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200: Radiographics. 2003 Mar-Apr;23(2):425-45; quiz 534-5. Related Articles, Links
MR imaging of the uterine cervix: imaging-pathologic correlation.
Okamoto Y, Tanaka YO, Nishida M, Tsunoda H, Yoshikawa H, Itai Y.
Department of Radiology, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan. okamotchi@muf.biglobe.ne.jp
Magnetic resonance (MR) imaging is useful not only for preoperative staging of gynecologic malignancies but also for prediction of the histopathologic features of a variety of intrapelvic tumors. Familiarity with the specific imaging findings that have been reported for the uterine cervix is a goal of radiologists. The typical MR imaging findings of uterine cervical lesions correspond to the histopathologic features. These lesions can be categorized as epithelial neoplasms, nonepithelial neoplasms, and nonneoplastic diseases. Cervical carcinoma accounts for most cases of malignant lesions and is staged by using the classification system established by the International Federation of Gynecology and Obstetrics. MR imaging allows differentiation between endophytic and exophytic growth and between normal and abnormal findings after hysterectomy and irradiation. Other epithelial neoplasms of the uterine cervix include adenoma malignum, which is a special type of cervical adenocarcinoma, as well as carcinoid tumor and malignant melanoma. Nonepithelial neoplasms of the uterine cervix include malignant lymphoma and leiomyoma. Nonneoplastic diseases of the uterine cervix include cervical pregnancy, cervicitis, nabothian cysts, polyps, and endometriosis. Copyright RSNA, 2003
Publication Types: · Review · Review, Tutorial
PMID: 12640157 [PubMed – indexed for MEDLINE]

201: Vestn Khir Im I I Grek. 2002;161(6):79-81. Related Articles, Links [Rational surgical strategy in urgent non-gravidic metrorrhagia] [Article in Russian] Rukhliada NN, Bagnenko SF, Tsvelev IuV.
The authors made an analysis of aspects of using the diagnostic and operative hysteroscopy in diagnosis and treatment of urgent nongravidary metarrhagias (UNM) under conditions of the department of urgent gynecology of the multiprophile hospital. The authors have analyzed the causes of the development of UNM, revealed high incidence of adenomyosis (44.3%).
PMID: 12638501 [PubMed – indexed for MEDLINE]
202: Nippon Rinsho. 2003 Feb;61(2):314-8. Related Articles, Links
[Bone loss induced by GnRHa treatment in women] [Article in Japanese] Matsuo H.
Department of Maternity Nursing, Faculty of Health Sciences, Kobe University School of Medicine.
The hypoestrogenic state induced by gonadotropin-releasing hormone agonist(GnRHa) has been shown to be effective in the treatment of uterine leiomyoma and endometriosis but to induce bone loss. The BMD significantly decreased from baseline(-4.9 +/- 2.5%, mean +/- SD) after 24 weeks of treatment of leuprolide acetate depot(p < 0.01), and remained significantly below the baseline(-3.4 +/- 2.7%, p < 0.01) at 12 months after the treatment period. To minimize bone loss without compromising efficacy, several investigators have sought to ‘add-back’ sex-steroid hormones or other bone-sparing agents. Unresolved issues from these studies include ideal regimens and whether the add-back therapy prevents bone loss without compromising efficacy. GnRHa plus oral bisphosphonate therapy prevents bone loss without deteriorating the therapeutic effect of GnRHa.
Publication Types: · Review · Review Literature
PMID: 12638227 [PubMed – indexed for MEDLINE]
203: Obstet Gynecol. 2003 Mar;101(3):594-611. Related Articles, Links
Chronic pelvic pain.
Howard FM.
Department of Obstetrics and Gynecology, Division of Gynecologic Specialties, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA. fred_howard@urmc.rochester.edu
Chronic pelvic pain is a common and significant disorder of women. It is estimated to have a prevalence of 3.8% in women. Often the etiology of chronic pelvic pain is not clear, as there are many disorders of the reproductive tract, gastrointestinal system, urological organs, musculoskeletal system, and psychoneurological system that may be associated with chronic pelvic pain. The history and physical examination are crucial in evaluating a woman with chronic pelvic pain and must address all of the possible systems potentially involved in chronic pelvic pain, not just the reproductive system. Laboratory and imaging studies should be selectively utilized, as should laparoscopy. Conscious laparoscopic pain mapping has been proposed as a way to improve information derived from laparoscopic evaluations. Treatment of chronic pelvic pain may consist of two approaches. One is to treat chronic pain itself as a diagnosis, and the other is to treat diseases or disorders that might be a cause of or a contributor to chronic pelvic pain. These two approaches are not mutually exclusive, and in many patients effective therapy is best achieved by using both approaches. Treatment of chronic pain as well as treatment of four of the more common disorders associated with chronic pelvic pain (endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis) are discussed in this review.
Publication Types: · Review · Review, Tutorial
PMID: 12636968 [PubMed – indexed for MEDLINE]
204: Clin Exp Obstet Gynecol. 2002;29(4):271-3. Related Articles, Links
Reproductive outcome after laparoscopic treatment of endometriosis.
Porpora MG, Pultrone DC, Bellavia M, Franco C, Crobu M, Cosmi EV.
Institute of Gynecological Sciences, Perinatology and Child Health, Policlinico Umberto I-University La Sapienza, Rome, Italy.
PURPOSE OF INVESTIGATION: To evaluate the pregnancy rate after laparoscopic treatment of endometriosis. PATIENTS AND METHODS: 47 infertile women undergoing laparoscopic treatment of endometriosis. RESULTS: rAFS stage was as follows: 11% of patients had Stage I, 11% Stage II, 53.3% Stage III and 24.4% Stage IV. The mean duration of follow-up was 48.5 +/- 18.44 months. The overall pregnancy rate was 64.4%. Eighteen out of 26 women (69%) became pregnant within six months after laparoscopy, 23% at 12 months, 11% within 24 months, and 11% after two years (p < 0.01). Adnexal adhesions and tubal status significantly affected the pregnancy rate. No differences were found regarding the stage of disease and the presence of ovarian endometriomas. CONCLUSION: Laparoscopic treatment of endometriosis enhances fertility and the pregnancy rate is highest within the first six months after surgery. Adnexal adhesions and tubal conditions influence the reproductive outcome.
Publication Types: · Evaluation Studies
PMID: 12635743 [PubMed – indexed for MEDLINE]
205: Am J Obstet Gynecol. 2003 Mar;188(3):857; author reply 857-8. Related Articles, Links
The endometrial-myometrial interface.
Quinn M.
Publication Types: · Letter
PMID: 12634676 [PubMed – indexed for MEDLINE]
206: Am J Obstet Gynecol. 2003 Mar;188(3):606-10. Related Articles, Links
Coagulation or excision of ovarian endometriomas?
Vercellini P, Chapron C, De Giorgi O, Consonni D, Frontino G, Crosignani PG.
First Department of Obstetrics and Gynecology, University of Milano, Italy. paolo.vercellini@unimi.it
A systematic review was undertaken to determine whether coagulation or laser vaporization of endometriomas is associated with an increase in the risk of cyst recurrence compared with excision of the pseudocapsule. In the four comparative trials identified, endometrioma recurrence was reported in 39 of 212 (18.4%) women treated with coagulation or laser vaporization compared with 19 of 295 (6.4%) in those who underwent cystectomy. The odds ratios of endometrioma recurrence ranged from 1.41 to 9.38 with 95% CIs including unity in two studies. The common odds ratio was 3.09 (95% CI 1.78-5.36). Coagulation or laser vaporization of endometriomas without excision of the pseudocapsule seems to be associated with a significant increase in risk of cyst recurrence.
