Arch Gynecol Obstet. 2011 Oct 22. [Epub ahead of print]
Division of Pediatric-Adolescent Gynecology and Reconstructive Surgery (Referal Centre of Greece), 2nd Department of Obstetrics and Gynecology, “Aretaieion” Hospital, University of Athens, 76, Vas. Sofias Av., 11528, Athens, Greece.
The aim of this study was to underline the significance of premenarcheal gynecological examination in patients with transverse vaginal septum that could possibly be complicated with endometriosis.
Retrospective study including the period between January 2008 and December 2010.
Second Department of Obstetrics and Gynecology.
We searched our databases regarding cases of hematocolpos caused by transverse vaginal septum.
Among the patients presented with hematocolpos we identified 4 cases caused by transverse vaginal septum.
We present the management of these cases regarding diagnosis, differential diagnosis, and treatment. The mean age of the patients was 13.1 years. All patients presented in our department with hypogastric abdominal pain and hematocolpos. No problems in adrenarche or thelarche were mentioned. The U/S and MRI revealed a normal cystic in the upper part of the vagina–hematocolpos varying from 42 × 26 × 30 to 73 × 55 × 32 mm. Three of the patients had an upper transverse vaginal septum while one had a middle transverse vaginal septum. Only one patient had a concomitant anomaly of the urinary system (ectopic kidney). In our patients, after laparoscopic examination 3 out of 4 patients had findings of endometriosis (2/3 with stage I-minimal endometriosis and 1/3 with stage II-mild endometriosis).
Physicians should be aware of transverse vaginal septum in the differential diagnosis of hematocolpos with abdominal pain and primary amenorrhea in the early adolescent years. Early diagnosis could be based on premenarcheal gynecological examination and could lead to correct management in order to avoid the complications of endometriosis (dysmenorrhea or infertility).
Gynecol Obstet Fertil. 2011 Oct 21. [Epub ahead of print]
Pôle de gynécologie-obstétrique, CHU Estaing Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
To evaluate in infertile women the benefit of laparoscopic surgical treatment of endometriosis.
PATIENTS AND METHODS:
All infertile patients aged 18 to 43 years old, operated between February 2004 and March 2008, with a minimal follow-up of 18 months, coming from the Auvergne cohort of endometriosis has been, were included. The primary end point was the achievement of a pregnancy.
One hundred and twenty-three patients have been included. Global pregnancy rate was 48%, which 47% was spontaneous with a mean postoperative delay of 6±4.5 months. Sixty-three patients had benefited from Assisted Reproductive Technology (ART) and 25 pregnancies were obtained (pregnancy rate: 39.7% with a mean delay of 10±3.8 months). Eighty-one percent of spontaneous pregnancies were obtained during the first 12 postoperative months. Duration of preoperative infertility and tubal involvement were significantly associated with lower spontaneous pregnancy rate. No significant differences were found between endometriosis stage I and II compared to stage III and IV, and between patient under 34 years old compared to older.
DISCUSSION AND CONCLUSION:
With this first study on infertility from the Auvergne cohort of endometriosis, we are confirmed that surgery is one of the central issues in the treatment of infertile endometriosis patient. The postoperative delay to obtain a spontaneous pregnancy requires a quick management by ART after 6 to 12 postoperative month and an immediate management by ART in case of tubal involvement or former infertility.
Fertil Steril. 2011 Dec;96(6):1396-400. Epub 2011 Oct 22.
Department of Gynecology and Obstetrics, Rouen University Hospital-Charles Nicolle, Rouen, France. [email protected]
To use postoperative examination by three-dimensional (3D) ultrasound to compare loss of ovarian parenchyma after ovarian endometrioma ablation with the use of plasma energy versus cystectomy.
Retrospective “before and after” comparative study.
University tertiary referral center.
Thirty women with no previous history of ovarian surgery managed for unilateral ovarian endometrioma >30 mm in diameter.
Endometrioma ablation using plasma energy and ovarian tissue-sparing cystectomy.
