130: Hum Reprod. 2004 Aug;19(8):1821-5. Epub 2004 May 27. A combination of interleukin-6 and its soluble receptor impairs sperm motility: implications in infertility associated with endometriosis.
Yoshida S, Harada T, Iwabe T, Taniguchi F, Mitsunari M, Yamauchi N, Deura I, Horie S, Terakawa N.
Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago 683-8504, Japan . souichi@grape.med.tottri-u.ac.jp
BACKGROUND: We previously reported that the level of interleukin (IL)-6 is increased in the peritoneal fluid of women with endometriosis. This study was undertaken to assess the effects of IL-6 and soluble IL-6 receptor (sIL-6R) on in vitro sperm motility. METHODS: Sperm (n = 20) were cultured with IL-6 or sIL-6R, or with a combination of both. After 24 h cultures, sperm motility was evaluated using a computer-assisted semen analysis system. Gene and protein expressions of IL-6, IL-6 receptor (IL-6R), and glycoprotein 130 (gp130) were examined in sperm by RT-PCR analysis and western blot analysis. RESULTS: Addition of IL-6 or sIL-6R individually to the culture media had no affect on sperm motion. However, adding a combination of IL-6 and sIL-6R dose-dependently reduced the percentage of motile and rapidly moving sperm. Adding anti-IL-6R antibody abolished these adverse effects. Sperm expressed the gp130 gene and protein, but not IL-6 or IL-6R. CONCLUSIONS: A combination of IL-6 and sIL-6R may be associated with gp130 expressed in the sperm and reduce sperm motility. IL-6 and sIL-6R may contribute to the pathogenesis of endometriosis-associated infertility. Copyright 2004 European Society of Human Reproduction and Embryology
PMID: 15166129 [PubMed – in process]

131: Cytopathology. 2004 Jun;15(3):131-41.
Peritoneal washing cytology.
Shield P.
Department of Cytology, Sullivan Nicolaides Pathology, Brisbane, Qld , Australia . paul_shield@snp.com.au
Peritoneal washing cytology (PWC) is a useful indicator of ovarian surface involvement and peritoneal dissemination by ovarian tumours. It may identify subclinical peritoneal spread and thus provide valuable staging and prognostic information, particularly for non-serous ovarian tumours. The role of PWC as a prognostic indicator for endometrial carcinoma is less clear, due in part to the questionable significance of identifying endometrial tumour cells in the peritoneum. Detection of metastatic carcinoma in PWC is based on the recognition of non-mesothelial cell characteristics. However a number of conditions such as reactive mesothelial cells, endometriosis and endosalpingiosis may mimic this appearance. Cells from these conditions may have a similar presentation in PWC to that of serous borderline tumours and low-grade serous carcinoma. The presence of cilia, lack of single atypical cells, prominent cytoplasmic vacuolation, marked nuclear atypia or two distinct cell populations are features favouring a benign process. Attention to these features along with close correlation with clinical history and the results of surgical pathology should help avoid errors. Additional assistance may be provided by the use of cell blocks and special stains.
PMID: 15165269 [PubMed – in process]

132: Int J Colorectal Dis. 2004 Sep;19(5):502-4. Epub 2004 May 26.Subileus caused by intestinal endometriosis: experience from three cases.
Szendei G, Mathe Z, Hernadi Z, Peter A.
First Department of Obstetrics and Gynecology, Divison of Endocrinology, Semmelweis University, Baross u. 27, 1088, Budapest, Hungary, szendei@noi1.sote.hu
PMID: 15164215 [PubMed – in process]

