leuprolide and Postoperative-Complications

Endoscopic endonasal approaches have been shown to be as effective as transcranial approaches for sinonasal malignancies involving the skull base. Although they are associated with less risk than an open cranial resection, cerebrospinal fluid (CSF) leaks remain a main concern. Some drugs can raise the intracranial pressure and exacerbate the risk of a postoperative CSF leak. In this case report, we present a 32-year-old woman who was treated via endoscopic endonasal approach for an olfactory neuroblastoma and later underwent fertility preservation treatment with leuprolide, which likely led to a delayed CSF leak.. A 32-year-old woman diagnosed with a large invasive olfactory neuroblastoma underwent resection via an endonasal transcribriform approach and repair of skull base defect using a pericranial flap. Forty-seven days post operation the patient returned, presenting with a clear nasal discharge. Magnetic resonance imaging raised concern for focal flap necrosis, while computed tomography cisternogram revealed a defect in the pericranial flap. The defect was debrided and repaired; a postoperative lumbar drain was placed and showed an opening pressure of 26 cm of water. Discussion with the patient revealed that she received fertility preservation treatment with leuprolide followed by oocyte retrieval 32 days before presentation of her delayed CSF leak.. Leuprolide or any drug that can potentially increase intracranial pressure should be held for 3 months after surgery or until after a skull base defect has fully healed.

Topics: Adult; Cerebrospinal Fluid Leak; Endoscopy; Esthesioneuroblastoma, Olfactory; Female; Fertility Agents, Female; Fertility Preservation; Humans; Leuprolide; Nasal Cavity; Nasal Surgical Procedures; Nose Neoplasms; Oocyte Retrieval; Postoperative Complications; Risk Factors

The most common location of extragenital endometriosis is the bowel. Medical treatment may not provide long-term improvement in patients who are symptomatic, and consequently most of these patients may require surgical intervention. Over the past century, surgeons have continued to debate the optimal surgical approach to treating bowel endometriosis, weighing the risks against the benefits. In this expert review we will describe how the recommended surgical approach depends largely on the location of disease, in addition to size and depth of the lesion. For lesions approximately 5-8 cm from the anal verge, we encourage conservative surgical management over resection to decrease the risk of short- and long-term complications.

Topics: Anal Canal; Conservative Treatment; Contraceptives, Oral, Combined; Danazol; Digestive System Surgical Procedures; Endometriosis; Endosonography; Estrogen Antagonists; Female; Humans; Intestinal Diseases; Laparoscopy; Leuprolide; Magnetic Resonance Imaging; Ovulation Inhibition; Pelvic Pain; Postoperative Complications; Progestins; Rectal Diseases; Ultrasonography

To assess the factors associated with future pregnancy and successful delivery in women who were treated for uterine adenomyoma with combination (surgical-medical) therapy using ultramini- or mini-laparotomy conservative surgery and gonadotropin-releasing hormone agonist.. One hundred and two women were evaluated. Items for analysis included: age, body mass index, and conception history; clinical symptoms of dysmenorrhea and menorrhagia; tumor location and preoperative serum level of cancer antigen 125 (CA125); the intraoperative findings of the weight of the removed tumor, and the uterine cavity opening.. After excluding those patients using contraception or searching for an assisted reproductive technique, a total of 56 women were enrolled for analysis. Twenty-three (41.1%) women had 27 clinical pregnancies after 3 years of follow-up; 15 went on to deliver a healthy live-born child; two delivered preterm but healthy babies; seven had elective abortions; four had spontaneous abortions; and one had an ectopic pregnancy. The women who had a successful delivery during the 3-year follow-up after treatment tended to be younger, with a lower body mass index, lower baseline analgesic usage score, and lower preoperative serum level of CA125, be nulliparous, and with an adenoma in an anterior location. The linear regression model showed that age and baseline analgesic usage score were independent predictors of successful delivery and accounted for 56.5% of the total variance related to successful delivery.. Age was an important factor associated with future successful delivery, therefore, caution should be taken in considering the maintenance of future fertility in older women treated with surgical-medical therapy.

Topics: Adenomyoma; Adult; Antineoplastic Agents, Hormonal; Combined Modality Therapy; Dysmenorrhea; Female; Follow-Up Studies; Humans; Infertility, Female; Laparotomy; Leuprolide; Linear Models; Menorrhagia; Middle Aged; Postoperative Complications; Pregnancy; Severity of Illness Index; Treatment Outcome; Uterine Neoplasms; Uterus

To determine if 3 months of preoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment decreases postoperative uterine adhesions after open abdominal surgery for the removal of uterine fibroids.. Prospective, randomized, clinical study.. A tertiary care medical center.. Women of reproductive age with symptomatic uterine fibroids not amenable to hysteroscopic removal.. Twenty patients underwent an initial abdominal myomectomy followed by a second-look laparoscopy for evaluating uterine adhesions after random allocation to groups receiving either GnRH analog or placebo for 3 months before the initial surgery.. Adhesion formation between treatment groups and by incision number and aggregate length.. Presurgical GnRH-a treatment did not decrease adhesion formation compared with placebo. For every additional centimeter of incision length, the total adhesion area over the uterine serosal surface increased by 0.55 cm(2). The number of myomas removed and the number of incisions were positively correlated with total adhesion area.. Preoperative treatment with GnRH-a for 3 months before open abdominal myomectomy did not decrease postoperative uterine adhesions. Following the standards of good surgical technique, adhesions are minimized with fewer and smaller incisions.

