Eur J Obstet Gynecol Reprod Biol. 2010 Mar 18. [Epub ahead of print]

Coagulation versus excision of primary superficial endometriosis: A 2-year follow-up.

Radosa MP, Bernardi TS, Georgiev I, Diebolder H, Camara O, Runnebaum IB.

Department of Gynecology and Obstetrics, Jena University Hospital, Bachstrasse 18, 07743 Jena, Germany.

OBJECTIVE: Even the common mild forms of endometriosis can strongly affect quality of life due to dysmenorrhea, dyspareunia, dyschezia, or subfertility. We compared the effectiveness of the two laparoscopic methods, coagulation versus excision, for intraperitoneal superficial endometriosis with regard to recurrence and symptom control. STUDY DESIGN: In a retrospective analysis we evaluated the postoperative follow-up of 79 patients, aged 16-42, with superficial manifestation of endometriosis (median rASRM score 9.2) operated on in the Department of Gynecology and Obstetrics at the Jena University Hospital. Forty-three patients were treated by electrocoagulation and 36 underwent sharp excision. Therapy success was evaluated by using a questionnaire after a mean follow-up of 29 months. Patients were interviewed about pain associated with endometriosis such as dysmenorrhea, dyspareunia, dyschezia and possible medical treatment after surgery. We evaluated the number of surgically proven relapses and questionnaire results using a pain score on an ordinal scale (1-5) for the three categories dysmenorrhea, dyspareunia, and dyschezia. RESULTS: Both treatment methods resulted in a low number of endometriosis-related symptoms after surgical intervention and in recurrences of 2.8% in the coagulation group and 18.6% in the excision group. The recurrence rate in the coagulation group was lower (p=0.001). The coagulation group was also presented with a significantly lower postoperative pain score at our long-term follow-up (p=0.0067). CONCLUSION: In cases of superficial endometriosis, laparoscopic surgery achieved low recurrence rates and good symptom control. Compared to sharp excision the use of bipolar electrocoagulation might result in fewer endometriosis-related symptoms as well as fewer relapses with need for surgical re-intervention after a more than 2-year interval. Due to the retrospective, non-randomized character of this study the results should be interpreted carefully. Further prospective studies are needed to assess the value of both surgical approaches in the treatment of endometriosis. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

J Urol. 2010 May;183(5):1848-52. Epub 2010 Mar 29.

Development, validation and testing of an epidemiological case definition of interstitial cystitis/painful bladder syndrome.

Berry SH, Bogart LM, Pham C, Liu K, Nyberg L, Stoto M, Suttorp M, Clemens JQ.

RAND Corp., Santa Monica, California 90407, USA.

PURPOSE: No standard case definition exists for interstitial cystitis/painful bladder syndrome for patient screening or epidemiological studies. As part of the RAND Interstitial Cystitis Epidemiology study, we developed a case definition for interstitial cystitis/painful bladder syndrome with known sensitivity and specificity. We compared this definition with others used in interstitial cystitis/painful bladder syndrome epidemiological studies. MATERIALS AND METHODS: We reviewed the literature and performed a structured, expert panel process to arrive at an interstitial cystitis/painful bladder syndrome case definition. We developed a questionnaire to assess interstitial cystitis/painful bladder syndrome symptoms using this case definition and others used in the literature. We administered the questionnaire to 599 women with interstitial cystitis/painful bladder syndrome, overactive bladder, endometriosis or vulvodynia. The sensitivity and specificity of each definition was calculated using physician assigned diagnoses as the reference standard. RESULTS: No single epidemiological definition had high sensitivity and high specificity. Thus, 2 definitions were developed. One had high sensitivity (81%) and low specificity (54%), and the other had the converse (48% sensitivity and 83% specificity). These values were comparable or superior to those of other epidemiological definitions used in interstitial cystitis/painful bladder syndrome prevalence studies. CONCLUSIONS: No single case definition of interstitial cystitis/painful bladder syndrome provides high sensitivity and high specificity to identify the condition. For prevalence studies of interstitial cystitis/painful bladder syndrome the best approach may be to use 2 definitions that would yield a prevalence range. The RAND Interstitial Cystitis Epidemiology interstitial cystitis/painful bladder syndrome case definitions, developed through structured consensus and validation, can be used for this purpose. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

J Med Life. 2010 Jan-Mar;3(1):76-9.

Endometrium and ovarian cancer synchronous to endometriosis–a retrospective study of our experience of 7 years.

Grammatikakis I, Zervoudis S, Evangelinakis N, Tziortzioti V.

Lito Maternity Hospital, Department of Gynecology 7-13 Mouson Street, 11524, Paleo Psychiko, Greece.

PURPOSE: Although endometriosis is a benign disorder, recent studies suggest that endometriosis could be viewed as a neoplastic process. The objective of this study is to explore the epidemiology of synchronous neoplasms (SPN) in women with severe endometriosis. PATIENTS & METHODS: The prevalence of SPN in cases with endometriotic ovarian cysts that underwent surgery at “Lito” Maternity Hospital of Athens and at Anticancer Institute of Bucharest was investigated. The review period was from the year 2000 to 2008. The medical records and pathology were reviewed to confirm the diagnosis and stage of tumors. RESULTS: Five women with synchronous cancer of the genital tract were identified. All of our patients had a grade-I endometrioid carcinoma of the uterus (Ia in 3, Ib in 2). Myometrium was invaded in less than 1/3, in 4 cases, and less than 1/2 in one case. Similarly, 4 out of 5 ovarian cancers were endometrioid, while one was serum cystadenosarcoma. All of the ovarian malignancies were grade I (Ib in 3 and Ia in 2). The median diameter of the ovarian neoplasias was of 4.3 cm, as opposed to 4.5 cm that was the median diameter of all endometrioid cysts. When the larger ovarian malignant cyst in each patient was accounted, the median diameter was calculated as having 5.8 cm. CONCLUSIONS: Women with synchronous primary cancers of the endometrium and ovary have distinct clinical characteristics including younger age, premenopausal status, and nulliparity. This suggests that a hormonal “field effect” may account for the development of these simultaneous endometrioid cancers, supporting the theory of estrogen receptors.

Int Surg. 2009 Oct-Dec;94(4):310-4.

