[Intra-uterine pregnancy brought to term after preservation of a pregnant single fallopian tube].
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BACKGROUND AND OBJECTIVE: To evaluate the effect of changed criteria for sperm count and morphology when performing fallopian tube sperm perfusion (FSP) in unexplained infertility. PATIENTS AND METHODS: We report on a longitudinal study in which two periods of insemination cycles are compared. One hundred and eighty-three couples who started 361 stimulation cycles intended for FSP were included in the first period and 190 couples starting 303 cycles in the second period. The sperm requirement in the first study period was at least 7 million sperm in the prepared test sample. The FSP cycle included downregulation, controlled ovarian hyperstimulation (COH), ovulation induction and intrauterine and intrafallopian tube insemination using a sperm suspension of 3 mL volume. To avoid high-order multiple pregnancies, cycles at risk were converted to in vitro fertilization (IVF). Based on the results from the first period, sperm requirements were lowered to a sperm count of 3 million and at least 5% normal morphology according to strict criteria. RESULTS: FSP was performed in 51% and 60% of started cycles during the two periods with similar pregnancy (24% and 23%) and birth (15% and 19%) rates. Neither sperm count nor morphology above the requirements affected pregnancy rates. IVF-converted, completed cycles reached equal pregnancy (41%) and delivery (32%) rates in both periods. Multiple pregnancy rates were higher after IVF (38%) than after FSP (24%). CONCLUSION: The lowered requirements for sperm count and morphology have not impaired pregnancy results after FSP. Patients who either completed an FSP cycle or had their cycle converted to IVF were all at high risk of multiple pregnancy.
To study the efficacy of topically administered thrombin as an adjuvant in tubal microsurgery, 24 rabbits underwent a 1-cm resection and microsurgical anastomosis of both fallopian tubes and were randomized to either thrombin or cautery for hemostasis. Ovarian wedge biopsies were done on the left ovary. The animals were mated 4 to 5 weeks postoperatively with a buck of proven fertility. They were killed at 2 to 3 weeks' gestation to note the number of fetuses per patent tube and presence or absence of pelvic adhesions. There was no effect of topical thrombin on the crude pregnancy rate but it was associated with a marked reduction in the number of fetuses per patent tube, despite similar rates of pelvic adhesions between groups. Topically administered thrombin appeared to reduce fertility in this experimental model by an undefined mechanism.
The history is described of a patient with bilateral non-simultaneous torsion of the fallopian tubes occurring 10 yr after sterilization and with an interval of 1 yr. A review of the literature is presented which highlights the incidence, the clinical picture, the etiology, the prevention and the treatment of tubal torsion.
A total of 43 patients who had undergone laparoscopic tubal occlusion by means of bipolar cauterization underwent bilateral salpingectomy 6-30 months later. The macroscopic and microscopic changes in the fallopian tubes are described. Although 35 patients appeared to have occluded tubes on macroscopic examination, only 22 showed occlusion on microscopic examination.
A woman is presented in whom cellular atypia and signs of abnormal fibrinolysis in a jet washing caused persistent suspicion of malignancy after a benign curettage. Nearly 3 years later a fallopian tube carcinoma was diagnosed. The value of determination of biological markers of neoplasia in addition to the cytologic interpretation of uterine fluid is emphasized.
Spontaneous uterine rupture in the second trimester of pregnancy with twins following a previous re-fertilization is very rare. A case of spontaneous cornual uterine rupture following re-implantation of the Fallopian tubes in a 35-year-old multigravid woman is described. The atypical clinical presentation and the findings at the operation are discussed.
The effects of gamma-aminobutyric acid (GABA) and some GABA ergic compounds were examined on the spontaneous contractile activity of the ampullar segment of human Fallopian tubes in vitro. In both circular and longitudinal smooth muscle layers, GABA increased the frequency, and decreased the amplitude of the contractions. In longitudinal muscle layer, this effect occurred independently of endocrine status, while in the circular muscle layer, the amplitude was affected only in follicular phase and in postmenopause, but not in the luteal phase. Baclofen mimicked the effects of GABA, whereas muscimol and bicuculline failed to influence the contractility. Our findings suggest that, in the ampulla of the human oviduct, GABAB-receptors may be involved in the regulation of motility, and thus in the modulation of ovum transport and fertility.
PROBLEM: The aim of this study was to examine whether ectopic pregnancy is associated with increased levels of human decidua-associated protein (hDP) 200, identified as a monoclonal rheumatoid factor, in the related fallopian tube as compared with normal tubes. METHOD OF STUDY: Tubal fluid samples were obtained prospectively from two groups of patients: group I, 20 patients admitted for total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO); group II, 14 women with ectopic pregnancy, undergoing unilateral salpingectomy by laparoscopy or laparotomy. hDP 200 was assayed using double-site enzyme-linked immunosorbent assay. RESULTS: Very low levels of hDP 200 were found in normal tubes, while tubes with ectopic pregnancy demonstrated significantly higher levels of tubal fluid hDP 200 (P < 0.00001). In addition, in women with ectopic pregnancy, the uterine fluid level of hDP 200 was significantly lower than the level of hDP 200 in the tube containing ectopic pregnancy (P < 0.0001). CONCLUSION: The increased level of hDP 200 (a monoclonal rheumatoid factor) in the tube containing ectopic pregnancy, as compared with uterine cavity and normal tubes, might be associated with the implantation site of the pregnancy.
