250: Gynecol Endocrinol. 2002 Oct;16(5):391-402. Related Articles, Links
Gene expression of adhesion molecules and matrix metalloproteinases in endometriosis.
Ueda M, Yamashita Y, Takehara M, Terai Y, Kumagai K, Ueki K, Kanda K, Hung YC, Ueki M.
Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan.
Various types of cell adhesion molecules and matrix metalloproteinases (MMPs) seem to play an important role in the invasion process of endometriosis; however, limited investigation has focused on their gene expression in human peritoneal endometriotic lesions. A total of 63 endometriotic tissues were surgically obtained from 35 women with endometriosis, which included 43 pigmented and 20 non-pigmented lesions. Gene expression levels of E-cadherin, alpha- and beta-catenin, MMP-2, MMP-9 and membrane-type 1 (MT1)-MMP in these endometriotic lesions were compared with those in normal eutopic endometrium obtained from 12 women without endometriosis. MMP-2, MMP-9 and MT1-MMP mRNA expression in pigmented lesions was significantly higher than that in normal endometrium (p < 0.05), whereas E-cadherin, alpha- and beta-catenin mRNA expression was not suppressed in endometriotic lesions. There was a close correlation between MMP-2 or MT1-MMP and E-cadherin, alpha- or beta-catenin gene expression in 63 endometriotic tissues examined (p < 0.01). Immunohistochemical expression of E-cadherin, alpha- and beta-catenin in glandular epithelial cells was positive not only for all of seven cases with normal eutopic endometrium but also for 9 of 11 with ovarian endometriosis. MMP expression in ectopic endometrium was much greater than that in eutopic endometrium. These results suggest that endometriotic tissues expressing MMPs might be invasive and simultaneously possess cell-to-cell adhesion property in pelvic peritoneal foci.
PMID: 12587534 [PubMed – indexed for MEDLINE]
251: Lik Sprava. 2002;(7):83-5. Related Articles, Links
[Thoracoscopy in verification of thoracal endometriosis] [Article in Ukrainian] Duzhyi ID, Madiar VV, Boiko VI, Duzha OI.
The authors submit data from the published literature, showing that endometriosis is a grave disease in young women of reproductive age. The incidence of endometriosis tends to be on the increase. At the same time, cases have come to be seen of polyorgan localization of the process, the thoracal one included. The paper contains a presentation of a case of thoracal endometriosis accompanied by spontaneous pneumothorax diagnosed after her having been ill with the disease for ten years. Arguments are submitted in favour of a pleural investigation to be conducted in patients with spontaneous pneumothorax, which reasoning determines further therapeutic policy in such patients. In the authors’ opinion, it is thoracotomy that is to be embarked upon, the volume of intervention being determined by revision of organs of the pleural cavity.
PMID: 12587317 [PubMed – indexed for MEDLINE]
252: Acta Cytol. 2003 Jan-Feb;47(1):88-92. Related Articles, Links
Well-differentiated papillary mesothelioma in the pelvic cavity. A case report.
Haba T, Wakasa K, Sasaki M.
Department of Pathology, Osaka City University Hospital, 1-5-7, Asahi-machi, Abeno-ku, Osaka City, Osaka, 545-8586, Japan.
BACKGROUND: Well-differentiated papillary mesothelioma (WDPM) is considered to be a distinct subtype of peritoneal mesothelioma. It occurs in the peritoneum, is most commonly seen in young women and is found incidentally at laparotomy for other indications. Clinically, WDPM is considered to be benign or to have low malignancy potential. CASE: A 48-year-old female with no history of asbestos exposure presented with hypermenorrhea. An operation was performed for adenomyosis, and six papillary nodules, 2 cm or less, were found in the serosa of the pelvic cavity. Peritoneal lavage fluid and imprint material from the tumor were obtained for cytologic examination. The cytologic specimens showed many scattered cells and sheetlike clusters and some papillary clusters. These cells had abundant, polygonal, cyanophilic cytoplasm; clearly outlined borders; and slitlike intercellular spaces. The cell arrangement was orderly. The nuclei were uniform in size, with a single centrally located nucleolus, and there were no binucleated forms or mitosis. There was no increase in chromatin. On the luminal surface of the cells, a brush border was observed. CONCLUSION: It is important to differentiate WDPM from diffuse malignant mesothelioma or other peritoneal malignant tumors to avoid treating them as malignant tumors.
PMID: 12585037 [PubMed – indexed for MEDLINE]
253: Rev Med Brux. 2002;23 Suppl 2:69-76. Related Articles, Links
[The gynecology-obstetrics department] [Article in French] Englert Y, Anaf V, Buxant F, Delbaere A, Devreker F, Donner C, Emiliani S, Kirkpatrick C, Simon P.
yenglert@ulb.ac.be
The scientific and clinical activities of the Department of Obstetrics and Gynaecology have involved the three main subdivisions: the gynecological surgery, the obstetrics and fetal medicine, the endocrinology and the reproductive medicine. Minimal invasive surgery including laser assisted laparoscopy or robotic assisted surgery has been particularly developed. Endometriosis, a frequent and sometimes particularly invasive disease, and oncologic surgeries have been developed in collaboration with the digestive surgery department. The department has also contributed to the comprehension and treatment of prenatal pathologies such as premature labor and deliveries or the gestational diabetes. The department has supported the development of techniques to study the fetal well-being in utero: the prenatal echography, the chorionic villous sampling, the amniotic puncture or the cordocentesis for prenatal genetic diagnosis or fetal infectious contaminations, the CMV transmission more specifically. In endocrinology and reproductive medicine, the department has mainly developed the in vitro fertilization techniques. The prolonged embryo culture, the study of preimplantation embryo metabolism, the preimplantation genetic diagnosis and the cryopreservation of ovarian fragments to preserve fertility in women undergoing oncologic treatments represent the more recent developed topics. Finally, the security of viral transmission in assisted procreation and the treatment of these patients with chronic viral diseases (Hepatitis C or HIV) are another domain with important scientific activity.
PMID: 12584916 [PubMed – indexed for MEDLINE]
254: Rev Med Brux. 2002;23 Suppl 2:17-21. Related Articles, Links
[The pathology department] [Article in French] Salmon I, Nagy N, Noel JC, Remmelink M.
The evolution of the Laboratory of Pathology at Erasmus Hospital is directly related to the morphological diagnosis integration in the medico-surgical organization of the Hospital. Such integration is based on the creation of links between the Laboratory of Pathology and the clinical departments and necessitates permanent adaptations to new complementary technology. Immunohistochemical methods were gradually included in the surgical morphological diagnosis. Currently, new markers from molecular biology are needed to obtain accurate pathological diagnosis. We observe an increasing hyperspecialization of the morphological classification with complete integration of such biological markers leading to the necessity of carrying out collegial diagnosis. The development of the telepathology technology permits international collegial diagnosis. According to its central position the Laboratory of Pathology plays an important part in the development of the clinical and fundamental research. The research subjects of the Laboratory of Pathology concern diagnostic and prognostic evaluation in colic cancers, sarcomas, brain tumors and HPV related tumors endometriosis.
Publication Types: · Review · Review, Tutorial
PMID: 12584903 [PubMed – indexed for MEDLINE]
255: Med Pregl. 2002 Sep-Oct;55(9-10):415-8. Related Articles, Links
[Endometriosis and pain] [Article in Serbo-Croatian (Roman)] Topalski Fistes N, Maticki Sekulic M, Kopitovic V, Tabs D.
