Zhonghua Fu Chan Ke Za Zhi. 2006 Oct;41(10):664-8.[Effects of levonorgestrel-releasing intrauterine system on pain and recurrence associated with endometriosis and adenomyosis][Article in Chinese]Deng S, Lang JH, Leng JH, Liu ZF, Sun DW, Zhu L.Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.OBJECTIVE: To observe the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) in treatment of pain associated with endometriosis (EM) and adenomyosis (AM), and in prevention of disease recurrence. METHODS: Thirty-three cases of moderate to severe EM or AM patients received insertion of LNG-IUS immediately after conservative operation, or after recurrence of simple pain, and were self controlled respectively before and after insertion of LNG-IUS. The visual analogue scale (VAS) was compared, and the change of the lesion and the uterine size, as well as the serum steroid and CA(125) were observed. The side-effects, such as bleeding pattern were recorded. The bleeding period was compared between the cases injected with or without gonadotropin-releasing hormone agonist (GnRHa) before insertion of LNG-IUS. RESULTS: Baseline and follow-up VASs of EM were 8.09 +/- 0.21 and 1.64 +/- 1.12 (P = 0.042), of AM were 8.41 +/- 1.59 and 3.99 +/- 3.87 (P = 0.068), respectively. During nearly 2 years’ follow-up, moderate dysmenorrhea recurred in only 1 case who was hyper-estrogenism at that time. Generally, irregular bleeding and spotting period were longer in this LNG-IUS treated group than those reported in literatures in which LNG-IUS was used for contraception. Persistent prolonged spotting was seen in most of the patients during 1 year follow-up. Average bleeding days in one month during the first 6 months after insertion of LNG-IUS were both around 18 days, whether using GnRHa or not. CONCLUSIONS: LNG-IUS greatly reduces pain associated with EM and AM, and delays disease recurrence. Irregular bleeding and spotting is the main side effects. Administration of GnRHa in advance does not improve the bleeding symptoms.Publication Types: ? English AbstractPMID: 17199919 [PubMed – in process] ________________________________________ Zhonghua Fu Chan Ke Za Zhi. 2006 Oct;41(10):656-9.[Effect of triptorelin and an extended-interval dosing regimen in the treatment of patients with endometriosis and adenomyoma][Article in Chinese]Liu DY, Gu MJ, Shu JZ, Shi YX, Wang CY, Han ZQ.Department of Obstetrics and Gynecology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.OBJECTIVE: To study the role of triptorelin in the treatment of patients with endometriosis, adenomyoma and fibromyoma and the effect of an extended-interval dosing regimen. METHODS: Seventy patients suffering from endometriosis, adenomyoma and fibromyoma were divided into two groups: extended-interval dosing (group E) and conventional dosing (group C). There were treated with injection of triptorelin 3.75 mg intramuscularly either every 6 weeks of totally four dose regimen (group E) or every 4 weeks of six dose regimen (group C). Comparison was made in improvement of symptoms, size of uterus and volume of tumor, as well as in serum levels of 17beta-estradiol, luteinizing hormone, and follicle-stimulating hormone. RESULTS: In each group, symptoms and tumor growth significantly improved after treatment (P < 0.05). For the patients of both groups E and C, the levels of gonadotropins and gonadal steroids were obviously reduced throughout the treatment period and up to 8 – 10 weeks after the injection of the last dose (P < 0.05). The hormonal profile of group E was similar to group C (P > 0.05). CONCLUSIONS: Gonadotropin-releasing hormone agonist is efficacious in the treatment of endometriosis and adenomyoma through reducing the serum levels of follicle-stimulating hormone, luteinizing hormone and 17beta-estradiol. The curative effect is satisfactory in most patients receiving an extended interval dosing regimen. To reduce the cost of treatment, the extended-interval dosing regimen of triptorelin should be adopted in well-equipped hospitals.Publication Types: ? English AbstractPMID: 17199917 [PubMed – in process] ________________________________________ Zhonghua Fu Chan Ke Za Zhi. 2006 Oct;41(10):652-5.[Summary of the second national conference on endometriosis][Article in Chinese]Zhu L, Tan XJ.PMID: 17199916 [PubMed – in process] ________________________________________ Zhonghua Fu Chan Ke Za Zhi. 2006 Oct;41(10):649-51.[Present and future of studies on endometriosis (part two)][Article in Chinese]Lang JH.Publication Types: ? EditorialPMID: 17199915 [PubMed – in process] ________________________________________ Taiwan J Obstet Gynecol. 