1: BJOG. 2004 Sep;111(9):950-9.
A double-blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain.
Johnson NP, Farquhar CM, Crossley S, Yu Y, Peperstraten AM, Sprecher M, Suckling J.
Department of Obstetrics and Gynaecology, National Women’s Hospital, University of Auckland , Auckland , New Zealand .
Objective To determine the effectiveness of laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain in women with endometriosis and women with no laparoscopic evidence of endometriosis. Design A prospective double-blind randomised controlled trial (RCT). Setting Single-centre, secondary-level gynaecology outpatient service and tertiary-level pelvic pain and endometriosis outpatient service in Auckland , New Zealand . Population One hundred and twenty-three women undergoing laparoscopy for investigation and management of chronic pelvic pain, 56 with no laparoscopic evidence of endometriosis and 67 with endometriosis. Methods Women were randomised from the two populations, firstly those with no evidence of endometriosis and secondly those undergoing laparoscopic surgical treatment for endometriosis, to receive LUNA or no LUNA. Participant and assessor blinding was employed. Follow up for pain outcomes was undertaken at 24 hours, 3 months and 12 months. Main outcome measures Changes in non-menstrual pelvic pain, dysmenorrhoea, deep dyspareunia and dyschezia were assessed primarily by whether there was a decrease in visual analogue score for these types of pain of 50% or more from baseline and additionally whether there was a significantly different change in median visual analogue score. The numbers requiring further surgery or starting a new medical treatment for pelvic pain and complications were also measured. Results There was a significant reduction in dysmenorrhoea at 12 month follow up in women with chronic pelvic pain in the absence of endometriosis who underwent LUNA (median change in visual analogue scale (VAS) from baseline -4.8 versus-0.8 (P= 0.039), 42.1%versus 14.3% experiencing a successful treatment defined as a 50% or greater reduction in visual analogue pain scale for dysmenorrhoea (P= 0.045). There was no significant difference in non-menstrual pelvic pain, deep dyspareunia or dyschezia in women with no endometriosis undergoing LUNA versus no LUNA. The addition of LUNA to laparoscopic surgical treatment of endometriosis was not associated with a significant difference in any pain outcomes. Conclusions LUNA is effective for dysmenorrhoea in the absence of endometriosis, although there is no evidence of effectiveness of LUNA for non-dysmenorrhoeic chronic pelvic pain or for any type of chronic pelvic pain related to endometriosis.
PMID: 15327610 [PubMed – in process]

2: Int J Gynaecol Obstet. 2004 Sep;86(3):371-6.
Malignant transformation of endometriosis and genetic alterations of K-ras and microsatellite instability.
Amemiya S, Sekizawa A, Otsuka J, Tachikawa T, Saito H, Okai T.
Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo , Japan .
Objectives: To clarify the role of specific genetic alterations in the multi-step process of malignant transformation of endometriosis. Methods: In cases of ovarian endometrioid carcinoma, we separated regions of normal endometriosis, atypical endometriosis and ovarian endometrioid carcinoma by laser microdissection, and examined K-ras mutation and microsatellite instability in each separated tissue sample. Results: We detected K-ras mutation and microsatellite instability in endometrioid carcinoma tissue, but not in normal or atypical endometriosis bordering the cancerous region. Conclusions: The present findings suggest that K-ras mutation and microsatellite instability are associated with malignant transformation from atypical endometriosis to ovarian endometrioid carcinoma.
PMID: 15325855 [PubMed – in process]

3: Med Hypotheses. 2004;63(4):602-8.

Endometriosis: the consequence of neurological dysfunction?
Quinn M.
Department of Gynaecology, Hope Hospital , Stott Lane , Salford , Manchester M6 8HD , UK .
Endometriosis describes endometrium found outside the uterine cavity and is frequently associated with clinical presentations of chronic pelvic pain, dysmenorrhoea, dyspareunia and subfertility. It was originally attributed to retrograde menstruation with endometrium passing in a reverse direction along the Fallopian tubes into the peritoneal cavity though this theory does not account for the spectrum of intrapelvic findings. Denervation followed by reinnervation in the uterine isthmus is proposed as the primary source of clinical symptoms, and, retrograde menstruation with adhesion of endometrium to injured tissue surfaces the variable laparoscopic findings. Primary sources of denervation are difficult intrapartum episodes (parous women) and persistent straining to achieve defaecation (nulliparous women). Progressive reinnervation including stromal nerve fibre proliferation, microneuroma formation and periarterial nerve fibre proliferation, takes place over five to ten years. Damage to uterine innervation interrupts normal patterns of uterine contractility, causing loss of fundocervical polarity which promotes retrograde menstruation. Ectopic endometrium may be a marker for prior tissue damage and does not contribute to the clinical symptoms – the disease may have been largely defined by an epiphenomenon.
PMID: 15325003 [PubMed – in process]

