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ABSTRACT: The purpose of this study was to elucidate the feasibility of gasless laparoscopically assisted myomectomy (LAM) using a wound retraction system. This method treats symptomatic uterine myomas by combining laparoscopy with a mini-laparotomy to enucleate myoma nodules and to close the uterine myometrium.
This study includes 275 patients who underwent gasless LAM. For patients with fewer than three myoma nodules, the location of the largest nodule was classified as anterior, fundal, or posterior. The operative outcomes, intraoperative and postoperative courses, and complications were examined.
All operations were performed satisfactorily, and no conversions to laparotomy were required. None of the patients developed serious complications. The mean blood loss and operating time were 190.3 mL and 152.2 minutes, respectively. The mean myoma size was 8.9 cm, and the mean number of myomas per patient was 2.8. The average postoperative hospital stay was 5.7 days. There were no significant differences in resected myoma size, blood loss, and surgical duration with respect to the location of the largest nodule.
Gasless LAM with a wound retractor is feasible and allows surgeons to perform myomectomy safely and cost-effectively, without requiring advanced laparoscopic surgical skills and while maintaining minimum invasiveness.
Asian Journal of Endoscopic Surgery 08/2011; 4(3):133-7.
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ABSTRACT: We report the case of a patient with adenomyosis complicated by deep vein thrombosis in whom low-dose gonadotropin-releasing hormone agonist (GnRHa) therapy was useful as a uterus-conserving therapeutic option. The patient was a 34-year-old nulliparous woman who presented with edema and pain in the left lower leg. The patient had been treated with four cycles of GnRHa therapy for adenomyosis and repeatedly experienced chronic pelvic pain, dysmenorrhea and anemia due to hypermenorrhea. Leg venography confirmed deep vein thrombosis, and thrombolytic therapy was performed to eliminate symptoms. Because the patient strongly wanted to conserve the uterus, low-dose GnRHa therapy was initiated. The patient is currently taking 450 microg/day buserelin acetate nasally (regular dose: 900 microg/day), and estradiol levels have been maintained at 24-50 pg/ml. Anemia, leg numbness and chronic pelvic pain have dissipated, and the patient has not experienced estrogen deficiency symptoms for more than two years.
Clinical and experimental obstetrics & gynecology 02/2009; 36(2):123-5. · 0.43 Impact Factor
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S Akira
Journal of Nippon Medical School 01/2002; 68(6):524-9.
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ABSTRACT: The efficacy of laparoscopic intratubal injection of methotrexate is reportedly controversial.
A 29-year-old woman with an interstitial-isthmic pregnancy and a 30-year-old woman with an ampullary pregnancy surrounded by dense adhesions were treated with intraamniotic injection of methotrexate with ultrasonographically guided laparoscopy (LUS). The ectopic pregnancies resolved quickly, without further intervention. The human chorionic gonadotropin concentrations were negligible by 18 and 25 days.
Intraamniotic methotrexate injection with LUS is an effective treatment for unruptured interstitial and tubal pregnancies in patients with dense adhesions.
The Journal of reproductive medicine 11/2000; 45(10):844-6. · 0.87 Impact Factor
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ABSTRACT: There are three types of endoscopic surgery in obstetrics and gynecology: laparoscopy; hysteroscopy; and salpingoscopy. The main indications for laparoscopic surgery are myoma uteri, ovarian tumors, ectopic pregnancy, infertility, and endometriosis. Currently the indications are limited to benign disease. The main indications for hysteroscopic surgery are submucous myoma uteri, uterine anormalies, and Asherman syndrome. During hysteroscopy the uterine cavity is dilated with liquid and then a resectoscope or hysterofiberscope is used. Salpingoscopy is useful in examining the tubal cavity and a potent tool for tubal recanalization. Endoscopic surgical techniques will develop rapidly in the near future to serve the various needs of female patients.
Nippon Geka Gakkai zasshi 09/2000; 101(8):561-7.
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ABSTRACT: Are cell adhesion molecules involved in the murine model of immunologically-mediated spontaneous abortion?
Pregnant CBA/J female mice mated with DBA/2 male mice were injected with monoclonal antibodies (MAbs) to intercellular adhesion molecule-1 (ICAM-1) and leukocyte function-associate antigen-1 (LFA-1). On day 13 of gestation. viable and resorbed embryos were counted. Natural killer (NK) cell activity in the spleen, mixed lymphocyte reactions (MLR), mixed lymphocyte-placenta reactions (MLPR), and levels of interferon (IFN)-gamma were assayed.
