Previous Sterilization Research Articles

Migrated tubal sterilisation clip presenting as a subcutaneous gluteal foreign body 24 years later: a case report and literature review

BackgroundThe incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor.Case presentationA 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5 cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15 × 7 mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated.ConclusionsThis was a case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 34 case reports of sterilisation clip migration, mostly to the bladder. Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor.

Tubal Sterilization and Cervical Cancer Underscreening in the United States.

Background: Tubal sterilization is more commonly utilized by racial/ethnic minority groups and has been implicated in underscreening for cervical cancer. The objective is to determine if prior tubal sterilization is a risk factor for cervical cancer underscreening. Methods: National Survey of Family Growth dataset from 2015 to 2019 used for analysis; data were weighted to represent the 72 million women in the U.S. population aged 22-49. Chi-square tests, Fisher exact tests, and logistic regression were used for analysis. The primary predictor variable was tubal sterilization which was categorized into no previous sterilization, sterilization completed <5 years ago, and sterilization completed ≥5 years ago. The outcome variable was underscreened versus not underscreened. Other predictor variables included age, household income as a percent of federal poverty level, previous live birth, primary care provider, and insurance status. Results: Prevalence of tubal sterilization completed 5 or more years ago was 12.5% and varied by most measured characteristics in univariate analyses. Approximately 8% of women were underscreened for cervical cancer. In multivariable analyses, women with a tubal sterilization 5 or more years ago had 2.64 times the odds (95% confidence interval = 1.75-4.00) of being underscreened for cervical cancer compared with women who did not have a tubal sterilization. Conclusions: Approximately 4.3 million women ages 22-49 in the United States are potentially underscreened for cervical cancer and women with previous tubal ligation ≥5 years ago are more likely to be underscreened. These results may inform the need for culturally sensitive public health messages informing people who have had these procedures about the need for continued screening.

437 Migrated tubal sterilisation clip presenting as a subcutaneous gluteal foreign body 24 years later: A case report and literature review

Abstract Introduction The incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor. Case A 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15x7mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated. Discussion This is the first reported case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 35 case reports of sterilisation clip migration, mostly to the bladder. Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor.

Lipid production by Rhodosporidium toruloides from biodiesel-derived glycerol in shake flasks and bioreactor: Impact of initial C/N molar ratio and added onion-peel extract

Rhodosporidium toruloides NRRL Y-27012 grown in glycerol, produced yeast biomass and secondary metabolites as lipids (L) and intra-cellular polysaccharides (IPS) in trials under nitrogen limitation (initial C/N molar ratios ≈ 50, ≈ 100, ≈ 160 and ≈ 240). The initial glycerol (Glol0) concentration for all experiments was ≈ 90 g/L. The yeast demonstrated significant dry cell weight (DCW) production irrespective of the C/N ratio employed, ranging between 19 and 29 g/L. The optimum C/N ratio medium was that of 100 moles/moles, where a DCWmax = 24.5 g/L containing c. 50% w/w of lipids was recorded. Endopolysaccharides presented indeed impressive values (≥ 50% w/w) even at the very early growth steps, while IPS/DCW values decreased as the fermentation proceeded, with simultaneous increase of L/DCW values. Experiments were also conducted in media with a hydroglycerolic extract of onion peels (at 40 mL/L), while a blank experiment (no extract) was also realized. The trial with the added extract was performed under both aseptic (previous sterilization) and non-aseptic (previous thermal treatment at T = 100 °C; 5 min) conditions. The aseptic experiment with the added extract resulted in a relative decrease in lipid production in relation to the control (L=8.6 g/L in the control vs L = 6.2 g/L with the extract). Under non-aseptic conditions, lipid production was slightly lower (L = 5.2 g/L). Finally, the optimum trial in shake flasks was scaled-up in a batch bioreactor, and higher glycerol assimilation rate, and biomass and lipid production occurred compared to the flask trial (final DCW and lipid values ≈27 g/L and 13.5 g/L respectively). Cellular lipids, rich in palmitic and oleic acid, were mainly composed of neutral fractions. Phospholipids were more saturated than the neutral lipids.

