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51: Endocrinology. 2003 Jul;144(7):2870-81. Related Articles, Links
Expression profiling of endometrium from women with endometriosis reveals candidate genes for disease-based implantation failure and infertility.
Kao LC, Germeyer A, Tulac S, Lobo S, Yang JP, Taylor RN, Osteen K, Lessey BA, Giudice LC.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA 94305-5317, USA.
Endometriosis is clinically associated with pelvic pain and infertility, with implantation failure strongly suggested as an underlying cause for the observed infertility. Eutopic endometrium of women with endometriosis provides a unique experimental paradigm for investigation into molecular mechanisms of reproductive dysfunction and an opportunity to identify specific markers for this disease. We applied paralleled gene expression profiling using high-density oligonucleotide microarrays to investigate differentially regulated genes in endometrium from women with vs. without endometriosis. Fifteen endometrial biopsy samples (obtained during the window of implantation from eight subjects with and seven subjects without endometriosis) were processed for expression profiling on Affymetrix Hu95A microarrays. Data analysis was conducted with GeneChip Analysis Suite, version 4.01, and GeneSpring version 4.0.4. Nonparametric testing was applied, using a P value of 0.05, to assess statistical significance. Of the 12,686 genes analyzed, 91 genes were significantly increased more than 2-fold in their expression, and 115 genes were decreased more than 2-fold. Unsupervised clustering demonstrated down-regulation of several known cell adhesion molecules, endometrial epithelial secreted proteins, and proteins not previously known to be involved in the pathogenesis of endometriosis, as well as up-regulated genes. Selected dysregulated genes were randomly chosen and validated with RT-PCR and/or Northern/dot-blot analyses, and confirmed up-regulation of collagen alpha2 type I, 2.6-fold; bile salt export pump, 2.0-fold; and down-regulation of N-acetylglucosamine-6-O-sulfotransferase (important in synthesis of L-selectin ligands), 1.7-fold; glycodelin, 51.5-fold; integrin alpha2, 1.8-fold; and B61 (Ephrin A1), 4.5-fold. Two-way overlapping layer analysis used to compare endometrial genes in the window of implantation from women with and without endometriosis further identified three unique groups of target genes, which differ with respect to the implantation window and the presence of disease. Group 1 target genes are up-regulated during the normal window of implantation but significantly decreased in women with endometriosis: IL-15, proline-rich protein, B61, Dickkopf-1, glycodelin, N-acetylglucosamine-6-O-sulfotransferase, G0S2 protein, and purine nucleoside phosphorylase. Group 2 genes are normally down-regulated during the window of implantation but are significantly increased with endometriosis: semaphorin E, neuronal olfactomedin-related endoplasmic reticulum localized protein mRNA and Sam68-like phosphotyrosine protein alpha. Group 3 consists of a single gene, neuronal pentraxin II, normally down-regulated during the window of implantation and further decreased in endometrium from women with endometriosis. The data support dysregulation of select genes leading to an inhospitable environment for implantation, including genes involved in embryonic attachment, embryo toxicity, immune dysfunction, and apoptotic responses, as well as genes likely contributing to the pathogenesis of endometriosis, including aromatase, progesterone receptor, angiogenic factors, and others. Identification and validation of selected genes and their functions will contribute to uncovering previously unknown mechanism(s) underlying implantation failure in women with endometriosis and infertility, mechanisms underlying the pathogenesis of endometriosis and providing potential new targets for diagnostic screening and intervention.
PMID: 12810542 [PubMed – indexed for MEDLINE]
52: Eur J Gynaecol Oncol. 2003;24(3-4):258-68. Related Articles, Links
Effects of tamoxifen on the human female genital tract: review of the literature.
Varras M, Polyzos D, Akrivis Ch.
Obstetrics and Gynaecology, G. Gennimatas, General State Hospital of Athens, Second District National Health System of Athens, Greece.
Tamoxifen is a non-steroidal triphenylethylene derivate, with clear antioestrogenic effects on the breast, that is orally administrated for the treatment of breast cancer and its prevention in a high-risk population. This article analyzes the effects of tamoxifen on the adult human female genital tract and considers its carcinogenicity in the gynaecological reproductive organs. It has been found that tamoxifen causes oestrogenic changes of the vaginal and cervical squammous epithelium and increases the incidence of cervical and endometrial polyps. The action of tamoxifen on the human endometrium in postmenopausal women is connected with simple oestrogenic effects including hyperplasia, while in others with endometrial cystic atrophy. In cases where tamoxifen induces endometrial polyps and hyperplasia, the extensive fibrosis accounts for difficulties in obtaining endometrial biopsy or resecting the polyps. In premenopausal patients tamoxifen disrupts the menstrual cycles and causes ovarian cysts, while in postmenopausal patients it induces ovarian cystic tumors and endometriomas. Also, postmenopausal patients treated with tamoxifen may develop endometriosis, adenomyosis and leiomyomata. In addition, randomized trials have shown a link between tamoxifen use in breast cancer patients and the development of endometrial carcinomas. Moreover, of note is the fact that the association of tamoxifen therapy with uterine mesenchymal neoplasms is higher than expected. In conclusion, the most worrying gynaecological side-effect of tamoxifen is the well-known increased risk of endometrial carcinomas. Women with breast cancer treated with tamoxifen should undergo annual gynaecological examination, but endometrial sampling should be obtained only in the event of endometrial bleeding.
PMID: 12807236 [PubMed – in process]
53: Int J Gynecol Cancer. 2003 May-Jun;13(3):376-80. Related Articles, Links
Extensive pelvic endometriosis with malignant change in tamoxifen-treated postmenopausal women.
Bese T, Simsek Y, Bese N, Ilvan S, Arvas M.
Departments ofObstetrics and Gynecology, Division of Gynecologic Oncology; Radiation Oncology; and Pathology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
The aim of this study was to document a case of tamoxifen-associated extensive pelvic endometriosis and attract the attention to this side effect of tamoxifen use in the postmenopausal patient. A 74-year-old woman with a history of breast carcinoma who received tamoxifen therapy for 2 years was admitted with uterine bleeding. Hysteroscopic polypectomy revealed a hyperplastic polyp. Extensive pelvic endometriosis was detected at the operation and due to dense adhesions, subtotal hysterectomy and bilateral salpingo-oophorectomy were performed. The patient continued to use tamoxifen. A supracervical pelvic mass was detected 14 months later. The cervix, rectum, and the accompanying mass were resected. Histopathologic examination revealed endocervical adenocarcinoma and endometriosis involving cervix uteri and the rectal muscular wall. The patient had two normal cervical smears within the last 3 years and no abnormal appearance was detected within the cervical canal in the hysteroscopic examination. As cervical cancer occurred in a short period, it might be speculated that tamoxifen might have stimulated the proliferative and mitotic activity of cervical endometrial tissue which has progressed into invasive cancer in time.
PMID: 12801273 [PubMed – in process]
54: Fertil Steril. 2003 Jun;79(6):1288-93. Related Articles, Links
Oxidative stress may be a piece in the endometriosis puzzle.
Szczepanska M, Kozlik J, Skrzypczak J, Mikolajczyk M.
