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Medical ozone therapy decreases postoperative uterine adhesion formation in rats
DESIGN: Prospective experimental study. MATERIALS AND METHODS: Normal peritoneal and adhesion fibroblasts isolated from the same women undergoing laparotomy for pelvic pain (n ¼ 3) were treated with or without 0.2 mM DNP for 24 hours. RNA levels of the adhesion phenotype markers type I collagen, vascular endothelial growth factor (VEGF), and hypoxia-inducible factor (HIF)-1a were measured via quantitative RT-PCR. All experiments were performed in triplicate. Paired t-tests were utilized to analyze differences between treatment groups. A significance value of p < .05 was used to establish statistical significance. RESULTS: In agreement with prior findings, adhesion fibroblasts exhibited significantly higher basal levels of type I collagen, VEGF, and HIF-1a compared to normal peritoneal fibroblasts. Treatment of normal peritoneal fibroblasts with 0.2 mM DNP for 24 hours resulted in significant increases in type I collagen (10.2 2.0 vs. 18.4 2.2 fg/mg RNA, P¼0.02) and VEGF (8.2 2.3 vs. 14.6 4.8 fg/mg RNA, P¼0.05) over baseline. However, HIF-1a levels did not increase when normal peritoneal fibroblasts were treated with 0.2 mM DNP. CONCLUSION: The adhesion phenotype is reproduced by uncoupling oxidative phosphorylation with DNP, as evidenced by an increase in type I collagen and VEGF, via a mechanism distinct from hypoxia-induced upregulation of HIF-1a. These observations are consistent with the hypothesis that 1) the adhesion phenotype represents a state of intracellular metabolic depletion and that 2) oxidative stress, as opposed to hypoxia per se, may be the inciting event leading to postoperative adhesion development. Supported by: ACOG District V Junior Fellow Grant.
MATERIALS AND METHODS: Thirty female Wistar rats (200–250 g) were divided into three groups: sham, control, and ozone groups. The control and ozone groups were subjected to the postoperative adhesion procedure created by bipolar coagulation set at 10 watts per second on the uterine horns and corresponding pelvic sidewall parietal peritoneum. In the control and ozone groups, approximately 2 cm of the both uterine horns and 4 cm2 of the opposing pelvic sidewall peritonea of the rats were electrocoagulated using bipolar forceps and a power setting of 10 W/sec. The rats in the ozone group were administered a single dose of 0.7 mg/kg/day ozone/oxygen mixture intraperitoneally (i.p.) after adhesion induction. The animals were killed on the 7th day and uterine adhesions were evaluated according to the scoring system published by Leach et al. (1998). The adhesions, electrocoagulated tissues, and samples of peritoneal washing fluid were collected for biochemical evaluation. RESULTS: In the control group, a significant elevation in TNF-a level in the peritoneal washing fluids, increased levels of MDA in the uterine tissues, and decreased antioxidant enzyme activities (SOD and GSH-Px) in the uterine tissues were observed. None of these changes were found in the ozone group. Macroscopic adhesion scores were significantly higher in the control group than those observed in the other groups (P<0.05, control vs. sham and control vs. ozone group). CONCLUSION: Medical ozone therapy decreased postoperative intraabdominal adhesions in a rat model, probably by modulating TNF-a, which resulted in reduced oxidative stress.
