Infect Dis Obstet Gynecol. 2006 Sep;14(3):84140.Endometrioma complicated by tubo-ovarian abscess in a woman with bacterial vaginosis.Kavoussi SK, Pearlman MD, Burke WM, Lebovic DI.Background. Tubo-ovarian abscess involvement of an endometrioma has been reported in cases of patients with polymicrobial sources such as Neisseria gonorrhoeae, Chlamydia trachomatis, and obligate anaerobic bacteria; however, bacterial vaginosis (BV) predisposing to abscess formation in an endometrioma has not been reported to date. Case. Superinfection of an endometrioma was surgically diagnosed in a patient with known advanced-stage endometriosis after she presented with acute pelvic inflammatory disease symptoms and was unresponsive to antibiotic therapy. Gram-negative rods were cultured from the endometrioma. On admission, cervical, blood, and urine cultures were negative; BV was diagnosed on normal saline wet prep and gram stain. Conclusion. This case raises the possibility of BV ascension to the upper genital tract predisposing to abscess formation in endometriomas. Therefore, aggressive treatment of BV in patients with known advanced-stage endometriosis may be considered to prevent superinfected endometriomas.PMID: 17485813 [PubMed – in process] ________________________________________ Front Biosci. 2007 May 1;12:3247-55.Genetics of endometriosis: current status and prospects.Vigano P, Somigliana E, Vignali M, Busacca M, Blasio AM.Molecular Biology Laboratory, Istituto Auxologico Italiano, Milano, Italy. paola.vigano@unimi.itFamily and twin studies have shown that heritability accounts for endometriosis development to an extent similar to other complex genetic diseases. Both linkage analysis and association studies have been performed to identify genetic determinants for the disease. Results from the linkage scan of 1,176 families collected thanks to a joint effort between an Australian and a UK group supported significant linkage to a novel susceptibility locus on chromosome 10q26. Although gene variants with effects on the disease predisposition have been proposed to exist and several candidates have been put forward, their effects have not been or are yet to be confirmed. The main categories of candidate genes studied have been those involved in detoxification processes, sex steroid biosynthesis and action, immune system regulation. Genetic studies on endometriosis face numerous challenges as the disease has several manifestations and different forms. Moreover, strong gene-environmental interactions might definitively influence approaches to identify genetic variants involved. Genome-wide association studies that survey most of the genome for causal genetic variants provide the potential for future progress.PMID: 17485295 [PubMed – in process] ________________________________________ Front Biosci. 2007 May 1;12:3140-51.Apoptosis and endometriosis.Harada T, Taniguchi F, Izawa M, Ohama Y, Takenaka Y, Tagashira Y, Ikeda A, Watanabe A, Iwabe T, Terakawa N.Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan. tasuku@grape.med.tottori-u.ac.jpApoptosis plays a critical role in maintaining tissue homeostasis and represents a normal function to eliminate excess or dysfunctional cells. Accumulated evidence suggest that apoptosis helps to maintain cellular homeostasis during the menstrual cycle by eliminating senescent cells from the functional layer of the uterine endometrium during the late secretory and menstrual phase of the cycle. BCL-2 family and Fas/FasL system have been extensively studied in human endometrium and endometriotic tissues. Eutopic endometrium from women with endometriosis reportedly has some fundamental differences compared with normal endometrium of women without endometriosis. The differences could contribute to the survival of regurgitating endometrial cells into the peritoneal cavity and the development of endometriosis. One mechanism that recently gained a lot of interest is the finding that apoptosis appeared in eutopic and ectopic endometrium of patients with endometriosis. This study is a current review of the literature focused on the physiological role of apoptosis in normal endometrium and the alterations in regulation of apoptosis in eutopic and ectopic endometrium from women with endometriosis. Finally, role of apoptosis in the treatment of endometriosis is reviewed to link the basic research findings into clinical applications.PMID: 17485289 [PubMed – in process] ________________________________________ Gynecol Endocrinol. 