***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background The study aim ed to investigate the effectiveness of a single versus double dose of prostagl and in E2 “ misoprostol , 400 microgram ” prior to myomectomy for multiple uterine fibroids . Methods This was a prospect i ve r and omized controlled trial comprised of 69 patients with multiple myomas undergoing myomectomy .  Patients received either an intra-vaginal single dose of 400 microgram misoprostol 1 hr pre-operatively ( group A , 34 cases ) or 2 doses , 3 and 1 hr prior to surgery ( group B , 35 cases ) . Operation time , intra and post-operative blood loss , hemoglobin concentration , blood pressure and body 's temperature were estimated and compared in both groups . The data were statistically analyzed using chi-square test . The p<0.05 was considered significant . Results In group B , the mean operative time was significantly ( p<0.001 ) shorter than in group A ( 25.8±4.14 vs. 35.4±5.6 min respectively ) . The mean value for operative blood loss was significantly ( p<0.001 ) smaller in group B ( 101.4±25.5 vs. 200.16±18.8 ml ) . There was a significant ( p<0.01 ) rise of the body temperature in group B ( 38.5±0.7 vs. 37.18±0.84 ° C ) . There were no differences between the two groups regarding hemoglobin levels , post-operative febrile morbidity or length of hospital stay . Conclusion In this study , two doses of pre-operative intra-vaginal misoprostol were more effective than one dose in reducing intra and post-operative blood loss and shortening of operation time during abdominal myomectomy OBJECTIVE To investigate the effectiveness of a single preoperative dose of misoprostol in abdominal myomectomies . DESIGN Placebo-controlled r and omized prospect i ve study . SETTING Department of obstetrics and gynecology in a university hospital . PATIENT(S ) Twenty-five women with symptomatic uterine leiomyomas . INTERVENTION(S ) Among patients undergoing abdominal myomectomies  , an hour before the operation women in the study group ( n = 13 ) were given a single dose of vaginal misoprostol ( 400 microg ) ; those in the control group ( n = 12 ) were given placebo . MAIN OUTCOME MEASURE(S ) Intraoperative blood loss , duration of operation , duration of postoperative hospitalization , and the need for blood transfusion were compared between the control and study groups . RESULT ( S ) Blood loss , operation time , and need for postoperative blood transfusion were significantly reduced in the group given vaginal misoprostol . No difference was observed among patients in terms of the time of hospitalization . CONCLUSION ( S ) A single preoperative dose of vaginal misoprostol is a simple , reliable method for reducing intraoperative blood loss and need for postoperative blood transfusion after abdominal myomectomies PURPOSE OF INVESTIGATION We performed a r and omized clinical trial to estimate whether preoperative use of misoprostol may reduce intraoperative blood loss of patients treated by minimally invasive surgery ( MIS ) , such as laparoscopic ( LM ) or laparoscopically assisted myomectomy ( LAM ) . METHODS Sixty-seven menstruating patients with three or less myomas of a maximum diameter of 90 mm , scheduled for MIS , were r and omly allocated to receive a preoperative single dose of intravaginal misoprostol or placebo .  Sixty-four patients remained in the final analysis : 30 in the misoprostol  ( I ) and 34 in the placebo group ( II ) . Estimated blood loss ( EBL ) , decline of postoperative hemoglobin ( Hb ) and side-effects of administered agent were the outcomes of main interest . RESULTS The EBL was significantly higher in the placebo versus misoprostol group ( 217 + /- 74 vs 126 + /- 41 , respectively ) . Similarly , the decline of postoperative Hb was significantly higher in group II ( 1.6 + /- 0.43 ) compared to group I ( 1 + /- 0.33 ) . The operative time was comparable in both groups , while the rate of side-effects was similar between groups . CONCLUSION The preoperative use of misoprostol in patients with uterine fibroids managed by minimally invasive surgery significantly reduces intraoperative blood loss .  