133: Abdom Imaging. 2004 May 27 [Epub ahead of print]
US and MRI features of pelvic endometriosis.
Carbognin G, Guarise A, Minelli L, Vitale I, Malago R, Zamboni G, Procacci C.
Department of Radiology, University Hospital "G. B. Rossi", P.le L.A. Scuro, 10, 37134 Verona , Italy .
Endometriosis represents a common and important clinical problem of women of childbearing age. It is a disabling disorder manifesting with pain and infertility. The exact pathogenesis of the disease remains unclear, despite the different theories that have been formulated. The literature on endometriosis is extensive, but often in regard to classic endometrioma. It is surprising that, to the best of our knowledge, the many radiologic features of extraovarian endometriosis have not been well documented thus far. Although ultrasound ( US ) remains the imaging modality of choice in the radiologic evaluation of female patients with pelvic pain, the role of magnetic resonance imaging (MRI) in the evaluation of abdominal pain is expanding. In the young patient, MRI may be performed if a gynecologic disorder is not suspected at first, especially if US findings are equivocal or the abnormality extends beyond the field of view of the sonographic probe. Moreover, MRI is useful whenever further characterization of pelvic disorder is required. In fact, many causes of pelvic disorders and of endometriosis in particular demonstrate characteristic MRI findings. For these reasons, in this work we describe the protean US and MRI appearances of endometrial foci as encountered in daily experience.
PMID: 15162229 [PubMed – as supplied by publisher]

134: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):349-71.
Endometriosis and the development of malignant tumours of the pelvis. A review of literature.
Van Gorp T, Amant F, Neven P, Vergote I, Moerman P.
Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, University Hospital Leuven , Herestraat 49, 3000 Leuven , Belgium .
For several decades, endometriosis has been suspected of playing a role in the aetiology of ovarian cancer. The literature concerning a possible histogenesis of ovarian cancer from benign endometriosis is reviewed in this chapter. Epidemiological evidence from large-cohort studies confirms endometriosis as an independent risk factor for ovarian cancer. Further circumstantial evidence for this link was found in the common risk factors for ovarian cancer and endometriosis. These risk factors influence retrograde menstruation and endometriosis in the same positive or negative way. Based on data in the literature, the prevalence of endometriosis in epithelial ovarian cancer has been calculated to be 4.5, 1.4, 35.9, and 19.0% for serous, mucinous, clear-cell and endometrioid ovarian carcinoma, respectively. The risk of malignant transformation in ovarian endometriosis was calculated at 2.5% but this might be an underestimate. In addition, some authors described atypical endometriosis in a spatial and chronological association with ovarian cancer. Finally, molecular studies have detected common alterations in endometriosis and ovarian cancer. These data suggest that some tumours, especially endometrioid and clear-cell carcinomas, can arise from endometriosis. Moreover, endometriosis-associated ovarian cancer represents a distinct clinical entity, with a more favourable biological behaviour, given a lower stage distribution and better survival than non-endometriosis-associated ovarian cancer.
PMID: 15157647 [PubMed – in process]

135: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):329-48.
Surgical management of endometriosis.
Donnez J, Pirard C, Smets M, Jadoul P, Squifflet J.
Department of Gynecology, Universite Catholique de Louvain, Cliniques Universitaires St-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium.
The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain is a source of ongoing controversy. Complete resolution of endometriosis is not yet possible and current therapy has three main objectives: (1) to reduce pain; (2) to increase the possibility of pregnancy; and (3) to delay recurrence for as long as possible. It is possible that a consensus will never be reached on the optimal treatment of minimal and mild endometriosis. In case of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with a gonadotropin-releasing hormone (GnRH) agonist) should be considered as ‘first-line’ treatment. The mean pregnancy rate of 50% reported in the literature following surgery provides scientific proof that operative treatment should first be undertaken to give our patients the best chance of conceiving naturally. In case of rectovaginal adenomyotic nodules, surgery must be considered as first-line therapy, medical therapy being relatively inefficacious.
PMID: 15157646 [PubMed – in process]

