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J Obstet Gynaecol Can. 2012 Feb;34(2):123.

Villar’s nodule: umbilical endometriosis in a patient with stage IV endometriosis and previous umbilical hernia repair.

El-Chaâr D, Posner G.

Source

Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa ON.

J Pediatr Adolesc Gynecol. 2012 Feb;25(1):e5-e7. Epub 2011 Nov 3.

Ovarian endometrioma in an 11-year-old girl before menarche: a case study with literature review.

Gogacz M, Sarzyński M, Napierała R, Sierocińska-Sawa J, Semczuk A.

Source

2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland.

Abstract

BACKGROUND:

To date, a limited number of endometriosis cases occurring before or around the time of menarche have been documented.

CASE:

An 11-year-old adolescent underwent an emergency operation for left ovarian endometrioma. Her menarche occurred spontaneously 6 months after surgery.

RESULTS AND CONCLUSIONS:

We discuss the above mentioned case and consider data published in the literature. Endometrioma should be considered even in premenarcheal girls with ovarian cysts, regardless of their size.

J Ultrasound Med. 2012 Feb;31(2):319-31.

The unicornuate uterus and its variants: clinical presentation, imaging findings, and associated complications.

Khati NJ, Frazier AA, Brindle KA.

Source

Department of Radiology, George Washington University Medical Center, 900 23rd St NW, Washington, DC 20037, USA. nkhati@mfa.gwu.edu

Abstract

This article will describe the different variants of the unicornuate uterus, their clinical presentation and imaging findings, as well their associated complications. We will also review the associated renal anomalies. Patients’ symptoms and their imaging findings will vary depending on the unicornuate subtype. Radiologic evaluation includes a combination of hysterosalpingography, sonography, and magnetic resonance imaging. Complications include obstetric ones related to the small uterine size and endometriosis and ectopic pregnancies when a cavitary rudimentary uterine horn is present. Radiologists should be familiar with all variants of the unicornuate uterus as well as their clinical presentation and associated imaging findings.

Korean J Urol. 2012 Feb;53(2):120-5. Epub 2012 Feb 20.

Ureteral injury in gynecologic surgery: a 5-year review in a community hospital.

Park JH, Park JW, Song K, Jo MK.

Source

Department of Urology, Korea Cancer Center Hospital, Seoul, Korea.

Abstract

PURPOSE:

We reviewed the cases of ureteral injury during gynecologic surgeries in a community hospital and attempted to find possible options for alleviating these distressing situations.

MATERIALS AND METHODS:

A total of 2,927 patients underwent gynecologic surgeries in the last 5 years at our hospital. We retrospectively analyzed the cases, particularly the possible risk factors and management according to the time of detection of the injury. Thirty-five cases (1.2%) were identified with ureteral injury in a total of 2,927 gynecologic surgeries. Risk factors included endometriosis, pelvic inflammatory disease, previous pelvic surgery, history of pelvic radiation, and congenital anomalies. Among 2,927 patients, 522 had predisposing factors for ureteral injuries.

RESULTS:

The incidence of ureteral injury in laparoscopic cases was 1.1%, similar to the cases of laparotomy (1.2%). The rate of ureteral injury was significantly higher in the group with risk factors (2.7%) than in the group without risk factors (0.9%; p=0.002). Prophylactic ureteral stenting was performed in 101 of 522 patients with risk factors according to the gynecologic surgeon’s preference. The injury rate (1.0%) in the stenting group was lower than that in the non-stenting group (3.1%; p=0.324). Management of ureteral injuries was successful in all cases. Of the patients with postoperatively diagnosed injuries, two patients were managed with secondary procedures, such as retrograde balloon dilatation or ureteroneocystostomy.

CONCLUSIONS:

The incidence of ureteral injury was significantly higher in cases having risk factors than in cases without risk factors. Surgeons should be cautious to avoid ureteral injury during gynecologic surgery, especially in patients with risk factors.

Med Monatsschr Pharm. 2012 Feb;35(2):44-51; quiz 53-4.

Treatment of endometriosis.

[Article in German]

Römer T.

Source

Klinik für Gynäkologie und Geburtshilfe, Evangelisches Krankenhaus Köln-Weyertal, Weyertal 76, 50931 Köln. thomas.roemer@evk-koeln.de

Abstract

Endometriosis is one of the frequent gynecological diseases in premenopausal women. The clinical diagnostics is difficult because symptoms of endometriosis are variable. The surgical removal of endometriosis is the primary therapeutic aim. Medical treatment plays a very important role in the therapy of this chronic disease. A symptomatic therapy by analgetics should be combined with a hormonal treatment. The use of oral contraceptives in extended cycle or long-term use is effective against endometriosis associated pain. Progestogens, especially dienogest, which is licensed for endometriosis treatment and good investigated, are very effective and also available for long-term use. GnRH-analogues are effective for a short-term treatment (duration of 3 months). The long-term treatment with GnRH-analogues should only be used in selected cases and in combination with an add back therapy. Treatment of endometriosis should be planned individually for each patient, dependent on stage, localization and activity of endometriosis and further family planning. By the combination of hormonal and operative treatment possibilities a maximum period free of pain or recurrence of endometriosis can be reached.

Minerva Ginecol. 2012 Feb;64(1):9-14.

Chronic pelvic pain in patients with endometriosis: results of laparoscopic treatment.

[Article in Italian]

Teodoro MC, Genovese F, Rubbino G, Palumbo M, Zarbo G.

