JSLS. 2013 Jan-Mar;17(1):100-6.

Perioperative outcomes of robotic versus laparoscopic hysterectomy for benign disease.

Patzkowsky KE1As-Sanie SSmorgick NSong AHAdvincula AP.

 

Abstract

BACKGROUND AND OBJECTIVES:

We compared the perioperative outcomes of hysterectomy performed by robotic (RH) versus laparoscopic (LH) routes for benign indications using the Dindo-Clavien scale for classification of the surgical complications.

METHODS:

Retrospective chart review of all patients who underwent robotic (n=288) and laparoscopic (n=257) hysterectomies by minimally invasive surgeons at the University of Michigan from March 2001 until June 2010.

RESULTS:

Age, body mass index, operative time, and estimated blood loss were not statistically different between groups. The RH subgroup had a larger uterine weight (LH 186.4±130.6 g vs RH 234.9±193.9 g, P=.001), higher prevalence of severe adhesions (13.2% vs 23.3%, respectively, P=.003), and stage III-IV endometriosis (4.7% vs 15.3%, respectively, P<.05). There were no differences in the rates of Dindo-Clavien grade I, grade II, and grade III surgical complications between the RH and LH groups (9.7%, 13.2%, and 3.1%, respectively, in the RH group vs 6.2%, 9.3%, and 5.8%, respectively, in the LH group, P>.05). However, the rates of urinary tract infection were higher in the RH group (LH 2.7% vs RH 6.9%, P=.02), whereas the conversion to laparotomy rate was higher in the LH group (LH 6.2% vs RH 1.7%, P=.007).

CONCLUSIONS:

Perioperative outcomes for laparoscopic and robotic hysterectomy for benign indications appear to be equivalent.

 

 

Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2013 Jun;30(3):335-9.

Association of P53 gene polymorphisms with susceptibility to endometriosis.

Huang Y1Zong LLin JFu YLiu ZMao TZeng JWang YZhao X.

 

Abstract

OBJECTIVE:

To assess the association of a single nucleotide polymorphism(SNP) in tumor suppressor gene P53 with the risk of endometriosis (EM) in Han Chinese women.

METHODS:

For 460 EM patients, 113 patients with endometrial carcinoma and 530 matched unrelated controls, a rs1042522(C/G) SNP of the P53 gene was genotyped by polymerase chain reaction-single strand polymorphism (PCR-SSP) and DNA sequencing.

RESULTS:

A significant difference has been detected in the distribution of rs1042522 alleles and genotypes between the EM patients and controls (P< 0.01). Allele G has increased the risk of EM by 1.209 times, while allele C has reduced this risk by 0.837 times. Compared with GG genotype, GC and CC genotypes have both increased the risk for EM (OR=2.073, 95%CI: 1.521-2.820, and OR=1.930, 95%CI: 1.363-2.733, respectively). Significant differences were also detected in the distribution of rs1042522 alleles and genotypes between endometrial carcinoma patients and controls (P< 0.01). Allele G has increased the risk to endometrial carcinoma by 1.311 times, while allele C has reduced this risk by 0.757 times. Compared with GG genotypes, individuals with GC and CC genotypes are more likely to be affected with endometrial carcinoma (OR=2.778, 95%CI: 1.585-4.870, and OR=2.864, 95%CI: 1.557-5.263, respectively).

CONCLUSION:

Our study has suggested a significant association between the rs1042522(G/C) polymorphism and susceptibility to EM in Han Chinese women. The mechanism of EM is similar to carcinoma from genetics point of view.

 

 

Acad Radiol. 2013 Jul;20(7):838-46

Multivariate normally distributed biomarkers subject to limits of detection and receiver operating characteristic curve inference.

Perkins NJ1Schisterman EFVexler A.

 

Abstract

RATIONALE AND OBJECTIVES:

Biomarkers are of ever-increasing importance to clinical practice and epidemiologic research. Multiple biomarkers are often measured per patient. Measurement of true biomarker levels is limited by laboratory precision, specifically measuring relatively low, or high, biomarker levels resulting in undetectable levels below, or above, a limit of detection (LOD). Ignoring these missing observations or replacing them with a constant are methods commonly used although they have been shown to lead to biased estimates of several parameters of interest, including the area under the receiver operating characteristic (ROC) curve and regression coefficients.

MATERIALS AND METHODS:

We developed asymptotically consistent, efficient estimators, via maximum likelihood techniques, for the mean vector and covariance matrix of multivariate normally distributed biomarkers affected by LOD. We also developed an approximation for the Fisher information and covariance matrix for our maximum likelihood estimations (MLEs). We apply these results to an ROC curve setting, generating an MLE for the area under the curve for the best linear combination of multiple biomarkers and accompanying confidence interval.

RESULTS:

Point and confidence interval estimates are scrutinized by simulation study, with bias and root mean square error and coverage probability, respectively, displaying behavior consistent with MLEs. An example using three polychlorinated biphenyls to classify women with and without endometriosis illustrates how the underlying distribution of multiple biomarkers with LOD can be assessed and display increased discriminatory ability over naïve methods.

CONCLUSIONS:

Properly addressing LODs can lead to optimal biomarker combinations with increased discriminatory ability that may have been ignored because of measurement obstacles.

 

 

Eur J Pharm Sci. 2013 Jul 16;49(4):732-6.

Sunitinib as an anti-endometriotic agent.

Abbas MA1Disi AMTaha MO.

 

Abstract

Endometriosis is one of the most frequent diseases in gynecology. Currently available medical therapies for this disease are unsatisfactory. Based on current understanding of the pathogenic mechanisms in endometriosisespecially the similarity between this disease and cancer, this study was designed to investigate the efficacy of the anticancer drug sunitinib in treating endometriosis. The effect of sunitinib on regression of endometriotic implants was studied in a rat surgical model. Sunitinib reduced cyst cross sectional area by 78.8% and caused complete cyst disappearance in 50% of the animals. Histologically, extensive fibrosis was detected in sunitinib-treated group with positive reaction in TUNEL assay indicating that apoptosis is a mechanism of action.

 

 

 

Front Biosci (Elite Ed). 2013 Jun 1;5:900-10.

Epigenetic aberration of gene expression in endometriosis.

Izawa M1Taniguchi FTerakawa NHarada T.

 

Abstract

Endometriosis is an estrogen-dependent inflammatory disease. In endometriotic tissues, a high-estrogen environment associated with up-regulation of the aromatase gene has been well documented. There is accumulating evidence supporting a concept that endometriosis is a disease associated with an epigenetic disorder. Epigenetics is one of the most expanding fields in the current biomedical research. The word ‘epigenetics’ refers to the study of mitotically and/or meiotically heritable changes in gene expression that occur without changes in the DNA sequence. The disruption of such changes (epigenetic aberration or disorder) underlies a wide variety of pathologies. Epigenetic regulation includes DNA methylation and histone modifications, and is responsible for a number of gene transcription associated with chromatin modifications that distinguish the states of diseases. In this review, we summarized our studies as well as recent studies from other laboratories using an epigenetic approach focused on DNA methylation. We also summarized studies using advanced technologies including Genome-Wide (GW) methylation profiling analysis and GW Association Study (GWAS). We reviewed recent monozygotic twins studies in relation to environmental factors since they may provide insight into the epigenetic background of endometriosis. Finally, we referred to a new concept of GW DNA methylation.

 

 

Front Biosci (Elite Ed). 2013 Jun 1;5:1033-56.

Angiogenesis, lymphangiogenesis and neurogenesis in endometriosis.

Hey-Cunningham AJ1Peters KMZevallos HBBerbic MMarkham RFraser IS.

 

Abstract

Endometriosis is a common, benign gynecological disease affecting 10 – 15% of reproductively aged women. It is characterized by the presence of endometrial-like tissue at sites outside the uterus. The most widely accepted theory of endometriosis pathogenesis proposes that shed menstrual endometrium can reach the peritoneum, implant and grow as endometriotic lesions. Angiogenesis, lymphangiogenesis and neurogenesis are implicated in successful ectopic establishment and the generation of endometriosis-associated symptoms. This review considers these processes as they occur in the eutopic endometrium and ectopic endometriotic lesions of women with endometriosis. Their regulation is inter-connected and complex. Dysregulation in endometriosis occurs on a background of accumulating evidence that endometriosis is an endometrial disease with underlying genetic influences and cross talk with endometriotic lesions. Understanding the roles of angiogenesis, lymphangiogenesis and neurogenesis in endometriosis pathophysiology is essential for the development of novel therapeutic approaches.

