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Prog Urol. 2006 Nov;16(5):588-93.[Ureteric and bladder involvement of deep pelvic endometriosis. Value of multidisciplinary surgical management][Article in French]Marcelli F, Collinet P, Vinatier D, Robert Y, Triboulet JP, Biserte J, Villers A.Service d’Urologie, CHRU de Lille, France.OBJECTIVES: To evaluate the clinical features, staging by medical imaging, treatment strategy and results of surgical management of deep pelvic endometriosis with bladder and/or ureteric involvement. MATERIALS AND METHODS: Eighteen cases of ureteric and/or bladder deep pelvic endometriosis (DPE) were treated in our centre between 1996 and 2004. Preoperative data (clinical symptoms, MR imaging), intraoperative data (resection and urinary tract diversion procedures, associated procedures on the genital and gastrointestinal tracts), and postoperative data (histological results, complications, anatomical follow-up by imaging and functional assessment) were reviewed. RESULTS: Urinary symptoms were present in 55% of cases, genital symptoms were present in 83% of cases and gastrointestinal symptoms were present in 46% of cases. A combination of gynaecological and gastrointestinal lesions was demonstrated on imaging in 82% of cases. The mean postoperative follow-up was 16 months (range: 6-36 months). Six patients presented anterior vesical endometriosis. In these cases, the sensitivity and specificity of MRI were 100%. Six partial cystectomies were performed. All corresponded to endometriotic lesions on histological examination. No cases of recurrence of vesical endometriosis were observed. Posterior endometriosis with ureteric involvement was observed in 13 patients (including one with vesical endometriosis). The ureteric lesion was asymptomatic in 8 out of 13 cases (61%). The diagnostic sensitivity of MRI was 92% for posterior nodules, identifying 4 lateral parametrial nodules and 8 median retrocervical nodules. Ureterohydronephrosis was observed in 3 patients with lateral parametrial nodules and 8 patients with median retrocervical nodules, and was bilateral for 3 patients, i.e. 14 dilated renal units. Surgical management consisted of 2 ureteric resections with end-to-end anastomosis, 3 psoas bladder reimplantations, and 9 ureterolyses (8 patients). Two out of 13 patients (15%) with ureteric lesions treated by ureterolysis developed recurrence of the ureteric stricture with upper tract dilatation related to recurrence of the lateral nodule. In 14 patients, genital and/or gastrointestinal resections were associated with the urinary tract procedure. CONCLUSION: Preoperative evaluation of all DPE lesions is based on MRI with reconstruction images of the ureter in the presence of urinary tract lesions. Systematic ureteric stenting prior to surgical dissection of the pelvic wall is recommended in patients with posterior nodules and in the case of partial cystectomy for anterior nodules when the ureteric meati are adjacent to the lesion. Ureteric reimplantation onto a psoas hitch bladder must be performed when the DPE lesions are extensive and partly resected or invade the ureteric wall. The frequency of associated lesions (urinary, gynaecological gastrointestinal) justifies a multidisciplinary surgical approach.Publication Types: ? English AbstractPMID: 17175957 [PubMed – indexed for MEDLINE] ________________________________________ Taiwan J Obstet Gynecol. 2006 Dec;45(4):346-9. Very early stage adenocarcinoma arising from adenomyosis in the uterus.Hsu MI, Chou SY, Lin SE, Liang SJ, Chiu HC, Hsu CS.Department of Obstetrics and Gynecology, Taipei Medical University–Municipal Wan Fang Hospital, Taipei, Taiwan.OBJECTIVE: Malignant transformations of adenomyosis in premenopausal women with normal endometrium are extremely rare. We report a case of adenocarcinoma arising from an adenomyotic focus in the uterus, which was found unexpectedly in a woman undergoing myomectomy for adenomyosis. CASE REPORT: A 47-year-old premenopausal woman presented with massive vaginal bleeding and anemia. She was admitted and underwent myomectomy under the initial diagnosis of uterine leiomyoma. Microscopic studies revealed endometrioid adenocarcinoma, which was a malignant transformation of a focus of adenomyosis in the surgical specimen. A total hysterectomy and bilateral salpingo-oophorectomy with pelvic and para-aortic lymphadenectomy was then performed. Pathologic studies showed no residual tumors in the entire resected specimen except for the previous lesion. The endometrium had normal thickness with mild proliferative activity throughout the cavity. There was no atrophic or hyperplastic change in the whole endometrium. The adenocarcinoma was present exclusively in the myometrium, and a transition between the carcinoma and the adenomyotic glands was observed. CONCLUSION: This case report presents evidence that adenocarcinoma may a rise de novo from an adenomyotic lesion in the uterus.Publication Types: ? Case ReportsPMID: 17175497 [PubMed – indexed for MEDLINE] ________________________________________ Taiwan J Obstet Gynecol. 2006 Sep;45(3):247-9. Scar endometriosis at the site of cesarean section.Ding DC, Hsu S.Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan. dah1003@yahoo.com.twOBJECTIVE: Scar endometriosis is a rare condition. We report a case of scar endometriosis occurring at the site of an old cesarean section scar. CASE REPORT: A 29-year-old multiparous woman complained of painful sensation during menstruation for 2 years that occurred at the site of her cesarean section surgical scar. On examination, there was a firm nodule measuring 2 x 1.5 cm in size at the mid-point of the scar. In view of the possibility of scar endometriosis, the mass was completely excised. Pathologic findings were compatible with scar endometriosis. Postoperatively, danazol was prescribed to prevent recurrence. CONCLUSION: A surgical scar becoming painful and swollen during menstruation is the classic symptom of scar endometriosis. Causes include iatrogenic transplantation of endometrium to the surgical wound. Surgical excision is the main treatment. Postoperative GnRH-agonist or danazol may be prescribed to patients with scar endometriosis.Publication Types: ? Case ReportsPMID: 17175473 [PubMed – indexed for MEDLINE] ________________________________________ J Pediatr Adolesc Gynecol. 