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100: Di Yi Jun Yi Da Xue Xue Bao. 2003 Apr;23(5):458-9. Related Articles, Links
Association between glutathione S-transferase M1 gene deletion and genetic susceptibility to endometriosis.
Peng DX, He YL, Qiu LW, Yang F, Lin JM.
Department of Obstetrics and Gynecology, Zhujiang Hospital, First Military Medical University, Guangzhou 510282, China.
OBJECTIVE: To evaluate the possible association of the glutathione S-transferase M1 (GSTM1) gene polymorphism with the susceptibility to endometriosis in women of Han nationality in Guangdong Province. METHODS: Polymerase chain reaction was used to identify the GSTM1 genotypes in 76 patients with endometriosis and 80 controls (surgical patients for gynecological problems other than endometriosis). RESULTS: The frequencies of the GSTM1 null genotypes in patients with endometriosis and controls were 65.8% and 46.3%, respectively, showing a significant difference between the endometriotic cohort and the control group (X(2)=6.03, P < 0.05). Individuals with GSTM1 null genotype were exposed to risks for endometriosis 2.24 times that of subjects without these genotypes OR=2.24, 95% CI=1.17-4.27 . CONCLUSION: GSTM1 gene deletion might bea risk factor for endometriosis in women of Han nationality who are native residents in Guangdong Province.
PMID: 12754129 [PubMed – in process]
101: Afr J Med Med Sci. 2002 Sep;31(3):281-2. Related Articles, Links
Isolated umbilical endometriosis–a rare finding.
Okunlola MA, Adekunle AO, Arowojolu AO, Oluwasola AO.
Department: of Obstetrics and Gynaecology , University College Hospital, Ibadan, Nigeria. uchmed@skannet.com.ng
A 32 yr old multiparous Nigerian woman presented with histological confirmed umbilical endometriosis. There was no evidence of endometrotic deposits elsewhere. Apart from cyclical bleeding from the umbilicus, she was relatively free of any of the other signs and symptoms of Endometriosis. She had excision of the endometeriotic lesion and responded favourably to treatment. A high index of suspicion is required in making a diagnosis of endometriosis in remote extra pelvic sites especially with little or no characterisitic pointers to the disease.
PMID: 12751574 [PubMed – indexed for MEDLINE]
102: Fertil Steril. 2003 Apr;79(4):1023-7. Related Articles, Links
Sonovaginography is a new technique for assessing rectovaginal endometriosis.
Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB.
Department of Pharmacology, Gynecology and Obstetrics, University of Sassari, Sassari, Italy. dessole@uniss.it
OBJECTIVE: To evaluate the efficacy of a new technique, the sonovaginography, for the assessment of rectovaginal endometriosis. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Forty-six women were scheduled for laparotomic or laparoscopic surgery because of rectovaginal endometriosis suspected on the basis of patient history and/or clinical examination. INTERVENTION(S): Before surgery, all the women underwent transvaginal ultrasonography and then sonovaginography. The latter is based on transvaginal ultrasonography combined with the introduction of saline solution to the vagina that creates an acoustic window between the transvaginal probe and the surrounding structures of the vagina. Ultrasound findings were compared with the results of surgical exploration and histological examination. MAIN OUTCOME MEASURE(S): We assessed the accuracy of transvaginal ultrasonography and of sonovaginography for the detection and the location and extension assessment of rectovaginal endometriotic lesions, as well as compared patient compliance between the procedures. RESULT(S): Sonovaginography diagnosed rectovaginal endometriosis more accurately than did transvaginal ultrasonography, with a sensitivity and specificity of 90.6% and 85.7%, respectively, whereas the transvaginal ultrasonography has shown a sensitivity and specificity of 43.7% and 50%, respectively. Patient discomfort did not differ significantly between the procedures. CONCLUSION(S): Sonovaginography is a reliable and simple method for the assessment of rectovaginal endometriosis and provides information on location, extension, and infiltration of the lesions, which are important factors in selecting the kind of surgery.
Publication Types: · Clinical Trial
PMID: 12749448 [PubMed – indexed for MEDLINE]
103: Fertil Steril. 2003 Apr;79(4):829-43. Related Articles, Links
Role of reactive oxygen species in the pathophysiology of human reproduction.
Agarwal A, Saleh RA, Bedaiwy MA.
Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function, Urological Institute and Department of Obstetrics-Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. agarwaa@ccf.org
OBJECTIVE: To summarize the role of reactive oxygen species (ROS) in the pathophysiology of human reproduction. DESIGN: Review of literature. SETTING: Fertility research center and obstetrics and gynecology department in a tertiary care facility. RESULT(S): ROS plays an essential role in the pathogenesis of many reproductive processes. In male-factor infertility. oxidative stress attacks the fluidity of the sperm plasma membrane and the integrity of DNA in the sperm nucleus. Reactive oxygen species induced DNA damage may accelerate the process of germ cell apoptosis, leading to the decline in sperm counts associated with male infertility. ROS mediated female fertility disorders share many pathogenic similarities with the ones on the male side. These similarities include a potential role in the pathophysiology of endometriosis and unexplained infertility. High follicular fluid ROS levels are associated with negative IVF outcomes, particularly in smokers. Moreover, oxidative stress may be responsible in hydrosalpingeal fluid mediated embryotoxicity as well as poor in vitro embryonic development. CONCLUSION(S): High levels of ROS are detrimental to the fertility potential both in natural and assisted conception states.
Publication Types: · Review · Review, Tutorial
PMID: 12749418 [PubMed – indexed for MEDLINE]
104: Ceska Gynekol. 2003 Mar;68(2):63-8. Related Articles, Links
[Long-term follow-up after complete treatment of peritoneal endometriosis with the CO2 laser] [Article in Czech] Cibula D, Kuzel D, Fucikova Z, Hill M, Fanta M, Toth D, Jurovich P, Hruskova H, Zivny J.
Gynekologicko-porodnicka klinika 1. LF UK a VFN v Praze, Praha. david.cibula@iol.cz
OBJECTIVE: To evaluate the effect of laparoscopic CO2 laser ablation of peritoneal endometriosis in the treatment of pelvic pain with a long-term follow-up. To differentiate the effect of surgery on different types of pelvic pain. DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: Patients with 1st to 3rd stage endometriosis, with manifestation of pelvic pain, and with complete excision of peritoneal endometriosis lesions, were included in the study. All visible lesions were vaporized by CO2 laser following adhesiolysis and complete visualization of the pelvis. After the procedure, patients were followed up at 6-month intervals. The severity of pelipathia, dyspareunia, dysmenorrhea, pain during micturition, and pain during defecation were monitored using a visual analog score of 10 points. RESULTS: A total of 31 patients were included in the study. After 6, 12, and 18 months after surgery, the recurrence of pelvic pain was found in 12 (39%), 15 (48%), and 19 (61%) patients, respectively. Improvement or disappearance of complaints was documented 18 months after the surgery in 11 cases of dysmenorrhea (50%), 9 cases of dyspareunia (50%), 14 cases of pelipathia (58%), 12 cases of pain during micturition (71%), and in 14 cases of pain during defecation (87.5%). The proportion of recurrences increases with the length of the interval after the procedure, mainly in dysmenorrhea and dyspareunia. CONCLUSIONS: The effect (improvement or disappearance of pelvic pain) of a complete CO2 laser ablation of peritoneal endometriosis continues 18 months after the surgery in about 40% of patients. A graduated increase in the number of recurrences is apparent during follow-up, most significantly in dysmenorrhea and dyspareunia. The effect of surgery on different types of pelvic pain varies. A small number of recurrences was found in pain during micturition and pain during defecation, on the other hand, less success was apparent in the treatment of dysmenorrhea.
