Fertil Steril. 2009 Nov 14. [Epub ahead of print]
Mannose-binding lectin levels in endometriosis.
Department of Obstetrics and Gynecology, Uludağ University, Bursa, Turkey.
The serum concentrations of mannose-binding lectin in patients with or without endometriosis do not differ. Mannose-binding lectin could be involved in the modulation of inflammatory responses, but it does not seem to take part in endometriosis pathogenesis.
Ann Diagn Pathol. 2009 Dec;13(6):373-7.
Cyclooxygenase-2 expression, Ki-67 labeling index, and perifocal neovascularization in endometriotic lesions.
Department of Breast, Gynecologic and Perinatal Pathology, Institute of Pathology, University of Leipzig, D-04103 Leipzig, Germany. firstname.lastname@example.org
There is a suggested pathogenetic role of cyclooxygenase-2 (COX-2) in endometriosis via angiogenesis and proproliferative mechanisms. The aim of the study was to investigate the immunohistochemical COX-2 expression in different anatomical sites of endometriosis and its correlation to proliferative activity and periendometriotic vascularization. Sixty endometrioses from different sites (ovarian, uterine, and peritoneal) were evaluated immunohistochemically for COX-2 expression. Cyclooxygenase-2 staining of 75% or more of the cells was defined as COX-2 overexpression and used as cutoff. Proliferative activity was determined by performing Ki-67-labeling index. Periendometriotic vascularization was evaluated by determining microvessel density surrounding the endometriotic focus using CD-34-immunostaining. Cyclooxygenase-2 overexpression was significant more frequent in ovarian endometriosis, when compared with uterine and peritoneal localization (70.8% versus 41.7%; P = .027). There was no significant correlation between COX-2 overexpression and perifocal neovascularization (P = .49). Endometriotic lesions with COX-2 overexpression represented reduced proliferative activity (P = .055). Cyclooxygenase-2 is expressed in the majority of endometriosis, but differences exist within the frequency of overexpression at different anatomical sites of the endometriosis. Cyclooxygenase-2 inhibitors are of clinical interest as treatment options.
J Ovarian Res. 2009 Nov 16;2(1):18.
Thrombospondin-1 serum levels do not correlate with pelvic pain in patients with ovarian endometriosis.
Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain. email@example.com.
ABSTRACT: OBJETIVE: Thrombospondin-1 serum levels is correlate with pelvic pain in patients with ovarian endometriosis. PATIENTS: Thrombospondin-1 serum levels were prospectively analysed in 51 patients (group A asymptomatic patients or patients presenting mild dysmenorrhea and women comprised group B severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia) who underwent surgery for cystic ovarian endometriosis to asses whether a correlation exists among thrombospondin-1 serum levels and pelvic pain. RESULTS: From 56 patients, five cases were ultimateley excluded, because the histological diagnosis was other than cystic ovarian endometriosis (2 teratomas and 3 haemorragic cysts). The mean thrombospondin-1 serum levels in group A was 256,69 pg/ml_+37,07 and in group B was 291,41 pg/ml + 35,59. CONCLUSION: Pain symptoms in ovarian endometriosis is not correlated with thrombospondin-1 serum levels.
Hum Reprod. 2009 Nov 12. [Epub ahead of print]
Altered glycosylation in peri-implantation phase endometrium in women with stages III and IV endometriosis.
Academic Health Sciences Centre, Maternal and Fetal Health Research Group, University of Manchester, St Mary’s Hospital, 5th Floor (Research), Oxford Road, Manchester M13 9WL, UK.
BACKGROUND Endometriosis is a common cause of infertility and pelvic pain. Lectin histochemistry has shown that glycan expression is a sensitive marker of differentiation in the normal endometrium. Endometrial biopsies were taken during the implantation window from women with subfertility and advanced (stage III and IV) endometriosis to evaluate specific glycans bound by lectins from Dolichos biflorus agglutinin (DBA) and Vicia villosa agglutinin (VVA), which detect related but distinct glycan sequences regulated by progesterone action. METHODS Endometrial tissue from 12 women with subfertility and advanced endometriosis and 11 healthy controls were taken on days 19-24 of the menstrual cycle and processed into either epoxy resin or paraffin wax. Lectin histochemistry was analysed using light microscopy to quantify the amount of glandular reaction product. RESULTS There was a significant (P = 0.011) reduction in DBA binding to endometrium from patients with endometriosis compared with controls, which was not seen with VVA (P = 0.135). Three stage IV biopsies and one stage III biopsy completely failed to bind DBA and, of these, three showed moderate glandular binding of VVA. DBA and VVA binding differed significantly (P= 0.0039) in the endometriosis specimens whereas in controls no significant difference was detected (P = 0.812). CONCLUSION Secretory phase glycosylation in women with advanced endometriosis differs from that in healthy women with a reduction in fucosylated N-acetylgalactosamine sequences bound by DBA. Shorter VVA-binding glycans are not significantly affected. In addition to indicating abnormalities of epithelial differentiation, these findings may be directly relevant to implantation failure, as blastocyst attachment requires a critical interaction with the epithelial glycocalyx.
Hum Reprod. 2009 Nov 12. [Epub ahead of print]
Neuroendocrine cells in eutopic endometrium of women with endometriosis.
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China.
BACKGROUND Endometriosis is a common gynaecological disease, but the pathogenesis of endometriosis and pathophysiological basis for endometriosis-associated painful symptoms are still uncertain. Little is known about neuroendocrine (NE) cells in the uterus. METHODS For this study, 38 premenopausal women with histologically diagnosed ovarian endometrioma or peritoneal endometriosis and 24 women without endometriosis were selected. Biopsy samples from eutopic endometrium were used for immunohistochemical staining to detect synaptophysin (SYN) and neuron-specific enolase (NSE) expression in women with and without endometriosis. RESULTS There were substantially more NE cells of eutopic endometrium stained with SYN and NSE in women with endometriosis than in those without endometriosis (3.8 +/- 1.8 versus 0.5 +/- 0.7/mm(2), P < 0.001, and 2.8 +/- 2.1 versus 0.4 +/- 0.6/mm(2), respectively, P < 0.001). These cells were scattered in the epithelium of endometrial glands. At all stages of the menstrual cycle, the densities of NE cells stained with SYN and NSE were greater in women with endometriosis than in those without endometriosis (P < 0.05). CONCLUSIONS These results suggest that NE cells in eutopic endometrium probably play some role in the pathogenesis or symptoms of endometriosis.
