Surg Endosc. 2009 May 23. [Epub ahead of print]

Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases.

Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Minelli L.

Department of General Surgery, Sacro Cuore Don Calabria General Hospital, Negrar, Verona, Italy.

BACKGROUND: Complete removal of all visible lesions is considered the adequate treatment of pelvic endometriosis in order to reduce recurrence. Laparoscopic colorectal resection of bowel endometriosis is still challenging. A large series is reported. METHODS: A longitudinal evaluation of surgical and clinical complications of 436 cases of severe endometriosis with colorectal resection was carried out. All procedures were performed laparoscopically in a single center and short-term complications were surveyed. RESULTS: The overall complication rate was 8.3% with need for laparoconversion in 3.2%. Sixty patients required blood transfusion (13.7%), and rectovaginal fistulae were the most frequent postoperative complication (3.2%). CONCLUSION: Laparoscopic colorectal resection for endometriosis is a relatively safe procedure in a context of close collaboration between gynecologists and surgeons, although it requires adequate training.

Fertil Steril. 2009 Jul;92(1):395.e13-6. Epub 2009 May 21.

Spontaneous rupture of subserous uterine veins during late pregnancy after in vitro fertilization.

Zhang Y, Zhao Y, Wei Y, Li R, Qiao J.

Department of Obstetrics and Gynecology, Third Hospital of Peking University, Beijing, People’s Republic of China.

OBJECTIVE: To report the clinical presentation and treatment of spontaneous rupture of uterine surface veins during late pregnancy after in vitro fertilization (IVF). DESIGN: Case report. SETTING: Medical Unit of Third Hospital of Peking University, Beijing, China. PATIENT(S): A total of 573 pregnancies resulting from IVF in our hospital were reviewed for examples of spontaneous rupture of uterine veins. INTERVENTION(S): Data were obtained from medical charts, delivery summaries, and surgical reports in the historical files. MAIN OUTCOME MEASURE(S): Explorative laparotomy was performed. RESULT(S): Three women were found experiencing significant intra-abdominal bleeding in the third trimester of pregnancy due to a lesion resulting from endometriosis and chronic pelvic inflammatory disease. The intra-abdominal bleeding occurred between 29 and 35 weeks of gestation. A major prenatal symptom was severe abdominal pain in all of the cases. The pain was not relieved by the application of tocolytics or mild analgesics. Explorative laparotomy, performed in all three cases, revealed the presence of massive intra-abdominal bleeding stemming from subserous uterine veins. Fetal death occurred in one case. Immediate institution of effective resuscitative measures and early surgical intervention were essential to both fetal and maternal survival. CONCLUSION(S): Patients undergoing IVF treatment may be at increasing risk for intra-abdominal bleeding in the third trimester of pregnancy.

Publication Types:

Sichuan Da Xue Xue Bao Yi Xue Ban. 2009 Mar;40(2):228-31, 244.


Inhibition effect and mechanisms of quercetin on surgically induced endometriosis

[Article in Chinese]

Zhang X, Wang X, Wang HJ, Yang Q, Qie MR.

Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu 610041, China.

OBJECTIVE: To evaluate the therapeutic effect of quercetin on the rat endometriosis models and the relationship between the inhibition effect and the expression of HSP70 and VEGF. METHODS: A surgical model to simulate endometriosis was established and the rats were divided into four groups. After 3 weeks of daily administration of quercetin, dazazol, combined quercetin+dazazol, and placebo, the potential rule of quercetin to inhibit endometriosis in rats were evaluated by measuring the implants, examining the histology and detecting the expression of heat shock protein 70 (HSP70) and vascular endothelial growth factor (VEGF) in ectopic endometrium with immunohistochemistry. RESULTS: Compared to placebo, quercetin [100 mg/(kg x d)], dazazol [36 mg/(kg x d)], and combined quercetin + dazazol decreased the size of implants significantly respectively, and there was no significant difference among the three groups. HSP70 and VEGF were both significantly reduced by quercetin or combination treatment, but no significant difference was seen between quercetin and combination treatment groups. CONCLUSION: Quercetin inhibits surgically induced endometriosis in rats, and the possible mechanism is to inhibit the expression of HSP70 and VEGF.

Publication Types:

Obstet Gynecol. 2009 Jun;113(6):1370, author reply 1370-1.

Comment on:

Prediction of treatment outcomes after global endometrial ablation.

McCausland AM, McCausland VM.

Publication Types:

Obstet Gynecol. 2009 Jun;113(6):1259-67.

Erratum in:

  • Obstet Gynecol. 2009 Sep;114(3):696-7.

Factors associated with undergoing bilateral salpingo-oophorectomy at the time of hysterectomy for benign conditions.

Jacoby VL, Vittinghoff E, Nakagawa S, Jackson R, Richter HE, Chan J, Kuppermann M.

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94115, USA.

OBJECTIVE: To identify possible factors associated with undergoing bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy among women with benign conditions. METHODS: This was a cross-sectional analysis using the 2005 Nationwide Inpatient Sample. Women aged 18 years or older who underwent hysterectomy with BSO or hysterectomy only for a benign condition were included. We examined a broad range of factors associated with undergoing BSO in multivariable analyses. RESULTS: Fifty-two percent of 461,321 hysterectomies included BSO, with a mean age of 49 years compared with 43 years in the hysterectomy-only group (P<.001). The odds of BSO were two times higher in the Midwest and South and 1.67 times higher in the West as compared with the Northeast (P<.001). Women who were uninsured or had Medicaid were more likely to undergo BSO compared with those with private insurance (odds ratio 1.86, 95% confidence interval 1.14-3.04 for “no charge/charity,” odds ratio 1.21, 95% confidence interval 1.08-1.35 for Medicaid) Although BSO was more common among white women than African-American, Latina, and Asian women (P<.001), lower income was associated with BSO among African-American and white women only, not among Asian and Latina women (P=.007 for test for interaction). BSO was eight times as likely with a laparoscopic hysterectomy and 12 times as likely with an abdominal hysterectomy compared with a vaginal approach (P<.001). Women who had endometriosis, pelvic infection, or an ovarian cyst were more likely to undergo BSO (P<.001) compared with women who did not have these diagnoses. CONCLUSION: There is significant nationwide variation in the practice of BSO. Age, route of hysterectomy, and diagnosis at surgery affect BSO rates. Nonclinical factors such as race or ethnicity, insurance status, income, and geographic location are also associated with BSO practice. LEVEL OF EVIDENCE: II.

