Endometriosis Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):281-284
DOI 10.1590/S0100-72031999000500006
Purpose: to demonstrate the experimental endometriosis induction in animals. Method: we used adult female Wistar rats weighing 200 - 250 g anesthetized with ethyl ether to open the abdominal cavity. After identifying the uterine horns, we removed an approximately 4 cm fragment from the right uterine horn. This fragment was placed in physiological saline and, with the aid of a stereoscopic magnifying glass, the endometrium was separated from the myometrium and cut into rectangles of approximately 4 x 5 mm. These rectangles were fastened to the lateral abdominal wall near great blood vessels, taking care that the free portion of the endometrium was directed towards the lumen of the abdominal cavity. After 21 days the animals were again operated to observe the size of the implants and to remove the ectopic endometrium for microscopic analysis. Results: we macroscopically observed a significant growth of the endometrial implants. Microscopic examination showed presence of glandular epithelium and stroma similar to topic epithelium. Conclusion: this model reproduces endometriosis in the female rat allowing a better study of this pathology, mainly the action of drugs on these implants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):281-284
DOI 10.1590/S0100-72031999000500006
Purpose: to demonstrate the experimental endometriosis induction in animals. Method: we used adult female Wistar rats weighing 200 - 250 g anesthetized with ethyl ether to open the abdominal cavity. After identifying the uterine horns, we removed an approximately 4 cm fragment from the right uterine horn. This fragment was placed in physiological saline and, with the aid of a stereoscopic magnifying glass, the endometrium was separated from the myometrium and cut into rectangles of approximately 4 x 5 mm. These rectangles were fastened to the lateral abdominal wall near great blood vessels, taking care that the free portion of the endometrium was directed towards the lumen of the abdominal cavity. After 21 days the animals were again operated to observe the size of the implants and to remove the ectopic endometrium for microscopic analysis. Results: we macroscopically observed a significant growth of the endometrial implants. Microscopic examination showed presence of glandular epithelium and stroma similar to topic epithelium. Conclusion: this model reproduces endometriosis in the female rat allowing a better study of this pathology, mainly the action of drugs on these implants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(10):613-618
DOI 10.1590/S0100-72032005001000008
PURPOSE: to evaluate the results of 14 cases of laparoscopic surgical treatment of patients with deep endometriosis of the rectovaginal septum in the Sector of Gynecological Endoscopy of the 'Hospital do Servidor Público Estadual "Francisco Morato de Oliveira"'. METHODS: a retrospective analysis was accomplished with data from the records, associated with postoperative evaluation of the patients operated between February 2002 and February 2004. The patients' age varied from 33 to 44 years, with a mean of 38.4. The parity ranged from 0 to 3, with a mean of 1.1. The main preoperative symptoms were: dysmenorrhea in 14 (100%), deep dyspareunia in 12 (85.7%), non-ciclic pelvic pain in 10 (71.4%), pain at defecation in two (14.3%), rectal bleeding in two (14.3%), and infertility in two (14.3%). The plasma level of CA-125 ranged from 3.6 to 100.3 U/mL, with a mean of 52.9 U/mL. RESULTS: the histological examination of the lesions of the rectovaginal septum was compatible with endometriosis in nine (64.3%) patients. Concerning painful symptoms, there was total regression in seven (50%) patients, partial regression (more than 80% relief) in two (14.3%), no improvement in four (28.6%), and worsening in one (7.1%). The incidence of complications was 14.3%: a ureter lesion associated with lesion of the sigmoid and a lesion of the rectum diagnosed on the 8th postoperative day. Conclusion: it can be concluded that endometriosis of the rectovaginal septum can be treated through laparoscopic surgery with low morbidity, leading to a complete or almost complete relief of the symptoms in most of the patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(10):613-618
DOI 10.1590/S0100-72032005001000008
