Fertil Steril. 2007 Oct;88(4):906-10.
Stage I ovarian carcinoma: different clinical pathologic patterns.
The Mount Sinai School of Medicine, Department of Pathology, New York, NY 10029, USA.
OBJECTIVE: To analyze clinicopathologic patterns of early ovarian carcinoma. DESIGN: Retrospective chart and histopathology review. SETTING: Mount Sinai School of Medicine, New York and the Centre Jean Perrin, Clermont Ferrand, France. PATIENT(S): Seventy-six consecutive cases of Fédération Internationale de Gynécologie et d’Obstétrique stage I ovarian carcinoma. INTERVENTION(S): Surgical staging. MAIN OUTCOME MEASURE(S): Symptomatology, pathology, and histology analysis. RESULT(S): Twenty-two cases (29%) were serous papillary carcinomas and 54 were nonserous carcinomas (71%) (40 endometrioid, 10 clear cell, and 4 mixed endometrioid and clear cell carcinomas). Ninety-eight percent of ovarian endometriosis, 95% of endometrial carcinomas, and 83% of endometrial polyps and hyperplasias were associated with nonserous carcinomas. Most patients with serous papillary carcinoma presented with asymptomatic pelvic masses; patients with nonserous carcinomas presented with pelvic pain or abnormal vaginal bleeding with or without pelvic mass. CONCLUSION(S): Over two thirds of stage I ovarian carcinomas were nonserous, and were diagnosed because of associated symptoms: pelvic pain with endometriosis and/or adnexal masses, or vaginal bleeding from endometrial pathology. Serous papillary carcinomas were often asymptomatic and diagnosed during follow-up evaluations in breast cancer patients. Stage I ovarian carcinoma has different clinical and pathologic patterns than advanced ovarian carcinoma. The risk of ovarian and endometrial malignancy should be taken into consideration during evaluation of patients with endometriosis and breast cancer histories.
Reprod Sci. 2007 Jul;14(5):486-97.
Relative expression of 1,25-dihydroxyvitamin D3 receptor, vitamin D 1 alpha-hydroxylase, vitamin D 24-hydroxylase, and vitamin D 25-hydroxylase in endometriosis and gynecologic cancers.
Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Lübeck, Germany.
The authors demonstrate expression of the vitamin D receptor (VDR) and its hydroxylases in the endometrium and ovaries of women with and without endometriosis and endometrial or ovarian cancer. Immunohistochemistry showed strong staining of the VDR in endometriosis and endometrial cancer, with the most intense staining in epithelial cells. The VDR mRNA was significantly increased in patients with endometrial and ovarian cancer compared to the control group. There was a significantly higher 1 alpha-hydroxylase expression in the endometrium of patients with endometriosis compared to healthy controls. The observed differences in VDR and 1 alpha -hydroxylase mRNA levels were maintained at the protein level. The authors found no differences in 25-OH vitamin D levels between the serum of patients with endometriosis (25.7 +/- 2.1 ng/mL, n = 46) and healthy controls (22.6 +/- 2.0 ng/mL, n = 33, P = .31). They hypothesize that vitamin D might influence the local activity of immune cells and cytokines thought to play important pathogenic roles in the development and maintenance of endometriosis.
Gynecol Obstet Fertil. 2007 Oct;35(10):1015-23. Epub 2007 Oct 1.
[Clinical factors associated with the outcome of oocyte donation][Article in French]
Instituto Valenciano de Infertilidad -Barcelona, 14, Ronda General-Mitre, 08017 Barcelone, Espagne. email@example.com
This article aims at reviewing the literature in order to provide a summary of the actual knowledge about the clinical factors of the oocyte recipient (other than those affecting the morphology of the uterine cavity) influencing the outcome of oocyte donation cycles. Recipient age, from 45 years onwards, is clearly associated with a poorer outcome in oocyte donation cycles as well as the presence of a hydrosalpinx. The negative impact of smoking has recently been confirmed. The exact influence of a high body mass index is under examination but it is likely that it is associated with a lower ongoing pregnancy rate. Endometriosis does not have a negative impact when standard endometrial priming protocols are used in oocyte donation. During endometrial priming, serum estradiol levels and endometrial thickness, if >5 mm, does not influence negatively the outcome; however duration of estrogen treatment of more than 7 weeks is associated with a diminished pregnancy and implantation rate.
J Ultrasound Med. 2007 Oct;26(10):1449-51.
Inguinal endometriosis presenting as a multicystic mass on sonography.
Department of Radiology, Kyung Hee University East-West Neo Medical Center, 149 Sangil-dong, Gangdong-gu, Seoul 134-090, Korea. firstname.lastname@example.org
J Obstet Gynaecol. 2007 Aug;27(6):605-7.
Rectovaginal endometriosis — a frequently missed diagnosis.
Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK. email@example.com
To assess the proportion of women found to have rectovaginal endometriosis who underwent a previous laparoscopy with negative findings, a 5-year retrospective observational study was carried out at the University Hospital of Wales, Cardiff UK, from 2001 to 2005. A total of 61 cases with potential symptoms of rectovaginal endometriosis who underwent laparoscopy were identified. Rectovaginal endometriosis was identified in 16 of these cases. Previous laparoscopy was carried out in 33 of these 61 cases. In the group of women found to have rectovaginal endometriosis, 14 cases of rectovaginal endometriosis were not identified by pre-referral laparoscopy. This study supports the anecdotal idea that rectovaginal endometriosis is an often missed diagnosis at the time of laparoscopy. Diagnostic laparoscopy by generalist gynaecologists frequently fails to diagnose rectovaginal endometriosis. The routine use of rectal probes at laparoscopy is recommended to increase diagnostic accuracy.
Am J Surg Pathol. 2007 Oct;31(10):1490-501.
Primary endometrioid adenocarcinoma of the vagina: a clinicopathologic study of 18 cases.
