Effect of Chitosan-assisted Combination of Laparoscope and Hysteroscope on the Levels of IFN-γ and ICAM-1 in Treatment of Infertility Caused by Obstruction of Fallopian Tubes.

This experiment was carried out to investigate the effect of combined treatment of tubal obstruction infertility with deacetylated chitosan and two microscopes on the levels of IFN-γ and ICAM-1. In this study, 100 infertile patients with fallopian tube obstruction who were treated in Jiangbei District Hospital of traditional Chinese medicine from January to August 2019 were divided into two groups according to the alternating grouping method, group A (50 cases) received combined surgery, and Group B (50 cases) received combined surgery and chitosan. The curative effect and postoperative pelvic adhesion of the two groups were analyzed, and the levels of IFN-γ, ICAM-1 and IL6(IL-6), laminin (LN), Transforming growth factor beta 1(TGF-ß1) and fibronectin (FN) were observed before and after treatment. Results showed that the total effective rate of Group B was higher than that of Group A (92. 00% vs 76. 00%). The incidence of pelvic adhesion was lower in Group A (4. 00% vs 16. 00%) (P < 0.05). The levels of IFN-γ, ICAM-1, IL-6, LN, FN and TGF-ß1 in Group B were significantly lower than those in group A (P < 0.05). In conclusion, the treatment of tubal obstruction infertility with combined deacetylated chitosan and biendoscopy is effective, which can reduce the levels of IFN-γ and ICAM-1, improve the expression of adhesion-related factors and reduce the occurrence of pelvic adhesion.

Health Care Provider Adherence to Surgical Guidelines for Risk-Reducing Salpingo-Oophorectomy.

OBJECTIVE: To evaluate health care provider adherence to the surgical protocol endorsed by the National Comprehensive Cancer Network and the American College of Obstetricians and Gynecologists at the time of risk-reducing salpingo-oophorectomy and compare adherence between gynecologic oncologists and obstetrician-gynecologists (ob-gyns). METHODS: In this multicenter retrospective cohort study, women were included if they had a pathogenic BRCA mutation and underwent risk-reducing salpingo-oophorectomy between 2011 and 2017. Adherence was defined as completing all of the following: collection of washings, complete resection of the fallopian tube, and performing the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) pathologic protocol. RESULTS: Of 290 patients who met inclusion criteria, 160 patients were treated by 18 gynecologic oncologists and 130 patients by 75 ob-gyns. Surgery was performed at 10 different hospitals throughout a single metropolitan area. Demographic and clinical characteristics were similar between groups. Overall, 199 cases (69%) were adherent to the surgical protocol. Gynecologic oncologists were more than twice as likely to fully adhere to the full surgical protocol as ob-gyns (91% vs 41%, P<.01). Specifically, gynecologic oncologists were more likely to resect the entire tube (99% vs 95%, P=.03), to have followed the SEE-FIM protocol (98% vs 82%, P<.01), and collect washings (94% vs 49%, P<.01). Complication rates did not differ between groups. Occult neoplasia was diagnosed in 11 patients (3.8%). The incidence of occult neoplasia was 6.3% in gynecologic oncology patients and 0.8% in obstetrics and gynecology patients (P=.03). CONCLUSION: Despite clear surgical guidelines, only two thirds of all health care providers were fully adherent to guidelines. Gynecologic oncologists were more likely to follow surgical guidelines compared with general ob-gyns and more likely to diagnose occult neoplasia despite similar patient populations. Rates of risk-reducing surgery will likely continue to increase as genetic testing becomes more widespread, highlighting the importance of health care provider education for this procedure. Centralized care or referral to subspecialists for risk-reducing salpingo-oophorectomy may be warranted.

Cost-effectiveness analysis of medical management versus conservative surgery for early tubal pregnancy.

