Gynecol Obstet Invest. 2013;76(1):10-3. doi: 10.1159/000348520. Epub 2013 Mar 13.

 

The British society for gynaecological endoscopy endometriosis centres project.

Saridogan E1Byrne D.

 

Abstract

Management of advanced endometriosis frequently requires a multidisciplinary team approach and international guidelines suggest treatment in centres of expertise. Due to variability of published outcome data, prospective data collection and standardisation of reporting systems have been suggested to improve our understanding of surgical outcomes. The British Society for Gynaecological Endoscopy (BSGE) Endometriosis Centres were established to manage rectovaginal endometriosis, to collect treatment and outcome data, and to provide these data to patients, clinicians and healthcare commissioners. The BSGE Endometriosis Centres Project works on the principle of voluntary participation. Centres that would like to be recognised or accredited as a BSGE Endometriosis Centre need to fulfil a number of basic requirements including working in appropriate multidisciplinary clinical teams, auditing their outcome and having sufficient workload to maintain their surgical skills. The project has already had an impact on where the patients with advanced endometriosis are treated in the United Kingdom. Patients and healthcare professionals are becoming aware of their presence and more patients with the condition are being referred to these centres. It is also expected that the accredited centre status would be required for funding by healthcare commissioners for this type endometriosis.

 

 

Mucosal Immunol. 2013 May;6(3):439-50. doi: 10.1038/mi.2013.9. Epub 2013 Mar 13.

The role of lipoxin A4 in endometrial biology and endometriosis.

Canny GO1Lessey BA.

 

Abstract

Lipoxin A4 (LXA4), an endogenous anti-inflammatory and immunomodulatory mediator studied in many disease states, is recently appreciated as a potentially significant player in the endometrium. This eicosanoid, synthesized from arachidonic acid via the action of lipoxygenase enzymes, is likely regulated in endometrial tissue during the menstrual cycle. Recent studies revealed that LXA4 acts as an estrogen receptor agonist in endometrial epithelial cells, antagonizing some estrogen-mediated activities in a manner similar to the weak estrogen estriol, with which it shares structural similarity. LXA4 may also be an anti-inflammatory molecule in the endometrium, though its precise function in various physiological and pathological scenarios remains to be determined. The expression patterns for LXA4 and its receptor in the female reproductive tract suggest a role in pregnancy. The present review provides an oversight of its known and putative roles in the context of immuno-endocrine crosstalk. Endometriosis, a common inflammatory condition and a major cause of infertility and pain, is currently treated by surgery or anti-hormone therapies that are contraceptive and associated with undesirable side effects. LXA4 may represent a potential therapeutic and further research to elucidate its function in endometrial tissue and the peritoneal cavity will undoubtedly provide valuable insights.

 

 

 

Minerva Ginecol. 2013 Mar 13. [Epub ahead of print] Italian.

Administration of MICRONIZED PALMITOYLETHANOLAMIDE (PEA)-transpolydatin in the treatment of chronic pelvic pain in women affected by endometriosis: preliminary results.

Lo Monte G1Soave IMarci R.

 

Abstract

Aim: Aim of the study was to evaluate the effectiveness of micronized palmitoylethanolamide (PEA)-transpolydatin in the treatment of chronic pelvic pain in women affected by endometriosis. Methods: Twenty-four patients with suspected endometriosis affected by severe pelvic pain were enrolled. All patients received two tablets a day of PEA 400 mg and 40 mg polydatin for 90 days consecutively. A Visual Analogic Scale was used for the assessment of the severity of global pain, dysmenorrhea, dyspareunia, dysuria and dischezia. A second questionnaire was submitted to patients to assess the quality of life. The compilation of a diary lead us to evaluate the monthly assumption of any painkillers. Patients were evaluated at the begin of the treatment and then monthly until the end of the study (90 days). The statistical analysis was performed by using the ANOVA for the analysis of variance. Results: Statistically significant results were found in relation to pelvic pain, dysmenorrhea and dyspareunia compared to the initial evaluation of patients. Results related to dysuria and dischezia were not statistically significant (P>0.05). The decrease in pelvic pain leads to an improvement of the quality of life of patients. A decreased assumption of nonsteroidal anti-inflammatory drugs (NSAIDs) was also observed. Conclusion: PEA could be considered an effective supplement to conventional analgesic therapies in the management of pelvic pain related to endometriosis.

 

 

 

 

Ginekol Pol. 2012 Dec;83(12):934-8.

Robotic surgery in gynecology.

Hibner M1Marianowski PSzymusik IWielgós M.

 

Abstract

Introduction of robotic surgery in the first decade of the 21 century was one of the biggest breakthroughs in surgery since the introduction of anesthesia. For the first time in history the surgeon was placed remotely from the patient and was able to operate with the device that has more degrees of freedom than human hand. Initially developed for the US Military in order to allow surgeons to be removed from the battlefield, surgical robots quickly made a leap to the mainstream medicine. One of the first surgical uses for the robot was cardiac surgery but it is urology and prostate surgery that gave it a widespread popularity Gynecologic surgeons caught on very quickly and it is estimated that 31% of hysterectomies done in the United States in 2012 will be done robotically. With over half a million hysterectomies done each year in the US alone, gynecologic surgery is one of the main driving forces behind the growth of robotic surgery Other applications in gynecology include myomectomy oophorectomy and ovarian cystectomy resection of endometriosis and lymphadenectomy Advantages of the surgical robot are clearly seen in myomectomy The wrist motion allows for better more precise suturing than conventional “straight stick” laparoscopy The strength of the arms allow for better pulling of the suture and the third arm for holding the suture on tension. Other advantage of the robot is scaling of the movements when big movement on the outside translates to very fine movement on the inside. This enables much more precise surgery and may be important in the procedures like tubal anastomosis and implantation of the ureter Three-dimensional vision provides excellent depth of field perception. It is important for surgeons who are switching from open surgeries and preliminary evidence shows that it may allow for better identification of lesions like endometriosis. Another big advantage of robotics is that the surgeon sits comfortably with his/her arms and head supported. This results in much less fatigue and therefore increases precision and potentially may decrease the number of medical errors. The eyes of the surgeon are directed at where the hands should be, which is more natural, allows for a more natural body position and mimics open surgery Robot also enables better teaching, especially when two consoles are used. The surgeon and the student may be either sharing the instruments with two consoles or switching between one another. In a situation where the student operates, the surgeon can use the telestation to teach. Robotic simulator attached to one of the consoles allows students to practice after hours. In summary surgical robot is a great tool, especially in gynecology but also in urology cardiac surgery general surgery and laryngology The device will evolve and most likely with time will eliminate laparoscopy

 

 

 

Ginekol Pol. 2012 Dec;83(12):950-2.

Application of levonorgestrel-releasing intrauterine system in early pregnancy: a case report.

Gardyszewska A1Czajkowski K.

 

Abstract

Intrauterine device is a popular cost-effective method of contraception known worldwide. It is extremely effective, with pregnancy rates comparable to tubal ligation (5-year cumulative rate varying from 0.5 to 1.1). LNG-IUS increases in popularity and may be used as the method of choice for adults because it offers non-contraceptive benefits: slight menstrual bleeding, decreased number of incidents of dysmenorrhea, and reduced pain associated with endometriosis. The levonorgestrel-releasing intrauterine system (LNG-IUS) provides a release rate of 20 microg/24 h of levonorgestrel. The hormone released from the intrauterine device causes some systemic changes, however local effects, such as glandular atrophy and stromal decidualization, in addition to foreign body reaction, are dominant. According to the Food and Drug Administration regulations, category X was assigned to LNG. The use of the product is contraindicated in women who are or may become pregnant. We report a case of a 30-year old woman who has already been pregnant before the insertion of a levonorgestrel -releasing intrauterine system (LNG-IUS). The patient was lactating after the previous pregnancy the first menstruation had not appeared yet. The patient planned to have the IUD inserted but she missed her appointed visits twice. The third visit took place 8 weeks postpartum. During that visit, the doctor asked her about the possibility of being pregnant, but the patient denied. The gynecologist inserted the intrauterine device and performed transvaginal ultrasound examination. The location of LNG-IUS was proper and there was no gestation sac in the uterine cavity. After the next six weeks, transvaginal ultrasonography and manual examination showed an intrauterine pregnancy at 8 weeks of gestation. The intrauterine device was not detectable in the uterine cavity by ultrasound, and the IUD strings were not visualized in the vagina. It was impossible to remove the device without causing miscarriage. Other risks during pregnancy were connected with potential masculinisation of the fetus by levonorgestrel, premature delivery and preterm rupture of the membranes. The pregnancy progressed normally and the delivery was uncomplicated. A female infant was born without congenital abnormalities. The pediatrician did not find any indices of infection. The IUD was found in fetal membranes. The postpartum recovery was uneventful. This case report demonstrates that a healthy infant can be delivered at term with an IUS in situ, probably without causing any abnormalities. Due to that fact that adverse effects of fetal exposure to the LNG-IUS have not been yet established, the exclusion of pregnancy before IUD insertion is strictly indicated.

