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BMC Res Notes. 2013 Jan 14;6:13. doi: 10.1186/1756-0500-6-13.

Elevated levels of whole blood nickel in a group of Sri Lankan women with endometriosis: a case control study.

Silva N1Senanayake HWaduge V.

Abstract

BACKGROUND:

Endometriosis is characterized by the persistence of endometrial tissue in ectopic sites outside the uterine cavity. Presence of nickel, cadmium and lead in ectopic endometrial tissue has been reported previously. While any association between blood levels of nickel and endometriosis is yet to be described in literature, conflicting reports are available with regards to cadmium and lead levels in blood and urine.

FINDINGS:

In fifty patients with endometriosis and fifty age-matched controls confirmed by laparoscopy or laparotomy, whole blood samples were collected and digested using supra pure 65% HNO3. Whole blood levels of nickel and lead were measured using Total Reflection X-ray Fluorescence (TXRF) while cadmium levels were evaluated using graphite furnace atomic absorption spectroscopy (GFASS). Women with endometriosis had significantly higher (P=0.016) geometric mean (95% CI) whole blood nickel levels [2.6(1.9-3.3) μg/L] as compared to women without endometriosis [0.8 (0.7-0.9) μg/L]. Whole blood levels of cadmium and lead were similar between the two groups.

CONCLUSIONS:

Although women with endometriosis in this study population had higher levels of nickel in whole blood compared to controls, whether nickel could be considered as an aetiological factor in endometriosis remains inconclusive in view of the smaller sample that was evaluated.

 

 

JSLS. 2012 Jul-Sep;16(3):451-5. doi: 10.4293/108680812X13462882736213.

Silent loss of kidney seconary to ureteral endometriosis.

Nezhat C1Paka CGomaa MSchipper E.

Abstract

BACKGROUND:

Ureteral endometriosis is a serious localization of disease burden that can lead to urinary tract obstruction, with subsequent hydroureter, hydronephrosis, and potential kidney loss. Diagnosis is elusive and relies heavily on clinical suspicion as ureteral endometriosis can occur with both minimal and extensive disease. Surgical technique to treatment varies, but the goal is to salvage renal function and decrease disease burden.

CASE DESCRIPTIONS:

We describe 3 cases in which there was documentation of renal atrophy and function loss with subsequent workup and surgical intervention.

RESULTS:

The cases illustrate varying surgical approaches tailored to localization of ureteral endometriosis. All cases were carried out laparoscopically.

CONCLUSION:

Ureteral endometriosis, albeit rare, can be complicated by potential loss of renal function. Clinical suspicion and preoperative assessment may help with diagnosis and allows for a multidisciplinary preconsultation. Laparoscopic surgical approach is based on extent of disease and localization and can be carried out successfully in the hands of a highly experienced laparoscopic surgeon.

 

 

 

JSLS. 2012 Jul-Sep;16(3):461-5. doi: 10.4293/108680812X13462882736295.

Transvaginal hydrolaparoscopy.

Ezedinma NA1Phelps JY.

 

Abstract

Transvaginal hydrolaparoscopy (THL) is being performed regularly in Europe and China, but rarely in the United States. The reasons may be physicians’ unfamiliarity with the procedure and their uneasiness over potential rectal puncturing due to the proximity of the rectum to the vaginal trocar insertion site. THL has the advantage over hysterosalpingography (HSG) in that it allows for direct visualization of the tubal mucosa in addition to determining tubal patency. THL has advantages over traditional laparoscopy in that it does not require an abdominal incision and has the capability of being conducted in an outpatient office setting with local anesthesia. Studies have shown that THL has comparable accuracy to laparoscopy with 96.1% concordance between THL and laparoscopic findings. THL may be combined with chromopertubation and salpingoscopy. In addition to diagnostic purposes, THL may be used for operative intervention including adhesiolysis, endometriosis ablation, and ovarian drilling. Studies from France and China report the occurrence of rectal injury from 0% to1%. Despite the advantages of THL and low reports of rectal injury, THL has not gained popularity in the United States. The purpose of this article is to familiarize gynecologists in the United States with THL.

 

 

Hum Reprod. 2013 Mar;28(3):651-7. doi: 10.1093/humrep/des454. Epub 2013 Jan 14.

PMID:23321214

 

Levels of circulating angiogenic cells are not altered in women with endometriosis.

Webster KE1Kennedy SHBecker CM.

Abstract

STUDY QUESTION:

Are levels of circulating angiogenic cells (CACs) affected by the presence of endometriosis?

SUMMARY ANSWER:

Levels of CACs are equivalent in women with and without endometriosis.

WHAT IS KNOWN ALREADY:

Murine models have suggested a role for CACs in the development of endometriosis, but their levels in humans have not yet been studied.

STUDY DESIGN, SIZE, DURATION:

Eighty-seven women participated in this study. Recruitment took place from July 2010 to May 2012.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

All women underwent laparoscopy for investigation of symptoms suggestive of endometriosis. Thirty women had no evidence of endometriosis, and 47 women were found to have endometriosis at laparoscopy. CAC levels were determined in peripheral blood by flow cytometry in 64 women. Colony forming unit (CFU) analysis was conducted in 30 women. A separate group of 10 healthy, asymptomatic women donated blood at four time points to assess the effect of the menstrual cycle on CAC levels.

MAIN RESULTS AND THE ROLE OF CHANCE:

For the whole sample, CAC levels (0.0797 ± 0.0052%) and CFU number (10.68 ± 1.98) were equivalent in women with and without endometriosis. CAC levels and CFU number were also unaffected by the stage of disease. No changes in CACs were detected during the menstrual cycle.

LIMITATIONS, REASONS FOR CAUTION:

A difference of at least one standard deviation between the groups would be required to detect a difference with this sample size. Therefore, while CAC levels are not a useful biomarker of disease it is still possible that they are modestly altered by the presence of endometriosis. We did not describe specific types of lesion and it is possible that CAC elevation only occurs when vessel development is at its most prolific. Furthermore, although signals from endometriotic lesions may recruit CACs from blood, this may be insufficient to alter peripheral levels.

WIDER IMPLICATIONS OF THE FINDINGS:

These data show that CACs are not a useful biomarker of endometriosis and indicate that they may be unaffected by the presence of this disease.

STUDY FUNDING/COMPETING INTEREST(S):

This work was supported by grants from the MRC (New Investigator Award, G0601458 to C.M.B.), the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the Department of Health’s NIHR Biomedical Research Centres Scheme and the Oxfordshire Health Services Research Committee (OHSRC). There are no conflicts of interest to be declared.

 

 

J Med Syst. 2013 Apr;37(2):9899. doi: 10.1007/s10916-012-9899-y. Epub 2013 Jan 17

Mining medical data: a case study of endometriosis.

Wang YF1Chang MYChiang RDHwang LJLee CMWang YH.

 

Abstract

Ultrasound guided aspiration of ovarian endometrioma had been tried as an alternative therapeutic modality in patients whose desire to avoid surgery or surgical approach is contraindicated since 1991. Cyst puncture can reduce tumor volume and destruct the cyst wall, alleviate sticking circumstances and enhance the chance of recovery. But simple aspiration without other treatments results in high recurrence rate (28.5 % to 100 %). In order to reduce recurrence after aspiration, ultrasound-guided aspiration with instillation of tetracycline, methotrexate, and recombinant interleukin-2 has been combined and proven to be effective with the recurrence rates of 46.9 %, 18.1 %, and 40 % respectively. Noma et al. (2001) reported that conduct of ethanol instillation for more than 10 min particularly for a case with a single endometrial cyst is considered most effective from the standpoint of recurrence (14.9 %). Our goal is to analyze patients with recurrent pelvic cyst who underwent surgical intervention. The research data are based on clinical diagnosis, symptoms and medical intervention classification, and the cyst numbers are defined as forecast project target. The decision tree, methodology of data mining technology, is used to find the meaningful characteristic as well as each other mutually connection. The experimental result can help the clinical faculty doctors to better diagnose and provide treatment reference for future patients.

 

 

Gynecol Endocrinol. 2013 Apr;29(4):305-8. doi: 10.3109/09513590.2012.743017. Epub 2013 Jan 17.

Improvement in chronic pelvic pain after gonadotropin releasing hormone analogue (GnRH-a) administration in premenopausal women suffering from adenomyosis or endometriosis: a retrospective study.

Morelli M1Rocca MLVenturella RMocciaro RZullo F.

 

Abstract

The aim of this study was to evaluate the improvement in catamenial chronic pelvic pain (CPP) after Gonadotropin Releasing Hormone analogue (GnRH-a) administration in women affected by adenomyosis or endometriosis. We retrospectively analysed clinical data of 63 premenopausal women with clinical suspect of adenomyosis (15 women, Group A) or endometriosis (48 women, Group B), which received GnRH-a in order to reduce CPP intensity during the time on surgery waiting list. Main outcome measures were variation of CPP intensity, numbers of days requiring analgesics and lost work productivity before and three months after GnRH-a administration. Compared to baseline, a significant decrease in CPP intensity (p < 0.05) was observed in both groups, even if this reduction was significantly higher in Group A than in Group B (p < 0.001). In both groups, moreover, a significant reduction in number of days requiring analgesics (p < 0.05) and lost work productivity (p < 0.05) was detected. In conclusion, GnRH-a administration in women with clinical suspect of adenomyosis induces a greater reduction in CPP when compared to women with endometriosis, thus representing a potential ex adiuvantibus criteria, helping TV-US in the clinical diagnosis of adenomyosis.

 

 

Rev Bras Ginecol Obstet. 2012 Dec;34(12):568-74. Portuguese.

Expression of neurotrophic and inflammatory mediators in rectosigmoid endometriosis.

