Eur J Obstet Gynecol Reprod Biol. 2009 Nov;147(1):65-8. Epub 2009 Jul 19.

Serum C-reactive protein in the differential diagnosis of ovarian masses.

Hefler-Frischmuth K, Hefler LA, Heinze G, Paseka V, Grimm C, Tempfer CB.

Department of Laboratory Medicine, Wilhelminenspital, Vienna, Austria.

OBJECTIVE: A number of serum tumor markers have been investigated to aid clinicians in the differential diagnosis of ovarian masses. Serum C-reactive protein (CRP) is a widely used biomarker of inflammation and has been previously shown to be a promising biomarker in patients with ovarian cancer. STUDY DESIGN: In a retrospective single-center study, we evaluated serum CRP in 576 patients with benign and in 242 patients with malignant (ovarian tumors of low malignant potential [LMP]: n=44, epithelial ovarian cancer [EOC]: n=198) ovarian masses. Results were correlated to clinical data. RESULTS: Median (25th, 75th percentiles) serum CRP in patients with benign ovarian tumors, with ovarian tumors of LMP, and with EOC were 0.5 (0.5, 0.6)mg/dL, 0.5 (0.5, 0.9)mg/dL, and 1.36 (0.5, 4.9)mg/dL, respectively (p<0.001). In the subgroup of patients with EOC, serum CRP significantly correlated with FIGO stage (p<0.001), residual tumor mass (p<0.001), and patients’ age (p=0.04), but not with tumor grade (p=0.2) and histologic type (p=0.4). In univariable and multivariable models including serum CRP, serum CA 125, and patients’ age, serum CRP independently predicted the presence of malignant ovarian masses (p<0.0001; Odds Ratio [OR] 5.3, 95% Confidence Interval [CI] 3.8-7.4). Serum CRP had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying malignant ovarian masses of 49.8%, 84.1%, 57.1%, and 79.8%, respectively. CONCLUSION: Serum CRP is associated with the presence of malignant ovarian tumors independent of serum CA 125 and patients’ age and can therefore be used as additional diagnostic marker in the differential diagnosis of ovarian masses.

Urology. 2009 Dec;74(6):1232-3. Epub 2009 Jul 17.

Ectopic decidual reaction in the urinary bladder presenting as a vesical tumor.

Szopiński TR, Sudoł-Szopińska I, Dzik T, Borówka A.

Department of Urology, Postgraduate Medical Educational Center, Warsaw, Poland.

A urinary bladder tumor in young pregnant women is a very rare finding. It may bring diagnostic problems despite use of advanced imaging techniques. We report on a case of an exceedingly rare occurrence of a decidual reaction in the urinary bladder of a pregnant young woman. To the best of our knowledge, it is the first such case reported in published medical data. The final diagnosis was possible only after histopathologic assessment of a specimen obtained during diagnostic cystoscopy, which showed typical decidual changes within detrusor muscle, without ectopic endometrium, which could suggest more frequent vesical endometriosis.

Eur J Obstet Gynecol Reprod Biol. 2009 Oct;146(2):219-21. Epub 2009 Jul 15.

Plasminogen activator inhibitor-1 4G/5G polymorphism and susceptibility to endometriosis in the Italian population.

Gentilini D, Vigano P, Castaldi D, Mari D, Busacca M, Vercellini P, Somigliana E, di Blasio AM.

Molecular Biology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy.

OBJECTIVES: Some controversy exists for the potential association of the plasminogen activator inhibitor-1 (PAI-1) gene polymorphism 4G/5G and susceptibility to endometriosis. To clarify this issue, we have examined the prevalence of this polymorphism in a case-control study in the Italian population. STUDY DESIGN: The PAI-1 4G/5G polymorphism was evaluated in n=368 reproductive year aged Caucasian women who underwent gynaecological laparoscopy for chronic pelvic pain, infertility, ovarian cysts and myomas. A second group of controls included n=329 normal subjects. RESULTS: The 697 women enrolled were divided as follows: the endometriosis group (n=204), the gynaecological control group (n=164) and the general population control group (n=329). No statistical significant differences emerged between endometriosis patients and gynaecological controls with regard to the allele frequencies and co-dominant and dominant models of genotype distribution. A borderline statistical difference was only observed for the recessive model of inheritance in which, contrary to previous findings, the PAI-1 4G/4G genotype seems to be less linked to the disease development. CONCLUSION: The findings reported herein do not support the previously reported data indicating a greater susceptibility to endometriosis in patients harbouring the PAI-1 4G/5G and 4G/4G genotypes and exclude a significant role of polymorphism in endometriosis development.

Curr Opin Obstet Gynecol. 2009 Aug;21(4):318-24.

Clinical utility of progesterone receptor modulators and their effect on the endometrium.

Spitz IM.

Institute of Hormone Research and Ben Gurion University of the Negev, Jerusalem, Israel.

PURPOSE OF REVIEW: In view of the spate of recent publications related to mifepristone and some second generation progesterone receptor modulators (PRMs), this appears to be an opportune time to view the clinical status of these compounds. RECENT FINDINGS: Randomized double-blind placebo-controlled trials have been conducted with mifepristone, CDB-4124 (Proellex), CDB-2914 (VA 2914, Ulipristal) and asoprisnil (J867). All these PRMs are effective in the treatment of uterine fibroids where they are associated with a reduction in pain, bleeding and improvement in quality of life and decrease in fibroid size. CDB-4124 is also efficacious in endometriosis. Long-term treatment with PRMs may be associated with endometrial thickening on ultrasound and there have been reports of endometrial hyperplasia. Several reassuring recent publications have done much to explain the mechanism underlying these endometrial changes. The most common histological finding is cystic glandular dilatation often associated with both admixed estrogen (mitotic) and progestin (secretory) epithelial effects. This histology has not been previously encountered in clinical practice and should not be confused with endometrial hyperplasia. The endometrial thickness is related to this cystic glandular dilatation. SUMMARY: At this stage of development, PRMs cannot be administered for longer than 3 or 4 months. Even over this time, there is improvement of symptoms associated with fibroids and endometriosis. Clinicians and pathologists need to be aware that the endometrial thickening and histological appearance do not represent endometrial hyperplasia.

Fertil Steril. 2009 Dec;92(6):2074-7. Epub 2009 Jul 9.

Histologic classification of specimens from women affected by superficial endometriosis, deeply infiltrating endometriosis, and ovarian endometriomas.

Kamergorodsky G, Ribeiro PA, Galvão MA, Abrão MS, Donadio N, Lemos NL, Aoki T.

Department of Obstetrics and Gynecology, Santa Casa Medical School, São Paulo, Brazil.

In this retrospective observational study involving 176 patients and 271 biopsies, the histologic differentiation in superficial endometriosis, deeply infiltrating endometriosis, and ovarian endometriomas was evaluated according to a previously proposed classification system. Results showed a predominance of the undifferentiated glandular pattern (33.5%) and mixed glandular pattern (46.9%) in deeply infiltrating endometriosis lesions, whereas the well-differentiated glandular pattern (41.8%) was most frequently seen in superficial endometriosis lesions, and in ovarian endometriomas a predominance of both the undifferentiated (40.5%) and mixed patterns (37.8%) was observed.

J Pediatr Adolesc Gynecol. 2010 Feb;23(1):e35-7. Epub 2009 Jul 8.

Endometriosis in a patient with Mayer-Rokitansky-Küster-Hauser syndrome and complete uterine agenesis: evidence to support the theory of coelomic metaplasia.

Mok-Lin EY, Wolfberg A, Hollinquist H, Laufer MR.

Division of Gynecology, Department of Surgery, Children’s Hospital Boston, Boston, Massachusetts, USA.

BACKGROUND: There are many hypotheses regarding the pathogenesis of endometriosis. Most theories, including retrograde menstruation, require the existence of a uterine structure and endometrial tissue. We report endometriosis with the absence of a uterus. This finding supports the theory of coelomic metaplasia. CASE: A 20-year-old with Mayer-Rokitansky-Küster-Hauser syndrome presented with increasing pelvic pain and underwent laparoscopy. Uterine, cervical, vaginal, and tubal agenesis was confirmed. Stage I endometriosis was visualized in the posterior cul-de-sac and destroyed. She received medical therapy for 5 years until she represented with pain and underwent another laparoscopy, at which endometriosis was again identified and destroyed. SUMMARY AND CONCLUSION: This case of endometriosis in a patient with complete uterine agenesis supports the theory of coelomic metaplasia. Copyright 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Arch Gynecol Obstet. 2010 Feb;281(2):307-9. Epub 2009 Jul 8.

