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P769 Preliminary results of uterine artery embolization for adenomyosis in patients of reproductive age
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
sections was performed using the monoclonal antibody S 100 and CD 1A. Results: We found S100 and CD1A positive cells in endometriotic implants. P767 Triumph: Genome-based expression profiles as a single standardized microarray platform for the pathogenesis of endometriosis L. Tseng1 , I. Chen2 , M. Chen3 , C. Lee4 . 1 Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, 2 University of Sydney, 3 Stanford University, 4 Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, Taiwan, China To identify the mechanisms underlying endometriosis using oligonucleotide microarray, Microarray gene expression profiles are studied in ovarian endometriosis lesions corresponding to normal endometrial tissues obtained from the same patient at the same time. The results were very interesting. Firstly, complex metabolic reactions, including carbohydrate, glucose, lipid, cofactors, vitamins, xenobiotics, nucleotide and amino acid metabolisms, are involved in. Secondly, the presence of endometriosis is linked to the differential effect of IgH, IgK and IgL genes. Thirdly, endometriosis activates complement and coagulation cascades promoting muscle contraction, phagocyte recruitment, T cell and B cell mediated immune responses. Fourthly, WNT and TGF-beta receptor signaling pathways are involved in the development of endometriosis. Fifthly, there is an indication of Netrin- and Semaphorin-mediated axon guidance promoting retrograde menstruation in endometriosis. The success of this investigation has enabled the classification of samples of unknown, equivocal or ambiguous history, thus offering the basis for a minimally invasive test and therapeutic targets for endometriosis. P768 The effect of endometriosis on quality of life in patients with a diagnosis in their younger reproductive years H. Turnbull1 , S. Mukhopadhyay2 , E. Morris3 . 1 Ipswich Hospital, Suffolk, United Kingdom, 2 Norfolk and Norwich University Hospital, Norwich, Norfolk, UK, 3 Norfolk & Norwich University Hospital, Norwich, Norfolk, UK Aims and Objective: The research aim was to explore the experiences and perceptions of women living with endometriosis from a younger than usual age, its effects on their lives and the strategies used to manage their disease. Background: Endometriosis significantly affects the quality of women’s lives due to its symptoms of severe pain and dyspareunia. Much research has looked into this negative effect, but little has focused on the effect on women whose symptoms started at a younger age, specifically on education, early relationships and personal development. Design: A qualitative research design using questions taken from the Endometriosis Health Profile Questionnaire and SG-36 Health Survey. Methods: Ten women, whose symptoms started before the age of 25, agreed to take part in the research. The individual, audio-taped 1-to-2-hour interviews were semi-structured and interactive. The interviews were analysed using a thematic analysis approach. Results: The dominant feature of data from the interviews was the experience and impact of chronic pain. Analysis resulted in six themes: – type of pain – effect on life (education, work, social, family relationships & fertility) – coping skills – improvements required at diagnosis
S631
– lack of awareness hinders coping and – patients’ needs. Conclusion: The diagnostic process took between 3–17 years, indicating that primary healthcare practitioners need a higher level of “suspicion” for the condition, and a lower referral threshold. This younger age bracket of women needs to be recognised earlier to prevent long-term misery, poor educational achievement and scarred early sexual relationships. Once eventually reaching a diagnosis, the women highlighted that secondary care practitioners provided unsatisfactory explanations, with very little available written literature or advice for life-style adjustments. Prior to diagnosis, and having eventually reached a diagnosis, the women felt abandoned by both primary and secondary health care. This highlighted a need for local support groups, but primarily, a role for gynaecology specialist nurses to give advice and support during treatment and between the infrequent follow-up appointments, and to lessen the need for these women to search elsewhere for relevant information. Since completion of this research project, the participants have been put in touch with eachother, and have formed a new Norfolk branch of the United Kingdom’s Endometriosis Society. This research project was carried out as part of an undergraduate MB/BS Medical degree. P769 Preliminary results of uterine artery embolization for adenomyosis in patients of reproductive age O. Mishiyeva1 , I. Krasnova1 , S. Kapranov2 , N. Shevchenko1 , E. Vaganov1 . 