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. firstname.lastname@example.org
Vaginal adenocarcinoma is the second most common primary cancer of the vagina, yet there has been very little study of most subtypes other than clear cell carcinoma. We reviewed 18 cases of primary vaginal endometrioid adenocarcinoma, in our experience the second most common subtype. The patients ranged from 45 to 81 years of age (mean 60). Most presented with vaginal bleeding, and had had a prior hysterectomy. Five had a history of unopposed estrogen therapy but none had a history of intrauterine diethylstilbestrol exposure. The tumors were at the vaginal apex in 10 cases, in the posterior wall in 3, the lateral wall in 3, and the anterior wall in 1. On microscopic examination, each of the tumors had a pure or predominant component of typical endometrioid adenocarcinoma. There was squamous metaplasia in 4 cases, mucinous metaplasia in 4, and prominent nonvillous papillae in 2. The tumors were grade 1 of 3 in 4 cases, grade 2 in 13, and grade 3 in 1. Eleven cases were FIGO stage I, 5 stage II, and 2 stage IV. Vaginal endometriosis was identified in 14 cases, and is important in indicating a primary vaginal tumor, rather than secondary spread from the endometrium. Other subtypes of adenocarcinoma (such as serous when the tumor has a papillary pattern) and atypical forms of endometriosis, including polypoid endometriosis, are the most common other differential diagnostic considerations. The prognosis seems to be good in low-stage patients, with 11 patients alive and well and 2 alive with recurrent disease.
Hum Reprod. 2007 Nov;22(11):2857-62. Epub 2007 Sep 21.
Lipiodol fertility enhancement: two-year follow-up of a randomized trial suggests a transient benefit in endometriosis, but a sustained benefit in unexplained infertility.
Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand. email@example.com
BACKGROUND: A New Zealand randomized trial has shown that lipiodol treatment enhances fertility with high short-term effectiveness for women with endometriosis. METHODS: An open randomized trial in a single-centre secondary- and tertiary-level infertility service assessing lipiodol flushing versus no intervention. A total of 158 women with unexplained infertility (62 women with mild endometriosis and 96 women with pure unexplained infertility) were evaluated at 24 months after trial entry. The main outcome measure was clinical pregnancy, assessed using a Cox proportional hazards regression model. RESULTS: There was a significant benefit in overall pregnancy rate following lipiodol [hazard ratio 2.0, 95% confidence interval (CI) 1.3-3.2]. Among women with endometriosis, the benefit in pregnancy rate seen in the first 6 months following lipiodol (hazard ratio 5.4, 95% CI 2.1-14.2) was not present at 6-24 months (hazard ratio 0.6, 95% CI 0.2-2.1). There was a more consistent effect of lipiodol on fertility throughout the 24-month follow-up among women with unexplained infertility (hazard ratio 2.0, 95% CI 1.1-3.5). CONCLUSIONS: Lipiodol flushing is effective at enhancing fertility not only for women with endometriosis, but also for those with pure unexplained infertility.
Nurs Womens Health. 2007 Apr;11(2):200-4.
Chronic pelvic pain: can you guess the cause?
Charlottesville Gynecology Specialists in Charlottesville, VA, USA.
Indian J Pathol Microbiol. 2007 Jul;50(3):601-2.
Mullerianosis in post-caesarean section abdominal scar.
J Reprod Med. 2007 Aug;52(8):733-6.
Occult perineal endometrioma diagnosed by endoanal ultrasound and treated by excision: a report of 3 cases.
Division of Colon and Rectal Surgery, Department of Pathology, Western Pennsylvania Hospital, Clinical Campus of Temple University School of Medicine, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
BACKGROUND: Isolated perineal endometrioma is a rare entity and often causes diagnostic uncertainty. CASES: Three premenopausal women, none with a prior history of endometriosis, presented with vague perineal pain 3-6 months following obstetric delivery with episiotomy. The latency periods between the onset of symptoms and definitive diagnosis were 3 months, 18 months and 3 years despite multiple physician evaluations in the interim. Patient presentation and management were virtually identical in all cases. Detailed questioning revealed that the pain was located adjacent to the episiotomy incision and waxed and waned with menses. Physical examination revealed a vague fullness adjacent to the episiotomy incision. Endoanal ultrasound revealed a mass of mixed echogenicity adjacent to the external anal sphincter. Transperineal exploration revealed a tumor with the gross appearance of an endometrioma, which was confirmed histologically. Excision of the mass with preservation of the anal sphincter muscle resulted in resolution of symptoms in all patients without the need for hormonal manipulation. No patient suffered diminution of fecal continence. CONCLUSION: Occult perineal endometriosis should be considered when a woman presents with cyclic pain in the perineum following delivery and episiotomy. Endoanal ultrasound can assist with the diagnosis. Transperineal excision with sparing of the anal sphincter can be curative, without compromising continence.
J Reprod Med. 2007 Aug;52(8):715-21.
Modulating interaction of glutathione-S-transferase polymorphisms with smoking in endometriosis.
Department of Obstetrics and Gynecology, Mersin University, School of Medicine, Mersin, Turkey.
OBJECTIVE: To evaluate the interaction of glutathione-S-transferase (GST) gene polymorphisms and smoking as a risk factor for endometriosis. STUDY DESIGN: The study group consisted of 150 women who were diagnosed by means of surgery and histopathology as having endometriosis. The control group consisted of 150 women who displayed no evidence of endometriosis during exploratory laparotomy or laparoscopy. We assessed the interaction of smoking and GSTM1 and GSTT1 polymorphisms in these patients. RESULTS: Logistic regression analyses showed that the GSTM1-null allele was associated with a significantly increased risk of endometriosis and smoking with a decreased risk of endometriosis separately. There was no association between endometriosis and the GSTT1-null allele. The interaction of smoking and GST polymorphisms showed a joint effect. We found that the GSTM1-null allele was more prevalent in active smoking endometriosis patients (63.4%) than in the controls (35.0%), and the difference was statistically significant. A similar tendency was also observed in the GSTT1 allele distribution. CONCLUSION: Genetic factors could modify the response to environmental pollutants in endometriosis.
