Ann Urol (Paris). 2005 Oct;39 Suppl 3:S56-8.
[GnRH antagonists: present and future] [Article in French] Bouchard P.
Service d’endocrinologie, hopital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France. [email protected]
Antagonists act by competitive inhibition of pituitary GnRH receptors for which they have a high affinity with a dose-dependent activity. The inhibition concerns LH but also FSH by inhibiting their secretion for 24 hours. At this time, only three molecules are available. Cetrorelix is mainly used for in vitro fertilization protocols, but research is currently being carried out in benign prostatic hypertrophy. Ganirelix is only used in medically assisted procreation. Abarelix is used in the United States as a monthly "depot" injection for the treatment of prostate cancer resistant to other therapies. Other molecules including orally active antagonists are in the course of clinical evaluation or in preclinical phases. The development of this therapeutic class is hampered by conflicting industrial interests and also by problems of tolerability in particular because of the side effects due to induced histamine release. The current indications in France are therefore limited to Assisted Reproductive Technology, and, recently, prostate cancer pending comparative studies versus agonists. The indications under development are endometriosis, myoma and precocious puberty, fields in which agonists have already been found to be effective. Male contraception seems to have a future however this therapeutic regimen remains very expensive. Finally, in benign prostatic hypertrophy, the antagonists administrated intermittently may be used to rapidly improve urinary flow.
PMID: 16302712 [PubMed – indexed for MEDLINE]
Gastrointest Endosc. 2005 Dec;62(6):978-9; discussion 979.
Erratum in: ? Gastrointest Endosc. 2006 Jan;63(1):198. Abrao, Mauricio [corrected to Abrao, Mauricio S].
Rectal endometriosis.
Averbach M, Abrao MS, Podgaec S, Correa P.
Endoscopy Unit, Hospital Sirio Libanes, Sao Paulo, Brazil.
Publication Types: ? Case Reports
PMID: 16301050 [PubMed – indexed for MEDLINE]
Rev Mal Respir. 2005 Sep;22(4):677-80.
[Pleural endometriosis: an unusual presentation] [Article in French] Baram A, Bagan P, Danel C, Badia A, Riquet M.
Service de Chirurgie Thoracique, Hopital Europeen Georges Pompidou, Universite Paris 5, France.
INTRODUCTION: Numerous conditions can produce chronic exudative pleural effusions. Pleural endometriosis is a rare cause of unilateral effusion with diffuse pleural thickening. CLINICAL CASE: We report the case of chronic pleural effusion in a thirty year old African woman, where pleural endometriosis was diagnosed only following pleuro-pulmonary decortication, with the diagnosis being confirmed by immunohistochemistry. CONCLUSION: Pleural endometriosis must be considered as a possible diagnosis in women with pleural effusions of unknown aetiology. The presence of endometrial glands or of chorionic cells within the pleura is characteristic. Immunohistochemistry is an important diagnostic tool.
Publication Types: ? Case Reports
PMID: 16294186 [PubMed – indexed for MEDLINE]
Gastroenterol Clin Biol. 2005 Aug-Sep;29(8-9):942-4.
[Peritonitis by sigmoid perforation in two patients with endometriosis: report of 2 cases] [Article in French] Vialle R, Pietin-Vialle C, Burdy G, Drain O, Gillot V, Bernier M, Frileux P.
Publication Types: ? Case Reports ? Letter
PMID: 16294169 [PubMed – indexed for MEDLINE]

Hum Reprod. 2006 Mar;21(3):810-7. Epub 2005 Nov 17.
Quantification of endometriotic lesions in a murine model by fluorimetric and morphometric analyses.
Defrere S, Van Langendonckt A, Ramos RG, Jouret M, Mettlen M, Donnez J.