1 Department of Obstetrics and Gynecology, Russian State Medical University, 2 Scientific Laboratory of radiological surgery, Russian State Medical University Objective: To evaluate the efficacy of uterine artery embolization (UAE) for adenomyosis in patients in reproductive age. Materials and Methods: Forty two women (age range 29–46 years) underwent UAE. Fifteen patients had different forms of adenomyosis (9 –nodular, 4 – diffuse, 2 – focal) and 27 – diffuse adenomyosis combined with uterine fibroids. The indications for UAE were: profuse uterine bleeding (n = 5); ineffective hormonal treatment (n = 21); impossibility of hormonal treatment (n = 6), combination of adenomyosis and fibroid (n = 27). All patients underwent UAE as alternative treatment because all of them definitely refused the operation. The embolic agents were polyvinyl alcohol particle. In all cases 350–500 mm particles were used initially and followed by 500–710 mm particles. Results: In patients with profuse uterine bleeding embolization resulted in haemostatic effect directly during the operation (n = 5). Follow-up period from 6 months to 3 years showed an improvement of menstrual function in 39 patients treated with UAE. Recurrence of uterine bleeding observed in two women with nodular adenomyosis and in one woman with combination of adenomyosis with fibroid. After UAE in all patients (n = 24) algodismenorrhea faded without recurrences. Conclusion: UAE may be recommended as effective alternative for hysterectomy in treatment of uterine bleedings in patients with adenomyosis alone or its combination with fibroid. Our experience suggests it reasonable to use UAE concurrently with hormonal therapy. P770 Clinical significance of dystrophic and inflammatory Pap smears: an analysis of 55,271 smears J. Baldauf1 , D. Wiltzer2 , M. Fender2 , E. Sauleau3 . 1 Departement de Gyn´ecologie-Obst´etrique CHRU Strasbourg France, 2 Association EVE, 69 route du Rhin, F-67400 Illkirch Graffenstaden, 3 Departement d’Informatique M´edicale CHRU Strasbourg France Objective: In the context of an organized cervical cancer screening programme, cytopathologists from the Alsace region distinguish
sections was performed using the monoclonal antibody S 100 and CD 1A. Results: We found S100 and CD1A positive cells in endometriotic implants. P767 Triumph: Genome-based expression profiles as a single standardized microarray platform for the pathogenesis of endometriosis L. Tseng1 , I. Chen2 , M. Chen3 , C. Lee4 . 1 Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, 2 University of Sydney, 3 Stanford University, 4 Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, Taiwan, China To identify the mechanisms underlying endometriosis using oligonucleotide microarray, Microarray gene expression profiles are studied in ovarian endometriosis lesions corresponding to normal endometrial tissues obtained from the same patient at the same time. The results were very interesting. Firstly, complex metabolic reactions, including carbohydrate, glucose, lipid, cofactors, vitamins, xenobiotics, nucleotide and amino acid metabolisms, are involved in. Secondly, the presence of endometriosis is linked to the differential effect of IgH, IgK and IgL genes. Thirdly, endometriosis activates complement and coagulation cascades promoting muscle contraction, phagocyte recruitment, T cell and B cell mediated immune responses. Fourthly, WNT and TGF-beta receptor signaling pathways are involved in the development of endometriosis. Fifthly, there is an indication of Netrin- and Semaphorin-mediated axon guidance promoting retrograde menstruation in endometriosis. The success of this investigation has enabled the classification of samples of unknown, equivocal or ambiguous history, thus offering the basis for a minimally invasive test and therapeutic targets for endometriosis. P768 The effect of endometriosis on quality of life in patients with a diagnosis in their younger reproductive years H. Turnbull1 , S. Mukhopadhyay2 , E. Morris3 . 