Int J Clin Oncol. 2008 Jun;13(3):266-70. Epub 2008 Jun 14.

Endometrioid adenocarcinoma arising in adenomyosis: elucidation by periodic magnetic resonance imaging evaluations.

Motohara K, Tashiro H, Ohtake H, Saito F, Ohba T, Katabuchi H.

Department of Obstetrics and Gynecology, School of Medicine, Kumamoto University, Kumamoto, Japan.

There are several case reports of adenocarcinomas developing within adenomyosis. However, there is no report demonstrating the natural course from adenomyosis to adenocarcinoma. We report a patient (a 41-year-old Japanese woman) who was observed every 6 months after being diagnosed with adenomyosis at our University Hospital. Although she went through menopause at age 51, she occasionally complained subsequently of abnormal genital bleeding. Eleven years after the initial diagnosis, endometrial cytology revealed the presence of malignant cells. Pelvic magnetic resonance imaging (MRI) demonstrated replacement of the adenomyotic lesion by a poorly demarcated lesion, compared to the findings on prior MRI. Consequently, we performed a modified radical hysterectomy and pelvic lymph node dissection, under a presumptive diagnosis of adenocarcinoma arising in adenomyosis. Histological diagnosis revealed an endometrioid adenocarcinoma (G3) transformed from adenomyotic epithelium, which was classified, according to the International Federation of Gynecology and Obstetrics, as stage Ic, pT1cN0M0. In this patient, periodic MRI evaluations, in conjunction with pathological examination, identified the transformation from adenomyosis to adenocarcinoma.

Hum Reprod. 2008 Sep;23(9):2104-12. Epub 2008 Jun 13.

Regulation and activation of ezrin protein in endometriosis.

Ornek T, Fadiel A, Tan O, Naftolin F, Arici A.

Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520-8063, USA.

BACKGROUND: Ezrin protein and its activated form phospho-ezrin play a role in cell morphology, motility and adhesiveness. In this study, we hypothesized that these proteins play a role in the pathogenesis of endometriosis by promoting adhesion and invasion of endometrial stromal cells (ESCs) in ectopic sites. METHODS: We compared the expression of ezrin and phospho-ezrin in normal endometrium from women without endometriosis with their expression in eutopic and ectopic endometrial tissues from women with endometriosis, using immunohistochemistry and western blot analysis. Paired eutopic and ectopic endometrial tissue samples from women with endometriosis (n = 13) and normal endometrium from women without endometriosis (n = 12) were collected. Invasive potential of ESCs from each of these samples was compared using Matrigel membrane invasion assay. RESULTS: Eutopic and ectopic endometrial tissues from women with endometriosis have higher ezrin and phospho-ezrin levels as confirmed by immunohistochemistry and western blot analysis (P < 0.05). The Matrigel membrane invasion assay revealed that ectopic ESCs have more invasive characteristics, more protrusions and higher ezrin staining than normal ESCs (P < 0.05). CONCLUSIONS: Ezrin can be a potential marker for endometrial cell invasion and may play a role in the pathogenesis of endometriosis.

Hum Reprod. 2008 Sep;23(9):2024-30. Epub 2008 Jun 14.

Evaluation of the efficacy of a danazol-loaded intrauterine contraceptive device on adenomyosis in an ICR mouse model.

Zhang X, Yuan H, Deng L, Hu F, Ma J, Lin J.

Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, People’s Republic of China. xinmei6@yahoo.com

BACKGROUND: Danazol, a synthetic steroid with antigonadotrophic properties, has been widely used for the treatment of endometriosis and adenomyosis. However, the local application of danazol to the uterus to treat adenomyosis is controversial. The objective of this study is to develop an effective treatment for adenomyosis using danazol via intrauterine contraceptive device (IUCD) delivery. METHODS: An adenomyosis animal model was established using Institute for Cancer Research, Swiss-derived (ICR) mice, grafted with a single pituitary gland (n = 30). Four months after grafting, IUCDs with three different quantities of danazol were prepared and used to treat the ICR mice with adenomyosis. After 2 months of treatment with a danazol-loaded IUCD, the number of adenomyosis nodules and the hematoxylin-eosin staining scores were measured and compared with mice given daily oral danazol and controls (no adenomyosis). RESULTS: As the danazol dose increased, the nodule number decreased reaching significance at a dose of 2.0 mg per 20 g body weight (P = 0.002). When compared with oral administration, the plasma danazol concentrations with IUCD delivery were low and stable. CONCLUSIONS: These results suggest that an IUCD loaded with an appropriate dose of danazol may be an effective treatment for adenomyosis and that human trials are warranted.

J Pediatr Adolesc Gynecol. 2008 Jun;21(3):151-3.

Unilateral renal agenesis and associated Müllerian anomalies: a case report and recommendations for pre-adolescent screening.

Hollander MH, Verdonk PV, Trap K.

Middelheim Hospital, Antwerp, Belgium. martine-hollander@hotmail.com

Reprod Biomed Online. 2008 Jun;16(6):817-24.

Multiple endometrial antigens are targeted in autoimmune endometriosis.

Gajbhiye R, Suryawanshi A, Khan S, Meherji P, Warty N, Raut V, Chehna N, Khole V.

Department of Reproductive Endocrinology and Infertility, National Institute for Research in Reproductive Health, Indian Council of Medical Research, J. M. Street, Parel, Mumbai, India, 400 012.

Endometriosis is defined as the growth of endometrial glands and stroma in ectopic locations. Its aetiology is multifactorial, but autoimmunity has been shown to play a role in its onset and development. The present study aimed to investigate the presence of both IgG and IgM anti-endometrial antibodies in sera of endometriosis patients in comparison with age-matched controls, and to also investigate the cognate endometrial proteins involved. Sera from these groups were screened by western blot and immunohistochemistry. Thirteen out of the 40 sera tested were positive for IgG isotype, and 10/27 IgG negative patients were positive for IgM isotype. These findings indicate that endometrial antibodies of IgG and IgM classes could be detected in almost 60% of endometriosis patients. Of the various identified endometrial antigens, 30 and 45 kDa antigens were immunodominant in both IgG and IgM positive endometriosis patients. With immunohistochemistry, positive sera showed reactivity in luminal epithelium, glandular epithelium and stroma. These anti-endometrial antibodies might be partially responsible for failure of implantation leading to infertility. Identification of specific targets would be a help in understanding the pathophysiology of endometriosis, and would also help in setting up a non-invasive test for the diagnosis of endometriosis.

Reprod Biomed Online. 2008 Jun;16(6):817-24.

Multiple endometrial antigens are targeted in autoimmune endometriosis.

Gajbhiye R, Suryawanshi A, Khan S, Meherji P, Warty N, Raut V, Chehna N, Khole V.

Department of Reproductive Endocrinology and Infertility, National Institute for Research in Reproductive Health, Indian Council of Medical Research, J. M. Street, Parel, Mumbai, India, 400 012.

Endometriosis is defined as the growth of endometrial glands and stroma in ectopic locations. Its aetiology is multifactorial, but autoimmunity has been shown to play a role in its onset and development. The present study aimed to investigate the presence of both IgG and IgM anti-endometrial antibodies in sera of endometriosis patients in comparison with age-matched controls, and to also investigate the cognate endometrial proteins involved. Sera from these groups were screened by western blot and immunohistochemistry. Thirteen out of the 40 sera tested were positive for IgG isotype, and 10/27 IgG negative patients were positive for IgM isotype. These findings indicate that endometrial antibodies of IgG and IgM classes could be detected in almost 60% of endometriosis patients. Of the various identified endometrial antigens, 30 and 45 kDa antigens were immunodominant in both IgG and IgM positive endometriosis patients. With immunohistochemistry, positive sera showed reactivity in luminal epithelium, glandular epithelium and stroma. These anti-endometrial antibodies might be partially responsible for failure of implantation leading to infertility. Identification of specific targets would be a help in understanding the pathophysiology of endometriosis, and would also help in setting up a non-invasive test for the diagnosis of endometriosis.

