Murat Osman

Senior Research Columnist: Murat Osman is a MD candidate at The George Washington University School of Medicine and Health Sciences. His interest in research is primarily focused on Medical Oncology and Radiology. He is also focused on cultivating his passion for medical science and human health through scientific writing and advocacy.

Feasibility of MRI-Transvaginal Ultrasound Imaging for Deeply Infiltrating Endometriosis

Endometriosis is a disease whereby endometrial tissue is present outside of endometrium. A specific form of endometriosis, Deeply Infiltrating Endometriosis (DIE), is characterized by endometriotic glands that invade through the endometrium and other structures in the pelvis and is associated with significant morbidity. Developing noninvasive and safe imaging techniques that accurately diagnose DIE will allow for a patient’s team of doctors to plan for appropriate treatments. Fusion imaging is a new technology and includes the merging of cross-sectional imaging data…

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How Ovarian Endometriomas and DIE affect ART outcomes

Previous studies have evaluated the impact of an ovarian endometrioma on ovarian reserve and its impact on the success of assisted reproductive technology (ART) outcomes have controversial results.  ART is a method by which a woman’s own hormones are used in a controlled and timed clinical setting to achieve fertility. One such hormone, anti-Müllerian hormone (AMH) is routinely used to predict how well a woman is likely to respond to ovarian stimulation for in vitro fertilization (IVF) treatment and what doses of…

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Endometriosis involvement of the pouch of Douglas: TVUS vs pelvic exam

Deep infiltrating endometriosis (DIE) can lead to a partial or complete obliteration of the pouch of Douglas (POD). POD involvement has been associated with dyschezia, deep dyspareunia, and increased infertility rates. Assessing the extent of endometriosis involvement of the cul-de-sac allows surgeons to plan an appropriate surgical course to maximize morbidity. The presence of POD involvement can be assessed through TVUS via a technique known as the “sliding sign” or through a routine pelvic examination. The sliding sign technique assesses whether…

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Toxic Pelvic Cavity and Infertility

Endometriosis is a disease defined by the presence of endometrial tissue outside of the uterine cavity and has an incidence of approximately 10% in women of reproductive age. Thus, it is an important consideration in chronic pelvic pain and infertility in this age group. Additionally, it can also interfere with the success of assisted reproductive technology (ART) and in vivo conception. Removing endometriotic lesions via surgery has been seen to improve the ability to conceive naturally between 12-18 months after…

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A Balancing Act: How Endometriosis Invades the Body

Endometriosis is a disease defined by the presence of endometrial tissue outside of the uterine cavity. Ectopic endometrial tissues have been shown to have some features that mimic malignancy. For example, endometriosis can invade surrounding structures and attach to surfaces such as the ovary and peritoneum. This ability is thought to be linked to matrix metalloproteinases (MMPs), a group of enzymes that are involved in extracellular matrix and basement membrane breakdown and remodeling. Several different MMPs have been classified depending on…

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Coumarin based compounds found to inhibit the estradiol synthesis pathway

Endometriosis is a disease characterized by ectopic endometrial tissue outside the endometrium. Several biochemical and molecular pathways have been researched and used to alleviate endometriosis symptoms by inhibiting key molecules involved in the menstrual cycle. This review paper by Niinivehmas et al. titled, “Blocking oestradiol synthesis pathways with potent and selective coumarin derivatives”, published in the Journal of Enzyme Inhibition and Medicinal Chemistry, aims to present the different coumarin derivatives that have been investigated to inhibit an enzyme involved in…

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Oxidative Stress and Endometriosis

Endometriosis is a disease characterized by ectopic endometrial tissue outside the endometrium and is associated with a background of a chronic inflammation. Recent studies have aimed to elucidate the inflammatory mediators involved in endometriotic lesions by studying immune cell interactions, reactive oxygen species (ROS), and free radicals within the related areas. This review paper by Vitale et al. titled, “The Role of Oxidative Stress and Membrane Transport Systems during Endometriosis: A Fresh Look at a Busy Corner” and published in…

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Health-related quality of life in women with Endometriosis and Rheumatoid Arthritis

Endometriosis is a chronic inflammatory disease that is defined by the presence of ectopic endometrial tissue outside of the uterus. Unfortunately, endometriosis continues to be a leading cause of chronic pelvic pain and long-term morbidity in women of reproductive age. A large contributor to endometriosis-related morbidity are the physical symptoms associated with the disease: dysmenorrhea, dyspareunia, and infertility. This article titled, “Health-related quality of life in women with endometriosis, compared to the general population and women with rheumatoid arthritis” by…

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East/South East Asian Ethnicity and Moderate-to-Severe Endometriosis

Endometriosis is a chronic inflammatory disease that is defined by the presence of ectopic endometrial tissue outside of the uterus. Understanding how this disease affects diverse groups of people will aid doctors in assessing and diagnosing populations that are high-risk for advanced endometriosis. This article titled, “East/South East Asian Ethnicity and Moderate-to-Severe endometriosis” published in The Journal of Minimally Invasive Gynecology by Williams et al. from institutions in British Columbia and Alberta, Canada aims to investigate the ethnic differences for…

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Is there a definitive guideline for the surgical management of endometriosis?

