Unexpected pregnancies after tubal recanalization failure with selective catheterization.

OBJECTIVE: To evaluate selective salpingography sensitivity. DESIGN: Retrospective study. SETTING: Obstetrics and Gynecology Department, University of Genoa, Italy. PATIENTS: One hundred seventeen patients previously submitted to selective salpingography because of unilateral or bilateral proximal tubal injection failure. RESULTS: Seven pregnancies, one of which was ectopic, were obtained in 17 patients who had only recanalized tubes available for conception; 15 pregnancies were obtained in 39 patients who had one tube recanalized and one already patent; 3 tubal pregnancies were obtained in 12 patients who had only one tube already patent; 4 pregnancies, one of which was ectopic, were obtained in 19 patients who had neither patent nor recanalized tubes. CONCLUSIONS: Selective salpingography can give false-positive results; therefore, it is possible to obtain a pregnancy even after selective salpingography failure.

Transcervical selective salpingography: a diagnostic and therapeutic approach to cases of proximal tubal injection failure.

OBJECTIVE: Evaluation of selective salpingography for diagnosis and treatment of tubal injection failure during hysterosalpingography (HSG). DESIGN: Prospective study. SETTING: Obstetrics and Gynecology Department, University of Genoa (Italy)--tertiary care. PATIENTS: One hundred eighty infertile women with unilateral or bilateral proximal tubal injection failure during HSG were submitted to the procedure. INTERVENTION: Under fluoroscopy, a 4.5-F nylon catheter (3-F tip) was inserted into the ostium with or without the aid of a J-shaped, coaxial, angiographic guide wire, and 2 to 3 mL of contrast medium were injected. The procedure lasts 20 to 30 sec/tube. MAIN OUTCOME MEASURES: Of 155 tubal ostia, 145 (94.2%) were catheterized. RESULTS: Of the 146 catheterized tubes, 110 (75%) were rendered patent. Of the others, 21 (14.3%) presented hydrosalpinx or distal obstructions, and isthmic obstruction was present in 5 (3.4%). Patency of at least one tube was achieved in 82 (81.2%) of the 101 catheterized women; 8 conceived spontaneously and 11 after gamete intrafallopian transfer to the recanalized tube. CONCLUSIONS: During HSG, selective salpinography can be performed when proximal injection failure is observed to determine its cause or to restore patency.

Comparison of different ovarian stimulation protocols for gamete intrafallopian transfer in patients with minimal and mild endometriosis.

Three different stimulation protocols were tested in patients affected by stage I and II endometriosis with no other causes of infertility, and scheduled for the gamete intrafallopian transfer technique. In two protocols a gonadotropin hormone-releasing hormone analog was used. The analog was started 6 months before stimulation in the former and along with the exogenous gonadotropin in the latter. Patients receiving only gonadotropin served as controls. Sixty patients were selected for this study; 55 reached laparoscopy. Whereas patients receiving either gonadotropin alone or simultaneous analog and gonadotropin had similar pregnancy rates, this was much higher in the patients undergoing a prolonged, medically induced hypoestrogenism. Prolonged analog pretreatment before ovarian stimulation may give better chances of success in endometriosis patients undergoing assisted reproduction techniques.

Endometrial morphology after 12 months of vaginal oestriol therapy in post-menopausal women.

The endometrial effect of long-term vaginal oestriol (E3) therapy for urogenital atrophy was assessed in 23 post-menopausal women. Hysteroscopic and histological examinations were performed in each patient to assess endometrial atrophy before treatment and after 6 and 12 months of therapy (0.5 mg vaginal E3 for 21 days, then 0.5 mg twice weekly). The primary atrophic picture was confirmed at the end of the 6th month in all but one of the patients. In one case, the histology showed an abnormal stromal reaction with no epithelial alterations. Treatment was continued and after the 12th month complete atrophy was confirmed both hysteroscopically and histologically in all patients. Efficacy as regards vaginal and urogenital complaints was good. Our results demonstrate that in women with endometrial atrophy effective and well-tolerated treatment with vaginal E3 can be safely continued for up to 12 months.

Endometrial response in sequential cyclic therapy assessed with associated hysteroscopy and histology.

A morphologic study was performed on the endometrium in 37 asymptomatic postmenopausal women under effects of cyclically administered oestrogens. Eighty-seven postmenopausal women were taken as control group. Medroxyprogesterone acetate (MPA), 10 mg daily, was administered in association with two types of oestrogen replacement therapy: conjugated equine oestrogens 0.625 mg (CEE) or transdermal 17 beta-oestradiol 0.05 mg (E2-TTS). Endometrial biopsies were taken under hysteroscopic control before treatment and on days 8-12 of combined therapy at the 6th month. Follow-up at 12 and 18 months was only performed in 8 and 5 patients, respectively, with transdermal 17 beta-oestradiol treatment. Various types of endometrial response were identified from atrophy to hyperplasia and secretory patterns. No atypical hyperplasia was found. All cases of simple or complex hyperplasia showed a regression after increased MPA dosage treatment (20 mg). This work is aimed at investigating the endometrial response during sequential cyclic therapy by using morphologic criteria based on hysteroscopy and histology. A large number of patients with hyperplasia can be detected with target biopsy under hysteroscopy, thus playing an important role in the management of patients during replacement therapy in research protocols.

