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Biomedical subjects

S G Kaali

Publications and source records attributed to S G Kaali.

At least 19 recordsLinked to original sources
PubMed2002

Five years experiences with microinjection of testicular spermatozoa into oocytes in Hungary.

The aim of the study was to summarize our five years experience (1996-2000) of testicular spermatozoa for intracytoplasmic sperm injection in Hungary. The influence of sperm count, maternal age, number of transferred embryos, and application of assisted hatching on outcome was investigated. Testicular spermatozoa were retrieved by microsurgical testicular sperm extraction. Samples were classified depending on the number of spermatozoa. Indication for testicular sperm extraction in conjunction with intracytoplasmic sperm injection was severe azoospermia or azoospermia combined with tubal origin infertility. Ovarian stimulation was carried out using an ultrashort protocol with GnRH agonist and gonadotrophin. Intracytoplasmic sperm injection was performed without PVP. Embryos were cultured for 48 or 72 h before embryo transfer. Indications for assisted hatching included elevated maternal age, increased zona thickness or at least two previous unsuccessful IVF cycles. Testicular spermatozoa were successfully retrieved in 218 out of 273 cases. Extreme low sperm count was found more frequently in cases of nonobstructive azoospermia. No significant differences were observed in fertilization rate (61.1% vs. 51.7%) or clinical pregnancy rate (29.0% vs. 26.7%) between patients with obstructive or nonobstructive azoospermia. Maternal age, number of transferred embryos and application of assisted hatching had a significant effect on outcome. A total of 55 clinical pregnancies were achieved, including 14 sets of twins, three sets of triplets and two sets of quadruplets. It is concluded that testicular sperm extraction is an efficient way of obtaining testicular spermatozoa, allowing not only successful fertilization by ICSI, but also freezing of testicular spermatozoa for use in subsequent cycles.

Female↗
PubMed2001

Seasonal influences on in vitro fertilization and embryo transfer.

PURPOSE: The study was aimed to investigate the influence of time factors (day, week, month) on pregnancy rates and in vitro fertilization (IVF) and embryo transfer (ET) parameters. METHODS: 8,184 IVF-ET cycles, taking place in two IVF centers from 1992 to 1999, were analyzed. Multiple logistic and linear regression methods were performed as statistical analyses. RESULTS: Oocyte pickup on Tuesdays achieved a significantly higher mean number of oocytes (median: 7) and the highest pregnancy rate (PR) (33.4%) per ET There was a significant variation over the year, with the lowest PR/ET in July (25.71%) and the highest in December (35.5%). Concerning outcomes, the age factor and the number of embryos transferred had the highest significant (p < 0.0001) influence. CONCLUSIONS: The observed weekly rhythm for oocyte pick-ups is certainly due to preprogrammed ovarian stimulation used in our IVF programs. Age as well as the number of embryos transferred are the main influencing factors on a positive outcome and more predictive than seasonal aspects.

Adult↗
PubMed1998

Establishment of primary port without insertion of a sharp trocar.

A new method allows a primary laparoscopic port to be established without inserting a Veress needle or sharp cannula. In this prospective case series of 348 consecutive healthy women undergoing elective laparoscopic sterilization, the laparoscope was complemented with an access cannula that enabled the surgeon to guide it directly into the abdominal cavity.

Adult↗
PubMed1997

Modified open laparoscopy through placement of an optical surgical obturator.

OBJECTIVE: To describe a new technique for open laparoscopy. DESIGN: Prospective case series. SETTING: Ambulatory surgical unit. PATIENT(S): Fifty-six women undergoing laparoscopic sterilization. INTERVENTION(S): Intra-abdominal placement of an optical surgical obturator. MAIN OUTCOME MEASURE(S): Evaluation of surgical technique. RESULT(S): The technique was completed successfully in all cases. CONCLUSION(S): This new surgical approach may assist surgeons in avoiding inadvertent injuries.

Female↗
PubMed1994

Comparison of visual and tactile localization of the trocar tip during abdominal entry.