4: Hum Reprod. 2004 Aug 19 [Epub ahead of print]
The tumor necrosis factor-{alpha} promoter -1031C polymorphism is associated with decreased risk of endometriosis in a Japanese population.
Asghar T, Yoshida S, Kennedy S, Negoro K, Zhuo W, Hamana S, Motoyama S, Nakago S, Barlow D, Maruo T.
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, chuo-ku, Kobe , 650-0017, Japan .
BACKGROUND: Tumor necrosis factor-alpha (TNF-alpha) is a multifunctional proinflammatory cytokine, associated with various inflammatory and autoimmune diseases. Elevated TNF-alpha levels in peritoneal fluid have been reported in women with endometriosis, suggesting that TNF-alpha may be involved in the development of endometriosis. In this study, we investigated the possible association between endometriosis and the TNF-alpha gene promoter polymorphisms -238G/A, -308G/A, -857C/T, -863C/A and -1031T/C in a Japanese population. METHODS: We compared the distribution of the -238G/A, -308G/A, -857C/T, -863C/A and -1031T/C polymorphisms in the promoter region of TNF-alpha in 130 endometriosis cases and 185 controls using PCR-RFLP analysis. RESULTS: The allele frequencies of -238A, -308A, -857T, -863A and -1031C in controls were 2.0%, 1.3%, 19.4%, 17.0% and 18.6%, and in the cases 1.1%, 0.3%, 19.6%, 18.6% and 13.6%, respectively. No significant differences in frequencies were found between the crude endometriosis cases and controls. However, when the endometriosis group was divided into a subgroup of women with stage IV disease only, the frequency of the -1031C allele was significantly lower in this subgroup than controls. CONCLUSIONS: The variability of the -1031T/C polymorphism of the TNF-alpha gene may be associated with susceptibility to (AUTHOR: as meant?) endometriosis.
PMID: 15319381 [PubMed – as supplied by publisher]

5: Akush Ginekol (Sofiia). 2004;43(4):36-8. [Cell proliferation in endometrium of women with endometriosis] [Article in Bulgarian] [No authors listed] The purpose of this study was to describe the endothelial cell activity of the endometrial tissue in women with and without endometriosis, and find out the diagnostic opportunities for everyday gynecologic practice. There were 30 women with laparoscopic proved endometriosis involved in our study and 27 women with no endometriosis used as a control group. The histological findings were scored after Noyes criteria and classified according to the phase of the menstrual cycle. We found out a significant difference between the two groups, especially during the proliferate phase of the menstrual cycle.
PMID: 15318542 [PubMed – in process]

6: Acta Obstet Gynecol Scand. 2004 Sep;83(9):783-95.

Review of epidemiological evidence for reproductive and hormonal factors in relation to the risk of epithelial ovarian malignancies.
Riman T, Nilsson S, Persson IR.
Department of Obstetrics and Gynecology, Falu Hospital , Falun , Sweden .
Ovarian cancer is the leading cause of mortality related to gynecologic malignancies in Sweden but there is no current screening program. Based upon epidemiological research there is evidence that certain reproductive factors are associated with ovarian cancer risk. Most studies generally indicate that each childbirth incurs a 15-20% risk reduction. Women who have used oral contraceptives for 5 years or longer experience about half the risk of ovarian cancer compared with never users. Breastfeeding seems to be protective while age at menarche and at menopause are less consistent risk predictors. Tubal ligation and hysterectomy seem to reduce ovarian cancer risk by up to 80%. Although some studies found endometriosis, polycystic ovarian syndrome (PCOS) and pelvic inflammatory disease (PID) to be positively related to ovarian cancer, the role of these factors is not yet established. Most recent studies observed an approximately 50% ovarian cancer risk increase among ever users of hormone replacement therapy (HRT) compared with never users, and the risk increased further with long-term use. There is less information concerning separate estrogen and progestin effects of HRT and ovarian cancer risk. Although the cause of ovarian cancer remains obscure, hypotheses relating to "incessant" ovulation, excessive gonadotropin secretion, retrograde carcinogen transportation, apoptosis and estrogen/progestin imbalance have been invoked as etiological explanations. All these hypotheses find various epidemiological support. The aim of this review is to summarize the epidemiological findings on reproductive factors and ovarian cancer risk. These findings are considered in the context of etiologic hypotheses and some new research areas are suggested.
PMID: 15315588 [PubMed – in process]