Source

Azienda Ospedaliera Universitaria, Italia. cris_teo85@virgilio.it

Abstract

AIM:

The chronic pelvic pain (CPP) linked to endometriosis, relatively frequent condition in women of reproductive age, often represents the main complaint for which the patient seeks medical advice. The purpose of this prospective study was to evaluate if and to which extent systematic ablation of endometriotic lesions causes an improvement and/or disappearance of pain in patients with ascertained endometriosis and in whom the main preoperative symptom is chronic pelvic pain.

METHODS:

This study examined 109 patients, affected by chronic pelvic pain secondary to endometriosis, underwent laparoscopic treatment. All patients in the preoperative phase and only the 92 coming back for follow up, were asked both to fill out an anonymous questionnaire about their quality of life and to indicate on a numeric visual analogue scale (VAS) the intensity of the perceived pain.

RESULTS:

Overall the median of the VAS score for pain decreased from 7.5 before surgery to 2.5 at one-year postoperative-follow up, which was consistent (Wilcoxon test) with a statistically significant regression (P<0.0001) of the intensity of perceived pain (disappearance or marked reduction) in the operated patients, independently from the stage of the disease and the type of pain; also data on quality of life during work and social activity indicated a relevant improvement respectively in 82% and in 83% of patients following the laparoscopic procedure.

CONCLUSION:

For this reason and as suggested by the present international guidelines, when the medical therapy against pain fails and/or in the presence of an adnexal mass (chocolate cyst) or deep endometriotic lesion, it is generally correct to rely on surgical ablation of the lesions preferably by laparoscopy.

Minerva Med. 2012 Feb;103(1):63-72.

Urological morbidity of colorectal resection for endometriosis.

Daraï E, Zilberman S, Touboul C, Chereau E, Rouzier R, Ballester M.

Source

Université Pierre et Marie Curie, Paris, France. emile.darai@tnn.aphp.fr

Abstract

Colorectal resection for endometriosis is a major operation exposing patients to the risk of severe digestive and urological complications. The objective of this review is to evaluate surgery-related urological morbidity of which little is known to date. We searched MEDLINE for articles published on colorectal resection for endometriosis between 1998 and March 2011 using the following terms: “bowel”, “rectal”, “colorectal”, “rectovaginal”, “rectosigmoid”, “resection” and “endometriosis”. We were not able to perform a meta- analysis due to a lack of complete data on urological complications so have focused this review on voiding dysfunction and ureteral injury. Thirty-two articles reporting on 3047 colorectal resections for endometriosis including 1930 segmental resections, 271 discoid resections and 846 rectal shavings were analysed. For voiding dysfunction, 28 series including 2563 colorectal resections were available. Postoperative voiding dysfunction varied from 0% to 30.4% with a mean value of 3.4% (73/2118). Fourteen series reported an incidence of ureterolysis comprising between 8.5% and 100% with a mean value of 46% (815/1772 patients). The risk of urinary fistulae evaluated in 26 series was estimated at 0.9% (24/2581 patients). Only one case of hydronephrosis was reported in 9 series including 1256 patients (0.07%). The incidence of urological morbidity associated with colorectal endometriosis is poorly documented and probably underestimated due to the short follow-up reported in the series. Moreover, as complication rates varied widely according to the type of surgery and the experience of the teams, further studies are required to identify risk factors of urological morbidity so as to adequately inform patients.

Mod Pathol. 2012 Feb;25(2):282-8. doi: 10.1038/modpathol.2011.161. Epub 2011 Nov 18.

Loss of ARID1A expression is related to shorter progression-free survival and chemoresistance in ovarian clear cell carcinoma.

Katagiri A, Nakayama K, Rahman MT, Rahman M, Katagiri H, Nakayama N, Ishikawa M, Ishibashi T, Iida K, Kobayashi H, Otsuki Y, Nakayama S, Miyazaki K.

Source

Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Japan.

Abstract

Recently, the ARID1A gene has been identified as a novel tumor suppressor in ovarian clear cell carcinoma. The prognostic significance of the loss of ARID1A expression is not known. The current study was designed to evaluate whether ARID1A was a prognostic factor for progression, survival, and chemoresistance in ovarian clear cell carcinoma. A total of 60 patients, who were surgically treated for primary ovarian clear cell adenocarcinoma, were enrolled. Surgical specimens were examined for ARID1A protein expression by immunohistochemistry. The correlations between the loss of ARID1A expression and clinicopathological characteristics, prognosis, and chemosensitivity were investigated. Loss of ARID1A expression was identified in 9 (15.0%) of 60 ovarian clear cell carcinoma samples. Loss of ARID1A staining intensity (0+) was more frequently found in cells of clear cell carcinomas than in high-grade serous carcinomas (P<0.01). Loss of ARID1A expression was significantly correlated with advanced FIGO stage and high CA125 levels (P=0.02, 0.01). There were no significant correlations between loss of ARID1A expression and patient age, status of residual tumor, Ki-67 labeling index, or the status of endometriosis. Loss of ARID1A correlated with shorter progression-free survival of patients with clear cell carcinomas treated with platinum-based chemotherapy (P<0.01). Loss of ARID1A expression tended to correlate with shorter overall survival in patients with ovarian clear cell carcinomas treated with platinum-based chemotherapy. When data were stratified for the multivariate analysis, only the loss of ARID1A expression remained a significant (P=0.03) predictor of reduced progression-free survival. Of the 60 patients with ovarian clear cell carcinomas, 14 patients had measurable residual tumor after primary cytoreductive surgery. Tumors with loss of ARID1A expression were more likely to be chemoresistant than tumors with positive ARID1A expression (100.0 vs 40.0%, P=0.04). This study demonstrates that loss of ARID1A in ovarian clear cell carcinoma is a negative prognostic factor in patients treated with platinum-based chemotherapy. Measurement of ARID1A expression may be a method to predict resistance to platinum-based chemotherapy in patients with ovarian clear cell carcinoma.

