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Biomedical subjects

P F McComb

Publications and source records attributed to P F McComb.

At least 19 recordsLinked to original sources
PubMed2001

Role of laparoscopic salpingostomy in the treatment of hydrosalpinx.

OBJECTIVE: To determine pregnancy rates after laparoscopic salpingostomy in occlusive distal tubal disease. To evaluate the relative impact of various historical, physical, and operative factors on pregnancy outcome using a multivariate statistical analysis. DESIGN: Prospective cohort. SETTING: University-affiliated tertiary care infertility clinic. PATIENT(S): One hundred thirty-nine infertile women with occlusive distal tube disease. INTERVENTION(S): Laparoscopic salpingostomy. MAIN OUTCOME MEASURE(S): The occurrence of intrauterine (IUP) and ectopic pregnancy (EP). RESULT(S): The overall IUP and EP rates were 24.5% and 16.5%, respectively. Analysis of historical variables, assessed independently, demonstrated a significantly higher IUP rate with a positive history of gonorrhea and a significantly higher EP rate with a positive history of pelvic inflammatory disease, lack of history of intrauterine device (IUD) usage, or the performance of a bilateral procedure. The logistic regression model to predict intrauterine pregnancy had an overall predictive value of 77.5% and included the following significant variables: secondary infertility, positive history of gonorrhea, and the operative finding of moderate periadnexal adhesions. The logistic regression model to predict ectopic pregnancy had an overall predictive value of 89.0% and included the following significant variables: previous ectopic pregnancy, negative history of IUD use, positive history of PID, a bilateral procedure, and perihepatic adhesions. CONCLUSION(S): Operative laparoscopy may be effective for the correction of hydrosalpinges in selected patients. The probability of achieving an intrauterine or an ectopic pregnancy can be predicted based on combinations of significant variables.

Adult↗
PubMed1997

Simplified therapy for Asherman's syndrome.

OBJECTIVE: To evaluate a technique that converts a blind hysteroscopic procedure to a "septum" division. DESIGN: Open noncomparative clinical study. SETTING: Tertiary care center. PATIENT(S): Six women with Asherman's syndrome; five with complete and one with incomplete obliteration of the uterine cavity. INTERVENTION(S): The patients underwent recreation of the uterine cavity by the hysteroscopic-laparoscopic technique described to establish the correct dissection plane. MAIN OUTCOME MEASURE(S): The ability to reestablish the uterine cavity; postoperative resumption of menses and fertility. RESULT(S): In all patients, the cavity of the uterus was restored; menses resumed in all women who were previously amenorrheic; and 5 women conceived, of whom four had live births and one a missed abortion. At hysteroscopy, two women incurred perforations and in another hemorrhage occurred. CONCLUSION(S): This technique appears to be effective and safe for the reconstruction of a functional endometrial cavity in women with Asherman's syndrome.

Adult↗
PubMed1996

Laparoscopic lateral ovarian transposition.

OBJECTIVE: To determine if the new technique laparoscopic lateral transposition of the ovaries before pelvic radiotherapy for anal canal carcinoma prevents radiation-related ovarian failure. DESIGN: A case report. SETTING: The operating room of a Canadian teaching hospital. PATIENTS: A single patient with anal canal carcinoma, requiring pelvic radiotherapy, who desired preservation of ovarian function. INTERVENTIONS: Laparoscopic ovarian transposition to the level of the pelvic brim. MAIN OUTCOME MEASURES: Follow-up clinical and laboratory evidence of ovarian failure. RESULTS: Initially ovarian failure was confirmed with the appearance of postmenopausal symptoms and the elevation of serum gonadotropins. These symptoms resolved by 8 months after radiotherapy, normal menstrual cycles resumed, and normal FSH levels were detected at that time. CONCLUSIONS: The laparoscopic, lateral transposition of this patient's ovaries was effective at preventing radiation-related ovarian failure.

Adult↗
PubMed1995

Laparoscopic oophoropexy for recurrent adnexal torsion.