MAIN OUTCOME MEASURE(S):
3D ultrasound assessment of postoperative reduction in ovarian volume and antral follicle count (AFC).
Fifteen women with comparable baseline characteristics were managed by each technique. Those who underwent cystectomy showed a statistically significant reduction in ovarian volume and AFC when compared with women who underwent ablation using plasma energy. Multivariate analysis showed that the relationship between the decrease in ovarian volume and AFC and the use of cystectomy remained statistically significant after adjustment for age, previous pregnancy, and cyst diameter.
When compared with plasma energy ablation, cystectomy is responsible for a statistically significant decrease in ovarian volume and a statistically significant reduction in AFC. This data should be taken into account in therapeutic decision-making concerning women attempting pregnancy, especially where there are other risk factors for postoperative ovarian failure.
Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):439-42. Epub 2011 Oct 21.
Reproductive Science Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, United Kingdom.
Mirena(®) has been shown to improve symptoms in women with minimal to moderate endometriosis. The precise mechanisms for this have not been thoroughly investigated. We investigate here one possible mechanism-alteration in the number of mast cells in the endometriotic tissue.
Tissues (endometrial, endometriotic and normal peritoneal biopsies) prospectively collected from twenty-eight women with laparoscopically confirmed minimal to moderate endometriosis before and 6 months after treatment with Mirena(®) were processed for immunohistochemistry for ER and PR expression followed by toluidine blue staining for mast cells. Photographs were obtained and the receptors and mast cells identified and quantified.
The mean (± SEM) age of the twenty-eight women was 31 (±7.2) (range 18-42) years. Eight of the endometrial biopsies were in the proliferative phase and twenty in the secretory phase. Six months after Mirena(®), the number of mast cell expressed in the tissues decreased significantly in the eutopic (P=0.0358) and ectopic endometrium (P=0.0220) but not in the normal peritoneum (P>0.05). There were no ERs or PRs found in mast cells.
Mirena(®) causes a reduction in mast cell numbers in ectopic and eutopic endometrium in women undergoing symptomatic treatment of minimal to moderate endometriosis. This reduction could partly explain the efficacy of Mirena(®) in modulating pain in these women.
Contraception. 2011 Nov;84(5):e11-6. Epub 2011 Jun 25.
Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil. [email protected]
Despite the high contraceptive efficacy and the additional noncontraceptive benefits of the levonorgestrel-releasing intrauterine system (LNG-IUS), concerns persist with respect to its use in nulligravidas. The objective of this study was to evaluate the ease of insertion and clinical performance of the LNG-IUS in nulligravida women up to 1 year after insertion.
Two cohorts were formed after LNG-IUS insertion, one consisting of 159 nulligravidas and the other of 477 parous women. Each nulligravida women was paired with three parous women who had an LNG-IUS inserted on the same day. Insertion was classified as easy or difficult, and when classified as difficult, the use of Hegar dilators and/or misoprostol and insertion failure were additional factors recorded.
In almost 80% of cases, no difficulty was encountered during insertion, and dilators and misoprostol were seldom required; however, when necessary, dilator use was almost threefold higher in nulligravida women. Insertion failed in one nulligravida women and in two parous women. Contraception was the most common reason for insertion, although some of the women received the LNG-IUS for both contraceptive and therapeutic purposes, including heavy menstrual bleeding, hematologic diseases, warfarin use, endometriosis-associated pain and following kidney or liver transplantation. The clinical performance of the device showed zero pregnancy rate, expulsion rates of ∼4/100 women-year and 1-year continuation rate of over 90% in both groups.
The LNG-IUS is suitable for use by nulligravidas. It is simple to insert, and its clinical performance in nulligravidas is similar to that found in parous women.
Am J Reprod Immunol. 2012 Feb;67(2):160-8. doi: 10.1111/j.1600-0897.2011.01077.x. Epub 2011 Oct 21.
Polymorphisms of dioxin receptor complex components and detoxification-related genes jointly confer susceptibility to advanced-stage endometriosis in the taiwanese han population.
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.