PURPOSE: to evaluate the results of 14 cases of laparoscopic surgical treatment of patients with deep endometriosis of the rectovaginal septum in the Sector of Gynecological Endoscopy of the 'Hospital do Servidor Público Estadual "Francisco Morato de Oliveira"'. METHODS: a retrospective analysis was accomplished with data from the records, associated with postoperative evaluation of the patients operated between February 2002 and February 2004. The patients' age varied from 33 to 44 years, with a mean of 38.4. The parity ranged from 0 to 3, with a mean of 1.1. The main preoperative symptoms were: dysmenorrhea in 14 (100%), deep dyspareunia in 12 (85.7%), non-ciclic pelvic pain in 10 (71.4%), pain at defecation in two (14.3%), rectal bleeding in two (14.3%), and infertility in two (14.3%). The plasma level of CA-125 ranged from 3.6 to 100.3 U/mL, with a mean of 52.9 U/mL. RESULTS: the histological examination of the lesions of the rectovaginal septum was compatible with endometriosis in nine (64.3%) patients. Concerning painful symptoms, there was total regression in seven (50%) patients, partial regression (more than 80% relief) in two (14.3%), no improvement in four (28.6%), and worsening in one (7.1%). The incidence of complications was 14.3%: a ureter lesion associated with lesion of the sigmoid and a lesion of the rectum diagnosed on the 8th postoperative day. Conclusion: it can be concluded that endometriosis of the rectovaginal septum can be treated through laparoscopic surgery with low morbidity, leading to a complete or almost complete relief of the symptoms in most of the patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(10):599-606
DOI 10.1590/S0100-72032005001000006
PURPOSE: comparative analysis of the outcome of women with advanced pelvic endometriosis and women with tubal sterilization submitted to intracytoplasmic sperm injection (ICSI). METHODS: ninety-three infertile women, with normal menstrual cycle, without hormonal or surgical treatment during 12 months, body mass index of 20-25, ovaries with no tumors or cysts were included in the present study and divided into two groups: tubal sterilization (TUB), 39 women, and endometriosis (EDT), 54 women with III-EDT and IV-EDT, undergoing ovulatory induction using r-FSH and ICSI. Clinical and laboratorial data were compared. chi2, Fisher, Student's t, and Mann-Whitney tests were employed. RESULTS: lower estradiol levels (2,243.1 vs 1,666.3; p=0.001) and lower number of follicles per patient (16.9 vs 13.9, p=0.001) were noted in EDT group, in spite of more units of r-FSH (1,775.6 vs 1,998.6; p=0.007, for TUB and EDT, respectively). There were no differences in the rates of retrieved oocyte (69 vs 73.5%; p=0.071) as well as in normal fertilization rates (83.7 vs 81.7%; p=0.563, for TUB and EDT, respectively. However, lower number of top quality preembryos were obtained in patients from EDT group (36.5 vs 24.8%, TUB and EDT, respectively; p=0.005). Total pregnancy (41.0 vs 42.6%; p=0.950) and implantation rates (13.9 vs 14.5%; p=0.905) were not different when groups TUB and EDT were compared. CONCLUSIONS: ovaries of women from EDT group seem to be less responsive to ovulatory induction with r-FSH. EDT seems to impair the mean number of follicles and top quality preembryos with no impairment of retrieved oocyte and fertilization rates. However, once obtained, preembryos from EDT patients are able to exhibit similar implantation potential and pregnancy when compared with patients from TUB group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(10):599-606
DOI 10.1590/S0100-72032005001000006
PURPOSE: comparative analysis of the outcome of women with advanced pelvic endometriosis and women with tubal sterilization submitted to intracytoplasmic sperm injection (ICSI). METHODS: ninety-three infertile women, with normal menstrual cycle, without hormonal or surgical treatment during 12 months, body mass index of 20-25, ovaries with no tumors or cysts were included in the present study and divided into two groups: tubal sterilization (TUB), 39 women, and endometriosis (EDT), 54 women with III-EDT and IV-EDT, undergoing ovulatory induction using r-FSH and ICSI. Clinical and laboratorial data were compared. chi2, Fisher, Student's t, and Mann-Whitney tests were employed. RESULTS: lower estradiol levels (2,243.1 vs 1,666.3; p=0.001) and lower number of follicles per patient (16.9 vs 13.9, p=0.001) were noted in EDT group, in spite of more units of r-FSH (1,775.6 vs 1,998.6; p=0.007, for TUB and EDT, respectively). There were no differences in the rates of retrieved oocyte (69 vs 73.5%; p=0.071) as well as in normal fertilization rates (83.7 vs 81.7%; p=0.563, for TUB and EDT, respectively. However, lower number of top quality preembryos were obtained in patients from EDT group (36.5 vs 24.8%, TUB and EDT, respectively; p=0.005). Total pregnancy (41.0 vs 42.6%; p=0.950) and implantation rates (13.9 vs 14.5%; p=0.905) were not different when groups TUB and EDT were compared. CONCLUSIONS: ovaries of women from EDT group seem to be less responsive to ovulatory induction with r-FSH. EDT seems to impair the mean number of follicles and top quality preembryos with no impairment of retrieved oocyte and fertilization rates. However, once obtained, preembryos from EDT patients are able to exhibit similar implantation potential and pregnancy when compared with patients from TUB group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(10):597-602
DOI 10.1590/S0100-72031999001000006
