Reproduction. 2007 Jan;133(1):265-74.

Increased expression of interleukin-1 receptor type 1 in active endometriotic lesions.

Lawson C, Al-Akoum M, Maheux R, Akoum A.

Centre de Recherche, Hôpital Saint-François d’Assise, Centre Hospitalier Universitaire de Québec, Québec, Canada.

The establishment and progression of ectopic endometrial implants are dependent upon their interaction with and responsiveness to the stimuli present in their new environment. According to our and other previous studies, immune cells-derived cytokines, such as IL-1, may alone or in concert with estrogens, enhance the capability of ectopic endometrial cells to implant and develop into the host tissue. In the present study, immunohistochemical and dual immunofluorescence analyses showed that the functional signaling interleukin-1 receptor type 1 (IL-1RI) is expressed in endometriotic tissue, particularly in the glands, and identified endothelial cells, macrophages, and T-lymphocytes as cells having marked expression of IL-1RI. The highest concentrations of IL-1RI protein in endometriotic tissue, as evaluated using histological score (HSCORE) and measured by ELISA, were found in red endometriotic lesions as compared with typical black-blue or white lesions. Western blotting showed a significant increase in the levels of the 50 kDa band, whose apparent molecular weight corresponds to the soluble form of IL-1RI. RT-PCR analysis of IL-1 mRNA levels showed a pattern of expression comparable to that of the protein. Interestingly, IL-1RI expression was more significant in the proliferative than in the secretory phase of the menstrual cycle. Marked expression of IL-1RI, the functional signaling receptor that mediates cell activation by IL-1, in red endometriotic implants, which are highly vascularized and represent the earliest and most active forms of the disease, point to a higher cell receptivity for IL-1 in these lesions, a relationship with the activity of the disease and a possible involvement in the early steps of endometriotic tissue growth and development.

J Eur Acad Dermatol Venereol. 2007 Feb;21(2):280-1.

Umbilical endometriosis.

Farhi D, Zimmermann U, Chapron C, Dupin N.

Surg Today. 2007;37(2):141-4. Epub 2007 Jan 25.

Successful video-assisted thoracic surgery for pulmonary endometriosis: Report of a case.

Haruki T, Fujioka S, Adachi Y, Miwa K, Taniguchi Y, Nakamura H.

Division of General Thoracic Surgery, Tottori University Hospital, 36-1 Nishi-machi, Yonago, Tottori, 683-8504, Japan.

Pulmonary endometriosis is a disease in which uterine endometrial cells with stromal components grow in the pulmonary parenchymal tissues or pleura. Surgical resection is considered an effective and radical treatment for pulmonary endometriosis to avoid the adverse effects of long-term hormone therapy in young women of childbearing years with a localized abnormal lesion. We report a case of pulmonary endometriosis with catamenial hemoptysis, an uncommon result of this disease, which was diagnosed histologically and treated successfully by video-assisted thoracic surgery.

Nat Clin Pract Endocrinol Metab. 2007 Feb;3(2):157-67.

Drug Insight: clinical use of agonists and antagonists of luteinizing-hormone-releasing hormone.

Engel JB, Schally AV.

Medical University of Würzburg Department of Obstetrics and Gynecology, Würzburg, Germany. joergbengel@hotmail.com

This article reviews the clinical uses of agonists and antagonists of luteinizing-hormone-releasing hormone (LHRH), also known as gonadotropin-releasing hormone. In particular, the state of the art treatment of breast, ovarian and prostate cancer, reproductive disorders, uterine leiomyoma, endometriosis and benign prostatic hypertrophy is reported. Clinical applications of LHRH agonists are based on gradual downregulation of pituitary receptors for LHRH, which leads to inhibition of the secretion of gonadotropins and sex steroids. LHRH antagonists immediately block pituitary LHRH receptors and, therefore, achieve rapid therapeutic effects. LHRH agonists and antagonists can be used to treat uterine leiomyoma and endometriosis; furthermore, both types of LHRH analogs are used to block the secretion of endogenous gonadotropins in ovarian-stimulation programs for assisted reproduction. The preferred primary treatment of patients with advanced, androgen-dependent prostate cancer is based on the periodic administration of depot preparations of LHRH agonists; these agonists can be likewise used to treat estrogen-sensitive breast cancer in premenopausal women. LHRH antagonists have been successfully used to treat prostate cancer and benign prostatic hypertrophy. Since receptors for LHRH are present on a variety of human tumors, (notably breast, prostate, ovarian, endometrial and renal cancers), cytotoxic therapy that targets these tumors with hybrid molecules of LHRH might be possible in the near future. Analogs of LHRH are now a well-established means of treating sex-steroid-dependent, benign and malignant disorders.

Virchows Arch. 2007 Mar;450(3):349-53. Epub 2007 Jan 18.

Extrauterine endometrial stromal sarcoma with JAZF1/JJAZ1 fusion confirmed by RT-PCR and interphase FISH presenting as an inguinal tumor.

Sato K, Ueda Y, Sugaya J, Ozaki M, Hisaoka M, Katsuda S.

Department of Pathophysiological and Experimental Pathology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan. sato-k@kanazawa-med.ac.jp

Endometrial stromal sarcomas are rare malignant mesenchymal tumors that usually develop in the uterine corpus and occasionally arise at various extrauterine sites. This report describes the first case of primary extrauterine endometrial stromal sarcoma arising in the extraperitoneal portion of the round ligament presenting as a solitary inguinal mass in a 46-year-old woman. The patient presented gradually growing tumor in the right inguinal region. Local tumor resection was performed and no recurrence or metastasis was found at 15 months after the operation. Histological examination revealed that the tumor comprised uniform, spindle-shaped cells with blunt nuclear figure and scattered small arteries, and infiltrated into adjacent tissue. No endometriosis was morphologically identified in the lesion. Immunohistochemically, the tumor cells were positive for CD10, estrogen receptor, progesterone receptor, alpha-smooth muscle actin, and calponin. We confirmed JAZF1/JJAZ1 fusion by reverse transcription-polymerase chain reaction and the corresponding chromosomal translocation by interphase fluorescence in situ hybridization on paraffin sections. It is essential that the inguinal region should be recognized as a possible primary site of endometrial stromal sarcoma, and the detection of a JAZF1/JJAZ1 fusion can be useful when the diagnosis is not confirmed by microscopic observation or immunohistochemistry for the tumor arising in extrauterine sites.

Hum Reprod. 2007 Apr;22(4):1091-4. Epub 2007 Jan 18.

Prognostic capacity of transvaginal hydrolaparoscopy to predict spontaneous pregnancy.

van Tetering EA, Bongers MY, Wiegerinck MA, Mol BW, Koks CA.

Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands. ovantetering@gmail.com

BACKGROUND: In 1998, transvaginal hydrolaparoscopy (THL) was introduced as a new outpatient procedure for exploration of tubo-ovarian structures and tubal patency in subfertile patients. At present, there are no large studies that relate the findings at THL to fertility outcome. METHODS: Consecutive patients undergoing THL for subfertility between 2000 and 2004 were included in this prospective cohort study. Follow-up ended when ongoing pregnancy or tubal surgery occurred or at the day of last contact. Kaplan-Meier curves for the occurrence of intrauterine pregnancy (IUP) (spontaneous or after intrauterine insemination) were constructed for a normal THL, a THL with a one-sided tubal pathology and a THL with a two-sided tubal pathology. Fecundity rate ratios (FRRs) were calculated to express the association between THL findings and the occurrence of IUP. Patients rated their pain experiences and acceptability on a visual analogue scale (VAS). RESULTS: We included 272 women. In 96% (261) of the patients, access to the pouch of Douglas was achieved. Complications occurred in 2% of the procedures. In 203 (78%) patients, both tubo-ovarian structures could be visualized and tubal patency was shown. One-sided tubal occlusion was found in 10%, whereas two-sided tubal occlusion was seen in 4% of the patients. Adhesions and/or endometriosis were observed in 8% of the patients. The FRRs for one-sided tubal pathology, two-sided tubal pathology and adhesions/endometriosis were 0.59, 0 and 0.80, respectively. The VAS scores showed pain to be limited and the procedure to be acceptable. CONCLUSION: THL is a feasible technique. Its capacity to predict spontaneous ongoing pregnancy is comparable to that of laparoscopy.

Hum Reprod. 2007 May;22(5):1474-80. Epub 2007 Jan 18.

High-dose atorvastatin causes regression of endometriotic implants: a rat model.

Oktem M, Esinler I, Eroglu D, Haberal N, Bayraktar N, Zeyneloglu HB.

Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey. mesutoktem@hotmail.com

BACKGROUND: This prospective randomized-controlled animal study was designed to determine the effects of atorvastatin on experimentally induced endometriosis in a rat model. METHODS: Thirty-seven Wistar-Albino rats in which endometriotic implants were induced were randomly divided into four groups. Group I (Low-dose atorvastatin group, eight rats) were given 0.5 mg kg(-1) day(-1) oral atorvastatin. Group II (High-dose atorvastatin group, 10 rats) were given 2.5 mg kg(-1) day(-1) oral atorvastatin. Group III were given a single dose of 1 mg kg(-1) s.c. leuprolide acetate (GnRH agonist group, nine rats). Group IV were given no medication and served as controls (10 rats). All rats received the treatment for 21 days and were then euthanized to assess the implants’ size, vascular endothelial growth factor (VEGF) level in peritoneal fluid and histological score. RESULTS: At the end of the treatment, the mean areas of implants were smaller and VEGF levels in peritoneal fluid were lower in Groups II and III than those in Group I and the control group (all P < 0.05). The mean areas of implants decreased from 41.2 +/- 13.9 to 22.7 +/- 13.9 mm(2) after medication in Group II and decreased from 41.2 +/- 18.1 to 13.1 +/- 13.8 mm(2) in Group III (both P < 0.05), whereas in Group I, the mean area increased from 43.0 +/- 12.7 to 50.5 +/- 13.9 mm(2) (P < 0.05). CONCLUSIONS: High-dose atorvastatin caused a significant regression of endometriotic implants.

Hum Reprod. 2007 May;22(5):1373-9. Epub 2007 Jan 18.

Endometriosis: an inflammatory disease with a Th2 immune response component.

Podgaec S, Abrao MS, Dias JA Jr, Rizzo LV, de Oliveira RM, Baracat EC.

Department of Obstetrics and Gynecology, Teaching Hospital, University of São Paulo, São Paulo, Brazil. spodgaec@uol.com.br

BACKGROUND: Efforts have been made to correctly characterize the role of the immune response in endometriosis. The objective of this study was to analyse the interaction between Th1 and Th2 immune response patterns and endometriosis by evaluating a panel of cytokines. METHODS: Between January 2004 and November 2005, 98 patients, classified into two groups according to the histologically confirmed presence (Group A) or absence of endometriosis (Group B), were evaluated. Interleukins (IL) 2, 4 and 10, tumour necrosis factor-alpha and interferon-gamma (IFN-gamma) were measured by flow cytometry in the peripheral blood and peritoneal fluid of all patients. RESULTS: IFN-gamma and IL-10 levels were significantly higher in the peritoneal fluid of patients with endometriosis compared to those without endometriosis (P < 0.05). There was a significant alteration in the IL-4/IFN-gamma (P < 0.001), IL-4/IL-2 (P = 0.006), IL-10/IFN-gamma (P < 0.001) and the IL-10/IL-2 ratios (P < 0.001) in the peritoneal fluid of patients with endometriosis, with a predominance of IL-4 and IL-10, reflecting a shift towards Th2 immune response despite the increase in IFN-gamma concentrations. CONCLUSIONS: Endometriosis is an inflammatory disease involving a possible shift towards Th2 immune response component, as demonstrated by the relative increase in cytokines characteristic of this pattern of immune response.

Acta Obstet Gynecol Scand. 2007;86(1):111; author reply 112.

Comment on:

Acta Obstet Gynecol Scand. 2006;85(1):88-92.

Prevalence of depression in women with endometriosis.

Ferrero S, Remorgida V, Ragni N.

Acta Obstet Gynecol Scand. 2007;86(1):73-80.

Risk factors for abdominal scar endometriosis after obstetric hysterotomies: a case-control study.

de Oliveira MA, de Leon AC, Freire EC, de Oliveira HC, Study SO.

Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil. Maurelio@infolink.com.br

OBJECTIVE: To identify risk factors that are associated with the development of scar endometriosis after obstetric hysterotomies. The hypothesis is that early hysterotomy in pregnancy (before 22nd week) is the main risk factor for the development of scar endometriosis. METHODS: The authors conducted a case-control study between April 2000 and June 2003. A total of 117 women were selected, including 39 cases and 78 controls. Exposure and confounding variables were measured by a standardized questionnaire, which included sociodemographic characteristics, reproductive/physiologic history, past pathological history, history of obstetric surgeries, family history, and social history. The odds ratio (OR) and its 95% confidence interval (CI) were calculated using bivariate analysis for each possible risk factor. These estimates were obtained by multivariate analysis using unconditional logistic regression. Tests were made to assess the fit of the final model. RESULTS: In the multivariate analysis, positive associations were observed between scar endometriosis and hysterotomy type (early versus late: OR = 42.99; CI 8.77-210.81), amount of the menstrual blood flow (heavy versus light/normal: OR = 11.97; CI 2.35-60.82), and alcoholic consumption (yes versus no: OR = 5.31; CI 1.22-23.11). Negative association was observed between scar endometriosis and parity (OR = 0.61; CI 0.31-1.23), however it was not statistically significant (p>0.05). CONCLUSIONS: Early hysterotomy in pregnancy is the main risk factor for scar endometriosis. Increased menstrual flow and alcohol consumption are also risk factors, while high parity may be a protecting factor.

Acta Obstet Gynecol Scand. 2007;86(1):4-15.

Surgical interruption of pelvic nerve pathways in dysmenorrhea: a systematic review of effectiveness.

Latthe PM, Proctor ML, Farquhar CM, Johnson N, Khan KS.