Department of Gynaecology, Universite Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
BACKGROUND: In animal models of endometriosis, the identification and quantification of lesions originating from human endometrium is often hampered by the small size of the implants and their embedding in murine tissue. The purpose of the present study was to develop two new methods of quantifying endometriosis-like lesions in a nude mouse model: fluorimetry and morphometry. METHODS: Human menstrual endometrium was labelled using a fluorescent tracker, carboxyfluorescein diacetate, succinimidyl ester (CFDA-SE), and transplanted into the pelvic cavity of mice by injection through the peritoneum after performing a cutaneous incision. After 5 days, lesions were recovered by laparotomy. The fluorescence of the recovered endometriotic lesions was measured. Endometrial stroma and glands were immunostained in lesion sections with anti-CD10 and anti-CK22 antibodies, and their surface area was evaluated by morphometric analysis. RESULTS: Fluorescent labelling allows identification of lesions not visible macroscopically. A good correlation was observed between fluorimetry and morphometry (r=0.88) applied for lesion quantification. CONCLUSIONS: Fluorimetric evaluation combined with morphometric analysis of endometriosis-like lesions allows objective and reliable recording of endometriosis development in a nude mouse model. This quantification method could therefore be useful for future pharmacological and toxicological studies.
PMID: 16293650 [PubMed – in process]
Dis Colon Rectum. 2006 Feb;49(2):169-74.
Laparoscopic management of rectal endometriosis.
Jatan AK, Solomon MJ, Young J, Cooper M, Pathma-Nathan N.
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Newton, New South Wales, Australia.
PURPOSE: Surgical treatment of females with rectal endometriosis is challenging. The aim of this study was to review the results of laparoscopic intervention in the management of females with this complex disorder. METHOD: All cases of complex tertiary referral pelvic endometriosis requiring laparoscopic surgical intervention of the rectum were identified and reviewed from a prospective database. RESULTS: Between April 1996 and August 2004, 95 patients with pelvic endometriosis involving the rectum had laparoscopic surgical procedures performed by one gynecologist and one colorectal surgeon. Eighty percent of rectal procedures were completed laparoscopically. Forty-three (45 percent) were treated with diathermy excision, 18 (19 percent) had shave partial-thickness disc excision, 20 (21 percent) had full-thickness disc excision (including 14 endoanally using a circular stapler), while 14 (15 percent) were managed with laparoscopic-assisted segmental low anterior resection. A history of rectal pain during defecation present only during menstruation (adjusted odds ratio = 8.6, 95 percent confidence interval (CI) = 1.8-41.2) and previous laparoscopy (adjusted odds ratio = 3.2, 95 percent CI = 1.2-8.3) independently predicted a need for more extensive surgery than diathermy excision. There were no rectal anastomotic leaks, with 8 percent overall morbidity. The only significant predictor of ongoing postoperative symptoms was a history of dyspareunia (P = 0.03). CONCLUSIONS: Patients with complex endometriosis of the rectum can be safely managed laparoscopically using a multidisciplinary approach. This case series suggests that a history of rectal pain during defecation that occurs only during menstruation is predictive of females with more extensive rectal disease.
PMID: 16322961 [PubMed – in process]
Endocrinology. 2006 Mar;147(3):1264-70. Epub 2005 Dec 1.
All-trans retinoic acid inhibits vascular endothelial growth factor expression in a cell model of neutrophil activation.
Tee MK, Vigne JL, Taylor RN.
