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351: BJOG. 2002 Nov;109(11):1298-300. Related Articles, Links
Interleukin-1 receptor antagonist polymorphism in women with peritoneal adhesions.
Wieser F, Tempfer C, Schneeberger C, van Trotsenburg M, Huber J, Wenzl R.
Department of Obstetrics and Gynaecology, University of Vienna, Austria.
Interleukin (IL)-1 has been shown to induce peritoneal adhesions. We determined the IL-1 receptor antagonist (IL-1RN) genotype with respect to the two most common variant alleles IL-1RN*2 and IL-1RN*3 in Caucasian women with peritoneal adhesions. One hundred seven women with surgically verified peritoneal adhesions and 79 controls without peritoneal adhesions served as controls. Univariate analysis showed an increased risk for peritoneal adhesions for Caucasian women carrying the mutant IL-1RN*2 allele (OR: 2.1; 95% CI: 1.3-3.4; P = 0.004). Multiple logistic regression analysis demonstrated an increased risk for peritoneal adhesions, which is independent of previous abdominal surgery and endometriosis. Our data suggest that IL-1RN*2 allele carriers have an increased risk for adhesion formation.
PMID: 12452470 [PubMed – indexed for MEDLINE]
352: Diagn Cytopathol. 2002 Dec;27(6):379-81. Related Articles, Links
Pelvic endometriosis diagnosed on touch imprint cytology.
Selvaggi SM.
Department of Pathology and Laboratory Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA. sselvaggi@facstaff.wisc.edu
A case of pelvic endometriosis on touch imprint cytology in a 34-yr-old woman is presented and discussed. Touch preparations of the core biopsies showed both epithelial and spindle cell components. Bland-appearing epithelial cells, arranged in tight clusters and sheets, contained finely granular chromatin and scant cytoplasm. Clusters of bland-appearing spindle cells with oval nuclei containing small prominent nucleoli were present. The differential diagnosis and diagnostic pitfalls are discussed. Copyright 2002 Wiley-Liss, Inc.
PMID: 12451571 [PubMed – indexed for MEDLINE]
353: Med Hypotheses. 2003 Jan;60(1):84-8. Related Articles, Links
Endometriosis is sustained by tumour necrosis factor-alpha.
Bullimore DW.
Barnsley District General Hospital Trust, Barnsley, UK. dwwbullimore@compuserve.com
Endometriosis is a common gynaecological disorder causing pain, infertility, and emotional distress. Evidence presented here suggests that abnormal production of tumour necrosis factor-alpha (TNF-alpha) is required for the establishment and maintenance of endometriosis and also is responsible for the associated infertility through its effect on sperm motility and function and oocyte development. Infliximab, which blocks TNF-alpha function, could be used in the treatment of endometriosis to reverse the above effects.
Publication Types: · Review · Review, Tutorial
PMID: 12450770 [PubMed – indexed for MEDLINE]
354: Tidsskr Nor Laegeforen. 2002 Oct 10;122(24):2367-8. Related Articles, Links
[Drug treatment of endometriosis] [Article in Norwegian] Moen MH.
Kvinneklinikken, St. Olavs Hospital, 7006 Trondheim. mette.moen@medisin.ntnu.no
PMID: 12448251 [PubMed – indexed for MEDLINE]
355: Obstet Gynecol Surv. 2002 Nov;57(11):768-80. Related Articles, Links
COX-2 inhibitors and their role in gynecology.
Hayes EC, Rock JA.
Reproductive Endocrinology and Infertility, Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, USA. ehayes2@emory.edu
This review summarizes current knowledge about the roles of cyclooxygenases and prostaglandins in reproductive medicine. With the development of COX-2 specific inhibitors, new therapeutic options are available to obstetricians and gynecologists, offering better-tolerated alternatives to conventional NSAIDs. The analgesic effectiveness of COX-2 specific inhibitors is well established, and they are already in use in a range of painful conditions. Both celecoxib and valdecoxib are indicated for the treatment of primary dysmenorrhea, and may be effective in postoperative pain, including hysterectomy, and pain associated with endometriosis. There is also speculation that COX-2 specific inhibitors may be effective tocolytic agents without the risks to the fetus seen with conventional NSAIDs. The role of COX-2 in oncogenesis is also under investigation, and COX-2 specific inhibitors may eventually be used in the prevention and treatment of gynecologic malignancies. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to describe the two types of cylooxygenase enzymes (COX), to list the effects and side effects of NSAIDs and COX-2 medications, and to outline the various changes in COX expression during pregnancy.
Publication Types: · Review · Review, Tutorial
PMID: 12447099 [PubMed – indexed for MEDLINE]
356: Int J Gynaecol Obstet. 2002 Dec;79(3):229-35. Related Articles, Links
Angiogenic activity and IL-8 concentrations in peritoneal fluid and sera in endometriosis.
Barcz E, Rozewska ES, Kaminski P, Demkow U, Bobrowska K, Marianowski L.
Ist Department of Obstetrics and Gynecology, The Medical University of Warsaw, Warsaw, Poland. ewa.barcz@interia.pl
OBJECTIVES: During menstruation endometrial fragments are transported into the peritoneal cavity where they form endometriotic lesions. Angiogenesis is proposed as one of the mechanisms in endometriosis pathogenesis. The aim of the study was to determine the angiogenic activity and interleukin 8 concentrations in peritoneal fluid and sera in endometriosis. METHODS: Angiogenesis was determined in cutaneous assay in Balb/c mice; IL-8 concentrations were measured by ELISA test in sera and peritoneal fluid of 32 control and 56 endometriosis patients. Wilcoxon and Mann-Whitney tests and Spearman rank correlations were used in statistical analysis. RESULTS: Peritoneal fluid and sera from the examined group had higher angiogenic activity and interleukin 8 concentrations. There was correlation found between AFS and neovascularization induced by sera and PF of patients with peritoneal lesions. CONCLUSIONS: Angiogenesis plays an important role in pathogenesis of endometriosis. Although IL-8 takes part in neovascularization, there are other factors modulating angiogenesis in endometriosis.
PMID: 12445988 [PubMed – indexed for MEDLINE]
357: Gynecol Obstet Invest. 2002;54 Suppl 1:52-8; discussion 59-62. Related Articles, Links
Current thinking on the pathogenesis of endometriosis.
Donnez J, Van Langendonckt A, Casanas-Roux F, Van Gossum JP, Pirard C, Jadoul P, Squifflet J, Smets M.
Department of Gynecology, Catholic University of Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium. donnez@gyne.ucl.ac.be
This manuscript is a review of new ideas regarding the pathogenesis of peritoneal endometriosis, ovarian endometriosis, and retroperitoneal adenomyosis. Peritoneal endometriosis, the different aspects of which (black, red and white) represent distinctive steps in the evolutionary process, can be explained by the transplantation theory. Red lesions are the most active and most highly vascularized lesions and are considered to be the first stage of peritoneal endometriosis. The retroperitoneal nodule is an adenomyotic nodule whose histopathogenesis is not related to the implantation of regurgitated endometrial cells but to metaplasia of Mullerian remnants located in the rectovaginal septum. Metaplastic changes of Mullerian rests into adenomyotic glands involving the rectovaginal septum and the retroperitoneal space are responsible for the striking proliferation of the smooth muscle, creating an adenomyomatous appearance similar to that of adenomyosis in the endometrium. Copyright 2002 S. Karger AG, Basel
Publication Types: · Review · Review, Tutorial
PMID: 12441661 [PubMed – indexed for MEDLINE]
358: Gynecol Obstet Invest. 2002;54 Suppl 1:43-51. Related Articles, Links
Diagnosis and imaging of adenomyotic disease of the retroperitoneal space.
