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89: Natural Pregnancy After Laparoscopic Treatment of Rectal Endometriosis
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Journal of Minimally Invasive Gynecology, Vol 14, No 6, November/December Supplement 2007
88 Superoxide Induces the Adhesion Phenotype: Role of Hypoxia in the Pathogenesis of the Adhesion Development Diamond MP, Jiang ZL. Wayne State University, Detroit, Michigan Study Objective: To determine the effect of xanthene oxidase (XO), a superoxide generating system, and superoxide dismutase (SOD), a superoxide scavenger, on the expression of the adhesion phenotype markers; TGF-B1 and type I collagen. Exposure of normal peritoneal fibroblasts to hypoxia has been shown to induce irreversible molecular changes in peritoneal fibroblasts that produce a phenotype, which increases type I collagen and transforming growth faxtor beta 1 (TGF-B1) expression and thereby would promote adhesion development. This effect is hypothesized to be mediated by superoxide ions generated upon exposure to hypoxia. Design: Cell Culture Study. Setting: University Research Laboratory. Patients: Normal and adhesion fibroblasts isolated from gynecological surgical patients. Intervention: Xanthene Oxidase (XO) or Superoxide Dismutase (SOD) Treatment. Measurements and Main Results: Fibroblasts form normal peritoneal and adhesion tissues were cultured with and without SOD (10 U/ml) or XO (14.4 U/ml), which generates superoxide at a rate of 1.4 uM per minute, for 24 hours. Real time RT/PCR was utilized to measure mRNA levels for TGF-B1 and type I collagen. As expected, adhesion fibroblasts exhibited significantly higher basal mRNA levels for both RGF-B1 and type I collagen as compared to normal peritoneal fibroblasts. Treatment with XO resulted in a significant increase in both TGF-B1 and type I collagen in normal peritoneal and adhesion fibroblasts. In contrast, treatment with SOD resulted in a significant decrease in both TGF-B1 and type I collagen in normal peritoneal and adhesion fibroblasts. Conclusion: Our results clearly indicate that superoxide is a key player in the formation of the adhesion phenotype. Furthermore, reduction in superoxide levels was shown to significantly reduce the adhesion phenotype markers suggesting a possible mechanism for intervention in the development of the adhesion phenotype. 89 Natural Pregnancy After Laparoscopic Treatment of Rectal Endometriosis 1 Dias JA, 2Averbach M, 1M Gonzales. 1University of Sao Paulo, Sao Paulo, Brazil; 2Sirio Libanes Hospital, Sao Paulo, Brazil Study Objective: The aim of the study was to evaluate whether clinical and surgical aspects could predict the nat-
ural pregnancy rates in patients submitted to laparoscopic treatment of deeply infiltrating rectum endometriosis. Design: Prospective. Setting: Faculty of Medicine of Sao Paulo University and Sirio-Libanes Hospital, Sao Paulo, Brazil. Patients: From July of 2003 to July of 2005, 120 consecutive patients were submitted to laparoscopic treatment of endometriosis affecting the rectum. Intervention: We describe our experience with complete laparoscopic management of deep pelvic endometriosis infiltrating the rectum and the natural pregnancy rates after the laparoscopy. Laparoscopic treatment consisted of resection of the bowel involved, disc resection or shaving (depending on the size, depth, and the number of the lesions in the rectum, previously evaluated by transvaginal and transrectal ultrasound) and resection of all other implants of endometriosis. Measurements and Main Results: The mean age was 33.4(⫾4.5) years. From the 27 patients who tried to get pregnant, nine succeed (33,3%) until 18 months after the laparoscopy. There were no statistical differences concerning the age, number of previous pregnancies, number or type of delivery, ASRM stages between the two groups. The type of surgery also did not affect the natural pregnancy rates. We found that 6/9 (66,6%) patients with previous history of infertility in the group that got pregnant, while 18/18 (100%) of those that did not get pregnant were infertile before the surgery (p⫽0.02). We also found a higher length of infertility (4.7 ⫾4.3 years) in the group that did not get pregnant, while 1.5 ⫾ 1.1 years in the group that got pregnant (p⫽0.03). Conclusion: These results showed that previous history of infertility and higher length of infertility decrease the natural pregnancy rates in patients treated laparoscopically of rectal endometriosis. 90 Ureteral Endometriosis is Associated With Deep Retrocervical and Rectum Endometriosis and Not With Bladder Disease Dias JJ, Bellelis P. University of Sao Paulo, Sao Paulo, Brazil Study Objective: The aim of the study was to evaluate patients with ureteral endometriosis and to compare different clinical and surgical characteristics with patient without ureteral endometriosis. Desing: Case-Control. Setting: Multidisciplinary group practice and teaching hospital at Sao Paulo - Brazil. Patients: From July 1999 to December 2006, 765 patients had a laparoscopic and histological proven diagnosis of endometriosis and 12 of these patients had lesions compromising the ureter (study group). Control group consisted of the 753 patients without ureteral endometriosis.