Reprod Biomed Online. 2009 Oct;19(4):604-9.
Effect of piroxicam administration before embryo transfer on IVF outcome: a randomized controlled trial.
Tecnobios Procreazione, Centre for Reproductive Health, Via Dante 15, I-40125 Bologna, Italy.
Two hundred women aged between 28 and 43 years, with infertility from tubal, male, endometriosis or unexplained factor were randomly allocated into treatment (100 patients) and control (100 patients) groups. On the day after oocyte retrieval, each patient began supplementation with progesterone 8% vaginal gel, once daily. The patients in the treatment group received a single oral dose of 10 mg of the non-steroidal anti-inflammatory drug piroxicam 1-2 h before embryo transfer. No statistically significant difference was found between the two groups in any of the analysed endpoints. The rate of positive beta-human chorionic gonadotrophin test per transfer was 37% in the women treated with piroxicam and 47% in controls. The clinical pregnancy rate per transfer and implantation rate were 34% and 19.2% with piroxicam, 38% and 21.9% in controls. The miscarriage rate was 11.8% and 13.2%. No beneficial effect of piroxicam on pregnancy rates was found evaluating either different infertility causes or different ages. This study shows that the administration of a single dose of piroxicam before embryo transfer has no additional effect on pregnancy outcome in patients receiving adequate doses of progesterone for luteal phase supplementation after IVF or ICSI.
Gynecol Endocrinol. 2009 Nov;25(11):757-61.
Chronic pelvic pain: cause, diagnosis and therapy from a gynaecologist’s and an endoscopist’s point of view.
Frauenärzte am Staden, ETC – European Training Center for Gynecologic Endoscopy and Gynecologic Surgery, Saarbrücken, Germany. firstname.lastname@example.org
Chronic pelvic pain is a significant problem in gynaecology, as the causes often cannot be found by a general gynaecologic examination. Subsequently, the women often consult various physicians without a right and precise diagnosis being made. Thus, it is necessary to find a possibility for how to help these women quickly and effectively. As in nearly 1/3 of the cases the reason for the pain is an endometriosis and in another third, adhesions are responsible for the pain, the biggest part can be diagnosed and treated by laparoscopy. If laparoscopically no reason can be found, it is advisable to send the patient to a psychosomatic physician, who then can start a correspondingly differentiated diagnosis and therapy.
Gynecol Endocrinol. 2009 Nov;25(11):734-40.
Endometriosis in Italy: from cost estimates to new medical treatment.
Division of Obstetrics and Gynecology, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy. email@example.com
Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induced a chronic inflammatory reaction. The data collected from Italy showed that around 3 million women are affected by endoemtriosis and the condition was predominantly found in women of reproductive age (50% of women were in the 29-39 age range), only 25% of women were asymptomatic. The associated symptoms can create an impact in general physical, mental, and social well-being. Endometriosis is associated with severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical, or perimenstrual symptoms, with or without abnormal bleeding, infertility, and chronic fatigue. The annual cost for hospital admission can be estimated to be in a total around 54 million euros. The average time for right diagnosis is around 9 years still today and it follows a long and expensive diagnostic search. Therapies can be useful to relieve and sometimes solve the symptoms, encourage fertility, eliminate endometrial lesions, and restore the anatomy of the pelvis. For medical therapy, several different preparations (oral contraceptives, progestogenics, gestrinone, danazol, and GnRHa) and new options (GnRH antagonists, aromatase inhibitors, estrogen receptor beta agoinist, progesterone receptor modulators, angiogenesis inhibitors, and COX-2 selective inhibitors) are available.
Gynecol Endocrinol. 2009 Nov;25(11):717-21.
Endometriosis and in vitro fertilisation: a review.
Department of OB/GYN and Reproductive Medicine, Faculty of Medicine, University Hospital Arnaud de Villeneuve, INSERM 637, University Montpellier I, 34295 Montpellier cedex 5, France. firstname.lastname@example.org
This review aims to evaluate whether severe endometriosis has an impact on the outcome of in vitro fertilisation (IVF), whether IVF is associated with specific complications in this context, whether a specific ovarian stimulation protocol is most appropriate, whether the endometrial condition progresses following ovarian stimulation, and whether endometrial cysts pose a specific problem for IVF. In patients with severe endometriosis, IVF represents an effective treatment option for infertility, as a complement to surgery. The prognostic parameters of IVF are identical to those of other patients. However, the risks related to the severity of endometriosis, particularly the risk of ovarian deficiency, need to be considered. Because of this issue, to which endometriosis-related pain often adds, IVF treatment should be initiated as early as possible, using appropriate protocols and after having fully informed the patient about the specific oocytes retrieval-related risks.
Gynecol Endocrinol. 2009 Nov;25(11):707-12.
Effect of peritoneal fluid from endometriosis patients on neuroblastoma cells in culture.
Department of Obstetrics/Gynaecology, University of Berne, Berne, Switzerland. email@example.com
AIM: Endometriosis is often associated with lower abdominal pain, dysmenorrhea, dyspareunia, and chronic pelvic pain. There is no correlation between the extent of endometriosis and the intensity of pain. The mechanism of pain in endometriosis is unknown. The aim of our study was to investigate the influence of peritoneal fluid (PF) from endometriosis patients on cultured neural cells that are the morphological basis of nociception, and to determine whether there was a relationship between the rAFS staging and an elevation of TGF-beta1 production by these cells. METHODS: Different human neuroblastoma cell lines were grown to 3/4 confluence and then cultured in presence of PF pooled according to the presence of no, mild, or severe endometriosis. After 6 and 24 h of incubation, the morphological changes were assessed and the metabolic activity was determined. RESULTS: The different cell lines showed strongly varying proliferation and aggregation patterns. The metabolic activity was also varying between cell lines, but no consistently increased cell turnover in the PF when compared with the control medium nor associated to a particular, endometriosis-derived PF pool could be shown. In this experimental setting, we have observed that the cell proliferation in the presence of PF was inhibited, and not enhanced as it might have been expected. Measurement of TGF-beta1 showed higher production rates for this cytokine under exposure to PF than in controls for some but not all tested cell lines, but there was no association with the stage (rAFS) of the disease. CONCLUSION: The neuronal cell culture model may become a useful tool to investigate the endometriosis-derived pain, but different endpoints and cell lines may have to be introduced.
