400: Minerva Pediatr. 2002 Dec;54(6):525-38. Related Articles, Links
[Dysmenorrhea, endometriosis and premestrual syndrome] [Article in Italian] Tonini G.
Centro di Endocrinologia Pediatrica-Auxologia, Clinica Pediatrica, IRCCS Burlo Garofolo, Trieste, Italy.
Dysmenorrhea is the most frequent gynaecological problem in adolescent girls (the prevalence is 80-90%). Genetic influence, style of life (diet and physical activity) social, economical and cultural factors can affect symptoms. Prostaglandins and leucotrienes produced by endometrium, abnormal uterine smooth muscle contractility and modifications of the local blood flow are responsible for abdominal pain. Frequently daily activities are negatively affected (missing time at school) dysmenorrhoea can be primary or secondary to anatomical anomalies of internal genitalia or presence of synechie (post surgery or inflammatory pelvic diseases). Therapy may consist of traditional medicine (relaxing techniques such as yoga, agopuncture, mild analgesic drugs or more effective FANS). In case of therapeutical failure, contraceptive and/or GnRH agonists can represent the last choice. Endometriosis is less frequent, etiopatogenesis is not completely understood, but the anatomical lesions consist of an oestrogen-dependent neo-angiogenesis. Oestrogen inhibitors, oral contraceptives or GnRH agonists may be useful in treating this pathology. In case of drug failure surgery is suggested. For the effective diagnosis laparoscopy and biopsy are absolutely necessary. Premenstrual syndrome is cyclical, extremely complex, unusual in adolescent girls, sometimes associated to pre-existent psychic disorders. It can be treated with symptomatic drugs or, more recently, using drugs that alter the levels of serotonin, but their use in the adolescent patient is not yet recommended.
PMID: 12388941 [PubMed – in process]
401: J Am Assoc Gynecol Laparosc. 2002 Nov;9(4):519-24. Related Articles, Links Histologic appearance of endometriosis infiltrating uterosacral ligaments in women with painful symptoms.
Bonte H, Chapron C, Vieira M, Fauconnier A, Barakat H, Fritel X, Vacher-Lavenu MC, Dubuisson JB.
Service de Chirurgie Gynecologique, Clinique Universitaire Baudelocque, Cochin Port-Royal, 123 Boulevard Port-Royal, 75014 Paris, France.
STUDY OBJECTIVE: To describe the histologic appearance of deep endometriosis infiltrating the uterosacral ligaments (USL). DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: One hundred forty-nine women with pain due to endometriosis. INTERVENTION: Resection of one or both USL. MEASUREMENTS AND MAIN RESULTS: One hundred seventy-two USL were examined by histology after unilateral resection in 126 patients (84.6%) and bilateral resection in 23 (15.4%). Two-thirds of women (122, 70.9%) had a classic appearance of endometriosis. Lesions of myoproliferative endometriosis with a histologic appearance of so-called adenomyotic nodules were observed in 25 (14.5%). Associated fibrosis was most frequent in patients with positive compared with negative histology (85, 69.7% vs 18, 36.0%). CONCLUSION: Anatomicopathologic lesions of deep endometriosis infiltrating the USL are heterogeneous. Adenomyotic nodules are not frequently observed.
PMID: 12386367 [PubMed – indexed for MEDLINE]
402: J Soc Gynecol Investig. 2002 Sep-Oct;9(5):313-8. Related Articles, Links Tumor necrosis factor-alpha promotor polymorphisms and endometriosis.
Wieser F, Fabjani G, Tempfer C, Schneeberger C, Zeillinger R, Huber JC, Wenzl R.
Department of Obstetrics and Gynecology, Division of Gynecological Endocrinology and Assisted Reproduction, Vienna, Austria.
To explore whether having the mutant tumor necrosis factor (TNF)2 (G-308*A) and TNFA-A (G-238*A) alleles in the TNF-alpha gene promotor region is higher in women with endometriosis, we determined the respective genotype and allele frequencies in a retrospective case-control study.Polymerase chain reaction was performed to identify the G-308A and G-238A promotor polymorphisms in 92 women with surgically and histologically confirmed endometriosis. A series of 69 healthy women without a history of endometriosis served as clinical controls.The allele frequencies of the TNF2 polymorphism were 0.13 and 0.16 in women with endometriosis and in the control group, respectively, and the frequencies of the TNFA-A polymorphisms in women with endometriosis and in the control group were 0.04 and 0.05, respectively, with no significant difference between the study and control groups. The TNF2 polymorphism was present in the homozygous form (TNF(2/2)) in 4.3% of women with endometriosis and in 2.9% of controls (P=.7). No TNFA-A homozygotes (TNFA(A/A)) were detected.We studied TNF-alpha promotor gene variants among women with endometriosis and found that having the G-308A TNF-alpha and the G-238A TNF-alpha polymorphism was not associated with endometriosis in a white population.
PMID: 12383917 [PubMed – indexed for MEDLINE]
403: Obstet Gynecol. 2002 Oct;100(4):788-95. Related Articles, Links Ovarian and extraovarian endometriosis-associated cancer.
Modesitt SC, Tortolero-Luna G, Robinson JB, Gershenson DM, Wolf JK.
Department of Gynecologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. smodesit@mdanderson.org
OBJECTIVE: To determine clinical characteristics of women with endometriosis-associated intraperitoneal cancers, to assess differences based on the relationship of the cancer to the endometriosis, and to assess factors associated with survival. METHODS: A search of medical records at The University of Texas M. D. Anderson Cancer Center from 1970 to 1999 identified patients who had synchronous endometriosis and intraperitoneal cancer. Demographic and clinicopathologic characteristics were evaluated for differences based on the relationship of the cancer to the endometriosis and for correlation with survival. RESULTS: One hundred fifteen patients were identified: 25 patients with ovarian cancer arising in endometriosis, 21 with an extraovarian cancer arising in endometriosis, 33 patients with endometriosis and ovarian cancer in the same location but without a definite transition point, and 36 patients with ovarian cancer and incidental endometriosis. Women with extraovarian cancers arising in endometriosis were more likely to be postmenopausal (P <.001) and use hormone replacement (P <.001). The median age was 47 years, the most common histological tumor types were clear cell and endometrioid (23% each), and the most common stage was stage I (31%). The median survival was 35 months. Univariate survival analysis revealed that gravidity (P <.038), grade (P <.001), stage (P <.001), histology (P <.01), and type of chemotherapy (P <.011) correlated with survival. Multivariable analysis revealed that stage and gravidity independently predicted survival. CONCLUSION: Women with endometriosis-associated cancers are typically premenopausal, have a high incidence of endometrioid and clear cell histologies, and have early stage disease. Stage and gravidity independently predicted survival.
PMID: 12383550 [PubMed – indexed for MEDLINE]
404: Histopathology. 2002 Oct;41(4):313-21. Related Articles, Links Immunohistochemical staining with MIB1, bcl2 and p16 assists in the distinction of cervical glandular intraepithelial neoplasia from tubo-endometrial metaplasia, endometriosis and microglandular hyperplasia.
Cameron RI, Maxwell P, Jenkins D, McCluggage WG.
Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northen Ireland.