Department of Gynecology and Obstetrics and Cell Biology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Infiltrating neutrophil granulocytes are a particularly rich source of vascular endothelial growth factor (VEGF) in the endometrium and may contribute to the angiogenesis of endometriosis lesions. The objective of this study is to evaluate the expression and regulation of VEGF in endometrial neutrophils and in a model of neutrophil differentiation relevant to endometriosis. Immunohistochemistry was performed on endometriosis patient biopsies and cultured neutrophil-like HL-60 cells were assessed. The study was set in a reproductive biology division within an academic medical center. Endometrial biopsies were performed on women with endometriosis and HL-60 cells were treated with all-trans retinoic acid (atRA) and dimethyl sulfoxide in vitro. Immunofluorescence histochemistry, VEGF mRNA and protein quantification, and transfection studies of VEGF gene promoter-luciferase constructs were all main outcome measures. Immunofluorescence studies verified the presence of neutrophils in eutopic endometrium from women with endometriosis. Examination of the regulation of VEGF using differentiated HL-60 cells as a model, revealed that atRA induced a dose- and time-dependent suppression of VEGF mRNA and protein. Transient transfection, truncation, EMSA, and site-directed mutagenesis of human VEGF promoter-luciferase constructs in HL-60 cells indicated that atRA repressed VEGF gene transcription via a direct repeat 1 element located between -443 and -431 bp relative to the transcription initiation site. Because retinoic acid is synthesized de novo in endometrial cells under the influence of progesterone, our findings suggest that the up-regulated VEGF and angiogenesis in tissue from women with endometriosis may reflect failure of neutrophil differentiation in these cases, and provide a rationale for retinoid therapy in this condition.
PMID: 16322068 [PubMed – in process]

Exp Cell Res. 2006 Mar 10;312(5):561-74.
The effect of genetic diversity on angiogenesis.
Rogers MS, D’Amato RJ.
Vascular Biology Program, Children’s Hospital, and Department of Ophthalmology Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
Angiogenesis is the process by which new blood vessels are formed from existing vessels. Mammalian populations harbor genetic variations that alter angiogenesis. Some of these changes result in Mendelian traits of variable penetrance, with telangiectasia being a common symptom. Other more subtle variations exist, with promoter variations in the VEGF gene being of particular interest. Genetic diversity in angiogenesis-regulating genes has been linked to increased susceptibility to multiple angiogenesis-dependent diseases in humans. These diseases include cancer, arthritis, atherosclerosis, and cardiovascular disease, endometriosis, diabetic retinopathy, retinopathy of prematurity, psoriasis, and sarcoidosis. Also, multiple disturbances in pregnancy including miscarriage, spontaneous preterm delivery, and severe pre-eclampsia have been linked to alterations in angiogenesis-regulating genes. Present efforts to dissect the complexity of the genetic diversity that regulates angiogenesis have used laboratory animals due to the availability of genome sequence for many species and the ability to perform high volume controlled breeding. Ongoing mapping studies have identified multiple loci that control angiogenic responsiveness in several mouse models. Genetic alterations responsible for discrete angiogenic alterations will then be studied in appropriate mouse disease models.
PMID: 16321383 [PubMed – in process]
J Reprod Med. 2005 Oct;50(10):771-8.
Microlaparoscopy vs. conventional laparoscopy for the management of early-stage pelvic endometriosis: a comparison.
Ikeda F, Vanni D, Vasconcelos A, Podgaec S, Abrao MS.
Departments of Obstetrics and Gynecology and of Anesthesiology, University of Sao Paulo Medical School, Sao Paulo, Brazil. [email protected]
OBJECTIVE: To evaluate the advantages and disadvantages of microlaparoscopy vs. conventional laparoscopy in the management of patients with early-stage pelvic endometriosis. STUDY DESIGN: In this prospective, randomized study we evaluated 54 patients with a clinical diagnosis of stage I and II pelvic endometriosis according to the classification of the American Society for Reproductive Medicine, revised in 1996. The patients were divided into 3 groups and underwent, respectively, microlaparoscopy under sedation, microlaparoscopy under general anesthesia and conventional laparoscopy for definitive diagnosis and treatment of the disease. RESULTS: Microlaparoscopy caused less pain, required lower consumption of analgesics and permitted a faster return to daily activities. Sedation decreased the incidence of nausea, vomiting and oropharyngeal pain. Microlaparoscopy under sedation led to a shorter hospital stay and reduced cost. CONCLUSION: Microlaparoscopy under sedation is a viable alternative for the management of patients with suspected early-stage pelvic endometriosis.
