Int J Surg Case Rep. 2013;4(12):1073-5.

Isolated endometriosis causing sigmoid colon obstruction: A case report.

Bascombe NA1Naraynsingh VDan DHarnanan D.

 

Abstract

INTRODUCTION:

Isolated endometriosis of the intestine causing large bowel obstruction is rare.

PRESENTATION OF CASE:

We present a case of endometriosis presenting as large bowel obstruction in a woman of childbearing age. She had no previous symptoms to suggest endometriosis and on presentation urgent surgery was required. The diagnosis of endometriosis was made only after pathological evaluation of the specimen.

DISCUSSION:

No cases of endometriosis confined to this sigmoid colon without pelvic involvement were noted in the literature.

CONCLUSION:

The diagnosis of endometriosis should be entertained when women of childbearing age presents with large bowel obstruction, whether or not the patient has other evidence of the disease.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Feb;173:83-7.

Surgical treatment of rectovaginal endometriosis with extensive vaginal infiltration: results of a systematic three-step vagino-laparoscopic approach.

Angioli R1De Cicco Nardone C1Cafà EV2Plotti F1Muzii L1Montera R1Guzzo F1Luvero D1Terranova C1.

 

Abstract

OBJECTIVE:

Recto-vaginal endometriosis remains a surgical challenge. We propose a systematic surgical approach combining vaginal and laparoscopic steps for patients affected by deep endometriosis infiltrating the vaginal wall.

STUDY DESIGN:

This is a prospective observational study, performed at Campus Bio-Medico of Rome, University Teaching Hospital. All consecutive patients, from 2008 to 2011, affected by symptomatic deep recto-vaginal endometriosis with full thickness vaginal wall involvement, underwent a systematic surgical approach, based on three consecutive surgical steps: vaginal route, laparoscopic approach and final vaginal excision. All patients included in the study were scheduled for two years’ follow-up with pelvic examination, transvaginal ultrasound and visual analog scale (VAS) evaluation of symptoms (dysmenorrhea, dyspareunia and chronic pelvic pain) at 3, 6, 12 and 24 months.

RESULTS:

Thirty-four patients were enrolled. No major complications were registered. Complications included superficial vascular lesions in two cases (5.9%), ureteral stenosis two weeks after surgery in one patient (2.9%), and bowel obstruction for paralytic ileus in one patient (2.9%). A de novo endometrioma was found at 12 months after surgery and a recurrent endometrioma was evident at 24 months. For all symptoms evaluated, there was a significant improvement within 3 months after surgery (p<0.05) and no statistically significant difference during follow-up (at 3, 6, 12 and 24 months).

CONCLUSION:

The proposed systematic surgical approach consisting of three consecutive steps could simplify the approach to deep endometriosis while at the same time increasing the quality of endometriosis surgery, with important benefit for the women affected.

 

 

Zhonghua Bing Li Xue Za Zhi. 2013 Aug;42(8):515-8

[Expression of suppressor of cytokine signaling-3 and caspase-3 in endometriosis and their correlation].

[Article in Chinese]

Wei WD1Ruan FTu FXZhou CYLin J.

 

Abstract

OBJECTIVE:

To investigate the expression of suppressor of cytokine signaling(SOCS)-3 and caspase-3 and their correlative significance in endometriosis.

METHODS:

Immunohistochemical EnVision method was used to detect the SOCS-3 and caspase-3 protein expression in ectopic and eutopic endometrium (n = 32) of patients with endometriosis, as well as normal endometrium (n = 30) of women without endometriosis.

RESULTS:

SOCS-3 and caspase-3 proteins were expressed in all three groups and not affected by the menstrual cycles. The expression of SOCS-3 in ectopic endometrium (5.54 ± 2.12) was significantly lower than that in eutopic (7.39 ± 1.09, P = 0.001) and control group (7.48 ± 1.26, P < 0.01), but without difference between the eutopic and control group (P = 0.756). SOCS-3 expression in ectopic and eutopic endometrium was significantly lower in III/IV stages than that in I/II stages of endometriosis (P < 0.05). Significantly lower expression of caspase-3 protein was found in ectopic (3.20 ± 1.24) and eutopic endometrium (3.88 ± 1.93) as compared with the control group (6.49 ± 1.85, P < 0.01), however ectopic and eutopic endometrium showed no significant difference (t = 1.66, P = 0.10). There was no significant difference of the expression of caspase-3 in ectopic and eutopic endometrium at different disease stages (P > 0.05). Positive correlation was found between the expression of SOCS-3 and caspase-3 proteins in ectopic endometrium (r = 0.655, P < 0.01).

CONCLUSION:

SOCS-3 may be involved in the development of endometriosis through inhibition of apoptosis of ectopic endometrial cells.

 

 

Exp Ther Med. 2013 Dec;6(6):1385-1389.

Effect of traditional Chinese medicine (Xiaochaihu Tang) on the expression of MMP-2 and MMP-9 in rats with endometriosis.

Jiao L1Qi XLu GZhang QZhang CGao J.

 

Abstract

The aim of this study was to explore the effect of a traditional Chinese medicine (Xiaochaihu Tang, XCHT) on the expression of matrix metalloproteinase-2 (MMP-2) and MMP-9 in rats with endometriosis (EMs). A total of 48 specific-pathogen-free (SPF) female Sprague-Dawley (SD) rats were randomly divided into control (n=8) and EMs (n=40) groups. The EMs model was established using a surgical procedure. At 21 days, the rats with EMs were screened and divided into four subgroups (n=8): the model control, low-dose (7.5 g/kg) XCHT-treated, high-dose (15 g/kg) XCHT-treated and gestrinone-treated (0.5 mg/kg) groups. Following 21 days of treatment, the rats were sacrificed. Reverse transcription-polymerase chain reaction (RT-PCR) and western blotting were used to examine the mRNA and protein levels of MMP-2 and MMP-9 in the endometrium. The expression levels of MMP-2 and MMP-9 were significantly increased in the rats with EMs compared with those in normal rats. Moreover, XCHT was able to significantly inhibit the expression of MMP-2 and MMP-9 compared with that in the model control group. In conclusion, XCHT was able to decrease the expression of MMP-2 and MMP-9 in the ectopic endometrium. The present results may provide a potential theoretical basis for the therapy of EMs.

 

 

 

 

Reprod Biomed Online. 2014 Jan;28(1):39-46.

Efficacy and safety of IVF/ICSI in patients with severe endometriosis after long-term pituitary down-regulation.

van der Houwen LE1Mijatovic V2Leemhuis E2Schats R2Heymans MW3Lambalk CB2Hompes PG2.

 

Abstract

Long-term pituitary down-regulation with a gonadotrophin-releasing hormone (GnRH) agonist for 3–6 months prior to IVF/intracytoplasmic sperm injection (ICSI) improves clinical pregnancy rates in endometriosis patients. However, some discussion about this treatment strategy still exists. This retrospective study from a tertiary-care university hospital examined the efficacy and safety of IVF/ICSI with and without long-term pituitary down-regulation in severe endometriosis patients (surgically confirmed American Society for Reproductive Medicine stages III and IV). All first IVF/ICSI treatment cycles between January 2009 and January 2012 were analysed. In patients treated with (n = 68) and without (n = 45) long-term pituitary down-regulation, 13 (19.1%) versus nine (20.0%) ongoing pregnancies after fresh embryo transfer (adjusted OR 0.58, 95% CI 0.18–1.86,) and 24 (35.3%) versus 10 (22.2%) ongoing pregnancies after fresh and cryopreserved embryo transfers (adjusted OR 1.62, 95% CI 0.60–4.38) were accomplished, respectively. Three complications (2.7%) and three recurrences (2.7%) were reported, only in patients treated with long-term pituitary down-regulation. The 1-year cumulative endometriosisrecurrence rate was 7.3%. IVF/ICSI in patients with severe endometriosis is safe with low complication and recurrence rates. A favourable effect, albeit non-significant, of long-term pituitary down-regulation in achieving an ongoing pregnancy was observed only after including cryopreserved embryo transfers.

 

 

Korean J Radiol. 2013 Nov-Dec;14(6):918-22.

MR imaging findings of extraovarian endocervical mucinous borderline tumors arising from pelvic endometriosis.

Yeo DM1Rha SEByun JYLee AKim MR.

 

Abstract

We report MR imaging findings of a rare case of endocervical mucinous borderline tumor (MBT) involving the cul-de-sac and left fallopian tube arising from extensive pelvic endometriosis with pathologic correlation in a 35-year-old woman presented with vague pelvic pain. Endocervical MBT is a type of endometriosis-associated carcinoma. Imaging findings of endocervical MBT are unilocular or oligolocular cystic lesions with enhancing mural nodules, which are different from those of the more common intestinal type MBT.

