J Minim Invasive Gynecol. 2014 Nov-Dec;21(6):1029-35.

The role of ovarian suspension in endometriosis surgery: a randomized controlled trial.

Seracchioli R1Di Donato N2Bertoldo V1La Marca A3Vicenzi C1Zannoni L1Villa G1Monti G1Leonardi D1Giovanardi G1Venturoli S4Montanari G1.

 

Abstract

STUDY OBJECTIVE:

A very high percentage of patients with severe pelvic endometriosis develop adhesions after laparoscopic surgery. The objective of this trial was to evaluate the role of ovarian suspension performed during surgery for severe endometriosis on ovarian adhesions and postoperative pelvic pain.

DESIGN:

A randomized controlled trial (Canadian Task Force classification I).

SETTING:

The tertiary care University Hospital of Bologna, Bologna, Italy.

PATIENTS:

Eighty patients with ovarian and posterior deep infiltrating endometriosis were included in the study.

INTERVENTIONS:

Patients underwent laparoscopic surgery for endometriosis and were randomized sequentially into 2 groups: transient ovarian suspension was performed in the treatment group (n = 40), whereas in the control group (n = 40) ovaries were left free in the pelvis. Symptom intensity (dysmenorrhea, chronic pelvic pain, dyspareunia, dyschezia, and dysuria) were ranked using a visual analog scale. Postsurgical ovarian adhesions were evaluated using transvaginal ultrasonographic scans performed by an ultrasound operator who was blinded to the details of the operative procedure and women’s randomization allocation. Complications, lesion localization, endometrioma diameter, and surgery time were recorded.

MEASUREMENTS AND MAIN RESULTS:

At follow-up, a significantly lower rate of ultrasound-detectable ovarian adhesions with the uterus and the bowel was observed in the treatment group, respectively (46.7% vs 77.3%, p = .003 and 26.7% vs 68.2%, p < .0005). Patients in the control group showed a higher percentage of fixed ovaries with moderate and severe adhesions than the treatment group, respectively (56.8% vs 28.9%, p = .003 and 20.5% vs 8.9%, p = .110). No differences between the 2 groups were found regarding complications and pelvic pain.

CONCLUSION:

Ovarian suspension seems to be an additional effective surgical procedure associated with an increased ovarian mobility in women treated for severe endometriosis. Moreover, it is feasible, safe, simple, and fast. Hence, it should be routinely used during laparoscopic surgery for endometriosis.

 

 

 

Reprod Sci. 2015 Feb;22(2):165-72

Behavior of tumor necrosis factor-α and tumor necrosis factor receptor 1/tumor necrosis factor receptor 2 system in mononuclear cells recovered from peritoneal fluid of women with endometriosis at different stages.

Salmeri FM1Laganà AS2Sofo V1Triolo O3Sturlese E3Retto G3Pizzo A3D’Ascola A4Campo S4.

 

Abstract

During endometriosis, a breakdown occurs in endometrial and peritoneal homeostasis caused by cytokine-induced cell proliferation and dysregulation of apoptosis. We studied tumor necrosis factor (TNF)-α, TNF receptor (TNFR) 1, and TNFR2 gene expression at both messenger RNA (mRNA) and protein levels in peritoneal fluid (PF) mononuclear cells (PFMCs), the percentages of these cells bearing the same markers, and soluble TNF-α (sTNF-α) values in PF of 80 women with endometriosis. We found that TNFR1 mRNA and protein levels, the percentages of TNFR1-bearing PFMCs, and sTNF-α values decreased from minimal to severe stages of the disease. Instead, TNF-α and TNFR2 mRNA and protein levels, the percentages of membrane TNF-α (mTNF-α)- and TNFR2-bearing PFMCs increased as the disease worsened. These data allow us to hypothesize that, in early stages, the high percentages of TNFR1-bearing PFMCs and the high levels of sTNF-α could address signal toward complex I pathway, favoring the inflammatory response. With the worsening of the disease, the low percentages of TNFR1-bearing PFMCs are probably due to decreased TNFR1 mRNA transcription and protein translation rate. In early stages (minimal and mild), the percentages of both TNFR2- and mTNF-α-bearing PFMCs are so low, due to decreased mRNA transcription and protein translation rate, that subsequent cellular events may depend minimally by this interaction. The high levels of sTNF-α may be rerouted to bind TNFR1. In contrast, in the moderate and severe stages, the high percentages of TNFR2-bearing PFMCs may be saturated by high percentages of mTNF-α-bearing PFMCs, triggering death process. So, in endometriosis, each component of the TNF-α/TNFRs system may trigger opposite cellular fate.

 

 

Aust N Z J Obstet Gynaecol. 2014 Jun;54(3):218-24

Bowel and bladder function after resection of deeply infiltrating endometriosis.

Li YH1De Vries BCooper MKrishnan S.

 

Abstract

AIMS:

To compare bowel and bladder function following uterosacral or rectovaginal excision of endometriosiswith excision of endometriosis from other sites of the pelvis.

METHODS:

A retrospective cohort study was performed via a questionnaire derived from validated questionnaires in the literature. This was applied to the two groups of women who have had endometriosisresected in the last 15 years–those with deeply infiltrating endometriosis (DIE) and those with endometriosis from other sites. In the questionnaire, voiding dysfunction, urinary stress incontinence, urinary urge incontinence, stool evacuation and overall symptoms post-surgery were investigated. The higher the score, the higher the level of dysfunction.

RESULTS:

Women with DIE had higher levels of urinary stress dysfunction than the control group (mean 1 vs 0, IQR 3 vs 2, P = 0.047). Women with DIE also expressed a higher level of bowel dysfunction (mean 2 vs 2, IQR 1 vs 0, P = 0.002). However, women with DIE also reported significant improvement in urinary and bowel dysfunction postoperatively. There were no significant differences between the other variables.

CONCLUSION:

The study demonstrated no clear association between the depth of excision of endometriosis with urinary and bowel dysfunction. The differences in urinary stress incontinence and bowel dysfunction may be explained by DIE itself causing damage to the hypogastric plexus.

 

 

Gynecol Endocrinol. 2014 Sep;30(9):671-5.

Distinct peritoneal fluid ghrelin and leptin in infertile women with endometriosis and their correlation with interleukin-6 and vascular endothelial growth factor.

Rathore N1Kriplani AYadav RKJaiswal UNetam R.

 

Abstract

OBJECTIVE:

The objective of the present study was to evaluate the levels of leptin, ghrelin, interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in peritoneal fluid in patients with endometriosis and infertility, and study their correlation.

DESIGN AND SETTING:

This cross-sectional study included women undergoing diagnostic and/or therapeutic laparoscopy for endometriosis with chief complaint of infertility and/or pain at a tertiary care hospital. Based upon laparoscopic and histopathological findings, patients were categorized as with endometriosis and no endometriosis. Of the 50 patients with infertility (age 23-41 years), 19 had endometriosis while 31 had no endometriosis. The markers were assessed using ELISA kits.

RESULTS:

The median levels of leptin in patients with endometriosis (10.20 ng/mL) were higher (p = 0.04) and median levels of ghrelin in patients with endometriosis (150.4 pg/mL) were lower (p = 0.037) versus patients with no endometriosis (5.07 ng/mL and 229.6 pg/mL, respectively). The median levels of IL-6 and VEGF in patients with endometriosis were not different between the groups. The correlation analyses showed that leptin levels and IL-6 were positively correlated (p = 0.0001).

CONCLUSIONS:

The results suggest that ghrelin and leptin might play a key role in pathophysiology of endometriosis, and leptin is associated with inflammation in endometriosis.

 

 

Minerva Ginecol. 2014 Apr;66(2):155-64.

Ovarian cancer in endometriosis: clinical and molecular aspects.

Lyttle B1Bernardi LPavone ME.

