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Taiwan J Obstet Gynecol. 2012 Sep;51(3):393-6. doi: 10.1016/j.tjog.2012.07.013.

Comparison of Ki-67 proliferative index between eutopic and ectopic endometrium: a case control study.

Kahyaoglu I1Kahyaoglu SMoraloglu OZergeroglu SSut NBatioglu S.

 

Abstract

OBJECTIVE:

In this study, the Ki-67 proliferative indices among the stages of the endometriosis were compared to clarify whether the proliferation was increased with increasing disease stage.

MATERIALS AND METHODS:

Thirty-eight patients who underwent surgery either by laparotomy or by laparoscopy with the diagnosis of endometriosis and 21 patients, as controls, who underwent hysterectomy with the diagnosis of myoma uteri and without any endometrial pathology at our hospital between 2005 and 2007 were studied. Biopsy specimens of endometriotic foci and endometriomas in study group, and eutopic endometrium of hysterectomy specimens of control group were studied.

RESULTS:

Fifty-nine patients were divided into Group 1 (21 patients in control), Group 2 (19 patients in stage I and II of endometriosis), and Group 3 (19 patients in stage III and IV). A moderate correlation between the stage of endometriosis and the degree of Ki-67 staining was found. When Ki-67 immunohistochemical staining was considered according to the threshold value for CA-125 (35 U/mL), Ki-67 positivity was increased with the increase in CA-125 value, but this increase was not statistically significant.

CONCLUSION:

Endometriosis shows some characteristics of tumors such as high rate of invasion, getting autonomy, and proliferation as the disease progresses with subsequent damage to target organs. When the stage of the disease increases, environment becomes more suitable for increased proliferation and invasion. In this study, the increase in proliferative activity as the severity increases is shown by the increase in Ki-67 index. As more studies are being conducted in this field, pathogenesis will be clarified, which could help in the development of new treatment modalities.

 

 

Comp Med. 2012 Aug;62(4):303-10

Alternative activation of macrophages in rhesus macaques (Macaca mulatta) with endometriosis.

Smith KA1Pearson CBHachey AMXia DLWachtman LM.

 

Abstract

Endometriosis is one of the most frequently encountered gynecologic diseases and a common cause of chronic pelvic pain and infertility. The pathophysiology of this syndrome can best be described as the presence of ectopic endometrium and a pelvic inflammatory process with associated immune dysfunction and alteration in the peritoneal environment. Macrophages play an important role in the progression and propagation of endometriosis. Alternative macrophage activation occurs in rodents and women with endometriosis but had not been examined previously in nonhuman primates. This case-control study aimed to characterize macrophage polarization in the ectopic and eutopic endometrial tissue of nonhuman primates with and without endometriosis. In addition, circulating cytokines in endometriosis cases and normal controls were investigated in an effort to identify serum factors that contribute to or result from macrophage polarization. Endometriosis lesions demonstrated increased infiltration by macrophages polarized toward the M2 phenotype when compared with healthy control endometrium. No serum cytokine trends consistent with alternative macrophage activation were identified. However, serum transforming growth factor α was elevated in macaques with endometriosis compared with healthy controls. Findings indicated that the activation state of macrophages in endometriosis tissue in nonhuman primates is weighted toward the M2 phenotype. This important finding enables rhesus macaques to serve as an animal model to investigate the contribution of macrophage polarization to the pathophysiology of endometriosis.

 

Einstein (Sao Paulo). 2012 Jan-Mar;10(1):39-43.

Lag time between onset of symptoms and diagnosis of endometriosis.

Santos TM1Pereira AMLopes RGDepes Dde B.

 

 

Abstract

OBJECTIVE:

To assess lag time between onset of symptoms and diagnosis of endometriosis in patients followed up at the Outpatients Clinic of Endometriosis and Chronic Pelvic Pain, at the Hospital do Servidor Público Estadual de São Paulo “Francisco Morato de Oliveira”, from January 2003 to November 2009.

METHODS:

In a retrospective analytical study, a total of 310 women with endometriosis confirmed by surgery and pathological examination were evaluated in the period from January 6, 2003 to November 29, 2009. Data were gathered through revision of the follow-up visit forms at the specialized outpatients clinic and medical records. The software Epi-Info 3.3.2 was used for statistical analysis.

RESULTS:

The mean lag time between onset of symptoms and confirming diagnosis of endometriosis was 46.16 months (3.84 years), ranging from 6 to 324 months. Patients aged under 20 years had a mean time until diagnosis of 2.8 years (33.6 months, range of 6 to 144 months). In patients aged 20-29 years, it was 3.51 years (42.18 months, range 6-192 months). In those aged 30-40 years, the mean time was 4.14 years (49.69 months, range 6-324 months). And in women age over 40 years, it was 3.15 years (37.86 months, range 6-216 months).

CONCLUSION:

The lag time between onset of symptoms and diagnosis of endometriosis was shorter, as compared to other national and international evaluations.

 

Surg Endosc. 2013 Mar;27(3):946-56. doi: 10.1007/s00464-012-2539-2. Epub 2012 Oct 6.

Causes and prevention of laparoscopic ureter injuries: an analysis of 31 cases during laparoscopic hysterectomy in the Netherlands.

Janssen PF1Brölmann HAHuirne JA.

 

Abstract

BACKGROUND:

Ureter injuries are the most dreaded complication in gynecological surgery. Some risk factors for the occurrence of urinary tract injuries are known, but clear guidelines to prevent ureter injuries during laparoscopic hysterectomy (LH) are lacking. The aim of this study was to analyze all known ureter injuries that occurred during LH for a benign indication in the Netherlands, in order to identify patient- and surgeon-related risk factors.

METHODS:

Ninety-five LH-performing gynecologists were asked to recall all cases of known ureter injuries during LH in their hospital. After identification of ureter injuries, a structured interview was performed with a questionnaire that focused on the identification of predisposing factors which could account for the cause of the injury.

RESULTS:

Forty-one injuries were detected in 37 patients (4 bilateral ureter injuries) in a 20-year period. The questionnaire could be completed for 31 cases. Predisposing factors were retrospectively assessed and classified into categories: patient-related (i.e., deep infiltrating endometriosis, intraligamentary fibroids) (n = 18), surgeon-related (insufficient experience and/or technique) (n = 16), or both (insufficient experience and difficult case) (n = 8). According to earlier-mentioned recommendations in a Delphi study among experts, in 48.4 % of these ureter injury cases, more than one of the recommended techniques or predisposing conditions were not applied or available. Only one ureter injury was diagnosed during the LH; the mean time to diagnose the injury was 29 days.

CONCLUSIONS:

Incomplete learning curve, insufficient applied technique such as coagulation of the uterine artery without the use of a uterine manipulator, and/or from the contralateral side and/or without previously performed ureterolysis in case of distorted anatomy may be considered as the main predisposing factors.

 

 

Arch Gynecol Obstet. 2013 Jan;287(1):123-30. doi: 10.1007/s00404-012-2567-0. Epub 2012 Oct 4.

Endocrine and inflammatory factors and endometriosis-associated infertility in assisted reproduction techniques.

Du YB1Gao MZShi YSun ZGWang J.

 

 

Abstract

PURPOSE:

Our research aimed to evaluate the effect of endometriosis on folliculogenesis and pregnancy, and to assess the involvement of inflammatory factors (IL1b, PGE2, PGF2α, and TGFβ2) in follicular fluid.