2006 Dec;19(6):363-71. Dysmenorrhea in adolescents and young adults: etiology and management.Harel Z.Associate Professor of Pediatrics, Division of Adolescent Medicine/Hasbro Children’s Hospital and Department of Pediatrics, Brown University, Providence, Rhode Island 02903, USA. Zharel@Lifespan.orgDysmenorrhea is the most common gynecologic complaint among adolescent and young adult females. Dysmenorrhea in adolescents and young adults is usually primary (functional), and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of adolescents and young adults with severe dysmenorrhea symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins and potent leukotrienes play an important role in generating dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAID) are the most common pharmacologic treatment for dysmenorrhea. Adolescents and young adults with symptoms that do not respond to treatment with NSAIDs for 3 menstrual periods should be offered combined estrogen/progestin oral contraceptive pills for 3 menstrual cycles. Adolescents and young adults with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. The care provider’s role is to explain about pathophysiology of dysmenorrhea to every adolescent and young adult female, address any concern that the patient has about her menstrual period, and review effective treatment options for dysmenorrhea with the patient.Publication Types: ? ReviewPMID: 17174824 [PubMed – indexed for MEDLINE] ________________________________________ Fertil Steril. 2007 Mar;87(3):697.e1-4. Epub 2006 Dec 14. Spontaneous viable pregnancies in cervical and rectal endometriosis: a report of two cases.Ganesh AL, Chakravarty B.School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, Kolkata, India.OBJECTIVE: To report two cases of advanced pelvic endometriosis, both with deep rectal involvement and one with extensive cervical involvement appearing like a carcinoma, where both patients achieved spontaneous pregnancy and delivered viable babies. DESIGN: Case report. SETTING: Institute of Reproductive Medicine. PATIENT(S): Two nulliparous patients, one with extensive cervical and rectal and other with deep rectal endometriosis and primary infertility. INTERVENTION(S): Medical management. MAIN OUTCOME MEASURE(S): Description and treatment of two patients with advanced pelvic endometriosis and pregnancy. RESULT(S): Delivery of viable babies in both cases. CONCLUSION: Prolonged medical treatment may have helped to arrest the progression of the disease by restoring anatomic proximity leading to spontaneous pregnancy in both cases.Publication Types: ? Case ReportsPMID: 17173901 [PubMed – indexed for MEDLINE] ________________________________________ Actas Dermosifiliogr. 2006 Dec;97(10):666-8. [Spontaneous cutaneous umbilical endometriosis][Article in Spanish]Bordel Gomez MT, Roman Curto C, Cardenoso Alvarez E, Santos Duran JC, Sanchez Estella J, Corral de la Calle M.Servicio de Dermatologia, Complejo Asistencial Virgen de la Concha, Zamora, Spain. matebordel@yahoo.esEndometriosis consists of extrauterine endometrial growths. Although it is usually located in the pelvis it can also be found in other sites. Endometriosis of the skin is rare and the most frequent form develops over gynecologic or obstetric scars, although it may also appear spontaneously in the umbilical area. We present a 39-years-old woman with an umbilical nodule as a clinically characteristic form of spontaneous cutaneous endometriosis. The histopathological examination confirmed the clinical diagnosis.Publication Types: ? Case Reports ? English Abstract PMID: 17173832 [PubMed – indexed for MEDLINE] ________________________________________ Diagn Cytopathol. 2007 Jan;35(1):12-7. Weeding atypical glandular cell look-alikes from the true atypical lesions in liquid-based Pap tests: a review.Wood MD, Horst JA, Bibbo M.Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. moira.wood@mail.tju.eduThe purpose of this review is to identify features that separate atypical glandular cells (AGC) associated with glandular neoplasia from its mimickers, both benign and neoplastic. We reviewed cases of AGC diagnosed on liquid-based Pap tests (LBP) for which corresponding histological follow-up was available. A review of the literature for similar studies in LBP tests was also conducted. We find that certain benign mimics can be reliably separated from AGC, but recommend caution in attempting to increase specificity at the risk of losing sensitivity. Although accounting for only a small percentage of diagnoses AGC require a thorough clinical evaluation, including colposcopy. Most cases are ultimately found to be benign. When evaluating smears suspicious for AGC, it is important to examine the subtle features which make truly atypical cells discernible from their numerous benign mimickers.Publication Types: ? ReviewPMID: 17173299 [PubMed – indexed for MEDLINE] ________________________________________ BJOG. 2007 Feb;114(2):165-9. Epub 2006 Dec 4. Adenomyosis and risk of preterm delivery.Juang CM, Chou P, Yen MS, Twu NF, Horng HC, Hsu WL.Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and Department of Epidemiology, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan. cmjuang@yahoo.com.twOBJECTIVE: To evaluate the risk of preterm delivery in patients with adenomyosis. DESIGN: A 1:2 nested case-control study. SETTING: Tertiary-care institution. POPULATION: A base cohort population of 2138 pregnant women who attended routine prenatal check-up between July 1999 and June 2005. METHODS: From this base cohort population, gravid women with singleton pregnancy who delivered prior to the completion of 37 weeks of gestation were identified and formed the study group. Singleton gravid women who had term delivery and who matched with age, body mass index, smoking, and status of previous preterm delivery were recruited concurrently and served as control group. Preterm delivery cases were further divided into spontaneous preterm delivery and preterm premature rupture of membranes (PPROM) cases. MAIN OUTCOME MEASURES: Risk analysis of preterm delivery between gravid women with and without adenomyosis. RESULTS: One-hundred and four preterm delivery case subjects and 208 control subjects were assessed. Overall, gravid women with adenomyosis were associated with significantly increased risk of preterm delivery (adjusted odds ratio 1.96, 95% CI 1.23-4.47, P=0.022). For subgroup analysis, gravid women with adenomyosis had an adjusted 1.84-fold risk of spontaneous preterm delivery (95% CI 1.32-4.31, P=0.012) and an adjusted 1.98-fold risk of PPROM (95% CI 1.39-3.15, P=0.017). CONCLUSIONS: Gravid women with adenomyosis were associated with increased risk of both spontaneous preterm delivery and PPROM. A common pathophysiological pathway may exist in these two disorders. Further in-depth biochemical and molecular studies are necessary to explore this phenomenon.Publication Types: ? Research Support, Non-U.S. Gov’tPMID: 17169011 [PubMed – indexed for MEDLINE] ________________________________________ Akush Ginekol (Sofiia). 2006;45(5):14-21.[Pain profile of women with endometriosis and chronic pelvic pain-determining factors and significance][Article in Bulgarian]Lukanova M, Popov I, Velkova A.PURPOSE OF THE STUDY: To determine the severity of the separate components of chronic pelvic pain syndrome/dysmenorrhoea, dyspareunia, dysuria, dyschezia ,etc/ in the different stages of the disease and according to the localization of endometriotic lesions. To determine to what extent the severity of the separate chronic pain components correlates with stage of the disease and localization of endometriomas. MATERIALS AND METHODS: The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004 – 01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, type of the disease – internal or external genital endometriosis, adenomyosis, stage of the disease, localization of endometriotic lesions. The following methods were used for the purpose of the study: visual analogue scale, documentary method, R-AFS classification of E, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide. RESULTS AND DISCUSSION: The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. When the mean value of pain assessment was reported, there was noted a non-correspondence between severity of pain and stage of the disease. It was found no significant correlation between the extent of manifestation of the separate components of the pain syndrome according to the stage of the disease. The severity of the separate components of the pain syndrome was determined according to the localization of the E-lesions. Statistically significant correlation was found between the extent of manifestation of dyspareunia, postcoital ache and dyschezia, and the localization of the E- lesions /p<0,05/ and that correlation was strongly supported in cases of adenomyosis and the components mentioned above. Statistically significant differences were found between the extent of manifestation of the relevant component of the chronic pain syndrome and some of the localization of E foci. CONCLUSION: It was established a correlation between localization of E lesions and the severity of the separate components of the chronic pain syndrome. No correlation was found between the extent of pain manifestation, when assessed in total and in each pain component, and the stage of endometriosis.Publication Types: ? English AbstractPMID: 17168491 [PubMed – indexed for MEDLINE] ________________________________________ Akush Ginekol (Sofiia). 2006;45(6):16-23.[Endometriosis and chronic pelvic pain][Article in Bulgarian]Lukanova M, Popov I, Velkova A.Endometriosis /E/ is a frequently met disease in women in reproductive age. One of its most typical clinical manifestations is chronic pelvic pain /CPP/ and as components of the chronic pain syndrome- dysmenorrhoea, dyspareunia, intermenstrual pain, and sometimes dyschezia and dysuria. PURPOSE OF THE STUDY: To build up pain profile of patients with E by using quantitative and qualitative characteristics. MATERIALS AND METHODS: The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, body mass index, blood group affiliation, stage of the disease, etc. The following methods were used for the purpose of the study: pain map, monthly pain calendar, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide; documentary method, R-AFS classification of E. Factors that provoke appearance and manifestation of pain, and factors that alleviate pain were studied too. RESULTS AND DISCUSSION: The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. They corroborated the hypothesis for typical pain profile of women with E. CONCLUSION: The building up of pain profile in total with other diagnostic methods /ultrasonography, magnetic resonance imaging/ has a determining role in the further diagnostic and therapeutic management of women with E and CPP. Pain profile can also be used as an assessment tool of conducted treatment /conservative or surgical/.Publication Types: ? English AbstractPMID: 17168478 [PubMed – indexed for MEDLINE] ________________________________________ World J Surg Oncol. 