Trikloroasetik asit atuşman ve instillasyon yöntemlerinin over rezervi ile over yüzey epitelindeki displazik değişiklikler üzerine olan etkisinin incelenmesi

Amaç: %3, %50, %75 ve %95’lik konsantrasyonlardaki trikloroasetik asitin, endometriyal ablasyon için, atuşman ve instillasyon yöntemleri ile uygulanmasının rat over rezervi ile yüzey epitelindeki displazik değişiklikler üzerine etkisinin incelenmesi. Gereç ve Yöntem: 90 adet, Sprague Dawley rat, estrus fazında randomize blok düzenli (konsantrasyon karşılaştırmalı) çalışma programına alındı. Grup 1: (n=10): Batın açılıp kapatılan grup. Batın açılıp sol uterin horn distaline 2 cm’lik uzunlamasına insizyonu takiben, %3’lük TCA (Gruop 2, n=10), %50’lik TCA (Grup 3, n=10), %75’lik TCA (Grup 4, n=10) ve %95’lik TCA (Grup 5, n=10) atuşmanı yapılan grup. Batın açılıp sol uterin horna 0,1 ml %3’lük TCA (Grup 6, n=10), %50’lik TCA (Grup 7, n=10), %75’lik TCA (Grup 8, n=10) ve %95’lik TCA (Grup 9, n=10) instillasyonu yapılan grup. Tüm ratların 21 gün sonra estrus fazında batını açıldı. Sol ooferektomi yapıldı. Hematoksilen Eozin ile boyanan preparatlarda over folikül rezervi ve over yüzey epitel değişiklikleri değerlendirildi. Grup 2-Grup 6 ile, Grup 3-Grup 7 ile, Grup 4-Grup 8 ile, Grup 5-Grup 9 ile Mann Whitney U test ile karşılaştırıldı. Tüm grupların karşılaştırılması, Kruskall Wallis varyans analizi ile yapıldı. p0.05, Mann Whitney U test). Tüm grupla-rın karşılaştırılmasında, over folikül rezervi ve yüzey epitel değişiklikleri benzer bulundu (p>0.05, Kruskall Wallis varyans analizi). Sonuç: Farklı konsantrasyonlardaki trikloroasetik asitin, endometriyal ablasyon için, atuşman ve instillasyon yöntemleri ile uygulanmasının rat over rezervi ve over yüzey epiteli üzerine olumsuz bir etkisi yoktur.

Examination of the effect of trichloroacetic acid attachment and ınstillation methods on ovarian reserve and dysplasic changes in ovarian surface epithelium

Objective: To examine the effect of applying 3%, 50%, 75% and 95% concentrations of trichloroacetic acid by attachment and instillation methods for endometrial ablation on ovarian reserve and dysplasic changes in ovarian surface epithelium in rats. Material and Method: Ninety rats were included in a randomized, bloc-designed, concentration-matched study program. Group1: (n=10): Abdomen was opened and closed. The groups in which 3% (Group 2, n=10), 50% (Group 3, n=10), 75% (Group 4, n=10), and 95% (Group 5, n=10) TCA attachment was applied, after abdomen was opened and a 2 cm. lengthwise incision was made in the left uterine horn. The groups in which 0,1 ml of 3% (Group 6, n=10), 50% (Group 7, n=10), 75% (Group 8, n=10) and 95% (Group 9, n=10) TCA instillation was applied to the left uterine horn, after the abdomen was opened. Abdomens of all rats were opened 21 days later. Left oophorectomy was performed. Preparations were evaluated in terms of ovarian follicle reserve and changes in ovarian surface epithelium. Group 2 and Group 6, Group 3 and Group 7, Group 4 and Group 8, Group 5 and Group 9 were compared (MWU test). Kruskall Wallis variance analysis was employed in the comparison including all groups (p<0.05 significant). Results: Ovarian reserve and changes in surface epithelium were found similar in instillation and attachment groups (p>0.05). The comparison including all groups revealed that ovarian follicle reserve and surface epithelium changes were similar (p>0.05). Conclusion: Application of various concentrations of TCA by attachment and instillation methods for endometrial ablation doesn&#8217;t have any unfavorable effect on ovarian reserve and ovarian surface epithelium in rats.

