JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the femal... more Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein.
Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in wom... more Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the e...
The Journal of the American Association of Gynecologic Laparoscopists, 1998
To investigate the effects of peritoneal exposure to carbon dioxide (CO2) on peritoneal microcirc... more To investigate the effects of peritoneal exposure to carbon dioxide (CO2) on peritoneal microcirculation and free radical scavenger (FRS) metabolism, and its role in potential adhesion formation after operative laparoscopy. Randomized, controlled study (Canadian Task Force classification I). University-affiliated hospital. Twenty-eight women undergoing operative laparoscopy for adnexal masses. For each patient, a 1 x 1-cm sidewall peritoneal flap was excised at the end of laparoscopy and numbered randomly. Similar flaps obtained from 24 women immediately after entering the abdomen during laparotomy served as controls. Changes in glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels were studied in homogenized peritoneal tissues. The duration of CO2 exposure and amount of CO2 used were correlated with levels of free radical scavengers and compared with controls. Mean CO2 exposure, amount of CO2 used, and CO2 pressure (15 mm Hg) was similar between low irrigation and irrigated laparoscopy (118.3 +/- 25 and 39.2 +/- 8.81 min and 125 +/- 20 and 44.5 +/- 6.81 min, respectively). The change in FRS levels was significantly correlated with duration and amount of CO2 exposure (r = -0.92). Levels of GSH-Px, SOD, CAT, and GSH were significantly lower in the CO2 exposure group than in controls (0.57 micro mol, 1.8 ng, 48.5 micro mol, 1.5 nmol vs 0.8 micro mol, 2.6 +/- 0.4 ng, 79 micro mol, 3.6 nmol, respectively). Exposure to CO2 has adverse effects on peritoneal microcirculation and cell-protective systems, which are proposed mechanisms in adhesion formation. Avoiding long CO2 exposure and copiously irrigating the abdominal cavity throughout surgery may lessen these effects. The potential role of the peritoneal FRS system on postoperative adhesion formation and its relation to estrogen status mandates further studies.
The Journal of the American Association of Gynecologic Laparoscopists, 1998
To investigate the effects of gonadotropin-releasing hormone (GnRH) analog pretreatment on endome... more To investigate the effects of gonadotropin-releasing hormone (GnRH) analog pretreatment on endometrial Na+, K+-adenosine triphosphatase (ATPase) pump function and peripheral blood vasopressin levels, and their role in fluid absorption and mechanisms of hyponatremia in patients undergoing hysteroscopic endometrial ablation. Prospective, randomized, placebo-controlled study (Canadian Task Force classification I). University-affiliated hospital. Seventeen women with dysfunctional uterine bleeding. Nine women received a GnRH analog and eight received saline approximately 6 to 8 weeks before hysteroscopic ablation by electrosurgery. Both before randomization and immediately before surgery, endometrial biopsy samples were obtained and numbered consecutively without patient identification. Operative hysteroscopy was performed with glycine 1.5% mixed with 2% alcohol. The amount of irrigant and irrigant deficit; blood levels of albumin and ethanol; hematocrit and hemoglobin; changes in sodium levels; and central venous pressure were compared. The Na+, K+-ATPase pump activity was significantly increased in the GnRH analog group compared with the saline group and correlated with decreased estradiol levels (0.4 +/- 0.08 vs 0.26 +/- 0.06 micro mol/min/ml). Vasopressin levels were significantly lower in the GnRH group (3.2 +/- 0.9 vs 7.6 +/- 1.7 micro mol/L). Mean volume of irrigant used and operating time were similar in both groups. Volume deficit, decrease in protein, and hematocrit were less in GnRH than in the saline group. Blood ethanol levels, decrease in sodium, and irrigant deficit were significantly lower in GnRH group. Pretreatment with GnRH analogs may prevent the adverse effects of estradiol on endometrial Na+, K+-ATPase and creates a protective mechanism against iatrogenic hyponatremia, which is more critical in women than men in case of absorption of irrigating fluid. Moreover, created hypoestrogenism may enhance Na+, K+-ATPase activity in brain as well as endometrium, thus decreasing women's susceptibility to hyponatremic complications and brain damage. Suppressed vasopressin levels may be protective against fluid absorption in GnRH analog-treated patients.
Objective To assess the levels of malon dialdehyde (MDA); a lipid peroxide product, total nitrite... more Objective To assess the levels of malon dialdehyde (MDA); a lipid peroxide product, total nitrite; a stabile product of nitric oxide (NO), and adrenomedulin (AM), to determine whether their levels are altered in premenstrual syndrome (PMS) and to search for their possible pathophysiological role in this peculiar syndrome. Study design Twenty-one patients aged between 28 and 37 years, who had regular menses for at least six previous cycles, and were in general good health condition, were taken into the study. Blood samples were obtained from each patient at the 3rd and 21st day of their menstrual cycles. AM, nitrite, MDA and estradiol levels have been assessed in these samples for each patient.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the femal... more Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein.
Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in wom... more Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the e...
The Journal of the American Association of Gynecologic Laparoscopists, 1998
To investigate the effects of peritoneal exposure to carbon dioxide (CO2) on peritoneal microcirc... more To investigate the effects of peritoneal exposure to carbon dioxide (CO2) on peritoneal microcirculation and free radical scavenger (FRS) metabolism, and its role in potential adhesion formation after operative laparoscopy. Randomized, controlled study (Canadian Task Force classification I). University-affiliated hospital. Twenty-eight women undergoing operative laparoscopy for adnexal masses. For each patient, a 1 x 1-cm sidewall peritoneal flap was excised at the end of laparoscopy and numbered randomly. Similar flaps obtained from 24 women immediately after entering the abdomen during laparotomy served as controls. Changes in glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels were studied in homogenized peritoneal tissues. The duration of CO2 exposure and amount of CO2 used were correlated with levels of free radical scavengers and compared with controls. Mean CO2 exposure, amount of CO2 used, and CO2 pressure (15 mm Hg) was similar between low irrigation and irrigated laparoscopy (118.3 +/- 25 and 39.2 +/- 8.81 min and 125 +/- 20 and 44.5 +/- 6.81 min, respectively). The change in FRS levels was significantly correlated with duration and amount of CO2 exposure (r = -0.92). Levels of GSH-Px, SOD, CAT, and GSH were significantly lower in the CO2 exposure group than in controls (0.57 micro mol, 1.8 ng, 48.5 micro mol, 1.5 nmol vs 0.8 micro mol, 2.6 +/- 0.4 ng, 79 micro mol, 3.6 nmol, respectively). Exposure to CO2 has adverse effects on peritoneal microcirculation and cell-protective systems, which are proposed mechanisms in adhesion formation. Avoiding long CO2 exposure and copiously irrigating the abdominal cavity throughout surgery may lessen these effects. The potential role of the peritoneal FRS system on postoperative adhesion formation and its relation to estrogen status mandates further studies.
The Journal of the American Association of Gynecologic Laparoscopists, 1998
To investigate the effects of gonadotropin-releasing hormone (GnRH) analog pretreatment on endome... more To investigate the effects of gonadotropin-releasing hormone (GnRH) analog pretreatment on endometrial Na+, K+-adenosine triphosphatase (ATPase) pump function and peripheral blood vasopressin levels, and their role in fluid absorption and mechanisms of hyponatremia in patients undergoing hysteroscopic endometrial ablation. Prospective, randomized, placebo-controlled study (Canadian Task Force classification I). University-affiliated hospital. Seventeen women with dysfunctional uterine bleeding. Nine women received a GnRH analog and eight received saline approximately 6 to 8 weeks before hysteroscopic ablation by electrosurgery. Both before randomization and immediately before surgery, endometrial biopsy samples were obtained and numbered consecutively without patient identification. Operative hysteroscopy was performed with glycine 1.5% mixed with 2% alcohol. The amount of irrigant and irrigant deficit; blood levels of albumin and ethanol; hematocrit and hemoglobin; changes in sodium levels; and central venous pressure were compared. The Na+, K+-ATPase pump activity was significantly increased in the GnRH analog group compared with the saline group and correlated with decreased estradiol levels (0.4 +/- 0.08 vs 0.26 +/- 0.06 micro mol/min/ml). Vasopressin levels were significantly lower in the GnRH group (3.2 +/- 0.9 vs 7.6 +/- 1.7 micro mol/L). Mean volume of irrigant used and operating time were similar in both groups. Volume deficit, decrease in protein, and hematocrit were less in GnRH than in the saline group. Blood ethanol levels, decrease in sodium, and irrigant deficit were significantly lower in GnRH group. Pretreatment with GnRH analogs may prevent the adverse effects of estradiol on endometrial Na+, K+-ATPase and creates a protective mechanism against iatrogenic hyponatremia, which is more critical in women than men in case of absorption of irrigating fluid. Moreover, created hypoestrogenism may enhance Na+, K+-ATPase activity in brain as well as endometrium, thus decreasing women's susceptibility to hyponatremic complications and brain damage. Suppressed vasopressin levels may be protective against fluid absorption in GnRH analog-treated patients.
Objective To assess the levels of malon dialdehyde (MDA); a lipid peroxide product, total nitrite... more Objective To assess the levels of malon dialdehyde (MDA); a lipid peroxide product, total nitrite; a stabile product of nitric oxide (NO), and adrenomedulin (AM), to determine whether their levels are altered in premenstrual syndrome (PMS) and to search for their possible pathophysiological role in this peculiar syndrome. Study design Twenty-one patients aged between 28 and 37 years, who had regular menses for at least six previous cycles, and were in general good health condition, were taken into the study. Blood samples were obtained from each patient at the 3rd and 21st day of their menstrual cycles. AM, nitrite, MDA and estradiol levels have been assessed in these samples for each patient.
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