Post-hysterectomy menstruation: a rare phenomenon.

Lyngdoh BT, Kriplani A, Garg P, Maheshwari D, Bansal R.

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Post-menopausal bleeding is a common problem with varied etiology in the age group between 50 and 60 years. It is more likely to be of some pathologic cause which needs to be ruled out. Bleeding in a patient after hysterectomy is even rarer with varied causes like atrophic vaginitis, cervical stump cancer, infiltrating ovarian tumors, estrogen secreting tumors in other parts of the body. Endometriosis of the vault sometimes can cause post-menopausal bleeding. Diverticulitis of the bowel may give rise to vaginal discharge due to fistula, but bleeding is rare. Bladder pathology may cause vaginal bleeding. Our case is a rare case of vault endometriosis and should always be kept as a differential diagnosis in patients with bleeding after hysterectomy.

Fertil Steril. 2009 Dec;92(6):2100-2. Epub 2009 Jul 5.

Fenofibrate causes regression of endometriotic implants: a rat model.

Onalan G, Zeyneloglu HB, Bayraktar N.

Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey.

Fenofibrate -a peroxisome proliferator-activated receptor-a agonist- is an angiostatic agent that is commonly used in human liver diseases, therefore it may interfere with the angiogenetic process required for endometriosis. In a rat endometriosis model, we demonstrated that peritoneal implant areas and vascular endothelial growth factor levels in the peritoneal flud were significantly decreased in high dose or low dose finofibrate and luprolide acetate treated groups compared to control.

Gynecol Obstet Invest. 2009;68(2):116-21. Epub 2009 Jun 24.

Interval of injections of intramuscular depot medroxyprogesterone acetate in the long-term treatment of endometriosis-associated pain: a randomized comparative trial.

Cheewadhanaraks S, Peeyananjarassri K, Choksuchat C, Dhanaworavibul K, Choobun T, Bunyapipat S.

Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110 Thailand.

AIM: To determine the optimal interval of injections of intramuscular depot medroxyprogesterone acetate 150 mg in the long-term treatment of endometriosis-associated pain. METHOD: 112 patients with symptomatic endometriosis were randomized to receive either injections every month for 6 months, then every 3 months for a total of 15 months or injections every 3 months for 15 months. The primary outcome measure was patients’ satisfaction. RESULT: At months 3, 6, 9, 12 and 15 of the treatment phase, there was no statistically significant difference of percentages of patients with satisfaction between the two regimens (85.7 vs. 76.8%, 76.8 vs. 73.2%, 66.1 vs. 58.9%, 60.7 vs. 55.4%, 60.7 vs. 55.4%, respectively). CONCLUSION: The optimal interval of injections of depot medroxyprogesterone acetate 150 mg is every 3 months. Copyright 2009 S. Karger AG, Basel.

Reprod Sci. 2010 Jan;17(1):5-12. Epub 2009 Jun 22.

Reviews: in vitro models to study the pathogenesis of endometriosis.

Griffith JS, Rodgers AK, Schenken RS.

Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Texas Health Science Center San Antonio, San Antonio, Texas 78229, USA.

Several in vitro models that attempt to replicate the intraperitoneal environment have been developed to study the pathogenesis of endometriosis. The chicken chorioallantotic membrane has been used, but it has not been well characterized and may introduce some species specific variables. In vitro models using human tissues include amniotic membrane, human peritoneal explants, and cell culture monolayers. These models have been used to qualitatively, quantitatively, and temporally assess attachment of endometrial cells to peritoneal mesothelial and subsequent transmesothelial invasion. These models have also been used to assess the role of cytokines in the development of the early endometriotic lesion. Two- and three dimensional invasion chamber models have been utilized to assess endometrial cell interactions with peritoneal mesothelial cells and the extracellular matrix. Invasion models are also useful to evaluate novel therapeutic approaches. This review will focus on the above models to assist reproductive scientists interested in the pathogenesis of endometriosis.

Gynecol Endocrinol. 2009 Sep;25(9):610-5.

Leptin concentrations in the peritoneal fluid of women with ovarian endometriosis are different according to the presence of a ‘deep’ or ‘superficial’ ovarian disease.

Alviggi C, Clarizia R, Castaldo G, Matarese G, Colucci CC, Conforti S, Pagano T, Revelli A, De Placido G.

Department of Obstetrical, Gynecological and Urological Sciences, Turin, Italy.

Some studies have suggested a possible role of leptin, an active cytokine produced by adipocytes, in the pathogenesis of pelvic endometriosis. The present study was designed to assess leptin levels in the peritoneal fluid (PF) of women with the ‘deep’ or ‘superficial’ types of ovarian endometriosis. Twenty-seven women with a single ovarian endometrioma having a mean diameter between 3 and 5 cm were included in the study. Patients were divided into two groups according to the type of ovarian endometriosis: Group A (n = 11) consisted of women with ‘superficial’ endometriomas located at the ovarian surface; Group B (n = 16) included patients with ‘deep’ intra-ovarian endometriomas. Women undergoing laparoscopy for unexplained infertility and not affected by pelvic and/or ovarian endometriosis were considered as controls (Group C, n = 10). Patients with an ovarian endometrioma had significantly increased PF leptin concentrations than endometriosis-free controls (Groups A and B vs. Group C, p < 0.01). Patients with ‘superficial’ endometriomas had significantly higher PF leptin levels compared with patients with ‘deep’ endometriomas (Group A vs. B, p < 0.01). This difference remained significant after correction for the BMI; moreover, a positive correlation between PF leptin and BMI was observed in Groups B and C, but not in women with ‘superficial’ endometrioma (Group A). Our observations suggest that: (a) leptin could play an active role in promoting the development of ‘superficial’ ovarian endometriomas and (b) ‘superficial’ and ‘deep’ ovarian endometriomas could have a different pathogenesis.

BJOG. 2009 Oct;116(11):1524-6. Epub 2009 Jun 17.

Pleural effusion following use of saline and fluid anti-adhesion agents at laparoscopic surgery–a case series of three patients.

Ronghe R, Bjornsson S, Hannah P.

Department of Obstetrics and Gynaecology, Southern General Hospital, Glasgow, UK.

Gynecol Endocrinol. 2009 Sep;25(9):621-3.

Health-related quality of life following surgical menopause and following gonadotrophin-releasing hormone analogue-induced pseudomenopause.

Bhattacharya SM.

Department of Obstetrics and Gynecology, S. C. Das Memorial Medical and Research Center, Kolkata, India.

OBJECTIVE: To compare the health-related quality of life (HRQOL) following surgical menopause with that following gonadotrophin-releasing hormone analogue (GnRHa)-induced pseudomenopause. MATERIALS AND METHODS: Thirty-one women who received 3.75 mg of triptorelin injection subcutaneously every 4 weeks for 12 weeks after conservative surgery for severe endometriosis were reviewed (Group A). Thirty women who had surgical menopause for non-malignant conditions were reviewed after 12 weeks (Group B). Menopause-rating scale (MRS II) was used to assess the HRQOL. RESULT: Surgical menopause caused significant deterioration of HRQOL after 12 weeks, as compared to that caused by the pseudomenopause induced by the GnRHa injection (total MRS score: Group A, 16.60; Group B, 20.41; p = 0.04). Among the three subscales, there were no differences in the scores of somato-vegetative symptoms (Group A, 6.63; Group B, 6.90; p = 0.72) and urogenital symptoms (Group A, 3.50; Group B, 4.80; p = 0.06). Psychological symptoms showed significant difference (Group A, 6.46; Group B, 8.70; p = 0.01). CONCLUSION: Surgical menopause causes significant deterioration of HRQOL than that caused by the pseudomenopause state of GnRHa injection. Psychological symptoms are more pronounced in surgical menopause.

Colorectal Dis. 2010 Jan;12(1):66-70.

Single incision laparoscopic sigmoid colon resections without visible scar: a novel technique.