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AJR Am J Roentgenol. 2009 Jun;192(6):1632-44.

Unusual imaging appearances of endometriosis.

Choudhary S, Fasih N, Papadatos D, Surabhi VR.


Department of Radiology, The Ottawa Hospital, ON, Canada.

OBJECTIVE: Endometriosis is defined as tissue resembling the endometrium occurring outside the uterus. The purpose of this article is to familiarize the radiologist with the wide spectrum of pelvic endometriosis and to review the distinctive imaging findings. Infrequent manifestations of endometriosis, including malignant degeneration, scar endometriosis, association with ascites, and invasive endometriosis, are described. CONCLUSION: The manifestations of endometriosis commonly present a challenge to the gynecologist and radiologist. Familiarity with its varied presentations may allow accurate diagnosis.

Publication Types:

AJR Am J Roentgenol. 2009 Jun;192(6):1625-31.

Anatomic distribution of posterior deeply infiltrating endometriosis on MRI after vaginal and rectal gel opacification.

Loubeyre P, Petignat P, Jacob S, Egger JF, Dubuisson JB, Wenger JM.

Department of Imaging, Women’s Imaging, Geneva University Hospitals, Switzerland.

OBJECTIVE: The challenges of imaging posterior deeply infiltrating endometriosis with MRI are to image a small anatomic area encompassing several thin fibromuscular anatomic structures such as uterosacral ligaments, and the vaginal and rectal walls; and to image endometriotic lesions, which are fibromuscular structures and have an MRI signal intensity very close to those of surrounding fibromuscular anatomic structures. CONCLUSION: We show the capability and potential of MRI in diagnosing and staging of posterior deeply infiltrating endometriosis after vaginal and rectal gel opacification.

AJR Am J Roentgenol. 2009 Jun;192(6):1618-24.

Endometriosis of the posterior cul-de-sac: clinical presentation and findings at transvaginal ultrasound.

Hensen JH, Puylaert JB.

Department of Radiology, Maasstad Hospital, Rotterdam, Zuid Holland, The Netherlands.

OBJECTIVE: The purpose of our study was to evaluate the clinical findings and transvaginal ultrasound features of posterior cul-de-sac endometriosis. MATERIALS AND METHODS: A retrospective search of cases over a 13-year period was performed and yielded 25 patients with posterior cul-de-sac endometriosis. The diagnosis of posterior cul-de-sac endometriosis was confirmed by histology (n = 13), conventional barium enema (n = 13), colonoscopy (n = 8), CT (n = 8), MRI (n = 17), diagnostic laparoscopy (n = 14), and laparotomy (n = 13). All patients underwent transvaginal and abdominal ultrasound including power Doppler examination. Two radiologists working in consensus analyzed the clinical data and reviewed the imaging studies. RESULTS: All 25 patients presented with lower abdominal pain that was cyclic in six patients. Eleven patients were unintended childless. Rectal discomfort was mentioned by 17 patients, two of whom also reported rectal blood loss. At physical examination, eight patients had a palpable mass in the posterior cul-de-sac. Transvaginal ultrasound detected one or more hypoechoic masses in the posterior cul-de-sac in all 25 patients. All masses were solid, noncompressible, and localized on the serosal surface of the rectosigmoid with sparing of mucosa and submucosa. The lesions had a rounded or ovoid shape and a mean sagittal diameter of 37 mm with vascularity. The masses had a spiculated or tethering contour in 19 patients. Abdominal ultrasound detected thick-walled adnexal cysts in 11 patients, hydronephrosis in eight, and involvement of the ileocecal region in five. CONCLUSION: Patients with endometriosis of the posterior cul-de-sac frequently present with atypical noncyclic symptoms. The transvaginal ultrasound features characteristic of posterior cul-de-sac endometriosis are a solid, often spiculated, noncompressible mass near the posterior cul-de-sac that is localized at the serosal surface of the rectosigmoid, spares the mucosa and submucosa, and is vascular.

Ophthal Plast Reconstr Surg. 2009 May-Jun;25(3):254-5; author reply 255.

Comment on:

Re: “Presumed nasolacrimal endometriosis”.

Brown TM, Masselos K, Wang LW, Figueira EC, Francis IC, Wilcsek G.


Publication Types:

In Vivo. 2009 May-Jun;23(3):459-64.

Rectovaginal septum endometriosis: an immunohistochemical analysis of 62 cases.

Signorile PG, Campioni M, Vincenzi B, D’Avino A, Baldi A.

Fondazione Italiana Endometriosi, Via E. Longoni, 81, 00159 Rome, Italy.

Deep infiltrating endometriosis of rectovaginal septum is a particular form of endometriosis located under the peritoneal surface. This kind of lesions are very active and strongly associated with pelvic pain symptoms. A study on 62 cases of rectovaginal septum endometriosis by means of immunohistochemistry was conducted in order to evaluate the oestrogen and progesterone receptor levels in these cases and to correlate them to the level of vascularization (CD34 expression) and the amount of nerve fibres (S100 expression). Data showed great heterogeneity in the expression of all the parameters analyzed. Nevertheless, by using Spearman correlation test to assess relationship among oestrogen and progesterone receptors, S100 and CD34 staining, a significant direct correlation was found between all the parameters analyzed. These observations sustain the hypothesis that oestrogen and progesterone play an important role in the genesis of endometriotic glands, in the vascularization and in the proliferation of nerves.