To establish a multilocus model for studying the effect of dioxin receptor complex components and detoxification-related enzymes on advanced endometriosis.
METHOD OF STUDY:
Six single-nucleotide polymorphisms (SNPs) and two deletion polymorphisms from eight genes (CYP1A1, CYP1B1, GSTM1, GSTT1, GSTP1, AhR, ARNT, and AhRR) were genotyped.
In the single SNP analysis, GSTM1 null type and AhRR variant type were associated with a significantly increased risk of endometriosis [odds ratio (OR)=2.38 and 2.45, respectively]. Using multiple SNPs in the logistic regression for covariates, wild-type AhR and mutant AhRR combination was significantly higher in patients (67.8%) than in controls (48.0%) (OR=2.76). On the other hand, mutant AhRR in combination with GSTM1 null genotype was significantly higher in patients (35.5%) than in controls (19.3%) (OR=6.12).
Polymorphisms of dioxin receptor complex components and detoxification-related genes jointly confer susceptibility to advanced-stage endometriosis in the Taiwanese Han population.
J Chiropr Med. 2011 Sep;10(3):189-93. Epub 2011 Aug 6.
Chiropractic spinal manipulative treatment of migraine headache of 40-year duration using Gonstead method: a case study.
Chiropractor and Physiotherapist, Atlasklinikken, Fridtjof Nansens plass 8, 0160 Oslo, Norway.
The purpose of this article is to present a case study of chiropractic spinal manipulative treatment (CSMT) using the Gonstead method for a patient with migraines.
The patient was a 52-year-old married woman with a long-term history of chronic migraines, which included nausea, vomiting, and photophobia. The patient had endometriosis, but did not relate the migraines to her menstrual cycles. She also reported not using medication for her migraines due to previous drug-related issues. The average frequency of episodes before treatment was 1 per month, and her migraines often included an aura. The pain was moderate, was located on the right side, was pulsating, and lasted for approximately 15 hours. The numeric pain scale for an average episode was 8 out of a possible 10. The aura involved nausea, photophobia, and visual disturbances including black dots in the visual field lasting for approximately 10 minutes.
INTERVENTION AND OUTCOME:
The patient reported all episodes being eliminated following CSMT. At 6-month follow-up, the patient had not had a single migraine episode in this period. The patient was certain that there had been no other lifestyle changes that could have contributed to her improvement.
This case adds to previous research suggesting that some migraine patients may respond favorably to CSMT. The case also provides information on the Gonstead method. A case study does not represent significant scientific evidence in context with other studies conducted; this study suggests that a trial of CSMT using the Gonstead methods could be considered for chronic, nonresponsive migraines.
Presse Med. 2011 Oct 18. [Epub ahead of print]
AP-HP, hôpital Cochin, université Paris-Descartes, service de chirurgie digestive, hépatobiliaire et endocrinienne, 75679 Paris cedex 14, France.
Endometriosis affects 6 to 10 % of all women of childbearing age. Intestinal involvement is defined by muscularis infiltration and has been estimated to occur in 8 % to 12 % of women with endometriosis. The most common sites are rectum, sigmoid and ileocaecal junction. In most cases, intestinal endometriosis is associated with deep infiltrating endometriosis, multifocal and aggressive form of endometriosis, responsible for refractory pelvic pain and infertility. The symptoms are nonspecific but are characterized by cyclic exacerbation of pain. The preoperative work-up includes a rectal endoscopic ultrasonography, a transvaginal ultrasonography, a pelvic magnetic resonance imaging and a multidetector CT scan. There is currently no cure other than surgical removal of lesions. Medical treatments are based on a hormone used to block ovarian function.
Arch Gynecol Obstet. 2011 Oct 20. [Epub ahead of print]
Expression of miR-126 and Crk in endometriosis: miR-126 may affect the progression of endometriosis by regulating Crk expression.
Department of Gynecology and Obstetrics, Shengjing Hospital, China Medical University, 36 Sanhao Street, Shenyang, 110004, China, [email protected]
To evaluate the relationship between miR-126 and Crk and discuss the role of miR-126 in the development and progression of endometriosis (EMs).