Brunner W, Schirnhofer J, Waldstein-Wartenberg N, Frass R, Weiss H.

Department of General Surgery, SJOG Hospital, A-5010 Salzburg, Austria.

OBJECTIVE: On the way to ‘no-scar’ techniques we developed a novel method for colorectal resection utilizing three intraumbilical trocars which results in a nonvisible postoperative scar. METHOD: Two female patients (Age: 56a, 42a) underwent laparoscopic colorectal resection for diverticulitis and infiltrating endometriosis of the rectosigmoid colon, respectively. The entire operation was carried out transumbilically following the standardized principles of colorectal resection. RESULTS: The operative time was 110 and 180 min, respectively. No intraoperative adverse events or significant perioperative complication was noticed. The specimen measured 22 and 18 cm in length respectively. Estimated blood loss was minimal in both cases. Oral diet was resumed on postoperative day one. Patients were discharged on postoperative day 7 and day 6, respectively. At follow-up, patients presented with an optimal cosmetic result without apparent scarring. CONCLUSION: For the first time, a novel laparoscopic technique for sigmoid colon resection utilizing a single intraumbilical approach is presented. This new method allows further reduction of the surgical trauma and obviates any visible scar.

G Chir. 2009 May;30(5):230-3.

Umbilical primary endometrioma. Case report.

[Article in Italian]

Spaziani E, Di Filippo A, Picchio M, Briganti M, De Cristofano C, Ceci F, Martellucci A, Cipriani B, Nardecchia G, De Angelis F, Iorio O, Nicodemi S, Pattaro G, Stagnitti F.

ASL Latina, Ospedale “A. Fiorini” Terracina (LT), UOC Chirurgia.

Umbilical primary endometrioma is a rare extra-uterine localization of endometriosis with a documented neoplastic risk. It is often difficult to distinguish primary umbilical endometriosis from other benign and malignant tumors of the abdominal wall. The Authors report a case of umbilical endometriosis in a 36-year old female. Endometriosis was suspected because of the presence of the typical cyclic bleeding and swelling. Abdominal CT excluded the presence of other endometriotic localizations. The umbilical mass was widely excised together with umbilicus, fascia and peritoneum. The tissue defect was primary closed without prosthetic mesh. Histological examination of the specimen showed the presence of endometrial glands with stromal component, compatible with the diagnosis of endometriosis. The Authors suggest that surgery should be performed in the first 3-4 days of the follicular phase, to minimize the risk of diffusion of endometriotic cells. Moreover, the excision should be wide in order to prevent local recurrence.

Kaohsiung J Med Sci. 2009 Apr;25(4):217-21.

Endoscopic management of a ureteral obstruction caused by endometriosis: a case report.

Juan HC, Yeh HC, Hsiao HL, Yang SF, Wu WJ.

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Ureteral obstruction secondary to endometriosis is relatively uncommon. We present a 49-year-old female (gravida 3, para 2, abortion 1), who was identified as suffering from right hydronephrosis while undergoing her regular health examination. Retrograde pyelography demonstrated a partial obstruction of the right ureter in the distal third. She underwent ureteroscopy and biopsy to remove a right ureteral tumor. Histological examination confirmed ureteral endometriosis. During follow-up at the obstetrics and gynecology outpatient department, an abdominal echo was detected that revealed a right endometrioma (size, 7.5 x 4.8 x 5.5 cm) on the ovary. As a result, a total hysterectomy and bilateral salpingo-oophorectomy was performed. Although the patient had right residual hydronephrosis, the creatinine level improved to 1.2 mg/dL during follow-up.

Gynecol Endocrinol. 2009 Jul;25(7):472-4.

Dienogest and the breast.

Schindler AE, Henkel A, Christensen B, Oettel M, Moore C.

Institute for Medical Research and Education, Hufelandstrasse 55, D-45122 Essen, Germany.

In a clinical pilot study, 21 women with endometriosis have been primarely treated with dienogest 2 x 10 mg daily p.o. for 24 weeks. Besides the effect on endometriosis the action of such high-dose progestogen treatment on the breast was evaluated by breast ultrasound prior to medication and at 24 weeks of medical treatment. In all women, a significant size reduction of the mammary gland (p < 0.023) and regression of mastopathic changes were observed. There was a non-significant reduction (p = 0.089) of the maximum diameter of the ducts. The portion of the fatty tissue increased slightly, but not significantly (p = 0.348).

Gynecol Endocrinol. 2009 Aug;25(8):530-5.

Role of CYP2C19 polymorphisms in patients with endometriosis.

Cayan F, Ayaz L, Aban M, Dilek S, Gümüş LT.

Department of Obstetrics and Gynecology, University of Mersin School of Medicine, Mersin, Turkey.

AIM: To investigate the association of CYP2C19 genotypes with endometriosis. METHODS: The study included 100 women who underwent laparotomy or laparoscopy: 50 patients with endometriosis diagnosed with surgery and histopathology, and 50 control subjects who had no evidence of endometriosis during exploratory laparotomy or laparoscopy. Genomic DNA of subjects was extracted from the whole blood using High Pure PCR template preparation kit. Genotyping of CYP2C19 polymorphisms were detected by using a LightCycler CYP2C19 mutation detection kit in a real-time PCR, and were compared between the two groups. RESULTS: Logistic regression analyses showed that the CYP2C19*2 heterozygote genotype was associated with a significantly increased risk of endometriosis. The odds ratio of endometriosis for the CYP2C19*2 heterozygote genotype was 3.165 (p = 0.023) compared with the control group. CYP2C19*3 genotype was detected as wild in all subjects in the endometriosis and control groups. CONCLUSION: Our results suggest that CYP2C19*2 heterozygote genotype has higher risk of developing endometriosis. Therefore, CYP2C19*2 allele gene polymorphisms may be associated with genetic susceptibility of endometriosis.

Gynecol Endocrinol. 2009 Jul;25(7):435-40.

Clinical manifestations in patients with ovarian clear cell carcinoma with or without co-existing endometriosis.

Lim MC, Lee DO, Kang S, Seo SS, Lee BY, Park SY.

Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Korea, Goyang, Gyeonggi, Republic of Korea.

OBJECTIVES: The symptoms associated with ovarian cancer are vague. Endometriosis, which causes dysmenorrhea and dyspareunia, is frequently detected along with ovarian clear cell carcinoma (OCCC). We have therefore evaluated the clinical manifestations of OCCC based on the co-existence of endometriosis. METHODS: A retrospective analysis was conducted on 43 patients who had been treated for OCCC at the National Cancer Center between June 2000 and July 2007. Using medical records and the cancer registry, the clinical features and laboratory findings were analysed. RESULTS: Endometriosis was identified in 16 (37.2%) of the 43 patients with OCCC. The main presenting symptoms included a hard, palpable mass (32.6%), and newly developed or an exacerbation of dysmenorrhea (32.6%) and dyspareunia (25.6%). Gastrointestinal symptoms, pelvic pain, and abdominal distension existed in nine (20.9%), eight (18.6%) and one (2.3%) of the patients, respectively. The symptoms did not differ statistically in patients with or without endometriosis. Thirty-seven percent (11/30) of the patients had a normal CA-125 level (<35 U/ml); 18.8% (3/16) of the patients without endometriosis and 57% (8/14) of the patients with endometriosis had normal levels of CA-125 (<35 U/ml). Nine of 16 (56.3%) patients with early stage OCCC had a normal CA-125 level. CONCLUSIONS: The main presenting symptoms in patients with OCCC include a hard, palpable mass, dysmenorrhea and dyspareunia, irrespective of co-existing endometriosis. A normal CA-125 level has limited value in excluding OCCC, especially in the early stages.

J Reprod Immunol. 2009 Jul;81(1):89-96. Epub 2009 Jun 3.

Effects of estrogen replacement therapy on estrogen receptor expression and immunoregulatory cytokine secretion in surgically induced menopausal women.

Xia X, Zhang S, Yu Y, Zhao N, Liu R, Liu K, Chen X.

Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fang Xie Road, Shanghai 200011, China.