7: Lik Sprava. 2001 Jan-Feb;(1):86-7.
[Cryohormonal treatment of internal endometriosis] [Article in Ukrainian] [No authors listed] Our objective in this work was to study efficiency of cryohormonal treatment in patients with internal endometriosis. As many as 27 female patients were treated, in whom the diagnosis of internal endometriosis had been confirmed with the aid of ultrasound investigation, hysteroscopy and laparoscopy. All above patients underwent intrauterine cryodestruction of endometrioidal loci by a contact technique over 3 minutes with subsequent administration of dipherelin, 3.75 mg every 28 days, a total of 4 to 6 injections for the course. The study made has shown high efficacy of the employed treatment option.
PMID: 15311703 [PubMed – in process]

8: J Urol. 2004 Sep;172(3):885-7.

Secondary malignant involvement of gynecologic organs in radical cystectomy specimens in women: is it mandatory to remove these organs routinely?
Ali-El-Dein B, Abdel-Latif M, Mosbah A, Eraky I, Shaaban AA, Taha NM, Ghoneim MA.
Urology Department, Urology and Nephrology Center , Mansoura University , Mansoura , Egypt . balieldein@yahoo.com
PURPOSE: We report the incidence of concomitant secondary malignancy of gynecologic organs (uterus, ovaries and vagina) and the incidence of benign lesions affecting these organs in female radical cystectomy specimens. MATERIALS AND METHODS: Between January 1983 and December 2001, 2,055 radical cystectomies were performed, including 609 in females. Pathological findings in gynecologic organs in female cystectomy specimens were reviewed. These data were correlated with different tumor characteristics. RESULTS: Mean age of the female patients +/- SD was 47 +/- 9 years (range 20 to 73). Mean followup was 4.3 +/- 4.2 years (range 0.5 to 19). Of these women 390 (64%) had squamous cell bladder carcinoma. Gynecologic organ involvement was documented in 16 of 609 patients (2.6%). Benign ovarian lesions (49 cases or 8%), a simple serous cyst (31), a dermoid cyst (1), a hemorrhagic cyst (3), bilharzial granuloma (6) and corpus albicans (8) were detected. Benign uterine lesions (30 cases or 5%), endometrial hyperplasia (20), endometriosis (4) and fibroids (6) were diagnosed. No primary genital cancers were detected in this study. Gynecologic organ involvement was more frequent in high grade tumors and the transitional cell cancer type than low grade tumors and the squamous cell type (p = 0.01 and 0.05, respectively). Posterior wall tumors were more frequently associated with genital involvement than other sites, although the difference was not statistically significant. CONCLUSIONS: Evidence is provided that the risk of secondary malignant involvement of genital organs in female cystectomy specimens is low. This low risk together with the low risk of primary cancers of genital organs in this group of patients does not strongly support the routine removal of uninvolved gynecologic organs during radical cystectomy in women.
PMID: 15310990 [PubMed – in process]