Minerva Ginecol. 2008 Jun;60(3):209-21.

The effect of endometriosis on in vitro fertilization outcome.

Catenacci M, Falcone T.

Department of Obstetrics and Gynecology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44159, USA.

AIM: Endometriosis is a leading cause of pelvic pain and infertility. Implantation of endometrial cells to the peritoneal surface can lead to a spectrum of disease severity with the most severe causing extensive pelvic adhesions and anatomic distortion. Infertility can result from anatomic abnormalities as well proinflammatory cellular and immune factors. Treatment options for women seeking pregnancy include surgical removal and/or in vitro fertilization. The aim of this study was to review current literature on the pathogenesis of endometriosis and treatment options for infertility. METHODS: Recent published articles regarding infertility and endometriosis have been reviewed analyzing PubMed and Cochrane databases. RESULTS: In vitro fertilization (IVF) is a valid option for patients after surgical management has not restored fertility. IVF may be offered sooner to older patients or to those with more severe disease. It is unclear if prior surgical treatment has deleterious effects on IVF outcomes. It does appear, however, that surgical removal of endometriomas may lead to decreased ovarian reserve. This may not affect fertility outcomes. CONCLUSION: Endometriosis is a leading cause of pelvic pain and infertility. The most accepted theory of how endometriosis develops is the retrograde transplant theory by Sampson, but a constellation of numerous other factors are involved. The gold standard for diagnosis is operative; therefore, the true prevalence of this disease is uncertain. Many women with endometriosis will seek fertility treatment. In this case if endometriosis is found, it should be treated.

Vet Microbiol. 2008 Nov 25;132(1-2):111-8. Epub 2008 May 2.

Genomic characterization of Arcanobacterium pyogenes isolates recovered from the uterus of dairy cows with normal puerperium or clinical metritis.

Silva E, Gaivão M, Leitão S, Jost BH, Carneiro C, Vilela CL, Lopes da Costa L, Mateus L.

Department of Reproduction and Obstetrics, C.I.I.S.A., Faculty of Veterinary Medicine, Avenida Universidade Técnica, Alto da Ajuda, Polo Universitário, 1300-477 Lisbon, Portugal.

Arcanobacterium pyogenes is considered to be the most relevant bacterium involved in the establishment of puerperal uterine infection in cattle due to its persistence in utero, resistance to treatment and synergic action with Gram negative anaerobes. Once the infection is established, A. pyogenes is responsible for the persistence of the infection. The objective of this study was to characterize A. pyogenes field isolates recovered from the uterus of cows with either normal puerperium or clinical metritis, in an attempt to identify factors that might be associated with the establishment and persistence of the disease. This characterization was based on BOX-PCR typing and on screening of eight virulence factor genes (plo, nanP, nanH, cbpA, fimA, fimC, fimE, fimG) by conventional PCR. Finally, a relationship between clonal types, virulence factors and presence of disease was investigated. A. pyogenes clonal types identified from isolates recovered from the uterus of postpartum dairy cows differed among herds. Although some clonal types were strictly associated with the development of clinical metritis, others were identified from isolates recovered from normal puerperium and clinical metritis cows. Moreover, the presence of the eight virulence factor genes was not related with the ability to induce clinical metritis, suggesting that the type of A. pyogenes may not be a determinant factor in the development of the disease. We suggest that host intrinsic factors, the synergism between A. pyogenes and other bacteria and the differential gene expression of virulence factor genes may play a more relevant role in the establishment of puerperal uterine infections.

Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2008 Jun;25(3):280-3.

[Study on the association of SNPs of MMP-2 and TIMP-2 genes with the risk of endometriosis and adenomyosis]

[Article in Chinese]

Zhao XW, Li Y, Wang N, Zhao J, Li XL, Liu Q, Jia JH, Yang ZF, Kang S.

Department of Obstetrics and Gynecology, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011 People’ Republic of China.

OBJECTIVE: To investigate the association of single nucleotide polymorphisms (SNPs) in matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) with the risk of endometriosis and adenomyosis. METHODS: Genotypes of MMP-2 and TIMP-2 were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method among 298 endometriosis patients, 180 adenomyosis patients and 324 matched control women. RESULTS: No significant difference was found in allele frequencies and genotype distributions of MMP-2 -1306C/T polymorphism between endometriosis patients and control women (P> 0.05). However, there were significant differences in genotype and allele distributions of MMP-2 -1306C/T polymorphism between adenomyosis patients and control women (P< 0.05). Compared with CT+TT genotypes, CC genotype significantly increases the risk of adenomyosis, with an odds ratio of 1.83 (95% CI was 1.13-2.96). No significant difference was shown in allele frequencies and genotype distributions of the MMP-2 -735C/T polymorphism among the three groups (P>0.05). MMP-2 -1306C/T and -735C/T polymorphisms displayed linkage disequilibrium (D’=0.74). There was no significant difference in haplotype distributions of the two MMP-2 SNPs among the three groups ( P> 0.05). No significant difference was found in allele frequencies of TIMP-2 -418G/C polymorphism among the three groups (P> 0.05). However, the frequency of TIMP-2 CC genotype in endometriosis patients (0.7%) was significantly lower than that in the control women (3.7%) (P< 0.05). CONCLUSION: The C allele of MMP-2 -1306C/T polymorphism did not modify the risk of developing endometriosis but significantly increase the risk of developing adenomyosis. The MMP-2 -735C/T and TIMP-2 -418G/C polymorphisms were not associated with the risk of developing endometriosis or adenomyosis.

Endocr Relat Cancer. 2008 Sep;15(3):665-92. Epub 2008 Jun 9.

Design and validation of specific inhibitors of 17beta-hydroxysteroid dehydrogenases for therapeutic application in breast and prostate cancer, and in endometriosis.

Day JM, Tutill HJ, Purohit A, Reed MJ.

Department of Endocrinology and Metabolic Medicine, Imperial College, London, London W2 1NY, UK.

17beta-Hydroxysteroid dehydrogenases (17beta-HSDs) are enzymes that are responsible for reduction or oxidation of hormones, fatty acids and bile acids in vivo, regulating the amount of the active form that is available to bind to its cognate receptor. All require NAD(P)(H) for activity. Fifteen 17beta-HSDs have been identified to date, and with one exception, 17beta-HSD type 5 (17beta-HSD5), an aldo-keto reductase, they are all short-chain dehydrogenases/reductases, although overall homology between the enzymes is low. Although named as 17beta-HSDs, reflecting the major redox activity at the 17beta-position of the steroid, the activities of these 15 enzymes vary, with several of the 17beta-HSDs able to reduce and/or oxidise multiple substrates at various positions. These activities are involved in the progression of a number of diseases, including those related to steroid metabolism. Despite the success of inhibitors of steroidogenic enzymes in the clinic, such as those of aromatase and steroid sulphatase, the development of inhibitors of 17beta-HSDs is at a relatively early stage, as at present none have yet reached clinical trials. However, many groups are now working on inhibitors specific for several of these enzymes for the treatment of steroid-dependent diseases, including breast and prostate cancer, and endometriosis, with demonstrable efficacy in in vivo disease models. In this review, the recent advances in the validation of these enzymes as targets for the treatment of these diseases, with emphasis on 17beta-HSD1, 3 and 5, the development of specific inhibitors, the models used for their evaluation, and their progress towards the clinic will be discussed.

Arkh Patol. 2008 Mar-Apr;70(2):6-8.

[Endometrial pathomorphology in bacterial vaginosis associated with chronic endometritis]

[Article in Russian]

Kovalenko VL, Voropaeva EE, Kozachkov EL, Kozachkova EA.