Squifflet J, Feger C, Donnez J.
Department of Gynecology, Universite Catholique de Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium.
This manuscript discusses the diagnosis and imaging of adenomyotic disease of the retroperitoneal space, a pathology that we have defined as retroperitoneal adenomyotic disease (RAD). By prospective analysis, comparing barium enema, magnetic resonance imaging (MRI) and transrectal ultrasonography, we distinguished three types of retroperitoneal adenomyotic lesions. The most frequently encountered types were posterior vaginal fornix lesions, followed by hourglass-shaped or diabolo-like lesions, and then by rectovaginal septum lesions. This anatomical classification based on clinical examination and imaging will allow us in the future to define the most appropriate treatment for each entity. Copyright 2002 S. Karger AG, Basel
Publication Types: · Review · Review, Tutorial
PMID: 12441660 [PubMed – indexed for MEDLINE]
359: Gynecol Obstet Invest. 2002;54 Suppl 1:36-40; discussion 41-2. Related Articles, Links
Pretreatment for ovarian endometrial cyst before in vitro fertilization.
Suganuma N, Wakahara Y, Ishida D, Asano M, Kitagawa T, Katsumata Y, Moriwaki T, Furuhashi M.
Infertility Center, Toyohashi Municipal Hospital, Toyohashi, Japan. sugasan@par.odn.ne.jp
Assisted reproductive technology is a widely accepted treatment for infertile women with endometriosis. The presence of an ovarian endometrial cyst reduces the quality of oocytes, while surgical resection of endometrioma may reduce the ovarian reserve for ovarian stimulation by exogenous gonadotropins. To determine what pretreatment should be performed for ovarian endometrial cyst before IVF-ET, we analyzed IVF outcomes with or without pretreatment in patients with endometrioma. Infertile women with endometrioma who underwent IVF-ET were divided into 3 groups, including patients who had received laparotomy or laparoscopy, patients for whom the endometrioma content had been aspirated and treated with or without alcohol fixation, and patients who did not undergo pretreatment. The number of retrieved oocytes, rate of mature oocytes, and fertilization rate were compared among groups. The results showed that pretreatment for endometrioma reduces the number of retrieved oocytes. Although oocyte quality as a rate of mature oocytes was not affected by the presence of an ovarian endometrial cyst, the fertilization rate was improved by cyst aspiration. We propose that surgical pretreatment is not necessary for ovarian endometrial cyst before IVF-ET, but cyst aspiration may be beneficial after several failed attempts of IVF. Copyright 2002 S. Karger AG, Basel
Publication Types: · Review · Review, Tutorial
PMID: 12441659 [PubMed – indexed for MEDLINE]
360: Gynecol Obstet Invest. 2002;54 Suppl 1:30-4; discussion 34-5. Related Articles, Links
Laparoscopic treatment of endometrioma-associated infertility and pregnancy outcome.
Takuma N, Sengoku K, Pan B, Wada K, Yamauchi T, Miyamoto T, Ohsumi D, Ishikawa M.
Department of Obstetrics and Gynecology, Asahikawa Medical College, Asahikawa, Japan. ntakuma@asahikawa-med.ac.jp
Ovarian endometriomas do not respond well to medical treatment with hormonal suppression, and surgical removal of the endometriomas is usually required. In this study, we attempt to identify the optimal laparoscopic procedures in laparoscopic treatment of ovarian-endometrioma-associated infertility. Among cases in which patients received no IVF-ET after the laparoscopic treatment, the pregnancy rate after complete cystectomy of endometriomas was statistically lower than that after fenestration with electrocoagulation of the cyst wall. Among cases in which patients received IVF-ET, there was no difference in ovarian response between patients that had complete cystectomy and fenestration with electrocoagulation of the cyst wall. However, the pregnancy rate in patients who had aspiration alone was statistically lower than that in patients who had aspiration followed by ethanol fixation. Thus, it appears that for patients who do not require follow-up IVF-ET, fenestration with electrocoagulation of the cyst wall is suitable, whereas for patients who need follow-up IVF-ET, ethanol fixation may be a better choice. Copyright 2002 S. Karger AG, Basel
PMID: 12441658 [PubMed – indexed for MEDLINE]
361: Gynecol Obstet Invest. 2002;54 Suppl 1:24-7; discussion 27-9. Related Articles, Links
Laparoscopic surgery for the management of ovarian endometrioma.
Yoshida S, Harada T, Iwabe T, Terakawa N.
Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan. souichi@grape.emd.tottori-u.ac.jp
The purpose of this study was to evaluate the effects of laparoscopic surgery on the symptoms associated with ovarian endometrioma. We also examined serum IL-6 concentrations in patients with endometrioma. Ninety-two patients who underwent laparoscopic surgery for ovarian endometrioma were enrolled in this study. The mean duration of follow-up was 27.6 months. Transvaginal ultrasound examinations revealed a recurrence of endometrioma in 13% of the cases. We evaluated the severity of dysmenorrhea using a 0-3-point verbal rating scale, and found that the dysmenorrhea score was statistically improved after the operation. Follicular growth was preserved in 94%, and the pregnancy rate was 43%. We measured serum IL-6 concentrations in 14 patients with ovarian endometrioma and 4 patients with benign gynecologic disease without endometriosis. IL-6 was significantly higher in patients with endometrioma than in those without endometriosis at the time of diagnosis. The mean serum IL-6 concentration significantly decreased after the operation. In conclusion, laparoscopic surgery is effective for alleviating pain and preserving fertility in patients with endometrioma. Measurements of serum IL-6 concentrations may be useful for the management of endometrioma. Copyright 2002 S. Karger AG, Basel
PMID: 12441657 [PubMed – indexed for MEDLINE]
362: Gynecol Obstet Invest. 2002;54 Suppl 1:18-21; discussion 21-3. Related Articles, Links
Is endometriosis really associated with pain?
Momoeda M, Taketani Y, Terakawa N, Hoshiai H, Tanaka K, Tsutsumi O, Osuga Y, Maruyama M, Harada T, Obata K, Hayashi K.