 

 

 

Ginekol Pol. 2013 Jan;84(1):62-4.

The role of iron metabolism and oxidative stress in the pathogenesis of endometriosis.

Polak G1Wertel IKwaśniewski WDerewianka-Polak MKotarski J.

 

Abstract

Despite many years of extensive investigations and increasing number of studies, the pathogenesis of endometriosis remains unclear Accumulated data suggests that disrupted iron metabolism may induce oxidative stress in the peritoneal cavity of endometriosis patients.

 

 

 

Acta Obstet Gynecol Scand. 2013 May;92(5):598-600. doi: 10.1111/aogs.12102. Epub 2013 Mar 12.

Well-leg compartment syndrome after gynecological laparoscopic surgery.

Boesgaard-Kjer DH1Boesgaard-Kjer DKjer JJ.

 

Abstract

Well-leg compartment syndrome in the lower extremities after surgery in the lithotomy position is a rare but severe complication requiring early diagnosis and intervention. Several circumstances predispose to this condition as a consequence of increased intra-compartmental pressure, such as positioning of the legs during operation (lithotomy and Lloyd-Davies positions), a prolonged operation, external compression and vascular insults, both pre- and intra-operatively. To prevent well-leg compartment syndrome it is important to improve knowledge of the condition among surgeons and nursing staff. Potential risk factors and preventive initiatives are listed to reduce the risk in future patients. We describe two patients who underwent gynecologic laparoscopic surgery and postoperatively developed well-leg compartment syndrome.

 

 

Fertil Steril. 2013 Jun;99(7):1980-6.e9. doi: 10.1016/j.fertnstert.2013.02.021. Epub 2013 Mar 13.

Mitochondrial displacement loop alterations are associated with endometriosis.

Govatati S1Deenadayal MShivaji SBhanoori M.

Abstract

OBJECTIVE:

To evaluate the association of mitochondrial displacement (D-) loop alterations with endometriosisin south Indian women.

DESIGN:

Case-control study.

SETTING:

Biochemistry and molecular biology laboratories.

PATIENT(S):

Women with (n = 152) and without (n = 150) endometriosis of south Indian origin.

INTERVENTION(S):

All women had a transvaginal ultrasound scan at screening followed by a laparoscopy to confirm the diagnosis (revised American Fertility Society stage III = 54; stage IV = 98).

MAIN OUTCOME MEASURE(S):

Genotyping of entire D-loop (1,124 bp) was carried out on genomic DNA of blood from cases and controls by polymerase chain reaction sequencing analysis.

RESULT(S):

Twelve novel mutations and 187 reported polymorphisms were identified in the D-loop region of cases and/or controls. The A189G, 310 C insertion, T16189C polymorphisms, and 189G/310TC/16189C haplotype have significantly higher frequency in cases compared with controls.

CONCLUSION(S):

Mitochondrial D-loop alterations may constitute an inheritable risk factor for endometriosis. The analysis of D-loop alterations may help to identify patients at high risk for disease outcome.

 

 

 

Gynecol Obstet Fertil. 2013 Mar;41(3):179-83. doi: 10.1016/j.gyobfe.2013.01.004. Epub 2013 Mar 11.

Uterosacral ligament and hypogastric nerve anatomical relationship. Application to deep endometriotic nodules surgery.

Azaïs H1Collinet PDelmas VRubod C.

 

Abstract

Endometriosis is a concern for 10 to 15% of women of childbearing age. The uterosacral ligament is the most frequent localization of deep infiltrating endometriosis. Laparoscopic excision of endometriotic nodules may lead to functional consequences due to potential hypogastric nerve lesion. Our aim is to study the anatomical relationship between the hypogastric nerve and the uterosacral ligament in order to reduce the occurrence of such nerve lesions during pelvic surgeries. We based our study on an anatomical and surgical literature review and on the anatomical dissection of a 56-year-old fresh female subject. The hypogastric nerves cross the uterosacral ligament approximately 30mm from the torus. They go through the pararectal space, 20mm below the ureter and join the inferior hypogastric plexus at the level of the intersection between the ureter and the posterior wall of the uterine artery, at approximately 20mm from the torus. No anatomical variation has been described to date in the path of the nerve, but in its presentation which may be polymorphous. Laparoscopy and robot-assisted laparoscopic surgery facilitate the pelvic nerves visualization and are the best approach for uterosacral endometriotic nodule nerve-sparing excision. Precise knowledge by the surgeon of the anatomical relationship between the hypogastric nerve and the uterosacral ligament is essential in order to decrease the risk of complication and postoperative morbidity for patient surgically treated for deep infiltrating endometriosis involving uterosacral ligament.

 

 

 

J Obstet Gynaecol Res. 2013 May;39(5):1095-7. doi: 10.1111/jog.12003. Epub 2013 Mar 17.

Endometriosis of the perineum.

Nasu K1Okamoto MNishida MNarahara H.

 

Abstract

Endometriosis of the perineum and vulva is extremely rare, with the most common site being episiotomy scars. We report here a case of spontaneously developing perineal endometriosis successfully treated with local excision. A 39-year-old woman was admitted complaining of a painful vulvar lump with cyclic swelling. She had first noticed the mass 7 years before, and it had gradually increased in size. Gynecological examination showed a walnut-size, painful, subcutaneous mass in the left perineum. Magnetic resonance imaging revealed a multilobular cystic mass with inner hemorrhage, suggesting vulvar endometriosis. The patient was treated by local excision of the vulvar mass, and complete excision was achieved. The pathological diagnosis of the excised tissue was endometriosis. The patient is well without evidence of disease 5 months following the local excision. Spontaneous perineal and vulvar endometriosis is extremely rare. However, any lesion that evolves in response to the menstrual cycle should be considered endometriosis.

 

 

 

Gynecol Obstet Fertil. 2013 Mar;41(3):149-55. doi: 10.1016/j.gyobfe.2013.01.005. Epub 2013 Mar 13.

Infected hematoma of Douglas pouch: a specific complication of the surgical excision of deep endometriosis involving the vagina.

Sanguin S1Roman HVassilieff MBridoux VDa Costa CMartin CMarpeau LPuscasiu L.

Abstract

OBJECTIVE:

Surgical management of deep pelvic endometriosis may be responsible for various complications, such as infected pelvic haematic collection of the Douglas pouch. The aim of this study is to describe this unfavourable outcome and to estimate its frequency in the series of women managed by our team.

PATIENTS AND METHODS:

Retrospective study enrolling 163 women undergoing surgical removal of deep posterior endometriosis involving the vagina, from January 2008 to September 2011. We indentified women presenting with postoperative fever associated with computed tomographic findings suggesting an abscess of the Douglas pouch. Women characteristics, complication’s management and outcomes were analysed in each case.

RESULTS:

Ten patients presented an inflammatory syndrome associated to hypothetical Douglas pouch abscess, revealed 6 days postoperatively on average. All women reported increasing pelvic pain, fever higher than 38.5°C, increased level of leucocytes and C reactive protein, and liquid collection of the Douglas pouch. Surgical management was carried out in nine women, revealing a pelvic collection of cloudy haematic liquid. Various bacteria were identified in six cases out of nine, suggesting liquid contamination through vagina opening. Postoperative outcome were immediately favourable.

DISCUSSION AND CONCLUSION:

Inflammatory syndrome associated with infected haematic collection of the Douglas pouch is a postoperative complication of the surgical removal of deep endometriosis involving the posterior vagina. Surgical removal of the haematic collection allows rapid and definitive favourable outcomes.

 

 

 

 

 

 

Mol Cell Endocrinol. 2013 May 6;370(1-2):138-48. doi: 10.1016/j.mce.2013.02.016. Epub 2013 Mar 14.

The genetic basis of female reproductive disorders: etiology and clinical testing.

Layman LC1.

 

Abstract

With the advent of improved molecular biology techniques, the genetic basis of an increasing number of reproductive disorders has been elucidated. Mutations in at least 20 genes cause hypogonadotropic hypogonadism including Kallmann syndrome in about 35-40% of patients. The two most commonly involved genes are FGFR1 and CHD7. When combined pituitary hormone deficiency includes hypogonadotropic hypogonadism as a feature, PROP1 mutations are the most common of the six genes involved. For hypergonadotropic hypogonadism, mutations in 14 genes cause gonadal failure in 15% of affected females, most commonly in FMR1. In eugonadal disorders, activating FSHR mutations have been identified for spontaneous ovarian hyperstimulation syndrome; and WNT4 mutations have been described in mullerian aplasia. For other eugonadal disorders, such as endometriosis, polycystic ovary syndrome, and leiomyomata, specific germline gene mutations have not been identified, but some chromosomal regions are associated with the corresponding phenotype. Practical genetic testing is possible to perform in both hypogonadotropic and hypergonadotropic hypogonadism and spontaneous ovarian hyperstimulation syndrome. However, clinical testing for endometriosis, polycystic ovary syndrome, and leiomyomata is not currently practical for the clinician.