Gynecol Endocrinol. 2009;25(12):844-7.
Appendectomy in retrograde order for complete removal of endometriosis.
Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea.
Endometriosis frequently involves the intestines. Appendectomy would be often required as part of complete removal of endometriosis. We present a patient with endometriosis who required very difficult appendectomy. For complete removal of endometriosis, hysterectomy, bilateral salpingooophorectomy, low anterior resection and accompanying pelvic peritonectomy were performed through a mid-line incision. Unexpectedly, the appendiceal tip was attached to peri-hepatic tissue with the appendix adhered to the surrounding peritoneum and bowel. Completion of the appendectomy was possible in retrograde order after extension of the surgical incision above the umbilicus. Our findings suggest that preoperative image evaluation for location or position of the appendix might be helpful in patients with suspected endometriosis to offer correct counselling, obtaining adequate consent, determining the optimal surgical approach and scheduling opportune intraoperative consultation by a colorectal surgeon.
Gynecol Endocrinol. 2009 Nov 11. [Epub ahead of print]
Endometriotic epithelial cells induce MMPs expression in endometrial stromal cells via an NFsmall ka, CyrillicB-dependent pathway.
Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, the People’s Republic of China.
Objective. To explore the stroma-epithelium interactions in endometriosis and to identify the possible signalling pathways involved in this cross-talk. Design. Laboratory study via primary cultured endometrial stromal and epithelial cells. Setting. University Hospital. Patients. Fifteen patients with endometriosis confirmed by histopathology were recruited in the study, and 12 women free of endometriosis were used as control group. Intervention(s). Specific NFsmall ka, CyrillicB inhibitor 1-Pyrrolidinecarbodithioic acid ammonium salt (PDTC) was used in cell cultures. Main outcome measure(s). The expression and secretion of MMP-2, MMP-9, TIMP-1, TIMP-2 and the DNA-binding activity of NFsmall ka, CyrillicB in normal endometrial stromal cells or in co-cultures with normal or endometriotic epithelial cells from patients with endometriosis. Result(s). Endometrial epithelial cells induced MMP-9 and MMP-2 expression in normal stromal cells in vitro. In co-cultures with endometriotic epithelial cells, normal endometrial stromal cells expressed and secreted higher MMP-2 (p < 0.05) and MMP-9 (p < 0.05). Specific inhibition of NFsmall ka, CyrillicB pathway in stromal cells abolished this induction effect by epithelial cells. Conclusion(s). Endometriotic epithelial cells induce MMPs expression and secretion in normal endometrial stromal cells via an NFsmall ka, CyrillicB-dependent pathway in vitro. This cross-talk between epithelial cells and stromal cells may facilitate the implantation and extension of the ectopic foci and favour the development of the disease.
Gynecol Endocrinol. 2009 Nov;25(11):762-4.
Minimal endometriosis: a therapeutic dilemma?
Department of Obstetrics-Gynecology, Diakonissenkrankenhaus Karlsruhe, Academic Teaching Hospital, University of Freiburg, Germany. firstname.lastname@example.org
Accidental finding of minimal endometriosis during surgery for complaints unassociated with endometriosis presents a therapeutical dilemma. Because the clinical significance of minimal endometriosis is not thoroughly defined, it is uncertain by which means, if at all, such types of peritoneal or ovarian lesions should be treated. We, therefore, compiled our clinical observations and evaluated them in relation to the results reported in the recent literature. A search on the clinical importance and the need for any treatment of minimal and mild endometriosis was conducted. Based on the available evidence, we are tempted to conclude that minimal endometriosis should be treated surgically when accidentally discovered. This approach should be exerted even in the absence of clinical symptoms. However, postoperative medical treatment is not warranted in those patients who are without clinical complaints. Because the clinical course of minimal endometriosis is not predictable, any benefit from specific medications remains uncertain. When associated with infertility, minimal endometriosis should be surgically erased, thus to allow spontaneous conceptions to occur. As there is no evidence of medical treatment modalities altering the clinical course of minimal and mild endometriosis, any specific medical treatment (i.e. GnRH analogues, danazol) is not indicated in asymptomatic patients and those desiring pregnancy.
Gynecol Endocrinol. 2009 Nov;25(11):751-6.
Progestins and medical treatment of endometriosis – physiology, history and society.
Maternité Pinard, Hopital Saint Vincent de Paul, Université René Descartes Paris France. email@example.com
The transitory effect of hormonal treatment is the alleged main reason to criticize progestins (PGS) and combined pills (OP) in the managment of endometriosis. To the contrary their poor efficacy in the long run is often underlined. As a result, medical treatment is too seldom advised in endometriosis. In this article, we shall focus on the analysis of the reasons of the paucity of the medical interest given to progestins, reasons, which are not of a scientific or objective nature. The ultimate aim of this analysis is to develop arguments in favour of continuous administration of hormones as to obtain not simply an anovulation but a state of prolonged amenorrhea much more efficacious than the simple suppression of ovulation too often advised. And, with an emphasis on the fundamental role of surgery in the treatment of endometriosis, to give the greatest consideration to the specific nature of this disease, which is a chronic disease, justifying the long duration of hormonal administration.
Gynecol Endocrinol. 2009 Nov;25(11):748-50.
Endometriosis in the north Italian province of South Tyrol.
Department of Obstetrics and Gynaecology, Center for Human Reproductive Medicine, Hospital Bruneck, Spitalstrasse 11, 39031 Italy.
Here, we report regarding the health status and medical support for patients suffering from endometrioisis in South Tyrol, which is a politically autonomous province in the north of Italy containing three different ethnic groups. The health service is administered largely by the autonomous regional government. Because of the establishment of a centre for reproductive medicine and the introduction of laparoscopy as a prime surgery method, the gynaecological department of the hospital in Bruneck developed into a reference centre for diagnosis and surgical treatment for endometriosis. The planned future social, health care and insurance developments on local and national level regarding this illness will be discussed.
Gynecol Endocrinol. 2009 Nov;25(11):741-7.
Expression of the human endogenous retroviruse-W envelope gene syncytin in endometriosis lesions.