Factors associated with long-acting reversible contraception usage: Results from the National Survey of Family Growth.

The authors aimed to identify factors associated with long-acting reversible contraception (LARC) usage. The current cross-sectional study used data from the National Survey of Family Growth from 2011 to 2019. Respondents aged 15 to 44 years were included. Those with previous sterilization, infertility, or pregnant were excluded. The outcome evaluated was use of a LARC. Of 61 543 814 women, 44 287 911 (72.0%) met inclusion criteria. The rate of LARC use was 13.4%. Factors associated with an increased likelihood of LARC usage were married/living with a partner (adjusted relative risk [aRR], 1.18 [95% CI, 1.02-1.37]), perceived good health (aRR, 1.44 [95% CI, 1.13-1.84]), year of survey 2017 to 2019 (aRR, 1.53, [95% CI, 1.28-1.83]), one or two past pregnancies (aRR, 1.62 [95% CI, 1.24-2.12]) or three or more past pregnancies (aRR, 1.67 [95% CI, 1.22-2.28]), age at first live birth <20 years (aRR, 1.58 [95% CI, 1.20-2.08]) or 20 to 24 years (aRR, 1.45 [95% CI, 1.13-1.87]), age at onset of sexual activity 13-19 years (aRR, 1.50 [95% CI, 1.26-1.78]), and a 0- to 5-month period of nonintercourse in the past year (aRR, 1.63 [95% CI, 1.40-1.90]). Factors associated with decreased LARC usage were age ≥ 35 years (aRR, 0.74 [95% CI, 0.65-0.85]), being non-Hispanic Black (aRR, 0.75 [95% CI, 0.62-0.89]) or non-Hispanic other (aRR, 0.72 [95% CI, 0.59-0.88]), intending to have children (aRR, 0.65 [95% CI, 0.57-0.74]), and never being sexually active (aRR, 0.10 [95% CI, 0.06-0.16]). Using a nationally representative sample of women in the United States, the authors identified modifiable factors associated with LARC use. Results may be used to plan interventional trials to increase LARC usage.

Evaluation of Pregnancy Outcome and Influencing Factors of Microsurgical Tubal Recanalisation as a Reversal of Tubal Ligation in a Tertiary Hospital

Background: Tubal microsurgical recanalization is a procedure which restores the fertility in women who have undergone sterilization voluntarily, thinking that her family is complete. However due to unforeseen circumstances, 1–3% of these women subsequently demand reversal of sterilization. Aims and Objectives: This study aims to evaluate the pregnancy rate after reversal surgery and to find out the various factors that influence the success of tubal microsurgical recanalization. Materials and Methods: The current study was hospital-based retrospective one involving 48 women undergoing reversal of sterilization at the department of gynecology and obstetrics in tertiary hospital, Kolkata, during the period of 3 years, from July 2015 to June 2018. The women were followed up for a period of 1 year by telephonic contact. Women seeking tubal recanalization was in age group of 20–35 years with normal ovulation and normal semen analysis. Women, &gt;35 years old, anovulation, with obvious pelvic inflammatory disease, endometriosis or fibroid were excluded, women with any contraindications to pregnancy or surgery and any male factor infertility also excluded from the study. Results: Out of 48 study subjects, intrauterine pregnancy was achieved in 27 cases (93.1%)), 2 patients (6.9%) had ectopic pregnancy. Out of 27 intrauterine pregnancies, 4 had abortions (13.8%), 3 (10.3%) are ongoing pregnancies, and 20 patients had live birth (69%). Conclusion: Tubal microsurgery offers good chances of pregnancy outcome which is favored by the age below 30 years, interval between sterilization and its reversal &lt;4 years, isthmo-isthmic anastomosis, reconstructed tubal length being more than 6 cm, and type of previous sterilization were by Pomeroy’s method.

Effect of the Melicoccus bijugatus leaf and fruit extracts and acidic solvents on the antimicrobial properties of chitosan-starch films.

