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101: Hum Reprod Update. 2004 Jan-Feb;10(1):29-38. Related Articles, Links
Apoptosis in human endometrium and endometriosis.
Harada T, Kaponis A, Iwabe T, Taniguchi F, Makrydimas G, Sofikitis N, Paschopoulos M, Paraskevaidis E, Terakawa N.
Department of Obstetrics and Gynaecology, Tottori University School of Medicine, 36-1 Nishimachi, 683-8504, Yonago, Japan. tasuku@grape.med.tottori-u.ac.jp
Apoptosis plays a critical role in maintaining tissue homeostasis and represents a normal function to eliminate excess or dysfunctional cells. Accumulated evidence suggests that apoptosis helps to maintain cellular homeostasis during the menstrual cycle by eliminating senescent cells from the functional layer of the uterine endometrium during the late secretory and menstrual phase of the cycle. The BCL-2 family and Fas/FasL system have been extensively studied in human endometrium and endometriotic tissues. Eutopic endometrium from women with endometriosis reportedly has some fundamental differences compared with normal endometrium of women without endometriosis. The differences could contribute to the survival of regurgitating endometrial cells into the peritoneal cavity and the development of endometriosis. One mechanism that recently gained a lot of interest is the finding that apoptosis appeared in eutopic and ectopic endometrium of patients with endometriosis. This study is a current review of the literature focused on the physiological role of apoptosis in normal endometrium and the alterations in regulation of apoptosis in eutopic and ectopic endometrium from women with endometriosis. Similarities in characteristics of endometriosis at a molecular level with gynaecological tumours are also discussed. Finally, the role of apoptosis in the treatment of endometriosis is revieAwed to link the basic research findings into clinical applications.
PMID: 15005462 [PubMed]
102: Hum Cell. 2003 Sep;16(3):141-9. Related Articles, Links
Role of immunoreactions and mast cells in pathogenesis of human endometriosis–morphologic study and gene expression analysis.
Konno R, Yamada-Okabe H, Fujiwara H, Uchiide I, Shibahara H, Ohwada M, Ihara T, Sugamata M, Suzuki M.
Department of Gynecology, Omiya Medical Center, Jichi Medical School, Amanuma-cho, Omiya, Saitama, Japan. kryo77@excite.co.jp
STUDY OBJECTIVES: To investigate the pathophysiology of human endometriosis, we examined by morphological and molecular biological methods. METHODS: Samples of ovarian endometriosis and normal ovarian tissues were obtained laparoscopically after informed consent. A morphological study by toluidine blue staining, immunohistochemistry of c-kit and electron microscopy demonstrated the localization of mast cells in the stromal lesions of endometriosis. Oligonucleotide microarrays were used for gene expression analysis. RESULTS: Infiltration of numerous mast cells and development of fibrosis was observed throughout the stromal lesions. Gene expression analysis by oligonucleotide microarrays indicated inflammatory immunoreactions in the lesions. Expressions of the FCER1G and PGDS, which are considered to be mast cell-specific genes, were upregulated in the ovarian endometriotic lesions as compared to the normal ovarian tissues. Furthermore, expressions of genes associated with immunological inflammation, such as IL-8, GRO1, GRO2, CXCR4, MCP1, and those related to tissue remodeling (MMP, COL4A2, and COL5A2) were also higher in endometriotic lesions than in the normal ovarian tissue. CONCLUSIONS: Thus it is likely that mast cells and their relAated inflammatory immunoreactions via chemokines play important roles in producing fibrosis and adhesions in endometriotic lesions.
PMID: 15005245 [PubMed]
103: J Clin Endocrinol Metab. 2004 Mar;89(3):1397-401. Related Articles, Links
Peritoneal macrophages induce RANTES (regulated on activation, normal T cell expressed and secreted) chemokine gene transcription in endometrial stromal cells.
Lebovic DI, Chao VA, Taylor RN.
Reproductive Endocrinology Division, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109-0276, USA. lebovic@umich.edu
Peritoneal fluid macrophages (PFM) are activated in women with endometriosis, in whom they are thought to mediate or exacerbate inflammation. The effect of PFM on endometrial stromal cells (ESC) was studied using a coculture model to evaluate the influence of IL-1 beta and other macrophage-derived cytokines on the transcriptional activation of the human RANTES (regulated on activation, normal T cell expressed and secreted) gene. Normal endometrial biopsies from four patients were used to prepare stromal cell cultures, and pelvic fluid was collected to isolate peritoneal macrophages. A full length (-940 bp) human RANTES promoter construct provided an indicator of transcriptional activation in luciferase reporter transfection assays. Without lipopolysaccharide (LPS), cocultures with PFM had no effect on ESC RANTES gene expression. However, when PFM were treated with LPS within the coculture apparati, ESC RANTES promoter activity was increased more than 2-fold (P < 0.05). The addition of IL-1 receptor antagonist abrogated activation of the RANTES luciferase transgene by LPS-induced PFM products (P < 0.05). We identified IL-1 from PFM as a major stimAulus to initiate ESC RANTES gene expression in cocultures. We postulate that PFM stimulation of RANTES production by ESC could lead to a self-propagating recruitment of inflammatory cells that contribute to the development and progression of endometriotic lesions.
PMID: 15001640 [PubMed]
104: J Clin Endocrinol Metab. 2004 Mar;89(3):1089-95. Related Articles, Links
Antiangiogenesis therapy for endometriosis.
Nap AW, Griffioen AW, Dunselman GA, Bouma-Ter Steege JC, Thijssen VL, Evers JL, Groothuis PG.
Department of Obstetrics and Gynecology, Research Institute for Growth and Development, Maastricht University and University Hospital, 6202 AZ Maastricht, The Netherlands.
It is known that angiogenesis is of pivotal importance for the development of endometriosis. However, in the treatment of endometriosis patients, prevention of endometriosis lesion development only will not be sufficient as a therapy. Treatment options, aimed at interfering with established lesions, have to be developed. In this study we evaluated whether inhibition of angiogenesis by angiostatic therapy is also effective in antagonizing the sustentation of endometriosis. We evaluated the effect of the angiostatic compounds antihuman vascular endothelial growth factor, TNP-470, endostatin, and anginex on the growth of established endometriosis lesions in the nude mouse model. We show that human endometrium in the proliferative endometrium is highly angiogenic and that vascular endothelial growth factor-A is the most important angiogenesis promotory factor. The angiostatic compounds significantly decreased microvessel densities and the number of established endometriosis lesions. In the remaining lesions, the number of pericyte-protected vessels is not different in contArol and treated mice; however, the number of unprotected vessels was significantly reduced in the groups treated with the angiostatic agents. Our data demonstrate that inhibitors of angiogenesis effectively interfere with the maintenance and growth of endometriosis by inhibiting angiogenesis. This suggests that the use of angiostatic agents may be promising as a therapy for endometriosis.
PMID: 15001592 [PubMed]
105: Hum Reprod. 2004 Mar;19(3):709-14. Epub 2004 Jan 29. Related Articles, Links
Role of IL-18 in pathogenesis of endometriosis.
Oku H, Tsuji Y, Kashiwamura SI, Adachi S, Kubota A, Okamura H, Koyama K.
