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Biomedical subjects

Togas Tulandi

Publications and source records attributed to Togas Tulandi.

At least 37 records · Page 2Linked to original sources
PubMed2005

Adhesion in gynecology complication, cost, and prevention: a review.

The objective of this chapter is to evaluate the magnitude of the problems of adhesions in Gynecology, complications, cost for the health care, and methods to prevent adhesion formation. It contains a review of relevant literature on intra-abdominal adhesion, adhesion-reducing substances, and their related cost. Adhesions can cause infertility, abdominal pain, or bowel obstruction. The impact of adhesions to the health-care system is huge. The total cost of adhesion-related problems in the United States is more than dollar 1 billion dollars annually. Modification in surgical technique, such as the use of laparoscopy, can minimize adhesion formation. Another approach is by using adhesion-reducing substances. Many substances and materials have been used to decrease the adhesion formation; however, there remains no unequivocally effective adhesion-reducing substance. Also, its use is costly. To our knowledge, no study has been published to date that addresses the use of adhesion-reducing substances as relates to the risk of bowel obstruction or long-term costs to the health-care system.

Abdomen↗
PubMed2004

The art of taking a history.

The standard questionnaire is a tool to collect information for a survey, but its validity for patient management is doubtful. Taking a history is a skill that cannot be replaced by a questionnaire.

Fallopian Tube Diseases↗
PubMed2004

Nerve fibers in ovarian dermoid cysts and endometriomas.

No nerve fibers are found in endometriomas or in the endometrioma-containing ovaries. These findings are consistent with our previous report that no correlation exists between the presence of nerve fibers and endometriosis.

Dermoid Cyst↗
PubMed2004

A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation.

OBJECTIVE: To compare the effects of the aromatase inhibitor letrozole (7.5 mg) and clomiphene citrate (CC; 100 mg) in women undergoing superovulation and IUI. DESIGN: Prospective randomized trial. SETTING: University teaching hospital. PATIENT(S): We studied a total of 238 cycles of superovulation and IUI in women with idiopathic infertility. INTERVENTIONS: Patients were randomized into treatment with 7.5 mg of letrozole daily (74 patients, 115 cycles) or 100 mg of CC daily (80 patients, 123 cycles). MAIN OUTCOME MEASURE(S): Number of follicles, endometrial thickness, pregnancy rate, and miscarriage rate. RESULT(S): The mean age, parity, and duration of infertility in both groups of patients were similar. There was no significant difference between the total number of developing follicles in the letrozole (5.7 +/- 3.7) and in the CC groups (4.8 +/- 2.5). The number of follicles of > or =14 mm and of >18 mm were 2.1 +/- 1.2 and 1.4 +/- 0.7 in the letrozole group, and 1.7 +/- 0.9 and 1.1 +/- 0.5 in the CC group, respectively. No difference was found in the endometrial thickness between the two groups (7.1 +/- 0.2 mm in the letrozole group, 8.2 +/- 5.9 mm in the CC group). The pregnancy rate per cycle was 11.5% in the letrozole group and 8.9% in the CC group. Four of the 11 pregnancies in the CC group resulted in a miscarriage (36.6%). CONCLUSION(S): Superovulation and IUI with letrozole and CC are associated with similar pregnancy rates, but the miscarriage rate is higher with CC. The ideal dose of letrozole remains unknown and further study is needed.

Abortion, Spontaneous↗
PubMed2004

Laparoscopic abdominal cerclage.

Cervical cerclage is an effective treatment of cervical incompetence. It is conventionally done by laparotomy approach. Laparoscopic abdominal cerclage is a less invasive technique that could replace the laparotomy technique. Laparoscopic abdominal cerclage does not require hospitalization, is associated with less pain, and leads to a faster recovery. Laparoscopic abdominal cerclage is equal to or may be better than abdominal cerclage by laparotomy.

Abdomen↗
PubMed2004

Laparoscopic fertility preservation.

