Community-based follow-up for late patients enrolled in a district-wide programme for antiretroviral therapy in Lusaka, Zambia.

Timely adherence to clinical and pharmacy appointments is well correlated with favourable patient outcomes among HIV-infected individuals on antiretroviral therapy. To date, however, there is little work exploring reasons behind missed visits or evaluating programmatic strategies to recall patients. For this study we implemented community-based follow-up of late patients as part of a large-scale programme for HIV care and treatment in Lusaka, Zambia. Through a network of local home-based care organizations, we attempted home visits to recall patients using locator information provided at time of enrolment. Between May and September 2005, home-based caregivers were dispatched to trace 1,343 patients with missed appointments. Of these, 554 (41%) were untraceable because the provided address was invalid, the patient had moved or no one was at the home. Of the remaining 789, 359 (46%) were reported to have died. Only 430 (54% of those traced, 32% overall) were contacted directly and encouraged to return for care. The likelihood of patient return was higher among traced patients in crude analysis (relative risk [RR] = 2.5; 95%CI = 1.9-3.2) and in multivariable analysis controlling for baseline body mass index, sex and CD4 + count < or = 50/microL (adjusted RR = 2.3; 95%CI = 1.7-3.2). However, the process was inefficient: one late patient returned for every 18 home visits that were made. Reasons for missed visits were provided in 271 of 430 (63%) of the patients who were successfully traced. Common reasons included feeling too sick to come to the clinic, travelling away from home and being too busy. Despite the availability of free ART in Lusaka, patients face significant barriers to attending scheduled clinical visits. Cost-effective and feasible strategies are urgently needed to improve timely patient follow-up.

[Laparoscopic-assisted replacement of inverted puerperal uterus: a case report and brief review of the literature]. / Laparoskopisch-assistierte Reposition bei Inversio uteri: Fallbericht und kurze Literaturübersicht.

Chronic inversion of the uterus is a serious obstetric complication often requiring laparotomy as manual replacement alone usually fails. We report on the successful laparoscopic-assisted replacement of a chronically inverted puerperal uterus on the 11th day post partum. The scientific literature back to the 19th century is briefly discussed.

Continuous, intermitted and sporadic motor unit activity in the trapezius muscle during prolonged computer work.

The Cinderella hypothesis postulates the continuous activity of specific motor units (MUs) during low-level muscle contraction. The MUs may become metabolically overloaded, with the subject developing muscle pain and strain. The hypothesis requires MUs that are active for a time long enough to actually damage muscle fibers. The aim of this study was to determine if there are continuously active MUs in the right trapezius muscle during normal computer work using a computer mouse. Fourteen healthy subjects executed an interactive computer-learning program (ErgoLight) for 30 min. Six-channel intramuscular EMG and two-channel surface EMG signals were recorded from two positions of the trapezius muscle. Decomposition was achieved with automated, multi-channel, long-term decomposition software (EMG-LODEC). In two out of the 14 subjects, three MUs were continuously active throughout the 30 min. Although the majority of the MUs were active during only part of the experimental session, an ordered on-off behavior (e.g. substitution) pattern was not observed. As long-lasting activity was verified in some subjects, the results support the Cinderella hypothesis. However, it cannot be concluded here how long the MUs could stay active. If continuous activity overloads low threshold MUs, the potential exists for selective fibre injuries in low threshold MUs of the trapezius muscle in subjects exposed to long-term computer work.

The contribution of type of daily activity to loading across the hip and knee joints in the elderly.

OBJECTIVE: In the elderly, we evaluated loading across the hip or knee joints during different daily activities. METHODS: Elderly people drawn from the community entering an exercise study underwent a full kinetic and kinematics analysis of five different activities, standing, walking, arising from a chair, going downstairs and bending over. Inverse dynamic equations were used to compute forces and torques across the knees and hips during all of these activities. RESULTS: 132 elderly people, mean age 75, participated. Compressive forces across the knees and hips were, by far, the greatest vector forces and were highest during stair descent and, to a lesser extent, during walking. Compressive forces were lowest during standing. The highest moments were flexion and adduction moments, and these were maximal during stair descent. CONCLUSION: Of the five activities we studied, descending stairs was associated with the highest calculated forces and torques across the knees and hips, and that may account for its tendency to cause joint symptoms and for its possible association with osteoarthritis incidence.