Department of Gynecology and Obstetrics, Division of Reproduction, Karol Marcinkowski University of Medical Sciences, Poznan, Poland. matmikol@gpsk.am.poznan.pl
OBJECTIVE: To assess the total antioxidant potential of women with endometriosis-associated infertility, women with idiopathic infertility, and fertile controls. DESIGN: Retrospective study. SETTING: University medical hospital. PATIENT(S): Sixty-five women admitted for diagnostic laparoscopy. MAIN OUTCOME MEASURES: Peritoneal fluid samples were analyzed for superoxide dismutase activity and total antioxidant status on spectrophotometry, glutathione peroxidase activity on enzyme-linked immunosorbent assay, and lipid peroxides levels on colorimetry. RESULT(S): Mean activity of superoxide dismutase, glutathione peroxidase, and total antioxidant status was lowest and lipid peroxide level was highest among infertile patients with endometriosis. Women with idiopathic infertility, in contrast, had the highest superoxide dismutase, glutathione peroxidase, and total antioxidant status activity and the lowest lipid peroxide level. CONCLUSION(S): High antioxidant potential is not a contributing factor in women with idiopathic infertility. Low total antioxidant status and low activity of antioxidant enzymes in the peritoneal fluid of infertile women with endometriosis probably do not influence fertility in these women, but these factors may play a role in the development of the disease.
PMID: 12798872 [PubMed – indexed for MEDLINE]
55: Life Sci. 2003 Jul 4;73(7):907-16. Related Articles, Links
Increase in the number of integrinbeta1-immunoreactive monocyte-lineage cells in experimentally-induced adenomyosis in mice.
Kawahara R, Matsuda M, Mori T.
Department of Biological Sciences, Graduate School of Science, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan. ryouka@clubaa.com
Uterine adenomyosis is a disease in which hyperplastic endometrial stroma and glands invade the myometrium. We have previously demonstrated that hyperprolactinemia leads to the development of adenomyosis in mice. In the present study, a subtracted cDNA library was made by suppression subtractive hybridization to find specific genes that are abundantly expressed in the adenomyotic but not normal tissue in mice. A cDNA fragment of integrinbeta1 (ibeta1) was found in the library, and the expression of the gene product was increased in the adenomyotic uteri at mRNA and protein levels. Intense ibeta1-immunoreactivity was localized on a group of cells dispersing throughout the endometrial stroma. The number of ibeta1-immunoreactive (ibeta1-ir) cells was significantly greater in the uteri of mice with adenomyosis than normal mice. The majority of the ibeta1-ir cells expressed CD14-ir signal, a marker for monocyte-lineage cells, whereas an increase in the number of CD14-ir cells was also evident in the adenomyotic uteri, especially in the ectopic endometrial tissue. Thus, the adenomyotic stromal tissue contained numerous monocyte-lineage cells with higher expression levels of ibeta1, one of their products. The relationship between the increased number of monocyte-lineage cells and the hyperplastic proliferation of endometrial tissues was discussed with a view to understanding the progressive mechanism of adenomyosis.
PMID: 12798416 [PubMed – indexed for MEDLINE]
56: Med J Aust. 2003 Jun 16;178(12):625-9. Related Articles, Links
Update on treatment of menstrual disorders.
Hickey M, Farquhar CM.
UWA School of Women’s and Infants’ Health, University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA 6008, Australia. mhickey@obsgyn.uwa.edu.au
There is evidence from well designed randomised controlled trials that modern medical and conservative surgical therapies (including endometrial ablation) are effective treatments for heavy menstrual bleeding for many women. Submucous fibroids may be resected directly via the hysteroscope, reducing menstrual bleeding, although data are available only from case series. Endometriosis is common, may also occur in young women and may present with atypical or non-cyclical symptoms; conservative laparoscopic surgery increases fecundity and reduces dysmenorrhoea and dyspareunia. Randomised trials of the levonorgestrel intrauterine system in women with menorrhagia have shown that hysterectomy can be avoided in 80% of cases, and that this system is an effective therapy for menorrhagia. The levonorgestrel intrauterine system may also be useful for managing symptoms of endometriosis, adenomyosis and endometrial hyperplasia, based on observational data.
PMID: 12797850 [PubMed – in process]
57: Med J Aust. 2003 Jun 16;178(12):621-3. Related Articles, Links
The efficacy of non-contraceptive uses for hormonal contraceptives.
Fraser IS, Kovacs GT.
Department of Obstetrics and Gynaecology, University of Sydney, Sydney, NSW 2006, Australia. helena@med.usyd.edu.au
In addition to providing safe and effective contraception, both the combined oral contraceptive pill (COCP) and selected long-acting progestogen-only contraceptives have significant health benefits. The COCP may reduce menstrual blood loss, dysmenorrhoea and premenstrual syndrome; unequivocally reduces the later incidence of endometrial and ovarian cancer; appears to help protect future fertility, probably by reducing the risk of acute pelvic inflammatory disease, endometriosis and uterine fibroids. The quality of evidence for individual non-contraceptive health benefits of the COCP is very variable.
PMID: 12797849 [PubMed – in process]
58: Ultrasound Obstet Gynecol. 1993 Jul 1;3(4):264-7. Related Articles, Links
Laser surgery under sonographic control: preliminary experimental investigations.
Feichtinger W, Strohmer H, Feldner-Busztin M.
Institute of Sterility Treatment, Vienna, Austria.
The laser has gained increasing importance during recent years as a useful addition to the physician’s therapeutic armoury. Reports on successful prostatectomy by ultrasound-guided laser coagulation in an animal model encouraged us to evaluate the possibility of using this technique for gynecological indications (for example, ectopic pregnancy, endometriosis, ovarian cysts, and other areas of medicine). We used two different laser systems. The devices consisted of a real-time abdominal scanner (4-5 MHz) or a transvaginal sector scanner (5-7.5 MHz) coupled to a neodymium : YAG laser with a 1064 nm wavelength or a holmium : YAG laser with 2120 nm wavelength. An experimental set-up using a water bath revealed clear visibility of the fiber tip and the laser irradiation in real-time ultrasound at 7.5 MHz. Subsequently, a needle (routinely used in transvaginal puncture of ectopic pregnancy) was placed in animal and human tissue specimens and the laser fiber was inserted. The tissue was exposed to both laser systems at different energy densities, pulse rates and pulse widths. The sonographic appearance was recorded and correlated with the macroscopic findings. Results indicate that the holmium : YAG laser at a pulse rate of 5 Hz and a power of 2 watts is effective in removing substantial amounts of tissue. Moreover, it offers immediate visualization and control of the damaged area by producing a strongly echogenic focus. The neodymium : YAG laser showed comparatively poorer sonographic visibility and a precarious thermal mode of action, which are important considerations influencing its applicability. The holmium : YAG laser system with its non-thermal mode of action seems promising for the further clinical application of ultrasound-guided laser surgery. Copyright 1993 International Society of Ultrasound in Obstetrics and Gynecology
PMID: 12797273 [PubMed]
59: J Urol. 2003 Jul;170(1):20-5. Related Articles, Links
Ureteral endometriosis.
Yohannes P.
Division of Urology, Department of Surgery, Creighton University, Omaha, NE, USA.
