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T Tulandi

Publications and source records attributed to T Tulandi.

At least 37 records · Page 2Linked to original sources
PubMed2000

Prospective randomized study of human chorionic gonadotrophin priming before immature oocyte retrieval from unstimulated women with polycystic ovarian syndrome.

The present study examined whether the rates of oocyte maturation, fertilization and development, as well as pregnancy rate could be improved by human chorionic gonadotrophin (HCG) priming 36 h before immature oocyte retrieval in patients with polycystic ovarian syndrome (PCOS). Immature oocyte retrieval was performed on day 10-14 of the cycles and patients were randomly allocated either to be primed with 10 000 IU of HCG before the retrieval, or not primed. Immature oocytes were cultured for 24-48 h in TC-199 medium with 20% (v/v) inactivated fetal bovine serum (FBS) supplemented with 75 mIU/ml follicle stimulating hormone (FSH) and luteinizing hormone (LH). Intracytoplasmic sperm injection (ICSI) was performed in all mature oocytes and the resulting embryos were transferred on day 2 or 3 after ICSI. A total of 17 patients underwent 24 completed treatment cycles. Thirteen cycles were primed with HCG and 11 other cycles were not primed. The mean number of oocytes retrieved was comparable in the two groups (7.8 +/- 3.9 versus 7.4 +/- 5.2). The percentage of oocytes achieving maturation at 48 h was significantly higher (P < 0.05) in the HCG-primed group (84.3%, 86/102) than in the non-HCG-primed group (69.1%, 56/81). Oocyte maturation was hastened in the HCG-primed group. Following 24 h of culture, 78.2 +/- 7.1% of oocytes were matured in the HCG-primed group compared with 4.9 +/- 2.5% of oocytes in the non-HCG-primed group (P < 0.001). There were no significant differences in the rates of oocyte fertilization and cleavage in these two groups. There were five clinical pregnancies (38.5%) in the HCG-primed group, and three pregnancies (27.3%) in the non-HCG-primed group.

Adult↗
PubMed2000

Evidence-based management of ectopic pregnancy.

In selected cases, medical treatment of ectopic pregnancy with methotrexate is as effective as laparoscopic surgery. However, medical treatment might have a more negative impact on the health-related quality of life than surgical treatment. This is partly because of the long resolution time after medical treatment. New evidence suggests that combining methotrexate and mifepristone can shorten this resolution time.

Fallopian Tube Diseases↗
PubMed1999

Adhesion-related small-bowel obstruction after gynecologic operations.

OBJECTIVE: Our purpose was to evaluate a possible relationship between adhesion-related small-bowel obstruction and gynecologic operations. STUDY DESIGN: The records of all female patients with the diagnosis of small-bowel obstruction from 1989 to 1996 were studied. The cause of bowel obstruction, the type and technique of previous operations, and whether the parietal peritoneum was closed at the completion of the procedure or was left open were evaluated. RESULTS: Among 262 women the most common cause of small-bowel obstruction was intra-abdominal adhesions (37.0%). Among 92 women with adhesion-related small-bowel obstruction, 35 women (38%) had undergone a previous abdominal hysterectomy. The incidence of small-bowel obstruction after an abdominal hysterectomy was 16.3 per 1000 hysterectomies. The incidence of small-bowel obstruction after cesarean delivery (5/10,000 cesarean deliveries) was significantly less than after other abdominal operations. Adhesions were found between the small bowel and the pelvis in 14 women (29.8%), and all were in women who had undergone a hysterectomy. In 33 others (70.2%) the adhesions were found between the previous abdominal incision and the intestine. The median interval between the initial operation and the small-bowel obstruction was 5.3 years. CONCLUSION: The most common cause of small-bowel obstruction is postsurgical adhesions. Adhesionrelated small-bowel obstruction is commonly found after an abdominal hysterectomy. Bowel obstruction can occur many years after the initial abdominal surgery.

Adnexal Diseases↗
PubMed1999

Production of steroids from human cumulus cells treated with different concentrations of gonadotropins during culture in vitro.

