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Biomedical subjects

T Tulandi

Publications and source records attributed to T Tulandi.

At least 19 recordsLinked to original sources
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↗
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

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↗
PubMed1995

Excision of ovarian dermoid cyst by laparoscopy and by laparotomy.

OBJECTIVES: Our purpose was to evaluate the efficacy of laparoscopic ovarian dermoid cystectomy and to compare the operative course, postoperative course, and complications between the laparoscopy and the laparotomy techniques. STUDY DESIGN: The safety and efficacy of laparoscopic ovarian dermoid cystectomy were evaluated in 40 women. Twenty-nine of 40 patients underwent laparoscopic excision of a solitary dermoid cyst without any additional procedure. The operative course, the postoperative course, and complications among these 29 women were compared with those of 26 other women who underwent a similar procedure by laparotomy. RESULTS: Spillage of the cyst's content did not lead to any complication. The operating time in the laparoscopy group was 73.5 +/- 4.7 minutes and in the laparotomy group it was 41.4 +/- 2.9 minutes. The duration of hospitalization was significantly shorter in the laparoscopy group (0.7 +/- 0.2 days) than in the laparotomy group (3.8 +/- 0.1 days). CONCLUSIONS: Although ovarian dermoid cystectomy by laparoscopy is associated with a longer operating time than by laparotomy, the duration of hospitalization is shorter and recovery is faster. Spillage of the contents of the dermoid cyst does not lead to any complication; perhaps this is due to the liberal irrigation of the peritoneal cavity.

Adult↗
PubMed1995

Laparoscopic treatment of interstitial pregnancy.

The conventional treatment of interstitial pregnancy has been cornual resection of hysterectomy by laparotomy. We have used a laparoscopic approach to treatment of interstitial pregnancy, consisting of cornual excision in four patients and salpingotomy incision via the myometrium in another. In all five cases, the procedure was associated with minimal bleeding and no complications.

Electrocoagulation↗
PubMed1995

Operative laparoscopy: surgical modalities.

OBJECTIVE: To review basic physics of different surgical modalities and their clinical applications and outcomes. DESIGN: The relevant literature and personal experience were used to prepare the manuscript. RESULTS: Operative laparoscopy is safe and effective whether using sharp dissection, electrosurgical, or laser energy. The newer surgical modalities, including the vibrating ultrasound scalpel and argon beam coagulator, need further evaluation. CONCLUSIONS: The results of laparoscopic surgery are independent of the surgical modality used. The surgeon's skill and experience, his or her preference of the technique, and proper patient selection play a more important role.

Electrosurgery↗
PubMed1995

Reactions to infertility based on extent of treatment failure.

OBJECTIVE: To examine the relationship between amount of treatment failure and personal and marital distress. DESIGN: In this cross-sectional design, three groups of women (n = 91) with varying amounts of treatment failure experience were compared on measures of general and infertility-related distress and marital and sexual distress. RESULTS: The relationship between treatment failure experience and personal and marital distress was found to be curvilinear. The group that had a moderate amount of treatment failure experienced the most distress whereas the distress level of those without or with a high amount of treatment failure experience was comparable. The results also showed that the relationship between amount of treatment failure and distress was independent of age, years infertile, or years in treatment. CONCLUSION: The findings of this study provide support for infertility theories that suggest that infertility is a process rather than a series of independent emotional events and suggest that the distress women experience during infertility is a necessary part of their evolution toward acceptance of their infertility.

Adult↗
PubMed1994

Histopathological and adhesion formation after incision using ultrasonic vibrating scalpel and regular scalpel in the rat.

OBJECTIVE: To evaluate and to compare changes that occur in the uterine tissue of the rat after a standard incision with an ultrasonic vibrating scalpel and with a regular scalpel. SETTING: Sprague-Dawley white rats (Charles River Canada Inc., St. Constant, Quebec, Canada) in a conventional laboratory setting. INTERVENTIONS: A standardized incision was performed on the uterine horn with a regular scalpel on one uterine horn and with an ultrasonic scalpel on the opposite horn. MAIN OUTCOME MEASURES: Degree of adhesions and histopathological changes of the uterine horns. RESULTS: The degree of adhesion formation was similar, but the uterine horn distal to the incision was dilated in most uterine horns that were incised with ultrasonic scalpel. The degree of coagulation necrosis was significantly higher 7 and 14 days after incision with an ultrasound scalpel than after incision with a regular scalpel. CONCLUSION: The use of an ultrasonic vibrating scalpel is associated with more tissue injury than that of a regular scalpel, but it does not produce more adhesion formation.

Animals↗
PubMed1994

Medical and surgical treatment of ectopic pregnancy.

Laparoscopic removal of the products of conception remains the treatment of choice for ectopic pregnancy (EP). Systemic administration of methotrexate (MTX) is a promising new treatment; however, its efficacy has to be established in clinical trials. Local treatment by laparoscopy with MTX, prostaglandin, or other substances is not as effective as laparoscopic salpingostomy.

