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42–year–old man, former smoker, with allergic asthma. From February 2022, three weeks after the third dose of SARS–CoV–2 vaccine Spikevax (mRNA–1273), he experienced subcontinuous chest pain, worsened by breathing, sometimes with fever over 38°C, treated at home with ibuprofen and antibiotics without clinical benefit. After one month, blood chemistry tests showed increased inflammatory markers (CRP 76.5 mg/dL, ESR 55 mm/h), with negative troponin I. SARS–CoV–2 Polymerase Chain Reaction test was negative. On suspicion of subacute pericarditis, ibuprofen (600 mg b.i.d.) and colchicine (0.5 mg b.i.d.) were prescribed. After a week, he was admitted to hospital for reappearance of fever, chest pain and a syncopal episode. On ECG, negative T waves in DII, DIII, aVF; on echocardiogram, circumferential pericardial effusion (max 12 mm); indices of inflammation were increased; troponin I, auto–antibody and viral pattern were negative. On cardiac MRI: pericardial effusion (max 20 mm) with a fluid–corpuscular appearance, meso–subepicardial patchy areas of late gadolinum enhancement (LGE) at the antero– and infero–lateral wall of the left ventricle. Prednisone 25 mg/day and colchicine 1 mg/day were prescribed, with initial benefit. Two weeks later (April 2022), when the prednisone dose was reduced by half, chest pain with fever and pericardial effusion reappeared. The patient restarted prednisone at full dose (0.5 mg/Kg/day) in addition to colchicine and it was decided to do a very gradual décalage over the next six months. On follow–up cardiac MRI: thickening and enhancement of the pericardial leaflets with resolution of the fluid–filled effusion and mesomyocardial LGE striae. Further episodes of NSAID–sensitive chest pain were occasionally reported during cortisone dose reductions. In October 2022, at a dose of 2.5 mg/day dose of prednisone, there was another recurrence of pericarditis, with subcontinuous chest pain and marked increase in inflammatory indices. It was therefore decided to prescribe IL–1 inhibitor therapy (Anakinra) 100 mg/day subcutaneously for six months (ongoing follow–up). Pericarditis is a rare complication of SARS–CoV–2 mRNA vaccine, generally with a benign course, responsive to evidence–based therapy for acute pericarditis. This rare case of recurrent corticosteroid–dependent and colchicine–resistant vaccine–induced pericarditis emphasizes the importance of early diagnostic recognition and correct treatment in the acute phase.

IV lysine acetylsalicylate (aspirin) has been shown to be effective in the treatment of acute migraine attacks, but little is known about its effectiveness and safety in patients hospitalized for management of severe headache, typically arising from abrupt withdrawal of other acute attack medications.We present an audit of our use of IV aspirin in 168 patients in a tertiary referral setting.The findings demonstrate subjective approval of this medication by the patients and objective improvements in pain scores, a decrease of ≥3 points on a 10-point visual analog pain scale being seen on25% occasions on which the medication was administered. Further, side effect rates were low (5.9%), with no serious adverse events.IV aspirin is safe, effective, and useful in the inpatient management of headache.

Patients affected with severe endometriosis are at significant risk for ovarian tissue damage, which may lead to infertility, reduced response to ovarian stimulation, and occasionally, premature ovarian failure. The risk for a compromised ovarian reserve in young patients is especially high following repeated surgical intervention and in the presence of bilateral endometriomas. In many cases, enhanced loss of ovarian reserve may also result from the damaging effect of the pathologic process on follicle reservoir even without surgical interventions. Women diagnosed with severe endometriosis and those designated for extensive ovarian surgical intervention are frequently not planning to conceive. In light of recent advances in fertility preservation techniques (FPT), such as oocytes and ovarian tissue freezing, as well as their increasing success rates, we critically evaluate the options for FPT in patients suffering from endometriosis. Personalized counseling should be offered to all patients with endometriosis taking into account age, extent of ovarian involvement, current ovarian reserve, previous and impending surgeries for endometriosis, along with current success rates and possible risks associated with FPT.