Kuteken FS1Lancellotti CLRibeiro HSAldrighi JMRibeiro PA.

Abstract

PURPOSE:

To evaluate the expression of neurotrophic (NGF, NPY and VIP) and pro-inflammatory (TNF-α) mediators in the rectum and sigmoid fragments compromised by endometriosis.

METHODS:

Twenty-four patients were selected to undergo surgical treatment of endometriosis of the rectum and sigmoid colon with a segmental resection technique, followed by end-to-end anastomosis with a circular stapler from January 2005 to December 2007. The study included premenopausal women who underwent surgical treatment for deep endometriosis infiltrating the rectum with involvement of the rectum and sigmoid, reaching the level of the muscle layer, submucosa or mucosa. Twenty-four rectum and sigmoid fragments with histologically confirmed endometriosis, one from each of the 24 selected patients, were used for the study group. For the control group, we used a fragment of the distal resection margin called anastomosis ring from each of the 24 patients enrolled in the study. Samples were grouped into Tissue Micro Array (TMA) blocks and subjected to immunohistochemistry to evaluate the expression of tumor necrosis factor alpha (TNF-α), nerve growth factor (NGF), neuropeptide Y (NPY) and P vasoactive intestinal peptide (VIP), followed by semiquantitative analysis of immunostaining by reading the relative optical density (OD).

RESULTS:

There was higher optical density relative to TNF-α immunostaining and NGF in the study group (samples with intestinal endometriosis), DO=0.01, for the two proteins, respectively (p<0.05), compared to controls without endometriosis. There was no statistically significant difference in the optical density of immunostaining of NPY and VIP.

CONCLUSION:

We identified increased immunostaining of TNF-α antibodies and fragments of NGF in the rectum and sigmoid compromised by endometriosis compared to disease-free controls. We did not identify any statistical difference in immunostaining of NPY and VIP proteins.

 

 

 

 

Rev Bras Ginecol Obstet. 2012 Dec;34(12):575-81. Portuguese.

Serum anti-Müllerian hormone to predict ovarian response in assisted reproduction cycles.

Romão GS1Navarro PAFerriani RADib LARodrigues JBortolieiro MA.

Abstract

PURPOSE:

To compare serum anti-Mullerian hormone (AMH) levels on the seventh day of ovarian stimulation between normal and poor responders.

METHODS:

Nineteen women aged ≥35, presenting with regular menses, submitted to ovarian stimulation for assisted reproduction were included. Women with endometriosis, polycystic ovarian syndrome or those who were previously submitted to ovarian surgery were excluded. On the basal and seventh day of ovarian stimulation, a peripheral blood sample was drawn for the determination of AMH, FSH and estradiol levels. AMH levels were assessed by ELISA and FSH, and estradiol by immunochemiluminescence. At the end of the stimulation cycle patients were classified as normal responders (if four or more oocytes were obtained during oocyte retrieval) or poor responders (if less than four oocytes were obtained during oocyte retrieval or if the cycle was cancelled due to failure of ovulation induction) and comparatively analyzed by the t-test for hormonal levels, length of ovarian stimulation, number of follicles retrieved, and number of produced and transferred embryos. The association between AMH and these parameters was also analyzed by the Spearman correlation test.

RESULTS:

There was no significant difference between groups for basal or the seventh day as to AMH, FSH and estradiol levels. There was a significant correlation between seventh day AMH levels and the total amount of exogenous FSH used (p=0.02).

CONCLUSIONS:

AMH levels on the seventh day of the ovarian stimulation cycle do not seem to predict the pattern of ovarian response and their determination is not recommended for this purpose.

 

 

 

 

 

 

Semin Reprod Med. 2013 Jan;31(1):69-76. doi: 10.1055/s-0032-1331800. Epub 2013 Jan 17.

Somatic stem cells in the human endometrium.

Cervelló I1Mas AGil-Sanchis CSimón C.

 

Abstract

The existence of human endometrial somatic stem cells was proposed in the mid-20th century for the first time. This hypothesis became stronger and was revised by two authors between 1978 and 1989. Nevertheless, it was not until 2004 that scientific evidence was first published. As we describe here, the great regenerative capability of the human endometrium has been finally questioned in the last 8 years, and this period can be considered the most productive in endometrial stem cell biology given the new scientific information recapitulated to date. We provide a detailed summary based on the actual scientific knowledge obtained about (1) the existence of somatic stem cells in murine (detected with label-retaining cell methods) and human (cells isolated by different methods) endometria, (2) the involvement of bone marrow as a putative extrauterine source of endometrial somatic stem cells, (3) the implication and biological pathways of these cells in several pathologies like endometriosis and endometrial cancer, and (4) the future of endometrial somatic stem cells in regenerative medicine to provide new strategies in autologous transplant and bioengineering.

 

 

 

Reprod Biol Endocrinol. 2013 Jan 18;11:4. doi: 10.1186/1477-7827-11-4.

Effects of ovarian endometriotic fluid exposure on fertilization rate of mouse oocytes and subsequent embryo development.

Piromlertamorn W1Saeng-anan UVutyavanich T.

Abstract

BACKGROUND:

Accidental exposure of oocyte/cumulus complex to endometriotic fluid is not uncommon during oocyte retrieval. Only two studies were available on this subject and they gave conflicting results. In this study, we used a mouse model to evaluate the effect of controlled exposure of oocytes to ovarian endometriotic fluid.

METHODS:

Mouse oocytes/cumulus complexes (n = 862) were divided into 4 groups, and were exposed to endometriotic fluid (group 1), pooled sera from subjects without endometrioma (group 2), phosphate-buffered saline (group 3), and fertilization medium (controls). After five minutes, oocytes were washed and inseminated. Embryo development was observed daily. The quality of hatching blastocysts was assessed by counting the number of inner cell mass (ICM) and trophectoderm (TE) cells.

RESULTS:

The fertilization, cleavage and blastocyst formation rates in the four groups were not statistically different. The proportions of hatching/hatched blastocysts from fertilized oocytes in groups 1 and 2 were significantly lower than those in group 3 and controls (P = 0.015). Hatching blastocysts from all groups showed no significant difference in the number of ICM and TE cells.

CONCLUSIONS:

Exposure of mouse oocytes/cumulus complexes to endometriotic fluid had subtle detrimental effects on subsequent blastocyst development. However, one should be cautious in projecting the results of this study to contaminated human oocytes in a clinical setting.

 

 

 

Int J Gynaecol Obstet. 2013 Apr;121(1):35-40. doi: 10.1016/j.ijgo.2012.10.025. Epub 2013 Jan 16.

Analysis of biomarker expression in severe endometriosis and determination of possibilities for targeted intraoperative imaging.

van den Berg LL1Crane LMvan Oosten Mvan Dam GMSimons AHHofker HSBart J.

Abstract

OBJECTIVE:

To evaluate the expression of biomarkers in endometriotic tissue in order to determine the most promising molecules for targeted intraoperative imaging.

METHODS:

Tissue samples were obtained from 18 patients with endometriosis. The intensity and pattern of expression of the following biomarkers were assessed by immunohistochemistry: C-X-C chemokine receptor type 4 (CXCR4), epithelial cell adhesion molecule (EpCAM), estrogen receptor (ER), folate receptor α (FR-α), hypoxia-inducible factor 1-α (HIF-1α), progesterone receptor (PR), and vascular endothelial growth factor A (VEGF-A). The Target Selection Criteria scoring system was used to select the most promising biomarkers for intraoperative imaging.

RESULTS:

Expression of CXCR4, EpCAM, ER, PR, and VEGF-A was scored as strong in endometriotic epithelium. Expression of FR-α was detected in 94.4% of samples, whereas HIF-1α was expressed in just 5.6% of samples. Of note, CXCR4, ER, and VEGF-A were also expressed in surrounding healthy tissue, thus reducing the target-to-background ratio.

CONCLUSION:

Of the 7 biomarkers assessed in the present study, EpCAM, FR-α, and VEGF-A seem the most promising for targeted intraoperative imaging of endometriosis.

 

 

Rev Pneumol Clin. 2013 Feb;69(1):50-4. doi: 10.1016/j.pneumo.2012.11.005. Epub 2013 Jan 14.

The catamenial pneumothorax: a diagnosis often overlooked.

Anastasio C1Wémeau-Stervinou LJaillard SMariage PWallaert B.

 

Abstract

The catamenial pneumothorax (CP) is defined as recurrent pneumothorax occurring from the day before menstruations until 72 hours after their beginning, but remains a diagnostic and therapeutic problem. We herein report the cases of two young women who presented several episodes of pneumothorax. The first patient (28 years old) underwent 18 recurrent pneumothorax before the diagnosis of CP. The video-assisted mini-thoracotomy found many diaphragmatic perforations, which were sutured after resection and biopsy. The latter patient underwent four pneumothorax before diagnosis of CP. A video-assisted mini-thoracotomy associated with pleurectomy and pleural freshening was then performed. CP is a rare entity of spontaneous pneumothorax often associated with thoracic endometriosis. The difficulty remains in diagnosis (diagnostic delay before the start of appropriate care), as well as in the treatment. Overall, CP requires a multidisciplinary approach combining pulmonology, thoracic surgery and gynecology.

 

 

Int J Surg Case Rep. 2013;4(3):253-5. doi: 10.1016/j.ijscr.2012.12.003. Epub 2012 Dec 25.

Transmural sigmoid colon endometrioma in a young reproductive age woman.

Calasanz ER1Nazim MKauffman RP.

Abstract

INTRODUCTION:

Endometriosis is a common disease affecting women of reproductive age. Endometrial tissue can implant to various tissues including gastrointestinal tissues and cause significant GI symptoms. Rarely, these implants cause constricting lesions that require surgical intervention.