Klinika za ginekologiju i akuserstvo, Klinicki centar Novi Sad.
INTRODUCTION: The main symptoms of endometriosis are pain, adnexal tumor and infertility. Pelvic pain and dysmenorrhea are cardinal symptoms as well as pain upon defecation, suprapubic pain (dysuria), pain during coitus and during gynecologic examination. Pain can be caused by fibrotic reaction of the adjacent tissue, adhesions, prostaglandins produced both in endometrium inside the uterus and ectopic endometrium, and also by increased macrophages in the peritoneal fluid. MATERIAL AND METHODS: 500 infertile patients underwent the procedure of laparoscopy in order to determine the cause of infertility. The control group comprised 200 fertile women. The presence of pain in the small pelvis was compared in two groups of patients: with or without endometriosis. Correlation of pain with the stage of disease and location of endometriotic implants in the small pelvis has also been investigated. RESULTS: Endometriosis was diagnosed by laparoscopy in 26% of infertile and 5% of fertile women. The difference was statistically significant (p < 0.001). Dysmenorrhea was present in 46.92% of infertile women with endometriosis and in 48.68% of women without endometriosis. The difference was not statistically significant. Dysmenorrhea was present in 30% of fertile women and in realtion to infertile women, the difference was statistically significant (p < 0.05), no matter if they have endometriosis or not. In relation to stages of endometriosis (the revized classification of the American Fertility Society), there is no significant difference concerning dysmenorrhea. Dysmenorrhea occurred in the first stage in 48%, in the second stage in 44.19%, in the third stage in 50% and in the fourth stage in 44.44%. The correlation coefficient ranged from -8.85 to -0.89. The correlation existed, it was high, but negative. Sensitivity, specificity and prognostic value of symptoms of dysmenorrhea have been estimated in relation to endometriosis with following results: sensitivity was 47%, specificity 51% and the prognostic value i.e. the possibility of occurrence in patients with dysmenorrhea was 25%. Localization of endometriotic foci did not affect occurrence of pain symptoms.
PMID: 12584896 [PubMed – indexed for MEDLINE]
256: J Pathol. 2003 Mar;199(3):318-23. Related Articles, Links
Increased expression of IgE-dependent histamine-releasing factor in endometriotic implants.
Oikawa K, Kosugi Y, Ohbayashi T, Kameta A, Isaka K, Takayama M, Kuroda M, Mukai K.
Department of Pathology, Tokyo Medical University, Tokyo, Japan.
A complex network of cytokines mediates the immunoregulatory responses leading to endometriosis. Recent intensive studies suggest that monocyte and T cell chemoattractants contribute to the inflammatory environment of endometriotic implants. The relationship between the inflammation present during endometriosis and the development of endometriotic implants in the peritoneal cavity remains unclear. On the other hand, the association between endometriosis and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD; dioxin) exposure has been discussed in recent years, and our previous results revealed that IgE-dependent histamine-releasing factor (HRF) is inducible by TCDD. The present study aimed to clarify the expression, localization, and function of HRF in endometriosis. Northern blot analysis demonstrated that HRF is overexpressed in endometriotic implants. RT-PCR with Southern blot analysis, however, showed that HRF overexpression was not always accompanied by CYP1A1 induction in endometriotic implants, suggesting that HRF is inducible in endometriosis without exposure to TCDD. HRF is also inducible by macrophage colony-stimulating factor (M-CSF). Immunohistochemistry showed CD68-positive macrophages in the stroma of endometriotic implants, adjacent to regions with prominent HRF accumulation. HRF-overexpressing cells exhibited high implantation efficiency in comparison to control cells when the cells were injected into the peritoneal cavities of nude mice. These results suggest that the accumulation of macrophages in endometriotic implants induces HRF; the overexpression of HRF accelerates the growth of endometriotic implants. Copyright 2003 John Wiley & Sons, Ltd.
PMID: 12579533 [PubMed – indexed for MEDLINE]
257: Int J Oncol. 2003 Mar;22(3):551-60. Related Articles, Links
Genome-wide cDNA microarray analysis of gene-expression profiles involved in ovarian endometriosis.
Arimoto T, Katagiri T, Oda K, Tsunoda T, Yasugi T, Osuga Y, Yoshikawa H, Nishii O, Yano T, Taketani Y, Nakamura Y.
Laboratory of Molecular Medicine, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan.
Using a cDNA microarray consisting of 23,040 genes, we analyzed gene-expression profiles of ovarian endometrial cysts from 23 patients in order to identify genes involved in endometriosis. By comparing expression patterns between endometriotic tissues and corresponding eutopic endometria, we identified 15 genes that were commonly up-regulated in the endometrial cysts during both proliferative and secretory phases of the menstrual cycle, 42 that were up-regulated only in the proliferative phase, and 40 that were up-regulated only in the secretory phase. The up-regulated elements included genes encoding some HLA antigens, complement factors, ribosomal proteins, and TGFBI. On the other hand, 337 genes were commonly down-regulated throughout the menstrual cycle, 144 only in the proliferative phase, and 835 only in the secretory phase. The down-regulated elements included the tumor suppressor TP53, genes related to apoptosis such as GADD34, GADD45A, GADD45B and PIG11, and the gene encoding OVGP1, a protein involved in maintenance of early pregnancy. Semi-quantitative RT-PCR experiments supported the results of our microarray analysis. These data should provide useful information for finding candidate genes whose products might serve as molecular targets for diagnosis or treatment of endometriosis.
PMID: 12579308 [PubMed – in process]
258: J Obstet Gynaecol Can. 2003 Feb;25(2):98-113. Related Articles, Links
Gonadotropin-releasing hormone and reproductive medicine.
Shalev E, Leung PC.
Department of Obstetrics and Gynecology, Haemek Hospital, Afula, affiliated with the Faculty of Medicine, the Technion Israel Institute of Technology, Haifa, Israel.
The hypothalamic gonadotropin-releasing hormone (GnRH) is a key regulator of the reproductive system, mainly through its effects on pituitary luteinizing hormone (LH) and follicle-stimulating hormone (FSH) release. Gonadotropin-releasing hormone analogues are modifications of the natural decapeptide, being either agonists (GnRHa) or antagonists. GnRHa may imitate the native hormone and induce an endogenous LH surge; however, sustained treatment with GnRHa results in complete refractoriness of LH and FSH production. This aspect of GnRHa action is the main application of the GnRHa in reproduction today. The hypogonadotropic hypogonadal state that results from the sustained treatment is the basis for additional applications of the GnRHa. The agonists appear to be effective, to some extent, for the treatment of endometriosis and were proved to be beneficial prior to surgery for fibroma uteri. GnRHa is used in assisted reproduction for both induction of an endogenous LH surge and for induction of ovulation, and its capacity to cause refractoriness of the pituitary may be used to avoid a premature LH surge. It is suggested that the GnRHa have a direct effect on ovarian steroidogenesis, which is independent of its action on the pituitary. This unwanted effect and other possible drawbacks of the agonists are thought to be eliminated with the use of the antagonists. The mechanism of action of these antagonists is through competitive blocking of the GnRH receptor, which results in a rapid but reversible suppression of gonadotropin secretion. As for GnRHa, GnRH antagonists have been proven effective to prevent the LH surge and to reduce the incidence of severe ovarian hyperstimulation syndrome in controlled ovarian stimulation cycles.
