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Biomedical subjects

T Tulandi

Publications and source records attributed to T Tulandi.

At least 55 records · Page 3Linked to original sources
PubMed1998

Ovarian stimulation and in vitro fertilization in women with mature cystic teratomas.

OBJECTIVE: To report the results of ovulation induction and in vitro fertilization-embryo transfer (IVF-ET) in patients with ovarian cystic teratomas. METHODS: Six women with ultrasonographically diagnosed ovarian cystic teratomas (mean diameter 2.4 cm) who presented with infertility underwent IVF-ET (n = 4) or ovulation induction (n = 2). Serial ultrasound examinations were used to determine the size of the cystic teratomas during therapy and throughout pregnancy. RESULTS: Ovarian stimulation was successful, as evidenced by the serum estradiol concentration on the day of hCG administration (mean in IVF-ET patients, 3558+/-1319 pg/mL) and the number of oocytes retrieved (10+/-4.24). Three patients having IVF-ET and both patients having ovulation induction conceived, and six healthy infants were born. Cyst sizes remained unchanged throughout treatment and pregnancy. There were no cyst-related complications during ovulation induction or IVF-ET, or during the entire course of pregnancy, labor, and delivery. CONCLUSION: The presence of ovarian cystic teratoma should not be considered a contraindication for therapy in women undergoing ovulation induction and IVF-ET.

Adult↗
PubMed1998

Surgical management of polycystic ovarian syndrome.

The objective of this chapter is to review the role of surgical management of polycystic ovarian syndrome in infertile women. Pertinent studies and their references were identified through computer medline search. To date there is no standardization of the technique of laparoscopic ovarian drilling. However, it appears that the results are promising, with a high ovulation rate ranging between 70% and 90% and a pregnancy rate of 70%. Clomiphene citrate remains the first line of treatment to induce ovulation in infertile women with polycystic ovarian syndrome. Laparoscopic ovarian drilling can be offered to clomiphene-resistant women, especially to those who have also failed to respond to gonadotrophin treatment or who have experienced ovarian hyperstimulation syndrome. It appears that the pregnancy rate after ovarian drilling is comparable with that for gonadotrophin therapy. However, until more complete and long-term data are available, caution must be exercised when offering this type of treatment.

Electrosurgery↗
PubMed1998

Incidental liver abnormalities at laparoscopy for benign gynecologic conditions.

STUDY OBJECTIVE: To evaluate liver abnormalities among women undergoing laparoscopy for benign gynecologic conditions. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: Tertiary care academic centers. PATIENTS: Women undergoing laparoscopy for benign gynecologic indications. INTERVENTION: The upper abdomen was examined by directing the laparoscope cranially. MEASUREMENTS AND MAIN RESULTS: Incidental liver abnormalities were found in 4.7% of 823 patients. The most common was perihepatic adhesions (Fitz-Hugh-Curtis syndrome), located mainly on the right lobe (66.7%) or on both lobes. Pelvic inflammatory disease was present in one-half of women with perihepatic adhesions. Other abnormalities were consistent with hepatic cirrhosis, adenoma, and hemangioma. CONCLUSION: Our results suggest the importance of exploring the upper abdomen during laparoscopic surgery.

Female↗
PubMed1998

Surgical and medical management of tubal and non-tubal ectopic pregnancies.

This article highlights recent findings in the diagnosis and management of ectopic pregnancy. While the search for the ideal biochemical marker for ectopic pregnancy continues, new protocols have been described for the management of persistent ectopic pregnancy. The role of nuclear marker Ki-67 in trophoblastic proliferation and the only randomized trial to date involving systemic methotrexate and laparoscopic surgery are discussed. The management of cervical, interstitial and heterotopic pregnancies are reviewed.

Female↗
PubMed1997

The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women.