J Reprod Med. 2007 Aug;52(8):703-8.
Effect of French maritime pine bark extract on endometriosis as compared with leuprorelin acetate.
Department of Obstetrics and Gynecology, Keiju Medical Center, Tomioka-chou 94, Nanao City, Ishokawa, Japan. firstname.lastname@example.org
OBJECTIVE: To clarify the effect of Pycnogenol (Horphag Research, Geneva, Switzerland), French maritime pine bark extract, on endometriosis. STUDY DESIGN: Fifty-eight women were included in this study. They were operated on conservatively for endometriosis and surgically diagnosed with the condition. All patients were followed at 4, 12, 24 and 48 weeks after starting treatment to check for endometriosis signs and symptoms, including changes in CA-125 and estrogen levels (E2). Thirty-two patients in the Pycnogenol treatment group took 60 mg Pycnogenol orally a day for 48 weeks. The 26 patients who received gonadotropin-releasing hormone agonist (Gn-RHa) were treated in the standard way. RESULTS: Treatment with Pycnogenol slowly but steadily reduced the symptom scores. Treatment with Gn-RHa reduced the scores more efficiently; however, 24 weeks after the end of treatment, the scores suggested a recurrence of signs. No influence of treatment on menstrual cycles or E2 was observed in the Pycnogenol group. CA-125 decreased in both treatment groups. Patients with smaller endometriomas responded better to treatment as compared to patients with larger endometriomas. In the Gn-RHa group, the lowering of CA-125 concentrations was far more pronounced; however, a clear rebound effect was observed. CONCLUSION: Pycnogenol is a therapeutic alternative to Gn-RHa in the treatment of endometriosis.
World J Gastroenterol. 2007 Oct 28;13(40):5400-2.
Sigmoid colon endometriosis treated with laparoscopy-assisted sigmoidectomy: significance of preoperative diagnosis.
Department of Organ Regenerative Surgery, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan. email@example.com
We present a female patient with sigmoid colon endome-triosis who was diagnosed correctly preoperatively and underwent minimally invasive surgery. She was admitted to our hospital with rectal bleeding and constipation. We performed several workups. Colonoscopy and endoscopic ultrasonography showed sigmoid colon stenosis caused by submucosal tumor, and magnetic resonance imaging revealed a sigmoid colon tumor displaying signal hy-pointensity on both T1- and T2-weighted imaging. However, colonoscopic ultrasonography-assisted needle aspiration biopsy could not specify tumor characteristics. From these examinations, the lesion was diagnosed as sigmoid colon endometriosis and laparoscopy-assisted sigmoidectomy was performed. Pathological diagnosis from the resected specimen was identical to preoperative diagnosis, i.e., colonic endometriosis. Since differential diagnosis of intestinal endometriosis seems difficult, a cautious preoperative diagnosis is required to select treatments including minimally invasive surgery.
BJOG. 2007 Oct;114(10):1278-82.
Urological and colorectal complications following surgery for rectovaginal endometriosis.
Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK.
OBJECTIVES: To report the short- and medium-term complications of laparoscopic laser excisional surgery for rectovaginal endometriosis. DESIGN: Retrospective cohort study. SETTING: University teaching hospital, UK. POPULATION: A total of 128 women with histologically confirmed rectovaginal endometriosis who underwent laparoscopic laser surgery between May 1999 and September 2006. METHODS: Women were identified from operative database, and a case note review was performed. Data for surgical outcome and surgical complications were collected. MAIN OUTCOME MEASURES: Rates of urinary tract and colorectal complications. RESULTS: A total of 128 women underwent surgery. Of these, 32 required intraoperative closure of a rectal wall defect, including 3 segmental rectosigmoid resections. There were three rectovaginal fistulae and one ureterovaginal fistula. Ureteric damage occurred in two women, and five women suffered postoperative urinary retention. The risk of intraoperative bowel intervention was increased in women who complained of cyclical rectal bleeding. CONCLUSION: Laparoscopic laser excision of rectovaginal endometriosis is a safe procedure with similar, if not lower, complication rates to other published surgical series.
Immunol Res. 2007;37(3):201-10.
Relationship between diseases accompanied by tissue destruction and granulocytes with surface adrenergic receptors.
Department of Immunology, Niigata University School of Medicine, Niigata, 951-8510, Japan. firstname.lastname@example.org
It is well-known that physiological phenomena and certain diseases, including neonatal granulocytosis, age-associated granulocytosis, periodontitis, pancreatitis, Crohn’s disease, ulcerative colitis, hemorrhoids, endometriosis, and NSADs-enteritis, are accompanied by tissue destruction and granulocytosis. We investigated what is a key factor connecting tissue destruction and granulocytosis, attention being focused on adrenergic receptors on granulocytes and stress-induced sympathetic nerve stimulation. If we introduce the concept that “granulocytosis and subsequent tissue destruction are induced by sympathetic nerve stimulation,” the mechanisms underlying many physiological phenomena and the etiology of several uncurable diseases in humans can be clearly understood.
Endocrine. 2007 Apr;31(2):167-73.
Tyrosine receptor kinase B (TrkB) protein expression in the human endometrium.
Reproductive Biology Division, Department of Obstetrics & Gynecology, HSC-3N52D, McMaster University, 1200 Main Street W, Hamilton, ON, Canada.
