Pag. 19

Int J Gynaecol Obstet.2012 Feb;116(2):109-11. Epub 2011 Nov 17.

Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis.

Chalermchockchareonkit A, Tekasakul P, Chaisilwattana P, Sirimai K, Wahab N.

Source

Department of Obstetrics and Gynecology, Thai-German Multidisciplinary Endoscopic Training Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Abstract

OBJECTIVE:

To compare the surgical outcomes of laparoscopic hysterectomy (LH) versus abdominal hysterectomy (AH) in patients with severe pelvic endometriosis.

METHODS:

A retrospective review of patients undergoing hysterectomy for endometriosis was conducted between January 2002 and December 2007. A total of 503 patients had severe pelvic endometriosis; of these, 115 patients underwent LH and 388 patients underwent AH. Surgical outcomes-including operative time, blood loss, length of hospital stay, and need for blood transfusion-were analyzed and compared between the 2 treatment groups.

RESULTS:

Operative time was significantly longer for LH than for AH (185.1 ± 48.7 minutes and 139.9 ± 52.4 minutes, respectively; P<0.001). However, estimated volume of blood loss, length of hospital stay, and complication rates were significantly less for patients in the LH group than for those in the AH group (302.6 ± 255.1 mL versus 760.9 ± 633.2 mL [P<0.001]; 3.5 ± 1.1 days versus 6.4 ± 3.0 days [P<0.001]; and 18.3% versus 49.0% [P<0.001], respectively).

CONCLUSION:

Compared with AH, LH was associated with fewer complications. LH should, therefore, be the preferred surgical option for women with severe pelvic endometriosis who require a hysterectomy.

Int J Gynaecol Obstet.2012 Feb;116(2):169-70. Epub 2011 Nov 17.

Inhibin B for assessment of ovarian reserve after laparoscopic treatment of ovarian endometriomas.

Coric M, Goluza T, Juras J.

Source

Department of Gynecological Surgery, Zagreb University Hospital Center, Croatia. mcoric77@gmail.com

Int J Gynecol Cancer.2012 Feb;22(2):238-44.

The utility of human epididymal protein 4, cancer antigen 125, and risk for malignancy algorithm in ovarian cancer and endometriosis.

Kadija S, Stefanovic A, Jeremic K, Radojevic MM, Nikolic L, Markovic I, Atanackovic J.

Source

Faculty of Medicine, University of Belgrade, Serbia.

Abstract

BACKGROUND:

In women with pelvic mass, cancer antigen 125 (CA125) had not achieved satisfactory sensitivity and specificity in the detection of ovarian cancer, particularly in patients with underlying endometriosis. The aim of this study was to determine the diagnostic potential of human epididymal protein 4 (HE4), the combination of HE4+CA125, and the Risk of Ovarian Malignancy Algorithm (ROMA) for patients with pelvic mass, particularly in differentiating endometriosis from carcinoma.

METHODS:

A prospective cross-sectional study was conducted at the Clinic for Gynecology and Obstetrics, Clinical Center of Serbia. Serum samples were obtained preoperatively from 108 women undergoing surgery for pelvic mass; 29 of them had ovarian carcinoma, and 79 had a nonmalignant ovarian disease (39 with benign tumor, 20 with endometriosis, 20 healthy controls). Sera were analyzed for the levels of HE4 and CA125 and were then compared with the final pathologic results. The diagnostic performance of HE4 and CA125 was estimated using receiver operating characteristic curve and area under the receiver operating characteristic curve.

RESULTS:

The level of HE4 and CA125 was significantly higher among the patients with malignant tumors, compared with patients with nonmalignant disease. At the predefined specificity of 95%, HE4 and CA125 showed sensitivity of 65.5% and 58.6%, respectively, whereas the combination of HE4+CA125 reached 68.9% at the same specificity. Importantly, the level of HE4 did not differ significantly between the patients with endometriosis and with other nonmalignant diseases (which was not the case with CA125). Risk of Ovarian Malignancy Algorithm classified 96% of benign premenopausal cases as at low risk for ovarian cancer.

CONCLUSIONS:

HE4 showed satisfactory capability of distinguishing endometriosis from ovarian cancer, which CA125 lacked. The Risk of Ovarian Malignancy Algorithm score proved to be useful in excluding malignant diagnosis in premenopausal women.

Int J Oncol.2012 Feb;40(2):350-6. doi: 10.3892/ijo.2011.1226. Epub 2011 Oct 6.

Narrow band imaging in gynecology: a new diagnostic approach with improved visual identification (Review).

Kisu I, Banno K, Tsuji K, Masuda K, Ueki A, Kobayashi Y, Yamagami W, Susumu N, Aoki D.

Source

Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan.

Abstract

Narrow band imaging (NBI) is a new endoscopic technique in which images of mucosal microstructures and capillary structures are enhanced by shifting the light spectrum to a narrow band. Image-enhanced gastrointestinal endoscopy using NBI has improved the qualitative diagnosis of the grade and depth of invasion of an atypical lesion. NBI is currently not commonly used in gynecological endoscopy, but has recently been applied in laparoscopy and hysteroscopy. The utility of NBI for diagnosis of endometrial lesions and endometriosis has also been shown. In gynecological endoscopy, NBI provides enhanced images of mucosal microstructures and capillary structures and improves visual identification of lesions. Therefore, image-enhanced observation using NBI is likely to be useful for improved detection of lesions in endoscopic diagnosis. However, this technique remains experimental so far, and no study has demonstrated improved clinical outcome using this technique. In this review, we discuss the utility and potential applications of NBI in clinical practice in gynecology.