Analysing the antimicrobial activity-against food-borne micro-organisms-of modified chitosan-starch films using formic and acetic acid as chitosan solvents and Melicoccus bijugatus leaves and fruit extracts. The films' antimicrobial activity against mesophilic aerobic bacteria, total coliform and fungi were also analysed, in accordance with the Mexican Official Norms (NOM-092-SSA1-1994, NOM-111-SSA1-1994 and NOM-113-SSA1-1994). The pH values of the films and extracts were measured, and the volatile compounds of the extracts and two films were determined by Gas Chromatography-Mass Spectrometry (GC-MS) considering the relationship among the type of compounds, extracts concentration, films' pH and the antimicrobial activity against bacteria and fungi. The best results are obtained by films with formic acid and 10% (v/v) of leaf and fruit extracts, in comparison with untreated chitosan-starch films. The extracts' compounds improved the films' antimicrobial capacity and inhibited the growth of micro-organisms with no previous sterilization required. It is correlated to the pH of the media, the combination of solvent/extract used and its concentration. This is one of the few researches where the antimicrobial activity of M. bijugatus extracts is studied. It was found that the presence of these extracts is capable of improving the antimicrobial activities of chitosan-starch films. The performance of the modified films suggests their potential application as novel food packaging materials and encourages further research.

Cost-Effectiveness Analysis of Tubal Surgery Versus in Vitro Fertilization As Treatment for Tubal Infertility

Study Objective: Surgical management of tubal factor infertility has largely been replaced by in vitro fertilization (IVF). Trainees now have little exposure to surgical techniques such as fimbrioplasty and tubal reanastomosis. This study compares the cost-effectiveness of tubal surgery and IVF for tubal factor infertility. This comprehensive analysis includes costs and probabilities from the infertility treatments themselves to adverse birth outcomes depending on the mode of conception. Design This cost-effectiveness analysis compares surgery and IVF in decision trees for hydrosalpinx, proximal obstruction, endometriosis, and previous sterilization. Clinical probabilities and effectiveness were derived from published literature. Estimated costs were taken from the reimbursements from five major third party payers to a major teaching hospital. Analysis was performed with TreeAge Pro Healthcare 2020 for Windows. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results Our initial analysis includes tubal factor infertility caused by hydrosalpinx, proximal occlusion, endometriosis, and prior sterilization. Fimbrioplasty for hydrosalpinges with mild pathophysiological changes was more cost-effective than IVF. Fimbrioplasty for hydrosalpinges with advanced changes cost less than IVF, but were not very effective. Likewise, surgical repair of proximal occlusions was more cost-effective than IVF despite the failure rates of these procedures. Laparoscopic excision of endometriosis demonstrated more cost-effectiveness than IVF at all stages of disease. However, with higher maternal age and severe disease that makes ovarian dysfunction an overriding infertility factor, IVF is more cost-effective. Tubal reanastomosis was more cost-effective than IVF for patients Conclusion Surgical intervention should be considered as a viable alternative for tubal factor infertility treatment in certain cases. Continued training in tubal surgery should be encouraged in both residency and fellowships.

Shaping an ethical approach to trans research: Some reflections from my doctoral project

From 2016 to 2019, I conducted my doctoral project research on trans and gender-diverse experiences in Norway, focussing on the impact of a new law on gender recognition through which the previous sterilisation requirement for legal gender change was overturned. Over the course of this research, I have been exploring what it means to be an ethical feminist scholar and working to foster what I feel is a more ethical approach to research on trans individuals. In this article, I outline what I have found to be essential theoretical and methodological considerations to ethical trans research. I apply these to my own doctoral research process to demonstrate the importance of trans-focussed research, reflecting on the challenges I faced when writing my thesis.

