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1: Fertil Steril. 2004 May;81(5):1441-1446. Endometriosis and infertility.
The Practice Committee of the American Society for Reproductive Medicine.
Birmingham, Alabama, USA.
Women with endometriosis typically present with pelvic pain, infertility or an adnexal mass. Surgery for persistent adnexal masses may be indicated to remove an endometrioma or other pelvic pathology. Surgical or medical therapy is efficacious for pelvic pain due to endometriosis, but treatment of endometriosis in the female partner of an infertile couple raises a number of complex clinical questions that do not have simple answers.
PMID: 15136136 [PubMed]
2: Fertil Steril. 2004 May;81(5):1411-3.
Association of peroxisome proliferator-activated receptor gamma 2 Pro-12-Ala polymorphism with endometriosis.
Dogan S, Machicao F, Wallwiener D, Haering HU, Diedrich K, Hornung D.
Department of Gynecology and Obstetrics, Tuebingen, Germany.
We explored the association of the PPAR-gamma2 (peroxisome proliferator-activated receptor) Pro-12-Ala polymorphism with endometriosis in a case-control study with 51 women with endometriosis stages I-IV and 55 control women without endometriosis. The 12-Pro allele of PPAR-gamma2 may have protective effects avoiding the development and progression of endometriosis.
Publication Types: · Letter
PMID: 15136115 [PubMed]
3: Fertil Steril. 2004 May;81(5):1395-8.
Successful treatment of severe endometriosis in two premenopausal women with an aromatase inhibitor.
Shippen ER, West WJ Jr.
Shillington Diagnostic Center, Shillington, Pennsylvania, USAand the Reading Hospital and Medical Center, West Reading, Pennsylvania, USA.
OBJECTIVE: To treat severe endometriosis in premenopausal women with an aromatase inhibitor and to document the efficacy and side effects of this new treatment. DESIGN: Case report. SETTING: Clinical practice setting. PATIENT(S): Patients were premenopausal endometriosis cases confirmed by prior laparoscopy. INTERVENTION(S): Oral administration of the aromatase inhibitor anastrozole with the addition of 200-mg oral progesterone (P) capsules once daily, hs, and calcitriol 0.5 microg oral capsules twice daily. All three medications were given daily for 21 days followed by 7 days off, for a 28-day treatment cycle. Additionally, rofecoxib 12.5 mg was administered once a day continuously for the 28-day cycle. The dose could be increased to 25-50 mg daily as needed for increased pain. Six repeat 28-day cycles were planned for the treatment course depending on patient tolerance and response. MAIN OUTCOME MEASURE(S): Reduction of symptoms, elimination of endometrial implants, and improvement in fertility potential in the future. Monitoring for ovarian hyperstimulation as a side effect of aromatase inhibitor therapy. Documentation of potential symptoms or side effects when an aromatase inhibitor is used in menstruating women. RESULT(S): Treatment resulted in a rapid, progressive reduction in symptoms over 3 months with the maintenance of remission of symptoms for over 24 months after treatment in both cases. There was confirmation of absence of disease in one case by follow-up laparoscopy 15 months after treatment. Pregnancy was achieved in both cases after 24 months. CONCLUSION(S): This is the first case report of successful treatment of severe endometriosis in premenopausal women with the aromatase inhibitor anastrozole combined with P, rofecoxib, and calcitriol. Treatment resulted in a rapid elimination of symptoms and was well tolerated in both cases.
PMID: 15136110 [PubMed]
4: Fertil Steril. 2004 May;81(5):1235-9.
Matrix metalloproteinase 2 is associated with changes in steroid hormones in the sera and peritoneal fluid of patients with endometriosis.
Huang HF, Hong LH, Tan Y, Sheng JZ.
Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine,Zhejiang, China.
OBJECTIVE: To determine matrix metalloproteinase 2 (MMP-2) levels in sera and peritoneal fluids of women with or without endometriosis-associated infertility and to determine whether MMP-2 had correlation with 17beta-E(2) and P in the sera and peritoneal fluids of the patients with endometriosis. DESIGN: A case-control study. SETTING: A women’s hospital in China. PATIENT(S): Forty patients with endometriosis-associated infertility undergoing laparoscopy and 18 women undergoing tubal ligation. INTERVENTION(S): Sera and peritoneal fluids were collected from women with or without endometriosis. MAIN OUTCOME MEASURE(S): Matrix metalloproteinase 2, 17beta-E(2), and P concentration. RESULT(S): Compared with the control women, the patients with endometriosis had higher MMP-2 levels in their sera and peritoneal fluids. Serum and peritoneal fluid MMP-2 levels were higher in the proliferative phase than in the secretory phase. The level of MMP-2 in the patients was correlated positively with 17beta-E(2) in serum and peritoneal fluid and negatively with P. CONCLUSION(S): The results demonstrated a correlation between MMP-2 concentrations and steroid hormones in sera and peritoneal fluids of the patients with endometriosis-associated infertility. Estradiol might up-regulate MMP-2, resulting in the formation of endometriosis. Progesterone might down-regulate MMP-2 to inhibit the formation and development of endometriosis.
PMID: 15136083 [PubMed]
5: Fertil Steril. 2004 May;81(5):1229-34.
Decreased levels of interleukin-18 in peritoneal fluid but not in serum of patients with endometriosis.
Zhang X, Lin J, Qian Y, Deng L.
Affiliated Women’s Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China.
OBJECTIVE: To determine the concentrations of interleukin-18 (IL-18) in peritoneal fluid and serum in patients with endometriosis in comparison with the control group. DESIGN: A prospective analytical study. SETTING: The obstetrics and gynecology department of an academic training hospital. PATIENT(S): Forty-four patients who underwent laparoscopic surgery for benign gynecologic diseases. INTERVENTION(S): Specimens of peripheral blood and peritoneal fluid were obtained before and during laparoscopic procedures, and the levels of IL-18 were analyzed. MAIN OUTCOME MEASURE(S): The concentrations of IL-18 in peritoneal fluid and serum were correlated with the presence of endometriosis, disease stage, and the phase of the menstrual cycle. RESULT(S): Interleukin-18 was detectable in 98% of the peritoneal specimens and 84% of the serum specimens of the patients tested. Peritoneal fluid IL-18 concentrations were statistically significantly lower in patients with endometriosis than in patients without endometriosis; the difference in serum IL-18 levels showed no statistically significant difference between the patients with and without endometriosis. The concentrations of IL-18 in peritoneal fluid and serum were not correlated with the stage of endometriosis or the phase of the menstrual cycle. CONCLUSION(S): Our results suggest that the decreased levels of IL-18 in peritoneal fluid in patients with endometriosis as compared with the control group may play an important role in the pathogenesis of this disease.
PMID: 15136082 [PubMed]
6: Fertil Steril. 2004 May;81(5):1204-5.
Management of endometriosis in fertility patients.
Gibbons WE.
Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA.
The management of endometriosis in fertility patients remains empiric. Adverse effects on every reproductive component have been reported. How to counsel couples regarding treatment and the effects of endometriosis on fertility is still uncertain.
PMID: 15136077 [PubMed]
7: Fertil Steril. 2004 May;81(5):1201-3.
Understanding endometriosis is the key to successful therapeutic management.
Sharpe-Timms KL, Young SL.
Department of Obstetrics and Gynecology, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA.