Department of Gynecology and Obstetrics, University of Erlangen, Erlangen, Germany. Peter.Oppelt@akh.linz.at
BACKGROUND: None of the existing theories provides a satisfactory explanation of the development of endometriosis. One hypothesis that may lead to further clarification is that the expression of specific proteins of human endogenous retroviruses (HERVs) might influence the development of endometriosis lesions. Such endogenous retroviral proteins include syncytin, coded by HERV-W, which is associated with the physiological development of the placenta during pregnancy. This study investigated the influence of HERV-W gene expression in endometriosis foci (EM) quantitatively at the RNA level. MATERIALS AND METHODS: Specific RNA expression of syncytin (HERV-W) was investigated in various endometrial tissues from 42 patients (with normal endometrium, postmenopausal endometrium, EM, and endometrial carcinoma). RNA was isolated from the tissue samples and transcribed into DNA using reverse transcriptase polymerase chain reaction. The resulting DNA fragments were analyzed using agarose gel electrophoresis and assessed quantitatively. RESULTS: Normalized syncytin expression was low in EM. In Histologically normal endometrium from endometriosis patients, the expression of normalized syncytin was seven times higher in comparison with the histologically normal endometrium in the control group. CONCLUSIONS: HERV-W syncytin expression apparently does not play a role in EM. However, it may possibly influence the development of endometriosis because of increased expression in normal endometrium in endometriosis patients.
Gynecol Endocrinol. 2009 Nov;25(11):726-33.
Neurokinin 1 receptor gene polymorphism might be correlated with recurrence rates in endometriosis.
Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany.
INTRODUCTION: Dysmenorrhoea is the major symptom in women with endometriosis. Recently, pain modulation through Neurokinin-1-receptor (NK1R) pathways have been investigated in neuropathic pain patients. Aim of this study was, therefore, to examine the effect of a single nucleotide polymorphism (SNP) of the NK1R gene on the susceptibility for endometriosis and the disease free survival (DFS) after surgery for endometriosis. MATERIAL AND METHODS: A case-control study was conducted and germline DNA was isolated. Patients were followed up for a recurrence of the disease up to 4 years. Case-control analyses were performed for parameters of the medical history and the genotype of the NK1R-SNP rs881. Furthermore, DFS probabilities were calculated. RESULTS: Concerning the DFS preoperative pain levels and the NK1R genotype were independent predictors for a recurrence with hazard ratios of 2.55 (95% CI: 1.32-4.95) for patients with a high preoperative pain level and 0.44 for patients with a heterozygous or homozygous variant genotype in rs881 (95% CI: 0.21-0.88). CONCLUSION: The polymorphism rs811 seems to be associated with a lower recurrence risk in endometriosis patients. Thus, there might be a clinical relevant role of the NK1 pathway in the pain perception of endometriosis patients.
Gynecol Endocrinol. 2009 Nov;25(11):722-5.
Impact of endometriosis on quality of life: a pilot study.
Department of Obstetrics and Gynecology, Justus Liebig University of Giessen, Giessen, Germany.
Endometriosis affects 6-10% of women in reproductive age, 35-50% of whom experience pain, infertility or both. Mild cases are managed medically but surgery provides relief to women in pain. However, symptoms recur in 75% of cases within 2 years. We investigated the impact of endometriosis on quality of life among 65 women aged 18-60 years working at a city supermarket in Giessen, Germany. Of the 65 women, 12 had undergone surgeries, 22 had dysmenorrhoea, 24 dyspareunia and 3 were infertile. Of the 22 women with dysmenorrhoea, 10 had difficulties performing gardening, housework, sports and leisure activities. Five of these 10 women experienced social isolation, 6 professional setbacks; 6 declined efficiency at work and 3 had taken time off work. Of the 24 women with dyspareunia, 7 experienced minimal, 12 light and 5 moderate to strong pain. Only 16 of these 24 women discussed the problem with their partners. This study demonstrates that pain is a major cause of physical, psycho-social, emotional and professional or work related impairment among women with endometriosis. Because endometriosis is likely to impose emotional and financial burdens, we suggest that future studies should be extended to include interviews with family members.
Gynecol Endocrinol. 2009 Nov;25(11):713-6.
Anti muellerian hormone serum levels in women with endometriosis: a case-control study.
Department of Obstetrics and Gynecology, IVF-Unit, Landesfrauen- und Kinderklinik, Linz, Austria. firstname.lastname@example.org
OBJECTIVE: To compare the anti muellerian hormone (AMH) serum levels in women with and without endometriosis. DESIGN: A case-control study SETTING: Women’s General Hospital, Linz, Austria. PATIENT(S): Our study included a total of 909 patients undergoing in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) treatment or consulting our specific endometriosis unit. After proofing the exclusion criteria, 153 of these patients with endometriosis (study group) were matched with 306 patients undergoing IVF/ICSI treatment because of a male factor (control group). INTERVENTIONS: None. MAIN OUTCOME MEASURES: AMH serum level. RESULTS: Mean AMH serum level was significantly lower in the study than in the control group (2.75 + or – 2.0 ng/ml vs. 3.46 + or – 2.30 ng/ml, p < 0.001). In women with mild endometriosis (rAFS I-II), the mean AMH level was almost equal to the control group (3.28 + or – 1.93 ng/ml vs. 3.44 + or – 2.06 ng/ml; p = 0.61). A significant difference in mean AMH serum level was found between women with severe endometriosis (rAFS III-IV) and the control group (2.38 + or – 1.83 ng/ml vs. 3.58 + or – 2.46 ng/ml; p < 0.0001). CONCLUSION: Lower AMH serum levels and an association with the severity were found in women with endometriosis. Physicians have to be aware of this fact. Because of the expected lower response on a controlled ovarian hyperstimulation (COH), AMH serum level should be measured to optimise the dose of gonadotropin treatment previous to a COH, especially in women with severe endometriosis.
Gynecol Endocrinol. 2009 Nov;25(11):701-6.
Correlation between symptoms of pain and peritoneal fluid inflammatory cytokine concentrations in endometriosis.
Department of Obstetrics/Gynaecology and Department of Clinical Research, University of Berne, Berne, Switzerland.
