Using the LigaSure vessel sealing device in the large uterus at laparoscopic hysterectomy.

OBJECTIVE: To compare intraoperative hemorrhage and other operative parameters between patients with large and small weighted uterus who underwent laparoscopic hysterectomy (LH). MATERIALS AND METHODS: Forty-six patients intending to have LH were divided into two groups according to uterine weight (group 1 > 300 grams vs. group 2 < 299 grams). Intraoperative blood loss, operating time, periopera- tive complications, and duration of hospitalization were compared. RESULTS: Intraoperative blood loss was significantly higher in the large uterus group (group 1); 350 (227-454) ml vs. 250 (182-320) ml (p < 0.001). However, it was not significantly different between the groups in the laparoscopy step. Mean operating time was 90 (77-103) minutes and 80 (62-98) minutes in groups 1 and 2, respectively (p < 0.001) revealing ten-minute delay in group 1. Similarly, this was also not significantly different in the laparoscopy step. No significant differences were found between two groups; in terms of hemoglobin concentration decrease, major and minor complications, and hospitalization duration. CONCLUSION: The authors conclude that LigaSure can be safely used for LH in patients with a large uterus.

The effect of low-dose combined oral contraceptive containing 100 ug levonorgestrel on plasma plasminogen activator inhibitor-1 concentrations.

OBJECTIVE: The objective of the current study was to investigate the effect of a combined oral contraceptive (COC) containing 20 ug ethinyl estradiol (EE) and 100 ug levonorgestrel (LNG) which is currently used on plasma plasminogen activator inhibitor-1 (PAI-1) concentrations. MATERIAL AND METHODS: Twenty-five women who had not used any COC for at least three months before the initiation of the study were enrolled in the control group. Twenty women who had been using COC containing 20 ug EE and 100 ug levonorgestrel LNG for at least three months prior to the study were enrolled in the LNG/EE group. Serum samples for PAI-1 and other biochemical parameters were obtained at the early follicular phase (cycle day 2-5). RESULTS: No significant difference was observed in PAl- 1 concentrations between the LNG/EE and control group (group LNG/EE: 62.4 +/- 30.2 ng/ml; control group: 58.7 +/- 26.0 ng/ml). CONCLUSION: Although we observed similar PAI-1 concentrations in both groups, there is need for further interventions to evaluate the clinical relevance of our findings.

Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei.

BACKGROUND AND AIMS: Surgical improvement can be achieved in selected patients with pseudomyxoma peritonei (PMP) by major cytoreductive surgery and intraperitoneal chemotherapy (IPEC). The purpose of this retrospective study was to analyze morbidity, mortality, and survival following therapy. PATIENTS AND METHODS: Between July 1995 and September 2003, 28 patients (mean age 56 years, range 28-79) with PMP were operated on with the aim of complete macroscopical cytoreduction. Surgery was followed by IPEC. RESULTS: A macroscopically complete cytoreduction was achieved in 11 patients (40%). The mean operating time was 6 h with a mean of three peritonectomy procedures per patient. Cisplatin (15 out of 28), mitomycin C (6 out of 28) and 5-FU (7 out of 28) were used for the intraoperative chemotherapy. Overall morbidity was 36%. Most frequent surgical complications were digestive fistulae (3 out of 28), abscesses (5 out of 28) and bleeding (2 out of 28). Two patients died postoperatively. Patients with low tumor volume (mean survival time 78+/-11 vs. 37+/-9 months, p=0.05) and complete cytoreduction (73+/-10 vs. 24+/-8 months, p<0.05) had an improved prognosis. CONCLUSIONS: Cytoreductive surgery combined with IPEC is associated with acceptable morbidity and mortality. Complete cytoreduction may improve survival, particularly in selected patients with PMP who have a low tumor volume, complete cytoreduction, and no organ metastases.