Publication Types: · Review · Review, Tutorial
PMID: 12634628 [PubMed – indexed for MEDLINE]
207: Int J Gynecol Cancer. 2003 Jan-Feb;13(1):98-99; author reply 100. Related Articles, Links
Aggressive endometriosis.
Zardawi I.
Publication Types: · Letter
PMID: 12631230 [PubMed – indexed for MEDLINE]
208: Gynecol Endocrinol. 2002 Dec;16(6):493-504. Related Articles, Links
Molecular mechanisms contributing to the pathogenesis of endometriosis.
Heinig J, von Otte S, Greb RR, Kiesel L.
Department of Obstetrics and Gynecology, University of Munster, Munster, Germany.
Publication Types: · Review · Review, Tutorial
PMID: 12626036 [PubMed – indexed for MEDLINE]
209: Gynecol Obstet Invest. 2003;55(1):20-4. Related Articles, Links
Thiazolidinedione inhibition of peritoneal inflammation.
Hornung D, Chao VA, Vigne JL, Wallwiener D, Taylor RN.
Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco, Calif, USA. D.Hornung@macnews.de
Chemoattraction of macrophages into the peritoneal cavity is one of the important characteristics in patients with endometriosis. An inflammatory response is postulated to be responsible for infertility and pelvic pain associated with this syndrome. The present in vivo studies were designed to test if thiazolidinediones (TZDs), activators of peroxisome proliferator activated receptor gamma, could inhibit monocyte chemotaxis in a murine model. TZDs were first used as orally bioavailable insulin-sensitizing agents. They are currently under investigation in the treatment of inflammatory diseases, including arthritis or colitis. Intraperitoneal injection of thioglycollate was used to elicit high numbers of activated peritoneal macrophages in female mice. Concomitant peritoneal injection of ciglitazone, a member of the TZD family, significantly reduced the number of macrophages. When cultured and stimulated by tumor necrosis factor alpha, these peritoneal macrophages also secreted less RANTES and less IL-1beta protein. This animal model suggests that treatment of endometriosis patients with TZDs may diminish symptoms associated with intraperitoneal inflammation. Copyright 2003 S. Karger AG, Basel
PMID: 12624547 [PubMed – indexed for MEDLINE]
210: Gynecol Obstet Invest. 2003;55(1):7-13. Related Articles, Links
Impact of epidermal growth factor and transforming growth factor beta-1 on the release of fibrinolytic factors from cultured endometrial and ovarian endometriotic stromal cells.
Guan YM, Carlberg M, Bruse C, Bergqvist A.
Department of Clinical Sciences, Unit for Obstetrics and Gynecology, Huddinge University Hospital, Stockholm, Sweden.
We have investigated whether there are any differences in the release of urokinase plasminogen activator (uPA) and its inhibitor (PAI-1) from cultured endometrial and endometriotic stromal cells, and whether the release is regulated by epidermal growth factor (EGF) or transforming growth factor beta1 (TGFbeta1). The cells were isolated from endometriomas and endometrium from women with and without endometriosis. After treatment with EGF or TGF and in untreated controls, incubated media collected at 0, 24, 48 and 72 h were analyzed by ELISA. Stromal cells from all three types of tissues released uPA and PAI-1, but the soluble receptor of uPA was not measurable in any group. The basal release of uPA and PAI-1 from endometriotic cells was higher than from endometrial cells. The uPA release in endometriotic cells was reduced with and without the addition of EGF (p < 0.05) or TGFbeta1 (p < 0.05). EGF increased the release of PAI-1 from stromal cells from women without endometriosis (p < 0.05) but decreased the release of PAI-1 from stromal cells from endometriotic women (p < 0.05). TGFbeta1 increased the release of PAI-1 from endometriotic cells (p < 0.05) but had no effect in endometrial cells. Copyright 2003 S. Karger AG, Basel
PMID: 12624545 [PubMed – indexed for MEDLINE]
211: Fertil Steril. 2003 Mar;79 Suppl 1:815-20. Related Articles, Links
Epithelial neutrophil-activating peptide 78 concentrations are elevated in the peritoneal fluid of women with endometriosis.
Mueller MD, Mazzucchelli L, Buri C, Lebovic DI, Dreher E, Taylor RN.
Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland. michel.mueller@insel.ch
OBJECTIVE: To investigate the presence of epithelial neutrophil-activating peptide 78 (ENA-78) in peritoneal fluid of women with and without endometriosis and to identify the cells that produce this inflammatory protein. DESIGN: Case-control study. SETTING: University hospital. PATIENT(S): Eighteen women with and 9 women without endometriosis. MAIN OUTCOME MEASURE(S): ENA-78 protein and mRNA levels were compared among women with and without endometriosis in samples of peritoneal fluid, samples of endometriotic lesions obtained by biopsy during laparoscopy, and peritoneal macrophages. Enzyme-linked immunosorbent assay, reverse transcription polymerase chain reaction, and in situ hybridization methods were used. Secretion of ENA-78 protein by interleukin-1beta-stimulated endometriotic stromal cells and in the media of lipopolysaccharide-stimulated peritoneal macrophages were compared to that in unstimulated cell cultures. RESULT(S): Peritoneal fluid concentrations of ENA-78 were significantly higher in affected women than in controls. Ectopic epithelial and stromal cells and peritoneal macrophages express ENA-78 messenger RNA. Interleukin-1beta stimulation of stromal cell cultures resulted in a 23-fold increase in ENA-78 concentration, and lipopolysaccharide stimulation of peritoneal macrophages increased concentrations by 8-fold. CONCLUSION(S): Levels of ENA-78 are elevated in the peritoneal fluid of women with endometriosis. Ectopic glandular cells, ectopic stromal cells, and peritoneal macrophages express this inflammatory chemokine. Epithelial neutrophil-activating peptide 78 may play an important role in the pathogenesis of endometriosis.
PMID: 12620496 [PubMed – indexed for MEDLINE]
212: Fertil Steril. 2003 Mar;79 Suppl 1:789-94. Related Articles, Links
Presence of endometrial epithelial cells in the peritoneal cavity and the mesothelial inflammatory response.
Song M, Karabina SA, Kavtaradze N, Murphy AA, Parthasarathy S.
Emory Center for Advanced Research on Women’s Health, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
OBJECTIVE: To determine the contribution of endometrial cells in the development of endometriosis. Specifically the response of the mesothelium to endometrial cells in the production of monocyte chemotactic protein-1 (MCP-1), interleukin-6 (IL-6), and IL-8 was studied. DESIGN: In vitro study. SETTING: University Research Laboratory. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Cellular MCP-1, IL-6 secretion and MCP-1, and IL-6 and IL-8 messenger RNA expression were evaluated by ELISA and reverse transcription-polymerase chain reaction (RT-PCR) assay. RESULT(S): The mesothelial cells produced more MCP-1 and IL-6 than endometrial epithelial and stromal cells. Mesothelial cells cultured in the presence of endometrial epithelial cells produced even greater levels of MCP-1 and IL-6 than those cultured in the presence of stromal cells or cultured alone. The MCP-1, IL-6, and IL-8 mRNA expression also increased when mesothelial cells were co-cultured with endometrial epithelial cells. CONCLUSION(S): The results suggest that endometrial epithelial cells may be important in evoking the inflammatory reaction in the peritoneal cavity during retrograde menstruation and that mesothelial cells may play an important role in the chemotaxis of monocytes and in the inflammatory process during the development of endometriosis.