Publication Types:

Arch Dermatol. 2009 May;145(5):605-6.

Cutaneous incisional endometriosis.

Brown AS, Malone JC, Brown TS, Callen JP.

Publication Types:

Reproduction. 2009 Aug;138(2):341-50. Epub 2009 May 18.

The effects of tamoxifen and estradiol on myometrial differentiation and organization during early uterine development in the CD1 mouse.

Mehasseb MK, Bell SC, Habiba MA.


Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, UK.

We used a neonatal mouse model to examine the histogenesis of uterine adenomyosis, and to test whether adenomyosis is due to an abnormality in myometrial differentiation, or in extracellular matrix proteins expression. We also studied the effects of tamoxifen and estradiol on uterine development, myometrial differentiation, and organization. Female CD1 pups were treated with oral tamoxifen (1 mg/kg) (n=27) or estradiol (0.1 mg/kg) (n=24) from age 1 to 5 days. Uteri from control (n=27) and treated mice were obtained on days 2, 5, 10, 15, and 42 of age. We examined the sections histologically, using image analysis and immunohistochemistry for alpha-smooth muscle actin (alpha-SMA), desmin, vimentin, laminin, fibronectin, and estrogen receptor-alpha. Following tamoxifen exposure, all uteri showed adenomyosis by 6 weeks of age (seen as early as day 10). The inner myometrium showed thinning, lack of continuity, disorganization, and bundling. alpha-SMA expression was normal. Desmin expression normally showed a wave of maturation that was absent in tamoxifen-treated mice. In the estradiol group, adenomyosis was not observed. All uterine layers were normally developed, but hypertrophied. The inner myometrium retained its circular arrangement. There was no difference in the localization of laminin or fibronectin between groups (laminin expression was reduced in the tamoxifen treated uteri). Vimentin could not be detected in all groups. Our results suggest that the development of the inner myometrium is particularly sensitive to estrogen antagonism, and can be affected by steroid receptors modulation. Disruption of the inner myometrium may play a role in the development of uterine adenomyosis.

Publication Types:

Hum Reprod. 2009 Jun;24(6):1241.

Senior experts in endometriosis make a plea that all registered and completed phase II/III clinical trials on endometriosis should be published.

Van Steirteghem A.

Publication Types:

J Dairy Sci. 2009 Jun;92(6):2737-46.

Effect of dietary protein content on the fertility of dairy cows during early and mid lactation.

Law RA, Young FJ, Patterson DC, Kilpatrick DJ, Wylie AR, Mayne CS.

Agri-Food and Biosciences Institute, Agriculture Branch, Hillsborough, BT26 6DR, Northern Ireland.

Ninety autumn-calving Holstein dairy cows (45 primiparous and 45 multiparous; mean parity, 3.1) were allocated to 1 of 3 treatments; 173, 144, or 114 g of crude protein (CP)/kg of dry matter (DM) from calving until d 150 of lactation. On d 151 of lactation, half the animals receiving 114 g of CP/kg of DM went onto 144 g of CP/kg of DM, half of the animals receiving 144 g of CP/kg of DM went onto 173 g of CP/kg of DM, and half of the animals receiving 173 g of CP/kg of DM went onto 144 g of CP/kg of DM, with the remaining animals staying on their original treatments. This resulted in 6 treatments in mid to late lactation: 114/114; 144/144; 173/173; 114/144; 144/173; and 173/144 g of CP/kg of DM. Overall, 95.3% of cows intended for breeding conceived during a 6-mo breeding period. The average pregnancy rates to first service and first plus second service were 30.9% [standard error of the difference (SED), 0.05] and 56.7% (SED, 0.05) respectively. The average 100 d in-calf rate from the start of the breeding period was 70.5%, and at least one abnormal progesterone profile was observed in 62% of animals. An increase in dietary protein content decreased the requirement for treatment of metritis. There was no effect of dietary protein content on any of the reproductive or progesterone measures; for example, days to conception, calving interval, 100 d in-calf rate (from commencement of breeding), days to onset of luteal activity, average luteal phase, average interovulatory interval, or average interluteal interval. An increase in dietary protein content decreased the average daily energy balance. A more positive energy balance was associated with an increased requirement for the treatment of metritis in the current study. Cumulative energy balance was positively associated with conception. There was no effect of the concentration of plasma urea on any of the reproductive variables; however, the concentration of serum leptin was favorably associated with the time to progesterone increase above 3 ng/mL, which has been deemed essential for embryo survival. Additionally, the average peak concentration of progesterone and the duration of the average luteal phase were favorably associated with the interval from calving to conception. The latter relationships emphasize the importance of progesterone in achieving and maintaining pregnancy.

Publication Types:

Mol Immunol. 2009 Jul;46(11-12):2413-8. Epub 2009 May 17.

ERB-041, a selective ER beta agonist, inhibits iNOS production in LPS-activated peritoneal macrophages of endometriosis via suppression of NF-kappaB activation.

Xiu-li W, Wen-jun C, Hui-hua D, Su-ping H, Shi-long F.

Department of Gynecology, First Affiliated Hospital of Nanjing Medical University, 368 North-Jiangdong Road, Nanjing, China.

