The techniques and outcomes of hysteroscopic metroplasty.

PURPOSE OF REVIEW: To evaluate the reproductive outcomes and surgical techniques of the hysteroscopic metroplasty in women with septate uterus and recurrent abortions or primary unexplained infertility. RECENT FINDINGS: Septate uterus is the most frequent congenital uterine anomaly caused by inadequate resorption of the Müllerian ducts. Hysteroscopic metroplasty has replaced the traditional laparotomy approach because of its positive and satisfactory outcomes in pregnancy and live-birth rates, and also many different postoperative benefits. The aim of metroplasty is to restore a normal anatomy of the uterine cavity as a prerequisite for a positive implantation and subsequent good obstetrical outcomes. This treatment clearly demonstrates its effectiveness both in recurrent abortion and in primary unexplained infertility. SUMMARY: The hysteroscopic metroplasty with its simplicity, safety, and improved reproductive outcomes has liberalized the approach to treatment. Today, hysteroscopic metroplasty is a common practice to treat septate uterus with salutary effects both in infertile patients and in patients with recurrent pregnancy loss or premature labor, especially if in-vitro fertilization is being contemplated. Decisions on when to treat uterine septa are discussed in particular because of lack of prospective, randomized controlled trials.

Hysteroscopic metroplasty: reproductive outcome in relation to septum size.

PURPOSE: Our aim is to determine if the reproductive performance after hysteroscopic resection of partial uterine septum was related to septum size. METHODS: The retrospective and comparative cohort study was conducted in a University-affiliated Hospital. A cohort of 112 non-parous patients was treated for a partial uterine septum. The septum size was evaluated by hysteroscopy and transvaginal 3-dimensional ultrasound. The patients were stratified into two groups: group 1 (85 women) with small partial uterine septum (≤2.5 cm) and group 2 (27 women) with large partial uterine septum (>2.5 cm). They were also divided according to their obstetrics history: 39 infertile women and 73 aborters. All underwent hysteroscopic metroplasty with a resectoscope with an equatorial semicircular loop cutting 0° with monopolar energy. All septa were almost completely removed and no complications occurred. RESULTS: The two groups of patients with small (group 1) and large (group 2) partial uterine septum were compared in the terms of reproductive history and performance before and after surgery. In the overall population the reproductive performance after surgery is greatly improved. No significant differences in reproductive performance were evident between patients with small and large partial uterine septa. The reproductive performance was also similar in infertile patients and in aborters. CONCLUSIONS: This study demonstrates that hysteroscopic metroplasty in cases of partial uterine septum and infertility significantly improves the reproductive performance irrespectively of septum size and that reproductive performance is independent from previous obstetrics history.

Metroplasty in a large population of women with septate uterus.

STUDY OBJECTIVE: To determine the reproductive outcome after hysteroscopic metroplasty in women with septate uterus. DESIGN: Retrospective comparative single-center study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Two hundred forty-six patients with septate uterus undergoing hysteroscopic metroplasty between January 1998 and December 2007. The diagnosis was based on hysteroscopy and 3-dimensional ultrasonography. In the most cases laparoscopy was also available. The subjects were divided into 2 age-matched groups. Group 1 consisted of 108 women with unexplained infertility, and group 2 consisted of 138 women suffering from recurrent abortion. INTERVENTIONS: Patients underwent hysteroscopic metroplasty by use of resectoscopy with an equatorial semicircular loop cutting at 0 degree with monopolar energy. All septa were completely removed without complications of bleeding, infection, risk of perforation, visceral injury, or uterine dehiscence during pregnancy. MEASUREMENT AND MAIN RESULTS: The 2 groups were compared in terms of reproductive performance in mean ± SD follow-up of 37 ± 18 months. In group 1, 61 (56.5%) patients achieved pregnancy. Seventy-one pregnancies ensued, including 1 twin gestation. Fourteen of the 71 pregnancies (19.7%) ended in miscarriage. In group 2, 90 (65.3%) patients achieved pregnancy. One hundred twenty-nine pregnancies ensued, including 2 twin gestations. Forty-four of the 129 pregnancies (34.1%) ended in miscarriage. The 2 groups have no significant differences in terms of reproductive outcome after surgery, except for the number of abortions, which was higher in group 2 (p <.05). CONCLUSION: This study confirms that hysteroscopic metroplasty is a simple, safe, and rapid surgical procedure with no complications for achieving normal uterine architecture, which is peculiar to a good reproductive outcome. The use of an equatorial semicircular loop may give satisfactory and similar results to those obtained with Collin's loop.

Isolation and characterization of endophytic bacteria from the nickel hyperaccumulator plant Alyssum bertolonii.

We report the isolation and characterization of endophytic bacteria, endemic to serpentine outcrops of Central Italy, from a nickel hyperaccumulator plant, Alyssum bertolonii Desv. (Brassicaceae). Eighty-three endophytic bacteria were isolated from roots, stems, and leaves of A. bertolonii and classified by restriction analysis of 16S rDNA (ARDRA) and partial 16S rDNA sequencing in 23 different taxonomic groups. All isolates were then screened for siderophore production and for resistance to heavy metals. One isolate representative of each ARDRA group was then tested for plant tissue colonization ability in sterile culture. Obtained results pointed out that, despite the high concentration of heavy metals present in its tissues, A. bertolonii harbors an endophytic bacterial flora showing a high genetic diversity as well as a high level of resistance to heavy metals that could potentially help plant growth and Ni hyperaccumulation.