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450: Hum Reprod. 2002 Oct;17(10):2725-36. Related Articles, Links
Endometriosis results from the dislocation of basal endometrium.
Leyendecker G, Herbertz M, Kunz G, Mall G.
Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Academic Teaching Hospital to the Universities of Frankfurt and Heidelberg, Grafenstrasse 9, Germany. gerhard.leyendecker@t-online.de
BACKGROUND: The hypothesis is tested that both adenomyotic and endometriotic lesions are derived from basal endometrium. METHODS: Normal uteri and uteri with adenomyosis obtained by hysterectomy, excised endometriotic lesions and menstrual blood of women with and without endometriosis were used. Estrogen receptor (ER), progesterone receptor (PR), progesterone receptor B isoform (PR(B)) and P450 aromatase (P450A) immunohistochemistry was performed with the use of specific monoclonal antibodies. RESULTS: With respect to the parameters studied there was a fundamental difference between the cyclical patterns of the basalis and the functionalis of the eutopic endometrium. The endometrium of endometriotic and adenomyotic lesions mimicked the cyclical pattern of the basalis. The peristromal muscular tissue of endometriotic and adenomyotic lesions displayed the same cyclical pattern of ER and PR expression as the archimyometrium. There was a significantly higher prevalence of fragments of shed basalis in menstrual blood of women with endometriosis than in healthy controls. CONCLUSIONS: These data suggest that ectopic endometrial lesions result from dislocation of basal endometrium. Dislocated basal endometrium has stem cell character resulting in the ectopic formation of all archimetrial components such as epithelial and stromal endometrium as well as peristromal muscular tissue.
PMID: 12351554 [PubMed – indexed for MEDLINE]
451: Hum Reprod. 2002 Oct;17(10):2715-24. Related Articles, Links
High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis.
Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P.
Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, NIH, 10 Center Drive, Building 10, Room 9D42, MSC 1583, Bethesda, MD 20892-1583, USA. sinaiin@mail.nih.gov
BACKGROUND: Women with endometriosis may also have associated disorders related to autoimmune dysregulation or pain. This study examined whether the prevalence of autoimmune, chronic pain and fatigue and atopic disorders is higher in women with endometriosis than in the general female population. METHODS AND RESULTS: A cross-sectional survey was conducted in 1998 by the Endometriosis Association of 3680 USA members with surgically diagnosed endometriosis. Almost all responders had pain (99%), and many reported infertility (41%). Compared with published rates in the general USA female population, women with endometriosis had higher rates of hypothyroidism (9.6 versus 1.5%, P < 0.0001), fibromyalgia (5.9 versus 3.4%, P < 0.0001), chronic fatigue syndrome (4.6 versus 0.03%, P < 0.0001), rheumatoid arthritis (1.8 versus 1.2%, P = 0.001), systemic lupus erythematosus (0.8 versus 0.04%, P < 0.0001), Sjogren’s syndrome (0.6 versus 0.03%, P < 0.0001) and multiple sclerosis (0.5 versus 0.07%, P < 0.0001), but not hyperthyroidism or diabetes. Allergies and asthma were more common among women with endometriosis alone (61%, P < 0.001 and 12%, P < 0.001 respectively) and highest in those with fibromyalgia or chronic fatigue syndrome (88%, P < 0.001 and 25%, P < 0.001 respectively) than in the USA female population (18%, P < 0.001 and 5%, P < 0.001 respectively). CONCLUSIONS: Hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and asthma are all significantly more common in women with endometriosis than in women in the general USA population.
PMID: 12351553 [PubMed – indexed for MEDLINE]
452: Hum Reprod. 2002 Oct;17(10):2523-8. Related Articles, Links
In-vitro adhesion of endometrium to autologous peritoneal membranes: effect of the cycle phase and the stage of endometriosis.
Debrock S, Vander Perre S, Meuleman C, Moerman P, Hill JA, D’Hooghe TM.
Leuven University Fertility Center and Department of Pathology, UZ Gasthuisberg, Belgium. sophie.debrock@uz.kuleuven.ac.be
BACKGROUND: Endometrium can adhere to autologous peritoneum. This study was undertaken to determine the effect of the menstrual cycle phase and the presence and stage of endometriosis on in-vitro adhesion of endometrium onto autologous peritoneum. METHODS: This was performed in an academic medical research centre. Sixty-seven subfertile women with a visually normal pelvis (n = 18) and with biopsy-proven endometriosis (n = 49) were included. Endometrial and peritoneal biopsies were obtained at laparoscopy during menstrual, follicular and luteal phase. Endometrium was cultured in vitro with autologous peritoneum, followed by fixation, paraffin embedding, serial sectioning, hematoxylin-eosin and immunohistochemical staining. Endometrial-peritoneal adhesion was evaluated using light microscopy. RESULTS: Endometrial-peritoneal adhesion was observed in approximately 80% of the adhesion assays and was not affected by the phase of the cycle, or by the presence and stage of endometriosis. The continuity of the mesothelial layer was disrupted at the attachment sites. Epithelialization was observed along the edges to integrate the endometrial implant. After adhesion, histological changes were observed within and below the implant. CONCLUSIONS: Endometrium obtained during menstrual, follicular or luteal phase appears to have a similar potential to implant in vitro on autologous peritoneum, and this adhesion process is not affected by the stage of endometriosis.
PMID: 12351522 [PubMed – indexed for MEDLINE]
453: Contracept Rep. 1997 Nov;8(5):12-3. Related Articles, Links
Oral contraceptives and endometriosis.
[No authors listed] PIP: Since retrograde menstruation has been proposed as a major factor in the development of endometriosis, contraceptive methods that influence menstrual flow may increase the risk of endometriosis. The literature on a possible association between oral contraceptive (OC) use and endometriosis is conflicting. Recent reports, including the 1994 Oxford Family Planning Association Study and the Royal College of General Practitioners OC Study, suggest that current OC users have a lower risk of endometriosis, while former users may have an increased risk. The observed increase in risk after OC discontinuation presumably reflects a selection bias in which women who choose to take OCs may be selected or self-selected to use this method because of problems with their menstrual cycle. Since endometrial tissue proliferates in response to estrogen, low-dose OCs with progestin are recommended for the prevention or suppression of endometriosis.
PMID: 12348249 [PubMed – indexed for MEDLINE]
454: Annu Rev Popul Law. 1987;14:363-4. Related Articles, Links
Act of 17 June 1987.
United States. Texas.
PIP: This document reprints provisions of the 1987 Act of Texas relating to insurance coverage for in vitro fertilization procedures. The Act requires all insurers to cover outpatient expenses associated with in vitro fertilization if the insurance plan provides pregnancy benefits. The coverage applies only if the fertilization or attempt at fertilization involves use of the patient’s spouses’ sperm and the patient and spouse are insured and: 1) have a history of infertility of at least 5 continuous years’ duration; 2) have infertility associated with endometriosis, exposure in utero to diethylstilbestrol, blockage or removal of one or both fallopian tubes, or oligospermia; or 3) less costly treatments have been unsuccessful. In each case, the procedures must be performed at an appropriate medical facility. An insurer associated with a bona fide religious denomination holding as an integral part of its beliefs and practices that in vitro fertilization is contrary to its essential moral principles is exempt from this requirement.
