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PubMed2004

[Expression of hepatocyte growth factor and its receptor c-met gene in the endometrium of women with endometriosis].

OBJECTIVE: To study the role of hepatocyte growth factor (HGF) and its receptor (c-Met) in the pathogenesis of endometriosis. METHODS: In situ hybridization and immunohistochemistry method was used to examine HGF mRNA and protein expression in eutopic and ectopic endometrium obtained from 54 women in reproductive age with endometriosis confirmed by laparoscopy and histological examination (including 28 cases of stages I/II and 26 of stages III/IV) and from the endometrium of 24 healthy fertile women. RESULTS: In patients with endometriosis, the positivity rate of HGF/c-Met expression was similar in the eutopic and ectopic endometria, but the number of positive cells and expression intensity were much higher in ectopic endometrium. The positive expression rate varied little between the proliferative and secretory stages of the endometrium. Compare with the healthy controls, patients with endometriosis of stages I/II and III/IV had significantly elevated positivity rate of HGF and c-Met expressions in either eutopic and ectopic endometrium, but without significant difference between the two patient groups (P<0.01). The rate of strong c-Met protein expression was significantly higher in III/IV endometriosis than in the controls, without statistical difference between other groups. CONCLUSION: The expressions of HGF and c-met gene are correlated with the pathogenesis of endometriosis, which is preceded by eventful changes in the biological behavior of the eutopic endometrium.

Endometriosis↗
PubMed2004

[Comparison of steroid metabolism markers in endometrium of women with endometriosis, endometrial hyperplasia and without pathological changes of endometrium].

OBJECTIVE: To find out any relationship between presence of P450 aromatase and estrogen (ER) and progesterone (PR) receptors in eutopic endometrium of women with and without endometriosis and in estrogen-dependent gynecologic lesions (endometrial hyperplasia and endometriosis). DESIGN: Retrospective study. SETTING: Sikl's Institute of Pathology, Department of Gynecology and Obstetrics, University Hospital and Medical Faculty in Pilsen, Charles University. METHODS: The examined samples were obtained from patients of Department of Gynecology and Obstetrics, University Hospital and Medical Faculty in Pilsen (2001-2002) and elaborated in Sikl's Institute of Pathology, University Hospital and Medical Faculty in Pilsen. There were four experimental groups: endometrial hyperplasia, endometriosis and eutopic endometrium of women with and without endometriosis. P450 arom, ER and PR were detected by using immunohistochemical methods with specific antibodies. RESULTS: P450 aromatase was detected in a higher amount in endometriosis, hyperplasia and some samples of metaplasia. Estrogen and progesterone receptors were detected in all examined tissues. Number and spreading of ER and PR depend on the phase of the cycle. Lower number of ER was found in atrophic and metaplastic endometrium and in atypic hyperplasia. There was not found any direct relationship between presence of P450 aromatase and both types of receptors. CONCLUSION: Steroid metabolism in examined pathologically changed tissues is due to molecular aberrations regulated on the local level. It is not possible to use detection of P450 aromatase as a diagnostic test for pelvic endometriosis.

Adult↗
PubMed1992

Treatment of endometriosis with leuprorelin acetate depot: a German multicentre study.