Academic Department of Obstetrics & Gynaecology, University of Birmingham, Birmingham, UK. pallavi@doctors.org

OBJECTIVES: To assess the effectiveness of surgical interruption of pelvic nerve pathways in primary and secondary dysmenorrhea. Data sources. The Cochrane Menstrual Disorders and Subfertility Group Trials Register (9 June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to Nov. 2003), EMBASE (1980 to Nov. 2003), CINAHL (1982 to Oct. 2003), MetaRegister of Controlled Trials, the citation lists of review articles and included trials, and contact with the corresponding author of each included trial. REVIEW METHODS: The inclusion criteria were randomized controlled trials of uterosacral nerve ablation or presacral neurectomy (both open and laparoscopic procedures) for the treatment of dysmenorrhea. The main outcome measures were pain relief and adverse effects. Two reviewers extracted data on characteristics of the study quality and the population, intervention, and outcome independently. RESULTS: Nine randomized controlled trials were included in the systematic review. There were two trials with open presacral neurectomy; all other trials used laparoscopic techniques. For the treatment of primary dysmenorrhea, laparoscopic uterosacral nerve ablation at 12 months was better when compared to a control or no treatment (OR 6.12; 95% CI 1.78-21.03). The comparison of laparoscopic uterosacral nerve ablation with presacral neurectomy for primary dysmenorrhea showed that at 12 months follow-up, presacral neurectomy was more effective (OR 0.10; 95% CI 0.03-0.32). In secondary dysmenorrhea, along with laparoscopic surgical treatment of endometriosis, the addition of laparoscopic uterosacral nerve ablation did not improve the pain relief (OR 0.77; 95% CI 0.43-1.39), while presacral neurectomy did (OR 3.14; 95% CI 1.59-6.21). Adverse events were more common for presacral neurectomy than procedures without presacral neurectomy (OR 14.6; 95% CI 5-42.5). CONCLUSION: The evidence for nerve interruption in the management of dysmenorrhea is limited. Methodologically sound and sufficiently powered randomized controlled trials are needed.

Expert Rev Mol Med. 2007 Jan 16;9(2):1-20.

Endometriosis: disease pathophysiology and the role of prostaglandins.

Wu MH, Shoji Y, Chuang PC, Tsai SJ.

Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan 701, Taiwan, Republic of China.

Endometriosis is considered to be a polygenic disease with a complex, multifactorial aetiology that affects about 10% of women in the reproductive age. Women with endometriosis have symptoms that include chronic pelvic pain, dysmenorrhoea and dyspareunia, significantly reducing their quality of life. Endometriosis is also the primary cause of infertility in women, with the prevalence rate ranging from 20% to 50%. The high prevalence and severe outcomes of this disease have made it a major public health concern in modern society. Currently, the mechanism(s) responsible for the initiation and promotion of this disease remains obscure. In this review, we focus on the expression, regulation and action of prostaglandins in the cellular and molecular mechanisms that contribute to the development and/or maintenance of endometriosis.

Arch Pathol Lab Med. 2007 Jan;131(1):138-44.

Primary peritoneal serous borderline tumors.

Hutton RL, Dalton SR.

Department of Pathology and Laboratory Services, Brooke Army Medical Center, 3856 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA. robert.hutton@amedd.army.mil

CONTEXT: Primary peritoneal serous borderline tumor is a rare epithelial proliferation that can present as an incidental finding at laparotomy and raises concern for a primary ovarian tumor with peritoneal implants. OBJECTIVE: To present a brief history of this condition and describe its distinctive histology and clinical presentation, as well as to review the chief differential diagnostic considerations, to include mesothelial proliferations, endosalpingiosis, endometriosis, high-grade primary peritoneal papillary serous carcinoma, and implants from primary ovarian serous neoplasms. DATA SOURCES: Relevant articles indexed in PubMed (National Library of Medicine) between 1966 and 2005, references thereof, and reference surgical pathology texts. CONCLUSIONS: Primary peritoneal serous borderline tumor should be considered in the differential diagnosis of an epithelial proliferation with prominent psammoma bodies on the peritoneal surface of specimens submitted for nongynecologic complaints.

Fertil Steril. 2007 Jun;87(6):1468.e9-12. Epub 2007 Jan 12.

Concomitant treatment of severe uterine adenomyosis in a premenopausal woman with an aromatase inhibitor and a gonadotropin-releasing hormone agonist.

Kimura F, Takahashi K, Takebayashi K, Fujiwara M, Kita N, Noda Y, Harada N.

Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Japan.

OBJECTIVE: To assess the effect of aromatase inhibitors with GnRH agonist for a severe symptomatic adenomyosis that is refractory to GnRH agonist and danazol with GnRH agonist. DESIGN: Case report. SETTING: Clinical practice in university hospital. PATIENT(S): A 34-year-old woman with a complaint of severe dysmenorrheal, symptomatic anemia, and a desire to retain fertility. INTERVENTION(S): Aromatase inhibitor anastrozole given orally (1.0 mg or 2.0 mg daily) for 16 weeks and GnRH agonist given monthly (injected SC, 1.8 mg) for 4 months. MAIN OUTCOME MEASURE(S): Measurements of uterine volume and levels of serum E(2), estrone, A, dehydroepiandrosterone sulfate, LH, FSH, and CA125. RESULT(S): Uterine volume was reduced. The reduction rate of uterine volume estimated by magnetic resonance imaging and ultrasonography was 60% after 8 weeks of treatment. CONCLUSION(S): Aromatase inhibitor with GnRH agonist therapy was useful for the management of a severely adenomyotic woman whose desire was for conservative treatment.

J Urol. 2007 Feb;177(2):450-6.

Erratum in:

J Urol. 2007 Jun;177(6):2402.

Comment in:

J Urol. 2007 Sep;178(3 Pt 1):1121.

Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review.

Bogart LM, Berry SH, Clemens JQ.

Rand Corp., Santa Monica, California, USA. lbogart@rand.org

PURPOSE: In women symptoms of interstitial cystitis are difficult to distinguish from those of painful bladder syndrome and they appear to overlap with those of urinary tract infection, chronic urethral syndrome, overactive bladder, vulvodynia and endometriosis. This has led to difficulties in formulating a case definition for interstitial cystitis, and complications in the treatment and evaluation of its impact on the lives of women. We performed a systematic literature review to determine how best to distinguish interstitial cystitis from related conditions. MATERIALS AND METHODS: We performed comprehensive literature searches using the terms diagnosis, and each of interstitial cystitis, painful bladder syndrome, urinary tract infection, overactive bladder, chronic urethral syndrome, vulvodynia and endometriosis. RESULTS: Of 2,680 screened titles 604 articles were read in full. The most commonly reported interstitial cystitis symptoms were bladder/pelvic pain, urgency, frequency and nocturia. Interstitial cystitis and painful bladder syndrome share the same cluster of symptoms. Chronic urethral syndrome is an outdated term. Self-reports regarding symptoms and effective antibiotic use can distinguish recurrent urinary tract infections from interstitial cystitis in some but not all women. Urine cultures may also be necessary. Pain distinguishes interstitial cystitis from overactive bladder and vulvar pain may distinguish vulvodynia from interstitial cystitis. Dysmenorrhea distinguishes endometriosis from interstitial cystitis, although many women have endometriosis plus interstitial cystitis. CONCLUSIONS: In terms of symptoms interstitial cystitis and painful bladder syndrome may be the same entity. Recurrent urinary tract infections may be distinguished from interstitial cystitis and painful bladder syndrome via a combination of self-report and urine culture information. Interstitial cystitis and painful bladder syndrome may be distinguished from overactive bladder, vulvodynia and endometriosis, although identifying interstitial cystitis and painful bladder syndrome in women with more than 1 of these diseases may be difficult.

Arch Gynecol Obstet. 2007 Jul;276(1):87-9. Epub 2007 Jan 12.

Successful outcome following pre-viability amniorrhexis.

Engemise S, Kalu E, Haque K.