2007 Jan;23(1):29-33.Genetic polymorphisms of cytochrome P450cl7alpha (CYP17) and progesterone receptor genes (PROGINS) in the assessment of endometriosis risk.De Carvalho CV, Nogueira-De-Souza NC, Costa AM, Baracat EC, Girao MJ, D’Amora P, Schor E, da Silva ID.Molecular Gynecology Laboratory, Federal University of Sao Paulo, Sao Paulo, Brazil.We designed the present study in order to evaluate the eventual role of polymorphisms in the genes encoding cytochrome P450c17alpha (CYP17) and the progesterone receptor (PROGINS) as risk factors for endometriosis development. Eligible cases consisted of 121 women with surgically confirmed endometriosis who underwent treatment in a hospital in Sao Paulo, Brazil during the period from September 2003 to September 2005. The 281 controls were participants with normal gynecological as well as pelvic ultrasound evaluation, who did not have any gynecological conditions during their reproductive lives such as pelvic pain and/or dyspareunia nor infertility history. Genomic DNA was obtained from buccal cells and processed for DNA extraction using the GFX DNA extraction kit (GE Healthcare). The CYP17 (-34T–>C) polymerase chain reaction-restriction fragment length polymorphism assay has been described previously, as has the progesterone receptor polymorphism (PROGINS) detection assay. PROGINS heterozygosis genotype frequencies were shown to be statistically higher in endometriosis cases compared with controls. On the other hand, differences in the CYP17 polymorphism (-34T–>C) frequencies were not even close to significance (p = 0.278) according to our findings.Publication Types: ? Research Support, Non-U.S. Gov’tPMID: 17484509 [PubMed – in process] ________________________________________ Gynecol Endocrinol. 2007 Jan;23(1):5-12.Endometriosis: the way forward.Hompes PG, Mijatovic V.Division of Reproductive Medicine, Department of Obstetrics & Gynecology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. p.hompes@vumc.nlEndometriosis, a common cause of morbidity, affects 10% of women of reproductive age. In this review we focus on the new developments in pathogenesis, diagnosis and treatment options, reviewing the literature published about this enigmatic disorder over the past three years. More specifically, new theories of the pathogenesis of the syndrome of Sampson and Cullen are discussed. The new era of genomics may characterize endometriosis and transform clinical management of the disease. Literature suggesting that endometriosis may have an environmental origin is reviewed. New approaches to medical therapy of endometriosis have been developed, including the levonorgestrel-releasing intrauterine device, aromatase inhibitors, immunomodulatory drugs, angiogenesis inhibitors, selective estrogen and progesterone receptor modulators, and statins. Subfertility is another well-known result of endometriosis and often complex decisions must be made regarding management of the endometriosis patient who wishes to conceive. Laparoscopic surgery and assisted reproduction–with or without gonadotropin-releasing hormone-agonist treatment–are reviewed. Finally we speculate about new developments in the field of endometriosis in the coming three years.PMID: 17484506 [PubMed – in process] ________________________________________ Mol Hum Reprod. 2007 May 5; [Epub ahead of print] Nuclear factor-kappa B is constitutively activated in peritoneal endometriosis.Gonzalez-Ramos R, Donnez J, Defrere S, Leclercq I, Squifflet J, Lousse JC, Van Langendonckt A.Department of Gynecology, Universite Catholique de Louvain, Cliniques Universitaires St Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium.Red (active), black and white endometriotic lesions are characteristic of peritoneal endometriosis. The transcription factor nuclear factor-kappa B (NF-kappaB) activates proinflammatory, proliferative and antiapoptotic genes in many cell types. To determine whether NF-kappaB is activated in peritoneal endometriosis in women, and further ascertain the differential inflammatory status of endometriotic implants, NF-kappaB activation and intercellular adhesion molecule (ICAM)-1 expression were investigated in peritoneal endometriotic lesions according to their type. Furthermore, p65 and p50 subunits of active NF-kappaB dimers were evaluated in endometriotic lesions to gain some insight into NF-kappaB-implicated pathways. Thirty-six biopsies of peritoneal endometriotic lesions were analyzed. Constitutive NF-kappaB activation, involving p65- and p50-containing dimers, was demonstrated in peritoneal endometriotic lesions by electrophoretic mobility shift assays and supershift analyses, as well as NF-kappaB (p65) DNA-binding activity immunodetection assays. NF-kappaB activation and ICAM-1 expression (evaluated by immunoblotting) were significantly higher in red lesions than black lesions, whereas IkappaBalpha (NF-kappaB inhibitory protein) expression was constant, as shown by western blot analysis. This is the first study to demonstrate constitutive NF-kappaB activation in peritoneal endometriosis in women. NF-kappaB activation and ICAM-1 expression in red lesions confirm the more extensive inflammatory pattern of these lesions compared with black lesions. The involvement of p50/p65 dimers in NF-kappaB activation suggests implication of the classic NF-kappaB activation pathway, making it an attractive therapeutic target in endometriosis.PMID: 17483545 [PubMed – as supplied by publisher] ________________________________________ Thromb Res. 2007 May 4; [Epub ahead of print] More than menorrhagia: A review of the obstetric and gynaecological manifestations of von Willebrand disease.James AH.Women’s Hemostasis and Thrombosis Clinic, Duke University Medical Center, Durham, NC 27710, USA.Menorrhagia is the most common symptom experienced by women with von Willebrand’s disease (VWD), but several other gynaecological disorders also occur more frequently in these women; primarily ovarian cysts and endometriosis. Women with VWD are most likely to experience an increased incidence of gynaecological disorders and obstetric complications that manifest with bleeding. The incidence of these disorders and the complications of pregnancy are discussed with particular reference to a case-control study conducted by the U.S. Centers for Disease Control and Prevention.PMID: 17482662 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2007 May 5; [Epub ahead of print] Artificial neural networks combined with surface-enhanced laser desorption/ionization mass spectra distinguish endometriosis from healthy population.Wang L, Zheng W, Yu JK, Jiang WZ, Mu L, Zhang SZ.Department of Gynecology.Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry protein chip array technology was used to detect the serum proteomic patterns in patients with endometriosis. Four potential biomarkers (8,141 m/z, 6,096 m/z, 5,894 m/z, and 3,269 m/z) were found. This method showed great potential in screening better biomarkers for endometriosis.PMID: 17482609 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2007 May 4; [Epub ahead of print] Association between endometriosis and polymorphisms in endostatin and vascular endothelial growth factor and their serum levels in Korean women.Kim JG, Kim JY, Jee BC, Suh CS, Kim SH, Choi YM.Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea.The aim of present study was to evaluate the relationship between endometriosis and polymorphisms in the enodostatin and vascular endothelial growth factor (VEGF) genes, and their levels in serum in a Korean population. Serum endostatin levels (but not VEGF levels) were negatively correlated with the development of endometriosis, specifically in early-stage enodmetriosis patients, compared with women without endometriosis, but endometriosis was not associated with the endostatin G(4349)A and VEGF C(936)T polymorphisms.PMID: 17482599 [PubMed – as supplied by publisher] ________________________________________ J Reprod Immunol. 2007 May 3; [Epub ahead of print] Peritoneal fluid from endometriosis patients switches differentiation of monocytes from dendritic cells to macrophages.Na YJ, Jin JO, Lee MS, Song MG, Lee KS, Kwak JY.Department of Obstetrics and Gynecology, Medical Research Institute, Pusan National University, Busan 602-739, Republic of Korea.Immunological abnormalities of cell-mediated and humoral immunity might be associated with the pathogenesis of endometriosis. This study has examined the effects of peritoneal fluid obtained from patients with endometriosis (ePF) on the phenotypic characteristics of macrophages and dendritic cells (DCs) derived from monocytes. Monocytes were obtained from healthy young volunteers and cultured with ePF (n=12) or a control PF (cPF) (n=5) in the presence or absence of macrophage-colony stimulating factor (M-CSF) or IL-4 plus granulocyte macrophage-colony stimulating factor (GM-CSF). The ePF was demonstrated to increase expression levels of CD14 and CD64 on isolated monocytes in the presence or absence of M-CSF. Compared with cPF, addition of 10% ePF to GM-CSF plus IL-4-treated monocytes significantly down-regulated CD1a expression and up-regulated CD64 expression, but did not enhance expression levels of class II MHC. ePF had no effect, however, on tumor necrosis factor-alpha-induced maturation of DC. Levels of IL-6, IL-10 and M-CSF production were higher in ePF-treated than cPF-treated