J Minim Invasive Gynecol.

2010 Oct 9. [Epub ahead of print]

Preoperative Evaluation of Posterior Deep-Infiltrating Endometriosis Demonstrates a Relationship with Urinary Dysfunction and Parametrial Involvement.

Ballester M, Santulli P, Bazot M, Coutant C, Rouzier R, Daraï E.

Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie, Paris VI, Paris, France (Drs. Ballester, Santulli, Coutant, Rouzier and Daraï), From the Service de Radiologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie, Paris VI, Paris, France (Dr. Bazot).

STUDY OBJECTIVE: To estimate the association between urinary symptoms and quality of life in patients with posterior deep-infiltrating endometriosis (DIE) with anatomical locations of endometriosis.

DESIGN: Prospective nonrandomized study (Canadian Task Force classification II-2).

SETTING: Tertiary care hospital.

PATIENTS: One hundred fifty-three patients with DIE and 28 control subjects.

INTERVENTIONS: Clinical examination completed using transvaginal ultrasonography and magnetic resonance imaging.

MEASUREMENTS AND MAIN RESULTS: Urinary symptoms and quality of life were evaluated using the International Prostate Symptom Score (IPSS) and Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaires. There was a higher incidence of urinary symptoms and a high IPSS in patients with posterior DIE compared with the control group. The IPSS questionnaire detected a relation between parametrial endometriosis and voiding symptoms (p = .03), altered quality of life (p = .02), and a high total score (p = 0.04) in patients with posterior DIE. No difference in urinary symptoms and total BFLUTS score was observed between the groups. A relation was found between parametrial endometriosis and urinary symptoms (p = .02), altered quality of life (p = .04), and high total score (p = .03) in patients with posterior DIE. At multivariable analysis, a correlation was found between parametrial endometriosis and IPSS total score (p = .03), IPSS voiding symptoms (p = .04), and IPSS quality of life (p = .009). Similarly, a correlation was found between parametrial endometriosis and BFLUTS symptoms (p = .003), BFLUTS quality of life (p = .003), and BFLUTS total score (p = .007).

CONCLUSION: Patients with posterior DIE have a high incidence of urinary symptoms. Moreover, parametrial endometriosis is associated with altered urinary function and should be systematically evaluated in these patients.

Copyright © 2010 AAGL. Published by Elsevier Inc. All rights reserved.

J Minim Invasive Gynecol. 2010 Oct 9. [Epub ahead of print]

Histopathologic Analysis of Intestinal Endometriosis after Laparoscopic Low Anterior Resection.

Jinushi M, Arakawa A, Matsumoto T, Kumakiri J, Kitade M, Kikuchi I, Sakamoto K, Takeda S.

Departments of Obstetrics and Gynecology (Drs. Jinushi, Kumakiri, Kitade, Kikuchi, and Takeda), Human Pathology (Drs. Arakawa and Matsumoto), and Coloproctological Surgery (Dr. Sakamoto), Juntendo University School of Medicine, Tokyo, Japan.

STUDY OBJECTIVE: To determine how intestinal endometriosis spreads, and, thus, to improve outcomes of curative surgery.

DESIGN: Descriptive study (Canadian Task Force classification II-2).

SETTING: University hospital.

PATIENTS: Ten patients who underwent laparoscopic low anterior resection of intestinal endometriosis at our hospital between January 1999 and August 2007.

INTERVENTION: Laparoscopic low anterior resection of intestinal endometriosis.

MEASUREMENTS AND MAIN RESULTS: Mapping of endometriotic foci, degree of vertical infiltration to the intestinal layers, and longitudinal spread of endometriotic foci to the intestinal plane were defined using hematoxylin-eosin, estrogen receptor, progesterone receptor, and CD10 staining.

RESULTS: Endometriotic foci tended to spread concentrically around a primary lesion that comprised most of a resected specimen. The deepest layer containing endometriotic foci at the primary lesion was the submucosal layer in 7 specimens (70%), and the internal circular muscle layer in 3 (30%). Satellite lesions comprising thickened areas that were independent of the primary lesion were detected in 5 specimens (50%). Multiple endometriotic foci were confirmed in all satellite lesions.

CONCLUSIONS: Endometriotic foci might not only infiltrate the primary lesion in intestinal endometriosis but also disseminate to other areas. Thus, the primary lesion of intestinal endometriosis with a large margin must be excised via low anterior resection.

Copyright © 2010 AAGL. Published by Elsevier Inc. All rights reserved.

Fertil Steril. 2010 Oct 8. [Epub ahead of print]

CA 125 serum values in surgically treated endometriosis patients and its relationships with anatomic sites of endometriosis and pregnancy rate.

Patrelli TS, Berretta R, Gizzo S, Pezzuto A, Franchi L, Lukanovic A, Nardelli GB, Modena AB.

Department of Maternal and Child Health-Obstetrics and Gynecology Unit, University of Parma, Parma, Italy; Department of Maternal and Child Health-Obstetrics and Gynecology Unit, University of Ljubljana, Ljubljana, Slovenia.

Endometriosis is a benign gynecologic disease defined as the presence of functional endometrial glands and stroma outside the uterine cavity, causing dysmenorrhea, dyspareunia, menstrual irregularities, and infertility. Serum CA-125 measurement is now a consolidated method for diagnosing this condition, and its interpretation has posed a number of problems, particularly regarding utility in diagnosing minimal-mild endometriosis, whereas its value as a diagnostic aid in moderate-severe stages is well recognized. In our cohort, serum CA-125 values were significantly elevated in patients with ovarian and mixed endometriosis lesions (median levels 48 U/mL), compared with those who had exclusively extraovarian foci (median levels 27 U/mL), and so the correlation between this marker and the surgical and pathologic finding of ovarian and deep endometriosis was found to be statistically significant; however, the location did not affect the fertility rate.