OBJECTIVE: To evaluate prospectively the evolution of ovarian dermoid cysts and the safety of nonsurgical management in premenopausal women. DESIGN: A prospective study. SETTING: Tertiary hospital-based ultrasonographic unit. PATIENT(S): Between 1985 and 1994, 72 premenopausal and 14 postmenopausal women had ovarian dermoid cysts < 6 cm in diameter diagnosed by ultrasound and were followed up at Kaplan Medical Center in Israel. INTERVENTION(S): Ultrasound examination was scheduled at 3 and 9 months after the initial diagnosis and then annually. Every cyst was measured in three planes. The growth rate of the cysts was calculated from the data gathered. MAIN OUTCOME MEASURE(S): Prospective evaluation of the evolution of dermoid cysts and the safety of nonsurgical management in premenopausal women by an ultrasonographic follow-up. RESULT(S): For the premenopausal and postmenopausal women, the mean age (+/-SD) at diagnosis was 32.3 +/- 8.2 and 61.1 +/- 6.9 years, the mean duration of follow-up was 34.5 +/- 21.6 and 35.3 +/- 26.8 months, the mean cyst size at diagnosis was 3.7 +/- 1.2 and 4.1 +/- 1.5 cm, and the calculated mean growth rate was 1.77 +/- 3.86 and -1.59 +/- 2.48 mm/y, respectively. The difference in the mean growth rate of the cysts between the two groups was statistically significant. The mean growth rate was significantly different from zero in the premenopausal group but not in the postmenopausal group. Twenty-eight women were delivered of 35 healthy infants without complications attributable to the dermoid cysts. The cysts were removed surgically in 24 of the 86 women (27.9%), and benign cystic teratomas were confirmed by histologic examination in all cases. CONCLUSION(S): Premenopausal women with ovarian dermoid cysts of < 6 cm in diameter can be safely managed expectantly, especially if pregnancy is desired. The mean growth rate of dermoid cysts in premenopausal women is 1.8 mm/y.

Adolescent↗
PubMed1997

Current status of surgical and nonsurgical management of ectopic pregnancy.

OBJECTIVES: To review the efficacy, safety, costs, and subsequent reproductive outcome of surgical and nonsurgical management of ectopic pregnancy (EP). DESIGN: Pertinent studies were identified through computer Medline search. The rates of intrauterine pregnancy (IUP) and EP were calculated from the raw data in the original publications so that the denominator would be consistent. RESULT(S): The efficacy of laparoscopic treatment of EP is similar to that by laparotomy. The rate of persistent EP after conservative surgery ranges from 3% to 20%. Based on a review of 1,514 patients attempting to conceive after linear salpingostomy, the IUP and recurrent EP rates were 61.4% and 15.4%, respectively, among patients who had laparotomy, and 61% and 15.5%, respectively, among patients who had laparoscopic procedure. Of 3,584 patients who had partial or total salpingectomy, the subsequent IUP rate was 38.1% and the recurrent EP rate was 9.8%. Of 540 patients treated with a single-dose methotrexate, 84% did not require further treatment and, among 215 patients who attempted to conceive, 54% had subsequent IUP and 8% had recurrent EP. The success rate of expectant management was 69.2% in 347 patients reviewed. CONCLUSION(S): There is no difference in the reproductive outcome after treatment of EP by laparotomy and by laparoscopy. Salpingostomy is associated with higher subsequent IUP and recurrent EP rates compared with salpingectomy. Methotrexate is a viable alternative to laparoscopic salpingostomy for a selected group of patients.

Female↗
PubMed1997

Randomized controlled trial of superovulation and insemination for infertility associated with minimal or mild endometriosis.

