Pag. 16

Rom J Morphol Embryol. 2011;52(1 Suppl):237-40.

Extra-genitally located endometriosis.

Dimitrakoupoulos I, Surlin P, Mateescu G, Hîncu M, Coman M, Gheorghe E.

Source

Department of Gynecology, IASO Center, Athens, Greece.

Abstract

Endometriosis is defined by the presence of ectopic and endometrial islands outside the uterus. The significance of its finding is also outlined by its less frequent localizations (intestine, gall bladder, lungs) and by its differentiated symptoms complicating the differential diagnosis. The definitive diagnosis can only be reached through a histopathological examination as the detection of this affliction may lead to severe therapeutic errors (radical resection). The importance of an early diagnosis may help in preventing and delaying the effects of this affliction.

Epidemiology. 2010 Jul;21 Suppl 4:S77-84.

Identifying subsets of complex mixtures most associated with complex diseases: polychlorinated biphenyls and endometriosis as a case study.

Gennings C, Sabo R, Carney E.

Source

Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23298-0032, USA. [email protected]

Abstract

BACKGROUND:

Exploratory statistical analyses have been conducted on an epidemiologic data set in which the relationship was examined between exposure to polychlorinated biphenyl (PCB) mixtures and risk of endometriosis in women. In that study, the association between endometriosis and the sum of 4 antiestrogenic PCBs (PCBs 105, 114, 126, and 169) was borderline significant (P = 0.079), whereas an association was not found (P = 0.681) with the sum of 12 estrogenic PCBs. This finding was inconsistent with the widely held notion that endometriosis is an estrogen-dependent disease, prompting further statistical analyses to explore these associations in more detail.

METHODS:

As an alternative method of data reduction, an optimization algorithm was developed to determine weights in a linear combination of scaled PCB levels that has the strongest possible association with the risk of endometriosis.

RESULTS:

Application of this method to the antiestrogenic PCB subgroup revealed that PCB 114 was responsible for nearly 100% of the association. The fact that PCB 114 is neither the most potent nor abundant antiestrogen in the mixture suggests that PCB 114 might be estrogenic or that the association may be driven by a different mechanism. Use of this statistical weighting method for further analyses of 12 estrogenic PCBs showed that any association with endometriosis was driven mainly by PCBs 99 and 188 and possibly a few others.

CONCLUSION:

Although the role of PCB mixtures in endometriosis remains unclear, these results demonstrate how the integration of refined statistical methods coupled with toxicologic and biologic interpretation can generate testable hypotheses that might not otherwise have been generated.

Epidemiology. 2010 Jul;21 Suppl 4:S58-63.

Empirical and parametric likelihood interval estimation for populations with many zero values: application for assessing environmental chemical concentrations and reproductive health.

Kang L, Vexler A, Tian L, Cooney M, Louis GM.

Source

Department of Biostatistics, University at Buffalo, Buffalo, NY 14214-3000, USA. [email protected]

Abstract

BACKGROUND:

Understanding the health effects associated with environmental chemicals is challenging when individuals have concentrations at or below the laboratory limits of detection as well as when the values may round to zero or are presented in the form of 0 to substitute for missing values, which may result in many zeros in the database. Comparison of mean concentrations between individuals with and without disease necessitates estimation procedures that allow for data with many zero values. The main aim of this article is to propose and examine parametric and distribution-free methods for comparing data sets containing many zero observations. An important application of this approach is related to assessing environmental chemical concentrations and reproductive health.

METHODS:

We extended the empirical likelihood technique for estimating confidence intervals (CIs) in data sets with many zeros. We examined the proposed empirical likelihood interval estimations via a broad Monte Carlo study that compares the proposed method with parametric techniques. Certain characteristics of Monte Carlo simulations were chosen to be close to parameters of the real data set. We applied the method to a cohort study comprising 84 women aged 18-40 years who had undergone laparoscopy between 1999 and 2000 in whom serum concentrations of 2 organochlorine pesticides–Aldrin and beta-Benzene hexachloride (β-BHC) were measured using gas chromatography with electron capture.

