RESUMO
PROBLEM: To search for molecular markers of endometriosis the following polymorphisms: p53 codon 72 Pro (apoptosis), TNF alpha-308 (inflammation), VEGF-1164AA (angiogenesis), and SOD2 (oxidative stress) were investigated. METHOD OF STUDY: Forty-two women-24 with surgically proven endometriosis and 18 with no endometriosis found at the time of laparoscopy-had buccal swabs taken for DNA analyses of 4 gene polymorphisms including p53codon72, TNF-308 G/A, VEGF-1154G/A, SOD Ala16Val DNA. The frequencies of genotypes and alleles of these polymorphisms were compared between women with and without endometriosis. RESULTS: No specific gene mutation differences for the four genes tested nor differences in the frequencies of heterozygous and homozygous mutations were found between patients with endometriosis and controls. In addition, no differences in allelic frequencies of the four genetic polymorphisms were observed between patients with endometriosis and control. CONCLUSION: Endometriosis is not associated with gene mutations for p53codon72, TNF-308 G/A, VEGF-1154G/A, SOD Ala16Val.
Assuntos
Endometriose/genética , Superóxido Dismutase/genética , Fator de Necrose Tumoral alfa/genética , Proteína Supressora de Tumor p53/genética , Fator A de Crescimento do Endotélio Vascular/genética , Adulto , Apoptose/genética , Análise Mutacional de DNA , Feminino , Frequência do Gene , Marcadores Genéticos/genética , Genótipo , Humanos , Inflamação/genética , Pessoa de Meia-Idade , Neovascularização Patológica/genética , Estresse Oxidativo/genética , Polimorfismo Genético , Risco , Adulto JovemRESUMO
BACKGROUND: Endometriosis is a common condition in women that affects up to 45% of patients in the reproductive age group by causing pelvic pain. It is characterized by the presence of endometrial tissue outside the uterine cavity and is rarely found subcutaneously or in abdominal incisions, causing it to be overlooked in patients with abdominal pain. METHODS: A 45-year-old woman presented with lower abdominal pain 2 years following a laparoscopic supracervical hysterectomy. She was found to have incidental cholelithiasis and a large abdominal mass suggestive of a significant ventral hernia on CT scan. RESULTS: Due to the peculiar presentation, surgical intervention took place that revealed a large 9cm×7.6cm×6.2cm abdominal wall endometrioma. CONCLUSION: Although extrapelvic endometriosis is rare, it should be entertained in the differential diagnosis for the female patient who presents with an abdominal mass and pain and has a previous surgical history.
Assuntos
Parede Abdominal , Endometriose/cirurgia , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Adulto , Colecistectomia Laparoscópica , Diagnóstico Diferencial , Endometriose/patologia , Feminino , Cálculos Biliares/epidemiologia , Cálculos Biliares/cirurgia , Hérnia Ventral/diagnóstico , Humanos , Achados Incidentais , Leiomioma/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias Uterinas/cirurgiaRESUMO
BACKGROUND AND OBJECTIVES: The first laparoscopic appendectomy was performed over 25 years ago, and yet controversy still exists over the open method vs. the laparoscopic approach, and whether an incidental appendectomy is warranted. This study aimed to evaluate our experience in performing a laparoscopic incidental appendectomy and to address these issues. METHODS: A total of 772 laparoscopic appendectomies were performed and analyzed and statistically evaluated. RESULTS: Mean age of the patients was 30.8+/-7.0 years. Mean operating time for an incidental appendectomy was 12.3+/-4.5 minutes. Most common pathology result was adhesions, and the rarest was endometriosis. Of patients with confirmed appendicitis, 75.8% did not have an initial preoperative diagnosis of appendicitis. When warranted, 103 (13.3%) patients underwent a second-look laparoscopy: 75.5% had no adhesions, 23.5% had mild adhesions, 2% had moderate adhesions. Backward elimination logistic regression revealed that endometriosis (P=0.016), endometrioma (P=0.039), pelvic or abdominal adhesions (P=0.015) were associated with a reduced likelihood of encountering appendicitis on pathology examination. The complication rate was 0.13%. Anesthesia cost was lower for an incidental appendectomy compared with an urgent one. CONCLUSION: Laparoscopic incidental appendectomy is safe and quick to perform. Due to the complex nature of confirming the diagnosis of pelvic and abdominal pain, this study supports the routine performance of an incidental appendectomy in the female patient.
Assuntos
Apendicectomia/métodos , Endoscopia/métodos , Doenças dos Genitais Femininos/cirurgia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Achados Incidentais , Cirurgia de Second-Look , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
BACKGROUND: Situs inversus is an uncommon condition caused by a single autosomal recessive gene of incomplete penetration. A potential diagnostic dilemma can occur in the young female patient with a history of situs inversus who presents with pelvic pain. METHODS: A 32-year-old multiparous patient with a known history of situs inversus presented with complaints of pelvic pain. A medical history and full physical examination were indicative of possible endometriosis. RESULTS: The patient underwent an operative laparoscopy, which revealed stage II pelvic endometriosis based on the American Fertility Society Revised Classification for Endometriosis (R-AFS), with appendicular and periappendicular adhesions involving the cecum. Ablation of endometriosis and an appendectomy were performed. CONCLUSION: The authors believe the laparoscopic approach to an appendectomy is ideal in a patient with situs inversus and should be performed at the time of laparoscopy performed for another reason.