Publication Types: ? Randomized Controlled Trial
PMID: 16320557 [PubMed – indexed for MEDLINE]
J Reprod Med. 2005 Oct;50(10):745-58.
Chronic pelvic pain associated with autoimmunity and systemic and peritoneal inflammation and treatment with immune modification.
Thomson JC, Redwine DB.
Departments of Obstetrics and Gynecology, National Women’s Health, Auckland, New Zealand. [email protected]
OBJECTIVE: To determine the prevalence of chronic inflammation of the pelvic peritoneum, systemic inflammation and autoimmunity in chronic pelvic pain and to explore the significance of these findings and assess the response to treatment with immune modification. STUDY DESIGN: Prospective, observational clinical studies from 2 centers were performed on 3,238 women presenting with pelvic pain to determine the prevalence of chronic inflammation by biopsy when endometriosis was absent. A second study included 40 women with chronic pelvic pain not resulting from endometriosis; immunologic investigations were carried out and therapy instituted. RESULTS: Chronic inflammation of the peritoneum, while not evident in the absence of pelvic pain, was present in 15.7% of women with chronic pelvic pain. In the second group, 10% had histologic evidence of chronic inflammation, 55% demonstrated evidence of systemic inflammation, and 37.5% were found to have autoimmune disorders. Chronic inflammation of the vagina was found in 42.5% and polycystic ovary syndrome in 22% of those with systemic inflammation. Twelve of the 40 were subsequently treated, with considerable success, with immune-modifying drugs, hydroxychloroquine and methotrexate. CONCLUSION: Chronic pelvic pain is frequently associated with systemic inflammation, including autoimmune diseases. Peritoneal chronic inflammation is sometimes also associated. It is often successfully treated with immune-modifying drugs.
Publication Types: ? Multicenter Study
PMID: 16320555 [PubMed – indexed for MEDLINE]

Gynecol Obstet Fertil. 2005 Dec;33(12):1052-3. Epub 2005 Nov 28.
Comment on: ? Gynecol Obstet Fertil. 2005 Jun;33(6):416-22.
[Ovarian endometrioma and infertility: when not to treat?] [Article in French] Belaisch-Allart J.
Publication Types: ? Comment ? Letter
PMID: 16316772 [PubMed – indexed for MEDLINE]
Ginecol Obstet Mex. 2005 Sep;73(9):492-9.
[Endometriosis. Is it a problem of the immunological signs?] [Article in Spanish] Hernandez Quijano T, Hernandez Valencia M, Zarate Trevino A, Perez Figueroa E.
Unidad de Investigacion Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional, Instituto Mexicano del Seguro Social.
Endometriosis syndrome affects 5% to 35% of women in reproductive age. Many theories have been suggested, but the true importance is the survival mechanism of endometriotic tissue, which seems to be related to a defect of the immunological vigilance from macrophages, which are responsible for secretion of a variety of biochemical substances such as cytokines, prostaglandins and growth factors, which through different ways stimulates the growth of the endometrial cells. This has been observed for the clear interrelation between the homeostasis of the body and the evident association of the hormonal factors with the processes of the immunological system, in whose field many steps are unknown.
Publication Types: ? Review
PMID: 16312275 [PubMed – indexed for MEDLINE]
Ginecol Obstet Mex. 2005 Sep;73(9):471-6.
[Incidence of endometriosis in infertile women: clinical and laparoscopic characteristics] [Article in Spanish] Preciado Ruiz R, Torres Calleja J, Zuniga Montiel JA, Martinez Chequer JC, Manterola Alvarez D, Garcia Luna A.