A complex morphological and morphometric study was used to examine endometrial biopsy specimens from 133 patients with bacterial vaginosis (BV). Chronic endometritis (CE) was detected in 100% of them. The morphological components of CE in BV were significant dystrophic changes in integumentary endotheliocytes and glandular cells, differently pronounced polymorphocellular infiltration of the uterine mucosa with signs of tissue lymphopenia, as well as stromal and vascular fibroblastic changes with the decreased volume density of the endometrial integumentary endothelium, lower relative volumes of glands, and increased relative volume of connective tissue. The characteristic structural changes for CE and BV are intensive processes of apoptosis of the uterine mucosal epithelium in the presence of its slight proliferative activity, which determines progressive endometrial atrophy and may contribute to non-developing pregnancy. As this takes place, discrinism occurs in the uterine mucosa, mainly as inadequate progesterone reception of endometrial target cells, which leads to uterine gland dysfunction and may also cause fetal depletion syndrome.

Pol J Vet Sci. 2008;11(1):9-16.

Absorption of proinflammatory cytokines from inflamed porcine uterus into the uterine venous blood–preliminary data.

Kucharski J, Stefańczyk-Krzymowska S, Jana B.

Division of Endocrinology and Pathophysiology, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Tuwima 10, 10-747 Olsztyn, Poland.

The aim of the present study was to estimate the absorption of 125I-labeled proinflammatory cytokines–interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) from inflamed porcine uterus into the uterine venous blood. Moreover, in order to test the hypothesis that the above cytokines penetrate directly into ovaries and oviduct via local destination transfer in the area of the ovarian vascular pedicle and bypassing the systemic circulation, the concentration of IL-1beta, IL-6 and TNF-alpha in ovarian and oviductal tissues was also studied. These cytokine concentrations were also estimated in the ovarian venous blood. IL-1beta, IL-6 and TNF-alpha from both control and inflamed uteri were absorbed into the uterine venous blood, but it was higher (P < 0.05-0.001) from the pathologically changed uteri. The uterine tissues, particularly the endometrium, of both control and inflamed uteri retained all studied cytokines, but to a higher degree (P < 0.001) in the inflamed uteri. Injections of IL-1beta, IL-6 and TNF-alpha into the control and inflammatory changed uteri produced the presence of these proteins in the ovary and oviduct. However, the concentrations of IL-1beta and IL-6 in the ovarian and oviductal tissues was low after injections of control and inflamed uteri with these cytokines. In turn, administration of TNF-alpha into the inflammatory changed uteri lead to an enhancement in the concentration of this cytokine in the ovarian parenchyma (P < 0.05) and oviduct (P < 0.001). All studied cytokines were found in the ovarian venous blood after their injection into both control and inflamed uteri, which indicated its local destination transfer to the ovary. However, the concentration of cytokines increased (P <0.05-0.001) in the gilts with pathologically changed uteri as compared to controls. The study showed that both control and inflamed porcine uteri absorbed IL-1beta, IL-6 and TNF-alpha into the uterine venous blood, but the values of absorbed cytokines from inflamed uteri were higher. Moreover, the quantity and the manner of the studied cytokineS absorption into the uterine venous blood differed.

Vet Rec. 2008 Jun 7;162(23):746-9.

Risk of pyometra in bitches treated for mismating with low doses of oestradiol benzoate.

Whitehead ML.

Chipping Norton Veterinary Hospital, Albion Street, Chipping Norton, Oxfordshire.

A review of the literature concerning the effect of oestrogens for treating mismating in bitches on the occurrence of pyometra indicated that low doses of oestradiol benzoate substantially increase the incidence of pyometra. A retrospective study of the clinical records of a UK general practice found that the incidence of pyometra in the four months after administration of low doses of oestradiol benzoate was 8.7 per cent, whereas the incidence in the practice’s untreated at-risk population was estimated to be less than 1.32 per cent per interoestrus interval, suggesting that more than 85 per cent of pyometras occurring within four months of treatment are iatrogenic.

J Minim Invasive Gynecol. 2008 Jul-Aug;15(4):440-5. Epub 2008 Jun 6.

Ureteral injuries during classic intrafascial supracervical hysterectomy: an 11-year experience in 1163 patients.

Jung SK, Huh CY.

Department of Obstetrics and Gynecology, School of Medicine, KyungHee University, Seoul, Korea. xaup@hanafos.com

STUDY OBJECTIVE: To examine the incidence, characteristics, and treatment of ureteral injuries during classic intrafascial supracervical hysterectomy for benign gynecologic diseases. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Department of obstetrics and gynecology, university teaching hospital. PATIENTS: A total of 1163 women with benign gynecologic diseases. INTERVENTIONS: Classic intrafascial supracervical hysterectomy. MEASUREMENTS AND MAIN RESULTS: A retrospective chart review was conducted to determine the rate of ureteral injury. Four cases of ureteral injuries occurred among the 1163 classic intrafascial supracervical hysterectomy procedures (0.34%). Ureteral injury occurred during peritoneal dissection in 1 case, which was treated immediately with laparoscopy. In 2 cases, ureteral injuries were recognized by watery vaginal discharge several days after the operation and were treated with laparotomy procedures. Ureteral injury was not detected postoperatively in another case, resulting in a laparoscopic nephrectomy caused by a nonfunctioning kidney 3 years after the initial operation. The predisposing factors for ureteral injury were adhesion as a result of endometriosis, and earlier surgery in which the normal pelvic anatomy was distorted. CONCLUSION: The incidence of ureteral injury during classic intrafascial supracervical hysterectomy as noted in this study is 0.34%. Postoperative cases were associated with high morbidity. Early detection of ureteral injury is crucial for appropriate management as intraoperative diagnosis and repair of the injury then has fewer consequences and less serious complications than postoperative cases.

Hum Pathol. 2008 Jun;39(6):954-9.

Ureteral endometriosis: clinicopathological and immunohistochemical study of 7 cases.

Al-Khawaja M, Tan PH, MacLennan GT, Lopez-Beltran A, Montironi R, Cheng L.

Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

Ureteral endometriosis is a rare yet important entity that can lead to renal failure due to silent obstruction of the ureter. Awareness of clinical and morphologic features can help in early detection and treatment. We analyzed the clinical, pathologic, and immunohistochemical findings of 7 cases of ureteral endometriosis. Mean age of patients was 51 years. All patients presented with hydroureter, accompanied in the most cases by hydronephrosis. Superimposed pyelonephritis was experienced by 2 of 7 patients. Most patients (4 of 7) had previously undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy. In 6 of 7 cases, endometriosis involved the left ureter. The distal one third of the ureter was involved in 6 cases, whereas the middle third was involved in 1 case. In 4 cases, endometriosis was located extrinsic to the ureter, whereas in 3 cases, the ureter showed intrinsic involvement by endometriosis. One case showed simple endometrial hyperplasia. Surgical management included nephrectomy in 2 cases, distal ureterectomy with reimplantation in 3 cases, ureteral stent placement followed by ureteroureterostomy in 1 case, and relief of ureteral obstruction by resection of pelvic endometrioma in 1 case. Immunostains for cytokeratin-7 (CK7) and progesterone receptor (PR) were positive in all of the cases, whereas immunostains for estrogen receptor (ER) were positive in 83% of cases and immunostains for CK20 were negative in all cases. CA125 immunostains were positive in 67% of cases. The stromal cells were positive for CD10, ER, and PR immunostaining. Our findings suggest that the diagnosis of ureteral endometriosis is preceded in most cases by hysterectomy and bilateral salpingo-oophorectomy, possibly because of prior symptoms related to adenomyosis or pelvic endometriosis and that ureteral endometriosis has a strong predilection for involvement of the lower third of the left ureter. Ureteral endometriosis should be included in the differential diagnosis of obstructive ureteral lesions in women, particularly those involving the lower third of the left ureter, even in postmenopausal patients. Immunostains for ER, PR, CK7, CA125, and CD10 can be helpful in challenging cases.

