Fertil Steril. 2007 Aug;88(2):317-25.

Combination of 17beta-estradiol with the environmental pollutant TCDD is involved in pathogenesis of endometriosis via up-regulating the chemokine I-309-CCR8.

Shi YL, Luo XZ, Zhu XY, Li DJ.

Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China.

OBJECTIVE: To explore the effects of the combined E(2) with the environmental pollutant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on CCR8-I-309 expression by the endometriotic lesion-associated cells in the pathogenesis of endometriosis. DESIGN: Prospective laboratory study. SETTING: University hospital. PATIENT(S): Chinese women with endometriosis. INTERVENTION(S): The endometriotic tissue and matched eutopic endometrium were collected. Endometrial stromal cells (ESCs), HPMC, and U937 cells were treated with 17beta-E(2) or TCDD. The ESCs were stimulated with I-309. MAIN OUTCOME MEASURE(S): The expression of CCR8 in tissues was analyzed by reverse transcription-polymerase chain reaction and immunohistochemistry. The effect of I-309 on integrin beta1 and alphavbeta3 expression intensity was analyzed by flow cytometry, and the chemotactic activity of I-309 on the ESC was explored by chemotactic assay. Concentration of I-309 in the culture supernatant was quantified by enzyme-linked immunosorbent assay. RESULT(S): CCR8 was overexpressed in the endometriotic tissue. I-309 promoted the expression of integrin beta1. Estradiol and TCDD up-regulated CCR8 expression by ESCs. Estradiol magnified the stimulatory effect of TCDD on I-309 secretion by U937. The interaction of HPMC and U937 cells promoted I-309 secretion. CONCLUSION(S): These findings imply that the combination of 17beta-E(2) with the environmental pollutant TCDD is involved in the pathogenesis of endometriosis via up-regulating the chemokine CCR8-I-309.

 

Eur J Cancer. 2007 Sep;43(13):2011-8. Epub 2007 Aug 10.

Differential expression of cyclin-dependent kinase inhibitors and apoptosis-related proteins in endocervical lesions.

El-Ghobashy AA, Shaaban AM, Innes J, Prime W, Herrington CS.

Department of Obstetrics and Gynaecology, St James’s University Hospital, Leeds, United Kingdom.

The development of neoplasia is associated with abnormalities of cell cycle control and apoptosis. In this study, a panel of cyclin-dependent kinase inhibitors (CDKIs) and apoptosis-related proteins (p16, p21, p53, Bcl2 and hsp27) was analysed by immunohistochemistry in 91 glandular cervical lesions. A significant increase in p21 and p53 expression occurred from normal cervix (n=11) through endometriosis/tubo-endometrioid metaplasia (TEM) (n=19) and cervical glandular intraepithelial neoplasia (CGIN)/adenocarcinoma in situ (AIS) (n=33) to invasive adenocarcinoma (n=28). p16 showed diffuse strong expression in CGIN/AIS and invasive adenocarcinoma compared with focal expression in some TEM/endometriosis lesions and no expression in normal cervix. Bcl2 was highly expressed in TEM/endometriosis compared with CGIN/AIS and adenocarcinoma. p16 immunostaining discriminated accurately between neoplastic and non-neoplastic cervical lesions, provided that diffuse strong positivity was present. Similarly, diffuse expression of Bcl2 distinguished endometriosis/TEM from CGIN/AIS. These data demonstrate that analysis of CDKIs and apoptosis-related proteins provides useful information in the diagnostic assessment of glandular lesions of the cervix.

 

Magn Reson Med Sci. 2007;6(2):61-6.

Hypointensity on postcontrast MR imaging from compression of the sacral promontory in enlarged uterus with huge leiomyoma and adenomyosis.

Uotani K, Monzawa S, Adachi S, Takemori M, Kaji Y, Sugimura K.

Department of Radiology, Hyogo Medical Center for Adults, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan. uota2@med.kobe-u.ac.jp

PURPOSE: In patients with huge leiomyoma and with adenomyosis of the uterus, a peculiar area of hypointensity was occasionally observed on postcontrast magnetic resonance (MR) imaging in the dorsal portion of the enlarged uterus near the sacral promontory. We describe the imaging characteristics of these MR findings and correlate them with histopathological findings to examine whether the areas represent specific pathological changes. METHODS: Ten patients with huge leiomyomas and two with huge adenomyotic lesions whose imaging revealed the hypointensity were enrolled. All had enlarged uteri that extended beyond the sacral promontory. MR findings of the hypointense areas were evaluated and correlated with histopathological findings in 5 patients with leiomyoma and two with adenomyosis who had hysterectomy. RESULTS: The ten patients with leiomyoma showed flare-shaped hypointensity arising from the dorsal surface of the uterine body that extended deep into the tumor. The base of the hypointense areas was narrow in 5 patients with intramural leiomyoma and broad in five with subserosal leiomyoma. Two patients with adenomyosis showed nodular-shaped areas of hypointensity in front of the sacral promontory. Precontrast T(1)- and T(2)-weighted MR images showed no signal abnormalities in the portions corresponding to the hypointensity in any of the 12 patients. Pathological examinations showed no specific findings in the portions corresponding to the hypointensity in the 7 patients who had hysterectomy. CONCLUSION: The areas of hypointensity may represent functional changes, such as decreased localized blood flow caused by compression of the sacral promontory.

 

J Obstet Gynaecol Res. 2007 Aug;33(4):490-5.

Cytokine profiles in serum and peritoneal fluid from infertile women with and without endometriosis.

Kalu E, Sumar N, Giannopoulos T, Patel P, Croucher C, Sherriff E, Bansal A.

Assisted Conception Unit, St Helier Hospital, Carshalton, Surrey, UK.

