Pag. 12


Colorectal Dis. 2011 Jun;13(6):e104-11. doi: 10.1111/j.1463-1318.2011.02599.x.

Transvaginal specimen extraction in colorectal surgery: current state of the art.

Diana M, Perretta S, Wall J, Costantino FA, Leroy J, Demartines N, Marescaux J.


IRCAD/EITS, University Hospital of Strasbourg, Strasbourg, France.



Background: The expected benefit of transvaginal specimen extraction is reduced incision-related morbidity.


A systematic review of transvaginal specimen extraction in colorectal surgery was carried out to assess this expectation.


Search strategy: The following keywords, in various combinations, were searched: NOSE (natural orifices specimen extraction), colorectal, colon surgery, transvaginal, right hemicolectomy, left hemicolectomy, low anterior resection, sigmoidectomy, ileocaecal resection, proctocolectomy, colon cancer, sigmoid diverticulitis and inflammatory bowel diseases. Selection criteria: Selection criteria included large bowel resection with transvaginal specimen extraction, laparoscopic approach, human studies and English language. Exclusion criteria were experimental studies and laparotomic approach or local excision. All articles published up to February 2011 were included.


Twenty-three articles (including a total of 130 patients) fulfilled the search criteria. The primary diagnosis was colorectal cancer in 51% (67) of patients, endometriosis in 46% (60) of patients and other conditions in the remaining patients. A concurrent gynaecological procedure was performed in 17% (22) of patients. One case of conversion to laparotomy was reported. In two patients, transvaginal extraction failed. In left- and right-sided resections, the rate of severe complications was 3.7% and 2%, respectively. Two significant complications, one of pelvic seroma and one of rectovaginal fistula, were likely to have been related to transvaginal extraction. The degree of follow up was specified in only one study. Harvested nodes and negative margins were adequate and reported in 70% of oncological cases.


Vaginal extraction of a colorectal surgery specimen shows potential benefit, particularly when associated with a gynaecological procedure. Data from prospective randomized trials are needed to support the routine use of this technique.

Fertil Steril. 2011 Jul;96(1):102-6. Epub 2011 May 11.

Involvement of estrogen receptor-related receptors in human ovarian endometriosis.

Cavallini A, Resta L, Caringella AM, Dinaro E, Lippolis C, Loverro G.


Laboratory of Biochemistry, National Institute for Digestive Diseases, I.R.C.C.S. Saverio de Bellis, Castellana Grotte, Bari, Italy.



To determine whether decreased estrogen receptor alpha (ER-α) expression in endometriotic lesions could be balanced by an increased expression of estrogen receptor-related receptors (ERRs). To evaluate whether ERR-α expression is influenced by hormonal change in fertile and menopausal women.


Prospective controlled study.


University Hospital, Department of Gynecology.


Twenty-five women: 20 women of reproductive age with (n = 10) and without (control; n = 10) endometriosis and 5 menopausal women.


Real-time polymerase chain reaction (qPCR). Immunohistochemistry.


The ER and ERR expression levels were studied by reverse transcriptase-qPCR, ELISA, and immunohistochemistry using endometriotic and normal endometrial tissues. The ERR-α protein distribution was performed by immunohistochemistry in fertile and menopausal women.


Increased levels of ER-β were associated with ER-α, ERR-α, and ERR-γ reductions in ectopic tissue but not in eutopic and normal endometria. Similar levels of ERR-β were found in women with and without endometriosis. The ERR-α expression was similar in proliferative and secretory endometrial samples, whereas a down-regulation of this receptor was found in atrophic tissue.


Our data confirm the up-regulation of ER-β as the principal receptor involved in the progression of human endometriosis. In addition, we found that ERR-α seems to be unresponsive to hormonal changes during the menstrual cycle.

Arch Gynecol Obstet. 2011 May 10. [Epub ahead of print]

Epigenetic inactivation of hMLH1 in the malignant transformation of ovarian endometriosis.

Ren F, Wang D, Jiang Y, Ren F.


Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China,



To investigate the role of epigenetic inactivation of hMLH1 during the malignant transformation of ovarian endometriosis (EMs), and to explore the relationship between the epigenetic inactivation of hMLH1 in eutopic endometria and the malignant transformation of ovarian EMs.


