Sperm motility improvement: comparison of two methodologies of reproductive techniques.

The objective of this study was to compare two methods for the extraction of high motility sperm; washed semen and swim-up techniques, on 172 ejaculates from 53 patients with suspected infertility. High quality motile sperm had been essential for the success of the assisted reproductive procedures, in which these patients were enrolled. Semen analyses were performed according to the criteria recommended by the WHO. In both methods Ham's F-10 medium plus 7.5% human cord serum were used. The incubations were carried out at 37 degrees C +/- 1. The percentage of motile spermatozoa with forward progression was measured in the fresh sample and after incubation with both methods. The results were analyzed by the two-way analysis of variance. Motility rates were significantly higher in swim-up than fresh samples (mean 41.158%, SD 20.1 vs. 27.572%, SD 16.6; p < 0.0001) and washed semen compared with fresh sample (mean 36.966%, SD 16.3 vs. 27.572% SD 16.6; p < 0.0001).

[Assisted reproduction. Alternatives]. / Reproducción asistida. Alternativas.

From the first publications about fertilization in vitro (FIVTE) Patrick Steptoe and Robert Edwards, added several knowledges and new concepts in modern Gynecology, so starting a new era of Reproductive Medicine, so ideating a series of programs and methodologies to emulate the physiological ovarian cycle; with this concept Ricardo Asch carries the transference of gametes to tubes and calling this procedure GIFT. These methodologies with a high technology have been called Assisted Reproduction, which is reviewed in this paper.

[Endometriosis. Potential mechanism of sterility. Management of patients with endometriosis. Review and reflections]. / Endometriosis. Mecanismos potenciales de esterilidad. Esquema inductor en pacientes con endometriosis. Revisión y reflexiones.

Endometriosis is an ailment which has no exact etiology due to its uncertain genesis, its inception can develop unnoticed, its silent evolution makes it difficult to identify it until a cardinal symptom appears and its semeiology provides us facts to integrate a diagnosis, it is an entity that does not have relation while and/or with the reproductive stage, neither with the parity, but we are aware it occurs in its different stages, varying from 9% to 33% in the reproductive cycle, it can be recurring after being medically or surgically treated, appearing endometriomas in it or in the infundibulum stump in the latter case. It is characterized by a collagenosis, endometrio abnormal implant out of the uterus cavity, thereby generating and inflammatory process in the zone of implant, increasing the cytokines production (polypeptide secreted by the lymphocytes and macrophages playing an important role in the immunological response), involving a dysfunction in the hypothalamus-pituitary-ovarian, altering the endocrinos physiology; regarding the genetic aspect, alterations in the chromosomes 4.9 in the Endometriosis frames have been found. The human semen preparation with half Ham F 10 enriched with ascorbic acid is described. In cases of permeable tubes or FIVTE.

[Laparoscopic findings during bilateral tubal obstruction]. / Hallazgos laparoscópicos durante la obstrucción tubaria bilateral.

During the period 1987 to 1990 at Hospital Luis Castelazo Ayala, IMSS, a prospective study was carried out. For this study 374 bilateral tubal obstructions (BTO) were included in interval of gestation by means of laparoscopy with silastic rings. The objective was to observe the status presented by the organs contained in the pelvic cavity of women considered healthy; so, as to present pathology, opportunely treat it. Main findings were: Pelvic adhesions 37 cases (9.8%), uterine myomatosis 33 cases (8.8%), tubal pathology 18 cases (4.8%), ovarian cysts 11 cases (2.9%), and endometriosis 9 cases (2.4%). Global pathology was 108 cases (28.8%). The use of laparoscopy in BTO allows to find non expected pathology in apparently healthy women and offers them the opportunity of receiving treatment immediately, avoiding thus to attribute to BTO symptomatology that could be derived from existing pathology.

[Closure of the skin with cyanoacrylate in surgical wounds after tubal sterilization]. / Cierre de la piel con cianocrilato en las heridas quirúrgicas después de la obstrucción tubaria bilateral.

Close of skin with cyanocrilate in surgical wounds after tubary sterilization. The objective was to determine the use of cyanocrillate in surgical wounds coalescence, to decrease the time employed when closing the skin, as well as to aid the healing process. This is an observation, prospective, length, comparison, study. Since March, 1995, the Gyneceum-Obstetrics "Luis Castelazo Ayala" Hospital has carried out this research, forming two groups as follows. Group A: Tubary sterilization (OBT) was practiced to 36 patients applying a superficial coat of cyanocrilate. Group B included 31 patients whose skin was sutured with catgut 00. In Group A. the average time for skin closure is 14.5 seconds, in wounds with a length of 2 to 6 cm. In Group B the average time is 3.9 minutes, in wounds with a length of 1 to 4 cm. 4 cases of group A reported pain for the first 12 hours (11.1%), pruritus in wound in 3 cases (8.3%), partial dehiscence of wound, 1 case (2.7%). While in Group B the result are: Pain in 10 cases (32.2%), pruritus in 3 cases (9.6%), partial dehiscence of wound in 3 cases (9.6%), 1 case with poor edges coaptation (3.2%), and reaction to suture in 2 cases (6.4%). Not even an infection condition occurred. Cyanocrilate used in selected cases is an inexpensive, fast, easy to use efficient method, with little morbidity and likely to improve the aesthetic of surgical scar.

