Biomedical subjects
Publications and source records attributed to J A Fayez.
The records of 63 patients who had appendectomy for chronic lower abdominal pain were reviewed. Histologically 92% of the removed appendices revealed abnormality, and 95% of these patients were completely cured. It is concluded that appendicopathy does exist and could be the cause of chronic lower abdominal pain.
Medical records and postoperative hysterosalpingograms on 23 women following tubal surgery who failed to become pregnant within 2-28 months were reviewed. A total of 39 tubes were analyzed. The surgical indications were reversal of tubal ligation in 24 tubes and correction of tubal or perifimbrial disease in 15 tubes. Tubal ligation had been performed by a variety of methods. At surgery, tubal patency, as shown by chromotubation, was seen in 37 (95%) of 39 tubes. On postoperative hysterosalpingography, tubal spillage was present in 32 (82%) of 39 tubes. Radiographically, the tubes that spilled appeared normal except for occasional shortening after reversal of tubal ligation. The eventual pregnancy rate was 8 (35%) of 23 patients, with 7 intrauterine. Pregnancy occurred only in women under 35 years and was more likely in the group having reversal of tubal ligation. We conclude that among patients who do not initially become pregnant following tubal surgery for infertility, tubal patency is restored in most. During hysterosalpingography, tubes operated on may appear normal or shortened. On long-term follow-up, younger patients and those requiring tubal anastomosis only had a higher pregnancy rate.
OBJECTIVE: To evaluate the short hospital stay for different gynecologic reconstructive procedures performed by laparotomy. METHODS: Two hundred twelve patients who had tubal reanastomosis, 124 who had salpingoneostomy, and 148 who had myomectomy were studied retrospectively. The study evaluated pregnancy rates, adhesion formation, discomfort, and complications in each group. RESULTS: Pregnancy rates for the reanastomosis, salpingoneostomy, and myomectomy patients were 72, 34, and 63%, respectively. Twenty-three percent of salpingoneostomy patients developed flimsy periadnexal adhesions, whereas only 9% in the myomectomy group developed flimsy pelvic adhesions. No complications occurred in any of the three groups. Less than 1% of patients in the two tuboplasty groups complained of minimal abdominal discomfort before discharge, and 4% had similar complaints in the myomectomy group. CONCLUSION: Patients who have gynecologic reconstructive surgery can be discharged within 24 hours after the procedure with an excellent outcome.
In a prospective study designed to evaluate four methods of endometrioma treatment by laparoscopy, 26 patients had the endometriomas excised, 24 had them opened and the lining stripped off, 30 had them opened and the lining evaporated by CO2 laser, and 44 had them opened and drained. Only women who had laparoscopy because of pelvic pain and who had no immediate desire for pregnancy were included in this study. Those who did not undergo a second-look laparoscopy were excluded. Pain disappeared completely from all subjects regardless of the method of treatment. At second-look laparoscopy, all women in the excision group, nine (37%) in the group who had the lining stripped, nine (30%) in the group who had the lining evaporated, and 12 (27%) in the drainage group had periadnexal adhesions. Residual endometriosis was found in 23, 25, 33, and 30% of these groups, respectively. Because there was a statistical difference between the excision group and each of the remaining three groups in the formation of adnexal adhesions and because there was no statistical difference among the four groups regarding the presence of residual endometriosis, we conclude that laparoscopic treatment of endometriomas should not include excision but rather drainage with or without elimination of the inner lining.
This is a retrospective study designed to compare the results of treatment of minimal and mild types of endometriosis with danazol alone, operative laparoscopy and danazol combined, and operative laparoscopy alone. The population consisted of 112 patients with minimal endometriosis and 126 patients with the mild type. Pregnancy rate and endometriosis resolution were lowest in patients who were treated with danazol alone and highest in patients treated with operative laparoscopy alone. It is concluded that in an infertile population with minimal to mild endometriosis danazol alone appears ineffective in improving the pregnancy rate or in achieving complete resolution of endometriosis. Laparoscopic surgery for the treatment of minimal to mild endometriosis seems to be a promising method of treatment.
Pregnancy outcomes were evaluated retrospectively in 350 women to investigate the relationship between endometriosis and spontaneous abortions. The frequency of spontaneous abortions in women with endometriosis was significantly higher than in both a fertile nonendometriosis group and an infertile group with tubal disease. There was no correlation between the severity of the endometriosis and the frequency of spontaneous abortions. After treatment, the frequency of spontaneous abortions was significantly decreased in both the endometriosis and the tubal disease group, but these values were not significantly different from each other. We conclude that high spontaneous abortion rates are a characteristic of other subgroups of women with secondary infertility and not just in women with endometriosis, and that the majority of spontaneous abortions associated with endometriosis are not caused by the condition.