Mol Biol Rep. 2012 Feb;39(2):1029-36. Epub 2011 May 15.

The cancer marker neutrophil gelatinase-associated lipocalin is highly expressed in human endometrial hyperplasia.

Liao CJ, Huang YH, Au HK, Wang LM, Chu ST.

Source

Institute of Biochemical Science, College of Life Science, National Taiwan University, Taipei 10617, Taiwan.

Abstract

Recently, endometrial hyperplasia was identified as presenting a higher risk for progressing to endometrial carcinoma more readily than adenomyosis. The Lcn-2 gene encodes neutrophil gelatinase-associated lipocalin (NGAL), which promotes cell proliferation and serves as a cancer marker in some cancers. In our current study, we investigated the relationship between the expression of NGAL and that of pathogenic cytokines and cancer-related genes including cyclooxygenase-2 (COX-2), E-cadherin, β-catenin, and vimentin in patients with endometrial disorders. NGAL expression was examined by Western blotting, immunohistochemistry, and reverse-transcription polymerase chain reaction (RT-PCR) in hyperplasia and adenomyosis biopsy samples. Immunohistochemistry demonstrated the occurrence of NGAL in glandular epithelial cells but not in the stromal cells of hyperplasia biopsy samples. NGAL protein and mRNA expression were significantly greater in endometrial hyperplasia than in endometrial adenomyosis. Although our data showed no difference in pathogenic cytokines between patients with endometrial hyperplasia and endometrial adenomyosis, we observed high expression levels of COX-2, β-catenin, vimentin, and E-cadherin in patients with endometrial hyperplasia. NGAL mRNA expression correlated positively with COX-2 and E-cadherin mRNA expression (r = 0.41 and r = 0.57, respectively), but correlated negatively with vimentin and β-catenin mRNA expression (r = -0.42 and r = -0.61, respectively). Our data suggest that NGAL is up-regulated in patients with endometrial hyperplasia to prevent the transition from hyperplasia to carcinoma.

Obstet Gynecol. 2012 Feb;119(2 Pt 1):276-85.

Proteomics analysis of plasma for early diagnosis of endometriosis.

Fassbender A, Waelkens E, Verbeeck N, Kyama CM, Bokor A, Vodolazkaia A, Van de Plas R, Meuleman C, Peeraer K, Tomassetti C, Gevaert O, Ojeda F, De Moor B, D’Hooghe T.

Source

Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Gasthuisberg, Belgium.

Abstract

OBJECTIVE:

To test the hypothesis that differential surface-enhanced laser desorption/ionization time-of-flight mass spectrometry protein or peptide expression in plasma can be used in infertile women with or without pelvic pain to predict the presence of laparoscopically and histologically confirmed endometriosis, especially in the subpopulation with a normal preoperative gynecologic ultrasound examination.

METHODS:

Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry analysis was performed on 254 plasma samples obtained from 89 women without endometriosis and 165 women with endometriosis (histologically confirmed) undergoing laparoscopies for infertility with or without pelvic pain. Data were analyzed using least squares support vector machines and were divided randomly (100 times) into a training data set (70%) and a test data set (30%).

RESULTS:

Minimal-to-mild endometriosis was best predicted (sensitivity 75%, 95% confidence interval [CI] 63-89; specificity 86%, 95% CI 71-94; positive predictive value 83.6%, negative predictive value 78.3%) using a model based on five peptide and protein peaks (range 4.898-14.698 m/z) in menstrual phase samples. Moderate-to-severe endometriosis was best predicted (sensitivity 98%, 95% CI 84-100; specificity 81%, 95% CI 67-92; positive predictive value 74.4%, negative predictive value 98.6%) using a model based on five other peptide and protein peaks (range 2.189-7.457 m/z) in luteal phase samples. The peak with the highest intensity (2.189 m/z) was identified as a fibrinogen β-chain peptide. Ultrasonography-negative endometriosis was best predicted (sensitivity 88%, 95% CI 73-100; specificity 84%, 95% CI 71-96) using a model based on five peptide peaks (range 2.058-42.065 m/z) in menstrual phase samples.

CONCLUSION:

A noninvasive test using proteomic analysis of plasma samples obtained during the menstrual phase enabled the diagnosis of endometriosis undetectable by ultrasonography with high sensitivity and specificity.

LEVEL OF EVIDENCE:

Radiology. 2012 Feb;262(2):538-43. Epub 2011 Dec 20.

Levator ani muscle complex: anatomic findings in nulliparous patients at thin-section MR imaging with double opacification.

Loubeyre P, Copercini M, Petignat P, Dubuisson JB.

Source

Department of Imaging, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland. Pierre.loubeyre@hcuge.ch

Abstract

PURPOSE:

To determine levator ani muscle complex anatomic findings in nulliparous patients at magnetic resonance (MR) imaging examinations performed with opacification of the vagina and rectum with ultrasonographic gel.

