Amy S. Thurmond

Intrauterine insemination outperforms intracervical insemination in a randomized, controlled study with frozen, donor semen

OBJECTIVE To assess the efficacy of intrauterine insemination (IUI) in a donor insemination program. DESIGN Prospective randomized clinical trial. SETTING Donor insemination program. PATIENTS, PARTICIPANTS Women undergoing insemination were randomly assigned to receive either IUI or intracervical insemination for a maximum of six cycles. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Cycle fecundity rates between the two routes were compared. RESULTS The monthly fecundity rate for intracervical insemination was 5.1% compared with 23% by IUI. By life table analysis, pregnancy rates for IUI were significantly higher than intracervical insemination (P = 0.02). CONCLUSIONS Intrauterine insemination with quarantined donor sperm is superior to intracervical insemination.

GADOLINIUM-DTPA TRANSPLACENTAL TRANSFER AND DISTRIBUTION IN FETAL TISSUE IN RABBITS

&NA; Novak Z, Thurmond AS, Ross PL, Jones MK, Thornburg KL, Katzberg RW. Gadolinium‐DTPA transplacental transfer and distribution in fetal tissue in rabbits. Invest Radiol 1993;28: 828‐830. rationale and objectives. The authors assessed to what extent the commonly used the magnetic resonance imaging contrast agent, gadopentetate dimeglumine, crosses the placenta. methods. Eight pregnant rabbits in the third trimester were injected with 0.1 mmol/kg of gadopentetate dimeglumine, and killed 5, 15, 30, or 60 minutes after injection. Placental and fetal tissues were analyzed for gadolinium content. results. Placental concentrations of gadolinium were initially high (16.6 ± 3.4 micrograms/gram) and then declined with a biexponential pattern. Initial gadolinium levels in the fetal organs were low and remained so except for the fetal kidneys, which showed increased levels of gadolinium from 4.3 ± 1.1 micrograms/gram at 5 minutes to 6.8 ± 1.8 micrograms/gram at 60 minutes. conclusions. The results indicate that gadolinium does cross the rabbit placenta, and that concentrations in the placenta and the fetal urinary tract are sufficient for imaging as well as possible fetal toxicity.

First-trimester diagnosis of exencephaly

First-trimester diagnosis of fetal exencephaly is reported. Vaginal ultrasonography showed a normal volume of fetal brain with abnormal internal anatomy. The diagnosis was confirmed by repeat ultrasonography at 14 weeks and at subsequent termination of pregnancy. This is the earliest reported diagnosis of exencephaly by prenatal ultrasonography.

Terbutaline in diagnosis of interstitial fallopian tube obstruction

Effectiveness of terbutaline, a potent uterine muscle relaxant, for differentiation of temporary and anatomic interstitial fallopian tube obstruction (IFTO) at hysterosalpingography (HSG) was explored. In 43 IFTO evaluated, HSG after terbutaline showed patency in only one of 16 tubes in which IFTO was caused by spasm or other temporary cause. We conclude that terbutaline is not helpful in differentiating temporary from anatomic tubal obstruction during HSG.

Enlarged cisterna magna in trisomy 18: prenatal ultrasonographic diagnosis.

Ultrasonographic visualization of an enlarged cisterna magna was the initial clue that led to the prenatal diagnosis of trisomy 18 in five patients. Prenatal diagnosis of trisomy 18, a lethal defect, is important for proper patient counseling and management.

Transcatheter tubal sterilization in rabbits. Technique and results.

Ross PL, Thurmond AS, Uchida BT, Jones MK, Scanlan RM, Kessel E. Transcatheter tubal sterilization in rabbits: technique and results. Invest Radiol 1994;29:570-573. RATIONALE AND OBJECTIVES.A potential method of nonsurgical tubal sterilization was tested in rabbits. METHODS.Metal coils were designed which could be placed into the uterotubal junction using transvaginal fluoroscopic fallopian tube catheterization. These metal coils were successfully placed unilaterally in the uterotubal junction of 32 rabbits. The contralateral fallopian tube and uterus were used as a control. The rabbits were bred, and the presence of pregnancies was confirmed by palpation. RESULTS.In 21 rabbits (66%), the coil stayed in place. Sixteen rabbits had multiple gestations on the side without the coil and no gestations on the side with the coil. Three rabbits had gestations on both sides, even though the coil was in place, and two rabbits never conceived. In 11 rabbits (34%) the coil was dislodged as early as 5 days and as late as 18 weeks after the procedure. Five of these 11 rabbits had bilateral embryos, 4 had embryos only on the side contralateral to where the coil had been, and 2 never conceived. CONCLUSIONS.The metal coil does prevent conception if it stays in place at the uterotubal junction. However, the coil failed to prevent pregnancy in 3 of 19 rabbits, and was dislodged in 11 rabbits, giving an overall failure rate for contraception of 44%.

