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Biomedical subjects

D A Johns

Publications and source records attributed to D A Johns.

12 recordsLinked to original sources
PubMed2003

Initial feasibility study of a sprayable hydrogel adhesion barrier system in patients undergoing laparoscopic ovarian surgery.

STUDY OBJECTIVE: To assess the safety and effectiveness of SprayGel as a barrier to reduce the frequency of adhesion formation and reformation after ovarian surgery, and to determine the feasibility of the study design for a larger, multicenter pivotal trial. DESIGN: Prospective, randomized, internally controlled trial (Canadian Task Force classification I). SETTING: Two metropolitan, academic-affiliated, nonprofit hospitals. PATIENTS: Fourteen women. INTERVENTION: Bilateral adnexal surgery. MEASUREMENTS AND MAIN RESULTS: On completion of surgery, one adnexa was randomized to receive optimal surgical treatment plus application of the adhesion barrier, and the contralateral one to receive optimal surgical treatment alone. Patients returned in 3 to 16 weeks for second-look laparoscopy. All initial and second-look procedures were videotaped and reviewed by a blinded surgeon reviewer, and assessed for frequency, extent, and severity of adhesions. The frequency and extent of adhesion formation at second-look laparoscopy were statistically reduced on treatment sides compared with control sides (71% reduction in frequency, p = 0.0488; 69% reduction in extent, p = 0.0494). Adhesion severity score was reduced by 43% on the treatment side. SprayGel was associated with no adverse effects and was applied successfully in all patients. CONCLUSION: This material shows great promise in preventing postoperative adhesion formation in a population of patients greatly in need of such an adjunct. These findings warrant a larger, pivotal, multicenter study to evaluate SprayGel further.

Adhesives↗
PubMed1999

Use of Crinone vaginal progesterone gel for luteal support in in vitro fertilization cycles.

OBJECTIVE: To investigate the efficacy and safety of intravaginal Crinone 8% (Columbia Research Laboratories, Miami. FL) versus IM progesterone for luteal phase support after IVF-ET. DESIGN: Prospective open trial with comparison to historical controls. SETTING: University hospital. PATIENT(S): Two hundred six women undergoing IVF-ET. INTERVENTION(S): One hundred patients received Crinone vaginal progesterone gel (90 mg once daily) and 106 patients received IM progesterone (50 mg once daily) beginning on the evening of oocyte retrieval. MAIN OUTCOME MEASURE(S): Pregnancy and miscarriage rates, and midluteal serum progesterone levels. RESULT(S): Positive beta-hCG pregnancy rates, clinical pregnancy rates per transfer, and ongoing pregnancy rates were similar for the Crinone and IM progesterone groups. Women who received Crinone had higher rates of biochemical pregnancy loss but lower rates of clinical pregnancy loss (i.e., spontaneous abortion) than women who received IM progesterone. Midluteal serum progesterone concentrations were significantly higher in the IM progesterone group (94.3+/-8.8 ng/mL versus 57.7+/-7.4 ng/mL). Several women who received Crinone had vaginal bleeding 11-13 days after oocyte retrieval. CONCLUSION(S): For all age categories, positive beta-hCG and ongoing pregnancy rates were similar when Crinone or IM progesterone was given for luteal phase support in IVF-ET cycles, despite lower serum progesterone concentrations and higher rates of biochemical pregnancy loss with Crinone. Although the results of this study support the use of Crinone as an acceptable alternative for luteal support after IVF-ET, differences in bleeding patterns and rates of biochemical pregnancy loss demonstrate the need for a prospective randomized study.

Administration, Intravaginal↗
PubMed1997

Prostaglandin E2 stimulates aromatase expression in endometriosis-derived stromal cells.

