Infertility and Assisted Reproductive Techniques文档.ppt

* Patient selection is important prior to gonadotropin use b/c of its great expense and its greater complication rates * Patient selection is important prior to gonadotropin use b/c of its great expense and its greater complication rates * Patient selection is important prior to gonadotropin use b/c of its great expense and its greater complication rates * Patient selection is important prior to gonadotropin use b/c of its great expense and its greater complication rates * * * Adhesions causing small bowel obstruction. * After a localized trauma to the peritoneum, the mesothelial cells die and degenerate, leaving a denuded area. The border of this damaged site contains dying cells, as shown on the slide. The process of re-epithelialization is initiated by the local production of chemotactic messengers that arise in conjunction with coagulation. * Healing of the peritoneum occurs primarily by re-epithelization of the damaged site. New peritoneal cells are attracted to the site of injury by chemotactic messengers released by platelets, blood clots, or leukocytes within the injured tissue. At this point, healing of the peritoneum differs from that seen with skin. With skin, healing occurs by granulation at the periphery of the injury. As a result, the duration of healing directly correlates with the size of the injury. Larger injuries take longer to heal than smaller ones. In contrast, re-epithelization of peritoneal injuries occurs by the formation of multiple islands of new mesolethial cells scattered upon the surface of the peritoneum. The source of these epithelial cells is controversial and includes adjacent normal mesothelial cells and subperitoneal stem cells. The mesothelial cells in each island continue to divide until the surface of the entire site of injury is covered by a new mesothelium. * After trauma to the peritoneum, there is increased vascular permeability, mediated by histamine, which often produces an inflammatory exudate and the