OBJECTIVE: The aim of the present study was to assess the anti-inflammatory effects of selective ER beta (ER beta) agonist on lipopolysaccharide (LPS)-induced inducible nitric oxide synthase (iNOS) production in peritoneal macrophages (PMs) of endometriosis (EMS). METHODS: ER alpha (ER alpha) and ER beta expressions in PMs were analyzed by RT-PCR and immunoblot. The PMs of endometriosis were exposed to increasing concentrations of ER beta agonist ERB-041 over a period from 0.5 to 8h before stimulation with LPS and the levels of iNOS protein were evaluated by immunoblot. Subsequently, the PMs were pretreated with vehicle, ERB-041 or ER alpha agonist PPT before exposing to LPS. iNOS expression, p65 protein and active extracellular signal-regulated kinases (ERKs) level accumulated in the nuclear were detected by immunoblot. For experiment investigating the role of ERKs in LPS-induced iNOS expression, the PMs were pretreated with U0126, a specific ERK inhibitor, for 60 min before LPS treatment and iNOS expression was detected by immunoblot. RESULTS: The PMs of EMS expressed ER beta to a greater extent compared with normal women. Pretreatment the PMs with ERB-041 resulted in a significant inhibition of LPS-induced iNOS expression and NF-kappaB activation by preventing its nuclear translocation. The ERKs pathway was involved in the LPS-induced iNOS production and was not repressed by the activation of ERs. CONCLUSION: The inhibitory effect of ER beta agonist on LPS-induced iNOS production in PMs of EMS is likely mediated via repressing of nuclear factor-kappa B (NF-kappaB) but not ERKs signaling pathways.

Adv Drug Deliv Rev. 2009 Aug 10;61(10):822-35. Epub 2009 May 13.

Gene therapy of benign gynecological diseases.

Hassan MH, Othman EE, Hornung D, Al-Hendy A.

Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt.

Gene therapy is the introduction of genetic material into patient’s cells to achieve therapeutic benefit. Advances in molecular biology techniques and better understanding of disease pathogenesis have validated the use of a variety of genes as potential molecular targets for gene therapy based approaches. Gene therapy strategies include: mutation compensation of dysregulated genes; replacement of defective tumor-suppressor genes; inactivation of oncogenes; introduction of suicide genes; immunogenic therapy and antiangiogenesis based approaches. Preclinical studies of gene therapy for various gynecological disorders have not only shown to be feasible, but also showed promising results in diseases such as uterine leiomyomas and endometriosis. In recent years, significant improvement in gene transfer technology has led to the development of targetable vectors, which have fewer side-effects without compromising their efficacy. This review provides an update on developing gene therapy approaches to treat common gynecological diseases such as uterine leiomyoma and endometriosis.

Publication Types:

J Steroid Biochem Mol Biol. 2009 Mar;114(1-2):72-7.


Recent advances in 17beta-hydroxysteroid dehydrogenases.

Prehn C, Möller G, Adamski J.

Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Experimental Genetics, Genome Analysis Center, Neuherberg, Germany.

The metabolism of steroids at position 17 is catalysed by a growing number of 17beta-hydroxysteroid dehydrogenases (17beta-HSDs). Several human diseases like breast or prostate cancer, endometriosis,metabolic syndrome and mental diseases were associated with dysfunctions of 17beta-HSDs, which consequently became drug targets. This review will focus on identities of 17beta-HSDs and recent advances in analyses of their physiological roles in steroid and lipid metabolism. It will also address the potential of metabolomics in drug development.

Publication Types:

Biomed Chromatogr. 2009 May 14;23(11):1186-1190. [Epub ahead of print]

Measurement of bisphenol A and bisphenol B levels in human blood sera from healthy and endometriotic women.

Cobellis L, Colacurci N, Trabucco E, Carpentiero C, Grumetto L.

Department of Gynaecology, Obstetrics and Reproductive Medicine, Second University of Naples, Largo Madonna delle Grazie 1, I-80130 Naples, Italy.

A sensitive HPLC method with fluorescence detection was developed for the determination of bisphenol A (BPA) and bisphenol B (BPB) in human blood serum. The detection limits of the method were 0.18 and 0.20 ng/mL for BPA and BPB, respectively. A single-step liquid-liquid extraction was used for the pre-treatment of serum samples. The recoveries of BPA and BPB spiked to sera were 85.6 and 87.7%, respectively. The analyses of sera from both healthy and endometriotic women emphasized the absence of bisphenols in all the control cases (11 women), whereas BPA was found in 30 sera (51.7%) and BPB was found in 16 sera (27.6%) in the group of 58 patients with endometriosis; in nine of such sera BPA and BPB were present simultaneously. Only relatively to the sera quantitated, BPA concentrations ranged from 0.79 to 7.12 ng/mL (mean concentration 2.91 +/- 1.74 ng/mL), whereas BPB concentrations ranged from 0.88 to 11.94 ng/mL (mean concentration 5.15 +/- 4.16 ng/mL). Therefore, the presence of at least one of the two bisphenols was verified in a percentage as high as 63.8% in the sera from endometriotic women, suggesting the existence of a relationship between endometriosis and BPA and/or BPB exposure. Indeed, it is well known that bisphenols can work as xenoestrogens, owing to their structural similarity to natural and synthetic estrogens (e.g. estradiol and dietilstilbestrol). However, further studies are necessary to confirm this hypothesis and to assess the actual dose at which exposures to bisphenols are able to increase the sensitivity of the endometriotic cells to estradiol. Copyright (c) 2009 John Wiley & Sons, Ltd.

Hum Reprod. 2009 Sep;24(9):2348-52. Epub 2009 May 14.

Is there an association between endometriosis and the risk of pre-eclampsia? A population based study.

Hadfield RM, Lain SJ, Raynes-Greenow CH, Morris JM, Roberts CL.

Perinatal Research, Kolling Institute, University of Sydney, B52, Level 2, Royal North Shore Hospital, St Leonard’s, NSW 2065, Sydney, Australia.