 

 

 

Am J Obstet Gynecol. 2013 May;208(5):e1-2. doi: 10.1016/j.ajog.2013.03.014. Epub 2013 Mar 15.

Discussion: ‘Ovarian epithelial carcinoma with pelvic endometriosis,’ by Wang et al.

Van Le L1Jackson ASchuler KSuri ADoll KStine JKim K.

 

Abstract

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Wang S, Qui L, Lang JH, et al. Clinical analysis of ovarian epithelial carcinoma with coexisting pelvic endometriosis.

 

 

 

 

Am J Obstet Gynecol. 2013 Oct;209(4):307-16. doi: 10.1016/j.ajog.2013.03.009. Epub 2013 Mar 15.

Endometriosis: a life cycle approach?

Brosens I1Puttemans PBenagiano G.

 

Abstract

To improve the still fragmented understanding of endometriosis, a life cycle approach was adopted that revealed unexpected aspects of the natural history of the disease throughout a woman’s life. Three age-related stages of endometriosis are distinguished. In premenarcheal and adolescent endometriosis, 2 types can be distinguished: a classic form that can occur before menarche, and a congenital obstructive form that is caused by uterine anomaly and outflow obstruction. The lesions include superficial peritoneal implants, but adhesions and endometrioma can also occur. It is suggested that premenarcheal and possibly adolescent endometriosis develop by activation of resting stem cells shed at the time of neonatal retrograde uterine bleeding. In the adult, endometriosis can be related to uterine preconditioning by cyclic menstruations acting as a priming mechanism for deep placentation. In adult life, the typical lesions are peritoneal, ovarian, and deep or adenomyotic endometriosis. More recently, endometriosis has been associated with endometrial dysfunction and myometrial junctional zone hyperplasia. These uterine changes can be linked with some major obstetrical syndromes. In postmenopause, endometriosis can develop or be reactivated both in the presence or absence of exogenous estrogens and can spread to a variety of organs and structures causing constrictive lesions.

 

 

 

Arch Gynecol Obstet. 2013 Sep;288(3):569-76. doi: 10.1007/s00404-013-2793-0. Epub 2013 Mar 17.

Costs of endometriosis in Austria: a survey of direct and indirect costs.

Prast J1Oppelt PShamiyeh AShebl OBrandes IHaas D.

Abstract

PURPOSE:

The literature includes a wealth of medical data on endometriosis, but the economic significance of the condition has so far been neglected. An analysis of hospital costs for endometriosis in Austria was, therefore, carried out for economic purposes.

METHODS:

Seventy-three patients with endometriosis were included in the study. A bottom-up approach was used to collect data on the average hospital costs of an endometriosis patient over a time period of 1 year. In addition, a prevalence approach was used that allows subsequent estimation of the total costs of endometriosisfor the health-care system in Austria for that period. Retrospective questionnaire survey was conducted.

RESULTS:

The average annual costs of one case of endometriosis are <euro>7,712, with <euro>5,605.55 attributable to direct costs and <euro>2,106.34 to indirect costs. This indicates an overall economic burden of <euro>328 million. In-patient care (45 %) and loss of productivity (27 %) were identified as the major cost factors. The patients themselves pay for 13 % of the costs (through out-of-pocket payments).

CONCLUSIONS:

This study impressively demonstrates the financial burden on the economy and on each individually affected patient caused by the disease of endometriosis. The massive consumption of resources represents a high level of usage of the medical services provided. The question arises as to whether more timely diagnosis, followed by better-targeted treatment, might have the potential to reduce these costs. The overall economic burden of endometriosis in Austria is currently comparable with that of Parkinson’s disease.

 

 

 

Cell Biol Int. 2013 Aug;37(8):799-804. doi: 10.1002/cbin.10093. Epub 2013 Apr 11.

Silencing Cofilin-1 blocks PDGF-induced proliferation in eutopic endometrium of endometriosis patients.

Wang DB1Xu YLChen PChen YHLi Y.

Author information

Abstract

Platelet-derived growth factor (PDGF) is well known to induce proliferation in variety of cells. The aim of this study was to investigate whether there is a correlation between the expression of Cofilin-1 (CFL1) and the proliferation of eutopic endometrium stromal cells (ESC) in response to PDGF stimulation. Results show that PDGF induced the expression of CFL1 in ESC and promoted proliferation of ESC significantly in a time- or dose-dependent manner. After silencing CFL1, the effect of PDGF on promoting ESC proliferation was significantly decreased. These data demonstrate that PDGF can induce CFL1 expression in ESC. Silencing CFL1 blocks PDGF-induced proliferation in ESC.

 

 

 

 

Acta Obstet Gynecol Scand. 2013 May;92(5):491-5. doi: 10.1111/aogs.12121. Epub 2013 Mar 19.

Endometriosis in adolescence: predictive markers and management.

Steenberg CK1Tanbo TGQvigstad E.

 

Abstract

Endometriosis has long been thought mostly to affect the adult female population. However, awareness of possible endometriosis already in adolescence is now receiving increasing attention. It seems that certain markers in adolescence are associated with a subsequent diagnosis of the disease. These include chronic pelvic pain, severe dysmenorrhea, dysmenorrhea resistant to non-steroidal anti-inflammatory drugs and oral contraceptive pills, and pain interfering with daily activity. Based on current knowledge, it should be possible to diagnose endometriosis before adulthood, thereby alleviating symptoms and possibly limiting sequelae. To do so, knowledge of adolescent endometriosis has to be improved among both health professionals and the public.

 

 

 

Urology. 2013 Jun;81(6):e35. doi: 10.1016/j.urology.2013.02.008. Epub 2013 Mar 16.

The iatrogenic ureterovaginal fistula.

McAchran SE1Paolone DR.

 

Abstract

A 46-year-old woman underwent a robotic-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy for the treatment of endometriosis. Two weeks postoperatively, she presented with pelvic pain and vaginal drainage. A right ureterovaginal fistula was diagnosed with the assistance of computed tomography (CT) urography and nephrostogram.

 

 

 

J Pediatr Adolesc Gynecol. 2013 Jun;26(3):171-5. doi: 10.1016/j.jpag.2012.12.006. Epub 2013 Mar 16.

Prevalence of pain syndromes, mood conditions, and asthma in adolescents and young women with endometriosis.

Smorgick N1Marsh CAAs-Sanie SSmith YRQuint EH.

Abstract

STUDY OBJECTIVE:

Adult women with endometriosis are often diagnosed with comorbid pain, mood, and autoimmune conditions. This study aims to describe the occurrence of pain syndromes, mood conditions, and asthma in adolescents and young women with endometriosis evaluated at our medical center.

DESIGN:

Retrospective review of medical records.

SETTING:

Department of Obstetrics and Gynecology at a tertiary referral center.

PARTICIPANTS:

138 adolescents/young women who were less than age 24 years at the time of their initial visit at our medical center, and whose surgical diagnosis of endometriosis was made at our institution or by outside institutions by the age of 21.

INTERVENTIONS:

None.

MAIN OUTCOME MEASURES:

Prevalence of comorbid pain syndromes (defined as interstitial cystitis, irritable bowel syndrome, chronic headaches, chronic low back pain, vulvodynia, fibromyalgia, temporomandibular joint disease, and chronic fatigue syndrome), mood conditions (defined as depression and anxiety), and asthma.

RESULTS:

Comorbid pain syndromes were found in 77 (56%) women, mood conditions in 66 (48%) women, and asthma in 31 (26%) women. Comparing endometriosis patients with and without comorbid pain syndromes, no differences were found in age at time of diagnosis, endometriosis symptoms, and endometriosis stage. Patients with comorbid pain syndromes were more likely to report mood conditions (62% vs 30% respectively, P < .001) and smoking (31% vs 10% respectively, P = .003), underwent more surgeries for endometriosis (median of 2 [range, 1-7] vs 1 [range, 1-5], P < .005), and were more likely to undergo appendectomy or cholecystectomy (30% vs 13%, P = .02).

CONCLUSIONS:

Comorbid pain syndromes, mood conditions and asthma are common in adolescents and young women with endometriosis.

 

 

 

Biomed Res Int. 2013;2013:682326. doi: 10.1155/2013/682326. Epub 2013 Feb 13.

Very small embryonic-like stem cells: implications in reproductive biology.

Bhartiya D1Unni SParte SAnand S.

 

Abstract

The most primitive germ cells in adult mammalian testis are the spermatogonial stem cells (SSCs) whereas primordial follicles (PFs) are considered the fundamental functional unit in ovary. However, this central dogma has recently been modified with the identification of a novel population of very small embryonic-like stem cells (VSELs) in the adult mammalian gonads. These stem cells are more primitive to SSCs and are also implicated during postnatal ovarian neo-oogenesis and primordial follicle assembly. VSELs are pluripotent in nature and characterized by nuclear Oct-4A, cell surface SSEA-4, and other pluripotent markers like Nanog, Sox2, and TERT. VSELs are considered to be the descendants of epiblast stem cells and possibly the primordial germ cells that persist into adulthood and undergo asymmetric cell division to replenish the gonadal germ cells throughout life. Elucidation of their role during infertility, endometrial repair, superovulation, and pathogenesis of various reproductive diseases like PCOS, endometriosis, cancer, and so on needs to be addressed. Hence, a detailed review of current understanding of VSEL biology is pertinent, which will hopefully open up new avenues for research to better understand various reproductive processes and cancers. It will also be relevant for future regenerative medicine, translational research, and clinical applications in human reproduction.