Significant suppression of fetal resorption was observed by the injection of MAb to ICAM-1 and LFA-1. NK cell activity and the MLR anti-(CBA/J x DBA/ 2)F1 were reduced in the antibody-treated CBA/J spleen. Moreover, the level of IFN-gamma was significantly lower in the MLPR supernatants from the antibody-treated group than those of the control group.
One mechanism in the murine model of spontaneous abortion may be through the interaction of cell adhesion molecules, which may modulate NK cell activities and cytokine production.
American journal of reproductive immunology (New York, N.Y.: 1989) 04/2000; 43(3):180-5. · 3.05 Impact Factor
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ABSTRACT: The efficacy and safety of gasless laparoscopic ovarian cystectomy during pregnancy were compared with those of conventional laparotomy. Study Design: Subjects for the 2 study groups were selected from consecutive patients who satisfied all entrance criteria. Seventeen women who underwent gasless laparoscopic cystectomy were compared with 18 women who underwent cystectomy by laparotomy. The intraoperative and postoperative courses, pregnancy outcomes, and complications were compared.
The patients' ages, body mass indexes, mean cyst diameters, fetal gestational ages, and types of cysts did not differ significantly between the two groups. Blood loss, analgesic use, and need for tocolytic agents were significantly less in the laparoscopy group than in the laparotomy group. No abortions or preterm deliveries occurred in the laparoscopy group, whereas 1 abortion was recorded in the laparotomy group.
Gasless laparoscopic ovarian cystectomy offers significant advantages with respect to laparotomy for the pregnant patient.
American Journal of Obstetrics and Gynecology 04/1999; 180(3 Pt 1):554-7. · 3.47 Impact Factor
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ABSTRACT: The effect of testosterone on growth hormone (GH) secretory pattern during a 6-hour continuous infusion of human GH-releasing factor (GRF) (1-44) NH2 was observed in unrestrained adult female Wistar rats. Rats had been ovariectomized or sham operated 6 weeks previously. Three weeks after the ovariectomy, the rats received sesame oil or testosterone propionate at a dose of 1 or 2 mg s.c. daily for 21 days. All rats were provided with two indwelling cannulae: one in the right atrium for undisturbed blood collection and the other in the inferior vena cava for vehicle or GRF infusion. Vehicle or GRF was administered by an infusion pump at a dose of 50 ng/kg/min for 6 h. Serial blood specimens were obtained every 20 min. Sham-operated adult female Wistar rats exhibited a high-frequency, low-amplitude pulsatile GH secretion during a 6-hour vehicle infusion. When they received a 6-hour continuous infusion of GRF, the amplitudes of GH pulses and baseline GH values were markedly augmented, but the pulse frequency remained unaltered. The GH secretory pattern during a 6-hour vehicle infusion among ovariectomized rats was similar to that of sham-operated female rats, whereas the magnitude of elevation of GH pulse and baseline level in ovariectomized rats were significantly lower than in sham-operated rats. The ovariectomized female rats that had received 2 mg testosterone for 21 days showed a low-frequency, regularly timed, high-amplitude pulsatile GH secretion, and GH values during the intervening period were low. This GH secretory pattern was indistinguishable from that in adult male rats.(ABSTRACT TRUNCATED AT 250 WORDS)
Neuroendocrinology 03/1988; 47(2):116-24. · 2.38 Impact Factor
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ABSTRACT: A radioimmunoassay (RIA) for human pro-LRF(14-69)OH was developed with an antiserum, generated in a rabbit, to [Tyr67]pro-LRF(47-67)NH2 conjugated to BSA. This antiserum bound 28-32% of [125I]pro-LRF(14-69)OH at a final dilution of 1:2500 and the binding was inhibited by pro-LRF(14-69)OH in a dose-dependent manner. The sensitivity of the RIA was 31.2-62.5 pg and the dose that inhibited 50% of the binding to the tracer was 280-320 pg. Intra- and inter-assay coefficients of variation at 50% inhibition were 8 and 12%, respectively. Neither LRF nor pro-LRF(14-37)OH was recognized by the antiserum. The dilution curve generated with human hypothalamic extract was parallel to that of pro-LRF(14-69)OH. In addition the extract yielded a major immunoreactive peak emerging in elution volumes concordant with [125I]pro-LRF(14-69)OH on Sephadex G-50 chromatography.
Endocrinologia japonica 03/1987; 34(1):133-7.