9: Ginecol Obstet Mex. 2004 Mar;72:120-4.
[Splenosis and pelvic pain. A report of a case and literature review] [Article in Spanish] Molina Vargas P, Cruz Minoli V, Morales Gomez R, Carreto Chavez G, Ceniceros Franco LG, Rocha del Valle G.
Servicio de ginecologia y obstetricia, Hospital ABC.
Initially described by Buchbinder and Lipkoff in 1929, esplenosis is the transplant of the splenic heterotopy weave in the abdominal cavity. It is observed after the splenic traumatic rupture and appendectomy. It occurs also during the embryonic development. The most frequent places where it takes place are: the intrathoraxic cavity, intraperitoneal, retroperitoneo, and brain. Although the presence of this ectopic splenic weave is symptomatic, this pathology can be evident by pain in the pelvis or it can be confused with other pathologies such as hemangiomas of intestine, and endometriosis including metastasis carcinoma. It is impossible to predict which patients will develop the splenosis after the splenic trauma. The time of rupture or damage of the splectonomy and the amount of blood in the peritoneal cavity are not related with the number of implants. The symptoms are the clue. When the splenosis is diagnosed incidentally in a symptomatic patient, the complete surgery removal is not indicated. However this surgery is recommended when the abdominal pain or the diagnosis is uncertain. In this paper a case with a secondary pelvic pain, probably due to a tubaric abortion, agreeing with secondary splenosis and a traumatic splenic rupture, is reported.
PMID: 15310105 [PubMed – in process]

10: Ceska Gynekol. 2004 May;69(3):218-24.
[Comparison of steroid metabolism markers in endometrium of women with endometriosis, endometrial hyperplasia and without pathological changes of endometrium] [Article in Czech] Petrlova B, Hejda V, Ulcova-Gallova Z, Mukensnabl P, Rokyta Z.
Sikluv patologicko-anatomicky ustav LF UK a FN Plzen.
OBJECTIVE: To find out any relationship between presence of P450 aromatase and estrogen (ER) and progesteron (PR) receptors in eutopic endometrium of women with and without endometriosis and in estrogen-dependent gynecologic lesions (endometrial hyperplasia and endometriosis). DESIGN: Retrospective study. SETTING: Sikl’s Institute of Pathology , Department of Gynecology and Obstetrics, University Hospital and Medical Faculty in Pilsen, Charles University . METHODS: The examined samples were obtained from patients of Department of Gynecology and Obstetrics, University Hospital and Medical Faculty in Pilsen (2001-2002) and elaborated in Sikl’s Institute of Pathology , University Hospital and Medical Faculty in Pilsen. There were four experimental groups: endometrial hyperplasia, endometriosis and eutopic endometrium of women with and without endometriosis. P450 arom, ER and PR were detected by using immunohistochemical methods with specific antibodies. RESULTS: P450 aromatase was detected in a higher amount in endometriosis, hyperplasia and some samples of metaplasia. Estrogen and progesterone receptors were detected in all examined tissues. Number and spreading of ER and PR depend on the phase of the cycle. Lower number of ER was found in atrophic and metaplastic endometrium and in atypic hyperplasia. There was not found any direct relationship between presence of P450 aromatase and both types of receptors. CONCLUSION: Steroid metabolism in examined pathologically changed tissues is due to molecular aberrations regulated on the local level. It is not possible to use detection of P450 aromatase as a diagnostic test for pelvic endometriosis.
PMID: 15309998 [PubMed – in process]

11: J Obstet Gynaecol Can. 2004 Aug;26(8):709-16.
Endometriosis-associated ovarian cancer: a clinicopathologic review.
[Article in English, French] Steed H, Chapman W, Laframboise S.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology.
Endometriosis is a common clinical disorder in women and usually presents with pelvic pain, infertility, or adnexal masses secondary to intracystic hemorrhage with the formation of an endometrioma. Endometriosis shares certain characteristics with malignant neoplasms, and malignant ovarian tumours have been documented in women with endometriosis. Endometriosis-associated ovarian cancer (EAOC) usually occurs in younger women, has favourable outcomes, and appears as either a low-grade tumour of endometrioid cell type or as a clear cell tumour. As it has been suggested that the pathologic features of "atypical endometriosis" may constitute a precancerous state, women with atypical endometriosis may be at an increased risk of developing EAOC. There are no prospective randomized trials assessing treatment regimens for EAOC. Most women receive treatment similar to other epithelial ovarian cancers. However, women with EAOC represent a subgroup of patients that may require different therapeutic options. English-language journals indexed in MEDLINE and PubMed were searched for relevant articles that evaluated the association between endometriosis and ovarian cancer, theories of pathogenesis and transformation, the clinical presentation and pathologic features of EAOC, as well as the treatment options available.
PMID: 15307975 [PubMed – in process]

12: Int J Gynecol Cancer. 2004 Jul-Aug;14(4):683-6.