 

 

 

Diagn Cytopathol. 2013 Mar 20. doi: 10.1002/dc..

Morphologic features of endometriosis in various types of cytologic specimens.

Barkan GA1Naylor BGattuso PKüllü SGalan KWojcik EM.

 

Abstract

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. This study evaluates the cytomorphologic features of endometriosis in various cytologic specimen types [fine-needle aspiration (FNA), effusion cytology (EF), touch imprint (ToP), and cervical smear (PAP)], and assesses the key elements helpful in recognizing this lesion. A total of 18 cases (8 FNA, 4 EF, 5 ToP, and 1 PAP) of cytologically diagnosed and histologically/clinically confirmed endometriosis diagnosed between 1988 and 2006 comprises the material for this study. The morphologic features evaluated of the three components included: cellularity, presence of sheets of glandular cells, three-dimensional (3D) glandular clusters, tubular structures, single cells, syncytial groups of stromal cells, stromal cells entrapped within basement membrane (BM)-like material, cytologic atypia, presence of mitotic figures, and hemosiderin-laden histiocytes. Endometrial glands, stroma, and hemosiderin-laden histiocytes were all identified in 14/18 (77.8%) cases. FNA specimens were more cellular than that of both EF and ToP specimens. Tubular structures, 3D glandular clusters, stromal cells entrapped in BM and syncytial stromal groups were more common in FNAs, and ToPs compared with the EFs. The ratio of the endometrial glandular and stromal cells was similar in all specimen types. Atypia and mitotic figures were rarely encountered. Diagnosis of endometriosis could be made independently on either smears/ThinPrep slides or on cell blocks in all cases where these preparations were available. On follow up, none of the patients developed malignancy. Endometriosis can be reliably and safely diagnosed in various cytologic materials. Cytologic atypia is uncommon. Components of endometriosis could show minor morphologic alterations in different specimen types. Diagn. Cytopathol. 2013. © 2013 Wiley Periodicals, Inc.

 

 

 

Ginecol Obstet Mex. 2013 Jan;81(1):57-9.

Chronic pelvic pain and cervical endometriosis after a subtotal hysterectomy.

Acosta Martínez M1Zamora Escudero RGarcía-Benítez CQVieyra Cortés EA.

 

Abstract

The ectopic location of endometrial glands and stroma may cause the formation of a tumor known as endometrioma. It almost always occurs in the ovary, and due to its characteristic appearance has been called “chocolate cyst”. Cervical localization of this disease is extremely rare, and when it occurs, tends to be an exocervical and/or endocervical injury, as a result of cervical procedures. We communicate the case of a patient with cystic endometriosis in the cervix after a subtotal abdominal hysterectomy, performed by obstetric hemorrhage. Even though there have been reports about cases of cervical endometriosis, most of them have been reported as superficial cervical endometriosis and as a discovery after a total hysterectomy or cervical biopsy, in some cases even with original diagnosis ofAGUS (atypical glandular cells of undetermined significance). We concluded that in this case, instrumented uterine curettage and subtotal hysterectomy by obstetric indication are a possible origin of cervical endometriosis, due to “seeding” endometrial tissue during the curettage in a friable cervix.

 

 

Med Hypotheses. 2013 Jun;80(6):709-10. doi: 10.1016/j.mehy.2013.02.016. Epub 2013 Mar 19.

Regional treatment with liquid barrier agents: a novel therapeutic option for intraperitoneal endometriosis?

Laschke MW1Rudzitis-Auth JMenger MD.

 

Abstract

Endometriosis is a frequent gynecological disease, which is characterized by the presence of endometriotic lesions, i.e. ectopic endometrial glands and stroma, outside the uterine cavity. Most of these lesions are located in the peritoneal cavity, where they induce a chronic inflammatory and angiogenic tissue response. This is often associated with the formation of peritoneal adhesions. Accordingly, endometriosis is crucially dependent on the close interaction of the ectopic endometrial tissue with the peritoneum and the peritoneal fluid. Therefore, we hypothesize in the present paper that regional treatment of endometriosis, selectively targeting the peritoneal microenvironment without inducing severe systemic side effects, may represent a promising novel treatment strategy. This may be achieved by the application of liquid barrier agents, which are already well established in clinical practice for peritoneal dialysis, treatment of peritoneal surface malignancies and prevention of postoperative adhesions. Of interest, some of these agents have been shown to exhibit anti-inflammatory, anti-oxidant and anti-tumoral properties. Thus, they may act as pleiotropic compounds, affecting multiple mechanisms, which are involved in the pathogenesis of endometriosis.

 

 

Fertil Steril. 2013 Jun;99(7):1987-93. doi: 10.1016/j.fertnstert.2013.02.038. Epub 2013 Mar 18.

Transcriptional changes in the expression of chemokines related to natural killer and T-regulatory cells in patients with deep infiltrative endometriosis.

Bellelis P1Barbeiro DFRizzo LVBaracat ECAbrão MSPodgaec S.

Abstract

OBJECTIVE:

To evaluate the expression of chemokines that regulate natural killer (NK) and T-regulatory (T-reg) cell activity in eutopic and ectopic endometrial tissue samples from endometriosis patients.

DESIGN:

Case-control study (Canadian Task Force classification II-2).

SETTING:

Tertiary referral hospital.

PATIENT(S):

Sixty-four consecutive patients with and without endometriosis.

INTERVENTION(S):

After videolaparoscopy, patients were divided into three groups: bowel endometriosis (n = 22), retrocervical endometriosis (n = 10), and endometriosis-free women (n = 32).

MAIN OUTCOME MEASURE(S):

Gene expression of the chemokines that regulate NK (CXCL9, CXCL10, CXCL11, CXCL12, XCL1, and CX3CL1) and T-reg cell activity (CCL17 and CCL21) evaluated by real-time polymerase chain reaction.

RESULT(S):

Of the chemokines associated with NK cells, CX3CL1 and CXCL12 expression was statistically significantly greater in the foci of endometriosis compared with the eutopic endometrium in patients and controls. From the chemokines associated with T-reg cells, CCL17 expression was statistically significantly greater in the eutopic endometrium of the patients with rectosigmoid endometriosis compared with the foci of endometriosis or eutopic endometrium of the patients with retrocervical endometriosis or the disease-free women.

CONCLUSION(S):

Both T-reg and NK cells mediate inflammatory response and may play a fundamental role in endometriosis by causing an impaired clearing of endometrial cells. Establishing how CCL17, CXCL12, and CX3CL1 modulate this response is essential to understanding inflammatory responses in endometriosis.

 

 

J Pediatr Adolesc Gynecol. 2013 Apr;26(2):120-4. doi: 10.1016/j.jpag.2012.11.002.

Use of the levonorgestrel intrauterine system in adolescents with endometriosis.

Yoost J1LaJoie ASHertweck PLoveless M.

Abstract

STUDY OBJECTIVE:

The purpose of this study was to evaluate our adolescent patient population who had received a levonorgestrel intrauterine system (LNG-IUS) at or after the time of endometriosis diagnosis, and determine efficacy of the LNG-IUS in regards to pain and bleeding on follow-up exam.

DESIGN:

Retrospective cohort study.

SETTING:

Pediatric Adolescent Gynecology Clinic and Children’s Hospital in a metropolitan area.

PARTICIPANTS:

Adolescent patients age 14-22 with pathology-proven endometriosis who had the LNG-IUS placed during the course of their treatment for this disease. Patients were divided into LNG-IUS placement at the time of surgical diagnosis versus placement some time after diagnosis.

MAIN OUTCOME MEASURES:

Pain and bleeding were assessed by follow-up exam. Pain was classified at each follow-up visit as either none, minimal, moderate, or severe. Bleeding was classified as none, irregular spotting, irregular bleeding, or daily bleeding.

RESULTS:

The majority of patients (67%) required additional hormonal therapy for pain and bleeding suppression. Time to bleeding suppression and pain suppression was sooner in the group with interval time between surgical diagnosis and LNG-IUS placement, compared to LNG-IUS placement at the time of surgery (2.4 months vs 5.3 months until bleeding suppression, and 3.8 months vs 4.8 months until pain suppression), although statistical significance was not achieved.

CONCLUSIONS:

The LNG-IUS is an option for treatment of endometriosis in adolescents. As pain is the main problem associated with endometriosis, LNG-IUS placement is beneficial at the time of surgery when it is diagnosed. A prospective study is needed for further assessment of outcomes.

 

 

 

J Pediatr Adolesc Gynecol. 2013 Jun;26(3):176-9. doi: 10.1016/j.jpag.2013.01.062. Epub 2013 Mar 19.

