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Biomedical subjects

C Nezhat

Publications and source records attributed to C Nezhat.

At least 19 recordsLinked to original sources
PubMed2001

Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-3 mRNA expression in ectopic and eutopic endometrium in women with endometriosis: a rationale for endometriotic invasiveness.

OBJECTIVE: To investigate mRNA expression of metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-3 (TIMP-3) in ectopic endometriosis tissue and uterine endometrium from women with and without endometriosis throughout the menstrual cycle. DESIGN: Molecular studies in human tissue. SETTING: Department of Gynecology and Obstetrics, Reproductive Immunology Laboratory, Stanford University Medical Center. PATIENT(S): Fifty-three premenopausal woman (23 women with endometriosis and 30 women without endometriosis undergoing laparoscopic surgery). Endometrium and ectopic endometriosis tissue were obtained at the time of surgery. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): mRNA expression from eutopic and ectopic endometrium was analyzed by quantitative, competitive PCR. RESULT(S): Both uterine endometrium and ectopic endometriotic tissue from women with endometriosis expressed significantly (P<.05) lower levels of TIMP-3 than endometrium from normal women. Also, ectopic endometrium expressed higher levels of MMP-9 and a higher ratio of MMP-9/TIMP-3 than eutopic endometrium from normal and endometriosis patients. CONCLUSION(S): These results suggest that ectopic and eutopic endometrium from endometriosis patients may be more invasive and prone to peritoneal implantation because of greater MMP and less TIMP-3 mRNA expression than endometrium from women without endometriosis. Thus, increased proteolytic activity may be one of the reasons for the invasive properties of the endometrium, resulting in the development of endometriosis.

Actins↗
PubMed2001

Hemorrhage in obstetrics and gynecology.

Hemorrhage has always been a significant potential complication in the field of obstetrics and gynecology. Throughout the years, a variety of medical and surgical modalities aimed at controlling uterine hemorrhage have been developed. Most recently, these have focused on attempting to decrease the morbidity associated with obstetric and gynecologic hemorrhage. Specifically, the aim of recent developments has been to reduce the need for laparotomy and increase the likelihood of uterine preservation (and thus the preservation of fertility). The present review addresses the use of such interventions in a sequential manner for attaining hemostasis.

Embolization, Therapeutic↗
PubMed1999

Normal variations of abdominal and pelvic anatomy evaluated at laparoscopy.

OBJECTIVE: To describe certain anatomic relationships in the pelvis and abdominal wall at laparoscopy and the effect of body mass index (BMI) on those parameters. METHODS: In 103 patients we determined the following: distances from the midline to each medial umbilical ligament and the respective inferior epigastric vessels; distances between each ureter and the ipsilateral uterosacral and the infundibulopelvic ligament; relative visibility of the ureters, umbilical and uterosacral ligaments, and the sacral promontory; and the presence and location of congenital bowel attachments to the pelvic walls. RESULTS: The right ureter ran significantly closer to the infundibulopelvic and uterosacral ligaments than the left ureter. The right inferior epigastric vessels and umbilical ligament coursed more laterally than did those on the left. Both sets of inferior epigastric vessels, and the left umbilical ligament and ureter were significantly more difficult to identify in overweight women. In 69% of the subjects, the uterosacral ligaments were found to be thick or moderately thick. In two thirds, the sacral promontory was more than 75% visualized. Congenital bowel attachments were observed in 74.8% of subjects on the left pelvic sidewall, and 48.5% on the right. CONCLUSION: Left and right pelvic anatomy are not necessarily mirror images laparoscopically. The course of the inferior epigastric vessels can be more difficult to identify in overweight patients. Despite marked obesity or congenital bowel attachments to the pelvic side walls, both ureters can usually be identified. The proximity of the ureter to the uterosacral and infundibulopelvic ligaments reaffirms the need to identify them before dissection.

Abdominal Muscles↗
PubMed1999

A randomized, prospective study of endometrial resection to prevent recurrent endometrial polyps in women with breast cancer receiving tamoxifen.