Department of Obstetrics and Gynecology, Institute for Advanced Medical Sciences, Japan.
BACKGROUND: Endometriosis is a complex disease associated with a wide range of immune responses, including pain, adhesion, exudation of peritoneal fluid, elevation of cytokine levels and generation of autoantibodies. Interleukin (IL)-18 is a strong pleiotropic cytokine known to be involved in various immune diseases. The aim of this study is to elucidate the role of IL-18 in the pathogenesis of endometriosis. METHODS: IL-18 and IL-1beta concentrations were measured in the peritoneal fluid and sera of 39 endometriosis patients and 15 control women. Expression of IL-18 and IL-18 receptor alpha-chain (IL-18Ralpha) was analysed in endometriotic tissues immunohistochemically. The effects of IL-18 on cyclooxygenase (COX)-II gene expression were analysed in peritoneal fluid monocytes and endometriotic cells of endometriosis patients. RESULTS: IL-18 concentrations in the peritoneal fluid of endometriosis patients averaged 592.57 +/- 108.27 pg/ml, significantly higher than 260.50 +/- 55.88 pg/ml in non-endometriotic samples. IL-18 concentrations iAn the serum did not differ significantly between endometriosis and control patients. Similarly, no significant differences were observed in IL-1beta concentrations in either the peritoneal fluid or the serum. IL-18 and IL-18Ralpha were expressed in endometriotic tissues. IL-18Ralpha expression was also observed in cells infiltrating into the inflammatory area of the endometriosis patients. COX-II was induced in peritoneal fluid monocytes and in endometriotic cells in response to IL-18 stimulation. CONCLUSIONS: The elevation of IL-18 in the peritoneal fluid of endometriosis patients and the induction of COX-II in peritoneal monocytes by IL-18 suggest that IL-18 plays a pathogenic role in endometriosis.
PMID: 14998974 [PubMed]
106: Clin Exp Obstet Gynecol. 2004;31(1):25-30. Related Articles, Links
Implications of the diagnosis of endometriosis on the success of infertility treatment.
Calhaz-Jorge C, Chaveiro E, Nunes J, Costa AP.
Human Reproduction Unit, Department of Obstetrics and Gynaecology, Hospital de Santa Maria, Lisbon, Portugal.
PURPOSE: Endometriosis is a clinically very heterogeneous disorder and its implications on the resolution of infertility are not clear. METHODS: Clinical data of 783 consecutive infertile couples were retrospectively analyzed in three groups: A–with minimal/mild endometriosis: B–with moderate/severe endometriosis; C–without endometriosis. Subgroups of groups A and C with unexplained infertility were also compared. RESULTS: Endometriosis was found in 349 patients (44.6%)–263 in group A and 86 in group B. Group C comprised 434 patients. Overall pregnancy rates were 57.0% for group A, 48.8% for B and 55.8% for C (not statistically different). Of couples in groups A, B, C, respectively, 39.2%, 51.1% and 39.2% needed IVF (B vs C – p = 0.042; B vs A – p = 0.059). Of couples in group A 45.6% that underwent IVF achieved a pregnancy by this technique; corresponding numbers were 43.2% for group B and 46.5% for C. Overall pregnancy rates in couples with unexplained infertility in groups A (n = 116) and C (n = 110) were respectively, 58.6% and 56.4%; IVF was needed in 40.5% and 32.7% of those couples, and the cumulative pregnancy rates resulting from IVF were 40.4% and 47.2% (NS). CONCLUSION: The diagnosis of endometriosis had no influence on the successful resolution of infertility although moderate/severe endometriosis was related to a greater need for IVF. Couples with unexplained infertility had similar pregnancy rates either in the presence or in the abtsence of minimal/mild endometriosis.
PMID: 14998182 [PubMed]
107: J Ultrasound Med. 2004 Feb;23(2):307-13. Related Articles, Links
Small echogenic foci in the ovaries: correlation with histologic findings.
Brown DL, Frates MC, Muto MG, Welch WR.
Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA. brown.douglas@mayo.edu
OBJECTIVE: The purpose of this study was to determine the histologic correlate of small echogenic foci in the ovary and to assess for any association with endometriosis or endosalpingiosis. METHODS: Women planning to have a normal ovary surgically removed were scanned preoperatively with transvaginal sonography. If echogenic foci were present in either normal ovary on the preoperative scan, the removed ovary was scanned in a saline bath, and the surface was marked with india ink over an echogenic focus. Histologic sections were then obtained at the marked site. RESULTS: Echogenic foci were detected in 23 ovaries of 16 women. Possible causes were found in 17 of the 23 ovaries: hemosiderin in 6 cases, calcification in 5 cases, hemosiderin and calcification in 2 cases, clusters of inclusion cysts in 2 cases, 1 of which also had hemosiderin, and dense cortical nodules in 2 cases. Histologic findings were benign in all cases except in 1 patient who had primary peritoneal carcinoma unrelated to the echogenic foci. One ovary in another patient had both endosalpingiosis and endometriosis. One other patient had endometriosis involving a fallopian tube but not the ovary. There were no other cases of endometriosis or endosalpingiosis. CONCLUSIONS: Small echogenic foci in the ovaries are most frequently due to hemosiderin or calcification. A few small echogenic foci in the ovaries tare associated with benign histologic changes and do not appear to be reliable indicators of endosalpingiosis or endometriosis.
PMID: 14992370 [PubMed]
108: Hum Reprod. 2004 Apr;19(4):1025-30. Epub 2004 Feb 27. Related Articles, Links
Maternal C-reactive protein levels are raised at 4 weeks gestation.
Sacks GP, Seyani L, Lavery S, Trew G.
Department of Reproductive Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK. g.sacks@imperial.ac.uk
BACKGROUND: The aim of this study was to determine whether there is evidence of a systemic maternal inflammatory response in very early pregnancy. METHODS: Successive women receiving treatment by IVF or ICSI had serum C-reactive protein (CRP) levels measured on the day of their pregnancy blood test at 4 weeks gestation (14 days post-egg collection). Women with positive betaHCG levels had ongoing pregnancies confirmed by serial transvaginal ultrasound scans up to 8 weeks gestation. RESULTS: Pregnant women (n = 40) were significantly younger (mean age 34 years) than women who failed to become pregnant (n = 95, mean age 37 years, P < 0.001), received significantly lower treatment doses of recombinant FSH (2000 versus 2400 IU, P < 0.05) and had significantly more eggs collected (11 versus 8, P < 0.01). There were no significant differences in body mass index, parity, a history of smoking, endometriosis or polycystic ovaries, pre-treatment CRP levels and white cell counts, peak serum estradiol levels and numbers of embryos transferred. Pregnant women had significantly higher CRP levels (median 3.68 mg/l) than those who were not pregnant (median 1.495 mg/l, P < 0.0001), a difference that persisted after excluding potential confounding variables. Six pregnant women with ovarian hyperstimulation syndrome had higher CRP levels than those who did not (P < 0.01). CONCLUSIONS: This well-controlled study is the first to demonstrate that maternal CRP levels are raised as early as 4 weeks gestation and thus that the maternal inflammatory response is established during the earliest phases of implantation. It is hypothesized that an abnormal response (either exaggerated or absent) could cause some cases of miscarriage.