P-134 Tuesday, October 18, 2011 P-132 Tuesday, October 18, 2011 THE EFFECT OF USING LONG-DIPHERELINE AND ULTRASOUND-GUIDED PUNCTURING TO TREAT OVARIAN ENDOMETRIOTIC CYST AND ITS IMPACT ON THE OUTCOME OF ASSISTED REPRODUCTIVE TECHNOLOGY. G. Yihong. Reproductive Medical Centre, Zhengzhou, Henan, China. OBJECTIVE: To investigate the effect of using Long-Diphereline and ultrasound-guided puncturing to treat ovarian endometriotic cyst and on the outcome of assisted reproductive technology. MATERIALS AND METHODS: This was a retrospective study, in which 42 cases of endometrial cysts were selected as trial group, and 84 cases were selected as control group. In trial group, Long-Diphereline was given to each patient for three months before and after injecting pure alcohol into cyst. In control group, Long-Diphereline was given to each patient alone. Blood samples were obtained from patients on the day of the operation and using Gn, on the 2nd or 3rd day of the menstrual cycle. The two groups were compared in indicates of clinical, the rate of implantation and pregnancy. RESULTS: No significant difference were observed in bFSH level, bLH level, bE2 level,LH level on the day of using Gn, the reduction rate of mean ovarian diameter and the outcomes of pregnancy between the two groups. The reduction rate of mean cyst diameter, we could observe a significant difference between the two groups. The FSH level on the day of using Gn was significantly less than that in control group. The E2 level on the day of retrieving oocytes was significantly higher than that in control group. The number of morphologically good-quality embryos in trial group was significantly more than that in control group. CONCLUSION: This method is safe and effective method for endometrial cyst of ovary with its definite therapeutic effect for the patients who need assisted reproductive technology, especially for the patient who unlike operation.
P-133 Tuesday, October 18, 2011 MEDICAL OZONE THERAPY DECREASES POSTOPERATIVE UTERINE ADHESION FORMATION IN RATS. S. Demirbag, B. Uysal, A. Guven, N. Yesildaglar, I. Surer. Pediatric Surgery, Gulhane Military Medical Academy, Ankara, Turkey; Physiology, Gulhane Military Medical Academy, Ankara, Turkey; Obstetrics and Gynecology, Yeditepe University, Istanbul, Turkey. OBJECTIVE: Various studies have been performed to find out novel treatment strategies to prevent postoperative adhesion formation. Ozone therapy was shown to reduce inflammation in several pathological conditions. DESIGN: Therefore, we aimed to evaluate the efficacy of ozone therapy in an experimental model of postoperative adhesions.
FERTILITY & STERILITYÒ
FALLOPOSCOPIC TUBOPLASTY (FT) IS AN ESTABLISHED ENDOSCOPIC SURGERY FOR TUBAL INFERTILITY AND AN ALTERNATIVE TO ART: OUR EXPERIENCE OF 852 CASES FOLLOWED UP OVER SIX MONTHS AFTER FT. S. Kokeguchi, N. Kataoka, S. Ogata, S. Yamada, Y. Matsumoto, M. Shiotani. Hanabusa Women’s Clinic, Kobe, Hyogo, Japan. OBJECTIVE: Falloposcopic tuboplasty (FT) has been recognized as a highly useful treatment of both an assessment of tubal luminal lesion and a surgical technique of recanalization of tubal occlusion and stenosis. We have used FT as a diagnosis and a treatment for about 1500 over tubal infertility patients since 2003. The aim of this study was to evaluate feature of the outcome without ART after FT and to identify who are the best indication for routine clinical application before ART. DESIGN: Retrospective study. MATERIALS AND METHODS: FT was performed for the 1468 patients with tubal bilateral, unilateral occlusion and bilateral stenosis between 2005 and 2010. All FT was performed bilaterally with the procedure of transcervical balloon tuboplasty in outpatient base. 852 patients were able to follow up. Patients with hydrosalpings and severe male factor were excluded. RESULTS: Mean age of the patients was 33.5 years old (ranged from 22 to 49) .Clinical pregnancies occurred in 253/852 patients (29%). They have been pregnant by natural intercourse or artificial insemination. The miscarriage was 7.5%. The pregnancy rates were 39.7%(48/121) in the under 29 y/o, 32.7%(125/382) in the 30-34 y/o, 25.6%(75/290) in the 35-39 y/o and 5.1%(3/59) in the over 40 y/o. The oldest pregnancy case was 41 years old, but had a miscarriage. The mean duration to pregnancy after FT was 3.5 months. Many pregnancy cases occurred within the first month. Within 6 months after FT, 85.7% (216/252) of the women became pregnant. Ectopic pregnancy was 1.6% (4/253). CONCLUSION: Although ART has been used for women with tubal lesion as a standard treatment, we apply FT as an initial and routine treatment before ART. Our results show that FT is useful for the patients with tubal infertility and does not cause an increase of ectopic pregnancy. FT might be recommended to the patients with tubal infertility under 40 years old before conducting IVF and also recommended to reconsider the therapeutic plan for these patients about 6 months over after FT.