Malignant fibrous histiocytoma associated with a meningothelial meningioma.

A 72-year-old woman was operated for a left parietal tumor of the meninges. The symptomatology began 22 years earlier with a right hemiparesis. The histological examination of the tumor showed a proliferation of meningothelial cells with whorl formation, associated with a pleomorphic proliferation of a malignant fibrous histiocytoma. The meningothelial meningioma showed a typical aspect, with nuclear inclusions and absence of mitotic activity. The second tumor component showed a storiform architecture with giant multinucleated cells, necrosis and many typical and atypical mitoses. There was also an inflammatory component with infiltrates of lymphocytes. This tumor component at the border with the meningioma appeared to arise from the septa of the meningioma with many prongs merging into one large and pleomorphic histiocytomatous tumor. The dual histological aspect and the case are discussed in the light of what is already known in the literature. The woman has been irradiated after surgery and she is doing well 6 months after operation.

Gestational choriocarcinoma arising in a cornual pregnancy.

A of a case of cornual pregnancy associated with initial transformation to choriocarcinoma is reported. Appropriate monitoring of HCG titers following conservative management of ectopic pregnancy is important not only to diagnose persistent ectopic gestation, but to avoid missing trophoblastic disease, albeit rarely.

[Use of a new ultrasonographic contrast medium (Echovist-200) in the study of the tubal factor of infertility]. / Impiego di un nuovo mezzo di contrasto ecografico (Echoivist-200) nello studio del fattore tubarico di infertilità.

UNLABELLED: OBJECTIVE. Use of a new sonographic contrast medium (Echoivist-200) for the evaluation of tubal patency and morphology. DESIGN: Comparative study. SETTING: Istituto di Ginecologia ed Ostetricia dell'Università di Genova. PATIENTS: Thirty women with primitive or secondary infertility since al least two years. INTERVENTIONS: Hysterosonosalpingography has been performed on patients using a new sonographic contrast medium. MEASUREMENTS: Tubal patency and morphology have been evaluated. RESULTS: This procedure allowed to obtain a correct diagnosis in 86% of cases. 83% of patients had light pelvic pain, 20% of them experienced nausea and vomiting in one case a lipothymia occurred. CONCLUSIONS: Hysterosonosalpingography with a new sonographic contrast medium should become the first choice procedure in the evaluation of tubal patency, addressing to the radiological examination only the uncertain cases or cases in which, the presence of a proximal tubal obstruction could be treated by selective catheterization.

Macro-kinetic investigation on phenol uptake from air by biofiltration: Influence of superficial gas flow rate and inlet pollutant concentration.

The macro-kinetic behavior of phenol removal from a synthetic exhaust gas was investigated theoretically as well as experimentally by means of two identical continuously operating laboratory-scale biological filter bed columns. A mixture of peat and glass beads was used as filter material. After sterilization it was inoculated with a pure strain of Pseudomonas putida, as employed in previous experimental studies. To determine the influence of the superficial gas flow rate on biofilter performance and to evaluate the phenol concentration profiles along the column, two series of continuous tests were carried out varying either the inlet phenol concentration, up to 1650 mg . m(-3), or the superficial gas flow rate, from 30 to 460 m(3) . m(-2) . h(-1). The elimination capacity of the biofilter is proved by a maximum volumetric phenol removal rate of 0.73 kg . m(-3) . h(-1). The experimental results are consistent with a biofilm model incorporating first-order substrate elimination kinetics. The model may be considered a useful tool in scaling-up a biofiltration system. Furthermore, the deodorization capacity of the biofilter was investigated, at inlet phenol concentrations up to 280 mg . m(-3) and superficial gas flow rates ranging from 30 to 92 m(3) . m(-2) . h(-1). The deodorization of the gas was achieved at a maximum inlet phenol concentration of about 255 mg . m(-3), operating at a superficial gas flow rate of 30 m(3) . m(-2) . h(-1). (c) 1996 John Wiley & Sons, Inc.

Laparoscopic surgery in pregnancy. A case report with a brief review of the topic.