Hemicrania continua (HC) is a relatively rare primary headache disorder characterized by unilateral pain and an exquisite response to indomethacin. Since the term was introduced in 1984, more than 100 cases have been reported in the literature. Useful information regarding the pathophysiology comes from functional imaging that suggests a role for subcortical neural structures. A positron emission tomography (PET) study in HC patients showed activation of the contralateral posterior hypothalamus, the ipsilateral dorsal pons, and ipsilateral ventral midbrain. Taken together with the unique effect of indomethacin to block the pain, the data point to the classification of HC as a unique syndrome that belongs to trigeminal autonomic cephalalgias (TACs).

Dificulties and lack of skills to recognize, describe and solve math problems in real contexts have been recently detected on secondary students by international educational researchs. In this article we present an innovative instructional proposal to teach lineal equations in context, involving the economic Laws of Supply and Demand, and Point of Equilibrium between prices and quantities. Secondary students’ achievements during the development of this instructional proposal led us to consider the importance and interest to teach math in real contexts, and to argue on the actual meaning of a math didactic situations., Recientes estudios comparativos internacionales de evaluación del desempeño matemático en estudiantes secundarios han puesto de relieve dificultades y falta de destrezas para reconocer, formular y abordar problemas matemáticos en contextos reales. En este trabajo presentamos una propuesta didáctica innovadora para la enseñanza del tema ecuaciones matemáticas lineales, enmarcada en el contexto de las leyes económicas de Oferta, Demanda, y de Punto de Equilibrio entre precios y beneficios. Los logros de la aplicación de esta propuesta en estudiantes recientemente egresados de secundaria nos muestra el interés de enseñar contenidos matemáticos aplicados a contextos reales, y nos lleva a reflexionar sobre qué significa generar una situación didáctica en matemáticas.

Studies aided by transmission electron microscopy were made in order to evaluate the occurrence and efficiency of the human follicular fluid in the activation of the processes leading to the acrosome reaction; quantitative, qualitative and morphological data and relative evaluations are here presented. The effects of the human follicular fluid were compared with those determined by other types of treatment, semen untreated, Pellet-Swim-up, and Centrifugation on Discontinuous Percoll Gradient. The transmission electron microscope observations permitted to evaluate the percentage of sperm with an activation of the acrosome reaction in the different groups. The analysis of the data showed a statistically relevant difference (P0.001) among the first group (Control group) and the SU group, the MP group and the hFF group, regarding the sperm with AR activation. The sperm treatment with 50% diluted hFF represents an important option to the preparation protocols of the semen samples useful for ART.

Our work with a group involved in Assisted Conception (AC) has provided us with a perfect opportunity for making an assessment of the efficiency of the techniques used for the treatment of Male Antisperm Autoimmunization (MAA) and Female Antisperm Isoimmunization (FAI). The aim of this study is to present all the most important methods of AC used by our group for the treatment of immunological infertility, such as intrauterine insemination, intraperitoneal insemination, intrafallopian gamete transfer, in-vitro insemination and intrauterine embryo transfer, intrafallopian zygote transfer, intrafallopian embryo transfer, and gamete micromanipulation. In-vitro fecundation would appear to be particularly efficient in cases of FAI, while MAA would seem to benefit more from the use of gamete micromanipulation.