STUDY QUESTION: Is conservative surgery (laparoscopic salpingotomy) cost-effective, using fertility as the endpoint compared with medical management (Methotrexate) in women with an early tubal pregnancy? SUMMARY ANSWER: Conservative surgery appeared slightly, but not statistically significantly, more effective than medical management but also more costly. WHAT IS KNOWN ALREADY: Women with an early tubal pregnancy treated with medical therapy (Methotrexate) or conservative surgery (laparoscopic salpingotomy) have comparable future intrauterine pregnancy rates by natural conception. Also, cost-minimisation studies have shown that medical therapy was less expensive than conservative surgery, but there is no cost-effectiveness study comparing these two treatments with fertility as the endpoint. STUDY DESIGN, SIZE, DURATION: A multicentre randomised controlled trial-based (DEMETER study) cost-effectiveness analysis of conservative surgery compared with medical therapy in women with an early tubal pregnancy was performed. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Included women had an ultrasound that confirmed an early tubal pregnancy. They were randomly allocated to conservative surgery or to medical therapy. The study clinical outcome was the intrauterine pregnancy rate. The payer's perspective was considered. Costs of conservative surgery and medical therapy were compared. The analysis was performed according to the intention-to-treat principle. Missing variables were imputed using the fully conditional method. To characterise uncertainty and to provide a summary of it, a non-parametric bootstrap resampling was executed and cost-effectiveness accessibility curves were constructed. MAIN RESULTS AND THE ROLE OF CHANCE: At baseline, costs per woman in the conservative surgery group and in the medical therapy group were 2627€ and 2463€, respectively, with a statistically significant difference of +164€. Conservative surgery resulted in a marginally, but non-significant (P = 0.46), higher future intrauterine pregnancy rate compared to medical therapy (0.700 vs. 0.649); leading, after bootstrap, to an incremental cost-effectiveness ratio of 1299€ (95% CI = -29 252; +29 919). Acceptability curves showed that conservative surgery could be considered a cost-effective treatment at a threshold of 3201€ for one additional future intrauterine pregnancy. LIMITATIONS, REASONS FOR CAUTION: A limitation was that monetary valuation was carried out using 2016 euros while the DEMETER study took place from 2005 to 2009. Anyway, the results would not have been very different given the marginal changes in the health insurance reimbursement tariffs during this period. WIDER IMPLICATIONS OF THE FINDINGS: Conservative surgery can be considered a cost-effective treatment, if the additional cost of 3201€ per additional future intrauterine pregnancy is an acceptable financial effort for the payer. STUDY FUNDING/COMPETING INTEREST(S): None. TRIAL REGISTRATION NUMBER: NCT 00137982.

Does bupivacaine in laparoscopic ports reduce postsurgery pain in tubal ligation by electrocoagulation? A randomized controlled trial.

BACKGROUND: Tubal ligation (TL) is the most popular method of permanent contraception. In order to reduce postoperative pain, different analgesic techniques have been proposed. The objective of this study was to compare the level of postoperative pain in patients submitted to TL with electrocoagulation, under general anesthesia, using bupivacaine infiltration vs. placebo in trocar ports. STUDY DESIGN: Consecutive patients scheduled for laparoscopic TL were randomized by sequenced coded envelopes to receive bupivacaine 0.5% (n=29) or placebo (n=24). Pain was blindly assessed at 15 min, 30 min, 120 min and 14 h postoperatively, by verbal analogue scale (VAS). Standard pain medications (morphine, dipyrone and sodium diclofenac) were prescribed for the subjects and compared between groups. RESULTS: No difference in pain assessment was found between bupivacaine and placebo groups at all times [median (25-75 quartiles)] (all p>.05): 15 min: 3 (1-6.3) vs. 4 (0-7); 30 min: 1.5 (0-4.3) vs. 2 (0-5); 2 h: 0 (0-0.5) vs. 0 (0-1); 14 h: 1 (0-4) vs. 0 (0-4); and for use of analgesics: dipyrone (g): 1 (0-1) vs. 1 (0-1); morphine (mg): 3 (0-3) vs. 3 (0-3.5); sodium diclofenac (mg): 0 (0-50) vs. 0 (0-50). CONCLUSION: The use of local injection of bupivacaine 0.5% in the trocar ports was not superior to placebo to reduce pain after laparoscopic TL with electrocoagulation under general anesthesia.

