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J Gynecol Obstet Biol Reprod (Paris). 2007 Dec;36(8):749-55.

[The role and value of optical coherence tomography in gynecology]

[Article in French]

Ascencio M, Collinet P, Cosson M, Mordon S.

Clinique de gynécologie, hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59037 Lille cedex, France.

Optical coherence tomography is one of the most important technological progress of the last ten years in the field of medical imaging. It is similar to ultrasound imaging except that it uses properties of light instead of ultrasound. Optical coherence tomography provides images of tissue structure, and at a cellular level, in situ, in real time, with much better spatial resolution than ultrasound and without removal of tissue (optical biopsy). Using optical coherence tomography in combination with catheters or endoscopes may enable the imaging of internal organs as the cervix, the uterine tissue and the ovary. The use of optical coherence tomography in the gynecological field is still experimental and is mainly about the in vitro and in vivo diagnosis of cervical dysplasia, cervical cancer, ovary cancer, endometrial cancer and endometriosis. We aim to present the principles of optical coherence tomography and to expose the main ways of research and the future and potential clinical applications of this technique in gynecology.

 

Ultrasound Q. 2007 Sep;23(3):189-91.

[Müllerian adenosarcoma of the ovary: case report and review of the literature.]

Shetty M, Lal N, Vu NH.

Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Müllerian adenosarcoma is a rare neoplasm that can arise in both uterine and extrauterine locations. This report describes the ultrasound and magnetic resonance imaging findings of one case of ovarian adenosarcoma and reviews the literature as to the previously described imaging findings. Adenosarcoma should be considered in patients with a predominantly solid pelvic mass on imaging, particularly in those with a history of endometriosis or findings compatible with endometriosis on ultrasound or magnetic resonance imaging. A very low resistive index on ultrasound may also be suggestive of this diagnosis.

 

Reprod Toxicol. 2007 Aug-Sep;24(2):253-8. Epub 2007 Jul 27.

[Long-term adverse effects of neonatal exposure to bisphenol A on the murine female reproductive tract.]

Newbold RR, Jefferson WN, Padilla-Banks E.

Developmental Endocrinology and Endocrine Disruptor Section, Laboratory of Molecular Toxicology, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC 27709, USA. newbold1@niehs.nih.gov

The developing fetus is uniquely sensitive to perturbation by chemicals with hormone-like activity. The adverse effects of prenatal diethylstilbestrol (DES) exposure are a classic example. Since concern has been mounting regarding the human health and environmental effects of bisphenol A (BPA), a high-production-volume chemical with estrogenic activity used in the synthesis of plastics, we investigated its long-term effects in an experimental animal model that was previously shown useful in studying the adverse effects of developmental exposure to DES. Outbred female CD-1 mice were treated on days 1-5 with subcutaneous injections of BPA (10, 100 or 1000 microg/kg/day) dissolved in corn oil or corn oil alone (Control). At 18 months, ovaries and reproductive tract tissues were examined. There was a statistically significant increase in cystic ovaries and cystic endometrial hyperplasia (CEH) in the BPA-100 group as compared to Controls. Progressive proliferative lesion (PPL) of the oviduct and cystic mesonephric (Wolffian) duct remnants were also seen in all of the BPA groups. More severe pathologies of the uterus following neonatal BPA treatment included adenomyosis, leiomyomas, atypical hyperplasia, and stromal polyps. These data suggest that BPA causes long-term adverse effects if exposure occurs during critical periods of differentiation.

 

Cir Esp. 2007 Aug;82(2):122-4.

[Ileal endometriosis and Crohn’s disease. A difficult differential diagnosis]

[Article in Spanish]

López PA, Martín L, Vicente M, Girón O, del Pozo M.

Servicio de Cirugía General y Aparato Digestivo II, Hospital Universitario Virgen de la Arrixaca, El Palmar, B.30007 Murcia, Spain. peterangel@ono.com

Endometriosis is an endometrial tissue proliferation that occurs in any extrauterine site and is usually confined to the pelvis. When the terminal ileum is affected, this entity can simulate Crohn’s disease both clinically and radiologically. We describe 2 patients previously diagnosed with Crohn’s disease with inadequate response to treatment, who showed intestinal obstruction located in the ileum. One patient had an enterocutaneous fistula, which is extremely unusual. In both patients intestinal endometriosis was diagnosed after histopathologic assessment. Although complex, the differential diagnosis between endometriosis and Crohn’s disease should be kept in mind since the prognosis and treatment of these 2 entities differ.

 

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2007 Aug;32(4):656-9.

[Effect of gene polymorphism of TNF-beta on the concentration of TNF in serum of patient with endometriosis]

[Article in Chinese]

Luo M, Shen DX, Zhang HB, Wang J, Zong LL, Guan T, He YL.

Department of Obstetrics and Gynecology, General Hospital of Guangzhou Military Area Command, Guangzhou 510010, China.

OBJECTIVE: To determine the polymorphism in +252 site of tumor necrosis factor-beta(TNF-beta) gene in patients with or without endometriosis, to evaluate the levels of TNF-alpha and TNF-beta in the serum with or without endometriosis, to explore the relation between polymorphism of TNF-beta gene and the genetic susceptibility of endometriosis, and to explore the pathogenic mechanism of endometriosis at gene level. METHODS: By polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, polymorphism on +252 site of TNF-beta gene was measured in 82 patients with endometriosis (the endometriosis group) and 80 patients without endometriosis (the control group). With the sandwich-enzyme-linked immunosorbent assay (ELISA), the levels of TNF-alpha and TNF-beta in the serum of the two groups were determined. RESULTS: The TNF-beta level in the serum in the endometriosis group with TNF-beta gene +252 site AA genotype significantly increased, compared with GG genotype (t=2.029, P<0.05); while TNF-alpha and TNF-beta level in the serum had no statistical significance in patients with other genotypes in TNF-beta gene +252 site in the endometriosis group and the control group. CONCLUSION: TNF-beta gene +252 site AA genotype might be enhance TNF-beta level in the serum of patients with endometriosis.

 

Mol Hum Reprod. 2007 Nov;13(11):797-806. Epub 2007 Aug 31.

[The expression profile of micro-RNA in endometrium and endometriosis and the influence of ovarian steroids on their expression.]

Pan Q, Luo X, Toloubeydokhti T, Chegini N.

Department of Obstetrics/Gynecology, University of Florida, Box 100294, Gainesville, FL 32610, USA.

