150: Obstet Gynecol Clin North Am. 2003 Mar;30(1):221-44. Related Articles, Links
Future directions in endometriosis research.
D’Hooghe TM, Debrock S, Meuleman C, Hill JA, Mwenda JM.
Leuven University Fertility Center, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, 3000 Leuven, Belgium. thomas.dhooghe@uz.kuleuven.ac.be
Future research in endometriosis must focus on pathogenesis studies in the baboon model, the early interactions between endometrial and peritoneal cells in the pelvic cavity at the time of menstruation, and potential differences between eutopic endometrium and myometrium in women with and without endometriosis. More integration is needed between the areas of epidemiology and genetics. Pelvic inflammation in women with endometriosis could be the target for new diagnostic and therapeutic approaches. Important questions remain regarding the relationship between endometriosis and environmental factors. Systemic and extrapelvic manifestations of endometriosis must be analyzed carefully, and better tools are needed to measure quality of life in women with chronic pain caused by endometriosis. Most current evidence supports a causal relationship between endometriosis and subfertility, and the spontaneous progressive nature of endometriosis has been demonstrated in 30% to 60% of patients. Recurrence of endometriosis after classic medical and surgical therapy is a major and underestimated problem, especially in women with advanced disease. Integrated clinical and research teams are needed that combine expert medical, surgical, and holistic care with state-of-the-art research expertise in immunology, endocrinology, and genetics to discover new diagnostic methods and medical treatments for endometriosis.
Publication Types: · Review · Review, Tutorial
PMID: 12699268 [PubMed – indexed for MEDLINE]
151: Obstet Gynecol Clin North Am. 2003 Mar;30(1):209-20. Related Articles, Links
Relieving endometriosis pain: why is it so tough?
Campbell PF.
Endometriosis Association International Headquarters, 8585 North 76th Place, Milwaukee, WI 53223, USA. endo@endometriosisassn.org
Finding the solution for the pain of endometriosis is likely to be a time-consuming, often frustrating task. But it is a task that can begin in earnest only once the pain is identified and believed. If a girl or woman with endometriosis is ashamed to discuss her pain or her symptoms are dismissed or minimized by her physician, it is inevitable that her pain will continue untreated. The first step in treating the pain of endometriosis is to encourage patients to discuss their pain frankly. A pain map, diary, and descriptors may be helpful, but listening and believing the patient are essential.
Publication Types: · Review · Review, Tutorial
PMID: 12699267 [PubMed – indexed for MEDLINE]
152: Obstet Gynecol Clin North Am. 2003 Mar;30(1):193-208. Related Articles, Links
Management of endometriosis-associated infertility.
Surrey ES, Schoolcraft WB.
Colorado Center for Reproductive Medicine, 799 East Hampden Avenue, #300, Englewood, CO 80110, USA. esurrey@colocrm.com
Management of infertility associated with endometriosis remains challenging. The clinician must rule out all other causes of infertility before creating a treatment plan. It is important to remember that women with infertility and endometriosis with tubal patency can conceive spontaneously, albeit at lower rates than in the fertile population. Surgical ablation or resection seems to provide benefit even in the absence of correctable anatomic defects. One should note, however, that the goal of surgery is not only to eliminate disease effectively but also to restore pelvic anatomy to normal. After reconstruction or in patients with less extensive disease, controlled ovarian hyperstimulation techniques potentially in conjunction with intrauterine inseminations can be effective. It is important to monitor patients carefully given the risk of high order multiple gestation reported with these techniques. IVF represents an effective means of bypassing the hostile peritoneal environment and anatomic distortion associated with this disease state. Although medical suppression of endometriosis alone has virtually no benefit in the asymptomatic patient, there seems to be significant benefit of pretreatment with GnRH agonists immediately before IVF cycle initiation. Whether only a specific subset or all patients with endometriosis would benefit from this approach has not yet been determined. The use of endometrial implantation markers may be helpful in this regard. The selection of the most effective approach to overcome infertility must be individualized and based on extent of disease, additional infertility factors, patient comfort, and a frank discussion of success rates and risks with patients.
Publication Types: · Review · Review, Tutorial
PMID: 12699266 [PubMed – indexed for MEDLINE]
153: Obstet Gynecol Clin North Am. 2003 Mar;30(1):181-92. Related Articles, Links
How does endometriosis affect infertility?
Navarro J, Garrido N, Remohi J, Pellicer A.
Instituto Valenciano de Infertilidad (IVI-Sevilla), Avda de la Republica Argentina 58, 41011-Seville, Spain. jnavarro@ivi.es
Prospective and retrospective clinical trials suggest a decreased oocyte and embryo quality in women with endometriosis. Based on these observations, the authors described an altered intrafollicular milieu in endometriosis, which explains the bad quality oocytes and the resulting embryos with lower capacity to implant. Whether these changes affect the oocytes or are the consequence of genomic alterations manifested by biochemical and chromosomal differences in healthy women is an unresolved issue. If the effects of endometriosis on follicular development are nongenomic in origin, modulation of the process of folliculogenesis may be sufficient to treat the disease and cure infertility associated with endometriosis. A genomic defect needs specific genetic therapy, which currently is not available.
Publication Types: · Review · Review, Tutorial
PMID: 12699265 [PubMed – indexed for MEDLINE]
154: Obstet Gynecol Clin North Am. 2003 Mar;30(1):163-80. Related Articles, Links
Endometriosis: preoperative and postoperative medical treatment.
Vercellini P, Frontino G, De Giorgi O, Pietropaolo G, Pasin R, Crosignani PG.
Luigi Mangiagalli Department of Obstetrics and Gynecology, University of Milano, Via Commenda, 12 20122 Milano, Italy. paolo.vercellini@unimi.it
The quality of the evidence that supports the use of medical treatment before conservative surgery for endometriosis is manifestly poor, and no recommendations can be made based on the results of the published studies. There are practical advantages inherent to this schedule, but whether this translates into better conception rates and reduced pain recurrence rates is unproven. The effect of drug therapy after surgery can be assessed better as data from seven true randomized, controlled trials are available. The results of the current review do not support the notion that suppressing ovarian activity postoperatively increases the long-term pregnancy rate. As far as pelvic pain is concerned, more data are needed to verify the reduced symptoms recurrence rate found in four trials in women who were allocated to postoperative medical therapy, particularly in view of the different results obtained in some of the considered studies. The observed differences among various drugs used before or after surgery are limited in clinical terms and, in the absence of formal randomized comparisons, are difficult to interpret. Because of their tolerable side effects and limited cost, progestins with or without estrogens should be considered strongly as first-line postoperative medical treatment if and when suppression of ovulation after conservative surgery is deemed opportune.
Publication Types: · Review · Review, Academic
PMID: 12699264 [PubMed – indexed for MEDLINE]
155: Obstet Gynecol Clin North Am. 2003 Mar;30(1):151-62. Related Articles, Links
Surgical management of endometriosis-associated pain.
Martin DC, O’Conner DT.
