90: J Obstet Gynaecol. 2004 Apr;24(3):330-1.
Not all endometriosis is benign.
Byrd L, Slade R, Mamtora H.
Hope Hospital , Salford , UK .
Publication Types:
Case Reports
PMID: 15203654 [PubMed – indexed for MEDLINE]

91: J Obstet Gynaecol. 2004 Apr;24(3):327.
Vesical endometriosis.
Manikandan R, Pollard A, Pritchard S, Adeyoju A.
Department of Obstetrics and Gynaecology, Urology, Stepping Hill Hospital , Stockport , UK . armanikan@aol.com
Publication Types:
Case Reports
PMID: 15203651 [PubMed – indexed for MEDLINE]

92: J Obstet Gynaecol. 2004 Jun;24(4):468-9.
Persistent post-coital bleeding due to cervical endometriosis.
Doshi J, Doshi S, Sanusi FA, Padwick M.
Department of Obstetrics and Gynaecology, Watford General Hospital , Watford , UK . jdoshi@doctors.org.uk
Publication Types:
Case Reports
PMID: 15203603 [PubMed – indexed for MEDLINE]

93: J Obstet Gynaecol. 2004 Jun;24(4):446-7.
Post-treatment hypomenorrhoea–a clinical indicator of long-term successful outcome of transcervical resection of the endometrium.
Agboola AJ, Kulatilake K, Jayawickrama NS .
Department of Obstetrics and Gynaecology, Singleton Hospital , Sketty Lane , Swansea , UK .
This study aims to evaluate the long-term effectiveness and define one of the indicators of successful outcome of endometrial resections. The study was carried out in a district general hospital setting. This was a retrospective analysis of 54 consecutive women who underwent endometrial resection over a 5-year period. Three (5.5%) complications were noted. Two were primary haemorrhage and one was a postoperative vaginal discharge. Eighty per cent of the patients expressed satisfaction with the outcome of their treatment. Expression of satisfaction at a later date was related to reduced menstrual flow at 6 months (0.005<P<0.001, P=0.18 (95% CI=0.13-0.23). Dissatisfaction was noted in 10 patients. These included two patients whose expectations of outcome were amenorrhoea, although they admitted to reduced menstrual flow. Four patients had other complications, such as adenomyosis, pelvic inflammatory disease and pelvic endometriosis. Endometrial resection is still an effective option for the majority of patients for whom it is a preferred choice. Amenorrhoea at 6 months may be an objective indicator of long-term successful outcome of this procedure, and hence a useful tool for patient counselling.
PMID: 15203589 [PubMed – indexed for MEDLINE]

94: J Obstet Gynaecol. 2004 Jun;24(4):434-40.
Are the anticipated benefits of myomectomy achieved in women of reproductive age? A 5-year review of the results at a UK tertiary hospital.
Olufowobi O, Sharif K, Papaionnou S, Neelakantan D, Mohammed H, Afnan M.
Birmingham Women’s Hospital, Birmingham , UK . femi.olufowobi@bwhct.nhs.uk
Fibroids are the most common benign tumours of the pelvis in women, with a prevalence estimated at 20-50%. They are more common towards the end of the reproductive years. There is a racial preponderance, being more common in black than white women. This may relate to the aetiology, which is still poorly understood. Generally, fibroids do not cause symptoms but some sufferers do complain about pressure symptoms, abnormal vaginal bleeding and infertility. For these reasons, myomectomy is often resorted to after failure of medical interventions on the premise that it brings about improvement/cure of symptoms and enhancement of fertility. However, the evidence for these indications for surgery is hazy. An analysis of the 109 medical records of symptomatic patients who had myomectomy over a 5-year period at a tertiary centre revealed the following. Single-symptom presentation in 41 (38%), menorrhagia in 20 (18%) being the most common. Only 52 (48%) patients had medical treatment of one form or another before myomectomy. Additional operative findings included pelvic adhesions, evidence of PID and endometriosis. Thirty-four (31%) had an estimated blood loss 500 ml and 23 of these patients needed blood transfusion. There were four cases of unscheduled hysterectomies due to uncontrollable bleeding. Pyrexia was the most common (38%) postoperative complication followed by superficial wound infection in 5%. We observed improvement of symptoms, assessed over a range of 2-24 months, in 34 cases (68%) in patients without fertility symptoms who accounted for 50 of these women. The symptomatic benefit was less (36%) in the ‘infertility group’. Following an observation period of over 12-36 months, 17 patients in the ‘infertility group’ were lost to follow-up. Two (14%) of the 14 patients who attempted in vitro fertilisation (IVF) were successful. In the non-IVF group, 13 (46%) of the 28 achieved natural conception. These results suggest that symptomatic improvement and fertility enhancement may be possible in some patients with fibroids. In view of the risks and potential failure of treatment associated with myomectomy these results, yet again, support the fact that patients should be properly counselled before embarking on myomectomy and we strongly advocate local data to form the basis of the advice given during the consultation rather than what obtains in the literature.
PMID: 15203587 [PubMed – indexed for MEDLINE]