To investigate the effect of oral and transdermal estrogen replacement therapy (ERT) on the expression of different estrogen receptor (ER) subtypes and the secretion of immunoregulatory cytokines, we performed a clinical investigation on previously healthy women who had undergone a total hysterectomy and bilateral salpingo-oopherectomy. These women were randomly distributed into two groups: an oral ERT group and transdermal ERT group. Before and after ERT, the serum levels of estradiol (E2) and follicle stimulating hormone (FSH) were measured, ERalpha and ERbeta expression of peripheral blood T lymphocytes was tested, and secretion of specific immunoregulatory cytokines (IFNgamma, IL-2 and IL-4) by T lymphocytes was examined. Our results confirm that for both groups, the serum E2 level was increased after ERT (P<0.01) and the serum FSH level was decreased after ERT (P<0.01), with no significant difference in hormone levels between the two groups. ERalpha expression by T lymphocytes was significantly higher after ERT than before (P<0.01) in both groups. Levels of type 1 cytokines (IL-2 and IFNgamma), which were secreted by T helper 1 (Th1), after ERT were substantially decreased. The level of type 2 cytokine (IL-4), which were secreted by T helper 2 (Th2), was significantly increased after ERT (P<0.01 for the oral group and P<0.05 for the transdermal group). In summary, both oral and transdermal ERT increased serum E2 levels, decreased serum FSH levels and relieved the effects of peri-menopausal symptoms. These data suggest that both oral and transdermal ERT act to improve the balance of Th1/Th2 cytokines by the effects of estrogen potentially acting in T lymphocytes mainly through ERalpha.

Drugs. 2009 May 29;69(8):943-52. doi: 10.2165/00003495-200969080-00001.

Pharmacological treatment of endometriosis: experience with aromatase inhibitors.

Ferrero S, Venturini PL, Ragni N, Camerini G, Remorgida V.

Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Largo R. Benzi 1, Genoa, Italy.

Current treatment of endometriosis is mainly based on surgery and ovarian suppressive agents. In the last 10 years, it has been demonstrated that aromatase P450, a key enzyme for estrogen biosynthesis, may have a pathogenic role in endometriosis because it is aberrantly expressed in endometriotic implants and in eutopic endometrium of women with endometriosis. Therefore, inhibition of aromatase activity may represent a new therapeutic option for endometriosis. Case reports and observational studies have shown that pain symptoms caused by endometriosis quickly improve after administration of aromatase inhibitors. Limited data are available on the long-term course of pain symptoms after completion of treatment with aromatase inhibitors; however, some recent studies suggest that symptoms may recur at short-term follow-up. A range of results are reported on the effects of aromatase inhibitors on endometriotic lesions, with some authors describing improvements and other authors reporting persistence of pelvic lesions at second-look laparoscopy after treatment. No severe adverse effect has been reported during treatment with aromatase inhibitors both in pre- and postmenopausal women. On the basis of the available data, administration of aromatase inhibitors should now be offered only to the small number of women who have severe pain despite previous surgical and hormonal therapies. Further research in the form of randomized controlled trials will be required before recommending the routine use of these agents.

Gynecol Obstet Invest. 2009;68(2):88-103. Epub 2009 May 27.

Surgery for deep endometriosis: a pathogenesis-oriented approach.

Vercellini P, Carmignani L, Rubino T, Barbara G, Abbiati A, Fedele L.

Department of Obstetrics and Gynecology, Istituto Luigi Mangiagalli, University of Milan, IT-20122 Milan, Italy.

BACKGROUND: Deep endometriosis is usually associated with severe symptoms and constitutes a complex treatment challenge. METHODS: The available evidence has been revisited with the aim of defining an effective diagnostic workup and a safe surgical strategy based on pathogenetic findings. RESULTS: Vaginal, rectal, and bladder detrusor endometriosis appear to be caused by intraperitoneal seeding of regurgitated endometrial cells which implant in the posterior and anterior cul-de-sac and trigger an inflammatory process leading to adhesion of contiguous organs. Excision of posterior deep lesions implies removal of a fibrotic cast of the Douglas’s pouch which may involve the posterior vaginal fornix and the rectal muscular layer, with a not negligible risk of major complications. Removal of full-thickness bladder detrusor endometriosis entails excision of the bladder dome or posterior wall, generally well above the trigone. Transurethral resection is contraindicated. A radical approach to obstructive uropathy is suggested, with resection of the stenotic ureteral tract and reimplantation with antireflux vesicoureteral plasty. CONCLUSION: Infiltrating endometriotic lesions appear to originate intraperitoneally sharing common pathogenetic mechanisms. Involvement of the intestinal and urologic apparatuses should be identified before surgery, in order to schedule intraoperative consultation and to inform the woman about the type of intervention required and its potential sequelae. Copyright 2009 S. Karger AG, Basel.

Arch Gynecol Obstet. 2010 Feb;281(2):373-4. Epub 2009 May 27.

ABO and Rh blood groups distribution in patients with endometriosis.

Demir B, Dilbaz B, Zahran M.

Comment on:

Surg Endosc. 2010 Jan;24(1):63-7. Epub 2009 May 23.

Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases.

Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Minelli L.

Department of General Surgery, Sacro Cuore Don Calabria General Hospital, Verona, Italy.

BACKGROUND: Complete removal of all visible lesions is considered the adequate treatment of pelvic endometriosis in order to reduce recurrence. Laparoscopic colorectal resection of bowel endometriosis is still challenging. A large series is reported. METHODS: A longitudinal evaluation of surgical and clinical complications of 436 cases of severe endometriosis with colorectal resection was carried out. All procedures were performed laparoscopically in a single center and short-term complications were surveyed. RESULTS: The overall complication rate was 8.3% with need for laparoconversion in 3.2%. Sixty patients required blood transfusion (13.7%), and rectovaginal fistulae were the most frequent postoperative complication (3.2%). CONCLUSION: Laparoscopic colorectal resection for endometriosis is a relatively safe procedure in a context of close collaboration between gynecologists and surgeons, although it requires adequate training.

Mol Endocrinol. 2009 Aug;23(8):1291-305. Epub 2009 Apr 30.

Selective inhibition of prostaglandin E2 receptors EP2 and EP4 induces apoptosis of human endometriotic cells through suppression of ERK1/2, AKT, NFkappaB, and beta-catenin pathways and activation of intrinsic apoptotic mechanisms.

Banu SK, Lee J, Speights VO Jr, Starzinski-Powitz A, Arosh JA.

Reproductive Endocrinology and Cell Signaling Laboratory, Department of Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas 77843, USA.

Endometriosis is a benign chronic gynecological disease of reproductive-age women characterized by the presence of functional endometrial tissues outside the uterine cavity. It is an estrogen-dependent disease. Current treatment modalities to inhibit biosynthesis and actions of estrogen compromise menstruation, pregnancy, and the reproductive health of women and fail to prevent reoccurrence of disease. There is a critical need to identify new specific signaling modules for non-estrogen-targeted therapies for endometriosis. In our previous study, we reported that selective inhibition of cyclooxygenase-2 prevented survival, migration, and invasion of human endometriotic epithelial and stromal cells, which was due to decreased prostaglandin E(2) (PGE(2)) production. In this study, we determined mechanisms through which PGE(2) promoted survival of human endometriotic cells. Results of the present study indicate that 1) PGE(2) promotes survival of human endometriotic cells through EP2 and EP4 receptors by activating ERK1/2, AKT, nuclear factor-kappaB, and beta-catenin signaling pathways; 2) selective inhibition of EP2 and EP4 suppresses these cell survival pathways and augments interactions between proapoptotic proteins (Bax and Bad) and antiapoptotic proteins (Bcl-2/Bcl-XL), facilitates the release of cytochrome c, and thus activates caspase-3/poly (ADP-ribose) polymerase-mediated intrinsic apoptotic pathways; and 3) these PGE(2) signaling components are more abundantly expressed in ectopic endometriosis tissues compared with eutopic endometrial tissues during the menstrual cycle in women. These novel findings may provide an important molecular framework for further evaluation of selective inhibition of EP2 and EP4 as potential therapy, including nonestrogen target, to expand the spectrum of currently available treatment options for endometriosis in women.

Biol Reprod. 2009 Sep;81(3):545-52. Epub 2009 Apr 29.

Constitutive activation of Beta-catenin in uterine stroma and smooth muscle leads to the development of mesenchymal tumors in mice.

Tanwar PS, Lee HJ, Zhang L, Zukerberg LR, Taketo MM, Rueda BR, Teixeira JM.

