Neutropenic enterocolitis in acute leukemia: diagnostic and therapeutic dilemma.

The main purpose of this report is to focus on the importance of an accurate etiologic diagnosis of gastrointestinal complications during chemotherapy for acute myeloid leukemia, taking into account that a syndrome characterized by bowel wall thickening associated with diarrhea and abdominal pain may have etiologies different from neutropenic enterocolitis (NE) and in such a case necessitate a different treatment approach. We describe a case of a 46-year-old woman affected by acute myeloid leukemia presenting the onset of a syndrome with clinical features of NE. Supportive therapy for NE was instituted, but during treatment the patient presented a life-threatening gastrointestinal bleeding and was submitted in emergency to hemicolectomy. Following surgery, the patient recovered completely and she is currently alive in complete remission after receiving allogeneic bone marrow transplantation. Histological examination of the surgical specimens showed that the acute abdominal syndrome was related to massive infiltration of the bowel by leukemia cells. A correct baseline evaluation and a prompt diagnosis of the complication may help in making the therapeutic decision, which in our case led necessarily to a surgical procedure, because the bleeding was due to post-chemotherapy necrosis of the leukemic infiltrating tissue. A close collaboration between the hematologist and the surgeon may provide guidelines for behavior in such cases, giving these patients the possibility of survival and the opportunity to carry on the treatment planned for the primary disease.

The role of diagnostic hysteroscopy and endometrial biopsy in assisted reproductive technologies.

OBJECTIVE: To study the incidence of unsuspected endouterine abnormalities in patients for whom IVF-ET repeatedly fails. DESIGN: Prospective study. SETTING: Infertility Unit of the Department of Obstetrics and Gynecology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. PATIENT(S): One hundred patients for whom two IVF-ET cycles failed in which > or =2 good-quality embryos were transferred. INTERVENTION(S): In-office diagnostic hysteroscopy and endometrial biopsy. MAIN OUTCOME MEASURE(S): Relation between IVF-ET failure and unsuspected endouterine abnormalities. RESULT(S): In 18 patients, hysteroscopy showed an important unsuspected endouterine abnormality. Fifteen of these patients did not become pregnant after IVF-ET, and 3 became pregnant but had a spontaneous abortion. Histologic examination of the endometrium revealed chronic endometritis in 1 patient and tuberculous endometritis in another. CONCLUSION(S): Previous studies have reported that the incidence of endouterine abnormalities is high in patients undergoing IVF-ET. Our data confirm the previous reports and lead us to conclude that diagnostic hysteroscopy should be performed on all patients before they undergo IVF-ET.

Induction of ovulation for gamete intrafallopian transfer (GIFT) using a gonadotropin-releasing hormone agonist and "pure" FSH: results obtained in 30 normally menstruating women.

About 30% of the ovulation induction cycles in GIFT and FIVET programmes are cancelled due to an inadequate response of patients to gonadotropins and/or clomiphene citrate. GnRH agonist-gonadotropins and/or "pure" FSH combination has been successful in inducing ovulation in patients with a previous history of cycle cancellation and/or alterations in the menstrual cycles. In order to reduce the number of cycle cancellations and obtain more homogeneous oocytes, GnRH agonist-gonadotropins and/or "pure" FSH combination in all candidates for GIFT and FIVET has been recently hypothesised. The Authors report results obtained from GnRH agonist-"pure" FSH combination in 30 normally menstruating patients of the GIFT programme: in 93% of cases the harvested oocytes were preovulatory, in 27.6% of cycles and in 28.6% of the GIFTs respectively an ongoing pregnancy was obtained. While the results obtained must be considered preliminary, they nevertheless suggest that the use of a combination of GnRH-agonist "pure" FSH in all patients in the GIFT programme may be of real clinical validity.

The direct IgG-MAR test (mixed antiglobulin reaction test): results and correlations with seminal analysis in 1176 men from infertile couples.

The direct IgG mixed antiglobulin reaction (IgG-MAR) test was carried out as a screening test and as a routine test of semen analysis in 1176 male patients from infertile couples. We correlated the results of the IgG-MAR test with the semen analysis parameters. The test was only positive in 3.1% of the cases; other Authors describe incidences of much higher positive results than ours, for which reason we emphasize that our patients had not previously undergone any kind of preliminary section. The positive IgG-MAR test proved to correlate significantly both with the number and motility of the spermatozoa, while there appeared to be no correlation between its positiveness and the other parameters of the seminal liquid.