Endometriosis affects 10-20% of women during reproductive age and is a common cause of infertility and pain leading to work absenteeism and reduced quality of life.The objective of this study was to investigate the association between the presence and concentration of interleukin-8 (IL-8), RANTES, osteoprotegerin (OPG), pregnancy-associated plasma protein A (PAPP-A), tumour necrosis factor-alpha (TNF-alpha), midkine and glycodelin in the peritoneal fluid (PF) and the intensity of pain reported by patients undergoing laparoscopy in our clinic. They rated their pain during menstruation, intercourse and lower abdominal using a visual analogue scale. During laparoscopy, PF was aspirated. Pain scores were correlated to the concentration of the above substances in the PF and to the stage of endometriosis. Endometriosis was histologically confirmed in 41 of 68 participating women; 27 without such evidence were considered as controls. TNF-alpha and glycodelin correlated positively with the level of menstrual pain. For IL-8, RANTES, OPG and PAPP-A no correlation between their PF concentration and the menstrual pain scores was observed. Patients with severe dysmenorrhoea had increased PF cytokine and marker levels; the difference was significant for TNF-alpha and glycodelin when compared with the other patients (no or moderate pain). TNF-alpha and glycodelin may thus play a role in endometriosis and the severity of menstrual pain.
Gynecol Endocrinol. 2009 Nov;25(11):694-700.
Endometriosis in Hungary.
Faculty of Medicine, Division of Endocrinology and Endometriosis, First Department of Obstetrics and Gynecology, Semmelweis University, H-1088 Budapest, Baross u. 27., Hungary. email@example.com
Endometriosis is a growing healthcare problem all around the world. I discuss in this article how the hungarian healthcare system is working and helping patients suffering from endometriosis. I discuss all diagnostic and therapeutic possibilities which are available for the patients. I discuss also some data from my own practice, 181 patients suffering from chronic pelvic pain caused by endometriosis.
Gynecol Endocrinol. 2009 Nov;25(11):693.
Endometriosis – an European perspective.
Endometriosis Research Foundation.
Acta Gastroenterol Belg. 2009 Jul-Sep;72(3):379-80.
Abdominal wall scar endometriosis. A report of two cases with emphasis on diagnostic strategies.
Ir Med J. 2009 Oct;102(9):301.
Endoscopic ultrasound and EUS-guided FNA in the diagnosis of rectal endometriosis.
Endometriosis is characterised by the presence of endometrial glands and stroma outside the uterus. The GI tract is the most common site for extra-pelvic endometriosis, in particular the rectum and sigmoid colon. Using endoscopic ultrasound (EUS), which combines endoscopy with real-time ultrasonography, the wall of the GI tract and adjacent structures can be examined. EUS-guided fine needle aspirates can be also obtained during the procedure. We report a case of rectosigmoid endometriosis which was diagnosed using EUS.
Case Report Med. 2009;2009:379578. Epub 2009 Nov 8.
Colonic endometriosis mimicking colon cancer on a virtual colonoscopy study: a potential pitfall in diagnosis.
Department of Radiology, Northwestern Medical Faculty Foundation, Chicago, IL 60611, USA.
Colonic endometriosis has been reported in the literature to mimic colon cancer. Patients can present with symptoms almost identical to colon cancer. We present an exemplary case of a woman who was found to have a mass on conventional colonoscopy. Virtual colonoscopy was instrumental in characterizing the obstructive sigmoid mass. A biopsy of the mass revealed sigmoid endometriosis.
Epidemiology. 2009 Nov 5. [Epub ahead of print]
Adult Physical Activity and Endometriosis Risk.
From the aDepartment of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; bChanning Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; and cDepartment of Epidemiology, Harvard School of Public Health, Boston, MA.
BACKGROUND:: Regular exercise has been associated with a 40%-80% reduction in risk for endometriosis in several case-control studies. However, women experiencing symptoms prior to their diagnosis may be less likely to exercise than healthy controls, thus biasing the observed association. METHODS:: Using data collected from the Nurses’ Health Study II, a prospective cohort study of premenopausal US nurses that began in 1989, we have attempted to clarify this relation. Data are updated every 2 years with follow-up for these analyses through 2001. In 1989, 1991, and 1997 women reported average amount of time per week engaging in various physical activities. A metabolic equivalent (MET) score was assigned to each activity, and these were summed to estimate total activity. RESULTS:: A total of 102,197 premenopausal women contributed 996,422 person-years of follow-up with 2703 cases of laparoscopically confirmed endometriosis. After adjusting for BMI at age 18, current BMI, smoking, parity, infertility status, oral contraceptive use, age at menarche, and menstrual cycle length and pattern in college, we observed only a slight reduction in the incidence of endometriosis, comparing the highest level of activity (>/=42 MET hours/week) to the lowest (<3 MET hours/week) (rate ratio = 0.89 [95% confidence interval = 0.77-1.03]). The association was limited to participants with no past or concurrent infertility (P = 0.002, test for heterogeneity). No associations were seen with inactivity. CONCLUSIONS:: In this first prospective assessment, we did not find evidence of the strong inverse association previously reported, although we cannot rule out a modest inverse association.
Acta Obstet Gynecol Scand. 2009 Nov 10. [Epub ahead of print]
Costs and health-related quality of life effects of hysterectomy in patients with benign uterine disorders.
Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Abstract Objective. To gain knowledge about the utility of hysterectomy in a real-world setting and to relate the utility of the intervention to its costs. Design. Prospective observational study. Setting. University referral hospital in Helsinki. Population. A total of 337 women entering for routine hysterectomy due to a benign disease (210 benign uterine or ovarian cause, 20 endometriosis, 51 uterovaginal prolapse, 56 menorrhagia). Methods. Patients filled in the 15D health-related quality of life (HRQoL) questionnaire before and six months after the operation. Costs were examined from the perspective of secondary care provider. Benefits of surgery were extrapolated till the end of remaining statistical life expectancy of each woman in the prolapse group and until menopause in the other groups. Main outcome measures. HRQoL and cost per quality-adjusted life year (QALY) gained. Results. Mean [standard deviation (SD)] HRQoL score (on a 0-1 scale) in the whole group improved from the preoperative of 0.905 (0.073) to 0.925 (0.077) six months after the operation (p < 0.001). The largest mean (SD) improvement was seen in patients with endometriosis [0.048 (0.067)] followed by those with menorrhagia [0.024 (0.054)], benign uterine or ovarian cause [0.018 (0.071)], and prolapse [0.017 (0.055)]. In the whole group, the intervention produced a mean (SD) of 0.222 (1.270) QALYs at mean (SD) direct hospital cost of euro3,138 (2,098). Consequently, the cost per QALY gained in the whole group was euro14,135 varying from euro3,720 to 31,570 in the disease groups. Conclusions. The cost per QALY gained for hysterectomy for benign uterine disorders is strongly dependent on the indication for surgery.
Eur J Gynaecol Oncol. 2009;30(5):579-82.