Advances in cancer therapy have improved the long-term survival of young patients suffering from malignancies. The adverse effects of the treatment, however, are sterility and loss of gonadal function especially in females. If preservation of fertility in males by sperm freezing is already established, for young women undergoing cancer treatment the availability of preserving the gonadal function and fertility has just begun. Diseases commonly treated with radiation or chemotherapeutic agents in young women are breast cancer, lymphoma, leukemia, blood dyscrasia, glomerulonephritis, lupus erythematosus, and rheumatoid arthritis.

Female↗
PubMed2004

Ovarian function after uterine artery embolization and hysterectomy.

STUDY OBJECTIVE: To evaluate the effect of uterine artery embolization (UAE) and hysterectomy on ovarian function. DESIGN: Prospective case control study (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: Eighty-four healthy premenopausal women with symptomatic uterine myoma(s) undergoing UAE or hysterectomy. INTERVENTION: Patients had blood drawn to measure follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) levels and underwent transvaginal ultrasound to measure volume of the myoma(s) and uterus on cycle day 3 before the procedures. These measurements were repeated 3 and 6 months after treatment. MEASUREMENTS AND MAIN RESULTS: The main outcome was the differences in serum FSH, LH, E2, and ultrasound findings before and after UAE or hysterectomy. Of the 68 patients who underwent UAE and 16 who underwent hysterectomy, 48 and 13 respectively, completed 6-month follow-up. The mean age of the patients in the UAE group was 44.9 +/- 3.8 years and 43.7 +/- 5.6 years in the hysterectomy group. There was no significant difference in serum FSH before (8.9 +/- 0.7 IU/L) and 6 months after UAE (9.9 +/- 1.0 lU/L), and between the baseline (10.4 +/- 1.8 lU/L) and 6 months posthysterectomy (7.8 +/- 1.8 lU/L). The uterine volume 6 months after UAE (361 +/- 50 mL) was significantly smaller than before UAE(538 +/- 38mL; p =.005, 95% CI 44-241). Compared with baseline (154 +/- 20 mL), the dominant myoma volume was smaller at 6 months after UAE (97 +/- 16 mL; p <.05, 95% CI 1.57-62). CONCLUSION: Uterine artery embolization is associated with a significant reduction in myoma and uterine volume. Ovarian function at 6 months, as indicated by day 3 FSH levels, is not affected by UAE or hysterectomy.

Adult↗
PubMed2004

Effects of repeated treatment failure on the quality of life of couples with infertility.

OBJECTIVE: To determine the impact of repeated treatment failure of clomiphene and intrauterine insemination on the quality of life of couples with infertility. METHODS: A prospective comparative study involving 3 groups of 50 couples each. The first group consisted of infertile couples with repeated treatment failure (group FT), the second group consisted of infertile couples who had never attempted any medical treatment (group NT), and the third was a control group of couples with at least 1 child and no history of infertility. Participants completed a comprehensive questionnaire to assess 16 areas of quality of life. RESULTS: The quality of life score of the control group was higher than the scores reported by groups NT and FT (P <.001). There was no significant difference in the quality of life score reported by group NT and group FT or between male and female partners. Among the women, a high quality of life was reported by 22% in group FT, 14% in group NT, and 54% in the control group. Among the men, a high quality of life was reported by 14% in group FT, 12% in group NT, and 60% in the control group. In contrast to their male partners, the women with repeated treatment failure placed higher importance on children and home than their counterparts who had not started the treatment (P <.05). CONCLUSION: Although couples with repeated treatment failure of clomiphene and intrauterine insemination do not demonstrate a lower overall quality of life than other infertile couples beginning baseline assessment, the quality of life of infertile couples is lower than that of fertile couples.

Adult↗
PubMed2004

Adhesion prevention in gynecologic surgery.