Publication Types: · Review · Review, Tutorial
PMID: 12577127 [PubMed – indexed for MEDLINE]
259: J Clin Endocrinol Metab. 2003 Feb;88(2):730-5. Related Articles, Links
Tumor necrosis factor-alpha-induced interleukin-8 (IL-8) expression in endometriotic stromal cells, probably through nuclear factor-kappa B activation: gonadotropin-releasing hormone agonist treatment reduced IL-8 expression.
Sakamoto Y, Harada T, Horie S, Iba Y, Taniguchi F, Yoshida S, Iwabe T, Terakawa N.
Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago 683-8504, Japan. sakayasu@grape.med.tottori-u.ac.jp
Endometriosis, a common disease among women of reproductive age, is characterized by the presence of endometrial-like tissue outside the uterus. We previously reported that TNFalpha promoted proliferation of endometriotic stromal cells by inducing IL-8 gene and protein expression. We hypothesize that TNFalpha may induce IL-8 production in endometriotic cells through nuclear factor-kappa B (NF-kappa B) activation. Western blot analyses and electrophoretic mobility shift assays revealed that incubation with TNF alpha induced the expression of phosphorylated inhibitor kappa B (p-I kappa B) and activation of NF-kappa B in endometriotic stromal cells. The NF-kappa B inhibitor, N-tosyl-L-phenylalanine chloromethyl ketone, reduced TNFalpha-induced IL-8 gene and protein expression. The medical treatment of endometriosis with GnRH agonist (GnRHa) has been shown to induce hypoestrogenemia and reduce the observable number of endometriotic implants. We compare the expression of IL-8 gene and protein in endometriotic stromal cells of patients treated with GnRHa and those of patients without treatment before laparoscopic cystectomy for endometrioma. The addition of TNFalpha (0.1 ng/ml) significantly increased protein and gene expression of IL-8 in the cells of patients without GnRHa treatment, but this expression was not observed in the cells of patients with GnRHa. The addition of estradiol (E2; 10(-7) M) enhanced the expression of IL-8. However, in the cells of patients who received GnRHa treatment, TNFalpha and E2 did not show any significant effect. In endometriotic stromal cells without GnRHa treatment, TNFalpha and E2 increased the expression of p-I kappa B. In contrast, TNFalpha and E2 had no significant effect on the expression of p-I kappa B in cells that received GnRHa treatment. These findings demonstrate that NF-kappa B activation is critical for TNFalpha-induced IL-8 expression in endometriotic stromal cells. The current study showed for the first time that GnRHa treatment attenuated the expression of IL-8 by reducing TNFalpha-induced NF-kappa B activation.
PMID: 12574206 [PubMed – indexed for MEDLINE]
260: Gynecol Obstet Invest. 2002;54(3):150-3. Related Articles, Links
Studies on the human leukocyte antigen class I antigens in Japanese patients with macroscopically diagnosed endometriosis.
Ishii K, Takakuwa K, Adachi H, Higashino M, Hataya I, Tanaka K.
Department of Obstetrics and Gynecology, Niigata University School of Medicine, Asahimachi-dori, Niigata, Japan. keisui28@med.niigata-u.ac.jp
An increasing number of reports suggest that endometriosis is associated with abnormal immune function, although the etiology of the disease remains undefined. The human leukocyte antigen system (HLA) is known to play a role in the etiology of a number of diseases. This study examines the possible association between the HLA system and endometriosis. Fifty-five patients diagnosed with endometriosis by laparoscopic examination were typed for HLA class I antigens – HLA-A, -B, and -C antigens – using the standard microlymphocytotoxity technique of Terasaki. The frequency of HLA-B 54 and that of HLA-Cw7 were significantly higher in the patient population than in the control population. No significant difference was found between the two groups in the frequencies of the other HLA-class I antigens. The results of this study may implicate the HLA system in the development of endometriosis. Copyright 2002 S. Karger AG, Basel
PMID: 12571436 [PubMed – indexed for MEDLINE]
261: Hum Reprod. 2003 Feb;18(2):429-32. Related Articles, Links
Increased levels of interleukin-15 in the peritoneal fluid of women with endometriosis: inverse correlation with stage and depth of invasion.
Arici A, Matalliotakis I, Goumenou A, Koumantakis G, Vassiliadis S, Selam B, Mahutte NG.
Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520-8063, USA. aydin.arici@yale.edu
BACKGROUND: Interleukin (IL)-15 is a novel cytokine with immunoregulatory and angiogenic properties. We compared IL-15 levels in the peritoneal fluid (PF) of women with and without endometriosis. METHODS: PF samples were obtained from 55 women with endometriosis (23 with superficial peritoneal implants, 19 with deep endometriotic implants and 13 with ovarian endometriomas). Eighteen women with normal pelvic anatomy undergoing tubal sterilization served as controls. RESULTS: PF IL-15 concentrations were increased in women with endometriosis (2.7 +/- 0.5 pg/ml) versus controls (2.1 +/- 0.3 pg/ml; P < 0.001). However, IL-15 levels were higher in women with superficial peritoneal implants (2.9 +/- 0.5 pg/ml) than women with deep endometriotic implants (2.6 +/- 0.4 pg/ml; P = 0.01) or ovarian endometriomas (2.2 +/- 0.4 pg/ml; P < 0.001). IL-15 was also higher in women with deep implants than in those with endometriomas (P < 0.05). PF IL-15 correlated inversely with both depth of invasion (r = -0.52) and the stage of endometriosis (r = -0.42). PF IL-15 levels demonstrated little variation during the menstrual cycle, and did not discriminate between women with infertility or pelvic pain. CONCLUSION: PF IL-15 levels are increased in women with endometriosis. However, IL-15 levels are inversely correlated with the depth of invasion and disease stage, suggesting a possible role for this cytokine in the early pathogenesis of endometriosis.
PMID: 12571184 [PubMed – in process]
262: Hum Reprod. 2003 Feb;18(2):423-8. Related Articles, Links
Insulin-like growth factor (IGF)-1 and IGF binding protein-1 and -3 in the follicular fluid of infertile patients with endometriosis.
Cunha-Filho JS, Lemos NA, Freitas FM, Kiefer K, Faller M, Passos EP.
Obstetrics and Gynecology Department, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
BACKGROUND: Endometriosis is associated with pituitary-ovarian axis dysfunction. The study of the follicular fluid in patients with endometriosis is important to elucidate the pathophysiological mechanism of this disease. The objective of this present paper was to analyse the dosages of insulin-like growth factor-1 (IGF-1) and IGF binding protein-1 and 3 (IGFBP-1 and IGFBP-3) in the follicular fluid environment of infertile patients with endometriosis. METHODS: A total of 41 infertile patients undergoing IVF between January 1999 and January 2000 participated in the cross-sectional prospective study. Patients were divided into three groups: group I, minimal/mild endometriosis (n = 12); group II, moderate/severe endometriosis (n = 10); and group III, tubal obstruction (n = 19). The ultra-short protocol was used in association with recombinant FSH for ovulation induction. Follicular fluid analysis was performed using radioimmunoassay with specific kits. RESULTS: Follicular fluid IGF-1 and IGFBP-3 levels were not significantly different among the groups; however, follicular fluid IGFBP-1 levels were lower in those patients with moderate/severe endometriosis (P < 0.05). Comparison of ovulation induction time, number of recombinant FSH units, number of follicles, oocytes and embryos, and fertilization and gestation/cycle rates showed non-significant differences. CONCLUSION: Infertile patients with moderate/severe endometriosis, which is associated with ovulatory dysfunction, presented lower levels of IGFBP-1 in the follicular fluid when undergoing IVF.
