Goserelin and oral contraceptive combination versus laparoscopic ovarian cauterization and their effects on the endocrine changes in women with clomiphene citrate resistant polycystic ovary disease

The aim of this study was to compare the effects of combination of long acting GnRH agonist [Goserelin] and oral contraceptive [OC] therapy and laparoscopic ovarian cauterization on the endocrine changes in women with clomiphene citrate [CC] - resistant polycystic ovary disease [PCOD]. Twenty one women with CC- resistant PCOD were included randomly in the study to either laparoscopic ovarian cautery [n = 10] or GnRH-a and OC therapy for 3 months [n = 11]. Serum concentrations of LH, F.S.H, androstenedione [A], testosterone [T] and sex hormone binding globulin [SHBG] were determined in each group and during the follicular phase of first menstrual cycle after cessation of each treatment. Our results showed that the mean serum concentrations and clinical profiles were similar in both groups. Both groups showed significant decrease in LH, A and T and significant increase in FSH compared with pretreatment levels. The SHBG concentration increased in both groups after therapy, however, the increase was significant only in the goserelin and OC group. There were no significant difference in the final concentrations of LH, FSH and A between the two study groups after each treatment, whereas, T was significantly decreased and SHBG significantly increased in the goserelin and OC group. The ovulation rate after the cessation of either therapy was similar [8/10 versus 9/11, p > 0.05]. On the basis of our results, we conclude that despite similar endocrine effects, medical treatment with GnRH-a and OC may be more appropriate and effective in reversing the abnormal cascade in PCOD. Although both regimens have temporary and similar improvement on PCOD, the adhesion forming potential, invasiveness, cost and surgical complications of laparoscopic ovarian cauterization may enable GnRH-a and OC combination to be cost effective option in women with CC-resistant PCOD

Obstetric analgesia by intrathecal morphine

Opiate receptors have been demonstrated in the brain and the spinal substantia gelatinosa. Intrathecal injection of morphine produces prolonged increase in pain threshold of rats, rabbits and cats. Also postoperative pain relief is successfully managed by intrathecally injected morphine. So, this work evaluates the effects of intrathecal morphine as a method for obstetric analgesia. This study was performed on 80 full term parturients in active labour out of which 40 were given intrathecal morphine. Morphine 0.4 mg diluted in 4 ml normal saline were injected in L[3-4] level when the cervix was 2 fingers dilated. Observations were done for pulse, B.P, onset, duration and degree of analgesia, progress of labour, Apgar score for the neonates and any side effects. Analgesia started 15-20 minutes after morphine injection. 95% of parturients reported complete relief of labour pain. There were no changes in pulse rate, B.P, respiration or motor power of the mother. The process of labour was normally progressed in 80%. Mean Apgar score was 9.85. However, episiotomies needed local infiltration. The patient seemed sleepy, itching occured in 31 cases [77.5%] and miosis was observed in 2 cases [5%]. It is concluded that intrathecal morphine is a valuable method for obstetric analgesia

relation between thyroid diseases and the endometrium

This study included thirty female patients with different thyroid swellings. They were classified into three group: Premenstrual, postmenstrual and postmenopausal. All patients were subjected to clinical examination, histopathological study of the thyroid gland, histopathological and histochemical studies of the endometrium and laboratory evaluation of T[3], T[4] and F.T.I. The work showed that there is evident endometrial changes in thyrotoxic patients only