ABSTRACT
Anovulatory infertility is prmmt in 75% of patients with polycystic ovarian syndrome [PCOS], in addition to oligomenorrhoea and signs and symptoms of hyperandrogenism. This study was performed to find the role oflaparoseopic ovarian drilling [LOD] in correcting anovulation, menstrual irregularities and failure of conception. Possible role of the factors as the predictors of success was also studied. This prospective cohort study included 49 women who were diagnosed with PCOS and anovulatory infertility. These patients had already tried various ovulation induction drugs for conception, and underwent LOD between January i, 2006 untill December 31, 2008 in the Department of Gynaecology and Obstetrics, at the Tertiary Care Hospital, Lahore. The major outcome measures spontaneous ovulation, menstrual regularity after LOD and influence of various pre-operative characteristics on pregnancy rates. Among 49 patients 33 [67.3%] started to menstruate regularly and ovulated spontaneously in 59.2%, of them 23 [46.9%] conceived. Younger age [less than 25 years], duration and infertility less than 5 years and higher LH [more than 12 lU/lit] emerged as clinically significant factors to have impact on successful outcome. BMI > 27 Kg / m[2], cycle pattern, morphology of ovary, LH / FSH ratios did not manifest significant role. Women with PCOS respond favour ably to LOD
ABSTRACT
Objective: to determine the sensitivity and specificity of SAAG in predicting the presence of esophageal varices and to find out the association between level of SAAG and increase in portal vein diameter
Study design: prospective-observational study
Place and duration of study: medical Unit III, JPMC Karachi from August 1999 to March 2000
Patients and methods: patients with ascites were selected on the basis of selection criteria demonstrated by history, physical examination and ultrasonography. Ascetic fluid aspirated for DR and albumin, and simultaneously blood sample taken for total protein and albumin estimation at the time of paracentesis. After determining the level of SAAG upper GI endoscopy was performed. To determine the cause of ascites detailed history was taken and relevant investigations were carried out. At the end of our study sensitivity and specificity of serum ascites albumin gradient were determined in comparison of endoscopy findings
Results: among 50 subjects SAAG more than 1.1-g/dl was found in 30 [60%] patients and less than 1.1-g/dl in 20 patients [40%] of total 50 patients. Out of 30 patients with gradient more than 1.1-g/dl esophageal varices present in 27 patients and portal vein diameter more than 1.3-cm present in 24 patients. The commonest cause of ascites among subjects with SAAG more than 1.1-g/dl was chronic liver disease with portal hypertension and the commonest cause of ascites among SAAG less than 1.1-g/dl was abdominal tuberculosis. The sensitivity and specificity of SAAG were 100% and 87.8% respectively
Conclusion: serum ascites albumin gradient is a reliable marker to differentiate ascites into portal hypertensive and non-portal hypertensive etiology. Based upon our finding we conclude that the presence of esophageal varices is significantly associated with high SAAG levels