PMID: 12571183 [PubMed – in process]
263: Hum Reprod. 2003 Feb;18(2):364-9. Related Articles, Links
Endometrial integrin expression in women undergoing IVF and ICSI: a comparison of the two groups and fertile controls.
Thomas K, Thomson AJ, Wood SJ, Kingsland CR, Vince G, Lewis-Jones DI.
Reproductive Medicine Unit, Liverpool Women’s Hospital, Liverpool and Departments of Obstetrics and Gynaecology and Immunology, University of Liverpool, Liverpool, UK.
BACKGROUND: Integrins are thought to play a vital role in implantation. Three integrins in particular (alpha(4)beta(1), alpha(v)beta(3) and alpha(1)beta(1)) are all present during the implantation window. Defects in their expression have been linked to tubal disease, unexplained infertility and endometriosis. Hence, a reduced endometrial integrin expression would be expected in women attending for IVF due to these causes of infertility when compared with those with male factor infertility attending for ICSI. METHODS: Women attending for IVF (n = 25) and ICSI (n = 25) treatment were recruited, and timed endometrial biopsies were taken during the ‘implantation window’ (cycle day 20-24). A group of fertile women (n = 15) attending for sterilization was used as controls. RESULTS: There was no significant difference in integrin expression between patients undergoing IVF or ICSI. Neither did these groups differ from the control group. CONCLUSIONS: The endometrium in patients undergoing ICSI treatment is sometimes thought to be more receptive, as the infertility might be due to a male factor. This study shows that there is no significant difference in integrin expression between patients attending for IVF or ICSI and the control group. These data add to the increasing uncertainty about the clinical value of assessing the endometrium with only one marker, in this case integrins.
PMID: 12571175 [PubMed – in process]
264: Fertil Steril. 2003 Feb;79(2):445-8. Related Articles, Links
Mutation analysis of BrCA1, BrCA2, and p53 versus soluble HLA class I and class II in a case of familial endometriosis.
Goumenou AG, Vassiliadis S, Matalliotakis IM, Koumantakis EG, Lembessis P, Koutsilieris M.
Department of Obstetrics and Gynecology, University of Crete, Heraklion, Greece.
OBJECTIVE: To investigate possible correlation(s) between mutations of BrCA1, BrCA2, and p53 genes versus soluble HLA expression in familial endometriosis. DESIGN: Mutation analysis. SETTING: University teaching departments and hospital. PATIENT(S): A family with seven women in two generations with familial endometriosis. INTERVENTION(S): Mutation analysis of BrCA1, BrCA2, and p53 genes. MAIN OUTCOME MEASURE(S): A point mutation of the BrCA1 gene appears to inhibit soluble HLA secretion. RESULT(S): Among the three genes examined, only the BrCA1 gene showed a T to A mutation at position 3232 that correlates with total abolishment of both class I and class II antigen release. CONCLUSION(S): A possible correlation between a BrCA1 mutation and soluble HLA expression appears to exist. The mutation is not stage dependent and seemingly influences the secretion of both class I and class II antigens that are totally absent from the serum of only one family member.
PMID: 12568865 [PubMed – indexed for MEDLINE]
265: Fertil Steril. 2003 Feb;79(2):424-7. Related Articles, Links
Dizygotic twin delivery following in vitro fertilization and transfer of thawed blastocysts cryopreserved at day 6 and 7.
Sills ES, Sweitzer CL, Morton PC, Perloe M, Kaplan CR, Tucker MJ.
Georgia Reproductive Specialists LLC, Atlanta, USA. dr.sills@ivf.com
OBJECTIVE: To report the first conception and delivery following transfer of thawed human blastocysts maintained in extended in vitro culture with cryopreservation at day 6 and 7. DESIGN: Case report. SETTING: Major urban infertility referral center. PATIENT(S): A 26-year-old woman with pelvic endometriosis and two prior unsuccessful in vitro fertilization/embryo transfer (IVF-ET) attempts. INTERVENTION(S): The patient underwent controlled ovarian hyperstimulation using a combined FSH + hMG protocol, and 24 oocytes were retrieved. MAIN OUTCOME MEASURE(S): Dizygotic twin delivery after IVF and intracytoplasmic sperm injection (ICSI), assisted embryo hatching, and ultrasound-guided transfer of cryopreserved blastocysts. RESULT(S): After three embryos were subjected to assisted hatching, they were transferred fresh on day 3, but no implantation occurred. All nontransferred embryos (n = 11) were observed during extended in vitro culture and three blastocysts were selected for cryopreservation on day 6 and 7; thaw and transfer occurred the following month and a pregnancy was achieved. Dizygotic twins (female/female) were delivered by cesarean in the early third trimester. CONCLUSION(S): Substantial advancements have been made in the field of embryo cryogenics and in vitro fertilization, but controversy remains regarding the value of freezing late-developing human blastocysts. Here we describe the first reported live births with IVF after extended in vitro culture and cryopreservation at day 6 and 7 after fertilization.
PMID: 12568858 [PubMed – indexed for MEDLINE]
266: Fertil Steril. 2003 Feb;79(2):361-6. Related Articles, Links
Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination.
Tanahatoe S, Hompes PG, Lambalk CB.
Department of Obstetrics, Gynaecology and Reproductive Medicine, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. s.tanahatoe@vucm.nl
OBJECTIVE:To evaluate the accuracy of diagnostic laparoscopy after normal hysterosalpingography (HSG) and before intrauterine insemination (IUI) with respect to laparoscopic findings leading to a change of treatment decisions in couples with male subfertility, cervical hostility, or idiopathic infertility. DESIGN: Retrospective chart review. SETTING: University medical centre. PATIENT(S): Infertility patients who had undergone diagnostic laparoscopy after a normal HSG and before IUI in a period of 5 years. INTERVENTION(S): Diagnostic laparoscopy in infertility work-up before IUI. MAIN OUTCOME MEASURE(S): Prevalence of laparoscopic findings leading to change in treatment decision. RESULT(S): Of 495 patients, 21 (4%) had severe abnormalities that resulted in a change of treatment to in vitro fertilization or open surgery. In 103 patients (21%) abnormalities, endometriosis (stages I and II), and adhesions were directly treated by laparoscopic intervention, followed by IUI treatment. If surgery to remove early stage endometriosis does not improve pregnancy rates, then the laparoscopic yield would be 40 out of 495 (8.1%). CONCLUSION(S): Diagnostic laparoscopy altered treatment decisions in an unexpectedly high number of patients before IUI. This suggests that laparoscopy may be of considerable value, provided the change in treatment is effective. Further prospective studies are required to assess whether the diagnostic use of laparoscopy is cost effective and whether interventions as result of laparoscopic findings are effective in improving pregnancy rates.
PMID: 12568846 [PubMed – indexed for MEDLINE]
267: Microsc Res Tech. 2003 Mar 1;60(4):445-9. Related Articles, Links
Stromal vascularization in the endometrium during adenomyosis.