The expression levels of miR-126 and Crk mRNA were quantified using real time fluorescent quantitative polymerase chain reaction (real time PCR) in ectopic endometrium (ECs) and eutopic endometrium (EUs) in patients with EMs and normal endometrium (ENs) in EMs-free subjects. The expression levels of Crk protein in all samples were evaluated by Western blot.
The expression level of miR-126 was significantly downregulated in ECs versus EUs (p = 5.45E(-5)) in the experimental group and in EUs versus ENs (p = 0.019). The expression level of Crk mRNA did not distinguish ECs from EUs (p = 0.995) but was overexpressed in EUs versus ENs (p = 0.006). Crk protein was overexpressed in ECs versus EUs (p = 0.002) in the experimental group and in EUs versus ENs (p = 1.13E(-6)). The expression level of miR-126 had no correlation with Crk mRNA (p = 0.496) but was negatively correlated with Crk protein (p = 3.134E(-5)). The expression level of miR-126 in EUs and ECs was negatively correlated with American Fertility Society (AFS) stage (p = 0.022, p = 0.025) and AFS score (p = 0.002, p = 0.007). miR-126 expression decreased with the progression of EMs, but the decrease was not significantly different.
miR-126 may play an initial role in the development and progression of EMs. Crk may be regulated by miR-126, and synergism between abnormal expressions may play an important role in the pathogenesis of EMs.
Br J Radiol. 2011 Nov;84(1007):e210-2.
Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Korea.
There are several reports of adenocarcinoma developing within adenomyosis of the uterus, but imaging features of MRI, including diffusion-weighted imaging (DWI) and positron emission tomography (PET)-CT, have not been published. Herein we report a rare case of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis to emphasise the unusual growth features, as well as the imaging findings of the tumour on MRI and PET-CT.
J Reprod Med. 2011 Sep-Oct;56(9-10):425-30.
Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medical Sciences and National Institute of Hormones and Women’s Health, University of Campinas, Campinas, São Paulo, Brazil.
To evaluate the effect of functional constipation on women with and without chronic pelvic pain (CPP).
One hundred women ages 18-50 were separated into three groups: (A) women without CPP, (B) women with CPP but without functional constipation, and (C) women with CPP with functional constipation according to Rome III criteria. All participants were followed over 3 months, completing a questionnaire on pain and constipation daily. CPP was evaluated using a visual analog scale (VAS).
In Group A, 16 of 31 women complained of lumpy or hard stools; 13 had symptoms of functional constipation. In Group B, 4 of 19 women had lumpy or hard stools. In Group C, 46 of 50 reported straining or incomplete bowel movements and 49 reported lumpy or hard stools. Regarding CPP, no significant differences were found in VAS pain score between Groups B and C; no changes were found in VAS pain score throughout the 12-week evaluation period. The most common diagnoses associated with CPP were idiopathic pain, endometriosis, and pelvic adhesions.
Functional constipation was significantly more prevalent in women with CPP than women without CPP; however, it does not appear to have a role in worsening the pain.
J Reprod Med. 2011 Sep-Oct;56(9-10):405-9.
Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University Women’s Healthcare, 1200 East Michigan Avenue, Suite 700, Lansing, MI 48912, USA. [email protected]
Bladder pain syndrome–formally known as interstitial cystitis–is a chronic bladder disorder characterized by pelvic pain and urinary irritability symptoms. The physiopathology is still unclear but is thought to involve bladder mucosal injury, inflammation and neurologic dysfunction. It is hard to diagnose this entity due to symptoms that are common to several other pathologies such as chronic pelvic pain, endometriosis, overactive bladder, urinary tract infection, and vulvodynia, and due to the lack of specific findings. A combination of history, physical examination, and diagnostic tools helps the establishment of the diagnosis by ruling out other similar pathologies. Treatment is multimodal and combines behavioral changes, drugs administered orally or intravesically and even surgery for refractory cases.