Contraception and fertility counseling in patients receiving chemotherapy.

e23055 Background: Cancer care advances allow more patients to pursue fertility. Unfortunately, treatments may have detrimental effects both on fertility and risks to fetus should pregnancy occur. This study examines patient perceptions of fertility and contraception counseling, as well as physician documentation thereof. Methods: After IRB approval, a cross-sectional study was performed identifying men and women, ages 18-50, seen between May 2017 and 2018 with newly diagnosed malignancy. Patients with previous sterilization procedures, a secondary or synchronous cancer, or prior lines of chemotherapy, were excluded. Consented patients received a survey regarding their perception receipt and quality of counseling. Demographic data, including contraception use, reproductive history, and physician documentation were obtained. Differences in receipt of counseling and perception of received counseling were evaluated using chi-square tests. Results: Of 179 patients identified, 53 ultimately participated. Majority were women (75 v 25%). Counseling documentation for contraception and fertility occurred in 5% and 32% of charts, respectively. Though 42% and 49% perceived receipt, respectively. Of those receiving counseling, it was perceived as sufficient by 64% regarding contraception and 72% regarding fertility. Race, gender, and reproductive history were not found to be associated to whether patients perceived counseling on contraception (p &gt; 0.1). Men were more likely than women to be perceive counseling regarding fertility (85 v 43%, p = 0.010). However, both felt fertility counseling to be sufficient with similar rates of documentation. Caucasians were more likely to perceive receipt of fertility counseling and to perceive it to be sufficient, then African Americans (68 v 29% and 70 v 40%, respectively) at same rate of documentation (35%). Conclusions: Significant discrepancies in perception of contraception and fertility counseling were seen, though documentation rates were similar across all groups examined. Despite equal rates of physician documentation, gender and race were important factors for the perception of fertility counseling, while race was a factor to quality of perceived counseling.

Antimicrobial, Optical and Mechanical Properties of Chitosan-Starch Films with Natural Extracts.

Natural extracts possess several kinds of antioxidants (anthocyanins, betalains, thymol, carvacrol, and resveratrol) that have also demonstrated antimicrobial properties. In order to study these properties, extracts from cranberry, blueberry, beetroot, pomegranate, oregano, pitaya, and resveratrol (from grapes) were obtained. Growth inhibition tests of mesophilic aerobes, coliforms, and fungi were conducted in films prepared from the extracts in accordance with Mexican Official Norms (NOM). Optical properties such as transparency and opacity, mechanical properties, and pH were also analyzed in these materials. The films with beetroot, cranberry, and blueberry extracts demonstrated the best antimicrobial activity against various bacteria and fungi in comparison with unmodified chitosan–starch film. This study shows that the addition of antioxidants improved the antimicrobial performance of these films. It was also found that antimicrobial properties are inherent to the films. These polymers combined with the extracts effectively inhibit or reduce microorganism growth from human and environmental contact; therefore, previous sterilization could be unnecessary in comparison with traditional plastics. The presence of extracts decreased transmittance percentages at 280 and 400 nm, as well as the transparency values, while increasing their opacity values, providing better UV–VIS light barrier properties. Despite diminished glass transition temperatures (Tg), the values obtained are still adequate for food packaging applications.

Tubal anastomosis after previous sterilization: a systematic review.

Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized alternative is IVF. The choice between surgery and IVF is often influenced by reimbursement politics for that particular geographic location. We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success. Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness. We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated. In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF.

A Study of Tubal Recanalization in Era of ART (Assisted Reproduction Technology).

Tubectomy remains one of the most popular methods of permanent contraception in developing countries. But about 10% of them regret their decision and 1% want to restore their fertility. Out of many options open method of tubal recanalisation is one of the method of restoring fertility. Primary objective was to analyse whether open tubal recanalization is a feasible option for those planning to conceive after tubectomy. Secondary objective was to evaluate the pregnancy rate and analyse the various factors affecting pregnancy rate after tubal recanalization. A prospective study, follow-up of 2 year in patients treated with tubal recanalization during 2012-2013 at tertiary teaching hospital. 10 women underwent tubal recanalization procedure. Open surgery was done and the principles of microsurgery were followed meticulously throughout the procedure. All statistical analyses were performed using SPSS for Windows version 17.0 (SPSS Inc., Chicago, IL, USA). Data were expressed as means, medians, standard deviations, and percentages. We used Student's t-test to compare group means and Fisher-exact test to compare proportions. A p-value of <0.05 was considered significant. Out of 10 women who went recanalization an overall 50% pregnancy rate was achieved. All pregnancies occurred within 1 year of procedure. When previous sterilisation was done by laparoscopic route, after reversal all of them (100%) conceived while in those sterilised by Pomeroys method the pregnancy rate after reversal was only 16.6%. Following reversal pregnancy was stastically more significant in those with final tubal length of >5cm (p=0.04) and in those with Isthmo-Isthmic type of anastomosis . Open tubal recanalisation remains a feasible option for those planning pregnancy after tubectomy. The important factors for determining the success of operation were age of the patient, time interval between sterilization and reversal, site of ligation, method used for previous ligation and the remaining length of the tube after recanalisation.

