Further laparoscopic evaluation of the pelvic organs in bilharzial patients

The laparoscopic findings in 205 bilharzial infertile patients were compared to those of 203 infertile patients free from bilharziasis. The incidence of Bilharziasis of the upper genital tract [except that of the endometrium] is not such low as previously reported. Bilharzial nodules were visualized on the surface of the corpus uteri. Fallopian tubes, broad ligaments and pelvic peritoneum. Periuterine adhesions were significantly increased in the bilharzial group. Peritubal adhesions, fimbrial phimosis and tubal occlusion were not significantly different in the bilharzial and non-bilharzial cases. Periovarian adhesions and ovarian elargment were significantly increased in the bilharzial group. During laparoscopy, the presence of nodules on the suface of the pelvic organs with patent Fallopian tubes in patients with urinary and /or intestinal bilharziasis is fairly diagonstic of bilharzial infestation of the upper genital organs

Laparoscopie evaluation of the pelvic organs in genital bilharziasis

In order to elucidate the laparoscopic findings in the upper female gential tract in cases with genital bilharzial infertile cases. Laparoscopic evaluation of the pelvic organs was done in 24 infertile cases with proved infertile non bilharzial cases shosen at random. The incidence of tubal obstruction, peritubal or periovarian adhessions were not statistically different, in cases genital bilharziasis compared with controls. Also no lesions suggestive of bilharzial infestation of the action of the upper tract could be visualised. We conclude that periovarian or peritubal adhesions can not be implicated as a significant factor in bilharzial infertile cases. As well, laparoscopic examination should be combined with histopathological examination of biopsies for the diagnosis of bilfrarziasis of the upper genital tract when feasible

Histopathological and histochemical observations on the endometrium in bilharzial patients

The endometrium of 40 patients with genital and/or extragenital bilharziasis and that obtained from 40 healthy women of comparable age and parity were examined histologically and histochemically for glycogen and enzymes. Bilharzial patients showed no bilharzial endometrial affection. However, in 7.5% of these subjects, there was persistent anovulation while all healthy women were ovulating. Luteal phase defects, evaluated by his-tological dating of endometrial biopsies, were present in 12.5% of bilharzial patients compared with 5% incidence in healthy women. Histochemical alterations in glycogen and the enzymes [succinic dehydrogenase, non-specific esterase, alkaline phosphatase and acid phosphatase] were observed in these women with corpus luteum insufficiency. It is believed that the increased incidence of anovulation and of corpus luteum insufficiency, with endometrial histochemical alterations, are partly resposible for the higher incidence of female infertility among the bilharzial population, reported by some authors; and observed in the present investigation

Long term effects of oral hormonal contraceptives on the urinary tract

One Hundred healthy women in the childbearing period and a similar number of pill users for more than three years were investigated. Significant bacteriuria was demonstrated in 36% of pill users compared with 16% in healthy controls. Dilatation of the lower ureter was encountered in 24% of pill users and in 8% of controls. Grade I vesicoureteric reflux was demonstrated in 15 women on oral hormonal contraceptives compared with 4% in controls. Hypotonicity of the urinary tract musculature, as well as other factors, are believed to be responsible for these changes. Periodic urologic investigations are suggested for these who use pills for prolonged time. Structural changes demonstrated in the urinary tract during normal pregnancy have been attributed at least in part to the presence of placental steroid hormones [Youssef, 1956 : Fainstat, 1963]. The effects of oral hormonal contraceptives on the upper urinary tract had been studied with contradictory results. Marshall et al., [1966] observed dilatation of the ureters and renal pelvis in women using oral hormonal con-pills were discontinued. However felding [1966] who followed a small group of women taking Anovlar I for 3-9 months, found no radiologic evidence of ureteral dilatation. Descending urograms were normal in 10 patients on oestrogen-progestagen combination studied by Marchant [1972]. Couriere et al., [1970] observed no urologic changes in women after year of pill use. Recently, Youssef et al., [1975] demonstrated bladder hypotonia and increased capacity durign the use of oral hormonal contraceptive which was more manifest during the second year. Aaso, Zahran et al., [1976] observed bladder trabeculations in pill users. However, the susceptibility of the urinary system to infection after servical years of pill use is not clear. In most of the reports, the duration of pill use was in the range of 1-3 years [Courriere et al., 1970 and Zahran et al., 1976]. This stimulated us to study women on oral hormonal contraceptives for more than three years

Tubal ligation by minilaparotomy: a technique that fasciltates the tubal approach

Female interval sterilisation using a tiny suprapubic incision [minilparotomy], was performed on 185 acceptors. Jayle's vaginal retractor was used to retract the suprapubic wound adges. This facilitated exposure of the tubes even in obese women. We met. with 3.42% overall morbidity in the form of mild infection. The method is simple, rapid, inexpensive and acceptable method for permanent contraception. The operation can be performed by gynaecologists and general surgeons with moderate experiance with minimal complications. It can be advocated as a means of demographic control particularly in developing countries