STUDY OBJECTIVE: To assess the role of endometrial resection in preventing recurrence of tamoxifen-associated endometrial polyps in women with breast cancer. DESIGN: Randomized, prospective study (Canadian Task Force classification I). SETTING: Tertiary university-affiliated medical center. PATIENTS: Twenty consecutive women (age range 43-61 yrs). INTERVENTIONS: Hysteroscopic removal of tamoxifen-associated endometrial polyps with or without simultaneous resection of the endometrium. MEASUREMENTS AND MAIN RESULTS: Patients were randomized to undergo (10 women) or not undergo (10) concomitant endometrial resection. They were followed for at least 18 months (range 18-24 mo), including transvaginal ultrasonography every 6 months and hysteroscopy when endometrial irregularity was noted. The main outcome variable was recurrence of endometrial polyps; occurrence of uterine bleeding was also noted. In women who underwent endometrial resection, only one had a 1 x 1-cm endometrial polyp diagnosed and removed during follow-up. Seven women remained amenorrheic, and three experienced spotting for a few days every month. In the control group, six women had recurrent endometrial polyps requiring hysteroscopic removal (two-tail Fisher's exact test p <0.06). CONCLUSION: Recurrence of endometrial polyps, one of the most common problems in patients with breast cancer receiving long-term treatment with tamoxifen, may be reduced by performing endometrial resection at the time of hysteroscopic removal of polyps. The possible risk of occult endometrial cancer is yet to be determined. (J Am Assoc Gynecol Laparosc 6(3):285-288, 1999)

Adult↗
PubMed1998

A randomized prospective study of the use of endometrial ablation for prevention of recurrent endometrial polyps in breast cancer patients receiving tamoxifen.

Objective: To assess the roles of endometrial ablation in prevention of recurrence of tamoxifen-associated endometrial polyps in breast cancer patients.Design: A randomized prospective study of tamoxifen-treated patients who underwent hysteroscopic removal of endometrial polyps with or without simultaneous resection of the endometrium.Materials and Methods: Twenty consecutive women (aged 43-61 years) undergoing hysteroscopic removal of tamoxifen-associated endometrial polyps were randomized via a computer-generated random table to undergo or not to undergo concomitant endometrial ablation. All patients had undergone endometrial sampling prior to the procedure. The patients were followed for at least 18 months (range 18-24 months). The follow-up included transvaginal ultrasonography every 6 months and hysteroscopy when endometrial irregularity was noted. The main outcome variable was recurrence of endometrial polyps while the occurrence of uterine bleeding was noted.Results: In the 10 study group women, who underwent endometrial ablation, only 1 patient had a 1 x 1 cm endometrial polyp diagnosed and removed during the follow-up period. Seven of the study women remained amenorrheic, and 3 experienced spotting a few days every month. In the control group, a recurrent endometrial polyp, necessitating hysteroscopic removal, was diagnosed postoperatively in 6 women (two-tailed Fisher's Exact test; P <.06).Conclusion: Recurrence of endometrial polyps, one of the most common problems in breast cancer patients receiving long-term treatment with tamoxifen, can be significantly reduced by performing endometrial ablation at the time of hysteroscopic removal of the polyp. The possible risk of occult endometrial cancer is yet to be determined.

Journal Article↗
PubMed1998

Are the long-term adverse effects of laparoscopic presacral neurectomy for the management of central pain associated with endometriosis acceptable?

