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68: BMC Health Serv Res. 2004 Jun 28;4(1):14.

Effect of prize draw incentive on the response rate to a postal survey of obstetricians and gynaecologists: a randomised controlled trial. [ISRCTN32823119].
Moses SH, Clark TJ.
Worcestershire Royal Hospital , Worcester WR5 1DD UK . smoses@doctors.org.uk
BACKGROUND: Response rates to postal questionnaires are falling and this threatens the external validity of survey findings. We wanted to establish whether the incentive of being entered into a prize draw to win a personal digital assistant (PDA) would increase the response rate for a national survey of consultant obstetricians and gynaecologists. METHODS: A randomised controlled trial was conducted. This involved sending a postal questionnaire to all Consultant Obstetricians and Gynaecologists in the United Kingdom . Recipients were randomised to receiving a questionnaire offering a prize draw incentive (on response) or no such incentive. RESULTS: The response rate for recipients offered the prize incentive was 64% (461/716) and 62% (429/694) in the no incentive group (relative rate of response 1.04, 95% CI 0.96 – 1.13) CONCLUSION: The offer of a prize draw incentive to win a PDA did not significantly increase response rates to a national questionnaire survey of consultant obstetricians and gynaecologists.
Publication Types:
Clinical Trial Randomized Controlled Trial
PMID: 15222889 [PubMed – indexed for MEDLINE]

69: Proteomics. 2004 Jul;4(7):1897-902.
Proteomic approaches in endometriosis research.
Poliness AE, Healey MG, Brennecke SP, Moses EK.
Departments of Perinatal Medicine and Gynaecology, The Royal Women’s Hospital, 132 Grattan Street , Carlton , Melbourne 3053, Australia . anne.poliness@rwh.org.au
To date, the quest to develop a noninvasive diagnostic test for endometriosis has mostly concentrated on the levels of cytokines and growth factors that are involved in inflammation, angioneogenesis and tissue remodeling, present in serum, peritoneal fluid, endometrium and endometriotic lesions. As this has not yet translated into the development of such a diagnostic test, proteomic techniques are now being employed to identify proteins that are potential biomarkers for the disease. As proteomics allows the comprehensive analysis of complex fluid and tissue samples with good sensitivity and resolution, it has promise in delivering markers associated with endometriosis. Once identified, the challenge will be in translating these markers into a clinically useful test for endometriosis, as the pathophysiology of this disease is unknown and likely to be complex and multifactorial. Also, with variation between individuals and the influences of steroid hormones during the menstrual cycle, it could be difficult to validate findings relating to a single protein or small groups of proteins differentially expressed in the disease state. Proteomic profiling, using mass spectrometry in combination with sophisticated bioinformatics software to identify protein patterns, may be where a significant clinical diagnostic contribution can be made.
PMID: 15221746 [PubMed – in process]

70: Med Electron Microsc. 2004 Jun;37(2):97-100.
Malignant transformation of endometriosis: application of laser microdissection for analysis of genetic alterations according to pathological changes.
Sekizawa A, Amemiya S, Otsuka J, Saito H, Farina A, Okai T, Tachikawa T.
Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. sekizawa@med.showa-u.ac.jp
Endometriosis is considered to be a possible precancerous disease. Pathologically, we observed malignant transformation of endometriosis to clear cell carcinoma or endometriotic carcinoma of the ovary, via the step of atypical endometriosis. Pathological changes reflected genetic alterations. In cases of clear cell carcinoma, we assessed K- ras mutations in regions of normal endometriosis, atypical endometriosis, and clear cell carcinoma, and obtained tissue samples by laser microdissection. We found that K- ras mutations were associated with malignant transformation of clear cell carcinoma. The present results indicate that laser microdissection can be used to combine assessment of genetic and pathological changes. Copyright 2004 The Clinical Electron Microscopy Society of Japan
Publication Types:
Review Review, Tutorial
PMID: 15221651 [PubMed – indexed for MEDLINE]