MicroRNAs (miRNAs), through mRNA degradation or repression, act as key regulator of gene expression. Our aim was to identify specific miRNAs that are expressed in endometrium of women with and without endometriosis. We profiled the expression of 287 miRNAs in paired eutopic and ectopic endometrium and isolated endometrial cells using microarray and validated the expression of selected miRNAs using real-time PCR. On the basis of global normalization, 65 of these miRNAs were identified to be expressed above the threshold levels set during the analysis in the endometrium of women without endometriosis with a progressive decline in expression in paired eutopic and ectopic endometrium. Statistical analysis (ANOVA) identified 48 of these miRNAs as differentially expressed among these tissues and 32 miRNAs between isolated endometrial stromal cell (ESC) and glandular epithelial cell (GEC) (P < 0.05). The expression of hsa-miR20a, hsa-miR21, hsa-miR26a, hsa-miR18a, hsa-miR206, hsa-miR181a and hsa-miR142-5p, predicted to target many genes, including TGF-betaR2, ERalpha, ERbeta and PR, respectively, was validated in these tissues and cells using real-time PCR. Treatment of ESC and GEC with 17beta-estradiol and medroxyprogesterone acetate (10(-8) M) differentially regulated the expression of hsa-miR20a, hsa-miR21 and hsa-miR26a, which in part reversed following co-treatment with ICI-182780 and RU-486 (10(-6) M), respectively (P < 0.05). In conclusion, we provided evidence for the expression of a number of differentially expressed miRNAs in eutopic/ectopic endometrium and isolated endometrial cells, opening up the possibility that aberrant/altered expression of some miRNAs whose expression is regulated by the ovarian steroids may influence the expression of specific target genes with central roles in normal endometrial cellular activities and pathogenesis of endometriosis.

 

Eur Respir J. 2007 Sep;30(3):594-7.

[A common presentation with a rare cause.]

Cutz JC, Woods JS, Mitchell JH, Colby TV, Leslie KO.

Department of Pathology, Mayo Clinic Scottsdale, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.

 

Obstet Gynecol. 2007 Sep;110(3):594-600.

[Plasma urocortin levels in the diagnosis of ovarian endometriosis.]

Florio P, Reis FM, Torres PB, Calonaci F, Toti P, Bocchi C, Linton EA, Petraglia F.

Department of Pediatrics, Obstetrics and Reproductive Medicine, Section of Obstetrics and Gynecology, University of Siena, Siena, Italy. florio@unisi.it

OBJECTIVE: Urocortin is a neuropeptide, member of the corticotropin-releasing hormone family, that is produced by the human endometrium. Ovarian endometrioma is a prevalent gynecologic disorder still lacking specific serum markers. In the present study we measured systemic levels of urocortin to assess the diagnostic performance of its determination in distinguishing endometriomas from other benign ovarian cysts. METHODS: Plasma urocortin was measured by radioimmunoassay in women with ovarian endometrioma (n=40) and in women with benign, nonendometriotic ovarian cysts (n=40). The diagnostic accuracy of urocortin measurement was evaluated by receiver operating characteristic curve and compared with the standard marker, CA 125. To support the local origin of the peptide, we also evaluated its localization in endometriomas by immunohistochemistry and its concentrations in cyst fluid and peritoneal fluid of 12 women with endometrioma. RESULTS: Plasma urocortin levels were twice as high in women with endometrioma (median 49 pg/mL, interquartile range 41-63 pg/mL) than in the control group (19 [15-23] pg/mL, P<.001) and significantly higher in the cystic content of endometriomas than in the peritoneal fluid and plasma (P<.05). The peptide was immunolocalized in endometrioma glands and stromal capillary vessels. Elevated plasma urocortin levels detected 88% of the cases of endometrioma with 90% specificity, whereas CA 125 detected only 65% of the cases with the same specificity. CONCLUSION: Plasma urocortin is increased in women with endometriomas, and its measurement may be useful for the differential diagnosis of endometrioma compared with other benign ovarian cysts. LEVEL OF EVIDENCE: II.

 

Eur J Contracept Reprod Health Care. 2007 Sep;12(3):194-202.

[Pathogenesis of endometriosis: the role of defective ‘immunosurveillance’.]

Christodoulakos G, Augoulea A, Lambrinoudaki I, Sioulas V, Creatsas G.

2nd Department of Obstetrics and Gynaecology, University of Athens, Aretaieion Hospital, Athens, Greece.

OBJECTIVE: To analyse the aetiopathogenesis and the role of defective ‘immunosurveillance’ in endometriosis. METHOD: Review of studies on the pathogenesis of endometriosis, focusing particularly on novel molecules which express adhesive or proteolytic properties. Hypotheses addressing the role of oxidative stress in endometriosis were also reviewed. RESULTS: Endometriosis is a multifactorial disease associated with a general inflammatory response aiming to clear the peritoneal cavity from the ectopic endometriotic cells and tissue. Modern theories suggest that this inflammatory response creates an environment that may promote implantation and proliferation due to defective ‘immunosurveillance’. CONCLUSION: The modern interpretation of the theory of reflux menstruation holds that women destined to develop endometriosis have a deficient immune system, which cannot defend against regurgitated endometrial cells. New findings on genetics, immune modulation, and secreted products of endometriotic lesions of affected women have given insight into the pathogenesis of this disorder and may serve as the background for new treatments of endometriosis-associated pain and infertility.

 

Pain. 2007 Nov;132 Suppl 1:S22-5. Epub 2007 Aug 29.

[Pain and endometriosis.]

Evans S, Moalem-Taylor G, Tracey DJ.

Endometriosis Care Centres Australia, Adelaide, SA 5067, Australia.

 

JSLS. 2007 Apr-Jun;11(2):182-9.

[Patients with chronic pelvic pain: endometriosis or interstitial cystitis/painful bladder syndrome?]

Butrick CW.

The Urogynecology Center, Overland Park, Kansas 66215, USA. CButrick@aol.com

BACKGROUND: Endometriosis and interstitial cystitis/painful bladder syndrome share similar symptoms. Interstitial cystitis was once considered rare, but it is now recognized as more common than previously thought. This review examines evidence that patients presenting with symptoms typically attributed to endometriosis or with unresolved pelvic pain after treatment for endometriosis may, in fact, have interstitial cystitis, and suggests approaches for appropriate diagnosis. METHODS: A MedLine search using “chronic pelvic pain,” “endometriosis,” “interstitial cystitis,” and “bladder origin pain” as key words was performed for the most recent English-language articles. Additional references were obtained through cross-referencing the bibliography cited in each publication. DISCUSSION: The symptoms of endometriosis and interstitial cystitis frequently overlap, and these 2 conditions may even coexist in the same patient. In cases of unresolved endometriosis and persistent pelvic pain, patients may have interstitial cystitis. A variety of tools are available to aid in identifying interstitial cystitis. CONCLUSION: Gynecologists should be alert to the possible presence of interstitial cystitis in patients who present with chronic pelvic pain typical of endometriosis.

 

JSLS. 2007 Apr-Jun;11(2):175-81.

