Endometriosis is one of the most common gynaecologic diseases in women of reproductive age. It is characterized by the presence of endometrial tissue outside the uterine cavity. The women affected suffer from pelvic pain and infertility. The complex etiology is still unclear and it is based on three main theories: retrograde menstruation, coelomic metaplasia, and induction theory. Genetics and epigenetics also play a role in the development of endometriosis. Recent studies have put the attention on the role of oxidative stress, defined as an imbalance between reactive oxygen species (ROS) and antioxidants, which may be implicated in the pathophysiology of endometriosis causing a general inflammatory response in the peritoneal cavity. Reactive oxygen species are intermediaries produced by normal oxygen metabolism and are inflammatory mediators known to modulate cell proliferation and to have deleterious effects. A systematic review was performed in order to clarify the different roles of oxidative stress and its role in the development of endometriosis. Several issues have been investigated: iron metabolism, oxidative stress markers (in the serum, peritoneal fluid, follicular fluid, peritoneal environment, ovarian cortex, and eutopic and ectopic endometrial tissue), genes involved in oxidative stress, endometriosis-associated infertility, and cancer development.

Background: The authors tested the hypothesis that during laparoscopic surgery, Trendelenburg position and pneumoperitoneum may worsen chest wall elastance, concomitantly decreasing transpulmonary pressure, and that a protective ventilator strategy applied after pneumoperitoneum induction, by increasing transpulmonary pressure, would result in alveolar recruitment and improvement in respiratory mechanics and gas exchange. Methods: In 29 consecutive patients, a recruiting maneuver followed by positive end-expiratory pressure 5 cm H 2 O maintained until the end of surgery was applied after pneumoperitoneum induction. Respiratory mechanics, gas exchange, blood pressure, and cardiac index were measured before (T BSL ) and after pneumoperitoneum with zero positive end-expiratory pressure (T preOLS ), after recruitment with positive end-expiratory pressure (T postOLS ), and after peritoneum desufflation with positive end-expiratory pressure (T end ). Results: Esophageal pressure was used for partitioning respiratory mechanics between lung and chest wall (data are mean ± SD): on T preOLS , chest wall elastance (E cw ) and elastance of the lung (E L ) increased (8.2 ± 0.9 vs. 6.2 ± 1.2 cm H 2 O/L, respectively, on T BSL ; P = 0.00016; and 11.69 ± 1.68 vs. 9.61 ± 1.52 cm H 2 O/L on T BSL ; P = 0.0007). On T postOLS , both chest wall elastance and E L decreased (5.2 ± 1.2 and 8.62 ± 1.03 cm H 2 O/L, respectively; P = 0.00015 vs. T preOLS ), and PaO 2 /inspiratory oxygen fraction improved (491 ± 107 vs. 425 ± 97 on T preOLS; P = 0.008) remaining stable thereafter. Recruited volume (the difference in lung volume for the same static airway pressure) was 194 ± 80 ml. Pplat RS remained stable while inspiratory transpulmonary pressure increased (11.65 + 1.37 cm H 2 O vs. 9.21 + 2.03 on T preOLS ; P = 0.007). All respiratory mechanics parameters remained stable after abdominal desufflation. Hemodynamic parameters remained stable throughout the study. Conclusions:In patients submitted to laparoscopic surgery in Trendelenburg position, an open lung strategy applied after pneumoperitoneum induction increased transpulmonary pressure and led to alveolar recruitment and improvement of E cw and gas exchange. LAPAROSCOPY is a well-established procedure for pelvic gynecologic surgery often performed in Trendelenburg position.1,2 To facilitate laparoscopic surgical manipulation, a pneumoperitoneum is usually induced through carbon dioxide inflation. Both the increase in abdominal pressure as a result of carbon dioxide inflation and the head down body position have been shown to impair the respiratory function during the procedure, mainly inducing atelectasis formation in the dependent lung regions. 1,[3][4][5][6] The resulting decrease in functional residual capacity poses Address correspondence to Dr. Cinnella: Departmentt of Anesthesia and Intensive Care, Policlinico 'Riuniti' -University of Foggia, Viale Pinto 1 -71100 Foggia, Italy. g.cinnella@unifg.it. Information on purchasing reprints may be found at www.anesthesiology.org...

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Objectives: We evaluated sexual function, quality of life and perceived body image of women with deep endometriosis in comparison to that of healthy women. Methods: The sample consisted of 41 women with deep endometriosis and 40 healthy women without endometriosis. Sexual, psychological and pain evaluation were performed. Results: The study evidenced that deep endometriosis has a significant impact on sexuality and body image. Conclusions: An integrated and patient-centered approach to medical and psychological and sexual issues is suggested