The target tissue from 29 cases of the endometriosis-associated ovarian carcinoma (EAOC) group, 20 cases of EMs group and 16 cases of control endometrium (CEs) group was obtained by laser capture microdissection (LCM). The methylation statue of hMLH1 promoter was determined by methylation-specific PCR (MSP) and the protein expression of hMLH1 was analysed by immunohistochemistry.


The frequency of promoter hypermethylation of hMLH1 in the neoplastic tissue or ectopic endometria of the EAOC group was higher than that of the EMs group (p < 0.05), and the frequency of promoter hypermethylation of hMLH1 in eutopic endometria of the EAOC group was higher than that of the EMs and CEs groups (p < 0.05). In addition, the protein expression of hMLH1 in eutopic endometria of the EAOC group was lower than that of the EMs and CEs group (p < 0.05), and absence of hMLH1 protein expression was significantly correlated with promoter hypermethylation of the gene.


Epigenetic inactivation of hMLH1 was an early event in the malignant transformation of ovarian EMs. Epigenetic inactivation of hMLH1 in eutopic endometria was synchronous with that in ectopic endometria and the epigenetic inactivation of hMLH1 in eutopic endometria of EMs might be a potential molecular tool for early diagnosis of the malignant transformation of ovarian EMs.

Curr Pain Headache Rep. 2011 May 10. [Epub ahead of print]

Endometriosis and Headache.

Stovner LJ, Aegidius K, Linde M.


Norwegian National Headache Centre, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim University Hospital, 7006, Trondheim, Norway,


Headache and endometriosis show some similarities in their clinical and epidemiological features that are probably due to the influence of female sexual hormones on both disorders. Epidemiological studies indicate that they are comorbid disorders. However, the nature of the comorbidity is not known with certainty, but a likely explanation may be common susceptibility genes. Another possibility is that, because they both are related to pain, increased pain sensitivity induced by one of the disorders may lead to a higher likelihood of developing the other, possibly mediated by nitrogen oxide or prostaglandins. A common link to the widespread use of estroprogestins may seem less probable. For physicians dealing with women with either of these disorders, awareness of the comorbidity may be helpful in the treatment of the patient.

G Chir. 2011 Apr;32(4):199-202.

L’endometriosi inguinale. Case report e revisione della letteratura.

[Article in Italian]

Casarotto A, Cerofolini A, Landoni L, Contin F, Chiappetta A, Rebonato M.


Versione italiana Riassunto: L’endometriosi inguinale. Case report e revisione della letteratura. A. Casarotto, A. Cerofolini, L. Landoni, F. Contin, A. Chiappetta, M. Rebonato L’endometriosi è una patologia relativamente frequente che colpisce donne in età fertile ed è caratterizzata dalla presenza di tessuto endometriale ectopico che risponde agli stimoli ormonali del normale ciclo mestruale. L’etiologia è tuttora sconosciuta e la sintomatologia è piuttosto aspecifica. La diagnosi si basa sull’utilizzo dell’esame ultrasonografico, caratterizzato da elevata sensibilità e specificità, e della RMN. L’approccio laparoscopico, associato o meno alla terapia medica pre- e post-chirurgica, rappresenta il trattamento terapeutico di scelta. Viene presentato un caso di una giovane donna giunta alla nostra osservazione per la presenza di una massa in regione inguinale, rivelatasi poi sede di focolaio endometriosico. Tale caso ha suggerito la revisione della letteratura scientifica internazionale, con particolare attenzione alle metodiche diagnostiche e alla relazione esistente fra endometriosi tumore ovarico, soprattutto con i sottotipi endometrioide (EAC) e a cellule chiare (CCC). English version Summary: Inguinal endometriosis. Case report and review of the literature. A. Casarotto, A. Cerofolini, L. Landoni, F. Contin, A. Chiappetta, M. Rebonato Endometriosis is a common gynaecological condition which affects women during their reproductive years. It is characterized by ectopic endometrial tissue responding to hormonal changes associated with menstrual cycle. Aetiology is unknown and symptoms are quite aspecific (dysmenorrhoea, pelvic pain, infertility or pelvic mass). Ultrasonography (US) and Magnetic Resonance Imaging (MRI) are accurate diagnostic exams but laparoscopy represents the gold standard in diagnosis and therapy (excision or ablation). Medical treatment pre or postoperatively may be useful prolonging the symptom free interval. In this paper we report the case of a young woman affected by an inguinal mass: diagnostic examinations and histological speciment revealed to be an endometrial focus. We review the literature focusing the diagnostic techniques and relationships between endometriosis and ovarian cancer (endometrioid and clear cell subtypes).

