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Biomedical subjects

Togas Tulandi

Publications and source records attributed to Togas Tulandi.

At least 19 recordsLinked to original sources
PubMed2006

Effects of treatment with leuprolide acetate depot on working memory and executive functions in young premenopausal women.

The goal of this study was to assess the influence of sex steroid hormone suppression on performance on tests of prefrontal cortex (PFC) and working memory function (WM) in premenopausal women. Twenty-five women were treated with leuprolide acetate depot (LAD), a gonadotropin releasing hormone (GnRH) analog that chemically suppressed ovarian function as treatment of various benign gynecologic disorders. Performance on tests of PFC and WM of the LAD-treated women was assessed at pretreatment baseline and, again, following 4 weeks of treatment and their performance was compared to that of 25 healthy, control participants matched on age, education, and general intelligence. Following 4 weeks of LAD treatment, estrogen levels decreased to the postmenopausal range whereas progesterone levels fell to the lower limit of the menstrual cycle range of values. Furthermore, the LAD-treated women also experienced a significant deterioration in mood, in health-related symptoms and in performance on two tests of WM following 4 weeks of treatment. It was determined that only the post-treatment declines in estrogen, but not those in progesterone, in mood, or in health-related symptoms were associated with the worsening of performance on the WM tests. These findings provide new evidence that estrogen is influential in the maintenance of WM processes in premenopausal women.

Adult↗
PubMed2006

Congenital malformations among 911 newborns conceived after infertility treatment with letrozole or clomiphene citrate.

OBJECTIVE: To evaluate the incidence of congenital malformations among offspring of mothers who conceived with clomiphene citrate (CC) or with letrozole treatment for infertility. DESIGN: Retrospective study. SETTING: 5 fertility centers in Canada. PATIENTS: 911 newborns from women who conceived following CC or letrozole treatment. INTERVENTIONS: Examination of medical files of both mother and newborn, and cross-checked with the parents by telephone calls. MAIN OUTCOME MEASURES: Identified major and minor congenital malformations, birth weight, age of the mother, and type of treatment that led to the conception. RESULTS: Overall, congenital malformations and chromosomal abnormalities were found in 14 of 514 newborns in the letrozole group (2.4%) and in 19 of 397 newborns in the CC group (4.8%). The major malformation rate in the letrozole group was 1.2% (6/514) and in the CC group was 3.0% (12/397). One newborn in the letrozole group was found to have a ventricular septal defect (0.2%) compared to 4 newborns in the CC group (1.0%). In addition, the rate of all congenital cardiac anomalies was significantly higher (P: 0.02) in the CC group (1.8%) compared to the letrozole group (0.2%). CONCLUSION: There was no difference in the overall rates of major and minor congenital malformations among newborns from mothers who conceived after letrozole or CC treatments. However, it appears that congenital cardiac anomaly is less frequent in the letrozole group. The concern that letrozole use for ovulation induction could be teratogenic is unfounded based on our data.

Adult↗
PubMed2006

Failure of uterine fibroid embolization.

OBJECTIVE: To assess the outcomes of patients who underwent uterine fibroid embolization (UFE) and to evaluate factors associated with failure of UFE. DESIGN: Retrospective study. SETTING: University teaching hospital. PATIENT(S): Two hundred thirty-three consecutive patients who underwent UFE from November 1997 to February 2004. INTERVENTION(S): Uterine fibroid embolizations were performed by three interventional radiologists using 355-500-mu polyvinyl alcohol particles. MAIN OUTCOME MEASURE(S): Hysterectomy rate, myomectomy rate, and repeat UFE rate. RESULT(S): With a mean follow-up of 13 months, a total of 22 patients underwent surgery after UFE (9.4%); 16 had hysterectomies (6.9%), and 6 had myomectomies (2.6%). This included 3 patients who underwent repeat UFE and subsequently required surgical intervention. The mean (+/- SEM) time interval between UFE and subsequent treatment was 12.5 +/- 2.0 months. Among patients who required surgery, 13 (59.1%) presented with recurrent menorrhagia, and 5 (22.7%) complained of persistent abdominal pain. Histopathologic examination revealed concomitant findings of adenomyosis in 25% of hysterectomy specimens. Patients who failed UFE were more likely to have had a previous myomectomy (13% vs. 2.4%) and significant reduction in the uterine size 6 months after UFE (57.1% vs. 25.2%). CONCLUSION(S): The overall failure rate of UFE is 9.4%. Failure is mainly due to persistent menorrhagia and abdominal pain. Shrinkage of the uterus after UFE does not necessarily correlate with long-term success of UFE.