OBJECTIVE: To study the serum and peritoneal fluid cytokine profiles in infertile women with minimal/mild active endometriosis. METHODS: Fifty-seven consecutive infertile women undergoing laparoscopy for unexplained infertility had peritoneal fluid and serum samples obtained at the time of laparoscopy. The levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-1 beta (IL-1 beta), vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-alpha), monocyte chemotatic protein-1 (MCP-1), RANTES, platelet derived growth factor (PDGF), soluble Fas (sFas), and soluble Fas Ligand (sFasL) in peritoneal fluid and serum were measured to compare the concentration in both biological fluids, in women who have minimal/mild red endometriosis using women with no endometriosis as controls. RESULTS: Peritoneal fluid levels of MCP-1, IL-8 and IL-6 were significantly higher in the endometriosis group (P < 0.012, P = 0.003, and P = 0.015, respectively). There was no significant difference in the peritoneal fluid levels of IL-1 beta, TNF-alpha, RANTES, VEGF, PDGF, sFas and sFasL in the two groups. Although serum levels of IL-8 were higher in women with endometriosis, the difference was not significant (P = 0.07). Serum levels of PDGF, IL-6, RANTES, IL-1 beta, TNF-alpha, and sFas, were not significantly different in the two groups. CONCLUSION: The elevated levels of MCP-1, IL-6, and IL-8 in peritoneal fluid but not serum may indicate the importance of local macrophage activating factors in the pathogenesis of endometriosis.

 

J Hum Genet. 2007;52(9):703-11. Epub 2007 Aug 9.

Polymorphisms and haplotypes of the gene encoding the estrogen-metabolizing CYP19 gene in Korean women: no association with advanced-stage endometriosis.

Hur SE, Lee S, Lee JY, Moon HS, Kim HL, Chung HW.

Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, South Korea.

A variety of factors affect the development of endometriosis, including hormonal status and genetic factors. The growth of endometriosis is stimulated by local estrogen production in conjunction with circulating estrogen. The CYP19 gene encodes a steroid aromatase that catalyses the conversion of C-19 androgens to estrogens. This study investigated whether polymorphisms of the CYP19 gene are associated with the risk of advanced endometriosis in Korean women. Blood samples were collected from 224 female patients with endometriosis of stages III and IV, as diagnosed by both pathologic and laparoscopic findings, and from a control group comprising of 188 women undergoing laparoscopic surgery or laparotomy for nonmalignant lesions. Single-nucleotide polymorphisms, restriction fragment length polymorphisms, and tetranucleotide tandem repeat polymorphisms were discriminated by the polymerase chain reaction (PCR). Haplotype analysis was also performed. CYP19 115T>C, 240G>A, and 1531C>T polymorphisms and [TTTA]n tetranucleotide repeat polymorphisms in the CYP19 gene and their haplotypes were not significantly associated with the risk of endometriosis. The risk of endometriosis also did not increase significantly with the number of higher risk alleles of the CYP19 gene. In conclusion, our findings suggest that CYP19 genetic polymorphisms are not associated with advanced-stage endometriosis in Korean women.

 

Thorax. 2007 Aug;62(8):744.

MRI features of pleural endometriosis after catamenial haemothorax.

Picozzi G, Beccani D, Innocenti F, Grazzini M, Mascalchi M.

Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 50134, Florence, Italy.

 

J Coll Physicians Surg Pak. 2007 Jul;17(7):429-30.

Umbilical endometriosis.

Mushtaq N, Dar FA, Shahid MA.

Department of Gynecology and Obstetrics, Alghat General Hospital, Riyadh Region, Saudi Arabia-11914.

A case of umbilical endometriosis in a 36 years old Saudi female is described.The patient presented with 4 months history of bleeding and discharge from the umbilicus and was treated with local and systemic antibiotics. Histopathology of tissues collected from the umbilicus revealed endometrial stroma and glands. The patient underwent umbilectomy at a tertiary centre as definitive management.

 

Zhonghua Yi Xue Za Zhi. 2007 May 8;87(17):1181-3.

[Clinical analysis of 30 patients with perineal endometriosis]

[Article in Chinese]

Wang HB, Zhu L, Lang JH, Liu ZF, Sun DW, Leng JH, Fan QB.

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

OBJECTIVE: To investigate the diagnosis and treatment of perineal endometriosis. METHODS: The clinical date of 30 patients with perineal endometriosis, aged 32.3 (23 approximately 44), who were admitted 1983 – 2006, operated on, and followed up for 0.5 approximately 13 years, were analyzed. RESULTS: The incidence of perineal endometriosis was 0.32% among the total endometriosis cases. Five of these 30 patients (16.7%) suffered from perineal endometriosis combined with pelvic endometriosis. The latent period was 4 months to 13 years. There was no significant difference in onset of age. All patients had cyclical and painful lesions. The level of CA125 was normal. All patients were cured after complete surgical excision. CONCLUSION: Diagnosis of perineal endometriosis can be made based on the patients’ history and clinical manifestations. Surgical excision is the first choice of treatment. The recurrent rate of the cases without anal sphincter involvement is lower than that with anal sphincter invasion since the complete incision can be made. It is important to evaluate pre-operatively if the anal sphincter is involved.

 

ANZ J Surg. 2007 Sep;77(9):758-60.

Intussusception of the veriform appendix due to endometriosis presenting as acute appendicitis.

Moradi P, Barakate M, Gill A, Farrow G.

Departments of Surgery, Manly Hospital and Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia.

 

Gynecol Obstet Fertil. 2007 Apr;35 Suppl 1:S14-6.

[Indications for GnRH analogs in the treatment of genital endometriosis]

[Article in French]

Daraï E, Azoulay C, Dubernard G.

Service de Gynécologie-Obstétrique, Hôpital Tenon, AP-HP, France. emile.darai@tnn.aphp.fr

Three GnRH agonists are currently available in France in clinical medicine with the indication: “Genital or extragenital endometriosis (from stage I to stage IV of the rAFS classification [4] ).” The 2004 Cochran meta-analysis showed a significant improvement in the pain score in patients treated with GnRH compared with placebo, with the effect lasting 12 months after cessation of the medication, but few data are available on their advantages in the perioperative situation and in deep endometriosis. A. Audebert found an advantage to preoperative use of GnRHa in severe cases of endometriosis, with a significantly higher rate of patients having surgery that was considered optimal at the end of the intervention, both in terms of the endometriosis lesions and adherences. The benefits of GnRH treatment before medically assisted procreation are, however, supported by the literature.

 

Gynecol Obstet Fertil. 2007 Apr;35 Suppl 1:S8-13.