2006 Dec 12;4:93. Metachronic malignant transformation of small bowel and rectal endometriosis in the same patient.Marchena-Gomez J, Conde-Martel A, Hemmersbach-Miller M, Alonso-Fernandez A.Department of General Surgery, University Hospital Gran Canaria "Dr, Negrin", Las Palmas G,C,, Spain. jmarchena@dcmq.ulpgc.es.ABSTRACT: BACKGROUND: Malignant transformation of intestinal endometriosis is a rare event with an unknown rate of incidence. Metachronous progression of endometriosis to adenocarcinoma from two distant intestinal foci happening in the same patient has not been previously reported. CASE PRESENTATION: We describe a case of metachronic transformation of ileal and rectal endometriosis into an adenocarcinoma occurring in a 45-year-old female without macroscopic pelvic involvement of her endometriosis. First, a right colectomy was performed due to intestinal obstruction by an ileal mass. Pathological examination revealed an ileal endometrioid adenocarcinoma and contiguous microscopic endometriotic foci. Twenty months later, a rectal mass was discovered. An endoscopic biopsy revealed an adenocarcinoma. En bloc anterior rectum resection, hysterectomy and bilateral salpingectomy were performed. A second endometrioid adenocarcinoma arising from a focus of endometriosis within the wall of the rectum was diagnosed. CONCLUSION: Intestinal endometriosis should be considered a premalignant condition in premenopausal women.PMID: 17164003 [PubMed – in process] ________________________________________ Gynecol Endocrinol. 2006 Dec;22(12):713-5. Difficult management of recurrent catamenial pneumothorax.Oger P, Alifano M, Regnard JF, Gompel A.Unite de Gynecologie Medicale, Hotel-Dieu, Assistance Publique-Hopitaux de Paris, Universite Paris V, Paris, France.Catamenial pneumothorax is an uncommon disease whose management is not consensual. We report the case of a patient who experienced several episodes of pneumothorax. She was initially treated by repair of diaphragmatic defects and hormonal treatment. During the therapeutic amenorrhea, no recurrence occurred. However, each cessation of medical therapy was followed by recurrence. Finally, talc pleurodesis and tubal ligature were performed without any recurrence in the subsequent 12 months. This report outlines the great difficulties that can be encountered in the management of patients with catamenial pneumothorax.Publication Types: ? Case ReportsPMID: 17162716 [PubMed – indexed for MEDLINE] ________________________________________ Gynecol Endocrinol. 2006 Dec;22(12):698-703. Effect of short-term, low-dose treatment with tamoxifen in patients with primary dysmenorrhea.Pierzynski P, Swiatecka J, Oczeretko E, Laudanski P, Batra S, Laudanski T.Department of Pathophysiology of Pregnancy, Medical University of Bialystok, Bialystok, Poland.Current treatment of painful periods and other symptoms related to primary dysmenorrhea (PD) is usually commenced with non-steroidal anti-inflammatory drugs or oral contraceptives, which fails in about 10% of affected patients. Tamoxifen, a selective estrogen-receptor modulator (SERM), has been demonstrated to directly inhibit uterine contractions, causing improvement in uterine blood flow. It could be considered for application in selected groups of dysmenorrheic patients, for instance carriers of breast cancer-associated antigen (BRCA) genes, breast cancer survivors or women with advanced endometriosis. Thus the aim of the present study was to investigate the effect of short-term treatment with tamoxifen on PD and PD-related symptoms, as well as its direct effect on parameters of intrauterine pressure during the painful menstruation, in a group of dysmenorrheic patients. After two cycles of administration of tamoxifen we noted a significant decrease in bleeding together with reductions in the severity of menstrual cramps, diarrhea, headache, fatigue and anxiety. In intrauterine pressure assessments, tamoxifen significantly decreased propagation of uterine contractions. In conclusion, SERMs such as tamoxifen may constitute a therapeutic option in selected groups of patients, improving dysmenorrheic symptoms. Additionally to its receptor-mediated effects, tamoxifen was shown to exert a direct influence on uterine contractile activity that may explain the decrease of menstrual pain and cramps noted in the studied group.Publication Types: ? Clinical Trial ? Research Support, Non-U.S. Gov’t PMID: 17162713 [PubMed – indexed for MEDLINE] ________________________________________ Gynecol Endocrinol. 2006 Dec;22(12):655-9. Clinical applications of mifepristone.Tang OS, Ho PC.Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, SAR, China. ostang@graduate.hku.hkMifepristone is a progesterone antagonist that has been studied for a number of clinical applications. It is a well-known abortifacient that is effective for both first- and second-trimester medical abortion when used with a prostaglandin analog. It is also an effective cervical priming agent that can be used to soften the cervix before surgical evacuation. Its clinical efficacy as an emergency contraception has been proven. Other applications including treatment for fibroids, endometriosis and various cancers have been explored. However, its association with abortion limits the applications of mifepristone in many of these areas.Publication Types: ? ReviewPMID: 17162706 [PubMed – indexed for MEDLINE] ________________________________________ Hum Reprod. 2007 Mar;22(3):717-28. Epub 2006 Dec 11. Significant evidence of one or more susceptibility loci for endometriosis with near-Mendelian inheritance on chromosome 7p13-15.Zondervan KT, Treloar SA, Lin J, Weeks DE, Nyholt DR, Mangion J, MacKay IJ, Cardon LR, Martin NG, Kennedy SH, Montgomery GW.Wellcome Trust Centre for Human Genetics, University of Oxford, UK. krinaz@well.ox.ac.ukBACKGROUND: Endometriosis is a common disease with a heritable component. The collaborative International Endogene Study consists of two data sets (Oxford and Australia) comprising 1176 families with multiple affected. The aim was to investigate whether the apparent concentration of cases in a proportion of families could be explained by one or more rare variants with (near-)Mendelian autosomal inheritance. METHODS AND RESULTS: Linkage analyses (aimed at finding chromosomal regions harbouring disease-predisposing genes) were conducted in families with three or more affected (Oxford: n = 52; Australia: n = 196). In the Oxford data set, a non-parametric linkage score (Kong & Cox (K&C) Log of ODds (LOD)) of 3.52 was observed on chromosome 7p (genome-wide significance P = 0.011). A parametric MOD score (equal to maximum LOD maximized over 357 possible inheritance models) of 3.89 was found at 65.72 cM (D7S510) for a dominant model with reduced penetrance. After including the Australian data set, the non-parametric K&C LOD of the combined data set was 1.46 at 57.3 cM; the parametric analysis found an MOD score of 3.30 at D7S484 (empirical significance: P = 0.035) for a recessive model with high penetrance. Critical recombinant analysis narrowed the probable region of linkage down to overlapping 6.4 Mb and 11 Mb intervals containing 48 and 96 genes, respectively. CONCLUSIONS: This is the first report to suggest that there may be one or more high-penetrance susceptibility loci for endometriosis with (near-)Mendelian inheritance.Publication Types: ? Multicenter StudyPMID: 17158817 [PubMed – indexed for MEDLINE] ________________________________________ Am J Reprod Immunol. 