PMID: 12620492 [PubMed – indexed for MEDLINE]
213: Fertil Steril. 2003 Mar;79 Suppl 1:770-8. Related Articles, Links
Time series analysis of transmesothelial invasion by endometrial stromal and epithelial cells using three-dimensional confocal microscopy.
Witz CA, Cho S, Centonze VE, Montoya-Rodriguez IA, Schenken RS.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA. witz@uthscsa.edu
OBJECTIVE: To evaluate endometrial adhesion and invasion of peritoneal mesothelium. DESIGN: Descriptive study using confocal laser-scanning microscopy. SETTING: University-based laboratory. PATIENT(S): Women undergoing surgery for benign conditions. INTERVENTION(S): Fluorescence-labeled peritoneal mesothelial cells (PMCs) were grown on coverslips. Fluorescence-labeled endometrial stromal cells (ESCs) and epithelial cells (EECs) and myometrial cells (Myos) were plated on the PMCs. Cultures were examined at 1, 6, 12, and 24-27 hours with differential interference contrast and confocal laser-scanning microscopy. MAIN OUTCOME MEASURE(S): Demonstration of adherence and invasion of endometrial cells through peritoneal mesothelium. RESULT(S): At 1 hour, there was adherence of the ESCs, EECs, and Myos on the perimeter of PMCs. There was no invasion by the Myos. By 6 hours, ESCs and EECs spread over the surface of the PMCs and extended cell processes through PMC junctions. Extension of pseudopodia under the PMCs followed. By 12 hours, there was vacuolization and lifting of PMCs that had been undermined by endometrial cells. CONCLUSION(S):This is the first time-phase study to demonstrate adherence and the process of invasion of endometrial cells through the mesothelium. The application of three-dimensional confocal laser-scanning microscopy is a novel technique that can be used to further examine mechanisms involved in the pathogenesis of the early endometriotic lesion.
PMID: 12620490 [PubMed – indexed for MEDLINE]
214: Fertil Steril. 2003 Mar;79 Suppl 1:763-9. Related Articles, Links
Cytokine regulation by peroxisome proliferator-activated receptor gamma in human endometrial cells.
Wanichkul T, Han S, Huang RP, Sidell N.
Division of Research, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
OBJECTIVE: To determine whether peroxisome proliferator-activated receptor (PPAR)-gamma ligands can affect the expression of interleukin-6 (IL-6) and cytokines related to the pathogenesis of endometriosis. DESIGN: In vitro study to determine whether PPARs are expressed in human endometrial cells and determine the effects of various PPAR-gamma ligands on IL-6 and other cytokine expression in these cells. SETTING: Academic medical center. PATIENT(S): Women presenting for infertility workup. INTERVENTION(S): Endometrial cell cultures were treated with PPAR-gamma ligands. MAIN OUTCOME MEASURE(S): Interleukin-6, IL-8, colony stimulating factor-1 (CSF-1) and macrophage chemotactic factor (MCP-1) protein secretion, messenger RNA expression of IL-6, PPAR-alpha, -beta, and -gamma. RESULT(S): Using a human endometrial cell line (EM42), as well as primary stromal and epithelial endometrial cells, we show the presence of PPAR-alpha, -beta, and -gamma by reverse transcription-polymerase chain reaction (RT-PCR) in these cells. PPAR-gamma ligands stimulated IL-6 secretion and induced enhancement of IL-6 mRNA levels. These ligands also stimulated the secretion of IL-8 and CSF-1. CONCLUSION(S): PPAR-gamma may play a role in the pathogenesis of endometriosis related to the production of IL-6 and some other cytokines.
PMID: 12620489 [PubMed – indexed for MEDLINE]
215: Fertil Steril. 2003 Mar;79 Suppl 1:735-42. Related Articles, Links
Gonadotropin-releasing hormone agonist and danazol normalize aromatase cytochrome P450 expression in eutopic endometrium from women with endometriosis, adenomyosis, or leiomyomas.
Ishihara H, Kitawaki J, Kado N, Koshiba H, Fushiki S, Honjo H.
Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
OBJECTIVE: To investigate whether GnRH agonists or danazol therapy normalizes estrogen metabolism in the eutopic endometrium of women with endometriosis, adenomyosis, or leiomyomas. DESIGN: Prospective clinical study. SETTING: University hospital. PATIENT(S): Fifty-three women with endometriosis, adenomyosis, or leiomyomas. INTERVENTION(S): Patients received GnRH agonist or danazol. Biopsy samples of the endometrium were obtained before and after endocrine therapy. Nontreated endometrial explants were cultured in the presence of either drug. MAIN OUTCOME MEASURE(S): Reverse transcription polymerase chain reaction-Southern blot and immunohistochemical analyses of the endometrial expression of aromatase cytochrome P450, estrogen receptor, progesterone receptor, and Ki-67. Nontreated endometrial explants were cultured in the presence of either drug. RESULT(S): Messenger RNA and protein of aromatase cytochrome P450 were greatly reduced in the eutopic endometrium of patients treated with GnRH agonist for 2 months or more or with danazol for 1 month or more. Culture of endometrial explants with GnRH agonist (10(-9)-10(-7) M) did not change the amount of aromatase cytochrome P450, whereas danazol (10(-7)-10(-6) M) efficiently reduced aromatase cytochrome P450 expression. CONCLUSION(S): Therapy with GnRH agonist or danazol decreases expression of aromatase cytochrome P450 in diseased eutopic endometrium. Endocrine therapy normalized in part the impaired hormonal expression of the eutopic endometrium. GnRH agonist reduced aromatase cytochrome P450 expression mainly by promoting a hypoestrogenic state, whereas danazol reduced aromatase cytochrome P450 in part by direct action on the eutopic endometrium.
PMID: 12620485 [PubMed – indexed for MEDLINE]
216: Fertil Steril. 2003 Mar;79 Suppl 1:724-9. Related Articles, Links
Adhesion of endometrial cells labeled with 111Indium-tropolonate to peritoneum: a novel in vitro model to study endometriosis.
Beliard A, Noel A, Goffin F, Frankenne F, Foidart JM.
Laboratory of Biology of Tumors and Development, University of Liege, Sart-Tilman, Liege, Belgium.
OBJECTIVE: To evaluate, in a new original in vitro assay, putative factors that could modulate the adhesion of endometrial cells to peritoneum. DESIGN: Prospective, controlled in vitro study. SETTING: Academic research laboratory. PATIENT(S): Fourteen nonmenopausal women undergoing hysterectomy or laparoscopy for benign gynecologic indication. INTERVENTION(S): Endometrial cells obtained from women with regular cycles without endometriosis were labeled with 111Indium and confronted in vitro with mouse peritoneum in the presence of various cytokines and/or antiadhesive compounds. MAIN OUTCOME MEASURE(S): Radioactivity in 111Indium-labeled endometrial cells. RESULT(S): The adhesion of human endometrial cells to mouse peritoneum was increased by treatment with pro-inflammatory cytokines (interleukin IL-1beta, IL-6, TNF alpha, TGF-beta1). Whereas heparan sulfate had no effect on cell adhesion, a gel of ferric hyaluronate (Intergel) was able to counteract the pro-adhesive effect of cytokines. Interestingly, the pretreatment of peritoneum with cytokines, 24 hours before cell seeding in the presence of the ferric hyaluronate gel, restored the cytokine-promoting effect on cell adhesion. CONCLUSION(S): Proinflammatory cytokines promote the in vitro peritoneal adhesion of endometrial cells. An antiadhesive hyaluronate gel used in clinics decreases the adhesion in a dose-dependent manner and reduces cytokine bioavailability.