2006 Jun;45(2):167-9. Mitotically active leiomyoma of the uterus in a postmenopausal breast cancer patient receiving tamoxifen.Liu IF, Yen YS, Cheng YM, Chou CY.Department of Obstetrics and Gynecology, National Cheng Kung University Medical Center, Tainan, Taiwan.OBJECTIVE: Mitotically active leiomyoma of the uterus complicated with postmenopausal vaginal bleeding has never been reported in Taiwan. Here, we present a case of mitotically active leiomyoma of the uterus complicated with postmenopausal vaginal bleeding in a breast cancer patient who had been receiving tamoxifen for 2 years. CASE REPORT: A 56-year-old woman visited our clinic due to abnormal vaginal spotting for 3 months. This patient had been menopausal for about 6 years without hormone replacement therapy. She had been suffering from breast cancer, had undergone conservative breast surgery, and had been taking tamoxifen (20 mg/day) for 2 years. Pelvic ultrasound was performed and revealed an 8.9 x 7.7 cm uterine mass. After simple total hysterectomy, we found an enlarged uterus with a mass over the posterior wall. Final pathology demonstrated a mitotically active leiomyoma, adenomyosis of the uterus, and proliferation of the endometrium. CONCLUSION: Endometrial cancer is rarely noted in breast cancer patients taking tamoxifen. Further, none have reported mitotically active leiomyoma of the uterus. From this case, endometrial proliferation and mitotically active leiomyoma of the uterus may be related to tamoxifen therapy, and should not be neglected in breast cancer patients.Publication Types: ? Case ReportsPMID: 17197361 [PubMed – indexed for MEDLINE] ________________________________________ Taiwan J Obstet Gynecol. 2006 Jun;45(2):142-5. Failure of laparoscopy to relieve ureteral obstruction secondary to endometriosis.Chen HY, Huang MC, Hung YC, Hsu YH.Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.OBJECTIVES: To present a case of hydronephrosis and hydroureter secondary to pelvic endometriosis and to discuss the pitfalls in laparoscopic management. CASE REPORT: A 37-year-old nulligravida woman had mild elevation of blood pressure for about 1 year without abdominal pain, dyspareunia, or dysmenorrhea. Renal ultrasound revealed left hydronephrosis and a 4-cm pelvic cyst. Intravenous pyelogram showed distal ureteral obstruction. An MRI with fat saturation disclosed a left ovarian endometrioma and a lesion in the uterosacral ligament causing periureteral compression. Laparoscopic findings included a dilated left ureter above the uterosacral ligament, left uterosacral ligament endometriosis with adhesions, and a 4-cm left ovarian endometrioma. Cystoureteroscopy showed external ureteral compression 2 cm above the ureteral orifice. A ureteral catheter was placed. The left endometrioma was enucleated and ureterolysis was performed. The latter procedure had to be discontinued because of bleeding from descending uterine vessels. The ureteral catheter was removed 2 months later and her blood pressure gradually returned to normal. However, after 1 year, she was found to have recurrent hydronephrosis and underwent segmental resection of the distal ureter and reconstruction by end-to-end reanastomosis. CONCLUSION: In women of reproductive age, hydronephrosis and hypertension may be the only symptoms of endometriosis. While laparoscopic treatment is useful in endometriosis, it may fail in the presence of chronic inflammation and severe fibrosis.Publication Types: ? Case ReportsPMID: 17197355 [PubMed – indexed for MEDLINE] ________________________________________ Fertil Steril. 2007 Jan;87(1):33-8. Effects of photodynamic therapy using 5-aminolevulinic acid on cultured human adenomyosis-derived cells.Suzuki-Kakisaka H, Murakami T, Hirano T, Terada Y, Yaegashi N, Okamura K.Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan. suharuka@mail.tains.tohoku.ac.jpOBJECTIVE: To evaluate the potential of photodynamic therapy with aminolevulinic acid (ALA) on human adenomyosis-derived cells compared with endometrial stromal cells. DESIGN: In vitro study. SETTING: Department of Obstetrics and Gynecology, Tohoku University Hospital. PATIENT(S): Women with adenomyosis attending the University hospital. INTERVENTION(S): Photodynamic treatment. MAIN OUTCOME MEASURE(S): Cell survival rates. RESULT(S): Treatment with both ALA and irradiation caused significantly decreased survival of cells derived from human adenomyosis compared with ALA or irradiation alone. The combination of irradiation and ALA led to 79.3%, 68.0%, and 59.5% cell survival at 1.6, 4, and 8 J/cm2, respectively, whereas ALA and irradiation alone caused 92.8% and 97% survival, respectively. CONCLUSION(S): Photodynamic therapy using ALA caused extensive death of cells derived from human adenomyosis. Photodynamic treatment using ALA may be a new treatment for patients with adenomyosis uteri in the future.PMID: 17197284 [PubMed – indexed for MEDLINE] ________________________________________ Clin Exp Med. 2006 Dec;6(4):171-6. Imbalance of mononuclear cell infiltrates in the placental tissue from foetuses after spontaneous abortion versus therapeutic termination from 8th to 12th weeks of gestational age.Lambropoulou M, Tamiolakis D, Venizelos J, Liberis V, Galazios G, Tsikouras P, Karamanidis D, Petrakis G, Constantinidis T, Menegaki M, Papadopoulos N.Department of Histology-Embryology, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.Placental