The semen of the male partners of 37 infertile couples was analyzed with the use of the HTM-S Motility Analyzer (HTM-S MA). For each sample it was thus possible to assess the Total Concentration (TC), the Motile Cell Population Concentration (MCPC), the Progressive Cell Population Concentration (PCPC), the Average Path Velocity (VAP), the Straight Line Velocity (VSL), the Curvilinear Velocity (VCL), the Straightness (STR), the Linearity (LIN), the Lateral Head Displacement (ALH) and the Head Size (HS). The same parameters were then measured on the same semen after treatment with the Pellet Swim-up (PSu) and following Centrifugation on reduced-volume Discontinuous Percoll gradient (mini-CDPG). There was a significant difference in the TC (51.63 M/ml +/- 43.99 in the untreated ejaculate, 11.48 M/ml +/- 9.66 after PSu, 7.94 M/ml +/- 7.3 after mini-CDPG; chi r2 = 50.392, p0.05), in the MCPC (20.95 M/ml +/- 26.29 in the untreated ejaculate, 3.79 M/ml +/- 4.26 after PSu, and 2.74 M/ml +/- 3.73 after mini-CDPG; chi r2 = 33.55, p0.05), and in the PCPC (7.8 M/ml +/- 12.87 in the untreated ejaculate, 1.81 M/ml +/- 2.36 after PSu, and 1.28 M/ml +/- 1.73 after min-CDPG; chi r2 = 6.38; p0.05). The overall comparison between the couples showed a significant difference in the MCPC after PSu and after mini-CDPG (z = -2.09, p0.05) whereas no significant difference was found in the comparison off the results of either the TC after PSu and after mini-CDPG (z = -1.9; NS), or of the PCPC after PSu and after mini-CDPG (z = -1.68; NS).(ABSTRACT TRUNCATED AT 250 WORDS)

In 26 couples undergoing in-vitro fertilization and embryo transfer (IVF/ET), where the male partner was severely dyspermic, the seminal fluid was treated with Pellet Swim-up (PSu), modified by a 20-minute sperm incubation period in non-decomplemented human follicular fluid (hFF) diluted to 50%. In another group of 26 severely dyspermic couples undergoing IVF/ET, the semen was treated with a variant of centrifugation on discontinuous Percoll gradients (CDPG), called mini-CDPG. Pre-treatment with hFF produced a significant increase in oocyte fertilization rate (46.8% in the hFF group compared with 18.4% in the mini-CDPG couples; Kolmogorov-Smirnov Test: D = 0.5, p0.01), in the transfer rate per patient (96.1% in the hFF group and 50% in the mini-CDPG group; (Chi-square Test: x2 = 11.827, p0.001), and in the pregnancy rate per patient (respectively of 26.9% and 0%; Fisher's exact probability test: P = 0.0049, p0.01). There was a high miscarriage rate in the pregnancies obtained in the hFF group (42.8%). The results might be linked to a positive effect of the hFF on sperm capacity and on acrosome reaction. The Authors conclude that the use of hFF would seem to be an extremely useful treatment of the semen of severely dyspermic patients in assisted fertilization programs.

Both the male and female partners of 28 couples with muco-semen incompatibility and of 8 couples with unexplained infertility were examined for the presence of genital infections by Chlamydia T. and/or Mycoplasma H. and/or Ureaplasma U. (CMU infections), and for topical and serum antisperm antibodies (AS-abs). The presence of other common genital infections, and for Candida A. and Trichomonas had previously been excluded in all the subjects; all the female partners presented normal hysterosalpingographs, regular ovulatory function and cervical scoreor = 10. The main cause of the muco-semen incompatibility was dysspermia (35.7%), either associated or not with male CMU infections, followed by female CMU infections (21.4%), male CMU infections without dysspermia (3.6%), and the presence of AS-abs in the mucus (3.6%) and in the semen (3.6%); in 32.6% of the cases no plausible explanation was found for muco-semen incompatibility. In 42.8% CMU infections were implicated in the muco-semen incompatibility; furthermore, there was associated dysspermia in 50% of the cases. AS-abs were found in the mucus or in the serum of 70% of the patients with CMU infections, while this figure went down to 34.6% in subjects not affected by such infections. None of the patients with CMU infections showed AS-abs either in the semen and/or in the serum. AS-abs were found in the serum of 25% of the female patients with so-called "unexplained" infertility. CMU infections are important for the determination of muco-semen incompatibility, both with and without dyspermia.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro fertilization is used for several years as a technique for resolving infertility problems due to moderate or severe oligospermia. More recently, techniques of micro-insemination of oocytes have also become available for cases of extremely severe oligospermia which cannot be resolved by classical I.V.F. Nevertheless, although these particular techniques have already led to results which have gone far beyond initial hopes, they are not able to resolve all cases of male sterility. There are indeed many situations of excretory azoospermia associated with normal spermatogenesis; the spermatozoa remain trapped in a more or less extensive part of the epididymis because its passage is blocked, either because of post-infectious sclerosis, or of agenesis of a variably extensive area of the Wolffian duct. Post-inflammatory occlusions can be treated by micro-surgery, whereas in cases of agenesis, attempts to collect spermatozoa by means of an artificial spermatocele have led to far too many failures, and this technique has now been abandoned, in spite of some successful pregnancies. The extraordinary development of in vitro fertilization techniques has led to the logical idea that it might be possible to collect epididymal spermatozoa for oocyte fertilization.

