Is Laparoscopy Still Necessary in the Management of Tubal Infertility?

Objectives: To compare between hysterosalpingography (HSG) and laparoscopic findings in patients tested for infertility and thereby to determine the significance of the latter examination. Methods: This was a descriptive study performed in two Gynecology departments in the Dakar (Senegal). Included were 84 patients with suspicious tubal-infertility who underwent HSG followed by laparoscopy. The Kappa (K) statistics was used to clarify the concordance between HSG vs. laparoscopy findings. Results: Kappa concordance between HSG and laparoscopy showed the followings: 0.08 for proximal tubal obstructions (poor agreement), 0.40 for distal tubal obstructions (moderate agreement), and -0.08 for peritoneal adhesions (no agreement). Laparoscopy revealed pelvic adhesions in 84% of cases, pelvic endometriosis in 12% of cases, and apparently normal tubes in 12%. According to the distal tubal operability score, 16.6% of the lesions were classified as stage 4 and 23.8% at stage 1. Conclusion: HSG and laparoscopy findings did not agree in patients with tubal infertility, and thus, laparoscopy should be employed, especially when HSG showed abnormal findings. HSG has a low diagnostic value in adhesions.

E_Breast: A Computerized Database Management System for Breast Diseases Patients in a Low Income Country

Objectives: To report our experience in using an electronic database for management of breast diseases in a developing country. Materials and methods: E-Breast is a database developed on FileMaker Pro Advanced to serve as patient file and breast diseases registry. The development of the platform, its usage and advantages on a manual filing system are described. Results: For 6 years, we use this database, which accounts more than 2000 patients and includes data from more than 10 years. An overview of the activity is easily generated by E-Breast. The generated reports are used to the routine care of patients, statistics and clinical research. Data entered are immediately useful in addition to simultaneously implement the database for clinical research. Many custom features are integrated. For research purposes, the system has the ability to perform detailed analyses on subsets defined by the user as breast cancer, breast benign diseases, etc. Conclusion: E-Breast has proven to be a useful way of documentation that has become an integral and essential part of the daily activity and also a valuable research tool.