95: Di Yi Jun Yi Da Xue Xue Bao. 2004 Jun;24(6):619-22.
[Expression of hepatocyte growth factor and its receptor c-met gene in the endometrium of women with endometriosis] [Article in Chinese] Zong LL, Li YL, Song ST, Jiang ZF, Zhao J.
Department of Oncology, 307 Hospital of Academy of Military Medical Sciences, Beijing 100850, China . zonglili67@hotmail.com
OBJECTIVE: To study the role of hepatocyte growth factor (HGF) and its receptor (c-Met) in the pathogenesis of endometriosis. METHODS: In situ hybridization and immunohistochemistry method was used to examine HGF mRNA and protein expression in eutopic and ectopic endometrium obtained from 54 women in reproductive age with endometriosis confirmed by laparoscopy and histological examination (including 28 cases of stages I/II and 26 of stages III/IV) and from the endometrium of 24 healthy fertile women. RESULTS: In patients with endometriosis, the positivity rate of HGF/c-Met expression was similar in the eutopic and ectopic endometria, but the number of positive cells and expression intensity were much higher in ectopic endometrium. The positive expression rate varied little between the proliferative and secretory stages of the endometrium. Compare with the healthy controls, patients with endometriosis of stages I/II and III/IV had significantly elevated positivity rate of HGF and c-Met expressions in either eutopic and ectopic endometrium, but without significant difference between the two patient groups (P<0.01). The rate of strong c-Met protein expression was significantly higher in III/IV endometriosis than in the controls, without statistical difference between other groups. CONCLUSION: The expressions of HGF and c-met gene are correlated with the pathogenesis of endometriosis, which is preceded by eventful changes in the biological behavior of the eutopic endometrium.
PMID: 15201072 [PubMed – in process]

96: J Am Assoc Gynecol Laparosc. 2004 May;11(2):223-8.
Preoperative double-contrast barium enema in patients with suspected intestinal endometriosis.
Landi S, Barbieri F, Fiaccavento A, Mainardi P, Ruffo G, Selvaggi L, Syed R, Minelli L.
Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Negrar (Verona) Italy.
STUDY OBJECTIVES: To assess the usefulness of double-contrast barium enema (DCBE) in the diagnosis of endometriotic lesions of the bowel and to define its potential value in preoperative decision making for intestinal surgery . DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: General hospital with a specialized endometriosis unit. PATIENTS: One hundred and eight women with symptoms suggestive of intestinal endometriosis who underwent DCBE before laparoscopic surgery . INTERVENTION: Laparoscopic complete excision of endometriosis. MEASUREMENTS AND MAIN RESULTS: Fifty-five patients were found to have an entirely normal colon on DCBE studies. Twenty-eight of these were found to have adhesions of the bowel at laparoscopy. Radiographic abnormalities suggestive of endometriosis were detected in 53 patients; 20 of these underwent laparoscopic bowel segmental resection, 10 laparoscopic full-thickness disc excision, 4 laparoscopic mucosal skinning, and 4 total laparoscopic hysterectomy with bilateral salpingo-oophorectomies. Fourteen patients refused intestinal surgery . One patient had no endometriosis but severe adhesions. In all cases but one, the radiographic findings on DCBE were confirmed by surgery and with histopathologic examination of the resected specimens (accuracy 99%). In these same cases, the preoperative choice of intestinal surgery remained unchanged during the procedure. CONCLUSION: Our data show that, in expert hands, DCBE correlated with a patient’s clinical history and clinical findings is capable of diagnosing bowel wall involvement due to endometriosis, which could require intestinal surgery . This allows for proper preoperative planning of surgical procedures and a thorough informed consent.
PMID: 15200779 [PubMed – indexed for MEDLINE]

