Cochrane Database Syst Rev. 2013 Mar 28

Anti-TNF-α treatment for pelvic pain associated with endometriosis.

Lu D1Song HShi G.

 

Abstract

BACKGROUND:

Endometriosis is a chronic, recurring condition that can develop during the reproductive years. It is characterised by the development of endometrial tissue outside the uterine cavity. It is the most common cause of pelvic pain in women. This endometrial tissue development is dependent on oestrogen produced primarily by the ovaries and, therefore, traditional management has focused on suppression of ovarian function. Mounting evidence shows that altered immune function plays a crucial role in the genesis and development of endometriosis. In this review we considered modulation of the inflammation as an alternative approach.

OBJECTIVES:

To determine the effectiveness and safety of anti-tumour necrosis factor-α (anti-TNF-α) treatment in the management of endometriosis in premenopausal women.

SEARCH METHODS:

For the first publication of this review, we searched for trials in the following databases (from their inception to August 2009): Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO. In addition, we searched all reference lists of included trials and contacted experts in the field in an attempt to locate trials. We reran this search to 3 September 2012 for this update.

SELECTION CRITERIA:

Randomised controlled trials (RCTs) comparing anti-TNF-α drugs with placebo, no treatment, medical treatment, or surgery for pelvic pain associated with endometriosis were included.

DATA COLLECTION AND ANALYSIS:

Two review authors independently selected trials for inclusion, assessed trial quality, and extracted data using data extraction forms. The domains assessed for risk of bias were sequence generation, allocation concealment, blinding, incomplete outcome data, and selective outcome reporting. We used risk ratios (RR) for reporting dichotomous data with 95% confidence intervals (CI), whilst we expressed continuous data as mean differences (MD). We assessed statistical heterogeneity using the I(2) statistic.

MAIN RESULTS:

Only one trial involving 21 participants was included. The results showed no evidence of an effect of infliximab, one of the known anti-TNF-α drugs, on pelvic pain reduction using the Biberoglu-Behrman (BB) score (0 to 3 scale) for participants (MD -0.14, 95% CI -0.43 to 0.15), the BB score for clinicians (MD -0.14, 95% CI -0.39 to 0.11), or a visual analogue pain score (VAS, 100 mm scale) (MD -5.60, 95% CI -16.10 to 4.90), or on the use of pain killers (ibuprofen, g/day) (MD -0.10, 95% CI -0.30 to 0.10). There was no evidence of an increase in adverse events in the infliximab group compared with placebo (RR 3.73, 95% CI 0.22 to 63.66). We found no evidence of clinical benefits of infliximab for endometriotic lesions, dysmenorrhoea, dyspareunia, or pelvic tenderness. To date, there is no trial that has reported a cost-effectiveness analysis of anti-TNF-α drugs, or the odds of recurrence.

AUTHORS’ CONCLUSIONS:

This review was updated in 2012. The results of the original review published in 2010 remain unchanged. There is still not enough evidence to support the use of anti-TNF-α drugs in the management of women with endometriosis for the relief of pelvic pain.

 

 

J Clin Diagn Res. 2013 Feb;7(2):378-80. doi: 10.7860/JCDR/2013/5075.2775. Epub 2013 Feb 1.

Stromal endometriosis of the intestine: an elusive presentation with a review of the literature: a case report.

Upreti S1Bansal RUpreti SMathur S.

 

Abstract

Although endometriosis involves the small intestine only rarely, when present, this condition may simulate a variety of inflammatory and sometimes neoplastic conditions because of its nonspecific symptoms. We are reporting here, a case of ileal, caecal and appendiceal endometriosis which presented in the emergency as a case of an acute intestinal obstruction with a long history of symptoms which were referable to the GI tract. The patient had the diffuse involvement of a segment of the ileum with mural thickening and luminal narrowing, which led to obstruction. The literature on small bowel endometriosis has been reviewed and the clinical and pathological features have been discussed.

 

 

J Adolesc Health. 2013 Apr;52(4 Suppl):S54-8. doi: 10.1016/j.jadohealth.2012.09.022.

Use of levonorgestrel intrauterine system for medical indications in adolescents.

Bayer LL1Hillard PJ.

 

Abstract

The levonorgestrel intrauterine system (LNG-IUS) is an underused contraceptive method in adolescent populations. In addition to being a highly effective, reversible, long-acting contraception, the LNG-IUS has many noncontraceptive health benefits including reduced menstrual bleeding, decreased dysmenorrhea and pelvic pain related to endometriosis, and menstruation suppression in teens with physical or developmental disabilities. The LNG-IUS can also provide endometrial protection in teens with chronic anovulation, and may be used to treat endometrial hyperplasia and cancer. This review examines the evidence supporting the use of the LNG-IUS in adolescents for these noncontraceptive benefits.

 

 

Zhonghua Fu Chan Ke Za Zhi. 2013 Feb;48

Clinicopathological features of 151 cases with abdominal wall endometriosis.

Yuan L1Zhang JHLiu XS.

 

Abstract

OBJECTIVE:

To investigate clinicopathological features of abdominal wall endometriosis (AWE).

METHODS:

A retrospective study was conducted on 151 consecutive AWE patients undergoing treatment in Affiliated Obstetrics and Gynecology Hospital, Fudan University from January 2003 to December 2010. The period of following up was at range of 16 to 97 months.

RESULTS:

(1) The incidence of AWE was 1.96% (166/8469). All 151 AWE cases followed up had previous cesarean sections. The period between the previous cesarean section (CS) and the onset of symptoms of AWE was 24 months (3 – 192 months). However, the latency was not associated with the age at CS, incision site, gestational week at CS, duration of lactation, postpartum menstruation recovery, the choice of contraceptives and size of AWE (P > 0.05). The duration of disease, defined to be the time interval between the onset of symptoms and surgery, was 26 months (2 – 168 months), which was negatively correlated with the latent period (r = -0.267, P < 0.05) and was positively with size of AWE (patients with large-scar endometrioma with diameter of lesions ≥ 3 cm had longer disease duration than those with small-scar endometriomas < 3 cm, r = 0.326, P < 0.05). (2) The rate of pre-operational ultrasonography detection was 97.4% (147/151). The lesion size detected by pre-operative ultrasonography was significantly smaller than that measured intraoperatively by palpation (20 mm versus 35 mm, P < 0.05). Moreover, only 26.5% (40/151) of AWE patients were found to have deep infiltration by pre-operative ultrasonography. (3) All patients were managed by surgical treatment to completely excise lesions on the abdominal wall. Of all 34 patients (22.5%, 34/151) took medicine pre-operatively while 57 patients (37.7%, 57/151) taking medicine post-operatively. The rate of recurrence was 3.1% (3/96) of cases with lesions ≥ 3 cm, which was significantly lower than 17.8% (8/45) in cases with lesion < 3 cm (P < 0.05). (4) After surgery, the symptoms were found to be relieved in 93.4% (141/151) of patients. The recurrence rate was 7.8% (11/141) while the average recurrent time was (20 ± 16) months.

CONCLUSION:

Surgery is the main management on AWE. The risk factors associated with recurrence were size of lesion and postoperative medication.

 

 

 

Zhonghua Fu Chan Ke Za Zhi. 2013 Feb;48(

Relationship of pelvic clinic-pathological features and the pain symptoms in ovarian endometrioma.

Dai Y1Leng JHLang JHZhang JJLi XYShi JHLi MH.

 

Abstract

OBJECTIVE:

To study the relationship between the clinic-pathological features and pain symptoms in patients with endometriotic cyst (EM).

METHODS:

The medical data of symptoms, laparoscopy and pathology examination in 416 patients with endometriosis were studied retrospectively. All cases were divided into two groups on the existence of ovarian endometrioma, including 338 patients in cyst group and 78 cases in non-cyst group. The relationship between clinical symptoms and location and type of endometrioma was studied.

RESULTS:

(1) Serum CA125 level: the level of CA125 were (61 ± 39) kU/L in cyst group (28 ± 24) kU/L in non-cyst group, which reached statistical difference (P < 0.01). (2) Pathological features: among 338 cases, 34.0% of cyst were on left side (115/338), 26.3% were right side (89/338), and 39.6% were on both side (134/338). And 95.8% (324/338) of cases were combined with the other type of endometriosis, which were 48.5% (164/338) with peritoneal endometriosis, 47.3% (160/338) with deep infiltrating endometriosis (DIE). In cystic patients, the incidences of endometriosis lesion were 13.9% (47/338) on the uterine surface, 38.5% (130/338) on obstruction of cul-de sac, 40.5% (137/338) on utero-sacral ligament of DIE, which were significantly higher than 5.1%, (4/78), 9.0% (7/78) and 28.2% (22/78) in noncyst group. (3) Pain symptom: the incidence and degree of dysmenorrhea and dyschezia had no statistical difference between two groups (P > 0.05), and the incidence of chronic pelvic pain (CPP) of 24.6% (83/338) and dyspareunia of 29.9% (101/338) in the cyst group were significantly lower than 35.9% (28/78) and 44.9% (35/78) in non-cyst group (P < 0.05). The incidence of dysmenorrheal was 85.1% (114/134) in cases with bilateral cyst, which was higher than 74.0% (151/204) in cases with single cyst. The incidence of dysmenorrheal and dyschezia in moderate-severe adhesion was 89.0% (138/155) and 18.7% (29/155), which was significantly higher than 68.8% (126/183) and 8.2% (15/183) in mild adhesion. In the patients cyst existed with DIE, the risk of dysmenorrheal, CPP, dyspareunia, and dyschezia were obviously raised (OR respectively was 5.17, 3.01, 3.05, 2.75).

CONCLUSIONS:

The endometriotic cyst often co-exists with other type of endometriotic lesions. Ovarian endometrioma was associated with lesion localized on uterine surface, cul-de-sac, sacrum ligament. The risk of all the pain symptoms would be raised when the endometriotic cyst co-exit with the DIE lesions. So the treatment for DIE lesions was as same important as the endometriotic lesions in order to relieve pain symptoms and delay the relapse.

 

 

Reprod Fertil Dev. 2014 Mar;26(3):414-20. doi: 10.1071/RD12258.

Evaluation of selected angiogenic and inflammatory markers in endometriosisbefore and after danazol treatment.

Szubert M1Suzin J1Duechler M2Szuławska A3Czyż M3Kowalczyk-Amico K1.

