摘要:

The effect of suppression of gonadotropin secretion was evaluated in 21 patients with the polycystic ovary syndrome. Medroxyprogesterone acetate (MPA) was administered intramuscularly in a dose of 400 mg every 15 days for 9 months. A significant decrease in luteinizing hormone (LH) and testosterone levels (70 and 40%, respectively) was apparent after 3 months. At the end of the treatment period, the ovaries had become impalpable and hirsutism was markedly improved in 13 of 19 women. Side effects of treatment included local pain, vaginal spotting, galactorrhea, and hyperprolactinemia. Discontinuation of therapy was followed by a rapid return of follicle-stimulating hormone levels to baseline values, whereas LH and testosterone levels recovered only partially after more than 1 year. The improvement of hirsutism and ovarian shrinkage persisted for up to 2 years, and endometrial biopsy uniformly showed a pseudodecidual reaction in the stroma. After 1 year, prolactin levels declined to 52% of the baseline value and galactorrhea disappeared. The suppression of all the peripheral abnormalities of the reproductive system in polycystic ovary syndrome with MPA treatment suggests a primary hypothalamic disorder as the cause for the syndrome.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

To investigate the possibility of using urinary estradiol- 17β-glucuronide (E2-17G) measured by direct radioimmunoassay to monitor ovulation induction with human menopausal gonadotropin (hMG), serum estrogen and urinary E2-17G levels were determined daily in 21 women treated with hMG for a total of 32 treatment cycles. Urinary E2- 17G was measured in 24-hour and overnight specimens. A significant correlation was found between serum estrogens (primarily estradiol) measured by radioimmunoassay without preceding chromatography and urinary E2-17G excretion measured at 24 hours and overnight. The correlation was not significantly improved by correcting the 24-hour and overnight urinary E217G excretion levels with creatinine measurements. Although there was significant correlation between serum estrogens and urinary E2-17G measured by direct radioimmunoassay, the urinary E2-17G concentrations observed when serum estrogen levels indicated preovulatory follicle maturation (ie, at serum estrogen levels between 500 and 1000 pg/ml) varied so much that a clinical decision to trigger or not to trigger ovulation with human chorionic gonadotropin could not be reached in each case. These data indicate that significant correlation is not the only prerequisite for a new method to replace a proved procedure. Further studies are required to determine the reliability of monitoring hMG therapy with direct E2-17G radioimmunoassays in overnight urine collections.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Reversal of previous tubal ligation procedures for the restoration of fertility has become an increasingly frequent request. Microsurgical techniques are believed to offer a postoperative pregnancy rate superior to that obtained with macroscopic procedures. Of 63 women who requested reversal, microsurgical reanastomosis was performed in 40. With at least 6 months' follow-up, 22 women have become pregnant (55%), and there has been 1 ectopic pregnancy (2.5%). Comparison with previous studies using standard macroscopic techniques indicates that the use of meticulous surgical methods with precise reapproximation of the fallopian tubes results in a significant (P<.005) improvement in pregnancy rates.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Several periovulatory symptoms sometimes used in natural family planning are correlated with the estimated time of ovulation in 23 subjects and 64 hormonally normal menstrual cycles. The data suggest that intermenstrual pain may not be due to 1 specific cause but rather to several related factors. As a symptom of ovulation, intermenstrual pain was more specific than low backache, abdominal bloating, and intermenstrual bleeding; nonetheless, intermenstrual pain has a broad periovulatory association. The most reproducible and predictable sign in this series appeared to be the postovulatory occurrence of breast tenderness.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The most reliable ultrasonographic criteria for diagnosing ectopic pregnancy are based on the appearance of the uterus in the presence of a positive urine pregnancy test. The absence of an intrauterine sac signifies ectopic pregnancy, whereas its presence indicates intrauterine gestation. These criteria cannot be applied when serum pregnancy tests are used unless the serum human chorionic gonadotropin (hCG) level at which the sac of an intrauterine pregnancy becomes visible on ultrasound is known, because these tests are far more sensitive and identify pregnancy at an earlier stage than does sonar. In this study, the hCG level that distinguishes patients with intrauterine pregnancies in whom a gestational