Neurolysis with alcohol for deep dyspareunia caused by trigger points in the uterosacral stumps.

Neurolysis with alcohol has been rarely used in gynecology. We describe a case of deep dyspareunia caused by trigger points in the uterosacral stumps that was successfully treated using alcohol neurolysis. We highlight the risk of voiding dysfunction after uterosacral neurolysis and recommend a 2-step procedure with unilateral injection of alcohol, 1 side at a time at an interval of 2 to 3 months.

[Electropulse therapy in the early postoperative rehabilitation period after reconstructive and plastic surgery on fallopian tubes].

The efficiency of sinusoidal modulated currents applied to the vaginosacral region in the early postoperative rehabilitation period after plastic and reconstructive surgery on the fallopian tubes was assessed in 30 women aged from 21 to 38 (mean 29.3+/-0.6) years. All of them had endoscopically diagnosed tubuloperitoneal infertility. Treatment with sinusoidally-modulated current in he early postoperative period had beneficial effect on the luteal phase of the menstrual cycle in 55.6%, on the hypothalamo-pituitary-ovarian axis in 23.3%, on hemodynamics in the small pelvis organs in 46.7%, on uterine tube activity in 36.7%, and on the reproductive function in 30% of the patients. These women suffered tubuloperitoneal infertility for less than 5 years and underwent grade I-II adhesive process in the absence of endoscopic signs of atrophic or hypetrophic changes in uterine tube walls.

The interval from surgery to chemotherapy in the treatment of advanced epithelial ovarian carcinoma.

BACKGROUND: To study the effect of the interval between surgery and the start of chemotherapy in the treatment of patients with advanced ovarian cancer. METHODS: We stratified patients according to the start of platinum-based chemotherapy in group 1 (within 4 weeks from surgery), group 2 (between 4 and 8 weeks) and group 3 (between 8 and 12 weeks). RESULTS: Three hundred and ninty-four stage III ovarian cancer patients were analysed. In the multivariate analysis there were no differences in survival according to the interval between surgery and chemotherapy among the three groups. The independent prognostic variables were type of procedure (p = 0.014), performance status (p = 0.040) and post-chemotherapy CA-125 (p < 0.0001). CONCLUSIONS: The interval between surgery and chemotherapy does not affect outcome.

[Effect of peloid therapy on morphofunctional changes of ovaries and oviducts caused by suturing (experimental study)]. / Vliianie peloidoterapii na morfofunktsional'nye izmeneniia iaichnikov i iaitsevodov pri nalozhenii shvov (éksperimental'noe issledovanie).

A course of ultraphonophoresis of the extract of high-polar lipids of sulfide mud attenuated inflammation of uterine appendages in rats caused by catgut suturing of the ovaries and oviducts. On postoperative day 75-120 peloid therapy resulted in degradation of the suture material and its replacement with connective tissue. The peloid limited postoperative intensification of follicular atresia, raised content of growing follicles and yellow bodies in the ovaries.

Preoperative autologous blood deposition in support of gynaecological repair procedures.

Autologous blood transfusion was evaluated in gynaecological repair procedures including abdominal/ vaginal hysterectomy with vaginal repair, post-hysterectomy vaginal suspension and fixation, uni/bilateral salpingo-oophorectomy with vaginal colpopexy and sling procedures. A total of 247 autologous units were collected from 95 patients at the regional blood centre with 1-3 units (mean 2-6 units) deposition from each patient. One hundred and ninety of all collected units were transfused (collection/transfusion ratio = 1.3). Of these patients, 86 (90.5%) received autologous blood; 12 (13%) being transfused with 1 unit, 44 (46%) with 2 units and 30 (32%) with 3 units. Two of these patients received additional homologous blood. The average preoperative haemoglobin level was 119 g L-1 and average post-operative haemoglobin level was 105 gL-1. The post-operative Hb level was used as a retrospective indicator for the requirement for blood transfusion. The results show that overall 75% of patients had post-operative haemoglobin levels < or = 110 and 33% of patients with Hb levels < 100, respectively. These results suggest that preoperative autologous blood deposition may be appropriate in the patients undergoing reconstructive gynaecological repair procedures since there was a high rate of usage of autologous blood and low post-operative haemoglobin in a significant proportion of patients.