The concentrations of estradiol-17 beta (E2) and progesterone (P) were measured in the ampullary and isthmic portions of the fallopian tube of nonpregnant menstruating women and the cyclic fluctuations were related to the concentrations of these hormones in plasma. The steroid concentrations were determined by radioimmunoassays. There was no significant difference in the isthmic and ampullary concentrations of either steroid in any of the menstrual phases. The mean value for E2 was highest in the ovulatory phase and for P during the luteal phase. The tissue (per gm)/plasma (per ml) ratio for the steroid concentrations was above unity in all measurements. The ratio for E2 was highest (isthmus:12, ampulla:8) in the follicular phase and for P (isthmus:26, ampulla:18) during ovulation. Since these highest ratios were attained when plasma steroid concentrations were relatively low they were interpreted as reflections of a maximal receptor contribution.
A patient with recurrent pleural effusions posed a diagnostic challenge. The pleural aspirate CA-125 assay was markedly elevated which indicated a primary ovarian pathologic process. However, in this case a rare fallopian tube adenocarcinoma was the underlying problem. Meigs' syndrome can resemble a metastatic pelvic carcinoma in its presentation, but the prognosis is much more favourable when the syndrome is associated with a benign ovarian tumour.
The localization of the Mg++-activated adenosine triphosphatase (ATPase) in the human Fallopian tube has been studied by means of histochemical methods. The samples were obtained from 18 women in the age from 23--62 years. Some of them were treated by various steroid hormones. Endosalpinx ciliary ATPase-activity represents dynein and is therefore an indicator of ciliary motility. Estrogens and gestagens have a different influence on the ATPase-activity. All cilia of one ciliated cell react in the same manner and may be regarded as a reaction unit. The relation of negative to positive ciliary borders differs characteristically in the tubal isthmus, ampulls and infundibulum and coincides with commonly known phenomena of egg transport through the oviduct. Postovulatory, reaction units increase in ampulla and infundibulum compared with the proliferative phase. The oviducts of postmenopausal women possess but a scanty outfit of reaction units. Short-time treatment with estrogen in the early secretory phase results in a great number of reaction units in all tubal segments; a similar treatment in the proliferative phase diminishes the reaction units in the ampulla. Midcycle progesterone treatment activates the ciliary ATPase in the isthmus. Low doses of lynestrenol (minipill) in the proliferative phase leads to a decrease of reaction units in all tubal segments; the pattern of ciliary reaction under low doses of lynestrenol at the time of ovulation coincides with that of the proliferative phase. Treatment with a contraceptive steroid (0,05 mg ethinylestradiol and 0,25 d-norgestrel) causes a considerable activation of the ciliary ATPase in all portions of the oviduct.
Infection of mucosal surfaces by N. gonorrhoeae and N. meningitidis may result in inflammation indicating potential injury to host cells. We used human fallopian tube organ cultures (FTOC) and human nasopharyngeal organ cultures (NPOC) to study the mechanisms by which gonococci and meningococci damage human mucosal surfaces. Early in the course of FTOC infected with gonococci and NPOC infected with meningococci, damage was most apparent to ciliary activity. Loss of ciliary activity was accompanied by sloughing of ciliated cells. The damage to ciliated cells was not associated with attachment of gonococci or meningococci to these cells or the presence of organisms within ciliated cells. Infection with the commensal N. subflava did not result in significant damage to human FTOC or NPOC ciliary activity. LPS appears to be a major toxin of gonococci for human FTOC ciliated cells. Gonococcal peptidoglycan fragments also damage FTOC ciliary activity. Both piliated (P+) and nonpiliated (P-) gonococci and meningococci damage FTOC and NPOC ciliary activity, but P+ organisms damage ciliary activity more rapidly than P- organisms. Damage to FTOC ciliated cells was produced by less than 10 micrograms/ml of purified gonococcal and meningococcal LPS. By 1-2h after exposure to LPS, vesicles containing LPS were distributed throughout the cytoplasm of ciliated cells. Polymyxin B neutralized LPS-induced damage, suggesting that the lipid A portion of LPS was the toxic moiety. In contrast, purified gonococcal and meningococcal LPS at 100 micrograms/ml did not damage human NPOC or FTOC from rabbits, pigs and cows. These studies indicate that N. gonorrhoeae and possibly N. meningitidis damage ciliated epithelial cells indirectly by release of toxins from the organisms. The differences in susceptibility of FTOC and NPOC to LPS may suggest changes in density of receptors for LPS and may help explain variation in severity of gonococcal and meningococcal interactions at different human mucosal surfaces.