BACKGROUND: An association between endometriosis and reduced risk of pre-eclampsia has recently been reported. Longitudinally-linked electronic hospital records are a valuable resource for investigating such findings in a large, population-based sample. Our aim was to determine whether women with a history of endometriosis were at modified risk for pregnancy hypertension or pre-eclampsia. METHODS: A population-based, longitudinal study of all women in the Australian state of New South Wales, aged from 15 to 45 years of age with a singleton birth during the period 2000-2005. Endometriosis was identified using ICD-10 codes. Endometriosis subgroups were analysed based on: (i) site of endometriosis (ovary or peritoneum), (ii) multiple (i.e. two or more) sites affected and (iii) infertility. To investigate the association between pregnancy hypertension and endometriosis, number of weeks gestation at birth and maternal age, we used logistic regression. RESULTS: In the 3239 (1.6%) women with endometriosis diagnosed before their first birth, 352 (10.9%) had a diagnosis of pregnancy hypertension compared with 23,186/205,640 (11.3%) in women with no endometriosis diagnosis (OR 0.96; 95% CI 0.9-1.3). The frequency of pregnancy hypertension and pre-eclampsia was not significantly different in women with more severe endometriosis or endometriosis in conjunction with infertility when compared with those with no endometriosis. After adjusting for maternal age and weeks gestation there was still no altered risk. CONCLUSIONS: We have found no evidence for an association between endometriosis and subsequent risk of either pregnancy hypertension or pre-eclampsia in this large population-based dataset.

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Anticancer Res. 2009 May;29(5):1591-3.

Primary abdominal wall clear cell carcinoma: case report and review of literature.

Williams C, Petignat P, Belisle A, Drouin P.

CHUM, Hôpital Notre-Dame, Gynecologic Oncology Service, 1560 Sherbrooke Est, Montreal QC, H2K 4E9, Canada.

BACKGROUND: The development of a mass in a surgical scar poses a diagnostic dilemma due to similarities in appearance to hernias, abscesses, hematomas or desmoid tumors. Scar endometriosis is uncommon and malignant change within this ectopic tissue is rare. Case Report: The case of a 55-year-old woman with an isolated clear cell adenocarcinoma in an area of scar endometriosis more than 17 years after a cesarean section is presented. Initially, this tumor was thought to be a chronic abscess, but was finally diagnosed as clear cell carcinoma. This case highlights the difficulties in preoperative diagnosis as well as the poor prognosis of these tumors. CONCLUSION: Accurate diagnosis of a lump within a scar is important to define the prognosis and treatment. Further data are needed for the management of this pathology.

Publication Types:

Fertil Steril. 2009 May 12. [Epub ahead of print]

Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial.

Seracchioli R, Mabrouk M, Frascà C, Manuzzi L, Savelli L, Venturoli S.

Minimally Invasive Gynaecological Surgery Unit, Reproductive Medicine Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

OBJECTIVE: To evaluate postoperative long-term cyclic and continuous administration of combined oral contraceptive (OC) pills in preventing endometriosis-related pain recurrence. DESIGN: Prospective, randomized, controlled trial. SETTING: Tertiary care university hospital. PATIENT(S): Three hundred eleven women who underwent laparoscopic excision for symptomatic ovarian endometrioma. INTERVENTION(S): Patients were randomly divided into three groups: nonuser group receiving no therapy, and cyclic user group and continuous user group receiving low-dose, monophasic OC pills for 24 months in either cyclic or continuous administration. MAIN OUTCOME MEASURE(S): Presence and intensity of dysmenorrhea, dyspareunia, and chronic pelvic pain were assessed by a 10-point visual analogue scale (VAS) at 6, 12, 18, and 24 months postoperatively. RESULT(S): A significant reduction in recurrence rate and VAS scores for dysmenorrhea was evident in the continuous users versus the other groups at 6 months, and in cyclic users versus nonusers at 18 months postoperatively. No significant differences in recurrence rate and VAS scores for dyspareunia and chronic pelvic pain were demonstrated among the groups. The increase of VAS scores from 6-24 months during the study period for dysmenorrhea, dyspareunia, and chronic pelvic pain was significantly higher in nonusers than in the other groups. CONCLUSION(S): Long-term postoperative use of OC pills can reduce the frequency and the severity of recurrent endometriosis-related dysmenorrhea.

Hum Reprod. 2009 Sep;24(9):2341-7. Epub 2009 May 12.

Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome.

Stephansson O, Kieler H, Granath F, Falconer H.

Clinical Epidemiology Unit and Centre for Pharmacoepidemiology, Department of Medicine, Karolinska University Hospital and Institute, Stockholm, Sweden.

BACKGROUND: Endometriosis, a common gynaecological disease, is characterized by local and systemic inflammation, which may cause infertility and consequently, increased utilization of assisted reproduction technology (ART). We aimed to estimate the risk for preterm birth, small-for-gestational-age (SGA) birth, stillbirth, Caesarean section, pre-eclampsia and antepartal haemorrhage among women with a previous diagnosis of endometriosis compared with women with no previous diagnosis of endometriosis. METHODS: In a nationwide Swedish study including 1,442,675 singleton births we assessed the association between adverse pregnancy outcome, ART and a previous diagnosis of endometriosis. Information was obtained by linkage of data between 1992 and 2006 in the Medical Birth Register with the Patient Register between 1964 and 2006. RESULTS: There were 13,090 singleton births among 8922 women diagnosed with endometriosis. Compared with women without endometriosis, women with endometriosis had higher risks of preterm birth [adjusted odds ratio 1.33, 95% confidence interval (CI), 1.23-1.44]. Among women with endometriosis 11.9% conceived after ART compared with 1.4% of women without endometriosis. The risk of preterm birth associated with endometriosis among women with ART was 1.24 (95% CI, 0.99-1.57), and among women without ART 1.37 (95% CI, 1.25-1.50). Women with endometriosis had higher risks of antepartal bleeding/placental complications, pre-eclampsia and Caesarean section. There was no association between endometriosis and risk of SGA-birth or stillbirth. CONCLUSIONS: Endometriosis appears to be a risk factor for preterm birth, irrespective of ART. Women with endometriosis may be more likely to be delivered by Caesarean section and to suffer from antepartal haemorrhage/placental complications and pre-eclampsia.

Publication Types:

Fertil Steril. 2009 Oct;92(4):1243-5. Epub 2009 May 12.

Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy.

Brosens IA, Fusi L, Brosens JJ.

Leuven Institute for Fertility and Embryology, Leuven, Belgium.

Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but dramatic cause of perinatal mortality and morbidity. Emerging evidence suggests that pelvic endometriosis may play an important role in the pathogenesis of SHiP.

Colorectal Dis. 2009 Apr 27. [Epub ahead of print]

The early outcome of laparoscopic sigmoid and rectal resection for endometriosis.

Kössi J, Setälä M, Enholm B, Luostarinen M.


Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland.

Aim Deeply infiltrating endometriosis (DIE) is the most severe form of endometriosis and may affect the rectum and sigmoid colon. The most effective treatment is segmental resection. We report our results of rectal and sigmoid resection for this. Method The study comprises all patients who have had laparoscopic bowel resection for rectal or sigmoid endometriosis in the Päijät-Häme Central Hospital between 1 January 2004 and 31 May 2007. Patient demographics, operative details, complications and early postoperative recovery were prospectively collected and analysed. Results Thirty one patients were treated using a multidisciplinary approach. The mean age was 33.6 years (range 21.7 – 48.6) and BMI 24.2 (17 – 40). The mean operation time was 253.5 min (range 56 – 484). There were three sigmoid and 28 rectal resections and 80 concomitant gynecological procedures. Conversion to open surgery was not required. Twent three (74.2%) patients recovered without complications. There were two major complications (anastomosic leakage and rectovaginal fistula). Minor complications included transient urinary retention (2), wound infection (1), pneumonia (1) and undefined fever (2). The mean time to full peroral diet was 3.8 days (range 3 – 7), to first flatus 2.6 days (1 – 4), to first bowel movement 3.5 days (2 – 6) and to discharge 5.7 days (4 – 13). Conclusion Laparoscopic rectal and sigmoid resection for deep intestinal endometriosis is safe with few severe complications rapid recovery. The long-term outcome on symptoms requires further study.

J Reprod Med. 2009 Apr;54(4):255-8.


Intramural pregnancy associated with adenomyosis after in vitro fertilization and embryo transfer: a case report.

Choi DH, Kwon H, Kim YS, Kim JH.

Fertility Center of Bundang CHA General Hospital, Pochon CHA University, Seongnam, South Korea.

BACKGROUND: Intramural pregnancy associated with adenomyosis after in vitro fertilization and embryo transfer is a rare occurrence. CASE: A 37-year-old woman presented with a history of 2 dilation and curettage procedures after 2 miscarriages in the first trimester. She underwent transvaginal ultrasound and systemic and sonography-guided local methotrexate injection. RESULT: The woman was successfully treated, and her fertility was maintained with no complications from the procedure. CONCLUSION: Early diagnosis of intramural pregnancy by skipped menstruation, elevated beta human chorionic gonadotropin (beta-hCG) and intramural cyst not connected the with the endometrium and with no other possible sites of ectopic pregnancy allows the clinician to plan the conservative treatment method at the optimum time, with more opportunity for conservation of fertility.

Publication Types:

J Reprod Med. 2009 Apr;54(4):223-31.

GnRH analogue remarkably down-regulates inflammatory proteins in peritoneal fluid proteome of women with endometriosis.

Ferrero S, Gillott DJ, Remorgida V, Anserini P, Ragni N, Grudzinskas JG.

Reproductive Physiology Laboratory, St. Bartholomew’s School of Medicine and Dentistry, Queen Mary and Westfield College, 48-53 St. Bartholomew’s Close, St. Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE, United Kingdom.

OBJECTIVE: To determine the changes in the peritoneal fluid proteome of women with endometriosis determined by the administration of gonadotropin-releasing hormone analogues (GnRH-a). STUDY DESIGN: Peritoneal fluid samples were collected during laparoscopy from patients under GnRH-a and from women who did not receive any type of hormonal treatment in the 6 months before surgery. Samples were subjected to 2-D gel electrophoresis and compared by computerized analysis. Protein spots differentially expressed between the study groups were identified by liquid chromatography tandem mass spectrometry. RESULTS: More than 470 protein spots were analyzed. Several proteins with significant alterations were found. The down-regulated molecules were isoforms of alpha 2-HS glycoprotein, alpha 1-antitrypsin, S100-A8, haptoglobin alpha chain and vitamin D-binding protein. No protein spot had significantly higher expression in peritoneal fluid of women under GnRH-a than in untreated patients. CONCLUSION: Several inflammatory molecules present in peritoneal fluid are down-regulated during treatment with GnRH-a; administration of this drug reduces the inflammation in the peritoneal cavity.

ANZ J Surg. 2009 Apr;79(4):311-2.

Scar endometriosis.

Shelat VG, Low CH.

Publication Types:

Aust N Z J Obstet Gynaecol. 2009 Apr;49(2):220-5.

A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescents.

Paterson H, Miller D, Devenish C.

Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand.

BACKGROUND: The levonorgestrel intrauterine device (LNG-IUD) is an established treatment for adult women. Although it is being used in adolescents, there is little published research in this age group to date. Recent reviews and editorials have challenged the long-held views that intrauterine devices should not be used in young women. AIMS: This study aimed to identify the patterns of use, including indications and contraindications of the LNG-IUD in adolescents by RANZCOG Fellows practising in New Zealand. METHODS: A postal survey of New Zealand RANZCOG Fellows on their use of the LNG-IUD in females aged 10-19 years. RESULTS: There was a 72% response rate. Half of the respondents had inserted the LNG-IUD in adolescents. Non-inserters identified a significantly greater number of contraindications than inserters (chi2, P < 0.0001). Over half of those respondents who had inserted a device in an adolescent did so fewer than three times per year. Intellectual disability and endometriosis, both unlicensed indications, were the two most commonly identified circumstances for insertion by respondents. CONCLUSIONS: Patterns of insertion of the LNG-IUD in adolescents by RANZCOG Fellows in New Zealand differ and there was equipoise over its use. Further research is required to establish the efficacy, safety and acceptability of the LNG-IUD in adolescents.

Publication Types:

Nippon Rinsho. 2009 May;67(5):1027-30.


