Biomedical subjects
T Tulandi
Publications and source records attributed to T Tulandi.
Effect of intraperitoneal 32% dextran 70 on blood coagulation and serum electrolytes.
The most promising intraperitoneal agent for preventing adhesion formation is 32% dextran 70. To investigate its effect on blood coagulation and serum electrolytes, 22 women who required surgery for infertility were studied. No significant difference was seen in prothrombin time, partial thromboplastin time, platelet count or red-blood-cell indices between the dextran group (n = 12) and the control group (n = 10) on day 0 (before surgery) and postoperative days 1 and 3. In both groups the decrease in hematocrit and a proportionate decrease in serum albumin 24 hours after the operation suggested hemodilution. There was no further decrease in hematocrit on postoperative day 3. The dextran had no effect on serum electrolytes. These results suggest that intraperitoneal 32% dextran 70 does not impair blood coagulation and is not associated with an electrolyte inbalance.
Effect of prostaglandin E2 on puerperal breast discomfort and prolactin secretion.
The effect of prostaglandin E2 (PGE2) (3 mg/day orally for four days) on puerperal breast discomfort and prolactin secretion was investigated in eight women in a double-blind, placebo-controlled study. Scoring systems were used for daily assessment of the degree of breast discomfort. PGE2 had no effect on breast lactation, breast swelling or pain. No difference was seen between serum prolactin in the placebo- and PGE2-treated women. Contrary to a previous report, in our experimental design PGE2 had no effect on puerperal breast lactation, swelling or pain or on serum prolactin.
Infertility surgery with the laser beam.
The results of the use of CO2 laser in infertility surgery are encouraging. The unique properties of CO2 laser--precision of application, minimal bleeding, rapid healing, and minimal scarring--are beneficial for infertility surgery. It remains to be seen, however, whether the pregnancy rate in "laser patients" is superior to that in "conventional surgical patients." A well-controlled, randomized study and a long-term follow-up period are required to clarify this matter. A good understanding of the basic concepts of laser physics and a familiarity with the laser instruments are mandatory for the laser surgeon. A well-informed operating room staff will certainly be helpful in conducting effective and safe laser surgery. For example, all flammable and explosive material must be removed from the laser area, and protective coverings for the eyes must be worn by all personnel. Simplification, reduction in the bulk of the present instruments, and the development of a flexible CO2 laser transmission fiber that can be utilized through an endoscope will be beneficial.
Effect of methyldopa on menopausal flushes, skin temperature, and luteinizing hormone secretion.
The effect of methyldopa (100 mg intravenously), the precursor of the alpha-receptor agonist alpha-methylnorepinephrine, on subjectively experienced menopausal flushes, skin temperature, and luteinizing hormone secretion was investigated in seven women in a double-blind, saline-controlled, crossover study. Subjects were monitored over a 3-hour period. Methyldopa significantly decreased the number of subjective flushes (p less than 0.05) and the number of cutaneous temperature peaks (p less than 0.05) but had no effect on the number of luteinizing hormone secretory pulses, variability of luteinizing hormone secretion, or total luteinizing hormone secretion. These studies indicate that alpha-adrenergic mechanisms (central and/or peripheral) play a role in the pathophysiology of menopausal flushes.
Non-Hodgkin's lymphoma in Bartholin's gland: case report and review of literature.
Described in this report is a systemic lymphoma which had selectively involved the Bartholin gland. The true prevalence of this phenomenon is not known, but greater attention to these areas of the genital tract may uncover additional cases and provide better insight into the natural history of lymphomas that involve the lower female genital tract.
Vaginal lubricants: effect of glycerin and egg white on sperm motility and progression in vitro.
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Reconstructive surgery of hydrosalpinx with and without the carbon dioxide laser.
Pregnancy rates and surgery-conception intervals were determined in 91 women operated on for bilateral terminal tubal occlusion with different techniques. The intrauterine pregnancy rate following salpingostomy utilizing the CO2 laser was 21.7% (n = 23) and following salpingostomy with the microdiathermy needle was 22.7% (n = 22) at 1 year's follow-up. The pregnancy rate following conventional surgery was 17.4% (n = 46) at 5 years' follow-up. The surgery-conception interval was shorter in the laser group than in the other two groups. This preliminary report suggests that there is no difference between the pregnancy rate following salpingostomy with CO2 laser or microdiathermy needle; however, the surgery-conception interval is shorter. This might reflect the rapid healing of the tube after laser surgery.
Ovarian hyperstimulation syndrome following ovulation induction with human menopausal gonadotropin.
Twenty-seven anovulatory women who had episode(s) of ovarian hyperstimulation during ovulation induction with hMG were studied. Twenty-nine of the total 89 treatment cycles were complicated by ovarian hyperstimulation. Twenty-four-hour urinary estrogen concentrations 3 days prior to hCG administration were significantly higher in the hyperstimulated (H) than in the nonhyperstimulated cycles (NH). Patients who had progesterone withdrawal bleeding (Group I) were more prone to be hyperstimulated in the first treatment cycle than patients who had no progesterone withdrawal bleeding (Group II). In all instances, the syndrome resolved spontaneously with time. The pregnancy rate of H was threefold NH. It is concluded that hyperstimulation in patients who had evidence of endogenous estrogen activity as demonstrated by progesterone withdrawal bleeding tend to occur in the first treatment cycle. Strict monitoring decreased the incidence of severe hyperstimulation. A minimal amount of hyperstimulation might be beneficial to improve the pregnancy rate.
Fertility aspect of women with tubal diverticulosis: a 5-year follow-up.
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Altered pituitary hormone secretion in patients with pseudocyesis.