Servicio de biologia de la reproduccion, Hospital Luis Castelazo Ayala, IMSS, Mexico. [email protected]
BACKGROUND: The incidence and symptomatology of endometriosis vary according to the different populations. OBJECTIVES: To determine the incidence of endometriosis as well as the clinical and laparoscopic characteristics in infertile women with endometriosis. PATIENTS AND METHODS: This study included 68 infertile patients with endometriosis diagnosed by laparoscopy; in all of them we analyzed the demographic and clinical characteristics. RESULTS: In 68 out of 197 medical files that were analyzed, endometriosis was reported (34.5%). The average age was 30.3 +/- 3.9 years. Forty patients had primary infertility (58.8%) and 28 (41.29%) secondary infertility. In 34 patients endometriosis (50%) was mild, moderate in 16 (23.5%) and severe in 18 (26.5%). Only one endometriosic foci was found in 25% of the patients and multiple foci in 75% of them. The most common sites in which it was found were the uterosacral ligaments, Douglas pouch and the ovaries. In patients with primary infertility it predominated the medium-high socioeconomic level and in those with secondary infertility the low one. In severe endometriosis the predominant symptom was the moderate or severe dysmenorrhea, while in mild and moderate endometriosis was mild dysmenorrhea (p < 0.007). Six out of 16 patients with severe endometriosis had endometrioma. CONCLUSIONS: The endometriosis incidence in infertile women was similar to that reported in literature, as well as age of presentation. It was also observed a direct relationship between endometriosis severity and dysmenorrhea intensity.
PMID: 16312272 [PubMed – indexed for MEDLINE]
Hum Reprod. 2006 Apr;21(4):864-869. Epub 2005 Nov 25.
HLA-G is expressed by the glandular epithelium of peritoneal endometriosis but not in eutopic endometrium.
Barrier BF, Kendall BS, Ryan CE, Sharpe-Timms KL.
Department of Obstetrics, Gynecology and Women’s Health, Division of Reproductive and Perinatal Research, University of Missouri-Columbia, Missouri and Department of Pathology, Wilford Hall Medical Center, Lackland A.F.B., Texas, USA.
BACKGROUND: HLA-G is a major histocompatability antigen with documented immune-regulatory function. Various epithelial cancers and tissue allografts have been noted to express HLA-G, which is postulated to aid in their escape from immunosurveillance. We evaluated peritoneal endometriosis and eutopic endometrium for the expression of HLA-G protein and gene transcript. METHODS: Two experiments were performed: (i) archived tissue blocks from peritoneal endometriotic lesions (n = 15) and eutopic endometrium (n = 12) were evaluated for extent of protein immunostaining, and (ii) eutopic endometrial biopsies from women without (n = 17) and with (n = 24) endometriosis, and peritoneal endometriotic lesions (n = 14) were evaluated for presence of RNA transcript by in situ hybridization. RESULTS: HLA-G protein localized in the glandular epithelium of 14 of 15 (93.3%) peritoneal endometriotic lesions, but not in stromal cells. HLA-G protein staining was absent in endometrial biopsies (n = 12). HLA-G gene transcript localized to the glandular epithelium in 13 of 14 (92.8%) peritoneal endometriotic lesions. HLA-G transcript was never observed in eutopic endometrium, regardless of cycle stage or whether from women with (n = 24) or without (n = 18) endometriosis. CONCLUSIONS: HLA-G is expressed by endometriotic glandular epithelium but not by eutopic endometrium under normal conditions. Differential expression of HLA-G suggests that peritoneal inflammation or cellular stress may up-regulate mechanisms to promote ectopic endometrial survival.
PMID: 16311290 [PubMed – as supplied by publisher]
Gynecol Obstet Fertil. 2005 Dec;33(12):1014-7. Epub 2005 Nov 28.
[Indications of GnRH analogues before and after surgery for endometriosis] [Article in French] Darai E, Dubernard G, Azoulay C, Barranger E, Antoine JM, Uzan S.