Department of Obstetrics and Gynaecology, St Helier Hospital, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK. engemisesam@doctors.org.uk

A 34-years-old primigravida conceived following a fourth attempt at in vitro fertilization and embryo transfer for severe bilateral tubal disease and grade IV endometriosis. Pregnancy progressed well until 17 weeks gestation when she spontaneously ruptured her membranes. She elected to continue with the pregnancy despite the significant risks associated with prolonged rupture of membranes (PROM) and anhydramnion at extremes of viability. Pregnancy was carried to 28 weeks gestation, when delivery was necessitated by a major antepartum haemorrhage following abruption placentae. A male infant weighing 1,100 g was delivered by emergency caesarean section in good condition, and with no features oligohydramnion tetrad (Potter’s features, skeletal deformities, intrauterine growth restriction, and pulmonary hypoplasia). This case adds to the small number of cases in the literature of successful outcome following prolonged pre-viability PROM. Counselling and psychological support to the parents in this situation is extremely important since the anxiety and uncertainty associated with expectant management of PROM does not end with the “successful” delivery of the baby but persists all through the neonatal period and for several years later.

J Minim Invasive Gynecol. 2007 Jan-Feb;14(1):128-31.

Septate uterus with double cervices, unilaterally obstructed vaginal septum, and ipsilateral renal agenesis: a rare combination of müllerian and wolffian anomalies complicated by severe endometriosis in an adolescent.

Hur JY, Shin JH, Lee JK, Oh MJ, Saw HS, Park YK, Lee KW.

Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, Korea.

We present a previously unreported combination of müllerian and wolffian anomalies of a septate uterus with double cervices, unilaterally obstructed vaginal septum, and ipsilateral renal agenesis; this constellation of findings may offer clues that could modify classic embryologic explanations. In spite of the young age of our patient (15-years old), a chief complaint of malodorous vaginal discharge, and absence of dysmenorrhea or any other symptoms of endometriosis, laparoscopic examination revealed severe endometriosis with dense adhesions, probably as a result of abundant menstrual regurgitation. Laparoscopic resection of endometriotic lesions, adhesiolysis, and vaginoscopic septotomy were successfully performed while preserving hymenal integrity.

J Minim Invasive Gynecol. 2007 Jan-Feb;14(1):113-5.

Laparoscopic treatment of recurrent small bowel obstruction secondary to ileal endometriosis.

Orbuch IK, Reich H, Orbuch M, Orbuch L.

Advanced Gynecologic Laparoscopy Center, New York, New York, USA. iriskerin@hotmail.com

Endometriosis is a relatively common condition characterized by implantation and proliferation of endometrial glands outside the uterus affecting 8% to 15% of women. Intestinal involvement is common, reported in 12% to 37% of individuals with the disease. The sites most often affected are the sigmoid colon and rectum (85%), while small bowel involvement is seen less frequently (7%) and usually confined to the distal ileum. The cecum (3.6%) and appendix (3%) are the sites least affected.

J Minim Invasive Gynecol. 2007 Jan-Feb;14(1):54-8.

Pentoxifylline therapy after laparoscopic surgery for different stages of endometriosis: a prospective, double-blind, randomized, placebo-controlled study.

Alborzi S, Ghotbi S, Parsanezhad ME, Dehbashi S, Alborzi S, Alborzi M.

Division of Infertility and Endoscopic Surgery, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. alborzis@sums.ac.ir

STUDY OBJECTIVE: To evaluate the effects of pentoxifylline administration on patients with different stages of endometriosis on whom laparoscopy was performed. DESIGN: Prospective, double-blind, randomized, placebo-controlled clinical (Canadian Task Force classification I). SETTING: University and private hospitals. PATIENTS: Eighty-eight women, all with infertility, some with dysmenorrhea, dyspareunia, or pelvic pain, on whom a laparoscopic diagnosis of endometriosis was made. INTERVENTIONS: The treatment group received 800 mg pentoxifylline daily for 6 months immediately after surgery. The control group received placebo capsules. All patients were followed-up for 1 year thereafter. MEASUREMENTS AND MAIN RESULTS: A comparison of pregnancy rate and recurrence of signs and symptoms in the 2 groups was performed. Forty-three patients were studied in the pentoxifylline group and 45 in the placebo group. The cumulative pregnancy rate was 39.5% and 35.6% in the treatment and control groups, respectively. The overall recurrence of signs and symptoms was 14% in the former group and 15.6% in the latter. There were no statistically significant differences between the 2 groups in rates of pregnancy and recurrence (p = .700 and .832, respectively). Nor was there any significant statistical difference between the same stages in the 2 groups regarding immunomodulation. CONCLUSIONS: According to the results of this study, and while keeping in mind that appropriate surgery is the main aspect of endometriosis treatment, there is no evidence that immunomodulation with pentoxifylline aids fertility or lessens recurrence of signs and symptoms in women with different stages of endometriosis (i.e., minimal, mild, moderate, or severe).

J Minim Invasive Gynecol. 2007 Jan-Feb;14(1):49-53.

Comment in:

J Minim Invasive Gynecol. 2007 Jul-Aug;14(4):531-2; author reply 532-3.

The prevalence of fimbrial pathology in patients with early stages of endometriosis.

Abuzeid MI, Mitwally MF, Ahmed AI, Formentini E, Ashraf M, Abuzeid OM, Diamond MP.

Center for Reproductive Medicine, Hurley Medical Center, Flint, Michigan 48503, USA. reprod1@hurleymc.com

STUDY OBJECTIVE: The presence of fimbrial pathology in advanced endometriosis is clearly understood. However, little is known about the prevalence of fimbrial pathology in early stages of endometriosis. The purpose of this study is to determine the prevalence of fimbrial pathology in patients with infertility with early stages of endometriosis. DESIGN: Historical cohort study (Canadian Task Force classification II/III). SETTING: Tertiary referral center. PATIENTS: The study group (Group 1) consisted of 315 infertile women who were found to have stage I or stage II endometriosis, and the control group (Group 2) consisted of 152 infertile women without endometriosis (Group 2). INTERVENTION: Laparoscopic evaluation for the presence and type of fimbrial pathology. MEASUREMENTS AND MAIN RESULTS: The prevalence of fimbrial pathology was significantly higher in infertile patients with early stages of endometriosis (50.2%) compared with infertile patients with no endometriosis (17.8%, p <.0001). CONCLUSION: These preliminary data suggest the presence of fimbrial pathology in many patients with early stages of endometriosis. Such pathology may act as a mechanical factor interfering with the ovum pick-up mechanism.

J Minim Invasive Gynecol. 2007 Jan-Feb;14(1):33-8.

Comment in:

J Minim Invasive Gynecol. 2007 Jul-Aug;14(4):529-30; author reply 530.

Outcome after rectum or sigmoid resection: a review for gynecologists.

Ret Dávalos ML, De Cicco C, D’Hoore A, De Decker B, Koninckx PR.

Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. lorenaret@hotmail.com

It remains unclear when to perform a discoid or segmental bowel resection for large endometriotic nodules with intestinal invasion. Moreover, endometriosis series are rather small to fully evaluate functional consequences of bowel resection. We therefore reviewed the incidence of leakage and functional problems after anterior and sigmoid resection as reported in the surgical literature albeit for other indications. Endoscopic resection clearly is feasible but requires an experienced surgeon. The incidence of leakage is not different after hand-sewn or stapled anastomosis, but is higher after a low rectum resection than after a sigmoid resection. Similarly, functional bowel problems are higher after a low rectum resection than after sigmoid resection. Low rectum resection in addition can be associated with functional bladder problems and sexual disturbances as anorgasmia. In conclusion, short- and long-term complications are much higher after a low rectum than after a sigmoid resection. This seems to be important in making the decision to perform a discoid or a segmental bowel resection for severe endometriosis.

J Minim Invasive Gynecol. 2007 Jan-Feb;14(1):23-32.

Villar’s nodule: a case report and systematic literature review of endometriosis externa of the umbilicus.

Victory R, Diamond MP, Johns DA.

Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan 48201, USA. rvictory@med.wayne.edu

We report a case of umbilical endometriosis externa and systematically review the literature regarding this finding. In our case report, a 47-year-old woman with cyclic umbilical bleeding, pelvic pain, and no previous umbilical surgery developed a spontaneous umbilical endometrioma, cured by surgical resection and bilateral salpingo-oophorectomy. In our review, 122 patients with documented umbilical endometriomas from 1966 to the present and 109 cases reported before 1953 were analyzed. Procedures used for diagnosis and/or therapeutic intervention included umbilical biopsy or resection, abdominal wall repair, diagnostic and/or operative laparoscopy, adhesiolysis, hysterectomy, and bilateral salpingo-oophorectomy. Variables included patient age; race; medical and surgical history; past use of oral contraceptives; history of umbilical pain, bleeding, or swelling; duration of signs and symptoms; size and color of the lesion; diagnostic evaluations; and medical or surgical management. Mean age of the study population was 37.7 +/- 0.98 years. Up to 40% of patients with extrapelvic endometriosis present with umbilical endometriomas, with symptoms occurring an average of 17.8 +/- 3.9 months before presentation. Lesions averaged 2.3 +/- 0.2 cm in diameter; were predominantly brown (19.1%), blue (13.2%), or purple (10.3%); and patients frequently had with pain (77.93%), cyclical bleeding (47.1%), and swelling (88.2%). Most patients had no history of endometriosis (73.1%), and laparoscopic, umbilical trocar-related seeding was identified in only 5 patients. Three patients received medical management, and surgical management was invariably curative, though 1 patient required repeat surgical therapy. Umbilical endometriosis is a common manifestation of external endometriosis, representing primary or secondary endometriosis, with a typical presentation that has little variation. Laparoscopic endometrioid tissue excision can result in iatrogenic seeding to the umbilicus. Historical and physical findings are pathognomonic, thus justifying a formal name–Villar’s nodule, after the initial reporting physician. Surgical intervention is recommended, but medical therapy may result in long-term symptom control with minimal malignancy risk.

Australas Radiol. 2007 Feb;51(1):91-4.

Inguinal endometriosis attaching to the round ligament.

Hagiwara Y, Hatori M, Moriya T, Terada Y, Yaegashi N, Ehara S, Kokubun S.

Departments of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan.

We report a case of endometriosis in the right inguinal region, attached to the right round ligament in a 28-year-old woman. At the age of 20, laparoscopic left ovarian cystectomy and pelvic adhesiolysis for endometriosis was carried out. She noticed a right tender groin mass 7 months previously, and the tumour size fluctuated with the menstrual cycle. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpated in her right inguinal region. Magnetic resonance imaging showed a 2.5 cm x 2.5 cm mass in the right inguinal canal and a 5.4 cm x 6.8 cm mass was seen in the left ovary. The mass enlarged during menstruation. The groin mass was removed, in addition to carrying out laparoscopic ovarian cystectomy. At operation, the groin mass was found to be in continuity with the round ligament of extraperitoneal portion. Histological diagnosis of endometriosis was made in both ovarian and inguinal tumours. After surgery, the pain disappeared completely. Worth mentioning is that MRI clearly showed the change of tumour size depending on the menstrual cycle, which aided in arriving at the correct diagnosis of endometriosis in an unusual location.

Hum Reprod. 2007 Apr;22(4):1026-30. Epub 2007 Jan 9.

The G2964A 3′-untranslated region polymorphism of the signal transducer and activator of transcription 6 gene is associated with endometriosis in South Indian women.

Bhanoori M, Deenadayal M, Kennedy S, Shivaji S.

Centre for Cellular and Molecular Biology, Hyderabad, Andhra Pradesh, India.

BACKGROUND: The aim of the study was to test whether the signal transducer and activator of transcription 6 (STAT6) gene influences the risk of developing endometriosis. METHODS: The single-nucleotide polymorphism, G2964A, in the 3′-untranslated region (UTR) of the STAT6 gene was tested for association in a case-control study of 232 affected women and 210 women with no evidence of disease. All the women were infertile, ascertained from the same infertility clinic and of South Indian origin. The genotype frequencies of this polymorphism were compared using PCR and sequencing analysis. RESULTS: There were statistically significant differences in the genotype distributions (P = 0.002) and allele frequencies (P = 0.0002) between the cases and controls, according to codominant, dominant and recessive genotype models. CONCLUSIONS: We report for the first time an association between the STAT6 G2964A 3′-UTR polymorphism and endometriosis in South Indian women. This finding suggests that STAT6 may contribute to disease susceptibility in endometriosis, which carries an extra interest as the gene lies in a region which has been implicated, albeit weakly, in a previous genomewide scan.

Eur J Obstet Gynecol Reprod Biol. 2007 Jun;132(2):140-7. Epub 2007 Jan 8.

Endometriosis, dysmenorrhea and diet–what is the evidence?

Fjerbaek A, Knudsen UB.

Department of Gynecology and Obstetrics, Odense University Hospital, University of Southern Denmark, DK-5000 Odense C, Denmark.

The objective of this study is to assess the literature concerning the effect of diet on endometriosis and dysmenorrhea and to elucidate evidential support, to give dietary recommendations to women suffering from these conditions. A systematic search in electronic databases on a relationship between diet and endometriosis/dysmenorrhea was performed. Data on diet and endometriosis were limited to four trials of which two were animal studies. The articles concerning human consumption found some relation between disease and low intake of vegetable and fruit and high intake of vegetarian polyunsaturated fat, ham, beef and other red meat. Results concerning fish intake were not consistent. Eight trials of different design, with a total of 1097 women, investigated the relationship between diet and dysmenorrhea. Intake of fish oil seemed to have a positive effect on pain symptoms. This study concludes that literature on diet and endometriosis is sparse, whereas eight studies have looked at diet and dysmenorrhea. No clear recommendations on what diet to eat or refrain from to reduce the symptoms of endometriosis can be given, while a few studies indicate that fish oil can reduce dysmenorrhea. Further research is recommended on both subjects.

J Reprod Immunol. 2007 Jun;74(1-2):124-32. Epub 2007 Jan 8.

Intraperitoneal recombinant interleukin-2 activates leukocytes in rat endometriosis.

Velasco I, Quereda F, Bermejo R, Campos A, Acién P.