Intestinal endometriosis: role of laparoscopy in diagnosis and treatment.

Lattarulo S, Pezzolla A, Fabiano G, Palasciano N.

Department of Emergency and Organs Transplantation, U. O. General Surgery “V. Bonomo,”, University of Bari, Bari, Italy.

Endometriosis is a disease in women in which endometrial tissue is found in abnormal sites, frequently in the peritoneum and pelvic viscera. Endometriosis may therefore affect the genital organs, particularly the left ovary, or it may occur elsewhere in the abdomen, principally the digestive tract in the sigmoid-rectum. The difficulty of prompt diagnosis of nongenital endometriotic lesions, whose symptoms are usually nonspecific, and the inadequacy of traditional diagnostic approaches mean the disease has time to progress. A case report is used here to show the use of laparoscopy with immediate histologic examination for the prompt diagnosis and intraoperative treatment of intestinal endometriosis. For patients with extragenital endometriosis, laparoscopic resection offers immediate postoperative advantages but also gives gradual relief of symptoms and in some cases improves reproductive capacity; there is also less formation of adhesions in this disease, which by definition tends to cause them, often making a second look indispensable.

Arch Virol. 2010 May;155(5):695-703. Epub 2010 Mar 19.

Low prevalence of DNA viruses in the human endometrium and endometriosis.

Vestergaard AL, Knudsen UB, Munk T, Rosbach H, Bialasiewicz S, Sloots TP, Martensen PM, Antonsson A.

Department of Molecular Biology, Aarhus University, C. F. Moellers Allé 3, 8000, Aarhus C, Denmark.

The chronic female disease endometriosis causes debilitating pain and lowered fertility. The aetiology is unknown, but indications of an infectious agent are present. This study investigates the possible involvement of a pathogenic virus in endometriosis patients and controls. DNA was purified from biopsies and subjected to highly sensitive PCR tests detecting human papillomavirus (HPV) types, the herpes family viruses HSV-1 and -2, CMV, and EBV, and the polyomaviruses SV40, JCV, BKV, KIV, WUV, and MCV. The prevalence of pathogenic DNA viruses in the human endometrium was generally low (0-10%). The virus prevalence was found to vary slightly when comparing the endometrium of healthy women and women with endometriosis. However, these were not significant differences, and no viruses were identified in endometriotic lesions. These results do not point towards any evidence that endometriosis is caused by these viruses.

Obstet Gynecol Int. 2010;2010:989127. Epub 2010 Mar 14.

Long-term outcomes following laparoscopic and abdominal supracervical hysterectomies.

Lieng M, Lømo AB, Qvigstad E.

Department of Gynecology and Obstetrics, Oslo University Hospital Ullevål, Kirkeveien 166, 0407 Oslo, Norway.

Long-term outcomes, in terms of cervical stump symptoms and overall patient satisfaction, were studied in women both after abdominal (SAH) and laparosocopic (LSH) supracervical hysterectomies. Altogether, 134 women had SAH and 315 women LSH during 2004 and 2005 at our department. The response rate of this retrospective study was 79%. Persistent vaginal bleeding after the surgery was reported by 17% in the SAH group and 24% in the LSH group. Regular bleeding was reported by only 8% in both study groups, and the women rarely found the bleeding bothersome. The women reported a significant pain reduction after the surgery, but women having a hysterectomy because of pain and/or endometriosis should be informed about the possibility of persistent symptoms. The overall patient satisfaction after both procedures was high, but the patients should have proper preoperative information about the possibility of cervical stump symptoms after any supracervical hysterectomy.

J Biomed Biotechnol. 2010;2010:369549. Epub 2010 Mar 10.

Differential expression of microRNAs between eutopic and ectopic endometrium in ovarian endometriosis.

Filigheddu N, Gregnanin I, Porporato PE, Surico D, Perego B, Galli L, Patrignani C, Graziani A, Surico N.

Laboratory of Oncological Gynecology, Department of Clinical and Experimental Medicine, and Biotechnology Center for Applied Medical Research, University of Piemonte Orientale Amedeo Avogadro, 28100 Novara, Italy.

Endometriosis, defined as the presence of endometrial tissue outside the uterus, is a common gynecological disease with poorly understood pathogenesis. MicroRNAs are members of a class of small noncoding RNA molecules that have a critical role in posttranscriptional regulation of gene expression by repression of target mRNAs translation. We assessed differentially expressed microRNAs in ectopic endometrium compared with eutopic endometrium in 3 patients through microarray analysis. We identified 50 microRNAs differentially expressed and the differential expression of five microRNAs was validated by real-time RT-PCR in other 13 patients. We identified in silico their predicted targets, several of which match the genes that have been identified to be differentially expressed in ectopic versus eutopic endometrium in studies of gene expression. A functional analysis of the predicted targets indicates that several of these are involved in molecular pathways implicated in endometriosis, thus strengthening the hypothesis of the role of microRNAs in this pathology.

J Clin Pathol. 2010 May;63(5):452-4. Epub 2010 Mar 18.

Multifocal polypoid endometriosis in a young woman simulating vaginal and pelvic neoplasm.

Kaushal S, Dadhwal V, Mathur SR, Ray R, Durgapal P, Deka D.

Department of Pathology, AIIMS, New Delhi, India.

A 27-year-old nulliparous woman presented with large finger-like projections protruding from her vagina. Intraoperatively there were deposits in the pouch of Douglas. Clinical presentation and history of vaginal bleeding suggested malignancy. Histopathology of both the vaginal and pouch of Douglas masses showed endometrial glands and stroma. There was no architectural complexity or cytological atypia of glands or stroma. Immunohistochemistry for oestrogen receptor, progesterone receptor and CD10 was positive. Based on morphological and immunohistochemical findings, multifocal polypoid endometriosis was diagnosed; this is a recently described entity having a clinical presentation and age range completely different from conventional or non-polypoid endometriosis. Although an association between tamoxifen use, unopposed oestrogen therapy and polypoid endometriosis has been suggested, the patient had no history of tamoxifen or oestrogen intake. Polypoid endometriosis should be part of the differential diagnosis in young women presenting with vaginal growth.

Cochrane Database Syst Rev. 2010 Mar 17;3:CD008088.