University of Tennessee, Department of Obstetrics and Gynecology, 6215 Humphreys, Suite 400, Memphis, TN 38120, USA. dnmartin46@aol.com
General surgical guidelines are reasonable, but treatment frequently must be individualized. Laparoscopic coagulation can be used for many cases of superficial endometriosis. Resection seems to be associated with an increased resolution of endometriosis. Resection increases the difficulty of the procedure, the time of the operation, and the cost, however. When endometriosis is found coincidentally, it may need no treatment because many women have endometriosis as a self-limited disease. Distinguishing patients who need no treatment from patients who need intermediate or extensive treatment can be difficult. Care is needed to attempt to ensure that patients are neither overtreated nor undertreated.
Publication Types: · Review · Review, Tutorial
PMID: 12699263 [PubMed – indexed for MEDLINE]
156: Obstet Gynecol Clin North Am. 2003 Mar;30(1):133-50. Related Articles, Links
Medical management of endometriosis-associated pain.
Mahutte NG, Arici A.
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA. neal.mahutte@yale.edu
In the coming years, basic science research into the mechanisms of endometriosis development and persistence almost certainly will open new avenues for treatment. A wide armamentarium of medical therapies already exists, however. The efficacy of most of these methods in reducing endometriosis-associated pain is well established. The choice of which to use depends largely on patient preference after an appropriate discussion of risks, side effects, and cost. Typically, oral contraceptives and NSAIDs are first-line therapy because of their low cost and mild side effects (Box 6). Because of its greater potential for suppressing endometrial development, consideration should be given to prescribing a low-dose monophasic oral contraceptive continuously. If adequate relief is not obtained or if side effects prove intolerable, consideration should be given to the use of progestins (oral, intramuscular, or IUD) or a GnRH agonist with immediate add-back therapy. Progestins are less expensive, but GnRH agonists with add-back may be better tolerated. If none of these medications proves beneficial or if side effects are too pronounced, then repeat surgery is warranted. The surgery may have analgesic value and serves to reconfirm the diagnosis. Finally, if endometriosis is identified at the time of surgery, then consideration should be given to prescribing medical therapy postoperatively.
Publication Types: · Review · Review, Tutorial
PMID: 12699262 [PubMed – indexed for MEDLINE]
157: Obstet Gynecol Clin North Am. 2003 Mar;30(1):115-32. Related Articles, Links
The current staging system for endometriosis: does it help?
Roberts CP, Rock JA.
Department of Gynecology and Obstetrics, Emory University, 1639 Pierce Drive, WMB Room 4208, Atlanta, GA 30322, USA.
A multicenter collaboration for data collection and statistical analysis may be necessary to establish and validate a classification system based on empirically derived scores for specific pathologic observations. The endometriosis pain instrument may be a tool for some of those variables with regard to pelvic pain. A similar strategy for uniform collection of data for analysis of important factors also is necessary for infertility. The challenge of creating a satisfactory classification of endometriosis remains. The ability of the current classification schemes to predict pregnancy outcome or aid in the management of pelvic pain is recognized to be inadequate. Further revisions of the current classification scheme are anticipated as the understanding of how endometriosis contributes to infertility and pelvic pain evolves. In any revision of the classification system, use of empirically derived weights and breakpoints to define disease stages based on outcome data in larger clinical trials should be attempted. It is also possible that additional factors, such as CA-125 level or lesion characteristics, may be shown to play an important role in prognosis. If so, these must be accounted for in the classification scheme. Careful and consistent use of the recommendations of the American Society for Reproductive Medicine classification of endometriosis subcommittee should allow for collection of data for use in further revisions. It is possible that a classification scheme that is designed to predict outcome with respect to pregnancy may be totally inadequate in assessing patients who have endometriosis and pelvic pain. Factors found to be important in the assessment of pelvic pain may be different from those involved with the pathophysiology of endometriosis and infertility. The AFS form suggested for use in the management of endometriosis in the presence of pelvic pain allows for recording of variables such as depth of invasion, histology, and documenting adjunct investigations and preoperative physical findings. Such prospective data collection and review in large centers may provide a large clinical base from which to derive empirical point scores and breakpoints in a classification scheme.
Publication Types: · Review · Review, Tutorial
PMID: 12699261 [PubMed – indexed for MEDLINE]
158: Obstet Gynecol Clin North Am. 2003 Mar;30(1):95-114, viii-ix. Related Articles, Links
Noninvasive diagnosis of endometriosis: the role of imaging and markers.
Brosens J, Timmerman D, Starzinski-Powitz A, Brosens I.
Institute of Reproductive and Developmental Biology, Wolfson and Weston Research Centre for Family Health, Faculty of Medicine, Imperial College School of Medicine, Hammersmith Hospital, London, W12 ONN, United Kingdom. j.brosens@ic.ac.uk
Endometriosis is defined by the presence of endometrial tissue outside the uterus. Clinical and basic research in endometriosis has been hampered severely by the lack of accurate noninvasive diagnostic techniques. Transvaginal ultrasonography, MRI, and endometrial and serum markers have the potential to facilitate the diagnosis and can be useful in the follow-up of patients. Endometriosis research has entered the postgenomic era, and powerful genomic and proteomic technology is being applied in the search for novel diagnostic and therapeutic approaches. This article explores the recent advances in imaging techniques and the development of diagnostic molecular markers of endometriosis.
Publication Types: · Review · Review, Tutorial
PMID: 12699260 [PubMed – indexed for MEDLINE]
159: Obstet Gynecol Clin North Am. 2003 Mar;30(1):83-93, viii. Related Articles, Links
Typical and subtle atypical presentations of endometriosis.
Donnez J, Squifflet J, Casanas-Roux F, Pirard C, Jadoul P, Van Langendonckt A.
Department of Gynecology, St. Luc’s Hospital, Universite Catholique de Louvain, Avenue Hippocrate, 1200 Brussels, Belgium. donnez@gyne.ucl.ac.be
The diagnosis of peritoneal endometriosis at the time of laparoscopy is often made by the observation of typically puckered black or bluish lesions. There are also numerous subtle appearances of peritoneal endometriosis. The lesions are frequently non-pigmented. Red flame-like lesions, glandular excrescences, and subovarian adhesions must be considered as the most active lesions. Sometimes, however, subtle endometriotic lesions can be the only lesions seen at laparoscopy.
Publication Types: · Review · Review, Tutorial
PMID: 12699259 [PubMed – indexed for MEDLINE]
160: Obstet Gynecol Clin North Am. 2003 Mar;30(1):63-82, viii. Related Articles, Links
Adenomyosis.
Matalliotakis IM, Kourtis AI, Panidis DK.
Department of Obstetrics and Gynecology, University of Crete, Heraklion, Greece.
Adenomyosis is characterized as ectopic endometrial tissues within the myometrium in the uterus. The etiology and pathogenetic mechanism(s) responsible for adenomyosis are poorly understood. Definite diagnosis is made on hysterectomy specimens, although attempts are made at securing preoperative diagnosis by magnetic resonance imaging and myometrial biopsies. Definite treatment of symptomatic women is hysterectomy.
