401: Clin Exp Dermatol. 2003 Sep;28(5):571-2. Related Articles, Links

Case 4. Umbilical endometriosis.
Rubegni P, Sbano P, Santopietro R, Fimiani M.
Departments of Dermatology and Pathology, University of Siena, Siena, Italy.rubegni@unisi.it
Publication Types:
· Case Reports
PMID: 12950365 [PubMed]
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402: J Med Assoc Thai. 2003 Aug;86(8):702-7. Related Articles, Links

Hormonal replacement therapy in surgical menopause with underlying endometriosis.
Rattanachaiyanont M, Tanmahasamut P, Angsuwatthana S, Techatraisak K, Inthawiwat S,Leerasiri P.
Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology,Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
OBJECTIVE: To evaluate the effect of hormonal replacement therapy (HRT) regimens insurgical menopause patients with underlying endometriosis. DESIGN: Observationalretrospective study. MATERIAL AND METHOD: 123 women with endometriosis afterdefinite surgery (total abdominal hysterectomy with bilateral salpingo-oophorectomy)were followed in the Gynecologic Endocrinology and Menopause clinics. Patients wereclassified into 4 groups according to HRT regimens, i.e. control (no HRT, n=17),estrogen only (ERT, n=50), cyclic estrogen/progestin regimen (cyclic E/P, n=16), andcontinuous combined estrogen/progestin (ccE/P, n=24). 12 patients who received morethan one regimen and 4 patients who received less than 6 months of HRT were excludedfrom the study. The information was obtained from the medical records. RESULTS: Meanage at surgery of all patients was 38.9 years old. Mean duration of HRT was 41.2months. There was no difference in age at surgery or duration of follow-up in eachgroup. There was 1 (2%) case of recurrent endometriosis and 3 (6%) cases ofrecurrent symptoms in the estrogen only group; none of them required additionalsurgical treatment. Malignant transformation was not found. CONCLUSIONS: Althoughthe present series is small, it seems that HRT is safe for postmenopausal women withunderlying endometriosis. Recurrence of endometriosis has rarely been a problem withHRT, especially in those who received the combination of estrogen and progestinregimens.
PMID: 12948267 [PubMed]
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403: Mayo Clin Womens Healthsource. 2000 Aug;4(8):6. Related Articles, Links

Endometriosis. A leading cause of pelvic pain and infertility.
[No authors listed] PMID: 12944775 [PubMed]
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404: Folia Med (Plovdiv). 2003;45(1):25-9. Related Articles, Links

Women with one ovary in in-vitro fertilisation.
Asimakopoulos B, Simopoulou M, Al-Hasani S, Nikolettos N.
Laboratory of Reproductive Physiology-IVF, Faculty of Medicine, Demokritus Univ. ofThrace, Alexandroupolis, Hellas, Greece. basima@med.duth.gr
Pelvic inflammatory disease, endometriosis and ectopic pregnancy are some of thecauses that may lead to unilateral oophorectomy. Women with one ovary compose agroup of specific interest in assisted reproduction. Several researchers have triedto answer whether these women have lower pregnancy rates in in-vitro fertilisationcompared to women with both ovaries. Most of the available studies include singleovary women following conventional in vitro fertilisation programs, with variousstimulation protocols. Only a few studies include single ovary women followingintracytoplasmic sperm injection/embryo transfer programs. The reported results areusually conflicting. The present review deals with the following aspects of thissubject: The response of single ovary women to external stimulation. Theimplantation and pregnancy rates of single ovary women. The correlation of thein-vitro fertilisation outcome of single ovary women with the location of the ovary.
Publication Types:
· Review
· Review, Tutorial
PMID: 12943064 [PubMed]
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405: Hunan Yi Ke Da Xue Xue Bao. 2003 Apr;28(2):102-6. Related Articles, Links

[Expression of Bcl-2 and Bax protein in endometriosis] [Article in Chinese] Huang FY, Lin QH, Fang XL.
Department of Obstetrics and Gynecology, Second Xingya Hospital, Central SouthUniversity, Changsha 410011, China.
OBJECTIVE: To study the pathophysiological effect of the expression of theapoptosis-regulating protein Bcl-2 and Bax in endometrosis. METHOD: Samples wereobtained from 16 patients with adenomyosis, 12 ovarian endometriosis, and 17 normalendometrum. Bcl-2 and Bax expression were examined by immunohistochemical ABCstaining with specific monoclonal antibodies. RESULTS: 1. The expression of Bcl-2 orBax in the eutopic endometrium was the same as the normal endometrium and theirimmunoreactivity was found predominately in the glandular epithelial cells, showingobvious cyclic changes. 2. The Bcl-2 and Bax expression in adenomyosis was not thecyclic change in ectopic glandular cells. 3. Less expression of Bcl-2 and Bax wasfound in the ovarian endometriosis. CONCLUSIONS: 1. The Bcl-2 and Bax cyclic changemay play an important role in the proliferation and physiologic death of normal andeutopic endometrial glandular epithelial cells. 2. Bcl-2 may play an important rolein forming adenomyosis. 3. Bcl-2 may be the cause of forming chocolate cyst byprompting apoptosis.
PMID: 12934347 [PubMed]
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406: Endocrinology. 2003 Sep;144(9):3934-42. Related Articles, Links

Transactivation of steroidogenic acute regulatory protein in human endometrioticstromalcells is mediated by the prostaglandin EP2 receptor.
Sun HS, Hsiao KY, Hsu CC, Wu MH, Tsai SJ.
Institute of Molecular Medicine, National Cheng Kung University Medical College,Tainan 70101, Taiwan, Republic of China.
Steroidogenic acute regulatory protein (StAR) regulates the first committed step inthe biosynthesis of steroids, and thus aberrant expression of StAR in endometrioticimplants plays a critical role in the etiology of endometriosis. However, themechanism responsible for abnormal expression of StAR in ectopic endometriotictissues remains unknown. In the present study, we demonstrate that prostaglandin(PG) E(2) stimulates StAR protein expression at the cellular and molecular levels.PGE(2) caused a rapid increase in StAR expression that involves activation of theEP2 receptor-coupled protein kinase A pathway. Activation of EP2 receptor-inducedphosphorylation of ERK and cAMP response element binding protein (CREB). However,activation of ERK did not involve in CREB phosphorylation or concomitantly StARexpression. Phosphorylation of CREB induced by PGE(2) increased the recruitment ofCREB binding protein and thus histone H3 acetylation. Chromatin immunoprecipitationexperiments showed that acetylated histone H3 bound to the proximal region of theStAR promoter was increased after 30 min treatment with PGE(2), and this wasmirrored by an increase in nascent StAR RNA transcription. Treatment with thehistone deacetylase inhibitor, tricostatin A, enhanced PGE(2)-induced nascent StARRNA transcription. We conclude that increased histone H3 acetylation involving theEP2 receptor, protein kinase A, CREB, and CREB binding protein is responsible forPGE(2)-induced StAR gene activation in endometriotic stromal cells. Our currentreport may provide new insights in understanding mechanism of abnormally localproduction of estrogen and the etiology of endometriosis.
PMID: 12933667 [PubMed]
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407: AJR Am J Roentgenol. 2003 Sep;181(3):851-6. Related Articles, Links