UNLABELLED: The objectives of this study are to evaluate the magnitude of postsurgical adhesions clinically, their impact on the hospital budget, and the available adhesion-reducing substances. We conducted a review of relevant literature on intraabdominal adhesion, adhesion-reducing substances, and their related cost. The relevance of adhesions to gynecology not only relates to infertility and abdominal pain, but also to the occurrence of bowel obstruction. There have been many substances and materials used to decrease the adhesion formation. However, there is still no adhesion-reducing substance that is unequivocally effective. Its use is also costly. The most common cause of small-bowel obstruction is postsurgical adhesions. Indeed, more than one half of patients with adhesion-related small-bowel obstruction had previous gynecologic operations, and a high percentage occurs after abdominal hysterectomy. To date, there has been no study suggesting that the use of adhesion-reducing substances decreases the risk of bowel obstruction or the long-term costs to the healthcare system. The long-awaited substance or barrier that unequivocally prevents adhesion formation is yet to come. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to list the causes of small bowel obstruction, to describe the commercially available adhesion-reducing substances, and to compare the efficacy of the various adhesion-reducing substances.

Biocompatible Materials↗
PubMed2004

Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry.

OBJECTIVE: To summarize management of interstitial pregnancy and its outcome among 32 reported cases in the world. METHODS: From 1999 to 2002, 32 cases of interstitial pregnancy were reported to the registry of the Society of Reproductive Surgeons. The participants completed a five-page questionnaire regarding when and how diagnosis was made, the characteristics of the pregnancy, treatment modalities, and subsequent reproductive outcome. RESULTS: History of ipsilateral salpingectomy was encountered in 37.5% of patients, and the diagnosis was made by ultrasound in 71.4% of the patients. Eight women were treated with methotrexate either systemically (n = 4), locally under ultrasound guidance (n = 2), or under laparoscopic guidance (n = 2). Eleven patients were treated by laparoscopy and 13 by laparotomy. Three patients failed systemic methotrexate treatment and subsequently required surgery. Persistently elevated serum beta human chorionic gonadotropin levels were found in one patient after laparoscopic cornual excision, and she was successfully treated with methotrexate. Fourteen cases (43.7%) of rupture of interstitial pregnancy were found. This included five cases (15.6%) of heterotopic pregnancy; all were the results of in vitro fertilization, and all ruptured at the time of diagnosis. Subsequent pregnancy was achieved in ten patients. No uterine rupture was encountered during pregnancy or labor. CONCLUSION: Ipsilateral salpingectomy, previous ectopic pregnancy, and in vitro fertilization are predisposing factors for interstitial pregnancy. Contrary to previous belief, rupture of interstitial pregnancy occurs relatively early in pregnancy. In selected patients, laparoscopic cornual excision is a viable treatment option.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

Laparoscopic treatment of polycystic ovaries: is its place diminishing?

PURPOSE OF REVIEW: The purpose of this review is to provide a critical discussion on the place of laparoscopic ovarian drilling and medical treatment with metformin for polycystic ovary syndrome. RECENT FINDINGS: Laparoscopic ovarian drilling remains popular. It is associated with an ovulation rate of approximately 80% and a pregnancy rate of 50-60% within 1 year of the procedure. The technique results in a decrease in ovarian stromal blood flow. An increasing amount of data, however, suggests that treatment with metformin is equally as effective. The use of metformin in pregnancy appears to be safe; it decreases the miscarriage rate and possibly the incidence of gestational diabetes. SUMMARY: Laparoscopic ovarian drilling and metformin improve ovulatory dysfunction and pregnancy rate to a similar extent. The advantages of metformin continue beyond conception. It reduces the miscarriage rate and also decreases the likelihood of developing gestational diabetes. A randomized trial comparing the effects of metformin and laparoscopic ovarian drilling in women with polycystic ovary syndrome is recommended.

Female↗
PubMed2004

Fertility preservation in children and young adults undergoing treatment for malignancy.