Tyrosine kinase receptor B (TrkB) gene expression, a neurotrophic factor receptor expressed in the brain and ovary, has recently been identified in deep infiltrating endometriosis by gene array. TrkB is thought to be important in resistance to anchorage independent apoptosis (ANOIKIS) and thus could be important in the pathogenesis of endometriosis. However, TrkB protein expression in the eutopic endometrium of women with and without endometriosis is unknown. Therefore, we examined TrKB protein expression in the endometrium by Western blot (n = 50) and immunohistochemistry (n = 17). Immunoblots of endometrial biopsies were prepared from women with endometriosis (n = 21) vs. healthy controls (n = 29) undergoing benign gynecological surgery at McMaster University Medical Centre. TrkB protein expression was significantly higher in immunoblots from women with endometriosis compared to women without endometriosis. In samples of archived paraffin-embedded endometrial tissue TrkB was localized to the cytoplasm of epithelial cells of the eutopic endometrium from women with endometriosis (n = 7) and without endometriosis (n = 10). We conclude that TrkB protein is expressed in human endometrium. Our results also suggest that TrkB expression may be greater in women with endometriosis compared to women without endometriosis.
J Pediatr Adolesc Gynecol. 2007 Oct;20(5):293-7.
Bone density in adolescents treated with a GnRH agonist and add-back therapy for endometriosis.
Division of Adolescent Medicine, Children’s Hospital Boston, MA 02115, USA. email@example.com
STUDY OBJECTIVE: To evaluate the bone density of adolescents with endometriosis treated with a GnRH-agonist and “add-back” therapy with norethindrone acetate. DESIGN: Retrospective chart review. SETTING: Pediatric gynecology clinic at a tertiary care center. PARTICIPANTS: 36 adolescents, ages 13 to 21 years, with endometriosis. MAIN OUTCOME MEASURES: Bone mineral density (BMD, g/cm(2)) by dual energy x-ray absorptiometry (DXA); BMD Z-scores of hip and spine. RESULTS: The mean BMD Z-score at the total hip was -0.24 +/- 1.0, with a range of -2.4 to 1.7. At this site, 6 subjects had a BMD Z-score between -1.0 and -2.0 SD, while 2 had a Z-score < or = -2.0 SD. The mean BMD Z-score at the lumbar spine was 0.55 +/- 1.1, with a range of -2.8 to 1.4. At the spine, 11 subjects had a BMD Z-score between -1.0 and -2.0 SD, while 3 had a Z-score < or = -2.0 SD. There was no correlation noted between duration of therapy with the GnRH-agonist plus add-back and BMD at the hip or spine. CONCLUSION: BMD at the hip was normal in most adolescents with endometriosis who were receiving a GnRH-agonist plus add-back therapy with norethindrone acetate. Almost one third of subjects exhibited skeletal deficits at the spine. These data suggest that BMD should be carefully monitored in adolescents receiving treatment with GnRH agonists.
J Pak Med Assoc. 2007 Jul;57(7):373-5.
Clear cell carcinoma of ovary with associated mucinous cystadenoma and endometriosis.
Department of Pathology & Microbiology, The Aga Khan University Hospital, Karachi.
A 45 year old woman presented with right sided ovarian mass with multiple omental deposits and liver metastases. The right ovary was enlarged and showed a partly cystic partly solid cut surface. Histological picture showed clear cell carcinoma with areas of mucinous cystadenoma and endometriosis. Clear cell carcinoma is known to be associated with endometriosis. To the best of author’s knowledge, it’s association with mucinous cystadenoma has been described only once in the literature, where clear cell carcinoma was shown to be associated with mucinous cystadenoma without any evidence of endometriosis.
Hum Reprod. 2007 Nov;22(11):3021-6. Epub 2007 Sep 13.
The risk of cancer and the role of parity among women with endometriosis.
Department of Obstetrics and Gynaecology, Karolinska University Hospital, Huddinge, K57, Stockholm, Sweden. firstname.lastname@example.org
BACKGROUND: Several epidemiological studies have shown an increased cancer risk among women with endometriosis, especially ovarian cancer. Infertility and nulliparity are also known risk factors for different types of cancer. The aim of this study is to investigate cancer risk among women with endometriosis, stratifying for parity. METHODS: Women discharged from a hospital, with the diagnosis of endometriosis from 1969 to 2002, were identified using the National Swedish Inpatient Register. Data were linked to the National Swedish Cancer Register to identify cases of cancer and to the Swedish Multi-Generation Register to calculate parity and age at first birth. Standardized incidence ratios (SIR) were calculated. RESULTS: A total of 63,630 women entered the study. To exclude cancers already present at the time of endometriosis diagnosis, the first year of follow-up was excluded, leaving a number of 3,822 cases of cancer. There was no increased overall risk of cancer (SIR 1.01) among women with endometriosis. Endometriosis was associated with elevated risks for endocrine tumours (SIR 1.38), ovarian cancer (SIR 1.37), renal cancer (SIR 1.36), thyroid cancer (SIR 1.33), brain tumours (SIR 1.27), malignant melanoma (SIR 1.23) and breast cancer (SIR 1.08), as well as a reduced risk for cervical cancer (SIR 0.71). There were no significant differences between nulliparous and parous women with endometriosis regarding cancer risk for any of the cancer types. There was a non-significant decrease in risk of ovarian cancer with increasing parity for women with endometriosis. CONCLUSIONS: Women with endometriosis have an increased risk for several malignancies. The increased risks do not seem to be related to parity.
Reprod Biomed Online. 2007 Sep;15(3):321-5.
Differential expression of follicular fluid cytokines: relationship to subsequent pregnancy in IVF cycles.
