrial-specific estrogen antagonism compared with other SERM.

Hum Reprod Update. 2011 May 17. [Epub ahead of print]

Vasculogenesis: a new piece of the endometriosis puzzle.

Laschke MW, Giebels C, Menger MD.


Institute for Clinical & Experimental Surgery, University of Saarland, D-66421 Homburg/Saar, Germany.


BACKGROUND Endometriosis is a complex disease with a multifactorial pathogenesis, which is crucially dependent on the development of new blood vessels. Based on the current literature, the present review highlights the fact that the neovascularization of endometriotic lesions is not only driven by angiogenesis, but also involves de novo formation of microvessels from circulating endothelial progenitor cells (EPCs). This process, termed post-natal vasculogenesis, is a characteristic of various pathogenic conditions, such as tumour growth and atherosclerosis, and typically comprises the activation, mobilization and recruitment of bone marrow-derived EPCs to the sites of tissue hypoxia. METHODS Literature searches were performed in PubMed, MEDLINE and ISI Web of Knowledge for publications focusing on vasculogenesis in the endometrium and endometriotic lesions. RESULTS Recent studies indicate that up to 37% of the microvascular endothelium of ectopic endometrial tissue originates from EPCs, partly controlled by the stromal-cell-derived factor-1/chemokine receptor type 4 axis. Accordingly, blockade of EPC recruitment effectively inhibits the formation of microvascular networks in developing endometriotic lesions, indicating that vasculogenesis represents an integral part of the pathogenesis of endometriosis. CONCLUSIONS The involvement of vasculogenesis in endometriosis may offer the exciting opportunity for the future establishment of novel diagnostic and therapeutic strategies for this frequent gynaecological disease.

Mol Hum Reprod. 2011 May 16. [Epub ahead of print]

Coding regions of INHBA, SFRP4 and HOXA10 are not implicated in familial endometriosis linked to chromosome 7p13-15.

Lin J, Zong L, Kennedy SH, Zondervan KT.


Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom.


Endometriosis is a common, chronic gynaecological disease affecting up to 10% of women in their reproductive years. Its aetiology still remains unclear, but evidence indicates genetic factors play a role. We previously identified a region of significant linkage on chromosome 7 in 52 families comprising at least three affected women, stretching approximately 6.4 Mb. We screened coding regions and parts of the regulatory regions of three candidate genes with a known role in endometrial development and function – INHBA, SFRP4 and HOXA10 – located under or very near the linkage peak, for potential causal mutations using Sanger sequencing. Sequencing was conducted in 47 cases from the 15 families contributing most to the linkage signal (Zmean ≥ 1). Minor allele frequencies (MAF) of observed variants were compared with MAFs from two publicly available reference populations of European ancestry: 60 individuals in HapMap and 150 individuals in the 1000 Genomes Project. A total of 11 variants were found, five (45%) of which were common (MAF >0.05) among the 15 case families and the reference populations (P values for MAF difference: 0.88-1.00). The remaining six were rare and unlikely to be individually or cumulatively responsible for the linkage signal. The results indicate that the coding regions of these three genes do not harbour mutations responsible for linkage to endometriosis in these families.

Fertil Steril. 2011 Jun 30;95(8):2722-2724.e1. Epub 2011 May 14.

High prevalence of endometrial polyps in endometriosis-associated infertility.

Shen L, Wang Q, Huang W, Wang Q, Yuan Q, Huang Y, Lei H.


Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, People’s Republic of China.


In a retrospective study, examination of 431 infertile women (158 cases with endometriosis and 273 without endometriosis) showed a significantly increased frequency of endometrial polyps in patients with endometriotic infertility and no significant differences among different stages and locations of endometriosis. Hysteroscopic polypectomy and removal of endometriotic foci significantly increased the chances of achieving a pregnancy compared with those without polyps.

Fertil Steril. 2011 Jul;96(1):e42-4. Epub 2011 May 14.

Pelviperitonitis by colorectal perforation in the third trimester of pregnancy after surgery for deep pelvic endometriosis.