The increasing incidence of male subfertility as an indication for ART is first discussed. The tendency to use assisted reproduction techniques in such cases is attributed to the disappointing results of classical treatments. The Authors deal with two problems: the choice of the best treatment methods of the sperm and the choice of the best technique of ART for treating male infertility. The analysis of 138 couples treated for male subfertility showed that the centrifugation on discontinuous Percoll gradients (CDPG) and especially on the mini-Percoll (mini CDPG) offers the best results if compared with pellet swim up and other techniques. With reference to the technique of choice, an accurate analysis of tubal (TET and ZIFT) and uterine (IVF/ET) transfers shows that no advantage seems to be obtained with the more sophisticated and exacting tubal transfer. This final conclusion is presently evaluated on the basis of a retrospective study.

Recent reports in the literature have focused on the increased risk of heterotopic pregnancy after the transfer of multiple concepti or oocytes. In an international collaborative patient registry between 1985 and 1989, 601 clinical pregnancies resulted from 2092 gamete intra-Fallopian transfer (GIFT) retrieval cycles. Five of the pregnancies were heterotopic (0.83%). After surgical intervention, all five cases of combined gestation resulted in live birth from intrauterine pregnancies. Routine vaginal ultrasonographic examination of the adnexa in patients who conceive after GIFT may help early diagnosis of heterotopic pregnancy. If the diagnosis is made early, conservative treatment may preserve the future fecundity of the patient and more intrauterine pregnancies may be salvaged.

Recent reports in the literature have focused on the increased risk of heterotopic pregnancy after the transfer of multiple concepti or oocytes. In an international collaborative patient registry between 1985 and 1989, 601 clinical pregnancies resulted from 2092 gamete intra-Fallopian transfer (GIFT) retrieval cycles. Five of the pregnancies were heterotopic (0.83%). After surgical intervention, all five cases of combined gestation resulted in live birth from intrauterine pregnancies. Routine vaginal ultrasonographic examination of the adnexa in patients who conceive after GIFT may help early diagnosis of heterotopic pregnancy. If the diagnosis is made early, conservative treatment may preserve the future fecundity of the patient and more intrauterine pregnancies may be salvaged.

A pregnancy obtained in a patient with 46XY gonadal dysgenesis (Swyer's syndrome) after ovum donation and IVF/ET is described. The efficacy of this technique in overcoming particular cases of otherwise irreversible infertility is discussed.

The Authors record the results in a group of patients with immunologic recurrent abortion (IRA) treated with two different immunoprophylaxis regimen. The first one is an active prophylaxis therapy with preparation and administration from donor mononucleates. According to their previous original experience, the Authors started giving high doses of IV-Ig (HD IV-Ig) in a second group of pregnant patients with the same diagnosis of immunologic recurrent abortion (IRA). The results of this not randomized study show better reproductive outcome in the group treated with use of HD IV-Ig.

The authors report their experience with the use of ultrasonography and fetal blood flow measurement in the evaluation of fetal conditions recording patients with previous repeated immunologic abortion (R.I.A.) and with pre-eclampsia. In both groups of patients, the two biophysical methods, proved to be extremely valuable indicators of the fetal conditions.