 

 

Reprod Biomed Online. 2014 Jan;28(1):64-9.

Probability of live birth in women with extremely low anti-Müllerian hormone concentrations.

Lukaszuk K1Kunicki M2Liss J3Bednarowska A4Jakiel G5.

 

Abstract

The aim of the present study was to investigate the clinical pregnancy and live birth rates in women with extremely low (≤ 0.4 ng/ml) anti-Müllerian hormone (AMH) concentrations. The study included 101 women (188 cycles) with extremely low AMH concentrations undergoing IVF cycles and compared the number of live births in women with low AMH. Moreover, the study compared the number of live births in women with or without endometriosis stage III/IV. Fourteen clinical pregnancies and 14 live births (including one pair of twins) were recorded; one woman miscarried. Significantly higher clinical pregnancy (P = 0.046) and live birth rates (P = 0.018) were found in women aged < 35 years compared with older women. AMH concentration did not differ significantly between women with or without endometriosis and there were six live births in women with endometriosis. This was not significantly different from the rate in healthy women. It is concluded that live births are possible in women with extremely low AMH concentrations. The presence of endometriosis stage III/IV did not affect live birth rates in women with extremely low AMH concentrations although an important limitation of the study is the small number of women included who were affected by that disease.

 

 

Reprod Biomed Online. 2014 Jan;28(1):116-24.

What is the societal burden of endometriosis-associated symptoms? a prospective Belgian study.

Klein S1D’Hooghe T2Meuleman C2Dirksen C3Dunselman G4Simoens S5.

 

Abstract

Endometriosis is a complex disease that affects a large number of women of reproductive age and imposes a significant burden on patients and society. The aim of this study was to evaluate diagnosis, comorbidities, healthcare resource use, treatment patterns, costs and quality of life of women with endometriosis seen in a Belgian tertiary care centre. A total of 134 patients were included in a prospective questionnaire-based cost-of-illness study. Patients were diagnosed after a median delay of 2 years after onset of symptoms. Almost all patients reported having at least one comorbidity. Total annual costs per patient were €9872 (95% confidence interval €7930–11,870), with costs of productivity loss representing 75% of total costs. Hospitalizations, surgeries, infertility treatments, pain and anxiety increased total costs significantly (P 0.001). Patients generated an average of 0.82 QaLY over a 1-year time horizon. This study showed that direct and indirect costs attributable to endometriosis-associated symptoms are substantial. Earlier diagnosis and cost-effective treatment of endometriosis may decrease productivity loss, quality of life impairment and healthcare consumption and consequently reduce total costs to patients and society.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Jan;172:36-9.

Endometriosis and pregnancy outcome: are pregnancies complicated by endometriosis a high-risk group?

Mekaru K1Masamoto H2Sugiyama H2Asato K2Heshiki C2Kinjyo T2Aoki Y2.

 

Abstract

OBJECTIVES:

Increased incidence of preterm birth, pregnancy-induced hypertension (PIH) and small-for-gestational-age (SGA) babies have been reported in women with endometriosis, but the study populations included women in whom a definitive diagnosis was not attainable, and women who conceived via in vitro fertilization/embryo transfer (IVF/ET), which, in itself, is a risk factor for adverse pregnancy outcome. Thus there is a lack of consensus on the effects of endometriosis on pregnancy outcome. This study compared the pregnancy outcomes of women with or without a definitive diagnosis of endometriosis on laparoscopy.

STUDY DESIGN:

Retrospective comparison of pregnancy outcomes of 108 women who underwent managed delivery of pregnancies established after laparoscopic investigation of infertility. Women with factors known to affect pregnancy outcome, such as age ≥41 years, conception via IVF/ET and multiple births, were excluded. Forty-nine of the study participants had endometriosis (En+ group) and 59 participants did not have endometriosis (En- group).

RESULTS:

There were no significant differences in mean (±standard deviation) age (33±3.8 vs 33.6±4.1 years), history of miscarriage, history of preterm birth and history of PIH between the two groups. Ovulation induction was used for infertility treatment in 26.5% of the En+ group and 30.5% of the En- group, and artificial insemination was used in 30.6% of the En+ group and 32.2% of the En- group. Regarding pregnancy outcomes, no significant differences in miscarriage (18.4% vs 18.6%), subchorionic haematoma (5.0% vs 2.1%), preterm birth (7.5% vs 8.3%), PIH (15.0% vs 12.5%), caesarean section (32.5% vs 22.9%), gestational age at delivery (38.9±1.5 vs 38.8±1.7 weeks), birth weight (3013.3±480 vs 2934.5±639.5g) and SGA babies (2.5% vs 2.1%) were found between the En+ and En- groups. Placental abruption did not occur in either group. One neonate had trisomy 21 in the En+ group, and one woman had gestational diabetes in the En- group.

CONCLUSION:

Endometriosis may not affect pregnancy outcome, but there is a need for a large prospective study.

 

 

Fertil Steril. 2014 Feb;101(2):427-34.

The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas.

Alborzi S1Keramati P2Younesi M2Samsami A2Dadras N2.

 

Abstract

OBJECTIVE:

To evaluate the effects of laparoscopic cystectomy on ovarian reserve in patients with endometriomas.

DESIGN:

Prospective study.

SETTING:

Private and university hospitals.

PATIENT(S):

A total of 193 patients with endometriomas undergoing laparoscopic cyctectomy.

INTERVENTION(S):

Serum levels of antimüllerian hormone (AMH), FSH, and E₂, as well as antral follicle count (AFC) were measured preoperatively and 1 week, 3 and 9 months postoperatively for AMH, and 3 months for other values.

MAIN OUTCOME MEASURE(S):

Ovarian reserve based on the comparison of AMH alterations. The secondary end points are changes in FSH, E₂, and AFC.

RESULT(S):

Serum AMH level decreased significantly from the baseline (3.86 ± 3.58 ng/mL) to 1 week (1.66 ± 1.92 ng/mL), 3 months (2.06 ± 2.5 ng/mL), and 9 months (1.77 ± 1.76 ng/mL) postoperatively. Those patients with bilateral endometriomas had significantly lower levels of AMH, 1 week, 3 and 9 months after operation. Also, patients older than 38 years had lower postoperative AMH levels. The FSH levels increased significantly from baseline to 3 months postoperatively. The AFC level increased significantly from baseline to 3 months after operation.

CONCLUSION(S):

The AMH level decreased and the FSH level increased after laparoscopic cystectomy for endometriomas, especially in older patients and those with bilateral cysts.

 

 

Mol Hum Reprod. 2014 Mar;20(3):260-70.

Reduced connexin 43 in eutopic endometrium and cultured endometrial stromal cells from subjects with endometriosis.

Yu J1Boicea ABarrett KLJames COBagchi ICBagchi MKNezhat CSidell NTaylor RN.

 

Abstract

Accumulating evidence indicates that reduced fecundity associated with endometriosis reflects a failure of embryonic receptivity. Microdomains composed of endometrial gap junctions, which facilitate cell-cell communication, may be implicated. Pharmacological or genetic inhibition of connexin (Cx) 43 block human endometrial cell differentiation in vitro and conditional uterine deletion of Cx43 alleles cause implantation failure in mice. The aim of this study was to determine whether women with endometriosis have reduced eutopic endometrial Cx43. Cx26 acted as a control. Endometrial biopsies were collected from age, race and cycle phase-matched women without (15 controls) or with histologically confirmed endometriosis (15 cases). Immunohistochemistry confirmed a predominant localization of Cx43 in the endometrial stroma, whereas Cx26 was confined to the epithelium. Cx43 immunostaining was reduced in eutopic biopsies of endometriosis subjects and western blotting of tissue lysates confirmed lower Cx43 levels in endometriosis cases, with Cx43/β-actin ratios=.4±1.5 in control and =1.2±0.3 in endometriosis biopsies (P<0.01). When endometrial stromal cells (ESC) were isolated from endometriosis cases, Cx43 levels and scrape loading-dye transfer were reduced by ∼45% compared with ESC from controls. In vitro decidualization of ESC derived from endometriosis versus control subjects resulted in lesser epithelioid transformation and a significantly reduced up-regulation of Cx43 protein (1.2±0.2- versus 1.7±0.4-fold, P<0.01). No changes in Cx26 were observed. While basal steady-state levels of Cx43 mRNA did not differ with respect to controls, ESC from endometriosis cases failed to manifest a response to hormone treatment in vitro. In summary, eutopic endometrial Cx43 concentrations in endometriosis cases were <50% those of controls in vivo and in vitro, functional gap junctions were reduced and hormone-induced Cx43 mRNA levels were blunted.