Boileau L, Borie F, Laporte S, Tailland ML, Mares P, de Tayrac R.


Department of Obstetrics and Gynecological Surgery, CHU Nimes, Nîmes, France.



To report a severe complication after colorectal resection for rectovaginal endometriosis.


Case report.


University hospital.


A 37-year-old patient treated with colorectal resection 3 years ago for rectovaginal endometriosis was admitted with a rectal perforation at 37 weeks’ gestation.


Caesarean section and simple interrupted stitch of the perforation by absorbable Vicryl.


Determination of the cause of the perforation in healthy rectal tissue above the anastomosis.


The most likely mechanism was secondary colonic hyperpressure owing to stenosis of the colorectal anastomosis.


Young patients planning to conceive but scheduled to undergo colorectal resection should be made aware of the significant complication rate associated with this procedure and the promising results of nodule excisions. We recommend close monitoring of patients suffering from chronic constipation after resection for rectosigmoid endometriosis.

J Coll Physicians Surg Pak. 2011 May;21(5):304-5.

Endometriosis: a rare cause of appendicitis.

Salati SA, Raza AA.


Department of Surgery, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir.


Endometriosis is a relatively common disorder affecting about 15% females in the reproductive age group. It is a wellknown cause of infertility but endometriosis presenting as appendicitis is rare. We present a case of a 29 years old nulliparous lady in whom appendectomy was done for appendicitis and histopathological examination of the retrieved specimen revealed endometriosis.

Harefuah. 2011 Mar;150(3):255-9, 303.

Oxidation and female reproduction: the good, the bad and what’s between.

[Article in Hebrew]

Wiener-Megnazi Z, Reznick AZ, Lahav-Baratz S, Shiloh H, Koifman M, Grach B, Arnon T, Avraham L, Auslander R, Dirnfeld M.


Fertility and IVF Unit, Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa.


Reactive oxygen and nitrogen species constitute an inseparable part of aerobic life on earth. They have been known to science for about 90 years, but only during the last 50 years research in this field has expanded. Initially, scientists focused on the free radicals-induced damage to biological systems. Since the eighties, a new concept has emerged, namely, that alongside the oxidative stress-induced deleterious effect and its association with a variety of diseases, a certain threshold level of oxidation is essential to intracellular signaL transduction. Recently, some data has accumulated regarding the involvement of oxidative processes in various aspects of female reproduction, including ovarian function, fertilization, early development of the embryo and implantation. Nevertheless, there is still a long way before comprehensive and thorough understanding of their role, both at the molecular level and the expression in the clinical setup of fertility patients can be achieved. In this article, we shall address some molecular biochemical processes involved in the activity of free radicals, and review the present knowledge regarding their role in female fertility, including ovarian physiology, follicular and oocyte maturation, development of the early embryo and implantation, as well as their association with reproductive pathologies such as endometriosis, polycystic ovary disease and recurrent pregnancy loss.

BMC Womens Health. 2011 May 11;11:14.

Effectiveness of ovarian suspension in preventing post-operative ovarian adhesions in women with pelvic endometriosis: A randomised controlled trial.

Hoo WL, Saridogan E, Cutner A, Pandis G, Jurkovic D.


Department of Obstetrics and Gynaecology, University College Hospital, 235 Euston Road, London, NW1 2BU, UK.




Endometriosis is a common benign condition, which is characterized by the growth of endometrial-like tissue in ectopic sites outside the uterus. Laparoscopic excision of the disease is frequently carried out for the treatment of severe endometriosis. Pelvic adhesions often develop following surgery and they can compromise the success of treatment. Ovarian suspension (elevating both ovaries to the anterior abdominal wall using a Prolene suture) is a simple procedure which has been used to facilitate ovarian retraction during surgery for severe pelvic endometriosis. The study aims to assess the effect of temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis on the prevalence of post-operative ovarian adhesions.