Topics: Double-Blind Method; Female; Gonadotropin-Releasing Hormone; Humans; Leiomyoma; Leuprolide; Postoperative Complications; Prospective Studies; Tissue Adhesions; Uterine Neoplasms

Between December 1991 and December 1993, 74 BPH patients with an increased operative risk and concomitant diseases such as diabetes mellitus and hypertension were submitted to a transurethral incision of the prostate (TUIP). After TUIP, patients were randomized to two different groups: group 1 was followed without additional treatment and group 2 received an LHRH analogue for the first 6 months of follow-up. With respect to transurethral resection of the prostate (TURP), TUIP has been shown to demonstrate a lower perioperative morbidity. This advantage has lent further support to this technique as a valid alternative for patients in poor general conditions who are at high risk with more invasive procedures. One of the limits of TUIP is the long-term effectiveness. Aim of this study was to ascertain whether in patients with BPH and an increased operative risk who require immediate and definitive treatment but with a low perioperative morbidity, the long-term effectiveness of TUIP can be stabilized by the administration of an LHRH analogue. At present postoperative follow-up ranges from a minimum of 24 months to a maximum 48 months (mean 38.4 months). Perioperative morbidity rate associated with TUIP was 8.1%. In the group randomized to combination therapy (TUIP + LHRH analogue), the clinical condition of the patients was not modified by LHRH analogue treatment and none of the patients withdrew from treatment. Loss of sexual potency occurred in all patients on LHRH analogue, however, none of these patients discontinued treatment for this reason. At the end of the cycle of hormone treatment, sexual potency returned to pretreatment values in 69.5% of patients after a mean of 3.2 months. In this study the objective efficacy of the treatment was evaluated using flow rate measurements, and the subjective assessment of outcomes, using the International Prostate Symptom Score. Statistically significant differences between the two groups (TUIP alone or TUIP + LHRH analogue) (p < 0.01) were reported at 6 months and were still maintained at 24 months of follow up. Results emerging from this investigation confirm that TUIP may be considered extremely safe procedure with low operative risk. In selected BPH patients who are at high risk, with a more invasive procedure and who must be submitted to immediate and definitive treatment, the association of an LHRH analogue seems to increase the long-term effectiveness of TUIP. Five year follow-up studies are still in progress

Topics: Aged; Antineoplastic Agents, Hormonal; Combined Modality Therapy; Erectile Dysfunction; Follow-Up Studies; Humans; Leuprolide; Male; Postoperative Complications; Prostatic Hyperplasia; Urodynamics

Eighteen premenopausal women with symptomatic leiomyomata uteri were enrolled in a stratified, randomized, double-blind, placebo-controlled study evaluating the efficacy of leuprolide acetate (LA) depot treatment before myomectomy. Stratification was based on pretreatment uterine volume (less than 600 cm3 versus greater than or equal to 600 cm3). Nine women received intramuscular (IM) depot LA 3.75 mg every 4 weeks for 12 weeks (group A); nine women received IM placebo with the same injection schedule (group B). All women underwent myomectomy within 4 weeks of their last injection. Mean total intraoperative blood loss was 213 +/- 44 mL (mean +/- standard error of the mean [SEM]) in group A and 302 +/- 43 mL in group B. When data from patients with large uteri (pretreatment uterine volumes of 600 cm3 or greater) were analyzed, mean total blood loss was 189 +/- 44 mL in group A and 390 +/- 20 mL in group B. These data suggest that leuprolide depot treatment before myomectomy may decrease intraoperative blood loss in women with large leiomyomata uteri.

Topics: Delayed-Action Preparations; Double-Blind Method; Estradiol; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Hemorrhage; Hormones; Humans; Intraoperative Complications; Leiomyoma; Leuprolide; Placebos; Postoperative Complications; Premedication; Uterine Neoplasms; Uterus