PMID: 14990546 [PubMed]
109: Obstet Gynecol. 2004 Mar;103(3):583; author reply 583-4. Related Articles, Links
Comment on: · Obstet Gynecol. 2003 Nov;102(5 Pt 2):1125-7.
Iatrogenic endometriosis caused by uterine morcellation during a supracervical hysterectomy.
Brown RL.
Publication Types: · Comment · Letter
PMID: 14990425 [PubMed]
110: Zhonghua Fu Chan Ke Za Zhi. 2004 Jan;39(1):24-6. Related Articles, Links
[Expression of heparanase gene in eutopic and ectopic endometrium of women with endometriosis] [Article in Chinese] Zong LL, Ma L, Wang XN, Zhang JH, He YL.
Department of Obstetrics and Gynecology, Zhujiang Hospital, First Military Medical University, Guangzhou 510282, China.
OBJECTIVE: To study the function of heparanase gene in the pathogenesis of endometriosis. METHODS: In situ hybridization method was used to examine the heparanase mRNA expression in the eutopic and ectopic endometrium of patients with endometriosis (EM group, 23) and the eutopic endometrium of women without endometriosis (control group, 25). RESULTS: (1) In EM group: The frequency of heparanase gene expression in eutopic was at similar to that in ectopic endometrium. However the number of positive cells and the intensity of heparanase gene expression in ectopic endometrium was more than that in eutopic endometrium. The frequency of heparanase gene expression in proliferative phase was 83.3% (10/12), while in secretory phase it was 72.7% (8/11), the difference is not significant; (2) In control group: The frequency of heparanase gene expression in proliferative phase was 41.7% (5/12), while in secretory phase it was 7.7% (1/13), the difference is significant; (3) The frequency of heparanase gene expression in endometrium of patients with endometriosis and women without endometriosis were 78.3% (18/23) and 24.0% (6/25) respectively, the difference is significant. CONCLUSIONS: Heparanase gene may play some roles in the pathogenesis of endometriosis, and it may participate the regulation of menstrual cycle, and that it may participate the regulation of menstrual cycle. It may be an important target of the trentment for endometriosis.
PMID: 14989983 [PubMed]
111: Pathologica. 2003 Oct;95(5):233-4. Related Articles, Links
[Fertility: hysteroscopic features and endometrial disease] [Article in Italian] Piccoli R, Guida M, Acunzo G, Di Stefano M, Santoro MG, Lavitola G, Cirillo D, Nappi C.
Dipartimento di Ginecologia, Ostetricia e Fisiopatologia della Riproduzione, Universita Federico II di Napoli.
PMID: 14988984 [PubMed]
112: Tunis Med. 2003 Dec;81(12):972-5. Related Articles, Links
[Endometriosis: a rare cause of acute intestinal obstruction] [Article in French] Mlik K, Arfa MN, Zaafrani R, Gharbi L, Gouttelier Ben Fadhel C, Mestiri, Mzabi Regaya S, Khalfallah MT.
Service de chirurgie generale, Hopital Mongi Slim La Marsa.
In the differential diagnosis of intestinal obstruction, the endometriosis is an uncommon disease, rarely reported preoperatively. Surgical objective is a total resection of endometriomas, to guarantee symptom relief and ovoid recurrence. In elective cases, preoperative GH-RH analogue hormonal treatment makes easier the surgical procedures. Conservative surgery of the ovaries is mandatory in premenopausal patients.
Publication Types: · Case Reports
PMID: 14986536 [PubMed]
113: Mol Hum Reprod. 2004 Mar;10(3):159-66. Epub 2004 Jan 29. Related Articles, Links
In situ localization of mRNA for the fibrinolytic factors uPA, PAI-1 and uPAR in endometriotic and endometrial tissue.
Bruse C, Radu D, Bergqvist A.
Department of Obstetrics and Gynaecology, Huddinge University Hospital, SE-141 86 Stockholm, Sweden. christine.bruse@hs.se
Endometriotic tissue grows invasively. The plasminogen-activating system is suggested to participate in degradation of extracellular matrix (ECM) and modulation of cell adhesion and migration. We have previously demonstrated elevated levels of the fibrinolytic factors urokinase plasminogen activator (uPA) and plasminogen activator inhibitor (PAI-1) in endometriotic tissue and endometrium from women with endometriosis. The aim of the present study was to localize the uPA, PAI-1 and urokinase plasminogen activator receptor (uPAR) mRNA in endometriotic tissue and in endometrium both from women with and without endometriosis. With in situ hybridization, we found that uPA mRNA seems to be up-regulated in endometriotic glands and endometrial stroma as well as PAI-1 mRNA in endometriotic and endometrial stroma from women with endometriosis. uPAR mRNA likewise appears to be up-regulated in both glands and stroma in endometriotic tissue and in endometrial glands from patients compared to endometrial glands and stroma from healthy women. These differences might be important for menstrual shedding and adherence of endometrial fragments to peritoneal lining in women developing endometriosis and for the invasive growth of endometriotic tissue.
PMID: 14981142 [PubMed]
114: Mol Hum Reprod. 2004 Mar;10(3):155-7. Epub 2004 Jan 29. Related Articles, Links
Analysis of the involvement of CCR5-Delta32 and CCR2-V64I variants in the development of endometriosis.
Antinolo G, Fernandez RM, Noval JA, Molini JL, Borrego S.
Unidad Clinica de Genetica y Reproduccion, Hospitales Universitarios Virgen del Rocio, Avda. Manuel Siurot s/n, 41013 Seville, Spain. guillermo.antinolo.sspa@juntadeandalucia.es
Several arguments support the proposal that the cytokine network plays a critical role in the aetiology of endometriosis. Among various chemokines, regulated-on-activation, normal-T-cell-expressed and -secreted (RANTES) and monocyte chemotactic protein 1 (MCP-1) concentrations have been shown to be increased in the peritoneal fluid of women with endometriosis. Some studies have demonstrated that, in the context of endometriosis, these chemokines are involved in apoptosis, angiogenesis and/or chemotaxis. Since the chemokines exert their effects by binding to their receptors, it would be plausible that factors affecting such interactions might play a role in the pathogenesis of endometriosis. Thus we postulated that the genes encoding CCR5 and CCR2, which are the receptors for RANTES and MCP-1 respectively, could be good candidate genes for the disease. We have used real-time PCR and FRET technologies to genotype and evaluate the variants CCR5-Delta32 and CCR2-V64I, as susceptibility factors in a cohort of Spanish women with endometriosis. No differences have been found in the frequencies of the two polymorphisms nor in the haplotype/genotype distribution between cases and controls. These data would suggest the lack of association between these polymorphisms and endometriosis in our population, although they do not permit us to discard completely a possible role of other variants within CCR5 and CCR2 genes in this pathology.
PMID: 14981141 [PubMed]
115: J Soc Gynecol Investig. 2004 Feb;11(2):118-21. Related Articles, Links
No association of endometriosis with glutathione S-transferase M1 and T1 null mutations in a Japanese population.
Morizane M, Yoshida S, Nakago S, Hamana S, Maruo T, Kennedy S.