AIMS: Preinvasive endocervical glandular lesions, termed cervical glandular intraepithelial neoplasia, are increasing in incidence. The distinction of cervical glandular intraepithelial neoplasia from benign mimics, especially tubo-endometrial metaplasia, endometriosis and microglandular hyperplasia, can be difficult. This study investigates the value of immunohistochemical staining with MIB1, bcl2 and p16 in the distinction of cervical glandular intraepithelial neoplasia from these benign mimics. METHODS AND RESULTS: Immunohistochemical staining using the monoclonal antibodies MIB1, bcl2 and p16 was performed on cases of cervical glandular intraepithelial neoplasia (n = 21), tubo-endometrial metaplasia (n = 13), endometriosis (n = 7) and microglandular hyperplasia (n = 14). With tubo-endometrial metaplasia and microglandular hyperplasia staining with MIB1 was either negative or involved <10% of cells, while with cervical glandular intraepithelial neoplasia the majority of cases (86%) exhibited >10% positive cells. Two cases of endometriosis exhibited a MIB1 index of 10-30% while in the other cases <10% cells stained. With bcl2 the cells of microglandular hyperplasia were negative although there was staining of associated reserve cells in 43% of cases. All cases of tubo-endometrial metaplasia except one and all cases of endometriosis stained diffusely positive with bcl2. Cases of cervical glandular intraepithelial neoplasia were negative or exhibited focal staining. With p16 all cases of cervical glandular intraepithelial neoplasia exhibited diffuse strong positivity, generally involving 100% of cells, while all cases of microglandular hyperplasia were negative. Sixty-two percent of cases of tubo-endometrial metaplasia showed focal positivity, the remainder being negative. Cases of tubo-endometrial metaplasia were never diffusely positive with p16. In three cases of endometriosis there was staining of >50% of cells while the other cases were either focally positive or negative. CONCLUSIONS: A panel of antibodies, comprising MIB1, bcl2 and p16, is a useful adjunct to histology in distinguishing cervical glandular intraepithelial neoplasia from tubo-endometrial metaplasia, endometriosis and microglandular hyperplasia. Cases of cervical glandular intraepithelial neoplasia are diffusely positive for p16 and generally exhibit a high proliferation index with MIB1, while bcl2 is negative or, at most, focally positive. Tubo-endometrial metaplasia and endometriosis are characterized by strong diffuse positivity with bcl2 and a low proliferation index with MIB1 (although occasional cases of endometriosis show moderate proliferative activity). p16 is negative or exhibits focal positivity in tubo-endometrial metaplasia but in endometriosis there may be quite widespread positivity. Microglandular hyperplasia shows a low proliferation index with MIB1 and is negative for bcl2 and p16.
PMID: 12383213 [PubMed – indexed for MEDLINE]
405: J Nippon Med Sch. 2002 Oct;69(5):445-50. Related Articles, Links Assessment of fallopian tube cytology for the diagnosis of endometriosis and hydrosalpinx.
Matsushima T, Kaseki H, Ishihara K, Araki T.
Department of Obstetrics and Gynecology, Nippon Medical School, Japan. matsushi@nms.ac.jp
Fallopian tube cytology has been used as a useful tool in the diagnosis of infertility. In this study, we developed an intra-fallopian tube cell collection method with the simultaneous use of a laparoscope and hysteroscope, and examined its safety and applicability for the diagnoses of endometriosis and hydrosalpinx. Fallopian tube cells were collected at laparoscopy and hysteroscopy from 20 volunteer patients who visited the infertility clinic. There were 10 patients with normal fallopian tubes (Group 1), 7 with pelvic endometriosis (Group 2), and 3 with hydrosalpinx (Group 3). The collected cells were fixed onto glass slides using an auto-smear method, stained by the Papanicolaou method and subjected to detailed cytomorphological examinations. In each case, an adequate number of cells with well-preserved morphology for a reliable evaluation was obtained. Cells from normal fallopian tubes were mainly fallopian tube epithelial cells including ciliated columnar cells and secretory cells. The number of inflammatory cells was quite low. A characteristic feature in cases with pelvic endometriosis was the presence of a large number of macrophages, some of which showed hemosiderin phagocytosis. In contrast, cases with hydrosalpinx showed an extremely low cellular component. No complications were found in any of the patients. Our study indicates that the present intra-fallopian tube cell collection method using a laparoscope and hysteroscope is a reliable and safe method that can be applied to the diagnosis of endometriosis, hydrosalpinx, as well as pelvic infertility.
PMID: 12382004 [PubMed – indexed for MEDLINE]
406: J Gynecol Obstet Biol Reprod (Paris). 2002 Sep;31(5):417-39. Related Articles, Links [MRI in gynecology] [Article in French] Robert Y, Launay S, Mestdagh P, Moisan S, Boyer C, Rocourt N, Cosson M.
Service de Radiologie et d’Imagerie Medicale, Hopital Jeanne-de-Flandre, CHRU Lille, rue E. Avinee, 59037 Lille Cedex. yrobert@chru-lille.fr
OBJECTIVES: To review the complementary role and contribution of magnetic resonance imaging (MRI) in gynecology diseases. RESULTS: Tissue characterization can be obtained with T2, T1 weighted images before and after contrast medium injection and T1 fat sat sequences. Localization of the lesion and relationships with adjacent structures are facilitated by multiplanar imaging. Endometrium and ovarian follicles display high signal intensity, visualizing the normal uterine and ovarian components. The relative high signal intensity of uterine tumors facilitates evaluation of extension. Uterine leiomyoma diagnosis is supported by its low signal intensity, allowing localization, size, and number assessment, and to distinguish adenomyoma. In doubtful malformation cases, MRI may be contributive. Ovarian mass characterization can be done with MRI, particularly for dermoid cyst and endometrioma. In this case, deep endometriosis can be associated and be extensive. Recent technical advances enable fast imaging, which can be useful for pelvic floor assessment with dynamic evaluation. CONCLUSION: MRI is becoming the complementary reference imaging tool for us. Its increasing indications are: gynecologic cancer, pelvis endometriosis, pelvis floor, indeterminate pelvis mass and fibroleiomyoma.
Publication Types: · Review · Review, Tutorial
PMID: 12379827 [PubMed – indexed for MEDLINE]
407: Trop Anim Health Prod. 2002 Sep;34(5):359-81. Related Articles, Links
Listeric infections in humans and animals in the Indian subcontinent: a review.
Malik SV, Barbuddhe SB, Chaudhari SP.
Division of Veterinary Public Health, Indian Veterinary Research Institute, Izatnagar 243 122, India.
Listeriosis is an important bacterial zoonosis caused by the intracellular pathogen Listeria monocytogenes. The disease has been reported in animals from the Indian subcontinent, usually in the form of sporadic cases but occasionally as outbreaks. Cases of listeriosis arise mainly from the ingestion of contaminated food. Listeriosis has been reported to cause encephalitis, abortion, mastitis, repeat breeding and endometriosis in animals. Listeric infections occur in children and women with a poor obstetric history. The epidemiological aspects and pathogenesis of listeriosis in animals and humans are not yet fully understood. This review offers comprehensive information on experimental studies and field cases in animals and on cases of human listeriosis. There are also sections on isolation from foods, diagnosis and treatment in humans and animals.
