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Biomedical subjects

P McComb

Publications and source records attributed to P McComb.

At least 19 recordsLinked to original sources
PubMed2000

Crohn's disease and tubal infertility: the effect of adhesion formation.

The purpose of this paper was to assess the management of tubal disease in women with Crohn's disease. We are presenting a case series describing four patients with Crohn's disease who were treated at a tertiary infertility clinic within an university hospital. Fertility investigations and appropriate therapy plans in these patients with Crohn's disease who also had tubal infertility are outlined. The clinical outcome in all four cases demonstrated interference with the management and surgical therapy of the tubal infertility by extensive adhesion formation. We conclude that adhesion formation complicates the investigation and surgical therapy of patients with Crohn's disease.

Adult↗
PubMed1998

Heterotopic pregnancy complicating in vitro fertilization.

A review was undertaken of the cases of heterotopic pregnancy resulting from in vitro fertilization/embryo transfer (IVF/ET) and frozen embryo replacement (FER) in a 6-year cohort of women at National Women's Hospital in Auckland. The incidence of heterotopic pregnancy was 2.9% (5 cases) in 173 clinical pregnancies resulting from 901 embryo replacements. Of the 5 women with heterotopic pregnancy, 1 had unilateral tubal patency and 4 had bilateral tubal blockage; 3 had 'high responder' peak serum oestradiol levels (greater than 9,000 pmol/L) prior to oocyte pick-up (OPU); 3 had a serum human chorionic gonadotrophin beta subunit (beta-HCG) level greater than 600 IU/L on Day 14 following embryo transfer (ET) in the absence of a multiple intrauterine gestation on subsequent ultrasound scan. In the 4 women in whom unequivocal diagnosis of heterotopic pregnancy was not made on the initial ultrasound scan, there was delay in appropriate management, in 1 for more than 5 months. In conclusion, early IVF pregnancies require a transvaginal ultrasound scan performed by a sonographer experienced in the diagnosis of ectopic pregnancy and management of early pregnancy complications by clinicians in close consultation with the IVF centre itself. No single risk factor, laboratory test or combination of these is sensitive or specific enough to predict the occurrence of heterotopic pregnancy. The first-line surgical treatment of heterotopic pregnancy should be laparoscopic salpingectomy with excision of all except the intramural portion of the affected Fallopian tube.

Adult↗
PubMed1992

Midtubal occlusion: etiology, management, and outcome.

OBJECTIVE: To assess the significance of pathological midtubal occlusion in infertility. DESIGN: Retrospective descriptive case review. SETTING: Tertiary referral center. PATIENTS: Sixteen women, 26 to 38 years of age presenting with infertility and diagnosed as having midtubal occlusion. INTERVENTIONS: Assessment of the etiology of the occlusive disease and yield of microsurgical tubotubal anastomosis. MAIN OUTCOME MEASURES: Histologic examination of occluded tubal segment and fertility outcome subsequent to anastomosis. RESULTS: Occlusion was because of tuberculous salpingitis (n = 6), resolved tubal pregnancy (n = 3), endometriosis (n = 2), chronic inflammatory reaction (n = 1), tubal cyst (n = 1), intratubal adhesions (n = 1), infant hernia repair (n = 1), and calcification (n = 1). Of eight women (including the patient with tuberculous salpingitis) who underwent tubal anastomosis only for midtubal occlusion, three had subsequent term deliveries, two had tubal pregnancies, and three women did not conceive. CONCLUSION: Midtubal occlusion of the tube because of an infectious process is rare. Excluding tuberculous salpingitis, microsurgical anastomosis yields satisfactory fertility, albeit with significant risk of ectopic pregnancy.

Adult↗
PubMed1989

A comparative histologic study on the healing process after tissue transection. I. Carbon dioxide laser and electromicrosurgery.

The present study was undertaken to evaluate and compare histologic parameters of wound healing subsequent to a standard uterine incision with carbon dioxide laser and electromicrosurgery in the rat model. The following histologic parameters were assessed and scored: scar width; amount of particulate carbon and necrotic debris; number of polymorphonuclear leukocytes, lymphocytes, histiocytes, and giant cells; and extent of edema, exudate, and collagen in the scar. The incisions were evaluated on postoperative days 0, 4, 7, 14, and 21. The ensuing scars were similar with respect to scar width and the amount of collagen in the scar. Foreign body reaction, denoted by histiocytes and giant cells, was significantly more pronounced in the electromicrosurgery group. Carbon particles, along with necrotic debris, appear to induce a foreign body tissue reaction. The particulate carbon in the electromicrosurgical incisions was significantly more extensive and was associated with the pronounced and longer lasting foreign body reaction in this group.

Animals↗
PubMed1989

A comparative histologic study on the healing process after tissue transection. II. Carbon dioxide laser and surgical microscissors.