 

 

 

 

J Assist Reprod Genet. 2014 Feb;31(2):163-8.

Analyzing the possible involvement of anti-Müllerian hormone and anti-Müllerian hormone receptor II single nucleotide polymorphism in infertility.

Yoshida Y1Yamashita YSaito NOno YYamamoto HNakamura YHayashi ATerai YOhmichi M.

 

Abstract

PURPOSE:

We performed TaqMan genotyping assays of anti-Mullerian hormone (AMH) and anti-Mullerian hormone receptor type II (AMHRII) single nucleotide polymorphisms (SNPs) in order to investigate how their frequency and distribution affect infertility treatment outcome.

METHODS:

Eighty Japanese women (advanced age: n = 51, endometriosis: n = 18, male infertility as a control: n = 11) who undertook ART were included in the study, and all couples underwent a full infertility investigation protocol. In order to investigate the natural distribution of SNPs, a naturally pregnant group of 28 subjects was recruited from among women who conceived naturally and subsequently delivered in our department. Genomic DNA was extracted from peripheral blood and genotyping was conducted by TaqMan genotyping assay. The relationship of AMH and AMHRII SNPs and treatment outcome in infertile women. Comparison of allele and genotype frequencies of infertile patients with naturally pregnant women.

RESULTS:

AMHRII -482 A>G homozygote mutation was complicated with ISV 5-6 C>T homozygote mutation and showed a significantly lower oocyte retrieval rate compared with a wild type. Two of 3 cases of AMHRII -482 A>G homozygote mutation were poor responders, and the distribution and frequency of each allele of naturally pregnant women showed no statistical difference compared with infertile women.

CONCLUSIONS:

This study revealed the possible involvement of AMHRII -482 A>G polymorphism on the malfunction of follicular development in Japanese women.

 

 

Cancer Res. 2014 Feb 1;74(3):852-61

Risk of ovarian cancer and the NF-κB pathway: genetic association with IL1A and TNFSF10.

Charbonneau B1Block MSBamlet WRVierkant RAKalli KRFogarty ZRider DNSellers TATworoger SSPoole ERisch HASalvesen HBKiemeney LABaglietto LGiles GGSeveri GTrabert BWentzensen NChenevix-Trench Gfor AOCS/ACS groupWhittemore ASSieh WChang-Claude JBandera EVOrlow ITerry KGoodman MTThompson PJCook LSRossing MANess RBNarod SAKupryjanczyk JLu KButzow RDörk TPejovic TCampbell ILe NDBunker CHBogdanova NRunnebaum IBEccles DPaul JWu AHGayther SAHogdall EHeitz FKaye SBKarlan BYAnton-Culver HGronwald JHogdall CKLambrechts DFasching PAMenon USchildkraut JPearce CLLevine DAKjaer SKCramer DFlanagan JMPhelan CMBrown RMassuger LFSong HDoherty JAKrakstad CLiang DOdunsi KBerchuck AJensen ALubinski JNevanlinna HBean YTLurie GZiogas AWalsh CDespierre EBrinton LHein ARudolph ADansonka-Mieszkowska AOlson SHHarter PTyrer JVitonis AFBrooks-Wilson AAben KKPike MCRamus SJWik ECybulski CLin JSucheston LEdwards RMcGuire VLester Jdu Bois ALundvall LWang-Gohrke SSzafron LMLambrechts SYang HBeckmann MWPelttari LMVan Altena AMvan den Berg DHalle MKGentry-Maharaj ASchwaab IChandran UMenkiszak JEkici ABWilkens LRLeminen AModugno FFriel GRothstein JHVergote IGarcia-Closas MHildebrandt MASobiczewski PKelemen LEPharoah PDMoysich KKnutson KLCunningham JMFridley BLGoode EL.

 

Abstract

A missense single-nucleotide polymorphism (SNP) in the immune modulatory gene IL1A has been associated with ovarian cancer risk (rs17561). Although the exact mechanism through which this SNP alters risk of ovarian cancer is not clearly understood, rs17561 has also been associated with risk of endometriosis, an epidemiologic risk factor for ovarian cancer. Interleukin-1α (IL1A) is both regulated by and able to activate NF-κB, a transcription factor family that induces transcription of many proinflammatory genes and may be an important mediator in carcinogenesis. We therefore tagged SNPs in more than 200 genes in the NF-κB pathway for a total of 2,282 SNPs (including rs17561) for genotype analysis of 15,604 cases of ovarian cancer in patients of European descent, including 6,179 of high-grade serous (HGS), 2,100 endometrioid, 1,591 mucinous, 1,034 clear cell, and 1,016 low-grade serous, including 23,235 control cases spanning 40 studies in the Ovarian Cancer Association Consortium. In this large population, we confirmed the association between rs17561 and clear cell ovarian cancer [OR, 0.84; 95% confidence interval (CI), 0.76-0.93; P = 0.00075], which remained intact even after excluding participants in the prior study (OR, 0.85; 95% CI, 0.75-0.95; P = 0.006). Considering a multiple-testing-corrected significance threshold of P < 2.5 × 10(-5), only one other variant, the TNFSF10 SNP rs6785617, was associated significantly with a risk of ovarian cancer (low malignant potential tumors OR, 0.85; 95% CI, 0.79-0.91; P = 0.00002). Our results extend the evidence that borderline tumors may have a distinct genetic etiology. Further investigation of how these SNPs might modify ovarian cancer associations with other inflammation-related risk factors is warranted.

 

 

Ginekol Pol. 2013 Oct;84(10):877-81

[Proteomics in endometriosis].

Marianowski P1Szymusik IHibner MBarcz EWielgoś M.

 

Abstract

Despite significant scientific progress, etiology of endometriosis remains enigmatic. New advances in molecular biology have allowed the use of proteomics in demystifying this puzzling disease. Proteomics is a technology that permits the visualization of thousands of proteins inside a cell, tissue, or organism, and simultaneous observation of any alterations in protein expression and post-translational modification that may have important, clinical implications. Owing to its capacity to reveal the structural and functional properties of proteins, proteomics might illuminate the biology of the disease much better than genomics can. This state-of-the-art technology allows us to globally compare the expression and regulation profiles of proteins found in endometriosis with normal eutopic tissues (endometrium and peritoneum), as well as to compare those found in the different forms of endometriosis (i.e., peritoneal endometriosis, endometrioma, and adenomyoma). Proteomic analysis has been employed in endometriosis research in hope of discovering endometriosis-specific proteins, pathways, and potential biomarkers for precise, early detection. In recent years, several published studies have compared serum and peritoneal fluid protein content in women with and without endometriosis, as well as protein composition in endometrial implants, eutopic endometrium, endometriomas, menstrual blood and urine. It appears that use of proteomics could revolutionize our understanding of etiopathogenesis of the disease. Some of the identified proteins could indeed be responsible for the onset and progression of endometriotic implants. Because early stages of endometriosis may be difficult to diagnose, it would be of the utmost importance to identify specific biological markers of the disease. Additionally specific implant proteins could become targets for molecular treatment of endometriosis. It is very challenging, however to draw clear conclusions from the analysis of the obtained samples. First of all, the samples are usually pathologically confirmed to be endometriotic, but from a molecular stand point, the particular portion of the sample that is analyzed may matter greatly; none of the methods allow us to gain information about the molecular and pathological pattern of the same sample. Secondly it is very difficult to define an ‘unaffected peritoneum’ as a control for the endometriotic lesions. Thirdly the variety of options in each individual makes it difficult to see the molecular picture of the diseased area (such as the ovary or peritoneum) clearly ideally the samples would be of greater value if obtained at an early age, that is, before puberty in each individual and then again when endometriosis occurs later in reproductive age. Such a project cannot be performed prospectively although it may be considered as retrospective analysis of obtained material in some patients after successful chemotherapy due to oncological conditions.

 

 

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2013 Sep;33(9):1179-82.

[Dan’e fukang soft extract improved the oocyte quality and GDF-9 expressions of endometriosis patients: an experimental study].

[Article in Chinese]

Lian F1Li XN.

 

Abstract

OBJECTIVE:

To study the mechanism of Dan’e Fukang Soft Extract (DFSE) on improving oocyte and embryo qualities in endometriosis patients undergoing in vitro fertilization-embryo transfer (IVF-ET).

