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Query: UMLS:C0021359 (infertility)
 26,075 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hysteroscopy has added a new dimension to the management of patients with common clinical problems, increasing the accuracy of diagnosis and serving as an adjunct in treatment of intrauterine conditions. This report summarizes the hysteroscopic experience with 320 selected patients, 104 in the reproductive age group with abnormal uterine bleeding, 91 who underwent hysteroscopy for location and retrieval of intrauterine contraceptive devices, 36 with primary or secondary infertility, 36 with postmenopausal bleeding, and 15 with uterine leiomyomas. Paracervical block anesthesia was used successfully in 214 patients. General anesthesia was used in the remainder because of planned additional surgical intervention. Uterine distention was achieved with D5W in 270 patients, with dextran 32% in 30 patients, and with CO2 gas insufflation in 20 patients. In 71.6 per cent of the patients,visually recognizable or pathologically suspicious intrauterine abnormalities were found. This study further demonstrated the utility of hysteroscopy in diagnosis of endometrial polyps, uterine submucous leiomyomas, uterine malformations, and intrauterine adhesions. Hysteroscopy was also helpful in taking directed biopsies of selected areas of the endometrium in patients with adenomatous hyperplasia and early adenocarcinoma of the endometrium and helpful in removal of intrauterine foreign bodies and evaluation of the recently pregnant uterus when there was a question of persistent pregnancy. Hysteroscopy is a safe ambulatory procedure that is appealing to both patient and gynecologist in its economy and simplicity.
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PMID:Hysteroscopy: a clinical experience with 320 patients. 83 33

Twelve ASA physical status I-II patients undergoing pelvic laparoscopy for infertility were enrolled in a study to quantify the effects of CO2 insufflation and the Trendelenburg position on CO2 elimination and pulmonary gas exchange, and to determine the minute ventilation required to maintain normocapnia during CO2 insufflation. Measurements of O2 uptake (VO2), CO2 elimination (VCO2), minute ventilation (VE), FIO2, and respiratory exchange ratio (RQ) were made during three steady states: control (C) taken after 15 min of normoventilation but before CO2 insufflation, after 15 min (L1) and 30 min (L2) of hyperventilation during CO2 insufflation. The FIO2 was controlled at 0.5 and arterial blood gases were used to calculate the oxygen tension-based indices of pulmonary gas exchange. After 15 min and 30 min of CO2 insufflation, the volume of CO2 absorbed from the peritoneal cavity was estimated at 42.1 +/- 5.1 and 38.6 +/- 6.6 (SEM) ml.min-1 respectively, increasing CO2 elimination through the lungs by about 30%. Hyperventilation of the lungs by a 20-30% increase in minute ventilation maintained normocapnia. Despite the CO2 pneumoperitoneum and Trendelenburg position, there was no impairment of pulmonary oxygen exchange as estimated by (A-alpha)DO2. This study demonstrated that a 30% increase in minute ventilation, achieved by increasing tidal volume to more than 10 ml.kg-1, is sufficient to eliminate the increased CO2 load and maintain normal pulmonary O2 exchange during pelvic laparoscopy.
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PMID:Carbon dioxide absorption and gas exchange during pelvic laparoscopy. 139 55

The hysteroscope is a valuable tool for selective viewing of the uterine cavity and the endocervical canal. With smaller-diameter scopes, hysteroscopy can be performed in the office setting, often without the need for cervical dilatation or local anesthesia. Controlled-rate CO2 insufflators allow safe distention of the uterine cavity with minimal side effects. Indications for office hysteroscopy include the evaluation of abnormal uterine bleeding, genital carcinoma and infertility and the investigation of a "lost" intrauterine device. Hysteroscopy is an adjunct to endometrial sampling, dilatation and curettage, hysterosalpingography and cervical cytology.
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PMID:Diagnostic hysteroscopy. 144 72