In a previous study we have demonstrated that tissue transection with a carbon dioxide laser produces less carbon and less foreign body reaction than electromicrosurgery. The purpose of this study was to compare the healing process subsequent to transection of the rat uterine horn with carbon dioxide laser and microscissors. Incisions were histologically examined on postoperative days 0, 4, 10, 14, and 21. The following histologic parameters were assessed: scar width; amount of carbon and necrotic debris; number of polymorphonuclear leukocytes, lymphocytes, histiocytes, and giant cells; and extent of edema, exudate, and collagen in the scar. The results show that cutting with a carbon dioxide laser causes significantly more necrosis and hence more extensive foreign body reaction than cutting with microscissors.

Animals↗
PubMed1989

Successful transplantation of a free fimbrial graft to the peritoneum.

Loss of fertility due to prior segmental resection of the fallopian tube (for ectopic pregnancy or sterilization) can be treated with a free fimbrial graft, especially when the fimbrial segment is contralateral to the proximal tube that is needed for the anastomosis. To evaluate the structure and function of the fimbria after free grafting, the fimbria was cut from the tube and sewn without a blood supply to the peritoneum in 14 rabbits. After convalescence, scanning electron microscopy showed fewer secondary mucosal folds in the grafted fimbria than in the normal fimbria. The ciliated and secretory cells in the graft were identical to those of normal cells. The transport rate of surrogate ova across the grafted fimbrial mucosa was consistent with that across the normal fimbrial mucosa, demonstrating that near-normal structure and function are preserved after a free graft of the fimbria.

Anastomosis, Surgical↗
PubMed1988

Characteristics of state hospital patients who are hard to place.

As a result of deinstitutionalization, acute care beds in state hospitals have become blocked by patients who lack access to appropriate community placements but who have derived maximum benefit from hospital care. To help plan community services for these patients, this study identified and described patients at an Oregon state hospital who were hospitalized longer than therapeutically necessary because no community facility could treat them. A total of 146 patients were identified during a three-month period, and 81 were described; 65 percent were men, 70 percent were schizophrenic, and 90 percent presented a risk to themselves or others. The patients exhibited few strengths, and one-third had a substance abuse problem, at least one counter-therapeutic attitude, or a need for medical monitoring. The authors describe how new community residential facilities can meet the needs of these difficult patients.

Adult↗
PubMed1986

The effectiveness of CO2 laser and electromicrosurgery in adhesiolysis: a comparative study.

This study was undertaken to assess the relative effectiveness of the CO2 laser and electromicrosurgery in adhesiolysis. Intraperitoneal adhesions were produced in 44 female white rats by inflicting a standard and reproducible injury to the serosa of a specific area of the right uterine horn. At a second intervention, 2 weeks later, the adhesions formed by the initial injury were assessed and division of adhesions effected in a random manner, either with the use of the CO2 laser or with electromicrosurgery, adhering to accepted microsurgical techniques. At a third intervention, results were assessed. The results demonstrate that electromicrosurgery and the CO2 laser are equally effective for adhesiolysis in the rat model.

Animals↗
PubMed1986

Microsurgical tubocornual anastomosis for occlusive cornual disease: reproducible results without the need for tubouterine implantation.

Microsurgical tubocornual anastomosis (TCA) and tubouterine implantation are the two primary operations used to treat proximal tubal occlusion (PTO). Tubouterine implantation usually has been reserved for cases of PTO in which the occlusion spans the entire intramural tubal segment. Yet TCA has proven to be more likely to lead to successful pregnancy than tubouterine implantation. In this series, all PTO was treated by TCA. The article compares the reproducibility of results of TCA by two different operators and establishes the usefulness of TCA in all cases of PTO without resort to tubouterine implantation. Fifteen of 26 women achieved viable intrauterine pregnancies, a rate virtually identical to that published earlier by Gomel. Microsurgical TCA can be used to the exclusion of tubouterine implantation to achieve higher pregnancy rates, despite complete intramural occlusion.

Fallopian Tube Diseases↗
PubMed1986

The oviductal cilia and Kartagener's syndrome.

Women who have Kartagener's syndrome (primary ciliary dyskinesia) may or may not be fertile. The bronchial mucociliary clearance is reduced markedly in most of these women; this has led investigators to the conclusion that the cilia in the respiratory tract are immotile, and that "beating cilia may have no indispensable role in the female reproductive tract." Yet motile cilia are considered by many workers to be essential for normal ovum transport. More recently, bizarre ciliary motion has been described in the respiratory cilia of Kartagener's women. Our hypothesis was that the dyskinetic ciliary activity (or immotility) would be the same in both the respiratory and reproductive tracts and thus explain the fertility (or lack of it) in Kartagener's women. This report shows an identical ultrastructure and absolute immotility of cilia in both the respiratory tract and reproductive tract of a woman with Kartagener's syndrome who has never conceived. From this concordance, we suggest that the fertility of Kartagener's women is explained by the dyskinetic motion of oviductal cilia, and that the ciliated endosalpinx is essential for human reproduction.