Female↗
PubMed1993

Effects of synthetic growth hormone-releasing factor in women treated with gonadotrophin.

To evaluate the effects of synthetic growth hormone-releasing factor (GRF) in women with idiopathic infertility who were treated with human menopausal gonadotrophin (HMG), 13 women with this condition were randomly assigned to undergo treatment with HMG-GRF (500 micrograms twice daily) or HMG-placebo. Conception occurred in four of six women (14 cycles) who received HMG-GRF and in one of seven women (22 cycles) who received HMG-placebo. No difference was found in the amount of HMG and the duration of HMG required to induce ovulation between the two groups of patients. The overall serum growth hormone and insulin-like growth factor I concentrations were higher in the GRF than in the placebo group. No difference was found in serum oestradiol or inhibin concentrations between the two groups. Our results suggest that in women with idiopathic infertility, administration of GRF does not decrease the duration or the amount of HMG required to induce ovulation. However, it appears that in this small group concomitant treatment with GRF increases the pregnancy rates in women who are treated with HMG (4/14 cycles compared with 1/22 cycles).

Adult↗
PubMed1993

Spontaneous resolution of ectopic pregnancy: initial appearance and evolution at transvaginal US.

Spontaneous resolution of ectopic pregnancy (EP) diagnosed with transvaginal ultrasound (US) was confirmed in 13 patients from May 1990 to December 1991. These cases accounted for 24% of the total number of EPs seen in our institution during the same period. These EPs ranged in size from 1 to 3.5 cm, and the beta subunit of human chorionic gonadotropin (beta-hCG) level was less than 1,000 IU/L in all patients. The serum beta-hCG levels became undetectable in 3-45 days (mean, 15.8 days). All EPs had completely resolved at follow-up transvaginal US performed 10-63 days (mean, 30 days) after initial examination. A gestational sac was present in three of these patients, and various degrees of vascularity were detected in four. Four of the resolving EPs increased in size. Four of the nine EPs without detectable flow initially became mildly vascular during the course of resolution. The authors concluded that spontaneous resolution of EP is not an uncommon phenomenon and occurs more commonly in patients with less advanced and less vascular EPs and serum beta-hCG levels less than 1,000 IU/L. EPs can increase in size and become more vascular during their course of resolution.

Adult↗
PubMed1993

Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy.

OBJECTIVES: To evaluate adhesion formation after myomectomy and the reproductive outcome of infertile women with a large leiomyomatous uterus after myomectomy and second-look laparoscopy. METHODS: Twenty-six infertile women with a large leiomyomatous uterus underwent second-look laparoscopy 6 weeks after a myomectomy. At laparoscopy, the degree of adhesions was scored using the American Fertility Society classification of adnexal adhesions, and the adhesions were lysed. The pregnancy rates of these women were evaluated by life table analysis. RESULTS: A myomectomy incision on the posterior wall of the uterus was associated with more adnexal adhesions than that on the fundus or anterior uterine wall (93.7 versus 55.5%; P = .04). The degree of adnexal adhesions was also higher among women who underwent myomectomy with a posterior uterine incision (22.2 +/- 2.3 points) than in those with a fundal or anterior uterine incision (2.7 +/- 1.2 points) (P < .000001). The cumulative pregnancy rate was 33.4% at 6 months and 66.7% at 12 months after the procedures. CONCLUSIONS: Myomectomy incisions on the posterior uterine wall are associated with more and a higher degree of adnexal adhesions than those on the fundus and anterior wall. Conception occurs in the majority of infertile women with a large myomatous uterus who undergo myomectomy and second-look laparoscopy.

Adnexal Diseases↗
PubMed1992

The effects of female sexual response in coitus on early reproductive processes.

Research has shown that infertility and its medical investigation are stressful for couples and have adverse effects on sexual functioning. The purpose of this study was to examine how female sexual functioning could influence aspects of the reproductive process. This question was examined within the context of the postcoital test (PCT) routinely performed during the infertility investigation. The sample consisted of 85 women with a mean age of 30 years (SD = 3.8 years) and a mean infertile period of 2.5 years (SD = 1.1 years). Prior to the physiological examination, women completed a battery of questionnaires about their sexual functioning during the scheduled encounter engaged in for purposes of the PCT and during other nonscheduled encounters. The results indicated that the PCT contributed to deterioration in female sexual functioning, and in turn, a poor sexual response was associated with poorer physiological results. The implications of sexual behavior influencing physiohormonal reproductive factors are discussed.

Adult↗
PubMed1992

Nonsurgical treatment of ectopic pregnancy.

Expectant management and medical treatment of ectopic pregnancy either systemically or locally are reviewed. Because of the risks of tubal rupture, this nonsurgical management should be done with utmost care. To date, surgical removal of an ectopic pregnancy remains the method of choice and this can be safely done by laparoscopy. Alternate treatments should be carefully evaluated in clinical trials.

Abortifacient Agents, Nonsteroidal↗