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The Fallopian Tubes
SN Tripathy
SECTION ONE: BASICS
1:
The Fallopian Tubes: An Overview
ANATOMY AND PHYSIOLOGY
EMBRYOLOGY AND CONGENITAL ANOMALIES
DISEASES OF THE TUBES
Infertility and Tubes
Tubal Functions
HYSTEROSALPINGOGRAPHY
Laparoscopy and Hysteroscopy
Salpingoscopy and Falloposcopy
Transvaginal Hydrolaparoscopy
Hystero-contrast-sonography
Ultrasonography
Hysterosalpingoscintigraphy
Management of Tubal Factor Infertility
Ectopic Pregnancy
Risk Factors
Pelvic Inflammatory Disease
Fallopian Tube Malignacy
Tuberculous Salpingitis
Endometriosis and Tubes
THE NEW FRONTIERS
Tubal Transplantation
Robotic Surgery
Tubes as a Source of Mesenchymal Stem Cells
Stem Cell Therapy to Restore Tubal Functions
CONCLUSION
2:
Surgical Anatomy of the Fallopian Tube
HISTORY
GROSS ANATOMY
Segments of the Fallopian Tube
Structure
FUNCTION IN FERTILIZATION
Vascular Supply
Embryology
3:
Fimbria
SEGMENTS OF FALLOPIAN TUBE
ANATOMY OF FIMBRIA
HISTOLOGY
ELECTRON MICROSCOPY
Role of Fimbria in Fertilization
Diseases of Fimbria
Fimbrioplasty
4:
Molecular Biology of Endosalpinx
INTRODUCTION
STRUCTURE OF THE HUMAN FALLOPIAN TUBE EPITHELIUM3
Cyclical Variation in Human Tubal Morphology
Molecular Biology
Tubal Transport
Structure of the Cilia
CROSS-SECTION OF A CILIA
Cyclical Changes in Ciliary Beat
Regulation of Ciliary Beat
Role of the Cilia in Tubal Transport
Ovum Transport
Sperm Transport
Tubal Secretion
Tubal Fluid
Maturation of Secretory Granules in the Endosalpinx
Oviductal Fluid Composition
Growth Factors and Receptors
Hormones and Receptors
Energy Substrates
Elemental Composition of Fluid in the Human Fallopian Tube
Amino Acids
Prostaglandin
Inhibins and Activins
Proteases and Inhibitors
Antioxidant and Protective Agents
Glycosidases and Glycosyl Transferases
Chaperones and Heat Shock Proteins
Proteins
Oviduct-specific Glycoprotein
Interleukins
Oviduct Secretions and Sperm
Oviductal Secretions: Oocyte and ZP Maturation
Oviductal Secretions and Embryo Development
CONCLUSION
5:
Effect of Ovarian Steroids on Fallopian Tube
GENERAL DESCRIPTION
STRUCTURES
Inhibin, Activin and Follistatin and Antimullerian Hormone
Ovarian Steroidal Cyclical Variation in Tubal Morphology
Progesterone Receptor
ROLE OF CILIA IN TUBAL TRANSPORT
Ovum Transport
At the Time of Ovulation
6:
Reproductive Significance of Fallopian Tube Cilia
HISTOLOGY OF FALLOPIAN TUBE
STRUCTURE OF CILIA
Morphologic Characteristics of Tubal Epithelium
Cyclical Variation in Tubal Morphology
Different Receptors in Ciliary Function
Ciliary Beat Frequency
Oocyte Pick-up and Cilia
TRANSPORT OF SPERM
Embryo Transport in the Oviduct
Ciliary Activity in Different Diseases of Fallopian Tube
HYDROSALPINX AND CILIA
Endometriosis and Ciliary Function
Drugs and Other Chemical Substance and Ciliary Function
Ectopic Pregnancy and Cilia
CONCLUSION
SECTION TWO: OBSTETRICS
7:
The Dialogue between Ovum and Sperm: Role of Fallopian Tubes
ANATOMY AND TUBAL FUNCTIONS
Gamete Activation
Sperm Activation
Oocyte Activation
Zona Pellucida
Cytoplasmic Maturation
Sperm Oocyte Fusion
Sperm Receptors Involved in Sperm-ZP Interaction
Cortical Reaction
Sperm Trigger of Egg Activation
Sperm Penetration through the ZP
Fast and Slow Block to Polysperm
Reactivation of Meiosis
Sperm Fusion to the Oolemma
DNA Synthesis
Pre-implantation Development
ROLE OF CHEMOTAXIS AND THERMOTAXIS IN HUMAN REPRODUCTION
Human Sperm Chemotaxis
Chemoattractants and their Sources
Physiological Significance of Human Sperm Chemotaxis
Human Sperm Thermotaxis
CONCLUSION
SECTION THREE: GYNECOLOGY
8:
INFERTILITY: Fallopian Tube Function Tests
INTRODUCTION
METHYLENE BLUE TEST
Rubin's Test (Gas Hydrotubation)
Technique
Laparoscopy and Dye Test