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

Fertil Steril. 2010 Oct 8. [Epub ahead of print]

Development and prevention of postsurgical adhesions in a chimeric mouse model of experimental endometriosis.

Herington JL, Crispens MA, Carvalho-Macedo AC, Camargos AF, Lebovic DI, Bruner-Tran KL, Osteen KG.

Women’s Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee.

OBJECTIVE: To examine the impact of a recent surgery on development of endometriosis-related adhesions in a chimeric model and to determine the therapeutic efficacy of pioglitazone (PIO).

DESIGN: Human endometrial biopsies were maintained in E(2) with or without PIO for 24 h before intraperitoneal injection into immunocompromised mice also treated with or without PIO at multiple time points after peritoneal surgery. The presence and extent of adhesions were examined in animals relative to the initial establishment of experimental endometriosis.

SETTING: Medical school research center.

PATIENT(S): Endometrial biopsies for experimental studies were provided by normally cycling women without a medical history indicative of endometriosis or adhesions.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Examination of the development of endometriosis-related adhesions in an experimental model.

RESULT(S): Without therapeutic intervention, injection of E(2)-treated human endometrial tissue into mice near the time of peritoneal surgery resulted in multiple adhesions and extensive endometriotic-like disease. In contrast, PIO treatment reduced adhesive disease and experimental endometriosis related to surgical injury.

CONCLUSION(S): The presence of human endometrial tissue fragments in the peritoneal cavity of mice with a recent surgical injury promoted development of both adhesive disease and experimental endometriosis. Targeting inflammation and angiogenesis with PIO therapy limited the development of postsurgical adhesions associated with ectopic endometrial growth.

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

Am J Obstet Gynecol. 2010 Oct 8. [Epub ahead of print]

Repeat transvaginal ultrasound-guided aspiration of ovarian endometrioma in infertile women with endometriosis.

Zhu W, Tan Z, Fu Z, Li X, Chen X, Zhou Y.

OBJECTIVE: We sought to investigate the effectiveness of repeated transvaginal ultrasound-guided aspiration of endometriomas in infertile women with endometriosis.

STUDY DESIGN: A retrospective study was performed in our department of reproductive health on 129 infertile women who underwent monthly repeated transvaginal aspiration of endometriomas. The recurrence and pregnancy were monitored during a follow-up period of 24 months.

RESULTS: Recurrences of cysts were found in 118 (91.5%) patients in the first postaspirate month and 86 (66.7%) in the second, 60 (46.5%) in the third, 28 (21.7%) in the fourth, 12 (9.3%) in the fifth, 7 (5.4%) in the sixth, and 36 (27.9%) in the 24th postaspiration month. Mean 3.1 ± 2.8 times of aspirations per patient were performed without any adverse effect. There was a linear regression relationship between the change of times of aspirations and the chance of recurrence of cysts. Overall pregnancy rate of 43.4% (56/129) was obtained.

CONCLUSION: The repetitive aspiration of endometriomas is an effective therapeutic option in patients with endometriosis.

Copyright © 2010 Mosby, Inc. All rights reserved.

Contraception. 2010 Nov;82(5):442-52. Epub 2010 Feb 1.

Mifepristone: where do we come from and where are we going? Clinical development over a quarter of a century.

Spitz IM.

Institute of Hormone Research and Ben Gurion University of the Negev, Jerusalem 92548, Israel. Irving@spitz.com

Administration of mifepristone followed by the prostaglandin, misoprostol, has been used successfully in the medical termination of pregnancy for over 25 years, and the method is registered in 35 countries. Single doses of mifepristone are also effective as an emergency postcoital contraceptive. Mifepristone administered for 3 months or longer to women with uterine leiomyomas, is associated with a reduction in pain and bleeding with improvement in quality of life and decrease in fibroid size. Mifepristone is also effective in decreasing pain in women with endometriosis. In both these conditions, serum estradiol levels are in the range of those in the early follicular phase. A daily dose of at least 2 mg mifepristone blocks ovulation. In contrast, weekly administration of 25 or 50 mg does not consistently block ovulation but has contraceptive potential by delaying endometrial development. Mifepristone in a dose of 200 mg, administered 48 h after the Luteinizing Hormone (LH) surge, also acts as a contraceptive, but this strategy is not practical for widespread use. Administration of mifepristone for 4-6 months or longer may lead to endometrial thickening. Endometrial histology reveals cystic glandular dilation together with admixed estrogen (mitotic) and progestin (secretory) epithelial effects. This histological pattern does not represent endometrial hyperplasia.

Copyright © 2010 Elsevier Inc. All rights reserved.

Contraception. 2010 Nov;82(5):396-403.

Non-contraceptive health benefits of intrauterine hormonal systems.

Fraser IS.

Department of Obstetrics, Gynaecology and Neonatology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, NSW 2006, Australia. i_fraser@med.usyd.edu.au

Non-contraceptive health benefits are now recognized as an important aspect of the overall impact of all hormonal contraceptives. The levonorgestrel-releasing intrauterine systems (LNG IUS) are particularly effective at producing a number of health benefits for women using the LNG IUS as a contraceptive (reduced menstrual bleeding; reduced dysmenorrhea and the potential for prevention of a number of gynecological conditions in the longer term, such as iron-deficiency anemia, endometrial hyperplasia, uterine fibroids, acute episodes of pelvic inflammatory disease, endometriosis and perhaps others). The LNG IUS also has the potential to specifically treat a range of pre-existing gynecological conditions such as heavy menstrual bleeding due to a wide range of underlying causes, endometrial hyperplasia, uterine fibroids, adenomyosis, and endometriosis. These health benefits should be recognized as a key component in the decision-making process for individual women in choosing a specific type of hormonal or other contraceptive. Investment in research into the very substantial health benefits of hormonal contraceptives, such as the LNG IUS, has generally been ignored in comparison with the massive investment into understanding the often subtle or rare complications of hormonal contraceptive use. Both are important, but there is a real need to define more accurately those women who will benefit most from these health benefits.