Understanding endometriosis on a molecular, biochemical, and genetic level will lead to better methods for the diagnosis and therapeutic management of this enigmatic disease.
PMID: 15136076 [PubMed]
8: Fertil Steril. 2004 May;81(5):1198-200.
Endometriosis and the outcome of in vitro fertilization.
Brosens I.
Leuven Institute for Fertility and Embryology, Leuven, Belgium.
A generalized reproductive dysfunction rather than endometriotic implants is likely to have an impact on the outcome of IVF.
PMID: 15136075 [PubMed]
9: J Reprod Med. 2004 Apr;49(4):321-3.
Endometriosis presenting as a urethral diverticulum: a case report.
Chowdhry AA, Miller FH, Hammer RA.
Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
BACKGROUND: Pelvic pain is a common complaint among women of childbearing age. It has an extensive differential diagnosis that at times can make it difficult to determine its etiology. One must therefore rely on the characteristics of the physical examination, symptoms and imaging studies. However, in doing so, one should keep in mind that many diseases mimic one another. Physicians must be careful not to fall into the trap of simply assigning a specific disease to a given group of symptoms. CASE: A 35-year-old woman, gravida 2, para 0020, presented to a clinic complaining of left lower abdominal pain. She had a history of dyspareunia, dysmenorrhea, urinary frequency and numerous urinary tract infections. Previous laparoscopies had been negative for endometriosis. Physical examination demonstrated a 1.5-cm mass left of the midurethra. No pus was expressed through the urethra with cyst massage. Imaging showed a 1.1 x 1.1-cm lesion in the left posterolateral aspect of the urethra consistent with a urethral diverticulum. Uterine adenomyosis was also noted. Although clinical symptoms, physical examination and imaging suggested a urethral diverticulum, a vaginal endometriotic cyst was encountered at surgery. Pathologic evaluation of the surgically excised lesion revealed endometriosis, revealed endometriosis. CONCLUSION: In this case, clinical findings, location and imaging characteristics of a periurethral endometriotic lesion suggested a urethral diverticulum. Endometriosis should be considered in patients with a history of pelvic pain who present with urinary frequency and a periurethral lesion.
PMID: 15134160 [PubMed]
10: Qual Life Res. 2004 Apr;13(3):705-13.
Evaluating the responsiveness of the Endometriosis Health Profile Questionnaire: the EHP-30.
Jones G, Jenkinson C, Kennedy S.
Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom. g.l.jones@sheffield.ac.uk
OBJECTIVES: To evaluate the sensitivity to change of the Endometriosis Health Profile-30 (EHP-30) questionnaire. SETTING: The Women’s Center, John Radcliffe Hospital, Oxford. DESIGN: Postal survey to 66 women undergoing conservative surgery for the treatment of endometriosis-associated pain. The EHP-30 and the Short Form-36 (SF-36) were administered 2 weeks before the operation, and 4 months post-operatively. At T2 a transition question was included to evaluate changes in patients health status. To evaluate responsiveness effect sizes, standardised response means, the index of responsiveness and the minimally and clinically important differences were calculated. RESULTS: Forty (66.6%) patients returned the questionnaires at time 1 and 2. Overall less responsive effect size scores were found for the SF-36 (0.1-0.5) compared to the EHP-30 (-0.1-1.1) for all patients who had undergone treatment. Minimally important differences and the index of responsiveness were overall higher for the EHP-30 (0.4-2.0) compared to the SF-36 (0.1-1.0). Change scores for four of the five scales were significantly correlated with women’s responses to the transition question. CONCLUSIONS: Results suggest that the EHP-30 is sensitive to change. Its application in clinical trials should prove beneficial in assessing the impact of medical and surgical interventions upon quality of life for women with endometriosis.
PMID: 15130032 [PubMed]
11: Qual Life Res. 2004 Apr;13(3):695-704.
Development of the Short Form Endometriosis Health Profile Questionnaire: the EHP-5.
Jones G, Jenkinson C, Kennedy S.
Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom. g.l.jones@sheffield.ac.uk
OBJECTIVE: To develop and validate a short form version of the Endometriosis Health Profile-30 questionnaire which consists of a 30-item core questionnaire and a 23 item modular questionnaire. METHODS: Three studies were carried out to develop the Endometriosis Health Profile-5. Study 1: a short form version of the Endometriosis Health Profile-30 core questionnaire was developed. Study 2: the results were verified in a new data set. Study 3: a short form version of the 23 item modular questionnaire was produced. The modular questionnaire contains six dimensions which may not be applicable to every woman with endometriosis and is used to supplement the five scales on the core questionnaire when required. RESULTS: The final instrument contained 11 items: five items from the core questionnaire and six items from the modular questionnaire. The 95% confidence intervals for Study 1 indicated that the scale scores overlapped with each item score and were confirmed in the second analysis (study 2). Each item was most highly correlated to its parent scale and less with the remaining four core questionnaire scales which was verified in study 2. In both studies all correlations were significant at the 0.01 level (two tailed test). CONCLUSION: The Endometriosis Health Profile-5 is a reliable and valid short form questionnaire which can also be supplemented with a short form version of the modular questionnaire when required. It will be especially useful in clinical settings where a short and economical endometriosis health status measure is required.
PMID: 15130031 [PubMed]
12: J Clin Endocrinol Metab. 2004 May;89(5):2390-6.
EMX2 Gene Expression in the Female Reproductive Tract and Aberrant Expression in the Endometrium of Patients with Endometriosis.
Daftary GS, Taylor HS.
Division of Reproductive Endocrinology, School of Medicine, Yale University, New Haven, Connecticut 06520.
EMX2 is a transcription factor necessary for reproductive tract development. Sex steroids regulate endometrial HOXA10 expression, which in turn negatively regulates EMX2. In this study, we characterize menstrual cycle-dependent expression of EMX2 in endometrium from women with and without endometriosis. In the absence of endometriosis, EMX2 mRNA levels declined 50% in periimplantation endometrium compared with levels in the proliferative phase. To determine whether the decrease in endometrial EMX2 expression was regulated by endogenous endometrial HOXA10, primary endometrial stromal cells were transfected with an EMX2-reporter construct containing a HOXA10 binding site. Acting via this site, we observed HOXA10-mediated repression of reporter expression. In the endometrium of patients with endometriosis, unlike normal endometrium, EMX2 levels were not decreased in the periimplantation period. We have previously shown that up-regulation of HOXA10 in periimplantation endometrium fails to occur in women with endometriosis. To determine whether elevated endometrial EMX2 levels were due to failure of HOXA10-mediated transcriptional repression, secondary to low HOXA10 levels in endometriosis, we transfected stromal cells with HOXA10 antisense and an EMX2-reporter construct. Reporter expression was increased, indicating reversal of HOXA10-mediated transcriptional repression. Endometrial EMX2 expression is aberrant in women with endometriosis and is mediated by altered HOXA10 expression.
PMID: 15126568 [PubMed]
13: MMWR Surveill Summ. 2004 Apr 30;53(1):1-20.
Assisted reproductive technology surveillance–United States, 2001.
Wright VC, Schieve LA, Reynolds MA, Jeng G, Kissin D.
Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion, CDC, USA.
