Quality of life assessment by the endometriosis health profile (EHP-30) questionnaire prior to treatment for ovarian endometriosis in brazilian women / Avaliação da qualidade de vida através do questionário Endometriosis Health Profile (EHP-30) antes do tratamento da endometriose ovariana em mulheres Brasileiras

Abstract Objective To evaluate the existence of an association between ultrasound findings and epidemiological and clinical factors using results obtained from the EHP-30 questionnaire in women with ovarian endometriosis. Methods A cross-sectional observational study was performed between July 2012 and May 2015, in which patients with chronic pelvic pain suggestive of endometrioma, as indicated by the results from a transvaginal pelvic ultrasonography, completed the standardized Endometriosis Health Profile - 30 (EHP-30) questionnaire to access quality-of-life scores before beginning treatment for endometriosis. A total of 65 patients were included. The data was analyzed in the statistical program IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA) for the comparison of data through linear multiple regression. Results The suitability of the linear regression model was confirmed by the histogram of the dependent variable and the residue distribution plot, confirming the trend of linearity as well as the homogeneous dispersion of the residues. The mean age of the patients was 39.7 ± 7.1 years old. Themajority was Caucasian (64.5%), had completed higher education (56.5%) and was nulligravida (40.3%). Infertility was present in 48.4% of the patients studied. Out of the total sample, 80.6% of the cases were symptomatic and complained mainly of acyclic pain, 79% of dysmenorrhea, and 61.3% of dyspareunia. This reflects the negative influence of endometriosis on the quality of life of patients with this disease. Conclusion Dyspareunia and acyclic pain were independent factors of correlation with high scores in the EHP-30 questionnaire, reflecting a worse quality of life.

Resumo Objetivo Avaliar a existência de associação entre os achados ultrassonográficos e os fatores epidemiológicos e clínicos com os resultados obtidos no questionário EHP-30 em mulheres com diagnóstico de endometriose ovariana. Métodos Realizou-se um estudo observacional transversal entre julho de 2012 emaio de 2015, no qual as pacientes com dor pélvica crônica com imagem sugestiva de endometrioma na ultrassonografia pélvica transvaginal preencheram o questionário padronizado Endometriosis Health Profile - 30 (EHP-30) para acessar os escores de qualidade de vida antes de iniciar qualquer tratamento para a endometriose. Foram incluídas 65 pacientes. Os dados foram analisados no programa estatístico IBM SPSS Statistics for Windows, Versão 22.0 (IBM Corp., Armonk, NY, EUA) para a comparação dos dados através de regressão múltipla linear. Resultados A adequabilidade do modelo de regressão linear foi confirmada através do histograma da variável dependente e do gráfico de distribuição dos resíduos, confirmando a tendência de linearidade, assim como a dispersão homogênea dos resíduos. A idade média das pacientes foi de 39,7 ± 7,1 anos. Amaioria era caucasiana (64,5%), apresentava ensino superior completo (56,5%), e era nuligesta (40,3%). Infertilidade estava presente em 48,4% das pacientes estudadas. Do total de casos 80,6% eram sintomáticas e queixaram-se principalmente de dor acíclica, 79%de dismenorreia , e 61,3% de dispareunia em , refletindo a influência negativa da endometriose sobre a qualidade de vida das pacientes portadores desta doença. Conclusão Dispareunia e dor acíclica foram fatores independentes de correlação com altos escores no EHP-30, refletindo uma pior qualidade de vida.

Nanotechnology for the treatment of deep endometriosis: uptake of lipid core nanoparticles by LDL receptors in endometriotic foci

OBJECTIVE: Rapidly dividing cells in multiple types of cancer and inflammatory diseases undergo high low density lipoprotein (LDL) uptake for membrane synthesis, and coupling an LDL-like nanoemulsion, containing lipid nanoparticles (LDE) to a chemotherapeutic agent efficiently targets these cells without significant systemic effects. This was a prospective exploratory study that evaluated the uptake of a radioactively labeled LDE emulsion by receptors of endometriotic foci and the capacity of the LDE for cellular internalization. METHODS: The lipid profile of each patient was determined before surgery, and labeled LDE were injected into fourteen patients with intestinal or nonintestinal endometriosis. The radioactivity of each tissue sample (intestinal endometriosis, nonintestinal endometriosis, healthy peritoneum, or topical endometrium) was measured. RESULTS: The group with intestinal endometriosis presented higher levels of plasma LDL but lower LDE uptake by foci than the nonintestinal group, suggesting less cell division and more fibrosis. The uptake of LDE was highest in the topical endometrium, followed by the healthy peritoneum, and lowest in the endometriotic lesion. Since the endometriotic foci showed significant LDE uptake, there was likely increased consumption of LDL by these cells, similar to cells in cancers and inflammatory diseases. Plasma cholesterol levels had no influence on LDE uptake, which showed that the direct delivery of the nanoemulsion to target tissues was independent of serum lipoproteins. There were no significant differences in the parameters (p>0.01) because of the small sample size, but the findings were similar to those of previous studies. CONCLUSION: Nanotechnology is a promising therapeutic option for surgery and hormonal blockage for deep endometriosis, with a lower complication rate and no systemic side effects.