Department of Obstetrics and Gynecology, University of Tokyo, Japan. momoeda-tky@umin.ac.jp
To address the contrasting findings regarding how pain is related to endometriosis, the relationship between pain and stage of endometriosis was dissected differently by the chief complaint to eliminate selection biases. A total of 1,092 women with endometriosis were classified into two groups depending on their chief complaint, i.e., infertility (infertility group; n = 476) or pain (pain group; n = 616). The correlations between disease stage and various types of pain were analyzed differently in each group. The frequencies of chronic pelvic pain and dyspareunia increased with disease stage either in the infertility group, in the pain group or in the aggregate. On the other hand, no significant relation between the severity of dysmenorrhea and disease stage was observed in the aggregate. Interestingly, a parallel increase in the severity of dysmenorrhea with disease stage was observed in the infertility group, but not in the pain group. In view of selection biases involved in analyzing endometriosis associated with pain, these results could be seen to support the contention that chronic pelvic pain, dyspareunia and dysmenorrhea are in fact related to the extent of endometriosis. Copyright 2002 S. Karger AG, Basel
PMID: 12441656 [PubMed – indexed for MEDLINE]
363: Gynecol Obstet Invest. 2002;54 Suppl 1:2-7; discussion 7-10. Related Articles, Links
The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain.
Donnez J, Squifflet J, Pirard C, Jadoul P, Wyns C, Smets M.
Department of Gynecology, Universite Catholique de Louvain, Cliniques Universitaites St-Luc, Brussels, Belgium. donnez@gyne.ucl.ac.be
This article is a review of the efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain. Endometriosis is the cause of pelvic pain (dysmenorrhea, dyspareunia) and infertility in more than 35% of women of reproductive age. Complete resolution of endometriosis is not yet possible but therapy has essentially three main objectives: (1) to reduce pain; (2) to increase the possibility of pregnancy; (3) to delay recurrence for as long as possible. It could be concluded that a consensus will probably never be reached on minimal and mild endometriosis. Nevertheless, because the Canadian study reported a large number of cases, we strongly support the view that visible endometriosis must be removed at the time of surgery. In cases of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with GnRH-a) must be considered as ‘first-line’ treatment. The mean pregnancy rate of 50% reported in the literature following surgery provides scientific proof that operative treatment should be undertaken first to give our patients the best chance of conceiving naturally. Copyright 2002 S. Karger AG, Basel
Publication Types: · Review · Review, Tutorial
PMID: 12441654 [PubMed – indexed for MEDLINE]
364: Toxicol Sci. 2002 Dec;70(2):161-70. Related Articles, Links
Environmental dioxins and endometriosis.
Rier S, Foster WG.
Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Endometriosis is a common gynecologic problem of unknown etiology. Estrogen dependence and immune modulation are established features of this disease and recently environmental contaminants have been suggested to play a role in the pathobiology of endometriosis as well. Previous work in nonhuman primates has shown that exposure to the dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is associated with an increased prevalence and severity of endometriosis. Further animal experiments have implicated dioxin and dioxin-like compounds in this disease. Rodent studies support the plausibility for a role of environmental contaminants in the pathophysiology of endometriosis although a convincing mechanistic hypothesis has yet to be advanced. Small hospital-based case-control studies have failed to provide compelling evidence for or against an association of environmental contaminants and endometriosis. Herein we review the available literature that provides evidence that dioxin and dioxin-like compounds are potent modulators of immune and endocrine function critical to the pathobiology of endometriosis. Furthermore, perspectives on the potential mechanism(s) of dioxin and dioxin-like compound-induced toxicity in endometriosis, important knowledge needs, potential animal models for endometriosis studies, and considerations integral to future human case-control studies are discussed.
Publication Types: · Review · Review, Tutorial
PMID: 12441361 [PubMed – indexed for MEDLINE]
365: Arch Gynecol Obstet. 2002 Dec;267(2):110-2. Related Articles, Links
Acute disseminated intravascular coagulation developed during menstruation in an adenomyosis patient.
Nakamura Y, Kawamura N, Ishiko O, Ogita S.
Department of Obstetrics and Gynecology, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan. obgyyoshin@med.osaka-cu.ac.jp
We report a case of acute disseminated intravascular coagulation (DIC) developed during menstruation in an adenomyosis patient. No known predisposing factor for DIC such as infection or pregnancy was involved in this case. As anticoagulation therapy and supplementation of coagulation factors quickly improve the state, surgical removal of the uterus was not required. We speculate that hemorrhage in the adenomyosis legion and subsequent local thrombosis played crucial role in pathophysiology of this case of acute DIC.
PMID: 12439560 [PubMed – indexed for MEDLINE]
366: Am J Obstet Gynecol. 2002 Nov;187(5):1395-400. Related Articles, Links
The prevalence of interstitial cystitis in gynecologic patients with pelvic pain, as detected by intravesical potassium sensitivity.
Parsons CL, Dell J, Stanford EJ, Bullen M, Kahn BS, Willems JJ.
Division of Urology, University of California San Diego Medical Center, 92103-8897, USA. jpoehling@ucsd.edu
OBJECTIVE: The purpose of this study was to determine the prevalence of interstitial cystitis in a large number of gynecologic patients with pelvic pain versus control subjects, as indicated by a positive result on a potassium sensitivity test. STUDY DESIGN: Gynecologists at four US medical centers administered the potassium sensitivity test to consecutive unselected patients with pelvic pain and control subjects. Before testing, each patient with pelvic pain was given an initial clinical diagnosis on the basis of the chief symptomatic complaint(s) and was surveyed for urologic symptoms. RESULTS: Of 244 patients with pelvic pain, 197 patients (81 %) had a positive result from a potassium sensitivity test. Positive potassium sensitivity test rates were comparable across all four sites and all clinical diagnoses that included endometriosis, vulvodynia (vulvar vestibulitis), and pelvic pain. Urologic symptoms were reported by 84% of patients, but only 1.6% of the patients had received an initial diagnosis of interstitial cystitis. None of the 47 control subjects were tested positive with the potassium sensitivity test. CONCLUSION: Interstitial cystitis may be a common unrecognized cause of pelvic pain in gynecologic patients and deserves greater, if not primary, consideration in the differential diagnosis of pelvic pain.
PMID: 12439537 [PubMed – indexed for MEDLINE]
367: Gastroenterol Clin Biol. 2002 Aug-Sep;26(8-9):800-1. Related Articles, Links
[Intestinal endometriosis manifested as intestinal occlusion. Value of computed tomography] [Article in French] Tissot B, Penin H, Lamy A, Perraudeau F, Manouvrier JL, Imbert Y.
Publication Types: · Letter
PMID: 12434088 [PubMed – indexed for MEDLINE]
368: Paediatr Drugs. 2002;4(12):797-805. Related Articles, Links
A contemporary approach to dysmenorrhea in adolescents.
Harel Z.
Division of Adolescent Medicine, Hasbro Children’s Hospital, 593 Eddy Street, Providence, RI 02903, USA. Zharel@Lifespan.org
Dysmenorrhea is the most common gynecologic complaint among adolescent girls. Despite progress in understanding the physiology of dysmenorrhea and the availability of effective treatments, many adolescent girls do not seek medical advice or are undertreated. Dysmenorrhea in adolescents is usually primary (functional), and is associated with normal ovulatory cycles and no pelvic pathology. In approximately 10% of adolescents with severe dysmenorrhea, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins from the second series and potent leukotrienes from the fourth series play an important role in generating dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for dysmenorrhea. A loading dose of NSAIDs (typically twice the regular dose) should be used as initial treatment for dysmenorrhea in adolescents followed by a regular dose until symptoms abate. Adolescents with symptoms that do not respond to treatment with NSAIDs for three menstrual periods should be offered combined estrogen/ progestin oral contraceptive pills for three menstrual cycles. Adolescents with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. Adolescent care providers have the important roles of educating adolescent girls about menstruation-associated symptoms, as well as evaluating and effectively treating patients with dysmenorrhea.