Adenomyosis: MRI of the uterus treated with uterine artery embolization.
Jha RC, Takahama J, Imaoka I, Korangy SJ, Spies JB, Cooper C, Ascher SM.
Department of Radiology, Georgetown University Medical Center, 3800 Reservoir Rd.N.W., Washington, DC 20007, USA.
OBJECTIVE: The purpose of this study was to determine the MRI features seen afteruterine artery embolization and to evaluate the clinical response in patients withadenomyosis. MATERIALS AND METHODS: Thirty women with adenomyosis underwent uterineartery embolization and follow-up MRI for 1 year. Of the 30, 27 patients werediagnosed with uterine fibroids and adenomyosis on the basis of MRI before uterineartery embolization. In six of the 27 patients, the dominant disease wasadenomyosis. Three of the 30 patients had adenomyosis alone. The distribution,thickness, and enhancement of adenomyosis were analyzed in each patient. Patientscompleted a symptom questionnaire. RESULTS: After uterine artery embolization, thejunctional zone-myometrial ratio did not change significantly. There were regions ofdevascularization of adenomyosis on contrast-enhanced images in 12 patients, allwith a junctional zone thickness before uterine artery embolization of more than 20mm (mean thickness, 39.2 mm). Eleven of the 12 patients had focal or asymmetricdistribution patterns of adenomyosis. All three patients with pure adenomyosis andall six patients with dominant adenomyosis reported an improvement in symptoms.CONCLUSION: In patients treated with uterine artery embolization, MRI shows changesin areas of adenomyosis with a decrease in junctional zone vascularity in patientswith thickening of the junctional zone greater than 20 mm. Devascularization may berelated to the distribution of adenomyosis. The presence of adenomyosis should notbe used as a contraindication to uterine artery embolization because most patientsshow clinical improvement after undergoing this procedure.
PMID: 12933493 [PubMed]
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408: Eur J Obstet Gynecol Reprod Biol. 2003 Sep 10;110(1):105-6. Related Articles, Links

Extremely elevated CA 125 level due to an unruptured large endometrioma.
Atabekoglu CS, Sonmezer M, Aydinuraz B, Dunder I.
Department of Obstetrics and Gynecology, Ankara University School of Medicine,Cebeci 06100, Ankara, Turkey. csatabek@yahoo.com
Publication Types:
· Case Reports
PMID: 12932883 [PubMed]
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409: Ginekol Pol. 2003 May;74(5):412-8. Related Articles, Links

[Serum CA125 variability–new aspects of clinical usefulness] [Article in Polish] Fiegler P, Kaminski K, Wegrzyn P.
Kliniki Perinatologii i Ginekologii Slaskiej Akademii Medycznej, Katowicach.
Serum levels of CA125 turned out to be a valuable parameter not only as a marker ofovarian carcinoma but also in other fields of obstetrics and gynaecology. Up to datemost of the studies dealing with the subject remain experimental and their clinicalusefulness is not widely acknowledged. Accessible and relatively cheap testsmeasuring the serum level of this antigen together with its proven clinical valuemight contribute to a more frequent and much wider use than it takes placecontemporarily.
Publication Types:
· Review
· Review, Tutorial
PMID: 12931470 [PubMed]
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410: J Med Assoc Thai. 2003 Jun;86 Suppl 2:S417-21. Related Articles, Links

Risk factors of ectopic pregnancy.
Bunyavejchevin S, Havanond P, Wisawasukmongchol W.
Department of Obstetrics and Gynecology, Faculty of Medicine, ChulalongkornUniversity, Bangkok 10330, Thailand.
OBJECTIVES: To assess the risk factors of ectopic pregnancy in Thai women. SETTING:Department of Obstetrics and Gynaecology, Faculty of Medicine, ChulalongkornUniversity. DESIGN: Case controlled study. MATERIAL AND METHOD: From 1999 to 2000,208 cases of ectopic pregnancy and 781 controls (postpartum women) were included inthe study. The women were interviewed by trained research interviewers using astandardized questionnaire. Detailed information regarding age at first intercourse,number of sexual partners, history of changing partners within 6 months, previousobstetric history, history of spontaneous and criminal abortion, history of pelvicinflammatory disease, smoking, history of endometriosis and history of previousectopic pregnancy was collected. RESULTS: By multivariate analysis, 5 variablesremained as strong and independent risk factors for ectopic pregnancy: the number ofsexual partners > or = 2 (OR = 3.02, 95% CI (1.75-5.23), vaginal delivery > or = 1(OR = 0.005, 95% CI (0.002-0.0015), history of pelvic inflamatory disease (OR =3.17, 95% CI (1.40-7.19), smoking (OR = 2.49, 95% CI (1.36-4.55), infertility (OR =2.74, 95% CI (1.35-5.54)). CONCLUSION: Problems of multiple sexual partners, pelvicinflammatory disease, smoking and infertility were the main risk factors of ectopicpregnancy in Thai women.
PMID: 12930019 [PubMed]
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411: J Med Assoc Thai. 2003 Jun;86 Suppl 2:S404-8. Related Articles, Links

Laparoscopic finding in Thai women with chronic pelvic pain.
Bunyavejchevin S, Rungruxsirivorn T, Pinchantra P, Wisawasukmongchol W, SuwajanakornS, Limpaphayom K.
Gynaecologic Endosocpy Unit, Department of Obstetrics and Gynecology, Faculty ofMedicine, Chulalongkorn University, Bangkok 10330, Thailand.
OBJECTIVE: To study the laparoscopic findings in Thai women with chronic pelvicpain. SETTING: The Gynecology Endoscopy unit, Department of Obstetrics andGynecology, Faculty of Medicine, King Chulalongkorn Memorial hospital. DESIGN:Descriptive study. MATERIAL AND METHOD: The medical records of Thai women withchronic pelvic pain undergoing laparoscopic diagnosis from January 1996 to December2001 at King Chulalongkorn Hospital were reviewed. Patients’ characteristics andlaparoscopic findings were reviewed and analyzed. RESULTS: One hundred and teneligible women were enrolled in this study. The mean age was 33.9 +/- 7.2 years old(16-54 years old). Sixty-seven (60.90%) women had endometriosis, 14 (12.73%) womenhad pelvic adhesion, 4 (3.64%) women had myoma uteri, 4 (3.64%) women had tubalocclusion and 13 (11.81%) women had normal findings. The majority (38.15%) ofendometriosis findings were in minimal stage of American Fertility Society (AFS)scores. CONCLUSIONS: The vast majority of causes of chronic pelvic pain in women inthis study was pelvic endometriosis. Laparoscopic diagnosis was an important toolfor identifying the causes in Thai patients.
PMID: 12930017 [PubMed]
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412: Hum Reprod Update. 2003 Jul-Aug;9(4):387-96. Related Articles, Links