136: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):319-28.
New medical treatments for endometriosis.
Olive DL, Lindheim SR, Pritts EA.
Department of Obstetrics and Gynecology, University of Wisconsin Medical School, 600 Highland Ave, H4/628 Madison, WI 53792, USA.
The medical treatment of endometriosis has long centered upon producing a hypoestrogenic environment by producing pituitary suppression or a progestin-dominant environment. However, as more is uncovered regarding the pathogenesis and pathophysiology of this disease, more targeted therapies can be developed. Current research has focused upon medications designed to attack specific aspects of the development and maintenance of endometriosis. These include progesterone receptor modulators, gonadotropin releasing hormone (GnRH) antagonists, aromatase inhibitors, tumor necrosis factor alpha (TNF-alpha) inhibitors, angiogenesis inhibitors, matrix metalloproteinase inhibitors, pentoxifylline (and other general immune modulators), and estrogen receptor beta agonists. It is hoped that this new wave of medications will improve the response to medical therapy for this disorder.
PMID: 15157645 [PubMed – in process]

137: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):305-18.
Serum and endometrial markers.
Yang WC, Chen HW, Au HK, Chang CW, Huang CT, Yen YH, Tzeng CR.
Graduate Institute of Biomedical Materials, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan, ROC.
Endometriosis is a benign but aggressive disease. It occurs when shed endometrium from the female reproductive tract grows at a site outside the uterus. The physiological changes in endometriosis-abnormal tissue growth, invasion, and adhesion phenomena-are similar to those seen in tumorous tissues. Although the etiology of endometriosis is not well understood, the disease is widely accepted to result from the ectopic implantation of refluxed menstrual tissues. In addition, immunologic changes, genetic factors, and environmental factors might also affect a woman’s susceptibility to develop endometriosis. Thus far, laparoscopic examination is required to confirm the presence of endometriosis; there is no reliable marker for its diagnosis. Many studies are therefore focusing on identifying markers for the diagnosis and follow-up of endometriosis. This chapter provides a systematic review of these studies, including recent findings from our group on the identification of molecules, in serum and/or endometrium, which are associated with the development of endometriosis at different stages. From this research, we hope to be able to suggest how to approach the potential markers. The identification of highly sensitive and specific markers of endometriosis should facilitate the development of accurate and non-invasive techniques for diagnosis and prognosis.
PMID: 15157644 [PubMed – in process] 137: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):305-18.
Serum and endometrial markers.
Yang WC, Chen HW, Au HK, Chang CW, Huang CT, Yen YH, Tzeng CR.
Graduate Institute of Biomedical Materials, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan, ROC.
Endometriosis is a benign but aggressive disease. It occurs when shed endometrium from the female reproductive tract grows at a site outside the uterus. The physiological changes in endometriosis-abnormal tissue growth, invasion, and adhesion phenomena-are similar to those seen in tumorous tissues. Although the etiology of endometriosis is not well understood, the disease is widely accepted to result from the ectopic implantation of refluxed menstrual tissues. In addition, immunologic changes, genetic factors, and environmental factors might also affect a woman’s susceptibility to develop endometriosis. Thus far, laparoscopic examination is required to confirm the presence of endometriosis; there is no reliable marker for its diagnosis. Many studies are therefore focusing on identifying markers for the diagnosis and follow-up of endometriosis. This chapter provides a systematic review of these studies, including recent findings from our group on the identification of molecules, in serum and/or endometrium, which are associated with the development of endometriosis at different stages. From this research, we hope to be able to suggest how to approach the potential markers. The identification of highly sensitive and specific markers of endometriosis should facilitate the development of accurate and non-invasive techniques for diagnosis and prognosis.
PMID: 15157644 [PubMed – in process]

138: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):285-303.
Diagnosis of endometriosis: pelvic endoscopy and imaging techniques.
Brosens I, Puttemans P, Campo R, Gordts S, Kinkel K.
Leuven Institute for Fertility and Embryology, Tiensevest 168, Leuven B-3000, Belgium .
Although laparoscopy is the gold standard for the diagnosis of endometriosis, the need for this invasive diagnostic tool is a major stumbling-block in both effective clinical management and for research into this common and debilitating disease. As visual inspection of the pelvis has also major limitations, particularly for the diagnosis of posterior pelvis, bowel and bladder endometriosis, it is not surprising that considerable efforts are being made to improve the diagnosis by imaging techniques. Peritoneal endometriosis and ovarian endometriomata are predominantly haemorrhagic lesions. During laparoscopy, these lesions are readily identified by the presence of old or recent bleeding. Both transvaginal sonography and magnetic resonance (MR) imaging have a low sensitivity for the diagnosis of peritoneal and ovarian implants and adhesions. Transvaginal sonography is useful in the diagnosis of ovarian endometriomata, providing the diameter is larger than 2 cm. As transvaginal sonography costs less than MR imaging, transvaginal sonography might be the preferred method of confirming a sizeable endometrioma. Posterior pelvis endometriosis is an infiltrating adenomyotic lesion with microendometriomata. High-resolution transvaginal ultrasonography, and in particular MR imaging, are increasingly used to diagnose the presence and extent of infiltrating lesions and the involvement of rectosigmoid and ureters.
PMID: 15157643 [PubMed – in process]

