Tubal anastomosis after tubal sterilization: a review.

PURPOSE: To evaluate various techniques for restoring tubal patency after sterilisation. METHODS: A search strategy was designed, and for each subject either thesaurus terms (MeSH descriptors) or terms from the title or summary were used. RESULTS: Mean length of hospital stay following laparoscopy seems to be shorter in comparison with laparotomy (3.3 vs. 6.1 days, P < 0.05). Rate of conversion to laparotomy is 5%. Pregnancy rates observed are between 54 and 88% for laparotomy and 31-85% for laparoscopy. Mean time to conception was between 2 and 9.6 months. Most pregnancies occurred in the 2 years following restoration of tubal patency (cumulative conception rate 80% at 12 months). Young age (<35 years), type of ligature (rings), how recently the ligature was done (<8 years), the anastomosis site (in the middle of the tube) and a good length of remaining tube (>7 cm) are the factors that govern whether there can be good restoration of tubal patency. Ectopic pregnancy rates observed are between 1.7 and 12% for laparotomy and 0-7% for laparoscopy. There are no randomised or quasi-randomised studies comparing tubal anastomosis and in vitro fertilization. CONCLUSIONS: There are few good-quality controlled studies in this area. Results of restoration of tubal patency seem to be comparable, regardless of the route of approach (laparotomy or laparoscopy).

Vaginal myomectomy: literature review.

The objective of this literature review was to evaluate the results obtained at vaginal myomectomy. The databases consulted were Medline, Cochrane Library, National Guideline Clearinghouse, and Health Technology Assessment Database. Keywords used for research were colpotomy, myomectomy, and vaginal myomectomy, and then abdominal myomectomy, laparoscopic-assisted vaginal myomectomy, and laparoscopic myomectomy. Eight case series and 2 case reports were analyzed, and included 372 patients. Reported rates of conversion to laparotomy during the operation ranged from 0% to 17.6%. The most frequently described risk factors for conversion to laparotomy were location of the myoma in the fundus and a large volume of myoma to be extracted, although no maximum threshold size can be defined. Performing laparoscopy first does not seem to limit the risk. Reported rates of transfusion during the operation ranged from 0% to 40%. Several cases of pelvic abscess have been described, with reported frequency of 2.2% to 5.7%. Authors mentioned the role of the vaginal drain that is inserted at the end of the procedure. No specific studies have been performed on long-term effectiveness, postoperative adhesions, integrity of the scar, or subsequent fertility. There are no good controlled studies of this technique. Feasibility seems to be acceptable, although the risk of pelvic infection in the postoperative period may be increased. Long-term effectiveness and safety were not assessed. A vaginal approach may be considered an alternative to laparotomy or laparoscopy in surgery to treat accessible myomas, and seems to be the simplest method.

Gating of heteromeric retinal rod channels by cyclic AMP: role of the C-terminal and pore domains.

Cyclic nucleotide-gated channels are tetramers composed of homologous alpha and beta subunits. C-terminal truncation mutants of the alpha and beta subunits of the retinal rod channel were expressed in Xenopus oocytes, and analyzed for cGMP- and cAMP-induced currents (single-channel records and macroscopic currents). When the alpha subunit truncated downstream of the cGMP-binding site (alpha D608stop) is co-injected with truncated beta subunits, the heteromeric channels present a drastic increase of cAMP sensitivity. A partial effect is observed with heteromeric alpha R656stop-containing channels, while alpha K665stop-containing channels behave like alpha wt/beta wt. The three truncated alpha subunits have wild-type activity when expressed alone. Heteromeric channels composed of alpha wt or truncated alpha subunits and chimeric beta subunits containing the pore domain of the alpha subunit have the same cAMP sensitivity as alpha-only channels. The results disclose the key role of two domains distinct from the nucleotide binding site in the gating of heteromeric channels by cAMP: the pore of the beta subunit, which has an activating effect, and a conserved domain situated downstream of the cGMP-binding site in the alpha subunit (I609-K665), which inhibits this effect.