Reproductive Research Centre, Department of Obstetrics-Gynaecology and Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
The objective of this study was to investigate the role of cytokines in the peri-ovulatory follicular fluid (FF) during IVF cycles. FF from 112 women was obtained during oocyte retrieval for IVF. The concentrations of five cytokines [interleukin (IL)- 1beta, IL-6, IL-12, IL-13, and tumour necrosis factor alpha (TNFalpha )] were measured in FF and their concentrations compared among women who became pregnant and those who did not. Thirty-one endometriosis patients, 15 idiopathic infertility, 21 tubal factor infertility, 15 ovarian factor infertility, and 30 patients with male factor infertility were included. Interleukin-13 and TNFalpha were absent in the peri-ovulatory FF of all patients. Fifty-two patients achieved pregnancy, whereas 60 did not. Both pregnant and non-pregnant groups were comparable for age, parity, ovarian stimulation parameters, fertilization rates, and embryo freezing rates. Concentrations of FF IL-1beta were not significantly different between pregnant and non-pregnant cycles. Concentrations of FF IL-6 were significantly higher in pregnant compared with non-pregnant cycles (P = 0.0005). Concentrations of FF IL-12 were significantly lower in pregnant compared with non-pregnant cycles (P = 0.0002). Higher concentrations of IL-12 and lower concentrations of IL-6 in the peri-ovulatory FF are associated with a negative outcome in IVF treatment. Interleukins-12 and IL-6 are biological markers that appear to affect IVF outcome.
Reprod Biomed Online. 2007 Sep;15(3):316-20.
Follicular fluid vascular endothelial growth factor and tumour necrosis factor alpha concentrations in patients with endometriosis undergoing ICSI.
Department of In-Vitro Fertilization, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey. email@example.com
The aim of this study was to investigate follicular fluid vascular endothelial growth factor (VEGF) and tumour necrosis factor alpha (TNFalpha) concentrations in endometriosis, and their effect on the outcome of intracytoplasmic sperm injection (ICSI). A prospective study was performed among patients who had either a laparoscopic diagnosis of endometriosis (n = 48) or who had normal laparoscopic findings with unexplained infertility (n = 43). The number of gonadotrophin units, peak oestradiol concentrations, number of oocytes retrieved, fertilization, cleavage and pregnancy rates, and number of embryos transferred, were the main outcome measurements. There was no difference in these parameters between the two study groups. Significantly higher concentrations of VEGF were found in the endometriosis group (P = 0.031), but there was no difference in TNFalpha concentrations. No relationship was found between VEGF and TNFalpha concentrations and ICSI outcome. Despite a higher concentration of intrafollicular VEGF in the endometriosis group, it was concluded that this parameter had no predictive value with respect to ICSI outcome. In addition, intrafollicular TNFalpha concentrations were not different in the endometriosis group and there was no relationship between VEGF or TNFalpha concentrations and the outcomes measured.
Colorectal Dis. 2007 Oct;9(8):701-5.
Laparoscopic colorectal surgery – results from 200 patients.
Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, Surrey, UK.
OBJECTIVE: Laparoscopic surgery is increasingly being performed for benign and malignant colorectal disease. This study examines the short-term results in a consecutive series of laparoscopic colorectal procedures performed over 2 years. METHOD: A prospective database was established for all elective patients undergoing laparoscopic colorectal surgery by one surgeon. The main outcome measures assessed were operative duration, conversion rate, length of hospital stay, morbidity and mortality and lymph node harvest. RESULTS: Two hundred and thirty-one consecutive patients were referred for elective colorectal surgery, with 18 patients excluded from laparoscopic surgery. Thirteen patients had nonresective laparoscopic colorectal procedures for endometriosis and have been excluded from the series. Of 200 patients who underwent a laparoscopic colorectal procedure, 114 (57%) were female, the median age was 67 years (inter-quartile range (IQR) 57-76), and there were 116 malignancies. The most common operations were anterior resection and sigmoid colectomy (n = 82), right hemicolectomy (n = 62) and left hemicolectomy (n = 12). The median operating time was 120 min (IQR 90-150) and 10 patients (5%) required conversion to open surgery. The median lymph node harvest in malignancies was 21 nodes (IQR 15-30) and no positive resection margins were found. There were two deaths and 29 significant complications (14.5%), with seven patients requiring re-operations because of postoperative complications. The median postoperative hospital stay was 4 days (IQR 3-6) and 13 patients (6.5%) were re-admitted within 30 days of hospital discharge. CONCLUSION: Laparoscopic colorectal surgery is possible for most benign and malignant conditions, with low conversion and complication rates, as well as short hospital stay.
Rev Med Liege. 2007 Jul-Aug;62(7-8):487-91.
[Catamenial pneumothorax : a case report][Article in French]
Service de Pneumologie, CHR Citadelle Liège, Belgique.
Catamenial pneumothorax is an unusual and rarely recognized entity that belongs to the thoracic endometriosis syndrome. The increase a number of published cases over the last years allows a more frequent diagnosis and understanding. We describe the story of a young woman with a recurrent right sided pneumothorax and discuss the different pathogenic mechanisms and current therapies. The rarity of the disease makes a prospective study very difficult. To this day, there is no consensus on a standardized therapeutic attitude.
J Psychosom Obstet Gynaecol. 2007 Dec;28(4):201-8.
Remembering the pain: accuracy of pain recall in endometriosis.
University of Nevada, Las Vegas, NV 89154-5030, USA.
Endometriosis diagnosis and treatment planning are guided primarily by retrospective pain recall, despite the facts that (1) there is only a tenuous relationship between pain reports and physical pathology, and (2) the accuracy of pain recall has never been assessed in this population. The current study investigated the accuracy of endometriotic pain recall for pain experienced over a 30-day period, as well as potential psychological mediators of pain recall accuracy, including psychological wellbeing, distress specific to infertility, passive and active coping, and pain present at time of recall in 100 women with endometriosis. Findings indicated that women were relatively accurate in their recall of pain. Only passive coping and pain present at recall were predictive of accuracy, with greater passive coping and lower pain at recall predictive of overestimation of past pain. Study implications are discussed, including: (1) report of pain over a 30-day duration appears credible for the majority of patients with endometriosis and (2) women exhibiting greater passive coping may benefit from psychological treatment in addition to medical intervention.
Gynecol Endocrinol. 2007 Jul 3:1-3.
Subhepatic retroperitoneal endometrioma: Report of a case.
