Laparoscopic sterilization with spring-loaded clips: double-puncture technique.

The application of a spring-loaded clip to each fallopian tube using a second-incision clip applicator is a safe and effective method of laparoscopic sterilization. The operation is quick and easy to perform and is suitable for use with local anesthesia. The method avoids the dangers of hemorrhage, for the clip only alters 3 mm of the fallopian tube and does not transect the tube or mesosalpinx. No pregnancies have followed the sterilization procedure. An intrauterine pregnancy has occurred after a reversal procedure in one patient.     

Effect of thrombin-induced hemostasis on the efficacy of an absorbable adhesion barrier.

Serosal injury, bleeding and fibrin deposition are major factors in the development of surgical adhesions; meticulous hemostasis is desirable but not always achievable. The effects of thrombin on adhesion formation and the performance of Interceed Barrier were tested in separate series using a standard model and two levels of bleeding: an "oozing" model in which rabbit uterine horns were scraped to produce uncontrolled punctate bleeding and a "bleeding" model, in which four small blood vessels nicked on the ligament to each horn produced heavier bleeding. Substantial clots in the bleeding model were not removed. Adhesions, assessed after two weeks, were not worsened by the use of thrombin to control bleeding. While Interceed Barrier alone did not reduce adhesions at sites of bleeding, achieving hemostasis with thrombin and then applying Interceed Barrier significantly reduced adhesions. The effect was not achieved by applying thrombin to previously blood-soaked Interceed Barrier. The efficacy of Interceed Barrier applied after achieving hemostasis was further improved by moistening it with heparin. Achieving hemostasis at a bleeding site with thrombin facilitates the efficacy of Interceed Barrier.     

A clinical evaluation of absorbable polydioxanone ligating clips in abdominal and pelvic operations

An absorbable vascular ligating clip made of polydioxanone polymer was evaluated in 44 patients who underwent abdominal and pelvic operations. These clips were used in place of conventional metallic clips primarily in performing pelvic and para-aortic lymphadenectomy. The polydioxanone clips were found to be superior to the metallic clips in ease of clip loading to the applier, security of clips in the transfer to the surgeon and security of the clip in the applier when positioning to ligate vessels. The use of polydioxanone clips, which absorb within 210 days, may also lead to improved CAT or NMR imaging by precluding energy scatter which is known to occur with some metallic clips. Clip applier function, security on tissues ligated and clip visibility were equivalent to previous experience using metallic clips. Selection of proper clip size is important so that excessive amounts of tissue are not contained within the clip jaws which might prevent clip closure. No postoperative complications were noted in the use of these clips.     

Laparoscopic sterilization with electrocautery, spring-loaded clips, and Silastic bands: technical problems and early complications.

Among 2283 patients, rates of technical failure, technical difficulty, and operative and early postoperative complications were evaluated for different methods of tubal occlusion at laparoscopy: electrocoagulation (980 cases), spring-loaded clip application (991 cases), and Silastic band application (312 cases). Rates of technical failure and technical difficulty at surgery were significantly higher (P less than 0.05) for the spring-loaded clip technique than for the electrocoagulation and Silastic band techniques. Mechanical and optical difficulties with the prototype spring clip applicator were the major sources of technical difficulties. Rates of operative (1.2%) and early postoperative (1.9%) complications were not significantly different for the three techniques of tubal occlusion. It is concluded that all three study techniques appear to be practical, and large, long-term, randomized, comparative studies to determine rates of failure and subsequent gynecologic problems are necessary to determine the best method of sterilization.     

Laparoscopic sterilization with electrocautery, silastic bands and spring-loaded clips: report of our experience with 790 patients

A comparative study was carried out in 790 women undergoing one of the 3 most frequently used laparoscopic sterlization techniques: high-frequency unipolar electrocoagulation of the tubes, application of silastic rings or spring-loaded clips to the tubes. The technical problems and per- and postoperative (early) complications are assessed. The use of high-frequency unipolar current has been superseded by today's mechanical and non-electrical sterilization methods. The spring-loaded clip method appears to be a sterilization technique with a minimum of severe complications, and theoretically the greatest chances for possible refertilization.     