Publication Types: · Legislation
PMID: 12346709 [PubMed – indexed for MEDLINE]
455: Afr Med. 1990 Sep;29(288):429-32. Related Articles, Links
[High risk pregnancies and family planning] [Article in French] Sama DA.
PIP: Each year as a consequence of pregnancy and delivery at least 500,000 women die, 99% of them in developing countries. Most maternal deaths are avoidable. For each death, 10-15 other women suffer serious health effects which may lead to chronic pain or even social isolation. Childbirth is riskier for women who are too young or too old, who have many children, or whose births are too closely spaced. Limiting family size reduces both maternal and child deaths. In developed countries, 5-30 women die per 100,000 births, compared to 50-800 in developing countries. Maternal mortality rates at 2 hospitals in Yaounde, Cameroon, have declined significantly in recent years, probably due to establishment of high risk pregnancy clinics, improved monitoring during labor, and child spacing clinics. Improved obstetric services and child spacing could reduce maternal mortality in developing countries as they have in the developed world. The use of contraception has been a controversial topic in traditional African societies, but by now the majority of governments of developing countries include family planning programs in their development plans for their health as well as their economic benefits. Despite gradual increases, fewer than 5% of women in most African countries use modern contraception. African men play an insignificant role in family planning. The continuing practices of prolonged lactation and postpartum abstinence in rural areas have compensated to some extent for the absence of modern contraception. Oral contraceptives are the most widely used reversible method. They may protect against vaginal infection, iron deficiency anemia, ectopic pregnancy, benign breast disease, ovarian and endometrial cancer, dysmenorrhea, endometriosis, and rheumatoid arthritis. There is evidence that some steroid hormones have a beneficial effect in stabilizing the cellular membranes of red blood cells in women with sickle cell anemia. The danger of infection with the IUD is largely limited to the 1st 4 months of use and to women with sexually transmitted diseases. Careful selection of candidates, aseptic insertion, and regular follow-up are needed to ensure IUD safety. The IUD is contraindicated for nulliparas. Barrier methods provide contraception as well as some protection against sexually transmitted diseases. Condoms have a significant protective effect against HIV infection. Diaphragms, cervical caps, and vaginal sponges provide some protection against infections like gonorrhea and chlamydiae that invade the cervical cells. Many adolescents resist condoms because they diminish sensation. But condoms provide protection against sexually transmitted diseases and are appropriate for individuals with sporadic sex lives. Oral contraceptives are more effective but adolescents are at risk of forgetting pills. IUDs are the least attractive option for adolescents because of the danger of infection and subsequent infertility.
PMID: 12343159 [PubMed – indexed for MEDLINE]
456: Abort Res Notes. 1988 Dec;17(3-4):1-2. Related Articles, Links
RU-486: a continuing saga.
[No authors listed] PIP: A month after the approved marketing of RU-486 in France as a nonsurgical option for abortion, the company Roussel-Ulcaf withdrew the product in response to boycott threats and threats to company officials and their families. The government of France approved the drug on an experimental basis under the name of Mifepristone; the conditions of the approval were that the drug had to be used within the 1st 49 days after the 1st day of last menstruation and had to be administered under medical supervision at a hospital with the expertise to perform an abortion. Following trials in France, China, and the United Kingdom, RU-486, when administered in a single dose of 3 pills, was observed to have a 95% success and to be very safe. The international boycott and personal threats propelled a convention of more than 1,000 physicians in the World Congress of Gynecology and Obstetrics in Rio de Janeiro to sign a petition that advocated to Roussel-Uclaf the importance of insuring "that women have access to the benefits of scientific progress." The World Health Organization regretted the withdrawal of the drug as 1 off-shoot of the decision would be that developing companies would not be able to run clinical trials on RU-486. Shortly after the company’s decision to remove the drug, the French Minister of Health, Claude Evin, ordered a continuation of experimental trials of RU-486. While no US companies have demonstrated interest in the drug, boycotts and threats exacerbate product liability coverage problems. However, should it prove effective in treating breast cancer, endometriosis or ectopic pregnancy, RU-486 may begin to increase in distribution and use.
PMID: 12342356 [PubMed – indexed for MEDLINE]
457: Contracept Fertil Sex (Paris). 1988 Jun;16(6):453-7. Related Articles, Links
[LHRH analogues in female contraception] Sitruk-ware R.
PIP: Since the luteinizing hormone-releasing hormone (LH-RH) has been identified and its mode of action understood, it has become possible to imagine a therapeutic use of long acting, nontoxic analogues. Biochemical modifications of the decapeptide have resulted in the synthesis of potent LH-RH antagonists and agonists. Paradoxically, however, the agonists, devised to induce ovulation, exert an antagonistic action due to a decrease in the number of pituitary LH-RH receptors and to desensitization of the pituitary gland to the decapeptide. These inhibitory effects are associated with the prolonged activity of the analogues, in contrast with the stimulant effects of physiological LH-RH which has a short 1/2-life and is secreted in bursts. These effects have been used in order to inhibit ovulation in female contraception. Preliminary studies clearly indicate a high efficiency of these molecules devoid of metabolic side effects. However, it appears necessary to add sequential progestin therapy on a monthly basis as estradiol levels are those of an early follicular phase. Such a peptide contraception aims at ovulation suppression and not at a complete blockage as in cases of endometriosis and estrogen-dependent cancers. (author’s)
PMID: 12342002 [PubMed – indexed for MEDLINE]
458: Contracept Technol Update. 1986 Feb;7(2):13-5. Related Articles, Links
Factors seen as possible links to posttubal ligation syndrome.
[No authors listed] PIP: Dr. Herbert B. Peterson of the Center for Disease Control (CDC) recently reported at a conference at Emory University in Atlanta that research now indicates 2 new hypotheses for the genesis of posttubal ligation syndrome. When 2 groups of women, both with histories of menstrual problems, were compared over time, those who had not undergone tubal ligation had fewer menstrual problems than women who had. That fact suggests that preexisting menstrual problems can be aggravated by tubal sterilization. In addition, posttubal ligation syndrome could be related to performance of sterilization shortly after delivery. 3 primary types of evidence — clinical, laboratory, and epidemiologic — used to support the conclusion that posttubal ligation syndrome does exist deserve further investigation. Clinical evidence is the most easily observable by health care providers but may be unreliable. The relationship between age and posttubal ligation syndrome has not been strictly established. According to Peterson, 10 years following sterilization, women may be experiencing mesntrual problems because of time passage alone. Additionally, about 30% of American women have used oral contraceptives (OCs) up to the time of the procedure. Possibly mesntrual complaints after sterilization in such cases can be attributed to cessation of OC use rather than to tubal ligation. Laboratory data documenting functional, anatomic, and hormonal changes after posttubal ligation are vague. Several recent studies involving such data do add "biologic plausibility" to certain hypotheses. A unifying hypothesis to account for disturbances in ovarian function is that tubal ligation results in destruction of the uterovarian blood supply. Different methods of fallopian tube occlusion destroy different parts of the tube and the tube’s blood supply. A 2nd hypothesis is that certain types of tubal occlusion are more likely than others to result in endometriosis, which can affect menstrual function. The 3rd hypothesis is that tubal sterilization may cause an estrogen-progesterone imbalance. Epidemiologic data obtained from shortterm studies fail to support the existence of posttubal ligation syndrome. According to Peterson, women who did not have adverse bleeding before sterilization were more likely to have adverse bleeding problems than the unsterilized women. Adverse bleeding was even more pervasive among the sterilized group in the longterm results. Further studies should investigate 2 possibilities: that posttubal ligation syndrome is related to a preexisting adverse menstrual condition that fails to improve and that symptom severity may be pregnancy related.