2007 Jan;57(1):49-54. Expression of glycodelin and cyclooxygenase-2 in human endometrial tissue following three-dimensional culture.Esfandiari N, Ai J, Nazemian Z, Javed MH, Gotlieb L, Casper RF.Toronto Centre for Advanced Reproductive Technology, and Division of Reproductive Sciences, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada. nesfand@excite.comPROBLEM: Our previous study showed that in vitro culture of human endometrial tissue in a three-dimensional (3D) fibrin matrix could mimic the early stages of endometriosis with invasion, gland and stroma formation and sprouting of new vessels. The objective of the present study was to evaluate the expression of glycodelin (Gd) and cyclooxygenase-2 (COX-2), two angiogenic factors, to further validate the 3D culture model of endometriosis. METHOD OF STUDY: Human endometrial fragments were obtained from endometrial biopsies and placed in a 3D fibrin matrix culture. Immunohistochemistry with specific antibodies to Gd and COX-2 was used to examine endometrial epithelium and blood vessels, and 4, 6-diamidino-2-phenylindole staining was used for nuclear identification. RESULTS: Three-dimensional culture of human endometrial tissue in the fibrin matrix resulted in the proliferation of endometrial stromal cells, glandular epithelium and angiogenesis. Gd positive glandular epithelium was seen in 85% of wells with developing endometrial glands and COX-2 positive new vessels were seen in 80% of wells with angiogenesis-like structures after 4 weeks of culture. CONCLUSION: Our findings confirm that angiogenesis occurs following the culture of endometrial tissue in the 3D fibrin matrix, and suggests that Gd and COX-2 might play important roles in promoting neovascularization and cell proliferation in the establishment of endometriosis.PMID: 17156191 [PubMed – indexed for MEDLINE] ________________________________________ Abdom Imaging. 2006 Dec 7; [Epub ahead of print] Bowel endometriosis: CT-enteroclysis.Biscaldi E, Ferrero S, Remorgida V, Rollandi GA.Department of Radiology, Galliera Hospital, Via Mura delle Capuccine 14, 16128, Genoa, Italy, ennio.biscaldi@fastwebnet.it.Although several radiological techniques have been used for the diagnosis of bowel endometriosis, no gold standard is currently established. We used multislice computerized tomography (CT) combined with the distention of the colon by rectal enteroclysis (MSCTe) for the diagnosis of bowel endometriosis. Following bowel preparation, pharmacological hypotonicity, retrograde colonic distention by water enteroclysis, and intravenous injection of iodinated contrast medium, a single volumetric acquisition of the abdomen is performed. MSCTe findings suggestive of bowel endometriosis are the presence of solid nodules with positive enhancement, contiguous or penetrating the colonic wall. When endometriotic lesions are detected, the degree of infiltration of the intestinal wall can be estimated; however, the depth infiltrated by nodules reaching the submucosa may be underestimated. MSCTe is well tolerated by the patients. The strength of MSCT consists in the high spatial resolution; volumetric data acquired by using thin slices provide isotropic voxels and multiplanar reconstructions have a quality comparable with that of the original axial scans. The potential of MSCTe for the diagnosis of bowel endometriosis relies on the fact that the serosal, muscular, and mucosal layers of the bowel wall can be evaluated.PMID: 17151903 [PubMed – as supplied by publisher] ________________________________________ Radiol Clin North Am. 2006 Nov;44(6):879-99. Practical approach to the adnexal mass.Patel MD.Department of Radiology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA. patel.maitray@mayo.eduGynecologic sonography has matured into a highly effective and accurate tool enabling confident diagnosis of a variety of adnexal masses. Using a practical evidence-based approach, sonologists are well equipped to differentiate expected findings in the normal ovary from pathologic entities and can often generate specific conclusions regarding the cause of an adnexal mass. Mastery of the diagnostic strategies to use when an adnexal mass is identified and the sonographic patterns of various types of adnexal pathology contributes greatly to the proper and cost-effective care of a woman with an adnexal mass.Publication Types: ? ReviewPMID: 17147991 [PubMed – indexed for MEDLINE] ________________________________________ Ultrasound Q. 2006 Dec;22(4):273-80. Endometriosis: sonographic spectrum.Bhatt S, Kocakoc E, Dogra VS.Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.Endometriosis is the presence of functional endometrial tissue outside the uterine cavity and the myometrium. It is an important cause of infertility and pelvic pain in women older than 25 years. Endometriomas are relatively common and can mimic other adnexal masses, and ultrasonography is often the first choice of imaging. This pictorial essay presents the sonographic appearance of endometriomas and similar-appearing adnexal masses and their characteristics, which may aid in their differentiation on routine ultrasonographic examination.Publication Types: ? ReviewPMID: 17146335 [PubMed – indexed for MEDLINE] ________________________________________ Best Pract Res Clin Obstet Gynaecol. 