- Email: [email protected]
Thoracic Endometriosis: A Case Report
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S116–S131 treatment and operative techniques for hysteroscopic transection, as well as the complications associated with surgical management, postoperative care, follow-up, and post-treatment outcomes.
S121
406 Thoracic Endometriosis: A Case Report Chamsy DJ, Kho KA. Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
404 Geometrically Efficient Laparoscopic Suturing Hudgens JL, Pasic RP. OB/GYN, University of Louisville, Louisville, Kentucky Study Objective: Geometrically efficeint laparoscpoic suturing is a chapter that presents a systematic approach to learning laparoscopic suturing. This system is based upon the understanding of basic geometric relationship and how they relate to surgical efficiency. This system is also based on well understood educational principles. The goal of this work is to present the complex task of laparoscopic suturing in a systematic manner that leads to effcient learning. Design: Text format accompanied by video illustrations. Patients: Multiple clinical senarios highlighting different suturing techniques are presented. Conclusion: The study of this text and the accompaing videos should help the learner better understand laparoscopic suturing and present a framework to become a proficient laparoscopic suturer.
POSTER SESSION: ENDOMETRIOSIS 405 A Low-Cost Genome-Wide Association Study in Endometriosis Borghese B,1 Tost J,2 Mondon F,3 Vaiman D,3 Chapron C.1 1Department of Gynecology and Obstetrics and Reproductive Medicine, Paris Descartes University, Paris, France; 2Laboratory for Epigenetics, CEA - Institut de Genomique, Evry, France; 3Institut Cochin, CNRS UMR 8104, INSERM U1016, Paris, France Study Objective: Identification of genes responsible for endometriosis remains difficult, despite recent expensive genome-wide association studies (GWAS). We aimed to build a rapid and low-cost GWAS testing hundreds of thousands of single nucleotide polymorphisms (SNP) for the association with three endometriosis phenotypes in a Caucasian population: superficial endometriosis (SUP), ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE). Design: Genomic DNA samples from patients and controls were pooled within clinical classes of the disease for use in 250 K SNP arrays. Statistically relevant SNP were then submitted for individual validation by pyrosequencing. Setting: University tertiary referral center. Patients: 20 SUP, 20 OMA, 20 DIE and 20 control patients were used for pooling and GWAS. 551 additional patients and controls were used for individual genotyping. Intervention: All patients were operated for complete surgical treatment of the lesions and sorted into the subtypes through pathologic examination considering the most severe endometriotic lesion. All controls were surgically checked for the absence of endometriosis. Measurements and Main Results: After statistical analysis and MonteCarlo simulations, 279 SNP were significantly associated with one or more clinical classes of endometriosis. 86 (30.8%) of the nearby genes were expressionally modified, which is higher than on the complete microarray, where 8010 genes were modified amongst 47633 (16.8%) (p\0.005). Many of these genes were transcriptional factors, some of them related with estrogen production. 5 SNP out of the top 21 were validated by individual genotyping in an independent population of 551 patients and controls. Conclusion: Used for the first time in endometriosis, the pooling-based GWAS presents an efficient, cost-effective alternative to classic GWAS. This approach identifies putative genetic variants associated with the disease, allowing to uncover new genes possibly implicated in the pathogenesis of endometriosis.
Study Objective: To educate phycisians about thoracic endometriosis as they are often unfamiliar with this rare disease entity. Its various clinical manifestations, underlying pathophysiology, diagnostic tools, pathologic findings and management options are thoroughly reviewed. Design: Case report. Setting: University teaching hospital. Patients: 35 year olf nulliparous female who presented with dyspnea and pleuritic chest pain. Intervention: Pelvic ultrasonography revealed a right endometriomas. Chest radiography and thoracenthesis were performed. 500 ml of hemorrhagic fluid was aspirated. Right sided thoracotomy revealed hemorrhagic implants along the pleural surface of the diaphragm and diaphragmatic defects which were repaired. Measurements and Main Results: Pathologic examination of pleural hemorrhagic implants revealed hemosiderin laden macrophages. Immunohistochemical staining showed stromal cells positive for estrogen receptors and CD10 marker supporting the diagnosis of thoracic endometriosis. Patient was advised to undergo total abdominal hysterectomy with bilateral salpingo-ophorectomy, however she desired future fertility, so received a trial of DepoLupron. She has so far responded well to medical management. Conclusion: Although thoracic endometriosis is a gynecologic disorder, gynecologists are rarely the first to evaluate patients. Primary care and emergency medicine physicians need to be educated about this rare entity. The key lies in performing a detailed gynecologic review of systems and making a temporal association between pulmonary symptoms and menstruation.