Copyright © 2010 Elsevier Inc. All rights reserved.

JSLS. 2010 Apr-Jun;14(2):169-77.

Complications associated with two laparoscopic procedures used in the management of rectal endometriosis.

Roman H, Rozsnayi F, Puscasiu L, Resch B, Belhiba H, Lefebure B, Scotte M, Michot F, Marpeau L, Tuech JJ.

Department of Gynecology and Obstetrics, University Hospital Charles Nicolle, Rouen, France. horace.roman@gmail.com

BACKGROUND: To evaluate intra- and postoperative complications associated with laparoscopic management of rectal endometriosis by either colorectal segmental resection or nodule excision.

METHODS: During 39 consecutive months, 46 women underwent laparoscopic management of rectal endometriosis and were included in a retrospective comparative study. The distinguishing feature of the study is that the choice of the surgical procedure is not related to the characteristics of the nodule.

RESULTS: Colorectal segmental resection with colorectal anastomosis was carried out in 15 patients (37%), while macroscopically complete rectal nodule excision was performed in 31 women (63%). No intraoperative complications were recorded. In the colorectal resection group, 3 women (18%) had a bladder atony (spontaneously regressive in 2 women), 4 women (24%) experienced chronic constipation, one had an anastomosis leakage (6%), while 2 women (13%) had acute compartment syndrome with peripheral sensory disturbance. In the nodule excision group, 1 woman (4%) developed transitory right obturator nerve motor palsy. Based on both postoperative pain and improvement in quality of life, all 29 women in the excision group (100%) and 14 women in the colorectal resection group (82%) would recommend the surgical procedure to a friend suffering from the same disease.

CONCLUSION: Our study suggests that carrying out colorectal segmental resection in rectal endometriosis is associated with unfavourable postoperative outcomes, such as bladder and rectal dysfunction. These outcomes are less likely to occur when rectal nodules are managed by excision. Information about complications related to both surgical procedures should be provided to patients managed for rectal endometriosis and should be taken into account when a decision is being made about the most appropriate treatment of rectal endometriosis in each case.

Yao Xue Xue Bao. 2010 May;45(5):548-54.

The action of p38 MAP kinase and its inhibitors on endometriosis.

[Article in Chinese]

Zhou WD, Chen QH, Chen QX.

Key Laboratory of Ministry of Education for Cell Biology and Tumor Cell Engineering, School of Life Sciences, Xiamen University, Xiamen 361005, China.

Endometriosis, an oestrogen-dependent disorder, is related to inflammation, p38 Mitogen activated protein kinases (p38 MAPK) can be activated by sex hormone and inflammatory factors, which plays an important role in many cellular reactions such as apoptosis, proliferation, inflammation and stresses, etc. Many studies showed that p38 MAPK was participated directly in regulating the pathogenesis of endometriosis. The special regulatory action of p38 MAPK on sex hormone and inflammation may help us to understand the intricate endometriosis pathological hypothesis. p38 MAPK inhibitors play a key role in the the study of endometriosis, and show great promise for the future. Blocking and regulating the expression of p38 MAPK on the signal transduction pathway level may hope to be a new strategy to prevent and treat endometriosis.

Isr Med Assoc J. 2010 Jun;12(6):334-7.

Measurement of electrical resistance of dermal-visceral zones as a diagnostic tool for gynecologic disorders.

Itsekson A, Shepshelovich D, Kanevsky A, Seidman DS.

Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.

BACKGROUND: Non-invasive screening tests may allow early diagnosis and prompt treatment, thereby potentially reducing morbidity and mortality and reducing costs for the community. This may be especially important for gynecologic pathologies that are difficult to promptly diagnose, such as endometriosis or ovarian cancer.

OBJECTIVES: To evaluate the reliability of measuring skin resistance using the Medex Test for screening and diagnosis of gynecologic pathologies in a blinded single-center study.

METHODS: We enrolled 150 patients: 59 with a functional disorder and 91 with an organic disease. Measurements were carried out in all patients and the results were analyzed separately by a second physician who was blinded to the patients’ diagnosis.

RESULTS: A high correlation was found between the clinical diagnosis and the results of the measurement of electrical skin resistance, with a specificity of 76.3% (45/59) for functional disorders and a sensitivity of 85.7% (78/91) for organic disorders, positive predictive value of 84.8% (78/92) and negative predictive value 77.6% (45/58). The kappa value for the results was 0.622, representing a value much better than expected randomly.

CONCLUSIONS: The Medex Test has a good specificity and a high sensitivity for the diagnosis of gynecologic disorders. Further prospective studies are needed to validate these preliminary findings.

J Obstet Gynaecol. 2010;30(7):712-5.

Laparoscopy–or not–for management of unexplained infertility.

Badawy A, Khiary M, Ragab A, Hassan M, Sherif L.