Second Department of Surgery, Athens University Medical School Areteion Hospital, Athens, Greece.
A 38-year-old woman with a history of pelvic endometriosis was referred to our surgical department for the treatment of a cystic lesion most probably originating from the liver. At the laparotomy a solitary cyst was found in the retroperitoneum, connected to the inferior surface of the liver, and was resected. Histopathological examination of the resected specimen revealed that it was an endometriotic cyst. The occurrence of endometriotic cyst in the upper abdomen is very rare: there are no published reports of an endometriotic cyst in that anatomic location. The literature on this subject is reviewed.
Gynecol Endocrinol. 2007 Jul 24:1-5.
Association study between epidermal growth factor receptor and epidermal growth factor polymorphisms and endometriosis in a Japanese population.
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
Objective. We investigated a possible association between endometriosis and polymorphisms in the genes encoding epidermal growth factor (EGF) receptor (EGFR) and EGF in a Japanese population. Methods. We compared the distribution of the Egfr+2073 A/T and Egf+61 G/A polymorphisms by polymerase chain reaction-restriction fragment length polymorphism analysis in 146 affected women and 181 controls. Results. No significant differences in the frequency and genotype distribution of the Egfr+2073 A/T and Egf+61 G/A polymorphisms were found between endometriosis patients with all disease stages and controls. Stratification by disease stage had no effect on the results. Conclusion. The Egfr+2073 A/T and Egf+61 G/A polymorphisms are not associated with an increased risk of endometriosis in a Japanese population.
Acta Obstet Gynecol Scand. 2007 Sep 4:1-7.
Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Denmark.
Background. Postmenopausal endometriosis is rare. The purpose of this presentation is to give a review of the topic based on existing literature. Methods. A Medline search concerning postmenopausal endometriosis was carried out. Hormone therapy and risk of malignancy in these patients are discussed. Results. Some 32 case reports on postmenopausal endometriosis were found. The most common location is in the ovaries. Estrogens stimulate endometriosis. There is a risk of recurrence or de novo occurrence of endometriosis after the menopause in patients who take hormone therapy (HT); especially estrogen only therapy (ET). So far, treatment has primarily been surgery (hysterectomy (TAH) and bilateral oophorectomy (BSO)). There is little experience with medical treatment (aromatase inhibitors). The risk of malignant transformation of premenopausal endometriosis is around 1%. Furthermore, patients with endometriosis have an increased risk of ovarian cancer, and, apparently, other malignancies. The risk of malignant transformation appears to be further elevated in patients who take ET, although this subject is not fully elucidated. Conclusions. Although the condition is rare, it is important to be aware of endometriosis after the menopause. Postmenopausal endometriosis infers a risk of recurrence and malignant transformation. Although solid evidence is lacking, the risk of malignant transformation appears to be lower during combined HT compared to ET. Thus, hormone replacement therapy should generally be reserved for patients with severe climacteric complaints, and if indicated, combined therapy should be used.
Acta Obstet Gynecol Scand. 2007;86(12):1467-71. Epub 2007 Sep 6.
Laparoscopic laser resection of rectovaginal pouch and rectovaginal septum endometriosis: the impact on pelvic pain and quality of life.
Department of Gynaecology, Glostrup University Hospital, Denmark. firstname.lastname@example.org
BACKGROUND: The aim of this study was to assess the impact on pelvic pain and quality of life of laparoscopic resection of the rectovaginal pouch (RV) and RV septum in patients with endometriosis. METHODS: The design was a descriptive retrospective study. The study included 48 women presenting to the Department of Obstetrics and Gynaecology with RV pouch and RV septum endometriosis, between 1 January 2003 and 1 January 2006. The setting was a university teaching hospital, one of two referral centres in Denmark for the surgical treatment of stage III and IV endometriosis. Questionnaires and Visual Analogue Scale (VAS) scores for a number of different symptoms associated with endometriosis were used. The main outcome measures were: effect of laparoscopic excision on pain scores and quality of life, operative findings, type of surgery, duration of surgery, and incidence of intra- and postoperative complications. RESULTS: Significant statistical differences were found between preoperative and postoperative pain scores, quality of life, frequency of sexual activity, percentage taking analgesics or non-steroidal anti-inflammatory drugs, percentage having work difficulties due to pain, and percentage of women having sick-leave. CONCLUSION: Endometriosis in the RV pouch and RV septum can be effectively treated with laser laparoscopy performed by experienced endoscopic gynaecologists.
J Minim Invasive Gynecol. 2007 Sep-Oct;14(5):638-43.
Modified virtual colonoscopy: a noninvasive technique for the diagnosis of rectovaginal septum and deep infiltrating pelvic endometriosis.
Endometriosis Institute of Southern Africa, Parklane Clinic, Parktown, Johannesburg, South Africa. email@example.com
In this study, we modified the standard virtual colonoscopy technique to diagnose deep infiltrating pelvic endometriosis. The following modifications were used: (1) insertion of a large obstetric tampon high into the vagina; (2) insertion of a Foley catheter into the rectum and insufflation with CO(2); and (3) scanning only the pelvis. We used a Toshiba Aquillion 64-multidetector computed tomography scanner coupled to a 3-D workstation. By employing various reconstruction modules such as endo-luminal fly-through, cubed volume, 2-D multiplanar reconstruction, 3-D transparent view, and 3-D volume-rendered and maximum intensity projection, we were able to demonstrate deep infiltrating pelvic endometriosis in bowel, urinary tract, and rectovaginal and retroperitoneal spaces.
J Minim Invasive Gynecol. 2007 Sep-Oct;14(5):628-32.
Relationship between site and size of bladder endometriotic nodules and severity of dysuria.
