Amir H. Ansari

End-to-End Tubal Anastomosis Using an Absorbable Stent *

Using absorbable suture as a stent, end-to-end anastomosis of previously ligated or cauterized fallopian tubes was performed in 15 cases. Luminal patency of at least one fallopian tube has been achieved in all cases, and thus far seven pregnancies have occurred in six cases. The technique for inserting the absorbable suture into the distal and proximal portions of the tube is fully described, and the importance of repeated hydrotubations to maintain tubal patency is emphasized.

Diagnostic Procedures for Assessment of Tubal Patency

That slender and narrow seminal duct rises, fibrous and pale, from the horns of the uterus itself, becomes, when it has gone a little bit away, appreciably broader, and curls like a branch until it comes near the end, then losing the horn-like curl, and becomes very broad, has a distinct extremity which appears fibrous and fleshy through its red color, and its end is torn and ragged like the fringe of a well-worn garment, and it has a wide orifice which lies always closed through the ends of the fringe falling together; and if these be carefully separated and opened out, they resemble the orifice of a brass trumpet. Wherefore, since the seminal duct from its beginning to its end has a likeness to the bent-parts of this classic instrument, separated or attached, therefore, it has been called by me uteri tuba (trumpet of the uterus). These are present not only in the human body, but also in sheep, cows and all other animals which I have dissected.

Clinical and Laboratory Evaluation of a New Progestational Compound

A study was carried out to evaluate the systemic effects of a new and potent progestational compound ethynodiol diacetate. In combination with .1 mg mestranol 2 mg and 1 mg dose levels of this compound are known as Metrulen and Ovulen respectively. 18 patients took Metrulen and 12 received Ovulen for a total of 130 cycles. Various tests and assays were performed. It was determined that Metrulen and Ovulen are effective in conception control. 4 infertile patients became pregnant within 1-3 months after discontinuation of the medication indicating achievement of a rebound phenomenon which indirectly suggests an improvement of hormonal interaction and more receptive target organs (cervix vagina uterus and tubes). Side effects were transitory and did not necessitate discontinuation of therapy. There were no significant electrolyte changes. Vaginal cytologic changes and changes in cervical mucus and endometrium were all transient and there was a return to normal after completion of the treatment. Hormonal assays showed a definite decrease in all urinary hormones measured except gonadotropins in 4 cases. The metyrapone (SU 4885) test performed during progestin treatment reported for the first time yielded equivocal results.

Quinestrol: a potential contraceptive agent.

To test the contraceptive effectiveness of the estrogen derivative Quinestrol 6 women 23-30 years old with confirmed fertility were administered 1 mg Quinestrol orally on Days 1 8 and 15 of the cycle for a total of 34 treated cycles. A single oral dose of 20 mg medroxyprogesterone acetate was administered on Day 22 to achieve proper cyclic withdrawal bleeding. Complete blood and urine analyses were conducted before during and after the treatment cycles. Ovulation was successfully suppressed by Quinestrol in all of the treated cycles and resumed within several months after cessation of treatment. Side-effects including mucorrhea bleeding and nausea were common. Menorrhagia caused early termination of the treatment in 1 patient and a diagnostic curettage in another. No breakthrough bleeding occurred and safety tests were normal. It is concluded that Quinestrol is safe effective and acceptable as an oral contraceptive compound and dosage alterations are recommended which might reduce presently reported side-effects.

Liver Tumors and Oral Contraceptives

A possible causal relationship between oral contraceptives and liver cell adenomas has been postulated in the recent literature. In this presentation three additional cases are reported to support the existence of such an association. The possible etiologic causes for this newly described condition and specific diagnostic procedures for its accurate diagnosis are presented.

VAGINAL TUBAL LIGATION

Of the various methods of permanent conception control, tubal ligation is one of the most simple, practical and effective. If abdominal tubal sterilization is the most widely recommended procedure during the postpartum period, then the vaginal approach is preferred whenever an interval sterilization is contemplated. It is an especially suitable method of conception control for women who want to conclude their childbearing early. When the technic and results of 90 vaginal tubal ligations (Jan 1, 1964 to Dec 31, 1969) were examined and compared with other sterilization procedures, including 344 postpartum and 30 interval abdominal tubal ligations, the vaginal was found to be superior to the abdominal approach. Whenever performed in a judiciously selected patient, the vaginal approach was associated with very little risk of immediate or late postoperative complications. Furthermore, the vaginal route was better accepted by most patients than was the abdominal approach and, due to the shortened hospital stay, also proved to be of definite economic benefit.

Sodium Bicarbonate Douching for Improvement of the Postcoital Test**Presented in part at the Thirty-Fourth Annual Meeting of The American Fertility Society, March 29 to April 1, 1978, New Orleans, La.

In the hope of improving sperm survival within the cervical mucus, 93 infertile patients with unfavorable postcoital tests were advised to douche with a solution of sodium bicarbonate 30 to 60 minutes prior to sexual intercourse. In most patients observed, the repeatedly poor postcoital test improved remarkably, and 31 pregnancies have been achieved. In the majority of patients, the postcoital test was repeated on 2 subsequent days (without and with the benefit of sodium bicarbonate douching) with astonishing differences in the test results. In addition to pH changes, sodium bicarbonate douching resulted in significant alteration of the cervical mucus electrolyte components (detected by scanning electron microscopy and energy-dispersive x-ray analysis). The possible modes of action of sodium bicarbonate douching are fully analyzed.

DIAGNOSIS AND MANAGEMENT OF INTRAUTERINE DEVICE WITH MISSING TAIL

Using various diagnostic procedures, the exact locations of nine intrauterine devices with missing tails were determined. In 5 cases the device was found to be within the abdominal cavity. Aside from 1 patient in whom laparoscopic removal was possible, laparotomy was necessary in all cases. Various factors contributing to uterine perforation are discussed, and certain procedures to avoid this complication are described.