Progestogens for endometriosis: forward to the past.
Vercellini P, Fedele L, Pietropaolo G, Frontino G, Somigliana E, Crosignani PG.
Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, Universita diMilano, Milano, Italy. paolo.vercellini@unimi.it
We performed a MEDLINE and EMBASE search to identify all studies published in thelast decade in the English language literature on the use of progestogens for thetreatment of endometriosis. Our aim was to clarify the biological rationale fortreatment and define the drugs that can be used with their doses, routes ofadministration, efficacy and tolerability. Progestogens may prevent implantation andgrowth of regurgitated endometrium inhibiting expression of matrixmetalloproteinases and angiogenesis, and they have several anti-inflammatoryin-vitro and in-vivo effects that may reduce the inflammatory state generated by themetabolic activity of the ectopic endometrium, and the consequent immune response.Oral contraceptives increase the abnormally low apoptotic activity of theendometrium of women with endometriosis. Moreover, anovulation, decidualization,amenorrhoea and the establishment of a steady estrogen-progestogen milieu contributeto disease quiescence. Progestogens are effective in the control of pain symptoms inapproximately three out of four women with endometriosis. Their effect does not seemto be inferior to that of other drugs used for the disease. Different compounds canbe administered by the oral, intramuscular, subcutaneous, intravaginal orintrauterine route, each with specific advantages or disadvantages. Medicaltreatment plays a role in the therapeutic strategy when administered over aprolonged period of time. Given their good tolerability, minor metabolic effects andlow cost, progestogens must therefore be considered drugs of choice and arecurrently the only safe and economic alternative to surgery. However, theircontraceptive effectiveness limits their use to women who do not wish to havechildren in the short term.
Publication Types:
· Review
· Review Literature
PMID: 12926531 [PubMed]
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413: Intern Med. 2003 Aug;42(8):765-6. Related Articles, Links

Catamenial hemoptysis.
Hachiya T, Okada M, Takamizawa A, Hasegawa M, Honda T, Kubo K.
Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto.
Publication Types:
· Case Reports
PMID: 12924510 [PubMed]
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414: Hum Reprod. 2003 Sep;18(9):1922-7. Related Articles, Links

The effects and effectiveness of laparoscopic excision of endometriosis: aprospective study with 2-5 year follow-up.
Abbott JA, Hawe J, Clayton RD, Garry R.
Department of Endo-Gynaecology, Royal Hospital for Women, University of New SouthWales, Sydney, Australia.
BACKGROUND: This study investigates the outcomes for women up to 5 years afterlaparoscopic excision of endometriosis. METHODS: In this prospective observationalcohort study, 254 women with chronic pelvic pain were referred to two unitsspecializing in minimal access surgical management of endometriosis. Of these, 216women underwent surgical assessment and 176 were confirmed to have endometriosis.Questionnaires and visual analogue scale (VAS) scores for dysmenorrhoea,non-menstrual pelvic pain, dyspareunia and dyschesia as well as quality of lifeinstruments; the EQ-5Dindex and EQ-5Dvas, Short-Form 12 (SF-12) and sexual activityquestionnaires were completed pre-operatively. Intra-operative details of revisedAmerican Fertility Society (rAFS) stage, site of disease, associated tests, durationof surgery and complications were noted. Follow-up was performed by postalquestionnaire and chart review. For women who had further surgery, rAFS stage, siteof disease, other procedures and histology were all recorded. RESULTS: Pain scoreswere all significantly reduced at 2-5 years for dysmenorrhoea (median VAS baselineversus follow-up 2-5 years); 9 versus 3.3 (P < 0.0001), non-menstrual pelvic pain 8versus 3 (P < 0.0001), dyspareunia 7 versus 0 (P < 0.0001) and dyschesia 7 versus 2(P < 0.0001). Quality of life was improved for the EQ-5Dindex (P = 0.008 and theEQ-5Qvas (P = 0.03) and for sexual function with pleasure (P = 0.001) and habit (P =0.012) being improved and discomfort being decreased (P = 0.001). The chance ofrequiring further surgery as determined by the Kaplan-Meier survival curve was 36%.A rAFS score of >70 was predictive of requiring further surgery (P = 0.03). Of womenwho had further surgery, endometriosis was found histologically in 68%. CONCLUSIONS:Laparoscopic excision of endometriosis significantly reduces pain and improvesquality of life for up to 5 years. The probability of requiring further surgery is36%. Return of pain following laparoscopic excision is not always associated withclinical evidence of recurrence.
PMID: 12923150 [PubMed]
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415: Hum Reprod. 2003 Sep;18(9):1841-7. Related Articles, Links

Tubal damage in infertile women: prediction using chlamydia serology.
Akande VA, Hunt LP, Cahill DJ, Caul EO, Ford WC, Jenkins JM.
University Division of Obstetrics and Gynaecology, St Michael’s Hospital, BristolBS2 8EG, UK. valentine.akande@bristol.ac.uk
BACKGROUND: The study explores the relationship between serum chlamydia antibodytitres (CATs) and detection of tubal damage in infertile women. METHODS: The tubalstatus and pelvic findings in 1006 women undergoing laparoscopy for infertility wererelated to CAT, which was measured using the whole-cell inclusion immunofluorescencetest. RESULTS: A negative correlation between CAT and age was noted. A linear trendbetween serum CAT and the likelihood of tubal damage, including severe damage, wasobserved (P < 0.001). Titres in women with tubal damage (median 1:1024; range<1:64-1:4096) were significantly (P < 0.001) higher than in women with endometriosisalone (median <1:64; range <1:64-1:512) or those with a normal pelvis (median <1:64;range <1:64-1:1024). Women with positive titres were more likely to have pelvicadhesions than tubal occlusion unless titres were very high, when tubal damage waslikely to be more severe. CONCLUSIONS: CATs are of predictive value in the detectionof tubal damage and are quantitatively related to the severity of damage. Forpractical clinical purposes, Chlamydia serology is useful mainly as a screening testfor the likelihood of tubal damage in infertile women and may facilitate decisionson which women should proceed with further investigations without delay.
PMID: 12923136 [PubMed]
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416: Hum Reprod. 2003 Sep;18(9):1820-7. Related Articles, Links