 

Abstract

Endometriosis is a gynecological condition characterized by specific histological, molecular and clinical findings, that affects 5-10% of premenopausal women and has been implicated as a precursor for certain types of ovarian cancer. Clinical studies of endometriosis associated ovarian cancer (EAOC) suggest that patients present at a young age with a lower stage and grade of tumor, and are more likely to be premenopausal than women with other ovarian cancers. However, when overall survival is compared between these types of ovarian cancers, there is no difference noted. In addition, EAOC tumors are more likely to be found with a concurrent diagnosis of cancer, most commonly endometrial. Advances in technology, primarily the ability for whole genome sequencing, have led to the discovery of new mutations and further understanding of previously identified genes and pathways associated with EAOCs including PTEN, CTNNB1 (beta-catenin), KRAS, microsatellite instability and ARID1A. This paper will review the most recent clinical and molecular advances in the association of endometriosis and ovarian cancer.

 

 

J Assist Reprod Genet. 2014 Jul;31(7):829-35.

Basal serum testosterone levels correlate with ovarian response but do not predict pregnancy outcome in non-PCOS women undergoing IVF.

Sun B1Wang FSun JYu WSun Y.

 

Abstract

PURPOSE:

To evaluate basal testosterone (T) levels in women undergoing in vitro fertilization (IVF) cycles and examine the association between basal T levels and ovarian response or IVF pregnancy outcome.

METHODS:

We retrospectively analyzed 1413 infertile Chinese women undergoing their first IVF treatment at our institution’s reproductive center from March 2011 to May 2013. The basal testosterone (T) levels in women undergoing in vitro fertilization (IVF) and the relationship between basal T levels and ovarian response or IVF pregnancy outcome were determined. These patients did not have polycystic ovary syndrome (PCOS) or endometriosis, and were treated with a long luteal down-regulation protocol. Subjects were divided into 2 groups according to basal testosterone (T) levels: Group 1, basal T values <20 ng/dl (n = 473), and Group 2, basal T values >20 ng/dl (n = 940). We evaluated the association of basal T levels with ovarian response and IVF outcome in the two groups.

RESULTS:

In this study, BMI, basal follicle-stimulating hormone (FSH) levels, basal luteinizing hormone (LH) levels, antral follicle count (AFC), days of stimulation, total gonadotrophin dose, basal FSH/LH ratio, and the number of follicles >14 mm were significantly different (P < 0.05) between the two groups. Basal T level positively correlated with ovarian reserve function, number of follicles >14 mm on human chorionic gonadotrophin (HCG) day, and total gonadotropin dose. However, basal T levels play no role in predicting IVF pregnancy outcome.

CONCLUSION:

Basal T level can be used as a good predictor for ovarian response and the number of large follicles on HCG day. Additionally, we may use basal T level as a marker to predict FSH dosage. In general women, lower level of T might relate with potential poor ovarian response. However, based on our data, basal T levels do not predict pregnancy outcome.

 

 

BMJ Case Rep. 2014 May 21;2014.

Endometrioma contained within the broad ligament.

Trehan ATrehan AK.

 

Abstract

We present a rare case of an endometrioma present within and firmly adherent to the broad ligament in a patient who experienced an episode of acute abdominal pain. The endometrioma was excised laparoscopically and the broad ligament repaired.

 

 

Gynecol Obstet Invest. 2014;78(1):1-9.

The history of endometriosis.

Benagiano G1Brosens ILippi D.

 

Abstract

A dispute has recently emerged whether early descriptions exist of the condition we name endometriosis. A first question is: ‘Who identified endometriosis?’ To respond, two non-complementary methods have been employed: searching for ancient descriptions of symptoms associated with endometriosis or, alternatively, identifying researchers who described pathological features we associate with the presence of endometriosis in its various forms. We opted for the latter and found no evidence that in older times anyone delineated the macroscopic features of endometriosis; descriptions of menstrual or cyclic pain cannot be taken as proof of knowledge of what caused it. During the mid-part of the 19th century, Rokitansky had a great intuition: endometrial glands and stroma can be present in ovarian and uterine neoplasias. However, using histological parameters of endometrial structure and activity, the first scientist to delineate peritoneal endometriosis under the name ‘adenomyoma’ was Cullen. On the other hand, Rokitansky was the first to describe a form of adenomyosis (an adenomatous polyp). Early descriptions of ovarian endometrioma as ‘haematomas of the ovary’ or ‘chocolate cysts’ date back to the end of the 19th century. The first mention of an ‘ovary containing uterine mucosa’ was published in 1899 by Russel, but Sampson was the first to demonstrate specific endometrial activities, such as desquamation at the time of menstruation and decidualization in pregnancy; subsequently, he presented a theory on its pathogenesis.

 

 

J Ovarian Res. 2014 May 10;7:52.

Immunoexpression of aromatase cytochrome P450 and 17β-hydroxysteroid dehydrogenase in women’s ovaries after menopause.

Brodowska A1Brodowski J2Laszczyńska M3Słuczanowska-Głąbowska S4Rumianowski B3Rotter I5Starczewski A1Ratajczak MZ6.

 

Abstract

BACKGROUND:

Menopause results in a lack of regular menstrual cycles, leading to the reduction of estrogen production. On the other hand, ovarian androgen synthesis is still present at reduced levels and requires expression of several steroidogenic enzymes.

METHODS:

This study was performed on 104 postmenopausal women hospitalized due to uterine leiomyomas, endometriosis, and/or a prolapsed uterus. Patients were divided into three groups depending on the time from menopause. Group A patients experienced menopause 1-5 years before enrollment in the study (42 women). Group B included women who had their last menstruation 5-10 years before the study (40 women). Group C consisted of 22 women who were more than 10 years past menopause. Hysterectomy or removal of the uterine corpus with adnexa was performed during laparotomy. We evaluated the expression of aromatase cytochrome P450 (CYP 19) and 17β-hydroxysteroid dehydrogenase (17β HSD) by employing immunohistochemistry.

RESULTS:

Activity of 17β-HSD and CYP19 was demonstrated in the cytoplasm of stromal cells of postmenopausal ovaries, epithelium cells coating the ovaries, vascular endothelial cells, and epithelial inclusion cysts. However, overall expression of both 17β-HSD and CYP 19 decreased with time after menopause.

CONCLUSION:

Demonstration of the activity of the key enzymes of ovarian steroidogenesis, CYP 19 and 17β-HSD, confirms steroidogenic activity in the ovaries of postmenopausal women. Nevertheless, ovarian steroidogenic activity decreases with time, and its significant decrease occurs 10 years after menopause.

 

 

Rev Prat. 2014 Apr;64(4):545-50.

Endometriosis.

Daraï EBazot MBallester MBelghiti J.

Abstract

Endometriosis is a benign disorder affecting 10 to 15% of women of reproductive age. It is defined by the presence of endometrium-like tissue outside the uterus. There are three different entities of endometriosis: superficial endometriosis, ovarian endometriotic cyst and deep infiltrating endometriosis. The main clinical features are dysmenorrhea, chronic pelvic pain and dyspareunia. Endometriosis is also responsible for infertility. Transvaginal sonography and magnetic resonance imaging are required to assess mapping of endometriotic lesions. Medical therapies based on progestins or combined oral contraceptives allow to relief symptoms. Despite a relative efficacy of medical treatment or in case of infertility, surgery is necessary preferentially in specialized centers.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:209-15.

Endometriosis and type 1 allergies/immediate type hypersensitivity: a systematic review.

Bungum HF1Vestergaard C2Knudsen UB3.

 

Abstract

Endometriosis is a chronic and debilitating disorder affecting up to 5-10% of women in reproductive age. Investigators have described deficiency in cellular immunity in women suffering from endometriosis, and in the recent years endometriosis has been linked to other diseases, allergic disease being one of them. The objective of this paper is to systematically review the existing literature on the possible association between endometriosisand allergic disease. This review is based on the recommendations by the preferred reporting of systematic reviews and meta-analysis (PRISMA) statement. PubMed and Embase were searched for studies on women diagnosed with endometriosis and with manifestations of allergic disease who were compared to a reference group. Out of 316 articles screened, 6 were reviewed and 5 ultimately met the inclusion criteria. Four out of the five studies reported a positive correlation between endometriosis and allergic manifestations, including hay fever, sinus allergic rhinitis, and food intolerance/sensitivities (food allergy). Investigators reported an odds ratio (OR) as high as 4.28 (95% CI: 2.93-6.27) for a positive history of allergy among women suffering from endometriosis. Equivocal results were found on asthma prevalence in women with endometriosis. Due to the heterogeneity of the included studies, no meta-analyses could be performed. The available literature clearly indicates that women with endometriosis are at an increased risk of allergic disorders compared to controls, but due to the lack of a concise definition of allergic disease and therefore diagnostic criteria, further studies are needed in order to draw firm conclusions on the association between endometriosis and allergic disease.