J Altern Complement Med. 2008 Jun;14(5):515-22.

Development of protocols for randomized sham-controlled trials of complex treatment interventions: Japanese acupuncture for endometriosis-related pelvic pain.

Schnyer RN, Iuliano D, Kay J, Shields M, Wayne P.

New England School of Acupuncture, Watertown, MA, USA. rosa_schnyer@hms.harvard.edu

BACKGROUND: Very little research has been conducted in the West to evaluate the clinical efficacy of Japanese acupuncture (JA). The characteristics that define and differentiate JA from Chinese acupuncture styles add specific challenges to the operationalization of treatment protocols for use in clinical trials. OBJECTIVES: To develop an ecologically valid and viable multimodal treatment intervention, including active and sham protocols, for use in a pilot randomized sham-controlled trial of a style of JA in treating endometriosis-related chronic pelvic pain in adolescents and young women. METHODS: A focus group format was used to systematize the diagnostic framework, operationalize the intake, design the treatment protocols, and develop a viable and effective sham acupuncture intervention using the Streitberger device and sham moxibustion. Implementation of the treatment protocol employed the manualization process to provide flexibility of treatment while assuring replicability and standardization. SETTING: The Japanese Acupuncture Department at the New England School of Acupuncture in Newton, MA. RESULTS: Completed study visit forms indicated good compliance of study practitioners with active and sham treatment protocols. The specific JA protocols used in our pilot study were well tolerated by the adolescent girls who participated in the trial. No serious adverse events were reported by any participants. Our protocols were successful in maintaining patient blinding and minimizing differences in outcome expectations between treatment groups. CONCLUSIONS: Manualization provided a viable method for conforming to the interactive nature of JA treatments, yet facilitated compliance with a replicable treatment protocol. Sham controls of complex, multicomponent JA interventions pose unique challenges. The modified Streitberger needle in conjunction with sham moxibustion showed promise as a viable control in clinical trails of JA; both components of this sham protocol require further validation.

Zhongguo Zhong Yao Za Zhi. 2008 Feb;33(3):303-7.

[Inhibitory effects of Sanleng pellet on angiogenesis of endometriosis in rats]

[Article in Chinese]

Chen Y, Xu XY, Ye L, Zhu HF, Chen H, Chen G.

School of Pharmaceutical and Chinese Traditional Pharmaceutical Sciences, Southwest University, Chongqing 400716, China.

OBJECTIVE: To investigate the effect of Sanleng pellet on angiogenesis of endometriosis in SD rats. METHOD: The rat model of endometriosis were treated with Sanleng pellet. Observe microvessels density by immunohistochemical test as well as the expression of vascular endothelial growth factor and tumor necrosis factor-alpha in ectopic endometriotic tissue by immunohistochemical test and RT-PCR. RESULT: Sanleng pellet can reduce MVD, and inhibit the level of protein and mRNA of vascular endothelial growth factor and TNF-alpha in ectopic endometriotic tissue. CONCLUSION: Sanleng pellet can reduce the degree of angiogenesis in the endometriosis rats, and its mechanism might be associated with inhibiting the expression of vascular endothelial growth factor and TNF-alpha in the heterotopic tissue.

Zhongguo Zhong Yao Za Zhi. 2008 Mar;33(5):567-9.

[Influence of Xianglingwan on dysmenorrhea and serum CA125 in treating patients with endometriosis]

[Article in Chinese]

Yang CB, Chen Y, Jin HM, Ying WW.

Affiliated Obsretrics and Gynecology Hospital, College of Medicine, Zhejiang University, Hangzhou 310006, China.

OBJECTIVE: To observe the influence of Xianglingwan on dysmenorrhea and serum CA125 in treating patients with endometriosis. METHOD: A total of 54 patients with endometriosis and without medical complications were random selected. Xianglingwan was administered from the fifth day of the menstrual cycle for 3 weeks every month as a therapeutic course, and three months for a therapeutic period. Pelvic type B ultrasonograph and blood CA125 were detected before and after treatment. Visual analogue scale was admitted to evaluate the dysmenorrhea. RESULT: The serum CA125 reduced obviously after therapy. There was a significant difference between them (P < 0.01). The symptom of dysmenorrhea also reduced obviously after treatment. There was a significant difference between them (P < 0.05). CONCLUSION: Xianglingwan can treat edometriosis effectively, and has less adverse reactions, it can also reduce the symptom of dysmenorrheal and the serum CA125.

Hum Reprod Update. 2008 Sep-Oct;14(5):447-57. Epub 2008 Jun 5.

The search for genes contributing to endometriosis risk.

Montgomery GW, Nyholt DR, Zhao ZZ, Treloar SA, Painter JN, Missmer SA, Kennedy SH, Zondervan KT.

Genetic and Molecular Epidemiology Laboratories, Queensland Institute of Medical Research, Royal Brisbane Hospital, 300 Herston Road, Brisbane, QLD 4029, Australia. grant.montgomery@qimr.edu.au

BACKGROUND: Genetic variation contributes to the risk of developing endometriosis. This review summarizes gene mapping studies in endometriosis and the prospects of finding gene pathways contributing to disease using the latest genome-wide strategies. METHODS: To identify candidate-gene association studies of endometriosis, a systematic literature search was conducted in PubMed of publications up to 1 April 2008, using the search terms ‘endometriosis’ plus ‘allele’ or ‘polymorphism’ or ‘gene’. Papers included were those with information on both case and control selection, showed allelic and/or genotypic results for named germ-line polymorphisms and were published in the English language. RESULTS: Genetic variants in 76 genes have been examined for association, but none shows convincing evidence of replication in multiple studies. There is evidence for genetic linkage to chromosomes 7 and 10, but the genes (or variants) in these regions contributing to disease risk have yet to be identified. Genome-wide association is a powerful method that has been successful in locating genetic variants contributing to a range of common diseases. Several groups are planning these studies in endometriosis. For this to be successful, the endometriosis research community must work together to genotype sufficient cases, using clearly defined disease classifications, and conduct the necessary replication studies in several thousands of cases and controls. CONCLUSIONS: Genes with convincing evidence for association with endometriosis are likely to be identified in large genome-wide studies. This will provide a starting point for functional and biological studies to develop better diagnosis and treatment for this debilitating disease.

Aust N Z J Obstet Gynaecol. 2008 Jun;48(3):292-5.

Fertility and pain outcomes following laparoscopic segmental bowel resection for colorectal endometriosis: a review.

Wills HJ, Reid GD, Cooper MJ, Morgan M.

Faculty of Medicine, University of New South Wales, New South Wales, Australia.

Intestinal involvement in endometriosis is thought to occur in up to 12% of all endometriosis cases. While colorectal resection is being increasingly advocated as a feasible management option in patients with severe disease, there still remains significant resistance towards this surgery. This article aims to review the current literature to determine the pain and fertility outcomes following segmental bowel resection for colorectal endometriosis.

World J Gastroenterol. 2008 Jun 7;14(21):3430-4.

Acute small bowel obstruction caused by endometriosis: a case report and review of the literature.

De Ceglie A, Bilardi C, Blanchi S, Picasso M, Di Muzio M, Trimarchi A, Conio M.

Department of Gastroenterology, General Hospital, C.so Garibaldi 187/3, Sanremo 18038, Italy.