Balance prosthesis based on micromechanical sensors using vibrotactile feedback of tilt.

A prototype balance prosthesis has been made using miniature, high-performance inertial sensors to measure lateral head tilt and vibrotactile elements mounted on the body to display head tilt to the user. The device has been used to study the feasibility of providing artificial feedback of head tilt to reduce postural sway during quiet standing using six healthy subjects. Two vibrotactile display schemes were used: one in which the individual vibrating elements, called tactors, were placed on the shoulders (shoulder tactors); another in which columns of tactors were placed on the right and left sides of the trunk (side tactors). Root-mean-square head-tilt angle (Tilt) and center of pressure displacement (Sway) were measured for normal subjects standing in a semi-tandem Romberg position with eyes closed, under four conditions: no balance aids; shoulder tactors; side tactors; and light touch. Compared with no balance aids, the side tactors significantly reduced Tilt (35%) and Sway (33%). Shoulder tactors also significantly reduced Tilt (44%) and Sway (17%). Compared with tactors, light touch resulted in less Sway, but more Tilt. The results suggest that healthy normal subjects can reduce their lateral postural sway using head tilt information as provided by a vibrotactile display. Thus, further testing with balance-impaired subjects is now warranted.

SOCS proteins: negative regulators of cytokine signaling.

Cytokines regulate the growth and differentiation of cells by binding to cell-surface receptors and activating intracellular signal transduction cascades such as the JAK-STAT pathway. Cytokine signaling is negatively regulated with respect to both magnitude and duration, and it is now clear that the suppressor of cytokine signaling (SOCS) family of proteins (SOCS1-SOCS7 and CIS) contributes significantly to this process. Transcripts encoding CIS, SOCS1, SOCS2, and SOCS3 are upregulated in response to cytokine stimulation, and the corresponding SOCS proteins inhibit cytokine-induced signaling pathways. SOCS proteins therefore form part of a classical negative feedback circuit. SOCS family members modulate signaling by several mechanisms, which include inactivation of the Janus kinases (JAKs), blocking access of the signal transducers and activators of transcription (STATs) to receptor binding sites, and ubiquitination of signaling proteins and their subsequent targeting to the proteasome. Gene targeting has been used to generate mice lacking socs1, socs2, or socs3, in order to elucidate the physiological function of these SOCS family members. The analysis of socs1(-/-) mice has revealed that SOCS1 plays a key role in the negative regulation of interferon-gamma signaling and in T cell differentiation. Socs2(-/-) mice are 30%-40% larger than wild-type mice, demonstrating that SOCS2 is a critical regulator of postnatal growth. Additionally, the study of embryos lacking socs3 has revealed that SOCS3 is an important regulator of fetal liver hematopoiesis. The biological role of other SOCS proteins remains to be determined.

Analysis of postural perturbation responses.

People with cerebellar ataxia lack lower limb coordination and dissipate sway motion slowly and inefficiently after a posture perturbation. We report a practical and low-cost "human resonance frequency test" for both laboratory and clinical use to quantify progress in balance and cerebellar rehabilitation. We assumed that the center-of-pressure (COP) oscillation rate of decay following a standing posture perturbation is directly related to resonance frequency; a more rapidly dissipating COP oscillation about the position of equilibrium indicates, by definition, more efficient postural control. We hypothesized that following successful physical rehabilitation, people with cerebellar degeneration will have a faster rate of decay of the COP response to an external perturbation. Because the COP is modulated by a synergy of trunk and lower limb motion strategies, COP decay rate may be a useful measure of lower limb coordination in people with cerebellar ataxia. The method was applied to three subjects with cerebellar ataxia before and after rehabilitation; there was good agreement between the calculated COP decay rate and conventionally used gait stability parameters providing pilot data for this simple approach.

Mechanical energy transfer during gait in relation to strength impairment and pathology in elderly women.