 

Mymensingh Med J. 2014 Apr;23(2):389-91.

A case of abdominal wall scar endometriosis.

Saha K1Shahida SMMostafa GAhmed M.

 

Abstract

Endometriosis is presence of functioning endometrial tissue outside the uterine cavity. Endometriosis can sometimes occur in a previous surgical scar. Scar endometriosis is rare and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. This condition is often confused with other surgical conditions. We are reporting a case of scar endometriosis following caesarean section, which was being treated as stitch granuloma for long time. Medical treatment was not helpful. The patient required wide surgical excision of the lesion. Now the patient is under regular follow up, because there is chance of recurrence.

 

 

J Minim Invasive Gynecol. 2014 Nov-Dec;21(6):1041-8.

Surgical and clinical impact of extraserosal pelvic fascia removal in segmental colorectal resection for endometriosis.

Ballester M1Belghiti J2Zilberman S2Thomin A2Bonneau C3Bazot M4Thomassin-Naggara I4Daraï E5.

 

Abstract

STUDY OBJECTIVE:

To describe the characteristics of patients with colorectal endometriosis and extraserosal pelvic fascia (EPF) involvement and to assess the effect of EPF resection.

DESIGN:

Prospective cohort study (Canadian Task Force classification II-2).

SETTING:

University hospital.

PATIENTS:

Two hundred twenty-seven patients who underwent segmental colorectal resection to treat symptomatic deep infiltrating endometriosis between 2001 and 2011, with or without EPF resection.

INTERVENTIONS:

Segmental colorectal resection with or without EPF resection.

MEASUREMENTS AND MAIN RESULTS:

One hundred twelve patients (49.4%) required EPF resection. In these patients the total American Society for Reproductive Medicine endometriosis scores were higher (p = .004), there were more associated resected lesions of deep infiltrating endometriosis (p <.001), and the operative time was longer (p <.001). They were more likely to require blood transfusion (p = .003) and to experience intraoperative complications (p = .01) and postoperative voiding dysfunction (p = .04).

CONCLUSION:

EPF infiltration reflects disease severity in patients with colorectal endometriosis. Its removal affects intraoperative morbidity and leads to a higher rate of voiding dysfunction.

 

 

J Minim Invasive Gynecol. 2014 Nov-Dec;21(6):1095-102.

Totally laparoscopic intracorporeal anastomosis with natural orifice specimen extraction (NOSE) techniques, particularly suitable for bowel endometriosis.

Akladios C1Faller E2Afors K3Puga M3Albornoz J3Redondo C3Leroy J3Wattiez A2.

 

Abstract

The objective of this retrospective study was to evaluate the feasibility of natural orifice specimen extraction (NOSE) techniques in 41 patients undergoing bowel resection for treatment of deep infiltrating endometriosis. In all patients laparoscopic treatment of rectovaginal endometriosis with bowel resection had been performed. In 32 patients the classic approach was adopted (group 1), and in 9 a NOSE technique was performed (group 2). Demographic, operative, and postoperative data were compared. Statistical analyses were performed using SPSS software, version 16.0. When needed, qualitative variables were compared using the χ(2) test or the Fisher exact test. Quantitative variables using the t-test were used. The threshold of statistical significance was set at p = .05. No statistically significant difference was observed between the 2 groups. Eight complications (19.5%) were observed, 2 minor (4.8%) and 6 major (14.6%). Of major complications, 2 were observed in the NOSE group (n = 2; 22.2%). It was concluded that the NOSE technique is a feasible approach in patients undergoing bowel resection for treatment of deep infiltrating endometriosis.

 

 

J Minim Invasive Gynecol. 2014 Nov-Dec;21(6):1061-6.

Long-term fertility after laparoscopy for endometriosis-associated pelvic pain in young adult women.

Wilson-Harris BM1Nutter B2Falcone T3.

 

Abstract

STUDY OBJECTIVE:

To describe the long-term fertility outcomes in young patients with endometriosis-associated pelvic pain treated with laparoscopic surgery.

DESIGN:

Retrospective case series (Canadian Task Force classification II-2).

SETTING:

Tertiary care hospital.

PATIENTS:

Women aged 18 to 25 years who underwent laparoscopic surgery between 2000 and 2005 at the Cleveland Clinic Foundation solely to treat endometriosis-associated pelvic pain.

INTERVENTIONS:

Patients answered a telephone or mail survey questionnaire assessing fertility outcome after surgery.

MEASUREMENTS AND MAIN RESULTS:

Twenty-eight of 74 eligible patients (37.8%) were enrolled in the study. With a median (interquartile range) age of 23.5 (1.5) years at follow-up, these patients completed the telephone or postal questionnaire to assess fertility outcomes at follow-up of 102.5 (16.6) months. In most participants the diagnosis was less advanced endometriosis (stage I, 60.7%; stage II, 28.6%). Twenty women (71.4%) had at least 1 pregnancy during follow-up that resulted in a live birth, of which >80% were spontaneous without the use of assisted reproductive technologies.

CONCLUSION:

Long-term pregnancy rates are excellent in young women undergoing laparoscopic surgery to treat pelvic pain. However, a future prospective study is needed to determine whether laparoscopy has any hindrance on future fertility.

 

 

Hum Reprod Update. 2014 Sep-Oct;20(5):717-36.

Peripheral changes in endometriosis-associated pain.

Morotti M1Vincent K2Brawn J3Zondervan KT4Becker CM2.

 

Abstract

BACKGROUND:

Pain remains the cardinal symptom of endometriosis. However, to date, the underlying mechanisms are still only poorly understood. Increasing evidence points towards a close interaction between peripheral nerves, the peritoneal environment and the central nervous system in pain generation and processing. Recently, studies demonstrating nerve fibres and neurotrophic and angiogenic factors in endometriotic lesions and their vicinity have led to increased interest in peripheral changes in endometriosis-associated pain. This review focuses on the origin and function of these nerves and factors as well as possible peripheral mechanisms that may contribute to the generation and modulation of pain in women with endometriosis.

METHODS:

We conducted a systematic search using several databases (PubMed, MEDLINE, EMBASE and CINAHL) of publications from January 1977 to October 2013 to evaluate the possible roles of the peripheral nervous system in endometriosis pathophysiology and how it can contribute to endometriosis-associated pain.

RESULTS:

Endometriotic lesions and peritoneal fluid from women with endometriosis had pronounced neuroangiogenic properties with increased expression of new nerve fibres, a shift in the distribution of sensory and autonomic fibres in some locations, and up-regulation of several neurotrophins. In women suffering from deep infiltrating endometriosis and bowel endometriosis, in which the anatomical distribution of lesions is generally more closely related to pelvic pain symptoms, endometriotic lesions and surrounding tissues present higher nerve fibre densities compared with peritoneal lesions and endometriomas. More data are needed to fully confirm a direct correlation between fibre density in these locations and the amount of perceived pain. A better correlation between the presence of nerve fibres and pain symptoms seems to exist for eutopic endometrium. However, this appears not to be exclusive to endometriosis. No correlation between elevated neurotrophin levels and pain severity appears to exist, suggesting the involvement of other mediators in the modulation of pain.

CONCLUSIONS:

The increased expression of neurotrophic factors and nerve fibres in endometriotic lesions, eutopic endometrium and the peritoneum imply a role of such peripheral changes in the pathogenesis of endometriosis-associated pain. However, a clear link between these findings and pain in patients with endometriosis has so far not been demonstrated.

 

 

Rev Med Chil. 2014 Jan;142(1):16-9.

Prevalence of endometriosis in 287 women undergoing surgical sterilization in Santiago Chile.

