Esat Orhon

Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility

OBJECTIVE To assess the safety and efficacy of hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. DESIGN Retrospective case report series. SETTING The obstetrics and gynecology clinic of a medical school. PATIENT(S) Forty women with recurrent pregnancy loss or infertility resulting from intrauterine adhesions. INTERVENTION(S) Hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. MAIN OUTCOME MEASURE(S) Postoperative adhesion formation, intraoperative complication, conceivement after surgery, pregnancy rate, and pregnancies resulted in term or viable preterm infants. RESULT(S) Most patients with minimal or moderate adhesions were free of adhesions when compared with postoperative control subjects. However, adhesion re-formation was noted in 60% of the patients who initially had severe adhesions. Normal menstrual flow was restored in 81% of the patients. All the patients who had recurrent pregnancy loss conceived after treatment, and 71% of the pregnancies resulted in a term or viable preterm infant. Of the 16 infertile patients treated, 10 (63%) conceived and 6 (37%) were delivered of viable infants. CONCLUSION(S) Hysteroscopic adhesiolysis is a safe and effective procedure for restoring the normal menstrual pattern and fertility. The initial severity of the adhesions appears to correlate best with the reproductive outcome.

Primary squamous cell carcinoma of the endometrium

15@300 mg pamidronate daily tolerated treatment reasonably well but those receiving 450-600 mg daily had an unacceptable incidence of adverse events. The toxicities in patients receiving the effervescent tablet, at all dose levels, tended to be worse and in view of its inconvenient mode of administration, this formulation will not be studied further. 5 patients taking the effervescent formulation and 2 receiving the enteric-coated capsule stopped treatment because of poor tolerability. Studies of oral pamidronate as an adjunct to systemic therapy are now indicated. Toxicity was infrequent with the entericcoated capsule at a dose of 150-300 mg daily and is therefore suitable for further study. However, the search continues for an even better tolerated formulation.

Microsurgical transposition of the human fallopian tube.

Reports of tubal microsurgical transposition techniques to restore fertility are quite rare. In this article, an interesting microsurgical procedure, in a woman with congenital uterine and tubal abnormality is presented. Under certain circumstances, microsurgical transposition of the human fallopian tube has the potential of being a useful therapeutic alternative.