Gastrointestinal involvement of endometriosis has been found in 3%-37% of menstruating women and exclusive localization on the ileum is very rare (1%-7%). Endometriosis of the distal ileum is an infrequent cause of intestinal obstruction, ranging from 7% to 23% of all cases with intestinal involvement. We report a case in which endometrial infiltration of the small bowel caused acute obstruction requiring emergency surgery, in a woman whose symptoms were not related to menses. Histology of the resected specimen showed that endometriosis was mainly prevalent in the muscularis propria and submucosa and that the mucosa was not ulcerated but had inflammation and glandular alteration. Endometrial lymph node involvement, with a cystic glandular pattern was also detected.

Rev Port Pneumol. 2008 May-Jun;14(3):427-35.

[Thoracic endometriosis]

[Article in Portuguese]

Costa F, Matos F.

Interna do Internato Complementar de Pneumologia, Centro Hospitalar de Coimbra.

Thoracic endometriosis is defined by the presence of endometrial tissue in the lungs or pleura, and is characterised by cyclic hemoptysis or recurrent hemothorax or pneumothorax occurring with the menstruation. Being a rare clinical entity, it is not always considered in the differential diagnosis when these symptoms are evaluated. The exams performed during the diagnostic work-up frequently show nonspecific alterations, however a presumptive diagnosis can be made based on the typical clinical history. The key to the diagnosis are the catamenial symptoms, so a thorough clinical history is essential to promptly reach the correct diagnosis. Hormonal treatment and surgery are the two mainstays of therapy for this pathology. The authors present the case of a 27 year-old female patient presenting with cyclic hemoptysis during the menstruation. The diagnostic workup was inconclusive. Based on the clinical history, the diagnosis of pulmonary endometriosis was assumed and treatment was initiated with oral contraceptives with total resolution of symptoms. The authors make a brief review of the main symptoms, pathogenesis, diagnosis and treatment of thoracic endometriosis.

J Comput Assist Tomogr. 2008 May-Jun;32(3):369-71.

Magnetic resonance manifestations of endometrial cysts at 3 T compared with 1.5 T.

Takeuchi M, Matsuzaki K, Kubo H, Nishitani H.

Department of Radiology, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, Japan. mayumi@clin.med.tokushima-u,ac.jp

OBJECTIVE: To evaluate the feasibility of magnetic resonance (MR) imaging at 3 T compared with 1.5 T while focusing on the shading sign of endometrial cysts on T2-weighted images. METHODS: Fifteen ovarian endometrial cysts in 10 patients underwent pelvic MR scans on 3-T and 1.5-T scanners. Fast spin-echo T2-weighted images were obtained. The images were evaluated qualitatively for the presence of the shading sign. Quantitative evaluation was performed by comparing the cyst-to-muscle signal intensity ratio at 3 T and that at 1.5 T. RESULTS: The signal intensity of the cysts was lower at 3 T than that at 1.5 T by visual evaluation. In 2 lesions, the shading sign was demonstrated at 3 T but was not at 1.5 T. The cyst-to-muscle signal intensity ratio at 3 T was significantly lower than that at 1.5 T. CONCLUSION: Magnetic resonance imaging at 3 T is useful for the diagnosis of endometrial cysts with better demonstration of the shading sign on T2-weighted images.

J Comput Assist Tomogr. 2008 May-Jun;32(3):353-5.

Magnetic resonance manifestations of decidualized endometriomas during pregnancy.

Takeuchi M, Matsuzaki K, Nishitani H.

Department of Radiology, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, Japan. mayumi@clin.med.tokushima-u.ac.jp

OBJECTIVE: Decidual changes of endometrial tissue in endometriomas during pregnancy may manifest as mural nodules and mimic malignant transformation. We evaluated magnetic resonance findings of decidualized ovarian endometriomas for the differentiation from malignant transformation. METHODS: Magnetic resonance manifestations of 5 decidualized ovarian endometriomas were evaluated. High b-value diffusion-weighted images were performed in 3 cases. RESULTS: The mural nodules were demonstrated as linear, small nodular, broad-based nodular, or polypoid structures, which showed prominent hyperintensity on T2-weighted images and on diffusion-weighted images similar to normal endometrium or placenta. The apparent diffusion coefficient of decidualized mural nodules was significantly higher than that of malignant mural nodules of 7 ovarian cancers. CONCLUSIONS: Endometrioma with prominent hyperintense mural nodules on T2-weighted images in a pregnant woman is highly suggestive for decidualized endometriomas. Diffusion-weighted images with the apparent diffusion coefficient measurement may help the diagnosis of this rare entity.

BJOG. 2008 Aug;115(9):1159-64. Epub 2008 May 30.

Comment in:

BJOG. 2008 Dec;115(13):1715; author reply 1715-6.

The use of JJ stent in the management of deep endometriosis lesion, affecting or potentially affecting the ureter: a review of our practice.

Weingertner AS, Rodriguez B, Ziane A, Gibon E, Thoma V, Osario F, Haddad C, Wattiez A.

Department of Obstetric and Gynecology, University Hospital of Strasbourg, Strasbourg, France. annesophie.w@wanadoo.fr

OBJECTIVE: With the increasing number of operative laparoscopies performed for the treatment of deep pelvic endometriosis, technical difficulties and risk of complications inevitably increase. We report our experience using JJ stents, in women treated for deep pelvic endometriosis, with regard to prevention and management of ureteral lesions. DESIGN: Descriptive retrospective analysis between March 2004 and March 2007. SETTING: Department of Obstetrics and Gynaecology, University Hospital, Strasbourg, France. POPULATION AND METHODS: Cases of women who underwent laparoscopic surgery for severe endometriosis and who needed a JJ stent in their management were recorded. Laparoscopic surgery was performed at the Department of Obstetrics and Gynaecology at CMCO-SIHCUS and Hautepierre Hospitals, Strasbourg, which are referral centres in the treatment of deep endometriosis. MAIN OUTCOME MEASURES: To evaluate the contribution of JJ stent in the prevention and management of ureteral lesions from endometriotic origin and/or iatrogenic origin in women treated for deep pelvic endometriosis. RESULTS: A total of 145 women had surgery for deep pelvic endometriosis. Seventeen (11.7%) women had a JJ ureteral stent inserted. In 82.4% of women, the stent was inserted pre- or peroperatively. We noted three ureteral complications, of which only one needed management by laparotomy. CONCLUSIONS: Except in extreme cases, management of ureteral endometriosis should be performed laparoscopically. Ureteral lesions whether iatrogenic, or secondary to endometriotic disease, can be treated by cystoscopy, JJ stent and laparoscopy. The combination of these three elements is the optimal management and is unlikely to cause subsequent complications. Laparotomy and its associated morbidity should be avoided.

Pharmacogenomics. 2008 Jun;9(6):765-71.

Current trends in N-acetyltransferase research arising from the 2007 International NAT Workshop.

Boukouvala S, Westwood IM, Butcher NJ, Fakis G.

Department of Molecular Biology & Genetics, Democritus University of Thrace, Demetras 19, Alexandroupolis 68100, Greece.

Arylamine N-acetyltransferase (NAT) research has been influenced in recent years by the rapid progress in genomics, proteomics, structural genomics and other cutting-edge disciplines. To keep up with these advancements, the NAT scientific community has fostered collaboration and exchange of know-how between its members. As a specialized event bringing together experts from many different laboratories, the triennial International NAT Workshop has been instrumental in maintaining this culture over the past ten years. The 2007 Workshop took place in Alexandroupolis, Greece, and covered ongoing research on the structure and enzymatic function of human NATs, the prokaryotic and eukaryotic models for NAT, the mechanisms of NAT gene regulation and expression, the frequencies and effects of polymorphisms in the human NAT genes, and the involvement of NATs in multifactorial diseases, including cancer, allergic conditions, endometriosis and endemic nephropathies. Gene nomenclature issues were also addressed and the participants discussed current trends in the field.

Hinyokika Kiyo. 2008 Apr;54(4):301-4.

