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PubMed1984

Pelvic endometriosis and tubal inflammatory disease.

The incidence of tubal inflammatory disease in women with endometriosis who had undergone surgery was compared with that in women who had undergone similar operative procedures but who did not have endometriosis and with that in a group of clinically healthy women undergoing tubal sterilisation. The incidence of tubal inflammatory lesions was much higher in all women who had undergone surgery than in those undergoing sterilisation, but there was no difference in the incidence of tubal lesions between those women with endometriosis and those not suffering from this disease. Women with endometriosis and tubal inflammatory disease did not have a significantly lower mean gravidity than did those with healthy tubes. It is concluded that there is no specific association between endometriosis and tubal inflammation and that tubal inflammatory disease is unlikely to be a significant factor contributing to infertility in endometriosis.

Endometriosis↗

PubMed1982

Danazol in the treatment of endometriosis and infertility.

Endometriosis is an enigmatic condition of unknown cause and poorly understood histogenesis. It affects women in their reproductive years limiting their fertility and seriously impairing their health. It is not entirely clear what is the mechanism of infertility associated with endometriosis but it is well accepted that treatment of the latter improves significantly chances for conception. Danazol is a synthetic steroid, derivative of 17 alpha-ethinyl testosterone. It suppresses ovarian function through a direct inhibitory effect on ovarian steroidogenesis and through inhibition of FSH and LH secretion. The drug is a mild androgen but has no estrogenic or progestational properties. In normally cycling women danazol induces the state of pseudomenopause characterized by complete suppression of ovarian function, amenorrhea and hypoestrogenic state. Uterine endometrium and ectopic endometrium undergo atrophy during treatment, resulting in a regression and disappearance of endometriosis. The therapy should commence with the onset of the menstrual period and should be continued for three to six months or longer depending on the initial extent of the disease and a clinical response. The clinical and symptomatic improvement and disappearance of endometriosis is observed in over 80% of the patients. The corrected pregnancy rate after discontinuation of treatment exceeds 70%, but depends on the initial extent of the disease and on the severity and location of pelvic adhesions. Pseudomenopause alone has a limited value in the treatment of infertility in patients with extensive endometriosis combined with severe pelvic adhesive disease. In such patients a combined medical and surgical treatment offers advantages over each of these two approaches when applied individually. A three to six month course of danazol prior to conservative surgery facilitates surgical resection of endometriosis and limits its extent and is associated with better clinical results.

Amenorrhea↗

PubMed1982

[Endometriosis and cancer].

Such features as single-phase cycling, endocrine infertility, endometriosis concomitant endometrial hyperplasia, endometrial carcinoma and endometriosis with concomitant uterine myoma and proliferative processes in the mammary glands as well as hormono-metabolic disorders frequently occur both in endometriosis and endometrial carcinoma and, therefore, suggest that pathogenesis of these hormone-dependent diseases has something in common. It was established experimentally that the likelihood of proliferation development and malignancy in the endometrium is great, when it is dislocated and, particularly, when hormonal disorders occur. An autoimmune nature of endometriosis is suggested. The similarity and differences in diagnosis of endometriosis and some types of cancer as well as common principles of treatment of the diseases are discussed. It is recommended in conclusion that patients with endometriosis of the uterus, ovary and other sites should be referred to a group at high risk for cancer.

Adult↗

PubMed1994

[Endometriosis in clinical practice].

The authors are investigated the frequency of the cases of genital endometriosis, its most frequent localization and the choice of treatment on 864 women patients who have undergone operations connected with other gynaecological disorders and on 32 women patients, suffering sterility and proved endometriosis. Most frequent are the cases of combination between uterine myoma and endometriosis of the uterine wall-5.74% and with the patients who have undergone surgery for malignant disease between endometrium carcinoma and uterine endometriosis. The conservative treatment is the method of choice with the infertile women suffering a slight stage of endometriosis and the least conservative method is the surgical treatment, followed by a hormonal treatment resulting in the increase of the fertility of women who have the average stage of development of endometriosis.

Adult↗

PubMed1995

[Epidemiological study on risk factors of pelvic endometriosis].

