J Minim Invasive Gynecol. 2007 Jan-Feb;14(1):33-8.Outcome after rectum or sigmoid resection: a review for gynecologists.Ret Davalos ML, De Cicco C, D’Hoore A, De Decker B, Koninckx PR.Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. lorenaret@hotmail.comIt remains unclear when to perform a discoid or segmental bowel resection for large endometriotic nodules with intestinal invasion. Moreover, endometriosis series are rather small to fully evaluate functional consequences of bowel resection. We therefore reviewed the incidence of leakage and functional problems after anterior and sigmoid resection as reported in the surgical literature albeit for other indications. Endoscopic resection clearly is feasible but requires an experienced surgeon. The incidence of leakage is not different after hand-sewn or stapled anastomosis, but is higher after a low rectum resection than after a sigmoid resection. Similarly, functional bowel problems are higher after a low rectum resection than after sigmoid resection. Low rectum resection in addition can be associated with functional bladder problems and sexual disturbances as anorgasmia. In conclusion, short- and long-term complications are much higher after a low rectum than after a sigmoid resection. This seems to be important in making the decision to perform a discoid or a segmental bowel resection for severe endometriosis.Publication Types: ? ReviewPMID: 17218226 [PubMed – indexed for MEDLINE] ________________________________________ J Minim Invasive Gynecol. 2007 Jan-Feb;14(1):23-32. Villar’s nodule: a case report and systematic literature review of endometriosis externa of the umbilicus.Victory R, Diamond MP, Johns DA.Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan 48201, USA. rvictory@med.wayne.eduWe report a case of umbilical endometriosis externa and systematically review the literature regarding this finding. In our case report, a 47-year-old woman with cyclic umbilical bleeding, pelvic pain, and no previous umbilical surgery developed a spontaneous umbilical endometrioma, cured by surgical resection and bilateral salpingo-oophorectomy. In our review, 122 patients with documented umbilical endometriomas from 1966 to the present and 109 cases reported before 1953 were analyzed. Procedures used for diagnosis and/or therapeutic intervention included umbilical biopsy or resection, abdominal wall repair, diagnostic and/or operative laparoscopy, adhesiolysis, hysterectomy, and bilateral salpingo-oophorectomy. Variables included patient age; race; medical and surgical history; past use of oral contraceptives; history of umbilical pain, bleeding, or swelling; duration of signs and symptoms; size and color of the lesion; diagnostic evaluations; and medical or surgical management. Mean age of the study population was 37.7 +/- 0.98 years. Up to 40% of patients with extrapelvic endometriosis present with umbilical endometriomas, with symptoms occurring an average of 17.8 +/- 3.9 months before presentation. Lesions averaged 2.3 +/- 0.2 cm in diameter; were predominantly brown (19.1%), blue (13.2%), or purple (10.3%); and patients frequently had with pain (77.93%), cyclical bleeding (47.1%), and swelling (88.2%). Most patients had no history of endometriosis (73.1%), and laparoscopic, umbilical trocar-related seeding was identified in only 5 patients. Three patients received medical management, and surgical management was invariably curative, though 1 patient required repeat surgical therapy. Umbilical endometriosis is a common manifestation of external endometriosis, representing primary or secondary endometriosis, with a typical presentation that has little variation. Laparoscopic endometrioid tissue excision can result in iatrogenic seeding to the umbilicus. Historical and physical findings are pathognomonic, thus justifying a formal name–Villar’s nodule, after the initial reporting physician. Surgical intervention is recommended, but medical therapy may result in long-term symptom control with minimal malignancy risk.Publication Types: ? Case Reports ? Review PMID: 17218225 [PubMed – indexed for MEDLINE] ________________________________________ Australas Radiol. 2007 Feb;51(1):91-4. Inguinal endometriosis attaching to the round ligament.Hagiwara Y, Hatori M, Moriya T, Terada Y, Yaegashi N, Ehara S, Kokubun S.Departments of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan.We report a case of endometriosis in the right inguinal region, attached to the right round ligament in a 28-year-old woman. At the age of 20, laparoscopic left ovarian cystectomy and pelvic adhesiolysis for endometriosis was carried out. She noticed a right tender groin mass 7 months previously, and the tumour size fluctuated with the menstrual cycle. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpated in her right inguinal region. Magnetic resonance imaging showed a 2.5 cm x 2.5 cm mass in the right inguinal canal and a 5.4 cm x 6.8 cm mass was seen in the left ovary. The mass enlarged during menstruation. The groin mass was removed, in addition to carrying out laparoscopic ovarian cystectomy. At operation, the groin mass was found to be in continuity with the round ligament of extraperitoneal portion. Histological diagnosis of endometriosis was made in both ovarian and inguinal tumours. After surgery, the pain disappeared completely. Worth mentioning is that MRI clearly showed the change of tumour size depending on the menstrual cycle, which aided in arriving at the correct diagnosis of endometriosis in an unusual location.Publication Types: ? Case ReportsPMID: 17217498 [PubMed – indexed for MEDLINE] ________________________________________ Clin Exp Obstet Gynecol. 2006;33(4):201-2.Evaluation of the effect of endometriosis on oocyte quality and endometrial environment by comparison of donor and recipient outcomes following embryo transfer in a shared oocyte program.Katsoff B, Check JH, Davies E, Wilson C.The Univ. of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital/Univ. Medical Center Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Camden, USA.PURPOSE: To determine whether endometriosis has an effect on the uterine environment vs the oocyte itself. METHODS: A retrospective study comparing pregnancy outcome of infertile donors sharing oocytes with donor egg recipients according to whether the donor or recipient had endometriosis or not was carried out. RESULTS: There were 26 transfers from donors with endometriosis vs 144 in donors without endometriosis. The clinical and viable PRs and implantation rates were 42.9%, 38.1%, and 29.4% for the endometriosis group vs 60.9%, 51.9%, and 33.2%, respectively, for donors without endometriosis (p = NS). The clinical and viable PRs and implantation rates for donors with endometriosis per ET was 41.2%, 35.3%, and 20.4% vs 50.4%, 48.0% and 28.4% for donors without endometriosis, respectively (p = NS). CONCLUSIONS: Though no significant differences were found in donors with or without endometriosis in any parameters, there did appear to be a trend for lower PRs and implantation rates in women undergoing controlled ovarian hyperstimulation.PMID: 17214020 [PubMed – indexed for MEDLINE] ________________________________________ Zentralbl Gynakol. 2006 Dec;128(6):311-7. [Fluorescence diagnosis and photodynamic therapy with 5-aminolevulinic acid induced protoporphyrin IX in gynecology: an overview][Article in German]Loning M, Diddens H, Friedrich M, Altgassen C, Diedrich K, Huttmann G.Klinik fur Frauenheilkunde und Geburtshilfe, Universitatsklinikum Schleswig-Holstein Campus Lubeck, Lubeck, Germany. loening@gmx.deFluorescence diagnosis and photodynamic therapy with 5-aminolevulinic acid induced protoporphyrin IX are promising new options in the diagnosis and therapy of diseases in a wide spectrum of medical disciplines such as urology, dermatology, gastroenterology, surgery, neurosurgery and gynecology. The techniques are based on the application of the heme biomolecule precursor 5-aminolevulinic acid which induces the endogenous accumulation of the photosensitizer protoporphyrin IX in designated tissues. After external excitation with blue light a strong red fluorescence can be initiated particularly in tumorous tissues. In gynecology many studies have been performed evaluating the usefulness of fluorescence based detection of cervical dysplasias, breast cancer, endometrial diseases, ovarian cancer and endometriosis. This work aims on the principles of fluorescence detection as an important tool in biomedical optical imaging and its current status in gynecology.Publication Types: ? English Abstract ? Review PMID: 17213968 [PubMed – indexed for MEDLINE] ________________________________________ Hum Reprod. 