METHODS:

Totally 70 patients with endometriosis confirmed by laparoscope were randomly assigned to two groups, the treated group and the control group, 35 cases in each group. Patients in the treated group were treated with DFSE + controlled ovarian hyperstimulation (COH), while those in the control group were treated with DFSE placebo + COH. Besides, recruited were another 35 subjects undergoing intracytoplasmic sperm injection-embryo transfer (ICSI-ET) as a normal control group. The content of growth differentiation factor 9 (GDF-9) in the granulocytes of the mature follicular fluid on the oocyte retrieval day was determined by Western blot. The mRNA expression of GDF-9 was detected by RT-PCR. The oocyte retrieval number, the cleavage rate, the fertilization rate,the high-quality embryo rate, and the pregnancy rate were compared.

RESULTS:

The mRNA expression of GDF-9 in the granulocytes was significantly higher in the treated group than in the control group, showing statistical difference (P < 0.05), but with no statistical difference when compared with that of the normal control group. There was no statistical difference in the cleavage rate between the two groups (P > 0.05). The fertilization rate and the high-quality embryo rate were higher in the treated group than in the control group, showing statistical difference (P < 0.05), but with no statistical difference when compared with that of the normal control group.

CONCLUSIONS:

DFSE could improve the oocyte and embryo qualities of endometriosis patients undergoing IVF-ET. Its mechanism might be associated with regulating the GDF-9 mRNA level of granulocytes.

 

 

Gastroenterol Clin North Am. 2013 Dec;42(4):785-800.

Chronic pelvic pain.

Stein SL1.

 

Abstract

Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments.

 

 

Akush Ginekol (Sofiia). 2013;52(4):12-5.

[Mini-invasive treatment by cases of moderate and severe pelvic endometriosis].

Totev TStoykov STomov SGorchev G.

 

Abstract

OBJECTIVE:

The purpose is to investigate the characteristics of the performed mini-invasive surgical treatment by patients with III-IV stage of pelvic endometriosis and to establish the advantages of this surgical approach, such as the concomitant complications.

MATERIAL AND METHODS:

90 patients, who underwent operation, with histologically proved endometriosiswere studied for a period of 2 years: 60 of them with moderate and 14–with severe endometriosos, determinated by the revised ASRM classification.

RESULTS AND DISCUSSION:

The most commonly done laparoscopic operation is the cystectomy–totally 57 (77%) for the whole group, followed by the cystadnexectomy–11 cases (14.9%). By 4 of the cases (5.5%) there was a conversion into laparotomy and by 2 of the cases (2.7%) mini-invasive surgical procedures were accomplished.

CONCLUSION:

Mini-invasive approach by patients with pelvic endometriosis offers several options: to stage the condition, to diagnose the tubal sterility and to perform surgical treatment. In this study we establish the structure of the accomplished operations, noting the low count of complications and conversions, such as the short operative time and recovery days.

 

 

Clin Exp Obstet Gynecol. 2013;40(3):372-6.

The expression and role of oxidative stress markers in the serum and follicular fluid of patients with endometriosis.

Liu F1He LLiu YShi YDu H.

 

Abstract

OBJECTIVE:

To investigate the expression and role of oxidative stress markers in the serum and follicular fluid of patients with endometriosis.

MATERIALS AND METHODS:

A prospective case-control study was conducted in 42 patients who underwent in vitro fertilization-embryo transfer (IVF-ET). They were divided into Group I: patients with endometriosis (n = 20) and Group II: patients with tubal factor infertility (n = 22). All patients underwent a long gonadotropin-releasing hormone (GnRH) agonist protocol for pituitary downregulation followed by controlled ovarian hyperstimulation. Level of reactive oxygen species (ROS), superoxide dismutase (SOD), and vitamin E (VE) were measured by enzyme-linked immunosorbent assay (ELISA). The results of IVF-ET between the two groups were compared.

RESULTS:

The ROS levels in both serum and follicular fluid of the study group were significantly higher than in the control group. The serum levels of SOD and VE in the study group were significantly lower than those in the control group, but there was no difference in follicular fluid levels of SOD and VE between the two groups. Furthermore, the mature oocyte and fertilization rates in the study group were significantly lower than those of the control group. However, the levels of ROS, SOD, and VE in serum and follicular fluid were not significantly correlated with outcome following IVF-ET.

CONCLUSION:

Patients with endometriosis have increased oxidative stress, as well as lower mature oocyte rates and fertilization rates. Nevertheless, there is no evidence that the oxidative stress status is directly related to the outcome of IVF treatment.

 

 

Clin Exp Obstet Gynecol. 2013;40(3):457-9.

Simultaneous dermoid cyst and endometriosis in the same ovary: a case report.

Prorocic M1Tasic LVasiljevic MJurisic ASmiljkovic ODRaznatovic SSaranovic M.

 

Abstract

The authors present a case of a 33-year-old infertile woman with coincidental dermoid cyst and ovarian endometriosis in the same ovary. She was admitted to the Clinic because of cystic tumor of the left adnexa. Transvaginal ultrasound (TVUS) examination found a bilocular tumor of complex structure on the left ovary. Video-laparoscopy was also performed. On the left ovary, two adjacent cystic formations were found. Laparoscopic ovarian cystectomy was performed and a surgical specimen was sent for histopathologic analysis. The diagnosis was a dermoid cyst and ovarian endometriosis. Without complications, the patient was released from the hospital. The patient was treated with an analogue of gonadotropin releasing hormone (GnRH) for three months as a preparation for in vitro fertilization (IVF).

 

 

Biomarkers. 2014 Feb;19(1):16-21.

Evaluation of elevated urinary enolase I levels in patients with endometriosis.

Yun BH1Lee YSChon SJJung YSYim SYKim HYPark JHSeo SKCho SChoi YSLee BS.

 

Abstract

OBJECTIVE:

The aim of this study is to validate and investigate the clinical value of urinary enolase I in patients with endometriosis.

METHODS:

Urine samples of 39 patients with histologically confirmed endometriosis and 20 patients without endometriosis were collected. Western blot analysis and enzyme-linked immunosorbent assay were used to detect the increase of enolase I in patients’ urine.

RESULTS:

Urinary enolase I expression corrected for creatinine ratio (non neuronal enolase (NNE)-Cr) was significantly greater in patients with endometriosis (p = 0.026). When the diagnostic performance of NNE-Cr was evaluated with serum CA-125 combination, the area under the curve was 0.821 (95% confidence interval 0.713-0.928) with sensitivity and specificity of 76.9% and 85.0%, respectively.

CONCLUSION:

Elevated urinary enolase I, in conjunction with serum CA-125, may be used as a potential biomarker for endometriosis.

 

 

Zhonghua Fu Chan Ke Za Zhi. 2013 Jul;48(7):508-10.

[Short-term outcome of leuprorelin acetate in preventing recurrence of ovarian endometrioma after conservative surgery].

[Article in Chinese]

Yuan L1Wu QJLiu XS.

 

Abstract

OBJECTIVE:

To evaluate the short-term effect of leuprorelin acetate microspheres in preventing recurrence of ovarian endometrioma after conservative surgery.

METHODS:

From January 2011 to September 2011, 190 ovarian endometrioma patients undergoing conservative laparoscopic surgery at Affiliated Obstetrics and Gynecology Hospital Affiliated to Fudan University were enrolled in this retrospective study. Among 184 patients were followed up, the range of following up were 12 to 21 months. 116 cases presented dysmenorrheal. Based on postoperative treatment, they were classified into 124 cases treated by domestic gonadotropin releasing hormone agonist(GnRH-a) post-operatively for 3-6 months and 60 cases without postoperative treatment. Among all, 63 patients were treated with, that was leuprorelin acetate microspheres for injection (Beiyi, 3.75 mg, q28 d), 61 patients were treated with imported GnRH-a post-operatively for 3-6 months, that were either Zoladex(3.6 mg, q28 d), Dophereline(3.75 mg, q28 d) or Enatone (3.75 mg, q28 d). The recurrence and pain improvement were compared among those groups.

RESULTS:

(1) The total rate of cyst recurrence was 12.5% (23/184) while the average recurrent time was (13.7 ± 2.6) months (2-21 months). The cyst recurrence rate was significantly lower in patients treated with GnRH-a post-operatively than those who didn’t take medications [21.7% (13/60) versus 8.1% (10/24), P < 0.05]. However, there was no significant difference between domestic GnRH-a group and the imported one [7.9% (5/63) versus 8.2% (5/61), P > 0.05]. (2) After conservative surgery, symptoms were found to be relieved in 87.1% (101/116) patients among 116 patients complaining of dysmenorrheal pre-operatively and the pain recurrence rate was 12.9% (13/101). However, there was no significant difference in either symptom relief rate or pain recurrence rate among different groups. The symptom relief rate were 87% (33/38), 86% (37/43) and 89% (31/35) while the pain recurrence rate were 12% (4/33), 14% (5/37) and 13% (4/31) respectively in none, imported GnRH-a group and domestic GnRH-a group.