Adult↗
PubMed1985

The Estes operation (transposition of one ovary to the uterine cavity): its results in the rabbit model.

Pregnancies have been reported after the Estes procedure (EP). These results have not been duplicated in modern attempts. The recent report of intrauterine fertilization in humans gives support to the feasibility of this procedure as a possible alternative to in vitro fertilization. An animal model is needed to evaluate the outcome of this operation. Consequently, 14 mature New Zealand white rabbits had one ovary placed in the uterine cavity after contralateral oophorectomy and bilateral salpingectomy. One month later, the animals were mated with a fertile buck. Fourteen to 16 days after that, the outcome was evaluated. Twenty-five to 75% of the ovarian surface was exposed to the uterine lumen, and no evidence of ovulation or implantation was found. The lack of pregnancies was attributed to an ovulatory dysfunction. Anovulation after the EP may also occur in the clinical situation, as suggested by one histologic study. The ovulatory function of these patients has not been characterized in the literature. Documentation of a successful intrauterine fertilization with delivery of a term baby supports the theoretical feasibility of the EP; however, anovulation incurred by our procedure appears to be the major drawback.

Animals↗
PubMed1985

Microsurgical transposition of the human fallopian tube and ovary with subsequent intrauterine pregnancy.

This is the report of a case of a single left unicornuate uterus in a woman whose ipsilateral tube and ovary had been removed subsequent to a left tubal pregnancy. On the right side were present an ovary and a short oviduct (composed of infundibulum and ampulla) immobilized high on the pelvic side wall. Surgical transposition of the right ovary and tube with preservation of their vascular supply permitted anastomosis between the left intramural and the right ampullary tubal segments. The ovary was mobilized to restore a proper spatial relationship with the fimbrial extremity of the tube. In the third postoperative cycle, the patient was successful in achieving an intrauterine pregnancy and has now been delivered of a normal live infant. The potential of microsurgical techniques in restoring fertility in the face of unusual pelvic anatomy is reiterated.

Adult↗
PubMed1984

The functional potential of the rabbit fimbria.

The ability of the normal rabbit fimbria to retrieve eggs after progressive reduction of its mucosal surface was tested on 16 New Zealand white rabbits. Group 1 had a small fimbrial resection; group 2 had a large one. The resected tissue was weighed, and in both groups the contralateral fimbria (internal control) was cut and sutured without resection. Four weeks later the animals were mated, and 12 hours afterwards the ovulation sites on each ovary were counted and both tubes excised. In vivo observations of the transport of cumulus surrogates by the experimental fimbria were made before tubal excision in group 2 animals. The natural eggs retrieved by the fimbria were recovered by flushing the resected tubes with saline. The infundibulum and fimbria were cut from the ampulla and weighed to calculate the amount of fimbrial resection achieved. In group 1 the experimental side retrieved 82% of the eggs; in group 2 the experimental side retrieved 72%. In vivo observations revealed the presence of a spontaneously formed neofimbria that transported cumulus surrogates in a normal pattern and at a normal rate. The fimbria appeared dispensable, a fimbrialike structure formed spontaneously, the functional results were optimal, and the number of ovulation after surgery was unchanged. Some similarities can be observed in women.

Animals↗
PubMed1984

Decreasing the number of ovulations in the rabbit with surgical division of the blood vessels between the fallopian tube and ovary.

The effect of surgical division of the anastomotic blood vessels between the ovary and the fimbria upon the number of ovulations in that ovary was tested in 32 New Zealand white rabbits. A significant reduction in the number of ovulations occurred, from an average of 5.6 for the control ovary to 3.3 for the experimental ovary (p less than 0.01). This finding suggests that every effort be made to preserve the tuboovarian blood supply in women at the time of reconstructive fertility surgery.

Animals↗
PubMed1981

The influence of fallopian tube ampullary length on the fertility of the rabbit.

The relationship between length of the ampullary segment of the fallopian tube and degree of fertility was investigated in 22 New Zealand White rabbits subjected to the microsurgical resection of differing lengths of ampullar with preservation of the full isthmus. The correlation was poor (r = 0.33; P = not significant); the subsequent fertility being unpredictable from a given a length of remaining ampulla. These data are in contrast with those of our previous tubal resection study, where segments of proximal oviduct were excised (1). There, a linear correlation between length of oviduct remaining distally and degree of fertility was demonstrated. Possible reasons for the unpredictability of fertility after segmental resection of ampulla are discussed. Until human data are available, such animal data suggest that the length of distal tubal remnants may predict potential fertility better than the length of proximal tubal remnants. For this reason, a sterilization procedure might best be performed on the proximal oviduct (isthmus) to allow predictability of reversal of the procedure should the occasion arise.

Animals↗