[Septate uterus and reproduction disorders: current results of hysteroscopic septoplasty]. / Cloisons utérines et troubles de la reproduction: résultats actuels de la septoplastie hystéroscopique.

Uterus septus is the most frequent congenital uterine anomalies caused by insufficient resorption of the müllerian ducts. Retrospective statistical analysis shows that the uterine septa have the worst reproductive outcome with a high incidence of early abortions. It is well recognized that it increased the incidence of recurrent (> or = 3) miscarriages (79% among 1,601 pregnancies), reproductive failure and obstetric complications. A septate uterus does not seem to be an infertility factor. On the other hand, the incidence of unexplained infertility was significantly higher (40%) in the patients with secondary infertility; thus, a contribution from the uterine septum in delayed conception of these patients cannot be excluded. Hysteroscopic surgery has replaced conventional abdominal route. Hysteroscopic metroplasty improves obstetrical prognosis in women with septate uterus, and it's advantages are easiness, low morbidity rate, without the hysterotomy's consequences like adnexial adhesions. Metroplasty is indicated in women with a history of miscarriages (2 or more), which decreased to 15%, in patients with an unexplained infertility, and in women in whom assisted reproductive treatment is being contemplated. Combined with laparoscopy, the hysteroscopic metroplasty is the gold standard for assessing uterine septa, especially in these infertile women. Laparoscopy also is required to complete the diagnostic work up of infertility, and provides an opportunity to treat any coexisting pelvic pathology.

The potential for elderly suicide. . . Is health care missing it?

Assessment of elderly patients at risk for suicide, presents a unique challenge in healthcare. Assessment of residents entering long term care facilities does not end once they are admitted. Learning to identify the warning signs and situations that can precede "silent suicide" requires extraordinary sensitivity (Simon, 1989). A case study is utilized to review some of the most common risk factors for suicide in the elderly population. The impact on elderly people when they must leave their homes, is highlighted in the discussion of"relocation stress" (Harkulich, 1992) The reason why healthcare workers could misinterpret the signs and symptoms of potential elderly suicide is also included.