Adult↗
PubMed2006

A new era in ovulation induction.

OBJECTIVE: To evaluate the efficacy of aromatase inhibitors in ovulation induction, superovulation, and IVF. DESIGN: A literature search was conducted with the key words "aromatase inhibitor," "letrozole," "anastrazole," "ovulation induction," "ovulation," and "superovulation" in MEDLINE, EMBASE, and the Cochrane Database of systematic reviews. RESULT(S): Ovulation induction with letrozole is associated with an ovulation rate of 70%-84% and a pregnancy rate of 20%-27% per cycle. In one study, ovulation and pregnancy rates with letrozole seemed to be higher than those of anastrazole. In superovulation, letrozole is associated with few developing follicles and thick endometrium. The use of letrozole for superovulation is associated with a pregnancy rate higher than with the use of clomiphene citrate (CC) (16.7% vs. 5.6%). The addition of letrozole to FSH treatment leads to a decreased FSH requirement. The pregnancy rate for treatment with letrozole and FSH was similar to that for FSH alone. CONCLUSION(S): Aromatase inhibitors are as effective as or superior to CC in ovulation induction and in superovulation. Unlike CC, they do not carry an antiestrogenic effect on the endometrium. Given the advantages of aromatase inhibitors, they can be used to replace CC as ovulation-inducing drugs. Their role in IVF remains to be determined.

Aromatase Inhibitors↗
PubMed2006

A randomized trial of superovulation with two different doses of letrozole.

OBJECTIVE: The aim of this study was to evaluate the effects of either a 2.5-mg or a 5-mg daily dose of letrozole in women undergoing superovulation and intrauterine insemination (IUI). DESIGN: Prospective randomized trial. SETTING: Academic teaching hospital. PATIENT(S): Women <40 years old, with patent fallopian tubes and infertility of >1 year in duration. INTERVENTION(S): Patients were randomized into either a 2.5-mg dose of letrozole (34 patients) or a 5-mg dose of letrozole (38 patients) daily for 5 days. When the leading follicle reached 18 mm in diameter, ovulation was triggered by an injection of hCG and IUI was performed 24 and 48 hours later. MAIN OUTCOME MEASURE(S): The number of follicles, endometrial thickness, and pregnancy rate. RESULT(S): Compared with those treated with 2.5 mg of letrozole, the total number of follicles was significantly higher in patients receiving 5 mg of letrozole. No difference in the endometrial thickness was found between the two groups. The pregnancy rate per cycle in patients receiving 5mg of letrozole was statistically higher than in patients receiving 2.5 mg of letrozole (26.3% vs. 5.9%, P<.05). No multiple pregnancies occurred. CONCLUSION(S): Compared with the daily dose of 2.5 mg, 5 mg of letrozole is associated with more follicles and a higher pregnancy rate. It appears that 5 mg daily for 5 days is a preferable letrozole dose for superovulation.

Adult↗
PubMed2006

Effects of different stages of endometriosis on the outcome of in vitro fertilization.

