Histol Histopathol. 2009 Nov;24(11):1479-86.
Hepatocyte nuclear factor-1beta(HNF-1beta) in human urogenital organs: its expression and role in embryogenesis and tumorigenesis.
Kato N, Motoyama T.
Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan. nkato@med.id.yamagata-u.ac.jp
Molecules responsible for embryogenesis are often involved in tumorigenesis. Recent exhaustive cDNA microarray analyses in human neoplasms expanded knowledge of such molecules. Hepatocyte nuclear factor-1beta (HNF-1beta) is a homeobox transcription factor that functions as a homodimer or heterodimer with HNF-1alpha. In contrast to HNF-1alpha, HNF-1beta is very weakly expressed in the liver and is commonly expressed in the kidneys. During human embryonic stage, HNF-1beta plays an important role in organogenesis, especially of the urogenital system. In the human fetus, HNF-1beta expression is common in mesonephric duct derivatives and metanephros (permanent kidneys). HNF-1beta germline mutations cause malformations of these structures. Recent microarray analyses have disclosed that HNF-1beta is aberrantly up-regulated in clear cell carcinoma of the ovary, which is a carcinoma of müllerian nature, but which was initially misnamed “mesonephroma”. HNF-1beta is also expressed in ovarian endometriosis, which is a probable origin of clear cell carcinoma. On the other hand, HNF-1beta is down-regulated in renal neoplasms, such as chromophobe cell carcinoma. In this review, we first summarize HNF-1beta expression in the developing urogenital system of the human embryo. Then, we describe the HNF-1beta status in human urogenital neoplasms and discuss its role in tumorigenesis.


J Obstet Gynaecol. 2009 Oct;29(7):590-3.
Endometriosis: the elusive epiphenomenon.
Quinn M.

The denervation-reinnervation view proposes that retrograde menstruation results from loss of normal, fundocervical polarity caused by injuries to uterine nerves. Injuries may be sporadic (following vaginal delivery) or recurrent (after persistent straining during defaecation) creating very different appearances at laparoscopy. Clinical symptoms of pelvic pain, menstrual problems, dyspareunia, and dysmenorrhoea result from aberrant reinnervation that may occur with, or without deposits of pelvic endometriosis. Endometrium, delivered by retrograde menstruation, adheres to any injured tissues in the lower pelvis. Classical ‘endometriosis’ is largely an epiphenomenon to underlying processes of denervation and reinnervation.


Gynecol Endocrinol. 2009 Sep 12:1-6. [Epub ahead of print]

Progestins and medical treatment of endometriosis – Physiology, history and society.

Belaisch J.
Maternite Pinard, Hopital Saint Vincent de Paul, Universite Rene Descartes Paris France.

The transitory effect of hormonal treatment is the alleged main reason to criticize progestins (PGS) and combined pills (OP) in the managment of endometriosis. To the contrary their poor efficacy in the long run is often underlined. As a result, medical treatment is too seldom advised in endometriosis. In this article, we shall focus on the analysis of the reasons of the paucity of the medical interest given to progestins, reasons, which are not of a scientific or objective nature. The ultimate aim of this analysis is to develop arguments in favour of continuous administration of hormones as to obtain not simply an anovulation but a state of prolonged amenorrhea much more efficacious than the simple suppression of ovulation too often advised. And, with an emphasis on the fundamental role of surgery in the treatment of endometriosis, to give the greatest consideration to the specific nature of this disease, which is a chronic disease, justifying the long duration of hormonal administration.


Gynecol Endocrinol. 2009 Sep 15:1. [Epub ahead of print] Endometriosis – an European perspective.
Schindler AE, Druckmann R.
Mol Biol Rep. 2009 Sep 13. [Epub ahead of print] Association of interleukin 1beta gene (+3953) polymorphism and severity of endometriosis in Turkish women.
Attar R, Agachan B, Kucukhuseyin O, Toptas B, Attar E, Isbir T.
Department of Obstetrics and Gynecology, Yeditepe University Hospital, Istanbul, Turkey.

Endometriosis is regarded as a complex trait, in which genetic and environmental factors contribute to the disease phenotype. We investigated whether the interleukin (IL) 1beta (+3953) polymorphism is associated with the severity of endometriosis. Diagnosis of endometriosis was made on the basis of laparoscopic findings. Stage of endometriosis was determined according to the Revised American Fertility Society classification. 118 women were enrolled in the study. 78 women didnot have endometriosis, 6 women had stage I, 3 had stage II, 13 had stage III and 18 had stage IV endometriosis. Polymerase Chain Reaction (PCR), Restriction Fragment Length Polymorphism (RFLP), and agarose gel electrophoresis techniques were used to determine the IL 1beta (+3953) genotype. Frequencies of the IL-1beta (+3953) genotypes in the control group were: CC, 0.397; TT, 0.115; CT, 0.487. Frequencies of the IL-1beta (+3953) genotypes in cases were: CC, 0.375; TT, 0.225; CT, 0.400. We found a 2.22 fold increase in TT genotype in the endometriosis group. However, the difference was not statistically significant (P > 0.05). We also observed an increase in the frequency of IL-1beta (+3953) T allele in the endometriosis group. However, the difference was not statistically significant. We also investigated the association between IL-1beta (+3953) polymorphism and the severity of endometriosis. The frequencies of CC+CT genotypes in stage I, III and IV endometriosis patients were 83.3, 84/6 and 72.2%, respectively; and TT genotypes were 16.7, 15.4 and 27.8%, respectively. We observed a statistically insignificant increase in TT genotype in stage IV endometriosis (P > 0.05). We suggest that IL-1beta (+3953) polymorphism is not associated with endometriosis in Turkish women.
Radiographics. 2009 Sep-Oct;29(5):1353-70.
Female infertility: a systematic approach to radiologic imaging and diagnosis.
Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM.
Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA. jsteinkeler@lifespan.org

Imaging plays a key role in the diagnostic evaluation of women for infertility. The pelvic causes of female infertility are varied and range from tubal and peritubal abnormalities to uterine, cervical, and ovarian disorders. In most cases, the imaging work-up begins with hysterosalpingography to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at hysterosalpingography but typically require further characterization with hysterographic or pelvic ultrasonography (US) or pelvic magnetic resonance (MR) imaging. Hysterographic US helps differentiate among uterine synechiae, endometrial polyps, and submucosal leiomyomas. Pelvic US and MR imaging help further differentiate among uterine leiomyomas, adenomyosis, and the various müllerian duct anomalies, with MR imaging being the most sensitive modality for detecting endometriosis. The presence of cervical disease may be inferred initially on the basis of difficulty or failure of cervical cannulation at hysterosalpingography. Ovarian abnormalities are usually detected at US. The appropriate selection of imaging modalities and accurate characterization of the various pelvic causes of infertility are essential because the imaging findings help direct subsequent patient care. (c) RSNA, 2009.


