Transcervical balloon tuboplasty; a multicenter study

Article Abstract:

Approximately one quarter of all cases of female infertility are caused by blockages of the fallopian tubes (oviducts). Surgical intervention to open such blockages constitutes approximately 20 percent of all tubal surgery. The most common type of surgery is a relatively delicate operation in which the blocked segment of the tube is removed and the cut ends reconnected (tubal anastomosis). This procedure is carried out with the aid of a microscope, and at best, the patient has a 44 percent chance of conceiving within the following year. The method requires a great deal of skill, is expensive, and requires both anesthesia and a laparotomy (surgical opening of the abdomen). An alternative method is to collect mature eggs, fertilize them outside of the body, and implant them back in the patient's uterus, thereby circumventing the blockage. This method has only a 16 percent rate of pregnancy per attempt, and is also costly. Recently, balloon catheters were adapted for use in unblocking fallopian tubes. Balloon catheters are commonly used in cardiovascular surgery to open blocked arteries, whereby the catheter, a thin flexible tube, is threaded into the diseased vessel and when properly positioned, a small balloon in the catheter's tip is inflated. A similar balloon catheter can be inserted into the vagina, through the uterus and up a fallopian tube to open a blocked fallopian tube. The method, known as transcervical balloon tuboplasty, was performed on 77 women in several medical centers, and was capable of achieving an opening of a lower blockage in the fallopian tubes for 71 (92 percent) of the women. In 13 of these patients, additional, higher blockages in the fallopian tube were then able to be discovered. Of the remaining 64 patients in whom a completely opened fallopian tube could be documented, 22 pregnancies (34 percent) have been confirmed during the first year following. Seventy-seven percent of these conceptions resulted in normal deliveries and five miscarriages occurred. When the 25 patients who did not conceive within six months were re-examined, 17 (68 percent) of the group were found to have fallopian tubes which remained patent (opened). Transcervical balloon tuboplasty is a safe procedure that can be rapidly taught. The method is an economical and effective method of opening obstructed oviducts without the technical difficulties and surgical risks of microsurgical reanastomosis of fallopian tubes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Abnormalities, Diagnosis, Causes of, Fallopian tubes, Hysterosalpingography, Salpingectomy

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Expansion of health care to the uninsured and underinsured has to be cost-neutral

Article Abstract:

A critique of the US health care system is offered by a former chairman of an academic department who also practiced medicine under a system of socialized medicine. Improving health care for the millions of uninsured and underinsured in this country must begin with a realistic approach to the economics of their situation. It is unlikely that enough additional monies will be provided to cover these approximately 55 million people; rather, present funds must suffice. Suggestions are made concerning ways this could be accomplished without sacrificing the quality of care. Significant reductions can be made in four areas: the part of hospital costs that is related to ''hotel'' functions, such as television sets, bedside telephones, and fancy meals; staffing expenses; the mania for equipment and procedures; and unnecessary surgery. Staffing expenses can be reduced by allowing medical residents and non-nursing staff to perform more procedures, and to pay them for their services at lower rates than the more highly trained attending physicians and registered nurses command. New, expensive medical technology should be used only if it is clearly superior to older, less expensive methods. Physicians should exercise a leadership role in the national health care system, a change that could restore the profession to public esteem. The following proposals are made: (1) every US citizen has a right to good medical care; (2) total health care expenditures should be frozen at present levels; (3) within 12 months, the medical community should establish criteria for hospital care, staffing, and equipment needs; (4) within 12 months, each medical specialty should establish practice guidelines; and (5) governmental funding for uninsured and underinsured people should be provided only from the monies saved by the above policy changes. All involved parties, including the public, who must accept fewer hotel services when ill, must cooperate in a spirit of goodwill and sacrifice. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Medically uninsured persons, Health insurance, National health insurance

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Reducing the risk of high-order multiple pregnancy after ovarian stimulation with gonadotropins

Article Abstract:

Stimulating the ovaries with hormones called gonadotropins can cause several eggs to mature at the same time. This in turn increases the woman's risk of having twins, triplets, quintuplets, etc. In a study of 1,494 women who received gonadotropins to induce ovulation, those with high estradiol levels and seven or more mature follicles were twice as likely to have a multiple pregnancy compared to other women. Less intensive gonadotropin induction might reduce this risk, but it would also lower the chances of a pregnancy.

Risk factors, Gonadotropin, Gonadotropins, Pregnancy, Multiple, Multiple pregnancy

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