Rev Gastroenterol Mex. 2008 Jul-Sep;73(3):159-162.

[Rectal endometriosis: entity difficult to diagnose.]

[Article in Spanish]

Hernández-Ramírez D, Cravioto-Villanueva A, Barragan-Rincón A.

Servicio de Tumores de Colon y Recto, División de Cirugía Oncológica.Hospital de Oncología, Centro Medico Nacional “Siglo XXI” IMSS, México. D.F.

Endometriosis is a gynecologic disorder caracterizedby the presence of endometrial glands andstroma outside the endometrial cavity and theuterine musculature. Although the ectopic endometrioticimplants are most commonly found inthe pelvis, the GI tract is the most common siteof extrapelvic endometriosis The diagnosis ofrectosigmoid is difficult to make on colonoscopybecause of the subepithelial location of the endometrioticimplants. We present a case report ofa 38-years-old woman referred with a diagnosisof rectal cancer with large intestine symptoms.Rectal endometriosis should be considered in thedifferential diagnosis of extramucosal rectal massesin premenopausal women, particularly if thepatient has gynecological complaints or a historyof infertility.Key words: Rectal endometriosis, rectum submucousinjuries.

 

J Gynecol Obstet Biol Reprod (Paris). 2008 Dec;37 Suppl 8:S368-83.

[Methods and efficacy of medical and surgical treatment of non functional menorrhagia]

[Article in French]

Brun JL, André G, Descat E, Creux H, Vigier J, Dallay D.

Hôpital Pellegrin, service de gynécologie-obstétrique, Place Amélie-Raba-Léon, 33076 Bordeaux cedex, France. jean-luc.brun@chu-bordeaux.fr

OBJECTIVES: To assess the efficacy of therapies in menorrhagia related to atypical endometrial hyperplasia, polyps, myoma, adenomyosis and arteriovenous malformation of the uterus. MATERIALS AND METHODS: Medline and Cochrane contents were searched to June 2008. RESULTS: Atypical endometrial hyperplasia is classically treated by hysterectomy, but may temporarily regress under hormone therapy (progestins, Gn-RH agonists) in women of childbearing age. Hysteroscopic resection is the standard treatment for endometrial polyps. Recurrence of bleeding is reduced by combining it with endometrial ablation. Myoma-related menorrhagia can be treated by Gn-RH agonists for 3 months or levonorgestrel in utero (LNG-IUS). Hysteroscopic resection is the standard treatment of submucous myomas. Interstitial myomas can be treated by myomectomy, myolysis, uterine artery embolisation or occlusion, or hysterectomy. Laparoscopic myomectomy and uterine artery embolisation are effective, well tolerated, and the best researched. LNG-IUS is effective and well tolerated to treat adenomyosis-related menorrhagia. The effect of other conservative treatments of the uterus (endometrial ablation, uterine artery embolisation or occlusion) is limited, especially in case of deep and extensive adenomyosis. Uterine artery embolisation is the standard treatment for arteriovenous malformation. CONCLUSIONS: Numerous medical and technical innovations have been recently developed as conservative treatments for menorrhagia. However, hysterectomy remains the standard treatment of atypical endometrial hyperplasia and adenomyosis.

 

 

J Gynecol Obstet Biol Reprod (Paris). 2008 Dec;37 Suppl 8:S343-8.

[Good practice and accuracy of office hysteroscopy and endometrial biopsy]

[Article in French]

Agostini A, Collette E, Provansal M, Estrade JP, Blanc B, Gamerre M.

Hôpital La Conception, service de gynécologie obstétrique, 147, boulevard Baille, 13005 Marseille, France. aubert.agostini@ap-hm.fr

Office hysteroscopy may be performed without anaesthesia. Endometrial biopsy can be performed during hysteroscopy. Antalgics or other treatment to reduce discomfort are not indicated. Prophylactic antibiotics are not indicated. Diagnostic value of hysteroscopy for endometrial pathology is interesting. Pipelle is the most appropriate instrument for endometrial biopsy.

J Hum Reprod Sci. 2008 Jul;1(2):56-64.

Recognising, understanding and managing endometriosis.

Fraser IS.

Professor Fraser is a Professor in Reproductive Medicine, Department of Obstetrics and Gynaecology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, NSW.

Endometriosis is defined as the presence of tissue lesions or nodules, histologically similar to the endometrium, at sites outside the uterus. It is a highly variable condition that has a wide spectrum of symptoms. The aetiology of endometriosis is probably multifactorial, with a strong familial component recognised. Women with endometriosis have multiple disturbances of function in the eutopic endometrium that women without the disease do not have. A firm diagnosis of endometriosis is rarely possible in general practice. The ‘gold standard’ for the diagnosis of pelvic endometriosis is currently a diagnostic laparoscopy.

Pathologica. 2008 Dec;100(6):473-5.

Primary umbilical endometriosis: a rare variant of extragenital endometriosis.