Inflamm Allergy Drug Targets. 2009 Sep;8(4):285-91.
Leptin in non-autoimmune inflammation.
Cai C, Hahn BH, Matarese G, La Cava A.
Department of Medicine, University of California Los Angeles, Los Angeles, California 90095-1670, USA.
Leptin is an adipokine that modulates multiple functions including energy homeostasis, thermoregulation, bone metabolism, endocrine and pro-inflammatory immune responses. Several studies have implicated leptin in the pathogenesis of chronic autoimmune inflammatory conditions such as autoimmune encephalomyelitis, intestinal bowel inflammation and type-1 diabetes. This review focuses on the role of leptin in non-autoimmune inflammatory diseases that include renal, liver and lung inflammation, atherosclerosis and metabolic syndrome, Behçet’s disease and endometriosis.
J Obstet Gynaecol Res. 2009 Aug;35(4):753-60.
McGill Pain Questionnaire: A multi-dimensional verbal scale assessing postoperative changes in pain symptoms associated with severe endometriosis.
Fabbri E, Villa G, Mabrouk M, Guerrini M, Montanari G, Paradisi R, Venturoli SSeracchioli R.
Centre for Reconstructive Pelvic Endo-Surgery, Reproductive Medicine Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Background: Objective evaluation of pelvic pain symptoms using a standard pain questionnaire is essential to assessing the treatment of endometriosis and related pain. Aim: To evaluate the McGill Pain Questionnaire (MPQ) as a multi-dimensional verbal scale in providing information about chronic pelvic pain associated with endometriosis, before and after laparoscopic surgery. Methods: Fifty-five women undergoing laparoscopy for severe endometriosis were asked to complete the MPQ before surgery and at the 6-month follow up. All patients presented with preoperative pain symptoms of variable severity. We obtained the pain indexes and studied their relation with: patients’ characteristics (age, body mass index, parity, qualification, occupation); operative findings (number, site and size of endometriotic lesions and presence of pelvic adhesions); and postoperative evolution of variable MPQ pain indexes at the 6-month follow up. Results: Median present pain index (PPI) (index of pain intensity), before surgical treatment was 3 (2-4): preoperative PPI was <2 in 25% of patients while 25% of patients had PPI > 4. Overall median PPI after surgical treatment was 1 (0-2): postoperative index of pain intensity was <1 in 50% of patients, >2 in 25% of patients while 25% of patients did not experience postoperative pain. Overall pain intensity significantly decreased after laparoscopic treatment of endometriosis (Wilcoxon test P < 0.0005). None of the patients’ characteristics were found to be significantly correlated with the severity or improvement of preoperative pain at postoperative follow up (P > 0.05), and the intensity of preoperative pain was not correlated to any of the operative variables. There was a significant reduction in all individual MPQ pain indexes; however 18.2% of women did not show improvement of pain symptoms after laparoscopic surgery. An increasing endometrioma diameter was associated with a significant decrease in the difference in evaluative rank score of pain rating index between pain indexes at the 6-month follow up and preoperatively (P = 0.04, Spearman’s rank correlation Rho = -0.277). Conclusions: MPQ appears to be useful as a multi-dimensional scale in describing patients’ pain semiology and evaluating pain evolution after surgical treatment. However, due to the extreme variability of pain experience, MPQ results don’t clarify the relationship between pain intensity and the severity of endometriosis.
Minerva Ginecol. 2009 Aug;61(4):371.
Severe hydroureteronephrosis due to deep infiltrating ureteral endometriosis.
Leanza V, Accardi M, Cavallaro A, Russo ER.
Dipartimento di Ginecologia e Ostetricia, Università di Catania, Catania, Italia leanza@tiscalinet.it.


Minerva Ginecol. 2009 Aug;61(4):299-318.
Endometriosis and the role of reproductive medicine.
Bukulmez O.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA obukulmez@ufl.edu.

Endometriosis is a complex trait with significant environmental and genetic influences that are likely to affect its phenotype. Natural history of the disease varies from one individual to another. The gold standard of surgical diagnosis is limited in accuracy by visibility and recognition of lesions by the attending surgeon. Several lines of evidence suggest that pelvic endometriosis results from the reflux of viable endometrial tissue through the fallopian tubes. Endometriosis is an inflammatory disease that nuclear factor kappa B pathway may play an important role in its pathogenesis. Endometriotic lesions demonstrate increased aromatase expression in association with increased cyclo-oxygenase-2 expression, especially in red lesions which represent earlier stages of inflammation. Estrogen and progesterone receptor expressions vary according to the morphology and the inflammatory status of the endometriotic lesions. Normal endometrial tissue fragments can adhere and implant to peritoneum. Aromatase expression, a possible intrinsic survival factor for endometrial tissue, is inducible in human endometrial fragments by androstenedione at physiological concentrations found in peritoneal fluid. Inflammatory response to ectopic endometrial tissue, which may vary in each individual seems to be important in disease progression. Current therapies for endometriosis include surgical and medical approaches aimed at cytoreduction or hormonal suppression. However, the disease have tendency to recur in many symptomatic women. Although new management approaches are emerging, properly designed clinical trials are desperately needed in treatment of pain and subfertility associated with endometriosis. Future studies should also focus on identifying risk population to develop preventive strategies, since the treatment of endometriosis is costly and challenging.


Minerva Ginecol. 2009 Aug;61(4):285-98.
Endometriosis: a critical appraisal of the advances and the controversies of a challenging health problem.
Bedaiwy MA, Abdel-Aleem MA, Miketa A, Falcone T.
Departments of Obstetric/Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA falcont@ccf.org.
Endometriosis is an enigmatic disorder with obscure pathogenesis. The objective of this review was to critically appraise the recent advances in the etiopathogenesis, diagnosis and clinical management of endometriosis. Several studies support the familial role in the initiation of the disease with key roles of endometriosis-associated polymorphisms in the genes that control fibrinolysis, angiogenesis, steroidogesis, aromatization of androgens, proliferation and cytokine production. Many active substances (cytokines, growth factors, hormones and oxidative stress parameters) have been identified in endometriosis patients at different stages of the disease. In addition to the traditional diagnostic role of ultrasonography and CA 125, evidence is accumulating regarding a potential role sonorectovaginography. Currently the routine use of antiflammatory drugs and birth control pills is not supported by evidence. New protocols of medications incorporation new gonadotrophin releasing hormone agonists with add back therapy, androgenic agents and aromatase inhibitors have been proposed. Prospective randomiazed controlled trials proved that surgical treatment of endometriosis is better than placebo for endometriosis related pain and infertility for patients with stage I and II disease.