Endometriose umbilical: relato de caso e revisão de literatura / Umbilical endometriosis: a case report and literature review

A endometriose é caracterizada pela presença de tecido endometrial fora da cavidade uterina. Seu mecanismo fisiopatológico é pouco esclarecido, mas várias hipóteses são descritas - dentre elas a disseminação de células endometriais por via hematogênica ou linfática. A apresentação clínica é bastante variável, mas podem estar presentes massa palpável, sangramentos cíclicos ou alterações de coloração da pele na região afetada. O diagnóstico é estabelecido a partir do exame clínico, associado a exames de imagem e biópsia da lesão. O tratamento de escolha é o cirúrgico com excisão da lesão e reconstrução da anatomia local. Apresentamos um relato de caso de uma paciente de 35 anos, com endometriose umbilical, com necessidade de excisão da lesão e confecção de novo umbigo. A evolução da afecção descrita é estritamente relacionada ao manejo diagnóstico e propedêutico instituído; sendo assim, a exclusão de diagnósticos diferenciais, benignos ou malignos, é de suma importância.

Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity. The pathophysiology of this condition is poorly understood. However, several hypotheses have been proposed, including the spread of endometrial cells via hematogenous or lymphatic routes. The clinical presentation is variable but includes a palpable nodule, cyclic bleeding, and changes in the color of the skin in the affected region. Diagnosis is established by clinical examination combined with imaging and lesion biopsy. The treatment of choice is surgical, with excision of the lesion and tissue reconstruction. We report the case of a 35-year-old female patient with umbilical endometriosis and the need for removal of the lesion with umbilical reconstruction. The presentation of this condition determines the diagnostic and management approach. Therefore, the exclusion of other benign or malignant disorders is essential.

Primary umbilical endometriosis / Endometriose umbilical primária

ABSTRACT Objective: to report the characteristics, evolution and outcome of patients with primary umbilical endometriosis. Methods: an observational and descriptive study of patients with primary umbilical endometriosis diagnosed between 2014 and 2017. The clinical variables evaluated were age, clinical picture, lesion characteristics, diagnostic methods, treatment and recurrence. Results: six patients diagnosed with primary umbilical endometriosis aged 28 to 45 years were operated on during the study period. They had lesions ranging from one to 2.5cm in diameter, violet in five patients and erythematous-violaceous in one. The duration of the symptoms until diagnosis ranged from one to three years and in all the cases studied the diagnosis was made through the clinical manifestations and confirmed by histopathological analysis. No case was associated with neoplastic alterations. All patients evaluated had pain and umbilical bleeding in the menstrual period. Conclusion: umbilical endometriosis is an uncommon disease and should be included in the differential diagnosis of women as umbilical nodules. The treatment of choice is the total exeresis of the lesion.

RESUMO Objetivo: relatar as características, evolução e desfecho de pacientes portadoras de endometriose umbilical primária. Métodos: estudo observacional e descritivo de pacientes portadoras de endometriose umbilical primária diagnosticada entre 2014 e 2017. As variáveis clínicas avaliadas foram: idade, quadro clínico, características das lesões, métodos diagnósticos, tratamento e recidiva. Resultados: seis pacientes com diagnóstico de endometriose umbilical primária, com idades entre 28 e 45 anos foram operadas no período do estudo. Elas apresentavam lesões que variavam de 1,0cm a 2,5cm de diâmetro, de cor violácea em cinco pacientes e eritemato-violácea em uma. O tempo de duração dos sintomas até o diagnóstico variou de um a três anos e em todos os casos estudados o diagnóstico foi feito por meio das manifestações clínicas e confirmado por meio da análise histopatológica. Nenhum caso foi associado com alterações neoplásicas. Todas as pacientes avaliadas apresentavam como manifestação clínica dor e sangramento umbilical no período menstrual. Conclusão: a endometriose umbilical é uma doença pouco frequente e deve ser incluída no diagnostico diferencial de mulheres como nódulo umbilical. O tratamento de eleição é a exérese total da lesão.