PRESENTATION OF CASE:

We report a case of a 27-year-old woman with extensive endometriosis and new onset gastrointestinal symptoms. A near-complete constricting endometrioma involving the sigmoid colon was identified and required surgical resection with side-to-side anastomosis.

DISCUSSION:

When endometrial tissue implants to gastrointestinal tissues it can cause GI symptoms including rectal bleeding and dyschezia. If left untreated, progressive endometriosis may result in partial or complete bowel obstruction requiring surgical resection.

CONCLUSION:

Obstruction of the GI tract by endometrial implantation can be prevented with early identification and treatment (medical and surgical).

 

 

 

Minerva Chir. 2012 Dec;67(6):499-504.

Gluten-free diet: a new strategy for management of painful endometriosisrelated symptoms?

Marziali M1Venza MLazzaro SLazzaro AMicossi CStolfi VM.

Abstract

AIM:

Pelvic pain affects 4% to 39% of women and accounts for 10-40% of all outpatient gynecologic visits. The etiology of painful endometriosis-related has not been fully delineated. No studies have been published concerning gluten-free diet administered to achieved relief of painful symptoms endometriosis-related. The aim of this retrospective study was to evaluate the effectiveness for the outcomes of endometriosis-related pain and quality of life of gluten-free diet in a follow-up of 12 months in patients with chronic pelvic pain endometriosis-related.

METHODS:

Two hundred seven patients with severe painful endometriosis-related symptoms entered the study. At enrolment time, the baseline values of painful symptoms were assessed by Visual Analogue Scale (VAS) for dysmenorrhoea, non-menstrual pelvic pain, and dyspareunia. According to VAS, pain severity was scored from 0-10; 0 indicating the absence of pain, and 1-4, 5-7 and 8-10 mild, moderate and severe respectively. A gluten-free diet was submitted to all patients and a new evaluation was performed after 12 months of diet. Student t test was used for statistical analysis.

RESULTS:

At 12 month follow-up, 156 patients (75%) reported statistically significant change in painful symptoms (P<0.005), 51 patients (25%) reported not improvement of symptoms. No patients reported worsening of pain. A considerable increase of scores for all domains of physical functioning, general health perception, vitality, social functioning, and mental health was observed in all patients (P<0.005).

CONCLUSION:

In our experience, painful symptoms of endometriosis decrease after 12 months of gluten free diet.

 

 

 

Angiogenesis. 2013 Jul;16(3):541-51. doi: 10.1007/s10456-013-9333-1. Epub 2013 Jan 19.

Vascular endothelial growth factor C is increased in endometrium and promotes endothelial functions, vascular permeability and angiogenesis and growth of endometriosis.

Xu H1Zhang TMan GCMay KEBecker CMDavis TNKung ALBirsner AED’Amato RJWong AWWang CC.

 

Abstract

Endometriosis is an angiogenesis-dependent disease. Many studies demonstrated inhibition of angiogenesis leads to inhibition of endometriotic growth, however underlying mechanism is still not fully understood. Our previous study suggested vascular endothelial growth factor C (VEGF-C) as a target of anti-angiogenesis therapy for endometriosis. In this study, VEGF-C in endometrium and its role in angiogenesis of endometriosis were studied. Human endometrium were obtained from women with and without endometriosis for molecular studies. VEGF-A, VEGF-B, VEGF-C and VEGF-D mRNA and proteins in eutopic and ectopic endometrium were measured. Human endothelial cells were transfected with VEGF-C siRNA in vitro, effects of VEGF-C on endothelial cell migration, invasion and tube formation were investigated in vitro. Angiogenesis was inhibited in wild type mice, vascular permeability in dermal skin was determined in vivo. Transplanted endometrium were inhibited by VEGF-C siRNA in immunocompromised mice, development, growth and angiogenesis of the experimental endometriosis were compared in vivo. The results showed that VEGF-C mRNA and protein were increased in eutopic and ectopic endometrium of endometriosis patients. VEGF-C siRNA significantly inhibited endothelial cell migration and tube formation. VEGF-C siRNA significantly inhibited development and angiogenesis of the experimental endometriotic lesions in mice. Supplementation and over-expression of VEGF-C significantly reversed the inhibitory effects on the endothelial functions, vascular permeability and endometriotic growth. In conclusion, VEGF-C is increased in endometrium and it promotes endothelial functions, vascular permeability and development of experimental endometriosis. VEGF-C is important for angiogenesis in endometriosis.

 

 

Epidemiology. 2013 Mar;24(2):261-9. doi: 10.1097/EDE.0b013e3182806445.

Childhood and adolescent exposures and the risk of endometriosis.

Kvaskoff M1Bijon AClavel-Chapelon FMesrine SBoutron-Ruault MC.

Abstract

BACKGROUND:

Because endometriosis is diagnosed predominantly in young women, exposures occurring during childhood or adolescence may have a major impact on the disease. However, potential risk factors during this time period have received little attention. Our objective was to investigate relationships between childhood and adolescent exposures and the risk of endometriosis.

METHODS:

E3N is a prospective cohort of 98,995 French women aged 40-65 at enrollment in 1990. Follow-up questionnaires were sent every 2-3 years. Using a nested case-control design, we computed odds ratios (ORs) and 95% confidence intervals using unconditional logistic regression models.

RESULTS:

A total of 2684 endometriosis cases were reported as surgically ascertained among the 75,918 included women. There were inverse relationships of endometriosis risk with menarcheal age (test for trend, P < 0.0001) and with menstrual cycle length before 17 years of age (test for trend, P = 0.06), whereas menstrual cycle regularity before 17 years of age was not associated with risk. There were modest associations of endometriosisrisk with exposure to pet animals (OR = 1.12 [95% confidence interval =1.02-1.22]) or living in a farm for 3 or more consecutive months during childhood (1.12 [1.02-1.24]), although with no link to any specific type of farm animal. In addition, there were positive linear associations between endometriosis risk and level of indoor exposure to passive smoking during childhood (up to 1.34 [1.09-1.64] with several hours exposure a day), experiencing food deprivation during World War II (1.34 [0.94-1.91]), and walking activity at 8-15 years of age (1.17 [1.05-1.31] for 5+ hours a week).

CONCLUSIONS:

This large study suggests that some exposures during childhood or adolescence may influence the risk of endometriosis. Further research is needed to confirm and better understand these relationships.

 

 

J Pediatr Adolesc Gynecol. 2013 Apr;26(2):117-9. doi: 10.1016/j.jpag.2012.11.011. Epub 2013 Jan 20.

Clinical characteristics of adolescent endometrioma.

Lee DY1Kim HJYoon BKChoi D.

Abstract

STUDY OBJECTIVE:

To evaluate the clinical characteristics of endometrioma in adolescent women compared to women of other age groups.

DESIGN:

Cross-sectional study.

SETTING:

A university hospital.

PARTICIPANTS:

Three-hundred seventy-six women.

INTERVENTION:

Women of reproductive age who underwent surgery for the treatment of endometrioma were classified into 4 groups according to age (group 1, ≤20 years; group 2, 21-30 years; group 3, 31-40 years; group 4, 41-45 years), and compared.

MAIN OUTCOME MEASURE:

Clinical characteristics including demographic factors, menstrual patterns, and characteristics of endometriosis.

RESULTS:

Group 1 (adolescent females) experienced menarche at earlier age compared to other groups (P < .005 for all comparisons). In group 1, main symptom was pain (77%) and the proportion of incidental detection (23%) was low, similar to findings for group 2. However, the proportions of incidental detection (45%) and infertility (10%) were increased in group 3, and the proportion of incidental detection (60%) was even higher than that of pain (40%) in group 4 showing that the distributions of presenting symptoms differed from those of group 1. There were no differences in menstrual pattern among groups. In addition, except for the absence of coexisting gynecologic problems such as myoma or adenomyosis in group 1, other characteristics of endometrioma did not differ among groups.

CONCLUSION:

Adolescents with endometrioma experience more frequent pain, but other clinical characteristics are similar to adults.

 

 

 

J Clin Endocrinol Metab. 2013 Mar;98(3):E463-71. doi: 10.1210/jc.2012-3402. Epub 2013 Jan 21.

Effects of simvastatin on retinoic acid system in primary human endometrial stromal cells and in a chimeric model of human endometriosis.

Sokalska A1Anderson MVillanueva JOrtega IBruner-Tran KLOsteen KGDuleba AJ.

Abstract

CONTEXT:

Retinoic acid (RA) may promote survival or apoptosis of cells, depending on the levels of binding proteins: apoptosis-inducing cellular RA binding protein 2 (CRABP2), and cell survival-promoting fatty acid binding protein 5 (FABP5). Increased cellular uptake of retinol and altered actions of RA related to reduced expression of CRABP2 may contribute to the development of endometriosis. Recently statins have been shown to inhibit growth of human endometrial stromal (HES) cells and to reduce the number and size of endometriotic implants in experimental models of this disorder.

OBJECTIVE:

The objective of the study was to determine whether effects of simvastatin on HES cells and experimental endometriotic implants are related to the modulation of the RA system.

METHODS:

Effects of simvastatin and RA on proliferation and apoptosis of HES cells were evaluated. Expression of stimulated by RA 6 (STRA6), CRABP2, and FABP5 was determined by real-time PCR and Western blotting. Effects of simvastatin were also evaluated in a nude mouse model of human endometriosis.

RESULTS:

Simvastatin potentiated an inhibitory effect of RA on growth of HES cells. In HES cells, simvastatin induced expression of STRA6 and CRABP2 but not FABP5. Similarly, simvastatin treatment of nude mice bearing human endometrial xenografts led to an increased expression of CRABP2 and STRA6 proteins in ectopic lesions.