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
OBJECTIVE: Endometriosis is inherited as a complex trait, which means that multiple susceptibility genes interact with each other and with environmental factors to produce the phenotype. We investigated the frequency of glutathione S-transferase M1 and T1 (GSTM1 and GSTT1) null mutations in women with endometriosis in a Japanese population. METHODS: One hundred fourteen unrelated women with endometriosis were enrolled. Samples of umbilical cord blood obtained from 179 female newborn infants were used as population controls. Genomic DNA isolated from endometriosis patients and controls were subjected to multiple polymerase chain reactions to determine the GSTM1 and GSTT1 genotypes. RESULTS: There were no significant differences in the frequencies of the GSTM1 (P = .83, odds ratio 0.95) and GSTT1 (P = .24, odds ratio 0.75) null mutations between endometriosis patients and controls. The endometriosis group was divided into a subgroup of stage IV disease only, but no statistically significant differences were observed in the frequency of the GSTM1 null mutation (P = .88, odds ratio 0.96, 95% confidence interval 0.57-1.63) and the GSTT1 null mutation (P = .33, odds ratio 0.77, 95% confidence interval 0.45-1.30) between any of these groups and the controls. CONCLUSION: These findings suggest that the GSTM1 and GSTT1 null mutations are not likely to be associated with an increased risk of endometriosis in a Japanese population.
PMID: 14980314 [PubMed]
116: Hinyokika Kiyo. 2003 Dec;49(12):753-5. Related Articles, Links
[A case of umbilical endometriosis] [Article in Japanese] Yasui T, Okamura T.
Department of Urology, Federation of National Public Service Mutual Aid Associations, Meijo Hospital.
A 54-year-old female was referred to us for a nodule under her umbilical region. The nodule had enlarged slowly and reached a size of 20 mm in diameter over the last 2 years. She had no symptoms and there was no oozing of blood or pain during menstruation. The nodule was removed under lumbar anesthesia. Histological examination of the resected nodule revealed an island of glandular tissue in the deep dermis, which was composed of a single layer of columnar cells, and was diagnosed as umbilical endometriosis. There was no associated lesion in the intrauterine or pelvic space. There has not been any evidence of recurrence five months postoperatively. On finding an umbilical mass in women, this rare disease must be considered.
Publication Types: · Case Reports
PMID: 14978960 [PubMed]
117: Int Immunopharmacol. 2004 Jan;4(1):159-60. Related Articles, Links
Increased soluble VEGF levels in endometriosis appears independent of clinical indices.
Matalliotakis IM, Goumenou AG, Koumantakis GE, Neonaki MA, Koumantakis EE, Dionyssopoulou E, Athanassakis I, Vassiliadis S.
Department of Obstetrics and Gynaecology, University of Crete School of Medicine, 7 Giannikou Str, 71201 Heraklion, Crete, Greece.
Publication Types: · Letter
PMID: 14975371 [PubMed]
118: Int Immunopharmacol. 2004 Jan;4(1):157-8; author reply 159-60. Related Articles, Links
Matalliotakis IM, Goumenou AG, Koumantakis GE, Neonaki MA, Koumantakis EE, Dionyssopoulou E, Athanassakis I, Vassiliadis S. Serum concentrations of growth factors in women with and without endometriosis: the action of anti-endometriosis medicines [Int Immunopharmacol 2003; 3(1):81-89].
Ferrero S.
Publication Types: · Comment · Letter
PMID: 14975370 [PubMed]
119: JSLS. 2004 Jan-Mar;8(1):3-7. Related Articles, Links
Laparoscopic ureteroneocystostomy and vesicopsoas hitch for infiltrative endometriosis.
Nezhat CH, Malik S, Nezhat F, Nezhat C.
Nezhat Medical Center, Atlanta, Georgia 30342, USA. info@nezhat.com
OBJECTIVE: To report a series of laparoscopic vesicopsoas hitch procedures performed for the treatment of infiltrative ureteral endometriosis. METHODS: A retrospective chart review of 6 women with severe endometriosis and ureteral obstruction caused by infiltrative disease of the distal ureter was performed. The patients underwent successful laparoscopic ureteroneocystostomy and vesicopsoas hitch. RESULTS: Five of the 6 patients had a history of endometriosis, and their obstructions were diagnosed during prior surgeries. The other patient was diagnosed with severe endometriosis of the rectum, bladder, and ureter at the time of the procedure. She was referred for evaluation of an incidental finding of hydroureter and hydronephrosis. Three patients were treated with gonadotrophin-releasing hormone (GnRH) analog for at least 3 months preoperatively. Five patients had ureteral stents in place prior to the psoas hitch surgery. No intra- or postoperative complications occurred. All patients had a normal cystogram performed 10 to 14 days postoperatively prior to Foley catheter removal. Stents were kept in place for 6 to 8 weeks, and an intravenous pyelogram (IVP) was done 2 weeks after removal. All patients had a normal renal ultrasound, computer tomography, or intravenous pyelogram at least 1 year postoperatively. CONCLUSION: Laparoscopic vesicopsoas hitch can be a safe and effective alternative to the laparotomy with the known benefits of laparoscopy.
PMID: 14974654 [PubMed]
120: Gynecol Obstet Invest. 2004;57(1):54-6. Related Articles, Links
Anti-angiogenic treatment of endometriosis: biochemical aspects.
Taylor RN, Mueller MD.
Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, CA, USA.
PMID: 14974461 [PubMed]
121: Gynecol Obstet Invest. 2004;57(1):53-4. Related Articles, Links
Steroid and cytokine regulation of matrix metalloproteinases and the pathophysiology of endometriosis.
Osteen KG, Igarashi TM, Yeaman GR, Bruner-Tran KL.
Women’s Reproductive Health Research Center, Department of Obstetrics and Gynaecology, Vanderbilt University School of Medicine, Nashville, TN, USA.
PMID: 14974460 [PubMed]
122: Gynecol Obstet Invest. 2004;57(1):52-3. Related Articles, Links
Inhibition of endometrial peritoneal attachment in the prevention and treatment of endometriosis.
Groothuis PG, Dunselman GA.
Department of Obstetrics and Gynaecology, Resesarch Institute GROW, Maastricht University, Maastricht, The Netherlands.
PMID: 14974459 [PubMed]
123: Gynecol Obstet Invest. 2004;57(1):51-2. Related Articles, Links
Medical treatment of endometriosis.
Simon C, Garcia-Velasco J.
Instituto Valenciano de Infertilidad, Valencia University, Valencia, Spain.
PMID: 14974458 [PubMed]
124: Gynecol Obstet Invest. 2004;57(1):49-51. Related Articles, Links
Quantitative assessment of endometrial-peritoneal interaction in vitro: a non-invasive diagnostic test for women with endometriosis?
Debrock S, Hill JA, D’Hooghe TM.
Leuven University Fertility Center, UZ Gasthuisberg, KU Leuven, Belgium.
PMID: 14974457 [PubMed]
125: Gynecol Obstet Invest. 2004;57(1):47-9. Related Articles, Links
The future of endometriosis research: genomics and proteomics?
Taylor RN.
Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, CA, USA.
PMID: 14974456 [PubMed]
126: Gynecol Obstet Invest. 2004;57(1):46-7. Related Articles, Links
Endometriosis in the baboon.
Fazleabas AT, Brudney A, Chai D, Mwenda J.
Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA.
PMID: 14974455 [PubMed]
127: Gynecol Obstet Invest. 2004;57(1):43-6. Related Articles, Links
Baboon model for fundamental and preclinical research in endometriosis.
D’Hooghe TM, Debrock S, Kyama CM, Chai DC, Cuneo S, Hill JA, Mwenda JM.
Institute of Primate Research, Karen, Nairobi, Kenya.
PMID: 14974454 [PubMed]
128: Gynecol Obstet Invest. 2004;57(1):42-3. Related Articles, Links
Etiology of endometriosis: hypotheses and facts.
Dunselman GA, Groothuis PG.
Department of Obstetrics and Gynaecology, Resesarch Institute GROW, Maastricht University, Maastricht, The Netherlands.
PMID: 14974453 [PubMed]
129: Gynecol Obstet Invest. 2004;57(1):40-2. Related Articles, Links
The prevalence of endometriosis among African-American and African-indigenous women.
Kyama MC, D’Hooghe TM, Debrock S, Machoki J, Chai DC, Mwenda JM.
Institute of Primate Research,A? Karen and Nairobi, Kenya.
PMID: 14974452 [PubMed]
130: Surg Endosc. 2003 Dec 29;17(9). [Epub ahead of print] Related Articles, Links
Umbilical endometriosis.
Frischknecht F, Raio L, Fleischmann A, Dreher E, Luscher KP, Mueller MD.
Department of Obstetrics and Gynaecology, Kantonsspital Munsterlingen, 8596 Scherzingen, Switzerland.
We report two women who presented with a recurrent, mildly painful, bluish nodule in the umbilicus. Both patients complained of local tenderness and occasional bleeding that increased during menstruation. Neither patient had had previous pelvic surgery. Excision of the lesions revealed a primary umbilical endometriosis; in one case, a simultaneous laparoscopy showed a pelvic endometriosis. We review the current literature and discuss the possible etiopathogenesis and when a laparoscopy is indicated to diagnose a concomitant pelvic endometriosis. Umbilical endometriosis is a very rare disease but should be considered in the differential diagnosis of umbilical lesions.
PMID: 14973733 [PubMed]
131: Surg Endosc. 2003 Jul 21 [Epub ahead of print] Related Articles, Links
A laparoscopic approach to small bowel obstruction secondary to endometriosis.
Weizman DA, Sullivan P.
Department of General Surgery, Toronto East General Hospital, 840 Coxwell Avenue, Toronto, Ontario, M4C 5T2 Canada.
The complications of endometriosis are well recognized and extend beyond the pelvis. Gastrointestinal manifestations of this disease have been well described; however, reports of small bowel obstruction are rare. We describe the case of a 44 year-old-woman who presented with high-grade smalA?l bowel obstruction secondary to an endometrioma. We review the epidemiology and pathology associated with this condition and describe a laparoscopic approach to its management.
PMID: 14973670 [PubMed]
132: J Obstet Gynecol Neonatal Nurs. 2004 Jan-Feb;33(1):71-9. Related Articles, Links
More than just menstrual cramps: symptoms and uncertainty among women with endometriosis.
Lemaire GS.
University of Maryland School of Nursing, Department of Behavioral and Community Health, Baltimore, MD 21201, USA. Lemaire@son.umaryland.edu
OBJECTIVE: To examine the frequency, severity, interference with daily life, and symptom distress associated with endometriosis and to explore the relationships among symptoms, emotional distress, uncertainty, and preference for and adequacy of information. DESIGN: A descriptive, cross-sectional correlational study. SETTING: Data were collected at a conference of the Endometriosis Association in Milwaukee, Wisconsin. PARTICIPANTS: A convenience sample of 298 women attending an educational program. MAIN OUTCOME MEASURES: Endometriosis symptoms and symptom distress, emotional distress, and adequacy of information were assessed using author-developed scales. Preference for information was measured by a revision of the Krantz Health Opinion Survey Information Subscale. Uncertainty was assessed using the Mishel Uncertainty in Illness Scale-Community Form. RESULTS: Women experienced multiple symptoms associated with varying levels of distress, including symptoms not typically associated with endometriosis. Participants sought out information but were undecided about whether they had sufficient information about the disease. Uncertainty about endometriosis was relatively high and associated with emotional distress and lack oA?f information about the disease. CONCLUSIONS: Reported symptoms demonstrate the complexity and impact of endometriosis. Women’s preference for information and experience of emotional distress and uncertainty suggest the need for information and support. Prospective, controlled studies on the impact of endometriosis and interventions to inform and support patients are needed.
PMID: 14971555 [PubMed]
133: Klin Lab Diagn. 2003 Dec;(12):16-9. Related Articles, Links
[In Process Citation] [Article in Russian] [No authors listed] One hundred and fifty-three women with external genital endometriosis (EM), stages 1-4, and 30 healthy fertile women were examined. The peripheral-blood serum and daily urine were tested with the level of the mean weight molecules (MWM) being determined spectrophotometrically at lambda = 230-300 nm. The minimal MWM concentrations were detected in blood in cases of the stage-1 endometrioid process; they were significantly lower versus those observed in the healthy women at the maximal urine concentrations, i.e. well above the normal value. An increasing MWM blood content is registered in stages 2-4 EM, which exceeds the normal figure, whereas MWM was minimal in urine in stage 2, it was progressively increasing later but did not reach the value of stage 1. The external EM was associated with an enhanced MWM formation; it is noteworthy, that their concentrations in blood serum directly correlated with a stage of the endometrioid process. A reliably lower MWM level in stage 1 EM is below the normal value, while its maximal increase in urine could be regarded as a compensation-adaptation reaction aimed at removing the toxic substances from the body. A reduced MWM discharge with urine and its growth in bloA?od plasma were observed in further progressing of the endometrioid process, which is preconditioned by the toxic impact of MWM exerted on the nephron.
PMID: 14971319 [PubMed]
134: Gynecol Obstet Invest. 2004;57(4):214-7. Epub 2004 Feb 11. Related Articles, Links
Indices of oxidative stress in eutopic and ectopic endometria of women with endometriosis.
Oner-Iyidogan Y, Kocak H, Gurdol F, Korkmaz D, Buyru F.
Department of Biochemistry, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
This study was designed to determine the activities of superoxide dismutase and glutathione peroxidase and some of the lipid peroxidation indices (malondialdehyde and total sulfhydryl groups) in eutopic and ectopic endometria of patients with endometriosis. Ectopic endometrial tissues (ovarian cysts; n = 22) were obtained laparoscopically during the preovulatory period. Statistical analyses were made using the Wilcoxon signed-rank test. The levels of malondialdehyde and total sulfhydryl groups were similar in the eutopic and ectopic endometria, whereas the superoxide dismutase activity was found to be significantly higher in the latter (1,893 +/- 780 vs. 3,512 +/- 1,502 U/g protein; p = 0.002). Although the glutathione peroxidase activity was slightly lower in the ectopic than in the eutopic tissues, the difference was not found to be statistically significant. The malondialdehyde levels were positively correlated with the plasma 17beta-estradiol concentrations in the ectopic endometria (r = 0.683, p = 0.001). No such correlation was seen in the eutopic tissue. It is suggested that various factors, such as cytokines released by activated macrophages in the peritoneal fluid and 17beta-estradiol itself synthesized by the ovaries, may locallA?y affect the oxidant status of ectopic endometria. Copyright 2004 S. Karger AG, Basel
PMID: 14970668 [PubMed]
135: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S48-50. Related Articles, Links
[Biological aspects of endometriosis in vitro fertilization] [Article in French] Lornage J.