71: Virchows Arch. 2004 Jun;444(6):587-9. Epub 2004 Apr 23.
Endometrioid carcinoma of the urinary bladder complicating vesical Mullerianosis: a case report and review of the literature.
Garavan F, Grainger R, Jeffers M.
Department of Cellular Pathology, The Adelaide and Meath Hospital , Tallaght, Dublin 24, Ireland .
Endometriosis of the urinary bladder is uncommon, and malignant transformation within vesical endometriosis is extremely rare. Vesical endometriosis and Mullerianosis can cause problems in differential diagnosis with vesical neoplasm, and, conversely, primary vesical neoplasm arising in endometriosis can be difficult to distinguish from secondary vesical involvement. Mullerianosis has rarely been described in the urinary bladder. A case of endometrioid adenocarcinoma of the urinary bladder is reported, which illustrates the difficulties in diagnosis and the importance of morphology and ancillary studies in establishing the correct diagnosis. Copyright 2004 Springer-Verlag
Publication Types:
Case Reports
PMID: 15221475 [PubMed – indexed for MEDLINE]

72: Arch Gynecol Obstet. 2004 May;269(4):290-3. Epub 2002 Nov 09.
Hepatocellular adenoma and focal nodular hyperplasia after long-term use of danazol for endometriosis: a case report.
Bartley J, Loddenkemper C, Lange J, Mechsner S, Radke C, Neuhaus P, Ebert AD.
Endometriosis Research Center Berlin , Department of Obstetrics and Gynecology, University Hospital Benjamin Franklin, Free University of Berlin , Hindenburgdamm 30, 12200 Berlin , Germany .
Danazol, an inhibitor of pituitary gonadotropin with weak androgenic effect, is currently being used for the treatment of endometriosis. In contrast to other C17 alkylated anabolic steroids, it has been rarely associated with the occurrence of primary liver tumors. We present the case of a patient with endometriosis in whom a hepatocellular adenoma was discovered after 14 years of treatment with danazol for endometriosis. The patient showed no clinical signs of a liver tumor and it was only detected by ultrasonography and magnetic resonance imaging (MRI). When long-term danazol therapy is required, regular ultrasonography for monitoring and early tumor detection is recommended.
Publication Types:
Case Reports
PMID: 15221322 [PubMed – indexed for MEDLINE]

73: Ann Pathol. 2004 Apr;24(2):172-5.
[Independent endometrial and ovarian carcinomas: two cases of synchronous and metachronous endometrioid carcinomas] [Article in French] de la Fouchardiere A, Frachon S, Gengler C, Devouassoux-Shisheboran M.
Service d’Anatomie Pathologique, Hopital de la Croix Rousse, 103 Grande rue de la Croix Rousse, 69317 Lyon 04.
Simultaneous carcinomas involving both the ovary and the endometrium may cause diagnostic difficulties, particularly if the tumors have a similar histology. We report two cases of independent endometrioid carcinomas of the endometrium and the ovary. Tumor development was synchronous in one case and metachronous in the other. These cases illustrate the morphological criteria helpful in distinguishing independent primaries from metastatic carcinomas which have a different therapeutic implication. Endometrial tumors were intra-mucosal without myometrial or vascular invasion, or tubal involvement and were associated with atypical complex hyperplasia (case 2). The ovarian tumors were uninodular, unilateral, without hilar invasion and were associated with endometriosis (case 2). The prognosis of endometrioid type carcinomas is better than for other histological types of carcinoma. Both our patients are well and disease free at 27 and 24 months.
PMID: 15220837 [PubMed – in process]

74: Hum Reprod. 2004 Jul;19(7):1680-1.
‘Endometriosis rediscovered?’: Reply.
Garry R.
PMID: 15220311 [PubMed – in process]

75: Hum Reprod. 2004 Jul;19(7):1679-80; author reply 1680-1.
Endometriosis rediscovered?
Brosens I.
Publication Types:
PMID: 15220310 [PubMed – in process]

