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Togas Tulandi

Publications and source records attributed to Togas Tulandi.

At least 55 records · Page 3Linked to original sources
PubMed2003

A randomized trial of sublingual misoprostol for cervical priming before hysteroscopy.

STUDY OBJECTIVE: To evaluate the effects of sublingual misoprostol on cervical dilatation before hysteroscopy. DESIGN: Prospective randomized study (Canadian Task Force classification I). SETTING: University teaching center. PATIENTS: Forty nulliparous women who received injection of leuprolide acetate 4 weeks before hysteroscopy, of whom 20 were randomized to treatment with misoprostol and 20 to placebo. INTERVENTION: Sublingual misoprostol 100 mug or placebo administered 12 hours before operative hysteroscopy. MEASUREMENTS AND MAIN RESULTS: Misoprostol was associated with mild abdominal cramps in four women (20%) and vaginal bleeding in another. No side effects were reported among women in the placebo group. There was no difference in baseline diameter of the cervical opening between the misoprostol group (4.0 +/- 0.1 mm) and the control group (4.2 +/- 0.2 mm). Time to dilate cervix up to 9 mm was also not significantly different (misoprostol 48.4 +/- 9.2 sec, placebo 37.7 +/- 4.1 sec). We found no difference in degree of difficulty dilating the cervix between groups. Cervical tear occurred in one patient in the misoprostol group. CONCLUSION: Sublingual misoprostol 100 mug does not facilitate cervical dilatation before hysteroscopy. This may be related to leuprolide's hypoestrogenic effect.

Administration, Sublingual↗
PubMed2003

Laparoscopic preservation of ovarian function: an underused procedure.

OBJECTIVE: There are many young women undergoing irradiation or chemotherapy without having the option of preserving their ovarian function. Our purpose was to review the literature on laparoscopic ovarian transposition, to evaluate its efficacy, and to provide clinical opinion on the subject. STUDY DESIGN: We evaluated the English articles on laparoscopic ovarian transposition identified through a MEDLINE search. We also report a case of laparoscopic ovarian tranposition in a 28-year-old woman with rectal cancer. RESULTS: Laparoscopic ovarian transposition in women <40 years old is associated with preservation of ovarian function in 88.6% of cases. During and afer irradication, our patient never missed her menstrual periods. CONCLUSION: Despite its simplicity and efficacy, this procedure is underused. We encourage clinicians to discuss and propose it to their patients.

Adult↗
PubMed2003

Nonclosure of peritoneum: a reappraisal.

In our specialty, the practice of closing or not closing the peritoneum is still being debated. Our purpose was to review the literature on the subject, to evaluate the advantages and disadvantages of the procedure, and to provide clinical opinions. Closure of the peritoneum either parietal or visceral peritoneum is unnecessary, it is associated with a slightly longer operating time and more postoperative pain, and there are some suggestions that it might cause more adhesion formation. There are more advantages than disadvantages to not closing the peritoneum. We encourage clinicians not to close both parietal and visceral peritoneum.

Animals↗
PubMed2002

Cost analysis of tubal anastomosis by laparoscopy and by laparotomy.

STUDY OBJECTIVE: To compare the costs of tubal anastomosis performed by laparoscopy and by laparotomy. DESIGN: Cost analysis study using the hospital administrative database (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: Eighty-nine women. Intervention. Tubal anastomosis by laparoscopy (43) and by laparotomy (46). MEASUREMENTS AND MAIN RESULTS: Tubal anastomosis took longer when performed by laparoscopy than by laparotomy; however, the total time patients spent in the operating room was similar. Women treated by laparoscopy spent more time in the recovery room. Labor costs for nurses in the operating room and recovery room costs were significantly higher in the laparoscopy group. Costs for operating room supplies were similar. Pharmacy costs and expenses in the ward were lower in the laparoscopy group. The mean total cost for laparoscopic tubal anastomosis was $861 +/- 137 and for laparotomy was $1348 +/- 188 (p <0.001). CONCLUSION: Laparoscopic tubal anastomosis costs less than tubal anastomosis by laparotomy.

Anastomosis, Surgical↗
PubMed2002

Cost analysis of myomectomy, hysterectomy, and uterine artery embolization.