Legal abortion and hemostasis. Histological examinations and comparison to post partum hemostasis (author's transl)]

30 women were examined to determine the hemostasis during the legally induced abortion. The blood coagulated in the intervillous spaces while the fetus is removed. Immediately after the termination of the curettment the nidation area is covered by filaments of fibrin and incorporated erythrocytes. More frequent as post partum platelet thrombi occur especially in the area of decidua parietalis. The intravascular findings are similar to post partum changes after the removal of the placenta. Obstruction clots of the spiral arterioles contain fibrin deposits, pletelet thrombi and erythrocytes (mixed form of thrombi). Residual decidua and trophoblast cells are seldom involved in the obturation of the vessels. The traumatic damages of the uterine wall are described (extravascular fibrin deposits, interstitial bleeding, succulent tissue a.s.o.).     

Breast feeding of twins with regard to pre-term infants

The benefits of breast-feeding for health and development pre-term and full-term infants changed the attitude towards nutrition of twins and higher-order multiples. Mothers of twins are often at risk of unsuccessful initiation of lactation while in hospital. The possibilities to provide appropriate intervention and support when a mother breastfeeds twins are presented.     

Evaluation of endometrial tissue specific complement activation in women with endometriosis.

OBJECTIVE: To determine if endometrial tissue specific complement (C) activation occurs in patients with endometriosis. DESIGN: Prospective. SETTING: University of Oklahoma Health Sciences Center, a tertiary care referral center. PATIENTS: Twenty-six women, 9 with endometriosis and 17 without endometriosis. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Uterine and ectopic endometria were evaluated by the immunofluorescence assay for the presence of activated products of the initial (C3d) and terminal (C5b-9) C pathway, C3 regulatory proteins (decay-accelerating factor and membrane cofactor protein), and terminal C regulatory proteins (clusterin and vitronectin). RESULTS: The initial (C3d) and terminal (C5b-9) C components were deposited on blood vessel walls in uterine and/or ectopic endometria of women with and without endometriosis. In the stromal compartment at both sites, C deposition was colocalized with terminal C inhibitors/cell-cell attachment factors, clusterin and vitronectin on elastic fibers. No specific staining for C proteins was detected on the glandular epithelium of uterine and ectopic endometrial tissues examined. Furthermore, intense staining of endometrial epithelium for C3 regulatory proteins, decay-accelerating factor, and membrane cofactor protein was noted on endometrial glands from women with and without endometriosis. CONCLUSIONS: Our findings demonstrate a lack of specific deposition of C in the glandular epithelial cells of endometria of women with endometriosis. The localization of C3 regulatory proteins, decay-accelerating factor, and membrane cofactor protein on glandular epithelium may suggest the involvement of intrinsic protective mechanisms on these cells from autologous C attack in vivo.     

Adhesion induction by suture of varying tissue reactivity and caliber

The importance of suture size and chronic reactivity in adhesion induction was evaluated in two experiments. In experiment I interrupted sutures (4/0 chromic, 4/0 polyglactin, and 6/0 polyglactin) were placed in the dorsal surfaces of rabbit uterine horns. Adhesions were infrequently induced by all suture materials. In experiment II 4-cm-long incisions were made in the distal antimesenteric uterine horns. These were then reapproximated with running sutures (4/0 chromic, 4/0 polyglactin, 6/0 polyglactin, and 8/0 nylon). Adhesion formation occurred to 16 of 18 incisions closed with 4/0 or 6/0 suture, whereas none of five incisions closed with 8/0 suture formed adhesions. These observations suggest that suture size rather than tissue reactivity is paramount in adhesion induction.     