Division of Gynecology, School of Medicine, Miguel Hernández University, Alicante, Spain. ivelasco@umh.es

The aim of this double-blinded study was to determine changes in leukocyte populations in blood, peritoneal lavage fluid, eutopic and ectopic endometrium after treatment with recombinant rat interleukin-2 (IL-2) using an in vivo experimental model of rat endometriosis. The in vivo model involved transplanting four square fragments of autologous endometrium onto the inner surface of the abdominal wall in 20 Wistar rats. The control group was constituted by 20 sham-operated rats. Both groups were randomly treated (1-month interval treatment) with 2 intraperitoneal doses of glucose solution (5%) that did or did not contain recombinant IL-2, and animals were sacrificed 4 weeks after the last dose of treatment. Blood and peritoneal lavage were obtained during the initial and final laparotomy, whereas eutopic and ectopic endometrium were collected at the end of the experiment. Endometriotic implants were measured in each laparotomy to determine any change in size. Leukocyte populations were analyzed by flow cytometry and immunofluorescence microscopy. Cytometric results were similar in blood and peritoneal lavage. CD25+ and natural killer (NK) cell levels in peripheral blood were lower in rats with endometriosis treated with IL-2, whereas NK cells increased in lavage compared to placebo group. The percentage of macrophages and dendritic cells in blood were higher in all rats treated with IL-2, as well as peritoneal dendritic cells. Implant size of these rats decreased significantly, showing a greater number of activated lymphocytes, macrophages, NK and dendritic cells inside them. In conclusion, recombinant IL-2 induced recruitment of activated leukocytes into endometriotic-like foci, and this was related to a reduction of the implant size, suggesting potential effectiveness of IL-2 as an immunomodulatory agent in this pathology.

Hum Reprod. 2007 Apr;22(4):945-52. Epub 2007 Jan 5.

Altered apoptosis and proliferation in endometrial stromal cells of women with adenomyosis.

Yang JH, Wu MY, Chen CD, Chen MJ, Yang YS, Ho HN.

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

BACKGROUND: The eutopic endometrium in a woman suffering from adenomyosis is known to be biologically different from that of healthy women. The aim of this study was to examine the apoptosis and proliferation of eutopic endometrium from women with adenomyosis. METHODS: We enrolled 23 women with adenomyosis (study group) and 21 without (control group). Eutopic endometrium was obtained and separated into single endometrial stromal cells (ESCs). ESCs were treated in vitro with hydrogen peroxide (H(2)O(2)) to examine their apoptosis using a fluorescence-activated cell sorter. Cells were also treated with estradiol (E(2)), medroxyprogesterone acetate, interleukin (IL)-6, lipopolysaccharide and interferon-gamma (IFN-gamma) to test their proliferation using a non-radioactive cell proliferation assay. RESULTS: The percentage of annexin V ( + )/7-amino-actinomycin D ( + ) ESCs was much lower in women with adenomyosis after 24 h culture with and without H(2)O(2) treatment when compared with the control group. ESCs of adenomyosis proliferated more rapidly than those of the control group, whether they were cultured alone or were treated with E(2), MPA, IL-6 or IFN-gamma. The immunocytochemical Ki-67 labelling index was much more prominent in adenomyotic ESCs than that of the control group (7.7% versus 1.1%, P < 0.001). CONCLUSIONS: Altered apoptosis and proliferation of eutopic endometrium possibly elucidate some aspects of the pathophysiology of adenomyosis. A high Ki-67 labelling index in immunocytochemistry might be a potential indicator in predicting the occurrence of adenomyosis.

Gynecol Obstet Fertil. 2007 Jan;35(1):77-8. Epub 2007 Jan 8.

Comment on:

Gynecol Obstet Fertil. 2006 Jul-Aug;34(7-8):583-92.

[Laparoscopic surgery of deep endometriosis. About 118 cases]

[Article in French]

Canis M.

Gynecol Obstet Fertil. 2007 Jan;35(1):38-40. Epub 2007 Jan 8.

[Treating severe endometriosis by pregnancy: a risky business]

[Article in French]

Roman H, Friederich L, Khalil H, Marouteau-Pasquier N, Hochain P, Marpeau L.

Clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France. horace.roman@chu-rouen.fr

We report the case of a young woman presenting with painful deep and rectal endometriosis. This condition had started long ago while the diagnosis had been delayed. Brutal colon occlusion followed the discontinuation of oral contraception. Left colectomy with terminal colostomy was carried out in emergency. The conservative surgical management of deep endometriosis was performed three months later. In women presenting deep endometriosis, the discontinuation of hormonal treatment in order to attempt a spontaneous pregnancy should not be recommended before undertaking a thorough endometriosis and fertility status investigation.

Gynecol Obstet Fertil. 2007 Jan;35(1):78-9. Epub 2007 Jan 8.

Comment on:

Gynecol Obstet Fertil. 2006 Jul-Aug;34(7-8):583-92.

[Laparoscopic surgery of deep endometriosis. About 118 cases]

[Article in French]

Daraï E.

Fertil Steril. 2007 Apr;87(4):988-90. Epub 2007 Jan 4.

Detection of endometriosis with the use of plasma protein profiling by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry.

Liu H, Lang J, Zhou Q, Shan D, Li Q.

In this prospective case-control study, we determined the role of surface-enhanced laser desorption and ionization time-of-flight mass spectrometry in the detection of histologically proven endometriosis. In the plasma of the group with endometriosis, there were 20 different protein peaks, and the classifier showed a sensitivity of 87.5% and a specificity of 80% in the diagnosis of endometriosis.

Reprod Biomed Online. 2007 Jan;14(1):49-56.

Assessment of human oocyte developmental competence by cumulus cell morphology and circulating hormone profile.

Sato C, Shimada M, Mori T, Kumasako Y, Otsu E, Watanabe H, Utsunomiya T.

St Luke Clinic, 5 Tsumori-Tomioka, Oita 870-047, Japan.

The predictive value of the morphology of the cumulus–oocyte complex (COC) has not yet been explored as a possible factor contributing to the success of human in-vitro maturation (IVM). In the present study, development-supporting competency of oocytes encircled in a large ( > or = 5) (grade A), moderate (3 approximately 4) (grade B) or small ( < or = 2) (grade C) number of cumulus cell layers was assessed, together with changes in hormonal profile following a truncated course of 150 IU pure FSH administration for 3 days prior to aspiration on laparoscopy indicated for endometriosis. FSH priming increased the number of COC aspirated without changing the proportion of the three morphological types of COC, which were then subjected to IVM in the presence of 200 mIU/ml FSH plus 1000 mIU/ml human chorionic gonadotrophin, followed by intracytoplasmic sperm injection. The highest development-supporting competence was observed not with oocytes in grade A COC harvested from natural cycles, but with oocytes in grade B COC from FSH-primed cycles. Hormonal profiles in patients bearing grade B COC were characterized by moderate response in oestradiol and progesterone production following FSH, with LH/FSH ratio being below 1.0. It is concluded that an optimal window of hormonal profile(s) may exist for follicle aspiration to obtain grade B COC in FSH-stimulated human IVM cycles.

Hum Reprod. 2007 Apr;22(4):938-44. Epub 2007 Jan 4.

Collagen gel contractility is enhanced in human endometriotic stromal cells: a possible mechanism underlying the pathogenesis of endometriosis-associated fibrosis.

Yuge A, Nasu K, Matsumoto H, Nishida M, Narahara H.

Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan.