An incidental peritoneal serous borderline tumor during laparoscopy for endometriosis.
Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy. firstname.lastname@example.org
BACKGROUND: Primary peritoneal serous borderline tumor (PPSBT) is an uncommon lesion, histologically indistinguishable from non-invasive peritoneal implants found in association with ovarian tumours of borderline malignancy. CASE: A 37-year-old white woman was admitted for acute pelvic pain due to two 5 cm retrouterine bilateral ovarian cysts with an endometrioid aspect. Clinical examination, CA 125, transvaginal ultrasonography and magnetic resonance were used preoperatively to confirm the suspected diagnosis of pelvic endometriosis; conservative laparoscopy with an extensive pelvic toilette of pelvic scarring was performed to preserve her fertility. Surgeons performed cyst removal, detached bowel adhesions, removed all soft vesicular cysts and a soft blue nodule from the bowel, and coagulating all similar endometriotic islands in the pelvis. Surprisingly, the anatomopathological examination of samples revealed a rare PPSBT with diffuse implants on the bowel, bladder, and visceral and parietal peritoneum of the Douglas pouch. CONCLUSION: Although PPSBT is a rare entity, it is nonetheless important because of its macroscopic similarity to endometriosis and microscopic similarity to other peritoneal and mullerian proliferations of both benign and malignant biologic potential. It should be considered in the differential diagnosis of endometrioid lesions on the peritoneal surfaces of visceral and parietal peritoneum in patients submitted for gynaecological problems.
Eur J Gynaecol Oncol. 2009;30(5):575-8.
Primary clear cell carcinoma of the peritoneum: report of two cases and a review of the literature.
Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan. email@example.com
The most common neoplasms of the peritoneum are malignant mesothelioma and serous papillary adenocarcinoma. Clear cell carcinoma (CCC) is mostly derived from the ovary and often associated with endometriosis. We describe the clinicopathologic features of two cases diagnosed as CCC of the peritoneum origin. Case 1, a 53-year-old woman, presented with upper abdominal and pelvic tumors. Case 2, a 66-year-old woman, presented with massive ascites and abdominal tumor. The ovaries and uterine endometrium of these cases were not affected, and the tumors were diagnosed as Stage IIIc CCC of the peritoneum origin. Pathologically, endometriosis was not observed in either case. Adjuvant chemotherapy using irinotecan and cisplatin was effective in one case. The cases and a review of the literature suggested that residual tumor volume size determines the survival of these patients, and that the tumors show resistance to conventional platinum-based chemotherapy.
Eur J Gynaecol Oncol. 2009;30(5):563-5.
Malignant transformation of extragonadal endometriosis: a case report.
Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.
Though malignant transformation of endometriosis has been documented, malignancy arising from extragonadal endometriosis is rare. We present the case of a 39-year-old woman with abdominal pain and fullness after menstruation. Evaluation revealed a cul-de-sac mass and CA-125 level of 1048 U/ml. A hysterectomy, bilateral salpingo-oophorectomy, and omentectomy were performed. Endometrioid adenocarcinoma with a clearly defined transition zone from endometriosis to adenocarcinoma was noted histologically. Adjuvant chemotherapy and GnRH agonist treatment was administered. Serum CA-125 level was 1.51 U/ml 19 months after completion of treatment. Patients with endometriosis and elevated CA-125 levels should be managed aggressively and CA-125 levels monitored until they have normalized.
J Mol Med. 2009 Nov 8. [Epub ahead of print]
Neuroendocrine circuitry and endometriosis: progesterone derivative dampens corticotropin-releasing hormone-induced inflammation by peritoneal cells in vitro.
Center of Internal Medicine and Dermatology, Division of PsychoNeuroImmunology, Charité, Universitätsmedizin Berlin, Campus Virchow, Forum 4, Raum 2.0549, Augustenburger Platz 1, 13353, Berlin, Germany.
Clinical symptoms of endometriosis, such as pain and infertility, can be described as persistent stressors. Such continuous exposure to stress may severely affect the equilibrium and bidirectional communication of the endocrine and immune system, hereby further aggravating the progression of endometriosis. In the present study, we aimed to tease apart mediators that are involved in the stress response as well as in the progression of endometriosis. Women undergoing diagnostic laparoscopy due to infertility were recruited (n = 69). Within this cohort, early stage of endometriosis were diagnosed in n = 30 and advanced stage of endometriosis in n = 8. Levels of progesterone in serum were determined. Frequency of progesterone receptor (PR) expression on CD56(+) and CD8(+) peritoneal lymphocytes was analysed by flow cytometry. The production of tumour necrosis factor (TNF) and interleukin (IL)-10 by peritoneal leukocytes upon stimulation with the potent stress mediator corticotropin-releasing hormone (CRH) and the progesterone derivative dydrogesterone, or both, were evaluated. Furthermore, the production of progesterone-induced blocking factor (PIBF) by peritoneal leukocytes and the expression of PR in endometriotic tissue were investigated. Levels of progesterone in serum were decreased in women with endometriosis and inversely correlated to pain scores. Furthermore, an increased frequency of CD56(+)PR(+) and CD8(+)PR(+) peritoneal lymphocytes was present in advanced endometriosis. The TNF/IL-10 ratio, reflecting cytokine secretion by peritoneal cells, was higher in cells derived from endometriosis patients and could be further heightened by CRH stimulation, whereas stimulation with dydrogesterone abrogated the CRH-mediated inflammation. Finally, the expression of PIBF by peritoneal leukocytes was increased in endometriosis. Low levels of progesterone in the follicular phase could be responsible for the progression of endometriosis and related pain. Peripheral CRH, increasing upon high psychological stress, might contribute to the peritoneal inflammation present in endometriosis. The therapeutic application of progesterone derivatives, CRH blocking agents as well as improvement of stress coping may disrupt the vicious circle between the chronic peritoneal inflammation and high perception of psychological stress in endometriosis.
Rev Gastroenterol Peru. 2009 Jul-Sep;29(3):272-5.
Eosinophilic enteritis as a rare cause of ascites: case report.[Article in Spanish]
Hospital Nacional Cayetano Heredia.
The case of a 23-year old woman with a history of epigastric pain, a palpable tumor that covered the epigastrium and the left hypochondrium, and an episode of acute pancreatitis was reported. The computerized tomography revealed a pancreatic cyst. The CA-125 increased significantly. An exploratory laparotomy was performed, finding an endometrioma. The pathological anatomy showed necrotic tissue, mucus and blood, with a presence of macrophages with hemosiderin phagocytosis. The symptoms and signs, pathogenesis and treatment of the endometriosis of the pancreas are discussed.