During the past decade, the development of various gonadotrophin-releasing hormone (Gn-RH) agonists, which induce reversible hypo-oestrogenism has opened a new area in the medical management of endometriosis. In an open, multicentre phase III study, the efficacy, tolerance and safety of the Gn-RH agonist leuprorelin acetate were tested. The preliminary results of 104 women treated in seven German centres are presented. Pelvic endometriosis was diagnosed by laparoscopy and classified according to the American Fertility Society scoring system: 33% of patients had minimal, 22% mild, 28% moderate and 8% severe endometriosis and in 9% no pathological results were obtained. The patients' mean age was 30 +/- 6 years and 66 had infertility problems. Treatment was started within the first 3 days of the menstrual cycle and consisted of a subcutaneous injection of leuprorelin acetate 3.75 mg, repeated once monthly over 24 weeks. A follow-up period of 12 months after the last injection has been completed in 70 patients, including a second laparoscopy. At all visits, symptoms were evaluated, physical examinations performed, and blood samples collected for haematological screening, serum chemistry determinations and measurement of the gonadotrophins oestradiol and progesterone and leuprorelin acetate. The median score at laparoscopy fell from 12 before operation to 8 after operation and 2 after treatment with leuprorelin acetate. Of the total number of patients, 89% had improvements in their endometriosis, 8% a deterioration and 3% no change. Patients reported improvement in the following: dysmenorrhoea 93%, dyspareunia 62% and pelvic pain 70%. However, all women complained of at least one of the following symptoms: hot flushes 86%, sleep disturbance 62%, sweating 61%, headache 41%, nausea 32% and depression 20%. Fifty-five percent of patients reported additional side effects such as vaginal dryness, fatigue and lower abdominal pain. After the third injection, amenorrhoea persisted in 94% of the women. Four weeks after the first leuprorelin acetate injection median concentrations of oestradiol fell from 45 pg/ml to 11 pg/ml, follicle-stimulating hormone from 7 U/L to 3 U/L and luteinising hormone from 5 U/L to 1 U/L and remained almost unchanged over the observation period. During the 6 months' treatment, laboratory parameters showed no significant deviations from normal; only total cholesterol, high-density lipoprotein cholesterol and alkaline phosphatase increased. Treatment results were judged as good and satisfactory in 82% and 11% of cases, respectively. On the basis of this study, it can be concluded that leuprorelin acetate treatment is safe, well tolerated and effective in the medical management of endometriosis and endometriosis-related complaints.

Adult↗
PubMed2004

Thoracic endometriosis: a report of two cases.

We describe two patients with recurrent hemopneumothorax associated with pelvic endometriosis. The first patient a 37-year-old nulliparous lady with recurrent bilateral hemopneumothorax. She had a past history endometriosis years earlier. Laparoscopy and biopsy confirmed widespread endometriosis including in the omentum. Recurrence of the hemopneumothorax stopped after danazol therapy suggesting thoracic endometriosis as the cause of hemopneumothorax. The second lady is 47-years old with 2 children. She first presented with hemopneumothorax associated with menstrual period but ultrasound of pelvis did not reveal evidence of endometriosis. However, when she presented with a second episode of hemopneumothorax one year later, she was confirmed to have endometriosis and no further recurrence after treatment with Gonadotropin-releasing hormone analogue.

Adult↗
PubMed2004

Laparoscopic hysterectomy for advanced endometriosis including rectosigmoid disease.

Endometriosis is best treated by surgical excision. This can be accomplished either by excision of the endometriosis with reproductive tract preservation or by excision of endometriosis with hysterectomy. This latter approach eliminates endometriosis in the muscle of the uterus (where it is called adenomyosis) and is especially effective for pelvic pain. Ovarian preservation can be considered using hysterectomy if the surgeon excises most of the endometriosis. Techniques to excise endometriosis, including rectosigmoid disease, and perform hysterectomy are detailed in this chapter.

Adult↗
PubMedDate not supplied

Interstitial cystitis and endometriosis in patients with chronic pelvic pain: The "Evil Twins" syndrome.

OBJECTIVE: To determine the prevalence of interstitial cystitis and endometriosis in patients with chronic pelvic pain. METHODS: A prospective analysis was conducted in 178 women with CPP who presented with bladder base/anterior vaginal wall and/or uterine tenderness, with or without irritative voiding symptoms. The Potassium Sensitivity Test was used to assess bladder epithelial dysfunction. Patients were evaluated with concurrent laparoscopy and cystoscopy with hydrodistention. RESULTS: Laparoscopic findings among the 178 patients with chronic pelvic pain supported a diagnosis of endometriosis in 134 (75%) patients, and cystoscopy confirmed a diagnosis of interstitial cystitis in 159 (89%) patients. Both interstitial cystitis and endometriosis were diagnosed in 115 patients (65%). The Potassium Sensitivity Test was positive in 146 (82%) patients, with 140 (96%) of these patients diagnosed with interstitial cystitis and 105 (72%) with endometriosis. CONCLUSIONS: Results of this prospective study show that interstitial cystitis and endometriosis may frequently coexist in patients with chronic pelvic pain. A positive Potassium Sensitivity Test accurately predicted the presence of interstitial cystitis in 96% of these patients with chronic pelvic pain, as confirmed by cystoscopic hydrodistention. It is necessary to consider the diagnosis of endometriosis and interstitial cystitis concurrently in the evaluation of patients with chronic pelvic pain to avoid unnecessary delay in identifying either condition.