METHODS:

A total of 65 follicular fluid aspirates were collected. Concentrations of inflammatory factors (IL1b, PGE2, PGF2α, and TGFβ2) and steroid hormones (E2, progesterone, FSH, and LH) within follicular fluid as well as serum E2 and LH concentrations were measured. The mRNA expression of IL1b, Ptgs2, aromatase, and PPARγ in granulosa cells was determined. The outcome of ART was monitored and recorded.

RESULTS:

The oocyte retrieval, rate of metaphase II oocyte, cleavage rate, effective embryo rate, and pregnancy rates of patients with endometriosis were all significantly lower than those of the control patients. In those with endometriosis, serum E2 concentrations were lower than those observed in controls. Aromatase levels in the granulosa cells of the endometriosis group were lower while concentrations of PGE2 in follicular fluid were higher than in the control group. Concentrations of PGE2, PGF2α, TGFβ2, and IL1b were significantly correlated with each other.

CONCLUSIONS:

These results suggest that the outcomes of ART, in relation to serum E2 concentration, were adversely affected by the presence of endometriosis. Furthermore, the results supported that, among the endocrine and inflammatory factors, PGE2 within the follicular fluid impairs the number and quality of oocytes.

 

 

Arch Gynecol Obstet. 2013 Mar;287(3):447-53. doi: 10.1007/s00404-012-2581-2. Epub 2012 Oct 9.

Changes in the size of rectovaginal endometriotic nodules infiltrating the rectum during hormonal therapies.

Ferrero S1Leone Roberti Maggiore UScala CDi Luca MVenturini PLRemorgida V.

 

Abstract

PURPOSE:

To evaluate the changes in the volume of rectovaginal endometriotic nodules infiltrating the rectum during 12-month treatment with hormonal therapies.

MATERIALS AND METHODS:

This prospective, non-randomized, self-controlled clinical trial included patients with rectovaginal endometriotic nodules infiltrating at least the muscularis propria of the rectum, who received one of the following therapies: norethisterone acetate, triptorelin and tibolone, norethisterone acetate and letrozole, desogestrel, sequential oral contraceptive pill. The volume of the nodules was determined by virtual organ computer-aided analysis (VOCAL, GE Healthcare, USA) at baseline and after 6 and 12 months of treatment.

RESULTS:

Eighty-three women (90.2 %) completed the 12-month treatment. When compared with baseline values, the volume of the nodules decreased at 6-month (p < 0.001) and 12-month treatment (p < 0.001). After 12-month treatment, the volume of the nodules decreased in all study groups. The volume of the nodules decreased during therapy in 68 women (73.9 %) and increased in 11 women (12.0 %).

CONCLUSION:

12-month administration of hormonal therapies reduces the volume of rectovaginal endometriotic nodules infiltrating the rectum in the majority of cases.

 

Qual Life Res. 2013 Sep;22(7):1537-41. doi: 10.1007/s11136-012-0285-5. Epub 2012 Oct 7.

Health-related quality of life in patients with interstitial cystitis/bladder pain syndrome and frequently associated comorbidities.

Suskind AM1Berry SHSuttorp MJElliott MNHays RDEwing BAClemens JQ.

 

Abstract

PURPOSE:

To estimate the association of chronic non-urologic conditions [i.e., fibromyalgia (FM), chronic fatigue syndrome (CFS), and irritable bowel syndrome (IBS)] with health-related quality of life (HRQOL) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS).

METHODS:

A total of 276 women with established diagnoses of IC/BPS completed a telephone interview which included demographics, self-reported medical conditions, the SF-36 health survey, and the interstitial cystitis symptom index (ICSI). Multivariate linear regression analysis was used to identify correlates of SF-36 physical and mental component summary scores.

RESULTS:

Mean patient age was 45.1 (SD 15.9) years, and 83% of the subjects were white. Mean values for the SF-36 Physical Component Score (PCS) and Mental Component Score (MCS) means were 39 (SD 14) and 45 (SD 12), respectively, indicating significant HRQOL reductions. Mean ICSI score was 11.27 (SD = 4.86). FM and IBS were significantly associated with worse SF-36 scores: -8 points on the PCS (p < 0.001) and -6 points on the MCS (p < 0.001). CFS and the presence of other pelvic conditions (overactive bladder, vulvodynia, endometriosis) were not significantly associated with SF-36 PCS and MCS scores.

CONCLUSIONS:

In patients with IC/BPS, the presence of FM, CFS, and IBS has a significant association with HRQOL, equivalent in impact to the bladder symptoms themselves. These results emphasize the importance of a multidisciplinary approach to treating patients with IC/BPS and other conditions.

 

 

Stat Med. 2013 Jun 15;32(13):2209-20. doi: 10.1002/sim.5654. Epub 2012 Oct 11.

Nonparametric ROC summary statistics for correlated diagnostic marker data.

Tang LL1Liu AChen ZSchisterman EFZhang BMiao Z.

 

Abstract

We propose efficient nonparametric statistics to compare medical imaging modalities in multi-reader multi-test data and to compare markers in longitudinal ROC data. The proposed methods are based on the weighted area under the ROC curve, which includes the area under the curve and the partial area under the curve as special cases. The methods maximize the local power for detecting the difference between imaging modalities. We develop the asymptotic results of the proposed methods under a complex correlation structure. Our simulation studies show that the proposed statistics result in much better powers than existing statistics. We apply the proposed statistics to an endometriosis diagnosis study.

 

 

 

Evid Based Complement Alternat Med. 2012;2012:591391. doi: 10.1155/2012/591391.

The traditional chinese medicine prescription pattern of endometriosispatients in taiwan: a population-based study.

Fang RC1Tsai YTLai JNYeh CHWu CT.

 

Abstract

Background. Traditional Chinese medicine (TCM), when given for symptom relief, has gained widespread popularity among women with endometriosis. The aim of this study was to analyze the utilization of TCM among women with endometriosis in Taiwan. Methods. The usage, frequency of service, and the Chinese herbal products prescribed for endometriosis, among endometriosis patients, were evaluated using a randomly sampled cohort of 1,000,000 beneficiaries recruited from the National Health Insurance Research Database. Results. Overall, 90.8% (N = 12, 788) of reproductive age women with endometriosis utilized TCM and 25.2% of them sought TCM with the intention of treating their endometriosis-related symptoms. Apart from the usage of either analgesics or more than one type of medical treatment, the odds of using TCM and Western medicine were similar in all types of conventional endometriosis treatment. However, endometriosis patients suffering from symptoms associated with endometriosis were more likely to seek TCM treatment than those with no symptoms. There were 21,056 TCM visits due to endometriosis and its related symptoms, of which more than 98% were treated with Chinese herbal products (CHPs). Conclusion. Gui-Zhi-Fu-Ling-Wan (Cinnamon Twig and Poria Pill) containing sedative and anti-inflammatory agents is the most commonly prescribed Chinese herbal formula mainly for the treatment of endometriosis-related symptomatic discomfort and the effects of these TCMs should be taken into account by healthcare providers.

 

 

Best Pract Res Clin Obstet Gynaecol. 2012 Dec;26(6):777-88.

In vitro fertilisation treatment and factors affecting success.

Huang JY1Rosenwaks Z.

 

Abstract

The efficacy of assisted reproductive technologies has improved significantly over the past decades. The main indications for in vitro fertilisation include tubal obstruction, severe male-factor infertility, severe endometriosis, ovulatory dysfunction, diminished ovarian reserve, and infertility of unexplained cause. In vitro fertilisation has also become an effective treatment option for couples wishing to undergo pre-implantation genetic diagnosis or screening, and for those wishing to cryopreserve their oocytes or embryos for preservation of fertility. The management of women in late reproductive age poses a major challenge; the optimum in vitro fertilisation treatment for poor responders remains elusive. The success of in vitro fertilisation treatment can be optimised by taking an individualised, patient-centered approach to controlled ovarian hyperstimulation. Key components involve selection of an appropriate controlled ovarian protocol, close-cycle monitoring, adjustment of gonadotropin dosage to avoid hyper-response, and individualised timing of human chorionic gonadotropin injection. Future directions of assisted reproductive technologies include development of non-invasive embryo selection methods, use of transcriptomics, proteomics, metabolomics, and time-lapse imaging technologies.

