RESUMEN
OBJECTIVE: To evaluate the hemostatic efficacy and handling of gelatin-thrombin matrix in abdominal myomectomy. DESIGN: Prospective and randomized trial. SETTING: University teaching hospital. PATIENT(S): Women (n = 50) with uterine fibroids with a uterine size equivalent to > or =16 weeks gestation. INTERVENTION(S): Gelatin-thrombin matrix (FloSeal Matrix; Baxter Healthcare Corp., Fremont, CA) was delivered to the site of the uterine bleeding during myomectomy. MAIN OUTCOME MEASURE(S): Patient age, parity, number of myomas, operative time, blood loss, transfusion, intraoperative and postoperative complications, and length of hospitalization were evaluated. RESULT(S): The average blood loss during surgery was 80 +/- 25.5 mL for the FloSeal group and 625 +/- 120.5 mL for the control group. Intraoperative blood transfusion was necessary in five patients from the control group. Postoperative blood loss was 25 +/- 5 mL for the FloSeal group and 250 +/- 75 mL for the control group. Length of the postoperative hospital stay was 2.5 +/- 1.2 days for FloSeal group and 4.5 +/- 1.3 for the control group. No major immediate or delayed complications were observed in either group. CONCLUSION(S): Reductions in hemorrhage in FloSeal-treated women undergoing a myomectomy are encouraging, and provide evidence for the ability of gelatin-thrombin matrix to reduce blood loss when applied immediately and directly to bleeding uterine tissue.
Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Hemostáticos/uso terapéutico , Leiomioma/cirugía , Mioma/cirugía , Neoplasias Uterinas/cirugía , Adulto , Femenino , Gelatina , Hemostasis Quirúrgica/efectos adversos , Humanos , Selección de Paciente , Estudios Prospectivos , Trombina , Adulto JovenRESUMEN
OBJECTIVE: To compare the messenger RNA (mRNA) expression of vascular endothelial growth factor (VEGF) receptors (KDR, Flt-1, and sflt) in the different endometrial locations of septate uterus and normal uterus. DESIGN: Prospective, observational study. SETTING: University teaching hospital. PATIENT(S): Twelve women with complete septate uterus undergoing hysteroscopic metroplasty and 12 women with normal uterus. INTERVENTION(S): Endometrial tissue samples were obtained from the endometrium covering the septum and the endometrium lining the lateral wall of the uterus. Moreover, endometrial samples were obtained from patients with normal uterus. MAIN OUTCOME MEASURE(S): Differences in the mRNA expression of VEGF receptors between the endometrial samples of septate and normal uterus. RESULT(S): The mRNA expression of VEGF receptors, both KDR and Flt-1, was significantly lower in the endometrium lining the septum as compared with the endometrium covering the lateral wall of septate and normal uterus. Conversely, no differences were observed in mRNA expression in the soluble receptor sflt between the different endometrial samples studied. CONCLUSION(S): The results suggest that a local defect of both VEGF transmembranous receptors (KDR and Flt-1) in the endometrium covering the septal area may be responsible for the clinical comportment of this müllerian anomaly.
Asunto(s)
Endometrio/metabolismo , Receptores de Factores de Crecimiento Endotelial Vascular/metabolismo , Útero/metabolismo , Adulto , Estudios de Casos y Controles , Femenino , Regulación de la Expresión Génica , Humanos , Estudios Prospectivos , ARN Mensajero/metabolismo , Receptores de Factores de Crecimiento Endotelial Vascular/genética , Receptor 1 de Factores de Crecimiento Endotelial Vascular/genética , Receptor 1 de Factores de Crecimiento Endotelial Vascular/metabolismo , Receptor 2 de Factores de Crecimiento Endotelial Vascular/genética , Receptor 2 de Factores de Crecimiento Endotelial Vascular/metabolismoRESUMEN
We describe a cotyledonoid dissecting leiomyoma in a 33-year-old nulliparous woman treated by laparoscopy.