PMID: 12340520 [PubMed – indexed for MEDLINE]
459: Contracept Technol Update. 1984 Sep;5(9):118-20. Related Articles, Links
Contraception and cardiac disease: can the pill, IUD be prescribed?
Neinstein LS, Katz B.
PIP: This article discusses oral contraceptive (OC) and IUD use among women with cardiac disease. OCs are associated with the side effects of fluid retention and hyperlipidemia, contraindicating their use in women with preexisting hypertension, thromboembolic disorders, cerebrovascular disease, and coronary artery disease. A further contraindication is the presence of more than 1 cardiac risk factor (smoking, diabetes, hypertension, hyperlipidemia, and obesity). Since the cardiovascular side effects of OCs are related both to the estrogen and progestin components, clinicians are advised to prescribe a pill with 50 mcg or less of estrogen and the equivalent of 1 mg or less of norethindrone. progestin only OC causes fewer side effects in women with cardiac disease, but should be used in conjunction with a backup method such as foam or condoms if pregnancy would pose a significant health risk. Safe but less reliable methods of contraception (condoms, foam, diagphragm) are recommended only for highly moviated couples. The IUD is not considered an appropriate choice for cardiac patients with a history of pelvic inflammatory disease and multiple sex partners. Such patients are at increased risk of developing endometriosis. In patients with mitral valve prolapse, antibiotic prophylaxis should be administered during IUD insertion.
PMID: 12339673 [PubMed – indexed for MEDLINE]
460: Contracept Technol Update. 1982 Jul;3(9):112-3. Related Articles, Links
Commentary [on contraceptive method and future fertility] Hatcher RA.
PIP: An important question that arises is what are the implications to those working in family planning of the various causes of infertility which increase as a woman passes from her late teens to the late 20s or 30s. The family planning professional should periodically discuss with any woman any known risk factors she might have for infertility, e.g., pelvic infection, family history, or endometriosis. As a woman approaches 30, it may be appropriate to suggest that she begin to give some serious thought as to when she might want to start having children if that is one of her goals. The family planning professional needs to also be aware that the methods of birth control he/she provides to patients may affect a woman’s future ability to become pregnant or to carry a pregnancy successfully. A woman should not use IUDs if she wants to have children in the future. Obviously sterilization should not be performed when future pregnancy is a serious consideration. Barrier contraceptives and spermicides offer protection against pelvic inflammatory disease as do oral contraceptives (OCs). OCs may also protect women from ectopic pregnancies and from intrauteral pregnancies. Age dependent and intercourse dependent variables are listed.
PMID: 12338302 [PubMed – indexed for MEDLINE]
461: Contracept Fertil Sex (Paris). 1980 Feb;8(2):145-52. Related Articles, Links
[Peritoneal fluid in female fertility and sterility (author’s transl)] [Article in French] Koninckx PR, Brosens IA, Heyns WH.
PIP: The authors have analyzed samples of peritoneal liquid to determine how and in which measure the level of steroid hormones allows to distinguish between follicular rupture and ovulation, and follicular luteinization without rupture and lack of ovulation. Volume of peritoneal fluid is not influenced by endometriosis or by pelvic varicosities, but it increases during the luteal phase; peritoneal protein concentration is also at its highest during the luteal phase. Progestin and estradiol-17 beta are higher in peritoneal fluid than in serum; such high concentration is maintained for at least a week after ovulation. The concentration of such hormones is higher in women with ovulatory scars than in those with luteinized unruptured follicle syndrome. Such findings show that peritoneal liquid is a transudate of the hyperemic active ovary, and that the level of concentration of progestin and estradiol-17 beta can be used in the diagnosis of luteinized unruptured follicle syndrome.
PMID: 12336187 [PubMed – indexed for MEDLINE]
462: J Obstet Gynaecol India. 1979 Aug;29(4):727-30. Related Articles, Links
Operative laparoscopy: a preliminary study.
Khandwala SD.
PIP: Khandwala cites 30 cases of operative laparoscopy, a technique utilizing several surgical procedures for treating pathological conditions. All cases consisting of the following operative procedures were done under local anesthesia: 1) 20 cases (65%) of adhesiolysis. The procedure consisted of separating the adhesions and coagulating the blood vessels. In all cases the pelvis was cleared of adhesions; 2) 3 cases (10%) of aspiration of Ovarian cyst; 3) 2 cases (6.6%) fulguration of endometrial implants. Early diagnosis and treatment of endometriosis is thought to be one of the more useful achievements of laparoscopy; 4) 2 cases (6.6%) of IUD removal. X-rays are required for determining the exact location of the IUD. Plastic devices appear easier to remove than copper devices which produce adhesions and may require laparotomy; 5) 2 cases (6.6%) of partial salpingectomy; and 6) 1 case (3.3%) resection of uterosacrals due to chronic pelvic pain.
PMID: 12336027 [PubMed – indexed for MEDLINE]
463: Contracept Fertil Sex (Paris). 1979 May;7(5):357-61. Related Articles, Links
[Endometriosis and infertility] [Article in English, French] Faguer C.
PIP: Endometriosis is certainly responsible for many instances of infertility, although its physiopathological mechanism is not very clear. Tubal endometriosis can lead to occlusion of the tubes, ovarian endometriosis can cause adhesions, and peritoneal endometriosis can cause adnexitis. Sterility caused by endometriosis is often secondary, while amenorrhea, menstrual fever, and pain are always present. Clinical medical examinations should be completed by hysterography and celioscopy. Endometriosis can be treated with hormonotherapy: lynestrenol and norethindrone atrophy the endometrium, block ovulation, and cause persistent amenorrhea. Surgical treatment has benefited enormously from the recent progress in microsurgery; it is now possible not only to resect the unwanted tissue, but to reconstitute the healthy one. It would be now reasonable to expect a pregnancy in about 50% of treated cases.
PMID: 12335903 [PubMed – indexed for MEDLINE]
464: Female patient. 1977 Jul;2(7):61-4. Related Articles, Links
Levinson CJ.
