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Am Fam Physician. 2007 May 15;75(10):1541-2.

Pain in the right lower quadrant.

Chou JS, Chung CR, Hu WM.

dr166@mail.tygh.gov.tw

Br J Gen Pract. 2007 Jun;57(539):470-6.

Management of endometriosis in general practice: the pathway to diagnosis.

Pugsley Z, Ballard K.

University of Surrey, Postgraduate Medical School, Guildford. zoelee@doctors.org.uk

BACKGROUND: The prevalence of endometriosis is estimated to be around 10%. Diagnosis is through visualisation of the lesions, mostly via laparoscopy. Studies reveal that there is an average delay in the diagnosis of endometriosis of between 8 and 12 years. Little is known about the reasons for delays in diagnosis women’s experiences of primary care prior to diagnosis. AIM: To investigate women’s experiences of endometriosis from first presentation to diagnosis. DESIGN OF STUDY: Retrospective analysis of data collected from primary care records in four general practices. SETTING: General practice in south-east England. METHOD: Women with a Read Code diagnosis of endometriosis were recruited to the study. Details of consultations, investigations, and referrals related to endometriosis were recorded from the notes. Data were analysed using descriptive statistics. RESULTS: The prevalence of endometriosis in women aged over 16 years was 1.44%. A third of women had consulted their GP six or more times before being diagnosed. Ultrasound was frequently requested by GPs, but was helpful in diagnosing endometriosis in only 10.6% of women who underwent a scan. Thirty-nine per cent of women were referred to gynaecologists two or more times before a positive diagnosis was made. The median time from first presentation with symptoms to diagnosis was 9.0 years (interquartile range = 4.5-13.5 years). CONCLUSION: Repeated consultations and negative investigations contribute to a median delay of 9.0 years before diagnosis of endometriosis. Further research into GPs’ interpretation of symptoms and patients’ experiences of negative investigations and consultations may lead to a more positive outcome for women with this condition.

Aust N Z J Obstet Gynaecol. 2007 Jun;47(3):247-9.

Simultaneous use of a levonorgestrel intrauterine system and an etonogestrel subdermal implant for debilitating adolescent endometriosis.

Al-Jefout M, Palmer J, Fraser IS.

Department of Obstetrics and Gynaecology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, New South Wales, Australia.

Adolescent familial endometriosis may cause severe and persistent symptoms that are disruptive to lifestyle. Treatment may be difficult in many cases. We describe the novel and successful first use of a simultaneous combination of a levonorgestrel intrauterine system and an etonogestrel subdermal implant in a teenager with severe pain symptoms as a result of laparoscopically confirmed endometriosis, which was refractory to other treatments.

Aust N Z J Obstet Gynaecol. 2007 Jun;47(3):230-4.

Laparoscopic-assisted vaginal hysterectomy for patients with extensive pelvic adhesions: a strategy to minimise conversion to laparotomy.

Hsu WC, Chang WC, Huang SC, Sheu BC, Torng PL, Chang DY.

Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

AIM: To evaluate a strategy for successful laparoscopic-assisted vaginal hysterectomy (LAVH) in patients with extensive pelvic adhesion. METHODS: Two hundred and thirty-six patients who underwent LAVH at National Taiwan University Hospital were retrospectively enrolled. Twenty-three patients (9.7%) had unexpected extensive pelvic adhesions. A special procedure of uterine artery preligation through retroperitoneal downstream ureter tracking was applied to overcome this problem. The clinical characteristics of the study group were analysed. The operative parameters and the outcome were compared between those with and without extensive pelvic adhesions. RESULTS: Having extensive adhesions, 17 patients were associated with endometriosis and the other six were secondary to previous Caesarean delivery or pelvic inflammation. The cul-de-sac was partially and totally obliterated in 10 and 13 patients, respectively. These 23 patients had longer operation time (184 vs 146 min, P < 0.05), more blood loss (146 vs 89 mL, P < 0.05), but smaller extirpated uteri (278 vs 372 g, P = 0.063), compared with the other 213 patients. The average hospital stay was comparable (3.2 vs 3.4 days) and there were no ureteral injuries or excessive bleeding. Most importantly, not a single case was converted to laparotomy. CONCLUSION: Pelvic adhesions of various underlying diseases are associated with increased complication and conversion rates during LAVH. Although this technique is not new, we believe that the special procedure of uterine artery preligation through retroperitoneal downstream ureter tracking may provide a safe approach for general gynecologists to complete successful LAVH in patients with unexpected extensive pelvic adhesions.

Aust N Z J Obstet Gynaecol. 2007 Jun;47(3):222-5.

Letrozole and desogestrel-only contraceptive pill for the treatment of stage IV endometriosis.

Remorgida V, Abbamonte LH, Ragni N, Fulcheri E, Ferrero S.

Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Genoa, Italy.

BACKGROUND: It has recently been suggested that aromatase inhibitors may effectively reduce pain symptoms related to the presence of endometriosis both in postmenopausal women and in subjects of reproductive age. AIMS: This study aims to evaluate the effectiveness of a combination of letrozole and desogestrel in the treatment of pain symptoms related to the presence of endometriosis. METHODS: This open-label prospective study included 12 women with endometriosis-related pain symptoms that were refractory to previous medical and surgical treatments. All women had previous laparoscopy documenting stage IV endometriosis. The treatment protocol included the daily oral administration of letrozole 2.5 mg (Femara), desogestrel 75 microg (Cerazette), elemental calcium 1000 mg and vitamin D 880 I.U. The scheduled treatment period was six months. RESULTS: None of the women included in the study completed the six-month treatment because all patients developed ovarian cysts; the median length of treatment was 84 days (range, 56-112). At interruption of treatment, all women reported significant improvements in dysmenorrhoea and dyspareunia. Pain symptoms quickly recurred at three-month follow up. There were no severe adverse effects of treatment; no significant change in the mineral bone density was observed during treatment. CONCLUSIONS: The combination of letrozole and desogestrel induces a relief of pain symptoms in women with endometriosis but it causes the development of ovarian cysts. Pain symptoms quickly recur after the completion of treatment.

Hum Reprod. 2007 Aug;22(8):2273-8. Epub 2007 Jun 4.

Vitamin D reserve is higher in women with endometriosis.