MATERIALS AND METHODS:

The institutional review board approved this retrospective study, and the informed consent requirement was waived. Findings from pelvic MR imaging examinations with double opacification in 123 consecutive nulliparous patients (mean age, 32.13 years; age range, 17-45 years) who were suspected of having endometriosis were reviewed. The pubococcygeal muscles were analyzed on coronal sections obtained through the middle part of the vagina, perineal body, and anal canal. The puborectalis muscles were analyzed on coronal sections obtained through the perineal body. The iliococcygeal muscles were analyzed on coronal sections obtained through the rectum. Miscellaneous findings such as visibility of deep transverse muscles of the perineum, perineal body, and focal muscle defects were also noted.

RESULTS:

In 56% (69 of 123) of patients, at least one morphologic variant (thinning or aplasia) of a muscle of the levator ani complex was noted. Variants of puborectalis muscles were noted in 6% of patients. Variants of iliococcygeal muscles were noted in 13%. Variants of pubococcygeal muscles were noted in 32% at the anal canal level, in 49% at the perineal body level, and in 49% at the vaginal level. Variants of pubococcygeal muscles were noted on the left side in 53 patients (77% of pubococcygeal muscle variants).

CONCLUSION:

Numerous morphologic variants of the levator ani muscle complex are noted at coronal thin-section MR imaging with double opacification. Most involve the pubococcygeal muscle on the left side at perineal body and vaginal levels. Whether some of these anatomic findings may favor prolapse after vaginal birth may be questioned.

Reprod Sci. 2012 Feb;19(2):152-62. Epub 2011 Dec 2.

Nuclear receptor, coregulator signaling, and chromatin remodeling pathways suggest involvement of the epigenome in the steroid hormone response of endometrium and abnormalities in endometriosis.

Zelenko Z, Aghajanova L, Irwin JC, Giudice LC.

Source

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94143, USA.

Abstract

Human endometrium, a steroid hormone-dependent tissue, displays complex cellular regulation mediated by nuclear receptors (NRs). The NRs interact with histone-modifying and DNA-methylating/-demethylating enzymes in the transcriptional complex. We investigated NRs, their coregulators, and associated signaling pathways in endometrium across the normal menstrual cycle and in endometriosis, an estrogen-dependent, progesterone-resistant disorder. Endometrial tissue was processed for analysis of 84 genes using NR and coregulator polymerase chain reaction (PCR) arrays. Select genes were validated by immunohistochemistry. Ingenuity pathway analysis identified DNA methylation and transcriptional repression signaling as the most affected pathway in endometrium in women with versus without endometriosis, regardless of cycle phase. Thyroid hormone receptor (THR) and vitamin D receptor (VDR) pathways were also regulated in normal and disease endometrium by activation of TH or vitamin D regulated genes. These data support the involvement of the epigenome in steroid hormone response of normal endometrium throughout the cycle and abnormalities in endometrium in women with endometriosis.

Urology. 2012 Feb;79(2):270-6.

Multidetector computed tomography virtual cystoscopy: an effective diagnostic tool in patients with hematuria.

Kuehhas FE, Weibl P, Tosev G, Schatzl G, Heinz-Peer G.

Source

Department of Urology, Medical University of Vienna, Vienna, Austria. fkuehhas@hotmail.com

Abstract

OBJECTIVE:

To evaluate the efficacy and the potential use of multidetector computed tomography virtual cystoscopy (MDCT-VC) in patients with gross hematuria.

METHODS:

A total of 32 patients underwent MDCT-VC, cystoscopy, and a cytologic examination. The slice thickness of MDCT was 1 mm. Bladder distension was done with room air. The data were converted into 3-dimensional virtual reconstructive models. The data sets were reviewed independently by 2 experienced radiologists. Tumors confined to the mucosa, infiltrating the muscularis, and transmural tumors were distinguished.

RESULTS:

VC showed a sensitivity and specificity of 100%. The radiologic accuracy regarding T stage correlated in 87.5%. MDCT-VC identified 21 bladder lesions suspicious for bladder cancer in 18 patients. The histologic results showed 22 patients with bladder lesions, 18 were diagnosed with transitional cell carcinoma of the bladder, 3 had bladder endometriosis, and 1 had an infiltrating colon cancer. Four patients had concomitant carcinoma in situ lesions, which were not seen completely with MDCT-VC. However, cytology was positive in those cases. Ten patients did not have any tumor signs on VC and the subsequent conventional cystoscopy did not bring any change to the initial tumor-free diagnosis of VC.

CONCLUSION:

MDCT-VC combined with urine cytology is a good alternative to conventional cystoscopy for patients with painless gross hematuria. It should be used as a decision-making aid to identify patients who will benefit from additional cystoscopic examination. Future developments should focus on the visibility of sessile and carcinoma in situ lesions.

Cochrane Database Syst Rev. 2012 Jan 18;1:CD007677.

Pentoxifylline for endometriosis.

Lu D, Song H, Li Y, Clarke J, Shi G.

Source

Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.

Abstract

BACKGROUND:

Endometriosis is a chronic, recurring condition that occurs during the reproductive years. It is characterized by endometrial tissue developing outside the uterine cavity. This endometrial tissue development is dependent on oestrogen produced primarily by the ovaries and, therefore, traditional management has focused on ovarian suppression. In this review we considered the role of modulation of the immune system as an alternative approach. This is an update of a Cochrane Review previously published in 2009 (Lu 2009).

