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Biomedical subjects

M W Surrey

Publications and source records attributed to M W Surrey.

At least 19 recordsLinked to original sources
PubMed2001

Appendiceal disease in women with endometriosis and right lower quadrant pain.

STUDY OBJECTIVE: To evaluate the frequency and range of appendiceal disease in women with endometriosis and right lower quadrant (RLQ) pain, and to estimate the value of preoperative gastrograffin enema (GGE) as a screen for the disease. DESIGN: Nonrandomized clinical trial (Canadian Task Force classification II-2). SETTING: University-affiliated hospital with a private practice setting. PATIENTS: A subpopulation of 65 women from a group of 337 patients undergoing laparoscopy for symptomatic endometriosis. INTERVENTION: Preoperative GGE was performed whenever possible in these women. At laparoscopy, the appendix was removed if it appeared abnormal or if the preoperative GGE was positive. MEASUREMENTS AND MAIN RESULTS: Of 65 women (19%) with symptomatic endometriosis and preoperative RLQ pain, 52 (80%) underwent appendectomy as part of surgery. Of these 52 excised appendixes, 39 (75%) had histologically confirmed pathology including appendicitis or periappendicitis, endometriosis, fibrous obliteration, lymphoid hyperplasia, and carcinoid tumor. Preoperative GGE had sensitivity of 74% and specificity of 83% for appendiceal disease. Its positive predictive value was 95% and negative predictive value was 42%. No complications from laparoscopic appendectomy occurred. CONCLUSION: Disease of the appendix is common in women with endometriosis and RLQ pain. Appendectomy is particularly likely if preoperative GGE is positive.

Abdominal Pain↗
PubMed2000

Role of GnRH agonists in managing proximal fallopian tube obstruction.

OBJECTIVE: To assess the response of proximal fallopian tube obstruction to a medically induced hypoestrogenic state after control for spasm at the uterotubal ostium. STUDY DESIGN: This was a prospective, randomized, placebo-controlled, pilot study in a tertiary care, university-affiliated infertility practice. Twenty-one infertile women with unilateral or bilateral proximal tubal obstruction previously diagnosed by standard hysterosalpingography or laparoscopic chromotubation were randomized into two groups in a 2:1 design. Group I, 14 patients (27 occluded tubes), was administered a depot preparation of the gonadotropin-releasing hormone (GnRH) agonist leuprolide acetate, 3.75 mg intramuscularly every 28 days. Group II, seven patients (11 occluded tubes), was administered a placebo. Follow-up hysterosalpingography was performed after administration of the antispasmodic glucagon within four weeks of completion of the protocol. RESULTS: Evidence of ovarian suppression was confirmed within four weeks in group I. A trend toward higher posttherapy patency rates was noted in group I (74.7% vs. 40%). The lack of statistical significance may have been a function of sample size. Similarly, spontaneous intrauterine pregnancy rates were also higher in GnRH agonist-treated patients (35.1% vs. 16.6%, P < .05). Tubal patency rates were significantly greater in patients with documented estrogen-sensitive disorders who received the agonist (75% vs. 20%, P < .05) CONCLUSION: Proximal tubal obstruction may be an estrogen-sensitive phenomenon in a subset of infertile patients. The administration of GnRH agonists may successfully overcome this state and result in enhanced conception rates.

Adult↗
PubMed1999

Is intracytoplasmic sperm injection necessary for couples undergoing in vitro fertilization-embryo transfer with normal semen analyses but failing hamster egg penetration assays?

PURPOSE: Our purpose was to assess whether in vitro fertilization (IVF)-embryo transfer (ET) candidate couples with basically normal semen analyses but failing zona-free hamster egg penetration assay (HEPA) scores benefit from intracytoplasmic sperm injection (ICSI). METHODS: Twenty consecutive IVF candidate couples with normal-borderline semen analyses and failing HEPA scores were recruited. Mature oocytes obtained from each woman were randomly divided between ICSI (group I; n = 126 oocytes) and standard insemination techniques (group II; 138 oocytes). Fertilization (two pronuclei) and cleavage (2-4 cells) rates were assessed for both groups. RESULTS: There were no statistically significant differences between the two groups with respect to (mean +/- standard error of the mean) fertilization (group I, 63.1 +/- 7.75; group II, 77.8 +/- 4.7%) or cleavage (group I, 87.3 +/- 2.4%; group II, 91.2 +/- 3.5%) rates. CONCLUSIONS: ICSI is not beneficial for IVF-ET when sperm samples demonstrate a failing HEPA score but have normal or minimally compromised semen analysis parameters.