Effectiveness of in vitro fertilization in women with previous tubal sterilization

ObjectiveThe objective was to determine the effectiveness of in vitro fertilization (IVF) on live-delivery rates in women who had previously undergone tubal sterilization. Study designWe examined first IVF live deliveries for women aged 20–44 years at their first embryo transfer (ET) with history of hospital admission for tubal sterilization in Western Australia (WA). The ET cycles (n=178) were ascertained over the period of 1996 to 2010 using WA hospital records. A control group of subfertile women matched by age was randomly selected (n=178). We used Kaplan–Meier curves and life-table analysis to evaluate the cumulative live-delivery rates. ResultsAn overall cumulative live-delivery rate in women who had undergone previous tubal sterilization (31%) was comparable to that of subfertile controls (34%) within the first 24 months. Younger women (aged 20–34 years) with previous sterilization (34%) were slightly more likely to deliver an IVF live baby than older women (aged 35–39 and 40–44 years) (33% and 22%, respectively), although this difference was not statistically significant (p=.449). ConclusionWomen who desire fertility after a tubal sterilization procedure and undergo IVF have rates of pregnancy similar to age-matched subfertile IVF control patients. ImplicationsIn vitro fertilization success in women who had undergone previous tubal sterilization is similar to that of the subfertile controls and thus does not depend on past fertility. Age is the most important predictive factor in achieving pregnancy.

Quiz Page June 2014: A 45-Year-Old Woman With Acute Anuria

Quiz Page June 2014: A 45-Year-Old Woman With Acute Anuria

Laparoscopic Tubal Anastomosis. An Assessment of the “One-Stitch Technique”

The aim of the present study was to evaluate fertility outcome after laparoscopic microsurgical tubal anastomosis (one-stitch technique). We carried out a retrospective study of 51 patients seeking reversal of previous tubal sterilization. The mean age of the patients was 33.2 years (range: 30-44.5 years). Surgery lasted 122 minutes on average, (60-204 minutes). Mean time to pregnancy was 8.2 months (4-32 months) and the rate of pregnancy obtained was 56.2%. Twenty seven patients became pregnant and 12 had ectopic pregnancies; of the 15 intrauterine pregnancies, 3 miscarried spontaneously before 9 weeks. Our study observed valuable qualities of feasibility, simplicity and rapidity of the “one-stitch technique” in laparoscopic tubal anastomosis surgery, with related good rates of intrauterine pregnancy. The rate of pregnancy obtained is fairly similar to the rates reported in the literature with the same technique. However, the high proportion of ectopic pregnancies makes us believing that laparoscopic procedures using more than one single stitch should be preferred.

Multiple Bowel Perforations Requiring Extensive Bowel Resection and Hysterectomy After Microwave Endometrial Ablation

Heavy menstrual bleeding, or menorrhagia, is a primary cause of morbidity in women. Herein, we present the case of a 41-year-old woman who underwent day-surgery endometrial microwave ablation because of dysfunctional uterine bleeding. She had undergone previous laparoscopic sterilization, and had no other risk factors except for a retroverted uterus. The procedure was performed without any documented difficulties. The patient was readmitted the following day with clinical signs of acute abdomen. Emergency laparotomy revealed a large perforation on the anterior uterine wall, full-thickness burns in the distal ileum, and multiple ischemic areas in the ileum, cecum, and ascending colon secondary to microwave burns. A right hemicolectomy was required, with extended ileal resection and subtotal hysterectomy with ovarian conservation. Although microwave endometrial therapy seems to offer many advantages, in particular in terms of efficiency and technique, complications occur, and extensive safety measures must be implemented to prevent adverse effects such as occurred in this patient.