Somigliana E, Panina-Bordignon P, Murone S, Di Lucia P, Vercellini P, Vigano P.

Infertility Unit, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via M. Fanti 6, 20122 Milan, Italy. dadosomigliana@yahoo.it

BACKGROUND: An immune-mediated defect in recognition and elimination of endometrial fragments refluxed in the peritoneal cavity has been hypothesized to play a crucial role in endometriosis development. Since vitamin D is an effective modulator of the immune system, we have hypothesized that the vitamin D status may have a role in the pathogenesis of endometriosis. METHODS: Women of reproductive age selected for surgery for gynecological indications were enrolled in this prospective cohort study. Serum levels of 25-hydroxyvitamin-D(3), 1,25-dihydroxyvitamin-D(3) and Ca(2+) were assessed. RESULTS: Eighty-seven women with endometriosis and 53 controls were recruited. Mean (+/- SD) levels of 25-hydroxyvitamin-D(3) in women with and without endometriosis were 24.9 +/- 14.8 ng/ml and 20.4 +/- 11.8, respectively (P = 0.05). The Odds Ratio (95% Confidence Interval) for endometriosis in patients with levels exceeding the 75th percentile of the serum distribution of the molecule (28.2 ng/ml) was 4.8 (1.7-13.5). A positive gradient according to the severity of the disease was also documented. A trend towards higher levels of 1,25-dihydroxyvitamin-D(3) and Ca(2+) was observed in women with endometriosis, but differences did not reach statistical significance. As expected, serum concentrations of 25-hydroxyvitamin-D(3) and 1,25-dihydroxyvitamin-D(3,) but not Ca(2+), are influenced by the season (P < 0.001, P = 0.004, P = 0.57, respectively), while levels of the three molecules did not vary according to the phase of the menstrual cycle. CONCLUSIONS: Endometriosis is associated with higher serum levels of vitamin D.

Fertil Steril. 2007 Nov;88(5):1293-7. Epub 2007 Jun 4.

“Tenderness-guided” transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain.

Guerriero S, Ajossa S, Gerada M, D’Aquila M, Piras B, Melis GB.

Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, Italy. gineca.sguerriero@tiscali.it

OBJECTIVE: To determine the accuracy of transvaginal ultrasonography (TVUS) using a modified “tenderness-guided” approach in the diagnosis of deep endometriosis of the cul-de-sac, retrocervical region, and rectovaginal septum. DESIGN: Prospective study. SETTING: Academic department of obstetrics and gynecology. PATIENT(S): Fifty women scheduled for laparoscopy for chronic pelvic pain. INTERVENTION(S): All patients underwent TVUS. The modified tenderness-guided approach consisted of TVUS combined with the introduction of 12 mL of ultrasound transmission gel (instead of the usual 4 mL) in the probe cover to create a stand-off to visualize the near-field area. The posterior fornix was evaluated accurately with an up-and-down sliding movement of the probe. In addition, when the patient indicated that tenderness was evoked by the probe’s pressure, the sliding movement was stopped, and particular attention was paid to the painful site for detection of endometriosis lesions. MAIN OUTCOME MEASURE(S): Sensitivity, specificity, and kappa values. RESULT(S): Using this approach, we obtained a specificity of 95% with a sensitivity of 90%, associated with a very high kappa value of 0.86 (95% CI, 0.56-0.91). CONCLUSION(S): Our new TVUS approach appears to be an accurate, inexpensive, and less invasive method for the diagnosis of deep endometriosis.

Ginecol Obstet Mex. 2007 Mar;75(3):172-7.

[Tests of estrogenic substances activity in women. Application to the study of etinil-estradiol and of bisdehydrodoisynolic acid. 1952]

[Article in Spanish]

Varangot J.

Univ. de Paris

Ginecol Obstet Mex. 2007 Mar;75(3):121-6.

[Clinical implication and frequency of the incidental finding of endometriosis during oocyte retrieval]

[Article in Spanish]

Ruiz Anguas J, Carballo Mondragón E, Anta Jaen E, Durán Monterrosas L, Kably Ambe A.

Unidad de Reproducción Asistida, Centro Especializado para la Atención de la Mujer, Hospital Angeles de las Lomas, Valle de las Palmas, Estado de México. drjruiz@prodigy.net.mx

BACKGROUND: Endometriosis is a clinical disease that is associated with poor outcomes in in vitro fertilization (IVF) programs with a decrease in oocyte retrieval, oocyte quality, implantation and pregnancy rates. When an endometrioma is diagnosed, it is indicated to remove endometrial cysts by laparoscopy or perform an aspiration before the cycle of IVF. OBJECTIVES: To evaluate the effect of endometriosis diagnosed incidentally during oocyte retrieval on the IVF outcome, as well as to establish its frequency. MATERIAL AND METHODS: Retrospective analysis of 1,000 files of patients who underwent to oocyte retrieval between January 2002 and March 2005, in the Centro Especializado para la Atenci6n de la Mujer in Mexico City. Of the total procedures tubal factor was the first indication for IVF and male factor was on second place. Only in seven patients of 1,000 oocyte retrievals was detected the presence of endometriosis fluid instead of folicular fluid. RESULTS: The prevalence of endometriosis diagnosed incidentally during oocyte retrieval was 0.7%, and the oocyte quality was 1.55 (regular). The fertilization rate for patients with endometriomas was 45% and the implantation and pregnancy rates were zero per cent while the patients without endometriomas the fertilization rate was 65% with an implantation rate of 18% and the pregnancy rate was 35%. CONCLUSION: Endometriosis is a disease that must be treated before an IVF cycle in stages III-IV and especially in presence of endometriomas because it could affect negatively IVF outcomes.

Cleve Clin J Med. 2007 May;74 Suppl 3:S54-62.

Interstitial cystitis/painful bladder syndrome: symptom recognition is key to early identification, treatment.

Rosenberg MT, Newman DK, Page SA.