Vincent Center for Reproductive Biology, Vincent Obstetrics and Gynecology Services, and Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.

Leiomyomas and other mesenchymally derived tumors are the most common neoplasms of the female reproductive tract. Presently, very little is known about the etiology and progression of these tumors, which are the primary indication for hysterectomies. Dysregulated WNT signaling through beta-catenin is a well-established mechanism for tumorigenesis. We have developed a mouse model that expresses constitutively activated beta-catenin in uterine mesenchyme driven by the expression of Cre recombinase knocked into the Müllerian-inhibiting substance type II receptor promoter locus to investigate its effects on uterine endometrial stroma and myometrium. These mice show myometrial hyperplasia and develop mesenchymal tumors with 100% penetrance that exhibit histological and molecular characteristics of human leiomyomas and endometrial stromal sarcomas. By immunohistochemistry, we also show that both transforming growth factor beta and the mammalian target of rapamycin are induced by constitutive activation of beta-catenin. The prevalence of the tumors was greater in multiparous mice, suggesting that their development may be a hormonally driven process or that changes in uterine morphology during pregnancy and after parturition induce injury and repair mechanisms that stimulate tumorigenesis from stem/progenitor cells, which normally do not express constitutively activated beta-catenin. Additionally, adenomyosis and endometrial gland hyperplasia were occasionally observed in some mice. These results show evidence suggesting that dysregulated, stromal, and myometrial WNT/beta-catenin signaling has pleiotropic effects on uterine function and tumorigenesis.

Nan Fang Yi Ke Da Xue Xue Bao. 2009 Apr;29(4):757-9.

Small interference RNA targeting nuclear factor-kappaB inhibits endometriotic angiogenesis in chick embryo chorioallantocic membrane.

[Article in Chinese]

Liu MB, He YL, Zhong J.

Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

OBJECTIVE: To investigate the effect of small interference RNA (siRNA) targeting nuclear factor-kappaB (NF-kappaB) on endometriosis. METHOD: The eutopic endometrium of women with endometriosis were transplanted into the nonvascular region of 8-day-old chicken embryo chorioallantocic membrane (CAM), and the effects of NF-kappaB p65 siRNA on the vascularization and endometriotic lesion formation were tested with proper controls. RESULTS: Transplantation of the endometrium onto the CAM resulted in a strong angiogenic response in the chicken tissue. The angiogenesis was significantly reduced and endometriotic lesion formation significantly suppressed with siRNA targeting NF-kappaB in comparison with the control group. CONCLUSIONS: The NF-kappaB pathway is involved in the development of endometriotic lesions in vitro, and NF-kappaB gene silencing reduces endometriotic angiogenesis and promotes cell apoptosis in the endometriotic lesions, suggesting that NF-kappaB might be a good target for endometriosis treatment.

Gynecol Obstet Invest. 2009;68(2):73-81. Epub 2009 Apr 28.

Gonadotropin-releasing hormone agonist reduces aromatase cytochrome P450 and cyclooxygenase-2 in ovarian endometrioma and eutopic endometrium of patients with endometriosis.

Kim YA, Kim MR, Lee JH, Kim JY, Hwang KJ, Kim HS, Lee ES.

Department of Obstetrics and Gynecology, Ilsan Paik Hospital, Inje University, Ilsan, Korea.

AIMS: To investigate whether the GnRH agonist may reduce aromatase P450 and COX-2 in the eutopic endometrium of patients with endometriosis and ovarian endometrioma. MATERIALS AND METHODS: Endometrial specimens and ovarian endometrioma were obtained from 15 women with endometriosis undergoing laparoscopic surgery. The stromal cells of the eutopic endometrium and ovarian endometroma were cultured in the presence of the GnRH agonist (leuprolide acetate 0, 1, 5 and 10 microM) for 24 h. To investigate the effects of the GnRH agonist on the eutopic endometrium in vivo, biopsy samples of the endometrium (n = 5) among the patients who underwent laparoscopy were obtained after GnRH agonist therapy. The protein production of aromatase cytochrome P450 and COX-2 was examined by Western blot. RESULTS: Proteins of aromatase P450 and COX-2 were reduced in the eutopic endometrium of patients with endometriosis treated with the GnRH agonist for 3 months. The stromal cells in the culture of endometrial explants and ovarian endometrioma which were treated with the GnRH agonist reduced the aromatase P450 and COX-2. CONCLUSION: The GnRH agonist reduced aromatase P450 and COX-2 by direct action on the eutopic endometrium of patients with endometriosis and ovarian endometrioma. Copyright 2009 S. Karger AG, Basel.

Reprod Sci. 2009 Dec;16(12):1117-24. Epub 2009 Apr 20.

Review: luminescence as a tool to assess pelvic endometriosis development in murine models.

Defrère S, Colette S, Lousse JC, Donnez J, Van Langendonckt A.

Department of Gynecology, Université Catholique de Louvain, Brussels, Belgium.

Classic murine endometriosis models may be insufficient to evaluate the effect of therapeutic agents on endometriosis development, because the process of identification and measurement of induced lesions is often impeded, as implants are small and embedded in murine tissue. In this context, as summarized in the current review, luminescence techniques have proved useful for identifying and visualizing or quantifying endometriotic transplants. They are also a valuable tool for endometrial cell tracking in live animals, yielding further information by adding spatial and temporal dimensions to biological processes in vivo. Such approaches involve transplanting luminescently labeled murine or human endometrium into animals. Two main strategies are applied to label endometrium before injection: use of genetically modified tissue or tissue labeled with a fluorescent dye. Each model has its advantages and disadvantages, the choice of model depends on the study objectives/design (long- or short-term studies, homologous or heterologous model).

Fertil Steril. 2010 Feb;93(2):490-8. Epub 2009 Apr 18.

Practice patterns and outcomes with the use of single embryo transfer in the United States.

Luke B, Brown MB, Grainger DA, Cedars M, Klein N, Stern JE; Society for Assisted Reproductive Technology Writing Group.

Department of Obstetrics, Gynecology, and Reproductive Biology and Department of Epidemiology, Michigan State University, B227 West Fee Hall, East Lansing, Michigan 48824, USA.

OBJECTIVE: To evaluate factors associated with the use of elective single embryo transfer (eSET) and its effect on assisted reproductive technology (ART) outcome. DESIGN: Historical cohort. SETTING: Clinic-based data. PATIENT(S): A total of 69,028 ART cycles of autologous fresh embryo transfers with additional embryos cryopreserved during the same cycle performed during 2004-06 and reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Factors associated with the number of embryos transferred, and the odds of pregnancy, live birth, and multiple-infant live birth by number of embryos transferred as adjusted odds ratios (AORs). RESULT(S): Single embryo transfer was used more with uterine factor (AOR 1.76) and less with male factor, endometriosis, or tubal factor (AOR 0.81, 0.72, 0.83, respectively). Compared with women aged <30 years, eSET was used less among women aged 35-39 years and > or =40 years (AOR 0.74 and 0.39, respectively). Compared with White women, eSET was used more with Asian (AOR 1.52) and less with Black or Hispanic women (AOR 0.73 and 0.67, respectively). Compared with eSET, the likelihood of pregnancy, live birth, or multiple-infant live birth was more likely with two embryos (AOR 1.33, 1.34, and 27.4, respectively). CONCLUSION(S): Elective SET, used more for younger women with specific diagnoses, is associated with slightly reduced likelihood of a live birth but much reduced likelihood of multiples. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Gynecol Endocrinol. 2009 Jun;25(6):410-2.

Autoimmune progesterone dermatitis diagnosed by intravaginal progesterone provocation in a hysterectomised woman.

Németh H, Kovács E, Gödény S, Simics E, Pfliegler G.

Division of Rare Diseases, Institute of Medicine, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary.