RESULTS:

When applied to the cohort study, the method produced efficient 95% CIs, allowing for the comparison of mean serum Aldrin concentrations for women with and without endometriosis (0.000338, 0.003561) and (0.000803, 0.004211), respectively. Mean β-BHC concentrations also could be compared (0.000493, 0.005869) and (0.000680, 0.003807) based on individuals with and without the disease, respectively. Differences in mean concentrations for Aldrin and β-BHC could be estimated (-0.001563, 0.003025) and (-0.003522, 0.002890), respectively.

CONCLUSIONS:

We found the empirical likelihood method for estimating CIs robust when data sets contain many zeros. In so doing, mean concentrations of Aldrin or β-BHC did not differ by endometriosis diagnosis.

Isr Med Assoc J. 2011 Jan;13(1):51-4.

Distribution of causes of infertility in patients attending primary fertility clinics in Israel.

Farhi J, Ben-Haroush A.

Source

Fertility Clinics, Women’s Health Centers, Clalit Medical Services, Ashdod and Holon, Israel.

Abstract

BACKGROUND:

Infertility is one of the most prevalent health disorders in young adults.

OBJECTIVES:

To study the distribution of causes of infertility in couples referred to primary infertility clinics in Israel.

METHODS:

Data for a 9 year period were derived from two clinics of major women’s hospitals run by the country’s largest health insurance fund. All patients were treated by one physician. Laparoscopy was not performed to rule out endometriosis.

RESULTS:

Of the 2515 couples identified, 1991 (79.2%) had a definitive diagnosis following complete workup (including hysterosalpingography). Mean age was 29.6 +/- 6.0 years; mean duration of infertility was 1.7 +/- 1.8 years. Primary infertility accounted for 65% of cases. Causes of infertility were male factor (45%), oligo-ovulation disorders (37%), and tubal damage (18%). Infertility factors were identified in the woman alone in 30.6% of cases and the man alone in 29.2%. Two combined infertility factors were found in 18% of patients, and three combined factors in 0.5%. The rate of unexplained infertility (which probably includes non-tubal endometriosis) was 20.7%.

CONCLUSIONS:

As male factor accounts for almost half of all cases of infertility in couples, sperm analysis is mandatory before any treatment.

Comment in

PLoS One. 2011 Mar 21;6(3):e18074.

The role of DJ-1 in the pathogenesis of endometriosis.

Rai P, Shivaji S.

Source

Centre for Cellular and Molecular Biology, Hyderabad, India.

Abstract

BACKGROUND:

Endometriosis is an estrogen-dependent disease causing pelvic pain and infertility in 10% of reproductive-aged women. Despite a long history of the disease the pathogenesis of endometriosis is poorly understood. It is known that the expression of several proteins is either up or down regulated during endometriosis, but their precise role remains to be determined. DJ-1 is one such protein that is upregulated in eutopic endometrium of women having endometriosis suggesting that DJ-1 may be involved in the pathogenesis of endometriosis.

METHODOLOGY AND PRINCIPAL FINDINGS:

The role of DJ-1 in the pathogenesis of endometriosis was investigated. For this purpose the influence of DJ-1 on endometrial cell survival, attachment, proliferation, migration, and invasion either by overexpressing DJ-1 in normal endometrial cells or by knocking down DJ-1 expression in endometriotic cells using siRNA was investigated. The results indicated that DJ-1 protects endometrial cells from oxidative stress mediated apoptosis. Overexpression of DJ-1 in normal endometrial epithelial cells increases the adhesion on collagen type IV. However, no significant difference was observed incase of stromal cells. It was further demonstrated that DJ-1 regulates cell proliferation, migration, and invasion in normal endometrial and endometriotic epithelial cells whereas in the case of normal endometrial and endometriotic stromal cells, it regulates cell proliferation and invasion but not migration. Furthermore, the present study also indicated that DJ-1 regulates these cellular processes by modulating PI3K/Akt pathway by interacting and negatively regulating PTEN.

CONCLUSIONS:

Abnormally high levels of DJ-1 expression may be involved in endometriosis, possibly by stimulating endometrial cell survival, proliferation, migration, and invasion.

Fertil Steril. 2011 Jun;95(7):2228-35, 2235.e1. Epub 2011 Mar 27.