Adult↗
PubMed1998

Clinical and endocrine effects of a microdose GnRH agonist flare regimen administered to poor responders who are undergoing in vitro fertilization.

OBJECTIVE: To assess the endocrine and clinical responses to microdose GnRH agonist (GnRH-a) that was administered in the early follicular phase before controlled ovarian hyperstimulation to poor responders who were candidates for IVF-ET. DESIGN: Prospective nonrandomized trial with historical controls. SETTING: Tertiary care university-affiliated infertility practice. PATIENT(S): Thirty-four IVF-ET candidates with a prior poor response to a standard long-protocol GnRH-a controlled ovarian hyperstimulation regimen (cycle A). Patients were divided into two groups based on their age at the initiation of cycle A (Group 1: < or = 39 years, n = 15; Group 2: > or = 40 years, n = 19). INTERVENTION(S): Low-dose oral contraceptive (x 21 d) followed by GnRH-a (leuprolide acetate; 40 micrograms s.c. b.i.d.) flare and urofollitropin initiated on day 3 of GnRH-a administration (cycle B). MAIN OUTCOME MEASURE(S): Comparative analysis of clinical responses (total urofollitropin dose used and number of oocytes retrieved as well as fertilization and clinical and ongoing pregnancy rates) and endocrine responses (serum E2, FSH, LH, T, and P levels) between cycles A and B in the two groups. Early follicular phase serum E2 and FSH changes in groups 1 and 2 were compared with changes in nine normal responder controls who were receiving a standard long-protocol GnRH-a/urofollitropin regimen (group 3). RESULT(S): Maximal E2 levels as well as clinical and ongoing pregnancy rates were higher in cycle B patients receiving microdose GnRH-a. Cancellation rates in cycle B were lower than in cycle A. Statistically significant increases in treatment day 6 serum FSH levels were noted during cycle B in both groups 1 and 2 but not in group 3 controls. No abnormal rises in LH, P, or T were noted in any of the groups. CONCLUSION(S): Microdose GnRH-a enhances urofollitropin response and clinical outcome in poor responders undergoing IVF-ET. This may be due to enhanced release of early follicular phase endogenous FSH without concomitant deleterious rises in androgen levels or corpus luteum rescue.

Adult↗
PubMed1998

Presidential address.

Gynecologic endoscopic surgeons have achieved remarkable results in the past decade. We have frequently improved results compared with traditional open techniques. This has resulted in billions of dollars saved for the work force by converting inpatient to outpatient procedures and as a result decreasing the amount of time patients must be out of work. The growth of several industries including ambulatory surgicenters, managed care, and medical device manufacturers has been encouraged. Incomes for endoscopic surgeons have, however, decreased. Possible solutions include decreasing overhead, increasing income by participating in facility fees and performing a greater percentage of office procedures, and educating ourselves in billing processes and attempting to improve reimbursements for gender-specific procedures.

Cost Savings↗
PubMed1997

Multicenter feasibility study of a new coaxial falloposcopy system.

We compared falloposcopy employing a new coaxial system with traditional laparoscopic chromotubation and hysterosalpingography in a prospective, multicenter clinical trial at five tertiary infertility centers. Based on findings at hysterosalpingography or laparoscopic chromotubation, the 16 women (22 tubes) in group 1 had a presumed diagnosis of proximal tubal obstruction, and the 4 (7 tubes) in group 2 had unexplained infertility. Cannulation was successfully achieved in 83.3% of tubes. In group 1, 85% (17/20) of visualized tubes were patent and 35% (7/20) were normal. In group 2, 40% (2/5) of visualized tubes were abnormal. Management was changed in 52.4% of women as a result of falloposcopic findings. Falloposcopy with this new coaxial system allows improved visualization with less bulky and less traumatic instruments. The system provides valuable information regarding the fallopian tube lumen that correlates poorly with that obtained with more traditional techniques.

Adult↗
PubMed1996

Correlation between salpingoscopic and laparoscopic staging in the assessment of the distal fallopian tube.