Khaled A, Hammami H, Fazaa B, Zermani R, Ben Jilani S, Kamoun MR.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia. aida.khaled@rns.tn

Endometriosis is defined as the presence of extra-uterine endometrial tissue. The prevalence rate of umbilical endometriosis ranges from 0.5 to 1.0% of all patients with extragenital endometriosis. In this report, we present a case of primary umbilical endometriosis to highlight the challenges encountered during diagnosis. A nulliparous 39-year-old woman presented to our department with a 2-year history of a tender, painful and non-reducible, firm umbilical mass that enlarged slowly reaching 2 cm in diameter. She had never been pregnant nor had any abdominal surgery. There was no sequential bleeding. Ultrasound of the umbilical region showed a well defined, oval shaped anechoic area. Histological examination on a cutaneous biopsy concluded umbilical endometriosis. The patient was subsequently referred to a gynecologist and underwent surgery with en bloc excision of the lesion. Generally, umbilical endometriosis presents as a roundish tumuor that can either partly or completely occupy the umbilical scar with intermittent bleeding. Characteristically, the mass increases with the menstrual cycle, becoming more evident and usually harder and is associated with cyclic pain. Its pathogenesis remains uncertain. Clinical diagnosis is difficult, and umbilical endometriosis can be easily confused with other conditions such as benign and malignant tumours. Ultrasound examination is useful, and surgical excision is the treatment of choice. Several cases of malignant transformation have also been described.

Afr Health Sci. 2008 Sep;8(3):196-8.

Endometriosis of the appendix.

Al Oulaqi NS, Hefny AF, Joshi S, Salim K, Abu-Zidan FM.

Department of Surgery, Al-Ain Hospital, Al-Ain, United Arab Emirates.

Endometriosis is a well known cause of infertility. Endometriosis of the appendix is a very rare condition. To highlight this rare entity, we are reporting a case of a young lady who was admitted with recurrent attacks of lower abdominal pain associated with primary infertility. Preoperative diagnosis was acute appendicitis. Histopathological examination of the appendix revealed endometriosis. Endometriosis should be considered in the differential diagnosis of recurrent lower abdominal pain in young females especially with history of infertility.

J Gastrointest Cancer. 2008;39(1-4):104-6. Epub 2009 Mar 31

Primary extrauterine endometrial stromal cell sarcoma: a case and review.

Zemlyak A, Hwang S, Chalas E, Pameijer CR.

Stony Brook University Medical Center, Stony Brook, NY, USA.

BACKGROUND: Extrauterine endometrial stromal sarcoma (ESS) is a rare neoplasm. Little is known about its pathophysiology or best treatment approach. CASE: We are describing a case of extrauterine ESS in a 70-year-old woman on hormone replacement therapy and with a history of endometriosis. We also present a brief review of the literature on ESS and its relationship to endometriosis and hormonal therapy. CONCLUSIONS: Complete resection should remain the treatment of choice for ESS. Unresectable or metastatic low-grade ESS may respond well to progestin therapy, but outcomes of high-grade ESS tend to be poor.

An Med Interna. 2008 Jun;25(6):307-8.

[Ileal endometriosis as cause of intestinal obstruction. A case presentation]

[Article in Spanish]

Ruiz R, Pacheco M, Oliden O.

 

Rev Med Chir Soc Med Nat Iasi. 2008 Apr-Jun;112(2):393-7.

[Abdominal wall endometriosis after gynecologic procedures: an under-appreciated diagnosis in general surgery]

[Article in Romanian]

Vintilă D, Neacşu CN, Popa P, Vlad N, Târcoveanu E, Georgescu SO, Dănilă N.

Universitatea de Medicină si Farmacie Gr T Popa Iaşi, Facultatea de Medicină, Clinica I Chirurgie.

Incisional endometriosis is a clinical entity described in the gynecologic literature but it is not well recognized among general surgeons. The preoperative diagnosis is often mistaken for a suture granuloma, abscess, lipoma, cyst or incisional hernia. MATERIAL AND METHOD: This is a retrospective review of six cases of incisional endometriosis in our hospital aimed at determining which, if any, factors would suggest the diagnosis preoperatively. All general surgery patients with a diagnosis of endometriosis in their pathology specimens from January 1990 to February 2006 were reviewed. RESULTS: All six patients had previous cesarean sections through either a Pfannenstiel (n = 4) or lower midline (n = 2) incision. Ages ranged from 28 to 43 years (mean 34.3 years). All patients presented with a palpable painful lesion located in the area of cesarean section incision. Three of the patients had a change in symptoms with their menstrual cycle. The duration of symptoms ranged between 2 months to 6 years. All patients underwent surgical excision. The size of the excised endometrioma ranged from 3 cm to 9 cm (mean 5.3 cm). CONCLUSION: Incisional endometriosis seems to be common in women with a history of cesarean section. Most patients presented with a painful abdominal mass. Three patients presented cyclic changes in pain and size of the mass with menses, but this may be due to physician’s lack of awareness and questioning. The management of choice is to remove the lesion completely even if fascial excision is required.

Orthopedics. 2008 Apr;31(4):400.

Post-traumatic catamenial sciatica.

Hughes MS, Burd TA, Allen WC.

Department of Orthopaedic Surgery, University of Missouri Hospital and Clinics, Columbia, MO, USA.

This article presents a unique case of posttraumatic extrapelvic endometriosis presenting as a gluteal mass causing cyclic sciatica. A 38-year-old woman presented with an enlarging right buttock mass over the previous 6 years. She also had symptoms of radicular pain referred to the right leg and foot with sitting and daily activity. Four years prior to noticing the mass, she sustained a gunshot wound through the lower abdomen while 5 months pregnant. Excisional biopsy of the gluteal mass revealed endometrioma. Sciatica is a common and painful disorder that is believed to have an incidence of 40% in the adult population. Sciatica is most often due to intraspinal pathology affecting the lumbar nerve roots. There are many recognized extraspinal etiologies for sciatica in the literature including aneurysms, sciatic hernia, abcess, neoplasm, trochanteric wire, piriformis syndrome, ischial fracture, a posteriorly flexed uterus, and even an intrauterine device following uterine perforation. Similarly, endometriosis is a gynecologic condition that represents a significant health problem for women of reproductive age as it occurs in up to 50% of premenopausal women and 71% to 87% in women with chronic pelvic pain. Although rare, endometriosis has a well known ability to migrate outside of the abdominal cavity and proliferate ectopically under the control of systemic estrogen.