monocytes for both cell culture conditions with GM-CSF plus IL-4 and M-CSF. A neutralizing IL-6 antibody, but not an IL-10 antibody, abrogated the ePF-induced down-regulation of CD1a, up-regulation of CD64 and secretion of M-CSF. These results suggest that ePF favorably induces monocyte differentiation toward macrophages rather than DCs, and that this effect is mediated by IL-6. A reciprocal mode of cell differentiation between macrophages and DCs in response to ePF may be related to the pathogenesis of endometriosis.PMID: 17482270 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2007 May 3; [Epub ahead of print] Role of interleukin-1 receptor type II in the pathogenesis of endometriosis.Hou Z, Zhou J, Ma X, Fan L, Liao L, Liu J.Center of Clinical Reproductive Medicine, Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, People’s Republic of China.OBJECTIVE: To determine the role of interleukin-1 receptor type II (IL-1RII) in the pathogenesis of endometriosis. DESIGN: Cultures of endometrial cells exposed to soluble IL-1RII or the recombinant adenovirus of IL-1RII (rAd-RII). SETTING: Gynecology clinic and human reproduction research laboratory. PATIENT(S): Women with endometriosis undergoing hysterectomy. INTERVENTION(S): Cell culture media were collected 12 hours after addition of soluble IL-1RII or infection of rAd-RII. MAIN OUTCOME MEASURE(S): The levels of IL-6 and IL-8 in the culture media were measured via enzyme-linked immunoabsorbent assay. Furthermore, proteins of the cells were collected for two-dimensional electrophoresis and the differential protein expression was identified by the matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. RESULT(S): Addition of soluble IL-1RII (2.0 mug/mL) significantly inhibited IL-1beta-induced IL-6 and IL-8 secretion by endometrial cells in vitro. Infection of endometrial cells with rAd-RII significantly decreased IL-1beta-induced IL-8 secretion, compared with the PBS and rAd-LacZ controls but had no significant effect on IL-6 secretion. Proteins of the infected cells were collected for two-dimensional electrophoresis, and intensities of 62 spots were significantly increased or decreased when compared with those in the PBS group. Thirty-four proteins were identified by MALDI-TOF mass spectrometry. The majority of the identified proteins are related to cellular metabolism and proliferation. CONCLUSION(S): These results suggest that IL-1RII can neutralize IL-1beta and counteract its effect on endometrial stromal cells, and may provide a new clinical strategy for the treatment of endometriosis.PMID: 17482186 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2007 May 3; [Epub ahead of print] Immunohistochemical study of osteopontin and l-selectin in a rat endometriosis model and in human endometriosis.Odagiri K, Konno R, Fujiwara H, Netsu S, Ohwada M, Shibahara H, Suzuki M.Department of Gynecology, Omiya Medical Center, Jichi Medical School, Saitama.OBJECTIVE: To investigate the localization of the proteins osteopontin (OPN) and l-selectin (SELL). DESIGN: Retrospective nonrandomized immunohistochemical study in a surgically induced rat model of peritoneal endometriosis and in samples of human endometriotic lesions of ovaries. SETTING: Department of gynecology in a university hospital. PATIENT(S): A rat endometriosis model was induced in 10 8-week-old SLC-Sprague-Dawley rats by surgical autotransplantation of uterus. Fourteen premenopausal women with histologically diagnosed endometriosis were selected (mean age, 39 y; range, 25-53 y). Twenty endometriotic specimens were obtained from 14 patients who underwent laparoscopic surgery for enlarged endometriotic cysts. INTERVENTION(S): Histopathological examination of endometriotic ovarian specimens for OPN and SELL expression by immunohistochemistry. MAIN OUTCOME MEASURE(S): Demonstration of the immunoreactive staining of OPN and SELL expressions in tissues of a rat endometriosis model and of human endometriosis. RESULT(S): In both tissues from a rat endometriosis model and from human endometriosis, OPN was stained more prominently in glandular epithelium than in interstitial space, whereas SELL stained more prominently in interstitial space (macrophages and lymphocytes) than in epithelium. The staining pattern of OPN in ectopic endometriotic lesions was very similar to that in eutopic normal human endometrium in the secretory phase. CONCLUSION(S): These results suggested important roles for OPN and SELL in the pathogenesis of endometriosis.PMID: 17482182 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2007 May 3; [Epub ahead of print] Levels of complement components