CONCLUSIONS:

Simvastatin interacts with the RA system, inducing the expression of the key protein regulating the uptake of retinol (STRA6) and the expression of apoptosis-promoting CRABP2. These effects may contribute to cooperative apoptosis-inducing effects of simvastatin and RA and support the examination of these compounds in the treatment of endometriosis.

 

Hum Reprod. 2013 Apr;28(4):1045-53. doi: 10.1093/humrep/det003. Epub 2013 Jan 22.

Suppression of annexin A2 by prostaglandin E₂ impairs phagocytic ability of peritoneal macrophages in women with endometriosis.

Wu MH1Chuang PCLin YJTsai SJ.

Abstract

STUDY QUESTION:

Is annexin A2 involved in the reduced phagocytic ability of macrophages in endometriosis?

SUMMARY ANSWER:

Data from women with endometriosis and a murine model of the disease show that expression of annexin A2 in peritoneal macrophages is inhibited by prostaglandin E2 (PGE2) and this impairs the phagocytic ability of macrophages.

WHAT IS ALREADY KNOWN:

Endometriosis is a chronic inflammatory disease that recruits many immune cells, especially macrophages, to the peritoneal cavity. The phagocytic ability of peritoneal macrophages isolated from women with endometriosis is reduced.

STUDY DESIGN, SIZE, DURATION:

A laboratory study. Thirty-five patients (20 with and 15 without endometriosis) of reproductive age with normal menstrual cycles were recruited.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Peritoneal macrophages isolated from women with or without endometriosis were cultured and treated with vehicle, PGE2 and different EP receptor agonists, and the expression of annexin A2 was quantified by RT-PCR and western blotting. Annexin A2 was knocked down (by small interfering RNA) in normal macrophages or overexpressed (by treatment with recombinant protein) in endometriotic macrophages and their phagocytic ability was measured by flow cytometry. Peritoneal macrophages were isolated from a mouse model of endometriosis and treated with PGE2 or cyclo-oxygenase (COX) inhibitors, and annexin A2 mRNA was quantified.

MAIN RESULTS AND THE ROLE OF CHANCE:

Levels of annexin A2 were markedly reduced in peritoneal macrophages from women with endometriosis versus controls (mRNA: P < 0.01). The level of annexin A2 mRNA in the macrophages was reduced by PGE2 (P < 0.01/P < 0.05 in women without/with endometriosis versus control) via the EP2/EP4 receptor-dependent signaling pathway. Treatment with PGE2 or knockdown of annexin A2 inhibited the phagocytic ability of macrophages (P < 0.05 versus control), while treatment with annexin A2 recombinant protein enhanced phagocytosis. Autologous transplantation animal studies further confirmed that levels of annexin A2 in peritoneal macrophages were markedly reduced in mice treated with PGE2 (P < 0.01 versus control). In contrast, treatment with COX inhibitors to inhibit PGE2 production enhanced annexin A2 expression in peritoneal macrophages (P < 0.05 versus control).

LIMITATIONS, REASONS FOR CAUTION:

We have provided no direct demonstration that phagocytic activity is indeed decreased in peritoneal cells from patients with endometriosis or that their endometriotic fluid contains increased amounts of PGE2 when compared with control subjects.

WIDER IMPLICATIONS OF THE FINDINGS:

Inhibiting PGE2 signaling, in order to restore or enhance the phagocytic capability of macrophages, may represent a new direction of thinking in developing novel strategies against endometriosis.

STUDY FUNDING/COMPETING INTEREST(S):

This work was supported by grants from National Science Council of Taiwan, Republic of China (NSC97-2314-B-006-020-MY3) to M.-H.W. and (NSC98-2320-B-006-026-MY3) to S.-J.T., and grants from the Chang Gung Memorial Hospital, Taiwan, Republic of China (CMRPG891432 and CMRPG8A0531) to P.-C.C. None of the authors have any conflicts of interest.

 

 

Best Pract Res Clin Obstet Gynaecol. 2013 Jun;27(3):381-92. doi: 10.1016/j.bpobgyn.2012.12.003. Epub 2013 Jan 20.

Surgical strategy in endometriosis.

Wattiez A1Puga MAlbornoz JFaller E.

 

Abstract

Endometriosis is a common disease affecting young women. Its clinical manifestations include pain and infertility, and it can dramatically affect quality of life. Treatments should be tailored to address the wishes of women according to the specific characteristics of the disease. Although many questions remain unanswered, strong evidence supports the use of laparoscopic surgery to improve pain and infertility. The systematisation of strategy is essential to make surgery more reproducible, safer and less time-consuming. Nevertheless, even in the most expert hands, complications may occur. Further investigations are needed to compare the different approaches. Outcomes must, however, include pain, fertility, organ dysfunction, and quality of life.

 

 

Diagn Cytopathol. 2014 May;42(5):441-4. doi: 10.1002/dc.22945. Epub 2013 Jan 22.

Hepatic endometriosis diagnosed by liquid-based cytology: a case report.

Hertel JD1Guimaraes MYang J.

 

Abstract

A 44-year-old woman presented to Emergency Department with sudden onset of severe upper abdominal pain. T2-weighted MRI image showed a large cystic mass with a thickened wall measuring 9.5 × 9.1 × 11.2 cm in the right hepatic lobe. It was radiologically interpreted as a cystic mass with differential diagnosis including echinococcal cyst, biliary cystadenoma, and malignant neoplasm. The cystic mass was intraoperatively aspirated and a liquid-based cytology preparation (ThinPrep) and a cell block were made. The ThinPrep slides showed three dimensional clusters of epithelioid cells with scant delicate cytoplasm and tissue fragments composed of small stromal cells with round to oval shaped nuclei and a small amount of dense cytoplasm lined by the cuboidal epithelial cells. Occasional ciliated cells and abundant hemosiderin laden macrophages were also present. The cell block showed many tissue fragments containing glands and stroma with associated hemorrhage and hemosiderin laden macrophages, typical of endometrial tissue. Although it is uncommon, hepatic endometriosisshould be considered in the differential diagnosis of cystic liver mass in women, especially those with a history of endometriosis or obstetric/gynecologic surgery.

 

 

 

Urologia. 2013 Apr 24;80 Suppl 22:24-7. doi: 10.5301/RU.2013.10619. Epub 2013 Jan 22.

Management of iatrogenic gynecologic injuries with urologic relevance. Causes and prevention of complications: the gynecologist’s opinion.

Jasonni VM1Matonti G.

Abstract

OBJECTIVE:

To detect and prevent urinary tract injuries in gynecological surgery.

METHODS:

A brief review of the literature about recognition and prevention of ureteral and bladder injuries.

RESULTS:

It is well known that factors as intra-operative bleeding, pelvic adhesions and infections, pelvic masses, endometriosis and obesity can make surgery difficult. For these reasons the study of the urinary tract and the use of ureteral catheters may be helpful when alterations of the urinary tract anatomy is suspected. However the surgeon should always operate under direct vision of the ureters with a judicious use of diathermy and taking care when separating bladder from the uterus where the blunt dissection is blind and dangerous. When there are some doubts about the integrity of ureters, the control with i.v. infusion of indigo-carmine or with ureteral catheters should be performed. The same applies for the bladder: the cystoscopy should be in the armamentarium of gynecological surgeons to control the ureteral efflux and the bladder integrity. To fill the bladder with methylene blue at the end of the surgery is also helpful in revealing, under the pressure, even very small lesions as well as partial thickness of the bladder that can cause a delayed fistula.

CONCLUSIONS:

Surgeons’ training is the most important factor in avoiding and detecting urinary tract injuries. This is important not only for the technique but also in the selection of patients, and then in planning the more appropriate pre-operative study and in recognizing the presence of injuries during surgery.

 

 

 

Diagn Pathol. 2013 Jan 23;8:11. doi: 10.1186/1746-1596-8-11.

Significance of HE4 estimation in comparison with CA125 in diagnosis of ovarian cancer and assessment of treatment response.

Hamed EO1Ahmed HSedeek OBMohammed AMAbd-Alla AAAbdel Ghaffar HM.

Abstract

BACKGROUND:

Human epididymis protein 4 (HE4) is a novel and specific biomarker for ovarian cancer. The aim of this study is to evaluate a new tumor marker, HE4, in comparison with CA125 in diagnosis of epithelial ovarian cancer (EOC) and benign gynecological diseases.

METHODS:

CA125 and HE4 serum levels were determined in 30 patients with epithelial ovarian cancer (21 serous, 6 endometrioid and 3 mucinous tumors), 20 patients with benign gynecological diseases (8 patients with ovarian cyst, 5 patients with endometriosis, 4 patients with fibroid and 3 patients with pelvic inflammatory disease) and 20 healthy women. CA125 and HE4 cut-offs were 35 U/ml and 150 pmol/l, respectively.

RESULTS:

Serum HE4 and CA125 concentrations were significantly higher in the ovarian cancer patients compared with those seen in patients with benign disease or in the healthy controls (p = 0.001 and p < 0.001 respectively). In the receiver operating characteristic analysis (ROC), the area under the curve (AUC) values for HE4 was 0.96 (95% confidence interval, 0.9-1.0) and CA125 was 0.82 (95% confidence interval, 0.7-0.94). Compared to CA125, HE4 had higher sensitivity (90% vs. 83.3%), specificity (95% vs. 85%), PPV (93.1% vs. 80.7%) and NPV (92.7% vs. 87.2%), the combination of HE4 + CA125 the sensitivity and PPV reached 96.7% and 97% respectively.