Sao Paulo Med J. 2008 Nov;126(6):305-8.

Accuracy of laparoscopy for assessing patients with endometriosis.

de Almeida Filho DP, de Oliveira LJ, do Amaral VF.

Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.

CONTEXT AND OBJECTIVE: Diagnoses of endometriosis are based on observation of endometriotic lesions by means of laparoscopy, along with the pathological findings. The aim of this study was to evaluate the sensitivity and specificity of the macroscopic findings in relation to the histopathological findings. More specifically, we aimed to test the efficacy of laparoscopy alone for diagnosing endometriosis and to evaluate the laterality of endometriosis among the study population. DESIGN AND SETTING: Cross-sectional study on women undergoing laparoscopy due to pelvic pain or infertility, in the Gynecology Department of Hospital Santa Cruz in Curitiba, Paraná, Brazil, and Pontifícia Universidade Católica do Paraná. METHODS: A total of 976 patients underwent laparoscopy and biopsy due to pelvic pain and/or infertility. We analyzed the laparoscopic and histopathological findings from patients with pelvic endometriosis (n = 468) and patients without endometriosis (n = 508). RESULTS: In 468 (47.95%) of the cases, the clinical and laparoscopic findings were consistent with endometriosis, and this was confirmed histopathologically in 337 (34.5%). Among the remaining 508 patients, although the laparoscopy was performed for other reasons relating to acute pelvic pain, eight were diagnosed with endometriosis from histopathological examination of the pelvic specimens obtained. Therefore, endometriosis was confirmed in 345 patients (35.3%). In comparison with the histopathology, laparoscopy alone presented 97.68% sensitivity, 79.23% specificity, 72% positive predictive value and 98.42% negative predictive value. CONCLUSION: Laparoscopy should be used in conjunction with histopathology for diagnosing endometriosis.

Chirurgia (Bucur). 2008 Sep-Oct;103(5):587-90.

Endometriosis involving the rectus abdominis muscle and subcutaneous tissues: fine needle aspiration appearances.

Tamiolakis D, Antoniou C, Mygdakos N, Tsiminikakis N, Economou C, Nikolaidou S, Georgiou G, Costopoulou A.

Department of Cytopathology, Regional Hospital of Chania, Crete, Greece. nikolas@doctors.org.uk

OBJECTIVE: Endometriosis is defined as functioning endometrial tissue outside the uterine cavity. It occurs in up to 15% of menstruating females and in most cases is located within the pelvis. Endometrial implants, however have been described in soft tissues, particularly in the skin and subjacent tissues of surgical scars, and diagnosis might be problematic. CASE STUDY: A 32 aged female presented with a suprapubic abdominal mass, which appeared suddenly after exercise. Fine needle aspiration was performed. RESULTS: Epithelial sheets were shown in direct aspirates. No evident endometrial stromal cells were seen. CD10 immunostaining in additional cell block preparations using a commercial antibody gave positive results. The cell pattern and immunocytochemical profile suggested a cytodiagnosis of endometriosis. The patient was administered with leuprolide acetate. She experienced adverse effects related to estrogen deficiency. Medical treatment was discontinued and the patient underwent surgical excision. Histological sections revealed endometrial glands surrounded by stroma and embedded in fibrous connective tissue. CONCLUSION: With optimal preparations a confident cytological diagnosis of endometriosis may be established easily, allowing correct treatment of the disease and, in selected cases, planning of preoperative pharmacologic therapy.

Pathologica. 2008 Oct;100(5):416-9.

Multicystic peritoneal mesothelioma: report of three cases.

Charfi S, Chetaille B, Marcy M, Turrini O, Chaise De Maison C, Delpero JR, Viret F, Xerri L, Monges G.

Department biopathology, Paoli-Calmettes Institute, 232 Bd St-Marguerite, 13273, Marseille, Cedex 9, France. charfislim@gmail.com

Multicystic peritoneal mesothelioma is a rare lesion occurring mainly in women in a reproductive age. Its pathogenesis is unclear. We report three cases of multicystic peritoneal mesothelioma in patients that were 28, 38 and 47 years of age (one male, two females). A history of abdominal surgery was reported in two cases. Explorative laparotomy was presumptive of a pseudomyxoma peritoni in two cases, and hyperthermic intraperitoneal chemotherapy was performed. Histological examination demonstrated multicystic lesions with mesothelial cells lining confirmed by immunohistochemical analysis. Unusual findings such as hyperplasia, hobnail features, cytoplasmic vacuolisation and papillary pattern were occasionally noted. The clinical presentation, pathogenesis and pathologic features including differential diagnosis of multicystic peritoneal mesothelioma are discussed.

Am J Reprod Immunol. 2008 Nov;60(5):449-61.

Immune status, psychosocial distress and reduced quality of life in infertile patients with endometriosis.

Siedentopf F, Tariverdian N, Rücke M, Kentenich H, Arck PC.