CONCLUSIONS:

Leuprorelin acetate microspheres could be effective in preventing recurrence of ovarian endometrioma, but not in symptom relieving after conservative surgery in short term. The effect of domestic and imported GnRH-a was similar.

 

 

Biol Reprod. 2014 Jan 30;90(1):19.

Inhibition of follicle-stimulating hormone-induced preovulatory follicles in rats treated with a nonsteroidal negative allosteric modulator of follicle-stimulating hormone receptor.

Dias JA1Campo BWeaver BAWatts JKluetzman KThomas RMBonnet BMutel VPoli SM.

 

Abstract

We previously described a negative allosteric modulator (NAM) of FSHR (ADX61623) that blocked FSH-induced cAMP and progesterone production but did not block estradiol production. That FSHR NAM did not affect FSH-induced preovulatory follicle development as evidenced by the lack of an effect on the number of FSH-dependent oocytes found in the ampullae following ovulation with hCG. A goal is the development of a nonsteroidal contraceptive. Toward this end, a high-throughput screen using human FSHR identified an additional nonsteroidal small molecule (ADX68692). Although ADX68692 behaved like ADX61623 in inhibiting production of cAMP and progesterone, it also inhibited FSH-induced estradiol in an in vitro rat granulosa primary cell culture bioassay. When immature, noncycling female rats were injected subcutaneously or by oral dosing prior to exogenous FSH administration, it was found that ADX68692 decreased the number of oocytes recovered from the ampullae. The estrous cycles of mature female rats were disrupted by administration by oral gavage of 25 mg/kg and 10 mg/kg ADX68692. In the highest dose tested (25 mg/kg), 55% of animals cohabited with mature males had implantation sites compared to 33% in the 10 mg/kg group and 77% in the control group. A surprising finding was that a structural analog ADX68693, while effectively blocking progesterone production with similar efficacy as ADX68692, did not block estrogen production and despite better oral availability did not decrease the number of oocytes found in the ampullae even when used at 100 mg/kg. These data demonstrate that because of biased antagonism of the FSHR, nonsteroidal contraception requires that both arms of the FSHR steroidogenic pathway must be effectively blocked, particularly estrogen biosynthesis. Thus, a corollary to these findings is that it seems reasonable to propose that the estrogen-dependent diseases such as endometriosis may benefit from inhibition of FSH action at the ovary using the FSHR NAM approach.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Feb;173:1-6.

Dyspareunia and quality of sex life after surgical excision of endometriosis: a systematic review.

Fritzer N1Tammaa A2Salzer H2Hudelist G3.

 

Abstract

Dyspareunia, a common symptom of endometriosis, severely affects quality of sex life in affected women. The objective of the present work was to review the effect of surgical resection of endometriosis on pain intensity and quality of sex life. MEDLINE and EMBASE databases were searched for papers investigating the outcome after surgical endometriosis resection on dyspareunia and quality of sex life measured via VAS/NAS respectively via standardised measuring instruments. Data did not permit a meaningful meta-analysis. Out of 64 papers, three studies fulfilled the predefined inclusion criteria involving 128 patients with endometriosis and dyspareunia preoperatively. All included studies showed a significant postoperative reduction (p<0.05) of dyspareunia after a follow-up period of 12 up to 60 months. Sex life also improved significantly (p<0.05), and predominantly evaluated parameters like quality of life and mental health. Intra- and postoperative complications were described in two out of three studies. Surgical excision of deep infiltrating endometriosis is feasible and improves dyspareunia and quality of sex life significantly.

 

 

 

Eur J Radiol. 2014 Feb;83(2):261-7.

Multidetector computerized tomography enema versus magnetic resonance enema in the diagnosis of rectosigmoid endometriosis.

Biscaldi E1Ferrero S2Leone Roberti Maggiore U3Remorgida V4Venturini PL5Rollandi GA6.

 

Abstract

PURPOSE:

To compare the accuracy of multidetector computerized tomography enema (MDCT-e) and magnetic resonance enema (MRI-e) in determining the presence of sigmoid and rectal endometriotic nodules.

MATERIALS AND METHODS:

260 women (32.6 ± 4.3 years) with symptoms suggestive of rectosigmoid endometriosis underwent MDCT-e and MRI-e prior to laparoscopy. After retrograde colonic distention and injection of intravenous contrast medium, patients were scanned on a 64-row MDCT scanner. MRI-e was performed on a 1.5T magnet using an 8 channels phased array coil; intestinal distention was achieved by introducing in the rectum 250-300 ml of ultrasonographic gel diluted with saline solution. Radiological findings were compared with surgical and histological results.

RESULTS:

176 women had rectosigmoid endometriosis at surgery. There was no significant difference in the accuracy of MDCT-e (98.5%) and MRI-e (96.9%) in the diagnosis of sigmoid and rectal endometriosis(p=0.248). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of MDCT-e and MRI-e were respectively 98.3%, 98.8%, 99.4%, 96.5%, 81.59, 0.02 and 97.2%, 96.4%, 98.3%, 94.1%, 26.89, 0.03.

CONCLUSIONS:

Both MDCT-e and MRI-e are accurate in the diagnosis of rectal and sigmoid endometriosis.

 

Hum Reprod. 2014 Feb;29(2):253-66.

Can chemokines be used as biomarkers for endometriosis? A systematic review.

Borrelli GM1Abrão MSMechsner S.

 

Abstract

STUDY QUESTION:

Can we use chemokines as biomarkers to diagnose patients with endometriosis in clinical practice?

SUMMARY ANSWER:

Some chemokines, especially CXCL8 (IL-8), CCL-2 (MCP-1) and CCL5 (RANTES), have the potential to work as biomarkers to identify patients with endometriosis but their accuracy could be improved by combination with other non-inflammatory markers in a panel of biomarkers.

WHAT IS ALREADY KNOWN:

The need for a good marker to diagnose endometriosis has increased in recent years and research in this field has intensified. Chemokines have been reported to be associated with endometriosis in several studies over the last 20 years. Many of these studies measured one or more chemokines in peritoneal fluid (PF) and peripheral blood (PB) or through endometrial biopsies in patients with and without endometriosis.

STUDY DESIGN, SIZE, DURATION:

A systematic review was done on all published studies that compared chemokine concentrations in patients with and without endometriosis to evaluate their potential as biomarkers for the disease.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Using MEDLINE database from December 1993 to August 2013 and the MeSH terms ‘Endometriosis’ and ‘Chemokines’, we identified relevant studies to include in the present review, which was based on the PRISMA statement. Studies that measured at least one chemokine in patients with endometriosis and matching controls in PB, PF or endometrial samples were included. We did not include samples from ectopic lesions. All review articles as well as studies with animals and those not written in English were excluded from this systematic review. The studies were assessed using a modified version of the Quality Assessment of Diagnostic Accuracy Studies criteria. Two authors independently assessed studies for inclusion and risk of bias, and extracted data.

MAIN RESULTS AND THE ROLE OF CHANCE:

After inclusion and exclusion criteria, 62 studies were selected to be included in this systematic review. A total of 27 different chemokines or their receptors were evaluated in the reviewed studies. The most studied chemokines (including their receptors) were CXCL8 (51.6%), CCL2 (38.7%) and CCL5 (19.3%) (% of studies). CXCL8 (IL-8) appears to have the best results among all the other chemokines as a marker for endometriosis.

LIMITATIONS, REASONS FOR CAUTION:

Some studies included have low power due to small sample size and study designs vary in the assessment criteria for the markers, the state of the patients (e.g. phase of the cycle and stage of disease) and the nature of the controls.

WIDER IMPLICATIONS OF THE FINDINGS:

Our findings could guide future research in this field to select the chemokines with the best potential, and to stimulate better-designed studies to determine whether they can become a useful diagnostic tool in clinical practice.

STUDY FUNDING/COMPETING INTEREST(S):

There was no funding to support this systematic review. The authors have no competing interest to declare.

 

 

 

Updates Surg. 2014 Mar;66(1):59-64.

Management of rectosigmoid obstruction due to severe bowel endometriosis.

Ruffo G1Crippa SSartori APartelli SMinelli LFalconi M.

 

Abstract

Bowel obstruction is a rare complication of intestinal endometriosis. The aim of this work was to evaluate outcomes after colorectal resection for bowel obstruction due to endometriosis. Of 720 patients who underwent colorectal resection for bowel endometriosis, 12 (1.7 %) presented with bowel obstruction. Preoperative work-up, management, perioperative and long-term outcomes were analyzed. All lesions were localized in the rectosigmoid tract. All patients underwent colorectal resection, which was carried out laparoscopically in 4 (33 %). Rate of low or ultra-low colorectal anastomoses was 83 %. Four patients (33 %) required blood transfusions. Two patients developed rectovaginal fistulas. After a median follow-up of 38 months, there were no cases of disease recurrence and dyschezia improved in 75 % of patients. Bowel endometriosis should be considered in the differential diagnosis of young women with bowel obstruction. Despite challenging operations, colorectal resections are associated with good outcomes.