During a period of 18 months with a history of chronic pelvic pain symptomatology (severe dysmenorrhea, severe dyspareunia, extramenstrual pain) retroverted or retroflexed uterus, and infertility were subjected to laparoscopy for diagnostic and therapeutic purposes as well. These women were able to follow up this protocol. After informed consent had been presented patient decided, in a case of endometriosis being verified by the tissue pathology intraoperatively, which one mode of therapy (Group I or Group II) would be administered in her case. All women failed to respond to non-steroidal, antiinflammatory medication, as well as to oral contraceptive treatment. Proposed intraoperative staging of pelvic endometriosis that has not yet been published, was utilized by the author. Group I twenty women were subjected to a translaparoscopic CO2 laser excision and (or vaporization of endometriosis implants, CO2 laser uterine nerve ablation, uterine suspension with Falope Rings and intraperitoneally 32% Dextran was installed. Group II twenty women were subjected only to a translaparoscopic CO2 laser endometriosis excision and/or vaporization and intraperitoneally 32% Dextran-70 was installed. In Group I extramenstrually pain was 90%, severe dysmenorrhea 85%, and infertility 90% were cured. Ten per cent of extramenstrual pain, 5% of severe dysmenorrhea, and 15% of severe dyspareunia were improved. Infertility in this group was unchanged in 10%. Patients' symptoms were not worsened during the 18 months of observation. In Group II only 60% infertility was curred. In 60% extramenstrual pain, in 35% severe dysmenorrhea, in 5% severe dyspareunia were improved. Symptoms were noted to worsen in 5% extramenstrual pain, in 5% severe dysmenorrhea, in 10% severe dyspareunia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A new translaparoscopic approach in endometriosis treatment: a. CO2 laser endometriosis excision and/or vaporization. b. CO2 laser uterine nerve ablation. c. Uterine suspension with Falope Rings. d. Intraperitoneally 32% Dextran-70 installation. 172 45

Hysteroscopy and laparoscopy are relatively non-invasive methods routinely employed in the investigation of infertility. The danger of air embolism during these procedures was recognized early, and carbon dioxide was substituted for air since it is more readily soluble in blood. In this report we describe 3 cases of circulatory collapse and cardiac arrest in healthy young women during routine hysteroscopy (out of a total of 62 patients during the period 1989-1990) which were most probably caused by massive carbon dioxide embolism. Premedication was with oral diazepam 10 mg. Anesthesia was induced with 0.1 mg fentanyl, 2.5 mg droperidol and 100 mg methohexital (100 mg propofol in one case). Intubation was facilitated with 2 mg pancuronium and 50-100mg succinylcholine. Anesthesia was maintained with nitrous oxide 66% and halothane. Ventilation was controlled with a tidal volume of 10 ml per kilogram body weight at a rate of 10 per minute. Monitoring included ECG, automated non-invasive blood pressure, capnometry, pulse oximetry and body temperature. Anesthesia was uneventful prior to insufflation. In each case the signs and symptoms began approximately 5-8 minutes after the start of insufflation and consisted of an initial tachycardia rapidly followed by ventricular dysrhythmias, bradycardia and cardiac arrest. The end-tidal CO2 decreased during the tachycardic phase and prior to asystole. The patients were cyanotic with engorged jugular veins. Resuscitation with closed chest heart massage and intravenous epinephrine or orciprenaline was successful in every case. The typical "mill wheel phenomenon" of gas embolism was audible on auscultation after heart activity had returned, but disappeared after about 5 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Gas embolism with cardiac arrest during hysteroscopy. A case report on 3 patients]. 177 42

One hundred women with cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis (48 partial, 52 complete) were treated laparoscopically for infertility (46 cases), pain (46), hypermenorrhea (7) and a mass (1). The surgical techniques included aqua-dissection, electrosurgery, CO2 laser, scissors, probes to identify the upper posterior vagina and rectum, and multiple rectovaginal examinations. In all the procedures the anterior rectum was freed to the loose areolar tissue of the rectovaginal septum prior to excising deep fibrotic endometriosis. The viable intrauterine pregnancy rate among patients with infertility was 70% (32/46). Of patients presenting with pain, 89% (41/46) reported significant relief. The average operating time was 178 minutes. Laparoscopic cul-de-sac dissection, though time intensive, offers increased fertility potential and significant symptom relief.
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PMID:Laparoscopic treatment of cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis. 183 40