Anti-TNF-alpha treatment for pelvic pain associated with endometriosis.

Lv D, Song H, Shi G.

Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University, No.21, Third Part of Ren Min Nan Road, Chengdu, Sichuan, China, 610041.

BACKGROUND: Endometriosis is a chronic, recurring condition that can develop during the reproductive years. It is characterized by the development of endometrial tissue outside the uterine cavity. It is the most common cause of pelvic pain in women. This endometrial tissue development is dependent on estrogen produced primarily by the ovaries and, therefore, traditional management has focused on suppression of ovarian function. The mounting evidence shows that altered immune function plays a crucial role in the genesis and development of endometriosis. In this review we considered modulating the inflammation as an alternative approach. OBJECTIVES: To determine the effectiveness and safety of anti-tumour necrosis factor-alpha (anti-TNF-alpha) drugs in the management of pelvic pain associated with endometriosis. SEARCH STRATEGY: We searched for trials in the following databases (from their inception to August 2009): Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO. In addition, all reference lists of included trials were searched and experts in the field were contacted in an attempt to locate trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing anti-TNF-alpha drugs with placebo, no treatment, medical treatment, or surgery for pelvic pain associated with endometriosis were included. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, assessed trial quality, and extracted data using data extraction forms. The domains assessed for risk of bias were sequence generation, allocation concealment, blinding, incomplete outcome data, and selective outcome reporting. Risk ratios (RR) were used for reporting dichotomous data with 95% confidence intervals (CI), whilst mean differences (MD) were expressed for continuous data. Statistical heterogeneity was assessed using the I(2) statistic. MAIN RESULTS: Only one trial involving 21 participants was included. Results showed no evidence of an effect of infliximab, one of the known anti-TNF-alpha drugs, on pain reduction using the Biberoglu-Behrman (BB) score for patients (MD -0.15, 95% CI -0.51 to 0.21), the BB score for clinicians (MD -0.15, 95% CI -0.45 to 0.15), the visual analogue pain score (VAS) (MD 11.30, 95% CI -3.00 to 25.60) and the use of pain killers (MD -0.10, 95% CI -0.60 to 0.40). There was no evidence of an increase in adverse events in the infliximab group compared with placebo (RR 3.73, 95% CI 0.22 to 63.66). No evidence of clinical benefits of infliximab was found for endometriotic lesions, dysmenorrhoea, dyspareunia or pelvic tenderness. No trial reported the effects of anti-TNF-alpha drugs using economic evaluations and the odds of recurrence. AUTHORS’ CONCLUSIONS: There is no enough evidence to support the use of anti-TNF-alpha drugs in the management of women with endometriosis for the relief of pelvic pain.

Bioorg Med Chem Lett. 2010 Apr 15;20(8):2512-5. Epub 2010 Mar 3.

Synthesis and biological evaluation of piperazinyl heterocyclic antagonists of the gonadotropin releasing hormone (GnRH) receptor.

Vera MD, Lundquist JT 4th, Chengalvala MV, Cottom JE, Feingold IB, Garrick LM, Green DM, Hauze DB, Mann CW, Mehlmann JF, Rogers JF, Shanno L, Wrobel JE, Pelletier JC.

Department of Chemical, Wyeth Research, Collegeville, PA 19426, USA.

Antagonism of the gonadotropin releasing hormone (GnRH) receptor has resulted in positive clinical results in reproductive tissue disorders such as endometriosis and prostate cancer. Following the recent discovery of orally active GnRH antagonists based on a 4-piperazinylbenzimidazole template, we sought to investigate the properties of heterocyclic isosteres of the benzimidazole template. We report here the synthesis and biological activity of eight novel scaffolds, including imidazopyridines, benzothiazoles and benzoxazoles. The 2-(4-tert-butylphenyl)-8-(piperazin-1-yl)imidazo[1,2-a]pyridine ring system was shown to have nanomolar binding potency at the human and rat GnRH receptors as well as functional antagonism in vitro. Additional structure-activity relationships within this series are reported along with a pharmacokinetic comparison to the benzimidazole-based lead molecule. Copyright 2010 Elsevier Ltd. All rights reserved.

Eur J Obstet Gynecol Reprod Biol. 2010 Mar 15. [Epub ahead of print]

Awareness and perception of intra-abdominal adhesions and related consequences: Survey of gynaecologists in German hospitals.

Hackethal A, Sick C, Brueggmann D, Tchartchian G, Wallwiener M, Muenstedt K, Tinneberg HR.

Department of Obstetrics and Gynaecology, Justus-Liebig-University of Giessen, Klinikstrasse 32, 35385 Giessen, Germany.

OBJECTIVE: Intra-abdominal adhesion formation after abdominal surgery is the most common postsurgical complication, and the consequences are a considerable burden for patients, surgeons and health systems. Since a wide variety of factors influence adhesion formation, it is difficult to define clear guidelines on how to reduce adhesion formation in daily practice. Given this dilemma, this study assessed the awareness and perception of adhesion formation among gynaecologists in Germany in order to define a baseline for further research and education. STUDY DESIGN: The Clinical Adhesion Research and Evaluation (CARE) group of the University of Giessen designed a questionnaire that was sent to the heads of all gynaecological departments in Germany. The director or one of the surgical consultants was asked to complete the questionnaire and return it for evaluation. RESULTS: The completed questionnaire was returned by 279 of 833 gynaecological departments. Interviewed surgeons expected adhesions to form in 15% of cases after laparoscopy and 40% after laparotomy. Before surgery, 83.1% of the respondents told their patients about the risk of prior adhesion formation. More than 60% believed that postsurgical adhesion accounts for major morbidity. Infections within the abdomen, previous surgery and extensive tissue trauma were thought to have the most influence on adhesion formation. Risk of adhesion formation was thought to be highest in endometriosis and adhesiolysis surgery. The respondents agreed on performing adhesiolysis in symptomatic but not in all patients. Only 38.4% used adhesion reduction agents regularly. A total of 65.1% of a repertoire of adhesion prevention agents were familiar to the interviewed surgeons. Only 22.0% of them used anti-adhesion products in clinical practice. In general, the respondents were uncertain whether these products play an important role in adhesion reduction, represented by a range of 1.97+/-0.98% on a scale from 0 to 4. CONCLUSIONS: Even though postoperative adhesions are recognized as a major cause for morbidity, and it is widely agreed that infections, extensive tissue trauma and surgery lead to adhesion formation, there is uncertainty about the treatment and prophylactic strategies for dealing with adhesions. This dilemma reflects the awareness and perception of gynaecologists in Germany and is an initial point for further research. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Fertil Steril. 2010 Mar 15. [Epub ahead of print]

“Spot”-ting differences between the ectopic and eutopic endometrium of endometriosis patients.