Pituitary function studies were performed in two patients with pseudocyesis, one of whom was reinvestigated during a recurrent episode. There was an exaggerated prolactin response to thyrotropin-releasing hormone, an aberrant growth hormone increase, and an impaired growth hormone response to dopamine receptor agonists (apomorphine or bromocriptine). These findings point to a derangement in hypothalamic-pituitary function in pseudocyesis and may indicate an underlying impairment in dopaminergic function in this disorder.
Effect of intravenous clonidine on menopausal flushing and luteinizing hormone secretion.
The effect of clonidine (0.075 mg given intravenously) on subjectively experienced menopausal flushes, skin temperature and luteinizing hormone (LH) secretion was investigated in eight women in a double-blind, saline-controlled cross over study. Subjects were monitored over a 5-hour period. The number and magnitude of temperature peaks (increment greater than 1 degree C) was unaffected by clonidine. Clonidine significantly decreased the number of subjectively experienced flushes as well as the intensity of the flushes. Clonidine had no effect on the number of LH secretory pulses or on total LH secretion. These results indicate that the therapeutic effect of clonidine is independent of factors responsible for episodic skin temperature changes or factors regulating LH secretion.
Effect of saliva on sperm motility and activity.
Infertile couples frequently experience sexual dysfunction during their infertility investigations, including inadequate vaginal lubrication. In a attempt to look for a lubricant that would not impair sperm motility and activity, saliva was added to normal semen from healthy male donors. Saliva induced a "shaking movement" in 12% of the total sperm population incubated with high concentrations of saliva. This phenomenon did not occur with low concentrations of saliva, but sperm motility and progression significantly decreased. The results indicate that saliva has a deleterious effect on sperm motility and activity and should not be encouraged as a vaginal lubricant for the infertile couple.
Pseudocyesis: pituitary function before and after resolution of symptoms.
Pseudocyesis was clinically established in a 39-year-old woman. Pituitary function was assessed with the use of hypothalamic peptides and dopamine receptor agonists. Basal serum concentrations of anterior pituitary and ovarian hormones were normal. An exaggerated rise in luteinizing hormone (LH) and prolactin levels was seen following the administration of luteinizing hormone-release hormone and thyrotropin-releasing hormone (TRH), respectively. A paradoxic rise in growth hormone (GH) levels followed TRH administration, whereas the response to dopamine receptor agonists was normal. Pituitary hormone secretion after deflation remained similar to that before deflation, although a normal response of GH to apomorphine was reestablished. These data indicate that the amenorrhea of pseudocyesis is associated with normoprolactinemia and a readily releasable pituitary LH pool, which suggests a suprahypophyseal etiology of the amenorrhea. The abnormalities in GH secretion may also support this contention.
Infertility in women over the age of 36.
Ninety-three couples of which the female partner was over 36 years of age were studied. Tubal factor was the most common etiologic factor in the women aged 36 to 40 years, and unexplained infertility was the most common factor in the women over the age of 40. It appears that in the aging infertile population, the ovulatory factor is not the most important cause of infertility. The over-all pregnancy rate (33%) is lower and the abortion rate (31%) is increased with advancing age as compared with the general infertile population. The implication of aging as a cause of infertility is discussed.
Premature ovarian failure.
Premature ovarian failure remains a multifactorial syndrome in which genetic, immune, and environmental factors may play a role. The possible etiology and pathophysiology of premature ovarian failure is reviewed. A scheme of the management of premature ovarian failure is illustrated. This allows a logical approach in which the final diagnosis has to be made with laparotomy ovarian biopsy. It is hoped that future research can be directed to the solution of the etiology of premature menopause and insensitive ovary syndrome, as well as the management of patients with insensitive ovary syndrome, so that either by estrogen replacement or stimulation with hypothalamic/pituitary hormone these primordial follicles can be induced to develop normally.
Arcuate and bicornuate uterine anomalies and infertility.
Twenty-three patients presenting with infertility were found to have uterine anomalies. Eighteen had primary infertility. Six (86%) of seven patients with arcuate uterus achieved a term pregnancy. Five patients of these seven had primary infertility. Of the 13 patients with bicornuate uterus, 6 subsequently underwent a metroplasty and 4 (67%) of these latter patients achieved a term pregnancy. Of the remaining seven patients with bicornuate uterus, one achieved pregnancy during investigations, one refused surgery, and five were not operated upon because of uncorrected nonuterine factors. One other patient was found to have uterus didelphys and two had a unicornuate uterus. No patients with septate uterus were found. The implications of a uterine anomaly as a cause of primary infertility are discussed.
Modern surgical approaches to female reproductive tract.
Laparoscopic and hysteroscopic surgery have changed the management of many gynaecological disorders. Procedures that previously required a long duration of hospitalization can now be done on an outpatient basis or with a short hospital stay. Surgical treatment remains the definitive and universal treatment of ectopic pregnancy and it can be safely done by laparoscopy. Most reproductive operations are done by laparoscopy and the results appear to be similar to those obtained with laparotomy. Those needing a laparotomy will be better treated by in-vitro fertilization. Laparoscopic ovarian drilling is a viable alternative for infertile women with polycystic ovarian syndrome. Most ovarian cysts and endometriosis should be treated by laparoscopy. Although uterine myomas can be removed by laparoscopy, the uterine integrity after the procedure is questionable. Surgery should be reserved for women who have completed their family or those with pedunculated or shallow intramural myomas. Alternatively, a laparoscopically assisted myomectomy can be done. For laparoscopic hysterectomies for benign lesions, supracervical hysterectomy appears to be a good option. Hysteroscopy has changed our management, particularly for abnormal uterine bleeding. A submucous myoma and polyp can be removed by hysteroscopy and, as an alternative to hysterectomy, endometrial ablation can be done. In the future, most procedures will be done by endoscopy and laparotomy will be reserved only for selected cases.