Leng Jh

Expression of vascular endothelial growth factor and thrombospondin-1 mRNA in patients with endometriosis

OBJECTIVE To investigate the expression of vascular endothelial growth factor (VEGF) mRNA and thrombospondin-1 (TSP-1) mRNA in endometriosis. DESIGN Molecular studies in human tissue. SETTING Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China. PATIENT(S) Patients undergoing laparoscopy for infertility or other benign gynecologic conditions. INTERVENTION(S) Biopsies were taken from endometriotic lesions (red peritoneal lesion, ovarian endometrioma, and unterosacral ligament nudule) and eutopic endometrium during laparoscopy. MAIN OUTCOME MEASURE(S) mRNA expression from endometriotic lesion and eutopic endometrium was analyzed by reverse transcriptase polymerase chain reaction (PCR) and Northern blotting. RESULT(S) Among the endometriotic lesions, red peritoneal lesions expressed higher levels of VEGF mRNA and lower levels of TSP-1 mRNA, whereas ovarian endometrioma expressed lower levels of VEGF mRNA and higher levels of TSP-1 mRNA. Eutopic endometrium of women with endometriosis had higher expression levels of VEGF mRNA and lower expression levels of TSP-1 mRNA than that of women without endometriosis. CONCLUSION(S) The expression of VEGF and TSP-1 in endometriotic lesions appears to be associated with the extent of their neovascularization. The imbalance in expression of VEGF and TSP-1 in the endometrium may play a role in the development of endometriosis.

Abdominal wall endometriomas.

Objective: To investigate the clinical characteristics, treatment, and factors of recurrence of abdominal wall endometriomas (AWE). Method: Sixty‐four cases of AWE diagnosed at Peking Union Medical College Hospital (PUMCH) from 1983 to 2003 were reviewed retrospectively. Result: There was an AWE incidence of 0.044% among the parturients undergoing cesarean section at PUMCH, of whom 87.5% had the typical complaint of an enlarging mass and pain during menstruation. Among these women, 62 underwent low abdominal surgery for endometrioma (2 for primary umbilicus endometrioma); 2 women with small endometriomas opted for a temporary medical solution and had relief after menopause. The latent period of AWE positively correlated to the womens age at onset of symptoms (P < 0.001). Of the 62 women who underwent local excision, 19 had an unsatisfactory experience with medical management. There were 5 recurrences and 1 evolution to malignancy during a mean follow‐up of 83.7 months. Recurrence was closely related to the size and depth of lesions. Conclusion: Because of its typical clinical manifestations, abdominal wall endometriomas could be diagnosed before pregnancy. Surgical excision is the only effective treatment and wide local excision with clear margins is the key point to prevent recurrence.

Obstetric Outcomes in Chinese Women with Endometriosis: A Retrospective Cohort Study

Background:The effect of endometriosis on obstetric outcomes is still ambiguous. The aim of our study was to determine the association between endometriosis and adverse obstetric outcomes in a cohort of Chinese women. Methods:A retrospective cohort study was undertaken to compare obstetric outcomes between 249 women with endometriosis and 249 women without endometriosis. All women were nulliparous and achieved singleton pregnancies naturally. Women with endometriosis were diagnosed during surgery and confirmed histologically. Odds ratios (ORs) and 95% confidence intervals (CIs) of measures of obstetric outcomes were calculated. Results:Women with endometriosis showed significantly increased risks of preterm labor (adjusted OR, 2.42; 95% CI, 1.05–5.57), placenta previa (adjusted OR, 4.51; 95% CI, 1.23–16.50), and cesarean section (adjusted OR, 1.93; 95% CI, 1.31–2.84). No significant differences were observed in the incidence of pregnancy-induced hypertension, fetal growth restriction, small for gestational age, placental abruption, or luteal support in the first trimester between the two groups. Conclusions:Women with endometriosis are at a higher risk of preterm labor, placenta previa, and cesarean section during pregnancy and need additional care.

Presentation and management of perineal endometriosis

To analyze the clinical presentation of perineal endometriosis and evaluate its treatment.

Clinical characteristics and management experience of unexpected uterine sarcoma after myomectomy

To identify the prevalence of unexpected uterine sarcoma after myomectomy for presumed leiomyoma and compare clinical outcomes after primary myomectomy with and without power morcellation.

Follicle loss after laparoscopic treatment of ovarian endometriotic cysts

To evaluate follicle loss and its associated factors during laparoscopic cystectomy for ovarian endometrioma.

Clinical Characteristics and Prognosis of Unexpected Uterine Sarcoma After Hysterectomy for Presumed Myoma With and Without Transvaginal Scalpel Morcellation.