[The relationship between interstitial cystitis and endometriosis in patients with chronic pelvic pain.]

Paulson JD, Delgado M.

Washington Area Reproductive and Urogynecology Services, Reston, Virginia, USA. endodoc11@aol.com

OBJECTIVE: This study was designed to determine the relationship between interstitial cystitis (IC), endometriosis (endo), and chronic pelvic pain (CPP) in individuals in whom nongynecological and nonurological problems had been previously ruled out. METHODS: A prospective study of 162 consecutive women with a complaint of chronic pelvic pain seen in the clinic was performed between August 2002 and December 2005. These patients underwent a workup to exclude other causes of pelvic pain, had PUF (Pain Urgency and Frequency) questionnaires filled out, and underwent a laparoscopy and a cystoscopy with hydrodistention. Pain levels were determined, and treatment was reviewed and enumerated. Results were obtained and quantified. RESULTS: In this study, 123 (76%) patients were diagnosed with active endometriosis, 133 (82%) were diagnosed with interstitial cystitis, and 107 (66%) had both disease entities simultaneously. Thirteen (8%) patients were diagnosed with pathologies unrelated to endometriosis and interstitial cystitis. Pain levels were seen to decrease at 6 months in all groups of patients with the exception of those patients with endometriosis only. CONCLUSION: CPP is a difficult, taxing, and frustrating concern for many women in the United States. These individuals have traditionally been difficult to treat. A large number of women with CPP in our patient population have been shown to have endometriosis, interstitial cystitis, or both. Therefore, a workup for premenopausal individuals with CPP involves obtaining a history that keys into possible nongynecologic causes of pain, a complete accounting of urinary problems, and a thorough history of gynecological problems. A physical examination with a comprehensive history should be performed, and the investigation may include the possibility of a simultaneous laparoscopy and cystoscopy if warranted. These procedures can serve as both a means for diagnosis and treatment of these problems when encountered.

 

Singapore Med J. 2007 Sep;48(9):e240-2.

Abdominal cocoon associated with endometriosis.

Santos VM, Barbosa ER Jr, Lima SH, Porto AS.

Department of Internal Medicine, Catholic University Medical Course, Armed Forces Hospital, Estrada do Contorno do Bosque s/n, Brasilia DF, Brazil. vitorinomodesto@gmail.com

Abdominal cocoon is a rare cause of intestinal obstruction in adults. Diagnosis is usually established at laparotomy in patients with recurrent attacks of non-strangulating small bowel obstruction. A 40-year-old infertile Brazilian woman with intestinal obstruction and massive haemoserous ascites, due to coexistent ovarian endometriosis and abdominal cocoon, is reported. Abdominal pain, nausea, vomiting and a palpable mass, in addition to imaging of small bowel obstruction and thickened peritoneum, raised diagnostic suspicion. Higher awareness allows for early diagnoses and yields better results during management.

 

Lupus. 2007;16(9):736-40.

Prevalence of endometriosis in women with systemic lupus erythematosus and Sjogren’s syndrome.

Matorras R, Ocerin I, Unamuno M, Nieto A, Peiró E, Burgos J, Expósito A.

Department of Obstetrics and Gynecology, Hospital de Cruces, País Vasco University, Baracaldo, Vizcaya, Spain. rmatorras@hcru.osakidetza.net

Endometriosis is associated with a number of immunologic alterations. It has been suggested that autoimmune disorders could be more frequent in patients with endometriosis. The aim of this study is to ascertain whether the prevalence of two well-known autoimmune diseases [systemic lupus erythematosus (SLE) and Sjögren’s syndrome (SS)] is increased in women with endometriosis. The clinical charts of four different populations assisted at the same hospital were manually revised: (i) SLE population (n = 120), (ii) SS (n = 22), (iii) endometriosis (n = 342) and (iv) control population (n = 501 consecutive unselected asymptomatic women). Among SLE women, the prevalence of endometriosis was 1.67% (2/120), similar to the 4.39% prevalence of the control group (22/501), the OR being 0.37 [95%CI 0.09-1.59]. Among SS women, the prevalence of endometriosis was 9.09 (2/22), also similar to the control group OR 2.17 [95%CI 0.48-9.90]. In the same way, when comparing endometriosis cases with asymptomatic women, similar frequencies of SLE (0.58% and 0.2%) and SS were found (0% and 0%). Women with endometriosis do not have an increased prevalence of SLE or SS.

 

Lancet Oncol. 2007 Aug;8(8):675.

Nulliparity does not equal cancer.

Siva N.

 

Rev Med Liege. 2007 May-Jun;62(5-6):414-22.

[Therapeutic progress in gynecology: organic diseases]

[Article in French]

Herman P, Lifrange E, Nisolle M, Kridelka F, Nervo P, Gaspard U.

Service de Gynécologie CHU Sart Tilman, Liège, Belgique.

Over the last ten years, progress in evidence-based medicine coupled with technological and surgical breakthroughs have deeply changed the management of our patients. Uterine bleeding is the first cause of gynaecological consultation and the intrauterine progestin delivery system as well as new hysteroscopic procedures have optimized the therapeutic approach to this problem. Introduction of magnetic resonance imaging and interventional procedures have improved breast disease diagnosis and management; likewise sentinel node localization, introduction of aromatase and growth factors inhibitors, new radiotherapy procedures and pharmacogenomics, have helped to ameliorate breast cancer treatment. Pelvic surgery has been switching more and more towards laparoscopic procedures not only in the field of benign lesions (eg endometriosis), of surgery of prolapse and incontinence with new prosthetic materials, but also for an improved management of gynaecological cancers.

 

World J Gastroenterol. 2007 Sep 7;13(33):4517-9.

Gallbladder endometriosis as a cause of occult bleeding.

Saadat-Gilani K, Bechmann L, Frilling A, Gerken G, Canbay A.

Department of Medicine, Division of Gastroenterology and Hepatology, University of Essen, Hufelandstr 55D-45122, Essen, Germany.

A 17-year-old girl with colicky abdominal pain and chronic anemia presented to the gastrointestinal service of the University Hospital of Essen. In the routine workup, there were no pathological findings despite the anemia. Because of the fluctuation of symptoms with a climax at the time of menstruation, consecutive ultrasound studies were performed revealing a visible mass inside the gallbladder. This finding was confirmed by a magnetic resonance imaging (MRI) study performed at the same time. Because of the severe anemia by that time, a cholecystectomy was performed, and histology reconfirmed the diagnosis of isolated gallbladder endometriosis. The patient recovered well and has had no recurrence of the disease to date.

 

Arkh Patol. 2007 May-Jun;69(3):56-60. Links

[Molecular biological aspects of the pathogenesis of adenomyosis]

Voloshchuk IN, Romadanova IuA, Ishchenko AI, Bakhvalova AA.