Purpose: evaluation of the effect of elcometrine on ovarian endometriomata. Method: subdermal implants containing 50 mg elcometrine were inserted in 51 women with ovarian endometriomata, the volumes of which were recorded by vaginal sonography before and after each three-month interval of treatment. A new implant was inserted every 6 months according to the need for continuing treatment. Results: at admission, 74% of patients presented with dysmenorrhea, 57% chronic pelvic pain and 31% dyspareunia. Pain was rated as severe or incapacitating by 82% of the subjects. A total of 924 months of observation was recorded during the four years of study. Relief of pain was observed during the first month of treatment and severe or incapacitating pain was no longer reported by any subject by the end of the first trimester. Volume of endometriomata was reduced in 86% of the patients. In 45%, ovarian volume was restored to normal. In 41% the volume reduction was incomplete and in 14% there was no volume reduction. Seventy-seven percent presented amenorrhea during treatment. The most common adverse events were decreased libido (21%) and feeling of heaviness in lower limbs (14%). One year after discontinuation of treatment, 33% of the patients were symptomless, while 28% presented recurrence of the endometriomata before 3 months post-discontinuation. Thirty-nine percent of the patients preferred to continue using the method in order to maintain amenorrhea. Conclusion: elcometrine is effective in reducing ovarian endometriomata, without some of the side effects of other treatments.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(10):597-602
DOI 10.1590/S0100-72031999001000006
Purpose: evaluation of the effect of elcometrine on ovarian endometriomata. Method: subdermal implants containing 50 mg elcometrine were inserted in 51 women with ovarian endometriomata, the volumes of which were recorded by vaginal sonography before and after each three-month interval of treatment. A new implant was inserted every 6 months according to the need for continuing treatment. Results: at admission, 74% of patients presented with dysmenorrhea, 57% chronic pelvic pain and 31% dyspareunia. Pain was rated as severe or incapacitating by 82% of the subjects. A total of 924 months of observation was recorded during the four years of study. Relief of pain was observed during the first month of treatment and severe or incapacitating pain was no longer reported by any subject by the end of the first trimester. Volume of endometriomata was reduced in 86% of the patients. In 45%, ovarian volume was restored to normal. In 41% the volume reduction was incomplete and in 14% there was no volume reduction. Seventy-seven percent presented amenorrhea during treatment. The most common adverse events were decreased libido (21%) and feeling of heaviness in lower limbs (14%). One year after discontinuation of treatment, 33% of the patients were symptomless, while 28% presented recurrence of the endometriomata before 3 months post-discontinuation. Thirty-nine percent of the patients preferred to continue using the method in order to maintain amenorrhea. Conclusion: elcometrine is effective in reducing ovarian endometriomata, without some of the side effects of other treatments.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(3):141-146
DOI 10.1590/S0100-72032000000300004
Purpose: urinary tract involvement by endometriosis is uncommon and the bladder is the most common site. We observed that clinical misdiagnosis of bladder cancer frequently is made. Because the disease is generally described in case reports there is not a consensual management. We present and discuss our experience of diagnostic and therapeutic issues. Methods: retrospective analysis of urinary endometriosis slides of the Department of Pathology files was made. Medical charts and follow-up were reviewed in detail and interviews were performed during or after treatment. Results: we describe four cases with cyclic disuria, abdominal mass, pelvic pain and imaging diagnosis of bladder tumor. Pathological specimens were obtained by endoscopic resection (3 cases) and laparoscopic biopsy (1 case). Therapeutic options were exclusive medical treatment or surgical removal with transurethral resection or partial cystectomy supplemented with adjuvant medication. Conclusions: we review the clinical and therapeutic aspects of urinary tract endometriosis stressing that this is an important differential diagnosis of bladder cancer in reproductive women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(3):141-146
DOI 10.1590/S0100-72032000000300004