Fuentes AEscalona JCéspedes PEspinoza AJohnson MC.

 

Abstract

BACKGROUND:

The clinical manifestations of endometriosis are infertility, dysmenorrhea, sexuality disturbances, and chronic pelvic pain. It is the cause of 30 to 50% of infertility cases. In developed countries, the prevalence of endometriosis among women undergoing surgical sterilization is approximately 6%.

AIM:

To determine the prevalence of endometriosis among women with proven fertility in Santiago de Chile.

MATERIAL AND METHODS:

Review of surgical protocols of 287 women aged 25 to 49 years, subjected to a surgical sterilization between 2007 and 2011.

RESULTS:

Endometriosis was found in 14 of the 287 women (4.9%). In spite of being asymptomatic, five of the 14 women with endometriosis were classified as severe, due to the presence of at least one endometrioma. In order of frequency, the most commonly affected anatomical sites were the ovary, the peritoneum, the posterior cul-de-sac and uterosacral ligaments.

CONCLUSIONS:

Our findings are very similar to those found elsewhere and suggest that fertile women could better tolerate endometriosis than their infertile counterparts.

 

 

Gynecol Obstet Invest. 2014;78(1):45-52.

Serum prolactin and CA-125 levels as biomarkers of peritoneal endometriosis.

Bilibio JP1Souza CARodini GPAndreoli CGGenro VKde Conto ECunha-Filho JS.

 

Abstract

BACKGROUND/AIMS:

To evaluate serum prolactin and CA-125 levels as biomarkers for the diagnosis of peritoneal endometriosis.

METHODS:

A prospective study was performed. Blood samples were drawn from a peripheral vein during the secretory phase of the menstrual cycle (day 19-21 prior to the surgery) to analyze through relative operating characteristic curve the serum prolactin and CA-125 levels for diagnosis of peritoneal endometriosis. The study was performed with 97 participants, 63 women with peritoneal endometriosis and 34 healthy women.

RESULTS:

The sensitivity and specificity of peritoneal endometriosis diagnosis were equivalent for prolactin (21 and 99%) and for CA-125 (27 and 97%; p = 0.58). These two markers were used in a parallel test utilizing the usual cutoff (prolactin 20.0 ng/ml and CA-125 35 U/I). The sensitivity and specificity were 44 and 99%. However, by utilizing the best cutoff (prolactin 14.8 ng/ml and for CA-125 19.8 U/I), sensitivity, specificity and negative predictive value were 77, 88 and 97%, respectively.

CONCLUSION:

Serum CA-125 and prolactin levels assessed together, and considering the cutoff for CA-125 (19.9 U/I) and prolactin (14.8 ng/ml), allow the diagnosis of peritoneal endometriosis with acceptable sensitivity and specificity (77 and 88%) and a high negative predictive value (97%).

 

 

Best Pract Res Clin Obstet Gynaecol. 2014 Jul;28(5):655-81.

Imaging for the evaluation of endometriosis and adenomyosis.

Exacoustos C1Manganaro L2Zupi E3.

 

Abstract

Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment.

 

J Neurosci Methods. 2014 Jul 30;232:118-24.

Use of dynamic weight bearing as a novel end-point for the assessment of abdominal pain in the LPS-induced peritonitis model in the rat.

Gruen M1Laux-Biehlmann A1Zollner TM1Nagel J2.

 

Abstract

BACKGROUND:

Chronic pelvic pain (CPP) is defined as long-lasting and severe pelvic pain persisting over six months in cyclic or non-cyclic chronic manner. Various pathologic conditions like endometriosis, abdominal infections, intra-peritoneal adhesions or infection, underlie CPP which is often the leading symptom of the associated diseases. Pharmacological approaches addressing CPP are hampered by the absence of a straight-forward, objective, and reliable method for the assessment of CPP in rodents.

METHOD:

In the presented study, the dynamic weight bearing system (DWB) was employed for the first time for the evaluation of pelvic pain in a rat model of LPS-induced peritonitis. Rats were pretreated with the COX-2 inhibitor rofecoxib and PGE2 levels were evaluated in peritoneal lavage.

RESULTS:

DWB analysis revealed that rats treated with LPS showed a relief posture by a significantly increased weight distribution to the front when compared to vehicle-treated animals. This effect was prevented by rofecoxib treatment indicating the sensitivity of the model for pelvic pain related to peritonitis. Analysis of the PGE2 levels in the peritoneal fluid indicated a correlation with the relief posture intensity.

COMPARISON WITH EXISTING METHOD(S):

In contrast to others weight bearing approaches, the use of DWB allows evaluation of spontaneous posture changes as a consequence of pelvic pain.

CONCLUSION:

Taken together, we were able to show, that DWB combined with LPS-induced peritonitis may deliver a new reliable animal model addressing pelvic pain with high construct validity (peritoneal inflammation), and face validity (pain related relief posture).

 

 

Ultrasound Obstet Gynecol. 2014 Dec;44(6):710-8.

Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study.

Reid S1Lu CHardy NCasikar IReid GCario GChou DAlmashat DCondous G.

 

Abstract

OBJECTIVE:

To use office gel sonovaginography (SVG) to predict posterior deep infiltrating endometriosis (DIE) in women undergoing laparoscopy.

METHODS:

This was a multicenter prospective observational study carried out between January 2009 and February 2013. All women were of reproductive age, had a history of chronic pelvic pain and underwent office gel SVG assessment for the prediction of posterior compartment DIE prior to laparoscopic endometriosissurgery. Gel SVG findings were compared with laparoscopic findings to determine the diagnostic accuracy of office gel SVG for the prediction of posterior compartment DIE.

RESULTS:

In total, 189 women underwent preoperative gel SVG and laparoscopy for endometriosis. At laparoscopy, 57 (30%) women had posterior DIE and 43 (23%) had rectosigmoid/anterior rectal DIE. For the prediction of rectosigmoid/anterior rectal (i.e. bowel) DIE, gel SVG had an accuracy of 92%, sensitivity of 88%, specificity of 93%, positive predictive value (PPV) of 79%, negative predictive value (NPV) of 97%, positive likelihood ratio (LR+) of 12.9 and negative likelihood ratio (LR-) of 0.12 (P = 3.98E-25); for posterior vaginal wall and rectovaginal septum (RVS) DIE, respectively, the accuracy was 95% and 95%, sensitivity was 18% and 18%, specificity was 99% and 100%, PPV was 67% and 100%, NPV was 95% and 95%, LR+ was 32.4 and infinity and LR- was 0.82 and 0.82 (P = 0.009 and P = 0.003).

CONCLUSIONS:

Office gel SVG appears to be an effective outpatient imaging technique for the prediction of bowel DIE, with a higher accuracy for the prediction of rectosigmoid compared with anterior rectal DIE. Although the sensitivity for vaginal and RVS DIE was limited, gel SVG had a high specificity and NPV for all forms of posterior DIE, indicating that a negative gel SVG examination is highly suggestive of the absence of DIE at laparoscopy.

 

 

Gynecol Obstet Invest. 2014;78(2):69-80.

The patient-centeredness of endometriosis care and targets for improvement: a systematic review.

Dancet EA1Apers SKremer JANelen WLSermeus WD’Hooghe TM.

 

Abstract

BACKGROUND:

Endometriosis is a prevalent condition compromising physical and psychosocial health and thus requiring patient-centered care, which is guided by patients’ values. This study aimed to find out what the patient’s perspective on endometriosis care is and how the patient-centeredness of endometriosis care can be improved.

METHODS:

Electronic databases were searched systematically, and study selection was based on eligibility and quality. Study methodology was examined. Specific care aspects valued by patients were organized according to 10 dimensions of patient-centered endometriosis care. Based on patients’ assessments of service quality, patient-centered improvement targets and strengths were identified.

RESULTS:

Twelve of 20 eligible studies had sufficient quality to be included. Endometriosis patients valued all 10 dimensions of patient-centered endometriosis care. Problematic service quality was reported for all dimensions but ‘coordination and integration’ and ‘involvement of significant others’. Two patient-centered strengths and 29 patient-centered improvement targets were identified. The most frequently reported improvement targets on which studies agreed were ‘timely diagnosis’ and ‘being believed and respected by staff’.