Department of Obstetrics and Gynecology, DRK-Kliniken Westend, Berlin, Germany. f.siedentopf@drk-kliniken-westend.de

PROBLEM: The aim of the study was to identify if (i) psychosocial factors differ in endometriosis; (ii) related psychosocial aspects alter immune markers of depression/sickness behaviour; and (iii) serum immune marker may be indicative for endometriosis. METHOD OF STUDY: We enrolled 103 women in a case-control study. Psychosocial data were obtained, serum levels of interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-12, IL-13, interferon (IFN)-gamma, TNF-alpha, IFN-alpha and soluble intercellular adhesion molecule-1 (sICAM-1) were analysed. RESULTS: Among 69 eligible patients, endometriosis was diagnosed in 38 women. Patients with endometriosis reported reduced quality of life, increased stress perception/depressive symptoms; the Th1/Th2 ratio was in favour of Th1, accompanied by the increased levels of IFN-alpha. sICAM-1 levels were unaffected. No correlation could be confirmed between psychosocial and immune markers. CONCLUSION: Women with endometriosis may benefit from strategies contributing to reduction of stress and development of coping mechanisms, thus helping to break the vicious circle of inflammation, sickness behaviour and depression.

Am J Reprod Immunol. 2008 Nov;60(5):449-61.

Immune status, psychosocial distress and reduced quality of life in infertile patients with endometriosis.

Siedentopf F, Tariverdian N, Rücke M, Kentenich H, Arck PC.

Department of Obstetrics and Gynecology, DRK-Kliniken Westend, Berlin, Germany. f.siedentopf@drk-kliniken-westend.de

PROBLEM: The aim of the study was to identify if (i) psychosocial factors differ in endometriosis; (ii) related psychosocial aspects alter immune markers of depression/sickness behaviour; and (iii) serum immune marker may be indicative for endometriosis. METHOD OF STUDY: We enrolled 103 women in a case-control study. Psychosocial data were obtained, serum levels of interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-12, IL-13, interferon (IFN)-gamma, TNF-alpha, IFN-alpha and soluble intercellular adhesion molecule-1 (sICAM-1) were analysed. RESULTS: Among 69 eligible patients, endometriosis was diagnosed in 38 women. Patients with endometriosis reported reduced quality of life, increased stress perception/depressive symptoms; the Th1/Th2 ratio was in favour of Th1, accompanied by the increased levels of IFN-alpha. sICAM-1 levels were unaffected. No correlation could be confirmed between psychosocial and immune markers. CONCLUSION: Women with endometriosis may benefit from strategies contributing to reduction of stress and development of coping mechanisms, thus helping to break the vicious circle of inflammation, sickness behaviour and depression.

Am J Reprod Immunol. 2008 Nov;60(5):383-404.

Immunopathogenesis of pelvic endometriosis: role of hepatocyte growth factor, macrophages and ovarian steroids.

Khan KN, Kitajima M, Hiraki K, Fujishita A, Sekine I, Ishimaru T, Masuzaki H.

Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. nemokhan@nagasaki-u.ac.jp

Endometriosis, a chronic disease characterized by endometrial tissue located outside the uterine cavity is associated with chronic pelvic pain and infertility. However, an in-depth understanding of the pathophysiology of endometriosis is still elusive. It is generally believed that besides ovarian steroid hormones, the growth of endometriosis can be regulated by innate immune system in pelvic microenvironment by their interaction with endometrial cells and immune cells. We conducted a series of studies in perspectives of pelvic inflammation that is triggered primarily by bacterial endotoxin (lipopolysaccharide) and is mediated by toll-like receptor 4 and showed their involvement in the development of pelvic endometriosis. As a cellular component of innate immune system, macrophages were found to play a central role in inducing pelvic inflammatory reaction. We further report here that peritoneal macrophages retain receptors encoding for estrogen and progesterone and ovarian steroids also participate in producing an inflammatory response in pelvic cavity and are involved in the growth of endometriosis either alone or in combination with hepatocyte growth factor (HGF). As a pleiotropic growth factor, HGF retains multifunctional role ometriosis. We describe here the individual and step-wise role of HGF, macrophages and ovarian steroid hormones and their orchestrated involvement in the immunopathogenesis of pelvic endometriosis.

Bull Acad Natl Med. 2008 Jun-Jul;192(6):1159-71; discussion 1172-3.

[Selective progesterone receptor modulators: future clinical applications]

[Article in French]

Bouchard P, Ouzounian S, Chabbert-Buffet N.

Endocrinologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine–75012 Paris.

Progesterone antagonists belong to the family of selective progesterone receptor modulators. SPRMs already have several applications in women’s health. Their main value lies in their effect on endometrium. For example, they can be used to reduce tumor volume and uterine bleeding before uterine myoma surgery. They are also being evaluated for the treatment of endometriosis, and for estrogen-free contraception.

Akush Ginekol (Sofiia). 2008;47(5):29-34.

[Immunocompetent cells in pathogenesis of endometriosis]

[Article in Bulgarian]

Nalbanski A, Kiurkchiev D.

The pathogenic mechanisms which lead to development of endometriosis are still unclear. Despite that the immunological mechanisms are not the primary, there is no doubt that they take a part in pathogenesis of the disease. In current review, the influence of the cells of the immune system which are connected with endometriosis is described.

Akush Ginekol (Sofiia). 2008;47(4):28-34.

[Therapeutical management of the most frequent gynaecological diseases and chronic pelvic pain in the Gynaecological Clinic, UMPHAT “Dr. G. Stransky”-Pleven in the period 2004-2007]

[Article in Bulgarian]

Lukanova M, Miteva I, Gorgioski S, Popov I.