Publication Types: · Review · Review, Tutorial
PMID: 12431132 [PubMed – indexed for MEDLINE]
369: Semin Reprod Med. 2002 Aug;20(3):277-84. Related Articles, Links
The essential role of the aromatase/p450arom.
Meinhardt U, Mullis PE.
Department of Pediatrics, Pediatric Endocrinology/Diabetology and Metabolism, University Children’s Hospital, Inselspital, CH-3010 Bern, Switzerland.
Aromatase (P450arom) catalyzes the conversion of testosterone to estradiol, androstenedione to estrone, and 16a-hydroxylated dehydroepiandrosterone to estriol. P450arom is encoded by the human CYP19 gene (15q21.1) spanning about 123 kb with a coding region of 9 exons (about 30 kb, exon II to exon X). Although there are a number of alternative first exons and nine different transcriptional start sides with individual promoters that permit tissue-specific regulation of expression, the protein expressed in these various tissue sites (placenta, adipose tissue, brain, bone, ovary, etc.) always remains the same. As not only androgens but also estrogens are of importance particularly in male pubertal development including bone changes, which were classically considered androgen dependent, the features of the aromatase deficiency syndrome in affected boys and girls as well as adult males and females are discussed. There is growing awareness that androgens and estrogens have general metabolic roles that reach far beyond reproductive processes. For instance, estrogen has a significant impact on carbohydrate and lipid metabolism, vascular function, and arteriosclerosis. In addition, extragonadal estrogen biosynthesis plays an important but often underestimated physiological and pathophysiological role, for example, in breast cancer and endometriosis. Based on that knowledge, progress has been made as far as treatment and follow-up of this disorder are concerned.
Publication Types: · Review · Review, Tutorial
PMID: 12428207 [PubMed – indexed for MEDLINE]
370: Int J Gynaecol Obstet. 2002 Nov;79(2):101-4. Related Articles, Links
Cesarean section as a cause of chronic pelvic pain.
Almeida EC, Nogueira AA, Candido dos Reis FJ, Rosa e Silva JC.
Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil.
OBJECTIVE: To determine if the history of cesarean section was associated with chronic pelvic pain, independent of the presence of other conditions such as pelvic adhesions, endometriosis, sequelae of pelvic inflammatory disease, leiomyoma and pelvic varices. METHODS: Retrospective case-control study conducted on 199 patients consecutively admitted from January 1998 to January 2000, 116 of them submitted to laparoscopy for the diagnosis of chronic pelvic pain and 83 asymptomatic patients submitted to tubal ligation by laparoscopy. A logistic regression analysis was used to verify the association between chronic pelvic pain and the history of previous cesarean section. RESULTS: In women with chronic pelvic pain, a history of cesarean section was observed in 67.2% of cases, adhesions in 51.7%, endometriosis in 33.6%, sequelae of pelvic inflammatory disease in 31.9%, leiomyoma in 6.9% and pelvic varices in 11.2%. In asymptomatic women, a history of cesarean section was observed in 38.5%, adhesions in 24.1%, endometriosis in 9.6%, sequelae of pelvic inflammatory disease in 4.8%, leiomyoma in 7.2% and pelvic varices in 3.6%. In a logistic model, chronic pelvic pain was associated with a history of cesarean section (O.R.=3.7), as well as with endometriosis (O.R.=8.5), sequelae of pelvic inflammatory disease (O.R.=10.5). CONCLUSIONS: In the present study cesarean section was associated with chronic pelvic pain. This fact may be the cause of a public health problem in the coming years, due to the raised rates of cesarean section in Brazilian women.
PMID: 12427392 [PubMed – indexed for MEDLINE]
371: Obstet Gynecol. 2002 Nov;100(5 Pt 2):1065-7. Related Articles, Links
Dysmenorrhea after bilateral tubal ligation: a case of retrograde menstruation.
Morrissey K, Idriss N, Nieman L, Winkel C, Stratton P.
Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, Bethesda, Maryland 20892-1583, USA.
BACKGROUND:Endometriosis, arising de novo, is believed to be uncommon in women who have undergone bilateral tubal ligation because the occluded tube prevents outflow of blood and menses.CASE:A woman 10-year status-post bilateral tubal ligation suffered from dysmenorrhea and menorrhagia that began within 1 year after sterilization. At the time of bilateral tubal ligation, no endometriosis was observed. A recent magnetic resonance imaging scan showed no pelvic abnormalities, and the patient underwent a diagnostic laparoscopy in anticipation of finding endometriosis, yet none was found. At laparoscopy performed on day 3 of her menstrual cycle, the proximal segments of her occluded fallopian tubes were dilated with blood. As this was the only abnormality found, we postulated that her dysmenorrhea might be related to the dilated proximal tubal stumps. We evacuated the bloody fluid and occluded the proximal tube at the cornua with Filshie clips. One year after surgery, the patient remains asymptomatic.CONCLUSION:This case is unique because bilateral tubal ligation combined with retrograde menstrual flow appears to have caused dysmenorrhea. Women who have undergone tubal ligation and who have dysmenorrhea may benefit from a diagnostic laparoscopy during menstruation to evaluate the possibility of retrograde menstruation dilating the proximal tubal stumps.
PMID: 12423806 [PubMed – indexed for MEDLINE]
372: Biochim Biophys Acta. 2002 Nov 11;1592(3):323-43. Related Articles, Links
The role of transsignalling via the agonistic soluble IL-6 receptor in human diseases.
Kallen KJ.
Biochemisches Institut, Christian-Albrechts-Universitat zu Kiel, Germany. kjkallen@biochem.uni-kiel.de
The activation of cells that do not express the membrane bound interleukin-6 6 receptor (IL-6R) by IL-6 and the soluble IL-6 receptor (sIL-6R) is termed transsignalling. Transsignalling may be an pathogenetic factor in human diseases as diverse as multiple myeloma (MM), Castleman’s disease, prostate carcinoma, Crohn’s disease, systemic sclerosis, Still’s disease, osteoporosis and cardiovascular diseases. IL-6 and sIL-6R may directly or indirectly enhance their own production on endothelial or bone marrow stromal cells. Positive feedback autocrine loops thus created in affected organs may either cause or maintain disease progression. In autoimmune or vasculitic disease, the ability of the IL-6/sIL-6R complex to inhibit apoptosis of autoreactive T-cells may be central to the development of tissue specific autoimmunity. The anti-apoptotic effect of the IL-6/sIL-6R complex may be involved in tumour genesis and resistance to chemotherapy.Only in rare cases, where counterregulation has failed, there is a notable systemic effect of IL-6/sIL-6R. Appropriate animal models are necessary to establish the pathogenetic role of the IL-6/sIL-6R complex. A specific treatment option for diseases influenced by the sIL-6R could be based on gp130-Fc, a soluble gp130 (sgp130) linked to the Fc-fragment of IgG1. gp130-Fc has shown efficacy in vivo in animal models of Crohn’s disease.
