Laparoscopic non-microsurgical tubal reanastomosis: A retrospective cohort study.

OBJECTIVE: To determine the pregnancy rate achieved through laparoscopic tubal reanastomosis using only standard 5 mm laparoscopic instruments and standard suturing material. METHODS: Data from 100 consecutive laparoscopic tubal reanastomosis procedures done between September 2002 and September 2010 were retrospectively analysed. All procedures were performed by the same surgeon using standard 5 mm laparoscopic instruments and with the placing of three or four sutures of standard polyglycan 4/0 suturing material. The main outcome measures were: (intrauterine) pregnancy rate and live birth rate before and after 40 years of age, and tubal patency rate. RESULTS: Six patients had no active child wish and six others were lost to follow-up, thus leaving 88 of 100 patients for evaluation. Fifty-eight of these conceived, giving a total pregnancy rate (PR) of 66%. The PR in women younger than 40 years was significantly greater than that achieved by those aged 40 or more (73% vs. 29%, p = 0.001). CONCLUSIONS: Laparoscopic tubal reanastomosis with standard 5 mm laparoscopic instruments results in a satisfactory pregnancy rate.

Pemphigoid gestationis.

A 39-year-old woman in the 39th week of her fifth pregnancy presented with severe itching. In recent weeks she had developed an increasingly itchy rash on her trunk and arms. Upon examination we observed multiple erythematous plaques and vesicles. Histological examinations of two skin biopsies confirmed the diagnosis of pemphigoid gestationis. Because the patient's complaints worsened we decided to deliver the baby, and as it was in transverse lie this was by caesarean section. A healthy son without rash was born. Although pemphigoid gestationis occurs in only 1 in 50,000 pregnancies, it is very important to be aware of this condition when a pregnant woman has itching. Not recognising pemphigoid gestationis may lead to inadequate maternal treatment and possible preterm birth and neonatal pemphigoid gestationis.

Clinical value of morphometric and DNA flow cytometric variables as independent predictors of survival in epithelial ovarian carcinoma: a 5-year follow-up study.

The aim of this follow-up study is to validate the clinical significance of quantitative morphometric and DNA flow cytometric variables as independent prognostic factors of overall survival and progression-free survival in epithelial ovarian carcinoma. Tumor samples were collected from 135 patients with epithelial ovarian carcinoma at 3 hospitals in the Netherlands. Evaluated clinico-pathologic variables were age, histologic subtype, differentiation grade, clinical stage [International Federation of Gynecology and Obstetrics (FIGO)], presence of ascites, serum CA-125, and the completeness of debulking surgery. Morphometry and DNA flow cytometric techniques were assessed on each tumor sample to determine the mitotic activity index (MAI), volume percentage epithelium, mean nuclear area (MNA), standard deviation of MNA (SD MNA), nuclear perimeter (NP), and DNA ploidy. Univariate analysis showed that differentiation grade, FIGO stage, presence of ascites, preoperative CA-125 levels, DNA ploidy, and MAI, NP, and MNA were of significant prognostic value. After multivariate analysis (using forward Cox proportional hazard analysis), only differentiation grade and FIGO stage remained significant. From this study, we can conclude that morphometry and DNA flow cytometry are not independent prognosticators and therefore have no clinical value in predicting prognosis in ovarian carcinoma.