2006 Dec;20(6):841-79. Health technology assessment of surgical therapies for benign gynaecological disease.Owusu-Ansah R, Gatongi D, Chien PF.Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.This chapter summarises the evidence of the benefits and harm of surgical therapies for benign gynaecological disease. We have limited the discussion in this chapter to three gynaecological conditions – menorrhagia, endometriosis and benign ovarian tumours – with a further section on the different surgical approaches for performing a hysterectomy for menorrhagia due to dysfunctional uterine bleeding and pelvic masses such as fibroids and benign adnexal masses. The currently available evidence suggests that there is little to choose between the four first-generation endometrial destruction techniques – laser ablation, transcervical resection of endometrium, vaporisation ablation and rollerball ablation – in terms of clinical efficacy and patient satisfaction. There is a paucity of evidence with regards to the comparison of the different second-generation endometrial-destruction techniques but current evidence suggests that bipolar radiofrequency ablation is more effective than thermal balloon ablation for treating menorrhagia. Overall, the second-generation techniques are at least as effective as first-generation methods but are easier to perform and can be done under local rather than general anaesthesia in some circumstances. Hysteroscopic endometrial ablation is an alternative to hysterectomy and should be offered to women with menorrhagia because of its high satisfaction rates, shorter operation time, shorter hospital stay, earlier recovery and reduced postoperative complications; hysterectomy remains the surgical option of choice for women with intractable menorrhagia despite repeated endometrial ablations and for those who do not wish under any circumstances to continue to have menstrual bleeding. The combined use of laparoscopic laser ablation, adhesiolysis and uterine nerve ablation has been shown to have a beneficial effect on pelvic pain associated with mild to moderate endometriosis. Current evidence also supports the use of laparoscopic treatment of minimal and mild endometriosis to improve the on-going pregnancy and live birth rate in infertile patients. The current available evidence suggests that the laparoscopic approach is superior to laparotomy for the surgical management of benign ovarian cysts. It results in less postoperative pain and a shorter postoperative hospital stay; it also costs less. With regards to the surgical approach for performing a hysterectomy for menorrhagia and benign pelvic masses, vaginal hysterectomy should be performed over laparoscopic and abdominal hysterectomy when possible. Where it is not possible to perform the hysterectomy vaginally, then laparoscopic hysterectomy can be employed instead of abdominal hysterectomy to avoid a laparotomy scar. There appears to be no significant advantage in performing a subtotal hysterectomy instead of the total removal of the uterine corpus and cervix.PMID: 17145485 [PubMed – in process] ________________________________________ Fertil Steril. 2007 Feb;87(2):373-80. Epub 2006 Dec 4. Intraobserver and interobserver reliability of videotaped laparoscopy evaluations for endometriosis and adhesions.Weijenborg PT, ter Kuile MM, Jansen FW.Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands. p.t.m.weijenborg@lumc.nl <p.t.m.weijenborg@lumc.nl>OBJECTIVE: To determine the intra- and interobserver reliability of evaluations during videotaped laparoscopy, with real-time laparoscopy as the "gold standard." DESIGN: Prospective evaluation. SETTING: University hospital. PATIENT(S): Women who underwent laparoscopy for chronic pelvic pain, sterilization, or infertility workup. INTERVENTION(S): Real-time laparoscopies were videotaped and scored then later reassessed. MAIN OUTCOME MEASURE(S): Intra- and interobserver levels of agreement between evaluations for endometriosis and adhesions. RESULT(S): With the use of reassessments on 90 (videotaped) laparoscopies, the intra- and interobserver levels of agreement between the scorings for endometriosis were found to be substantial, except for ovarian implantations. A high agreement was found in the staging of endometriotic disease. The intra- and interobserver levels of agreement for scoring adhesions were only fair to moderate, and a substantial number of differences between measurements in adhesion total scores was found. No systematic difference between the number of disagreements was observed in either setting. CONCLUSION(S): Although special attention has to be given to the assessments of ovarian lesions, the evaluations of videotaped laparoscopies for endometriosis were reliable and justified the use of recorded findings. Because evaluations of adhesions during videotaped laparoscopy are not reliable, in some cases a second laparoscopy may need to be performed.PMID: 17141769 [PubMed – indexed for MEDLINE] ________________________________________ Eur J Obstet Gynecol Reprod Biol. 2006 Nov 30; [Epub ahead of print] Expression of heparanase and angiopoietin-2 in patients with endometriosis.Jingting C, Yangde Z, Yi Z, Mengxiong L, Rong Y, Yu Z, Guoqing P, Lixiu P.Department of Obstetrics and Gynecology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China.OBJECTIVE: The objective was to investigate the expression of heparanase (Hpa) and angiopoietin-2 (Ang-2) in endometriosis. STUDY DESIGN: In ectopic and eutopic endometrium of patients undergoing laparoscopy for endometriosis (n=86) and in normal endometrium of patients undergoing laparoscopic tubal ligation or hysteroscopic resection because of uterus septus (n=30), we determined Hpa and Ang-2 gene expression by RT-PCR. To support the mRNA data, the expression of Hpa and Ang-2 protein was measured by Western