OBJECTIVE: To determine the trend in application of the basic therapeutical procedures in the most common gynaecological diseases combined or not with chronic pelvic pain /CPP/. MATERIALS AND METHODS: In the prospective study conducted in the Gynaecological Clinic at the Department of Obstetrics and Gynaecology, MU-Pleven in the period 01.03.2004-01.07.2007, 1356 women with leiomyomatosis /L/, endometriosis /E/, adenomyosis /A/, pelvic congestion syndrome /PCS/, Allen-Masters syndrome /AMS/, pelvic inflammatory disease /PID/ and adhaesion syndrome /AS/, were included in it. They were grouped according to their age, type of disease, presence of CPP, type of therapeutical procedure and histological verification of the condition. For the purpose of the study the following methods were used: documentary method, R-AFS classification of E, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, accepted worldwide. RESULTS AND DISCUSSION: The highest frequency was determined for L, E and A, and AS. In the majority of the total number of consecutively admitted patients with those diseases an operative intervention was done, and almost one-sixth of women underwent conservative treatment. The same trend was observed in patients with chronic pain symptomatic, regarding their operative and conservative management. Histological verification of the condition was closely related with etiological reason and diagnostic approach. CONCLUSION: A balance between conservative and operative treatment should be set in the basis of therapeutical management, consistent with modern diagnostic procedures. Determination of the trend in treatment of women with CPP will lead to falling off of indiscriminate application of operative methods prior to exact diagnostic specification and setting of multidisciplinary approach. That will serve as a background for the future conduct to that group of patients.

Akush Ginekol (Sofiia). 2008;47(4):19-22.

[The use of biochemical markers in diagnosis of endometriosis]

[Article in Bulgarian]

Nalbanski A, Kiurkchiev D.

The aim of this study was to evaluate Ca 125 II, C-reactive protein (CRP) and serum amyloid A (SAA) and anticardiolipin antibody (aCL) concentrations for the diagnosis of pelvic endometriosis. The study population consisted of 15 women without endometriosis, as confirmed by laparoscopy (group A), and 35 patients with pelvic endometriosis. All of them were diagnosed by laparoscopy or laparotomy. Group B patients were divided into those at stages I and II of the disease (B I/II) and those at stages III and IV (B III/IV). Blood samples were obtained twice during the menstrual cycle: on day 1-3 of the cycle and on day 8-10 of the cycle. Our results claim that the measurement of these molecules may therefore provide a valuable tool in the diagnosis and management of endometriosis.

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Nov;28(11):981-5.

[Regulatory effect of ligustrazine and Radix astragalus on RANTES and receptor CCR5 expression in the genesis and development process of endometriosis]

[Article in Chinese]

Min ZH, Zhang JN, Hua KQ.

The First Maternity and Infant Healthy Institute Affiliated to Fudan University, Shanghai.

OBJECTIVE: To investigate the regulatory effect of ligustrazine and Radix Astragalus (Chinese drugs for supplementing qi and activating blood circulation) on uterine mucosa stromal cyto-chemotactic factor RANTES and receptor CCR5 expression. METHODS: The eutopic and ectopic endometrial stromal cells (EMSC) isolated and purified from 10 patients with ovarian endometrial cyst were selected as the experimental group, while those from 10 patients with benign lesion were selected as the control group. After they were intervened by different factors, including astragalus injection (AI), ligustrazine injection (LI), AI + LI, and Danazol, the expression levels of RANTES and CCR5 in the cells were detected by ELISA and RT-PCR. RESULTS: RANTES expressions in eutopic and ectopic EMSC were different insignificantly (P > 0.05). The ectopic EMSC RANTES expression was 13.602 +/- 3.358 ng/L and eutopic EMSC RANTES was 12.850 +/- 7.997 ng/L in the positive control group, which was significantly higher than that in the negative control group (both being 0.027 +/- 0.016 ng/L, P <0.05), and the ectopic EMSC expressions after intervened with Chinese drugs were significantly lower than that in the positive control group (P <0.05). CCR5 expression in ectopic EMSC was 0.759 +/- 0.039 ng/L, which was higher than that in eutopic EMSC (0.249 +/- 0.026 ng/L, P <0.05). Ectopic EMSC CCR5 expression was higher in the positive control group than that in the negative control group (0.759 +/- 0.039 ng/L vs 0.478 +/- 0.094 ng/L, P <0.05). Similar situation also was shown between the positive and negative control groups in terms of eutopic EMSC CCR5 expression (0.249 +/- 0.026 ng/L vs 0.131 +/- 0.021 ng/L, P < 0.01), and the expression was significantly lower in all the Chinese drugs treated EMSC groups as compared with that in the positive control group (P < 0.01). CONCLUSION: CCR5 expression was higher in ectopic EMSC than that in eutopic EMSC. Ligustrazine and Radix Astragalus could down-regulate the auto-secretion of RANTES and CCR5 in patients with endometriosis.

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Nov;28(11):971.

[Treatment of endometriosis by puerarin]

[Article in Chinese]

Yu CQ.

chqyu81@gmail.com

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Nov;28(11):969-71.

[Integrative medical diagnosis and treatment of sterility patients with endometriosis]

[Article in Chinese]

Situ Y, Cao LX.

styghs@126.com

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Nov;28(11):968-9.

[Stasis-toxin theory for pathogenesis of endometriosis]

[Article in Chinese]

Lian F.

f_lian@163.com

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Nov;28(11):966-8.

