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Biomedical subjects

C Nezhat

Publications and source records attributed to C Nezhat.

At least 109 records · Page 6Linked to original sources
PubMed1986

Surgical treatment of endometriosis via laser laparoscopy.

The carbon dioxide laser has been used laparoscopically for the removal of endometriotic implants, excision of endometrioma capsules, and lysis of adnexal adhesions in 102 patients. These patients were followed for a period ranging from 12 to 18 months, during which time there were 62 pregnancies, including 9 spontaneous abortions and 1 elective termination. The rates of conception after surgery were as follows: 75% for patients with mild endometriosis, 62% for patients with moderate endometriosis, 42.1% for patients with severe endometriosis, and 50% for patients with extensive endometriosis. Of 102 patients presenting with infertility attributed to endometriosis, 60.7% conceived within 24 months after laser laparoscopy. In this patient group, no immediate or subsequent laparotomy was required before conception was achieved, nor was hormonal therapy enacted during the study period after surgery.

Adult↗
PubMed1982

The role of estrogens in mastopathy and mammary cancer in perimenopausal women.

Fibrocystic disease of the breast (FCD) is an exaggeration of the normal physiologic response to cyclic estrogen and progesterone stimulation. The disorder can persist, with much less severity, in the menopausal woman. Whether FCD predisposes to mammary cancer remains moot. A new steroidal agent, danazol, can eliminate nodosities in the majority of women with FCD. Thermography may identify women who are at greater risk because of increased heat production. Mammography should be employed in women with persistently abnormal thermograms, even though no suggestive breast masses are palpable. Needle biopsy or surgical biopsy should be undertaken whenever a firm indurated mass is palpated, regardless of negative findings with a thermogram or mammogram. In a series of 1548 women treated for 10,715 women-years, the incidence of breast cancer after prolonged estrogen therapy was not increased. Although estrogens and prolactin have been incriminated in the etiology of mammary cancer, no hard facts exist to confirm such allegations.

Adolescent↗
PubMed1980

Estradiol implants for conception control.

Oral contraceptives are associated with serious untoward effects and have been proscribed for woman over 35 years of age. It was thought that the use of a natural estrogen (pellets of 25 mg of 17 beta-estradiol) implanted in descending doses (four, three, two, one) at 6-month intervals might cause less disturbance in metabolic parameters and side effects. Our experience with this regimen encompasses 18,480 cycles of 1,540 women years. The corrected Pearl index was 0.273, which compares favorably with other modes of conception control. Pellet implants proved to be quite acceptable to those who could not tolerate oral contraceptives.

Adult↗
PubMed1980

Danazol for benign breast disease.

Three groups of women with benign breast disease were treated with danazol for 3 to 6 months. Doses of 100 mg per day were given to 40 patients, 200 mg to 55, and 400 mg to 35. The age range of the patients was 20 to 48 years. The patients were rechecked at 6-month intervals over a period of 48 months. Most of them were seen four or more times after completion of therapy. Elimination of nodularity occurred in about two thirds; three experienced no improvement, and partial resolution was obtained in the remainder. Untoward effects were minimal or trivial. Danazol proved to be an excellent hormonal agent in the management of fibrocystic disease of the breast.

Adult↗
PubMed1980

The treatment of benign breast disease with danazol.

Benign breast disease, aside from fibroadenomas and intraductal papillomas, frequently responds favorably to hormonal therapy. Although the use of estrogen, androgens, and progestogens often proves useful, danazol, in our hands, was found more consistently effective. Danazol, an impeded androgen derived from a progestogen, 17 alpha-ethinyltestosterone, was employed in doses of 100 to 400 mg/day for 3 to 6 months in the treatment of fibrocystic disease. This agent proved efficacious in eliminating nodularity in the majority of cases, with partial resolution in most of the others. Many women to whom surgery had been previously suggested were spared surgical interference because of a satisfactory response to danazol therapy.

Adult↗
PubMed1979

Update on the male and female climateric.