Adolescent↗
PubMedDate not supplied

Synchronous rectovaginal, urinary bladder, and pulmonary endometriosis.

BACKGROUND: Extragenital endometriosis is an uncommon condition that can affect almost any organ system and tissue in the human body. Disease involving multiple distant sites is extremely uncommon. METHODS: We report a rare case of synchronous rectovaginal, urinary bladder, and pulmonary endometriosis. We performed a Medline literature search using keywords "endom etriosis," "recto vaginal," "pulmonary," "bladder," "ureteral," "bowel," "extrapelvic," and "extragenital" and were unable to find any prior case reports of such findings. A 31-year-old female presented with catamenial dysuria of 1-year duration, pleurisy associated with spontaneous pneumothoraces of 7 months' duration and a long-standing history of pelvic pain. A multispecialty team with experience in endoscopic techniques was assembled, consisting of a thoracic, a urologic, and a gynecologic surgeon. Video-assisted thoracoscopic surgery with fulguration of all visible pleural endometriosis and pleurodesis was performed, followed by laparoscopic segmental bladder wall endometrioma excision and resection of rectovaginal endometriosis. Twelve months after surgery and without additional hormonal treatment, the patient is symptom free. CONCLUSION: Extragenital endometriosis may coexist in multiple sites. A high index of suspicion aids in the diagnosis. A multidisciplinary approach in a tertiary center, followed by appropriate surgical eradication of visible disease, can successfully treat endometriosis even in such extreme cases.

Adult↗
PubMed2005

[Changes of serum epithelial neutrophil-activating peptide-78 in patients with endometriosis].

OBJECTIVE: To investigate the role of serum epithelial neutrophil-activating peptide-78 (ENA-78) in the pathogenesis of endometriosis. METHODS: Serum concentrations of ENA-78 were measured by means of enzyme-linked immunosorbent assay (ELISA) in 42 patients with endometriosis (20 in stages I and II and 22 in stages III and IV) in comparison with 25 women without endometriosis (control group). RESULTS: Serum concentrations of ENA-78 were significantly higher in endometriosis group than in the control group (2.97+/-1.91 ng/ml vs 0.72+/-0.24 ng/ml, P>0.001), and ENA-78 levels in stages III and IV were significantly higher than those in stages I and II (4.48+/-1.25 ng/ml vs 1.30+/-0.74 ng/ml, P>0.001). Significant difference in ENA-78 levels between follicular phase and luteal phase was found in neither of the groups. CONCLUSION: Patients with endometriosis have elevated serum ENA-78 levels, which might be a pathogenic factor of endometriosis.

Adult↗
PubMed2004

[Influence of GnRH analogue on the intensification of endometriosis symptoms and infertility treatment].

OBJECTIVES AND STUDY DESIGN: The aim of this study was to evaluate the influence of the treatment with oral doses of 50 mg GnRH analogue on the intensification of endometriosis symptoms and infertility amongst women with evident symptoms of endometriosis in comparison with placebo group. A group of 34 women at the age from 18 to 45 were introduced into the study. The inclusion criteria for investigated population contained: endometriosis symptoms, endometriosis diagnosed by laparoscopy, its surgical or pharmacological treatment, negative pregnancy test score and regular menses. The patients were divided into 2 groups: investigated group and control group. Women completed "Diary" every day in which they estimated main endometriosis symptoms: dysmenorrhea, dyspareunia, pelvic pain and vaginal bleeding (according to Pain Grading Scale). The intensification of dysmenorrhea and vaginal bleeding was reduced in the investigated group in comparison with control one. These differences were statistically significant. Although the extremity of dyspareunia was decreased in two groups, this correlation was statistically significant only in the investigated group. Pelvic pain evaluation showed that its level was lower in the investigated group (p > 0.05). It was found that 11 women (investigated group) and 5 women (control group) got pregnant after the period of 12-week treatment. CONCLUSIONS: GnRH analogues have an efficient influence on the reduction of endometriosis symptoms. GnRH analogues could be used in the management of infertility.