C19 steroids are converted to estrogens by aromatase P450 (P450arom). Aromatase expression in humans is regulated by use of tissue-specific promoters in the placenta (promoter I.1), adipose tissue (promoters I.4, I.3, and II), and gonads (promoter II). The use of each promoter gives rise to a population of P450arom messenger ribonucleic acid (mRNA) species with a unique untranslated 5'-terminus. Aromatase is not expressed in the endometrium of disease-free women. We demonstrated, however, the presence of P450arom mRNA in pelvic endometriotic implants and eutopic endometrial curettings of women with endometriosis. In the current report, aromatase activity and P450arom gene expression were investigated in cultured stromal cells derived from eutopic endometrium and ovarian endometriomas of women with pelvic endometriosis. We also investigated the hormonal regulation of aromatase expression and alternative promoter use in these cells. The effects of interleukin-1 beta (IL-1 beta), IL-2, IL-6, IL-11, oncostatin M, IL-15, tumor necrosis factor-alpha, PGE2, estradiol, R5020, dexamethasone, and dibutyryl cAMP (Bt2cAMP) on aromatase activity in endometriosis-derived stromal cells were assessed. We chose treatments with PGs and ILs because of the inflammatory nature of endometriosis. PGE2 stimulated aromatase activity in endometriosis-derived stromal cells by 19- to 44-fold (37-221 pmol/mg protein-4 h), whereas Bt2cAMP induction was 26- to 60-fold the baseline level. No stimulation was observed by estradiol or R5020 or by IL-1 beta, IL-2, IL-6, IL-11, IL-15, or TNF alpha in the presence or absence of glucocorticoids. A modest induction of aromatase activity (2-fold) was observed in dexamethasone- plus oncostatin M-treated cells. These changes in aromatase activity were accompanied by comparable changes in the levels of P450arom mRNA levels, determined by a quantitative reverse transcription-PCR method. Promoter-specific 5'-ends of P450arom transcripts in total RNA from endometriosis-derived stromal cells treated with PGE2 and Bt2cAMP were amplified employing a novel modified rapid amplification of cDNA5'-ends/Southern hybridization method using exon-specific oligonucleotide probes. The majority of P450arom transcripts in these cells contained the gonadal-type promoter II-specific sequences, whereas very few transcripts contained adipose-type promoter I.3- and I.4-specific sequences. PGE2 appears to be the most potent known stimulator of aromatase in endometriosis. Aromatase expression in PGE2-stimulated stromal cells of endometriosis is regulated primarily by the classically located promoter II, which, in turn, is regulated by cAMP. As PGE2 is known to increase intracellular cAMP levels, estrogen biosynthesis in endometriosis may be primarily regulated by PGE2 that is locally produced. Consequent local estrogen production may promote the growth of endometriotic implants.

Aromatase↗
PubMed1995

The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital.

OBJECTIVE: Our purpose was to evaluate the medical and economic impact of of operative laparoscopy on the surgical approach to hysterectomy for benign disease in a large, metropolitan, not-for-profit hospital. STUDY DESIGN: Retrospective analyses were performed on 2563 hysterectomies (without vaginal or bladder repair) for benign disease, performed by 37 gynecologists between January 1991 and December 1993. Disposable laparoscopic instruments and stapling devices were not used at any time during the study period. Electrosurgery and sutures were used for hemostasis. Parameters analyzed included surgical approach (total abdominal hysterectomy, vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and failed laparoscopically assisted vaginal hysterectomy), operative time, postoperative diagnosis, operative blood loss, length of stay, complications, uterine weight, and hospital changes. Charges in each of these parameters were analyzed and compared in 6-month increments. RESULTS: During the study period the percent of hysterectomies performed abdominally declined from 65% to 36%. Laparoscopically assisted vaginal hysterectomy increased from 12% to 45%, and vaginal hysterectomy varied from 23% to 19%. Average operative time was 82 minutes (+/- 2 minutes) for total abdominal hysterectomy, 102 minutes (+/- 2.3 minutes) for laparoscopically assisted vaginal hysterectomy, and 63 minutes (+/- 2 minutes) for vaginal hysterectomy. Hospital stay was 68 hours (+/- 1.5 hours) for total abdominal hysterectomy, 44 hours (+/- 1.2 hours) for laparoscopically assisted vaginal hysterectomy, and 43 hours (+/- 4.1 hours) for vaginal hysterectomy. The average hospital charge was $6552 (+/- $108) for total abdominal hysterectomy, $6431 (+/- $100) for laparoscopically assisted vaginal hysterectomy, and $5869 (+/- $116) for vaginal hysterectomy. CONCLUSIONS: Contrary to previously published studies, our study demonstrates (1) laparoscopically assisted vaginal hysterectomy is a cost-effective procedure when performed with reusable instruments, (2) laparoscopically assisted vaginal hysterectomy is a safe procedure, even when performed by a variety of gynecologists with different skill levels, and (3) the number of hysterectomies performed abdominally was decreased by 29% without incurring more complications or reducing the number of vaginal cases.

Blood Loss, Surgical↗
PubMed1994

Laparoscopically assisted vaginal hysterectomy.

The list of gynecologic operations that can be performed by operative laparoscopy has expanded rapidly and now includes hysterectomy, yet there has been little critical assessment of the clinical outcome and complications of these procedures. This report is a retrospective review of 119 laparoscopically assisted vaginal hysterectomies (LAVHs). The most common indications were pelvic pain, menorrhagia, pelvic mass and uterine myomas. Of the 119 women, 94 (79%) had one or more factors considered to be absolute or relative contraindications to vaginal hysterectomy. The average operating time was 79 +/- 3 (SEM) minutes, with an estimated blood loss of 135 +/- 10 mL and an average length of hospitalization of 59 +/- 2 hours. Intraoperative complications were limited to vaginal entry into the bladder in one patient. Sixteen women had estimated blood losses > 300 mL; none received a blood transfusion. To more accurately describe the laparoscopic procedure performed, a staging system classifying the extent of the laparoscopic portion of the procedure is presented. Such a system is helpful for assessing the risk/benefit ratio of LAVH. While the findings of this study suggest the potential advantages of LAVH, future studies will be required to determine the specific efficacy of the procedure.