 

 

umori. 2013 Mar-Apr;99(2):e49-54.

Malignant transformation of abdominal wall endometriosis: case report and literature review.

Vinchant M1Poncelet CZiol MVons CBricou A.

 

Abstract

In recent years we have seen an increase in the frequency of cesarean sections. We present a case report of an endometrioid adenocarcinoma arising from abdominal wall endometriosis in a patient with a history of cesarean sections and describe its diagnostic and therapeutic management.

 

 

Reprod Sci. 2014 Feb;21(2):183-9

Influence of ovarian endometrioma on expression of steroid receptor RNA activator, estrogen receptors, vascular endothelial growth factor, and thrombospondin 1 in the surrounding ovarian tissues.

Lin K1Ma JWu RZhou CLin J.

 

Abstract

This study investigates the influence of ovarian endometrioma on expression of steroid receptor RNA activator (SRA), estrogen receptors (ERs), vascular endothelial growth factor (VEGF), and thrombospondin 1 (TSP-1) in the surrounding ovarian tissues. Taken from the women with ovarian endometrioma and mature teratoma during laparoscopy, the biopsies were analyzed by real-time polymerase chain reaction and Western blot. Our results indicated that ovarian tissues surrounding endometrioma had lower SRA and ER-α levels but higher SRA protein (SRAP) and ER-β levels than ovarian endometrioma. With lower VEGF levels and higher TSP-1 levels, the surrounding ovarian tissues showed higher expression levels of SRA, SRAP, ER-α, and ER-β in the ovarian endometrioma group when compared to the controls. These data showed that ovarian endometrioma increases SRA, ERs, and TSP-1 but decreases VEGF levels in the surrounding ovarian tissues, suggesting that abnormal expression of these molecules may affect biological behaviors of ovarian endometrioma.

 

 

Gynecol Obstet Invest. 2013;76(2):75-82.

Laparoscopic ovarian cystectomy versus fenestration/coagulation or laser vaporization for the treatment of endometriomas: a meta-analysis of randomized controlled trials.

Dan H1Limin F.

 

Abstract

AIM:

To compare outcomes after laparoscopic ovarian cystectomy versus fenestration/coagulation or laser ablation for the treatment of endometriomas.

METHODS:

Studies were identified by searching the PubMed, EMBASE, SCOPUS, and Cochrane Central Register of Controlled Trials databases using the terms ovarian, endometrioma or endometriosis, cystectomy, fenestration, coagulation, laser, and ablation or vaporization. The outcomes of interest were recurrence of signs/symptoms and endometrioma, reoperation, pregnancy, and ovarian reserve.

RESULTS:

Seven studies were included. The risk of recurrence of signs/symptoms after surgery was significantly lower for laparoscopic cystectomy compared with fenestration/coagulation [risk ratio (RR): 0.29; 95% CI: 0.15-0.55; I² = 0%; p < 0.001], as was the risk of recurrence compared with fenestration/coagulation (RR: 0.50; 95% CI: 0.26-0.97; I² = 0%; p = 0.04) and laser vaporization (RR: 0.33; 95% CI: 0.12-0.88; I² = 0%; p = 0.03). The risk of pregnancy was significantly higher for cystectomy compared with fenestration/coagulation (RR: 2.64; 95% CI: 1.49-4.69; I² = 0%; p < 0.001), but not laser vaporization (RR: 0.92; 95% CI: 0.30-2.80; p = 0.89). There were inadequate data for the meta-analysis of ovarian reserve.

CONCLUSIONS:

Our findings suggest that cystectomy provides better outcomes than fenestration/coagulation or laser ablation regarding recurrence of symptoms and endometrioma as well as pregnancy rate (fenestration/coagulation only). Further studies are needed to clarify the effect of these surgical approaches on ovarian reserve.

 

 

 

Surg Laparosc Endosc Percutan Tech. 2013 Jun;23(3):e131-3

Colonic obstruction as an unusual presentation of endometrioma: a case report.

Vahdat M1Sariri EMehdizadeh ANajmi ZShayanfar N.

 

Abstract

Endometriosis usually occurs in the pelvis but can be found nearly anywhere in the body. Bowel involvement in endometriosis is uncommon and it is estimated to be present in 3.7% to 35% of women with endometriosis. It can rarely result in intestinal obstruction. Here, we present a synchronous localization of endometriosis, ovarian and intestinal, resulting in chronic gastrointestinal symptoms and colonic obstruction in a 33-year-old woman.

 

 

Ultrasound Obstet Gynecol. 2014 Mar;43(3):322-7.

Can rectal endoscopic sonography be used to predict infiltration depth in patients with deep infiltrating endometriosis of the rectum?

Rossi L1Palazzo LYazbeck CWalker FChis CLuton DKoskas M.

 

Abstract

OBJECTIVES:

To evaluate the diagnostic accuracy of rectal endoscopic sonography (RES) in the prediction of the infiltration depth of rectal endometriosis and to ascertain whether RES could be used to choose between segmental bowel resection and a more conservative approach, such as shaving or discoid resection.

METHODS:

In this retrospective study, 38 consecutive patients with symptomatic deep infiltrating endometriosisof the rectum who underwent laparoscopic colorectal resection were included. RES results for infiltration depth of rectal endometriosis were compared with results of pathological examination. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), positive and negative likelihood ratios (LRs) and test accuracy were calculated for the presence of infiltration of the muscularis layers and submucosal/mucosal layers, as demonstrated by RES and confirmed by histopathological analysis.

RESULTS:

For the detection of muscularis layer infiltration by endometriosis, the PPV of RES was 100%, whereas for the detection of submucosal/mucosal layer involvement, the sensitivity was 89%, specificity was 26%, PPV was 55%, NPV was 71%, test accuracy was 58% and positive and negative LRs were 1.21 and 0.40, respectively.

CONCLUSIONS:

RES is a valuable tool for detecting rectal endometriosis as endometriotic infiltration of the muscularis layer can be predicted accurately. However, RES is less accurate in detecting submucosal/mucosal layer involvement and cannot, therefore, be used to choose between bowel resection and a more conservative approach.

 

 

Biofizika. 2013 Mar-Apr;58(2):302-12

Dinitrosyl iron complexes with glutathione recover rats with experimental endometriosis.

Adamian LVBurgova ENTkachev NAMikoian VDStepanian AASonova MMVanin AF.

 

Abstract

The effect of binuclear dinitrosyl iron complexes (DNIC) with glutathione on endometrioid tumors in rats with experimental endometriosis has been studied. The latter was induced by an autotransplantation model, where two fragments of endometrium with myometrium (2 x 2 mm) from the left uterine horn was grafted to the inner surface of the anterior abdominal wall. The test animals received intraperitoneal injections of 0.5 ml DNIC-glutathione at the dose of 12.5 micromole per kg daily for 12 days 28 days after operation. The injections resulted in more than a 2-fold decrease in the total volume of both large tumors formed from grafts and small additive tumors formed nearby grafts. The disappearance of the additive tumors was also observed in test animals. The EPR signal with g(av) = 2.03 characteristic of protein bound DNIC with thiol-containing ligands was recorded in livers, graft and additive tumors of test and control animals pointing out intensive generation of nitric oxide in rats with experimental endometriosis. Ribonucleotide reductase activation discovered by doublet the EPR signal at g = 2.0 with 2.3 mT hyperfine structure splitting was found in small tumors. The cytotoxic effect of DNIC-glutathione on endometrioid tumors was suggested to be due to DNIC degradation nearby the tumors induced by iron chelating compounds released from the tumors. The degradation resulted in release of a high amount of nitric oxide molecules and nitrosonium ions from DNICs affecting the tumors by way of the cytotoxic effect.

 

 

 

Fertil Steril. 2013 Sep;100(3):770-6.

Histone deacetylase inhibitors down-regulate G-protein-coupled estrogen receptor and the GPER-antagonist G-15 inhibits proliferation in endometriotic cells.

Imesch P1Samartzis EPDedes KJFink DFedier A.

 

Abstract

OBJECTIVE:

To investigate whether histone deacetylase inhibitors reduce the expression of the G-protein-coupled estrogen receptor (GPER) and whether the functional inhibition of GPER by the antagonist G-15 decreases the proliferation of endometriotic cells.

DESIGN:

In vitro study.

SETTING:

University hospital.

PATIENT(S):

Immortalized epithelial endometriotic cells.

INTERVENTION(S):

Treatment with the histone deacetylase inhibitor romidepsin or suberoylanilide hydroxamic acid (SAHA), or with the GPER antagonist G-15.