Publication Types: · Review · Review, Academic
PMID: 12421676 [PubMed – indexed for MEDLINE]
373: Reprod Biomed Online. 2002 Sep-Oct;5(2):162-6. Related Articles, Links
Effects of previous ovarian surgery for endometriosis on the outcome of assisted reproduction treatment.
Geber S, Ferreira DP, Spyer Prates LF, Sales L, Sampaio M.
ORIGEN, Centro de Medicina Reprodutiva, Av. Contorno 7747, Belo Horizonte, Minas Gerais, CEP 30 010020, Brazil. sjgeber@bhnet.com.br
Endometriosis affects 2-50% of women at reproductive age. Surgery is an option for treatment, but there is no convincing evidence that it promotes a significant improvement in fertility. Also, the removal of ovarian endometrioma might lead to a reduction in the follicular reserve and response to stimulation. Therefore, the aim of this study was to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. A total of 61 women, with primary infertility and previously having undergone ovarian surgery for endometriosis, who had received 74 IVF/intracytoplasmic sperm injection (ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within#10; the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as a control group. Patients were matched for age and treatment performed. Patients </=35 years with previous ovarian surgery had fewer retrieved oocytes than the patients in the control group (P = 0.049). The number of ampoules used for ovulation induction, duration of folliculogenesis; (days), number of follicles and fertilization rate was similar in both groups. The same was observed for pregnancy rates, with 24 patients (53.3%) having had previous ovarian surgery and 27 (56.2%) in the control group becoming pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for ovulation induction (P = 0.017) and had fewer follicles and oocytes than women in the control group (P = 0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Although a lower pregnancy rate was observed in patients who had undergone previous ovarian surgery, this difference was not statistically significant (P = 0.424). In conclusion, ovarian surgery for the treatment of endometriosis reduces the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, for infertile patients, non-surgical treatment might be a better option to avoid reduction of the ovarian response.
PMID: 12419041 [PubMed – indexed for MEDLINE]
374: J Reprod Med. 2002 Oct;47(10):801-8. Related Articles, Links
Impact of endometriosis on implantation. Data from the Wilford Hall Medical Center IVF-ET Program.
Hickman TN.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA. timothy.hickman@jhu.edu
OBJECTIVE: To investigate the effect of endometriosis on implantation. STUDY DESIGN: In a retrospective cohort study, 149 consecutive in vitro fertilization retrieved cycles were analyzed. Patients with endometriosis (n = 27, 31 cycles) were compared with a control group with tubal infertility (n = 104, 118 cycles). The main outcome measure was implantation rate (gestational sac per transferred embryo). RESULTS: The patients in the tubal infertility group were slightly younger and tended to have a better response to stimulation and increased number of oocytes retrieved than did the patients in the endometriosis group; however, there were no differences in fertilization rates, number of embryos transferred or clinical pregnancy rates per cycle between the endometriosis group and tubal infertility group. The overall clinical pregnancy rate per cycle was similar for women in the endometriosis and tubal infertility groups (54.8% and 55.1%, respectively). The implantation rate was not different in the endometriosis versus tubal infertility group (28% [28/100] and 29.8%, [108/363], respectively; P = .75, relative risk = .94, 95% confidence interval .66, 1.34). CONCLUSION: For women undergoing in vitro fertilization-embryo transfer with endometriosis, the implantation rate is not markedly different from that for women undergoing in vitro fertilization-embryo transfer with tubal infertility.
PMID: 12418061 [PubMed – indexed for MEDLINE]
375: Fertil Steril. 2002 Nov;78(5):1088-95. Related Articles, Links
Comment in: · Fertil Steril. 2003 Jun;79(6):1467-8; author reply 1468.
Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination.
Dickey RP, Taylor SN, Lu PY, Sartor BM, Rye PH, Pyrzak R.
The Fertility Institute of New Orleans, New Orleans, Louisiana 70128, USA. info@fertilityinstitute.com
OBJECTIVE: To determine how diagnosis, age, sperm quality, and number of preovulatory follicles affect pregnancy rates when multiple cycles of clomiphene citrate (CC)-IUI are performed. DESIGN: Fifteen-year prospective observational study. SETTING: Private infertility clinic. PATIENT(S): Three thousand, three hundred eighty-one cycles of husband or donor IUI. INTERVENTION(S): Ovulation induction with CC and IUI. MAIN OUTCOME MEASURE(S): Per-cycle pregnancy rate (PR), cumulative pregnancy rate (CPR). RESULT(S): Pregnancy rates remained constant through four cycles, then fell significantly for diagnoses other than ovulatory dysfunction. Mean PRs for cycles 1-4 were significantly lower for patients with the following characteristics: age >/=43 years, poor semen quality, single preovulatory follicles, and diagnoses other than ovulatory dysfunction. Additional cycles of CC-IUI compensated for low PRs because of age, semen quality, or number of follicles. After four cycles, CPRs were 46% for ovulatory dysfunction; 38% for cervical factor, male factor, and unexplained infertility; 34% for endometriosis; and 26% for tubal factor. After six cycles, CPRs were 65% for ovulation dysfunction, 35% for endometriosis, and unchanged for other diagnoses. CONCLUSION(S): Clomiphene citrate-intrauterine insemination should be performed for a minimum of four cycles. Additional cycles of CC-IUI can compensate for low pregnancy rates due to age, semen quality, or follicle number in patients with ovulation dysfunction.
PMID: 12413999 [PubMed – indexed for MEDLINE]
376: Fertil Steril. 2002 Nov;78(5):973-8. Related Articles, Links
Role of endocrine status and cell type in adhesion of human endometrial cells to the peritoneum in nude mice.
Beliard A, Noel A, Goffin F, Frankenne F, Foidart JM.
Laboratory of Biology of Tumors and Development, University of Liege, Liege, Belgium.
OBJECTIVE: To investigate the role of different cellular types (epithelial and stromal endometrial cells and peritoneal cells) in the ectopic implantation of endometrium and to evaluate the importance of endocrine environment on the adhesion of endometrial cells to the peritoneum. DESIGN: Experimental prospective study. SETTING: University hospital, department of cell biology. ANIMAL(S): One hundred one nude mice. INTERVENTION(S): Monolayer culture of human epithelial and stromal endometrial cells obtained from patients undergoing hysterectomy or laparoscopy for benign disease. Intraperitoneal injection of cells into nude mice. MAIN OUTCOME MEASURE(S): Two weeks after cell injection, adhesion of endometrial cells was evaluated by histological and immunohistochemical examination. RESULT(S): Mixed cultures of stromal and epithelial cells, but not purified epithelial or stromal cells alone, adhered to the mouse peritoneum and led to endometriotic-like nodules. Pretreatment of cells with estrogen alone or with estrogen and progestin resulted in a higher percentage of animals developing endometriotic-like nodules, whereas treatment with progestin alone did not affect endometriotic implantation. CONCLUSION(S): Our data indicate that the success of endometrial cell implantation is dependent on the cooperativeness between stromal and epithelial endometrial cells, as well as on the endocrine environment of endometrial cells, but not that of recipient animals. The results emphasize the role of both endometrial cell types for ectopic implantation.