HYSTEROSALPINGO-CONTRAST SONOGRAPHY
Disadvantages
Selective Salpingography
FALLOPOSCOPY
CONTRAINDICATIONS
Fertiloscopy (Transvaginal Hydrolaparoscopy)
Salpingoscopy and Microsalpingoscopy
Operative Technique
RADIONUCLIDE HYSTEROSALPINGOGRAPHY
MSCT–H
MSCT-H Procedure
Magnetic Resonance Imaging
CONCLUSION
9:
Hysterosalpingogram
INTRODUCTION
ADVANTAGES OF HYSTEROSALPINGOGRAM
HSG Procedure
Contrast Agents
Catheter or Metal Cannula
Interpretation of a HSG Plate
Therapeutic Effects of HSG
Contraindications for HSG
HSG Versus Laparoscopy
HSG AND LAPAROTOMY
HyCoSy and HSG
HSG Versus Selective Salpingography
MSCT-H AND HSG
Variability in Interpretation Between Interobserver and Intraobserver
10:
Ultrasonography in Tubal Pathology
PATHOLOGICAL STATES
Pelvic Inflammatory Disease
COLOR DOPPLER FINDINGS
INTERVENTIONAL PROCEDURE
Torsion
ECTOPIC PREGNANCY
Sonographic Findings
BENIGN TUMORS
MALIGNANT TUMORS OF FALLOPIAN TUBES
CONCLUSION
11:
The Laparoscopic Assessment of Fallopian Tubes
LAPAROSCOPY TO ASSESS THE FALLOPIAN TUBES
Instrumentation for Laparoscopy
The “Alpha” Sequence of Examination of the Pelvis1
Examination of the “Fallopian Tubes”
Proximal Fallopian Tube
Diseases that can Affect Proximal Tube
Mid Fallopian Tube
Diseases Affecting Mid Fallopian Tube
Distal Tubal Disease
Anatomic Derangement of the Tubo-ovarian Capture Mechanism1
SALPINGOSCOPY
Instrumentation for Salpingoscopy
Findings2,3
Normal Structure
Abnormalities
Fertiloscopy
Instruments
Technique
Procedure
Contraindication
Laparoscopic Assessment of Genital Tuberculosis
Pathology
Laparoscopic Findings
Mild Forms
Moderate Form
Severe Forms
MICROLAPAROSCOPY
Instrumentation
Technique
12:
INFECTIONS: Tuberculous Salpingitis
PATHOGENESIS AND PATHOPHYSIOLOGY
Lymphatic Spread
Direct Spread from a Neighboring Viscus
SIGNS AND SYMPTOMS
INVESTIGATIONS
Screening for Tuberculosis
Investigations
Imaging
Tubal Outline
Tubal Occlusion
Tubal Dilatation
Peritubal Adhesion
Calcifications
ULTRASONOGRAPHY
Laparoscopy
Histopathology
Direct Smear
Culture
DIAGNOSIS
Management
Management of Infertility
Medical
Surgery
In Vitro Fertilization and Embryo Transfer
CONCLUSION
13:
Pelvic Inflammatory Disease: Recent Advances
EPIDEMIOLOGY
MICROBIOLOGY OF PELVIC INFECTION
PATHOPHYSIOLOGY7 (Figs 1A to D)
Host-Pathogen Interaction
Risk Factors
Factors Related to Sexual Behavior
Diagnostic Considerations
Physical Signs
Transvaginal Ultrasonographic Scanning
Laparoscopy
Computed Tomography
Magnetic Resonance Imaging
Culdocentesis
Endometrial Biopsy
Differential Diagnosis
Complications
MANAGEMENT
Treating Pelvic Inflammatory Disease
Starting Therapy
Outpatient Treatment
Alternative Oral Regimens
Inpatient Treatment
Follow-up
Partner Notification
Special Consideration
Contraception Options and PID
Long-term Sequelae
CONCLUSION
14:
TUBAL ECTOPIC PREGNANCY: Risk Factors for Ectopic Pregnancy with Special Reference to Bilateral Tubal Pregnancy
TUBAL FACTORS
15:
Conservative Management of Ectopic Pregnancy
EARLY DIAGNOSIS
Risk Factors
Clinical Features
Investigations
LABORATORY ASSESSMENT
β-hCG Assays
Discriminatory hCG Level
Diagnosis of Ectopic Pregnancy by USG
Pregnancy of Unknown Location
TREATMENT
Expectant Management
Follow-up
Medical Therapy
DRUG ADMINISTRATION
Methotrexate Treatment Protocols
Caveats for Physicians and Patients Regarding the Use of MTX
Serious Side Effects
Common Side Effect
Predictors of MTX Treatment Failure
Other Complications of MTX Treatment
Reproductive Performance after Ectopic Pregnancy38
SUMMARY
16:
Heterotopic Pregnancy
KEYNOTE
17:
TUBAL MALIGNANCY: Malignancy and the Fallopian Tubes: An In-depth Study
EPIDEMIOLOGY
Fallopian Tube—as Originator of Ovarian Cancer
Clinical Presentations and Diagnosis
PATHOLOGY
Histopathologic Types