A prospective double blind randomised controlled trial for patients with severe pelvic endometriosis requiring extensive laparoscopic dissection with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion will be confirmed at surgery. Patients unable to provide written consent, inability to tolerate a transvaginal ultrasound scan, unsuccessful surgeries or suffer complications leading to oophorectomies, bowel injuries or open surgery will be excluded.Both ovaries are routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each participant will be randomised to having only one ovary suspended post-operatively. A new transabdominal suture will be reinserted to act as a placebo. Both sutures will be cut 36 to 48 hours after surgery before the woman is discharged home. Three months after surgery, all randomised patients will have a transvaginal ultrasound scan to assess for ovarian mobility. Both the patients and the person performing the scan will be blinded to the randomisation process.The primary outcome is the prevalence of ovarian adhesions on ultrasound examination. Secondary outcomes are the presence, intensity and site of post-operative pain.


This controlled trial will provide evidence as to whether temporary ovarian suspension should be included into the routine surgical treatment of women with severe pelvic endometriosis.

Curr Med Chem. 2011;18(17):2554-65.

Inhibitors of aldo-keto reductases AKR1C1-AKR1C4.

Brožič P, Turk S, Rižner TL, Gobec S.


Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.


The AKR1C aldo-keto reductases (AKR1C1-AKR1C4) are enzymes that interconvert steroidal hormones between their active and inactive forms. In this manner, they can regulate the occupancy and trans-activation of the androgen, estrogen and progesterone receptors. The AKR1C isoforms also have important roles in the production and inactivation of neurosteroids and prostaglandins, and in the metabolism of xenobiotics. They thus represent important emerging drug targets for the development of agents for the treatment of hormone-dependent forms of cancer, like breast, prostate and endometrial cancers, and other diseases, like premenstrual syndrome, endometriosis, catamenial epilepsy and depressive disorders. We present here the physiological roles of these enzymes, along with their structural properties and an overview of the recent developments regarding their inhibitors. The most important strategies of inhibitor design are described, which include the screening of banks of natural compounds (like cinnamic acids, flavonoids, jasmonates, and related compounds), the screening of and structural modifications to non-steroidal anti-inflammatory drugs, the substrate-inspired design of steroidal and nonsteroidal inhibitors, and computer-assisted structure-based inhibitor design.

Ginekol Pol. 2011 Feb;82(2):102-7.

ACE I/D polymorphism in Polish patients with endometriosis.

Kowalczyńska LJ, Tomasz F, Wojciechowski M, Mordalska A, Pogoda K, Malinowski A.


Department of Biology and Medical Genetics, Medical University of Łódź, Poland.



To analyse I/D polymorphism of ACE gene in women with diagnosed endometriosis and to determine the correlation of the identified genotypes with the stage of the disease and its clinical picture.


The analysis of ACE I/D gene polymorphism was performed in a group of 121 women with endometriosis and in the control group of 122 women. In the study group the stage of the disease, number of pathological foci, occurrence of chronic pain in pelvis minor and infertility were taken into consideration.


In the study group the following distribution was found of ACE gene genotypes: II-25.62%, ID-47.93%, DD–26.45%, whereas in the control group: II–35.25%, ID–41.80%, DD–22.95%. The comparison of the frequency of analysed genotypes and alleles between the study and control groups did not demonstrate statistically significant differences (p > 0.05). Similarly no correlation was found for these parameters when the four stages of the disease acc. to rAFS (p > 0.05) were compared. In the study group the frequency was compared of the analysed ACE gene genotypes and alleles in women with infertility (n = 59) and in fertile women (n = 62). The comparison of these parameters did not demonstrate statistically significant differences between the analysed groups (p > 0.05). The frequency of genotype II was 17.07%, ID–46.34% and DD–36.59% in women with endometriosis complaining of pain (n=41). In the group of women with endometriosis without pain the frequency of the investigated genotypes (II, ID, DD) was respectively: 26.53%, 59.18%, 14.29%. DD genotype and D allele were more frequent in patients with pain complaints (p < 0.05).


In analysed population no association was found of ACE I/D polymorphism and the prevalence of endometriosis, its stages or the number of disease foci. However the association of DD genotype and D allele with the occurrence of pain within pelvis minor in women with endometriosis was found.


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