PURPOSE: This review discusses the pathophysiology, presentation, and different minimally invasive medical and surgical treatment options for ureteral endometriosis. MATERIALS AND METHODS: A comprehensive literature review of reports on the diagnosis and management of ureteral endometriosis was performed using MEDLINE. RESULTS: Ureteral endometriosis is a rare disease. Most cases present with silent obstruction, as opposed to cyclical hematuria. The diagnosis of ureteral endometriosis requires a high index of suspicion. A variety of diagnostic tests can help identify the extent of disease and the degree of renal function on the side of ureteral involvement. CONCLUSIONS: Ureteral endometriosis can be treated with hormones or surgical intervention. While surgery is reserved for hormone refractory cases and obstruction associated with extensive scarring, the majority of cases can be managed with hormones only. A combination of hormones and surgery is also effective. Surveillance for obstructive uropathy with periodic noninvasive monitoring of kidney function is currently recommended for all patients with endometriosis.
Publication Types: · Review · Review, Tutorial
PMID: 12796637 [PubMed – indexed for MEDLINE]
60: Kyobu Geka. 2003 Jun;56(6):513-5. Related Articles, Links
[Catamenial pneumothorax due to diaphragmatic endometriosis; report of a surgical case] [Article in Japanese] Hasumi T, Yamanaka S, Yamanaka H, Suda H.
Department of Thoracic Surgery, Ohta Nishinouchi Hospital, Kohriyama, Japan.
A 27-year-old female was complained repeated right pneumothorax. Each episode was obviously related to the onset of menstruation, suggesting catamenial pneumothorax. Thoracoscope revealed the presence of several fistulas in the central tendon of the diaphragm. Partial resection of the diaphragm including these lesions was performed under thoracoscopic procedure. Microscopic examination of the excised specimen showed endometriosis. The patient was followed without hormonal therapy, but recurrent pneumothorax occurred. For the catamenial pneumothorax, hormonal treatment is considered necessary even after surgical treatment.
PMID: 12795161 [PubMed – indexed for MEDLINE]
61: J Comput Assist Tomogr. 2003 May-Jun;27(3):297-306. Related Articles, Links
Rare benign and malignant appendiceal lesions: spectrum of computed tomography findings with pathologic correlation.
Chiou YY, Pitman MB, Hahn PF, Kim YH, Rhea JT, Mueller PR.
Department of Radiology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA.
Although acute appendicitis is the most common disease of the appendix, the appendix can be involved by a wide range of diseases. Diseases other than acute appendicitis may produce signs and symptoms indistinguishable from those of acute appendicitis. Computed tomography (CT) can provide important information for diagnosis and evaluation of appendiceal diseases. The various CT and histologic features of appendiceal benign and neoplastic diseases are discussed, illustrated, and correlated in this article. Radiologists need to understand the full spectrum of appendiceal abnormalities, their underlying pathologic changes, and associated CT imaging findings.
Publication Types: · Review · Review, Tutorial
PMID: 12794590 [PubMed – indexed for MEDLINE]
62: Ginecol Obstet Mex. 2003 Mar;71:137-42. Related Articles, Links
[Presacral neurectomy and uterine nerve ablation in chronic pelvic pain. Laparoscopic management. A comparative study.] [Article in Spanish] Garcia Leon F, Oviedo Ortega G, Reyes Cuervo H, Ibarrola Buenabad E, Von der Meden W.
Servicio de Ginecologia y Obstetricia, Hospital ABC, Ciudad de Mexico.
Chronic pelvic pain is a difficult handling medical and surgical condition and of transcendent importance to women who suffer from it. This condition has been associated to different diseases as endometriosis, adenomiosis, adnexal mass, pelvic inflammatory disease, pelvic adhesive disease. The present study was carried out comparing two laparoscopic surgical methods in an randomized way; laparoscopic uterine nerve ablation and a presacral neurectomy, with 12 patients in each group and a follow up of 12 mont. Results demonstrate a similar resolution on both groups in the short term and a significant difference on pain’s resolution within the presacral neurectomy group in the long term without post-surgery or trans-surgery complications. Concluding the presacral neurectomy is a safe and dependable method that allows a high success rate on chronic pelvic pain patients.
PMID: 12793022 [PubMed – indexed for MEDLINE]
63: Int J Mol Med. 2003 Jul;12(1):95-8. Related Articles, Links
Leptin inhibits decidualization and enhances cell viability of normal human endometrial stromal cells.
Tanaka T, Utsunomiya T, Bai T, Nakajima S, Umesaki N.
Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-8510, Japan. tetanaka@wakayama-med.ac.jp
Recent reports have demonstrated that the peritoneal fluid and serum concentrations of leptin are increased in women with endometriosis. However, the pathophysiological roles of leptin in endometriosis have not been well characterized. In this study, we examined the direct effects of leptin on normal human endometrial stromal cells using an in vitro decidualization assay system with 8-Br-cAMP, a decidualization inducer. No effects of leptin on cell viability and prolactin secretion were found in unstimulated endometrial stromal cells. Leptin dose-dependently enhanced the viability of stromal cells co-stimulated with 8-Br-cAMP and leptin while PRL secretion from the cells was significantly inhibited in a dose-dependent manner. As for 8-Br-cAMP-stimulated cells, leptin significantly enhanced their cell viability in a dose-dependent manner but not their PRL secretion. These results indicate that leptin enhances the cell viability of PRL-non-secreting 8-Br-cAMP-stimulated stromal cells, and that it inhibits the decidualization process of endometrial stromal cells. Increased leptin in endometriotic patients might play an antiapoptotic role in some activated ESCs in the peritoneal cavity to stimulate endometrial cell implantation, and might cause infertility by inhibiting stromal decidualization.
PMID: 12792816 [PubMed – in process]
64: Acta Obstet Gynecol Scand. 2003 Jul;82(7):649-53. Related Articles, Links
Diagnostic delay in women with pain and endometriosis.
Husby GK, Haugen RS, Moen MH.
Department of Obstetrics and Gynecology, St Olav’s Hospital, Trondheim University Hospital, N-7006 Trondheim, Norway.
BACKGROUND: Women with endometriosis claim that delayed diagnosis is a problem. Anglo-American studies have shown a delay from 3 to 11 years between the onset of pain symptoms and the final diagnosis of endometriosis. The aim of this study was to find the time difference between the onset of pelvic pain symptoms and the final diagnosis of endometriosis among Norwegian patients. MATERIAL AND METHODS: Questionnaires were sent to 400 women, of whom 313 were members of the Norwegian Endometriosis Association and 87 were patients with endometriosis being hospitalized at St Olav’s Hospital, Trondheim, in recent years. The response rate was 89%. Among the 356 questionnaires returned, 95 were excluded as not fulfilling the inclusion criterion of surgically verified symptomatic endometriosis or incomplete questionnaires. Data were analyzed from 261 women, of whom 223 were members of the Norwegian Endometriosis Association. In all included patients, pain was an indication for diagnostic surgery. RESULTS: The mean delay in diagnosis was 6.7 +/- 6.2 years and the median delay was 5.0 years for the two groups in total. There was no statistically significant difference in delay between the two recruitment groups. Mean delay in diagnosis had not changed significantly with time. Women reporting infertility in addition to pain did not have a significantly shorter delay. CONCLUSION: In Norway there is a considerable delay in the diagnosis of endometriosis, with figures comparable to results from Anglo-American studies. A greater awareness of symptoms of endometriosis and a more rapid investigation should thus be encouraged.