[Clinical characteristics of endometriosis and its treatment by Chinese and Western medicine]

[Article in Chinese]

Shi CX.

shichangxu@yahoo.cn

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Nov;28(11):965-6.

[Actions of inner and outer environment factors on the genesis of endometriosis]

[Article in Chinese]

Li DJ.

djli@shmu.edu.cn

Ther Clin Risk Manag. 2008 Oct;4(5):905-11.

Evaluation of extended and continuous use oral contraceptives.

Wright KP, Johnson JV.

University of Vermont College of Medicine and Reproductive Endocrinology and Infertility, Women’s Health Care Services, Fletcher Allen Health Care, Burlington, VT USA.

Oral contraceptives are classically given in a cyclic manner with 21 days of active pills followed by 7 days of placebo. In the past 4 years, new oral contraceptives have been introduced which either shorten the placebo time, lengthen the active pills (extended cycle), or provide active pills every day (continuous). These concepts are not new; extended and continuous pills were first studied in the 1960s and 1970s and have been provided in an off-label manner by gynecologists to treat menstrual disorders, such as menorrhagia and dysmenorrhea, and gynecologic disorders, such as endometriosis. Now that extended and continuous combined oral contraceptives are available for all patients, it is critical for providers to understand the physiology, dosing, side effects, and benefits of this form of oral contraceptive. This article reviews the history and the potential uses of the new continuous combined oral contraceptive.

Clin Exp Obstet Gynecol. 2008;35(4):295-6.

Bowel obstruction due to endometriosis in the rectovaginal septum.

Takai N, Ueda T, Nishida M, Nasu K, Narahara H.

Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita, Japan. takai@med.oita-u.ac.jp

It is very rare that endometriotic lesions in the rectovaginal septum cause ileus. We report a case of bowel obstruction due to endometriotic lesions in the rectovaginal septum in a 22-year-old woman whose barium enema presented with apple-core-like findings. Diagnostic and treatment modalities were discussed. Preoperative and postoperative gonadotropin-releasing hormone analog and aromatase inhibitor therapy promote relief of clinical symptoms, a reduction of tumor volume and a better approach to radical surgery.

Clin Exp Obstet Gynecol. 2008;35(4):291-4.

Xanthogranulomatous salpingitis: report of three cases and comparison with a case of pseudoxanthomatous salpingitis.

Kostopoulou E, Daponte A, Kallitsaris A, Papamichali R, Kalodimos G, Messinis IE, Koukoulis G.

Department of Pathology, University Hospital of Larissa, Medical School of Thessaly, Larissa, Greece. ekosto@med.uth.gr

Xanthogranulomatous inflammation, an uncommon form of chronic inflammation, has been described in several organs including those of the female genital tract. A rare condition described as pseudoxanthomatous salpingitis or pseudoxanthomatous salpingiosis, which is often associated with endometriosis, has been distinguished from xanthogranulomatous inflammation of the fallopian tube based on its histological features. In the present report three cases of xanthogranulomatous salpingitis and one case of pseudoxanthomatous salpingitis are presented and their clinical, pathological and histochemical features are compared.

In Vivo. 2008 Nov-Dec;22(6):811-5.

Umbilical endometriosis, our experience.

Dessy LA, Buccheri EM, Chiummariello S, Gagliardi DN, Onesti MG.

Department of Plastic and Reconstructive Surgery, University La Sapienza, Rome, Italy.

BACKGROUND: Endometriosis is the presence of functioning endometrial tissue outside the uterine cavity. Umbilical endometriosis has been reported in more than one hundred cases and the umbilicus represents the location of 0.5-1% of ectopical endometrioses. A correct differential diagnosis can be difficult and the use of epiluminescence and MRI is suggested for the accuracy of preoperative diagnosis. PATIENTS AND METHODS: We report our experience in preoperative differential diagnosis and treatment of four cases of umbilical endometriosis. An accurate anamnesis and clinical examination together with the use of 13 MHz probe ultrasonography with echocolor duplex scan led us to an accurate pre-operative diagnosis of umbilical endometriosis. The surgical approach to umbilical endometriosis represented an important step in achieving a satisfying result. RESULTS AND CONCLUSION: In all treated cases, a hemi-circumferential incision in the inner aspect of the umbilical opening was performed allowing adequate access to the lesion and umbilical repositioning. At the follow-up visit (from 6 to 24 months after surgery), no symptoms or signs of recurrence were evidenced. A natural-looking umbilicus was observed in all cases with minimal visible scars.

Chin Med Sci J. 2008 Dec;23(4):218-23.

Management of ureteral endometriosis: a report of ten cases.

Li CY, Wang HQ, Liu HY, Lang JH.

Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021.

OBJECTIVE: To investigate the clinical features and management of ureteral endometriosis. METHODS: Patients surgically and histologically diagnosed as ureteral endometriosis from January 2001 to January 2007 in Peking Union Medical College Hospital were retrospectively reviewed. RESULTS: Ten patients were diagnosed as ureteral endometriosis among 7561 cases with surgically and histologically proved diagnosis of endometriosis, with an incidence of 0.132%. Nine out of 10 patients were extrinsic ureteral endometriosis and concomitant with severe pelvic endometriosis, and the other was intrinsic ureteral endometriosis. Hormone therapy failed in 2 patients with urinary tract obstruction. Ureterolysis was performed in 6 patients and ureterectomy was performed in 4 patients. One case of ureteral recurrence was observed in a postmenopausal woman without hormonal replacement therapy who received laparoscopic ureterolysis and hysterectomy with bilateral adnexectomy. No relapse was observed in the other 9 patients. CONCLUSIONS: Ureteral endometriosis is a rare entity. The upper urinary tract should be evaluated in patients with severe endometriosis, even in postmenopausal women. The treatment of ureteral endometriosis usually requires surgery, while ureterolysis should not be performed in patients with extensive disease. As a form of adjuvant therapy of surgery, hormonal therapy is an appropriate option.