Publication Types: · Review · Review, Tutorial
PMID: 12699258 [PubMed – indexed for MEDLINE]
161: Obstet Gynecol Clin North Am. 2003 Mar;30(1):41-61. Related Articles, Links
Pathogenesis of endometriosis.
Seli E, Berkkanoglu M, Arici A.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8063, USA.
Endometriosis is a common gynecologic disorder characterized by the presence of endometrial tissue outside the uterine cavity. Various theories have been put forth to explain the mechanisms for the development of this disease. Although no single theory can explain all cases of endometriosis, the retrograde menstruation theory has gained the widest acceptance. This theory proposes that viable endometrial tissue is refluxed through the fallopian tubes during menstruation and implants on peritoneal surface or pelvic organs. Retrograde menstruation occurs in 76% to 90% of women. The much lower prevalence of endometriosis suggests that additional factors determine susceptibility to endometriosis. Once in the peritoneal cavity, the survival and implantation of endometrial cells seem to be mediated by abnormal MMP and TIMP expression, altered immune milieu, aberrant local aromatase activity, and genetic and environmental factors.
Publication Types: · Review · Review, Tutorial
PMID: 12699257 [PubMed – indexed for MEDLINE]
162: Obstet Gynecol Clin North Am. 2003 Mar;30(1):21-40, vii. Related Articles, Links
Genetics of endometriosis.
Simpson JL, Bischoff FZ, Kamat A, Buster JE, Carson SA.
Department of Obstetrics and Gynecology, Baylor College of Medicine, 6550 Fannin, Suite 901A, Houston, TX 77030, USA. jsimpson@bcm.tmc.edu
Endometriosis long has been recognized as showing heritable tendencies, with recurrence risks of 5% to 7% for first-degree relatives. The risk indicates that polygenic and multifactorial etiology is far more likely to be the cause than mendelian inheritance. The current task is to determine the number and location of genes responsible for endometriosis. Molecular advances of the past decade make identification and elucidation of these genes a reality. The authors review the basis for concluding that endometriosis is a genetic disorder of polygenic/multifactorial inheritance. Genome-wide strategies for identifying causative genes are considered and available data on association or linkage to putative candidate genes systematically reviewed.
Publication Types: · Review · Review, Tutorial
PMID: 12699256 [PubMed – indexed for MEDLINE]
163: Obstet Gynecol Clin North Am. 2003 Mar;30(1):1-19, vii. Related Articles, Links
The epidemiology of endometriosis.
Missmer SA, Cramer DW.
Ob/Gyn Epidemiology Center, Brigham and Women’s Hospital, 121 Longwood Avenue, Boston, MA 02115, USA. smissmer@hsph.harvard.edu
The epidemiologic study of endometriosis presents researchers with unique challenges. As a result, few well-designed studies have been published. The authors briefly describe the primary pathogenic hypotheses, discuss methodologic issues specific to endometriosis, and review the small body of literature addressing risk factors. Finally, they offer a brief interpretation of these findings and suggest hypotheses for future research.
Publication Types: · Review · Review, Tutorial
PMID: 12699255 [PubMed – indexed for MEDLINE]
164: J Reprod Med. 2003 Mar;48(3):204-5. Related Articles, Links
Suburethral endometrioma. A case report.
Wu YC, Liang CC, Soong YK.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan, Taiwan, R.O.C. 10591.
BACKGROUND: Extrapelvic endometriosis may occur at unusual sites. We report a rare case of an endometrioma presenting as a suburethral mass in a woman without a previous surgical history. CASE: A 27-year-old, nulliparous woman presented with a painful suburethral mass, dyspareunia and voiding difficulty. Ultrasonographic examination showed an echolucent mass over the suburethral area measuring 3.7 cm in diameter. Double-balloon cystourethrography showed that the mass did not communicate with the urethral lumen. Complete excision was performed later. The final pathologic examination revealed endometriosis. CONCLUSION: Extrapelvic endometriosis should be considered as a possible diagnosis for a suburethral mass even if no pelvic endometriosis is detected from a detailed history and vaginal examination. Ultrasonography and double-balloon cystourethrography may be helpful for clinical evaluation. Complete excision is advisable for management of a suburethral endometrioma.
PMID: 12698781 [PubMed – indexed for MEDLINE]
165: Complement Ther Nurs Midwifery. 2003 May;9(2):62-8. Related Articles, Links
Learning to take charge: women’s experiences of living with endometriosis.
Cox H, Henderson L, Wood R, Cagliarini G.
Deakin University/Epworth Hospital, School of Nursing, 221 Burwood Highway, Richmond, Vic, Australia. helencox@deakin.edu.au
This paper describes aspects of a study that was conducted to determine women’s needs for information related to laparoscopy for endometriosis. Sixty-one women attended focus groups, during which they described endometriosis as a disease of multiple losses: of relationships, of career and of a sense of self-worth. The women indicated that the pathway to diagnosis and treatment had been long and unnecessarily difficult. Many women said that they had reached a point where they decided enough was enough: the medical merry-go-round had to finish. They had to become assertive, take control and decide for themselves how they were going to manage their disease and their quality of life. For all but one woman in the study, complementary therapies were vital. For some women, alternative therapies had replaced allopathic medicine completely. Complementary/alternative therapies were a mechanism for regaining control.
PMID: 12697156 [PubMed – indexed for MEDLINE]
166: Ups J Med Sci. 2002;107(3):159-64. Related Articles, Links
A case of inguinal endometriosis with difficulty in preoperative diagnosis.
Hagiwara Y, Hatori M, Katoh H, Kokubun S.
Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Japan.
An unusual case of endometriosis involving the right round ligament in a 40-year-old woman is presented. After giving birth to two children, she first noticed a tender mass in the right groin at the age of 36. It didn’t change in size but pain appeared at the age of 38, disturbing her daily life. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpable in her right inguinal region. Magnetic resonance imaging demonstrated a 2×3 cm mass in the right inguinal canal. At operation, a mass was found to be in continuity with the round ligament at the inguinal canal. Histological diagnosis was endometriosis. After operation, she was completely relieved of pain. It is important to include endometriosis in the differential diagnosis for painful inguinal masses in women of childbearing age.
PMID: 12696574 [PubMed – in process]
167: Kaohsiung J Med Sci. 2003 Jan;19(1):38-41. Related Articles, Links
Multilobular cyst as endosalpingiosis of uterine serosa: a case report.
Chang Y, Tsai EM, Yang CH, Kuo CH, Lee JN.
Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
A case of endosalpingiosis presented as a multilobular cyst on sonography. The tentative clinical diagnosis was an ovarian tumor; however, laparotomy revealed a degenerative cyst of the uterine myoma with a stalk connecting to the uterus. Histopathologically, it showed characteristics of endosalpingiosis. To our knowledge, such a multilobular cyst of endosalpingiosis originating solely from the uterine serosa has not been reported.