___

  • 1. Rosenfeld JA. Treatment Decisions in the Management of Menorrhagia. Medscape Womens Health 1997; 2: 6.
  • 2. Bourdrez P, Bongers MY, Mol BW. Treatment of dysfunctional uterine bleeding: patient preferences for endometrial ablation, a levonorgestrel-releasing intrauterine device, or hysterectomy. Fertil Steril 2004; 82: 160-6.
  • 3. Gervaise A, Fernandez H, Capella-Allouc S.et al. Thermal balloon ablation versus endometrial resection for the treatment of abnormal uterine bleeding. Hum Reprod 1999; 14: 2743-7.
  • 4. Janson PO, Janson I. The acute effect on ovarian blood supply. Am J Obstet Gynecol 1997; 127: 349–52.
  • 5. Stone SC, Dickey RP, Mickal A. The acute effect of hysterectomy on ovarian bloodflow. Am J Obstet Gynecol 1975; 121: 193–7.
  • 6. Derksen JG, Brolmann HA, Wiegerinck MA, Vader HL, Heintz AP. The effect of hysterectomy and endometrial ablation on follicle stimulating hormone (FSH) levels up to 1 year after surgery. Maturitas 1998; 29: 133-8.
  • 7. Richardson SJ, Senikas V, Nelson JF. Follicular depletion during the menopausal transition: evidence accelerated loss and ultimate exhaustion. J Clin Endocrin Metab 1987; 65: 1231–7.
  • 8. Choi KC, Kang SK, Tai CJ, Auersperg N, Leung PCK. Follicle-Stimulating Hormone Activates Mitogen-Activated Protein Kinase in Preneoplastic and Neoplastic Ovarian Surface Epithelial Cells. J Clin Endocrinol Metab 2002; 87: 2245-53.
  • 9. Hung T-H, Skepper JN, Charnock-Jones DS, Burton GJ: Hypoxia/reoxygenation: a potent inducer of apoptotic changes in the human placenta and possible etiological factor in preeclampsia. Circ Res 2002; 90: 1274-81.
  • 10. Hung TH, Charnock-Jones DS, Skepper JN, Burton GJ. Secretion of tumor necrosis factor-alpha from human placental tissues induced by hypoxia-reoxygenation causes endothelial cell activation in vitro: a potential mediator of the inflammatory response in preeclampsia. Am J Pathol 2004; 164: 1049-61.
  • 11. Marsden PA, Brenner BM. Transcriptional regulation of the endothelin-1 gene by TNF- . Am J Physiol 1992; 262: 854-61.
  • 12. Corpechot C, Barbu V, Wendum D, et al. Hypoxia induced VEGF and collagen I expressions are associated with angiogenesis and fibrogenesis in experimental cirrhosis. Hepatology 2002, 35: 1010-21.
  • 13. Taysi S, Polat F, Gul M, Sari RA, Bakan E. Lipid peroxidation, some extracellular antioxidants, and antioxidant enzymes in serum of patients with rheumatoid arthritis. Rheumatol Int 2002; 21: 200-4.
  • 14. Jagetia GC, Reddy TK. Modulation of radiation-induced alteration in the antioxidant status of mice by naringin. Life Sci 2005; 77: 780-94.
  • 15. Kucukozkan T, Kadioglu BG, Uygur D, Moroy P, Mollamahmutoglu L, Besli M. Chemical ablation of endometrium with trichloroacetic acid. Int J Gynaecol Obstet 2004; 84: 41-6.
  • 16. Kucuk M, Okman TK. Intrauterine instillation of trichloroacetic acid is effective for the treatment of dysfunctional uterine bleeding. Fertil Steril 2005;83:189-94.
  • 17. Fehr MK, Tromberg BJ, Svaasand LO, Ngo P, Berns MW, Tadir Y. Structural and functional effects of endometrial photodynamic therapy in a rat model. Am J Obstet Gynecol 1996; 175: 115-21.