iC3b, C3c, C4, and SC5b-9 in peritoneal fluid and serum of infertile women with endometriosis.Kabut J, Kondera-Anasz Z, Sikora J, Mielczarek-Palacz A.Department of Immunology and Serology, Medical University of Silesia, Katowice, Poland.OBJECTIVE: To assess whether complement components iC3b, C3c, C4, and SC5b-9 may be involved in the pathogenesis of endometriosis. DESIGN: Prospective, experimental trial. SETTING: Medical university. PATIENT(S): 112 women infertile women undergoing laparoscopy. INTERVENTION(S): Venipuncture and laparoscopic peritoneal fluid collection. MAIN OUTCOME MEASURE(S): Peritoneal fluid and serum iC3b, C3c, C4, and SC5b-9 levels were measured by the enzyme-linked immunosorbent assay (ELISA) method. RESULT(S): Higher levels of C3c, C4, and SC5b-9 complement components were found in the serum compared with the peritoneal fluid, but the levels of iC3b were higher in the peritoneal fluid. We observed higher concentrations of C3c, C4, and SC5b-9 in the peritoneal fluid and serum of women with endometriosis compared with healthy women. However, the levels of iC3b in both peritoneal fluid and serum were statistically significantly lower than in the control group. CONCLUSION(S): The impairment of the mechanisms involved in the regulation of activation of complement system may be an important factor in the pathogenesis of endometriosis and endometriosis-associated infertility.PMID: 17482181 [PubMed – as supplied by publisher] ________________________________________ J Steroid Biochem Mol Biol. 2007 Mar 20; [Epub ahead of print] A sensitive HPLC method for the assessment of metabolic conversion of estrogens.Delvoux B, Husen B, Aldenhoff Y, Koole L, Dunselman G, Thole H, Groothuis P.Research Institute GROW, University Hospital Maastricht, University of Maastricht, The Netherlands; Department of Obstetrics and Gynaecology, University Hospital Maastricht, University of Maastricht, The Netherlands.Disorders of estrogen-responsive tissues are frequently associated with aberrations in steroid metabolism due to altered expression of synthesizing and metabolizing enzymes. For instance, overexposure to unopposed 17beta-estradiol has been associated with the pathogenesis of endometrial proliferative disorders, such as endometriosis. Investigations into the metabolic conversion in tissues and cells have been rather limited. This is mostly due to fact that such studies have to make use of radioactive steroid hormones and expensive equipment to obtain sufficient sensitivity. We adapted a sensitive non-radioactive HPLC method to study estrogen metabolism in more detail. This HPLC method is based on the solid phase extraction of estrogens and the derivatization of the steroids with 2-(4-carboxy-phenyl)-5,6-dimethylbenzimidazole. The technique is sensitive, robust and is useful for the detection of aromatase, 17beta-HSD types 1 and 2 and sulfatase activities in lysates of placenta and endometrium.PMID: 17481886 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2007 May 2; [Epub ahead of print] Immunohistochemical detection of heparanase-1 expression in eutopic and ectopic endometrium from women with endometriosis.Xu X, Ding J, Ding H, Shen J, Gattuso P, Prinz RA, Rana N, Dmowski WP.Department of General Surgery, Rush University Medical Center, Chicago.OBJECTIVE: To investigate the expression of heparanase-1, an endoglycosidase that degrades heparan sulfate proteoglycans, in eutopic and ectopic endometrial tissues from women with endometriosis. DESIGN: An immunohistochemical study. SETTING: Academic research laboratory and a private infertility clinic affiliated with a university medical center. PATIENT(S): Premenopausal women undergoing laparoscopy for endometriosis. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Expression of heparanase-1 analyzed by immunohistochemical staining in 91 eutopic and 14 ectopic endometrial specimens. RESULT(S): We found that 17% (4/24) of the eutopic endometrial specimens in the early proliferative phase and 32% (9/28) of the samples in the midproliferative phase were heparanase-1 positive. However, >/=80% of eutopic endometrial specimens at late proliferate phase and at luteal phase were heparanase-1 positive. Twelve of 14 ectopic endometriotic specimens stained heparanase-1 positive. Comparison of heparanase-1 expression in paired eutopic and ectopic endometrial tissues revealed that 5 of 6 ectopic specimens in the early proliferative phase were heparanase-1 positive, whereas only 1 eutopic specimen was heparanase-1 positive. In comparison with our recent study of heparanase-1 expression in normal endometrium, we found that