Department of Obstetrics and Gynecology, Mansoura University, Egypt. ambadawy@yahoo.com

This study aimed at evaluating the role of laparoscopy in the management of unexplained infertility in a prospective randomised controlled trial. The study comprised of 255 patients as a study group and 257 patients as a control group. All women had unexplained infertility. Patients in the study group had laparoscopy followed by ovarian stimulation and timed intercourse for six cycles, while patients in the control group were treated directly with ovarian stimulation and timed intercourse for six cycles. Severe adhesions were found in one in each of the two groups, respectively. They were referred directly to the IVF/ICSI programme. Moderate pelvic endometriosis was demonstrated in three cases in the two groups. Again, severe endometriosis was found in two cases in the study groups and they were referred to the IVF/ICSI programme. After 6 months of follow-up, clinical pregnancy occurred in 114/255 (44.7%) in the study group and 107/257 (41.7%) in the control group and the difference was not statistically significant (p > 0.05). The miscarriage rate was similar in the two groups. We concluded that laparoscopy could be postponed when proceeding in the management of unexplained infertility, until ovarian stimulation and timed intercourse had been found to be unsuccessful in achieving pregnancy.

Reprod Sci. 2010 Oct 5. [Epub ahead of print]

Generalized Hyperalgesia in Women With Endometriosis and Its Resolution Following a Successful Surgery.

He W, Liu X, Zhang Y, Guo SW.

Although pains of various kinds top the list of complaints from women with endometriosis and are the most debilitating of the disease, little is known about the mechanism/mechanisms of endometriosis-associated pains. To test the hypothesis that women with endometriosis have generalized hyperalgesia which may be alleviated by a successful surgery, we recruited 100 patients with surgically and histologically confirmed endometriosis and 70 women without, and tested their responses to pain stimulations. Before the surgery, all patients rated their dysmenorrhea severity by Visual Analog scale (VAS) and went through an ischemic pain test (IPT) and an electrical pain test (EPT). The controls were also administrated with IPT/EPT. Three and 6 months after surgery, all patients were administrated with IPT/EPT and rated their severity of dysmenorrhea. We found that patients with endometriosis had significantly higher IPT VAS scores and lower EPT pain threshold than controls, but after surgery their IPT scores and EPT pain threshold were significantly and progressively improved, along with their dysmenorrhea severity. Thus, we conclude that women with endometriosis have generalized hyperalgesia, which was alleviated by surgery. Consequently, central sensitization may be a possible mechanism underlying various forms of pain associated with endometriosis, and its recognition should have important implications for the development of novel therapeutics and better clinical management of endometriosis.

Reprod Biol Endocrinol. 2010 Oct 5;8:116.

The frequency of CD25+CD4+ and FOXP3+ regulatory T cells in ectopic endometrium and ectopic decidua.

Basta P, Majka M, Jozwicki W, Lukaszewska E, Knafel A, Grabiec M, Stasienko E, Wicherek L.

Department of Gynecology and Oncology of the Jagiellonian University, Krakow, Poland. mowicher@cyf-kr.edu.pl.

BACKGROUND: The presence of regulatory T (Treg) cells in human endometrium is crucial for maintaining immunological homeostasis within the uterus. For this study we decided to evaluate the subpopulations of Treg cells in conditions where a disturbance in the immunological equilibrium in ectopic endometrium and decidua has been observed, such as in cases of ovarian endometriosis (involving local immune cell suppression) and ectopic pregnancy (involving an increase in local immune system activity). We then compared these findings to what we observed in the normal eutopic endometrium of women during the secretory phase of the menstrual cycle (with immune cells under individual control).

METHODS: The endometrium tissue samples evaluated in our study were obtained from 47 women during one of two kinds of laparoscopic procedures. 16 of the women underwent laparoscopies due to Fallopian tube pregnancies (EP), and 16 due to ovarian endometrioma, while 15 women made up a control group. The presence of regulatory T cells in these tissue samples was evaluated by FACS.

RESULTS: In our study, the percentages of FOXP3+ cells within the subpopulation of CD4+ T lymphocytes found in the decidua of the patients treated for Fallopian tube pregnancies were statistically significantly lower than both those observed in the ovarian endometriosis tissue samples and those found in the secretory eutopic endometrium samples of the control group.

CONCLUSION: The disturbance in the immunological equilibrium observed in ectopic endometrium and decidua would seem to be related to the alteration in the Treg cell population that occurs in these ectopic tissues.

Reprod Sci. 2010 Oct 1. [Epub ahead of print]

The mRNA-Binding Protein HuR is Regulated in the Menstrual Cycle and Repressed in Ectopic Endometrium.

Karipcin FS, Ensari TA, Kayisli UA, Guzel E, Kallen CB, Seli E.

Cytokines modulate turnover of the endometrium during the menstrual cycle and contribute to the pathogenesis of endometriosis. Gene expression for cytokines is often regulated by proteins that bind to adenosine- and uridine-rich elements (AREs) in their transcripts to stabilize or destabilize bound messenger RNAs (mRNAs). HuR/ELAVL1 is an RNA-binding protein that stabilizes ARE-containing mRNAs. We hypothesized that HuR might play a role in regulating cytokine expression during the menstrual cycle and in endometriosis and characterized the expression and regulation of HuR in eutopic and ectopic human endometrium. Tissue sections obtained from normal (n = 23) and ectopic (n = 16) endometrium were immunostained for HuR, and staining intensity was evaluated by HSCORE. Cultured stromal cells isolated from normal endometrium were treated with vehicle, estradiol (E2), progesterone (P), E2 + P, tumor necrosis factor-α (TNF-α), and interleukin 1β (IL-1β) for 24 hours, and HuR expression was determined by Western blot. HuR immunoreactivity was significantly lower in the early proliferative and late secretory phases (157.5 ± 11.08 and 190.0 ± 15.2, respectively), compared to the mid-late proliferative (270.0 ± 8.0) and early-mid secretory phases (256.6 ± 20.2; P < .01, analysis of variance [ANOVA]). Furthermore, HuR expression was significantly lower in ectopic endometrial cells compared to normal endometrium in mid-late proliferative and early-mid-secretory phases (P < .01). Estrogen, P, or cytokines did not alter HuR expression in cultured endometrial stromal cells. Increased HuR levels in the mid-menstrual phases are likely to contribute to reduced mid-cycle cytokine expression and enhanced cellular survival in eutopic endometrium. In ectopic endometrium, elevated cytokine levels associated with endometriosis likely reduce HuR expression.