PMID: 12413980 [PubMed – indexed for MEDLINE]
377: Fertil Steril. 2002 Nov;78(5):961-72. Related Articles, Links
Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process.
Gambone JC, Mittman BS, Munro MG, Scialli AR, Winkel CA; Chronic Pelvic Pain/Endometriosis Working Group.
Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. jgambone@mednet.ucla.edu
OBJECTIVE: To develop recommendations for the medical and surgical care of women who present with chronic pelvic pain (CPP) and are likely to have endometriosis as the underlying cause. DESIGN: An expert panel comprised of practicing gynecologists from throughout the United States and experts in consensus guideline development was convened. After completion of a structured literature search and creation of draft algorithms by an executive committee, the expert panel of >50 practicing gynecologists met for a 2-day consensus conference during which the clinical recommendations and algorithms were reviewed, refined, and then ratified by unanimous or near-unanimous votes. PATIENT(S): Women presenting with CPP who are likely to have endometriosis as the underlying cause. MAIN OUTCOME MEASURE(S): None. CONCLUSION(S): Chronic pelvic pain frequently occurs secondary to nongynecologic conditions that must be considered in the evaluation of affected women. For women in whom endometriosis is the suspected cause of the pain, laparoscopic confirmation of the diagnosis is unnecessary, and a trial of medical therapy, including second-line therapies such as danazol, GnRH agonists, and progestins, is justified provided that there are no other indications for surgery such as the presence of a suspicious adnexal mass. When surgery is necessary, laparoscopic approaches seem to offer comparable clinical outcomes to those performed via laparotomy, but with reduced morbidity. The balance of evidence supports the use of adjuvant postoperative medical therapy after conservative surgery for CPP. There is some evidence that adjuvant presacral neurectomy adds benefit for midline pain, but currently, there is inadequate evidence to support the use of uterosacral nerve ablation or uterine suspension. Hysterectomy alone has undocumented value in the surgical management of women with endometriosis-associated CPP.
Publication Types: · Consensus Development Conference · Review
PMID: 12413979 [PubMed – indexed for MEDLINE]
378: Zhonghua Fu Chan Ke Za Zhi. 2002 Sep;37(9):539-41. Related Articles, Links
[Study on the expression of vascular endothelial growth factor in patients with adenomyosis of the uterus] [Article in Chinese] Han Y, Zhou Y, Zheng S.
Department of Obstetrics and Gynecology, Zhongshan City People’s Hospital, Guangdong Province, Zhongshan 528403, China.
OBJECTIVE: To investigate the role of angiogenesis and expression of vascular endothelial growth factor (VEGF) in the pathophysiology of adenomyosis of the uterus. METHODS: The study included 32 patients with histologically proven adenomyosis and 30 patients with asymptomatic leiomyoma of the uterus. Immunohistochemical staining was used to detect VEGF expression in different parts of the uterus. A computerized morphometric study on the VEGF expression was performed. RESULTS: The VEGF H-Score of glandular cells in the endometrium of adenomyosis uterus [proliferative phase (9.6 +/- 1.4), secretory phase (11.7 +/- 1.6)] was much higher than that of leiomyoma uterus [proliferative phase (8.3 +/- 1.7), secretory phase (10.2 +/- 1.5)] (P < 0.05), and increased in the secretory phase (P < 0.05). Compared with eutopic endometrium, the VEGF H-Score in ectopic endometrium [proliferative phase (11.9 +/- 1.8), secretory phase (13.0 +/- 1.7)] increased significantly (P < 0.05), but showed no cyclic change (P > 0.05). The VEGF H-Score of myometrium around the ectopic lesions [proliferative phase (9.5 +/- 1.3), secretory phase (8.7 +/- 1.3)] was higher than that of normal myometrium [proliferative phase (4.8 +/- 1.9), secretory phase (4.5 +/- 1.4)] (P < 0.01). CONCLUSION: The angiogenesis activity of the endometrium and myometrium of adenomyosis uterus was markedly increased.
PMID: 12411015 [PubMed – indexed for MEDLINE]
379: Zhonghua Fu Chan Ke Za Zhi. 2002 Sep;37(9):536-8. Related Articles, Links
[Investigation of the hemodynamic changes during uterine arterial embolization in the treatment of adenomyosis] [Article in Chinese] Liu P, Chen C, Liu L, Liu J.
Department of Obstetrics and Gynecology, Guangzhou First Municipal People’s Hospital, Guangzhou 510180, China.
OBJECTIVE: To investigate the hemodynamic changes before and after uterine arterial embolization (UAE) in the treatment of adenomyosis. METHODS: UAE was performed in 30 patients with adenomyosis diagnosed by clinical manifestation, magnetic resonance and/or color Doppler flow imaging (CDFI). The mean flow velocity (Vm), resistance index (RI) and pulsatility index (PI) of bilateral uterine arteries were measured by CDFI 1 week before, 1 week, 1 month and 3 months after UAE. Mean time of the blood flow in normal myometrium and adenomyosis lesions were observed by color Doppler energy. RESULTS: Vm, PI and RI were markedly reduced after UAE, especially on the 7th day after UAE (P < 0.01). Concomitantly the blood flow volume (BFV) in normal myometrium was also decreased and recovered to normal again 1 month and 3 months after treatment (P < 0.05, compared to the 7th day after UAE) but the BFV inside the adenomyosis lesion kept lower state after UAE. CONCLUSIONS: The most obvious hemodynamic changes of uterine arteries occurred 1 week after UAE. The blood supply of normal myometrium recovered to normal after 30 days. But those of lesions were irreversible until 3 months after UAE.
PMID: 12411014 [PubMed – indexed for MEDLINE]
380: Dtsch Med Wochenschr. 2002 Nov 2;127(44):2317-20. Related Articles, Links
[Endometriosis of the transverse colon–a rare localization] [Article in German] Hartmann D, Schilling D, Roth SU, Bohrer MH, Riemann JF.
Medizinische Klink C, Gastroenterologie, Hepatologie, Diabetologie, Akademisches Lehrankenhaus der Johannes-Gutenberg-Universitat Mainz, Germany.
HISTORY: A 65-year-old woman with no complaints came to our hospital for a colonoscopy because of a family history of a colorectal carcinoma. Because of postmenopausal complaints she had been undergoing estrogen therapy for the past five years. INVESTIGATIONS: Colonoscopy revealed a 2 x 2 cm polyp like structure with central tissue proliferation in the transverse colon. Neither chromoendoscopy with indigocarmine nor multiple biopsies indicated an adenomatous glandular proliferation. Miniendosonography revealed the image of a tumour located in the muscularis propria. DIAGNOSIS AND CLINICAL COURSE: As a malign process could not definitely be excluded, a colon segment resection was carried out by laparoscopy. In the operative specimen there was a 2 x 2 cm large tumour growing under the mucosa. Histologically it was an intramural manifestation of an extragenital endometriosis in the area of the muscularis propria with resulting nodular proliferation of the local muscle system. The ectopic endometrial glands in the area of the endometriosis revealed a complex hyperplasia without atypical features, an image suggesting oestrogen stimulation. CONCLUSION: In many cases the diagnosis of an intestinal endometriosis can not be made through a non-invasive diagnostic method such as colonoscopy with biopsy because of the intramural localisation in the muscularis propria. In order to safely rule out a malignant lesion, in unclear cases a resection should be aimed at.
