Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial.

STUDY OBJECTIVE: To estimate whether the suture of the ovary is superior to bipolar coagulation in preserving ovarian reserve in infertile women undergoing laparoscopic stripping of bilateral endometriomas. DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING: University teaching hospital. PATIENTS: 100 patients with bilateral endometriomas. INTERVENTIONS: Patients underwent stripping of bilateral endometriomas and were randomized to undergo hemostasis by use of either laparoscopic suturing (LS group) or bipolar coagulation (BC group). Changes in ovarian reserve were investigated by measuring the levels of anti-Mullerian hormone (AMH) and basal follicle-stimulating hormone (FSH) before surgery and at 3, 6 and 12 months from surgery. MEASUREMENTS AND MAIN RESULTS: At 3-month, 6-month, and 12-month follow-up, in both study groups, postsurgical AMH levels were significantly lower and basal FSH levels were significantly higher than before surgery. There was no significant difference in the mean percentage decrease of AMH levels in the BC group and LS group at 3-, 6-, and 12-month follow-up. The mean percentage increase in basal FSH was higher in the BC group than in the LS group at both 3-month (p = .023) and 6-month follow-up (p = .029), but not at 12-month follow-up. Pregnancy rate, time to conception, and rate of endometrioma recurrence was similar in the 2 study groups. CONCLUSION: Laparoscopic stripping of ovarian endometriotic cyst significantly decreases serum AMH levels and increases basal FSH levels independent from the method used to obtain hemostasis on the ovarian tissue.

The preoperative diagnosis of borderline ovarian tumors: a review of current literature.

PURPOSE: To evaluate the available information on the preoperative diagnosis of borderline ovarian tumors (BOTs). METHODS: Articles were identified through electronic databases (Medline and EMBASE, MEDLINE, PubMed), no date or language restrictions were placed; relevant citations were hand searched. RESULTS: Women with BOTs are more likely to have no symptom than women with invasive ovarian cancers; however, the type of symptoms is similar in patients with BOTs and invasive ovarian cancers. Up to 61% of women with BOTs have elevated CA-125; CA 19.9 and endoglin are not useful for diagnosing BOTs. Further studies are required to determine whether the measurements of calprotectin, oviductal glycoprotein 1 and growth differentiation factor-15 are useful for diagnosing BOTs. Ultrasonography and magnetic resonance imaging (MRI) are the mainstay for the diagnosis of BOTs. Combining MRI and positron emission tomography may facilitate the identification of BOTs. CONCLUSION: After completion of this article, the reader should be aware of the symptoms of BOTs, the potential role and pitfalls of tumor marker measurement. In addition, the reader will understand the appearance of BOTs at imaging techniques; the reader will be able to compare and combine ultrasonography, MRI and positron emission tomography in diagnosing BOTs. In clinical practice, the reader should be better able to assess whether an ovarian mass is a benign tumor, a BOT or an invasive cancer.

GnRH analogue remarkably down-regulates inflammatory proteins in peritoneal fluid proteome of women with endometriosis.

OBJECTIVE: To determine the changes in the peritoneal fluid proteome of women with endometriosis determined by the administration of gonadotropin-releasing hormone analogues (GnRH-a). STUDY DESIGN: Peritoneal fluid samples were collected during laparoscopy from patients under GnRH-a and from women who did not receive any type of hormonal treatment in the 6 months before surgery. Samples were subjected to 2-D gel electrophoresis and compared by computerized analysis. Protein spots differentially expressed between the study groups were identified by liquid chromatography tandem mass spectrometry. RESULTS: More than 470 protein spots were analyzed. Several proteins with significant alterations were found. The down-regulated molecules were isoforms of alpha 2-HS glycoprotein, alpha 1-antitrypsin, S100-A8, haptoglobin alpha chain and vitamin D-binding protein. No protein spot had significantly higher expression in peritoneal fluid of women under GnRH-a than in untreated patients. CONCLUSION: Several inflammatory molecules present in peritoneal fluid are down-regulated during treatment with GnRH-a; administration of this drug reduces the inflammation in the peritoneal cavity.

Proteomic analysis of peritoneal fluid in fertile and infertile women with endometriosis.

