Lysis of postoperative pelvic adhesions in infertility

Ovum pickup, sperm transport, and zygote transfer depend on unrestricted contractile, ciliary, and peristaltic mechanisms in the uterine tube and ovary. When adhesions hobble these mechanisms, infertility results. Traditional surgical correction may invite new adhesions thru trauma, disruption of blood supply, and inflammatory reactions from foreign materials. Microsurgery with electrosurgery reduced such surgical sequelae and doubled the term pregnancy rate.

Microsurgical reconstruction of the uterin tube in sterilized patients

Increasing requests for reversal of sterilization prompt a re-evaluation of guidelines for sterilization and for methods of reconstruction. The method of nonmicroscopic (gross) reconstruction is examined, and its frequent failures are felt to be in consequence of surgically induced distortion and damage to physiologic function. Microsurgery minimizes these failings and results in a doubled pregnancy rate. Microsurgical procedures are described and illustrated, and criteria are given for selection of candidates.

Folic acid nonresponsive homocystinuria due to methylenetetrahydrofolate reductase deficiency

Four siblings from a family with 11 children of Irish ancestry were observed to suffer from an essentially identical clinical illness, consisting of delayed psychomotor development in infancy and childhood, severe mental retardation, and upper motor neuron dysfunction. Death occurred at an early age in three siblings. In cases in which detailed physical examinations were performed, ectopia lentis, marfanoid features, and severe bony deformities were absent. Homocystinuria, homocystinemia, relatively normal concentrations of methionine and cystine in tissue fluids, and absence of methylmalonic aciduria were found. A deficiency of methylenetetrahydrofolate reductase was demonstrated in cultured skin fibroblasts from two siblings. Postmortem examination of two of the three patients who died showed extensive vascular thrombosis. No biochemical improvement was observed in the surviving child following treatment with large doses of folic acid.