PMID: 12749171 [PubMed – indexed for MEDLINE]
105: Ceska Gynekol. 2003 Mar;68(2):59-63. Related Articles, Links
[The role apoptosis in the extent of endometriosis and its clinical symptomatology] [Article in Czech] Cibula D, Hach P, Kucera T, Kuzel D, Fucikova Z, Martinek J, Hill M, Zivny J.
Gynekologicko-porodnicka klinika 1. LF UK a VFN v Praze, Praha. david.cibula@iol.cz
OBJECTIVE: To evaluate the presence and intensity of apoptosis in lesions of peritoneal endometriosis. To consider the role of different intensity of apoptosis in the progression of the disease and in the manifestation of clinical symptoms. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology and Department of Histology and Embryology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: Lesions of peritoneal endometriosis were excised at laparoscopy in women with 1st to 3rd stage of the disease. Specimens were fixed in the Karnowski solution. The presence of apoptosis was assessed immunohistochemically. RESULTS: Biopsies of peritoneal endometriosis were consecutively taken in 48 women. Altogether, 29 patients were symptomatic, and 19 did not complain of any symptoms. The average duration of symptoms was 16.6 months. The presence of apoptosis was detected in 11 out of 35 evaluated specimens. In comparing the groups with and without apoptosis, no differences were found in the stage of the disease, in the proportion of asymptomatic patients, and in the manifestation of different subjective complaints. CONCLUSIONS: The study confirmed a frequent presence of apoptosis in biopsies of peritoneal endometriosis. However, there were no relationships found between the presence of apoptosis and the stage of the disease or manifestation or character of subjective complaints.
PMID: 12749170 [PubMed – indexed for MEDLINE]
106: Am J Obstet Gynecol. 2003 May;188(5):1171-3. Related Articles, Links
Characteristics predictive of response to ovarian diathermy in women with polycystic ovarian syndrome.
Stegmann BJ, Craig HR, Bay RC, Coonrod DV, Brady MJ, Garbaciak JA Jr.
Department of Obstetrics and Gynecology, Maricopa Integrated Health System, 2601 E. Roosevelt, Phoenix, AZ 85008, USA.
OBJECTIVE AND STUDY DESIGN: Ovarian needle diathermy was used in the treatment of clomiphene-resistant polycystic ovarian syndrome (PCOS). Factors predictive of pregnancy in our study group included younger age, lower body weight, and surgery before 1998. RESULTS AND CONCLUSION: Insulin resistance and adhesions at surgery were negatively associated with pregnancy. Sixty-six percent of the study group cycled spontaneously after surgery and 50% became pregnant.
PMID: 12748468 [PubMed – indexed for MEDLINE]
107: J Pediatr Adolesc Gynecol. 2003 Jun;16(3 Suppl):S27-8. Related Articles, Links
Tips on treating teens with endometriosis.
Ballweg ML.
Endometriosis Association, International Headquarters, Milwaukee, WI 53223, USA. Endo@EndometriosisAssn.org
PMID: 12742184 [PubMed – in process]
r the detection of endometriosis.
Stratton P, Winkel C, Premkumar A, Chow C, Wilson J, Hearns-Stokes R, Heo S, Merino M, Nieman LK.
Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA. ps79c@nih.gov
OBJECTIVE: To evaluate the utility of fat-suppressed magnetic resonance imaging (MRI) in the diagnosis of endometriosis. DESIGN: A prospective clinical trial. SETTING: A government research hospital. PATIENT(S): Forty-eight women with pelvic pain. INTERVENTION(S): Magnetic resonance imaging followed by surgical excision and pathologic diagnosis of endometriosis. MAIN OUTCOME MEASURE(S): Presence and extent of endometriosis suggested by preoperative MRIs compared with surgical inspection and biopsy. RESULT(S): A preoperative MRI in 46 women detected fewer endometriosis lesions than histopathology or laparoscopy (78 vs. 101 vs. 150). Few MRI lesions correlated with those identified by laparoscopy (50 of 150) or pathology (38 of 101). Of 42 women with surgically diagnosed endometriosis, 28 had at least one corresponding abnormality on MRI, 5 had abnormalities that didn’t correlate with surgical findings, and 9 had normal MRIs. The sensitivity of MRI in detecting biopsy-proven endometriosis for any woman was 69% (25 of 36), and the specificity was 75%. CONCLUSION(S): Although MRI identifies fewer areas of endometriosis than seen at surgery, it suggested endometriosis in 75% of those with at least mild disease. Only 67% of lesions identified at surgery contained histologic evidence of endometriosis.
Publication Types: · Clinical Trial · Randomized Controlled Trial
PMID: 12738499 [PubMed – indexed for MEDLINE]
117: Obstet Gynecol. 2003 May;101(5 Pt 2):1098-100. Related Articles, Links
Familial Mediterranean fever presenting as recurrent acute pelvic inflammatory disease.
Adair R, Colon JM, McGovern PG.
Department of Obstetrics, Gynecology, and Women’s Health, UMD-New Jersey Medical School, Newark, NJ 07103, USA.
BACKGROUND: Recurrent acute episodes of pelvic inflammatory disease (PID) often present a diagnostic dilemma. The differential diagnosis should include reinfection, appendicitis, endometriosis, irritable bowel syndrome, colitis, persistent ovarian cyst, and antibiotic-resistant bacterial strains. CASE: NA young Palestinian woman presented with recurrent episodes of pelvic pain with rebound tenderness, fever, and elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. The patient underwent extensive workup, multiple courses of intravenous and oral antibiotics, and diagnostic laparoscopies, with continued recurrent episodes. Treatment with colchicine for suspected familial Mediterranean fever resulted in resolution of symptoms. CONCLUSION: In patients of Mediterranean ancestry who have symptoms of recurrent PID that are refractory to conventional treatment, familial Mediterranean fever should be included in the differential diagnosis.
PMID: 12738114 [PubMed – indexed for MEDLINE]
118: Gynecol Endocrinol. 2003 Apr;17(2):143-50. Related Articles, Links
Increased vascular surface density in ovarian endometriosis.
Inan S, Kuscu NK, Vatansever S, Ozbilgin K, Koyuncu F, Sayhan S.
Department of Histology and Embryology, Celal Bayar University, School of Medicine, Manisa, Turkey.
Our goal in this study was to investigate the presence of angiogenesis-related factors in endometriomas by evaluating their vascular surface densities. Thirty ovarian samples were included in the study. Of these, ten were histologically confirmed endometriomas, ten were ovarian specimens in the follicular phase and ten were ovarian specimens in the luteal phase, serving as controls. Histological specimens were immunostained for von Willebrand factor (vWF: factor VIII-related antigen) and CD34. The area with the highest microvessel density in endometriosis and in the normal ovary was evaluated by using an intercept grid. All microvessels in a specific field (x 100 magnification) were counted and vascular surface density was measured, as 164.01 +/- 21.26 vs. 125.15 +/- 11.28 and 117.44 +/- 9.27 by using vWF, and as 172.97 +/- 25.64 vs. 138.65 +/- 32.21 and 120.34 +/- 18.40 by using CD34 in endometriotic, follicular and luteal ovarian samples, respectively (p < 0.001). The mean vascular surface density was significantly higher in endometriosis than in the ovarian samples of the follicular phase or the luteal phase. No significant difference was seen between normal ovarian samples. Endometriosis was associated with angiogenic properties. Having demonstrated elevated angiogenic factors in endometriotic samples, we concluded that activation of angiogenesis might be a key factor in the pathogenesis of endometriosis.