The review of literature concerns some aspects of the pathogenesis of adenomyosis in terms of occurring molecular biological processes. It pools the literature data on endometrial capacity to be plunged into the deep myometrial layers–the expression of adhesive molecules, endometrial proteolytic activity, angiogenetic factors, and apoptosis-proliferation relationships. Evidence for the metaplastic theory of the disease is also presented. Emphasis is laid on the characteristics of a subendometrial zone whose pathology plays an important role in adenomyosis.

 

Acta Derm Venereol. 2007;87(5):428-9.

Diagnosis and treatment of post-Caesarean scar endometriosis.

Neri I, Tabanelli M, Dika E, Valeria G, Patrizi A.

 

Hum Reprod. 2007 Oct;22(10):2693-7. Epub 2007 Aug 24.

Thyroid autoimmunity and thyroid dysfunction in women with endometriosis.

Petta CA, Arruda MS, Zantut-Wittmann DE, Benetti-Pinto CL.

Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), Caixa Postal 6181, 13084-971 Campinas, Brazil. cpetta@attglobal.net

BACKGROUND: Women with endometriosis may have higher rates of autoimmune disorders, including hypothyroidism. The objective of this study was to compare the prevalence of thyroid dysfunction and autoimmune thyroid disease (AITD) between women with endometriosis and a control group. METHODS: This was a cross-sectional study carried out in 148 women with surgically confirmed endometriosis and 158 controls. The mean age of the study group was 34.6 (7.1 SD) years (range 21-42) and 32.1 (7.7 SD) years (range 18-44) for controls. Serum levels of thyroid-stimulating hormone, free thyroxine and the anti-thyroperoxidase and anti-thyroglobulin antibodies were evaluated. RESULTS: Thyroid disorders were identified in 20.9% of the endometriosis group and 26.5% of the control group (P = 0.25). The overall frequency of thyroid dysfunction was 12.2% and 10.8% for the endometriosis and control groups, and the frequency of positive thyroid antibodies, 14.9% and 22.2%, respectively (P = 0.20). Endometriosis stage and infertility history were not associated with thyroid dysfunction and AITD in the study group. CONCLUSIONS: The prevalence of thyroid dysfunction and AITD was similar in the two study groups. Screening for thyroid disturbances in women with endometriosis is not indicated.

 

J Psychosom Res. 2007 Sep;63(3):269-74. Epub 2007 Aug 2.

Hysterectomy and loss of fertility: implications for women’s mental health.

Leppert PC, Legro RS, Kjerulff KH.

Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA.

OBJECTIVE: The objective of this study was to assess the percentage of women scheduled for hysterectomy who would have liked to have had a child or more children and associated factors. METHODS: The study sample included 1140 premenopausal women having hysterectomy for benign indications who were interviewed before and after their surgery over the course of a 2-year follow-up period. The main outcome measures for this study were desire for a (or another) child measured preoperatively; concurrent measures of psychological distress, including anxiety, depression, anger, and confusion, and seeking of professional help for emotional problems; and psychological distress measured 12 and 24 months postoperatively. RESULTS: Of the sample, 10.5% (n=120) answered yes to the question, “Before you were told you needed a hysterectomy, would you have wanted a (or another) child?” As compared with those who did not, those who desired a (another) child were younger; more likely to be nulliparous; waited longer before having surgery; were more likely to have an indication of endometriosis; had higher levels of depression, anxiety, anger, and confusion; and were more than twice as likely to have seen a mental health professional for anxiety or depression in the 3 months before their surgery. These differences in psychological distress persisted over the course of the 2-year follow-up period. CONCLUSIONS: The issue of loss of fertility should be discussed candidly with women considering hysterectomy, and those who express ambivalence, sadness, or regret at the loss of future childbearing options may benefit from further exploration of fertility-sparing treatments.

 

Pol J Pathol. 2007;58(2):99-103.

The pathomorphology of Bartholin’s gland. Analysis of surgical data.

Sośnik H, Sośnik K, Hałoń A.

Department of Pathomorphology, Regional Specialistic Hospital, Wrocław.

Medline data did not reveal any statistical approach to Bartholin’s gland pathomorphological lesions, especially when the social aspect was considered. Objectives. To complete knowledge and data according to this subject on the basis of own surgical material analysis. Microscopic examinations of histopathological 5 microm thick specimens stained with hematoxylin-eosin and in selected cases with histochemical and immunohistochemical methods on 104 Bartholin’s glands taken from 103 female patients in age of 39.4 +/- 9.6. Retention cysts, suppurating lesions (abscesses), extrauterine endometriosis and neoplasms were separated from obtained samples. Localization of lesions, the patients’ age and education status were determined. P < 0.05 was considered as statistically significant. Retention cysts were observed in 84.6% of cases, abscesses in 10.6%, extrauterine endometriosis in 2% and neoplasms in nearly 3% of patients. In 54.1% of cases the lesion was localized on the left side, in 45.9% on the right. 17.2% of female patients presented with university education, 29.9% with elementary education, while 52.9% with secondary education. The average age of operated patients amounted to 33 +/- 9.8 years in case of university education, being significantly lower as compared to the average age of secondary (40.5 +/- 7 years) and elementary (42.4 +/- 12 years) education (p < 0.01 and p < 0.02 respectively). 47.7% of retention cysts demonstrated various degrees of inflammatory infiltration. However, the anatomical variability of the ductal and glandular epithelium was higher in cases of non-inflammatory cysts. Considering three Bartholin’s gland neoplasms, two were diagnosed as adenocarcinomas and one as a fibromyoma. All of them were observed in female patients with a rare blood type (twice Rh-minus and once AB Rh-plus). There was no significant relationship between the type of pathomorfological lesions and age of operated patients, in spite of the fact that the lowest mean age was observed in woman with endometriosis while the highest in those with neoplasms. The pathology of Bartholin’s gland mostly concerns female patients with secondary education. However, early diagnosis is associated with patients with university education. Thus, further investigations considering the statistical analysis of Bartholin’s gland neoplasms in order to determine the possible relationship between blood type antigens and neoplasm development are required.

 

MMW Fortschr Med. 2007 Jun 28;149(27-28):5.

[Nodules in the navel. From time to time comes bloody secretion]

[Article in German]

Sand M, Bechara FG, Mann B.

 

Gynecol Obstet Fertil. 2007 Sep;35(9):898-903. Epub 2007 Aug 21.

[Pathogenesis of endometriosis]

[Article in French]

Nisolle M, Alvarez ML, Colombo M, Foidart JM.

