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[Early rehabilitative physiotherapy following the microsurgical reconstruction of the fallopian tubes (a clinico-chronobiological validation)].

Three preformed physical factors (low-frequency alternating magnetic field, supersonic frequency current, low-frequency monopolar square-wave impulses for electrostimulation of the uterine tubes) were tested in aftercare following plastic microsurgery in gynecology. The treatment can be started as early as postoperative day 1. The criteria of the differential choice of the modalities have been developed. The use of the above physiotherapy was found valid.

Adult↗

Falloposcopic classification and treatment of fallopian tube lumen disease.

OBJECTIVE: To devise a diagnostic classification and scoring system for tubal lumen disease based on falloposcopy and to evaluate it against tuboplasty procedures and pregnancy outcomes. DESIGN: Prospective study approved by the hospital Institutional Review Board. SETTING: Academic tertiary infertility center. PATIENTS: Seventy-five women with hysterosalpingographic and laparoscopic evidence of endotubal disease had 112 tubes available for falloposcopic evaluation. INTERVENTION: Diagnostic and operative falloposcopy was performed, when indicated, using aquadissection, flexible wire cannulation, or direct balloon tuboplasty. RESULTS: The endotubal lumens were considered to be falloposcopically normal in 52 tubes (46%), to contain mild to moderate disease in 33 (29%), and severe to obstructive disease in 27 (25%) cases. Within a year of the procedure, 6 of the 28 women (21%) in whom at least 1 tube was normal conceived, in 2 of 22 (9%) with mild to moderate disease, and in 0 of 16 (0%) with severe endotubal disease. CONCLUSIONS: Falloposcopy provides a visual means of scoring endotubal disease and may be intrinsically therapeutic for dislodging intraluminal debris and breaking down filmy adhesions in normal or minimally diseased tubes. The presence of severe disease remains resistant to the use of current endotuboplasty treatments as reflected by poor pregnancy outcome, and such women should be provided the option of microsurgical tubal repair or in vitro fertilization and embryo transfer procedures.

Adult↗

[Distal lesions of the Fallopian tubes. Prognostic values of peroperative tubal biopsy].

78 biopsies were carried out during 63 distal tubal microsurgical operations, followed up for two years at least. The clinical outcome was studied according to the pathological state of the better tube: Viable pregnancies become more frequent with subnormal tubes (40%) and with tubes with moderate chronic salpingitis (65%). The risk of extra-uterine pregnancy is at a maximum with chronic cicatricial salpingitis (29.4%). Progressive chronic salpingitis results in only 6.6% viable pregnancies and will definitely constitute an indication for in vitro fertilization rather than microsurgery.

Biopsy↗

[Microsurgery of the fallopian tube].

The goal of infertility surgery is to restore anatomic relationship to as close to normal as possible maximizing the chances for conception and intrauterine pregnancy. The outcome has been markedly, improved by the advent of microsurgical techniques. More than 10 years of microsurgical experience have enabled us to clearly define situations where infertility surgery is especially successful. In refertilization after tubal sterilization, the results with microsurgery are unsurpassed. In proximal, but also distal, postinfectious tubal disease, intrauterine pregnancy rates are clearly better than those achieved with in vitro fertilization or other techniques.

Adult↗

Microsurgery of the fallopian tube with the carbon dioxide laser: analysis of 230 cases with a two-year follow-up.

Between September 1979 and December 1982, 230 cases of tubal reconstructive surgery were followed for 2 years. An analysis of these cases showed 75% to have had more than one procedure performed. There were 91 pregnancies in this group. In the bipolar disease population, 36% achieved an intrauterine pregnancy. Tubal reversal procedure resulted in comparable rates when compared to conventional surgery (71%). The ectopic pregnancy rate was 4.4%, and spontaneous abortion rate was 6.6%. The carbon dioxide laser appears to have a place in the armamentarium of the microsurgeon.

Adult↗

[Uterine abnormality and fallopian tube damage--surgical correction in one session?].

From 1983 to 1990 15 metroplasties were carried out at the Department of Obstetrics and Gynecology Greifswald. 11 of these operations were combined with a microsurgical tubal operation. For the diagnostics of uterus malformation and tubal damage as many methods as possible (hysterosalpingography, laparoscopy with chromotubation, hysteroscopy and sonography) should be used. A postoperative life birth rate of 62.5% shows that an operative correction of uterus malformation and tubal damage in one session is justified. Metroplasty is also indicated at primary tubal sterility with simultaneous uterus malformation. A caesarean section is not primarily indicated after metroplasty.

Abortion, Habitual↗

Serial scintigraphic imaging for visualization of passive transport processes in the human fallopian tube.

Spontaneous migration of a radionuclide tracer from the vagina to the peritoneum may be visualized by scintigraphic imaging (hysterosalpingoscintigraphy, HSS). A prospective study was designed to evaluate diagnostic criteria for normal tubal passage of a control group (n = 7) and to establish the predictive value of the HSS technique in defining functional deficiency in anatomically patent tubes. In 56 patients with tubal and unexplained infertility, a comparison between the results of the tracer migration study and of contrast hysterosalpingography and laparoscopy was made. The overall correlation was 65%. Clearly discrepant results (i.e. an abnormal migration pattern in anatomically patent tubes) were recorded in 18% and were positively, yet not significantly associated with tubal adhesive disease and with a history of tubal microsurgery. Interpretation of scans was equivocal in another 18% of patients due to undetectable ascension of the tracer to the uterus. It is suggested that the radionuclide is moved forward by the same passive transport processes which are concerned with support of the migration of spermatozoa to the ovum, and that failure of tubal migration of the tracer may render patients eligible for in-vitro fertilization/embryo transfer treatment.

Adult↗

The reproductive significance of human Fallopian tube cilia.

Effective tubal transport of ova, sperm and embryos is a prerequisite for successful spontaneous pregnancy. Although there is much yet to be discovered about the mechanisms involved, it is evident that tubal transit is a far more complicated process than initially thought. Propulsion of gametes and embryos is achieved by complex interaction between muscle contractions, ciliary activity and the flow of tubal secretions. Evidence is accumulating of the important and possibly pre-eminent role of ciliary motion in this process; and this review describes current knowledge about ciliary activity and its physiological regulation. There is also a description of the effects on ciliary function of cigarette smoking and various pathological states, including endometriosis and microbial infection, with consideration given as to how altered ciliary activity may impact upon fertility.

Chlamydia↗