PMID: 12410434 [PubMed – indexed for MEDLINE]
381: Arch Gynecol Obstet. 2002 Nov;267(1):37-40. Related Articles, Links
Fecundity of infertile women with minimal or mild endometriosis. A clinical study.
Milingos S, Mavrommatis C, Elsheikh A, Kallipolitis G, Loutradis D, Diakomanolis E, Michalas S.
Division of Fertility – Sterility, 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra University Hospital, Athens, 1 A, Pindarou street, 14578 Ekali, Greece.
Despite significant developments in medical and surgical approaches for treating endometriosis, the optimal therapy has yet to be established. The relationship between prevalence of fecundity and stage of endometriosis according to their management was studied. Of 151 consecutive women with laparoscopy-proved endometriosis stage-1 and 2, operative laparoscopy was performed in 49, medical treatment in 59 and expectant management in 43 cases. During a 24-month period the cumulative pregnancy rates were found to be 36.7%, 30.5% and 20.9% respectively. Survival analysis showed that the probability of carrying the pregnancy beyond 20 weeks were 30.6%, 25.4% and 16.2% respectively. Diagnosis and treatment of early endometriosis is beneficial for the infertile women. Laparoscopic surgery seems to be the milestone of treatment in these cases, increasing the fecundity and involving minimal risk.
PMID: 12410372 [PubMed – indexed for MEDLINE]
382: Rev Pneumol Clin. 2002 Sep;58(4 Pt 1):233-6. Related Articles, Links
[A patient with pulmonary endometriosis] [Article in French] L’huillier JP, Salat-Baroux J.
Cabinet de Pneumologie, 112, avenue du Bac, 94210 La Varenne-Saint-Hilaire, France. lhuillier.jean-pierre@wanadoo.fr
A 30-year-old woman consulted for recent repeated episodes of hemoptysis occurring at the onset of the menses a few months after interruption of estrogen-progesterone treatment. This patient’s only surgical history involved uterine curetage. She was a smoker and had cumulated 10 pack-years. Physical examination and chest x-rays were normal. Bronchial endoscopy and cytological examination of the bronchial aspiration were normal. Thoracic CT demonstrated an alveolar image in the right lower lobe. A second CT performed later after resolution of the episode of hemoptysis was normal. Laparoscopy was performed and visualized an endometrial nodule in the pelvis which was removed. The patient’s clinical signs disappeared after treatment with triptoreline. Bronchopulmonary endometriosis is an uncommon condition. The main manifestations are catamenial hemoptysis during the first days of the menses. Chest pain is exceptional. Diagnosis may result from an incidental discovery. A traumatic intervention on the uterus is often found in the patient’s history. The most commonly proposed pathogenic mechanism involves hematogenic migration following a uterine procedure. Imaging does not disclose specific signs and bronchial endoscopy is often normal but may demonstrate a tracheal or bronchial plaque of endometriosis, or exceptionally endometrial tissue in the endoscopy biopsies. LH-RH agonists remain the current treatment.
PMID: 12407288 [PubMed – indexed for MEDLINE]
383: Hum Reprod. 2002 Nov;17(11):2977-80. Related Articles, Links
Endometrioma of uterine serosa in a woman with mosaic Turner’s syndrome receiving hormone replacement therapy: case report.
Tazuke SI, Milki AA.
Department of Gynecology and Obstetrics, Stanford University School of Medicine, Stanford, CA 94305, USA.tazuke@stanford.edu
Endometriosis in Turner’s syndrome patients has only been reported in five isolated cases. We present here an endometrioma on the uterine serosa and pelvic endometriosis arising in a mosaic Turner’s patient receiving hormone replacement therapy (HRT). The 24 year old patient with mosaic Turner’s syndrome [45,X; 46,X pseudo dicentric Y (q11.23)], on cyclic HRT after laparoscopic gonadectomy 5 years previously, was found to have an adnexal mass on routine examination. Given her history, due to the fear of a malignant process arising from a potential gonadal remnant, she underwent a laparoscopy and was found to have a 5 cm serosal endometrioma arising on a stalk from the uterine fundal surface as well as pelvic endometriosis. De-novo endometrioma and endometriosis occurred in a mosaic Turner’s patient after gonadectomy on cyclic HRT. The presentation was also unusual with a pedunculated endometrioma arising from the uterine serosa. Due to the fact that the patient did have cyclic menstrual flow, her endometriosis may have arisen from retrograde menstruation or coelomic metaplasia induced by exogenous hormones.
PMID: 12407060 [PubMed – indexed for MEDLINE]
384: Ir Med J. 2002 Sep;95(8):247. Related Articles, Links
Endometriosis in caesarean section scars.
Eogan M, McKenna P.
Department of Obstetrics, Rotunda Hospital, Dublin. maeveeogan@eircom.net
We report two cases of endometriosis in caesarean section scars. This is a condition, which, in our experience, follows approximately one caesarean section in every thousand. With increasing rates of caesarean section this potentially troublesome condition may be seen more frequently, and we propose a modification in practise to reduce its incidence.
PMID: 12405503 [PubMed – indexed for MEDLINE]
385: J Indian Med Assoc. 2002 Apr;100(4):238-9, 246. Related Articles, Links
Clinicopathological study of hysterectomies.
Shergill SK, Shergill HK, Gupta M, Kaur S.
Department of Gynaecology & Obstetrics, Government Medical College, Amritsar.
A randomised study of 100 cases undergoing hysterectomy in the age group of 20-70 years was carried out and clinicopathological correlation was done. Maximum number of women who underwent hysterectomy were in the age group of 31-50 years. Abnormal menstrual flow was the most common complaint (66%). Clinically main indications for hysterectomy were fibroid (34%), dysfunctional uterine bleeding (DUB) (26%) and uterine prolapse (24%). Abdominal hysterectomy was the procedure of choice in conditions other than uterovaginal prolapse. Out of 34 cases, clinically diagnosed as fibroid uterus, leiomyoma was found on histopathology in 25 cases and adenomyosis in 3 cases. In 3 cases, both leiomyoma and adenomyosis were present. Out of 26 cases, clinically diagnosed as DUB, histopathological examination revealed leiomyoma in 6 cases, adenomyosis in 9 cases, endometrial polyp in 3 cases. Hence, after exclusion of organic pathology, DUB was confirmed in 8 cases.
PMID: 12405332 [PubMed – indexed for MEDLINE]
386: Ann Ital Chir. 2002 May-Jun;73(3):323-9; discussion 329-30. Related Articles, Links
[Intestinal endometriosis. Three new cases and review of the literature] [Article in Italian] Caterino S, Ricca L, Cavallini M, Ciardi A, Camilli A, Ziparo V.
Divisione di IV Patologia Chirurgica, Dipartimento di Chirurgia Pietro Valdoni, Universita degli Studi di Roma La Sapienza.