Adult↗
PubMed2005

[Application of two dimensional electrophoresis,western blot and mass spectrum to screen markers of endometriosis].

OBJECTIVE: To find out markers of endometriosis. METHODS: The two dimensional gel images of proteins extracted from eutopic endometrium from endometriosis patients and controls were analyzed by software Phoretix 2D,and the proteins expressed differently were identified primarily by query of data base. The proteins extracted from ectopic endometrium of ovarian endometriosis were transferred from two dimensional gel onto nitrocellulose membranes, followed by incubation with sera from women with and without endometriosis. Analyzed by MALDI-TOF-MS, the proteins hybridized differently were identified through their Peptide Mass Footprints. RESULTS: Having compared the reproducible two dimensional gel images of proteins from eutopic endometrium of women with and without endometriosis,we obtained 11 proteins expressed differently. Through Western Blot technique,we found three proteins hybridized differently which were identified as vimentin, beta-actin and ATP synthase beta subunit respectively. CONCLUSION: The protein expression spectra of eutopic endometrium from patients with endometriosis are significantly different from those of the controls, and the anti-endometrial autoantibodies against vimentin, beta-actin and ATP synthase beta subunit may be induced.

Actins↗
PubMed2001

[Endometriosis in adolescents: analysis of 6 cases].

OBJECTIVE: To review the diagnosis and treatment of endometriosis in adolescents and to evaluate the surgical and medical treatment options for this special population. METHOD: To review the 6 cases of adolescent endometriosis and to review the literature research. RESULTS: Three hundred and ninety nine cases under age 18 had undergone gynecological operation. So the incidence among this period is 1.8% (6/339) in hospitalized adolescents. Four cases have complicated genital tract anomalies. Preoperative diagnosis is rare. Good prognosis is expected in most patients. Only 1 case relapsed 9 years after medical therapy. Endometriosis is the most common cause of chronic pelvic pain in adolescents. There may be a natural progression of endometriosis from atypical lesions in adolescents to classic lesions in adults. Congenital abnormalities of the reproductive tract are the main reason for the adolescent endometriosis. CONCLUSIONS: Endometriosis should be strongly suspected in adolescent with chronic pelvic pain especially with no response to oral contraceptives and nonsteroidal antiinflammatory medicine. The treatment involves the surgical operation and medicine. Adolescence;

Adolescent↗
PubMed2001

[Expression of vascular endothelial growth factor and thrombospondin-1 in the ectopic and eutopic endometrium of women with endometriosis].

OBJECTIVE: To detect the expression of vascular endothelial growth factor (VEGF) and thrombospondin (TSP)-1 mRNA in the ectopic and eutopic endometrium of patients with endometriosis. METHODS: Thirty-two specimens of ovarian endometrioma, 12 red peritoneal lesion, 8 uterosacral ligament nodule, and 30 matched eutopic endometrium were biopsied from 38 patients with endometriosis, another 25 specimens of endometrium were biopsied from women without endometriosis. Reverse transcript-polymerase chain reaction (RT-PCR) and Northern Blot analysis were utilized to examine VEGF mRNA and TSP-1 mRNA expression and their relative levels in the above endometrium. RESULTS: Among endometriotic lesions, red peritoneal lesion expressed higher level of VEGF and lower level of TSP-1, whereas ovarian endometrioma expressed lower level VEGF and higher level of TSP-1. Eutopic endometrium of women with endometriosis had higer level of VEGF expression and lower level of TSP-1 expression than women without endometriosis. CONCLUSIONS: The expression of VEGF and TSP-1 in endometriotic lesion appears to be associated with its neovalscualization extent. The imbalance in expression of VEGF and TSP-1 in endometrium might be related to the development of endometriosis and its biological behavior.

Blotting, Northern↗
PubMed2004

[Diagnosis and treatment of endometriosis in adolescents].