OBJECTIVE: The purpose of this study was to compare inpatient hospital costs of different treatments of uterine fibroid tumors, including myomectomy, hysterectomy, and uterine artery embolization in a teaching hospital. STUDY DESIGN: We reviewed the hospital database of 545 women with uterine fibroid tumors who were treated with abdominal myomectomy, total abdominal hysterectomy, vaginal hysterectomy, and uterine artery embolization between April 1997 and October 2001. RESULTS: Women who underwent hysterectomies and uterine artery embolization were significantly older than the women who underwent myomectomy. Uterine artery embolization was associated with the shortest hospital stay, although the hospital stay in the vaginal hysterectomy group was shorter than in the abdominal myomectomy and the total abdominal hysterectomy groups. Compared with other groups, the inpatient cost of nursing in the uterine artery embolization group was the lowest. The total inpatient cost of uterine artery embolization ($1,007.44 +/- $60.65 [Canadian dollars]) was significantly lower than the cost of total abdominal hysterectomy ($1,933.37 +/- $47.68 [Canadian dollars]), abdominal myomectomy ($1,781.73 +/- $47.16 [Canadian dollars]), and vaginal hysterectomy ($1,515.39 +/- $66.72 [Canadian dollars]; P <.001). Sixteen of the 85 patients (18.8%) were hospitalized after uterine artery embolization, mainly for abdominal pain. CONCLUSION: Compared with abdominal myomectomy, abdominal hysterectomy, and vaginal hysterectomy, uterine artery embolization is associated with a lower hospital cost and a shorter hospital stay. Hospitalization after uterine artery embolization is mainly for abdominal pain after the procedure. A better method of pain control to reduce the rate of hospitalization and its cost is needed.

Adult↗
PubMed2002

Serum vascular endothelial growth factor as a possible marker for early ectopic pregnancy.

BACKGROUND: This study evaluated serum vascular endothelial growth factor (VEGF) concentrations in women with normal intrauterine pregnancy (IUP), arrested IUP and ectopic pregnancy (EP). METHOD: This was a prospective, case-control study evaluating serum VEGF concentrations among 45 early pregnant women who subsequently were found to have an EP, a normal IUP or an arrested IUP (15 women in each group). Patients were stratified according to serum VEGF concentrations above and below 200 pg/ml. RESULTS: There was a significant difference in VEGF concentrations among women with EP, arrested IUP and normal IUP (306.1 +/- 26.5, 169.7 +/- 16.6 and 27.0 +/- 4.4 pg/ml respectively, P < 0.001). With a cut-off concentration of 200 pg/ml, serum VEGF could distinguish normal IUP from EP with a sensitivity of 88%, a specificity of 100% and a positive predictive value of 100%. Between EP and arrested IUP, the sensitivity was 87.5%, specificity 75% and positive predictive value of 77.8%. CONCLUSIONS: VEGF is a potential marker for EP. Its concentrations in women with EP are higher than in those with normal and arrested IUP.

Biomarkers↗
PubMed2002

Safety and risks of laparoscopy in pregnancy.

PURPOSE OF REVIEW: The purpose of this review is to evaluate the indications, and the safety and efficacy of operative laparoscopy in pregnancy with a particular attention to the pregnancy outcome. RECENT FINDINGS: Hemodynamics changes during laparoscopic surgery in pregnancy are similar to those observed in the nonpregnant state. The procedure appears to be safe and reduces hospital admissions and frequency of premature labor. The safest time to perform laparoscopic surgery in pregnancy is at the second trimester. However, it can be complicated by injury to the gravid uterus and pregnancy loss. This is illustrated by a recent report of accidental gas insufflation into the amniotic cavity leading to the fetal loss. SUMMARY: The most common indications of laparoscopy in pregnancy are cholelithiasis, appendicitis, persistent ovarian cyst and adnexal torsion. In general, it is associated with a good maternal and fetal outcome. The occurrence of a miscarriage, premature labor or fetal death appears to be related to the underlying pathology, independent of the operative intervention. Due to the displacement of the appendix by the gravid uterus and the physiologic elevation of white blood cell count in pregnancy, diagnosis of appendicitis in pregnancy can be delayed with its sequelle. In one report, the incidence of fetal loss is 1.5% in uncomplicated appendicitis and 35% in the presence of ruptured appendicitis. Similarly, the fetal loss rate in uncomplicated cholecystectomy is 4%, but the fetal mortality in gallstone pacreatitis could be up to 60%. Laparoscopy in pregnancy should be performed with utmost care. In the second trimester of pregnancy, open laparoscopic approach is strongly recommended.