Luteal phase dose-response relationships of the antiprogestin CDB-2914 in normallycycling women.
Passaro MD, Piquion J, Mullen N, Sutherland D, Zhai S, Figg WD, Blye R, Nieman LK.
Pediatric and Reproductive Endocrinology Branch, National Institute of Child Healthand Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD20892, USA.
BACKGROUND: Progesterone receptor modulators have potential therapeutic use inprogesterone-dependent conditions such as endometriosis, fibroids and induction oflabour. The synthetic steroid CDB-2914 binds to the progesterone and glucocorticoidreceptors. In animals it has antiprogestational activity at doses 50-fold less thanthose required for antiglucocorticoid effects. METHODS AND RESULTS: We evaluated thebiological activity, blood levels and safety of CDB-2914 at escalating single doses,in 36 normally cycling women at mid-luteal phase. CDB-2914 at doses of 1-100 mg didnot change luteal phase length, but after 200 mg, all women had early endometrialbleeding. Four women with early menses had concurrent functional luteolysis (one at10, 50, 100 and 200 mg). There were no biochemical or clinical signs of toxicity,and no effect on urinary cortisol or circulating thyroxine, prolactin,adrenocorticotrophic hormone or renin levels. Higher serum equivalents of CDB-2914were observed by radioimmunoassay than by high performance liquid chromatographydetection, indicating a considerable contribution of metabolites. CONCLUSIONS:Mid-luteal administration of CDB-2914 antagonizes progesterone action on theendometrium, in a dose-dependent fashion, without apparent antiglucocorticoideffects. Further study of CDB-2914 is needed to determine its clinical role.
Publication Types:
· Clinical Trial
· Randomized Controlled Trial
PMID: 12923133 [PubMed]
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417: Hum Reprod. 2003 Sep;18(9):1767-71. Related Articles, Links

Effect of GnRH analogues on apoptosis and release of interleukin-1beta and vascularendothelial growth factor in endometrial cell cultures from patients withendometriosis.
Meresman GF, Bilotas MA, Lombardi E, Tesone M, Sueldo C, Baranao RI.
Instituto de Biologia y Medicina Experimental (IBYME-CONICET), Vuelta de Obligado2490, (C1428DNA) Buenos Aires, Argentina. meresman@dna.uba.ar
BACKGROUND: The aim of the present study was to evaluate the effect of GnRHanalogues on the in-vitro eutopic endometrial cell apoptosis and release ofinterleukin-1beta (IL-1beta) and vascular endothelial growth factor (VEGF). METHODS:Biopsy specimens of eutopic endometrium obtained from 16 women with untreatedendometriosis and 14 controls were studied. Apoptosis, IL-1beta and VEGF releasewere evaluated in epithelial endometrial cell cultures after incubation withleuprolide acetate (LA) as GnRH agonist, antide as GnRH antagonist, and acombination of both. The percentage of apoptotic cells was evaluated by the acridineorange-ethidium bromide technique, and IL-1beta and VEGF concentrations wereassessed by using commercial enzyme-linked immunosorbent assay (ELISA) kits.RESULTS: We found that LA (100 ng/ml) enhanced apoptosis in endometrial cellcultures from endometriosis patients and controls and this effect was reversed byantide at 10(-7) mol/l. IL-1beta and VEGF release was downregulated by LA incultures from controls and endometriosis patients. The addition of antide 10(-7)mol/l reversed this inhibition. Endometrial cultures treated with antide at 10(-7)mol/l did not show any significant effects compared with basal conditions.CONCLUSIONS: GnRH agonists appear to have a direct effect in endometrial cellscultures, by enhancing the percentage of apoptotic cells and decreasing the releaseof pro-mitogenic cytokines such as IL-1beta and VEGF.
PMID: 12923126 [PubMed]
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418: Di Yi Jun Yi Da Xue Xue Bao. 2003 Aug;23(8):757-60. Related Articles, Links

Determination of HGF concentration in serum and peritoneal fluid in women withendometriosis.
Zong LL, Li YL, Ha XQ.
Department of Obstetrics and Gynecology, Zhujiang Hospital, First Military MedicalUniversity, Guangzhou 510282, China. zonglili67@hotmail.com
Scatter factor (hepatocyte growth factor, SF/HGF) is a multifunctional polypeptidegrowth factor that plays an important role in tumor proliferation, angiogenesis andinvasiveness. The aim of this study was to investigate the role of HGF inendometriosis and their relationship. Peritoneal fluid and serum samples of 126women of reproductive age receiving laparoscopy (72 with endometriosis and 54without endometriosis) were obtained and enzyme-linked immunosorbent assay (ELISA)was employed to measure HGF concentrations. The results revealed that theconcentrations of HGF were significantly elevated in women with endometriosis stagesI/II and III/IV as compared with HGF level in the control group (peritoneal fluidlevels of 0.337+/-0.065, 0.458+/-0.160, 0.915+/-0.113, P<0.001; serum level of0.335+/-0.663, 0.456+/-0.151, 0.907+/-0.170, P<0.001 respectively). A positivecorrelation was found between peritoneal fluid and serum levels of HGF, which variedlittle with phases of the menstrual cycle. Comparisons of the women in the samemenstrual cycle between the three groups revealed that increased levels of HGF inpatients with advanced endometriosis were not attributed to the cycle phase. Ourresults indicated that the degree of endometriosis was positively correlated withHGF concentration in peritoneal fluid and serum. Therefore, the detection of serumHGF concentration may be useful in classifying endometriosis, and may also help inselecting the optimal treatment methods.
PMID: 12919890 [PubMed]
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419: J Obstet Gynaecol. 2003 May;23(3):328-9. Related Articles, Links

Silent pelvic endometriosis presenting as pyelonephritis and ureteric obstruction.
Sanyal D, Argent VP.
Department of Obstetrics and Gynecology, Eastbourne District General Hospital, UK.
Publication Types:
· Case Reports
PMID: 12918509 [PubMed]
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420: Arzneimittelforschung. 2003;53(7):507-14. Related Articles, Links

