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Biomedical subjects

O Istre

Publications and source records attributed to O Istre.

13 recordsLinked to original sources
PubMed1996

The incidence of fallopian tube patency after transcervical resection of the endometrium including rollerball diathermy to the tubal ostia.

OBJECTIVE: To evaluate the incidence of tubal patency as well as the shape of the endometrial cavity after transcervical resection of the endometrium. DESIGN: An open observational trial. SETTING: The obstetrics and gynecology unit at a district hospital in Norway. PATIENTS: Fifty consecutive patients who had undergone treatment for menorrhagia and metrorrhagia by resection of the endometrium and coagulation of the tubal ostium were included in the study. INTERVENTION: A hysterosalpingogram was performed with a semistiff catheter and injection of 20 mL contrast dye 5 to 12 months after transcervical resection of the endometrium and fibroids. MAIN OUTCOME MEASURES: Tubal patency and uterine cavity morphology. RESULTS: Forty-four patients showed total occlusion of the fallopian tubes, and the uterine cavity showed fibrosis and narrowing of the cavity. Three patients showed bilateral and three patients unilateral tubal patency. CONCLUSION: Shrinkage and fibrosis of the uterine cavity occur after endometrial resection. A significant number of women after transcervical resection of the endometrium have patient tubes (13%) despite coagulation of the tubal ostia.

Adult↗
PubMed1995

Changes in amino acids, ammonium, and coagulation factors after transcervical resection of the endometrium with a glycine solution used for uterine irrigation.

OBJECTIVE: Transcervical resection of the endometrium with the use of 1.5% glycine for irrigation is associated with postoperative nausea in some patients. This could be because of hyponatremia or toxic effects of glycine and its metabolites. Moreover, 1.5% glycine is hypoosmolar, and hemolysis and fibrinolysis are possible. Changes in plasma factors related to these potential complications of transcervical resection of the endometrium were measured. STUDY DESIGN: In 101 patients undergoing transcervical resection of the endometrium sodium, ammonium, and coagulation factors were measured preoperatively and postoperatively at intervals. In the initial 30 patients glycine and 28 other amino acids were measured at the same intervals. The results were correlated with the patients' clinical status and operative parameters. RESULTS: Glycine and nine other amino acids and ammonia showed increased postoperative plasma levels; these changes were correlated with the absorption of the irrigating glycine solution and the development of hyponatremia. Minor activation of fibrinolysis and hemolysis was also seen. CONCLUSION: Nausea after transcervical resection of the endometrium with 1.5% glycine for irrigation may be partly explained by toxic effects of glycine and its secondary metabolites in addition to the effects of water intoxication and hyponatremia. Minor, clinically insignificant changes in the coagulation system may also occur. Studies on alternatives to glycine for creation of near-isotonic irrigating solutions are encouraged.

Adult↗
PubMed1994

Postoperative cerebral oedema after transcervical endometrial resection and uterine irrigation with 1.5% glycine.

Absorption of irrigating solution during transcervical resection of endometrium can cause dilutional hyponatraemia, nausea, and cerebral oedema. We studied 6 patients who absorbed more than 1500 mL of 1.5% glycine, and 14 patients who absorbed less. Cerebral oedema was diagnosed by blinded, paired comparison of computed tomography (CT) scans 3-6 hours and 3-6 days after operation. The absorbed volume of irrigating glycine solution was correlated with peroperative decrease in serum sodium. 10 patients who absorbed 500 mL of glycine or more had postoperative nausea, with cerebral oedema suspected in 9. None of the 10 patients who absorbed less than 500 mL had nausea; changes on CT scan suggestive of cerebral odema were found in 1. 8 patients who absorbed 1000 mL or more had a decrease in serum sodium of 10 mmol/L or more, nausea, and cerebral oedema on CT scan. Cerebral oedema may contribute to the development of postoperative nausea in patients undergoing transcervical surgery who absorb more than 500 mL of 1.5% glycine irrigating solution.

Absorption↗
PubMed1993

Acute tissue effects during transcervical endometrial resection.

The acute tissue effects of transcervical endometrial resection (TCRE) with a standard Iglesias resectoscope using glycine 1.5% for irrigation were studied in 8 women prior to hysterectomy. Combinations of 80 or 120 W cutting current with blend 1 or 2 were applied for endometrial resection, preceded by cornual endometrial coagulation with the roller ball electrode with a coagulation effect of 40 or 60 W. The temperature was measured at the uterine vessels, ovarian ligaments and serosal surface. The increase in temperature at the serosal surface was 2.0 degrees C during cornual coagulation and 0.3 degrees C during endometrial resection, independent of the current effect applied. The maximum depth of tissue damage was 1.7 mm. No change in temperature was found at the uterine vessels or ovarian ligaments. The tissue destruction and the increase in temperature of the uterine surface are minimal, and TCRE offers excellent histological material. Careful coagulation/resection in the cornual and isthmus regions is recommended.

