Fertility preservation and pregnancy outcome after malignancy.

Purpose Of Review: The overall survival and cure rates of patients with childhood and adult malignancies have improved dramatically, but cancer treatment can be associated with diminished reproductive potential. However, research on the preservation of fertility in these patients has given patients new options. This article discusses the mechanisms of reproductive failure after cancer therapy and the currently available fertility preservation strategies.

Endometriosis of the liver containing mullerian adenosarcoma: case report.

We present a case of a liver endometrioma in a postmenopausal woman. After failed management with leuprolide acetate, the mass was resected and contained focal areas of mullerian adenosarcoma. This is a rare case of mullerian adenosarcoma that appeared to arise within an endometrioma of the liver.

Laparoscopic robotic gynecologic surgery.

The first gynecologic procedure performed with a robot was a tubal anastomosis. This was performed in 1998 with the Zeus robot. Over the past several years other gynecologic procedures have been performed with other robots.

Laparoscopy in the second trimester of pregnancy.

Advances in laparoscopic surgery have led to the development of methods to perform traditionally major abdominal surgery and reduce morbidity using minimally invasive surgery techniques. Because a growing number of reports in the literature have suggested its safe use, laparoscopy is being performed in pregnancy with increasing frequency in many centers. Any surgeon treating pregnant patients must have a thorough understanding of the physiology of the pregnant patient and risks and benefits of the surgical procedure.

Ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that is associated with modern techniques for in vitro fertilization. Extensive efforts have been made to understand the pathophysiology and to improve the management of this entity. The severe and life-threatening forms of the ovarian hyperstimulation syndrome are still challenging for critical care physicians.

Hormones and seizures.

The opposing effects of estrogen (proconvulsant) and progesterone (anticonvulsant) on seizure threshold have been noted in animal and human studies. Levels of these hormones fluctuate throughout the menstrual cycle, and, in some women with epilepsy, these fluctuations may be related to the occurrence of seizures around the time of menses or an increase in seizures in relation to the menstrual cycle, also known as catamenial epilepsy. Variations in concentrations of antiepileptic drugs across the menstrual cycle may also contribute to increased seizure susceptibility.

Differential growth of human embryos in vitro: role of reactive oxygen species.

Objective: To examine the relationship of early human embryonic development with the level of reactive oxygen species (ROS) in the culture media on the first day (day 1 ROS) after insemination.

Design: A prospective study.

Setting: Patients undergoing assisted reproduction in a teaching hospital.

Effect of tumor necrosis factor-alpha blocker (infliximab) on blastocyst development in vitro.

Infliximab does not have any toxic effects on early cleaving embryos.

Ovarian tissue banking for cancer patients: reduction of post-transplantation ischaemic injury: intact ovary freezing and transplantation.

Despite reasonable achievements in different animal species, the debate about many technical aspects of ovarian tissue banking is continuing. Human ovarian tissue banks are increasingly established around the world without a clear plan about how to make the best use of such tissue. One of the important challenges facing this growing technology is to determine the ideal method for the use of this cryopreserved ovarian tissue.

Ovarian function preservation in the cancer patient.

Objective: To review the clinical modalities that are available to women receiving potentially sterilizing cancer therapy.

Design: The MEDLINE database was reviewed for all publications on medication, surgery, or assisted reproductive technology that could potentially preserve fertility in women who are receiving cancer therapy.

Conclusion(s): There are many options available to a patient undergoing a treatment that will negatively impact her fertility.

Laboratory testing for endometriosis.

Background: Typically, endometriosis is diagnosed surgically by laparoscopy. CA-125 is the principal serum marker used in the diagnosis and management of late-stage endometriosis. The search for a body fluid marker of early stage disease has included studies of serum, peritoneal fluid (PF), and/or tissue levels of secretory proteins, cell adhesion molecules, cytokines, tumor necrosis and vascular endothelial growth factors (VEGFs), chemokines, antiendometrial antibodies, autoantibodies to oxidized lipoproteins, aromatase P-450 expression, cytokeratins, and hormone receptors.

Robotics in gynecology.

The surgical robot has the potential to enable a laparoscopic approach to procedures that are presently performed by laparotomy due to the technical difficulties intrinsic to laparoscopy. The use of the current robot prototypes are not cost-effective for gynecologic procedures that are already performed by laparoscopy. The rapid evolution of robotics will likely allow for more widespread application in all surgical specialties in the future.

Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions.

Objective: The purpose of this study was to map the course of the ilioinguinal and iliohypogastric nerves.

Study Design: The courses of iliohypogastric and ilioinguinal nerves from 11 fresh frozen cadavers were mapped from their lateral emergence on the anterior abdominal wall to their midline termination in reference to fixed bony landmarks. Bivariate fit ellipses were generated for each nerve and compared with sites of standard abdominal surgical incisions.

Laparoscopic repair of ureteral injuries.

Study Objectives: To evaluate the laparoscopic approach for repairing ureteral injuries, and assess the effect of ureteral dissection (ureterolysis) on tissue healing.

Design: Randomized animal study (Canadian Task Force classification I).

Setting: Biological Resources Unit, Cleveland Clinic Foundation.

Alterations in mitochondria membrane potential and oxidative stress in infertile men: a prospective observational study.

Objective: To evaluate the mitochondrial membrane potential (MMP) of spermatozoa and its correlation with semen parameters and production of reactive oxygen species (ROS) in infertile men and healthy donors.

Design: Controlled prospective study.

Setting: Male infertility clinic, Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio.

Catamenial epilepsy: pathophysiology, diagnosis, and management.

In women with epilepsy, seizures can be influenced by variations in sex hormone secretion during the menstrual cycle. The proconvulsant effects of estrogen have been demonstrated in both animals and humans, whereas progesterone has been found to have anticonvulsant properties. Catamenial epilepsy affects approximately one-third of women with epilepsy.

Oxidative stress is associated with increased apoptosis leading to spermatozoa DNA damage in patients with male factor infertility.

Objective: To evaluate ejaculated spermatozoa from patients with male factor infertility for the role of cytochrome c and caspases 9 and 3 (the proteins known to mediate apoptosis) and to examine association between semen quality and apoptosis in the presence of oxidative stress.

Design: Prospective study.

Setting: Male infertility clinic at a tertiary health care center.

The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients.

Unlabelled: Morbidly obese (MO) patients undergoing laparoscopy have lower PaO(2) compared with normal-weight (NW) patients. We hypothesized that increases in tidal volume (V(T)) or respiratory rate (RR) would improve oxygenation. All measurements were performed at: 1) baseline: V(T) 600-700 mL and 10 breaths/min, 2) double V(T): V(T) 1200-1400 mL and 10 breaths/min, and 3) double rate: V(T) 600-700 mL and 20 breaths/min.

Total antioxidant capacity and reactive oxygen species in amniotic fluid.

Objective: To identify the presence and/or absence of reactive oxygen species and total antioxidant capacity in amniotic fluid and to determine changes in the levels of reactive oxygen species and total antioxidant capacity with advancing gestational age of pregnancy and fetal or neonatal weights.

Methods: Amniotic fluid was collected from a total of 26 nonsmoking patients. Nine specimens were collected in the third trimester of pregnancy, and 17 specimens were collected in the second trimester.

Restoration of ovarian function after autotransplantation of intact frozen-thawed sheep ovaries with microvascular anastomosis.

Objective: To test the feasibility of transplanting an intact frozen-thawed ovary with microvascular anastomosis of the ovarian vascular pedicle to the deep inferior epigastric vessels.

Design: Chronic survival study.

Setting: Biological Resources Unit, The Cleveland Clinic Foundation.