Publication Types: · Review · Review, Tutorial
PMID: 12379055 [PubMed – indexed for MEDLINE]
408: Fertil Steril. 2002 Oct;78(4):886; author reply 886-7. Related Articles, Links
Comment on: · Fertil Steril. 2002 Jan;77(1):52-61.Important effects of cyproterone acetate on endometriosis?
Moran C.
Publication Types: · Comment · Letter
PMID: 12372480 [PubMed – indexed for MEDLINE]
409: Fertil Steril. 2002 Oct;78(4):879-81. Related Articles, Links Massive and acute hemoperitoneum due to rupture of the uterine artery by erosion from an endometriotic lesion.
Janicki TI, David LJ, Skaf R.
University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA. tij@att.net
OBJECTIVE: To report a case of acute hemoperitoneum due to erosion of the uterine artery by an endometriotic lesion of the left ovary. DESIGN: Case report and review of literature. SETTING: University medical center. PATIENT(S): A 39-year-old nulliparous woman with stage 3 endometriosis. INTERVENTION(S): Operative laparoscopy followed by laparotomy, oophorectomy, and ligation of the bleeding uterine artery. RESULT(S): Patient is fully recovered and is attempting to conceive. CONCLUSION(S): An endometriotic lesion eroded the wall of the uterine artery, causing massive, acute hemoperitoneum. Such an event may be overlooked during laparotomy and attributed to the trauma of surgery.
Publication Types: · Review · Review of Reported Cases
PMID: 12372473 [PubMed – indexed for MEDLINE]
410: Fertil Steril. 2002 Oct;78(4):876-8. Related Articles, Links Laparoscopic ovarian cystectomy of endometriomas does not affect the ovarian response to gonadotropin stimulation.
Marconi G, Vilela M, Quintana R, Sueldo C.
Instituto de Ginecologia y Fertilidad, Buenos Aires, Argentina. gmarconi@fibertel.com.ar
OBJECTIVE: To evaluate the ovarian response cycles of IVF-ET in patients who previously underwent laparoscopic cystectomy for endometriomas. DESIGN: Retrospective study with prospective selection of participants and controls. SETTING: Instituto de Ginecologia y Fertilidad Buenos Aires, Argentina. PATIENT(S): Thirty-nine patients underwent an operation for ovarian endometriomas by atraumatic removal of the pseudocapsule with minimal bipolar cauterization of small bleeders and an IVF-ET cycle (group A) and 39 control patients of similar age underwent an IVF-ET cycle for tubal factor infertility (group B). INTERVENTION(S): Laparoscopic endometrioma cystectomy, IVF-ET cycle. MAIN OUTCOME MEASURE(S): E(2) levels, number of gonadotropin ampoules, follicles, oocytes retrieved, number and quality of embryos transferred, and clinical pregnancy rate. RESULT(S): There were no differences in all the parameters studied (E(2) levels, number of follicles, oocytes retrieved, number and quality of embryos transferred, and clinical pregnancy rate) except for the number of gonadotropin ampoules needed for ovarian hyperstimulation, which was significantly higher in group A than in group B. CONCLUSION(S): Our results indicate that laparoscopic cystectomy for endometriomas is an appropriate treatment since it did not negatively affect the ovarian response for IVF-ET.
PMID: 12372472 [PubMed – indexed for MEDLINE]
411: Fertil Steril. 2002 Oct;78(4):872-5. Related Articles, Links Laparoscopic management of 15 patients with infiltrating endometriosis of the bladder and a case of primary intravesical endometrioid adenosarcoma.
Nezhat CH, Malik S, Osias J, Nezhat F, Nezhat C.
Center for Special Pelvic Surgery, Atlanta, Georgia, USA. info@nezhat.com
OBJECTIVE: To report laparoscopic management of 15 patients with infiltrative bladder wall endometriosis and to report a case of endometrioid adenosarcoma. DESIGN: Prospective chart review. SETTING: Referral center for endometriosis. PATIENT(S): Fifteen women with infiltrating endometriosis of the bladder. INTERVENTION(S): Laparoscopic segmental cystectomy and pathologic review of endometriotic bladder nodules in 15 patients. MAIN OUTCOME MEASURE(S): Location and characteristics of endometriotic bladder nodules. RESULT(S): Laparoscopic and cystoscopic evaluation confirmed that the endometriotic lesions were penetrating through the bladder wall. In 8 patients, the lesions were located in the dome of the bladder. In the remaining 7, the lesions were in the posterior wall, above the trigone. It was possible to treat all the lesions by performing a laparoscopic partial cystectomy. No intraoperative complications occurred. Deeply infiltrating endometriosis was confirmed on histologic evaluation in 14 cases. One patient was diagnosed with endometriosis on frozen section, but the final pathology revealed an adenosarcoma of the bladder. CONCLUSION(S): Surgical excision of deeply infiltrating endometriosis of the bladder wall can be performed laparoscopically and offers the benefit of a definitive pathologic diagnosis to rule out an occult malignancy.
PMID: 12372471 [PubMed – indexed for MEDLINE]
412: Fertil Steril. 2002 Oct;78(4):865-71. Related Articles, Links Influence of severe endometriosis on gene expression of vascular endothelial growth factor and interleukin-6 in granulosa cells from patients undergoing controlled ovarian hyperstimulation for in vitro fertilization-embryo transfer.
Yamashita Y, Ueda M, Takehara M, Yamashita H, Suzuki Y, Hung YC, Terai Y, Ueki M.
Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan. gyn028@poh.osaka-med.ac.jp
OBJECTIVE: To evaluate how endometriosis affects expression of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) in granulosa cells. DESIGN: Prospective study. SETTING: IVF-ET program at Osaka Medical College. PATIENT(S): Seventeen patients with revised American Fertility Society stage IV endometriosis and 17 patients with tubal infertility and no endometriosis. INTERVENTION(S): Granulosa cells obtained at oocyte retrieval were examined for VEGF and IL-6 gene expression. MAIN OUTCOME MEASURE(S): Serum E(2) and P levels at hCG administration, number of oocytes, fertilization rate, high-quality embryo rate, and pregnancy rate, and expression of VEGF and IL-6 genes. RESULT(S): Total hMG and FSH levels were statistically significantly higher in patients with endometriosis; however, the number of retrieved oocytes and the fertilization rate were lower compared with patients with tubal infertility. Serum E(2) levels and expression of VEGF in patients with tubal infertility were statistically significantly higher than those in patients with endometriosis. Interleukin-6 gene expression did not differ between the groups. CONCLUSION(S): In severe endometriosis, lower VEGF gene expression in granulosa cells may adversely affect oocyte development and maturation.
PMID: 12372470 [PubMed – indexed for MEDLINE]
413: Fertil Steril. 2002 Oct;78(4):860-4. Related Articles, Links Alterations in expression of endometrial endothelial nitric oxide synthase and alpha(v)beta(3) integrin in women with endometriosis.
Khorram O, Lessey BA.