MAIN OUTCOME MEASURE(S):

Western blot analysis and quantitative real-time polymerase chain reaction (PCR) were used to monitor the expression of GPER in response to drug treatment. Effects of GPER stimulation and inhibition on cell proliferation were investigated by the 93-(4,5-dimethylthiazol-2-yl)2,5-diphenyl tetrazolium bromide (Sigma) (MTT) assay.

RESULT(S):

Our results demonstrate that romidepsin and SAHA reduce GPER expression in a concentration-dependent manner. This reduction correlated with the accumulation of acetylated histones. No decreased expression of the estrogen receptor (ER)-α and ERβ was found under comparable experimental conditions. Pretreatment of endometriotic cells with the GPER agonist G-1 stimulated cell proliferation accompanied by rapid Akt phosphorylation. G-15 reversed this stimulation and inhibited cell proliferation, which was accompanied by Akt dephosphorylation.

CONCLUSION(S):

G-protein-coupled estrogen receptor is proposed as a potential therapeutic target in endometriosis. The down-regulation of GPER and/or the impairment of its function may reduce the estrogen responsiveness in endometriosis, and therefore might be considered a possible treatment option of endometriosis.

 

 

 

Fertil Steril. 2013 Sep;100(3):777-81.

Reduced hemopexin levels in peritoneal fluid of patients with endometriosis.

Wölfler MM1Meinhold-Heerlein IMHenkel CRath WNeulen JMaass NBräutigam K.

 

Abstract

OBJECTIVE:

To study altered hemopexin concentrations in peritoneal fluid (PF) samples from patients with endometriosis. Recent data implicate a role of altered iron metabolism in endometriosis patients. Hemopexin is the major transport protein for heme. Like iron, heme exposure to the epithelial surface can provoke oxidative stress on the peritoneal epithelium. Therefore, altered hemopexin concentrations and heme scavenging in PF might play a role in the pathophysiology of endometriosis.

DESIGN:

Prospective explorative study.

SETTING:

Academic tertiary care center.

PATIENT(S):

Eighty symptomatic patients scheduled for laparoscopy for the diagnosis and/or therapy of endometriosis.

INTERVENTION(S):

Aspiration of PF samples during laparoscopy.

MAIN OUTCOME MEASURE(S):

Hemopexin and heme concentration in PF.

RESULT(S):

At laparoscopy, 47 of 80 (58.8%) patients exhibited endometriosis, and 33 (41.2%) were proven disease-free (CO). By means of ELISA significantly lower concentrations of hemopexin in the samples from patients with endometriosis (endometriosis 0.377 ± 0.16 mg/mL) compared with controls (disease-free 0.479 ± 0.20 mg/mL) could be demonstrated. Heme levels in the samples were not significantly different between groups (endometriosis 9.130 ± 6.124 μM and disease-free 9.990 ± 4.485 μM). There was no significant correlation between heme and hemopexin levels (Pearson’s correlation coefficient r = -0.146). Demographic data between the groups were comparable.

CONCLUSION(S):

These data provide further evidence that hemopexin is significantly down-regulated in PF samples from patients with endometriosis compared with controls. This study confirms recent findings in two-dimensional gel electrophoresis demonstrating a down-regulation of hemopexin in PF from patients with endometriosis in a larger series of samples.

Fertil Steril. 2013 Sep;100(3):801-9.

Remodeling of estrogen-dependent sympathetic nerve fibers seems to be disturbed in adenomyosis.

Barcena de Arellano ML1Oldeweme JArnold JSchneider AMechsner S.

 

Abstract

OBJECTIVE:

To investigate neuronal remodeling processes in the uterine innervation, particularly a remodeling of sympathetic nerve fibers, as well as the role of estrogen in this modulation in adenomyosis.

DESIGN:

Retrospective case-control study.

SETTING:

University hospital endometriosis center.

PATIENT(S):

Forty-two patients with histologically proven adenomyosis and 19 patients without adenomyosis.

INTERVENTION(S):

Endometrial and myometrial tissue were immunohistochemically analyzed to further characterize the uterine innervation.

MAIN OUTCOME MEASURE(S):

Immunohistochemical analysis was used to identify PGP 9.5-, substance P-, and tyrosine hydroxylase-positive nerve fibers. The expression of the aromatase cytochrome P450 was evaluated in uterine tissue, and the expression of the estrogen receptor (ER) -α and ERβ in uterine nerve fibers was analyzed.

RESULT(S):

Adenomyotic lesions are not innervated. The density of sympathetic nerve fibers in the myometrium of women with adenomyosis is reduced when compared with the nonadenomyosis group. The aromatase expression in the myometrium of women with adenomyosis was increased when compared with the control group. The ERα/ERβ ratio is in trend shifted to the ERα side in the myometrial tyrosine hydroxylase-positive nerve fibers in adenomyosis compared to the controls.

CONCLUSION(S):

The disruption of the modulation of the uterine sympathetic innervation seems to be an important aspect in the pathogenesis of adenomyosis. Estrogen and its receptors seem to play a crucial role in the depletion of myometrial sympathetic nerve fibers.

 

 

J Minim Invasive Gynecol. 2013 Sep-Oct;20(5):573-82

Postoperative recurrence and fertility after endometrioma ablation using plasma energy: retrospective assessment of a 3-year experience.

Roman H1Auber MBourdel NMartin CMarpeau LPuscasiu L.

 

Abstract

STUDY OBJECTIVE:

To assess recurrence and pregnancy rates in women with ovarian endometrioma treated via ablation using plasma energy.

DESIGN:

Retrospective non-comparative pilot study including 55 patients treated during 28 months, with prospective recording of data (Canadian Task Force classification II-2).

SETTING:

Tertiary referral center.

PATIENTS:

Fifty-five consecutive women with pelvic endometriosis in whom ovarian endometriomas were managed solely via ablation using plasma energy. The minimum follow-up was 1 year.

INTERVENTION:

Endometrioma ablation using plasma energy.

MEASUREMENTS AND MAIN RESULTS:

Information was obtained from the database of the North-West Inter Regional Female Cohort for Patients with Endometriosis, based on self-questionnaires completed before surgery, surgical and histologic data, and systematic recording of recurrences, pregnancy, and symptoms. Recurrences were assessed using pelvic ultrasound examination. Mean (SD) follow-up was 20.6 (7.2) months (range, 12-39 months). In 75% of patients, deep infiltrating endometriosis was treated, and 40% had colorectal involvement. Preoperative infertility was recorded in 42% of patients. The rate of postoperative recurrence was 10.9% for the entire series. Of 33 women who wished to conceive, 67% became pregnant, spontaneously in 59%. Time from surgery to the first pregnancy was 7.6 (4.3) months. After discontinuation of postoperative hormone therapy, the probability of not conceiving at 12 months was 0.36 (95% confidence interval, 0.19-0.53), and at 24 months was 0.27 (95% confidence interval, 0.12-0.44).

CONCLUSIONS:

Recurrence and pregnancy rates are encouraging in that they seem comparable to the best reported results after endometrioma cystectomy. Plasma energy may have an important role in the management of ovarian endometrioma in women seeking to conceive. Patients most in need of surgical procedures that can spare ovarian parenchyma, such as those with bilateral endometriomas or a history of ovarian surgery, may particularly benefit from ablation using plasma energy.

Curr Opin Obstet Gynecol. 2013 Aug;25(4):280-6.

The genetics and biochemistry of endometriosis.

Burney RO1.

 

Abstract

PURPOSE OF REVIEW:

Endometriosis is a common gynecologic disorder characterized by the displacement of endometrial tissue to ectopic locations. Although predisposition to endometriosis is likely multifactorial, a genetic component is evident. The biochemistry of the disorder is an area of active investigation with translational potential. This review synopsizes recent developments regarding the molecular underpinnings of endometriosis.

RECENT FINDINGS:

Significant advancements in understanding the molecular hallmarks of endometriosis have occurred in recent years. Inflammation, attenuated progesterone action, and neuroangiogenesis constitute emerging themes in the pathophysiology of endometriosis.

SUMMARY:

Delineation of the biochemical processes involved in endometriosis has important implications for clinical care. The discovery of a sufficiently sensitive and specific biomarker for the nonsurgical detection of endometriosis promises earlier diagnosis and prevention of deleterious sequelae. Understanding the inflammatory cause, attenuated progesterone action at the level of the endometrium, and neuronal sensitization of endometriotic lesions has facilitated development of novel therapeutic approaches for associated pain and infertility.

 

 

Case Rep Obstet Gynecol. 2013;2013:386783.

Scar endometriosis: a case report of this uncommon entity and review of the literature.