PMID: 12693725 [PubMed – indexed for MEDLINE]
168: J Coll Physicians Surg Pak. 2003 Mar;13(3):164-5. Related Articles, Links
Primary umbilical endometriosis–a rare variant of cutaneous endometriosis.
Hussain M, Noorani K.
Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi.
A case of primary umbilical endometriosis is being reported here, who presented with a dark brown nodule on the umbilicus with black pigmentation around it for the last seven months, associated with cyclical pain and bleeding from the nodule. Wide local excision of the nodule, laparoscopic tubal ligation and visualization of pelvic cavity was performed, revealing no sign of pelvic endometriosis. Histopathology report showed endometrial glands with stroma in the excised nodule.
PMID: 12689538 [PubMed – indexed for MEDLINE]
169: Saudi Med J. 2003 Feb;24(2):206-8. Related Articles, Links
Laparoscopic management of non-communicating rudimentary horn in a dysmenorrheic and infertile patient.
Saleh AM, Sultan SF, Al-Jawad HM, Al-Ghazali SD, Al-Shalahi NJ.
Department of Obstetrics and Gynecology, King Fahad National Guard Hospital, PO Box 1011, Riyadh 11431, Kingdom of Saudi Arabia. Tel. +966 (1) 4544031. Fax. +966 (1) 4537462. E-mail: drsaleh2002@hotmail.com
A case of laparoscopic excision of non-communicating rudimentary horn. The anatomical features of this case were unique. A 19-year-old nulligravida presented with severe dysmenorrhea and primary infertility. Hysterosalpingogram revealed a left uterine horn that had a solitary patent tube. Magnetic resonance imaging showed a left unicornuate uterus continuous with the cervix and the vagina, and a rudimentary right uterine horn. This confirmed the diagnosis of non-communicating cavitated right rudimentary horn. At laparoscopy the patient had stage III endometriosis, and non-communicating right rudimentary horn, which was attached to the unicornuate uterus by a long fibrous band. The rudimentary horn was freed from the pelvic side wall, excised and removed laparoscopically with no complication.
PMID: 12682690 [PubMed – in process]
170: Dis Colon Rectum. 2003 Apr;46(4):503-9. Related Articles, Links
Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience.
Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW.
Department of Colorectal Surgery and the Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
INTRODUCTION: Laparoscopic sigmoid colectomy has been accepted slowly despite potential advantages because of the perceptions of a steep learning curve and increased operative times and costs. The purpose of this article is to review the outcome of a standardization of all the intraoperative and postoperative processes used in our department for the performance of laparoscopic sigmoid colectomy. METHODS: A consecutive series of patients requiring laparoscopic sigmoid colectomy from March 1999 through December 2001 at the Cleveland Clinic Foundation, Cleveland, Ohio, was analyzed. Patients requiring sigmoid or rectosigmoid resection for all colonic pathologies were included. Criteria for exclusion from an attempted laparoscopic sigmoid colectomy were body mass index >35 and prior major abdominal surgeries (exclusive of hysterectomy, cholecystectomy, or appendectomy). Data collected included age, gender, indication for surgery, American Society of Anesthesiology class, body mass index, operative duration, length of hospital stay, complications, mortality, and 30-day readmission. The operative steps for laparoscopic sigmoid colectomy were as follows: 1) open insertion of the umbilical port; 2) placement of three operating ports; 3) dissection/division of the vascular pedicle after identification of the left ureter; 4) mobilization of the sigmoid and descending colon; 5) rectal mobilization/division; 6) exteriorization of the specimen; and 7) circular stapled anastomosis. Instrumentation for the procedure was standardized. Conversion was performed when a sequential step could not be completed in a reasonable time frame. A standard perioperative care plan was used. RESULTS: From March 1999 through December 2001, the primary surgeon performed 207 sigmoid colectomies, including 181 (87.4 percent) attempted laparoscopic sigmoid colectomies and 22 (12.1 percent) conversions. Indications for the laparoscopic sigmoid colectomies were diverticular disease (115), colonic neoplasia (32), prolapse (14), endometriosis (10), and other (10). The male/female ratio was 85:96, and the mean body mass index was 27.3 +/- 5.6. Mean operative time was 119 +/- 35 minutes. Mean length of stay was 2.9 +/- 1.2 days for completed cases and 6.4 +/- 1.4 days for converted cases. Anastomotic leaks occurred in two patients (1.1 percent), one of whom died of multisystem organ failure, yielding an operative mortality of 0.6 percent. The overall complication rate was 6.6 percent, and the 30-day readmission rate was 8 percent. CONCLUSION: The results indicate that a structured approach to laparoscopic sigmoid colectomy provides the surgeon with objective measures of operative progress that limit unduly long operations without increasing conversion rates and that control resource utilization. This approach provides a potential guideline for teaching and mastering laparoscopic sigmoid colectomy, reducing the learning curve, and optimizing results.
PMID: 12682545 [PubMed – indexed for MEDLINE]
171: Russ J Immunol. 2001 Apr;6(1):55-60. Related Articles, Links
Local Epidermal Growth Factor Production in Women with Endometriosis.
Sotnikova NY, Antsiferova YS, Shokhina MN.
Research Institute of Maternal and Childhood, Ivanovo, Russia.
The aim of the study was to elucidate the role of epidermal growth factor (EGF) in pathogenesis of endometriosis at different stages of disease. The level of EGF in peritoneal fluid (PF) of fertile and infertile women with endometriosis and in pooled supernatants of 24-h cultures of peritoneal macrophages was assessed by ELISA method. It was found that in fertile women with early stages of disease EGF level in PF did not differ from that in control group, but at the advanced stages of endometriosis the significant elevation of EGF concentration in PF was observed. The spontaneous production of EGF by peritoneal macrophages in this group was diminished. It might be suggested that elevation of EGF concentration in PF in this group is the result of secretory activity of endometriosis lesions and macrophages didn’t regulate the local EGF production in fertile women. EGF level in PF of infertile women was increased only in women with minimal manifestations of endometriosis but not in women with advanced stages of the disease. Simultaneously the increase of EGF production by peritoneal macrophages of infertile women with advanced stages of endometriosis was shown. These facts give an evidence in favor of high level of macrophage activation and their participation in regulation of EGF level in peritoneal cavity in infertile women with endometriosis.
PMID: 12687207 [PubMed – as supplied by publisher]
172: Russ J Immunol. 2000 Oct;5(3):307-314. Related Articles, Links
A Study of Peritoneal Immunocompetent Cells in External Genital Endometriosis.
Sotnikova NY, Antsiferova YS, Posiseeva LV, Shor AL, Solovjeva TA.
Research Institute of Maternal and Childhood, Ivanovo, Russia.