Mid-Michigan Health Centers, Jackson, MI 49201, USA. mattoren@yahoo.com

Once thought to be rare, interstitial cystitis (IC) is now believed to have a markedly higher prevalence. This potentially devastating disease is also known as painful bladder syndrome (PBS) and can significantly impact quality of life. It is diagnosed by its symptoms, as there are no proven pathological findings. Unfortunately, the symptoms of IC/PBS overlap those of other common disease states such as overactive bladder, endometriosis, urinary tract infection, and prostatitis, which complicates the differential diagnosis. Understanding the presenting symptoms of urinary frequency, urinary urgency, and pelvic pain in the presence of otherwise normal findings can enhance primary care providers’ ability to appropriately identify the disease. Early identification may allow initiation of therapy or referral before the disease becomes refractory to standard treatment, which typically includes behavioral therapy and possibly multimodal drug therapy.

Minim Invasive Neurosurg. 2007 Feb;50(1):33-6.

Laparoscopic neurolysis of the sacral plexus and the sciatic nerve for extensive endometriosis of the pelvic wall.

Possover M, Baekelandt J, Flaskamp C, Li D, Chiantera V.

Department of Obstetrics and Gynecology, St. Elisabeth Hospital, Cologne, Germany. Marc.Possover@hohenlind.de

BACKGROUND: The aim of this study is to report on the feasibility of laparoscopic neurolysis of the plexus sacralis and the sciatic nerve in deep endometriotic infiltration of the lateral pelvic wall. METHODS: A transperitoneal approach to the pelvic nerves combined with the LANN technique for intraoperative assessment of the function of the exposed nerves permit exposure and sparing of all somatic nerves during resection of the endometriotic lesion. RESULTS: We report on our short experience with 21 patients who underwent this technique for the treatment of endometriotic infiltration of the sacral plexus at different levels. CONCLUSION: In young patients with chronic unilateral sciatica or unilateral pudendal neuralgia – Alcock’s canal syndrome – where no neurological/orthopedic etiologies have been found, endometriotic infiltration of the lateral pelvic wall has to be implicated as a potential etiology and an indication for laparoscopy must be discussed. Laparoscopic neurolysis of the pelvic somatic nerves is a feasible procedure for trained laparoscopic surgeons who have a good knowledge of the retroperitoneal pelvic (neuro)anatomy.

Curr Opin Oncol. 2007 Jul;19(4):347-52.

Hormonal therapy of endometrial stromal sarcoma.

Reich O, Regauer S.

Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria. olaf.reich@meduni-graz.at

PURPOSE OF REVIEW: Low-grade endometrial stromal sarcomas are steroid receptor positive tumors with slow tumor progression and high recurrence rates, which lack established treatment protocols. We present an update on hormonal therapy options. RECENT FINDINGS: In the past, hormonal therapy consisted of progestins for advanced/recurrent/metastatic low-grade endometrial stromal sarcomas. Aromatase inhibitors and gonadotropin-releasing hormone analogues have become new effective alternatives for first and second line treatment. The high recurrence rates after short disease free intervals in low-grade endometrial stromal sarcoma patients were partly due to inadvertent growth stimulation during estrogen-containing hormone replacement therapy and tamoxifen treatment, which – according to current knowledge – are contraindicated. Recently, hormonal therapy has been introduced for the prevention of recurrences. Aromatase inhibitors are becoming the treatment of choice, since progestins are poorly tolerated due to side effects. The effective duration of preventive hormonal therapy is still undetermined. SUMMARY: Hormonal therapy with progestins, aromatase inhibitors and gonadotropin-releasing hormone analogues has become an effective treatment alternative to radiation and chemotherapy for low-grade endometrial stromal sarcoma patients. Preventive hormonal therapy is of particular interest in the setting of concomitant endometriosis.

Nan Fang Yi Ke Da Xue Xue Bao. 2007 Apr;27(4):538-40.

[Expression of hypoxia-inducible factor-1alpha in endometriosis]

[Article in Chinese]

Ren X, He YL, Pan SL, Peng DX.

Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China. renxu@fimmu.com

OBJECTIVE: To detect the expression of hypoxia-inducible factor-1alpha(HIF-1alpha) in endometriosis and explore the possible role of HIF-1alpha in the pathogenesis of endometriosis. METHODS: Immunohistochemistry was performed to examine the expression of HIF-1alpha in 20 normal endometrium, 20 ectopic endometrium and 68 eutopic endometrium specimens from 68 endometriosis patients, and the results were analyzed statistically. RESULTS: The expression of HIF-1alpha was significantly increased in ectopic endometrium than in normal endometrium (P<0.01), and the expression did not undergo changes with the normal menstrual cycle in the three types of endometrium. CONCLUSION: HIF-1alpha expression increases in ectopic endometrium, suggesting that HIF-1alpha plays an important role in the pathogenesis of endometriosis.

Clin Gastroenterol Hepatol. 2007 Jun;5(6):A30.

Small bowel obstruction caused by endometriosis.

Attar A, Lagorce C.

Service de Gastro-entérologie et d’Assistance Nutritive, Hôpital Beaujon, Clichy, France.

Fertil Steril. 2007 Oct;88(4):789-94. Epub 2007 Jun 4.

Efficacy of vaginal danazol treatment in women with recurrent deeply infiltrating endometriosis.

Razzi S, Luisi S, Calonaci F, Altomare A, Bocchi C, Petraglia F.

Division of Obstetrics and Gynecology, Department of Pediatrics, Gynecology and Reproductive Medicine, University of Siena, Siena, Italy.

OBJECTIVE: To describe a safe long-term medical treatment for deeply infiltrating endometriosis, a critical condition characterized by multiple painful symptoms and a high recurrence rate after surgical treatment. DESIGN: Prospective study. SETTING: University of Siena. PATIENT(S): Twenty-one women with deeply infiltrating endometriosis. INTERVENTION(S): In a nonrandomized prospective study a low dose of vaginal danazol (200 mg/d) was self-administered for 12 months. After a previous laparoscopic surgery, these patients had reported recurrent severe dyspareunia, dysmenorrhea, and pelvic pain (in five cases also painful defecation). MAIN OUTCOME MEASURE(S): Before and every 3 months during the treatment a visual analogue pain scale was used. Transvaginal and transrectal ultrasound examinations were performed before and after 6 and 12 months of treatment. Adverse effects were registered, and serum concentration of cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, glycemia, protein S, protein C, antithrombin III, and homocysteine was evaluated before and after 12 months. RESULT(S): Dysmenorrhea, dyspareunia, and pelvic pain significantly decreased within 3 months and disappeared after 6 months of treatment, with a persistent effect during the 12 months of treatment. A relief of painful defecation was also shown. Ultrasound examination showed a reduction of the nodularity in the rectovaginal septum within 6 months. The medical treatment did not affect metabolic or thrombophilic parameters; few local vaginal adverse effects were reported. CONCLUSION(S): Vaginal danazol resulted in effective medical treatment for the various painful symptoms in women with recurrent deeply infiltrating endometriosis, and because of the lack of significant adverse effects it may be proposed as an alternative to repeated surgery.