OBJECTIVE: To examine the relationships among strength impairment, pathology and the mechanical energy transfers across the leg and low-back joints in a sample of frail elderly women with functional limitations. BACKGROUND: Past studies suggest mechanical energy analyses may be useful for identifying compensatory strategies used by elders during gait, but also suggest that age and strength are not the only factors that determine the extent of compensatory strategy use. METHODS: Gait data for 75 functionally limited women 60-90 years of age were analyzed. Subjects were categorized by strength and pathology diagnoses. Inverse dynamics was used to compute concentric (positive) and eccentric (negative) mechanical energy expenditures of the ankle, knee, hip and low-back during the stance phase of gait. Joint mechanical energy expenditures were compared between strength and diagnoses groups, and relationships among joint mechanical energy expenditures examined within groups. RESULTS: Weaker subjects demonstrated lower concentric ankle and eccentric knee mechanical energy expenditures, and higher eccentric low-back mechanical energy expenditures, than stronger subjects. Subjects with orthopaedic impairments demonstrated higher eccentric low-back mechanical energy expenditures than subjects with other impairments. Inverse correlations were found between ankle mechanical energy expenditures and hip and low-back mechanical energy expenditures for subjects with orthopaedic impairments. CONCLUSIONS: Elders with weak leg muscles and orthopaedic impairments increased hip and low-back mechanical energy expenditures, apparently to compensate for reduced ankle and knee mechanical energy expenditures. Further research is warranted to determine what long-term influences these compensatory strategies have on function and disability. Relevance. Mechanical energy methods could be useful for developing rehabilitative training programs to eliminate mobility impairments and avoid disablement in frail elders.fs

Age-related changes in lower trunk coordination and energy transfer during gait.

The effects of aging on lower trunk (trunk-low-back joint-pelvis) coordination and energy transfer during locomotion has received little attention; consequently, there are scant biomechanical data available for comparison with patient populations whose upper body movements may be impaired by orthopaedic or neurologic disorders. To address this problem, we analyzed gait data from a cross-sectional sample of healthy adults (n = 93) between 20 and 90 yr old (n = 44 elderly, >50 yr old; n = 49 young, <50 yr old). Gait characteristics of elders were mostly typical: gait speed of elders (1.13 +/- 0.20 m/s) was significantly (P = 0.007) lower than gait speed of young subjects (1.20 +/- 0.18 m/s). Although elders had less low-back (trunk relative to pelvis) range of motion (ROM; P = 0.013) during gait than young subjects, no age-related differences were detected in absolute trunk and pelvis ROM or peak pitch angles during gait. Despite similar upper body postures, there was a strong association between age and pelvis-trunk angular velocity phase angle (r = 0.48, P < 0.001) with zero phase occurring at approximately 55 yr of age; young subjects lead with the pelvis while elderly subjects lead with the trunk. Age related changes in gait speed and low-back ROM were unable to explain the above findings. The trunk-leading strategy used by elders resulted in a sense reversal of the low-back joint power curve and increased (P = 0.013) the mechanical energy expenditure required for eccentric control of the lower trunk musculature during stance phase of gait. These data suggest an age-related change in the control of lower trunk movements during gait that preserves upper body posture and walking speed but requires a leading trunk and higher mechanical energy demands of lower trunk musculature-two factors that may reduce the ability to recover from dynamic instabilities. The behavioral and motor control aspects of these findings may be important for understanding locomotor impairment compensations in aging humans and in quantifying falls risk.

Immunological consolidation of ovarian carcinoma recurrences with monoclonal anti-idiotype antibody ACA125: immune responses and survival in palliative treatment. See The biology behind: K. A. Foon and M. Bhattacharya-Chatterjee, Are solid tumor anti-idiotype vaccines ready for prime time? Clin. Cancer Res., 7:1112-1115, 2001.

The aim of the present study was to assess whether the induction of specific immune responses by vaccination with the murine monoclonal anti-idiotypic antibody ACA125, which imitates the tumor-associated antigen CA125, has a positive influence on the survival of patients with recurrent ovarian carcinoma. Forty-two patients with platinum-pretreated recurrences were included in a clinical Phase I/II trial of consolidation in third-line therapy. Patients initially received four immunizations with 2 mg of alum-precipitated anti-idiotype ACA125 every 2 weeks and then monthly applications. No serious allergic reactions could be detected within a maximal control period of 56 months. Hyperimmune sera of 27 of 42 patients (64.2%) showed increased concentrations of human antimouse antibodies. Specific anti-anti-idiotypic antibodies as a marker for induced immunity were detected in 28 of 42 patients (66.7%). The survival of the whole ACA125-treated collective of patients after a mean of 12.6 antibody applications was 14.9 +/- 12.9 months. The survival of patients with a positive immune response was 19.9 +/- 13.1 months in contrast with 5.3 +/- 4.3 months in those patients without detectable anti-CA125 immunity (P < 0.0001). According to these results, vaccination with a suitable anti-idiotypic antibody offers an effective way to induce specific immunity against a primarily nonimmunogenic tumor antigen such as CA125 and is associated with a positive impact on the survival of patients with recurrent ovarian cancer with few side effects, which warrants a Phase III trial for ovarian cancer patients after primary therapy.