PROBLEM/CONDITION: In 1996, CDC initiated data collection regarding assisted reproductive technology (ART) procedures performed in the United States to determine medical center-specific pregnancy success rates, as mandated by the Fertility Clinic Success Rate and Certification Act (FCSRCA) (Public Law 102-493, October 24, 1992). ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization and related procedures). Patients who undergo ART treatments are more likely to deliver multiple-birth infants than women who conceive naturally. Multiple births are associated with increased risk for mothers and infants (e.g., pregnancy complications, premature delivery, low-birthweight infants, and long-term disability among infants). REPORTING PERIOD: 2001. DESCRIPTION OF SYSTEM: CDC contracts with a professional society, the Society for Assisted Reproductive Technology (SART), to obtain data from fertility medical centers located in the United States. Since 1997, CDC has compiled data related to ART procedures. The Assisted Reproductive Technology Surveillance System was initiated by CDC in collaboration with the American Society for Reproductive Medicine, the Society for Assisted Reproductive Technology, and RESOLVE: The National Infertility Association. RESULTS: In 2001, a total of 29,344 live-birth deliveries and 40,687 infants resulting from 107,587 ART procedures were reported from 384 medical centers in the United States and U.S. territories. Nationally, 80,864 (75%) of ART treatments used freshly fertilized embryos from the patient’s eggs; 14,705 (14%) used thawed embryos from the patient’s eggs; 8,592 (8%) used freshly fertilized embryos from donor eggs; and 3,426 (3%) used thawed embryos from donor eggs. Overall, 40% of ART procedures that progressed to the transfer stage resulted in a pregnancy; 33% resulted in a live-birth delivery (delivery of > or =1 infant); and 21% resulted in a singleton live birth. The highest live-birth rates were observed among ART procedures using freshly fertilized embryos from donor eggs (47%). The greatest numbers of ART procedures were performed among residents of California (13,124), New York (12,379), Massachusetts (8,151), Illinois (7,933), and New Jersey (6,011). These five states also reported the highest number of live-birth deliveries and infants born as a result of ART. The ratio of number of ART procedures per million population ranged from 74 in Idaho to 1,273 in Massachusetts, with a national average of 371 ART procedures started per million persons. Among ART treatments in which freshly fertilized embryos from the patient’s eggs were used, substantial variation in live birth rates by patient (e.g., women aged < or =40 years) and treatment characteristics (e.g., ovulatory dysfunction, endometriosis, or unexplained infertility) was observed. The risk for a multiple-birth delivery was highest for women who underwent ART transfer procedures using freshly fertilized embryos from either donor eggs (42%) or from their own eggs (36%). Among ART transfer procedures in which the patient’s own eggs were used, an inverse relation existed between multiple-birth risk and patient age. Number of embryos transferred and embryo availability (an indicator of embryo quality) were also strong predictors of multiple-birth risk. Of the 40,687 infants born, 46% were twins, and 8% were triplet and higher order multiples. The total multiple-infant birth rate was 53%. Approximately 1% of U.S. infants born in 2001 were conceived through ART. Those infants accounted for 16% of multiple births nationally. INTERPRETATION: Whether an ART procedure resulted in a pregnancy and live-birth delivery varied according to different patient and treatment factors. ART poses a major risk for multiple births. This risk varied according to the patient’s age, the type of ART procedure performed, the number of embryos transferred, and embryo availability (an indicator of embryo quality). PUBLIC HEALTH ACTION: ART-related multiple births represent a sizable proportion of all multiple births nationally and in selected states. Efforts should be made to limit the number of embryos transferred for patients undergoing ART.
PMID: 15123982 [PubMed]
14: Gynecol Obstet Fertil. 2004 Mar;32(3):199-209.
[Surgical management of rectovaginal septum endometriosis from a continuous series of 50 cases] [Article in French] Camagna O, Dhainaut C, Dupuis O, Soncini E, Martin B, Palazzo L, Chosidow D, Madelenat P.
Service de gynecologie-obstetrique, hopital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France. olivier.camagna@bch.ap-hop-paris.fr
OBJECTIVES: To assess the value of MRI and ano-rectal endosonography (ARES) for the diagnosis and surgical prognosis of rectovaginal septum endometriosis and to analyse the surgical management in order to evaluate its functional results and complications. PATIENTS AND METHODS: Retrospective study of 50 consecutive patients operated for a clinical presumption of endometriosis nodule of the recto vaginal septum. Thirty-nine patients had a MRI, 31 an ARES and 28 both exams. All the patients had a complete dissection of the rectovaginal septum and all lesions were excised. RESULTS: For the diagnosis of rectovaginal septum endometriosis nodule, MRI results are: sensitivity 73%, specificity 50%, positive predictive value (PPV) 89%, negative predictive value (NPV) 25%; for uterosacral ligaments involvement: sensitivity 84%, specificity 95%, PPV 94%, NPV 86% and for rectal wall infiltration: sensitivity 53%, specificity 82%, PPV 69%, NPV 69%. The ARES results for diagnosis of rectovaginal septum endometriosis nodule are: sensitivity 93%, specificity 100%, PPV 100%, NPV 50% and for rectal wall infiltration: sensitivity 100%, specificity 71%, PPV 81%, NPV 100%. ARES appeared more sensitive than MRI for the detection of rectal wall infiltration (P = 0.002) and for rectovaginal septum endometriosis nodule diagnosis (P = 0.03). Eighty-nine percent of the patients had a coelioscopy in first intention and 15 laparoconversions were performed, 11 in order to perform a digestive resection: 45 nodules were found. In 43cases the nodule was excised, associated to 19 digestive resections, 30 colpectomys, and 22 uterosacral ligaments resections. Three patients required an additional surgical treatment by Hartman’s procedure with Mickulicz’s drainage for peritonitis. Forty-one nodules were endometriosis nodules: the two other cases were fibrosis nodules. Thirty-three patients were interviewed about the evolution of their pains over a mean history of 20 months: 90% of the patients were satisfied with the management results. DISCUSSION AND CONCLUSIONS: Our data support the efficiency of MRI for rectovaginal septum endometriosis nodule and uterosacral ligaments involvement diagnosis; accord ARES to rectovaginal septum endometriosis nodule diagnosis and its reliability in establishing a diagnosis of rectal wall involvement. The surgical cure of rectovaginal septum nodules without digestive infiltration is performed by coelioscopic or coelio-vaginal procedure, but in case of associated digestive affliction, laparotomy is actually the standard procedure in order to achieve a complete cure of the lesions. Complications, in particular peritonitis, are not frequent. Our data support the efficiency of radical surgical treatment for the improvement of pain symptoms. Results on fertility seem to be satisfactory, but complication risks suggest being careful in this indication. Clinical examination during a catamenial period is essential in order to evoke the diagnosis. MRI yields a complete map of the sub-peritoneal and peritoneal lesions and ARES allows for the diagnosis of an infiltration of the rectal wall. Pre-operative association of those two exams is actually indispensable for the surgical management of those patients, which consists of complete excision of endometriosical lesions and is efficient at treating pain symptoms and fertility. Complications are rare but severe, therefore, justifying a cure in specialised centres.
PMID: 15123117 [PubMed]
15: Obstet Gynecol. 2004 May;103(5):1089-91.
Spontaneous rupture of the uterine vessels in pregnancy.
Aziz U, Kulkarni A, Lazic D, Cullimore JE.
Department of Obstetrics and Gynecology, Great Western Hospital, Swindon, United Kingdom.