To investigate the effects of GnRH antagonist (GnRH-ant) and agonist (GnRH-a) in the prevention of postoperative pelvic adhesions by a visual scoring system and immunohistochemical methods in a rat uterine horn model.. Controlled experimental animal study.. Animal laboratory at an academic research environment.. Twenty-one Wistar albino rats.. Rats were randomized into three groups. One week before the operation the rats received either GnRH-ant or GnRH-a or saline solution; they then underwent surgical laparotomy, and both uterine horns were traumatized by a scalpel. Three weeks later, all rats were sacrificed and extension and severity of the adhesions in each group were scored by a visual scoring system. Adhesion tissues were evaluated immunohistochemically for vitronectin and u-PAR.. Scores of extend and severity of adhesions and staining of vitronectin and u-PAR.. The extent of adhesion scores were 1.85 ± 0.86, 0.78 ± 1.05, and 0.42 ± 0.64, and the severity of adhesion scores were 1.71 ± 0.91, 0.57 ± 0.85, 0.50 ± 0.75 for control, GnRH-ant, and GnRH-a groups, respectively. The extent and severity of adhesions were significantly lower in both GnRH-ant and GnRH-a groups when compared with the control group. Adhesion extent scores in the GnRH-a group were lower than in the GnRH-ant group, but this difference was not significant. vitronectin and u-PAR staining were significantly greater in both the GnRH-ant and GnRH-a groups than in the control group.. GnRH-ant as well as GnRH-a reduced postoperative adhesion formation in a rat model. This finding was supported immunohistochemically by vitronectin and u-PAR staining.

Topics: Animals; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Immunohistochemistry; Leuprolide; Postoperative Complications; Rats; Rats, Wistar; Receptors, Urokinase Plasminogen Activator; Severity of Illness Index; Time Factors; Tissue Adhesions; Uterine Diseases; Uterus; Vitronectin

To determine the optimal approach to prevent adhesions comparing leuprolide acetate (GnRH-a), Interceed (oxidized regenerated cellulose; Johnson & Johnson Medical, Inc., New Brunswick, NJ), and a combination of leuprolide with Interceed in a rabbit uterine horn adhesion model.. Prospective, randomized, blinded study.. Certified animal care facility.. Twenty-eight sexually mature, female New Zealand White rabbits.. Animals were prospectively randomized (by number generator) to receive GnRH-a or saline. After 6 weeks, standard surgical manipulations were performed at three sites in each uterine horn by [1]. suture, [2]. unipolar cautery, and [3]. superficial abrasion. Interceed was applied over one randomly assigned uterine horn only. Six weeks after surgery, uterine adhesions were assessed visually, and tissue fibrosis was assessed by histology.. Presence or absence of adhesions and microscopic tissue fibrosis.. Gonadotropin-releasing hormone agonist significantly decreased adhesions, whereas Interceed alone did not reduce adhesions. However, GnRH agonist plus Interceed was the most effective measure to reduce tissue fibrosis.. Preoperative GnRH-a is more effective than Interceed in preventing surgical adhesions in the rabbit uterine horn. However, preoperative GnRH-a plus Interceed may provide optimal results in this animal model, because microscopic tissue fibrosis is minimized with this combination.

Topics: Animals; Cellulose, Oxidized; Disease Models, Animal; Drug Therapy, Combination; Female; Fibrosis; Gonadotropin-Releasing Hormone; Gynecologic Surgical Procedures; Leuprolide; Postoperative Complications; Preoperative Care; Prospective Studies; Rabbits; Random Allocation; Regression Analysis; Tissue Adhesions; Uterus

Prostate carcinoma presenting initially as multiple pulmonary nodules in an asymptomatic patient without previous prostate carcinoma is unusual. Whether the incidence of prostate carcinoma is significantly increased in patients treated previously for germ cell tumors is unclear. We report such a patient, who responded to combination androgen blockade therapy.

Topics: Adenocarcinoma; Adult; Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Combined Modality Therapy; Etoposide; Flutamide; Humans; Leuprolide; Lung Neoplasms; Male; Neoplasms, Germ Cell and Embryonal; Neoplasms, Multiple Primary; Neoplasms, Second Primary; Orchiectomy; Postoperative Complications; Prostatic Neoplasms; Radiography; Testicular Neoplasms

To evaluate the effects of two barriers, one solution, and two pharmacologic agents, in single or in combined use, for preventing postsurgical adhesion formation in the rat model.. A randomized, prospective study to evaluate the ability of leuprolide acetate, oxidized regenerated cellulose, medroxyprogesterone acetate, sodium hyaluronate, sodium hyaluronate/carboxymethyl cellulose, in single or in combined use, for preventing adhesion formation in a rat model.. Wistar female rats.. University animal laboratory.. Intramuscular injection of pharmacologic agents before surgery and intraperitoneal application of barriers and solution at the end of surgery.. Two weeks after surgery, a second laparotomy was performed and the extent of adhesion formation was determined.. All the treatment groups had fewer, less severe adhesions when compared with controls. The combination of medroxyprogesterone acetate and oxidized regenerated cellulose did enhance the adhesion-reducing capacity of oxidized regenerated cellulose. The performance of sodium hyaluronate solution for adhesion prevention was statistically significant, when compared with oxidized regenerated cellulose alone, or sodium hyaluronate used with carboxymethyl cellulose film.. Pharmacologic agents, barriers, or solutions result in significant reduction of postsurgical adhesions. The sodium hyaluronate solution alone and medroxyprogesterone acetate treatment alone had the least adhesion prevention scores. However, neither monotherapy nor combined therapy proved to be significantly more beneficial.