OBJECTIVES:

To assess the effects of pentoxifylline, which has anti-inflammatory effects, in subfertile, premenopausal women for the management of endometriosis.

SEARCH METHODS:

For the first publication of this review we searched the following databases (from inception to December 2008) for trials: Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO. In addition, all reference lists of included trials were searched and experts in the field were contacted in an attempt to locate trials. This search was rerun to 23 November 2011, for this update.

SELECTION CRITERIA:

Randomised controlled trials (RCTs) comparing pentoxifylline with placebo or no treatment, medical treatment, or surgery in subfertile, premenopausal women were included.

DATA COLLECTION AND ANALYSIS:

Two review authors independently selected trials for inclusion, assessed trial risk of bias, and extracted data using data extraction forms. We contacted study authors for additional information and data. The domains assessed for risk of bias were sequence generation, allocation concealment, blinding, incomplete outcome data, and selective outcome reporting. Peto odds ratios (OR) were used for reporting dichotomous data with 95% confidence intervals (CI), whilst mean differences (MD) were expressed for continuous data. Statistical heterogeneity was assessed using the I(2) statistic.

MAIN RESULTS:

Four trials involving 334 participants were included. One RCT [n=34] showed pentoxifylline had no significant effect on reduction in pain (MD -1.60, 95% CI -3.32 to 0.12). There was no evidence of an increase in clinical pregnancy events in the pentoxifylline group compared with placebo (three RCTs [n=67] OR 1.54, 95% CI 0.89 to 266). One RCT studied recurrence of endometriosis [n=88] (OR 0.88,95% CI 0.27 to 2.84). No trials reported the effects of pentoxifylline on the odds of live birth rate per woman, improvement of endometriosis-related symptoms, or adverse events.

AUTHORS’ CONCLUSIONS:

This review has been updated in 2011. The results of the original review published in 2009 remain unchanged. There is still not enough evidence to support the use of pentoxifylline in the management of premenopausal women with endometriosis in terms of subfertility and relief of pain outcomes.

Update of

Ultrasound Obstet Gynecol. 2012 Jan 17. doi: 10.1002/uog.11102. [Epub ahead of print]

Comparison between transvaginal ultrasound, sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis.

Saccardi C, Cosmi E, Borghero A, Alberto T, Dessole S, Litta P.

Source

Department of Gynaecological Sciences and Human Reproduction. University of Padova, Padova, Italy; Department of Gynaecological and Obstetrical Sciences and Neonatology, University of Parma, Parma, Italy. carlosaccardi@yahoo.it.

Abstract

Objective: to compare clinical evaluation, transvaginal ultrasound, sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep pelvic endometriosis. Methods: women suspected of having posterior deep pelvic endometriosis on the basis of subjective symptoms and clinical evaluation, underwent clinical evaluation, transvaginal ultrasound, sonovaginography and magnetic resonance imaging. Laparoscopy was performed and specimens were sent to histological examination. Sensitivity, specificity, positive and negative predictive value, as well as positive and negative likelihood ratios was analysed for every diagnostic method. Results: Fifty-four patients out of 102 women suspected of having posterior DPE underwent laparoscopic surgery. Among these, in 46 (85.2%) cases DPE was confirmed at laparoscopic and histological examination. Sonovaginography correctly identified 43 (93.5%) cases, presenting higher accuracy compared to other procedures. Sonovaginography and even magnetic resonance imaging were more accurate in diagnosing and discriminating the different localizations of endometriotic lesions, with sensibility respectively of 94.7% and 73.1% for vaginal fornix, 88.9% and 66.7% for utero-sacral ligaments, and 80.6% and 83.3% for recto-vaginal septum involvement; Specificity of sonovaginography and MRI was respectively of 97.1% and 94.3% for vaginal fornix, 95.6% and 95.6% for utero-sacral ligaments, and 100% and 77.8% for recto-vaginal septum involvement. In the diagnosis of rectal endometriosis, we found mean values of sensibility, 66.7% for both the two techniques and specificity of 93.8% and 95.8%, for sonovaginography and magnetic resonance imaging, respectively. Conclusions: transvaginal ultrasound should be used as first-line diagnostic techniques and both sonovaginography and/or magnetic resonance imaging as second-line methods in the diagnosis of deep pelvic endometriosis.

J Am Vet Med Assoc. 2012 Jan 15;240(2):151-3.

Theriogenology question of the month. Endometrioma.

Shuster KA, Nemzek-Hamlin JA, Baker NK, Bergin IL, Nowland MH.

Source

Unit for Laboratory Animal Medicine, Medical School, University of Michigan, Ann Arbor, MI 48109, USA. shuster1@msu.edu

Pathol Res Pract. 2012 Jan 15;208(1):59-61. Epub 2011 Nov 21.

Paratesticular endometriosis in a man with a prolonged hormonal therapy for prostatic carcinoma.

Fukunaga M.

Source

Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan. maasafu@jikei.ac.jp

Abstract

A rare case of paratesticular endometriosis in a 69-year-old male with prostatic carcinoma, who had a history of 9-year hormonal therapy, is presented. The lesion was a multilocular cyst, 5.2 cm × 3.1 cm × 3.0 cm in size, in the left paratestis. The cysts were lined by a single layer of cuboidal cells. A small number of glands were scattered in the underling stroma composed of closely packed small round or ovoid cells with scant cytoplasm resembling endometrial stromal cells, and abundant capillaries. Hemosiderin deposits were observed. Immunohistochemically, the lining cells of the cysts and glands were positive for CAM5.2, vimentin and calretinin, and were negative for CD10, estrogen and progesterone-receptors, indicating mesothelial profiles. The stromal cells expressed vimentin, estrogen- and progesterone-receptors and CD10. The findings indicated stromal endometriosis associated with the tunica vaginalis. Mullerian or endometriotic metaplasia and stromal cell hyperplasia under the influence of prolonged estrogen therapy may be the mechanism of this lesion.