OBJECTIVE: This study was undertaken to evaluate the effects of different stages of endometriosis on the outcome of treatment in an in vitro fertilization (IVF) program. METHODS: This was a retrospective, matched case-control study in an academic tertiary referral centre. The study group consisted of 87 women with laparoscopically diagnosed endometriosis, and the control group consisted of 87 age-matched women undergoing IVF for different reasons. The primary outcomes were duration of stimulation, total gonadotropin dose requirement, peak serum estradiol level, total number of oocytes retrieved, fertilization rate, embryo quality, implantation rate, and clinical pregnancy rate. The effect of obliteration of the cul-de-sac by endometriosis was also evaluated. RESULTS: Women with endometriosis required significantly higher gonadotropin doses than women in the control group (P < 0.01). The fertilization rate was significantly lower for women with endometriosis (P < 0.05), although there was no difference in embryo quality or in the number of embryos transferred. In patients with an obliterated cul-de-sac, fewer oocytes were retrieved than in patients in the control group (P < 0.01). CONCLUSION: The presence of endometriosis, including stages III and IV, does not affect IVF outcome. However, women with endometriosis require more gonadotropin stimulation than those with no endometriosis. Women with an obliterated cul-de-sac have fewer oocytes retrieved than women without obliteration.

Adult↗
PubMed2006

Adhesion-related bowel obstruction after hysterectomy for benign conditions.

OBJECTIVE: To evaluate the occurrence of small bowel obstruction after hysterectomy. METHODS: Analysis of 326 cases of women who were admitted with a diagnosis of small bowel obstruction during the period 1998-2005. Among cases with small bowel obstruction after hysterectomy for benign conditions, we evaluated the type and technique of hysterectomy and whether the parietal peritoneum was sutured at the completion of the procedure. RESULTS: The main causes of bowel obstruction were intra-abdominal adhesions (41.9%) and abdominal malignancy (40.1%). After excluding oncologic cases, we found that, of 135 cases of adhesion-related small bowel obstruction, gynecologic operations played the largest role in the occurrence of bowel obstruction (n=68, 50.4%). Among all gynecologic operations for benign conditions, total abdominal hysterectomy (TAH) was the most common cause of small bowel obstruction (13.6 per 1,000 TAHs). We did not encounter small bowel obstruction after laparoscopic supracervical hysterectomy. The reduction in absolute risk of small bowel obstruction from TAH to laparoscopic supracervical hysterectomy is 13.6 per 1,000 cases; 73 patients would undergo laparoscopic supracervical hysterectomy to prevent one small bowel obstruction. The median interval between TAH and small bowel obstruction was 4 years. The adhesions were adherent to the previous laparotomy incision in 27 cases (75%) and to the vaginal vault in nine cases (25%). Peritoneal closure was not associated with small bowel obstruction. CONCLUSION: Hysterectomy plays a major role in the occurrence of adhesion-related small bowel obstruction. Closure of the parietal peritoneum does not contribute to the occurrence of adhesion-related small bowel obstruction, and small bowel obstruction rarely occurs after laparoscopic supracervical hysterectomy. LEVEL OF EVIDENCE: II-3.

Female↗
PubMed2005

Diagnosis and treatment of ectopic pregnancy.

Ectopic pregnancy is a life- and fertility-threatening condition that is commonly seen in Canadian emergency departments. Increases in the availability and use of hormonal markers, coupled with advances in formal and emergency ultrasonography have changed the diagnostic approach to the patient in the emergency department with first-trimester bleeding or pain. Ultrasonography should be the initial investigation for symptomatic women in their first trimester; when the results are indeterminate, the serum beta human chorionic gonadotropin (beta-hCG) concentration should be measured. Serial measurement of beta-hCG and progesterone concentrations may be useful when the diagnosis remains unclear. Advances in surgical and medical therapy for ectopic pregnancy have allowed the proliferation of minimally invasive or noninvasive treatment. Guidelines for laparoscopy and for methotrexate therapy are provided.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

Quality of fertility clinic websites.