Mucinous adenocarcinoma in an ovarian remnant.
Dereska NH , Cornella J, Hibner M, Magrina JF.
Department of Gynecologic Surgery, Mayo Clinic, Scottsdale , AZ , USA .
The ovarian remnant syndrome, a complication of bilateral salpingo-oophorectomy, is progressively receiving more attention in the gynecological surgery literature. The syndrome is manifested by pelvic pain and a palpable or sonographic finding of a pelvic mass. However, in rare cases, patients can present with large masses and radiographic suggestion of malignancy. We present the case of a 76-year-old white female, 23 months after bilateral salpino-oophorectomy at the same institution, complaining of 3.5 months of right flank and abdominal pain. Clinical and radiological evidence of a right ovarian remnant was discovered. Subsequent laparoscopic resection was consistent with a well-encapsulated mucinous adenocarcinoma in a right ovarian remnant. Curiously, this patient had no history of endometriosis, dense pelvic adhesions, pelvic inflammatory disease, or difficulty encountered during the original hysterectomy. This is the seventh published case report in the international literature about carcinoma developing in an ovarian remnant. However, this case differs in that the patient had no preexisting gynecologic conditions at the time of hysterectomy and bilateral salpingo-oophorectomy to account for residual ovarian tissue. Additionally, the oophorectomy was performed vaginally, in contrast to multiple previous case reports.
PMID: 15304167 [PubMed – in process]

13: Fertil Steril. 2004 Aug;82(2):507-10.
Expression of E26 transformation specific (ETS-1) related to angiogenesis in ovarian endometriosis.
Sakaguchi H, Fujimoto J, Aoki I, Toyoki H, Sato E, Tamaya T.
Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu City, Japan.
ETS-1 in ovarian endometriomas was significantly positively correlated with microvessel counts (MVCs), but ETS-1 and MVC were not significantly altered during the menstrual cycle. Because ETS-1 persistently expresses in the subepithelial area of endometriotic endometrium, this might contribute to the growth of ovarian endometriomas via subepithelial angiogenesis independently of the menstrual cycle.
PMID: 15302318 [PubMed – in process]

14: Fertil Steril. 2004 Aug;82(2):498-9.
Increased occurrence of tubo-ovarian abscesses in women with stage III and IV endometriosis.
Chen MJ, Yang JH, Yang YS, Ho HN.
Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University , Taipei , Taiwan .
Women who had stage III-IV endometriosis and who were nulliparous or who had delivered no more than two children were much more likely to develop tubo-ovarian abscesses than those without endometriosis.
PMID: 15302314 [PubMed – in process]

15: Fertil Steril. 2004 Aug;82(2):437-41.
Sclerotherapy with 5% tetracycline is a simple alternative to potentially complex surgical treatment of ovarian endometriomas before in vitro fertilization.
Fisch JD, Sher G.
Sher Institute for Reproductive Medicine, Las Vegas , Nevada , USA .
OBJECTIVE: Conventional treatment of endometriosis involves drainage and removal of the cyst wall, which often results in inadvertent resection of normal ovarian tissue. We previously reported that 12 patients were successfully treated with sclerotherapy using 5% tetracycline. We now report our experience with sclerotherapy before in vitro fertilization (IVF) in an additional 20 patients with ovarian endometriomas. DESIGN: Prospective, cohort. SETTING: Private practice. PATIENT(S): Women (n = 32) with sonographic evidence of an ovarian endometrioma were offered sclerotherapy in lieu of laparoscopy. INTERVENTION(S): Sclerotherapy was performed under conscious sedation and transvaginal ultrasound guidance. An 18-guage, single-lumen needle was inserted into the endometrioma, and the cyst contents were sequentially aspirated and flushed with sterile saline until the aspirated fluid was clear. Tetracycline (5%) (5-10 mL) was then instilled into the cyst. Saline was injected into the cul-de-sac to dilute any tetracycline that may have leaked. The fluid was then removed. Ultrasound was performed 6 weeks later to assess the efficacy of treatment. MAIN OUTCOME MEASURE(S): Resolution of endometrioma and subsequent IVF pregnancy rate. RESULT(S): Complete resolution was observed in 24 (75%) of 32 patients, at follow-up exam. Repeat aspiration of watery fluid was required in eight patients before resolution. Repeat treatment with tetracycline was needed in two patients. Only one patient did not ultimately respond. In vitro fertilization was performed in 28 patients; an ongoing gestation resulted in 16 (57%) from the next cycle. CONCLUSION(S): Sclerotherapy with 5% tetracycline is a simple, effective (and, in our limited series, safe) alternative to surgical intervention for treatment of endometriomas before IVF.
PMID: 15302295 [PubMed – in process]