Département de gynécologie-obstétrique, université de Liège, hôpital de la Citadelle, 1, boulevard du 12(e) de Ligne, 4000 Liège, Belgique. michelle.nisolle@chrcitadelle.be

Endometriosis, defined by the development of endometrial tissue outside the uterus, is a benign disease responsible for infertility and pelvic pain. The diagnosis based on a detailed gynecological history and a careful clinical examination should be done as early as possible in order to treat patients correctly. Medical treatment is not appropriate in all cases and surgical treatment should be proposed but morbidity is related to the severity of the lesion. Ectopic implantation of endometrial cells needs complex interactions between host tissue and epithelial endometrial cells. The conditions for the development of endometriosis are estrogeno-dependent growth of endometrial cells, induction of angiogenesis and lymphangiogenesis. Principal cellular and molecular factors of angiogenesis, lymphangiogenesis and fibrosis should be identified in order to develop new therapeutic strategies of endometriosis.

 

Eur J Gynaecol Oncol. 2007;28(4):278-81.

MMAC tumor supressor gene expression in ovarian endometriosis and ovarian adenocarcinoma.

Cirpan T, Aygul S, Terek MC, Kazandi M, Dikmen Y, Zekioglu O, Sagol S.

Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey.

OBJECTIVE: The aim of this study was to investigate the role of MMAC1 protein in the relationship between ovarian endometriosis and clear cell and endometrioid-type ovarian adenocarcinomas. METHODS: A total of 63 subjects who underwent surgery for a pelvic tumoral mass, 30 of whom were diagnosed with grade 1 to 3 ovarian adenocarcinoma and 33 of whom were diagnosed with grade 1 to 4 endometriosis during histopathological examination were included in this study. The mean age for subjects with ovarian endometrioid type adenocarcinoma was 51.8 +/- 12.4, whereas the mean age for subjects with ovarian clear cell type adenocarcinoma was 59.5 +/- 13.7. Ovarian carcinomas were graded in accordance with the FIGO 1989 grading system. The mean age for subjects with endometriosis was 37 +/- 11.9. New sections were obtained from paraffin blocks in the archives of Ege University, School of Medicine, Department of Pathology onto lysinated slides and immunohistochemical staining by using mouse monoclonal antibody (MMAC1, 28H6 clone, Novocastra, UK) as MMAC antibody was applied in order to determine MMAC1 protein. Brown staining on the nucleus was considered as positive immunoreactivity. Immunoreactive staining was evaluated as percentage staining over the whole preparative. RESULTS: Of the 63 subjects included in the immunohistochemical study, ovarian endometrioid adenocarcinoma was identified in 18 subjects, while 12 subjects were diagnosed with ovarian clear cell adenocarcinoma and 33 subjects with ovarian endometriosis. No significant relationships were observed between age and MMAC immune staining in the ovarian endometrioid adenocarcinoma (r = -0.41, p = 0.08) and ovarian endometriosis (r = 0.12, p = 0.50) groups, whereas a significant relationship was observed in the ovarian clear cell adenocarcinoma group (r = 0.631, p = 0.02). No significant relationships were observed between CA125 levels and MMAC immune staining in the ovarian endometrioide adenocarcinoma (r = 0.056, p = 0.82), ovarian endometriosis (r = 0.21, p = 0.36) and ovarian clear cell adenocarcinoma (r = 0.363, p = 0.24) groups. No correlations were observed between endometriosis stages and the MMAC immune staining (r = -0.17, p = 0.92). There was no correlation between mean diameter of endometrioma and MMAC immune staining (r = -0.230, p = 198). Mean endometrioma diameter was 5.7 +/- 3.5 (1-15.5). No correlations were detected between MMAC immune staining and ovarian endometrioide adenocarcinoma or ovarian clear cell adenocarcinoma stage (r = -0.22, p = 0.37; r = 0.44, p = 0.14, respectively). No significant relationships with respect to MMAC immune staining were detected between the endometriosis and ovarian clear cell adenocarcinoma groups (p = 0.05) and between the ovarian clear cell adenocarcinoma and ovarian endometrioid adenocarcinoma groups (p = 0.27). A significant relationship with respect to MMAC immune staining was observed between ovarian endometrioide adenocarcinoma and endometriosis groups (p = 0.001). CONCLUSION: Immunohistochemical determination of MMAC defective protein expressions could be considered for utilization as a new, simple and useful technique in determination of endometriosis patients with increased risk of malignant transformation, patients where early surgical treatment would be necessary and patients that should be subjected to follow-up controls with a higher frequency.

Chin Med J (Engl). 2007 Aug 5;120(15):1381-2.

Terminal ileum perforation: a rare complication of intestinal endometriosis.

Fu CW, Zhu L, Lang JH.

Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.

Reproduction. 2007 Sep;134(3):525-34.

Stable inhibition of interleukin 1 receptor type II in Ishikawa cells augments secretion of matrix metalloproteinases: possible role in endometriosis pathophysiology.

Guay S, Akoum A.

Unité d’Endocrinologie de la Reproduction, Centre de Recherche, Hôpital Saint-François d’Assise, Centre Hospitalier Universitaire de Québec, 10 rue de l’Espinay, Local D0-711, Québec, Canada, G1L 3L5.

Our previous studies showed a marked deficiency in interleukin 1 receptor type II (IL1R2) in the endometrial tissue of women with endometriosis, particularly in epithelial cells. We believe that such a deficiency in IL1R2, a potent and specific IL1 inhibitor, makes endometrial cells more sensitive to IL1 and less capable of buffering the cytokine’s effects, which may lead to functional changes that favor endometriosis development. The main objective of our study was to stably inhibit IL1R2 expression in endometrial cells in order to evaluate the role of IL1R2 deficiency in endometriosis pathophysiology. Stable clones of Ishikawa adenocarcinoma endometrial cells transfected with IL1R2 antisense and showing downregulation of IL1R2 protein expression, or with the empty expression vector alone and showing no noticeable difference in IL1R2 expression, were selected. The downregulation of IL1R2 expression in IL1R2 antisense transfectants when compared with control cells was confirmed by ELISA, Western blot and immunofluorescence. In these cells, IL1R2 expression was markedly reduced, compared with non-transfected cells or cells transfected with the empty vector, and there was a significant increase in the basal and the IL1-beta (IL1B)-induced levels of matrix metalloproteinase (MMP)-2 and MMP-9 secretion. Furthermore, a significant decrease in IL1B-induced secretion of tissue inhibitor of MMPs-1, a known MMP-9 inhibitor, was observed. These in vitro data make plausible a role for IL1R2 deficiency in the capability of endometrial cells to invade the host tissue and develop in ectopic locations.

J Immunol. 2007 Sep 1;179(5):3012-25.

Sensitive and specific real-time polymerase chain reaction assays to accurately determine copy number variations (CNVs) of human complement C4A, C4B, C4-long, C4-short, and RCCX modules: elucidation of C4 CNVs in 50 consanguineous subjects with defined HLA genotypes.