OBJECTIVE: The study was undertaken to identify some features of the intestinal endometriosis such as symptoms, helpful investigations, pattern of distribution and surgical management. PATIENTS: Three consecutive cases, observed during a sixteen month period, are reported. The most frequent symptoms were chronic pelvic and abdominal pain, dysmenorrhea, alterated bowel habit and menorrhagia. The diagnosis of intestinal endometriosis was incidental in all but one case admitted for an intestinal subocclusive syndrome in patient with a past history of pelvic endometriosis previously documented by laparoscopy. RESULTS: All patients presented a sigmoid localization of endometriosis with different degree of stenosis and underwent sigmoid resection, followed by a resolution of abdominal symptoms. DISCUSSION: Although the exact frequency of intestinal endometriosis is difficult to know because of the lack of specific symptoms and reliable investigations, it has been estimated that implants to the bowel may occur in 3%-37% of women affected by endometriosis. The sigmoid colon is the most common site of localization. The main symptoms are pelvic pain, dysmenorrhea, infertility and diarrhoea or constipation; rarely patients present bowel occlusion due to stenosis (less than 15% of the cases) or cyclic rectal bleeding. CONCLUSION: Generally, intestinal endometriosis is not suspected preoperatively in those patients without a past history of this condition; however an accurate diagnosis can be provided throughout laparoscopy, before open surgery. The hormonal therapy is not successful in alleviating moderate to severe obstructive symptoms. Thus surgery still remains the most effective treatment for advanced intestinal endometriosis.
Publication Types: · Review · Review, Multicase
PMID: 12404901 [PubMed – indexed for MEDLINE]
387: Aust N Z J Obstet Gynaecol. 2002 Oct;42(4):407-8. Related Articles, Links
Small bowel perforation associated with microwave endometrial ablation.
Jamieson R, Hammond I, Maouris P.
Gynaecological Clinical Care Unit, King Edward Memorial Hospital, Perth, Western Australia, Australia.
PMID: 12403291 [PubMed – indexed for MEDLINE]
388: Int Surg. 2002 Jul-Sep;87(3):175-7. Related Articles, Links
Abdominal wall endometrioma after cesarean section: a preventable complication.
Wasfie T, Gomez E, Seon S, Zado B.
McLaren Medical Center, Flint, Michigan, USA.
The occurrence of abdominal wall scar endometrioma after cesarean section has been reported previously in the literature. However, steps to prevent this complication have not been delineated. A study was undertaken of six patients seen at our general surgical clinic, each of whom had presented with a painful mass at a previous cesarean section site. Ages ranged from 20 to 34 years. The duration of their symptoms ranged from 6 to 84 months. All patients underwent surgical exploration and excision of the mass, which was revealed by histology to be endometrioma. It is strongly recommended that, at the conclusion of the procedure of cesarean section, the abdominal wall wound be cleaned thoroughly and irrigated vigorously with high-jet saline solution before closure.
PMID: 12403094 [PubMed – indexed for MEDLINE]
389: Int J Cancer. 2002 Dec 1;102(4):398-406. Related Articles, Links
Possible involvement of hMLH1, p16(INK4a) and PTEN in the malignant transformation of endometriosis.
Martini M, Ciccarone M, Garganese G, Maggiore C, Evangelista A, Rahimi S, Zannoni G, Vittori G, Larocca LM.
Department of Pathology, Universita Cattolica del Sacro Cuore, Rome, Italy.
Endometriosis is a common gynecologic disease, which generally follows a benign course. Notwithstanding, several clinical and histologic studies as well as molecular data show that endometriosis could be a precursor of sporadic endometrioid and clear cell carcinomas at extrauterine loci. Several reports have implicated alterations of the hMLH1 and p16(ink4a) (p16) genes, in particular hypermethylation of the promoter region, and of the PTEN gene, principally genetic mutations, in endometrial and ovarian cancers and have indicated that these alterations are already present in precancer conditions. In this report, we analyzed the methylation status of hMLH1 and p16 and the protein expression of PTEN and hMLH1 in 46 cases of endometriosis stages III and IV to better define the possible involvement of these genes in the malignant transformation of endometriosis. We found abnormal methylation of hMLH1 in 4 of the 46 cases (8.6%). In addition, these cases had no detectable hMLH1 protein expression. Regarding patients with hMLH1 alterations, 2 were classified as stage IV and 2 showed coexistent endometriosis and carcinoma. Only 1 case of endometriosis (2.17%), classified as atypical, showed abnormal methylation of p16. Reduced PTEN protein expression was detected in 7 of 46 cases (15.21%): 5 were clinically classified as stage IV, and the other 2 presented both cancer and hypermethylated hMLH1. Our preliminary study suggests that reduced expression of both hMLH1 and PTEN may be involved in the malignant evolution of endometriosis and should be used as markers of neoplastic transformation in aggressive endometriosis with elevated tumor markers. Copyright 2002 Wiley-Liss, Inc.
PMID: 12402310 [PubMed – indexed for MEDLINE]
390: Curr Opin Obstet Gynecol. 2002 Oct;14(5):467-74. Related Articles, Links
Adolescent endometriosis.
Black AY, Jamieson MA.
Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada.
PURPOSE OF REVIEW: Endometriosis can exist in the adolescent female. It can be a very disruptive disease and cause significant dysfunction at a time in life when self-esteem, school attendance, and school performance are critical to achievement of life goals. Approaches to diagnosis and management in the recent literature are reviewed, focusing on those that apply directly to the adolescent or indirectly, by extrapolation from work done in the adult population. Practical strategies for adolescent patient care are presented. RECENT FINDINGS: Recent research has focused on the efficacy of current treatment modalities and management of potential adverse side effects. Possible etiologies of endometriosis have been proposed, and therapies directed at those causes are being explored. Methods of diagnosis, both invasive and noninvasive, have been studied in order to determine the most effective way of diagnosing the disease. SUMMARY: A better understanding of the etiology of endometriosis would probably assist in determining the most suitable treatment strategies. Future work in adolescent endometriosis should focus on developing safe, minimally invasive, yet definitive options for diagnosis and treatment.
Publication Types: · Review · Review, Tutorial
PMID: 12401973 [PubMed – indexed for MEDLINE]
391: Lancet. 2002 Oct 19;360(9341):1221-2. Related Articles, Links
Erratum in: · Lancet. 2003 Jan 4;361(9351):90..
Peritoneal fluid, endometriosis, and ciliary beat frequency in the human fallopian tube.
Lyons RA, Djahanbakhch O, Saridogan E, Naftalin AA, Mahmood T, Weekes A, Chenoy R.
Academic Department of Obstetrics and Gynaecology, St Bartholomew’s Hospital and The London School of Medicine and Dentistry, London, UK.
Endometriosis and infertility are known to be associated, but it is unclear whether endometriosis causes infertility. We used contrast analogue enhancement to study the effect of peritoneal fluid from women with early stage endometriosis on the ciliary beat frequency of human fallopian tube epithelium. We obtained peritoneal fluid from six women with early stage endometriosis and from six fertile women with no eviden

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