title: Gonadotrophin-releasing hormones agonist therapy increases peritoneal fibrinolytic activity and prevents adhesion formation after myomectomy.
abstract: The aim of this study was to evaluate uterine adhesions after myomectomy and peritoneal fibrinolytic capacity in women treated with gonadotrophin-releasing hormone agonist (GnRHa) before surgery. A prospective observational study comprised 15 infertile women who underwent myomectomy. Before surgery, 10 were treated with buserelin acetate (900 microg/day) for 10-12 weeks followed by additional postoperative treatment with GnRHa for 4 weeks (GnRHa group) and five received no treatment (control group). Peritoneal fluid specimens were taken at the beginning of myomectomy and the adhesions were estimated by second-look surgery (caesarean section or laparoscopy). Levels of plasminogen activator (PA) and PA inhibitor (PAI) were determined by enzyme-immunosorbent assays. Pre- and postoperative GnRHa therapy significantly reduced adhesion formation compared with control groups (adhesion scores; 0.2 +/- 0.4 vs. 2 +/- 1, P<0.0001). GnRHa group showed a significant decrease in PAI level (P<0.0001) but no significant change in PA level, suggesting increased fibrinolytic capacity in peritoneal fluid from GnRHa-treated patients. These data suggest that GnRHa therapy is successful in preventing adhesion formation after myomectomy. GnRHa-induced shift to more fibrinolytic activity, mainly because of a decreased level of PAI, may play a critical role in the mechanism of the GnRHa's action on postoperative adhesion development.
authors: Department of Obstetrics and Gynaecology, Gifu University School of Medicine, Japan. atsushi@cc.gifu-u.ac.jp
authors: A
authors: A
authors: Imai
authors: M
authors: M
authors: Sugiyama
authors: T
authors: T
authors: Furui
authors: S
authors: S
authors: Takahashi
authors: Teruhiko
authors: T
authors: Tamaya
mesh_terms: D000328:Adult; D002064:Buserelin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000601:surgery*; D010532:Peritoneal Diseases / Q000473:pathology / Q000517:prevention & control*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D010960:Plasminogen Activators / Q000097:blood; D011183:Postoperative Complications / Q000517:prevention & control; D011292:Premedication; D011446:Prospective Studies; D024162:Second-Look Surgery; D012720:Severity of Illness Index; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D017395:Plasminogen Activator Inhibitor 1; D010960:Plasminogen Activators; D002064:Buserelin