 

 

Ann Hum Genet. 2012 Nov;76(6):464-71. doi: 10.1111/j.1469-1809.2012.00726.x.

Association of the vascular endothelial growth factor gene polymorphisms (-460C/T, +405G/C and +936T/C) with endometriosis: a meta-analysis.

Xu S1Wu WSun HLu JYuan BXia YDe Moor BMarchal KWang XXu PCheng W.

 

Abstract

Published data on the association between the vascular endothelial growth factor (VEGF) gene -460C/T (rs833061), +405G/C (rs2010963), +936T/C (rs3025039) polymorphisms and endometriosis risk are inconclusive. Eleven eligible case-control studies including 2690 cases and 2803 controls were included in this meta-analysis through searching the databases of PubMed and CBMdisc (up to August 1, 2011). In the overall analysis, no significant association between the -460C/T and +405G/C polymorphisms and risk of endometriosis was observed. However, significant associations were observed between endometriosis risk and VEGF+936T polymorphism with summarized odds ratio of 1.19 (95%CI, 1.02-1.37), 1.18 (95%CI, 1.03-1.37), 1.15 (95%CI, 1.01-1.30) for CT versus CC genotype, dominant mode (CT/TT vs. CC) and allele comparison (T vs. C), respectively. Furthermore, stratified analysis showed that significantly strong association between +936T/C polymorphism and endometriosis was present only in stage III-IV (OR = 1.32 for dominant mode; OR = 1.30 for T vs. C), but not in stage I-II. However, no significantly increased risk of endometriosis was found in any of the genetic models in Asians or in Caucasians. This meta-analysis supports that VEGF+936T/C polymorphism is capable of causing endometriosis susceptibility.

 

 

Acta Obstet Gynecol Scand. 2013 Jan;92(1):3-7. doi: 10.1111/aogs.12026. Epub 2012 Nov 5.

The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses.

Haas D1Shebl OShamiyeh AOppelt P.

 

Abstract

The revised American Society for Reproductive Medicine (rASRM) score is currently the best-known classification of endometriosis and is the one most widely used throughout the world. It is relatively easy to use, but it does not take into account the involvement of retroperitoneal structures with deeply infiltrating endometriosis. For this reason, the Enzian classification was developed as a supplement to the rASRM score, in order to provide a morphologically descriptive classification of deeply infiltrating endometriosis. The Enzian classification currently has a poor level of international acceptance and is mainly used in the German-speaking countries. It was revised in 2011 and is now also easier to use. This article describes the strengths and weaknesses of the rASRM score and the Enzian classification and their common potential for classifying endometriosis.

 

 

Fertil Steril. 2012 Dec;98(6):1356-8. doi: 10.1016/j.fertnstert.2012.09.042. Epub 2012 Oct 11.

The use of aromatase inhibitors in in vitro fertilization.

Garcia-Velasco JA1.

 

Abstract

The use of aromatase inhibitors (AIs) in IVF patients remains controversial. AIs can be considered for ovulation induction for IVF in women who are normal and poor responders, are at risk of ovarian hyperstimulation syndrome or thrombosis, who have endometriosis, and/or are undergoing fertility preservation procedures as a result of estrogen-dependent cancers, primarily breast and endometrial cancers. Although the biologic plausibility of the capacity of AIs in IVF patients is promising, results should be interpreted with caution, because the efficacy of AIs needs to be proven in randomized trials.

 

Radiographics. 2012 Oct;32(6):1675-91. doi: 10.1148/rg.326125518.

MR imaging of endometriosis: ten imaging pearls.

Siegelman ES1Oliver ER.

 

Abstract

Endometriosis, which is defined as the presence of ectopic endometrial glands and stroma outside the uterus, is a common cause of pelvic pain and infertility, affecting as many as 10% of premenopausal women. Because its effects may be devastating, radiologists should be familiar with the various imaging manifestations of the disease, especially those that allow its differentiation from other pelvic lesions. The “pearls” offered here are observations culled from the authors’ experience with the use of magnetic resonance (MR) imaging for the detection and characterization of pelvic endometriosis. First, the inclusion of T1-weighted fat-suppressed sequences is recommended for all MR examinations of the female pelvis because such sequences facilitate the detection of small endometriomas and aid in their differentiation from mature cystic teratomas. Second, it must be remembered that benign endometriomas, like many pelvic malignancies, may exhibit restricted diffusion. Although women with endometriosis are at risk for developing clear cell and endometrioid epithelial ovarian cancers (ie, endometriosis-associated ovarian cancers), imaging findings such as enhancing mural nodules should be confirmed before a diagnosis of ovarian malignancy is offered. The presence of a dilated fallopian tube, especially one containing hemorrhagic content, is often associated with pelvic endometriosis. Deep (solid infiltrating) endometriosis can involve the pelvic ligaments, anterior rectosigmoid colon, bladder, uterus, and cul-de-sac, as well as surgical scars; the lesions often have poorly defined margins and T2 signal hypointensity as a result of fibrosis. The presence of subcentimeter foci with T2 hyperintensity representing ectopic endometrial glands within these infiltrating fibrotic masses may help establish the diagnosis.

 

 

Radiographics. 2012 Oct;32(6):E233-50. doi: 10.1148/rg.326125515.

Imaging of müllerian duct anomalies.

Behr SC1Courtier JLQayyum A.

 

Abstract

The müllerian ducts are paired embryologic structures that undergo fusion and resorption in utero to give rise to the uterus, fallopian tubes, cervix, and upper two-thirds of the vagina. Interruption of normal development of the müllerian ducts can result in formation of müllerian duct anomalies (MDAs). MDAs are a broad and complex spectrum of abnormalities that are often associated with primary amenorrhea, infertility, obstetric complications, and endometriosis. MDAs are commonly associated with renal and other anomalies; thus, identification of both kidneys is important. However, MDAs are not associated with ovarian anomalies. Hysterosalpingography (HSG) is routinely used in evaluation of infertility. Because a key component of MDA characterization is the external uterine fundal contour, HSG is limited for this purpose. Patients suspected of having an MDA are often initially referred for pelvic ultrasonography (US). Magnetic resonance (MR) imaging is typically reserved for complex or indeterminate cases. MR imaging is the imaging standard of reference because it is noninvasive, does not involve ionizing radiation, has multiplanar capability, allows excellent soft-tissue characterization, and permits a greater field of interrogation than does US. Use of MR imaging for evaluation of MDAs reduces the number of invasive procedures and related costs by guiding management decisions.

 

 

 

 

 

J Obstet Gynaecol Can. 2012 Oct;34(10):939-946. doi: 10.1016/S1701-2163(16)35407-X. French.

Results of gynecologic laparoscopy in the Central University Hospital (CHU) of Dakar: prospective series of 128 cases.

[Article in French]

Mbaye M1Cissé MLGuèye SMDièmé MEDiouf AAGuèye MDiouf AMoreau JC.

 

Abstract

OBJECTIVES:

To analyze the results of, and to evaluate, gynaecologic laparoscopy in Dakar Teaching Hospital.