Advances in cancer therapy have improved the long-term survival of young patients suffering from malignancies. However, the adverse effects of the treatment are sterility and loss of gonadal function especially in females. Preservation of fertility in males by sperm freezing is more practical and already established. For young women undergoing cancer treatment, the availability of preserving the gonadal function and fertility has just begun. Today, we can cryopreserve the oocytes, the embryos or the ovarian tissue and in those undergoing pelvic irradiation, laparoscopic lateral ovarian suspension can be considered. Because women with non-gynecological malignancies seek advice from a general surgeon or a medical oncologist, increasing the awareness of the physicians and general public is recommended.

Adolescent↗
PubMed2003

Effects of letrozole on superovulation with gonadotropins in women undergoing intrauterine insemination.

OBJECTIVE: To investigate the effects of letrozole in patients undergoing superovulation with gonadotropins and IUI. DESIGN: Retrospective analysis. SETTING: Academic teaching hospital. PATIENT(S): Women younger than 40 years of age with patent fallopian tubes and infertility of more than 1 year in duration who were undergoing IUI and gonadotropin therapy. INTERVENTION(S): Gonadotropins alone administered from day 3 or a combination of letrozole, 5 mg/d on day 3 to 7, and gonadotropins starting on day 5 of the menstrual cycle. Ultrasonography was performed before initiation of treatment, on day 9 of menstrual cycle, and as required thereafter until the dominant follicle reached 18 mm in diameter. Ovulation was triggered with 10,000 IU of hCG, and IUI was performed 24 and 48 hours later. MAIN OUTCOME MEASURE(S): Gonadotropin requirements, endometrial thickness, number of follicles, and pregnancy rate. RESULT(S): All 205 IUI treatment cycles conducted from March 2001 to March 2002 were included. Gonadotropins alone were used in 145 cycles and combination therapy was used in 60 cycles. Patients cotreated with letrozole required fewer gonadotropin administrations (median difference, 300 IU [95% confidence interval (CI), 225-375 IU]), developed more follicles larger than 14 mm (median difference, 1 follicle [95% CI, 1-2 follicles), and had a thinner endometrium (median difference, 1 mm [95% CI, 0.4-1.6 mm]). The pregnancy rate did not differ between patients using gonadotropin alone and those using gonadotropin plus letrozole (20.9% vs. 21.6%). CONCLUSION(S): The addition of letrozole to gonadotropins decreases gonadotropin requirements, increases the number of pre-ovulatory follicles and decreases endometrial thickness, without a negative effect on pregnancy rates.

Adult↗
PubMed2003

A prospective study to evaluate the efficacy of two- and three-dimensional sonohysterography in women with intrauterine lesions.

OBJECTIVE: To measure the accuracy of three-dimensional (3D) sonohysterography in detecting intrauterine lesions. DESIGN: Prospective study. SETTING: Teaching hospital. PATIENT(S): Two hundred nine infertile patients suspected to have an intrauterine lesion on 2D ultrasound or hysterosalpingography. INTERVENTION(S): Three-dimensional ultrasound, 2D and 3D sonohysterography (SHG). Ninety-two of the patients had a lesion distorting the endometrium on the 3D SHG, and those were referred for hysteroscopy. MAIN OUTCOME MEASURE(S): Sensitivity and specificity of 2D, 3D ultrasound, and 2D SHG compared to 3D SHG. RESULT(S): Of the 92 patients with a lesion, 48 had polyps, 35 submucous/intramural myomas, 3 both polyps and myomas, 4 müllerian anomalies, 1 thick endometrium, and 1 synechiae. Compared with the 3D SHG results, the sensitivity and specificity were 97% and 11% for the 2D transvaginal ultrasound, 87% and 45% for the 3D ultrasound, and 98% and 100% for the 2D SHG. In the group of 59 patients who had hysteroscopy, the sensitivity of the 2D SHG and 3D SHG were 98% and 100%, with a positive predictive value of 95% and 92%, respectively. CONCLUSION(S): Three-dimensional sonohysterography allows precise recognition and localization of lesions. If 2D and 3D SHG are normal, invasive diagnostic procedures such as hysteroscopy could be avoided.