76: J Soc Gynecol Investig. 2004 Jul;11(5):318-22.
Apoptosis and differential expression of apoptosis-related proteins in endometriotic glandular and stromal cells.
Goumenou AG, Matalliotakis IM, Tzardi M, Fragouli YG, Mahutte NG, Arici A.
Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8063, USA.
OBJECTIVE: Apoptosis is an important regulator of eutopic endometrial function. Endometriosis, the growth of endometrial tissue outside the uterus, could result from increased cellular proliferation or decreased apoptosis in response to appropriate stimuli. The objective of this study was to evaluate the rate of apoptosis and the expression of apoptosis-related Bcl-2 and Bax proteins in endometriotic tissues within the glandular and stromal compartments, according to the phase of the menstrual cycle and the stage of disease. METHODS: Ovarian endometriosis samples were evaluated in 75 women who had surgery at a university hospital. Apoptotic cells were detected with the use of the dUTP nick-end labeling (TUNEL) assay. Bcl-2 and Bax expression were assessed by immunohistochemical techniques. RESULTS: The percentage of apoptotic cells was significantly higher in endometriotic stromal cells (73.3%) compared with glandular cells (48%; P =.002). In contrast, the expression of the apoptosis-related proteins Bcl-2 and Bax was significantly lower in the endometriotic stroma (17.3% for both) than in the glandular epithelium (38.6% and 41.3%, respectively; P <.004). No significant menstrual cycle phase-dependent changes or endometriosis stage-related changes were observed in TUNEL, Bcl-2, or Bax positivity within ovarian endometriotic tissues. CONCLUSION: Apoptosis occurs in ovarian endometriotic lesions at significantly higher levels in the stroma than the glandular epithelium. However, Bcl-2 and Bax proteins are distributed preferentially in glandular epithelial cells. The apoptotic rate as well as Bcl-2 and Bax expression in ovarian endometriotic cells were not affected by the stage of endometriosis or the phase of the menstrual cycle.
PMID: 15219886 [PubMed – in process]

77: Nefrologia. 2004;24 Suppl 3:85-8.
[Porphyria and inappropriate antidiuretic hormone syndrome] [Article in Spanish] Lopez Montes A, Lorenzo I, Perez Martinez J.
Servicio de Nefrologia, Hospital General Universitario de Albacete, Albacete . auroralmontes@hotmail.com
We report the case of a 37-years-old woman with inappropriate antidiuretic hormone syndrome due to an attack of acute porphyria. The patient was admitted to our hospital for abdominal pain, sleepiness and pink urine. Family and personal history were normal. Seven days before the admission the patient had a laparoscopy operation for endometriosis in her left ovary. The patient had had two normal pregnancies. The physical examination was normal, the skin turgor was good and no edema was present, the blood pressure was 140/90 mmHg. Her serum sodium was 114 mEq/L, serum osmolality 243 mOsm/kg, urine sodium 146 mEq/L and urine osmolality 457 mOsm/kg. Values from laboratory examination revealed a normal peripheral haematogram, a normal kidney function, normal liver, adrenal and thyroid function. The urine tested for amino-levulinic acid, coproporphyrin and uroporphyrin was strongly positive. These findings are compatible with Porphyria Variegata or Coproporphyria Hereditary. A diagnosis of Porphyria acute with SIADH was made, and water fluid restriction, i.v. hypertonic saline infusion and furosemide to correct the hyponatremia was begun. In 1966, lesions of the median eminence of the hypothalamus and both hypothalamic -hypophyseal tracts were described in a patient with Porphyria acute intermittent and SIADH. It was suggested that SIADH occurred because of damage to these areas of the brain from excessive exposure to porphyrins.
Publication Types:
Case Reports
PMID: 15219077 [PubMed – indexed for MEDLINE]