BACKGROUND: Hemoperitoneum resulting from spontaneous rupture of the uterine vessels in pregnancy is rare and associated with high maternal and fetal mortality. CASE: A woman presented with acute abdominal pain and hypovolemic shock at 20 weeks of gestation. Immediate laparotomy revealed massive hemoperitoneum resulting from spontaneous rupture of the left uterine vessels associated with a left adnexal mass consisting of decidualized endometriosis. The fetus was delivered by hysterotomy, hemostasis was achieved, and the woman made a good recovery. CONCLUSION: We report a case of hemoperitoneum in pregnancy that resulted from spontaneous rupture of the uterine vessels associated with decidualized endometriosis.
PMID: 15121618 [PubMed]
16: Obstet Gynecol. 2004 May;103(5):1051-4.
Surgical cytoreduction and hormone therapy of an advanced endometrial stromal sarcoma of the ovary.
Geas FL, Tewari DS, Rutgers JK, Tewari KS, Berman ML.
Division of Gynecologic Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, California.
BACKGROUND: Primary endometrial stromal sarcomas of the ovary are rare gynecologic malignancies. We report a disseminated case of this tumor arising from ovarian endometriosis. CASE: A 45-year-old woman presented with an abdominal pelvic mass and an elevated CA 125. Exploration showed extensive tumor spread from the ovaries to the upper abdomen. Surgery included a total hysterectomy, bilateral salpingo-oophorectomy, splenectomy, partial gastrectomy, partial pancreatectomy, transverse colectomy, appendectomy, and omentectomy. Final pathology showed a low-grade endometrial stromal sarcoma of the ovary arising from foci of endometriosis. Megestrol acetate was initiated, and she is currently without evidence of disease. CONCLUSION: This is an advanced case of a primary low-grade endometrial stromal sarcoma of the ovary arising from endometriosis managed by total resection and progestational therapy.
PMID: 15121605 [PubMed]
17: J Soc Gynecol Investig. 2004 May;11(4):237-40.
Androgen receptor gene cytosine, adenine, and guanine trinucleotide repeats in patients with endometriosis.
Lattuada D, Vigano P, Somigliana E, Odorizzi MP, Vignali M, Di Blasio AM.
Molecular Biology Laboratory Istituto Auxologico Italiano, Milan, Italy.
OBJECTIVE: A genetic variation in the androgen receptor (AR) has been associated with the risk of developing endometriosis. The AR gene is located on the X chromosome and contains a highly polymorphic trinucleotide repeat (cytosine, adenine, and guanine: CAG) in its first exon, whose length and methylation pattern affect both AR expression and function. Thus, we sought to further investigate the potential association between endometriosis and the AR-CAG polymorphism. METHODS: Genomic DNA was obtained from a consecutive series of 197 white Italian women of reproductive age who underwent laparoscopy for benign gynecologic pathologies. Molecular analysis of AR-CAG repeats was performed by polymerase chain reaction amplification and Genescan evaluation. The pattern of CAG repeat distribution was compared between subjects with and without endometriosis. RESULTS: Endometriosis was documented in 105 women (stage I-II in 33 women and stage III-IV in 72 women). We found no difference in the number of AR-CAG repeats between women with endometriosis and controls. The CAG repeat length ranged from eight to 27 (mean +/- standard deviation, 17.4 +/- 1.9) for endometriosis patients and from 11 to 27 (mean +/- standard deviation, 17.4 +/- 2) for controls. Moreover, no association was found between AR gene polymorphisms and the various clinical manifestations of the disease. CONCLUSION: We conclude that AR-CAG repeat length does not constitute an important factor for the genetic predisposition to endometriosis.
PMID: 15120698 [PubMed]
18: J Soc Gynecol Investig. 2004 May;11(4):232-6.
Polymorphism at codon 72 of the p53 gene is not associated with endometriosis in a Japanese population.
Omori S, Yoshida S, Kennedy SH, Negoro K, Hamana S, Barlow DH, Maruo T.
Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom.
OBJECTIVE: Endometriosis is inherited as a complex trait, which means that multiple susceptibility genes interact with each other and the environment to produce the phenotype. Previous studies have implicated p53, a tumor suppressor gene, as a factor in the development of the disease. In a Japanese population, we investigated the frequency of the p53 polymorphism in women affected with endometriosis. METHODS: We compared the distribution of the p53 codon 72 polymorphism in endometriosis cases (n = 111) and population controls consisting of female neonates (n = 180) by using polymerase chain reaction restriction fragment-length polymorphism analysis in a Japanese population. RESULTS: The frequencies of the three p53 genotypes, Arginine (Arg)/Arg, Arg/Proline (Pro), and Pro/Pro in controls were 39.4%, 41.7%, and 18.9 %, respectively. The crude genotype frequencies in the endometriosis cases were similar to those of the controls (35.2%, 48.6%, and 16.2%, respectively). Using the Arg/Arg genotype as the reference, the odds ratios of the Arg/Pro and Pro/Pro genotypes were 1.30 (95% confidence interval [CI] 0.72-1.86, P =.33) and 0.96 (95% CI 0.47-1.94, P =.91), respectively. Thus, there were no significant differences in the frequency of the p53 codon 72 polymorphism between endometriosis cases and controls in this population. The endometriosis cases with severe disease only were also evaluated, but no significant difference was observed in the frequency of the polymorphism between this subgroup and the controls. CONCLUSION: Our findings suggest that the p53 codon 72 polymorphism is unlikely to be associated with endometriosis in Japanese women.
PMID: 15120697 [PubMed]
19: J Soc Gynecol Investig. 2004 May;11(4):203-6.
High concentrations of activin a in the peritoneal fluid of women with epithelial ovarian cancer.
Cobellis L, Reis FM, Luisi S, Danero S, Pirtoli L, Scambia G, Petraglia F.
Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
OBJECTIVE: The aim of the present study was to evaluate the concentrations of activin A in the peritoneal fluid of women with epithelial (serous) ovarian cancer. METHODS: A group of 160 women was studied and divided in four subgroups as follows: 1) serous ovarian carcinoma (n = 32); 2) serous ovarian cystadenoma (n = 20); 3) endometriosis (n = 53); and 4) healthy controls (n = 55), including both fertile (n = 32) and postmenopausal women (n = 23). Specimens of peritoneal fluid were collected during surgical interventions, and activin A was quantified using a specific two-site enzyme immunoassay. RESULTS: Peritoneal fluid activin A concentrations in women with ovarian carcinoma were about five-fold higher than those found in the control group (median [interquartile range] = 7.60 [2.85-10.15] and 1.50 [1.00-2.50] ng/mL, respectively, P <.001). In contrast, the women with benign serous cystadenoma had peritoneal fluid activin A concentrations (1.50 [1.0-2.70] ng/mL) similar to those of the control group. High peritoneal fluid activin A levels (>2 multiples of the mean) distinguished carcinoma from cystadenoma with a sensitivity of 72% and a specificity of 80%. The follow-up of nine patients with stage IIIc ovarian cancer showed no apparent relationship between the peritoneal fluid activin A levels and overall survival. No significant difference in peritoneal fluid activin A concentrations between patients with endometriosis and control women was observed. CONCLUSION: Most women with serous ovarian carcinoma had high concentrations of activin A in the peritoneal fluid, supporting a possible role of this growth factor in ovarian cancer.
PMID: 15120692 [PubMed]
20: JSLS. 2004 Apr-Jun;8(2):175-7.