Endometriomas in adolescents and young women.

Özyer S1Uzunlar ÖÖzcan NYeşilyurt HKarayalçin RSargin AMollamahmutoğlu L.

Abstract

STUDY OBJECTIVE:

To evaluate clinical aspects of endometriomas encountered in late adolescent females and young women and to review the issues specifically related to the disease in this age group.

DESIGN:

Retrospective medical chart review study.

SETTING:

Adolescent gynecology and infertility clinic of a tertiary care hospital with women’s health focus.

PARTICIPANTS:

Sixty-three late adolescent females and young women aged ≤ 24 years with endometrioma.

INTERVENTIONS:

Operative laparoscopy for endometriomas.

MAIN OUTCOME MEASURES:

Baseline clinical characteristics of the patients including age, marital status, body mass index, symptoms on admission, family history of endometriosis, past medical history, CA-125 levels, presence of a müllerian anomaly, endometriosis characteristics at the time of surgery, and correlation between ASRM scores and patient characteristics.

RESULTS:

The mean age and body mass index of the patients were 22 ± 2 (range 17-24) years and 20.8 ± 2.6 (range 16.6-28.5) kg/m(2) respectively. Chronic pelvic pain was the most common symptom (44%). Two patients had a diagnosis of genital malformation. Forty-one (65%) patients had endometrioma on the right ovary, and 14 (22%) patients had bilateral endometriomas. Only one patient had posterior cul-de-sac completely obliterated. Fifty-five (87%) patients had score <16 points for adnexal adhesions calculated according to the revised American Society for Reproductive Medicine classification.

CONCLUSION:

Endometriomas, although rare, can be encountered in adolescents and young women. The disease in adolescent patient group offers particular importance since early intervention is essential in order to decrease pain, prevent progression of the disease and enhance future fertility.

 

 

Ceska Gynekol. 2012 Dec;77(6):566-71.

The structural basis for transport through the Fallopian tube.

Kajanová M1L DS PMiko MUrban LBokor TVarga I.

 

Abstract

The Fallopian tube has until recently been a neglected structure, bypassed by in vitro fertilization and seen only as a tube that transports the oocyte or early embryo to the uterus. More recently, its role is even more undervalued after the introduction of techniques of assisted reproduction, in which the Fallopian tubes become like unnecessary. The Fallopian tube performs several important functions. It captures the oocyte after ovulation, maintains and controls the migration of spermatozoa to the site of fertilization. It provides the special microenvironment for fertilization; nourishes the early embryo while it is being carried to the uterus and amplifies signals from embryo to the mother. In our article we conducted a systematic review of relevant articles found in PubMed, Scopus and ISI Web of Knowledge, focused on the new insights into the functional morphology of Fallopian tube. We described the possible function of muscle layer motility, ciliary activity and tubal fluid movement on transport of gamets / embryo, as well as we mentioned the negative factors (such as smoking, chlamydial infection or endometriosis) affecting the transport through the Fallopian tube.

 

Cir Cir. 2013 Mar-Apr;81(2):163-8.

Endometriosis as a risk factor for ovarian cancer.

Vargas-Hernández VM1.

 

Abstract

A history of endometriosis is a risk factor for some subtypes of epithelial ovarian cancer. Endometriosis is associated with increased risk of ovarian clear cell, serous low-grade endometrioid cancer, but it is unclear what the role of endometriosis is in the development of other histopathological subtypes of ovarian cancer, such as high-grade serous borderline tumors subtypes or borderline serous and mucinous cancers. An understanding of the mechanisms leading to malignant transformation of endometriosis will be needed to identify subgroups of women at increased risk of ovarian cancer. This is important because of their high prevalence and cause of infertility in Mexico and the world. All factors must be considered during the decision-making process for the treatment of endometriosis, including the rare malignant transformation.

 

 

Hum Reprod. 2013 Jun;28(6):1552-68. doi: 10.1093/humrep/det050. Epub 2013 Mar 25.

Consensus on current management of endometriosis.

Johnson NP1Hummelshoj LWorld Endometriosis Society Montpellier Consortium.

Collaborators (55)

Abstract

STUDY QUESTION:

Is there a global consensus on the management of endometriosis that considers the views of women with endometriosis?

SUMMARY ANSWER:

It was possible to produce an international consensus statement on the current management of endometriosis through engagement of representatives of national and international, medical and non-medical societies with an interest in endometriosis.

WHAT IS KNOWN ALREADY:

Management of endometriosis anywhere in the world has been based partially on evidence-based practices and partially on unsubstantiated therapies and approaches. Several guidelines have been developed by a number of national and international bodies, yet areas of controversy and uncertainty remain, not least due to a paucity of firm evidence.

STUDY DESIGN, SIZE, DURATION:

A consensus meeting, in conjunction with a pre- and post-meeting process, was undertaken.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

A consensus meeting was held on 8 September 2011, in conjunction with the 11th World Congress on Endometriosis in Montpellier, France. A rigorous pre- and post-meeting process, involving 56 representatives of 34 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement.

MAIN RESULTS AND THE ROLE OF CHANCE:

A total of 69 consensus statements were developed. Seven statements had unanimous consensus; however, none of the statements were made without expression of a caveat about the strength of the statement or the statement itself. Only two statements failed to achieve majority consensus. The statements covered global considerations, the role of endometriosis organizations, support groups, centres or networks of expertise, the impact of endometriosis throughout a woman’s life course, and a full range of treatment options for pain, infertility and other symptoms related to endometriosis.

LIMITATIONS, REASONS FOR CAUTION:

This consensus process differed from that of formal guideline development. A different group of international experts from those participating in this process would likely have yielded subtly different consensus statements.

WIDER IMPLICATIONS OF THE FINDINGS:

This is the first time that a large, global, consortium, representing 34 major stake-holding organizations from five continents, has convened to systematically evaluate the best available current evidence on the management of endometriosis, and to reach consensus. In addition to 18 international medical organizations, representatives from 16 national endometriosis organizations were involved, including lay support groups, thus generating input from women who suffer from endometriosis.

 

 

 

Rom J Morphol Embryol. 2013;54(1):91-7.

Endometriosis – clinical approach based on histological findings.

Cristescu C1Velişcu AMarinescu BPătraşcu ATraşcă ETPop OT.

 

Abstract

Endometriosis is a benign disease defined by the presence of endometrial glands and stroma outside of the uterus and is associated with both pelvic pain and infertility. The most common sites of endometriosis, in decreasing order of frequency, are the ovaries, anterior and posterior cul-de-sac, posterior broad ligaments, uterosacral ligaments, uterus, fallopian tubes, sigmoid colon, appendix, and round ligaments. The main treatment is surgical, but often-microscopic islands of endometrial tissue remain, which proliferate and are responsible for relapses. We tested the efficacy of two drugs (Medroxyprogesterone and Triptorelinum), administered for six months to prevent recurrence after surgery. Treatment with Medroxyprogesterone was 100% effective in terms of relapse, while Triptorelinum could not prevent recurrence of endometriosis.

 

 

 

Stat Med. 2013 Sep 10;32(20):3472-85. doi: 10.1002/sim.5784. Epub 2013 Mar 26.

A crossed random effects modeling approach for estimating diagnostic accuracy from ordinal ratings without a gold standard.

Xie Y1Chen ZAlbert PS.

 

Abstract

In diagnostic studies without a gold standard, the assumption on the dependence structure of the multiple tests or raters plays an important role in model performance. In case of binary disease status, both conditional independence and crossed random effects structure have been proposed and their performance investigated. Less attention has been paid to the situation where the true disease status is ordinal. In this paper, we propose crossed subject-specific and rater-specific random effects to account for the dependence structure and assess the robustness of the proposed model to misspecification in the random effects distributions. We applied the models to data from the Physician Reliability Study, which focuses on assessing the diagnostic accuracy in a population of raters for the staging of endometriosis, a gynecological disorder in women. Using this new methodology, we estimate the probability of a correct classification and show that regional experts can more easily classify the intermediate stage than resident physicians.

 

 

 

Diagn Cytopathol. 2013 Nov;41(11):936-42. doi: 10.1002/dc.22979. Epub 2013 Mar 26.

Morphologic features of endometriosis in various types of cytologic specimens.

Barkan GA1Naylor BGattuso PKüllü SGalan KWojcik EM.