Effects of the novel orally active antiestrogen TZE-5323 on experimental endometriosis.
Saito T, Yoshizawa M, Yamauchi Y, Kinoshita S, Fujii T, Mieda M, Sone H, Yamamoto Y,Koizumi N.
Pharmacology Department, Teikoku Hormone Mfg. Co., Ltd., Kawasaki, Kanagawa, Japan.saito-t1@kw.teikoku-hormone.co.jp
Danazol and gonadotropin-releasing hormone agonists which are used as therapeuticdrugs for endometriosis, develop adverse reactions in association with theirlong-term use. The efficacy of anti-estrogens for endometriosis, anestrogen-dependent disorder, has not been demonstrated. A novel, orally activeanti-estrogen, TZE-5323 ((2-cyclohexy-6-hydroxybenzo[b]thien-3-yl)[4-[2-(1-piperidinyl)ethoxy]phenyl] methanone hydrochloride, CAS 150797-71-0; free saltformula) was developed. TZE-5323 showed strong affinity for human estrogen receptoralpha (hER alpha) and beta (hER beta), and dose-dependently inhibitedestradiol-stimulated transcriptional activation via hER alpha and hER beta.Furthermore, TZE-5323 dose-dependently reduced estrogen-increased uterine weight inovariectomized rats. Tamoxifen showed agonistic activity on hER alpha, whileTZE-5323 did not show such activity. In the experimental endometriosis model in ratsin which endometrial tissue is autotransplanted into the renal subcapsular space,TZE-5323 dose-dependently reduced the volume of the endometrial implant as diddanazol and leuprorelin acetate. Furthermore, the long-term administration ofTZE-5323 neither showed a decrease in bone mineral density nor did it affect serumestradiol concentrations in intact rats. Therefore, TZE-5323 suggested its potentialas a novel therapeutic drug for endometriosis which is effective also in long-termuse.
PMID: 12918217 [PubMed]
——————————————————————————–
421: Cochrane Database Syst Rev. 2003;(3):CD000155. Related Articles, Links

Update of:
· Cochrane Database Syst Rev. 2000;(2):CD000155.
Ovulation suppression for endometriosis.
Hughes E, Fedorkow D, Collins J, Vandekerckhove P.
Rm HSC-4F7, Dept of Obstetrics & Gynecol, McMaster University, 1200 Main St West,Hamilton, Ontario, Canada, L8N 3Z5.
BACKGROUND: Endometriosis is the finding of endometrial glands or stroma in sitesother than the uterine cavity. Endometriosis appears to be an estrogen dependentcondition. This hormonal dependency has prompted the therapeutic use of ovulationsuppression agents, in an effort to improve subsequent fertility. OBJECTIVES: Todetermine the effectiveness of a) ovulation suppression with danazol, medroxyprogesterone acetate, gestrinone, combined oral contraceptive pills and GnRHanalogues versus placebo or no treatment and b) any of the above agents versusdanazol, for the treatment of endometriosis-associated subfertility. SEARCHSTRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group trialregister (searched 30 April 2002), the Cochrane Central Register of ControlledTrials (Cochrane Library, Issue 2, 2002), MEDLINE (January 1966 to December 1998),EMBASE (January 1985 to December 1997) and reference lists of articles. We alsocontacted manufacturers and researchers in the field. SELECTION CRITERIA: Trialscomparing the interventions described above, were included if allocation totreatment was based on a random process. Six RCTs with seven treatment arms comparedan ovulation suppression agent with placebo or no treatment. Ten trials wereidentified comparing a suppressive agent with danazol. DATA COLLECTION AND ANALYSIS:Relevant data were extracted independently by two reviewers using the standardiseddata extraction sheet. Validity was assessed in terms of method of randomisation,completeness of follow-up, presence or absence of crossover and co-intervention. 2 x2 tables were generated for all relevant outcomes. Odds ratios were generated usingthe Peto modified Mantel-Haenszel technique. Statistical heterogeneity was assessedusing Breslow-Day X2. MAIN RESULTS: The odds ratio for pregnancy following ovulationsuppression versus placebo or no treatment was 0.74 (95%CI 0.48 to 1.15). These datawere statistically homogeneous, despite the use of a variety of suppression agents.They suggest no statistically significant benefit from treatment. The odds ratio forpregnancy following all agents versus danazol, the most commonly used agent prior tothe advent of gonadotropin releasing hormone agonists (GnRHa), was 1.3 (95% CI 0.97to 1.76). When GnRHa and danazol were directly compared, the odds ratio forpregnancy across six trials, was similar to the summary statistic for all tenstudies: 1.29 (95% CI 0.9 to 1.85). Again, this suggests no statisticallysignificant difference between these interventions. REVIEWER’S CONCLUSIONS: Theseresults rule out a benefit of more than a 15% increase in odds, and do not justifythe risk of side effects when used as therapy for endometriosis-associatedsubfertility.
Publication Types:
· Review
· Review, Academic
PMID: 12917884 [PubMed]
——————————————————————————–
422: Semin Reprod Med. 2003 May;21(2):255-62. Related Articles, Links

Future directions in endometriosis research.
Hastings JM, Fazleabas AT.
Department of Obstetrics and Gynecology, College of Medicine, University of Illinoisat Chicago, 820 South Wood Street, Chicago, IL 60612, USA.
Endometriosis is an estrogen-dependent condition that affects 5 million Americanwomen; however, its etiology is not fully understood. The development of the baboonmodel of endometriosis provides an extremely powerful tool to investigate thedevelopment and progression of endometriosis from the early invasive phase to theadvanced established disease. The inflammatory reaction that occurs in theperitoneal cavity at the site of endometriotic lesions does not clear the refluxedendometrial fragments. Moreover, this reaction appears to promote the survival ofthe tissue and the development of the disease. Exploration of the interactionsbetween peritoneal macrophages and cytotoxic T cells and endometrial cells willdetermine whether their ability to scavenge and induce apoptosis is altered.Determining the mechanism(s) that induces the expression of estrogen and itsreceptor (ERbeta) is crucial to our understanding of the progression of the disease.The effects of ERbeta activation in endometriotic lesions should be investigated. Itis important to determine the effects of estrogen on the function of the immunecells, either directly or indirectly. Finally, determining the effect of events atsites of ectopic endometrium on the eutopic endometrium may elucidate themechanism(s) of infertility associated with endometriosis.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917794 [PubMed]
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423: Semin Reprod Med. 2003 May;21(2):243-54. Related Articles, Links