Complementary use of hysterosalpingography, hysteroscopy and laparoscopy in 100 infertile patients: results and comparison of their diagnostic accuracy.

While there is no disputing the invaluable role of laparoscopy in the study of the infertile woman, the function of hysterosalpingography (HSG) and hysteroscopy is still left open to debate. Our research concerns 100 infertile women undergoing HSG, hysteroscopy and laparoscopy; the aim of the study was to check the diagnostic accuracy of the three tests. The sensitivity and specificity of HSG vs hysteroscopy were 74.2% and 91.3% respectively. The sensitivity and specificity of HSG vs laparoscopy were 64.5% and 63.3% as regards tubal patency and 6.9% and 92.8% in the diagnosis of tubal phimosis and pelvic pathology. Despite the limits HSG revealed, our results show that a correct study of the infertile woman can only be accomplished by a combination of all three tests; we therefore recommend a combined approach using all three procedures in all infertile patients.

Panoramic diagnostic microhysteroscopy and female sterility: analysis of results in 284 patients.

The results of panoramic diagnostic microhysteroscopy are reported in 284 patients with sterility or infertility problems. In 33.5% of the patients, microhysteroscopy revealed uterine pathology; in the majority of cases they were pathologies which are unanimously recognized as being causes of sterility, while in others there were pathologies whose role infertilities is still unclear. There was a good correlation between microhysteroscopy and histology in cases of endometrial hyperplasia and of endometritis, whereas in cases of endometrial polyps and functional diagnosis of the endometrium, the correlation was less satisfactory. Although it is not possible at present to draw definite conclusions about the real value and advantages of microhysteroscopy in the diagnosis of female infertility, we are convinced that it is of great use and that it should be at the basis of any investigation involving the infertile woman.

Panoramic diagnostic microhysteroscopy: analysis of results obtained from 976 patients.

Panoramic diagnostic microhysteroscopy was performed in the outpatients department on 976 patients without using any type of anaesthetic. In 889 patients, that is 91%, the examination was successful, while it failed in 87 cases, that is, 9%. In 90% of the patients, the examination caused no pain whatsoever, and none of the patients suffered serious complications, either immediately after the examination of later. Comparison with the definite histological diagnosis showed 100% sensitivity and 86% specificity of microhysteroscopy. We can state that panoramic diagnostic microhysteroscopy performed in the outpatients department has proved to be a reliable examination from a diagnostic point of view, and is moreover safe and without pain for the patients.

[Clinical aspects of acute pelvic inflammation: our experience in 118 cases]. / Clinica della flogosi pelvica acuta: nostra esperienza in 118 casi.

PIP: The authors examined 118 patients with acute pelvic inflammation between January 1978-June 1984. Acute pelvic inflammation data are not very different in women with (32%) or without (68%) an IUD. The average age of the patients was 29.8 years while 33% had neither been pregnant nor had had children. 41% of the women suffered from leukocytosis, 31% from hyperpyrexia, and BST was high in 70% of the cases when patients were admitted to the hospital. During the course of acute pelvic inflammation, pelvic pain was experienced by 97% of the women, hyperpyrexia by 35%, and metrorrhagia by 10%. Therapy was surgical in 25% of the cases and the hospital stay lasted an average of 12.6 days. Considering the diagnostic and therapeutic difficulties which are often connected with acute pelvic inflammation, the authors emphasize that it is necesary to pay great attention to this illness which mainly affects young women and which can, as a consequence, lead to chronic pelvic pain, extrauterine pregnancies, and infertility. (author's modified)^ieng

[Unilateral Mayer-Rokitansky-Küster-Hauser syndrome (unilateral Müllerian dysgenetic syndrome)]. / Unilaterales Mayer-Rokitansky-Küster-Hauser-Syndrom (Unilaterales Müllersches dysgenetisches Syndrom).

A case of unilateral Mayer-Rokitansky-Küster-Hauser-Syndrome is reported. Anatomical and etiopathogenetical aspects of the syndrome and a review of the literature are presented.

"Hysteroscopy and female sterility: analysis of the results from 213 patients".

Hysterosalpinogography, laparoscopy and hysteroscopy are three complementary examinations in the morphological study of the utero-tubal factor of female sterility. The Authors describe their experience with Hamou's microhysteroscopy in the sterility diagnosis field: they confirm the advantages and new prospects offered by Hamou's microhysteroscopy, encountering uterine pathology in 34 percent of the studied patients and propose that all patients suffering from sterility and infertility problems should be subjected to hysteroscopy.