[Voiding dysfunction after surgical resection of deeply infiltrating endometriosis: pathophysiology and management]

[Article in French]

Deffieux X, Raibaut P, Hubeaux K, Ismael SS, Amarenco G.

Laboratoire d’Urodynamique et d’Explorations Neurophysiologiques du Périnée, Service de Rééducation Neurologique, Hôpital Rothschild, AP-HP, Paris, France. x.deffieux@free.fr

Autonomic nerve (sympathic and parasympathic) damage plays a crucial role in the aetiology of bladder dysfunction that occurs after resection of deeply infiltrating endometriosis (uterosacral ligaments, colorectal bowel, rectovaginal wall). This review presents an overview of the pathophysiology and management of voiding dysfunction that occur after this kind of surgery. The rate of significant post-voiding residual volume and/or hypoactive bladder after colorectal resection for endometriosis ranges from 15 to 20%. This rate seems to be higher (up to 30%) after proximal utero-sacral ligaments resection. This is explained by the location of the inferior hypogastric plexus at the proximal portion of the utero-sacral ligaments. Urodynamics investigations show non specific hypoactive bladder and altered uroflowmetry. Concerning treatment, further controlled studies are needed to assess the hypothetical usefulness of parasympathomimetic and prokinetic agents for hypoactive bladder occurring after pelvic autonomic denervation. Neuromodulation is a successful treatment for patients with refractory lower urinary tract dysfunction. However, there is no controlled study that focused on its efficacy in voiding dysfunction after radical pelvic surgery. Overall, the main objective of the treatment is to avoid the complications of post-voiding residue (such as infection) and of abdominal pushing effort (deterioration of perineal tissues). Therefore, self catheterization should be recommended when this postoperative complication occurs. An understanding of the location of the autonomic pelvic network should help prevent iatrogenic injury through the adoption of surgical techniques, such as nerve sparing, that reduce postoperative autonomic dysfunction.

 

Gynecol Obstet Fertil. 2007 Apr;35 Suppl 1:S1-7.

[Assessment of the urinary side effects after surgery for deep pelvic endometriosis]

[Article in French]

Dubernard G, Rouzier R, Piketty M, Bazot M, Daraï E.

Service de Gynécologie Obstétrique, Hôpital Tenon AP-HP, 4, rue de la Chine, 75020 Paris, et Université Pierre et Marie Curie, Paris VI, France. gil.dubernard@tnn.aphp.fr

OBJECTIVE: To evaluate the urinary side effects after laparoscopic surgery for deep endometriosis. PATIENTS AND METHOD: Longitudinal study including 86 patients operated for deep pelvic endometriosis : 58 (68%) with colorectal endometriosis, 21 (24%) with utero-sacral ligament endometriosis and 7 (8%) with recto-vaginal septum endometriosis. Assessment of the urinary side effects was permormed using the Bristole Female Lower Urinary Tract Symptom questionnaire. RESULTS: On postsurgical follow-up, almost all patients described: hesistancy (p = 0.02), strain to start (p = 0.04), stopping flow (p = 0.01), incomplete emptying (p = 0.008) and reduce stream (p=0.02). Only patients who had resection of both utero-sacral ligaments had significative postsurgical urinary dysfunction with stopping flow (p = 0.02) and incomplete emptying (p = 0.004). Patients with colorectal resection had also significative postsurgical urinary dysfunction with hesitancy (p = 0.02), strain to start (p = 0.03), stopping flow (p = 0.007) and incomplete emptying (p = 0.004). In patients with rectal resection, urinary dysfunctions are raised when rectal resection is associated to resection of both utero-sacral ligaments. CONCLUSION: Postoperatively, urinary side effects occurred only in patients with segmental colorectal endometriosis resection associated with bilateral utero-sacral ligament resection. Sparing nerve surgery of the pelvic nerves, can reduce these urinary side effects.

 

Fertil Steril. 2007 Sep;88(3):764-5; author reply 765-6. Epub 2007 Aug 6.

Comment on:

Fertil Steril. 2007 May;87(5):1231-4.

How much confidence to place in a negative result?

Roman H, Hulsey TF, Hulsey TC.

 

Int J Gynaecol Obstet. 2007 Oct;99(1):38-42. Epub 2007 Aug 3.

Efficacy of levamisole on experimental endometriosis.

Ocal G, Kokcu A, Cetinkaya MB, Tosun M, Kefeli M, Kandemir B.

Department of Obstetrics and Gynecology, School of Medicine, University of Ondokuz Mayis, Samsun, Turkey.

OBJECTIVE: To investigate the efficacy of levamisole on experimental endometriosis. METHODS: After the implantation of endometrial tissue on abdominal peritoneum, 40 rats were randomized to 1 of 4 equal intervention groups. Levamisole (2 mg/rat) was applied subcutaneously to group “L” once a week. Depot medroxyprogesterone acetate (3 mg/kg) was applied intramuscularly to group “M” twice at 4-week intervals. Leuprolide (0.075 mg/kg) was applied subcutaneously to group “G” twice at 4-week intervals. Saline (0.1 cm(3)/rat) was applied subcutaneously to group “C” once a week for 8 weeks. The efficacy of levamisole was determined by volume measurement and characterizing the histological structure of the implants. RESULT: Volume increase of the implants in group C (P<0.05), and volume decrease in groups M, G, and L was found (P<0.05, P<0.01, and P<0.01, respectively.) Stromal tissue and glandular activity were not different between groups L and G. CONCLUSION: Levamisole was found to be as effective as leuprolide in regression of the volume of endometriotic implants.

 

J Proteome Res. 2007 Sep;6(9):3402-11. Epub 2007 Aug 3.

Proteomic analysis of peritoneal fluid in women with endometriosis.

Ferrero S, Gillott DJ, Remorgida V, Anserini P, Leung KY, Ragni N, Grudzinskas JG.

Reproductive Physiology Laboratory, St. Bartholomew’s School of Medicine & Dentistry, Queen Mary University of London, United Kingdom.

This study aims to evaluate differences in the expression of proteins present in the peritoneal fluid (PF) of women with and without endometriosis. PF samples were subjected to two-dimensional gel electrophoresis; protein spots of interest were identified by liquid chromatography tandem mass spectrometry. Several molecules had aberrant expression in PF of women with endometriosis; they may be useful for a better understanding of the pathogenesis of this disease.