Fertil Steril. 2007 Oct;88(4):968.e15-7. Epub 2007 Jun 4.

Extremely elevated serum CA-125 level as a result of unruptured unilateral endometrioma: the highest value reported.

Kahraman K, Ozguven I, Gungor M, Atabekoglu CS.

Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey. korhankahraman@hotmail.com

OBJECTIVE: To present a case of a unilateral endometrioma with extremely elevated serum CA-125 levels. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 25-year-old woman with left adnexal mass and extremely elevated serum CA-125 level, 7,900 U/mL, underwent laparoscopy. There were unilateral endometrioma and stage IV endometriosis. INTERVENTION(S): Laparoscopic excision of the endometrioma, unilateral salpingectomy, adhesiolysis, ablation of endometriotic foci, and partial omentectomy were performed, and histopathologic results confirmed the diagnosis of endometriosis. MAIN OUTCOME MEASURE(S): Extremely elevated serum CA-125 levels and unruptured ovarian endometrioma. RESULT(S): On the second, sixth, and 13th days of the menstrual period, serum CA-125 levels were 7,900 U/mL, 1,577 U/mL, and 627 U/mL, respectively. On the third postoperative day serum CA-125 level was 56 U/mL. CONCLUSION(S): Ovarian endometrioma and advanced endometriosis may be associated with extremely elevated serum CA-125 levels. For this reason ovarian endometrioma should be considered with respect to differential diagnosis of reproductive-age women presenting with an ovarian mass even if it resembles an ovarian malignancy.

Best Pract Res Clin Obstet Gynaecol. 2007 Dec;21(6):1007-21. Epub 2007 Jun 1.

Modern management of abnormal uterine bleeding: the levonorgestrel intra-uterine system.

Mansour D.

Graingerville Clinic, Newcastle General Hospital, Newcastle upon Tyne, UK. diana.mansour@newcastle-pct.nhs.uk

Since its launch, more than 9 million women worldwide have used the levonorgestrel intra-uterine system (IUS) for contraception, as a treatment for heavy menstrual bleeding and as the progestogen component of hormone-replacement therapy. For women in their reproductive years, the IUS has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists and decreasing the need for operative gynaecological surgery. This article will outline the development of the IUS, highlighting the most important recent areas of research covering its use to control menstrual blood loss and pain.

Pain. 2007 Nov;132 Suppl 1:S96-103. Epub 2007 Jun 1.

Influence of endometriosis on visceromotor and cardiovascular responses induced by vaginal distention in the rat.

Nagabukuro H, Berkley KJ.

Program in Neuroscience, Florida State University, Tallahassee, FL 32306-1270, USA.

This study examined pseudoaffective responses elicited by vaginal distention in urethane-anesthetized rats, and tested hypotheses that responses would be increased by endometriosis (ENDO) and vary with the estrous cycle. Three groups were studied: ENDO, shamENDO, and Naive. ENDO was induced by autotransplanting small pieces of uterine horn (or, for shamENDO, fat) on mesenteric arteries. Ten weeks later, rats in proestrus or metestrus were anesthetized with urethane. Distendable latex balloons were inserted into the vaginal canal. While an increasing series of vaginal distentions was delivered, changes in electromyographic activity of the external oblique musculature (visceromotor response, VMR) and mean arterial pressure (pressor) responses were simultaneously measured. Vaginal distention produced VMR and pressor responses in all groups. These responses were significantly greater in ENDO than in the other groups, and greater in proestrus than metestrus. Although the overall amount of cystic tissue was greater in proestrous than metestrous rats, there was no correlation between these amounts and VMR or pressor responses. Acute spinalization (T8-T9) and bilateral pelvic, but not hypogastric, neurectomy attenuated both VMR and pressor responses, supporting the hypothesis that vaginal nociception involves suprathoracic spinal processing of information conveyed by the pelvic nerve. These effects on VMR and pressor responses to vaginal distention parallel behavioral escape responses to the same stimuli reported previously. The findings encourage continued use of VMR and pressor responses for further investigation of mechanisms underlying pain associated with ENDO and its potential treatment.

Asian Cardiovasc Thorac Ann. 2007 Jun;15(3):249-51.

Diaphragmatic laceration, partial liver herniation and catamenial pneumothorax.

Bobbio A, Carbognani P, Ampollini L, Rusca M.

U.O. of Thoracic Surgery, Department of Surgical Science, University of Parma, Parma, Italy. antonio.bobbio@unipr.it

Catamenial pneumothorax is a recurrent pneumothorax temporally associated with menstruation. Pathogenesis remains debated however pleural endometriosis or diaphragmatic abnormalities are almost always present. We report the case of a 35-year-old woman with recurrent right catamenial pneumothorax. At thoracoscopy a large laceration of the diaphragm with partial intrathoracic liver herniation was seen. Treatment involved repair of the diaphragmatic lacerations, and pleurodesis. This report shows that large diaphragmatic defects may be observed in patients with catamenial pneumothorax.

Obstet Gynecol. 2007 Jun;109(6):1421-3.

Aromatase inhibitors in the treatment of severe endometriosis.

Mousa NA, Bedaiwy MA, Casper RF.

Institute of Medical Science, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

BACKGROUND: Endometriosis-associated chronic pelvic pain unresponsive to surgical menopause is a difficult clinical problem. CASE: A middle-aged woman presented with endometriosis and severe pelvic pain after hysterectomy and bilateral salpingo-oopherectomy. She was first treated with exemestane without improvement of symptoms. However, another aromatase inhibitor, letrozole, relieved her pain, and concomitant treatment with estrogen relieved hot flushes without pain reactivation. CONCLUSION: Letrozole was superior to exemestane in relieving the endometriosis-associated pain in this postmenopausal woman. This suggests that patients may respond variably to different aromatase inhibitors.