J Obstet Gynaecol Can. 2008 Dec;30(12):1095-6.

Vulvar endometriosis.

[Article in English, French]

Kouach J, Elhassani M, Moussaoui DR, Mohamed D.

Service de Gynécologie Obstétrique, Hôpital Militaire Mohamed V, Rabat, Morocco.

Rev Bras Ginecol Obstet. 2008 Aug;30(8):413-9.

[Meiotic abnormalities of oocytes from patients with endometriosis submitted to ovarian stimulation]

[Article in Portuguese]

Barcelos ID, Vieira RC, Ferreira EM, Araújo MC, Martins Wde P, Ferriani RA, Navarro PA.

Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.

PURPOSE: to evaluate the meiotic spindle and the chromosome distribution of in vitro mature oocytes from stimulated cycles of infertile women with endometriosis, and with male and/or tubal infertility factors (Control Group), comparing the rates of in vitro maturation (IVM) between the two groups evaluated. METHODS: fourteen patients with endometriosis and eight with male and/or tubal infertility factors, submitted to ovarian stimulation for intracytoplasmatic sperm injection have been prospectively and consecutively selected, and formed a Study and Control Group, respectively. Immature oocytes (46 and 22, respectively, from the Endometriosis and Control Groups) were submitted to IVM. Oocytes presenting extrusion of the first polar corpuscle were fixed and stained for microtubules and chromatin evaluation through immunofluorescence technique. Statistical analysis has been done by the Fisher’s exact test, with statistical significance at p<0.05. RESULTS: there was no significant difference in the IVM rates between the two groups evaluated (45.6 and 54.5% for the Endometriosis and Control Groups, respectively). The chromosome and meiotic spindle organization was observed in 18 and 11 oocytes from the Endometriosis and Control Groups, respectively. In the Endometriosis Group, eight oocytes (44.4%) presented themselves as normal metaphase II (MII), three (16.7%) as abnormal MII, five (27.8%) were in telophase stage I and two (11.1%) underwent parthenogenetic activation. In the Control Group, five oocytes (45.4%) presented themselves as normal MII, three (27.3%) as abnormal MII, one (9.1%) was in telophase stage I and two (18.2%) underwent parthenogenetic activation. There was no significant difference in meiotic anomaly rate between the oocytes in MII from both groups. CONCLUSIONS: the present study data did not show significant differences in the IVM or in the meiotic anomalies rate between the IVM oocytes from stimulated cycles of patients with endometriosis, as compared with controls. Nevertheless, they have suggested a delay in the outcome of oocyte meiosis I from patients with endometriosis, shown by the higher proportion of oocytes in telophase I observed in this group.

Rev Bras Ginecol Obstet. 2008 Aug;30(8):400-5.

[Double-contrast barium enema in the diagnosis of intestinal deeply infiltrating endometriosis]

[Article in Portuguese]

Ribeiro HS, Ribeiro PA, Rodrigues FC, Donadio N, Auge AP, Aoki T.

Departamento de Obstetrícia e Ginecologia, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil. hsaayrozaribeiro@uol.com.br

PURPOSE: to evaluate the sensitivity, specificity, positive and negative predictive value of double contrast barium enema (DCBE) for the diagnoses of rectum and sigmoid endometriosis. METHODS: prospective transversal study including 37 patients with suspicion of deep endometriosis. Patients were submitted to DCBE, according to the standard technique described in the literature, and then, to laparoscopy. The results of laparoscopy and the DCBE images were interpreted and compared, based on the histological evaluation. Statistical analysis was done by association (chi2 test) and agreement analyses (Kappa’s test). RESULTS: patients’ average age was 35.8+/-4.4 years old (age group from 28 to 48 years), 85.6% of them being white and 14.4%, black women. Deep endometriosis was confirmed by laparoscopy and histological exam in all the studied patients. Intestinal endometriosis was confirmed by histological exam in 27 women (72.9%) of them. DCBE demonstrated suggestive radiologic signs of intestinal infiltration by endometriosis in 24 women (64.9%) and no signs in 13 women (35.1%). The method sensitivity was 67.5%, specificity 53.8%, positive predictive value, 77.8% and negative predictive value, 70%. Among the 24 abnormal exams, 16 (43.2%) presented radiologic speculum-type image, 16 (43.2%), an image compatible with stenosis, and four (10.8%), double contour. CONCLUSIONS: the DCBE presents high sensitivity and high positive predictive value, in the diagnosis of the rectum and sigmoid endometriosis. Radiologic images speculum and stenosis-type present high sensitivity and positive predictive value for the intestinal infiltration by endometriosis.

Rev Bras Ginecol Obstet. 2008 Aug;30(8):384-92.

[Validation of Brazilian Portuguese version of quality of life questionnaire for women with endometriosis (Endometriosis Health Profile Questionnaire–EHP-30)]

[Article in Portuguese]

Mengarda CV, Passos EP, Picon P, Costa AF, Picon PD.