[A case of genital Chlamydia trachomatis infection with acute post renal failure]

[Article in Japanese]

Hirayama T, Matsumoto K, Song S, Matsushita K, Satoh T, Iwamura M, Baba S.

Department of Urology, Kitasato University School of Medicine.

A 29-year-old woman presented with bilateral hydronephroses concomitant with acute renal failure. Retrograde pyelography demonstrated bilateral ureteral strictures located at the lower segment of ureters. Computed tomography revealed inflammation of the left ovary and severe colon adhesion. She received the operation, i.e. left ovariectomy and colon adhesiotomy, because of a possibility of gynecological disease including endometriosis and malignant tumors. Clinical and pathological findings showed non-specific inflammation in the pelvis and ovary. A pelvic inflammatory disease due to a genital Chlamydia trachomatis was highly suspected and she was treated with targeted antibiotics. There have been no signs of hydronephroses or renal failure during six years’ follow-up after the treatment. We discus this rare case of bilateral hydronephroses due to genital Chlamydia trachomatis.

Obstet Gynecol. 2008 Jun;111(6):1445; author reply 1446.

Comment on:

Obstet Gynecol. 2008 Feb;111(2 Pt 2):558-61.

Catamenial appendicitis.

Basaran A.

Obstet Gynecol. 2008 Jun;111(6):1285-92.

Erratum in:

Obstet Gynecol. 2008 Sep;112(3):710.

Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery.

Shakiba K, Bena JF, McGill KM, Minger J, Falcone T.

Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio 44159, USA.

OBJECTIVE: To investigate the need for further surgery after laparoscopic excision of endometriosis or hysterectomy. METHODS: In this retrospective study, women who had surgery for endometriosis-associated pain at the Cleveland Clinic were assessed for requirement for subsequent surgery. One hundred twenty patients who underwent hysterectomy with or without oophorectomy for endometriosis and 120 patients who had laparoscopic excision of their endometriotic lesions only (local excision group) formed the study population. Estimates of reoperation-free survival at 2, 5, and 7 years were calculated using Kaplan-Meier methods, and estimates of risk (hazard ratios) were computed using Cox proportional hazards models. A significance level of .05 was assumed for all tests. RESULTS: In women who underwent local excision with ovarian preservation, the surgery-free percentages were 79.4%, 53.3%, and 44.6%, respectively, at 2, 5, and 7 years. In women who underwent hysterectomy with ovarian preservation, the 2-, 5-, and 7-year reoperation-free percentages were 95.7%, 86.6%, and 77.0%, respectively. In women who underwent hysterectomy without ovarian preservation, the percentages were 96.0%, 91.7%, and 91.7%, respectively. However, in women between 30 and 39 years of age, removal of the ovaries did not significantly improve the surgery-free time. CONCLUSION: Local excision of endometriosis is associated with good short-term outcomes but, on long-term follow-up, has a high reoperation rate. Hysterectomy is associated with a low reoperation rate. Preservation of the ovaries at the time of hysterectomy remains a viable option. LEVEL OF EVIDENCE: II.

Clin J Oncol Nurs. 2008 Jun;12(3):411-4.

Evaluation of an adnexal mass.

Webb N.

Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. nfwebb@mdanderson.org

Fertil Steril. 2008 Jul;90(1):238; author reply 238-9. Epub 2008 Jun 2.

Comment on:

Fertil Steril. 2008 Jan;89(1):246-50.

Risks versus benefits of valproic acid?

Chandrareddy A, Muneyyirci-Delale O.

Am J Surg. 2008 Aug;196(2):207-12. Epub 2008 May 29.

Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases.

Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M.

Department of Surgery, William Beaumont Army Medical Center, 5005 N. Piedras St., El Paso, TX 79920-5001, USA. John.horton2@amedd.army.mil

BACKGROUND: Abdominal wall endometriosis (AWE) is defined as endometrial tissue superficial to the peritoneum. AWE often is misdiagnosed and referred to surgeons for treatment. We performed a systematic review of published cohorts to quantify demographics, symptoms, and outcomes of patients having AWE. METHODS: An English language PubMed search from January 1951 to August of 2006 was conducted using several search terms for endometrioma. CONCLUSIONS: Twenty-nine articles describing 455 patients were identified and met inclusion criteria. The pooled mean age was 31.4 years. Ninety-six percent presented with a mass, 87% presented with pain, and 57% presented with cyclic symptoms. AWE was associated with a caesarian scar or hysterectomy in 57% and 11% of cases, respectively. The interval from index surgery to presentation was 3.6 years. Recurrence after resection was 4.3%. The most common presentation of AWE is the development of a painful mass after uterine surgery. Surgical treatment appears to result in a cure more than 95% of the time.

Electrophoresis. 2008 Jun;29(12):2706-13.

Multiplexed quantitation of endogenous estrogens and estrogen metabolites in human peritoneal fluid.

Xu X, Othman Eel-D, Issaq HJ, Hornung D, Al-Hendy A, Veenstra TD.

Laboratory of Proteomics and Analytical Technologies, Advanced Technology Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, MD, USA.

Endogenous estrogens and estrogen metabolites (EM) in human peritoneal fluid may play an important role in health and disease, yet little is known regarding their types and levels present in human peritoneal fluid, primarily due to the lack of an analytical method that is capable of directly quantifying their absolute abundances. In this report, we describe the application of a capillary LC-MS/MS method for identifying and quantifying biologically active and total endogenous EM in human peritoneal fluid. The method requires only 50 muL of peritoneal fluid, yet can quantify 13 distinct EM. Calibration curves for each EM were linear over a 10(3)-fold concentration range and the lower LOQ was 50 fg on-column. For a charcoal stripped human peritoneal fluid sample containing 10 pg/mL of each EM, accuracy ranged from 83 to 118%, and intrabatch precision ranged from 0.2 to 4.4% RSD and interbatch precision ranged from 5.5 to 15.5% RSD. The analyses of human female peritoneal fluid shows that at least 10 biologically active and 11 total endogenous EM can be positively identified and quantitatively measured. Many of the biologically active forms are present in high abundance and possess distinct biological activities which warrant further study. Although micellar EKC gave baseline separation of a standard mixture of 10 EM, the LOQs using UV detection were not suitable for the assay of the low level estrogens in biological samples.

Tech Coloproctol. 2008 Mar;12(1):57-9. Epub 2008 May 30.

Rectal obstruction due to endometriosis.

Mourthé de Alvim Andrade M, Batista Pimenta M, de Freitas Belezia B, Duarte T.

Department of General Surgery, Odilon Behrens Hospital Belo, Horizonte, MG, Brazil. monicamourtheaa@yahoo.com.br

Although endometriosis is a disorder commonly found in reproductive-age women, it does not involve the bowel very often. The circumferential involvement of the rectum is rare and the obstructive symptoms can be difficult to differentiate from those of inflammatory or malignant diseases. We report two patients with rectal endometriosis whose first prominent symptoms were those of intestinal obstruction. A 26-year-old woman was admitted with obstructive symptoms. In order to alleviate the obstruction and extend the preoperative evaluation, a decompressive colostomy was done. The diagnosis of endometriosis was made by laparoscopy and biopsies of the thickened cul-de-sac peritoneum. Another woman, 40 years of age, was referred to us with a colostomy. She had undergone a laparotomy due to an obstructive acute abdomen a year before, and a frozen pelvis was found. Biopsy specimens had been collected and the pathological report revealed endometrioma. A rectosigmoidectomy, encompassing the stenotic rectal segment, was done along with primary anastomosis. The pathological examination confirmed rectal endometriosis. The conclusion is that, although rare, rectal endometriosis can cause significant stenosis of the organ, leading to obstructive symptoms. Despite its low frequency, it should always be considered in the differential diagnosis of rectal stenosis involving women of childbearing age.