J Pineal Res. 2012 Jan 11. doi: 10.1111/j.1600-079X.2012.00977.x. [Epub ahead of print]

Melatonin prevents hypochlorous acid-induced alterations in microtubule and chromosomal structure in metaphase-II mouse oocytes.

Banerjee J, Maitra D, Diamond MP, Abu-Soud HM.

Source

Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Detroit, MI, USA Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, MI, USA.

Abstract

Hypochlorous acid (HOCl) is generated by myeloperoxidase, using chloride and hydrogen peroxide as substrates. Here we demonstrate that HOCl alters metaphase-II mouse oocyte microtubules and chromosomal (CH) alignment which can be prevented by melatonin. Metaphase-II mouse oocytes, obtained commercially, were grouped as: control, melatonin (150, 200 nmol/mL), HOCl (10, 20, 50, and 100 nmol/mL), and HOCl (50 nmol/mL) pretreated with 150 and 200 nmol/mL of melatonin. Microtubule and CH alignment was studied utilizing an indirect immunofluorescence technique and scored by two observers. Pearson chi-square test and Fisher’s exact test were used to compare outcomes between controls and treated groups and also among each group. Poor scores for the spindle and chromosomes increased significantly at 50 nmol/mL of HOCl (P < 0.001). Oocytes treated with melatonin only at 150 and 200 nmol/mL showed no changes; significant differences (P < 0.001) were observed when oocytes exposed to 50 nmol/mL of HOCl were compared to oocytes pretreated with 200 nmol/mL melatonin. Fifty percent of the oocytes demonstrated good scores, both in microtubule and CH alterations, when pretreated with melatonin at 150 nmol/mL compared to 0% in the HOCl-only group. HOCl alters the metaphase-II mouse oocyte spindle and CH alignment in a dose-dependant manner, which might be a potential cause of poor oocyte quality (e.g., in patients with endometriosis). Melatonin prevented the HOCl-mediated spindle and CH damage, and therefore, may be an attractive therapeutic option to prevent oocyte damage in endometriosis or inflammatory diseases where HOCl levels are known to be elevated.

Reprod Biol Endocrinol. 2012 Jan 10;10:1.

Expression of HOXA11 in the mid-luteal endometrium from women with endometriosis-associated infertility.

Szczepańska M, Wirstlein P, Skrzypczak J, Jagodziński PP.

Source

Department of Obstetrics, Gynecology and Gynecological Oncology, Division of Reproduction, Poznan Medical University of Sciences Poland.

Abstract

BACKGROUND:

A decrease in HOXA11 expression in eutopic mid-secretory endometrium has been found in women with endometriosis-associated infertility.

METHODS:

Using Real-time quantitative PCR (RQ-PCR) and western blotting analysis we studied the HOXA11 transcript and protein levels in mid-luteal eutopic endometrium from eighteen infertile women with minimal endometriosis, sixteen healthy fertile women and sixteen infertile women with fallopian tubal occlusion from the Polish population. We also evaluated transcript levels of DNA methyltransferases DNMT1, DNMT3A and DNMT3B in these groups of women.

RESULTS:

There were significantly lower levels of HOXA11 transcripts (p = 0.003, p = 0.041) and protein (p = 0.004, p = 0.001) in women with endometriosis as compared to fertile women and infertile women with tubal occlusion. Moreover, we found significantly higher methylation levels of the CpG region in the first exon of HOXA11 in infertile women with endometriosis compared with fertile women (p < 0.001) and infertile women with tubal occlusion (p < 0.001). We also observed significantly increased levels of DNMT3A transcript in women with endometriosis than fertile women (p = 0.044) and infertile women with tubal occlusion (p = 0.047). However, we did not observe significant differences in DNMT1 and DNMT3B transcript levels between these investigated groups of women.

CONCLUSIONS:

We confirmed that reduced HOXA11 expression may contribute to endometriosis-associated infertility. Moreover, we found that DNA hypermethylation can be one of the possible molecular mechanisms causing a decrease in HOXA11 expression in the eutopic mid-secretory endometrium in infertile women with endometriosis.

Environ Health Prev Med. 2012 Jan 6. [Epub ahead of print]

Failure to detect significant association between estrogen receptor-alpha gene polymorphisms and endometriosis in Japanese women.

Matsuzaka Y, Kikuti YY, Izumi SI, Goya K, Suzuki T, Cai LY, Oka A, Inoko H, Kulski JK, Kimura M.

Source

Division of Basic Molecular Science and Molecular Medicine, School of Medicine, Tokai University, Bohseidai, Isehara, Kanagawa, 259-1193, Japan, yasunari.matsuzaka@helmholtz-muenchen.de.

Abstract

OBJECTIVES:

The aim of the study was to test whether estrogen receptor 1 (ESR1) gene polymorphisms are correlated with the risk of the development of endometriosis in Japanese women, as a preliminary study.

