J Minim Invasive Gynecol. 2010 Mar-Apr;17(2):258-61.Large-muscle endometriosis involving the adductor tight compartment: case report.Fambrini M, Andersson KL, Campanacci DA, Vanzi E, Bruni V, Buccoliero AM, Pieralli A, Livi L, Scarselli G.Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, Florence, Italy. [email protected] endometriosis is an uncommon condition but can ...
Tech Coloproctol. 2009 Mar;13(1):65-8. Epub 2009 Mar 14.
Laparoscopic-assisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES?
Department of Digestive Surgery, Mariaziekenhuis Noord-Limburg, Overpelt, Belgium. [email protected]
The combination of standard laparoscopy and specimen extraction through a natural orifice has the potential to decrease wound related complications. We describe the technical approach to laparoscopic sigmoidectomy in which the specimen is extracted transanally through a proctoscope. Laparoscopic-assisted sigmoidectomy with transanal specimen removal avoids an abdominal wall extraction incision and may be considered an alternative approach to conventional minimally invasive sigmoidectomy in patients with disease of the sigmoid or left colon.
Fertil Steril. 2009 Mar 12. [Epub ahead of print]
Unusual complication of excision of pelvic endometriosis: pseudoaneurysm of the left uterine artery.
Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Genoa, Italy.
We report on a patient who had a pseudoaneurysm arising from the left uterine artery after surgical excision of deep endometriosis. The diagnosis was based on contrast-enhanced multidetector computed tomography angiography. Transfemoral selective catheterization and embolization of the left uterine artery determined a quick improvement of the symptoms.
Fertil Steril. 2009 Mar 12. [Epub ahead of print]
Prokineticin 1 mRNA expression in the endometrium of healthy women and in the eutopic endometrium of women with endometriosis.
Istituto Scientifico Internazionale (ISI) “Paolo VI,” Università Cattolica del Sacro Cuore (UCSC), Rome, Italy.
OBJECTIVE: To examine prokineticin 1 (PROK1) mRNA expression in eutopic endometrial glands obtained from patients with or without endometriosis, to investigate the presence of additional endometrial abnormalities in women with endometriosis. DESIGN: Prospective laboratory study. SETTING: University hospital. PATIENTS: Twelve control women and 12 patients affected by endometriosis in the secretory phase of the menstrual cycle. INTERVENTION(S): Endometrial specimens were obtained from women affected (cases) or not (control group) by endometriosis. Endometrial glands were freshly isolated from endometrial biopsies. MAIN OUTCOME MEASURE(S): PROK1 mRNA expression levels by real-time polymerase chain reaction analysis. RESULTS: PROK1 mRNA was detectable in 4 of 12 (33%) samples obtained from women affected by endometriosis, whereas 10 of 12 (83%) samples obtained from normal women were positive for PROK1 detection by real-time polymerase chain reaction. Moreover, detectable PROK1 mRNA levels were 10 times lower in samples obtained from women with endometriosis than in samples obtained from control women. CONCLUSION(S): PROK1 is a newly discovered angiogenic factor implicated in the vascular function of peri-implantation endometrium and early pregnancy. An altered expression of PROK1 could be one of the several biochemical abnormalities characterizing eutopic endometrium in endometriosis.
Reprod Sci. 2009 Jun;16(6):559-72. Epub 2009 Mar 12.
Eutopic endometrium from women with endometriosis shows altered ultrastructure and glycosylation compared to that from healthy controls–a pilot observational study.
Maternal and Fetal Health Research Centre, School of Clinical and Laboratory Science, University of Manchester, Manchester, United Kingdom. [email protected]
Endometrial curettings from a cohort of 24 women with endometriosis were compared with matched biopsies from 14 healthy, fertile women and examined for ultrastructural changes and the secretion of glycans bound by the lectin from Dolichos biflorus. Ultrastructural analysis of glandular endometrial tissue from women with stages I to III endometriosis showed heterogeneous responses to the disease, biopsies often showing a mixture of features, combining delays in the maturation sequence with characteristics of later phenotypes particularly in the mid-late secretory phase of the menstrual cycle. Expression of glycans bound by Dolichos biflorus agglutinin was very variable in these cases but generally matched the observed ultrastructure. Biopsies from women with stage IV endometriosis showed immature gland morphology later in the cycle and also failed to express Dolichos biflorus agglutinin-binding glycans, suggesting an association between histological and biochemical function in advanced disease states. These findings may explain in part endometriosis-associated subfertility as blastocyst attachment is intimately associated with appropriate glycosylation and gland morphology.
Eur J Obstet Gynecol Reprod Biol. 2009 May;144 Suppl 1:S61-4. Epub 2009 Mar 17.
Uterine contraction signals–application of the linear synchronization measures.
Department of Medical Informatics, Institute of Computer Science, University of Białystok, Sosnowa 64, 15-887 Białystok, Poland.
OBJECTIVE: In physiological research, there are not too many studies on multivariate data sets, containing two or more simultaneously recorded time series. It is important to examine synchronization in these kinds of signals. The aim of this study is to present the linear measures: the cross-correlation function, the coherence function, the wavelet cross-correlation and the wavelet coherence to assess synchronization between contractions in different topographic regions of the uterus. STUDY DESIGN: Spontaneous uterine activity was recorded directly by a dual micro-tip catheter (Millar Instruments, Inc., USA). The device consisted of two ultra-miniature pressure sensors. One sensor was placed in the fundus, the other one in the cervix. For this analysis, a healthy patient with normal contractions, a patient with dysmenorrhea, a patient with fibromyomas in the follicular phase, and the patient with endometriosis were selected. RESULTS: For each method the values of synchronization parameters for normal contractions were higher than the values of these parameters for other pairs of signals. The differences between these four groups of the uterine contraction signals were clear. The lowest values of the synchronization measures were in the case of dysmenorrheic patient. CONCLUSION: The analysis of synchronization of the uterine contractions signals may have a diagnostic value. For intrauterine pressure signals results obtained by means of different synchronization methods are different, but consistent.
J Med Primatol. 2009 Aug;38(4):257-62. Epub 2009 Mar 5.