there was no significant difference in heparanase-1 expression in the eutopic endometrium from women with or without endometriosis. CONCLUSION(S): Heparanase-1 was differentially expressed in the eutopic endometrium in the different menstrual phases. Heparanase-1 was highly expressed in the ectopic endometriotic lesions regardless of their menstrual phases, suggesting that the local environment is responsible for increased heparanase-1 expression.PMID: 17481627 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2007 May 2; [Epub ahead of print] Effects of a protein kinase C inhibitor on the initial development of ectopic implants in a syngeneic mouse model of endometriosis.Matsuzaki S, Canis M, Darcha C, Dechelotte PJ, Pouly JL, Mage G.Universite d’Auvergne-Clermont I, Centre d’Endoscopie et des Nouvelles Techniques Interventionnelles; CHU Clermont-Ferrand, Polyclinique-Hotel-Dieu, Gynecologie Obstetrique et Medecine de la Reproduction.OBJECTIVE: To evaluate the effect of protein kinase C inhibition on surgically induced endometriosis in mice. DESIGN: Prospective, randomized study. SETTING: Academic facility. ANIMALS: Sixty adult female C57BJ6 mice. INTERVENTION(S): On day -7, oral gavage of a vehicle alone or of a protein kinase C inhibitor (100 mg/kg/day, once a day) was started and continued for 1 week in donor groups A and B, respectively. On day 0, uterine fragments from donor group A were implanted into recipient mice. Recipient mice were divided randomly into two groups: group 1 (vehicle) and group 2 (protein kinase C inhibitor). Uterine fragments from donor group B were implanted into recipient mice, and they were divided randomly into two groups: group 3 (vehicle) and group 4 (protein kinase C inhibitor). Oral gavage of a protein kinase C inhibitor (100 mg/kg/day, once a day) or vehicle was continued for 1 week. MAIN OUTCOME MEASURE(S): Presence and number of ectopic implants. RESULT(S): The number of mice that developed ectopic implants was significantly lower in groups 3 (40%) and 4 (30%) than in group 1 (100%). The number of ectopic implants was significantly lower in groups 2, 3, and 4 than in group 1. CONCLUSION(S): Protein kinase C inhibitor use partially prevented the development of ectopic implants in a mouse model of endometriosis.PMID: 17481625 [PubMed – as supplied by publisher] ________________________________________ Eur J Gynaecol Oncol. 2007;28(2):77-82. Robotic surgery in gynecology.Magrina JF.Director Division of Gynecologic Oncology Department of Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA.Robotic technology is nothing more than an enhancement along the continuum of laparoscopic technological advances and represents only the beginning of numerous more forthcoming advances. It constitutes a major improvement in the efficiency, accuracy, ease, and comfort associated with the performance of laparoscopic operations. Instrument articulation, downscaling of movements, absence of tremor, 3-D image, and comfort for the surgeon, assistant and scrub nurse are all new to the practice of laparoscopy. In our hands, robotic operative times for simple and radical hysterectomy are shorter than those obtained by conventional laparoscopy. Robotic technology is preferable to conventional laparoscopic instrumentation for the surgical treatment of gynecologic malignancies and most operations for benign disease of certain complexity such as hysterectomy myomectomy, and invasive pelvic endometriosis.PMID: 17479665 [PubMed – in process] ________________________________________ Qual Health Res. 2007 May;17(5):571-85. Relational patterns of couples living with chronic pelvic pain from endometriosis.Strzempko Butt F, Chesla C.San Francisco, California.Chronic pelvic pain (CPP) is a disabling condition affecting 15 to 20% of U.S. women of reproductive age. Endometriosis, one of the most common causes of CPP, is associated with symptoms of pelvic pain, painful sexual intercourse, and infertility. In this qualitative study, the authors examined the relational impact of CPP from endometriosis on 13 couples through narrative interviews conducted individually and jointly. They describe five relational patterns that vary on degree of closeness, how care responsibilities are enacted, the degree to which couples are conjoined in their experiences, and how much their lives are overtaken with the disease. These patterns articulate couples’ relational concerns as well as daily management of illness.PMID: 17478641 [PubMed – in process] ________________________________________ J Minim Invasive Gynecol. 