The gonadal steroids--estrogens and androgens--appear to have a mood-elevating, psychotonic effect. The improved sense of well-being and increased vigor probably is engendered by restoration of somatic efficiency and psychic equilibrium. 1. The male climacteric, as observed in a limited number of men, is associated with a low level of serum testosterone. The levels of follicle-stimulating hormone and luteinizing hormone are not elevated because estrogen concentration continues unaltered well into old age. Androgen replacement therapy often lessens fatigue, depression and headaches, and headaches, and improves libidinous drives. 2. In the aging female, many climatric symptoms other than those due to vasomotor instability were heretofore considered merely coincidental. Recent studies suggest that the metabolism of cerebral hormones is markedly influenced by endogenous and exogenous gonadal steroids. Thus, postmenopausal depression, headaches, and nervousness may be hormone-dependent symptoms. 3. The incidence of endometrial cancer is no greater and is probably less in estrogen-treated women than in women not treated with estrogen, if regular cyclic courses of an oral progestogen are added to the regimen.

Adult↗
PubMedDate not supplied

The role of laparoscopy in the management of gynecologic malignancy.

With the advent of minimally invasive laparoscopic techniques, most gynecologic procedures for benign conditions can be performed in an outpatient setting. However, the role of such techniques in gynecologic oncology is not well defined. By reviewing the literature and presenting some new data, we attempt to elucidate the applications of operative videolaparoscopy in gynecologic oncology. Advanced laparoscopic techniques are utilized for the management of cervical cancer as well as the staging and treatment of endometrial and ovarian cancers. Such techniques are used in performing radical hysterectomy for early stage cervical cancer, pelvic and paraaortic lymphadenectomy, and second look laparoscopy following chemotherapy for ovarian cancer. Even though preliminary data are encouraging, large prospective controlled studies with long-term follow-up are necessary to better define the role and limitations of laparoscopy in the treatment of gynecologic malignancies.

Female↗
PubMedDate not supplied

Laparoscopic repair of small bowel and colon. A report of 26 cases.

This is a retrospective review of laparoscopic repair for enterotomies created during therapeutic or diagnostic laparoscopy in 26 women. All patients had mechanical and antibiotic bowel preparation preoperatively. The indication for operative laparoscopy was endometriosis (18), severe abdominal adhesive disease (7), and adhesions with Crohn's disease (1). Enterotomies were secondary either to CO2 laser vaporization or excision of endometriosis and/or lysis of adhesions (23) and trocar insertion (3). The injuries included small-bowel enterotomies (9), colotomies (4), and rectotomies (13). No clinical complications related to enterotomy repair were noted. Twenty-three patients were discharged 1 day after surgery; one was discharged on postoperative day 2; and two were discharged on postoperative day 3. We concluded that small- and large-bowel enterotomies can be repaired safely via the laparoscope with minimum morbidity in patients with prepared bowel.

Adult↗
PubMedDate not supplied

The role of laparoscopic-assisted myomectomy (LAM).

Laparoscopic myomectomy has recently gained wide acceptance. However, this procedure remains technically highly demanding and concerns have been raised regarding the prolonged time of anesthesia, increased blood loss, and possibly a higher risk of postoperative adhesion formation. Laparoscopic-assisted myomectomy (LAM) is advocated as a technique that may lessen these concerns regarding laparoscopic myomectomy while retaining the benefits of laparoscopic surgery, namely, short hospital stay, lower costs, and rapid recovery. By decreasing the technical demands, and thereby the operative time, LAM may be more widely offered to patients. In carefully selected cases, LAM is a safe and efficient alternative to both laparoscopic myomectomy and myomectomy by laparotomy. These cases include patients with numerous large or deep intramural myomas. LAM allows easier repair of the uterus and rapid morcellation of the myomas. In women who desire a future pregnancy, LAM may be a better approach because it allows meticulous suturing of the uterine defect in layers and thereby eliminates excessive electrocoagulation.

Female↗
PubMedDate not supplied

Laparoscopic repair of a uteroperitoneal fistula.

Repairs of pelvic fistulas using abdominal, vaginal, and laparoscopic approaches have been described. In the present case report, we describe our experience with the laparoscopic repair of a uteroperitoneal fistula.