Endometrial and cervical polyps in 22 baboons (Papio sp.), 5 cynomolgus macaques (Macaca fascicularis) and one marmoset (Callithrix jacchus).
Southwest National Primate Research Center at the Southwest Foundation for Biomedical Research, San Antonio, TX 78245-0549, USA.
BACKGROUND: Endometrial and cervical polyps are masses of endometrium or cervical epithelium that bulge into the uterine or cervical lumen. The physiopathology and contributing factors of endometrial polyps development are still unknown. METHODS: Clinical and pathology records of 28 non-human primates with histologically confirmed endometrial and cervical polyps were reviewed. Twenty-one baboons with endometrial polyps were evaluated for age at diagnosis, body weight, menstrual cycle length, presence of endometriosis and adenomyosis and number of offspring, cesarean sections, and stillbirths. RESULTS: Endometrial polyps in baboons were associated with increased age, decreased menstrual cycle lengths, endometriosis, and decreased parity. No differences were found for weight, adenomyosis, or number of cesarean sections or stillbirths. CONCLUSIONS: Baboons are a promising model for the study of endometrial polyps because of their similarity to humans in both the development of endometrial polyps and association of many of the same risk factors.
Hum Reprod Update. 2009 Jul-Aug;15(4):441-61. Epub 2009 Mar 11.
Recurrence of endometriosis and its control.
Institute of Obstetric and Gynecologic Research, Shanghai Jiao Tong University School of Medicine, Renji Hospital, 145 Shandong Zhong Road, Shanghai 200001, People’s Republic of China. [email protected]
BACKGROUND Although surgery is currently the treatment of choice for managing endometriosis, recurrence poses a formidable challenge. To delay or to eliminate the recurrence is presently an unmet medical need in the management of endometriosis. To this end, proposals to investigate patterns of recurrence, to develop biomarkers for recurrence and to carry out biomarker-based intervention have been made. METHODS Publications pertaining to the recurrence of endometriosis and its related yet unaddressed issues were identified through MEDLINE. The reported recurrence rates, risk factors for recurrence, the effects of post-operative medication and causes of recurrence were reviewed and synthesized. In addition, several poorly explored issues such as time hazard function and mechanisms of recurrence were reviewed. Approaches to the development of biomarkers for recurrence and future intervention are discussed. RESULTS The reported recurrence rate was high, estimated as 21.5% at 2 years and 40-50% at 5 years. Few risk factors for recurrence have been consistently identified, and the evidence on the efficacy of the post-operative use of medication was scanty. The investigation on the patterns of recurrence may provide us with new insight into the possible mechanisms of recurrence and its control. The attempt to identify biomarkers for recurrence has started only very recently. CONCLUSIONS Much research is needed to better understand the patterns of recurrence and risk factors, and to develop biomarkers. One top priority is to develop biomarkers for recurrence, which may provide much needed clues to the possible mechanisms underlying recurrence and would allow the identification of patients with high recurrence risk, and permit for targeted intervention.
Hum Reprod. 2009 Jun;24(6):1501-6. Epub 2009 Mar 11.
Relative weight at ages 10 and 16 years and risk of endometriosis: a case-control analysis.
Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Herston, Brisbane 4006, Australia. [email protected]
BACKGROUND:Although previous epidemiological studies have shown that women with endometriosis are more likely to be thinner and underweight, it is currently not clear whether this is a true characteristic of women who develop endometriosis or a consequence of their disease and its symptoms. The aim of this study was to investigate the relationship between endometriosis and relative weight in childhood and adolescence, prior to diagnosis. METHODS:This case-control study included 268 Australian women with surgically confirmed moderate to severe endometriosis (cases) and 244 women without endometriosis (controls). Relative weight at ages 10 and 16 years, as recalled and classified (‘underweight’, ‘average weight’ and ‘overweight’) separately by the women themselves and their mothers, was analyzed. RESULTS:Women who reported being overweight at 10 years had an increased risk of endometriosis (OR 2.8; 95% CI 1.1-7.5). Mothers’ reports and concordant responses among mother-daughter pairs were consistent with this association. There was no clear evidence of an association between relative weight at 16 years and risk of endometriosis. CONCLUSIONS:These data suggest that being overweight during late childhood is associated with the development of endometriosis; however, the results warrant confirmation in larger study populations.
Gynecol Obstet Fertil. 2009 Mar;37(3):216-21. Epub 2009 Mar 10.
Bladder endometriosis: diagnosis and treatment. A series of 24 patients
[Article in French]
Service de gynécologie-obstétrique, hôpital Bichat – Claude-Bernard, AP-HP, Paris, France. [email protected]
OBJECTIVE: This study aims to show the treatment outcome in women affected by bladder endometriosis. PATIENTS AND METHODS: Retrospective review of records of 24 women with deep vesical endometriosis treated between 1998 and 2007. RESULTS: All cases had cyclic symptoms even though they were not specific. A percentage of 66% of women had concomitantly deep nodules of the rectovaginal septum and/or uterosacral ligaments. Five patients (20.8%) had previously undergone a transurethral resection (TUR) of the bladder lesion, but this therapy has failed in all cases. Partial cystectomy was carried out in 14 patients (60.8%) and an extramucosal dissection of the endometriotic lesion in nine patients (39.2%). Laparoscopy was used in 19 cases (82.6%). Recurrence of bladder endometriotic lesions was documented in two patients. This was mainly due to an incomplete initial treatment. Success rate, defined by total improvement of symptoms after the initial treatment, was estimated at 86.7% in this series. The only complication encountered was a pelvic hematoma with bladder compression that required a ureteral cannulation (JJ). Seven patients out of 11 became pregnant; four of them were infertile before the surgical treatment. DISCUSSION AND CONCLUSION: Diagnosis of bladder endometriosis is often difficult to make because of its non-specific symptoms. The management is mainly surgical and resection should be complete. TUR is not an optimal treatment for bladder endometriosis.
Micron. 2009 Jul-Aug;40(5-6):639-45. Epub 2009 Feb 20.
Composition of sulfated glycosaminoglycans and immunodistribution of chondroitin sulfate in deeply infiltrating endometriosis affecting the rectosigmoid.