 

 

J Robot Surg. 2013 Dec;7(4):345-9.

Robotic-assisted laparoscopic trachelectomy: a case series and review of surgical technique.

Tam T1Harkins G2Davies M2.

 

Abstract

We present a retrospective case series of patients who underwent robotic-assisted laparoscopic trachelectomies from August 1, 2011 to August 30, 2012, with a description of the surgical technique for successful cervical removal. The patients, at the Department of Obstetrics and Gynecology, Division of Urogynecology and Minimally Invasive Surgery at Penn State Milton S. Hershey Medical Center, were identified using ICD-9 coding for robotic-assisted trachelectomy. Of the 180 patients who had robotic-assisted gynecologic surgery during the study period, eight underwent robotic-assisted laparoscopic trachelectomy. The patients’ average age was 40.4 years, average parity was 1.5, and mean body mass index was 28. The time interval from initial surgery of supracervical hysterectomy to robotic-assisted trachelectomy was 4 years. Pre-operative cervical cytology was negative in all patients. The average length of stay was one overnight admission. The primary indication for prior supracervical hysterectomy was dense pelvic adhesions, and the main indications for robotic-assisted trachelectomy were pelvic pain due to endometriosis and cyclic vaginal bleeding. Surgical outcomes included minimal blood loss (<50 ml) and mean operative time of 1.15 h (74.88 min), without any immediate intra-operative or post-operative complications reported. Histopathology reports on all cervical specimens were normal. Adnexectomy is the most common concomitant procedure performed with trachelectomy. Robotic-assisted laparoscopic trachelectomy is a viable option for patients requesting a minimally invasive approach to cervical stump removal.

 

 

J Robot Surg. 2013 Dec;7(4):371-5.

A pilot study of robotic uterine and vaginal vault manipulation: the ViKY Uterine Positioner™.

Akrivos N1Barton-Smith P2.

 

Abstract

A pilot study of uterine and vaginal vault manipulation using a new surgical robot-The ViKY Uterine Positioner™–enrolled 36 cases comprising 31 hysterectomies, two myomectomies, two sacrocolpopexies and one excision of severe endometriosis performed between July 2010 and February 2012 in a tertiary referral District General Hospital in the UK. Mean age was 48 years, body mass index 25.7 kg/m(2) and uterine weight 231 g. Nine cases were foot-controlled and 27 by Bluetooth voice control. ViKY UP™ docking time once V-Care™ was inserted was 4.3 min. The device caused no peri-operative complications. Adequate mobilization, visualization and range of movement was possible in 81, 78 and 61 % of cases, respectively, with most of the problems arising in cases with uterine weight >350 g. ViKY UP™ was detached and an assistant was required in three cases, whilst V-Care™ came out of the uterus in one case. The learning curve led to various adjustments including optimizing patient position, increasing the device range of movement and adjusting device sensitivity. As a result, problems were minimized in our last nine cases. Adding robotic uterine manipulation is the obvious next step to give the gynecologist the ultimate control and stability of the uterus during robotic-assisted surgery without having to lift their head from the viewfinder or rely on a remotely situated perineal assistant. ViKY UP™ is the first device to deliver this. Pilot study results did not demonstrate compromised safety, and the device appears to be effective and easy to learn.

 

 

Asian Pac J Cancer Prev. 2013;14(10):5589-97.

Endometriosis, leiomyoma and adenomyosis: the risk of gynecologic malignancy.

Verit FF1Yucel O.

 

Abstract

The aim of this review article was to evaluate the relationship and the possible etiological mechanisms between endometriosis, leiomyoma (LM) and adenomyosis and gynecological cancers, such as ovarian and endometrial cancer and leiomyosarcoma (LMS). MEDLINE was searched for all articles written in the English literature from July 1966 to May 2013. Reports were collected systematically and all the references were also reviewed. Malignant transformation of gynecologic benign diseases such as endometriosis, adenomyosis and LM to ovarian and endometrial cancer remains unclear. Hormonal factors, inflammation, familial predisposition, genetic alterations, growth factors, diet, altered immune system, environmental factors and oxidative stress may be causative factors in carcinogenesis. Early menarche, low parity, late menopause and infertility have also been implicated in the pathogenesis of these cancers. Ovarian cancers and endometriosis have been shown to have common genetic alterations such as loss of heterozygosity (LOH), PTEN, p53, ARID1A mutations. MicroRNAs have also been implicated in malignant transformation. Inflammation releases proinflammatory cytokines, and activates tumor associated macrophages (TAMS) and nuclear factor kappa b (NF-KB) signaling pathways that promote genetic mutations and carcinogenesis. MED12 mutations in LM and smooth muscle tumors of undetermined malignant potential (STUMP) may contribute to malignant transformation to LMS. A hyperestrogenic state may be shared in common with pathogenesis of adenomyosis, LM and endometrial cancer. However, the effect of these benign gynecologic diseases on endometrial cancer should be studied in detail. This review study indicates that endometriosis, LM, adenomyosis may be associated with increased risk of gynecological cancers such as endometrial and ovarian cancers. The patients who have these gynecological benign diseases should be counseled about the future risks of developing cancer. Further studies are needed to investigate the relationship between STUMPs, LMS and LM and characteristics and outcome endometrial carcinoma in adenomyotic patients.

 

 

Fertil Steril. 2014 Feb;101(2):595-601.

Dienogest inhibits nerve growth factor expression induced by tumor necrosis factor-α or interleukin-1β.

Mita S1Shimizu Y2Sato A1Notsu T1Imada K1Kyo S3.

 

Abstract

OBJECTIVE:

Dienogest (DNG), a selective P receptor (PR) agonist, is used to treat endometriosis. To investigate whether DNG affects nerve growth factor (NGF) expression, we stimulated human endometrial epithelial cells (hEECs) with inflammatory cytokines.

DESIGN:

Prospective basic research study using immortalized hEEC lines.

SETTING:

Development Research, Mochida Pharmaceutical Co., Ltd., Japan.

PATIENT(S):

None.

INTERVENTION(S):

Not applicable.

MAIN OUTCOME MEASURE(S):

In immortalized hEECs, NGF production induced by tumor necrosis factor-α (TNF-α) or interleukin-1β (IL-1β) was evaluated in the presence or absence of the synthetic progestin DNG or endogenous P. The NGF messenger RNA (mRNA) and protein were measured using real-time reverse transcriptase-polymerase chain reaction (PCR) and ELISA, respectively. The NGF bioactivity in the culture medium was measured by assaying neurite outgrowth of PC-12 cells.

RESULT(S):

Tumor necrosis factor-α and IL-1β induced NGF mRNA and protein and increased NGF bioactivity in the culture medium. These activities were inhibited by DNG in a hEEC line that stably expresses PR. In contrast, in an hEEC line that constitutively expresses faint levels of PR, no inhibitory effect of DNG on NGF mRNA was detected. The NGF mRNA was also inhibited in hEEC lines that express only PR-A or only PR-B.

CONCLUSION(S):

Nerve growth factor is one of the key mediators that generates the pain associated with endometriosis. Dienogest inhibits NGF expression through PR-A and PR-B in hEEC, which may contribute to the pharmacological mechanisms of how DNG relieves pain in endometriosis.

 

 

Fertil Steril. 2014 Feb;101(2):435-41.

Decline of serum antimüllerian hormone levels after laparoscopic ovarian cystectomy in endometrioma and other benign cysts: a prospective cohort study.

Kwon SK1Kim SH2Yun SC3Kim DY1Chae HD1Kim CH1Kang BM1.

 

Abstract

OBJECTIVE:

To identify the most important factor in predicting ovarian reserve after laparoscopic ovarian cystectomy and to evaluate whether there is any difference in the postoperative decline of ovarian reserve between women with endometrioma and those with other benign ovarian cysts.

DESIGN:

Prospective cohort study.

SETTING:

University hospital.

PATIENT(S):

A total of 100 women who had undergone laparoscopic ovarian cystectomy for endometrioma (n = 68) or other benign ovarian cysts (n = 32).

INTERVENTION(S):

Serum antimüllerian hormone (AMH) levels measured by enzyme immunoassay preoperatively and at 3 months after surgery.

MAIN OUTCOME MEASURE(S):

Rate of AMH decline after surgery and follicle numbers retained in cystectomy specimens.

