Biomedical subjects
Publications and source records attributed to R S Neuwirth.
MCA is a tissue adhesive which can be delivered transcervically to the Fallopian tubes by means of the FEMCEPT device. In the patients treated with this system, both prior to hysterectomy and on an ambulatory basis, there have been no significant complications or side effects. In the most recent series of ambulatory patients treated with the REMCEPT-MCA system, the bilateral tubal closure rate was 78%.
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New instrumentation and a new technique are described which simplify the hysteroscopic removal of the pedunculated submucous fibroid and make possible the partial removal of the sessile variety. Experience with the method is presented including the follow-up of four patients.
Two intratubal devices, one covered with a flock made from ethylene vinyl acetate and the other constructed of titanium-aluminum-vanadium alloy with an etched surface were evaluated after being placed in the Fallopian tubes of pigtail monkeys. In some instances, the devices were medicated with 10% silver nitrate or 50% quinacrine hydrochloride. The microflock device anchored in the tube mechanically, but there is no evidence that either the polymeric or metal alloy device formed an actual attachment with Fallopian tube epithelium. It is suggested that a mechanical design approach to ITDs might be more productive than one which assumes a tissue-device bond.
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An instrument is described with which it is possible to deliver low-viscosity material consistently to the interstitial and isthmic portions of the Fallopian tube in a blind fashion on an outpatient basis. Considerable care with instrument design has been taken in order to reduce potential complications and to ensure precision. The efficiency of this system in delivering a variety of dyes has been demonstrated in hysterectomy specimens with the use of laparoscopic control. We believe this system is simple to use and may be found acceptable for application by relatively unskilled personnel. If it produces a high degree of tubal closure without significant complications or pregnancies, it should be an important addition to the techniques for limiting family size and population growth.
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Hysteroscopy offers a new option in the diagnosis and management of submucus fibroids. The hysteroscopic excision of submucus fibroids in five cases is described. The problems and potentials of this approach are discussed.
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This review comprises 36 patients who were treated for Asherman's syndrome from 1968 to 1974 at the Sloane Hospital for Women. Of the 18 patients who later conceived only 6 had uncomplicated term deliveries. Four had premature deliveries resulting in neonatal death. Three had placenta accreta and postpartum hemorrhage, necessitating a cesarean hysterectomy in 1. Two patients required cesarean section for complications due to the syndrome, 2 had spontaneous abortion, and 1 had a cervical pregnancy requiring total hysterectomy. Only 10 babies survived. The incidence and severity of complications in conceptions following treatment for Asherman's syndrome is high, and the obstetrician must be prepared to manage them.
Twenty-one female rabbits underwent laparotomy and a standardized injury was produced on the right uterine horn and Fallopian tube. Following the injury eight animals were used as controls and thirteen were injected intrapertoneally with 50 ml. of 32 per cent dextran 70. Six weeks later the animals were killed and the adhesions graded. All control animals had dense adhersions of the injured areas to bowel or peritoneum. The dextran animals showed marked reduction in the extent and degree of adhesions. Possible mechanisms for these findings are discussed and the problems raised, by adhesion formation, to the gynecologist are reviewed.
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The combination of a growing need for improved contraceptive technology, plus the new advances in endoscopic equipment, have resulted in widespread use of laparoscopic sterilization throughout the world. Recent developments have succeeded in making hysteroscopy a reliable technique and it too has been quickly evaluated for a new, simpler female sterilization method. This work is still in progress and no reliable clinical method is yet available. However, the use of a chemical, such as methyl cyanoacrylate, delivered by hysteroscope, or possibily by a blind method, does seem to be most promising as a new clinical technique shortly.
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