The aim of the present investigation was to study the peculiarities of peritoneal lymphoid cell activation at the local level during external endometriosis and the possible role of secretory products of peritoneal macrophages in this process. Immunocompetent cells of peritoneal fluid from 16 women with endometriosis and 14 healthy women were studied by two-color flow cytometry method. It was found that endometriosis was associated with high level of expression of CD25 and HLA DR molecules and diminishment of Fas expression by CD3(+) subset of peritoneal lymphocytes. Experimentally it was established that supernatant of 24-h culture of peritoneal macrophages from women with endometriosis induced the expression of CD25 marker by CD4(+) but not CD8(+) cells and decreased Fas expression by both cell subsets in donor lymphocytes. It can be supposed that altered secretory function of peritoneal macrophages in situ impair the apoptosis of activated clones of T lymphocytes. Observed effect of macrophage secretory products was not associated with TNF-alpha production by peritoneal macrophages in the process of their cultivation.
PMID: 12687185 [PubMed – as supplied by publisher]
173: Acta Cytol. 2003 Mar-Apr;47(2):321-4. Related Articles, Links
Ovarian endometriosis showing decidual change and Arias-Stella reaction with biotin-containing intranuclear inclusions.
Sakaki M, Hirokawa M, Sano T, Takahashi H, Tezuka K, Abe K, Sano M.
Publication Types: · Letter
PMID: 12685213 [PubMed – indexed for MEDLINE]
174: Nurs Stand. 2003 Mar 19-25;17(27):47-53; quiz 54-5. Related Articles, Links
Endometriosis.
Gould D.
Faculty of Health, South Bank University, London.
Endometriosis is a common condition that causes pain and distress to many women. A variety of medical and surgical treatment options exist, and the nursing role is mainly one of information-giving and support.
Publication Types: · Review · Review, Tutorial
PMID: 12683119 [PubMed – indexed for MEDLINE]
175: J Clin Endocrinol Metab. 2003 Apr;88(4):1697-704. Related Articles, Links
Suppression of a pituitary-ovarian axis by chronic oral administration of a novel nonpeptide gonadotropin-releasing hormone antagonist, TAK-013, in cynomolgus monkeys.
Hara T, Araki H, Kusaka M, Harada M, Cho N, Suzuki N, Furuya S, Fujino M.
Pharmaceutical Research Division, Takeda Chemical Industries, Ltd., Osaka 532-8686, Japan. Hara_Takahito@takeda.co.jp
TAK-013 is a novel nonpeptide and orally active GnRH antagonist. We first examined the effect of TAK-013 on GnRH-stimulated LH release using primary-cultured pituitary cells of cynomolgus monkeys. TAK-013 suppressed LH release to below basal levels at concentrations higher than 100 nM with the IC(50) value of 36 nM. Next, we examined the effect of chronic oral administration of TAK-013 on serum hormone levels in regularly cycling female cynomolgus monkeys. TAK-013 administered at 90 mg/kg x d (30 mg/kg 3 times daily) for approximately 80 d continued to suppress LH, estradiol, and progesterone, but not FSH. The suppressive effect was reversible, in that normal profiles of sex steroids were observed immediately after discontinuation of the TAK-013 treatment. Interestingly, the suppressive effect of TAK-013 was not observed in marmoset monkeys. In summary, TAK-013 by oral administration suppresses a pituitary-ovarian axis continuously and reversibly in cynomolgus monkeys. Considering that TAK-013 has more potent antagonistic properties for human GnRH receptor than for monkey receptor, our data suggest that TAK-013 would be effective for reproductive disorders such as endometriosis and uterine leiomyoma and useful for assisted reproductive technology procedures.
PMID: 12679460 [PubMed – indexed for MEDLINE]
176: Reprod Biomed Online. 2003 Mar;6(2):238-43. Related Articles, Links
Differential induction of matrix metalloproteinase 1 and 2 in ectopic endometrium.
Wolber EM, Kressin P, Meyhofer-Malik A, Diedrich K, Malik E.
Beth Israel Deaconess Medical Center, Cancer Biology Program, Harvard Institutes of Medicine, Boston, MA, USA.
According to the transplantation theory, endometriosis develops from endometrial fragments that are retrogradely menstruated into the peritoneal cavity. In order to develop into endometriotic lesions, they have to connect to the vascular system by angiogenesis, probably involving matrix metalloproteinases (MMP) as key enzymes in extracellular matrix remodelling. A model of endometriosis using the chorioallantoic membrane (CAM) of chick embryos was established. Eutopic endometrium from healthy women was transferred to the CAM and cultivated ectopically for up to 3 days. Before transplantation and after 24, 48 and 72 h of culture on the CAM, total RNA was extracted and reverse transcribed. Human MMP-1 (interstitial collagenase) and MMP-2 (gelatinase A) mRNA expression was assessed by competitive PCR. Results were normalized to the content of human glyceraldehyde 3-phosphate dehydrogenase (GAPDH) mRNA. In eutopic endometrium, 0.29 amol MMP-1 mRNA and 0.42 fmol MMP-2 mRNA per fmol GAPDH mRNA were found. Relative MMP-1 mRNA concentrations increased strongly after culture on the CAM, while MMP-2 mRNA levels were nearly unaltered. This differential regulation suggests different roles of these enzymes in the angiogenesis of ectopic endometrial fragments and during the development of endometriosis.
PMID: 12676008 [PubMed – in process]
177: Orv Hetil. 2003 Feb 23;144(8):373-4. Related Articles, Links
[Endometrial carcinoma arising from endometriosis in the episiotomy scar] [Article in Hungarian] Nagy P.
Zala Megyei Korhaz Szuleszet-nogyogyaszati Osztaly, Zalaegerszeg.
The author presents a case of a 70-year-old womens adenocarcinoma, arising from endometriosis in the scar of an episiotomy decades after labour. Although the discrete lesion appeared to be removed completely it soon recurred after operation. Due to the worsening progression of her general condition she failed to receive an adequate therapy. Despite the fatal outcome of this case the author emphasis the importance of an early diagnosis and medical intervention. The knowledge of this phenomenon is essential in the everyday practice.
PMID: 12666385 [PubMed – indexed for MEDLINE]
178: Endocr Res. 2003 Feb;29(1):53-65. Related Articles, Links
Identification of genes with differential regulation in primate endometrium during the proliferative and secretory phases of the cycle.
Allan G, Campen C, Hodgen G, Williams R, Charnock-Jones DS, Wan J, Erlander M, Palmer S.
Reproductive Therapeutics, Johnson & Johnson Pharmaceutical Research and Development, Raritan, New Jersey, USA. gallan@prdus.jnj.com
To study gene expression in the endometrium at different stages of the menstrual cycle, differential mRNA display and reverse Northern analysis were performed on uterine tissues from cynomolgus monkeys. Eutopic endometrial RNA was prepared from uteri of animals that were either ovariectomized and supplemented with hormones, or were not ovariectomized but were subjected to surgically induced endometriosis. A number of genes were identified whose levels fluctuated between the proliferative and secretory phases of the cycle. Expression of four genes thus identified was further examined by in situ hybridization to normal human endometrial biopsies. Iodothyronine deiodinase was uniformly expressed at all stages of the human cycle that were studied: proliferative, secretory, and menstrual. Fibulin 1, osteopontin, and cathepsin H exhibited complex temporal and spatial regulation. Fibulin 1 was expressed in glandular epithelia during the menstrual phase, but expression switched to the stroma during the secretory phase. During the menstrual phase, osteopontin was expressed at high levels in glandular epithelia and in isolated stromal cells that may be of immune origin. Secretory phase expression of osteopontin was confined to a sub-population of epithelial cells. Cathepsin H was expressed in proliferative and menstrual phase endometrium, but expression disappeared in the secretory phase. Messenger RNA for fibulin 1, osteopontin, and iodothyronine deiodinase was detected in an endometriosis sample. Our data support functional roles for fibulin 1, osteopontin, cathepsin H and thyroid hormone in endometrium.