Chehna-Patel N, Sachdeva G, Gajbhiye R, Warty N, Khole V.

Department of Gamete Immunobiology, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India.

OBJECTIVE: To examine proteins aberrantly expressed in the ectopic endometrium compared with eutopic endometrium from the same patient. DESIGN: Experimental study. SETTING: Research institute and an obstetrics and gynecology clinic (National Institute for Research in Reproductive Health and Sanjeevani Diagnostic Center and Maternity Home, India). PATIENT(S): Twenty participants with (n = 11) and without (n = 9) endometriosis. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Protein identification by two-dimensional (2D) electrophoresis and mass spectrometry as well as validation of the identified proteins by studying protein expression via Western blot and protein localization via immunohistochemical analysis. RESULT(S): Computer-assisted image analysis detected the presence of 53 protein spots in ectopic 2D gels that were conspicuous by their absence in the 2D maps of eutopic and control endometrium, i.e., these spots were detected only in ectopic gels. Eleven spots were identified by mass spectrometry. The expression of four of these proteins-haptoglobin, Rho-GDIalpha, SM-22alpha, and Rab37-have been validated by immunohistochemical and Western blotting analysis. CONCLUSION(S): This study assumes significance, as there are no reports on the comparison of the global protein profiles of paired eutopic and ectopic endometrium. Furthermore, the study demonstrates a definitive difference in the protein repertoire of the ectopic endometrium compared with its uterine counterpart in the same patient. Such studies are relevant in deciphering the complex biology of the endometriotic lesion. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Acta Obstet Gynecol Scand. 2010 May;89(5):646-50.

Public perceptions of endometriosis: perspectives from both genders.

Shah DK, Moravek MB, Vahratian A, Dalton VK, Lebovic DI.

Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA.

OBJECTIVE: Many women with endometriosis experience significant delay between the onset of symptoms and definitive diagnosis. Much is published on physician awareness of endometriosis and on the experiences of women with the condition. There is a paucity of data, however, surrounding perceptions of endometriosis in the general population. This study aims to assess knowledge of endometriosis among individuals of both genders. DESIGN: Survey study. SETTING: Family waiting room of a large university hospital. POPULATION: A total of 543 men and women. METHODS: Surveys were distributed to men and women over the age of 18 in the family waiting room of a large university hospital. MAIN OUTCOME MEASURES: A series of questions regarding the etiology, symptoms, and treatments for endometriosis were combined into a composite knowledge score. RESULTS: Knowledge of endometriosis was positively correlated with female gender, education level, regular health care, and exposure to individuals with the disease. Women diagnosed with endometriosis were more likely to have discussed symptoms of the condition with their physicians than women without the diagnosis. CONCLUSIONS: Individuals of both genders have limited knowledge of the signs and symptoms of endometriosis, which may contribute to the delay in diagnosis of the condition.

Ginekol Pol. 2010 Jan;81(1):20-3.

Peritoneal fluid iron levels in women with endometriosis.

[Article in Polish]

Polak G, Wertel I, Tarkowski R, Kotarski J.

I Katedra i Klinika Ginekologii Onkologicznej i Ginekologii Uniwersytetu Medycznego w Lublinie.

AIM: Endometriosis is characterized by a cyclic hemorrhage within the peritoneal cavity. Accumulating data suggests that iron homeostasis in the peritoneal cavity may be disrupted by endometriosis. The aim of our study was to evaluate iron levels in peritoneal fluid (PF) of women with and without endometriosis. MATERIAL AND METHODS: Seventy-five women were studied: 50 women with endometriosis and, as a reference group, 25 patients with functional follicle ovarian cysts. Iron concentrations in the PF were measured using a commercially available colorimetric assay kit. RESULTS: Iron concentrations were significantly higher in PF from women with endometriosis as compared to the reference group. Patients with stages III/IV endometriosis had significantly higher PF iron concentrations than women with stages I/II of the disease. CONCLUSIONS: Disrupted iron homeostasis in the peritoneal cavity of women with endometriosis plays a role in the pathogenesis of the disease.

Arch Surg. 2010 Mar;145(3):305-6.

Image of the month–quiz case. Endometriosis.

Maxey D, Wick EC, Gearhart S.

Department of Surgery, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD 21287, USA.

Int J Biochem Cell Biol. 2010 Mar 15. [Epub ahead of print]

Endometriosis: New concepts in the pathogenesis.

Signorile PG, Baldi A.

Fondazione Italiana Endometriosi, Via E. Longoni 81, 00155 Rome, Italy.

Endometriosis is a gynaecological disease defined by the histological presence of endometrial glands and stroma outside the uterine cavity. Though there are several theories, research scientists remain unsure as to the definitive cause(s) of endometriosis. Considering the relevant health problems caused by endometriosis, all new information on the pathogenesis of this disease, may have important clinical implications. Goal of this article is to summarize the latest advances in the pathogenesis of endometriosis, with particular emphasis on the embryological theory, that has been recently re-proposed. The possible clinical implications of these findings will be discussed. Copyright © 2010 Elsevier Ltd. All rights reserved.

Expert Opin Pharmacother. 2010 May;11(7):1123-34.

Current pharmacotherapy for endometriosis.

Ferrero S, Remorgida V, Venturini PL.

San Martino Hospital and University of Genoa, Department of Obstetrics and Gynaecology, Largo Rosanna Benzi 1, 16132, Genoa, Italy.