Estrogen and progesterone receptor isoform distribution through the menstrual cycle in uteri with and without adenomyosis.

Mehasseb MK, Panchal R, Taylor AH, Brown L, Bell SC, Habiba M.

Source

Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, and Histopathology Department, Leicester Royal Infirmary, University Hospital of Leicester NHS Trust, Leicester, United Kingdom. [email protected]

Abstract

OBJECTIVE:

To test the hypothesis that the expression of the different isoforms of the estrogen receptor alpha (ER-α) and beta (ER-β) and the progesterone receptor A (PR-A) and B (PR-B) would be differentially modulated in uteri with adenomyosis compared with controls and that modulation would be related to the menstrual cycle.

DESIGN:

Case control, blinded comparison.

SETTING:

University department.

PATIENT(S):

54 premenopausal women with and 35 without uterine adenomyosis as the sole pathology.

INTERVENTION(S):

Multiple samples studied using immunohistochemistry for estrogen and progesterone receptors.

MAIN OUTCOME MEASURE(S):

Histomorphometric analysis of receptor expression.

RESULT(S):

The ER-α expression in the adenomyotic endometrium was different from that of the normal endometrium and the foci in the midsecretory phase of the cycle, but expression of ER-α in the inner and outer myometrium was not statistically significantly different. The ER-β expression was statistically significantly elevated in the adenomyotic functionalis gland during the proliferative phase and throughout the myometrium across the entire menstrual cycle. Expression of PR-A was similar to that of PR-B, with reduced expression in the basalis stroma, and inner and outer myometrium in the adenomyotic samples. The pattern of ER-β, PR-A, and PR-B expression was similar in the endometrial basalis and adenomyotic foci.

CONCLUSION(S):

These data suggest ER-β expression and the lack of PR expression are related to the development and/or progression of adenomyosis and might explain the poor response of adenomyosis-associated menstrual symptoms to progestational agents.

J Clin Periodontol. 2011 Jun;38(6):542-6. doi: 10.1111/j.1600-051X.2011.01720.x. Epub 2011 Mar 28.

Periodontal status of males attending an in vitro fertilization clinic.

Klinger A, Hain B, Yaffe H, Schonberger O.

Source

Department of Periodontics, Hebrew University and Hadassah Faculty of Dental Medicine, Jerusalem, Israel. [email protected]

Abstract

AIMS:

An association has been demonstrated previously between periodontal diseases and various systemic conditions, including endometriosis. A possible role of dental infection in male infertility was also suggested. The aim of the present study was to examine the association between fertility parameters and the periodontal status of men attending a fertility and in vitro fertilization (IVF) clinic.

METHODS:

The study population consisted of 75 men attending the clinic for sperm analysis before homologue semen insemination or IVF. The quality of sperm was assessed according to WHO criteria. On the same day, patients received a clinical periodontal examination.

RESULTS:

The patients were diagnosed with either gingivitis (40%) or periodontitis (48%), whereas the remaining 12% were classified as “periodontally healthy”. Normospermia was attributed to 37%, oligozoospermia to 48% and azoospermia to 15% of these patients. Familial infertility was significantly associated with having at least one WHO parameter contributing to infertility. A higher number of sites with deep periodontal pockets tended to associate positively with sperm sub-motility. Clinical attachment levels were significantly associated with sperm sub-motility.

CONCLUSIONS:

These findings may point to a possible association between male infertility, diminished semen quality and periodontal infections in men attending fertility and IVF clinics.

Curr Drug Targets. 2011 Aug 1;12(9):1291-302.

FOXO Transcription Factors and their Role in Disorders of the Female Reproductive Tract.

Christian M, Lam EW, Wilson MS, Brosens JJ.