Uterine velocimetry was performed in 13 pregnant women with pregnancy induced hypertension (PIH) and in 15 pregnant women with recurrent spontaneous abortion syndrome (RSA-S). Measurement were performed on both uterine arteries and averaged. 75% of PIH group had RI 95th percentile from the first measurement (20 weeks gestation). In the RSA-S group, RI was between 75th and 95th percentile, suggesting an almost pathological vascularization.

The activity of the blocking factor (BF) was studied in 88 patients affected by recurrent abortion syndrome (RAS) by means of the determination of lymphocyte proliferation rate (LPR) in one-way mixed maternal-paternal lymphocyte cultures (MLC). Forty patients (45.5%) showed inadequate blocking activity (LPR greater than 80%). Pearson's correlation did not reveal any link between patient age and LPR (m2 = 0.031), or between LPR and number of aborted pregnancy (m20.058). Fifteen of the 88 patients had had only two consecutive abortions, but Pearson's correlation did not result in any particular differences in the link between LPR and number of abortions in this group; we therefore felt perfectly justified in extending the study to these subjects.

In the second bimester of 1990 we have performed IVF/ET in a group of patients who had previously been excluded from the IVF/ET programme for severe dyspermia and negative Pellet Swim-up Test (PST). This group consisted of 101 cases of whom 38 underwent semen treatment with Centrifugation on a Discontinuous Percoll Gradient (CDPG) and 63 with Pellet Swim-up (PS); the control group was made up of 31 normospermic patients where the semen was treated by PS. Furthermore, in the same period, we performed Tubal Embryo Stage Transfer (TEST) on 5 normospermic and on 2 dyspermic cases, as well as Zygote Intra-Fallopian Tubal Transfer (ZIFT) on 2 normospermic patients. In all these cases the sperm was always treated with PS. We obtained disappointing IVF/ET results in the dyspermic patients with negative PST where the semen was treated with PS, with only one pregnancy (pregnancy rate 1.6% per patient). Unexpected results were obtained in cases of severe dyspermia where the semen was treated with CDPG (5 pregnancies out of 38 cases; pregnancy rate 13.1% per patient) (chi square = 7.03, p 0.01). We obtained remarkable Test results: 4 pregnancies out of 5 cases of unexplained infertility and one pregnancy out of 2 cases of dyspermia. Moreover we obtained one pregnancy in the two ZIFT's performed. The use of CDPG, possibly associated with Test, will open new horizons in the treatment of dyspermic patients by means of assisted fecundation techniques.

The authors report three cases of immunologic spontaneous abortions and fetal death. In the first patient there was lupus-like anticoagulant activity with a diagnosis of sub-clinical autoimmune disease; the second showed inadequate blocking factor activity, while the third subject presented excessive lymphocytotoxicity. In these cases three different therapeutic protocols were successfully used: flucortolone and salicylates, high-dose intravenous gammaglobulins and subcutaneous heparin.

Twenty-nine women with serum antisperm antibodies underwent in vitro fertilization and embryo transfer. Half the oocytes from each patient were treated with patient-serum-supplemented medium with antibodies (medium A), and the other half with donor-serum-supplemented medium without antibodies (medium B). In 9 cases the antibodies were against the sperm head and these showed a significant difference in the number of embryos obtained between the two media (p = 0.001): 10.5% of fertilization of type 3 and/or 4 oocytes with medium A and 81.2% with medium B. A lower rate resulted also when the antibodies were against the middle and main portion of the tail, but fertilization did not seem to be affected when they were directed against the tail tip. No definite conclusions are possible, however, since the number of cases studied was too small.