97: J Am Assoc Gynecol Laparosc. 2004 May;11(2):219-22.
Laparoscopic spectral analysis of endometriosis.
Demco L.
University of Calgary , Calgary , Canada .
STUDY OBJECTIVE: To determine if lesions of endometriosis will preferentially absorb light of the blue spectrum thus enabling the detection of nonvisualized disease. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University based teaching hospital. PATIENTS: Twenty-five women with pain suggestive of endometriosis. INTERVENTION: A noninvasive technique was employed to better visualize lesions of endometriosis at time of diagnostic laparoscopy. MEASUREMENTS AND MAIN RESULTS: A Storz PDD light source, which delivers a blue light at a specified frequency of 440 Hz, was used concurrently with full-spectrum white light. A Storz PDD laparoscope, which utilizes filters to detect the blue spectrum of light, was then coupled to the blue-light source. Lesions of endometriosis were compared using standard white light to that of blue light. The new lesions seen using blue light were sampled to confirm pathology. Using standard white light, black, red, and clear lesions were identified, and the borders of the lesions were marked. The same lesions were observed using the blue spectrum of light. The lesions absorbed blue light, but nonvisible endometriosis surrounding the classic lesions were also identified. Biopsies confirmed endometriosis in newly visible lesions. CONCLUSION: Lesions of endometriosis preferentially absorb the blue-light spectrum. Laparoscopic spectral analysis enables visualization of previously nonvisible endometriosis and makes other visible lesions easier to identify.
PMID: 15200778 [PubMed – indexed for MEDLINE]

98: J Am Assoc Gynecol Laparosc. 2004 May;11(2):170-4.
Laparoscopic supracervical hysterectomy for the large uterus.
Lyons TL, Adolph AJ, Winer WK.
Center for Women’s Care and Reproductive Surgery, Atlanta , Georgia , USA .
STUDY OBJECTIVE: The purpose of this study was to review outcomes of laparoscopic supracervical hysterectomy (LSH) performed on patients with large uteri and compare those outcomes with existing series of hysterectomies reporting removal of large uteri. DESIGN: Retrospective analysis (Canadian Task Force classification II-3). SETTING: Single surgeon, independent surgery center. PATIENTS: Women with symptomatic myomas and/or menorrhagia. INTERVENTION: Laparoscopic supracervical hysterectomy. MEASUREMENTS AND MAIN RESULTS: All patients undergoing LSH procedures for uteri weighing more than 300 g between the years 1997 and 2001 were evaluated. A retrospective chart review and videotape review were used to assess outcome measures including operative time, complications, estimated blood loss, uterine weight, and pathologic diagnoses. A quality of life questionnaire was submitted to the patients postoperatively. During the 5 years of the study, 329 LSHs were performed, 54 (16.4%) involved uterine weight greater than 300 g, and 31 (67%) of this group had a uterine weight greater than 500 g. Seven patients (2%) had complex pathologies with leiomyomata and endometriosis. There were five cases of reported complications: two intraoperative complications and three postoperative fevers. One procedure was converted to laparotomy. Transfusion rate was 0%, with an average estimated blood loss of 77 mL. The mean number of days to return to work or normal activity was 10.1. Sexual relations were reported to be as good as or better than before the procedure in 88.9% of patients. All the patients reported being satisfied with the procedure. CONCLUSION: The LSH procedure in this series provided an effective, low-morbidity alternative for patients with large uteri to accomplish uterine extirpation. Since reduction of morbidity and improved quality of care for women undergoing hysterectomy are goals of all gynecologists, we believe that LSH is an alternative that should be considered.
PMID: 15200769 [PubMed – indexed for MEDLINE]