IMPORTANCE OF THE FIELD: Medical therapy is the most commonly used treatment for endometriosis. In particular, the administration of hormonal therapies aims to improve symptoms with minimal adverse effects. AREAS COVERED IN THIS REVIEW: Observational and randomized studies evaluating the efficacy of medical therapy on symptoms associated with endometriosis were reviewed. We searched Medline, Embase and the Cochrane Library up to December 2009. WHAT THE READER WILL GAIN: The reader will obtain information on the available medical therapies used to treat endometriosis-related symptoms either after surgery or as an alternative to the surgical excision of endometriosis. The effectiveness of therapies, the dose of drugs, the length of treatment and the adverse effects are examined. TAKE HOME MESSAGE: Medical therapies can efficaciously reduce the severity of pain symptoms caused by endometriosis. Recurrence of symptoms is common after discontinuation of medical therapies; therefore, the choice of the therapy should be based not only on the improvements of symptoms but also on the potential adverse effects and patients’ satisfaction.

Acta Obstet Gynecol Scand. 2010 Mar 15. [Epub ahead of print]

Acute abdomen in pregnancy with endometriosis.

Granese R.

Intern Med. 2010;49(6):573-6. Epub 2010 Mar 15.

Ureteral endometriosis with obstructive uropathy.

Hsieh MF, Wu IW, Tsai CJ, Huang SS, Chang LC, Wu MS.

Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.

Endometriosis is a common disease, but ureteral involvement is rare. The symptoms and signs of ureteral endometriosis mimic those of ureteral malignancy. This case report describes a woman who presented with chronic back pain for 5 years. Imaging studies showed a right small contracted kidney with hydronephrosis and a bladder tumor. Endometriosis of the right lower ureter was ultimately diagnosed. The patient was healthy without recurrence during follow-up. It is difficult to differentiate between ureteral endometriosis and malignancy; in fact, renal loss may occur before diagnosis. Ureteral endometriosis should be considered for women with ureteral obstruction manifesting as chronic backache.

Eur J Obstet Gynecol Reprod Biol. 2010 Mar 11. [Epub ahead of print]

Letrozole and norethisterone acetate in colorectal endometriosis.

Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Seracchioli R, Remorgida V.

Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Largo R. Benzi 1, 16132 Genoa, Italy.

OBJECTIVE: Up to now limited attention has been given to the medical treatment of bowel endometriosis. This study evaluates the efficacy of aromatase inhibitors and norethisterone acetate in treating pain and gastrointestinal symptoms caused by bowel endometriosis. STUDY DESIGN: This prospective pilot study included six women with colorectal endometriosis; all women had intestinal nodules infiltrating at least the muscularis propria of the bowel and did not have a stenosis of the bowel lumen >60%; the patients suffered from pain and intestinal symptoms. The study subjects received letrozole (2.5mg/day) and norethisterone acetate (2.5mg/day) continuously for 6 months. The presence and intensity of symptoms were evaluated before starting the treatment, and after 3 and 6 months of treatment. RESULTS: The double-drug regimen improved pain, non-menstrual pelvic pain, deep dyspareunia, dyschezia, symptoms mimicking diarrhoea-predominant irritable bowel syndrome, intestinal cramping, abdominal bloating and passage of mucus in the stools, and 67% of the patients declared that the treatment improved their gastrointestinal symptoms. CONCLUSIONS: The administration of letrozole and norethisterone acetate reduces pain and gastrointestinal symptoms of women with colorectal endometriosis, particularly when patients suffer from symptoms mimicking diarrhoea-predominant irritable bowel syndrome. Copyright © 2010. Published by Elsevier Ireland Ltd.

J Minim Invasive Gynecol. 2010 Mar-Apr;17(2):258-61.

Large-muscle endometriosis involving the adductor tight compartment: case report.

Fambrini M, Andersson KL, Campanacci DA, Vanzi E, Bruni V, Buccoliero AM, Pieralli A, Livi L, Scarselli G.

Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, Florence, Italy.

Extrapelvic endometriosis is an uncommon condition but can involve nearly every organ, resulting in a wide range of clinical manifestations. Herein, we describe the case of a 45-year-old woman not a candidate for hormonal therapy who had cyclic pain in the left thigh associated with progressive impairment of walking ability. Clinical, instrumental, and laboratory data supported the diagnosis of endometriosis involving the adductor muscles compartment associated with ovarian endometriomas. Laparoscopic bilateral salpingo-oophorectomy and local wide excision in collaboration with an experienced orthopedic oncologist were performed, and definitive histologic analysis confirmed the diagnosis of endometriosis. The patient was pain-free at 6-month follow-up and demonstrated substantial improvement in ambulation and quality of life. Large-muscle endometriosis is a rare entity that can compromise musculoskeletal integrity and decrease quality of life. In this case, surgical excision in collaboration with an orthopedic oncologist was the cornerstone of treatment. Copyright 2010 AAGL. Published by Elsevier Inc. All rights reserved.

Int J Clin Oncol. 2010 Mar 10. [Epub ahead of print]

A case of diaphragmatic clear cell carcinoma in a patient with a medical history of ovarian endometriosis.

Fujiu K, Miyamoto H, Hashimoto S, Suzuki N, Takano Y, Teranishi Y, Sakuma H, Suzuki H.

Department of General Thoracic Surgery, Southern Tohoku General Hospital, 7-115 Yatsuyamada, Koriyama, Fukushima, 963-8563, Japan,

We present a case of clear cell carcinoma located in the diaphragm in a patient with a medical history of ovarian endometriosis. Ultrasonography revealed the presence of a 2.5-cm nodule on the surface of the liver in a 65-year-old woman. She had undergone right salpingo-oophorectomy for treatment of an endometrial cyst of the right ovary at the age of 43 years and hysterectomy for treatment of a myoma of the uterus at the age of 51 years. We performed laparotomy and found that the tumor had originated from the diaphragm and invaded the liver. The diaphragm and liver were partially resected. Histopathological examination revealed the presence of clear cells and hobnail cells. The clear cells contained pale or eosinophilic cytoplasm and were arranged in a solid pattern. The hobnail cells lined the lumen and papillae. Immunohistochemical examination of the tumor cells showed positive staining for CK-7 and CA-125; negative staining for CK-20, TTF-1, and CA19-9; and weak positive staining for CEA. The findings were compatible with those of ovarian clear cell carcinoma. After 1 year, the patient had metastasis in the lung, and right lower lobectomy was performed.

DNA Cell Biol. 2010 Mar 10. [Epub ahead of print]

A Functional Promoter Polymorphism in NFKB1 Increases Susceptibility to Endometriosis.

