Initial experience of a new linear everting falloposcopy system in comparison with hysterosalpingography.

OBJECTIVE: To assess the endolumenal portion of the fallopian tube from ostium to fimbria using a specially designed linear everting catheter and microendoscope. The study compared falloposcopy results with those obtained with hysterosalpingography (HSG) in the same patients and explored the system's ability to classify internal tubal conditions. DESIGN: A prospective study of a new diagnostic technique, falloposcopy, versus conventional means of evaluating tubal status. SETTING: A tertiary university infertility center. PATIENTS: Eighteen infertile patients with a previous history of infertility of at least 2 years duration. INTERVENTION: Diagnostic falloposcopy was performed on a total of 31 tubes. RESULTS: Although the results of HSG and falloposcopy were in agreement in 19 cases, falloposcopy findings were at significant variance with HSG in 12 cases (40%). Seventeen of the tubes visualized by falloposcopy were considered to be normal, 10 showed mild disease, and 4 were severely damaged. CONCLUSION: Falloposcopy using the linear everting catheter is rapid and atraumatic. It provides more complete information concerning tubal status than HSG and as such constitutes an important advance in diagnosis and therapy planning.

[Echography in assisted reproduction techniques]. / L'ecografia nelle tecniche di riproduzione assistita.

The Authors describe the A.R.T. echoguided techniques, that can be routinely used in IVF/ET programs. All these techniques are simple and have replaced the previous ones. The echoguided oocyte recovery is now widely accepted instead of the laparoscopic way: the gamete intrafalloppian transfer can be easily performed under local anesthesia; the selective fetal reduction in cases of multiple pregnancies can be easily carried out on an outpatient basis.

Echohysterosalpingography: new diagnostic possibilities with S HU 450 Echovist.

The use of a new sonography contrast medium (Echovist Shering SH U 450) is evaluated in this paper. This new method offers the possibility of investigating both the uterine cavity and the tubes representing an easy screening method for infertility and other gynecological problems. The possibility of examining the patient using ultrasound gives us the possibility of avoiding X-ray exposure (necessary for HSG) or general anaesthesia (required for laparoscopy). Our data is still insufficient in order to make a definite conclusion on the absolute replacement of HSG and, sometime, of laparoscopy with this method.

Conservative treatment of ectopic pregnancy by means of a single injection of methotrexate into the gestational sac.

The authors treated an ectopic pregnancy with a single dose of MTX injected into the gestational sac. With the resolution of the clinical symptoms, a complete "restitutio ad integrum" was obtained.

Conservative treatment of ectopic pregnancies using a single echo-guided injection of methotrexate into the gestational sac.

The authors describe the possibility of the conservative treatment of five early ectopic pregnancies. A single injection of methotrexate into the tubal gestational sac was performed under vaginal ultrasound guidance. In all five cases, a clear ectopic gestational sac could be visualized. The pregnancies dated from the 5th to the 7th week of amenorrhea. Strict ultrasound follow-up following injection showed a gradual reduction in the size of the tubal gestational sac. At the same time, plasma beta-hCG gradually decreased to zero after a maximum time period of 25 days. Subsequent hysterosalpingography performed on all of the women demonstrated bilateral normal patent tubes. It is concluded that, in selected patients, transvaginal injection provides an alternative relatively non-invasive approach to the management of ectopic pregnancy. It is proposed that the adoption of a policy of earlier diagnosis and treatment may lead to a reduction in the incidence of some tubal causes of infertility.

Hysteroscopic metroplasty: the role of ultrasound in the diagnosis and monitoring of patients with uterine septa.

52 patients with septate uterus underwent hysteroscopic metroplasty in the Obstetric and Gynecologic Clinic "R" in Palermo. In this group of patients ultrasound examinations were also performed in order to define their role in diagnosis of type of malformations and in monitoring the endoscopic surgical procedure. Preliminary results seem to indicate that real-time ultrasound is a reliable technique for both purposes.

Immunological problems in the recurrent abortion syndrome.

The recurrent abortion syndrome has been considered a serious obstetrical problem, since it was not possible to diagnose the causes in over 40% of the cases. Great progress has now been made with the knowledge of the immunological mechanisms involved in the maintenance of pregnancy. The disorders of such immunological mechanisms, both due to auto- or alloimmune problems, are demonstrated in about 40% of the cases of recurrent abortions. The Authors have studied a group of 56 patients with recurrent abortion syndrome in a complex diagnostic work-up involving: 1) The research of an autoimmune cause; 2) The research of the presence of the Blocking-factors by means of one-way mixed lymphocyte cultures; 3) The research of an altered antipaternal lymphocytotoxic activity or of an excessive HLA-sharing. According to the results of the investigations, several forms of therapeutic management have been used: 1) Steroids-aspirin-calcic heparin for Autoimmune cases. 2) Active immunotherapy for the cases due to the lack of blocking factors. 3) Calcic heparin for the altered antipaternal lymphocytotoxic activity. At the moment it is difficult to evaluate the results of pregnancy rate with this type of therapeutic management because of the too short follow-up.

New perspectives for the therapeutic management of recurrent immunological abortion.

Up to now the only effective therapy for recurrent abortion syndrome due to the absence of the so-called blocking-factor has been active immunotherapy with partner or third-party donor mononucleates. The Authors report their in vivo and in vitro experience with high-dose intravenous gammaglobulin (i IV Ig) in order to treat women with recurrent abortion syndrome. In the Authors opinion there are sufficient experimental reasons for continuing this research with IV Ig obtained from multiparous women plasma pools.