 

Abstract

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. This study evaluates the cytomorphologic features of endometriosis in various cytologic specimen types [fine-needle aspiration (FNA), effusion cytology (EF), touch imprint (ToP), and cervical smear (PAP)], and assesses the key elements helpful in recognizing this lesion. A total of 18 cases (8 FNA, 4 EF, 5 ToP, and 1 PAP) of cytologically diagnosed and histologically/clinically confirmed endometriosis diagnosed between 1988 and 2006 comprises the material for this study. The morphologic features evaluated of the three components included: cellularity, presence of sheets of glandular cells, three-dimensional (3D) glandular clusters, tubular structures, single cells, syncytial groups of stromal cells, stromal cells entrapped within basement membrane (BM)-like material, cytologic atypia, presence of mitotic figures, and hemosiderin-laden histiocytes. Endometrial glands, stroma, and hemosiderin-laden histiocytes were all identified in 14/18 (77.8%) cases. FNA specimens were more cellular than that of both EF and ToP specimens. Tubular structures, 3D glandular clusters, stromal cells entrapped in BM and syncytial stromal groups were more common in FNAs, and ToPs compared with the EFs. The ratio of the endometrial glandular and stromal cells was similar in all specimen types. Atypia and mitotic figures were rarely encountered. Diagnosis of endometriosis could be made independently on either smears/ThinPrep(™) slides or on cell blocks in all cases where these preparations were available. On follow up, none of the patients developed malignancy. Endometriosis can be reliably and safely diagnosed in various cytologic materials. Cytologic atypia is uncommon. Components of endometriosis could show minor morphologic alterations in different specimen types.

 

 

 

Zhonghua Fu Chan Ke Za Zhi. 2013 Jan;48(1):6-10.

Study on the factors associated with clinical pregnancy rate of in-vitro fertilization in endometriosis related infertility.

Hou Z1Mao YDLiu JY.

Abstract

OBJECTIVE:

To evaluate the factors associated with clinical pregnancy rate of in-vitro fertilization (IVF) in endometriosis related infertility.

METHODS:

Total of 326 patients with endometriosis related infertility undergoing IVF between January 2007 and December 2011 were studied in Department of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, retrospectively, which were divided into 141 cases in clinical pregnancy group and 185 cases in non-pregnancy group. Those factors including age, body mass index (BMI), basic FSH, antral follicle count (AFC), CA125 and CA199, endometriotic stage and history of surgery, stimulation scheme were analyzed by bivariate analysis and multivariable logistic regression.

RESULTS:

(1) Pregnancy rate:total of 141 pregnant cases and 185 non-pregnant cases treated by IVF were observed, pregnancy rate was 43.2% (141/326). (2) Basic parameters: there was no statistical difference in age, BMI, basic FSH, AFC, CA125 and CA199 between clinical pregnancy group and non-pregnancy group (P > 0.05). (3) Bivariate analysis: clinical pregnancy rate of 50.0% (87/174) among patients with infertility year less than five years was significantly higher than 35.5% (54/152) in patients with more than five years. Pregnancy rate of 56.1% (46/82) in stage I-II was significantly higher than 42.5% (79/186) in stage III-IV. Pregnancy rate of 46.6% (125/268) with history of surgery was significantly higher than 27.6% (16/58) with no history of surgery (P < 0.05). Pregnancy rate of 48.2% (79/164) in long-term scheme was higher than 38.3% (62/162) in short-term scheme, but there was no significant difference (P = 0.075). (4) Multivariable logistic regression: clinical pregnancy rate of infertility year with less than 5 years, stage I-II, history of surgery proved stage I-II and stage III-IV was significantly higher compared with infertility year more than 5 years, stage III-IV and no history of surgery respectively (adjusted OR and 95%CI: 2.003, 1.263 – 3.175; 1.899, 1.110 – 3.248; 3.769, 1.802 – 7.887, P < 0.05).

CONCLUSION:

Factors affecting clinical pregnancy rate of IVF in endometriosis related infertility were infertility year, stage and surgery.

 

 

Zhonghua Fu Chan Ke Za Zhi. 2013 Jan;48(1):11-5.

 

Impact on ovarian reserve function by different homostasis methods during laparoscopic cystectomy in treatment of ovarian endometrioma.

Li CZ1Wei DYWang FWang HQYang CR.

Abstract

OBJECTIVE:

To investigate the impact on ovarian reserve function by different hemostasis methods during laparoscopic surgery in treatment of ovarian endometrioma.

METHODS:

From September 2008 to February 2010, 162 cases with ovarian endometrioma undergoing laparoscopic surgery in Shandong Provincial Hospital were enrolled in this study. At the 3rd day of the menstrual cycle before surgery and the 1st, 3rd, 6th and 12th cycle after surgery, serum FSH and anti-mullerian hormone (AMH) and ultrasound basal antral follicle count (AFC) and peak systolic velocity (PSV) were examined and compared. Based on hemostasis method, those patients were divided into 3 groups, including 54 cases in bipolar hemostasis, 54 cases in ultrasonic scalpel hemostasis and suture after excision of endometrioma.

RESULTS:

(1) Before surgery: no significant different factors among three groups before surgery were observed, including age, size of endometrioma, the level of FSH, AMH, AFC, PSV(P > 0.05). (2) Ovarian reserve function after surgery: 1) FSH: at the 1st, 3rd, 6th and 12th month follow-up, the FSH in the bipolar group was (11.7 ± 4.0), (9.9 ± 4.0), (9.5 ± 4.3), (9.5 ± 3.9) U/L, and the FSH in ultrasonic scalpel group was (11.4 ± 4.3), (9.7 ± 4.0), (9.2 ± 3.7), (9.9 ± 4.6) U/L, were significantly higher than (9.3 ± 3.8), (6.7 ± 3.0), (6.5 ± 3.2), (6.4 ± 2.2) U/L in suture group respectively (all P < 0.05). 2) AMH: at the 1st, 3rd, 6th and 12th month follow-up, the AMH in the bipolar group was (1.8 ± 0.9), (1.8 ± 1.0), (1.9 ± 1.0), (2.0 ± 1.0) µg/L, and the AMH in the ultrasonic scalpel group was (1.6 ± 0.8), (1.8 ± 1.0), (2.0 ± 1.1), (2.1 ± 1.0) µg/L, which were significantly lower than (2.8 ± 1.7), (2.9 ± 1.6), (3.0 ± 1.3), (3.2 ± 1.5) µg/L in suture group, respectively (all P < 0.05). 3) AFC: there was no significant difference of APC among the three groups in the 1st month after surgery. However, at the 3rd, 6th and 12th month follow-up, the AFC of 4.8 ± 1.4, 5.9 ± 1.5, 6.1 ± 1.5 in the suture group was significant higher than 3.7 ± 1.4, 4.1 ± 1.4, 4.0 ± 1.5 in bipolar group and 3.6 ± 1.3, 4.0 ± 1.1, 3.9 ± 1.5 in ultrasonic group, respectively (all P < 0.05). 4) PSV: at the 1st, 3rd, 6th and 12th month follow-up, the PSV of the bipolar group (7.9 ± 3.5), (8.1 ± 3.3), (8.4 ± 3.1), (8.6 ± 3.0) cm/s in bipolar group and (8.1 ± 3.5), (8.0 ± 3.0), (7.9 ± 3.2), (8.0 ± 2.9) cm/s in ultrasonic group were significant lower than (10.9 ± 3.3), (12.0 ± 3.2), (11.8 ± 3.0), (12.1 ± 4.1) cm/s in suture group, respectively. (all P < 0.05).

CONCLUSIONS:

Bipolar or ultrasonic scalpel hemostasis during laparoscopic excision of ovarian endometrioma is associated with a significant reduction in ovarian reserve. Electrocoagulation of the ovarian tissue should be avoided.

 

 

 

Zhonghua Fu Chan Ke Za Zhi. 2013 Jan;48(1):16-9.

Clinical effect on women with different types of endometriosis related infertility treated by conservative surgery.

Xue Q1Zeng CXu YShang JZhang LZhu SNZuo WLZhou YF.

Abstract

OBJECTIVE:

To study pregnancy outcome and recurrence in patients with different type of endometriosis related infertility treated by conservative surgery.

METHODS:

From January 2005 to December 2010, 79 patients with endometriosis related infertility underwent conservative laparoscopic surgery in Peking University First Hospital, including 16 cases with deep infiltrating endometriosis, 39 cases with ovarian endometriosis and 24 cases with peritoneal endometriosis. At 1 to 5 years follow-up after surgery, natural pregnancy outcome and recurrence were studied.

RESULTS:

(1) The accumulated pregnancy rate were 6/16 in deep infiltrating endometriosis group, 36% (14/39) in ovarian endometriosis group, and 46% (11/24) in peritoneal endometriosis group, which did not reached statistical difference (P > 0.05). (2) The median interval between pregnancy and surgery were 38.5 months in deep infiltrating endometriosis group, 9.5 in ovarian endometriosis group and 6.0 months in peritoneal endometriosis group. The median interval in deep infiltrating endometriosis was significantly longer than that in peritoneal endometriosis group and ovarian endometriosis group (P < 0.01). Total of 11 patients in peritoneal endometriosis group and 11 patients in ovarian endometriosis group acquired pregnancy at 18 months after surgery. (3) The recurrent rate were 5/16 in deep infiltrating endometriosis group, 13% (5/39) in ovarian endometriosis group and 4% (1/24) peritoneal endometriosis group, respectively (P > 0.05).

CONCLUSIONS:

There was no difference among these three groups in accumulated pregnancy rate. However, the interval between pregnancy and surgery was significantly longer in patients with deep infiltrating endometriosis when compared with those in the other groups.