 

Abstract

Angiogenesis and inflammation are pivotal processes in developing endometriosis in the peritoneal cavity. The aim of the present study was to evaluate these two processes in women with endometriosis who had been treated with danazol to determine the sensitivity of a non-invasive test in diagnosing endometriosis. The clinical follow-up study was conducted in a group of 103 women diagnosed laparoscopically with endometriosis. Thirty-five patients qualified for danazol treatment. Pain was assessed using a visual analogue scale, whereas endometriosis was assessed using the revised American Society of Reproductive Medicine (rASRM) scale. Cancer antigen (CA)-125 and C-reactive protein (CRP) concentrations in plasma and peritoneal fluid were determined by immunoenzymatic methods, whereas vascular endothelial growth factor (VEGF) and interleukin (IL)-1β concentrations in plasma and peritoneal fluid were determined by ELISA. Endometrial expression of IL-8 and platelet-derived growth factor alpha polypeptide (PDGF-A) was determined using real-time polymerase chain reaction (PCR). Women with endometriosis (68.9% of patients) had higher plasma concentrations of CA-125, as well as higher concentrations of both CA-125 and VEGF in the peritoneal fluid. Endometrial expression of IL-8 mRNA was significantly higher, whereas that of PDGF-A was significantly lower, in contrast. After danazol treatment the patients reported lower pain scores; in addition, CA-125 concentrations in the plasma were decreased (P<0.001), whereas VEGF concentration in the plasma increased (P=0.009). For the diagnosis of endometriosis, none of the combinations of given markers had a sensitivity >60%. Danazol treatment is highly effective in relieving pain and decreasing CA-125 concentrations in the plasma. Higher plasma concentrations of VEGF after treatment could imply stimulation of angiogenesis.

 

 

J Endourol. 2013 Aug;27(8):994-9. doi: 10.1089/end.2013.0075. Epub 2013 Jun 13.

Single surgeon experience with robot-assisted ureteroureterostomy for pathologies at the proximal, middle, and distal ureter in adults.

Lee Z1Llukani EReilly CEMydlo JHLee DIEun DD.

 

Abstract

PURPOSE:

To describe our initial experience with robot-assisted ureteroureterostomy (RUU) at the proximal, middle, and distal ureter.

MATERIALS AND METHODS:

Twelve consecutive patients underwent RUU by a single surgeon (D.D.E.) between July 2009 and November 2012. Indications included three iatrogenic injuries, two impacted stones, two ureterovaginal fistulas, two idiopathic ureteral strictures refractory to conservative treatment, one primary transitional cell carcinoma of the ureter, one colon cancer metastasis to the ureter, and one invasive endometriosis. There were two proximal, three middle, and seven distal ureteral pathologies.

RESULTS:

Tension-free anastomosis was achieved in all 12 patients. All patients with proximal and middle ureteral pathology received concomitant downward nephropexy (DN) as a standard part of RUU. Mean age of patients at the time of surgery was 52 years (range 30-69), mean body mass index was 30.0 kg/m(2) (range 21-38), mean operative room time was 190 minutes (range 104-354), mean estimated blood loss was 181 mL (range 50-400), and mean length of excised ureter on pathologic analysis was 2.0 cm (range 1.0-4.5). There was one intraoperative complication in which liver and gallbladder laceration occurred during trocar placement. Mean length of hospital stay was 1.4 days (range 1-5), and there were no postoperative complications. Mean follow up was 10 months (range 3-36). One patient had a ureteral stricture recurrence at 7 months postoperatively that led to renal unit loss and eventual nephrectomy.

CONCLUSION:

RUU is feasible, safe, and demonstrates good outcomes for pathologies at the proximal, middle, and distal ureter. Concomitant DN during RUU may assist in achieving a tension-free anastomosis for proximal and middle ureteral repairs.

 

 

Cytokine. 2013 May;62(2):253-61. doi: 10.1016/j.cyto.2013.03.003. Epub 2013 Mar 30.

Evidence of neurotrophic events due to peritoneal endometriotic lesions.

Barcena de Arellano ML1Arnold JLang HVercellino GFChiantera VSchneider AMechsner S.

 

Abstract

To investigate the neurotrophic properties of endometriosis, as well as the involvement of neurotrophic factors in the development of chronic pelvic pain in patients with endometriosis, we performed a prospective clinical study. The presence of neurotrophins was investigated in the peritoneal fluid (PF) of patients with peritoneal endometriotic lesions or adenomyosis, as well as from women with non-endometriotic adhesions and from women without endometriosis/adenomyosis/adhesions. The PF from patients with peritoneal endometriotic lesions was divided in three groups: asymptomatic endometriosis, minimal pain and severe pain. PF from patients with adenomyosis or with non-endometriotic adhesions and the control group were divided in patients without pain and with pain. Neurotrophin expression in PF was analyzed using Elisa and the neuronal growth assay with cultured chicken sensory ganglia (dorsal-root-ganglia, DRG) and sympathetic ganglia. PF from women with peritoneal endometriotic lesions overexpress nerve growth factor (NGF) and neurotrophin-3 (NT-3), but not brain derived neurotrophic factor (BDNF), whereas the PF of women with adenomyosis or adhesions seems to express normal amounts of these factors. Neurotrophin expression did not differ among the pain groups. Furthermore, the PF from patients with peritoneal endometriotic lesions induced a strong sensory and a marginal sympathetic neurite outgrowth, while the PF from women with adenomyosis and non-endometriotic adhesions induced an outgrowth similar to the control group. The induced neurite outgrowth could only be inhibited in DRG incubated with peritoneal endometriotic lesions. Interestingly, the outgrowth of sympathetic ganglia was inhibited in all studied groups. The present study suggests that only peritoneal endometriotic lesions lead to an increased release of NGF and NT-3 into the PF and that NGF modulates the nerve fiber growth in endometriosis.

 

 

Int J Mol Med. 2013 May;31(5):1011-6. doi: 10.3892/ijmm.2013.1325. Epub 2013 Mar 28

Expression and localisation of osteopontin and prominin-1 (CD133) in patients with endometriosis.

D’Amico F1Skarmoutsou EQuaderno GMalaponte GLa Corte CScibilia GD’Agate GScollo PFraggetta FSpandidos DAMazzarino MC.

 

Abstract

In this study, we investigated the expression and localisation of the proteins, osteopontin (OPN) and prominin-1 (CD133), as well as the plasma OPN levels in the endometrium of patients with endometriosis. Samples of ectopic endometriotic lesions and normal endometrium were obtained from 31 women with endometriosis and 28 healthy control subjects. The mRNA and protein expression of OPN and CD133 was analysed by real‑time RT-PCR and immunohistochemistry. The plasma levels of OPN were determined by ELISA. Our results revealed that OPN mRNA and protein expression, as well as its release in the blood, was significantly increased in the endometriotic lesions in comparison to normal tissue. Although the presence of CD133+ cells was detected in the normal endometrium, as well as in the endometriosis specimens, a significant quantitative variation of this protein was not demonstrated in the patients with endometriosis. In conclusion, our data indicate that OPN is involved in the development of endometriosis by enhancing the invasiveness, proliferation and survival of endometrial cells in ectopic lesions. CD133 cannot be used as a disease marker for endometriosis, although an involvement of this protein in the pathogenesis of endometriosis cannot be excluded.

 

 

 

Arch Gynecol Obstet. 2013 Oct;288(4):901-4. doi: 10.1007/s00404-013-2794-z. Epub 2013 Apr 3.

Initiation of ovarian stimulation independent of the menstrual cycle: a case-control study.

Buendgen NK1Schultze-Mosgau ACordes TDiedrich KGriesinger G.

 

Abstract

PURPOSE:

In the GnRH-antagonist protocol, ovarian stimulation with gonadotropins typically commences on cycle day 2 or 3. Initiation of ovarian stimulation with a spontaneously occurring menstruation, however, poses significant organizational challenges for treatment centres and patients alike. It has previously been demonstrated in the context of fertility preservation that initiation of stimulation in the luteal phase is feasible in terms of retrieval of mature oocytes for cryopreservation. Herein, we report the extension of this concept to a routine IVF setting with the aim of establishing an ovarian stimulation protocol, which can be utilized independent of menstruation. Because of asynchrony of endometrium and embryo in such a setting, all fertilized oocytes have to be cryopreserved for a later transfer.

METHODS:

This was a prospective, case-control study (trial registration: NCT00795041) on the feasibility of starting ovarian stimulation in a GnRH-antagonist protocol in the luteal phase. Inclusion criteria were: IVF or ICSI; 18-36 years; ≤3 previous IVF/ICSI attempts; BMI 20-30 kg/m(2); regular cycle (28-35 days); luteal phase progesterone >7 ng/ml at initiation of stimulation. Exclusion criteria were: PCOS, endometriosis ≥AFS III°, unilateral ovary, expected poor response. Stimulation was performed with highly purified uFSH (Bravelle®) 300 IU/day and 0.25 mg/day GnRH-antagonist starting on cycle day 19-21 of a spontaneous menstrual cycle and commencing until hCG administration when three follicles ≥17 mm were present. All 2PN stage oocytes were vitrified for later transfers in programmed cycles. Feasibility was defined as the achievement of ongoing pregnancies progressing beyond the 12th gestational week in at least 2/10 study subjects (primary outcome). Secondary outcomes were gonadotropin consumption per oocyte obtained, stimulation duration, and fertilization rates. Study subjects were matched in a 1:3 ratio with concomitantly treated control cases of similar age, BMI, and duration of infertility who were treated in a conventional GnRH-antagonist protocol with 150-225 rFSH or HP-HMG/day.

RESULTS:

The study group consisted of ten subjects, mean age 31.4 years, BMI 25.4 kg/m(2), of which one had fertilization failure. Mean stimulation duration was 11.7 (SD 1.6) vs. 9.1 (SD 1.3) days, mean cumulative FSH dose was 3,495.0 (SD 447.5) vs. 2,040.5 (SD 576.2) IU, and mean number of oocytes was 8.8 (SD 5.0) vs. 10.0 (SD 5.4) in study vs. control group, respectively. Per follicle ≥10 mm, the cumulative FSH dose was 274.5 (SD 130.8) IU vs. 245.2 (SD 232.3) IU in study and control groups, respectively. Cumulative ongoing pregnancy rates were 1/10 (10 %) and 6/30 (20.0 %) in study and control group, respectively (difference: 10 %, 95 % confidence interval of the difference: -29.2-22.2 %, p = 0.47). Fertilization rate was similar between groups, with 63.5 % (SD 32.9) in the study and 61.3 % (SD 26.7) in the control group, respectively. Serum estradiol levels were significantly lower on the day of triggering final oocyte maturation with 1,005.3 (SD 336.2) vs. 1,977.4 pg/ml (SD 1,106.5) in study and control group, respectively. Similarly, peak estradiol biosynthesis per growing follicle ≥10 mm was lower in the study group (134 pg/ml, SD 158.4 vs. 186.7 pg/ml, SD 84.7).