CONCLUSION:

Endometriosis patients value patient-centeredness in addition to effectiveness and safety of care, and its 10 dimensions require attention in clinical practice. Research into the assessment and improvement of patient-centered endometriosis care is required.

 

 

Gynecol Obstet Invest. 2014;78(1):59-64.

Endometriosis is not associated with inferior pregnancy rates in in vitro fertilization: an analysis of 616 patients.

Polat M1Boynukalın FKYaralı IEsinler IYaralı H.

 

Abstract

BACKGROUND/AIMS:

To analyze whether the presence of endometriosis per se is associated with inferior pregnancy rates in women undergoing in vitro fertilization (IVF).

METHODS:

Between July 2005 and November 2012, a total of 485 patients with endometriosis under the age of 38 years undergoing their first IVF attempt at our center were included; 72 patients had minimal-mild disease and the remaining 413 patients had moderate-severe disease. 131 patients with laparoscopically confirmed tubal factor infertility not harboring endometriosis and hydrosalpinx under the age of 38 years undergoing their first IVF attempt at our center served as the control group.

RESULTS:

The bilateral antral follicle count and controlled ovarian hyperstimulation response were diminished in the moderate-severe group. However, the implantation, clinical pregnancy, miscarriage and live birth rates were comparable among the three groups. The recurrence of endometrioma following pre-IVF cystectomy was not associated with inferior pregnancy rates. Female age, bilateral antral follicle count and number of embryos transferred were noted to be significant independent predictors of live birth.

CONCLUSION:

We conclude that neither the presence nor the extent of endometriosis have any detrimental effect on IVF pregnancy rates.

 

 

 

Fertil Steril. 2014 Aug;102(2):e7

Laparoscopic and transanal excision of large lower- and mid-rectal deep endometriotic nodules: the Rouen technique.

Roman H1Tuech JJ2.

 

Abstract

OBJECTIVE:

To report an original technique of combined laparoscopic and transanal disc excision of lower- and mid-rectal deep endometriotic nodules.

DESIGN:

Video article introducing a new surgical technique.

SETTING:

University hospital.

PATIENT(S):

A 30-year-old nullipara with symptomatic deep endometriosis-large nodules involving the vagina and the lower rectum over 30 mm.

INTERVENTION(S):

An original technique of combined laparoscopic and transanal approaches, including deep rectal shaving using PlasmaJet, followed by transanal full thickness disc excision of the shaved area using the Contour Transtar stapler.

MAIN OUTCOME MEASURE(S):

The procedure is based on specific properties of PlasmaJet (the lack of lateral thermal spread making the dissection on contact of the rectal wall safe, the precise ablative property allowing for in situ ablation of rectal endometriosis implants) and those of the Contour Transtar stapler, which was originally developed to perform stapled transanal rectal resection of the internal rectal prolapse or rectocele. The steps of the Rouen technique and the role of the two devices are emphasized. Surgical technique reports in anonymous patients are exempted from ethical approval by the Institutional Review Board. The patient gave consent to use the video in the article.

RESULT(S):

The patient’s functional outcome was uneventful, except for transitory incomplete bladder voiding. Since June 2009, we have successfully employed this technique in 15 patients with low rectal nodules, with only favorable digestive functional outcomes.

CONCLUSION(S):

Our technique is suitable for large nodules involving the lower and mid-rectum and avoids low colorectal resection, thus increasing the chance of favorable functional digestive outcomes.

 

 

 

 

 

World J Clin Cases. 2014 May 16;2(5):133-6.

Cesarean scar endometrioma: Case series.

Cöl C1Yilmaz EE1.

 

Abstract

AIM:

To evaluate endometrioma located at cesarean scatrix.

METHODS:

Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series. The diagnostic approaches and treatment is discussed.

RESULTS:

All patients had a painful mass located at abdominal scars with history of cesarean section. The ages ranged from 31 to 34 and Doppler ultrasonography (US) detected hypoechoic mass with a mean diameter of 30 mm. Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients. Treatment was achieved with surgical excision in 5 patients, and one is followed by hormone suppression therapy with gonadotropin.

CONCLUSION:

Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma. Imaging methods like doppler US, computed tomography and magnetic resonance imaging should be used for differential diagnosis. Definitive diagnosis can only be made histopathologically. The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences.

 

 

Biomed Res Int. 2014;2014:934261.

Recent concepts of ovarian carcinogenesis: type I and type II.

Koshiyama M1Matsumura N1Konishi I1.

 

Abstract

Type I ovarian tumors, where precursor lesions in the ovary have clearly been described, include endometrioid, clear cell, mucinous, low grade serous, and transitional cell carcinomas, while type II tumors, where such lesions have not been described clearly and tumors may develop de novo from the tubal and/or ovarian surface epithelium, comprise high grade serous carcinomas, undifferentiated carcinomas, and carcinosarcomas. The carcinogenesis of endometrioid and clear cell carcinoma (CCC) arising from endometriotic cysts is significantly influenced by the free iron concentration, which is associated with cancer development through the induction of persistent oxidative stress. A subset of mucinous carcinomas develop in association with ovarian teratomas; however, the majority of these tumors do not harbor any teratomatous component. Other theories of their origin include mucinous metaplasia of surface epithelial inclusions, endometriosis, and Brenner tumors. Low grade serous carcinomas are thought to evolve in a stepwise fashion from benign serous cystadenoma to a serous borderline tumor (SBT). With regard to high grade serous carcinoma, the serous tubal intraepithelial carcinomas (STICs) of the junction of the fallopian tube epithelium with the mesothelium of the tubal serosa, termed the “tubal peritoneal junction” (TPJ), undergo malignant transformation due to their location, and metastasize to the nearby ovary and surrounding pelvic peritoneum. Other theories of their origin include the ovarian hilum cells.

 

 

Hum Reprod. 2014 Aug;29(8):1677-87.

Antifibrotic properties of epigallocatechin-3-gallate in endometriosis.

Matsuzaki S1Darcha C2.

 

Abstract

STUDY QUESTION:

Is epigallocatechin-3-gallate (EGCG) treatment effective in the treatment of fibrosis in endometriosis?

SUMMARY ANSWER:

EGCG appears to have antifibrotic properties in endometriosis.

WHAT IS KNOWN ALREADY:

Histologically, endometriosis is characterized by dense fibrous tissue surrounding the endometrial glands and stroma. However, only a few studies to date have evaluated candidate new therapies for endometriosis-associated fibrosis.

STUDY DESIGN, SIZE, DURATION:

For this laboratory study, samples from 55 patients (45 with and 10 without endometriosis) of reproductive age with normal menstrual cycles were analyzed. A total of 40 nude mice received single injection proliferative endometrial fragments from a total of 10 samples.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

The in vitro effects of EGCG and N-acetyl-l-cysteine on fibrotic markers (alpha-smooth muscle actin, type I collagen, connective tissue growth factor and fibronectin) with and without transforming growth factor (TGF)-β1 stimulation, as well as on cell proliferation, migration and invasion and collagen gel contraction of endometrial and endometriotic stromal cells were evaluated by real-time PCR, immunocytochemistry, cell proliferation assays, in vitro migration and invasion assays and/or collagen gel contraction assays. The in vitro effects of EGCG on mitogen-activated protein kinase (MAPK) and Smad signaling pathways in endometrial and endometriotic stromal cells were evaluated by western blotting. Additionally, the effects of EGCG treatment on endometriotic implants were evaluated in a xenograft model of endometriosis in immunodeficient nude mice.

MAIN RESULTS AND THE ROLE OF CHANCE:

Treatment with EGCG significantly inhibited cell proliferation, migration and invasion of endometrial and endometriotic stromal cells from patients with endometriosis. In addition, EGCG treatment significantly decreased the TGF-β1-dependent increase in the mRNA expression of fibrotic markers in both endometriotic and endometrial stromal cells. Both endometriotic and endometrial stromal cell-mediated contraction of collagen gels were significantly attenuated at 8, 12 and 24 h after treatment with EGCG. Epigallocatechin-3-gallate also significantly inhibited TGF-β1-stimulated activation of MAPK and Smad signaling pathways in endometrial and endometriotic stromal cells. Animal experiments showed that EGCG prevented the progression of fibrosis in endometriosis.

