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Fertil Steril. 2011 Mar 15;95(4):1421-7. Epub 2011 Feb 12.

Deoxyribonucleic acid methyltransferases and methyl-CpG-binding domain proteins in human endometrium and endometriosis.

van Kaam KJ, Delvoux B, Romano A, D’Hooghe T, Dunselman GA, Groothuis PG.

Source

GROW, School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands. kimvankaam@yahoo.com

Abstract

OBJECTIVE:

To determine [1] expression levels of both DNA methyltransferases (DNMTs) and methyl-CpG-binding domain proteins (MBDs) in human endometrium throughout the menstrual cycle and in eutopic and ectopic endometrium of patients with endometriosis and [2] hormone responsiveness of DNMT and MBD expression in explant cultures of proliferative phase endometrium.

DESIGN:

In vitro study.

SETTING:

Academic medical center.

PATIENT(S):

Premenopausal women with and without endometriosis.

INTERVENTION(S):

Explant cultures of proliferative phase endometrium were treated with vehicle, 17β-E(2), or a combination of E(2) and P (E(2) + P) for 24 hours.

MAIN OUTCOME MEASURE(S):

Expression levels of DNMT1, DNMT2, and DNMT3B and MBD1, MBD2, and MeCP2 with use of real-time quantitative polymerase chain reaction.

RESULT(S):

Expression levels of DNMT1 and MBD2 were significantly higher in secretory-phase endometrium compared with proliferative endometrium and menstrual endometrium. In explant cultures, treatment with E(2) + P resulted in significant up-regulation of DNMT1 and MBD2. Expression levels of several DNMTs and MBDs were significantly lower in endometriotic lesions compared with eutopic endometrium of women with endometriosis and disease-free controls.

CONCLUSION(S):

These findings suggest a role for DNMTs and MBDs in the growth and differentiation of the human endometrium and support the notion that endometriosis may be an epigenetic disease.

Fertil Steril. 2011 May;95(6):2125.e1-3. Epub 2011 Feb 11.

Rupture of endometriotic ovarian cyst causes acute hemoperitoneum in twin pregnancy.

Reif P, Schöll W, Klaritsch P, Lang U.

Source

Department of Obstetrics, Medical University of Graz, Austria. philipp.reif@klinikum-graz.at

Abstract

OBJECTIVE:

To present a case of an acute hemoperitoneum caused by a ruptured ovarian cyst in a late twin pregnancy.

DESIGN:

Case report study.

SETTING:

Department of Obstetrics and Gynecology, Medical University of Graz, Austria.

PATIENT(S):

A woman with a history of surgery for endometriosis and currently pregnant with dichorionic twins after IVF presented with acute abdominal pain.

INTERVENTION(S):

Serial ultrasound assessment revealed a massive hemoperitoneum that was caused by a ruptured endometriotic ovarian cyst. Emergency laparotomy was performed.

MAIN OUTCOME MEASURE(S):

Hemostasis.

RESULT(S):

Laparotomy led to operative hemostasis and preterm cesarean section of healthy twins at 27 weeks of gestation.

CONCLUSION(S):

Endometriosis occurs in about 10% of women of reproductive age and carries an infertility rate of up to 50%. Severe endometriosis used to be a rare event in patients with spontaneously conceived pregnancies. However, during the last decade, the increased use of assisted reproductive technologies has led to higher fertility rates in patients with endometriosis and to a higher incidence of multiple gestations. Therefore, the number of pregnant women with endometriosis and associated complications may rise.

Fertil Steril. 2011 Apr;95(5):1574-8.

Comparison of revised American Fertility Society and ENZIAN staging: a critical evaluation of classifications of endometriosis on the basis of our patient population.

Haas D, Chvatal R, Habelsberger A, Wurm P, Schimetta W, Oppelt P.

Source

General Hospital Linz, Department of Obstetrics and Gynecology, Linz, Austria. dietmar.haas@akh.linz.at

Abstract

OBJECTIVE:

To develop a classification that takes deep infiltrating endometriosis into account, the ENZIAN score was introduced. The ENZIAN classification supplements the revised American Fertility Society (AFS) score with regard to the description of deep infiltrating endometriosis, retroperitoneal structures, and other organs. The null hypothesis was that classifying a lesion by the revised AFS as well as the ENZIAN system is not meaningful, because the two systems express different locations.

DESIGN:

Retrospective.

SETTING:

Hospital admissions.

PATIENT(S):

Two hundred nineteen women admitted for endometriosis.

INTERVENTION(S):

Surgical interventions.

MAIN OUTCOME MEASURE(S):

Classification of the severity of endometriosis according to the revised AFS and the ENZIAN classification, focusing on the distribution pattern in deep infiltrating endometriosis, and the identification of duplicate classifications of the same lesions in the revised AFS as well as the ENZIAN systems.

RESULT(S):

Deep infiltrating endometriosis was diagnosed in 160 of 219 patients (73%). These patients had 236 lesions of deep infiltrating endometriosis, which were classified by ENZIAN as follows: compartment a (vertical): 26%; compartment b (horizontal): 41%; compartment c (dorsal): 24%; uterine adenomyosis: 4%; bladder disease: 2%; ureter disease: 1%; and bowel disease: 2%. The severity of deep infiltrating endometriosis according to ENZIAN (grades 1 = mild to 4 = severe) was as follows: grade 1: 45%; grade 2: 26%; grade 3: 19%; grade 4: 10%. Fifty-eight patients were classified according to ENZIAN although they did not fulfill the criteria of deep infiltrating endometriosis and had previously been classified according to the revised AFS classification. Adaptation of the ENZIAN score would reduce the diagnoses of deep infiltrating endometriosis by 36% (95% confidence interval [CI] 29%-44%).

CONCLUSION(S):

The ENZIAN score is a helpful aid to describe deep infiltrating endometriosis, but needs to be adapted.

 

 

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