Laparoscopy performed with carboperitoneum in 30 women of infertility was studied to evaluate the changes of systemic blood pressure and end-tidal carbon dioxide (CO2) and their relationship. The patients were randomly divided into 2 groups. In group I (n = 15), the patient's respiration was set to maintain a nearly constant end-tidal CO2 by adjusting the minute ventilation. In group II (n = 15), the minute ventilation was kept constant to monitor the changes of end-tidal CO2. Perioperative measurements included end-tidal CO2, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) which were recorded the moment just before intra-abdominal CO2 administration and every 2 min thereafter for at least 10 min. The data showed that in both groups there were time-related changes of blood pressure with a maximum increase about 20-30% of baseline level found at 6 min later after the beginning of intra-peritoneal CO2 insufflation, and no significant change of HR was noted. The intergroup comparisons of SBP, DBP and HR were not statistically significant. With regard to end-tidal CO2 change in group II, it also appeared in a time-related fashion. A maximum increase was found 6 min later after the intra-abdominal CO2 administration. Our results disclosed that carboperitoneum during laparoscopy might consistently induce systemic arterial hypertension, and hypercarbia might not be the major determinant factor of hypertension.
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PMID:Hypercarbia is not the determinant factor of systemic arterial hypertension during carboperitoneum in laparoscopy. 183 24

Proximal tubal obstruction is encountered in 33% of women with tubal factor infertility. Traditional microsurgery and the most recent transcervical tuboplasty have achieved 20% to 30% intrauterine PR. Microdissection of the intramural segment of the fallopian tube with the CO2 laser, resection of the scarred tissue, and microsurgical tubal reanastomosis has resulted in 100% tubal patency and 71% intrauterine PRs.
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PMID:Intramural-isthmic fallopian tube anastomosis facilitated by the carbon dioxide laser. 190 79

Gamete intrafallopian transfer (GIFT) is performed currently using laparoscopy. We report on a pilot-study from 1.1.1987 to 31.12.1987 and from 1.5.1988 to 30.4.1989, in which we used hysteroscopy instead of laparoscopy for the GIFT-procedure. The entering conditions were: unexplained (idiopathic) infertility, failure of previous treatments, proven fertilization capability of the gametes in at least one IVF attempt, and request of the married couple to dispense with laparoscopy during GIFT procedure. Hysteroscopic GIFT was initially performed on hysterectomy specimens, using the Chorionoskop. Continuous flow CO2 through the fallopian tubes did not result in loss of gametes. Twenty-four treatment cycles were performed in 16 patients. In 19 cycles, gametes were transferred into one tube, and in two cycles they were transferred into both tubes. Four of 16 women conceived: one patient delivered at term, three pregnancies ended in a first trimester abortion. These results demonstrate that the hysteroscopic approach to intrafallopian gamete transfer can be successful. However, the technique is demanding and requires extensive training. We conclude that further improvements of hysteroscopic GIFT are needed.
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PMID:Hysteroscopy for gamete intrafallopian transfer (GIFT). 207 17

In 179 consecutive laparoscopies for infertility (n = 105), pain (n = 60), or both problems (n = 14), endometriosis was diagnosed in 77%, 82%, and 86%, respectively. Eighty implants with positive histology and with careful assessment of depth were sampled by CO2 laser excision from 53 patients. Deep (greater than or equal to 5 mm), intermediate (2 to 4 mm), and superficial (less than 1 mm) infiltration was found in 48%, 35%, and 17% of implants, respectively. Deep infiltration was observed in the pouch of Douglas (55%) and at the uterosacrals (34%), but was absent from the ovarian fossas. Deep implants were found to be active in 68%. At an intermediate depth, however, only 25% of implants were active, whereas 58% of superficial foci showed activity. Deep implants were in phase with the endometrium in 74%. At an intermediate depth, however, only 38% showed regular cyclicity, whereas 57% of superficial implants were in phase with the cycle. Deep infiltration occurred through loose connective tissue septa into the fibromuscular tissue and was always stopped at the underlying fat tissue. Very deep implants (greater than 10 mm) were found exclusively in patients with pain; superficial implants, on the contrary, were found most frequently in patients with infertility (83%).
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PMID:Deeply infiltrating pelvic endometriosis: histology and clinical significance. 214 Sep 94


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