LIMITATIONS, REASONS FOR CAUTION:

The attractiveness of epigallocatechin-3-gallate as a drug candidate has been diminished by its relatively low bioavailability. However, numerous alterations to the EGCG molecule have been patented, either to improve the integrity of the native compound or to generate a more stable yet similarly efficacious molecule. Therefore, EGCG and its derivatives, analogs and prodrugs could potentially be developed into agents for the future treatment and/or prevention of endometriosis.

WIDER IMPLICATIONS OF THE FINDINGS:

Epigallocatechin-3-gallate is a potential drug candidate for the treatment and/or prevention of endometriosis.

STUDY FUNDING/COMPETING INTERESTS:

This study was supported in part by Karl Storz Endoscopy & GmbH (Tuttlingen, Germany). No competing interests are declared.

 

 

BMJ Case Rep. 2014 May 29;2014.

An unusual presentation of endometriosis.

Abu Saadeh F1Wahab NA1Gleeson N1.

 

Abstract

A 25-year-old nulliparous woman attended an orthopaedic clinic with a 12-month history of right hip pain and was found to have a hard tender mass in her right groin. Fine-needle aspiration yielded a diagnosis of endometrial glands. The lesion was excised completely and the final diagnosis was round ligament endometriosis. The patient was pain free 3 months postsurgery.

 

 

J Surg Case Rep. 2014 May 15;2014(5).

Endometriosis within a left-sided inguinal hernia sac.

Albutt K1Glass C2Odom S3Gupta A3.

 

Abstract

Endometriosis is a common gynecologic disorder wherein ectopic endometrial glands and stroma are found at extrauterine sites. Extrapelvic endometriosis is a well-documented, yet rare, disease entity that can affect almost any organ system. Inguinal endometriosis is an extremely rare disease entity characterized by tender inguinal swelling. Here we report a case of a sudden-onset and acutely painful left inguinal hernia with concordant endometriosis. A review of the literature is presented. The presence of isolated endometriosis contained within a left-sided inguinal hernia sac has, to our knowledge, never been reported. Often diagnosed incidentally or on histologic examination, general surgeons should consider inguinal endometriosis in the differential diagnosis of inguinal masses, even in the absence of catamenial symptoms. Surgical excision, with gynecologic follow-up, is locally curative and the treatment of choice for inguinal endometriosis.

 

 

Biomed Res Int. 2014;2014:463058.

Long-term outcome after laparoscopic bowel resections for deep infiltrating endometriosis: a single-center experience after 900 cases.

Ruffo G1Scopelliti F1Manzoni A1Sartori A1Rossini R1Ceccaroni M2Minelli L2Crippa S1Partelli S1Falconi M1.

 

Abstract

BACKGROUND:

Laparoscopic bowel resections for endometriosis are safe and effective but only short-term follow-up has been evaluated. In the present study long-term outcome in terms of intestinal and urinary function, fertility, chronic pain, and recurrence was assessed.

MATERIALS AND METHODS:

From January 2002 to December 2010 nine hundred patients underwent laparoscopic bowel resection for endometriosis, and on 774 (86%) a questionnaire was administered. Patients were divided into 3 groups on the strength of the operation date. Postoperative diarrhea, constipation, rectal bleeding, tenesmus, dyschezia, dysuria, dyspareunia, fertility, and recurrence of disease were assessed.

RESULTS:

The median follow-up was 54 months (range 1-120). All the evaluated symptoms significantly improved over time, with P = 0.0001 for dyspareunia, constipation, and pelvic pain and P = 0.004 for diarrhea. Nonsignificant improvement was reported for dysuria and rectal bleeding (with P = 0.452 and P = 0.097, resp.).

CONCLUSIONS:

The present results confirm that bowel resections for endometriosis are correlated with an acceptable complication rate even at long-term follow-up and that symptoms significantly improve over time, except for rectal bleeding and dysuria, the latter associated with a neurological damage.

 

 

Curr Environ Health Rep. 2014 Jun;1(2):172-184.

Cadmium and Reproductive Health in Women: A Systematic Review of the Epidemiologic Evidence.

Pollack AZ1Ranasinghe S1Sjaarda LA2Mumford SL2.

 

Abstract

An evolving body of evidence supports that cadmium, a non-essential heavy metal, may be associated with multiple adverse women’s reproductive health outcomes. Our objective was to conduct a systematic review of epidemiologic studies that evaluated cadmium exposure and the following reproductive health outcomes: puberty/menarche, fertility, time to pregnancy, pregnancy loss, preeclampsia, endometriosis, uterine leiomyoma, and menopause. Twenty-two studies were identified based upon our search criteria. Available evidence was inadequate to draw meaningful conclusions for most of the reproductive outcomes studied. The strongest evidence was for a possible association between cadmium and preeclampsia, which was limited to cross-sectional studies. Some evidence, although conflicting, was also observed for fertility related outcomes. This lack of evidence underscores the need for additional research on cadmium and women’s reproductive health outcomes.

 

 

Emerg Radiol. 2014 Dec;21(6):589-95.

The accuracy of pre-appendectomy computed tomography with histopathological correlation: a clinical audit, case discussion and evaluation of the literature.

Collins GB1Tan TJGifford JTan A.

 

Abstract

The increasing use of computed tomography (CT) in acute appendicitis makes recognising the radiological hallmarks of the condition and its mimics vital. The differential diagnosis includes both appendiceal and nonappendiceal pathologies. The correlation between pre-appendectomy CT and post-appendectomy histopathology was audited retrospectively. Cases of clinico-histopathological discrepancy underwent blind peer-review, and possible improvements were discussed in the context of the medical literature. A grade for discrepancy was given based on the RADPEER scoring system, and interesting or discrepant cases were examined more closely to identify targets for education. Of the 199 procedures, 4 appendectomies were negative (histologically normal), 182 were positive (primary appendicitis) and 13 were incidental (another primary process caused inflammation). The positive predictive value for pre-appendectomy CT was 91.5 %, and the negative appendectomy rate was 2 %. There were many secondary pathologies, including neoplasia, tuberculosis and endometriosis. Although no CT reports missed a diagnosis that should be made “almost all of the time” and in 96 % of cases, the second, blinded radiologist agreed with the initial assessment, in 3 cases, a missed diagnosis altered clinical management; 2 were “understandable” misses but 1 was not. In five cases, a discrepancy was “understandable” but clinically insignificant. Overall, in comparison to the medical literature, the degree of clinico-histopathological correlation was good. Although identifying areas for improvement was challenging, after a pictorial review of four cases and a discussion of the medical literature, we present our audit results and some valuable learning points for use in the CT assessment of suspected acute appendicitis.

 

 

S Afr J Surg. 2014 Feb;52(1):26-8.

Endometriotic stricture of the sigmoid colon presenting with intestinal obstruction.

Jayant MKaushik RPunia RS.

 

Abstract

Endometriosis, a relatively common condition, rarely involves the bowel; even more rarely does it present as a large-bowel stricture with intestinal obstruction. We report the case of a young woman who presented to an emergency department with intestinal obstruction secondary to an endometriotic stricture of the sigmoid colon, without evidence of disease elsewhere in the peritoneal cavity. Although large-bowel obstruction is usually caused by a malignant tumour, it can sometimes result from rare causes such as endometriosis. Symptoms of a cyclical nature may remind the clinician of this possibility.

 

 

Duodecim. 2014;130(9):924-30.

Endometriosis-associated bowel symptoms.

Uotila RSetälä MHärkki PKössi JLavonius M.

 

Abstract

BACKGROUND:

In endometriosis endometrial tissue appears outside the uterine cavity causing dysmenorrhea, infertility, chronic abdominal pain and bowel symptoms.

MATERIAL AND METHODS:

The prevalence of bowel symptoms and the influence of surgical treatment of endometriosis on them were studied in 82 patients. The data were collected from patient records and by questionnaires.

