Endometrial resection follow up: late onset of pain and the effect of depot medroxyprogesterone acetate.

OBJECTIVE: To observe longer term (9 to 18 months) follow up of women after a transcervical resection of the endometrium (TCRE) and the effect of post-operative medroxyprogesterone acetate on the results. DESIGN: An observational study. SETTING: A district public hospital and a nearby private hospital in Sydney, Australia. SUBJECTS: Sixty-one women who underwent TCRE from January to December 1991 were contacted 9 to 18 months after the procedure. They were questioned about symptoms and levels of satisfaction at six months, 12 months and at the time of interview, 9-18 months after the procedure. The 27 women treated from 1 January to 31 August 1991 were given medroxyprogesterone acetate 150 mg at the time of surgery. From 1 September to 31 December 1991 no medroxyprogesterone acetate was given (32 women). Two women underwent immediate hysterectomy, and are included as unsuccessful TCREs but are excluded from description of effects of medroxyprogesterone acetate on the results of TCRE. RESULTS: Late onset, defined as after 12 months, of pain with or without bleeding occurred in 7 out of 52 women (13.5%). Overall, 49 out of 61 women (80.3%) were satisfied with the operation at the time of interview, 9 to 18 months post-operatively. Success rates, measured by satisfaction, were 89% (24/27) in the medroxyprogesterone acetate group and 75% (24/32) in the no medroxyprogesterone acetate group. CONCLUSION: Follow up after endometrial resection revealed that a definite subgroup of women develop late onset of pain with or without bleeding. Results at four to six months do not necessarily correlate with longer term outcomes. This needs to be investigated with larger, long term follow up studies, as does the apparently beneficial effects of medroxyprogesterone acetate on the long term results of TCRE.

The value of the monoclonal antibody (cancer antigen 125) in serial monitoring of ovarian cancer: a comparison with circulating immune complexes.

The use of circulating immune complexes and a commercial monoclonal antibody to ovarian cancer (CA 125 kit) in monitoring progress in patients with ovarian cancer has been assessed. While changes in immune complexes were apparent in some patients with active progression of disease, the marked change in values and linear trend make the use of CA 125 a useful clinical marker.

Unusual skeletal metastases in carcinoma of the cervix.

In a series of 1347 patients with carcinoma of the cervix, 62 or 4.6% had metastatic spread to the bones. Bone metastasis correlated with more advanced disease, occurring in 39.1% of patients with Stage II disease. The role of isotope bone scanning and of the radiographic skeletal survey in the investigation of carcinoma of the cervix is considered. Eight patients having unusual radiographic appearances of skeletal metastases are discussed.

Changing caesarean section rates. Experience at a Sydney obstetric teaching hospital.

The Caesarean section rate has been rising in Australia in recent years. This study compares Caesarean section rates and indications for Caesarean section in 2 separate 2-year periods, 1970-71 and 1980-81, in a Sydney teaching hospital. The Caesarean section rate increased from 6.4% to 16.2% in this decade. Dystocia is now the most frequent indication for Caesarean section and accounted for 33.2% of the increase in rate while fetal distress contributed 23.8% of that increase. Repeat Caesarean section and breech presentation contributed 16.9% and 13.3% of the increase respectively. Caesarean section rates for all birthweights increased, but particularly in the very small infant and those above 3,500 g. Caesarean sections for public patients rose from 3.4% to 9.3% while for private patients the rate increased from 12.0% to 20.7%. While there has been some convergence of rates for public and private patients during the decade, private patients were still twice as likely to have a Caesarean section in 1980-81. The contribution of dystocia, as an indication for Caesarean section, to the increase in the rate over this period is consistent with recent international experience and indicates a strong trend towards procedural intervention.

Hysterosalpingography in the assessment of infertility in black patients.

A series of 200 consecutive hysterosalpingograms for the evaluation of infertility in Black women attending a clinic at the Hillbrow Hospital, Johannesburg, is reviewed. A fallopian tube abnormality was found in 81,8% of cases, terminal hydrosalpinx being present in 64,4%. A uterine abnormality was present in 25% of cases. In comparison with other series it appears that our incidence of tubal lesions, especially terminal hydrosalpinx, is the highest yet reported. A high correlation with laparoscopic findings (75%) is documented. In our infertility clinic hysterosalpingography is one of the most valuable tools in the initial evaluation of the infertile couple.

Spontaneous rupture of a uterus at 16 weeks' gestation.

A case report of spontaneous rupture of a normal unscarred uterus at 16 weeks' gestation due to no apparent cause is presented. This is the earliest spontaneous rupture of the uterus documented and similar cases reported in the literature are reviewed. The aetiology and methods of treatment are discussed.

A solitary diverticulum of the fallopian tube.

A rare case is described in which a diverticulum of the middle portion of the right Fallopian tube was demonstrated by hysterosalpingography. The patient aged 26 years, had a history of a ruptured left mid-tubal pregnancy 8 years previously and was suffering from infertility. The radiographic appearance of the lesion is characteristic, the aetiology is obscure and treatment should be conservative.

Prolactin, cortisol and thyroxine levels and the premature infant.

The relationship of prolactin, cortisol and thyroxine values in cord and maternal plasma to fetal age and weight and to the incidence of hyaline membrane disease (HMD) was investigated in 80 neonates of whom 40 were born at more than 37 weeks' gestation. Of the 40 born at less than 36 weeks 11 developed HMD. Serum cortisol has been shown to be a differentiating factor for HMD, but cord thyroxine and prolactin levels seem to be related more to age and weight than to the occurrence of HMD.

Obstetrics in the very young black South African teenager.

A group of 200 14-16-year-old Black obstetric patients was compared with controls aged 20-23 years. We found a significantly higher incidence of occipitoposterior presentations in the former group, resulting in higher caesarean section and assisted delivery rates. Decreases i the incidence of pre-eclamptic toxaemia and in perinatal mortality are evident in comparison with a similar study 10 years age.

Amyloidosis and pregnancy. A case report.

A pregnancy in a patient with pre-existing renal amyloidosis and the nephrotic syndrome is reported. Details of the patient's history are documented, followed by a discussion of the effects of pregnancy on the renal condition and vice versa.

Comparative ratios of carcinoma of the vagina and cervix in different population groups.

A retrospective study of squamous carcinoma of the vagina at Baragwanath Hospital over a period of 20 years shows that the incidence of this condition is much lower than that reported in other series. In addition, the ratio of primary carcinoma of the vagina to that of the cervix is much lower than in comparable studies. The age distribution, aetiology and the sexual characteristics of the Black population are discussed.

Umbilical endometriosis. A case report.

A patient presented with a dark, painful and bleeding umbilicus, and was found to have endometriosis of the umbilicus. The details are presented, as well as a discussion of the aetiology, incidence, differential diagnosis and histological features of the condition.

Umbilical tumours. A case report and review of the literature.

A patient presented with a bleeding umbilical ulcer which was found to be a metastasis from an ovarian carcinoma. The details are presented, as well as a discussion on the significance and incidence of primary and secondary umbilical tumours.