Adult↗
PubMed1993

Laparoscopic tubal anastomosis: reversal of sterilization.

A case of laparoscopic reversal of tubal sterilization is reported. The patient was a 38 year old woman sterilized by bipolar diathermia two years earlier. Refertilization was performed by laparoscopic end to end anastomosis of one tube. Postoperatively, the patient had one menstruation and then achieved an intrauterine pregnancy. The laparoscopic method of refertilization saves expensive hospitalization costs.

Adult↗
PubMed1992

Changes in serum electrolytes after transcervical resection of endometrium and submucous fibroids with use of glycine 1.5% for uterine irrigation.

OBJECTIVE: We evaluated the postoperative changes in serum electrolytes in relation to the amount of irrigating fluid absorption and the occurrence of nausea and vomiting after transcervical resection of endometrium and submucous fibroids. METHODS: From May 1989 to October 1991, 101 consecutive patients were operated on for menometrorrhagia with transcervical resection of endometrium and submucous fibroids using glycine 1.5% for uterine irrigation. The deficit of glycine was assessed during and at the end of the operation. During the postoperative course, attention was paid to the occurrence of cerebral confusion, nausea (defined by at least one incident of vomiting), and dyspnea. The serum levels of sodium, potassium, and chloride were assessed before the operation, at the end of the procedure, and after 4, 8, and 12 hours. RESULTS: No marked water intoxication or signs of volume overload were seen, but 33% of the patients had nausea and vomiting in the postoperative period. These patients showed a more pronounced postoperative decrease in serum sodium (P = .0001) and a larger glycine deficit (P = .004) than did patients without nausea. The postoperative decrease in serum sodium correlated significantly to the glycine deficit (R2 = 0.83, P less than .001). CONCLUSION: Postoperative hyponatremia after transcervical resection of the endometrium correlated with the deficit of irrigant fluid but not with the operation time or the total amount of irrigant fluid used. We recommend that serum sodium be controlled and corrected if necessary postoperatively in patients with nausea and vomiting.

Absorption↗
PubMed1991

[Transcervical resection of endometrium and myomas in women with bleeding disorders].

Recently hysteroscopic resection of the endometrium and of fibroids has become an alternative to hysterectomy. This treatment preserves the uterus, the equipment is cheap and outpatient treatment is possible. 32 patients were treated with resection of the endometrium and 18 patients with resection fibroids. 23 patients have been followed up for a period of at least six months. Out of these, eight patients became amenorhoic and 15 experienced a more than 50% reduction in the use of sanitary pads. In conclusion, transcervical resection of the endometrium and of fibroids is a useful and a promising alternative in the treatment of the common complaint of meno/metroragia.

Adult↗
PubMed1991

Transcervical resection of endometrium and fibroids. Initial complications.

Transcervical resection of endometrium--and of submucous fibroids when present--seems to represent a new alternative to hysterectomy for patients with uncontrolled bleeding disorders. In the present study, we report our initial experience with the first 20 patients treated with a standard, rigid urological resectoscope. Resection of endometrium--and of fibroids when present--was carried out under general anesthesia. The uterine cavity was distended and irrigated with glycine 1.5%. Two perforations occurred, but damage to neighboring organs was not seen. In one patient, copious bleeding was encountered and hysterectomy became necessary the following day. Clinical signs of postoperative infection occurred in 3 patients. Otherwise, no major morbidity was seen during or after the procedure. In 2 patients with persistent metrorrhagia, re-resection was performed after 2-3 months and satisfactory bleeding control achieved. At the 3-month follow-up, 2 further patients complained of persistent bleeding and had an abdominal hysterectomy performed. In the remaining patients, satisfactory bleeding control was reported at the 6-month follow-up. Although large series are needed to assess the complications associated transcervical resection of the endometrium, the technique may be applied in departments with experience in routine hysteroscopy, and the approach seems to represent an attractive alternative to hysterectomy.

Adult↗
PubMed1988

Perineal rupture following vaginal delivery. Long-term consequences.

Twenty-five women with complete perineal rupture were compared with a control group of 25 women, with regard to risk factors and possible long-term sequelae as a consequence of perineal damage. Following an average period of 78 months (52-123), all women received a questionnaire and were invited to a clinical follow-up, which included perineal inspection and measurement of the anal pressure profile. Vacuum extraction was more frequent in the rupture group than among controls (p less than 0.002). Eighty percent of the women in the rupture group were primiparae, compared with an overall rate of 40% (p less than 0.02). Forty-two percent of the women in the rupture group reported anal incontinence, compared with none in the control group (p less than 0.01). Most of these women reported stress-provoked incontinence regarding flatus and loose stools. Measurement of the anal pressure profile showed markedly reduced sphincter pressure, with maximum squeeze in the rupture group, but no differences were found regarding maximum anal pressure at rest. Sphincter length was reduced both at rest and with maximal squeeze in the rupture group. It is concluded that complete perineal rupture is a condition with possible long-term consequences such as reduced sphincter strength and partial anal incontinence.

Adult↗