Topics: Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Cellulose, Oxidized; Disease Models, Animal; Double-Blind Method; Drug Therapy, Combination; Female; Fertility Agents, Female; Hyaluronic Acid; Leuprolide; Medroxyprogesterone Acetate; Membranes, Artificial; Postoperative Complications; Progesterone Congeners; Rats; Rats, Wistar; Tissue Adhesions

To assess whether the adhesion-preventing effect of gonadotropin-releasing hormone agonist (GnRHa) is through hypoestrogenism.. Four groups of previously ovariectomized rats received various combinations of depot leuprolide acetate injection (3.75 mg/kg/mo) subcutaneously, conjugated equine estrogens (50 micrograms/kg/d) orally and phosphate-buffered saline injection subcutaneously, yielding group 1, saline only; group 2, saline and conjugated equine estrogens; group 3, depot leuprolide acetate only; and group 4, depot leuprolide acetate and conjugated equine estrogens. Surgical adhesions were induced by monopolar cautery on the right uterine horn through laparotomy and were then scored on day 21 after surgery.. Adhesion scores for rats that received conjugated equine estrogens and saline were significantly higher than scores of those given conjugated equine estrogens and depot leuprolide acetate, depot leuprolide acetate only and saline only (P = .019, .026 and .027, respectively). However, there was no significant difference in the adhesion scores for these three groups.. Hypoestrogenism results in the development of fewer peritoneal adhesions postoperatively. Our findings also indicated that other mechanisms, in addition to those inducing hypoestrogenism, are at work in the adhesion-preventing effects of GnRHa therapy.

Topics: Animals; Delayed-Action Preparations; Estrogens, Conjugated (USP); Female; Horses; Leuprolide; Ovariectomy; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions; Uterine Diseases

To assess the effects of 8 months of neoadjuvant therapy on pathologic stage and biochemical recurrence rates.. One hundred fifty-six men with clinically localized prostate cancer were treated with neoadjuvant combined androgen withdrawal therapy for 8 months prior to radical prostatectomy. Preoperative clinical stage, Gleason score, and serum prostate-specific antigen (PSA) levels were compared with treatment outcome (pathologic stage and PSA recurrence).. PSA at diagnosis was 10 microg/L or higher in 36% with a mean of 11.5 microg/L. Clinical stage was T1c in 18%, T2 in 74%, and T3a in 8%. Gleason score was 6 or lower in 76% and 7 or higher in 24%. Pathologic stage was T0 in 13%, T2 in 66%, T3 (specimen confined) in 13%, T3 (margin positive) in 6%, and TxN+ in 2%. Incidence of positive margins increased with clinical stage T3a versus organ-confined disease (25% versus 4%, P <0.05), pretreatment Gleason scores 7 or higher versus Gleason scores 6 or lower (11% versus 4%, P = NS), and pretreatment PSA levels higher than 10 microg/L compared with PSA levels lower than 10 microg/L (15% versus 0%, P <0.01). Overall PSA recurrence rate was 12.2% after a mean postoperative follow-up of 54 months. Risk of PSA recurrence increased with clinical stage (25% T3 versus 11% organ confined, P <0.01), pretreatment PSA (7% if PSA lower than 10 microg/L versus 21% if 10 microg/L or higher, P <0.02), Gleason score (9% if 6 or lower versus 22% if 7 or higher, P <0.02), and pathologic stage (6% of pT2, 24% of pT3M-, and 56% of pT3M+, P <0.01). PSA recurrences occurred in 6% of patients with no adverse preoperative risk factors, 12% with any one of the high-risk factors, and 29% with any two of the high-risk factors.. Risk of PSA recurrence after 8 months of neoadjuvant therapy is low after 5 years of follow-up and remains proportional to the presence of adverse preoperative risk factors. Prospective randomized studies are required to determine whether longer duration of neoadjuvant therapy reduces the risk of biochemical recurrence after radical prostatectomy.

Topics: Adult; Aged; Androgen Antagonists; Antineoplastic Agents, Hormonal; Combined Modality Therapy; Cyproterone Acetate; Diethylstilbestrol; Drug Therapy, Combination; Flutamide; Follow-Up Studies; Humans; Leuprolide; Lymph Node Excision; Male; Middle Aged; Neoadjuvant Therapy; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Recurrence; Treatment Outcome

The purpose of this report is to estimate the effectiveness of gonadotropin-releasing hormone analogue (Gn-RHa) therapy for peritoneal inclusion cysts.. Patients who had cystic masses that developed after gynecological surgery and were strongly suspected of being peritoneal inclusion cysts based on the results of ultrasound, magnetic resonance imaging (MRI), and tumor marker studies, were treated with a Gn-RHa (buserelin acetate or leuprorelin acetate). Buserelin acetate was administered at a dose of 900 microg/day, and leuprorelin acetate at a dose of 3.75 mg/month. Ultrasonography was performed in the outpatient clinic every 2 weeks after the start of administration to measure the diameter of cysts.. We treated 8 patients with peritoneal inclusion cysts conservatively with a Gn-RHa. The cysts resolved in 7 of the patients. Two of them developed a recurrence, but further Gn-RHa therapy was followed by complete resolution of the cysts in one patient and we resume Gn-RHa therapy to the other patient. The peritoneal inclusion cysts failed to shrink in only one patient.. It is suggested that Gn-RHa therapy is effective in some cases of peritoneal inclusion cysts.

