Pregnancy after laparoscopic partial cystectomy for bladder endometriosis

We report a case of partial laparoscopic cystectomy in a 31-year-oldinferile patient presenting vesical endometriosis. This patienthad suffered severe dysmenorrhoea for 10 years previously togetherwith repeated episodes of urinary infection, mostly occurringduring the menstrual period. A diagnostic laparoscopy performedin another centre diagnosed a stage IV endometriosis. Gonadotrophin-releasinghormone agonists were prescribed for 9 months. After failureof this treatment, the patient came to consult us. A solid massin the left supratrigone was detected by pelvic ultrasonographyand confirmed by cystoscopy. Transurethral resection was carriedout. A recurrence of the symptoms 9 months later prompted operativelaparoscopy under cystoscopic control. This confirmed recurrenceof a 3.5 cm endometriotic nodule. Laparoscopic partial cystectomywas performed using the monopolar electrode. The bladder wasthen sutured via laparoscopy. No complications occurred. Nopostoperative treatment was given. Second-look cystoscopy 2months later revealed that healing was perfect. Eight monthslater, the patient is well and has a normal intra-uterine pregnancy.     

Lack of association of the common immunologically anomalous LH with endometriosis

BACKGROUND: Subfertile women with endometriosis have been reported to demonstrate impaired follicular growth, ovulatory dysfunction and disturbed LH patterns. In addition, abnormal LH and/or LH receptors have been linked with endometriosis-associated infertility. Carriers of a variant of the beta-subunit of luteinizing hormone (V-LH) are largely healthy; however, differences in their gonadal function such as alterations in gonadal steroidogenesis, ovarian reserve, pubertal development and predisposition to diseases such as infertility and polycystic ovarian disease have been found. METHODS AND RESULTS: To explore the possible relationship between endometriosis and V-LH, we examined its frequency in 230 women undergoing laparoscopic surgery for the investigation of infertility. For the entire study population, 185 (80.4%) were wild type; 42 (18.3%) were heterozygous; and three (1.3%) were homozygous for V-LH. No difference was found between women with (n = 85) and without (n = 145) endometriosis concerning the frequency of the type of LH. CONCLUSION: Our results do not support the hypothesis that the variant form of LH is associated with an altered risk of endometriosis in the population tested.     

Risk factors for endometriosis in the rhesus monkey (Macaca mulatta): a case-control study

The autopsy records between 1980 and 1995 of 399 female rhesusmonkeys (Macaca mulatta) at the Wisconsin Regional Primate ResearchCenter were examined. Spontaneous endometriosis was found in81 (20%) of the animals. The mean (±SD) ages at deathfor animals with and without endometriosis were 20.7±5.5(range 10-35) and 13.4±7.7 (range 4-37) years respectively.Many of the animals had been exposed to experimental procedures,including laparoscopies, hysterotomies and oestradiol implants,and these were examined as possible risk factors for endometriosis.Of the 81 affected animals, 62 were matched to unaffected controlsfor age at death (to within 1 year) and year of death (to within2 years) and the effect of various factors on the developmentof endometriosis was determined using conditional logistic regression.Exposure to three or more oestradiol implants or one or morehysterotomies were both significant risk factors, with estimatedrelative risks of 9.7 (95% confidence interval 2.5-37.2) and5.8 (95% confidence interval 1.6-20.2) respectively. Animalsthat had been exposed to one or more laparoscopies showed noincreased risk for developing endometriosis. These findingsprovide insight into the aetiology of the disease in women.     

Increase of activated mast cells in human endometriosis

PROBLEM: The proliferation of stromal cells in endometriosis promotes extensive adhesion; therefore, the morphological analysis of stromal lesions is important in the investigation of the pathogenesis of endometriosis. METHOD OF STUDY: In this study, the morphological and numeric comparisons of degranulated mast cells were performed between endometriotic lesions and comparative regions (eutopic endometrium and normal uterine serosa) of patients with and without endometriosis. RESULTS: In cases of endometriosis, diffuse infiltration of numerous mast cells was observed throughout the stromal lesions. These mast cells exhibited degranulation, and scattered granules were also observed. In the eutopic endometrium and normal uterine serosa of both the endometriosis patients and the controls, mast cells were rarely detected. CONCLUSIONS: These results suggest that an abnormal immune response, specifically a hypersensitivity reaction, is strongly related to endometriosis; our findings will be helpful in the development of methods for the treatment of endometriosis.     