Embryonic and Fetal Development↗
PubMed2002

Factors affecting early surgical intervention after uterine artery embolization.

UNLABELLED: Uterine artery embolization (UAE) is an effective technique for the management of uterine myoma. However, complications of this procedure can be serious, including uterine infection and bowel necrosis in conjunction with necrosis of subserous or pedunculated myomas. Treatment failure is more likely to occur in the presence of submucosal myoma associated with a uterine infection or a large myoma of more than 8 cm. Accordingly, patients whose primary symptoms include submucosal myoma and menorrhagia are best treated with a hysteroscopic myomectomy or hysterectomy. The role of the gynecologist is crucial for most effective management and safe use of uterine artery embolization. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the complications of uterine artery embolization for fibroids, to describe postembolization syndrome, and identify the myomas that are more likely to fail uterine artery embolization.

Abdominal Pain↗
PubMed2002

Correlations between extent and spread of adenomyosis and clinical symptoms.

OBJECTIVE: To correlate the histopathology of adenomyosis particularly the depth and spread of adenomyosis and symptomatology. STUDY DESIGN: Medical records of 94 patients who had undergone a hysterectomy and who were found to have adenomyosis on histopathologic examination were reviewed and histopathologic slides were reexamined. The symptoms were correlated with the presence of adenomyosis, the depth of penetration, and the spread of adenomyosis foci. RESULTS: Specimens were stratified according to the degree of adenomyosis penetration into 4 groups: group A consisted of specimens with adenomyosis penetration into the myometrium of up to 25%; group B, 26-50%; group C, 51-75%, and group D, >75%. There was a significant correlation between the depth of penetration and the number of adenomyosis foci (r = 0.3446; p = 0.0001). Hemosiderin deposition was found mainly in the specimens with penetration of >75%. The symptoms did not correlate with the degree of penetration (r = 0.088; p NS). However, the spread of adenomyosis correlated significantly with pelvic pain (r = 0.80, p = 0.02), and with dysmenorrhea (r = 0.81, p = 0.01), but not with menorrhagia or dyspareunia. CONCLUSIONS: Hemosiderin deposition and adenomyosis foci are found predominantly in specimens with deep adenomyosis penetration. It suggests that the deeper the penetration, the more extensive the adenomyosis. Symptoms of adenomyosis do not correlate with the depth of penetration, but there is a correlation between the spread of adenomyosis and pelvic pain, and dysmenorrhea.

Adult↗
PubMed2000

Hodgkin's Lymphoma: Choice of Therapy and Late Complications.

This review focuses on the different treatment options available for the treatment of Hodgkin's disease, with an emphasis on the importance of the long-term sequelae of these therapies. In Section I, Dr. Linch reviews the current status of Hodgkin's disease treatment. Survival rates have improved over the last three decades due both to better initial therapies and associated supportive care and to the success of salvage therapy. Unlike most other malignancies, a similar survival endpoint can be achieved by different means, e.g., intensive initial therapy resulting in a low relapse rate or less intensive initial therapy and more reliance on salvage therapy. Overall survival has thus become a difficult end-point for clinical trials of primary therapy, and the value of disease-free survival as an end-point can also be questioned. Quality-of-life issues are to the fore of clinical decision and include the psychological trauma of relapse and fertility status. Patient choice is increasingly important. The high level of success in treating Hodgkin's disease also means that attention must be focused on the very long term results and in this context the occurrence of second malignancies is a major issue. In Section II, Dr. Gosden with Dr. Tulandi and Dr. Tan review the risks of infertility following radio-therapy and chemotherapy and address the actions that can be taken to overcome this problem, particularly for females and prepubertal boys and girls. Particular attention is paid to the recent developments in ovarian cryopreservation and harvesting immature germ cells. In Section III, Dr. Hancock gives a comprehensive update of the incidence of secondary acute leukemia, non-Hodgkin's lymphoma and solid tumors in a large population of patients treated for Hodgkin's disease. The roles of radiotherapy, chemotherapy and combined modality treatment as risk factors contributing to the development of these secondary malignancies are reviewed. The importance of efforts to prevent late-occurring solid tumors such as lung cancer through smoking cessation programs and early detection by screening for cancers of the breast, thyroid and skin are emphasized.