Obstet Gynecol. 2007 Jun;109(6):1411-20.

Patterns of and risk factors for recurrence in women with ovarian endometriomas.

Liu X, Yuan L, Shen F, Zhu Z, Jiang H, Guo SW.

Department of Gynecology, Shanghai OB/GYN Hospital, Shanghai, China.

OBJECTIVE: To identify risk factors for and the patterns of recurrence of endometrioma and of dysmenorrhea in women with ovarian endometrioma. METHODS: We evaluated 710 consecutive patients operated on for ovarian endometriomas who were followed up for an average of 22.4 months. Twenty factors were examined to assess their effect on risk of recurrence of endometrioma and of dysmenorrhea using survival analysis. Hazard rate also was estimated to examine recurrence patterns. RESULTS: For recurrence of endometrioma, the revised American Fertility Society (rAFS) score, younger age at surgery, and previous medical treatment of endometriosis were identified to be risk factors. For recurrence of dysmenorrhea, rAFS score was the only risk factor. For both recurrences, there was a constant hazard rate in the first 28-30 months after surgery, indicating that the recurrence in that period is completely random. After that period, the hazard rate increased dramatically. CONCLUSION: The total rAFS score, but not rAFS stage, is a risk factor for recurrence of both endometrioma and dysmenorrhea, indicating that the rAFS stage has little prognostic value. The existence of a completely random recurrence period may be a universal phenomenon, with its duration and the magnitude of recurrence risk determined by patient characteristics and quality of care. The second phase of much higher recurrence risk may reflect successful reseeding, reimplantation, and regrowth of ectopic endometrium. Therefore, the identification of risk factors as well as patterns of recurrence should shed better light on possible causes for recurrence, which is now poorly understood.

Mol Hum Reprod. 2007 Aug;13(8):521-6. Epub 2007 May 30.

Allelic estrogen receptor 1 (ESR1) gene variants predict the outcome of ovarian stimulation in in vitro fertilization.

Altmäe S, Haller K, Peters M, Hovatta O, Stavreus-Evers A, Karro H, Metspalu A, Salumets A.

Department of Biotechnology, Institute of Molecular and Cell Biology, Estonian Genome Project, University of Tartu, Estonia, and Department of Clinical Science, Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden.

The outcome of in vitro fertilization (IVF) depends substantially on the effectiveness of controlled ovarian hyperstimulation (COH) induced by administration of follicle-stimulating hormone (FSH). In COH, endogenously produced estrogens extend the action of FSH in stimulating folliculogenesis. We determined the associations between genetic variations in estrogen receptor ESR1 and ESR2 genes and etiology of female infertility, and analysed the influence of these variations on COH outcome-the quantity and quality of oocytes retrieved. ESR1 PvuII T/C (rs2234693) and XbaI A/G (rs9340799) single-nucleotide polymorphisms (SNPs) and (TA)n microsatellite polymorphism, as well as ESR2 RsaI G/A (rs1256049) SNP and (CA)n microsatellite polymorphism were genotyped in 159 IVF patients. The ovarian response to FSH was diminished in patients with endometriosis when compared to tubal factor infertility. ESR1 PvuII and XbaI as well as ESR2 RsaI SNPs were associated with the microsatellite length of the respective genes. Shorter ESR1 (TA)n was linked with a higher risk for unexplained infertility, whereas longer ESR1 (TA)n associated with PvuII*C allele were predictive of a better COH, but not clinical pregnancy outcome in an age-independent manner. These data suggest the variations in ESR1 gene, in addition to the age of a woman, may predict the COH outcome in IVF.

Singapore Med J. 2007 Jun;48(6):e157-9.

Endometriosis of the inguinal canal mimicking a hernia.

Mashfiqul MA, Tan YM, Chintana CW.

Department of General Surgery, Singapore General Hospital, Singapore.

We report a 37-year-old Chinese woman who presented with a groin lump associated with constant and non-catamenial pain. Ultrasonography was suggestive of an inguinal hernia. Intraoperatively, an endometriotic lump with no laparoscopical evidence of endometriosis in the abdominopelvic region was found. Isolated endometriotic lesions in the inguinal canal is a rare occurrence. Surgeons, however, should consider this diagnosis in women of reproductive age who present with a painful groin lump.

Zhonghua Fu Chan Ke Za Zhi. 2007 Mar;42(3):173-5.

[Clinical analysis of conversion from gynecological laparoscopic surgery to laparotomy]

[Article in Chinese]

Cheng JM, Duan H, Wang JJ, Zhang HT, Liu Y.

Department of Center Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital University of Medical Sciences, Beijing 100006, China.

OBJECTIVE: To discuss the causes and clinical significance of conversion to laparotomy during laparoscopic surgery. METHOD: Three thousand two hundred and three cases who underwent laparoscopic surgery during the past five years were analyzed retrospectively. RESULTS: Three thousand one hundred and eighty cases underwent laparoscopic surgery, in which 23 cases were converted to laparotomy due to factors including severe pelvic adhesions (6 cases), complex disease with difficulties in laparoscopy (7 cases), massive haemorrhage (3 cases), bladder trauma (1 case), gastric trauma (1 case), intestinal trauma (1 case), as well as unexpected malignant genitalia neoplasm (4 cases). CONCLUSION: The major causes for the conversion to laparotomy during gynecology laparoscopic surgery are severe pelvic adhesion and complex disease with difficulties in laparoscopy. Careful evaluation before surgery and conversion to laparotomy at the right moment can decrease the complication.

Zhonghua Fu Chan Ke Za Zhi. 2007 Mar;42(3):165-8.

[Relationship between pain symptoms and clinico-pathological features of pelvic endometriosis]

[Article in Chinese]

Leng JH, Lang JH, Dai Y, Li HJ, Li XY.