In order to study the risk factors associated with pelvic endometriosis, a case-control study was carried out from Mar. 1991 to Feb. 1993 in our gynecological ward. A total of 190 cases with endometriosis and 192 patients with non-endometriosis diseases (control group) were interviewed. Single factor analysis indicated that risk factors related to endometriosis were menorrhagia (OR = 3.09), short menstrual cycle (< 27 days) (OR = 1.89), complicated with uterine leiomyoma and (or) adenomyosis (OR = 1.84), occupation as cader (OR = 1.71), all with statistical significance (P < 0.05). The artificial abortion rate of married patients was similar between the two groups, but the abortion frequency was fewer in endometriosis patients (P < 0.05). Multifactor analysis confirmed that the risk factors associated with endometriosis were menorrhagia and occupation as cadre only.

Adult↗

PubMed1995

[Painful symptoms of pelvic endometriosis].

From February 1991 to January 1993, a total of 383 women of child-bearing age who were hospitalized in gynecologic ward were investigated for their painful symptoms, of whom 192 were found to be patients with endometriosis (endometriosis group). The other 191 cases without endometriosis served as the control. The results showed that the frequency of dysmenorrhea, lower abdominal or pelvic pain, dyspareunia, anal pressure pain during menstruation were 65.6%, 44.3%, 30.2% and 32.3% respectively in patients with endometriosis, and 37.7%, 33.0%, 20.9%, and 20.4% respectively in the control, the former were all significantly higher than the later respectively. Whereas the frequency of all the painful symptoms and the severity of dysmenorrhea were not correlated with the stages of endometriosis. It is suggested that patients with endometriosis have more painful symptoms besides dysmenorrhea, which are very useful for better recognization and more accurate diagnosis of this disease.

Abdominal Pain↗

PubMed1995

Menstrual patterns, pain symptoms, body mass index and smoking habits in women with endometriosis.

Epidemiologic studies have investigated the risk factors for endometriosis, but currently the results are still controversial. The aim of this study is to evaluate the incidence of some of the risk factors that have been involved with endometriosis to better understand the natural history and evolution of this disease. The medical records of 186 women with laparoscopic diagnosis of endometriosis were studied. We analysed the characteristics of the menstrual cycle, the presence of pain symptoms and the familiarity for endometriosis. Moreover, the body mass index of all patients and the average cigarettes smoked per day were calculated. Despite the fact that some of the data collected resulted to be statistically significant when compared among the four stages of endometriosis, the roles of the many factors that have been associated with the risk or the evolution of pelvic endometriosis still remain unknown.

Adult↗

PubMed1994

Preoperative serum CA-125 and CA-72 in predicting endometriosis in infertility patients.

CA-125, a high-molecular-weight glycoprotein antigen, has been identified as a possible marker for endometriosis, with discrepant results. CA-72, another glycoprotein antigen, is expressed by a variety of adenocarcinomas, including endometrial carcinoma. This controlled, prospective study evaluated serum CA-125 and CA-72 levels in 35 consecutive patients with endometriosis of varying stages and in patients without endometriosis. Serum CA-125 and CA-72 were measured with immunoradiologic methods prior to diagnostic laparoscopy for infertility evaluation. Endometriosis, scored by American Fertility Society guidelines, was identified in 19 patients, and 16 patients had normal pelvic findings. CA-125 and CA-72 levels were not different between patients with no pelvic disease (controls) and women with stage I-IV endometriosis. The positive predictive value of CA-125 was 0%; the negative predictive value was 47%. The positive predictive value of CA-72 was 5%; the negative predictive value was 53%. CA-72 and CA-125 are not helpful in the routine workup of the infertile woman to determine the likelihood that she has pelvic endometriosis.

Antigens, Neoplasm↗

PubMed1994

The role of humoral immunity in endometriosis.

In many ways endometriosis represents yet another form of unexplained infertility. The disease is clearly associated with a decrease in fecundity and while in advanced stages of the condition this infertility can be attributed to tubal factors, in mild stages of the disease the cause for the decrease in fertility is unknown. As in unexplained infertility, we have suggested that the impairment in fertility is due to autoantibody abnormalities. Endometriosis patients exhibit the same immunologic profile as previously described in women with unexplained infertility and repeated pregnancy loss. In fact, endometriosis is not only characterized by unexplained infertility but also by repeated and excessive pregnancy wastage. Its clinical presentation mimics that of an autoimmune disease, raising the question whether endometriosis is, in fact, an autoimmune disease. Endometriosis demonstrates immunologic abnormalities not only in respect to autoreactivity. Abnormalities in immune function have been widely reported in reference to almost any lymphocyte and macrophage function and, once again, the similarity to findings in patients with unexplained infertility is blatant. Abnormalities can be found in peripheral blood and especially prominently in peritoneal fluid. Treatment of immunologic abnormalities, and especially of autoantibody abnormalities, restores a level of fertility in endometriosis patients. It has also been demonstrated, in an animal model, that non-specific immune modulation may improve fertility.