blot analysis. Finally, Hpa and Ang-2 in these tissues was localized by immunohistochemical staining. RESULT(S): The positive rate of Hpa and Ang-2 mRNA in ectopic and eutopic endometrium in the study group was significantly higher than that in normal endometrium in the control group. In the study group, ectopic and eutopic endometrium expressed a higher positive rate of Hpa and Ang-2 protein, whereas in the control group, normal endometrium expressed a lower positive rate of Hpa and Ang-2 protein. In eutopic and ectopic endometrium, there was balanced expression between Hpa and Ang-2. Both Hpa and Ang-2 showed a balanced expression between eutopic and ectopic endometrium. In ectopic endometrium, strong staining for Hpa and Ang-2 was observed both in epithelial cells and in stromal cells, but in eutopic endometrium, Hpa and Ang-2 were mainly expressed in epithelial cells. CONCLUSION: The higher expression of Hpa and Ang-2 in ectopic and eutopic endometrium may play an important role in the pathogenesis and development of endometriosis.PMID: 17141400 [PubMed – as supplied by publisher] ________________________________________ Fertil Steril. 2007 Mar;87(3):651-6. Epub 2006 Nov 29. Endometriosis may be generated by mimicking the ontogenetic development of the female genital tract.Gaetje R, Holtrich U, Engels K, Kissler S, Rody A, Karn T, Kaufmann M.Department of Obstetrics and Gynecology, Johann Wolfgang Goethe-University, Frankfurt, Germany. gaetje@em.uni-frankfurt.de <gaetje@em.uni-frankfurt.de>OBJECTIVE: To compare the expression of genes playing a decisive role during the embryonic development of the female genital tract (WNT4, WNT5A, WNT7A, PAX8) in the peritoneum of patients with endometriosis and control patients. DESIGN: Experimental study using real-time polymerase chain reaction and in situ hybridization. SETTING: University-based laboratory. PATIENT(S): Patients with and without endometriosis undergoing surgery for benign indications. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Percentage of samples positive for gene expression by using real-time polymerase chain reaction, as well as relative expression values compared with housekeeping genes. Confirmation of results by in situ hybridization. RESULT(S): Expression of WNT7A and PAX8 was found in the normal peritoneum in approximately half of the patients with endometriosis in contrast to the controls. In patients with endometriosis WNT7A and PAX8 in histologically normal peritoneum (with no evidence of endometriosis, endosalpingiosis, or other changes) were confirmed by in situ hybridization. CONCLUSION(S): The expression of these genes in the normal peritoneum suggests that endometriosis can arise through metaplasia and can in the process make use of the developmental steps involved in the embryonic development of the female genital tract.Publication Types: ? Research Support, Non-U.S. Gov’tPMID: 17140576 [PubMed – indexed for MEDLINE] ________________________________________ J Obstet Gynaecol Can. 2006 Oct;28(10):888-91.Effects of different stages of endometriosis on the outcome of in vitro fertilization.Al-Fadhli R, Kelly SM, Tulandi T, Tanr SL.Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.OBJECTIVE: This study was undertaken to evaluate the effects of different stages of endometriosis on the outcome of treatment in an in vitro fertilization (IVF) program. METHODS: This was a retrospective, matched case-control study in an academic tertiary referral centre. The study group consisted of 87 women with laparoscopically diagnosed endometriosis, and the control group consisted of 87 age-matched women undergoing IVF for different reasons. The primary outcomes were duration of stimulation, total gonadotropin dose requirement, peak serum estradiol level, total number of oocytes retrieved, fertilization rate, embryo quality, implantation rate, and clinical pregnancy rate. The effect of obliteration of the cul-de-sac by endometriosis was also evaluated. RESULTS: Women with endometriosis required significantly higher gonadotropin doses than women in the control group (P < 0.01). The fertilization rate was significantly lower for women with endometriosis (P < 0.05), although there was no difference in embryo quality or in the number of embryos transferred. In patients with an obliterated cul-de-sac, fewer oocytes were retrieved than in patients in the control group (P < 0.01). CONCLUSION: The presence of endometriosis, including stages III and IV, does not affect IVF outcome. However, women with endometriosis require more gonadotropin stimulation than those with no endometriosis. Women with an obliterated cul-de-sac have fewer oocytes retrieved than women without obliteration.PMID: 17140505 [PubMed – in process] ________________________________________ Eur J Gynaecol Oncol. 2006;27(5):531-3.Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection–case report.Sert BM, Abeler VM.Department of Gynecologic Oncology, University of Oslo, Montebello, Oslo, Norway.OBJECTIVE: The aim of this study was to describe the first robotic-assisted radical hysterectomy (Piver type III) and bilateral pelvic lymph node dissection for a patient with Stage Ib1 cervical carcinoma. CASE: A 43-year-old woman G1, P1, previously operated on due to endometriosis with removal of the left ovary and fallopian tube, came under our care. In addition, hysteroscopic myomectomy had been done two years before. Otherwise the patient was healthy. Preoperative conization histology revealed 6 mm of stromal infiltration. The patient was offered the da Vinci robotic Wertheim operation for the first time which was well accepted and she was discharged uneventfully on the 4th day postoperatively. Four months later at a routine check-up we found asymptomatic bilateral lymphocysts but otherwise normal status. CONCLUSION: It is fully possible to perform Piver type III laparoscopic radical hysterectomy using the da Vinci robotic system and it seems that radical dissection is much more precise than the conventional laparoscopic radical hysterectomy.Publication Types: ? Case ReportsPMID: 17139995 [PubMed – indexed for MEDLINE] ________________________________________ Gynecol Endocrinol. 