Wu YL, Savelli SL, Yang Y, Zhou B, Rovin BH, Birmingham DJ, Nagaraja HN, Hebert LA, Yu CY.

Center for Molecular and Human Genetics, Columbus Children’s Research Institute, 700 Children’s Drive, Columbus, OH 43205, USA.

Recent comparative genome hybridization studies revealed that hundreds to thousands of human genomic loci can have interindividual copy number variations (CNVs). One of such CNV loci in the HLA codes for the immune effector protein complement component C4. Sensitive, specific, and accurate assays to interrogate the C4 CNV and its associated polymorphisms by using submicrogram quantities of genomic DNA are needed for high throughput epidemiologic studies of C4 CNVs in autoimmune, infectious, and neurological diseases. Quantitative real-time PCR (qPCR) assays were developed using TaqMan chemistry and based on sequences specific for C4A and C4B genes, structural characteristics corresponding to the long and short forms of C4 genes, and the breakpoint region of RP-C4-CYP21-TNX (RCCX) modular duplication. Assignments for gene copy numbers were achieved by relative standard curve methods using cloned C4 genomic DNA covering 6 logs of DNA concentrations for calibrations. The accuracies of test results were cross-confirmed internally in each sample, as the sum of C4A plus C4B equals to the sum of C4L plus C4S or the total copy number of RCCX modules. These qPCR assays were applied to determine C4 CNVs from samples of 50 consanguineous subjects who were mostly homozygous in HLA genotypes. The results revealed eight HLA haplotypes with single C4 genes in monomodular RCCX that are associated with multiple autoimmune and infectious diseases and 32 bimodular, 4 trimodular, and one quadrimodular RCCX. These C4 qPCR assays are proven to be robust, sensitive, and reliable, as they have contributed to the elucidation of C4 CNVs in >1000 human samples with autoimmune and neurological diseases.

Contraception. 2007 Sep;76(3):195-9. Epub 2007 Jul 27.

Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging.

Bragheto AM, Caserta N, Bahamondes L, Petta CA.

Human Reproduction Unit, Department of Obstetrics and Gynecology, Campinas, 13084-971 SP, Brazil.

BACKGROUND: This study was conducted to evaluate the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on adenomyotic lesions diagnosed and monitored by magnetic resonance imaging (MRI). STUDY DESIGN: LNG-IUS was inserted during menstrual bleeding in 29 women, 24 to 46 years of age, with MRI-diagnosed adenomyosis associated with menorrhagia and dysmenorrhea. Clinical evaluations were carried out at baseline and at 3 and 6 months postinsertion. MRI was performed at baseline and at 6 months postinsertion and was used to calculate junctional zone thickness (in mm), to define the junctional zone borders, to identify the presence of high-signal foci on T(2)-weighted images and to calculate uterine volume (in mL). RESULTS: A significant reduction of 24.2% in junctional zone thickness was observed (p<.0001); however, no significant decrease in uterine volume was observed (142.6 mL vs. 136.4 mL; p=.2077) between baseline and the 6-month evaluation. A significant decrease in pain score was observed at 3 and 6 months after insertion (p<.0001); however, six women continued to report pain scores >3 at 6 months of observation. At 3 months of use, the most common bleeding pattern was spotting, and at 6 months of observation, oligomenorrhea was the most common pattern observed, although spotting was present in one third of the women. CONCLUSIONS: The insertion of an LNG-IUS led to a reduction in pain and abnormal bleeding associated with adenomyosis. MRI was useful for monitoring response of adenomyotic lesions to the LNG-IUS.

Hum Pathol. 2007 Nov;38(11):1676-87. Epub 2007 Aug 17.

Up-regulation of CXC chemokines and their receptors: implications for proinflammatory microenvironments of ovarian carcinomas and endometriosis.

Furuya M, Suyama T, Usui H, Kasuya Y, Nishiyama M, Tanaka N, Ishiwata I, Nagai Y, Shozu M, Kimura S.

Department of Molecular Pathology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan. furuya@faculty.chiba-u.jp

Molecular abnormalities in the epithelial cells of endometriosis and their relevance to carcinogenesis of the ovary have been well studied. On the other hand, the differences of proinflammatory microenvironments between endometriosis and ovarian carcinomas have not been well documented yet. In this study, the expression patterns of CXC chemokines (IL-8, ENA-78, GRO-alpha, I-TAC, Mig, and SDF-1) and their receptors (CXCR2, CXCR3, and CXCR4) were compared among 12 ovarian carcinomas, 8 endometriosis, and 6 normal ovaries using quantitative reverse transcriptase polymerase chain reaction and immunohistochemistry. The CXCR3-mediated signaling in ovarian carcinoma cells in vitro was also investigated. In quantitative reverse transcriptase polymerase chain reaction, ENA-78 was up-regulated both in endometriosis and carcinomas, whereas I-TAC was detected exclusively in carcinomas. CXCR3 was up-regulated both in carcinomas and endometriosis. However, immunohistochemical studies revealed that the localization of CXCR3 in carcinomas was distinctively different from that in endometriosis. In carcinoma-endometriosis coexisting cases, CXCR3-positive lymphocytes in benign lesions decreased in proportion as CXCR3-positive tumor cells replaced the tissues. CXCR3 was also detected in ovarian carcinoma cell lines in vitro. Administration of interferon gamma (IFN-gamma)-inducible chemokines induced extracellular signal-regulated kinase phosphorylation in these carcinoma cells. The results indicated that CXC chemokines might contribute to the progression of ovarian carcinomas and endometriosis in different manners. Aberrant expression of IFN-gamma-inducible chemokines and CXCR3 in carcinoma cells in association with reduced CXCR3-positive immune cells raised the possibility that IFN-gamma-inducible chemokines might not exert effective antitumor immune responses but that they might work in favor of tumor progression.

Acad Radiol. 2007 Sep;14(9):1050-7.

Functional imaging of estrogen receptors with radiolabeled-GAP-EDL in rabbit endometriosis model.

Takahashi N, Yang DJ, Kurihara H, Borne A, Kohanim S, Oh CS, Mawlawi O, Kim EE.

Division of Diagnostic Imaging, Box 57, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.