METHODS:

This exploratory and descriptive study deals with a continuous series of 128 gynaecologic laparoscopies carried out between January 1, 2006, and December 31, 2009. In each operative case, sociodemographic and clinical parameters,operative data, and outcomes were studied.

RESULTS:

Laparoscopies represented 14.37% of the programmed operative activities. The average age of the patients was 32 years,and the average parity was 1.2. The interventions were most frequently undertaken because of infertility (78.9%). A history of pelvic infections was found in 39.8% of the cases. The most frequent pathologies were tubal anomalies (70% of infertility cases) followed by ovarian cysts (10.1%) and endometriosis. The operative interventions included adhesiolysis in 35.1% of cases,and tubal surgery in 30.4%. A conversion, necessary in 7% of cases, was necessitated by the extent of adhesions (3 cases),the treatment of an associated pathology (4 cases), or a technical difficulty (2 cases).The main complications were vascular wounds and uterine perforations. The average operating times for diagnostic and operative laparoscopies were 56 minutes and 107 minutes,respectively. Outcomes were simple in 91.8% of cases. During the immediate postoperative period, a death occurred due to an acute pneumopathy. The average length of hospital stay was 3 days. We observed a pregnancy rate of 4.6%. Assisted reproduction was indicated in 28.7% of infertility cases.

CONCLUSION:

Given its many advantages, diagnostic and operative laparoscopy must be integrated and developed by gynaecology departments in developing countries. This necessity is emphasized by the prevalence of tubal infertility of infectious origins, which, if diagnosed and treated early by laparoscopy,could have a better prognosis.

 

 

 

 

Biochim Biophys Acta. 2013 Jan;1834(1):8-15. doi: 10.1016/j.bbapap.2012.10.004. Epub 2012 Oct 13.

Proteomics in reproductive biology: beacon for unraveling the molecular complexities.

Upadhyay RD1Balasinor NHKumar AVSachdeva GParte PDumasia K.

 

Abstract

Proteomics, an interface of rapidly evolving advances in physics and biology, is rapidly developing and expanding its potential applications to molecular and cellular biology. Application of proteomics tools has contributed towards identification of relevant protein biomarkers that can potentially change the strategies for early diagnosis and treatment of several diseases. The emergence of powerful mass spectrometry-based proteomics technique has added a new dimension to the field of medical research in liver, heart diseases and certain forms of cancer. Most proteomics tools are also being used to study physiological and pathological events related to reproductive biology. There have been attempts to generate the proteomes of testes, sperm, seminal fluid, epididymis, oocyte, and endometrium from reproductive disease patients. Here, we have reviewed proteomics based investigations in humans over the last decade, which focus on delineating the mechanism underlying various reproductive events such as spermatogenesis, oogenesis, endometriosis, polycystic ovary syndrome, embryo development. The challenge is to harness new technologies like 2-DE, DIGE, MALDI-MS, SELDI-MS, MUDPIT, LC-MS etc., to a greater extent to develop widely applicable clinical tools in understanding molecular aspects of reproduction both in health and disease.

 

 

 

Arch Gynecol Obstet. 2013 Mar;287(3):473-5. doi: 10.1007/s00404-012-2598-6. Epub 2012 Oct 17.

Spontaneous viable birth in a case of stage III pelvic endometriosis with bilateral tubal damage following diagnostic intervention: who deserves the credit?

Shekhar S1Sharma CSingh K.

 

Abstract

INTRODUCTION:

We are reporting a case of spontaneous conception and viable birth in a woman diagnosed with stage III pelvic endometriosis and bilateral tubal blockade.

CASE:

A 30-year-old woman was investigated for primary infertility and was diagnosed with stage III pelvic endometriosis, extensive distortion of pelvic anatomy and bilateral tubal damage on diagnostic laparoscopy and chromotubation. Patient was advised in vitro fertilization; however, she chose otherwise and conceived spontaneously, delivering a healthy baby by cesarean section at term.

DISCUSSION:

Spontaneous conception rates amongst women with advanced endometriosis nearly approaches zero; hence, expectant management is not recommended for associated infertility. Despite being and isolated case, this report raises questions regarding the association of infertility even with advanced endometriosis and also highlights the beneficial effect pregnancy has on endometriosis.

 

 

J Ovarian Res. 2012 Oct 18;5(1):29. doi: 10.1186/1757-2215-5-29

Health-related quality of life in women with endometriosis: a systematic review.

Jia SZ1Leng JHShi JHSun PRLang JH.

 

Abstract

Endometriosis has critical implications for women’s quality of life. However, an overview of the current knowledge of this issue is limited. The objective of this systematic review was to determine the extent of endometriosis and its treatment upon women’s health-related quality of life (HRQoL). PubMed, Embase, PsycoINFO, CINAHL and the Cochrane Clinical Trials were searched up to May 2012, and only studies using standardized instruments to evaluate HRQoL in women with endometriosis were selected. Our electronic searches identified 591 citations, of which 39 studies satisfied the inclusion criteria including nine qualitative studies and 30 treatment-related studies. Findings showed that endometriosis impaired women’s HRQoL. Pain was strongly related to a poor HRQoL, and medical or surgical treatment could partially restore this impairment. No conclusive evidence was available on whether endometriosis imposed an additional impairment in HRQoL per se, apart from the decrease caused by chronic pelvic pain, or on the superiority of various hormonal suppression agents. The impacts of disease extent, duration and fertility status upon HRQoL were inconsistent. In summary, HRQoL was impaired in women with endometriosis, and medical or surgical treatment to alleviate pain could partially restore this impairment.

 

 

Mol Biosyst. 2012 Oct 30;8(12):3281-7. doi: 10.1039/c2mb25353d.

A metabonomics approach as a means for identification of potential biomarkers for early diagnosis of endometriosis.

Dutta M1Joshi MSrivastava SLodh IChakravarty BChaudhury K.

 

Abstract

Our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using (1)H-NMR based metabonomics. PLS-DA modeling of bins obtained from CPMG spectra of serum samples discriminated endometriosis patients from controls with sensitivity and specificity levels of about 80% and 90%, respectively. Compared with those from controls, serum samples from endometriosis patients showed increased levels of lactate, 3-hydroxybutyrate, alanine, leucine, valine, threonine, lysine, glycerophosphatidylcholine, succinic acid and 2-hydroxybutyrate as well as decreased levels of lipids, glucose, isoleucine and arginine. Our work offers valuable information for non-invasive diagnosis of endometriosis and may be of potential benefit to understand pathogenesis of the disease.

 

Surg Today. 2013 Oct;43(10):1188-93. doi: 10.1007/s00595-012-0360-0. Epub 2012 Oct 19.

Hepatic endometrioma: a case report and review of the literature: report of a case.

Rivkine E1Jakubowicz DMarciano LPolliand CPoncelet CZiol MBarrat C.

 

Abstract

Hepatic endometriosis has an extremely rare occurrence characterized by the presence of ectopic endometrium in the liver. A diagnosis of hepatic endometriosis is established after surgery. A 51-year-old multiparous female was referred to our unit for investigation of a liver tumor. The patient reported a 6-month history of epigastric pain and vomiting. She had undergone conservative hysterectomy for uterine leiomyomas several years earlier. The results of liver function tests and the levels of tumor markers (CA 19.9, CEA, CA125, αFP) were normal. Radiological imaging (USS, CT and MRI) suggested the presence of liver cystadenoma, liver cystadenocarcinoma or cystic metastasis of the liver in the left liver lobe extending to the diaphragm with left hepatic vein compression. Laparotomy was performed. The intraoperative frozen sections suggested a diagnosis of endometriosis. Anatomical resection was performed, including left lobectomy with diaphragm resection. The final histology confirmed the presence of hepatic endometrioma without malignant transformation. Fourteen cases of hepatic endometrioma have been described in the medical literature. We herein report the 15th case. Making a preoperative diagnosis of hepatic endometriosis is very difficult, despite conducting a complete investigation, in the absence of clinical and radiological characteristics. The diagnosis is made according to a histological examination of the whole surgical sample.