Tubal Sterilization by Means of Selective Catheterization: Comparison of a Hydrogel and a Collagen Glue

PURPOSE To test, in an animal model, two potentially suitable materials for nonsurgical selective tubal sterilization. MATERIALS AND METHODS A hydrogel that forms an in situ plug by phase inversion of a polymer solution was placed in four rabbit fallopian tubes, and a proprietary collagen glue was placed into three rabbit fallopian tubes by means of transvaginal fluoroscopic fallopian tube catheterization. As controls, 11 tubes were catheterized without sterilization material injection. The rabbits were bred, and the presence of embryos was confirmed with palpation and at autopsy. Histologic analysis was performed. RESULTS The short-term contraception rate was 100% in the hydrogel group, 33% in the collagen glue group, and 0% in the control group (P < .001 hydrogel group, P not significant in collagen group). Inflammation was minimal in the three groups (P not significant). CONCLUSION The collagen glue had an insufficient contraceptive effect and should be abandoned. The hydrogel used proved effective and biocompatible, and long-term studies of this compound are warranted.

Salpingitis isthmica nodosa: results of transcervical fluoroscopic catheter recanalization *†

OBJECTIVE To investigate the role of transcervical tubal catheterization in diagnosis and treatment of proximal tubal obstruction associated with salpingitis isthmica nodosa. DESIGN Retrospective case study. SETTING University hospital and outpatient radiology practice. PATIENTS Fifty-two women with proximal tubal obstruction associated with salpingitis isthmica nodosa. INTERVENTION Selective salpingography and catheter recanalization using fluoroscopic guidance. MAIN OUTCOME MEASURES The number of tubes visualized to the fimbria as a percentage of the tubes with proximal tubal obstruction on the initial hysterosalpingogram was determined as a measure of diagnostic efficacy. To evaluate the treatment potential of catheter recanalization, the patients were grouped according to tubal status at the conclusion of the procedure and subsequent pregnancies were evaluated. RESULTS Forty-seven of 65 tubes (72%) with proximal tubal obstruction were recanalized successfully. Among the 19 women who were able to conceive only via a recanalized salpingitis isthmica nodosa tube, there were 6 live births (32%) and two tubal pregnancies (10%). CONCLUSION Selective salpingography allows complete tubal diagnosis in almost three fourths of patients with proximal tubal obstruction and salpingitis isthmica nodosa. The radiographic diagnosis of salpingitis isthmica nodosa may be pressure dependent. Intrauterine pregnancies occur via recanalized salpingitis isthmica nodosa tubes, therefore catheter recanalization may be attempted before tubal microsurgery or IVF in patients with proximal tubal obstruction and associated salpingitis isthmica nodosa.

Transvaginal fallopian tube catheterization in an animal model.

A rabbit model for testing the safety and effectiveness of diagnostic and interventional techniques of fallopian tube catheterization is presented. Hysterography with injection into the terminal portion of the uterine horn visualized the fallopian tube in only 6% of cases; however, this increased from 33% to 50% by pretreatment with progesterone, administration of glucagon or phentolamine, or increased pressure of injection with balloon obstruction of the uterine horn. Salpingography with a catheter introduced in the tubal ostium or directly inside the tube was most effective and resulted in a consistent (100%) visualization of the fallopian tube. The technique also allowed coaxial introduction of small diameter guidewires and catheters deep into the fallopian tube.

Aortic Valve Replacement for Acute Takayasu's Disease

A patient with aortic insufficiency secondary to Takayasus disease who was treated by aortic valve replacement during active aortic inflammation is described. The patient remains well 29 months postoperatively with minor additional treatment. A review of aortic insufficiency in Takayasus disease is presented.