Laparoscopic Evidence Of Endometriosis Research Articles

Prevalence,clinical profile of endometriosis among infertile women with normospermic partners and treatment options

Background: endometriosis is a chronic inflammatory disease affecting women of reproductive age. Studies have suggested that 25 to 50% of infertile women have endometriosis. However, the true prevalence is difficult to ascertain. The objective of study was to determine the prevalence of endometriosis in subset of sub-fertile women undergoing hysteron-laparoscopy and also to evaluate risk factors, clinical, laparoscopic characteristics of endometriosis and thereby therapeutic interventions done at same setting. Methods: it was a cross-sectional study done for period of 2 years comprising of 90 women undergoing hystero-laparoscopy for primary or secondary infertility were evaluated. endometriosis was diagnosed laparoscopically in 30 %. Staging of endometriosis was done according to r.AFS scoring. Results: Out of 90 subjects 27 (30%) had laparoscopic evidence of endometriosis Out of 27 cases studied, 10 (37%) had minimal, 6(22.2%) had moderate, 9(33.3%) severe endometriosis. Commonest complaint was dysmenorrhea which was present in 92% only 10 % were asymptomatic. Conclusion: Infertile women attending infertility clinic undergoing diagnostic hysteron-laparoscopy for evaluation, even minimal disease without symptomatology prior could be picked up. Increasing prevalence is because of increased use of laparoscopy as diagnostic modality and also increased awareness about symptom profile among reproductive women. additionally, among patients undergoing hystero-laparoscopy even minimal disease could be diagnosed. Our study shows higher incidence among infertile women and shows that risk factors like early menarche, frequent cycles are associated with increased risk of endometriosis , also symptoms like dysmenorrhea, dyspareunia strongly corelates with the underlying severity of disease and also stage of the disease

Prevalence; Characteristics and Management of Endometriosis Amongst Infertile Women: A One Year Retrospective Study.

Endometriosis appears to affect every aspect of a women's reproductive system resulting in infertility and spontaneous pregnancy loss. This study aims to find out the prevalence & clinical characteristics of endometriosis amongst infertile women. A Hospital based retrospective study over a period of one year. It is a retrospective study conducted in the gynaecology department in Institute of Kidney Diseases & Research Centre; Ahmedabad from April 2012 to March 2013 amongst women with a primary complaint of infertility (Primary/Secondary).A total of 372 patients underwent diagnostic hysterolaparoscopy and of these 180 patients who had laparoscopic evidence of endometriosis was included in the study. All of these patients and their findings were analysed with respect to the clinical signs and symptoms. The outcome after appropriate management was analysed in subsequent follow up. All collected data was entered into the SPSS version 20. Categorical data are expressed in frequency or percentage. Chi-Square test and Fisher-Exact test has been performed to carry out p-value for categorical data. P-value <0.05 shows statistically significant difference. The frequency of endometriosis among women with infertility subjected to diagnostic hysterolaparoscopy was found to be 48.38%. Statistical significant association with severity of disease was associated with symptoms like dysmenorrhea, chronic pelvic pain, restricted uterine mobility and adnexal tenderness. (p <0.01) Ultrasound finding of endometrioma with ground glas appearance also had statistical significant association with staging of disease (p <0.01). Endometriosis amongst infertile women is increasingly being detected due to greater use of laparoscopy in evaluation of infertility.Though most signs do not correlate with severity of disease however the presence of restricted uterine mobility, adnexal tenderness & chronic pelvic pain should always raise the suspicion of endometriosis. Laparoscopy remains the gold standard for diagnosing and staging endometriosis.

Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: a systematic review

BACKGROUND Endometriosis associated with pain symptoms in adolescents has been extensively reported, but the exact prevalence is unclear because pain symptoms may be atypical and endometriosis can only be diagnosed by laparoscopy. The aim of this paper is to provide a systematic review of the prevalence of endometriosis diagnosed by laparoscopy in adolescents. METHODS A systematic literature search was carried out for relevant articles published between 1980 and 2011 in the databases PUBMED and EMBASE, based on the keywords 'endometriosis', 'laparoscopy', 'adolescents' and 'chronic pelvic pain (CPP)'. In addition, the reference lists of the selected articles were examined. RESULTS Based on 15 selected studies, the overall prevalence of visually confirmed endometriosis was 62% (543/880; range 25-100%) in all adolescent girls undergoing laparoscopic investigation, 75% (237/314) in girls with CPP resistant to treatment, 70% (102/146) in girls with dysmenorrhea and 49% (204/420) in girls with CPP that is not necessarily resistant to treatment. Among the adolescent girls with endometriosis, the overall prevalence of American Society of Reproductive Medicine classified moderate-severe endometriosis was 32% (82/259) in all girls, 16% (17/108) in girls with CPP resistant to treatment, 29% (21/74) in girls with dysmenorrhea and 57% (44/77) in girls with CPP that is not necessarily resistant to treatment. Due to the quality of the included papers an overestimation of the prevalence and/or severity of endometriosis is possible. CONCLUSIONS About two-thirds of adolescent girls with CPP or dysmenorrhea have laparoscopic evidence of endometriosis. About one-third of these adolescents with endometriosis have moderate-severe disease. The value of early detection of endometriosis in symptomatic adolescents and the indications for laparoscopic investigation in adolescents require more research.

Expression of adiponectin, leptin, and their receptors in ovarian endometrioma

To evaluate the expression of leptin, leptin receptor (ObR), adiponectin, and adiponectin receptor (AdipoR) in ovarian endometriomas compared with normal endometrium, and to analyze relationships among adipokines and their receptors. Experimental study. A clinic for the treatment of endometriosis and basic research laboratories. Forty-four women with endometriosis and 42 age-matched women with no laparoscopic evidence of endometriosis as control subjects. Endometrial tissue samples were obtained during laparoscopic surgery. Immunohistochemical staining for leptin, ObR, adiponectin, and AdipoR was performed with the use of tissue microarray. Clinical characteristics were reviewed from the patient's medical records. The effect of leptin on the expression of adiponectin was evaluated in endometriotic cell line using real-time reverse-transcription polymerase chain reaction. Positive expression rates of leptin and ObR were significantly higher in ovarian endometrioma compared with normal endometrium, but those of adiponectin and AdipoR were similar (ovarian endometrioma vs. normal endometrium, respectively: leptin 100% vs. 59.5%; ObR 72.7% vs. 33.3%; adiponectin 31.8% vs. 42.9%; AdipoR 88.6% vs. 73.8%). Expression of adipokines and their receptors did not show any correlation with disease stage. A positive correlation was found between expression of ObR and adiponectin (correlation coefficient 0.488; P=.001). Leptin treatment in endometriotic cells induced mRNA expression of adiponectin. These data suggest that leptin and its receptor are induced in ovarian endometriomas, and that the leptin/ObR system regulates adiponectin gene expression in endometriotic cells.

Expression of 17beta-hydroxysteroid dehydrogenase type 2 in pelvic endometriosis

Lack of expression or a deficiency of 17β-hydroxysteroid dehydrogenase type 2 (17β-HSD2), a key enzyme in estradiol inactivation, could be involved in the pathophysiology of endometriosis. The aim of the present study was to evaluate expression of the gene (17β-Hsd2) encoding 17β-HSD2 in eutopic and ectopic endometrial tissues of women with endometriosis. Thirty-four infertile women were divided into a control group, without any clinical or laparoscopic evidence of endometriosis (n = 19), and a group with pelvic endometriosis (n = 15). Diagnosis was confirmed by histological examination of the endometriotic lesions. 17β-Hsd2 mRNA expression was detected by reverse transcription–polymerase chain reaction in the control group (54% of the samples), in the eutopic endometrium of patients with endometriosis (83% of the specimens analyzed) and in all endometriotic lesions. The semi-quantitative analysis of 17β-Hsd2 mRNA showed a significantly higher gene expression in the endometriotic implants compared with the intrauterine endometrium of the control group (p < 0.05). 17β-HSD2 protein was localized to the glandular epithelium of both eutopic endometrium and endometriotic implants. The present results refute the hypothesis of lower or absent 17β-HSD2 expression in pelvic endometriosis; therefore further studies are needed to assess other potential mechanisms leading to increased estrogenic activity within endometriotic implants.