Department of Obstetrics and Gynecology, University of Wisconsin, Wisconsin, Madison, USA. okhorram@obgyn.humc.edu
OBJECTIVE: To determine the expression of endometrial endothelial nitric oxide synthase (eNOS) protein and alpha(v)beta(3) integrin in patients with and without endometriosis. DESIGN: Case-control cohort study. SETTING: University-based tertiary care center. PATIENT(S): Endometrial biopsy samples were obtained from 9 fertile women with regular cycles and 30 infertile women with varying severity of endometriosis. Peritoneal fluid levels of nitric oxide were determined in 13 infertile women with a normal pelvis and 12 infertile women with endometriosis. MAIN OUTCOME MEASURE(S): Expression of eNOS and alpha(v)beta(3) integrin protein in the endometrium and peritoneal fluid levels of nitric oxide. RESULTS: In patients with endometriosis, expression of eNOS was significantly increased in the glandular and luminal epithelium, with no significant changes in the stroma. Peritoneal fluid levels of nitric oxide were unchanged, and expression of alpha(v)beta(3) integrin expression in glandular and luminal epithelium was significantly decreased compared with controls. A significant negative correlation was observed between luminal expression of eNOS and alpha(v)beta(3) integrin and between glandular expression of eNOS and luminal expression of alpha(v)beta(3) integrin. CONCLUSION(S): The nitric oxide pathway may play a role in the pathogenesis of endometriosis.
PMID: 12372469 [PubMed – indexed for MEDLINE]
414: Fertil Steril. 2002 Oct;78(4):855-9. Related Articles, Links Elevated soluble Fas ligand levels may suggest a role for apoptosis in women with endometriosis.
Garcia-Velasco JA, Mulayim N, Kayisli UA, Arici A.
IVI-Madrid, Madrid, Spain. jgvelasco@ivi.es
OBJECTIVE: To evaluate soluble Fas ligand concentrations in serum and peritoneal fluid from women with endometriosis and from fertile controls without endometriosis, and to study levels of soluble Fas ligand in conditioned media of cultured endometrial stromal cells. DESIGN: Prospective, experimental trial. SETTING: Two academic IVF centers. PATIENT(S): Twenty-nine fertile women without endometriosis and 57 infertile women with endometriosis (32 with stage I or II disease and 25 with stage III or IV disease). MAIN OUTCOME MEASURE(S): Enzyme-linked immunosorbent assay was used to measure soluble Fas ligand concentrations in paired samples of serum and peritoneal fluid from women with and without endometriosis. Concentrations were also measured in conditioned media of cultured endometrial stromal cells at basal conditions and after stimulation with interleukin-8 (0.001-10 ng/mL) and tumor necrosis factor-alpha (1-10 ng/mL). RESULT(S): Compared with fertile controls and women with early-stage of endometriosis, women with moderate to severe endometriosis had elevated serum (87.2 +/- 6.4, 88.2 +/- 6.9, and 162.3 +/- 7.8 pg/mL, respectively) and peritoneal fluid (81.0 +/- 6.0, 80.5 +/- 6.8, and 166.2 +/- 10.3 pg/mL, respectively) concentrations of soluble Fas ligand. Serum levels of soluble Fas ligand positively correlated with levels in peritoneal fluid. Comparison of patients in the same menstrual cycle in each group revealed that increased levels of soluble Fas ligand in patients with advanced endometriosis were not attributable to the difference in cycle phases. Soluble Fas ligand was not detected in conditioned media of endometrial stromal cells under baseline conditions or after stimulation. CONCLUSION(S): Serum and peritoneal fluid of women with moderate to severe endometriosis contain elevated concentrations of soluble Fas ligand compared to women with minimal or mild endometriosis and women without endometriosis. These findings suggest a role for apoptotic dysregulation in the pathophysiology of endometriosis.
PMID: 12372468 [PubMed – indexed for MEDLINE]
415: Fertil Steril. 2002 Oct;78(4):849-54. Related Articles, Links Altered expression of a cell-cycle suppressor gene, Tob-1, in endometriotic cells by cDNA array analyses.
Lebovic DI, Baldocchi RA, Mueller MD, Taylor RN.
Reproductive Endocrinology Division, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
OBJECTIVE: Interleukin (IL)-1beta, a product of activated peritoneal macrophages, is a central cytokine coordinating neovascularization and monocyte chemotaxis in endometriotic implants. To evaluate the effects of this cytokine on normal endometrial stromal cells and endometriotic stromal cells we performed cDNA expression array analyses before and after exposure to IL-1beta.DESIGN: Nested case-control study of women with and without laparoscopic evidence of endometriosis. SETTING: Reproductive endocrinology clinic at a university hospital. PATIENT(S): Endometriosis and normal endometrial biopsies from eight patients were used to prepare stromal cell cultures from which mRNA was extracted. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Commercially available expression arrays (Atlas Human cDNA Expression Array, Clontech, representing 597 individual genes) were used to screen for mRNAs whose expression was affected by 12 hours of exposure to IL-1beta (10 ng/mL). Northern blotting and subsequent quantitative densitometric evaluation was done to confirm steady-state levels of Tob-1 mRNA transcripts. RESULT(S): Array analyses revealed a cell-cycle regulatory gene, Tob-1, which was differentially expressed by the two cell types after incubation with IL-1beta. Tob-1 was reduced 48% in endometriotic stromal cells exposed to IL-1beta, but there was only a 16% reduction in normal endometrial stromal cells. Replicate Northern analyses (n = 4) showed that exposure to IL-1beta for 12 hours resulted in a 25% +/- 5% diminution of Tob-1 mRNA in endometriotic stromal cells. In contrast, no significant decrease (<3%) was observed in IL-1beta exposed normal endometrial stromal cells. CONCLUSION(S): Tob-1, a cell-cycle inhibitor gene is differentially responsive to IL-1beta in endometriotic stromal cells compared to normal endometrial stromal cells. IL-1beta down-regulated Tob-1 in endometriotic stromal cells, but had no significant effect on normal endometrial stromal cells. Our results suggest that IL-1beta promotes growth of endometriotic lesions through inhibition of Tob-1. These findings are the first to associate IL-1beta with an alteration of cell-cycle gene expression in cells derived from endometriotic implants.
PMID: 12372467 [PubMed – indexed for MEDLINE]
416: Fertil Steril. 2002 Oct;78(4):843-8. Related Articles, Links Induction of monocyte chemotactic protein-1 in peritoneal mesothelial and endometrial cells by oxidized low-density lipoprotein and peritoneal fluid from women with endometriosis.
Rong R, Ramachandran S, Santanam N, Murphy AA, Parthasarathy S.
Emory Center for Advanced Research on Women’s Health, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
OBJECTIVE: To elucidate the effect of oxidized low-density lipoprotein (LDL) and peritoneal fluid of women with endometriosis on monocyte chemotactic protein-1 (MCP-1) production by peritoneal mesothelial cells and endometrial cells.DESIGN: In vitro study. SETTING: University medical center. PATIENT(S): Five women undergoing surgery for pelvic pain, infertility, or endometriosis; five women without endometriosis who were undergoing tubal ligation were the controls. INTERVENTION(S): Mesothelial cells and endometrial cells in culture were treated with oxidized LDL and peritoneal fluid from control and endometriosis patients, then MCP-1 levels were measured. MAIN OUTCOME MEASURE(S): ELISA was used to measure MCP-1 in the culture supernatants exposed to oxidized LDL and peritoneal fluid from control and endometriosis patients. Cellular MCP-1 messenger RNA expression was evaluated by reverse transcription-polymerase chain reaction (RT-PCR) assay. RESULT(S): Treatment with oxidized LDL caused an increase in accumulation of immunoreactive MCP-1 in the medium of cultured mesothelial and endometrial cells (primary endometrial stromal cells and endometrial cell line EM42). The mesothelial cells secreted more MCP-1 than did endometrial cells under the culture condition. The EM42 cells cultured in the presence of peritoneal fluid from endometriosis patients secreted more MCP-1 than those cultured with peritoneal fluid from normal women. However, no differences were found in MCP-1 levels in the supernatant of endometrial stromal cells cultured with peritoneal fluid. CONCLUSION(S): This is the first report of MCP-1 expression in mesothelial cells induced by oxidized LDL, and provides direct evidence of inflammatory action of peritoneal fluid of women with endometriosis.