139: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):245-63.
Immunology of endometriosis.
Paul Dmowski W, Braun DP.
Rush Medical College , Chicago , IL , USA .
Endometriosis is a benign gynecologic disorder characterized by the ectopic growth of misplaced endometrial cells. A unifying hypothesis to explain endometriosis has not been elucidated as yet but numerous investigations have implicated disturbances in the immune response as fundamental to its etiology and pathogenesis. Clearly, the immune system is involved in endometriosis. It is not clear, however, whether and to what extent this involvement is a primary response leading to the initiation, promotion, and progression of the disease or a secondary response to the ectopic endometrial growth in an attempt to restore homeostasis. Thus, although numerous studies have shown alterations in cell-mediated and humoral immunity in subjects with endometriosis, the importance of these changes remains obscure. This review considers the past two decades of investigation of immune function changes in women with endometriosis with the expectation that this information will ultimately provide the basis for developing new approaches to patient management.
PMID: 15157641 [PubMed – in process]

140: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):233-44.
Pathogenesis of endometriosis.
Nap AW, Groothuis PG, Demir AY, Evers JL, Dunselman GA.
Department of Gynaecology and Obstetrics, Research Institute GROW, University Hospital Maastricht , Maastricht , The Netherlands .
Many women harbour spots of peritoneal endometriosis without having any symptoms; this is referred to as the phenomenon endometriosis. Some of these women go on to develop symptomatic endometriosis. Although we know the factors potentially involved in the aetiology and pathogenesis of endometriosis, the exact mechanism by which the phenomenon endometriosis develops into the disease endometriosis, with its associated signs and symptoms, remain obscure. The widely accepted theory is Sampson’s transplantation theory. Recent findings indicate that certain properties of the endometrium, and the influence of the local environment, are crucial in the development of endometriosis. Early endometriosis lesion formation is described in detail, as this seems to be a key process in the development of peritoneal endometriosis.
PMID: 15157640 [PubMed – in process]

141: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):219-32.
Genetics of endometriosis: heritability and candidate genes.
Bischoff F, Simpson JL.
Department of Obstetrics and Gynecology, Baylor College of Medicine, 6550 Fannin, Suite 885, Room 701, Houston, TX 77030, USA.
Endometriosis is a complex gynecologic disorder that affects as many as 10-15% of premenopausal women. Epidemiologic studies have confirmed that this disease is a genetic disorder of polygenic/multifactorial inheritance. The disorder has long been recognized to show heritable tendencies with recurrence risks of 5-7% for first-degree relatives. The current investigational goal is to determine the number and location of causative genes, a process that has been made possible by recent advances in molecular technology. This chapter discusses heritability studies supporting polygenic/multifactorial inheritance, the scientific basis of genome-wide strategies for identifying causative genes and potential candidate genes.
PMID: 15157639 [PubMed – in process]

142: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):201-18.
Impact of endometriosis on women’s health: comparative historical data show that the earlier the onset, the more severe the disease.
Ballweg ML.
Endometriosis Association, International Headquarters, 8585 North 76th Place , Milwaukee , WI 53223 , USA .
Looking at endometriosis from the bigger picture-as a systemic endocrine, immunological, and gastrointestinal disease-opens the door to broader treatments. The bigger-picture understanding of the disease also makes clear a variety of patterns of presenting symptoms, again clarifying the diagnosis. Data from over 7000 confirmed cases clearly show that delay in diagnosis (the average time to diagnosis is >9 years) is a major problem and that current treatments are far from satisfactory. In conclusion, the impact of endometriosis, a disease that already produces intense symptoms, is worsened by a current lack of understanding of the disease beyond its pelvic definition.
PMID: 15157638 [PubMed – in process]