16: Fertil Steril. 2004 Aug;82(2):405-14.
Ovarian cancer risk associated with varying causes of infertility.
Brinton LA, Lamb EJ, Moghissi KS, Scoccia B, Althuis MD, Mabie JE, Westhoff CL.
Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, Bethesda , Maryland , USA .
OBJECTIVE: To evaluate the risk of ovarian cancer as related to underlying causes of infertility. DESIGN: Retrospective observational cohort study. SETTING: Five large reproductive endocrinology practices. PATIENT(S): A total of 12,193 women evaluated for infertility between 1965 and 1988. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Ovarian cancer ascertained through 1999. RESULT(S): With 45 identified ovarian cancers, this cohort of infertility patients demonstrated a significantly higher rate of ovarian cancer than the general female population (standardized incidence ratio [SIR] = 1.98; 95% confidence interval [CI], 1.4-2.6). The risk was higher for patients with primary infertility (SIR = 2.73) than for those with secondary infertility (SIR = 1.44), and it was particularly high for patients who never subsequently conceived (SIR = 3.33). Women with endometriosis had the highest risk (SIR = 2.48; 95% CI, 1.3-4.2), with a further elevated risk among those with primary infertility (4.19, 2.0-7.7). Comparisons among the infertile women, which allowed calculation of rate ratios (RRs) after adjustment for multiple factors, also showed links with endometriosis. Compared with women with secondary infertility without endometriosis, patients with primary infertility and endometriosis had a RR of 2.72 (95% CI, 1.1-6.7). CONCLUSION(S): Determination of ovarian cancer risk should take into account the type of infertility (primary vs. secondary) and underlying causes. Further study of endometriosis may provide insights into ovarian carcinogenesis.
PMID: 15302291 [PubMed – in process]

17: Fertil Steril. 2004 Aug;82(2):322-6.
Gonadotropin-releasing hormone agonist inhibits estrone sulfatase expression of cystic endometriosis in the ovary.
Maitoko K, Sasaki H.
Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo , Japan .
OBJECTIVE: To clarify the inhibitory effect of GnRH agonist on estrone (E(1)) sulfatase expression. DESIGN: Retrospective immunohistochemical study. SETTING: The Jikei University Hospital , Tokyo , Japan . PATIENT(S): Thirty-three women who had undergone cystectomy of the ovary or oophorectomy and were proved histopathologically to have cystic endometriosis in the ovary. INTERVENTION(S): Fifteen of the 33 patients were treated with GnRH agonists monthly for 2-6 months before surgery . The other 18 patients did not receive any hormonal therapy. Tissue sections were immunostained with an anti-E(1) sulfatase monoclonal antibody (KM1049) originating from human placenta. MAIN OUTCOME MEASURE(S): Microscopic evaluation to assess the presence and localization of E(1) sulfatase and to describe any variations in its expression with or without treatment with GnRH agonist. RESULT(S): Immunostaining showed that E(1) sulfatase was localized only on the glandular epithelial cells of cystic endometriosis in the ovary. The immunostaining with anti-E(1) sulfatase proved that GnRH agonist inhibited E(1) sulfatase expression in the cystic endometriosis in the ovary. CONCLUSION(S): Gonadotropin-releasing hormone agonist inhibits E(1) sulfatase expression in cystic endometriosis in the ovary.
PMID: 15302278 [PubMed – in process]