BACKGROUND: Excessive fibrosis is frequently associated with endometriosis. To evaluate the involvement of the extracellular matrix contractility of endometriotic stromal cells (ECSCs) in the pathogenesis of endometriosis-associated fibrosis, we compared the collagen gel contractility of cultured ECSCs with that of normal endometrial stromal cells. To clarify the mechanism underlying collagen gel contraction by ECSCs, we also evaluated the effect of (+)-(R)-trans-4-(1-aminoethyl)-N-(4-pyridyl) cyclohexanecarboxamide dihydrochloride, monohydrate (Y-27632), a selective Rho-associated coiled-coil-forming protein kinase (ROCK) inhibitor, on the collagen gel contraction by ECSCs. METHODS AND RESULTS: ECSCs showed enhanced collagen gel contractility in comparison with NESCs. Myofibroblastic differentiation and the increased expression of fibronectin, RhoA, ROCK-I and ROCK-II proteins were observed with ECSCs using the 3D culture. Y-27632 significantly inhibited the collagen gel contractility of ECSCs without cytotoxicity. CONCLUSIONS: The present findings suggest that the enhanced collagen contractility in ECSCs is associated with myofibroblastic differentiation, the increased expression of fibronectin and the activation of the Rho-ROCK-mediated signalling pathway, all of which may be involved in the pathogenesis of endometriosis-associated fibrosis. These results suggest that the inhibition of the Rho-ROCK-mediated signalling pathway may provide a novel strategy for the treatment of this disease. In addition, our experimental system of ECSCs using 3D collagen gel culture would be suitable for evaluating novel treatments for endometriosis.

Gynecol Obstet Invest. 2007;64(1):24-35. Epub 2007 Jan 5.

Two unsuccessful clinical trials on endometriosis and a few lessons learned.

Guo SW, Olive DL.

Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226-0509, USA. swguo@mcw.edu

In 1999, a phase II clinical trial on the use of fulvestrant to treat endometriosis was launched; yet after 7 years there is still no report on its outcome. In 2005, another trial on the use of raloxifene to treat endometriosis was terminated early due to unfavorable outcome. The two apparently unsuccessful clinical trials on endometriosis have taught us a few important lessons. First, we need to understand endometriosis through more basic research. We have also been reminded that human endometriosis trials differ from animal studies; anatomy and physiology are often divergent, and outcome measures are certainly different. Ectopic endometrium can differ significantly from eutopic tissue, and this issue needs to be more thoroughly explored. We believe human cell lines will prove to be an inexpensive and valuable tool for future preliminary evaluation of medical therapies as well as discerning pathophysiologic processes of the disease. Based on our current understanding of endometriosis, some concrete benchmarks can be established for testing or screening potential compounds in vitro. Finally, estrogen receptor modulators are often tissue-, cell-, and context-specific in their actions; they should not be simplistically grouped together nor should extrapolations from one compound to another be undertaken in a cavalier manner. Copyright 2007 S. Karger AG, Basel.

Cardiovasc Intervent Radiol. 2007 Mar-Apr;30(2):268-72.

Use of the 4F Rösch inferior mesenteric catheter in embolization procedures in the pelvis: a review of 300 cases.

Kroencke TJ, Kluner C, Hamm B, Gauruder-Burmester A.

Department of Radiology, Charité Universitätsmedizin Berlin, 10098 Berlin, Germany. thomas.kroencke@charite.de

The aim of this study is to evaluate the use of a 4F Rösch inferior mesenteric (RIM) catheter for pelvic embolization procedures. Between October 2000 and January 2006, 364 patients (357 female, 7 male; age: 23-67 years) underwent embolization of various pathologies [uterine fibroids (n = 324), pure adenomyosis of the uterus (n = 19), postpartum hemorrhage (n =1), traumatic or postoperative hemorrhage (n = 9), bleeding related to cervical cancer (n =7), AV malformation of the uterus (n = 2) and high-flow priapism (n = 2)] at a single institution. In all cases, bilateral catheterization was primarily attempted with the use of a 4F hook-shaped braided endhole catheter (Rösch-Inferior-Mesenteric, RIM-Catheter, Cordis, Miami, FL). Frequency of initial failure to catheterize the vascular territory of interest and carry out the embolization were recorded and the types of difficulty encountered were noted. Catheterization of the main stem of the vessel territory of interest with the use of a unilateral femoral approach and the 4F RIM catheter was successful in 334/364 (91.8%) the embolization cases. Bilateral catheterization of the internal iliac arteries using a single common femoral artery access and the 4F RIM catheter was achieved in 322/364 (88.5%) patients. In 12/364 (3.3%) patients, a contralateral puncture was performed and the same 4F catheter was used. In 28/364 (7.7%) cases the 4F RIM catheter was exchanged for a catheter with a cobra-shaped or sidewinder configuration. The 4F RIM catheter is a simple and valuable alternative to catheters and techniques commonly employed for pelvic artery embolization.

Fertil Steril. 2007 Jan;87(1):33-8.

Effects of photodynamic therapy using 5-aminolevulinic acid on cultured human adenomyosis-derived cells.

Suzuki-Kakisaka H, Murakami T, Hirano T, Terada Y, Yaegashi N, Okamura K.

Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan. suharuka@mail.tains.tohoku.ac.jp

OBJECTIVE: To evaluate the potential of photodynamic therapy with aminolevulinic acid (ALA) on human adenomyosis-derived cells compared with endometrial stromal cells. DESIGN: In vitro study. SETTING: Department of Obstetrics and Gynecology, Tohoku University Hospital. PATIENT(S): Women with adenomyosis attending the University hospital. INTERVENTION(S): Photodynamic treatment. MAIN OUTCOME MEASURE(S): Cell survival rates. RESULT(S): Treatment with both ALA and irradiation caused significantly decreased survival of cells derived from human adenomyosis compared with ALA or irradiation alone. The combination of irradiation and ALA led to 79.3%, 68.0%, and 59.5% cell survival at 1.6, 4, and 8 J/cm2, respectively, whereas ALA and irradiation alone caused 92.8% and 97% survival, respectively. CONCLUSION(S): Photodynamic therapy using ALA caused extensive death of cells derived from human adenomyosis. Photodynamic treatment using ALA may be a new treatment for patients with adenomyosis uteri in the future.

Clin Evid (Online). 2007 Mar 1;2007. pii: 0802.

Endometriosis.

Johnson N, Farquhar C.

University of Auckland, Auckland, New Zealand.

INTRODUCTION: Ectopic endometrial tissue is found in up to 20% of asymptomatic women, up to 60% of those with dysmenorrhoea, and up to 30% of women with subfertility, with a peak incidence at around 40 years of age. However, symptoms may not correlate with laparoscopic findings. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of hormonal treatments given at diagnosis of endometriosis? What are the effects of hormonal treatments before surgery for endometriosis? What are the effects of non-hormonal medical treatments for endometriosis? What are the effects of surgical treatments for endometriosis? What are the effects of hormonal treatment after conservative surgery for endometriosis? What are the effects of hormonal treatment after oophorectomy (with or without hysterectomy) for endometriosis? What are the effects of treatments for ovarian endometrioma? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 32 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: combined oral contraceptives; danazol; dydrogesterone; gestrinone; gonadorelin analogues; hormonal treatment before surgery; hormonal treatment; laparoscopic cystectomy; laparoscopic removal of endometriotic deposits (alone or with uterine nerve ablation); laparoscopic removal plus presacral neurectomy; laparoscopic uterine nerve ablation; non-steroidal anti-inflammatory drugs; presacral neurectomy alone; and progestogens other than dydrogesterone.