PMID: 12737676 [PubMed – in process]
119: J Assist Reprod Genet. 2003 Mar;20(3):117-21. Related Articles, Links
Physiopathological aspects of corpus luteum defect in infertile patients with mild/minimal endometriosis.
Cunha-Filho JS, Gross JL, Bastos de Souza CA, Lemos NA, Giugliani C, Freitas F, Passos EP.
Obstetrics and Gynecology Department, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil. sabino@via-rs.net
PURPOSE: We describe a physiopathological model to the luteal insufficiency of infertile patients with mild/minimal endometriosis with normal hormone measurements in the early follicular phase. METHODS: We designed a case-control study with 24 patients, 14 fertile with in-phase endometrium (control group) and 10 infertile with mild/minimal endometriosis and luteal insufficiency (study group). The histologic dating of endometrium was performed during cycle days 23-25 and serum TSH, FSH, LH, prolactin, and estradiol levels were measured during the early follicular phase (cycle day 3). Progesterone serum levels were measured in three different occasions during the luteal phase. RESULTS: Patients with out-of-phase endometrium have lower estradiol levels (P = 0.031) and decreased progesterone secretion (P = 0.012) during the late luteal phase. Serum prolactin, TSH, FSH, and LH levels were similar between the groups (P > 0.05). CONCLUSIONS: The physiopathology of luteal phase defect in infertile patients with mild/minimal endometriosis is associated with a small and large luteal cells dysfunction, characterized by abnormal follicular phase (lower estradiol serum levels) and lower progesterone LH-dependent secretion.
PMID: 12735387 [PubMed – in process]
120: Eur J Hum Genet. 2003 May;11(5):402-8. Related Articles, Links
Influence of missense mutation and silent mutation of LHbeta-subunit gene in Japanese patients with ovulatory disorders.
Takahashi K, Karino K, Kanasaki H, Kurioka H, Ozaki T, Yonehara T, Miyazaki K.
1Department of Obstetrics and Gynaecology, Shimane Medical University, Izumo 693-8501, Japan.
The frequency of variant LHbeta containing two point mutations (T(986)-C and T(1008)-C) and its relationship to reproductive disorders differ widely between ethnic groups. In a Japanese population, variant luteinizing hormone (LH) correlates with ovulatory disorders. Here we examined the relationship between two missense mutations and five silent mutations (C(894)-T, G(1018)-C, C(1036)-A, C(1098)-T and C(1423)-T) in the LHbeta gene, and ovulatory disorders. We studied 43 patients with ovulatory disorders, 79 patients with normal ovulatory cycles, and 23 healthy men who agreed to join our DNA analysis. PCR-amplified LHbeta-subunit gene sequences were compared with a base sequence of wild-type LH reported after direct sequencing. The highest frequency (0.945) of novel allele was observed at the position of the C(1036)-A transition. No homozygotes for wild-type LHbeta (C(1036)) were identified. The frequency of novel allele in patients with polycystic ovary syndrome, endometriosis, premature ovarian failure and luteal insufficiency was significantly different from that of healthy women. The frequencies of novel alleles (C(894)-T, C(1098)-T and C(1423)-T) in patients with ovulatory disorders were significantly higher than those with normal ovulatory cycles. The mean incidence of point mutation in patients with ovulatory disorders was higher than in those with normal ovulatory cycles. Among patients with variant LH, five silent mutations were identified in 87.5% of patients with ovulatory disorders, whereas only a few silent mutations were identified in patients with normal ovulatory cycles. In a Japanese population, five silent mutations of variant LH could have influenced two missense mutations and/or other unknown missense mutations, causing ovulatory disorders.European Journal of Human Genetics (2003) 11, 402-408. doi:10.1038/sj.ejhg.5200968
PMID: 12734546 [PubMed – in process]
121: J Med Primatol. 2003 Feb;32(1):48-56. Related Articles, Links
Spontaneous ovarian tumors in twelve baboons: a review of ovarian neoplasms in non-human primates.
Moore CM, Hubbard GB, Leland MM, Dunn BG, Best RG.
Department of Cellular and Structural Biology University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA. moorec@uthscsa.edu
Twelve spontaneous ovarian tumors were found in the Southwest Foundation for Biomedical Research baboon colony. These included four granulosa cell tumors, three teratomas, two endometrioid carcinomas, one seromucinous cystadenofibroma, a cystic papillary adenocarcinoma, and an ovarian carcinoma. Age was a pre-disposing factor. With one exception, the tumors of surface epithelial- and sex cordstromal origin occurred in baboons over 17 years of age. The exceptional animal was 7 years of age when a malignant granulosa cell tumor with Sertoli cell differentiation was identified. The two endometrioid tumors, which were found in 17- and 30-year-old animals, were both associated with endometriosis. In contrast, the teratomas, which are tumors of germ cell origin, were found in younger animals, i.e. 17 years of age or younger. One case of an ovarian carcinoma with metastases was observed in a 6-month-old infant. Cases of spontaneous ovarian tumors from the literature are reviewed.
Publication Types: · Review · Review of Reported Cases
PMID: 12733602 [PubMed – indexed for MEDLINE]
122: J Med Primatol. 2003 Feb;32(1):39-47. Related Articles, Links
Record review of baboons with histologically confirmed endometriosis in a large established colony.
Dick EJ Jr, Hubbard GB, Martin LJ, Leland MM.
Pathobiology Element, Operations Flight, 59th Clinical Research Squadron, Wilford Hall Medical Center, Lackland AFB, TX 78236, USA. edward.dick@lackland.af.mil
Spontaneous endometriosis was diagnosed in 43 baboons over a 14-year period. Thirty-seven have died; five remain alive; one was sold and lost to follow-up. The average age at diagnosis was 17.2 years; 29 (67%) were between 12 and 21 years of age. Fifteen (35%) were diagnosed by biopsy and received surgical excision of the endometriotic tissue; four of these were identified during caesarian section, confirming one prior report of endometriosis in pregnant animals. Twenty-eight (65%) were diagnosed at or shortly preceding necropsy. When diagnosed by a palpable abdominal mass, there was a significantly greater likelihood the animal died or was killed as a result of complications of endometriosis. When diagnosis was at necropsy, there was a significantly greater likelihood that the animal died from causes unrelated to endometriosis. Early identification with surgical removal appears to provide a benefit for both survival and delivering offspring after diagnosis. In twenty-one baboons (49%), endometriosis affected multiple sites within the peritoneal cavity. In the remaining baboons, lesions were more localized. Ovarian involvement was seen in sixteen (37%) of these baboons. This paper is the first to describe significant ovarian involvement in baboons, previously considered a limitation of the usefulness of this species as an animal model. We also describe the first reported endometriosis seeding of an abdominal surgery scar in a baboon. Many of these baboons were middle aged, had few or no offspring, or had evidence of a long duration of uninterrupted menstrual cycles, consistent with risk factors for women. Endometriosis was an incidental finding in 17 (40%) of these baboons, consistent with previous reports of minimal endometriosis as a common asymptomatic finding in baboons and in women. Overall, endometriosis in baboons presents a spontaneously occurring animal model that shares important features with the disease in women and the rhesus macaque.