CONCLUSION:

Measuring serum HE4 concentrations along with CA125 concentrations may provide higher accuracy for detecting epithelial ovarian cancer.

 

 

 

J Obstet Gynaecol Can. 2013 Jan;35(1):44-8.

The role of appendectomy in gynaecologic surgery: a canadian retrospective case series.

Jocko JA1Shenassa HSingh SS.

Abstract

OBJECTIVE:

To review the indications for, and the associated pathology and complications of, appendectomy performed during gynaecologic surgery in a tertiary academic health sciences centre.

METHODS:

We performed a retrospective review of appendectomy cases performed from September 2007 to December 2011 in a tertiary level gynaecologic surgical practice. Cases were reviewed using a standardized intake sheet with surgical reports, history, and pathologic findings.

RESULTS:

A total of 71 appendectomies were performed during gynaecologic surgery in the study period. All cases were primary gynaecologic surgical cases; the most common diagnoses were endometriosis, pelvic pain, and pelvic mass. Overall, 42 (59%) of the study cases had abnormal histopathology in the appendix. Of the 44 women with a primary diagnosis of endometriosis, 28 (64%) had positive appendiceal pathology. In women with chronic pelvic pain, three of eight (38%) had pathology within their appendix. Of all appendixes removed that appeared normal on gross inspection, irrespective of diagnosis, 44% had positive pathology.

CONCLUSION:

When a structured approach is taken towards assessment of the appendix during gynaecologic surgical cases, with removal when indicated, a high rate of pathology may be found. In this series, there were no complications directly related to the appendectomy, providing support for the contention that appropriately trained gynaecologists can safely perform appendectomy. The findings in this Canadian series are in keeping with previous reports and support the need for evaluation and removal of the appendix when indicated at the time of gynaecological surgery.

 

 

 

Gynecol Endocrinol. 2013 May;29(5):444-7. doi: 10.3109/09513590.2012.758702. Epub 2013 Jan 24.

 

The influence of endocrine disruptors in a selected population of infertile women.

Caserta D1Bordi GCiardo FMarci RLa Rocca CTait SBergamasco BStecca LMantovani AGuerranti CFanello ELPerra GBorghini FFocardi SEMoscarini M.

 

Abstract

Several studies report that endocrine disrupting chemicals (EDC) able to interfere with endocrine homeostasis may affect women’s reproductive health. We analyzed EDC serum levels and nuclear receptors (NRs) expression in order to have an indication of the internal dose of biologically active compounds and a measurement of indicators of their effects, as a result of the repeated uptake from environmental source. The percentage of patients with detectable bisphenol A (BPA) concentrations was significantly higher in the infertile patients compared with fertile subjects. No significant difference was found between the groups with regard to perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), mono-ethylhexyl phthalate (MEHP) and di-(2-ethylhexyl) phthalate (DEHP) concentrations. Among infertile women, the mean expression of estrogen receptor alpha (ERα) and beta (Erβ), androgen receptor (AR) and pregnane X receptor (PXR) was significantly higher than fertile patients. The mean expression of aryl hydrocarbon receptor (AhR) and peroxisome proliferator-activated receptor gamma (PPARγ) did not show significant differences between two groups. Patients with endometriosishad higher levels of PPARγ than all women with other causes of infertility. This study led further support to EDC exposure as a risk factor for women’s fertility.

 

 

 

 

J Reprod Immunol. 2013 Mar;97(1):2-13. doi: 10.1016/j.jri.2012.10.009. Epub 2013 Jan 22.

Inflammation, NK cells and implantation: friend and foe (the good, the bad and the ugly?): replacing placental viviparity in an evolutionary perspective.

Chaouat G1.

Author information

Abstract

This review summarises an invited talk presented at the 2012 ESRI/ASRI meeting in Hamburg, concerning current views of inflammation in pregnancy, which is timely given that the effects of a local injury in the uterus acts to favour implantation. Recalling that inflammation can be good (it is useful and necessary for implantation), bad (in implantation failure, RSA) and ugly (at the extreme, endometriosis is associated with pain and infertility) leads to consideration of its status in pregnancy. Its role in implantation and the fact that pregnancy maintains some aspects of inflammation throughout, leads to revision of not only concepts of immunosuppression and the Th1/Th2 paradigm, but also the feto-maternal relationship as seen since Medawar’s hypotheses were advanced. This is examined from an evolutionary perspective, which should lead to further review of our perception of uterine NK cells, and the emergence of Treg cells to control some aspects of adaptive immunity, which appeared long after placentation.

 

 

 

Diagn Interv Imaging. 2013 Mar;94(3):263-80. doi: 10.1016/j.diii.2012.10.020. Epub 2013 Jan 21

MRI atlas of ectopic endometriosis.

Dallaudière B1Salut CHummel VPouquet MPiver PRouanet JPMaubon A.

 

Abstract

Ectopic endometriosis is a common condition which is often underdiagnosed, where MRI can help make a diagnosis simply, non-invasively and without irradiation. However, imagery signs of it are enormously polymorphic with a wide range of possible locations. In this paper, we have tried to illustrate comprehensively all its MRI appearances depending on the different locations where it occurs.

 

 

Med Glas (Zenica). 2013 Feb;10(1):59-62.

The significance of mean platelet volume on diagnosis and management of adenomyosis.

Bodur S1Gün IAlpaslan Babayigit M.

Abstract

AIM:

The present study was designed to assess the significance of mean platelet volume on the pathogenesis and management of adenomyosis.

METHODS:

A total of 26 patients out of 123 with pathologically confirmed adenomyosis in hysterectomy specimens without concomitant gynecological pathology were selected for the study. Control group was consisted of 24 symptom-free subjects out of 35, with normal smear test and without infection. Groups were compared in terms of mean platelet volumes and platelet counts.

RESULTS:

The mean platelet volume values of patients with pathologically confirmed adenomyosis were found to be significantly higher than the values in the control group (9.3±0.8 fL versus 7.3±0.8 fL; p less 0.05). Platelet count comparison between the two groups showed no statistical significance (p>0.05).

CONCLUSION:

This study confirms the previous studies indicating endometriosis and adenomyosis as inflammatory processes. As a result, mean platelet volume has shown to be a significant clinical marker for chronic inflammatory process of adenomyosis and endometriosis. This basic finding should be supported by new studies concerning the correlation of mean platelet volume levels with severity and duration of the disease, as well as response of mean platelet volume levels to therapies targeting chronic inflammatory process in adenomyosis and endometriosis pathogenesis.

 

 

 

Eur J Obstet Gynecol Reprod Biol. 2013 Jun;168(2):187-90. doi: 10.1016/j.ejogrb.2012.12.043. Epub 2013 Jan 23.

Increased levels of oxidative stress markers in the peritoneal fluid of women with endometriosis.

Polak G1Wertel IBarczyński BKwaśniewski WBednarek WKotarski J.

Abstract

OBJECTIVE:

To evaluate 8-hydroxy-2-deoxyguanosine (8-OHdG) and 8-isoprostane levels in the peritoneal fluid (PF) of women with endometriosis.

STUDY DESIGN:

One hundred and ten women with laparoscopically and histopathologically confirmed endometriosis and, as reference groups, 119 patients with simple serous (n=78) and dermoid (n=41) ovarian cysts were studied. Peritoneal fluid 8-OHdG and 8-isoprostane concentrations were evaluated by enzyme-linked immunosorbent assays.

RESULTS:

8-OHdG and 8-isoprostane levels in peritoneal fluid were significantly higher in patients with endometriosis compared with the reference groups. Higher PF 8-OHdG and 8-isoprostane concentrations were observed in patients with advanced stages of endometriosis. A statistically significant positive correlation was found between 8-OHdG and 8-isoprostane levels in peritoneal fluid.

CONCLUSION:

Endometriosis induces greater oxidative stress and frequent DNA mutations in peritoneal fluid than nonendometriotic ovarian cysts. The most severe oxidative stress occurs in the peritoneal cavity of women with more advanced stages of the disease.

 

 

Int J Gynaecol Obstet. 2013 Apr;121(1):41-4. doi: 10.1016/j.ijgo.2012.11.011. Epub 2013 Jan 23.

A retrospective review of abdominal wall endometriosis in Shanghai, China.

Ding Y1Zhu J.

Abstract

OBJECTIVE:

To quantify the demographic characteristics, symptoms, and outcomes of women with abdominal wall endometriosis (AWE) in order to identify the optimal treatment and prevention techniques for AWE in the Chinese population.

METHODS:

In a retrospective study, women diagnosed with AWE at the Gynecology Hospital of Fudan University, Shanghai, China, between January 2003 and December 2011 were identified from the hospital’s medical records. Data on patient age, previous surgeries, symptoms, asymptomatic time interval, duration of complaints, mass location, size, tenderness, diagnosis, treatment, and recurrence were analyzed.

RESULTS:

During the study period, 229 women were diagnosed with AWE, and histopathologic confirmation was obtained for 227 women (mean age, 31.7±3.8 years). Each of these patients had undergone previous surgery, and 14 had undergone resection for AWE. The primary symptoms were pain, either cyclical (65.2%) or noncyclical (27.3%), and presence of a mass (84.1%; mean diameter, 2.9±1.3 cm). The mean time interval between previous surgery and onset of symptoms was 2.3±2.2 years. For all patients, the abdominal mass was surgically excised. The postoperative recurrence rate was 1.5%.

CONCLUSION:

Complete resection is the primary treatment for AWE. A combination of surgical re-excision and postoperative adjuvant medical therapy is recommended for patients with recurrent AWE.

 

 

Eur J Pharmacol. 2013 Feb 28;702(1-3):12-9. doi: 10.1016/j.ejphar.2013.01.011. Epub 2013 Jan 23.