macrophages (Hofbauer cells) are located close to trophoblastic cells and foetal capillaries, which make them perfect candidates for involvement in regulatory processes within the villous core. Their capacity of producing several cytokines and prostaglandin-synthesising enzymes, and expressing vascular endothelial growth factor, indicate a possible role in placental development and angiogenesis in order to support pregnancy. Common cells to Hofbauer macrophages sharing similar cell surface markers (HLA-A, -B, -C and leukocyte common antigen) have been reported in the stroma, decidua and amnion, indicating additional foetal protection. Yet this is not always the case. Most spontaneous abortions occur before 12 weeks’ gestation, and most are due to chromosomal errors in the conceptus. Relatively few truly spontaneous abortions take place between 12 and 20 weeks’ gestation. Thereafter, between 20 and 30 weeks, another type of premature spontaneous termination becomes prevalent, which is due to ascending infection. The numbers of cells expressing the various markers of the monocytemacrophage lineage change throughout pregnancy. In the present study, we investigated the immunohistochemical expression of mononuclear infiltrations in paraffin-embedded placentas, from foetuses after spontaneous abortion (8th, 10th and 12th weeks of gestational age), and those after therapeutic abortion at the same time, using a panel of monoclonal antibodies for the identification of leukocytes (CD45/LCA), B-lymphocytes (CD20/L-26), T lymphocytes (CD45RO/UCHL1), CD68 and CD14 cells. Immunologic factors in human reproductive failure are plausible mechanisms of infertility and spontaneous abortion. Approximately 25% of cases of premature ovarian failure appear to result from an autoimmune aetiology. Unfortunately, current therapeutic options for these women are limited to exogenous hormone or gamete substitution. Local inflammations at the sites of endometriosis implants are postulated to mediate the pain and reduced fecundability associated with this clinical syndrome. The recruitment of immune cells, particularly monocytes and T-cells, neovascularisation around foci of invading peritoneal lesions, and the possible development of antiendometrial autoantibodies support an immunologic basis of this disorder. To date, treatment of pain and infertility associated with endometriosis is primarily surgical, although immune-based adjuvants are theoretical possibilities for the future. Finally, although hypotheses supporting immunologic mechanisms of recurrent pregnancy loss have been popular over the past decade, most clinical investigations in this area do not provide compelling evidence for this position. Reputable specialists in reproductive medicine use experimental immunotherapies judiciously in selected cases of repetitive abortion. For example, the use of anticoagulation therapy can be beneficial in cases with documented antiphospholipid antibodies. At present, however, efficacious immunotherapy protocols for general application have not been established. Despite these caveats, continued strides in our understanding of human reproductive immunology should yield considerable future progress in this field. During the physiological changes that occur in the first and in the beginning of the second trimester of pregnancy, spiral arteries of the placental bed are converted into the uteroplacental arteries. The essence of this conversion consists of losing the muscular elements in the vessel walls, making them unable to respond to vasomotor influences. Cells that infiltrate the walls of spiral arteries and replace their normal elements are called migratory, non-villous or intermediate trophoblastic cells. Besides infiltrating and replacing the anatomic structures of spiral arteries, intermediate trophoblastic cells also penetrate into the lumina of these vessels forming endovascular plugs. These plugs are one of the reasons why early uteroplacental blood flow cannot be visualised, even with transvaginal ultrasound, during the first 12 weeks of gestation. In uncomplicated pregnancies, the endovascular trophoblast is bound to disappear by the end of the second trimester of pregnancy, but the literature on this topic is scarce. Here we describe the detection, isolation and characterisation of CD45RO-, L26- and CD68/CD14-positive cells from human early pregnancy deciduas. These cells were found in close vicinity to endometrial glands, with preference to the basal layer of the decidua. We conclude that (1) maternal cells, apparently CD45RO/UCHL1-positive cells, cross the maternofoetal barrier and participate in spontaneous (involuntary) abortions, and (2) a small proportion of maternal cells (approximately 30%), apparently CD68/CD14-positive cells, also cross the maternal-foetal barrier and cause growth delay and recurrent reproductive failure. Further investigation of involvement of the intercellular adhesion molecules 1 and 2, platelet endothelial cell adhesion molecule, vascular cell adhesion molecule and E-selectin in leukocyte accumulation will be needed to support the passage of maternal cells to the foetus. The results were statistically significant (P<0.0001, Student’s t-test).Publication Types: ? Comparative StudyPMID: 17191109 [PubMed – indexed for MEDLINE] ________________________________________ Int J Gynaecol Obstet. 