We report the case of a 39-year-old Hungarian woman who cyclically experienced painful, erythematous, patchy skin lesions on her face and chest. Because of her irregular menses and hysterectomy performed later on to manage endometriosis, it was difficult to link her symptoms to the menstrual cycle. But on the basis of the cyclic nature of the rash and the previous negative results – acne vulgaris, psoriasis, atopic dermatitis, lichen planus, systemic lupus erythematosus and infections were ruled out – autoimmune progesterone dermatitis was suspected. As progesterone is not available in aqueous solution for intradermal allergen test in Hungary, we performed progesterone provocation vaginally. The patient developed the usual skin lesions to vaginal progesterone exposure, which confirmed the diagnosis. The patient became symptom free to gonadotropine-analogue treatment and remained so even after the cessation of the therapy after 6 months. To our knowledge, this is the first case in the medical literature, in which autoimmune progesterone dermatitis was proved by vaginal progesterone provocation.

Fertil Steril. 2009 May;91(5):e38; author reply e39. Epub 2009 Mar 27.

Modified ultrasound scanning is a cost-effective method for the detection of deep infiltrating endometriosis.

Guerriero S, Alcazar JL, Ajossa S, Melis GB.

Comment on:

Fertil Steril. 2009 May;91(5):e40; author reply e41. Epub 2009 Mar 27.

Good news for women with endometriosis!

Roman H.

Comment on:

Fertil Steril. 2010 Feb;93(2):480-5. Epub 2009 Mar 25.

Hepatitis B infection and outcomes of in vitro fertilization and embryo transfer treatment.

Lam PM, Suen SH, Lao TT, Cheung LP, Leung TY, Haines C.

Department of Obstetrics and Gynecology, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People’s Republic of China.

OBJECTIVE: To examine the prevalence of hepatitis B virus (HBV) infection, the associated causes of subfertility, and the outcomes of the first IVF and embryo transfer treatment cycles in these infertile couples. DESIGN: A retrospective cohort study. SETTING: Assisted reproduction technology (ART) unit. PATIENT(S): Two hundred eighty-seven couples undergoing IVF and embryo transfer cycles. INTERVENTION(S): Analysis of data on patients’ characteristics, controlled ovarian hyperstimulation (COH), embryology, and pregnancy (PR) and implantation rates of IVF and embryo transfer cycles according to HBV serostatus of the infertile couples, which was routinely screened. MAIN OUTCOME MEASURE(S): The PRs and the implantation rates. RESULT(S): Twenty-nine (10.1%) women were HBV seropositive, whereas 32 (11.1%) of their husbands were HBV seropositive. Concerning the causes of infertility, there was a trend toward more tubal blockage (57.1% vs. 42.2%) in the HBV-infected group. Among the 190 women undergoing their first IVF and embryo transfer cycles, both the ongoing PR or live birth rate and implantation rate in HBV group were significantly higher than the controls (53.3% vs. 24.2% per cycle with embryo transfer; and 43.3% vs. 18.4%, respectively). CONCLUSION(S): Our results demonstrate for the first time significantly higher PRs and implantation rates of IVF and embryo transfer cycles for couples with at least one partner being HBV seropositive. Further studies to elucidate the underlying mechanisms are warranted. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Colorectal Dis. 2010 Jan;12(1):61-5.

Transumbilical single incision laparoscopic sigmoidectomy for benign disease.

Bucher P, Pugin F, Morel P.

Department of Surgery, University Hospital Geneva, 1211, Geneva, Switzerland.

BACKGROUND: Transumbilical single incision laparoscopic surgery (SILS) has made its initial forays into clinical minimally invasive surgery. SILS combines in part the cosmetic advantage and decrease parietal trauma of natural orifice surgery, but allow operative realization with standard and validated laparoscopic instruments. We report here the first clinical transumbilical SILS sigmoidectomy for benign disease. METHOD: Preliminary experience with transumbilical single incision laparoscopic surgery (or embryonic natural orifice transluminal endoscopic surgery) sigmoidectomy in a female patient (34 years, BMI 22 kg/m(2)) with sigmoid stenosis caused by nodular endometriosis was reported. Transumbilical SILS treatment of pelvic endometriosis was performed during the same operation through cauterization. RESULTS: Transumbilical single incision laparoscopic sigmoidectomy was feasible with conventional laparoscopic instruments. The combined uses of straight and articulated laparoscopic instruments allow the avoidance of transparietal sling suture for exposition. Operative time for sigmoidectomy and endometriosis therapy was 125 min. No intra-operative or postoperative complications were recorded. SILS achieved excellent cosmetic results and may be associated with accelerated recovery. CONCLUSION: Transumbilical single incision laparoscopic sigmoidectomy is feasible by experienced laparoscopic surgeons using conventional laparoscopic instruments and staplers. The combined uses of strait and articulated instruments allow transumbilical SILS sigmoidectomy without the need for additional incision or transparietal sling suture. SILS sigmoidectomy may have the clinical advantage over NOTES of offering the safety of laparoscopic colectomy and the avoidance of vaginal access. It has to be determined if SILS offers benefit to the patient, except in cosmesis, compared with standard laparoscopic sigmoidectomy.

Arch Gynecol Obstet. 2009 Dec;280(6):1011-4. Epub 2009 Mar 24.

An endometriotic vault fistula presenting with monthly bleeding after hysterectomy.

Aydin Y, Atis A, Ercan E, Donmez M.

Istanbul University, Turkey.

INTRODUCTION: The aetiology of endometriosis remains unknown. The clinical presentation of endometriosis can be highly variable, occurring in numerous potential locations outside the abdomen and associated with distinct complaints. Recurrence is common, though we present a very rare case of recurrence and complication. CASE PRESENTATION: A 42-year-old caucasian woman was admitted to our unite with monthly vaginal bleeding lasting 3-5 days, beginning from 6 months after previous hysterectomy and right salpingo-oophorectomy surgery for myoma and endometrioma. We suspected of endometrioma of the left ovarium upon transvaginal ultrasonography, and diagnosed vault fistula from the endometriosis cyst to the vagina. We re-operated the patient using Pfannenstiel incision, and performed left-oophorectomy and fistula repairment. The Pouch of Douglas was obliterated and many bowel adhesions were present, indicating a stage IV endometriosis. According to our assessment, stage IV endometriosis had been present in the previous surgery. CONCLUSIONS: Considering that the short-term endometriosis recurrence is higher in premenopausal age and in advanced stage of endometriosis, bilateral oophorectomy together with hysterectomy may be a better operational choice for these patients.

Arch Gynecol Obstet. 2009 Dec;280(6):917-9. Epub 2009 Mar 20.

ABO and Rh blood groups distribution in patients with endometriosis.

Matalliotakis I, Cakmak H, Goumenou A, Sifakis S, Ziogos E, Arici A.

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, USA.

Comment in:

BACKGROUND: The aim of this investigation was twofold: first, to demonstrate an association between endometriosis, ABO blood groups and Rhesus factor and, second, to show potential correlation of ABO blood group and stages of endometriosis. METHODS: Two hundred and thirty-one women with endometriosis and 166 infertile women without endometriosis were studied retrospectively at the Yale University Hospital. All the cases were diagnosed by laparoscopy and in all of them ABO blood groups and Rhesus factor were determined by standard techniques. Women with endometriosis were divided into two groups according to the stage: Group 1 included 124 cases with stages I and II, and Group 2, 107 women with stages III and IV. Statistical methods included chi(2) and odds ratios (95% CI). RESULTS: The identified distribution of ABO and Rh blood groups in women with endometriosis differed significantly from that of the women without endometriosis [chi(2) = 26.27, (P < 0.001); chi(2) = 18.71, (P < 0.001), respectively]. The blood group A was more predominant in women with endometriosis, while blood group O was less predominant. The overall risk of women with endometriosis and A blood group was 2.89 (95%CI, 1.85-4.52). No significant difference was detected in ABO and Rh blood groups in women with endometriosis according to the severity of disease. CONCLUSION: Women with endometriosis have a 2.9-fold increased risk in the A blood group distribution. The role of blood groups in the development of endometriosis remains to be determined.

Surg Oncol. 2010 Mar;19(1):33-37. Epub 2009 Mar 18.

Endometriosis related to family history of malignancies in the Yale series.

Matalliotakis IM, Cakmak H, Krasonikolakis GD, Dermitzaki D, Fragouli Y, Vlastos G, Arici A.

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA; Department of Obstetrics and Gynecology, University of Crete, Heraklion, Greece.