OBJECTIVE: To evaluate the output of E2 and progesterone produced by cumulus cells, derived from mature and immature oocytes, in culture medium. DESIGN: Prospective randomized study. SETTING: McGill Reproductive Center, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada. PATIENT(S): Twenty-one women, <38 years of age and with normal menstrual cycles, who were undergoing intracytoplasmic sperm injection for assisted reproduction. INTERVENTION(S): Culture medium with or without fetal bovine serum (FBS) supplemented with either a physiologic (75 mIU/mL) or a supraphysiologic (7,500 mIU/mL) concentration of gonadotropins. MAIN OUTCOME MEASURE(S): Comparison of steroid levels in culture medium. RESULT(S): Estradiol secretion was significantly increased in the culture medium with FBS supplemented with both concentrations of FSH alone compared with control. However, E2 secretion was inhibited by both concentrations of FSH with LH. The level of E2 was undetectable in the medium without FBS even after supplementation with both concentrations of FSH alone, hCG alone, and FSH with LH. Progesterone production was increased in the medium with FBS supplemented with FSH alone, hCG alone, and FSH with LH compared with control. There was no difference in progesterone levels in the culture medium without FBS supplemented with both concentrations of FSH alone and hCG alone compared with control. However, progesterone secretion was increased in the medium without FBS supplemented with a physiologic concentration of FSH with LH. CONCLUSION(S): Culture medium with FBS supplemented with a physiologic and a supraphysiologic concentration of FSH stimulates E2 secretion from cumulus cells derived from mature and immature oocytes. This suggests that it may be not necessary to add E2 to the culture medium for maturation in vitro of immature human oocytes retrieved from patients undergoing stimulated cycles.

Adult↗
PubMed1999

Prospective randomized double-blind trial of the correlation between time of administration and antiestrogenic effects of clomiphene citrate on reproductive end organs.

OBJECTIVE: To investigate whether the timing of administration of clomiphene citrate (CC) affects hormone levels, follicular recruitment, reproductive end organs, and pregnancy rates. DESIGN: Prospective, randomized, double-blind trial. SETTING: Academic center. PATIENT(S): Twenty-three patients with unexplained infertility. INTERVENTION(S): Twenty-three patients with unexplained infertility underwent 45 cycles of CC and IUI. For each cycle, patients were randomized either to receive 100 mg of CC on days 1-5 and placebo on days 5-9 (study group), or placebo on days 1-5 and CC on days 5-9 (control group). MAIN OUTCOME MEASURE(S): The difference in uterine artery PI, number of follicles, endometrial thickness, and pregnancy rates. RESULT(S): Gonadotropins and E2 levels, as well as uterine artery pulsatility index, were significantly higher in the study group on day 5. In addition, in the study group, a longer time interval existed between finishing CC and IUI (8 versus 6 days; MD = 2 days; 95% CI = 1-3) and the pregnancy rate was higher than in the control group (6 versus 0; OR = 15.1; 95% CI = 1.1-72.4). CONCLUSION(S): Clomiphene citrate commenced on day 1 of the menstrual cycle, rather than day 5, results in more rapid follicular growth, a longer CC-free period before IUI, and higher pregnancy rates. Although methodologically sound, our results should be taken with some degree of caution because they are based on a relatively small number of patients.

Adult↗
PubMed1999

Ovarian stromal echogenicity in women with clomiphene citrate-sensitive and clomiphene citrate-resistant polycystic ovary syndrome.

OBJECTIVE: To compare stromal echogenicity in women with clomiphene citrate (CC)-sensitive and CC-resistant polycystic ovary syndrome (PCOS), and to compare stromal echogenicity before and after laparoscopic ovarian drilling in women with CC-resistant PCOS. DESIGN: Prospective study. SETTING: University teaching hospital. PATIENT(S): Twenty-two infertile women. INTERVENTION(S): Transvaginal ultrasound examination and laparoscopic ovarian drilling. MAIN OUTCOME MEASURE(S): Ovarian stromal index (ratio of mean ovarian stromal echogenicity to mean echogenicity of the entire ovary). RESULT(S): The mean (+/- SD) ovarian stromal index was 1.26+/-0.27 in the women with CC-sensitive PCOS and 1.22+/-0.11 in the women with CC-resistant PCOS. The ovarian stromal index and ovarian volume of the women with CC-resistant PCOS before and after ovarian drilling were not significantly different. CONCLUSION(S): There was no difference in the stromal index and ovarian volume between women with CC-sensitive PCOS and women with CC-resistant PCOS. There was no overall difference in the stromal index and ovarian volume in women with CC-resistant PCOS before and after ovarian drilling.