PMID: 12620483 [PubMed – indexed for MEDLINE]
217: Fertil Steril. 2003 Mar;79 Suppl 1:710-7. Related Articles, Links
Resolution of clonal origins for endometriotic lesions using laser capture microdissection and the human androgen receptor (HUMARA) assay.
Wu Y, Basir Z, Kajdacsy-Balla A, Strawn E, Macias V, Montgomery K, Guo SW.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226-0509, USA.
OBJECTIVE: To determine the clonal origins of endometriotic lesions using laser capture microdissection and PCR-based HUMARA assay. DESIGN: Molecular genetic study of human tissue. SETTING: Molecular genetics laboratory in an academic setting. PATIENT(S): Twenty patients with endometriosis. Forty specimens of endometriotic lesions from these patients and one specimen of normal endometrium were analyzed. INTERVENTION(S): Laser capture microdissection was used to harvest epithelial cells from single and multifocal endometrial lesions from paraffin-embedded and frozen tissues, and their clonality was determined with the HUMARA assay. MAIN OUTCOME MEASURE(S): Polymerase chain reaction-based HUMARA assay of clonality. RESULT(S): Thirty-eight specimens were polymorphic and thus informative. Most specimens were monoclonal, as determined by the HUMARA assay. In four specimens of multifocal lesions, polyclonality was detected, but upon more refined microdissections and further analyses, we found that each focus was monoclonal individually. CONCLUSION(S):Previously reported polyclonality is very likely to be attributed to the pooling of multifocal lesions or contamination of normal tissues. These results suggest that endometriotic lesions were monoclonal in origin, and in the case of multifocal lesions, each focus originates monoclonally; hence, different foci have independent origins. The monoclonality of endometriotic lesions suggests that they may carry neoplastic potentials, and the apparent independent origins of multifocal lesions suggest that reconstruction of individual lesion histories may help us to understand the initiation and progression of endometriosis.
PMID: 12620481 [PubMed – indexed for MEDLINE]
218: Fertil Steril. 2003 Mar;79 Suppl 1:702-9. Related Articles, Links
CYP1A1, CYP19, and GSTM1 polymorphisms increase the risk of endometriosis.
Arvanitis DA, Koumantakis GE, Goumenou AG, Matalliotakis IM, Koumantakis EE, Spandidos DA.
Department of Virology, Medical School, University of Crete, Heraklion, Crete, Greece.
OBJECTIVE: To investigate the possibility of genetic contribution of CYP1A1, CYP19, GSTM1, and GSTT1 polymorphisms to endometriosis. DESIGN: Genetic polymorphism analysis. SETTING: Case-control study. PATIENT(S): A group of 275 women with sporadic endometriosis was compared with a group of 346 fertile, endometriosis-free women. INTERVENTION(S): Surgical, laparoscopic, and histological examination. MAIN OUTCOME MEASURE(S): Blood specimens were obtained from endometriosis cases and controls. Polymerase chain reaction-based assays were performed for the determination of individual’s genotype. RESULT(S): The CYP19 VNTR, located in intron 4 (TTTA)(10) allele increases the risk for endometriosis development (odds ratio [OR], 4.99; 95% confidence interval [95% CI], 1.351 to 18.436). The combined genotype CYP1A1 wt/m1 or m1/m1 and GSTM1 null deletion adds to this risk (OR, 1.95; 95% CI, 1.266 to 2.995 and OR, 2.23; 95% CI, 0.631 to 7.906, respectively). In contrast, the CYP1A1 wt/wt genotype exhibits a protective effect, with a 38% reduction in the odds for endometriosis development (OR, 0.62; 95% CI, 0.440 to 0.883). CONCLUSION(S): Our data suggest that CYP19 VNTR (TTTA)(10) allele as well as the combined genotype CYP1A1 m1 polymorphism and GSTM1 null deletion associate with the endometriosis phenotype, whereas the GSTT1 null deletion does not.
PMID: 12620480 [PubMed – indexed for MEDLINE]
219: AORN J. 2003 Feb;77(2):298, 301-9, 312-3; quiz 314-6. Related Articles, Links
Endometriosis–a missed malady.
Taylor MM.
Endometriosis is a disease that affects approximately 5.5 million girls and women in their reproductive years in the United States and Canada. During the menstrual cycle, the endometrial lining of the uterus thickens in preparation to receive a fertilized egg. If fertilization does not occur, this lining sloughs off during menstruation. Endometrial tissue can migrate out of the fallopian tubes and grow outside of the uterus as endometrial implants. This can result in severe pain. Endometriosis is very difficult to detect because most women become accustomed to painful menstrual cycles at an early age. The disease often will go undiagnosed because even with extensive endometriosis it is possible to have minimal symptoms or none at all. Physicians have few diagnostic tools to detect the scars and growths of endometriosis. The only way to confirm the diagnosis and stage of endometriosis is by laparoscopy. Treatment options include hormone therapy and surgery. In the past, the most successful treatment was open laparotomy with excision of the endometrial implants. This article discusses the use of the ultrasonic scalpel to resect endometrial implants through the laparoscope. The patient’s perioperative course also is discussed.
Publication Types: · Review · Review, Tutorial
PMID: 12619848 [PubMed – indexed for MEDLINE]
220: Ginekol Pol. 2002 Oct;73(10):853-5. Related Articles, Links
[Urethral obstruction caused by endometriosis] [Article in Polish] Palczynski B, Blok K, Blok R, Karmowski A, Gabrys M.
I Katedry i Kliniki Ginekologii i Poloznictwa AM we Wroclawiu.
Two cases of unilateral urethral obstruction caused by endometriosis were reported. Two patients aged 48 and 35 years old were fully diagnosed with above mentioned abnormalities prior to a surgical operation. During the surgical operations the initial diagnosis was confirmed macroscopically, followed by the surgical amputation of the urethral parts pathologically changed. The anastomosis of urethra was finally performed after confirmation that the remaining parts were macroscopically unchanged. Histopathological examinations confirmed the initial diagnosis. After the surgical operation both patients were subjected to hormonal treatment attaining full recovery. The above presented cases–urethral endometriosis is one of rare complications caused by endometriosis. Proper and early diagnosis, followed by an effective treatment is important in obviating grievous consequences e.g. total renal failure.
PMID: 12619320 [PubMed – indexed for MEDLINE]
221: Hum Reprod. 2003 Mar;18(3):654-5. Related Articles, Links
What role does decreased ovarian reserve play in the aetiology of infertility related to endometriosis? Reply.
Cahill DJ.
University of Bristol, Division of Obstetrics and Gynaecology, St Michael’s Hospital, Southwell Street, Bristol BS2 8EG, UK e-mail: d.j.cahill@bris.ac.uk
PMID: 12615842 [PubMed – in process]
222: Hum Reprod. 2003 Mar;18(3):653-4; author reply 654-5. Related Articles, Links
What role does decreased ovarian reserve play in the aetiology of infertility related to endometriosis?
Check JH.
Publication Types: · Comment · Letter
PMID: 12615841 [PubMed – in process]
223: Hum Reprod. 2003 Mar;18(3):593-7. Related Articles, Links
Peritoneal fluid concentrations of interleukin-8 in patients with endometriosis depend on the severity of the disorder and are higher in the luteal phase.
Calhaz-Jorge C, Costa AP, Santos MC, Palma-Carlos ML.