 

Pathology. 2007 Aug;39(4):450-3.

Aggressive endometriosis with focal change suggesting early neoplastic transformation.

Yan M, Boulas J, Russell P.

 

Obstet Gynecol. 2007 Aug;110(2 Pt 2):530-3. Links

Radical excision of inguinal endometriosis.

Fedele L, Bianchi S, Frontino G, Zanconato G, Rubino T.

Department of Obstetrics, Gynecology and Neonatology, Fondazione Policlinico-Mangiagalli-Regina Elena, University of Milan, Milan, Italy. luigi.fedele@unimi.it

BACKGROUND: The diagnosis of inguinal endometriosis can be complex, and patients are often first operated by a general surgeon for a hernia. We present five cases of inguinal endometriosis in which primary surgery resulted in recurrence and a second correct procedure resulted in a cure. CASES: Five patients with inguinal endometriosis, operated between 1996 and 2002, were seen for the recurrence of symptoms. All underwent excision of the extraperitoneal portion of the round ligament and pelvic exploration. In all cases, both pelvic and round ligament endometriosic lesions were confirmed at histology. No complications or recurrence of inguinal endometriosis occurred. CONCLUSION: The complete excision of inguinal endometriosis must also include the extraperitoneal portion of the round ligament.

Obstet Gynecol. 2007 Aug;110(2 Pt 2):521-2.

Recurrent hemorrhagic ascites: a rare presentation of endometriosis.

Palayekar M, Jenci J, Carlson JA Jr.

Department of Obstetrics and Gynecology, Saint Peter’s University Hospital, New Brunswick, New Jersey 08901, USA. mpalayekar@hotmail.com

BACKGROUND: Endometriosis is rarely a cause of recurrent hemorrhagic ascites. This report draws attention to this uncommon condition, which could present a diagnostic dilemma. CASE: A young African-American woman who had experienced recurrent hemorrhagic ascites for more than 2 years underwent laparotomy and was found to have extensive pelvic endometriosis. After a hysterectomy and bilateral salpingo-oophorectomy, her ascites resolved. CONCLUSION: Endometriosis should be considered in the differential diagnosis of recurrent hemorrhagic ascites in premenopausal women. The diagnosis always requires operative assessment and histologic confirmation.

 

Obstet Gynecol. 2007 Aug;110(2 Pt 2):469-71.

Comment in:

Obstet Gynecol. 2007 Aug;110(2 Pt 2):453-4.

Isolated clear cell adenocarcinoma in scar endometriosis mimicking an incisional hernia.

Harry VN, Shanbhag S, Lyall M, Narayansingh GV, Parkin DE.

Department of Gynaecological Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom. v.harry@abdn.ac.uk

BACKGROUND: The development of a mass in association with a previous surgical scar can pose a diagnostic dilemma due to similarities in appearance to hernias, abscesses, hematomas, or desmoid tumors. Scar endometriosis is an uncommon cause of such a lump, but malignant change within this ectopic tissue is exceptionally rare. CASE: We present a case of a 55-year-old woman who was found to have an isolated clear cell adenocarcinoma in an area of scar endometriosis more than 30 years after an open tubal sterilization. This mass was initially thought to be an incisional hernia, but was later diagnosed intraoperatively by frozen section and then incompletely excised, highlighting the difficulties in preoperative diagnosis as well as surgical treatment. CONCLUSION: Malignant change within scar endometriosis is rare, but increased awareness of this phenomenon is required. Vigilance is paramount and a mass located in or close to a surgical scar should be treated with suspicion.

 

Rev Assoc Med Bras. 2007 May-Jun;53(3):200-1.

[Can endometriosis be the differential diagnosis of abdominal wall tumoral formation after caesarean section or aesthetics dermo-lipectomy?]

[Article in Portuguese]

Aldrighi JM, Munhoz AM, Aldrighi CM.

 

Br J Hosp Med (Lond). 2007 Jul;68(7):391.

Fungating giant umbilical endometrioma.

Rajendran N, Courtney ED, Hagger RW.

St George’s Hospital, University of London, London.

 

Reproduction. 2007 Aug;134(2):373-8.

Association of three single nucleotide polymorphisms of the E-cadherin gene with endometriosis in a Chinese population.

Shan K, Xiao-Wei M, Na W, Xiu-Feng Z, Deng-Gui W, Wei G, Zheng-Mao Z, Yan L.

Department of Obstetrics and Gynecology, Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China.

Endometriosis, one of the most frequent diseases in gynecology, is a benign but invasive and metastatic disease. The altered expression of E-cadherin may play an important role in developing endometriosis. In this paper, we discuss the association of three single nucleotide polymorphisms (SNPs) on the E-cadherin gene and risk of endometriosis. We examined the genotype frequency of three polymorphisms in 152 endometriosis patients and 189 control women. There was a significant difference in the frequency of the E-cadherin 3′-UTR C –> T genotypes between endometriosis and controls (P = 0.01). The frequency of the C allele in patients (71.1%) was significantly higher than in the controls (63.8%; P = 0.04). When compared with the T/T + T/C genotypes, the C/C genotype had a significantly increased susceptibility to endometriosis, with an adjusted odds ratio of 1.79 (95% confidence interval = 1.17-2.76). No significant difference was found between endometriosis and control women on two polymorphisms (-160 C –> A, -347 G –> GA) at the gene promoter region of E-cadherin. The -160 C –> A and -347 G –> GA polymorphisms displayed linkage disequilibrium (D’ = 0.999). The -160 A/-347 GA haplotype was only detected in endometriosis patients (2%). These data show a relation between the E-cadherin 3′-UTR C –> T polymorphism, the -160 A/-347 GA haplotype of two promoter polymorphisms and risk of endometriosis, suggesting a potential role in endometriosis development, at least in North Chinese women.

 

Ultrasound Obstet Gynecol. 2007 Sep;30(3):341-5.

Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate?

Kepkep K, Tuncay YA, Göynümer G, Tutal E.