PMID: 12790847 [PubMed – in process]
65: Afr Health Sci. 2001 Dec;1(2):97-8. Related Articles, Links
Menstruation in an unusual place: a case of thoracic endometriosis in Kampala, Uganda.
Byanyima RK.
Department of Radiology, Makerere Medical School, P. O. Box 7072, Kampala, Uganda. r_byanyima@hotmail.com
While pelvic endometriosis is relatively common, thoracic menstruation is rare. A report of what is believed to be the first case of thoracic endometriosis in Uganda is given. A 34-year-old female was complaining of on and off chest pain mainly on the right side. Clinically she had signs of pleural effusion and 500 mls of altered blood were tapped from her right pleural space. Worried about a possibility of a malignant process, an urgent chest CT scan was performed. A right posterior pleural mass and pleural effusion were found. A pleural biopsy was taken and confirmed at histology as endometrial tissue. She did well on surgical excision and hormonal therapy. This was a rare case of endometriosis which shows the usefulness of imaging in the patient work up.
PMID: 12789123 [PubMed – indexed for MEDLINE]
66: J Clin Endocrinol Metab. 2003 Jun;88(6):2889-99. Related Articles, Links
Antiangiogenic agents are effective inhibitors of endometriosis.
Hull ML, Charnock-Jones DS, Chan CL, Bruner-Tran KL, Osteen KG, Tom BD, Fan TP, Smith SK.
Department of Pathology, Reproductive Molecular Research Group, Cambridge, United Kingdom CB2 1QP. mlh30@cam.ac.uk
Endometriosis is a disease in which the lining of the uterus (endometrium), shed at the time of menstruation, becomes established at sites such as the peritoneum and ovaries. These explants develop a rich blood supply that enables them to survive and grow. We hypothesized that inhibitors of angiogenesis would prevent this growth by disrupting sensitive vessels supplying endometriotic lesions. Vessels sensitive to angiogenic antagonism have few associations with pericyte cells. The vessels supplying human endometriotic lesions were immunohistochemically characterized and found to be predominantly pericyte free. A model in which human endometrium is implanted into nude mice was used to test the effects of two antagonists of the angiogenic growth factor, vascular endothelial cell growth factor A. Soluble truncated receptor (flt-1; P = 0.002) and an affinity-purified antibody to human vascular endothelial cell growth factor A (P = 0.03) significantly inhibited the growth of nude mouse explants. Pericyte-free vessels were shown to supply endometrial lesions in nude mice and were disrupted in lesions taken from soluble flt-1-treated mice. In summary, antiangiogenic agents inhibited the growth of explants in an in vivo model of endometriosis by disrupting the vascular supply, and this effect is likely to apply to the human disease. These findings suggest that antiangiogenic agents may provide a novel therapeutic approach for the treatment of endometriosis.
PMID: 12788903 [PubMed – indexed for MEDLINE]
67: J Clin Endocrinol Metab. 2003 Jun;88(6):2853-9. Related Articles, Links
Different basic fibroblast growth factor and fibroblast growth factor-antisense expression in eutopic endometrial stromal cells derived from women with and without endometriosis.
Mihalich A, Reina M, Mangioni S, Ponti E, Alberti L, Vigano P, Vignali M, Di Blasio AM.
Molecular Biology Laboratory, Istituto Auxologico Italiano, 20135 Milan, Italy.
In all species studied, the basic fibroblast growth factor (bFGF) gene is transcribed into multiple mRNAs, one of which is an antisense RNA (1B FGF-AS) probably involved in regulating the stability of the sense transcript. In this study we investigated whether the regulatory mechanisms of bFGF expression might be altered in endometrial stromal cells derived from women with endometriosis. bFGF and 1B FGF-AS mRNA levels were quantified in primary cultures of eutopic endometrial stromal cells derived from 29 women without endometriosis and 24 patients affected by the disease. When the data were analyzed according to the phase of the menstrual cycle, endometrial stromal cells derived from patients in the late proliferative phase showed significantly higher bFGF mRNA values and significantly lower 1B FGF-AS mRNA levels compared with control samples. Furthermore, the mean bFGF/1B FGF-AS mRNA ratio was significantly higher in endometrial stromal cells derived from patients compared with that in controls (mean +/- SEM, 2.31 +/- 0,55 and 0.77 +/- 0.14, respectively; P = 0.009). Moreover, for bFGF expression the differences existing at the mRNA level were maintained at the protein level. These findings support the hypothesis that 1B FGF-AS mRNA could regulate the expression of the sense transcript and suggest that in endometrial cells derived from patients, the presence of higher bFGF levels could improve their ability to proliferate at the ectopic site.
PMID: 12788899 [PubMed – indexed for MEDLINE]
68: Pathol Int. 2003 Jun;53(6):371-5. Related Articles, Links
Fibrosis and smooth muscle metaplasia in rectovaginal endometriosis.
Itoga T, Matsumoto T, Takeuchi H, Yamasaki S, Sasahara N, Hoshi T, Kinoshita K.
Department of Obstetrics and Gynecology and First Department of Pathology, Juntendo University, School of Medicine and Institute for Urban Studies, Tokyo Metropolitan University, Tokyo, Japan.
Rectovaginal (RV) endometriosis presents with a nodular lesion composed of fibromuscular and endometriotic tissue, and the fibromuscular tissue is the major component in the severe stage. The purpose of our study was to examine the extending process of fibromuscular tissue in RV endometriosis. Histological examinations using immunostains, were performed in 90 RV tissue specimens from 37 women. Fibrosis was present in 89 specimens. In each specimen, the intensity of the fibrosis differed from area to area: in mildly fibrotic areas, the collagen fibers were present around the endometriotic tissue, and in severely fibrotic areas, the fibrosis widely extended into fat and connective tissus as well as within the endometriotic tissue. In the 60 specimens containing endometriotic tissue, the increase in the amount of endometriotic tissue significantly correlated to the increase in degree of fibrosis in the entire tissue. The presence of aggregated smooth muscles, unassociated with blood vessels, was defined as smooth muscle metaplasia (SMM), which was always present within the fibrotic areas, and was observed in 80 specimens. The degree of SMM in the entire tissue was significantly correlated with the degree of fibrosis. From these findings, the following was hypothesized. Initially, endometriotic tissue was present sporadically and fibrosis was present around the endometriotic tissue. Thereafter, proliferation of endometriotic tissue and an increase in fibrosis occur consecutively. The SMM was present within the fibrotic areas, and it became more severe, correlating with the increase in fibrosis. In conclusion, this is the first report describing the extending process of the fibromuscular tissue of RV endometriosis from a histological viewpoint, and we think that recognization of this process is useful for histological diagnosis and clinical management of RV endometriosis.
PMID: 12787311 [PubMed – in process]
69: Hinyokika Kiyo. 2003 Apr;49(4):185-7. Related Articles, Links
[Clinical evaluation of ureteral endometriosis: report of 8 cases] [Article in Japanese] Nishihara K, Kawai N, Hibino M, Tozawa K, Sasaki S, Hayashi Y, Kohri K.
Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences.
We report 8 cases of ureteral endometriosis. The mean age of the 8 patients was 42 years (range 29 to 60). In all patients, endometrial lesions were located in the lower third of the ureter and were unilateral. Six patients presented with flank pain and in one of the 6 cases the pain was associated with menses. One presented with gross hematuria. One had no symptoms. Seven out of 8 cases had gynecological diseases and 4 had had surgical treatment for the gynecological diseases. Four patients were treated with gonadotropin-releasing hormone (Gn-RH) analogue for hydronephrosis of endometriosis. In 2 patients, the therapy was effective, but hydronephrosis recurred. Surgical therapy was done on all patients. We recommend surgical therapy for hydronephrosis with ureteral endometriosis.
PMID: 12784710 [PubMed – indexed for MEDLINE]
70: Am J Surg. 2003 Jun;185(6):596-8. Related Articles, Links
Abdominal wall endometriomas.
Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH.
Department of Surgery, Bronx-Lebanon Hospital Center, 1650 Selwyn Ave., 4th Floor, Suite 4F, Bronx, NY 10457, USA.
BACKGROUND: The diagnosis of abdominal wall endometriomas is often confused with other surgical conditions. METHODS: A retrospective study was made of 12 patients presenting with an abdominal wall mass, which proved to be endometrioma. RESULTS: Of a total of 297 patients of endometriosis treated in our hospital over a 7-year period, 12 (4%) had isolated abdominal wall endometriomas. Their mean age was 29.4 years. The presenting symptoms were abdominal mass (n = 12), cyclical (n = 5) or noncyclic pain (n = 7), dyspareunia and dysmenorrhea (n = 1). All patients had a history of gynecologic operations and presented, after an average of 1.9 years, with a tender mass (average 4 cm) at the previous incision site. Preoperative diagnosis was correct in 4 patients (33%) who presented with a cyclically painful abdominal mass. The others were diagnosed as incisional hernia (n = 4), "abdominal wall tumor" (n = 2), and inguinal hernia (n = 2). All patients underwent wide excision of their endometrioma; 2 required polytetrafluoroethylene patch grafting for the resulting fascial defect. The diagnosis was confirmed at frozen section or conventional histological examination in all patients. At follow-up, ranging from 4 months to 3 years, there was no recurrence of endometrioma. CONCLUSIONS: Scar endometrioma commonly presents as an abdominal mass with noncyclical symptoms. Imaging techniques are nonspecific and needle biopsy may confirm the diagnosis. Wide excision is the treatment of choice for abdominal wall endometrioma as well as for recurrent lesions.
PMID: 12781893 [PubMed – indexed for MEDLINE]
71: Clin Exp Dermatol. 2003 May;28(3):315-7. Related Articles, Links
Cutaneous endometriosis: non-invasive analysis by epiluminescence microscopy.
De Giorgi V, Massi D, Mannone F, Stante M, Carli P.
Department of Dermatology, University of Florence, Florence, Italy. vdegi@tin.it
The clinical appearance of cutaneous endometriosis can share some features with malignant melanoma, thus representing a possible cause for concern in both patient and clinician. In recent years, the use of epiluminescence microscopy (ELM, dermoscopy) has proved useful in improving the accuracy of diagnosis of pigmented skin lesions. The purpose of this study was to analyse the dermoscopic features of cutaneous endometriosis with histopathological correlation. We studied a case which showed homogeneous reddish pigmentation, regularly distributed. Within this typical pigmentation there were small red globular structures, but more defined and of a deeper hue, which we called ‘red atolls’. ELM thus revealed a distinctive pattern in cutaneous endometriosis.
PMID: 12780722 [PubMed – in process]
72: J Pak Med Assoc. 2003 Apr;53(4):152-6. Related Articles, Links
Critical appraisal of endometriosis management for pain and subfertility.
Zuberi NF, Rizvi JH.
Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi.
OBJECTIVE: To critically appraise current best available management of pain and subfertility ascribable to endometriosis. METHODS: Medline and specialist computer databases were searched along with reference lists of known reviews and primary articles to identify cited articles not captured by electronic searches. We included all studies pertaining to treatment of pain and subfertility ascribable to endometriosis. DISCUSSION: Medical and surgical management options for pain and subfertility are presented as Evidence-based inquiries for critically appraised topics. Each problem is presented as an answerable question followed by assessment of literature search for level of evidence. This is followed by critical appraisal of results. In the end, take-home answer to individual problem is presented in view of best available evidence. CONCLUSION: Evidence-based management of endometriosis provides realistic therapeutic goals and expectations for the clinicians and women experiencing pain and subfertility due to this disease. It also promotes efficient and effective use of medical and surgical options when required.
Publication Types: · Review · Review, Tutorial
PMID: 12776900 [PubMed – indexed for MEDLINE]
73: Lik Sprava. 2003;(2):49-53. Related Articles, Links
[In Process Citation] [Article in Ukrainian] [No authors listed] Endometriosis is a grave pathological process that comes to be encountered in young women of the reproductive age, and it is not infrequently that it terminates in disability. Apart from genital organs, other organs may be affected by the disease, including those of the thorax. But in proportion of instances the process escapes early diagnosis. In the author’s opinion, the reason for the above-said is absence of classification, in view of which fact a classification is suggested that is supposed to advance diagnosis.
PMID: 12774475 [PubMed – in process]
74: Nature. 2003 May 29;423(6939):545-50. Related Articles, Links
Comment in: · Nature. 2003 May 29;423(6939):487-8.
Modulation of oestrogen receptor signalling by association with the activated dioxin receptor.
Ohtake F, Takeyama K, Matsumoto T, Kitagawa H, Yamamoto Y, Nohara K, Tohyama C, Krust A, Mimura J, Chambon P, Yanagisawa J, Fujii-Kuriyama Y, Kato S.
The Institute of Molecular and Cellular Biosciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-0032, Japan.
Environmental contaminants affect a wide variety of biological events in many species. Dioxins are typical environmental contaminants that exert adverse oestrogen-related effects. Although their anti-oestrogenic actions are well described, dioxins can also induce endometriosis and oestrogen-dependent tumours, implying possible oestrogenic effects. However, the molecular mechanism underlying oestrogen-related actions of dioxins remains largely unknown. A heterodimer of the dioxin receptor (AhR) and Arnt, which are basic helix-loop-helix/PAS-family transcription factors, mediates most of the toxic effects of dioxins. Here we show that the agonist-activated AhR/Arnt heterodimer directly associates with oestrogen receptors ER-alpha and ER-beta. This association results in the recruitment of unliganded ER and the co-activator p300 to oestrogen-responsive gene promoters, leading to activation of transcription and oestrogenic effects. The function of liganded ER is attenuated. Oestrogenic actions of AhR agonists were detected in wild-type ovariectomized mouse uteri, but were absent in AhR-/- or ER-alpha-/- ovariectomized mice. Our findings suggest a novel mechanism by which ER-mediated oestrogen signalling is modulated by a co-regulatory-like function of activated AhR/Arnt, giving rise to adverse oestrogen-related actions of dioxin-type environmental contaminants.