Int J Gynaecol Obstet. 2007 Jan;96(1):20-3. Epub 2006 Dec 21.

Sonohysterography versus transvaginal sonography for screening of patients with abnormal uterine bleeding.

Alborzi S, Parsanezhad ME, Mahmoodian N, Alborzi S, Alborzi M.

Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran. alborzis@sums.ac.ir

OBJECTIVES: To compare the accuracy of saline infusion sonohysterography (SIS) with transvaginal sonography (TVS) for the screening of causes of abnormal uterine bleeding (AUB) in out-patients. METHODS: 81 patients with AUB were studied. All cases who were examined with TVS, were further investigated with SIS using saline as contrast medium, finally hysteroscopy was used as the gold standard. RESULTS: TVS had sensitivity of 72%, specificity of 92%, positive predictive value of 94% and negative predictive value of 65%, while SIS had sensitivity of 94.1%, specificity of 95%, positive predictive value of 96% and negative predictive value of 90%. TVS had kappa measure of agreement of 0.60 while 0.86 was reported for SIS. CONCLUSIONS: In this study SIS was more sensitive and specific in diagnosing polyp, myoma and adenomyosis with high positive and negative predictive value. Furthermore, results obtained by SIS demonstrate more agreement with that obtained by hysteroscopy than TVS.

Pharmacogenomics. 2007 Jan;8(1):49-66.

Vascular endothelial growth factor pharmacogenetics: a new perspective for anti-angiogenic therapy.

Pasqualetti G, Danesi R, Del Tacca M, Bocci G.

University of Pisa, Division of Pharmacology and Chemotherapy, Department of Internal Medicine, Via Roma, 55, I-56126 Pisa, Italy.

The pharmacogenetic approach to anti-angiogenic therapy should be considered a possible strategy for many pathological conditions with high incidence in Western countries, including solid tumors, age-related macular degeneration or endometriosis. While pharmacogenetic studies are building stronger foundations for the systematic investigations of phenotype-genotype relationships in many research and clinical fields of medicine, pharmacogenetic data regarding anti-angiogenic drugs are still lacking. Here we review preclinical and clinical genetic studies on angiogenic determinants such as vascular endothelial growth factor and vascular endothelial growth factor receptor-2. We suggest that pharmacogenetic profiling of patients who are candidates for the currently available anti-angiogenic agents targeting vascular endothelial growth factor and vascular endothelial growth factor receptor-2 may aid the selection of patients on the basis of their likelihood of responding to the drugs or suffering from toxicity.

Int J Cancer. 2007 Mar 15;120(6):1372-5.

Risk for breast cancer among women with endometriosis.

Bertelsen L, Mellemkjaer L, Frederiksen K, Kjaer SK, Brinton LA, Sakoda LC, van Valkengoed I, Olsen JH.

Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark. lisbethb@cancer.dk

Although several risk factors are common to endometriosis and breast cancer, the results of observational studies of an association have so far been inconsistent. We evaluated the relationship between endometriosis and breast cancer on the basis of data on selected cancers and medical histories from the Danish nationwide cancer and hospital registries used in a large case-cohort study. A total of 114,327 women were included in the study of whom 1,978 women had received a diagnosis of endometriosis and 16,983 had had a diagnosis of breast cancer between 1978 and 1998. Of the women with endometriosis, 236 subsequently received a diagnosis of breast cancer. The crude overall rate ratio for breast cancer after endometriosis was 1.00 and after adjustment for reproductive factors, calendar-period, bilateral oophorectomy and benign breast disease, the rate ratio was 0.97 (95% confidence interval, 0.85-1.11). The risk for breast cancer increased with age at diagnosis of endometriosis, so that women in whom endometriosis was diagnosed at a young age (approximately <40 years) had a reduced risk for breast cancer and women in whom endometriosis was diagnosed at older ages (approximately > or =40 years) tended to have an increased risk for breast cancer. The reduced risks observed among young women may reflect their exposure to drugs with antiestrogenic effects. The increased risk associated with endometriosis among postmenopausal women may be due to common risk factors between postmenopausal endometriosis and breast cancer or an altered endogenous estrogen. (c) 2006 Wiley-Liss, Inc.

Mol Reprod Dev. 2007 Jul;74(7):808-14.

Angiotensin I-converting enzyme insertion-related genotypes and allele are associated with higher susceptibility of endometriosis and leiomyoma.

Hsieh YY, Lee CC, Chang CC, Wang YK, Yeh LS, Lin CS.

Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.

Endometriosis and leiomyoma display features similar to malignancy, requiring neovascularization to proliferation and growth. Altered vascular-related genes might be related to the development of endometriosis and leiomyoma. Polymorphisms of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) genes have been linked with some vascular diseases. This study investigates whether ACE I/D gene polymorphisms could be used as markers of susceptibility in endometriosis and leiomyoma. Women were divided into three groups: (1) endometriosis (n = 125); (2) leiomyoma (n = 120); (3) normal controls (n = 128). Genomic DNA was obtained from peripheral leukocyte. ACE I/D gene polymorphisms in intron 16 were amplified by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) Genotypes and allelic frequencies in both groups were compared. We observed the genotype distribution and allele frequency of ACE I/D gene polymorphisms in both groups were significantly different. Proportions of ACE*I homozygote/heterozygote/D homozygote in both groups were: (1) 50.4/24/25.6%; (2) 25/23.33/51.67%; (3) 10.2/29.7/60.1%. Proportions of I/D alleles in each group were: (1) 62.4/37.6%; (2) 36.7/63.3%; (3) 25/75%. We concluded that ACE*I/D gene polymorphisms are associated with endometriosis and leiomyoma susceptibilities. ACE*I-related genotypes and allele are strongly related to the occurrence of endometriosis and moderately related to the occurrence of leiomyoma.

Arch Gynecol Obstet. 2007 Jul;276(1):1-15. Epub 2006 Dec 22.

Therapeutic options for adenomyosis: a review.

Levgur M.

Department of Obstetrics and Gynecology, Maimonides Medical Center, 967 48th street, Brooklyn, NY, USA. mlevgur@maimonidesmed.org

BACKGROUND: To review the literature on various therapeutic modalities for uterine adenomyosis. METHODS: Reviews, case-controlled studies and reports from November 1949 until August 2006 written in English or summarized in English abstracts retrieved from Medline and Pubmed using the key words: adenomyosis and adenomyosis therapy. RESULTS: Symptoms of adenomyosis may be alleviated by antiprostaglandins, sex hormones, danazol and GnRH analogs. Minor surgical procedures for therapy include endomyometrial ablation, laparoscopic myometrial electrocoagulation and adenomyoma excision. Patient’s age and symptoms, desired fertility, site and extent of lesion and surgeon’s skills should be considered in choosing the appropriate procedure. Endomyometrial ablation is effective for lesions deeper than the endometrial-myometrial junction whereas the efficacy of hysteroscopic ablation is limited to foci 2-3 mm deep. Focal and diffuse disease may be managed by laparoscopic electrocoagulation or myometrial excision with preservation of fertility but risk of recurrence exists. Uterine artery embolization assumingly invokes infarction and necrosis. Encouraging results reported in some cases warrant expanding its use for more experience. Hysterectomy is the ultimate solution for women with deep myometrial involvement or if future fertility is not desired. CONCLUSIONS: Various therapeutic options for adenomyosis, including few minimally invasive procedures became available in the last two decades but need evaluation and improvement.

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