Bioorg Med Chem. 2008 Jul 1;16(13):6617-40. Epub 2008 May 11.

2-phenyl-4-piperazinylbenzimidazoles: orally active inhibitors of the gonadotropin releasing hormone (GnRH) receptor.

Pelletier JC, Chengalvala M, Cottom J, Feingold I, Garrick L, Green D, Hauze D, Huselton C, Jetter J, Kao W, Kopf GS, Lundquist JT 4th, Mann C, Mehlmann J, Rogers J, Shanno L, Wrobel J.

Department of Chemical & Screening Sciences, Wyeth Research, 500 Arcola Road, Collegeville, PA 19426, USA. Pelletj@wyeth.com

Antagonism of the gonadotropin releasing hormone (GnRH) receptor has shown positive clinical results in numerous reproductive tissue disorders such as endometriosis, prostate cancer and others. Traditional therapy has been limited to peptide agonists and antagonists. Recently, small molecule GnRH antagonists have emerged as potentially new treatments. This article describes the discovery of 2-phenyl-4-piperazinylbenzimidazoles as small molecule GnRH antagonists with nanomolar potency in in vitro binding and functional assays, excellent bioavailability (rat %F>70) and demonstrated oral activity in a rat model having shown significant serum leuteinizing hormone (LH) suppression.

Ginekol Pol. 2008 Feb;79(2):133-6.

[Endometriosis in pediatric and adolescent gynecology]

[Article in Polish]

Drosdzol A, Skrzypulec V.

Katedra Zdrowia Kobiety, Slaski Uniwersytet Medyczny, Katowice. cor111@poczta.onet.pl

Endometriosis is the most common cause of chronic pelvic pain in adolescent girls (50-70%), unresponsive to treatment of oral contraceptives and non-steroidal anti-inflammatory drugs. The most common symptoms of the disease are: acquired or progressive dysmenorrhea, acyclic and cyclic pain, dyspareunia (in sexually active girls), urological symptoms and gastrointestinal complaints. When evaluating an adolescent with suspected endometriosis, a gynecological examination (rectal or vaginal examination) and imaging studies (ultrasonography, magnetic resonance) should be performed. Moreover, in diagnostic process laparoscopy should be carried out in all girls and teenagers with chronic pelvic pain unresponsive to medical treatment. Initial therapy of endometriosis in adolescent girls involves: surgical methods (laparoscopy/laparotomy), hormonal pharmacotherapy (combined contraceptives, progestin-only protocols), GnRH agonists (adolescents over 16 years of age), non-steroidal anti-inflammatory drugs, alternative pain therapies and psychotherapy. Early diagnosis and treatment during adolescence may decrease disease progression and prevent subsequent infertility.

Ginekol Pol. 2008 Jan;79(1):31-5.

[Expression of tumor necrosis factor-alpha (TNF-alpha) on peritoneal fluid mononuclear cells in women with endometriosis]

[Article in Polish]

Gogacz M, Bogusiewicz M, Putowski L, Adamiak A, Wertel I, Jakowicki JA, Rechberger T.

II Katedra i Klinika Ginekologii Akademii Medycznej im. Prof. Feliksa Skubiszewskiego w Lublinie, Lublin. gogacz@yahoo.com

OBJECTIVES: Tumor necrosis factor-alpha (TNF-alpha) plays a key role in the processes underlying the development of pelvic endometriosis. TNF-alpha acts on target cells via two receptors: TNFR1(p55) and TNFR2(p75). Depending on cell type and its activation state, ligand binding to TNF-alpha may induce activation and proliferation of the cells or promote apoptosis. The aim of our study has been to evaluate the expression of TNFR1 and TNFR2 on peritoneal fluid macrophages and T lymphocytes derived from women with endometriosis. MATERIAL AND METHODS: The study group consisted of 22 patients with endometriosis (stage I and II rAFS). 14 patients with benign, non-inflammatory ovarian tumors composed the reference group. Mononuclear cells have been isolated from peritoneal fluid, obtained during laparoscopy. The expression of TNFR1 and TNFR2 proteins has been evaluated by means of flow cytometry, using monoclonal antibodies against CD120a, CD120b, CD3 and CD14. RESULTS: The percentage of peritoneal fluid macrophages revealing the expression of TNFR1 and TNFR2 proteins has been higher in patients with endometriosis, in comparison with control group (22.6+/-5.3% vs. 6.8+/-1,8%; p=0.03 and 29.3+/-2.3% vs. 8.8+/-1.8%; p=0.01, respectively). The percentage of T lymphocytes with the expression of TNFR1 and TNFR2 has been similar in endometriosis and control group. CONCLUSION: Higher percentage of peritoneal fluid macrophages expressing TNFR1 and TNFR2 proteins in endometriosis suggests dependence of these cells on TNF-alpha stimulation. Changes in TNF receptors distribution on PF macrophages, but not lymphocyte, may play its role in the pathogenesis of endometriosis.

Mol Hum Reprod. 2008 Jul;14(7):377-85. Epub 2008 May 28.

Potential involvement of iron in the pathogenesis of peritoneal endometriosis.

Defrère S, Lousse JC, González-Ramos R, Colette S, Donnez J, Van Langendonckt A.

Department of Gynecology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.

The aim of this study is to review the current literature associating endometriosis with iron and to discuss the potential causes and consequences of iron overload in the pelvic cavity. Indeed, iron is essential for all living organisms. However, excess iron can result in toxicity and is associated with pathological disorders. In endometriosis patients, iron overload has been demonstrated in the different components of the peritoneal cavity (peritoneal fluid, endometriotic lesions, peritoneum and macrophages). Animal models allow us to gather essential information on the origin, metabolism and effect of iron overload in endometriosis, which may originate from erythrocytes carried into the pelvic cavity mainly by retrograde menstruation. Peritoneal macrophages play an important role in the degradation of these erythrocytes and in subsequent peritoneal iron metabolism. Iron overload could affect a wide range of mechanisms involved in endometriosis development, such as oxidative stress or lesion proliferation. In conclusion, excess iron accumulation can result in toxicity and may be one of the factors contributing to the development of endometriosis. Treatment with an iron chelator could thus be beneficial in endometriosis patients to prevent iron overload in the pelvic cavity, thereby diminishing its deleterious effect.

Nat Clin Pract Endocrinol Metab. 2008 Jul;4(7):394-405. Epub 2008 May 27.

The role of thyroid autoimmunity in fertility and pregnancy.

Poppe K, Velkeniers B, Glinoer D; Medscape.

Thyroid Clinic, University Hospital, UZ Brussel, Brussels, Belgium. kris.poppe@uzbrussel.be

The thyroid gland and gonadal axes interact continuously before and during pregnancy. Hypothyroidism influences ovarian function by decreasing levels of sex-hormone-binding globulin and increasing the secretion of prolactin. In women of reproductive age, hypothyroidism can be reversed by thyroxine therapy to improve fertility and avoid the need for use of assisted reproduction technologies. For infertile women, preparation for medically assisted pregnancy comprises controlled ovarian hyperstimulation that substantially increase circulating estrogen concentrations, which in turn can severely impair thyroid function. In women without thyroid autoimmunity these changes are transient, but in those with thyroid autoimmunity estrogen stimulation might lead to abnormal thyroid function throughout the remaining pregnancy period. Prevalence of thyroid autoimmunity is significantly higher among infertile women than among fertile women, especially among those whose infertility is caused by endometriosis or ovarian dysfunction. Presence of thyroid autoimmunity does not interfere with normal embryo implantation, but the risk of early miscarriage is substantially raised. Subclinical and overt forms of hypothyroidism are associated with increased risk of pregnancy-related morbidity, for which thyroxine therapy can be beneficial. Systematic screening for thyroid disorders in pregnant women remains controversial but might be advantageous in women at high risk, particularly infertile women.