Acta Obstet Gynecol Scand. 2012 Jan;91(1):3-9. doi: 10.1111/j.1600-0412.2011.01303.x. Epub 2011 Nov 9.
Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
The levonorgestrel intrauterine system (LNG-IUS), originally designed for long-term contraceptive use, has been on the Scandinavian market for approximately 20 years. Novel clinical indications for the LNG-IUS, derived mainly from investigator-initiated studies, are emerging. These include heavy menstrual bleeding associated with uterine fibroids, endometriosis, adenomyosis, as well as endometrial hyperplasia. In both cohort and randomized studies, the LNG-IUS is effective in decreasing heavy menstrual bleeding, also in women diagnosed with uterine fibroids. In randomized studies the LNG-IUS has shown comparable clinical efficacy to GnRH analogues or progestins for the symptomatic treatment of endometriosis. Experience with LNG-IUS in adenomyosis is based on prospective cohort studies. Dysmenorrhea has been reported to decrease in all women, and uterine volume was seen to diminish in some of these studies. In the treatment of endometrial hyperplasias, including atypical hyperplasia, the LNG-IUS is equal or superior to treatment with systemic progestins. Further studies are needed to examine the full potential of the LNG-IUS in such common clinical situations.
Clin Dev Immunol. 2012;2012:606459. Epub 2011 Oct 5.
Department of Immunology, Institute of General and Molecular Pathology, University of Tartu, Ravila 19, Tartu 50411, Estonia.
Cytokines are key modulators of the immune system and also contribute to regulation of the ovarian cycle. In this study, Bender MedSystems FlowCytomix technology was used to analyze follicular cytokines (proinflammatory: IL-1β, IL-6, IL-18, IFN-γ, IFN-α, TNF-α, IL-12, and IL-23;, and anti-inflammatory: G-CSF), chemokines (MIP-1α, MIP-1β, MCP-1, RANTES, and IL-8), and other biomarkers (sAPO-1/Fas, CD44(v6)) in 153 women undergoing in vitro fertilization (IVF). Cytokine origin was studied by mRNA analysis of granulosa cells. Higher follicular MIP-1α and CD44(v6) were found to correlate with polycystic ovary syndrome, IL-23, INF-γ, and TNF-α with endometriosis, higher CD44(v6) but lower IL-β and INF-α correlated with tubal factor infertility, and lower levels of IL-18 and CD44(v6) characterized unexplained infertility. IL-12 positively correlated with oocyte fertilization and embryo development, while increased IL-18, IL-8, and MIP-1β were associated with successful IVF-induced pregnancy.
Haemophilia. 2012 Jan;18(1):e31-2. doi: 10.1111/j.1365-2516.2011.02675.x. Epub 2011 Oct 17.
Gynecol Endocrinol. 2012 Feb;28(2):134-8. Epub 2011 Oct 17.
The role of prostaglandin E(2) in endometriosis.
Department of Anatomy, Faculty of Medicine and Surgery, University of Malta , Tal-Qroqq, Msida MSD , Malta.
Endometriosis is a leading cause of infertility in women of reproductive age. It involves the occurrence of endometrial tissue outside the uterine endometrium, mainly in the peritoneal cavity. Prostaglandin E(2) is up regulated in the peritoneal cavity in endometriosis and is produced by macrophages and ectopic endometrial cells. This prostaglandin is involved in the pathophysiology of the disease and elicits cell signals via four receptor types. Prostaglandin E(2) increases estrogen synthesis by up regulating steroidogenic acute regulatory protein (StAR) and aromatase. It inhibits apoptosis and up regulates fibroblast growth factor-9 (FGF-9) promoting cell proliferation. Prostaglandin E(2) affects leukocyte populations and promotes angiogenesis through its effect on estrogen and up regulation of vascular endothelial growth factor (VEGF). Dienogest is a synthetic progestin targeting expression of genes involved in prostaglandin synthesis.
Fertil Steril. 2011 Dec;96(6):e165; author reply e166. Epub 2011 Oct 13.
It’s time to pay attention to the endometrium, including the nucleolar channel system.