PMID: 12733601 [PubMed – indexed for MEDLINE]
123: Urologe A. 2003 Feb;42(2):255-62. Related Articles, Links
[Urological complications of endometriosis] [Article in German] Carl PE.
Klinik fur Urologie und Kinderurologie, Klinikum Deggendorf. urologie@klinikum-deggendorf.de
Endometriosis (E) of the urinary tract is often not diagnosed at the beginning of the disease, particularly in cases with bladder wall involvement resulting in persistent dysuria and pelvic pain. Therefore, cystitis-like symptoms in younger women without evidence of urinary tract infections should be considered to be caused by E. Characteristic endoscopic findings may be missed and deep transurethral resection may be necessary for harvesting endometriotic tissue. This situation and improvement of diagnosis by ultrasound are demonstrated by a case report. The development of endometrial polyps in the uterus after tamoxifen (TAM) management is a well-known side effect of this antiestrogenic therapy. We observed a woman with endometrial polyps in the bladder after TAM. Endometriotic ureter stenosis in the absence of colics or other symptoms may results in irreversible loss of kidney function. Verification of the diagnosis is a common task of urology and gynecology. In three of six cases treated in our institution within 5 years, E of the ureter was first ascertained by the presence of ureter damage following surgical treatment of E. In two cases bowel E was present at the same time. Conservative treatment by suppression of ovarian function in most cases of stenosis of the ureter does not avoid the need for subsequent resection and reimplantation because of persistent fibrosis of the ureter wall.
PMID: 12733507 [PubMed – in process]
124: J Am Assoc Gynecol Laparosc. 2003 May;10(2):282-5. Related Articles, Links
Experience with 109 cases of transvaginal hydrolaparoscopy.
Moore ML, Cohen M, Liu GY.
Advanced Women’s Health Institute, University of Colorado Health Sciences Center, 210 University Boulevard, Suite 500, Denver, CO 80206; fax 303 321 0856.
(J Am Assoc Gynecol Laparosc 10(2):282-285, 2003) We conducted a prospective review of our experience with 109 transvaginal hydrolaparoscopies (THLs) performed in 97 women. The THL was considered complete in 101 procedures (93%) and adequate for management in 105 (96%). Two complications occurred (1.8%), one failed entry and one perforation of a retroflexed uterus. Diagnoses for 67 infertile patients were normal pelvis in 34 (51%), endometriosis in 14 (21%), adhesions in 6 (9%), and tubal obstruction in 10 (15%); 3 THLs (4%) were considered incomplete. Of 17 women with dysmenorrhea, a normal pelvis was found in 8 (47%) and endometriosis in 9 (53%). In 11 patients with pelvic pain endometriosis was found in 4 (36%), normal pelvis in 3 (27%), and adhesions in 3 (27%); THL was incomplete in 1 (9%). Six infertile patients (9%) had operative laparoscopy and 10 (15%) operative THL; 6 (9%) were counseled to seek in vitro fertilization. Pregnancy occurred in 16 patients (24%). Analog pain scores (0 = no pain, 10 = worst pain) were tracked in 39 consecutive patients. Pain during trocar insertion averaged 4.2 +/- 0.5, 2.2 +/- 0.2 at midprocedure, and 1.1 +/- 0.1 at the end of THL. We believe that THL should be considered instead of hysterosalpingogram and laparoscopy in selected patients.
PMID: 12732786 [PubMed – in process]
125: J Am Assoc Gynecol Laparosc. 2003 May;10(2):190-4. Related Articles, Links
Laparoscopic Mobilization of the Rectosigmoid and Excision of the Obliterated Cul-de-sac.
Hollett-Caines J, Vilos GA, Penava DA.
Department of Obstetrics and Gynecology, St. Joseph’s Health Care, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada; fax 519 646 6345.
(J Am Assoc Gynecol Laparosc 10(2):190-194, 2003) Study Objective. To evaluate the feasibility and surgical and clinical outcomes of laparoscopic excision of anterior recto-sigmoid wall endometriosis and en bloc dissection of the obliterated cul-de-sac. Design. Retrospective cohort (Canadian Task Force classification II-2). Setting. University-affiliated teaching hospital. Patients. Eighty-one women with infertility and/or chronic pelvic pain. Intervention. Laparoscopic excision of all endometrial implants and uterosacral ligaments, and dissection of the cul-de-sac using a horseshoe-shaped approach to mobilize, but not resect, the rectosigmoid. Measurements and Main Results. Eleven women (24%) had endometriomas. Cumulative pregnancy rates in 34 women with primary infertility and 12 with secondary infertility were 62% and 42%, respectively. Eighty-eight percent of 61 women with pain reported significant improvement of symptoms. Conclusion. Laparoscopic excision of cul-de-sac and rectovaginal endometriosis by this approach is feasible and safe when performed by an experienced surgeon, and results in high rates of cumulative pregnancy and relief of pain. Some patient variables may give higher rates of success for pregnancy than others.
PMID: 12732770 [PubMed – in process]
126: J Am Assoc Gynecol Laparosc. 2003 May;10(2):182-9. Related Articles, Links
Rectal surgery for endometriosis-should we be aggressive?
Varol N, Maher P, Healey M, Woods R, Wood C, Hill D, Lolatgis N, Tsaltas J.
Royal Prince Alfred Hospital Medical Centre, Suite 204, 100 Carillon Avenue, Newtown, N.S.W. 2042, Sydney, Australia; fax 61 2 955 71611.
(J Am Assoc Gynecol Laparosc 10(2):182-189, 2003) Study Objective. To assess the outcome of aggressive but conservative laparoscopic surgery in the treatment of severe endometriosis involving the rectum. Design. Retrospective study (Canadian Task Force classification III). Setting. Endosurgery unit of a tertiary referral center. Patients. One hundred sixty-nine women. Intervention. Laparoscopy or laparotomy. Measurements and Main Results. The procedure was completed successfully laparoscopically in 145 (86%) and by laparotomy in 24 women (14%). The rate of preoperative symptoms was higher in 25 women who underwent bowel resection compared with those who had other bowel surgery. In addition to bowel surgery, excision of uterosacral ligaments, adhesiolysis, excision of endometrioma, and oophorectomy were the four most commonly performed procedures. At 35-month follow-up 61 patients (36%) required further surgery for pain. The average time between primary and repeat surgery was 16 months. This second operation was performed by laparoscopy in over three-fourths of the women. Overall recurrent endometriosis was found in 26 patients (15%). Overall morbidity associated with all surgery was 12.4%. Conclusion. Surgery for endometriosis of the cul-de-sac and bowel involves some of the most difficult dissections encountered, but it can be accomplished successfully with the low postoperative morbidity typical of laparoscopy.
PMID: 12732769 [PubMed – in process]
127: J Am Assoc Gynecol Laparosc. 2003 May;10(2):166-8. Related Articles, Links
Laparoscopic appendectomy.
Agarwala N, Liu CY.