Identificação dos colágenos I, III, IV e α-SMA e participação dos miofibroblastos no processo fibrótico das endometroses equinas / Identification of collagens types I, III, IV and α-SMA and the participation of myofibroblasts in the fibrotic process in equine endometrosis

A endometrose é uma alteração degenerativa das glândulas uterinas e do estroma circundante, caracterizada pelo arranjo periglandular de miofibroblastos e pela deposição de matriz extracelular (ECM). O presente trabalho objetivou avaliar a expressão de colágenos tipos I, III e IV e α-actina de músculo liso (α-SMA) nas endometroses equinas, procurando esclarecer a participação dos miofibroblastos na progressão desses processos. Foram utilizadas 24 biópsias uterinas com diagnóstico de endometrose, recebidas pelo Serviço de Patologia Veterinária e de Reprodução Animal da FMVZ, Unesp, Botucatu, SP. Cortes histológicos foram submetidos às técnicas histoquímicas de tricrômico de Masson, picrosirius red sob luz polarizada e ácido periódico de Schiff (PAS) e imuno-histoquímicas para os três tipos de colágeno citados e α-SMA. Ainda, traçou-se um paralelo entre a técnica de picrosirius red e a imunomarcação dos colágenos tipos I e III. A análise histológica revelou que as fibras de colágeno denso correspondem ao colágeno tipo I, predominantes nas endometroses inativa e inativa destrutiva. As fibras de colágeno frouxo correspondem ao colágeno tipo III, predominantes nas endometroses ativas e ativas destrutivas. Nesses mesmos processos, a membrana basal revelou espessamento, aparentemente não relacionado ao colágeno tipo IV, e uma maior imunomarcação de miofibroblastos periglandulares em relação às endometroses inativa e inativa destrutiva. Dessa forma, nota-se que os miofibroblastos estão relacionados ao aumento na deposição de colágeno tipo III nos ninhos fibróticos ativos.(AU)

Endometriosis is a degenerative change of the uterine glands and surrounding stroma, characterized by periglandular arrangement of myofibroblasts and deposition of extracellular matrix (ECM). The aim of this study was to evaluate the expression of collagen type I, III and IV and α-smooth muscle actin (α-SMA) in equine endometriosis, and investigate the role of myofibroblasts in the progression of these processes. A parallel was made with histochemical techniques of Masson's trichrome, Picrosirius Red under polarized light and Periodic Acid-Schiff (PAS). Twenty four uterine biopsies received by the Veterinary Pathology Service and Animal Reproduction of FMVZ, UNESP, Botucatu, SP, were diagnosed with endometriosis. Histological analysis revealed that the orange dense collagen fibers correspond to type I collagen, being prevalent in inactive and inactive destructive endometriosis. The green loose collagen fibers correspond to type III collagen, and are predominant in active and active destructive endometriosis. In the same processes, a greater amount of periglandular myofibroblasts were observed in comparison to inactive and inactive destructive endometriosis. The presence of these cells in active processes are strongly related to an increased deposition of collagen type III in fibrotic nests. Regarding the basement membrane, the active destructive and active endometriosis shows thickening, apparently not related to an increase in expression of type IV collagen. The active destructive and inactive destructive endometriosis exhibited disruption areas in type IV collagen fibers. Thus, it is noted that the myofibroblasts are related to increased deposition of type III collagen in active fibrotic nests.(AU)

Correlation of the three-dimensional ultrasound findings with pathology in patients with deep pelvic infiltrating endometriosis submitted to surgery / Correlação dos achados da ultrassonografia tridimensional com o anatomopatológico em pacientes com endometriose pélvica infiltrativa profunda submetidos a tratamento cirúrgico

Objective: This study aims to correlate the findings of the three-dimensional anorectal ultrasonography (3D-AUS) with pathological findings in patients with deep pelvic infiltrating endometriosis. Methods: Prospective study of a series of 40 patients with deep pelvic infiltrating endometriosis diagnosed by three-dimensional anorectal ultrasonography and who were submitted to a laparoscopy. The specimens were examined histologically and compared with the results of the three-dimensional anorectal ultrasonography. The research was conducted between March 2008 and March 2011. Results: The results of the examinations were: 72.5% of patients (n = 29) with endometriosis, 12.5% (n = 5) with nonspecific chronic inflammatory reaction, 5% (n = 2) with nonspecific fibrous tissue, 2.5% (n = 1) with adenomyoma, 2.5% (n = 1) with colonic mucosa with foci of recent hemorrhage, edema of lamina propria and superficial erosions, 2.5% (n = 1) with hyperplasia of lymphoid follicles, and the remaining 2.5% (n = 1) with peritoneal tissue within normal limits. Conclusion: We conclude that the use of three-dimensional anorectal ultrasonography in patients with deep pelvic infiltrating endometriosis aid in the diagnosis of rectal lesions, when compared with the pathological findings of surgical specimens.