OBJECTIVE: Recent studies reported that endometriosis could behave as a neoplasmatic process. The purpose of this study is to investigate the family risk of ovarian, colon and prostate cancer in women with endometriosis. STUDY DESIGN: A search of medical records at the Yale New Haven Hospital from 1996 to 2002 identified 348 women with endometriosis and 179 women without endometriosis. All the cases were diagnosed by laparoscopy. Demographic characteristics were evaluated in women with positive or negative family history of cancers in women with endometriosis. RESULTS: The overall risk of patients with endometriosis and positive family history of cancers was 7.7 (95% confidence interval 3.8-15.7) (chi(2)=39.8, P<0.001). Significant excess was observed for ovarian cancer in first- and second-degree relatives (OR=10.5, 95% CI (2.5-44.2), chi(2)=14.3, P<0.001), colon cancer (OR=7.5, 95% CI (2.7-21.1), chi(2)=18.2, P<0.001) and prostate cancer (OR=4.5, 95% CI (14-15.3), chi(2)=6.1, P<0.001). We found similar results in first- and second-degree relatives with ovarian and colon cancer. Moreover, we found similar results regarding the demographic characteristics in women with positive family history of cancers and in women with negative history. CONCLUSIONS: These data suggest a familial association of endometriosis with ovarian, colon and prostate cancers. This evidence could support the genetics and molecular similarities between endometriosis and cancer. Future studies will be important to determine a clear genetic link between endometriosis and cancer. Copyright © 2009 Elsevier Ltd. All rights reserved.

Fertil Steril. 2010 Jan;93(1):264-6. Epub 2009 Mar 14.

Unusual complication of excision of pelvic endometriosis: pseudoaneurysm of the left uterine artery.

Ferrero S, Bogliolo S, Rossi UG, Baldi C, Valenzano Menada M, Ragni N, Remorgida V.

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. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Chin J Integr Med. 2009 Feb;15(1):42-6. Epub 2009 Mar 7.

Effect of Quyu Jiedu granule on microenvironment of ova in patients with endometriosis.

Lian F, Li XL, Sun ZG, Zhang JW, Liu YH, Ma FM.

Reproductive and Genetic Center of Intrgrative Medivine, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, China.

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.

Arch Gynecol Obstet. 2009 Nov;280(5):713-8. Epub 2009 Feb 20.

Bowel preparation before laparoscopic gynaecological surgery in benign conditions using a 1-week low fibre diet: a surgeon blind, randomized and controlled trial.

Lijoi D, Ferrero S, Mistrangelo E, Casa ID, Crosa M, Remorgida V, Alessandri F.

Division of Obstetrics and Gynaecology, Department of Women and Children, Imperia Hospital, Via Sant’ Agata, 57, 18100 Imperia, Italy.

PURPOSE: The aim of this randomized, surgeon-blind, controlled study was to evaluate the role of a 7 days minimal-residue (low fibre intake) pre-operative diet compared with a mechanical bowel preparation in laparoscopic benign gynaecological surgery. METHODS: This was a randomized, surgeon-blind, controlled study. The study included 83 women scheduled to undergo diagnostic or operative laparoscopy for various gynaecological benign conditions. Exclusion criteria were suspicion of malignancy, associated non-gynaecological surgical pathologies, severe endometriosis, and history of previous abdominal surgery. Study group had a total daily fibre intake inferior to 10 g for a week before the operation (n = 42). Control group had a mechanical bowel preparation the day before the operation (n = 41). The principal measures of outcome were the quality of bowel preparation, the acceptability of the preoperative diet and of the mechanical bowel preparation. Secondary outcomes included postoperative pain, time of ambulation, length of postoperative ileus, and length of postoperative hospital stay. RESULTS: The two treatment groups were comparable with respect to demographic characteristics and indications for surgery. Preoperatively, abdominal distension and overall discomfort were significantly more frequent in the control group (P = 0.061 and 0.034 respectively). There was no significant difference in the small and large bowel preparation between the two groups. Postoperatively, no significant difference was observed between the two groups in pain, nausea, abdominal swelling, length of ileus, and of postoperative stay. CONCLUSIONS: This study shows that preoperative low fibre diet and mechanical bowel preparation provide similar quality of surgical field exposure. However, when compared with mechanical bowel preparation, preoperative low fibre diet may be better tolerated by the patients, thus increasing compliance. Moreover, a 7 days preoperative low fibre diet allow the patient to continue working and social activities until the day of surgery without requiring admission to the hospital or home bowel preparation on the day before surgery.

Arch Gynecol Obstet. 2009 Oct;280(4):637-41. Epub 2009 Feb 15.

Primary peritoneal clear cell adenocarcinoma arising in previous abdominal scar for endometriosis surgery.

Matsuo K, Alonsozana EL, Eno ML, Rosenshein NB, Im DD.

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, Box 290, Baltimore, MD 21201, USA.

BACKGROUND: Endometriosis-associated ovarian cancer arising from the surgical incision site is an unusual clinical entity. CASE: A 37-year-old woman presented with a chief complaint of progressive swelling of the mons pubis. The patient was status post laparotomy for endometrioma/endometriosis 10 years ago. MRI showed a heterogeneous multiseptated large cystic mass within the mons pubis measuring 14 x 13.4 x 10.6 cm. Initial cytoreductive surgery revealed no evidence of tumor in the peritoneal cavity. The surgery was suboptimal due to severe adhesions to the symphysis pubis. The secondary cytoreductive surgery performed after six cycles of taxotere and carboplatin was optimal. Macroscopically, the tumor was a dusky pink-purple and contained a dense white-gray to light yellow gelatinous area. The tumor was a malignant cystic and glandular neoplasm. Immunohistochemical stains included CK7(+), CK5/6(-), EMA(+), Ber-Ep4(+), Calretinin(-), ER(-), and PR(-). CONCLUSION: Primary peritoneal clear cell adenocarcinoma arising from an abdominal scar associated with prior endometrioma/endometriosis surgery was first reported.

Clin Exp Obstet Gynecol. 2008;35(4):291-4.

Xanthogranulomatous salpingitis: report of three cases and comparison with a case of pseudoxanthomatous salpingitis.

Kostopoulou E, Daponte A, Kallitsaris A, Papamichali R, Kalodimos G, Messinis IE, Koukoulis G.

Department of Pathology, University Hospital of Larissa, Medical School of Thessaly, Larissa, Greece.

Comment in:

Xanthogranulomatous inflammation, an uncommon form of chronic inflammation, has been described in several organs including those of the female genital tract. A rare condition described as pseudoxanthomatous salpingitis or pseudoxanthomatous salpingiosis, which is often associated with endometriosis, has been distinguished from xanthogranulomatous inflammation of the fallopian tube based on its histological features. In the present report three cases of xanthogranulomatous salpingitis and one case of pseudoxanthomatous salpingitis are presented and their clinical, pathological and histochemical features are compared.

Fertil Steril. 2009 Dec;92(6):1850-5. Epub 2009 Feb 6.

Identification of novel peptides specifically binding to endometriosis by screening phage-displaying peptide libraries.

Chang CC, Hsieh YY, Wang YK, Hsu KH, Tsai HD, Tsai FJ, Lin CS.

Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.

OBJECTIVE: To search for novel peptides and common binding motif that specifically bind to endometriosis. DESIGN: Prospective study. SETTING: Department of Biological Science and Technology in national university. PATIENT(S): Specimens were divided into [1] ectopic endometrium (n = 10); [2] eutopic endometrium (n = 10). INTERVENTION(S): Peptides specifically binding to endometriosis are screened from a phage-displaying peptide library (Ph.D.-12) by using whole-cell screening technique after an adsorption elution amplification procedure. MAIN OUTCOME MEASURE(S): Combinatorial peptide libraries were used to identify small molecules that bind with high affinity to receptor molecules and mimic the interaction with natural ligands. Few pans of positive phage clones with significantly positive signals were identified by ELISA and analyzed by DNA sequencing. RESULT(S): During the biopanning processes, the recovered phage number (10(6) pfu/mL) in parts 1, 2, 3, 4, and 5 of the study were 9, 33, 82, 142, and 169. Nine phages consistently had residue Arg, whereas six clones had a consensus motif of Arg-X-Arg-X-X-X-X-Arg. The biotin-labeled peptide bound to endometriosis cells in a dose-dependent manner, yet the control peptide revealed lesser binding activity. CONCLUSION(S): The novel motif is associated with higher affinity of endometriosis, which might be useful in endometriosis targeting and as potential antiendometriosis therapies. We provide one potential approach for novel therapies toward endometriosis.