Objective: To assess the long-term genitourinary and gastrointestinal complaints following presacral neurectomy.Design: A prospective postoperative follow-up of patients who underwent laparoscopic presacral neurectomy and treatment of endometriosis.Materials and Methods: The mean follow-up of the 67 women (mean age 27.5 years, range 16-58 years) was an average of 36.8 months with a range of 6-69 years. Main outcome variables include diarrhea, constipation, bladder and urinary complaints, vaginal dryness, dyspareunia, and orgasm. The degree of pain and dysmenorrhea after surgery was also elevated.Results: Diarrhea was reported to have improved after surgery in 39.1% of the patients and none reported any worsening. Constipation improved in 28.6% and worsened in 12.5%. Only one patient suffered from debilitating constipation. Bladder and urinary problems were improved on 25.0% and worsened in 19.2%. A similar proportion of women (19.6%) reported improvement and worsening vaginal dryness. Pain during intercourse improved in 58.9% and worsened in 8.9%. The ability to achieve orgasm improved in 21.6% and worsened in 2.7%. Postoperatively, pain was improved by 80-100% in 46.6% of the women, by 50-80% in 36.5%, by less than 50% in 6.4%, and did not improve in 9.5%. Dysmenorrhea was improved by 80-100% in 35.2% of the women, by 50-80% in 38.8%, by less than 50% in 14.9%, and did not improve in 11.1%. Twelve of 16 patients trying to become pregnant were successful following surgery, two with the aid of in vitro fertilization.Conclusion: After laparoscopic presacral neurectomy, constipation and bladder and urinary problems were reported to have worsened in only a minority of patients. However, diarrhea and dyspareunia improved in a large proportion of patients. Since pelvic pain was relieved by more than 50% in 83.1%, the procedure seems to be associated with an acceptable rate of long-term side effects.

Journal Article↗
PubMed1998

Laparoscopic ureteroureterostomy: a prospective follow-up of 9 patients.

Objective: To report the technique and long-term outcome of laparoscopic ureteroureterostomy of injured ureter.Design: A prospective follow-up study.Materials and Methods: Follow-up of nine patients, aged 30-43 years, who acquired intentional ureteral injury during operative laparoscopy for treatment of endometriosis. They were treated between September 1991 and September 1997 by ureteral transection or resection with primary laparoscopic repair by ureteroureterostomy (8 procedures) and ureteroneocystostomy (2 procedures).Results: All operations were successfully completed by operative laparoscopy without need to convert to laparotomy. Estimated blood loss related to the ureteral portion of the procedure was less than 100 mL. Duration of follow-up was between 2 months and 6 years. Follow-up intravenous pyelogram revealed complete healing in seven patients. One patient had mild ureteral stricture, which resolved with transvesical ureteral dilatation, and she is doing well 4 years postoperatively. Another patient with severe endometriosis had recurrent ureteral stricture due to fibrosis distal to the anastomosis site. She underwent laparoscopic ureteroneocystostomy psoas hitch and is doing well 3 months postoperatively.Conclusions: This is the first series of laparoscopic ureter reanastomosis reported to date. The outcome was excellent with low postoperative morbidity typically associated with laparoscopy.

Journal Article↗
PubMed1998

Laparoscopic surgical management of diaphragmatic endometriosis.

OBJECTIVE: To review the clinical presentations of and management options for diaphragmatic endometriosis. DESIGN: Retrospective review. SETTING: Referral center. PATIENT(S): Twenty-four women with endometriosis of the diaphragm. INTERVENTION(S): Surgical management. MAIN OUTCOME MEASURE(S): Diagnostic accuracy and therapeutic feasibility of operative laparoscopy. RESULT(S): Operative findings in 17 patients included 2-5 spots of endometriosis on the diaphragm measuring <1 cm. Seven women had numerous lesions scattered across the diaphragm. Lesions were bilateral in 8 patients, limited to the right hemidiaphragm in 14 patients, and limited to the left hemidiaphragm in 2 patients. In 7 patients, six endometriosis lesions were directly in the line of the left ventricle and three lesions were adjacent to the phrenic nerve. Endometriosis was infiltrating into the muscular layer of the diaphragm in 7 patients. The symptoms in all 7 symptomatic patients decreased significantly after treatment, with a minimum follow-up period of 12 months. No postoperative complications occurred. CONCLUSION(S): The abdominal diaphragm can be involved with endometriosis and can be diagnosed and treated effectively with the use of videolaparoscopy.

Adolescent↗
PubMed1998

Immunoreactive gonadotropin-releasing hormone expression in cycling human endometrium of fertile patients.