Adult↗
PubMed1999

Conservative medical and surgical management of interstitial ectopic pregnancy.

OBJECTIVE: To review the definition and diagnosis of interstitial and heterotopic interstitial pregnancy and to evaluate the conservative management of these conditions. DESIGN: A MEDLINE computer search was used to identify relevant studies. The mean values for the duration of amenorrhea, serum beta-hCG level, size of the ectopic mass, and success rates of the various treatment modalities were calculated from the raw data in the original publications. RESULT(S): A review of 41 patients with interstitial pregnancy who were treated with methotrexate systemically, locally, or in combination revealed an overall success rate of 83%. The mean duration of amenorrhea, mean serum beta-hCG level, and mean size of the ectopic mass were 54 days, 15,127 mIU/mL, and 23 mm, respectively. Among 22 patients with interstitial pregnancy who were treated with conservative laparoscopic techniques, the overall success rate was 100%. In this group, the mean duration of amenorrhea, mean serum beta-hCG level, and mean size of the ectopic mass were 54 days, 7,572 mIU/mL, and 31 mm, respectively. There were nine cases of heterotopic interstitial pregnancy. Seven patients were managed with potassium chloride injected into the ectopic pregnancy, and two patients were treated by laparoscopy. Overall, 67% of the coexisting intrauterine pregnancies resulted in successful deliveries and the remainder ended in spontaneous abortions. CONCLUSION(S): Cornual resection or hysterectomy with a laparotomy should no longer be the first line of treatment for a hemodynamically stable patient with an interstitial pregnancy. In selected cases, methotrexate and laparoscopy can be used successfully in treating early interstitial pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMed1999

Reoperation after laparoscopic treatment of ovarian endometriomas by excision and by fenestration.

OBJECTIVE: To compare the reoperation rate after laparoscopic treatment of ovarian endometriomas by excision and by fenestration. DESIGN: Retrospective study. SETTING: University-affiliated teaching hospital. PATIENT(S): Two hundred thirty-one premenopausal women with ovarian endometriomas treated laparoscopically. INTERVENTION(S): Seventy women were treated with fenestration and ablation of the cyst wall and 161 women were treated with excision. MAIN OUTCOME MEASURE(S): The reoperation rates of the two groups of women were evaluated using life-table analysis. RESULT(S): The cumulative probability of reoperation was significantly higher after fenestration than after excision. The reoperation rates at 18 months and 42 months of follow-up were 6.1% and 23.6% after excision and 21.9% and 57.8% after fenestration, respectively. In the fenestration group, the age of the patient and the diameter of the endometrioma were not associated with a higher reoperation rate. In the excision group, a larger cyst was associated with a higher reoperation rate, but age had no influence on the reoperation rate. CONCLUSION(S): Laparoscopic excision of ovarian endometriomas is associated with a lower reoperation rate than that of fenestration. The reoperation rate after fenestration is independent of the size of the endometrioma and the age of the patient. However, after excision, the reoperation rate is higher in those with larger cysts.

Drainage↗
PubMed1999

Endoscopic myomectomy. Laparoscopy and hysteroscopy.

There is a place for both laparoscopy and laparotomy in the surgical management of patients with uterine myoma. The surgeon's expertise in laparoscopic suturing is a crucial requirement for laparoscopic myomectomy. Hysteroscopic myomectomy is the best treatment of women with submucous myoma.

Adult↗
PubMed1999

Effects of hydrosalpingeal fluid on murine embryo development and implantation.

PURPOSE: Our purpose was to evaluate the effects of various concentrations of hydrosalpingeal fluid (HSF) on the preimplantation development and implantation of murine embryos. METHODS: One-cell mouse embryos were cultured in KSOM culture medium with 0.1, 1.0, 10, or 50% HSF, without and with lactate supplementation. Late-stage embryos were transferred into the uteri of pseudopregnant CD-1 females to determine implantation rates. The embryo transfer technique used was developed by our group and its effectiveness was evaluated during this experiment. RESULTS: Blastocyst development in the 0.1, 1.0, 10, and 50% group was 45, 55.0, 12.5, and 17.5%, respectively, with lactate supplementation, and 35.0, 52.5, 12.5, and 5.0%, respectively, without lactate supplementation, while in the KSOM (control) group it was 63.8%. Blastocyst development was reduced compared to controls in the 10% HSF and 50% HSF groups. Implantation rates for the 0.1 and 1.0% groups with lactate supplementation were 43.0 and 25.0%, respectively, and those with lactate supplementation were 50.6 and 61.8%, respectively, while in the KSOM group the implantation rate was 65.5%. None of the implantation rates were significantly different. CONCLUSIONS: Hydrosalpingeal fluid has a concentration-dependent inhibitory effect on in vitro murine embryo development, but it has minimal effects on implantation rates.