The present study was carried out to investigate the influence of inhibitor factors on the immunological response of the mother. Using a FIVET program (in vitro fertilization and embryo-transfer) we were able to detect in vitro the modulation of lymphocyte response by hormones, utilizing subjects receiving hormone therapy. A new assay has been used to study the antibody response. The lymphocytes were adhered during the culture to the plastic surface of microplates, and the modulation of the expression of the surface IgG was detected with an E.L.I.S.A. assay in the same culture plate. Many hormones were tested in vitro using this assay. The addition to the lymphocyte cultures of hCG and oestradiol give a variable effect. This effect is concentration dependent and whilst in all instances the higher dosages were inhibitory, in same subjects the lower dosages had a stimulatory effect, but if the subjects were treated in vivo with hCG, then an inhibitory effect was observed in vitro even using very low concentrations of hormones. This could suggest that these hormones have an inhibitor effect on the lymphocyte response, inhibition that was enhanced when the lymphocytes were "primed" in vivo.

There is general agreement that unopposed estrogen therapy can cause cystic hyperplasia of the endometrial mucosa, and it is also possible a progression of this lesion towards borderline forms of hyperplasia and adenocarcinoma in patients where there is a predisposition. The Authors report their experience of a combined, hysteroscopic and histological, study made on a group of patients who had undergone cyclic therapy with conjugated estrogens. In this group the more complex forms of hyperplasia were found in those patients treated with the higher dose of estrogens. The Authors emphasize that cyclic therapy of small doses of estrogens associated with 7-12 days of progestins every month can prevent or correct endometrial cystic hyperplasia. The microhysteroscope is a new instrument very simple to use; because of its accuracy, it makes the gynecologist able to perform an immediate endo-uterine diagnosis, thus avoiding some of the other techniques used in the examination of the uterine cavity; in the Authors experience this very interesting endoscopic method has proved to be extremely useful in the controls of patients receiving replacement hormone treatment for menopausal troubles.

The Gamete Intrafallopian Transfer (GIFT) was carried out in 12 couples with unexplained infertility, in 2 cases with infertility associated with mild endometriosis, in 1 case of hostile mucus and 3 cases in which phymosis of the ampulla and/or periadnexal adhesions were previously identified. In 7 couples GIFT was carried out after several AID cycles for husband azoospermia or severe oligospermia. Three different protocols were used for the controlled ovarian hyperstimulation. In all cases an adequate follicular growth was obtained and mature oocytes were recovered. At first attempt 12 ongoing pregnancies (1 triplet, 1 twin) were obtained with a present pregnancy rate of 48%.

The authors report their experience on 140 diagnostic cordocenteses performed in the early trimester of pregnancy (technique, indications and complications). Furthermore the Authors report preliminary data concerning various fetal blood biochemical parameters (22) obtained by cordocentesis at 18-19 weeks of pregnancy (42 cases). Fetal and maternal values are compared.

16 couples belonging to couples with negative or doubtful PCT were selected according to the presence of antisperm immunization. 12 patients, 5 male and 7 female, showed both localized and generalized immunization. The former was diagnosed by means of a positive IgG MAR-Test, direct IgG Immunobead-Test, direct IgG Immunobead-Test and seminal TAT in the male patients, and Micro-SIT in the cervical mucus of the female patients, while for the latter there was simultaneous positivity of both serum TAT and SIT, except for two cases, in which the SIT only was positive. The 4 remaining patients, 2 male and 2 female, did not show any signs of antisperm immunization. The evaluation of the antisperm antibodies by means of the ZER ELISA Antisperm Kit in the serum of the 16 patients examined showed that there were no significant statistical differences between the serum TAT and the SIT. The former showed agreement of the results in 93.75% of the cases, and the latter in 81.25%. A strict correlation was observed between the ELISA for serum antisperm antibodies (ELISA-AS-Abs) and the local immunitary situation, with agreement in 93.75% of the cases. The ELISA-AS-Abs seems to bring the advantage of eliminating the need for fresh semen for antibody titration and also means that there is no subjective interference with the evaluation of the results.