78: Hum Reprod. 2004 Aug;19(8):1871-6. Epub 2004 Jun 24.
Use of the concomitant serum dosage of CA 125, CA 19-9 and interleukin-6 to detect the presence of endometriosis. Results from a series of reproductive age women undergoing laparoscopic surgery for benign gynaecological conditions.
Somigliana E, Vigano P, Tirelli AS, Felicetta I, Torresani E, Vignali M, Di Blasio AM.
Department of Obstetrics and Gynecology, Clinica ‘L.Mangiagalli’, University of Milano, Italy. dadosomigliana@yahoo.it
BACKGROUND: Recent studies have proposed the measurement of CA 19-9 and IL-6 as an alternative to CA 125 as markers for endometriosis. This study was performed in order to verify the clinical value of serum CA 125, CA 19-9 and IL-6 levels, either by themselves or combined, in the detection of the disease. METHODS: In a prospective cohort study, serum concentrations of CA 125, CA 19-9 and IL-6 were measured in a consecutive series of 80 women of reproductive age who underwent laparoscopy for benign gynaecological pathologies. RESULTS: Endometriosis was documented in 45 women (stage I-II in 14 cases and stage III-IV in 31 cases). Patients with endometriosis had significantly higher levels of CA 125 than controls [23.4 IU/ml (13.3-37.6) versus 11.4 IU/ml (9.1-18.5), P < 0.001)]. Conversely, women with and without the disease were shown to have similar levels of both IL-6 pg/ml [0.6 (undetectable-1.4) versus 1.0 pg/ml (0.4-1.9), P = 0.09] and CA 19-9 [9.8 IU/ml (4.5-20.8) versus 7.4 IU/ml (2.8-11.5), P = 0.11]. The area under the receiver operating characteristics curve resulted in a statistically significant difference from the null hypothesis only for CA 125 (P < 0.001). Sensitivity and specificity of CA 125 were 27 and 97% respectively and were higher than those related to CA 19-9 and IL-6. Concomitant use of the three dosages led to a sensitivity and a specificity of 42 and 71% respectively. CONCLUSIONS: The concomitant dosage of CA 125, CA 19-9 and IL-6 does not add significant information in respect to the CA 125 test alone in diagnosing either early or advanced stages of endometriosis. Copyright 2004 European Society of Human Reproduction and Embryology
PMID: 15218003 [PubMed – in process]

79: Hum Reprod. 2004 Sep;19(9):1974-8. Epub 2004 Jun 24.
Decreased expression of killer cell inhibitory receptors on natural killer cells in eutopic endometrium in women with adenomyosis.
Yang JH, Chen MJ, Chen HF, Lee TH, Ho HN, Yang YS.
Department of Obstetrics and Gynecology and Department of Medical Research, College of Medicine and the Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan.
BACKGROUND: Increased expression of killer cell inhibitory receptors (KIRs) has been found on natural killer (NK) cells in peritoneal fluid in women with endometriosis. In this study, we tried to measure the expression of KIRs on NK and T cells in women with adenomyosis, in an attempt to find the possible role of KIRs in the development of adenomyosis. METHODS: A total of 10 women with adenomyosis (study group) and 12 women with uterine myoma (control group) were included in this study. The expression of KIRs, including NKB1, GL183, EB6 and CD94, on NK and T cells in myometrium and endometrium was examined by flow cytometry. RESULTS: There was a decreased expression of NKB1 and GL183 on NK cells in the endometrium, but not in the myometrium, in women with adenomyosis. However, the expression of KIRs on T cells, either CD4(+) or CD8(+), was not different in either myometrium or endometrium between women with and without adenomyosis. CONCLUSIONS: The expression of KIRs on NK cells was decreased in eutopic endometrium in women with adenomyosis. It may be a compensatory effect in which the NK cytotoxicity is activated in order to eradicate the abnormal endometrial cells that might exit of the eutopic site of the endometrium.
PMID: 15217996 [PubMed – in process]