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

OBJECTIVE: To study the relationship between pain symptoms and the clinico-pathological features of pelvic endometriosis (EM). METHODS: One hundred thirty patients with laparoscopic diagnosis of EM were studied retrospectively and the relationship between pain symptoms including dysmenorrhea, chronic pelvic pain (CPP), dyspareunia and dyschezia and the anatomical features of pelvic endometriosis were evaluated. RESULTS: One hundred (76.9%) patients with pain symptoms and 30 (23.1%) without were included in this study. The number of patients with mild, moderate and severe dysmenorrhoea was 27 (20.8%), 41 (31.5%), and 32 (24.6%), respectively. Patients with dyspareunia, CPP and dyschezia were 46 (35.4%), 45 (34.6%) and 67 (51.5%), respectively. Compared with patients without dysmenorrhea, the proportion of deep utero-sacral nodules (45.0% vs 13.3%, P=0.00), recto-vaginal nodules (16.0% vs 0, P=0.01), complete obliteration of cul-de sac (41.0% vs 10.0%, P=0.00), and lesions of DIE (51.0% vs 16.7%, P=0.00) was significantly increased in patients with dysmenorrhea. The severity of dysmenorrhea was positively correlated with nodules in uterosacral ligaments (P=0.005, r=0.302), and invasive depth of uterosacral ligaments (P=0.016, OR=5.085). Among patients with endometrioma, significantly more moderate to severe adhesions were found in patients with dysmenorrhea, compared with those patients without dysmenorrhea (29.1% vs 8.3%, P=0.029). Patients with CPP had more nodules in the utero-sacral ligaments (51.1% vs 30.6%, P=0.018) and DIE lesions (57.8% vs 35.3%, P=0.011), compared with those without. More nodules in the utero-sacral ligaments (46.3% vs 28.6%, P=0.028), recto-vaginal nodules (19.4% vs 4.8%, P=0.01), complete obliteration of cul-de sac (44.8% vs 22.2%, P=0.005) and DIE lesions (53.7% vs 31.7%, P=0.01) were found in patients with dyschezia, compared with those without. Nodules in the recto-vaginal pouch were an independent risk factor of dyspareunia. CONCLUSION: Pain symptoms including dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia are remarkably related to endometriotic nodules at the posterior part of the pelvis or those with deep invasions.

Acta Cytol. 2007 May-Jun;51(3):380-4.

Fine needle aspiration cytology in cutaneous and subcutaneous endometriosis.

Catalina-Fernández I, López-Presa D, Sáenz-Santamaria J.

Department of Pathology, Perpetual Aid University Hospital, Badajoz, Spain. yaye@eresmas.net

OBJECTIVE: To study the role of fine needle aspiration cytology (FNAC) in the diagnosis of cutaneous and subcutaneous endometriosis. STUDY DESIGN: We present 7 cases of endometriosis in abdominal wall, inguinal region and perineum diagnosed by FNAC. All cases were confirmed with histologic follow-up. Cytologic and histologic material was prepared using standard methods. RESULTS: The smears were highly cellular, showing a hemorrhagic background with hemosiderin-laden macrophages and sheets of epithelial and stromal cells. Occasionally, these cellular components were closely associated. CONCLUSION: FNAC is useful in the diagnosis of cutaneous and subcutaneous endometriosis, providing a rapid and accurate preoperative diagnosis.

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2007 Apr;29(2):257-61.

[Effects of progesterone and progestin on expression of regulated on activation, normal T cell expressed and secreted in eutopic endometrium from patients with endometriosis]

[Article in Chinese]

Deng S, Dai Y, Lang JH, Leng JH, Liu ZF, Sun DW, Zhu L, Tan XJ.

Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.

OBJECTIVE: To investigate the effects of progesterone and progestin on the expressions of regulated on activation, normal T cell expressed and secreted (RANTES) in eutopic endometrium from patients with endometriosis. METHODS: We collected the samples of endometrium from patients with endometriosis before operation or after insertion of levenorgestrel releasing intrauterine system (LNG-IUS), administration of oral medroxyprogesterone (MPA), or injection of gonadotrophic hormone releasing hormone agonist (GnRHa). Reverse transcription-polymerase chain raction was used to assay the expression of RANTES mRNA. On the other hand, progesterone (Po) and tumor necrosis factor-alpha (TNFalpha) of different concentrations and different manners were used to treat cultured cells in vitro. RANTES secretion was evaluated in the culture medium using ELISA. In order to evaluate the effect of Po on the secretion of RANTES under stimulation of TNFalpha, the cells were cultured in medium containing 100 U/ml TNFalpha and Po of different concentrations for 24 hours. After the pretreatment of Po for 48 hours at different concentrations, TNFalpha (100 U/ml, 16 h) was added to observe whether Po inhibits RANTES or not. RESULTS: The expression of RANTES mRNA in eutopic endometrium of patients with endometriosis was significantly higher than in control group (28.0 +/- 9.0 vs. 22.0 +/- 5.6, P < 0.05). Following the exposures to LNG-IUS (24.0 +/- 4.2 vs. 25.9 +/- 4.2, P > 0.05) or GnRHa (23.0 +/- 12.9 vs. 26.9 +/- 5.2, P > 0.05), the expression of RANTES mRNA had no change. MPA significantly increased the expression of RANTES mRNA (42.6 +/- 3.1 vs. 24.3 +/- 5.7, P < 0.05). Po itself had no significant effect on the secretion of RANTES. Stimulated by Po and TNFalpha at the same time, the secretion of RANTES significantly increased. After pretreatment with Po for 48 hours, the reaction of RANTES to the stimulating effect of TNFalpha was down-regulated. CONCLUSION: The eutopic endometrium of patients with endometriosis has high chemotactic activity. It may be feasible to prevent and treat endometriosis with progestins.

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2007 Apr;29(2):252-6.

[Effects of medical treatment on apoptosis in eutopic endometrium of patients with endometriosis]

[Article in Chinese]

Deng S, Lang JH, Leng JH, Liu ZF, Sun DW, Zhu L, Tan XJ.

Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.