Purpose: urinary tract involvement by endometriosis is uncommon and the bladder is the most common site. We observed that clinical misdiagnosis of bladder cancer frequently is made. Because the disease is generally described in case reports there is not a consensual management. We present and discuss our experience of diagnostic and therapeutic issues. Methods: retrospective analysis of urinary endometriosis slides of the Department of Pathology files was made. Medical charts and follow-up were reviewed in detail and interviews were performed during or after treatment. Results: we describe four cases with cyclic disuria, abdominal mass, pelvic pain and imaging diagnosis of bladder tumor. Pathological specimens were obtained by endoscopic resection (3 cases) and laparoscopic biopsy (1 case). Therapeutic options were exclusive medical treatment or surgical removal with transurethral resection or partial cystectomy supplemented with adjuvant medication. Conclusions: we review the clinical and therapeutic aspects of urinary tract endometriosis stressing that this is an important differential diagnosis of bladder cancer in reproductive women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):715-719
DOI 10.1590/S0100-72032004000900007
PURPOSE: development of a new experimental model of endometriosis induction in rabbits evaluating its temporal evolution both macro-and microscopically. METHODS: thirty female rabbits were submitted to endometriosis induction through the fixation of a piece of the left uterine horn to the abdominal peritoneum. After four or eight weeks the viability of the lesions was verified by laparoscopy. The lesions were observed endoscopically. The implants were measured and histological analyses were made. The groups were compared for the presence of endometriotic lesion on laparoscopy, presence of adhesions, implant size and histological aspects. For statistical analyses we utilized Student's t and Mann-Whitney's tests, with a statistical significance of 5%. RESULTS: endometriotic lesions were identified in all cases submitted to laparoscopy after 4 weeks of induction, 64% of them cystic, and in 80% of the rabbits after eight weeks, 66% of which cystic. The adhesions were present in 71% of the rabbits after 4 weeks (none in the implants) and in 80% of the rabbits after 8 weeks (13% in the implants). The lesions were significantly larger after 8 weeks (p<0,0001). The histological analyses showed 100% of endometrial tissue in both groups. CONCLUSION: this experimental model showed that it is possible to simulate endometriosis in rabbits with a viable and simple technique, also allowing to record the characteristics and development of the implants macro-and microscopically. Although the histological aspects were similar, the lesions after eight weeks were larger than after four, making their manipulation easier.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):715-719
DOI 10.1590/S0100-72032004000900007
PURPOSE: development of a new experimental model of endometriosis induction in rabbits evaluating its temporal evolution both macro-and microscopically. METHODS: thirty female rabbits were submitted to endometriosis induction through the fixation of a piece of the left uterine horn to the abdominal peritoneum. After four or eight weeks the viability of the lesions was verified by laparoscopy. The lesions were observed endoscopically. The implants were measured and histological analyses were made. The groups were compared for the presence of endometriotic lesion on laparoscopy, presence of adhesions, implant size and histological aspects. For statistical analyses we utilized Student's t and Mann-Whitney's tests, with a statistical significance of 5%. RESULTS: endometriotic lesions were identified in all cases submitted to laparoscopy after 4 weeks of induction, 64% of them cystic, and in 80% of the rabbits after eight weeks, 66% of which cystic. The adhesions were present in 71% of the rabbits after 4 weeks (none in the implants) and in 80% of the rabbits after 8 weeks (13% in the implants). The lesions were significantly larger after 8 weeks (p<0,0001). The histological analyses showed 100% of endometrial tissue in both groups. CONCLUSION: this experimental model showed that it is possible to simulate endometriosis in rabbits with a viable and simple technique, also allowing to record the characteristics and development of the implants macro-and microscopically. Although the histological aspects were similar, the lesions after eight weeks were larger than after four, making their manipulation easier.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):613-617
DOI 10.1590/S0100-72032004000800004
OBJECTIVE: the aim of the present study was to verify whether there is a correlation between the prevalence of the polymorphism in the progesterone receptor gene named PROGINS and pelvic endometriosis at different stages. METHODS: a case-control study carried out from November 2003 to May 2004. The genotypes of 104 women were analyzed 66 women had had surgically confirmed endometriosis (26 women at stages I-II and 40 at stages III-IV), and 38 were healthy women. The 306-base pair Alu insertion polymorphism in the intron G of the progesterone receptor gene was detected by polymerase chain reaction and analyzed on 2% agarose gel stained with ethidium bromide. ANOVA analysis was performed in order to make comparisons between among the studied groups. RESULTS: the groups of women with endometriosis stages I-II (EndoI group) and stages III-IV (EndoII group) showed statistically significant increased incidence of PROGINS polymorphic allele as compared with the control group: 27% in the EndoI group, 38% in EndoII and 18% in the control group (p < 0.001. In the analyses, a high frequency of the PROGINS insertion was observed in women with endometriosis as compared to healthy women, disregarding the clinical stage of the disease (p = 0.0385). CONCLUSION: there is a significant statistical association between the PROGINS polymorphism and pelvic endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):613-617