Mod Pathol. 2009 Nov 6. [Epub ahead of print]
Cadherin expression in gastrointestinal tract endometriosis: possible role in deep tissue invasion and development of malignancy.
Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
Cadherins are cell surface proteins crucial for cell adhesion and tissue integrity. The mechanism of deep tissue invasion in gastrointestinal endometriosis is unknown and may be related to the altered expression of these cell surface proteins. The goal of this study was to evaluate the expression of N-cadherin, E-cadherin, and beta-catenin in peritoneal endometriotic implants, gastrointestinal endometriosis, and carcinoma arising in gastrointestinal endometriosis. Cases of peritoneal endometriosis, gastrointestinal endometriosis, and carcinoma arising in gastrointestinal endometriosis were identified from our pathology database. Immunohistochemistry was performed using antibodies against N-cadherin, E-cadherin, and beta-catenin on representative tissue sections. Cases of normal proliferative and secretory endometrium and adenomyosis were included in the study for comparison. The intensity and extent of staining for each marker was scored semiquantitatively. Appropriate positive and negative controls were used. A total of 38 cases (peritoneal endometriosis (n=14), gastrointestinal endometriosis (n=21: 11 colon, 8 appendix, 2 small bowel), and 3 cases of endometrioid carcinoma arising in colonic endometriosis (n=3)) were included in the study. Compared with normal proliferative endometrium, N-cadherin expression was decreased in intensity and extent in secretory endometrium. Peritoneal and gastrointestinal endometriosis also showed markedly decreased expression of N-cadherin compared with proliferative endometrium. All three cases of carcinoma arising in colonic endometriosis showed a total loss of N-cadherin in the tumor, but preserved E-cadherin and beta-catenin expression. In these cases, areas of benign endometriotic glands near the tumor showed weak and focal N-cadherin expression that was gradually lost. Moderate-to-strong membranous staining for beta-catenin expression and variable intensity of E-cadherin expression was seen diffusely in normal endometrium and all study cases. These results strongly suggest that alterations of N-cadherin expression in gastrointestinal endometriosis may have an important role in the mechanism that underlies deep tissue invasion, and possibly also in the development of malignancy.Modern Pathology advance online publication, 6 November 2009; doi:10.1038/modpathol.2009.127.
Hum Reprod. 2009 Nov 7. [Epub ahead of print]
Induction of a local pseudo-pregnancy via levonorgestrel-loaded microspheres for the treatment of endometriosis in a rabbit model.
Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, No. 17 Changle West Road, Xi’an, Shaan’xi 710032, China.
BACKGROUND Endometriosis is a chronic disease that responds to systemic pseudo-pregnancy therapy. However, side effects limit their long-term use, and recurrence often occurs after cessation of medication. Reducing side effects whereas improving therapeutic efficacy of pseudo-pregnancy therapy seems contradictory, but appealing. In order to address this dilemma, the efficacy and side effects of local pseudo-pregnancy therapy were investigated for the first time in an endometriosis animal model. METHODS AND RESULTS Levonorgestrel-loaded polylactic acid microspheres (LNG-microspheres) were prepared by using an oil-in-water emulsification-solvent evaporation method. Rabbits with experimental endometriosis were randomized to treatment with local pseudo-pregnancy therapy, local blank microspheres, systemic pseudo-pregnancy therapy, ovariectomy or the control. Local pseudo-pregnancy was induced by injection of LNG-microspheres directly into endometrial cysts. Compared with the systemic pseudo-pregnancy group, significantly higher intra-cystic drug levels were maintained for at least 6 months with much lower serum levels in the local pseudo-pregnancy group (P < 0.01). The high intra-cystic levonorgestrel simulated a state of potent pregnancy, which induced size reductions and endometrial atrophy comparable to those of ovariectomy. Moreover, major metabolic parameters and ovarian function were not disturbed by local pseudo-pregnancy therapy. CONCLUSIONS Induction of a local pseudo-pregnancy could achieve therapeutic efficacy comparable to that of ovariectomy without provoking any marked side effects in a rabbit endometriosis model. Thus it may be a preferable option for patients with endometriosis.
Hum Reprod. 2009 Nov 7. [Epub ahead of print]
Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in Victoria Australia.
Department of Obstetrics and Gynaecology, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168 Australia.
BACKGROUND Obstetric haemorrhages have been reported to be increased after assisted reproduction technologies (ART) but the mechanisms involved are unclear. METHODS This retrospective cohort study compared the prevalence of antepartum haemorrhage (APH), placenta praevia (PP), placental abruption (PA) and primary post-partum haemorrhage (PPH) in women with singleton births between 1991 and 2004 in Victoria Australia: 6730 after IVF/ICSI, 24 619 from the general population, 779 after gamete intrafallopian transfer (GIFT) and 2167 non-ART conceptions in infertile patients. Risk factors for haemorrhages in the IVF/ICSI group were examined by logistic regression. RESULTS The IVF/ICSI group had more APH: 6.7 versus 3.6% (adjusted OR 2.0; 95% CI 1.8-2.3), PP: 2.6 versus 1.1% (2.3; 1.9-2.9), PA: 0.9 versus 0.4% (2.1; 1.4-3.0) and PPH: 11.1 versus 7.9% (1.3; 1.2-1.4) than the general population. APH, PP and PA were as frequent in the GIFT group as in the IVF/ICSI group, but were less frequent in the non-ART group. Within the IVF/ICSI group, fresh compared with frozen thawed embryo transfers (FET) was associated with more frequent APH (1.5; 1.2-1.8) and PA (2.1; 1.2-3.7) and the odds ratio increased with number of oocytes collected (1.02; 1.00-1.04). Endometriosis patients had more PP (1.7; 1.2-2.4) and PPH (1.3; 1.1-1.6) than those without endometriosis. FET in artificial cycles was associated with increased PPH (1.8; 1.3-2.6) compared with FET in natural cycles. CONCLUSIONS Obstetric haemorrhages are more frequent with singleton births after IVF, ICSI and GIFT. The exploratory analysis of factors in the IVF/ICSI group, showing associations with fresh embryo transfers in stimulated cycles, endometriosis and hormone treatments, suggests that events around the time of implantation may be responsible and that suboptimal endometrial function is the critical mechanism.