CONCLUSIONS:

Per retrieved oocyte, a nearly threefold higher dose of FSH had to be administered when ovarian stimulation had been initiated in the luteal phase. Furthermore, the present study casts doubt on the efficacy of initiating ovarian stimulation in the luteal phase in terms of pregnancy achievement. Thus, this concept is currently not feasible for routine use, and it should also be explored further before using it at larger scale in the context of emergency stimulation for fertility preservation.

 

 

Arch Gynecol Obstet. 2013 Oct;288(4):793-7. doi: 10.1007/s00404-013-2822-z. Epub 2013 Apr 3.

Combination of non-invasive and semi-invasive tests for diagnosis of minimal to mild endometriosis.

Elgafor El Sharkwy IA1.

 

Abstract

OBJECTIVES:

Non-surgical diagnostic approach for endometriosis would be of great gain to both physicians and patients. The aim of this study was to evaluate the diagnostic value of serum measurement of IL-6 combined with the presence of nerve fibres in the functional layer of endometrium for diagnosis of minimal-mild endometriosis.

METHODS:

In this prospective study 114 women who underwent laparoscopy for infertility and/or pelvic pain were divided into two groups: control cases (40 cases) with no pathologic findings; and endometriosis patients (74 cases) [subdivided into stages 1-2 or minimal-mild (MM) and stages 3-4 or moderate-severe cases]. Blood was drawn one day before laparoscopy and stored for subsequent analysis of IL-6. Endometrial biopsy was obtained prior to laparoscopy and Immunohistochemistry was performed using the pan-neuronal marker protein gene product 9.5(PGP9.5). Then laparoscopic diagnosis of endometriosis confirmed by histopathology was done.

RESULTS:

Serum IL-6 with a threshold of 15.4 pg/ml was found to be able to diagnose MM endometriosis with 89.5 % sensitivity and 82.5 % specificity, but sensitivity and specificity of presence of nerve fibres in the functional layer of endometrium were 92 % and 80 % respectively. When two diagnostic modalities were combined the sensitivity and specificity were raised to 100 and 92.5 % respectively.

CONCLUSIONS:

Combination of both serum IL-6 and presence of nerve fibres in the endometrium is more reliable method for diagnosis of MM endometriosis than in single test.

 

 

 

Adv Exp Med Biol. 2013;784:159-86. doi: 10.1007/978-1-4614-6199-9_8.

Kisspeptin antagonists.

Roseweir AK1Millar RP.

 

Abstract

Kisspeptin is now known to be an important regulator of the hypothalamic–pituitary-gonadal axis and is the target of a range of regulators, such as steroid hormone feedback, nutritional and metabolic regulation. Kisspeptin binds to its cognate receptor, KISS1R (also called GPR54), on GnRH neurons and stimulates their activity, which in turn provides an obligatory signal for GnRH secretion-thus gating down-stream events supporting reproduction. The development of peripherally active kisspeptin antagonists could offer a unique therapeutic agent for treating hormone-dependent disorders of reproduction, including precocious puberty, endometriosis, and metastatic prostate cancer. The following chapter discusses the advances made in the search for both peptide and small molecule kisspeptin antagonists and their use in delineating the role of kisspeptin within the reproductive system. To date, four peptide antagonists and one small molecule antagonist have been designed.

 

 

 

J Sex Med. 2013 Jun;10(6):1559-66. doi: 10.1111/jsm.12133. Epub 2013 Apr 3.

Women with deep infiltrating endometriosis: sexual satisfaction, desire, orgasm, and pelvic problem interference with sex.

Montanari G1Di Donato NBenfenati AGiovanardi GZannoni LVicenzi CSolfrini SMignemi GVilla GMabrouk MSchioppa CVenturoli SSeracchioli R.

 

Abstract

INTRODUCTION:

Endometriosis is a chronic and progressive condition of women of reproductive age. It is strongly associated with a significant reduction of quality of life (QOL) and sexual function.

AIMS:

This study aims to objectively evaluate sexual function in women with deep infiltrating endometriosis (DIE) and to study the impact of endometriosis symptoms and type of lesion on patient’s sexual function.

METHODS:

This is a cross-sectional study in a tertiary care university hospital. It included 182 patients with preoperative clinical and ultrasound diagnosis of DIE who were referred to our center from 2008 to 2011.

MAIN OUTCOME MEASURES:

A sexual activity questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) was used to collect data pertaining to satisfaction, orgasm, desire, and pelvic problem interference with sex. Short Form 36 (SF-36) was used to evaluate QOL. Demographic and clinical characteristics were assessed: age, body mass index, parity, ethnicity, postsecondary education, employment, smoking, history of surgical treatment, and hormonal contraception. Patients were asked about pain symptoms (dysmenorrhea, dyspareunia, dyschezia, chronic pelvic pain, and dysuria) using a visual analog scale.

RESULTS:

The mean values obtained on the different scales of the SHOW-Q showed poor sexual function (mean SHOW-Q total score 56.38 ± 22.74). Satisfaction was the dimension most affected (mean satisfaction score 55.66 ± 34.55), followed by orgasm (mean orgasm score 56.90 ± 33.77). We found a significant correlation between the SF-36 scores and the SHOW-Q scores (P < 0.0001). Sexual dysfunction and deterioration of QOL seem to be correlated. Analyzing the impact of symptoms and lesions on sexual function, we found that dyspareunia and vaginal DIE nodules significantly affect sexual activity (P < 0.05).

CONCLUSION:

The results of this study demonstrated that women with DIE have a sexual function impairment, correlated with the overall well-being decrease. Moreover, the presence of dyspareunia and vaginal endometriotic lesions seems to be involved in sexual dysfunction.

 

 

J Obstet Gynaecol Res. 2013 May;39(5):985-90. doi: 10.1111/jog.12030. Epub 2013 Apr 3.

Postoperative administration of dienogest plus estradiol valerate versus levonorgestrel-releasing intrauterine device for prevention of pain relapse and disease recurrence in endometriosis patients.

Morelli M1Sacchinelli AVenturella RMocciaro RZullo F.

 

Abstract

AIM:

In recent years, both dienogest, a fourth-generation progestin, and levonorgestrel-releasing intrauterine device have been found to be effective in terms of endometriosis-related pelvic pain improvement. No data, however, are available about their efficacy in terms of postoperative recurrence prevention in women recently submitted to surgery for endometriosis at every stage. Our objective was to compare two postoperative medical approaches for pain control and reduction of recurrences in patients undergoing surgery for endometriosis.

MATERIAL AND METHODS:

Ninety-two patients undergoing surgery for endometriosis and subsequent treatment by estradiol valerate + dienogest (EP) (group A) or levonorgestrel-releasing uterine device (LNG-IUD) (Group B) between January 2009 and June 2010 were retrospectively analyzed. The primary endpoints were pain relapse and disease recurrence rate at 12 and 24 months. The secondary endpoint was patient satisfaction with the therapy at 24 months.

RESULTS:

Forty-eight patients in Group A and 44 in Group B were examined. At 12 and 24 months a statistically greater reduction both in Ca125 levels and VAS score was seen in women treated with EP compared to LNG-IUD. The recurrence rate at 12 and 24 months follow-up was slightly lower, but not at a significant level, in Group A than in Group B. Finally, satisfaction with treatment at 24 months was significantly higher in Group B.

CONCLUSION:

EP administration is significantly more effective than LNG-IUD in reducing pelvic pain and more effective in reducing recurrence rate but not at a significant level. LNG-IUD, however, has significantly higher patient satisfaction.

 

 

 

 

J Obstet Gynaecol Res. 2013 May;39(5):979-84. doi: 10.1111/jog.12033. Epub 2013 Apr 3.

Role of salpingoscopy in assessing the inner fallopian tubes of infertility patients with ovarian endometriomas.

Nakagawa K1Nishi YSugiyama RKuribayashi YAkira SSugiyama RInoue M.

Author information

Abstract

AIM:

The aim of this study was to observe the insides of the fallopian tubes of patients with unilateral or bilateral endometriomas by using salpingoscopy and evaluate the inner cavity of the fallopian tubes according to our original scoring system.

MATERIAL AND METHODS:

From April 2008 through December 2010, patients with unilateral or bilateral endometriomas were recruited (n = 157, endometrioma group). All patients underwent laparoscopic ovarian cystectomy and salpingoscopy. Using salpingoscopy, we observed the tubal lumen and calculated a fallopian tube score (F score) paying attention to the following six results: adhesions, loss of mucosal folds, rounded edges of mucosal folds, debris, foreign bodies, and abnormal vessels. The F scores were compared with those of the unexplained infertility patients who received those same procedures during the same period (n = 235; control group).

RESULTS:

Slightly more than three-quarters (75.9%) of the patients in the endometrioma group received F scores of 0, and this percentage was significantly higher than that for the control group (139/235 = 59.1%, P < 0.05). The pregnancy rate after conventional treatment for the endometrioma group was 21.7%, and all pregnant patients had achieved an F score of less than 2.

CONCLUSION:

It is highly possible that infertility patients with ovarian endometriomas are more likely to have intact fallopian tubes, by comparison with infertility patients who do not have ovarian endometriomas.

 

 

Diagn Pathol. 2013 Apr 3;8:53. doi: 10.1186/1746-1596-8-53.

Endobronchial endometriosis presenting as central-type lung cancer: a case report.

Yu JH1Lin XYWang LLiu YFan CFZhang YWang EH.

 

Abstract

A 45-year-old female patient was referred to our hospital for complaining of dyspnea and coughing in the past four months. The computed tomography scanning demonstrated a central lesion in the upper lobe of the left lung close to the hilar, and the subsequent bronchoscopy revealed a polypoid lesion of the distal of the left main bronchus. This patient was diagnosed clinically as “possibly central-type lung cancer”. However, the pathologic result of the surgically excised polypoid lesion was endobronchial endometriosis.

 

 

Arch Gynecol Obstet. 2013 Oct;288(4):805-14. doi: 10.1007/s00404-013-2828-6. Epub 2013 Apr 4.

Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis.

Wickiewicz D1Chrobak AGmyrek GBHalbersztadt AGabryś MSGoluda MChełmońska-Soyta A.