2007 Apr;22(4):1026-30. Epub 2007 Jan 9. The G2964A 3′-untranslated region polymorphism of the signal transducer and activator of transcription 6 gene is associated with endometriosis in South Indian women.Bhanoori M, Deenadayal M, Kennedy S, Shivaji S.Centre for Cellular and Molecular Biology, Hyderabad, Andhra Pradesh, India.BACKGROUND: The aim of the study was to test whether the signal transducer and activator of transcription 6 (STAT6) gene influences the risk of developing endometriosis. METHODS: The single-nucleotide polymorphism, G2964A, in the 3′-untranslated region (UTR) of the STAT6 gene was tested for association in a case-control study of 232 affected women and 210 women with no evidence of disease. All the women were infertile, ascertained from the same infertility clinic and of South Indian origin. The genotype frequencies of this polymorphism were compared using PCR and sequencing analysis. RESULTS: There were statistically significant differences in the genotype distributions (P = 0.002) and allele frequencies (P = 0.0002) between the cases and controls, according to codominant, dominant and recessive genotype models. CONCLUSIONS: We report for the first time an association between the STAT6 G2964A 3′-UTR polymorphism and endometriosis in South Indian women. This finding suggests that STAT6 may contribute to disease susceptibility in endometriosis, which carries an extra interest as the gene lies in a region which has been implicated, albeit weakly, in a previous genomewide scan.Publication Types: ? Research Support, Non-U.S. Gov’tPMID: 17213269 [PubMed – in process] ________________________________________ JSLS. 2006 Jul-Sep;10(3):317-20. Robotic-assisted laparoscopy in gynecological surgery.Nezhat C, Saberi NS, Shahmohamady B, Nezhat F.Department of OB/GYN and Surgery, Stanford University Medical Center, Palo Alto, California 94304, USA. nssaberi@quimbus.comBACKGROUND: Laparoscopic surgery has revolutionized the concept of minimally invasive surgery for the last 3 decades. Robotic-assisted surgery is one of the latest innovations in the field of minimally invasive surgery. Already, many procedures have been performed in urology, cardiac surgery, and general surgery. In this article, we attempt to report our preliminary experience with robotic-assisted laparoscopy in a variety of gynecological surgeries. We sought to evaluate the role of robotic-assisted laparoscopy in gynecological surgeries. METHODS: The study was a case series of 15 patients who underwent various gynecologic surgeries for combined laparoscopic and robotic-assisted laparoscopic surgery. The da Vinci robot was used in each case at a tertiary referral center for laparoscopic gynecologic surgery. An umbilicus, suprapubic, and 2 lateral ports were inserted. These surgeries were performed both using laparoscopic and robotic-assisted laparoscopic techniques. The assembly and disassembly time to switch from laparoscopy to robotic-assisted surgery was measured. Subjective advantages and disadvantages of using robotic-assisted laparoscopy in gynecological surgeries were evaluated. RESULTS: Fifteen patients underwent a variety of gynecologic surgeries, such as myomectomies, treatment of endometriosis, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy, and Moskowitz procedure. The assembly time to switch from laparoscopy to robotic-assisted surgery was 18.9 minutes (range, 14 to 27), and the disassembly time was 2.1 minutes (range, 1 to 3). Robotic-assisted laparoscopy acts as a bridge between laparoscopy and laparotomy but has the disadvantage of being costly and bulky. CONCLUSION: Robotic-assisted laparoscopic surgeries have advantages in providing a 3-dimensional visualization of the operative field, decreasing fatigue and tension tremor of the surgeon, and added wrist motion for improved dexterity and greater surgical precision. The disadvantages include enormous cost and added operating time for assembly and disassembly and the bulkiness of the equipment.PMID: 17212887 [PubMed – indexed for MEDLINE] ________________________________________ Eur J Obstet Gynecol Reprod Biol. 2007 Jan 6; [Epub ahead of print] Endometriosis, dysmenorrhea and diet-What is the evidence?Fjerbaek A, Knudsen UB.Department of Gynecology and Obstetrics, Odense University Hospital, University of Southern Denmark, DK-5000 Odense C, Denmark.The objective of this study is to assess the literature concerning the effect of diet on endometriosis and dysmenorrhea and to elucidate evidential support, to give dietary recommendations to women suffering from these conditions. A systematic search in electronic databases on a relationship between diet and endometriosis/dysmenorrhea was performed. Data on diet and endometriosis were limited to four trials of which two were animal studies. The articles concerning human consumption found some relation between disease and low intake of vegetable and fruit and high intake of vegetarian polyunsaturated fat, ham, beef and other red meat. Results concerning fish intake were not consistent. Eight trials of different design, with a total of 1097 women, investigated the relationship between diet and dysmenorrhea. Intake of fish oil seemed to have a positive effect on pain symptoms. This study concludes that literature on diet and endometriosis is sparse, whereas eight studies have looked at diet and dysmenorrhea. No clear recommendations on what diet to eat or refrain from to reduce the symptoms of endometriosis can be given, while a few studies indicate that fish oil can reduce dysmenorrhea. Further research is recommended on both subjects.PMID: 17210218 [PubMed – as supplied by publisher] ________________________________________ J Reprod Immunol. 