 

 

Case Rep Obstet Gynecol. 2013;2013:360459. doi: 10.1155/2013/360459. Epub 2013 Feb 27.

Appendiceal endometriosis and carcinoid presented as acute appendicitis in pregnancy: a rare case report and review of the literature.

Dimitriadis PA1Makar RRKingston GFarouk R.

 

Abstract

A 22-year-old pregnant woman presented at the twenty-seventh week of gestation in the Emergency Department with acute abdominal pain and right iliac fossa tenderness. Urgent MRI was done and was suggestive of acute appendicitis. A laparoscopy was performed that confirmed an inflamed and purulent appendix that was removed. The technique used is described in detail. The histopathologic findings were those of acute appendicitis, carcinoid, and endometriosis of the appendix. We report the first case of this extremely rare triad presented in pregnancy.

Asian Pac J Cancer Prev. 2013;14(1):603-6.

Role of ultrasound in characterization of ovarian masses.

Hafeez S1Sufian SBeg MHadi QJamil YMasroor I.

Abstract

BACKGROUND:

Ovarian cancer is the second most common malignancy in Pakistani women, accounting for 4% of all cancers in the female population. The aim of this study was to determine sensitivity, specificity, positive and negative predictive values and 95% confidence intervals for ultrasound in characterization of ovarian masses in patients presenting at public and private tertiary care hospitals in Karachi, Pakistan.

MATERIALS AND METHODS:

We adopted a cross-sectional analytical study design to retrospectively collect data from January 2009-11 from medical records of two tertiary care hospitals. Using a non-probability purposive sampling technique, we recruited a sample of 86 women aged between 15 and 85 years fulfilling inclusion criteria with histopathologically proven ovarian masses presenting for an ultrasound examination in our radiology departments.

RESULTS:

Our retrospective data depicted sensitivity and specificity of ultrasound to be 90.7%, 95%CI (0.77, 0.97) and 91.4%, 95%CI (0.76, 0.98) respectively. Positive predictive value was 93%, 95%CI (0.79, 0.98) and negative predictive value was 89%, 95%CI (0.73, 0.96). A total of 78 ovarian masses were detected, out of which 42 were malignant and 36 were benign.

CONCLUSIONS:

Results of our study further reinforce the conclusion that ultrasound should be used as an initial modality of choice in the workup of every woman suspected of having an ovarian mass. It not only results in decreasing the mortality but also avoids unnecessary surgical interventions.

 

 

Reprod Sci. 2013 Oct;20(10):1230-6. doi: 10.1177/1933719113483014. Epub 2013 Mar 27.

Regression of endometrial implants by resveratrol in an experimentally induced endometriosis model in rats.

Ergenoğlu AM1Yeniel AÖErbaş OAktuğ HYildirim NUlukuş MTaskiran D.

Abstract

OBJECTIVE:

To evaluate the effect of resveratrol on an experimentally induced endometriosis rat model.

STUDY DESIGN:

After endometriotic implants were surgically formed, rats were randomly divided into 2 groups as control group (saline treated, n = 6) and resveratrol group (10 mg/kg/d, n = 6). The inflammatory markers and histopathological changes were assessed at the end of the treatment period. Results Our results showed (1) significant reduction in the implant size (P < .0005); (2) significantly decreased levels of vascular endothelial growth factor (VEGF) in the peritoneal fluid and plasma (P < .005); and monocyte chemotactic protein 1 (MCP-1) in the peritoneal fluid (P < .05), (3) highly significant suppression of VEGF expression in the endometriotic tissue (P < .0005); and (4) considerable histological changes in the endometriotic foci following resveratrol treatment.

CONCLUSION:

Resveratrol appears to be effective on the development of endometriosis through its antiangiogenic and anti-inflammatory properties. Future studies with different doses of resveratrol might provide more comprehensive results regarding the treatment of endometriosis.

 

 

 

Reprod Sci. 2013 Nov;20(11):1293-301. doi: 10.1177/1933719113483018. Epub 2013 Mar 27.

Spindle and chromosomal alterations in metaphase II oocytes.

Sharma RK1Azeem AAgarwal A.

 

Abstract

The spindle apparatus is a vital structure and must be structurally intact for proper segregation of the oocyte’s genetic material during metaphase II. Endometriosis, oxidative stress, and cryopreservation can all adversely affect the structural integrity of the spindle, potentially resulting in aneuploidy and spontaneous abortion of the embryo. Advances in spindle imagery have made it possible to visualize the effects of environmental stresses on spindle structure. Deviation from an oocyte’s normal environment can seriously impair the positioning and integrity of the spindle. Oocytes cryopreservation causes depolymerization and repolymerization of the spindle. Oocytes can also be preserved in an immature state for later in vitro maturation. A comprehensive understanding of the spindle behavior is paramount for the effective manipulation of oocytes in an assisted reproductive setting.

 

 

 

Reprod Sci. 2013 Oct;20(10):1215-23. doi: 10.1177/1933719113483008. Epub 2013 Mar 27.

Therapeutic potential of Wenshen Xiaozheng tang, a traditional Chinese medicine prescription, for treating endometriosis.

Zhang Z1Hu CTang WGui TQian RXing YCao PWan G.

 

Abstract

The objective of this study is to investigate the effect of Wenshen Xiaozheng Tang (WXT) on the development of endometriosis in a rat model. Sprague-Dawley rats in which endometriotic implants were induced were divided randomly into 3 groups. The rats in the low-dose and high-dose WXT groups were administered WXT 8.57 and 17.14 g/kg/d, respectively. The rats in the control groups received an equal volume of dissolvent, as did the sham-operated rats. After treatment for 4 weeks, WXT significantly decreased the mean lesion size as well as the peritoneal fluid and serum levels of tumor necrosis factor α and interleukin 1β. Cyclooxygenase-2, matrix metalloproteinase 9, plasminogen activator inhibitor 1, and intercellular adhesion molecule 1 messenger RNA (mRNA) levels were downregulated, and the mRNA expression of tissue inhibitor of metalloproteinase 1 was upregulated in the endometriotic lesions of WXT versus control group. Our data suggested that WXT may suppress the development of endometriosis by inhibiting the production of proinflammatory cytokines and regulating the expression of invasion-related genes in the endometriotic lesions.

 

 

Reprod Sci. 2013 Oct;20(10):1224-9. doi: 10.1177/1933719113483012. Epub 2013 Mar 27.

The effects of ranibizumab on surgically induced endometriosis in a rat model: a preliminary study.

Sevket O1Sevket ABuyukpinarbasili NMolla TKilic GAtes SDansuk R.

Abstract

OBJECTIVE:

To examine the effect of ranibizumab on surgically induced endometriosis in rat models.

STUDY DESIGN:

Endometrial tissue was implanted onto the abdominal peritoneum of 20 rats that were randomized into 2 groups. The rats in group 1 (n = 9) were given 0.6 mg/kg ranibizumab on the 1st and 14th days after the second operation. The rats in group 2 (control group, n = 9) received no medication. All the rats were observed for a total of 28 days.

RESULTS:

At the end of the treatment, the mean volume and weight of the explants in group 1 (11.49 ± 6.87 mm(3) and 36.61 ± 17.84 mg) were significantly lower than that of the control group (190.6 ± 177.4 mm(3) and 187.3 ± 174.5 mg; both Ps < .01). Mean epithelial histologic scores were significantly lower in group 1 (1.11 ± 0.78) than that of the control group (2.33 ± 0.71; P < .01). When compared with the control group, vascular endothelial growth factor (VEGF) immunoreactivities in group 1 showed statistically significant reductions (1.67 ± 0.50; 2.67 ± 0.50; P < .01).

CONCLUSION:

Ranibizumab has significantly regressed the size of the endometriotic implants and caused atrophy of these lesions in rats by decreasing explant levels of VEGF.

 

 

 

Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):331-9. doi: 10.1016/j.ejogrb.2013.03.008. Epub 2013 Mar 26.

The influence of endometriosis-related symptoms on work life and work ability: a study of Danish endometriosis patients in employment.

Hansen KE1Kesmodel USBaldursson EBSchultz RForman A.

Abstract

OBJECTIVE:

Little is known about the implications of endometriosis on women’s work life. This study aimed at examining the relation between endometriosis-related symptoms and work ability in employed women with endometriosis.

STUDY DESIGN:

In a cohort study, 610 patients with diagnosed endometriosis and 751 reference women completed an electronic survey based on the Endometriosis Health Profile 30-questionnaire and the Work Ability Index (short form). Percentages were reported for all data. Binary and multivariate logistic regression analyses were used to assess risk factors for low work ability. The level of statistical significance was set at p<0.025 in all analyses.

RESULTS:

In binary analyses a diagnosis of endometriosis was associated with more sick days, work disturbances due to symptoms, lower work ability and a wide number of other implications on work life in employed women. Moreover, a higher pain level and degree of symptoms were associated with low work ability. Full regression analysis indicated that tiredness, frequent pain, a higher daily pain level, a higher number of sick days and feeling depressed at work were associated with low work ability. A long delay from symptom onset to diagnosis was associated with low work ability.