PMID: 12774124 [PubMed – indexed for MEDLINE]
75: Hum Reprod. 2003 Jun;18(6):1328-33. Related Articles, Links
Characteristic images of deeply infiltrating rectosigmoid endometriosis on transvaginal and transrectal ultrasonography.
Koga K, Osuga Y, Yano T, Momoeda M, Yoshino O, Hirota Y, Kugu K, Nishii O, Tsutsumi O, Taketani Y.
Department of Obstetrics and Gynecology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 and CREST Japan Science and Technology, 4-1-8 Honmachi, Kawaguchi 332-0012, Japan.
BACKGROUND: To evaluate the usefulness of transvaginal and transrectal ultrasonography for diagnosis and management of deeply infiltrating rectosigmoid endometriosis. METHODS: A series of six patients (aged 32-39 years) with rectosigmoid endometriosis underwent transvaginal and transrectal ultrasonography. In three patients undergoing surgical resection of the intestine, the ultrasonographic findings were compared with macroscopic and microscopic findings. In one patient, sequential observations of the lesion using ultrasonography were conducted before and after medical treatment and following childbirth. RESULTS: In all cases, the lesion was detected as a hypoechoic irregular-shaped area surrounded by a hyperechoic rim located posterior to the uterus, with size ranging from 18 x 17 to 29 x 28 mm in diameter. The comparison of the ultrasonographical findings with histology revealed that the hypoechoic irregular-shaped area corresponded to a layer of hypertrophic muscularis propria of the lesion, while the hyperechoic rim represented the layer including the mucosa, submucosa and serosa. In one patient, the lesion decreased in size and lost its central hypoechoic area after childbirth in association with pain relief. CONCLUSIONS: Transvaginal and transrectal ultrasonography provides characteristic appearances for rectosigmoid endometriosis that correlate well with its histological findings. The procedures would be useful in the management of rectosigmoid endometriosis.
PMID: 12773468 [PubMed – in process]
76: Hum Reprod. 2003 Jun;18(6):1323-7. Related Articles, Links
Histopathological extent of rectal invasion by rectovaginal endometriosis.
Kavallaris A, Kohler C, Kuhne-Heid R, Schneider A.
Department of Obstetrics and Gynecology, Friedrich Schiller University, Bachstrasse 18, 07740 Jena, Germany.
BACKGROUND: We aimed to evaluate the microscopic extent of endometriosis in surgical en-bloc specimens of vaginal skin, rectovaginal septum, cul-de-sac, and part of the rectosigmoid bowel. METHODS: From December, 1997 to October, 2001, 50 patients with the trias of intestinal pain, palpable disease in the rectovaginal septum, and laparoscopic diagnosis of endometriosis of the cul-de-sac and/or rectosigmoid colon underwent combined laparoscopic-vaginal en-bloc resection of the cul-de-sac with partial resection of the posterior vaginal wall and rectum with reanastomosis by minilaparotomy. All surgical specimens were histopathologically evaluated in a standardized fashion. RESULTS: The mean length of the bowel specimen was 7.48 cm. Endometriosis involved the serosa and muscularis propria in all patients, the submucosa in 17 patients (34%), and the mucosa in five patients (10%). After a mean follow-up of 32 months, 90% of patients reported a considerable improvement or were completely free of symptoms and the rate of recurrence was 4% (two patients). CONCLUSIONS: Partial bowel resection indicates the depth and multifocality of endometriosis affecting the recto-sigmoid colon. Such extensive surgery appears justified by the extent of the lesions and the long-term relief of symptoms achieved.
PMID: 12773467 [PubMed – in process]
77: Hum Reprod. 2003 Jun;18(6):1205-9. Related Articles, Links
Inverse correlation between peritoneal fluid leptin concentrations and the extent of endometriosis.
Mahutte NG, Matalliotakis IM, Goumenou AG, Vassiliadis S, Koumantakis GE, Arici A.
Yale University School of Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, New Haven, CT 06520-8063, USA and Departments of Obstetrics and Gynecology and Biology, University of Crete, Greece.
BACKGROUND: The role of leptin in reproductive processes has received increasing attention. Because leptin has intrinsic angiogenic properties, may be induced by inflammatory cytokines and induces matrix metalloproteinases, we examined peritoneal fluid (PF) leptin concentrations in women with endometriosis. METHODS: PF samples were collected from 60 women undergoing laparoscopy for endometriosis, and 18 controls undergoing tubal sterilization. Fifty of the women with endometriosis had received no prior hormonal treatment, while 10 with moderate- severe endometriosis were using GnRH agonists. RESULTS: Women with untreated endometriosis had significantly higher (mean +/- SD) PF leptin levels (34.9 +/- 7.9 ng/ml) than controls (17.9 +/- 4.1 ng/ml; P < 0.001). However, PF leptin levels were inversely correlated with the stage of disease (r = -0.62; P < 0.001). Nevertheless, women with stage III-IV endometriosis maintained significantly higher PF leptin levels (26.3 +/- 4.8 ng/ml; P < 0.001) than controls. Although PF leptin levels were significantly higher in the secretory versus proliferative phase of the menstrual cycle, they remained higher in both phases in women with untreated endometriosis. PF leptin levels in women on GnRH agonists were similar to controls. CONCLUSIONS: PF leptin levels are elevated in women with endometriosis, but inversely correlated with extent of disease. These findings suggest a potential role for leptin in the pathogenesis of peritoneal endometriosis.
PMID: 12773447 [PubMed – in process]
78: Gynecol Obstet Invest. 2003;55(2):96-104. Related Articles, Links
GnRH analogues, transvaginal ultrasound-guided drainage and intracystic injection of recombinant interleukin-2 in the treatment of endometriosis.
Acien P, Quereda FJ, Gomez-Torres MJ, Bermejo R, Gutierrez M.
Services of Obstetrics and Gynaecology, San Juan University Hospital, School of Medicine, Miguel Hernandez University, Campus of San Juan, Alicante, Spain.
We performed a double-blind, randomised controlled trial to evaluate the results of ultrasound-guided aspiration of endometriomas under the effect of GnRH analogues and a possible additional beneficial effect by leaving 600,000 IU of recombinant interleukin-2 (rIL-2) in the cysts. Twenty-four women with endometriosis-related symptoms, increased values of CA-125 and transvaginal ultrasonography showing endometriomas >3 cm who were initially sent to us for laparotomy and conservative surgery for endometriosis were included. Main outcome measures were severity of symptoms, size and percentage of echographical reduction of endometriomas and CA-125 levels after 2 menses post-GnRH analogues. Secondary outcome measures were the time until recurrence of abnormal parameters and the need for surgery after treatment. We found moderate clinical results after treatment with drainage plus GnRH analogues and significantly improved results in women having received rIL-2 intracystically. There were no side effects. Two out of 3 previously infertile patients became pregnant after therapy. Though the rates of recurrence of endometriomas >/=3 cm were similar in both groups, the period until recurrence was significantly greater when rIL-2 was used, and the rates of recurrence of symptoms and increased CA-125 values were also significantly lower in patients who received rIL-2. Surgery was finally performed on 10 patients (4 with and 6 without previous rIL-2 treatment) during follow-up (30 +/- 12.7 months). These findings led to the conclusion that transvaginal ultrasound-guided puncture and aspiration of endometriomas under endometrial suppressive therapy with GnRH analogues have some value for endometriosis treatment, improving the clinical manifestations and avoiding some surgical therapies, and that rIL-2 left in the cyst increases these beneficial effects significantly. Copyright 2003 S. Karger AG, Basel
PMID: 12771456 [PubMed – in process]
79: Gynecol Obstet Invest. 2003;55(2):63-7. Related Articles, Links
‘Invisible’ microscopic endometriosis: a review.