2007 Jan 6; [Epub ahead of print] Intraperitoneal recombinant interleukin-2 activates leukocytes in rat endometriosis.Velasco I, Quereda F, Bermejo R, Campos A, Acien P.Division of Gynecology, School of Medicine, Miguel Hernandez University, Alicante, Spain.The aim of this double-blinded study was to determine changes in leukocyte populations in blood, peritoneal lavage fluid, eutopic and ectopic endometrium after treatment with recombinant rat interleukin-2 (IL-2) using an in vivo experimental model of rat endometriosis. The in vivo model involved transplanting four square fragments of autologous endometrium onto the inner surface of the abdominal wall in 20 Wistar rats. The control group was constituted by 20 sham-operated rats. Both groups were randomly treated (1-month interval treatment) with 2 intraperitoneal doses of glucose solution (5%) that did or did not contain recombinant IL-2, and animals were sacrificed 4 weeks after the last dose of treatment. Blood and peritoneal lavage were obtained during the initial and final laparotomy, whereas eutopic and ectopic endometrium were collected at the end of the experiment. Endometriotic implants were measured in each laparotomy to determine any change in size. Leukocyte populations were analyzed by flow cytometry and immunofluorescence microscopy. Cytometric results were similar in blood and peritoneal lavage. CD25+ and natural killer (NK) cell levels in peripheral blood were lower in rats with endometriosis treated with IL-2, whereas NK cells increased in lavage compared to placebo group. The percentage of macrophages and dendritic cells in blood were higher in all rats treated with IL-2, as well as peritoneal dendritic cells. Implant size of these rats decreased significantly, showing a greater number of activated lymphocytes, macrophages, NK and dendritic cells inside them. In conclusion, recombinant IL-2 induced recruitment of activated leukocytes into endometriotic-like foci, and this was related to a reduction of the implant size, suggesting potential effectiveness of IL-2 as an immunomodulatory agent in this pathology.PMID: 17210185 [PubMed – as supplied by publisher] ________________________________________ Wiad Lek. 2006;59(7-8):570-2.[Intestinal tract endometriosis][Article in Polish]Sygut AR, Trzcinski RP, Galbfach PJ, Dziki AJ.Z Kliniki Chirurgii Ogolnej i Kolorektalnej Uniwersytetu Medycznego, lodzi.Pelvic endometriosis in 3-37% of cases involves the intestinal tract, mainly sigmoid colon and rectum. In clinical practice endometriosis of the intestinal tract is rarely diagnosed and usually after long-lasting symptoms. During 3 years we treated only 2 women with this disease and therefore we want to report this seldom disorder. One woman had been diagnosed as having had rectal endometriosis before she was admitted to the hospital and the other one was admitted because of complications after laparoscopic treatment of pelvic endometriosis. In spite of typical signs of intestinal tract endometriosis, the proper diagnosis was made after several years of symptoms in one woman and in the second female histopathology of removed sigmoid colon because of its lesion finally revealed endometriosis. Laparoscopy seems to be the best diagnostic method of intestinal endometriosis and its treatment is to remove the involved part of the bowel together with endometriotic foci and surrounding tissues. Cyclical intestinal endometriosis symptoms correlating with menstrual cycle should always draw our attention to this rare disorder.Publication Types: ? Case Reports ? English Abstract PMID: 17209363 [PubMed – indexed for MEDLINE] ________________________________________ Gynecol Obstet Fertil. 2007 Jan;35(1):77-8. Epub 2007 Jan 8. Comment on: ? Gynecol Obstet Fertil. 2006 Jul-Aug;34(7-8):583-92.[Laparoscopic surgery of deep endometriosis. About 118 cases][Article in French]Canis M.Publication Types: ? Comment ? Letter PMID: 17208495 [PubMed – indexed for MEDLINE] ________________________________________ Gynecol Obstet Fertil. 