Abstract
OBJECTIVE: Our purpose was twofold: to determine the distribution of the endogenous photosensitizer protoporphyrin IX in the uterus and to ascertain the time interval leading to maximal endometrial fluorescence after intrauterine instillation of 5-aminolevulinic acid. STUDY DESIGN: One milliliter of a 400 mg/ml 5-aminolevulinic acid - Hyskon solution was instilled into the uterine cavity of 27 women before hysterectomy. On frozen sections of uterine samples 5-aminolevulinic acid - induced fluorescence was measured with fluorescence microscopy. RESULTS: 5-Aminolevulinic acid - induced fluorescence could first be detected in the superficial endometrial glands 75 minutes after drug injection. In the endometrial gland stumps fluorescence intensity peaked 4 to 8 hours after 5-aminolevulinic acid instillation and was >48 times higher than in the underlying myometrium. CONCLUSIONS: Fluorescence in the endometrial glands suggests that selective photodynamic destruction of the endometrium may be possible 4 to 8 hours after intrauterine 5-aminolevulinic acid instillation. (Am J Obstet Gynecol 1996;175:1253-9.)
Highlights
Our purpose was twofold: to determine the distribution of the endogenous photosensitizer protoporphyrin IX in the uterus and to ascertain the time interval leading to maximal endometrial fluorescence after intrauterine instillation of 5-amJnolevulinic acid
Fluorescence in the endometrial glands suggests that selective photodynamic destruction of the endometrium may be possible 4 to 8 hours after intrauterine 5-aminolevulinic acid instillation. (Am J Obstet Gynecol 1996;175:1253-9.)
In this study we examined the conversion of 5-aminolevulinic acid and protoporphyrin IX in human uterine tissue after intrauterine instillation of an 5-aminolevulinic acid solution at different time intervals
Summary
Our purpose was twofold: to determine the distribution of the endogenous photosensitizer protoporphyrin IX in the uterus and to ascertain the time interval leading to maximal endometrial fluorescence after intrauterine instillation of 5-amJnolevulinic acid. CONCLUSIONS: Fluorescence in the endometrial glands suggests that selective photodynamic destruction of the endometrium may be possible 4 to 8 hours after intrauterine 5-aminolevulinic acid instillation. Photodynamic therapy is based on light-induced oxidation reactions that lead to tissue necrosis.2Several animal studiess4° have shown that selective endomecrial destruction with photodynamic therapy is feasible and may provide a viable alternative to routinely performed surgical treatment. Both systemic and topical application of various photosensitizers have been studied?' 3. In this study we examined the conversion of 5-aminolevulinic acid and protoporphyrin IX in human uterine tissue after intrauterine instillation of an 5-aminolevulinic acid solution at different time intervals. To the best of our knowledge, this is the first report describing selectively induced fluorescence of the human endometrial glands and the time interval needed for peak fluorescence
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