Adult↗
PubMedDate not supplied

Laparoscopic myomectomy.

Laparoscopic myomectomy was performed on 154 women, with minimal perioperative complications resulting. Small and single leiomyomata were managed more easily than multiple and larger tumors. Although suturing the excisional sites improved healing, it increased the incidence of adhesion formation. We conclude that laparoscopic myomectomy can be a safe and cost-effective alternative to laparotomy when performed by a skilled operative laparoscopist, but only in selected cases.

Adult↗
PubMedDate not supplied

Nonvisualized endometriosis at laparoscopy.

Apparently conflicting results have been reported regarding the incidence, and even the existence, of endometriosis in visually normal peritoneum. The present study was undertaken in view of the fact that the presence and incidence of nonvisualized deep and/or microscopic endometriosis may be of importance in patient management. One patient in this study demonstrated a 1-mm lesion of endometriosis beneath visually normal peritoneum. Two additional patients had cellular surface zones of possible endometrial stroma without a contiguous epithelial component. The results support the existence of unrecognized subperitoneal and microscopic surface endometriosis.

Adult↗
PubMedDate not supplied

Endocrine studies in postmenopausal women during oral replacement therapy with unconjugated oestrogens.

Two groups of postmenopausal women were seen at monthly intervals during a three-month trial of continuous therapy with oral unconjugated oestrogens. Ten women in the first group were administered daily Hormonin No. 1 containing oestriol (E3) 0.135 mg, oestradiol (E2) 0.3 mg and oestrone (E1) 0.7 mg. Eight women in the second group received Hormonin No. 2 containing E3 0.27 mg, E2 0.6 mg and E1 1.4 mg. E1, E2, E3 and dehydroepiandrosterone (DHA) as well as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were measured by radioimmunoassay. Maturation index of vaginal smears and clinical effects were also evaluated. Oral replacement therapy with these unconjugated oestrogens produced a significant elevation of E1 (p less than 0.05) and E2 (p less than 0.05) to values corresponding well with the premenopausal range measured in our laboratory. Postmenopausal levels of FSH and LH showed only a moderate but significant decrease (p less than 0.05). There was consistent relief of vasomotor symptoms. One case of endometrial focal adenomatous hyperplasia uncovered during the period of treatment was transformed to functional secretory endometrium after an appropriate course with progestogens. Oral administration of unconjugated oestrogens and periodic withdrawal bleeding induced with a progestational agent seems to be an effective method of replacement therapy in postmenopausal women.

Administration, Oral↗
PubMedDate not supplied

Laparoscopically assisted myomectomy: a report of a new technique in 57 cases.

OBJECTIVE: This study was undertaken to assess the efficacy of a combined operative laparoscopy and minilaparotomy technique to remove single and multiple large leiomyomas. PROCEDURE: Laparoscopy was used to treat associated pelvic pathology, to identify the leiomyoma(s) and bring it to a minilaparotomy incision and to remove by irrigation blood clots and debris at the end of the procedure. Through this incision, the leiomyoma(s) is grasped, shelled, morcellated, and the uterine defect is repaired in layers. RESULTS: We retrospectively evaluated the records of 57 women who underwent this procedure. The uteri ranged from 8 to 26 weeks' gestational size. The weight of the leiomyomas ranged from 28 g to 998 g (mean, 247 g); operative time ranged from 40 to 285 minutes (mean 127 minutes) and blood loss from 50 mL to 1,600 mL (mean, 267 mL). All procedures were completed without full laparotomy. Complications included one case of Klebsiella pneumonia requiring several days of antibiotics, and an incisional hernia at the minilaparotomy site. Forty-one patients were discharged on or before the first postoperative day, 12 on day 2, and four after 72 hours. Most women resumed normal activity within 3 weeks. CONCLUSION: We found laparoscopically assisted myomectomy to be a safe alternative to myomectomy by laparotomy. It is technically less difficult than laparoscopic myomectomy, allows better closure of the uterine defect, and may require less time to perform.

Adult↗