OBJECTIVE: To evaluate the efficacy of superovulation and IUI versus no treatment for infertility associated with minimal or mild endometriosis. DESIGN: Randomized trial. SETTING(S): London Health Sciences Centre, University Campus, The University of Western Ontario, London, Ontario; and Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada. PATIENT(S): Three hundred eleven cycles in 103 couples in whom minimal or mild endometriosis was the sole identified subfertility factor. INTERVENTION(S): Superovulation with FSH and IUI. MAIN OUTCOME MEASURE(S): Live birth. RESULT(S): Live birth followed 14 of 127 (11%) superovulation and IUI cycles and 4 of 184 (2%) no-treatment cycles. The odds ratio was 5.6 (95% confidence interval 1.8 to 17.4) in favor of superovulation and IUI. CONCLUSION(S): Treatment with superovulation and IUI was associated with superior outcome both by crude live-birth rates and proportional hazard analysis.

Adult↗
PubMed1997

A randomized clinical trial of oxidized regenerated cellulose adhesion barrier (Interceed, TC7) alone or in combination with heparin.

OBJECTIVE: To compare the efficacy of heparin-saturated oxidized regenerated cellulose absorbable adhesion barrier, Interceed (TC7; Johnson and Johnson Medical Inc., New Brunswick, NJ) to oxidized regenerated cellulose alone for the prevention of postoperative adhesions. DESIGN: Clinical trial. By random assignment, one ovary was wrapped in oxidized regenerated cellulose, and the contralateral ovary was wrapped in oxidized regenerated cellulose saturated with a heparin solution (1,000 U/mL). PATIENT(S): Forty women with defects on both ovaries due to adhesiolysis and/or ovarian cystectomy. MAIN OUTCOME MEASURE: Adhesion formation and raw ovarian surface area were assessed at second-look laparoscopy 10 days to 16 weeks later. RESULT(S): At the second-look laparascopy-adhesions were present on 52.5% (21/40) of the ovaries treated with oxidized regenerated cellulose plus heparin and in 65% (26/40) of the contralateral ovaries treated with oxidized regenerated cellulose alone. For ovaries treated with oxidized regenerated cellulose plus heparin, the raw surface area was reduced from 9.41 +/- 1.27 cm2 (mean +/- SE) at laparotomy to 1.33 +/- 0.52 cm2 at second-look laparoscopy. The corresponding figures for ovaries treated with oxidized regenerated cellulose alone were from 10.24 +/- 1.08 to 1.92 +/- 0.54 cm2, respectively. The mean difference between the reductions in raw surface area (85.9% for oxidized regenerated cellulose plus heparin; 81.3% for oxidized regenerated cellulose alone) was not significantly different from zero (difference = - 0.24 cm2; 95% confidence interval = -2.56 to 3.04). CONCLUSION(S): Adding heparin did not enhance significantly the adhesion-reducing capacity of oxidized regenerated cellulose adhesion barrier when applied to ovarian surfaces after cystectomy and/or ovariolysis at laparotomy. This conclusion is subject to the possibility of a type II error.

Adult↗
PubMed1997

A study of ruptured tubal ectopic pregnancy.

OBJECTIVE: Ectopic pregnancy continues to be a leading cause of maternal morbidity and of reduced childbearing potential among women of reproductive age. Because of tubal rupture it is still the main cause of pregnancy-related death during the first trimester. The purpose of our study was to evaluate factors that may predispose a woman to rupture of a tubal ectopic pregnancy. METHODS: In this retrospective study of 693 ectopic pregnancies from three McGill University teaching hospitals, we compared risk factors, preoperative ultrasound, and serum hCG levels between cases with ruptured and unruptured tubal ectopic pregnancy. RESULTS: The age and the number of pregnancies among the two groups of women were similar. The gestational age of women with an unruptured tube was 6.9 +/- 1.9 weeks, and of those with a ruptured tube, the gestational age was 7.2 +/- 2.2 weeks. Tubal rupture was encountered more often in women with at least one child than in childless women. History of ectopic pregnancy was found in 35% of women with an unruptured tubal pregnancy and in 26% of those with a ruptured tube. Serum hCG levels at the time of treatment were not significantly different among the two groups of women. Eleven percent of women with a ruptured tube had serum beta-hCG levels of less that 100 IU/L. CONCLUSION: Tubal rupture is encountered more often in women with no history of ectopic pregnancy and in those with at least one child. This suggests that ectopic pregnancy is less suspected in these women. Tubal rupture is encountered less often in ampullary pregnancy and in small ectopic pregnancies. There is no correlation between serum beta-hCG levels and tubal rupture, and rupture can occur even when serum beta-hCG levels are very low.