Lifting strategy and stability in strength-impaired elders.

STUDY DESIGN: Ninety-six subjects underwent biomechanical analysis of freestyle box lifting. OBJECTIVES: To relate lifting strategy to lower extremity muscle strength and postural stability in functionally limited elders. SUMMARY OF BACKGROUND DATA: Back pain and postural instability in elders is rampant and poorly understood. Much of the literature on lifting relates to young subjects. METHODS: Lifting strategy for 91 functionally limited elders was classified by timing of peak power in the back and knee joints. Isometric hip and knee extensor strength and postural stability were compared among strategy classifications. Postural stability was analyzed by measuring center of gravity (CG) displacement during lifting. RESULTS: Three lift strategy groups were established: back-lift, or back dominant strategy (BDS); leg-lift, or leg dominant strategy (LDS); and leg-dominant back-first mixed strategy (LDB). Subjects with relatively strong hip and knee extensors used leg dominant strategy; subjects with relatively strong knee, but weak hip, extensors used leg-dominant back-first mixed strategy; and subjects with weak hip and knee extensors used back dominant strategy. Leg dominant strategy and leg-dominant back-first mixed strategy engendered less center of gravity displacement and thus were posturally more stable than the back dominant strategy. CONCLUSION: Subjects apparently chose their lift strategy based on their hip and knee extensor strength. Weaker elders using a less stable back dominant strategy could be susceptible to falls and subsequent long bone and vertebral body fractures. Clinicians could identify at-risk elders by muscle testing. Beyond emphasizing strength and endurance exercise in elderly patients, weak elders should be taught to use a leg dominant lifting strategy, or if they are not physically able, to use a combined back/leg strategy.

Kalman filter detection of blinks in video-oculography: applications for VVOR measurement during locomotion.

A Kalman filter algorithm was implemented for automatic detection of blink artifacts in video-oculography (VOG) data, and a cubic spline used to patch the eliminated data. The algorithm was tested by randomly introducing artificial blinks into eye movement data and computing the errors introduced by the patches. We also computed visual vestibulo-ocular reflex (VVOR) gain and phase in healthy and vestibulopathic subjects during a locomotor task, before and after blink removal, to demonstrate the interpretive importance of eliminating blink artifacts. The error introduced by the patched data was small (0.50+/-0.32 degrees ) and within the resolution of head angle measurements. Comparison of gain and phase shift before and after removing blinks revealed that even when calculated values are within expected limits, coherence of the VVOR signal was significantly (p=0.003) lower prior to blink removal (0.51+/-0.37) compared to that after blink removal (0.92+/-0.08). Comparison of VVOR calculations between healthy and vestibulopathic subjects (after removal of blinks) revealed that vestibulopathic subjects had significantly decreased gains (p=0.018) and increased phase shifts (p=0.009): these results agree with data reported in literature. We conclude that the Kalman filter detection and cubic spline patching algorithms are useful tools for VOG and should enable reliable VVOR measurements during unconstrained, ecologically meaningful locomotor activities.

Vestibulopathy and age effects on head stability during chair rise.

It is unknown how vestibular dysfunction and age differentially affect balance control during functional activities. The objective of this study was to gain insight into the effects of age and vestibulopathy on head control when rising from a chair. Head relative to trunk (head-on-trunk) sagittal plane angular and linear control strategies were studied in patients with bilateral vestibular hypofunction (BVH) and in healthy subjects aged 30-80 years. A two-way analysis of variance was used to compare head-on-trunk kinematics by age (young vs elderly) and diagnosis (healthy vs BVH) at the time of liftoff from the seat. Angular control strategies differed with age but not diagnosis: young (healthy and BVH) subjects stabilized head rotations in space while elderly (healthy and BVH) subjects stabilized head rotations on the trunk. In contrast, linear control strategies differed by diagnosis but not age: BVH subjects (young and old) allowed a greater rate of head-on-trunk translation while healthy subjects (young and old) inhibited such translations. Young BVH subjects stabilized head-in-space rotations (as did young healthy subjects) without a functioning vestibular system, suggesting cervicocollic reflex and/or other sensory compensation for vestibular loss. Elderly BVH subjects stabilized head rotation with respect to the trunk, as did healthy elders, but did not stabilize head-on-trunk translations, suggesting a reliance on passive mechanical responses of the neck to sense head movements. We conclude that compensation strategies used by patients with vestibulopathy are age-dependent and appear to be more tractable in the younger BVH patient.