Fertil Steril. 2009 Nov 5. [Epub ahead of print]
Endometriosis-induced alterations in mouse metaphase II oocyte microtubules and chromosomal alignment: a possible cause of infertility.
Ob-Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio; Suez Canal University Hospital, Ismailia, Egypt.
OBJECTIVE: To examine the effect of peritoneal fluid (PF) of patients with endometriosis on the cytoskeleton of metaphase II oocytes and correlate the results with the stage of endometriosis and the duration of infertility. DESIGN: Prospective-controlled study. SETTING: Center for reproductive medicine at a tertiary-care hospital. PATIENT(S): Women with endometriosis (n=23) and tubal ligation/reversal (n=15). INTERVENTION(S): Peritoneal fluid obtained from 38 women (23 with endometriosis and 15 tubal ligation/reversal) after laparoscopy. Four hundred metaphase II oocytes were used: 165 frozen metaphase II oocytes were incubated in the PF of patients with endometriosis, 135 oocytes incubated in the PF of nonendometriosis patients (control subjects) and 100 oocytes incubated in human tubal fluid (HTF) media. MAIN OUTCOME MEASURE(S): Spindle abnormalities (microtubule and chromosomal) were evaluated by confocal imaging. RESULT(S): In the endometriosis group, the cytoskeleton had a higher frequency of abnormal meiotic spindle and chromosomal misalignment (score >/=3), indicating severe damage compared with the control groups. The proportions of abnormalities in microtubule and chromosome alterations in endometriosis (67.9% and 63.6%, respectively) were significantly higher than for oocytes incubated with PF of the nonendometriosis group (24.4% and 14.8%) as well as the HTF group (13% and 13%). Oocyte cytoskeleton damage positively correlated with the duration of infertility and the stage of endometriosis. CONCLUSION(S): Alteration of oocyte cytoskeleton might be one of the causes of poor oocyte quality in patients with endometriosis.
Fertil Steril. 2009 Nov 5. [Epub ahead of print]
Exposure to industrially polluted water resulted in regressed endometriotic lesions and enhanced adhesion formation in a rat endometriosis model: a preliminary study.
Department of Obstetrics and Gynecology, Yeditepe University Hospital, Istanbul, Turkey.
The effects of water collected from an industrially polluted river in a rat model with surgically induced endometriosis were investigated in this preliminary study. Exposure to industrially polluted water resulted in regressed endometriotic lesions and enhanced adhesion formation.
J Minim Invasive Gynecol. 2009 Nov-Dec;16(6):798-801.
Isolated Endometriosis on the Rectus Abdominis Muscle in Women without a History of Abdominal Surgery: a Rare and Intriguing Finding.
Department of Obstetrics and Gynaecology, University Hospital “Gaetano Martino,” v Consolare Valeria, Messina, Italy.
We report 2 rare cases of endometriosis on the rectus abdominal muscle diagnosed incidentally during an operation for inguinal hernia repair in women with no surgical history. Two women sought medical attention for a mass found in the pubic abdominal wall. Only 1 woman reported occasional pain. At physical examination in both women, an ovoid swelling in the right pubic area was felt. One woman experienced pain on palpation, and one reported slight discomfort. Ultrasonography demonstrated a heterogeneous hypoechogenic formation with indistinct edges; diagnosis was difficult. Routine clinical and instrumental (pelvic ultrasonography) gynecologic examination in both patients performed shortly before hospitalization had not revealed any macroscopic focus of endometriosis in the pelvic region. At surgery, a lesion consistent with the diagnosis of endometriosis was found, which was confirmed at histologic analysis. These cases could represent the consolidation of different theories of endometriosis diffusion. We suggest including endometriosis in the differential diagnosis of a symptomatic mass in the abdominal wall in women with and without a surgical history.
J Minim Invasive Gynecol. 2009 Nov-Dec;16(6):765-7.
Small intestinal submucosa patch for extensive vaginal endometriosis resection.
Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.
This case report describes use of a porcine small intestinal submucosa patch to prevent vaginal stiffness and retraction after extensive vaginal resection of an endometriosis nodule. A 32-year-old nulliparous woman was referred for surgical treatment of a large rectovaginal nodule that extended from the vaginal to the rectal mucosa. Surgical treatment was performed in 2 steps. Initially, a laparoscopic rectal resection was performed without opening the vagina to reduce the risk of fistula formation; 6 months later, the patient underwent a laparoscopic second-look combined with the vaginal approach to remove remaining disease. A small intestinal submucosa patch was successfully used to prevent vaginal shortening.
J Minim Invasive Gynecol. 2009 Nov-Dec;16(6):713-9.
Hyperinnervation in intestinal deep infiltrating endometriosis.
Departments of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China.
STUDY OBJECTIVE: To investigate the extent and types of innervation of endometriotic lesions in various regions of the bowel. DESIGN: Retrospective nonrandomized immunohistochemical study (Canadian Task Force classification II-3. SETTING: University-based laboratory. PATIENTS: Thirty-six women undergoing laparoscopy or laparotomy because of deep infiltrating endometriosis in various regions of the bowel, including the sigmoid colon, appendix, and rectum. INTERVENTIONS: Immunohistochemical staining of endometriotic specimens with antibodies against protein gene product 9.5, neurofilament, nerve growth factor, nerve growth factor receptors tyrosine kinase receptor A and p75, growth-associated protein 43, substance P, neuropeptide Y, and vasoactive intestinal peptide to demonstrate myelinated, unmyelinated, sensory, and autonomic nerve fibers. MEASUREMENTS AND MAIN RESULTS: There were significantly more nerve fibers in intestinal deep infiltrating endometriosis (mean [SD] 172.6 [94.2]/mm(2)) than in other deep infiltrating endometriotic lesions (e.g., cul-de-sac and uterosacral ligament) (67.6 [65.1]/mm(2); p<.01). Intestinal deep infiltrating endometriosis was innervated abundantly by sensory Adelta,sensory C, cholinergic, and adrenergic nerve fibers. Nerve growth factor, tyrosine kinase receptor A, and p75 were strongly expressed in endometriotic lesions, and growth-associated protein-43 was also strongly expressed in the endometriosis-associated nerve fibers. CONCLUSION: The hyperinnervation in intestinal deep infiltrating endometriosis may help to explain why patients with this type of lesion have more severe pain.