Altered expression of a cell-cycle suppressor gene, Tob-1, in endometriotic cells by cDNA array analyses

Objective: Interleukin (IL)-1β, a product of activated peritoneal macrophages, is a central cytokine coordinating neovascularization and monocyte chemotaxis in endometriotic implants. To evaluate the effects of this cytokine on normal endometrial stromal cells and endometriotic stromal cells we performed cDNA expression array analyses before and after exposure to IL-1β. Design: Nested case-control study of women with and without laparoscopic evidence of endometriosis. Setting: Reproductive endocrinology clinic at a university hospital. Patient(s): Endometriosis and normal endometrial biopsies from eight patients were used to prepare stromal cell cultures from which mRNA was extracted. Intervention(s): None. Main Outcome Measure(s): Commercially available expression arrays (Atlas Human cDNA Expression Array, Clontech, representing 597 individual genes) were used to screen for mRNAs whose expression was affected by 12 hours of exposure to IL-1β (10 ng/mL). Northern blotting and subsequent quantitative densitometric evaluation was done to confirm steady-state levels of Tob-1 mRNA transcripts. Result(s): Array analyses revealed a cell-cycle regulatory gene, Tob-1, which was differentially expressed by the two cell types after incubation with IL-1β. Tob-1 was reduced 48% in endometriotic stromal cells exposed to IL-1β, but there was only a 16% reduction in normal endometrial stromal cells. Replicate Northern analyses (n = 4) showed that exposure to IL-1β for 12 hours resulted in a 25% ± 5% diminution of Tob-1 mRNA in endometriotic stromal cells. In contrast, no significant decrease (<3%) was observed in IL-1β exposed normal endometrial stromal cells. Conclusion(s): Tob-1, a cell-cycle inhibitor gene is differentially responsive to IL-1β in endometriotic stromal cells compared to normal endometrial stromal cells. IL-1β down-regulated Tob-1 in endometriotic stromal cells, but had no significant effect on normal endometrial stromal cells. Our results suggest that IL-1β promotes growth of endometriotic lesions through inhibition of Tob-1. These findings are the first to associate IL-1β with an alteration of cell-cycle gene expression in cells derived from endometriotic implants.

Importance of histological diagnosis in women with chronic pelvic pain and laparoscopic evidence of endometriosis

Importance of histological diagnosis in women with chronic pelvic pain and laparoscopic evidence of endometriosis

Histocompatibility leukocyte antigen-G is not expressed by endometriosis or endometrial tissue

Objective: The immunological mechanisms that support persistence and proliferation of ectopic endometrial implants within the peritoneal cavity of women with endometriosis are unknown. Inhibition of natural killer (NK) and cytotoxic T-cell function has been proposed as a mechanism. We tested the hypothesis that expression of a nonclassical major histocompatibility antigen, HLA-G, might explain the local immunosuppression associated with ectopic endometrium. Design: Nested case-control study of women with and without laparoscopic evidence of endometriosis. Setting: Reproductive endocrinology clinic at a university hospital. Patient(s): Peritoneal fluid specimens from 10 women with revised AFS stage I–IV endometriosis and from 10 age-matched normal controls without laparoscopic evidence of endometriosis were tested for the presence of HLA-G protein. Endometriosis and normal endometrial biopsies from four patients were used to prepare stromal cell cultures directly evaluated for HLA-G protein. Intervention(s): None. Main Outcome Measure(s): The expression of HLA-G in peritoneal fluid, tissue, and cell cultures was determined by immunoblotting with a specific monoclonal antibody. Result(s): HLA-G protein was not detectable in peritoneal fluid specimens of endometriosis patients or controls. Moreover, ectopic and normal endometrial tissues and stromal cells did not express HLA-G. Conclusion(s): Immune cell inhibition in endometriosis must be mediated by factors other than HLA-G.

The importance of histological diagnosis in patients with chronic pelvic pain and laparoscopic evidence of endometriosis

Objective To assess the accuracy of laparoscopic diagnosis of pelvic endometriosis by histological evaluation of biopsies excised from pelvic peritoneal lesions suspicious for endometriosis in patients with chronic pelvic pain. Setting Centre for Endometriosis and Pelvic Pain, St Peter's Hospital, Chertsey, UK, between October 1997 and October 1998. Subjects 62 patients with the presenting complaint of chronic pelvic pain. These patients were included in the study irrespective of previous pelvic surgery or the earlier diagnosis of pelvic endometriosis. Intervention Laparoscopic assessment and excision of peritoneal lesions suspicious for endometriosis. Excision biopsy of all suspected endometriotic lesions was laparoscopically performed using a sculpted tip Nd: YAG laser fibre. All procedures were undertaken under the direct supervision of the same senior laparoscopic surgeon. No major complication was encountered. The biopsies obtained were labelled according to the anatomical site and histologically examined by light microscopy for the presence of endometriosis. Results We took 1–6 biopsies per patient and the total number of biopsies obtained was 150. Biopsies from three patients among the 62 were unsuitable for histological evaluation and were excluded from the study. In 43 patients (73%) there was histological confirmation of endometriosis in all or some of their biopsies. In all the biopsies from 14 patients (24%) there was no evidence of endometriosis, their biopsies comprising other tissues such as fibro-fatty, fibrovascular and fibromuscular tissues. In two patients (3%) all their biopsies showed endosalpingiosis only. The commonest anatomical sites of pelvic peritoneal endometriotic lesions were the uterosacral ligaments, the pouch of Douglas, the medial broad ligaments, the intestinal serosa, and the ovarian fossae, respectively. Conclusions The diagnosis of pelvic endometriosis in patients with chronic pelvic pain should be supported by excision biopsy and histological assessment, as the laparoscopic diagnosis is not always accurate. This would direct the clinician to the possible aetiology of the chronic pelvic pain and is of great value in counselling and planning future management for the patients.