Objetivo: Este estudo visa correlacionar os achados da ultrassonografia tridimensional com os achados anatomopatológicos em pacientes com endometriose pélvica infiltrativa profunda submetidos a tratamento cirúrgico. Métodos Estudo prospectivo de uma série de 40 pacientes com endometriose pélvica: infiltrativa profunda diagnosticados pela USR-3D e submetidos à videolaparoscopia. As peças cirúrgicas foram analisadas histologicamente e comparadas com os resultados das USR-3D. A pesquisa foi desenvolvida entre março de 2008 a março de 2011. Resultados: Os resultados dos estudos histopatológicos foram: 72,5% das pacientes (n = 29) com endometriose, 12,5% (n = 5) com reação inflamatória crônica inespecífica, 5% (n = 2) com tecido fibroso inespecífico, 2,5% (n = 1) com adenomioma, 2,5% (n = 1) com mucosa colônica com presença de focos de hemorragia recente, edema de lâmina própria e erosões superficiais, 2,5% (n = 1) com hiperplasia de folículos linfoides e o restante, 2,5% (n = 1), com tecido peritoneal dentro dos limites da normalidade. Conclusão: Conclui-se, portanto que a ultrassonografia anorretal tridimensional em pacientes portadoras de endometriose pélvica infiltrativa profunda ajuda no diagnóstico de lesões retais, quando essa técnica é comparada com os achados anatomopatológicos das peças cirúrgicas.

Endometriosis, Ovarian Reserve and Live Birth Rate Following In Vitro Fertilization/Intracytoplasmic Sperm Injection / Endometriose, reserva ovariana e taxa de nascidos vivos após FIV/ICSI

Abstract Purpose To evaluate whether women with endometriosis have different ovarian reserves and reproductive outcomes when compared with women without this diagnosis undergoing in vitro fertilization/intracytoplasmic sperm injection ( IVF/ ICSI), and to compare the reproductive outcomes between women with and without the diagnosis considering the ovarian reserve assessed by antral follicle count ( AFC ). Methods This retrospective cohort study evaluated all women who underwent IVF/ ICSI in a university hospital in Brazil between January 2011 and December 2012. All patients were followed up until a negative pregnancy test or until the end of the pregnancy. The primary outcomes assessed were number of retrieved oocytes and live birth. Women were divided into two groups according to the diagnosis of endometriosis, and each group was divided again into a group that had AFC 6 (poor ovarian reserve) and another that had AFC 7 (normal ovarian reserve). Continuous variables with normal distribution were compared using unpaired t-test, and those without normal distribution, using Mann-Whitney test. Binary data were compared using either Fisher's exact test or Chi-square (2) test. The significance level was set as p < 0.05. Results 787 women underwent IVF/ICSI (241 of which had endometriosis). Although the mean age has been similar between women with and without the diagnosis of endometriosis (33.8 4 versus 33.7 4.4 years, respectively), poor ovarian reserves were much more common in women with endometriosis (39.8 versus 22.7%). The chance of achieving live birth was similar between women with the diagnosis of endometriosis and those without it (19.1 versus 22.5%), and also when considering only women with a poor ovarian reserve (9.4 versus 8.9%) and only those with a normal ovarian reserve (25.5 versus 26.5%). Conclusions Women diagnosed with endometriosis are more likely to have a poor ovarian reserve; however, their chance of conceiving by IVF/ICSI is similar to the one observed in patients without endometriosis and with a comparable ovarian reserve.

Resumo Objetivo Avaliar se mulheres com endometriose possuem diferenças quanto a reserva ovariana (RO) e a resultados de reprodução assistida quando comparadas a mulheres sem este diagnóstico submetidas IVF/ICSI (in vitro fertilization/intracytoplasmic sperm injection), e comparar resultados reprodutivos entre mulheres com e sem o diagnóstico, considerando a RO obtida pela contagem de folículos antrais ( CFA ). Métodos Este estudo de coorte retrospectivo avaliou todas as mulheres submetidas à FIV/ICSI em uma universidade do Brasil nos anos de 2011 e 2012. Todas as pacientes foram seguidas até um teste negativo de gravidez ou até o final da gestação. Os desfechos primários analisados foram o número do oócitos captados e nascidos vivos. As mulheres foram divididas em 2 grupos de acordo com o diagnóstico de endometriose e subdivididas de acordo com a CFA 6 (baixa RO) e 7 (RO normal). As variáveis contínuas com distribuição normal foram comparadas pelo teste t não pareado e sem distribuição normal pelo teste de Mann-Whitney. Os dados binários foram comparados por ambos os testes Qui-quadrado (2) e exato de Fisher. O nível de significância foi definido como p < 0,05. Resultados 787 mulheres foram submetidas a IVF/ICSI (241 com endometriose). Embora a média de idade tenha sido similar entre as mulheres com e sem o diagnóstico de endometriose (33,8 4 versus 33,7 4.4 anos, respectivamente), a baixa RO é muito mais comum em mulheres com endometriose (39,8 versus 22,7%). A chance de obter um nascido vivo foi similar entre as mulheres com e sem endometriose (19,1 versus 22,5%), e também quando consideradas apenas as mulheres com baixa RO (9 , 4 versus 8,9%), e apenas com RO normal (25,5 versus 26 ,5% ). Conclusões Mulheres diagnosticadas com endometriose são mais susceptíveis a ter baixa RO; no entanto, suas chances de conceber por IVF/ICSI são similares às observadas em pacientes sem endometriose e com uma RO comparável.