Ann Diagn Pathol. 2011 May 5. [Epub ahead of print]

Unilateral pelvic mass presenting in postmenopausal patients: report of two unusual cases.

Hansen K, Simon RA, Lawrence WD, Quddus MR.


We encountered 2 unusual cases of polypoid endometriosis presenting as unilateral ovarian masses. The first was benign and was found in a 57-year-old postmenopausal patient; the second case gave rise to well-differentiated endometrioid carcinoma in an 80-year-old patient. The second patient also had a superficially invasive endometrioid adenocarcinoma of the endometrium arising in a background of complex atypical hyperplasia. Intraoperative evaluation was requested in both cases.

Fertil Steril. 2011 Jun 30;95(8):2735-7. Epub 2011 May 5.

In vitro fertilization outcomes in Hispanics versus non-Hispanic whites.

Shuler A, Rodgers AK, Budrys NM, Holden A, Schenken RS, Brzyski RG.


Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.


The in vitro fertilization (IVF) outcomes, including clinical intrauterine gestation rate and live birth rate, between Hispanic and non-Hispanic white women were compared, and there were no differences. Hispanics were more likely to have a diagnosis of tubal factor infertility, whereas non-Hispanic white women were more likely to have endometriosis as their infertility diagnosis.

J Obstet Gynaecol Can. 2010 Jul;32(7 Suppl 2):S1-32.

Endometriosis: diagnosis and management.

Leyland N, Casper R, Laberge P, Singh SS; SOGC.


Objective: To improve the understanding of endometriosis and to provide evidence-based guidelines for the diagnosis and management of endometriosis. Outcomes: Outcomes evaluated include the impact of the medical and surgical management of endometriosis on women’s experience of morbidity and infertility. Methods: Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of both location in Canada and type of practice, as well as subspecialty expertise along with general gynaecology background. The committee reviewed all available evidence in the English and French medical literature and available data from a survey of Canadian women. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. Results: This document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of endometriosis. The resulting recommendations may be adapted by individual health care workers when serving women with this condition. Conclusions: Endometriosis is a common and sometimes debilitating condition for women of reproductive age. A multidisciplinary approach involving a combination of lifestyle modifications, medications, and allied health services should be used to limit the impact of this condition on activities of daily living and fertility. In some circumstances surgery is required to confirm the diagnosis and provide therapy to achieve the desired goal of pain relief or improved fecundity. Women who find an acceptable management strategy for this condition may have an improved quality of life or attain their goal of successful pregnancy. Evidence: Medline and Cochrane databases were searched for articles in English and French on subjects related to endometriosis, pelvic pain, and infertility from January 1999 to October 2009 in order to prepare a Canadian consensus guideline on the management of endometriosis. Values: The quality of evidence was rated with use of the criteria described by the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described by the Task Force. See Table 1. Benefits, harms, and costs: Implementation of the guideline recommendations will improve the care of women with pain and infertility associated with endometriosis.

Hum Reprod. 2011 Jul;26(7):1892-8. Epub 2011 May 5.

TGF-β1 induces proteinase-activated receptor 2 (PAR2) expression in endometriotic stromal cells and stimulates PAR2 activation-induced secretion of IL-6.

Saito A, Osuga Y, Yoshino O, Takamura M, Hirata T, Hirota Y, Koga K, Harada M, Takemura Y, Yano T, Taketani Y.


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



Proteinase-activated receptor 2 (PAR2) is a G-protein-coupled receptor that is activated by several serine proteases. PAR2 activation in endometriotic stromal cells (ESCs) has been implicated in the development of endometriosis but the regulatory mechanism of PAR2 expression in ESC is unknown. Our objective was to study the mechanism by which PAR2 expression may be regulated in endometriotic lesions.


Primary cultures of ESCs were treated with transforming growth factor-β (TGF-β) 1, tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), and the expression of PAR2 was examined by real-time quantitative PCR. ESCs pretreated with or without TGF-β1 were treated with PAR2 agonist peptide (PAR2AP) and the secretion of the pro-endometriotic cytokine, IL-6, was measured using a specific enzyme-linked immunosorbent assay. Effects of TGF-β type 1 inhibitor, SB431542, and PAR2 small interfering RNA (siRNA) on the TGF-β1 stimulation of PAR2 gene expression and PAR2AP-induced IL-6 secretion were also evaluated. To study intracellular signaling, effects of inhibitors of mitogen-activated protein kinases (MAPKs) and phosphoinositide 3-kinase (PI3K) and of Smad4 siRNA on the TGF-β1-induced PAR2 gene expression were studied.


