Time course of pelvic endometriotic lesion revascularization in a nude mouse model.

Objective: To assess the timing of endometrial lesion revascularization in a murine model.

Design: Prospective experimental study.

Setting: An academic research environment.

Expression of platelet endothelial cell adhesion molecule-1 in red and black endometriotic lesions.

This immunohistochemical study shows that platelet endothelial cell adhesion molecule-1 (PECAM-1), known to play a role in neoangiogenesis and vascular development, is strongly and homogeneously expressed in endothelial cells lining blood vessels from red and black pelvic endometriotic lesions. The distribution of PECAM-1 within the stroma of the lesions was similar to that found in the corresponding eutopic endometrium, regardless of the phase of the cycle.

Characterization of iron deposition in endometriotic lesions induced in the nude mouse model.

Background: Pelvic endometriotic lesions are often laden with hemosiderin. In order to investigate the potential source of such iron deposits, we examined whether the seric and erythrocyte fractions of menstrual effluent might influence the occurrence of iron deposition within lesions in a murine model of endometriosis.

Methods: Endometriosis was induced in 57 nude mice by intraperitoneal injection of unfractionated human menstrual effluent, endometrial fragments plus serum, endometrial fragments plus erythrocytes or endometrial cell fraction alone.

Typical and subtle atypical presentations of endometriosis.

The diagnosis of peritoneal endometriosis at the time of laparoscopy is often made by the observation of typically puckered black or bluish lesions. There are also numerous subtle appearances of peritoneal endometriosis. The lesions are frequently non-pigmented.

Current thinking on the pathogenesis of endometriosis.

This manuscript is a review of new ideas regarding the pathogenesis of peritoneal endometriosis, ovarian endometriosis, and retroperitoneal adenomyosis. Peritoneal endometriosis, the different aspects of which (black, red and white) represent distinctive steps in the evolutionary process, can be explained by the transplantation theory. Red lesions are the most active and most highly vascularized lesions and are considered to be the first stage of peritoneal endometriosis.

Iron overload in the peritoneal cavity of women with pelvic endometriosis.

Objective: To examine the possible involvement of iron in the physiopathology of endometriosis.

Design: Prospective study.

Setting: Department of gynecology in a university hospital.

Oxidative stress and peritoneal endometriosis.

Objective: To review the literature associating pelvic endometriosis with oxidative stress and to discuss the potential causes and consequences of a pro-oxidant environment in the peritoneal cavity.

Design: Literature survey.

Result(s): Several studies suggest that oxidative stress is a component of the inflammatory reaction associated with endometriosis.

Potential involvement of hemoglobin and heme in the pathogenesis of peritoneal endometriosis.

Objective: To test whether hemoglobin may accumulate in the peritoneal cavity in case of endometriosis and to assess whether heme oxygenases (HO), detoxifying heme, are expressed in ectopic endometrium and peritoneal cells.

Design: Prospective study involving patients with and without endometriosis.

Setting: Department of gynecology in a university hospital.

Early-stage endometriosis: adhesion and growth of human menstrual endometrium in nude mice.

Objective: To evaluate the implantation of menstrual endometrium and the early stages of evolution of endometriotic lesions.

Design: Experimental prospective study.

Setting: An academic research environment.

Histologic and ultrastructural evaluation of fresh and frozen-thawed human ovarian xenografts in nude mice.

Objective: To compare histologic and ultrastructural characteristics of fresh and frozen-thawed human ovarian cortical tissue grafted into nude mice.

Design: Experimental prospective study.

Setting: An academic research environment.

Transplantation of cultured explants of human endometrium into nude mice.

The objective of this study was to analyse the histological and immunohistochemical characteristics of cultured explants of human endometrium transplanted into nude mice. Biopsies of eutopic endometrium were taken from six patients during laparoscopic surgery and classified according to the phase of the cycle. All the explants were cultured with oestrogen and progesterone for 24 h before transplantation into 15 mice.

Immunohistochemical study of the proliferation index, oestrogen receptors and progesterone receptors A and B in leiomyomata and normal myometrium during the menstrual cycle and under gonadotrophin-releasing hormone agonist therapy.

The cell proliferation-associated antigen Ki 67 and the immunohistochemical content of oestrogen receptors (ER), progesterone receptors AB (PRAB) and progesterone receptors B (PRB) were evaluated in leiomyomata and adjacent myometrium during the menstrual cycle and in leiomyomata under gonadotrophin-releasing hormone agonist (GnRHa) therapy. The proliferative status of muscular cells was measured by evaluating the percentage of nuclei staining positive for Ki 67 (proliferation index). Quantitative analysis (QH-score) was carried out using advanced stereographic computer technology to investigate ER, PRAB and PRB.

Vascular endothelial growth factor (VEGF) in endometriosis.

Angiogenesis is likely to be involved in the pathogenesis of endometriosis. According to the transplantation theory, when the exfoliated endometrium is attached to the peritoneal layer, the establishment of a new blood supply is essential for the survival of the endometrial implant and development of endometriosis. From the known angiogenic factors, vascular endothelial growth factor (VEGF) has emerged as a pivotally important regulator of normal angiogenesis and pathological neovascularization.