Mol Hum Reprod. 2009 Oct;15(10):609-24. Epub 2009 Sep 10.
Reassessing the evidence for the link between dioxin and endometriosis: from molecular biology to clinical epidemiology.
Guo SW, Simsa P, Kyama CM, Mihályi A, Fülöp V, Othman EE, D’Hooghe TM.
Institute of Obstetric and Gynecologic Research, and Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
A 1993 study reporting the link between exposure to dioxin and the risk of developing endometriosis in rhesus monkeys prompted many investigators to look suspiciously at dioxin. Since 1993, many in vitro, animal and epidemiological studies have been published, but the link between dioxin exposure and endometriosis is still unclear. The aim of our review is to present a summary of the biological effects of dioxin and its aryl hydrocarbon receptor, and to reassess the evidence presented in published, in vitro, preclinical and epidemiological studies regarding the association between dioxins and endometriosis. Although in vitro and animal studies provide results in support for a role of dioxins in the pathogenesis of endometriosis, caution should be exercised since these findings are mostly context dependent and since negative findings from these studies are rarely published. On the basis of our review of original epidemiological studies, no significant evidence can be found to support a link between dioxins and endometriosis in women. This observation can be explained by positive publication bias and by significant methodological problems associated with these studies, or by the absence of such a link. In conclusion, it seems that there is insufficient evidence at this moment in support of the hypothesis that dioxin exposure may lead to increased risk of developing endometriosis in women.
Mol Hum Reprod. 2009 Oct;15(10):575. Epub 2009 Sep 10.
Endometriosis: science and sense.
Winterhager E, Fazleabas A, Hillier S.


Ethiop Med J. 2009 Jan;47(2):171-4.
Cesarean scar endometriosis–a case report.
Bekele D, Kumbi S.
Department of Gynecology and Obstetrics, Medical Faculty, Hawassa College of Health Sciences, Hawassa University.
Scar endometriosis is a rare event which usually develops after pelvic operations involving the uterus and fallopian tubes. Its diagnosis can sometimes be difficult and may be confused with various other surgical conditions. We present here a case of abdominal wall scar endometriosis in a woman who has undergone cesarean delivery four years prior to her current presentation. The epidemiology, pathogenesis, clinical features, diagnosis, treatment and methods of prevention of this condition will be discussed in brief. This is an interesting case of surgical scar endometriosis and to the best of our knowledge this is the first case report in Ethiopia.
Hum Reprod. 2009 Sep 7. [Epub ahead of print] HOXA-10 expression in the mid-secretory endometrium of infertile patients with either endometriosis, uterine fibromas or unexplained infertility.
Matsuzaki S, Canis M, Darcha C, Pouly JL, Mage G
CHU Clermont-Ferrand, Polyclinique-Hôtel-Dieu, Gynécologie Obstétrique et Médecine de la Reproduction, Boulevard Léon Malfreyt, 63058 Clermont-Ferrand, France.
BACKGROUND The aim of this study was to investigate HOXA-10 expression in endometrium from infertile patients with different forms of endometriosis; with uterine fibromas, or with unexplained infertility and from normal fertile women. METHODS Expression levels of HOXA-10 mRNA and protein in endometrium were measured during the mid-secretory phase. This study utilized laser capture microdissection, real-time RT-PCR and immunohistochemistry. RESULTS HOXA-10 mRNA and protein expression levels in endometrial stromal cells were significantly lower in infertile patients with different types of endometriosis (deep infiltrating endometriosis, ovarian endometriosis and superficial peritoneal endometriosis), with uterine myoma, and unexplained infertility patients as compared with healthy fertile controls. HOXA-10 mRNA expression levels of microdissected glandular epithelial cells were significantly lower than those of microdissected stromal cells, without significant differences among the different groups. No protein expression was detected in glandular epithelial cells. The percentage of patients with altered protein expression of HOXA-10 in stromal cells were significantly higher in patients with only superficial peritoneal endometriosis (100%, 20/20, P < 0.05) compared with the other infertile groups (deep infiltrating endometriosis: 72.7%, 16/22; ovarian endometriosis: 70.0%, 14/20; uterine myoma: 68.8%, 11/16; unexplained infertility: 55.6%, 5/9). CONCLUSION The present findings suggested that altered expression of HOXA-10 in endometrial stromal cells during the window of implantation may be one of the potential molecular mechanisms of infertility in infertile patients, particularly in patients with only superficial peritoneal endometriosis. One of the underlying causes of infertility in patients with only superficial endometriosis may be altered expression of HOXA-10 in endometrial stromal cells.


Reprod Biol Endocrinol. 2009 Sep 8;7:94.
A cross-study gene set enrichment analysis identifies critical pathways in endometriosis.

Zhao H, Wang Q, Bai C, He K, Pan Y.
Shanghai Jiao Tong University, PR China. zhaohb@sjtu.edu.cn

BACKGROUND: Endometriosis is an enigmatic disease. Gene expression profiling of endometriosis has been used in several studies, but few studies went further to classify subtypes of endometriosis based on expression patterns and to identify possible pathways involved in endometriosis. Some of the observed pathways are more inconsistent between the studies, and these candidate pathways presumably only represent a fraction of the pathways involved in endometriosis. METHODS: We applied a standardised microarray preprocessing and gene set enrichment analysis to six independent studies, and demonstrated increased concordance between these gene datasets. RESULTS: We find 16 up-regulated and 19 down-regulated pathways common in ovarian endometriosis data sets, 22 up-regulated and one down-regulated pathway common in peritoneal endometriosis data sets. Among them, 12 up-regulated and 1 down-regulated were found consistent between ovarian and peritoneal endometriosis. The main canonical pathways identified are related to immunological and inflammatory disease. Early secretory phase has the most over-represented pathways in the three uterine cycle phases. There are no overlapping significant pathways between the dataset from human endometrial endothelial cells and the datasets from ovarian endometriosis which used whole tissues. CONCLUSION: The study of complex diseases through pathway analysis is able to highlight genes weakly connected to the phenotype which may be difficult to detect by using classical univariate statistics. By standardised microarray preprocessing and GSEA, we have increased the concordance in identifying many biological mechanisms involved in endometriosis. The identified gene pathways will shed light on the understanding of endometriosis and promote the development of novel therapies.