Source

Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London W12 0NN, UK. [email protected]

Abstract

All fundamental reproductive events in the human ovary and uterus, including ovulation, implantation and menstruation, are dependent upon profound tissue remodelling, characterized by cyclical waves of cell proliferation, differentiation, recruitment of inflammatory cells, apoptosis, tissue breakdown and regeneration. Although the rise and fall in ovarian hormones, estradiol and progesterone, orchestrate these reproductive events, FOXO transcription factors, an evolutionary conserved subfamily of forkhead transcription factors, have emerged major downstream effector molecules, capable of integrating hormonal cues with a variety of stress, growth factor and cytokine signal transduction pathways. The ability of FOXOs to regulate seemingly opposing cellular responses, ranging from cell cycle arrest and oxidative stress responses to differentiation and apoptosis, renders these transcription factors indispensable for cyclic tissue remodelling in the reproductive tract. Aberrant expression or perturbed activity of FOXO transcription factors are increasingly linked to prevalent reproductive disorders, such as endometriosis, endometrial cancer, primary ovarian insufficiency and pregnancy failure, which in turn highlights their potential as therapeutic targets.

Zhongguo Zhen Jiu. 2011 Feb;31(2):113-6.

Effect of abdominal acupuncture on pain of pelvic cavity in patients with endometriosis.

[Article in Chinese]

Xiang DF, Sun QZ, Liang XF.

Source

Department of Gynaecology, The Second School of Clinical Medicine, Guangzhou University of TCM, Guangzhou 510120, Guangdong Province, China. [email protected]

Abstract

OBJECTIVE:

To compare the effect of abdominal acupuncture and Chinese medicine on pain relieving in pelvic cavity in patients with endometriosis.

METHODS:

Fifty-eight cases were randomly divided into 2 groups. Thirty cases were in abdominal acupuncture group and 28 cases in Chinese medicine group. Abdominal acupuncture points such as Zhongwan (CV 12), Xiawan (CV 10) and Qihai (CV 6), etc. were adopted for the abdominal acupuncture group, and Tianqi Tongjing Capsule (radix notoginseng capsule for dysmenorrhea) was taken by the Chinese medicine group. After a 3-month treatment, the scores of McGill pain questionaire, level of serum CA125, average value of the radial line of endometrial cyst of ovary and the sum of 3 radial lines of the uterus of patients with adenomyosis as the complication of both groups were observed before and after treatment.

RESULTS:

The McGill estimation of 6 items for both groups improved obviously after treatment (all P < 0.01, except numbers of selected deseriptors in Chinese medicine group). The differences of the result of McGill estimation of 6 items after treatment had statistical significance, the scores in the abdominal acupuncture group were obviously better than those in the Chinese medicine group (all P < 0.01). The differences of CA125 levels within one group or between 2 groups had statistical significance (P < 0.01, P < 0.05). The difference of the radial lines of patients with endometrial cyst of ovary within one group or between 2 groups after treatment had not statistical significance (all P > 0.05). For the value of 3 radial lines of the uterus of patients with adenomyosis within one group before and after treatment, only the difference in the abdominal acupuncture group had statistical significance (P < 0.01). The differences before and after treatment in the Chinese medicine group and the difference between 2 groups after treatment had no statistical significance (all P > 0.05).

CONCLUSION:

Effect of abdominal acupuncture on relieving pain of pelvic cavity caused by endometriosis, reducing the level of serum CA125 is obverious than Tianqi Tongjing Capsule (radix notoginseng capsule for dysmenorrhea). However, the effects on reducing the size of the ovarian endometrial cyst and the size of uterus with adenomyosis are not significant. Therefore, it is concluded that abdominal acupuncture is a better choice for endometriosis with pain as the chief complaints.

Hum Reprod. 2011 Jun;26(6):1362-70. Epub 2011 Mar 25.

Inhibition of steroid sulfatase decreases endometriosis in an in vivo murine model.

Colette S, Defrère S, Lousse JC, Van Langendonckt A, Gotteland JP, Loumaye E, Donnez J.

Source

Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Department of Gynecology, Cliniques Universitaires St Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium.

Abstract

BACKGROUND:

Steroid sulfatase (STS) is involved in estrogen biosynthesis and expressed in eutopic and ectopic endometrium of disease-free and endometriosis patients. The present study was designed to investigate its role in endometriosis development.