We attempted to determine whether video-aided visual imaging during laparoscopic insertion of the trocar would improve the surgeon's ability to localize the sharp penetrating tip of the instrument. A newly described, visually directed laparoscopic trocar was inserted in 184 subjects to correlate visual localization of the tip with the accuracy of the conventional tactile sensory approach. In 164 of the 184 cases the fascia was recognized visually at the same time that the surgeon acknowledged tactile resistance. However, partial intraabdominal penetration was noted in 102 of these cases just before the anticipated loss of resistance could be felt manually. More important, in 20 women there was no subjective manual confirmation of the tip location by the time intraabdominal placement of the trocar was confirmed visually. In this limited series there were no multiple insertions or complications under visually directed trocar entry. Video-aided direct visualization improves the surgeon's ability to localize the tip of the trocar throughout the insertion. It may help the surgeon to recognize and possibly avoid some inadvertent distant intraabdominal organ injuries.

Abdominal Muscles↗
PubMed1993

Introduction of the Opti-trocar.

To deal with the problems associated with blind trocar insertion for conventional laparoscopy, an image-receivable and light-transmissible, optically clear trocar tip was conceived. Consultation with persons with optical engineering expertise resulted in the design of a prototype instrument for clinical testing. Results of a feasibility study conducted in 150 subjects indicate that a significant advance in the performance of laparoscopic surgery is possible with wide-scale implementation of this innovation. Video-aided continuous visual imaging during trocar insertion provides identification of distinct layers of the abdominal wall and helps ensure proper intraabdominal placement without the need for minilaparotomy or open laparoscopy.

Equipment Design↗
PubMed1992

Incidence of bowel injury due to dense adhesions at the sight of direct trocar insertion.

A retrospective review of 4,532 outpatient laparoscopic procedures was conducted to determine the frequency of dense bowel adhesions at the level of the umbilicus. The umbilicus is the classical site of entry for the laparoscopic trocar. Using direct trocar insertion in all cases we encountered four bowel injuries. Bowel adhesion to the insertion site was noted in one case.

Female↗
PubMed1990

Direct trocar insertion vs. Verres needle use for laparoscopic sterilization.

A randomized, prospective trial was designed to compare direct trocar insertion with prior peritoneal insufflation with a Verres needle for laparoscopic tubal sterilization. Direct trocar insertion resulted in fewer instrument insertions (21.8% vs. 7.8%) and use of smaller volumes of CO2 (2.67 vs. 2.32 L). Direct trocar use resulted in a decrease in operating time from 9 minutes, 40 seconds in the needle group to 7 minutes, 30 seconds in the trocar group. Minor omental injuries occurred in a small percentage of each group, while serious complications occurred once in each group.

Adult↗
PubMed1990

Updated screening protocol for abortion services.

We performed 2976 first-trimester abortions at our outpatient center in 1986. In 16 cases (0.54%), products of conception could not be confirmed histologically, although history, bimanual pelvic examination, and urine pregnancy test were suggestive of pregnancy. In 1987-1988, we prospectively evaluated 6689 women presenting for first-trimester abortions. Adding sonography and a semiquantitative serum hCG test to our earlier protocol, we were able to date and locate accurately 6510 pregnancies (97.3%) at the first visit. The remaining 179 patients (2.7%) required only one follow-up visit for final evaluation. This protocol reduced the number of visits for accurate evaluation of pregnancy and eliminated the risk of unnecessary curettage and unplanned second-trimester abortions.

Abortion, Induced↗
PubMed1989

[Vaginal ultrasonography: a new testing method in obstetrics and gynecology].

Transvaginal sonography represents a new tool for the gynecological diagnosis and decision making. The authors present theoretical and practical aspects of transvaginal sonography with special emphasis on the 6.5 MHz vaginal probe. Based on one thousand one hundred and eight examinations it is obvious that this procedure is valuable in diagnostic algorithm of ectopic pregnancy and to follow follicular growth, as well as ultrasound guided oocyte retrieval.