Redwine DB.
St. Charles Medical Center, Bend, Oreg., USA.
Endometriosis can have very subtle visual appearances. All theories of origin imply some early and presumably tiny form of the disease which potentially cannot be detected by the unaided human eye. A review of the literature indicates that with increasing magnification at surgery, virtually all endometriosis can be visualized. Invisible microscopic endometriosis is an unproven entity which retards intellectual progress in the study of this disease. Copyright 2003 S. Karger AG, Basel
PMID: 12771451 [PubMed – in process]
80: Gynecol Obstet Invest. 2003;55(2):61-2. Related Articles, Links
Invisible microscopic endometriosis: how wrong is the sampson hypothesis of retrograde menstruation to explain the pathogenesis of endometriosis?
D’Hooghe TM.
Publication Types: · Editorial
PMID: 12771450 [PubMed – in process]
81: Gynecol Obstet Fertil. 2003 Mar;31(3):197-206. Related Articles, Links
[Deeply infiltrating endometriosis: management and proposal for a "surgical classification"] [Article in French] Chapron C, Dubuisson JB, Chopin N, Foulot H, Jacob S, Vieira M, Barakat H, Fauconnier A.
Service de gynecologie obstetrique II, unite de chirurgie gynecologique, clinique universitaire Baudelocque, CHU Cochin-Saint-Vincent-de-Paul, 123, boulevard de Port-Royal, 75014 Paris, France. charles.chapron@cch.ap-hop-paris.fr
Deep pelvic endometriosis presents essentially in the form of a painful syndrome dominated by deep dyspareunia and painful functional symptoms that recur according to the menstrual cycle, with the semiology directly correlated with the location of the lesions (bladder, rectum). It is essential to investigate these deep endometriosis lesions and draw up a precise map, which is the only way to be sure that exeresis will be complete. The treatment of first intention remains surgery, and medical treatment is only palliative in the majority of cases. Success of treatment depends on how radical surgical exeresis is. Based on analysis of the anatomical distribution of deep pelvic endometriosis lesions, a "surgical classification" is proposed with the aim of establishing standard modes for surgical treatment. Further studies are required to clarify the place and modes for pre- and postoperative medical treatment.
PMID: 12770802 [PubMed – in process]
82: Mol Cell Endocrinol. 2003 Apr 28;202(1-2):195-9. Related Articles, Links
Immunological and endocrinological studies on lymphocyte subpopulation and medical treatment for infertility in patients with endometriosis.
Furuya K, Murakami M, Makimura N, Matsuda H, Ikou K, Saito K, Kawakami Y, Shibazaki T, Fukui U, Mizumoto Y, Tokuoka S, Nagata I, Kikuchi Y.
Department of Obstetrics and Gynecology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
We investigated the relationship between interleukin-6 (IL-6) levels and subset profiles of T lymphocyte (T-cell) and macrophage in peritoneal fluid (PF) with or without endometriosis (EM). IL-6 levels in PF with EM were significantly higher than those without EM. IL-6 producing cells with EM were analyzed in each activated mature T-cell (CD3+CD69+) and macrophage (CD14+) were 0.5 and 3.5%, respectively, whereas it was mostly negative in those without EM. Cytotoxic T-cell (CD8+CD11b-) profiles in PF with EM were also quiet different from those without EM. Cellular immunity in the peripheral blood did not change during the course of IVF-ET cycles, although plasma levels of ovarian steroid hormones significantly increased comparing with that in normal ovarian cycles. Cytotoxic T-cell type 1 (Tc1) profiles might be useful predictive values in the pregnancy outcome for infertile patients with EM.
PMID: 12770751 [PubMed – in process]
83: Mol Cell Endocrinol. 2003 Apr 28;202(1-2):37-45. Related Articles, Links
What we have learned from isolated cells from human ovary?
Okamura H, Katabuchi H, Ohba T.
Department of Obstetrics and Gynecology, Kumamoto University School of Medicine, Honjo 1-1-1, Kumamoto 860-8556, Japan. hokamura@kaiju.medic.kumamoto-u.ac.jp
In the ovary, morphodynamics of follicles with cyclic maturation, ovulation and repair occur under the control of various tropic factors. The ovarian functions have been mostly studied by using subhuman primates and non-primate animals because of the limited availability of closely staged human specimens. We have recently established the in vitro culture systems of ovarian surface epithelium (OSE) and granulosa cells of humans, and subsequently developed the immortalization of each cell. The immortalized cell lines may supply us advanced studies on ovarian disorders as well as its physiological functions. On the embryologically putative mullerian potential of coelomic epithelium, endometriosis can be explained by coelomic metaplasia from the peritoneal mesothelium, including OSE. We can microscopically observe a continuity from flat epithelial cells on the ovarian surface or within the cortical inclusion cysts to endometriotic gland cells. The primary human OSE cells exhibited a glandular-stromal structure similar to endometriosis when they were co-cultured with endometrial stromal cells in an estrogen-rich environment. Primary and immortalized OSE cells converted the estrone to estradiol, and expressed the genes for steroidogenic factor-1 (SF-1), p450arom and 17beta-HSDs. This character of OSE was, in part, similar to the granulosa cells. One of the immortalized OSE clone produces disseminated tumors mimicking undifferentiated carcinomas in nude mice. Ovarian granulosa cells play a key role in the functional maturation of the entire follicle. The molecular pathways in granulosa cells responsible for the growth, differentiation, and nursing the oocyte are still largely unknown. Our immortalized human granulosa cell line, GC1a, obtained from developing follicles, showed no steroid hormone biosynthesis, and no detectable expression of the genes for StAR or cytochrome p450 enzymes due to the lack of SF-1. Transfected SF-1 elicited estradiol secretion in GC1a cells with concomitant expression of the genes encoding the proteins for gonadal steroidogenesis. The enzymatic activity of 17beta-HSD was also achieved by SF-1 transgene. These results indicate that SF-1 controls the gene expression required for steroidogenesis in the human developing follicle. Clinically, immortalized GC1a cells from human origin, with steroidogenic capacity, may serve as a feeder layer for in vitro oocyte maturation. Further investigations of our immortalized OSE and granulosa cells of humans will allow us to clarify whether they have a single progenitor cell.
PMID: 12770728 [PubMed – in process]
84: Acta Med Croatica. 2002;56(4-5):171-80. Related Articles, Links
[Ultrasonography in acute pelvic pain] [Article in Serbo-Croatian (Roman)] Kupesic S, Aksamija A, Vucic N, Tripalo A, Kurjak A.
