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Biomedical subjects

R M Winston

Publications and source records attributed to R M Winston.

At least 145 records · Page 8Linked to original sources
PubMed1982

Microsurgery for tubal and ovarian disease.

The use of microsurgery has been responsible for improvements of various aspects of the management of tubal and ovarian disease. Microsurgery has not merely been a vital experimental tool in the study of tubal physiology and pathology, but has been of proven value in alleviating infertility following pelvic inflammatory disease and for reversal of sterilization. The most dramatic advance has been in the treatment of cornual damage but microsurgery also has a place for salpingostomy and for the preparation of the pelvis before attempts are made at egg recovery for in vitro fertilization.

Animals↗
PubMed1981

Progress in tubal surgery.

There is now established proof of the value of microscopic compared with conventional techniques in tubal surgery, to enable not only accurate anastomosis but also accurate dissection of adhesions to restore normal mobility and relations between tubes and ovaries. Microscopy has also highlighted the important need for adjunctive techniques such as wide exposure, careful handling of organs and peritoneum, low-power diathermy, the use of nonreactive suture material and proper peritoneal closure. All these techniques can and should always be used, not only in tubal reconstructive surgery but in all female pelvic surgery to protect the woman's future fertility. Use of the surgical microscope and details of the various tubal operations, including those for ectopic pregnancy and reversal of sterilization, have been described, together with an outline of research into future developments.

Adult↗
PubMed1981

Ovum capture and fertility following microsurgical fimbriectomy in the rabbit.

Microsurgical fimbriectomy with removal of the fimbria ovarica was performed on one side in 19 rabbits. The other tube was left intact as a control. In 10 animals the new ostium was left free, some distance from the ovary. In the remainder, the ostium was fixed to the ovarian capsule. Three animals with a fixed ostium developed mild hydrosalpinx even though the neostomy was patent. Of the remaining 16 rabbits, 15 conceived and became pregnant in both uterine horns. There was no significant difference between nidation index on the two sides. It is concluded that intact fimbriae with a fimbria ovarica are not essential for normal ovum capture. It is therefore suggested that methods for clinical salpingostomy may require re-evaluation.

Animals↗
PubMed1981

The evolution of experimentally induced hydrosalpinges in rabbits.

Damage to fallopian tubes caused by hydrosalpinges is a major reason for persisting infertility. We describe the mucosal changes that occur following induction of experimentally induced hydrosalpinges in 25 rabbits. Ampullary biopsies obtained at varying intervals were examined with light microscopy and scanning and transmission electron microscopy. Mucosal folds showed progressive atrophy. The epithelium was flattened. The population of ciliated cells decreased and, finally, deciliation became generalized. The morphology of nonciliated cells changed from an initial high content of granules of secretion to a final stage of vacuolated cytoplasm. Cell desquamation was common.

Animals↗
PubMed1980

Tubal lesions subsequent to sterilization and their relation to fertility after attempts at reversal.

Tubal biopsy specimens were obtained at the time of tubal anastomosis in 26 previously sterilized women. Scanning electron microscopy showed that half the patients had abnormalities of tubal mucosa, including loss of mucosal folds, deciliation, and polyposis. These pathologic conditions, the morphologic features of which we describe, significantly increase in incidence the longer the time after sterilization. Our evidence suggests that the sooner reversal is performed after sterilization the greater the change of a successful intrauterine pregnancy.

Adult↗
PubMed1980

Loupes or microscope for tubal anastomosis? An experimental study.

Standardized tubal anastomoses were performed alternatively using magnifying loupes or an operating microscope in 44 rabbits. The surgeon's personal assessment of the integrity of the anastomoses was subsequently compared with the histologic result and with pregnancies and nidation indices. After an initial learning period, the surgeon became equally satisfied with his intraoperative assessment of the anastomoses in both treatment groups. Healing was marginally better when the microscope was employed. Animals which had tubal anastomosis performed with the use of the microscope became pregnant in 81% of cases, whereas when the loupes were employed only 5% became pregnant. Measurement of the nidation index showed similar trends. It is concluded that the use of the microscope will offer superior results once the surgeon has gained limited experience with its use.

Animals↗
PubMed1977

Why 103 women asked for reversal of sterilisation.

Between 1975 and 1976 103 women requesting sterilisation reversal were interviewed at Hammersmith Hospital. Their average age at sterilisation was 26-7 years; 65 (63-1%) had been sterilised immediately after pregnancy, and many patients had previously used contraception inadequately when they were sterilised. When they had been sterilised 78 (75-7%) patients were unhappily married and remarriage was the chief reason for the request for reversal. Sexual dissatisfaction after sterilisation was common, but there was no obvious increase in menstrual disturbance. Thirty-nine (37-8%) patients had been sterilised by irreversible methods, and in only half the cases sterilised by tubal ligation were conditions technically suitable for reversal surgery. It therefore seems unwise to sterilise women under 30 particularly immediately after pregnancy or if their marriage is in jeopardy.

Adult↗
PubMed1977

Microsurgical tubocornual anastomosis for reversal of sterilisation.

11 of 16 patients had intrauterine pregnancies after microsurgical tubocornual anastomosis for reversal of sterilisation. This procedure has several important advantages over tubal reimplantation and may be of benefit in the treatment of infertile women with inflammatory blockage of the isthmus of the fallopian tube.

Evaluation Studies as Topic↗
PubMed1977

Influence of the central nervous system on fetal lung development. Experimental study.

Upper cervical cord injury was produced in fetal rabbits at 22-26 days' gestation. In 11 setuses with severe cord injury delivered at 28-29 days' gestation there was a median reduction in lung weight (expressed as a proportion of body weight) of 43% and a median reduction in estimated total lung DNA of 16% in comparison with paired operated littermates with intact cords. The hypoplastic lungs showed collapse on histology; if cord damage had been inflicted before 24 days' gestation there was retarded maturation. We conclude that the central nervous system plays a vital role in fetal lung growth and maturation, probably by maintenance of fetal respiratory movements.

Animals↗
PubMed1975

Microsurgical reanastomosis of rabbit oviduct and its functional and pathological sequelae.

A microsurgical technique for anastomosis of the oviduct is described using the rabbit as an animal model. A control group of five previously sterilized rabbits had both oviducts rejoined and all became pregnant. Another three groups of animals had a reanastomosis immediately after division of both oviducts. One oviduct was later removed for histological study and the animals were subsequently mated. Twenty-three out of 25 (92 per cent) conceived and delivered a normal litter after repair of the oviduct with very fine nylon sutures without postoperative splinting; only seven out of 15 (46.7 per cent) delivered after catgut sutures had been used without splinting and only 9 out of 20 (45 per cent) delivered when nylon sutures and prolonged splinting were associated with increased fibrosis, adhesion formation and poor healing of the anastomosis.

Animals↗