Laparoscopic ovarian transposition with subsequent intrauterine pregnancy.
A woman with a 3-year history of infertility underwent laparoscopic transposition of the ovary. This was followed immediately by a normal pregnancy.
Adult↗
Biomedical subjects
H Dabirashrafi
Publications and source records attributed to H Dabirashrafi.
Is estrogen necessary after hysteroscopic incision of the uterine septum?
STUDY OBJECTIVE: To evaluate the influence of estrogen after hysteroscopic incision of the uterine septum. DESIGN: Prospective, randomized, blinded study. SETTING: A national referral university hospital. PATIENTS: Fifty women in whom hysterosalpingography (HSG) showed a fundal defect and had septate uterus confirmed by laparoscopy. INTERVENTIONS: Preoperative HSG, hysteroscopic incision of the septum, and postoperative HSG. Four patients were omitted from the analysis because the angle of the uterus could not be corrected, as shown by postoperative HSG. Group 1 (23 women) received conjugated estrogen and progesterone postoperatively and group 2 (23 women) received no hormone. MEASUREMENTS AND MAIN RESULTS: The ratios of the length of the septum to the length of the uterus in the HSGs obtained preoperatively (a/b) and postoperatively (a'/b') were calculated and subtracted from each other (a/b - a'/b'). The means of the subtractions in the two groups were compared. The t test was used for statistical comparison. The results showed no statistically significant difference. CONCLUSION: Estrogen has no apparent role after hysteroscopic incision of the septum.
Double-Blind Method↗
Comparative Hysteroscopic Findings in Women with Primary and Secondary Infertility
We compared hysteroscopic findings in 248 patients with primary infertility with those of 150 women with secondary infertility. Weight and height were not significantly different. The result of hysteroscopy was normal in almost half of the patients, 133 and 68, respectively. Septate uterus (21, 17), endometrial polyps (8, 6), uterine myomata (8, 2), and ostial diaphragm (39, 17) were not statistically different between the groups. The prevalence of intrauterine synechiae was significantly different (24, 31, p <0.01); all of the synechiae in women with primary infertility were due to pelvic tuberculosis. Since the presence of ostial diaphragm was not statistically different between groups, we suggest that its etiology might be an anatomic defect rather than intrauterine synechiae.
Journal Article↗
New Technique for Reducing the Risk of Perforation of the Uterus at the Beginning of Dilatation and Curettage
The most critical part of dilatation and curettage (D&C) is blind dilatation of the cervix. A new technique is suggested to prevent perforation of the uterus when dilating a very narrow cervical canal. The external os is dilated only with a 2- to 7-mm Hegar dilator. Then a 7-mm rigid hysteroscope attached to a distending medium source is passed into the canal and, under hysteroscopic guidance, through the canal to the internal os. Thus the dilator is passed in the correct direction. When the smallest dilator cannot be passed after this maneuver, the internal os can be dilated using minigrasping forceps under hysteroscopic vision. We believe that this new technique will reduce the risk of perforating the uterus during D&C.
Journal Article↗
Occlusion of the Small Intestine After Operative Laparoscopy
A woman with diagnosis of missed abortion had complications of uterine perforation during dilatation and curettage (D&C). Under laparoscopic guidance the uterus was emptied of the remains of fetal tissue. An opening on the uterus was sutured laparoscopically. There was a superficial tear on the mesosigmoid. The sigmoid colon and the bladder were checked and were intact. Fourteen days after the operation the woman returned complaining of nausea, vomiting, and lower abdominal pain. The diagnosis was obstruction of small intestine. At laparotomy we found a loop of small intestine adhering to the ileum. This was untwisted and the patient was discharged in good condition. The cause of this complication might be trauma to small intestine during D&C that was not diagnosed by laparoscopy, or entry of infected tissue into the peritoneal cavity during D&C. Since the many loops of small intestine make it difficult to check at laparoscopy, it is suggested laparotomy be performed if the surgeon suspects trauma in the intestine.
Journal Article↗
Myoma of the Round Ligament Causing Severe Groin and Thigh Pain
A 40-year-old woman experienced severe right groin and thigh pain. Her history included abdominal hysterectomy 6 years and exploratory laparotomy 2 years earlier. During the latter, left oophorectomy and appendectomy were performed, but did not eliminate the patient's groin pain. At laparoscopy we found a 20-mm myoma on the round ligament, which was excised. Three months postoperatively the woman had no groin pain and was in good health.