Adult↗
PubMed1993

Adequacy of laparoscopic oophorectomy.

Ovarian remnant syndrome occurs infrequently after oophorectomy, yet when present it can contribute greatly to pelvic discomfort. The syndrome may be difficult to diagnose, identify surgically, and treat without intraoperative or postoperative complications developing. Recently, laparoscopic oophorectomy has been performed with increasing frequency. We assessed the outcome after laparoscopic removal of both ovaries or the sole remaining ovary in 27 premenopausal women. No intraoperative or postoperative complications were identified, and no patients have experienced symptoms consistent with ovarian remnant syndrome. All women had a marked rise in serum follicle-stimulating hormone (FSH) levels (81 to 72+/-5 mIU/ml), and luteinizing hormone (LH) levels (8+/-1 to 37+/-3 mIU/ml) after oophorectomy, and all but one had FSH levels 40 mIU/ml or above. Thirteen women had gonadotropin levels measured after 4 weeks of hormone replacement therapy; all had reductions in FSH levels, but 10 had elevations of their LH levels. These findings indicate that ovarian remnant syndrome occurs infrequently after laparoscopic oophorectomy. In addition, the data suggest a different, nonovarian regulation of gonadotropin secretion.

Adult↗
PubMed1993

Laparoscopic oophorectomy.

Oophorectomies were performed on 312 women as part of an operative laparoscopic procedure over an eight-year period. The average age of the women was 40.4 +/- 0.6 (SEM) years; 36.5% had previously undergone a hysterectomy. The median operating time was 120 minutes. The length of hospitalization was less than 24 hours in 77.6% of women, between 24 and 48 hours in 15.1% and over 48 hours in 7.4%. Intraoperative and/or postoperative complications occurred in 12 women (3.8%). Estimated blood loss greater than 300 mL occurred in two women. The most frequent diagnoses were endometriosis/endometrioma, functional cysts and normal ovarian tissue (usually from ovaries enmeshed in adhesions); two ovaries demonstrated borderline malignant potential. Laparoscopic oophorectomy is acceptable under appropriate conditions. Further studies are necessary to provide criteria for accurate differentiation of benign from malignant ovarian enlargement.

Adult↗
PubMed1993

Laparoscopic removal of gonads in women with abnormal karyotypes.

The objective of this study was to evaluate if laparoscopy can be an acceptable alternative to laparotomy for gonadectomy in women with gonadal dysgenesis (46,XY karyotype or 45,X karyotype with evidence of hyperandrogenism). We retrospectively analyzed five cases of gonadal dysgenesis that were managed by laparoscopic gonadectomy. All five patients underwent laparoscopic gonadectomy performed at a day surgery unit of a university medical center without any complications and were discharged the same day. The average operative time was 72 minutes (range, 35-95), the average blood loss was 20 mL, and the average cost was $4,380. We conclude that laparoscopic gonadectomy is a safe, effective and economical procedure to perform on patients with Y chromosomes or evidence of abnormal gonads. Laparoscopy should be accepted as the treatment of choice in these patients by physicians experienced in pelviscopic surgery.

Adolescent↗
PubMed1991

Clomiphene citrate-induced gamete intrafallopian transfer with diagnostic and operative laparoscopy.

STUDY OBJECTIVE: To examine the efficacy of clomiphene citrate (CC) gamete intrafallopian transfer (GIFT) with operative laparoscopy. DESIGN: Retrospective. SETTING: Private office and outpatient surgical center. PATIENTS: Sixty-two patients who were to undergo diagnostic and operative laparoscopy as part of their infertility evaluation underwent concomitant CC-stimulated GIFT. Any significant pelvic pathology was treated in conjunction with the GIFT procedure. RESULTS: The average number of oocytes retrieved per laparoscopy was 3.4 and an ongoing pregnancy rate (PR) of 24.6% was attained. Endometriosis, pelvic adhesive disease, and myoma were treated laparoscopically in conjunction with the GIFT procedure. CONCLUSION: Clomiphene citrate-induced GIFT in conjunction with diagnostic and operative laparoscopy results in an acceptable ongoing PR without significantly interfering with any operative laparoscopy procedure required.

Adult↗