OBJECTIVE: To investigate the protein expression of GnRH in the endometrium of fertile patients throughout the menstrual cycle. DESIGN: Prospective longitudinal study. SETTING: Department of Gynecology and Obstetrics, Reproductive Immunology Laboratory, Stanford University Medical Center. PATIENT(S): Twenty-two fertile premenopausal women submitted to laparoscopic surgery for benign gynecologic indications. None of the 22 women had endometriosis or pelvic inflammatory disease. INTERVENTION(S): An endometrial biopsy specimen using the Novak curette was obtained at the time of surgery. MAIN OUTCOME MEASURE(S): Protein expression and localization from unfractioned endometrial tissue was analyzed by immunohistochemistry. RESULT(S): Gonadotropin-releasing hormone is expressed at the protein level in both the endometrial stroma and epithelium throughout the entire menstrual cycle of fertile women. Immunostaining in the human epithelium reached maximal levels in the midluteal phase and was elevated in the stroma throughout the entire luteal phase. CONCLUSION(S): Our results demonstrate the presence of GnRH in the human endometrium at the protein level throughout the entire menstrual cycle of fertile women, with an increase in the luteal phase compared with the preovulatory endometrium.

Adolescent↗
PubMed1998

Laparoscopic appraisal of the anatomic relationship of the umbilicus to the aortic bifurcation.

STUDY OBJECTIVE: To determine the cephalocaudal relationship among the umbilicus, aortic bifurcation, and iliac vessels by direct measurement during laparoscopy. DESIGN: Prospective, consecutive study (Canadian Task Force classification II-1). SETTING: Tertiary referral center. PATIENTS: Ninety-seven women undergoing operative laparoscopy. INTERVENTIONS: The distance from the aortic bifurcation relative to the umbilicus was measured in both the supine and Trendelenburg positions with a marked suction-irrigator probe. Patients were stratified into three groups based on body mass index (kg/m2). The anatomic location of the common iliac vessels and course of the left common iliac vein were identified in 68 women. MEASUREMENTS AND MAIN RESULTS: The position of the aortic bifurcation ranged from 5 cm cephalad to 3 cm caudal to the umbilicus in the supine position, and from 3 cm cephalad to 3 cm caudal in the Trendelenburg position. In the supine position, the aortic bifurcation was located caudal to the umbilicus in only 11% of patients compared with 33% in the Trendelenburg position. This difference was statistically significant for the total study population (p <0.0001) and for the nonoverweight group (p <0.01). In both positions no significant correlation was found between the distance from the aortic bifurcation to the umbilicus and body mass index. Mean +/- SD distance of the aortic bifurcation from the umbilicus in the supine position was 0.1 +/- 1.2 cm for the nonoverweight group, 0.7 +/- 1.5 cm for the overweight group, and 1. 2 +/- 1.5 cm for the very overweight group. Respective values in Trendelenburg position were 1.0 +/- 1.1, -0.4 +/- 1.2, and -0.2 +/- 1.3 cm. The common iliac artery was caudal to the umbilicus in four women. The space between common iliac arteries was always at least partly occupied by the left common iliac vein, and was completely filled in 19 women (28%). CONCLUSIONS: The cephalocaudal relationship between the aortic bifurcation and umbilicus varies widely and is not related to body mass index in anesthetized patients. Regardless of body mass index, the aortic bifurcation is more likely to be located caudal to the umbilicus in the Trendelenburg compared with the supine position. Its presumed location can be misleading during Veress needle or primary cannula insertion, and a more reliable guide is necessary for this procedure to avoid major retroperitoneal vascular injury.

Adolescent↗
PubMed1998

Quantitative gonadotropin-releasing hormone gene expression and immunohistochemical localization in human endometrium throughout the menstrual cycle.

GnRH is one of the paracrine/autocrine regulators of hCG secretion produced by the human trophoblast during pregnancy. We hypothesized that GnRH may play a role in the embryonic/endometrial dialogue during early implantation. To examine this hypothesis, we assessed GnRH and GnRH-receptor mRNA and protein expression in human endometrium throughout the menstrual cycle of premenopausal fertile patients. Quantitation of the mRNA was performed by reverse transcription (RT)-competitive polymerase chain reaction (PCR) in the presence of a competitive cDNA fragment. RT-PCR revealed that unfractioned endometrium and isolated endometrial stromal and epithelial cells express GnRH and GnRH-receptor mRNA throughout all phases of the menstrual cycle. Quantitative PCR showed a dynamic pattern in the GnRH mRNA expression throughout the cycle, with a significant increase (p < 0.05) in the secretory phase as compared to the proliferative phase. Furthermore, quantitative competitive PCR of isolated glandular and stromal cells showed higher mRNA levels (p < 0.05) in the luteal phase in both compartments. GnRH immunostaining was localized in all major compartments, with the most intense staining during the luteal phase. On the basis of these data, we suggest that during reproductive life, endometrial GnRH may play a paracrine/autocrine role in the early stages of implantation by modulating embryonic trophoblastic secretion of hCG.