Studies on the human leukocyte antigen-DR in patients with endometriosis: genotyping of HLA-DRB1 alleles

BACKGROUND: An increasing number of reports suggest that endometriosis is associated with abnormal immune function involving changes in both cell-mediated and humoral immunity, although the aetiology of the disease remains undefined. The human leukocyte antigen system (HLA) is known to play a role in the aetiology of a number of diseases. This study examines the possible association between the HLA-DR and endometriosis. METHODS: Eighty-three patients diagnosed with endometriosis by laparoscopic examination were typed for HLA-DR antigens using a PCR-restriction fragment length polymorphism analysis. The frequency of HLA-DR genotypes in this patient population was compared with that in a population of general controls. RESULTS: The incidence of HLA-DRB1*1403 in the patient group was 6.0% (10/166 alleles) compared with 1.4% in the control group (6/444 alleles), and the incidence of the HLA-DRB1*1403 allele was significantly greater in patients with endometriosis compared with the control population [odds ratio 4.68, 95% confidence interval 1.67-13.09, P = 0.0013 (chi(2) analysis), (corrected P values: Pc = 0.0494)]. No significant difference was found between the two groups with regards to the frequency of the other HLA-DR alleles. CONCLUSIONS: The results from this study may be helpful to implicate a role of HLA-DR antigens in the development of endometriosis, although further investigation is required.     

Local Production of Interleukins and Growth Factors in External Genital Endometriosis

Secretion of some IL and growth factors (VEGF, IGF-I, TGFβ) by endometrial tissues and endometrioid heterotopies was studied in vitro in patients with external genital endometriosis of different severity. The production of IL-1β, IL-2, IL-6, and VEGF in the endometrium increased in severe external genital endometriosis, while the secretion of TGFβ decreased; hyperproduction of IL-2, IL-6, VEGF and decreased production of TGFβ were detected in endometrioid foci. Presumably, local cytokine imbalance and increased proliferative activity of endometrial cells are involved in the mechanisms of formation and functioning of endometrioid foci.__________Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 139, No. 4, pp. 439–42, April, 2005     

Endometriosis in reproductive immunology

PROBLEM: Endometriosis is suggested to represent an autoimmune disorder, but what is the prevalence of autoantibodies to antigens relevant to reproduction? METHOD OF STUDY: The humoral immune response to the women with endometriosis (stage I–II: 261 women; stage III–IV: 62 women) in serum and in peritoneal fluid was investigated compared with 101 healthy women. Enzyme‐linked immunosorbent assay (ELISA) was used in all the women for the detection of seven antiphospholipid antibodies [antiphospholipid antibodies (aPLs) against cardiolipin, L ‐phosphatidyl (ph)‐serine, ph‐glycerol, ph‐inositol, ph‐ethanolamine, phosphatidic (ph)‐acid and against β2‐glycoprotein I] of class IgG, IgA, and IgM. A passive haemmagglutination method and ELISA (BioGen) was used for assessment of antizona pellucida antibodies (aZP), tray agglutination test (TAT) and indirect mixed anti‐imunoglobulin reaction test (MAR‐test) for the determination of sperm antibody levels. RESULTS: Endometriosis I–II were associated with higher serum and peritoneal fluid levels of aPLs against inositol, cardiolipin, ethanolamine, and β2‐glycoprotein I. Forty percent of patients were positive for aZPA. CONCLUSIONS: Patients with lesions of endometriosis stage I–II had more autoantibodies than those with stage III–IV, and may be immunologically more active. This result may be significant for future treatments such as in vitro fertilization and embryo transfer.     

芳香化酶及环氧合酶抑制剂对大鼠子宫内膜异位症模型的作用

目的:探讨芳香化酶抑制剂(Arimidex)、环氧合酶-2抑制剂(celecoxib)对大鼠子宫内膜异位症(内异症)模型的作用。方法:采用子宫内膜自体移植方法建立大鼠内异症模型,将40只内异症大鼠随机分为5组(n=8):A:Arimidex组;B:celecoxib组:C:联合组;D:双卵巢切除组(OVX组);E:盐水对照组(NS对照组)。RIA方法测定各组血清FSH、LH、E2水平;检测各组处理前后异位囊肿体积变化;计算机图像分析各组异位内膜病理形态。结果:Arimidex单用或与celecoxib联合治疗1周均降低大鼠内异症模型血清E2水平(P<0.05),治疗4周对血清E2水平均无明显影响(P>0.05),治疗1周、4周血清FSH、LH水平略升高但与对照组比较差异均无统计学意义(P>0.05);单用celecoxib对大鼠内异症模型血清E2、FSH、LH水平无影响(P>0.05)。Arimidex组、联合治疗组及去势组均可使异位囊肿体积明显缩小(P<0.01);囊肿消失率:联合治疗组(37.5%)及去势组(50%)均较高,有统计学意义(P<0.05),Arimidex组、celecoxib组则无统计学意义。Arimidex组、联合治疗组及去势组均可使子宫内膜及腔上皮明显变薄(P<0.01), celecoxib组不影响异位子宫内膜厚度及腔上皮高度(P>0.05);Arimidex组、celecoxib组、联合治疗组未明显改变腺上皮高度及腺腔外径(P>0.05)。结论:芳香化酶抑制剂联合环氧合酶-2抑制剂对大鼠内异症异位内膜的作用略优于单用芳香化酶抑制剂;两者治疗1周可使血清E2水平降低, FSH、LH略升高;治疗4周对血清E2、FSH、LH无明显影响;环氧合酶抑制剂单用效果不明显。