Animals↗
PubMed1999

Ovarian stromal echogenicity in women with normal and polycystic ovaries.

Since the widespread use of transvaginal ultrasound to diagnose polycystic ovary syndrome (PCOS), a cardinal feature has been shown to be the presence of a bright, highly echogenic stroma. This is usually assessed subjectively. The objective of this study was to determine whether ovarian stromal echogenicity when measured objectively actually differed between women with polycystic ovaries and those with normal ovaries. A total of 67 women underwent a detailed ultrasound assessment before considering assisted conception treatment. Ovarian morphology was assessed and total ovarian volume, stromal volume, peak stromal blood flow velocity and mean stromal echogenicity were measured. The stromal index (ratio of mean stromal echogenicity to mean echogenicity of the entire ovary) and total stromal echogenicity were also calculated. Ovarian volume, stromal volume, and stromal peak blood flow velocity were all significantly higher in ovaries from women with PCOS. There was no difference in the mean stromal echogenicity, although the stromal index was significantly greater in women with polycystic ovaries. The apparent subjective increase in stromal echogenicity in women with polycystic ovaries, as exemplified by the greater stromal index, is due to a combination of the increased volume of ovarian stroma and the significantly lower mean echogenicity of the entire ovary in these women.

Dehydroepiandrosterone Sulfate↗
PubMed1999

Surgical management of ectopic pregnancy.

Laparoscopic salpingostomy remains the definitive and universal treatment of ectopic pregnancy in patients who are hemodynamically stable and who wish to preserve their fertility. The reproductive performance after salpingostomy appears to be equivalent or better than salpingectomy, but the recurrent ectopic pregnancy rate may be slightly greater. Expectant management has a poor efficacy and unproven benefit in subsequent reproductive outcome. Its use should be limited to situations in which the ectopic pregnancy is suspected but cannot be detected by transvaginal ultrasound. Methotrexate is an alternative to surgical treatment in selected patients who fulfill strict inclusion criteria, including compliance with follow-up evaluation. A large, prospective, randomized trial with significant power is needed, however, to study the prognostic factors for methotrexate success. The most practical and efficient method of methotrexate administration is a single intramuscular injection. Those who do not meet the criteria for methotrexate therapy should be treated surgically, which can be done by laparoscopy. Interstitial pregnancy also can be treated with methotrexate. Otherwise, a cornual resection or salpingotomy can be done. Although, it is feasible by laparoscopy, the laparoscopic approach should be done only by those who have an expertise in laparoscopic suturing. Abdominal and ovarian pregnancies are best treated surgically. Further, the diagnosis usually is established by laparoscopy, and an appropriate surgical treatment can be conducted at the same time.

Chronic Disease↗
PubMed1998

Reproductive outcome after treatment of mild endometriosis with laparoscopic excision and electrocoagulation.

OBJECTIVE: To compare the pregnancy rates (PRs) of infertile women with mild endometriosis treated laparoscopically by surgical excision and by electrocoagulation. Laparoscopic treatment of minimal and mild endometriosis usually is done by laser or electrocoagulation. Whether surgical excision is associated with similar results is unknown. DESIGN: Retrospective study with a historical control. SETTING: University teaching hospitals. PATIENT(S): One hundred one infertile women undergoing laparoscopic treatment of mild endometriosis. INTERVENTION(S): Forty-eight women were treated with electrosurgery (historical control) and 53 women were treated with excision. MAIN OUTCOME MEASURE(S): The PRs of the two groups of women were evaluated using life-table calculations and the Mantel-Cox test. RESULT(S): Of the total 24 pregnancies (PR: 57.1%) in the electrosurgery group, there were 3 spontaneous abortions (12.5%) and 1 ectopic pregnancy (4.2%). The total PR in the excision group was 53.5%, the abortion rate was 17.4% (4 of 23), and the ectopic PR was 8.7% (2 of 23). The median interval between surgery and conception was 10.7 months in the electrosurgery group and 13.3 months in the excision group. There was no statistically significant difference in the probability of conception between the two groups of women (Mantel-Cox test: z = 0.24). Using the Cox proportional-hazards model, the effects of age and duration of infertility were evaluated and were found not to be associated with a decreased PR. CONCLUSION(S): There is no difference in the PRs of infertile women with mild endometriosis treated laparoscopically by surgical excision and by electrocoagulation. The difference between these two modalities in women with endometriosis-related pelvic pain remains to be determined.

