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Biomedical subjects

T Tulandi

Publications and source records attributed to T Tulandi.

At least 19 recordsLinked to original sources
PubMed2001

Effects of laparoscopic ovarian drilling on adrenal steroids in polycystic ovary syndrome patients with and without hyperinsulinemia.

OBJECTIVE: To evaluate adrenal steroid responses to ACTH stimulation and insulin responses to oral glucose tolerance test (OGTT) in clomiphene-citrate-resistant anovulatory women with polycystic ovary syndrome (PCOS) before and after laparoscopic ovarian drilling. DESIGN: Prospective study. SETTING: Healthy participants in a university teaching hospital. PATIENT(S): Twenty clomiphene-citrate-resistant anovulatory women with PCOS. INTERVENTION(S): Laparoscopic ovarian drilling. MAIN OUTCOME MEASURE(S): Adrenal steroid responses to ACTH stimulation and insulin responses to OGTT before and after ovarian drilling. RESULT(S): Fourteen of 20 women completed the study. There was a correlation between body mass index and basal insulin levels before ovarian drilling. This correlation was lost after surgery. Area-under-the-curve glucose and insulin values before surgery in women with hyperinsulinemia (1,033.3 +/- 112.7 mmol/L and 141,919 +/- 26,177 pmol/L, respectively) were significantly higher than in those with normoinsulinemia (777.1 +/- 77.2 mmol/L and 69,867 +/- 19,390 pmol/L respectively, P<.05). There was a significant difference in insulin and glucose responses before and after ovarian drilling in women with hyperinsulinemia. No difference was found in women with normoinsulinemia. There was no significant difference in adrenal steroid responses to ACTH stimulation before and after ovarian drilling. CONCLUSION(S): PCOS women with hyperinsulinemia respond differently to laparoscopic ovarian drilling than do those with normoinsulinemia. Among women with hyperinsulinemia, surgery decreases glucose and insulin responses to OGTT. Regardless of the insulin level, laparoscopic ovarian drilling does not influence adrenal steroid dynamics.

Adrenocorticotropic Hormone↗
PubMed2001

Hysteroscopic appearance of the uterine cavity before and after microwave endometrial ablation.

STUDY OBJECTIVE: To evaluate the appearance of the uterine cavity before and after microwave endometrial ablation (MEA). DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: Sixty-two women with menorrhagia. INTERVENTION: Hysteroscopic examination the uterine cavity before and after MEA. MEASUREMENTS AND MAIN RESULTS: Ablation was complete in 55 patients (group A). Seven women had a small island of intact endometrium (group B); the uterine cavity was severely distorted in six of these patients due to submucous myomas in five and adenomyosis in one. Another patient in this group had an acutely retroverted uterus, a 15-mm intramural myoma, and a normal uterine cavity. Women in group B had deeper uterine cavity than those in group A (101.4 +/- 15.5 and 84.7. +/- 12.8 mm, respectively, p = 0.008). The duration of ablation was also longer in group B (329.1 +/- 158.4 sec) than in group A (206.1 +/- 67.4 sec, p = 0.01). CONCLUSION: Microwave endometrial ablation tends to be incomplete in women with a large and severely distorted uterine cavity. Whether, this results in a lower success rate remains to be seen. (J Am Assoc Gynecol Laparosc 8(1):83-86, 2001)

Adult↗
PubMed2001

Nerve fibers and histopathology of endometriosis-harboring peritoneum.