Immunohistochemical analysis of proliferative activity and steroid receptor expression in peritoneal and ovarian endometriosis.

Objective: To assess the proliferative activity of eutopic and ectopic endometrium throughout the menstrual cycle and its correlation to steroid receptor content.

Design: The immunohistochemical use of Ki 67 was applied to investigate the proliferation index. A recently advanced stereographic computer technology was used to investigate steroid receptors.

Rectovaginal septum adenomyotic nodules: a series of 500 cases.

Objective: Laparoscopic procedure with excision of deep fibrotic endometriotic nodules of the rectovaginal septum and histological study of the lesions.

Setting: An academic teaching hospital.

Participants: A series of 500 women undergoing laparoscopy for pelvic pain or infertility.

Peritoneal endometriosis and "endometriotic" nodules of the rectovaginal septum are two different entities.

Objective: To compare histologically and stereologically the endometriotic nodule of the rectovaginal septum to peritoneal endometriosis.

Design: Morphometric investigation, cytokeratin and vimentin content, and steroid receptor evaluation were performed on endometriotic tissue from the peritoneum (n = 52) and rectovaginal nodules (n = 68).

Setting: An academic teaching hospital.

Large ovarian endometriomas.

The management of large endometriomas was described in a series of 814 patients. Combined therapy using gonadotrophin-releasing hormone agonist (GnRHa) and carbon dioxide laser laparoscopy was proposed. Drainage and GnRHa for 12 weeks provoked a reduction of the endometrioma size up to 50% of the initial value.

Endometrial laser interstitial hyperthermy: a potential modality for endometrial ablation.

This study was undertaken to evaluate the efficacy and safety of an intrauterine device designed for endometrial ablation by Nd-YAG laser interstitial hyperthermy. Eight hysterectomy specimens were treated in vitro with an output power of 30 W for 5 minutes; tissue temperatures, recorded by thermocouples, were plotted to draw time-temperature and time-distance curves. As a preliminary series, ten patients were treated, with the first five subjected to local temperature monitoring; all ten were followed-up for 6-17 months.

Morphometric, immunohistological and three-dimensional evaluation of the endometrium of menopausal women treated by oestrogen and Crinone, a new slow-release vaginal progesterone.

Recently advanced computerized technology was applied to the investigation of morphometric, immunohistological and three-dimensional changes of the endometrial mucosa in order to evaluate quantitatively the effects of three doses of a new slow-release vaginal progesterone on the endometrium in post-menopausal women. A total of 20 menopausal women, deprived of ovarian function, were given oestrogen for 12 days and a combined therapy of oestrogen (administered orally) and progesterone for another 12 day period. Progesterone was administered vaginally through a new gel (Crinone) utilizing a bioadhesive, biocompatible polymer as a base to achieve a sustained release effect.

Stereometric evaluation of peritoneal endometriosis and endometriotic nodules of the rectovaginal septum.

A computerized morphometrical investigation was performed on endometriotic tissue from the peritoneum (n = 225) and rectovaginal nodules (n = 65) to compare histologically and stereologically the rectovaginal septum endometriotic nodule to peritoneal endometriosis. Mitotic activity, stromal vascularization and the epithelium/stroma ratio were found to be significantly different in peritoneal and rectovaginal endometriosis. The evaluation revealed a major role of glandular epithelium in rectovaginal nodules where the stroma sometimes appeared absent around glandular epithelium.

Coexpression of cytokeratin and vimentin in eutopic endometrium and endometriosis throughout the menstrual cycle: evaluation by a computerized method.

Objective: To evaluate quantitatively cytokeratin and vimentin staining in glandular and stromal cells of eutopic and ectopic endometrium.

Design: The investigation of cytokeratin and vimentin was carried out using the new computerized technology of image analysis.

Setting: University Hospital, Department of Gynecology.

Treatment of dysfunctional bleeding and fibroids by advanced endoscopic techniques with the Nd:YAG laser: from the present to the future.

Both the electrical current of the resectoscope and the energy of the Nd:YAG laser have been effective tools in the destruction of endometrial tissue to a sufficient depth to avoid regeneration. GnRH-agonist therapy effects a decrease in the total uterine cavity area which facilitates surgical treatment and reduces the risk of fluid overload syndrome. The recurrence rate of meno/metrorrhagia is higher when the uterine cavity is more than 10 cm2.

Rectovaginal septum, endometriosis or adenomyosis: laparoscopic management in a series of 231 patients.

A series of 231 cases of deep-infiltrating endometriosis of the rectovaginal septum is presented. Laparoscopic procedures with excision of deep fibrotic endometriotic nodules were performed in all cases. In three cases, the bowel lumen was entered.

Immunohistochemical analysis of estrogen and progesterone receptors in endometrium and peritoneal endometriosis: a new quantitative method.

Objective: To evaluate estrogen receptors (ER) and progesterone receptors (PR) content in glandular and stromal cells of eutopic and ectopic endometrium.

Design: A recently advanced stereographic computer technology was applied for the investigation of steroid receptors.

Setting: University hospital department of gynecology.