[Colorectal liver metastases resected with safe margin achieved by tissuelink monopolar floating ball]. / Colorectal liver metastases resected with safe margin achieved by tissuelink monopolar floating ball.

BACKGROUND: Nowadays many technological devices are present in hepatic surgery to permit safer liver resections. Main purpose is decrease the intraoperative blood loss. The aim of this study is to analyze our initial experience in hepatic resections for liver metastasis using the new water-cooled, high-density, monopolar device, the Tissuelink Monopolar Floating Ball and Dissecting Sealer (Tissuelink Medical, Inc., Dover, NH). MATERIALS AND METHODS: We analyzed patients who underwent hepatic surgery for metastases from colorectal cancer between January 2003 and December 2004. Sex, age, type of surgical procedure, duration of the surgical procedure, blood loss, use of vascular clamping of the liver, length of hospital stay, morbidity, and mortality were analyzed. RESULTS: Three liver resection, one segmentectomy and two limited resections were performed with the use of these new devices. In one case the devices was used to increase safe free margin of hepatic resection. Average blood loss was 150 ml (range, 50 to 300 ml). No mortality or morbidity were recorder. CONCLUSIONS: In conclusion, this new device permits a bloodless liver resection avoiding vascular clamping. In plus the effect of radiofrequency waves can be useful to enlarge free resection border in patients submitted to hepatic resection without macroscopically safe margins. Prospective randomized studies are needed in order to establish the effective usefulness.

Successful gamete intrafallopian transfer following failed artificial insemination by donor: evidence for a defect in gamete transport?

Gamete intrafallopian transfer (GIFT) was offered as an alternative treatment to 48 women who failed to conceive after artificial insemination with donor semen (AID) in numerous attempts (9 to 24 cycles). The evaluation of these women showed no major cause of infertility as evidenced by normal endocrine, cervical, uterine, and tubal factor studies. Their partners were either azoospermic or severely oligoasthenospermic. During the GIFT cycle, follicular development was induced with (1) clomiphene citrate (days 3 to 7) plus human menopausal gonadotropins (hMG) from day 6 on or (2) human follicle-stimulating hormone (days 3 to 4) plus hMG (day 5 on), until ultrasound revealed 2 follicles 16 mm and serum estradiol (E2) was greater than 700 pg/ml. Human chorionic gonadotropin (hCG) 10,000 IU was administered, and 36 hours later follicular aspiration was performed. One to three oocytes and 100,000 motile sperm were transferred to each fallopian tube through the fimbria via laparoscopy or minilaparotomy. Twenty-seven clinical pregnancies were achieved (56%) per GIFT cycle. Eight miscarriages occurred during the first trimester (29% of all pregnancies), whereas no ectopic pregnancies were observed. These data conclusively show the value of the GIFT procedure in the treatment of cases with failed AID.

Gamete intrafallopian transfer: different routes of transfer.

The Authors report their own experience and results using different approaches to oocyte pick-up and gamete transfer for gamete intrafallopian transfer (GIFT). The overall pregnancy rate of GIFT is 35.86% (66 pregnancies on 184 cases of GIFT). The Protocol I (Laparoscopic oocyte retrieval and gamete transfer) is presently the more used and gives better clinical results (pregnancy rate of 37.7%); in the Author's opinion, the protocols III (echographic pick-up + IVF + laparoscopic delayed zygote intrafallopian transfer (ZIFT), and VII (Laparotomic pick-up and transfer) are interesting complementary techniques for GIFT.

Direct intraperitoneal insemination (DIPI) for the treatment of refractory infertility unrelated to female organic pelvic disease.

344 couples with infertility unrelated to female organic pelvic disease underwent Direct Intraperitoneal Insemination (DIPI) for a total of a 429 DIPI cycles. Pregnancy per couple was 16.5% and per DIPI cycle 13.2%. DIPI was particularly effective in cases of infertility due to cervical mucus insufficiency and unexplained infertility with results respectively of 33.7% and 30.4% per couple and 30.7% and 28.7% per DIPI cycle. On the contrary, the results regarding male subfertility were 12.5% per couple and 10.5% per DIPI cycle. A significant difference was found (X2 A = 16.48, p less than 0.001) between these results and those of the group composed of cases of cervical mucus insufficiency and unexplained infertility. In cases of antisperm iso- and autoimmunization the results were on the whole poor, and were in any case influenced by corticosteroid pretreatment. The Pellet Swim-up Test (PST) proved to be a good prognostic sign for success of DIPI, since a significant difference was found between the PST group greater than or equal to 1.5 X 10(6)/ml (pregnancy per couple was 19.7% and per DIPI cycle 17.2%) and PST group less than 1.5 X 10(6)/ml (pregnancy per couple was 6.8% and per DIPI cycle was 4.5%) (X2 = 11.4. P less than 0.001).

IVF/ET and GIFT in andrology.

Improvement in both in-vitro fertilization/embryo transfer (IVF/ET) and gamete intra-Fallopian transfer (GIFT) procedures have led to a progressive extension of their use far beyond the indications represented by tubal problems. One of the most important examples of this is in the field of male infertility. Some researchers claim that IVF/ET is more efficient on the basis of the 'fertilization evidence', while others prefer the GIFT technique, stressing that as its results are clearly so much better that it should be used in all cases.

An ELISA for antisperm antibody detection in serum: comparison with TAT and SIT in serum, with MAR-test, immunobead-test and TAT in semen and with micro-SIT in cervical mucus.