Consultora da Secretaria Estadual da Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil. claudiamengarda@yahoo.com

PURPOSE: the objective of the present study was the development of the Brazilian Portuguese version of Endometriosis Health Profile Questionnaire (EHP-30), the cross-cultural adaptation to Brazil and the evaluation of EHP-30 Portuguese psychometric measures in a Brazilian sample. METHODS: the original instrument in English was translated into Portuguese following international guidelines, going through all stages of translation, back-translation and comparison of the versions for cross-cultural adaptation, face and content validity. A sample of 54 patients with endometriosis was used for internal consistency analyses using the Cronbach alpha. Test-retest reliability was evaluated through the intraclass correlation coefficient (ICC). In order to evaluate the convergent construct validity, the correlation between EHP-30 Portuguese and WHOQOL-Bref and Beck Depression Inventory (BDI) was tested. RESULTS: internal consistency presented alpha values of 0.8 to 0.9 suggesting homogeneity between questions. The test-retest reliability presented ICC of 0.8 to 0.9 showing instrument stability. In the construct validation, strong correlations were demonstrated of the EHP-30 Portuguese self-image scale with physical (-0.6) and psychological domains (-0.6) of WHOQOL-Bref, and EHP-30 Portuguese social support scale with BDI (0.5), confirming good correlation with other quality of life evaluation instruments. CONCLUSIONS: the EHP-30 Portuguese was found to be an easy, quickly applied instrument, and well-accepted by the patients. It presented good psychometric properties with appropriate reliability measures (internal consistency and test-retest reliability) and construct validity. These results show that EHP-30 Portuguese is an adequate instrument for quality of life evaluation in Brazilian women with endometriosis, both in clinical and research setting.

Rev Bras Ginecol Obstet. 2008 Apr;30(4):167-70.

[Umbilical endometriosis without previous pelvic surgery]

[Article in Portuguese]

Carvalho BR, Rosa e Silva JC, Rosa e Silva AC, Barbosa Hde F, Poli Neto OB, Reis FJ, Nogueira AA.

Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brasil.

PURPOSE: to present a series of cases of umbilical endometriosis in patients in reproductive age, with no previous pelvic surgery. METHODS: four patients aged between 33 and 43 years were included in the study. They all presented umbilical bleeding associated or not with pelvic pain, and medical history varied from two months to four years. Abdominal wall ultrasound was performed for diagnosis support before surgical excision of the umbilical lesions, and histological examination was also performed. RESULTS: the ultrasonographic evaluation of the four patients showed hypoechogenic umbilical lesion suggestive of endometriosis. All patients were submitted to surgical excision and histological examination of the lesions. CA-125 serum levels were measured in three of the patients, but they were within normal ranges (from 6.8 to 10.1 U/mL). In addition to umbilical surgery, laparoscopy was performed in all patients, but only one presented concomitant pelvic endometriosis. In a one-year follow-up, patients maintained asymptomatic and there was no recurrence of the lesions. CONCLUSIONS: umbilical endometriosis is a rare entity, but it may be remembered as a possibility in cases of umbilical nodulations or bleeding, even if there is no previous history of pelvic surgery with endometrial manipulation. Its treatment is always surgical and, in general, it is enough to promote complete elimination of the lesion and of the symptoms.

Arkh Patol. 2008 Sep-Oct;70(5):16-9.

[Cytochrome P-450 aromatase expression in the ectopic and eutopic endometrium in endometriosis]

[Article in Russian]

Zaĭrat’iants OV, Adamian LV, Sonova MM, Borzenkova IP, Opalenov KV, Barsanova TG, Movtaeva KhR.

An immunoperoxidase test was used to reveal the expression of cytochrome P-450 aromatase in the eutopic and ectopic endometrium of 14 patients with ovarian endometriosis and 26 with adenomyosis, whose age ranged from 21 to 47 years (38+/-2.0 years). Five endometrial samples taken at autopsy from the women who had died from injuries at ages of 32 to 47 years and who had no uterine or ovarian abnormities served as the control. Control observations revealed no aromatase expression by endometrial epithelial and stromal cells. Aromatase expression in the eutopic endometrium was found in patients with ovarian endometriosis and adenomysis in 80 and 58% of cases, respectively; while that in the ectopic endothelium was in all cases in both groups. In external genital endometriosis, the sensitivity and specificity of the test were 75 and 100%, respectively. In the glandular and stromal epithelium of both the ectopic and eutopic endometrium, aromatase expression increased with the higher extent of endometriosis.

Arkh Patol. 2008 Sep-Oct;70(5):12-6.

[The specific features of the expression of E-cadherin and beta-catenin in adenomyosis]

[Article in Russian]

Gorbacheva IuV, Romadanova IuA, Solomakhina MA, Popova OP, Voloshchuk IN.

The expression of E-cadherin and beta-catenin in the eutopic and ectopic endometrium was studied in 40 patients with adenomyosis and 12 without this condition, by using an immunohistochemical test and enzyme immunoassay. There was increased expression of E-cadherin and beta-catenin in the eutopic and ectopic endometrium in adenomyosis. The cytoplasmic expression of beta-catenin was also revealed in the smooth muscle cells surrounding the foci of adenomyosis. The E-cadherin concentration measured by enzyme immunoassay was significantly higher in the endometrium and myometrium of patients with adenomyosis than in the controls. There was a higher expression of this protein with a longer duration of the disease. Thus, the formation of ectopic foci in adenomyosis may be argued to be unassociated with the decreased adhesion of epithelial cells. On the contrary, the authors documented the enhanced adhesion of epithelial cells in the ectopic foci, which was likely to be adaptive due to the altered microcirculation.

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