Departement de Medecine et Biologie de la Reproduction, Hopital E.-Herriot, Lyon, France.
Rinsing cumulus oophorus after oocyte retrieval is routinely performed in our department in Lyon for in vitro fertilization procedures when ovarian endometriosis is suspected. The aim of this procedure is to remove factors which might alter oocyte and embryo quality and fertilization and pregnancy rates. These factors, such as Tumor Necrosis Factor alpha (TNFalpha) and reactive oxygen species are known to be surexpressed in endometriosis. Their effect is not exclusively on the development of the oocyte and embryo but also on fertilization and implantation. It has been demonstrated that peritoneal and follicular fluid contains some factors that interfere with effective gamete interaction, as it has been determined by an in vitro animal assay. Peritoneal fluid from patients with mild endometriosis has an increased activity of TNFalpha, interleukin-1 (IL-1), antibodies and reactive oxygen species. This observation might be of importance in explaining subfertility associated with early stages of endometriosis. Cumulus-oophorus rinsing after oocyte retrieval might help to remove these deleterious factors. IVF outcomes in women affecting by endometriosis seem to be similar after cumulus-oophorus rinsing, as compared to those of patients undergoing IVF for tubal-factor infertility. This rinsing procedure could also be usefull in women affecA?ted by unexplained infertility: peritoneal and follicular fluid of these women contains increased levels of TNFalpha and reactive oxygen species, like women affected by endometriosis.
Publication Types: · Review · Review, Tutorial
PMID: 14968070 [PubMed]
136: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S45-7. Related Articles, Links
[Results of IVF in women with endometriosis] [Article in French] Olivennes F.
Service de Gynecologie-Obstetrique et de Medecine de la Reproduction, Hopital Cochin, Paris, France.
When associated with infertility, endometriosis often requires in vitro fertilization (IVF). The need of IVF instead of other Assisted Reproductive Technologies is correlated with the severity of the lesions and associated tubal pathology. Results of IVF (in terms of pregnancy rates), are influenced by the existence of endometriosis, but this influence remains controversial, and focused on three possible points: poor ovarian reserve (and ovarian response), poor quality of oocytes and embryos, poor implantation. It seems that mild and moderate endometriosis (I-II American Fertility Society score) has few deleterious effect on ovarian reserve, ovarian response, and pregnancy rates. All these parameters are decreased by the existence of severe endometriosis (III-IV AFS). Its surgical treatment appears to improve the results of IVF, notably in women under 35. But iterative surgery of endometriomas might be deleterious for ovarian function. Previous treatment by Gn-RH agonists also improves the outcome of IVF, whereas ICSI does not modify either the biological parameters, nor the pregnancy rates. Ovarian hyperstimulation in women with endometriosis might increase the severity of the lesions and the risk of complications: the use of unstimulated cycle (n-IVF) in young patients with normal ovarian reserve might be interesting.
Publication Types: · Review · Review, Tutorial
PMID: 14968069 [PubMed]
137: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S42-4. Related Articles, Links
[Ovarian stimulation regimens in women with endometriosis] [Article in French] Devroey P.
Service de Gynecologie-Obstetrique, Bruxelles, Belgique.
Controversies concerning the optimal treatment of endometriosis and its related infertility still exist, and few comparative studies are available. The number of oocytes retrieved and pregnancy rates seem to be higher after in vitro fertilization that follows long-term down-regulation with Gn-RH agonists, but the available studies are retrospective and do not allow definitive conclusion. No comparative studies are available between extra long and short Gn-RH agonist in women affected by endometriosis. No benefit of the use of danazol has been demonstrated in this indication. There are no data available on Gn-RH antagonist pretreatment before ovarian stimulation in patients with endometriosis undergoing assisted reproduction techniques. Endometrioma resection prior to IVF may compromise or destroy adjacent normal ovarian cortex and thus might reduce the ovarian reserve. Aspiration of endometrioma is associated with an increased risk of infection.
Publication Types: · Review · Review, Tutorial
PMID: 14968068 [PubMed]
138: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S37-41. Related Articles, Links
[Endometriomas and in vitro fertilization outcomes] [Article in French] Pouly JL; D’apres la communication de.
Service de Gynecologie-Obstetrique, Clermont-Ferrand, France.
This paper reports the effects of endometrioma and their treatments on infertility out-come mainly in cases of in vitro fertilisation. This paper summarise a literature review and the experience of the Clermont-Ferrand infertility centre experience. The main conclusions are: the absence of any deleterious effects on IVF results in cases of endometriomas, the conservation of the oocytes stock in the ovary after any type of ovarian surgery for endometrioma (cystectomy or drainage plus laser vaporisation), the poor out-come of iterative surgical approach of endometrioma, the risk of ovarian abscess after puncture during an IVF procedure. From all these data the authors provides answers to the most frequent questions that arise in the cases of the presence of endometrioma in an infertile patient.
Publication Types: · Review · Review, Tutorial
PMID: 14968067 [PubMed]
139: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S32-6. Related Articles, Links
[Chronic pelvic pain and endometriosis] [Article in French] Chapron C; D’apres la communication de.
Service de Gynecologie-Obstetrique et de Medecine de la Reproduction, Hopital Cochin, Paris, France.
Chronic pelvic pain and endometriosis remain two of the most perplexing problems in gynaecology. In some women, the problem is to determine whether or not endometriosis causes the pain they are consulting for. Deep pelvic endometriosis presents essentially in the form of a painful syndrome dominated by deep dyspareunia and painful functional symptoms that recur according to the menstrual cycle. The semiology is directly correlated with the location of the lesions (bladder, rectum). Lesions of the utero-sacral ligaments are the most frequent deeply infiltrating endometriosis lesions. The following variables are related to the severity of dysmenorrhoea: number of previous surgical procedures for endometriosis, score in the revised American Fertility Society classification, extensiveness of adnexal adhesion, Douglas obliteration, size of the posterior deeply infiltrating endometriosis implant, extent of the sub-peritoneal infiltration by the posterior deeply infiltrating endometriosis. It is essential to investigate (clinically and with magnetic resonance imaging) these deep endometriosis lesions and to draw up a precise map, which is the only way to be sure that exeresis will be complete. Surgery remains the first intention treatment, whereas medical treatment is only palliative in the majority of cases. Success of treatment depends on how radical surgical exeresis is. Operative laparoscopy is efficient for bladder, utero-sacral ligaments and vaginal deeply infiltrating endometriosis. However, indications for laparotomy still exist, notably for bowel lesions. Based on analysis of the anatomical distribution of deep pelvic endometriosis lesions, a "surgical classification" is proposed with the aim of establishing standard modes for surgical treatment. Further studies are required to clarify the place and modes for pre- and postoperative medical treatment.