Departamento de Histologia e Embriologia, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Cidade Universitária-Ilha do Fundão, 21941-590 Rio de Janeiro, RJ, Brazil.
The composition of sulfated glycosaminoglycans (GAGs) and the tissue distribution of chondroitin sulfate (CS) were analyzed in deeply infiltrating endometriosis (DIE) of rectosigmoid, using metachromatic staining, and biochemical analysis employing electrophoresis before and after specific enzymatic or chemical degradations, and immunostaining with an antibody against CS. The sulfated GAGs were characterized as dermatan sulfate (DS), heparan sulfate (HS) and CS; and DS strongly predominated compared to HS and CS. Immunostaining procedures showed that CS was concentrated in the endometriosis foci, distributed throughout the stroma around the glands. This is the first report describing the composition of sulfated GAGs and the tissue location of CS in DIE by means of histochemical, biochemical and immunohistochemical analyses. These results confirmed that in DIE of rectosigmoid, as in eutopic endometrium [Nasciutti, L.E., Ferrari, R., Berardo, P.T., Souza, M.L.S., Takiya, C.M., Borojevic, R., Abrao, M.S., Silva, L.C.F., 2006. Distribution of chondroitin sulfate in human endometrium. Micron 37, 544-550], CS was the dominant sulfated GAG in stroma of the lesion foci.
Mini Rev Med Chem. 2009 Mar;9(3):324-8.
Future targets in endometriosis treatment: targeting the endometriotic implant.
Department of Obstetrics and Gynecology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas 66160, USA. [email protected]
Endometriosis is an enigmatic, debilitating disease which affects as many as 15% of all women of reproductive age and is characterized by pelvic pain and infertility. Current treatment regimes used to manage the disease do so by inducing a hypoestrogenic state. While the absence of circulating estrogen levels lead to a regression of the disease, this hypoestrogenism also induces many unpleasant side-effects. As such, these and other shortcomings of current drug therapies emphasize their limitations and the necessity for the development of novel endometriosis treatments. In this review, current therapies which target the biochemistry of the implant are discussed with emphasis on aromatase inhibitors, anti-angiogenic compounds and vascular-disrupting agents.
Br J Hosp Med (Lond). 2009 Mar;70(3):170-1.
Subcutaneous endometrial deposit: an unusual cause of right iliac fossa pain.
Cork University Hospital, Cork, Ireland.
This case illustrates the use of ultrasound in identifying endometrioma and the capability of ultrasound-guided biopsy in providing definitive histological diagnosis of this rare condition.
Chin J Integr Med. 2009 Mar;15(1):42-6. Epub 2009 Mar 7.
Effect of Quyu Jiedu Granule () on microenvironment of ova in patients with endometriosis.
Reproductive and Genetic Center of Intrgrative Medivine, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, China. [email protected]
OBJECTIVE: To observe the effect of Quyu Jiedu Granules (, QJG) on the micro- microenvironment of ova in patients with endometriosis (EM). environment METHODS: Twenty EM patients who received in vitro fertilization and embryo transfer (IVF-ET) were randomized equally into a treated group and a control group. Further, 20 patients who received IVF-ET due to oviduct factors were enrolled into a non-endometriosis group. The dosage of gonadotrophic hormone used, the number of ova attained, fertilization rate and clinical pregnancy rate were all observed, and the levels of tumor necrosis factor alpha (TNF-right harpoon over left harpoon) and interleukin 6 (IL-6) in follicular fluid as well as their mRNA expressions in ovarian granular cells were detected by RT-PCR on the very day of ovum attainment. RESULTS: The ova attainment (13.80+/-6.87) and fertilization rate (0.69+/-0.31) in the treated group were all higher than the corresponding values in the control group (9.80+/-5.32 and 0.47+/-0.22); the follicular fluid contents of TNF-alpha and IL-6 in the treated group were 1.38+/-0.21 ng/mL and 130.56+/-12.81 pg/mL, respectively, which were lower than those in the control group (1.98+/-0.34 ng/mL and 146.83+/-17.65 pg/mL, respectively). Further, the treated group showed much lower mRNA expressions of TNF-alpha and IL-6 in ovarian granular cells. CONCLUSIONS: The elevation of TNF-alpha and IL-6 contents in follicular fluid and their mRNA expressions in ovarian granular cells are possibly related to the low quality of ova in EM; QJG might raise the ova quality by reducing TNF-alpha and IL-6 levels to improve the living micro-environment for the ova.
J Korean Med Sci. 2009 Feb;24(1):162-5. Epub 2009 Feb 28.
Endometrioid adenocarcinoma in urethrovaginal septum: a diagnostic pitfall.
Center for Uterine Cancer, National Cancer Center, Goyang, Korea.
Primary endometrioid adenocarcinoma developed at urethrovaginal septum has not been reported. A 61-yr-old woman presented with recurrent urinary tract infection. She had received hormone replacement treatment with estrogen and progesterone for 5 yr. A pinpoint ulceration at slightly elevated anterior vaginal wall was found and biopsy revealed endometrioid adenocarcinoma. Magnetic resonance imaging showed the 4.3 cm sized mass in urethrovaginal septum. She has undergone anterior pelvic exenteration, pelvic lymph node dissection, and urostomy with ileal conduit. Microscopic finding of the pathology revealed endometrioid adenocarcinoma. Co-existence of endometriosis was not identified. Tumor at urethrovaginal septum was difficult to be detected till growing to be bulky, because of vaginal axis, misunderstanding of the tumor as symphysis pubis, no definitive symptom, and its rarity. This is the first reported case of extraovarian endometrioid adenocarcinoma developed at the urethrovaginal septum. Understanding normal functional anatomy and meticulous physical examination are essential to detect this rare tumor in the urethrovaginal septum.
J Minim Invasive Gynecol. 2009 May-Jun;16(3):302-6. Epub 2009 Mar 9.
Rectovaginal endometriosis-characteristics of operative treatment and factors predicting bowel resection.
Department of Obstetrics and Gynecology, University of Helsinki, Finland.