Effectiveness of bisphosphonate administration during Gn-RH agonist therapy for endometriosis

[Article in Japanese]

Aisaka K.

Department of Obstetrics and Gynecology, Hamada Hospital.

Gn-RH agonist therapy is widely used for treatment of endometriosis. However, it is well known that there are some side effects due to too much suppress of plasma sex steroid hormone levels. The decrease of the BMD (bone mineral density) is a serious side effect, and the BMD values are decreasing significantly even in the short period during Gn-RH agonist therapy. In this review, the author shows the effect of bisphosphonate administration on the prevention of the bone loss during Gn-RH agonist therapy for the endometriosis. By the administration of EP (estrogen-progestogen) preparations, the decreasing of the BMD can prevent (so called add-back therapy), however, there are some patients who could not be administrated these drugs because of their previous diseases. Bisphosphonate administration is much effective for the prevention of the bone loss compared with EP preparations. From these results, it is concluded that bisphosphonate administration has a beneficial effect for the prevention of the bone loss during Gn-RH agonist treatment.

Publication Types:

IDrugs. 2009 May;12(5):269-70.

American Chemical Society – 237th national meeting & exposition. Part 2.

Beecher N.

Thomson Reuters, 77 Hatton Garden, London EC1N 8JS, UK.

Publication Types:

Hum Reprod. 2009 Aug;24(8):1880-90. Epub 2009 May 8.

Expression of selected tumor suppressor and oncogenes in endometrium of women with endometriosis.

Laudanski P, Szamatowicz J, Kowalczuk O, Kuźmicki M, Grabowicz M, Chyczewski L.

Department of Perinatology, Medical University of Bialystok, ul. Marii Sklodowskiej-Curie 24a, Bialystok, Poland.

BACKGROUND: It is becoming increasingly evident that the eutopic endometrium of women with endometriosis shows certain genetic alterations which are not found in the endometrium of disease-free women. The aim of the study was to compare the expression level of mammalian target of rapamycin (mTOR) tumor suppressor and oncogene-related genes in the endometrium of women with and without endometriosis as well as in ovarian endometriosis. METHODS: A total of 81 regularly menstruating patients were recruited in the study. We applied the micro fluidic gene array to examine the expression of 15 human tumor suppressor and oncogenes in eutopic endometrium of 40 women with endometriosis and 41 controls without endometriosis. In 14 patients with endometriosis, gene expression was also studied in matched ovarian lesions. We studied the following genes: NF1, RHEB, mTOR, PTEN, TSC1, TSC2, KRAS, S6K1, TP53, EIF4E, LKB1, PIK3CA, BECN1, 4EBP1 and AKT1. Immunohistochemical studies were subsequently performed for selected proteins. RESULTS: Of the 15 studied genes, we found significantly higher levels of oncogene AKT1 (P = 0.006) and tumor suppressor gene 4EBP1 (P = 0.01) mRNAs in the eutopic endometrium of women with endometriosis compared with control patients. Immunohistochemistry showed that 4EBP1 and AKT1 proteins were expressed in eutopic endometrium. CONCLUSIONS: Our results suggest that up-regulation of AKT1 and 4EBP1 in eutopic endometrium may be associated with the pathogenesis of endometriosis, but their precise role remains to be established.

Publication Types:

J Steroid Biochem Mol Biol. 2009 Apr;114(3-5):200-6. Epub 2009 Feb 21.

Selective inhibition of 17beta-hydroxysteroid dehydrogenase type 1 (17betaHSD1) reduces estrogen responsive cell growth of T47-D breast cancer cells.

Kruchten P, Werth R, Bey E, Oster A, Marchais-Oberwinkler S, Frotscher M, Hartmann RW.

8.2 Pharmaceutical and Medicinal Chemistry, Saarland University, Saarbrücken, Germany.

The most potent estrogen estradiol (E2) plays a pivotal role in the initiation and progression of estrogen dependent diseases. 17beta-Hydroxysteroid dehydrogenase type 1 (17betaHSD1) catalyses the NADPH-dependent E2-formation from estrone (E1). It is often overexpressed in breast cancer and endometriosis. For this reason, inhibition of 17betaHSD1 is a promising strategy for the treatment of these diseases. In the present paper, we investigate the estrogen responsive cell growth of T47-D breast cancer cells, the intracellular inhibitory activity of non-steroidal 17betaHSD1-inhibitors and their effects on estrogen dependent cell growth in vitro. At equal concentrations the estrogens E1 and E2 induced the same extent of growth stimulation indicating fast intracellular conversion of E1 into E2. Application of inhibitors selectively prevented stimulation of proliferation evoked by E1-treatment whereas E2-mediated stimulation was not affected. Furthermore, intracellular E2-formation from E1 was significantly inhibited with IC(50)-values in the nanomolar range. In conclusion, our findings strongly support suitability of non-steroidal 17betaHSD1-inhibitors for the treatment of estrogen dependent diseases.

Publication Types:

J Gynecol Obstet Biol Reprod (Paris). 2009 Jun;38(4):304-11. Epub 2009 May 9.

Anatomical and histological study of the uterosacral ligament: practical surgical consequences

[Article in French]

Ramanah R, Parratte B, Hubert N, Arbez-Gindre F, Maillet R, Riethmuller D.

Service de gynécologie-obstétrique, CHU Saint-Jacques, 25000 Besançon, France.