Estrogen signaling in the proliferative endometrium: implications in endometriosis / Sinalização pelo estrogênio no endométrio proliferativo: implicações na endometriose

SUMMARY Even though the physiological role of estrogen in the female reproductive cycle and endometrial proliferative phase is well established, the signaling pathways by which estrogen exerts its action in the endometrial tissue are still little known. In this regard, advancements in cell culture techniques and maintenance of endometrial cells in cultures enabled the discovery of new signaling mechanisms activated by estrogen in the normal endometrium and in endometriosis. This review aims to present the recent findings in the genomic and non-genomic estrogen signaling pathways in the proliferative human endometrium specifically associated with the pathogenesis and development of endometriosis.

RESUMO Embora esteja bem estabelecido o papel fisiológico do estrogênio no ciclo reprodutivo feminino e na fase proliferativa do endométrio, as vias de sinalização por meio das quais a ação do estrogênio é exercida no tecido endometrial são ainda pouco conhecidas. Nesse sentido, o avanço nas técnicas de cultura celular e a manutenção de células endometriais em cultivo possibilitaram a descoberta de novos mecanismos sinalizadores ativados pelo estrogênio no endométrio normal e na endometriose. Esta revisão tem o objetivo de apresentar as descobertas recentes envolvendo as vias de sinalização genômica e não genômica do estrogênio no endométrio proliferativo humano, especificamente associadas à patogênese e ao desenvolvimento da endometriose.

ACE I/D Polymorphism in Brazilian Women with Endometriosis / Polimorfismo ACE I/D em Mulheres Brasileiras com Endometriose

Endometriosis is a chronic gynecological disease that displays some features similar to malignancy, such as local invasion, aggressive spread to distant organs and angiogenesis. Polymorphisms of the ACE gene have been linked with some vascular disease. To determine the frequency of the ACE I/D polymorphism in Brazilian patients with endometriosis compared to controls. This case-control study included a total of 134 women (49 endometriosis patients and 85 controls) who had undergone a laparoscopy or laparotomy. Molecular analysis was performed by polymerase chain reaction (PCR). For the statistical analysis, the chi-square and multiple logistic regression tests were used. The I/D ACE genotype frequencies in cases and controls were, respectively: II 16.3% and 16.5%; ID 24.5% and 20%; DD 59.2% and 63.5%. There was no statistically significant difference between cases and controls, either in the genotype frequencies (χ2 = 0.385; p = 0.825) or in the allele frequencies (χ2 = 0.098; p = 0.75) of the ACE I/D polymorphism. However, the genotype distribution was not consistent with the Hardy-Weinberg equilibrium, either in patients (χ2 = 7.84; p = 0.005) or in controls (χ2 = 20.09; p <0.0001). Multiple logistic regression analysis has not shown any differences amongst groups for the polymorphism studied [(OR 1.51; CI 95% 0.52- 4.41); p=0.4523]. Despite of the small sample size, the present study suggests that I/D ACE polymorphism is not related with endometriosis in brazilian patients.(AU)

A endometriose é uma doença ginecológica crônica que apresenta algumas características semelhantes à malignidade, tais como invasão local, disseminação para órgãos distantes e angiogênese. Polimorfismos no gene ACE têm sido relacionados com algumas doenças vasculares. Determinar a frequência do polimorfismo ACE I/D em pacientes brasileiros com endometriose em comparação aos controles. Estudo caso-controle que incluiu um total de 134 mulheres (49 pacientes com endometriose e 85 controles) que se submeteram a uma laparoscopia ou laparotomia. A análise molecular foi realizada por Reação em Cadeia da Polimerase (PCR). A análise estatística utilizou os testes de qui-quadrado e regressão logística. As frequências genotípicas ACE I/D em casos e controles foram, respectivamente: II 16,3% e 16,5%; ID 24,5% e 20%; DD 59,2% e 63,5%. Não houve diferença estatisticamente significativa entre os casos e controles, tanto nas frequências genotípicas (χ2 = 0,385; p = 0,825) ou nas frequências alélicas (χ2 = 0,098; p = 0,75) do polimorfismo ACE I/D. Entretanto, a distribuição genotípica não foi consistente com o equilíbrio de Hardy-Weinberg, tanto nos pacientes (χ2 = 7,84; p = 0,005) ou nos controles (χ2 = 20,09; p <0,0001). A análise de regressão logística não mostrou qualquer diferença entre os grupos para o polimorfismo estudado [(OR 1,51; CI 95% 0,52-4,41); p=0,4523]. Apesar do pequeno número de amostras, o presente estudo mostra que em pacientes brasileiras o polimorfismo ACE I/D não está relacionado com endometriose.(AU)