Objective To identify the prevalence of unexpected uterine sarcoma after total laparoscopic or abdominal hysterectomy for presumed leiomyoma and compare clinical consequences after hysterectomy with and without transvaginal scalpel morcellation (TVSM). Methods In this retrospective study, the medical records of patients who had unexpected uterine sarcoma after total laparoscopic or abdominal hysterectomy for presumed leiomyoma between 2009 and 2013 were reviewed. Results Among 3021 patients who underwent total hysterectomy for presumed leiomyoma, 18 (1/168, 0.60%) had unexpected uterine sarcoma (5 [1/604, 0.17%] had leiomyosarcoma and 13 [1/232, 0.43%] had low-grade endometrial stromal sarcoma). The risk of unexpected leiomyosarcoma increased steadily in ages from the 40s to the 50s, whereas the risk of unexpected endometrial stromal sarcoma (ESS) decreased steadily in the same period. The unexpected sarcoma was identified in 7 (1/158, 0.63%) of 1104 patients treated by laparoscopy and 11 (1/174, 0.57%) of 1917 patients by laparotomy. Transvaginal scalpel morcellation was performed to extract the uterus in majority (78.53%) of the patients with total laparoscopic hysterectomy. Sixteen (88.89%) cases were low grade, and 2 (11.11%) were high grade: 17 at stage I and 1 at stage II. Nine patients underwent a secondary operation, and 11 patients received adjuvant therapy postoperatively. Except for 1 patient with additional power morcellation, all patients with unexpected ESS survived without recurrence after total hysterectomy with and without TVSM, with mean follow-ups of 25.20 (16–36) months and 32.57 (21–50) months, respectively. Conclusions The overall incidence of unexpected uterine sarcoma after total hysterectomy for presumed leiomyoma was low. Low-grade endometrial stromal sarcoma was the dominant subtype of unexpected uterine sarcoma in the present study. Currently, incidental TVSM of unexpected ESS during total laparoscopic hysterectomy seemed to cause no additional increase in sarcoma dissemination in the short-term.

Vaginal adenosarcoma arising from refractory endometriosis: A case report

Standard management of Ogilvie’s Syndrome has not yet been established. Once obstruction of the large bowel has been excluded, management is separated into general, pharmacological and surgical. General measures include mobilising, adequate fluid intake and NG tube to decompress the stomach. Pharmacological measures include anti-emetics, IV fluids and IV neostigmine for clinical decompression of the colon. Surgical intervention can be decompression with a flexible colonoscope, cystograffin enema and surgery (caecostomy or colostomy). For patients who have not responded to conservative therapy, contemporary first-line treatment is neostigmine. Following this, surgical treatment may be necessary. Although these patients presented with similar symptoms, their management and outcomes were different. Late recognition of Ogilvie’s Syndrome resulted in colonic perforation for patients 1 and 2. The patients are presented in chronological order, the most recent patients with the most successful outcomes. Early recognition and increased staff awareness contributed to better management and recovery. Although management of Ogilvie’s syndrome still varies, recognition and awareness of the condition, particularly from nursing and junior medical staff, are paramount to preventing perforation and subsequent morbidity.

Ovarian steroid hormones differentially regulate thrombospondin-1 expression in cultured endometrial stromal cells: implications for endometriosis

Thrombospondin-1 messenger RNA and protein levels in cultured human endometrial stromal cells (ESCs) treated with 17-beta estradiol (10 nM) were reduced by 47.6% (+/-6.5% SD; P < 0.05) and 49.0% (+/-8.6%; P < 0.05) compared with untreated cells, whereas thrombospondin-1mRNA and protein levels in ESCs treated with progesterone (10 microM) were 2.1-fold (+/-0.4 SD; P < 0.05) and 2.3-fold (+/-0.6; P < 0.05) higher than those in untreated cells. These findings not only provide evidence for the estrogen dependence of endometriosis, but also partly explain the mechanisms by which progestins exert their therapeutic activities in endometriosis.

Expression of Potassium Channels in Uterine Smooth Muscle Cells from Patients with Adenomyosis.

Background:Adenomyosis (AM) has impaired contraction. This study aimed to explore the expression of potassium channels related to contraction in myometrial smooth muscle cells (MSMCs) of AM. Methods:Uterine tissue samples from 22 patients (cases) with histologically confirmed AM and 12 (controls) with cervical intraepithelial neoplasia were collected for both immunohistochemistry and real-time polymerase chain reaction to detect the expression of large conductance calcium- and voltage-sensitive K+ channel (BKCa)-&agr;/&bgr; subunits, voltage-gated potassium channel (Kv) 4.2, and Kv4.3. Students t-test was used to compare the expression. Results:The BKCa-&agr;/&bgr; subunits, Kv4.2, and Kv4.3 were located in smooth muscle cells, glandular epithelium, and stromal cells. However, BKCa-&bgr; subunit expression in endometrial glands of the controls was weak, and Kv4.3 was almost undetectable in the controls. The expression of BKCa-&agr; messenger RNA (mRNA) (0.62 ± 0.19-fold decrease, P < 0.05) and Kv4.3 mRNA (0.67 ± 0.20-fold decrease, P < 0.05) decreased significantly in the MSMCs of the control group compared with the AM group. However, there were no significant differences in BKCa-&bgr; subunit mRNA or Kv4.2 mRNA. Conclusions:The BKCa-&agr; mRNA and the Kv4.3 mRNA are expressed significantly higher in AM than those in the control group, that might cause the abnormal uterus smooth muscle contractility, change the microcirculation of uterus to accumulate the inflammatory factors, impair the endometrium further, and aggravate the pain.