Human Reproduction Unit, Department of Obstetrics and Gynaecology and Lisbon University Haematology and Immunology Centre, Hospital de Santa Maria, Av. Prof. Egas Moniz, Lisboa, Portugal.
BACKGROUND: Previous evaluations of the relationship between the concentrations of interleukin-8 (IL-8) in the peritoneal fluid and endometriosis led to non-consistent results. Our purpose was to investigate the correlation of the concentrations of IL-8 in the peritoneal fluid with the stage of endometriosis, the presence of red lesions and the phase of the menstrual cycle. METHODS: Ninety-two patients with infertility (n = 87) or undergoing sterilization (n = 5) had peritoneal fluid samples collected at laparoscopy. IL-8 determinations were performed using an enzyme-linked immunosorbent assay. RESULTS: The concentrations of IL-8 in the peritoneal fluid of the 68 women with endometriosis were not significantly different from those of the 24 controls. Patients with moderate/severe stages had IL-8 significantly higher than controls (P = 0.008) and marginally higher than patients with minimal/mild endometriosis (P = 0.053). Concentrations of IL-8 were significantly higher in patients than in controls in the luteal phase. Red lesions were associated with significantly increased levels of peritoneal fluid IL-8 only in the luteal phase. CONCLUSIONS: Our findings reinforce the importance of IL-8 in the pathogenesis of endometriosis.
PMID: 12615831 [PubMed – in process]
224: Hum Reprod. 2003 Mar;18(3):588-92. Related Articles, Links
Laparoscopic presacral neurolysis for endometriosis-related pelvic pain.
Soysal ME, Soysal S, Gurses E, Ozer S.
Department of Obstetrics and Gynecology and Department of Anesthesiology, Pamukkale University Medical Center, 20100, Denizli and Department of Psychiatry, Hacettepe University School of Medicine, 06200, Ankara, Turkey.
BACKGROUND: Some patients with endometriosis are candidates for sympathectomy of the superior hypogastric plexus. The objective of this paper is to describe our technique of laparoscopic presacral neurolysis for sympathectomy and to report 1 year results of the first 15 cases. METHODS: To achieve this objective in a prospective observational study of 1 year follow-up; we performed laparoscopic presacral chemical neurolysis with phenol in 15 patients with pelvic pain and minimal-moderate endometriosis. The main outcome measures were: the impact of treatment on pelvic symptom resolution, non-opioid analgesic consumption during menses, sexual performance and observed complications and side effects during 1 year follow-up. RESULTS: We noted a significant reduction in total pelvic symptom score as compared with baseline mean (SD) of 9.04 (1.2). The mean difference [95% confidence interval (CI)] of reduction was 5.7 (4.9-6.5), 5.8 (5.0-6.6) and 5.8 (4.9-6.6) from the baseline at the 3rd, 6th and 12th postoperative month (P < 0.001). We observed a significant improvement in Sabbatberg Sexual Rating Scale as compared with baseline mean (SD) of 30.9 (4.3). The mean difference (95% CI) of increase was 33.4 (30.3-36.4), 33.2 (30.1-36.2) and 33.2 (30.1-36.3) from the baseline at the 3rd, 6th and 12th postoperative month. We observed a significant reduction in analgesic consumption during menses in terms of total naproxen sodium tablets as compared with baseline mean (SD) of 8.9 (1.1). The mean difference (95% CI) of reduction in the total number of naproxen sodium 250 mg tablets was 6.5 (5.5-7.5), 6.7 (5.7-7.7) and 6.6 (5.6-7.6) from the baseline at the 3rd, 6th and 12th postoperative month. The most common side effect was constipation. CONCLUSION: Laparoscopic presacral neurolysis is feasible and simple. More data is needed to support its efficacy and safety.
PMID: 12615830 [PubMed – in process]
225: Hum Reprod. 2003 Mar;18(3):544-9. Related Articles, Links
An association of IgG anti-laminin-1 autoantibodies with endometriosis in infertile patients.
Inagaki J, Sugiura-Ogasawara M, Nomizu M, Nakatsuka M, Ikuta K, Suzuki N, Kaihara K, Kobayashi K, Yasuda T, Shoenfeld Y, Aoki K, Matsuura E.
Department of Cell Chemistry, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
BACKGROUND: Laminin-1, a multifunctional glycoprotein of the basement membrane, is thought to be important in embryogenesis, embryonic implantation, and placentation. We recently showed that serum IgG anti-laminin-1 autoantibodies (auto-Abs) are associated with recurrent first-trimester miscarriages. The present study assessed the clinical significance of anti-laminin-1 Abs with infertility, accompanied with or without endometriosis. METHODS: Sixty-eight infertile patients who underwent laparoscopy or laparotomy and 39 healthy non-pregnant women were tested for IgG anti-laminin-1 Abs. The association between the Abs and endometriosis was analysed. The presence of laminin-1 mRNA was detected in endometriotic lesions. RESULTS: Twenty infertile patients were positive for anti-laminin-1 Abs. The Ab levels in those patients were significantly higher than those in healthy non-pregnant women (P = 0.0005). The presence of the Abs was significantly associated with endometriosis in those patients (P = 0.0096). The Abs recognized a particular domain, i.e., the laminin-alpha1 chain G domain. mRNA encoding laminin-alpha1, -beta1, and -gamma1 chains was expressed in 90% of endometriotic lesions. CONCLUSIONS: IgG anti-laminin-1 Abs were significantly associated with endometriosis in infertile patients. The Abs might be clinically important in the development of autoimmune-mediated reproductive failures and the assessment of the Abs may provide a novel non-invasive diagnosis of endometriosis.
PMID: 12615822 [PubMed – in process]
226: Hokkaido Igaku Zasshi. 2003 Jan;78(1):75-83. Related Articles, Links
[Evaluation of fallopian tubes in infertile women by using laparoscopy and falloposcopy] [Article in Japanese] Sato O.
Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
PMID: 12613026 [PubMed – indexed for MEDLINE]
227: Tunis Med. 2002 Jul;80(7):373-9. Related Articles, Links
[Uterine adenomyosis. Clinical and therapeutic study. Report of 87 cases] [Article in French] Kdous M, Feerchiou M, Chaker A, Chargui R, Meriah S.
STUDY OBJECTIVE: The aim of our study is the analysis of Pound epidemiological, clinical, paraclinical and therapeutic aspects of adenomyosis. METHODES: A retrospective analysis was carried out on 87 patients who underwent hysterectomy for a variety of raisons (except for prolapse) between January 1, 1990, and December 31, 1997; and whose Histologic analysis of hysterectomy specimen revelated adenomyosis. RESULTS: 586 hysterectomy (except prolapse) was performed during the study period: frequency of adenomyosis in hysterectomy specimen is of 14.85%. The mean age of our patients is 43.97 years (Range: 26-64 years). 29.88% of them are postmenopausal and 41.37% had a past history of uterine trauma. Main symptoms were pelvic pain (71.22%) and abnormal uterine bleeding (82.77%). Preoperative diagnosis has been suspected on hysteroscopy in 63.22% of cases, hysterography in 58.46% and transvaginal sonography in 40.5%. A radical surgery first has been indicated in 57 cases, after failure of medical treatment in 16 cases and after failure of endometrial resection in 14 cases. Histologic analysis of the hysterectomy specimen shows associated myoma in 32.18% of cases, hyperplasia in 13.79%, polyps in 5.74% and atrophy in 3.44%. CONCLUSION: Adenomyosis, enigmatic disease, escapes always to a well-codified therapeutic strategy and bound closely related to hysterectomy. Earliest diagnosis could avoid the systematic evolution toward the radical treatments.