Klinika za ginekologiju i porodnistvo Opca bolnica Sveti Duh Sveti Duh 64 10,000 Zagreb, Hrvatska. sanja.kupesic@zg.hinet.hr
Acute pelvic pain may be the manifestation of various gynecologic and non-gynecologic disorders from less alarming rupture of the follicular cyst to life threatening conditions such as rupture of ectopic pregnancy or perforation of inflamed appendix. In order to construct an algorithm for differential diagnosis we divide acute pelvic pain into gynecologic and non-gynecologic etiology, which is than subdivided into gastrointestinal and urinary causes. Appendicitis is the most common surgical emergency and should always be considered in differential diagnosis if appendix has not been removed. Apart of clinical examination and laboratory tests, an ultrasound examination is sensitive up to 90% and specific up to 95% if graded compression technique is used. Still it is user-depended and requires considerable experience in order to perform it reliably. Meckel’s diverticulitis, acute terminal ileitis, mesenteric lymphadenitis and functional bowel disease are conditions that should be differentiated from other causes of low abdominal pain by clinical presentation, laboratory and imaging tests. Dilatation of renal pelvis and ureter are typical signs of obstructive uropathy and may be efficiently detected by ultrasound. Additional thinning of renal parenchyma suggests long-term obstructive uropathy. Ruptured ectopic pregnancy, salpingitis and hemorrhagic ovarian cysts are three most commonly diagnosed gynecologic conditions presenting as an acute abdomen. Degenerating leiomyomas and adnexal torsion occur less frequently. For better systematization, gynecologic causes of acute pelvic pain could be divided into conditions with negative pregnancy test and conditions with positive pregnancy test. Pelvic inflammatory disease may be ultrasonically presented with numerous signs such as thickening of the tubal wall, incomplete septa within the dilated tube, demonstration of hyperechoic mural nodules, free fluid in the "cul-de-sac" etc. Color Doppler ultrasound contributes to more accurate diagnosis of this entity since it enables differentiation between acute and chronic stages based on analysis of the vascular resistance. Hemorrhagic ovarian cysts may be presented by variety of ultrasound findings since intracystic echoes depend upon the quality and quantity of the blood clots. Color Doppler investigation demonstrates moderate to low vascular resistance typical of luteal flow. Leiomyomas undergoing degenerative changes are another cause of acute pelvic pain commonly present in patients of reproductive age. Color flow detects regularly separated vessels at the periphery of the leiomyoma, which exhibit moderate vascular resistance. Although the classic symptom of endometriosis is chronic pelvic pain, in some patients acute pelvic pain does occur. Most of these patients demonstrate an endometrioma or "chocolate" cyst containing diffuse carpet-like echoes. Sometimes, solid components may indicate even ovarian malignancy, but if color Doppler ultrasound is applied it is less likely to obtain false positive results. One should be aware that pericystic and/or hillar type of ovarian endometrioma vascularization facilitate correct recognition of this entity. Pelvic congestion syndrome is another condition that can cause an attack of acute pelvic pain. It is usually consequence of dilatation of venous plexuses, arteries or both systems. By switching color Doppler gynecologist can differentiate pelvic congestion syndrome from multilocular cysts, pelvic inflammatory disease or adenomyosis. Ovarian vein thrombosis is a potentially fatal disorder occurring most often in the early postpartal period. Hypercoagulability, infection and stasis are main etiologic factors, and transvaginal color Doppler ultrasound is an excellent diagnostic tool to diagnose it. Acute pelvic pain may occur even in normal intrauterine pregnancy. This may be explained by hormonal changes, rapid growth of the uterus and increased blood flow. Ultrasound is mandatory for distinguishing normal intrauterine pregnancy from threatened or spontaneous abortion, ectopic pregnancy and other complications that may occur in patients with positive pregnancy test. Incomplete abortion is visualized as thickened and irregular endometrial echo with certain amount of intracavitary fluid. If applied, color Doppler ultrasound reveals low vascular resistance signals in richly perfused intracavitary area. Transvaginal sonography has high sensitivity and specificity in visualization of uterine and adnexal signs of ectopic pregnancy. Color Doppler examination may aid in detection of the peritrophoblastic flow. Furthermore, it facilitates detection of ectopic living embryo, tubal ring or unspecific adnexal tumor. Corpus luteum cysts and leiomyomas are another cause of pelvic pain during pregnancy, which can be correctly diagnosed by ultrasound. Detection of uterine dehiscence and rupture in patients with history of prior surgical intervention on uterine wall relies exclusively on correct ultrasound diagnosis. In patients with placental abruption sonographer detects hypoechoic complex representing either retroplacental hematoma, subchorionic hematoma or subamniotic hemorrhage. In closing, ultrasound has already become important and easily available tool which can efficiently recognize patients with possibly threatening conditions of different origins.
Publication Types: · Review · Review, Tutorial
PMID: 12768897 [PubMed – indexed for MEDLINE]
85: Diagn Cytopathol. 2003 Jun;28(6):335-41. Related Articles, Links
Diagnostic pitfalls of peritoneal washing cytology and the role of cell blocks in their diagnosis.
Selvaggi SM.
Department of Pathology and Laboratory Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA. sselvaggi@facstaff.wisc.edu
Mesothelial cell hyperplasia, collagen balls, endometriosis, and endosalpingiosis are diagnostic pitfalls on peritoneal washing cytology in women who present with gynecologic lesions. Over an 8-month period, the peritoneal washings from 10 patients undergoing gynecologic surgery for presumed malignancy showed unusual cytologic findings, several of which posed diagnostic difficulties. The washings from four patients with ovarian carcinomas were cellular and contained clusters and strips of cells with cytologic atypia mimicking malignancy. Confirmation of their benign mesothelial origin was confirmed on immunohistochemistry utilizing cell block preparations. In two cases of endometrial endometrioid carcinoma, the washings contained several clusters of cells surrounding and/or admixed with a globular substance. Due to their similarity to endometrial cells, immunohistochemistry was performed on cell block preparations. The cells were positive for cytokeratin and negative for carcinoembryonic antigen and B72.3, confirming their mesothelial origin. In one case, clinically presumed to be a malignant mass, the washings contained tight clusters of cells with mild cytologic atypia admixed with hemosiderin-laden macrophages. In conjunction with the cell block findings, a diagnosis of endometriosis was made. Extensive endometriosis was found on the surgically resected specimen. In two cases, strips of ciliated epithelial cells resembling tubal epithelium were present on the cytologic and cell block preparations, consistent with endosalpingiosis. The peritoneal washings in one case contained several clusters and balls of atypical cells surrounding microcalcifications on cell block preparation. Since calcification within groups of cells in peritoneal washings always raised the possibility of malignancy, a serous carcinoma of the ovary, particularly of borderline malignancy, would have to be excluded. Fortunately, the resected specimen was free of tumor and showed calcified endosalpingiosis on the ovarian surface. Preparation of cell blocks from peritoneal washings is of value in the work-up and management of patients who present with cytologic mimickers of malignancy on fluid cytology. Copyright 2003 Wiley-Liss, Inc.
PMID: 12768641 [PubMed – in process]
86: Ultrasound Obstet Gynecol. 2003 May;21(5):480-5. Related Articles, Links
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