J Obstet Gynaecol Can. 2008 May;30(5):387-8.

Uterus didelphys with unilateral renal agenesis.

[Article in English, French]

Cheung VY.

Department of Obstetrics and Gynaecology, North York General Hospital, University of Toronto, Toronto, ON, Canada.

Ultrasound Obstet Gynecol. 2008 Jun;31(6):718-24.

Three-dimensional ultrasonographic characteristics of endometriomata.

Raine-Fenning N, Jayaprakasan K, Deb S.

Academic Division of Reproductive Medicine and Surgery, School of Human Development, Queen’s Medical Centre, University of Nottingham, Nottingham, UK. nick.fenning@nottingham.ac.uk

Semin Reprod Med. 2008 May;26(3):252-65.

Pelvic pain, adnexal masses, and ultrasound.

Shwayder JM.

University of Louisville School of Medicine, Louisville, Kentucky 40202, USA. james.shwayder@louisville.edu

Pelvic pain, acute or chronic, accounts for more than 10% of referrals to gynecologists. Pain accounts for more than 40% of gynecologic diagnostic laparoscopies. Predicting operative findings is critical in planning surgical interventions, as well as preoperative and postoperative medical therapy. Ultrasound is useful in preoperative evaluation and in predicting surgical findings. This section reviews the use of various ultrasound modalities in evaluating adnexal masses and associated pelvic pain. Morphologic assessment with two-dimensional (2-D) ultrasound is the foundation for adnexal evaluation. The ultrasound morphology of common ovarian and adnexal masses is reviewed. The application and reliability of Doppler assessment is also reviewed. New advances, such as three-dimensional (3-D) sonography, 3-D vascular assessment, and contrast imaging, augment diagnostic accuracy. These advances may find future application in the clinical evaluation of patients. This section reviews the application of 2-D morphology, Doppler analysis, 3-D morphology, rendering and vascular assessment, and the use of contrast agents in the ultrasound evaluation of patients with adnexal masses and pelvic pain.

Semin Reprod Med. 2008 May;26(3):217-22.

Ultrasound assessment of the ovary in the infertile woman.

Van Voorhis BJ.

Department of Obstetrics & Gynecology, University of Iowa Hospitals, Iowa City, Iowa 52242, USA. brad-van-voorhis@uiowa.edu

Few would argue that the introduction of transvaginal ultrasound (TVUS) revolutionized the practice of assisted reproduction. For example, full-bladder follicular scanning and laparoscopic oocyte retrievals were converted to TVUS-guided procedures. The application of higher-frequency scanning probes provided greater resolution and improved the clinician’s ability to evaluate the ovary for pathologic conditions, for determination of ovarian reserve, and for therapeutic decisions during ovarian stimulation cycles. All these uses of TVUS of the ovary will be discussed in this article.

Nan Fang Yi Ke Da Xue Xue Bao. 2008 May;28(5):816-9.

[Expression of vascular endothelial growth factor in nude mouse models of human endometriosis]

[Article in Chinese]

Yang F, Ma Y, He YL.

Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

OBJECTIVE: To investigate the expression of vascular endothelial growth factor (VEGF) in eutopic and ectopic endometrium of in nude mice models of endometriosis and understand the role of VEGF in the development of endometriosis. METHODS: Nude mouse models of endometriosis were established by subcutaneous implantation and abdominal injection of human endometrium xenograft from patients with endometriosis. The morphology of the foci was observed microscopically, and VEGF expression was measured with immunohistochemistry. RESULTS: Models of endometriosis were successfully established in 8 of the 10 mice receiving subcutaneous xenograft implantation and in 7 of the 10 mice with abdominal graft injection. Increased VEGF expression was observed in the ectopic endometrium in these models. CONCLUSION: VEGF expression is increased in the ectopic endometrium of the nude mouse models, and this animal model may facilitate future studies of angiogenesis and antiangiogenesis therapy.

Pain Pract. 2008 Jul-Aug;8(4):320-3. Epub 2008 May 23.

Ultrasound-guided steroid injection for obturator neuralgia.

Shankar H.

Clement Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee, Wisconsin 53295, USA.

Obturator neuralgia (ON) presents with pain in the groin, medial thigh, and sometimes the medial aspect of the knee. The causes include trauma, obturator hernia, pelvic cancer, pelvic surgery, hip surgery, following pelvic fractures, endometriosis, retroperitoneal hematoma, pregnancy, and delivery. Ultrasound (US) guidance facilitates real-time imaging, identification of vascular structures, and improves patient comfort in situations where nerve stimulation can be unpleasant. This is a case report of ON successfully treated with US-guided steroid injection. A 55-year-old man was referred to the pain clinic with groin pain and allodynia in the medial thigh and knee following a fall. He had tried multiple other therapies and none of them provided significant relief. Using a 10-5-MHz multi-frequency, 38-mm linear array transducer, the obturator nerve was scanned in both longitudinal and transverse directions. Under real-time imaging 10 mg of medroxy-progesterone in a volume of 1 mL was injected. Following the injection, a small area of the medial side of knee was still tender to light touch. A second injection was placed inferiorly and provided pain relief for more than 5 months. This successful demonstration of US guidance in ON may further encourage US guidance in pain clinic interventions.

Curr Probl Diagn Radiol. 2008 Jul-Aug;37(4):139-44.

Magnetic resonance imaging of cystic adnexal lesions during pregnancy.

Oto A, Ernst R, Jesse MK, Saade G.

Department of Radiology, University of Texas Medical Branch at Galveston, Galveston, TX, USA. aoto@radiology.bsd.uchicago.edu.

Management of cystic adnexal lesions diagnosed during pregnancy is a challenging issue for obstetricians. The range of treatment options changes from immediate surgery to close follow-up. This pictorial essay illustrates the magnetic resonance imaging findings of various cystic adnexal lesions in pregnant patients. Magnetic resonance imaging may help in better characterization of some of the cystic adnexal lesions diagnosed during pregnancy without exposing the fetus to ionizing radiation.

Life Sci. 2008 Jun 20;82(25-26):1224-30. Epub 2008 Apr 23.

Interleukin-1beta-mediated inhibition of the processes of angiogenesis in cardiac microvascular endothelial cells.

Mountain DJ, Singh M, Singh K.

Department of Physiology, James H. Quillen College of Medicine, James H. Quillen Veterans Affairs Medical Center, East Tennessee State University, Johnson City, TN 37614, United States.

Angiogenesis, the formation of new capillaries from preexisting vessels, plays an essential role in revascularization of the myocardium following myocardial infarction (MI). Interleukin-1beta (IL-1beta), a proinflammatory cytokine increased in the heart following MI, is shown to be essential for angiogenesis in the invasiveness of tumor cells, the progression of arthritic conditions and endometriosis, and the promotion of wound healing. Here we studied the steps of angiogenesis in response to IL-1beta in cardiac microvascular endothelial cells (CMECs) and aortic tissue. Cell cycle progression analysis using flow cytometry indicated a G0/G1 phase cell cycle arrest in IL-1beta-stimulated cells. IL-1beta significantly reduced levels of fibrillar actin in the cytoskeleton, a pre-requisite for tube formation, as indicated by phalloidin-FITC staining. Wound healing assays demonstrated IL-1beta prevents cell-to-cell contact formation. On the other hand, vascular endothelial growth factor-D (VEGF-D) initiated restoration of the cell monolayer. IL-1beta significantly inhibited in vitro tube formation as analyzed by three-dimensional collagen matrix assay. Aortic ring assay demonstrated that IL-1beta inhibits basal and VEGF-D-stimulated microvessel sprouting from aortic rings. The data presented here are novel and of significant interest, providing evidence that IL-1beta impedes the process of angiogenesis in myocardial endothelial cells.

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