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Objectives

Endometriosis is a chronic condition primarily affecting young women of reproductive age. Although some women with bowel endometriosis may be asymptomatic patients typically report a myriad of symptoms such as alteration in bowel habits (constipation/diarrhoea) dyschezia, dysmenorrhoea and dyspareunia in addition to infertility. To date, there are no clear guidelines on the evaluation of patients with suspected bowel endometriosis. Several techniques have been proposed including transvaginal and/or transrectal ultrasonography, magnetic resonance imaging, and double-contrast barium enema. These different imaging modalities provide greater information regarding presence, location and extent of endometriosis ensuring patients are adequately informed whilst also optimizing preoperative planning. In cases where surgical management is indicated, surgery should be performed by experienced surgeons, in centres with access to multidisciplinary care. Treatment should be tailored according to patient symptoms and wishes with a view to excising as much disease as possible, whilst at the same time preserving organ function. In this review article current perspectives on diagnosis and management of bowel endometriosis are discussed.

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1Cervical ripening is necessary for successful delivery. As cytokines are believed to be 2 involved in this process, the aim of this study was to investigate possible changes in the 3 mRNA and protein expression of pro-inflammatory (interleukin (IL)-1α, IL-1β, IL-12, IL-18) 4 and anti-inflammatory (IL-4, IL-10, IL-13) cytokines in the human cervix during pregnancy, 5 term and preterm labor. Cervical biopsies were taken from 59 women: 21 at preterm labor, 24 6 at term labor, 10 at term not in labor and 4 from non-pregnant women. mRNA was analyzed 7 with real-time RT-PCR and protein expression and/or secretion with immunohistochemistry 8 and ELISA. There was an upregulation of mRNA for IL-10, IL-13, IL-1α and IL-1β in the 9 laboring groups, while mRNA for IL-12 and IL-18 was downregulated (p<0.05). IL-4 mRNA 10 was detected more frequently, while IL-12 mRNA expression was lower, in the preterm labor 11 group than in the term labor group (p<0.05). The protein levels of IL-4 and IL-12 were lower 12 and IL-18 tended to be higher in the labor groups, while IL-10 protein levels were unaffected 13 by labor. IL-4 protein levels were significantly higher in the preterm subgroup with bacterial 14 infection than in the non-infected group (p<0.05). IL-10 had higher expression in squamous 15 epithelium at preterm labor than at term (p<0.05). In conclusion, the major changes in pro-16 inflammatory and anti-inflammatory cytokine mRNA and protein expression in cervix occur 17 during the labor process irrespective of the length of gestation. However, our results indicate 18 that dysregulation of anti-inflammatory cytokines in the human cervix could be involved in 19 the pathogenesis of preterm labor. 20 21