PMID: 12372466 [PubMed – indexed for MEDLINE]
417: Fertil Steril. 2002 Oct;78(4):836-42. Related Articles, Links Soluble interleukin-1 receptor type II blocks monocyte chemotactic protein-1 secretion by U937 cells in response to peripheral blood serum of women with endometriosis.
Kharfi A, Akoum A.
Departement d’Obstetrique-Gynecologie, Faculte de Medecine, Universite Laval, Quebec, Quebec, Canada.
OBJECTIVE: To assess the ability of peripheral blood serum from women with endometriosis to induce monocyte chemotactic protein-1 (MCP-1) secretion by monocytes and the putative role of the interleukin-1 (IL-1) system in endometriosis-associated monocyte activation. DESIGN: Cultures of U937 monocytic cells exposed to serum from normal women (control group) or women with endometriosis. SETTING: Gynecology clinic and human reproduction research laboratory. PATIENT(S): Seventy-nine women with endometriosis and 38 control women with no evidence of endometriosis at laparoscopy. INTERVENTION(S): Peripheral blood obtained a few days before laparoscopy. MAIN OUTCOME MEASURE(S): MCP-1 secretion in the culture medium and serum concentrations of soluble IL-1 receptor type II (sIL-1RII), IL-1beta, and IL-1alpha by ELISA or by enzyme immunometric assay. RESULT(S): Serum concentrations of sIL-1RII were significantly lower in women with stage I-II endometriosis than in control women, whereas serum concentrations of IL-1beta and IL-1alpha were comparable between the two groups. The serum of women with endometriosis induced higher secretion of MCP-1 by U937 cells than that of control women, particularly in the initial stages of endometriosis (stages I-II), and recombinant IL-1RII (rIL-1RII) significantly blocked that secretion. CONCLUSION(S): These findings point toward a deficiency in the mechanisms involved in the down-regulation of IL-1 actions at the systemic level and reveal sIL-1RII as a key factor involved in that process.
PMID: 12372465 [PubMed – indexed for MEDLINE]
418: Fertil Steril. 2002 Oct;78(4):830-5. Related Articles, Links Relationship between apoptosis and the number of macrophages in eutopic endometrium from women with and without endometriosis.
Braun DP, Ding J, Shen J, Rana N, Fernandez BB, Dmowski WP.
Institute for the Study and Treatment of Endometriosis, and Rush Medical College, Chicago, Illinois, USA. dbraun@mco.edu
OBJECTIVE: To investigate the relationship between apoptotic cells and macrophages in the eutopic endometrium of women with and without endometriosis. DESIGN: Retrospective analysis of archival uterine endometrial biopsy specimens. SETTING: Institute for the Study and Treatment of Endometriosis, and university-based pathology and research laboratories. PATIENT(S): Fifty-one women with endometriosis and 24 healthy control subjects without endometriosis. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The number of TUNEL+ (terminal deoxynucleotide transferase [TdT]-mediated deoxyuridine triphospate [dUTP] nick end-labeling-positive) (apoptotic) cells and CD68+ (CD68 positive) (macrophages). RESULT(S): Apoptotic cells and macrophage numbers were positively correlated in the eutopic endometrium of women with and without endometriosis. However, the number of apoptotic cells and the macrophage content in the endometrium of women with endometriosis was significantly reduced compared with that of healthy control subjects without endometriosis. Differences between apoptosis and macrophage numbers between the two populations were observed predominantly during the early proliferative phase of the menstrual cycle. CONCLUSION(S): The reduction in apoptosis described for endometrial cells in women with endometriosis may be related to reduced macrophage trafficking into the eutopic endomtrium during the early-proliferative phase of the menstrual cycle.
PMID: 12372464 [PubMed – indexed for MEDLINE]
419: Fertil Steril. 2002 Oct;78(4):825-9. Related Articles, Links Aromatase P450 messenger RNA expression in eutopic endometrium is not a specific marker for pelvic endometriosis.
Dheenadayalu K, Mak I, Gordts S, Campo R, Higham J, Puttemans P, White J, Christian M, Fusi L, Brosens J.
Department of Obstetrics and Gynaecology, Ealing Hospital, London, United Kingdom.
OBJECTIVE: To determine whether expression of aromatase P450 mRNA in eutopic endometrium is predictive of the presence of pelvic endometriosis. DESIGN: A prospective, multicenter, observational study. SETTING: Four tertiary centers for reproductive medicine. PATIENT(S): Sixty subjects of reproductive age undergoing laparoscopy for subfertility exploration, pain assessment, or sterilization. INTERVENTION(S): Endometrial biopsy at time of laparoscopy. MAIN OUTCOME MEASURE(S): The expression of aromatase P450 mRNA in endometrial specimens was determined by single-tube reverse transcription-polymerase chain reaction (RT-PCR). Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA was amplified in parallel to exclude amplification failure. RESULT(S): The RT-PCR amplification was successful in 56 of the 60 biopsies (93%). Pelvic endometriosis was diagnosed in 34 patients (61%) and was strongly associated with aromatase P450 mRNA expression in eutopic endometrium. As a diagnostic marker for endometriosis, aromatase P450 mRNA expression yielded a sensitivity of 82%, a specificity of 59%, a positive predictive value of 76%, and a negative predictive value of 67%. If additional uterine pathology was taken in account, the sensitivity increased to 84%, the specificity to 72%, the positive predictive value to 87%, but the negative predictive value remained unchanged (67%). CONCLUSION(S): Although endometrial aromatase P450 gene expression is highly predictive of the presence of pelvic disease, the relative high incidence of false-negative results and lack of specificity is likely to impair clinical application.
PMID: 12372463 [PubMed – indexed for MEDLINE]
420: Fertil Steril. 2002 Oct;78(4):820-4. Related Articles, Links Comparative immunohistochemical studies of endometriosis lesions and endometriotic cysts.
Nezhat FR, Kalir T.
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, The Mount Sinai School of Medicine, New York, NY 10029, USA. farr.nezhat@mssm.edu
OBJECTIVE: To compare immunohistochemical staining patterns in noncystic and cystic endometriosis lesions. DESIGN: Experimental. SETTING: Archived pathology material in an academic research environment. PATIENT(S): Endometriosis tissues from the pathology archives including slide tissue sections and blocks. INTERVENTION(S): None; this was a retrospective study. MAIN OUTCOME MEASURE(S): Immunohistochemical staining of the tissues was performed using anti-bcl-2, anti-p53, anti-matrix metalloproteinase IX, and anti-collagen VI antibodies. Staining was qualitatively assessed in terms of extent and intensity. RESULT(S): p53 showed no staining in both groups. Anti-bcl-2 stained 100% (30/30) of endometriosis lesions compared with only 23% (7/30) of endometriotic cysts (P<.0001), and anti-matrix metalloproteinase IX stained 85% (23/27) of endometriosis lesions and only 39% (14/36) of endometriotic cysts (P=.0003). Anti-collagen VI, however, stained only 6% (2/35) of endometriosis lesions and 75% (21/28) of endometriotic cysts (P<.0001). CONCLUSION(S): Compared with endometriosis lesions, endometriotic cysts display different expression of proteins with relative overexpression of collagen VI and underexpression of bcl-2 and metalloproteinase IX. This report is the first comparative immunohistochemical study showing these differences.