Laparoscopic appendectomy in a female patient with situs inversus: case report and literature review.
Song JY, Rana N, Rotman CA.
Oak Brook Institute of Endoscopy, Oak Brook Medical and Surgical Center, Oak Brook, Illinois, USA. JGSong@MSN.com
BACKGROUND: Situs inversus is an uncommon condition caused by a single autosomal recessive gene of incomplete penetration. A potential diagnostic dilemma can occur in the young female patient with a history of situs inversus who presents with pelvic pain. METHODS: A 32-year-old multiparous patient with a known history of situs inversus presented with complaints of pelvic pain. A medical history and full physical examination were indicative of possible endometriosis. RESULTS: The patient underwent an operative laparoscopy, which revealed stage II pelvic endometriosis based on the American Fertility Society Revised Classification for Endometriosis (R-AFS), with appendicular and periappendicular adhesions involving the cecum. Ablation of endometriosis and an appendectomy were performed. CONCLUSION: The authors believe the laparoscopic approach to an appendectomy is ideal in a patient with situs inversus and should be performed at the time of laparoscopy performed for another reason.
PMID: 15119665 [PubMed]
21: Am J Obstet Gynecol. 2004 Apr;190(4):1020-4.
Long-term follow-up after conservative surgery for rectovaginal endometriosis.
Fedele L, Bianchi S, Zanconato G, Bettoni G, Gotsch F.
Clinica Ostetrico-Ginecologica dell’ Universita di Milano, Ospedale San Paolo, Milan, Italy. luigi.fedele@unimi.it
OBJECTIVE: The purpose of this study was to evaluate long-term results in patients who received conservative surgical treatment for rectovaginal endometriosis. STUDY DESIGN: We analyzed the follow-up data for 83 women who underwent surgery for rectovaginal endometriosis. The inclusion criteria were age 20 to 42 years, moderate-to-severe pain symptoms, conservative treatment with retention of the uterus, and at least 1 ovary; the follow-up period was > or =12 months. Kaplan-Meier analysis and Cox regression were used to calculate recurrence rates. RESULTS: The cumulative rates of pain recurrence, clinical or sonographic recurrence, and new treatment were 28%, 34%, and 27%, respectively. The younger patients had the higher risk of recurrence. Pregnancy had protective effects against the recurrence of symptoms and a need for a new treatment. Patients who underwent bowel resection had fewer recurrences. CONCLUSION: Segmental resection and anastomosis of the bowel, when necessary, improves the outcome without affecting chances of conception. Higher recurrence rates in younger patients seems to justify a more radical treatment in this group of women.
PMID: 15118634 [PubMed]
22: J Thorac Cardiovasc Surg. 2004 May;127(5):1513-4.
Thoracic endometriosis: A case report and literature review.
Ziedalski TM, Sankaranarayanan V, Chitkara RK.
PMID: 15116017 [PubMed]
23: G Chir. 2004 Jan-Feb;25(1-2):39-42.
[Extragonadal endometriosis: three new cases] [Article in Italian] Capasso L, Sciano D, Iarrobino G, Ventriglia R, Schiavone F, Buonomo C, Rossi T, Borsi E.
Azienda Ospedaliera S. Sebasbano di Caserta di Rilievo Nazionale ed Alta Specializzazione, Unita Operativa di Chirurgia d’Urgenza.
Extragonadal endometriosis is rarely diagnosed preoperatively due the variety of its localizations. Presentation to general surgeons may be atypical and pose diagnostic difficulties. The Authors report three cases surgically treated between 2000-2003. The Authors stress the peculiarity of one of these cases with endometrial tissue involvement of the intestinal mucosa. They also discuss about various aetiological hypothesis, symptomatology, differential diagnosis and need for multidisciplinary treatment.
PMID: 15112760 [PubMed]
24: ILAR J. 2004;45(2):132-8.
Animal studies in endometriosis: a review.
Story L, Kennedy S.
University of Oxford Medical School, Oxford, United Kingdom.
Endometriosis is a common women’s health problem that is characterized by the presence of tissue resembling endometrium outside the uterus. The condition causes painful periods, chronic pelvic pain, and subfertility, which are potentially debilitating; and it affects millions of women worldwide. The diagnosis is made on visual inspection of the pelvis, usually at laparoscopy. The natural history is unknown, and well-controlled experiments are difficult to perform because of the need for repeated surgical procedures to assess endometriotic lesions over time. Thus, despite over 50 years’ research, the cause of endometriosis remains unclear, and treatment options are limited. Animal models provide an invaluable tool to study risk factors, prevalence, and the natural history of endometriosis especially in those menstruating nonhuman primates that develop the disease spontaneously. Many of the practical problems associated with studying the disease in humans can therefore be overcome. The pathophysiology of endometriosis can also be investigated and new treatments assessed in both nonprimates and nonhuman primates, with "disease" induced by placing autologous uterine tissue in ectopic sites, or human endometrium in the case of nude mice. However, although nonprimates have obvious advantages as a model, the extent to which the induced lesions are truly representative of the disease itself is debatable. This review explores the value of the experimental models that have been used to date.
PMID: 15111732 [PubMed]
25: Diagn Cytopathol. 2004 May;30(5):320-4.
ThinPrep evaluation of fluid samples aspirated from cystic ovarian masses.
Lu D, Davila RM, Pinto KR, Lu DW.
The Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University Medical Center, St. Louis, Missouri.
The cytological evaluation of ovarian cystic fluid using ThinPrep has not been reported. To determine the diagnostic accuracy of ThinPrep cytology in distinguishing between benign and nonbenign ovarian cystic lesions, we examined 65 fluid samples aspirated during intraoperative consultation with subsequent histologic correlation. One ThinPrep slide was prepared from each sample aspirated from surgically removed ovarian cystic masses and reviewed blindly by a panel of three cytopathologists. The parameters used in cytological evaluation were cellularity, cell types, cellular arrangement, and background. Four samples were acellular and excluded from the study. The consensus cytologic diagnoses were compiled for 61 cases which were assigned to one of the following diagnostic categories: negative for malignant cells (40 cases), atypical cytology (13 cases), and suspicious or positive for malignancy (8 cases). Histologic correlation of the cytological benign/negative cases showed that 26/40 (65%) were histologically benign and 14/40 were false-negative (35%, 5 carcinomas and 9 borderline tumors) with 10 of these cases being mucinous tumors. Most false-negative cytologic samples (11/14 or 79%) did not have an epithelial component. Of the 21 cytological nonbenign diagnoses (atypical/suspicious/positive), 15 (71%) were confirmed on histology (10 carcinomas and 5 borderline tumors). However, a nonbenign cytologic diagnosis was rendered in 6 histologically benign cases, including 2 serous cystadenomas, 1 mucinous cystadenoma, 1 serous cystadenofibroma, 1 endometriosis, and 1 corpus luteal cyst. The diagnostic sensitivity by ThinPrep evaluation of ovarian cystic masses is 81% (26/32) for benign and 52% (15/29) for nonbenign lesions. Our results concluded that ThinPrep examination of ovarian cystic fluid is not accurate in distinguishing benign from malignant cysts, given the significant number of false-negative diagnoses. Major contributing factors include sparse cellularity of the fluid samples and mucinous differentiation of the tumors. Diagn. Cytopathol. 2004;30:320-324. Copyright 2004 Wiley-Liss, Inc.