P-135 Tuesday, October 18, 2011 THE UTILITY OF THE SHOCK INDEX TO PREDICT INTRAABDOMINAL BLEEDING OF ECTOPIC PREGNANCY. M. Morita, Y. Katagiri, T. Tsuchiya, Y. Fukuda, I. Uchiide, M. Nakakuma. Obstetrics and Gynecology, Toho University, Ota-ku, Tokyo, Japan. OBJECTIVE: To assess the clinical utility of the Shock Index (SI: ratio of the heart rate to systolic blood pressure) to predict hemoperitoneum in cases of ectopic pregnancy.
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MATERIALS AND METHODS: Thirty female Wistar rats (200–250 g) were divided into three groups: sham, control, and ozone groups. The control and ozone groups were subjected to the postoperative adhesion procedure created by bipolar coagulation set at 10 watts per second on the uterine horns and corresponding pelvic sidewall parietal peritoneum. In the control and ozone groups, approximately 2 cm of the both uterine horns and 4 cm2 of the opposing pelvic sidewall peritonea of the rats were electrocoagulated using bipolar forceps and a power setting of 10 W/sec. The rats in the ozone group were administered a single dose of 0.7 mg/kg/day ozone/oxygen mixture intraperitoneally (i.p.) after adhesion induction. The animals were killed on the 7th day and uterine adhesions were evaluated according to the scoring system published by Leach et al. (1998). The adhesions, electrocoagulated tissues, and samples of peritoneal washing fluid were collected for biochemical evaluation. RESULTS: In the control group, a significant elevation in TNF-a level in the peritoneal washing fluids, increased levels of MDA in the uterine tissues, and decreased antioxidant enzyme activities (SOD and GSH-Px) in the uterine tissues were observed. None of these changes were found in the ozone group. Macroscopic adhesion scores were significantly higher in the control group than those observed in the other groups (P<0.05, control vs. sham and control vs. ozone group). CONCLUSION: Medical ozone therapy decreased postoperative intraabdominal adhesions in a rat model, probably by modulating TNF-a, which resulted in reduced oxidative stress.
P-134 Tuesday, October 18, 2011 P-132 Tuesday, October 18, 2011 THE EFFECT OF USING LONG-DIPHERELINE AND ULTRASOUND-GUIDED PUNCTURING TO TREAT OVARIAN ENDOMETRIOTIC CYST AND ITS IMPACT ON THE OUTCOME OF ASSISTED REPRODUCTIVE TECHNOLOGY. G. Yihong. Reproductive Medical Centre, Zhengzhou, Henan, China. OBJECTIVE: To investigate the effect of using Long-Diphereline and ultrasound-guided puncturing to treat ovarian endometriotic cyst and on the outcome of assisted reproductive technology. MATERIALS AND METHODS: This was a retrospective study, in which 42 cases of endometrial cysts were selected as trial group, and 84 cases were selected as control group. In trial group, Long-Diphereline was given to each patient for three months before and after injecting pure alcohol into cyst. In control group, Long-Diphereline was given to each patient alone. Blood samples were obtained from patients on the day of the operation and using Gn, on the 2nd or 3rd day of the menstrual cycle. The two groups were compared in indicates of clinical, the rate of implantation and pregnancy. RESULTS: No significant difference were observed in bFSH level, bLH level, bE2 level,LH level on the day of using Gn, the reduction rate of mean ovarian diameter and the outcomes of pregnancy between the two groups. The reduction rate of mean cyst diameter, we could observe a significant difference between the two groups. The FSH level on the day of using Gn was significantly less than that in control group. The E2 level on the day of retrieving oocytes was significantly higher than that in control group. The number of morphologically good-quality embryos in trial group was significantly more than that in control group. CONCLUSION: This method is safe and effective method for endometrial cyst of ovary with its definite therapeutic effect for the patients who need assisted reproductive technology, especially for the patient who unlike operation.