PIP: The laparoscope is a long, thin tube with a light source and an optical system. Ancillary instruments can allow a physician to perform procedures through the same incision, or sometimes a second incision. After distending the abdomen with gas, a sheath is inserted into the abdomen, and the telescope is placed within the sheath. Laparoscopy can be used for diagnostic purposes as well as surgical, and the most common operation performed is tubal ligation for sterilization. Other operative procedures that can be performed with the laparoscope are removal of adhesions or foreign bodies, drainage of cysts, and burning or elimination of small amounts of endometriosis. Postoperative effects include reactions to the gas or bloody discharge following a D&C. Properly used, laparoscopy has a great deal to offer patients and their physicians as an uncomplicated approach to diagnosis and/or therapy.
PMID: 12335488 [PubMed – indexed for MEDLINE]
465: J Obstet Gynaecol Br Emp. 1965 February;72(1):45-48. Related Articles, Links
The oral progestational and anti-ovulatory properties of megestrol acetate and its therapeutic use in gynaecological disorders.
Ostergaard E.
PIP: Megestrol acetate alone (47 cases), combined (115 cases) with mestranol, or sequential with dienestrol diacetate, was prescribed for various gynecologic disorders or for studies of its progestational effects. Doses were usually 1 Planovin tablet (5 mg megestrol acetate and .1 mg mestranol) for 20 day cycles, or from 2.5-15 mg megestrol acetate with or without 2.5-5 mg dienestrol diacetate. Results of treatment were 4 of 10 permanent cures of secondary amenorrhea; 10 permanent cures of dysmenorrhea with temporary improvement in 6; 6 of 7 patients with endometriosis were relieved, although 2 had to maintain cyclic treatment after up to 9 months continuous ingestion; 20 of 21 cases of metrorrhagia were relieved; 6 of 7 women with menopausal symptoms were improved; 18 of 21 women used Planovin successfully for contraception. Studies with 21 women who took megestrol acetate before undergoing planned sterilization showed that neither 5 mg megestrol acetate or .1 mg mestranol alone inhibited ovulation in all women, as observed during laparotomy, but the combined tables was 100% effective.
PMID: 12332461 [PubMed – indexed for MEDLINE]
466: Prog Gynecol. 1970;5:283-302. Related Articles, Links
Newer synthetic progestins for the treatment of endometriosis.
Kistner RW.
PIP: This paper outlines methods of therapy utilizing newer combinations of estrogens and progestins. The specific agent and length of treatment depends on the extent of disease, severity of symptoms, presence of infertility and response to pseudopregnancy. Structural formulas for 19 synthetic preparations are shown. Of 36 patients with proven endometriosis in which pseudopregnancy was induced by the use of these newer agents, satisfactory objective in 82%. Pregnancy occurred later in 6 of 10 patients who had previously been infertile and wished to become pregnant. The optimum maintenance dose is 4-6 mg of chlormadinone acetate or ethnodiol diacetate with .2 mg of mestranol and 5-10 mg of megestrol acetate with .2 mg of ethniyl estradiol. Dosage is increased only when break through bleeding occurs. Gain in weight occurred in almost 1/2 of the patients. The decidual reaction was just as great as that produced formerly by large doses of Enovid. In a more recent study 60 patients were treated with Norlestrin, 20 with Lyndiol and 20 with Ovral. Satisfactory objective and subjective remissions were obtained in 89%. Pregnancy has occurred subsequently in 17 to 43 patients who desired pregnancy. All infants have been normal. The optimum maintenance doses seem to be 10-15 mg if Norlestrin, 2.5-5 mg Lyndiol or .5-1 mg of Ovral. The most common side effect was weight gain in 35%. These agents may be used prior to conservative surgery in order to soften areas of fibrotic endometriosis or to pinpoint areas otherwise overlooked. The length of preoperative treatment depends on the extent of disease, 6 weeks being usual. The indication for prolonged pseudopregnancy is recurrent endometriosis following surgery, also proven vaginal endometriosis. Subsequent to conservative surgery, 12 to 24 weeks of therapy are given in order to inhibit ovulation and prevent reactivation of any remaining areas of endometriosis. Tables show commercial combinations and dosage regimens. Nausea, break through bleeding, breast soreness, acne, water retention, isoninia, irritability, lethargy, headaches or development of leiomyomas are side effects to be dealt with by modifying the treatment. Thromboembolic disease has not been a complication in over 500 patients but should be looked for as it has been reported by others. The effect of long-term use of these drugs has been shown to be entirely reversible without subsequent deleterious effects. Severe hepatic disease or previous mammary carcinoma are contraindications. Excessive side effects may necessitate other treatment but the newer drugs reduce this chance. The diagnosis of endometriosis should first be proven.
PMID: 12332429 [PubMed – indexed for MEDLINE]
467: J Obstet Gynaecol India. 1968 April;18(2):276-8. Related Articles, Links
Female sterilisation as a method of population control. Presented at the 14th All India Obstetric and Gynecology Congress, Nagpur, November 26-28, 1967.
Dawn CS, Samanta S, Poddar DL.
PIP: 210 puerperally sterilized women (1-20 years age) and 500 women of similar age and parity served as the experimental and control groups in a Calcutta hospital study. 96% of the sterilized women had the operation for socioeconomic reasons and multiparity. At sterilization mean age was 27 years 10 months and mean parity was 4.8. The group after sterilization had significantly higher rates of menorrhagia (27.6%), dysmenorrhea (18.09%), and pelvic pain (10%) than had the controls. Rates of dyspareunia and excess libido were 2.3% and 5.2% in the sterilized women, as compared with nil rates in the controls. After operation rates of hydrosalpinx, pelvic adhesions, abdominal incision hernias, and scar endometriosis were 4.76%, 3.8% 4.7%, and .4%, respectively. No significant psychological sequelae occurred. The pregnancy rate after sterilization was .4%. It is concluded that sterilization will be more acceptable to poor women if the method can be improved so less side effects occur.
PMID: 12331819 [PubMed – indexed for MEDLINE]
468: Am J Reprod Immunol. 2002 Jul;48(1):50-6. Related Articles, Links
Increased expression of cyclooxygenase-2 in local lesions of endometriosis patients.
Chishima F, Hayakawa S, Sugita K, Kinukawa N, Aleemuzzaman S, Nemoto N, Yamamoto T, Honda M.
Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan. fchishi@med.nihon-u.ac.jp
PROBLEM: Human endometrial glands contain the highest levels of cyclooxygenase (COX), although whether it is COX-1 and/or COX-2 has not been previously determined. Overexpression of COX-2 may result in the pathogenesis of endometriosis. METHOD OF STUDY: Tissue sections were obtained from 28 premenopausal women undergoing laparotomy or laparoscopic surgery for benign conditions. Endometrium, ectopic endometriosis tissue and peritoneum were obtained at the time of surgery. Informed consents were obtained from all the patients participating in this study. Immunohistochemistry was performed on consecutive sections of paraffin-embedded tissue using anti-COX-2 antibody. Expressions of COX-2 mRNA in endometrium, ectopic endometriosis tissue, and peritoneum were quantitavely determined by competitive reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: In the uterus, COX-2 was localized in the endometrial epithelium. Eutopic endometrial surface epithelium contains more COX-2 than does glandular epithelium. We observed more frequent and denser COX-2 staining in the ectopic endometriosis implants when compared with eutopic endometrium. Level of COX-2 mRNA in endometriosis was increased up to five times that of eutopic endometria. CONCLUSION: Hyper activation of COX-2 with abnormal prostaglandin generation is considered to contribute to the pathophysiology of endometriosis and disease progression.
PMID: 12322896 [PubMed – indexed for MEDLINE]
469: J Med Assoc Thai. 2002 Jun;85(6):733-8. Related Articles, Links
Cesarean section scar endometriosis: a case report and review of the literature.
Phupong V, Triratanachat S.
Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Cesarean section scar endometriosis is a rare event. The reported incidence is 0.03-1.7 per cent. Herein, the authors report a case of a 35-year-old woman, G1P1, who presented with cyclic pain at the left lateral edge of the pfannenstiel scar. The skin of this edge had also become dark brown. She had undergone a cesarean section for cephalopelvic disproportion four years previously. Physical examination revealed only mild tenderness and a dark brown nodule at the left lateral edge of the scar. Pre-operative diagnosis was scar endometriosis, surgical excision was performed and the tissue pathology confirmed the characteristic features of endometriosis. The post-operative course was uneventful, and no recurrence was found during the two-year follow-up period. The literature regarding cesarean section scar endometriosis was reviewed.
Publication Types: · Review · Review of Reported Cases
PMID: 12322849 [PubMed – indexed for MEDLINE]
470: Guttmacher Rep Public Policy. 1999 Feb;2(1):5-7. Related Articles, Links
The political challenges and educational opportunities around very early abortion.
Saul R.
PIP: In 1998, the US House of Representatives amended an appropriations bill to prohibit the US Food and Drug Administration (FDA) from approving abortifacients. While it would have had broader implications, this amendment targeted mifepristone, which has been used since 1988 in France to cause early medical abortions. The measure failed to gain the support of the Senate after opponents argued that it would represent an inappropriate interference of the Congress into scientific processes and pointed out that mifepristone is a promising treatment for other conditions, such as Cushing’s syndrome and endometriosis. Mifepristone is just one of a number of emerging technologies that allow women to obtain abortions at very early stages of pregnancy. Most public support for abortion is directed to early abortion, and most US women have early abortions (50% in the first eight weeks, and 90% in the first trimester). A 1997 poll revealed that the US public is largely uninformed about drugs used for early abortion, such as mifepristone or the cancer-fighting drug methotrexate, which is being used off-label as an abortifacient. However, 4200 medical abortions were performed in the US in 1996, and this figure increased to 4300 in the first half of 1997. The public must be informed that the process of medical abortion is not as simple as "popping a pill" but requires several days of medical supervision. In France, the abortion rate has declined since mifepristone was introduced.
PMID: 12321968 [PubMed – indexed for MEDLINE]
471: Contracept Fertil Sex (Paris). 1995 Feb;23(2):93-6. Related Articles, Links
[Endometriosis and fertility: physiopathology and treatment options] [Article in French] Antoine JM.
PIP: The relationship between endometriosis and infertility is not clear despite a large literature. 30-40% of women with endometriosis are infertile, compared to fewer than 10% in the general population. A direct relationship has never been proven, but numerous physiopathological hypotheses have been advanced to explain such a relationship. The role of severe forms of endometriosis in infertility is clear and there is consensus concerning treatment. In cases of destruction of the ovarian parenchyma by voluminous endometriomas, drug treatment is not sufficient and laparoscopic removal of the cyst is required. In cases of complete bilateral obstruction of the proximal tubes, drug treatment is usually disappointing and surgery or in vitro fertilization is required. Treatment choice for nonobstructing lesions is less clear. The role of small polyps and isolated localized diverticuli is doubtful. The most difficult treatment problems arise in cases of minimal to moderate endometriosis. Several cycle anomalies have been reported. In order to establish causality, such effects must be studied hormonally and sonographically for at least six consecutive cycles. Several potential mechanisms have been suggested to explain such effects, including hyperproduction of prostaglandins, hyperprolactinemia, anomalies in luteolysis, and biphasal LH peak, among others. Peritoneal endometrial implants may cause an aseptic inflammatory reaction and an antigenic stimulation leading to increased volume of peritoneal liquid, elevation of prostaglandins in the peritoneal liquid that then cause other problems, augmented number and activation of peritoneal and tubal macrophages with various effects, or auto-immune type responses. Associated male infertility factors may play a role. If endometriosis is a cause of infertility, pregnancy rates should be increased by specific treatment. Efficacy of different treatments was evaluated in a meta-analysis of 25 studies. Systematic destruction of lesions during laparoscopy appeared to offer the best results. In vitro fertilization may be proposed in severe forms or associated male infertility. The results have been similar to those for other indications, except possibly in severe and extensive forms characterized by diminished retrieval of oocytes. It is possible that endometriosis does not explain infertility except in forms severe enough to alter pelvic anatomy.
PMID: 12319250 [PubMed – indexed for MEDLINE]
472: Contracept Fertil Sex (Paris). 1993 Feb;21(2):129-31. Related Articles, Links
[High-dose progestational contraception: side effects] [Article in French] Gorins A.
PIP: Women rarely depend on progestational contraception. In France, physicians are unsure of its indications. Progestational contraception presents advantages for certain indications where a particular condition exists and, more particularly, for women aged 40 and over. Women who can use it are those who have contraindications to estrogen use. These contraindications include uterine fibroids, endometrial hyperplasia, endometriosis, and fibro-cystic disease of the breast. It does produces side effects but those affecting metabolism seem to be almost negligible, like those of the third generation progestins. These side effects are metrorrhagias, amenorrhea, weight gain, and atherogenic metabolic changes. Yet, the nor-pregnane derivatives (which do effectively suppress ovulation) do not adversely affect glucose and lipid parameters. Progestational contraception probably cannot assure absolute safety as can combined oral contraceptives. It is not yet clear whether women who have been treated for breast cancer should use progestational contraception.
PMID: 12318012 [PubMed – indexed for MEDLINE]
473: Contracept Fertil Sex (Paris). 1993 Feb;21(2):129-31. Related Articles, Links
[Macroprogestative contraception: side effects] [Article in French] Gorins A.
