OBJECTIVE: To evaluate the levels of tumor necrosis factor-alpha (TNF-alpha) and tumor necrosis factor-beta (TNF-beta) before and after conservative laparoscopic surgery in patients with endometriosis. METHODS: The levels of TNF-alpha and TNF-beta in the serum of both 82 patients with EMS and 68 controls were determined by ELISA. RESULTS: The levels of TNF-alpha and TNF-beta in the serum of patients with EMS were significantly higher than those of the controls (P < 0.01), and they increased with the clinical terms ( P < 0.05). After clearance of endometrosis foci with laparoscopic conservative surgery, the TNF-alpha levels decreased significantly in EMS III - IV, and TNF-beta levels decreased significantly in EMS I - IV. CONCLUSION Measuring TNF-alpha and TNF-beta levels in the serum of patients with EMS may have important value in postoperative follow-up, surveillance and evaluation of the effectiveness of the surgery.
Adolescent ; Adult ; Endometriosis ; blood ; surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Lymphotoxin-alpha ; blood ; Tumor Necrosis Factor-alpha ; metabolism

PURPOSE: To investigate whether preoperative serum anti-mullerian hormone (AMH) levels are lower in women with ovarian endometrioma and in women with mature cystic teratoma of the ovaries. MATERIALS AND METHODS: In a tertiary university hospital, a retrospective case-control study was performed. Serum AMH levels between an advanced (stage III and IV) endometrioma group (n=102) and an age- and body mass index (BMI)-matched control group were compared. Serum AMH levels between an ovarian mature cystic teratoma group (n=48) and age- and BMI-matched controls were also compared. RESULTS: Absolute serum AMH and multiples of the median for AMH (AMH-MoM) relevant to Korean standards were lower in the endometrioma group than controls, but this was not statistically significant (mean+/-SEM, 2.9+/-0.3 ng/mL vs. 3.3+/-0.3 ng/mL, p=0.28 and 1.3+/-0.1 vs. 1.6+/-0.1, p=0.29, respectively). Specifically, the stage IV endometriosis group (n=51) exhibited significantly lower serum AMH and AMH-MoM (2.1+/-0.3 vs. 3.1+/-0.4 ng/mL, p=0.02 and 1.1+/-0.1 vs. 1.7+/-0.2, p=0.03, respectively). Serum AMH and AMH-MoM levels were similar between stage III endometriosis and controls (3.7+/-0.5 vs. 3.4+/-0.5 ng/mL and 1.6+/-0.2 vs. 1.5+/-0.2, respectively), as well as between the mature cystic teratoma group and controls (4.0+/-0.5 ng/mL vs. 4.0+/-0.5 ng/mL and 1.6+/-0.2 vs. 1.6+/-0.3, respectively). Interestingly, AMH-MoM level was negatively correlated with endometriosis score with statistical significance (r2=0.13, p<0.01). CONCLUSION: In women with advanced ovarian endometrioma, preoperative serum AMH values tended to be lower than those for age and BMI-matched controls. Notably, stage IV endometrioma appeared to be closely associated with decreased ovarian reserve, even before operation. Clinicians should keep this information in mind before undertaking surgery of ovarian endometrioma.
Adult ; Anti-Mullerian Hormone/*blood ; Body Mass Index ; Case-Control Studies ; Endometriosis/blood/*surgery ; Female ; Humans ; Ovarian Neoplasms/blood/pathology/*surgery ; Ovary/pathology/*physiology/surgery ; Preoperative Period ; Retrospective Studies ; Teratoma/blood/*surgery

OBJECTIVETo investigate the clinical value of combination of human epididymis protein 4 (HE4), CA125 and the Risk of Ovarian Malignancy Algorithm (ROMA) in diagnosis of ovarian carcinoma.

METHODSTo detect the serum concentration of HE4 using ELISA and CA125 using ECL in patients of ovarian carcinoma group (n = 119), borderline ovarian tumor group (n = 36), benign ovarian neoplasm group (n = 96) and female healthy control group (n = 53). The ROMA based on the serum level of CA125, HE4 and a woman's menopausal status was used to calculate the predicted probability (PP) and diagnostic results of ovarian cancers.

RESULTSThe receiver operating characteristic (ROC) analysis showed the cut-off value was 67.3 pmol/L (the AUC was 0.906, the sensitivity was 80.7% and specificity was 94.6%). The serum levels of HE4 and CA125 in the ovarian carcinoma group were significantly higher than that in the borderline ovarian tumor group, benign ovarian neoplasm group and female healthy control group (P < 0.01). The serum levels of CA125 and HE4 showed statistically no significant difference between the borderline ovarian tumor group and benign ovarian neoplasm group (P > 0.05). The levels of HE4 and CA125 were reduced significantly in ovarian patients after surgery therapy (P < 0.01). The sensitivity and specificity of HE4 + CA125 combination was 92.7% and 72.5%. The ROMA that can classify patients into high and low risk groups was established as 9.3% in premenopausal and 27.3% in postmenopausal women.

CONCLUSIONSHE4 is a helpful biomarker for ovarian carcinoma diagnosis. Biomarker combination of HE4 and CA125, and applying of the ROMA are helpful to improve the accuracy in diagnosis of ovarian cancers.