OBJECTIVE: To evaluate the overall quality of the Society for Assisted Reproductive Technology (SART)-affiliated fertility clinic websites, according to American Medical Association (AMA) Internet health information guidelines. DESIGN: Cross-sectional evaluation. SETTING: Two hundred sixty-six websites drawn from the SART directory and the World Wide Web. INTERVENTION(S): Three objective scoring scales (ownership, content, and navigation) adapted from AMA guidelines. MAIN OUTCOME MEASURES: Seven objective criteria for ownership, 8 for content, and 11 for website navigation. RESULT(S): Two thirds of SART-affiliated fertility clinics have functional websites. Of the 236 sites evaluated, 58 belong to hospital centers. Overall, the scores for the three scoring scales were low. Compared with the websites of non-hospital clinics, those of hospital centers were more likely to include information about site ownership and affiliations (89.7% vs. 60.7%) and patient privacy (34.5% vs. 20.8%). Also, contents of hospital center websites were significantly easier to distinguish from advertisements (70.7% vs. 47.7%), and reference sources for specific contents were easier to identify (27.6% vs. 8.4%). Hospital center websites were more likely to indicate affiliations and financial disclosures of authors (25.9% vs. 10.7%), to feature a site map (25.9% vs. 12.3%), and to have a search function (31.0% vs. 5.6%). CONCLUSION(S): Websites of SART-affiliated clinics fail to meet most of the AMA health information guidelines. The quality of the hospital centers' websites is better than that of private clinics.

Academic Medical Centers↗
PubMed2005

A call for standardization of fertility clinic websites.

Websites for Society for Assisted Reproductive Technology-affiliated clinics fail to meet most American Medical Association health information guidelines. Professional organizations in reproductive medicine need to standardize the accuracy and appropriateness of online reproductive health information.

Ambulatory Care Facilities↗
PubMed2005

Insulin responses to the oral glucose tolerance test in women of different ethnicity with polycystic ovary syndrome.

OBJECTIVE: To evaluate insulin responses to the oral glucose tolerance test (OGTT) in women of different ethnic origins diagnosed with polycystic ovary syndrome (PCOS). METHODS: We evaluated 92 women diagnosed with PCOS. Their ethnic origins were Western European (n = 41), Middle Eastern (n = 18), African American (n = 15), East Indian (n = 9), and South American (n = 9). The clinical diagnosis of PCOS included at least 3 of the following symptoms: menstrual disturbances (amenorrhea or oligomenorrhea); ovulatory infertility, hirsutism, and elevated serum testosterone (> or = 2.0 nmol/L); or a luteinizing hormone/ follicle-stimulating hormone ratio of > or = 3. The diagnosis was also supported by ultrasonographic changes revealing the presence of multiple small antral follicles distributed peripherally. All investigations were performed after an overnight fast on days 2 through 5 of a spontaneous menstrual cycle or progesteroneinduced withdrawal bleeding. The women underwent an OGTT with a glucose loading of 75 g. The responses of glucose and insulin to the OGTT were analyzed as the area under the curve (AUC) and were calculated with the trapezoidal method. RESULTS: There were no significant differences in age or body mass index (BMI) among the different ethnic groups. All groups showed endocrine changes consistent with PCOS, but there were no differences in the hormonal levels among them. Middle Eastern women had higher AUC, glucose (P < 0.02; 95% confidence interval [CI], 0.5-3.5), and insulin (P < 0.04; 95% CI, 13.3-593.4) levels than did women with Western European origin. CONCLUSIONS: Middle Eastern women with PCOS expressed different insulin responses to OGTT than did Western European women, suggesting that Middle Eastern women with PCOS had poor carbohydrate metabolism.

Adult↗
PubMed2005

Adhesion prevention in gynecologic surgery.

PURPOSE OF REVIEW: The purpose of this review is to discuss new substances and techniques to prevent post-surgical adhesion formation. RECENT FINDINGS: Intraperitoneal administration of sprayable hydrogel and hyaluronic acid appears to decrease postmyomectomy adhesions. Intrauterine instillation of auto-crosslinked hyaluronic acid is associated with fewer intrauterine adhesions. Temporary abdominal oophoropexy after surgery of stage III and IV endometriosis might be beneficial in reducing ovarian adhesion. SUMMARY: There has been a wide range of adhesion-reducing substances evaluated in animal models. However, in clinical situations, no adhesion-preventing substance, material, or barrier is unequivocally effective. In view of surgical technique, compared to laparotomy, the laparoscopic approach is associated with less adhesion formation. Temporary abdominal oophoropexy may provide a promising technique to prevent ovarian adhesions. Future research should also be directed toward preventing intrauterine adhesions.

Animals↗