Zhou B, Rao L, Peng Y, Wang Y, Qie M, Zhang Z, Song Y, Zhang L.

1 Laboratory of Molecular Translational Medicine, West China Second University Hospital, Sichuan University , Chengdu, P.R. China .

Numerous proinflammatory cytokines, such as TNFalpha and IL-6, which are nuclear factor kappaB (NF-kappaB) target genes, have been shown to promote proliferation in endometriotic cells, and several other genes involved in promoting growth are also NF-kappaB target genes. The aim of this study was to investigate whether the functional insertion/deletion polymorphism (-94 insertion/deletion ATTG) in the promoter of nuclear factor kappaB gene (NFKB1) is associated with susceptibility to endometriosis. Polymerase chain reaction-polyacrylamide gel electrophoresis method was used to genotype the NFKB1 -94 insertion/deletion ATTG polymorphism in 206 women with endometriosis and 365 ethnicity-matched healthy control women. The genotyping method was confirmed by the DNA sequencing analysis. Genotype at the -94 insertion/deletion ATTG polymorphism in the NFKB1 promoter was in Hardy-Weinberg equilibrium in either case or control subjects. The frequency of the ATTG(2)/ATTG(2) genotype and ATTG(2) allele in the endometriosis was significantly higher than that of control subjects (59.7% vs. 37%, odds ratio = 3.069, p < 0.001 for ATTG(2)/ATTG(2) genotype; 75.2% vs. 59.7%, odds ratio = 2.049, p < 0.001 for ATTG(2) allele), indicating that the -94 insertion/deletion ATTG polymorphism in the NFKB1 promoter was associated with endometriosis. This study suggests that the functional -94 insertion/deletion ATTG polymorphism in the promoter of NFKB1 is associated with an increased risk for endometriosis.

Abdom Imaging. 2010 Mar 9. [Epub ahead of print]

Nuck canal endometriosis: MR imaging findings and clinical features.

Gaeta M, Minutoli F, Mileto A, Racchiusa S, Donato R, Bottari A, Blandino A.

Department of Radiological Sciences, Policlinico “G.Martino”, Messina, Italy.

OBJECTIVE: The purpose of this study was to describe the MR imaging findings of Nuck canal endometriosis (NCE). MATERIALS AND METHODS: In a 10-year period, 486 out of 612 patients, with laparoscopically and/or surgically proven diagnosis of pelvic endometriosis, underwent MR imaging examination. The examinations were reviewed by two urogenital experienced radiologists working in consensus. Data analysis included: lesions location, size, morphological and signal intensity pattern, involvement of the adjacent muscles, and tendons. RESULTS: In 372 out of 486 patients an MRI diagnosis of endometriosis was made. NCE was found in eight patients. All the lesions were located on the right side. The mean size of the lesions was 2.5 cm (range 1.5-4.5 cm). Two patterns of NCE were found: type 1, prevalently cystic (n = 2); and type 2, prevalently solid with small scattered cysts within lesion (n = 6). In all the patients, hemorrhagic hyperintense cysts could be seen on T1-weighted images. In four patients, the lesions involved the inguinal canal, and in another four patients, the lesions were only outside the inguinal canal. Involvement of the abdominis rectus muscle was seen in two patients, and of the adductor common tendon in two patients. CONCLUSION: MR imaging permits the diagnosis of NCE as well as the evaluation of exact extension of the disease.

Curr Opin Obstet Gynecol. 2010 Mar 6. [Epub ahead of print]

Update on the role of leukemia inhibitory factor in assisted reproduction.

Aghajanova L.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA.

PURPOSE OF REVIEW: To review the recent literature on the involvement and importance of leukemia inhibitory factor (LIF) in the human implantation process, and the attempts using LIF-based interventions to improve assisted reproductive technologies (ARTs) outcome in women with recurrent implantation failure. RECENT FINDINGS: High LIF expression is an indicator of receptive endometrium in fertile women. However, in infertile individuals, the data on endometrial LIF expression and secretion are controversial. Even after ruling out other causes of infertility, such as tubal, endocrine, male factor, and endometriosis, LIF-only detection is not sufficient for assessment of implantation potential in women with unexplained infertility. This is obviously in contrast to evidence of the crucial role of LIF in mouse endometrial physiology. In a large multicenter study, recombinant human LIF failed to improve the outcome of IVF treatment in women with recurrent implantation failure. SUMMARY: A better comprehension of the mechanisms underlying endometrial receptivity and implantation should guide clinicians through proper management and treatment of infertility and implantation failure, and may eventually enable widespread adherence to single embryo transfer practices.

Curr Opin Obstet Gynecol. 2010 Mar 6. [Epub ahead of print]

Ectopic pregnancy after assisted reproductive technology: what are the risk factors?

Chang HJ, Suh CS.

Health Promotion Center, South Korea bDepartment of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea cDepartment of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.

PURPOSE OF REVIEW: This review discusses recent publications that investigate risk factors associated with ectopic pregnancy after IVF. RECENT FINDINGS: Data on the risk factors for developing ectopic pregnancy after IVF are still inconsistent. Between fresh nondonor IVF and embryo transfer cycles, the significant risk factor for ectopic pregnancy was tubal factor infertility, and endometriosis, rather than male factor infertility. Higher ectopic pregnancy rate could be associated with zygote intrafallopian transfer, assisted hatching, large embryo transfer volume, deep fundal transfer, and frozen embryo transfer. The supraphysiologic progesterone level may decrease uterine contractility and enhance implantation in the uterine cavity in fresh embryo transfer compared with frozen embryo transfer cycles. Although recent results suggest reassurance in risk of ectopic pregnancy with frozen transfer, clinicians should be remembering this possibility while performing a frozen embryo transfer. Higher implantation potential per embryo at the blastocyst stage may increase the risk of ectopic pregnancy than cleavage stage. Especially, according to numbers of embryos transferred, different risk of ectopic pregnancy after IVF was noted. SUMMARY: Different hormonal milieu, the reproductive health characteristics of infertile women such as distorted tubal function, technical issues of IVF procedures, and the estimated embryo implantation potential are possible risk factors. How each factor contributes to the risk of occurring ectopic pregnancy after assisted reproductive technology is uncertain and needs further investigation.