18: Fertil Steril. 2004 Aug;82(2):314-21.
Incidence and characterization of diagnosed endometriosis in a geographically defined population.
Leibson CL, Good AE, Hass SL, Ransom J, Yawn BP, O’Fallon WM, Melton LJ.
Health Sciences Research, Mayo Clinic and Foundation, Rochester , Minnesota , USA .
OBJECTIVE: We examined whether widespread use of laparoscopy was accompanied by increased diagnosis of asymptomatic endometriosis, inflated rates of diagnosis, or changes in the clinical spectrum of disease. DESIGN: Population-based cohort. SETTING: Olmsted County , Minnesota . PATIENT(S): All participants were women residents, aged >/=15 years. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): We estimated the likelihood that women with a surgical procedure during which endometriosis could be visualized would receive a surgical diagnosis, as well as the proportions of all diagnoses, regardless of setting, that were [1] assigned without surgery , [2] refuted by surgery , [3] surgically confirmed, and [4] asymptomatic. The incidence of diagnosed endometriosis for 1987 to 1999 was compared with published rates for 1970 to 1979. RESULT(S): Of 8,229 women aged >/=15 years with >/=1 surgery during which endometriosis could be visualized, 11.5% received a surgical diagnosis of endometriosis. The incidence of diagnosed endometriosis, regardless of setting, was 1.9 per 1,000 person-years (10% were without relevant surgery , 6% had surgery but no surgical evidence, 85% had surgical evidence); 85% of surgically confirmed diagnoses had presenting symptoms. Using definitions comparable with those in the 1970 to 1979 study, the 1987 to 1999 incidence was 2.46 per 1,000 versus 2.49 per 1,000 for 1970 to 1979; 88% of symptomatic incident diagnoses were surgically confirmed versus 65% for 1970 to 1979. CONCLUSION(S): Widespread use of laparoscopy does not appear to have contributed to dramatically increased rates of endometriosis diagnoses but rather to a smaller proportion of diagnoses being assigned without surgical confirmation.
PMID: 15302277 [PubMed – in process]

19: Mol Hum Reprod. 2004 Aug 6 [Epub ahead of print]
DNA microarray analysis of gene expression profiles in deep endometriosis using laser capture microdissection.
Matsuzaki S, Canis M, Vaurs-Barriere C, Pouly JL, Boespflug-Tanguy O, Penault-Llorca F, Dechelotte P, Dastugue B, Okamura K, Mage G.
Department of Gynecology, Polyclinique de l’Hotel-Dieu, CHU, Clermont-Ferrand, France; Department of Obstetrics & Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Endometriosis, a common gynecological disorder that causes infertility and pelvic pain, is defined as the presence of endometrial glands and stroma within extra-uterine sites. However, despite extensive studies its etiology and pathogenesis are not completely understood. Differentially expressed genes were investigated in epithelial and stromal cells from deep endometriosis and matched eutopic endometrium using cDNA microarrays and laser capture microdissection. Validation of results of several up- and down-regulated genes was performed by quantitative real-time RT-PCR. Our data showed that platelet-derived growth factor receptor alpha (PDGFRA), protein kinase C beta1 (PKC beta1) and janus kinase 1 (JAK1) were upregulated, and Sprouty2 and mitogen-activated protein kinase kinase 7 (MKK7) were downregulated in endometriosis stromal cells, suggesting the involvement of the RAS/RAF/MAPK signaling pathway through PDGFRA in endometriosis pathophysiology. In addition, two potential negative regulators of aromatase expression, chicken ovalbumin upstream promoter transcription factor 2 (COUP-TF2) and prostaglandin E2 receptor subtype EP3 (PGE2EP3), were downregulated in endometriosis epithelial cells, which might result in increased local production of estrogen in endometriosis epithelial cells. Furthermore, three potential candidate genes that might be involved in endometriosis related pain were identified: tyrosine kinase receptor B (TRkB) in endometriosis epithelial cells, and serotonin transporter (5HTT) and mu opioid receptor (MOR) in endometriosis stromal cells were all upregulated. One of the candidate genes, MOR, may be involved in a defective immune system in endometriosis. This study has provided new insights into endometriosis pathophysiology.
PMID: 15299092 [PubMed – as supplied by publisher]

20: Mol Hum Reprod. 2004 Aug 6 [Epub ahead of print]