 

Abstract

PURPOSE:

To determine, with extended receiver operating characteristic (ROC) curve analysis, the diagnostic value of cytokines showing significantly different peritoneal concentrations between women with and without endometriosis.

METHODS:

Multiplex cytokine concentration measurement of IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ levels in peritoneal fluid of women with minimal to mild (n = 10) and moderate to severe (n = 26) endometriosis, and 42 controls.

RESULTS:

Only IL-6 and IL-10 concentrations were significantly higher in endometriosis patients than in controls. Specifically, significantly higher IL-6 and IL-10 levels were found in moderate to severe but not in minimal to mild endometriosis as compared to controls. For evaluation of diagnostic significance, ROC analysis determined discriminating parameters for IL-6, while those calculated for IL-10 were useless. Importantly, ROC analysis for IL-6 levels limited to women with moderate to severe endometriosis showed the highest area under the curve with the sample size sufficient to achieve 90 % power of the test. Finally, extended ROC including cost of analysis for this group of patients determined the optimal cut-off leading to high specificity and positive likelihood ratio resulting in 79 % effectiveness of the test.

CONCLUSIONS:

While our outcomes show moderate usefulness of peritoneal IL-6 levels in discrimination of moderate to severe endometriosis, further studies might be needed to determine the usefulness of peritoneal IL-6 levels in detection of early stages of endometriosis, as such a finding would be more relevant in clinical decision making.

 

 

 

Arch Gynecol Obstet. 2013 Oct;288(4):799-804. doi: 10.1007/s00404-013-2829-5. Epub 2013 Apr 4.

The FCRL3 -169T>C polymorphism and the risk of endometriosis-related infertility in a Polish population.

Szczepańska M1Wirstlein PHołysz HSkrzypczak JJagodziński PP.

 

Abstract

OBJECTIVE:

Recently, the FCRL3 -169T>C (rs7528684) single-nucleotide polymorphism (SNP) has been demonstrated to be a risk factor of endometriosis related infertility. We studied whether the FCRL -169T>C SNP can be associated with endometriosis-related infertility in a sample of the Polish population

METHODS:

Using PCR-RFLP analysis we genotyped 141 infertile women with endometriosis and 519 fertile women. FCRL3 transcript levels were determined by reverse transcription and real-time quantitative PCR analysis in CD19(+) B cells from women with endometriosis-associated infertility and fertile women

RESULTS:

We found a significantly increased frequency of the FCRL3 C/C genotype in women with endometriosis-associated infertility than controls [OR = 1.681 (95 % CI = 1.120-2.522, p = 0.0116, p corr = 0.0348)]. There was also a statistically increased frequency of the C/C and C/T genotypes in patients compared with controls [OR = 2.009 (95 % CI = 1.214-3.324, p = 0.0059, p corr = 0.0177)]. The p value of the χ (2) test for the trend observed for the FCRL3 -169T>C polymorphism was also statistically significant (p trend = 0.0012, p corr = 0.0036). We also found significantly increased FCRL3 transcript levels in carriers of the FCRL3 -169 CC vs TT and CT vs TT genotype both in women with endometriosis-related infertility (p = 0.012; p = 0.015) and fertile women (p = 0.017; p = 0.032) CONCLUSIONS: FCRL3 -169T>C polymorphism alters the expression of FCRL3 and can be a risk factor of endometriosis-related infertility.

 

 

 

Neurourol Urodyn. 2014 Mar;33(3):278-82. doi: 10.1002/nau.22401. Epub 2013 Mar 28

Obstructive sleep apnea increases the risk of bladder pain syndrome/interstitial cystitis: a population-based matched-cohort study.

Chung SD1Lin CCLiu SPLin HC.

 

Abstract

AIMS:

Previous studies indicated a possible association between bladder pain syndrome/interstitial cystitis (BPS/IC) and sleep disorders including sleep abnormalities with delayed onset of sleep, waking up before needed, and snoring. Nevertheless, no previous study has reported the association between obstructive sleep apnea (OSA) and BPS/IC. In this retrospective cohort study, we examined the risk of BPS/IC among subjects with OSA during a 3-year follow-up in Taiwan using a population-based dataset.

METHODS:

This study comprised 2,940 study subjects with OSA, and 29,400 randomly selected comparison subjects. We individually followed-up each sampled subject (n = 32,340) for a 3-year period to identify those subjects who subsequently received a diagnosis of BPS/IC. A Cox proportional hazards regression model was constructed to estimate the risk of subsequent BPS/IC following a diagnosis of OSA.

RESULTS:

Incidences of BPS/IC during the 3-year follow-up period were 13.61 (95% confidence interval [CI] = 7.37-23.13) and 3.60 (95% CI = 2.06-4.39) for subjects with and those without OSA, respectively. After adjusting for diabetes, hypertension, coronary heart disease, obesity, hyperlipidemia, chronic pelvic pain, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, depression, panic disorder, migraines, sicca syndrome, allergies, endometriosis, asthma, tobacco use disorder, and alcohol abuse, the stratified Cox proportional hazards regressions revealed that the hazard ratio for BPS/IC among subjects with OSA was 3.71 (95% CI = 1.81-7.62, P < 0.001) that of comparison subjects.

CONCLUSIONS:

This study provides epidemiological evidence of a link between OSA and a subsequent BPS/IC diagnosis. We suggest that clinical practitioners treating subjects with OSA be alert to urinary complaints in this population.

 

 

J Clin Endocrinol Metab. 2013 Jun;98(6):2469-77. doi: 10.1210/jc.2013-1019. Epub 2013 Apr 3

Induction of the neurokinin 1 receptor by TNFα in endometriotic tissue provides the potential for neurogenic control over endometriotic lesion growth.

McKinnon BD1Evers JBersinger NAMueller MD.

 

Abstract

CONTEXT:

Endometriosis is characterized by the growth of ectopic endometrial tissue. Nerve fibers are frequently associated with ectopic lesions, and neurogenic inflammation may play a role in endometriosis.

OBJECTIVE:

The purpose of this study was to determine the presence of tachykinin receptors in endometriotic lesions and the role of TNFα on their expression.

DESIGN:

This study was an assessment of matching eutopic and ectopic endometrial tissue and peritoneal fluid from patients with endometriosis and an in vitro analysis of primary endometrial cells.

SETTING:

The setting was a university hospital.

PATIENTS:

Participants were premenopausal women undergoing laparoscopy.

INTERVENTIONS:

Endometriotic lesions were removed surgically.

MAIN OUTCOME MEASURES:

Tachykinin mRNA (TACR1/2) and protein (neurokinin 1 receptor [NK1R]) expression in both eutopic and ectopic endometrial tissue from patients with endometriosis and the correlation to peritoneal fluid TNFα were measured. Primary endometrial epithelial and stromal cells were assessed in vitro to determine the induction of TACR1/2 and NK1R expression after TNFα treatment. Cell viability of endometrial stromal cells after substance P exposure was also assessed.

RESULTS:

Expression of both TACR1 and TACR2 mRNA was significantly higher in the ectopic than in the eutopic tissue. Both TACR1 mRNA and NK1R protein expression was significantly correlated with peritoneal fluid TNFα, and in vitro studies confirmed that TNFα treatment induced both TACR1 mRNA and NK1R protein expression in endometrial stromal cells. In endometrial stromal cells, substance P treatment enhanced cell viability, which was inhibited by a specific NK1R antagonist.

CONCLUSIONS:

NK1R expression is induced in ectopic endometrial tissue by peritoneal TNFα. Induction of NK1R expression may permit endometriotic lesion maintenance via exposure to substance P.

 

 

Ultrasound Obstet Gynecol. 2013 Jun;41(6):696-701. doi: 10.1002/uog.12468. Epub 2013 May 7.

Visualization of ureters on standard gynecological transvaginal scan: a feasibility study.

Pateman K1Mavrelos DHoo WLHolland TNaftalin JJurkovic D.

 

Abstract

OBJECTIVE:

To investigate the feasibility of identifying pelvic segments of normal ureters and measuring their size on standard transvaginal ultrasound examination.

METHODS:

This was a prospective observational study from June to July 2012. All women in the study underwent a transvaginal ultrasound examination performed for various indications either by an expert or by an intermediate-level operator. A standardized assessment of the pelvic organs was performed, recording any congenital or acquired uterine pathology and ovarian abnormalities. Visualization of pelvic segments of both ureters was attempted in all cases. The success in finding the ureters, the time required to identify them and their dimensions at rest and while exhibiting peristalsis were all recorded.

RESULTS:

A total of 245 consecutive women were included in the study. In all women at least one ureter was successfully identified. Both ureters were seen in 227 women (92.7% (95% CI, 89.4-96.0%)). In 17 (6.9% (95% CI, 3.7-10.1%)) the left ureter was not seen and in one woman (0.4% (95% CI, 0.0-1.2%)) the right ureter could not be visualized (P < 0.001). There were no significant differences in the median time required to visualize the right and left ureters (9.0 (interquartile range (IQR), 6.0-14.0) s vs 8.0 (IQR, 6.0 -14.0) s, respectively; P = 0.9). The median diameter of the right ureter was 1.7 (IQR, 1.4-2.2) mm at rest and 2.9 (IQR, 2.4-3.6) mm during peristalsis. The median diameter of the left ureter was 1.9 (IQR, 1.6-2.3) mm at rest and 2.9 (IQR, 2.4-3.6) mm during peristalsis.

CONCLUSION:

Pelvic segments of normal ureters can be identified in most women on transvaginal ultrasound examination. Visualization of the ureters could be integrated into the routine pelvic ultrasound examination, particularly in women presenting with pelvic pain or in those with suspected pelvic endometriosis.

 

 

PLoS One. 2013;8(3):e60165. doi: 10.1371/journal.pone.0060165. Epub 2013 Mar 28.

A novel role of the Sp/KLF transcription factor KLF11 in arresting progression of endometriosis.

Daftary GS1Zheng YTabbaa ZMSchoolmeester JKGada RPGrzenda ALMathison AJKeeney GLLomberk GAUrrutia R.