CONCLUSIONS:

These data indicate a severe impact of endometriosis on the work ability of employed women with endometriosis and add to the evidence that this disease represents a significant socio-economic burden.

 

 

 

J Pharmacol Sci. 2013;121(4):299-304. Epub 2013 Mar 29.

Sequential observation of implanted endometriosis by laparoscopy in rats: correlation between the prevalence rate and the estrous cycle.

Uchida M1Kobayashi O.

 

Abstract

This study aimed to clarify the correlation between the estrous cycle and prevalence rate of endometriosis by sequential laparoscopy in Wistar-Imamichi female rats. The peritoneal implantation of endometrial tissue was performed in four estrous cycle rats (proestrus, estrus, metestrus, and diestrus). One week after implantation, the volume of the ectopic endometriosis was measured, and sequential laparoscopy was performed for 4 weeks to observe the prevalence rate. Five weeks after implantation, the volume of the ectopic endometriosis was measured again after laparoscopy. One week after implantation, the volume of endometriosis was significantly larger in proestrus and estrus rats than metestrus and diestrus rats. Prevalence rate was decreased with time. Five weeks after implantation, the prevalence rate and volume were higher and larger in the metestrus, diestrus, and estrus rats than in the proestrus rats. These results show that the estrous cycle affects the change of ectopic endometriosis. The decrease of prevalence rate was slow in metestrus, diestrus, and estrus rats as compared to that in proestrus rats. The volume of ectopic endometriosis showed little decrease with time when the endometrial tissue was implanted during the metestrus and diestrus portion of the cycle. Moreover, sequential laparoscopy made it possible to observe the prevalence rate of endometriosis.

 

 

 

 

An Bras Dermatol. 2013 Jan-Feb;88(1):121-4.

Umbilical endometriosis: report of a case and its dermoscopic features.

Jaime TJ1Jaime TJOrmiga PLeal FNogueira OMRodrigues N.

 

Abstract

Cutaneous endometriosis is a rare manifestation of endometriosis, representing 0.5% to 1% of all endometriosiscases. It can be divided into primary and secondary, when appearing spontaneously or after a surgical procedure, when it is mostly found on surgical scar tissue. Some etiologies were proposed, but none of them could entirely explain the appearance of the tumor. Differential diagnosis includes melanoma, metastatic nodule, keloid and pyogenic granuloma. Dermoscopic features are not yet well established, but there are some characteristics that suggest the diagnosis. Treatment is surgical in larger sized lesions. Malignization can occur. The screening for endometriosis is mandatory by means of gynecologic, imaging and marked-tumor evaluation. We report a case of primary umbilical endometriosis and discuss its dermoscopic aspects.

 

 

 

Hum Reprod Update. 2013 Jul-Aug;19(4):406-18. doi: 10.1093/humupd/dmt010. Epub 2013 Mar 28.

Endometriosis: hormone regulation and clinical consequences of chemotaxis and apoptosis.

Reis FM1Petraglia FTaylor RN.

Abstract

BACKGROUND:

The recruitment of immune cells by chemokines and the regulation of endometrial cell apoptosis are critical aspects of endometriosis biology. Here, we review the local (paracrine) and systemic hormone (endocrine) modulation of these two specific, but highly related phenomena.

METHODS:

We searched Pubmed for items published in English between September 1991 and September 2011 and selected the studies evaluating the effects of hormones on chemokines or apoptosis in normal human endometrium and endometriosis.

RESULTS:

Estradiol has proinflammatory and antiapoptotic effects in endometrial cells, and these effects appear to be exacerbated in women with endometriosis. In these women, physiological estradiol concentrations are able to induce an enhanced inflammatory response mediated by local chemokine production and to reinforce mechanisms of cell survival mediated by extracellular signal-regulated kinases and Bcl-2. The main effect of progestogens is to inhibit interleukin-8 and other chemokines in stromal cells from both eutopic and ectopic endometrium. Progesterone is also effective in inducing apoptosis in endometrial and endometriotic cells through the inhibition of Bcl-2 and nuclear factor-κB.

CONCLUSIONS:

Estrogens and progestogens modulate chemotaxis and apoptosis in human endometrium and endometriotic cells and tissues. These endocrine and paracrine pathways are perturbed in women with endometriosis, contributing to inflammatory responses, abnormal tissue remodeling, therapeutic refractoriness and disease persistence. Ultimately, they promote adhesion formation and the clinical symptoms of pelvic pain and infertility. A more detailed understanding of the molecular mechanisms involved will offer new opportunities for novel pharmacological strategies to diagnose and treat endometriosis.

 

 

 

Fertil Steril. 2013 Jul;100(1):122-6. doi: 10.1016/j.fertnstert.2013.02.045. Epub 2013 Mar 27.

Pain in the upper anterior-lateral part of the thigh in women affected by endometriosis: study of sensitive neuropathy.

Pacchiarotti A1Milazzo GNBiasiotta ATruini AAntonini GFrati PGentile VCaserta DMoscarini M.

Abstract

OBJECTIVE:

To assess whether pain in the anterior-lateral part of the thigh in women affected by endometriosisis due to femoral nerve invasion by endometriotic implants.

DESIGN:

Case-control study.

SETTING:

Hospital.

PATIENT(S):

We enrolled 30 patients with endometriosis and leg pain in the anterior-lateral part of the thigh and 30 healthy women.

INTERVENTION(S):

Skin biopsy and neurologic examination for detection of neuropathy.

MAIN OUTCOME MEASURE(S):

Intraepidermal small fiber density reduction and positive neurologic examination agree with sensitive neuropathy.

RESULT(S):

Biopsy results showed no statistically significant difference between the case group and the control group. At neurologic examination nine patients in the study group (30%) showed positive results, none in the control group showed signs. These nine patients had reduced intraepidermal small fiber density, compared to the lower cutoff values of the control group, suggesting a sensitive neuropathy.

CONCLUSION(S):

When there is leg pain in women with endometriosis it is important to distinguish neuropathic from referred pain. Skin biopsy and neurologic examination should be introduced in the management of leg pain in endometriosis, due to their low invasiveness to diagnose a sensitive neuropathy. As a result early detection of nerve injury and planning for a prompt specific treatment would be possible.

 

 

 

Hum Reprod. 2013 Jul;28(7):1837-45. doi: 10.1093/humrep/det087. Epub 2013 Mar 29.

Do endometriomas induce an inflammatory reaction in nearby follicles?

Opøien HK1Fedorcsak PPolec AStensen MHÅbyholm TTanbo T.

Abstract

STUDY QUESTION:

Do endometriomas induce an inflammatory reaction with increased cytokine concentrations in nearby follicles and thereby affect follicular development during controlled ovarian stimulation for in vitro fertilization (IVF)?

SUMMARY ANSWER:

With most endometriomas, there is no evidence of increased cytokine concentrations in the ipsilateral leading follicle. Infrequently, the concentration of inflammatory cytokines is increased in the follicular fluid (FF) and associated with diminished ovarian response.

WHAT IS KNOWN ALREADY:

The link between peritoneal endometriosis, inflammation and infertility is well established; however, the association between intraovarian inflammation and endometrioma is unknown.

STUDY DESIGN, SIZE, DURATION:

This prospective cohort study included 117 infertile women undergoing IVF in a tertiary infertility clinic at Oslo University Hospital Rikshospitalet, Norway, during the period May 2009 to September 2011.

PARTICIPANTS, SETTING, METHODS:

There were 47 patients with unilateral endometrioma and 17 patients with bilateral endometrioma, while the 53 control patients had unexplained or male factor infertility. Concentrations of IL-1β, IL-6, IL-8, IL-10, IL-12 and TNF-α were measured in serum and in the fluid of the largest pre-ovulatory follicles from each ovary of each participant.

MAIN RESULTS AND THE ROLE OF CHANCE:

Cytokine levels in the follicular fluid from the two ovaries in women with unilateral endometriomas were comparable, and were not significantly altered compared with that of control groups with male factor infertility, unexplained infertility or bilateral endometriomas. Compared with serum levels, the follicular fluid levels of IL-8 and IL-6 were higher, suggesting a local production or recruitment. The follicular fluid IL-8 level varied considerably and showed an inverse relationship with IL-12, IL-10 and TNF-∝, suggesting a complex interaction between various immune cells. A small group of patients (n = 3) had increased levels of all follicular fluid cytokines combined with moderately to slightly elevated serum levels and these patients had a significantly lower ovarian response.

LIMITATIONS, REASONS FOR CAUTION:

For ethical reasons, the endometriomas were diagnosed indirectly by ultrasound rather than by histology.

WIDER IMPLICATIONS OF THE FINDINGS:

This paper reveals that endometriomas seldom induce inflammation in nearby follicles during IVF; therefore, routine cystectomy prior to IVF may not be necessary. Cytokine levels in the follicular fluid, nonetheless, show distinctive patterns and increased levels may be linked to reduced ovarian response independent of the cause of infertility.

 

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