Glutathione S-transferase M1 *null genotype but not myeloperoxidase promoter G-463A polymorphism is associated with higher susceptibility to endometriosis.
Hsieh YY, Chang CC, Tsai FJ, Lin CC, Chen JM, Tsai CH.
Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
Glutathione S-transferase M1 (GSTM1), one member of the GST family, is responsible for metabolism of xenobiotics and carcinogens. Myeloperoxidase (MPO) plays an important role in the oxidation and activation of carcinogens and nitric oxide. Allelic variants of GSTM1 and MPO gene polymorphisms might impair detoxification function and increase the susceptibility to endometriosis. We aimed to investigate if these polymorphisms are useful markers for predicting endometriosis susceptibility. Women were divided into two groups: (i) endometriosis (n=150); (ii) non-endometriosis (n=159). Polymorphisms for GSTM1 and MPO were amplified by polymerase chain reaction and detected by electrophoresis after restriction digestion. The relative frequencies of the GSTM1*wild (+/+,+/0)/null (0/0) genotypes and MPO-463*G/A gene polymorphisms between both groups were compared. The distribution of GSTM1 polymorphisms was significantly different between the two groups. Proportions of GSTM1*wild/null alleles in both groups were: (i) 36.7/63.3%; (ii) 95/5% (P=0.001). In contrast, MPO-463 genotypes were not significantly different between the two groups. Proportions of MPO*A homozygote/heterozygote/G homozygote in both groups were: (i) 2.7/17.4/79.9% and (ii) 1.9/17/81.1% (P> 0.05). We conclude that the GSTM1*null genotype is associated with a higher risk of endometriosis development. MPO-463*G/A gene polymorphism is not related to the susceptibility of endometriosis.
PMID: 15299090 [PubMed – as supplied by publisher]

21: Ann Chir. 2004 Jul-Aug;129(6-7):376-380.
[Malignant tumours arising in extraovarian endometriosis: three cases reports and review of the literature] [Article in French] Benoit L, Arnould L, Margarot A, Franceschini C, Collin F, Fraisse J, Cuisenier J.
Service de chirurgie, centre G.-F.-Leclerc, 1, rue du Pr-Marion, BP 77980, 21079 Dijon cedex, France.
In its extraovarian form, co-existence of carcinoma and endometriosis is a sufficient argument used in favour of the malignant transformation of endometric lesions. Estrogen as well as the loss of 5q chromosome heterozygosity are considerate as initiators of that type of carcinogenesis. Endometrioid histological type is the most frequent and is revealed usually by abdominal pain. The incidence of carcinoma arising in endometriosis is about 0.8% and 5-year survival rate of pelvic endometrioid form is about a 100% after surgery and radiotherapy.
PMID: 15297230 [PubMed – as supplied by publisher]

22: Eur J Obstet Gynecol Reprod Biol. 2004 Sep 10;116(1):100-2.The treatment with a COX-2 specific inhibitor is effective in the management of pain related to endometriosis.
Cobellis L, Razzi S, De Simone S, Sartini A, Fava A, Danero S, Gioffre W, Mazzini M, Petraglia F.
Department of Gynaecology, Obstetrics and Reproduction, Second University of Naples, Naples, Italy.
Objective: To evaluate the efficacy and safety of a cyclooxygenase (COX)-2 specific inhibitors versus placebo in the treatment of endometriosis-associated pelvic pain. Study design: A group of women ( [Formula: see text] ) with pelvic pain after conservative surgery for symptomatic endometriosis (Stage I and II) were enrolled at the Department of Pediatric, Obstetrics and Reproductive Medicine of University of Siena. A treatment with a COX-2 specific inhibitors (rofecoxib, 25mg per day) ( [Formula: see text] ) or placebo ( [Formula: see text] ) was given for 6 months. Pelvic pain quantification with a clinical evaluation, including Visual Analogue Scale (VAS) for pain, was performed before and up to 6 months after treatment. Results: A significant improvement of both pelvic pain and dyspareunia was observed after a 6 months persisting since the end of the treatment ( [Formula: see text] ). The efficacy of rofecoxib was higher than placebo and no recurrence occurred, while in the placebo-treatment a 16% (2/12) occurred. No significant side effects have been found with the use of rofecoxib. Conclusions: The use of COX-2 specific inhibitors was effective, safe and low cost therapy in the management of pelvic pain associated to endometriosis and might be also proposed in early stage of endometriosis.

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