RATIONALE AND OBJECTIVES: Endometriosis is a common women’s health problem. Animal models provide an invaluable tool to study the natural history of endometriosis. We previously have reported that (99m)Tc-labeled glutamate peptide-estradiol ((99m)Tc-GAP-EDL) is a useful agent for imaging functional estrogen receptor (ER) via an ER-mediated process. This study was to evaluate the feasibility of using radiolabeled GAP-EDL to image ER-positive (ER +) endometriosis in nonprimate animal models. MATERIALS AND METHODS: 3-Aminoethyl estradiol (EDL) was conjugated to glutamate peptide (GAP) to yield GAP-EDL. In vitro cellular uptake studies of (99m)Tc and (68)Ga-GAP-EDL inhibition with cold estrone were conducted in 13,762 rat mammary tumor cells. To create a rabbit model with endometriosis, part of uterine tissue was dissected and grafted in the peritoneal wall. Eight weeks after surgery, scintigraphic images were obtained after intravenous injection of (99m)Tc-GAP-EDL (1 mCi/rabbit, intravenous) at 0.5-2.0 hours, and (68)Ga-GAP-EDL at 45 minutes. We also performed (68)Ga-GAP-EDL blocking study in rabbit model by using tamoxifen. The rabbits were sacrificed and the grafts were excised for histologic examination. RESULTS: In vitro uptake study of (99m)Tc- and (68)Ga-GAP-EDL in 13,762 rat breast cancer cells showed gradually increasing uptake of both tracers. Accumulation of (68)Ga-GAP-EDL in 13,762 cells was inhibited with cold estrone in a dose-dependent manner. In the endometriosis model, the grafted uterine tissue could be visualized by (99m)Tc-GAP-EDL. Necropsy was performed at 2.5 hours after injection time. Four follicular endometrial lesions in eight implanted endometrial tissues were detected, and all lesions could be detected by (99m)Tc-GAP-EDL. Planar scintigraphy of uterus, ovary and implants of necropsy specimen revealed an increased uptake of (99m)Tc-GAP-EDL in comparison with surrounding abdominal wall tissue. Microscopic examinations support that (99m)Tc-GAP-EDL was accumulated in the microinvasive endometrial tissue. After blocking with tamoxifen, (68)Ga-GAP-EDL accumulation in the endometrial grafts could not be visualized, and endometrial tissue-to-normal tissue count ratios were statistically higher in a nonblocked image than that in the blocked image. CONCLUSIONS: Endometriosis uptake of radiolabeled GAP-EDL was via an estrogen receptor-mediated process. Radiolabeled-GAP-EDLs are useful agents for imaging endometriosis.

Obstet Gynecol Surv. 2007 Sep;62(9):616-28.

Endometriosis and genetic polymorphisms.

Falconer H, D’Hooghe T, Fried G.

Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.

Endometriosis is a benign gynecological disease with an unclear pathophysiology characterized by ectopic endometrium causing endometrium-like inflammatory lesions outside the uterine cavity. Recently, a number of studies have investigated genetic polymorphisms as a possible factor contributing to the development of endometriosis. In this review, we have summarized current data regarding genes with nucleotide polymorphisms investigated with regard to endometriosis. We searched PubMed for publications on endometriosis and polymorphism and found 108 publications between January 1979 and September 2005. These were classified according to the type of genetic polymorphism investigated and whether the result favored or did not favor association with endometriosis. We found a strikingly large amount of conflicting results. About 50% of the reviewed studies demonstrated positive correlations between different polymorphisms and endometriosis. This relation is most clearly seen in groups 1 (cytokines and inflammation), 2 (steroid-synthesizing enzymes and detoxifying enzymes and receptors), 4 (estradiol metabolism), 5 (other enzymes and metabolic systems), and 7 (adhesion molecules and matrix enzymes). Group 8 (apoptosis, cellcycle regulation, and oncogenes) seemed to be negatively correlated with the disease, whereas group 3 (hormone receptors), 6 (growth factor systems), and especially 9 (human leukocyte antigen system components) showed a relatively strong correlation. The review indicates that polymorphisms may have a limited value in assessing possible development of endometriosis. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall the complexity of attempting to link endometriosis to single nucleotide polymorphisms (SNPs), explain that the literature is varied on results and recommendations and is population specific, and state that there are some SNP relationships that are clinically stronger than others.

Hum Reprod. 2007 Oct;22(10):2698-701. Epub 2007 Aug 17.

Evaluation of a new questionnaire for the presurgical diagnosis of bladder endometriosis.

Fedele L, Bianchi S, Carmignani L, Berlanda N, Fontana E, Frontino G.

Department of Obstetrics, Gynaecology and Neonatology, Fondazione Policlinico-Mangiagalli-Regina Elena, University of Milano, Via della Commenda 12, 20122 Milano, Italy. luigi.fedele@unimi.it

BACKGROUND: The main objective was to evaluate the diagnostic accuracy of a new questionnaire for the presurgical diagnosis of bladder endometriosis in patients with a high suspicion index for this disease. METHODS: We included all patients of age <40 years undergoing laparoscopy or laparotomy for chronic pelvic pain. We partially modified the American Urologic Association Symptom Index with the aim of identifying bladder endometriosis among 157 women undergoing surgery for chronic pelvic pain. All patients underwent preoperative ultrasonography; selected patients, with suspected bladder endometriosis, underwent computed tomography and cystoscopy. The physicians performing both the preoperative evaluation and surgery were blinded to the questionnaires’ results. RESULTS: A total of 127 (81%) patients had pelvic endometriosis, 14 (8.9%) had bladder endometriosis. The questionnaires’ score for patients with and without bladder endometriosis was 21 +/- 8.7 and 4.6 +/- 5.7, respectively (P < 0.0001). The area under the receiver operating characteristic curve was 0.951. With a cut-off of 9, sensitivity was 93% and specificity 88%. CONCLUSIONS: The questionnaire proved to be effective in identifying bladder endometriosis, allowing a proper diagnostic work-up and surgical treatment, and minimizing the risk of recurrence. In this primary referral centre for endometriosis the prevalence of the disease was high-therefore it may achieve a lower diagnostic accuracy when evaluated on a population of women with a lower prevalence of bladder endometriosis.

Can Respir J. 2007 Jul-Aug;14(5):295-7.

Catamenial hemoptysis and pneumothorax in a patient with cystic fibrosis.

Parker CM, Nolan R, Lougheed MD.

Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen’s University, 102 Stuart Street, Kingston, Ontario, Canada. parkerc@post.queensu.ca

Hemoptysis or pneumothorax that recurs with the onset of menses is strongly suggestive of thoracic endometriosis syndrome (TES). TES is a rare disorder, with relatively few cases reported in the literature. A 32-year-old woman with cystic fibrosis, who over a period of several months had experienced recurrent catamenial hemoptysis and pneumothoraces, including an episode of life-threatening hemoptysis that coincided with menstruation, is presented. Thoracic computed tomography and magnetic resonance imaging scans, as well as a bronchoscopic evaluation that demonstrated endobronchial lesions that disappeared after menses, support the diagnosis of TES in the present patient. The patient was treated empirically with danazol and subsequently underwent a successful double-lung transplantation. Danazol was discontinued postoperatively, and she was started on an oral contraceptive. Eighteen months post-transplant, she has not experienced a recurrence of her catamenial symptoms, despite having resumed a regular menstrual cycle.