Eur J Obstet Gynecol Reprod Biol. 2010 Sep 30. [Epub ahead of print]

Risk factors for rupture in tubal ectopic pregnancy: definition of the clinical findings.

Goksedef BP, Kef S, Akca A, Bayik RN, Cetin A.

Haseki Teaching and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.

OBJECTIVES: The aim of this study is to determine the risk factors for rupture of an ectopic pregnancy (EP) to help physicians identify those women who are at greatest risk.

STUDY DESIGN: The study group comprised the cases of EP treated in our department from January 2003 to September 2009. The following parameters were retrospectively examined: rupture status, past history of pelvic infection or EP, use of an intrauterine device (IUD), parity and gestational age. Women with tubal rupture were compared to those without rupture. Where appropriate, univariate and multivariate analyses were used to identify predictors of the outcome of EP.

RESULTS: Two hundred and thirty-two cases of EP were retrieved. Eighty-eight of them (37.9%) were cases with ruptured EP and 144 (62.1%) were cases with unruptured EP. No significant associations existed regarding IUD use, smoking, previous ectopic pregnancy, past history of pelvic inflammatory disease (PID) or history of endometriosis. The mean gestation (in weeks) since the last menstrual period and the mean level of βhCG were significantly higher in patients with ruptured EP compared with patients with unruptured EP (7.8±1.09 versus 6.4±1.2, p<0.0001; and 8735.3±11317.8IU/ml versus 4506±5673.7IU/ml, p<0.0001, respectively). Logistic regression analysis revealed that 6-8 weeks of amenorrhoea (OR: 3.67; 95% CI: 1.60-8.41) and >8 weeks of amenorrhoea (OR: 46.46; 95% CI: 14.20-152.05) and also 1501-5000IU/ml of βhCG level (OR: 4.11; 95% CI: 1.53-11.01) and >5000IU/ml of βhCG levels (OR: 4.40; 95% CI: 1.69-11.46) were the significant risk factors for tubal rupture.

CONCLUSIONS: Higher βhCG levels and higher gestational age seem to be significant risk factors for rupture of an EP.

Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Am J Obstet Gynecol. 2010 Sep 29. [Epub ahead of print]

Laparoscopic incidental appendectomy during laparoscopic surgery for ovarian endometrioma.

Lee JH, Choi JS, Jeon SW, Son CE, Bae JW, Hong JH, Lee KW, Lee YS.

Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

OBJECTIVE: We sought to investigate the safety and efficacy of laparoscopic incidental appendectomy during laparoscopic surgery for endometrioma.

STUDY DESIGN: We conducted a retrospective study of 356 patients undergoing laparoscopic surgery for endometrioma with appendectomy (appendectomy group, n = 172) or not (nonappendectomy group, n = 184). Primary outcome measures were operating time, hemoglobin change, hospital stay, return of bowel activity, and any complications. The secondary outcome was appendiceal histopathology.

RESULTS: There were no statistical differences between groups in operating time, postoperative changes in hemoglobin concentration, hospital stay, return of bowel activity, or complication rate. Of the 172 resected appendices, 52 had histopathologically confirmed abnormal findings including appendiceal endometriosis in 16.

CONCLUSION: Incidental appendectomy at the time of laparoscopic surgery for endometrioma does not increase operative morbidity, and it has considerable diagnostic and preventive value. However, a large prospective randomized study is needed in the future to confirm this conclusion.

Copyright © 2010 Mosby, Inc. All rights reserved.

Zhongguo Zhen Jiu. 2010 Sep;30(9):725-8.

Clinical observation on acupuncture combined with acupoint sticking therapy for treatment of dysmenorrhea caused by endometriosis.

[Article in Chinese]

Chen M, Zhang H, Li J, Dong GR.

Department of Acupuncuture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, Shanghai 200437, China.

OBJECTIVE: To observe the clinical therapeutic effect of acupuncture combined with acupoint sticking therapy for treatment of dysmenorrhea caused by endometriosis, and to probe into the best therapy for this kind of disease.

METHODS: Seventy-three cases of dysmenorrhea caused by endometriosis were randomly divided into an acupuncture combined with acupoint sticking therapy group (observation group) and a medication group (control group). The observation group (36 cases) was treated with acupuncture combined with acupoint sticking therapy, Zhongji (CV 3), Guanyuan (CV 4), Zigong (EX-CA 1) etc. were selected; the control group (37 cases) was treated with oral administration of Jiawei Mojie tablet. The clinical effects, pain scores, onset time of producing analgesic and duration of both groups were observed before and after treatment.

RESULTS: The short term total effective rate of 91.2% (31/34) in observation group was better than that of 83.3% (30/36) in control group (P < 0.05); the long term total effective rates were 97.1% (33/34) and 69.4% (25/36) in observation group and control group respectively, with significant difference between two groups (P < 0. 05). The pain scores of both groups were decreased after treatment, and the improvement degree was more significant in observation group (P<0. 01); the onset time in observation group was shorter than that in control group (P<0. 05), the duration of effect in observation group was longer, and with a stable effect.

