Uterine necrosis after uterine artery embolization for leiomyoma.

BACKGROUND: A potential complication of uterine artery embolization is diffuse uterine necrosis. CASE: A woman with a large uterine leiomyoma underwent elective uterine artery embolization and 2 months later developed diffuse uterine necrosis requiring exploratory laparotomy, total hysterectomy, and left salpingo-oophorectomy. CONCLUSION: Although elective uterine artery embolization is a procedure with a low reported rate of complications, diffuse uterine necrosis can occur.

Intrafollicular insemination for male factor infertility.

Intrafollicular insemination is a promising new development that may have a major impact on ART, notably in the treatment of male factor infertility. Reported is the first successful intrafollicular insemination in the United States and the first successful intrafollicular insemination for male factor infertility. Although the results are encouraging, further investigations are currently underway to critically evaluate intrafollicular insemination.

Biopsy in laparoscopically diagnosed endometriosis.

A series of 273 consecutive patients with the primary complaint of pelvic pain were laparoscopically diagnosed as having endometriosis. Peritoneal and/or ovarian biopsy was performed at the endometriosis site or sites in 115 patients. Histologic confirmation of endometriosis was established in 64% of those patients. The severity of the disease did not correlate with positive or negative biopsy results. Thus, the diagnosis of endometriosis may not be histologically confirmed, even in the presence of grossly visible disease. Therefore, diagnosis and treatment of the disease should not depend upon histologic confirmation.

Quantitation of proteinuria in pregnancy by the use of single voided urine samples.

The most commonly used method to measure urinary protein involves a 24-hour urine collection. In a study of 54 specimens, we found excellent correlation between the protein content of a 24-hour urine collection and the protein/creatinine ratio of a single urine sample (r = 0.9936; P less than .0001). We conclude that the protein/creatinine ratio of a single urine specimen represents a highly accurate method to assess renal function in the pregnant patient, and seems clearly more practical than the 24-hour urine collection.

Free alpha-subunit response to gonadotropin-releasing hormone in women with polycystic ovaries.

The response of glycoprotein hormone free alpha-subunit to gonadotropin-releasing hormone (GnRH) was evaluated in 12 women with polycystic ovaries (PCOs). Six of these women were premedicated for 3 days with micronized 17 beta-estradiol before receiving a 100-micrograms bolus of GnRH. In nonmedicated PCO patients, GnRH did not significantly alter basal free alpha-subunit levels. In four of the six PCO patients receiving estrogen premedication, a significant increase in free alpha-subunit was observed; these four patients had low progesterone levels at the time of the GnRH test. Among the six premedicated patients, two had elevated (greater than 4 ng/ml) progesterone levels, and the GnRH tests showed no significant effect on the levels of free alpha-subunit. The study revealed a dissociation between the free alpha-subunit responses to GnRH and the responses of luteinizing hormone; a closer relationship was observed between free alpha-subunit and follicle-stimulating hormone responses. It was concluded that the lack of a free alpha-subunit response to GnRH in PCO patients is not due to a primary inability of the pituitary gonadotroph to produce free alpha-subunit but is a consequence of an altered estrogenic milieu, and a free alpha-subunit response to GnRH may reflect the replenishment of both follicle-stimulating hormone and luteinizing hormone in the gonadotrope.

Pelvic peritoneal defects and endometriosis: further observations.

Congenital or acquired defects in the mesentery are rare, and defects of the supporting structures and in the peritoneum of the pelvis are even more uncommon. Such pelvic peritoneal defects have been associated with endometriosis; however, the extent of this association has been unclear. In the present study, 309 patients had a diagnostic laparoscopy performed for pelvic pain in a prospective manner over a 2-year period. A total of 53 patients were found to have pelvic peritoneal defects. Seventy-nine percent of this group with peritoneal defects had associated endometriosis. Of the 309 patients undergoing laparoscopy, 148 patients were diagnosed as having endometriosis. Twenty-eight percent of this group with endometriosis had pelvic peritoneal defects. We conclude that when such defects are found at laparoscopy, the presence of endometriosis should be investigated thoroughly.

Competitive studies with dehydroepiandrosterone sulfate and 16 alpha-hydroxydehydroepiandrosterone sulfate in cultured human choriocarcinoma JEG-3 cells: effect on estrone, 17 beta-estradiol, and estriol secretion.