PMID: 15108229 [PubMed]
26: Surg Endosc. 2004 Feb;18(2):347.
Umbilical endometriosis.
Frischknecht F, Raio L, Fleischmann A, Dreher E, Luscher KP, Mueller MD.
Department of Obstetrics and Gynaecology, Kantonsspital Munsterlingen, 8596 Scherzingen, Switzerland.
We report two women who presented with a recurrent, mildly painful, bluish nodule in the umbilicus. Both patients complained of local tenderness and occasional bleeding that increased during menstruation. Neither patient had had previous pelvic surgery. Excision of the lesions revealed a primary umbilical endometriosis; in one case, a simultaneous laparoscopy showed a pelvic endometriosis. We review the current literature and discuss the possible etiopathogenesis and when a laparoscopy is indicated to diagnose a concomitant pelvic endometriosis. Umbilical endometriosis is a very rare disease but should be considered in the differential diagnosis of umbilical lesions.
PMID: 15106631 [PubMed]
27: Gynecol Endocrinol. 2004 Jan;18(1):37-40.
The presence of sex hormone receptors in the vesicouterine fistula.
Jozwik M, Jozwik M, Sulkowska M, Musiatowicz B, Sulkowski S.
Department of Gynecology, Medical University of Bialystok, Sklodowskiej 24a, 15-276 Bialystok, Poland.
Although the traditional management of vesicouterine fistula is surgical, a recent review of world data showed high efficacy of hormonal manipulation by the induction of amenorrhea. The prerequisite for the action of sex hormones is the presence of target receptors in the given tissue. The current study examined the histology of the vesicouterine fistula in order to identify the possible cellular components containing sex hormone receptors. The presence of an epithelium similar to endometrium containing sex hormone receptors was demonstrated immunohistochemically and by hematoxylin-eosin staining, a finding in agreement with the definition of endometriosis. Our paper provides an explanation for the high efficacy of hormonal manipulation in the treatment of this relatively rare type of fistula.
Publication Types: · Case Reports
PMID: 15106363 [PubMed]
28: Obstet Gynecol Surv. 2004 Mar;59(3):197-9.
The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2- to 5-year follow up.
Abbott JA, Hawe J, Clayton RD, Garry R.
PMID: 15105705 [PubMed]
29: Hum Reprod. 2004 Apr 22 [Epub ahead of print]
One year comparison between two add-back therapies in patients treated with a GnRH agonist for symptomatic endometriosis: a randomized double-blind trial.
Fernandez H, Lucas C, Hedon B, Meyer JL, Mayenga JM, Roux C.
Service de Gynecologie-Obstetrique, Hopital Antoine Beclere, AP-HP, 92141 Clamart, France.
BACKGROUND: It has been proposed that hormonal supplementation during prolonged GnRH agonist therapy prevents hypoestrogenic side effects, including bone loss. The optimal combination for long-term treatments with safe metabolic profile remains questionable. A norprogesterone derivative, promegestone, was assessed for the first time in a double-blind trial. METHODS: Seventy-eight patients with endometriosis with rAFS (Revised American Society for Reproductive Medicine) scores of III-IV were randomly assigned to monthly leuprorelin 3.75 mg (1 year) which, after the third injection was used in combination with promegestone 0.5 mg (P) plus either estradiol placebo (PL) or estradiol 2 mg (E) per day. Bone mineral density (BMD) was determined at baseline, 6 and 12 months, and biological and clinical quarterly assessments were performed. Analysis was by the intention to treat method. RESULTS: At month 12, BMD changes from baseline were -6.1 +/- 3.7 and -4.9 +/- 4.0% in the PL-P group, at the spine and hip, respectively. This bone loss was prevented in the E-P group: -1.9 +/- 3.1 and -1.4 +/- 2.3%, respectively (P < 0.0001 inter-group comparisons). The BMD decrease in the E-P group was explained by the changes occurring during the first 6 months of treatment. There was no deleterious change in lipid parameters. Clinical improvement was observed without an inter-group difference. CONCLUSIONS: Estradiol 2 mg and promegestone 0.5 mg per day is an effective and safe add-back therapy, which can be proposed for prolonged leuprorelin treatment over 6 months in severe endometriosis.
PMID: 15105403 [PubMed]
30: Hum Reprod. 2004 Apr 22 [Epub ahead of print]
Evidence for an increased release of proteolytic activity by the eutopic endometrial tissue in women with endometriosis and for involvement of matrix metalloproteinase-9.
Collette T, Bellehumeur C, Kats R, Maheux R, Mailloux J, Villeneuve M, Akoum A.
Centre de Recherche, Hopital Saint-Francois d’Assise, Centre Hospitalier Universitaire de Quebec, Canada; Departement d’Obstetrique et Gynecologie, Faculte de Medecine, Universite Laval, Quebec, Canada.
BACKGROUND: For the implantation of endometrium in ectopic locations, remodelling of the extracellular matrix (ECM) is necessary. Many studies have shown an increased expression of various proteases in the ectopic endometrium of women with endometriosis. Few, however, have addressed possible changes in protease expression in the eutopic endometrium. METHODS AND RESULTS: Herein, we reveal an increased release of proteolytic activity by the eutopic endometrium of women with endometriosis compared with normal women (P < 0.01). Using zymography and western blotting, we identified matrix metalloproteinase (MMP)-2 and MMP-9 in the culture medium, and further found that MMP-9 secretion, as assessed by zymography and enzyme-linked immunosorbent assay (ELISA), was elevated in women with endometriosis compared with normal women (P < 0.05). No statistically significant difference in MMP-2 secretion between women with and without endometriosis was noted. However, a significant difference in the levels of the tissue inhibitor of metalloproteinases (TIMP)-1, a known MMP-9 inhibitor, was found (P < 0.05). CONCLUSION: The endometriosis-associated increase in proteolysis and imbalance between the secretion of MMP-9 and that of its natural inhibitor, TIMP-1, revealed in the culture medium of endometrial tissue may reflect in vivo the enhanced capacity of this tissue to break down the ECM in host tissues, thereby favouring its ectopic implantation and development.
PMID: 15105396 [PubMed]
31: Hum Reprod. 2004 Apr 22 [Epub ahead of print]
Characterization of iron deposition in endometriotic lesions induced in the nude mouse model.
Van Langendonckt A, Casanas-Roux F, Eggermont J, Donnez J.
Department of Gynaecology, Universite Catholique de Louvain, 1200 Brussels, Belgium.
BACKGROUND: Pelvic endometriotic lesions are often laden with hemosiderin. In order to investigate the potential source of such iron deposits, we examined whether the seric and erythrocyte fractions of menstrual effluent might influence the occurrence of iron deposition within lesions in a murine model of endometriosis. METHODS: Endometriosis was induced in 57 nude mice by intraperitoneal injection of unfractionated human menstrual effluent, endometrial fragments plus serum, endometrial fragments plus erythrocytes or endometrial cell fraction alone. The number of implants, histologic aspect, proliferative activity and iron deposition in lesions was assessed. RESULTS: On day 5, lesions were evidenced in all 10 mice receiving menstrual effluent, in 9/13 of those injected with the cellular fraction, in 10/13 with the cellular fraction plus serum and in 10/12 with the cellular fraction plus erythrocytes. Iron conglomerates were observed at the interface between the lesion and peritoneum when menstrual effluent (47 deposits/mm(2)) and the cellular fraction with erythrocytes (20 deposits/mm(2)) were injected, but were scarce when the cellular fraction was injected without erythrocytes, either alone (4 deposits/mm(2)) or with serum (2 deposits/mm(2)) (P < 0.05). CONCLUSIONS: Iron conglomerates, typically found in the stroma of endometriotic lesions, were induced by erythrocytes present in menstrual effluent. This may be one of the factors triggering oxidative damage and chronic inflammation.