99: J Am Assoc Gynecol Laparosc. 2004 May;11(2):162-6.
Laparoscopic excision of adnexal masses.
Marana R, Muzii L, Catalano GF, Caruana P, Oliva C, Marana E.
Department of Obstetrics and Gynecology, Universita Cattolica del Sacro Cuore, Rome, Italy.
STUDY OBJECTIVE: The purpose of the present study was to evaluate a prospective series of consecutive patients with adnexal masses selected with strict preoperative clinical and ultrasonographic criteria. DESIGN: Prospective series of consecutive patients (Canadian Task Force classification II-2). SETTING: Tertiary care university hospitals. PATIENTS: Six hundred and eighty-three consecutive patients under 40 years of age with ultrasonographic evidence of an adnexal cystic mass without thick septa, internal wall papillation, or solid components, except for sonographic pattern suggestive of dermoid. INTERVENTIONS: Operative laparoscopy and follow-up. MEASUREMENTS AND MAIN RESULTS: After initial diagnostic laparoscopy in 13 patients with stage 4 endometriosis and extensive bowel adhesions, in 2 patients with large-volume dermoids, and in 1 patient with suspect ovarian and peritoneal implants, the procedure was converted to laparotomy. Therefore, 667 patients were completely managed by laparoscopy. There were 1069 cysts excised. Histologic diagnosis was endometrioma in 57% of the excised cysts, serous cyst in 13%, dermoid in 12%, paratubal in 8%, mucinous cysts in 5.3%, functional cyst in 2.8%, other benign histotypes in 1.1%, and ovarian malignancies (seven borderline tumors and one endometrioma with a microfocus of G1 endometrioid carcinoma) in 0.7% of the cysts and 1.2% of the patients. These last patients are alive with no evidence of disease after a mean follow-up of 62 months. CONCLUSIONS: In the present series, with accurate preoperative and intraoperative selection, the rate of unexpected borderline or focally invasive malignancies was 1.2% of the patients, and the laparoscopic management of these adnexal masses did not adversely impact on prognosis.
PMID: 15200767 [PubMed – indexed for MEDLINE]

100: J Am Assoc Gynecol Laparosc. 2004 May;11(2):153-61.
Deep endometriosis: definition, pathogenesis, and clinical management.
Vercellini P, Frontino G, Pietropaolo G, Gattei U, Daguati R, Crosignani PG.
Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy.
"Deep endometriosis" includes rectovaginal lesions as well as infiltrative forms that involve vital structures such as bowel, ureters, and bladder. The available evidence suggests the same pathogenesis for deep infiltrating vesical and rectovaginal endometriosis (i.e., intraperitoneal seeding of regurgitated endometrial cells, which collect and implant in the most dependent portions of the peritoneal cavity and the anterior and posterior cul-de-sac, and trigger an inflammatory process leading to adhesion of contiguous organs with creation of false peritoneal bottoms). According to anatomic, surgical, and pathologic findings, deep endometriotic lesions seem to originate intraperitoneally rather than extraperitoneally. Also the lateral asymmetry in the occurrence of ureteral endometriosis is compatible with the menstrual reflux theory and with the anatomic differences of the left and right hemipelvis. Peritoneal, ovarian, and deep endometriosis may be diverse manifestations of a disease with a single origin (i.e., regurgitated endometrium). Based on different pathogenetic hypotheses, several schemes have been proposed to classify deep endometriosis, but further data are needed to demonstrate their validity and reliability. Drugs induce temporary quiescence of active deep lesions and may be useful in selected circumstances. Progestins should be considered as first-line medical treatment for temporary pain relief. However, in most cases of severely infiltrating disease, surgery is the final solution. Great importance must be given to complete and balanced counseling, as awareness of the real possibilities of different treatments will enhance the patient’s collaboration.
Publication Types:
Review Review, Tutorial
PMID: 15200766 [PubMed – indexed for MEDLINE]