Center of Reconstructive Pelvic Endo-surgery, Reproductive Medicine Unit, S. Orsola Hospital, University of Bologna, Italy. firstname.lastname@example.org
STUDY OBJECTIVE: The purpose of this study was to evaluate the relationship between frequency/severity of dysuria with anatomic location and diameter of bladder endometriotic lesions. DESIGN: Retrospective analysis (Canadian Task Force classification II-3). SETTING: Tertiary care university hospital. PATIENTS: Forty-one patients with bladder endometriosis (endometrial glands and stroma microscopically diagnosed to infiltrate the muscularis propria). INTERVENTIONS: Laparoscopic partial cystectomy, preoperative scoring of dysuria using 10-point verbal analog scale (VAS). MEASUREMENTS AND MAIN RESULTS: Records of all patients with bladder endometriosis were assessed for frequency/severity of preoperative dysuria, anatomic location (base or dome), and diameter of bladder endometriotic nodule. Basal bladder lesions were observed in 18 (43.9%) of 41 patients versus 23 (56.1%) of 41 in the dome. Of the patients with basal lesions, 14 (77.8%) of 18 had preoperative dysuria versus 8 (34.8%) of 23 with dome lesions. Mean VAS score was 8.5 +/- 2.37 and 5.75 +/- 1.91 for base and dome lesions, respectively. Preoperative dysuria was found in 22 (53.7%) of 41 patients. Mean lesion diameter in patients with dysuria was 25.0 +/- 12.6 mm versus 16.3 +/- 6.8 mm in patients without dysuria. CONCLUSION: Frequency and severity of preoperative dysuria were significantly higher in patients with basal endometriotic nodules. There was a positive correlation between severity of dysuria and lesion diameter.
J Minim Invasive Gynecol. 2007 Sep-Oct;14(5):555-6.
Adenomyosis visualized during hysteroscopy.
Endoscopic Surgery Program, Gynecological Unit, Department of Obstetric and Gynecology, Clínica Las Condes, Santiago, Chile.
J Reprod Med. 2007 Jul;52(7):630-4.
Incisional endometriomas after Cesarean section: a case series.
From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, USA.
OBJECTIVE: To review a series of women with endometriomas developing in the scar of the skin incision performed for cesarean section. STUDY DESIGN: A total of 37 patients diagnosed with incisional endometrioma at the time of surgical excision from 1975 to 2005 were identified from the comprehensive surgical database, which includes all operative procedures performed at this institution. The medical records of 33 of the 37 patients were available for review. RESULTS: The endometriomas ranged in size from a diameter of 1-12 cm and were initially observed to be present 6 months to 9 years (mean, 3.2) after the surgical procedure. Diagnosis was best made by needle aspiration of chocolate colored fluid from the mass. Medical therapy with a gonadotropin releasing hormone agonist, medroxyprogesterone acetate or combination oral contraceptives had been attempted in 14 patients without a change in lesion size. All patients were cured by surgical excision of the endometrioma. CONCLUSION: The overall incidence of incisional endometriomas following cesarean section during the 30-year period was 0.08%. Optimal treatment is by surgical excision. It is hypothesized that failure to close the parietal and visceral peritoneum with sutures at the time of cesarean section may markedly increase the postoperative occurrence of an endometrioma in the skin incision scar.
J Reprod Med. 2007 Jul;52(7):581-4.
Cell growth effects of leuprolide on cultured endometrioma cells.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA.
OBJECTIVE: To examine the effect of the GnRH agonist leuprolide on the growth of cultured endometrioma cells. STUDY DESIGN: Experimental study in an academic setting on endometrioma cell lines cultured from 15 women undergoing laparoscopy or laparotomy for excision of endometrioma. RESULTS: Mean cell counts resulting from treatment with lower concentrations were not significantly different from those of the controls. Increasing concentrations of leuprolide resulted in inhibition of cell growth. The inhibitory effect of leuprolide was statistically significant when the 1,000 ng/mL concentration was compared with the control concentration. CONCLUSION: Increased concentrations of leuprolide has suppressive effects on the growth of cultured endometrioma cells. This suggests a direct effect of GnRH agonists acting via GnRH agonist receptors. Long-acting gonadotropin-releasing hormone (GnRH) agonists cause pituitary receptor down-regulation and ovarian suppression, a function that has made this class of agents useful for the treatment of endometriosis. Recent work has also revealed that this class of agents may also have a direct suppressive effect on peripheral target tissue, mediated by GnRH and GnRH agonist receptors. Preliminary work has suggested that there are GnRH receptors in endometriotic cells and that the growth of these cells is inhibited by GnRH agonists. This activity, however, has not been extensively studied in the growth of endometrioma cells. The present study evaluated the effect of the GnRH agonist leuprolide on 15 endometrioma cell lines.
Bioethics. 2007 Jun;21(5):263-9.
What motivates women to take part in clinical and basic science endometriosis research?
Department of Reproductive Medicine, UCSD School of Medicine, Basic Science Building #5040, 9500 Gilman Drive, La Jolla, California 92093-0633, USA. email@example.com
BACKGROUND: The objective of this study was to identify factors motivating women to take part in endometriosis research and to determine if these factors differ for women participating in clinical versus basic science studies. METHODS: A consecutive series of 24 women volunteering for participation in endometriosis-related research were asked to indicate, in their own words, why they chose to volunteer. In addition, the women were asked to rate, on a scale of 0 to 10, sixteen potentially motivating factors. The information was gathered in the form of an anonymous self-administered questionnaire. RESULTS: Strong motivating factors (mean score > 8) included potential benefit to other women’s health, improvement to one’s own condition, and participation in scientific advancement. Weak motivating factors (mean score < 3) included financial compensation, making one’s doctor happy, and use of ‘natural’ products. No difference was detected between clinical and basic science study participants. CONCLUSION: This study is the first study to specifically investigate the factors that motivate women to take part in endometriosis research. Understanding why women choose to take part in such research is important to the integrity of the informed consent process. The factors most strongly motivating women to participate in endometriosis research related to improving personal or public health; the weakest, to financial compensation and pleasing the doctor.