STUDY OBJECTIVE: To evaluate the presence of nerve fibers and histopathology of normal peritoneum and endometriosis-harboring peritoneum. DESIGN: Prospective, nonrandomized study (Canadian Task Force classification II-1). SETTING: University hospital. MATERIALS: Peritoneal specimen from 40 women with laparoscopic findings of endometriosis (24 confirmed histopathologically, group H, 16 diagnosed by laparoscopy, group L) and from 9 women with no endometriosis (controls). INTERVENTION: Histopathologic examination of peritoneal specimens with nerve fibers identified by immunocytochemistry staining with an antibody to neurofilament. MEASUREMENTS AND MAIN RESULTS: No differences in mean nerve score were seen among the three groups. Degrees of lymphocytic infiltration and mesothelial hyperplasia were higher in group H than in the other two groups (p <0.01 and <0.05, respectively). The degree of lymphocytic infiltration was significantly higher in group L than in the control group (p <0.05). There were no differences in all measurements between women in group H who experienced chronic pelvic pain and those who did not. CONCLUSION: The presence of nerve fibers in peritoneum is not related to endometriosis. Endometriosis-harboring peritoneum contains more lymphocytic infiltration than normal peritoneum. (J Am Assoc Gynecol Laparosc 8(1):95-98, 2001)

Adult↗
PubMed2001

Effects of leuprolide acetate on adhesion formation and wound healing in the rat model.

STUDY OBJECTIVE: To assess the effects of a hypoestrogenic state on adhesion formation and reformation and on wound healing in the rat model. DESIGN: Prospective, randomized study (Canadian Task Force classification I). SUBJECTS: Forty-eight female Sprague-Dawley rats. INTERVENTIONS: Rats were injected with gonadotropin-hormone releasing hormone (GnRH) agonist and control rats with normal saline. Two weeks later (day zero) laparotomy was performed to create adhesions and a full-thickness wound on the flank. On day 14 the adhesions were scored and liberated. The rats were sacrificed on day 28 and adhesion reformation was evaluated. The wound surface area was measured serially until complete closure. MEASUREMENTS AND MAIN RESULTS: Mean adhesion scores on day 14 after adhesion formation were not significantly different between GnRH agonist and control groups. Preadhesiolysis and postadhesiolysis scores were not significantly different. There was no significant difference in size of wounds between groups on days zero, 7, or 14. CONCLUSION: Administration of a GnRH agonist does not seem to influence postoperative adhesion formation or wound healing in the rat model. (J Am Assoc Gynecol Laparosc 8(1):124-128, 2001)

Animals↗
PubMed2001

Industry-sponsored research in minimally invasive surgery.

In many disciplines, including minimally invasive surgery, pharmaceutical and instrument companies are major sources of industry-sponsored research. There are two types of such research, industry-initiated and investigator-initiated. Distinction between them is sometimes blurred. In industry-sponsored research a conflict may occur between clinicians and sponsor. In all cases, a clinical trial should be done properly and ethically, and results, whether negative or positive, should be published. Disposition of intellectual property and authorship should be established before starting the trial.

Humans↗
PubMed2001

Retained fetal bones in the uterine cavity.

A 33-year-old woman was referred for infertility of 5 years' duration. Her history included pregnancy terminations at 6 weeks' gestation in 1992 and at 16 weeks' gestation in 1993. Both abortions were performed by curettage in West Africa. Her menses were every 28 days with normal flow. Due to a suggestion of a filling defect in the uterus on hysterosalpingography, hysteroscopic examination was performed. At hysteroscopy, several fragments of fetal bones were present in the uterus. These appeared as white structures, some with trabeculated pattern. They were removed until the entire uterine cavity was devoid of bony fragments. Histopathology examination confirmed the diagnosis. It is very likely that the findings were related to the woman's abortion in 1993. Similar to intrauterine contraceptive devices, fetal bones in the uterine cavity prevent conception.

Adult↗
PubMed2001

Effects of local bupivacaine instillation on pain after laparoscopy.