Adult↗
PubMed1997

Inhibitory effect of human hydrosalpingeal fluid on mouse preimplantation embryonic development is significantly reduced by the addition of lactate.

Implantation and pregnancy rates following in-vitro fertilization-embryo transfer are reduced in the presence of hydrosalpinges, but the basis of the inhibition is unknown. We examined the effect of hydrosalpingeal fluid on preimplantation development of mouse embryos. Embryos cultured in 100% hydrosalpingeal fluid were significantly inhibited developmentally as compared to embryos cultured in 100% defined medium, which served as controls. In contrast, embryos cultured in 50% hydrosalpingeal fluid/50% defined medium reached the blastocyst stage at the same frequency as the controls. When lactate (final concentration 10 mM) was added to 100% hydrosalpingeal fluid, the percentage of cultured embryos that reached the blastocyst stage was significantly increased as compared to 100% hydrosalpingeal fluid, although the percentage was slightly lower than that observed for embryos cultured in the 100% defined medium. A similar but less pronounced effect occurred when pyruvate was added to hydrosalpingeal fluid. These results do not support the concept that a potent embryotoxic agent is commonly present in hydrosalpingeal fluid. Rather, they are consistent with the notion that the inhibitory effect of hydrosalpingeal fluid on embryonic development is due to the absence of essential factors, and that this deficiency can be largely corrected by the addition of energy sources.

Animals↗
PubMed1997

How can we avoid adhesions after laparoscopic surgery?

Although fewer develop than after laparotomy, laparoscopic surgery is still associated with adhesion formation. In order to minimize this, nothing replaces good surgical technique. Basic principles of microsurgery, liberal irrigation of the abdominal cavity and instillation of a large amount of Ringer's lactate at the completion of the procedure should be followed. Among adhesion preventing substances, adhesion barriers including expanded polytetrafluoroethylene and regenerated oxidized cellulose are the most effective. Alternatively, a second look laparoscopy to liberate the adhesions can be performed.

Female↗
PubMed1996

Pulmonary edema: a complication of local injection of vasopressin at laparoscopy.

OBJECTIVE: To report a case of pulmonary edema after local injection of vasopressin at laparoscopy. SETTING: University teaching hospital. PATIENT: A 24-year-old woman who underwent a laparoscopic myomectomy. INTERVENTION: Injection of vasopressin (10 mL of 0.5 U/mL) into the uterine wall overlying the myoma. RESULTS: Bradycardia, atrioventricular block, and pulmonary edema. CONCLUSIONS: The use of vasopressin can be associated with severe cardiopulmonary complications.

Adult↗
PubMed1996

Reproductive Performance and Three-Dimension-Ultrasound Volume Determination of Polycystic Ovaries after Laparoscopic Ovarian Drilling