Chattanooga Women’s Laser Center, 1604 Gunbarrel Road, Chattanooga, TN 37421; fax 423 899 1160.
(J Am Assoc Gynecol Laparosc 10(2):166-168, 2003) Study Objective. To evaluate the effectiveness of laparoscopic appendectomy in women with chronic pelvic pain and to identify histopathology of the appendix. Design. Retrospective review over 6.5 years (Canadian Task Force classification II-3). Setting. Laparoscopic center and community hospital. Patients. Three hundred seventeen women. Intervention. Laparoscopic appendectomy in conjunction with other procedures. Measurements and Main Results. Of 317 patients who underwent appendectomy, 14 (4.4%) had involvement of the appendix with endometriosis, 12 (3.78%) had early acute appendicitis, 4 (1.26%) had carcinoid tumors of the appendix, 2 (0.63%) had a large mucocele, and 1 (0.9%) each had Enterobius vermicularis infection, benign neuroma, and mucinous cystadenoma. Seventy-eight women (24.6%) had obliteration of the appendiceal lumen and 22 (6.93%) had entrapping fibrous adhesions. Thirty-two patients (10%) reported relief of chronic pelvic pain in the absence of other pathology just by having diagnostic laparoscopy with appendectomy. Conclusion. The appendix is a key organ in the evaluation of undiagnosed chronic pelvic pain.
PMID: 12732765 [PubMed – in process]
128: Clin Exp Obstet Gynecol. 2003;30(1):35-9. Related Articles, Links
The association of minimal and mild endometriosis without adhesions and infertility with therapeutic strategies.
Check JH.
The University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School at Camden, Cooper Hospital/University Medical Center, Department of Obstetrics and Gynecology Division of Reproductive Endocrinology & Infertility, Camden, NJ, USA.
INTRODUCTION: Mild endometriosis may be present in fertile or infertile women. When present in infertile women it could be merely an innocent bystander, and some other problem is causing the difficulty in conceiving, or it may in some way be directly responsible for the infertility problem. Sometimes to achieve a pregnancy, only these other infertility factors need to be treated with no specific treatment for the endometriosis per se. However there are some data suggesting that sometimes treating the endometriosis surgically may be helpful. METHODS: The pregnancy outcome in women with probable endometriosis vs those without this entity (based on serum CA-125 levels) was compared with treatment rendered only to correcting ovulatory defects with no specific treatment rendered to the endometriotic lesions during the first six months of therapy. Another study evaluated the efficacy of laparoscopic removal of endometriosis vs leaving the lesions untouched on pregnancy outcome in women who failed to conceive after at least eight months of all infertility factors corrected. RESULTS: No differences in pregnancy outcome were found in women with probable endometriosis vs those without after six months of correcting ovulation defects. However, for the minority who did not conceive after such therapy, removing the endometriosis surgically significantly improved fertility rates in the next eight months. CONCLUSIONS: The probable presence of endometriosis based on symptoms, signs, or serologic evidence should prompt careful evaluation and treatment of subtle ovulatory problems, e.g., luteal phase defects and luteinized unruptured follicle syndrome. Therapeutic strategies for those women failing to conceive after six to eight months of conservative therapy could be laparoscopic removal of observed endometriotic implants or consideration of in vitro fertilization.
PMID: 12731742 [PubMed – in process]
129: Clin Exp Obstet Gynecol. 2003;30(1):13-8. Related Articles, Links
The association of minimal and mild endometriosis without adhesions and infertility with therapeutic strategies.
Check JH.
INTRODUCTION: Mild endometriosis may be present in fertile or infertile women. When present in infertile women it could be merely an innocent bystander, and some other problem could be causing the difficulty in conceiving, or it may in some way be directly responsible for the infertility problem. Sometimes to achieve a pregnancy, only these other infertility factors need to be treated with no specific treatment for the endometriosis per se. However there are some data suggesting that sometimes treating the endometriosis surgically may be helpful. METHODS: The pregnancy outcome in women with probable endometriosis vs those without this entity (based on serum CA-125 levels) was compared with treatment rendered only to correcting ovulatory defects with no specific treatment rendered to the endometriotic lesions during the first six months of therapy. Another study evaluated the efficacy of laparoscopic removal of endometriosis vs leaving the lesions untouched on pregnancy outcome in women who failed to conceive after at least eight months of all infertility factors corrected. RESULTS: No difference in pregnancy outcome was found in women with probable endometriosis vs none after six months of correcting ovulation defects. However, for the minority not conceiving after such therapy removing the endometriosis surgically significantly improved fertility rates in the next eight months. CONCLUSIONS: The probable presence of endometriosis based on symptoms, signs, or serologic evidence should prompt careful evaluation and treatment of subtle ovulatory problems, e.g., luteal phase defects and luteinized unruptured follicle syndrome. Therapeutic strategies for those women failing to conceive after 6-8 months of conservative therapy could be laparoscopic removal of observed endometriotic implants or consideration of in vitro fertilization.
Publication Types: · Editorial
PMID: 12731736 [PubMed – in process]
130: Arch Esp Urol. 2003 Mar;56(2):181-5. Related Articles, Links
[Extrinsic ureteral obstruction secondary to inflammatory gynecologic pathology] [Article in Spanish] Conde Santos G, Bielsa Gali O, Arango Toro O, Alonso Gracia N, Gelabert Mas A.
Servicio y Catedra de Urologia, Hospital del Mar, Universidad Autonoma de Barcelona, Barcelona, Espana. 92583@imas.imim.es
OBJECTIVE: To present two cases of extrinsic ureteral obstruction secondary to gynaecological inflammatory diseases, and to perform a bibliographic review. METHODS: We present two cases of obstructive uropathy with uretero-hydronephrosis secondary to tubo-ovarian abscesses diagnosed at our department. Clinical features at presentation, diagnostic tests, and preoperative management are reported. RESULTS: We report the clinical resolution of each case and perform a review about this pathology. CONCLUSIONS: Extrinsic ureteral obstruction is a frequent problem in urology. Inflammatory gynaecologic disease should be included among possible causes at the time of differential diagnosis. A methodical diagnosis process allows defining the exact location of the obstruction, diagnostic possibilities, and most adequate treatment plan for each case. Although association of gynaecological pathology and urinary tract obstruction is well known, there are not many bibliographic references in the national and international literature.
PMID: 12731448 [PubMed – indexed for MEDLINE]
131: Chirurgia (Bucur). 2001 Nov-Dec;96(6):615-20. Related Articles, Links
[Intestinal obstruction caused by abdominal pseudotumoral endometriosis mimicking a peritoneal carcinomatosis–case report] [Article in Romanian] Coros MF, Mulutin D, Toganel C, Sorlea S, Tudor A, Popa D.