Ota H, Tanaka T.
Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita-city, Akita-ken 010-8543, Japan. otah@obgyn.med.akita-u.ac.jp
In adenomyosis, the two major frequent symptoms are hypermenorrhea and dysmenorrhea. The incidence of the former is said to be high, ranging from 36 to 70%. It has been found that vascular distribution of the endometrium in adenomyosis is diversely different from fertile patients without adenomyosis. For example, hysteroscopy revealed that approximately half of the patients have abnormal vascularization. In these patients, vascular distribution was generally irregular, and vessels were thick, dilated, and/or reticular in some patients. Moreover, morphometric analysis of the endometrium revealed that in the fertile women, the mean surface area, total surface area, and total number of capillaries, all increased significantly in the secretory phase compared to the proliferative phase. In contrast, the above parameters increased in the adenomyosis group in both the proliferative phase and secretory phase compared to the fertile women. In particular, the total surface area of capillaries per mm(2) markedly rose, by 11.6 times, compared to that of the proliferative phase in the fertile women. These findings suggest that regulatory factors involved in the vascular proliferation are diversely exaggerated, and that the abnormal vascularization of the endometrium is closely related with hypermenorrhea. Copyright 2003 Wiley-Liss, Inc.
Publication Types: · Review · Review, Tutorial
PMID: 12567401 [PubMed – indexed for MEDLINE]
268: Gynecol Obstet Invest. 2002;54(2):82-7. Related Articles, Links
Behaviour of cytokine levels in serum and peritoneal fluid of women with endometriosis.
Pizzo A, Salmeri FM, Ardita FV, Sofo V, Tripepi M, Marsico S.
Department of Gynecological Sciences, University of Messina, Italy. vsofo@unime.it
Endometriosis is a disorder characterised by presence and growth of endometrial tissue outside the uterus, primarily into the peritoneum. The peritoneal fluid (PF) of women with endometriosis undergoes a number of biological changes, including local inflammatory-reparative phenomena and peripheral blood mononuclear cells (PBMC) involvement. These activated cells as well as the endometriotic cells secrete various cytokines with pleiotropic biological activities. Dynamic interplay among cytokines may contribute to realise a favourable microenvironment for the implantation of endometrial cells and the progression of the disease. In the present study, we evaluated the levels of cytokines, such as the tumour necrosis factor-alpha (TNF-alpha), transforming growth factor-beta (TGF-beta), interleukin-8 (IL-8) and monocyte chemotactic protein-1 (MCP-1) in PF and in serum (S) of women with endometriosis to compare their behaviour in both biological fluids. The patients (n = 26) were women of reproductive age attending our observation centre for infertility, diagnosed endometriosis at laparoscopy. Control group (n = 5) consisted of women affected by non-immunologic infertility, diagnosed by explorative laparoscopy. S samples were obtained from peripheral blood before anaesthesia and laparoscopy. PF samples were collected at the time of laparoscopy. Both biological fluids were examined for cytokine by ELISA assays. Our results showed that S and PF levels of TNF-alpha, not dosable in controls, were very high at the early stage and decreased significantly with the severity of the disease (p < 0.001). TGF-beta levels were significantly (p < 0.001) higher than in controls and increased with the severity of the disease (p < 0.001), particularly in the PF. S and PF IL-8 as well as MCP-1 concentrations at all stages were higher than in controls (p < 0.001), yet showed an opposite behaviour in both biological fluids. In fact, S levels of IL-8 and MCP-1 were significantly (p < 0.001) higher at early stages and decreased with the severity of the disease, whereas we observed a significant (p < 0.001) enhancement of these chemokine levels in PF from stage I to stage II and stage III. These observations showed that TNF-alpha and TGF-beta levels were overlapping in S and PF of women with endometriosis. On the contrary, MCP-1 and IL-8 S concentrations decreased with the severity of the disease, whereas PF levels showed markedly increased at severe stages. Taken together the observed changes may be due both to the increased peritoneal macrophage activity and to the larger recruitment of PBMC and autocrine release by endometriotic cells. Copyright 2003 S. Karger AG, Basel
PMID: 12566749 [PubMed – indexed for MEDLINE]
269: Gynecol Obstet Invest. 2002;54(2):64-5; author reply 65-6. Related Articles, Links
Comment in: · Gynecol Obstet Invest. 2002;54(2):61-2.
Comment on: · Gynecol Obstet Invest. 2002;53(3):163-9.
Concerning the article by Meaddough et al: Sexual activity, orgasm and tampon use are associated with a decreased risk for endometriosis.
Guidone HC, Marvel ME.
Publication Types: · Comment · Letter
PMID: 12566744 [PubMed – indexed for MEDLINE]
270: Gynecol Obstet Invest. 2002;54(2):63; author reply 65-6. Related Articles, Links
Comment in: · Gynecol Obstet Invest. 2002;54(2):61-2.
Comment on: · Gynecol Obstet Invest. 2002;53(3):163-9.
Concerning the article by Meaddough et al: Sexual activity, orgasm and tampon use are associated with a decreased risk for endometriosis.
Ballweg ML, Quinn BW.
Publication Types: · Comment · Letter
PMID: 12566743 [PubMed – indexed for MEDLINE]
271: Gynecol Obstet Invest. 2002;54(2):61-2. Related Articles, Links
Comment on: · Gynecol Obstet Invest. 2002;53(3):163-9. · Gynecol Obstet Invest. 2002;54(2):63; author reply 65-6. · Gynecol Obstet Invest. 2002;54(2):64-5; author reply 65-6.
Endometriosis, tampons and orgasm during menstruation: science, press and patient organizations.
D’Hooghe TM, Yankowitz J.
Publication Types: · Comment · Editorial
PMID: 12566742 [PubMed – indexed for MEDLINE]
272: Eur J Gynaecol Oncol. 2002;23(6):523-6. Related Articles, Links
Depot leuprorelin acetate versus danazol in the treatment of infertile women with symptomatic endometriosis.
Rotondi M, Labriola D, Rotondi M, Ammaturo FP, Amato G, Carella C, Izzo A, Panariello S.
Institute of Obstetrics and Gynecology, II University of Naples, Italy.
PURPOSE OF INVESTIGATION: Endometriosis is a common finding in women with infertility, but the mechanism by which it renders a woman infertile remains unclear. The medical treatment of pelvic endometriosis includes hormonal therapy that directly attacks endometriosis lesions or indirectly by inhibiting endometrial proliferation through estrogenic deprivation. The aim of this study was to compare the efficacy and safety of leuprorelin acetate depot and danazol for endometriosis in infertile women. METHODS: This randomized trial involved 81 women 19-41 years old with regular menses and known pelvic endometriosis who were recruited from the Fertility Center of the Second University of Naples between 1992 and 1999. Fifty-four women were given 3.75 mg of leuprolide acetate depot every 28 days for 24 weeks and the remaining 27 took 200 mg of danazol three times daily for 24 weeks. Efficacy assessments were based on pre-admission and end-of-treatment laparoscopic scores and subjective symptoms scores at 4-week intervals during and after treatment. Safety was evaluated by adverse events and clinical laboratory tests. RESULTS: In each group, endometriosis growth and symptoms significantly improved during treatment (p < 0.001). Significantly fewer patients randomized to leuprorelin acetate (5.5%) withdrew during treatment compared with 18.5% randomized to danazol (p < 0.05). After treatment symptoms returned in each group, but severity was less than at admission at all time points (p < 0.02). Hypoestrogenic side-effects were more common in those receiving leuprorelin, particularly hot flushes, but anabolic/androgenic side-effects of weight gain and acne were more common in those receiving danazol. CONCLUSION: Both leuprorelin acetate depot and danazol are effective in the treatment of endometriosis in infertile patients. The hypoestrogenic side-effects of leuprorelin may be better tolerated than the androgenic, anabolic effects of danazol.