2007 Jan;96(1):20-3. Epub 2006 Dec 21. Sonohysterography versus transvaginal sonography for screening of patients with abnormal uterine bleeding.Alborzi S, Parsanezhad ME, Mahmoodian N, Alborzi S, Alborzi M.Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran. alborzis@sums.ac.irOBJECTIVES: To compare the accuracy of saline infusion sonohysterography (SIS) with transvaginal sonography (TVS) for the screening of causes of abnormal uterine bleeding (AUB) in out-patients. METHODS: 81 patients with AUB were studied. All cases who were examined with TVS, were further investigated with SIS using saline as contrast medium, finally hysteroscopy was used as the gold standard. RESULTS: TVS had sensitivity of 72%, specificity of 92%, positive predictive value of 94% and negative predictive value of 65%, while SIS had sensitivity of 94.1%, specificity of 95%, positive predictive value of 96% and negative predictive value of 90%. TVS had kappa measure of agreement of 0.60 while 0.86 was reported for SIS. CONCLUSIONS: In this study SIS was more sensitive and specific in diagnosing polyp, myoma and adenomyosis with high positive and negative predictive value. Furthermore, results obtained by SIS demonstrate more agreement with that obtained by hysteroscopy than TVS.Publication Types: ? Clinical Trial ? Comparative Study PMID: 17187802 [PubMed – indexed for MEDLINE] ________________________________________ Pharmacogenomics. 2007 Jan;8(1):49-66. Vascular endothelial growth factor pharmacogenetics: a new perspective for anti-angiogenic therapy.Pasqualetti G, Danesi R, Del Tacca M, Bocci G.1University of Pisa, Division of Pharmacology and Chemotherapy, Department of Internal Medicine, Via Roma, 55, I-56126 Pisa, Italy. g.bocci@med.unipi.it.The pharmacogenetic approach to anti-angiogenic therapy should be considered a possible strategy for many pathological conditions with high incidence in Western countries, including solid tumors, age-related macular degeneration or endometriosis. While pharmacogenetic studies are building stronger foundations for the systematic investigations of phenotype-genotype relationships in many research and clinical fields of medicine, pharmacogenetic data regarding anti-angiogenic drugs are still lacking. Here we review preclinical and clinical genetic studies on angiogenic determinants such as vascular endothelial growth factor and vascular endothelial growth factor receptor-2. We suggest that pharmacogenetic profiling of patients who are candidates for the currently available anti-angiogenic agents targeting vascular endothelial growth factor and vascular endothelial growth factor receptor-2 may aid the selection of patients on the basis of their likelihood of responding to the drugs or suffering from toxicity.PMID: 17187509 [PubMed – in process] ________________________________________ Int J Cancer. 2007 Mar 15;120(6):1372-5. Risk for breast cancer among women with endometriosis.Bertelsen L, Mellemkjaer L, Frederiksen K, Kjaer SK, Brinton LA, Sakoda LC, van Valkengoed I, Olsen JH.Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen O, Denmark. lisbethb@cancer.dkAlthough several risk factors are common to endometriosis and breast cancer, the results of observational studies of an association have so far been inconsistent. We evaluated the relationship between endometriosis and breast cancer on the basis of data on selected cancers and medical histories from the Danish nationwide cancer and hospital registries used in a large case-cohort study. A total of 114,327 women were included in the study of whom 1,978 women had received a diagnosis of endometriosis and 16,983 had had a diagnosis of breast cancer between 1978 and 1998. Of the women with endometriosis, 236 subsequently received a diagnosis of breast cancer. The crude overall rate ratio for breast cancer after endometriosis was 1.00 and after adjustment for reproductive factors, calendar-period, bilateral oophorectomy and benign breast disease, the rate ratio was 0.97 (95% confidence interval, 0.85-1.11). The risk for breast cancer increased with age at diagnosis of endometriosis, so that women in whom endometriosis was diagnosed at a young age (approximately <40 years) had a reduced risk for breast cancer and women in whom endometriosis was diagnosed at older ages (approximately > or =40 years) tended to have an increased risk for breast cancer. The reduced risks observed among young women may reflect their exposure to drugs with antiestrogenic effects. The increased risk associated with endometriosis among postmenopausal women may be due to common risk factors between postmenopausal endometriosis and breast cancer or an