Only TGF-β1, but neither TNF-α nor IL-1β, increased gene expression of PAR2. Activation of PAR2 with PAR2AP increased the secretion of IL-6 from ESCs. As expected, TGF-β1 pretreatment dose-dependently enhanced the PAR2AP-induced increase in IL-6 secretion from ESCs. Treatment of ESCs with the TGF-β type 1 inhibitor, SB431542, inhibited both TGF-β1-stimulation of PAR2 gene expression and PAR2AP-induced IL-6 secretion. Transfection of ESCs with PAR2 siRNA produced a similar inhibition of IL-6 secretion. The TGF-β1-induced increase in PAR2 gene expression was repressed by inhibition of p38 MAPK, p42/44 MAPK or PI3K, but not by knockdown of Smad4 expression.


In view of significant roles of PAR2 and IL-6 in endometriosis, the TGF-β1-induced increase in PAR2 expression may be an elaborate mechanism that augments the progression of the disease.

J Minim Invasive Gynecol. 2011 May-Jun;18(3):381-5.

Laparoscopic management of pregnancy in a patient with uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis.

Nawfal AK, Blacker CM, Strickler RC, Eisenstein D.


Department of Gynecology, Obstetrics, and Women’s Health, Henry Ford Hospital, Detroit, Michigan 48202, USA.


Pregnancy in a rudimentary uterine horn is a rare and potentially lethal condition. The highest risk of rupture is reported to be during the late first and second trimester. The risk of rupture correlates with the thickness of the myometrium surrounding the fetal pole. In 2005, a 20-year-old woman was incompletely diagnosed by imaging studies and laparoscopy to have an absent right kidney, a bicornate uterus with a right rudimentary uterine horn and a single cervix, a transverse vaginal septum with hematocolpos, and endometriosis caused by reflux menstruation. The transverse vaginal septum was excised, and the surgeon observed a single cervix. Oral contraceptives were prescribed as complementary treatment for the endometriosis and associated dysmenorrhea. In 2009, magnetic resonance imaging confirmed resolution of hematocolpos and revealed a right cervix connected to the right horn of a uterus didelphys and covered by a partial longitudinal vaginal septum. The patient had a contraception failure and presented in 2010 at 9(6/7) weeks’ gestation. By ultrasonography and subsequent magnetic resonance imaging, the pregnancy was in the right uterus and the corpus luteum was on the left ovary. The myometrium was thinned to 2 to 3 mm atop the gestational sac. Using the Harmonic ACE, laparoscopic excision of the right fallopian tube and a supracervical right hysterectomy with an intact pregnancy was performed. This case supports the Acién hypothesis that the vagina forms from both Müllerian and Wolffian duct elements, and it illustrates the risk for uterine rupture when pregnancy forms in a rudimentary structure; presumed transperitoneal migration of an ovum that was captured by the opposite fallopian tube; and surgical management of the in situ pregnancy by laparoscopic supracervical excision of the rudimentary uterine body.

Acta Obstet Gynecol Scand. 2011 Aug;90(8):878-84. doi: 10.1111/j.1600-0412.2011.01161.x. Epub 2011 Jun 14.

Deep pelvic endometriosis negatively affects ovarian reserve and the number of oocytes retrieved for in vitro fertilization.

Papaleo E, Ottolina J, Viganò P, Brigante C, Marsiglio E, DE Michele F, Candiani M.


Infertility Unit, Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milan, Italy.


