Irem Onur, MD

Dr. Onur is an associate professor of pathology with subspecialty certification in cytopathology in Turkey. She is deeply interested in medical writing and conveying the latest scientific information to medical professionals as well as the public.

Which surgical approach for bowel endometriosis?

A group of researchers from Spain, led by Dr. Alicia Hernández Gutiérrez, conducted a retrospective study to compare postoperative complications and recurrence of three surgical techniques: segmental bowel resection (group I), discoid excision (group II), and rectal nodule shaving (group III). They analyzed 143 patients who underwent surgical treatment for symptomatic bowel endometriosis. Endometriosis patients who underwent segmental resection revealed a higher rate of severe postoperative complications in comparison with discoid resection or shaving groups. The authors explained the higher…

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Perinatal risk factors for endometriosis

Gao M. et al., from Sweden analyzed the associations of maternal and birth characteristics with the risk of endometriosis among Swedish women of reproductive age. They have recently published their study in the "International Journal of Epidemiology". The authors conducted a total-population register-based cohort study consisted of more than 625000 singleton women born in Sweden between 1973 and 1987. These women were followed for diagnosed endometriosis from age 15 years until the end of 2012. Among them, 8262 were diagnosed…

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Analysis of childless women with endometriosis

Facchin F. et al., from Italy studied if the beliefs of childless women regarding motherhood, female identity, and infertility affected their psychological health. They have recently published their study in the Journal of Health Psychology. The data of this study were derived from the study of Nisenblat et al. which analyzed the psychological impact of endometriosis on 190 women with a surgical or current clinical diagnosis of endometriosis. The participants matched the inclusion criteria of the current study such as diagnosis…

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Not a malignancy, it is "polypoid endometriosis"

Ghafoor S. et al., from Memorial Sloan Kettering Cancer Center, NY, USA, has recently reported a case of a 60-year-old postmenopausal woman with an incidental pelvic mass mimicking a pelvic malignancy on ultrasound. Their paper has been published in the journal Abdominal Radiology.  The patient had a history of a remote supracervical hysterectomy for symptomatic leiomyomata and resection of benign breast cysts. She had no remarkable medical history. Of note, she had been on continuous hormonal replacement therapy for the…

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Mortality of 49956 midlife women with surgically verified endometriosis

Saavalainen L. et al., from Finland recently published a retrospective large cohort study in the journal Human Reproduction, where they retrospectively examined the data of surgically verified endometriosis patients to find out if all-cause and the cause-specific mortality rate is increased in endometriosis patients. All endometriosis-associated diagnoses 1987 to 2012 were identified from the Finnish Hospital Discharge Register to identify surgically diagnosed cases. Altogether 57713 endometriosis diagnoses were detected among 49956 women. The reference cohort (n =98824) was randomly drawn…

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Botox as a promising treatment for chronic pelvic pain in endometriosis

Botulinum toxin (Botox) for treating chronic pelvic pain specifically addressing women with endometriosis has been studied for the first time by Tandon et al., from Bethesda, Maryland, USA. Their paper has recently been published in the journal Regional Anesthesia & Pain Medicine. In this proof-of-concept case series, 13 women with surgically diagnosed endometriosis and chronic pelvic pain persisting despite optimal surgical and hormonal treatments and pelvic floor muscle spasm were included in the study. Patients were recruited nationally within the…

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Chronic Fatigue Syndrome and Endometriosis: Comorbid Conditions

In the study of Dr. Boneva et al., from Atlanta, GA, the United States which has recently been published in the journal Frontiers in Pediatrics evaluated the impact of endometriosis on the health of women with chronic fatigue syndrome (CFS). The authors compared selected health characteristics and laboratory parameters in women with CFS with and without endometriosis. Thirty-six women with CFS from a cross-sectional study of CFS conducted between 2002 and 2003 were included in the study. The health characteristics and laboratory parameters…

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Control on endometriosis progression by a "tyrosine kinase inhibitor"

B cells, which are important players of the immune system, are increased in the blood and peritoneal cavity of endometriosis patients. Activation of B cells and the presence of anti-endometrial autoantibodies have been also been described in women with endometriosis, but their exact role in the disease mechanism is not known. Ibrutinib is a tyrosine kinase inhibitor which is essential for development and function of B cells. In order to better characterize the role of B cells on endometriosis, Riccio…

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"Endometriosis", "Fibromyalgia" and "Autoimmune diseases"

Greenbaum et al. from Israel, investigated the prevalence of and the association between endometriosis, fibromyalgia and autoimmune diseases in a large population database and described healthcare resource utilization in affected women. Their study has been published in the "American Journal of Reproductive Immunology". The authors performed a retrospective cross-sectional study using the computerized database of Maccabi Healthcare Services which has over 2.1 million members in Israel. Women aged ≥15 years who were registered in Maccabi Healthcare Services on 31/12/2015, had…

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Urocortin: A biomarker deserving investigation for endometriosis patients

Urocortin is a neuropeptide in the corticotropin-releasing hormone family and is expressed by eutopic and ectopic human endometria. Since it has paracrine and immunomodulatory effects, urocortin is thought to contribute to the pathogenesis of endometriosis. Its expression has been thoroughly investigated in the field of endometriosis. To find out if urocortin may be used as a screening and/or prognostic biomarker of endometriosis, Pergialiotis V. et al. from Athens, Greece, reviewed the literature and published their results in the "International Journal of…