Organ-Preserving and Reconstructive Microsurgery of the Fallopian Tubes in Tubal Infertility: Still an Alternative to In Vitro Fertilization (IVF)

Tubal infertility mostly results from infections. Conception only is possible through complex treatments (in vitro fertilization or surgery). Success cannot be guaranteed, even after repeated treatments. Unfortunately, many couples are not informed about the prospect for success of tubal reconstruction. Problems of in vitro fertilization are low pregnancy and birth rates of 28.4% and <20% respectively (Germany) and the high number of multiple pregnancies (21%). In this retrospective study 462 women with acquired tubal infertility and further 127 women after previous sterilization underwent microsurgical treatment (microsurgical adhesiolysis, anastomosis, fimbrioplasty, salpingostomy, and refertilization due to former sterilization). The main outcome measures are the pregnancy and birth rates following the microsurgical procedure. Pregnancy and birth rates of 43.4% and 29.2%, respectively, were higher than the outcomes post-single in vitro fertilization (abortion: 6.4%, extrauterine pregnancy: 7.9%). When reversal of sterilization was performed, pregnancy and birth rates were higher at 73% and 50.6%, respectively (abortion: 15.7%, extrauterine pregnancy: 6.7%). The advantages of reconstructive microsurgery over in vitro fertilization include the ideally permanent restoration of woman's ability to conceive naturally (repeated pregnancies are possible without further therapy), a high postoperative birth rate overall, and avoidance of multiple births. It is advisable to inform the patient about the objective possibility of reconstructive tubal surgery.

Bio-silage of mussel work-processing wastes by lactobacilli on semi-solid culture

The aim of this work was to evaluate the fermentability of mussel work-processing wastes by lactic acid bacteria in order to remove and to upgrade a material that generate important focuses of pollution in coastal areas. With this perspective, three lactobacilli ( Lactobacillus casei, Lactobacillus plantarum and Lactobacillus buchneri) were employed, and the production of metabolites, as well as the nutrient uptake, was evaluated. The effects of inoculum concentration and previous sterilization process were also studied. The kinetic tests were performed in semi-solid cultures and the results indicated the high feasibility of these materials as substrate for bio-silage production. Cultivations of 24 h led to productions of more than 90 g L −1 of lactic acid and 9 g L −1 of final protein. All the fermentation assays were stable for various days without contaminations by other bacteria.

REANASTOMOSIS TUBARIA LAPAROSCÓPICA POST ESTERILIZACIÓN: TÉCNICA DE TRES PUNTOS

SUMMARY Background: Advances in endoscopic surgical techniques have allowed well-trained and skilled surgeons to perform tubal anastomosis by laparoscopy reporting similar results than by laparotomy. Objective: To evaluate a new technique we called “three-stitch method”. Method: The outcomes for this evaluation were tubal patency and pregnancy rate. A retrospective analysis of five cases of previous tubal sterilization underwent endoscopic tubal reanastomosis using the “three-stitch technique” was done. In all patients a preoperative hysterosalpingogram was performed to confirm occlusion. Results: The average age was 35.8 ± 5.7 years (rango: 26-40 years). All the patients underwent previous tubal sterilization (four cases using Pomeroy technique and one case with Yoon Ring). Eighty percent (8/10) of tubes were reanastomosed. In two cases, due to inadequate conditions of distal or proximal ends of one tube, surgery was performed on the other only. The average surgical time was 150 ± 7.9 minutes (range 140-160 minutes). The pregnancy rate was 40% (2/5). Pregnancy was achieved in younger patients who underwent bilateral reanastomosis. In those patients where pregnancy was not accomplished, a hysterosalpingography was taken to evaluate tubal patency. All of the reanastomosed tubes showed tubal patency at six months follow-up.