OBJECTIVE: To investigate the apoptosis-related mechanisms of levenorgestrel-releasing intrauterine system (LNG-IUS), oral medroxyprogesterone (MPA), and injective gonadotrophic hormone releasing hormone agonist (GnRHa) on eutopic endometrium of patients with endometriosis. Methods We collected the samples of endometrium from patients with endometriosis before operation and after insertion of LNG-IUS, administration of oral MPA, or injection of GnRHa. The ultrastructure of endometria was observed and compared by electron microscopy. Apoptotic cells were assessed by the terminal deoxynucleotidyl transferase-mediated deoxy-UTP nick-end labeling (TUNEL) assay, and the expressions of Bax, Fas, and Fas-L mRNA were determined by semi-quantitative reverse transcription-polymerase chain raction. Results After have been exposured to LNG-IUS, the apoptotic rate of endometrial epithelial cells and stromal cells increased from (24. 4 +/- 35.0)% to (51.0 +/- 37.8)% (P = 0.027) and (35.3 +/- 30.2)% to (76.4 +/- 11.2)% (P = 0.008), respectively. The degree of apoptosis under transmission electron microscopy was in an order of GnRHa > LNG-IUS > MPA. The expression of Fas-L mRNA in eutopic endometrium of patients with endometriosis was significantly higher than that of the normal control (P < 0.05). The expressions of three apoptosis-related proteins had no significant difference. CONCLUSION: Medical treatments can increase the apoptosis of eutopic endometrial cells, and such effect was strongest in GnRHa and relatively weaker in LNG-IUS and MPA.

Fertil Steril. 2007 Dec;88(6):1703-5. Epub 2007 May 25.

Mitochondrial gene expression in granulosa cells of severe endometriosis with in vitro fertilization and embryo transfer.

Yamashita Y, Asano M, Morishima S, Fujino K, Terai Y, Ohmichi M.

Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan. gyn028@poh.osaka-med.ac.jp

The expression of mitochondrial genes in granulosa cells was quantitated by real-time polymerase chain reaction. The expression ratio of mitochondrial genes in granulosa cells of patients with severe endometriosis showed no statistically significant difference compared with cases of tubal infertility without endometriosis.

Contraception. 2007 Jun;75(6 Suppl):S134-9. Epub 2007 Feb 16.

Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, chronic pelvic pain and dysmenorrhea.

Bahamondes L, Petta CA, Fernandes A, Monteiro I.

Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), 13084-971, Campinas, SP, Brazil. bahamond@caism.unicamp.br

OBJECTIVES: This report is a review of the medical literature on the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) in women with endometriosis, adenomyosis, cyclic pelvic pain and dysmenorrhea. MATERIAL AND METHODS: A review was carried out using the MEDLINE and EMBASE databases to evaluate the use of LNG-IUS in women with endometriosis and adenomyosis. RESULTS: Nine studies were identified, only two of which were randomized clinical trials. One compared the insertion of LNG-IUS after surgery with expectant conduct and the other compared the use of the device with a GnRH analogue (GnRH-a). All studies reported an improvement in pelvic pain and dysmenorrhea, and a reduction in menstrual bleeding. One study found an improvement in the staging of the disease at 6 months of use, and the studies that evaluated the use of LNG-IUS in women with adenomyosis reported a reduction in uterine volume. Furthermore, the only study in which women were followed up for 3 years after insertion found improvement in pelvic pain at 12 months of use. However, there was no improvement after that period. CONCLUSIONS: The use of LNG-IUS is an alternative for the medical treatment of women suffering from endometriosis, adenomyosis, chronic pelvic pain or dysmenorrhea, but experience is limited and long-term studies are necessary to reach definitive conclusions. However, for women who do not wish to become pregnant, this device offers the possibility of at least 5 years of treatment following one single intervention.

Contraception. 2007 Jun;75(6 Suppl):S112-7. Epub 2007 Feb 16.

The promise and reality of the intrauterine route for hormone delivery for prevention and therapy of gynecological disease.

Fraser IS.

Department of Obstetrics and Gynaecology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, NSW 2006, Australia. helena@med.usyd.edu.au

CONTEXT: Progestins delivered by a variety of routes have been demonstrated, in addition to their high contraceptive effect, to have substantial benefits in the treatment of various gynecological disorders, and the intrauterine route has particular efficacy in treating endometrial and myometrial disorders. It should be possible to extend this to prevention of disease. THERAPY OF GYNECOLOGICAL DISEASE: Those conditions for which there is most evidence of therapeutic benefit from intrauterine release of progestins include heavy menstrual bleeding (due to most causes), endometrial hyperplasia, endometriosis and adenomyosis. PREVENTION OF GYNECOLOGICAL DISEASE: Reasonable evidence exists to support the findings that intrauterine levonorgestrel helps to prevent the development of uterine fibroids, endometriosis, endometrial hyperplasia, acute episodes of pelvic infection and a wide range of menstrual symptoms. There is also promise of prevention of endometrial carcinoma, endometrial polyps, infertility and perhaps adenomyosis. CONCLUSIONS: There is a need for specific studies to further explore the prevention of these gynecological conditions which can cause major health disturbances and community distress.

Saudi Med J. 2007 Jun;28(6):952-4.

Endometriosis presenting like a psoas abscess.

Bhat SN, Mohanty SP, Kustagi P.

Department of Orthopedics, Kasturba Medical College and Hospital, Manipal 576104, India. shyambhatn@yahoo.com

Endometriosis is the presence of ectopic endometrial tissue that responds to hormonal stimulation. Although endometriosis occurs most often in the pelvis, several unusual sites have been reported. We present a case of endometriosis mimicking, a psoas abscess. A 39-year-old lady presented with pain around the right hip, of 5 years duration. Computed tomography CT scan showed a multi-loculated mass in the right iliopsoas muscle. On exploration, a hemorrhagic cystic mass was seen pressing on the femoral nerve. The lesion was excised and histological examination of the tissue showed features of endometriosis. The patient was treated by cyclic hormonal suppressive therapy for 3 months. Her pain and the flexion deformity of the hip resolved completely. Retroperitoneal endometriosis presenting with deformity and pain in the hip may mimic a psoas abscess. If the possibility of this diagnosis is entertained, inappropriate treatment may be avoided.

J Thorac Imaging. 2007 May;22(2):172-5.

Endometrioma presenting as a cavitary lung mass with intense 18F-FDG uptake on PET-CT.

Derman AY, Sperling D, Merav A, Jain VR, Levin M, Jana S, Haramati LB.

Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.

[18F]-fluoro-2-deoxy-D-glucose positron emission tomography computed tomography is a useful tool to suggest the diagnosis of malignant processes. However, false positive results are known to occur in benign lesions that have a high metabolic activity. Here we describe the unusual diagnosis of a pulmonary endometrioma in a 47-year-old woman, presenting as a cavitary lung mass with intense (18)F-FDG uptake on PET-CT.