Health Ministry Göztepe Educational and Research Hospital, Clinic of Obstetrics and Gynecology, Istanbul, Turkey. drkumral@yahoo.com

OBJECTIVES: To evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis. METHODS: In this prospective study, 70 consecutive patients scheduled for hysterectomy underwent preoperative transvaginal sonography. If at least one of the following sonographic features was present, a diagnosis of adenomyosis was made: heterogeneous myometrial echotexture, globular-appearing uterus, asymmetrical thickness of the anteroposterior wall of the myometrium, subendometrial myometrial cysts, subendometrial echogenic linear striations or poor definition of the endometrial-myometrial junction. The sonographic features were compared with the histopathological results. RESULTS: The prevalence of adenomyosis was 37.1% (26/70 patients). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy of transvaginal ultrasound for the diagnosis of adenomyosis were 80.8%, 61.4%, 55.3%, 84.4% and 68.6%, respectively. We found that a regularly enlarged uterus with a globular appearance, subendometrial echogenic linear striations and myometrial cysts had the highest accuracy for the diagnosis of adenomyosis. Of all findings evaluated, heterogeneous myometrium was the most common in patients with adenomyosis (21/26 patients), but it had a poor specificity. The presence of subendometrial linear striations was the most specific sonographic feature (95.5%) and it had the highest PPV (80.0%) for the diagnosis of adenomyosis. CONCLUSIONS: The presence of subendometrial echogenic linear striations, a globular configuration and myometrial cysts on transvaginal ultrasound supports the diagnosis of adenomyosis. Among the transvaginal ultrasound diagnostic findings of adenomyosis, subendometrial linear striations have the highest diagnostic accuracy. Copyright 2007 ISUOG. Published by John Wiley & Sons, Ltd.

 

Fertil Steril. 2007 Oct;88(4 Suppl):1240-7. Epub 2007 Jul 20.

Direct effect of macrophage migration inhibitory factor on sperm function: possible involvement in endometriosis-associated infertility.

Carli C, Leclerc P, Metz CN, Akoum A.

Endocrinologie de la Reproduction, Centre de Recherche, Hôpital Saint-François d’Assise, Centre Hospitalier Universitaire de Québec (CHUQ), Faculté de Médecine, Université Laval, Québec, Canada.

OBJECTIVE: To evaluate the effect of macrophage migration inhibitory factor (MIF) on sperm capacitation, a maturational process that occurs in the female reproductive tract and enables spermatozoa to become fully competent at fertilizing the oocyte. DESIGN: Incubation of Percoll-washed spermatozoa with varying concentrations of human recombinant MIF or fetal cord serum (positive control). SETTING: Human reproduction research laboratories. INTERVENTION(S): Fresh semen samples obtained from healthy volunteers after a minimum of 2 days of sexual abstinence. MAIN OUTCOME MEASURE(S): Protein tyrosine phosphorylation by Western blotting, the acrosomal status upon binding to the Pisum sativum agglutinin conjugated to fluorescein isothiocyanate, and sperm motility by computer-assisted sperm analysis. RESULTS: MIF displayed a dose-dependent effect on the phosphotyrosine content of p105 and p81, the two major tyrosine-phosphorylated proteins associated with human sperm capacitation. A significant induction of tyrosine phosphorylation was seen at 2 ng/mL of MIF for both p105 and p81, but a trend for a down-regulation of the basal tyrosine phosphorylation level was noted at elevated concentrations (12-24 ng/mL). MIF pretreatment of spermatozoa resulted in a dose-dependent change in the acrosome reaction induced by the Ca(2+) ionophore A23187. After being increased at 1-4 ng/mL MIF with a statistically significant effect observed at 4 ng/mL, the acrosome reaction gradually decreased and fell below the control levels at higher concentrations. Furthermore, a significant decrease in the motility of spermatozoa was observed after exposure to an elevated concentration of MIF (12 ng/mL). CONCLUSION(S): The present data indicate that MIF may play a physiological role in sperm capacitation but may have deleterious effects on sperm function at abnormal pathophysiological levels, which suggests a role in endometriosis-associated infertility.

 

Pediatr Pulmonol. 2007 Sep;42(9):854.

Comment on:

Pediatr Pulmonol. 2007 Apr;42(4):386-8.

Pediatr Pulmonol. 2007 Aug;42(8):746.

Authors’ Reply to “CD10 in the Cytological Diagnosis of Endobronchial Endometriosis”.

Cimmino A, Martire B, Peruzzi S, De Mattia D, Giordano P, Loizzi M.

 

J Obstet Gynaecol. 2007 May;27(4):434-7.

Malignant transformation of post-hysterectomy vault endometriotic nodule.

Rachaneni S, Spencer C, Lloyd J, Farthing A.

St John’s Hospital, Chelmsford, UK. sunilama@yahoo.com

 

J Obstet Gynaecol. 2007 May;27(4):433-4.

A case report of recurrent endometriosis following Tibolone hormone replacement therapy.

Sundar SS, Gornall RJ, Kerr-Wilson R, Swingler GR, Kinder RB, McCarthy K.

Department of Gynaecological Oncology, Gloucestershire Hospitals NHS Trust, UK. sudha.sundar@glos.nhs.uk

 

Acta Obstet Gynecol Scand. 2007;86(8):963-7.

Serum resistin level is a predictor of ovarian response in in vitro fertilisation cycle.

Chen YC, Tsai EM, Chen HS, Liu YH, Lee CH, Chou FH, Chen IJ, Chen SY, Jong SB, Chan TF.

Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.

OBJECTIVES: To measure serum resistin levels in infertile women undergoing in vitro fertilisation-embryo transfer (IVF-ET), and to find any correlations between serum resistin levels and body weight, body mass index, the number of oocytes retrieved, and the outcome of IVF-ET. In addition, to assess whether there is any difference in serum resistin levels between infertility caused by polycystic ovary syndrome (PCOS) and infertility caused by other female factors. METHODS: We designed a case-control study, and a total of 44 infertile women were enrolled. The blood samples for resistin measurement were collected on day 3 of the menstrual cycle prior to the administration of gonadotropin during in vitro fertilisation. These cases were then divided into 2 subgroups (PCOS group versus non-PCOS group) and a number of variables were measured and compared, including serum resistin levels. RESULTS: Serum resistin levels were inversely correlated with the number of oocytes retrieved (r=-0.371, p=0.013). No significant correlation was found between serum resistin levels and body mass index or body weight, either in the whole group or in the 2 subgroups. Serum resistin levels in the non-PCOS group were significantly higher than in the PCOS group (p=0.049). Serum resistin levels in the non-PCOS group were inversely correlated to the number of oocytes retrieved (r=-0.386, p=0.039), but no similar correlation was found in the PCOS group. There was no correlation between serum resistin levels and fertility rate or clinical pregnancy rate in either subgroup. CONCLUSIONS: We observed a negative correlation between serum resistin levels and the number of oocytes retrieved during IVF. However, this phenomenon was only present in the non-PCOS group. This result suggests that serum resistin levels might be a good predictor of ovarian response in infertile women without PCOS during IVF. The role of serum resistin in response to inflammation caused by endometriosis or chronic pelvic infection, both of which are major causes of female infertility, should be examined in a further study.