Endometriosis and subfertility: is the relationship resolved?
D’Hooghe TM, Debrock S, Hill JA, Meuleman C.
Leuven University Fertility Center, Department of Obstetrics and Gynecology,University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
There are many arguments to support the hypothesis that there is a causalrelationship between the presence of endometriosis and subfertility. These argumentsare reviewed in this article and include: (1) an increased prevalence ofendometriosis in subfertile women compared with women of proven fertility; (2) areduced monthly fecundity rate (MFR) in baboons with mild to severe (spontaneous orinduced) endometriosis compared with those with minimal endometriosis or a normalpelvis; (3) a trend toward a reduced MFR in infertile women with minimal to mildendometriosis compared with women with unexplained infertility; (4) a dose-effectrelationship: a negative correlation between the r-AFS stage of endometriosis andthe monthly fecundity rate and crude pregnancy rate; (5) a reduced monthly fecundityrate and cumulative pregnancy rate after donor sperm insemination in women withminimal-mild endometriosis compared with those with a normal pelvis; (6) a reducedMFR after husband sperm insemination in women with minimal to mild endometriosiscompared with those with a normal pelvis; (7) a reduced implantation rate per embryoafter IVF in women with moderate to severe endometriosis compared with women with anormal pelvis; and (8) an increased monthly fecundity rate and cumulative pregnancyrate after surgical removal of minimal to mild endometriosis.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917793 [PubMed]
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424: Semin Reprod Med. 2003 May;21(2):235-42. Related Articles, Links

Pre- and post-surgical management of endometriosis.
Donnez J, Pirard C, Smets M, Jadoul P, Squifflet J.
Department of Gynecology, Universite Catholique de Louvain, Cliniques UniversitairesSt-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium.
The efficacy of medical and surgical treatment of endometriosis-associatedinfertility and pelvic pain is a source of questions and controversies. Completeresolution of endometriosis is not yet possible, but therapy has essentially threemain objectives: (1) to reduce pain, (2) to increase the possibility of pregnancy,and (3) to delay recurrence for as long as possible. It could be concluded that aconsensus will probably never be reached on minimal and mild endometriosis. In casesof moderate and severe endometriosis-associated infertility, the combined approach(operative laparoscopy with gonadotropin-releasing hormone agonist) must beconsidered as first-line treatment. The mean pregnancy rate of 50% reported in theliterature following surgery provides scientific proof that operative treatmentshould first be undertaken to give our patients the best chance of conceivingnaturally. In cases of rectovaginal adenomyotic nodule, surgery must be consideredas first-line therapy, medical therapy being relatively inefficacious.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917792 [PubMed]
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425: Semin Reprod Med. 2003 May;21(2):223-34. Related Articles, Links

Surgical management of endometriosis.
Adamson D.
Fertility Physicians of Northern California, 540 University Avenue, Suite 250, PaloAlto, CA 94301, USA.
Surgical management of endometriosis has assumed a prominent role in treatingendometriosis-associated infertility and pain. Given the relative lack ofprospective, randomized, controlled studies, firm conclusions regarding optimaltreatment are difficult. With respect to infertility, the available data generallysupport surgical management as effective for all stages of disease. Ovariansuppression is usually ineffective and should not be used forendometriosis-associated infertility except in highly selected cases. The managementof endometriosis-associated pain usually needs to be multifaceted with surgery beingan important, but not the only, component. Except for selected young womenresponding to ovarian suppression, most patients should have diagnostic laparoscopywith concurrent surgical therapy. The decision to operate depends on clinicaljudgment, surgeon skill, and individual patient needs. A comprehensive long-termmanagement plan incorporating various treatment modalities should be developed tooptimize each patient’s management with respect to pain, pelvic masses, andreproductive goals. More studies using sophisticated designs and statistical methodsand basic science initiatives in endocrinology, immunology, and genetics areincreasingly giving us better insight into endometriosis. With improved knowledge ofthis complex medical condition, more refined conclusions regarding optimal treatmentapproaches will become possible and enable clinicians to obtain better outcomes fortheir patients.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917791 [PubMed]
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426: Semin Reprod Med. 2003 May;21(2):209-22. Related Articles, Links

Medical therapy of endometriosis.
Olive DL.
Department of Obstetrics and Gynecology, University of Wisconsin Medical School, 600Highland Avenue, Madison, WI 53792-6188, USA.
The medical treatment of endometriosis is a critical aspect of the therapeuticapproach to this disease. Past methods have been based upon systemic hormonalalterations, resulting in suppression of this estrogen-responsive disorder.Treatments such as danazol, progestogens, oral contraceptives, GnRH-agonists, andgestrinone achieve their effects upon endometriosis via this method. However, with agrowing understanding of the pathogenesis of this disease, more precise moleculartargets for treatment have been identified. Thus, a series of newer agents are underdevelopment and hold the potential of greater efficacy and flexibility thantraditional treatments. This review analyzes the available and experimental medicaltreatments of endometriosis, their utility in the treatment of pain and infertility,and their role in the future.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917790 [PubMed]
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427: Semin Reprod Med. 2003 May;21(2):193-208. Related Articles, Links

Diagnosis of endometriosis.
Spaczynski RZ, Duleba AJ.
Division of Infertility and Reproductive Endocrinology, Department of Gynecology andObstetrics, Karol Marcinkowski University of Medical Sciences, Poznan, Poland.
Endometriosis is a common disorder of women of reproductive age, yet diagnosis ofthis condition is often problematic. The most frequent clinical presentations ofendometriosis include dysmenorrhea, pelvic pain, dyspareunia, infertility, andpelvic mass. However, the correlation between these symptoms and the stage ofendometriosis is poor. Currently available laboratory markers are of limited value.At present, the best marker, serum CA-125, is usually elevated only in advancedstages and therefore not suitable for routine screening. Transvaginal ultrasound andmagnetic resonance imaging are often helpful, particularly in detection ofendometriotic cysts. Recently, transrectal ultrasound and magnetic resonance imagingwere shown to be valuable in detection of deep infiltrating lesions, especially inthe rectovaginal septum. Although direct assessment of endometriotic foci atlaparoscopy may be viewed as a "gold standard" for identifying endometriosis, thecorrelation of laparoscopic observations with histological findings is often low.Ultimately, diagnosis of endometriosis requires a careful clinical evaluation incombination with judicious use and critical interpretation of laboratory tests,imaging techniques, and, in most instances, surgical staging combined withhistological examination of excised lesions.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917789 [PubMed]
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428: Semin Reprod Med. 2003 May;21(2):183-92. Related Articles, Links