Torsion of the adnexa has traditionally been treated by adnexectomy because of the fear of emboli departing from thrombosed ovarian veins. Several recent reports have described successful conservative management with unwinding of the twisted adnexa. As the trend toward conservative management progresses, the incidence of recurrent adnexal torsion may increase. We present a case of a 33 year old gravida 3, para 2 Caucasian female who presented at 7 weeks gestation complaining of symptoms similar to those experienced during an episode of right ovarian torsion treated by laparoscopic unwinding 6 years earlier. Colour Doppler sonography revealed absent flow in the right adnexa. The twisted right adnexa containing the presumed corpus luteum of pregnancy was laparoscopically unwound. Using an extracorporeal suturing technique, a laparoscopic oophoropexy was performed to prevent any further rotatory movement. This appears to be the first reported case of laparoscopic oophoropexy for a recurrent ovarian torsion; we encourage the use of this simple, minimally invasive procedure in cases of recurrent adnexal torsion.

Adnexal Diseases↗
PubMed1995

A new selection criterion for fimbriectomy reversal.

OBJECTIVE: To assess a new criterion for selection of patients who request reversal of fimbriectomy sterilization. DESIGN: Prospective study. SETTING: Division of reproductive endocrinology and infertility in an academic center. PATIENTS: Eight patients undergoing reversal of fimbriectomy using microsurgical techniques. The prerequisite inclusion criterion was the presence of more than 50% ampulla as shown at hysterosalpingography. This is easily determined, because the isthmic length approximates one half the ampullary length. RESULTS: The cumulative intrauterine pregnancy rate was 50%. There were no ectopic pregnancies. CONCLUSION: Similar pregnancy rates for reversal of fimbriectomy have been reported based upon different absolute selection criteria (viz., tubal length of > or = 8 cm and ampullary width of > or = 1 cm). By contrast, our new selection criterion is based upon the more readily determined proportion of ampulla that is available for surgical neostomy.

Female↗
PubMed1995

Predictors of success of reversal of sterilization.

OBJECTIVE: To determine the prognostic variables effecting the successful pregnancy outcome of reversal of sterilization. DESIGN: Demographic and clinical history data were collected prospectively. SETTING: Division of Infertility and Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada. PATIENTS AND INTERVENTION: Between 1981 and 1992, 217 consecutively referred patients underwent reversal of sterilization by a single surgeon using microsurgical techniques. MAIN OUTCOME MEASURES: Prognostic variables associated with success were examined using logistic regression and expressed as odds ratios with corresponding 95% confidence intervals. RESULTS: Age at reversal was a significant factor with the odds of a successful outcome for those < or = 35 years compared with those > 35 years being 2.3 with a 95% confidence interval of 1.3 to 4.1. There was some evidence that average tubal length as categorized in 2-cm intervals was a significant prognostic factor with the odds of a successful outcome for those with an average length of > 4 cm to those < or = 4 cm being 5.3 with a 95% confidence interval of 1.4 to 20.0. CONCLUSIONS: Nonsubjective analysis of the prognostic variables of reversal of sterilization associates only age and tubal length of > 4 cm with intrauterine pregnancy.

Adult↗
PubMed1994

Removal of the ovarian surface epithelium from the rabbit ovary--a cause of adhesions following a standard injury.

To assess the effect of the removal of ovarian surface epithelium on repair, a standard injury was induced in the ovaries of 10 rabbits. In one ovary the surface cells were denuded, and in the other they were left intact. The effect on adhesion formation was assessed at 12 days. Adhesions were assessed by visual inspection at laparotomy and histological examination of adhesion formation, including a stereological assessment of scar volume. On visual assessment the overall adhesion scores for the denuded ovaries were greater than for the intact ovaries. Histology showed the adhesions were attached only to the site of injury. The Fallopian tube was adherent to 35 and 4% of the denuded and intact ovarian segments respectively (P = 0.003). The scar volumes for each side were similar. After 12 days there was only partial re-epithelialization on the denuded ovaries. Electron microscopy confirmed the slow healing, with much of the surface still covered by a fibrinous-like exudate. The findings of this small study lend further weight to the importance of the surface epithelium in the control of adhesion formation. Standard surgical procedures may generate adhesions by the inadvertent denuding of surface epithelium from adjacent healthy tissues, possibly by the loss of plasminogen activator activity that is found in the mesothelium of the peritoneum. This study highlights the importance of controlling for inadvertent cell loss whilst investigating methods for adhesion prevention.