β-Caryophyllene causes regression of endometrial implants in a rat model of endometriosis without affecting fertility.

Abbas MA1Taha MOZihlif MADisi AM.

 

Abstract

Many studies have shown that anti-inflammatory agents are effective in the treatment of endometriosis. β-Caryophyllene exerted a potent anti-inflammatory effect in vivo. However, its effect on endometriosis has not been investigated. This study aims at investigating the effect of β-caryophyllene on endometriosis and on fertility and reproduction in adult female rats. Autologous fragments of the endometrium were implantated in the peritoneal cavity in adult female rats. The growth of the endometriotic implants that developed after four weeks was recorded. Treatment started then with β-caryophyllene (10 mg/kg or 30 mg/kg) or vehicle (control) for 21 days and the growth of the endometriotic implants was measured again. In fertility studies, female rats that received β-caryophyllene or vehicle were mated and reproductive functions were observed including number and viability of implants, number of corpora lutea, length of pregnancy and outcome of litter. β-Caryophyllene (10 mg/kg) suppressed the growth of endometriotic implants by 52.5% compared with controls. Also β-caryophyllene produced apoptosis in luminal epithelim of the cyst as well as in endothelial cells of blood vessels. Ultrstructural studies revealed the presence of active mast cells and eosinophils in both control and β-caryophyllene-treated rat cysts. No statistically significant difference was observed in any studied parameter between control and β-caryophyllene-treated groups in fertility study. Therapy with β-caryophyllene may present a promising novel, non-toxic therapeutic option for patients with endometriosis.

 

 

 

World J Hepatol. 2012 Dec 27;4(12):415-8. doi: 10.4254/wjh.v4.i12.415.

Liver metastasis of endometrial stromal sarcoma.

Ramia JM1De la Plaza RGarcia IPerna CVeguillas PGarcía-Parreño J.

 

Abstract

Resection of liver metastases from gynaecological tumours is uncommon. Endometrial stromal sarcomas (ESS) are low incidence gynecological tumours which can originate in previous sites of endometriosis or following metaplasia of the pelvic peritoneal wall, and which are exceptionally associated with liver metastasis. We present a 68-year-old woman with a ESS and metachronic liver metastasis treated by liver resection. There is very little literature on clinical management about liver metastasis from ESS, but extrapolating the data obtained with liver metastasis from sarcomas and uterine tumours, we should recommend resection as this is considered a resectable extrauterine metastasis. In cases with more sites of extrauterine disease, liver resection should also be performed if the other sites are resectable.

 

 

 

 

Expert Opin Pharmacother. 2013 Feb;14(3):291-305. doi: 10.1517/14656566.2013.767334. Epub 2013 Jan 29.

An update on the pharmacological management of endometriosis.

Streuli I1de Ziegler DSantulli PMarcellin LBorghese BBatteux FChapron C.

Abstract

INTRODUCTION:

Endometriosis is a common disease that causes pain symptoms and/or infertility in women in their reproductive years. The disease is characterised by the presence of endometrium-like tissue – glands and stroma – outside the uterine cavity. Different treatment options exist for endometriosis including medical and surgical treatments or a combination of the two approaches. The most commonly used medications are non-steroidal anti-inflammatory drugs, GnRH agonists, androgen derivatives such as danazol, combined oral contraceptive pills, progestogens and more recently the levonorgestrel intrauterine system.

AREAS COVERED:

The authors review current medical treatments used for symptomatic endometriosis and also discuss new treatment approaches. The authors conducted a literature search for randomised controlled trials related to medical treatments of endometriosis in humans, searched the Cochrane library for reviews and also searched for registered trials that have not yet been published on ClinicalTrials.gov.

EXPERT OPINION:

The medical treatment of endometriosis is effective at treating pain and preventing recurrence of disease after surgery. Remarkably, the oral contraceptive pill taken continuously is as effective as GnRH-a, while causing far less side-effects. Conversely, no treatment currently exists for enhancing fecundity in women whose infertility is associated with endometriosis. As all existing therapies of endometriosis are contraceptive, great efforts should be targeted at researching novel products that reduce the disease expression without shuttering ovulation.

 

 

 

J Proteome Res. 2013 Mar 1;12(3):1408-18. doi: 10.1021/pr3010474. Epub 2013 Feb 19

Microarray Glycoprofiling of CA125 improves differential diagnosis of ovarian cancer.

Chen K1Gentry-Maharaj ABurnell MSteentoft CMarcos-Silva LMandel UJacobs IDawnay AMenon UBlixt O.

 

Abstract

The CA125 biomarker assay plays an important role in the diagnosis and management of primary invasive epithelial ovarian/tubal cancer (iEOC). However, a fundamental problem with CA125 is that it is not cancer-specific and may be elevated in benign gynecological conditions such as benign ovarian neoplasms and endometriosis. Aberrant O-glycosylation is an inherent and specific property of cancer cells and could potentially aid in differentiating cancer from these benign conditions, thereby improving specificity of the assay. We report on the development of a novel microarray-based platform for profiling specific aberrant glycoforms, such as Neu5Acα2,6GalNAc (STn) and GalNAc (Tn), present on CA125 (MUC16) and CA15-3 (MUC1). In a blinded cohort study of patients with an elevated CA125 levels (30-500 kU/L) and a pelvic mass from the UK Ovarian Cancer Population Study (UKOPS), we measured STn-CA125, ST-CA125 and STn-CA15-3. The combined glycoform profile was able to distinguish benign ovarian neoplasms from invasive epithelial ovarian/tubule cancer (iEOCs) with a specificity of 61.1% at 90% sensitivity. The findings suggest that microarray glycoprofiling could improve differential diagnosis and significantly reduce the number of patients elected for further testing. The approach warrants further investigation in other cancers.

 

 

 

Arch Gynecol Obstet. 2013 Jul;288(1):167-72. doi: 10.1007/s00404-013-2722-2. Epub 2013 Jan 30.

Evaluation of HE4 as an extrabiomarker to CA125 to improve detection of ovarian carcinoma: is it time for a step forward?

Azzam AZ1Hashad DIKamel NA.

Abstract

PURPOSE:

To evaluate human epididymis protein 4 (HE4) as an extrabiomarker to cancer antigen 125 (CA125) to improve the detection of ovarian carcinoma.

METHODS:

Sixty patients with ovarian carcinoma, 50 patients with benign ovarian tumors and 30 healthy women were included in the present study. Serum concentration of HE4 was assayed using ELISA technique, while CA125 was assayed using chemiluminescent enzyme immunoassay.

RESULTS:

The median CA125 and HE4 serum values were significantly higher among ovarian cancer patients when compared with healthy control However, the median serum levels of CA125 but not HE4 were significantly higher among patients with benign ovarian tumors as compared to healthy women. Based on the receiver operator characteristics curve analysis, HE4 had higher sensitivities than CA125 for the detection of ovarian cancer at 90, 95 and 98 % specificities and the combination of both markers yielded a higher sensitivity than either alone. However, CA125 but not HE4 had higher sensitivities for the detection of benign ovarian tumors at the same specificities. In addition, a positive correlation was observed between HE4 and CA125 among patients with ovarian carcinoma.

CONCLUSION:

HE4 is a valuable marker for ovarian cancer diagnosis and when combined with CA125, they had a higher sensitivity at a set specificity, thus providing a more accurate predictor of ovarian cancer than either alone.

 

 

 

Clin Cancer Res. 2013 Mar 1;19(5):1213-24. doi: 10.1158/1078-0432.CCR-12-2726. Epub 2013 Jan 29.

Plasma microRNAs as novel biomarkers for endometriosis and endometriosis-associated ovarian cancer.

Suryawanshi S1Vlad AMLin HMMantia-Smaldone GLaskey RLee MLin YDonnellan NKlein-Patel MLee TMansuria SElishaev EBudiu REdwards RPHuang X.

Abstract

PURPOSE:

Endometriosis, a largely benign, chronic inflammatory disease, is an independent risk factor for endometrioid and clear cell epithelial ovarian tumors. We aimed to identify plasma miRNAs that can be used to differentiate patients with endometriosis and ovarian cancer from healthy individuals.

EXPERIMENTAL DESIGN:

We conducted a two-stage exploratory study to investigate the use of plasma miRNA profiling to differentiate between patients with endometriosis, patients with endometriosis-associated ovarian cancer (EAOC), and healthy individuals. In the first stage, using global profiling of more than 1,000 miRNAs via reverse transcriptase quantitative PCR (RT-qPCR) in a 20-patient initial screening cohort, we identified 23 candidate miRNAs, which are differentially expressed between healthy controls (n = 6), patients with endometriosis (n = 7), and patients with EAOC (n = 7) based on the fold changes. In the second stage, the 23 miRNAs were further tested in an expanded cohort (n = 88) of healthy individuals (n = 20), endometriosis (n = 33), EAOC (n = 14), and serous ovarian cancer cases (SOC; n = 21, included as controls).

RESULTS:

We identified three distinct miRNA signatures with reliable differential expression between healthy individuals, patients with endometriosis, and patients with EAOC. When profiled against the control SOC category, our results revealed different miRNAs, suggesting that the identified signatures are reflective of disease-specific pathogenic mechanisms. This was further supported by the fact that the majority of miRNAs differentially expressed in human EAOCs were mirrored in a double transgenic mouse EAOC model.

CONCLUSION:

Our study reports for the first time that distinct plasma miRNA expression patterns may serve as highly specific and sensitive diagnostic biomarkers to discriminate between healthy, endometriosis, and EAOC cases.

 

 

 

Korean J Urol. 2013 Jan;54(1):26-30. doi: 10.4111/kju.2013.54.1.26. Epub 2013 Jan 18.