125 male subjects belonging to infertile couples with negative or doubtful PCT underwent the following tests: IgG MAR Test, seminal TAT, indirect IgG-IgA-IgM-IBT in the seminal plasma, serum TAT, serum SIT, serum IgG-IgA-IgM-IBT. There was no significant difference in the incidence of autoimmunized patients and those resulting from classical testing methods (IgG MAR Test, seminal and serum TAT, serum SIT) (16%), and the results of the indirect IBT in the seminal plasma and in the serum (16.8%). The IBT showed an increase which was not, however, statistically significant in subjects with concomitant local and general autoimmunization, compared to the classical methods, (13.6% in the subjects examined versus 10.4%). There was a statistical significant difference between the results of the indirect IgA-IBT in the seminal plasma and those of the IgG MAR Test, (19 versus 12 positive patients, chi2 = 6.05, p less than 0.05). Furthermore, in 88.2% of the cases with concomitant positivity, the indirect IgA-IBT in the seminal plasma showed higher values than the indirect IgG-IBT in the seminal plasma. There was no significant difference between the results of the classical methods and the serum IBT, whereas both in the semen and in the serum the beads adhered mainly to the tail plus the tail up considering only the nemaspermic portion with the highest relative rate of adhered beads.(ABSTRACT TRUNCATED AT 250 WORDS)

After a review of the main problems related to metroplastics (i.e. frequency of malformations, their importance in maintaining infertility, clinical classifications, diagnostic techniques, the Authors discuss the problem of their surgical treatment. The results obtained in 54 cases from a cooperative study (Audebert 17 cases; Cittadini 25 and Cognat 12) are presented. In 50 out of 54 cases the Bret-Palmer technique has been performed and in several cases complementary operations such as adhesiolysis, salpingoplastics, ligamentopexies, myomectomies, cystectomies, wedge resections of ovaries, were performed. On the basis of their experience, the Authors affirm that the results of metroplastics are better when their indications are strictly selective and they stress that the overall results may be considered as favourable.

After a short discussion on the rationale for the use of GnRH agonists in the stimulation protocols of GIFT and IVF/ET cycles, the authors discuss their own experience with the use of Buserelin in these cases. Buserelin was administered nasally starting on day 21 of the cycle preceding the stimulation cycle. FSH and/or HMG were administered starting on day 3 of the cycle, until the proper moment for administration of HCG. 34 cycles of GIFT and 40 cycles of IVF were studied and it was possible to observe minor endogenous LH interferences with respect to control cycles. The number of harvested ovocytes was greater, the quality of ovocytes was clearly better and both the fertilization rate and pregnancy rate were higher. The authors stress the interest of pituitary temporary ablation as first choice treatment for IVF and GIFT protocols.

The Authors report their experience in the diagnosis and management of intrauterine adhesions in a group of 23 patients using the microhysteroscope. This new model of hysteroscope makes it possible to diagnose clinically suspected cases and to perform lysis of the adhesions in the out-patient department, without cervical dilatation and anesthesia. The technical features of the microhysteroscope made a double evaluation of adhesions possible: a) the macroscopic classification of the site and extension of the synechiae and b) their microscopic in vivo observation to identify the less vascularized areas and to perform adhesiolysis under direct visual control. Monthly hysteroscopic examinations were performed in order to follow the results of therapy and to remove residual or newly formed adhesions. In the authors' experience the microhysteroscope may be successfully used in the early diagnosis and subsequent best management of intrauterine adhesions in patients with previous medical history of curettage in a recent pregnant uterus.

Uterine malformations have long been considered as a cause of repeated abortions (Mauriceau, 1865). Recent progress in the field of human reproduction has not led to any major change in the concepts on this subject. After reviewing the basic principal elements of uterine abnormalities, this report will place emphasis on certain aspects of congenital Mullerian anomalies.