 

JSLS. 2007 Jan-Mar;11(1):131-5.

Ileocolic intussusception due to endometriosis.

Koutsourelakis I, Markakis H, Koulas S, Mparmpantonakis N, Perraki E, Christodoulou K.

Department of Surgery, Corfu General Hospital, Corfu, Greece. ykoutsourelakis@yahoo.gr

Intussusception is a rare cause of bowel obstruction in adults. Clinical manifestations are not specific, making the preoperative diagnosis difficult to establish. We report a case of acute small-bowel obstruction due to ileocolic intussusception. An emergency explorative laparoscopy was performed and revealed a mass in the right colon proximal to the ileocecal valve. Conversion to open laparotomy allowed us to perform a right hemicolectomy. The pathologic examination of the resected sample revealed endometriosis of the terminal ileus.

 

JSLS. 2007 Jan-Mar;11(1):127-30.

Broad ligament hernia-associated bowel obstruction.

Varela GG, López-Loredo A, García León JF.

Department of Surgery, American British Cowdray Medical Center (Centro Médico ABC), Mexico City, Mexico. surgeryabc@yahoo.com

BACKGROUND AND OBJECTIVE: We present the case of a female patient 29 years of age with antecedents of laparoscopic laser ablation for endometriosis, laparoscopic appendectomy, and umbilical hernioplasty. METHODS: The patient was admitted to the hospital’s emergency room for abdominal pain in the epigastrium, transfixing, irradiating to both upper quadrants and to the lumbar region, accompanied by nausea and gastrobiliary vomiting. Lipase determination was 170 mg/dL. Other laboratory findings were normal. Plain abdominal films on the patient’s admission were normal, and computed tomography (CT) showed data compatible with acute pancreatitis. Without improvement during the patient’s hospital stay, pain and vomiting increased in intensity and frequency. RESULTS: New abdominal x-rays revealed dilatation of small bowel loops. Management was begun for intestinal obstruction, with intravenous hydration and placement of a nasogastric tube without a good response. At 48 hours, a diagnostic laparoscopy was performed, revealing a 3-cm internal hernia in the left broad ligament in which a 20-cm segment of terminal ileum was encased. We performed liberation of the ileal segment and closed the hernial orifice by using the laparoscopic approach. CONCLUSION: The patient’s evolution was excellent.

 

Ginekol Pol. 2007 Mar;78(3):175-9.

[The role and place of the assisted reproductive technology (ART) in treatment of infertility]

[Article in Polish]

Szamatowicz M.

Klinika Ginekologii, Akademii Medycznej w Białymstoku. szamatow@pb.bialystok.pl

The assisted reproductive technics (ART) compose the very valuable tool in the infertility treatment additionally to pharmacological and surgical methods. ART comparises the classical in vitro fertilization and embryotransfer (IVF/ET) intracytoplasmic sperm injection (ICSI) intrauterine insemination (IUI), microepididymal sperm spiration (MESA), and testicular sperm aspiration (TESA). Male infertility, tubal factor, ovarian factor, endometriosis or an unexplained infertility constitute pathologies where ART can be applied as the methods of choice or as the methods of the last chance. The efficacy of ART is closely related to the age of the female partner. Hence, taking a decision of the inappropriate treatment of the infertility and prolongation of such treatment for years is the “Theft” of the reproductive time of women and a diminution or even deprivation of the chance for pregnancy. The role and the appropriate time of the ART application in different infertility causes are described.

 

Anticancer Res. 2007 Jul-Aug;27(4A):2023-5.

Expression of the glycodelin A gene and the detection of its protein in tissues and serum of ovarian carcinoma patients.

Richter C, Baetje M, Bischof A, Makovitzky J, Richter DU, Gerber B, Briese V.

Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany.

BACKGROUND: Glycodelin A (GdA), also known as placental protein 14 (PP14), has been detected in endometrial, cervical and ovarian carcinoma cells. It is suspected to be a marker of human ovarian cancer tissues. MATERIALS AND METHODS: We investigated serum, tissue and cyst fluid samples of patients with an ovarian carcinoma in contrast to patients with benign and malignant diseases such as uterine myoma, endometriosis, cervical, uterine and breast cancer, and metastases of bladder and colon carcinoma. Used methods were enzyme-immunoassay, immunohistochemistry (IHC) and polymerase chain reaction (PCR). RESULTS: In 81% of the control group the GdA-expression was negative, which was confirmed by IHC and PCR. Of the ovarian carcinoma group only 52% showed correspondence between IHC and PCR. CONCLUSION: These results indicate that determination of GdA is not sensitive or specific enough for use as a tumour marker.

 

J Ultrasound Med. 2007 Aug;26(8):993-1002.

Variations in appearance of endometriomas.

Asch E, Levine D.

Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

OBJECTIVE: Because of the range of patient ages with endometriosis, the persistence of endometriomas, and the degradation of internal blood products over time, the appearance of endometriomas is variable. The purpose of this study was to identify the prospective diagnoses in cases of surgically proven endometriomas and to illustrate the variety of appearances of endometriomas. METHODS: Sonographic images from 325 women with histologic confirmation of an adnexal mass during a 16-month period were reviewed. Eighty-seven endometriomas in 71 women were found. Prospective diagnoses were scored as follows: 1, the diagnosis was endometrioma only; 2, the differential diagnosis listed endometrioma first; 3, the differential diagnosis listed endometrioma but not first; 4, the diagnosis did not include endometrioma but included a complex or hemorrhagic cyst; and 5, the diagnosis did not include endometrioma. Lesions with the classic appearance of an endometrioma (hypoechoic mass with diffuse low-level internal echoes) or an atypical appearance were chosen for illustration. RESULTS: Thirty-five (60.3%) of 58 endometriomas measuring at least 2 cm in greatest dimension included endometrioma in the differential diagnosis at sonography. In 6 (10.3%) of 58, the lesions were described as complex or hemorrhagic cysts. Atypical endometriomas included cases with retracted clots that appeared solid but without blood flow, endometriomas in pregnant patients, and endometriomas in postmenopausal women with heterogeneous internal echoes and central calcification. A ruptured endometrioma was interpreted as pelvic inflammatory disease. Five endometriomas were suspected to be malignancies because of a solid appearance, blood flow, surrounding adhesions, and, in 1 pregnant patient, extensive decidualization. CONCLUSIONS: Recognition of the varied appearance of endometriomas should aid the interpreting physician in giving an appropriate prospective diagnosis of endometriomas.

 

Actas Urol Esp. 2007 Feb;31(2):153-6.

[Suburethral endometrioma]

[Article in Spanish]

Cabral Ribeiro J, Pérez García D, Martins Silva C, Ribeiro Santos A.

Servicio de Urología, Hospital de São Marcos, Braga, Portugal. jcabral@hsmbraga.min-saude.pt

Endometriosis is a common disease affecting mostly women in childbearing age. It usually involves the internal pelvic organs but occasionally can present in unusual locations. We report on a 32-year-old nulliparos female presenting with a suburethral painful mass causing obstructive voiding symptoms; she had also a long history of dismenorreia, perimenstrual pelvic pain, urinary tract infections, disúria and dispareunia. The diagnostic work-up revealed a suburethral cystic lesion consistent with a complicated urethral diverticulum or a suburethral endometrioma. Complete surgical excision confirmed an endometriotic cyst. The differential diagnosis of this rare suburethral location of endometriosis with other vaginal cysts is discussed.

 

Reprod Sci. 2007 May;14(4):374-82.

Trichostatin A, a histone deacetylase inhibitor, attenuates invasiveness and reactivates E-cadherin expression in immortalized endometriotic cells.

Wu Y, Starzinski-Powitz A, Guo SW.

Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226-0509, USA.

The objective of this study is to determine whether trichostatin A (TSA) can suppress the invasiveness of 2 endometriotic cell lines known to be invasive and E-cadherin negative. The membrane invasion culture system was used to assess cell invasion using invasive and a noninvasive bladder cancer cell lines as positive and negative controls, respectively. The E-cadherin mRNA levels and protein expression were evaluated by real-time reverse transcriptase polymerase chain reaction and Western blot analysis, respectively. The authors found that TSA attenuates the invasiveness of 2 cell lines in the presence or absence of tumor necrosis factor alpha (TNFalpha) stimulation. In addition, TSA treatment reactivates E-cadherin gene and protein expression in these cell lines. These results, along with recent findings that TSA suppresses proliferation, interleukin-1 beta-induced cyclo-oxygenase 2 expression, and constitutive or TNFalpha-stimulated nuclear factor kappa B activation in endometrial and endometriotic cells, makes histone deacetylase inhibitors a promising class of compounds for novel and more effective medical treatment of endometriosis, especially given the mounting evidence that endometrios be an epigenetic disease.

 

Reprod Sci. 2007 May;14(4):367-73.

Transforming growth factor beta1 gene polymorphism 509C/T in deep infiltrating endometriosis.

van Kaam KJ, Romano A, Dunselman GA, Groothuis PG.

Research Institute GROW, University Hospital of Maastricht, Maastricht, Netherlands. kvk@sgyn.azm.nl

Deep infiltrating endometriosis is characterized by the presence of nodular lesions largely composed of fibromuscular tissue. Transforming growth factor beta 1 (TGF-beta1) is the cytokine most causatively associated with disorders characterized by fibrosis throughout the body. Therefore, the hypothesis was tested that mechanisms increasing the fraction of biologically active TGF-beta1, such as TGF-beta 1 gene polymorphisms, lead to an increased risk of developing deep infiltrating endometriosis. The frequency of the -509C/T polymorphism of the TGF-beta 1 gene was tested in women with deep infiltrating endometriosis (n = 72), gynecological patients without symptoms of endometriosis (n = 95) and healthy females (n = 93). Detection of the -509C/T polymorphisms was performed using PCR-restriction fragment length polymorphism analysis. We did not observe statistically significant differences in the frequency of the -509C/T polymorphism between the groups. Our study does not support an association between the -509C/T polymorphism of the TGF-beta 1 gene and an increased risk of deep infiltrating endometriosis.

Rom J Morphol Embryol. 2007;48(2):195-7.

Endometriosis of the abdominal wall.

Comănescu M, Potecă A, Lăzăroiu A, Sajin M.

Department of Pathology, Emergency University Hospital of Bucharest, 169 Independenţei Avenue, Bucharest, Romania. mariacomanescu@yahoo.com

Endometriosis is characterized by the presence and proliferation of ectopic endometrial tissue. It occurs most often in the pelvic area but sometimes it presents as a lump in the abdomen. We report three cases of endometriosis of the abdominal wall, presented at the Emergency University Hospital of Bucharest during the last year. The diagnosis was made by the histopathological analysis of the surgical specimen.

 

Gynakol Geburtshilfliche Rundsch. 2007;47(3):132-9.

[Psychosomatic aspects of endometriosis–current state of scientific knowledge and clinical experience]

[Article in German]

Leeners B, Imthurn B.

Klinik für Reproduktions-Endokrinologie, Departement Frauenheilkunde, Universitätsspital Zürich, Zürich, Switzerland. Brigitte.Leeners@usz.ch

Current therapeutic options allow successful treatment in only part of the women presenting with endometriosis. Pain, fatigue/exhaustion, intensive and repeated therapies as well as a concentration on the disease lead to a variety of consequences concerning education/ profession, body perception, self-esteem, partnership/social contacts, sexuality and psychic well-being. Difficulties in becoming pregnant represent a further central problem in dealing with endometriosis. Therefore, biopsychosocial aspects should be integrated into current somatically oriented models of medical support. Copyright 2007 S. Karger AG, Basel

 

Gynakol Geburtshilfliche Rundsch. 2007;47(3):124-31.