Congenital Abnormalities↗
PubMed1989

The frequency and management of uterine perforations during first-trimester abortions.

The frequency and management of uterine perforation during first-trimester abortions remain a matter of continuing debate among gynecologists. The rate of uterine perforations was 1.3/1000 procedures (eight cases) in 6408 women undergoing first-trimester abortions at our clinic. We also performed 706 first-trimester abortions at the time of laparoscopic sterilization. Two perforations (2.8/1000 procedures) were reported before laparoscopy. Twelve (15.6/1000 procedures) unsuspected perforations were discovered during direct laparoscopic visualization. This represents a 19.8/1000 procedure rate of perforation (14 cases). All 22 patients with perforations were managed conservatively, and no immediate or late complications were noted. Our data suggest that the true incidence of uterine perforations is significantly underestimated and serious complications caused by perforations are rare. Conservative therapy is recommended rather than early surgical intervention.

Abortion, Induced↗
PubMed1989

Availability of donated oocytes from an ambulatory sterilization program.

An oocyte donor program was established at the Women's Medical Pavilion, Dobbs Ferry, New York, in 1987 for women lacking normal ovarian function. The oocytes were donated voluntarily in stimulated cycles by women undergoing laparoscopic sterilization. If the donors agreed to use ovulation-induction agents and be monitored, they were compensated for their time and inconvenience. Between Nov 15, 1987, and Feb 15, 1988, 194 laparoscopic sterilizations were performed. Only 41 women (21%) met certain of the eligibility criteria. Of the remaining group, only five (12%) agreed to participate. The preliminary results suggest that tubal ligation patients are reluctant to donate oocytes despite enthusiastic counseling, the relatively small risks involved and offers of financial compensation.

Adult↗
PubMed1989

Laparoscopic sterilization combined with dilation and evacuation up to 18 weeks' gestation.

First-trimester suction curettage abortion performed at the time of laparoscopic sterilization does not increase the morbidity or failure rate of either procedure. No studies have been done to determine the safety of laparoscopic sterilization in association with midtrimester pregnancy termination by dilation and evacuation. Between Jan 1, 1987, and Feb 1, 1988, we performed 21 laparoscopic sterilizations at the time of second-trimester terminations of pregnancy. There were no failed procedures or postoperative complications. With proper instrumentation and surgical skill, laparoscopic sterilization can be performed in this group of patients.

Abortion, Induced↗
PubMed1989

Association of previous abdominal surgery and significant adhesions in laparoscopic sterilization patients.

Many surgeons believe that women who have undergone laparotomy are not good candidates for laparoscopic sterilization. Many of those women are admitted for minilaparotomy. However, women without previous surgery can also have adhesions. We compared the incidence of significant adhesions in women with and without histories of abdominal surgery. We also examined the outcomes in each group after 955 laparoscopic sterilizations. Two hundred sixty-three women (28%) had had previous surgery. Of them, 61 (23%) displayed significant adhesions. Of the remaining 692 patients, 19 (2.7%) had significant adhesions. There were no major complications in either group. Thus, a history of previous abdominal or pelvic procedures increased the risk of significant adhesion formation nearly tenfold. Since no major complications occurred in those women, we conclude that while such patients are at increased risk, that risk is not inordinate and does not justify the routine use of minilaparotomy.

Abdomen↗
PubMed1988

Direct insertion of the laparoscopic trocar after an earlier laparotomy.

Direct insertion of the laparoscopic trocar without the aid of a prior pneumoperitoneum has been described previously. Prior laparotomy has been cited as a contraindication to this technique. At our free-standing ambulatory surgical unit, 1,670 consecutive laparoscopies utilizing direct insertion of the trocar were performed during a four-year period. Four hundred sixteen women had had previous abdominal surgery. One bowel injury occurred in this group. A patient without prior surgery sustained an intraabdominal laceration requiring further surgery and hospitalization. Based on this experience, we do not find previous abdominal surgery to be a contraindication to the use of direct insertion of the laparoscopic trocar.

Abdomen↗