PMID: 15105391 [PubMed]
32: J Am Assoc Gynecol Laparosc. 2004 Feb;11(1):50-4.
Rectal endoscopic ultrasound with a radial probe in the assessment of rectovaginal endometriosis.
Abrao MS, Neme RM, Averbach M, Petta CA, Aldrighi JM.
Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
STUDY OBJECTIVE: To evaluate the accuracy of rectal endoscopic ultrasound and to evaluate endometriosis in the rectovaginal septum, rectum, and sigmoid walls. DESIGN: Validation of diagnostic test (Canadian Task Force classification II-1). SETTING: Tertiary care hospital. PATIENTS: Thirty-two consecutive women clinically suspected of having rectovaginal septum endometriosis without previous surgical treatment. INTERVENTION: Colonoscopy, transrectal ultrasound, and rectal endoscopic ultrasound, followed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS: The disease was classified according to 1996 standards of the American Society of Reproductive Medicine. Images obtained by colonoscopy, endoscopic ultrasound, and surgery and histologic findings were compared. In 6 patients endometriosis infiltrated bowel muscularis wall, in 20 it infiltrated rectovaginal septum, and in the remaining 6 there was no evidence of lesions. In all women in whom infiltration of the intestinal wall was suspected, rectal endoscopic ultrasound and colonoscopy confirmed the lesions (sensitivity 100%, specificity 67%). CONCLUSION: Endoscopic ultrasound was useful in preoperative assessment of women with endometriosis.
PMID: 15104831 [PubMed]
33: J Am Assoc Gynecol Laparosc. 2004 Feb;11(1):47-9.
The role of intraoperative proctosigmoidoscopy in laparoscopic pelvic surgery.
Nezhat C, Seidman D, Nezhat F, Nezhat C.
Center for Special Pelvic Surgery, Atlanta, Georgia, USA.
STUDY OBJECTIVE: To report the outcome of rigid sigmoidoscopy during operative laparoscopy in patients at high risk for rectosigmoid and large bowel injury. DESIGN: Prospective patient database with retrospective chart review (Canadian Task Force classification II-3). SETTING: Referral practice and tertiary medical center. PATIENTS: Two hundred sixty-two women with rectosigmoid endometriosis and adhesions. INTERVENTIONS: Rigid sigmoidoscopy during laparoscopy. At the end of surgery, proctosigmoidoscopy was performed to evaluate intraluminal abnormality or rectosigmoid injury. The pelvis was then filled with isotonic fluid to observe laparoscopically for air leakage. MEASUREMENTS AND MAIN RESULTS: Sigmoidoscopy was performed due to a lesion involving the rectum or sigmoid in 60.7%, large bowel in 11.1%, and posterior cul-de-sac in 28.2% of patients. During laparoscopy, endometriosis was found in 30.5%, adhesions in 20.2%, and both in 43.5%. Four women (1.5%) had bowel injury identified during sigmoidoscopy; all bowel injuries were treated by intracorporeal laparoscopic suturing. One incomplete repair was detected by sigmoidoscopy. In one woman (0.4%) a rectal polyp was detected. CONCLUSION: Bowel injury is one of the most serious complications of laparoscopy. Early detection and prompt intraoperative management are essential to prevent a potentially catastrophic outcome. Sigmoidoscopy is a relatively easy procedure and aids during laparoscopy in the diagnosis of bowel perforation and in assessment of bowel wall invasion and potential stricture caused by endometriosis. It is a safe procedure even when performed immediately after extensive laparoscopic surgical treatment of rectosigmoid endometriosis and adhesions.
PMID: 15104830 [PubMed]
34: J Am Assoc Gynecol Laparosc. 2004 Feb;11(1):23-8.
Long-term effectiveness of presacral neurectomy for the treatment of severe dysmenorrhea due to endometriosis.
Zullo F, Palomba S, Zupi E, Russo T, Morelli M, Sena T, Pellicano M, Mastrantonio P.
Department of Obstetrics and Gynecology, University Magna Graecia, Catanzaro, Italy.
STUDY OBJECTIVE: To assess the long-term effectiveness of presacral neurectomy (PSN) in women with severe dysmenorrhea due to endometriosis treated with conservative laparoscopic surgical intervention. DESIGN: Randomized, controlled trial (Canadian Task Force classification I). SETTING: University-affiliated department of obstetrics and gynecology. PATIENTS: One hundred forty-one sexually active women of reproductive age. INTERVENTION: Conservative laparoscopic surgery without (group A) or with (group B) PSN. MEASUREMENTS AND MAIN RESULTS: At entry and 24-months after surgical procedures, cure rates; frequency and severity of dysmenorrhea, dyspareunia, and chronic pelvic pain; and quality of life were evaluated. At follow-up visit, the cure rate was significantly (P<0.05) higher in group B (83.3%) than in group A (53.3%). The frequency and severity of dysmenorrhea, dyspareunia, and chronic pelvic pain were significantly (P<0.05) lower in both groups compared with baseline values, and only severity was significantly (P<0.05) lower in group B. A significant (P<0.05) improvement in quality of life was observed after surgery in both groups and was significantly (P<0.05) increased in group B compared with group A. CONCLUSION: PSN improves long-term cure rates and quality of life in women treated with conservative laparoscopic surgery for severe dysmenorrhea due to endometriosis.
PMID: 15104826 [PubMed]
35: Am J Surg Pathol. 2004 Mar;28(3):285-97.
Polypoid endometriosis: a clinicopathologic analysis of 24 cases and a review of the literature.
Parker RL, Dadmanesh F, Young RH, Clement PB.