Am J Surg Pathol. 2011 Nov;35(11):1605-14.
Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA. [email protected]
In contrast to the controversy regarding the terminology and behavior of ovarian noninvasive low-grade serous tumors [atypical proliferative serous tumor (APST) and serous borderline tumor], little attention has been directed to their origin. Similarly, until recently, proliferative lesions in the fallopian tube had not been extensively studied. The recent proposal that ovarian high-grade serous carcinomas are derived from intraepithelial carcinoma in the fallopian tube prompted us to evaluate the possible role of fallopian tube in the genesis of low-grade serous tumors. We have identified a lesion, designated “papillary tubal hyperplasia (PTH),” characterized by small rounded clusters of tubal epithelial cells and small papillae, with or without associated psammoma bodies, that are present within the tubal lumen and which are frequently associated with APSTs. Twenty-two cases in this study were selected from a population-based study in Denmark of approximately 1000 patients with low-grade ovarian serous tumors in whom implants were identified on the fallopian tube. Seven additional cases were seen recently in consultation at The Johns Hopkins Hospital (JHH). These 7 cases were not associated with an ovarian tumor. PTH was found in 20 (91%) of the 22 cases in the Danish study. On the basis of this association of PTH with APSTs with implants and the close morphologic resemblance of PTH, not only to primary ovarian APSTs but also to noninvasive epithelial implants and endosalpingiosis, we speculate that the small papillae and clusters of cells from the fallopian tube implant on ovarian and peritoneal surfaces to produce these lesions. The 7 JHH cases of PTH that were not associated with an ovarian tumor support the view that PTH is the likely precursor lesion. We propose a model for the development of ovarian and extraovarian low-grade serous proliferations (APST, noninvasive epithelial implants, and endosalpingiosis) that postulates that all of these lesions are derived from PTH, which appears to be induced by chronic inflammation. If this hypothesis is confirmed, it can be concluded that low-grade and high-grade ovarian tumors develop from tubal epithelium and involve the ovary secondarily.
Int J Surg Pathol. 2011 Oct 13. [Epub ahead of print]
Belfast Health and Social Care Trust, Belfast, Northern Ireland.
Endometriosis is a common condition in women of reproductive age and has a known propensity to involve abdominal wall scars. The authors report 2 cases of endometriosis presenting as mass lesions involving the abdominal wall at the site of insertion of ventriculoperitoneal and lumboperitoneal shunts. In both cases, there was clinical evidence of shunt compromise. Endometriosis involving the site of shunt insertion is an extremely rare phenomenon with, as far as the authors are aware, only a single previously reported case. However, it should be considered in the differential diagnosis when a mass develops at a shunt site in a woman of reproductive age.
Biomaterials. 2012 Jan;33(2):634-43. Epub 2011 Oct 13.
Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, PR China.
To reduce the side effects and improve the lack of clinical treatment countermeasures in endometriosis chemotherapy, a polymeric micelle gene delivery system composed of lipid grafted chitosan micelles (CSO-SA) and the pigment epithelium derived factor (PEDF) was designed. Due to the cationic property, the glycolipid-like micelles could compact the PEDF to form complexes nanoparticles. The complexes nanoparticles with an N/P at 9.6 had 135.6 nm volume average hydrodynamic diameters with a narrow size distribution, and 6.4 ± 0.1 mV surface potential. PEDF can be distributed to endometriotic lesions in a rat model of peritoneal endometriosis mediated by CSO-SA via the intravenous injection. It showed that the CSO-SA/PEDF nanoparticles gene therapy caused decrease in the sizes of the endometriotic lesions and atrophy and degeneration of ectopic endometrium significantly. And it showed no toxicity to the reproductive organs under electron microscope observation. In addition, a reduction in microvessel density labeled by Von Willebrand factor was observed and no decrease in α-Smooth Muscle Actine-positive mature vessels. And the index of apoptotic was increased significantly in endometriotic lesions of CSO-SA/PEDF group. So, glycolipid-like structure micelles mediated PEDF gene delivery system could be used as an effective treatment approach for endometriosis disease.