 

Arch Gynecol Obstet. 2013 Mar;287(3):495-509. doi: 10.1007/s00404-012-2572-3. Epub 2012 Oct 19.

Financing of certified centers: a willingness-to-pay analysis.

Thiel FC1Scharl AHildebrandt TKotziabassis ESchrauder MGBani MRMüller AHauzenberger TLoehberg CRJud SMFasching PAHartmann ASchulz-Wendtland RStrnad VBeckmann MWLux MP.

 

Abstract

INTRODUCTION:

Although care in certified breast centers is now established throughout Germany, numerous services are still not being reimbursed. This also affects other centers involved in the specialty of gynecology such as gynecological cancer centers, perinatal centers, and endometriosis centers. Although a certified center is entitled to charge additional fees, these are in most cases not reimbursed. Calculation of additional costs is limited by the fact that data from the Institute for the Hospital Reimbursement System (Institut für das Entgeltsystem im Krankenhaus, InEK) do not reflect interdisciplinary services and procedures. For decision-makers, society’s willingness to pay is an important factor in guiding decisions on the basis of social priorities. A hypothetical maximum willingness to pay can be calculated using a willingness-to-pay analysis, making it possible to identify deficiencies in the arbitrary setting of health budgets at the macro-level.

MATERIALS AND METHODS:

In a multicenter study conducted between November 2009 and December 2010, 2,469 patients at a university hospital and at a non-university hospital were asked about the extent of their awareness of certified centers, the influence of centers on hospital presentation, and about personal attitudes toward quality-oriented reimbursement. A subjective assessment of possible additional charges was calculated using a willingness-to-pay analysis.

RESULTS:

In the overall group, 53.4 % of the patients were aware of what a certified center is and 27.4 % had specific information (obstetrics 40.0/32.3 %; mastology 66.8/23.2 %; gynecological oncology 54.7/27.3 %; P < 0.001). For 43.8 %, a certified center was one reason or the major reason for presentation (obstetrics 26.2 %; mastology 66.8 %; gynecological oncology 46.6 %; P < 0.001). A total of 72.6 % were in favor of quality-oriented reimbursement and 69.7 % were in favor of an additional charge for a certified center amounting to €538.56 (mastology €643.65, obstetrics €474.67, gynecological oncology €532.47). In all, 33.9 % would accept an increase in health-insurance fees (averaging 0.3865 %), and 28.3 % were in favor of reduced remuneration for non-certified centers.

CONCLUSIONS:

The existence of certified centers is being increasingly recognized by patients. Additional charges for certified centers are generally supported. There is therefore a clear demand for them-from patients as well. This may be useful when negotiations are being conducted.

 

 

 

Arch Gynecol Obstet. 2013 Mar;287(3):487-94. doi: 10.1007/s00404-012-2591-0. Epub 2012 Oct 19.

Aberrant histone acetylation and methylation levels in woman with endometriosis.

Xiaomeng X1Ming ZJiezhi MXiaoling F.

 

Abstract

OBJECTIVE:

To investigate the alterations in histone modifications in woman with endometriosis.

METHODS:

Global histone H3/H4 acetylation and H3K4/H3K9 methylation in eutopic and ectopic endometrium from 15 endometriosis patients were assayed using the EpiQuik global histone H3/H4 acetylation and H3K4/H3K9 methylation assay kits. Quantitative real-time reverse transcriptase-polymerase chain reaction was applied to measure mRNA levels of 12 members of histone-related chromatin modifier genes.

RESULTS:

Histone H4 hypoacetylation was detected both in eutopic and ectopic endometrium. There were no difference between patients with endometriosis and controls on global levels of H3 acetylation. Furthermore, global histone H3K4 hypomethylation and H3K9 hypomethylation were detected both in ectopic and eutopic endometrium (p < 0.001), and in ectopic endometrium (p < 0.001), respectively. SIRT1 mRNA level was significantly decreased in eutopic endometrium, while mRNA levels of HDAC1, SUV39H1, SUV39H2 and G9a were significantly downregulated in ectopic endometrium. HDAC2 mRNA level was significantly increased in eutopic endometrium. PCAF mRNA level was significantly increased in ectopic endometrium.

CONCLUSIONS:

Aberrant histone modification may play an important role in the pathogenesis of endometriosis.

 

 

Hum Reprod. 2013 Jan;28(1):178-88. doi: 10.1093/humrep/des369. Epub 2012 Oct 18.

Natural therapies assessment for the treatment of endometriosis.

Ricci AG1Olivares CNBilotas MABastón JISingla JJMeresman GFBarañao RI.

 

Abstract

STUDY QUESTION:

Can resveratrol and epigallocatechin-3-gallate (EGCG) inhibit the growth and survival of endometriotic-like lesions in vivo in a BALB/c model of endometriosis, and in vitro in primary cultures of human endometrial epithelial cells (EECs)?

SUMMARY ANSWER:

Resveratrol and EGCG exerted a potent inhibitory effect on the development of endometriosis in a BALB/c murine model and on the survival of EECs.

WHAT IS KNOWN ALREADY:

Endometriosis is a common condition associated with infertility and pelvic pain in women of reproductive age. Resveratrol and EGCG are two polyphenols with anticarcinogenic and antioxidant properties that have been proposed as natural therapies to treat endometriosis.

STUDY DESIGN, SIZE, DURATION:

Fifty-six 2-month-old female BALB/c mice underwent surgical induction of endometriosis. Treatments with resveratrol or EGCG started 15 days post-surgery and continued for 4 weeks. Human biopsies were taken with a metal Novak curette from the posterior uterine wall from 16 patients with untreated endometriosis and 15 controls who underwent diagnostic laparoscopy for infertility.

MATERIALS, SETTING, METHODS:

After the treatments, animals were sacrificed and lesions were counted, measured, excised and fixed. Immunohistochemistry for proliferating cell nuclear antigen and CD34 was performed for cell proliferation and vascularization assessment in the lesions. The terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labeling (TUNEL) technique was performed for apoptosis evaluation. Peritoneal fluid was collected to analyze vascular endothelial growth factor levels. Human EECs were purified from proliferative-phase endometrial biopsies and cultured. The effect of both polyphenols on cell proliferation was determined by a colorimetric assay using the CellTiter 96®AQueous One Solution Cell Proliferation Assay kit and on apoptosis by the TUNEL technique, using an In Situ Cell Death Detection Kit with Fluorescein.

MAIN RESULTS:

In the mouse model, both treatments significantly reduced the mean number (P < 0.05 versus control) and the volume of established lesions (P < 0.05 versus control). Treatments consistently statistically significantly diminished cell proliferation (resveratrol P < 0.01 and EGCG P < 0.05, versus control), reduced vascular density (resveratrol P < 0.01 and EGCG P < 0.001, versus control) and increased apoptosis within the lesions (resveratrol P < 0.01 and EGCG P < 0.05, versus control). Both compounds induced reduction in human EEC proliferation (P < 0.05 versus basal) and increased apoptosis (P < 0.05 versus basal) in primary cultures.

LIMITATIONS:

In vitro studies were only carried out in epithelial cells from human eutopic endometrium.