Topics: Adult; Buserelin; Cysts; Female; Genitalia, Female; Humans; Hysterectomy; Leiomyoma; Leuprolide; Magnetic Resonance Imaging; Middle Aged; Ovariectomy; Peritoneal Diseases; Postoperative Complications; Recurrence; Treatment Outcome; Ultrasonography; Uterine Neoplasms

To evaluate gonadotropin-releasing hormone agonists (GnRH-a) therapy and intraperitoneal Ringer's lactate solution (RL) for the prevention of postsurgical adhesion formation in rat models.. Forty rats were randomized into four groups: Group I was the control; in group II, RL was applied at the surgery; group III and IV received preoperative subcutaneous injections of the GNRH-a leuprolide acetate and only the diluent of the GNRH-a respectively. A standard lesion was created over the uterus of each rat. Adhesions were scored at relaparotomy 3 weeks later. Analysis of variance (Kruskal-Wallis) and Mann-Whitney U-tests were used for the statistical evaluation.. The average adhesion scores were 2.7+/-0.26, 1.4+/-0.27, 0.9+/-0.18, and 2.5+/-0.34 in groups I, II, III, and IV respectively. There were significant differences between the scores of groups I and II (P<0.01), groups I and III (P<0.001), groups II and IV (P<0.05), and groups III and IV (P<0.01); but not between the scores of groups II and III, and groups I and IV (P>0.05).. GNRH-a was successful in reducing postoperative adhesion formation but was not superior to intraperitoneal RL.

Topics: Animals; Female; Isotonic Solutions; Leuprolide; Peritoneal Diseases; Postoperative Complications; Rats; Ringer's Lactate; Tissue Adhesions

Fifty adult female rats were randomly divided into five groups. Before the standard surgical procedure which consisted of creating a lesion with electrocautery over the uterus, leuprolide acetate (LA) together with its diluent, the diluent alone and medroxyprogesterone acetate (MPA) were injected to the third, fourth, and fifth groups, respectively. Ringer's lactate (RL) solution was applied intraperitoneally to the second group at the end of the surgery. Group I received no medication. Relaparotomy was performed 3 weeks later to evaluate the adhesions. The mean adhesion scores were (mean +/- SD) 2.6 +/- 0.7, 1.4 +/- 0.8, 0.9 +/- 0.6, 2.3 +/- 0.8, and 0.8 +/- 0.6 in groups I, II, III, IV, and V, respectively. The postsurgical adhesions were significantly less in the groups treated with RL, LA, and MPA.

Topics: Animals; Female; Isotonic Solutions; Leuprolide; Medroxyprogesterone Acetate; Postoperative Complications; Rats; Ringer's Lactate; Tissue Adhesions; Uterine Diseases; Uterus

To assess the relationship of menstrual timing of administration of gonadotropin-releasing hormone (GnRH) agonist on the effectiveness of endometrial thinning and unwanted uterine bleeding.. Prospective observational study.. Gynecology department of a community hospital.. One hundred consecutive women in a private practice, without submucous myomas, scheduled for transcervical endomyometrial resection or ablation.. A GnRH agonist was administered at an unspecified time of the menstrual cycle. Transcervical hysteroscopic endomyometrial resection or ablation was performed 1 month later.. No significant statistical differences were seen in either the effectiveness of endometrial thinning or the occurrence or severity of unwanted uterine bleeding.. A GnRH agonist as pretreatment for endomyometrial resection or ablation can be administered at any time during the menstrual cycle with similar efficacy. Timing of surgery can be at the mutual convenience of patient and physician.

Topics: Adult; Antineoplastic Agents, Hormonal; Drug Administration Schedule; Endometrium; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Humans; Hysterectomy; Leuprolide; Menorrhagia; Menstruation; Middle Aged; Observation; Postoperative Complications; Preoperative Care; Prospective Studies; Time Factors

To evaluate the prevalence of resumption of menstruation after an interval of amenorrhea in women treated by endometrial ablation and myometrial resection.. Retrospective analysis.. Tertiary care university-affiliated teaching hospital.. One hundred fifty-seven consecutive patients treated for menorrhagia refractory to medical therapy.. Loop resection or rollerball ablation of the endometrium.. At 6 to 12 months postoperatively, 50. 6% of patients were amenorrheic and 35.1% had hypomenorrhea. Over follow-up of 13 to 30 months, 45.1% of women became amenorheic and 40.5% had satisfactory hypomenorrhea. Resumption of menstruation after any interval of amenorrhea occurred in 27.2% of amenorheic patients. We observed an increasing trend to resumption of menstruation after rollerball ablation (29.4%) compared with loop resection (26.7%) and after preoperative endometrial suppression with buserelin (37.5%) and leuprolide (27.1%) compared with danazol (12.5%) and goserelin (10.5%). Resumption of menstruation occurred in 44.4% of women who did not have preoperative endometrial suppression.. Our results suggest that resumption of menstruation does occur after a variable interval of amenorrhea following endometrial ablation and myometrial resection. It could potentially be used as a marker of failure of endometrial destruction.