STUDY OBJECTIVE: To evaluate the effect of preincisional and intraperitoneal bupivacaine administration on immediate and late pain after operative laparoscopy. DESIGN: Randomized study (Canadian Task Force classification I). SETTING: University teaching hospital. PATIENTS: One hundred fifty women undergoing laparoscopy for various gynecologic indications. INTERVENTION: A dose of 0.5% bupivacaine 10 ml (50 mg) was injected into cannula sites before incisions and another 10 ml diluted with 100 ml saline into the peritoneal cavity at completion of the procedure. Equal amount of physiologic saline was used in controls. MEASUREMENTS AND MAIN RESULTS: Modified McGill pain intensity scores and amount of analgesic required in the recovery room and within 24 hours postoperatively were evaluated. Of 150 women, 142 completed the study (71 bupivacaine group, 71 controls). Groups did not differ significantly in body mass index, duration of surgery, return to consciousness, and analgesic requirement during 3-hour observation in the recovery room and 24 hours after discharge. Pain scores were highest 30 minutes after the procedure in both groups. At that time the pain score in the bupivacaine group was lower than that in the control group (1.8 +/- 0.2 vs 2.3 +/- 0.2, p <0.05). Beyond that time, the groups did not differ in pain scores and analgesic requirements. CONCLUSION: Postoperative pain is the highest within 30 minutes after laparoscopy. Local instillation of bupivacaine before incision and intraperitoneally was effective in reducing pain immediately after operative laparoscopy, but the effect was not seen beyond 30 minutes.

Anesthetics, Local↗
PubMed2001

A documented clomiphene-induced follicular development in pregnancy.

A case of clomiphene-induced follicular growth in pregnancy is presented in a 34-year-old woman with ectopic pregnancy treated at a university teaching hospital. Following administration of clomiphene citrate in pregnancy, follicular growth to 18 mm mean diameter was noted. It is concluded that clomiphene citrate can induce follicular growth and maturation in pregnancy, possibly by reversing pregnancy-induced pituitary suppression.

Adult↗
PubMed2001

Occupational exposure to solvents and male infertility.

OBJECTIVES: To determine whether, in a case-referent study of infertility patients, cases with low motile sperm count were more likely than referents to have had exposure to organic solvents. METHODS: Occupations of men attending fertility clinics in Canada were assigned codes reflecting probable exposure to organic solvents, at four grades of intensity, using a job exposure matrix previously developed. A case referent design was used, with cases being defined as men with <12x10(6)/ml motile sperm. Information from 656 men in manual work attending a single clinic in Montreal in 1972-91 was used for the main study. A separate analysis was conducted with information for 574 men in manual work attending 10 further clinics across Canada in 1984-7. RESULTS: In the Montreal series a significant association was found between intensity of exposure to solvents and clinical findings of <12x10(6)/ml motile sperm. Odds ratios (ORs), after allowing for confounding, were 2.07 (95% confidence interval (95% CI) 1.24 to 3.44) for moderate exposure to solvents and 3.83 (95% CI 1.37 to 10.65) for high exposure. In the second series of 568 men, the effect was confirmed at high exposure to solvents (OR 2.90, 95% CI 1.01 to 8.34) but not at moderate exposure (OR 1.01, 95% CI 0.53 to 1.92). CONCLUSIONS: Exposure to organic solvents is common both at work and in recreational pursuits. The results of this study suggest that efforts should be made to identify the compounds hazardous to male fertility, and if the risk is confirmed, to regulate their use.

Adult↗
PubMed2000

Effects of laparoscopic ovarian drilling on serum vascular endothelial growth factor and on insulin responses to the oral glucose tolerance test in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the serum vascular endothelial growth factor concentrations and insulin responses to the oral glucose tolerance test before and after laparoscopic ovarian drilling in women with PCOS. DESIGN: Prospective study. SETTING: University teaching center. PATIENT(S): Twenty-seven women with clomiphene citrate-resistant polycystic ovary syndrome. INTERVENTION(S): Laparoscopic ovarian drilling. MAIN OUTCOME MEASURE(S): VEGF levels and insulin responses to OGTT before and after ovarian drilling. RESULT(S): No difference was found in VEGF levels in women with PCOS before (6.0 +/- 1.2 ng/mL) and after ovarian drilling (5.5 +/- 1.2 ng/mL). VEGF levels before and after ovarian drilling in women who conceived were, respectively, 5.9 +/- 1.0 and 5.1 +/- 0.9 ng/mL and in those who did not conceive were 6.0 +/- 1.3 and 5.7 +/- 1.2 ng/mL. No correlation was found between baseline serum insulin and VEGF levels. VEGF concentrations in women with normal ovaries (4.5 +/- 1.7 ng/mL) were significantly lower than in women with PCOS. There was no difference in glucose and insulin responses to OGTT before and after ovarian drilling. CONCLUSION(S): VEGF levels in women with PCOS are higher than in normal women, and ovarian drilling does not affect these levels. The procedure does not change insulin responses to OGTT.