Adult↗
PubMed2003

Laparoscopic treatment of polycystic ovaries: is it time to relinquish the procedure?

OBJECTIVE: To evaluate the role of laparoscopic ovarian drilling and treatment with metformin in the management of the polycystic ovary syndrome (PCOS). DESIGN: A literature search was conducted using the keywords laparoscopy, laparoscopic ovarian drilling, laparoscopic ovarian diathermy, PCOS, metformin, and ovulation. The MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews were searched. RESULTS: No randomized comparisons have been done between laparoscopic ovarian drilling and metformin therapy. However, the ovulation and pregnancy rates appear to be similar for both techniques. Both treatments decrease the incidence of ovarian hyperstimulation and the cancellation rate of IVF cycles. However, unlike laparoscopic ovarian drilling, metformin may decrease the incidence of type 2 diabetes and coronary heart disease. CONCLUSION(S): Given the similar magnitude of the results without the potential risks and complication of surgery, we propose that laparoscopic ovarian drilling should be used sparingly in favor of less invasive treatment with metformin.

Coronary Disease↗
PubMed2003

Left lateral predisposition of endometriosis and endometrioma.

To evaluate lateral distribution of endometriosis and ovarian endometrioma in women with endometriosis. We evaluated operative reports of women who underwent laparoscopic treatment of endometriosis (n = 330) and ovarian endometrioma (n = 185) from January 1996 to January 2002. Data on all operative findings consisted of a written report, a diagram, the revised American Fertility Society classification of endometriosis, and a printout of the dictated report. Endometriotic implants were confined to one side of the pelvis in 143 women and bilaterally in 187 others. Endometriosis was significantly more frequent in the left (64.3%) than in the right hemipelvis (P <.001, odds ratio 3.3, 95% confidence interval 2.0, 5.3). Of those with bilateral lesions, adhesions were also more frequently found on the left than on the right hemipelvis (16.6% versus 6.9%, P <.01, odds ratio 2.6, 95% confidence interval 1.3, 5.2). Endometrioma was found in the left ovary (n = 90), in the right ovary (n = 59), and bilaterally (n = 36). Left ovarian endometrioma was found more frequently (60.4%) than right endometrioma (P <.001, odds ratio 2.3, 95% confidence interval 1.5, 3.7). This trend was not related to the size of the endometrioma.Our results confirm a left lateral predisposition of endometriosis and ovarian endometrioma. It is possible that this is related to decreased fluid movement in the left side of the pelvis because of the presence of sigmoid colon. These findings may support the theory that the origin of endometriosis is from the regurgitated endometrial cells.

Adult↗
PubMed2003

Lateral distribution of ovarian dermoid cyst.

STUDY OBJECTIVE: To determine the distribution of ovarian dermoid cysts in a large series of women. DESIGN: Observational study (Canadian Task Force classification II-3). SETTING: University teaching hospitals. PATIENTS: Three hundred thirty-six women. INTERVENTION: Evaluation of operative reports. MEASUREMENTS AND MAIN RESULTS: Dermoid cysts had a mean diameter of 5.6 cm. They were present in the right ovary (48.8 %), left ovary (37.8%), and bilaterally (13.4%). Unilateral cysts were more frequent in the right ovary (56.4%) than in the left (p = 0.002, odds ratio 1.7, confidence interval 1.2-2.3). This was significantly different from the expected 50% (4.45, chi2). A similar predisposition was found when we included women with bilateral cysts (p < 0.01, OR 1.5, CI 1.1-1.9). Patient age and size of cyst did not differ between those with left and right lesions. CONCLUSION: In this large cohort of women, ovarian dermoid cysts had a predisposition to a right lateral location.

Adult↗