2007 May – June;14(3):339-344. Major complications arising from 1265 operative laparoscopic cases: A prospective review from a single center.Johnston K, Rosen D, Cario G, Chou D, Carlton M, Cooper M, Reid G.Sydney Women’s Endosurgery Centre (SWEC), St. George Private Hospital, Kogarah, New South Wales, Sydney, Australia.STUDY OBJECTIVE: To identify the volume and type of laparoscopic surgery being performed. To review the incidence, nature of associated complications, and reasons for conversion to laparotomy. DESIGN: A multicenter, prospective case load analysis and chart review, identifying operations performed by 6 advanced laparoscopic surgeons over a 12-month period (1/1/05 to 12/31/05). SETTING: Surgical cases were performed in 5 hospitals in Sydney, New South Wales. PATIENTS: One thousand two hundred sixty-five women underwent a variety of major and advanced operative procedures. MEASUREMENTS AND MAIN RESULTS: A total of 1265 major and advanced laparoscopic procedures were performed. Laparoscopic hysterectomy accounted for 364 cases (28.8%), pelvic floor repair and Burch colposuspension 280 cases (22.2%), excisional endometriosis surgery 354 cases (28%), adnexal surgery 177 cases (13.9%), adhesiolysis 75 cases (5.9%), and miscellaneous cases 15 (1.2%). Overall major complications in terms of bowel, urologic, or major vessel injuries accounted for 8 cases (0.6%). There were 4 injuries of the bowel, 2 injuries to the bladder, and 2 injuries to ureters. There were no major vessel injuries. There were no injuries associated with primary trocar or Veres needle insertion. The most common perioperative morbidity reported was the requirement for blood transfusion (11 cases [0.9%]), and the second most common was venous thromboembolism (4 patients [0.3%]). Six (0.5%) cases were converted to laparotomy, 2 as a result of a complication and 4 for technical reasons. Six of the 8 complications were managed laparoscopically, and a multidisciplinary input was sought only in 4 of the 8 complications. CONCLUSIONS: Despite the advanced nature of laparoscopic procedures performed by our group, the complication rate and conversion to laparotomy remain low. There is an increasing feasibility to perform traditional open operations laparoscopically. An increasing number of these complications are now being managed laparoscopically by the gynecologist.PMID: 17478366 [PubMed – as supplied by publisher] ________________________________________ J Minim Invasive Gynecol. 2007 May-Jun;14(3):334-8. What is the value of preoperative bimanual pelvic examination in women undergoing laparoscopic total hysterectomy?Condous G, Van Calster B, Van Huffel S, Lam A.Centre for Advanced Reproductive Endosurgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia; Early Pregnancy and Advanced Endosurgery Unit, Nepean Clinical School, University of Sydney, Sydney, Australia.OBJECTIVE STUDY: To estimate the value of preoperative bimanual examination of the pelvis in women undergoing total laparoscopic hysterectomy (TLH). DESIGN: Prospective observational cohort study. SETTING: Private hospitals and centre. PATIENTS: One hundred fourteen consecutive women undergoing TLH. INTERVENTION: All women who were scheduled to undergo TLH from May 2005 through June 2006 had a bimanual examination of the pelvis performed before surgery and the size of the uterus clinically estimated and recorded as gestational equivalents. The operating time, the estimated blood loss (EBL) during TLH, and the final weight of the uterus at histologic study were recorded. Spearman correlation coefficient analysis was used to determine whether there was a correlation between the estimated uterine size before surgery and actual uterine weight, operating time, and EBL. MEASUREMENTS AND MAIN RESULTS: Of the one hundred fourteen consecutive women eligible for the study, 75 had complete data and therefore were included in the final analysis. The median age was 46 years (range 34-71 years); 22.7% (17/75) had a clinically estimated normal uterus, 10.7% (8/75) had an 8-10/40 uterus, 12% (9/75) had a 10-12/40 uterus, 14.6% (11/75) had a 12-14/40 uterus, 20.0% (15/75) had a 14-16/40 uterus, 9.3% (7/75) had a 16-18/40 uterus, and 10.7% (8/75) had an 18-20/40 uterus. The median operating time was 110 minutes (range 59-240 minutes); the median EBL was 80 mL (range 20-1000 mL); and the median weight of the uterus was 181 g (range 52-1080 g). Histologic diagnoses included leiomyomata in 64.0% (48/75), adenomyosis in 44.0% (33/75), endometriosis in 22.7% (17/75), endocervical polyp in 4.0% (3/75), and normal uterus in 8.0% (6/75). The Spearman correlations between clinical size of the uterus and the weight of the uterus, the EBL, and the operating time were 0.81, 0.33, and 0.29, respectively; that is, the 2 variables tended to increase together. These correlations were all significant (p <.0001, .0044, and .0114, respectively). CONCLUSIONS: This study showed significant correlation between clinical estimate of uterine size and histologic weight of the uterus, operating time, and EBL in women undergoing laparoscopic hysterectomy. These findings are of great value in preoperative counseling in relation to the risk of bleeding and the potential need for blood transfusion, and in operating room planning.PMID: 17478365 [PubMed – in process] ________________________________________ Fertil Steril. 