Uterine and ovarian function in endometriosis.
Garrido N, Pellicer A, Remohi J, Simon C.
Instituto Valenciano de Infertilidad (IVI), Plaza Policia Local 3, 46015 Valencia,Spain.
Although numerous studies have attempted to elucidate the implication ofendometriosis for infertility, this matter still remains unexplained. Diverseclinical approaches based on assisted reproduction techniques have producedconflicting results on this issue. Nevertheless, impairment of implantation andpregnancy rates seems to affect women who suffer from endometriosis. Whether thiseffect is due to alteration of the oocyte/embryo or the endometrium still remains tobe elucidated, although actual data allude to deficiencies in both. Infertility dueto poor quality embryos derived from impaired oocytes obtained from malfunctioningovaries have been described by some groups. Endometrial defects have been argued byothers. Adding more confusion to this topic, the influence of peritoneal fluid inwomen with endometriosis and/or mixed causes also needs to be considered. The aim ofthis review is to describe the current situation in the endometriosis-relatedinfertility literature.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917788 [PubMed]
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429: Semin Reprod Med. 2003 May;21(2):173-82. Related Articles, Links

Cell adhesion molecules and endometriosis.
Witz CA.
Department of Obstetrics and Gynecology, The University of Texas Health ScienceCenter at San Antonio, 7703 Floyd Curl Drive, MSC 7836, San Antonio, TX 78229-3900,USA.
The pathogenesis of endometriosis remains poorly defined. The interaction ofendometrium with peritoneum is an important aspect of the disease process. Celladhesion molecules (CAMs) are transmembrane receptors that facilitate intercellularbinding and cellular interaction with the extracellular matrix (ECM). CAMs andcomponents of the ECM are divided into large families based on sequence homology andsimilarity of tertiary structures. The function of eutopic and ectopic endometrialCAMs has been a focus of recent studies concerning the pathogenesis ofendometriosis. Specific alterations in endometrial and peritoneal CAMs couldfacilitate binding of reflux menstruated endometrium at ectopic sites. In addition,the expression of CAMs by endometriotic lesions has been investigated to helpunderstand mechanisms involved in the maintenance of endometrial tissue in ectopiclocations. An understanding of the mechanisms involved in the interaction ofendometrium with peritoneal tissues may provide new strategies to preventendometriotic implants from forming and help treat existing lesions.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917787 [PubMed]
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430: Semin Reprod Med. 2003 May;21(2):165-72. Related Articles, Links

Apoptosis and the pathogenesis of endometriosis.
Garcia-Velasco JA, Arici A.
Instituto Valenciano de Infertilidad-Madrid, Madrid, Spain.
Apoptosis is a physiologic process that deletes unwanted cells without inducing aninflammatory reaction. Survival of endometriotic implants is associated withdecreased apoptosis and an inflammatory environment. The most widely acceptedtheory-transplantation theory-related to the pathogenesis of endometriosis issupported by the description of abnormal survival of regurgitated endometrial cells.Eutopic endometrial cells from women with endometriosis also seem to resistapoptosis further when compared with cells from disease-free women. Severalapoptotic pathways have been studied. Recent literature concerning apoptosis-relatedgenes such as bcl-2/bax and fas/fas ligand is summarized in this article. Specialemphasis is placed on sex steroid modulation and cell adhesion regulation, bothrelevant in early events of endometriosis.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917786 [PubMed]
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431: Semin Reprod Med. 2003 May;21(2):155-64. Related Articles, Links

Matrix metalloproteinases and endometriosis.
Osteen KG, Yeaman GR, Bruner-Tran KL.
Women’s Reproductive Health Research Center, Department of Obstetrics Gynecology,Vanderbilt University School of Medicine, B-1100 Medical Center North, Nashville, TN37232, USA.
Retrograde menstruation represents a plausible explanation for the development ofmost cases of endometriosis; nevertheless, additional factors must contribute to thedevelopment of disease in only 10 to 20% of women. The discriminating factor(s) indetermining the development of active endometriosis probably involves a complexarray of potentially interactive influences including steroid exposure,immunological disturbances, genetic predisposition, and, perhaps, environmentaltoxin exposure. Matrix metalloproteinases (MMPs), enzymes that mediate normal tissueturnover including endometrial breakdown at menstruation, appear to be involved inthe invasive establishment of the disease. In addition, several MMPs appear to beinappropriately expressed in the endometrium of women with this disease inassociation with a reduced sensitivity to progesterone. Altered regulation ofendometrial MMP expression in response to steroids may represent a mechanism linkingthe invasive potential of refluxed endometrium to the establishment of this diseaseonly in certain women.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917785 [PubMed]
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432: Semin Reprod Med. 2003 May;21(2):145-54. Related Articles, Links

Environmental dioxins and endometriosis.
Rier S, Foster WG.
The International Endometriosis Association, 8585 N. 76th Place, Milwaukee, WI53223, USA.
Endometriosis is a common gynecologic problem of unknown etiology. Estrogendependence and immune modulation are established features of this disease, andenvironmental contaminants have been suggested to play a role in the pathobiology ofthis disease as well. Previous work in nonhuman primates has shown that exposure tothe dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is associated with anincreased prevalence and severity of endometriosis. Further animal experiments haveimplicated dioxin and dioxin-like compounds in this disease. Rodent studies supportthe plausibility of a role of environmental contaminants in the pathophysiology ofendometriosis, although a convincing mechanistic hypothesis has yet to be advanced.Small hospital-based case-control studies have failed to provide compelling evidencefor or against an association of environmental contaminants and endometriosis.Herein we review evidence that dioxin and dioxin-like compounds are potentmodulators of immune and endocrine function critical to the pathobiology ofendometriosis. Furthermore, perspectives on the potential mechanism(s) of dioxin anddioxin-like compound-induced toxicity in endometriosis, important knowledge needs,potential animal models for endometriosis studies, and considerations integral tofuture human case-control studies are discussed.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917784 [PubMed]
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433: Semin Reprod Med. 2003 May;21(2):135-44. Related Articles, Links

Endometriosis: interaction of immune and endocrine systems.
Seli E, Arici A.
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology,Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8063, USA.
Endometriosis is a common gynecologic disorder characterized by the presence ofendometrial tissue outside the uterine cavity. Although no single theory can explainall cases of endometriosis, the most commonly accepted theory is Sampson’s theory ofretrograde menstruation. Retrograde menstruation occurs in 76 to 90% of women. Themuch lower prevalence of endometriosis suggests that additional factors determinesusceptibility to endometriosis. Endometriosis is associated with changes in bothcell-mediated and humoral immunity. Impaired natural killer cell activity resultingin inadequate removal of refluxed menstrual debris may play a role in thedevelopment of endometriotic implants. Moreover, although the peritoneal fluid ofwomen with endometriosis contains increased numbers of immune cells, these seem tofacilitate rather than inhibit the development of endometriosis. Macrophages thatwould be expected to clear endometrial cells from the peritoneal cavity appear toenhance their proliferation by secreting growth factors and cytokines. Although itis unclear whether these immunologic alterations induce endometriosis or are aconsequence of its presence, they appear to play an important role in allowingendometriosis implants to persist and progress and contribute to the development ofassociated infertility and pelvic pain. Danazol and gonadotropin-releasing hormone(GnRH) agonists are commonly used for the medical treatment of endometriosis. Thesemedications seem to down-regulate cellular and humoral immune responses concomitantwith their effect on endometriotic implants. Immunomodulatory effects of danazol andGnRH agonists are likely to contribute to the observed clinical improvementassociated with their use.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917783 [PubMed]
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434: Semin Reprod Med. 2003 May;21(2):125-34. Related Articles, Links