CONCLUSION: The therapeutic effect of acupuncture combined with acupoint sticking therapy is very significant for dysmenorrhea caused by endometriosis, and it is a good therapy for this kind of disease.

Reprod Sci. 2010 Sep 30. [Epub ahead of print]

Levo-Tetrahydropalmatine (l-THP) Retards the Growth of Ectopic Endometrial Implants and Alleviates Generalized Hyperalgesia in Experimentally Induced Endometriosis in Rats.

Zhao T, Liu X, Zhen X, Guo SW.

One primary goal of medical treatment of endometriosis is to alleviate pain and there is a pressing need for new therapeutics for endometriosis with better efficacy and side-effect profiles. Levo-tetrahydropalmatine (l-THP) has been used as a sedative or analgesic for chronic pains in China since 1970s. In this study, we sought to evaluate the efficacy of l-THP, with or without valproic acid (VPA), in a rat model of endometriosis. We surgically induced endometriosis in 55 adult female rats. Two weeks after, all rats were further divided into 5 groups randomly: untreated, low- and high-dose of l-THP, VPA, and l-THP + VPA. Response latency in hotplate test was measured before the surgery, before and after 3-week treatment of respective drugs. All rats were then sacrificed for analysis. The average lesion size and the immunoreactivity to N-methyl-<scp>d</scp>-asparate receptor 1 (NMDAR1), acid-sensing ion channel 3 (ASIC3), calcitonin gene-related peptide (CGRP), c-Fos, tyrosine kinase receptor A (TrkA), and histone deacetylase 2 (HDAC2) in dorsal root ganglia (DRG), to phorphorylated p65, HDAC2, TrkA, and CGRP in ectopic endometrium and to phorphorylated p65 and CGRP in eutopic endometrium were evaluated. We found that rats receiving l-THP, with or without VPA, had significantly reduced lesion size and exhibited significantly improved response to noxious thermal stimulus. The treatment also significantly lowered immunoreactivity to all mediators involved in central sensitization and to HDAC2 in DRG, to TrkA and CGRP in ectopic endometrium, and to CGRP in eutopic endometrium. In summary, l-THP reduces lesion growth and generalized hyperalgesia. Thus, l-THP may be a promising therapeutics for endometriosis.

Hum Reprod. 2010 Sep 30. [Epub ahead of print]

Pigmentary traits and risk of endometriosis.

Kvaskoff M, Bijon A, Mesrine S, Clavel-Chapelon F, Boutron-Ruault MC.

Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, ‘Nutrition, Hormones, and Women’s Health’ Team, Institut Gustave Roussy, F-94805 Villejuif, France.

Fertil Steril. 2010 Sep 29. [Epub ahead of print]

Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue.

Bayoglu Tekin Y, Dilbaz B, Kiykac Altinbas S, Dilbaz S.

Department of Obstetric and Gynecology, Agri Patnos Public Hospital, Ministry of Health, Patnos-Agri, Turkey.

OBJECTIVE: To compare efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) with depot GnRH analogue (GnRH-a; gosareline acetate; Zoladex) on endometriosis-related chronic pelvic pain (CPP) in patients with severe endometriosis during 12 months.

DESIGN: Prospective, randomized, controlled study.

SETTING: The reproductive endocrinology unit of a tertiary, research and education hospital.

PATIENT(S): Forty women with severe endometriosis (revised The American Fertility Society [AFS] classification >40) and endometriosis-related CPP and control groups were enrolled in the study.

INTERVENTION(S): The patients were treated with either LNG-IUS (n = 20) or GnRH-a (n = 20). The GnRH-a dose was repeated every 4 weeks for 24 weeks.

MAIN OUTCOME MEASURE(S): Scores of CPP were evaluated using a visual analogue scale (VAS) and total endometriosis severity profile (TESP).

RESULT(S): The TESP score decreased in the LNG-IUS group at first, third, and sixth month follow-up visits, whereas at the 12th month follow-up visit, the TESP scores were increased to values similar to pretreatment values. Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group, the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year. The LNG-IUS treatment showed a lower patient satisfaction.

CONCLUSION(S): Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis.

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

Fertil Steril. 2010 Sep 29. [Epub ahead of print]

Endometriosis and estroprogestins: the chicken or the egg causality dilemma.

Somigliana E, Vercellini P, Vigano P, Abbiati A, Benaglia L, Fedele L.

Department of Obstetrics, Gynecology, and Neonatology, Fondazione Cà Granda, Milan, Italy; Center for Research in Obstetrics and Gynecology, Milan, Italy.

Dysmenorrhea as a reason to initiate estroprogestins is significantly more common in women with endometriosis than in women without the disease. This might explain the previously reported mild association between endometriosis and past use of oral contraceptives.

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

J Magn Reson Imaging. 2010 Oct;32(4):1003-9.

Magnetic resonance imaging in the evaluation of (deep infiltrating) endometriosis: the value of diffusion-weighted imaging.

Busard MP, Mijatovic V, van Kuijk C, Pieters-van den Bos IC, Hompes PG, van Waesberghe JH.

Department of Radiology, Endometriosis Center VUMC, VU University Medical Center, Amsterdam, The Netherlands.

Erratum in:

  • J Magn Reson Imaging. 2010 Oct;32(4):1003.

Corrected and republished from:

PURPOSE: To assess the value of magnetic resonance (MR)diffusion-weighted imaging (DWI) in the evaluation of deep infiltrating endometriosis (DIE).