PMID: 12611346 [PubMed – indexed for MEDLINE]
228: Arch Esp Urol. 2002 Dec;55(10):209-15. Related Articles, Links
[Urinary endometrioma] [Article in Spanish] Llarena Ibarguren R, Lecumberri Castanos D, Padilla Nieva J, Crespo Atin V, Martin Bazaco J, Azurmendi Sastre V, Pertusa Pena C.
Servicio de Urologia, Hospital de Cruces, Plaza de Cruces s/n 48903 Baracaldo, Vizcaya, Espana.
OBJECTIVES: To analyze the series of cases of endometriosis with urologic involvement reported in our country. METHODS/RESULTS: We found a total of 26 cases of endometriosis including our case, 15 affected bladder and 11 ureter. Independently of ureteral or bladder location, the treatment performed varied, from transurethral resection and laser to cystectomy in cases involving bladder, from segmental ureterectomy with ureteral reimplantation to nephrectomy in ureteral cases. CONCLUSIONS: Surgery is the definitive solution for urinary tract endometriomas. The definitive treatment of endometriosis must be done by gynecologists, by means of hormonal and surgical treatment depending on age, severity and location of the lesions, patient’s wishes for future pregnancies, and tolerance to hormone therapy.
Publication Types: · Review · Review of Reported Cases
PMID: 12611218 [PubMed – indexed for MEDLINE]
229: J Reprod Med. 2003 Jan;48(1):46-8. Related Articles, Links
Successful pregnancy resulting from cryopreserved pronuclear and cleaved embryos thawed and cultured to blastocysts, refrozen and transferred. A case report.
Estes SJ, Laky DC, Hoover LM, Smith SE, Schinfeld JS, Somkuti SG.
Toll Center for Reproductive Sciences, Department of Obstetrics and Gynecology, Abington Hospital, Abington, Pennsylvania, USA.
BACKGROUND: Twice-frozen, thawed embryos may have utilization in vitro fertilization (IVF) cycles. CASE: A 37-year-old woman with endometriosis and infertility returned five years after a fresh IVF cycle. Seven cryopreserved embryos (2 pronuclear [pn] and cleaved) were thawed, and five developed to the blastocyst stage. One blastocyst was transferred, and the remaining four were recryopreserved. This transfer did not result in pregnancy. The remaining four blastocysts were thawed, and two were transferred resulting in a live, singleton delivery. CONCLUSION: Pregnancy can result from cryopreserved 2-pn and cleaved embryos cultured to blastocysts, refrozen and then transferred at the blastocyst stage.
PMID: 12611095 [PubMed – indexed for MEDLINE]
230: Pathol Res Pract. 2002;198(12):803-12. Related Articles, Links
Immunohistochemical localization of collagen type III and type IV, laminin, tenascin and alpha-smooth muscle actin (alphaSMA) in the human liver in peliosis.
Gulubova M.
Department of General and Clinical Pathology, Faculty of Medicine, Thracian University, Stara Zagora 6000, Bulgaria. mgulubova@hotmail.com
The expression of collagen types III and IV, laminin, tenascin, and hepatic stellate cells (HSCs) activation marker alphaSMA was evaluated immunohistochemically in the liver of three patients with non-bacilar peliosis. Peliosis was attributed to tuberculosis, endometriosis treated with anabolic androgenic steroids, and to pheochromocytoma. Ultrastructural examination of the lesions of the liver revealed cavities that were sometimes lined with sinusoidal endothelial cells or hepatocytic microvilli. In liver sinusoids around cavities, cystic dilatation of the space of Disse and an abundance of amorphous matrix were observed. At this location, HSCs were transformed into transitional cells or myofibroblasts. Extracellular matrix proteins (ECM) were increased in the dilated sinusoids around cavities perisinusoidally and in the wall of cavities themselves. AlphaSMA was also increased. Ultrastructural immunohistochemistry revealed strong intracellular deposits of collagen type IV, laminin, and alphaSMA in HSCs. Laminin immunoreactivity was also noted in the endocytic vesicles in the cytoplasm of a monocyte. These findings suggest that enhanced ECM accumulation and the transformation of HSCs into myofibroblasts constitute a secondary event in peliosis and an attempt of the liver to restrict and remove sinusoidal dilatation.
PMID: 12608657 [PubMed – in process]
231: Free Radic Res. 2002 Dec;36(12):1315-21. Related Articles, Links
Atherosclerosis, oxidation and endometriosis.
Santanam N, Song M, Rong R, Murphy AA, Parthasarathy S.
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA.
Endometriosis affects younger women of childbearing age. Atherosclerosis is considered as a disease of the old and increases with the ageing process. Both diseases are characterized by the increased presence of activated macrophages and associated increases in growth promoting activity and the production of inflammatory cytokines. In this review, we propose that oxidative stress and the presence of forms of oxidized low-density lipoprotein (LDL) might contribute to both Atherosclerosis and Endometriosis.
Publication Types: · Review · Review, Tutorial
PMID: 12607823 [PubMed – indexed for MEDLINE]
232: Ann Thorac Surg. 2003 Feb;75(2):378-81; discusssion 381. Related Articles, Links
Catamenial pneumothorax: retrospective study of surgical treatment.
Bagan P, Le Pimpec Barthes F, Assouad J, Souilamas R, Riquet M.
Service de Chirurgie Thoracique, Hopital Europeen Georges Pompidou, Paris, France.
BACKGROUND: Catamenial pneumothorax is a rare entity characterized by recurrent accumulation of air in the thoracic space during menstruation. Catamenial pneumothorax is also associated with a high rate of postoperative recurrence. The aim of this study was to discuss the etiology and to determine the optimal surgical treatment of this entity. METHODS: From December 1991 to September 2000, 10 patients with catamenial pneumothorax were treated at our institution. Median age at time of operation was 37 years (range, 21 to 44 years). We retrospectively evaluated the pathologic findings, the operation performed, and the results in all patients. The mean follow-up was 55.7 months. RESULTS: Pleurodesis alone was performed in 5 patients and an associated diaphragmatic procedure was performed in 5 patients. In 5 patients, no diaphragmatic anomaly was discovered: 3 experienced one or more recurrences and all still suffer from chronic catamenial chest pain. Hormonal therapy temporarily improved outcome for 6 months in 2 patients. On the contrary, in 5 patients surgical pleurodesis was associated with the repair of diaphragmatic defects (simple closure or coverage by a polyglactin mesh): these patients experienced no recurrence (n = 0/5, p = 0.0016) and no subsequent catamenial chest pain. CONCLUSIONS: The postoperative outcome is influenced by the diagnosis of diaphragmatic defects with or without endometriosis. Surgical treatment should be accomplished during menstruation for an optimal visualization of pleurodiaphragmatic endometriosis. Because diaphragmatic lesion is frequent and may be occult, we propose the systematic coverage of the diaphragmatic surface by a polyglactin mesh to prevent catamenial pneumothorax recurrence even when the diaphragm appears normal.
PMID: 12607643 [PubMed – indexed for MEDLINE]
233: Duodecim. 2003;119(2):95-101. Related Articles, Links
[The improved diagnostics of adenomyosis] [Article in Finnish] Niinimaki M, Paakko E, Kyllonen AP, Santala M.
OYS:n naistentautien klinikka PL 24, 90029 OYS. maarit.niinimaki@oulu.fi
Publication Types: · Review · Review, Tutorial
PMID: 12607424 [PubMed – indexed for MEDLINE]
234: J Pharmacol Exp Ther. 2003 May;305(2):688-95. Epub 2003 Jan 24. Related Articles, Links
Biological characterization of a novel, orally active small molecule gonadotropin-releasing hormone (GnRH) antagonist using castrated and intact rats.