Endometriosis: the ultimate hormonal disease.
Gurates B, Bulun SE.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics andGynecology, University of Illinois at Chicago, 820 S. Wood Street, M/C 808, Chicago,IL 60612, USA.
Estrogen is an extremely potent mitogen for endometrium and endometriosis.Progesterone, on the other hand, inhibits the mitogenic action of estrogen onendometrium and enhances differentiation. These antiproliferative anddifferentiative effects of progesterone are less pronounced on endometriosis tissuecompared with endometrium. Thus, endometriosis is, at least in part, resistant toprogesterone action. The product of a single gene named aromatase synthesizesestrogen. The potent estrogen estradiol is metabolized and thus inactivated by anenzyme termed 17beta-hydroxysteroid dehydrogenase (HSD) type 2 that is normallyinduced by progesterone in endometrium. Progesterone action is mediated by itsreceptor subtypes progesterone receptor (PR)-A and PR-B. We found a number ofabnormalities in the expression of aromatase, 17beta-HSD type 2, and the PR-B/PR-Aratio in endometriosis tissue. These abnormalities and their functional consequencesare discussed in this review article.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917782 [PubMed]
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435: Semin Reprod Med. 2003 May;21(2):119-24. Related Articles, Links

Genomics’ role in understanding the pathogenesis of endometriosis.
Giudice LC.
Division of Reproductive Endocrinology and Infertility, Department of Gynecology andObstetrics, Stanford University School of Medicine, 300 Pasteur Drive, HH333,Stanford, CA 94305-5317, USA.
Endometriosis is a benign, estrogen-dependent disorder that has multifactorialcomponents presumed in its pathogenesis. The molecular mechanisms underlyingendometrial tissue attachment to the peritoneal surface or metaplasia of themesothelium, and subsequent invasion and establishment of a blood supply andsurvival of the endometriotic implants, are not well understood. Recent advances inmolecular biology and genomics suggest an intrinsic abnormality in the eutopicendometrium of women with endometriosis that predisposes to these processes. Theseare discussed herein.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917781 [PubMed]
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436: Semin Reprod Med. 2003 May;21(2):111-8. Related Articles, Links

Genetics of endometriosis: a review of the positional cloning approaches.
Kennedy S.
Nuffield Department of Obstetrics Gynaecology, University of Oxford, John RadcliffeHospital, Oxford OX3 9DU, United Kingdom.
There is increasing evidence that endometriosis is inherited as a complex genetictrait in which multiple genes conferring disease susceptibility interact with eachother and the environment to produce the phenotype. Research groups worldwide aretrying to identify such susceptibility genes through a "positional cloning"approach. This involves mapping their approximate chromosomal localization usinglinkage analysis by studying the segregation of DNA markers with disease in familieswithout any knowledge of disease mechanisms. The next stage involves choosing acandidate gene in that region, based upon some theoretical or actual knowledge ofdisease mechanisms, and showing that polymorphisms in that gene occur morefrequently in affected individuals than in controls. The approach should produce aclearer understanding of the molecular and cellular mechanisms involved in diseaseetiology and pathogenesis. It is unlikely that endometriosis is a single diseaseentity, and it should be possible to categorize the disease into subtypes on thebasis of genetic information. The strategy should lead to the discovery of new drugtargets, which will be a major advance given that treatment to date has focused uponcrude manipulation of ovarian function.
Publication Types:
· Review
· Review, Tutorial
PMID: 12917780 [PubMed]
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437: Ginekol Pol. 2003 Apr;74(4):262-6. Related Articles, Links

Apoptosis expression in rats’ endometrium after surgical induction of endometriosis.
Szymanowski K, Mikolajczyk M, Skrzypczak J.
Division of Reproduction, Department of Obstetrics and Gynaecology, K. MarcinkowskiUniversity of Medical Sciences, Poznan, Poland.
OBJECTIVES: Endometriosis is characterised as a presence of proliferatingendometrial fragments growing outside uterus. Despite many investigations we stilldo not understand why in some women sheded endometrium implants itself intoperitoneum and grows, and in the others does not. It is possible that apoptoticstatus of endometrial fragments implanted into peritoneum is responsible forendometriosis growth as well as the treatment results. Cellular apoptosis ischaracterised morphologically by cell shrinkage, nuclear pyknosis, chromatincondensation, and blebbing of the plasma membrane. MATERIAL AND METHODS: The studywas performed on 28 mature Wistar rats. We studied endometria of rats afterinduction of endometriosis in peritoneal cavity. RESULTS: The only difference wasfound in endometrial glands. In animals with successful endometriosis implantationapoptosis indices in endometrial glands obtained during second laparotomy were lowerthan in the endometriosis free animals (p < 0.05).
PMID: 12916267 [PubMed]
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438: Ginekol Pol. 2003 Apr;74(4):257-61. Related Articles, Links

Integrin pattern in human endometrium–new diagnostic tool in pelvic endometriosis?
Szymanowski K, Skrzypczak J, Mikolajczyk M.
Division of Reproduction, Department of Gynecology and Obstetrics, K. MarcinkowskiUniversity of Medical Sciences, Poznan, Poland.
OBJECTIVES: The only possibility to diagnose peritoneal endometriosis is laparoscopyor laparotomy with tissue sampling for histology. Women with impalpableendometriosis not visible on ultrasound suffering from infertility or teenagers withpelvic pain, where endometriosis may also be expected, would greatly benefit from aninoperative diagnostic method. A sure and comfortable method of assessing theeffectiveness of endometriosis treatment does not exist. The aim of the study wasdescription of the alpha 3 beta 1, alpha 4 beta 1 integrins and beta 1 chainexpression in endometrial biopsies in women suffering from endometriosis. Materialand methods: Laparoscopy and hysteroscopy was performed in 32 patients because ofinfertility (n = 23) and/or pelvic pain (n = 11). For histochemical

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