Animals↗
PubMed1993

The ascites in the ovarian hyperstimulation syndrome does not originate from the ovary.

OBJECTIVE: To evaluate the direct ovarian contribution to ascites formation in the ovarian hyperstimulation syndrome (OHSS) in a rabbit model. DESIGN: Prospective experimental study. SETTING: Research center of a university teaching hospital. PARTICIPANTS: New Zealand White rabbits. INTERVENTIONS: Both ovaries of the rabbits in the experimental group were enclosed within a pouch developed from the surrounding peritoneum and mesosalpinx by microsurgery. Animals in the control group did not undergo any surgical intervention. Ovarian hyperstimulation was induced by alternate day equine chorionic gonadotropin and intermittent human chorionic gonadotropin (hCG). MAIN OUTCOME MEASURES: Degree of ascites formation and the morphological and endocrinologic signs of ovarian hyperstimulation. RESULTS: The serial plasma estradiol and progesterone levels, ovarian weights, and ascites response were not statistically different between the two groups. CONCLUSIONS: Isolation of both ovaries from the peritoneal cavity does not prevent ascites formation in the OHSS. Increased transudation across extraovarian serosal surfaces contributes to ascites formation in OHSS.

Animals↗
PubMed1992

Free autologous graft of fimbria to ampulla with subsequent oviductal function in the rabbit.

To test the hypothesis that a free, nonvascularized graft of fimbria would retain structure and function, fimbriae were transplanted autologously in 17 rabbits. Subsequently, the transplanted fimbrial tissue survived, with patency in almost all the animals, was capable of transporting surrogate cumulus oophorus but had reduced ovum capture capability. That the transplanted rabbit fimbria retains a degree of structure and function suggests that the technique warrants an investigation in women.

Animals↗
PubMed1991

Reproductive outcome after unilateral tubocornual anastomosis and contralateral salpingostomy by microsurgery.

A unilateral tubocornual anastomosis and a contralateral salpingostomy for unilateral proximal and contralateral distal occlusive disease yield similar fertility as does pure tubocornual anastomosis for proximal occlusive disease. Ascending inflammation is postulated as the mechanism for tubal occlusion, with distal sparing from disease if the initial insult results in initial occlusion of the proximal portion of the oviduct.

Adult↗
PubMed1991

Reproductive outcome after microsurgery for proximal and distal occlusions in the same fallopian tube.

The reproductive outcome after microsurgery for both proximal and distal occlusions in the same fallopian tube has been reported in only small numbers of women. Our case series is in agreement with other series and shows that microsurgery for correction of both proximal and distal occlusions in the same fallopian tube yields only modest fertility and may predispose to ectopic tubal pregnancies.

Adult↗
PubMed1991

The intussusception salpingostomy technique for the therapy of distal oviductal occlusion at laparoscopy.

A new technique of salpingostomy by laparoscopy for treatment of distal oviductal occlusion is described. This technique uses sharp dissection and can be performed rapidly. The intussusception salpingostomy is undertaken by making a relatively short incision in the hydrosalpinx and then prolapsing the tubal mucosa through this neostium. The borders of the incision thus act as a restrictive collar to maintain the mucosa in this newly everted configuration. In a series of 40 women subjected to this procedure, 22 were followed for more than 12 months postoperatively; the term pregnancy rate was 22.7%. This fertility is similar to that after salpingostomy by microsurgical laparotomy.

Adult↗
PubMed1991

Tubal occlusion after inguinal hernia repair. A case report.

Midtubal occlusion and infertility occurred subsequent to an inguinal hernia repair. Recognition of the traumatic etiology is important because other causes of midtubal obstruction, such as endometriosis, tuberculosis and adenomatoid tumor of the oviduct, may be considered contraindications to reconstructive surgery. Once recognized, the condition is highly amendable to microsurgical reconstruction.

Adult↗