METHODS:

To compare allelic frequencies and genotype distributions, a case-control study of 100 affected women and 143 women with no evidence of disease was performed using 10 microsatellite repeat markers and 66 single-nucleotide polymorphisms (SNPs) in the ESR1 gene region.

RESULTS:

Although our results might be insufficient to detect genetic susceptibility, owing to the small sample size and low genetic power, statistical analysis of the differences in allelic frequency between the cases and controls at each microsatellite locus demonstrated that no microsatellite locus in the ESR1 gene displayed a significant association with the disease when multiple testing was taken into account. Also, there were no statistically significant differences in the SNP allele frequencies and genotypes between the cases and controls when multiple testing was taken into account.

CONCLUSION:

The findings in our pilot study suggest that ESR1 polymorphisms do not contribute to endometriosis susceptibility.

Int J Biostat. 2012 Jan 6;8(2). pii: /j/ijb.2012.8.issue-2/1557-4679.1350/1557-4679.1350.xml. doi: 10.2202/1557-4679.1350.

Meta-analysis of observational studies with unmeasured confounders.

McCandless LC.

Source

Simon Fraser University.

Abstract

Meta-analysis of observational studies is an exciting new area of innovation in statistical science. Unlike randomized controlled trials, which are the gold standard for proving causation, observational studies are prone to biases including confounding. In this article, we describe a novel Bayesian procedure to control for a confounder that is missing across the sequence of studies in a meta-analysis. We motivate the discussion with the example of a meta-analysis of cohort, case-control and cross-sectional studies examining the relationship between oral contraceptives and endometriosis. An important unmeasured confounder is dysmennoreah, which is an indication for oral contraceptive use. To adjust for unmeasured confounding, we combine random effects models with probabilistic sensitivity analysis techniques. Information about the unmeasured confounder is incorporated into the analysis via prior distributions, and we use MCMC to sample from posterior.

J Cell Mol Med. 2012 Jan 6. doi: 10.1111/j.1582-4934.2011.01520.x. [Epub ahead of print]

Raf-1 levels determine the migration rate of primary endometrial stromal cells of patients with endometriosis.

Yotova I, Quan P, Gaba A, Leditznig N, Pateisky P, Kurz C, Tschugguel W.

Source

Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.

Abstract

Endometriosis is a disease characterized by the localization of endometrial tissue outside of the uterine cavity. The differences observed in migration of human endometrial stromal cells (hESC) obtained from patients with endometriosis versus healthy controls were proposed to correlate with the abnormal activation of Raf-1/ROCKII signalling pathway. To evaluate the mechanism by which Raf-1 regulates cytoskeleton reorganization and motility, we used primary eutopic (Eu-, n=16) and ectopic (Ec-, n=8; isolated from ovarian cysts) hESC of patients with endometriosis and endometriosis-free controls (Co-hESC, n=14). Raf-1 siRNA knockdown in Co- and Eu-hESC resulted in contraction and decreased migration vs. siRNA controls. This phenotype was reversed following the re-expression of Raf-1 in these cells. Lowest Raf-1 levels in Ec-hESC were associated with hyperactivated ROCKII and ezrin/radixin/moesin (E/R/M), impaired migration and a contracted phenotype similar to Raf-1 knockdown in Co- and Eu-hESC. We further show that the mechanism by which Raf-1 mediates migration in hESC includes direct myosin light chain phosphatase (MYPT1) phosphorylation and regulation of the levels of E/R/M, paxillin, MYPT1 and myosin light chain (MLC) phosphorylation indirectly via the hyperactivation of ROCKII kinase. Further, we suggest that in contrast to Co-and Eu-hESC, where the cellular Raf-1 levels regulate the rate of migration, the low cellular Raf-1 content in Ec-hESC might ensure their restricted migration by preserving the contracted cellular phenotype. In conclusion, our findings suggest that cellular levels of Raf-1 adjust the threshold of hESC migration in endometriosis. © 2011 The Authors Journal of Cellular and Molecular Medicine © 2011 Foundation for Cellular and Molecular Medicine/Blackwell Publishing Ltd.

J Vis Exp. 2012 Jan 6;(59):e3396. doi: 10.3791/3396.

Mouse model of surgically-induced endometriosis by auto-transplantation of uterine tissue.

Pelch KE, Sharpe-Timms KL, Nagel SC.

Source

Obstetrics, Gynecology and Women’s Health and Division of Biological Sciences, University of Missouri, USA.

Abstract

Endometriosis is a chronic, painful disease whose etiology remains unknown. Furthermore, treatment of endometriosis can require laparoscopic removal of lesions, and/or chronic pharmaceutical management of pain and infertility symptoms. The cost associated with endometriosis has been estimated at 22 billion dollars per year in the United States. To further our understanding of mechanisms underlying this enigmatic disease, animal models have been employed. Primates spontaneously develop endometriosis and therefore primate models most closely resemble the disease in women. Rodent models, however, are more cost effective and readily available. The model that we describe here involves an autologous transfer of uterine tissue to the intestinal mesentery (Figure 1) and was first developed in the rat and later transferred to the mouse. The goal of the autologous rodent model of surgically-induced endometriosis is to mimic the disease in women. We and others have previously shown that the altered gene expression pattern observed in endometriotic lesions from mice or rats mirrors that observed in women with the disease. One advantage of performing the surgery in the mouse is that the abundance of transgenic mouse strains available can aid researchers in determining the role of specific components important in the establishment and growth of endometriosis. An alternative model in which excised human endometrial fragments are introduced to the peritoneum of immunocompromised mice is also widely used but is limited by the lack of a normal immune system which is thought to be important in endometriosis. Importantly, the mouse model of surgically induced endometriosis is a versatile model that has been used to study how the immune system, hormones and environmental factors affect endometriosis as well as the effects of endometriosis on fertility and pain.