Histopathologic Grades12
Pattern of Spread and Staging
Treatment
Principle
Management of Early Stage Disease
Management of Carcinoma In Situ
FIGO Stage I and Stage II Disease
Management of Advanced Disease
FIGO Stage III
FIGO Stage IV12
Management of Sarcoma of Fallopian Tube12
Adjuvant Chemotherapy
FIGO Staging of Carcinoma of the Fallopian Tube15
Stage
Prognostic Factors and Survival
FIGO-Overall Survival at15
Follow-up
Our Experience at Regional Cancer Center, Cuttack (Unpublished Data)
CONCLUSION
SECTION FOUR: TUBAL SURGERY
18:
Evidence-based Management of Tubal Factors Infertility
INTRODUCTION
PROXIMAL TUBAL DISEASE OR TEROTUBAL DISEASE
Etiology
Midtubal Disease
Distal Tubal Disease
DIAGNOSIS OF TUBAL INFERTILITY
RCOG RECOMMENDATIONS FOR TUBAL ASSESSMENT
MANAGEMENT
Proximal Tubal Occlusion
Confirmation of PTO
Classification of PTO
Management of PTO
Transcervical Tubal Cannulation and Selective Salpingography
Tubocornual Anastomosis/Tubouterine Implantation
Role of Gonadotropin–Releasing Hormone Analogs in PTO
Distal Tubal Disease
Classification of Distal Tubal Occlusion
Management of DTO
Salpingostomy or Salpingoneostomy
Fimbrioplasty
Management of Hydrosalpinges
Treatment Modalities for Hydrosalpinx
Drainage of Hydrosalpinx Fluid
Salpingostomy
Proximal Tubal Ligation
Salpingectomy
Management of Adhesions
Management of Post-sterilization Tubal Obstruction
In Vitro Fertilization and Embryo Transfer
CONCLUSION
19:
Tubal Catheterization: The Recent Scenario
SELECTION OF PATIENTS
HISTORY
TUBAL CATHETERIZATION PROCEDURES
Coaxial Falloposcopy
LINEAR EVERTING CATHETER
Guidewire Cannulation
Free-hand Cannulation Technique
Hysteroscopic Tubal Catheterization
Selective Salpingography and Tubal Catheterization
Procedure
Fluoroscopically Guided Transcervical Balloon Tuboplasty
SONOGRAPHIC FALLOPIAN TUBE RECANALIZATION
KEY POINTS
20:
Tubal Surgery in the Treatment of Infertility in the Era of Assisted Reproductive Technology
INTRODUCTION
ETIOPATHOGENESIS OF TUBAL INJURY AND SELECTION OF THERAPY
Assessment of Tubal Function and Classification of Tubal Disease
Advantages and Disadvantages of Reconstructive Surgery and ART
Comparison of Pregnancy Outcome between Reconstructive Surgery and ART
Parameters to be Considered in Relation to Treatment Modalities
Advancement of Techniques
Selection of Treatments—Which Option When?
Surgery as Primary Therapy
ART as Primary Therapy
Surgery before IVF
Conflict between Surgery and IVF
CONCLUSION
21:
Tubal Sterilization: The Past, Present and Future
HISTORY
THE PRESENT SCENARIO
Timing
Routes
Counseling for Sterilization
Anesthesia
Successful Use of Anesthesia: Using Safe, Standardized Regimens
Procedure
MINILAPAROTOMY
Minilaparotomy has Several Advantages
Pomeroy Technique
Irving Technique
Uchida Technique
Fimbriectomy (Kroener's Technique)
Madlener Technique
Parkland Technique
Vaginal Tubal Ligation
Laparoscopic Tubal Occlusion
Bipolar Electrocoagulation Technique
Clips
Falope Ring
Postoperative Care and Instructions
Complications of Tubal Ligation
Effectiveness
The Future
Newer Non-surgical Methods
NEW SURGICAL TECHNIQUE
Issues Related to Tubal Sterilization
Ectopic Pregnancy Following Sterilization
Sterilization and Ovarian Cancer—a Benefit of Sterilization
Sexuality
Poststerilization Syndrome
Regret and Sterilization Reversal
Mortality
CONCLUSION
SECTION FIVE: NEW FRONTIERS
22:
Stem Cells and Fallopian Tubes
INTRODUCTION
TREATMENT OF DISEASED FALLOPIAN TUBES WITH STEM CELLS
CONCLUSION
23:
Robotic Surgery and the Tubes
ROBOTIC-ASSISTED TUBAL REVERSAL
Robotic Salpingo-Oophorectomy
CONCLUSION
24:
Tubal Transplantation
ADVANCES IN IMMUNE SUPPRESSION
CONCLUSION
INDEX
TOC
Index
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