HLA-G Does Not Mediate the Natural Killer Cell Suppression Associated with Endometriosis

Objectives: The immunological mechanisms that support persistence and proliferation of ectopic endometrial implants within the peritoneal cavity of women with endometriosis are unknown. However, evidence of inhibition in natural killer (NK) cell function has been described in several reports of this syndrome. In the current study we tested the hypothesis that a nonclassical major histocompatibility antigen, HLA-G, was responsible for NK cell suppression.Design: Nested case-control study of women with and without laparoscopic evidence of endometriosis.Materials and Methods: Peritoneal fluid specimens from 5 women with revised AFS stage I-IV endometriosis and 5 age-matched normal controls without laparoscopic evidence of endometriosis were tested for the presence of HLA-G protein. Endometriosis and normal endometrial biopsies (2 each) were directly evaluated for HLA-G or used to prepare stromal cell cultures for this purpose. The expression of HLA-G in peritoneal fluid, tissue and isolated cell culture lysates and supernatants was determined by immunoblotting with a specific monoclonal antibody.Results: Using the Western blotting assay, we were unable to detect HLA-G in specimens of peritoneal fluid from normal or endometriosis subjects. By contrast, JEG-3 cell lysates demonstrated the expected 37 kD immunopositive band. Neither normal endometrium nor endometriosis-derived biopsies contained detectable HLA-G protein. Under basal culture conditions neither normal endometrial nor endometriosis stromal cells expressed HLA-G protein. Even following incubation with TNF-α and IFN-γ the cells failed to express detectable HLA-G protein.Conclusions: HLA-G protein was not detectable in peritoneal fluid specimens of endometriosis patients or controls. Moreover, ectopic and eutopic endometrial tissues and stromal cells do not express HLA-G. NK cell inhibition in endometriosis must be mediated by factors other than HLA-G.These studies were supported in part by a grant from the Deutsche Forschungsgemeinschaft (DH) and the NIH/NICHD, through cooperative agreement U54-HD37321, as part of the Specialized Cooperative Centers Program in Reproduction Research (RNT). Objectives: The immunological mechanisms that support persistence and proliferation of ectopic endometrial implants within the peritoneal cavity of women with endometriosis are unknown. However, evidence of inhibition in natural killer (NK) cell function has been described in several reports of this syndrome. In the current study we tested the hypothesis that a nonclassical major histocompatibility antigen, HLA-G, was responsible for NK cell suppression. Design: Nested case-control study of women with and without laparoscopic evidence of endometriosis. Materials and Methods: Peritoneal fluid specimens from 5 women with revised AFS stage I-IV endometriosis and 5 age-matched normal controls without laparoscopic evidence of endometriosis were tested for the presence of HLA-G protein. Endometriosis and normal endometrial biopsies (2 each) were directly evaluated for HLA-G or used to prepare stromal cell cultures for this purpose. The expression of HLA-G in peritoneal fluid, tissue and isolated cell culture lysates and supernatants was determined by immunoblotting with a specific monoclonal antibody. Results: Using the Western blotting assay, we were unable to detect HLA-G in specimens of peritoneal fluid from normal or endometriosis subjects. By contrast, JEG-3 cell lysates demonstrated the expected 37 kD immunopositive band. Neither normal endometrium nor endometriosis-derived biopsies contained detectable HLA-G protein. Under basal culture conditions neither normal endometrial nor endometriosis stromal cells expressed HLA-G protein. Even following incubation with TNF-α and IFN-γ the cells failed to express detectable HLA-G protein. Conclusions: HLA-G protein was not detectable in peritoneal fluid specimens of endometriosis patients or controls. Moreover, ectopic and eutopic endometrial tissues and stromal cells do not express HLA-G. NK cell inhibition in endometriosis must be mediated by factors other than HLA-G. These studies were supported in part by a grant from the Deutsche Forschungsgemeinschaft (DH) and the NIH/NICHD, through cooperative agreement U54-HD37321, as part of the Specialized Cooperative Centers Program in Reproduction Research (RNT).

Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study.

In 100 consecutive patients who were undergoing laparoscopy for infertility (group 1, n = 52), chronic pelvic pain (group 2, n = 18) or tubal sterilization (group 3, n = 30, asymptomatic fertile women), peritoneal biopsies were taken from areas of visually normal peritoneum of uterosacral ligaments. Twenty-six patients in group 1 (50%), eight patients in group 2 (44.4%) and 13 patients in group 3 (43.3%), were found to have laparoscopic evidence of endometriosis elsewhere in the pelvis. The majority of women (80.7% in group 1, 87.5% in group 2, and 100% in group 3) had stage I disease. The incidence of the distinctive appearances of the lesions was similar in the three groups of patients and 7% of all women or 15% (7/47) of those patients having endometriosis at laparoscopy had only subtle (non-¿typical') endometriotic peritoneal lesions. Uterosacral biopsies showed the presence of endometriotic tissue in three cases (5.7%), two cases (11%) and three cases (10%) in groups 1, 2, and 3 respectively. One of the two patients in group 2 and two of the three patients in group 3 had no evidence of endometriosis at laparoscopy; thus histological study revealed the presence of endometriosis in normal peritoneum in 11% (5/47) of patients having macroscopic endometriosis and in 6% (3/53) of patients without endometriosis at laparoscopy. Previous oral contraceptive users were significantly higher among women having macroscopic and/or microscopic endometriosis than among women without the condition. In conclusion, our prospective study shows a high prevalence (45-50%) of endometriosis (including microscopic forms) in both patients with chronic pelvic pain and asymptomatic women (fertile and infertile), thus supporting the modern concept that in many women endometriosis may be a paraphysiological condition while probably only in some patients small amounts of endometriosis are an ¿annoyance' with implications to their reproductive health and may produce symptoms (e.g. pelvic pain) and therefore should be defined as a ¿dis-ease'. Previous use of oral contraceptives may increase the risk of developing endometriosis.

N-terminal truncated forms of insulin-like growth factor binding protein-3 in the peritoneal fluid of women without laparoscopic evidence of endometriosis

To characterize and purify peritoneal mitogens able to stimulate the proliferation of human endometrial cells in vitro. Peritoneal fluids (PFs) from 50 patients were collected at laparoscopy and pooled (270 mL) for purification of mitogenic activity. University infertility clinic and endocrinology of reproduction and molecular endocrinology laboratories. Fifty subjects presenting for tubal ligation, pelvic pain, mass, or infertility but otherwise having no evidence of endometriosis inflammation, infection, or tumor. None. Assessment of mitogenic activity by 3 H-thymidine incorporation into mouse embryo fibroblasts and into primary cultures of isolated epithelial and stromal cells of human endometrium. The PF mitogens were purified successively on carboxymethyl-sepharose and heparin-sepharose columns followed by fractionation on cartridges of C 18 silica and reverse-phase high-performance liquid chromatography (HPLC). Four distinct bands were eluted from Sep-Pak, (Mississauga, Ontario, Canada) with molecular weights of 17 to 18, 20, 25, and 29 to 30 kd. The eluted fractions of Sep-Pak exerted preferential mitogenic activity on epithelial-derived human endometrial cells at an equimolar ratio with epidermal growth factor. Microsequencing of the 17 to 18, 20, 25, and 29 to 30 kd bands showed a homologous sequence with N- terminal amino acid sequences of insulin-like growth factor binding protein-3 (IGFBP-3). These data indicate that the PF of normal women without evidence of endometriosis contains AT-terminal truncated forms of IGFBP-3 that mediate an apparent preferential mitogenic action on epithelial-derived endometrial cells. Therefore, they could play a role in the ectopic growth of endometrial cells.