2007 May;87(5):1180-99. Molecular profiling of experimental endometriosis identified gene expression patterns in common with human disease.Flores I, Rivera E, Ruiz LA, Santiago OI, Vernon MW, Appleyard CB.Department of Microbiology, Ponce School of Medicine, Ponce, Puerto Rico. iflores@psm.edu <iflores@psm.edu>OBJECTIVE: To validate a rat model of endometriosis using complimentary DNA (cDNA) microarrays by identifying common gene expression patterns between experimental and natural disease. DESIGN: Autotransplantation rat model. SETTING: Medical school department. ANIMALS: Female Sprague-Dawley rats. INTERVENTION(S): Endometriosis was surgically induced by suturing uterine horn implants next to the small intestine’s mesentery. Control rats received sutures with no implants. After 60 days, endometriotic implants and uterine horn were obtained. MAIN OUTCOME MEASURE(S): Gene expression levels determined by cDNA microarrays and real-time quantitative polymerase chain reaction (qPCR). The Cy5-labeled cDNA was synthesized from total RNA obtained from endometriotic implants. The Cy3-labeled cDNA was synthesized using uterine RNA from a control rat. Gene expression levels were analyzed after hybridizing experimental and control labeled cDNA to PIQOR (Parallel Identification and Quantification of RNAs) Toxicology Rat Microarrays (Miltenyi Biotec, Cologne, Germany) containing 1,252 known genes. The Cy5/Cy3 ratios were determined, and genes with >2-fold higher or <0.5-fold lower expression levels were selected. Microarray results were validated by QRT-PCR. RESULT(S): We observed differential expression of genes previously shown to be up-regulated in patients, including growth factors, inflammatory cytokines/receptors, tumor invasion/metastasis factors, adhesion molecules, and antiapoptotic factors. CONCLUSION(S): This study presents evidence in support of using this rat model to study the natural history of endometriosis and to test novel therapeutics for this incurable disease.Publication Types: ? Research Support, N.I.H., ExtramuralPMID: 17478174 [PubMed – in process] ________________________________________ Fertil Steril. 2007 May;87(5):1005-9. Pathologic findings and outcomes of a minimally invasive approach to ovarian remnant syndrome.Kho RM, Magrina JF, Magtibay PM.Department of Obstetrics and Gynecology, Mayo Clinic, Scottsdale, Arizona 85259, USA. kho.rosanne@mayo.eduOBJECTIVE: To review outcomes and pathologic findings of a primarily minimally invasive approach to ovarian remnant syndrome. DESIGN: Data were abstracted from medical records documenting bilateral salpingo-oophorectomy and subsequent treatment between 1996 and 2006 for pathologically confirmed ovarian remnant tissue. Follow-up was by mailed questionnaires and telephone interviews. SETTING: Tertiary care academic medical institution. PATIENT(S): Twenty patients (mean age, 48 years) receiving treatment for ovarian remnant tissue after prior bilateral salpingo-oophorectomy. INTERVENTION(S): Primarily minimally invasive approach (conventional laparoscopy and robot-assisted laparoscopy) for removal of ovarian remnant tissue. MAIN OUTCOME MEASURE(S): Postoperative complications and recurrence. RESULT(S): The 20 patients had a mean follow-up of 30 months. Indications were endometriosis in 8 and ovarian neoplasm in 6. Eighteen patients presented with pain, and 2 presented with a pelvic mass. Nineteen had laparoscopy (14 conventional; 5 robotic), and 1 had laparotomy. Remnant ovarian tissue was associated with endometriosis in 5 and corpus luteum in 3. Two patients had malignancy in remnant ovarian tissue. Postoperative complications included pneumonia (1 case). Follow-up identified no recurrence. CONCLUSION(S): Ovarian remnant syndrome can be managed safely and successfully with minimally invasive surgery. Risk of carcinoma mandates surgical resection.PMID: 17478171 [PubMed – in process]

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