Department of Pathology and Laboratory Medicine, University of Calgary, Calgary Laboratory Services, Calgary, Alberta, Canada. rlparker@interchange.ubc.ca
We describe 24 cases of polypoid endometriosis, most of which were referred because of problems in differential diagnosis, particularly distinction from a low-grade mullerian neoplasm. The patients were 23 to 78 years (mean 52.5 years) of age. Seven patients were on unopposed estrogen, four on combined estrogen-progestin therapy, and one patient had a synchronous ovarian thecoma. The most common clinical presentations were a pelvic mass, vaginal polypoid masses, and large bowel obstruction. In some cases, the intraoperative findings suggested a neoplasm. Sites of involvement in order of frequency included colon, ovary, uterine serosa, cervical and/or vaginal mucosa, ureter, fallopian tube, omentum, bladder, paraurethral and paravaginal soft tissue, and retroperitoneum. Multiple sites were involved in seven cases. Five cases occurred within ovarian or extraovarian endometriotic cysts. The lesions ranged up to 14 cm in size and formed polypoid, pink, gray or tan, masses. On microscopic examination, the polypoid masses were composed of an admixture of endometriotic glands and stroma. A variety of glandular architectural patterns were observed, sometimes in combination, most commonly cystic and noncystic simple hyperplasia, but also simple or complex hyperplasia with atypia, disordered proliferative, and cystic atrophy. Various types of epithelial metaplasia (tubal, mucinous, squamous, papillary syncytial metaplasia) were common. Hemorrhage, fibrosis, prominent thick-walled blood vessels, hemosiderin-laden histiocytes, and decidual change were also present in some cases. Eighteen cases were associated with usual (nonpolypoid) endometriosis. In one case, polypoid endometriosis merged with a mucinous borderline tumor of endocervical-type. In all but two cases, polypoid endometriosis lacked periglandular stromal hypercellularity, stromal atypia, and intraglandular stromal papillae, helping distinguish it from adenosarcoma. Focal intraglandular stromal papillae were noted in two cases with focal mild periglandular stromal hypercellularity in one of them, but no stromal atypia was present in either case. Follow-up data in 17 patients indicated that 15 patients were alive without evidence of residual disease, 1 was alive with residual endometriosis, and 1 died of other causes. In conclusion, polypoid endometriosis is a rare manifestation of endometriosis that may be mistaken for a neoplasm on clinical, intraoperative, or pathologic assessment. Some cases may be attributable to exogenous hormones or hyperestrinism and, like conventional endometriosis, some may evolve into a premalignant or, rarely, a neoplastic lesion. The main lesion in the differential is a mullerian (mesodermal) adenosarcoma.
Publication Types: · Review · Review of Reported Cases
PMID: 15104291 [PubMed]
36: Chin Med Sci J. 2004 Mar;19(1):56-9.
Changes of soluble fas and soluble fas ligand in serum and peritoneal fluid of infertile patients with endometriosis.
Linghu H, Xu X, Luo J, Zhuang L.
Department of Obstetrics and Gynecology, First Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing 400012.
OBJECTIVE: To evaluate the relationship between levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) in serum and peritoneal fluid of endometriosis-associated infertility. METHODS: The soluble Fas ligand and soluble Fas levels in serum and peritoneal fluid of 20 infertile patients with endometriosis were assessed with enzyme-linked immunosorbent assay, and were compared with 14 infertile patients due to chronic pelvic infectious disease and 16 fertile controls. RESULTS: The sFasL levels were significantly higher in infertile patients with endometriosis (175.09 +/- 80.55 pg/mL in serum and 284.50 +/- 152.38 pg/mL in peritoneal fluid) than those of infertile controls (88.47 +/- 43.55 pg/mL in serum and 17.30 +/- 9.62 pg/mL in peritoneal fluid) and fertile controls (16.13 +/- 11.75 pg/mL in serum and 8.84 +/- 2.31 pg/mL in peritoneal fluid). In contrast, as for the sFas levels, infertile patients with endometriosis (828.60 +/- 429.65 pg/mL in serum and 349.61 +/- 288.89 pg/mL in peritoneal fluid) did not show any significant difference compared with those in infertile patients resulting from pelvic infectious disease (868.75 +/- 570.48 pg/mL in serum and 181.76 +/- 157.78 pg/mL in peritoneal fluid) and fertile control (822.26 +/- 129.12 pg/mL in serum and 318.42 +/- 145.16 pg/mL in peritoneal fluid). CONCLUSIONS: Based upon these results, high level of sFasL in serum and peritoneal fluid and thus apoptosis mediated by it may be implicated in the mechanism involved in endometriosis-related infertility.
PMID: 15104227 [PubMed]
37: Gynecol Oncol. 2004 May;93(2):546-9.
Retroperitoneal mullerian carcinosarcoma associated with endometriosis: a case report.
Booth C, Zahn CM, McBroom J, Maxwell GL.
Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC, USA.
Background. Mixed mullerian tumors are rare malignancies of the female genital tract and extremely uncommon in extragenital sites. Case. A 71-year-old woman presented with a 3-month history of left-sided pelvic pain. Significant history included total abdominal hysterectomy and bilateral adnexectomy performed 19 years earlier for benign indications; she had no history of endometriosis. Bimanual exam and pelvic ultrasonography demonstrated a 6 x 5 x 6 cm complex mass in the left pelvis. Exploratory laparotomy revealed a retroperitoneal mass encasing the left ureter. The mass was debulked, necessitating resection of the distal ureter and ureteroneocystotomy. Histopathology demonstrated carcinosarcoma associated with endometriosis. Conclusion. Extragenital carcinosarcoma is a rare malignancy, with only one well-documented case associated with peritoneal endometriosis. We report a case of an extragenital retroperitoneal carcinosarcoma associated with endometriosis.
PMID: 15099978 [PubMed]
38: Clin Chest Med. 2004 Jun;25(2):311-9.
Catamenial pneumothorax and other thoracic manifestations of endometriosis.
Johnson MM.
Division of Pulmonary Medicine, The Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
PMID: 15099891 [PubMed]
39: Eur J Obstet Gynecol Reprod Biol. 2004 May 10;114(1):110-1.
Endometriosis in the Bartholin gland.
Gocmen A, Inaloz HS, Sari I, Inaloz SS.
Department of Obstetrics & Gynecology, Gaziantep University Medical Faculty, Gaziantep, Turkey.
A case of endometriosis infiltrating the Bartholin gland is presented. The initial diagnosis was a Bartholin gland cyst. The clinical diagnosis was made during the operation when chocolate-colored fluid poured into operation field. Laparoscopy was done during the same operation and minimal endometriosis was found. The presence of endometriosis may be considered as a diagnosis in cases with cystic mass in the Bartholin gland and laparoscopy might be performed to rule out the presence of intraperitoneal endometriosis if a woman is infertile.
PMID: 15099882 [PubMed]
40: Eur J Obstet Gynecol Reprod Biol. 2004 May 10;114(1):64-8.
Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingogram or suspected unilateral distal tubal pathology?
Lavy Y, Lev-Sagie A, Holtzer H, Revel A, Hurwitz A.
Department of Obstetrics and Gynecology, Hadassah Medical Organization, Hadassah University Hospital, Mt. Scopus, P.O. Box 24035, Jerusalem 91240, Israel.
Objective: To assess the diagnostic benefit of laparoscopy in infertile women with normal hysterosalpingography (HSG) or suspected unilateral pathology on HSG. Study design: Charts of infertile women that underwent complete infertility evaluation between 1996 and 1998 were retrospectively reviewed. Eighty-six patients in whom both HSG and laparoscopy were performed were included in the study. HSG results were compared with laparoscopic findings and the suggested treatment based on HSG results was compared with the treatment plan based on laparoscopic findings. Results: Among 63 patients with a normal HSG or suspected unilateral tubal pathology, who were assigned to ovulation induction and intrauterine insemination (IUI), 60 patients were found to have laparoscopic findings that did not necessitate any change in the original treatment plan. In three patients (4.8%), abnormalities discovered at laparoscopy were of such an extent that a change in the original treatment regimen and referral to in vitro fertilization (IVF) was needed. Among 23 patients with suspected bilateral tubal occlusion on HSG, 16 patients (69.6%) were found to have an abnormal laparoscopy with bilateral tubal adhesions, 6 patients (26%) had unilateral tubal adhesions, and 1 patient (4.3%) had pelvic adhesions with no obstruction. These latter findings led to changes in the original treatment plan of these seven patients from IVF to ovulation induction and IUI. Conclusions: Laparoscopy may be omitted in women with normal HSG or suspected uni

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