Obstet Gynecol Surv. 2010 Mar;65(3):189-95.

Pathogenesis of benign metastasizing leiomyoma: a review.

Awonuga AO, Shavell VI, Imudia AN, Rotas M, Diamond MP, Puscheck EE.

Division of Reproductive Endocrinology & Infertility, Wayne State University, Detroit, MI 48201, USA.

Uterine leiomyomas are benign tumors of smooth muscle origin with protean symptomatology, and are the most common gynecological tumor in women of reproductive age. Very rarely, benign uterine leiomyomas display bizarre growth patterns with associated extrauterine benign-appearing smooth muscle tumors, similar to the smooth muscle cells found in a uterine fibroid, and are given the name benign metastasizing leiomyoma (BML). We reviewed the published literature to outline the possible etiology of benign metastasizing leiomyoma (BML), and explored the similarities between BML and endometriosis. Several observations and animal experiments support the findings that BML may evolve from lymphatic and hematological spread, coelomic metaplasia and intraperitoneal seeding. The weight of available evidence support the conclusion that the mechanism used to explain the pathogenesis of endometriosis can also be used to explain BML. However, in making a diagnosis of BML, meticulous sampling of the pathology specimen should be undertaken to exclude leiomyosarcoma, which unlike BML, has an aggressive course. It is hoped that analyses of the etiology and features of this disorder will facilitate a better understanding of its pathogenesis and treatment. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to asses the clinical characteristics of Benign Metastasizing Leiomyoma. Compare the potential pathophysiology with endometriosis and differentiate benign metastasizing Leiomyoma from Leiomyosarcoma.

Reprod Biomed Online. 2010 May;20(5):681-688. Epub 2010 Feb 1.

Increased exposure to dioxin-like compounds is associated with endometriosis in a case-control study in women.

Simsa P, Mihalyi A, Schoeters G, Koppen G, Kyama CM, Den Hond EM, Fülöp V, D’Hooghe TM.

Leuven University Fertility Center, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven B-3000, Belgium; Department of Obstetrics and Gynaecology, National Institute of Health, Budapest 1139, Hungary.

Although endometriosis is thought to be an environmental disorder initiated by dioxin exposure, this association is controversial. This study was performed to test the hypothesis that endometriosis occurs more often in women exposed to higher concentrations of dioxin-like compounds (DLC) than in those women exposed to lower concentrations. Plasma samples collected prior to laparoscopic surgery from 96 women with endometriosis and 106 control patients with a normal pelvis were measured for DLC concentrations using the dioxin-responsive chemical-activated luciferase expression bioassay. The results showed that concentration (mean+/-SD) of DLC was marginally higher in patients with endometriosis (22.3+/-9.3pg CALUX-TEQ/g lipid) than in controls (20.5+/-10.8pg). After categorization of patients in a group with ‘low’ plasma concentrations (<25th centile) and a group with ‘high’ plasma concentrations (>75th centile) of DLC, the age-adjusted odds ratio to have endometriosis was 2.44 (95% CI 1.04-5.70; P=0.04) for women with high concentrations of DLC and it increased to 3.01 (95% CI 1.06-9.04; P=0.03) when only women with moderate severe endometriosis were considered. In conclusion, women exposed to higher plasma concentrations of DLC were at higher risk of having endometriosis than women exposed to lower concentrations of DLC within normal environmental concentrations. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Fertil Steril. 2010 Mar 5. [Epub ahead of print]

Selective blockade of prostaglandin E(2) receptor EP2 and EP4 signaling inhibits proliferation of human endometriotic epithelial cells and stromal cells through distinct cell cycle arrest.

Lee J, Banu SK, Rodriguez R, 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.

OBJECTIVE: To determine interactions between prostaglandin (PG) E(2) signaling and proliferation of endometriotic cells to increase our knowledge about PGE(2) signaling in the pathogenesis of endometriosis in humans. DESIGN: Immortalized human endometriotic epithelial and stromal cells were used as an in vitro model. Effects of inhibition of PGE(2) receptors on proliferation of endometriotic cells and associated cell cycle regulation were determined. SETTING: College Veterinary Medicine and Biomedical Sciences, Texas A&M University. PATIENT(S): Not available. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Cell proliferation, cell viability, cell cycle, regulation of cyclins, cyclin-dependent kinases, and cyclin-dependent kinase inhibitors. RESULT(S): Selective blockade of EP2/EP4 inhibited proliferation of human endometriotic cells by inducing cell cycle arrest at the G(1)-S and G(2)-M checkpoints in epithelial cells and at the G(2)-M checkpoint in stromal cells. This cell cycle arrest during specific checkpoints was associated with distinct regulation of respective cyclins and cyclin-dependent kinases. Inhibition of EP1 did not decrease endometriotic cell proliferation. CONCLUSION(S): For the first time data from the present study provide a direct molecular link between PGE(2) signaling and proliferation of endometriotic cells and suggest that inhibition of EP2/EP4 could be a potential nonestrogen (E) treatment option for endometriosis in women. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Ann Fr Anesth Reanim. 2010 Mar 3. [Epub ahead of print]

Rhabdomyolysis and compartment syndrome of two forearms after robotic assisted prolonged surgery.

[Article in French]

Deras P, Amraoui J, Boutin C, Laporte S, Ripart J.

Division anesthésie-réanimation-douleur-urgence, faculté de médecine Montpellier-Nîmes, université Montpellier 1, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France.

Robotic assisted laparoscopic surgery allows for a more precise dissection than classical laparoscopic surgery. However, it sometimes imposes specific exaggerated postures and extralong procedure duration. Combining these two factors may increase the risk for postural complications in at-risk patients. We report the case of an obese 30-year-old female patient who underwent a 12-hour duration robotic laparoscopic surgery for severe endometriosis, in Trendelenburg position. This was complicated by a two forearms rhabdomyolysis, with subsequent compartment syndrome with multiple neuropathy. Physicians must be aware of the cumulative risk for postural complications when extreme positions are associated to long duration procedures in predisposed patients. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

J Ovarian Res. 2010 Jan 19;3:2.

Endometriosis-associated ovarian cancer: A ten-year cohort study of women living in the Estrie Region of Quebec, Canada.