Heparin-sepharose binding growth factors in peritoneal fluid of women with endometriosis

To characterize and to purify the growth substances for mouse embryo fibroblasts (NIH/3T3) and endometrial-like cells of the peritoneal fluid of women with endometriosis. A pool of 102 mL of peritoneal fluid (PF) collected from 24 women with laparoscopic evidence of endometriosis was dialyzed and thereafter chromatographed onto carboxymethyl (CM)-sepharose, heparin-sepharose, cartridges of C18 silica, and reverse-phase high-performance liquid chromatography (reverse-phase HPLC). Mitogenic activity throughout various steps of chromatography was monitored by the increase of the ( 3 H)-thymidine incorporation into NIH/3T3 fibroblasts and enzymatically isolated epithelial cells of rabbit endometrium. Peritoneal fluid of women with endometriosis contained mitogen(s) for NIH/3T3 fibroblasts that were retained on and eluted from CM-sepharose, heparin-sepharose, cartridges of C18 silica, and reverse-phase HPLC columns performed sequentially. Mitogenic material purified 2,500-fold exerted bioactivity on NIH/3T3 and the enzymatically isolated epithelial cells from rabbit endometrium. Peritoneal fluid of women with endometriosis contains heparin-binding growth factors that can be purified by sequential chromatography on CM-sepharose, heparin-sepharose, and reverse-phase HPLC columns. The presence in the PF of potent mitogens for fibroblasts and endometrium-derived epithelial cells could play an important role in the pathogenesis of endometriosis.

Mitogen(s) for endometrial-like cells can be detected in human peritoneal fluid

To characterize the presence of mitogen(s) in the peritoneal fluid (PF). Aliquots of PF aspirated at laparoscopy were assessed for mitogenic activity by the rate of [3H]-thymidine incorporation into the deoxyribonucleic acid of various cell lines. Peritoneal fluids were obtained from patients having a laparoscopy for the investigation of infertility or pelvic pain or for tubal ligation. Seven women with laparoscopic evidence of endometriosis (stage I and II) and six without evidence of endometriosis. None. After 24 hours of culture in absence of serum, NIH/3T3 mouse embryo fibroblasts, (KLE) human endometrial adenocarcinoma cells, and primary cultures of rabbit endometrial cells were incubated in the presence of appropriate amounts of PF or bovine serum albumin (control) for 22 hours before adding the [3H]-thymidine for 2 hours. Aliquots of PF containing greater than 100 micrograms/mL total protein concentration stimulated the proliferation of all cell types. This mitogenic effect was dose-dependent and was greatest on endometrial-like cells. The mitogenic activity was fully recovered after adsorption on dextran-coated charcoal and was sensitive to tryptic digestion and to heat. It could not be retained on cartridge of C18 silica and was calculated to have a molecular weight greater than 30,000 by gel permeation chromatography. Peritoneal fluid from women with or without endometriosis contain growth factor(s) that are proteinaceous in nature and capable of stimulating the proliferation of endometrial-like cells and fibroblasts. These mitogens could play a role in the pathogenesis of endometriosis.

Laparoscopy in the Management of Women with Chronic Pelvic Pain

A review of 232 women who had diagnostic laparoscopy for chronic pelvic pain was undertaken. Diagnostic error in the preoperative pelvic examination in the series varied from 21% to 61%; of 135 patients who had normal pelvic examination findings preoperatively, 82 (61%) were found to have pelvic pathology on diagnostic laparoscopy, whereas 21 of 97 women (21.6%) who had abnormal pelvic examination, had normal findings on laparoscopy. The overall incidence of pelvic pathology in the series was found to be 69%. Our results suggest that there is poor correlation between findings of pelvic examination and the existence of pelvic disease. Laparoscopy has a definite place in the evaluation of patients with chronic pelvic pain and certainly justifies its increasing use in their management.

Endometriosis detection by US with laparoscopic correlation.

Endometriosis is a common cause of female infertility. It may affect as many as 40% of infertile women and may be the sole contributing factor to infertility in 15%. A study was undertaken to determine the usefulness of the routine pelvic ultrasound (US) examination in the detection of endometriosis by correlating pelvic US findings with laparoscopic findings in 85 patients who underwent both examinations. Forty-eight patients (56.5%) had no laparoscopic evidence of endometriosis, and 37 patients (43.6%) had endometriosis. Eight of the patients had abnormal sonograms; of these patients, only four had sonographic abnormalities that corresponded to laparoscopically identified endometriosis. Thus, US was successful in detecting endometriosis in only four (10.8%) of 37 patients. US is neither sensitive nor specific in diagnosing endometriosis. Furthermore, we believe that US does not have a significant role in the diagnosis or management of endometriosis in patients in whom a pelvic mass or other obvious pelvic abnormality is not suspected.