MATERIALS AND METHODS: In a prospective single-center study, DWI was added to the standard MRI protocol in 56 consecutive patients with known or suspected endometriosis. Endometriotic lesions as well as (functional) ovarian cysts were analyzed for location, size, and signal intensity on T1, T2, and DWI. Apparent diffusion coefficient (ADC) values were calculated using b-values of 50, 400, 800,and 1200 s/mm(2). Statistical analysis included the Spearman correlation coefficient, Mann-Whitney U, and Kruskal-Wallis tests.

RESULTS: A total of 110 lesions (62 endometrial cysts and 48 DIE) were detected, 60 of which were large enough to analyze. Mean ADC values of endometrial cysts and functional ovarian cysts were 1.10 x 10(-3)/mm(2)/s and 2.14 x 10(-3)/mm(2)/s, respectively. Mean ADC values of DIE retrocervical, infiltrating the colon, and bladder were 0.70 x 10(-3)/mm(2)/s, 0.77 x 10(-3)/mm(2)/s, and 0.79 x 10(-3)/mm(2)/s, respectively. ADC values of DIE did not show a significant difference between varying pelvic locations (P = 0.63).

CONCLUSION: Results of our study suggest that ADC values of DIE are consistently low, without significant difference between pelvic locations.

Int J Gynecol Pathol. 2010 Sep 28. [Epub ahead of print]

Squamous Cell Carcinoma of the Ovary Arising From a Mucinous Cystic Tumor of Endocervical (Müllerian) Type.

Dʼangelo E, Dadmanesh F, Pecorelli S, Prat J.

Department of Pathology (E.D’A., J.P.), Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain Department of Pathology (F.D.), Cedars-Sinai Medical Center, Los Angeles, CA Department of Gynecology and Obstetrics (S.P.), Spedali Civili di Brescia, University of Brescia, Brescia, Italy.

Primary squamous cell carcinoma of the ovary is extremely rare. We studied a 58-year-old woman in whom a keratinizing squamous cell carcinoma of the ovary had arisen from a mucinous cystic tumor of endocervical (müllerian) type. The tumor was interpreted initially as a transitional cell carcinoma of the ovary with marked squamous differentiation, but there was no evidence of either transitional cell carcinoma or malignant Brenner tumor. Furthermore, features of dermoid cyst (mature cystic teratoma), endometriosis, or adenosquamous carcinoma were not seen. The mucinous columnar epithelial component was largely benign and only focally proliferative or borderline. As found typically in endocervical (müllerian) mucinous tumors, numerous polymorphonuclear leukocytes were seen in the stroma and the neoplastic mucinous epithelium.

Endocrinology. 2010 Nov;151(11):5468-76. Epub 2010 Sep 29.

Recruitment of CCR6-Expressing Th17 Cells by CCL 20 Secreted from IL-1{beta}-, TNF-{alpha}-, and IL-17A-Stimulated Endometriotic Stromal Cells.

Hirata T, Osuga Y, Takamura M, Kodama A, Hirota Y, Koga K, Yoshino O, Harada M, Takemura Y, Yano T, Taketani Y.

Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. yutakaos-tky@umin.ac.jp.

In a novel paradigm of T cell differentiation, type 17 T helper (Th17) cells may play a significant role in endometriosis, a chronic inflammatory disease. However, the mechanism regulating the accumulation of Th17 cells in endometriotic tissues remains unknown. We hypothesized that Th17 cells migrate to endometriotic tissues through an interaction of the chemokine CC chemokine ligand (CCL)20 and its receptor CCR6. Using endometriotic tissues from women with endometriosis, we demonstrated, by flow cytometry, that Th17 cells in endometriotic tissues express CC chemokine receptor (CCR)6. Immunohistochemistry also revealed that CCL20 was expressed in the epithelial cells and stromal cells beneath the epithelium of endometriotic tissues. CCR6+ cells were small and round and scattered in the stroma in which abundant CCL20+ cells were detected. CCL20 caused selective migration of Th17 cells in the peripheral blood in a migration assay. IL-1β, TNF-α, and IL-17A increased the secretion of CCL20 in cultured endometriotic stromal cells. Inhibitors of p38- and p42/44-MAPKs, and stress-activated protein kinase/c-Jun kinase suppressed the secretion of CCL20 increased by IL-1β, TNF-α, and IL-17A. This suggests that the CCL20/CCR6 system is involved in the migration of Th17 cells to endometriotic tissues and that proinflammatory cytokines contribute to the development of endometriosis via up-regulation of CCL20 secretion from endometriotic stromal cells.

Mol Hum Reprod. 2010 Sep 27. [Epub ahead of print]

Estrogen-independent actions of environmentally relevant AhR-agonists in human endometrial epithelial cells.

Willing C, Peich M, Danescu A, Kehlen A, Fowler P, Hombach-Klonisch S.

Dept. of Human Anatomy and cell Science, University of Manitoba, 130 Basic Medical Sciences Building, 745 Bannatyne Ave., R3E 0J9 Winnipeg, Canada.