PMID: 12372462 [PubMed – indexed for MEDLINE]
421: Fertil Steril. 2002 Oct;78(4):810-9. Related Articles, Links Endometriotic haptoglobin binds to peritoneal macrophages and alters their function in women with endometriosis.
Sharpe-Timms KL, Zimmer RL, Ricke EA, Piva M, Horowitz GM.
Department of Obstetrics and Gynecology, University of Missouri-Columbia, Columbia, Missouri 65212, USA. timmsk@health.missouri.edu
OBJECTIVE: To evaluate the effects of endometriotic haptoglobin on peritoneal macrophage function. DESIGN: Prospective laboratory study. SETTING: School of medicine. PATIENT(S): Twenty-three women with and without endometriosis. INTERVENTION(S): Peritoneal macrophages cultured without or with haptoglobin. MAIN OUTCOME MEASURE(S): Peritoneal macrophage haptoglobin immunoreactivity, adhesion, and interleukin-6 (IL-6) production. RESULT(S): In vivo, significantly more peritoneal macrophages from women with endometriosis bound haptoglobin and exhibited reduced adhesion compared to women without endometriosis. In vitro, haptoglobin treatment significantly decreased peritoneal macrophage adherence only in women without endometriosis; this effect was not seen in women with endometriosis, probably owing to in vivo haptoglobin saturation. Conversely, haptoglobin treatment robustly increased IL-6 production only by macrophages from women with endometriosis, suggesting differential immune response in these women. CONCLUSION(S): Endometriotic lesions synthesize and secrete a unique form of haptoglobin (endometriosis protein-I) that is up-regulated by IL-6. This study shows that haptoglobin adheres to peritoneal macrophages; decreases adhesion, which may influence phagocytic function; and up-regulates IL-6 production. Hence, a feed-forward loop is proposed whereby endometriotic lesion haptoglobin decreases macrophage phagocytic function while increasing IL-6 production, which in turn increases endometriotic haptoglobin and promotes establishment of endometriosis.
PMID: 12372461 [PubMed – indexed for MEDLINE]
422: Fertil Steril. 2002 Oct;78(4):804-9. Related Articles, Links Involvement of catalase in the endometrium of patients with endometriosis and adenomyosis.
Ota H, Igarashi S, Sato N, Tanaka H, Tanaka T.
Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita-city, Akita-ken, Japan. otah@obgyn.med.akita-u.ac.jp
OBJECTIVE: To determine the distribution of catalase in eutopic and ectopic endometria in patients with endometriosis or adenomyosis. DESIGN: Retrospective randomized study. SETTING: Department of obstetrics and gynecology in a university hospital. PATIENT(S): Thirty-three patients with endometriosis, 36 with adenomyosis, and 47 fertile controls (total, 116 women). MAIN OUTCOME MEASURE(S): Semiquantitative immunostaining of endometrial cells obtained by biopsy sampling, followed by calculation of an evaluation nomogram score. RESULT(S): The score of catalase in the glandular epithelium of controls group fluctuated during the menstrual cycle; it was lowest in the early proliferative phase and peaked in the late secretory phase. In patients with endometriosis, catalase scores did not fluctuate during the cycle, and scores were high compared with controls throughout the menstrual cycle. Catalase scores did not vary in patients with adenomyosis, and scores in this group were consistently higher than those in patients with endometriosis throughout the cycle. CONCLUSION(S): Abnormal expression of catalase in the eutopic and ectopic endometrium strongly suggests pathologic involvement of free radicals in endometriosis and adenomyosis.
PMID: 12372460 [PubMed – indexed for MEDLINE]
423: Fertil Steril. 2002 Oct;78(4):787-95. Related Articles, Links Matrix metalloproteinase-2, membranous type 1 matrix metalloproteinase, and tissue inhibitor of metalloproteinase-2 expression in ectopic and eutopic endometrium.
Chung HW, Lee JY, Moon HS, Hur SE, Park MH, Wen Y, Polan ML.
Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea. hyewon@mm.ewha.ac.kr
OBJECTIVE: To investigate expression of matrix metalloproteinase-2 (MMP-2), membranous type 1 matrix metalloproteinase (MT1-MMP), and tissue inhibitor of metalloproteinase-2 (TIMP-2) in ectopic and eutopic endometrium from women with and without endometriosis throughout the menstrual cycle. DESIGN: Molecular studies in human tissue. SETTING: Reproductive immunology laboratory of a university medical center. PATIENT(S): Fifty-three premenopausal woman (23 with endometriosis and 30 without endometriosis) undergoing laparoscopic surgery. Endometrium and ectopic endometriosis tissue were obtained at the time of surgery. MAIN OUTCOME MEASURE(S): Messenger RNA and protein expression from eutopic and ectopic endometrium was analyzed by using quantitative competitive polymerase chain reaction, zymography, and Western blot assay. RESULT(S): Uterine endometrium from women with endometriosis expressed higher levels of MMP-2 and MT1-MMP and lower levels of TIMP-2 than did endometrium from normal women. CONCLUSION(S): Eutopic endometrium from patients with endometriosis may be more invasive and prone to peritoneal implantation because of greater expression of MMP-2 and MT1-MMP and lower expression of TIMP-2 messenger RNA, compared with endometrium from women without endometriosis. Thus, increased proteolytic activity may help to explain the invasive factors that result in endometriosis.
PMID: 12372458 [PubMed – indexed for MEDLINE]
424: Fertil Steril. 2002 Oct;78(4):782-6. Related Articles, Links Pathological evaluation of the rat endometriosis model.
Uchiide I, Ihara T, Sugamata M.
Department of Obstetrics and Gynecology, Japanese Red Cross Hospital Omori, Tokyo, Japan.
OBJECTIVE: To observe in detail the morphology of experimental rat endometriosis, specifically in peritoneum adjacent to uterine transplants attached via autotransplantation. DESIGN: Light and electron microscopic study. SETTING: Tochigi Institute of Clinical Pathology, Japan. ANIMAL(S): Female-SD rats maintained on a schedule of 12 hours of light and 12 hours of dark for 2 weeks. INTERVENTION(S): Uterine transplants were attached to rat peritoneum via the surgical autotransplantation technique. The implanted area of peritoneum, including abdominal muscle, were excised from anesthetized rats at four (n = 10), seven (n = 10), and 14 (n = 10) days after uterine autotransplantation. The mesenteries were autotransplanted as a comparative control. MAIN OUTCOME MEASURE(S): We examined the morphologic alterations of uterus-attached peritoneum following the time interval after the implantation. RESULT(S): In rat endometriosis models, the stromal tissue of uterus-attached peritoneum showed proliferation and infiltration of mast cells, eosinophils, plasma cells, lymphocytes, and macrophages. These lesions increased with time after implantation; however, ultimately these infiltrating cells disappeared and proliferation declined. CONCLUSION(S): Our findings suggest that uterine autotransplantation induces the infiltration of allergic inflammatory-related cells and proliferative lesions in peritoneal stroma attached endometrium. These data should prove useful for investigations of human endometriosis.