Adenocarcinoma, Mucinous ; blood ; diagnosis ; surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor ; blood ; CA-125 Antigen ; blood ; Cystadenocarcinoma, Serous ; blood ; diagnosis ; surgery ; Cystadenoma, Serous ; blood ; diagnosis ; surgery ; Endometriosis ; blood ; diagnosis ; Female ; Humans ; Menopause ; Middle Aged ; Ovarian Neoplasms ; blood ; diagnosis ; surgery ; Proteins ; metabolism ; ROC Curve ; Sensitivity and Specificity ; Teratoma ; blood ; diagnosis ; surgery ; Young Adult

The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data were consistent with DIC, and it was believed to be related to myometrial injury resulting from heavy intramyometrial menstrual flow. Gonadotropin is considered to play an important role in the development of fulminant DIC. This rare case suggests that physicians should be aware that gonadotropin may provoke fulminant DIC in women with adenomyosis.
Acute Kidney Injury/*diagnosis/etiology ; Adult ; Creatinine/blood ; Disseminated Intravascular Coagulation/*chemically induced/complications ; Endometriosis/*complications/diagnosis/surgery ; Female ; Fertilization in Vitro ; Gonadotropins/*adverse effects ; Humans ; Magnetic Resonance Imaging ; Menstruation/*physiology ; Uterus/pathology/surgery

OBJECTIVETo evaluate the effect and safety of acupuncture combined with Jiawei Mojie tablet for the prevention of endometriosis recurrence after surgery.

METHODSOne hundred and six patients after the conservative surgery against endometriosis were randomly divided into a western medication group and an acupuncture and medication group(a combination group), 53 cases in each one. In the western medication group, gestrinone was applied orally. In the combination group, acupuncture and Jiawei Mojie tablet with oral administration were adopted. Xuehai (SP 10), Sanyinjiao (SP 6) and Guanyuan (CV 4) were mainly used, and acupoints based on syndrome differentiation were combined. After the surgery and when the menstruation was end, 3 to 5 days later the preventive treatment was used successively for 6 months. Patients were followed up after treatment and in 3 months, 6 months, and 18 months (two years after surgery) after treatment. The recurrence [Abdominal/perineal ultrasonic examination, serum cancer antigen 125 (CA125) test], menstruation score, endometriosis health profile-5 (EHP-5) and the safety index of serum alanine aminotransferase (ALT) were compared between the two groups.

RESULTSEight patients (five cases in the western medication group and three cases in the combination group) were rejected because of dropping, and six ones (two cases in the western medication group and four cases in the combination group) discontinued. When patients were followed up in 18 months after treatment, the suspected recurrence rate through ultrasonic examination was 2.0% (1/50), and the unusual rate of serum CA125 text was 4.0% (2/50) in the combination group, which were apparently lower than 18.8% (9/48) and 25.0% (12/48) in the western medication group (both P < 0.01). After treatment and 3-month, 6-month, and 18-month following up, the menstruation scores of the combination group were obviously lower than those of the western medication group (P < 0.01, P < 0.05). After 18 months, the positive rate of EHP-5 in the combination group was 0 (0/50), which was markedly lower than 18.8% (9/48) in the western medication group (P < 0.01). After treatment and 3-month, 6-month, and 18-month following up, the unusual rates of serum ALT text in the combination group were lower than those in the western medication group (P < 0.01, P < 0.05). After treatment, the unusual rate of serum ALT text was not significantly different in the combination group compared with that before treatment (P > 0.05), and after treatment and 3-month, 6-month following up, the unusual rates of serum ALT text in the western medication group were remarkablely higher than those before treatment (P < 0.01, P < 0.05). After 18-month following up, the unusual rate of serum ALT text in the western medication group was not statistically significant compared with that before treatment (P > 0.05).

CONCLUSIONAcupuncture combined with Jiawei Mojie tablet can effectively prevent endometriosis recurrence after surgery, and improve menstruation condition and life quality, which are less injurious for liver than gestrinone.

Acupuncture Points ; Acupuncture Therapy ; Administration, Oral ; Adult ; CA-125 Antigen ; blood ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Endometriosis ; blood ; drug therapy ; prevention & control ; surgery ; Female ; Humans ; Male ; Recurrence ; Young Adult

OBJECTIVETo investigate the effect of laparoscopic surgery on the immune function of patients with endometriosis.

METHODBlood samples were obtained from 36 patients undergoing laparoscopy for endometriosis before and 1 day and 3 days after the operation. Peripheral blood T-cell subsets CD3, CD4, and CD8 were determined with flow cytometry, the levels of IgM, IgG, IgA, Complement (C)3, C4, C-reactive protein and (CRP) were detected with turbidimetry, and the levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were measured with enzyme linked immunosorbent assay (ELISA).

RESULTSNo significant variation were found in the T-cell subsets, IgM, IgA, C4 after the operation (P>0.05). The levels of IgG and C3 1 day after the operation were significantly lower than the preoperative levels (P<0.05) and nearly recovered the preoperative level 3 days after operation. Serum concentration of IL-6, TNF-alpha, and CRP 1 day after the operation were significantly higher than the preoperative levels (P<0.01) and decreased 3 days after the operation.

CONCLUSIONSThe immune function of patients with endometriosis is mildly affected by laparoscopic surgery and recover rapidly, which may be one of the reasons for quick recovery of patients after laparoscopy for endometriosis.

Adult ; C-Reactive Protein ; analysis ; CD3 Complex ; blood ; CD4 Antigens ; blood ; CD8 Antigens ; blood ; Complement C3 ; analysis ; Endometriosis ; blood ; immunology ; surgery ; Enzyme-Linked Immunosorbent Assay ; Female ; Flow Cytometry ; Humans ; Immunoglobulin G ; blood ; Interleukin-6 ; blood ; Laparoscopy ; Middle Aged ; T-Lymphocyte Subsets ; immunology ; metabolism ; Tumor Necrosis Factor-alpha ; blood ; Young Adult