Uzunçakmak C1Güldaş AOzçam HDinç K.

 

Abstract

Scar endometriosis is an infrequent type of extrapelvic endometriosis that is rather close together with obstetrical and gynecological surgeries. It is mostly confused with other dermatological or surgical conditions and delays the diagnosis. We report a case of a 50-year-old woman presenting with scar endometriosis 23 years after her last lower segment caesarean section. The epidemiology, diagnosis, pathogenesis, and treatment of the situation are discussed.

 

 

J Reprod Med. 2013 May-Jun;58(5-6):264-6.

Malignant transformation of endometriosis in a cesarean section abdominal wall scar: a case report.

Stevens EE1Pradhan TSChak YLee YC.

 

Abstract

BACKGROUND:

Endometriosis occurring in a cesarean section abdominal wall scar is reported at a rate of 0.03-0.45%. Malignant transformation of this type of endometriosis is exceptionally rare.

CASE:

A 51-year-old, G3P2012, Black woman presented with a lump in her cesarean section abdominal wall scar that was increasing in size. Biopsy of the mass revealed metastatic adenocarcinoma with poorly differentiated, nonmucinous ovarian primary. She received 3 cycles of neoadjuvant chemotherapy and underwent an interval debulking with the final pathology showing malignant transformation of endometriosis within her abdominal wall scar. She then completed radiotherapy to the area and is disease-free 6 months later.

CONCLUSION:

Our combination of neoadjuvant chemotherapy and excision of the mass with negative margins followed by adjuvant radiotherapy is a feasible treatment option.

 

 

Eur J Radiol. 2013 Sep;82(9):e411-6.

Diagnostic value of susceptibility-weighted imaging of abdominal wall endometriomas during the cyclic menstrual changes: a preliminary study.

Solak A1Sahin NGenç BSever ARGenç MSivrikoz ON.

 

Abstract

OBJECTIVE:

The purpose of this study is to investigate the value of susceptibility-weighted imaging (SWI) for the evaluation of cyclic morphological and hemorrhagic changes in abdominal wall endometriomas (AWE).

MATERIALS AND METHODS:

Fourteen patients with a total of 17 lesions who were admitted with complaints of abdominal wall mass and cyclic pain were evaluated by MRI. Patients were scanned during the first three days of the menstrual cycle and during the mid-cycle phase (day 13-15). In addition to conventional images SWI was performed. The signal changes within the lesions on SWI were compared and graded on both studies.

RESULTS:

There was no significant difference in the size of the lesions in the early days of the menstruation compared to the mid-menstrual period. The SWI taken on mid-cycle phase showed that the center was hyperintense and the peripheral zone was hypointense in all lesions. A signal void related to increased blood and the shrinkage of complete disappearance of hyperintensity in the venter of the lesion was seen 15 (88%) of the 17 cases on the SWI series performed during the menstrual phase scan.

CONCLUSION:

SWI is a sensitive technique and has the capability to show hemorrhage and deposition of hemosiderin within the lesions. For patients suspected with AWE, valuable diagnostic findings may be obtained if the MRI examination including SWI is performed during the early and mid phase menstrual cycle.

 

 

Eur J Obstet Gynecol Reprod Biol. 2013 Sep;170(1):20-4.

Ileal perforation and massive intestinal haemorrhage from endometriosis in pregnancy: case report and literature review.

Nishikawa A1Kondoh EHamanishi JYamaguchi KUeda ASato YKonishi I.

 

Abstract

An increasing number of women with severe endometriosis have conceived through assisted reproductive technology, but endometriosis can cause life-threatening complications for both the mother and baby during pregnancy. We describe a case of endometriosis-induced spontaneous ileal perforation in pregnancy with massive intestinal haemorrhage that required caesarean section, right hemicolectomy and terminal ileum resection at 33 weeks of gestation. Spontaneous perforation associated with intestinal endometriosis in pregnancy is a rare complication, and only seven cases have been reported in the English literature. To the best of our knowledge, this is the first report of spontaneous ileal perforation due to endometriosis. Moreover, this is probably the first case of massive intestinal haemorrhage in pregnancy that resulted from intestinal endometriosis. These risks must be explained to couples suffering from endometriosis-related infertility prior to conception by assisted reproductive technology, and multidisciplinary management may be mandatory for women with severe endometriosis in pregnancy.

 

 

 

 

 

Mod Pathol. 2014 Jan;27(1):128-34

Ovarian and endometrial endometrioid carcinomas have distinct CTNNB1 and PTEN mutation profiles.

McConechy MK1Ding J2Senz J1Yang W1Melnyk N1Tone AA3Prentice LM1Wiegand KC1McAlpine JN4Shah SP2Lee CH5Goodfellow PJ6Gilks CB5Huntsman DG7.

 

Abstract

Ovarian endometrioid carcinomas and endometrial endometrioid carcinomas share many histological and molecular alterations. These similarities are likely due to a common endometrial epithelial precursor cell of origin, with most ovarian endometrioid carcinomas arising from endometriosis. To directly compare the mutation profiles of two morphologically similar tumor types, endometrial endometrioid carcinomas (n=307) and ovarian endometrioid carcinomas (n=33), we performed select exon capture sequencing on a panel of genes: ARID1A, PTEN, PIK3CA, KRAS, CTNNB1, PPP2R1A, TP53. We found that PTEN mutations are more frequent in low-grade endometrial endometrioid carcinomas (67%) compared with low-grade ovarian endometrioid carcinomas (17%) (P<0.0001). By contrast, CTNNB1 mutations are significantly different in low-grade ovarian endometrioid carcinomas (53%) compared with low-grade endometrial endometrioid carcinomas (28%) (P<0.0057). This difference in CTNNB1 mutation frequency may be reflective of the distinct microenvironments; the epithelial cells lining an endometriotic cyst within the ovary are exposed to a highly oxidative environment that promotes tumorigenesis. Understanding the distinct mutation patterns found in the PI3K and Wnt pathways of ovarian and endometrial endometrioid carcinomas may provide future opportunities for stratifying patients for targeted therapeutics.

 

 

Int J Med Robot. 2014 Jun;10(2):140-6.

Robotic surgery for deep endometriosis: a paradigm shift.

Siesto G1Ieda NRosati RVitobello D.

 

Abstract

BACKGROUND:

Minimally invasive surgery represents the gold standard for the management of deep infiltrating endometriosis (DIE). This study aimed to evaluate the feasibility of robotic surgery for the management of DIE.

METHODS:

A 5-year retrospective cohort study was made of robotic procedures including: segmental bowel resections, removal of nodules from the rectovaginal septum (RVS) with or without rectal shaving and partial bladder resection.

RESULTS:

Overall, 19 bowel resections, 23 removals of RVS nodules and five bladder resections were performed, alone or in combination. Associated posterior vaginal resections were performed in 12 cases. Neither intra-operative complications, nor conversion to laparotomy occurred. One anastomotic leakage was recorded.

CONCLUSION:

This series of robotic procedures for DIE represents the largest currently available and it helps to promote robotics as a safe and attractive alternative to accomplish a comprehensive surgical treatment of DIE, especially when bowel or bladder resections are needed.

 

 

Obstet Gynecol Int. 2013;2013:859619.

Angiogenesis and endometriosis.

Rocha AL1Reis FMTaylor RN.

 

Abstract

A comprehensive review was performed to survey the role of angiogenesis in the pathogenesis of endometriosis. This is a multifactorial disease in which the development and maintenance of endometriotic implants depend on their invasive capacity and angiogenic potential. The peritoneal fluid of patients with endometriosis is a complex suspension carrying inflammatory cytokines, growth factors, steroid hormones, proangiogenic factors, macrophages, and endometrial and red blood cells. These cells and their signaling products concur to promote the spreading of new blood vessels at the endometriotic lesions and surroundings, which contributes to the endometriotic implant survival. Experimental studies of several antiangiogenic agents demonstrated the regression of endometriotic lesions by reducing their blood supply. Further studies are necessary before these novel agents can be introduced into clinical practice, in particular the establishment of the safety of anti-angiogenic medications in women who are seeking to become pregnant.

 

 

Bol Asoc Med P R. 2013;105(1):51-3.

Thoracic endometriosis: first reported case in Puerto Rico and review of literature.

García Gubern C1Rolón Colon LVazquez Torres OMartinez Alayón GSantos Santiago AMulero Portela E.