Development of a subcutaneous endometriosis rat model

PURPOSE: To present a rat model of subcutaneous endometriosis for the study of pathophysiology and the effects of drugs. METHODS: Fifty three-month-old female Wistar rats (Rattus norvergicus) were distributed into one control group and four treatment groups: estradiol (2.5; 5; 10mg/kg sc), medroxyprogesterone acetate (0.5; 2; 5mg/kg sc), triptorelin pamoate (0.18; 0.56mg/kg sc) and acetylsalicylic acid (3mg/kg per os). The animals were autoimplanted subcutaneously with 4x4-mm uterine fragments to induce endometriosis. The endometriomas were measured on days 1, 7, 14 and 21. The relative dry and wet weights of the endometrioma were used to evaluate response to the drug. Endometrial -like tissue was confirmed by histology. The greatest weight gain was observed on day 14 (relative wet weight: 29.1 ± 6.7mg%, relative dry weight: 5.3 ± 0.9mg %). Treatments were administered between day 5 and day 14. RESULTS: The relative wet weight of the hemiuterus in the 10mg/kg estradiol group differed significantly from control and the other two estradiol groups (p=0.0001). In the medroxyprogesterone acetate group the weight decreased significantly but this decrease was not dose-dependent. Weight reduction was also significant in the triptorelin pamoate and the acetylsalicylic acid groups. CONCLUSION: The model of subcutaneous endometriosis is reproducible, low-cost and easy to perform, and suitable for the study of pathophysiology and the effects of drugs. .

Differential expression of upstream stimulatory factor (USF) 2 variants in eutopic endometria from women with endometriosis: estradiol regulation

BACKGROUND: Endometriosis, pro-inflammatory and invasive benign disease estrogen dependent, abnormally express in endometria the enzyme P450Arom, positively regulated by steroid factor-1 (SF-1). Our objective was to study the nuclear protein contents of upstream stimulating factor 2 (USF2a and USF2b), a positive regulator of SF-1, throughout the menstrual cycle in eutopic endometria from women with and without (control) endometriosis and the involvement of nuclear estrogen receptors (ER) and G-coupled protein estrogen receptor (GPER)-1. RESULTS: Upstream stimulating factor 2 protein contents were higher in mid (USF2b) and late (USF2a and USF2b) secretory phase in eutopic endometria from endometriosis than control (p < 0.05). In isolated control epithelial cells incubated with E2 and PGE2, to resemble the endometriosis condition, the data showed: (a) significant increase of USF2a and USF2b nuclear protein contents when treated with E2, PPT (specific agonist for ERa) or G1 (specific agonist for GPER1); (b) no increase in USF2 binding to SF-1 E-Box/DNA consensus sequence in E2-treated cells; (c) USF2 variants protein contents were not modified by PGE2; (d) SF-1 nuclear protein content was significantly higher than basal when treated with PGE2, E2 or G1, stimulation unaffected by ICI (nuclear ER antagonist); and (e) increased (p < 0.05) cytosolic protein contents of P450Arom when treated with PGE2, E2, PPT or G1 compared to basal, effect that was additive with E2 + PGE2 together. Nevertheless, in endometriosis cells, the high USF2, SF-1 and P450Arom protein contents in basal condition were unmodified. CONCLUSION: These data strongly suggest that USF2 variants and P450Arom are regulated by E2 through ERa and GPER1, whereas SF-1 through GPER1, visualized by the response of the cells obtained from control endometria, being unaffected the endogenously stimulated cells from endometriosis origin. The lack of E2 stimulation on USF2/SF-1 E-Box/DNA-sequence binding and the absence of PGE2 effect on USF2 variants opposite to the strong induction that they exert on SF1 and P450 proteins suggest different mechanisms and indirect regulations. The sustained USF2 variants protein expression during the secretory phase in eutopic endometria from women with endometriosis may participate in the pathophysiology of this disease strongly associated with infertility and its characteristic endometrial invasion to ectopic sites in the pelvic cavity.