Eur J Obstet Gynecol Reprod Biol. 2009 Sep 4. [Epub ahead of print] Prediction of pelvic pathology in subfertile women with combined Chlamydia antibody and CA-125 tests.
Penninx J, Brandes M, de Bruin JP, Schneeberger PM, Hamilton CJ.
Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, The Netherlands.
OBJECTIVES: Chlamydia antibody test (CAT) has been proposed to predict tubal disease. A correlation between CA-125 and the extent of endometriosis has been found by others. In this study we explored whether a combination of the two tests adds to the predictive value of the individual tests for predicting tubal disease or endometriosis. We also used the combination of tests as a new index test to screen for severe pelvic pathology. STUDY DESIGN: This retrospective study compares the findings of 240 laparoscopies with the serological test results. Findings were classified according to the existing ASRM scoring systems for adnexal adhesions, distal tubal occlusion and endometriosis. Severe pelvic pathology was defined as the presence of ASRM classes III and IV tubal disease or ASRM classes III and IV endometriosis. The predictive value was calculated for both tests separately and for the combined test. The combined test was positive if at least one test result was abnormal (CAT positive and/or CA-125 >/=35IU/ml). RESULTS: 67/240 women had tubal disease, 81/240 had some degree of endometriosis. The odds ratios (ORs) of the CAT and the combined test to diagnose severe tubal disease were 6.6 (2.6-17.0) and 7.3 (2.9-19.3), respectively. The ORs of the CA-125 and the combined test to diagnose severe endometriosis were 15.6 (6.2-40.2) and 3.0 (1.2-8.0), respectively. Severe pelvic pathology was present in 65/240 women (27%). The ORs for severe pelvic pathology of the CAT, CA-125 and the combined test were 2.5 (1.4-5.3), 4.9 (1.9-9.6) and 6.6 (3.3-13.4), respectively. If the combined test was normal 15 out 131 women (11%) were shown to have severe pelvic pathology. CONCLUSIONS: The combined test adds hardly anything to the predictive value of CAT alone to diagnose severe tubal disease. The combined test is better than the CAT to predict severe pelvic pathology, but is not significantly better than the CA-125. If both the CAT and CA-125 are normal one could consider not performing a laparoscopy.


Best Pract Res Clin Obstet Gynaecol. 2009 Sep 2. [Epub ahead of print] Endometriosis, in vitro fertilisation and the risk of gynaecological malignancies, including ovarian and breast cancer.
Vlahos NF, Economopoulos KP, Fotiou S.
Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, 76 Vas. Sofias Av., 11527, Athens, Greece.
There is evidence that endometriosis as well as drugs used in the process of in vitro fertilisation appear to associate with increased risk for gynaecological cancer. In this review, we attempt to describe this relationship according to the most recent epidemiologic data and to present the possible mechanisms on the molecular level that could potentially explain this correlation. There are data to support that ovarian endometriosis could have the potential for malignant transformation. Epidemiologic and genetic studies support this notion. It seems that endometriosis is associated with specific types of ovarian cancer (endometrioid and clear cell). There is no clear association between endometriosis and breast or endometrial cancer. More studies are needed to establish the risk factors that may lead to malignant transformation of this condition and to identify predisposed individuals who may require closer surveillance. Currently, there is no proven relationship between any type of gynaecological cancer and drugs used for infertility treatment. In principle, infertile women have increased risk for gynaecologic malignancies. Nulligravidas who received treatment are at increased risk for malignancy compared with women who had conceived after treatment. There is limited evidence that clomiphene citrate use for more than six cycles or 900mg or treatment of women over the age of 40 could increase their risk for ovarian and breast cancer. More studies with the appropriate statistical power and follow-up time are required to evaluate accurately the long-term effects of these drugs and procedures.
Fertil Steril. 2009 Sep 2. [Epub ahead of print] Ovarian steroid hormones differentially regulate thrombospondin-1 expression in cultured endometrial stromal cells: implications for endometriosis.
Tan XJ, Lang JH, Zheng WM, Leng JH, Zhu L.
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China.
Thrombospondin-1 messenger RNA and protein levels in cultured human endometrial stromal cells (ESCs) treated with 17-beta estradiol (10 nM) were reduced by 47.6% (+/-6.5% SD; P < 0.05) and 49.0% (+/-8.6%; P < 0.05) compared with untreated cells, whereas thrombospondin-1mRNA and protein levels in ESCs treated with progesterone (10 muM) were 2.1-fold (+/-0.4 SD; P < 0.05) and 2.3-fold (+/-0.6; P < 0.05) higher than those in untreated cells. These findings not only provide evidence for the estrogen dependence of endometriosis, but also partly explain the mechanisms by which progestins exert their therapeutic activities in endometriosis.


Gynecol Obstet Invest. 2009 Sep 2;68(4):217-223. [Epub ahead of print] Apoptosis in Endometriosis.
Agic A, Djalali S, Diedrich K, Hornung D.
Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Apoptosis is a physiologic process that eradicates undesired cells without inducing an inflammatory reaction. It is an important regulator of eutopic endometrial function and evidence suggests that apoptosis aids in maintaining cellular homeostasis during the menstrual cycle by eliminating aging cells from the functional layer of the uterine endometrium. Endometriosis, which is characterized by the growth of endometrial tissue outside the uterus, could result from increased cellular proliferation or decreased apoptosis in response to appropriate stimuli. Eutopic endometrium from women with endometriosis has several differences compared with normal endometrium of women without endometriosis. These differences may contribute to the survival of regurgitated endometrial cells into the peritoneal cavity and thus to the development of endometriosis. In this article, we will summarize recent literature concerning apoptosis-related genes such as Bcl-2 and Fas, outline the molecular basis of apoptosis and review the literature focused on the alterations in regulation of apoptosis in eutopic and ectopic endometrium from women with endometriosis. Copyright © 2009 S. Karger AG, Basel.
Dis Markers. 2009;26(4):149-54.
Estrogen receptor-alpha gene (T/C) Pvu II polymorphism in endometriosis and uterine fibroids.
Govindan S, Shaik NA, Vedicherla B, Kodati V, Rao KP, Hasan Q.
Department of Genetics, Vasavi Medical and Research Centre, Khairtabad, Hyderabad-500 004, Andhra Pradesh, India.
Endometriosis and fibroids are estrogen-dependent benign pathologies of the uterus, which account for infertility and pelvic pain along with dysmenorrhea in women. Suppression of the disease and recurrence after discontinuing hormone therapy strongly suggests that these are responsive to hormones, especially estrogen, which acts via its receptor. A T/C SNP in intron 1 and exon 2 boundary of estrogen receptor (ER) alpha gene recognized by PvuII enzyme has been associated with several female pathologies like breast cancer, osteoporosis, endometriosis and fibroids in various ethnic groups. The aim of the present study was to assess this ER alpha T/C polymorphism in endometriosis and fibroid patients from Asian Indian population. Genomic DNA was isolated from 367 women, who included 110 cases of endometriosis, 142 cases of uterine fibroids and 115 healthy age matched women volunteers. PCR was carried out to amplify ER alpha gene followed by restriction digestion with Pvu II. Results indicate a significant association of C allele with both endometriosis [OR=2.6667, 95% CI=1.4166 to 5.0199; p < 0.05] and fibroids [2.0833, 95% CI=1.1327 to 3.8319; p < 0.05]. Further studies are needed in larger population to establish ERalpha C allele as a risk marker for endometriosis and fibroids in Asian Indian women. Ethnicity, race, diet etc may play a role in susceptibility to endometriosis and fibroids and further studies are warranted in this area.