1 Ipswich Hospital, Suffolk, United Kingdom, 2 Norfolk and Norwich University Hospital, Norwich, Norfolk, UK, 3 Norfolk & Norwich University Hospital, Norwich, Norfolk, UK Aims and Objective: The research aim was to explore the experiences and perceptions of women living with endometriosis from a younger than usual age, its effects on their lives and the strategies used to manage their disease. Background: Endometriosis significantly affects the quality of women’s lives due to its symptoms of severe pain and dyspareunia. Much research has looked into this negative effect, but little has focused on the effect on women whose symptoms started at a younger age, specifically on education, early relationships and personal development. Design: A qualitative research design using questions taken from the Endometriosis Health Profile Questionnaire and SG-36 Health Survey. Methods: Ten women, whose symptoms started before the age of 25, agreed to take part in the research. The individual, audio-taped 1-to-2-hour interviews were semi-structured and interactive. The interviews were analysed using a thematic analysis approach. Results: The dominant feature of data from the interviews was the experience and impact of chronic pain. Analysis resulted in six themes: – type of pain – effect on life (education, work, social, family relationships & fertility) – coping skills – improvements required at diagnosis
S631
– lack of awareness hinders coping and – patients’ needs. Conclusion: The diagnostic process took between 3–17 years, indicating that primary healthcare practitioners need a higher level of “suspicion” for the condition, and a lower referral threshold. This younger age bracket of women needs to be recognised earlier to prevent long-term misery, poor educational achievement and scarred early sexual relationships. Once eventually reaching a diagnosis, the women highlighted that secondary care practitioners provided unsatisfactory explanations, with very little available written literature or advice for life-style adjustments. Prior to diagnosis, and having eventually reached a diagnosis, the women felt abandoned by both primary and secondary health care. This highlighted a need for local support groups, but primarily, a role for gynaecology specialist nurses to give advice and support during treatment and between the infrequent follow-up appointments, and to lessen the need for these women to search elsewhere for relevant information. Since completion of this research project, the participants have been put in touch with eachother, and have formed a new Norfolk branch of the United Kingdom’s Endometriosis Society. This research project was carried out as part of an undergraduate MB/BS Medical degree. P769 Preliminary results of uterine artery embolization for adenomyosis in patients of reproductive age O. Mishiyeva1 , I. Krasnova1 , S. Kapranov2 , N. Shevchenko1 , E. Vaganov1 . 1 Department of Obstetrics and Gynecology, Russian State Medical University, 2 Scientific Laboratory of radiological surgery, Russian State Medical University Objective: To evaluate the efficacy of uterine artery embolization (UAE) for adenomyosis in patients in reproductive age. Materials and Methods: Forty two women (age range 29–46 years) underwent UAE. Fifteen patients had different forms of adenomyosis (9 –nodular, 4 – diffuse, 2 – focal) and 27 – diffuse adenomyosis combined with uterine fibroids. The indications for UAE were: profuse uterine bleeding (n = 5); ineffective hormonal treatment (n = 21); impossibility of hormonal treatment (n = 6), combination of adenomyosis and fibroid (n = 27). All patients underwent UAE as alternative treatment because all of them definitely refused the operation. The embolic agents were polyvinyl alcohol particle. In all cases 350–500 mm particles were used initially and followed by 500–710 mm particles. Results: In patients with profuse uterine bleeding embolization resulted in haemostatic effect directly during the operation (n = 5). Follow-up period from 6 months to 3 years showed an improvement of menstrual function in 39 patients treated with UAE. Recurrence of uterine bleeding observed in two women with nodular adenomyosis and in one woman with combination of adenomyosis with fibroid. After UAE in all patients (n = 24) algodismenorrhea faded without recurrences. Conclusion: UAE may be recommended as effective alternative for hysterectomy in treatment of uterine bleedings in patients with adenomyosis alone or its combination with fibroid. Our experience suggests it reasonable to use UAE concurrently with hormonal therapy. P770 Clinical significance of dystrophic and inflammatory Pap smears: an analysis of 55,271 smears J. Baldauf1 , D. Wiltzer2 , M. Fender2 , E. Sauleau3 . 1 Departement de Gyn´ecologie-Obst´etrique CHRU Strasbourg France, 2 Association EVE, 69 route du Rhin, F-67400 Illkirch Graffenstaden, 3 Departement d’Informatique M´edicale CHRU Strasbourg France Objective: In the context of an organized cervical cancer screening programme, cytopathologists from the Alsace region distinguish