Publication Types: · Clinical Trial · Randomized Controlled Trial
PMID: 12556096 [PubMed – indexed for MEDLINE]
273: J Am Assoc Gynecol Laparosc. 2003 Feb;10(1):127-30. Related Articles, Links
Midgut carcinoid tumor identified from a metastasis in the uterosacral ligament.
Vilos GA, Ettler HC, Rajgopal C, McDonald TJ.
Department of Obstetrics and Gynecology, St. Joseph’s Health Care, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.
Chronic pelvic pain is common in women of reproductive age and accounts for more than 40% of all laparoscopic procedures. In up to 40% of these patients laparoscopic findings are negative. As a result, many gynecologists frequently excise portions of the uterosacral ligaments and biopsy inconspicuous pelvic lesions in an effort to perform uterosacral nerve ablation and also to identify subclinical endometriosis. During diagnostic laparoscopy for chronic intermittent pelvic and abdominal pain, a 37-year-old woman was noted to have an incidental, 5-mm, pink-white nodule in the right uterosacral ligament. Pathologic examination reported features typical of a carcinoid tumor. Further evaluation by computerized tomographic scan and indium-III octreotide scan identified a 1.6-cm lesion in the mesentery. At laparotomy a 2-cm primary mucosal tumor in the terminal ileum and a 2-cm nodule in the adjacent mesentery were present. Carcinoid tumor was confirmed in 2 nodules and in 7 of 17 mesenteric lymph nodes. Liver and lung metastases were not seen.
PMID: 12555008 [PubMed – indexed for MEDLINE]
274: J Am Assoc Gynecol Laparosc. 2003 Feb;10(1):123-6. Related Articles, Links
Postlaparoscopic vulvar edema, a rare complication.
Yen CF, Wang CJ, Lin SL, Lee CL, Soong YK.
Department of Obstetrics and Gynecology, Division of Gynecologic Endoscopic Surgery, Chang Gung Memorial Hospital, #5, Fu-Hsing Street. Kwei-Shan, Tao-Yuan, 333, Taiwan.
Two cases of unilateral labial edema occurred after laparoscopic presacral neurectomy and were associated with massive chylous ascites. One woman was cured by a second laparoscopy to repair the chylous leakage. In the other, vulvar edema subsided in 2 days and chyloperitoneum subsided spontaneously in 3 weeks. The mechanism of postlaparoscopic vulvar edema is believed to be similar to that of Conn’s postparacentesis labial edema, in which the unhealed puncture tract permits ascites to travel through and accumulate in the labia majora.
PMID: 12555007 [PubMed – indexed for MEDLINE]
275: J Am Assoc Gynecol Laparosc. 2003 Feb;10(1):85-9. Related Articles, Links
The diagnostic dilemma of minimal and mild endometriosis under routine conditions.
Buchweitz O, Poel T, Diedrich K, Malik E.
Department of Gynaecology and Obstetrics, University of Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany.
STUDY OBJECTIVE: To evaluate the reliability of diagnosing minimal and mild endometriosis under routine conditions, and to determine to what extent disease activity is taken into account. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University teaching hospital. INTERVENTION: Laparoscopy. PATIENTS: One hundred eighteen consecutive women with minimal and mild endometriosis undergoing routine surgery between 1994 and 1999. MEASUREMENTS AND MAIN RESULTS: Analytic parameters were the total number of endometriotic lesions; intraoperative description of pigmented, nonpigmented, and nondefined lesions; and number of extirpated lesions and histologic detection rate. In 118 patients, 311 suspected endometriotic lesions were documented. Nonpigmented lesions were reported in only 27% of women. In 51% of surgical reports no importance was attached to disease morphology or activity. Only 1.2 biopsies/patient were taken. The histologic detection rate was 56%. In 49 patients the assumed intraoperative diagnosis was confirmed by histologic examination. CONCLUSIONS: Intraoperative description of endometriotic lesions is inadequate. Little attention is paid to the activity of the illness. There is room for improvement in the number of excisions and histologic detection, and an attempt should be made to find a way out of this diagnostic dilemma.
PMID: 12555000 [PubMed – indexed for MEDLINE]
276: J Am Assoc Gynecol Laparosc. 2003 Feb;10(1):46-8. Related Articles, Links
High frequency of endometrial polyps in endometriosis.
Kim MR, Kim YA, Jo MY, Hwang KJ, Ryu HS.
Department of Obstetrics and Gynecology, Ajou University School of Medicine, San 5, Wonchon-dong, Paldal-gu, Suwon 442-749, Korea.
STUDY OBJECTIVE: To evaluate the effectiveness of hysteroscopy and the frequency of endometrial polyps in women with endometriosis. DESIGN: Retrospective clinical study (Canadian Task Force classification II-2). SETTING: Infertility unit at a university-affiliated hospital. PATIENTS: One hundred eighty-three infertile women, 92 with endometriosis and 91 controls without the disease. INTERVENTION: Laparoscopy and scoring of endometriosis according to the American Fertility Society classification, and confirmation of endometrial polyps by pathologic examination. MEASUREMENTS AND MAIN RESULTS: There was no significant difference between groups with regard to age, mean duration of infertility, and frequency of primary or secondary infertility. Endometrial polyps were found in 43 women (46.7%) with endometriosis and in 15 controls (16.5%, p = 0.0000). Their frequency did not differ significantly according to stage of endometriosis. CONCLUSIONS: We strongly recommend hysteroscopy if endometriosis is detected in a woman undergoing evaluation for infertility, even if hysterosalpingography and transvaginal ultrasonography do not suggest endometrial polyps.
PMID: 12554993 [PubMed – indexed for MEDLINE]
277: J Am Assoc Gynecol Laparosc. 2003 Feb;10(1):33-7. Related Articles, Links
Frequency and laparoscopic management of ovarian remnant syndrome.
Abu-Rafeh B, Vilos GA, Misra M.
Department of Obstetrics and Gynecology, University of Western Ontario, London, Ontario N6A 4V2, Canada.
STUDY OBJECTIVE: To report the frequency and outcome of laparoscopy in women with chronic pelvic pain and/or pelvic mass who were found to have ovarian remnants. DESIGN: Cohort study. (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: One hundred nineteen women who had had hysterectomy and oophorectomy. INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Ovarian remnants were known in 5 and were found intraoperatively in 21 patients (18%). These 26 women had undergone at least one laparoscopy in an attempt to remove the remnants. After the ureter was identified, ovarian remnants were dissected and removed from the retroperitoneum laparoscopically with minimal risk of vessel or visceral injury. There were no intraoperative or postoperative complications and no conversions to laparotomy. In addition to ovarian remnants, adhesions were found in 19 women, endometriosis in 4, and no other pathology in 3. Twenty women had complete relief of symptoms. At follow-up of 1 to 8 years (mean 5 yrs), six underwent repeat laparoscopy for persistent pain; one had recurrent ovarian remnant. CONCLUSIONS: Ovarian remnant syndrome is not an infrequent complication after hysterectomy and oophorectomy in women with endometriosis.
