Biomedical subjects
Publications and source records attributed to T Tulandi.
One of the complications of abdominal surgery is the occurrence of intra-abdominal adhesions. The problems related to these adhesions have created a major impact on the health care system, thereby incurring a substantial cost to health care. In the field of gynaecology, adhesion-related problems include infertility, abdominal pain and bowel obstruction.
The effect of increasing serum estradiol levels on platelet [3H]PK 11195 binding was investigated to determine the influence of gonadal steroids on platelet peripheral benzodiazepine binding sites. Serum estradiol and platelet [3H]PK 11195 binding were determined in 10 anovulatory, but otherwise healthy women before and after treatment with human menopausal gonadotropin. Despite a 30-fold increase in posttreatment estradiol, the kinetic parameters of platelet [3H]PK 11195 binding (Kd, Bmax) remained essentially unchanged. These data indicate that peripheral benzodiazepine binding sites on platelets are not influenced by elevated concentrations of estradiol. Thus, it is suggested that variations in circulating levels of this female gonadal steroid are likely not responsible for the modifications in platelet peripheral benzodiazepine binding sites seen in association with various disease states.
Assisted reproductive technology and reproductive surgery can be complementary, and the feasibility of laparoscopic suturing has facilitated conducting reproductive surgery entirely by laparoscopy. Young women with tubal disease can be offered surgery, whereas older women, with their rapid decline in fertility, are better treated with in vitro fertilization (IVF). IVF should be the first line of treatment for women with a severe degree of hydrosalpinx, or with extensive and dense adhesions. However, the presence of hydrosalpinx decreases IVF pregnancy rates. In those whose hydrosalpinx is seen on ultrasound, especially after failed IVF cycles, a laparoscopic salpingectomy can be done. For tubal anastomosis, the superior results of this procedure are well established. The association between uterine myoma and infertility is unclear. However, in those with a distorted uterine cavity, and no other cause of infertility, myomectomy can be considered; myomectomy can be done by laparoscopy. Because of the risks of uterine rupture, proper closure of the uterine incision is of utmost importance.
The effects of intrauterine insemination (IUI), intracervical insemination (ICI), and timed intercourse (TI) in women who were treated with human menopausal gonadotropin (hMG) for anovulation were evaluated. The pregnancy rates per cycle following IUI (70 cycles), ICI (62 cycles) and TI (158 cycles) were 20%, 9.6%, and 17.7%, respectively; these differences are not statistically significant. The abortion rate and the multiple pregnancy rate were also not significantly different. This report suggests that in women who are undergoing treatment with hMG, there is no added benefit from artificial insemination (either intrauterine or intracervical insemination) over timed intercourse.
One hundred sixteen cycles of human menopausal gonadotropin (hMG) treatment for ovulation induction were studied. The ovarian response to hMG treatment was monitored by the daily determination of serum estradiol (E2) or by daily serum E2 and repeated ultrasonic examination of the ovaries. There were more follicles 18 mm in diameter or larger at the time of human chorionic gonadotropin (hCG) administration in the pregnancy than in the non-pregnancy cycles, and in the hyperstimulated than in the nonhyperstimulated cycles. The ovulatory rate and the pregnancy rate per cycle did not improve with the use of ultrasound. The number of treatment cycles required to achieve pregnancy was less in patients who had ultrasonic examination of the ovarian follicles. These results suggest that ultrasonic examination of the ovarian follicle helps to reduce the number of hMG cycles required to achieve pregnancy. The development of multiple follicles results in more pregnancies. However, the use of ultrasound does not improve the pregnancy rate.
Adhesions are a common sequela of laparoscopic surgery, even though they are reduced by as much as three-fourths in comparison with laparotomy. The main factors as found in the literature for decreasing adhesions post-laparoscopy are: meticulous technique and microsurgical principles, hemostasis, and liberal irrigation with Ringer's lactate or other instillates. Barrier materials offer promise for adhesion prevention, and estrogen antagonists, too, warrant further investigation.
OBJECTIVE: To evaluate the efficacy of treatment of ectopic pregnancy by local administration of methotrexate, systemic methotrexate, and laparoscopy. METHODS: This study was a retrospective analysis from the department of Obstetrics and Gynecology of two university-affiliated hospitals. Medical records of 40 patients who were treated by methotrexate from January 1991 to October 1994 and 66 patients who were treated surgically by laparoscopy from April 1986 to June 1994 were reviewed. Among the methotrexate group, 19 patients were treated by ultrasound-guided injection and 31 others were treated by intramuscular administration. Success rate of the primary treatment and the duration of hospitalization were examined for each group. The cases of methotrexate failure were characterized and compared with the primary laparoscopic group. RESULTS: The success rate was similar between the local (79.8%) and the systemic (66.7%) methotrexate groups. The primary laparoscopy group had a significantly higher success rate (95.5%) than the methotrexate group (72.5%); P < .01. When patients who had laparoscopy as their primary treatment (n = 66) were compared with those who underwent surgery after failed methotrexate treatment (n = 11), the primary laparoscopic group were seen to have shorter hospitalization time, smaller tubal diameter at surgery, and higher pre-operative hemoglobin level (P < .05). More patients in the methotrexate failure group (45.5%) had hemoperitoneum of > 500 mL than those in the primary laparoscopy group (1.5%; P < .001). CONCLUSIONS: There is no difference in efficacy between local and systemic methotrexate administration. Laparoscopic treatment of ectopic pregnancy is associated with a higher success rate than methotrexate treatment. Patients treated by laparoscopy after methotrexate failure were sicker than those who were treated by laparoscopy as their primary treatment.
OBJECTIVE: To evaluate the changes in ovarian volume and the reproductive outcome after laparoscopic treatment of polycystic ovaries (PCOS) in clomiphene-resistant anovulatory women. DESIGN: A prospective study of women undergoing laparoscopic treatment of polycystic ovaries. Ultrasound examination for three-dimensional (3D) volume determination was performed before and after surgery. SETTING: University teaching hospital. PATIENTS: Thirty-four women with polycystic ovarian syndrome who failed to ovulate with clomiphene citrate and who subsequently underwent laparoscopic ovarian drilling. INTERVENTIONS: Laparoscopic ovarian drilling and three-dimensional ultrasound examination. MAIN OUTCOME MEASURES: Cumulative probability of conception and changes in ovarian volume. RESULTS: Ovulation rate after the procedure was 30/34 (88.2%). Using Life Table Analysis, the cumulative probability of conception at 12 months follow-up was 70% (median, 8.1 months). The preoperative ovarian volume was 12.2 +/- 1.8 cm3 and 1 week after surgery it was 13.6 +/- 1.5 cm3. The ovarian volume 3 weeks after surgery, 6.9 +/- 1.3 cm3, was significantly smaller than that before surgery. CONCLUSIONS: Laparoscopic treatment of polycystic ovaries in women with clomiphene-resistant PCOS is associated with an ovulation rate of 88.2% and a cumulative pregnancy rate of 70% at 12 months. It appears also that laparoscopic ovarian drilling may result in a transient increase, with a subsequent significant reduction, in ovarian volume.