Clinica Chirurgie 1 Tg.-Mures, Spitalul Clinic Judetean Mures. tomaion@orizont.net
A 40-year-old woman was admitted in emergency condition with the symptomatology of bowel obstruction. Intraoperative findings consists of a pelvic fixed tumoral mass, and numerous other tumors spread in the whole abdominal cavity mimicking a peritoneal carcinomatosis without liver metastases. Three of the tumors where about 4 cm in diameter producing stenosis of the terminal ileurn and sigma. We considered the case as it was a peritoneal carcinomatosis caused by an uterus or ovarian cancer and we decided for palliative surgery, performing ileo-transversostomy and sigmoidostomy above the obstruction. The histopathologic findings from more pieces of tumors revealed endometriosis without cancerous changes. Postoperative the patient underwent cytostatic and then hormonal therapy. After 3 month the CT scan revealed an important reducing in volume of the pelvic tumoral mass and the barium enema didn’t showed any stenosis under the colostomy so, we closed it extraperitonealy. At 16 month after the first operation the patient was reoperated for a parietal defect. At the second look we found no tumors. The pelvic tumoral mass has disappeared, the uterus seemed to be normal but two big ovary cysts were present. We performed bilateral adnexectomy and the repair of the parietal defect. Postoperative evolution was favorable without any complication or complains at 3 month after the last operation.
PMID: 12731240 [PubMed – indexed for MEDLINE]
132: JSLS. 2003 Jan-Mar;7(1):53-8. Related Articles, Links
Complications of operative gynecological laparoscopy.
Miranda CS, Carvajal AR.
Department of Obstetrics and Gynecology, Clinic Hospital of the University of Chile, Santiago, Chile. gidenmir@mi-mail.cl
OBJECTIVE: To assess the incidence and type of laparoscopic complications. METHODS: A series of 2140 operative laparoscopies were reviewed in a retrospective study of patient records. The setting was a tertiary-care university hospital. Operative laparoscopy included minor procedures (minimal adhesiolysis, destruction of minimal endometriosis foci, ovarian biopsy, ovarian puncture, tubal sterilization), major laparoscopic surgery (extended adhesiolysis, tuboplasties, uterine suspension, treatment for ectopic pregnancy, salpingitis, ovarian cyst, moderate and severe endometriosis), and advanced laparoscopic surgery (hysterectomy, myomectomy, bladder neck suspension). RESULTS: Two major vascular complications, 3 intestinal injuries, 1 anesthesiological complication, and 4 urinary tract injuries occurred. Two minor and 5 postoperative complications were noted. The overall complication rate was 17/2140 (0.79%). The major complication rate was 10/2140 (0.46%). CONCLUSIONS: This review is useful for helping surgeons reduce the risk of injuries and to inform patients about potential complications. These rates are similar to those that have been previously reported.
PMID: 12722999 [PubMed – in process]
133: JSLS. 2003 Jan-Mar;7(1):15-8. Related Articles, Links
Accuracy of laparoscopic diagnosis of endometriosis.
Mettler L, Schollmeyer T, Lehmann-Willenbrock E, Schuppler U, Schmutzler A, Shukla D, Zavala A, Lewin A.
Department of Obstetrics and Gynaecology, University of Kiel, Kiel, Germany. endo-office@email.uni-kiel.de
BACKGROUND AND OBJECTIVE: Laparoscopy is the standard method to visually identify endometriotic lesions under magnification within and outside the minor pelvis. The aim of this study was to analyze the accuracy of laparoscopic visualization in diagnosing the various endometriotic sites as confirmed histologically. METHOD: Presumed endometriotic sites were observed in 164 patients operated on under the clinical suspicion of endometriosis. Targeted biopsies were performed for histologic corroboration, comparing the laparoscopic findings and diagnosis to the histological results. RESULT: The histological reports of the biopsies confirmed the presence of endometriosis in 138 patients (84.1%), but in 26 patients (15.9%), no evidence of endometriosis was observed. 100% of "red" lesions, 92% of "black" lesions, and 31% of "white" lesions turned out to be endometriosis. Of the 264 various suspected endometriotic sites observed, 142 (53.8%) were confirmed histologically. The most accurate diagnosis was in lesions on the parietal peritoneum of the pelvis, confirmed in 9/9 cases (100%); the ovarian fossa, confirmed in 8/12 cases (66.7%); and the uterosacral ligaments and posterior surface of the broad ligament, confirmed in 83/138 cases (60.1%). As for the other sites, the histologic confirmation rates in the ovarian surface, bowel serosa, and vesicouterine fold of the peritoneum were 48%, 40%, and 13%, respectively. CONCLUSION: Endometriosis has a multiple appearance, and the lesions may be confused with nonendometriotic lesions. It is clear that a nonhistology-based diagnosis may lead to unnecessary prolonged medical treatment and operations and may delay the proper treatment measures from being applied. Therefore, a meticulous histological confirmation should still be the first step in the laparoscopic diagnosis and treatment of suspected endometriosis.
PMID: 12722993 [PubMed – in process]
134: Surg Technol Int. 1998;VII:263-267. Related Articles, Links
Techniques of Treatment of Peritoneal Endometriosis: The Cavitational Ultrasonic Surgical Aspirator.
Vasquez J, Bastias C, Mink MB, Fleischer A.
Center for Reproductive Health, Reproductive Endocrinology and Infertility.
PMID: 12721990 [PubMed – as supplied by publisher]
135: Hum Reprod. 2003 May;18(5):1130. Related Articles, Links
Evidence that endometriosis results from the dislocation of basal endometrium?
D’Hooghe TM, Debrock S.
Leuven University Fertility Center, Department Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium.
PMID: 12721196 [PubMed – in process]
136: Hum Reprod. 2003 May;18(5):1130-1. Related Articles, Links
Evidence that endometriosis results from the dislocation of basal endometrium?
Leyendecker G.
Frauenklinik, Klinikum Darmstadt, Grafenstrasse 9, 64283 Darmstadt, Germany e-mail: leyendecker@ferticonsult.de
PMID: 12721195 [PubMed – in process]
137: Hum Reprod. 2003 May;18(5):985-9. Related Articles, Links
Associations between patients with endometriosis and HLA class II; the analysis of HLA-DQB1 and HLA-DPB1 genotypes.
Ishii K, Takakuwa K, Kashima K, Tamura M, Tanaka K.
Department of Obstetrics & Gynecology, Niigata University School of Medicine, 1-757, Asahimachi-dori, Niigata, 951-8510, Japan.
BACKGROUND: Although the aetiology of endometriosis remains unclear, many immunological abnormalities involving changes in cell-mediated and humoral immunity may be associated with endometriosis. Several disorders are thought to be associated with particular HLA antigen types. This study examines the possible association between HLA-DQ and DP. METHODS: A total of 83 patients diagnosed with endometriosis following laparoscopic examination were typed for the HLA-DQB1 and DPB1 alleles using PCR-restriction fragment length polymorphism (RFLP). The HLA DQB1 and DPB1 allele frequencies in these patients and in 222 controls were compared. RESULTS: The prevalence of HLA-DQB1*0301 in the patient group was 16.3% (27/166 alleles), compared with 8.3% in the overall control group (37/444 alleles) and 7.7% in the females of the control group (18/234 alleles). Thus, the prevalence of the HLA-DQB1*0301 allele was significantly greater in patients with endometriosis, compared with the general controls [OR 2.13, 95% CI 1.25-3.64, P = 0.004 (chi(2) analysis), Corrected P-values; Pc = 0.049] and with the general female controls [OR 2.33, 95% CI 1.24-4.39, P = 0.008 (chi(2) analysis), Pc; NS]. There was no significant association in the frequencies of DPB1 alleles between the patients and controls. CONCLUSIONS: The HLA systems may be involved in the aetiology of endometriosis, although further study is needed.
PMID: 12721173 [PubMed – in process]
138: J Chin Med Assoc. 2003 Feb;66(2):113-9. Related Articles, Links
Wound endometriosis: risk factor evaluation and treatment.