J Magn Reson Imaging.2012 Feb;35(2):352-60. doi: 10.1002/jmri.22832. Epub 2011 Oct 27.

MRI and “tenderness guided” transvaginal ultrasonography in the diagnosis of recto-sigmoid endometriosis.

Saba L, Guerriero S, Sulcis R, Pilloni M, Ajossa S, Melis G, Mallarini G.

Source

Department of Science of the Images, Azienda Ospedaliero Universitaria di Cagliari, s.s. 554 Monserrato, (Cagliari) Italy. lucasaba@tiscali.it

Abstract

PURPOSE:

To compare the diagnostic accuracy of MRI and “tenderness-guided” transvaginal ultrasonography (tg-TVUS) in the identification of recto-sigmoid endometriosis.

MATERIALS AND METHODS:

Institutional Review Board approval for this study was obtained, and written informed consent was given by all patients. This study is compliant with the STARD (Standards for Reporting of Diagnostic Accuracy) method. Fifty-nine patients (mean age, 33 years; range, 21-44 years) with clinical suspicion of deep pelvic endometriosis were prospectively enrolled. They underwent tg-TVUS and MRI before surgery. The characteristics of the MRI signal were analyzed. Mapping of recto-sigmoid endometriosis was performed and tg-TVUS and MR imaging results were compared with surgical and pathological findings. Sensitivity, specificity, and the positive and negative likelihood ratio (LR+ and LR-) were calculated. Inter-technique concordance was assessed using the Cohen statistic, and receiver operating characteristic (ROC) curves were obtained. Logistic regression analysis was performed.

RESULTS:

The prevalence of recto-sigmoid endometriosis was 51%. The specificity, sensitivity, and LR+ and LR- were 90%, 73%, 7.089 and 0.297, respectively, for MRI and 86%, 73%, 5.317 and 0.309, respectively, for tg-TVUS. The presence of a high T1 signal spot was an excellent specific finding (100%) but was associated with a low sensitivity (30%). Inter-technique concordance using the Cohen statistic indicated a kappa value of 0.658 (± 0.098 SD). According to the logistic regression equation obtained, the use of both tg-TVUS and MRI allows optimal diagnostic performance.

CONCLUSION:

MRI and tg-TVUS show similar results in the identification of recto-sigmoid endometriosis. The Cohen kappa value suggests that these methods may have complementary roles in the identification of recto-sigmoid endometriosis, depending on the site affected.

J Obstet Gynaecol.2012 Feb;32(2):173-6.

Pre-sampling ultrasound evaluation and assessment of the tissue yield during sampling improves the diagnostic reliability of office endometrial biopsy.

Van den Bosch T, Van Schoubroeck D, Van Calster B, Cornelis A, Timmerman D.

Source

Department of Obstetrics and Gynaecology, University Hospitals Leuven, K. U. Leuven, Belgium. thierry.van.den.bosch@skynet.be

Abstract

We evaluated the implementation of a strict procedure for endometrium biopsy, including pre-sampling ultrasound examination and assessment of the tissue yield during sampling, in 257 consecutive women with abnormal bleeding. The tissue yield was assessed during sampling and scored from 1 to 4. The median endometrial thickness as measured by ultrasound was 5.0 mm, 5.1 mm, 10.0 mm and 18.7 mm for a tissue yield score of 1, 2, 3 and 4, respectively. The median endometrial thickness at ultrasound and the median tissue yield score was 18.3 mm and score 4 in the endometrial cancer cases, compared with 3.9 mm and score 1, and 14.8 mm and score 3 in the case of endometrial atrophy and hyperplasia, respectively; and 11.5 mm and score 2 in endometrial polyp cases. Overall, 12 cancers were diagnosed. No endometrial cancer was diagnosed during follow-up (median 447 days). A strict office endometrial biopsy procedure contributes to the diagnostic reliability for intracavitary pathology.

J Obstet Gynaecol.2012 Feb;32(2):113-6.

Adenomyosis and female fertility: a critical review of the evidence.

Sunkara SK, Khan KS.

Source

Assisted Conception Unit, Guy’s and St Thomas’ Foundation Hospital, King’s College London, London, UK. sksunkara@hotmail.com

Abstract

Adenomyosis is frequent during the evaluation of infertile women. Present evidence suggests that adenomyosis has a negative impact on female fertility. Limited data from uncontrolled studies suggest that treatment of adenomyosis may improve fertility. This review critically appraises the existing evidence to determine the relationship between adenomyosis and female fertility. There is need for large epidemiological studies to substantiate the association between adenomyosis and infertility. Furthermore, if adenomyosis has a harmful impact on fertility there is a need to determine if its treatment improves fertility and the various treatment modalities reported need to be assessed for their effectiveness in randomised trials.

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, 200nmol/mL), HOCl (10, 20, 50, and 100nmol/mL), and HOCl (50nmol/mL) pretreated with 150 and 200nmol/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 50nmol/mL of HOCl (P<0.001). Oocytes treated with melatonin only at 150 and 200nmol/mL showed no changes; significant differences (P<0.001) were observed when oocytes exposed to 50nmol/mL of HOCl were compared to oocytes pretreated with 200nmol/mL melatonin. Fifty percent of the oocytes demonstrated good scores, both in microtubule and CH alterations, when pretreated with melatonin at 150nmol/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.

Lascia un commento

Cerca

Utilizzando il sito, accetti l'utilizzo dei cookie da parte nostra. maggiori informazioni

Questo sito utilizza i cookie per fornire la migliore esperienza di navigazione possibile. Continuando a utilizzare questo sito senza modificare le impostazioni dei cookie o cliccando su "Accetta" permetti il loro utilizzo.

Chiudi