Adolescent↗
PubMed1997

Incisional hernias after operative laparoscopy.

The objective of this study was to determine the possible risk factors of incisional hernias after operative laparoscopy. A retrospective case review was performed in a single referral obstetrics/gynecology clinic and center for special pelvic surgery considering the last 5300 surgeries. Of the approximately 5300 patients who underwent laparoscopy from January 1988 through June 1996, 10 women were evaluated for incisional hernias. A total of 11 hernias occurred, which is an incidence of approximately 0.2%. Omentum herniated in seven cases and bowel herniated in four cases. In one case, the sigmoid epiploica irreducibly herniated through the peritoneum and not the fascia. The hernia occurred through a 5-mm trocar incision site in five cases. The median duration of the laparoscopic surgeries was 192 minutes (range, 25-375 minutes). Six women required laparoscopic surgery in order to retract the entrapped omentum or bowel. In one case, laparoscopically assisted bowel resection was necessary. The underlying fascia and peritoneum should be closed not only when using trocars of 10 mm and larger as previously suggested but also when extensive manipulation is performed through a 5-mm trocar port, causing extension of the incision.

Adult↗
PubMed1997

Major retroperitoneal vascular injury during laparoscopic surgery.

We sought to assess the outcome of large retroperitoneal vascular injury that occurred during operative laparoscopy but was not related to trocar or Veress needle injury. We conducted a retrospective review of cases operated and reviewed by our centres. Eight cases were identified. Four women were undergoing lymphadenectomy, where vascular injury is a recognized risk. Distorted anatomy was a compounding factor in three of the remaining four patients who were undergoing intraperitoneal procedures. The injuries involved the inferior vena cava (n = 2), the right external iliac artery (n = 2), the left external iliac artery (n = 1), the right external iliac vein (n = 1), the hypogastric artery (n = 1) and the inferior mesenteric artery (n = 1). Injuries were caused by unipolar electrode (n = 1), electrosurgical scissors (n = 3), sharp scissors (n = 2) and CO(2) laser (n = 2). The vessel injury was repaired at laparotomy in four women. The other four cases were managed laparoscopically. Transfusion attributable to the vascular injury occurred in two cases. The outcome in all cases was good, except for one in which the patient died. These cases demonstrate that all energy sources used without proper understanding and caution can cause significant vascular injury. The adequacy and safety of laparoscopic control of major vessel bleeding should be investigated further and consultation with a vascular surgeon should be considered in all cases.

Adult↗
PubMed1997

Laparoscopic management of a noncommunicating uterine horn in a patient with an acute abdomen.

A 13-year-old girl with a history of cloacal anomalies presented with acute abdominal pain. Abdominal ultrasound was not definitive, and vaginal probe ultrasound was precluded by the patient's stenotic vagina. Magnetic resonance imaging delineated a left hematometra and hematosalpinx as well as a more normal-appearing right hemiuterus. Operative laparoscopy was used to lyse the extensive pelvic adhesions in a patient with a history of an imperforate anus and to resect a left rudimentary uterine horn with outflow obstruction. A review of cases in the world literature reveals that operative laparoscopy can be used to treat these patients successfully.

Abdomen, Acute↗
PubMed1996

Delayed recognition of iliac artery injury during laparoscopic surgery.

Vascular injury is one of the major complications of laparoscopic surgery. Prompt diagnosis is crucial for proper management of this potentially life-threatening complication. Two cases of iliac artery puncture occurred during operative laparoscopy. The injuries were not diagnosed immediately, probably due to the initial accumulation of blood in the retroperitoneum. Significant damage to large blood vessels may not be readily apparent during laparoscopic surgery.

Adult↗