Pathophysiology and management of proximal tubal blockage.

OBJECTIVE: To review the physiology, pathology, and treatment of proximal tubal disease. DATA IDENTIFICATION: Relevant reports on the pathophysiology of proximal tubal disease were reviewed. All studies in English of microsurgery and macrosurgery, and of radiographic and hysteroscopic cannulation in women with proximal tubal blockage were identified through MEDLINE searches. STUDY SELECTION: All studies of therapy for proximal blockage that included pregnancy rates were considered. Series of sterilization reversals, series of unilateral or combined procedures, and series in which the location of tubal blockage was not given were excluded from the data analyses. DATA ANALYSIS: Raw data were assessed for homogeneity, then standardized and pooled. Total and ongoing pregnancy rates after microsurgery and macrosurgery, as well as radiographic and hysteroscopic transcervical cannulation, were compared by the chi2 test. Relative risks for total and ongoing pregnancies were calculated for all treatment methods. RESULT(S): This meta-analysis suggests that, overall, microsurgical anastomosis results in higher total and ongoing pregnancy rates than macrosurgery or radiographic tubal cannulation. However, pregnancy rates in selected series of transcervical tubal cannulation are similar to those reported for microsurgery. CONCLUSION(S): Ongoing intrauterine pregnancy rates near 50% can be achieved in patients with proximal blockage of the fallopian tube. Selective salpingography and transcervical cannulation under fluoroscopic guidance are effective at establishing patency in appropriately selected patients and are less invasive and costly than the surgical alternatives.

[Radiodiagnosis in obstetrics and gynecology]. / Radiodiagnostiek in de verloskunde en de gynaecologie.

Immediately after Röntgen's discovery, people started trying to find uses for the new rays in gynecology and obstetrics. Although the first reports date from 1896-97, even in the 1920's there were textbooks to be found without any mention of the use of radiology in both areas of medicine. The availability of reliable contrast media led to the development of new imaging techniques and to the golden age of obstetrical and gynecological radiology in the 1930-1970 period. Nowadays ultrasound has replaced most conventional techniques while MRI is becoming more and more important. A historical overview of the different radiological techniques is provided.

Histerossalpingografia: análise de 473 exames alterados / Hysterosalpingography: analysis of 473 abnormal examinations

Foram revisados 1.200 prontuarios de pacientes atendidos no setor de esterilidade conjugal da Faculdade de Ciências Médicas da Unicamp com queixa de esterilidade, no período de julho de 1974 a dezembro de 1981, de onde foram analisados os laudos de 473 histerossalpingografias (HSG) com resultados anormais, para avaliar incidencia e alteraçöes mais frequentes. As principais alteraçöes encontradas foram: fatores tuboperitoneais em 91% dos exames, alteraçöes de cavidade uterina em 17,4% e cervicais em 6,3% dos exames. Os exames mostraram a grande incidencia de alteraçöes tuboperitoneais como causa de esterilidade conjugal em um serviço universitario que atende a uma populaçäo predominantemente de baixa renda.

[New advances in gynecologic diagnosis and therapy]. / Nuovi avanzamenti nella diagnostica e terapia ginecologica.

PIP: Over the last 30 years, enormous advances have been made in all fields of gynecology. Gynecology made its 1st real advances in the late 1800s. The 1st uterine endoscopy goes back to the late 1800s; it used an external illumination endoscope, however, the results were not impressive until an endoscope patterned after an urethroscope was used. In 1924, the problem of visualization of the uterine cavity was resolved with hysterosalpingography. Celioscopy was introduced in the early 1900s, bringing the female genital region into view by way of endoperitoneal infusion of gas. Cytomonology came into play in 1917 for the study of hormonal variations, followed by cytodiagnosis of cancer. The examination of cervical mucus was studied as far back as 1837 and is used to determine the phases of the hormonal cycle. Hormonology goes back to the 19th century. Since its inception many advances have been made, including exploration of the entire hypothalamo-hypophysis-ovarian axis, and even metabolism. The 1st endocavitary applications of radium for adenocarcinomas of the uterus go back to 1903, which led to a much more precise technique known as cavitary curietherapy. Now other radioactive materials usually take the place of radium, but the results have been quite good. There have also been great advances regarding contraception. Among these are the oral method (the pill); IUDs, either copper or progesterone; and also more permanent techniques such as vasectomy and tubal ligation. In addition, surgical techniques have improved for the correction of malformations in the genital region and for curing vulvar cancer, malignant ovarian tumors, and uterine cancer.^ieng