 

Abstract

Endometriosis affects approximately 10% of young, reproductive-aged women. Disease associated pelvic pain; infertility and sexual dysfunction have a significant adverse clinical, social and financial impact. As precise disease etiology has remained elusive, current therapeutic strategies are empiric, unfocused and often unsatisfactory. Lack of a suitable genetic model has impaired further translational research in the field. In this study, we evaluated the role of the Sp/KLF transcription factor KLF11/Klf11 in the pathogenesis of endometriosis. KLF11, a human disease-associated gene is etiologically implicated in diabetes, uterine fibroids and cancer. We found that KLF11 expression was diminished in human endometriosis implants and further investigated its pathogenic role in Klf11-/- knockout mice with surgically induced endometriotic lesions. Lesions in Klf11-/- animals were large and associated with prolific fibrotic adhesions resembling advanced human disease in contrast to wildtype controls. To determine phenotype-specificity, endometriosis was also generated in Klf9-/- animals. Unlike in Klf11-/- mice, lesions in Klf9-/- animals were neither large, nor associated with a significant fibrotic response. KLF11 also bound to specific elements located in the promoter regions of key fibrosis-related genes from the Collagen, MMP and TGF-β families in endometrial stromal cells. KLF11 binding resulted in transcriptional repression of these genes. In summary, we identify a novel pathogenic role for KLF11 in preventing de novo disease-associated fibrosis in endometriosis. Our model validates in vivo the phenotypic consequences of dysregulated Klf11 signaling. Additionally, it provides a robust means not only for further detailed mechanistic investigation but also the ability to test any emergent translational ramifications thereof, so as to expand the scope and capability for treatment of endometriosis.

 

 

Fertil Steril. 2013 Jul;100(1):127-34.e1. doi: 10.1016/j.fertnstert.2013.03.006. Epub 2013 Apr 1.

Altered circulating levels of matrix metalloproteinases 2 and 9 and their inhibitors and effect of progesterone supplementation in women with endometriosis undergoing in vitro fertilization.

Singh AK1Chattopadhyay RChakravarty BChaudhury K.

 

Abstract

OBJECTIVE:

To investigate differences in the activity of matrix metalloproteinases (MMPs) 2 and 9 and their respective tissue inhibitors (TIMPs) in follicular fluid of women with endometriosis, to correlate the findings with IVF outcome, and to examine the therapeutic potential of progesterone supplementation in restoring the fine balance between MMPs and TIMPs.

DESIGN:

Prospective case-control clinical study.

SETTING:

Infertility clinic and reproductive health research unit.

PATIENT(S):

A total of 340 infertile women undergoing IVF.

INTERVENTION(S):

Natural micronized progesterone capsules were administered for luteal support.

MAIN OUTCOME MEASURE(S):

Association of MMPs 2 and 9 and TIMP-1 with oocyte maturity and embryo development.

RESULT(S):

An abnormal expression of MMP-2, MMP-9, and TIMP-1 with extensive MMP-9/TIMP-1 imbalance in women with endometriosis undergoing IVF was observed. Transforming growth factor β1 plays an important role in these women with possible involvement of Smad-2 and -3 proteins. Progesterone supplementation improves the imbalance in MMP-9/TIMP-1 ratio significantly in women with endometriosis who conceive after IVF.

CONCLUSION(S):

Increase in MMP-2 and -9 and decrease in TIMP-1 expression was associated with poor oocyte and embryo development in women with endometriosis undergoing IVF. MMP-9/TIMP-1 balance was highly affected in these women, and progesterone supplementation appeared to restore this imbalance to a considerable degree.

 

 

 

Br J Cancer. 2013 Apr 30;108(8):1553-9. doi: 10.1038/bjc.2013.126. Epub 2013 Apr 4. Review.

New perspectives on molecular targeted therapy in ovarian clear cell carcinoma.

Tan DS1Miller REKaye SB.

 

Abstract

Ovarian clear cell carcinomas (OCCCs) account for about 5-13% of all epithelial ovarian carcinomas in Western populations. It is characterised by resistance to conventional platinum-based chemotherapy, and new therapeutic strategies are urgently required. This article will focus on how recent discoveries have enhanced our understanding of the molecular pathogenesis of OCCCs, leading to new therapeutic opportunities. These include mutations in ARID1A, which provides a link to endometriosis, upregulation of the phosphatidylinositol 3-kinase/AKT pathway, particularly through mutations of PIK3CA and inactivation of PTEN, and increased activity of pathways involved in angiogenesis. Targeting HER2, apoptotic escape mechanisms and mismatch repair defects offer additional opportunities for treating this enigmatic tumour subtype.

 

 

 

 

Ethiop J Health Sci. 2013 Mar;23(1):69-72.

Endometriosis of the appendix presenting as acute appendicitis: a case report and literature review.

Uwaezuoke S1Udoye EEtebu E.

 

Abstract

Endometriosis is a common disease generally, but appendiceal endometriosis causing acute appendicitis is a very uncommon clinical phenomenon and a few cases have been reported. The authors aim to highlight the rarity of such clinical entity in Nigeria. A 29 year old nulliparous woman presented with severe right iliac fossa pains, tenderness and rebound tenderness on her second day of menstruation. She subsequently had appendicectomy and a histopathological diagnosis of appendiceal endometriosis causing acute appendicitis. Appendiceal endometriosis causing acute appendicitis is rare, and definitive diagnosis is performed through histopathological evaluation. Post-operative gynaecological follow-up is highly recommended.

 

 

Acta Obstet Gynecol Scand. 2013 May;92(5):546-54. doi: 10.1111/aogs.12123. Epub 2013 Apr 8.

Hormonal and surgical treatments for endometriosis and risk of epithelial ovarian cancer.

Melin AS1Lundholm CMalki NSwahn MLSparèn PBergqvist A.

 

Abstract

OBJECTIVE:

Whether hormonal or surgical treatment of endometriosis is associated with risk of epithelial ovarian cancer.

DESIGN:

Nested case-control study.

SETTING:

Sweden.

POPULATION:

All women with a first-time discharge diagnosis of endometriosis in 1969-2007 were identified using the National Swedish Patient Register and constituted our study base.

METHODS:

By linkage to the National Swedish Cancer Register we identified all women diagnosed with epithelial ovarian cancer at least one year after the endometriosis diagnosis (cases). Two controls per case with no ovarian cancer before the date of cancer diagnosis of the case were randomly selected from the study base and matched for year of birth. Two-hundred-and-twenty cases and 416 controls entered the study. Information on hormonal and surgical treatments and other reproductive factors was extracted from medical records according to pre-specified protocols. Conditional logistic regression was used for all calculations.

MAIN OUTCOME MEASURES:

Crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) for all hormonal as well as surgical treatments.

RESULTS:

There was a significant association between one-sided oophorectomy, as well as for radical extirpation of all visible endometriosis, and ovarian cancer risk in both univariate analyses (crude OR 0.42, 95% CI 0.28-0.62 and OR 0.37, 95% CI 0.25-0.55, respectively) and multivariate analyses (adjusted OR 0.19, 95% CI 0.08-0.46 and OR 0.30, 95% CI 0.12-0.74, respectively).

CONCLUSIONS:

One-sided oophorectomy as well as radical extirpation of all visible endometriosis is protective against later development of ovarian cancer.

 

 

Clin Res Hepatol Gastroenterol. 2013 Jun;37(3):e85-8. doi: 10.1016/j.clinre.2013.02.011. Epub 2013 Apr 4.

Liver endometriosis presenting as a liver mass associated with high blood levels of tumoral biomarkers.

Bouras AF1Vincentelli ABoleslawski ETruant SLiddo GPrat APruvot FRZerbib P.

 

Abstract

Endometriosis is a dissemination of endometrial-like tissue outside the uterine cavity, responsible for pain and impaired fertility in women of childbearing age. Although endometriosis generally occurs in the pelvis, it can be located further away. We describe the case of a 35-year-old woman who was admitted for further evaluation of a cystic mass of the liver that had invaded the right ventricle and caused pain. Serum levels of the tumor markers CA 125, CA 15-3 and CA 19-9 were elevated. The tumor was resected with a small part of the right ventricle free wall, the diaphragm and the left liver lobe. A histological analysis confirmed that the mass was a benign endometrial cyst. The postoperative course was uneventful and the patient remains asymptomatic with 5 year follow-up. A diagnosis of endometriosis should be considered for thoraco-abdominal cystic masses associated with menses-related pain in women of childbearing age.

 

 

 

Curr Opin Obstet Gynecol. 2013 Jun;25(3)

Regenerating endometrium from stem/progenitor cells: is it abnormal in endometriosis, Asherman’s syndrome and infertility?

Deane JA1Gualano RCGargett CE.

 

Abstract

PURPOSE OF REVIEW:

Stem/progenitor cells are present in human and rodent endometrium and have a key role in endometrial regeneration in normal cycling and after parturition. We review emerging evidence of multiple types of endometrial stem/progenitor cells, and that abnormalities in their location and function may contribute to endometriosis.

RECENT FINDINGS:

Candidate human endometrial stem/progenitors have been identified as clonogenic, Side Population and possessing tissue reconstitution activity. Markers have been identified for human endometrial mesenchymal stem cells, showing their perivascular location in functionalis and basalis endometrium. Human embryonic stem cells can be induced to develop endometrial epithelium, recapitulating endometrial development. In rodent studies, endometrial stem/progenitor cells were identified as label-retaining cells and their role in endometrial repair and regeneration revealed, perhaps via mesenchymal to epithelial transition. Studies of Wnt signalling in the regulation of endometrial stem/progenitor cells may yield insights into their function in endometrial regeneration. Stem/progenitor cells can be isolated from endometrial biopsy or menstrual blood and may be used autologously to regenerate endometrium in Asherman’s syndrome.

SUMMARY:

There is much to be learnt about endometrial stem/progenitor cell biology and their role in endometriosis. Endometrial stem/progenitor cells hold great promise for new treatments for infertility associated disorders, including thin dysfunctional endometrium and Asherman’s syndrome.

 

 

J Minim Invasive Gynecol. 2013 Jul-Aug;20(4):473-81. doi: 10.1016/j.jmig.2013.01.019. Epub 2013 Apr 6.

Combined surgical and hormone therapy for endometriosis is the most effective treatment: prospective, randomized, controlled trial.

Alkatout I1Mettler LBeteta CHedderich JJonat WSchollmeyer TSalmassi A.

 

Abstract

STUDY OBJECTIVE:

To evaluate 3 therapy strategies: hormone therapy, surgery, and combined treatment.

DESIGN:

Prospective, randomized, controlled study (Canadian Task Force classification I).

SETTING:

University-based teaching hospital.

PATIENTS:

Four hundred fifty patients with genital endometriosis, aged 18 to 44 years, before first laparoscopy.

INTERVENTIONS:

Patients were randomly assigned to 1 of 3 treatment groups: hormone therapy, surgery, or combined treatment. Patients were reevaluated at second-look laparoscopy, at 2 to 2 months after 3-month hormone therapy in groups 1 and 3 and at 5 to 6 months in group 2 (surgical treatment alone). Outcome data were focussed on the endometriosis stage, recurrence of symptoms, and pregnancy rate.