Anderes KL, Luthin DR, Castillo R, Kraynov EA, Castro M, Nared-Hood K, Gregory ML, Pathak VP, Christie LC, Paderes G, Vazir H, Ye Q, Anderson MB, May JM.
Research Pharmacology, Pfizer Global Research and Development-La Jolla/Agouron Pharmaceuticals, Inc., 10724 Science Center Drive, San Diego, CA 92121, USA. kenna.anderes@pfizer.com
Gonadotropin-releasing hormone (GnRH) receptor antagonists have potential in treating numerous hormone-dependent pathologies including cancers of the prostate, breast, and ovary, endometriosis, and fertility disorders. An unmet clinical need exists for an orally available GnRH receptor antagonist. Guided by structure-activity relationships, ligand-based targeted library designs, and biomarker measurements, our discovery efforts have yielded a novel, small molecule GnRH receptor antagonist, 5-[(3,5,5,8,8-pentamethyl-5,6,7,8-tetrahydro-2-naphthalenyl)methyl]-N-(2,4,6-trimethoxyphenyl)-2-furamide (CMPD1). CMPD1 bound with low nanomolar affinities to human, rat, and mouse GnRH receptors (6.0, 3.8, and 2.2 nM, respectively). CMPD1 was more than 100-fold selective for GnRH receptors versus various G-protein-coupled receptors and other enzymes and ion channels. In cells expressing recombinant rat GnRH receptors, CMPD1 was a competitive antagonist of GnRH-stimulated increases in extracellular acidification rates in Cytosensor microphysiometer assays. In cells expressing recombinant human GnRH receptors, CMPD1 was a potent inhibitor of GnRH-stimulated total inositol phosphate accumulation. The effects of CMPD1 on circulating levels of luteinizing hormone (LH) and testosterone were studied in castrated and intact male rats, respectively. Intravenous and oral administration of CMPD1 dose dependently suppressed GnRH-mediated elevations of LH in castrated male rats and testosterone in gonad-intact male rats. Moreover, CMPD1, when given at 20 mg/kg i.v. to intact male rats, inhibited the elevations of LH and testosterone stimulated by the superagonist of GnRH, [d-Ala(6), des-Gly(10)]GnRH (GnRH-A). These data suggest that CMPD1 is a potent, selective, orally active GnRH receptor antagonist that may have potential application as a therapeutic agent for treating hormone-dependent cancers and diseases.
PMID: 12606616 [PubMed – indexed for MEDLINE]
235: Expert Opin Investig Drugs. 2003 Mar;12(3):337-51. Related Articles, Links
The therapeutic potential of aromatase inhibitors.
Miller WR, Jackson J.
University of Edinburgh, Edinburgh Breast Unit Research Group, Paderewski Building, Western General Hospital, Edinburgh, EH4 2XU, UK. w.r.miller@ed.ac.uk
The third generation aromatase inhibitors are both remarkably potent and specific endocrine agents inhibiting aromatase activity and reducing circulating oestrogen levels in postmenopausal women to levels never previously seen. Their therapeutic potential is consequently much greater than the earlier prototype drugs. Their excellent side-effect profile also allows for potential wider indications in the treatment of oestrogen-related diseases, including breast cancer. It still remains to determine whether their potent endocrine effects translate into increased therapeutic benefit. In advanced breast cancer, aromatase inhibitors have been shown to have improved efficacy and toxicity profiles when compared with progestins, aminoglutethimide and tamoxifen. Aromatase inhibitors have also been used in the neoadjuvant setting, where they have been shown to achieve higher response rates than tamoxifen and to be more successful at downstaging tumours. Early results comparing an aromatase inhibitor with tamoxifen in the adjuvant setting in early breast cancer show anastrozole to be superior to tamoxifen in terms of both disease-free survival and a lower incidence of new contralateral tumours. There was also a more favourable side-effect profile, which has implications for potential future prophylactic treatment. Additionally, since aromatase inhibitors have different mechanisms of action, unlike antioestrogens, they may be particularly useful as chemopreventive agents if oestrogens are themselves genotoxic. Aromatase inhibitors have been used to date almost exclusively in postmenopausal women. The potential of combining them with luteinising hormone-releasing hormone analogues allows the possibility of treating premenopausal women with either oestrogen receptor-positive breast cancer or benign conditions such as cyclical breast pain, fibroadenomata, recurrent cystic disease or endometriosis. There is also the potential for their use in men with conditions such as gynaecomastia or prostate cancer. These new generation aromatase inhibitors may well have an increasing role in the future management of a number of conditions in addition to breast cancer.
PMID: 12605559 [PubMed – in process]
236: Clin Evid. 2002 Dec;(8):1864-74. Related Articles, Links
Farquhar C.
School of Medicine, University of Auckland, Auckland, New Zealand.
PMID: 12603973 [PubMed – in process]
237: Am J Vet Res. 2003 Feb;64(2):188-94. Related Articles, Links
Use of threshold serum and milk ketone concentrations to identify risk for ketosis and endometritis in high-yielding dairy cows.
Reist M, Erdin DK, von Euw D, Tschumperlin KM, Leuenberger H, Hammon HM, Kunzi N, Blum JW.
Group of Animal Breeding, Institute of Animal Science, Swiss Federal Institute of Technology, ETH Zentrum, CH-8092 Zurich, Switzerland.
OBJECTIVE: To use threshold concentrations of acetone and beta-hydroxybutyrate in milk and serum, respectively; identify risk for ketosis and endometritis; and assess analyses of blood and milk samples as predictors of risk for ketosis in high-yielding dairy cows. ANIMALS: 90 multiparous Holstein cows. PROCEDURE: At intervals before and after parturition, blood samples were obtained for determination of glucose, nonesterified fatty acids, leptin, insulin, insulin-like growth factor-1, and beta-hydroxybutyrate concentrations. Samples of milk were obtained at similar intervals after parturition for determination of fat content and concentrations of acetone, protein, and lactose. Reproductive examination of each cow was performed weekly. RESULTS: For each cow, threshold concentrations of acetone and beta-hydroxybutyrate were calculated as 75th and 90th percentiles of maximum postpartum concentrations of acetone in milk (0.40 and 0.87 mmol/L) and beta-hydroxybutyrate in serum (2.30 and 3.51 mmol/L). Significant decrease in milk production (442 to 654 kg of energy-corrected milk/305-day period per cow) was associated with acetone or beta-hydroxybutyrate in excess of threshold values. Milk acetone concentrations > 0.40 mmol/L were associated with 3.2 times higher risk for endometritis. Low plasma glucose, high serum beta-hydroxybutyrate, and high milk acetone concentrations during week 1 after parturition were indicators of increased risk for ketosis later during lactation. CONCLUSIONS AND CLINICAL RELEVANCE: Determination of milk acetone concentration during the week after parturition may identify cows at risk for ketosis and endometritis; with appropriate interventions, development of disease and production losses may be reduced.
PMID: 12602588 [PubMed – indexed for MEDLINE]
238: Ann Chir. 2003 Feb;128(1):34-9. Related Articles, Links
[Symptomatic bladder or ureteral endometriosis: report of 8 cases and review of the literature] [Article in French] Acker O, Robert Y, Carpentier F, Vinatier D, Cosson M.