Laparoscopic ureteroneocystostomy: modification of current techniques.

Ahn JH1Han JYNam JKPark SWLee SDChung MK.

Abstract

PURPOSE:

To review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end in various distal ureteral lesions.

MATERIALS AND METHODS:

We conducted a retrospective review of 5 laparoscopic procedures of ureteroneocystostomy with extracorporeal eversion of the ureteral end. Of these, 4 patients (range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or a large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of a ureteral stent and extracorporeal eversion of the ureter through the 10-mm port on the affected side.

RESULTS:

The laparoscopic ureteral reimplantations with and without a psoas hitch in patients with distal ureteral lesions was successful in all patients. The mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional psoas hitch. In all patients, short-term success was confirmed by voiding cystourethrography and intravenous pyelography conducted 3 months after the operation. The mean follow-up of the entire group was 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow-up period.

CONCLUSIONS:

The technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to evolve. Surgeons should be versatile with various options and technical nuances when dealing with these cases. Simple modifications of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end, nonreflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.

 

 

 

Br J Pain. 2013 Feb;7(1):31-8. doi: 10.1177/2049463713481191

Endometriosis-associated pain syndrome: a nurse-led approach.

Cambitzi J1Nagaratnam M1.

 

Abstract

Endometriosis is an enigmatic disease and its fundamental cause is still unknown. Endometriosis-associated pain syndrome is a common problem; it is underdiagnosed and patients suffering from the syndrome are rarely seen in specialist pain clinics. The correlation between the extent of the disease and pain is weak. Endometriosis-associated pain syndrome may be cyclical or persistent and the pain may radiate to other pelvic organs. Optimum treatment is timely intervention using a multidisciplinary approach.

 

 

 

J Hum Genet. 2013 Apr;58(4):202-9. doi: 10.1038/jhg.2013.1. Epub 2013 Jan 31.

A microRNA-520 mirSNP at the MMP2 gene influences susceptibility to endometriosis in Chinese women.

Tsai EM1Wang YSLin CSLin WYHsi EWu MTJuo SH.

 

Abstract

The MMP2 gene has been implicated in the pathogenesis of endometriosis. We investigated the role and function of single-nucleotide polymorphisms (SNP) of MMP2 in relation to endometriosis. First a case-control study was conducted and 17 SNPs were examined in 211 patients and 344 controls. Regression analysis was used to evaluate the genetic effect. We used reporter assay to validate the functional consequences of the significant SNP. Two SNPs (rs243832 and rs7201) had P-values <0.05 and they are in strong linkage disequilibrium (D’=0.96 and r(2)=0.47). Further analysis showed that rs7201 but not rs246832 was an independent risk factor and the risk C allele of rs7201 had an odds ratio (OR) of 1.88 (P=0.004). SNP rs7201 is located at the 3′-untranslated region and is predicted to be within the microRNA-520g binding site. The reporter assay for rs7201 showed that the risk C allele had a higher expression level than the A allele (P=0.027). Using microRNA-520g mimic and inhibitor, the results indicated that the A allele but not the risk C allele can be regulated by microRNA-520g. The C allele of SNP rs7201 increases a risk for endometriosis because of out of regulation by microRNA-520g.

 

 

 

Int J Cancer. 2013 Aug 1;133(3):730-9. doi: 10.1002/ijc.28064. Epub 2013 Mar 13.

Ovarian cancer risk factors by tumor dominance, a surrogate for cell of origin.

Kotsopoulos J1Terry KLPoole EMRosner BMurphy MAHecht JLCrum CPMissmer SACramer DWTworoger SS.

 

Abstract

Differentiating ovarian tumors based on developmental pathway may further enhance our understanding of the disease. Traditionally, ovarian cancers were thought to arise from the ovarian surface epithelium; however, recent evidence suggests that some tumors originate in the fallopian tube. We classified cases in a population-based case-control study (New England Case-Control [NECC] Study) and two cohort studies (Nurses’ Health Study [NHS]/Nurses’ Health Study II [NHSII]) by tumor dominance, a proxy for tissue of origin. Dominant tumors (likely ovarian origin) are restricted to one ovary or are at least twice as large on one ovary compared to the other. Ovarian cancer risk factors were evaluated in relation to dominant and nondominant tumors (likely tubal origin) using polytomous logistic regression (NECC) or competing risks Cox models (NHS/NHSII). Results were combined using random-effects meta-analyses. Among 1,771 invasive epithelial ovarian cancer cases, we observed 1,089 tumors with a dominant mass and 682 with no dominant mass. Dominant tumors were more likely to be mucinous, endometrioid or clear cell, whereas nondominant tumors were more likely to be serous. Tubal ligation, two or more births, endometriosis and age were more strongly associated with dominant tumors (rate ratio [RR] = 0.60, 0.83, 1.58 and 1.37, respectively) than nondominant tumors (RR = 1.03, 0.93, 0.84 and 1.14, respectively; p-difference = 0.0001, 0.01, 0.0003 and 0.01, respectively). These data suggest that risk factors for tumors putatively arising from ovarian versus fallopian tube sites may differ; in particular, reproductive factors may be more important for ovarian-derived tumors. As this is the first study to evaluate ovarian cancer risk factors by tumor dominance, these results need to be validated by other studies.

 

 

 

Gynecol Endocrinol. 2013 May;29(5):452-4. doi: 10.3109/09513590.2012.758704. Epub 2013 Jan 31.

Anti-Müllerian hormone trend after laparoscopic surgery in women with ovarian endometrioma.

Litta P1D’Agostino GConte LSaccardi CCela VAngioni SPlebani M.

Abstract

Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to investigate the extent of the ovarian reserve damage after stripping technique of unilateral endometriomas, by dosing the Anti-Müllerian Hormone (AMH). This prospective study was conducted at the Center of Minimally Invasive Pelvic Surgery of the Department of Health of Woman and Child, University of Padua, from October 2010 to June 2012. Twenty-five women underwent excision of monolateral endometriosis ovarian cyst by stripping without accessing a bipolar coagulation and performing an intracortical suture. The AMH serum levels were estimated in the early proliferative phase of the cycle, before surgery (time 0), 24 h after surgery (time 1), the first menstrual cycle after surgery (time 2) and the third menstrual cycle after surgery (time 3). We found a nonstatistically significant decreases in serum AMH levels after surgical excision of the cysts. Our results suggest that an appropriate surgical technique, without the use of the bipolar coagulation of ovarian border, does not determine a significant reduction of ovarian reserve.

 

 

 

Eur J Obstet Gynecol Reprod Biol. 2013 Apr;167(2):190-3. doi: 10.1016/j.ejogrb.2012.11.019. Epub 2013 Jan 28.

Effect of human interferon-alpha-2b on experimental endometriosis in rats: comparison between short and long series of treatment.

Ingelmo JM1Quereda FAcién P.

Abstract

OBJECTIVE:

A randomised and controlled experimental study was carried out to determine the effect of short and long series of treatment with recombinant human interferon-alpha-2b on surgically induced endometriosis in rats.

STUDY DESIGN:

Ninety-six Wistar adult female rats, which had undergone an autotransplant into the peritoneal cavity of four endometrial fragments measuring 4.5mm at the side, were randomly divided into three groups. One third of the animals were manipulated like the treated animals but were not given treatment and served as control (group C). Another third (group S) were treated with three doses (one every 48 h, 100,000 U per dose) of recombinant human interferon-alpha-2b (subcutaneous route), and the last third (group L) were treated with fifteen doses of interferon (100,000 U every 48 h).

RESULTS:

Before interferon was administered, there were no differences between groups in the average growth of experimental endometriosis per animal (17.3±6.7, 18.1±9.2, 16.4±5.6mm in groups C, S and L respectively). After the treatment, experimental endometriosis per animal was significantly smaller in the groups treated with interferon than in the control non-treated group (p<0.001), and in the group treated with 15 doses versus the group treated with 3 doses (p<0.05), (17.6±7.5, 14.0±9.5, 9.4±6.0mm in groups C, S, and L respectively). While the implants of the animals in the control group showed no change in size throughout the study (120 days) (+1.96% of variation), the mean size of the implants in the treated rats decreased, (22.7% with the short and 42.8% with the long series of treatment with interferon). Only one implant in group C (0.8%) disappeared, while this occurred in 27 cases (22.5%) in group S (p<0.001) and in 45 (37.5%) in group L (p<0.001 versus group C and p<0.05 versus group S).

CONCLUSION:

The long series of treatment with human interferon-alpha-2b was more effective than the short one in reducing the size of surgically induced endometriosis in the peritoneal cavity of the rat.

 

 

 

J Plast Reconstr Aesthet Surg. 2013 Apr;66(4):e111-3. doi: 10.1016/j.bjps.2012.12.024. Epub 2013 Jan 29.

Scar endometriosis: a rare skin lesion presenting to the plastic surgeon.

Marsden NJ1Wilson-Jones N.

Abstract

Endometriosis is the presence or growth of endometrial tissue outside the uterus, most commonly affecting the ovaries, uterine ligaments and the peritoneum. Cutaneous endometriosis is much rarer, and is mostly found at the sites of surgical scars, such as laparoscopies, hysterectomies and caesarean sections. We present a rare case of scar endometriosis in a 33 year-old women presenting to the plastic surgeon as a possible skin malignancy and review the literature.

 

 

Int J Gynecol Pathol. 2013 Mar;32(2):149-55. doi: 10.1097/PGP.0b013e31825b0585.

Is the detection of endometrial nerve fibers useful in the diagnosis of endometriosis?

Leslie C1Ma TMcElhinney BLeake RStewart CJ.