Journal of Minimally Invasive Gynecology, Vol 14, No 6, November/December Supplement 2007
88 Superoxide Induces the Adhesion Phenotype: Role of Hypoxia in the Pathogenesis of the Adhesion Development Diamond MP, Jiang ZL. Wayne State University, Detroit, Michigan Study Objective: To determine the effect of xanthene oxidase (XO), a superoxide generating system, and superoxide dismutase (SOD), a superoxide scavenger, on the expression of the adhesion phenotype markers; TGF-B1 and type I collagen. Exposure of normal peritoneal fibroblasts to hypoxia has been shown to induce irreversible molecular changes in peritoneal fibroblasts that produce a phenotype, which increases type I collagen and transforming growth faxtor beta 1 (TGF-B1) expression and thereby would promote adhesion development. This effect is hypothesized to be mediated by superoxide ions generated upon exposure to hypoxia. Design: Cell Culture Study. Setting: University Research Laboratory. Patients: Normal and adhesion fibroblasts isolated from gynecological surgical patients. Intervention: Xanthene Oxidase (XO) or Superoxide Dismutase (SOD) Treatment. Measurements and Main Results: Fibroblasts form normal peritoneal and adhesion tissues were cultured with and without SOD (10 U/ml) or XO (14.4 U/ml), which generates superoxide at a rate of 1.4 uM per minute, for 24 hours. Real time RT/PCR was utilized to measure mRNA levels for TGF-B1 and type I collagen. As expected, adhesion fibroblasts exhibited significantly higher basal mRNA levels for both RGF-B1 and type I collagen as compared to normal peritoneal fibroblasts. Treatment with XO resulted in a significant increase in both TGF-B1 and type I collagen in normal peritoneal and adhesion fibroblasts. In contrast, treatment with SOD resulted in a significant decrease in both TGF-B1 and type I collagen in normal peritoneal and adhesion fibroblasts. Conclusion: Our results clearly indicate that superoxide is a key player in the formation of the adhesion phenotype. Furthermore, reduction in superoxide levels was shown to significantly reduce the adhesion phenotype markers suggesting a possible mechanism for intervention in the development of the adhesion phenotype. 89 Natural Pregnancy After Laparoscopic Treatment of Rectal Endometriosis 1 Dias JA, 2Averbach M, 1M Gonzales. 1University of Sao Paulo, Sao Paulo, Brazil; 2Sirio Libanes Hospital, Sao Paulo, Brazil Study Objective: The aim of the study was to evaluate whether clinical and surgical aspects could predict the nat-
ural pregnancy rates in patients submitted to laparoscopic treatment of deeply infiltrating rectum endometriosis. Design: Prospective. Setting: Faculty of Medicine of Sao Paulo University and Sirio-Libanes Hospital, Sao Paulo, Brazil. Patients: From July of 2003 to July of 2005, 120 consecutive patients were submitted to laparoscopic treatment of endometriosis affecting the rectum. Intervention: We describe our experience with complete laparoscopic management of deep pelvic endometriosis infiltrating the rectum and the natural pregnancy rates after the laparoscopy. Laparoscopic treatment consisted of resection of the bowel involved, disc resection or shaving (depending on the size, depth, and the number of the lesions in the rectum, previously evaluated by transvaginal and transrectal ultrasound) and resection of all other implants of endometriosis. Measurements and Main Results: The mean age was 33.4(⫾4.5) years. From the 27 patients who tried to get pregnant, nine succeed (33,3%) until 18 months after the laparoscopy. There were no statistical differences concerning the age, number of previous pregnancies, number or type of delivery, ASRM stages between the two groups. The type of surgery also did not affect the natural pregnancy rates. We found that 6/9 (66,6%) patients with previous history of infertility in the group that got pregnant, while 18/18 (100%) of those that did not get pregnant were infertile before the surgery (p⫽0.02). We also found a higher length of infertility (4.7 ⫾4.3 years) in the group that did not get pregnant, while 1.5 ⫾ 1.1 years in the group that got pregnant (p⫽0.03). Conclusion: These results showed that previous history of infertility and higher length of infertility decrease the natural pregnancy rates in patients treated laparoscopically of rectal endometriosis. 90 Ureteral Endometriosis is Associated With Deep Retrocervical and Rectum Endometriosis and Not With Bladder Disease Dias JJ, Bellelis P. University of Sao Paulo, Sao Paulo, Brazil Study Objective: The aim of the study was to evaluate patients with ureteral endometriosis and to compare different clinical and surgical characteristics with patient without ureteral endometriosis. Desing: Case-Control. Setting: Multidisciplinary group practice and teaching hospital at Sao Paulo - Brazil. Patients: From July 1999 to December 2006, 765 patients had a laparoscopic and histological proven diagnosis of endometriosis and 12 of these patients had lesions compromising the ureter (study group). Control group consisted of the 753 patients without ureteral endometriosis.