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The association of significant hemoperitoneum (blood in the abdominal cavity) and deep pelvic endometriosis

 Although there are several theories to explain the etiology of deep endometriosis, the cause is unknown and there are currently no effective strategies to prevent its development. Bean E. et al., from University College London Hospital, UK,  observed that some women in their gynecology clinic who were referred with symptoms of chronic pelvic pain following conservative management of hemoperitoneum developed deep endometriosis. Based on this observation, the authors conducted a prospective observational cohort study to test their hypothesis that the…

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The relationship between periodontal disease and endometriosis

Thomas et al. have recently studied the association between endometriosis and periodontal disease which may share a common pathogenesis, and have published it in the Journal of Human Reproductive Sciences. The authors screened a total of50 women; 25 with and 25 without endometriosis, for periodontal diseases. The periodontal parameters included plaque index, gingival index, probing pocket depth, and loss of attachment. Scores for plaque index, the measures for probing pocket and loss were similar among cases and controls. The proportion of…

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Vaginal Sexual Intercourse during Menstruation

Mazokopakis and Samonis from Greece examined and discussed the vaginal sexual intercourse during menstruation from a biblical as well as a modern medical point of view in their paper published in MAEDICA – a Journal of Clinical Medicine in September 2018. According to the Old Testament (Provisions of clean and unclean of the Mosaic Law), menstruating women were perceived as unclean for 7 days and must not be approached to have sexual intercourse by men. Otherwise, men will be regarded as…

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The association of endometriosis and peritoneal malignant mesothelioma

Endometriosis is well known to cause chronic inflammation of the serosa and incite mesothelial hyperplasia. Although multilocular peritoneal inclusion cysts and well-differentiated papillary mesothelioma were reported to be associated with endometriosis, the association of malignant mesothelioma has not been reported before. Butnor et al. reported 6 cases of peritoneal malignant mesothelioma arising in the setting of endometriosis. Their study which is the first report of malignant mesothelioma in women with endometriosis has recently been published in the Journal of Clinical Pathology in November…

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Extragenital endometriosis and ultrasound

Contrast-enhanced ultrasound (CEUS) is a non-invasive imaging method with no exposure to radiation. There are a few reports on the use of CEUS in the assessment of endometriosis in the literature. Dong et al. reported 3 histopathologically proven cases of extragenital (sigmoid colon, pancreas, posterior bladder wall) endometriosis and reviewed the relevant literature. Their paper has recently been published in the Journal of Ultrasonography. The patient with intestinal endometriosis showed a rapidly and heterogeneously enhancing lesion during the arterial and…

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Endometriosis: A review on anatomic principles and the management

In the study of Alimi et al. which has been published in the journal Cureus, various aspects of endometriosis such as the pathophysiology, the anatomy, the pain mechanism, the perineural spread theory, clinical manifestations, diagnosis, and imaging, infertility, unusual cases, the management, and treatment are reviewed. The hypotheses of the pathophysiology of endometriosis include the implantation or metastatic, metaplasia, induction, and endometriosis disease theories, and most recently, the stem cell theory. Endometriosis that begins with endometrial stem cells tends to…

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Programmed-cell death pathway and immune dysfunction in endometriosis

Endometriosis is an estrogen-dependent, immune-associated disease. Women with endometriosis have different proportions of the activated forms of immunocompetent cells, such as T cells and macrophages compared to those from women without. Immune cell dysfunction in the uterine and abdominal cavity microenvironment enhances the ability of endometrial cells to adhere and invade. This leads to an increased proliferation and angiogenesis, as well as poor clearance of ectopic endometrium by immune cells. The molecule named “programmed-death-1 (PD-1)” is a negative regulator of…

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Preoperative Staging of Endometriosis: The Value of MRI After Dynamic Transvaginal Ultrasound

Since endometriosis is a chronic and progressive disease, early diagnosis and proper staging are important for the patient and for the clinician to discuss and plan the required surgical procedures for treatment. Common diagnostic tools for pre-operative staging of deep infiltrating endometriosis are the clinical history, physical examination, dynamic TVUS, and MRI. A team of researchers from Netherlands, Berger et al., evaluated the added value of each step (history, clinical examination, dynamic TVUS, and MRI) in the diagnostic pathway for…

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Any adjustable risk factor for Endometriosis?

Endometriosis is believed to be estrogen and progesterone-dependent. Lifestyle factors such as alcohol/caffeine intake, smoking, and physical activity influence estrogen levels in the body and, therefore, may impact the development of endometriosis. In the study of Hemmert et al. which has been published in Paediatric and Perinatal Epidemiology, the relationships between caffeine and alcohol intake, smoking, and physical activity levels reported prior to the diagnosis of endometriosis were evaluated. Four hundred and seventy-three women, ages 18-44 years, who underwent laparoscopy…

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A novel neurotransmitter, Ninj1, has been found to be expressed in endometriosis

Chronic inflammation is involved in the pathogenesis of endometriosis and adenomyosis, and inflammatory cytokines such as IL-1b are highly expressed in them. Inflammation and subsequent hyperinnervation are involved in the pathophysiology of pain generation. High levels of expression of various neurotransmitters are also present in these tissues. Nerve injury-induced protein 1 (Ninjurin, Ninj1), an adhesion molecule originally identified in dorsal root ganglion neurons and Schwann cells after nerve injury. It mediates hemophilic adhesion and promotes neurite outgrowth. The Ninj1 is…

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