407 Laparoscopic Application of Seprafilm in Mild, Moderate, Severe Endometriosis Chuang Y-C,1 Chen M-J,2 Kan Y-Y.1 1GYN, Fooyin University Hospital, Pingtung, Taiwan; 2GYN, Taichuang Veterans General Hospital, Taichuang, Taiwan Study Objective: Laparoscopic fulgation or electrocauterization of endometriosis or enucleation of chocolate cyst and lysis of deep endometriosis has been the standard treatment. However, the de-novo formation of adhesion and reformation of adhesion incidence over adnexa and CDS is high. Transient abdominal oophopexy is a solution for the patient who receives ovarian chocolate cyst operation or deep endometriosis. However, it is painful for the patient to endure the post operation procedure with the suture on abdominal wall. We try to apply the anti-adhesion barrier seprafilm in different severity of the endometriosis laparoscopically. Design: Retrospective analysis of operation recorded video and photograph. Setting: University Hospital. Patients: 30 patients with different severity of endometriosis. Intervention: After major operation for laparoscopic management of endometriosis. The seprafilm was cut into small pieces as Chuang,s description. In brief, one to three layers of small pieces of seprafilm were rolled with a piece of plastic bag and rolled into a roll. Drive the seprafilm roll through the 10-11 mm trocar sleeve. The ovary was temporal sutured with 1-0 Catgut, the surgical assistant elevate the ovary when the operator apply the seprafilm laparoscopically. The procedure and result image was photographed and video-taped. Measurements and Main Results: The image was reviewed and successful application was defined as totally covered the traumatized lesion and bilateral adnexa, and the CDS.
S121
406 Thoracic Endometriosis: A Case Report Chamsy DJ, Kho KA. Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
404 Geometrically Efficient Laparoscopic Suturing Hudgens JL, Pasic RP. OB/GYN, University of Louisville, Louisville, Kentucky Study Objective: Geometrically efficeint laparoscpoic suturing is a chapter that presents a systematic approach to learning laparoscopic suturing. This system is based upon the understanding of basic geometric relationship and how they relate to surgical efficiency. This system is also based on well understood educational principles. The goal of this work is to present the complex task of laparoscopic suturing in a systematic manner that leads to effcient learning. Design: Text format accompanied by video illustrations. Patients: Multiple clinical senarios highlighting different suturing techniques are presented. Conclusion: The study of this text and the accompaing videos should help the learner better understand laparoscopic suturing and present a framework to become a proficient laparoscopic suturer.