Aris A.

Department of Obstetrics and Gynecology, Sherbrooke University Hospital Centre, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4 Canada.

ABSTRACT: OBJECTIVES: Endometriosis has been believed to increase the risk of developing ovarian cancer, but recent data supporting this hypothesis are lacking. The aim of this study was to verify whether the incidence of endometriosis, ovarian cancer and the both increased during the last 10 years among women living in the Estrie region of Quebec. METHODS: We collected data of women diagnosed with endometriosis, ovarian cancer or both, between 1997 and 2006, from a population living in the Estrie region of Quebec. We performed this retrospective cross-sectional study from the CIRESSS (Centre Informatisé de Recherche Evaluative en Services et Soins de Santé) system, the database of the CHUS (Centre Hospitalier Universitaire of Sherbrooke), Sherbrooke, Canada. RESULTS: Among the 2854 identified patients, 2521 had endometriosis, 292 patients had ovarian cancer and 41 patients had both ovarian cancer and endometriosis. We showed a constant increase in the number of ovarian cancer (OC) between 1997 and 2006 (r2 = 0.557, P = 0.013), which is not the case for endometriosis (ENDO) or endometriosis-associated ovarian cancer (EAOC). The mean age +/- SD was 40.0 +/- 9.9 and 53.9 +/- 11.4 for patients having ENDO and OC, respectively. Mean age of women with EAOC was 48.3 +/- 10.8, suggesting an early onset of ovarian cancer in women having endometriosis of about 5.5 years average, P = 0.003. Women with ENDO were at increased risk for developing OC (Rate Ratio [RR] = 1.6; 95% Confidence Interval [CI] = 1.12-2.09). Pathological analyses showed the predominance of endometrioid type (24.4%) and clear-cell type (21.9%) types in EAOC compared to OC, P = 0.0070 and 0.0029, respectively. However, the serous type is the most widespread in OC (44.5%) in comparison to EAOC (19.51%), P = 0.0023. CONCLUSION: Our findings highlight that the number of cases of ovarian cancer is constantly increasing in the last ten years and that endometriosis represents a serious risk factor which accelerates its apparition by about 5.5 years.

Mol Endocrinol. 2010 Mar 4. [Epub ahead of print]

Minireview: Steroidogenic Factor 1: Its Roles in Differentiation, Development, and Disease.

Schimmer BP, White PC.

Banting and Best Department of Medical Research (B.P.S.), University of Toronto, Toronto, Ontario, Canada M5G 1L6; and Department of Pediatrics (P.C.W.), University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063.

The orphan nuclear receptor steroidogenic factor 1 (SF-1, also called Ad4BP, encoded by the NR5A1 gene) is an essential regulator of endocrine development and function. Initially identified as a tissue-specific transcriptional regulator of cytochrome P450 steroid hydroxylases, studies of both global and tissue-specific knockout mice have demonstrated that SF-1 is required for the development of the adrenal glands, gonads, and ventromedial hypothalamus and for the proper functioning of pituitary gonadotropes. Many genes are transcriptionally regulated by SF-1, and many proteins, in turn, interact with SF-1 and modulate its activity. Whereas mice with heterozygous mutations that disrupt SF-1 function have only subtle abnormalities, humans with heterozygous SF-1 mutations can present with XY sex reversal (i.e. testicular failure), ovarian failure, and occasionally adrenal insufficiency; dysregulation of SF-1 has been linked to diseases such as endometriosis and adrenocortical carcinoma. The current state of knowledge of this important transcription factor will be reviewed with a particular emphasis on the pioneering work on SF-1 by the late Keith Parker.

JSLS. 2009 Oct-Dec;13(4):496-503.

Laparoscopic excision of endometriosis may require unilateral parametrectomy.

Landi S, Mereu L, Indraccolo U, Favero R, Fiaccavento A, Zaccoletti R, Clarizia R, Barbieri F.

Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Verona, Italy.

OBJECTIVE: We investigated the effects of laparoscopic excision of endometriosis with unilateral parametrectomy on bladder, rectal, and sexual function as well as patient satisfaction. METHODS: Women who underwent this procedure between February 1, 2006 and November 15, 2007 were enrolled. Patient characteristics, pre- and postoperative findings, and follow-up data were retrospectively collected from a computerized database. RESULTS: Twelve patients were enrolled in the study. All of the symptoms except dysuria improved after surgery, worsening long after the operation. It seems that all parameters including sexuality, micturition, and defecation are equally important in regards to the final judgement of satisfaction, with a trend towards amelioration long after the operation. CONCLUSIONS: Unilateral parametrectomy may offer successful results in terms of patient satisfaction despite some impairment in bladder, bowel, and sexual function. The risk of permanent functional impairment is high; therefore, surgeons need to maintain the integrity of the contralateral nerve pathway. This is highly important, because pain relief seems to be partially involved in the final judgement of postoperation satisfaction.

JSLS. 2009 Oct-Dec;13(4):479-83.

Use of neutral argon plasma in the laparoscopic treatment of endometriosis.

Nezhat C, Kho KA, Morozov V.

Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia, USA.

BACKGROUND AND OBJECTIVES: To report the feasibility and safety of the use of a novel energy source that uses an electrically neutral beam of pure argon plasma for the laparoscopic management of endometriosis. METHODS: In this prospective pilot study, 20 patients undergoing laparoscopic treatment of endometriosis were included. Characteristic endometriotic lesions throughout the pelvis were vaporized or resected using neutral argon plasma. Specimens were evaluated for the presence of endometriosis and thermal effects on tissue. The bases of the treated lesions were biopsied to determine whether residual endometriosis was present. RESULTS: Neutral argon plasma was used in 18 of the 20 patients for laparoscopic treatment of pelvic endometriosis. All biopsies confirmed complete vaporization or resection with no residual endometriosis at the base. Endometriosis was identified on pathology in all lesions excised. Thermal effects did not interfere with histologic analysis in any of the lesions. No complications occurred. CONCLUSION: Neutral argon plasma can be utilized as a multi-functional device that has vaporization, coagulation, and superficial cutting capacities with minimal thermal spread and acceptable outcomes. The use of neutral argon plasma appears to be efficacious and safe for the complete treatment of endometriotic implants.

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