MEASUREMENTS AND MAIN RESULTS:

All treatment options, independent of the initial Endoscopic Endometriosis Classification stage, achieved an overall cure rate of ≥50%. A cure rate of 60% was achieved with the combined treatment, 55% with exclusively hormone therapy, and 50% with exclusively surgical treatment. Recurrence of symptoms was lowest in patients who received combined treatment. Significant benefit was achieved for dysmenorrhea and dyspareunia. An overall pregnancy rate of 55% to 65% was achieved, with no significant difference between the therapeutic options.

CONCLUSION:

In the quest to find the most effective treatment of genital endometriosis, this clinical randomized study shows the lowest incidence of recurrence with combined surgical and medical treatment and improved pregnancy rate in any medically treated patients with or without surgery. The highest cure rate (Endoscopic Endometriosis Classification stage 0) for endometriosis was also achieved in the combined treatment group.

 

 

Zhonghua Yi Xue Za Zhi. 2013 Jan 15;93(3):208-11.

Application of half-dose depot long-acting triptorelin in postoperative adjuvant therapy for endometriosis.

Liu X1Zhang HXWang LPFu WP.

 

Abstract

OBJECTIVE:

To evaluate the efficacy and adverse effects of half-dose depot long-acting triptorelin in the therapy of endometriosis.

METHODS:

The efficacy and adverse effects of routine-dose or half-dose triptorelin in postoperative endometriosis patients were prospectively observed. A total of 186 postoperative patients with moderate or severe endometriosis received an intramuscular injection of triptorelin every 28 days for 6 times. They were randomly divided into 3 groups, i.e. half-dose group (n = 99): 1.875 mg each time; “draw-back” group (n = 52): 3.75 mg first time, then 1.875 mg each time; and routine-dose group (n = 35): 3.75 mg each time.

RESULTS:

Amenorrhea was effectively induced in all patients after the second injection. There was no significant difference in the rate of serum E2 level at Day 28 of every injection below the upper limit of “estrogen threshold (110 – 146 pmol/L)” not stimulating ectopic endometrium proliferation among half-dose group, “draw-back” group and routine-dose group (99% vs 100% and 99.0%, P > 0.05), the percentage of E2 < 37 pmol/L in E2 < 110 pmol/L in half-dose group was significantly lower than that in “draw-back” and routine-dose groups after 2-5(th) injection (69% vs 79% and 85%, P < 0.01), but there was no significant difference after first half-dose and routine-dose injection (71% vs 73%, P > 0.05). No significant difference existed in the rate of pelvic pain relief during the first returning menstruation and the recurrence rate of endometriosis within 1 year postoperation among three groups (both P > 0.05). However, the incidences of menopausal syndrome and severe menopausal syndrome in half-dose group were significantly lower than those in “draw-back” and routine-dose groups (both P < 0.01). And the incompletion rate of six-time drug for severe menopause syndrome was also significantly lower (P < 0.05) while the completion rate of six-time drug use in half-dose group was significantly higher (P < 0.05).

CONCLUSION:

As a postoperative adjuvant, half-dose depot triptorelin therapy is efficacious for endometriosis. It reduces menopausal syndrome and treatment cost and enhances patient compliance.

 

 

Curr Opin Obstet Gynecol. 2013 Jun;25(3)

Endometriosis Fertility Index: is it better than the present staging systems?

Adamson GD1.

 

Abstract

PURPOSE OF REVIEW:

Endometriosis is a complex disease, one aspect being the existence of multiple staging systems. The recent Endometriosis Fertility Index (EFI) is compared with other endometriosis infertility staging systems and three new studies assessing the EFI are reported.

RECENT FINDINGS:

The revised American Fertility Society classification system has historically been most widely used but does not predict pregnancy rates. The ENZIAN classification system is designed to describe more severe disease as an adjunct to the ASRM system, but does not predict pregnancy rates. The American Association of Gynecological Laparoscopists (now named AAGL) is developing a categorization system more focused on pain. Novel research in imaging, biomarkers, histology and the human genome may provide useful information to develop future classification systems. The EFI has recently been published as a validated prospective staging system that predicts non-assisted reproductive technology pregnancy rates in infertility patients following surgical diagnosis. Three other investigators have now validated the EFI.

SUMMARY:

The only validated endometriosis classification system that predicts a clinical outcome is the EFI. The EFI has now been validated by three additional investigators. Renewed interest in the importance and utility of classification systems will hopefully result in novel classification systems that are useful for other clinical presentations of endometriosis.

 

 

Sultan Qaboos Univ Med J. 2013 Feb;13(1)

Chronic Umbilical Discharge: An unusual presentation of endometriosis.

Jafferbhoy S1Symeonides PLevy MShiwani MH.

 

Abstract

Umbilical endometriosis is an important differential diagnosis of any umbilical lesion. A 35-year-old type 2 diabetic woman presented with intermittent umbilical discharge which failed to respond to various antibiotics. An ultrasound scan and MRI scan failed to show any obvious abnormality. The umbilicus was excised and histology confirmed endometriosis. Surgical excision provides a definitive diagnosis and curative treatment for isolated endometriosis.

 

 

 

BJOG. 2013 Aug;120(9):1075-83

Unsafe abortion after legalisation in Nepal: a cross-sectional study of women presenting to hospitals.

Rocca CH1Puri MDulal BBajracharya LHarper CCBlum MHenderson JT.

 

Abstract

OBJECTIVE:

To investigate abortion practices of Nepali women requiring postabortion care.

DESIGN:

Cross-sectional study.

SETTING:

Four tertiary-care hospitals in urban and rural Nepal.

SAMPLE:

A total of 527 women presenting with complications from induced abortion in 2010.

METHODS:

Women completed questionnaires on their awareness of the legal status of abortion and their abortion-seeking experiences. The method of induction and whether the abortion was obtained from an uncertified source was documented. Multivariable logistic regression was used to identify associated factors.

MAIN OUTCOME MEASURES:

Induction method; uncertified abortion source.

RESULTS:

In all, 234 (44%) women were aware that abortion was legal in Nepal. Medically induced abortion was used by 359 (68%) women and, of these, 343 (89%) took unsafe, ineffective or unknown substances. Compared with women undergoing surgical abortion, women who had medical abortion were more likely to have obtained information from pharmacists (161/359, 45% versus 11/168, 7%, adjusted odds ratio [aOR] 8.1, 95% confidence interval 4.1-16.0) and to have informed no one about the abortion (28/359, 8% versus 3/168, 2%, aOR 5.5, 95% CI 1.1-26.9). Overall, 291 (81%) medical abortions and 50 (30%) surgical abortions were obtained from uncertified sources; these women were less likely to know that abortion was legal (122/341, 36% versus 112/186, 60%, aOR 0.4, 95% CI 0.2-0.7) and more likely to choose a method because it was available nearby (209/341, 61% versus 62/186, 33%, aOR 2.5, 95% CI 1.5-4.3), compared with women accessing certified sources.

CONCLUSIONS:

Among women presenting to hospitals in Nepal with complications following induced abortion of pregnancy, the majority had undergone medically induced abortions using unknown substances acquired from uncertified sources. Women using medications and those accessing uncertified providers were less aware that abortion is now legal in Nepal. These findings highlight the need for continued improvements in the provision and awareness of abortion services in Nepal.

 

 

 

Biol Reprod. 2013 May 16;88(5):122. doi: 10.1095/biolreprod.112.103598. Print 2013 May.

Caldesmon: new insights for diagnosing endometriosis.

Meola J1Hidalgo Gdos SSilva JCSilva LEPaz CCFerriani RA.

 

Abstract

Considerable effort has been invested in searching for less invasive methods of diagnosing endometriosis. Previous studies have indicated altered levels of the CALD1 gene (encoding the protein caldesmon) in endometriosis. The aims of our study were to investigate whether average CALD1 expression and caldesmon protein levels are differentially altered in the endometrium and endometriotic lesions and to evaluate the performance of the CALD1 gene and caldesmon protein as potential biomarkers for endometriosis. Paired biopsies of endometrial tissue (eutopic endometrium) and endometriotic lesions (ectopic endometrium) were obtained from patients with endometriosis to evaluate CALD1 gene expression and caldesmon protein levels by real-time PCR and Western blot analysis, respectively. In addition, immunostaining for caldesmon to determine cellular localization was also performed. Endometrium from women without endometriosis was used as a control. Increased CALD1 expression and caldesmon levels were detected in the endometriotic lesions. The electrophoretic profile of caldesmon by Western blot analysis was clearly different between the control group (endometrium of women without endometriosis) and the group of women with endometriosis (eutopic endometrium and endometriotic lesions). Caldesmon expression as determined by immunostaining showed no variation among the cell types in endometriotic lesions and eutopic endometrium. Stromal cells marked positively in eutopic endometrium from control patients and in the endometriotic lesions. The presence of caldesmon in the endometrium of patients with and without endometriosis permitted diagnoses with 95% sensitivity (specificity 100%) and 100% sensitivity (specificity 100%) for the disease and for minimal to mild endometriosis in the proliferative phase of the menstrual cycle, respectively. In the secretory phase, minimal to mild endometriosis was detected with 90% sensitivity and 93.3% specificity. Caldesmon is a possible predictor of endometrial dysregulation in patients with endometriosis. A potential limitation of our study is the fact that other endometrial diseases were not excluded, and therefore prospective studies are needed to confirm the potential of caldesmon as a biomarker exclusively for endometriosis.

 

 

 

Mol Reprod Dev. 2013 Jun;80(6):441-50. doi: 10.1002/mrd.22180. Epub 2013 May 24.

Proteomic analysis of follicular fluid from women with and without endometriosis: new therapeutic targets and biomarkers.

Lo Turco EG1Cordeiro FBLopes PHGozzo FCPilau EJSoler TBda Silva BFDel Giudice PTBertolla RPFraietta RCedenho AP.