 

Abstract

Endometriosis is defined as the presence of endometrial tissue in extra uterine sites. It affects 5-15% of females during their reproductive years. Thoracic endometriosis syndrome is characterized by the presence of functional endometrial tissue within the pleura, the lung parenchyma or the airway. The overall prevalence of this condition is unknown due to a lack of epidemiological studies, variety of symptoms, signs and locations. We present the first reported case of recurrent catamenial pneumothorax in Puerto Rico and a review of recent literature.

 

 

Urology. 2013 Aug;82(2):307-12.

Endoscopic management of intraluminal ureteral endometriosis.

Castaneda CV1Shapiro EYAhn JJVan Batavia JPSilva MVTan YGupta M.

 

Abstract

OBJECTIVE:

To present the largest experience on the ureteroscopic management of ureteral obstruction secondary to intraluminal endometrial implantation.

MATERIALS AND METHODS:

We retrospectively evaluated patients who underwent ureteroscopic management of intraluminal endometriosis from 1996 to 2012. All patients were diagnosed with ureteroscopic biopsy and underwent at least 1 ureteroscopic ablation with a holmium YAG (Ho:Yag) laser. Patients were monitored for evidence of disease persistence, recurrence, or progression with computed tomography, sonography, renal scan, ureteroscopy, and retrograde urography. Success was defined as the complete eradication of ureteral endometriosis, resolution of symptoms, and maintenance of renal function.

RESULTS:

Five patients were identified. Mean age was 37.5 years. All patients had hydroureteronephrosis at presentation whereas 2 had severely impaired renal function. Three patients were successfully treated with a single ablative procedure, whereas 2 had persistent symptomatic hydroureteronephrosis and underwent repeat ablation. Of those requiring repeat ablation, 1 became disease-free after the second ablation, whereas the other had persistence of disease, requiring nephroureterectomy. Three patients developed ureteral strictures, requiring balloon dilation and serial stent exchanges. At a median follow-up of 35 months (16-84), overall success rate was observed in 4 of 5 patients (80%).

CONCLUSION:

Endometriosis affects approximately 15% of premenopausal women and can present anywhere along the urinary tract including the ureters, which might result in urinary obstruction and impaired renal function. Although surgical resection is the conventional treatment option for intraluminal endometriosis, ureteroscopic management is a viable nephron-sparing alternative. Follow-up imaging, including ureteroscopic surveillance and retrograde urography is recommended to detect disease recurrence or progression, or both.

 

 

Reprod Biomed Online. 2013 Aug;27(2):212-6.

Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve.

Urman B1Alper EYakin KOktem OAksoy SAlatas CMercan RAta B.

 

Abstract

Endometrioma surgery by stripping the cyst capsule has been associated with a reduction in ovarian reserve. It is still not clear whether the inflicted damage is immediate, sustained over time or associated with the use of electrocautery, nor which marker is more accurately reflects the post-operative reduction in ovarian reserve. This observational study assessed the damage inflicted by endometrioma removal with anti-Müllerian hormone (AMH) concentration and antral follicle count (AFC) pre and post-operatively. Twenty-five women with unilateral endometrioma underwent laparoscopic stripping of the endometrioma cyst capsule. There was a significant decrease both in AMH concentration (24%) and in AFC (11%) 1 month following surgery (P<0.01). At 6months post-operatively, the respective values were 24% and 15% less than preoperatively. AMH concentration and AFC showed no correlation with the use of bipolar electrocautery during surgery. Primordial follicles embedded adjacent to the cyst capsule were found in 61.5% of the specimens. Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve. The reduction is immediate and sustained over time. AMH appears to be a better indicator for post-operative quantification of the ovarian reserve.

 

 

Chin Med J (Engl). 2013;126(11):2011-4.

Diagnostic value of the neutrophil-to-lymphocyte ratio and the combination of serum CA-125 for stages III and IV endometriosis.

Yang H1Lang JHZhu LWang SSha GHZhang Y.

 

Abstract

BACKGROUND:

Currently, all the diagnostic indicators for endometriosis lack perfect sensitivity and specificity. According to the characteristic of endometriosis, we analyzed the new biomarker neutrophil-to-lymphocyte ratio (NLR) and the combination of NLR and serum CA-125 to investigate their diagnostic value for identifying stages III and IV endometriosis.

METHODS:

The values of serum CA-125 and routine blood tests were collected from 197 patients with endometriosis, 102 with benign tumors and 112 healthy individuals. We investigated the sensitivity and specificity of NLR and its combination with serum-CA-125 for diagnosing stages III and IV endometriosis by using receiver operating characteristic (ROC).

RESULTS:

The mean values of NLR, the combination of serum CA-125 and NLR (combination) of the groups with stages III and IV endometriosis were significantly higher than the other two groups. Serum CA-125, NLR, and the combined biomarkers could significantly discriminate the stages III and IV endometriosis group from the other two groups (P < 0.05). NLR shows a lower sensitivity of 57.9% and specificity of 65.2% with a cutoff value at 1.82. And the combination of biomarkers has the highest AUC of 0.949 with a sensitivity of 86.8% and specificity of 92.0% at the cutoff value of 44.40. In addition, for patients with negative CA-125, 55.36% and 53.57% of the patients were able to be diagnosed with endometriosis by using NLR alone and the combination of biomarkers.

CONCLUSION:

For diagnosing stages III and IV endometriosis, the neutrophil-to-lymphocyte ratio is a better adjuvant to serum CA-125, and the neutrophil-to-lymphocyte ratio is valuable in diagnosing stages III and IV endometriosis for patients with negative serum CA-125.

 

 

Am J Obstet Gynecol. 2013 Sep;209(3):248.e1-7.

The uterine junctional zone: a 3-dimensional ultrasound study of patients with endometriosis.

Exacoustos C1Luciano DCorbett BDe Felice GDi Feliciantonio MLuciano AZupi E.

 

Abstract

OBJECTIVE:

The uterine junctional zone (JZ) alterations are correlated with adenomyosis. An accurate evaluation of the JZ may be obtained by 3-dimensional transvaginal sonography (TVS). The aim of the present prospective study was to assess the value of detectable alterations by 3-dimensional TVS of the JZ in patients with pelvic endometriosis (diagnosed by laparoscopy and histologic condition) and to compare these findings with those of women without pelvic endometriosis.

STUDY DESIGN:

Eighty-two patients who were scheduled for laparoscopy had undergone previous surgery and 2- and 3-dimensional TVS. Uterine multiplanar sections that were obtained by 3-dimensional TVS were used to evaluate JZ features. During laparoscopy, an accurate staging of pelvic endometriosis was performed. JZ thickness and JZ alterations were correlated with stage of endometriosis.

RESULTS:

Of the 82 patients, 59 patients had endometriosis at laparoscopy and histology. The maximum thickness of JZ in patients with endometriosis was significantly greater than in patients without endometriosis (6.5 ± 1.9 mm vs 4.8 ± 1.0 mm; P < .001). The features of JZ appeared similar at different stages, whereas they are statistically different if correlated with patients without endometriosis.

CONCLUSION:

JZ thickness and its alterations are different in patients with endometriosis compared with those women without endometriosis and are not correlated with American Society of Reproductive Medicine staging methods. Because these JZ ultrasound features are associated mostly with adenomyosis, a correlation between endometriosis and JZ hyperplasia and adenomyosis could be hypothesized. Noninvasive evaluation of the JZ may be useful in the identification of those women who are affected by endometriosis also in early stage of the disease when there are no other sonographic signs of pelvic endometriosis.

 

 

Curr Opin Obstet Gynecol. 2013 Aug;25(4):287-92.

The use of gonadotropin releasing hormone analogues in adolescent and young patients with endometriosis.

DiVasta AD1Laufer MR.

 

Abstract

PURPOSE OF REVIEW:

Endometriosis is increasingly being recognized and diagnosed in adolescents. As a result of this earlier diagnosis, treatment with agents like gonadotropin releasing hormone agonist (GnRHa) begins earlier and may last longer. Long-term effects of GnRHa treatment for endometriosis are of concern when treating adolescents.

RECENT FINDINGS:

GnRHas are used for adolescents with surgically confirmed endometriosis. GnRHa treatment is effective for pain reduction, but is associated with menopausal symptoms and decreases in bone density. Different regimens of hormonal add-back therapy have been studied in adults to attempt to prevent these side-effects.

SUMMARY:

GnRHa therapy is a highly effective, nonsurgical treatment option for many adolescents with endometriosis, but is accompanied by side-effects of bone loss and menopausal symptoms. Side-effects may be decreased by introducing appropriate add-back therapy. Monitoring of bone density by DXA is recommended for prolonged use of GnRHa in adolescents.