RESULTS:

At least one bowel symptom was found in 74% of patients, 73% presented dyschezia and 49% chronic abdominal pain. Surgical removal of endometriosis reduced dyschezia and diarrhea significantly (p < 0.001).

CONCLUSIONS:

Dyschezia, chronic abdominal pain and functional bowel symptoms are more common among patients suffering from endometriosis than in the general population. Surgery may relieve these symptoms.

 

 

Rozhl Chir. 2014 Apr;93(4):212-5

Intestinal endometriosis – a case report.

 

Kováč IStebnický MSvajdler PKudláč MBelák J.

 

Abstract

Endometriosis is defined as the presence of functional endometrial tissue outside the uterine cavity. The most common clinical symptoms of endometriosis are infertility and chronic pelvic pain. Endometriosis affects 8-10% of women of reproductive age and the condition is highly associated with infertility. Ectopic endometrial tissue is usually found in the small pelvis and the peritoneum, but endometrial tissue deposits have also been reported in other anatomical locations in the human body. We describe the case of a young patient with persistent abdominal pain and bleeding via the rectum during menstrual periods, hospitalised at the Second Department of Surgery, Pavol Jozef Šafárik University, Faculty of Medicine and Louis Pasteur University Hospital Košice.

 

Fertil Steril. 2014 Jun;101(6):1545-51.

MicroRNA and gynecological reproductive diseases.

Santamaria X1Taylor H2.

 

Abstract

MicroRNAs (miRNAs) are a class of small non-coding RNAs estimated to regulate the translation of mRNAs in 30% of all genes in animals by inhibiting translation. Aberrant miRNA expression is associated with many human diseases, including gynecological diseases, cancer, inflammatory diseases, and cardiovascular disorders. Abnormal expression of miRNAs has been observed in multiple human reproductive tract diseases including preeclampsia, endometrioid endometrial adenocarcinoma, uterine leiomyomata, ovarian carcinoma, endometriosis, and recurrent pregnancy loss. In the following review, an update of the role of microRNA and gynecological diseases is performed covering, not only impact of microRNA dysregulation in the origin of each disease, but also showing the potential useful diagnostic and therapeutic tool that miRNA may play in these gynecological pathologies.

 

 

Reprod Biol Endocrinol. 2014 May 18;12:42.

Increased expression of the pluripotency markers sex-determining region Y-box 2 and Nanog homeobox in ovarian endometriosis.

Song YXiao LFu JHuang W1Wang QZhang XYang S.

 

Abstract

BACKGROUND:

The precise etiology of endometriosis is not fully understood; the involvement of stem cells theory is a new hypothesis. Related studies mainly focus on stemness-related genes, and pluripotency markers may play a role in the etiology of endometriosis. We aimed to analyze the transcription pluripotency factors sex-determining region Y-box 2 (SOX2), Nanog homeobox (NANOG), and octamer-binding protein 4 (OCT4) in the endometrium of reproductive-age women with and without ovarian endometriosis.

METHODS:

We recruited 26 women with laparoscopy-diagnosed ovarian endometriosis (endometriosis group) and 16 disease-free women (control group) to the study. Endometrial and endometriotic samples were collected. SOX2, NANOG, and OCT4 expression were analyzed with quantitative real-time polymerase chain reaction, western blotting, and immunohistochemistry.

RESULTS:

Compared to the control group, SOX2 mRNA and protein expression was significantly higher in the eutopic endometrium of participants in the endometriosis group. In the endometriosis group, SOX2 and NANOG mRNA and protein expression were significantly increased in ectopic endometrium compared with eutopic endometrium; there was a trend towards lower OCT4 mRNA expression and higher OCT4 protein expression in ectopic endometrium.

CONCLUSIONS:

The transcription pluripotency factors SOX2 and NANOG were overexpression in ovarian endometriosis, their role in pathogenesis of endometriosis should be further studied.

 

 

 

Reprod Biol Endocrinol. 2014 May 9;12:37.

Bisphenol A and the female reproductive tract: an overview of recent laboratory evidence and epidemiological studies.

Caserta D1Di Segni NMallozzi MGiovanale VMantovani AMarci RMoscarini M.

 

Abstract

Bisphenol A (BPA) is a high production volume monomer used for making a wide variety of polycarbonate plastics and resins. A large body of evidence links BPA to endocrine disruption in laboratory animals, and a growing number of epidemiological studies support a link with health disorders in humans. The aim of this review is to summarize the recent experimental studies describing the effects and mechanisms of BPA on the female genital tract and to compare them to the current knowledge regarding the impact of BPA impact on female reproductive health. In particular, BPA has been correlated with alterations in hypothalamic-pituitary hormonal production, reduced oocyte quality due to perinatal and adulthood exposure, defective uterine receptivity and the pathogenesis of polycystic ovary syndrome. Researchers have reported conflicting results regarding the effect of BPA on premature puberty and endometriosis development. Experimental studies suggest that BPA’s mechanism of action is related to life stage and that its effect on the female reproductive system may involve agonism with estrogen nuclear receptors as well as other mechanisms (steroid biosynthesis inhibition). Notwithstanding uncertainties and knowledge gaps, the available evidence should be seen as a sufficient grounds to take precautionary actions against excess exposure to BPA.

 

 

J Exp Clin Cancer Res. 2014 May 29;33:46.

Anti-mullerian hormone is expressed by endometriosis tissues and induces cell cycle arrest and apoptosis in endometriosis cells.

Signorile PG1Petraglia FBaldi A.

 

Abstract

BACKGROUND:

The anti-mullerian hormone (AMH) is a member of the transforming growth factor β (TGF-β) superfamily, which is responsible of the regression of the mullerian duct. AMH is expressed in the normal endometrium, where, acting in a paracrine fashion, negatively regulates cellular viability. Our objective was to evaluate the in vitro effects of the treatment with AMH of endometriosic cells.

METHODS:

AMH expression in human endometriosis glands was evaluated by immunohistochemistry. RT-PCR has been used to quantify the expression levels of AMH and AMH RII isoforms, as well as of cytochrome P450 in both endometriosis epithelial and stromal cells Effects of AMH and AMH-cleaved treatment in endometriosiscells were evaluated by flow-cytometry analysis. Finally, it has been evaluated the effect of plasmin-digested AMH on cytochrome P450 activity.

RESULTS:

AMH and AMH RII isoforms, as well as cytochrome P450, were expressed in both endometriosisepithelial and stromal cells. Treatment of endometriosis stromal and epithelial cell growth with AMH was able to induce a decrease in the percentage of cells in S phase and increase percentage of cells in G1 and G2 phase; coherently, decreased cell viability and increased percentage of cells death fraction was observed. The plasmin-digested AMH was able to suppress most of the cytochrome P450 activity, causing an increase of pre-G1 phase and of apoptosis induction treating with plasmin-digested AMH in both cell lines, most marked in the epithelial cells.

CONCLUSIONS:

The data produced suggest a possible use of AMH as therapeutic agents in endometriosis.

 

 

Aust N Z J Obstet Gynaecol. 2014 Jun;54(3):225-30.

Evidence for ethnic and environmental contributions to frequency of ovarian clear cell carcinoma.

Tay SK1Cheong MA.

 

Abstract

BACKGROUND:

Ovarian clear cell carcinoma (OCCC) is reportedly more common in Asians than Caucasians. We investigated the epidemiology of OCCC in an Asian population.

MATERIALS AND METHODS:

Cases of epithelial ovarian cancer (EOC) diagnosed between January 2004 and December 2009 in a gynaecologic oncology unit were studied retrospectively. Patient details and tumour characteristics were retrieved from hospital records and tested for their association with OCCC by univariate and binomial logistic regression analysis. A time trend in the proportion of OCCC among EOC was computed with data from the National Cancer Registry of Singapore (1968-2006).