PMID: 12372457 [PubMed – indexed for MEDLINE]
425: Fertil Steril. 2002 Oct;78(4):777-81. Related Articles, Links Development of a Web site for the genetic epidemiology of endometriosis.
Zondervan K, Cardon L, Kennedy S.
Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom. krina.zondervan@well.ox.ac.uk
OBJECTIVE: Endometriosis is a complex trait, in which genetic and environmental factors act together to produce the phenotype. So far, research into candidate genes has largely been based on biological and clinical hypotheses. Results of these studies and the wealth of gene and marker sequence information from the Human Genome Project could–when brought together–provide the researcher with new etiological avenues to explore. DESIGN: Online review. SETTING: The Web site being developed draws together evidence of genetic variants associated with endometriosis and new etiological hypotheses. It incorporates links to up-to-date genomic information relevant to the candidates from a range of bioinformatics databases. PATIENT(S): Endometriosis cases and controls in association studies. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Allele and genotype frequencies. RESULT(S): The Web site summarizes the main hypotheses for endometriosis etiology that provide the basis for the search for genes involved, together with [1] the existing evidence of associations with candidate genes, with links to the relevant publications; [2] details of these candidate genes and the surrounding chromosomal area (location, function, polymorphisms, marker maps); [3] molecular biological findings, from studies of aberrant gene and protein expression in relevant tissues; and [4] chromosomal regions that have been implicated. CONCLUSION(S): This Web site should provide a useful information tool for the endometriosis researcher. We encourage researchers worldwide to use it, contribute to it, and share their knowledge about the condition.
PMID: 12372456 [PubMed – indexed for MEDLINE]
426: Fertil Steril. 2002 Oct;78(4):773-6. Related Articles, Links A long-term follow-up study of women with asymptomatic endometriosis diagnosed incidentally at sterilization.
Moen MH, Stokstad T.
Department of Obstetrics and Gynecology, St. Olav’s University Hospital, Trondheim, Norway. mette.moen@medisin.ntnu.no
OBJECTIVE: To evaluate whether asymptomatic endometriosis diagnosed in connection with tubal sterilization is likely to cause symptoms later in the woman’s life. DESIGN: Controlled, clinical follow-up study of women who were examined for endometriosis in connection with tubal sterilization performed between 1986 and 1989. SETTING: University hospital. PATIENT(S): Thirty-nine women with mostly minimal endometriosis discovered at sterilization and 157 control women with no endometriosis discovered at sterilization. INTERVENTION(S): Interview in 2001 by a posted questionnaire. MAIN OUTCOME MEASURE(S): Report on pain, pelvic operations, menopausal status, and use of hormone replacement therapy. RESULT(S): Pelvic pain was more frequently reported by controls than by women with endometriosis (28% vs. 6%). There was no significant difference between the groups concerning dysmenorrhea, premenstrual pain, or dyspareunia, nor was there any significant difference in the hysterectomy rate. CONCLUSION(S): There is little risk that asymptomatic, minimal endometriosis found incidentally will become symptomatic.
PMID: 12372455 [PubMed – indexed for MEDLINE]
427: Fertil Steril. 2002 Oct;78(4):767-72. Related Articles, Links Characteristics of patients with endometriosis in the United States and the United Kingdom.
Kuohung W, Jones GL, Vitonis AF, Cramer DW, Kennedy SH, Thomas D, Hornstein MD.
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
OBJECTIVE: To investigate differences in characteristics of patients with endometriosis in the United States and the United Kingdom. DESIGN: Patient questionnaire. SETTING: Two university-based endometriosis referral centers. PATIENT(S): Women with surgically diagnosed endometriosis. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Patient demographics, menstrual and obstetric history, contraceptive use, medical history, risk factors, family history, endometriosis diagnosis, and current pain status and treatment. RESULT(S): Most demographic characteristics were similar between groups. However, patients in the United States were diagnosed at a younger age than were patients in the United Kingdom (25.6 +/- 6.7 years vs. 28.0 +/- 7.1 years) and more commonly presented with an ovarian mass. More U.K. women used oral contraceptives before diagnosis and were younger at first use. U.K. patients underwent fewer additional surgeries than U.S. patients but reported that surgery alone provided the best relief of symptoms, whereas most U.S. patients reported that surgical and medical therapy together provided the best relief of symptoms. CONCLUSION(S): The many similarities in demographics and symptoms among women with endometriosis in the U.S. and the U.K. support the universality of the disease process. Despite a variety of treatments, most patients from both groups still experienced pain from their endometriosis at the time of the survey.
PMID: 12372454 [PubMed – indexed for MEDLINE]
428: Fertil Steril. 2002 Oct;78(4):763-6. Related Articles, Links Peritoneal defects and the development of endometriosis in relation to the timing of endoscopic surgery during the menstrual cycle.
Schweppe KW, Ring D.
Department of Obstetrics and Gynaecology, Ammerland Clinic GmbH, Academic Teaching Hospital of the University of Gottingen, Westerstede, Germany. schweppe@ammerland-klinik.de
OBJECTIVE: In vitro studies demonstrated that implantation on membranes (peritoneum, amniotic membranes) can take place if there are defects on the surface of the membranes. If these mechanisms play a role for the development of endometriosis in vivo, then patients with surgical treatment of peritoneal endometriosis in the luteal phase must have a high recurrence rate. DESIGN: Retrospective analysis of operation charts and follow-up data. SETTING: Department of gynecology, in a hospital-based endometriosis treatment center. PATIENT(S): Two hundred twenty premenopausal women. INTERVENTION(S): Laparoscopic treatment for peritoneal endometriosis, stage I and II by revised American Society for Reproductive Medicine guidelines. MAIN OUTCOME MEASURE(S): During the follow-up period of 2 years, symptoms and gynecological and sonographic findings were documented. In case of suspected recurrence a repeat laparoscopy with biopsy was performed to prove the recurrent endometriosis macroscopically and histologically. RESULT(S): The total recurrence rate after 2 years was 9.6%. The recurrence rate of group III (15%) was twice as high as those of group I (7%) and group II (8%), as indicated by subjective complaints, clinical findings, macroscopy, and histology; no differences were found between groups I and II. CONCLUSION(S): Endoscopic surgery for the treatment of peritoneal endometriosis should not be performed in the luteal phase.
PMID: 12372453 [PubMed – indexed for MEDLINE]
429: Fertil Steril. 2002 Oct;78(4):757-62. Related Articles, Links Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis.
Rickes D, Nickel I, Kropf S, Kleinstein J.