Hum Reprod. 2009 Sep 3. [Epub ahead of print] The role of survivin in the resistance of endometriotic stromal cells to drug-induced apoptosis.
Watanabe A, Taniguchi F, Izawa M, Suou K, Uegaki T, Takai E, Terakawa N, Harada T.
Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago 683-8504, Japan.
BACKGROUND Decreased susceptibility of endometrial tissue to apoptosis may contribute to the pathogenesis of endometriosis. We investigate the role of survivin in the pathophysiology of endometriosis through the ability of ectopic and eutopic endometrial stromal cells (ESCs) to resist apoptosis. METHODS Ectopic ESCs were obtained from ovarian chocolate cysts in patients undergoing laparoscopic surgery (n = 22). Eutopic ESCs were isolated from endometrial tissue of cyclic premenopausal women undergoing hysterectomy for fibroids (n = 22). Purified stromal cells were studied in vitro. The number of surviving cells and activation of caspases were assessed by WST-8 assay and immunoblotting. Expression of inhibitor of apoptosis proteins (IAP) family members: cIAP1 (birc2), cIAP2 (birc3), XIAP (birc4), survivin (birc5) were examined using cDNA array and real-time RT-PCR. Effects of gene silencing by small inhibitor RNAs (siRNA) were examined by WST-8-assay, Annexin-V staining and immunoblotting. RESULTS After staurosporine (SS) treatment, 55% of eutopic ESCs survived versus 70% of ectopic ESCs. Procaspase-3 or -7 was more intensely activated by SS treatment in eutopic than in ectopic ESCs (P < 0.01). mRNAs for IAP-family genes, such as cIAP-1, XIAP and survivin, were highly expressed in ectopic ESCs before SS treatment. The fold induction of survivin expression after SS treatment was higher in ectopic than eutopic ESCs (2.8 +/- 0.27 versus 0.69 +/- 0.07, respectively). Survivin gene silencing in SS-treated ectopic ESCs led to an increase of apoptotic cells (P < 0.05, versus control siRNA). CONCLUSIONS We demonstrated that survivin plays a critical role in susceptibility of ESCs to apoptosis. Our results indicate that a survivin inhibitor may be effective as a novel treatment for endometriosis.


Hum Reprod. 2009 Sep 2. [Epub ahead of print] Letrozole combined with norethisterone acetate compared with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis.
Ferrero S, Camerini G, Seracchioli R, Ragni N, Venturini PL, Remorgida V.
Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Largo R. Benzi 1 16132, Genoa, Italy.
BACKGROUND The available data on effectiveness of aromatase inhibitors in treating pain symptoms related to endometriosis is limited. We compared the efficacy and tolerability of the aromatase inhibitor letrozole combined with norethisterone acetate versus norethisterone acetate alone in treating pain symptoms. METHODS This prospective, open-label, non-randomized trial included 82 women with pain symptoms caused by rectovaginal endometriosis. Patients received either a combination of letrozole and norethisterone acetate (group L) or norethisterone acetate alone (group N) for 6 months. Changes in pain symptoms during treatment and in the 12 months of follow-up were evaluated. Side effects of each treatment protocol were recorded. RESULTS Intensity of chronic pelvic pain and deep dyspareunia significantly decreased during treatment (P < 0.001 versus baseline by 3 months) in both study groups. At both 3- and 6-month assessment, the intensity of chronic pelvic pain (P < 0.001, P = 0.002, respectively) and deep dyspareunia (P < 0.001, P = 0.005, respectively) was significantly lower in group L than group N. At completion of treatment, 63.4% of women in group N were satisfied with treatment compared with 56.1% in group L (P = 0.49). Pain symptoms recurred after the completion of treatment; at 6-month follow-up no difference was observed in the intensity of pain symptoms between the groups. Adverse effects were more frequent in group L than in group N (P = 0.02). CONCLUSIONS The combination drug regimen was more effective in reducing pain and deep dyspareunia than norethisterone acetate; however, letrozole caused a higher incidence of adverse effects, cost more and did not improve patients’ satisfaction or influence recurrence of pain.
JAMA. 2009 Sep 2;302(9):955-61.
Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial.
Daniels J, Gray R, Hills RK, Latthe P, Buckley L, Gupta J, Selman T, Adey E, Xiong T, Champaneria R, Lilford R, Khan KS; LUNA Trial Collaboration.Collaborators (56)

Latthe P, Selman T, Daniels J, Adey E, Hills R, Hiller L, Buckley L, Xiong T, Champaneria R, Gair R, Powell R, Lynch L, Goodsell S, Hilken N, Tyler E, Wilcockson A, Khan KS, Latthe P, Selman T, Gupta JK, Mann C, Clark TJ, Newton J, Chien P, Macleod M, Thornton J, Rose E, Connor M, Baxter A, Farrell T, Bonner C, Kay V, Crystal W, Pheely M, Irani S, Dwarakanath L, Hollingworth J, Honest H, Chin K, Kabukoba J, Samra JS, Cox CW, Fender GR, Ismail KM, Keay S, Awadzi G, Shaxted EJ, Hitchcock R, Smith J, Zakaria M, Beecham N, Phillips WD, Brocklehurst P, Jordan J, Braunholtz P, Sandercock J.