PMID: 12554991 [PubMed – indexed for MEDLINE]
278: J Obstet Gynaecol. 2002 Nov;22(6):701. Related Articles, Links
Cervical stump carcinoma following subtotal hysterectomy.
Shah AN, Olah KS.
Department of Obstetrics and Gynaecology, Warwick Hospital, Warwick, UK.
PMID: 12554282 [PubMed – indexed for MEDLINE]
279: Anticancer Res. 2002 Nov-Dec;22(6C):3985-8. Related Articles, Links
A matrix metalloproteinase inhibitor, ONO-4817, retards the development of mammary tumor and the progression of uterine adenomyosis in mice.
Mori T, Nakahashi K, Kyokuwa M, Yamasaki S, Nagasawa H.
Department of Biological Sciences, Graduate School of Science, University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan.
The inhibitory effects of a novel matrix metalloproteinase inhibitor, ONO-4817, on the development of mammary tumors and the progression of uterine adenomyosis were examined in SHN mice. First, multiparous mice which developed mammary tumors spontaneously were used. The first palpable tumor was removed, and the mice were thereafter fed chow containing ONO-4817. Any second mammary tumor developing in the other mammary fat pad was also removed, and the mice were continuously fed the chow containing ONO-4817. The mice were killed when a third tumor was detected in the other fat pad. The periods between the occurrence of the first and second tumors, and the second and third ones were significantly increased in the mice treated with ONO-4817 compared to the mice not given ONO-4817 treatment. Second, to test ONO-4817 suppression of the progression of the invasion of uterine adenomyotic tissue, mice with experimentally-induced adenomyosis were treated with ONO-4817 for 4 weeks. The degree of pathological progression of adenomyosis was less in the uteri exposed to ONO-4817 than in the uteri not exposed to the inhibitor.
PMID: 12553022 [PubMed – indexed for MEDLINE]
280: Eur J Obstet Gynecol Reprod Biol. 2003 Feb 10;106(2):227-9. Related Articles, Links
The laparoscopic appearance of Schistosomiasis may be mistaken for "non-pigmented" endometriosis.
Jones KD, Okaro EO, Sutton C.
Department of Gynaecological Endoscopic Surgery, The Royal Surrey County Hospital, Egerton Road, Guildford, GU2 5XX, Surrey, UK
The authors report the case history of a patient with symptoms and signs suggestive of endometriosis, who was found to have Schistosomiasis. The laparoscopic appearance was of gelatinous deposits throughout the pelvis which were thought to be "non-pigmented" endometriosis. However, histological examination of the biopsy specimens revealed Schistosomiasis.
PMID: 12551799 [PubMed – in process]
281: Eur J Obstet Gynecol Reprod Biol. 2003 Feb 10;106(2):170-4. Related Articles, Links
Soluble intercellular adhesion molecule 1 in the peritoneal fluid of patients with endometriosis correlates with the extension of peritoneal implants.
Calhaz-Jorge C, Costa AP, Santos MC, Palma-Carlos ML.
Department of Obstetrics and Gynaecology, Human Reproduction Unit, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
OBJECTIVE: To investigate the correlation of the concentrations of soluble intercellular adhesion molecule 1 (sICAM-1) in the peritoneal fluid (PF) with the extent of peritoneal endometriotic lesions and with the presence of red lesions (RLs). STUDY DESIGN: Sixty-seven patients with endometriosis and 19 controls with normal pelvis had PF samples collected during laparoscopy. RESULTS: The concentrations of sICAM-1 in the PF of patients and controls were not different. Patients with peritoneal implant scores 4 or more had higher concentrations of sICAM-1 in the PF than those with implant scores less than 4 (P=0.018) and controls (P=0.031). No significant difference was found in sICAM-1 levels in patients with and without RLs. No correlation was detected between sICAM-1 and interleukin 1beta (IL-1beta) in either patients or controls. CONCLUSIONS: The increased concentrations of sICAM-1 in the PF of patients with greater implant scores may indicate an active shedding of the molecule from the endometriotic peritoneal tissue. No significant association was found with the presence of RLs. The levels of IL-1beta in the PF were not a relevant factor influencing the concentrations of sICAM-1.
PMID: 12551787 [PubMed – in process]
282: J Obstet Gynaecol Can. 2003 Jan;25(1):33-44. Related Articles, Links
Do environmental contaminants adversely affect human reproductive physiology?
Foster WG.
Division of Reproductive Biology, Department of Obstetrics and Gynaecology, McMaster University Medical Centre, Hamilton, ON, Canada.
There is increasing concern among Canadian women that unwitting and unwanted exposures to environmental contaminants are adversely affecting their health, particularly their ability to become pregnant and have a healthy baby. Evidence of adverse reproductive outcomes among populations exposed to environmental contaminants in the workplace via accidental poisoning, together with detection of environmental contaminant residues in serum and ovarian follicular fluid, has led to the hypothesis that chemical contaminants may be contributing to adverse reproductive outcomes such as infertility, endometriosis, polycystic ovary syndrome, spontaneous abortion, preterm labour, intrauterine growth restriction, and pregnancy-induced hypertension in the general population. The lack of clear evidence concerning the association between exposure to environmental contaminants and adverse reproductive outcomes hampers the clinician’s ability to counsel women who are trying to conceive or who have concerns about their pregnancy. This review summarizes the evidence linking environmental contaminant exposure to selected adverse health outcomes by examining the changes in health-outcome trends, the consistency of the epidemiological evidence of an association between the health outcome of concern and exposure to environmental contaminants, and the biological plausibility for environmental contaminant mediated effects on human reproductive health. At best, only a moderate association can be found linking exposure to environmental contaminants with evidence of deleterious reproductive effects in women. Lack of disease trend data, weak exposure assessments, and limited mechanistic data supporting the biological plausibility of potential effects are the primary limitations to the hypothesis that exposure to environmental contaminants adversely affects human reproductive physiology.
Publication Types: · Review · Review, Tutorial
PMID: 12548323 [PubMed – indexed for MEDLINE]
283: Int Immunopharmacol. 2003 Jan;3(1):81-9. Related Articles, Links
Serum concentrations of growth factors in women with and without endometriosis: the action of anti-endometriosis medicines.
Matalliotakis IM, Goumenou AG, Koumantakis GE, Neonaki MA, Koumantakis EE, Dionyssopoulou E, Athanassakis I, Vassiliadis S.