OBJECTIVE: To discuss the clinical feature, diagnosis and treatment options of adolescent endometriosis. METHODS: The records of adolescent patients with endometriosis (11-20 years old) who were admitted to First, Second and Third Affiliated Hospital of Zhongshan University and Guangdong Provincial People's Hospital between 1990 and 2003 were retrospectively reviewed. RESULTS: Forty-three patients were diagnosed as endometriosis either by laparotomy or laparoscopy. The chief symptoms leading to the diagnosis were palpable pelvic mass (18/43), dysmenorrhea (15/43), chronic pelvic mass (10/43) and acute pelvic pain (4/43). The majority of patients (53%) presented with the revised AFS-r classification stage III, 8 cases (19%) presented with stage I, 3 cases (7%) with stage II and 9 cases (21%) with stage IV. Nine cases (21%) had complicated genital tract abnormalities. Conservative operations, including salpingo-oophorectomy ins cases, ovarian cystectomy in 31 cases and laparoscopic vaporization in 8 cases, were performed. Surgeries were followed by hormonal suppression using oral contraceptives in a continuous or cyclic manner. CONCLUSIONS: Adolescent endometriosis may occur around 4.6 years after menarche. The chief symptoms are palpable pelvic mass and dysmenorrhea. The treatment of endometriosis in adolescence does not differ principally from that in adult women. In the treatment of endometriosis and for the prevention of recurrence, it is recommended to give 3-6 months of oral contraceptives.

Adolescent↗
PubMed2005

Colonic obstruction due to rectal endometriosis: report of a case.

Although endometriosis is a common disease in women of childbearing age, intestinal endometriosis is unusual and may cause clinically significant complications. We report a 46-year-old woman with rectal endometriosis who presented with intestinal obstruction. She was operated on with a preoperative diagnosis of malignancy. The diagnosis of endometriosis was made only after histological examination of the resected specimen. Intestinal endometriosis has a diverse clinical spectrum, with nonspecific features in many patients. In female patients who have unexplained digestive complaints, endometriosis should also be considered in the differential diagnosis.

Biopsy↗
PubMed2005

[Combined usage of duphaston and reaferon for infertility treatment in patients with endometriosis].

A new method of treatment of endometriosis includes combination of surgical and hormonal therapy. Surgical method included excision of tissue with endometriosis, while the hormonal therapy involved the combination of dufaston and reaferon-EC (recombinant interferon alpha 2b). The aim of this study was to develop effective method of treatment of infertility caused by endometriosis using combination of dufaston and reaferon. There were 114 patients under observation who suffered from endometriosis and infertility. At the first stage of treatment thermokouterisation of area with endometrosis has been used. At the second stage of treatment all patients were divided into different clinical groups. To 34 patients from the study group reaferom-EC has been administered on the 5th, 8th, 10th, 12th, 14th days of menstrual cycle. The control group was represented by 80 patients, which was divided into two subgroups, 40 patients in each group. The patients from the first subgroup got hormonal therapy 20 mg dufaston from the 5th to 25th days of menstrual cycle, while the patients from the second subgroup got 20 mg dufaston from the 15th-20th to 25th days. The treatment was successful among the patients who got the combination of reaferon and dufaston, the frequency of pregnancy in the study group reached 52% vs. 27.3% in the control group (p>0.05). Those patients who had so called "small form" of endometriosis became pregnant in 34% cases in the study group and in 22.7% cases in the control group. Patients who had endometriosal cystoma became pregnant in 18.7% in the study group, but only in 9.4% in the test group, which shows that the treatment is less effective among these categories of patients. As a result of our study it is proved that the method of combination of reaferon and dufaston gives a chance to increase therapeutic effect and the number of pregnancy among the patients with endometriosis.

Adult↗
PubMed2005

[Diagnostic value of the detection of aromatase cytochrome P450 and CA125 for endometriosis].

OBJECTIVE: To evaluate the diagnostic value of examining endometrial biopsy specimens for aromatase cytochrome P450 and CA125 for endometriosis. METHODS: The expression of aromatase cytochrome P450 in endometrium was detected by immunohistochemical analysis for 36 endometriosis women and 22 non-endometriosis but subfertility or pelvic pain women served as controls; the serum CA125 levels were measured by chemical radiation method. RESULTS: By measuring serum CA125, the sensitivity of the serum CA125 assay was 44%, the specificity was 82%, the positive predictive value was 80%, and the negative predictive value was 47%; the sensitivity of aromatase cytochrome P450 in biopsy endometrium of endometriosis was 82%, the specificity was 59%, the positive predictive value was 76%, and the negative predictive value was 67%. CONCLUSION: The combination assay of aromatase cytochrome P450 in eutopic endometrium and CA125 can be used as a diagnostic test for endometriosis, especially for the early stage of endometriosis, which is superior to the assay of CA125.