Journal Article↗
PubMedDate not supplied

Cervical stump necrosis and septic shock after laparoscopic supracervical hysterectomy.

The decision to retain or remove the cervix when performing laparoscopic hysterectomy remains a topic of debate. A 38-year-old woman with multiple sclerosis underwent laparoscopic supracervical hysterectomy (LASH) for menometrorrhagia. Two weeks later, she was seen at our institution with septic shock. She underwent an exploratory laparotomy and was found to have cervical stump necrosis and peritonitis. Trachelectomy was performed. The postoperative course was prolonged by persistent fever, pleural effusion, and abscess collections. Although rare, cervical stump necrosis is a possible complication of LASH.

Adult↗
PubMedDate not supplied

Reproductive performance after selective tubal catheterization.

STUDY OBJECTIVE: To evaluate the reproductive performance of women after selective tubal catheterization. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospital. PATIENTS: Ninety-eight infertile women with hysterosalpingographic findings of proximal tubal occlusion. INTERVENTION: Hysterosalpingography and selective tubal catheterization. MEASUREMENTS AND MAIN RESULTS: Repeat hysterosalpingography examination before selective tubal catheterization in 98 patients revealed bilateral tubal patency in 14 patients and patency of one of the tubes in 12 others (12.2%). True proximal tubal occlusion was encountered in 72 patients (139 tubes). Successful recanalization of both tubes was achieved in 25 patients (34.7%), and successful recanalization of at least one tube was achieved in 44 patients (61.1%). Of the 72 patients who underwent selective tubal catheterization, 23 patients conceived. The cumulative probability of conception was 28%, 59%, and 73% at 12, 18, and 24 months of follow-up, respectively. The median procedure-conception interval was 16.2 months. CONCLUSION: One-quarter of patients diagnosed with bilateral proximal tubal occlusion on hysterosalpingography do not have tubal obstruction. Among those with true occlusion, selective tubal catheterization leads to an overall pregnancy rate of 31.9%.

Adult↗
PubMedDate not supplied

Audit of morbidity and mortality rates of 1792 hysterectomies.

STUDY OBJECTIVE: To audit morbidity and mortality rates of laparoscopic, abdominal, and vaginal hysterectomy. DESIGN: Retrospective review of monthly morbidity and mortality rates (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: One thousand seven hundred ninety-two women who underwent hysterectomy for benign, nonobstetric indications at the Sir Mortimer B. Davis-Jewish General Hospital. INTERVENTIONS: Laparoscopic supracervical (LASH), vaginal (VH), and abdominal (AH) hysterectomies. MAIN OUTCOME MEASURES: Morbidity outcomes of different types of hysterectomy. Reoperation, admission to the intensive care unit, discordant diagnosis, and prolonged hospitalization also were evaluated. RESULTS: We studied 223 cases of LASH, 1349 AH, and 220 VH. The overall hysterectomy-related morbidity rate was 6.1%. The rate of morbidity was higher in the LASH group (9.4%) than in the AH group (5.2%, p <.01), but no significant difference was noted between AH and VH (8.6%). The incidence of intraoperative bowel injury was 0.4% in the LASH group (a trocar injury in a patient) and 0.3% in the AH group. Bladder injury was encountered in two patients in the LASH group (0.9%) and in another two in the AH group (0.1%). Ureteral injury occurred in a patient in the AH group (0.07%). There were no cases of intraoperative vascular injury. Vaginal hysterectomy was associated with more urinary retention and hematoma formation than the other two groups. Discordant diagnosis was noted in four cases (two missed endometrial cancer, atonic and distended bladder mistaken for an ovarian cyst, and pelvic tuberculosis). The conversion rate to laparotomy was 1.7% in the LASH group and 0.4% in the VH group, and the incidence of reoperation was 0.4% in the AH group. CONCLUSIONS: The overall hysterectomy-related morbidity rate in our series is 6.1%. Compared with other types of hysterectomy, more urinary retention and hematoma formation occur after VH. Laparoscopic supracervical hysterectomy is associated with a higher morbidity rate than AH; mainly because of conversion to laparotomy and blood transfusion.

Adult↗