The human endometrium is a cyclically-regenerating organ under the influence of ovarian steroid hormones. Disturbances in this highly coordinated regulation of endometrial proliferation and differentiation may result in infertility and diseases such as endometriosis and endometrial cancer. Environmental toxins belonging to the group of polyhalogenated aromatic hydrocarbons (PAHs) are lipophilic xenobiotics which accumulate in biological systems. PAHs have been implicated the etiology of uterine pathologies, including infertility, endometriosis and endometrial cancer. However, suitable cellular models of the endometrium are lacking and the molecular mechanism of PAH action in the endometrium is not fully understood. In this study, we have characterized a previously established immortalized human endometrial epithelial cell model (hTERT-EEC) as a responsive in-vitro cell model to investigate the cellular and molecular mechanisms of selected environmentally relevant PAH in human endometrial epithelial cells. We show that dioxin-type PAHs activate the endogenous arylhydrocarbon receptor (AhR) signaling pathway in hTERT-EEC in a time-, concentration-, and congener-specific manner and that the induction of AhR target genes is modulated by estrogen. Strikingly, AhR activation did not interfere with estrogenic actions in these endometrial epithelial cells. Independent of their ability to bind to AhR, the PAHs investigated here increased cell migration by hTERT-EEC. Furthermore, we have identified several candidates by proteomic analysis which are involved in heat shock responses and protein modification and turnover. Our data suggest that AhR-activating environmental pollutants directly alter endometrial cell stress responses and metabolism independent of estrogenic actions.

Reprod Sci. 2010 Sep 27. [Epub ahead of print]

Acceptability of Preclinical Research on Nonhuman Primates in Reproductive Medicine: The Patient Perspective.

Dancet EA, Spiessens C, Vangenechten R, Billiet J, Tavernier JD, Welkenhuysen M, D’Hooghe TM.

U.Z. Leuven.

The attitude of patients with reproductive disorders regarding the use of nonhuman primates (NHPs) in preclinical reproductive research and its determinants was examined. A survey was conducted on 299 patients with fertility problems and/or endometriosis in a European fertility center (RR = 80%). The main outcome measure was the attitude toward reproductive research on NHPs. In total, 70.6% accept and 29.4% reject NHP research. Factors significantly positively related to acceptance are confidence in researchers and previous pregnancy. Factors significantly negatively related to acceptance include having a pet, membership of a nature organization, vegetarian, and having lived abroad. To the best of our knowledge, this study is the first on patients’ perspective on NHP research. The majority of the patients accept reproductive research on NHPs. Trust in researchers was the most important positively related factor; therefore, researchers are advised to actively try to gain the trust of patients and the public.

Br J Nutr. 2010 Sep 28:1-9. [Epub ahead of print]

Diet and risk of endometriosis in a population-based case-control study.

Trabert B, Peters U, De Roos AJ, Scholes D, Holt VL.

Department of Epidemiology, University of Washington, Seattle, WA 98195, USA.

Diet plausibly has a role in the aetiology of endometriosis through effects on steroid hormone levels; however, few published studies have examined the diet and endometriosis risk. We evaluated dietary risk factors for endometriosis in a population-based case-control study. Cases were 284 Group Health (GH) enrollees aged 18-49 years with newly diagnosed, surgically confirmed endometriosis between 1996 and 2001. Controls were 660 randomly selected age-matched female GH enrollees without a history of endometriosis. Nutrients and selected food groups were assessed using the Women’s Health Initiative FFQ. OR of endometriosis risk associated with dietary exposures were estimated using unconditional logistic regression and adjusted for identified covariates. Increased total fat consumption was associated with decreased endometriosis risk (fourth quartile v. lowest: OR 0·5, 95 % CI 0·2, 1·0, P-trend = 0·12). Increased β-carotene consumption and servings/d of fruit were associated with increased risk (β-carotene third quartile v. lowest: OR 1·7, 95 % CI 1·1, 2·6; fourth quartile v. lowest: OR 1·6, 95 % CI 1·0, 2·5, P-trend 0·16; fruit >2 servings/d v. < 1: OR 1·5, 95 % CI 1·0, 2·3, P-trend = 0·04). We also found a suggestion of decreased endometriosis risk associated with the consumption of dairy products (2 servings/d v. ≤ 1: OR 0·6, >2 servings/d v. ≤ 1: OR 0·7), but this association was not statistically significant for the highest tertile. The present study suggests that specific dietary components may be associated with endometriosis risk.

J Clin Lab Anal. 2010;24(5):357-62.

Evaluation of serum autoantibody levels in the diagnosis of ovarian endometrioma.

Yi YC, Wang SC, Chao CC, Su CL, Lee YL, Chen LY.

Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan.

OBJECTIVE: We analyzed autoantibodies against tumor-associated antigens (TAAs) in the serum of patients with endometrioma and healthy controls to determine whether autoantibodies can be accurate biomarkers for the diagnosis of ovarian endometrioma.

METHODS: Serum samples were obtained from 56 patients with endometriosis and 66 healthy women who served as normal controls. The titers of antibodies against a panel of eight TAAs were analyzed using enzyme-linked immunosorbent assay.

RESULTS: We found that the serum IGFII mRNA-binding protein 1 (IMP1) autoantibody and cyclin B1 autoantibody could discriminate between healthy controls and endometriosis patients (AUC-ROC 0.777; 95% confidence interval [CI] 0.694-0.860, P<0.0005, and AUC-ROC 0.614; 95%confidence interval [CI] 0.513-0.714, P=0.031, respectively). Using 0.073 and 0.007 as the cutoff values for IMP1 and Cyclin B1 autoantibody, respectively, the sensitivity and specificity of IMP1 were 85.7 and 63.6%, respectively. When cylcin B1 was combined with IMP1, the specificity increased to 72.7% and the sensitivity slightly decreased to 83.9%.

CONCLUSIONS: Our data suggest that IMP1 alone or combined with cyclin B1 seems to fulfill the requirements of sensitivity and specificity to become a useful clinical biomarker of endometrioma. However, further studies will be required to establish the predictive value and to support the clinical use of IMP1/cyclin B1 in the diagnosis and/or screening of endometriosis.

J. Clin. Lab. Anal. 24:357-362, 2010. © 2010 Wiley-Liss, Inc.

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