RESULT(S):

Serum AMH levels were obviously decreased at 3 months after the surgery (4.97 ± 2.83 vs. 3.33 ± 2.08 ng/mL, mean ± standard deviation). Adjusting for several parameters, we could see that bilaterality of the ovarian cyst was the only significant factor in predicting the rate of postoperative decline of AMH levels. The rate of AMH decline did not differ between the endometrioma group and the other benign ovarian cyst group.

CONCLUSION(S):

Bilaterality of the ovarian cyst is the only significant factor in predicting the rate of decline of AMH level after laparoscopic ovarian cystectomy. The rate of decline of AMH levels after surgery was similar between the endometrioma group and the other benign ovarian cyst group.

 

 

Fertil Steril. 2014 Feb;101(2):568-76.

Effect of oxygen tensions on the proliferation and angiogenesis of endometriosis heterograft in severe combined immunodeficiency mice.

Lu Z1Zhang W2Jiang S2Zou J3Li Y4.

 

Abstract

OBJECTIVE:

To investigate the effects of oxygen on the proliferation and angiogenesis of endometriosis in vivo.

DESIGN:

Animal studies.

SETTING:

Animal research facility.

ANIMAL(S):

Thirty-six female severe combined immunodeficiency (SCID) mice, implanted with eutopic endometrium from seven endometriosis patients.

INTERVENTION(S):

Human eutopic endometrial tissues were randomized to normoxia, hyperoxia, or hypoxia pretreatment and were subcutaneously implanted into estrogen-treated ovariectomized SCID mice.

MAIN OUTCOME MEASURE(S):

The growth and quality of the implants were measured, and the expression of proliferation- and angiogenesis-associated markers (i.e., Ki67, CD31, vascular endothelial growth factor, and hypoxia-inducible factor-1α) were assessed using immunohistochemistry and Western blot analyses.

RESULT(S):

The growth curves of the implants were distinct with different oxygen pretreatments. The growth of the implants of the hypoxia group was significantly increased compared with the normoxia group, but the growth of the implants of the hyperoxia group was significantly decreased compared with the normoxia group. Microscopic examination indicated that lesions with hyperplastic cylindrical glandular epithelium were surrounded by the endometrial stroma in the hypoxia group, but the glandular epithelium was partially depauperate in the hyperoxia group. The expression of Ki67, CD31, vascular endothelial growth factor, and hypoxia-inducible factor-1α in the hypoxia-pretreated implants was significantly higher compared with the hyperoxia or normoxia groups.

CONCLUSION(S):

Oxygen can alter the growth patterns of endometriosis implants in a SCID mouse model. Hypoxia pretreatment promoted the proliferation and angiogenesis of endometriosis, whereas hyperoxia pretreatment exhibited the opposite effect.

 

Int J Gynaecol Obstet. 2014 Feb;124(2):169-73.

Biopsychosocial correlates of persistent postsurgical pain in women with endometriosis.

Carey ET1Martin CE2Siedhoff MT3Bair ED4As-Sanie S5.

 

Abstract

OBJECTIVE:

To examine pain and biopsychosocial correlates over time for women with persistent postsurgical pain after surgery for endometriosis.

METHODS:

Cross-sectional study of women who underwent any endometriosis surgery between 2003 and 2006. Following surgery, patients completed validated questionnaires (Short-Form McGill Pain Questionnaire, 12-item Short-Form Health Survey, Beck Depression Inventory, Coping Strategies Questionnaire catastrophizing subscale). The primary outcome was pelvic pain intensity, measured by the McGill total pain score. Bivariate comparisons between each potential predictor and pain intensity were performed using the χ(2) and t tests, 1-way analysis of variance, and simple linear regression.

RESULTS:

In total, 79 completed the questionnaires and were included in the present analysis. The McGill affective pain score was negatively correlated with age (β-coefficient -0.12, P=0.002) and positively correlated with catastrophization (β-coefficient 0.66, P=0.01). Women with a history of dyspareunia scored significantly higher on the McGill total pain score (P<0.001); there was no association between pain intensity and endometriosis severity.

CONCLUSION:

Younger age and catastrophization are correlated with persistent pain following surgery for endometriosis. The severity of endometriosis does not predict persistent pain. Further evaluation of psychosocial factors may identify patients who are least likely to benefit from surgeries for endometriosis-associated pelvic pain.

 

 

Int J Surg Case Rep. 2013;4(12):1145-8.

Primary umbilical endometriosis. Case report and discussion on management options.

Fancellu A1Pinna AManca ACapobianco GPorcu A.

 

Abstract

INTRODUCTION:

We report a recently observed case of primary umbilical endometriosis (UE), with the main aim to discuss the management of this rare condition.

PRESENTATION OF CASE:

A 24-year-old woman complained of a painful nodule on her umbilical region, bleeding with her menstrual cycle. Ultrasonography showed a hypoechoic superficial mass in the umbilicus and no signs of intra-abdominal endometriosis. Excision of the nodule under local anesthesia was performed. Histopathological analysis confirmed the diagnosis of umbilical endometriosis. Neither symptoms nor signs of local recurrence have been observed after 24 months.

DISCUSSION:

UE should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. Although there is a substantial agreement about the necessity of surgery, treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis.

CONCLUSION:

Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.

 

 

Dis Model Mech. 2014 Feb;7(2):225-32.

Luminal epithelium in endometrial fragments affects their vascularization, growth and morphological development into endometriosis-like lesions in mice.

Feng D1Menger MDWang HLaschke MW.

 

Abstract

In endometriosis research, endometriosis-like lesions are usually induced in rodents by transplantation of isolated endometrial tissue fragments to ectopic sites. In the present study, we investigated whether this approach is affected by the cellular composition of the grafts. For this purpose, endometrial tissue fragments covered with luminal epithelium (LE(+)) and without luminal epithelium (LE(-)) were transplanted from transgenic green-fluorescent-protein-positive (GFP(+)) donor mice into the dorsal skinfold chamber of GFP(-) wild-type recipient animals to analyze their vascularization, growth and morphology by means of repetitive intravital fluorescence microscopy, histology and immunohistochemistry during a 14-day observation period. LE(-) fragments developed into typical endometriosis-like lesions with cyst-like dilated endometrial glands and a well-vascularized endometrial stroma. In contrast, LE(+) fragments exhibited a polypoid morphology and a significantly reduced blood perfusion after engraftment, because the luminal epithelium prevented the vascular interconnection with the microvasculature of the surrounding host tissue. This was associated with a markedly decreased growth rate of LE(+) lesions compared with LE(-) lesions. In addition, we found that many GFP(+) microvessels grew outside the LE(-) lesions and developed interconnections to the host microvasculature, indicating that inosculation is an important mechanism in the vascularization process of endometriosis-like lesions. Our findings demonstrate that the luminal epithelium crucially affects the vascularization, growth and morphology of endometriosis-like lesions. Therefore, it is of major importance to standardize the cellular composition of endometrial grafts in order to increase the validity and reliability of pre-clinical rodent studies in endometriosis research.

 

 

Arch Gynecol Obstet. 2014 May;289(5):1119-24.

Molecular evaluation of proliferative-phase endometrium may provide insight about the underlying causes of infertility in women with endometriosis.

Hurst BS1Shimp KEElliot MMarshburn PBParsons JBahrani-Mostafavi Z.

 

Abstract

PURPOSE:

To determine if endometrial gene expression is different in women with endometriosis-related infertility and fertile women.

METHODS:

Prospective study of mid-follicular phase endometrium in 47 subjects in two phases: microarray study of 10 infertile women with endometriosis and five fertile controls, and a quantitative real-time PCR (qRT-PCR) study of 27 infertile women with endometriosis and 15 fertile controls. Gene expression was determined by DNA microarray, and qRT-PCR used for 12 “promising” genes based on the microarray analysis.

RESULTS:

Compared to fertile controls, women with stage I-II endometriosis had 23, and women with stage III-IV had 35 genes that were significantly up- or down-regulated by microarray. However, using qRT-PCR, only chemokine ligand (CXCL) 13 was significantly down-regulated and somatostatin was significantly up-regulated with early endometriosis, and only CXCL 14 was significantly down-regulated with advanced endometriosiscompared to fertile controls.

CONCLUSIONS:

Our findings indicate that the pattern of gene expression in proliferative-phase endometrium is different when comparing tissue from patients with endometriosis versus fertile controls. Recognition of these endometrial alterations could be helpful to diagnose and stage endometriosis, and may provide insight to explain why conception rates are low in women with endometriosis.

 

 

Int J Clin Exp Pathol. 2013 Nov 15;6(12):2824-34.