OBJECTIVE: To correlate the severity and extent of intraluminal tubal abnormalities assessed by transfimbrial salpingoscopy with traditional criteria for evaluating distal tubal disease at laparoscopy. DESIGN: Prospective 2-year clinical trial with long-term follow-up. SETTING: University-affiliated tertiary care reproductive medicine and surgery practice. PATIENTS: Fifty-five infertile women with suspected distal tubal disease or unexplained infertility. INTERVENTIONS: Transfimbrial salpingoscopy was performed at the time of laparoscopy and terminal neosalpingostomy when appropriate. Salpingoscopic and laparoscopic findings of 91 fallopian tubes were scored independently. RESULTS: No correlation between laparoscopic and salpingoscopic findings was noted in group I tubes (n = 51) categorized as having minimal disease or no pathology by traditional staging. In contrast, a strong correlation was noted between findings obtained from these two techniques in group II tubes (n = 40) diagnosed as having moderate-to-severe tubal disease at laparoscopy. Intrauterine pregnancy was achieved in 38.9% (7/18) of patients with mean salpingoscopy scores < or = to 12 versus 3.8% (1/26) of patients with mean scores > 12. Life-table analyses of cumulative estimated pregnancy rates were significantly different between the groups. CONCLUSIONS: Fallopian tubes with minimal pathology appreciated at laparoscopy may have more significant intraluminal disease appreciated at salpingoscopy. In contrast, laparoscopic and salpingoscopic findings do correlate well in cases of more severe distal disease. Elevated mean salpingoscopy scores are associated with an extremely poor prognosis for conception.

Adnexal Diseases↗
PubMed1995

Operative hysteroscopy: American Association of Gynecologic Laparoscopists' 1993 membership survey.

The 1993 American Association of Gynecologic Laparoscopists' membership survey on operative hysteroscopy had 713 respondents reporting 14,707 procedures. Directed biopsy and endometrial ablation were the most commonly reported. The majority of operative hysteroscopies were performed for a complaint of abnormal bleeding (78%). The most frequent reported complication was uterine perforation not requiring transfusion (14.2/1000 procedures). The rates of water intoxication and pulmonary edema stayed essentially unchanged from 1991: 2/1000 in 1993 compared with 1.4/1000 in 1991. No deaths were reported this year. The consistency in rates of procedures performed and complications within the three surveys conducted in 1988, 1991, and 1993 add credibility to the data from these retrospective studies.

Biopsy↗
PubMed1995

Operative laparoscopy: American Association of Gynecologic Laparoscopists' 1993 membership survey.

The American Association of Gynecologic Laparoscopists' 1993 membership survey on operative laparoscopy had 825 respondents reporting 45,042 procedures. The most frequent indication was pelvic pain (56% of procedures), followed by infertility (38%). There were 7382 laparoscopically assisted hysterectomies reported. Compared with 1988 and 1991 survey data, the rates of unintended laparotomy, hemorrhage, and bowel or urinary tract injury increased, but the overall complication and death rates remained essentially unchanged.

Female↗
PubMed1995

Laparoscopic sterilization: American Association of Gynecologic Laparoscopists' 1993 membership survey.

The 1993 membership survey of the American Association of Gynecologic Laparoscopists received 938 responses, or 13% of the membership. The surgeons reported performing 22,966 sterilizations and 36,482 diagnostic procedures. The distribution of sterilization techniques has remained stable since 1985. Complication rates associated with diagnostic procedures remain consistently higher than those with sterilizations. One death was reported from sterilization, none for diagnostic procedures.

Female↗
PubMed1994

Treatment of endometriosis by carbon dioxide laser during gamete intrafallopian transfer.

BACKGROUND: Endometriosis is often encountered during laparoscopy performed for gamete intrafallopian transfer (GIFT) procedures. STUDY DESIGN: A prospective randomized study involving 44 patients with endometriosis (American Fertility Society (AFS) stages I through IV) was conducted. All patients underwent controlled ovarian hyperstimulation followed by laparoscopic GIFT procedures. Twenty-one patients had no carbon dioxide laser vaporization of endometriosis and twenty-one patients did receive laser vaporization. Two patients could not have GIFT performed due to tubal and peritubal disease. RESULTS: The results showed a clinical pregnancy rate of 38.1 percent in the treatment groups versus 47.9 percent in the control group (not significant, Chi square, and Student's test). The live birth rate from both groups was identical, at 23.8 percent per group. CONCLUSIONS: We conclude that CO2 laser vaporization of AFS stages I to IV endometriosis at the time of the GIFT procedure does not significantly affect either the clinical pregnancy rate or live birth rate from this form of assisted reproductive technology.

Adult↗
PubMed1993

Operative laparoscopy. American Association of Gynecologic Laparoscopists 1991 membership survey.