METHODS:

Human endometrial explants were cultured on inserts for 24 h to assess the effectiveness of an STS inhibitor (STS-I), estradiol-3-O-sulfamate (E2MATE), on STS activity in endometrial tissue. Endometriosis was induced in mice, and E2MATE (or vehicle alone) was given orally for 21 days. Plasma estradiol levels were measured, and STS activity was assessed in murine organs (uterus, liver and leukocytes) and in lesions. Lesion number, weight and size (morphometry) were quantified. Lesion STS and progesterone receptor (PR) expression, proliferation and apoptosis rates were determined by immunohistochemistry.

RESULTS:

In vitro, addition of 1 µM E2MATE to the culture medium resulted in decreased STS activity in endometrial explants (P < 0.001). Treatment of mice with E2MATE (1.0 and 0.5 mg/kg) did not modify plasma estradiol levels, but inhibited STS activity in murine uterus (P < 0.05), liver (P < 0.001) and leukocytes (P < 0.001), as well as in induced lesions (P < 0.05). E2MATE reduced lesion weight (P < 0.01) and size (P < 0.05), but had no impact on proliferation or apoptosis rates, nor STS protein expression. Stromal edema was observed in the uterus of animals treated with E2MATE, but not in the stroma of lesions. Increased PR expression was detected in endometriotic lesions (P < 0.001).

CONCLUSIONS:

E2MATE was shown to effectively inhibit STS activity in endometrial tissue in vitro. In vivo, E2MATE decreased endometriosis development without affecting systemic estradiol levels. Use of STS-I could therefore be of potential interest in endometriosis treatment.

Hum Reprod. 2011 Jun;26(6):1600-1; author reply 1601-2. Epub 2011 Mar 25.

Oral contraceptives and endometriosis.

Roman H.

Comment on

Semin Reprod Med. 2011 Mar;29(2):155-68. Epub 2011 Mar 24.

Robot-assisted laparoscopy, natural orifice transluminal endoscopy, and single-site laparoscopy in reproductive surgery.

Gargiulo AR, Nezhat C.

Source

Center for Infertility and Reproductive Surgery, Brigham and Women’s Hospital, Department of Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA 02115, USA. [email protected]

Abstract

Minimally invasive gynecologic surgery is continuously pushing its limits by embracing ever more sophisticated technology. This is also true for reproductive surgery, arguably the birthplace of gynecologic endoscopy, where minimally invasive treatment of uterine, tubal, ovarian, and peritoneal pathology has long become the gold standard. This article describes in some detail three novel minimally invasive surgery approaches that have seen the light during the past decade: robot-assisted laparoscopic surgery, natural orifice transluminal endoscopic surgery, and single-incision laparoscopic surgery. These fascinating technologies, far from being widely adopted, are sure to generate scientific controversy for years to come. Nonetheless, they follow in the footsteps of the tradition of innovation that is a defining aspect of our specialty and hold the promise to potentially revolutionize the field of reproductive surgery.

Semin Reprod Med. 2011 Mar;29(2):124-9. Epub 2011 Mar 24.

Surgical management of pain and infertility secondary to endometriosis.

Diwadkar GB, Falcone T.

Source

Department of Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.

Abstract

The management of pain and infertility secondary to endometriosis remains a challenge. Surgical management of early-stage endometriosis-associated infertility has only a mild effect with a number needed to treat of at least 12 to achieve one pregnancy. Excision of endometriomas provides the best outcome for fertility and pain; however, there is a potential to reduce the ovarian reserve. Pain relief is seen in most patients undergoing surgical management but with a high recurrence rate over time. Long-term postoperative medical suppressive therapy with oral contraceptives may have some benefit in reducing recurrence of symptoms. Hysterectomy is effective in the long-term management of chronic pain associated with endometriosis.

Semin Reprod Med. 2011 Mar;29(2):95-100. Epub 2011 Mar 24.

Transvaginal hydrolaparoscopy.

Catenacci M, Goldberg JM.

Source

Section of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio 44195, USA.