MiR-195 inhibits proliferation and growth and induces apoptosis of endometrial stromal cells by targeting FKN.

Wang Y1Chen HFu YAi AXue SLyu QKuang Y.

 

Abstract

MiR-195, which exhibits a proliferation-inhibiting role in different tumors, has been reported to be down-regulated in the ectopic endometrium. The aim of this study was to determine the impact of miR-195 on the biological characteristic of the endometrial stromal cells (ESCs). MiR-195 has been presumed to target the 3′-untranslated regions (3′-UTR) of Fractalkine (FKN), which also plays important roles in endometriosis. Fluorescence reporter assays showed that miR-195 effectively binds to the 3′-UTR of FKN. The normal ESCs showed a significant higher miR-195 expression than that of eutopic and ectopic ESCs associated with endometriosis, while the FKN expression showed opposite results. MiR-195 mimics inhibited proliferation and growth and induced apoptosis of eutopic ESCs, and these effects were abolished by FKN-siRNA. miR-195 could decrease the expression of survivin, matrix metalloproteinase-9 (MMP9) and up-regulate the expression of CD82, tissue inhibitor of metalloproteinase 1 (TIMP1) and TIMP2 of eutopic ESCs by targeting FKN. Our study has demonstrated for the first time that miR-195 plays important roles in regulating the functions of ESCs through targeting FKN. The information may be useful for developing a new therapeutic strategy for endometriosis.

 

 

Int J Clin Exp Pathol. 2013 Nov 15;6(12):2949-54.

Leiomyomatosis peritonealis disseminata coexisting with endometriosiswithin the same lesions: a case report with review of the literature.

Toriyama A1Ishida MAmano TNakagawa TKaku SIwai MYoshida KKagotani ATakahashi KMurakami TOkabe H.

 

Abstract

Leiomyomatosis peritonealis disseminata (LPD) is an extremely rare condition, which is characterized by the presence of multiple peritoneal and subperitoneal nodules composed of bland smooth muscle cells. Albeit extremely rare, coexistence of endometriosis within LPD lesions has also reported. Herein, we report the seventh documented case of LPD coexisting with endometriosis within the same lesions and review the pathogenesis of this lesion. A 42-year-old Japanese female presented with an abdominal tumor. Computed tomography revealed a tumorous lesion in the right ovary and multiple small nodules in the abdominal cavity. Under a clinical diagnosis of ovarian cancer with peritoneal dissemination, resection of these lesions was performed. Histopathological study of the disseminated peritoneal nodules revealed proliferation of interlacing bundles of spindle cells with eosinophilic cytoplasm and bland cigar-shaped nuclei. Mitotic figures were hardly seen. The peritoneal nodules of the rectum had cystic cavities within the spindle cell bundles, and endometrial glands and stroma were present around the cystic cavities and spindle cells. The resected tissues of the ovary and cecum showed the same histopathological features. Accordingly, a diagnosis of LPD with endometriosiswithin the same lesions was made. A possible origin of LPD is thought to be the submesothelial multipotential stem cells, also referred to as the secondary müllerian system. The presence of endometrial tissues within LPD lesions, as seen in the present case, also support this hypothesis because endometrial tissues are also derived from the müllerian system.

 

 

 

Eksp Klin Gastroenterol. 2013;(3):11-4.

[Endoscopic diagnostics of colorectal endometriosis].

Matronitskiĭ RBMel’nikov MVChuprynin VDAskol’skaia SIKhabas GNKhil’kevich EG.

 

Abstract

The purpose of the study is to explore and systematize the endoscopic features of colorectal endometriosis and to evaluate the role of colonoscopy in its diagnosis.

MATERIAL AND METHODS:

Were analyzed 320 diagnostic colonoscopies performed during the period from March 2011 till November 2012 in patients admitted to the hospital with a diagnosis of “infiltrative form of external endometriosis”.

RESULTS:

Among all the identified cases of intestinal endometriosis (n = 67) pathological process was localized more often in the upper section of the rectum ampullar – 38 (56.7%), less often were revealed lesions of lower ampullar section of rectum and anal canal in 5 (7.4%). In 6 (8.9%) cases were detected multifocal lesions of the intestine. Authentic signs of colorectal endometriosis were detected in lesions of the mucous membrane. These include: polypoid growths above the endometriosis lesion (15 (22.4%)), endometrioid heterotopias in the colon mucosa (7 (10.4%)), the presence of ulceration of the mucous membrane in the projection of endometriosis (4 (5.9%)) geoidal mucosa (3 (4.5%)). Colorectal endometriosis can be systematized according to the following endoscopic criteria: localization of the pathological focus, growth, the presence of mucosal lesions.

 

 

Acta Chir Belg. 2013 Sep-Oct;113(5):357-63.

Leiomyomatosis peritonealis disseminata associated with ascites and endometriosis: a case report and review of the literature.

De Vos T1Weyers SBraems GVilleirs GLambein KMakar ATummers PVan Den Broecke R.

 

Abstract

We present a case of leiomyomatosis peritonealis disseminata (LPD) and review the literature. LPD is a rare, benign disorder that is characterized by multiple subperitoneal or peritoneal nodules of varying sizes on the omentum and peritoneal surfaces, grossly resembling disseminated carcinoma. It should be differentiated from other peritoneal tumors. It is mostly asymptomatic and diagnosis is often incidental during surgery. One should be aware of the iatrogenic component of this entity. LPD is being documented with increasing frequency. We report the case of a 39-year-old woman with chronic abdominal pain and heavy dysmenorrhea due to endometriosis associated with LPD. She underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy. LPD and endometriosis is a known association. LPD with ascites and endometriosis however has not yet been reported.

 

 

Diagn Pathol. 2013 Dec 2;8:194.

Extrapelvic endometriosis: a rare entity or an under diagnosed condition?

Machairiotis NStylianaki ADryllis GZarogoulidis P1Kouroutou PTsiamis NKatsikogiannis NSarika ECourcoutsakis NTsiouda TGschwendtner AZarogoulidis KSakkas LBaliaka AMachairiotis C.

 

Abstract

Endometriosis is a clinical entity characterized by the presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. Endometriosis can be either endopelvic or extrapelvic depending on the location of endometrial tissue implantation. Despite the rarity of extrapelvic endometriosis, several cases of endometriosis of the gastrointestinal tract, the urinary tract, the upper and lower respiratory system, the diaphragm, the pleura and the pericardium, as well as abdominal scars loci have been reported in the literature. There are several theories about the pathogenesis and the pathophysiology of endometriosis. Depending on the place of endometrial tissue implantation, endometriosis can be expressed with a wide variety of symptoms. The diagnosis of this entity is neither easy nor routine. Many diagnostic methods clinical and laboratory have been used, but none of them is the golden standard. The multipotent localization of endometriosis in combination with the wide range of its clinical expression should raise the clinical suspicion in every woman with periodic symptoms of extrapelvic organs. Finally, the therapeutic approach of this clinical entity is also correlated with the bulk of endometriosis and the locum that it is found. It varies from simple observation, to surgical treatment and treatment with medication as well as a combination of those.

 

 

 

Gynecol Obstet Invest. 2014;77(1):35-9.

Regression of experimentally induced endometriosis with a new selective cyclooxygenase-2 enzyme inhibitor.

Kilico I1Kokcu AKefeli MKandemir B.

 

Abstract

BACKGROUND:

Cyclooxygenase-2 (COX-2) levels increase in women with endometriosis. COX-2, via increasing prostaglandin E2, contributes to an increase in vascular endothelial growth factor. In this way, COX-2 may contribute to the progression and continuity of endometriosis. We investigated the effect of dexketoprofen trometamol, a new selective COX-2 enzyme inhibitor, on experimentally induced endometriotic cysts.

METHODS:

Experimental endometriotic cysts were created in 60 adult female Wistar albino rats. The rats were randomized to 2 equal groups, a control (group Con) and a dexketoprofen (group Dex) group. Six weeks later, cyst volumes were measured as in vivo (volume 1). Following volume 1 measurement, for 4 weeks group Con received 0.1 ml distilled water; group Dex received 0.375 mg dexketoprofen trometamol/0.1 ml distilled water, intramuscularly, twice a day. At the end of administration, the cyst volumes were remeasured (volume 2), and the cysts totally excised and weighed. Glandular (GT) and stromal tissues (ST) and natural killer (NK) cell contents in the cyst wall were scored.

RESULTS:

NK cell content and volume 1 were not different between the 2 groups. Volume 2, cyst weight, and GT and ST contents in group Dex were significantly lower than those in group Con.

CONCLUSION:

Dexketoprofen trometamol significantly reduced the development of experimentally induced endometriotic cysts both macroscopically and microscopically.

 

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