PMID: 12665318 [PubMed – in process]
179: Hum Fertil (Camb). 2003 Feb;6(1):34-40. Related Articles, Links
Pathogenesis of endometriosis – current research.
Witz CA, Allsup KT, Montoya-Rodriguez IA, Vaughan SL, Centonze VE, Schenken RS.
Department of Obstetrics and Gynecology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229-3900, USA.
Proliferative, secretory and menstrual endometrial cells of both the stroma and epithelium adhere to intact peritoneal mesothelium and mesothelial monolayers. Endometrial attachment to the mesothelium appears to occur rapidly (within 1 h) and transmesothelial invasion occurs between 1 and 18-24 h. These results demonstrate that the mesothelium is not a ‘no-stick’ surface and indicates that molecules present at the surface of the mesothelium are involved in the pathogenesis of the early endometriotic lesion. The inhibition of endometrial cell adherence to peritoneal mesothelium by hyaluronidase indicates that CD44-hyaluronan binding is at least one of the mechanisms involved in the pathogenesis of endometriosis. We believe that investigation of mesothelial cell adhesion molecules is central to understanding the pathogenesis of endometriosis.
PMID: 12663961 [PubMed – in process]
180: Ginecol Obstet Mex. 2002 Dec;70:619-21. Related Articles, Links
[Abdominal wall endometriosis. Case report and literature review.] [Article in Spanish] Ceniceros Franco G, Cruz Minoli V, Diaz Arguello D, Munuzuri Iniguez F.
Departamento de Ginecologia y Obstetricia, Hospital American British Cowdray (ABC).
Endometriosis, is a disorder affecting as many as 15% of women of childbearing age, is defined as the aberrant or heterotopic growth of glands and stroma identical to the lining uterus. Endometriosis, can be macroscopically identified generally confined to the pelvis, but it can proliferate in other areas like pleura, skin, extremities, lung, spleen, gallbladder, stomach, kidney and abdominal wall. Abdominal wall endometriosis usually occurs in the surgical scar of previous cesarean sections. This condition often looks like a cyclic abdominal pain with a palpable mass or tumor. We report a case of abdominal endometriosis. The definitive diagnosis was established by pathologic analysis.
Publication Types: · Review · Review of Reported Cases
PMID: 12661336 [PubMed – indexed for MEDLINE]
181: Gynecol Obstet Fertil. 2002 Dec;30(12):979-84. Related Articles, Links
[Utility of rectal endoscopic ultrasonography for digestive involvement of pelvic endometriosis. Technique and results] [Article in French] Dumontier I, Chapron C, Chaussade S, Dubuisson JB.
Service d’hepato-gastro-enterologie, hopital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. christian-dumontier@wanadoo.fr
Intestinal endometriosis present in up to 37% of cases is difficult to diagnose and treatment remains complex. Until recently barium enema and colonoscopy are the only two diagnostic tools. However there were many drawbacks and technical limitations due to the particular development of the endometrial lesions with frequent respect of the mucosa. Digestive involvement was often preoperative discovery and treatment was frequently incomplete. Development of endoscopic ultrasonography has improved the potential for preoperative diagnosis of digestive endometriosis. Many publications have now demonstrated its utility. Compared to other imaging techniques endoscopic ultrasonography has better sensibility close to 100%. Endoscopic ultrasonography is superior to Magnetic Resonance Imaging for the diagnosis of rectosigmoid endometriosis. Magnetic Resonance Imaging however gives a largest view of the pelvis. Using preoperatively endoscopic ultrasonography in patients who are at risk of digestive involvement will help to choose between different therapeutic modalities and surgical techniques.
Publication Types: · Review · Review, Tutorial
PMID: 12661288 [PubMed – indexed for MEDLINE]
182: Hum Reprod. 2003 Apr;18(4):760-6. Related Articles, Links
Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease.
Chapron C, Fauconnier A, Dubuisson JB, Barakat H, Vieira M, Breart G.
Service de chirurgie gynecologique, Clinique universitaire Baudelocque, CHU Cochin, Saint Vincent de Paul, La Roche-Guyon, 123, bd Port-Royal 75079 Paris Cedex 14, France. charles.chapron@cch.ap-hop-paris.fr
BACKGROUND: Little is known about the precise nature of the relationship between dysmenorrhoea (DM) and endometriosis. Our aim was to evaluate the relationship between the severity of DM in women with posterior deep infiltrating endometriosis (DIE) and indicators of the extent of their disease. METHODS: Various indicators of the extent of DIE were recorded during surgery in 209 women. The severity of their DM was assessed with a pain scale. The scale was retrospective for 155 women and prospective for 54. Correlations were sought with an ordinal logistic regression model with cumulative odds. RESULTS: On univariate analysis the following variables were related to the severity of DM: number of previous surgical procedures for endometriosis; revised American Fertility society classification; extensiveness of adnexal adhesion; Douglas obliteration; size of the posterior DIE implant; extent of the sub-peritoneal infiltration by the posterior DIE (rectal, vaginal or both versus sub-peritoneal only). Current infertility was associated with less severe DM. After multiple regression analysis, presence of a rectal or vaginal infiltration by the posterior DIE and extensiveness of adnexal adhesion were the only factors that remained related to DM severity. CONCLUSIONS: The concept of ‘very deep infiltrating endometriosis’, defined as implants invading the wall of the pelvic organ, should be tested in future classification systems specifically addressed to the prediction of endometriosis-related pain.
PMID: 12660268 [PubMed – in process]
183: Hum Reprod. 2003 Apr;18(4):756-9. Related Articles, Links
Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women.
Arruda MS, Petta CA, Abrao MS, Benetti-Pinto CL.
Department of Obstetrics and Gynaecology, Universidade Estadual de Campinas (UNICAMP), Campinas and Department of Obstetrics and Gynaecology, Universidade de Sao Paulo (USP), Sao Paulo, Brazil.