Endometriosis is a chronic inflammatory disease that is defined by the presence of ectopic endometrial tissue outside of the uterus. Unfortunately, endometriosis continues to be a leading cause of chronic pelvic pain in women of reproductive age. This article titled, “Surgical treatment of different types of endometriosis…” by Kho et al. from the Women’s Health Institute in Cleveland clinic and institutions in Sao Paulo, Brazil aim to elucidate and compare the current treatment options and guidelines for patients with different…

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What is being done to help surgeons detect endometriosis during laparoscopy

The gold standard for the diagnosis of endometriosis is diagnostic laparoscopy and histologic confirmation. During laparoscopy, visualization of as many lesions as possible may hold better long-term clinical outcomes. Peritoneal endometriosis is difficult to diagnose intraoperatively due to the heterogeneity of the endometriotic lesions (lesions are currently grouped as either non-pigmented, red, white, or black based on gross findings). Thus, enhanced imaging techniques such as contrast agents may have the potential to aid surgeons in locating these lesions and providing…

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Contraceptives for the management of endometriosis pain

Endometriosis is a common gynecologic disease that affects many women of reproductive age and is associated with significant morbidity. One of the treatment options for women with endometriosis is the use of oral contraceptives (OCPs) for pain management. However, its effectiveness has not been clearly presented in randomized control studies.  This article titled, "Oral contraceptives for pain associated with endometriosis" by Brown et al. published in the "Cochrane Database of Systematic Reviews" aims to determine if there is any significant…

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Therapeutic strategies involving uterine stem cells in reproductive medicine

Stem cells are undifferentiated cells that often serve to regenerate tissue in states of injury or apoptosis. The endometrium has progenitor cells that replace tissue lost after each menstrual cycle. It has been postulated that excessive stem cell recruitment to the endometrium may contribute to the development of endometriosis. Thus, preventing stem-cell trafficking may lessen disease progression. Bone marrow-derived stem cells are mesenchymal stem cells that originate from the bone marrow. These cells not only produce immune cells, but also…

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Emerging medical treatments for endometriosis

Endometriosis is a disease whereby uterine tissue grows outside the walls of the uterus to the surfaces of other tissues in the body. It is a chronic disease and relies upon estrogen to grow and survive. Current medical therapies take advantage of this weakness by creating a hypoestrogenic environment either by blocking ovarian estrogen secretion (GnRH-agonist, GnRH-a) or by inhibiting estrogenic stimulation of the ectopic endometrium (progestins and androgenic progestins). Clemenza and authors at the University of Florence, Italy have…

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Thoracic Endometriosis Syndrome : A case report describing endometriosis involvement of the lung

Leonardo-Pinto and authors from the Universidade Estadual de Campinas, Brazil, have recently published a case report titled, "Hemoptysis and Endometriosis: An Unusual Association - Case Report and Review of the Literature" in the Journal, Revista Brasileira De Ginecologia E Obstetricia describing a rare clinical presentation of endometriosis. Thoracic endometriosis syndrome describes one of the extrapelvic manifestations of endometriosis. TES is characterized by catamenial (symptoms predominantly during menstrual periods) pneumothorax (air in the pleural space), hemothorax (blood in the pleural space), hemoptysis (coughing…

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Endometriosis surgery and preservation of fertility, what surgeons should know

Endometriosis can involve most of the pelvic organs including the uterus, ovaries and fallopian tubes and thus has the potential to cause infertility. This article titled, “Endometriosis surgery and preservation of fertility, what surgeons should know” written by H. Roman and published in the Journal of Visceral Surgery aims to discuss several surgical indications for surgery in women with endometriosis. An overarching consideration in the management of surgery is to weigh the potential benefits and complications between excising all endometriotic…

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The use of retinoic acid for the treatment of endometriosis

Endometriosis is one of the leading causes of chronic pelvic pain in women during their childbearing years. Several drugs have been researched to either reduce inflammation, decrease growth, or kill endometriotic cells. Retinoic acid (Vitamin A) is one such molecule that has been researched in the treatment of many conditions. Lu et al. from the Clinical Medical College of Dali University recently published a study titled, “Retinoic acid regulates endometriotic stromal cell growth through upregulation of Beclin 1". Lu et…

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Direct shedding of endometrioma contents visualized by ultrasonography

Endometriosis is one of the leading causes of chronic pelvic pain in women during their childbearing years. Researchers from Italy have recently published a case report in the European Journal of Obstetrics & Gynecology and Reproductive Biology observing the direct shedding of endometriotic cyst contents to a neighboring ovarian follicle.  Case reports detail the clinical management of a patient in order to highlight a certain clinical phenomenon or to raise questions for further study. A 39-year old gravida 0, para 0 (never pregnant)…

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Using the "Mushroom Cap" sign to describe endometriotic masses

Endometriosis is a disease whereby ectopic endometrial cells attach and grow outside of the uterus. A number of imaging techniques have been used to evaluate and assess endometriotic lesions. Magnetic resonance imaging (MRI) is a type of imaging modality used to assess tissues and can be used to evaluate and locate endometriotic lesions. Doctors Arevalo and Mendez at the University Hospital of San Carlos, Madrid, Spain recently published a paper in Abdominal Radiology describing and detailing what they see on MRI…

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Independent development of endometrial epithelium and stroma within the same endometriosis

Endometriosis is one of the leading causes of chronic pelvic pain in women during their childbearing years. A popular theory for the pathogenesis of endometriosis posits that circulating progenitor cells differentiate into the endometrial stroma and glandular tissue once they attach onto a surface outside the uterus. However, the understanding of the origin of the components that make up these lesions is still being elucidated. This article elucidates the evolution of endometriotic stroma and glandular tissue by tracking synonymous and…

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