101: Reprod Biol Endocrinol. 2004 Jun 16;2(1):34.
Uterine receptivity and implantation: the regulation and action of insulin-like growth factor binding protein-1 (IGFBP-1), HOXA10 and forkhead transcription factor-1 (FOXO-1) in the baboon endometrium.
Kim JJ, Fazleabas AT.
Department of Obstetrics and Gynecology, Northwestern University, Chicago , IL , USA . j-kim4@northwestern.edu
In primates, the phase of the menstrual cycle when the uterus becomes receptive is initially dependent on estrogen and progesterone. Further morphological and biochemical changes are induced as a result of biochemical signals between the embryo and the maternal endometrium. Blastocyst implantation in the baboon usually occurs between 8 and 10 days post ovulation and is similar to that described for the rhesus macaque. In the baboon, when chorionic gonadotropin is infused in a manner that mimics blastocyst transit, this has physiological effects on the three major cell types in the uterine endometrium. The luminal epithelium undergoes endoreplication and distinct epithelial plaques are evident. The glandular epithelium responds by inducing transcriptional and post-translational modifications in the major secretory product, glycodelin. The stromal fibroblasts initiate their differentiation process into a decidual phenotype and are characterized by the expression of actin filaments. Decidualization, is the major change that occurs in the primate endometrium after conception. During this process the fibroblast-like stromal cells change morphologically into polygonal cells and express specific decidual proteins. Studies in the baboon demonstrated that insulin-like growth factor binding protein-1 (IGFBP-1) gene expression is a conceptus-mediated response. Subsequent studies in vitro established that IGFBP-1 is transcriptionally regulated by FOXO1 and HOXA10 which together upregulate the IGFBP-1 promoter activity. A baboon endometriosis model was utilized to determine if the changes observed during uterine receptivity in normally cycling animals were compromised. The data suggests that in animals with disease, markers of uterine receptivity are not appropriately expressed in the eutopic endometrium. It is possible that these differences influence the fertility of the animals with disease and the baboon could be used as a primate model to study the causes of infertility as a result of endometriosis.
PMID: 15200677 [PubMed – in process]

102: Obstet Gynecol Surv. 2004 Jul;59(7):510-1.
Cancer risk after hospital discharge diagnosis of benign ovarian cysts and endometriosis.
Borgfeldt C, Andolf E.
Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden; and the Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Using the Swedish Hospital Discharge Register, the authors identified all Swedish women born before 1970 who had been hospitalized for benign ovarian cyst (n = 42,217), functional ovarian cyst (n = 17,998), or endometriosis (n = 28,163). To serve as controls, they matched each study patient to 3 women listed in the Swedish Population Register with the same birth date. The National Swedish Cancer Register was then used to identify any of these subjects or controls who developed gynecologic cancer. Women who had undergone ovarian cyst resection and/or unilateral oophorectomy had a much higher risk of ever developing ovarian cancer than those who had not (odds ratio [OR], 8.8; 95% confidence interval [CI], 0.35-0.66 vs. OR, 0.48; 95% CI, 5.5-14.8). Whether or not they underwent surgery , women who were hospitalized with a benign or function ovarian cyst when they were 10 to 29 years of age had an increased risk of ovarian cancer later in life (OR for benign cyst, 2.23; 95% CI, 1.29-3.86; OR for functional cyst, 1.76; 95% CI, 1.5-2.0). Women in this age group with endometriosis had an even higher risk of later ovarian cancer (OR, 3.52; 95% CI, 1.56-7.95). However, women who developed an ovarian cyst after the age of 50 years were at decreased risk for subsequent ovarian cancer. When all age groups were combined, there remained an association between endometriosis and later development of ovarian cancer (OR, 1.34; 95% CI, 1.03-1.75). Benign or functional ovarian cysts were not associated with ovarian cancer over all age groups. Nulliparity was a significant factor in the development of ovarian cancer among women who had functional ovarian cysts or endometriosis. The odds ratios for the development of ovarian cancer were 2.28 and 1.89, respectively (95% CI, 1.18-4.37 and 1.19-3.01), for nulliparous women. For women who had 4 or 5 pregnancies before being hospitalized for functional cyst or endometriosis, the odds ratios were 1.01 and 1.27 (95% CI, 0.19-5.29 and 0.24-6.63), respectively. Compared with the control group, women who were hospitalized for benign ovarian cyst developed ovarian cancer at a younger age (47.6 vs. 54.1 years; P < 0.001). Similarly, women who were hospitalized for a functional ovarian cyst or endometriosis were diagnosed with ovarian cancer at a younger age than controls (40.7 vs. 49.1 years, P < 0.02; and 49.0 vs. 51.6 years, P < 0.001, respectively). Excluding women who developed ovarian cancer at ages younger than 30 and 35 years did not eliminate the association of ovarian cysts, functional cysts, or endometriosis with a lower mean age for ovarian cancer when compared with controls (P < 0.05 for all comparisons). Women who had a hospital discharge diagnosis of endometriosis had a lower overall risk for development of endometrial cancer. There was no association seen with the diagnosis of benign or functional ovarian cyst with later cancer of the breast or cervix.
PMID: 15199262 [PubMed – in process]