2007 Jan;35(1):38-40. Epub 2007 Jan 8. [Treating severe endometriosis by pregnancy: a risky business][Article in French]Roman H, Friederich L, Khalil H, Marouteau-Pasquier N, Hochain P, Marpeau L.Clinique gynecologique et obstetricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France. horace.roman@chu-rouen.frWe report the case of a young woman presenting with painful deep and rectal endometriosis. This condition had started long ago while the diagnosis had been delayed. Brutal colon occlusion followed the discontinuation of oral contraception. Left colectomy with terminal colostomy was carried out in emergency. The conservative surgical management of deep endometriosis was performed three months later. In women presenting deep endometriosis, the discontinuation of hormonal treatment in order to attempt a spontaneous pregnancy should not be recommended before undertaking a thorough endometriosis and fertility status investigation.Publication Types: ? Case Reports ? English Abstract PMID: 17208494 [PubMed – indexed for MEDLINE] ________________________________________ Gynecol Obstet Fertil. 2007 Jan;35(1):78-9. Epub 2007 Jan 8. Comment on: ? Gynecol Obstet Fertil. 2006 Jul-Aug;34(7-8):583-92.[Laparoscopic surgery of deep endometriosis. About 118 cases][Article in French]Darai E.Publication Types: ? Comment ? Letter PMID: 17208491 [PubMed – indexed for MEDLINE] ________________________________________ Eur J Obstet Gynecol Reprod Biol. 2007 Jan 5; [Epub ahead of print] The effect of intraperitoneal interleukin-2 on surgically induced endometriosis in rats.Quereda F, Bermejo R, Velasco I, Campos A, Acien P.Division of Gynecology, School of Medicine, "Miguel Hernandez University", Alicante, Spain.OBJECTIVE: To evaluate the effect of interleukin-2 (IL-2) on an experimental model of endometriosis. STUDY DESIGN: Double blind and randomized experimental prospective placebo-controlled study. Experimental endometriosis was induced in 66 three-month-old female Wistar rats, by auto-transplanting fragments of endometrium to the peritoneum. After four weeks, the size of each implant was measured in millimeters by laparotomy (L2), and animals were randomly distributed for intraperitoneal administration of human-IL-2, rat-IL-2 or placebo. Four weeks later, the implants were measured (L3) and a second dose was given. After four weeks, endometriosis size was evaluated again (L4). RESULTS: We found a reduction of experimental endometriosis at L3 that was only significant in IL-2 treated groups: 20.1% and 30.3% with human-IL-2 and rat-IL-2, respectively (p<0.001 with respect to L2 size), versus a non-significant reduction of 9.0% found in placebo group, but the differences were not statistically significant between groups. The decrease after a second dose (L4) was: 49.8%, 41.8% and 11.4% with human-IL-2, rat-IL-2 and placebo, respectively (p<0.001 in IL-2 groups versus L2 and L3, and p<0.05 in both groups versus placebo at L4). CONCLUSION: Intraperitoneal administration of IL-2 reduces experimental endometriosis, and this effect is similar using rat-IL-2 or human IL-2 (non specie-specific effect).PMID: 17208346 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2007 Apr;87(4):988-90. Epub 2007 Jan 4. Detection of endometriosis with the use of plasma protein profiling by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry.Liu H, Lang J, Zhou Q, Shan D, Li Q.In this prospective case-control study, we determined the role of surface-enhanced laser desorption and ionization time-of-flight mass spectrometry in the detection of histologically proven endometriosis. In the plasma of the group with endometriosis, there were 20 different protein peaks, and the classifier showed a sensitivity of 87.5% and a specificity of 80% in the diagnosis of endometriosis.Publication Types: ? Letter ? Research Support, Non-U.S. Gov’t PMID: 17207800 [PubMed – indexed for MEDLINE] ________________________________________ Eur J Obstet Gynecol Reprod Biol. 2007 Jan 3; [Epub ahead of print] Differential flow cytometric detection of intracellular cytokines in peripheral and peritoneal mononuclear cells of women with endometriosis.Gmyrek GB, Sieradzka U, Goluda M, Gabrys M, Sozanski R, Jerzak M, Zbyryt I, Chrobak A, Chelmonska-Soyta A.Laboratory of Reproductive Immunology, Institute of Immunology and Experimental Therapy, Rudolfa Weigla 12, 53-114 Wroclaw, Poland.OBJECTIVE: The pathogenesis of endometriosis is related to functional changes in CD3+ and CD14+ cells observed both at the local and systemic level. Here we investigated whether, and if so, how the body compartment influences cytokine expression in stimulated peritoneal and peripheral CD3+ and CD14+ cells of women with endometriosis. STUDY DESIGN: Isolated peripheral blood (PB) and peritoneal fluid (PF) mononuclear cells from women with endometriosis were cultured under non-adherent conditions and stimulated with PMA and ionomycin for 6h to induce intracellular cytokine synthesis of TNF-alpha, IFN-gamma, and IL-8 by CD3+ cells or with LPS for 9h to produce