trelstar and Blood-Loss--Surgical

The preservation of fertility and integrity of the reproductive organs has increasingly been of concern to most women with adenomyosis. Adenomyomectomy is conservative surgery that is now widely applied; however, relapse is a serious problem after the operation. Postoperative treatment, such as gonadotropin-releasing hormone agonist (GnRHa) has been suggested to result in reducing the rate of disease recurrence. However, there is still a lack of evidence from randomized clinical trials examining the efficacy of GnRHa in decreasing the postoperative recurrence rate.. Relapse after conservative surgery combined with triptorelin acetate versus conservative surgery only in women with focal adenomyosis is a multicenter, prospective, randomized controlled trial. The primary outcome is relapse assessed using a visual analogue scale (VRS) and numeric rating scale (NRS), pictorial blood loss assessment chart (PBAC) score, and the size of the uterus and the lesion as measured by two/three-dimensional color doppler ultrasonography (2D/3D-CDUS) or magnetic resonance imaging (MRI). The secondary outcomes include quality of life, clinical pregnancy, ovarian reserve, adverse events, assessment by the Short Form (36) Health Survey and Female Sexual Function index, serum follicle-stimulating hormone, estradiol levels, and anti-Muellerian hormone and so on. All these indexes are measured at 3, 6, 12, 18, 24, 30, and 36 months after conservative surgery.. The result of this large, multicenter randomized trial will provide evidence for one of the strategies of long-term management in focal adenomyosis after conservative operation.. Chinese Clinical Trial Registry: ChiCTR1800014340. Registered on 6 January 2018.

Topics: Adenomyosis; Blood Loss, Surgical; Female; Humans; Luteolytic Agents; Magnetic Resonance Imaging; Multicenter Studies as Topic; Pregnancy; Pregnancy Rate; Prospective Studies; Quality of Life; Randomized Controlled Trials as Topic; Recurrence; Treatment Outcome; Triptorelin Pamoate; Ultrasonography, Doppler, Color; Uterine Myomectomy; Uterus

To evaluate if pre-operative GnRH-a modify uterine leiomyoma pseudocapsule and the possible clinical effects of these changes.. The study was performed at the University Federico II of Naples on 33 premenopausal patients submitted to laparotomic myomectomy after treatment with triptorelin depot. 29 untreated patients formed the control group. The operating time, the intraoperative bleeding and the prompt identification of the cleavage plan between myoma and myometrium were evaluated. The pseudocapsule features and the immunoexpression of PCNA and CD34 in this area were studied.. Treated patients showed lower blood loss and not clearly identifiable cleavage plan, but without any significant increase in the operating time. Treated lesions showed less evident border between myoma and myometrium and lower PCNA and CD34 pseudocapsule immunoexpression than untreated ones.. We propose the changes of leiomyoma pseudocapsule as partial explanations of the reported clinical and surgical findings after pre-operative GnRH-a.

Topics: Adult; Antigens, CD34; Antineoplastic Agents, Hormonal; Blood Loss, Surgical; Cell Proliferation; Delayed-Action Preparations; Female; Gonadotropin-Releasing Hormone; Humans; Leiomyoma; Myometrium; Neovascularization, Pathologic; Preoperative Care; Proliferating Cell Nuclear Antigen; Triptorelin Pamoate; Uterine Neoplasms

To ascertain whether adjuvant gonadotropin-releasing hormone (GnRH) agonist therapy decreases blood loss during abdominal myomectomy.. Randomized controlled trial.. Academic reproductive surgery center.. One hundred premenopausal women requiring first-line conservative surgery for symptomatic intramural or subserous fibroids.. Eight weeks of treatment with depot triptorelin before myomectomy or immediate surgery.. Intraoperative blood loss, operating time, degree of difficulty of the procedure, and short-term rate of fibroid recurrence.. Mean (+/-SD) intraoperative blood loss was 265 +/- 181 mL in triptorelin recipients and 296 +/- 204 in patients who had immediate surgery (mean difference, -31 mL [95% CI, -108 to 46 mL]). No significant differences were observed in blood loss according to uterine volume, number of fibroids removed, or total length of myometrial incisions. Most procedures in either group were of routine difficulty. On ultrasonography 6 months after myomectomy, four women in the GnRH agonist group and one in the immediate surgery group had tumor recurrence.. Treatment with a GnRH agonist before abdominal myomectomy has no significant effect on intraoperative blood loss. Thus, systematic use of medical therapy before abdominal myomectomy does not seem to be justified.

Topics: Adult; Antineoplastic Agents, Hormonal; Blood Loss, Surgical; Female; Hemoglobins; Humans; Leiomyoma; Triptorelin Pamoate; Uterine Neoplasms

To investigate the outcome of neo-adjuvant hormone treatment before radical prostatectomy regarding local tumour extension, peri-operative blood loss and operation time.. Of 111 surgically treated patients with prostate cancer (T1b-T3a, N0, M0, G1-3), 55 were randomised to immediate radical prostatectomy and 56 to 3 months of neo-adjuvant treatment with triptorelin (3.75 mg i.m. every 28 days) and cyproterone acetate (50 mg b.i.d. for 3 weeks to prevent flare).. No differences were found in blood loss or operation time but patients who had neo-adjuvant treatment had a significantly lower frequency of positive margins (41 vs. 23%, p = 0.013).. Neo-adjuvant treatment does not facilitate radical prostatectomy but may improve the chance of local cure. This must, however, be documented with long-term follow-up in randomised patients.

Topics: Aged; Androgen Antagonists; Antineoplastic Agents, Hormonal; Blood Loss, Surgical; Chemotherapy, Adjuvant; Cyproterone Acetate; Humans; Male; Neoplasm Staging; Prostate; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Testosterone; Time Factors; Triptorelin Pamoate

Following the introduction of GnRH analogue drugs the medical treatment of uterine myomatosis has been proposed. The use of these compounds in fact causes a reduction in mean plasma levels of 17-beta-estradiol which is reflected in the target tissue of myomas. Using this hormone-dependence as a starting Tryptoreline point, the study examined the volumetric changes induced by LH-RH agonist analogue, Tryptoreline, administered to a group of 15 selected patients. The results are encouraging: in all cases there was a marked reduction of tumour volume ranging between 30 and 40%. The therapeutic effect, however, gradually wore off following the suspension of treatment. For this reason, the use of this analogue should be reserved for premenopausal or younger patients for the treatment of menometrorrhagic episodes, or as a preoperative therapy in order to limit blood loss during surgery.

Topics: Adolescent; Adult; Age Factors; Blood Loss, Surgical; Drug Evaluation; Female; Humans; Leiomyoma; Middle Aged; Preoperative Care; Remission Induction; Triptorelin Pamoate; Uterine Neoplasms

Topics: Blood Loss, Surgical; Female; Gonadotropin-Releasing Hormone; Gynecologic Surgical Procedures; Humans; Leiomyoma; Lypressin; Terlipressin; Triptorelin Pamoate; Uterine Neoplasms; Vasoconstrictor Agents