Appl Immunohistochem Mol Morphol. 2007 Jun;15(2):170-4.

The cytoskeletal proteins alpha-actinin, Ezrin, and talin are De-expressed in endometriosis and endometrioid carcinoma compared with normal uterine epithelium.

Slater M, Cooper M, Murphy CR.

Department of Anatomy and Histology, School of Biomedical Sciences, The University of Sydney, NSW, Australia. michaels@anatomy.usyd.edu.au

In this retrospective study on banked tissue, we found that alpha-actinin and talin were completely de-expressed in both endometriosis and endometrioid carcinoma tissue. Some patchy, depolarized labeling for ezrin was noted in the endometrioid carcinoma but not in endometriosis. The loss of these proteins in both endometriosis and endometrioid carcinoma tissue indicates a significant change in the integrity of these tissues compared with normal and the possibility that individual cells may break away from the parent histology due to loss of cell adhesion. It also indicates a similarity between endometrioid cancer and endometriosis with respect to epithelial cell function and adhesion.

Mol Hum Reprod. 2007 Aug;13(8):595-604. Epub 2007 May 24.

Human chorionic gonadotrophin attenuates NF-kappaB activation and cytokine expression of endometriotic stromal cells.

Huber AV, Saleh L, Prast J, Haslinger P, Knöfler M.

Department of Obstetrics and Gynecology, Medical University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

Recently, a clinical study provided evidence that treatment of endometriotic women with human chorionic gonadotrophin (hCG) alleviates disease-related pain and sleeplessness suggesting therapeutic effects of the hormone. Since endometriosis is associated with aberrant concentrations of inflammatory mediators in the peritoneal fluid, we investigated whether hCG may affect cytokine-dependent activation of the key-regulatory transcription factor NF-kappaB and expression of two nuclear factor kappa B (NF-kappaB)-inducible genes, tumour necrosing factor (TNF-alpha) and interleukin (IL)-1beta, in stromal cells isolated from ectopic endometriotic tissues. Electrophoretic mobility shift assay revealed that treatment of these cultures with the urinary preparation hCG-A suppressed TNF-alpha- or IL-1beta-induced NF-kappaB DNA-binding activity, whereas another urinary hCG preparation (hCG-B) was less effective. Recombinant alphahCG or epidermal growth factor (EGF), a contaminant of some urinary hCG preparations, did not alter cytokine-dependent NF-kappaB activation. Immunofluorescene of its p65 subunit revealed that pre-incubation with hCG-A strongly decreased TNF-alpha-dependent nuclear expression of NF-kappaB. Accordingly, hCG-A diminished IL-1beta-induced TNF-alpha transcript levels and protein release measured by quantitative real-time PCR and enzyme-linked immunosorbent assay. The hormone also attenuated TNF-alpha-dependent mRNA expression of IL-1beta. Western blot analyses revealed that hCG-A impaired TNF-alpha-mediated phosphorylation and degradation of the inhibitor IkappaBalpha suggesting that the hormone may reduce nuclear import of NF-kappaB by stabilizing its inhibitor. The data suggest that hCG attenuates inflammation-dependent NF-kappaB activation and cytokine expression that could provide one explanation for the beneficial role of the hormone in endometriotic patients.

Surg Today. 2007;37(6):510-3. Epub 2007 May 28.

Laparoscopic appendectomy for appendiceal endometriosis presenting as acute appendicitis: report of a case.

Idetsu A, Ojima H, Saito K, Yamauchi H, Yamaki E, Hosouchi Y, Nishida Y, Kuwano H.

Department of General Surgical Science (Surgery 1), Gunma University, Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, and Department of Surgery, Gunma Prefecture Saiseikai-Maebashi Hospital, Japan.

Endometriosis is a relatively common disorder in women of reproductive age; however, appendiceal endometriosis is rare. Thus, a definitive diagnosis is likely to be established only by histology of the appendix. We report a case of endometriosis of the appendix in a 42-year-old woman who presented with symptoms of acute appendicitis. We treated the patient by performing laparoscopic appendectomy, which resulted in a good outcome.

Ann Plast Surg. 2007 Jun;58(6):691-3.

Abdominal wall endometrioma: case report and review.

Gabriel A, Shores JT, Poblete M, Victorio A, Gupta S.

Division of Plastic Surgery, Loma Linda University Medical Center, California 92354, USA.

Women with chronic, cyclical abdominal wall pain after gynecologic surgery may present in the plastic surgeon’s office requesting body contouring. We present one such case in which an abdominal wall endometrioma was found. Resection of the endometrioma with the abdominal panniculus resulted in symptomatic cure for the patient. Plastic surgeons should be aware of the association of endometriosis with chronic pelvic/abdominal pain. Furthermore, suspicion of abdominal wall endometrioma should be entertained when patients present with chronic intermittent or cyclical abdominal wall pain after surgery of the pelvis or abdomen, especially after gynecologic or obstetric procedures.

Cancer Biomark. 2007;3(2):73-8.

Association of progesterone receptor gene polymorphism (PROGINS) with endometriosis, uterine fibroids and breast cancer.

Govindan S, Ahmad SN, Vedicherla B, Kodati V, Jahan P, Rao KP, Ahuja YR, Hasan Q.

Department of Genetics, Vasavi Medical and Research Centre, Khairtabad, Hyderabad-500 004, Andhra Pradesh, India.

Endometriosis, uterine fibroids and breast cancer are female health disorders associated with a great deal of morbidity. Since all these disorders are hormone responsive, our present study has been carried out to identify the association of 306bp Alu insertion polymorphism in intron 7 of progesterone receptor gene (PROGINS). DNA was isolated from the blood samples of 445 Asian Indian women, which included 100 endometriosis, 80 fibroids and 157 cases of breast cancer along with 108 age matched normal healthy women as controls. PROGINS polymorphism was assessed by PCR followed by agarose gel electrophoresis. Results showed that T2 allele frequency is 5%, 10% and 14.6% in endometriosis, uterine fibroids and breast cancer, as compared to 5.5% in controls. This indicates that PROGINS can be considered as a predisposing risk marker for breast cancer but not for endometriosis and uterine fibroids.

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