Mechanical energy analysis identifies compensatory strategies in disabled elders' gait.

Current concepts in disablement emphasize the importance of identifying mobility impairments in aging humans to enable timely intervention and, ultimately, prevent disability. Because mobility impairments are likely to result in compensatory movement strategies, recognizing and understanding those strategies may be critical in designing effective interventions for preventing disability. We sought to determine if mechanical energy methods are useful for identifying and understanding lower extremity compensatory movement strategies due to disabilities. Aleshinski's method was used to compute mechanical energy expenditure (MEE) and mechanical energy compensation (MEC) for the sagittal plane stance leg and low-back joints of healthy elders (HE) and disabled elders (DE) during preferred speed and paced (120 steps min(-1)) gait. DE subjects expended less ankle energy in late-stance and more low-back energy in mid-stance than did the HE subjects. When controlling for walking speed, the difference in ankle MEE disappeared, but mid-stance hip MEE was significantly higher for the DE subjects. Despite increased hip and low-back MEE, the DE subjects compensated hip and low-back muscles greater then HE subjects by increasing energy transferred into the pelvis, particularly when walking faster than their self-selected speed. Increased energy transfers into the pelvis during mid-stance may be a strategy used to assist in advancing and controlling the contralateral limb's swing phase. Increased trunk energy, however, may compromise dynamic stability and increase the risk of falling. We conclude that mechanical energy methods are useful for identifying and understanding compensatory movement strategies in elders with disabilities.

High curvature and jerk analyses of arm ataxia.

We investigated high curvature analysis (HCA) and integrated absolute jerk (IAJ) for differrentiating healthy and cerebellopathy (CB) patients performing pointing tasks. Seventeen CB patients and seventeen healthy controls were required to move a pointer at their preferred pace between two 50.8 cm laterally spaced targets while standing with theirarm extended in front of their body. HCA was used to quantify the frequency of sharp turns in the horizontal-plane (anterior-posterior and medio-lateral) velocity trajectory of the hand-held pointer. IAJ was assesssed by integration of absolute jerk (second time derivative of velocity) time histories in the anterior-posterior and medio-lateral directions. HCA scores and IAJ scores were then compared between CB patients and healthy controls; for both analyses, higher scores indicateless smooth movements. We hypothesized that CB patients would have less smooth movement trajectories than healthy controls due to upper extremity ataxia asssociated with cerebellar disease and degeneration. We found that CB patients had higher HCA scores than healthy controls (P = 0.014). Although CB patients had higher IAJ scores in both anterior-posterior (P = 0.060)and medio-lateral (P = 0.231) directions compared to the healthy controls, the differences were not significant. The difference in sensitivity between the HCA andthe IAJ analysis might be explained by primitive neural activation commands, ubiquitous though only evident with some cerebellar dysfunctions, which produce submovements which are themselves minimal jerk curves. We conclude that HCA may be a useful tool for quantifying upper extremity ataxia in CB patients performing a repeated pointing task.

Association of soluble HLA-G plasma levels with HLA-G alleles.