Topics: Amenorrhea; Buserelin; Danazol; Electrocoagulation; Endometrium; Female; Follow-Up Studies; Goserelin; Humans; Leuprolide; Menorrhagia; Myometrium; Postoperative Complications; Preoperative Care; Retrospective Studies; Time Factors; Treatment Failure

To evaluate the efficacy of a commonly used progestogen, medroxyprogesterone acetate (MPA), in the prevention of postoperative adhesion formation.. A double-blind, controlled study evaluated the efficacy of MPA to reduce postoperative adhesion formation and compared it with other adjuvants and controls in a rat model.. Animal Care Facility of an academic research setting.. Seventy-five Sprague-Dawley female rats randomly divided into five groups.. Three weeks before surgery, the animals from each group were administered an IM injection of one of the following regimens: [1] 15 mg MPA; [2] both 15 mg MPA and 0.75 mg leuprolide acetate (LA); [3] 0.75 LA; or [4] and [5] comparable volumes of sterile saline. A standardized surgical trauma was inflicted in all animals. Before abdominal closure, 2 mL of Ringer's Lactate was instilled in the abdominal cavity of all groups except group 5 (controls). Three weeks after surgery, the rats were killed and the adhesions were scored on a scale of 0 to 3 according to their size, thickness, and vascularity.. Postoperative adhesions.. The preoperative administration of MPA resulted in the least number and the least severe adhesions. The combination of LA and MPA did not reduce postoperative adhesion formation. Both Ringer's Lactate and LA reduced postoperative adhesions but not to the same extent as MPA.. The preoperative administration of MPA in our laboratory animal model results in the most significant reduction of postoperative adhesion formation. This action of MPA may be mediated by the induction of both a progestational and a hypoestrogenemic milieu. However, the ultimate role of MPA in a clinical situation requires further investigation.

Topics: Abdomen; Animals; Double-Blind Method; Drug Combinations; Female; Leuprolide; Medroxyprogesterone Acetate; Pelvis; Postoperative Complications; Rats; Rats, Sprague-Dawley; Sodium Chloride; Tissue Adhesions

Menorrhagia was treated with the "rollerball" method for five years, 1988-1993, in 200 patients. All the patients were evaluated and treated at Kaiser-Permanente facilities in northern California. All patients were candidates for hysterectomy based on excessive bleeding from benign conditions. The procedures were done on an out-patient basis. Complications were minimal, with a mean follow-up of 2.5 years. Relief was achieved in 90% of patients. Eight patients required repeat ablations. Of those, one required hysterectomy. Ten patients had hysterectomies following rollerball ablation. The data add to the growing opinion that endometrial ablation ("rollerball") is an economical, effective method of treating menorrhagia without resorting to hysterectomy.

Topics: Electrocoagulation; Endometrium; Female; Humans; Hysterectomy; Leuprolide; Life Tables; Medroxyprogesterone Acetate; Menorrhagia; Norethindrone; Norethindrone Acetate; Postoperative Complications; Reoperation; Uterine Hemorrhage

To evaluate the effectiveness of GnRH agonist (GnRH-a) therapy on adhesion formation and reformation in established rat models for surgically induced adhesion formation and endometriosis.. Before surgery, female Sprague-Dawley rats were injected with GnRH-a or control diluent. Six days later, rats were assigned to one of four surgical groups: [1] endometriosis, [2] endometriosis sham, [3] adhesion model, or [4] adhesion sham. Three weeks after surgery, a second-look laparotomy was performed, adhesions were scored (0 = no adhesions to 3 = severe adhesions) and mechanically disrupted, and rats received a second GnRH-a or diluent injection either analogous to their initial injection or in a crossover design. Three weeks after the second injection, rats were killed and adhesion reformation was scored. Data were evaluated using nonparameteric tests including Mann-Whitney, Kruskal-Wallis, and Friedman's tests comparing GnRH-a treatments with diluent controls.. Preoperative GnRH-a therapy reduced adhesion scores in rats with surgically induced endometriosis (mean +/- SEM; GnRH-a 1.1 +/- 0.2 versus diluent 2.2 +/- 0.2) and adhesions (GnRH-a 0.3 +/- 0.1 versus diluent 0.6 +/- 0.1). Pretreatment GnRH-a therapy did not affect adhesion scores in the endometriosis sham procedure. Combined preoperative and postoperative GnRHa therapy (GnRH-a-GnRH-a) but not postoperative GnRH-a therapy alone (diluent-GnRH-a) reduced adhesion reformation after adhesiolysis in the endometriosis model (GnRH-a-GnRH-a 1.1 +/- 0.3, diluent-GnRH-a 1.6 +/- 0.7), the endometriosis sham (GnRH-a-GnRH-a 0.7 +/- 0.2, diluent-GnRHa 1.8 +/- 0.1), and the adhesion model (GnRH-a-GnRH-a 0.3 +/- 0.2, diluent-GnRHa 1.0 +/- 0.5). No adhesions were observed in the adhesion sham group.. Gonadotropin-releasing hormone agonist therapy was successful in reducing adhesion formation and reformation. These studies suggest that GnRH-a therapy for adhesion prevention in women should be explored.