altered endogenous estrogen. (c) 2006 Wiley-Liss, Inc.Publication Types: ? Research Support, N.I.H., Intramural ? Research Support, Non-U.S. Gov’t PMID: 17187365 [PubMed – indexed for MEDLINE] ________________________________________ Neuro Endocrinol Lett. 2006 Dec;27(6):813-7.The usefulness of laparoscopy and hysteroscopy in the diagnostics and treatment of infertility.Kaminski P, Gajewska M, Wielgos M, Szymusik I, Ziolkowska K, Bartkowiak R.1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.OBJECTIVES: The aim of the study was to analyze the use of endoscopic procedures in the group of infertile patients. MATERIAL AND METHODS: The study material consisted of 636 patients, aged 20-41. They all had endoscopic procedures performed (laparoscopy and/or hysteroscopy) due to infertility, and were qualified for the procedure after a gynecological examination and ultrasound scan. The study group was divided into subgroups of primary and secondary sterility and endoscopic procedures were then analyzed. RESULTS: A total of 724 endoscopic procedures were performed on 636 patients. Eighty eight women had both hysteroscopy and laparoscopy performed, 476 had only laparoscopy, while 72–only hysteroscopy. Women diagnosed due to primary sterility more often had no visible abnormalities in the pelvic region (30%) and patent oviducts than those with secondary sterility. The remaining 70% more often had ovaries typical for polycystic ovarian syndrome and endometriosis. However, periadnexal adhesions and tubal impotency were more common in the group of secondary sterility. As to hysteroscopy, women with primary sterility more often had congenital uterine malformations, while submucosal myomas and intrauterine adhesions were less common in that group. All the surgical procedures performed during laparoscopies were analyzed. Tubal patency assessment and ovarian drilling were significantly more often performed in the subgroup of primary sterility. All intrauterine pathologies were treated during hysteroscopy. CONCLUSIONS: Laparoscopy and hysteroscopy play an important role as both diagnostic and therapeutic tools in the infertility treatment centers.Publication Types: ? Clinical TrialPMID: 17187014 [PubMed – indexed for MEDLINE] ________________________________________ Neuro Endocrinol Lett. 2006 Dec;27(6):779-85.The characterization of the exposure to immune mediated apoptosis and the regulation of immune cytotoxic activity in the environment of a neoplasm and in decidua.Popiela TJ, Klimek M, Wicherek L, Dutsch-Wicherek M, Galazka K, Rudnicka-Sosin L.Department of Radiology, Jagiellonian University, Krakow, Poland.Acquiring the immune-mediated apoptosis and the ability to regulate the cytotoxic immune response are the main phenomena playing fundamental roles in such situations as neoplasm survival and creation of immune tolerance during pregnancy. The aim of this study was to investigate these phenomena through the evaluation of metallothionein and RCAS1 proteins in neoplasm and its healthy environment (clear surgical margin), physiological conditions in placenta and its environment (decidua) and the comparison to non-neoplasmatic lesions originating from the environment (nasal polyps, endometriosis). We have shown that the growth of RCAS1 expression was simultaneous to the infiltration of activated immunological cells of tumor environment as well as decidua. The activity of immunological cells was in our study selectively suppressed. Metallothionein expression growth was also observed in healthy tumors stroma and in decidua probably in response to the growing cytotoxic activity and tumor spread. Alterations in RCAS1 and Metallothionein expression seem to be associated with local immune dysfunction in nasal polyps and endometriosis. In conclusion, the ability to compensate the growing cytotoxic immune response is physiologically observed in decidua, the lost of this ability in tumor environment might participate in the development of tumor spread.Publication Types: ? Comparative StudyPMID: 17187008 [PubMed – indexed for MEDLINE] ________________________________________ Mol Reprod Dev. 2007 Jul;74(7):808-14. Angiotensin I-converting enzyme insertion-related genotypes and allele are associated with higher susceptibility of endometriosis and leiomyoma.Hsieh YY, Lee CC, Chang CC, Wang YK, Yeh LS, Lin CS.Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.Endometriosis and leiomyoma display features similar to malignancy, requiring neovascularization to proliferation and growth. Altered vascular-related genes might be related to the development of endometriosis and leiomyoma. Polymorphisms of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) genes have been linked with some vascular diseases. This study investigates whether ACE I/D gene polymorphisms could be used as markers of susceptibility in endometriosis and leiomyoma. Women were divided into three groups: (1) endometriosis (n = 125); (2) leiomyoma (n = 120); (3) normal controls (n = 128). Genomic DNA was obtained from peripheral leukocyte. ACE I/D gene polymorphisms in intron 16 were amplified by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) Genotypes and allelic frequencies in both groups were compared. We observed the genotype distribution and allele frequency of ACE I/D gene polymorphisms in both groups were significantly different. Proportions of ACE*I homozygote/heterozygote/D homozygote in both groups were: (1) 50.4/24/25.6%; (2) 25/23.33/51.67%; (3) 10.2/29.7/60.1%. Proportions of I/D alleles in each group were: (1) 62.4/37.6%; (2) 36.7/63.3%; (3) 25/75%. We concluded that ACE*I/D gene polymorphisms are associated with endometriosis and leiomyoma susceptibilities. ACE*I-related genotypes and allele are strongly related to the occurrence of endometriosis and moderately related to the occurrence of leiomyoma. Mol. Reprod. Dev. 74: 808-814, 2007. (c) 2006 Wiley-Liss, Inc.PMID: 17186537 [PubMed – in process] ________________________________________ Urologe A. 2007 Jan;46(1):71-79. [Endometriosis of the ureter and urinary bladder.][Article in German]Zugor V, Krot D, Rosch WH, Schrott KM, Schott GE.Urologische Klinik mit Poliklinik, Friedrich-Alexander-Universitat Erlangen-Nurnberg, 91054, Krankenhausstrasse 12, Erlangen, Deutschland, vahudin.zugor@uro.imed.uni-erlangen.de.Endometriosis is a benign growth of ectopic endometrial mucous membrane which has maintained the histological characteristics and biological reactions of uterine mucous membrane. In only 1-2% of cases does it occur in the urinary system, most commonly in the urinary bladder. Such an endometriosis is often diagnosed very late due both to its commonly asymptomatic course and its rarity. Individual therapy is dependent on the age of the patient, the wish for children and the extent of the growth. For endometriosis covering a large area, surgery is recommended. Methods of choice are laparoscopic bladder resection for the urinary bladder, ureterocystoneostomy using the Psoas hitch for the distal ureter, end to end anastomosis or endoscopic incision for short, proximal cases, and for extended areas, ileum cross-bridge attachment or kidney mobilization using nephropexy.PMID: 17186195 [PubMed – as supplied by publisher] ________________________________________ J Chir (Paris). 2006 Sep-Oct;143(5):278-84. [Management of ovarian cysts][Article in French]Raiga J, Djafer R, Benoit B, Treisser A.Service de Gynecologie Obstetrique, Centre Hospitalier Princesse Grace Monaco, Monaco. jraiga@chpg.mcOvarian cysts occur frequently in women of reproductive age. These are usually functional cysts which resolve spontaneously and whose evolution can be followed with ultrasound. Non-functional cysts have diverse histologic origins. The most common are serous and mucinous cystadenomas which arise from the epithelial wall of the ovary, endometriomas which arise in the setting of pelvic endometriosis, and dermoid cysts which arise from the germinal cells of the ovary. Endovaginal ultrasound with Doppler enhancement is the best imaging technique to establish the nature of cysts and to distinguish cysts suspicious for malignancy which require more invasive investigation. Pelvic laparoscopy is the surgical approach of choice for the treatment of non-functional benign ovarian cysts. Conservative treatment to shell out the cyst and preserve functional ovarian tissue should be reserved for women desirous of future pregnancies. The risk of ovarian cancer remains a major preoccupation of the surgeon. Where malignancy is suspected, laparoscopy is contraindicated and a median laparotomy is appropriate for radical extirpative surgery. This article describes the diagnostic techniques which allow a laparoscopic approach to presumably benign cysts and discusses surgical techniques specifically adapted to their different histologic nature of ovarian cysts.Publication Types: ? English AbstractPMID: 17185953 [PubMed – indexed for MEDLINE] ________________________________________ Int J Fertil Womens Med. 2006 Jul-Aug;51(4):160-2.Endometriosis in a woman with mosaic Turner’s syndrome: case report.Lazovic G, Spremovic S, Cmiljic I, Vilendacic Z, Milicevic S.Institute of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia and Montenegro. zovicg@eunet.yuThe coexistence of endometriosis and Turner’s syndrome is extremely rare, and therefore poses certain questions on the mechanisms of endometriosis. We present a case of a 27-year-old woman with Turner’s syndrome [(46, X(x) (q10); 45X], primary amenorrhea and menopausal hormonal profile in which peritoneal endometriosis was revealed laparoscopically.Publication Types: ? Case ReportsPMID: 17184100 [PubMed – indexed for MEDLINE] ________________________________________ Hum Reprod. 