Department of Obstetrics and Gynecology, Birmingham Women’s Hospital, University of Birmingham, Metchley Park Road, Edgbaston, Birmingham, B15 2TG UK. j.p.daniels@bham.ac.uk
CONTEXT: Chronic pelvic pain is a common condition with a major effect on health-related quality of life, work productivity, and health care use. Operative interruption of nerve trunks in the uterosacral ligaments by laparoscopic uterosacral nerve ablation (LUNA) is a treatment option for patients with chronic pelvic pain. OBJECTIVE: To assess the effectiveness of LUNA in patients with chronic pelvic pain. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of 487 women with chronic pelvic pain lasting longer than 6 months without or with minimal endometriosis, adhesions, or pelvic inflammatory disease, who were recruited to the study by consultant gynecological surgeons from 18 UK hospitals between February 1998 and December 2005. Follow-up was conducted by questionnaires mailed at 3 and 6 months and at 1, 2, 3, and 5 years. INTERVENTION: Bilateral LUNA or laparoscopy without pelvic denervation (no LUNA); participants were blinded to the treatment allocation. MAIN OUTCOME MEASURES: The primary outcome was pain, which was assessed by a visual analogue scale. Data concerning the 3 types of pain (noncyclical pain, dysmenorrhea, and dyspareunia) were analyzed separately as was the worst pain level experienced from any of these 3 types of pain. The secondary outcome was health-related quality of life, which was measured using a generic instrument (EuroQoL EQ-5D and EQ-VAS). RESULTS: After a median follow-up of 69 months, there were no significant differences reported on the visual analogue pain scales for the worst pain (mean difference between the LUNA group and the no LUNA group, -0.04 cm [95% confidence interval {CI}, -0.33 to 0.25 cm]; P = .80), noncyclical pain (-0.11 cm [95% CI, -0.50 to 0.29 cm]; P = .60), dysmenorrhea (-0.09 cm [95% CI, -0.49 to 0.30 cm]; P = .60), or dyspareunia (0.18 cm [95% CI, -0.22 to 0.62 cm]; P = .40). No differences were observed between the LUNA group and the no LUNA group for quality of life. CONCLUSION: Among women with chronic pelvic pain, LUNA did not result in improvements in pain, dysmenorrhea, dyspareunia, or quality of life compared with laparoscopy without pelvic denervation. TRIAL REGISTRATION: controlled-trials.com Identifier: ISRCTN41196151.
Gynecol Endocrinol. 2009 Aug 28:1-6. [Epub ahead of print] Preoperative pain and recurrence risk in patients with peritoneal endometriosis.
Renner SP, Rix S, Boosz A, Lermann JH, Strissel PL, Thiel FC, Oppelt P, Beckmann MW, Fasching PA.
Department of Gynaecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany.
Objective. Pain symptoms in endometriosis patients do not necessarily correlate with the extent of the disease, and there is little evidence regarding the recurrence risk. Aim of this study was to assess the risk factors for the recurrence of endometriosis, with regard to preoperative and postoperative pain. Design. Retrospective observational study. Setting. Single institution study. Population. A total of 150 patients were followed up for recurrence after surgical treatment for endometriosis. Methods. The patients were interviewed retrospectively to obtain information about pain levels during the course of the disease. Main outcome measures. Disease free survival. Results. High preoperative pain levels were associated with a higher risk of recurrence after 4 years of follow-up. The hazards ratio was 2.30 (95% CI, 1.22-4.31; p = 0.009). None of the other parameters assessed for medical history, reproductive history, or lifestyle was associated with the recurrence risk. Conclusions. The risk for recurrence after surgery for endometriosis may be substantially influenced by the patients’ perception of pain. Risk classifications for the recurrence risk in endometriosis are nonexistent. Developing these is imperatively needed soon to improve further treatment and/or prophylaxis for patients after surgery. A classification might be improved by adding sensory testing before surgery.
Gynecol Endocrinol. 2009 Aug 28:1-7. [Epub ahead of print] Endometriosis and ovarian cancer: A review.
Vlahos NF, Kalampokas T, Fotiou S.
Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Objectives. To describe the relationship between endometriosis and ovarian cancer. Search strategy. Review of the relevant clinical, epidemiologic, and molecular biology literature. Selection criteria. Studies published in the English language using the MEDLINE database. Data collection and analysis. Relevant studies were reviewed by the three authors and those that seem to be of significant scientific value, based on the methodology and statistical power, were included. Main results. Endometriosis and ovarian cancer share many common predisposing factors. Both conditions demonstrate similar patterns regarding local invasion and distal spread they respond similarly to estrogen-induced growth signaling, they express resistance to apoptotic mechanisms and they are characterized by genomic instability. Endometrioid and clear-cell are the most frequent types of ovarian cancer associated with endometriosis. Tubal ligation, in women with endometriosis, seems to prevent retrograde menstruation but it has also been shown to be protective from these types of ovarian cancer. Conclusion. There is evidence to support that endometriosis (by definition a benign process), could simultaneously have the potential for malignant transformation. More studies are needed to establish risk factors that may lead to malignant transformation of this condition and to identify predisposed individuals who may require closer surveillance.
Int J Gynaecol Obstet. 2009 Aug 27. [Epub ahead of print] A surgical window to access the obliterated posterior cul-de-sac at vaginal hysterectomy.