80: J Med Assoc Thai. 2004 Apr;87(4):361-6.
Comparison of fecundity after second laparotomy for endometriosis to in vitro fertilization and embryo transfer.
Cheewadhanaraks S.
Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University , Songkla , Thailand . csophon@medicine.psu.ac.th
OBJECTIVE: To study the prognosis for conception subsequent to a second conservative laparotomy for infertile patients with moderate and severe endometriosis, compared with the reproductive outcome of one cycle of in vitro fertilization and embryo transfer (IVF-ET). MATERIAL AND METHOD: From January 1990 to February 2000, 190 infertile patients had initial conservative laparotomy for pelvic endometriosis at a university hospital. All of these patients had moderate or severe endometriosis. After the failure of the initial operation to restore fertility, 32 patients requested the second operation while 24 patients underwent one cycle of IVF-ET. The cumulative pregnancy rate after the second operation was compared with the clinical pregnancy rate after one cycle of IVF-ET. RESULT: The cumulative pregnancy rate following the reoperation was 20.5% within 1 year with no additional increase in 2 and 3 years of follow up. The clinical pregnancy rate per stimulation of one cycle of IVF-ET was 12.5%. There was no statistically significant difference (P = 0.54). CONCLUSION: Despite a trend toward a higher cumulative pregnancy rate following the second conservative laparotomy, there was no statistically significant difference, when compared with one cycle of IVF-ET in moderate and severe endometriosis-associated infertile patients who had not conceived after the initial operation.
PMID: 15217170 [PubMed – indexed for MEDLINE]

81: Ginecol Obstet Mex. 2004 Feb;72:76-84.
[Progesterone antagonists: biochemical and pharmacological aspects and clinical usefulness] [Article in Spanish] Teran Davila J, Teppa Garran A.
Servicio de investigaciones y docencia, Maternidad Concepcion Palacios, Caracas , Venezuela . catireteran@hotmail.com
Although classically the antiprogestins have been used for the control of pregnancy diseases and adrenal function, in the medical literature are a plenty of papers about the treatment with progesterone antagonists of leiomyoma, breast cancer, endometriosis and meningioma. The treatment is beneficial or mitigating in greatest number of cases, but they have other different uses than usual like contraception and abortion.
Publication Types:
Review Review, Tutorial
PMID: 15216905 [PubMed – indexed for MEDLINE]

82: Rozhl Chir. 2004 May;83(5):239-41.
[Extragenital endometriosis as a subject of interest for the surgeon] [Article in Czech] Suchy T, Stepan J.
Endometriosis is a common gynaecological disorder, affecting 10-15% of the fertile female population. Most frequently, it affects internal genitalia, the main symptoms being pelvialgia and infertility. In 5% of the cases the disorder may also affect extragenital structures and present itself as endometriomas of the appendix, the small or the large intestine, the umbilicus, the inguinal canal, the residual scars after laparotomies or the diaphragm. They may also imitate a malignancy. The diagnostic key is the cyclic character of the pain or of the bleeding to the tract and the laparoscopic confirmation of the presence of the foci. When the diagnosis is known, a simple excision, extirpation or resection suffices. In case the malignancy cannot be excluded, a more extensive procedure is indicated. The authors present two case-reviews during a twelve-year period, in both cases the sigmoid was affected. In the first case, a radical resection of the rectosigmoid due to a suspected malignancy was performed, while in the second case, a simple excision of the endometrioma where the diagnosis was known was performed. The authors stress-out advantages of the interdisciplinary approach to the treatment of the complicated cases of endometriosis, so that the disorder would be solved in one surgical procedure.
Publication Types:
Case Reports
PMID: 15216680 [PubMed – indexed for MEDLINE]

83: J Radiol. 2004 Apr;85(4 Pt 1):409-10.
[Incisional subcutaneous endometrioma of the abdominal wall: report of two cases] [Article in French] Merran S, Karila-Cohen P.
Departement d’Imagerie Medicale, Federation Mutualiste Parisienne, 24 Rue saint Victor, 75005 Paris . samuel.merran@wanadoo.fr
Endometriosis occurs in up to 15% of menstruating women. Abdominal wall involvement is rare and always secondary to an invasive procedure. The authors report the imaging and clinical findings of two patients with subcutaneous endometrioma following cesarean section.
PMID: 15213651 [PubMed – in process]

