Faculty Bibliography

PURPOSE: We report the clinical characteristics and the principles of laparoscopic management of ureteral endometriosis at our institution. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients with ureteral endometriosis. RESULTS: Preoperatively 97% of patients complained of pain but only a third had urinary symptoms. The left ureter was affected in 64% of cases and disease was bilateral in 10%. Four patients had hydroureter and 2 had hydronephrosis. CONCLUSIONS: To our knowledge this report represents the largest series of laparoscopically treated, pathologically confirmed ureteral endometriotic cases to date. It confirms that laparoscopic diagnosis and management of ureteral endometriosis are safe and efficient. All patients who undergo laparoscopy for endometriosis should be evaluated for possible ureteral involvement regardless of the presence or absence of urinary symptoms, or prior radiological evaluation since undiagnosed ureteral disease may result in loss of renal function

STUDY OBJECTIVE: We aim to describe the clinical characteristics and the principles of combined laparoscopic and thoracoscopic management of women with diaphragmatic endometriosis at our institution. DESIGN: Case series (Canadian Task Force Classification II2). SETTING: Tertiary care referral center. PATIENTS: Four women with diaphragmatic endometriosis. INTERVENTIONS: Laparoscopy and thoracoscopy. MEASUREMENTS: We retrospectively reviewed the charts of 4 consecutive women with diaphragmatic endometriosis who underwent laparoscopy and thoracoscopy from June 2008 through September 2008. MAIN RESULTS: Four patients underwent a combination of laparoscopy for treatment of abdominopelvic endometriosis and thoracoscopy for treatment of diaphragmatic endometriosis. All patients had a history of chest pain. Three had a history of pelvic pain. Two had a history of catamenial hemothorax or pneumothorax. Two had been previously diagnosed with endometriosis, and three had a history of hormonal pharmacotherapy. All underwent laparoscopy and thoracoscopy without complications. All had uneventful recoveries. At nine-month follow-up, all patients were free of chest pain, and one patient had recurring pelvic pain. CONCLUSIONS: To the best of our knowledge, this constitutes the only reported series of patients with endometriosis who underwent a procedure systematically combining both laparoscopy and thoracoscopy for treatment of abdominopelvic and thoracic disease. It confirms that combined laparoscopic and thoracoscopic diagnosis and management of diaphragmatic endometriosis is reasonable. The inferior aspect of the diaphragm should be evaluated in all patients undergoing laparoscopy for endometriosis. Concomitant thoracoscopy should be considered for all patients with history of catamenial hemopneumothorax, cyclic chest or shoulder pain, or cyclic dyspnea. The aim of treatment should be to remove endometriotic lesions, to provide symptomatic relief, and to avoid recurrence. The use of these minimally invasive techniques may reduce the need for laparotomy or thoracotomy in affected patients

OBJECTIVES: We previously reported a 10% rate of catheter complications, including inflow obstruction and infection, using a fenestrated catheter to administer intraperitoneal (i.p.) chemotherapy for ovarian cancer. Because of recent reports of higher rates of catheter complications, we performed this study to update our experience with the fenestrated catheter. METHODS: We reviewed the medical records of all patients who had a fenestrated catheter placed at our institution from 5/97-5/06. Data were collected regarding patient demographics, surgical procedure, timing of catheter insertion, and reasons for discontinuing i.p. chemotherapy. RESULTS: We identified 342 patients who had fenestrated catheters placed and for whom follow-up data were available. Nine patients (3%) required discontinuation of chemotherapy due to catheter complications. Three patients experienced catheter infection, 5 patients had inflow obstruction, and 1 patient's port could not be accessed. Seventy-one patients (21%) discontinued i.p. chemotherapy for reasons unrelated to the catheter. The percentage of patients who completed the intended chemotherapy regimen was similar for patients who underwent a bowel resection (22/30 [73%]) compared to those who had not (226/312 [72%]) (P=1.0). CONCLUSIONS: The fenestrated catheter for i.p. chemotherapy continues to be associated with a low risk of catheter-related complications. The low rate of complications, even in the setting of bowel resection and increase in utilization during upfront chemotherapy, suggest that the fenestrated catheter is still a feasible method for the administration of i.p. chemotherapy

BACKGROUND: This case describes a birth-training device used by a pregnant woman to stretch the perineum. CASE: A primigravida suffered near cardiovascular collapse and subsequent acute respiratory distress syndrome after using the device at home. Her symptoms and clinical course of disease revealed a high likelihood of venous air embolism. CONCLUSION: The patient likely suffered a venous air embolism in association with the use of the birth-training device. The complications suffered by this patient should give caution about use of such devices