Endometriosis tracto urinario: revisión de la literatura / Urinary tract endometriosis: review of the literature

Se define como endometriosis a la presencia de tejido endometrial fuera de la cavidad uterina. La endometriosis del tracto urinario (ETU) se refiere a la presencia de tejido endometrial en o alrededor de la vejiga, uréteres, uretra o riñones, lo que ocurre en alrededor de 1por ciento de los casos. El objetivo de esta revisión es realizar una puesta al día en los conceptos relativos a esta rara enfermedad. Se analiza clínica, fisiopatología y tratamiento.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Urinary tract endometriosis (ETU) refers to the presence of endometrial tissue in or around the bladder, ureters, urethra or kidneys, which occurs in about 1percent of cases. The objective of this review is to update the concepts concerning this rare disease. Clinic, pathophysiology and treatment are discussed.

Consenso Centroamericano sobre la fisiopatología, diagnóstico y tratamiento de la endometriosis / American Consensus on the pathophysiology, diagnosis and treatment of endometriosis

La endometriosis se define como la presencia de tejido endometrial fuera de la cavidad uterina y tiene una prevalencia de 6-10% en las mujeres en edad reproductiva. Es una enfermedad inflamatoria crónica de patogénesis compleja. El elemento principal de su fisiopatología es el hecho de ser estrógeno dependiente, por lo que sus manifestaciones clínicas mejoran en la menopausia y durante la gestación y empeoran con la menstruación...

Endometriose: papel da superfamília do fator transformador de crescimento beta / Endometriosis: the role of transforming growth factor β superfamily

A endometriose é uma condição ginecológica, que atinge mulheres em idade reprodutiva e pode ser causa de dor e infertilidade. A patogênese da doença é multifatorial e envolve a perda da capacidade de diferenciação das células endometrióticas, moléculas de adesão celular para adesão do endométrio ao peritônio, neoangiogênese, características do fluido peritoneal e alterações do sistema imune. A superfamília do fator transformador de crescimento β (TGF-β) parece exercer papéis importantes na implantação e manutenção do tecido ectópico na endometriose. Ativinas, inibinas, folistatina, hormônio anti-mülleriano e as proteínas morfogenéticas ósseas são membros da superfamília do TGF-β. Estas moléculas são expressas no endométrio humano e apresentam ações importantes na proliferação celular, diferenciação celular, função imune, regulação da apoptose e remodelamento dos tecidos, apresentando, por conseguinte, um importante papel no ciclo menstrual, decidualização do endométrio e no início da gestação. Este artigo objetiva rever os achados sobre tais proteínas no endométrio e seus possíveis papéis na gênese e fisiopatologia da endometriose

Endometriosis is a gynecological pathological entity typical of women in reproductive age, associated with pelvic pain and infertility. The pathogenesis of the disease is multifactorial and it involves loss of the endometriotic cell differentiation, cell adhesion, neo-angiogenesis, peritoneal fluid characteristics, and changes in the immune system. The transforming growth factor β (TGF-β) superfamily seems to play important roles in the implementation and maintenance of ectopic tissue in endometriosis. Activin, inhibin, follistatin, anti-Mullerian hormone, and bone morphogenetic proteins are members of the superfamily of TGF-β. The TGF-β and family members are expressed by human endometrium and act on cell proliferation, differentiation, immune function, apoptosis and tissue remodeling, playing a role in menstrual cycle, decidualization, and early pregnancy. The aim of this study is to review the findings about these molecules in the endometrium and their possible roles in the genesis and pathophysiology of endometriosis

Endometriosis, a modern syndrome.

The identification of endometriosis has been a subject of intense debate over the last decade. There is, however, no doubt that Thomas Cullen was the first to describe endometriosis and adenomyosis as one disease characterized by the presence of endometrium-like tissue outside the uterine cavity. With the introduction of laparoscopy in the early 1960s three different clinical presentations of endometriosis were distinguished: peritoneal, deep adenomyotic and cystic ovarian. As soon as synthetic steroids became available, pioneer clinicians started utilizing these in an attempt to replace radical surgery by a medical treatment. While medical therapy may resort in relief, in most cases the current approach consists of a combination of medical and surgical therapy. While the pathogenesis of endometriosis is still enigmatic and complex, there is increasing evidence that endometriosis is part of a uterine reproductive dysfunction syndrome. For prevention of complications, it is very important that diagnosis is made as early as possible in a woman's life.