Fertil Steril. 2010 Feb;93(2):646-51. Epub 2009 Jan 26.

Does endometrial integrin expression in endometriosis patients predict enhanced in vitro fertilization cycle outcomes after prolonged GnRH agonist therapy?

Surrey ES, Lietz AK, Gustofson RL, Minjarez DA, Schoolcraft WB.

Colorado Center for Reproductive Medicine, 10290 Ridge Gate Circle, Lone Tree, CO 80124, USA.

OBJECTIVE: To determine whether endometrial expression of the integrin alpha(v)beta(3) vitronectin can predict which endometriosis patient subgroup will benefit from pre-IVF cycle prolonged GnRH agonist (GnRHa) therapy. DESIGN: Prospective randomized institutional review board approved pilot trial. SETTING: Private assisted reproductive technology program. PATIENT(S): IVF candidates with regular menses, surgically confirmed endometriosis, and normal ovarian reserve. INTERVENTION(S): All patients underwent endometrial biopsy 9 to 11 days post-LH surge to evaluate alpha(v)beta(3) integrin expression. Patients were randomized either to receive depot leuprolide acetate 3.75 mg every 28 days for three doses before controlled ovarian hyperstimulation (COH) or to proceed directly to COH and IVF. Group 1: integrin-positive controls (N = 12); group 2: integrin-positive administered prolonged GnRHa (N = 8). Group A: integrin-negative controls (N = 7); group B: integrin-negative administered prolonged GnRHa (N = 9). MAIN OUTCOME MEASURE(S): COH responses, ongoing pregnancy and implantation rates. RESULTS: There were no significant effects of GnRH agonist treatment in either of the integrin expression strata regarding ongoing pregnancy or implantation rates, although these outcomes were more frequent in group 2 vs. 1 (62.5% vs. 41.6% and 35% vs. 20.6%, respectively). This effect may have because of limited sample size. The value of a negative integrin biopsy in predicting an ongoing pregnancy after prolonged GnRH agonist therapy was only 44.4%. CONCLUSION(S): Endometrial alpha(v)beta(3) integrin expression did not predict which endometriosis patients would benefit from prolonged GnRHa therapy before IVF. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Eur J Radiol. 2010 Feb;73(2):339-344. Epub 2008 Dec 11.

Long-term results of symptomatic fibroids treated with uterine artery embolization: In conjunction with MR evaluation.

Kim MD, Lee HS, Lee MH, Kim HJ, Cho JH, Cha SH.

Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University, Republic of Korea.

OBJECTIVE: The aim of the present study is to determine long-term clinical efficacy of uterine fibroid embolization (UFE) for symptomatic fibroids in conjunction with MR evaluation. MATERIALS AND METHODS: Sixteen patients with a follow-up period of 4 years or longer were analyzed retrospectively. Ages ranged from 27 to 45 (mean 39.5) years. Mean follow-up periods were 5.8 years (range: 4.1-6.9 years). The symptom changes, in terms of menorrhagia and dysmenorrhea and bulk-related symptoms, were assessed. The primary embolic agent was polyvinyl alcohol particle (250-710mum). All patients underwent preprocedural and long-term follow up MR imaging. Uterine volumes were calculated using MRI. RESULTS: Symptom improvements were reported for menorrhagia (8/9, 88.9%), dysmenorrhea (5/5, 100%), and bulk-related symptoms (7/9, 77.8%) at long-term follow up. Two patients (12.5%) had symptom recurrences at long-term follow-up. Tumor regrowth from incomplete infarction was a cause of recurrence in one patient and newly developed leiomyomas in the other one. One patient underwent hysterectomy because endometriosis developed 4 years after UFE. Of the 14 necrotic myomas on short-term follow up MR after UFE, eight (57.1%) demonstrated maintaining necrosis with further shrinkage and six (42.9%) were no longer visualized on long-term follow up MR images. Overall, the mean volume reduction rates of the predominant fibroid and uterus were 80.5%, 36.7% at long-term follow up, respectively. CONCLUSION: UFE is an effective treatment for symptomatic fibroids with an acceptable long-term success rate. Long-term MR imaging after UFE revealed persistent necrotic fibroid, non-visualization of fibroids and tumor regrowth when incompletely infarcted. Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.

Fertil Steril. 2010 Feb;93(3):716-21. Epub 2008 Dec 4.

Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study.

Porpora MG, Pallante D, Ferro A, Crisafi B, Bellati F, Benedetti Panici P.

Department of Gynecology and Obstetrics, University of Rome Sapienza, Viale Regina Elena, 324-00161 Rome, Italy.

OBJECTIVE: To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s). DESIGN: Prospective observational study. SETTING: Tertiary care university hospital. PATIENT(S): One-hundred sixty-six consecutive women affected by uni- or bilateral ovarian endometrioma(s). INTERVENTION(S): Laparoscopic conservative treatment of endometriosis. MAIN OUTCOME MEASURE(S): Patient demographic characteristics, surgical findings, and surgical results were prospectively recorded. Postoperative follow-ups were carried out every 3 months to identify pain and/or endometrioma recurrence for a minimum of 3 years. RESULT(S): Dysmenorrheal, dyspareunia, and chronic pelvic pain recurred in 14.5%, 6%, and 5.4% of women, respectively. Prior surgery for endometriosis, adhesion extension, and use of ovarian stimulation drugs (OSD) were unfavorable prognostic factors for pain symptoms. Ovarian endometrioma recurred in 9.6% of cases; negative factors were prior surgery for endometriosis, OSD, pelvic adhesions, and high American Society for Reproductive Medicine disease scores. Postoperative pregnancy showed a significant protective effect on pain and disease recurrences. CONCLUSION(S): Prior surgery, presence of adhesions, and ovulation drugs are negative prognostic factors. Pregnancy has a protective effect on disease and pain recurrence. Copyright 2010. Published by Elsevier Inc.

J Clin Endocrinol Metab. 2009 Feb;94(2):545-51. Epub 2008 Nov 25.

Suppression of gonadotropins and estradiol in premenopausal women by oral administration of the nonpeptide gonadotropin-releasing hormone antagonist elagolix.

Struthers RS, Nicholls AJ, Grundy J, Chen T, Jimenez R, Yen SS, Bozigian HP.

Neurocrine Biosciences Inc., 12780 El Camino Real, San Diego, California 92130, USA.

CONTEXT: Parenteral administration of peptide GnRH analogs is widely employed for treatment of endometriosis and fibroids and in assisted-reproductive therapy protocols. Elagolix is a novel, orally available nonpeptide GnRH antagonist. OBJECTIVE: Our objective was to evaluate the safety, pharmacokinetics, and inhibitory effects on gonadotropins and estradiol of single-dose and 7-d elagolix administration to healthy premenopausal women. DESIGN: This was a first-in-human, double-blind, placebo-controlled, single- and multiple-dose study with sequential dose escalation. PARTICIPANTS: Fifty-five healthy, regularly cycling premenopausal women participated. INTERVENTIONS: Subjects were administered a single oral dose of 25-400 mg or placebo. In a second arm of the study, subjects received placebo or 50, 100, or 200 mg once daily or 100 mg twice daily for 7 d. Treatment was initiated on d 7 (+/-1) after onset of menses. MAIN OUTCOME MEASURES: Safety, tolerability, pharmacokinetics, and serum LH, FSH, and estradiol concentrations were assessed. RESULTS: Elagolix was well tolerated and rapidly bioavailable after oral administration. Serum gonadotropins declined rapidly. Estradiol was suppressed by 24 h in subjects receiving at least 50 mg/d. Daily (50-200 mg) or twice-daily (100 mg) administration for 7 d maintained low estradiol levels (17 +/- 3 to 68 +/- 46 pg/ml) in most subjects during late follicular phase. Effects of the compound were rapidly reversed after discontinuation. CONCLUSIONS: Oral administration of a nonpeptide GnRH antagonist, elagolix, suppressed the reproductive endocrine axis in healthy premenopausal women. These results suggest that elagolix may enable dose-related pituitary and gonadal suppression in premenopausal women as part of treatment strategies for reproductive hormone-dependent disease states .

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