143: Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):177-200.
Endometriosis: epidemiology and aetiological factors.
Vigano P, Parazzini F, Somigliana E, Vercellini P.
Second Department of Obstetrics and Gynecology and Istituto Auxologico Italiano, Cusano Milanino, University of Milan, Milano, Italy.
Estimates of the frequency of endometriosis vary widely. Based on the few reliable data, the prevalence of the condition can reasonably be assumed to be around 10%. Although no consistent information is available on the incidence of the disease, temporal trends suggest an increase among women of reproductive age. This could be explained-at least in part-by changing reproductive habits. Numerous epidemiological studies have indicated that nulliparous women and women reporting short and heavy menstrual cycles are at increased risk of developing endometriosis; data on other risk factors are less consistent. These epidemiological findings strongly support the menstrual reflux hypothesis. Additional evidence in favour of this theory includes the demonstration of viable endometrial cells in the menstrual effluent and peritoneal fluid, experimental implantation and growth of endometrium within the peritoneal cavity, observation of some degree of retrograde menstruation in most women undergoing laparoscopy during menses, and an association between obstructed menstrual outflow and endometriosis.
PMID: 15157637 [PubMed – in process]

144: Surg Endosc. 2004 Jul;18(7):1109-12. Epub 2004 May 27.
Laparoscopic identification of pelvic nerves in patients with deep infiltrating endometriosis.
Volpi E, Ferrero A, Sismondi P.
Department of Gynecologic Oncology, University of Turin , Mauriziano Umberto I Hospital, Chief Prof. P. Sismondi, Largo Turati 67, 10128 Torino , Italy . jsbach1087@libero.it
BACKGROUND: Nerve sparing is suggested for cancer surgery , but no experience is available for deep endometriosis. The aim of this study was to laparoscopically identify the pelvic nerves in the posterior pelvis. METHODS: A total of 24 patients operated for deep endometriosis were considered. During surgery and on videotapes of the procedures, we evaluated single- or double-sided resection of the uterosacral ligaments and other structure’s visualization of the inferior hypogastric and the splanchnic nerves. The most important objective criteria for resection of the nerves was urinary retention after surgery , which was compared to surgical resection on the videotapes. RESULTS: Visualization of the inferior hypogastric nerves was possible in 20 of 22 patients (90.1%). Eight of the 24 patients had at least one inferior hypogastric nerve resected (33.3%). In seven patients (29.2%) resection of the uterosacral ligaments was bilateral, and in three of these the nerves were resected. Postoperatively, the median residual urine volume after the first spontaneous voiding was 40 ml (range, 20-400). Seven of eight patients (29.2%) with resection of the nerves had urinary retention and self-catheterization at discharge. The difference in urinary residuum after first voiding between patients undergoing self-catheterization and patients released without the catheter was significant ( p < 0.01). The median time to resume the voiding function in patients with self-catheterization was 18 days (range, 9-45). CONCLUSIONS: Nerve visualization is possible by means of laparoscopic surgery for deep endometriosis in a high rate of patients. Careful technique is necessary, but the laparoscopic approach may help. Even single-sided radical dissection can induce important urinary retention.
PMID: 15156387 [PubMed – in process]

145: Arch Gynecol Obstet. 2004 May 20 [Epub ahead of print] Inguinal endometriosis.
Kapan M, Kapan S, Durgun AV, Goksoy E.
Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University , Istanbul , Turkey .
INTRODUCTION. Extrapelvic endometriosis is a rarely seen condition and it is occasionally presented to the general surgeons. It is often diagnosed incidentally. CASE REPORT. In this report we presented three cases of inguinal endometriosis all of which were thought to be inguinal hernia preoperatively. They were diagnosed during the operation for inguinal hernia repair and treated with simple excision of the lesions with a part of the round ligament.
PMID: 15156329 [PubMed – as supplied by publisher]