P-133 Tuesday, October 18, 2011 MEDICAL OZONE THERAPY DECREASES POSTOPERATIVE UTERINE ADHESION FORMATION IN RATS. S. Demirbag, B. Uysal, A. Guven, N. Yesildaglar, I. Surer. Pediatric Surgery, Gulhane Military Medical Academy, Ankara, Turkey; Physiology, Gulhane Military Medical Academy, Ankara, Turkey; Obstetrics and Gynecology, Yeditepe University, Istanbul, Turkey. OBJECTIVE: Various studies have been performed to find out novel treatment strategies to prevent postoperative adhesion formation. Ozone therapy was shown to reduce inflammation in several pathological conditions. DESIGN: Therefore, we aimed to evaluate the efficacy of ozone therapy in an experimental model of postoperative adhesions.
FERTILITY & STERILITYÒ
FALLOPOSCOPIC TUBOPLASTY (FT) IS AN ESTABLISHED ENDOSCOPIC SURGERY FOR TUBAL INFERTILITY AND AN ALTERNATIVE TO ART: OUR EXPERIENCE OF 852 CASES FOLLOWED UP OVER SIX MONTHS AFTER FT. S. Kokeguchi, N. Kataoka, S. Ogata, S. Yamada, Y. Matsumoto, M. Shiotani. Hanabusa Women’s Clinic, Kobe, Hyogo, Japan. OBJECTIVE: Falloposcopic tuboplasty (FT) has been recognized as a highly useful treatment of both an assessment of tubal luminal lesion and a surgical technique of recanalization of tubal occlusion and stenosis. We have used FT as a diagnosis and a treatment for about 1500 over tubal infertility patients since 2003. The aim of this study was to evaluate feature of the outcome without ART after FT and to identify who are the best indication for routine clinical application before ART. DESIGN: Retrospective study. MATERIALS AND METHODS: FT was performed for the 1468 patients with tubal bilateral, unilateral occlusion and bilateral stenosis between 2005 and 2010. All FT was performed bilaterally with the procedure of transcervical balloon tuboplasty in outpatient base. 852 patients were able to follow up. Patients with hydrosalpings and severe male factor were excluded. RESULTS: Mean age of the patients was 33.5 years old (ranged from 22 to 49) .Clinical pregnancies occurred in 253/852 patients (29%). They have been pregnant by natural intercourse or artificial insemination. The miscarriage was 7.5%. The pregnancy rates were 39.7%(48/121) in the under 29 y/o, 32.7%(125/382) in the 30-34 y/o, 25.6%(75/290) in the 35-39 y/o and 5.1%(3/59) in the over 40 y/o. The oldest pregnancy case was 41 years old, but had a miscarriage. The mean duration to pregnancy after FT was 3.5 months. Many pregnancy cases occurred within the first month. Within 6 months after FT, 85.7% (216/252) of the women became pregnant. Ectopic pregnancy was 1.6% (4/253). CONCLUSION: Although ART has been used for women with tubal lesion as a standard treatment, we apply FT as an initial and routine treatment before ART. Our results show that FT is useful for the patients with tubal infertility and does not cause an increase of ectopic pregnancy. FT might be recommended to the patients with tubal infertility under 40 years old before conducting IVF and also recommended to reconsider the therapeutic plan for these patients about 6 months over after FT.
P-135 Tuesday, October 18, 2011 THE UTILITY OF THE SHOCK INDEX TO PREDICT INTRAABDOMINAL BLEEDING OF ECTOPIC PREGNANCY. M. Morita, Y. Katagiri, T. Tsuchiya, Y. Fukuda, I. Uchiide, M. Nakakuma. Obstetrics and Gynecology, Toho University, Ota-ku, Tokyo, Japan. OBJECTIVE: To assess the clinical utility of the Shock Index (SI: ratio of the heart rate to systolic blood pressure) to predict hemoperitoneum in cases of ectopic pregnancy.
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