Laparoscopic treatment of polycystic ovaries is a less invasive technique than ovarian wedge resection by laparotomy and is associated with less adhesion formation. Furthermore, the results appear to be superior. The purpose of the current study was to determine the changes in the ovarian volume and the reproductive outcome after laparoscopic treatment of polycystic ovaries. We studied 34 women with polycystic ovary syndrome (PCOS) who failed to ovulate with clomiphene and who subsequently underwent laparoscopic ovarian drilling. A standard procedure was done by a single surgeon using an insulated needle electrode. In six patients, ultrasound examination was performed to determine three-dimensional volume before surgery, and 1 week and 3 weeks postoperatively. Preoperative volume was 12.2 &plusmn; 1.8 cm3 and 1 week after surgery it was 13.6 &plusmn; 1.5 cm3. The ovarian volume 3 weeks after surgery (6.9 &plusmn; 1.3 cm3) was significantly smaller than that before surgery (p <0.05). Ovulation after the procedure occurred in 30 women (88.2%). Using life table analysis, the cumulative probability of conception at 12-month follow-up was 70% (median 8.1 mo). Two patients (6%) who did not ovulate with gonadotropin previously refused further expectant treatment after surgery and conceived in the first cycle of gonadotropin treatment. Aside from these women, the majority of pregnancies (76%) occurred spontaneously, and 18% conceived with clomiphene. We observed for the first time that there is a temporary swelling of the ovary after laparoscopic ovarian drilling. Subsequently, the volume decreases to the size smaller than the preoperative volume. Laparoscopic treatment of polycystic ovaries in women with PCOS who fail clomiphene therapy is associated with an ovulation rate of 88.2% and a pregnancy rate of 70% at 12-month follow-up.

Journal Article↗
PubMed1996

A comparison of methotrexate versus laparoscopic surgery for the treatment of ectopic pregnancy: a cost analysis.

This study was a cost analysis of direct medical costs of the methotrexate management versus laparoscopic surgery in the treatment of ectopic pregnancy. A total of 40 patients treated from January 1991 to October 1994 with methotrexate were compared with another 40 patients treated at the same hospital by laparoscopy from April 1986 to June 1994. Medical records for all these patients were received and hospital databases were used to retrieve information on cost. Treatment cost included the primary treatment, hospitalization and outpatient follow-up necessitated by treatment, complications and secondary treatment in cases of treatment failure. The cost related to diagnosis was excluded. The direct medical costs for methotrexate and laparoscopy groups were based on success rates of 72.5 and 95% respectively. The total cost of methotrexate treatment was Canadian $35,180 compared with Canadian $73,440 for the laparoscopic treatment. The mean +/- SD cost per patient was Canadian $880 +/- 160 in the methotrexate group compared with Canadian $1,840 +/- 150 in the laparoscopic group (P < 0.001). The mean +/- SE cost per patient with methotrexate success was Canadian $330 +/- 67 compared with Canadian $2,330 +/- 220 per patient with methotrexate failure (P = 0.001). A complete assessment of methotrexate treatment, including cost-benefit and cost-effectiveness, is warranted.

Chorionic Gonadotropin↗
PubMed1996

"Add-back" estrogen reverses cognitive deficits induced by a gonadotropin-releasing hormone agonist in women with leiomyomata uteri.

Treatment of women with uterine myomas with GnRH agonists results in symptoms of hypoestrogenism which can be prevented by concurrent "add-back" estrogen administration. We took advantage of these induced endocrine changes to investigate their effects on cognitive functioning in young women with myomas. Nineteen women with uterine myomas were tested before treatment. They all received the GnRH agonist, leuprolide acetate depot (LAD), every 4 weeks for 12 weeks and were then randomized to receive LAD plus estrogen or LAD plus placebo every 4 weeks for 8 additional weeks. Levels of all sex hormones decreased after 12 weeks of LAD treatment (P < 0.01), and only estradiol (E2) levels increased (P < 0.01) following 8 weeks of subsequent treatment in the group that received LAD plus E2. Scores on neuropsychological tests of verbal memory decreased from pretreatment to 12 weeks posttreatment with LAD (P < 0.05). These memory deficits were reversed in the group that received LAD plus E2 for 8 weeks coincident with an increase in plasma E2, whereas memory scores remained depressed in the group that received LAD plus placebo. These findings are consistent with those from studies on surgically menopausal women and strongly suggest that estrogen serves to maintain verbal memory in women. These results provide support for the efficacy of add-back estrogen regimens in women treated with GnRH agonists and also imply that estrogen may be important for maintaining memory in the postmenopause.

Adult↗