Wang PH, Juang CM, Chao HT, Yu KJ, Yuan CC, Ng HT.
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. phwang@vghtpe.gov.tw
BACKGROUND: Wound endometriosis is still a rare phenomenon. In this study, we tried to identify its risk factors and presented our experience in managing such disease. METHODS: We studied twenty-three women with pathologically confirmed wound endometriosis after surgery between January 1990 and June 1999 retrospectively. RESULTS: Patients were classified to three groups according to the types of operations including obstetric surgery (n = 6186), gynecologic surgery (n = 3231) and laparoscopic procedures (n = 2184), which made a significant difference in the occurrence rate of endometriosis (p = 0.04): 2.7 per 1000 obstetric surgeries, 1.5 per 1000 cases of gynecologic surgeries, and 0.5 per 1000 laparoscopic procedures. Obstetric surgery showed the relative risk of occurrence of wound endometriosis 7.71 (95%: 1.03-57.92) compared with laparoscopic procedures. The median time for occurrence of wound endometriosis in patients with normal preoperative CA-125 (< 15 mIU/ml), 760 days, was significantly longer than that in patients with abnormal preoperative CA-125 (> 15 mIU/ml) of 496 days (p = 0.03). Preoperative CA-125 level, patient’s age, preoperative extent of endometriosis, or operative time made no significant contributions to the occurrence of wound endometriosis. Combination therapy of surgical excision and postoperative adjuvant therapy of GnRH-agonist or Danazol showed the better prognosis because it could decrease the recurrence of wound endometriosis (42.9% versus 11%, p = 0.01). CONCLUSION: Obstetric surgery may be an important risk factor in contributing to wound endometriosis, and the aggressive behavior of endometriosis itself might also be a possible risk factor because it shortens the time of occurrence of wound endometriosis after surgery. Therapy might be dependent on individuals. Surgical excision with postoperative adjuvant therapy of either GnRH-agonist or Danazol might be valid, although its effectiveness needed proven in the future.
PMID: 12716010 [PubMed – indexed for MEDLINE]
139: Ginekol Pol. 2003 Jan;74(1):66-8. Related Articles, Links
Unusual case of adenomyosis of the uterine body with malignant clinical course.
Rabczynski J, Neuberg M, Gerber J, Jelen M, Kolodziej J.
Katedry i Zakladu Anatomii Patologicznej AM, Wroclawiu.
We report an unusual case of adenomyosis with asymptomatic thoracic endometriosis. A 30-year old woman had a history of nephroblastoma, two missed abortions and one childbirth by caesarean section. The pregnancy was complicated with asymmetric fetus hipotrophy. Two years after delivery she had assessments for dysmenorrhea, dyspareunia, pelvic pain, and anemia. Gynaecological examination and pelvic endovaginal ultrasonography revealed enlarged uterus. Tumour structure was found with diameter ranging from 40 to 63 mm. The round focus with diameter 15 mm in the left lung by chest roentgenogram was revealed. The patient was diagnosed as follows: hysterography, curettage, bronchoscopy, laparoscopy. Hysterectomy without adnexes was performed and tumour of the left lung was resected. Histologic diagnosis revealed adenomyosis of uterine body and parenchymal pulmonary endometriosis. Two years after operations patient alive without sings of disease.
PMID: 12715440 [PubMed – indexed for MEDLINE]
140: Histopathology. 2003 May;42(5):476-81. Related Articles, Links
Colorectal mass lesions masquerading as chronic inflammatory bowel disease on mucosal biopsy.
Gupta J, Shepherd NA.
Department of Histopathology & Cranfield Postgraduate Medical School in Gloucestershire, Gloucestershire Royal Hospital, Gloucester, UK.
AIMS: We bring to the attention of diagnostic pathologists a further cause of mimicry of chronic inflammatory bowel disease on mucosal biopsy, namely intramural and subserosal colorectal mass lesions. METHODS AND RESULTS: In a 10-year prospective study in one centre, we describe 26 cases in which the initial colonoscopic biopsies suggested a diagnosis of chronic inflammatory bowel disease, whereas subsequent information indicated that the mucosal changes were due to underlying mass lesions, without evidence of chronic inflammatory bowel disease. These mass lesions included underlying primary adenocarcinoma, metastatic carcinoma, pneumatosis, endometriosis and complicated diverticular disease. CONCLUSIONS: In the colon and rectum, intramural and subserosal mass lesions are a significant cause of chronic inflammatory bowel disease mimicry. Possible pathogenic mechanisms include mechanical effects, lymphatic obstruction by underlying tumour, relative mucosal ischaemia and mucosal prolapse. Since the changes seen on mucosal biopsies are a secondary phenomenon, we tentatively suggest that ‘secondary colitis’ may be an appropriate appellation.
PMID: 12713625 [PubMed – in process]
141: Zentralbl Gynakol. 2002 Oct;124(10):478-81. Related Articles, Links
[Endometrial carcinoma using GnRH analogues therapy in endometriosis] [Article in German] Mechsner S, Bartley J, Halis G, Lange J, Loddenkemper C, Ebert AD.
Endometriosezentrum Berlin, Frauenklinik und Poliklinik, Universitatsklinikum Benjamin Franklin der Freien Universitat Berlin.
Endometriosis affects a 10 % of women during their reproductive years. Unequoral statistics concerning the incidence of adenomyosis are not available although a combined occurrence of both diseases is found in a 20 % of cases. The risk that malignancy arises from endometrioid tissue typical for endometriosis is between a 0.3-1 %. 75 % of these malignancies are ovarian cancer in conjunction with pre-existing ovarian endometriosis; less frequently extraovarian malignancies are found. The development of malignancy of adenomyosis is very rarely reported. In this report we present the case of a 35 year old patient who suffered from both, endometriosis and adenomyosis and who underwent a therapy using GnRH analogues. After five months and before the completion of the therapy a hysterectomy with conservation of the ovaries was performed at the request of the patient (carcinophobia). The histology confirmed the diagnosis of adenomyosis and demonstrated the unexpected finding of an endometrium carcinoma. This latter arose from a complex atypical hyperplasia surrounded by hypoplastic endometrium. There is some evidence that suggests a slightly elevated risk of breast and ovarian cancer as well as haematological malignancies amongst patients with endometriosis. However, there does not appear to be an increased risk of endometrial carcinoma. Adipositas leads to an increased risk for the development of endometrial carcinoma due to the increased conversion of testosterone to estrone in fat. The peripheral synthesis of estrone is unaffected by GnRHa-therapy. A progesterone containing HRT should be added to a GnRHa-therapy in overweight patients to prevent the development of endometrial hyperplasia and/or carcinoma. In conclusion a careful indication has to be made for GnRHa-therapy in overweight patients and before and during the therapy high resolution ultrasound scan should be performed to evaluate the endometrium in those patients.
PMID: 12712390 [PubMed – indexed for MEDLINE]
142: Am J Obstet Gynecol. 2003 Apr;188(4):1103-4. Related Articles, Links
Twenty-year history of endometriosis-associated pelvic pain: too much surgery or not enough?