O papel dos desreguladores endócrinos na fisiopatologia da endometriose: revisão da literatura / The role of the endocrine disruptors in the physiopathology of endometriosis: review of literature

O efeito prejudicial que os desreguladores endócrinos podem ter na saúde humana está chamando a atenção da comunidade científica. Essas substâncias são capazes de mimetizar, bloquear ou modular a resposta endócrina por meio da interação com os receptores dos hormônios esteroides e incluem substâncias como pesticidas, fungicidas, dioxinas, ftalatos, bisfenol A, fitoestrogênios, entre outros. A endometriose é uma doença ginecológica comum, que acomete cerca de 15% das mulheres em período reprodutivo e 50% dasámulheres com problemas de fertilidade. Muitas teorias foram propostas para tentar explicar o desenvolvimento das lesões. Todavia, não existe, até o momento, uma teoria única que identifique e explique todos os aspectos clínicos dessa doença considerada multifatorial. Recentemente, contaminantes ambientais têm sido implicados na fisiopatologia da endometriose. Este trabalho teve por objetivo realizar uma revisão crítica da literatura médica sobre a influência de compostos ambientais no desenvolvimento da endometriose.

The hazardous effects that endocrine disruptors may have on human health have attracted the attention of scientific community. These chemicals have the capacity to mimic, block or modulate the endocrine response by the means of the interaction with steroidal receptors. Endocrine disruptors include substances such as pesticides, fungicides, dioxins, phthalates, bisphenol A, phytoestrogens and others. Endometriosis is a common gynecological disease affecting about 15% of women in reproductive ages and 50% of women with fertility problems. Several theories have been proposed to explain the development of the lesions. However, at present, there is not a single theory to identify and explain all clinical aspects of this multifactorial disease. Recently, environmental contaminants have been involved in the physiopathology of endometriosis. The aim of this work was a critic medical literature review about the influence of environmental contaminants on endometriosis development.

Avaliação da concordância entre a ultrassonografia transvaginal e a ressonância magnética da pelve na endometriose profunda, com ênfase para o comprometimento intestinal / Evaluation of agreement between transvaginal ultrasonography and magnetic resonance imaging of the pelvis in deep endometriosis with emphasis on intestinal involvement

OBJETIVO: Comparar achados ultrassonográficos e de ressonância magnética na endometriose profunda,com ênfase para o comprometimento intestinal. MATERIAIS E MÉTODOS: Dezoito pacientes entre 23 e 49 anos de idade, com suspeita clínica e exame ginecológico sugestivo de endometriose profunda, foram submetidas a ultrassonografia e ressonância magnética para correlação dos achados. RESULTADOS: A ultrassonografia detectou 40 lesões e a ressonância magnética detectou 53 lesões na pelve. O estudo comparativo entre ultrassonografia e ressonância magnética na detecção das lesões não mostrou diferença estatística significativa (p > 0,19 e p > 0,14, respectivamente). Considerando-se a junção retossigmoide, a ressonânciamagnética detectou uma lesão (5,6%) e a ultrassonografia apontou quatro lesões (22,2%). Nas lesões retais, a ultrassonografia apontou oito lesões (44,4%) e a ressonância magnética, sete lesões (38,9%). CONCLUSÃO: A concordância entre a ressonância magnética e a ultrassonografia não foi boa na junção retossigmoide e no reto, sendo que a ultrassonografia detectou um número maior de lesões nessas localizações, mas identificou número menor de lesões na pelve. Na análise comparativa global entre os dois métodos na detecção das lesões não houve diferença estatística significativa. O baixo custo, a boa tolerabilidadee o fácil acesso tornam a ultrassonografia instrumento diagnóstico valioso na endometriose profunda.

OBJECTIVE: To compare sonographic and magnetic resonance imaging findings in deep endometriosis withemphasis on intestinal involvement. MATERIALS AND METHODS: Eighteen women aged between 23 and 49 years with clinical suspicion and gynecological signs suggestive of deep endometriosis were submitted to ultrasonography and magnetic resonance imaging for correlation between findings. RESULTS:Ultrasonography detected 40 lesions while magnetic resonance imaging detected 53 lesions in the pelvis. A comparative study has not shown any statistically significant intermethod difference in the detection of lesions(respectively p > 0.19 and p > 0.14). In the rectosigmoid junction, magnetic resonance imaging has detected one (5.6%) lesion, while ultrasonography has detected four lesions (22.2%). In the rectum, ultrasonography has detected eight lesions (44.4%), and magnetic resonance imaging has detected seven lesions (38.9%). CONCLUSION: The intermethod agreement has not been good for lesions in the rectosigmoid junction, considering that ultrasonography has detected a higher number of lesions in this region, but a lower number of lesions in the pelvis as compared with magnetic resonance imaging. The global comparative analysis has demonstrated no statistically significant intermethod difference in the detection of lesions. Low cost, good tolerability and high availability make ultrasonography a valuable diagnostic tool in cases of deep endometriosis.