84: Am J Reprod Immunol. 2004 May;51(5):373-80.
The differential expression of intercellular adhesion molecule-1 (ICAM-1) and regulation by interferon-gamma during the pathogenesis of endometriosis.
Wu MH, Yang BC, Lee YC, Wu PL , Hsu CC.
Institute of Clinical Medicine, Department of Obstetrics and Gynecology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.
PROBLEM: To establish an in vitro culture model of the endometrium and endometriotic lesions, and demonstrate the different expressions of intercellular adhesion molecule-1 (ICAM-1) in these lesions. METHODS: Eight women with moderate to severe stages of endometriosis were enrolled. The specimens were collected from their eutopic endometrium, visually normal peritoneum, ovarian endometrioma and peritoneal endometriotic spots during the follicular phase of the menstrual cycle. ICAM-1 mRNA and protein were expressed by using reverse transcription-polymerase chain reaction, enzyme-linked immunosorbent assay, immunoblot, and immunocytochemistry. RESULTS: The results demonstrate that visually normal peritoneal cells and ovarian endometriomas of endometriotic patients can express high ICAM-1 mRNA. Normal peritoneal cells further expressed significant soluble ICAM-1 protein levels without cytokine stimulation. The eutopic endometrium expressed less soluble ICAM-1 protein, and ICAM-1 expressions increased in cultured stromal cells of eutopic endometrium, ovarian endometrioma, and peritoneal endometriotic spots under interferon-gamma (INF-gamma) stimulation. CONCLUSION: The ICAM-1 expression in visually normal peritoneal cells from women with endometriosis may play a role in the early implantation of peritoneal endometriosis. Peritoneal INF-gamma stimulation is significantly associated with ICAM-1 expression in endometriosis. Therefore, the differential expression and changes of ICAM-1 may be involved in the mechanism that can escape immunosurveillance and allow refluxed endometrial cells to spread and invade other location.
PMID: 15212674 [PubMed – indexed for MEDLINE]

85: Am J Reprod Immunol. 2004 May;51(5):364-72.
Killer inhibitory receptor CD158a overexpression among natural killer cells in women with endometriosis is undiminished by laparoscopic surgery and gonadotropin releasing hormone agonist treatment.
Maeda N, Izumiya C, Kusum T, Masumoto T, Yamashita C, Yamamoto Y, Oguri H, Fukaya T.
Department Obstetrics and Gynecology, Kochi Medical School Oko, Nankoku, Kochi , Japan . maedan@med.kochi-u.ac.jp
PROBLEM: Natural killer (NK) dysfunction is considered to contribute to the pathogenesis of endometriosis. In this study, we investigated the host immune response to endometriosis in terms of killer inhibitory receptor (KIR) expression by NK cells. METHOD OF STUDY: We compared cells from Japanese women laparoscopically diagnosed with endometriosis and treated with laparoscopic surgery (n = 98), 1 month after laparoscopic surgery (n = 36), and 12 weeks after gonadotropin releasing hormone agonist (GnRHa) treatment (n = 18) to cells from 104 women with other laparoscopic diagnoses. KIR expression by NK cells was assessed in peripheral blood and peritoneal fluid samples by flow cytometry. RESULTS: In women with endometriosis, the percentage of CD158a-expressing cells among CD16-expressing NK (CD158a(+)NK) cells in both peritoneal fluid and peripheral blood was significantly higher than in control subjects. No significant differences in proportion of CD158a(+)NK cells were identified between peripheral blood NK cells sampled before and 1 month after laparoscopic surgery , or 12 weeks after initiating GnRHa treatment. CONCLUSIONS: Increased percentage of CD158a(+)NK cells in peripheral blood from women with endometriosis was undiminished by laparoscopic surgery and GnRHa treatment; the persistence of CD158a(+)NK cell excess is probably related to NK cell suppression in endometriosis. This overexpression may represent a risk factor for development of endometriosis and its recurrence after treatments.
PMID: 15212673 [PubMed – indexed for MEDLINE]