RESULTS:

The institutional cohort of 341 cases included 81 OCCC and 260 non-OCCC EOC. Independent risk factors for OCCC were nulliparity (OR = 1.36) and endometriosis (OR = 4.87). Compared with other EOC, OCCC was significantly larger in tumour size (13.5 vs. 11.3 cm), more frequently located unilaterally (84.3 vs. 65.5%), diagnosed at FIGO stage-1 (63.0 vs. 33.9%) and negative for serum CA125 (34.2 vs. 8.2%), and less often (53 vs. 85%) associated with a positive Risk of Malignancy Index. Nation-wide statistics revealed a steady increase in the proportion of OCCC among EOC from 5.2 to 13.4% between 1968 and 2006. The frequency of OCCC in Singapore was higher than American Whites, similar to American Asians but lower than Japanese.

CONCLUSION:

The difference in epidemiologic and tumour characteristics between OCCC and other EOC was nondiscriminatory. Three distinct ethnic-related clusters of frequency distribution globally and the rising trend in proportion of OCCC in Singapore suggested that ethnic-genetic predisposition and economy-related environmental factors contributed to development of OCCC.

 

 

J Obstet Gynaecol Res. 2014 Jun;40(6):1803-6.

Successful pregnancy in a case of bladder and ovary endometriosis following cystoscopy-assisted laparoscopic resection.

Chishima F1Ichikawa GSato KIshige TSugitani MYamamoto T.

 

Abstract

A 34-year-old, gravida 0 para 0 Japanese woman visited a regional hospital complaining of dysmenorrhea, hematuria during menstruation, and right inguinal pain. She had a history of dysmenorrhea and three prior rounds of in vitro fertilization with embryo transfer, which were all with transfers of cryopreserved-thawed single embryos in natural cycles, resulting in no pregnancy. An ultrasound revealed a large 2 × 1-cm nodule between the bladder and the anterior wall of the uterus and a 3-cm cystic lesion in the right adnexal area. A combined cystoscopic and laparoscopic resection of the bladder endometriosis and cystectomy of the right endometrioma were carried out. A single ultrasound-guided transfer of a cryopreserved-thawed embryo in the cleavage stage was performed 4 months postoperatively, which resulted in an uncomplicated pregnancy. The combined, single procedure was minimally invasive and eradicated the lesions that may have caused the infertility.

 

 

J Obstet Gynaecol Res. 2014 Jun;40(6):1823-7.

Primary retroperitoneal Müllerian adenocarcinoma arising from endometriosis.

Tanaka K1Kobayashi YShibuya HNishigaya YMomomura MMatsumoto HIwashita M.

 

Abstract

Primary retroperitoneal Müllerian adenocarcinoma (PRMA) is an extremely rare tumor and the cause remains unknown. We report a case of PRMA arising from endometriosis. A 52-year-old woman with a history of malignant lymphoma underwent a follow-up computed tomography scan, which revealed a retroperitoneal tumor. Immunohistochemical analysis of tumor resected during laparoscopic surgery showed adenocarcinoma positive for cytokeratin 7 and negative for cytokeratin 20. The patient had undergone hysterectomy and bilateral salpingo-oophorectomy 14 years ago for myoma uteri and endometrial cysts and was treated with estrogen-replacement therapy. The size of the tumor increased and laparotomy was performed. Histopathological examination showed adenocarcinoma resembling endometrial adenocarcinoma, which stained positive for cancer antigen 125, cancer antigen 19-9, estrogen receptor, and progesterone receptor immunohistochemically. The focus of the endometriosis was found at the edge of the tumor, and the stromal cells around the tumor cells were CD10 positive. The patient was diagnosed as having PRMA arising from endometriosis, and treated with adjuvant chemotherapy.

 

 

 

Virchows Arch. 2014 Aug;465(2):193-8.

Mutational status of KRAS, NRAS, and BRAF in primary clear cell ovarian carcinoma.

Zannoni GF1Improta GChiarello GPettinato APetrillo MScollo PScambia GFraggetta F.

 

Abstract

Ovarian clear cell carcinoma (OCCC) is a subtype of epithelial ovarian cancer with characteristic biological features and aggressive clinical behavior. OCCCs show a pattern of gene mutations different from other type I ovarian malignancies, notably a higher frequency of PIK3CA mutations. In low grade serous ovarian cancer, KRAS and BRAF mutations are frequent, but little data are available on the mutational status of these genes in OCCCs. To clarify this issue, we designed a clinicopathological study with the aim to establish the incidence of KRAS, NRAS, and BRAF hot spot mutations in OCCC. Between December 2006 and June 2012, 22 patients with a proven diagnosis of OCCC were admitted to our Institutions. In all cases, final diagnosis was established according to FIGO and WHO criteria. All women received complete surgical staging. The PyroMark Q24 system (Qiagen GmbH, Hilden, Germany) was used for pyrosequencing analysis of KRAS, NRAS, and BRAF hot spot regions on 2.5-μm sections of formalin-fixed paraffin-embedded tissue from primary OCCC. Pyrosequencing analysis of KRAS, NRAS, and BRAF hot spot regions revealed the presence of mutations only at codon 12 in exon 2 of KRAS in 3 of 22 (14 %) cases. We found no mutations in the hot spot regions of NRAF (exons 2, 3, 4) or BRAF (exon 15). The median age of women with a KRAS mutated OCCC was 74 years. These OCCC were unilateral FIGO stage IA lesions in two cases associated with foci of endometriosis. We conclude that in 14 % of OCCCs, a KRAS mutation occurs in codon 2 exon 2. NRAS and BRAF mutations were not found.

 

 

Mol Med Rep. 2014 Aug;10(2):725-30

Identification of biomarkers for endometriosis in plasma from patients with endometriosis using a proteomics approach.

Hwang JH1Lee KS2Joo JK2Wang T1Son JB2Park JH2Hwang DY3Choi MH4Lee HG1.

 

Abstract

The present study aimed to examine potential biomarkers for the diagnosis of endometriosis. A plasma-based proteomic approach, including 2-dimentional electrophoresis and mass spectrometry, was used. Samples were obtained from patients with (n=15) and without (n=15) endometriosis, or from mice with surgically induced endometriosis. Seven spots corresponding to six differentially expressed proteins were identified in the human plasma samples. However, only haptoglobin (Hp) was identified to be significantly decreased in the plasma levels of patients with endometriosis (P<0.05) and in mice with surgically induced endometriosis (P<0.05). The results demonstrated that Hp was downregulated in females with endometriosis, and it therefore, may be a useful diagnostic tool as a biomarker of endometriosis.

 

 

Mol Med Rep. 2014 Aug;10(2):1072-6.

T regulatory lymphocytes in patients with endometriosis.

Gogacz M1Winkler I1Bojarska-Junak A2Tabarkiewicz J2Semczuk A1Rechberger T1Adamiak A1.

 

Abstract

The present study aimed to investigate the presence of T regulatory cells (Tregs) in the peripheral blood (PB) and peritoneal fluid (PF) in females with endometriosis. The present study included 42 patients who underwent laparoscopy between 2010 and 2011. Flow cytometry was used to determine the percentage of Tregs in the PF and PB of the patients. No significant difference was observed in the percentage of Tregs in the patients in the endometriosis group compared with those in the control group in the PF (9.1±5.4 vs. 9.1±3.8%) or the PB (6.5±3.2 vs. 6.5±3.7%). However, the percentage of Tregs was found to be higher in the PF compared with the PB in the patients in the endometriosis and control groups, but significance was found only in those in the control group. Furthermore, no significant difference was observed in the Treg concentration in the patients with early stage (I/II) endometriosis compared with those with late stage (III/IV) endometriosis. Moreover, no significant correlation was found between the percentage of Tregs and the white blood cell count, lymphocyte count or CA125 concentration in the patients. These findings suggest that the local host‑defense mechanism is deficient in patients with endometriosis, thus endometriosis should not be treated as an autoimmune condition.

 

 

Cleve Clin J Med. 2014 Jun;81(6):361-6

Role of imaging in endometriosis.

Lo Monte G1Wenger JM2Petignat P2Marci R3.

 

Abstract

Endometriosis–the presence of endometrial tissue outside the uterine cavity–is first suspected on the basis of its signs and symptoms. The diagnosis is confirmed by imaging and surgery. Imaging, particularly transvaginal ultrasonography and magnetic resonance imaging, is essential to confirm the diagnosis and guide surgical treatment.

 

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