WIDER IMPLICATIONS OF THE FINDINGS:

The present findings are promising and will assist the development of novel natural treatments for endometriosis.

STUDY FUNDING:

This study was supported by ANPCYT (PICT 6384 BID 1201 OC-AR) and CONICET (PIP 5471), Argentina. None of the authors has any conflict of interest to declare.

 

 

Gig Sanit. 2012 Jul-Aug;(4):35-7. Russian.

Night shift and the risk of hormone-dependent diseases in women.

 

Abstract

From cards of follow-up of industrial contingent passing preventive medical examinations, the frequency of disorders of the reproductive sphere and the endocrine system in 208 women employed in shift work including the night shift was investigated in comparison with 102 female members of administrative and managerial staff The relative risk (RR) of all investigated pathologies associated with employment in night shifts, was 1.52 (95% confidence interval (CI): 1.06-2.18). The increased risk of mastitis (OR = 1.13, 95% CI 0.95-1.35), and a uterine myoma (RR = 1.16, 95% CI: 1.00-1.36) was on the border of statistical significance. Endometriosis was significantly more frequent in the study group: RR = 1.23 (1.04-1.45). The risk of developing ovarian cysts was not significantly lower: RR = 0.94 (95% CI: 0.72-1.24). In connection with the employment in night shifts increased risk of all endocrine diseases was observed on the border of statistical significance: RR = 1.18 (95% CI: 0.99-1.40), including the development of obesity: RR = 1.22 (95% CI 1.05-1.43). The frequency of diabetes in the group of workers with night shifts was statistically significantly higher (OR = 1.13, 95% CI: 0.84-1.51). The pathology of the thyroid gland in the study group occurred less frequently than in the control one: RR = 0.88 (95% CI: 0.73-1.07). These data are preliminary, but they are consistent with the available experimental and epidemiological data.

 

 

 

Acta Obstet Gynecol Scand. 2013 Feb;92(2):125-36. doi: 10.1111/aogs.12036. Epub 2012 Dec 5

Continuous use of oral contraceptives: an overview of effects and side-effects.

Hee L1Kettner LOVejtorp M.

 

Abstract

OBJECTIVE:

To describe the effects and side-effects of the continuous use of oral contraceptives.

DESIGN:

A review of articles concerning oral contraceptives taken continuously or in cycles with hormones taken for more than 21 days per cycle.

METHODS:

We searched publications in PubMed and Embase. Randomized controlled trials were selected if possible, otherwise case-control studies or cohort studies with controls were chosen. A level of evidence as described by the Centre for Evidence Based Medicine (Oxford University, Oxford, UK) was assigned to all selected studies.

MAIN OUTCOME MEASURES:

Clinical and paraclinical effects and side-effects of oral contraceptives administered continuously.

RESULTS:

The studies suggest that the endometrium is inactive during continuous use of oral contraceptives and the risk of endometrial hyperplasia is not increased. Numbers of bleeding days are halved with continuous use; however, spotting and irregular bleeding are more often seen in the beginning of use, decreasing with time. Hemostatic parameters and serum lipid and carbohydrate profiles in continuous and conventional users do not differ. Menstrual cycle-related symptoms are relieved better by continuous treatment. After surgery for endometriosis, the effect of continuously used oral contraceptives on the risk of recurrence of pain has been found to be less than that of gonadotropin-releasing hormone (GnRH) analogues, but better than the rate seen during conventional cyclic use.

CONCLUSION:

Oral contraceptives taken continuously or in long cycles seem to offer benefits with regard to menstrual symptoms and the recurrence of symptoms related to endometriosis. Long-term studies, comprising large groups of women, are lacking.

 

 

J Minim Invasive Gynecol. 2012 Nov-Dec;19(6):680-3. doi: 10.1016/j.jmig.2012.08.004

Lesions of the umbilicus: what the minimally invasive gynecologic surgeon needs to know about the belly button.

Heller DS1.

 

Abstract

The umbilicus is viewed as a portal by the laparoscopic surgeon, a doorway to the real business at hand. However, the umbilicus itself may be the site of a variety of lesional conditions. Some of these may be iatrogenic, caused by prior surgical interventions, such as endometriosis or seeding of a malignant neoplasm. Some may be the initial presenting complaint. This review discusses umbilical lesions that may be encountered by the minimally invasive gynecologic surgeon.

 

 

J Minim Invasive Gynecol. 2012 Nov-Dec;19(6):722-30. doi: 10.1016/j.jmig.2012.08.001.

Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial.

Ferrero S1Venturini PLGillott DJRemorgida VLeone Roberti Maggiore U.

 

Abstract

STUDY OBJECTIVE:

To estimate whether the suture of the ovary is superior to bipolar coagulation in preserving ovarian reserve in infertile women undergoing laparoscopic stripping of bilateral endometriomas.

DESIGN:

Randomized controlled trial (Canadian Task Force classification I).

SETTING:

University teaching hospital.

PATIENTS:

100 patients with bilateral endometriomas.

INTERVENTIONS:

Patients underwent stripping of bilateral endometriomas and were randomized to undergo hemostasis by use of either laparoscopic suturing (LS group) or bipolar coagulation (BC group). Changes in ovarian reserve were investigated by measuring the levels of anti-Mullerian hormone (AMH) and basal follicle-stimulating hormone (FSH) before surgery and at 3, 6 and 12 months from surgery.

MEASUREMENTS AND MAIN RESULTS:

At 3-month, 6-month, and 12-month follow-up, in both study groups, postsurgical AMH levels were significantly lower and basal FSH levels were significantly higher than before surgery. There was no significant difference in the mean percentage decrease of AMH levels in the BC group and LS group at 3-, 6-, and 12-month follow-up. The mean percentage increase in basal FSH was higher in the BC group than in the LS group at both 3-month (p = .023) and 6-month follow-up (p = .029), but not at 12-month follow-up. Pregnancy rate, time to conception, and rate of endometrioma recurrence was similar in the 2 study groups.

CONCLUSION:

Laparoscopic stripping of ovarian endometriotic cyst significantly decreases serum AMH levels and increases basal FSH levels independent from the method used to obtain hemostasis on the ovarian tissue.

 

 

J Minim Invasive Gynecol. 2012 Nov-Dec;19(6):701-7. doi: 10.1016/j.jmig.2012.07.005

Effect of extreme obesity on outcomes in laparoscopic hysterectomy.

Siedhoff MT1Carey ETFindley ADRiggins LEGarrett JMSteege JF.

 

Abstract

STUDY OBJECTIVE:

To estimate the effect of body mass index (BMI) on several outcomes in laparoscopic hysterectomy, in particular in the extremes of obesity.

DESIGN:

Retrospective cohort study (Canadian Task Force classification II-3).

SETTING:

Tertiary-care university-based teaching hospital.

PATIENTS:

Eight hundred thirty-four patients who underwent laparoscopic hysterectomy from January 2007 to October 2011.

INTERVENTION:

Laparoscopic hysterectomy for benign indications.

MEASUREMENTS AND MAIN RESULTS:

Demographic, operative, and postoperative data were abstracted from medical records. The primary outcome was a composite index score that took into account operative time, nonsurgical operating room time, estimated blood loss, length of hospital stay, number of complications, and severity of complications according to the Dindo-Clavien classification. We individually examined elements of the composite index as a secondary outcome. Models were developed to assess the association of BMI with the composite index score and the components of the index, controlling for age, presence of diabetes, tobacco use, surgeon, type of hysterectomy (total vs supracervical), use of robotics, uterine weight, number of additional procedures performed, presence of adhesions requiring lysis, and deeply infiltrating endometriosis as potential confounders. Mean (SD) BMI was 31.4 (8.1). Mean (SD) uterine weight was 345 (388) g. Mean operative time was 150 (61) minutes. Increasing BMI was associated with a worse composite score (p < .01); longer operative time (p = .03), nonsurgical operating room time (p = .02), and total operating room time (p < .01); greater estimated blood loss (p < .01); and complication severity (p = .01).