103: Zhonghua Fu Chan Ke Za Zhi. 2004 May;39(5):311-4.
[Ureteral injury in gynecologic laparoscopies] [Article in Chinese] Gao JS, Leng JH, Lang JH, Liu ZF, Shen K, Sun DW, Zhu L.
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
OBJECTIVE: To investigate the ureteral injury in gynecological laparoscopies and discuss its diagnosis, treatment and prevention. METHODS: Ureteral injury in gynecological laparoscopies during the past 13 years was reviewed retrospectively. The clinical features of initial operations including the types of disease, uterine size, pelvic adhesion, operative procedures and the methods of diagnosis, treatment and prognosis of ureteral injury were studied. RESULTS: There were 8 ureteral injuries (0.14%) in 5 541 gynecological laparoscopies with seven in laparoscopically assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) (0.45%) and one in non-LAVH (0.03%). The main gynecological disorders included adenomyosis, endometriosis and leiomyoma. All patients had pelvic adhesions and 4 had previous pelvic operations. Uterine enlargement was found in 7. Patients presented increased vaginal drainage, flank pain, increased volumes of vaginal discharge, nausea and vomiting, fever, edema, or peritonitis from 0 to 13 days postoperatively. Ureteral injuries were mainly diagnosed via excretory urogram (IVP). The sites of injury were near the inferior margin of the sacroiliac joint in two women and at the inferior part of ureter (near the uterine vessel, uterosacral ligament and ureterovesical junction) in 6. Two patients whose injuries were found soon after operation received ureteral repair by laparotomy successfully. Two of the six patients whose injuries were found several days later were treated with internal ureteral stenting successfully, the other four failed with ureteral stenting and received ureteral repair by laparotomy. Outcomes were good in all cases. CONCLUSIONS: Ureteral injury is an uncommon and severe complication in gynecological laparoscopies. Symptoms like abnormally increased drainage, fever, flank pain, abnormal vaginal discharge and peritonitis after operation should be paid attention to and ureteral injury be considered. Surgical repair is the primary treatment.
PMID: 15196412 [PubMed – in process]

104: Biomarkers. 2003 Nov-Dec;8(6):529-34.
Dioxin/polychlorinated biphenyl body burden, diabetes and endometriosis: findings in a population-based study in Belgium .
Fierens S, Mairesse H, Heilier JF, De Burbure C, Focant JF, Eppe G, De Pauw E, Bernard A.
Toxicology Unit, Universite catholique de Louvain , Brussels , Belgium .
Dioxins and polychlorinated biphenyls (PCBs) are persistent organic pollutants widely distributed in the food chain, which is the main source of human exposure. Their effects on human health at background exposure levels are still poorly understood. Recent epidemiological evidence suggests a possible association between these pollutants and diabetes. We report here the results of a population-based study in Belgium on 257 (142 women and 115 men) environmentally exposed subjects, including 10 cases of endometriosis and nine cases of diabetes. Seventeen 2,3,7,8-polychlorinated dibenzodioxins/dibenzofurans (PCDD/Fs or dioxins), four coplanar PCBs (International Union of Pure and Applied Chemistry [IUPAC] nos 77, 81, 126 and 169) and 12 PCB markers (IUPAC nos 3, 8, 28, 52, 101, 118, 138, 153, 180, 194, 206 and 209) were quantified in serum fat from fasting blood samples in order to estimate the body burden of these pollutants. Whilst no difference was found between women with endometriosis and their controls, diabetic patients had significantly increased serum levels of dioxins, coplanar PCBs and the 12 PCB markers. After adjustment for age and other covariates, serum total toxic equivalent activity (sum of PCDD/Fs and coplanar PCBs) and 12 PCB marker concentrations in diabetics were 62% (p = 0.0005) and 39% (p = 0.0067) higher, respectively, than in controls. The risk of diabetes was significantly increased in subjects in the top decile for adjusted concentrations of dioxins (odds ratio 5.1, 95% confidence interval [CI] 1.18-21.7), coplanar PCBs (odds ratio 13.3, 95% CI 3.31-53.2) or 12 PCB markers (odds ratio 7.6, 95% CI 1.58-36.3). These findings warrant further studies to assess the significance of the associations between diabetes and environmental exposure to polychlorinated pollutants.
PMID: 15195683 [PubMed – indexed for MEDLINE]