J Neurol. 2012 Jan 4. [Epub ahead of print]

Sciatic endometriosis presenting as periodic (catamenial) sciatic radiculopathy.

Ghezzi L, Arighi A, Pietroboni AM, Jacini F, Fumagalli GG, Esposito A, Bresolin N, Galimberti D, Scarpini E.

Source

Department of Neurological Sciences, “Dino Ferrari” Center, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, lauraghezzi@me.com.

Hum Pathol. 2012 Jan 3. [Epub ahead of print]

HMGA gene rearrangement is a recurrent somatic alteration in polypoid endometriosis.

Medeiros F, Wang X, Araujo AR, Erickson-Johnson MR, Lima JF, Meuter A, Winterhoff B, Oliveira AM.

Source

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.

Abstract

The pathogenesis of endometriosis is unclear, and several genetic, endocrine, immune, and environmental agents have been evaluated with no putative causative factors identified. Here, we show somatic genetic alterations involving HMGA1 (6p21) and HMGA2 (12q15) in 3 cases of polypoid endometriosis. The lesions involved the small bowel mesentery and perirectal soft tissue in 1 case and the posterior vaginal fornix and sigmoid colon serosa in 2 other cases, respectively. All had a polypoid configuration with cystically dilated irregular glands and fibrotic stroma, containing thick-walled vessels. Conventional cytogenetic analysis of 1 case showed 46,XX,t(5;12)(q13;q15) in all metaphases. Fluorescence in situ hybridization studies confirmed the balanced rearrangement of HMGA2. HMGA1 rearrangements were present in 2 additional cases. Rearrangements were exclusively found in the stromal component but not in the glandular component. These findings suggest that HMGA rearrangements likely contribute to the pathogenesis of endometriosis. However, additional studies are needed to better define the biologic role of this genetic alteration.

Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness [Internet].

Editors

Andrews J, Yunker A, Reynolds WS, Likis FE, Sathe NA, Jerome RN.

Source

Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No.: 11(12)-EHC088-EF.
AHRQ Comparative Effectiveness Reviews.

Excerpt

OBJECTIVES:

The Vanderbilt Evidence-based Practice Center systematically reviewed evidence on therapies for women age 18 and over with noncyclic chronic pelvic pain (CPP). We focused on the prevalence of conditions thought to occur commonly with CPP; changes in pain, functional status, quality of life, and patient satisfaction resulting from surgical and nonsurgical treatment approaches; harms of nonsurgical approaches; evidence for differences in surgical outcomes if an etiology for CPP is identified postsurgery; and evidence for selecting one intervention over another after an approach fails.

DATA SOURCES:

We searched MEDLINE® via PubMed, PsycInfo®, EMBASE Drugs and Pharmacology, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases as well as the reference lists of included studies.

REVIEW METHODS:

We included studies published in English from January 1990 to May 2011. We excluded intervention studies with fewer than 50 adult women with CPP; cross-sectional studies or case series with fewer than 100 women with CPP addressing the prevalence of comorbidities; and studies lacking relevance to CPP treatment.

RESULTS:

Of 36 included studies, 18 were randomized controlled trials (RCTs) (2 good, 3 fair, and 13 poor quality); 3 were cohort studies (3 poor quality); and 15 were cross-sectional studies addressing the prevalence of comorbidities (quality varied by comorbidity). The most frequently reported comorbidities were dysmenorrhea, dyspareunia, and irritable bowel syndrome (IBS). Among studies addressing surgical interventions, there was no evidence that laparoscopic uterosacral nerve ablation (LUNA) is more effective than simple diagnostic laparoscopy and no evidence of benefit of lysis of adhesions. Evidence was insufficient to comment on relief of pain after hysterectomy. Nine studies of nonsurgical approaches assessed hormonal therapies for endometriosis-associated CPP and reported similar effectiveness among active agents. One exception was an RCT comparing raloxifene with placebo, which reported more rapid return of pain in the raloxifene group. Few studies assessed nonhormonal medical or nonpharmacologic management; benefits were reported in single studies of a pelvic physiotherapy approach, botulinum toxin, pelvic ultrasonography, and an integrated management approach. No studies provided evidence relating to a trajectory of care. Reporting of harms data was very limited.

CONCLUSIONS:

Improved characterization of the targeted condition, intervention, and population in CPP research is necessary to inform treatment choices for this commonly reported entity. A uniform definition of CPP and standardized evaluation of participants are lacking across the literature. Study populations likely vary widely, and studies may be reporting effects from treating symptoms rather than a diagnosed condition. Thus our understanding of potential treatment effects is diluted. Similarly, understanding comorbidity prevalence with CPP is difficult, as conditions may be considered part of the differential diagnosis or a concomitant condition. Among studies addressing treatment effects, little evidence demonstrates the effectiveness of surgical approaches. Studies of nonsurgical approaches typically addressed hormonal management of endometriosis-related CPP and were not placebo controlled, thus limiting our ability to understand whether hormonal therapies would be beneficial for women with CPP without endometriosis and whether pain relief is due simply to the placebo effect. Some studies reported benefits of other nonsurgical approaches, but nonhormonal and nonpharmacologic management remain understudied.

 

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