Service de gynecologie-obstetrique, hopital Tenon, UFR Saint-Antoine, universite Paris-VI, France. [email protected]
Indications of GnRH analogues before and/or after surgery for endometriosis remain controversial. Although some studies have underlined a decrease in rAFS scores using GnRH analogues pre-operatively, data are insufficient to recommend their systematic use in routine. In the same way, despite an increase in symptom free period subsequent to the use of GnRH analogues post-operatively, no effect of this therapeutic on recurrence rate and fertility outcome has been proved. In addition to a meta-analysis on GnRH analogues in endometriotic women, further studies, especially in women with large endometriomas and with deep pelvic endometriosis, are required to clarify the indications of GnRH analogues associated with surgical management.
Publication Types: ? Review
PMID: 16311060 [PubMed – indexed for MEDLINE]
J Reprod Immunol. 2006 Feb;69(1):53-64. Epub 2005 Nov 28.
Interleukin-11, IL-11 receptoralpha and leukemia inhibitory factor are dysregulated in endometrium of infertile women with endometriosis during the implantation window.
Dimitriadis E, Stoikos C, Stafford-Bell M, Clark I, Paiva P, Kovacs G, Salamonsen LA.
Prince Henry’s Institute of Medical Research, P.O. Box 5152, Clayton, Vic. 3168, Australia. [email protected]
Interleukin (IL)-11 is essential for embryo implantation in the mouse and evidence suggests it has a role in implantation in humans. This study has evaluated immunoreactive IL-11, IL-11 receptor (R) alpha and leukemia inhibitory factor (LIF) in endometrium of infertile women with endometriosis (I/E) and normal fertile women (controls) during the implantation window. Endometrial biopsies from I/E (N = 7) were timed from the LH surge and were post-ovulatory days (POD) 5-10. Control biopsies (N = 8) from women were between days 19 and 24 of the menstrual cycle. Staining intensity of IL-11, IL-11Ralpha and LIF evaluated using semi-quantitative immunohistochemistry scores. Immunoreactive IL-11, IL-11Ralpha and LIF were present predominantly in glandular epithelium, while luminal epithelium showed patchy staining. All controls stained positively for IL-11, IL-11Ralpha and LIF in glandular epithelium. IL-11 and IL-11Ralpha staining was absent from glandular epithelium in cohorts of I/E. LIF staining intensity in glandular epithelium was significantly lower in I/E compared to controls. The results suggest that reduced endometrial IL-11 and/or LIF may contribute to infertility in some endometriotic women.
PMID: 16310857 [PubMed – in process]
J Am Coll Surg. 2005 Dec;201(6):913-7. Epub 2005 Oct 10.
The LANN technique to reduce postoperative functional morbidity in laparoscopic radical pelvic surgery.
Possover M, Quakernack J, Chiantera V.
Department of Obstetrics and Gynecology, St Elisabeth-Hospital, Cologne, Germany.
BACKGROUND: We investigated the feasibility and advantages of introducing Laparoscopic Neuro-Navigation (LANN) into the field of laparoscopic gynecologic radical pelvic surgery. STUDY DESIGN: In a prospective pilot study, 261 consecutive patients underwent laparoscopic radical pelvic surgery for cervical cancer or deep infiltrating endometriosis of the parametria. During the procedure, dissection and electrostimulation, and consequently, sparing of the pelvic parasympathetic nerves by transection of the parametria, were performed. Postoperative bladder dysfunction was documented. RESULTS: Laparoscopic dissection and electrostimulation of the pelvic splanchnic nerves were feasible in all patients without any complications, and the rate of postoperative bladder dysfunction was considerably reduced, to less than 1% of the patients. CONCLUSIONS: The parasympathetic nerve-sparing method using the Laparoscopic Neuro-Navigation technique in laparoscopic radical pelvic gynecologic surgery is a feasible and reproducible technique that preserves postoperative bladder function.
PMID: 16310695 [PubMed – indexed for MEDLINE]

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