OBJECTIVE: To evaluate the peritoneal fluid (PF) proteome of fertile and infertile women with endometriosis. STUDY DESIGN: PF samples were collected at laparoscopy from 26 fertile women and 26 infertile ones. Samples were subjected to 2-dimensional gel electrophoresis and compared by computerized analysis. Protein spots were identified by liquid chromatography tandem mass spectrometry. RESULTS: One isoform of immunoglobulin light chain spot was more frequently present in PF of infertile women than infertile patients. Nine protein spots had significantly higher expression in PF of infertile patients than infertile controls. They were 2 isoforms of serotransferrin, 1 isoform of complement C3, serum amyloid P-component, alpha-1-antitrypsin and clusterin; 3 protein spots remain unidentified. No protein spots had significantly lower expression in PF of infertile women with endometriosis than in PF of fertile controls. Complement C3 had higher PF levels in the luteal than in the follicular phase of the menstrual cycle in both infertile and fertile patients. CONCLUSION: Among women with endometriosis, those with infertility have aberrant expression of several PF proteins; most of these molecules are involved in the immune response.

Proteomics technologies in endometriosis.

Endometriosis is a common disorder that is associated with infertility and pelvic pain. Diagnosis is based on the visualization of endometriotic lesions during surgery as no reliable serum marker is currently available. The etiology of endometriosis is largely unknown. Over the last 20 years, several proteomics technologies have been used to research novel proteins with a potential etiological role in endometriosis, and to identify candidate serum markers for this condition. While some molecules identified by proteomics technologies may have a relevant role in the pathogenesis of endometriosis, the research of potential serum markers for this condition is still far from any clinical application. This review summarizes the state of the art and potential applications of proteomics in endometriosis research.

Glycolytic enzyme expression in human granulosa cells.

OBJECTIVE: To examine the differences in specific protein expression between mural and cumulus granulosa cells following 24-hour in vitro culture. DESIGN: Laboratory study. SETTING: University Hospital. INTERVENTION(S): Human granulosa cells were collected at the time of egg collection during assisted reproduction. Cumulus cells associated with the oocyte were separated from mural cells from the periphery of the follicle before in vitro culture for 24 hours. Cells were then lysed and subjected to two-dimensional gel electrophoresis. MAIN OUTCOME MEASURE(S): Given that cumulus (cGC) and mural granulosa cells (mGC) differentiate from a single layer, it is likely that phenotypic differences between them may reflect specific molecular processes and structural adaptations. Computer-assisted analysis using dedicated software enabled the presence, absence, or relative volume of each individual protein spot to be estimated. Differentially expressed spots were identified using tandem mass spectrometry. RESULT(S): The mean number of separate protein spots detected in mGC gels was 1,105 +/- 146, and in cGC it was 887 +/- 236, although there was no statistically significant difference between the two. Five enzymes of the glycolytic pathway were never expressed in cGC after 24 hours in vitro; these were triose-phosphate isomerase, glyceraldehyde-3-phosphate dehydrogenase, phosphoglycerate kinase 1, and two isoforms of alpha enolase. These are the first data collected in humans consistent with a recent demonstration that isolated murine cGC cultured in vitro exhibit decreased expression of mRNA encoding glycolytic enzymes, and support the suggestion that some factor or factors secreted by the oocyte may be responsible for the maintenance of glycolysis in the adjacent cGC.

Haptoglobin beta chain isoforms in the plasma and peritoneal fluid of women with endometriosis.

OBJECTIVE: To estimate the expression of haptoglobin (Hp) beta chain isoforms in the peritoneal fluid (PF) and plasma (PL) of women with and without endometriosis. DESIGN: Cross-sectional study. SETTING: University hospital. PATIENT(S): Seventy-two patients with endometriosis and 35 controls. INTERVENTION(S): Peritoneal fluid and PL samples were subjected to two-dimensional gel electrophoresis, silver stained, digitally captured, and compared by semiquantitative computerized analysis. MAIN OUTCOME MEASURE(S): Expression of Hp beta chain isoforms. RESULT(S): No significant difference was observed in the frequency of expression of the Hp beta chain isoforms between the two groups. One beta chain isoform (HpbetaE; molecular weight, 38.40 +/- 0.94 kD; and isoelectric point, 5.63 +/- 0.17) had significantly higher expression in both the PF and PL of women with endometriosis than in the PF and PL of controls. No significant difference was observed in HpbetaE expression between women with mild (revised American Fertility Society [rAFS], stage I-II) and severe (rAFS, stage III-IV) endometriosis. In the control group, HpbetaE expression was correlated with the phase of the menstrual cycle. CONCLUSION(S): Women with endometriosis have higher PF and PL levels of HpbetaE. Further investigation should be aimed at producing antibodies against the HpbetaE-specific epitopes to determine whether its measurement may improve the clinical diagnosis of endometriosis.