Antibody Formation↗

PubMed1994

Hormonal therapies for endometriosis: implications for bone metabolism.

The non-surgical treatment of endometriosis involves hormone therapy that either affects the lesions directly, or indirectly inhibits endometrial proliferation and induces atrophy through estrogen deprivation, or through a combination of these effects. The medications used to treat endometriosis are progestins (e.g. norethindrone, medroxyprogesterone acetate), oral contraceptives (e.g. estrogen-progesterone acetate), androgens and their derivatives (e.g. danazol, gestrinone), and gonadotropin-releasing hormone (GnRH) agonists (e.g. buserelin, leuprolide acetate, nafarelin, goserelin, tryptorelin). Agents such as GnRH agonists that produce sustained and prolonged hypoestrogenemia, similar to the postmenopausal hypogonadal state, can have a significant negative impact on trabecular bone mass. Evidence from the use of oral contraceptives and medroxyprogesterone acetate indicated that they had no apparent adverse effect on bone mass. Initial studies with dual-photon absorptiometry were unable to detect any appreciable bone loss with GnRH agonists. Later studies, however, have invariably found significant bone loss as early as 3 months after the start of treatment. Quantitated computerized tomography always shows significant trabecular bone loss of the vertebrae and hip with GnRH agonists. Depot preparations appear to produce more marked loss than daily intranasal sprays. Recovery of bone loss may take 6-12 months after the end of therapy, with considerable individual variations. In contrast, treatment of endometriosis with danazol produces bone gain. If endometriosis has to be treated with bone-depleting agents, prevention or attenuation of bone loss using combined therapy with progestins, etidronate or calcitonin together with GnRH agonists should be considered; however, further studies are necessary to define the efficacy of such combined therapy. Smoking and excessive caffeine intake should be avoided. The risk of bone loss should be considered when choosing the appropriate management of endometriosis, the selection of patients, repeat therapies for recurrent endometriosis, and the formulation of such therapies, in order to minimize or overcome it.

Bone Density↗

PubMed1993

[Endometriosis of the large intestine. A report of 2 clinical cases].

Intestinal involvement of endometriosis requiring treatment is 5%, but only 0.7% needs intestinal resection. The authors report two cases of colic endometriosis and illustrate problems in diagnosis and management of this disease. Usually intestinal endometriosis takes the form of asymptomatic superficial serosal implants, encountered incidentally at laparotomy for other diseases, but it can also result in obstruction and occasionally bleeding. Any premenopausal woman with episodic bowel symptoms associated with gynecologic complaints should be suspected of endometriosis of the colon. Diagnosis can be suspected by double-contrast enema examination and colonoscopy with biopsy, although neither is likely to establish the diagnosis with certainty. In fact there are no radiologic or diagnostic imaging findings that are specific for endometriosis and unequivocal diagnosis requires microscopic examination. Differential diagnosis includes primary carcinoma of the colon and other benign diseases (pelvic inflammatory disease, diverticulitis, inflammatory bowel disease, pelvic abscess, polyps, etc.). The treatment of patients with uncomplicated, but symptomatic gastrointestinal endometriosis depends on the age of the patient and her childbearing attitude. Resection of the affected bowel should be done in patient with pain, bleeding, changes in bowel habits and intestinal obstruction and it is necessary to avoid neglecting a malignant tumor. Total abdominal hysterectomy and bilateral oophorectomy is the treatment of choice in the perimenopausal and menopausal women. In symptomatic women desiring children the only resection of involved colon may be appropriate treatment. In these subjects hormonal therapy can be useful.

Adult↗

PubMed1993

Pathophysiology and management of endometriosis.