 

 

Eur Rev Med Pharmacol Sci. 2013 Jun;17(11):1472-8.

Copper, ceruloplasmin and oxidative stress in patients with advanced-stage endometriosis.

Turgut A1Özler AGörük NYTunc SYEvliyaoglu OGül T.

 

Abstract

AIM:

To compare patients with advanced stage endometriosis with control patients without endometriosis with respect to serum Copper (Cu) and Ceruloplasmin (Cp) levels and oxidative stress markers in order to evaluate the importance of these parameters in the pathogenesis of endometriosis.

PATIENTS AND METHODS:

A total of 72 women who underwent laparoscopy or laparotomy for evaluation of infertility, pelvic pain, pelvic mass, tubal ligation or endometriosis were enrolled for this prospective clinical study. Patients were divided into two groups by visual diagnosis at surgery and histological confirmation of endometriosis: control patients (n=41) without endometriosis and study group (n=31) with stage III/IV (advanced stage) endometriosis. Serum Cu, Cp, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase-1 (PON-1), malondialdehyde (MDA), triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were compared between the two groups. Correlations between Cu, Cp and oxidative stress markers were determined.

RESULTS:

Serum TOS, OSI, Cu, Cp, TG, TC, LDL were significantly higher, whereas TAS, PON-1 activity and HDL were significantly lower, in women with advanced-stage endometriosis than in control groups. There was no difference in serum MDA activities between the two groups. Positive correlations were found between Cu and TOS, Cu and OSI, Cu and Cp, while a negative correlation was found between Cu and PON-1 in the advanced-stage endometriosis group. Positive correlations were found between Cp and TOS, and Cp and OSI in the advanced-stage endometriosis group.

CONCLUSIONS:

Cu and Cp appear to be associated with the etiopathogenesis of and oxidative stress in endometriosis.

 

 

Gynecol Endocrinol. 2013 Jul;29(7):712-5.

I405V polymorphism of CETP gene and lipid profile in women with endometriosis.

Sahmani M1Ghaleh TDDarabi MDarabi MRashvand ZNajafipour R.

 

Abstract

Genetic factors have an important role in the pathophysiology of endometriosis. In addition, abnormalities in lipid profile and intrinsic inflammatory status are associated with disease progression. The purpose of this study was to evaluate the effect of the I405V polymorphism of cholesteryl ester transfer protein (CETP) gene and lipid profile with the risk of endometriosis in women. Ninety-seven women with laparoscopy-diagnosed endometriosiswere recruited for this study, and 107 patients with no evidence of endometriosis confirmed by laparoscopy served as controls. Samples were analyzed for polymorphism of the CETP gene using polymerase chain reaction-restriction fragment length polymorphism-based methods. After adjustment for body mass index, high-density lipoprotein-C and low-density lipoprotein-C, the risk of endometriosis in patients with normal genotype homozygous was more of the rare allele (p < 0.001, odds ratio = 0.21, 95% confidence interval = 0.09-0.45). Our results suggest that I405V polymorphism of CETP gene plays an important role as independent factor in the risk of endometriosis in women.

 

 

Arch Gynecol Obstet. 2013 Dec;288(6):1323-8.

Deep endometriosis inflicting the bladder: long-term outcomes of surgical management.

Schonman R1Dotan ZWeintraub AYBibi GEisenberg VHSeidman DSGoldenberg MSoriano D.

 

Abstract

OBJECTIVE:

To assess the efficacy and safety of laparoscopic treatment of bladder endometriosis, especially in cases of full thickness endometriotic nodules.

DESIGN:

Retrospective review of medical records.

SETTING:

Tertiary medical center and a referral center for endometriosis.

POPULATION:

Sixty-nine patients with bladder endometriosis that underwent surgery between January 2005 and December 2011.

METHODS:

The records of all patients with bladder endometriosis were reviewed and the pre-, intra- and postoperative information of patients who underwent surgery was collected.

MAIN OUTCOME MEASURES:

Efficacy, safety and long-term outcome of laparoscopic treatment of bladder endometriosis.

RESULTS:

The mean age of 69 patients with bladder endometriosis was 31.3 ± 4.6 years. Preoperative urinary symptoms (such as frequency, urgency, dysuria and others) were present in 28 (40.0%) patients. Laparoscopy was performed in all patients. Deep detrusor involvement was found in 45 (65.2%) patients. Of these, 21 patients underwent partial cystectomy due to a full thickness lesion. Deep nodule resection without bladder invasion was performed in 24 (34.8%) patients and bladder nodule coagulation and ablation in the remaining 24 (34.8%) patients with superficial involvement. No intraoperative complications were noted. Postoperative follow-up results were available for all patients. After a median (range) follow-up period of 60 (4-92) months, 92.7% of the patients were asymptomatic or reported improvement in symptoms.

CONCLUSIONS:

After a long-term follow-up surgical management of bladder endometriosis is strongly recommended. During surgery, careful inspection and full excision of bladder lesions should be performed. Laparoscopic excision is a safe and efficacies approach.

 

 

J Clin Endocrinol Metab. 2013 Aug;98(8):E1364-8.

Relationship between serum polyunsaturated fatty acids and pregnancy in women undergoing in vitro fertilization.

Jungheim ES1Frolova AIJiang HRiley JK.

 

Abstract

CONTEXT:

Polyunsaturated fatty acids (PUFAs) and their metabolism may be important in normal reproductive function and fertility. Associations between physiologic PUFAs and pregnancy have not been established in women.

OBJECTIVE:

The purpose of this study was to investigate associations between serum levels of PUFAs and embryo implantation in women undergoing in vitro fertilization (IVF).

DESIGN:

This was a prospective cohort study conducted between 2010 and 2012.

SETTING:

The study was conducted at the Washington University Reproductive Medicine Center.

PATIENTS:

Participants were 200 women undergoing IVF and participating in an ongoing specimen tissue bank.

INTERVENTION:

Fasting serum PUFAs were measured with liquid chromatography-mass spectroscopy. PUFAs measured included linoleic acid (LA), α-linolenic acid (ALA), eicosapentaenoic acid, arachidonic acid, and docosahexaenoic acid.

MAIN OUTCOME MEASURES:

Relationships between serum levels of measured PUFAs and embryo implantation in women undergoing IVF were analyzed.

RESULTS:

In unadjusted analyses, none of the PUFAs alone were associated with a chance of pregnancy; however, women with increased LA:ALA ratios had a higher chance of pregnancy compared with women with lower LA:ALA ratios (relative risk, 1.52; 95% confidence interval, 1.09-2.13). This relationship held after multivariable logistic regression adjusting for age, antral follicle count, body mass index, history of previous pregnancy, and history of endometriosis (odds ratio, 2.7; 95% confidence interval, 1.3-5.7). Embryo implantation rates were also weakly associated with LA:ALA ratios (r = 0.21, P = .003).

CONCLUSIONS:

Our work shows that increased ω-6 to ω-3 PUFA ratios in women undergoing IVF are associated with increased implantation and pregnancy rates. Prospective trials are needed to determine whether manipulation of PUFA ratios through diet or pharmacologic intervention may benefit women planning to conceive.

 

 

J Pediatr Adolesc Gynecol. 2013 Jun;26(3):199-202.

Uterine remnants and pelvic pain in females with Mayer-Rokitansky-Küster-Hauser syndrome.

Marsh CA1Will MASmorgick NQuint EHHussain HSmith YR.

 

Abstract

OBJECTIVE:

To assess the association between pelvic pain and uterine remnants and review the management of pelvic pain in females with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

DESIGN:

Retrospective cohort.

SETTING:

Department of Obstetrics and Gynecology at a tertiary referring medical center.

PATIENTS:

Forty-eight females with MRKH presenting from 1997 to 2011 with anatomy confirmed by magnetic resonance imaging (MRI).

INTERVENTIONS:

None.

MAIN OUTCOME MEASURE:

Prevalence Of uterine remnants and the association of uterine remnants with pelvic pain in females with MRKH.

RESULTS:

Of the 48 females with MRKH, 23 (48%) had uterine remnants and 22 (46%) had pelvic pain. Presence of endometrium was associated with pelvic pain (RR = 2.3; 95% CI = 1.2-4.7) in females with MRKH. Of the females with MKRH and pain, 9/22 had laparoscopy, with endometriosis seen in 5/9 of the uterine remnants at stages higher than are usually seen in teenagers (56%). Nine patients with pain and uterine remnants (8 with endometrium, 1 without) had laparoscopic removal of uterine remnants with resolution of pain.