Misoprostol might be useful for the prevention of postoperative anemia in more extended minimal invasive interventions , such as myomectomy of large fibroids or laparoscopic hysterectomy Purpose To evaluate the effect of vaginal misoprostol on intraoperative bleeding during myomectomy . Method In this r and omized clinical trial , 80 women with myomas were r and omly assigned to receive 200 µg misoprostol or placebo ( vitamin B6 ) 3 h before surgery . Blood loss during surgery , postoperative need for blood transfusion , and the hemoglobin level before surgery , and 6 and 12 h after surgery were assessed in two groups . Results Mean age and the mean preoperative and postoperative Hb levels were not significantly different between the two groups . Mean duration of surgery and mean estimated blood loss were significantly higher in control group . Nine ( 22.5 % ) patients in control group needed blood transfusion while there was no need blood transfusion in misoprostol group ( p = 0.001 ) . Conclusion A single dose of vaginal misoprostol is effective in reducing hemorrhage during myomectomy BACKGROUND The aim of this study was to verify the efficacy of sodium-2-mercaptoethanesulfonate ( mesna ) in the chemical separation of tissues in abdominal myomectomies when used with the traditional mechanical separation techniques . STUDY DESIGN In a prospect i ve , r and omized study , 58 women underwent abdominal myomectomy .  In 29 of these , we used mesna for highlighting and separating tissues , and in the other 29 we used saline solution for the same purpose s. The variables evaluated included the number of myomas removed , the volume of the biggest myoma , and the total volume of the myomas removed in every intervention . We also recorded operating time , the length of hospital stay , the degree of procedure difficulty , perioperative blood loss , operative complications , and cost . RESULTS The operation was significantly shorter in the mesna group ( p < 0.05 ) even though the volume and the number of myomas were larger . The degree of difficulty evaluated by the surgeon at the end of every operation was not significantly different in the two groups . The reduction in hemoglobin 24 hours after operation was significantly less in the patients treated with mesna ( p = 0.006 ) , but this difference was probably altered by the increase in hematocrit levels . CONCLUSIONS Because of its ability as a chemical dissector , mesna may be a useful aid in this type of benign gynecologic operation . Larger studies to confirm this are needed This study examined whether the prostagl and in E(1 ) analogue misoprostol ( 400 microgram ) , when placed vaginally at the time of intrauterine insemination ( IUI ) improves pregnancy rates . A prospect i ve , placebo-controlled , r and omized and double-blind study involving 274 women in 494 IUI cycles result ed in a total of 64 pregnancies ( 13 % per cycle ) . Misoprostol cycles totalled 253 , with 43 pregnancies ( 17 % per cycle ) , whereas placebo cycles totalled 241 , with 21 pregnancies ( 9 % per cycle ) . The cumulative pregnancy rate with misoprostol treatment was significantly greater than with placebo ( P = 0.004 , Cox proportional hazards regression ) . The benefit of misoprostol was seen in clomiphene cycles ( 14 versus 4 % , P = 0.006 ) , and was indicated in FSH cycles ( 33 versus 15 % , borderline significance ) and natural cycles ( 15.6 versus 7.7 % , not significant ) , but was not seen in clomiphene/FSH cycles ( 18.2 versus 23.5 % , not significant ) . Misoprostol treatment did not increase pain score on the day of IUI ( 1.1 versus 1.4 ) and at 1 day post IUI ( 0.6 versus 0.8 ) . Complications were rare in both groups [ six ( 2 % ) subject cycles in the misoprostol cycles compared with two ( 1 % ) in the placebo group ] . It is concluded that the use of vaginal misoprostol may improve the chance for pregnancy in women having IUI in a wide variety of cycle types OBJECTIVE To compare the efficacy of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone as hemostatic agents for the reduction of blood loss during myomectomies . DESIGN Prospect i ve , r and omized , double-blind , controlled study . SETTING University of the West Indies and And rews Memorial Hospital . PATIENT(S ) Fifty women with symptomatic uterine fibroids , 25 receiving misoprostol and vasopressin and 25 receiving vasopressin alone before myomectomy .  