Endometriosis is a common disease that affects up to 5 million women in the United States. Specifically the prevalence of endometriosis is 1 in 15 (7%) women of reproductive age, and there is an associated incidence of infertility in as many as 30% to 40% of cases. The precise physiologic mechanism for the development of endometriosis lesions in the pelvis and abdominal cavity has not been elucidated. Substantial evidence exists, however, that endometriosis is dependent on estrogen for continued growth and proliferation. Therefore, suppression of the hypothalamic-pituitary-ovarian axis with analogues of a gonadotropin-releasing hormone is being increasingly undertaken. Since the most effective resolution of endometriosis occurs after oophorectomy or onset of menopause, the hypoestrogenic state induced by GnRH analogues is of major significance for patients with active disease. Medical therapy for endometriosis is often used as primary therapy for symptomatic disease or as an adjunct to surgical management of pelvic pain or infertility.

Endometriosis↗

PubMed1993

Platelet-activating factor acetylhydrolase activity in peritoneal fluids of women with endometriosis.

OBJECTIVE: To investigate whether platelet-activating factor acetylhydrolase may play a role in the pathophysiology of endometriosis. METHODS: Peritoneal fluids were obtained at laparoscopy from eight fertile women without endometriosis and 12 women with mild endometriosis. Platelet-activating factor acetylhydrolase activity was assayed in serum and peritoneal fluid by the release of 3H-acetate from [3H]-platelet-activating factor during a 15-minute incubation. RESULTS: Platelet-activating factor acetylhydrolase activity (mean +/- standard error of the mean) was significantly lower (P < .01) in peritoneal fluids from women with mild endometriosis (29.5 +/- 2.7%) than in controls (39.9 +/- 3.4%). The platelet-activating factor acetylhydrolase-cholesterol and -albumin ratios were also significantly lower in peritoneal fluids of women with endometriosis compared with controls (P < .006 and P < .012, respectively). CONCLUSION: These data suggest that mild endometriosis is associated with decreased platelet-activating factor acetylhydrolase activity in peritoneal fluid.

1-Alkyl-2-acetylglycerophosphocholine Esterase↗

PubMed1996

Basal and stimulated secretion of cytokines by peritoneal macrophages in women with endometriosis.

OBJECTIVE: To evaluate basal (constitutive) and stimulated synthesis of tumor necrosis factor alpha (TNF alpha), interleukin (IL)-8, IL-10 by peritoneal macrophages (PM) in women with endometriosis. DESIGN: Peritoneal macrophages were cultured in the presence or absence of lipopolysaccharide (LPS) for 24 hours. Peritoneal fluids (PF) and PM supernatants were assayed for cytokines using ELISA. SETTING: Institute for the Study and Treatment of Endometriosis and university-based research laboratories. SUBJECTS: Fertile controls undergoing tubal ligation (n = 8) and women with endometriosis (n = 17). INTERVENTION: Peritoneal fluid samples were obtained at the time of diagnostic laparoscopy (endometriosis group) or laparoscopy for tubal ligation; both were performed in the midluteal phase of the cycle. RESULTS: Both basal and LPS stimulated production of TNF alpha, IL-8, and IL-10 by the PM were elevated significantly in women with endometriosis as compared with the fertile controls. CONCLUSIONS: This study demonstrated that cytokines TNF alpha, IL-8, and IL-10 are synthesized at greater than normal levels by basal and stimulated PM from women with endometriosis. The levels of TNF alpha and IL-8 correlated with the levels in the PF, suggesting that PM are the principal source of these cytokines in the PF.

Ascitic Fluid↗

PubMed1996

Epidermal growth factor and basic fibroblast growth factor in peritoneal fluid of women with endometriosis.

OBJECTIVE: To determine and compare the concentrations of epidermal growth factor (EGF) and basic fibroblast growth factor (FGF) in the peritoneal fluid of women with and without endometriosis. DESIGN: Prospective study. SETTING: Tertiary care center affiliated with university medical school. PATIENTS: Forty-two women with endometriosis and 34 women without endometriosis confirmed by laparoscopy. MAIN OUTCOME MEASURES: Epidermal growth factor and basic FGF concentrations were determined by highly sensitive enzyme immunoassays using monoclonal antibodies. RESULT: Approximately 50% of the PF samples had EGF concentrations of > 0.4 pg/mL (conversion factor to SI unit, 0.17) and 90% had basic FGF concentrations of > 1 pg/mL (conversion factor to SI unit, 0.058). Concentrations of EGF or basic FGF in PF did not differ significantly between the two groups. In normal women, there was a significant correlation between EGF and basic FGF during the luteal phase. In women with endometriosis, EGF levels were higher during the luteal phase, but there was no correlation of either EGF or basic FGF levels with the severity of endometriosis. CONCLUSIONS: The concentrations of EGF and basic FGF were highly variable in the PF of women with or without endometriosis and did not differ significantly. The concentrations were so low that neither EGF nor basic FGF in PF could bind to its receptor.