STUDY OBJECTIVE: The purpose of this study was to characterize operative treatment of patients with rectovaginal endometriosis (RVE), with special emphasis on factors predicting bowel resection. DESIGN: A total of 153 symptomatic cases undergoing radical resection of RVE at our institution between January 2000 and May 2004 were reviewed. Univariable and multivariable association models were used in connection with various factors associated with bowel resection. SETTING: Tertiary referral center. MEASUREMENTS AND MAIN RESULTS: In all, 57 (37%) patients were treated laparoscopically, and 96 (63%) patients via laparotomy. Gastrointestinal and/or urologic surgeon was present in 30% of cases. A total of 54 (35%) patients underwent bowel resection. The median (range) operating times were 145 (75-315) minutes and 100 (20-300) minutes for patients with and without bowel resection, respectively (p <.0001). Four (2.6%) major complications occurred. In the univariable association model, the risk of bowel resection was increased among patients with previous surgery for endometriosis (OR 2.74, 95% CI 1.35-5.54), intestinal symptoms (OR 2.55, 95% CI 1.29-5.02), and revised American Fertility Society score IV (OR 4.71, 95% CI 2.06-10.78). Preoperative use of combined oral contraceptives was associated with a lower risk of bowel resection (OR 0.32, 95% CI 0.15-0.66). CONCLUSION: Operative treatment of RVE is demanding; a multidisciplinary approach is often needed. Patients with intestinal symptoms and those with a history of endometriosis surgery are at increased risk of bowel resection.
Hum Pathol. 2009 Jul;40(7):965-74. Epub 2009 Mar 9.
Immunohistochemical characterization of mullerian mucinous borderline tumors: possible histogenetic link with serous borderline tumors and low-grade endometrioid tumors.
Department of Anatomic Pathology, Graduate School of Medical Science, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan.
Mullerian mucinous borderline tumor and gastrointestinal mucinous borderline tumor are considered mucinous tumor subtypes. However, it has been reported that mullerian mucinous borderline tumor shares many clinicopathologic features with serous borderline tumor. Furthermore, some investigators have explained the histogenesis of mullerian mucinous borderline tumor by metaplastic and hyperplastic transformation of endometriosis (Fukunaga M, Ushigome S. Epithelial metaplastic changes in ovarian endometriosis. Mod Pathol. 1998;11:784-788). The purpose of this study is to substantiate the concept that mullerian mucinous borderline tumor is histogenetically closer to serous borderline tumor or low-grade endometrioid tumor than to gastrointestinal mucinous borderline tumor by directly comparing their immunophenotype. A total of 80 cases of low-grade ovarian tumors composed of 20 mullerian mucinous borderline tumors, 20 gastrointestinal mucinous borderline tumors, 20 serous borderline tumors, and 20 low-grade endometrioid tumors were immunohistochemically evaluated for the expression of estrogen receptor, progesterone receptor, vimentin, WT-1, beta-catenin, and PTEN. Almost all cases of mullerian mucinous borderline tumor, serous borderline tumor, and low-grade endometrioid tumor showed diffuse and strong nuclear expression of estrogen receptor and progesterone receptor. In addition, about half of the mullerian mucinous borderline tumor, serous borderline tumor, and low-grade endometrioid tumor cases showed focal but strong vimentin cytoplasmic expression. In contrast, gastrointestinal mucinous borderline tumor showed no expression of estrogen receptor, progesterone receptor, or vimentin, except for 1 case in which estrogen receptor expression was very focally and weakly observed. WT-1 nuclear expression was observed in most serous borderline tumors and only 15% of low-grade endometrioid tumor, but mullerian and gastrointestinal mucinous borderline tumor cases were completely negative. beta-Catenin nuclear expression was significantly more frequent in low-grade endometrioid tumor than in mullerian mucinous borderline tumor, gastrointestinal mucinous borderline tumor, or serous borderline tumor. PTEN expression was significantly lower in low-grade endometrioid tumor than in mullerian mucinous borderline tumor, gastrointestinal mucinous borderline tumor, and serous borderline tumor. Multiple comparisons of quantitative immunoreactivities of estrogen receptor, progesterone receptor, and vimentin revealed that the gastrointestinal mucinous borderline tumor expression profiles were significantly different from those of mullerian mucinous borderline tumors, serous borderline tumors, and low-grade endometrioid tumors. The immunohistochemical expression profiles of estrogen receptor, progesterone receptor, and vimentin substantiate the concept that the histogenesis of mullerian mucinous borderline tumor is closer to those of serous borderline tumor and low-grade endometrioid tumor than to that of gastrointestinal mucinous borderline tumor. However, aberrant beta-catenin and PTEN protein expression, both of which are known to contribute to the tumorigenesis of low-grade endometrioid tumor, appeared to be less important for the tumorigenesis of mullerian mucinous borderline tumor.
Fertil Steril. 2009 Mar 5. [Epub ahead of print]
15-Epi-lipoxin A(4) inhibits the progression of endometriosis in a murine model.
Department of Obstetrics and Gynecology, Tongji Hospital of Tongji Medical college of Huazhong
University of Science & Technology, Wuhan, People’s Republic of China; Department of Obstetrics and Gynecology, Xiamen First Hospital affiliated by Fujian Medical University, Xiamen, People’s Republic of China.
OBJECTIVE: To examine the pro-resolution actions of 15-epi-lipoxin A(4) (LXA(4)) on endometriotic lesions, on the concentrations and activities of matrix metalloproteinases (MMP-2 and MMP-9) in murine endometriosis. DESIGN: Prospective, vehicle-controlled experimental study. SETTING: Animal research facility. ANIMAL(S): BALB/c mice. INTERVENTION(S): Endometriosis (EM) was induced in 30 mice. Fifteen of them were administered LXA(4) for 24 days (LXA(4) group), whereas the other 15 served as a control group (EM group). Another 15 sham-operated mice (sham-operated group) were treated with vehicles. MAIN OUTCOME MEASURE(S): The weight of the endometriotic lesions was measured. The concentrations, mRNA, and activities of MMP-2 and MMP-9 were determined by enzyme-linked immunosorbent assay, quantitative real-time polymerase chain reaction, and gelatin zymography, respectively. RESULT(S): Compared with EM group, the weight of the endometriotic lesions was decreased, the concentrations of MMP-2 and MMP-9 dropped, the mRNA levels of MMP-2 and MMP-9 in the peritoneal fluid cells and the endometriotic lesions were reduced, and the activities of MMP-2 and MMP-9 were inhibited in the LXA(4) group. CONCLUSION(S): LXA(4) may inhibit the progression of endometriosis possibly by lowering the concentrations and the activities of MMP-2 and MMP-9.