J Obstet Gynaecol. 2007 Jul;27(5):540-1.

Endometrioid adenocarcinoma of the ovary arising from endometriosis and presenting as an acute abdomen.

Maruthini D, Amin A, Buxton J.

Reproductive Medicine Unit, Leeds General Infirmary, Leeds, UK. deivanayagam.maruthini@leedsth.nhs.uk

J Obstet Gynaecol. 2007 Jul;27(5):493-5.

Predicting the presence of rectovaginal endometriosis from the clinical history: a retrospective observational study.

Griffiths AN, Koutsouridou RN, Penketh RJ.

Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK. dr@anthony36.freeserve.co.uk

Rectovaginal endometriosis is a severe variant of endometriosis. Common presenting symptoms for endometriosis include dysmenorrhoea, pelvic pain and dyspareunia. It is now recognised that there are other less traditional symptoms of endometriosis that are also relatively common. The aim of this study is to assess the relative strength of each of the potential symptoms of rectovaginal endometriosis and compare these with the laparoscopic and histological findings. In this retrospective, observational study the overall prevalence of rectovaginal endometriosis in the group was 31.4%. The presence of dyschesia gave a likelihood ratio of 1.27 (95% CI: 0.56 – 2.89) with a predictive prevalence of rectovaginal endometriosis of 37%. Apareunia and nausea or abdominal bloating were particularly strong markers for rectovaginal disease with a predictive prevalence of 87% and 89%, respectively. The classical symptoms often attributed to irritable bowel syndrome are also common in women with rectovaginal disease.

N Engl J Med. 2007 Aug 16;357(7):e8.

Images in clinical medicine. Endometriosis.

Ferrero S, Remorgida V.

San Martino Hospital and University of Genoa, 16132 Genoa, Italy. dr@simoneferrero.com

Gut. 2007 Sep;56(9):1247, 1256.

Editor’s quiz: Sigmoid stricture in a 39-year-old female.

Greco S, Penati C, Ardizzone S, Bianchi Porro G.

Department of Clinical Sciences, Department of Gastroenterology, L. Sacco University Hospital, Via G.B. Grassi, 74, 20157 Milano, Italy. salvatore.greco@unimi.it

Chin Med J (Engl). 2007 Jul 20;120(14):1241-6.

Effect of recombinant human endostatin on endometriosis in mice.

Jiang HQ, Li YL, Zou J.

Department of Obstetrics and Gynecology, General Hospital of the People’s Liberation Army, Beijing 100853, China. drjhq91@sohu.com

BACKGROUND: Direct and indirect evidences have suggested that angiogenesis is a prerequisite for the development of endometriosis. Aiming at offering experimental evidences for anti-angiogenesis therapy, we transplanted the eutopic endometrium from patient with endometriosis into the severe combined immunodeficiency disease (SCID) mice, to evaluate the effect of the endostatin on the growth and angiogenesis of the established endometriosis lesions in SCID mice model. METHODS: Eutopic endometrium of women with endometriosis was transplanted into the SCID mice. The mice were randomized into treatment (n = 10) and control groups (n = 10). Two weeks after the implantation of endometrium fragment, the treatment group was injected with recombinant human endostatin YH-16 into the peritoneal cavity (2 mgxkg(-1)xd(-1)), whereas the control group received equivalent volume of PBS (200 microl/d). The volume of endometriotic lesions in SCID mice was measured every three days, and all the treatment lasted for 14 days. Immunohistochemistry was used to determine microvessel density (MVD) and the expression of VEGF. The results were analyzed by t test and chi(2) test to value the treating effect. RESULTS: Compared with the control group, growth of endometriosis lesion was reduced in the mice treated with YH-16. Statistically significant differences in the volume and weight of the ectopic lesions were observed between the treatment and the control groups (P < 0.05). Microscopical examination showed that after being treated with YH-16, the volume of the endometrial tissues decreased, the glands depauperated, and the glandular epithelium partially degenerated. Necrotic debris was observed in the endometrial stroma. MVD and expression of VEGF in the treatment group were significantly lower than those in the control group (P < 0.05). CONCLUSIONS: Recombinant human endostatin affects the maintenance and growth of endometriotic tissues by inhibiting angiogenesis and reducing the expression of VEGF in ectopic lesion. The angiostatic agent may be promising as a therapy for endometriosis.

J Reprod Med. 2007 Jun;52(6):551-2.

Recurrent umbilical endometriosis after laparoscopic treatment of minimal pelvic endometriosis: a case report.

Goldberg JM, Bedaiwy MA.

Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. goldbej@ccf.org

BACKGROUND: Umbilical endometriosis is extremely rare. The majority of cases occur spontaneously. There have been a few reported cases following laparoscopy but none for the treatment of pelvic endometriosis. CASE: Umbilical endometriosis occurred 20 months after laparoscopic treatment of stage 1 pelvic endometriosis. The symptoms recurred 7 months following excision of the lesion and were successfully treated with silver nitrate cautery. CONCLUSION: This is the first reported case of umbilical endometriosis following laparoscopic treatment of pelvic endometriosis as well as the first to demonstrate that chemical cautery may cure small lesions.

J Reprod Med. 2007 Jun;52(6):490-8.

Uterine weight as a predictor of morbidity after a benign abdominal and total laparoscopic hysterectomy.

Bonilla DJ, Mains L, Whitaker R, Crawford B, Finan M, Magnus M.

Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.

OBJECTIVE: To determine if an enlarged uterus is associated with an increased rate of intraoperative and postoperative complications and prolonged hospital length of stay (LOS) after benign total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). STUDY DESIGN: Women who underwent TAH or TLH were stratified, according to uterine weight, into 3 groups: group 1, uterine weight < 200 g; group 2, 201-500 g; and group 3, > 500 g. Indications included uterine leiomyomas, chronic pelvic pain, prolapsed uterus, endometriosis and adenomyosis, dysfunctional uterine bleeding; all had benign final pathology. Statistical analysis compared risks of intraoperative and postoperative morbidity and prolonged hospital stay. RESULTS: Prolonged hospital stay risk increased for uterine weight > 500 g (p < or = 0.001). There was a significant association between postoperative complications and uterine size (p < or = 0.001). Mean estimated blood loss (EBL) also increased with uterine weight > 500 g (p < or = 0.001). TLH was associated with fewer postoperative complications, shorter LOS and reduced EBL (p < or = 0.001). CONCLUSION: Average LOS and risk of blood loss, blood transfusion and other postoperative complications after hysterectomy for benign disease increased with increasing uterine weight. TLH is an excellent alternative for enlarged uteri; it was strongly associated with decreased morbidity, shorter LOS, and reduced EBL and blood transfusion rate in all uterine weight groups when adjusted for other variables.

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