The American Association of Gynecologic Laparoscopists 1991 membership survey on operative laparoscopy had a total of 878 respondents reporting 56,536 procedures, for a 1.5-fold increase over the number of procedures reported in 1988. The most frequent indication was pelvic pain (58% of procedures); next was infertility (42%). Laparoscopic management of ectopic pregnancy increased over twofold, from 1,914 cases in 1988 to 4,620 in 1991. As compared to the 1988 survey data, the rate of unintended laparotomy to manage hemorrhage, bowel or urinary tract injury may have increased, but the death rate remained low, 1.8 per 100,000 procedures.

Female↗
PubMed1993

Operative hysteroscopy. American Association of Gynecologic Laparoscopists 1991 membership survey.

The 1991 American Association of Gynecologic Laparoscopists membership survey on operative hysteroscopy had a total of 630 respondents (almost double the 1988 number) who reported performing 17,298 procedures as compared to 7,293 in 1988. Directed biopsy and endometrial ablation were the procedures reported most commonly. Endometrial ablation increased fivefold since 1988, and myomectomy increased fourfold. The majority of operative hysteroscopies were performed for a complaint of abnormal bleeding (73%). The most frequently reported complication was uterine perforation not requiring transfusion (11 per 1,000 procedures). The rate of water intoxication or pulmonary edema dropped from 3.4/1,000 in 1988 to 1.4/1,000 in 1991. However, some serious complications (eight laparotomies for bowel injury, three CO2 embolisms and three deaths) were reported for 1991.

Female↗
PubMed1993

Laparoscopic sterilization. American Association of Gynecologic Laparoscopists 1991 membership survey.

The 1991 membership survey of the American Association of Gynecologic Laparoscopists indicated more laparoscopic procedures than had been reported in the last survey, in 1988. The respondents reported 30,480 sterilizations, 41,160 diagnostic laparoscopies and 8,015 hysteroscopies. The distribution of sterilization by method of tubal occlusion has remained stable since 1985. Complications from diagnostic laparoscopy remain consistently higher than from sterilization. This year the complication rate for diagnostic procedures was higher than in any other year since 1976 (4.9 per 1,000 cases). One death was reported after sterilization and one after diagnostic laparoscopy.

Female↗
PubMed1992

Management of ovarian masses. AAGL 1990 survey.

The American Association of Gynecologic Laparoscopists (AAGL) membership was surveyed on the use of laparoscopy in the management of persistent ovarian masses in 1990. A total of 13,739 laparoscopies were performed for this indication. Ninety-six percent of the respondents performed laparoscopy for this indication on premenopausal women only. Among respondents performing laparoscopy for suspected cancer, there was a 14% conversion rate to laparotomy, compared to 9% among those who performed direct laparotomies when cancer was suspected. An overall incidence of 4 per 1,000 cases of stage I ovarian cancer was found, and about 70% of women with persistent adnexal masses were managed by laparoscopy alone. The risks to women with cancer, as well as the benefits to those without, are discussed.

Female↗
PubMed1987

Adhesion reformation and de novo adhesion formation after reproductive pelvic surgery.

At second-look laparoscopy, 82 of 161 women (51%) were noted to have adhesions at at least one new location. Such adhesions occurred at 31% of available sites. Among 121 women with adhesions at the initial operative procedure, the rate and type of recurrence assessed on the ovaries, fimbriae, and other sites were independent of the initial type. Additionally, neither the rate nor the type of adhesion recurrence observed at the time of second-look laparotomy was determined by the variable amount of time between the initial and second-look operative procedures. We conclude that reproductive pelvic surgical procedures are frequently complicated not only by adhesion reformation but by de novo adhesion formation as well.

Female↗
PubMed1986

Clinical results of terminal salpingostomy with the use of the CO2 laser: report of the Intraabdominal Laser Study Group.

Forty-eight women underwent terminal salpingostomies with a standard operative procedure with the use of the CO2 laser and microsurgical techniques at five centers. Early second-look laparoscopy was performed in all patients 1 to 12 weeks after the laparotomy. The tubal patency rate at the second look was 92% for these 48 patients, with a minimum of 6 months' follow-up study in all patients. Of these patients, ten became pregnant (21%), one with an ectopic pregnancy (10%). All pregnancies occurred within 12 months of the second-look procedure. It is preliminarily concluded from this series that use of the CO2 laser for neosalpingostomy at laparotomy with early second-look laparoscopy provides a term pregnancy rate similar to that previously achieved by nonlaser microsurgical techniques and shortens the time period between the surgical procedure and when conception would be expected to occur.

Adult↗