16 couples belonging to couples with negative or doubtful PCT were selected according to the presence of antisperm immunization. 12 patients, 5 male and 7 female, showed both localized and generalized immunization. The former was diagnosed by means of a positive IgG MAR-Test, direct IgG Immunobead-Test, direct IgG Immunobead-Test and seminal TAT in the male patients, and Micro-SIT in the cervical mucus of the female patients, while for the latter there was simultaneous positivity of both serum TAT and SIT, except for two cases, in which the SIT only was positive. The 4 remaining patients, 2 male and 2 female, did not show any signs of antisperm immunization. The evaluation of the antisperm antibodies by means of the ZER ELISA Antisperm Kit in the serum of the 16 patients examined showed that there were no significant statistical differences between the serum TAT and the SIT. The former showed agreement of the results in 93.75% of the cases, and the latter in 81.25%. A strict correlation was observed between the ELISA for serum antisperm antibodies (ELISA-AS-Abs) and the local immunitary situation, with agreement in 93.75% of the cases. The ELISA-AS-Abs seems to bring the advantage of eliminating the need for fresh semen for antibody titration and also means that there is no subjective interference with the evaluation of the results.

Intraperitoneal insemination (IPI) in couples with infertility unrelated to female organic pelvic disease.

6 couples, (4 with male subfertility, 1 with cervical mucus insufficiency, 1 with unexplained infertility), underwent direct intraperitoneal insemination of capacitated sperm in combination with induced and timed ovulation. 2 pregnancies were obtained, both of them in couples with male subfertility.

Gamete intrafallopian transfer in the treatment of infertility: the first series at the University of Palermo.

Twenty-six couples with unexplained infertility (UI), nine women with repeated failures of artificial insemination with donor semen (AID), three women with mild endometriosis, three with periadnexal adhesions, one with hostile (not immunologic) cervical mucus, and one couple in which the male partner was affected by asthenospermia were treated by the gamete intrafallopian transfer (GIFT) technique. Three different protocols for controlled ovarian hyperstimulation were used, and an adequate follicular growth and oocyte maturation were achieved in all cases. Seventeen pregnancies were obtained, for a global pregnancy rate of 38.6%. Two pregnancies (11.7%) ended in clinical abortions, and one (5.8%) was a tubal pregnancy. Of the ongoing pregnancies, one is twin and two are triplets. Seven pregnancies (six ongoing, one abortion) were obtained in the UI group (26%), six (all ongoing) in the failed AID group (66.6%), two continuing pregnancies in the three patients with endometriosis (66.6%); the tubal pregnancy and one clinical abortion occurred in the group with adnexal adhesions. No pregnancies were obtained in the patient with hostile cervical mucus and in the couple with infertility presumably due to poor semen. These encouraging results and the simplicity of the technique suggest that GIFT could be an effective approach that could be programmed during a well-timed laparoscopy where persistent infertility exists in association with apparently normal fallopian tubes.

One year's experience with the GIFT method.

From January 1985 to December 1985 we have performed 83 GIFTS for various indications such as unexplained infertility, immunological problems, endometriosis, male factor, fimbrial pathology. In 82 women out of 83, oocytes and sperm have been transferred and 31 pregnancies (37.8%) have been obtained. Twelve women have delivered 17 babies; 11 pregnancies are ongoing, 7 have been interrupted by an abortion and 1 by a tubal pregnancy. The present and future roles of GIFT in the treatment of infertility is discussed.

Gamete intra-fallopian transfer (GIFT): a new technique for the treatment of unexplained infertility.

The Gamete Intrafallopian Transfer (GIFT) was carried out in 12 couples with unexplained infertility, in 2 cases with infertility associated with mild endometriosis, in 1 case of hostile mucus and 3 cases in which phymosis of the ampulla and/or periadnexal adhesions were previously identified. In 7 couples GIFT was carried out after several AID cycles for husband azoospermia or severe oligospermia. Three different protocols were used for the controlled ovarian hyperstimulation. In all cases an adequate follicular growth was obtained and mature oocytes were recovered. At first attempt 12 ongoing pregnancies (1 triplet, 1 twin) were obtained with a present pregnancy rate of 48%.

In vitro fertilization as an out-patient procedure.

A new, non invasive method for IVF/ET is discussed. Twenty infertile patients were involved in an outpatient procedure; less risk for them, because of local anaesthesia and low costs for the clinic are the most remarkable advantages of this procedure. Four normal ongoing pregnancies followed this treatment.

Monitoring of follicular growth for I.V.F.-E.T. programme: the value of E2 assay and echography.

The possibility of a correlation between biological (E2) and morphological (U.S.) parameters, in view of obtaining a correct prevision of follicular maturation and ovulation is discussed. In this study normal patients with a tubal sterility were treated with clomiphene citrate and clomiphene plus H.M.G. The statistical analysis was performed by means of the linear correlation (r) and the relative test of significance (Student T.). The data obtained in this study show that notwithstanding that the rising plasma concentration of E2, which precedes ovulation, is the first and more constant marker of follicular maturation, because of its wide range of variability its usefulness in prediction of ovulation is nearly limited to spontaneous cycles. In fact in stimulated cycles the rising plasma-E2 concentration is rather an independent variable regarding the growth of single follicles (F.D.).

[Arterial hypertension. Medico-social and medico-legal problems]. / L'ipertensione arteriosa. Problemi medico-sociali e medico-legali.

After a brief mention of the incidence and clinical signs of hypertensive disease, stress is laid on certain social and legal medicine aspects relating above all to various prevention and medical education intervention and to rehabilitation. For an evaluation of the working capacity of the hypertense, a classification is proposed which can also be utilised for the purposes of judging pensionable invalidity as well as for assessing the risk increase coefficient for life insurance. The higher mortality percentage in relation to the seriousness of the diseases is pointed out.