J Obstet Gynaecol Res. 2007 Oct;33(5):671-6.
Impact of laparoscopic cystectomy on fecundity of infertility patients with ovarian endometrioma.
Division of Reproductive Medicine, Department of Perinatal Medicine and Maternal Care, National Center for Child Health and Development, Tokyo, Japan. firstname.lastname@example.org
AIM: To clarify the effect of laparoscopic cystectomy for ovarian endometrioma in infertility patients, the pregnancy outcome was evaluated. METHODS: This was a retrospective study. From August 2002 to February 2006, 33 infertility patients with ovarian endometrioma underwent laparoscopic cystectomy at our center. According to the laparoscopic findings 33 were divided into two groups; 10 were evaluated as the patients who need assisted reproductive technologies (ART) treatment (IVF subgroup) and 23 were evaluated as the patients who do not need ART treatment but conventional infertility treatment (non-IVF subgroup). During the same period, 70 patients who were age-matched and received ART treatment without laparoscopy were defined as control (control group). Following up to 12 months after laparoscopy, the cumulative pregnancy rate in the non-IVF subgroup was calculated. RESULTS: The patients age, duration of infertility and size of endometrioma were equal in the IVF and the non-IVF subgroups. The revised-American Society of Reproductive Medicine (r-ASRM) score in the IVF subgroup was significantly higher than that in the non-IVF group (P < 0.05). The pregnancy rates after laparoscopic cystectomy in IVF and non-IVF subgroups were 50.0% and 60.9%, respectively. These rates in the IVF and the non-IVF groups were slightly higher than that in control group (41.4%), but these differences were not significant. The cumulative pregnancy rate in the non-IVF group reached 52.2%, 12 months after laparoscopic surgery. CONCLUSIONS: Laparoscopic surgery should be performed prior to ART treatment not only for making a decision about the treatment course but also for establishing a good pelvic condition to induce a pregnancy during ART treatment in infertility treatment with ovarian endometrioma.
J Obstet Gynaecol Res. 2007 Oct;33(5):665-70.
Laparoscopy should be strongly considered for women with unexplained infertility.
Division of Reproductive Medicine, Department of Perinatal Medicine and Maternal Care, National Center for Child Health and Development, Tokyo, Japan. email@example.com
AIM: Women with unexplained infertility frequently become pregnant after diagnostic laparoscopy. In this study the effect of laparoscopic surgery on such women was evaluated by the pregnancy rate after laparoscopic surgery. METHODS: A total of 47 unexplained infertile women underwent laparoscopic evaluation during the period August 2002 to January 2005 in our center. The percentage of positive laparoscopic findings and the pregnancy rate after laparoscopy were calculated. The patients were divided into 5 subgroups according to maternal age, pregnancy rates were calculated for each group, and compared with the outcome of assisted reproductive technology (ART) treatment for the same age groups. RESULTS: In 87.2% of the women, laparoscopy revealed abnormal findings; endometriosis lesions, peritubal adhesions and tubal obstructions were found in 21, 17 and 3 cases, respectively. After laparoscopy 23 achieved pregnancy (pregnancy rate: 48.9%). The pregnancy rates of the groups at the age of 25 years old or less, 26-30, 31-35, 36-40 and over 41 years old were 100%, 75.0%, 45.5%, 27.2% and 0%, respectively. In the case of the 26-30 years old group, the pregnancy rate after laparoscopy was significantly higher than that in the ART treatment group (33.3%, P < 0.05). CONCLUSIONS: Laparoscopy should be strongly considered for examining women with unexplained infertility.
Am J Reprod Immunol. 2007 Oct;58(4):330-43.
Gene expression profiling of the rat endometriosis model.
Department of Gynecology, Omiya Medical Center Jichi Medical University, Amanuma-cho, Omiya, Saitama, Japan. firstname.lastname@example.org
PROBLEM: To investigate the molecular mechanism of endometriosis, gene expression profiling was analyzed in a rat endometriosis model. METHOD OF STUDY: An endometriosis model was induced by uterine autotransplantation in the peritoneal cavity on a female-SD rat (8 weeks old). As control samples, the normal uterine tissues were used. The gene expression was compared between endometriotic lesions and normal uterine tissues by cDNA microarray analysis, quantitative real time RT-PCR and immunohistochemistry. RESULTS: The expression of 71 genes was upregulated and that of 45 genes was downregulated in the endometriotic lesions compared to normal uterine tissues. The upregulated genes included genes encoding cytokines, chemokines, growth factors and cell adhesion molecules. The levels of transcripts of osteopontin, Lyn, Vav1, Runx1, and l-selectin in the endometriotic lesions were 130, 10, 10, 12 and 46-fold higher than the respective levels in the eutopic endometrial samples. CONCLUSION: The results suggest that osteopontin, Lyn, Vav1, Runx1, and l-selectin play important roles in the pathogenesis of endometriosis.
Orv Hetil. 2007 Sep 16;148(37):1745-50.
[Environmental dioxin compounds as the cause of endometriosis and other diseases][Article in Hungarian]
Országos Gyógyintézeti Központ, Nogyógyászati Osztály, Budapest. email@example.com
There has been much debate of late about whether or not dioxin, an industrial toxin, could be a causative agent in the onset of endometriosis, a gynaecological disease associated with infertility and pain. Studies found either no difference in serum dioxin concentrations when cases were compared to controls or a non-significant increase, or reached low statistical power. The introductory results on Rhesus monkey contradict with the observations on mice fed with dioxin and oestrogen simultaneously. Genetic comparison shows that human belongs to the dioxin resistant races so dioxin concentrations measured in the population could not cause disease especially not an oestrogen dependent one, like endometriosis.
Colorectal Dis. 2007 Sep;9(7):665.
Persistent vaginal discharge after proctocolectomy for ulcerative colitis.