Soluble HLA-G (sHLA-G) molecules are found in the peripheral blood of healthy females and males, in cord blood and in amniotic fluids and discussed to be a mediator in maternal-fetal tolerance. In this study we investigated whether there are allele-specific differences in expression of sHLA-G molecules. For this, the sHLA-G plasma concentrations of 94 healthy unrelated individuals were measured by ELISA and correlated to their HLA-G genotypes, as determined by sequence analysis of exon 2 and 3 of the HLA-G gene. Mean sHLA-G levels in individuals with the most common HLA-G alleles G*01011 (27.0+/-2.1 SEM ng/ml, n=66), G*01012 (28.4+/-3.2 SEM ng/ml, n=34) were very similar. In contrast, individuals carrying the HLA-G*01013 (8.1+/-1.7 SEM ng/ml, n=17) or the "null" allele HLA-G*0105N (8.2+/-3.2 SEM ng/ml, n=7) presented significantly (P(c)=0.001 and P(c)<0.01, resp.) reduced sHLA-G levels. Furthermore, individuals with the HLA-G*01041 allele had significantly (P(c)=0.004) increased sHLA-G levels (42.5+/-4.6 SEM ng/ml, n=14). These results demonstrate that the generation of sHLA-G molecules is associated to certain HLA-G alleles and imply that sHLA-G levels are under genetic control. As low and high sHLA-G plasma levels did not segregate with HLA haplotypes including the HLA-G*01013 or *01041 allele, additional mechanisms may be involved in the regulation of the individual sHLA-G levels. Nevertheless, the existence of "low" and "high secretor" HLA-G alleles further suggests different levels of functionality in immune regulation.

Photoradiation of perfused placental tissue--a suitable in vitro model for photodynamic therapy?

Our aim was to evaluate the isolated placental lobule as a model to study the cytotoxic effects of photodynamic therapy (PDT) in vitro. Ten human placental lobules were dually perfused with a modified medium 199 for a 4-hour period. Photosan III was added to the fetal perfusate at a dose of 5 mg/kg tissue, and laser light (630 nm wavelength) provided by an argon-pumped dye laser was applied at 50 J/cm2 in the experimental group (n=5). Potassium and lactate dehydrogenase (LDH) release into the perfusate as well as the transplacental creatinine passage from PDT-treated placentas and control placentas (n=5) were compared, and light microscopic examinations of the placental tissue were performed after the experiments. Potassium release into the fetal perfusate was higher in the PDT-treated placental lobules (p<0.05), and weight gain during the artificial perfusion suggests the development of edema only in the photoradiated lobules (p<0.01). The release of the bigger molecules of the LDH however was comparable in the two experimental groups, and transplacental creatinine passage was not affected by photoradiation. Light microscopic examinations demonstrated lesions at the cytotrophoblast, the syncytiotrophoblast and the endothelium of the fetal vessels of the photoradiated placentas, although they were not specific and could also be found in the control tissue. We conclude that the isolated placenta may be used to study cytotoxic effects of photoradiation in vitro, but better specifity and sensitivity might be achieved if a. The perfusion time is prolonged to make the difference between the experimental and the control group clearer and b. Electron microscopic investigations are made to demonstrate intracellular lesions of the mitochondria and the endoplasmic reticulum.

Predicting the outcome of infertility surgery.

We studied a group of 187 infertile patients who had electromicrosurgery after laparoscopy, and falloposcopy. Follow-up information about 154 of these patients (82.4%) was available. Success rates in terms of intrauteine pregnancy was inversely related to the severity of peritubal and intratubal adhesions. Electromicrosurgery should only be preformed when clinical benefit is reasonably likely.

[Prognostic value of Fallopian tube endoscopy]. / Prognostische Wertigkeit der Falloposkopie.

OBJECTIVE: Progress in sterility-therapy demands diagnostic methods, that ensure the right indication for certain therapies in order to avoid unsuccessful attempts. In this retrospective study we tried to find out, whether we could predict and influence the success rate of therapies with the use of falloposcopy prior to further treatment. MATERIAL AND METHODS: In 62 sterile patients the endotubal state was evaluated with a falloposcope (Imagyn, Irvine, USA), a system of linear everting catheter (LEC) and microendoscope, prior to further treatment. RESULTS: Twenty of the 62 patients had endotubal pathology of both tubes, 15 patients showed pathology of one tube and 25 patients were diagnosed to have a normal endotubal morphology. In 2 patients falloposcopy could not be performed because of blockage due to intramural myomas. Pregnancy rate of those patients with a normal endosalpinx was 52% altogether, following microsurgery 80% and following insemination even 100%. No extrauterine pregnancies were described in this group. Pregnancy rate of those patients with endotubal pathology of both tubes was 35%. In this group no pregnancy followed microsurgery and following insemination one extrauterine pregnancy could be noticed. Furthermore, IVF results were improved if morphologic evaluation showed normal mucosa. CONCLUSIONS: The falloposcopy is a helpful diagnostic procedure to evaluate endotubal pathology prior to microsurgery and insemination.