Objective. Endometriosis-associated infertility results in reduced ovarian response, fewer oocytes available for fertilization, compromised oocyte quality and higher miscarriage rates. A consistent proportion of women with endometriosis require in vitro fertilization. We sought to clarify the impact of deep infiltrating pelvic disease on antral follicle count and ovarian response to follicle-stimulating hormone (FSH) stimulation in patients with severe endometriosis. Design. Retrospective cohort study. Setting. University hospital. Population. Patients with severe endometriosis (stages III-IV; n=51) were divided into two groups regarding localization of endometriosis during surgical staging: ovarian (n=27) and both ovarian and deep infiltrating disease (n=24). Methods. A total of 73 long-protocol ovulation induction cycles with recombinant FSH for an intracytoplasmic sperm injection program were given. On day 3 of the cycle, measurements of FSH and luteinizing hormone and an ultrasound evaluation of antral follicle count were performed. Main Outcome Measures. Number of oocytes collected at ovum pick up, number of mature oocytes, number of embryos transferred and clinical pregnancy rate. Results. Ovarian reserve in terms of antral follicle count was damaged in both groups but, if adjusted for age, it was significantly lower in the ovarian and pelvic infiltrating group compared with patients having only ovarian endometriosis. Pelvic deep infiltrating disease significantly impacted on the number of oocytes collected at pick up when adjusted for age. Conclusions. Deep infiltrating pelvic disease can negatively affect ovarian reserve in terms of antral follicle count and number of oocytes retrieved. Mechanisms underlying this phenomenon need to be elucidated.

Diagn Cytopathol. 2011 Apr 28. doi: 10.1002/dc.21693. [Epub ahead of print]

Mullerianosis of the urinary bladder: Report of a case with diagnosis suggested in urine cytology and review of literature.

Guan H, Rosenthal DL, Erozan YS.


Department of Pathology, Division of Cytopathology, The Johns Hopkins Medical Institute, Baltimore, Maryland.


Mullerianosis of the urinary bladder is a rare entity characterized by the presence of an admixture of at least two types of mullerian tissue in the muscularis propria of the bladder. We report a case of mullerianosis of the urinary bladder in a 28-year-old nulliparous woman with no history of pelvic surgery or endometriosis, and the diagnosis of mullerianosis was suggested initially in urine cytopathology report. In this study, previously reported cases of mullerianosis of urinary bladder are reviewed, and differential diagnosis of endometrial-like cells in the urine has been discussed. Fewer than 20 cases of mullerianosis of the urinary bladder have been reported in the literature, and only one of these cases had cytological description in a urine specimen. Most of patients were of reproductive age ranging from 28 to 53 years and had no previous history of pelvic surgery or Cesarean section. The clinical presentations frequently were abdominal/pelvic pain and dysuria/hematuria, which may or may not be associated with menstruation. Radiologic study revealed polypoid, mass-like lesion ranging from 1 to 4.5 cm in size, predominantly involving the dome or posterior wall of the bladder. Histological sections showed two or more of the three related benign mullerian glandular epithelial proliferations-endometriosis, endosalpingiosis, and endocervicosis. Most of the patients have good prognosis with medical management. Diagn. Cytopathol. 2011; © 2011 Wiley-Liss, Inc.

Gastroenterology. 2011 Jun;140(7):e7-8. Epub 2011 Apr 28.

Unusual submucosal tumor in the stomach. Diagnosis: Endometriosis.

Kashyap P, Medeiros F, Levy M, Larson M.


Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

J Reprod Immunol. 2011 May;89(2):212-5. Epub 2011 May 6.

Association of FCRL3 C-169T promoter single-nucleotide polymorphism with idiopathic infertility and infertility-related endometriosis.

Teles JS, Bianco B, Vilarino FL, André GM, Christofolini DM, Barbosa CP.


Division of Pathological Gynecology and Human Reproduction, Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC (Santo André, São Bernardo do Campo and São Caetano do Sul County), Santo André, SP, Brazil.


An aberrant immunological mechanism is thought to be involved in the pathogenesis of endometriosis. The present study aimed to determine whether there is a relationship between endometriosis and/or infertility and the FCRL3 C-169T polymorphism. This case-control study included 167 infertile women with endometriosis, 60 women with idiopathic infertility and 167 fertile women. Detection of the FCRL3 C-169T polymorphism was performed using TaqMan PCR. A significant difference in the genotype and allele frequencies of the FCRL3 C-169T polymorphism between endometriosis-related infertility (p=0.003 and p=0.001) and idiopathic infertility (p=0.027 and p=0.0185) versus controls was demonstrated. In conclusion, the results suggest that the FCRL3 C-169T polymorphism may play an important role in the pathogenesis of endometriosis and/or infertility.

Expert Opin Investig Drugs. 2011 Jul;20(7):917-31. Epub 2011 May 2.

Are aromatase inhibitors effective in endometriosis treatment?