sac can be seen from those in whom it cannot be seen was determined and designated the discriminatory hCG zone. This zone lies between 6000 and 6500 mlU/ml. The absence of an intrauterine sac in conjunction with hCG values above this level signifies ectopic pregnancy; however, the absence of an intrauterine sac has no diagnostic significance when associated with hCG values below the discriminatory zone. An intrauterine sac associated with hCG levels above the discriminatory zone reliably indicates an intrauterine pregnancy, but at hCG values below the zone, it is suggestive of an abnormal pregnancy—either a missed abortion or an ectopic gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The possibility of distinguishing between normal intrauterine and ectopic pregnancies by determining the lower limit of the rate of human chorionic gonadotropin (hCG) increase in early pregnancy was investigated. This can be expressed as the slope of the log hCG-time curve or as the percent increase in hCG over a given sampling interval. For practical purposes, the rate is most easily determined from 2 samples drawn 48 hours apart. The difference between the 2 hCG values obtained is expressed as a percentage of the initial value, and should be 66% or greater for this sampling interval. Approximately 15% of normal intrauterine pregnancies screened in this way will appear abnormal, and the diagnosis in 13% of ectopic pregnancies will be delayed beyond 48 hours.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Implantation of the embryo in the uterine angle, medial to the uterotubal junction, may lead to several complications, both during pregnancy (persisting uterine pain and bleeding, spontaneous abortion, ruptured uterus) and in the puerperium (retained placenta). Nevertheless this entity is still rarely discussed in textbooks or in the literature. Its differential diagnosis from interstitial tubal pregnancy and cornual pregnancy is often confused. Four new cases of angular pregnancy with varied outcomes are described and 35 cases from the literature of the past 50 years are reviewed. Uterine anomalies, myomas, and uterotubal implantation may be predisposing conditions in a minority of cases. The differential diagnosis of angular intrauterine pregnancy from interstitial pregnancy, based on the position of the gestational enlargement in relation to the round ligament, is considered and the management discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The histologic and clinical manifestations of chronic endometritis were reviewed in 99 women. The morphologic features found to be of value in diagnosing this condition were superficial stromal edema, increased stromal density, and pleomorphic stromal inflammatory infiltrate dominated by lymphocytes in the absence of premenstrual changes or any other significant pathologic endometrial lesions. When these changes were present, a plasma cell infiltrate was invariably found. Clinically, the major presenting complaint was vaginal bleeding in 94% of the patients. No correlation was found between the presenting clinical complaint and either the extent of the lesion or the number of plasma cells in the leukocyte infiltrate. On follow-up, the lesion appeared to be eradicated by biopsy or curettage in approximately 80% of the patients. The major predisposing conditions were found to be intrauterine leiomyomas and a recent endometrial biopsy or curettage. The limitations of the plasma cell criterion for recognition the lesion are discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The histologic diagnoses of premalignant and malignant lesions of the cervix obtained by examining the colposcopically directed biopsy material from 643 patients were compared with those of the surgical material subsequently obtained. The procedures during which samples were acquired included hysterectomy (370), cervical conization (263), cervical amputation (2), and removal of a retained cervical stump (8). The diagnostic accuracy of colposcopically directed biopsy was 93.0% in those patients with satisfactory colposcopy, ie, the final diagnosis did not differ by more than 1 grade from that of the directed biopsy diagnosis. Two patients with widespread stage III cervical intraepithelial neoplasia on directed biopsy had microinvasive carcinoma in the therapeutic cone specimen. All invasive carcinomas (stage IB, occult) were diagnosed by directed biopsy and confirmed by subsequent examination of the surgical specimen.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The carbon dioxide laser was used to treat 192 patients with cervical intraepithelial neoplasia. Most patients were young and of low parity. Pretreatment colposcopic biopsies showed either severe dysplasia or carcinoma in situ in 70%. A single treatment session effectively eradicated the lesion in 73% of patients. The causes of treatment failure are discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID