Day clinic diagnostic hysteroscopy in a state hospital.

Within 6 years (1991-97), a total of 680 diagnostic hysteroscopies were performed at the Day Clinic of the 1st Department of Obstetrics and Gynecology of the University of Athens ("Alexandra" Hospital). The procedure was done without general or other forms of anesthesia, using the Siegler method of approach. However in 12 cases with cervical stenosis (1.7%) and 21 patients with marked nervousness (3.1%) general anesthesia proved inevitable. The leading indication was repeated failure of IVF (54.7%), while other indications included abnormal bleeding, amenorrhea and oligomenorrhea, a history of abortions, and infertility. Abnormal hysteroscopic findings were observed in 276 cases (40.5%) among which intrauterine adhesions, endometrial hyperplasia and polyps were the most common. We had no major complications or fatalities in our series and hysteroscopy proved to be a very useful, accurate and safe method of assessing uterine and endometrial functional status.

Hysterosalpingography and hysteroscopy in female infertility.

A total of 323 women of reproductive age (19-40 years) were submitted to a complete investigation of infertility routinely including hysterosalpingography and hysteroscopy. In 177 cases (54.7%) no pathological conditions were found by either of the applied methods, while in 65 cases (20.1%) similar abnormalities were observed by hysterosalpingography and hysteroscopy with a global correlation of 74.8%. Hysterosalpingography also presented false positive results in 11.7% and false negative ones in 13.3% of all the studied cases. In conclusion, the combined use of these techniques in infertility investigation gives complete and accurate information about the uterine cavity, despite the disadvantages of hysterosalpingography due to false positive and false negative results.

Operative hysteroscopy.

OBJECTIVE: Analysis of the obtained results after operative hysteroscopy for several intrauterine abnormalities. METHOD: Thirty women with uterine problems (7 polyps, 16 endometrial, 5 endocervical adhesions and 2 lost IUDs) were submitted to operative hysteroscopy under general anesthesia by using fine rigid auxiliary instruments at Lito Private Maternity Hospital and the 1st Department of Obstetrics and Gynecology of Athens University during 1991. RESULT: The adhesiolysis was successful in all the 21 cases with 5 subsequent pregnancies to date, the hysteroscopic excision of the 7 polyps was uneventful and the removal of the 2 lost IUDs was done by using a special forceps for foreign bodies. CONCLUSION: Operative hysteroscopy presented excellent results intra-operatively, post-operatively and in the routine follow-up by diagnostic hysteroscopy 3 months after intervention.

Insulin levels in the amniotic fluid and in maternal and fetal blood.

The effects of excessive maternal weight gain during pregnancy (five cases) and of glucose infusion in the mother (five cases) on insulin levels are compared with the insulin levels in a control group (19 normal pregnancies) by radioimmunologic determination of insulin levels in the amniotic fluid and in maternal and fetal blood. The mean values for insulin in the control group were as follows: mother, 23.9 +/- 2.23 muU per ml; fetus, 9.86 +/- 2.11 muU per ml; and amniotic fluid, 5.08 +/- 2.27 muU per ml. In patients with excessive weight gain during pregnancy, maternal insulin mean values were 38.45 +/- 4.16 muU per ml; fetal, 19.99 +/- 9.8 muU per ml; and amniotic fluid, 11.25 +/- 2.58 muU per ml. After an infusion of 25 mg of glucose in the mother, the mean maternal insulin values were 53.6 +/- 13.74 muU per ml; fetal, 24.7 +/- 6.67 muU per ml; and amniotic fluid, 14.3 +/- 5.52 muU per ml. Insulin concentrations in maternal blood (p less than 0.001), fetal blood (p less than 0.001) and amniotic fluid (p less than 0.001) were higher in pregnancies with excessive weight gain as compared to those in the control group, whereas the glucose infusion in the mother increased the concentration of insulin in the three components studied.

Pyometra.

Thirteen cases of pyometra without preoperative diagnosis in which vaginal or abdominal surgery was performed, are analysed in the present paper. The histologic examination revealed endocervicitis in all cases, while positive cultures for bacteria were found preoperatively in only eight of the above cases, thus, pyometra was considered to be a symptom of obstruction of the cervical canal.

E. coli growth inhibition by amniotic fluid.

Amniotic fluid samples were collected aseptically from 29 normal pregnancies, between the 38th and 41st week of gestation and checked for sterility in the laboratory, in order to investigate in vitro the effect of the liquor on the growth of E. coli. Brain Heart Infusion (B.H.I.) and Ringer solution were used as controls. E. coli cultures were inoculated in amniotic fluid, B.H.I., Ringer solution and amniotic fluid plus B.H.I. and incubated at 37degreesC for 48 hours. At 0, 1, 3, 6, 12, 24, 36 and 48 hours of incubation, surface viable counts were performed to estimate the number of E. coli viable cells. The growth of E. coli in B.H.I. started furing the 1st hours after inoculation and continued over 48 hours; in Ringer solution the mean growth curve and almost identical to that of B.H.I. In amniotic fluid the growth of E. coli began from the 1st hour of inoculation but the growth curve was much lower, became static in 24 hours and a permanent inhibition was observed thereafter. The addition of a small amount of B.H.I. in amniotic fluid enhanced the growth of E. coli, but the growth curve was lower in comparison to the curves of the two controls studied. In conclusion, after 48 hours of inoculation in amniotic fluid, 26 of the 29 cases showed bacteriostatic or bactericidal activity of the liquor upon the growth of E. coli.