Forty-four patients with partial or complete cornual occlusion of their tubes had undergone microsurgical repair in the form of either tubouterine implantation or tubouterine anastomosis. Eighteen of these patients had undergone the implantation procedure and 26 the anastomosis procedure. None of the patients in the implantation group had previous tubal sterilization, while in the anastomosis group 16 had tubal cauterization and 10 had other causes blocking the cornual end of their tubes. The patency rate in the implantation group was 70% and the pregnancy rate was 39%, while in the anastomosis group the rates were 94% and 69%, respectively. It is concluded that, when feasible, tubouterine anastomosis should be the procedure of choice for the repair of the cornual occlusion of the tube irrespective of the cause of obstruction.
Four hundred infertile patients had hysterosalpingography and hysteroscopy as part of their infertility workup. A comparison between the findings of these two procedures was carried out to study their diagnostic value in female infertility investigation. It was found that hysterosalpingography was as accurate as hysteroscopy in the diagnosis of normal or abnormal uterine cavities while the nature of the intrauterine filling defects was accurately revealed by hysteroscopy only. It is concluded that hysterosalpingography is an important screening procedure for the diagnosis of normal or abnormal uterine cavities and that hysteroscopy should be reserved only for the confirmation and treatment of intrauterine anomalies discovered by hysterosalpingography. Therefore we look at the two procedures, hysterosalpingography and hysteroscopy, as complementary techniques.
Serum CA-125 antigen levels were measured by radioimmunoassay before and during menses in women with and without endometriosis. Mean CA-125 levels were significantly increased in both groups during menses. Samples obtained during menses represent a potential source of elevated levels and false positive results.
Because serum CA-125 concentrations are increased in women with endometriosis, our objective was to determine whether CA-125 levels could be used to differentiate endometriotic from nonendometriotic benign cysts. During a 2-year period, all women who had an endometrioma (n = 33) or a nonendometriotic cyst (n = 27) that was greater than or equal to 4 cm were included. Serum CA-125 levels were measured by an immunoradiometric assay, and the mean concentrations in women with an endometriotic cyst increased as the diameter of the cyst increased. The mean CA-125 concentrations in women with cysts greater than or equal to 4 cm were 53 +/- 2 U/ml in 19 women with an endometriotic cyst, 11 +/- 1 U/ml in 20 women with a nonendometriotic cyst, and 15 +/- 1 U/ml in 7 women with a nonendometriotic cyst and endometriosis. In the fluid of 10 endometriomas, the mean CA-125 concentration was 290 +/- 94 X 10(3) U/ml (range 10 to 900 X 10(3) U/ml). With cysts diameters greater than or equal to 4 cm, 19 of 19 women with endometriotic cysts, zero of seven women with nonendometriotic cysts and endometriosis, and zero of 20 women with nonendometriotic cysts had CA-125 concentrations greater than or equal to 20 U/ml (99% upper normal limit). We conclude that serum CA-125 determinations offer an excellent method to differentiate endometriotic from nonendometriotic benign cysts.
This prospective study was designed to investigate the effect of glucocorticoids, promethazine (Phenergan), hyskon, heparin, and Ringer's lactated solution in the prevention of pelvic adhesion formation after pelvic surgery. The patients were divided into two groups: The first consisted of 396 patients who had laparotomy for different types of pelvic surgery, and the second group consisted of 546 patients who had operative laparoscopy for different types of pelvic disease. Patients in these two major groups were divided prospectively into different subgroups with different modalities of adjuvant therapy to prevent postoperative pelvic adhesions. A second-look laparoscopy was performed for some of the patients who failed to conceive in each of these subgroups. Pregnancy rate and adhesion formation were compared between these subgroups with no statistical difference noted. It is concluded that glucocorticoids, promethazine, heparin, and hyskon have no therapeutic advantage over Ringer's lactated solution in the prevention of postoperative pelvic adhesion formation.