2006 Oct;22(10):547-51. Effect of the menstrual cycle and oral contraceptives on aromatase and cyclooxygenase-2 expression in adenomyosis.Maia H Jr, Casoy J, Correia T, Freitas L, Pimentel K, Athayde C, Coutinho E.Centro de Pesquisa e Assistencia em Reproducao Humana (CEPARH), Salvador, Bahia, Brazil. ceparh@uol.com.brOBJECTIVES: To determine whether aromatase expression in the eutopic endometrium and adenomyotic foci is affected by previous use of oral contraceptives containing gestodene, and to determine whether changes in cyclooxygenase-2 (COX-2) expression occur in adenomyosis during the menstrual cycle. PATIENT AND METHODS: This was a retrospective cohort study carried out in paraffin-embedded endometrial tissue obtained from patients with a histological diagnosis of adenomyosis obtained during the proliferative (n = 25) and luteal (n = 10) phases of the menstrual cycle and following the use of continuous oral contraception with gestodene/ethinyl estradiol (n = 7). COX-2 and aromatase expression were measured in both eutopic endometrium and adenomyotic foci using immunohistochemical methods. RESULTS: Aromatase expression was detected in 80% of the endometrial slices by immunohistochemistry. In positive cases, aromatase was mainly detected in the stromal cells of the eutopic endometrium, whereas in the adenomyotic foci this expression was negative in the majority of the cases. Oral contraceptives containing gestodene, on the other hand, were effective in suppressing aromatase expression in both eutopic and ectopic endometrium. COX-2 expression was detected by immunohistochemistry in the glandular epithelium of both eutopic endometrium and adenomyotic foci and there were no significant changes in its intensity throughout the menstrual cycle. CONCLUSION: Aromatase expression in the eutopic endometrium and adenomyotic foci is suppressed by oral contraceptives containing gestodene. Increased aromatase activity may be responsible for the persistent COX-2 expression during the luteal phase.Publication Types: ? Comparative StudyPMID: 17135033 [PubMed – indexed for MEDLINE] ________________________________________ Eur J Obstet Gynecol Reprod Biol. 2006 Nov 27; [Epub ahead of print] Blue peritoneal implants-Is it always endometriosis?Vellayan M, Lotfallah HN.Rotherham District General Hospital, Rotherham, United Kingdom.Publication Types: ? LETTERPMID: 17134818 [PubMed – as supplied by publisher] ________________________________________ Curr Opin Gastroenterol. 2007 Jan;23(1):67-73. Recent developments in the role of endoscopic ultrasonography in diseases of the colon and rectum.Bhutani MS.Center for Endoscopic Ultrasound, University of Texas Medical Branch, Galveston, Texas 77555, USA. msbhutan@utmb.eduPURPOSE OF REVIEW: Endoscopic ultrasound has evolved as a useful technique for imaging and intervention in a variety of gastrointestinal and extraintestinal diseases including diseases of the colon and rectum. This paper will review recent developments in endoscopic ultrasound for colorectal diseases. RECENT FINDINGS: Recent studies have shown significant clinical impact of endoscopic ultrasound in rectal cancer staging. Iliac lymph node evaluation by endoscopic ultrasound-guided fine needle aspiration may further expand the role of endoscopic ultrasound in rectal cancer. Three-dimensional endoscopic ultrasound may help decrease some of the errors of staging with two-dimensional endoscopic ultrasound and may further improve staging accuracy. Recent studies have confirmed continued problems with re-staging rectal cancer after chemoradiation. Endoscopic ultrasound-fine needle aspiration can be helpful in detecting local recurrence of rectal cancer and has been shown to be useful in evaluation of subepithelial masses of the colon and rectum and evaluation of rectosigmoid endometriosis. SUMMARY: Endoscopic ultrasound continues to be useful for a variety of conditions of the colon and rectum with recent studies confirming its clinical impact as well as expanding its role into newer indications. Assessment for residual cancer after chemoradiation is still problematic and hopefully technological developments in ultrasound in the future may help in improving the accuracy of endoscopic ultrasound in this situation.Publication Types: ? ReviewPMID: 17133088 [PubMed – indexed for MEDLINE] ________________________________________ Ceska Gynekol. 2006 Sep;71(5):408-10.Transvaginal hydrolaparoscopy (THL) in diagnosing infertility.Kowalczyk D, Guzikowski W, Maczka M, Kubicki J.Gynecologic-Obstetrical and Neonatus Hospital, Opole, Poland. zoz@ginekologia.opole.plINTRODUCTION: In recent years novel gynecological diagnostic methods have emerged. One of them is transvaginal hydrolaparoscopy (THL). This method allows endoscopic visualization of the organs within the women pelvis accessed through the posterior fornix of the vagina (Veress’s needle was used) and with peritoneal distension by saline. OBJECTIVE: To evaluate a THL as a new technique for diagnosing pelvic pathology. METHODS AND RESULTS: In years 2002-2004, 56 patients underwent THL due to primary (40 cases) or secondary (16 cases) infertility (age 20-40). None of the patients had any history of previous pelvic surgery and all had normal findings on gynecological examination and vaginal sonography. The quality of the pelvic pictures was satisfactory in all cases. In the infertile group we observed in 42.8% cases of no macroscopic changes, in 57.2% some form of pelvic pathology ; 28.6% of demonstrated endometriosis, and 28.6% had tubal occlusion. There were no complications during or after the operation. CONCLUSIONS: THL is well-tolerated and accepted by the patients. THL is a safe, simple and inexpensive diagnostic method for pelvic pathology and infertility.PMID: 17131927 [PubMed – indexed for MEDLINE]

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