[Surgical management of endometriosis–an overview]

[Article in German]

Boing C, Kimmig R.

Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Duisburg-Essen, Essen, Germany. carsten.boeing@uk-essen.de

Laparoscopy is the treatment of choice in the diagnostics of endometriosis. Surgical management of early-stage endometriosis at the time of diagnosis is to be aimed at. Resection of peritoneal endometriosis is essential; coagulation/ablation may be an alternative. In the early stages, pain reduction is as effective as by drug therapy. Surgery improves fertility in these stages. Complete removal of an endometrioma lowers the recurrence rate and improves fertility. In cases of definitive surgical therapy, i.e. hysterectomy and adnexectomy, any accompanying endometriosis focuses have to be carefully resected. When clinically symptomatic, a deep endometriosis has to undergo radical surgery. In these cases, assisted reproduction is usually necessary when such a patient wants to become pregnant. The recurrence rate after complete surgical management of a serious endometriosis is lower compared to drug therapy; pain reduction is more effective. A postoperative drug therapy with GnRH analogues, danazole or gestagen does not improve fertility, the interval to a recurrence is however positively influenced. Hormonal replacement therapy after definitive surgical management has probably no influence on the recurrence rate. Copyright 2007 S. Karger AG, Basel

 

Gynakol Geburtshilfliche Rundsch. 2007;47(3):118-23.

[Conservative therapy of endometriosis]

[Article in German]

Oehmke F, Deisting C, Tinneberg HR.

Zentrum für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Giessen und Marburg GmbH, Standort Giessen, Giessen, Germany. Frank.Oehmke@gyn.med.uni-giessen.de

Endometriosis is the second most frequent benign disease of the female of reproductive age. In spite of extensive research, the etiology of this disease is still largely enigmatic. A causal therapy has not been found yet. Several drug therapy approaches are available but none offers a permanent cure of endometriosis. In addition, the range of side effects of the particular drug therapies has to be considered individually. The treatment of patients with endometriosis cannot be standardized but has to differentiate the individual factors and life circumstances of the patients. Copyright 2007 S. Karger AG, Basel

 

Gynakol Geburtshilfliche Rundsch. 2007;47(3):113-7.

[New insights into the pathophysiology of endometriosis]

[Article in German]

Neukomm C, Mueller MD.

Kliniken und Polikliniken für Frauenheilkunde, Universitätsspital Insel, Bern, Switzerland.

Endometriosis is a fascinating and complex disease resulting from a dysregulation between exfoliated menstrual endometrium and the intra-abdominal environment. Increased concentrations of activated pelvic macrophages and lymphocytes and elevated levels of specific cytokines and growth factors in the peritoneal fluid support this hypothesis. The precise roles of these soluble factors are currently unknown, but we propose that a complex interplay of these locally produced cytokines, growth factors, steroids and eicosanoids modulates the growth and inflammatory behavior of ectopic endometrial implants via neovascularization. The enhanced secretion of local proangiogenic proteins by endometriosis lesions and associated immune cells (and the concomitant reduction of antiangiogenic principles) promotes the recruitment of capillaries toward the growing lesions. Ultimately, a cascade of effects on the peritoneal microenvironment results in implant proliferation and invasion. Future therapeutic strategies to target these angiogenic stimuli have the potential to block the vascular pathogenesis of endometriosis. This article gives an overview of the different factors involved in the development, growth and progression of endometriosis. Copyright 2007 S. Karger AG, Basel

 

Gynakol Geburtshilfliche Rundsch. 2007;47(3):111-2.

[Endometriosis–a frequently underestimated disease]

[Article in German]

Fink D, Lang U, Kimmig R.

Endometriosis is one of the most frequent gynecological disorders. The diagnosis is usually confirmed by laparoscopy. As the etiology and pathogenesis of endometriosis are still mostly obscure, a causal therapy has not been found yet. As for the medicinal treatment of endometriosis, all modern therapeutic approaches aim at ovarian downregulation or at antagonizing the estrogen effects in the endometriosis focus. Surgery aims at a preferably complete resection of all endometriosis focuses. In addition to individual distress, the economic aspect must not be neglected because of its high morbidity, loss of workforce and the repeated therapeutic interventions. As treatment strongly depends on the specific complaints and the personal life circumstances of the patient, an individual therapy concept should always be considered. Copyright 2007 S. Karger AG, Basel

 

Proc Natl Acad Sci U S A. 2007 Jul 24;104(30):12451-6. Epub 2007 Jul 17.

Human endometriosis is associated with plasma cells and overexpression of B lymphocyte stimulator.

Hever A, Roth RB, Hevezi P, Marin ME, Acosta JA, Acosta H, Rojas J, Herrera R, Grigoriadis D, White E, Conlon PJ, Maki RA, Zlotnik A.

Neurocrine Biosciences, Department of Discovery Biology, San Diego, CA 92130, USA.

Endometriosis affects 10-20% of women of reproductive age and is associated with pelvic pain and infertility, and its pathogenesis is not well understood. We used genomewide transcriptional profiling to characterize endometriosis and found that it exhibits a gene expression signature consistent with an underlying autoimmune mechanism. Endometriosis lesions are characterized by the presence of abundant plasma cells, many of which produce IgM, and macrophages that produce BLyS/BAFF/TNFSF13B, a member of the TNF superfamily implicated in other autoimmune diseases. B lymphocyte stimulator (BLyS) protein was found elevated in the serum of endometriosis patients. These observations suggest a model for the pathology of endometriosis where BLyS-responsive plasma cells interact with retrograde menstrual tissues to give rise to endometriosis lesions.

Lascia un commento

Cerca

Utilizzando il sito, accetti l'utilizzo dei cookie da parte nostra. maggiori informazioni

Questo sito utilizza i cookie per fornire la migliore esperienza di navigazione possibile. Continuando a utilizzare questo sito senza modificare le impostazioni dei cookie o cliccando su "Accetta" permetti il loro utilizzo.

Chiudi