146: Expert Opin Emerg Drugs. 2004 May;9(1):167-177.
Emerging drugs for endometriosis.
Fedele L, Berlanda N.
San Paolo Hospital.
Medical treatment of endometriosis relies on drugs that suppress ovarian steroids and induce an hypoestrogenic state that causes atrophy of ectopic endometrium. Gonadotrophin-releasing hormone (GnRH) analogues, danazol, progestogens and oestrogen-progestin combinations have all proven effective in relieving pain and reducing the extent of endometriotic implants. However, symptoms often recur after discontinuation of therapy and hypoestrogenism-related side effects limit the long-term use of most medications. Furthermore, these therapies are of limited value in patients with a desire to become pregnant because they inhibit ovulation. An important target for current research is to identify effective therapies that can be safely administered in the long term. GnRH analogues with add-back therapy, progestogens and continuous oral contraceptive are options available for a medium or long-term systemic treatment. Mifepristone, an antiprogestogen, may constitute an alternative if encouraging preliminary data on its effectiveness and tolerability are confirmed. A very appealing area of interest is the possibility of treating endometriosis without suppressing ovarian function. Aromatase inhibitors might have such characteristics as they have been shown to inhibit oestrogen production selectively in endometriotic lesions, without affecting ovarian function; the clinical role of these drugs in the treatment of endometriosis is under evaluation. Levonorgestrel medicated intrauterine device has proven effective in relieving dysmenorrhoea associated with endometriosis, as well as pain associated with rectovaginal endometriosis. Although a systemic absorption is present determining side effects, this approach is promising in the long-term management of this condition. A fundamental objective of research in endometriosis treatment is to develop new therapeutic approaches based on the findings from experimental studies on the aetiopathogenesis of the disease; current research is focusing on anti-inflammatory drugs and modulators of the immune system. TNF-binding protein-1 and IL-12 have proved effective in reducing endometriotic lesions in animal models, while pentoxifylline and INF-alpha 2b have shown encouraging results in clinical studies. This area may be of paramount importance in the near future in order to develop a therapy that could prevent or eradicate endometriosis rather than merely relieving the symptoms.
PMID: 15155142 [PubMed – as supplied by publisher]

147: J Adv Nurs. 2004 Jun;46(6):641-8
Women’s experience of endometriosis.
Denny E.
School of Health and Policy Studies, University of Central England , Birmingham , UK . elaine.denny@uce.ac.uk
BACKGROUND: Endometriosis is a chronic disease affecting between 5% and 15% of women of reproductive age. Diagnosis can be delayed for many years, despite the existence of severe pain, and women often find that their experiences are not taken seriously by health professionals. Little research has been conducted into how endometriosis affects their lives. AIM: The aim of this paper is to report a study exploring women’s experience of living with endometriosis. METHOD: A qualitative approach was used, in which women were asked to relate their stories starting from the first experience of symptoms that they associated with endometriosis. Key areas to be followed-up during interviews were identified by women with endometriosis who were not participants. Fifteen semi-focused interviews were conducted, and thematic and content analysis were carried out using the identified key areas, and themes elicited from initial analysis of the interview transcripts. From these two processes the final themes of delay in diagnosis, pain, dyspareunia, treatment, work and social relationships, the workplace, and the future emerged. FINDINGS: Despite the existence of severe pain, often described as ‘intense’ or ‘overwhelming’, women experienced delay in receiving a diagnosis of endometriosis, and their symptoms were frequently trivialized or normalized. This, and the limited effectiveness of treatments, affected relationships with partners and family, work, and sexual relations, although individual experiences in each area were diverse. CONCLUSION: The experience of endometriosis pervades all aspects of a woman’s life. This experience is compounded by the side effects of many treatments. Women with this disease need to be taken seriously, and not have their pain trivialized or normalized. Nurses are often well-placed to assist patients in receiving sensitive and appropriate care.
PMID: 15154905 [PubMed – indexed for MEDLINE]