PIP: In the mid 1950s, when Pincus developed norethynodrel to reproduce a climate comparable to the female luteal phase or pregnancy, he added a synthetic estrogen to avoid uterine bleeding. The 1st pill contained estrogens to block gonadotropic activity and suppress the side effects of progestins used alone. But newer progestin compounds combine strong antigonadotropic activity with minimal androgenic effects and better control of uterine bleeding. The indications, advantages, and side effects of the newer high-dose progestin-only formulations should be weighed carefully in making decisions about their benefits. High-dose progestins are little used in France, but are widely known. They are appropriate for use in women with contraindications to estrogen such as uterine fibroids, endometrial hyperplasia, endometriosis, severe premenstrual syndrome, and polycystic breast disease. Another indication may be poor tolerance of combined oral contraceptives. It appears that high-dose progestins may be most useful for women over 40 who present the indicating conditions with some frequency. The most bothersome side effects are menstrual irregularities including metrorrhagia and amenorrhea. It has been estimated that fewer than 30% of users are effected by menstrual problems. Progestins derived from nortestosterone are anabolizing compounds and may cause significant weight gain. Norpregnane derivatives may be associated with a lower frequency and significance of weight gain, estimated to affect 10-15% of users. Nortestosterone derivatives are known to have atherogenic metabolic effects. But the 3rd generation of progestins do not seem to cause the same metabolic effects as the nortestosterone derivatives. It has not yet been determined whether they are suitable for obese and diabetic women. Neither is it known whether high-dose progestins may be suitable for women with histories of breast cancer. Although the Pearl index has not been well established, high-dose progestin contraception does not appear to be as effective as that achieved with combined formulations.
PMID: 12318011 [PubMed – indexed for MEDLINE]
474: Contracept Technol Update. 1991 Sep;12(9):144-7. Related Articles, Links
RU 486 approved in Britain; U.S. research still limited.
[No authors listed] PIP: RU-486 has been used as an alternative to surgical abortion in France, it has recently been approved for use in Britain. There is still a ban in the US on the importation of RU-486 even for medical research. Technically the US has not banned RU-486, it is just that no one has yet to apply to the FDA for new product approval. RU-486 promises to have many benefits beyond being a safe alternative to surgical abortion. It is theorized to be a possible treatment for breast cancer, endometriosis and other reproductive health concerns. It can be used to terminate pregnancies up to the 9th week and over 80,000 French women have used it as such. Its manufacturer, Roussel-Uclaf is planning to apply for approval in Scandinavia next, but is very unlikely to try to bring it to the US because of strong anti-abortion sentiment. RU-486 has proven to be 95% effective, when used in conjunction with prostaglandins, in inducing abortion. RU-486 could also be used as a once a month pill or as a post-coital contraceptive. The anti-abortion advocates in the US plan to apply a great deal of pressure if any one tries to bring RU-486 into the country, even if it is done so for reasons other than abortion.
PMID: 12317312 [PubMed – indexed for MEDLINE]
475: J Gynaecol Endocrinol. 1987;3(1-4):13-5. Related Articles, Links
Effect of oral contraceptives on the ultrastructure of the endometrium.
Mitra PK, Roychadhuri J.
PIP: A low dose oral contraceptive (OC) containing 0.3 mg norgestrel and 0.03 mg ethinyl estradiol was given for conception control in 10 cases, for dysfunction and uterine bleeding (DUB) in 10 cases, for dysmenorrhea in 5 cases, and for endometriosis in 5 cases. Prior to treatment and subsequently the endometrium was studied by transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Post therapeutic TEM indicated marked shrinkage of mitochondria, subnuclear lipid deposition, and loss of nuclear nests in the conception control and dysmenorrhea groups. In the DUB group the epithelial cells and mitochondria became stunted, Golgi-complexes developed, lysosomes appeared, and lipid deposition took place. Significant epithelial and stromal changes also occurred in the endometriosis group with increased of intracellular lipid and hugh enlargement of cell size without abnormal structural alteration. SEM showed stunted isolated cilia, small openings at cell apices, and clear-cut gland openings in the conception control and dysmenorrhea groups. In the DUB group rounded shrunken epithelium with scanty ciliation and prominent microvilli, whereas in the endometriosis group after 6 months total epithelial regression and atrophy was evident. OC therapy may help prevent endometrial carcinoma by inducing regression of subcellular organelles.
PMID: 12316565 [PubMed – indexed for MEDLINE]
476: Shengzhi Yu Biyun. 1987 Aug;7(3):3-9. Related Articles, Links
[Contraceptive and therapeutic applications of luteinizing hormone releasing hormone (LHRH) analogues] [Article in Chinese] Fraser HM.
PIP: In recent years, the concept of developing LHRH agonist to stimulate fertility has been completed changed. It was discovered that repeated agonist administration not only exiles to restore pituitary function in hypogonadotrophin patients, but also leads to inhibition of normal gonadal function. The ability of long term agonist treatment to cause suppression of pituitary and gonadal function can be utilized for contraception. Using LHRH as a contraceptive has its limitations, but clinical studies have not shown serious side effects. LHRH could be a possible alternative form of contraception for breast-feeding and post- partum amenorrheic women as against steroids. Using LHRH agonist in the treatment of endometriosis, excessive menstrual bleeding, and uterine fibroid has shown encouraging prospects. Long term use of LHRH agonist by males could produce contraceptive effects and it may also be used for treatment of prostate cancer. In the near future, LHRH could be developed into male or female contraceptives. Nasal spray may not be an appropriate medium of administration in developing countries, whereas implants could be a possible alternative. Further research is needed on the its side effects as a contraceptive, and their solutions.
PMID: 12315171 [PubMed – indexed for MEDLINE]
477: Contracept Technol Update. 1984 Jun;5(6):71. Related Articles, Links
Potential risks, benefits of progestins in birth control pills outlined.
[No authors listed] Progestins in oral contraceptives (OCs) produce potential complications, as well as noncontraceptive benefits, according to Robert A. Hatcher, MD, MPH, professor of gynecology and obstetrics, Emory University Medical School. Hatcher told CTU that lowering the progestin content in an OC may decrease complications, but could also decrease the benefits experienced by women. "The extent to which that will happen remains to be seen," he said. Hatcher cited the following potential complications of progestins in OC: hypertension; decreased levels of high density lipoproteins; acne; oily skin; headaches between pill cycles; dilated leg veins; pelvic congestion syndrome; thrombosis of superficial leg veins; gallstones; Monilia vaginitis; cholestatic jaundice; and depression, fatigue, and decreased libido. Progestins, according to Hatcher, also produce these noncontraceptive benefits: protection against PID; decreased dysmenorrhea; decreased menstrual blood loss, decreased iron deficiency anemia; protection against endometrial cancer; protection against fibrocystic breast disease, and fibroadenomas of the breast; decreased bleeding from fibroids; decreased growth of fibroids. When ovulation is suppressed, Hatcher emphasized, additional benefits that may occur include the following: decreased risk of functional ovarian cysts; elimination of mittleschmerz pain; decreased rick of ovarian cancer; protection against endometriosis. full text
PMID: 12313083 [PubMed – indexed for MEDLINE]
478: Contracept Fertil Sex (Paris). 1983 Nov;11(11):1233-42. Related Articles, Links
[Choosing the right synthetic progestogen] [Article in French] Rozenbaum H.