Clinic for Reproductive Medicine and Gynecologic Endocrinology, Faculty of Medicine, Otto-von-Guericke University, Magdeburg, Germany. juergen.kleinstein@medizin.uni-magdeburg.de
OBJECTIVE: To examine whether ultralong GnRH analog (GnRH-a) therapy after surgical treatment of endometriosis and before ART influences the pregnancy rate. DESIGN: Prospective, randomized, controlled study. SETTING: University clinic for reproductive medicine and gynecologic endocrinology. PATIENT(S): One hundred ten patients with stage II to IV endometriosis according to ASRM criteria. INTERVENTION(S): Fifty-five patients received GnRH-a for 6 months after surgery and subsequently underwent up to 3 cycles of ART, and 55 patients received 3 cycles of ART alone immediately after surgery. MAIN OUTCOME MEASURE(S): Clinical pregnancy rates. RESULTS: The pregnancy rate per patient was higher among patients who received follow-up treatment with GnRH-a. The same results were found in patients with stage III or IV endometriosis who were undergoing IUI or IVF/ICSI. CONCLUSION(S): Ultralong GnRH-a therapy increases the pregnancy rate of ART in patients with severe endometriosis.
Publication Types: · Clinical Trial · Randomized Controlled Trial
PMID: 12372452 [PubMed – indexed for MEDLINE]
430: Fertil Steril. 2002 Oct;78(4):750-6. Related Articles, Links Cycle-specific and cumulative fecundity in patients with endometriosis who are undergoing controlled ovarian hyperstimulation-intrauterine insemination or in vitro fertilization-embryo transfer.
Dmowski WP, Pry M, Ding J, Rana N.
Institute for the Study and Treatment of Endometriosis, Oak Brook, Illinois, USA. wpdmowski@oakbrookfertility.com
OBJECTIVE: To compare controlled ovarian hyperstimulation-intrauterine insemination (COH-IUI) or IVF-ET pregnancy rates per cycle (PR) and cycle and cumulative fecundity (f and cf) with COH-IUI or IVF-ET in endometriosis. DESIGN: Retrospective analysis. SETTING: Endometriosis research institute. PATIENT(S): Women with endometriosis and infertility (n = 313) who underwent consecutive COH-IUI (202 patients, 648 cycles), IVF-ET (111 patients, 139 cycles), or IVF-ET after failed COH-IUI (56 patients, 68 cycles). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Crude PR and life table-estimated f and cf. RESULT(S): With COH-IUI, 69 patients conceived; 65 conceived with IVF-ET; and 30 conceived with IVF-ET after COH-IUI (PR 11%, 47%, and 44%). With COH-IUI, six-cycle cf was 41%, and f for cycles 1-6 was 15%, 12%, 8%, 7%, 7%, and 0. With IVF-ET, three-cycle cf was 73%, whereas f for cycles 1-3 was 47%, 27%, and 33%. First-cycle f with IVF-ET was significantly higher than cf of six COH-IUI cycles. When the data were stratified according to the stage of endometriosis and women’s age, the benefit of IVF over COH was even more pronounced. Prior COH-IUI failure did not adversely affect IVF-ET outcome. CONCLUSION(S): In endometriosis, PR, f, and cf are significantly higher with IVF-ET than COH-IUI, especially in stage IV and in women >38 years of age. Considering adverse effects of prolonged ovarian stimulation on endometriosis, IVF-ET should be the first-line approach in the management of infertility in this disease. If COH-IUI is attempted, it should not exceed three to four cycles.
PMID: 12372451 [PubMed – indexed for MEDLINE]
431: Fertil Steril. 2002 Oct;78(4):743-9. Related Articles, Links Location, color, size, depth, and volume may predict endometriosis in lesions resected at surgery.
Stratton P, Winkel CA, Sinaii N, Merino MJ, Zimmer C, Nieman LK.
Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1853, USA. ps79c@nih.gov
OBJECTIVE: To correlate the diagnosis of endometriosis in lesions excised at laparoscopy with pathologic diagnosis. DESIGN: Prospective study. SETTING: U.S. government research hospital. PATIENT(S): Women with chronic pelvic pain thought to be due to endometriosis. INTERVENTION(S): Excision of lesions suspicious for endometriosis. MAIN OUTCOME MEASURE(S): Histologic examination of lesions for color, width, depth, and location of endometriosis. Lesion colors were grouped as black, red, white, mixed color, or endometriomas. RESULT(S): Sixty-five women with a surgical diagnosis of endometriosis had minimal (n = 22), mild (n = 25), moderate (n = 9), or severe disease (n = 9) according to the revised American Fertility Society classification. Endometriosis was confirmed in all but seven patients with minimal and one with severe disease. Twelve other patients did not have endometriosis. Of 314 lesions excised, 189 (61%) were endometriotic. Black or red lesions were less often histologically confirmed to be endometriosis than were white lesions, mixed-color lesions or endometriomas. Lesions > 5 mm wide or deep were more likely to be endometriosis than were narrower or shallower implants. Endometriomas deeper than 1 cm were histologically confirmed to be endometriosis, and 50% of peritoneal windows contained endometriosis. CONCLUSION(S): White lesions, mixed-color lesions, endometriomas, and larger lesions by depth or width were more likely to be histologically confirmed endometriosis than were smaller, black, or red lesions.
PMID: 12372450 [PubMed – indexed for MEDLINE]
432: Fertil Steril. 2002 Oct;78(4):740-2. Related Articles, Links Anatomopathological lesions of bladder endometriosis are heterogeneous.
Chapron C, Boucher E, Fauconnier A, Vieira M, Dubuisson JB, Vacher-Lavenu MC.
Assistance Publique, Hopitaux de Paris (AP-HP), Service de Chirurgie Gynecologique, Clinique Universitaire Baudelocque, Paris, France. charles.chapron@cch.ap-hop-paris.fr
OBJECTIVE: To present the anatomopathological characteristics of deep bladder endometriosis. DESIGN: Descriptive anatomapathological study. SETTING: A university hospital department of gynecological surgery. PATIENT(S): Eleven consecutive patients complaining of pelvic pain and painful urinary functional symptoms. INTERVENTION(S): Laparoscopic partial cystectomy. MAIN OUTCOME MEASURE(S): Macroscopic and microscopic characteristics of deep bladder endometriosis lesions. RESULT(S): Deep bladder endometriosis lesions were extremely heterogeneous, not only in any one patient but also from one patient to another. Bladder muscularis propria presented three aspects: [1] hyperplasia of the fibromuscular tissue (4/11); [2] simple dissociation of the smooth muscle fiber bundles with no veritable "disorganization" (4/11); [3] simple thickening of the interstitial collagen network, or sclerosis (3/11). A histological adenomyotic nodule aspect was only observed in one patient (9%). CONCLUSION(S): Bladder endometriosis is an enigmatic disease. No hypothesis can be proposed as a single explanation for its pathogenesis.
PMID: 12372449 [PubMed – indexed for MEDLINE]
433: Fertil Steril. 2002 Oct;78(4):733-9. Related Articles, Links Usefulness of CA19-9 versus CA125 for the diagnosis of endometriosis.
Harada T, Kubota T, Aso T.
Department of Comprehensive Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. t.harada.gyne@tmd.ac.jp
OBJECTIVE: To investigate the clinical value of the serum CA19-9 level in comparison with the serum CA125 level for diagnosing and determining the severity of endometriosis. DESIGN: Retrospective study. SETTING: Department of Comprehensive Reproductive Medicine in a university hospital. PATIENT(S): One hundred one women with endometriosis and 22 with

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