86: Am J Reprod Immunol. 2004 May;51(5):352-7.Genetic contribution of tumor necrosis factor (TNF)-alpha gene promoter (-1031, -863 and -857) and TNF receptor 2 gene polymorphisms in endometriosis susceptibility.
Teramoto M, Kitawaki J, Koshiba H, Kitaoka Y, Obayashi H, Hasegawa G, Nakamura N, Yoshikawa T, Matsushita M, Maruya E, Saji H, Ohta M, Honjo H.
Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
PROBLEM: Tumor necrosis factor (TNF)-alpha is a major cytokine involved in inflammatory and immune function. The aim of this study was to investigate whether polymorphisms at positions -1031, -863 and -857 in the TNF gene promoter region (TNFA) and TNF receptor type 2 gene (TNFR2) are responsible in part for genetic susceptibility to endometriosis. METHODS OF STUDY: TNFA and TNFR2 polymorphisms were determined in 123 patients with endometriosis and 165 fertile healthy women by the polymerase chain reaction (PCR) – preferential homoduplex formation assay and PCR-restriction fragment length polymorphism, respectively. RESULTS: The frequency of the TNFA-U01 haplotype was increased significantly in patients with endometriosis compared with controls (P = 0.045, OR = 1.45). The TNFA-U01 haplotype was strongly associated with HLA-B*0702. No difference was found in TNFR2 polymorphism between patients and controls. CONCLUSION: Our results indicated that TNFA promoter polymorphism was associated with susceptibility to endometriosis. However, this association was not independent of HLA-class I polymorphisms.
PMID: 15212671 [PubMed – indexed for MEDLINE]

87: Am J Reprod Immunol. 2004 May;51(5):341-4.
Localization of mast cells in endometrial cysts.
Fujiwara H, Konno R, Netsu S, Sugamata M, Shibahara H, Ohwada M, Suzuki M.
Department of Gynecology, Omiya Medical Center , Jichi Medical School , Amanuma-cho, Saitama , Japan . fujiwara@jichi.ac.jp
PROBLEM: Although the presence of mast cells in endometriosis lesions has been reported, there have been no reports of their pathological localization in ovarian endometrial cysts. METHODS OF STUDY: The localization of mast cells in ovarian endometrial cysts were investigated using hematoxyline and eosin and toluidine blue staining with light microscopy, immunohistochemical c-kits, and electron microscopy. RESULTS: Mast cells were identified in endometrial cyst tissues. Few mast cells were localized in the endometrial stroma, which is characteristic of endometrial gland-like regions. Many mast cells were noted around blood vessels and the interstitium with fibrosis, that is, the fibrotic interstitium of endometrial cysts. CONCLUSIONS: Mast cells may be involved in the development and progression of endometriosis. Localization of mast cells suggests a particularly close relationship with fibrosis and adhesion.
PMID: 15212669 [PubMed – indexed for MEDLINE]

88: Cancer. 2004 Jun 25;102(3):157-63.
Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy.
Vander Noot MR 3rd, Eloubeidi MA, Chen VK, Eltoum I, Jhala D, Jhala N, Syed S, Chhieng DC.
Department of Pathology, University of Alabama-Birmingham, Birmingham , Alabama , USA .
BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) allows detailed imaging of both intramural and extramural structures of the gastrointestinal (GI) tract and also allows tissue samples to be obtained from masses and lesions in the GI tract. The objective of the current study was to determine the diagnostic utility of EUS-FNA in evaluating intramural and extramural GI tract lesions. METHODS: The authors evaluated all EUS-FNA specimens of GI tract lesions obtained over a 30-month period (from August 2000 to February 2003). Samples of pancreatic and intrabdominal/mediastinal lymph nodes were excluded from the study. A single endosonographer performed all procedures. An attending cytopathologist also was present on site to assess specimen adequacy. Cytologic diagnoses were analyzed for correlations with final diagnoses, which were based on histologic examination of biopsied/resected pathology materials and/or clinical follow-up findings. RESULTS: Sixty-two EUS-FNA specimens of intramural and extramural GI tract lesions were obtained from a total of 60 patients. The mean patient age was 58.8 years (standard deviation, 15.3 years). Thirty-six patients (60%) were male, and 24 (40%) were female. Twenty-eight patients had surgical pathologic evaluation of the corresponding lesions. The remaining 32 patients were followed clinically for a mean duration of 9.5 months (standard deviation, 7.7 months). The anatomic sites of the lesions were as follows: esophagus in 23 patients (37%), stomach in 13 patients (21%), duodenum in 15 patients (24%), and rectum/sigmoid in 11 patients (18%). It is noteworthy that 29 patients (43%) previously had experienced unsuccessful attempts at tissue diagnosis by endoscopic forceps biopsy. Of the 62 EUS-FNA specimens, 43, 4, and 15 were reported as being positive for a neoplasm, suspicious, and benign, respectively. Neoplastic lesions included carcinoma (n = 24), gastrointestinal stromal tumor (GIST; n = 18), neuroendocrine neoplasm (n = 2), and lymphoma (n = 1). There were two cases of endometriosis, three foregut duplication cysts, and one case of diverticulosis. There were two lesions that yielded false-negative findings (one gastric lymphoma and one GIST) secondary to sampling or interpretive error. There also were three cases that yielded false-positive findings (one case of endometriosis, one case of duodenal diverticula with smooth muscle hyperplasia, and one case of normal pancreas, which presented as a periduodenal mass). The sensitivity, specificity, and diagnostic accuracy of EUS-FNA in diagnosing GI tract neoplastic lesions were 89%, 88%, and 89%, respectively. CONCLUSIONS: EUS-FNA provides accurate tissue diagnosis in a wide variety of extraintestinal mass lesions and intramural GI tumors, particularly in patients for whom previous endoscopic forceps biopsy was unsuccessful in establishing a diagnosis. Copyright 2004 American Cancer Society.
PMID: 15211474 [PubMed – indexed for MEDLINE]