Publication Types: · Review · Review, Tutorial
PMID: 14968066 [PubMed]
140: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S28-31. Related Articles, Links
[Perspectives on endometriosis: new physiopathologic approaches and treatments] [Article in French] Vigano P; D’apres la communication de.
Istituto Auxologico Italiano and Department Ostet/Ginecol, University of Milano, Milan, Italie.
Pathophysiology of deeply infiltrating endometriosis remains controversial whereas physiopathologic mechanism of superficial endometriosis is nearly demonstrated. Superficial peritoneal implants derive from adhesion and proliferation of endometrial cells regurgitated in peritoneum with retrograde menstruation. Peritoneal inflammation involving cytokines as TNFalpha and aromatase over-expression might be involved in the endometriosis invasion processus. Specific molecular defects of both eutopic and ectopic endometrium have been identified for each of the processes involved in the disease development. Aromatase inhibitors decrease endometriosis lesions in a mouse model of endometriosis which was induced surgically. Few studies report efficacy of aromatase inhibitors in human endometriosis. Theoretically, aromatase inhibitors should not be used alone in premenopausal women because of the resultant increase in gonadotropin levels. Nevertheless, in premenopausal women, aromatase inhibitors may be used in association with Gn-RH agonists. TNFalpha is a secretory factor of macrophages that is known to be increased in the peritoneal fluid of women with endometriosis. Granulosa cells from these women produce higher levels of TNFalpha. This cytokine can stimulate adhesion and proliferation of endometrial cells and enhances metalloproteasis expression, making thus endometrial cell invasion easier. It also stimulates angiogenesis by regulating expression of IL-8. TNFalpha is also cytotoxic to gametes. In mice and baboon models with induced endometriosis, anti-TNFalpha (TNF binding protein-1) decreases AFS score stage and reduces in size the endometriotic foci. No clinical assay has studied TNFalpha efficacy on human endometriosis.
Publication Types: · Review · Review, Tutorial
PMID: 14968065 [PubMed]
141: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S23-7. Related Articles, Links
[New concepts on pathophysiology, diagnosis and treatment of adenomyosis] [Article in French] Fernandez H.
Service de Gynecologie-Obstetrique, Hopital Antoine-Beclere, Clamart, France.
Adenomyosis is a relatively frequent disease, difficult to diagnose and which pathophysiology remains unknown. The treatment for the women which want to conserve or improve their fertility remains not well defined. Endovaginal ultrasonography seems to be as effective as MRI for the diagnosis of adenomyosis. Gn-RH agonist decreases symptoms and uterine volume; however, the symptoms reappear after discontinuation of agonist therapy, and side effects limit their prolonged use. Progesterone receptor modulators, anti-progestative and danazol or levonorgestrel-releasing intra-uterine system have been used as therapeutic modalities for adenomyosis, but the lack of controlled studies make their efficacy difficult to quantify. Some women with superficial adenomyosis may theoretically benefit from hysteroscopic myometrial or endometrial resection, but these procedures would be limited to women not wishing to conceive. Laparoscopic myometrial electrocoagulation or excision has proven to be effective but pregnancy following these techniques poses special problems, particularly the increased risk of uterine rupture. Transvaginal ultrasonography can successfully diagnose adenomyosis. Medical and conservative surgical treatments are already available.
Publication Types: · Review · Review, Tutorial
PMID: 14968064 [PubMed]
142: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S20-2. Related Articles, Links
[Surgical treatment for endometriomas] [Article in French] Dubuisson JB.
Service de Gynecologie-Obstetrique et de Medecine de la Reproduction, Hopital Cochin, Paris, France.
Endovaginal ultrasonography is relevant for the diagnosis of ovarian endometriomas with a good predictive value. Magnetic resonance imaging (MRI) may be recommended if deep endometriosis is suspected. Operative laparoscopic management is the ‘gold standard’ for surgical treatment, and medical treatment should not be given before surgery. Peritoneal lavage cytology must be performed before cystectomy. First, the cyst is opened and the endometriosic fluid is aspirated. The stripping technique is performed and after hemostasis, the ovarian cortex is reattached with microsurgical sutures. Coagulation or laser vaporization of endometriomas without excision of the pseudocapsule seems to be associated with a significant increase in risk of cyst recurrence. Recurrent ovarian surgery is not recommended in women with infertility, as it might be deleterious for ovarian reserve.
Publication Types: · Review · Review, Tutorial
PMID: 14968063 [PubMed]
143: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S15-9. Related Articles, Links
[Physiopathology, diagnosis and therapeutic management of stage III and IV endometriosis] [Article in French] Audebert A.
Stage III endometriosis is defined by a r-AFS score respectively ranging from 16 to 40 and stage IV over 40. Deep pelvic endometriosis presents essentially in the form of a painful syndrome dominated by chronic pelvic painful, dysmenorrhea and deep dyspareunia. Pathophysiology of pelvic pain associated with endometriosis remains unknown. In the literature, correlation between extension of the endometriosis and severity of the painful remains controversies. Contraception by levonorgestrel-releasing intra-uterine systems appears to decrease pain related to deeply infiltrating endometriosis. Surgery by laparoscopy remains the first intention treatment when infertility is associated with endometriosis, whereas medical treatment is only palliative in the majority of cases. Success of treatment depends on how radical surgical exeresis is. Spontaneous pregnancy rates are significantly increased after surgical treatment. Recurrent ovarian surgery is not recommended in women with infertility, as it might be deleterious for ovarian reserve. Medical treatment using Gn-RH agonists is indicated when recurrence occurs after surgery.
Publication Types: · Review · Review, Tutorial
PMID: 14968062 [PubMed]
144: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S11-4. Related Articles, Links
[Physiopathology and therapeutic management of stage I and II endometriosis] [Article in French] Nisolle M, Nervo P.
Service de Gynecologie-Obstetrique, Universite de Liege, Belgique.
Stage I and II endometriosis is defined by a r-AFS score respectively ranging from 1 to 5 and from 6 to 15. This mild, superficial endometriosis is a very common pathology occurring in infertile women. Nevertheless, these women with stage I/II endometriosis have usually few pelvic pain. This review summarizes the recent literature concerning new data on the pathogenesis of peritoneal endometriosis and its clinical management. Retrograde menstruation, peritoneal adhesion of shed endometrial tissue, and outgrowth of endometrial cells, glands and stroma, are essential elements in the pathogenesis of endometriosis according to Sampson’s classic implantation theory. Nevertheless, exact pathophysiology of endometriosis remains unknown. Superficial endometriotic lesions observed by laparoscopy have to be treated. Surgical procedure is not difficult for stage I and II of endometriosis. Surgical procedure remains controversial. Carbon dioxide (CO2) Laser can be used for laparoscopic destruction of endometriosis. Newer procedures, such as SurgiTouch (Lumenis), are more effective in vaporization and decrease the risk thermal damage of contiguous structures. The monopolar scissors can also be used in order to excise the peritoneal endometriotic lesions. Medical treatment may be usefull if surgical treatment is not complete or if the pelvic cavity is hypervascularized. In these cases, Gonadotropin-Releasing Hormone agonists (Gn-RHa) are the most common and effective treatment.;
Publication Types: · Review · Review, Tutorial
PMID: 14968061 [PubMed]
145: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):S5-10. Related Articles, Links
[Imaging features of endometriosis] [Article in French] Balleyguier C.