PIP: A number of synthetic progestogens are currently available which differ greatly among themselves in various ways. The common property of all progestogens is that they transform a proliferative endometrium into a secretory or luteal endometrium by fixing the progestogen or 1 of its metabolites to the progesterone receptor. Most progestogens also have a greater or lesser affinity for other hormonal receptors, and some cause modifications in metabolism, especially of lipids and glucose. Synthetic progestogens can be classified according to their chemical formulas, biologic properties, and efficiency in relation to hormone receptors, but none of the current classification systems is a satisfactory guide to use. It is not yet definitively known whether pro-hormones, which must be transformed into norethindrone in vivo before taking effect, are advantageous or disadvantageous for therapeutic use. Synthetic progestogens have been found to have varying metabolic effects according to their content and dosage; hepatic function, lipid metabolism, glucose metabolism, coagulation factors, and the renin-angiotensin-aldosterone system are among the functions affected. The metabolic effects of synthetic progestogens are the principal criteria of choice. High dose 19 norsteroids are recommended only for cancer treatment, 19 nor-pregnane derivatives and progesterone isomers appear suitable for treatment of conditions such as endometriosis, premenopausal menstrual irregularities, and menstrual irregularity resulting from luteal insufficiency in younger women. Low-dose 19 norsteroids remain the best choice for contraception. Levonorgestrel has been preferred over norethindrone for some time because it is effective at a dose of .150 mcg compared to 1 mg for norethindrone, but some recent research suggests that even at a much smaller dose, levonorgestrel may cause more metabolic modifications than norethindrone. The pro-hormones ethynodial diacetate and lynestrel have additional metabolic effects whose consequences are as yet unknown. Preparations containing levonorgestrel should be preferred until the expected appearance on the market of triphasic preparations containing norethindrone and desogestrel, which permit excellent cycle control. Among progestogen-only contraceptives, 10 mg/daily of lynestrenol is associated with high rate of side effects. Microdose synthetic progestogen preparations are sometimes useful but offer imperfect efficacy, poor cycle control, higher risk of extrauterine pregnancy and ovarian cysts, and creation of iatrogenic luteal insufficiency.
PMID: 12312705 [PubMed – indexed for MEDLINE]
479: Bull Postgrad Inst Med Educ Res Chandigarh. 1980 Sep;14(3):167-70. Related Articles, Links
Combined vesical and abdominal endometriosis following abdominal hysterotomy and tubal ligation.
Dhall K, Bhatia K, Sharma SK.
PIP: The article reports on the case of a 29 year old patient who developed abdominal endometriosis 4 years after having had hysterotomy and tubal ligation. About a month after the excision of the endometrial tissue she was examined for suprapubic pains, strangury, and frequency of micturition. A nodule was found in the deepest part of the abdominal wall and the patient was treated for 6 months, without success, with medroxyprogesterone acetate. A subsequent laparotomy showed bladder endometriosis, obviously still an endometrial implant at the time of hysterotomy, which was missed at the time of the first excision. Total hysterectomy was carried out and the patient recovered successfully. Bladder endometriosis is the most common site of involvement among urinary tract endometriosis. The peculiarity of the case presented here is in the total absence of hematuria, and in the fact that pains had no relation with the menstrual cycle. Hormonal therapy is often ineffective, and surgery often the only advisable form of treatment.
PMID: 12311304 [PubMed – indexed for MEDLINE]
480: Contracept Fertil Sex (Paris). 1977 December;5(9):731-42. Related Articles, Links
[Assessment of the treatment of endometriosis by an antigonadotropin] [Article in English, French] Audebert AJ, Emperaire JC.
PIP: Danazol (2-3 isoxazole-17 beta ethinyltestosterone) is an antigonadotropin used to treat endometriosis. It has a half-life of 4.4 hours in humans. It has no known teratogenic or embryotoxic effects. Danazol use causes slight alterations of liver functions and hyperglycemia curves. Danazol dosages of 200 mg induce ovulation. The secretion of luteinizing hormone is normal or elevated among women using Danazol. Atrophy of the endometrium is observed after 5 or 6 weeks of Danazol use. Regeneration begins on about the 10th day after Danazol use is discontinued. 54 women with endometrial lesions were treated with Danazol. 15 women were treated for severe endometrial lesions with 800 mg of Danazol; 5 experienced significant amelioration of the lesions. Of 31 infertile women, treated with 600-800 mg Danazol, 9 pregnancies were observed. Of 8 women with small endometrial lesions who had been sterile for more than 3 years, 4 pregnancies occurred after treatment with 200-600 mg. Danazol. Sudden flushes, decreased breast size, metrorrhagia, acne, weight gain, artralgia, and digestive and emotional disturbances were the most frequent side effects. The continuity rate was about 90%.
PMID: 12308838 [PubMed – indexed for MEDLINE]
481: West J Surg Obstet Gynecol. 1952 August;60(8):377-86. Related Articles, Links
The technic of posterior colpotomy.
Bradbury WC.
PIP: The technic of posterior colpotomy is described. The patient is put in the lithotomy position and conditions for possible contraindications are determined. The incision in the cul-de-sac is made well posterior in the fold between the uterosacral ligaments. The fascia is pushed downward with the index finger, displacing the rectum and exposing a widearea of thin peritoneum. The peritoneum is then opened without danger of injury to the bowel. The ovary is palpated with the index finger and grasped with a ring forceps bringing it up and medial, exposing the tube. When the uterus is anterior, gentle pressure is made over the fundus abdominally and the lateral aspect of the incision is elevated exposing the ovary. Lifting the ovary anterior and medial with pressure over the fundus abdominally facilitates exposure of the cornual portion of the tube. The incision is closed with interrupted mattress sutures including all layers. Colpotomy is a safe, certain method of confirming the diagnosis of tubal pregnancy. It is more accurate than needle aspiration of the cul-de-sac. Contraindications of this method include severe hemorrhage, shock, previous pelvic operations with extensive adhesions, endometriosis of the rectovaginal septum, fixed pelvic pathology and acute vaginitis.
PMID: 12307934 [PubMed – indexed for MEDLINE]
482: Tex State J Med. 1961 December;57(12):962-7. Related Articles, Links
Symposium on steroid hormones. 1. Synthetic progestational steroids. Their significance and use.
Goldzieher JW.
PIP: Synthetic progestational compounds are evaluated in terms of specifi c potencies and actions. The synthetic progestins have a wide spectrum of activity. Certain progestins might be preferred in 1 situation and others elsewhere. In reviewing the progestins, it was concluded that the management of habitual abortion might be most effective by administering 1 gm of progesterone or 40 mg of medroxyprogesterone daily by mouth. As an injectable, 17-hydroxyprogesterone caproate insures constancy of action and promotes a physiologic type of secretory endometrium. Medroxyprogesterone as an oral agent also appears favorable in this regard. The 19-norsteroids appear to have a hemostatic action. They have a definite role in the management of dysmenorrhea. Pregnancy has occurred with astonishing promptness in fertile women who have stopped the use of 19-norsteroids taken previously for contraceptive purposes. The 19-norsteroids and medroxyprogesterone are being used in the treatment of endometriosis. It was concluded that the concept of a synthetic progestin merely as a convenient substitute for progesterone is untenable and does not take advantage of the great potential of these new drugs.