Soc Sci Med. 2009 Apr;68(8):1489-97. Epub 2009 Mar 5.
Negotiating science and experience in medical knowledge: gynaecologists on endometriosis.
Department of Sociology and Social Anthropology, Dalhousie University, Nova Scotia, Canada B3H 4P9. [email protected]
This paper analyses the gynaecological literature on endometriosis, particularly endometriosis classification, to evaluate the epistemological concepts it uses. A qualitative content analysis was conducted on a sample of gynaecological literature published between 1985 and 2000, a period that witnessed the explosion of both evidence-based and patient-centred models of medicine, with their dwelling emphases on science and experience. It was found that the discourse of science is used strategically in this literature as a formal epistemology to lend weight to authors’ claims and to guide medical thinking and research. However, gynaecologists also use the notion of experience to assert their own credibility and to question the credibility of other experts. In fact, accounts of their own experience and the experiential accounts of their patients are foundational to gynaecologists’ claims-making activities, including their engagement with scientific research.
Hum Reprod. 2009 Jun;24(6):1247-54. Epub 2009 Mar 4.
A call for more transparency of registered clinical trials on endometriosis.
Renji Hospital, and the Institute of Obstetric and Gynecologic Research, Shanghai Jiao-Tong University School of Medicine, Shanghai 200001, China. [email protected]
In response to the pressing need for more efficacious and safer therapeutics for endometriosis, there have been numerous reports in the last decade of positive results from animal and in vitro studies of various compounds as potential therapeutics for endometriosis. A handful of these have undergone phase II/III clinical trials. Since the announcement of the International Committee of Medical Journal Editors that mandated registration as a prerequisite for publication, 57 endometriosis-related clinical trials have been registered at ClinicalTrials.gov, an Internet-based public depository for information on drug studies. Among them, 25 are listed as completed, and 2 as suspended. There are 15 completed phase II/III trials, which evaluated the efficacy of various promising compounds. Yet only three of the 15 trials (20%) have published their results. The remaining 12 (80%) studies so far have not published their findings. We argue that this apparent lack of transparency will actually not benefit the trial sponsors or the public, and will ultimately prove detrimental to research efforts attempting to develop more efficacious and safer therapeutics for endometriosis. Thus we call for more transparency of clinical trials on endometriosis.
Fertil Steril. 2009 May;91(5):1958.e1-3. Epub 2009 Mar 4.
Triplet pregnancy and successful twin delivery in a patient with congenital cervical atresia who underwent transmyometrial embryo transfer and multifetal pregnancy reduction.
Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China.
OBJECTIVE: To report an unusual case of congenital cervical atresia and tubal factor infertility, achieving triplet pregnancy through transmyometrial embryo transfer (ET) resulting in the delivery of healthy twins after multifetal pregnancy reduction (MFPR). DESIGN: Case report and literature review. SETTING: University hospital. INTERVENTION(S): Controlled ovarian hyperstimulation, oocyte retrieval, in vitro fertilization, transmyometrial ET, MFPR procedure for triplet pregnancy. PATIENT(S): A 33-year-old patient with endometriosis-associated and tubal factor infertility who underwent uterovaginal canalization surgery for congenital cervical atresia 9 years ago. MAIN OUTCOME MEASURE(S): Successful delivery after transmyometrial ET followed by MFPR. RESULT(S): A total of three IVF cycles and four procedures of transmyometrial ET were performed. In the third cycle a triplet pregnancy was achieved. MFPR was performed 35 days after embryos transfer, two healthy babies delivered at 31 weeks gestation. CONCLUSION(S): With aggressive therapy, successful pregnancy is possible in similar patients.
J Reprod Med. 2009 Jan;54(1):32-40.
Proteomic analysis of peritoneal fluid in fertile and infertile women with endometriosis.
Reproductive Physiology Laboratory, St. Bartholomew’s School of Medicine and Dentistry, QMW College, 48-53 St. Bartholomew’s Close, St. Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE, U.K. [email protected]
OBJECTIVE: To evaluate the peritoneal fluid (PF) proteome of fertile and infertile women with endometriosis. STUDY DESIGN: PF samples were collected at laparoscopy from 26 fertile women and 26 infertile ones. Samples were subjected to 2-dimensional gel electrophoresis and compared by computerized analysis. Protein spots were identified by liquid chromatography tandem mass spectrometry. RESULTS: One isoform of immunoglobulin light chain spot was more frequently present in PF of infertile women than infertile patients. Nine protein spots had significantly higher expression in PF of infertile patients than infertile controls. They were 2 isoforms of serotransferrin, 1 isoform of complement C3, serum amyloid P-component, alpha-1-antitrypsin and clusterin; 3 protein spots remain unidentified. No protein spots had significantly lower expression in PF of infertile women with endometriosis than in PF of fertile controls. Complement C3 had higher PF levels in the luteal than in the follicular phase of the menstrual cycle in both infertile and fertile patients. CONCLUSION: Among women with endometriosis, those with infertility have aberrant expression of several PF proteins; most of these molecules are involved in the immune response.
Eur J Obstet Gynecol Reprod Biol. 2009 May;144(1):48-53. Epub 2009 Mar 3.
Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study.
Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Denmark. [email protected]
OBJECTIVE: The key enzyme in the biosynthesis of estradiol, aromatase, has been demonstrated within endometriosis. Combined administration of aromatase inhibitor and GnRH-agonist may efficiently suppress estrogen biosynthesis through a combined pituitary, ovarian, peripheral and “in situ” action. The aim of this study was to test the concept of combined down-regulation prior to IVF in patients with endometriomas. STUDY DESIGN: Prospective pilot study in a university-based tertiary fertility clinic including 20 infertile patients with endometriomas undergoing IVF/ICSI. The patients received goserelin 3.6mg sc on treatment Days 1, 28 and 56, and one daily tablet of anastrozole 1mg from Day 1 to Day 69. Controlled ovarian stimulation was initiated from Day 70. Outcome measures were change in endometriomal volume and serum CA125 during down-regulation, standard IVF parameters including pregnancy and delivery rate, and endocrine response. The paired T test and Wilcoxon Signed Rank test were used to analyse paired differences. RESULTS: During the combined down-regulation, the endometriomal volume and the serum CA125 level decreased by 29% (3-39%) and 61% (21-74%), respectively (median (95%CI), P=0.007 and P=0.001). In the IVF/ICSI cycle, the number of oocytes retrieved was 7.5 (6.0-10.0) and the fertilization rate was 0.78 (0.38-1.0). Nine patients (45%) conceived, five (25%) had a clinical pregnancy, and three (15%) delivered healthy children (two singletons and one twin). CONCLUSIONS: Prolonged combined anastrozole and goserelin down-regulation significantly reduces endometriomal volume and serum CA125, and is compatible with IVF pregnancy and delivery. However, a high pregnancy loss was noted.
Eur J Obstet Gynecol Reprod Biol. 2009 May;144(1):64-7. Epub 2009 Mar 3.
Effect of the removal of the Fallopian tube during hysterectomy on ovarian survival: the orphan ovary syndrome.
Department of Obstetrics and Gynecology, County Teaching Hospital, University of Pecs, Hungary.
OBJECTIVE: The objective was to assess the long-term impact on ovarian survival of removing the Fallopian tube during hysterectomy. STUDY DESIGN: We modified our standard operative policy by adding the option of removing the Fallopian tube, thus leaving an “orphan” ovary behind. In a follow-up study, we identified 82 patients who had undergone hysterectomy followed by a second operation for an adnexal condition. In 45 there was presence and in 37 there was absence of the Fallopian tube. Data analysis included the time interval between hysterectomy and the occurrence of adnexa-related complaints; diagnoses prior to and the type of the second surgery; histological diagnosis after and the success rate of the second surgery. For statistical analysis, Kruskal-Wallis One-Way ANOVA on Ranks and the Mann-Whitney Rank Sum Test were used. RESULTS: In 35.5% of patients with an intact Fallopian tube, hydrosalpinx developed. Cystic degeneration of orphan ovaries occurred significantly earlier than that of the “regular” adnexae group (50.0 months vs. 84.2 months, p=0.031). Laparotomy and laparoscopy for second surgery showed equal success rates. CONCLUSION: Removal of the Fallopian tube at abdominal hysterectomy decreases the incidence of the development of pelvic masses later, but causes earlier cystic degeneration of the remaining ovaries.
01: J Clin Ultrasound. 2009 May;37(4):215-20.
Endometriomas in the region of a scar from Cesarean section: sonographic appearance and clinical presentation vary with the size of the lesion.
Unità Operativa di Ecografia Diagnostica e Interventistica, Presidio Ospedaliero Camilliani S Maria della Pietà, Casoria (NA), Italy.
PURPOSE: To describe the sonographic (US) appearances of endometriomas developed in the vicinity of a scar from Cesarean section and compare sonographic and clinical characteristics of large (> or =3 cm) scar endometriomas (LSEs) with small scar endometriomas (SSEs). METHOD: Twenty-eight consecutive women (mean age, 31 years; range, 20-42) with 31 scar endometriomas (mean diameter, 2.7 cm; range, 0.7-6 cm) were examined by US, including color Doppler imaging prior to surgery. Clinical and US findings in women with LSE were compared with those of women with SSE. RESULTS: Twelve patients had 12 LSEs with a mean longest diameter of 4.1 cm (range, 3-6 cm); in 1 case, a large nodule was associated with a small lesion. Sixteen women had 18 SSEs with a mean lesion size of 1.8 cm (range, 0.7-2.6 cm).The mean time interval between the last Cesarean section and hospital admission was longer in patients with LSE (66 versus 40 months; p < 0.01) as was the mean duration of symptoms before admission (43 versus 17 months; p < 0.01); in addition, 41.6% of patients with LSE had undergone previous inconclusive diagnostic examinations (CT, MRI, fine needle aspiration, or laparoscopy) compared with 0% in patients with SSE (p < 0.05). LSEs more frequently showed cystic portions and fistulous tracts (p < 0.05), loss of round/oval shape (p < 0.05), and increased vascularity (p < 0.05) than SSEs did. CONCLUSION: LSEs were associated with a delay in diagnosis and some US findings that could result in further diagnostic difficulties.
Gynecol Endocrinol. 2009 Feb;25(2):75-81.
The role of the oxidative-stress in the endometriosis-related infertility.
2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Athens University Medical School, Athens, Greece. [email protected]
Endometriosis is a common gynecological disorder of the reproductive age characterised by pelvic pain, dysmenorrhea and infertility. Classic theories have failed to propose a precise pathogenetic mechanism. Recent studies have investigated the role of the immune system and oxidative stress in the development of endometriosis as well as the identification of biomarkers for a non-invasive diagnosis of the disease. At endometriotic sites, inflammatory cells including eosinophils, neutrophils and macrophages generate reactive oxygen species that contribute to the development of oxidative stress in the peritoneal cavity. Oxidative stress further augments immune response in affected sites. The oxidants exacerbate the development of endometriosis by inducing chemoattractants and endometrial cell growth-promoting activity. The oxidative proinflammatory state of the peritoneal fluid is an important mediator of endometriosis. Many studies investigate the correlation of endometriosis and oxidative stress but the results are discrepant. Furthermore, oxidative stress has been implicated in unexplained infertility and has been associated with some of its causative factors. Oxidative stress influences women’s reproductive capacity. The association between endometriosis and infertility is described in several studies and still remains debated.
J Endourol. 2009 Mar;23(3):457-61.
Expanding the horizons: robot-assisted reconstructive surgery of the distal ureter.
Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida 33126, USA.
OBJECTIVES: To report our single-center experience with robotic ureteroneocystostomy for the treatment of distal ureteral obstruction. METHODS: We performed robot-assisted laparoscopic ureteroneocystostomies between May 2005 and October 2007. We retrospectively collected information on patient demographics, and compared renal scans with furosemide washout and radiographic imaging before and after repair to determine radiographic success. Statistical analysis was performed using statistical software via paired Student’s t test analysis. RESULTS: Eight robot-assisted laparoscopic ureteroneocystostomies on seven patients were performed over a 30-month period. The etiology of the ureteric stricture was iatrogenic injury after hysterectomy in three patients, impacted stone in three, and infiltrative endometriosis in one. Mean stricture length was 2.2 cm. Right ureteroneocystostomy was performed in five patients and on the left in one, while one patient had bilateral disease. Mean operative time was 247 minutes (range 120-480), and average blood loss was 109 mL (range 50-200). Mean length of hospital stay was 2 days. All the procedures were completed successfully robotically without open conversion. Of the seven patients, one patient experienced recurrent symptoms. Subsequent imaging confirmed an anastomotic narrowing, which was treated by balloon dilation. There were no intraoperative or postoperative complications. Subsequent (99m)Tc-mercaptoacetyltriglycine scans showed no evidence of obstruction. After a mean follow-up of 18 months (range 5-31), relative renal function of the entire group of patients improved after ureteroneocystostomy, although this did not achieve statistical significance (p = 0.26). CONCLUSIONS: Robotic ureteroneocystostomy is a safe and effective treatment option for the management of distal ureteric stricture disease.
Am J Surg. 2009 Jun;197(6):e66-8. Epub 2009 Feb 27.
Endometriosis-induced appendiceal intussusception.
Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
Appendiceal intussusception is a rare entity that is difficult to diagnosis before surgery both clinically and radiologically. We report here a case of a 55-year-old woman with a 6-month history of right lower abdominal pain caused by appendiceal intussusception. Laparoscopic appendectomy was performed. Endometriosis foci were identified in the appendix tip and became the leading point of the appendiceal intussusception. The appendix was removed laparoscopically, which is the optimal treatment for such patients.
Am J Surg. 2009 Jul;198(1):122-8. Epub 2009 Feb 27.
Intussusception of the appendix: comprehensive review of the literature.
Department of General Surgery, Yale New Haven Hospital, New Haven, CT, United States.
BACKGROUND: Intussusception of the appendix is a rare disease that constitutes a diagnostic challenge to the surgeon. The literature on this condition is limited to case reports. The demographics, presentation, and treatment remain debatable in the absence of a comprehensive review of the literature. DATA SOURCES: This article reports a case of a 40-year-old woman who presented with intussusception of the appendix caused by endometriosis. A comprehensive review of the English literature in PubMed was performed. The trends in incidence, sex predilection, presentation, and treatment of appendiceal intussusception were derived based on the reports of 191 patients. COMMENTS: The incidence was more common in adults (76%) than in children (24%). Female patients (72%) were 2 times more affected in adults than in children, whereas male patients (58%) seem to be more affected in the pediatric population. Intussusception of the appendix has most commonly a chronic presentation (63%). Endometriosis (33%) and inflammation (76%) were the most common pathologic findings in adults and children, respectively. Only 49% of patients were treated by simple appendectomy; 49% patients underwent partial colectomy; and 2% of patients had their appendixes endoscopically removed.
J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):243; author reply 243.
- J Minim Invasive Gynecol. 2006 May-Jun;13(3):245-8.
- J Minim Invasive Gynecol. 2008 Nov-Dec;15(6):745-8.
The Journal of Minimally Invasive Gynecology. [Letter]
J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):231-5.
Transvaginal-laparoscopic anterior rectum resection in a hysterectomized woman with deep-infiltrating endometriosis: Description of a gynecologic natural orifice transendoluminal surgery approach.
Departments of Obstetrics and Gynecology, German Endometriosis Research Center Berlin, Germany. [email protected]
Deep-infiltrating endometriosis may affect the vagina, the rectum, and the cervicoisthmic part of the uterus, resulting in severe pain, particularly dyschezia, dysmenorrhea, dyspareunia, and diminished quality of life. Advanced surgical techniques, such as laparoscopic-assisted anterior rectum resection, are recognized as safe and effective therapeutic approaches. In some cases, a laparotomy or minilaparotomy has to be performed for technical reasons. This can be avoided in some cases by transvaginal-laparoscopic low anterior rectum resection. The technique is a 4-step procedure, which can be described as follows: step 1 (vaginal) – rectovaginal examination, preparation of the rectovaginal septum, opening of the pouch of Douglas, mobilization of the endometriotic nodule and the rectum, temporary vaginal closure; step 2 (laparoscopic) – removal of additional endometriotic lesions, adhesiolysis, final mobilization of the rectum, mobilization of the rectosigmoid, endoscopic resection using an endoscopic stapler step 3 (vaginal) – transvaginal resection of the lesion, preparation of the oral anvil, closure of the vagina; and step 4 (laparoscopic) – endoscopic transanal stapler anastomosis and underwater rectoscopy, prophylaxis of adhesions, drainage. We used this procedure to treat a 46-year-old woman (gravida 2, para 2) who was admitted to our hospital for severe lower abdominal pain, constipation, dyspareunia, dyschezia, and cyclic rectal bleedings. The symptoms were caused by an endometriotic nodule accompanied by a palpable rectum stenosis. In addition, she reported a past abdominal hysterectomy with complications caused by symptomatic myomatous uterus. As a gynecologic natural orifice surgery approach, the transvaginal-laparoscopic anterior rectum resection may be an additional useful surgical technique that could be offered by surgical gynecologists to some women with deep-infiltrating endometriosis.
J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):216-8.
Case of accessory ovary in the round ligament with associated endometriosis.
Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, Pennsylvania 17822, USA. j[email protected]
The phenomenon of accessory ovary, initially described in 1864, is extremely rare. We report a case of an accessory ovary in a round ligament with endometriosis. At the time of laparoscopy a firm 2- to 3-cm mass was noted within the round ligament with a normal ovary visualized. Dissection and removal of the mass was performed. Histopathology revealed ovarian stroma and dense connective tissue with endometriosis. This case fulfills the criteria established in 1959 for accessory ovary and is the first case of an accessory ovary reported within the round ligament. A unique finding with the accessory ovary in this case is the presence of endometriosis. No reported cases exist of endometriosis within an accessory ovary. This information may be pertinent for evaluation of dysmenorrhea when no endometrial implants are present, or with the persistence or recurrence of endometriosis and pain after a bilateral salpingo-oophorectomy.
J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):174-80.
Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates.
Huntington Medicina Reprodutiva, São Paulo, Brazil. [email protected]
STUDY OBJECTIVE: We sought to compare the outcomes of in vitro fertilization (IVF) treatments in women with infertility-associated deep infiltrative endometriosis (DIE) who underwent extensive laparoscopic excision of endometriosis before IVF with those who underwent IVF only. DESIGN: Prospective cohort study. SETTING: Infertility clinic and private hospital in São Paulo, Brazil. PATIENTS: A total of 179 infertile patients younger than 38 years had symptoms and/or signs of endometriosis and sonographic images suggestive of DIE. INTERVENTIONS: After thorough counseling, 179 women were invited to participate in a prospective cohort study with 2 treatment options: IVF without undergoing laparoscopic surgery (group A, n = 105) and extensive laparoscopic excision of DIE before IVF (group B, n = 64). Ten women were lost to follow-up. The IVF outcomes were compared between the 2 groups. MEASUREMENTS AND MAIN RESULTS: In group B, patients had 5 +/- 2 (mean +/- SD) DIE lesions excised during laparoscopy. Patient characteristics in groups A and B, respectively, were: age (32 +/- 3 vs 32 +/- 3 years, p = .94), infertility duration (29 +/- 20 vs 27 +/- 17 months, p = .45), day-3 serum follicle-stimulating hormone levels (5.6 +/- 2.5 vs 5.9 +/- 2.5 IU/L, p = .50), and previous IVF attempts (1 +/- 1 vs 2 +/- 1, p = .01). The IVF outcomes differed between groups A and B, respectively, with regard to total dose of recombinant follicle-stimulating hormone required to accomplish ovulation induction (2380 +/- 911 vs 2542 +/- 1012 IU, p = .01), number of oocytes retrieved (10 +/- 5 vs 9 +/- 5, p = .04), and pregnancy rates (24% vs 41%, p = .004), but not number of embryos transferred (3 +/- 1 vs 3 +/- 1, p = 1). The odds ratio of achieving a pregnancy were 2.45 times greater in group B than in group A. CONCLUSION: Extensive laparoscopic excision of DIE significantly improved IVF pregnancy rates of women with infertility-associated DIE.
J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):169-73.
Clinical application and midterm results of laparoscopic partial resection of symptomatic adenomyosis combined with uterine artery occlusion.
Department of Obstetrics and Gynecology, Yangpu Central Hospital, Shanghai, China.
STUDY OBJECTIVE: To examine the clinical application of laparoscopic partial resection of symptomatic adenomyosis combined with uterine artery occlusion (UAO). DESIGN: Retrospective cohort study (Canadian Task Force classification III). SETTING: A district hospital. PATIENTS: A total of 37 patients with symptomatic adenomyosis who had indication for surgical intervention but needed conservative treatment. INTERVENTION: Uterine artery occlusion combined with partial resection of adenomyosis via laparoscopy. MEASUREMENTS AND MAIN RESULTS: From July 2003 through October 2005, 37 patients with symptomatic adenomyosis were treated by UAO combined with partial resection of adenomyosis via laparoscopy. All patients were followed up at 1, 6, and 12 months after the operation to estimate the volume of the uterus and changes of symptoms including pelvic pain and abnormal bleeding. Patients also were asked to participate in a clinical interview every year thereafter. No severe complications were noted during the surgical procedure or follow-up. The mean surgical time was 115.7 +/- 27.5 minutes (Mean +/- SD, 61-171 minutes), the mean blood loss was 80.0 +/- 35.2 mL (50-150 mL), and the median highest body temperature after the procedure was 38 degrees C (range 37.4 degrees C-39 degrees C). The postoperative fever morbidity was 10.8% (4/37). Improvement of menorrhagia occurred in all of 37 and 35 of 37 for dysmenorrhea. Hysterectomy was carried out in 2 patients because of persistence of dysmenorrhea. Pictorial blood loss assessment chart was used to measure menstrual blood loss and an 11-point numeric rating scale was used to evaluate the pain intensity during menstruation. The postoperative median scores of menorrhagia were 58, 56, and 59 at 1, 6, and 12 months, respectively, compared with 158 before treatment. Significant improvement occurred (p <.001, p <.001, p <.001), compared with each other, no significant difference existed (1 vs 6 months, p =.720; 6 vs 12 months, p =.992; 1 vs 12 months, p =.709). The postoperative median scores of dysmenorrhea were 7, 5, and 4 at 1, 6, and 12 months. Respectively, compared with 8 before operation; significant symptom lessening occurred (p <.001, p <.001, p <.001). Comparing with each other, significant difference also existed (1 vs 6 months, p <.001; 6 vs 12 months, p <.001; 1 vs 12 months, p =.0018). The volume of the uterus before procedure was 224.6 +/- 48.7 cm(3) (156.0-336.1 cm(3)). At 6 and 12 months it was 169.2 +/- 78.1 cm(3) (118.4-218.2 cm(3)) and 91.6 +/- 28.4 cm(3) (43.1-127.5 cm(3)), respectively. At 6 months after surgery the volume of uterus shrank 24.7% compared with preoperative volume; shrinkage rate was 59.2% at 12 months after surgery. A continuous decrease occurred (p <.001, p <.001, p <.001). CONCLUSION: Laparoscopic partial resection of adenomyosis combined with UAO is an effective treatment modality for symptomatic adenomyosis, but further controlled studies with large samples and long-term follow-up is needed for a decisive conclusion.