TNF-alpha, IL-6, IL-10, MCP-1, and IL-8 by CD14+ cells. RESULTS: The percentages of positive CD3+ cells stained for TNF-alpha and IFN-gamma were significantly higher and those stained for IL-8 were significantly lower in PF compared with PB, this being independent of the stage of endometriosis. In contrast, the percentages of CD14+ cells producing TNF-alpha, IL-6, IL-10, MCP-1, and IL-8 were significantly higher in PB than PF of women with endometriosis. CONCLUSIONS: Monocytes/macrophages and lymphocytes derived from the peripheral and peritoneal compartments of women with endometriosis differentially respond to stimulated cytokine synthesis induction. However, it is difficult to state whether the observed phenomenon is more related to body compartment influence per se or to the presence of endometriosis.PMID: 17207568 [PubMed – as supplied by publisher] ________________________________________ Reprod Biomed Online. 2007 Jan;14(1):49-56. Assessment of human oocyte developmental competence by cumulus cell morphology and circulating hormone profile.Sato C, Shimada M, Mori T, Kumasako Y, Otsu E, Watanabe H, Utsunomiya T.St Luke Clinic, 5 Tsumori-Tomioka, Oita 870-047, Japan.The predictive value of the morphology of the cumulus–oocyte complex (COC) has not yet been explored as a possible factor contributing to the success of human in-vitro maturation (IVM). In the present study, development-supporting competency of oocytes encircled in a large ( > or = 5) (grade A), moderate (3 approximately 4) (grade B) or small ( < or = 2) (grade C) number of cumulus cell layers was assessed, together with changes in hormonal profile following a truncated course of 150 IU pure FSH administration for 3 days prior to aspiration on laparoscopy indicated for endometriosis. FSH priming increased the number of COC aspirated without changing the proportion of the three morphological types of COC, which were then subjected to IVM in the presence of 200 mIU/ml FSH plus 1000 mIU/ml human chorionic gonadotrophin, followed by intracytoplasmic sperm injection. The highest development-supporting competence was observed not with oocytes in grade A COC harvested from natural cycles, but with oocytes in grade B COC from FSH-primed cycles. Hormonal profiles in patients bearing grade B COC were characterized by moderate response in oestradiol and progesterone production following FSH, with LH/FSH ratio being below 1.0. It is concluded that an optimal window of hormonal profile(s) may exist for follicle aspiration to obtain grade B COC in FSH-stimulated human IVM cycles.PMID: 17207331 [PubMed – indexed for MEDLINE] ________________________________________ J Endourol. 2006 Dec;20(12):1072-4. Laparoscopic partial cystectomy in the management of bladder endometriosis: report of two cases.Vitagliano G, Villeta M, Castillo O.Section of Endourology and Laparoscopic Urology, Department of Urology, Clinica Santa Maria, Santiago de Chile, Chile.Endometriosis is the proliferation of endometrial tissue outside the normal confines of the myometrium or uterine cavity. Endometriosis involving the urinary tract occurs in approximately 1% to 2% of cases. The bladder is affected in 80% of these patients. The diagnosis of vesical endometriosis is difficult, and it should be confirmed by cystoscopy with biopsy. Laparoscopic examination represents the gold standard for the diagnosis of pelvic endometriosis. Urinary bladder endometriosis may be treated surgically or medically with hormone-suppressive therapy. However, medical treatments usually are only palliative, and symptoms generally recur on discontinuation. We report our experience in two patients with vesical endometriosis who were managed successfully with cystoscopy-assisted laparoscopic partial cystectomy.Publication Types: ? Case ReportsPMID: 17206905 [PubMed – indexed for MEDLINE] ________________________________________ Hum Reprod. 2007 Apr;22(4):938-44. Epub 2007 Jan 4. Collagen gel contractility is enhanced in human endometriotic stromal cells: a possible mechanism underlying the pathogenesis of endometriosis-associated fibrosis.Yuge A, Nasu K, Matsumoto H, Nishida M, Narahara H.Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan.BACKGROUND: Excessive fibrosis is frequently associated with endometriosis. To evaluate the involvement of the extracellular matrix contractility of endometriotic stromal cells (ECSCs) in the pathogenesis of endometriosis-associated fibrosis, we compared the collagen gel contractility of cultured ECSCs with that of normal endometrial stromal cells. To clarify the mechanism underlying collagen gel contraction by ECSCs, we also evaluated the effect of (+)-(R)-trans-4-(1-aminoethyl)-N-(4-pyridyl) cyclohexanecarboxamide dihydrochloride, monohydrate (Y-27632), a selective Rho-associated coiled-coil-forming protein kinase (ROCK) inhibitor, on the collagen gel contraction by ECSCs. METHODS AND RESULTS: ECSCs showed enhanced collagen gel contractility in comparison with NESCs. Myofibroblastic differentiation and the increased expression of fibronectin, RhoA, ROCK-I and ROCK-II proteins were observed with ECSCs using the 3D culture. Y-27632 significantly inhibited the collagen gel contractility of ECSCs without cytotoxicity. CONCLUSIONS: The present findings suggest that the enhanced collagen contractility in ECSCs is associated with myofibroblastic differentiation, the increased expression of fibronectin and the activation of the Rho-ROCK-mediated signalling pathway, all of which may be involved in the pathogenesis of endometriosis-associated fibrosis. These results suggest that the inhibition of the Rho-ROCK-mediated signalling pathway may provide a novel strategy for the treatment of this disease. In addition, our experimental system of ECSCs using 3D collagen gel culture would be suitable for evaluating novel treatments for endometriosis.Publication Types: ? Research Support, Non-U.S. Gov’tPMID: 17204524 [PubMed – in process] ________________________________________ Gynecol Obstet Invest. 2007 Jan 5;64(1):24-35 [Epub ahead of print] Two Unsuccessful Clinical Trials on Endometriosis and a Few Lessons Learned.Guo SW, Olive DL.Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisc., USA.In 1999, a phase II clinical trial on the use of fulvestrant to treat endometriosis was launched; yet after 7 years there is still no report on its outcome. In 2005, another trial on the use of raloxifene to treat endometriosis was terminated early due to unfavorable outcome. The two apparently unsuccessful clinical trials on endometriosis have taught us a few important lessons. First, we need to understand endometriosis through more basic research. We have also been reminded that human endometriosis trials differ from animal studies; anatomy and physiology are often divergent, and outcome measures are certainly different. Ectopic endometrium can differ significantly from eutopic tissue, and this issue needs to be more thoroughly explored. We believe human cell lines will prove to be an inexpensive and valuable tool for future preliminary evaluation of medical therapies as well as discerning pathophysiologic processes of the disease. Based on our current understanding of endometriosis, some concrete benchmarks can be established for testing or screening potential compounds in vitro. Finally, estrogen receptor modulators are often tissue-, cell-, and context-specific in their actions; they should not be simplistically grouped together nor should extrapolations from one compound to another be undertaken in a cavalier manner. Copyright (c) 2007 S. Karger AG, Basel.PMID: 17202821 [PubMed – as supplied by publisher] ________________________________________ Zhonghua Fu Chan Ke Za Zhi. 2006 Oct;41(10):669-71.[Analysis of relative factors influencing recurrence of endometriosis after operation treatment][Article in Chinese]Zhao X, Liu JL, Chen SR, Liu Y.Department of Obstetrics and Gynecology, the Affiliated Hospital of Zunyi Medical College, Zunyi 563003, China.OBJECTIVE: To explore the relative factors influencing the recurrence of endometriosis. METHODS: Three hundred and fifty-six patients of endometriosis were treated with surgery and then followed up for 3 years. Seventy-five recurrent cases among them were analyzed retrospectively. RESULTS: The recurrent rate was different in the <or= 24 year age group (chi(2) = 11.212, P < 0.05), while there was no difference in the other age groups. According to pathological type, the recurrent rate of mixed pattern (29.2%) was significantly higher than that of the simple chocolate cyst (17.5%; chi(2) = 4.622, P < 0.05). The higher the clinical stage of the endometriosis, the higher the recurrent rate (P < 0.05). The recurrent rate of endometriosis in the third stage was different between laparoscopy and laparotomy (31.3% vs 11.3%; chi(2) = 7.971, P < 0.01). Mifepristone could prolong the interval of recurrence after operation [(13 +/- 4) vs (7 +/- 3) months; t = 4.575, P < 0.01]. CONCLUSIONS: Individualized therapeutic regimen should be made in treatment of endometriosis according to age, pathological type, and clinical stage. The recurrent rate could be reduced and the interval of recurrence could be prolonged using ovarian function inhibiting drugs for a short time post-operation.Publication Types: ? English AbstractPMID: 17199920 [PubMed – in process]

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