Journal Article↗
Complication of Laparoscopic Coagulation of an Endometrioma Surface
A 32-year-old infertile woman with a 9-cm right ovarian endometrioma with severe adhesions to nearby organs was treated with coagulation of the surface of the endometrioma during laparoscopy. Ultrasonography 6 months later showed a normal pregnancy with an 8-cm ovarian cyst. After a normal delivery at term, while cutting the adhesions on the right side, 200 ml of pus was released, the origin of which was not known. Another endometrioma was present on the left ovary. A drain was inserted into the peritoneal cavity and the operation was completed. Five months later the woman returned with a painful point of redness on the skin of her abdomen. Ultrasonography revealed an 8-week pregnancy. We drained the pus and the patient was discharged. The result of the culture was Escherichia coli. We believe this is a case of intestinal fistula caused by coagulation of the surface of the endometrioma in the first operation.
Journal Article↗
Septate uterus: new idea on the histologic features of the septum in this abnormal uterus.
OBJECTIVE: Our purpose was to examine some of the classic concepts about the histologic features of the uterine septum. STUDY DESIGN: Four biopsy specimens were taken from 16 patients with septate uteri during Tompkins metroplasty: biopsy A from the septum near the serosal layer, biopsy B from the midpoint of the septum, biopsy C from the tip of the septum, and biopsy D from the left posterior aspect of the uterus away from the septum. Thirteen characteristics were examined in these specimens by means of mean ridit analysis and Bonferroni criteria for multiple comparisons in relation to connective tissues (four characteristics), muscles (four characteristics), and vessels (five characteristics). RESULTS: In the septum the mean ridit score was less for the amount of connective tissues (p < 0.001) and higher for the amount of muscle tissue (p < 0.025), amount of muscle interlacing (p < 0.05), and vessels with a muscle wall (p < 0.005). However, the Bonferroni criterion for multiple comparisons was only significant for the amount of connective tissue (p < 0.001). CONCLUSION: Our findings of less connective tissue in the septum, which was confirmed by the Bonferroni criterion for multiple comparisons and the mean ridit results for the three other significant findings, were contrary to the classic view about the histologic features of the septum.
Adult↗
Histocompatibility leukocyte antigens in Rokitansky-Küster-Hauser syndrome.
Histocompatibility leukocyte antigens of 32 patients with Rokitansky-Küster-Hauser syndrome were compared with a control healthy population of 100. For analysis chi 2 with Yates' correction and Bonferroni criterion for multiple comparisons were used. Seven antigens were significant in the chi 2 test, but only three were confirmed in the Bonferroni criterion (Aw19, DRw52, and DQw1) (p < 0.001). The study showed certain associations between Rokitansky-Küster-Hauser syndrome and the major histocompatibility complex.
Abnormalities, Multiple↗
Laparoscopic Endometrial Ablation: A Case Report
A 14 year-old girl was operated on via laparoscopy because of a right adnexal mass. During the operation a noncommunicating right uterine horn was found with a massive right hematosalpinx. The right horn was attached to the left one with a narrow band. The right uterine horn was opened and the endometrial lining was ablated with unipolar cutting current. The layer was then deeply coagulated with a laparoscopic probe. The hematosalpinx was excised and the accumulated blood emptied. Adhesions around the right tube were separated. Operation time was 35 minutes. One year later the patient had a repeat laparoscopy which showed neither adhesion formation nor hematosalpinx. Now, two years after the original operation, the patient is in excellent condition.
Journal Article↗
Comparison of Adhesion Formation in Open Wedge Resection (OWR) With Microsurgical Wedge Resection (MWR)
In 21 patients with polycystic ovarian disease, a laparotomy ovarian wedge resection was performed on both ovaries. The vessels were coagulated with a mini-bipolar instrument. Then, randomly one ovary was left open and the other closed with Vicryl material (5-0 in the interior and 8-0 on the edge of the ovary). Six weeks later, during a second look laparoscopy, the ovaries were scored according to adhesion formation (AFS classification). The mean score of adhesion in the two groups was 52/21 MWR and 82/21 OWR. The mean and standard error for the differences of scores were 1.43 and 0.94, respectively, which were not significant. Contrary to the previous report (Am J Obstet Gynecol; 163:1674, 1990), our study in humans does not show that the OWR is superior to MWR.
Journal Article↗
The Use of Veress Needle and 10-mm Trocar (VN) Versus Direct Trocar Insertion (DTI) in the Beginning of Laparoscopy
Seven hundred fifty-six women were randomly divided into two groups. Group 1 (378 cases) were operated on via laparoscopy with VN and group 2 (378 cases) with DTI technique. Complications were compared between the two groups. No major complications occurred. Minor complications were: a problem with insufflation of CO2 (19 VN, 2 DTI, P<0.001); more than one insertion of the instrument (18 VN, 13 DTI, NS); need to alter the technique (6 VN, 10 DTI, NS); and penetration of the fascia but not the peritoneum by trocar sleeve (2 VN, 19 DTI, P<0.001). The significant differences found presented no serious problems, and we concluded that both methods were satisfactory.