Abstract

Transvaginal hydrolaparoscopy (THL) is a modification of culdoscopy that can be used to evaluate the posterior uterus, pelvic sidewalls, and adnexae. Diagnostic THL can be done in the office under local anesthesia. Combined with diagnostic hysteroscopy and chromotubation, it can replace hysterosalpingography (HSG) as the first-line diagnostic test for the infertile woman. Studies have shown high patient tolerability with less pain reported postprocedure than with HSG. THL has been shown to have a high concordance with HSG for tubal patency, but THL diagnosed more intrauterine abnormalities as well as finding adhesions and endometriosis not visible with HSG. In addition, salpingoscopy may be performed during THL to assess the tubal lumen. THL also has a high concordance rate with laparoscopy when a complete evaluation is accomplished during THL. Complications of THL are uncommon and minor. Finally, operative procedures such as ovarian drilling, coagulation of endometriosis, lysis of adhesions, treatment of ovarian cysts, and salpingostomy may be performed via THL.

Semin Reprod Med. 2011 Mar;29(2):83-94. Epub 2011 Mar 24.

Asherman’s syndrome.

March CM.

Source

Division of Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA. [email protected]

Abstract

Asherman’s syndrome is being diagnosed with increasing frequency. Although it usually occurs following curettage of the pregnant or recently pregnant uterus, any uterine surgery can lead to intrauterine adhesions (IUA). Most women with IUA have amenorrhea or hypomenorrhea, but up to a fourth have painless menses of normal flow and duration. Those who have amenorrhea may also have cyclic pelvic pain caused by outflow obstruction. The accompanying retrograde menstruation may lead to endometriosis. In addition to abnormal menses, infertility and recurrent spontaneous abortion are common complaints. Hysteroscopy is the standard method to both diagnose and treat this condition. Various techniques for adhesiolysis and for prevention of scar reformation have been advocated. The most efficacious appears to be the use of miniature scissors for adhesiolysis and the placement of a balloon stent inside the uterus immediately after surgery. Postoperative estrogen therapy is prescribed to stimulate endometrial regrowth. Follow-up studies to assure resolution of the scarring are mandatory before the patient attempts to conceive as is careful monitoring of pregnancies for cervical incompetence, placenta accreta, and intrauterine growth retardation.

Mol Endocrinol. 2011 May;25(5):821-32. Epub 2011 Mar 24.

Functional microRNA involved in endometriosis.

Hawkins SM, Creighton CJ, Han DY, Zariff A, Anderson ML, Gunaratne PH, Matzuk MM.

Source

Department of Obstetrics and Gynecology, Baylor College of Medicine, 1709 Dryden Drive, Suite 1100, Houston, Texas 77030, USA. [email protected]

Abstract

Endometriosis is a common disease seen by gynecologists. Clinical features involve pelvic pain and unexplained infertility. Although endometriosis is pathologically characterized by endometrial tissue outside the normal uterine location, endometriosis is otherwise not easily explained. Endometriomas, endometriotic cysts of the ovary, typically cause pain and distortion of pelvic anatomy. To begin to understand the pathogenesis of endometriomas, we describe the first transcriptome-microRNAome analysis of endometriomas and eutopic endometrium using next-generation sequencing technology. Using this approach, we generated a total of more than 54 million independent small RNA reads from our 19 clinical samples. At the microRNA level, we found 10 microRNA that were up-regulated (miR-202, 193a-3p, 29c, 708, 509-3-5p, 574-3p, 193a-5p, 485-3p, 100, and 720) and 12 microRNA that were down-regulated (miR-504, 141, 429, 203, 10a, 200b, 873, 200c, 200a, 449b, 375, and 34c-5p) in endometriomas compared with endometrium. Using in silico prediction algorithms, we correlated these microRNA with their corresponding differentially expressed mRNA targets. To validate the functional roles of microRNA, we manipulated levels of miR-29c in an in vitro system of primary cultures of human endometrial stromal fibroblasts. Extracellular matrix genes that were potential targets of miR-29c in silico were significantly down-regulated using this biological in vitro system. In vitro functional studies using luciferase reporter constructs further confirmed that miR-29c directly affects specific extracellular matrix genes that are dysregulated in endometriomas. Thus, miR-29c and other abnormally regulated microRNA appear to play important roles in the pathophysiology of uterine function and dysfunction.

Am J Pathol. 2011 Apr;178(4):1782-91.

Circulating endothelial progenitor cells are up-regulated in a mouse model of endometriosis.