Topics: Animals; Estradiol; Female; Leuprolide; Postoperative Complications; Progesterone; Rats; Rats, Sprague-Dawley; Tissue Adhesions

Progestin or estrogen-progestin combination therapy has not proven useful in the treatment of endometriosis of the abdominal scar after cesarean delivery. We report our experience in managing this condition with a gonadotropin agonist.. A 22-year-old black woman with a history of two previous cesareans developed endometriosis of the abdominal scar. The extent of the lesion was estimated by computed tomographic (CT) scan, and a 6-month preoperative course of leuprolide acetate was administered. The patient exhibited prompt symptomatic response to the gonadotropin agonist, but the physical examination and CT scan findings were unchanged. Pathologic examination after surgical removal of the lesion confirmed the clinical diagnosis.. Leuprolide acetate administered to a patient with cesarean scar endometriosis was associated with an improvement in symptoms, but there was no change in lesion size.

Topics: Adult; Cesarean Section; Cicatrix; Endometriosis; Female; Humans; Leuprolide; Postoperative Complications; Pregnancy; Tomography, X-Ray Computed

The ovarian remnant syndrome represents the development of symptoms due to residual ovarian tissue after bilateral salpingo-oophorectomy. Treatment generally consists of surgical resection but recurrence after resection is common. A case is reported in which a postoperative recurrent ovarian remnant was successfully managed by using a luteinizing hormone-releasing hormone agonist. In addition, this report includes a survey of gynecologists to determine the frequency of this syndrome and of ureteral involvement.

Topics: Adult; Fallopian Tubes; Female; Humans; Incidence; Leuprolide; Ovariectomy; Ovary; Postoperative Complications; Syndrome; Ureteral Obstruction

Topics: Combined Modality Therapy; Endometrium; Female; Follow-Up Studies; Humans; Hysterectomy; Hysterectomy, Vaginal; Hysteroscopy; Laparoscopy; Leuprolide; Postoperative Complications; Uterine Neoplasms

After orthotopic heart-lung transplantation and immunosuppression, a patient developed intractable nausea and vomiting in association with chronic cytomegalovirus infection. Chronic intestinal pseudoobstruction was documented by antroduodenal manometric study. The patient was treated with leuprolide acetate with resolution of symptoms and improvement of intestinal motility abnormality. This case demonstrates an association of chronic viral infection with acquired intestinal motor disorders. Gastrointestinal complications that are common after organ transplantation might be due to acquired neuromuscular disease. The potential efficacy of leuprolide in such neuromuscular disorders provides a rationale for diagnostic motility studies in patients with "functional" gastrointestinal disorders.

Topics: Adolescent; Chronic Disease; Cytomegalovirus Infections; Female; Gastric Emptying; Heart-Lung Transplantation; Humans; Immunosuppression Therapy; Intestinal Pseudo-Obstruction; Intestine, Small; Leuprolide; Postoperative Complications; Recurrence; Viremia

In 1988 and 1989, 67 women (mean age, 36.7 years) underwent myomectomy to remove uterine fibroids; selection of the procedure was based on the presence of symptoms and the patient's desire to avoid hysterectomy. For 8 weeks before myomectomy, 48 patients with a uterine size greater than or equal to 16 weeks' gestation received the gonadotropin releasing hormone (GnRH) analog leuprolide acetate, 0.5 mg self-administered daily by subcutaneous injection or 3.75 mg as the depot form every 28 days by intramuscular injection; the remaining 19 patients were used for a comparison. In the leuprolide-treated patients, the mean uterine size and mean number of fibroids removed per patient were significantly higher, and the mean postoperative hemoglobin concentration was significantly lower than in the non-leuprolide-treated group. The mean estimated blood loss and mean length of hospital stay were equivalent for the two groups. Eight patients (12%), all but one in the leuprolide-treated group, developed postoperative complications, primarily infections that were treated successfully with antibiotics; one patient, the only one undergoing a repeat myomectomy, experienced pelvic hematoma, infection and pelvic thrombophlebitis. There were no significant adverse reactions attributable to leuprolide administration.