DOI 10.1590/S0100-72032004000800004
OBJECTIVE: the aim of the present study was to verify whether there is a correlation between the prevalence of the polymorphism in the progesterone receptor gene named PROGINS and pelvic endometriosis at different stages. METHODS: a case-control study carried out from November 2003 to May 2004. The genotypes of 104 women were analyzed 66 women had had surgically confirmed endometriosis (26 women at stages I-II and 40 at stages III-IV), and 38 were healthy women. The 306-base pair Alu insertion polymorphism in the intron G of the progesterone receptor gene was detected by polymerase chain reaction and analyzed on 2% agarose gel stained with ethidium bromide. ANOVA analysis was performed in order to make comparisons between among the studied groups. RESULTS: the groups of women with endometriosis stages I-II (EndoI group) and stages III-IV (EndoII group) showed statistically significant increased incidence of PROGINS polymorphic allele as compared with the control group: 27% in the EndoI group, 38% in EndoII and 18% in the control group (p < 0.001. In the analyses, a high frequency of the PROGINS insertion was observed in women with endometriosis as compared to healthy women, disregarding the clinical stage of the disease (p = 0.0385). CONCLUSION: there is a significant statistical association between the PROGINS polymorphism and pelvic endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(4):299-304
DOI 10.1590/S0100-72032004000400006
OBJECTIVE: to determine GSTT1 and GSTM1 null genotype frequencies as well as CYP1A1 polymorphic allele frequencies in a group of women with endometriosis, and to compare these frequencies with those observed in a group without endometriosis (control), aiming at a possible identification of biomarkers of susceptibility to endometriosis. METHODS: a total of 50 women with suggestive clinical signs of endometriosis underwent videolaparoscopy and biopsies were evaluated histologically. Endometriosis was present in 25 women (case group). Negative results were found in 25 women (control group). GSTT1 and GSTM1 null genotypes were assessed by multiplex polymerase chain reaction (PCR). The investigation of the polymorphic allele of the gene CYP1A1 was performed by PCR-RFLP (restriction fragment length polymorphism). For statistical analysis, the Fisher exact test was used. RESULTS: in both groups, the deletion polymorphism frequencies presented values of 16% for the gene GSTT1 and of 44% for the gene GSTM1; therefore, the results did not show differences in the distribution of the GSTT1 and GSTM1 null genotypes among the studied groups. The allelic frequency for the m1 allele of the gene CYP1A1 was higher in the women with endometriosis (0.22), although not statistically significant, when compared to the control group (0.14). CONCLUSION: the results did not show an association between the evaluated polymorphisms and the endometriosis diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(4):299-304
DOI 10.1590/S0100-72032004000400006
OBJECTIVE: to determine GSTT1 and GSTM1 null genotype frequencies as well as CYP1A1 polymorphic allele frequencies in a group of women with endometriosis, and to compare these frequencies with those observed in a group without endometriosis (control), aiming at a possible identification of biomarkers of susceptibility to endometriosis. METHODS: a total of 50 women with suggestive clinical signs of endometriosis underwent videolaparoscopy and biopsies were evaluated histologically. Endometriosis was present in 25 women (case group). Negative results were found in 25 women (control group). GSTT1 and GSTM1 null genotypes were assessed by multiplex polymerase chain reaction (PCR). The investigation of the polymorphic allele of the gene CYP1A1 was performed by PCR-RFLP (restriction fragment length polymorphism). For statistical analysis, the Fisher exact test was used. RESULTS: in both groups, the deletion polymorphism frequencies presented values of 16% for the gene GSTT1 and of 44% for the gene GSTM1; therefore, the results did not show differences in the distribution of the GSTT1 and GSTM1 null genotypes among the studied groups. The allelic frequency for the m1 allele of the gene CYP1A1 was higher in the women with endometriosis (0.22), although not statistically significant, when compared to the control group (0.14). CONCLUSION: the results did not show an association between the evaluated polymorphisms and the endometriosis diagnosis.