CONCLUSION:

These data suggest that there is a significant association of BMI with surgical outcomes in laparoscopic hysterectomy, and the effect is most pronounced in the morbidly obese. These patients may stand to gain the greatest differential benefit from a laparoscopic approach to surgery. However, they should be properly counseled about the challenge that obesity poses to the operation.

 

 

 

J Minim Invasive Gynecol. 2012 Nov-Dec;19(6):742-8. doi: 10.1016/j.jmig.2012.08.773.

Thoracic endometriosis syndrome is strongly associated with severe pelvic endometriosis and infertility.

Soriano D1Schonman RGat ISchiff ESeidman DSCarp HWeintraub AYBen-Nun AGoldenberg M.

 

Abstract

STUDY OBJECTIVE:

To evaluate the clinical and surgical features of thoracic endometriosis syndrome (TES) represented by catamenial pneumothorax and pelvic endometriosis and to describe their association with infertility.

DESIGN:

Retrospective clinical study (Canadian Task Force classification: II-2).

SETTING:

Academic tertiary referral endometriosis center.

PATIENTS:

Seven patients who had undergone surgery because of thoracic and pelvic endometriosis between 2004 and 2010.

INTERVENTIONS:

Thoracic and pelvic exploration and treatment and fertility treatment.

MEASUREMENTS AND MAIN RESULTS:

Concurrently, thoracic and pelvic endometriosis, and subsequent fertility were determined during long-term follow-up after combined surgical and pharmacologic interventions. The most frequent thoracic finding was diaphragmatic implants. Except for 1 patient with recurrent pleurodesis at 1 month after video-assisted thoracoscopy, no patients experienced recurrence of thoracic symptoms during a median (range) follow-up of 31.4 (1-61) months. Severe pelvic endometriosis was diagnosed in 6 patients with notable urologic and gastrointestinal tract involvement. Only 1 patient with catamenial pneumothorax had no macroscopic pelvic lesions. There was a considerable delay between the onset of pelvic symptoms and diagnosis. Median postoperative follow-up was 31.5 (7-84) months. Most patients who tried to conceive had primary infertility.

CONCLUSION:

Thoracic endometriosis syndrome, represented by catamenial pneumothorax, was strongly associated with severe pelvic endometriosis and a high rate of infertility. Inasmuch as many patients with thoracic endometriosis syndrome are treated by thoracic surgeons using video-assisted thoracoscopy, it is desirable to involve an experienced gynecologist who can diagnose and treat concurrent pelvic endometriosis.

 

 

Rev Assoc Med Bras (1992). 2012 Sep-Oct;58(5):607-14. Review.

Minimal and mild endometriosis negatively impact on pregnancy outcome.

Carvalho LF1Below AAbrão MSAgarwal A.

 

Abstract

Endometriosis, a highly prevalent gynecological disease, can lead to infertility in moderate to severe cases. Whether minimal stages are associated with infertility is still unclear. The purpose of this systematic review is to present studies regarding the association between pregnancy rates and the presence of early stages of endometriosis. Studies regarding infertility, minimal (stage I, American Society of Reproductive Medicine [ASRM]) and mild (stage II, ASRM) endometriosis were identified by searching on the MEDLINE database from 1985 to September 2011 using the following MESH terms: endometriosis; infertility; minimal; mild endometriosis; pregnancy rate. 1188 articles published between January of 1985 and November of 2011 were retrieved; based on their titles, 1038 citations were excluded. Finally, after inclusion and exclusion criteria, 16 articles were selected to be part of this systematic review. Several reasons have been discussed in the literature to explain the impact of minimal endometriosis on fertility outcome, such as: ovulatory dysfunction, impaired folliculogenesis, defective implantation, decrease embryo quality, abnormal immunological peritoneal environment, and luteal phase problems. Despite the controversy involving the topic, the largest randomized control trial, published by Marcoux et al. in 1997 found a statistically different pregnancy rate after resection of superficial endometrial lesions. Earlier stages of endometriosis play a critical role in infertility, and most likely negatively impact pregnancy outcomes. Further studies into stage I endometriosis, especially randomized controlled trials, still need to be conducted.

 

 

Rev Assoc Med Bras (1992). 2012 Sep-Oct;58(5):620-32. Review. English, Portuguese.

Genetic polymorphisms and endometriosis: contribution of genes that regulate vascular function and tissue remodeling.

[Trovó de Marqui AB1.

 

Abstract

Endometriosis is a benign gynecological disease characterized by the presence and growth of endometrial cells outside the uterus. Genetic, endocrine, immunological, and environmental factors have been suggested in its pathogenesis. A great number of studies have related genetic polymorphisms as a factor that contributes to the development of endometriosis. This review presents a detailed description of the contribution of genetic polymorphisms in genes that regulate vascular function and tissue remodeling in endometriosis (alpha 2-HS glycoprotein [AHSG], epidermal growth factor receptor [EGFR], vascular endothelial growth factor [VEGF], endostatin, plasminogen activator inhibitor 1 [PAI-1], angiotensin I-converting enzyme [ACE], and matrix metalloproteinases [MMPs]). Some polymorphisms of the VEGF (-460 C/T, +405 G/C, +936 C/T), PAI, MMP-1, 2, and 3 genes were widely studied, while polymorphisms of the AHSG, EGF, endostatin, and VEGF (-1154 G/A, -2578 A/C) genes were not. In this latter case, additional studies are required to confirm the findings of the few studies that have analyzed these single nucleotide polymorphisms (SNPs). Additionally, studies that found a positive or negative association of SNP with endometriosis emphasize the relevance of studies with a large number of control cases to confirm their findings. The haplotype analysis was performed only for the VEGF (-460, +405, -1154 and -2578), ACE (-240/2350) and MMP-1, 2, 3, and 9 genes, and in most of them, there was no association with endometriosis. Of the eight works that analyzed haplotypes of the VEGF gene, five did not associate them with endometriosis. Haplotypes of ACE and MMP-2 genes were not associated with endometriosis, while those of MMP-1, 3, and 9 genes were related to a high risk for the disease.

 

 

Int J Womens Health. 2012;4:543-9. doi: 10.2147/IJWH.S36825. Epub 2012 Oct 10

Advantages of the association of resveratrol with oral contraceptives for management of endometriosis-related pain.

Maia H Jr1Haddad CPinheiro NCasoy J.

 

Abstract

BACKGROUND:

The effect of resveratrol on the management of endometriosis-related pain was investigated in 12 patients who failed to obtain pain relief during use of an oral contraceptive containing drospirenone + ethinylestradiol.

METHODS AND RESULTS:

The addition of 30 mg of resveratrol to the contraceptive regimen resulted in a significant reduction in pain scores, with 82% of patients reporting complete resolution of dysmenorrhea and pelvic pain after 2 months of use. In a separate experiment, aromatase and cyclo-oxygenase-2 expression were investigated in the endometrial tissue of 42 patients submitted to laparoscopy and hysteroscopy for the management of endometriosis. Sixteen of these patients were using oral contraceptives alone prior to hospital admission, while the remaining 26 were using them in combination with resveratrol. Inhibition of both aromatase and cyclo-oxygenase-2 expression was significantly greater in the eutopic endometrium of patients using combined drospirenone + resveratrol therapy compared with the endometrium of patients using oral contraceptives alone.