A 32-year-old white lady suffering from tubal infertility was referred to our institution in November 1992 because of low abdominal pain due to a heterotopic pregnancy (one intrauterine sac and the other in the right tube). The patient had undergone, 8 weeks before, her second successful attempt at in vitro fertilization and embryo transfer. We decided to perform a laparoscopic salpingectomy. At inspection, the presence of tubo-ovarian adhesions was noted, secondary to the previous tubal microsurgical procedure, that were lysed by means of monopolar electrocoagulation. Salpingectomy was performed by combined bipolar cauterization and blunt-scissor dissection of the mesosalpinx. No uterine contractions were noted after surgery and the patients were discharged the next day. The rest of the pregnancy was uneventful and the patient spontaneously delivered vaginally a healthy female newborn weighing 3,060 g (Apgar score = 9) on June 20, 1993, at 39 weeks of gestation. A review of the published literature on laparoscopic surgery in pregnancy is given.

[Tubal catheterization with selective salpingography in the diagnosis and therapy of fallopian tube obstruction]. / Il cateterismo tubarico con salpingografia selettiva nella diagnosi e terapia dell'ostruzione delle tube di Fallopio.

Fallopian tube catheterization with selective ostial [correction of osteal] salpingography is a new technique for the diagnosis of tubal factors of infertility and also for the treatment of proximal tubal occlusion (PTO). In this study, 246 women were considered, 20-42 years old, with primary or secondary infertility, who presented a unilateral or bilateral PTO at hysterosalpingography (HSG). Catheterization and selective salpingography have been successful in 93.9% of the cases. Failures (5.6%) have been ascribed to obstructive organic diseases, where it was impossible to overcome the stenosis with the catheter or the guide-wire. Twenty-six spontaneous pregnancies were obtained (15 full-term deliveries) and 17 patients became pregnant after GIFT (13 full-term deliveries). At follow-up, after 12 months 4 of 10 patients had normal tubes, while 6 patients presented a new unilateral or bilateral PTO. No major complications occurred; nevertheless, ectopic pregnancy is a possible event, because of the mechanically re-established patency in a nonfunctioning tube.

Intrauterine insemination with husband's semen as alternative to other assisted reproduction techniques.

The objectives of this study was to assess the efficacy and clarify how many intrauterine insemination cycles can justifiably be proposed, in terms of cost and benefits for the patient, as alternative to other assisted reproduction procedures. Two hundred and twenty infertile couples were referred to our centre and six intra-uterine insemination cycles in combination with controlled ovarian hyperstimulation were proposed for them. A total of 650 treatment cycles were completed. The indications of intra-uterine insemination were male factor (147 couples), cervical factor (31 couples), male and cervical factor (30 couples) and unexplained infertility (12 couples). Superovulation was induced in 92 patients with human menopausal gonadotrophins, in 90 with clomiphene citrate, in 22 with FSH HP, while in 16 patients the intra-uterine inseminations were carried out during spontaneous cycles. Considering the entire population, a mean monthly pregnancy rate equal to 8.9% was obtained and a cumulative pregnancy rate equal to 39% at the end of six intra-uterine insemination cycles. In particular, in the patients treated with HMG+hCG, a mean monthly pregnancy rate equal to 10.9% and a cumulative pregnancy rate to 46% at the end of the six cycles were obtained. In conclusion, when the indications allow, we believe it is justified to propose six cycles of intra-uterine insemination in combination with controlled ovarian hyperstimulation with HMG and hCG. The theoretical probability of success at the end of six cycles has proved comparable and advantageous in terms of cost and risks for the patient, if compared with other assisted reproduction techniques.

'Blind' transcervical transfer of gametes in the fallopian tube: a preliminary study.

The aim of the study was to assess, in a small number of volunteers, the feasibility of transferring gametes by blind transcervical tubal catheterization. Forty patients underwent ovarian stimulation with a combination of a luteinizing hormone-releasing hormone analogue and exogenous gonadotrophin. Twenty-six patients were submitted to echographical oocyte retrieval and subsequent blind transcervical tubal transfer of the gametes. Successful cannulation of the tube was achieved in 18 subjects, at the first attempt and in four subjects at the second attempt; in the remaining four subjects, three or more attempts were needed. No complications were recorded during the tubal transfer. Seven clinical pregnancies (27% of all transfers) were obtained: three ended in abortion (11%), one was ectopic (4%) and three were ongoing (11%). These preliminary results encourage larger studies using this approach.

The duration of pituitary suppression by means of intranasal gonadotropin hormone-releasing hormone analogue administration does not influence the ovarian response to gonadotropin stimulation and success rate in a gamete intrafallopian transfer (GIFT) program.

The aim of the study was to compare the ability to prevent endogenous luteinizing hormone interferences, ovarian response, and success rate between two groups of patients undergoing GIFT procedures and treated with the same stimulatory protocol but with a different timing in the administration of the gonadotropin hormone-releasing hormone analogue (GnRH-a). The former underwent a concomitant administration of gonadotropin and analogue; the latter started stimulation only after the achievement of complete hypogonadotropinism. The analogue was always given intranasally and stimulation was identical in the two groups. Our results showed that (1) prevention of premature luteinization is obtained with both approaches and (2) no significant difference in terms of length of stimulation, gonadotropin doses, ovarian response, and success rate was recorded between the two groups.