148: IDrugs. 2004 May;7(5):451-63.
Medical management of endometriosis: a systematic review.
Schroder AK, Diedrich K, Ludwig M.
University Schleswig-Holstein, Department of Gynecology and Obstetrics, University Clinic Hospital , Campus Lubeck , Ratzeburger Allee 160, 23538 Lubeck , Germany . Annika_Schroeder@web.de
Endometriosis is an important clinical problem in routine practice. Besides the problems of dysmenorrhea, dyspareunia and chronic abdominal pain, women with endometriosis are often infertile. We performed a systematic literature review on two issues: firstly, we clarified which medical treatment options have been investigated in prospective, randomized studies. Secondly, potential future treatments, still being preclinically investigated, were examined. A meta-analysis was not possible as the studies varied too much in their protocols and inclusion and exclusion criteria, as well as in the drugs and doses administered. Gonadotropin-releasing hormone (GnRH) agonists, progestins and oral contraceptives all appear to offer certain advantages for endometriosis patients. GnRH agonists appear to be the most effective but they are expensive and long-term treatment is not possible because of loss of bone mineral density. Estrogen add-back may offer some benefit for the clinical complaints of patients, but it may reduce the efficacy of GnRH agonists. Progestins have the best clinical profile and a good cost-effectiveness balance; however, most studies found that they were not as effective as GnRH agonists. Oral contraceptives are only effective during treatment and have a high relapse rate after therapy is completed. Future options may include the use of GnRH agonists, selective estrogen receptor modulators (SERMs) and anti-estrogens, as well as immunomodulators.
Publication Types:
Review Review, Tutorial
PMID: 15154107 [PubMed – indexed for MEDLINE]

149: AJR Am J Roentgenol. 2004 Jun;182(6):1543-6.
Cerebellar endometriosis.
Sarma D, Iyengar P, Marotta TR, terBrugge KG, Gentili F, Halliday W.
Division of Neuroradiology, Fell 3-210, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto M5T 2S8, Ontario, Canada.
Publication Types:
Case Reports Review Review of Reported Cases
PMID: 15150005 [PubMed – indexed for MEDLINE]

150: Clin Radiol. 2004 Jun;59(6):520-6.
Uterine artery embolization for adenomyosis without fibroids.
Kim MD, Won JW, Lee DY, Ahn CS.
Diagnostic Radiology, Bundang CHA General Hospital, Pochon CHA University, 351 Yatap-dong, Bundang-gu, Sungnam-si, Kyonggi-do, Sungnam, South Korea. mdkim@cha.ac.kr
AIM: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for symptomatic adenomyosis in patients without uterine fibroids. MATERIALS AND METHODS: Uterine artery embolization using polyvinyl alcohol particles sized 250-710 mm was performed in 43 patients (mean; 40.3 years, range; 31-52 years) with dysmenorrhoea, menorrhagia, or bulk-related symptoms (pelvic heaviness, urinary frequency) due to adenomyosis without fibroids. All patients underwent pre-procedural and 3.5 months (range 1-8 months) follow-up magnetic resonance imaging (MRI) with contrast enhancement. Clinical symptoms were also assessed at the time of MRI before and after embolization. RESULTS: Significant improvement of dysmenorrhoea (95.2%) and menorrhagia (95.0%) was reported in most patients. Contrast-enhanced MRI revealed non-enhancing areas suggesting coagulation necrosis of adenomyosis in 31 patients (72.1%), decreased size without necrosis in 11 patients (25.6%), and no change in one patient (2.3%). The mean volume reduction of the uteri after uterine artery embolization was 32.5% (from 321.7+/-142.9 to 216.7+/-130.1 cm(3)). CONCLUSION: Transcatheter uterine artery embolization is an effective therapy for the treatment of symptomatic pure adenomyosis, and may be a valuable alternative to hysterectomy.
Publication Types:
Evaluation Studies
PMID: 15145722 [PubMed – indexed for MEDLINE]