CONCLUSION:

These results suggest that resveratrol potentiates the effect of oral contraceptives in the management of endometriosis-associated dysmenorrhea by further decreasing aromatase and cyclo-oxygenase-2 expression in the endometrium.

 

 

J Reprod Med. 2012 Sep-Oct;57(9-10):446-8

Uterine cyst as a cause of chronic pelvic pain: a case report.

English DP1Verma UPearson JM.

 

Abstract

BACKGROUND:

Cystic adenomyosis is a rare form of adenomyosis. Presently, these cysts are generally considered to be of a benign nature and result from cyclical response to menstrual dynamics.

CASE:

A 31-year-old, African-American female presented for a second opinion with a chief complaint of pelvic pain. She had recently undergone an exploratory laparoscopy with findings suggestive of endometriosis. She was never pregnant and had been taking oral contraceptive pills for over 3 months with little relief This patient had no history of uterine surgery. Pelvic ultrasound performed after her surgery revealed a cystic structure, homogeneously echogenic in the anterior corpus of the uterus, measuring 2.7 x 2.4 x 3.5 cm. This structure appeared consistent with an adenomyotic cyst. The patient’s symptoms improved after the transvaginal aspiration, and she no longer required narcotics.

CONCLUSION:

Of all the possibilities considered, this cyst most closely resembled an adenomyotic cyst in its clinical presentation, location within the myometrium and gross appearance of the chocolate cyst fluid. Imaging is key in distinguishing this process from other congenital and acquired gynecologic entities. Awareness of this condition is important for timely and accurate diagnosis followed by appropriate intervention.

 

 

 

Obstet Gynecol Int. 2012;2012:869191. doi: 10.1155/2012/869191. Epub 2012 Oct 10.

Endometriosis in adolescence.

Dessole M1Melis GBAngioni S.

 

Abstract

Endometriosis is a common cause of pelvic pain and infertility. The majority of women report symptoms since adolescence, and there are rare cases of endometriosis in premenarchal age patients. Symptoms in adolescence are similar to those in adulthood. Treatment usually consists of oral contraceptives and nonsteroidal anti-inflammatory drugs. In cases where this treatment is not successful, laparoscopy and biopsy of the lesions are necessary for diagnosis. However, emerging new technologies provide new options, in particular the use of serological markers.

 

 

Arch Plast Surg. 2012 Sep;39(5):551-5. doi: 10.5999/aps.2012.39.5.551. Epub 2012 Sep 12.

Application of Mini-abdominoplasty after Conservative Excision of Extensive Cesarean Scar Endometriosis.

Lee ET1Park HMLee DGShin KJKim HSSung RHRyu DH.

 

Abstract

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity, and the standard treatment is extensive surgical excision. Cesarean scar endometriosis is a type of cutaneous endometriosis arising on or near a Cesarean section scar. A 44-year-old woman presented with a 9×6 cm sized dark-brown, stony-hard, irregular, lower abdominal mass of four years duration. The patient had a history of two Cesarean deliveries, 14 and 16 years ago. Suspecting endometriosis, we excised the tumor conservatively rather than extensively to prevent incisional hernia considering the benign nature of the tumor and the low possibility of recurrence because the patient’s age was near menopause, along with simultaneous bilateral salpingo-oophorectomy that was performed in this case. On reconstruction, mini-abdominoplasty was adopted to avoid possible wound complications and cosmetic deformities. The patient was satisfied with the cosmetic results, and neither recurrence nor functional problems occurred during the 1-year follow-up period. Plastic surgeons should keep in mind the possibility of cutaneous endometriosis in an abdominal mass of a female of reproductive age with a previous history of pelvic or intra-abdominal surgery. An optimal result from oncological, functional, and cosmetic standpoints can be achieved with conservative excision followed by mini-abdominoplasty of extensive Cesarean scar endometriosis.

 

 

 

J Psychosom Obstet Gynaecol. 2012 Dec;33(4):191-8. doi: 10.3109/0167482X.2012.729625. Epub 2012 Oct 25.

Physical therapy and psychological intervention normalize cortisol levels and improve vitality in women with endometriosis.

Friggi Sebe Petrelluzzi K1Garcia MCPetta CARibeiro DAde Oliveira Monteiro NRCéspedes ICSpadari RC.

 

Abstract

There is as yet no effective treatment for endometriosis. The objective of this study was to evaluate the effectiveness of submitting women with endometriosis and chronic pelvic pain to a therapeutic protocol involving physical and psychological therapy. Twenty-six female volunteers were submitted to a treatment protocol consisting of 2.5-h sessions, once a week for 10 weeks. We applied a Visual Analogue Scale, the Perceived Stress Questionnaire (PSQ), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Morning, afternoon, and evening levels of cortisol were determined in saliva samples. The PSQ scores were significantly lower after treatment, whereas the scores for the SF-36 vitality and physical functioning domains were significantly higher. Salivary cortisol levels were higher after treatment in the samples collected in the morning, but not in those collected in the afternoon or evening. The post-treatment cortisol levels were similar to those reported for healthy women. There were positive correlations between vitality, role emotional, social functioning, and mental health, and negative correlations to perceived stress. In conclusion, the physical and psychological intervention protocol applied in this study to women suffering of endometriosis was effective in reducing perceived stress, normalizing cortisol levels, increasing vitality and improving physical functioning.

 

 

Ceska Gynekol. 2012 Aug;77(4):314-9. Review. Czech.

Endometriosis.

Fanta M1Koliba PHrušková H.

 

Abstract

OBJECTIVE:

To summarize current knowledge of pathogenesis, diagnostics and treatment of endometriosis.

DESIGN:

Review article.

SETTING:

Centre for diagnostics and treatment of endometriosis, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Faculty of Medicine of Charles University, Prague.

METHODS AND RESULTS:

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. The condition is predominantly found in women of reproductive age, from all ethnic and social groups. The associated symptoms – pain, infertility – can impact on general physical, mental and social well being. Treatment must be individualised, taking the clinical problem in its entirety into account, including the impact of the disease and the effect of its treatment on quality of life. Pain symptoms may persist despite seemingly adequate medical and/or surgical treatment of the disease. In such circumstances, a multi-disciplinary approach involving a pain clinic and counselling should be considered early in the treatment plan.

CONCLUSION:

Endometriosis is a medical condition with high recurrence rate and especially those patients with deep infiltrating endometriosis should be centralized to the centres experienced in diagnostics, complicated surgical treatment and providing multi-disciplinary approach with adequate postoperative care.

 

 

Methods Mol Biol. 2013;945:347-63. doi: 10.1007/978-1-62703-125-7_21.

Human female reproductive tract epithelial cell culture.

Chan RW1Mak ASYeung WSLee KFCheung ANNgan HYWong AS.

 

Abstract

The female reproductive system is a complex system. Epithelia of the female reproductive system including the ovaries, the oviduct, and the uterus are important sites for follicular development, ovulation, fertilization, implantation, and embryo development. They are also able to synthesize and secrete various hormones, growth factors, and cytokines, which are essential to women’s health, sexuality, and reproduction. Conversely, their dysfunction has been implicated in disorders such as infertility, endometriosis, and many other gynecological diseases, as well as cancer. In this chapter, we describe detailed procedures for establishing and maintaining primary cultures of human ovarian surface epithelium, oviductal epithelium, and endometrium. We also provide protocols for cell immortalization, clonal isolation, and in coculture with stromal cells. These cultures can be useful models for investigating the molecular and cellular functions of these epithelia in both normal and pathological states.

 

 

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