Abstract

Laparoscopy is currently considered to be the gold standard investigation in patients suspected to have endometriosis, but this is an invasive and relatively costly procedure and there may be significant delays in diagnosis. As the eutopic endometrium is recognized to be abnormal in patients with endometriosis, it has been suggested that endometrial sampling could provide an indirect diagnostic approach. In particular, recent reports have suggested that the presence of nerve fibers within the endometrial functional layer could represent a specific and sensitive marker of concurrent peritoneal endometriosis. However, such studies have been performed in select patient groups and using novel sampling and analytic techniques that are not used routinely in clinical pathology laboratories. The present study was performed upon conventional endometrial biopsies from 68 patients who underwent laparoscopy for suspected endometriosis. The biopsies were stained immunohistochemically for the neural marker PGP 9.5 and examined in a blinded manner. Endometrial functional layer nerve fibers were identified in 15 (22%) biopsies overall including 9/47 (19%) cases with histologically confirmed peritoneal endometriosis and 6/21 (29% cases) without endometriosis. There was no correlation between the presence of functional layer nerve fibers and the presenting symptoms, endometrial histology, or current hormonal therapy. In our experience, endometrial functional layer nerve fibers assessment performed using standard immunohistochemical techniques on routine biopsy specimens proved neither sensitive nor specific for the diagnosis of endometriosis. Pathologists and gynecologists considering this diagnostic approach should carefully consider the methodological factors that may influence its reliability.

 

 

Arch Gynecol Obstet. 2013 Jul;288(1):201-5. doi: 10.1007/s00404-012-2700-0. Epub 2013 Feb 1.

Evaluation of novel serum biomarkers and the proteomic differences of endometriosis and adenomyosis using MALDI-TOF-MS.

Long X1Jiang PZhou LZhang W.

Abstract

BACKGROUND:

Both endometriosis and adenomyosis are common benign gynecological diseases. This study aimed to find the novel noninvasive, biochemical diagnostic markers for detection of endometriosis and adenomyosis, and evaluate the correlation of these two diseases at the protein level.

METHODS:

Serum samples from patients with endometriosis or adenomyosis were compared with control groups to detect specific serum biomarkers and to explore the different protein fingerprint of endometriosis and adenomyosis using MALDI-TOF-MS.

RESULT(S):

There were 13 protein peaks abnormally expressed in endometriosis as well as twelve in adenomyosis compared with control groups (P < 0.05). And five-peak mass was found downregulated significantly both in the women with endometriosis and adenomyosis. The common diagnostic model of endometriosis and adenomyosis we set up had a lower sensitivity and specificity than the separate diagnostic model of these two diseases.

CONCLUSION(S):

MALDI-TOF-MS technology plays an important role in screening the diagnostic biomarkers of endometriosis and adenomyosis. And our study found the correlation between endometriosis and adenomyosis in protein fingerprint and it is hard to separate the endometriosis from adenomyosis with the serum biomarkers.

 

 

 

Front Immunol. 2013 Jan 28;4:9. doi: 10.3389/fimmu.2013.00009. eCollection 2013.

Endometriosis, a disease of the macrophage.

Capobianco A1Rovere-Querini P.

Abstract

Endometriosis, a common cause of pelvic pain and female infertility, depends on the growth of vascularized endometrial tissue at ectopic sites. Endometrial fragments reach the peritoneal cavity during the fertile years: local cues decide whether they yield endometriotic lesions. Macrophages are recruited at sites of hypoxia and tissue stress, where they clear cell debris and heme-iron and generate pro-life and pro-angiogenesis signals. Macrophages are abundant in endometriotic lesions, where are recruited and undergo alternative activation. In rodents macrophages are required for lesions to establish and to grow; bone marrow-derived Tie-2 expressing macrophages specifically contribute to lesions neovasculature, possibly because they concur to the recruitment of circulating endothelial progenitors, and sustain their survival and the integrity of the vessel wall. Macrophages sense cues (hypoxia, cell death, iron overload) in the lesions and react delivering signals to restore the local homeostasis: their action represents a necessary, non-redundant step in the natural history of the disease. Endometriosis may be due to a misperception of macrophages about ectopic endometrial tissue. They perceive it as a wound, they activate programs leading to ectopic cell survival and tissue vascularization. Clearing this misperception is a critical area for the development of novel medical treatments of endometriosis, an urgent and unmet medical need.

 

 

 

Eur J Obstet Gynecol Reprod Biol. 2013 May;168(1):92-4. doi: 10.1016/j.ejogrb.2012.12.037. Epub 2013 Jan 31.

Responsiveness of the Dutch Endometriosis Health Profile-30 (EHP-30) questionnaire.

van de Burgt TJ1Kluivers KBHendriks JC.

Abstract

OBJECTIVE:

To evaluate the responsiveness to change and the minimal clinical important difference (MCID) of the Dutch Endometriosis Health Profile-30 (EHP-30) questionnaire.

STUDY DESIGN:

Prospective cohort study among endometriosis patients attending the Radboud University Nijmegen Medical Centre and members of the Dutch endometriosis patient-support group. EHP-30 was measured at baseline and after 6 months. Changes in treatment were recorded, as well as the subjective change in symptoms. Effect sizes and index of responsiveness were evaluated as appropriate. The MCID was estimated with use of the change in scores in women reporting to feel ‘somewhat better’ after 6 months.

RESULTS:

228 women were included. Effect sizes varied from 0.1 to 0.5 in the complete group and from 0.3 to 1.1 in the group of women who reported improvement. Index of responsiveness ranged from 0.1 to 0.7 on the eleven dimensions of the questionnaire. MCID was 3.2-17.5 depending on the dimension.

CONCLUSIONS:

The Dutch EHP-30 is sensitive to change and represents a useful tool in future research on the effect of endometriosis treatment on health status.

 

 

 

BMJ Case Rep. 2013 Jan 31;2013. pii: bcr2012008209. doi: 10.1136/bcr-2012-008209.

Postcoital bleeding due to cervical endometriosis.

Seval MM1Cavkaytar SAtak ZGuresci S.

Abstract

Endometriosis of the uterine cervix is a rare lesion that is generally asymptomatic in gynaecological practice. We present a case with postcoital bleeding due to a cervical mass mimicking cervical polyp or fibroma which was histologically proven as cervical endometriosis later. Cervical endometriosis should be considered in the differential diagnosis of cervical masses with postcoital bleeding.

 

 

Ginekol Pol. 2012 Nov;83(11):841-3.

Comparison of hysterosalpingography and laparoscopy in infertile Iranian women with tubal factor.

Mohammadbeigi R1Tanhaeivash R.

Abstract

OBJECTIVE:

Mechanical factors are responsible for approximately 30% of female infertility and various methods such as transvaginal ultrasonography, hysterosalpingography (HSG), hysteroscopy and laparoscopy have been used to investigate these factors. The aim of this study was to evaluate if HSG alone can be accurately used, compared with laparoscopy in order to reduce health care costs in high medical standard setting in infertile women with tubal factor

METHODS:

Retrospectively medical records of women admitted to a local Iranian hospital were selected. Records of those who underwent both HSG and laparoscopy were studied. Afterwards, the findings were compared in regard to tubal obstruction.

RESULTS:

A total number of 181 records was included into the study By both methods, 99 women were evaluated to have normal findings, and 37 women – abnormal findings, i.e. 136 of 181 (75%) HSG reports were accurate in reference to laparoscopy However there were 3 patients with abnormal fallopian tubes that were not detected by HSG and, moreover; 42 patients with normal tubes which were reported as abnormal by HSG. The calculated sensitivity and specificity of HSG in our study were 0.92 and 0.70, respectively

CONCLUSION:

Although laparoscopy is considered as the reference standard in infertility workup, HSG can be performed first and, therefore, the use of laparoscopy should be limited to cases suspected for etiologies other than intratubal, such as endometriosis and peritubal adhesions.

 

 

 

 

Ginekol Pol. 2012 Nov;83(11):871-6. Polish.

The statement of Polish Society’s Experts Group concerning diagnostics and methods of endometriosis treatment.

Basta ABrucka AGórski JKotarski JKulig BOszukowski PPoreba RRadowicki SRadwan JSikora JSkret ASkrzypczak JSzyłło KPolish Gynocologic Society Experts Group.

Abstract

Endometriosis is defined by endometrial glands and stroma outside of the endometrial cavity Three types of endometriosis have been described: peritoneal endometriosis, ovarian endometriosis and deep infiltrating endometriosis. Endometriosis afflicts 6-15% of women population. It occurs mainly in the group of women in reproductive age, but also in the group of minors and approximately 3% of women after menopause. Within the group of women suffering from infertility the frequency of endometriosis increased to 35-50% of cases. Endometriosis is associated with pain symptoms which can bear the character of pain occurring periodically and altering into constant pain, dysmenorrhea, dyspareunia, dysuria and dyschezia. The correlation between the stage of endometriosis and intensity of pain symptoms not always has to be proportionate. Laparoscopy can be perceived as a standard procedure in endometriosis diagnostics as it allows simultaneous treatment. Profound interview as well as visual diagnostics (USG, MRI) should precede laparoscopy Treatment of endometriosis can be divided into pharmacological and surgical treatment, which can be invasive or non-invasive. The type of treatment depends on patient’s age and her procreation plans, occurring ailments and endometriosis type. Important role is played by adjuvant treatment such as appropriate diet and lifestyle. Treatment of advanced endometriosis should be conducted in reference centres that are appointed with adequate equipment and have the possibility of interdisciplinary treatment. Presented standards can digest and outline the order of proceedings both in diagnostics and endometriosis treatment. The research group believes that the above compilation will facilitate undertaking appropriate decision in diagnosis and treatment of the disease, which will subsequently contribute to therapeutic success.

 

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