Colette S, Donnez J.


Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Department of Gynecology, 1200 Brussels, Belgium.


INTRODUCTION: Current therapies for endometriosis cannot completely cure the disease, and patients present with high recurrence rates. Novel medical approaches are, therefore, needed. AREAS COVERED: In endometriosis, aromatase was long thought to be involved in the in situ formation of estrogens, leading to a positive feedback loop favoring estrogens, themselves inducing prostaglandin production and inflammation. This hypothesis led to aromatase inhibitors (AIs) being proposed as the new medical therapy for endometriosis, as reported in all the studies reviewed here. Recent findings nevertheless indicate that aromatase may be less implicated in endometriosis than previously postulated. More than 10 years after the first successful treatment of a rare and severe case of postmenopausal endometriosis with an AI, there are only three small randomized controlled trials in the literature. EXPERT OPINION: Until recently, AIs were thought to be an alternative to current medical therapies for endometriosis. However, recent findings question their real utility in clinical practice in the context of this disease. Because there is no strong evidence of their efficacy or benefit compared to other molecules in existing clinical trials, AIs need to be investigated further in well-designed studies to confirm/disprove their hypothetical impact on endometriotic lesions.

J Egypt Public Health Assoc. 2011;86(1-2):21-6.

Epidemiologic determinants of endometriosis among Egyptian women: a hospital-based case-control study.

Mamdouh HM, Mortada MM, Kharboush IF, Abd-Elateef HA.


aDivision of Maternal and Child Health, Department of Family Health, High Institute of Public Health and bDepartment of Obstetrics and Gynecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.



Advances in understanding the epidemiology of endometriosis have lagged behind other diseases because of methodological problems related to disease definition and control selection.


To identify possible risk factors associated with the development of endometriosis among a sample of Egyptian women.


A case-control study was conducted in the University Maternity Hospital and some private hospitals in Alexandria. The sample included 110 cases recently diagnosed with endometriosis and 220 hospital-based, age-matched controls.


Using the logistic regression analysis, nulligravidae were four times more likely to develop endometriosis than gravid women [adjusted odds ratio (AOR)=4.0, 95% confidence interval (CI) (2.2-7.6)]. Short cycles were associated with approximately six times increase in risk of endometriosis [AOR=6.1, 95% CI (2.9-12.8)]. Women with irregular cycles were three times more likely to develop endometriosis than women with regular cycles [AOR=3.5, 95% CI (1.89-6.71)]. Similarly, women with a history of irritable bowel syndrome were twice as likely to develop endometriosis [AOR=1.9, 95% CI (1.03-3.87)]. Women who had one or more relatives with endometriosis were 1.2 times more likely to develop endometriosis [AOR=1.2, 95% CI (1.19-1.43)].


Nulliparous and women reporting short and irregular cycles were at a significantly increased risk of developing endometriosis. A weak association between reported family history of endometriosis and history of irritable bowel syndrome and the development of endometriosis was also observed. Designing and implementing health education programs about endometriosis and its related risk factors should be a priority to ensure early diagnosis of the disease.

Mymensingh Med J. 2011 Apr;20(2):303-7.

Outcome of pregnancies after inadvertent exposure to GnRH agonist in early pregnancy.

Fatima P, Hossain MM, Rahman D, Suman GM.


Department of Obstetrics & Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.


Four pregnancies were exposed to gonadotrophin-releasing hormone agonist (GnRHa) during early pregnancy and the patients were followed up to find out the outcome of their pregnancies. In three patients long-acting GnRHa (triptorelin acetate 3.75 mg) once monthly was used for severe pelvic endometriosis as part of preparation for undergoing assisted reproductive technology (ART) cycle, and in one patient daily injections of short-acting GnRHa (buserelin 0.05 mg) was given for down-regulation for ART cycle. The age of the patients ranged from 29 to 38 years and duration of infertility was 3 to 13 years. In patients prescribed long-acting GnRHa, diagnosis of pregnancy was done late at around 5-8 weeks by ultrasonography, whereas in patients using short-acting GnRHa diagnosis of pregnancy was made with blood beta human chorionic gonadotropin (HCG) level after the 26th day of injections. Three pregnancies were delivered around term and the babies had no apparent complication or any congenital anomaly. One of the pregnancies ended up into spontaneous abortion at 14 weeks of pregnancy. The children were regularly examined by pediatricians regarding physical and mental development and for any abnormal behavioral problems. All of them are normal till now.