Service de Radiologie Adultes, Hopital Necker, Paris, France.
Deep pelvic endometriosis is responsible of a painful syndrome dominated by deep dyspareunia and pelvic pain that recur according to the menstrual cycle. The semiology is directly correlated with the location of the lesions but is not specific. It is essential to investigate (clinically and with magnetic resonance imaging (MRI)) these deep endometriosis lesions and to draw up a precise map, which is the only way to be sure that surgical excisions will be complete. For the diagnosis of deep endometriosis, MRI is more sensitive and specific than endovaginal ultrasonography. Bowel and utero-sacral ligament lesions are often underestimated by clinical examination and ultrasonography. The MR diagnosis of these deep lesions is also difficult and require adapted sequences but may vary following experience of the radiologist. Preoperative endorectal ultrasonography or MRI are reliable techniques to visualize perirectal endometriomas and to assess rectal wall involvement. Surgical management can be based on preoperative imaging diagnosis, the Bladder and ureteral lesions are also underestimated. Renal ultrasonography must be performed in women affected by severe deeply infiltrating endometriosis. MRI does not improve sensitivity nor specificity of the radiologic diagnosis of ovarian endometriomas. Nevertheless, MRI is a reliable technique to visualize deeply infiltrating endometriosis lesions associated with ovarian endometriomas.
Publication Types: · Review · Review, Tutorial
PMID: 14968060 [PubMed]
146: J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 2):4S3-50. Related Articles, Links
[Proceedings of the 2nd Scientific Meeting on Infertility and Endometriosis. 13 June 2003] [Article in French] [No authors listed] Publication Types: · Congresses · Overall
PMID: 14968059 [PubMed]
147: Fertil Steril. 2004 Feb;81(2):456-8. Related Articles, Links
Increased serum polychlorobiphenyl levels in Belgian women with adenomyotic nodules of the rectovaginal septum.
Heilier JF, Ha AT, Lison D, Donnez J, Tonglet R, Nackers F.
The sum of bulk polychlorobiphenyl levels was significantly higher in women with rectovaginal adenomyosis than in women with endometriosis and controls.
Publication Types: · Letter
PMID: 14967391 [PubMed]
148: Fertil Steril. 2004 Feb;81(2):379-83. Related Articles, Links
Effects of alcohol consumption on female fertility during an 18-year period.
Eggert J, Theobald H, Engfeldt P.
Family Medicine Stockholm, Department of Clinical Science, Karolinska Institutet, Stockholm, Sweden. jan.eggert@klinvet.ki.se
OBJECTIVE: To investigate the long-term effects of alcohol consumption on female fertility. DESIGN: Prospective study of a random sample of 7,393 women, selected from the 445,000 inhabitants of Stockholm County, Sweden, in 1969. Self-estimated alcohol consumption was obtained from postal questionnaires. Data on hospitalizations for pregnancy outcomes including infertility examinations were analyzed until 1987. SETTING: Healthy women in Stockholm County, Sweden. PATIENT(S): Seven thousand three hundred ninety-three women in the age range 18-28 years. MAIN OUTCOME MEASURE(S): Rates of hospitalization for deliveries, miscarriages, legal abortions, extrauterine pregnancies, pelvic inflammatory disease, endometriosis, and infertility examinations were analyzed in relation to the intake of alcohol. RESULT(S): Two hundred fifty-two women underwent infertility examinations. High consumers had an increased risk for such examinations, as compared with moderate consumers: relative risk ratio (RR) = 1.59 (95% confidence interval [CI]: 1.09-2.31); and low consumers had a decreased risk (RR = 0.64; CI: 0.46-0.90). Moreover, for both high and low consumers we observed a significantly lower number of first and second partus. Rates of miscarriage, extrauterine pregnancy, and pelvic inflammatory disease did not differ between high and low consumers of alcohol. CONCLUSION(S): High alcohol consumption was associated with increased risk of infertility examinations at hospitals and with lower numbers of first and second partus. It may be important for the female partner in an infertile couple to limit alcohol intake or to not drink at all.
PMID: 14967377 [PubMed]
149: Fertil Steril. 2004 Feb;81(2):305-8. Related Articles, Links
Peritoneal fluid concentrations of epithelial neutrophil-activating peptide-78 correlate with the severity of endometriosis.
Suzumori N, Katano K, Suzumori K.
Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medicine, Nagoya, Japan. og.n.suz@med.nagoya-cu.ac.jp
OBJECTIVE: To assess the release of epithelial neutrophil-activating peptide-78 (ENA-78) into peritoneal fluid in women with and without endometriosis. DESIGN: Retrospective study. SETTING: Nagoya City University Hospital. PATIENT(S): Surgery was scheduled in the proliferative or secretory phase of the menstrual cycle for 59 women with (n = 35) and without (n = 24) endometriosis. INTERVENTION(S): Peritoneal fluid samples were obtained at laparotomy or laparoscopy. MAIN OUTCOME MEASURE(S): The ENA-78 concentrations in the peritoneal fluid were measured using enzyme-linked immunosorbent assay (ELISA). RESULT(S): The concentrations of ENA-78 in the peritoneal fluid were markedly elevated in the endometriosis patients as compared with the controls, especially in women with severe stage disease. CONCLUSION(S): We conclude that ENA-78 is an important factor that may contribute to the pathogenesis of endometriosis, possibly promoting neovascularization.
PMID: 14967364 [PubMed]
150: Fertil Steril. 2004 Feb;81(2):297-304. Related Articles, Links
Equivalence of the 3-month and 28-day formulations of triptorelin with regard to achievement and maintenance of medical castration in women with endometriosis.
Donnez J, Dewart PJ, Hedon B, Perino A, Schindler AE, Blumberg J, Querleu D.
Department of Gynecology and Andrology, Universite Catholique de Louvain, Service de Gynecologie, Brussels, Belgium. donnez@gyne.ucl.ac.be
OBJECTIVE: The present study aims at demonstrating the equivalence of the 28-day and 3-month formulations of triptorelin SR (sustained release) in terms of percentage of patients achieving castration levels of estradiol (<==50 pg/mL) 84 days after treatment initiation. DESIGN: A phase II, prospective, randomized, multicenter, open study was conducted in two parallel groups of women with endometriosis. SETTING: Academic hospitals. PATIENT(S): Seventy-two women with endometriosis. were treated with a single intramuscular injection of 3-month triptorelin SR, and 74 patients were treated with one intramuscular injection of 28-day triptorelin SR every 28 days for 3 months. INTERVENTION(S): As part of two parallel treatment groups, 72 women were given a single intramuscular injection of 3-month triptorelin SR, and 74 women were given one intramuscular injection of 28-day triptorelin SR every 28 days for 3 months. MAIN OUTCOME MEASURE(S): Percentage of patients achieving castration levels of estradiol at the end of the treatment period. RESULT(S): Patients participated in the study until resumption of menses. Ninety-seven percent of patients given the 3-month formulation and 94% of those given the 28-day formulation were in a state of medical castration on day 84. The mean time to achieve castration was shorter for the 3-month formulation, and the duration of castration was significantly longer. The FSH and LH parameters were comparable, though not always identical. CONCLUSIO

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