1,721,193 research outputs found
Peritoneal adhesions after laparoscopic gastrointestinal surgery
Full text linkAlthough laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO2 pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO2, N2O and O2 seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against adhesion formation has been no greater than 60%. A recent small, randomized clinical trial suggested that the combination of broad peritoneal cavity protection with local application of a barrier could be almost 100% effective in preventing post-operative adhesion formation. Future studies should confirm the efficacy of this global strategy in preventing adhesion formation after laparoscopy by focusing on clinical end points, such as reduced incidences of bowel obstruction and abdominal pain and increased fertility
Prolactin-releasing action of gonadotropin-releasing hormone in hypogonadal women.
No full textTo gain insight into the PRL-releasing effect of GnRH, serum PRL and gonadotropin responses to a 10-microgram iv bolus dose of exogenous GnRH were studied in hypergonadotropic hypogonadal women (HHW) and patients with functional hypothalamic amenorrhea (FHA). The results were compared with those obtained in normal cycling women during the early follicular phase of the cycle. GnRH induced a significant increase in PRL levels (P less than 0.001) in HHW compared to early follicular phase women, in whom no significant response occurred. In HHW, the maximal PRL percent increment was positively correlated with the ratio of the maximal percent increments of FSH and LH (r = 0.93). GnRH induced a significant increase in PRL levels in every FHA patient, but in four of them (high PRL responders), the PRL response was at least 5-fold greater than in the other six (low PRL responders). The clinical profiles, basal hormone concentrations, and LH responses to GnRH were similar in these two groups of FHA patients, but the FSH response to GnRH was greater (P less than 0.05) in the high PRL responders. The maximal percent increment of PRL was also positively correlated with the maximal percent increment of FSH (r = 0.76; P = 0.01). These data demonstrate that in these two hypogonadal models, the PRL response to exogenous GnRH corresponds to the FSH response and suggests that GnRH-stimulated PRL release may be mediated by a paracrine effect between FSH-enriched gonadotrophs and lactotrophs
Immunohistochemical Markers in Endometrial Cancer: Latest Updates
Full text linkTen years ago, The Cancer Genome Atlas (TGCA) Research Network classified endometrial cancer into four molecular categories with prognostic significance, suggesting sensitivity to postsurgical treatments [...
Unusual case of adenocarcinoma arising in endometriosis mimicking colorectal cancer in a young woman with a Müllerian anomaly
No full textObjective: To report a case of endometrioid adenocarcinoma that arose in endometriosis mimicking colorectal cancer in a young woman with a Mullerian anomaly.
Design: A case report.
Setting: A university hospital.
Patient(s): A 31-year-old, white nulligravida woman with a history of two previous laparoscopies for infertility
and chronic pelvic pain. A solid rectosigmoid mass adherent to the left pelvic sidewall was found in this patient.
Intervention(s): The patient was subjected to an exploratory laparotomy followed by adjuvant chemotherapy.
Main Outcome Measure(s): Surgical findings and histopathological observations are included in this report.
Result(s): Intraoperative and histologic examinations revealed endometriosis-associated colorectal cancer.
Conclusion(s): Although a rare event, this condition should be considered in the diagnosis of women with a previous history of pelvic endometriosis, Mullerian malformation, abdominal pain, constipation, or rectal bleeding
Uncommon Laparoscopic Findings in a Sexually Immature Agonadal XY Phenotypic Female
No full textA defect of intrauterine development occurring early in male embryogenesis results in a broad range of XY agonadal phenotypes. A 16-year-old girl was referred for evaluation of primary amenorrhea and failure of sexual development. Gynecological examination revealed infantile but otherwise normal female external genitalia with clitoral hypotrophy, absence of hymen, and a tight vaginal introitus. The vagina was 4 cm long and ended in a blind pouch. No masses were detected in inguinal canals or in labia majora. Ultrasonography, computerized tomography, and magnetic resonance imaging failed to demonstrate internal genitalia or gonads. Endocrine evaluation showed elevated plasma concentrations of Follicle Stimulating Hormone and Luteinizing Hormone with undetectable estradiol levels. The kariotype from cultures of peripheral leucocytes was 46, XY. At laparoscopy no uterus or ovarian structures were found. Only two small fibrous oval masses with a thin peduncle were found along each lateral pelvic wall and were excised. Histological examination of these masses revealed that they resembled oviduct tissue. Therefore, the present agonadal XY phenotypic female is the third of such cases that have been reported to have only rudiments of fallopian tubes but is the first of these three cases that has been explored entirely by laparoscopy
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