INTERVENTION(S ) Abdominal myomectomies on patients with symptomatic uterine fibroids . MAIN OUTCOME MEASURE(S ) Perioperative blood loss and febrile morbidity . RESULT ( S ) There were no statistically significant differences in sociodemographic , clinical , or myoma characteristics between the two groups at baseline . Postoperatively , there were no statistically significant differences in perioperative febrile morbidity or blood pressure between the groups . However , the group treated with misoprostol plus vasopressin had statistically significantly lower blood loss ( geometric mean with 95 % confidence interval , 334 mL [ 261 to 428 ] vs. 623 mL [ 354 to 1,094 ] , a smaller change in hemoglobin ( 1.6 ± 1.5 vs. 3.0 ± 2.0 ) , and a lower requirement for transfusion . In addition to treatment , significant determinants of blood loss were larger size of fibroids and greater number of fibroids . CONCLUSION ( S ) We conclude that perivascular vasopressin plus misoprostol caused a significant reduction in blood loss compared with perivascular vasopressin alone . CLINICAL TRIAL REGISTRATION NUMBER NCT01700478 OBJECTIVE To evaluate the influence of oxytocin on peroperative blood loss during  myomectomy .  STUDY DESIGN From October 1998 to May 2002 , 94 patients requiring surgical myomectomy by laparotomy or by the vaginal approach were enrolled in a r and omized double blind study . Patients were r and omized to two groups . In the first group ( 47 patients ) oxytocin was administered during myomectomy and in the second group ( 47 patients ) a placebo was used . The main outcome measures were peroperative blood loss and rates of blood transfusion and autotransfusion . RESULTS Peroperative blood loss was no different between the oxytocin group and the placebo group ( 508 + /- 558 ml versus 451 + /- 336 ml ; P=0.55 ) . Rates of autotransfusion and blood transfusion were also similar in both groups . CONCLUSION Administration of oxytocin during myomectomy did not reduce peroperative blood loss in our study . The benefits of using oxytocin to prevent hemorrhage during myomectomy seem to be limited OBJECTIVE To determine the effect of a single preoperative intravaginal prostagl and in E(2 ) ( PGE(2 ) ; dinoprostone ) suppository on reducing intraoperative blood loss and the need for subsequent blood transfusion at abdominal myomectomy for symptomatic leiomyomas . STUDY DESIGN In a prospect i ve r and omized double-blind placebo-controlled pilot study , 108 women who had abdominal myomectomy for symptomatic leiomyomas were enrolled . Patients were r and omly assigned to receive a single dose of intravaginal 20 mg dinoprostone ( n=54 ) or placebo ( n=54 ) 60 min before the operation . The primary outcome was the operative blood loss . The secondary outcomes were the need for blood transfusion , change in hemoglobin ( Hb ) level 24h after operation , and the prevalence of side effects . RESULTS Blood loss and transfusion rate were significantly greater in the group without PGE(2 ) suppository ( group B ) than in the group with PGE(2 ) ( group A ) : they were respectively 485.7 ± 361.3 mL vs 364.1 ± 279.4 mL ( P=.02 ; relative risk [ RR ] 0.95 ; 95 % confidence interval [ CI ] , 0.63 - 1.45 ) and 18.5 % vs 3.7 % ( P=.04 ; RR 1.32 ; 95 % CI , 3.7 - 18.5 ) . Group B had a significant decrease in Hb level 24h after operation compared with group A ( P<.05 ) . There was no difference in the patient demographics , intraoperative characteristics , postoperative stay , complications , and the side effects between the two groups . CONCLUSION A single pre-operative dose of dinoprostone administered intravaginally could be a safe and reliable method to help decrease blood loss during abdominal myomectomy . Further larger prospect i ve studies are required to support this conclusion 
    Output:
    
Conclusion Easy to use , minor or no side effects , and good clinical outcomes are the properties that render misoprostol useful in the realization myomectomy independently of the surgical technique applied