Service de gynecologie obstetrique, centre hospitalier de Roubaix, pavillon Paul-Gelle, 91, avenue J.-Lagache, BP 359, 59056 Roubaix cedex 1, France.
OBJECTIVES: The aim of this study was to determine the symptoms of bladder and ureteral endometriosis and to review the treatment approaches. MATERIALS AND METHODS: We conducted a retrospective studyover the period November 1989-July 2000. We reviewed the medical data of all women with bladder or utereral endometriosis who underwent a major surgery (ureteral reimplementation on psoas bladder, partial resection of the ureter, partial cystectomy). RESULTS: Eight women met the defined selection criterion, three with bladder injuryand five with ureteral injury. The only adverse postoperative complication was a passive ureteral reflux following ureteral reimplementation on psoas bladder. No recurrence on the urinary tract were reported. CONCLUSION: Surgical treatment is indicated for patient suffering from symptomatic bladder or ureteral endometriosis. Isolated bladder injuries due to endometriosis are mostly treated by laparoscopic surgery. Ureteral endometriosis may deteriorate the renal function. The initial step of the treatment may include an uterolysis by coelioscopy or an ureteral dilatation by ureteroscopy together with a medical treatment. The renal function must be closely monitored. In case of persistent or recurrent endometriosis, an ureteral resection would be justified.
Publication Types: · Review · Review of Reported Cases
PMID: 12600326 [PubMed – indexed for MEDLINE]
239: Minerva Ginecol. 2003 Feb;55(1):15-23. Related Articles, Links
[The therapy of endometriosis. New prospects] [Article in Italian] Somigliana E, Chiodini A, Odorizzi MP, Pompei F, Vigano P.
II Clinica Ostetrico-Ginecologica, Clinica Luigi Mangiagalli, Universita degli Studi di Milano, Milan, Italy.
Surgery is still the first line of therapy for endometriosis. At present, medical therapy is mostly indicated for treatment and prevention of recurrences. Current pharmacological regimens induce a hypoestrogenic state; this effect tends, on one hand, to inhibit the growth of endometriotic implants while, on the other hand, it significantly interferes with the integrity of the hypothalamus-pituitary-ovarian axis. The aim of this study is to review current knowledge on the new experimental therapeutic approaches to the disease. English articles on this topic have been searched by Medline. A particular attention has been paid to experimental therapeutic interventions supported by in vivo results. Three different novel strategies have been identified: 1) To act on estrogenic dependence of endometriosis using new drugs such as aromatase inhibitors and raloxifene. These drugs may have the advantage to act more specifically on the disease. 2) To treat the disease with immuno-modulators and anti-inflammatory drugs. These compounds may be helpful in both limiting the growth of endometriotic implants and in controlling the symptoms of the disease. 3) To prevent adhesion reformation after surgical lysis. Adhesions are an important hallmark of endometriosis which cannot be adequately eliminated by surgery. The use of barrier and fluid agents after surgical lysis seems to be effective in this regard. Results from studies aimed to investigate the effectiveness of these approaches are appealing. However, controlled clinical trials are now required to appropriately determine their real benefits and their specific indications.
PMID: 12598839 [PubMed – in process]
240: Virchows Arch. 2003 Feb;442(2):173-8. Epub 2002 Nov 26. Related Articles, Links
Pulmonary metastases from a low-grade endometrial stromal sarcoma confirmed by chromosome aberration and fluorescence in-situ hybridization approaches: a case of recurrence 13 years after hysterectomy.
Satoh Y, Ishikawa Y, Miyoshi T, Mukai H, Okumura S, Nakagawa K.
Department of Pathology, the JFCR Cancer Institute, 1-37-1 Kami-ikebukuro, Toshima-ku, Tokyo 170-8455, Japan. ysatoh@jfcr.or.jp
Pulmonary metastasis from low-grade endometrial stromal sarcomas (ESSs) occasionally are found after long, disease-free periods, mostly as incidental histological or radiological discoveries. We describe a case of low-grade ESS presenting as nodular pulmonary metastases finally diagnosed by estrogen-receptor staining, cytogenetic and fluorescence in situ hybridization (FISH) analyses, and perusal of the histology of hysterectomy material. An abnormal nodule in the lung field was discovered by means of chest X-ray of a 47-year-old woman. She had been disease free for 13 years after hysterectomy for an alleged leiomyoma. A computed tomographic scan revealed nodules, with fluctuation in size over the 2-year period, in both lungs. Finally the lesion in the left lung was resected, and pulmonary endometriosis was suspected because of the lack of stromal cell nuclear atypia and positive immunohistochemical reactions for estrogen and progesterone receptors. However, a characteristic karyotype was identified cytogenetically: 46, XX, t(7;17)(p15;q11), the translocation of which, specific to ESS, was confirmed by FISH analysis. A final diagnosis of pulmonary metastases from an ESS could be made by reviewing the histology of the previous uterine tumor. In this case, metastatic lesions from an ESS showed a decrease as well as an increase in size, despite the malignant potential. Immunostaining for estrogen and progesterone receptors and cytogenetic and FISH analyses, together with clinical information on the past gynecological history, are valuable diagnostic keys.
PMID: 12596070 [PubMed – indexed for MEDLINE]
241: FASEB J. 2003 Apr;17(6):693-5. Epub 2003 Feb 19. Related Articles, Links
Does endometriosis really have premalignant potential? A clonal analysis of laser-microdissected tissue.
Mayr D, Amann G, Siefert C, Diebold J, Anderegg B.
Department of Pathology, Ludwig-Maximilians University Munich, D-80337 Munich, Germany.
Since 1925, epidemiological and histological evidence for an association between endometriosis and ovarian neoplasia has accumulated. Recently, publications assaying the clonality of a given cell population have implied endometriosis has premalignant properties. However, the human androgen receptor used as a marker in these studies is of highly questionable reliability due to the instability of its methylation pattern in nonmalignant cells and during the course of malignancy. Therefore, we decided to readdress the question of clonality of endometriotic foci by using an alternative assay based on a polymorphism of the phosphoglycerate kinase-1 gene. We overcame the limitation to using ovarian cysts (a problem encountered in other studies) by laser-microdissecting defined tissue fractions of interest. From the 13/29 informative patients, a total of 32 endometriotic samples from various sites was assayed. Only 2/32 samples from different patients bore monoclonal tissue. With one of those cases, we present the first direct evidence of the two morphological endometric compartments comprising a single biphasic developmental unit. Neither monoclonal patient was characterized by any outstanding clinical parameters, including neoplasia. Individual endometriotic foci from the only patient in this study with neoplasia was assayed as being polyclonal. Therefore, former studies stating endometriosis as premalignant have to be cautiously reinterpreted.
PMID: 12594178 [PubMed – indexed for MEDLINE]
242: J Soc Gynecol Investig. 2003 Feb;10(2):118-21. Related Articles, Links
Expression of serum human leukocyte antigen and growth factor levels in a Greek family with familial endometriosis.
Matalliotakis IM, Goumenou AG, Koumantakis GE, Athanassakis I, Dionyssopoulou E, Neonaki MA, Vassiliadis S.
University of Crete, Faculty of Medicine-University Hospital and Department of Biology, Heraklion, Crete, Greece
An increased incidence of endometriosis in the first-degree relatives of patients with endometriosis has been reported, suggesting a familial predisposition and possible genetic influence. In this study, we present a family with four members who have histologically proven endometriosis (mother and three daughters) in two generations and one member with suspected endometriosis in the third generation. The aim of this study was to investigate the presence of serum-soluble class I and class II human leukocyte antigen (sHLA) levels, because they ha

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