The term breech presentation. A retrospective study with regard to the planned mode of delivery

BACKGROUND: To analyze retrospectively a large group of term breech and vertex deliveries, with regard to the influence of the mode of delivery on the frequency of fetal and maternal complications. METHODS: All singleton breech deliveries after completed 36 weeks of pregnancy, with a live fetus, delivered at Rogaland Central Hospital, from September 1 1996 to the May 10 2001 were included (n = 575). Correspondingly as a control group, 582 cases in vertex presentation were analyzed. RESULTS: Planned vaginal delivery (VD) for the fetus in breech presentation (n = 448) in comparison with elective caesarean section (CS) (n = 127) increased early neonatal morbidity (3.6% vs. 0%). The frequency of Apgar scores < 7 at 5 min also increased (4.2% vs. 0.8%), as well as umbilical artery pH < 7.0 (4.4% vs. 0%), and referrals to the neonatal intensive care unit (NICU) (15.8% vs. 6.3%). Corresponding figures for planned VD of the fetus in vertex presentation were: 0.5% neonatal morbidity, 0.2% Apgar scores < 7 at 5 min, 8.1% admissions to NICU and 1.5% pH < 7.0 in umbilical arteries. Results comparing maternal morbidity in the different breech groups were inconclusive, but there were more maternal complications in the breech group planned for VD than in the corresponding vertex group (5.1% vs. 1.9%). CONCLUSIONS: Elective CS for breech presentation will significantly decrease the risks for the fetus in comparison with planned VD.     

Epidemiology of secondary amenorrhea. II. A retrospective evaluation of etiology with special regard to psychogenic factors and weight loss

A random sample of 41 women aged 18 to 35 years with secondary amenorrhea within Uppsala County, Sweden, were compared to 82 age-matched nonamenorrheic women with respect to a number of background variables of etiological interest, especially psychogenic factors and weight loss. Social-hygiene factors and gynecologic data were also considered. The study was retrospective and performed by a postal inquiry. In the amenorrheic group significant differences were obtained (p less than .05) for the following items: a higher proportion of unmarried women and women with intellectual occupations; a higher proportion with a greater incidence of stressful life events; more consumption of sedatives or hypnotic drugs; and more underweight. Previous menstrual irregularity was also more common. Amenorrhea following use of oral contraceptive agents was reported by 9 women, most of whom also showed pronounced underweight. Symptoms characteristic of anorexia were present in 2 amenorrheic women. There may have been others among those reporting marked underweight. The estimated prevalence of anorexia nervosa is 1 per 1000. The findings may be interpreted as either a true increase in incidence of the disorder or perhaps the method of investigation.     

Insulin resistance and lipid profile in women with polycystic appearing ovaries: implications with regard to polycystic ovary syndrome.

The aim of this study was to investigate carbohydrate and lipid profiles in women with polycystic appearing ovaries (PCO) on ultrasound examination who did not fulfill the criteria for polycystic ovary syndrome (PCOS). We sonographically evaluated and biochemically diagnosed 35 patients with PCO, 31 women with PCOS and 23 healthy controls. We performed oral glucose tolerance tests (OGTT) and calculated the quantitative insulin sensitivity check index (QUICKI) and the homeostatic model assessment (HOMAIR) scores. Serum fasting insulin levels, 1-h insulin response, HOMAIR and QUICKI scores were significantly higher in the PCO and PCOS groups than in the controls. However, serum fasting glucose levels, fasting insulin levels, HOMAIR and QUICKI scores were similar in women with PCO and PCOS. In women with PCO, high-density lipoprotein (HDL) levels were higher, and very-low-density lipoprotein (VLDL) and triglyceride levels were lower compared with women with PCOS. Furthermore, insulin responses to OGTT, HOMAIR and QUICKI scores and lipid values correlated with serum androgen levels and body mass index (BMI) in PCO patients. In conclusion, women with PCO who do not fulfill the criteria for PCOS have abnormal insulin sensitivity and insulin resistance. The finding of similar insulin abnormalities in women with PCO to those in women with PCOS confirms that women with PCO have similar metabolic characteristics to those with PCOS.