105: Gynecol Endocrinol. 2004 Feb;18(2):114-6.
Umbilical endometriosis in pregnancy: a case report.
Razzi S, Rubegni P, Sartini A, De Simone S, Fava A, Cobellis L, Fimiani M, Petraglia F.
Department of Pediatrics, Obstetrics and Reproductive Medicine, Chair of Obstetrics and Gynecology, University of Siena, Italy.
To our knowledge, this is the first case reported in the literature of umbilical endometriosis in a pregnant woman. We report a case of umbilical endometriosis in a pregnant woman at 16 weeks of gestation. The patient revealed a reddish-brown polypoid nodule within the umbilical depression, with the typical history of monthly bleeding from the umbilicus. A nodule biopsy, testing of serum levels of CA-125 and a transabdominal ultrasound examination were performed. The diagnosis of endometriosis was confirmed by pathological examination. Serum levels of CA-125 were slightly increased and the pelvic ultrasound examination did not identify ovarian cysts of a possible endometriotic nature. The patient was also examined at 24 weeks’ gestation, after delivery and in the late postpartum period. No therapy was given and the lesion resolved spontaneously 2 months after the biopsy was taken.
Publication Types:
Case Reports
PMID: 15195504 [PubMed – indexed for MEDLINE]

106: Gynecol Endocrinol. 2004 Feb;18(2):101-6.
Proliferation kinetics in adenomyosis during the menstrual cycle and during oral contraceptive use.
Maia H Jr, Maltez A, Studart E, Athayde C, Coutinho EM.
Research Department, CEPARH, Salvador , Bahia , Brazil .
Our objective was to investigate the presence of focal p53 expression in relation to proliferation rates in adenomyotic lesions during the menstrual cycle and in women on oral contraception. Fifty-nine perimenopausal patients with menorrhagia and adenomyosis were submitted to endometrial resection. The procedure was carried out during menstruation (n = 14), during the proliferative phase (n = 15), during the luteal phase (n = 20) or following the use of oral contraceptives (n = 10). The number of Ki-67-positive cells was low during menstruation, during the luteal phase and following the use of progestins. In the proliferative phase, on the other hand, there was a significant increase in the percentage of Ki-67-positive cells. Focal p53 expression was detected mainly during the proliferative phase of the menstrual cycle when proliferation rates were high. PTEN expression was detected in all cases irrespective of the phase of the menstrual cycle or use of oral contraception. We conclude that proliferation rates in adenomyotic lesions undergo marked cyclic variations and this affects the percentage of cases showing focal p53 expression in the glandular epithelium.
PMID: 15195502 [PubMed – indexed for MEDLINE]

107: Gut. 2004 Jul;53(7):1000, 1019.
An unusual treatment for a colonic polyp.
Viscido A, Aratari A, Pimpo M, D’Ovidio V, Frieri G, Caprilli R, Porpora MG, Crobu M.
GI Unit, Department of Clinical Sciences and Gynaecological Unit, University La Sapienza, Rome, Italy.
Publication Types:
Case Reports
PMID: 15194651 [PubMed – indexed for MEDLINE]

108: Fertil Steril. 2004 Jun;81(6):1722; author reply 1722-3.
Potential cofounders in the laparoscopic detection of endometriosis.
Batt RE, Arroyo A, Mitwally MF, Yeh J.
PMID: 15193516 [PubMed – indexed for MEDLINE]

109: Fertil Steril. 2004 Jun;81(6):1650-6.
Polymorphisms in the estrogen receptor beta gene but not estrogen receptor alpha gene affect the risk of developing endometriosis in a Japanese population.
Wang Z, Yoshida S, Negoro K, Kennedy S, Barlow D, Maruo T.
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe , Japan .
OBJECTIVE: To determine whether polymorphisms in the estrogen receptor (ER) alpha and beta genes are associated with endometriosis in a Japanese population. DESIGN: Association study. SETTING: University hospital. PATIENT(S): Japanese women diagnosed with endometriosis by laparotomy or laparoscopy. INTERVENTION(S): Determination of polymorphisms in the ERalpha and ERbeta genes was performed by polymerase chain reaction restriction fragment-length polymorphism analysis in 132 affected women and 182 controls. MAIN OUTCOME MEASURE(S): Frequency and distribution of AluI and RsaI polymorphisms in ERbeta gene and of PvuII and XbaI polymorphisms in ERalpha gene. RESULT(S): No significant differences in the frequency of either AluI and RsaI polymorphisms in the ERbeta gene or of XbaI and PvuII polymorphisms in the ERalpha gene were found between endometriosis patients and controls. However, a positive association was noted between the AluI polymorphism in the ERbeta gene and stage IV endometriosis patients in the population studied. CONCLUSION(S): The AluI polymorphism in the ERbeta gene is associated with an increased risk of stage IV endometriosis in a Japanese population.
PMID: 15193490 [PubMed – indexed for MEDLINE]