  • 18. Krzemien AA, Van Vugt DA, Pottier RH, Dickson EF, Reid RL. Evaluation of novel nonlaser light source for endometrial ablation using 5-aminolevulinic acid. Lasers Surg Med 1999; 25: 315-22.
  • 19. Van Vugt DA, Krzemien A, Roy BN, et al.Photodynamic endometrial ablation in the nonhuman primate. J Soc Gynecol Investig 2000; 7: 125-30.
  • 20. Wyss P, Caduff R, Tadir Y, et al. Photodynamic endometrial ablation: morphological study. Lasers Surg Med 2003; 32: 305-9.
  • 21. Suhadi A, Anwar M, Soejoenoes A. 10-year follow-up of women who elected quinacrine sterilization (QS) in Wonosobo, Central Java, Indonesia. Int J Gynaecol Obstet 2003; 83: 137-9.
  • 22. Kurnick NB, Radcliffe IE. Reaction between DNA and quinacrine and other antimalarials. J Lab Clin Med 1962; 60: 669–88.
  • 23. Clarke JJ, Sokal DC, Cancel AM et al.Re-evaluation of the mutagenic potential of quinacrine dihydrochloride dihydrate. Mutat Res 2001; 494: 41-53.
  • 24. Souza AZ, Fonseca AM, Izzo VM, Clauzet RM, Salvatore CA. Ovarian histology and function after total abdominal hysterectomy. Obstet Gynecol 1986; 68: 847-9.
  • 25. Nieto JJ, Crow J, Sundaresan M et al. Ovarian epithelial dysplasia in relation to ovulation induction and nulliparity. Gynecol Oncol 2001; 82: 344-9.
  • 26. Fail PA, Martin P, Sokal D. Comparative effects of quinacrine and erythromycin in adult female rats: a nonsurgical sterilization study. Fertil Steril 2000; 73: 387-94.
  • 27. Bairagy NR, Mullick BC. Use of erythromycin for nonsurgical female sterilization in West Bengal, India: a study of 790 cases. Contraception 2004; 69: 47-9.
  • 28. Taylor A, Sharma M, Tsirkas P, Di Spiezio Sardo A, Setchell M, Magos A. Reducing blood loss at open myomectomy using triple tourniquets: a randomised controlled trial. BJOG 2005; 112: 340-5.
  • 29. Barksdale PA, Elkins TE, Sanders CK, Jaramillo FE, Gasser RF. An anatomic approach to pelvic hemorrhage during sacrospinous ligament fixation of the vaginal vault. Obstet Gynecol 1998; 91: 715-8.
  • 30. Nelson BE, Schwartz PE. Hemorrhage and shock. In: Nichols DH (eds ). Gynecologıc and obstetric surgery. 3. baskı. St Louis Mosby. 1993: 208-21.
  • 31. Zoumakis E, Margioris AN, Makrigiannakis A, Stournaras C, Gravanis A. Human endometrium as a neuroendocrine tissue: expression, regulation and biological roles of endometrial corticotropin-releasing hormone (CRH) and opioid peptides. J Endocrinol Invest 1997; 20: 158-67.
  • 32. Gravanis A, Makrigiannakis A, Zoumakis E, Margioris AN. Endometrial and myometrial corticotropin-releasing hormone (CRH): its regulation and possible roles. Peptides 2001; 22: 785-93.
  • 33. Givens JR, Andersen RN, Wiser WL, Coleman SA, Fish SA. A gonadotropin-responsive adrenocortical adenoma. J Clin Endocrinol Metab 1974; 38: 126–33.
  • 34. Sapmaz E, Akpolat N, Gürateş B, Çelik A, Atılgan R. Rat endometriumunda kimyasal ablasyon için trikloroasetik asit kullanımının incelenmesi. Türk Fertil Der 2004; 12: 209-16.
  • 35. Sapmaz E, Özercan İ, Ay G. Tıbbi tedaviye dirençli menorajilerde uterin foley balon ile sıcak salin ve dekstroz so-lüsyonu kullanımının karşılaştırılması. İn vivo insan uterusunda çalışma. T Klin Jinekol Obst 2002; 12: 456-62.
Fırat Tıp Dergisi-Cover
  • ISSN: 1300-9818
  • Başlangıç: 2015
  • Yayıncı: Fırat Üniversitesi Tıp Fakültesi