89: Radiology. 2004 Aug;232(2):379-89. Epub 2004 Jun 17.
Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease.
Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, Buy JN.
Department of Radiology, Hopital Tenon, Assistance Publique-Hopitaux de Paris, 4 rue de la Chine, Paris 75020 , France . marc.bazot@tnn.ap-hop-paris.fr
PURPOSE: To prospectively evaluate the accuracy of magnetic resonance (MR) imaging for the preoperative diagnosis of deep pelvic endometriosis and extension of the disease. MATERIALS AND METHODS: One hundred ninety-five patients (mean age, 34.2 years; range, 20-71 years) who were suspected of having pelvic endometriosis were recruited at two institutions. Two experienced radiologists evaluated the MR images independently. Deep pelvic endometriosis was defined as implants or tissue masses that appeared as hypointense areas and/or hyperintense foci on T1- or T2-weighted MR images in the following locations: torus uterinus, uterosacral ligaments (USLs), vagina, rectovaginal septum, rectosigmoid, and bladder. MR imaging results were compared with surgical and pathologic findings. Sensitivity, specificity, predictive values, and accuracy of MR imaging for prediction of deep pelvic endometriosis were assessed. RESULTS: Pelvic endometriosis was confirmed at pathologic examination in 163 (83.6%) of 195 patients. Endometriomas, peritoneal lesions, and deep pelvic endometriosis were diagnosed on the basis of surgical findings, alone or combined with pathologic findings, in 111 (68.1%), 83 (50.9%), and 103 (63.2%) of 163 patients, respectively. Torus uterinus and USL were the most frequent sites of deep pelvic endometriosis. The sensitivity, specificity, positive and negative predictive values, and accuracy of MR imaging for deep pelvic endometriosis were 90.3% (93 of 103), 91% (84 of 92), 92.1% (93 of 101), 89% (84 of 94), and 90.8% (177 of 195), respectively. The sensitivity, specificity, and accuracy, respectively, of MR imaging for the diagnosis of endometriosis in specific sites were as follows: USL, 76% (57 of 75), 83.3% (100 of 120), and 80.5% (157 of 195); vagina, 76% (16 of 21), 95.4% (166 of 174), and 93.3% (182 of 195); rectovaginal septum, 80% (eight of 10), 97.8% (181 of 185), and 96.9% (189 of 195); rectosigmoid, 88% (53 of 60), 97.8% (132 of 135), and 94.9% (185 of 195); and bladder, 88% (14 of 16), 98.9% (177 of 179), and 97.9% (191 of 195). CONCLUSION: MR imaging demonstrates high accuracy in prediction of deep pelvic endometriosis in specific locations. Copyright RSNA, 2004
PMID: 15205479 [PubMed – in process]

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