110: Fertil Steril. 2004 Jun;81(6):1528-33.
Immunohistochemical analysis of vascular endothelial growth factor cellular expression in ovarian endometriomata.
Goteri G, Lucarini G, Filosa A, Pierantoni A, Montik N, Biagini G, Fabris G, Ciavattini A.
School of Medicine, Universita Politecnica delle Marche, Ancona, Italy. g.goteri@ao-umbertoprimo.marche.it
OBJECTIVE: To evaluate the expression of vascular endothelial growth factor (VEGF) in the cell populations of ovarian endometriomata cyst layers. DESIGN: Experimental retrospective study. SETTING: University hospital. PATIENT(S): Twenty-eight patients with ovarian endometriomata. INTERVENTION(S): Surgical excision of 32 ovarian cysts. MAIN OUTCOME MEASURE(S): Histologic and VEGF immunohistochemical analysis of cyst layers. RESULT(S): Though the least represented cell types, macrophages exhibited the highest frequency of strong immunoreactivity, followed by capsular vessel endothelial and subepithelial stromal cells and by epithelial cells and capsular fibroblasts. Endothelia of the subepithelial stroma were the least immunoreactive cells. Diffuse VEGF expression in epithelial cells was associated with cyst diameters greater than 5.4 cm, and high VEGF expression in capsular fibroblasts was associated with bilateral cysts. CONCLUSION(S): Angiogenesis plays an active role in ovarian endometriosis, especially in the presence of large and bilateral cysts. Expression of VEGF in epithelial cells, capsular fibroblasts, and vessels was found to be related, suggesting that neoangiogenesis might especially affect the outer cyst wall, thus contributing to the fibrosing process of adhesion formation during cyst growth.
PMID: 15193472 [PubMed – indexed for MEDLINE]

111: Fertil Steril. 2004 Jun;81(6):1522-7.
An open and randomized study comparing the efficacy of standard danazol and modified triptorelin regimens for postoperative disease management of moderate to severe endometriosis.
Wong AY, Tang L.
Department of Obstetrics and Gynaecology, Kwong Wah Hospital , Hong Kong SAR, People’s Republic of China . alicewyk@netvigator.com
OBJECTIVE: To compare the efficacy of danazol and triptorelin (Decapeptyl CR, Ferring, Kiel, Germany) in the management of moderate and severe endometriosis in terms of symptom control and revised American Fertility Society (AFS) score reduction, and to evaluate the hormonal profile of patients treated with triptorelin every 6 weeks. DESIGN: Open and randomized trial. SETTING: Kwong Wah Hospital , a large public hospital in an urban location ( Hong Kong ). PATIENT(S): Forty patients after their first conservative operation for endometriosis, with surgical confirmation of revised AFS stage III or IV endometriosis. INTERVENTION(S): Postoperative 6 months’ therapy of danazol or triptorelin every 6 weeks, postmedical therapy second-look laparoscopy. MAIN OUTCOME MEASURE(S): Symptom control and patients’ tolerance during medical therapy, posttherapy revised AFS score, hormonal profile during triptorelin therapy. RESULT(S): Pain control was similar between danazol and triptorelin therapy. There was less breakthrough bleeding with triptorelin. More patients failed to complete the whole course of danazol because of its side effects. The revised AFS score at second-look laparoscopy did not show a significant difference between the two medications. Adequate pituitary suppression was observed with injection of triptorelin every 6 weeks. CONCLUSION(S): Lengthening of triptorelin administration intervals from 4 weeks to 6 weeks is effective in maintaining a hypoestrogenic state. Patients were more compliant with triptorelin than danazol. Thus, triptorelin injection every 6 weeks is more cost-effective than conventional regimens.
Publication Types:
Clinical Trial Randomized Controlled Trial
PMID: 15193471 [PubMed – indexed for MEDLINE]