BACKGROUND: The study aim was to assess the time elapsed between onset of symptoms and diagnosis of endometriosis, and to identify the factors associated with diagnostic delay in a group of Brazilian women. METHODS: In this retrospective cohort study, 200 women with surgically confirmed endometriosis were interviewed at an endometriosis outpatient clinic. RESULTS: The median (interquartile range) time elapsed from onset of symptoms until diagnosis of endometriosis was 7.0 (range 3.5-12.1) years. The younger the women at onset of symptoms, the longer the period for diagnosis to be made: the median delay was 12.1 (range 8.0-17.2) years in women aged </=19 years, and 3.3 (range 2.0-5.5) years in women aged >/=30 years. The median time period between onset of symptoms and diagnosis was 4.0 (2.0-6.0) years for women whose main complaint was infertility, but 7.4 (3.6-13.0) years for those with pelvic pain. CONCLUSIONS: The delay in diagnosis of endometriosis was considered to be long, and especially so for young women with pelvic pain. More information relating to endometriosis should be offered to general physicians and gynaecologists in order to reduce the time taken to diagnose this condition.
PMID: 12660267 [PubMed – in process]
184: Gynecol Obstet Fertil. 2003 Jan;31(1):43-5. Related Articles, Links
[Endometrioid carcinoma of the Fallopian tube arising in tubo-ovarian endometriosis. A case report] [Article in French] Bouraoui S, Goucha A, El Ouertani L, Mekni A, Bellil S, Mahjoub S, Zouari F, Kchir N, Haouet S.
Service d’anatomie pathologique, hopital la Rabta, 1007 Bab Saadoun, Tunis, Tunisie. moncef.zitouna@ms.tn
The primitive endometrioid carcinoma of the fallopian tube is exceptional. Only three cases have been reported in the literature. Its rise on tubal endometriosis like for the ovary needs to meet the strict histological criteria established by Sampson and Scott in 1953. We report one case observed on a patient aged 45 years, who needed a total hysterectomy with bilateral annexectomy for menometrorrhagias associated to uterine leiomyomas which resisted to medical treatment. The finding of a primitive intra-epithelial endometrioid carcinoma of the left fallopian tube developed on bilateral tubo-ovarian endometriosis was fortuitously found during histological examination. Our observation seems to be unique since it shows an evident filiation between the lesions of tubal endometriosis and the adjoining endometrioid carcinoma contrary to the similar unique case reported in the literature where the link between the two lesions has not been demonstrated.
PMID: 12659783 [PubMed – indexed for MEDLINE]
185: J Huazhong Univ Sci Technolog Med Sci. 2002;22(1):60-1. Related Articles, Links
Immunohistochemical study of HLA-DR antigen in endometrial tissue of patients with endometriosis.
Liu Y, Luo L, Zhao H.
Department of Obstetrics and Gynecology, Xiehe Hospital, Wuhan.
In order to evaluate the expression of HLA-DR antigen in glandular cells in eutopic and ectopic endometrium in patients with endometriosis, 19 infertile patients with endometriosis were analyzed immunohistochemically by labelled streptavidin biotin (LSAB) method. Nineteen infertile patients without endometriosis were studied as controls. The results showed that the expression of HLA-DR antigen in the glandular cells in both eutopic and ectopic endometrium was increased significantly as compared with that in the controls (P < 0.01). It is likely that aberrant expression of HLA-DR antigen in endometriotic tissue is involved in abnormal immunogenesis of endometriosis.
PMID: 12658786 [PubMed – in process]
186: Med Electron Microsc. 2003 Mar;36(1):9-17. Related Articles, Links
Histological classification of ovarian cancer.
Kaku T, Ogawa S, Kawano Y, Ohishi Y, Kobayashi H, Hirakawa T, Nakano H.
School of Health Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. kaku@shs.kyushu-u.ac.jp
The histology of ovarian tumors exhibits a wide variety of histological features. The histological classification of ovarian tumors by the World Health Organization (WHO) is based on histogenetic principles, and this classification categorizes ovarian tumors with regard to their derivation from coelomic surface epithelial cells, germ cells, and mesenchyme (the stroma and the sex cord). Epithelial ovarian tumors, which are the majority of malignant ovarian tumors, are further grouped into histological types as follows: serous, mucinous, endometrioid, clear cell, transitional cell tumors (Brenner tumors), carcinosarcoma, mixed epithelial tumor, undifferentiated carcinoma, and others. Clear cell and endometrioid carcinomas are highly associated with endometriosis. In stage distribution, serous carcinoma is found predominantly is stage III or IV. In contrast, clear cell and endometrioid carcinomas tend to remain confined to the ovary. Clear cell and endometrioid carcinomas may be unique histological types compared with serous carcinomas with respect to stage distribution and association with endometriosis.
PMID: 12658347 [PubMed – in process]
187: Glycoconj J. 2002 Jan;19(1):33-41. Related Articles, Links
Glycosylation and over-expression of endometriosis-associated peritoneal haptoglobin.
Piva M, Moreno JI, Sharpe-Timms KL.
Department of Obstetrics and Gynecology, The University of Missouri, Columbia, MO 65212, USA.
Peritoneal endometriotic tissues synthesize and secrete haptoglobin (pHp), which has an analogous nucleotide sequence to hepatic haptoglobin found in serum (sHp). This study performed enzymatic digestions and lectin binding assays to determine if differences in protein glycosylation exist between sHp and pHp, which may provide insight into pHp function and/or identify epitopes for development of novel methods of medical management of endometriosis. To reduce the dependence on surgical collection of peritoneal tissues from women, recombinant peritoneal Hp (rpHp) was produced and its glycosylation analyzed for future functional studies. These results showed the apparent molecular weight of pHp was 3 kDa smaller than sHp. Desialylation and complete N-deglycosylation elicited similar shifts in sHp and pHp electrophoretic migration, suggesting similar sialic acid content and indicating the 3 kDa variance was due to carbohydrate content, not protein degradation, respectively. Sequential deglycosylation of the four sHp N-glycan chains caused a 3 kDa shift per N-glycan removed suggesting the 3 kDa difference between sHp and pHp may be one N-glycan chain. Lectin ELISA and lectin-blotting analyses demonstrated increased pHp and rpHp interactions with MAL and LTL but no difference in binding to SNL compared to sHp from healthy individuals, identifying variations in the ratios of alpha(2-3) to alpha(2-6) sialic acid and fucose residues. Recombinant pHp was 100-fold over-expressed with a similar glycosylation pattern to pHp, albeit in an unprocessed alpha-beta Hp polypeptide form. These results are the first to identify differences between pHp and sHp glycosylation and lay groundwork further studies to characterize anomalies in glycan composition and structure, which likely impart pHp with known immunomodulatory functions and may be used as epitopes for development of immune based therapeutics for novel, non-surgical management of endometriosis.
PMID: 12652078 [PubMed – indexed for MEDLINE]
188: J Steroid Biochem Mol Biol. 2002 Dec;83(1-5):149-55. Related Articles, Links
Endometriosis: the pathophysiology as an estrogen-dependent disease.
Kitawaki J, Kado N, Ishihara H, Koshiba H, Kitaoka Y, Honjo H.
Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho Kamigyo-Ku, Kyoto 602-8566, Japan. kitawaki@koto.kpu-m.ac.jp
Endometriosis, defined as the presence of endometrial glands and stroma outside of the uterine cavity, develops mostly in women of reproductive age and regresses after menopause or ovariectomy, suggesting that the growth is estrogen-dependent. Indeed, the lesions contain estrogen receptors (ER) as well as aromatase, an enzyme that catalyses the conversion of androgens to estrogens, suggesting that local estrogen production may stimulate the growth of lesions. The expression patterns of ER and progesterone receptors in endometriotic lesions are different from those in the eutopic endometrium. Moreover, estrogen metabolism, including the expression pattern of aromatase and the regulation of 17 beta-hydroxysteroid dehydrogenase type 2 (an enzyme responsible for the inactivation of estradiol to estrone), is altered in the eutopic endometrium of women with endometriosis, adenomyosis, and/or leiomyomas compared to that in the eutopic endometrium of women without disease. Immunostaining for P450arom in endometrial biopsy specimens diagnosed these diseases with sensitivity and specificity of 91 and 100%, respectively. This is applicable to the clinical diagnosis of endometriosis. The polymorphisms in the ER-alpha gene, the CYP19 gene encoding aromatase, and several other genes are associated with the risk of endometriosis. Studies of these will lead to better understandings of the etiology and pathophysiology of endometriosis.
Publication Types: · Review · Review, Tutorial
PMID: 12650711 [PubMed – indexed for MEDLINE]
189: Verh K Acad Geneeskd Belg. 2002;64(6):389-99; discussion 400-2. Related Articles, Links
Thyroid and infertility.
Poppe K, Velkeniers B.
Academisch Ziekenhuis-Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussel.
Infertility is defined as the inability to conceive after one year of regular intercourse without contraception. The prevalence of infertility is estimated between 12 and 14% and remains stable in recent years. It thus represents a common condition, with important medical, economic and psychological implications. According to a standard protocol infertility evaluation usually identifies different causes, including, male infertility (30%), female infertility (35%), the combination of both (20%), and finally unexplained or "idiopathic" infertility (15%). Female causes of infertility comprise endometriosis, tubal damage and ovulatory dysfunction (OD). Thyroid dysfunction is a condition known to reduce the likelihood of pregnancy and to adversely affect pregnancy outcome. Data on the relationship between thyroid disorders and infertility remain scarce and the association with a particular cause of infertility has not thoroughly been analyzed. In a case-control study we have shown that the relative risk of positive TPO-Abs in infertility due to a female cause and in particular related to endometriosis is significantly increased. Thyroid dysfunction itself is a condition interfering with normal ovarian function and was more frequent in women with positive anti-TPO Abs. We therefore propose that a systematic screening of TSH, free T4 and TPO-Ab could be considered in all women with a female cause of infertility. Prospective follow-up of a cohort of infertile women undergoing assisted reproduction shows a significant increased risk of miscarriage in women with positive anti-TPO Abs compared to women without thyroid auto-immunity after clinical pregnancy is established by the ART procedure. The frequent association of the presence of anti-TPO-Abs and miscarriage is hypothetical explained by the fact that organ specific autoimmune diseases may be secondary to some basic cellular abnormality that directly affects pregnancy outcome. Alternatively, women with thyroid autoimmunity, may experience greater changes in free thyroxine levels during ART and subsequent pregnancy interfering with genital tract physiology and fetal development. Determining the presence of thyroid antibodies before ART procedure is thus useful in identifying women at risk for subsequent clinical miscarriage.
Publication Types: · Review · Review, Tutorial
PMID: 12649931 [PubMed – indexed for MEDLINE]
190: Int J Gynecol Pathol. 2003 Apr;22(2):209-12. Related Articles, Links
Mullerianosis of the mesosalpinx: a case report.
Lim S, Kim JY, Park K, Kim BR, Ahn G.
We report a case of mullerianosis of the mesosalpinx, the appearance of which simulated metastatic adenocarcinoma. The patient was a 37-year-old woman with a mixed epithelial cystadenoma of borderline malignancy associated with endometriosis in both ovaries. The left mesosalpinx contained a firm, 2.2-cm, gray-white mass that on microscopic examination consisted of glands lined mostly by endocervical-type epithelium with admixed tubal-type glands and foci of endometriosis. Rupture of glands with extravasation of mucin into the surrounding stroma was observed, but there was no desmoplastic stromal reaction. Awareness of this relatively uncommon lesion is critical to avoid misdiagnosis and overly aggressive treatment.
PMID: 12649681 [PubMed – in process]
191: Gynecol Oncol. 2003 Mar;88(3):394-9. Related Articles, Links
Evaluation of complete surgical staging with pelvic and para-aortic lymphadenectomy and paclitaxel plus carboplatin chemotherapy for improvement of survival in stage I ovarian clear cell carcinoma.
Ho CM, Chien TY, Shih BY, Huang SH.
Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Cathay General Hospital, 106, Taipei, Taiwan. cmho@ms52.url.com.tw
OBJECTIVE: The aim was to determine the benefits of lymphadenectomy and paclitaxel plus carboplatin chemotherapy for stage I ovarian clear cell carcinoma (defined as intra-abdominal disease confined to the ovaries). METHODS: Twenty patients with stage I pure clear cell carcinoma of the ovary diagnosed between 1991 and 2001 were divided into two groups: Group A (12 patients, 1997-2001) underwent complete surgical staging including bilateral salpingo-oophorectomy, hysterectomy, omentectomy, and pelvic and para-aortic lymphadenectomy, followed by paclitaxel and carboplatin chemotherapy. Group B (8 patients, 1991-1996) underwent bilateral salpingo-oophorectomy, hysterectomy, and omentectomy without lymphadenectomy, followed by cisplatin-based chemotherapy. The survival of the two groups was compared. The clinical characteristics of the two groups were evaluated for age distribution, grade, substage, preoperative CA-125, presence or absence of endometriosis, and maximal tumor diameter. RESULTS: The estimated 4-year survival rate was 76.9%. The clinical characteristics of the two groups were similar, except for lymphadenectomy and regimen of chemotherapy. With a median follow-up of 36 months (range: 11-130 months), one of 12 patients in Group A had recurrence in comparison with 6 of 8 patients in Group B (P = 0.004). The estimated 3-year recurrence-free survival and 4-year overall survival for Group A was significantly greater than that for Group B (91.7 vs 33.3%, P = 0.014; 100 vs 50%, P = 0.014). Median time to recurrence was 8 months. CONCLUSIONS: Complete surgical staging, including pelvic and para-aortic lymphadenectomy and paclitaxel plus carboplatin chemotherapy, appeared to be capable of improving survival of patients with stage I ovarian clear cell carcinoma.
Publication Types: · Clinical Trial
PMID: 12648592 [PubMed – indexed for MEDLINE]
192: Gynecol Oncol. 2003 Mar;88(3):318-25. Related Articles, Links
p53 mutations and overexpression affect prognosis of ovarian endometrioid cancer but not clear cell cancer.
Okuda T, Otsuka J, Sekizawa A, Saito H, Makino R, Kushima M, Farina A, Kuwano Y, Okai T.
Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
OBJECTIVE: Although ovarian clear cell adenocarcinoma (OCCA) and ovarian endometrioid adenocarcinoma (EC) are

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