CONCLUSIONS:

Given the high prevalence of uterine remnants in females with MRKH, anatomic evaluation with MRI should be considered when assessing the etiology of pelvic pain. Presence of endometrium within uterine remnants, and subsequent endometriosis, in females with MRKH may be associated with pelvic pain necessitating surgical or medical management.

 

 

Fundam Clin Pharmacol. 2014 Jun;28(3):331-41.

Effects of tramadol on viscero-visceral hyperalgesia in a rat model of endometriosis plus ureteral calculosis.

Lopopolo M1Affaitati GFabrizio AMassimini FLapenna DGiamberardino MACostantini R.

 

Abstract

The effects of tramadol versus placebo administration on behavioral indicators of ureteral pain, pelvic pain and referred lumbar muscle hyperalgesia were investigated in a rat model of viscero-visceral hyperalgesia from endometriosis plus ureteral calculosis (endo + stone). Fifty female Sprague-Dawley rats underwent surgical induction of endometriosis and, 2 weeks later, were randomly assigned to five groups (10 each), to be treated i.p., twice a day, with tramadol (0.625, 1.25, 2.5, or 5 mg/kg) or saline for 5 days (14-18th day postendometriosis; prestone treatment). On the 21st day, they underwent laparotomy for stone formation in the upper left ureter (dental cement injection). All were video-taped 24 h nonstop for 7 days before and 4 days after stone formation (14-25th day postendometriosis) to record ureteral and pelvic pain behaviors. Lumbar sensitivity (L1) was tested bilaterally, daily over the same period, by verifying presence/absence of vocalization upon muscle pinching at a predefined pressure (calibrated forceps). Additional fifty endo + stone rats underwent the same protocol, except that treatment was performed on 21st-25th day (poststone treatment). Tramadol vs. saline significantly reduced number and duration of ureteral crises, duration of pelvic behavior, and incidence of muscle hyperalgesia (P < 0.0001), with a dose-dependent effect. Prestone treatment was significantly more effective than poststone treatment for the 1.25 dose for all parameters and 2.5 dose for pelvic and muscle parameters (0.003 > P < 0.02). Tramadol, even at low doses, is thus highly protective against pain from ‘viscero-visceral hyperalgesia’ in endometriosis plus ureteral calculosis; it can represent a valid therapeutic approach in women with these comorbidities.

 

 

J Minim Invasive Gynecol. 2013 Sep-Oct;20(5):642-7.

Predicting pelvic pain after endometrial ablation: which preoperative patient characteristics are associated?

Thomassee MS1Curlin HYunker AAnderson TL.

 

Abstract

STUDY OBJECTIVE:

To determine which patient characteristics are associated with an increased risk of postablation pelvic pain.

DESIGN:

Canadian Task Force classification II-2.

METHODS:

Data were collected from a retrospective cohort of patients who underwent endometrial ablation between January 2006 and September 2010 at a large academic medical center. Patients were identified via Current Procedural Terminology codes (58563, 58353, and 58356) for any type of endometrial ablation (rollerball or global); the sample size was 437 women. Multiple conditions and comorbidities were recorded for each patient. Bivariate analysis of patient demographics and the incidence of pain after endometrial ablation were evaluated using the chi square, Fisher exact, and independent t tests where appropriate. A final multivariate analysis with logistic regression was conducted to determine the exact patient characteristics that are associated with pelvic pain after endometrial ablation.

RESULTS:

Of 437 women who underwent endometrial ablation, 20.8% reported pain after their ablation. Patients were followed for up to 6.5 years postablation with a median follow-up of 794 days. The median number of days for the development of pain after ablation was 301 days, with 75% of patients who developed pain reporting it within approximately 2 years of their procedure. The median time to hysterectomy for those with pain was 570 days. Other postablation treatments included hormonal therapies in 9.4% of the total population. A total of 20.8% of patients reported postablation pelvic pain, but only 6.3% underwent subsequent hysterectomy for that indication. Preablation patient characteristics significantly associated with the development of postablation pain include dysmenorrhea (aOR = 1.73), smoking status (aOR = 2.31), prior tubal ligation (aOR = 1.68), and age less than 40 (aOR 1.90). Although not statistically significant, a diagnosis of endometriosis appears to be related to postablation pain (aOR = 2.24). Adenomyosis (suggested on ultrasound) and body mass index associations were not statistically significant. A patient with all 4 risk factors for postablation pain (i.e., dysmenorrhea, smoking, prior tubal ligation, and <40 years old) has a 53% (95% confidence interval, 0.40-0.66) chance of experiencing postablation pain.

CONCLUSION:

The observed incidence of pelvic pain is 20.8% after endometrial ablation and is more frequently observed in women with preablation dysmenorrhea, tobacco use, prior tubal ligation, age less than 40, and possibly endometriosis. One should consider these preexisting conditions when counseling patients regarding outcome expectations after an endometrial ablation procedure.

 

 

Reprod Sci. 2014 Feb;21(2):190-7.

Expression patterns of progesterone receptor membrane components 1 and 2 in endometria from women with and without endometriosis.

Bunch K1Tinnemore DHuff SHoffer ZSBurney ROStallings JD.

 

Abstract

Endometriosis is a hormone-dependent inflammatory condition associated with pain and infertility. A growing body of evidence supports attenuated secretory-phase progesterone responsiveness in women with this disease. Herein, we compare the expression of progesterone receptor membrane components (PGRMC) 1 and 2 in eutopic endometrium from 11 women with laparoscopically and/or histologically proven stage III/IV endometriosisand 23 disease-free women. Menstrual cycle phase was determined using a combination of reported cycle day, serum hormone profile, and endometrial histologic dating. The PGRMC-1 (fold change -3.3; P < .05) and PGRMC-2 (fold-change -8.8; P < .05) gene expression were significantly downregulated in secretory phase, eutopic endometrium from women with endometriosis. Immunohistochemistry demonstrated decreased PGRMC-1 and PGRMC-2 protein expression in the secretory phase endometrial stroma cells of women with endometriosis. Consistent with the preclinical work of others, our results reflect downregulation of endometrial PGRMC-1 and PGRMC-2 expression in secretory phase endometrium from women with advanced stage endometriosis. Understanding the molecular mechanisms of attenuated progesterone action in endometriosis has important diagnostic and therapeutic implications.

 

 

Arch Gynecol Obstet. 2013 Oct;288(4):747-57.

Ectopic pregnancy: a review.

Rana P1Kazmi ISingh RAfzal MAl-Abbasi FAAseeri ASingh RKhan RAnwar F.

 

Abstract

PURPOSE:

Ectopic pregnancy (EP) presents a major health problem for women of child-bearing age. EP refers to the pregnancy occurring outside the uterine cavity that constitutes 1.2-1.4 % of all reported pregnancies. All identified risk factors are maternal: pelvic inflammatory disease, Chlamydia trachomatis infection, smoking, tubal surgery, induced conception cycle, and endometriosis. These developments have provided the atmosphere for trials using methotrexate as a non-surgical treatment for EP. The diagnosis measure of EP is serum human chorionic gonadotropin, urinary hCGRP/i-hCG, progesterone measurement, transvaginal ultrasound scan, computed tomography, vascular endothelial growth factor, CK, disintegrin and metalloprotease-12 and hysterosalpingography. The treatment option of EP involves surgical treatment by laparotomy or laparoscopy, medical treatment is usually systemic or through local route, or by expectant treatment.

RESULTS:

It was concluded that review data reflect a decrease in surgical treatment and not an actual decline in EP occurrence so that further new avenues are needed to explore early detection of the EP.

 

 

 

J Clin Pathol. 2013 Dec;66(12):1084-6.

Hernia sacs: is histological examination necessary?

Wang T1Vajpeyi R.

 

Abstract

The hernia sac is a common surgical pathology specimen which can occasionally yield unexpected diagnoses. The College of American Pathologists recommends microscopic examination of abdominal hernias, but leaves submission of inguinal hernias for histology to the discretion of the pathologist. To validate this approach at a tertiary care centre, we retrospectively reviewed 1426 hernia sacs derived from inguinal, femoral and abdominal wall hernias. The majority of pathologies noted were known to the clinician, including herniated bowel, lipomas and omentum. A malignancy was noted in three of 800 inguinal hernias and seven of 576 abdominal wall hernias; five of these lesions were not seen on gross examination. Other interesting findings in hernia sacs included appendices, endometriosis, a perivascular epithelioid cell tumour, and pseudomyxoma peritoneii. All hernia sacs should be examined grossly as most pathologies are grossly visible. The decision to submit inguinal hernias for histology may be left to the discretion of the pathologist, but abdominal and femoral hernias should be submitted for histology.