OBJECTIVE: To define the vascular and nervous relationships of the uterosacral ligament and to analyze histologically its content for a better description of this structure. MATERIALS AND METHODS: Three fresh fetal cadavers, three embalmed and one fresh adult cadavers were used. The anatomical relationships of the uterosacral ligament were studied by dissecting one fresh fetal pelvis and two embalmed adult pelves. By histological and immunohistological examinations, eight biopsies of the cervical origin of the complexe ligamentaire utérosacral (USLC) were analyzed: four from fresh fetuses, two from a fresh adult cadaver and two from an embalmed adult cadaver. The specimens were stained with haematoxylin eosin safran (HES) coloration, with antinervous cell specific antibodies (PS100) and with antismooth muscle actine antibodies (to visualize vessel walls) before examination under optical microscope. RESULTS: On anatomic examination, the uterosacral ligament was covered by the visceral pelvic fascia. By removing this fascia, the uterosacral ligament appeared to be a condensation of nervous fibers made up of hypogastric and pelvic nerves forming the hypogastric plexus. Histologically, the uterosacral ligament contained connective tissue, nervous fibers, sympathetic nodes, vessels and fatty tissue. No structured ligamentous organization was identified. CONCLUSION: The uterosacral “ligament” is in fact a “ligament complex” integrating connective tissue as well as nervous and vascular elements. Radical wide excisions of the USLC during cancer or endometriosis surgery and uterosacral suspension during pelvic floor reconstructive surgery should be performed with caution in order to preserve pelvic innervation.

Publication Types:

Reprod Biol Endocrinol. 2009 May 9;7:41.

Mechanisms of matrix metalloproteinase-2 (mmp-2) transcriptional repression by progesterone in jar choriocarcinoma cells.

Goldman S, Lovett DH, Shalev E.

Laboratory for Research in Reproductive Sciences, Department of Obstetrics and Gynecology, HaEmek Medical Centre, Afula, Israel.

BACKGROUND: Although the MMP-2 promoter lacks a canonical progesterone response element (PRE), the hormone inhibits MMP-2 expression and is part of treatment protocols in gynecological invasive pathologies, including endometriosis and endometrial hyperplasia. This study aimed to explore the mechanism by which progesterone inhibits MMP-2 expression. METHODS: The effect of progesterone on MMP-2 expression in the JAR human choriocarcinoma cell line was analyzed by gelatin zymography. MMP-2 transcript expression was studied using Northern blot and semi-quantitative RT-PCR. Rat promoter deletion analysis, electrophoretic mobility shift and chromatin immuno-precipitation assays were performed in order to locate the DNA binding site and the transcription factors involved in MMP-2 regulation. RESULTS: Progesterone significantly decreased secretion of pro-MMP-2 and MMP-2 transcript expression level in a dose-dependent manner. Progesterone (1 microM) significantly decreased both human and rat MMP-2 promoter activity (80.1% +/- 0.3 and 81.3% +/- 0.23, respectively). Progesterone acts through the SP1 family transcription factors-binding site, located between -1433 and -1342 bp region from the transcriptional start site of the rat MMP-2 promoter, which are present in the orthologous human MMP-2 promoter. Progesterone receptor (PR), SP2, SP3 and SP4 proteins are constitutively bound to this consensus sequence. CONCLUSION: Progesterone reduces PR and SP4 binding to the MMP-2 promoter, thereby suppressing transcription. Progesterone also promotes SP4 degradation. These novel mechanisms of MMP-2 regulation by progesterone provide the biological rationale for the use of progesterone in clinical settings associated with increased MMP-2 expression.

Publication Types:

Rev Gastroenterol Peru. 2009 Jan-Mar;29(1):55-60.

Endometriosis of the pancreas

[Article in Spanish]

Loja Oropeza D, Alvizuri Escobedo J, Vilca Vasquez M, Altamirano Bautista J.

Medico Internista, Departamento de Medicina Interna, Hospital Nacional Arzobispo Loayza, Peru.

The case of a 23-year old woman with a history of epigastric pain, a palpable tumor that covered the epigastrium and the left hypochondrium, and an episode of acute pancreatitis was reported. The computerized tomography revealed a pancreatic cyst. The CA-125 increased significantly. An exploratory laparotomy was performed, finding an endometrioma. The pathological anatomy showed necrotic tissue, mucus and blood, with a presence of macrophages with hemosiderin phagocytosis. The symptoms and signs, pathogenesis and treatment of the endometriosis of the pancreas are discussed.

Publication Types:

Fertil Steril. 2009 May 5. [Epub ahead of print]

Immunohistochemical evaluation of endometriotic lesions and disseminated endometriosis-like cells in incidental lymph nodes of patients with endometriosis.

Mechsner S, Weichbrodt M, Riedlinger WF, Kaufmann AM, Schneider A, Köhler C.

Endometriosis Research Center Charité, Department of Gynecology, Charité, Campus Benjamin Franklin, Berlin, Germany.

OBJECTIVE: To investigate the frequency of endometriotic lesions and disseminated endometriotic-like cells in a series of incidentally removed lymph nodes (LNs) in patients with endometriosis. DESIGN: Retrospective study. SETTING: University hospital endometriosis center. PATIENT(S): Premenopausal patients underwent surgery because of endometriosis-associated symptoms. INTERVENTION(S): Retrospective analysis of 108 coincidentally resected LNs of 24 patients with endometriosis. To identify endometriotic cells, immunohistochemical analysis of estrogen and progestogen receptor (ER-PR), CD10, and cytokeratin was performed. MEAN OUTCOME MEASURE(S): The occurrence of endometriotic lesions (ER-PR, CD10, and cytokeratin positive) and disseminated endometriotic-like ER-PR-positive cells in LNs. RESULT(S): Deep infiltrating endometriosis was diagnosed in 23 of the 24 patients with incidentally removed LNs. In 8 of 24 (33.3%) patients with incidentally removed LNs, typical endometriotic lesions were detected. Disseminated ER-PR-positive cells were found in 17 of 24 patients (70.8%). Lymph node involvement correlated directly with the deep infiltrating endometriosis lesional size. CONCLUSION(S): Estrogen receptor-progestogen receptor-positive endometriotic lesions and disseminated endometriotic-like cells frequently are detected in LNs of patients with deep infiltrating endometriosis and, therefore, might reflect “nonlocalized” disease. If clinical significance of such lesions were provided, adjuvant hormonal treatment could be considered as a possible additional mode of therapy. 

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