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CA-125, a cell-surface antigen, was measured by a radioimmunoassay in the serum of 414 women to determine its potential usefulness in the diagnosis and management of endometriosis. In women with minimal, mild, moderate, and severe endometriosis, the mean levels (+/- standard deviation) were 13.6 +/- 6.8, 22.8 +/- 15.5, 27 +/- 17, and 50 +/- 28 U/ml, respectively, and were significantly higher than mean levels (7.8 +/- 4.1) in 46 women with a normal laparoscopic examination. Higher mean CA-125 values also were observed in acute pelvic inflammatory disease, unexplained fertility, and pregnancy and during menstruation. The mean CA-125 value in women with treated endometriosis and a negative second-look laparoscopy was significantly lower than in women with untreated endometriosis. With the use of the 95% upper limit of 16 U/ml, the test had a sensitivity of 53% and specificity of 93%. The frequencies of elevated levels in minimal, mild, moderate, and severe endometriosis were 27%, 68%, 73%, and 100%, respectively. Changes in the CA-125 levels correlated with the clinical course of endometriosis in 37 of 44 (84%) women (P less than 0.001). The determination of CA-125 levels may assist in the evaluation and treatment of women with endometriosis.
Thirty-three patients were diagnosed by hysterosalpingography and laparoscopy as having septate uteri, which were assumed to be responsible for their infertility, recurrent abortions, or premature labor. Fourteen of these had Tompkins metroplasty (group 1) while the other 19 had their repairs done by hysteroscopic metroplasty (group 2). Post-operative hysterosalpingography for patients in group 1 revealed normal uterine cavities in 72%, incomplete septum excision in 14%, and intrauterine filling defects in 14%. The corresponding figures in group 2 were 88, 12, and 0%. In group 1, 71.0% became pregnant; of these, 70% continued to term (with delivery by cesarean section), 20% aborted, and 10% were tubal pregnancies. In group 2, 84% became pregnant; of these, 87% had term vaginal deliveries, and 13% miscarried. Patients in group 2 had less operative time, less blood loss, and shorter hospital stays. These findings demonstrate that hysteroscopic metroplasty may be preferable to the transabdominal procedure based on cost and morbidity considerations as well as on anatomic and reproductive outcome.
Thirty New Zealand White female rabbits underwent tubal resection and reanastomosis for comparison of conventional microsurgery and laser microsurgical techniques. The rabbits were divided into three groups. The first group of 10 rabbits had 3 cm of tissue resected by knife from each uterine horn; the cut ends were then reanastomosed in one layer with 8-0 Vicryl sutures with the use of the operating microscope. The second group of 10 rabbits had 3 cm of tissue resected by laser from each uterine horn; the cut ends were then reanastomosed in one layer with 8-0 Vicryl. The third group of 10 rabbits had 3 cm of tissue resected by laser from each uterine horn; the cut ends were then reanastomosed by "welding" the tissues with the laser. All rabbits in the first group became pregnant. Only four in the second group became pregnant, but none in the third group became pregnant. It is concluded that the carbon dioxide laser beam as used in this study has no place in tubal resection and reconstruction.
Eighty-three patients had tuboplasty by means of operative laparoscopic techniques. The procedures performed included salpingolysis, whereby only peritubal adhesions were lysed; ovariolysis, whereby only periovarian adhesions were lysed; salpingoovariolysis, whereby peritubal and periovarian adhesions were lysed; fimbrioplasty, whereby the partially agglutinated fimbrial end was teased open; and salpingoneostomy, whereby the completely blocked fimbrial ends were opened. Patency rates were, respectively, 100%, 100%, 100%, 64%, and 31%; and pregnancy rates were, respectively, 67%, 72%, 50%, 35%, and 10%. The only complication encountered was minimal bleeding in the patients in whom salpingoneostomy was performed. These results suggest that operative laparoscopy may be the method of choice for tubal operations that involve any of the first three categories, whereas the last two categories should be used in open laparotomy techniques.
The uterine horns of 40 New Zealand White female rabbits were resected and anastomosed to compare microsurgical anastomosis of the horns excised with microscissors, with a laser, and with a microelectrode. The rabbits were divided into four groups. In the first group of ten rabbits, 3 cm of tissue was resected by microscissors from each uterine horn; the cut ends were then anastomosed in one layer with 8-0 Vicryl sutures using the operating microscope. In the second group of ten rabbits, 3 cm of tissue was resected by laser from each uterine horn; the cut ends were then anastomosed in one layer with 8-0 Vicryl. In the third group of ten rabbits, 3 cm of tissue was resected by laser from each uterine horn; the cut ends were then anastomosed by "welding" the tissues with the laser. In the fourth group of ten rabbits, 3 cm of tissue was resected by a microelectrode; the cut ends were then anastomosed in one layer with 8-0 Vicryl sutures using loupe magnification. All the rabbits in the first and fourth groups became pregnant, only four became pregnant in the second group, and none became pregnant in the third group. It is concluded that the CO2 laser beam as used in this study has no place in tubal resection and reconstruction.