 

Abstract

Endometriosis is a gynecological disease that affects women of reproductive age. The protein profiles of women with endometriosis who were able or unable to achieve pregnancy and women without endometriosis who did achieve pregnancy were compared in this study. The follicular fluid was collected from 21 patients undergoing in vitro-fertilization treatment, according to the following groups: nine women in the control group (Group C), four women with endometriosis who achieved pregnancy (Group E.P), and eight women with endometriosis who did not achieve pregnancy (Group E.NP). Follicular fluid proteins were separated using 2D-electrophoresis, and their spots were compared, excised, and submitted to LC-ESI-MS/MS for proteins identification. The analysis showed 29 differentially expressed spots among the groups, and from these, 21 proteins were identified. Analysis showed some functional enrichment in the E.P group, including response to oxidative stress and apoptosis, while the E.NP group showed functions related to response to reactive oxygen species and positive regulation of apoptosis. These data suggest that endometriosis leads to differential protein expression in the follicular fluid, which can influences the outcome of pregnancy. These proteins may be potential targets for better diagnostics and new therapeutic intervention in affected women, as well as assisting in comprehending the physiopathologic mechanisms underlying endometriosis.

 

 

 

J Gynecol Obstet Biol Reprod (Paris). 2013 Jun;42(4) :325-33

Endometriosis-associated ovarian cancers: pathogenesis and consequences on daily practice.

Borghese B1Santulli PVaiman DAlexandre JGoldwasser FChapron C.

 

Abstract

Endometriosis is considered as a tumor-like lesion under the World Health Organization (WHO) classification of ovarian tumors. Data from large cohort and case-control studies indicate that patients with a history of endometriosis have an increased risk of ovarian cancer. Recent findings suggest an association between endometriosis and the entire type 1 ovarian tumors group including clear-cell, endometrioid and low-grade serous carcinomas. However, current evidence is lacking to draw definitive conclusion whether this association represents causality or the sharing of common risk factors. Nevertheless, assumption that endometriosis could be a precursor of malignancy raises many issues about serial screening, surgical management and surveillance of endometriosis. Beyond these concerns, endometriosis-associated ovarian cancers seem to be a genuine clinical entity as regards clinicopathological features. In view of the high incidence of endometriosis (10 % of women of childbearing age), the low incidence of endometriosis-associated ovarian cancers and the psychological consequences for those women, systematic screening and surgical exploration seem very questionable in this context.

 

 

 

 

 

 

Hum Reprod. 2013 Jul;28(7):1953-60.

The influence of intrauterine contraception on the prevalence and severity of dysmenorrhea: a longitudinal population study.

Lindh I1Milsom I.

 

Abstract

STUDY QUESTION:

Does intrauterine contraception influence the prevalence and severity of dysmenorrhea?

SUMMARY ANSWER:

In this longitudinal study, a copper intrauterine device (Cu-IUD) did not influence the severity of dysmenorrhea, whereas the levonorgestrel-releasing intrauterine system (LNG-IUS) reduced dysmenorrhea severity.

WHAT IS KNOWN ALREADY:

Dysmenorrhea is a common problem among young women. The LNG-IUS has been reported to be associated with less painful menstruation, although more long-term studies are necessary. In contrast Cu-IUDs have been reported to exacerbate dysmenorrhea.

STUDY DESIGN, SIZE, DURATION:

A longitudinal population study. The prevalence and severity of dysmenorrhea was compared in a longitudinal analysis of variance performed in the same women when using either intrauterine contraception (Cu-IUD or LNG-IUS) or combined oral contraceptives (COCs) with other methods of contraception or no contraception.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Random samples of 19-year-old women born in 1962 (n = 656), 1972 (n = 780) and 1982 (n = 666) assessed at 5-year intervals between 1981 and 2001. Current severity of dysmenorrhea was assessed on each occasion by a verbal multidimensional scoring system (VMS) and by a visual analog scale (VAS).

MAIN RESULTS AND THE ROLE OF CHANCE:

Dysmenorrhea severity was unchanged in the same woman when using a Cu-IUD compared with using other methods (= condom use, barrier methods, natural family planning, coitus interruptus and sterilization)/no method of contraception in the longitudinal analysis of factors influencing dysmenorrhea severity (VMS score: +0.05 units/VAS: -0.3 mm, both NS). LNG-IUS and COC use were associated with reduced dysmenorrhea severity compared with other methods/no method (LNG-IUS use, VMS score: -0.4 units/VAS: -13 mm, both P < 0.01; COC use, VMS score: -0.4 units/VAS: -11 mm, both P < 0.0001). Childbirth reduced dysmenorrhea (VMS score: -0.3 units, P < 0.05/VAS: -16 mm, P < 0.001). Dysmenorrhea severity decreased between the ages of 19 and 44 years.

LIMITATIONS, REASONS FOR CAUTION:

There was a decline in the response rate over time during the 20 years of this longitudinal study which may be due to the fact that the distribution of questionnaires has become much more common and people are becoming increasingly tired of answering questionnaires. No information about the diagnosis or treatment of endometriosis or adenomyosis, which are important confounding factors, were included in the questionnaire. In this study we specifically studied dysmenorrhea and have clearly separated this from the assessment of possible pain caused by intrauterine contraception experienced between periods. RCTs should be initiated to further investigate the influence of intrauterine contraception on dysmenorrhea and the risk of developing abdominal pain between periods.

WIDER IMPLICATIONS OF THE FINDINGS:

In this study Cu-IUD use did not influence the severity of dysmenorrhea and the LNG-IUS was shown to reduce the severity of dysmenorrhea. This is valuable information for prescribers and users when considering intrauterine contraception.

 

 

Fertil Steril. 2013 Jul;100(1):162-9.e1-2. doi: 10.1016/j.fertnstert.2013.03.026. Epub 2013 Apr 8

Bisphenol A and phthalates and endometriosis: the Endometriosis: Natural History, Diagnosis and Outcomes Study.

Buck Louis GM1Peterson CMChen ZCroughan MSundaram RStanford JVarner MWKennedy AGiudice LFujimoto VYSun LWang LGuo YKannan K.

 

Abstract

OBJECTIVE:

To explore the relation between bisphenol A and 14 phthalate metabolites and endometriosis.

DESIGN:

Matched cohort design.

SETTING:

Fourteen clinical centers.

PATIENT(S):

The operative cohort comprised 495 women undergoing laparoscopy/laparotomy, whereas the population cohort comprised 131 women matched on age and residence.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Surgically visualized or pelvic magnetic resonance imaging diagnosed endometriosis in the two cohorts, respectively.

RESULT(S):

Odds ratios (OR) and 95% confidence intervals (CIs) were estimated using logistic regression adjusting for age, body mass index, and creatinine. In the population cohort, six phthalate metabolites-mono-n-butyl phthalate, mono-[(2-carboxymethyl) hexyl] phthalate, mono (2-ethyl-5-carboxyphentyl) phthalate, mono (2-ethylhexyl) phthalate, mono (2-ethyl-5-hydroxyhexyl) phthalate, and mono (2-ethyl-5-oxohexyl) phthalate-were significantly associated with an approximately twofold increase in the odds of an endometriosis diagnosis. Two phthalates were associated with endometriosis in the operative cohort when restricting to visualized and histologic endometriosis (monooctyl phthalate; OR 1.38; 95% CI 1.10-1.72) or when restricting comparison women to those with a postoperative diagnosis of a normal pelvis [mono (2-ethylhexyl) phthalate; OR 1.35; 95% CI 1.03-1.78].

CONCLUSION(S):

Select phthalates were associated with higher odds of an endometriosis diagnosis for women with magnetic resonance imaging-diagnosed endometriosis. The lack of consistency of findings across cohorts underscores the impact of methodology on findings.

 

 

 

 

 

Fertil Steril. 2013 Aug;100(2):516-22.e3. doi: 10.1016/j.fertnstert.2013.03.032. Epub 2013 Apr 8.

One-year follow-up of serum antimüllerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve?

Sugita A1Iwase AGoto MNakahara TNakamura TKondo MOsuka SMori MSaito AKikkawa F.

 

Abstract

OBJECTIVE:

To investigate whether the serum antimüllerian hormone (AMH) levels recover within 1 year after cystectomy for endometriomas, and to analyze the pattern of sequential changes in the serum AMH levels.

DESIGN:

Prospective study.

SETTING:

University hospital.

PATIENT(S):

Thirty-nine patients undergoing cystectomy for unilateral endometrioma (n = 22) and bilateral endometriomas (n = 17).

INTERVENTION(S):

Serum samples collected 2 weeks before, and 1 month and 1 year after surgery were assayed for AMH levels.

MAIN OUTCOME MEASURE(S):

Assessment of the ovarian reserve damage based on alterations in the serum AMH levels and the association with parameters of endometriosis and surgery for endometriomas.

RESULT(S):

The median AMH levels were 3.56, 1.90, and 2.10 ng/mL before, 1 month after, and 1 year after surgery, respectively. Twenty patients showed higher AMH levels 1 year after surgery than 1 month after surgery (increase group); 19 patients showed lower AMH levels (decrease group). We found a statistically significant difference in the number of follicles removed by surgery between the two groups.

CONCLUSION(S):

The decrease in the serum AMH levels caused by cystectomy can recover. Our results suggest that removal of ovarian cortex might be involved in the decrease of the ovarian reserve just after surgery, and that a continuous decrease of the ovarian reserve after cystectomy might be attributed to other mechanisms.

 

 

Fertil Steril. 2013 Jul;100(1):135-41.e1-2. doi: 10.1016/j.fertnstert.2013.03.019. Epub 2013 Apr 8.

Expression of adiponectin, leptin, and their receptors in ovarian endometrioma.

Choi YS1Oh HKChoi JH.

 

Abstract

OBJECTIVE:

To evaluate the expression of leptin, leptin receptor (ObR), adiponectin, and adiponectin receptor (AdipoR) in ovarian endometriomas compared with normal endometrium, and to analyze relationships among adipokines and their receptors.

DESIGN:

Experimental study.

SETTING:

A clinic for the treatment of endometriosis and basic research laboratories.

PATIENT(S):

Forty-four women with endometriosis and 42 age-matched women with no laparoscopic evidence of endometriosis as control subjects.

INTERVENTION(S):

Endometrial tissue samples were obtained during laparoscopic surgery.

MAIN OUTCOME MEASURE(S):

Immunohistochemical staining for leptin, ObR, adiponectin, and AdipoR was performed with the use of tissue microarray. Clinical characteristics were reviewed from the patient’s medical records. The effect of leptin on the expression of adiponectin was evaluated in endometriotic cell line using real-time reverse-transcription polymerase chain reaction.

RESULT(S):

Positive expression rates of leptin and ObR were significantly higher in ovarian endometrioma compared with normal endometrium, but those of adiponectin and AdipoR were similar (ovarian endometrioma vs. normal endometrium, respectively: leptin 100% vs. 59.5%; ObR 72.7% vs. 33.3%; adiponectin 31.8% vs. 42.9%; AdipoR 88.6% vs. 73.8%). Expression of adipokines and their receptors did not show any correlation with disease stage. A positive correlation was found between expression of ObR and adiponectin (correlation coefficient 0.488; P=.001). Leptin treatment in endometriotic cells induced mRNA expression of adiponectin.