 

 

Hum Reprod. 2013 Sep;28(9):2389-97

Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection.

Van den Broeck U1Meuleman CTomassetti CD’Hoore AWolthuis AVan Cleynenbreugel BVergote IEnzlin PD’Hooghe T.

 

Abstract

STUDY QUESTION:

Is there a difference between women with endometriosis who underwent laparoscopic surgery with bowel resection or without bowel resection regarding depressive symptoms, relational adjustment and sexual functioning?

SUMMARY ANSWER:

Radical surgery for endometriosis in both groups improved the levels of depression and sexual functioning, but only the bowel resection patients showed improvements in relationship satisfaction. WHAT IS KNOWN ALREADY?: The frequent pain symptoms in endometriosis patients can have an impact on psychological issues, relationships and sexual functioning. There are no data available on depression and relationship adjustment after endometriosis surgery. Sexual dysfunction problems have been described after bowel resection for rectal cancer, but no data are available for endometriosis surgery.

STUDY DESIGN, SIZE, DURATION:

This prospective cohort study included 203 consecutive women operated at the Leuven University Fertility Center (LUFC) between 1 September 2006 and 30 September 2008 for moderate (n = 67) or severe (n = 136) endometriosis. The preoperative response rate was respectively 84% in the bowel resection group and 79% in the no bowel resection group.

PARTICIPANTS, SETTING, METHODS:

The beck depression inventory (BDI) measured depression, the dyadic adjustment scale (DAS) measured relationship satisfaction and the short sexual functioning scale (SSFS) measured sexual functioning before and 6, 12 and 18 months after women had laparoscopic surgery at the LUFC, a tertiary referral centre for fertility exploration, treatment and surgery.

MAIN RESULTS AND THE ROLE OF CHANCE:

Both groups had better post-operative outcomes when compared with the preoperative assessments. Mean BDI and DAS levels were comparable with the normal population. Overall assessment points, the bowel resection patients had better outcomes for DAS (P < 0.05) and SSFS ‘arousal’ (P < 0.05) than the no bowel resection patients. At 6 months after the operation, when compared with the no bowel resection group, the bowel resection group reported lower mean levels of BDI (P < 0.05), a lower incidence of SSFS ‘pain during intercourse’ and ‘orgasm problems’ (P < 0.05), and a lower proportion of patients with severe orgasm problems (P < 0.05). The data show that radical but fertility sparing surgery, with or without bowel resection, for the treatment of endometriosis results in comparable and good psychological outcomes concerning depression levels, relationship satisfaction and sexual functioning.

LIMITATIONS, REASONS FOR CAUTION:

Although the initial response rate was good, response dropped over time and was significantly higher for bowel resection patients compared with the no bowel resection patients (P = 0.05). A responder/non-responder analysis for the whole study population showed no significant differences concerning pain problems. This reduces the possible risk of (positive) bias in the results.

WIDER IMPLICATIONS OF THE FINDINGS:

Endometriosis is a complex condition and the focus should not be on a one-dimensional end-organ gynaecological outcome, but should take into account the role of psychological factors in pain-related outcome. To this end, more prospective data are needed on sexual functioning and psychological outcomes.

 

 

J Indian Assoc Pediatr Surg. 2013 Apr;18(2):81-3.

Congenital pouch colon in a girl associated with bilateral atresia of cervix uteri and uterus didelphys.

Chadha R1Puri MSaxena RAgarwala SPuri AChoudhury SR.

 

Abstract

This report describes a girl with congenital pouch colon (CPC), uterus didelphys with septate vagina, and a cloacal anomaly. The girl underwent cloacal reconstruction at the age of 15 months. Subsequently, at puberty, the child had primary amenorrhea with severe cyclic abdominal pain due to endometriosis of both the uteruses and adnexal cysts with hematometra and hematosalpinx. Laparotomy with removal of both uteri and the left fallopian tube was performed. Both uteri had atresia of the cervix uteri. This report emphasizes the need for comprehensive evaluation and a long-term management strategy for associated gynecologic anomalies in girls with CPC, especially with regard to patency of the outflow tract.

 

 

Reprod Health. 2013 Jun 22;10:32

There is no relationship between Paraoxonase serum level activity in women with endometriosis and the stage of the disease: an observational study.

Bragatto FB1Barbosa CPChristofolini DMPeluso Cdos Santos AAMafra FACavalcanti VHix SBianco B.

 

Abstract

BACKGROUND:

Endometriosis is a chronic condition whose pathophysiology is unknown, but there is evidence suggesting a link with oxidative stress. Paraoxonase is a serum enzyme which circulates associated with high-density lipoprotein (HDL). It acts protecting HDL and LDL of lipid peroxidation. We aimed to compare the serum levels of PON-1 activity in women with endometriosis in different stages of the disease (minimal/mild and moderate/severe).

METHODS:

80 infertile women with endometriosis diagnosed by laparoscopy/laparotomy with histologic confirmation of the disease were divided according to the American Society for Reproductive Medicine classification in minimal/mild (n = 33) and moderate/severe (n = 47) cases. Paraoxonase activity and arilesterase activity were measured by spectrophotometry. Body mass index and fasting glucose levels were also determined.

RESULTS:

The paraoxonase activity were 191.29 ± 22.41 U/l in women with minimal/mild endometriosis and 224.85 ± 21.50 U/l in women with moderate/severe disease (P = 0.274). Considering arilesterase level, the results showed 89.82 ± 4.61 U/l in women with minimal/mild endometriosis and 90.78 ± 3.43 U/l in moderate/severe disease (P = 0.888).

CONCLUSIONS:

Evidence of lower paraoxonase activity in women with endometriosis was not found in this study. Besides, no difference was found considering minimal/mild or moderate/severe endometriosis.

 

 

World J Gastroenterol. 2013 Jun 21;19(23):3707-10.

Ileocecal endometriosis and a diagnosis dilemma: a case report and literature review.

Tong YL1Chen YZhu SY.

 

Abstract

Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. We describe the case of a 41-year-old woman who presented to our hospital because of six months of recurrent abdominal pain, vomiting and diarrhea, without previous history of bowel disease. Physical examination revealed a palpable 3 cm × 5 cm mass in the right lower quadrant abdomen. Laboratory tests showed slightly elevated levels of CA19-9 and CA125. Small bowel computer tomography scanning revealed an ileocecal mass with bowel wall thickening and luminal narrowing. Small bowel endoscopy identified a deep longitudinal ulcer and mucosal edema in the distal ileum. All these findings supported the diagnosis of Crohn’s disease. The patient underwent a laparotomy, which identified a 5 cm × 5 cm ileocecal mass with severe mucosal edema and luminal stricture in the distal ileum. Histopathological examination confirmed a diagnosis of ileocecal endometriosis without other areas involved. After one-year follow-up, there was no recurrence of the symptoms.

 

 

 

 

J Obstet Gynaecol Res. 2013 Jul;39(7):1246-52.

Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro fertilization.

Takashima A1Takeshita NOtaka KKinoshita T.

 

Abstract

AIM:

The aim of this study was to assess the effect of coagulation versus suture used for hemostasis during laparoscopic excision of a unilateral endometrioma for outcome of in vitro fertilization (IVF).

MATERIAL AND METHODS:

This retrospective study was set in a university hospital. A total of 44 sterile patients underwent laparoscopic excision of a unilateral ovarian endometrioma. Bipolar electrocoagulation was performed for hemostasis in 21 patients and the remaining 23 patients underwent suturing. Samples of blood were taken on day 3 of menstruation before the operation. Serum levels of anti-Müllerian hormone, follicle-stimulating hormone and estradiol were measured. Number of antral follicles, follicular flushings, oocytes retrieved, and embryos were counted and the outcomes of IVF were recorded.

RESULTS:

No significant differences in the serum levels of any of the hormones were found between the pre- and postoperative samples, in either group. The mean antral follicle count, number of follicular flushings, oocytes retrieved and embryos obtained were significantly lower in the treated ovary as compared with the corresponding values in the contralateral intact ovary in the suture group. The pregnancy rates were similar in the two groups.

CONCLUSIONS:

There was no difference in the outcome of IVF between the two different methods of hemostasis.

 

Lascia un commento

Cerca

Utilizzando il sito, accetti l'utilizzo dei cookie da parte nostra. maggiori informazioni

Questo sito utilizza i cookie per fornire la migliore esperienza di navigazione possibile. Continuando a utilizzare questo sito senza modificare le impostazioni dei cookie o cliccando su "Accetta" permetti il loro utilizzo.

Chiudi