Adult↗
PubMed2006

Serum and peritoneal abnormalities in endometriosis: potential use as diagnostic markers.

Endometriosis is an ambiguous disease and its exact pathogenesis still remains elusive to clinicians and scientists. Local and systemic aberrations in immune response are associated with endometriosis. This article reviews the literature regarding various immunological factors such as cytokines, growth factors, adhesion molecules and angiogenic factors involved in the etiopathogenesis of this disease. Our review summarizes the literature regarding biomarkers, which may be reliable nonsurgical tools used in the diagnosis of endometriosis. Superior biomarkers characterized by high sensitivity, specificity and predictive value can help in the early detection and monitoring of disease progression as well as its response to therapeutic treatments critical for its management. A combination predictive model utilizing multiple biomarkers rather then individual markers alone is proposed to improve the diagnostic performance for identifying women with a high likelihood of having endometriosis. Immunomodulators and angiogenic factor blockers have a potential for endometriosis treatment and also to alleviate the pain or infertility associated with the disease. Potential new therapeutic agents include modulators, such as cytokine receptor blockers and angiogenic receptor blockers, presently used for treating endometriosis.

Ascitic Fluid↗
PubMed2006

[Ureteric and bladder involvement of deep pelvic endometriosis. Value of multidisciplinary surgical management].

OBJECTIVES: To evaluate the clinical features, staging by medical imaging, treatment strategy and results of surgical management of deep pelvic endometriosis with bladder and/or ureteric involvement. MATERIALS AND METHODS: Eighteen cases of ureteric and/or bladder deep pelvic endometriosis (DPE) were treated in our centre between 1996 and 2004. Preoperative data (clinical symptoms, MR imaging), intraoperative data (resection and urinary tract diversion procedures, associated procedures on the genital and gastrointestinal tracts), and postoperative data (histological results, complications, anatomical follow-up by imaging and functional assessment) were reviewed. RESULTS: Urinary symptoms were present in 55% of cases, genital symptoms were present in 83% of cases and gastrointestinal symptoms were present in 46% of cases. A combination of gynaecological and gastrointestinal lesions was demonstrated on imaging in 82% of cases. The mean postoperative follow-up was 16 months (range: 6-36 months). Six patients presented anterior vesical endometriosis. In these cases, the sensitivity and specificity of MRI were 100%. Six partial cystectomies were performed. All corresponded to endometriotic lesions on histological examination. No cases of recurrence of vesical endometriosis were observed. Posterior endometriosis with ureteric involvement was observed in 13 patients (including one with vesical endometriosis). The ureteric lesion was asymptomatic in 8 out of 13 cases (61%). The diagnostic sensitivity of MRI was 92% for posterior nodules, identifying 4 lateral parametrial nodules and 8 median retrocervical nodules. Ureterohydronephrosis was observed in 3 patients with lateral parametrial nodules and 8 patients with median retrocervical nodules, and was bilateral for 3 patients, i.e. 14 dilated renal units. Surgical management consisted of 2 ureteric resections with end-to-end anastomosis, 3 psoas bladder reimplantations, and 9 ureterolyses (8 patients). Two out of 13 patients (15%) with ureteric lesions treated by ureterolysis developed recurrence of the ureteric stricture with upper tract dilatation related to recurrence of the lateral nodule. In 14 patients, genital and/or gastrointestinal resections were associated with the urinary tract procedure. CONCLUSION: Preoperative evaluation of all DPE lesions is based on MRI with reconstruction images of the ureter in the presence of urinary tract lesions. Systematic ureteric stenting prior to surgical dissection of the pelvic wall is recommended in patients with posterior nodules and in the case of partial cystectomy for anterior nodules when the ureteric meati are adjacent to the lesion. Ureteric reimplantation onto a psoas hitch bladder must be performed when the DPE lesions are extensive and partly resected or invade the ureteric wall. The frequency of associated lesions (urinary, gynaecological gastrointestinal) justifies a multidisciplinary surgical approach.

Adult↗