Matalliotakis IM, Mahutte NG, Goumenou AG, Arici A.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Conn., USA. matakgr@yahoo.com
A 36-year-old woman with a 20-year history of endometriosis-associated pelvic pain was a unique case from a total of 700 patients with endometriosis recently evaluated at Yale University. Her previous treatments included 11 surgical procedures related to pelvic pain or endometriosis. Multiple recurrences of endometriosis were documented. Although clearly an unusual case, our patient highlights the importance of using even the most advanced surgical techniques judiciously.
PMID: 12712119 [PubMed – indexed for MEDLINE]
143: Gene. 2003 Apr 10;308:67-77. Related Articles, Links
Identification of distinct gene expression profiles associated with treatment of LbetaT2 cells with gonadotropin-releasing hormone agonist using microarray analysis.
Kakar SS, Winters SJ, Zacharias W, Miller DM, Flynn S.
Department of Medicine, University of Louisville, 570 South Preston Street, Baxter Building, Room 204 C, Louisville, KY 40202, USA. sskaka01@louisville.edu
Gonadotropin-releasing hormone (GnRH) is a neuropeptide that plays a pivotal role in reproductive processes. In recent years, it has become clear that it is also an anti-proliferative agent. GnRH analogs are now used clinically in the treatment of prostate cancer as well as endometriosis and precocious puberty. The target cells of GnRH include the gonadotropes of the anterior pituitary gland and the cells of various hormone-dependent tumors. Only a few target genes have been identified in these cells, however, and little is known concerning their regulation by GnRH. Therefore, we used a quantitative microarray assay to identify the genes that are regulated by GnRH in a murine gonadotrope tumor cell line (LbetaT2). Treatment of LbetaT2 cells with GnRH agonist des-gly(10),[D-Ala(6)]GnRH (GnRHA) for 1 h resulted in alterations in the levels of expression of genes that ranged in magnitude from 1.3- to 159-fold, with a total of 232 genes exhibiting a twofold or greater alteration in expression compared to vehicle treated cells. Of these 232 genes, 149 were up-regulated and, surprisingly, 83 were down-regulated by GnRHA treatment. After 24 h of treatment, the expression of most of the genes that had exhibited altered expression after 1 h of treatment had returned to baseline levels. Moreover, a different profile was observed after 24 h of treatment with 208 genes exhibiting a twofold or greater alteration. Of these, 95 were up-regulated and 113 down-regulated. Most of the affected genes were not known to be responsive to GnRH prior to this study. Treatment with GnRHA was found to affect the expression of a diverse range of genes, including oncogenes and those that encode transcription factors, ion channel proteins, and cytoskeletal proteins as well as other proteins that are involved in signal transduction, the cell cycle, cell proliferation and apoptosis. The altered expression of six of the genes that were found by microarray analysis to be regulated by GnRHA was confirmed by semiquantitative reverse transcriptase-polymerase chain reaction. This is first application of the microarray technique in the study of the global profile of genes regulated by GnRH, and should prove to be a powerful tool for future analysis of the mechanisms by which GnRH regulates the expression of gonadotropins and the growth of tumor cells.
PMID: 12711391 [PubMed – indexed for MEDLINE]
144: Tunis Med. 2003 Feb;81(2):126-9. Related Articles, Links
[Umbilical endometriosis: apropos of 3 cases] [Article in French] Chandoul A, Sbei N, Messaoudi F, Basly M, Messaoudi L, Chibani M, Ben Rejeb A, Rachdi R.
Service maternite, Service anatomo pathologie, Hopital militaire principal d’instruction de Tunis.
Umbilical endometriosis is a rare localisation of the disease. The authors report three cases of umbilical endometriosis. The symptomatology is not usually typic. The only effective treatment remains the surgical exercise thus allowing the confirmation histological.
PMID: 12708179 [PubMed – indexed for MEDLINE]
145: Ann Endocrinol (Paris). 2003 Feb;64(1):45-50. Related Articles, Links
Thyroid disorders in infertile women.
Poppe K, Velkeniers B.
Department of Endocrinology, Free University Brussels (AZ-VUB), Laarbeeklaan 101, 1090 Brussels-Belgium.
Thyroid hormones have profound effects on reproduction and pregnancy. There is a known association of hyper- and hypothyroidism with menstrual disturbances and decreased fecundity. Women with reproductive failure also have an increased prevalence of organ specific autoimmunity compared to fertile women. The present study aims to answer the following questions: 1) is there an increased prevalence of thyroid antibodies in infertile women? 2) are thyroid antibodies associated with a particular cause of infertility? and 3) do these antibodies influence outcome of the in vitro fertilization procedure? The answers to the two first questions were evaluated with a case-control study looking at the occurrence of thyroid autoimmunity and thyroid function tests among women of infertile couples (n=438), presenting for the first time at the department of reproductive medicine. For comparison, a control population of parous women (n=100), matched for age, was included. In 45% of the infertile couples a female cause of infertility was identified: endometriosis (11%), tubal disease (30%) and ovarian dysfunction (59%). Male infertility was diagnosed in 38% and idiopathic infertility in 17% of the couples. Mean serum TSH levels were significantly higher in patients with infertility compared with control patients: 1.6 +/- 2.6 versus 1.2 +/- 0.7 mIU/L. The proportion of positive TPO-Abs was higher in all women of infertile couples, compared with controls (14% versus 8%), but the difference was not significant. Considering only the female causes of infertility a significant higher proportion of women had positive TPO-Abs compared with controls (18% versus 8%), and in particular a high prevalence of thyroid autoimmunity was found in women suffering from endometriosis (29%). Both hypo- and hyperthyroidism were more frequent when TPO-Abs were positive, compared to women without thyroid autoimmunity. The results of the present study indicate that endometriosis, increases the relative risk for associated thyroid autoimmunity to 2.3, and therefore screening for thyroid auto-antibodies could be systematically proposed in these women.
PMID: 12707633 [PubMed – indexed for MEDLINE]
146: AJR Am J Roentgenol. 2003 May;180(5):1291-6. Related Articles, Links
Fast breath-hold T2-weighted MR imaging reduces interobserver variability in the diagnosis of adenomyosis.
Bazot M, Darai E, Clement de Givry S, Boudghene F, Uzan S, Le Blanche AF.
Department of Radiology, Hopital Tenon, Assistance Publique-Hopitaux de Paris, 4 rue de la Chine, 75020 Paris, France.
OBJECTIVE: We compared two rapid MR imaging T2-weighted pulse sequences with high-resolution turbo spin-echo for the diagnosis of adenomyosis, and we evaluated interobserver variability. SUBJECTS AND METHODS: Fifty-six consecutive patients referred for hysterectomy prospectively underwent MR imaging. Two fast pulse sequences using a breath-hold technique-true fast imaging with steady-state free precession (FISP) and turbo inversion recovery-and turbo spin-echo T2-weighted images of the pelvis were obtained in each patient. The images were analyzed in a blinded manner and independently by three reviewers with different levels of experience for the accuracy of adenomyosis diagnosis, image quality, anatomic visualization, and image artifacts. The accuracy for the diagnosis of adenomyosis on turbo spin-echo T2-weighted imaging combined with one or two fast pulse sequences was evaluated for each reviewer. RESULTS: Twenty-four patients (42.9%) had a histologic diagnosis of adenomyosis. The accuracy for the diagnosis of adenomyosis for reviewers 1, 2, and 3 using turbo spin-echo T2-weighted, true FISP, and turbo inversion recovery sequences was 83.9%, 6

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