Sheth SS.
Breach Candy Hospital, Sir Hurkisondas Nurrotamdas Hospital, and Sheth Gynaecological Nursing Home, Mumbai, Maharashtra, India.
OBJECTIVE: To perform vaginal hysterectomy and adnexectomy without laparoscopic assistance in women with ovarian endometriosis by accessing the posterior cul-de-sac via the posterior uterocervical-broad ligament space. METHOD: The author identified the posterior uterocervical-broad ligament space as a surgical window while reviewing his experience at accessing the pouch of Douglas in 40 women in whom vaginal hysterectomy without laparoscopic assistance was performed for ovarian endometriosis. He then used this window in 102 women to remove the adnexa vaginally during vaginal hysterectomy, also without laparoscopy. RESULTS: This new technique was successful in 98 women, with no major complications, but 4 of the first 50 required laparotomy to complete the surgery. CONCLUSION: This new approach allows experienced surgeons to treat women with endometrial ovarian cysts by removing the adnexa vaginally during vaginal hysterectomy without laparoscopy, and complete the surgery abdominally or laparoscopically when necessary.
Tohoku J Exp Med. 2009 Sep;219(1):39-42.
Benefit of diagnostic laparoscopy for patients with unexplained infertility and normal hysterosalpingography findings.
Tsuji I, Ami K, Miyazaki A, Hujinami N, Hoshiai H.
Department of Obstetrics and Gynecology, Kinki University of Medicine, Osaka, Japan. i-tsuji@sanfu.med.kindai.ac.jp
Patients with unexplained infertility following standard infertility screening tests usually undergo timing therapy that coordinates the time of ovulation and coitus, controlled ovarian hyperstimulation, or intrauterine insemination. If the treatment is unsuccessful, diagnostic laparoscopy is performed. However, with recent improvements in the assisted reproductive technology (ART), there has been a growing tendency that bypasses diagnostic laparoscopy and proceeds directly to ART. Therefore, the value of diagnostic laparoscopy in current fertility practice is under debate. In the present study, we evaluated the usefulness of diagnostic laparoscopy for patients with unexplained infertility and normal hysterosalpingography (HSG) findings. Between January 1997 and December 2006, 57 infertile patients with normal HSG findings underwent diagnostic laparoscopy at Kinki University Hospital. In 46 (80.7%) of these patients, diagnostic laparoscopy revealed pathologic abnormalities. Specifically, endometriosis and peritubal and/or perifimbrial adhesions were found in 36 (63.2%) and 5 (8.8%) of the patients, respectively. In 8 patients (14.0%), the management plan was switched to ART because of severe tubal diseases. Among the 57 patients, 29 pregnancies (50.9%) were achieved, including 6 ART-mediated pregnancies. We conclude that diagnostic laparoscopy is beneficial for patients with unexplained infertility and normal HSG findings. Indeed, by diagnostic laparoscopy, we are able to detect the cause(s) of infertility in the pelvic cavity and to design a suitable management plan, which could lead to postoperative pregnancy. Therefore, because of the potential diagnostic and therapeutic benefits, patients with unexplained infertility and normal HSG findings should undergo diagnostic laparoscopy prior to ART.
Gynecol Oncol. 2009 Aug 26. [Epub ahead of print] Extragenital adenosarcoma: A case report, review of the literature, and management discussion.
Huang GS, Arend RC, Sakaris A, Hebert TM, Goldberg GL.
Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women’s Health, Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Albert Einstein Cancer Center, 1695 Eastchester Road, Suite 601, Bronx, NY 10461, USA.
BACKGROUND: Müllerian adenosarcoma is a rare mixed epithelial-mesenchymal tumor. An extragenital site of origin and sarcomatous overgrowth are associated with aggressive clinical behavior. CASE: We present a rare case of extragenital adenosarcoma with sarcomatous overgrowth and coexistent endometriosis. She was treated with initial cytoreductive surgery and chemotherapy. She underwent a second surgery for management of a high-grade bowel obstruction, due to pathologically confirmed recurrent intraperitoneal adenosarcoma. A complete clinical response was achieved with liposomal doxorubicin, and the patient remains disease-free eighteen months after completion of chemotherapy. CONCLUSION: Liposomal doxorubicin appears to be an active agent for the treatment of adenosarcoma with sarcomatous overgrowth. In addition, we conclude from our review of all reported cases of extragenital adenosarcoma that concurrent endometriosis may represent a favorable prognostic factor.
Obstet Gynecol. 2009 Aug;114(2 Pt 2):425-6.
Endometriosis mimicking ovarian cancer in the setting of acquired immune deficiency syndrome.
Haeri S, Cosin JA.
Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7516, USA. SinaHaeri@Gmail.com
BACKGROUND: With rising rates of human immunodeficiency virus (HIV) among women and resultant immunosuppression, clinicians face varying presentations of gynecologic pathologies. We report a case of endometriosis in a patient with acquired immunodeficiency syndrome (AIDS) presenting with a Sister Mary Joseph’s nodule and mimicking carcinomatosis. CASE: A woman with AIDS and 2-month history of abdominal pain, distention, and weight loss was found to have periumbilical and pelvic masses, ascites, lymphadenopathy, and an elevated CA 125 level. Operative findings included chocolate-colored ascites and peritoneal seeding involving the ovaries, uterus, appendix, bowel, umbilicus, and omentum. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and resection of all gross disease. Pathologic diagnosis was endometriosis and AIDS-associated adenopathy. COMMENT: Immunodeficiency from AIDS can affect the progression of endometriosis to the point of mimicking ovarian malignancy.
Acta Obstet Gynecol Scand. 2009 Aug 25:1-9. [Epub ahead of print] The effect of second-line surgery on reproductive performance of women with recurrent endometriosis: A systematic review.
Vercellini P, Somigliana E, Vigano P, De Matteis S, Barbara G, Fedele L.
Department of Obstetrics and Gynecology, University of Milan, Milan, Italy.
Estimates of endometriosis recurrence after primary surgery are around 10% per annum during the first postoperative quinquennium. The aim of this study was to define the effect of reoperation in women seeking conception. A MEDLINE and PubMed search was conducted to identify English language studies published in the last 30 years evaluating reproductive performance after second-line surgery. Repeat surgery for recurrent endometriosis and identification of women seeking pregnancy were selected. Two authors abstracted data on standardized forms. The initial literature screening yielded 41 citations, but 19 were excluded because no data on reoperation were described, seven as no original figures were included, three because analyses were performed on the same cohort, and one because extremely skewed data were reported. A total of 313 patients who sought pregnancy after repetitive surgery for recurrent endometriosis were found, 139 in six non-comparative studies, and 174 in five retrospective comparative studies. Overall, pregnancy was achieved in 81 women (26%; 95% confidence interval (CI), 21-31%), without significant difference between the laparotomy (27%) and laparoscopy (25%) approach. Three studies compared pregnancy rate after second-line (28/124; 23%) and primary surgery (236/577; 41%; common odds ratio (OR), 0.44; 95% CI, 0.28-0.68%), and two compared the probability of conception after in-vitro fertilization (IVF) (14/27; 30%) and repetitive surgery (10/50; 20%; common OR, 1.51; 95% CI, 0.58-3.91%). Conclusions. The probability of conception after repeat surgery for recurrent endometriosis appeared limited and reduced compared with that after primary surgery. The results of IVF were not inferior to those of reoperation.
Ther Clin Risk Manag. 2009 Jun;5(3):561-74. Epub 2009 Aug 3.
The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability.