Journal Article↗
The Hyperglycemia and Hyponatremia Response of Patients During Operative Hysteroscopy with 5% Dextrose in Water (D5W)
In 20 patients undergoing operative hysteroscopy using D5W, the rate of hyperglycemia and hyponatremia was examined. All patients exhibited hyperglycemia during and two hours after the procedure as follows: ten patients had hyperglycemia but with less than 100% increase from the normal level of serum glucose, two patients had between a 100% and 300% increase, and eight patients had more than a 300% increase. The rate of hyponatremia was higher in group three than one (7/8 versus 1/10, P=0.0037). The oral GTT was normal in all of the patients. One explanation of these results is that the difference in absorption of glucose is the cause of different hyperglycemic responses. Can we find a test to distinguish these groups prior to hysteroscopic operation?
Journal Article↗
Surgical Vaginoscopy
Intravaginal operations in young girls is difficult. The narrowness of the vagina and desire by certain girls to have the hymen intact leads to limitations. The small view and the problem of performing surgery with the conventional vaginoscope are impractical. It was decided to use a 7 mm hysteroscope attached to D5W (for dilatation) in such situations. The benefits were: clear panoramic view, dilatation of vagina for better diagnosis, and better surgical maneuverability via the surgical channel of the hysteroscope. This abstract describes experiences in four young girls with: endocervical polyp (2 cases), pedunculated intracervical myoma (1 case) and a huge cervical cyst (1 case). Surgical vaginoscopy was facilitated by the use of a 7-mm hysteroscope and the operation was successful in all of these patients without traumatizing the hymen.
Journal Article↗
The Fate of a Myoma When Left Intraabdominally: A Case Report
A 30 year old infertile woman was a candidate for laparoscopic myomectomy. There were two large myomas, 6x7 cm, and 5x6 cm attached to the corpus of the uterus with a broad base. The 6x7 cm one was separated with the use of bipolar coagulation. At this point the anesthesiologist urged that the operation be finished because of cardiac arrhythmia. The separated mass (6x7 cm) was biopsied and left intraabdominally. After surgery, repeated sonographies showed gradual resolution of the mass. Four months afterwards she had another laparoscopy. There was no sign of the 6x7 cm myoma. There were no intraabdominal adhesions. However, there was an adhesion on the uterus at the place of the separation of the 6x7 cm myoma. During the second laparoscopy, the 5x6 cm myoma was separated by laparoscopy and then removed via minilaparotomy.
Journal Article↗
New laparoscopic instrument for removing hair from ovarian dermoid cysts.
A new laparoscopic instrument is available to remove hair from an ovarian dermoid cyst. It is constructed of Teflon, and is 35 cm in length and 9 mm in diameter. The distal 6 cm of the instrument tapers form 9 to 6 mm, and has longitudinal and transverse grooves. When the tapered part is rotated in the mat of hair, the hair attaches firmly to it and can be brought out easily.
Adolescent↗
Ovarian malposition in women with uterine anomalies.
OBJECTIVE: To evaluate the incidence of malposition of the ovary in patients with uterine anomalies compared to patients with a normal uterus. METHODS: Ovarian malposition was investigated in 1082 patients via laparoscopy. Only ovaries in which the upper pole was attached to the area above the common iliac vessels were designated as malpositioned; often the lower pole was attached inside the pelvis. These patients were divided into two groups. Group I consisted of women with congenital uterine anomalies (divided into subgroup A, congenital absence of the uterus and unicornuate uterus, and subgroup B, other uterine anomalies). Group II included those women with a normal uterus (control group). RESULTS: The incidence of malposition of the ovary was higher in group I than group II (P < .001). When we separately compared subgroup A and subgroup B with the control group, only subgroup A had a significantly higher incidence (P < .001). CONCLUSION: Our results reveal that the incidence of malposition of the ovary is higher in patients with congenital uterine anomalies than in a control group. This is especially true when the uterus is absent or is only partially present.
Abnormalities, Multiple↗
Three-contrasts method hysteroscopy: the use of real-time ultrasonography for monitoring intrauterine operations.
Thirty-four patients were operated on by the technique of three-contrasts method hysteroscopy in this article. In three-contrasts method hysteroscopy, sonography guidance was used instead of laparoscopy guide. The distending medium introduced into the uterus during hysteroscopy and injected normal saline into the bladder and abdomen (which flowed into the posterior cul-de-sac) created these three contrasts. As a result, the walls of the uterus were clearly seen at sonography. Advantages and disadvantages of this technique have been described in detail.
Adult↗