Department of Obstetrics and Gynecology, University of Crete, P.O. Box 1393, 714-09, Crete, Heraklion, Greece
Endometriosis is a common gynecologic syndrome of unknown etiology and pathogenesis. Growth factors and inflammatory mediators produced by peritoneal leukocytes have recently been postulated to participate in the pathogenesis of endometriosis. Angiogenic factors released from peritoneal macrophages may also play a role in the development of this disease. In the present study, we investigate the soluble levels of vascular endothelial growth factor (VEGF), epidermal growth factor-receptor (EGF-R), granulocyte/macrophage-colony stimulating factor (GM-CSF), Insulin-like growth factor-1 (IGF-1) and interferon-gamma (IFN-gamma) in the serum of 28 women with and 20 without endometriosis. We also compared these levels before, during and after treatment with danazol and leuprorelin acetate depot, the two therapeutic regiments of choice concerning this disease. We found that only sVEGF levels were higher in women with endometriosis in comparison to controls (P<0.001) while sEGF-R is not present. GM-CSF, IGF-1 and IFN-gamma soluble levels are not affected in either healthy or endometriotic subjects. The 6-month treatment with danazol decreased sVEGF levels (P<0.02) and increased sEGF-R levels (P<0.001). These observations support the view that VEGF may be associated with the disease process and that danazol may bring sVEGF levels to a normal threshold. However, future studies will be focused on the anti-angiogenic control of the action of VEGF in patients with endometriosis.
PMID: 12538037 [PubMed – in process]
284: Reprod Biomed Online. 2001;2(2):120-128. Related Articles, Links
The role of LHRH agonists and antagonists.
Chillik C, Acosta A.
CEGYR, Center for Gynecology and Reproduction Studies, Viamonte 1438, Capital Federal (1055), Buenos Aires, Argentina.
Administration of GnRH analogues (agonists as well as antagonists) produces suppression of the pituitary—gonadal axis, thus inhibiting the secretion of LH, FSH and sexual steroids. For this reason, analogs are indicated in all those clinical situations where suppression of gonadotrophins (precocious puberty, contraception) or of sexual steroids (endometriosis, prostate hyperplasia, cancer, uterine fibroids) is desired. For several years GnRH agonists have been used in combination with gonadotrophins for ovarian stimulation for assisted reproduction in order to control premature LH surges and to reduce cancellation rate with improvement of the pregnancy rate per cycle. This effect is obtained after 2 weeks of agonist administration. The immediate suppression of the pituitary achieved by GnRH antagonists without an initial stimulatory effect is the main advantage of these compounds over the agonists. The prevention of a premature LH surge by GnRH antagonists can be obtained by multiple dose or by a single administration. Both protocols offer the following advantages over the agonists: they require fewer ampoules of gonadotrophins, shorter duration of stimulation, there is a preserved pituitary response to GnRH, less risk of ovarian hyperstimulation syndrome and the luteal phase seems to be more preserved. The main disadvantages of the antagonists are that they are expensive and that pregnancy rate appears to be slightly lower than with the agonists. GnRH antagonists will probably replace agonists in ovarian stimulation treatment for assisted reproduction techniques.
PMID: 12537809 [PubMed – as supplied by publisher]
285: Reprod Biomed Online. 2002;5 Suppl 1(3):68-72. Related Articles, Links
Will GnRH antagonists assist in the treatment of benign gynaecological diseases?
Felberbaum RE, Kupker W, Diedrich K.
Department of Obstetrics and Gynaecology at the Medical University of Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany.
While GnRH agonists have become well-established tools for preoperative treatment of uterine fibroids or postoperative treatment in endometriosis for 3-6 months, GnRH antagonists seem to offer important advantages due to their specific pharmacological mode of action. Avoiding any flare-up effect, it seems to be possible to reduce treatment time to about only 2-4 weeks in the case of fibroids to obtain a clinically relevant reduction in size. Furthermore, due to the classic competitive receptor blockade induced by GnRH antagonists, it is feasible to preserve residual oestradiol secretion for a period of 8 weeks in patients with endometriosis. Endometriosis patients undergoing this treatment reported a symptom-free period, with no signs of mood changes, hot flushes, loss of libido, vaginal dryness or other symptoms. Serum oestradiol oscillated around a mean level of 50 pg/ml during therapy. Sequential administration of the GnRH antagonist cetrorelix (Cetrotide(R)), in a 3 mg dosage once weekly over 8 weeks in the case of endometriosis or administration every 4th day for a time span of 2-4 weeks for fibroids, creates a new opportunity for medical treatment. Although 3 mg of cetrorelix acetate obviously acts as an intermediate depot preparation, results obtained so far are very preliminary.
PMID: 12537785 [PubMed – as supplied by publisher]
286: Radiographics. 2003 Jan-Feb;23(1):137-50; discussion 151-5. Related Articles, Links
Transvaginal US and hysterosonography in postmenopausal women with breast cancer receiving tamoxifen: correlation with hysteroscopy and pathologic study.
Fong K, Causer P, Atri M, Lytwyn A, Kung R.
Department of Medical Imaging, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Ontario, Canada.
Tamoxifen citrate therapy increases the prevalence of benign and malignant uterine lesions. At transvaginal ultrasonography (US), the finding of a thickened central endometrial complex, with or without cystic changes, is often nonspecific and may be caused by an endometrial polyp, submucosal leiomyoma (fibroid), endometrial hyperplasia, carcinoma, or cystic atrophy. In addition, because of an increased prevalence of adenomyosis or adenomyosis-like changes in women receiving tamoxifen, proper transvaginal US assessment of endometrial thickness and abnormalities is difficult in some women. Hysterosonography, as an adjunct to transvaginal US, allows identification of intracavitary lesions and focal and diffuse endometrial abnormalities and helps determine whether an abnormality is endometrial or subendometrial. Endometrial polyps may be seen at transvaginal US as nonspecific thickening of the endometrial complex, with or without cystic changes. At hysterosonography, they appear as an echogenic mass with smooth margins. Submucosal leiomyomas may protrude into the endometrial cavity, causing false endometrial thickening at transvaginal US. Hysterosonography shows a round structure arising from the myometrium with a thin, overlying endometrium. At transvaginal US, when the endometrium cannot be accurately measured or when there is a nonspecific thickened central endometrial complex, hysterosonography can provide additional information and can help in the triage for hysteroscopic versus nondirected endometrial biopsy. Correlation of transvaginal US and hysterosonographic findings with hysteroscopic and pathologic findings enhances understanding of these changes, as well as the limitations and potential pitfalls of both imaging techniques. Copyright RSNA, 2003.
PMID: 12533649 [PubMed – indexed for MEDLINE]
287: Mol Hum Reprod. 2003 Jan;9(1):47-52. Related Articles, Links
Intercellular adhesion molecule-1 (ICAM-1) gene polymorphisms in endometriosis.
Vigano P, Infantino M, Lattuada D, Lauletta R, Ponti E, Somigliana E, Vignali M, DiBlasio AM.
Molecular Biology Laboratory, Istituto Auxologico Italiano, V.le Monte Nero 32, 20135 Milan, Italy.
Endometriosis is a gynaecological disease with a certain genetic background, but the locations of possible genomic aberrations are still poorly clarified. Intercellular adhesion molecule-1 (ICAM-1), which is a surface glycoprotein that promotes adhesion in immunological and inflammatory reactions, seems to play a role in this condition. The aim of this study was to examine the potential associations of ICAM-1 gene polymorphisms with endometriosis and its severity. Specifically, we have studied two polymorphic sites located in codons 241 (G/R241) and 469 (E/K469) of the ICAM-1 gene. Three hundred and sixty-three Italian Caucasian women of reproductive age who underwent laparoscopy for benign pelvic conditions were enrolled in the study. Endometriosis was documented and staged in 188 women while 175 subjects, in whom endometriosis was laparoscopically ruled out, served as the control group. The frequency of the R241 allele was only marginally higher in endometriosis patients than in c

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