PIP: 100 women undergoing bilateral tubal sterilization at a hospital in Mexico City between March and September 1995 participated in a prospective study of the use of the contact adhesive cyanoacrylate for closure of the surgical wound. Cyanoacrylate was used for the patients in group A, while in group B the skin was sutured with catgut 00. The remainder of the procedure was similar in both groups. The 36 patients in group A and 31 in group B who attended follow-ups at 12 hours, 7 days, and 40 days were included in the study. Patients in group A ranged in age from 20 to 36 and averaged 31.7 years, while those group B ranged from 18 to 35 and averaged 27.5 years. Group A patients had 2.8 and group B 3.1 children on average. The wounds in group A ranged from 2 to 6 cm and averaged 3.1 cm, while those in group B ranged from 1 to 4 cm and averaged 2.5 cm in length. The time for wound closure ranged from 4 to 30 seconds and averaged 14.5 seconds in group A, and from 1 to 7 minutes with an average of 3.9 minutes in group B. 4 patients in group A had pain (11.1%), 3 had pruritus (8.3%), and 1 each had (2.7%) poorly joined borders, partial dehiscence of the wound, and bleeding. 10 patients in group B had pain (32.2%), 3 each (9.6%) had pruritus and partial dehiscence of the wound, 1 had poorly joined borders (3.2%), and 2 had reactions at the site of the sutures (6.4%). It was concluded that, in appropriately selected cases, cyanoacrylate is inexpensive, rapid, easy to use, and efficient, with few side effects.

[Morbidity from bilateral tubal ligation, via laparoscopy]. / Morbilidad de la obstrucción tubaria bilateral, vía laparoscopia.

From January 1, 1987 January 30, 1990, 374 laparoscopic sterilizations using silastic rings (Falope), were carried out. Morbidity and main risk factors, were analyzed. More frequent surgical complications were: mesosalpinx rupture, and fallopian tube rupture in 22 cases (5.8%); abdominal wall emphysema, three cases (0.8%), uterine perforation, two cases (0.5%); other pelvic structures lesions, three cases (0.8%). Morbidity risk factors were: previous abdominal surgery, obesity, salpingitis, use of an uterine mobilizer in a puerperal uterus, and practice of tubal occlusion during the luteal phase of cycle, due to possibility of luteal phase pregnancy; therefore, if a risk factor is present, it is advisable to use other contraceptive technique.

PIP: Between January 1, 1987-January 30, 1990, 374 laparoscopic sterilizations using silastic rings (Falope) were undertaken. Morbidity and major risk factors were analyzed. The most frequent surgical complications were: mesosalpinx rupture and fallopian tube rupture in 22 cases (5.8%); abdominal wall emphysema in 3 cases (0.8%); uterine perforation in 2 cases (0.5%); other pelvic structure lesions in 3 cases (0.8%). Morbidity risk factors were: previous abdominal surgery, obesity, salpingitis, use of a uterine mobilizer in a puerperal uterus, and the practice of tubal occlusion during the luteal hase of the cycle due to the possibility of a luteal phase pregnancy. Therefore, if a risk factor is present, it is advisable to use another contraceptive method. (author's modified)

[Closure of the skin with cyanoacrylate in cesarean section]. / Cierre de la piel con cianoacrilato en las cesáreas.

The objective was to determine the usefulness of cyanocrilate when closing cesarean wounds, in comparison with silk and nylon usual sutures. 74 patients with cesarean without background of previous abdominal surgery or infection were observed. Patients were divided into two groups: the use of cyanocrilate to close skin on medium and Pfannenstiel incisions was practiced on 44 patients, and on the remaining 30 patients integrating the control group, silk or nylon suture was used. The population characteristics did not show differences. Evaluated parameters were as follows; both groups showed similar little to moderate pain. Pruritus predominated in the cyanocrilate group (CIAN) on about 18.1% vs 13.2% on the control group. Marks on the skin largely predominated on the control group with silk (75%), while there were no marks on the CIAN group. The reaction to a foreign body was greater in the CIAN group, 15.9% versus 6.6% in the control group. Superficial dehiscence on the CIAN group was 6%, while it was 10% on the control group. The CIAN group showed 2.2% of hematomas, and the group of control 6.6%. Poorly coapted edges resulted in 4.5% on the CIAN group versus 20% on the control group. Skin closure average time on the CIAN was 62.8 sec and 283 on the control group. The use of cyanocrilate on the cesaran wounds closure showed: efficiency, safety and surgical time reduction, the scar aesthetics was improved and costs were reduced.

[Hematometra & Listeria monocytogenes]. / Hematometra por Listeria monocytogenes.

The hematometra is a nosological entity that may not always be attributed to an embryonic defect of the paramesonefros; cervical-vaginal infections such as etiological possibilities due to Listeria monocytogenes (Lm), cervix malignant neoplasias, iatrogenias due to endometrial ablation with Lasser, traumatic bloody uterine curetage and because of cervical cryocoagulation or electrocoagulation are also mentioned. The case to be reported is from a woman in reproductive stage, who is 32 years old, and had menarca at the age of 13, starting her sexual life at 31, not using any method to control her fertility. When having an eight-week amenorrhea after 8 months of marriage, she visited the doctor for assumed pregnancy, within the prenatal analysis a pelvic echographic study was requested, finding out images that we concluded as hematometra, having been drained and demonstrated the presence of LM by anti-Lm antibodies, being administered Azitromicina and Espiramicina.