Becker CM, Beaudry P, Funakoshi T, Benny O, Zaslavsky A, Zurakowski D, Folkman J, D’Amato RJ, Ryeom S.

Source

Vascular Biology Program, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA. [email protected]

Abstract

Endometriosis is a debilitating disease characterized by the growth of ectopic endometrial tissue. It is widely accepted that angiogenesis plays an integral part in the establishment and growth of endometriotic lesions. Recent data from a variety of angiogenesis-dependent diseases suggest a critical role of bone marrow-derived endothelial progenitor cells (EPCs) in neovascularization. In this study we examined the blood levels of EPCs and mature circulating endothelial cells in a mouse model of surgically induced endometriosis. Fluorescence-activated cell sorting analysis revealed elevated levels of EPCs in the blood of mice with endometriosis compared with control subject that underwent a sham operation. EPC concentrations positively correlated with the amount of endometriotic tissue and peaked 1 to 4 days after induction of disease. In a green fluorescent protein bone marrow transplant experiment we found green fluorescent protein-positive endothelial cells incorporated into endometriotic lesions but not eutopic endometrium, as revealed by flow cytometry and immunohistochemistry. Finally, treatment of endometriosis-bearing mice with the angiogenesis inhibitor Lodamin, an oral nontoxic formulation of TNP-470, significantly decreased EPC levels while suppressing lesion growth. Taken together, our data indicate an important role for bone marrow-derived endothelial cells in the pathogenesis of endometriosis and support the potential clinical use of anti-angiogenic therapy as a novel treatment modality for this disease.

Am J Pathol. 2011 Apr;178(4):1415.

This Month in AJP.

[No authors listed]

Ultrasound Obstet Gynecol. 2011 Apr;37(4):480-7. doi: 10.1002/uog.8935.

Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis.

Hudelist G, Ballard K, English J, Wright J, Banerjee S, Mastoroudes H, Thomas A, Singer CF, Keckstein J.

Source

Department of Obstetrics and Gynaecology, Endometriosis and Pelvic Pain Clinic, Wilhelminen Hospital, Vienna, Austria. [email protected]

Abstract

OBJECTIVE:

The aim of this study was to compare the diagnostic performance of clinical vaginal examination with that of transvaginal sonography (TVS) in the presurgical diagnosis of deep infiltrating endometriosis.

METHODS:

One-hundred and fifty-five women with symptoms suggestive of endometriosis were included. One-hundred and twenty-nine patients met the inclusion criteria and were prospectively and independently assessed by vaginal examination and TVS prior to a diagnostic laparoscopy and, where appropriate, radical resection and histological confirmation of endometriosis was performed. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and positive and negative likelihood ratios (LR+ and LR-) were calculated for each test method.

RESULTS:

In total, 83 (64%) women had histological confirmation of endometriosis, 52 (40%) of whom had deep infiltrating endometriosis. The prevalence of endometriosis on the uterosacral ligaments, pouch of Douglas, vagina, bladder, rectovaginal space and rectosigmoid was 23.3%, 16.3%, 8.5%, 3.1%, 6.9% and 24%. PPV, NPV, LR+ and LR- for vaginal examination were 92%, 87%, 41.56 and 0.60 for ovarian endometriosis; 43%, 84%, 2.48 and 0.63 for uterosacral ligament disease; 64%, 95%, 9.14 and 0.26 for involvement of the pouch of Douglas; 80%, 97%, 42.91 and 0.28 for vaginal endometriosis; 78%, 98%, 46.67 and 0.23 for endometriosis of the rectovaginal space; 100%, 98%, 75.60 and 0.75 for bladder involvement; 86%, 84%, 18.97 and 0.63 for rectosigmoidal endometriosis. Values for TVS were similar with regard to vaginal and rectovaginal space endometriosis, but were clearly superior to vaginal examination in cases of ovarian (87%, 99%, 24.56 and 0.04), uterosacral ligament (91%, 90%, 31.35 and 0.37) and rectosigmoidal (97%, 97%, 88.51 and 0.1) endometriosis.

CONCLUSIONS:

TVS is a more useful test than is vaginal examination in detecting endometriosis in the ovaries and rectosigmoid.

 

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