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.

Endometriosis that involves the nerves: how Radiologists can help

Endometriosis is a disease with variable clinical symptoms. While rare, nerve involvement by endometriosis may cause neurologic symptoms such as pelvic pain, muscle weakness, bowel and bladder incontinence, and paraplegia depending on the specific nerve involved. Thus, abdominal radiologists should assess pelvic nerve anatomy especially on pelvic MRI and the possible patterns of presentation in patients with nerve-involving endometriosis in order to prevent permanent nerve damage. Therefore, early diagnosis of this rare disease manifestation cannot be overlooked. In this pictorial essay…

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Transvaginal Ultrasound and the Imaging of Endometriosis

Ultrasonography (US) is an imaging tool that uses sound waves to produce a two-dimensional picture inside of the body. The ultrasonography has become especially useful in the assessment of gynecologic pathologies such as endometriosis. Depending on the severity of endometriosis, various intra and extra-pelvic locations may be involved. One such category of endometriosis is deep endometriosis, which is characterized by the involvement of the posterior pelvic structures such the uterosacral ligaments, structures which attach the posterior aspect of the uterus…

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ENDORECT scoring system to identify patients at risk for rectosigmoid endometriosis

Patients who suffer from endometriosis may benefit from a preoperative score that predicts rectosigmoid involvement. A recent paper published by Huchon et al. at Poissy Saint-Germain en Laye, France, recruited 119 women who underwent laparoscopy for endometriosis between 2011 and 2016 with histologic verification. RE involvement was defined as one or more nodules infiltrating the muscle layer of the intestinal wall during complete excisional surgery. Of the 119 women, 47 had RE involvement while 72 did not. Of the patients…

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MRI-based "ENZIAN" scoring system and intra-operative endometriosis findings

Endometriosis is a chronic inflammatory disease whereby endometrial-like glands grow and invade the extra-uterine structures. Endometriosis may affect various parts of the body, including the peritoneum, ovaries, or retroperitoneum. Recently, non-invasive methods for detecting these lesions have included trans-vaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) for pre-operative planning of patients undergoing surgery. However, compared to the gold standard of diagnostic laparoscopy, these imaging methods have not been found to outcompete laparoscopy in terms of sensitivity and sensitivity. The "ENZIAN"…

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A guide on the Assessment of Pelvic Endometriosis Imaging

Endometriosis is a disease whereby ectopic endometrial-like tissue invades and survives outside of the endometrial cavity. While biopsy-proven confirmation of endometriosis during laparoscopy has been considered the gold standard for diagnosis, non-invasive imaging modalities are increasingly being utilized for preoperative planning. A multicenter group of clinicians, surgeons, and radiologists from Sao Paulo, Brazil, the Mayo Clinic, Arizona, and the Cleveland Clinic, Ohio, published an article in The Journal of Minimally Invasive Gynecology in order to highlight the radiologic characteristics, advantages/disadvantages, and…

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Endometriosis involving the superficial peritoneum in Adolescents: Surgical Management

Endometriosis is a chronic disease whereby endometrial glands and stroma grow and survive outside of the uterus. In some cases, endometriosis may become symptomatic and cause debilitating, chronic pelvic pain. Among pelvic organ and other surfaces that endometriosis can involve is the peritoneum. The peritoneum is a connective Endometriosis that affects adolescent girls typically presents as Stage I with superficial peritoneal disease (SPD) and less commonly as Stage III or IV with deeply infiltrating endometriosis (DIE). A 15-year-old adolescent female…

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The duration of impairment of ovarian reserve after laparoscopic surgery

Endometriosis is a chronic medical condition characterized by ectopic endometrial tissue that grows and invades extra-uterine tissues. It is a significant contributor to chronic pelvic pain in women of reproductive age. Endometriosis involving the ovaries and causing a cystic growth is called an "endometrioma". Laparoscopic ovarian cystectomy (LOC) for endometriomas has been widely used but may be associated with decreased ovarian reserve. Several hormonal markers including anti-mullerian hormone (AMH) have been used to assess ovarian reserve. In the present study,…

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Priorities and Unmet Needs of Endometriosis Management

Endometriosis is a systemic, chronic disease that is a significant contributor to morbidity in young women. Although endometriosis has gained increasing attention in the medical field, scientific progress for an effective and definitive treatment modality is progressing slowly. The Society for Women’s Health Research (SWHR), a non-profit organization, aimed to aid the current understanding of this disease, has designed a roundtable meeting to review both the diagnostics and treatment of endometriosis. An interdisciplinary dialogue between researchers, clinicians, patients, industry, and…

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Signs and Symptoms on Transvaginal Ultrasound associated with the presence of endometriosis.

Endometriosis is a disease whereby ectopic endometrial cells are present outside of the uterus. Transvaginal ultrasound (TVUS) is a highly specific test for endometriomas and deep endometriosis to assess the involvement of endometriosis in the posterior anatomic compartments. While the diagnosis of these involved areas can be performed using ultrasonography, the gold standard continues to be surgery and histopathologic confirmation especially for the diagnosis of superficial endometriosis. This study conducted by Reid et al. from several institutions in Sydney, Australia…

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Development of Less Invasive Diagnostic Tests for Endometriosis Through Proteomics

Proteomics is a field which utilizes various methods to carry out large-scale studies of proteins. Due to the inherent nature of the field, proteomics focuses on the identification, localization, and functional analysis of the protein make-up of a given type of cell. Understanding different proteins and their function, expression, and structure allow researchers to understand complex disease processes and identify new drug targets that may be useful in the clinical setting for individuals who suffer from endometriosis. Currently, the gold…

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Lipophilic Statins inhibit growth and invasiveness of human endometrial cells

Endometriosis is a disease process whereby cells of the endometrium grow and invade structures outside of the uterus. Through recent research, it has been seen that endometriotic foci in women with endometriosis exhibit an altered phenotype that contributes to its invasiveness and abnormal proliferation. Thus, understanding the interaction of potential medications to slow or halt the progression of endometriosis would allow for more targeted therapies to be developed. Statins are a class of HMG-CoA reductase inhibitors widely used today as…

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Laparoscopic mesenteric vascular and nerve sparing surgery as a tool for DIE resection

Endometriosis can be characterized by a wide range of clinical aggressiveness based upon the location, character, and growth of ectopic endometrial implants. As one of the most aggressive forms of endometriosis, deep infiltrating endometriosis (DIE) is known to involve the colon and bladder. Surgery in these patients may lead to complications such as urinary retention, constipation and sexual dysfunction. Surgical techniques aimed at minimizing these complications are being developed such as pelvic nerve-sparing surgery.  The researchers from the Department of…

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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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