Adult↗

PubMed1996

Spontaneous and induced synthesis of cytokines by peripheral blood monocytes in patients with endometriosis.

OBJECTIVE: To investigate the capacity of peripheral blood monocytes (PBM) from women with endometriosis to secrete tumor necrosis factor-alpha (TNF-alpha), interleukin (IL) IL-6, IL-8, and IL-10. DESIGN: Peripheral blood monocytes were cultured in the presence and absence of lipopolysaccharide for 24 hours before assessment of cytokines in supernatants by enzyme immunoassay. SETTING: Institute for the Study and Treatment of Endometriosis and university-based research laboratories. PATIENTS AND PARTICIPANTS: Fertile controls, n - 10; women with endometriosis, n = 20. INTERVENTIONS: None. RESULTS: Basal synthesis of TNF-alpha, IL-6, and IL-8 and the lipopolysaccharide-stimulated synthesis of TNF-alpha by PBM from women with endometriosis was significantly greater in comparison to that of fertile controls. Endometriosis had no effect on the basal or stimulated synthesis of IL-10. CONCLUSIONS: These data show that endometriosis is associated with increased basal and stimulated synthesis and secretion of several different cytokines by PBM. Each of the cytokines found to be affected has the capacity to play a role in the symptomatology or pathogenesis of the disease.

Cytokines↗

PubMed1996

[Peritoneal immune response in endometriosis].

The systematic analysis of immunity status in the peritoneum of women with endometriosis, is presented. Twenty five patients were studied, distributed as follows: A. Endometriosis, B. Sterility of non identified cause. In all the patients, peritoneal fluid was obtained (PF) during diagnostic laparoscopy, and a sample of peripheral blood was taken simultaneously. Both samples were processed analysis of lymphocytes subpopulations (ALS) by flux cytometry using monoclonal antibodies with reactivity to lymphocytes T total (CD+), lymphocytes B (CD19+), auxiliatory/inductory (CD3+CD4+), suppressor/cytotoxic (CD3+CD8+) and NK (CD3+CD16+ + 56+). The peritoneal ALS of both groups were characterized by a clear lymphocyte B diminution, moderate diminution of activators; a considerable increase of suppressors; altered CD4+/CD8+ relation in favour of suppression and NK diminution when comparing with its own blood compartment. All of these values were identical for both groups, and the only significant difference was found when comparing activated lymphocytes T subpopulation that was lesser in PF of women with endometriosis. This is the only fact that backs up the existence of altered immunity in the peritoneum of these patients, that affects the expression of activated lymphocytes. However, taking as a criterium the rest of subpopulations, in endometriosis as well as in ECNI the microenvironment goes for suppression and they are not distinguishable among them. On other side, it started signal characterization that conditions suppression induction for lymphocytes activation in peritoneal environment of women with endometriosis. Ten samples of PF of patients using peripheral purified lymphocytes by density gradient of voluntary donnors, normal, fertile, were analyzed. Cells were cultivated and stimulated in vitro with concanavaline A in presence of timidine 3H. In experimental holes PF was added at dose-response concentration, and it was evaluated as the difference in synthesis of radioactive ADN against the incubated cells in absence of PF. It was possible to demonstrate the presence of associated factors in PF of patients with endometriosis that inhibit proliferation of lymphocytes stimulated by Con A, and not so in samples of ECNI. With these factors one supposes the presence of soluble signals that condition local immunological suppression.

Adult↗

PubMed1996

[Correlation between endometriosis and fallopian tube patency in sterility patients especially after microsurgical sterility operations].

In 130 sterile women undergoing first look laparoscopy we found in 86.9% patent tubes. In this group in 34.5% an endometriosis was discovered. All patients with closed tubes had no signs of endometriosis. In a second look laparoscopy we found in 50% an endometriosis after microsurgery if the tubes were open. In this group we didn't also find an endometriosis if the tubes were closed. The frequency of endometriosis in women with laparoscopic sterilisation is 3.3%. After microsurgery in sterile women a second look laparoscopy seems to be very necessary to check the operation success and to exclude an endometriosis.

Adult↗