Laparoscopically assisted gamete intrafallopian transfer with local anesthesia and intravenous sedation.

OBJECTIVE: To determine the length of procedure, length of recovery, patient tolerance, complications, and pregnancy rate (PR) of laparoscopically assisted GIFT performed during local anesthesia with i.v. sedation. DESIGN: A retrospective study. SETTING: Freestanding private ambulatory surgical center. PATIENTS: Thirty-one consecutive couples with infertility. INTERVENTIONS: Laparoscopically assisted GIFT during local anesthesia with i.v. sedation. MAIN OUTCOME MEASURES: Surgery time, recovery time, patient tolerance, PR, miscarriage rate, and complications. RESULTS: Cannulation of at least one fallopian tube was achieved successfully in all patients. The average surgery time was 64 +/- 12 minutes (mean +/- SD). The average recovery time was 92 +/- 30 minutes. The PR was 39% with an ongoing PR of 32%. There were no intraoperative or postoperative complications. CONCLUSION: Local anesthesia with IV sedation for GIFT using a two-puncture laparoscopic technique was well tolerated by the patients. Our ongoing PR of 32% compares very favorably with other series using general anesthesia.

[Tubal pregnancy: the experience of early rehabilitative treatment]. / Trubnaia beremennost': opyt rannego vosstanovitel'nogo lecheniia.

The surgical treatment for tubal pregnancy including laparoscopy and antibacterial therapy were combined in 30 females with early start (on postoperative day 1) of rehabilitation: psychotherapy, diet, therapeutic exercise, low-frequency magnetotherapy. Hysterosalpingography and dynamic dopplerography assessed the effect as good.

Twenty-two years of office and outpatient laparoscopy: current techniques and why I chose them.

Since 1972 I have introduced the following technical modifications in outpatient laparoscopy under local anesthesia to improve safety, economy, and patient acceptability: avoiding the insufflating needle and sharp trocar in favor of open abdominal entry, using the Hasson cannula; introducing room air for insufflation instead of nitrous oxide or carbon dioxide; using the Hulka clip in place of tubal coagulation; making a single-incision, open surgical entry through the central umbilical fossa in obese patients; and completing fascial penetration with a blunt hemostat or Kelly clamp to minimize the risk of bowel or vessel injury.

[Early rehabilitative physiotherapy following microsurgical operations on the fallopian tubes]. / Ranniaia vosstanovitel'naia fizioterapiia posle mikrokhirurgicheskikh operatsii na matochnykh trubakh.

Clinical data, the findings of biorhythmologic studies and the results of kymographic perturbation evidence the efficacy of early restorative treatment with the use of preformed physical factors early (starting from the first day) after reconstructive microsurgery. Such treatment accelerates the postoperative adaptation of the body, improves the anatomy and function of the uterine tubes and promises a more favorable prognosis for the reproductive function recovery. Criteria for the differentiated application of 3 physical factors are presented, intermittent low-frequency magnetic field, supersonic current, low-frequency monopolar rectangular pulses for electrostimulation of the uterine tubes.

[Early rehabilitative physiotherapy following the microsurgical reconstruction of the fallopian tubes (a clinico-chronobiological validation)]. / Ranniaia vosstanovitel'naia fizioterapiia posle mikrokhirurgicheskoi rekonstruktsii matochnykh trub (kliniko-khronobiologicheskoe obosnovanie).