The Authors describe their experience with a new type of intratubal mechanical device to be inserted under hysteroscopic control. Up to present time, 1471 cycles without any other form of contraception have been observed. Although the promising results of this preliminary report in the field of hysteroscopic reversible tubal sterilization, the Authors underline that this new technique is still evolving and will be improved with further experience.Techniques for hysteroscopic tubal sterilization may be divided into 3 categories: destruction of the interstitial of the bube by means of electrocoagulation or cryonecrosis; injection of sclerosing substances or silicone liquid; and mechanical devices which will occlude the interstitial section. Experience with a new type of intratubal mechanical device to be inserted under hysteroscopic control is described. The detailed and enlarged visualization possible with the aid of microhysteroscope, during an atraumatic outpatient examination, led to the invention of a device which is suitable for this method and for the anatomo-physiological conditions of the interstitial section of the tube. The device is made of surgical nylon (1 mm diameter) having an open loop at its distal end with an elastic memory so that it can be opened at varying widths and be fixed in the tube, and preventing its migration into the uterine cavity. A similarly adaptable proximal loop stops it from migrating into the peritoneum and facilitates its removal by means of a simple hook. The middle section of about 28-30 mm in length is supple so that it can be atraumatically inserted in the interstitial section. The 2 devices are placed in a supple inserting catheter (diameter 1.5 mm) and a nylon guide thread enables their progression to be followed under visual control. The microhysteroscopic technique is the same as that used for a diagnostic examination or for surgery. From march 1982 to February 1984, 166 patients who requested permanent sterilization were informed about and accepted this method. The average patient age was 33.5 years, with and average parity of 2.4. Patients less than 30 years of age or who had fewer than 2 living children were excluded. In 149 patients it was possible to effect a bilateral insertion during the 1st microhysteroscopy. In 7 patients it was necessary to make 2 attempts, either because of bleeding or unsatisfactory visualization. There was serious retroversion in 3 cases, atresic tubal orifices in 4, and in 1 case the pain felt by the patient was so violent that an hour's rest was necessary. In these 8 patients the device was not inserted. The discomfort felt during the procedure is equal to that experienced during a diagnostic microhysteroscopic examination. A microhysteroscopic examination performed 1 month after insertion showed 4 expulsions. Up to the present time, 1471 cycles without any other form of contraception have been observed. 1 intrauterine pregnancy occurred 6 months after insertion. The technique is still evolving and will be improved with experience and further study.

3 types of hysteroscopic sterilization are in various stages of investigation at present: destruction of the interstitial portion of the tube with electrocoagulation or cryonecrosis, injection of sclerosing agents or liquid silicone, and mechanical devices. A nylon intratubal device measuring 4 cm long by 1 mm in diameter tested in a multicenter study was designed to prevent migration into the uterine cavity and had a nylon ring at the proximal extremity to facilitate removal of the device. The flexible middle part permitted insertion of the device without trauma. The proliferative phase of the cycle was the optimal time for insertion since the tubal orifices were most easily observed at that time. Among contraindications to use of the device were retroverted uterus, pelvic inflammatory disease, insufficiently large tubal opening, and sinuosity of the interstitial segment. 166 women aged 33.5 years of age on average and with an average parity of 2.4 children participated in a test of the method between March 1982 and February 1984. Bilateral insertion on the 1st attempt was possible for 149 women, 7 women required a 2nd attempt because of bleeding or poor visualization, and the others had functional or anatomic contraindications to use of the method. 29 insertions were done under paracervical local anesthesia and 6 under general anesthesia. Hysterographic control 1 month after insertion revealed 4 expulsions, 2 of which were bilateral. 1471 cycles without other contraception have been followed. 1 pregnancy occurred 6 months after insertion; in this case hysteroscopy showed that the device was in place. Microhysteroscopy permits a direct approach to the uterine cavity which can be done on an outpatient basis without general anesthesia. The surgical nylon of the device is inert and biocompatible, and microhysteroscopic controls have not demonstrated inflammatory tissue reactions. The flexibility of the device assures an insertion without risk of perforation. Although the method has been studies in 1471 cycles, further research is needed before conclusions can be drawn about its efficacy. Observations in 6 patients who underwent hysterectomy after use of the intratubal device showed a moderate reaction of neighboring tissue, but no evidence that the device could not be easily removed and permeability of the interstitial portion of the tubes recovered. Preliminary results support development of the method, but some difficulties in its use must still be overcome.