Analysis of Variance↗
PubMed2000

A randomized study of the effect of 10 minutes of bed rest after intrauterine insemination.

OBJECTIVE: To evaluate the effects of 10 minutes of bed rest after intrauterine insemination (IUI) on the pregnancy rate. DESIGN: Prospective randomized study. SETTING: University teaching hospital. PATIENT(S): One hundred sixteen couples with unexplained infertility. INTERVENTION(S): Patients were prospectively randomized either to immediate mobilization after IUI (group I) or to remain in a supine position for 10 minutes after the procedure (group II). MAIN OUTCOME MEASURE(S): Cumulative pregnancy rate. RESULT(S): Ninety-five couples were included in the analysis. Group I consisted of 40 couples (90 cycles), and group II consisted of 55 couples (120 cycles). The pregnancy rate per couple in group I (4 of 40 [10%]) was significantly lower than in group II (16 of 55 [29%]). The pregnancy rate per cycle in group I (4.4%) was also lower than in group II (13. 3%). With use of life-table analysis, the cumulative probability of pregnancy in group II was significantly higher than in group I. CONCLUSION(S): A 10-minute interval of bed rest after IUI has a positive effect on the pregnancy rate. We recommend that mandatory bed rest for 10 minutes after IUI should be adopted into a standard practice.

Adult↗
PubMed2000

Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal.

OBJECTIVE: To evaluate the reproductive outcome and adhesion formation after a standardized laparoscopic treatment of polycystic ovary syndrome (PCOS) in clomiphene-resistant infertile women. DESIGN: Retrospective study. SETTING: University teaching hospital. PATIENT(S): One hundred twelve clomiphene-resistant anovulatory women with PCOS. INTERVENTION(S): Laparoscopic ovarian drilling using an insulated needle cautery. MAIN OUTCOME MEASURE(S): Ovulatory rate, pregnancy rate, and adhesion formation. RESULT(S): After surgery, ovulation occurred spontaneously in 73.2% of patients. The cumulative probability of conception at 12, 18, and 24 months after surgery was 54%, 68%, and 72%, respectively. With use of Cox's proportional hazards model, the effects of age, body mass index, and duration of infertility were evaluated. These factors were not associated with the pregnancy rate. Of 15 women who underwent a second-look laparoscopy, 11 women were found to be free of adhesions. Four women had periadnexal adhesions that were filmy, minimal, and found on the ovarian surface only. CONCLUSION(S): Laparoscopic ovarian drilling is an effective alternative treatment in clomiphene-resistant anovulatory women with PCOS. The use of an insulated needle cautery is associated with a minimal amount of adhesion formation.

Adult↗
PubMed2000

Laparoscopic excision of a mesenteric cyst diagnosed preoperatively as an ovarian cyst.

Mesenteric cysts are uncommon benign, abdominal tumors usually managed by general surgeons. We encountered an unusual mesenteric cyst that was diagnosed preoperatively as an ovarian cyst. It was located in the pelvic cavity inside the mesoappendix. We excised the cyst and adjacent vermiform appendix by laparoscopy. Histopathologic examination revealed mucinous cystadenoma. To the best of our knowledge, this is the first reported case of a mesenteric cyst removed by a gynecologic laparoscopist.

Adult↗