Vet Pathol. 2011 Apr 26. [Epub ahead of print]

Pleural Endometriosis in an Aged Rhesus Macaque (Macaca mulatta): A Histopathologic and Immunohistochemical Study.

Assaf BT, Miller AD.


Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity and is one of the most common reproductive abnormalities encountered in women as well as Old World primates. The majority of endometriosis cases in Old World primates occur within the abdominal cavity, with spread to extraabdominal sites considered to be a rare event. A 19-year-old multiparous female rhesus macaque (Macaca mulatta) presented to necropsy for difficulty breathing and weight loss. Grossly, the animal had marked abdominal endometriosis and severe hemoabdomen and hemothorax, the latter of which was accompanied by marked pleural fibrosis. Histologic examination confirmed the abdominal endometriosis and also revealed numerous uterine glands and stroma embedded within the pleural fibrosis. Rafts of endometrial tissue were present within pulmonary lymphatics and the tracheobronchial lymph nodes. Immunohistochemically, all ectopic endometrial tissue had varying degrees of positive immunoreactivity to cytokeratin, vimentin, progesterone and estrogen receptors, and calretinin but was negative for desmin and carcinoembryonic antigen. Pleural endometriosis is an extremely rare manifestation of endometriosis in nonhuman primates. This case report emphasizes lymphatic spread as a likely mechanism for extrauterine endometriosis.

J Obstet Gynaecol Res. 2011 Apr 26. doi: 10.1111/j.1447-0756.2010.01509.x. [Epub ahead of print]

Expression patterns of the steroid receptor coactivator family in human ovarian endometriosis.

Kumagami A, Ito A, Yoshida-Komiya H, Fujimori K, Sato A.


Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima Department of Integrated Women’s Health, St. Luke’s International Hospital, Tokyo, Japan.


 Aim: Endometriosis is an estrogen-dependent disease that causes pelvic pain and infertility. In this study, to examine the estrogen-dependent mechanisms of human endometriosis The expression patterns of SRC-1, transitional intermediary factor 2 (TIF2), SRC-3, and ERα, were analyzed by immunohistochemistry of normal endometrium and ovarian endometriotic tissue. In addition, reverse transcription polymerase chain reaction (RT-PCR) for the SRCs was performed for ovarian , we focused on the expression patterns of the steroid receptor coactivator (SRC) family of cofactors for nuclear steroid receptors and estrogen receptor α (ERα). Material and Methods: endometriosis SRCs were expressed in all examined tissues. The expression levels of SRC-1 and the number of SRC-1-positive cells in ovarian . Results: endometriosis  The present study demonstrates the expression pattern of SRCs in ovarian were greater than those of TIF2 and SRC-3. In addition, immunohistochemistry showed that ERα was colocalized with SRC-1 in almost all glandular and many stromal cells in ovarian endometriotic tissue. Conclusion: endometriosis. It appears that SRC-1 is predominant among the other SRC family members and colocalizes with ERα. Although further study is needed, SRC-1 may affect the transcriptional activity of ERα in human ovarian endometriosis.

Am J Obstet Gynecol. 2011 Feb 27. [Epub ahead of print]

Factors associated with age of onset and type of menopause in a cohort of UK women.

Pokoradi AJ, Iversen L, Hannaford PC.


Centre of Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, United Kingdom.



We sought to describe the pattern of age at menopause and factors associated with type of menopause.


This was a prospective cohort study of 5113 postmenopausal health survey respondents in the Royal College of General Practitioners’ Oral Contraception Study. Logistic regression was used to evaluate associations between sociodemographics, lifestyle, and medical history and menopause type.


Median age at natural menopause (n = 3650) was 49.0 years (interquartile range, 45.0-51.0), and at surgical menopause (n = 1463) was 42.4 years (38.0-46.4). Early natural menopause was associated with smoking, ever-use of oral contraception, sterilization, and history of endometriosis (all increased odds ratios) and ever-use of hormone replacement therapy (decreased). Surgical menopause was associated with manual social class, sterilization, and having a history of endometriosis, menorrhagia, or painful menstruation (all increased), and ever-use of hormone replacement therapy (decreased).


Age at natural menopause was younger in this cohort than in other studies. More associations were found for surgical menopause than early natural menopause.


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