2007 Apr;22(4):1142-8. Epub 2006 Dec 20. Deep dyspareunia and sex life after laparoscopic excision of endometriosis.Ferrero S, Abbamonte LH, Giordano M, Ragni N, Remorgida V.Department of Obstetrics and Gynaecology, San Martino Hospital, University of Genoa, Genoa, Italy. simone.ferrero@fastwebnet.itBACKGROUND: Among subjects with endometriosis and deep dyspareunia (DD), those with endometriosis of the uterosacral ligament (USLE) have the most severe impairment of sexual function. This study examines the effect of laparoscopic excision of endometriosis on DD and quality of sex life. METHODS: This observational cohort prospective study included 68 women with endometriosis suffering DD (intensity of pain >or= 6 on a 10-cm visual analogue scale). Patients underwent laparoscopic full excision of endometriosis. Following surgery, they were asked to use nonhormonal contraception devices. Before surgery, at 6- and at 12-month follow-up, patients answered a self-administered questionnaire based on the Sexual Satisfaction Subscale of the Derogatis Sexual Functioning Inventory. RESULTS: At 6- and 12-month follow-up, women with and without USLE had significant improvement in DD. Subjects with USLE reported increased variety in sex life, increased frequency of intercourse, more satisfying orgasms with sex, relaxing more easily during sex and being more relaxed and fulfilled after sex. Similar improvements were observed among women without USLE; however, for some variables statistical significance was not reached. CONCLUSIONS: Surgical excision of endometriosis improves not only DD but also the quality of sex life.PMID: 17182665 [PubMed – in process] ________________________________________ AJR Am J Roentgenol. 2007 Jan;188(1):176-81. Long-term results of uterine artery embolization for symptomatic adenomyosis.Kim MD, Kim S, Kim NK, Lee MH, Ahn EH, Kim HJ, Cho JH, Cha SH.Department of Diagnostic Radiology, Bundang CHA General Hospital, Pochon CHA University, 351 Yatap-dong, Bundang-gu, Sungnam-si, Kyonggi-do, 463-712, Republic of Korea. mdkim@cha.ac.krOBJECTIVE: Controversy exists regarding the effectiveness of uterine artery embolization (UAE) in the management of symptomatic adenomyosis. The aim our study was to determine the long-term clinical efficacy of UAE in the management of symptomatic adenomyosis without fibroids. MATERIALS AND METHODS: The cases of all patients who underwent UAE for adenomyosis without fibroids between 1998 and 2000 were analyzed. This study was a retrospective review of a prospectively collected database. Of the 66 patients, 54 patients with a follow-up period of 3 years or longer were enrolled in the study. Twelve patients were lost to follow-up. The patients’ ages ranged from 29 to 49 years (mean, 40.2 years). The mean follow-up period was 4.9 years (range, 3.5-5.8 years). The primary embolic agent was polyvinyl alcohol particles (250-710 microm). All patients underwent MRI before UAE. Long-term follow-up MRI was performed on 29 patients; 22 of these patients had undergone short-term (3.5 months) follow-up MRI. Uterine volume was calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, 0 being no symptoms and 10 being the baseline, or initial symptoms. RESULTS: Thirty-one (57.4%) of the 54 women who underwent follow-up had long-term success. Four had immediate treatment failure, and 19 had relapses. Changes in mean menorrhagia and dysmenorrhea scores at long-term follow-up were -5.3 and -5.1, respectively (p < 0.001), representing significant relief of symptoms. The time between UAE and recurrence of symptoms ranged from 4 to 48 months (mean, 17.3 months). Five patients underwent hysterectomy because of symptom recurrence. Mean reduction in volume of the uterus was 26.3% at short-term follow-up and 27.4% at long-term follow-up. CONCLUSION: We found that UAE is effective in the management of symptomatic adenomyosis and has an acceptable long-term success rate. UAE should be considered a primary treatment method for patients with symptomatic adenomyosis. However, all patients should be given an explanation of the possibility of treatment failure, recurrence, and the need for hysterectomy.Publication Types: ? Clinical TrialPMID: 17179361 [PubMed – indexed for MEDLINE] ________________________________________ Mol Hum Reprod. 2007 Feb;13(2):135-40. Epub 2006 Dec 18. Interleukin-10 gene promoter polymorphisms and their protein production in peritoneal fluid in patients with endometriosis.Zhang X, Hei P, Deng L, Lin J.Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, PR China.Although associations of interleukin-10 (IL-10) gene promoter polymorphisms and their protein production with endometriosis risk have been reported, the correlations remain controversial. The objective of this study was to determine IL-10 gene promoter polymorphisms at -1082, -819 and -592 sites and their protein production in peritoneal fluid (PF) in patients with and without endometriosis. IL-10 gene promoter polymorphisms at -1082 site were detected by amplification refractory mutation system (ARMS)-PCR and that at -819 and -592 sites was genotyped by restriction fragment length polymorphism (RFLP)-PCR. Protein levels of IL-10 in PF were measured by enzyme-linked immunosorbent assay (ELISA). There were no significant differences in the genotype and allele