CONCLUSION(S):

These data suggest that leptin and its receptor are induced in ovarian endometriomas, and that the leptin/ObR system regulates adiponectin gene expression in endometriotic cells.

 

 

Ann Surg. 2014 Mar;259(3):522-31.

Clinical outcome after radical excision of moderate-severe endometriosis with or without bowel resection and reanastomosis: a prospective cohort study.

Meuleman C1Tomassetti CWolthuis AVan Cleynenbreugel BLaenen APenninckx FVergote IDʼHoore ADʼHooghe T.

 

Abstract

OBJECTIVE:

To assess the clinical outcome of women requiring laparoscopic excision of moderate-severe endometriosis in women with and without bowel resection and reanastomosis.

METHODS:

Two hundred three patients with laparoscopically excised moderate (n = 67) or severe (n = 136) endometriosis (rAFS: revised endometriosis classification of the American Fertility Society) were prospectively followed during a median of 20 months (1-45 months) using a CONSORT-inspired checklist. Patients completed the EHP30 Quality-of-Life Questionnaire and visual analogue scales (VAS) for dysmenorrhea, chronic pelvic pain, and deep dyspareunia and answered questions about postoperative complications, reinterventions/recurrences, and fertility outcome 1 month before and 6, 12, 18, and 24 months after surgery. Clinical outcome was compared between women with deeply infiltrative endometriosis undergoing CO2 laser ablative surgery with bowel resection (study group, 76/203; 37%) and without bowel resection (control group, 127/203; 63%).

RESULTS:

Both groups were similar with respect to population characteristics and clinical outcome, except for mean rAFS score [higher in study group (73 ± 31) than in control group (48 ± 26)] and minor complication rate [higher in study group (11%) than in control group (1%)]. In both groups, mean VAS and EHP30 scores improved significantly and remained stable for 24 months after surgery, with a pregnancy rate of 51%. Within 1, 2, and 3 years follow-up, the cumulative reintervention rate was 1%, 7%, and 10%, respectively, and the cumulative endometriosis recurrence rate was 1%, 6%, and 8%, respectively.

CONCLUSIONS:

Clinical outcome after CO2 laser laparoscopic excision of moderate-severe endometriosis was comparable in women with or without bowel resection and reanastomosis, except for a higher minor complication rate occurring in women with bowel resection and reanastomosis (NCT00463398).

 

 

 

Mod Pathol. 2013 Sep;26(9):1270-8. doi: 10.1038/modpathol.2013.51. Epub 2013 Apr 12.

Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases.

Jiang W1Roma AALai KCarver PXiao SYLiu X.

 

Abstract

Endometriosis involving the mucosa of the intestines is rare, but may lead to diagnostic pitfalls. We reviewed 15 cases (seven biopsies and eight resections) from 14 patients. The patients’ mean age is 48 years (31-66 years). Presenting symptoms included lower gastrointestinal bleeding, pelvic pain, rectal urgency, abdominal mass, and bowel obstruction. In the majority of cases, the lesion was located in the rectum (73%) with the remainder in the sigmoid colon (20%) and ileum (7%). The most common indication for biopsy was a polypoid lesion seen endoscopically (eight cases). For patients who underwent resections, the most common clinical impression was colonic carcinoma (75%), due to mass lesions and stricture as the most common macroscopic findings. Histologically, one case had stromal endometriosis only, but the remaining 14 cases had both endometrial glands and stroma. Epithelial metaplasia was present in all cases, mostly tubal metaplasia (ciliated epithelium). Hybrid glands and replacement of the surface epithelium by endometrial epithelium were also seen. Crypt architectural distortion, cryptitis, and crypt abscesses were seen in some cases, mimicking chronic active colitis or enteritis. A panel of immunohistochemical stains (CK7, CK20, CDX2, and ER) was found to be useful in biopsies with suspected endometriosis demonstrating unusual histology or only containing endometrioid stroma tissue. Vascular involvement by endometriosis was identified in one case. Endometrial hyperplasia (n=2) and cancer (n=1) were also seen in the ectopic tissue. All patients were alive at follow-up (3-216 months, mean 67 months).

 

 

Arch Gynecol Obstet. 2013 Oct;288(4):821-7.

Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference?

Cucinella G1Granese RCalagna GSvelato ASaitta STonni GDe Franciscis PColacurci NPerino A.

 

Abstract

OBJECTIVE:

The primary aim of the study was to analyze the endometrioma recurrence rate in patients who underwent laparoscopic excision followed by postoperative long-term regimen of oral contraceptives (OCs).

MATERIALS AND METHODS:

168 patients who underwent a conservative laparoscopic surgery for endometrioma, during the period between September 2009 and August 2010 in three university hospitals were studied. A long-term OCs therapy was offered to all women following surgery. Patients were randomly divided into three groups according to different progestins used (desogestrel, gestodene, dienogest). Women who refused a postoperative hormonal therapy served as control. Follow-up visits and transvaginal scan were planned at 1, 3, 6, 12, and 24 months after surgery. All patients who showed an ultrasound persistence of the endometrioma at 1 month follow-up were excluded from clinical analysis.

RESULTS:

Of the 168 patients, 131 completed the 24 months follow-up. Endometrioma recurrence was found in 21 (12.5 %) of all patients, it was unilateral in 17 cases while bilateral in 4 cases. The rate of recurrent endometrioma was statistically significant in non-users compared to the long-term OCs treated patients.

CONCLUSION:

The current data suggest the usefulness of long-term OCs regimen after conservative surgery for the prevention of ovarian endometrioma recurrence. As a statistical significant difference could not be observed between OCs groups, further study on the individual molecules is required in order to really understand the effect of each of them.

 

 

Reproduction. 2013 Mar 1;145(3):289-96.

Endometrial inflammatory markers of the early immune response in mares susceptible or resistant to persistent breeding-induced endometritis.

Woodward EM1Christoffersen MCampos JBetancourt AHorohov DScoggin KESquires ELTroedsson MH.

 

Abstract

Transient endometritis after breeding is necessary for clearance of bacteria and spermatozoa; however, in a subpopulation of mares, the inflammation fails to resolve in a timely fashion. The objective of this study was to describe the uterine inflammatory response in mares susceptible or resistant to persistent breeding-induced endometritis (PBIE) during the first 24 h after induction of uterine inflammation.Twelve mares were classified as susceptible (nZ6) or resistant (nZ6) to PBIE. Mares were inseminated over five estrous cycles and endometrial biopsies were collected at one time point per cycle before (0) and 2, 6, 12, and 24 h after insemination. qPCR analysis for IL1B, IL6, IL8, IFNG, TNF (TNFA), IL10, and IL1RN was performed, and endometrial inflammatory cells were counted for each sample. Relative quantification values reported fold changes in mRNA expression from 0 h values. A general pattern of expression post insemination was observed in both groups of mares. Cytokine mRNA increased at 2 h, peaked between 2 and 12 h, and then decreased.Differences were detected between groups of mares 6 h after challenge; resistant mares had higher mRNA expression of IL6, IL1RN,and IL10 than susceptible mares. Susceptible mares had an increased number of polymorphonuclear neutrophils in the endometrium 2 and 12 h after breeding when compared with resistant mares. These findings describe an inherent difference in the initial immune response to insemination and may help explain the transient nature of inflammation in resistant mares, whereas susceptible mares develop a persistent inflammation.

 

 

 

 

 

Am J Obstet Gynecol. 2013 Dec;209(6):524-30.

Bowel dysfunction before and after surgery for endometriosis.

Roman H1Bridoux VTuech JJMarpeau Lda Costa CSavoye GPuscasiu L.

 

Abstract

The relationship between deep fibrotic endometriosis of the rectum and digestive symptoms as well as the impact of surgical treatment on digestive complaints appears increasingly complex. With the exception of cases in which the disease leads to rectal stenosis, it seems likely that certain digestive symptoms are a result of cyclic inflammatory phenomena leading to irritation of the digestive tract and not necessarily the result of actual involvement of the rectum by the disease itself because they frequently occur in women free of rectal nodules. Functional or inflammatory bowel diseases and rectal hypersensitivity may be associated with pelvic endometriosis and consequently joepardize the hypothetical causal relationship between the presence of a rectal nodule and digestive complaints. Women treated surgically for rectal endometriosis may continue to experience postoperative digestive complaints, such as constipation. Despite successful surgery free of intra- and postoperative complications and significant improvement in well-being and pelvic pain, several unpleasant digestive symptoms may be incompletely cured by the surgery. Furthermore, de novo postoperative digestive complaints may occur after rectal surgery. Retrospective data suggest that performing colorectal resection is related to less favorable digestive functional outcomes than the use of conservative procedures such as shaving or full-thickness disc excision. These hypotheses need to be confirmed by prospective randomized trials comparing rectal radical and conservative approaches. Bearing in mind the complex relationship between rectal nodules, digestive symptoms and rectal surgery, particular care must be taken in the preoperative assessment of digestive function and in choosing the most suitable surgical procedure.

 

 

Reprod Sci. 2013 Nov;20(11):1382-9

Dysregulation of vascular endothelial growth factors and their neuropilin receptors in the eutopic endometrium of women with endometriosis.

Hey-Cunningham AJ1Markham RFraser ISBerbic M.

 

Abstract

Despite the importance of neuropilins (NRPs) in a number of processes that are altered in endometriosis, such as angiogenesis and neuronal guidance, these molecules have not been previously studied in the disease. Similarly, potent lymphangiogenic factors, vascular endothelial growth factor C (VEGF-C) and VEGF-D, have not been comprehensively investigated in endometriosis. The objective of this study was to examine their expression in women with and without endometriosis. NRPs and VEGFs were quantified in 79 histologically normal uterine tissue samples (37 control and 42 endometriosis, all menstrual cycle phases) using immunohistochemistry and automated cellular imaging analysis. NRP-1 was significantly reduced in women with endometriosis (P = .004). The normal significant menstrual cyclical variations in endometrial NRP-1, NRP-2, and VEGF-C were absent in endometriosis, and VEGF-D was dysregulated. Dysregulated expression of growth factors and receptors, such as NRPs and VEGFs, likely contribute to altered angiogenesis, lymphangiogenesis, neurogenesis and immune function in endometriosis and may reflect altered hormone signals.

 

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