Topics: Adult; Blood Loss, Surgical; Combined Modality Therapy; Female; Humans; Leiomyoma; Length of Stay; Leuprolide; Middle Aged; Postoperative Complications; Premedication; Treatment Outcome; Uterine Neoplasms

Attempts at inhibiting the thickness and vascularity of the endometrium in preparation for endometrial ablation by using different types of hormones have been reported. To evaluate the effects of two different progestins, danazol, and leuprolide acetate on the endometrium, compared with the features of early proliferative endometrium, histologic studies were done for at least five patients treated with each hormone who then underwent resectoscopic endometrial ablation for treatment of abnormal uterine bleeding. Significant and at times dramatic differences among the treatment groups were found, with progestin-prepared endometrium being the least successful and leuprolide-prepared endometrium the most successful. In addition, the prolonged suppression provided for a period of time after the procedure by depot leuprolide is likely to help inhibit endometrial regeneration and provide even better long-term success of the procedure.. Four hormonal treatments to inhibit endometrial development were compared, medroxyprogesterone acetate, norethindrone, danazol and leuprolide, before resectoscopic ablation of the endometrium in 25 women with hypermenstruation. The patients all had excessive and or prolonged heavy menstrual flow not helped by curettage or combined estrogen-progestins. They ranged in age from 37-48, and none were menopausal. The pretreatments were Depo-Provera 200 mg im for 6-9 weeks, norethindrone acetate (Norlutate, Parke Davis) 5 mg daily for 6 weeks, 600 or 800 mg danazol (Danocrine, Winthrop) daily orally for 6 weeks, or leuprolide acetate (Depot Lupron, TAP Pharmaceuticals) on Day 20-24 of the cycle 4-5 weeks before ablation. The resectoscopic ablation consisted of shaving the endometrium from the cornual areas and fundal surface to the internal os to a depth of 3-4 mm with a Storz gynecologic resectoscope, size 24 Fr., with a 90 degree angle wire loop electrode, at 110 W. Histologic sections showed a fluffy decidual response to progestins such that blunt dissection or suction curettage was needed to the ablation. Danazol produced inconsistent responses from atrophy to thick deciduoid, but all had a relatively thick endometrium. Leuprolide produced a consistently thin, but not atrophic endometrium, with spindle-like fibroblast-type stromal cells, and few glands. Untreated women in early proliferative phase, Days 4-8, had atypical, thin, hypovascular endometria, with dysynchronous mild hyperplasia of some glands and stroma in some cases. Ablation was easy in untreated women. The thickness of thermally damaged tissues was 217 mm in progestin-treated women, 175 mm in danazol-treated and 141 in leuprolide-treated women. Leuprolide produced the most dependable suppression of the endometrium of the 4 drug treatments.

Topics: Adult; Danazol; Electrosurgery; Endometrium; Female; Gonadotropin-Releasing Hormone; Hormones; Humans; Leuprolide; Middle Aged; Postoperative Complications; Postoperative Period; Premedication; Progestins; Uterine Diseases

Persistent ovarian cysts are considered to be the most troublesome complication of ovarian transposition. Transabdominal drainage or surgical removal is often required. This paper reports the successful use of leuprolide acetate, a GnRH agonist, in the treatment of a symptomatic and persistent ovarian cyst which developed after ovarian transposition. The benefits of this therapy over others are discussed.

Topics: Adult; Combined Modality Therapy; Female; Gonadotropin-Releasing Hormone; Hormones; Humans; Leuprolide; Ovarian Cysts; Ovary; Postoperative Complications; Uterine Cervical Neoplasms

In this informal initial study, four female patients with intractable chronic abdominal pain, daily nausea, intermittent vomiting, and altered stool habits due to "functional" disease were investigated. A gonadotropin-releasing hormone (GnRH) analog agonist, leuprolide acetate (Lupron) [D-leu6, Desgly-NH2(10), Proethylamide9], was administered once daily (0.5 mg subcutaneously) for three months. At the end of the three-month period, three subjects were symptom-free and the fourth experienced only mild and intermittent pain. The leuprolide regimen was continued for an additional three months, and estrogen (0.625 mg orally) and calcium (1000 mg orally) were given daily to prevent osteoporosis. The patients remained symptom-free. A challenge with progesterone then induced recurrence of mild symptoms in each subject. Withdrawing leuprolide induced the baseline symptoms in all patients within three to five days. This regimen has now been continued for up to 15 months, and all four patients have remained generally symptom-free. Progesterone has also been given every three months to induce menses. A fifth patient, with Roux-en-Y syndrome, has also been treated with leuprolide. She is symptom-free after six months and has gained weight. In this initial observation period in patients with severe functional (neuromuscular) bowel disease, the GnRH analog agonist leuprolide controlled pain, nausea, and vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Anastomosis, Roux-en-Y; Chronic Disease; Colonic Diseases, Functional; Drug Evaluation; Female; Gonadotropin-Releasing Hormone; Hormones; Humans; Leuprolide; Middle Aged; Postoperative Complications; Syndrome; Time Factors