PMID: 12305387 [PubMed – indexed for MEDLINE]
483: Di Yi Jun Yi Da Xue Xue Bao. 2002 Jun;22(6):539-41. Related Articles, Links
Expression of trophinin in the cycling endometrium and its association with infertility.
Wang HY, Xing FQ, Chen SL.
Assisted Reproduction Center, Department of Obstetrics and Gynecology, Nanfang Hospital, First Military Medical University, Guangzhou 510515, China.
OBJECTIVE: To observe the expression of trophinin in the cycling endometrium and investigate its relationship with infertility. METHODS: Trophinin expression in the endometrium was observed in 39 normal cycling women during different menstrual phases and 24 women with infertility during mid-luteal phase by immunohistochemical technique. RESULTS: Trophinin expression was detected in the luteal-phase endometrium of both normal and infertile women, which peaked in the mid-luteal phase. In comparison with normal women, infertile women with endometriosis or unexplained infertility had significantly weakened trophinin expression in the endometrium in the mid-luteal (P<0.001). CONCLUSIONS: Trophinin may play an important role in the process of implantation, and abnormal endometrial trophinin expression might be one of the major causes of infertility.
PMID: 12297480 [PubMed – indexed for MEDLINE]
484: Di Yi Jun Yi Da Xue Xue Bao. 2002;22(9):814-6. Related Articles, Links
Susceptibility to endometriosis in women of Han Nationality in Guangdong Province associated with Msp I polymorphisms of cytochrome P450 1A1 gene.
Peng DX, He YL, Qiu LW, Yang F, Lin JM.
Department of Obstetrics and Gynecology, Zhujiang Hospital, First Military Medical University, Guangzhou 510282, China.
OBJECTIVE: To assess the possible association of the Msp I polymorphisms of cytochrome P4501A1(CYP1A1) gene with the susceptibility to endometriosis in women of Han Nationality in Guangdong Province. METHODS: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was employed to analyze the 3 genotypes m1m1, m1m2 and m2m2 in 3′-flanking region of CYP1A1 in 76 patients with endometriosis and 80 healthy controls. RESULTS: The frequencies of genotypes m1m1, m1m2 and m2m2 were 30.3 %, 50.0 % and 19.7 % in patients with endometriosis while 42.5 %, 45.0 % and 12.5 % in the controls, respectively, showing no statistically significant difference in the frequencies of the three genotypes between the 2 groups. The frequencies of two alleles were of no significant difference between the patients and controls, either. CONCLUSION: Msp I polymorphisms of cytochrome P4501A1 in itself might not be associated with the susceptibility to endometriosis in women of Han Nationality in Guangdong Province.
PMID: 12297440 [PubMed – in process]
485: Int J Clin Pract. 2002 Sep;56(7):552-3. Related Articles, Links
Reversible hypertension in a young female: ureteric obstruction due to endometriosis.
Aldington S, Gujral S, Sibley GN.
Department of Medicine, Bristol Royal Infirmary, UK.
We present the case of a young female who, upon investigation for hypertension, was found to have a ureteric stricture secondary to endometriosis. After excision of the stricture and an end-to-end ureteric anastomosis the patient’s blood pressure returned to normal. This case highlights the need to investigate fully hypertension in young people and to consider the possibility of endometriosis in any female who presents with obstructive uropathy.
PMID: 12296621 [PubMed – indexed for MEDLINE]
486: Scientist. 1994 Jan 24;8(2):14-5. Related Articles, Links
RU 486 research forges on, despite political hurdles.
Watanabe ME.
PIP: One year after US President Bill Clinton lifted the ban on importation of RU-486, there has been no increase in new research on RU-486 and no increase in the modest amount of RU-486 projects receiving federal support. One theory is that the stigma of RU-486 being an abortifacient carries over to nonabortion related uses. Political and economic pressures within Roussel (the only source of RU-486 and a major supplier of research funds) and its parent firm, Hoechst AG in Berlin, are responsible for the limited research on RU-486. The lack of federal funding on RU-486 may be because many persons perceive RU-486 to be a women’s drug and women’s diseases receive little federal funding. Nevertheless, some research of RU-486 in nonabortifacient use is occurring. RU-486’s ability to interact with progesterone receptors make it a candidate for treating diseases not related to reproductive function. RU-486 also has a strong antiglucocorticoid effect. A Colorado researcher receives funding from the National Cancer Institute (NCI) to examine whether RU-486 can treat breast cancer. A small clinical trial will soon be conducted in California where women with advanced breast cancer will be treated with RU-486. NCI is supporting a Phase III clinical trial of the effects of RU-486 on nonresectable meningiomas (which have many progesterone receptors). A California researcher has conducted several small clinical trials of RU-486’s effect on endometriosis and on leiomyoma. The findings so far suggest that RU-486 demonstrates greater improvement with fewer side effects than other drugs. Findings of a clinical trial in Illinois suggest that RU-486 stimulates labor in women with dead fetuses. Some researchers at the National Institute of Child Health and Human Development use RU-486 to treat some patients with a subtype of Cushing’s syndrome. A clinical trial is examining whether RU-486 can improve memory in Alzheimer’s disease patients.
PMID: 12288152 [PubMed – indexed for MEDLINE]
487: Contracept Fertil Sex (Paris). 1993 Jul-Aug;21(7-8):563-5. Related Articles, Links
[Contraception and endometriosis] [Article in French] Brun G.
PIP: Choosing a contraceptive method for a woman with endometriosis is an uncommon problem because endometriosis is relatively rare and because an estimated 30-50% of women with endometriosis are infertile. Uterine or internal endometriosis or adenomyosis is characterized by a congestive and pseudoinflammatory uterus slightly increased in volume. It must be distinguished from pelvic or external or peritoneo-ovarian endometriosis. Pelvic implants may involve destruction of the ovaries by cysts or their imprisonment in adhesions. They may cause stenosis in the proximal portion of the tubes or entrap them in adhesions. 4 stages of endometriosis have been distinguished according to the significance of the lesions and a scoring system. Stage 4 patients with scores over 70 or with a score over 50 for adhesions have been unable to conceive despite treatment. No contraception is necessary in these cases. The choice of a contraceptive for other patients is conditioned by the features of endometriosis. Endometriosis refers to the abnormal localization of a normal endometrium. The implants are sensitive to estrogen. Each implant behaves like a miniature uterus; the mucus proliferates and bleeds if estrogen secretions are present, or atrophies if not. Endometriosis may be completely asymptomatic, or cause sterility, or be accompanied by pain and metrorrhagia. Several earlier treatments of endometriosis have been abandoned because of side effects. The current treatment of choice is an LHRH analo

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