frequencies of IL-10 gene promoter polymorphisms at position -1082 between the endometriosis and the control groups. However, the frequency of -819 or -592 C alleles was significantly increased in patients with endometriosis compared with controls. The protein levels of IL-10 in PF were statistically higher in the endometriosis group than in the control group. Moreover, the polymorphisms at -1082, -819 and -592 sites were associated with protein levels of IL-10 in PF in the endometriosis group while in the control group only the polymorphisms at position -1082 correlated with protein levels. Increased frequency of -819 or -592 C allele and increased protein production of IL-10 in PF in patients with endometriosis compared with controls and correlations of polymorphisms at -819 and -592 sites with protein levels of IL-10 in PF in patients with endometriosis may suggest that polymorphisms at -819 and -592 sites and their protein production are associated with endometriosis risk.Publication Types: ? Research Support, Non-U.S. Gov’tPMID: 17178764 [PubMed – in process] ________________________________________ Eur J Obstet Gynecol Reprod Biol. 2006 Dec 16; [Epub ahead of print] A randomized study comparing triptorelin or expectant management following conservative laparoscopic surgery for symptomatic stage III-IV endometriosis.Loverro G, Carriero C, Rossi AC, Putignano G, Nicolardi V, Selvaggi L.Department of Gynecology, Obstetrics, and Neonatology, University of Bari, Italy.OBJECTIVE: To investigate the role of adjuvant treatment with gonadotropin-releasing-hormone agonist (GnRHa) following conservative surgical treatment of endometriosis. STUDY DESIGN: Sixty patients in the reproductive age (mean age 28.6 years), with symptomatic stages III and IV endometriosis following laparoscopic surgery and without previous hormonal treatment were enrolled in a prospective, randomized, controlled trial to compare the effects of 3-month treatment with triptorelin depot-3.75 i.m. (30 patients) versus expectant management using placebo injection (30 patients). RESULTS: Six patients (one in triptorelin group and five in placebo group) were lost at follow-up, the remaining 54 were suitable for analysis. Pelvic pain persistence or recurrence, endometrioma relapses and pregnancy rate were evaluated during a 5-year follow-up. The results of 29 cases treated with triptorelin and 25 that received placebo did not show significant differences in pain recurrence (P=1, RR=0.94, 95% CI=0.57-1.55), endometrioma relapse (P=0.67, RR=1.29, 95% CI=0.66-2.50), and pregnancy rate in infertile women (P=0.80, RR=0.81, 95% CI=0.37-1.80). Curves of time of pain recurrence and pregnancy during 5-year follow-up did not show significant differences between the two groups (P=0.79 and P=0.51, respectively, using Mantel-Haenzsel logrank test). CONCLUSION: Triptorelin treatment after operative laparoscopy for stage III/IV endometriosis does not appear to be superior to expectant management in terms of prevention of symptoms recurrence and endometrioma relapse, and has no influence on pregnancy rate in endometriosis-associated infertility.PMID: 17178185 [PubMed – as supplied by publisher] ________________________________________ Zhejiang Da Xue Xue Bao Yi Xue Ban. 2006 Nov;35(6):653-7.[Research on relationship between gene polymorphisms of interleukin-1 family and endometriosis][Article in Chinese]Wen J, Deng L, Zhang XM.The Affiliated Obstetrics and Gynecology Hospital, College of Medicine, Zhejiang University, Hangzhou 310006, China.OBJECTIVE: To investigate whether interleukin-1 beta (IL-1beta ) and interleukin-1 receptor antagonist (IL-1RA) gene polymorphisms are associated with endometriosis (EMs) in Chinese women. METHODS: One hundred and thirty-eight patients with EMs and 100 women without EMs were enrolled in the study. Polymorphisms for IL-1 beta-511 promoter, IL-1 beta exon 5, and IL-1RA were detected by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). RESULT: There were no significant differences about the distribution of the genotypes and alleles of IL-1 beta -511 promoter and IL-1 beta exon 5 in two groups (P > 0.05). The frequencies of A1/A1, A1/A2, A1/A4 and A2/A2 of IL-1RA gene were 84.1 %, 12.3 %, 2.9 % and 0.7 % in EMs and 95 % , 4 % ,1 % and 0 % in controls, respectively (P=0.042). The A1, A2 and A4 alleles were 91.7 % , 6.9 % and 1.4 % in EMs and 97.5 % , 2 % and 0.5 % in controls (P=0.019). In comparison with the reference genotype, the wild A1/A1 homozygote, the odds ratio for A1/A2 was 3.48 (95 % CI: 1.13 – 10.69). Compared with the A1 allele, the odds ratio for the A2 allele was 3.66 (95 % CI: 1.23 – 10.94). CONCLUSION: Association between the IL-1 beta-511 promoter,IL-1 beta exon 5 polymorphisms and EMs in China is not found. However, the A2 allele of IL-1RA gene may be one of the risk factors for the Chinese women in Zhejiang Province to suffer EMs.Publication Types: ? English AbstractPMID: 17177339 [PubMed – in process]

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