POSTER SESSION: ENDOMETRIOSIS 405 A Low-Cost Genome-Wide Association Study in Endometriosis Borghese B,1 Tost J,2 Mondon F,3 Vaiman D,3 Chapron C.1 1Department of Gynecology and Obstetrics and Reproductive Medicine, Paris Descartes University, Paris, France; 2Laboratory for Epigenetics, CEA - Institut de Genomique, Evry, France; 3Institut Cochin, CNRS UMR 8104, INSERM U1016, Paris, France Study Objective: Identification of genes responsible for endometriosis remains difficult, despite recent expensive genome-wide association studies (GWAS). We aimed to build a rapid and low-cost GWAS testing hundreds of thousands of single nucleotide polymorphisms (SNP) for the association with three endometriosis phenotypes in a Caucasian population: superficial endometriosis (SUP), ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE). Design: Genomic DNA samples from patients and controls were pooled within clinical classes of the disease for use in 250 K SNP arrays. Statistically relevant SNP were then submitted for individual validation by pyrosequencing. Setting: University tertiary referral center. Patients: 20 SUP, 20 OMA, 20 DIE and 20 control patients were used for pooling and GWAS. 551 additional patients and controls were used for individual genotyping. Intervention: All patients were operated for complete surgical treatment of the lesions and sorted into the subtypes through pathologic examination considering the most severe endometriotic lesion. All controls were surgically checked for the absence of endometriosis. Measurements and Main Results: After statistical analysis and MonteCarlo simulations, 279 SNP were significantly associated with one or more clinical classes of endometriosis. 86 (30.8%) of the nearby genes were expressionally modified, which is higher than on the complete microarray, where 8010 genes were modified amongst 47633 (16.8%) (p\0.005). Many of these genes were transcriptional factors, some of them related with estrogen production. 5 SNP out of the top 21 were validated by individual genotyping in an independent population of 551 patients and controls. Conclusion: Used for the first time in endometriosis, the pooling-based GWAS presents an efficient, cost-effective alternative to classic GWAS. This approach identifies putative genetic variants associated with the disease, allowing to uncover new genes possibly implicated in the pathogenesis of endometriosis.
Study Objective: To educate phycisians about thoracic endometriosis as they are often unfamiliar with this rare disease entity. Its various clinical manifestations, underlying pathophysiology, diagnostic tools, pathologic findings and management options are thoroughly reviewed. Design: Case report. Setting: University teaching hospital. Patients: 35 year olf nulliparous female who presented with dyspnea and pleuritic chest pain. Intervention: Pelvic ultrasonography revealed a right endometriomas. Chest radiography and thoracenthesis were performed. 500 ml of hemorrhagic fluid was aspirated. Right sided thoracotomy revealed hemorrhagic implants along the pleural surface of the diaphragm and diaphragmatic defects which were repaired. Measurements and Main Results: Pathologic examination of pleural hemorrhagic implants revealed hemosiderin laden macrophages. Immunohistochemical staining showed stromal cells positive for estrogen receptors and CD10 marker supporting the diagnosis of thoracic endometriosis. Patient was advised to undergo total abdominal hysterectomy with bilateral salpingo-ophorectomy, however she desired future fertility, so received a trial of DepoLupron. She has so far responded well to medical management. Conclusion: Although thoracic endometriosis is a gynecologic disorder, gynecologists are rarely the first to evaluate patients. Primary care and emergency medicine physicians need to be educated about this rare entity. The key lies in performing a detailed gynecologic review of systems and making a temporal association between pulmonary symptoms and menstruation.
407 Laparoscopic Application of Seprafilm in Mild, Moderate, Severe Endometriosis Chuang Y-C,1 Chen M-J,2 Kan Y-Y.1 1GYN, Fooyin University Hospital, Pingtung, Taiwan; 2GYN, Taichuang Veterans General Hospital, Taichuang, Taiwan Study Objective: Laparoscopic fulgation or electrocauterization of endometriosis or enucleation of chocolate cyst and lysis of deep endometriosis has been the standard treatment. However, the de-novo formation of adhesion and reformation of adhesion incidence over adnexa and CDS is high. Transient abdominal oophopexy is a solution for the patient who receives ovarian chocolate cyst operation or deep endometriosis. However, it is painful for the patient to endure the post operation procedure with the suture on abdominal wall. We try to apply the anti-adhesion barrier seprafilm in different severity of the endometriosis laparoscopically. Design: Retrospective analysis of operation recorded video and photograph. Setting: University Hospital. Patients: 30 patients with different severity of endometriosis. Intervention: After major operation for laparoscopic management of endometriosis. The seprafilm was cut into small pieces as Chuang,s description. In brief, one to three layers of small pieces of seprafilm were rolled with a piece of plastic bag and rolled into a roll. Drive the seprafilm roll through the 10-11 mm trocar sleeve. The ovary was temporal sutured with 1-0 Catgut, the surgical assistant elevate the ovary when the operator apply the seprafilm laparoscopically. The procedure and result image was photographed and video-taped. Measurements and Main Results: The image was reviewed and successful application was defined as totally covered the traumatized lesion and bilateral adnexa, and the CDS.