Three preformed physical factors (low-frequency alternating magnetic field, supersonic frequency current, low-frequency monopolar square-wave impulses for electrostimulation of the uterine tubes) were tested in aftercare following plastic microsurgery in gynecology. The treatment can be started as early as postoperative day 1. The criteria of the differential choice of the modalities have been developed. The use of the above physiotherapy was found valid.

[Pain syndrome after gynecological operations]. / Bolevoi sindrom posle ginekologicheskikh operatsii.

The structure of the pain syndrome was studied in 110 patients on day 2 after surgery. A total of 76 parameters ware analyzed by 8 signs. Different combinations of the pain parameters, a negligible variability of the parameters of the pain intensity, depth of its site, and type, as well as the subjective sensations of the patients were distinguished, related to the patients' psychologic type. Opiate analgesia was associated with polymorphism of the pain syndrome. Transcutaneous electroanalgesia was sufficiently effective, promoting a narrowing of the range of pain parameters.

[Significance of prognostic factors in the treatment of tuboperitoneal infertility]. / Znachenie prognosticheskikh faktorov v lechenii trubnoperitoneal'nogo besplodiia.

The results of microsurgical treatment for tubo-peritoneal infertility are reported in 78 patients. Neosalpingostomy, combined with salpingo-ovariolysis, was performed in 51 patients, fimbriolysis and fimbrioplasty, in 8, tubal anastomosis in 7, and combined operations, in 12. Anatomical and functional assessment of the postoperative tubes was made using roentgeno-television hysterosalpingography, tubal insufflation and dynamic scintigraphy. Postoperative rehabilitation was supplemented by physical factors affecting tubal motility (supratonic frequency currents, tubal electrostimulation) with regard to the type of functional tubal disorder. Tubal patency was regained in 74.4%, and reproductive capacity, in 20.5% of the patients.

Esterilización de la mujer por vía endoscópica con anestesia local. 2 000 casos realizados en Guantánamo / Endoscopic female sterilization with local anesthesia: 2 000 cases performed in Guantanamo

Se le realizó esterilización por vía endoscópica con anestesia local a 2 000 pacientes femeninas de la provincia de Guantánamo y el método de mostró ser sencillo, eficaz, seguro y económico. Además puede practicarse en cualquier lugar de nuestro país con los recursos mínimos necesarios. En el grupo de edad de 15 a 29 años se esterilizaron 804 pacientes, en el de 30 a 44 años, 1 180 y hubo 16, que se esterilizaron con más de 45 años. Ninguna paciente de esta serie ha quedado embarazada después de la electrocoagulación de las trompas, solamente fue necesario realizar laparotomía a 3 pacientes debido a complicaciones sépticas. El resto de las complicaciones fueron leves y resueltas con tratamiento médico. este proceder constituye el método de elección para la esterilización de la mujer en nuestra provincia. Económicamente la esterilización por vía endoscópica proporcionó un ahorro de aproximadamente $930,000 en los 2 000 casos de esta serie

Esterilización de la mujer por vía endoscópica con anestesia local: 2 000 casos realizados en Guantánamo / Endoscopic female sterilization with local anesthesia: 2 000 cases performed in Guantanamo

Se le realizó esterilización por vía endoscópica con anestesia local a 2 000 pacientes femeninas de la provincia de Guantánamo y el método de mostró ser sencillo, eficaz, seguro y económico. Además puede practicarse en cualquier lugar de nuestro país con los recursos mínimos necesarios. En el grupo de edad de 15 a 29 años se esterilizaron 804 pacientes, en el de 30 a 44 años, 1 180 y hubo 16, que se esterilizaron con más de 45 años. Ninguna paciente de esta serie ha quedado embarazada después de la electrocoagulación de las trompas, solamente fue necesario realizar laparotomía a 3 pacientes debido a complicaciones sépticas. El resto de las complicaciones fueron leves y resueltas con tratamiento médico. este proceder constituye el método de elección para la esterilización de la mujer en nuestra provincia. Económicamente la esterilización por vía endoscópica proporcionó un ahorro de aproximadamente $930,000 en los 2 000 casos de esta serie