Beatty MN, Blumenthal PD.
Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.
The levonorgestrel-releasing intrauterine system (LNG-IUS) is a safe, effective and acceptable form of contraception used by over 150 million women worldwide. It also has a variety of noncontraceptive benefits including treatment for menorrhagia, endometriosis, and endometrial hyperplasia. The LNG-IUS has also been used in combination with estrogen for hormone replacement therapy and as an alternative to hysterectomy. Overall, the system is very well tolerated and patient satisfaction is quite high when proper education regarding possible side effects is provided. However, despite all of the obvious benefits of the LNG-IUS, utilization rates remain quite low in the developed countries, especially in the United States. This is thought to be largely secondary to the persistent negative impressions from the Dalkon Shield intrauterine experience in the 1970s. This history continues to negatively influence the opinions of both patients and health care providers with regards to intrauterine devices. Providers should resolve to educate themselves and their patients on the current indications and uses for this device, as it, and intrauterine contraception in general, remains a largely underutilized approach to a variety of women’s health issues.


Regul Pept. 2009 Aug 23. [Epub ahead of print] Effects of the LHRH antagonist Cetrorelix on affective and cognitive functions in rats.
Telegdy G, Adamik A, Tanaka M, Schally AV.
Department of Pathophysiology, University of Szeged, Hungary.
The decapeptide LHRH antagonist, Cetrorelix, inhibits gonadotropin and sex-steroid secretion. Cetrorelix is used for IVF-ET procedures and for the treatment of benign prostatic hyperplasia, endometriosis and leiomyomas. However little is known about the effects of Cetrorelix on brain functions. Previously we have tested Cetrorelix in mice on the impairment of the consolidation of a passive avoidance behavior caused by beta-amyloid 25-35, anxiolytic action in the plus-maze, antidepressive action in a forced swimming test, tail suspension and open-field behavior following its administration into the lateral brain ventricle. In the present study we repeated and extended the experiments in rats in order to determine whether there are species differences in the action of Cetrorelix between mice and rats. The effects of Cetrorelix evaluated included the methods used in mice without tail suspension test and extended by measuring core temperature. Cetrorelix fully blocked the impairment of the consolidation of passive avoidance learning when given icv 30 min following administration of beta-amyloid 25-35. If beta-amyloid 25-35 and Cetrorelix were given simultaneously, Cetrorelix was ineffective. Cetrorelix elicited slight anxiogenic and stronger anxiolytic action in the plus-maze, depending on the dose used. In the forced swimming tests, Cetrorelix showed antidepressive-like action. In open-field behavior tests Cetrorelix displayed a U-type action on locomotion with 0.5 and 2 microg increasing locomotion, and increase rearing but and had no effect on grooming at 0.5-2 microg. Cetrorelix had no action on core temperature. Our findings demonstrate that Cetrorelix is able to correct the impairment of the memory consolidation caused by beta-amyloid 25-35. Cetrorelix elicits anxiolytic and antidepressive action, slightly increases locomotion and rearing in open field, but it does not influence the core temperature. The results obtained in rats are similar to those reported previously by us in mice. Collectively our findings confirm the effects of Cetrorelix on brain function in two species and suggest the possible merit of a clinical trial with Cetrorelix in patients with anxiety, depression and Alzheimer’s disease.


J Sex Res. 2009 Aug 24:1-15. [Epub ahead of print] 

Sexual Functioning Following Elective Hysterectomy: The Role of Surgical and Psychosocial Variables.
Peterson ZD, Rothenberg JM, Bilbrey S, Heiman JR.
Department of Psychology and Institute for Women and Gender Studies, University of Missouri-St. Louis.
In this article, two studies were conducted to investigate the surgical and psychosocial correlates of women’s post-hysterectomy sexual functioning. In Study 1, sexual functioning was measured in an online convenience sample of 65 women who had undergone elective hysterectomy. Results suggested that most women experienced improved sexual functioning after their hysterectomy. Women who underwent hysterectomy to treat endometriosis reported less improvement in sexual functioning as compared to women who had hysterectomies for other indications, and women who had abdominal hysterectomies reported less improvement in sexual functioning as compared to women who had vaginal hysterectomies. Sexual functioning post-hysterectomy was associated with psychosocial variables, particularly body esteem and relationship quality. In Study 2, sexual functioning was investigated at two time points three to five months apart in a sample of 14 women who reported developing sexual problems following their elective hysterectomies. Results suggested that, among women suffering from post-hysterectomy sexual dysfunction, sexual pain and difficulty with orgasm increased over time.
Gynecol Endocrinol. 2009 Aug 20:1-5. [Epub ahead of print] Immunohistochemical expression of YKL-40 in peritoneal endometriosis.
Kim PJ, Hong DG, Park JY, Cho YL, Park IS, Lee YS.
Department of Obstetrics and Gynecology.
Aims. To evaluate the relationship between the immunohistochemical expression of YKL-40 and peritoneal endometriosis by using paraffinized peritoneal tissue blocks. Methods and materials. We retrospectively collected data from 27 patients whose pathologic reports indicated invasion of the peritoneum by endometriosis. A conventional peroxidase staining technique was performed using rabbit polyclonal antibody (Quidel(R) corporation, Santa Clara, CA) on peritoneal tissue blocks; their histology was then reviewed by a pathologist, and data were analyzed by nonparametric and Mann-Whitney tests. Results. YKL-40 was detected immunohistochemically in 17 (63%) of 27 cases. The number of biopsies which were invaded by endometriosis (P = 0.015), with a score based on the revised classification of endometriosis (American Society for Reproductive Medicine) had statistical significance (P = 0.001). The obstetric history, age, body mass index, severity, and occurrence of dysmenorrhea, menstrual phase, preoperative CA 125, erythrocyte sedimentation rate, and white blood cell count had no statistical significance. YKL-40 immunoreactivity was recognized as brown staining, localized to the cytoplasm of epithelial cells of endometrial gland in peritoneal endometriosis. There was no positive staining on endometrial stromal cells or smooth muscle cells. Conclusions. YKL-40 is related to severity of peritoneal endometriosis. However why a different expression level of immunohistochemical staining should occur is not known and needs further investigation.
Fertil Steril. 2009 Aug 21. [Epub ahead of print] Voiding dysfunction in women undergoing laparoscopic treatment for moderate to severe endometriosis.
Vashisht A, Gulumser C, Pandis G, Saridogan E, Cutner A.
Department of Obstetrics and Gynaecology, University College Hospital, London, United Kingdom.
We conducted a prospective study to evaluate the incidence and the surgical factors determining the development of postoperative voiding dysfunction following this surgery. The presence of rectovaginal dissection was significantly associated with the development of voiding dysfunction, and we suggest vigilance among practitioners about the possibility of the development of voiding dysfunction in this group of women. 

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