Adult↗
PubMed1998

Effects of pirfenidone and dermoid cyst fluid on adhesion formation.

OBJECTIVE: To evaluate the effects of pirfenidone and human dermoid cyst fluid on adhesion formation in a rat model. DESIGN: A prospective, blinded, controlled study. SETTING: Sprague-Dawley white rats in a conventional laboratory setting. INTERVENTION(S): Rats were divided into four groups according to the type of solution tested (dermoid fluid, 0.05 mg of pirfenidone, normal saline, and a combination of dermoid fluid and pirfenidone). In the first experiment, the solution (0.5 mL) was injected intraperitoneally. In the second experiment, the solution was instilled intraperitoneally after a standardized injury to the right uterine horn. The degree of adhesion formation was evaluated 2 weeks after the initial surgery. RESULT(S): Human dermoid cyst fluid caused adhesion in 4 of 10 intact rats and in 9 of 10 standardized injured rats. Pirfenidone did not decrease adhesion formation. No adhesion was found after injection of saline or pirfenidone in intact rats. The mean +/- SEM adhesion score in standardized injured rats was higher in the dermoid group (4.6 +/- 0.6) than in the pirfenidone group (2.8 +/- 0.7) or the saline group (3.8 +/- 0.5). The mean +/- SEM adhesion score in intact rats was 0.6 +/- 0.3 after dermoid fluid injection and after dermoid instillation in standardized injured rats was 4.6 +/- 0.6. CONCLUSION(S): Human dermoid fluid causes adhesion formation even in intact rats, and the adhesion is worse in the presence of serosal injury. Intraperitoneal pirfenidone does not decrease adhesion formation.

Animals↗
PubMed1998

Laparoscopic ovarian suspension before irradiation.

OBJECTIVE: To evaluate a technique of lateral ovarian transposition by laparoscopy. DESIGN: Case report. SETTING: Tertiary care center. PATIENT(S): A 34-year-old woman with rectal carcinoma. INTERVENTION(S): Laparoscopic ovarian transposition. MAIN OUTCOME MEASURE(S): Return of normal menstruation after irradiation. RESULT(S): Lateral ovarian transposition could be done by laparoscopy. However, division of the ovarian ligament was needed. The location of the ovaries after surgery was outside the radiation field. CONCLUSION(S): Lateral ovarian transposition can be done by laparoscopy. Contrary to a previous report, division of the ovarian ligament is required.

Adenocarcinoma↗
PubMed1998

A study of nerve fibers and histopathology of postsurgical, postinfectious, and endometriosis-related adhesions.

OBJECTIVE: To evaluate the presence of nerve fibers and histopathology of endometriosis-related adhesions, postsurgical adhesions, and postinfectious adhesions in women with and without pelvic pain. METHODS: We evaluated the presence of nerve fibers and histopathology of endometriosis-related adhesions, postsurgical adhesions, and postinfectious adhesions in 50 women. The nerve fibers were identified by immunocytochemistry staining with an antibody to neurofilament. RESULTS: Nerve fibers were found in the intraabdominal adhesions in 39 of the total 50 patients with such adhesions (78%). There was no significant difference in the proportion and the mean nerve score in adhesions due to previous intra-abdominal infection, endometriosis, and previous uninfected intra-abdominal surgery. The degree of lymphocytes and edema in endometriosis-related adhesions was significantly higher than in postsurgical adhesions and postinfectious adhesions (P < .05). No difference was found in the amount of nerve fibers and the mean nerve score in adhesions from women with pelvic pain and from those without pelvic pain. CONCLUSION: Nerve fibers are found commonly in intraabdominal adhesions, and their presence are not related to the underlying pathology or pelvic pain. Endometriosis-related adhesions contain more inflammatory cells and tissue edema than postsurgical or postinfectious adhesions.

Abdomen↗