The estradiol (E2) to estriol (E3) ratio during human pregnancy depends on fetal liver hydroxylation of fetal adrenal dehydroepiandrosterone sulfate (DHEAS) and conversion by the trophoblast of DHEAS and 16 alpha-hydroxy-DHEAS (16 OH-DHEAS) to estrone (E1), estradiol (E2), and estriol (E3), respectively. It is not known whether the conversion of DHEAS into E1 and E2 influence the conversion of 16OH-DHEAS into E3 and vice versa. To examine this question, we studied these interactions in human choriocarcinoma JEG-3 cells. In serum-free medium (Dulbecco's Modified Eagle's Medium), JEG-3 cells secreted hCG [27 +/- 3 (+/- SEM) ng/mg cellular protein X 24 h] and progesterone (22 +/- 2.5), but neither C-19 nor C-18 steroids. The addition of DHEAS resulted in secretion of E1 and E2; at a concentration of 500 ng DHEAS/ml, the secretion of E1 (1 +/- 0.16) and E2 (11 +/- 3.1) was maximal, while E3 remained undetectable. The addition of 1000 ng 16 OH-DHEAS/ml resulted in maximum E3 secretion (13 +/- 1.8), while E1 and E2 remained undetectable. The addition of increasing concentrations of DHEAS to cultures exposed to 1000 ng 16OH-DHEAS/ml caused a decrease in E3 secretion and increased secretion of E1 and E2. Conversely, addition of increasing concentrations of 16OH-DHEAS in cultures exposed to 500 ng DHEAS/ml resulted in inhibition of E1 and E2 secretion and increased E3 secretion. A concentration of 16OH-DHEAS that inhibited the conversion of DHEAS into E1 and E2 neither altered the intracellular to extracellular steroid ratios (approximately 0.1) nor reduced the secretion of DHEA, androstenedione, and testosterone. The inhibitory effect of 16OH-DHEAS was minimal at low DHEAS concentrations (favoring the secretion of E1 and E2) and was greatly enhanced at concentrations of DHEAS that induced maximum E1 and E2 secretions. The results indicate that in trophoblastic cells, the metabolism of DHEAS can modulate E3 secretion, and the metabolism of 16OH-DHEAS can modulate the secretion of E1 and E2; and this regulatory mechanism appears to take place at the level of the aromatase system.

Contraceptive practices of female physicians.

To evaluate a potential bias between methods of birth control used and prescribed by physicians, we surveyed sexually active female physicians in regards to their own methods of birth control. When the contraceptive practices of female physicians are compared to those of the general population, no difference in use of various contraceptive methods is found. Among female obstetrician-gynecologists, however, the intrauterine device continues to be a disproportionally popular method of contraception. It is concluded that no gender bias exists in prescribing patterns of contraceptives since contraceptive use in female physicians is identical to that of the general populations.

PIP: To evaluate a potential bias between methods of birth control used and prescribed by physicians, the authors surveyed sexually active female physicians in regards to their own methods of birth control. In Chicago in 1984, the authors distributed 1000 questionnaires; 314 were completed. Of these 314 respondents, 235 were between ages 25 and 44 and were sexually active. Results show that 10% used oral contraceptives, 14% used IUDs, 32% used some form of barrier method, 23% were sterilized, and 8% used the rhythm method. 13% used no form of birth control. When contraceptive methods by age group are compared between female physicians and the general population, there is no difference with 1 exception: female physicians aged 25-35 show a lower rate of sterilization than the general population (3% versus 12%). Once medical training and childbearing are completed, sterilization becomes the most common method of contraception. With increasing age, female physicians exhibit the same trends in contraceptive choice as the general population, namely decreasing use of oral contraceptives and barrier methods and a more steady use of the IUD and the rhythm method. Female physicians expose themselves to the possibility of unwanted pregnancy to the same extent as the general population. A surprising finding was the relative increase in IUD use among female obstetrician-gynecologists when compared to all other female physicians as well as to the general population. Since no difference in the use of the various contraceptive methods was noted between female physicians and the general population, it can also be concluded that apparently no gender bias exists among physicians who provide contraceptive advice.

Vesical endometriosis following bladder injury.

The development of endometriosis in the area of a previous bladder wall injury is described. This represents the first documented case of endometriosis occurring after such injury.

Synchronous multiple primary malignant neoplasms of the breast, colon and vulva. A case report.

Synchronous multiple primary malignant neoplasms of different tissues or organs are being documented with increasing frequency. Awareness among clinicians is essential to the evaluation and follow-up of these patients. A rare case of the simultaneous occurrence of vulvar, breast and colon carcinoma underlines this fact.

Vaginal douching. Pros, cons, and proper technique.

Vaginal douching is not necessary in routine feminine hygiene. When performed infrequently it is not harmful, but frequent douching may lead to recurrent vaginitis and mucosal irritation or ulceration. Douching should not be performed during pregnancy.

Coexistent complete hydatidiform mole and fetus after therapy with human menopausal gonadotropin. A case report.

A patient who had undergone therapy with human menopausal gonadotropin had a coexistent complete hydatidiform mole and fetus. This report is the first published account of such a case.

Limb salvage in recurrent vulvar carcinoma after rupture of femoral artery.

Bypass procedures in patients with gynecologic malignancies have been used rarely. Successful external iliac-femoral bypass to avoid amputation in a patient with a rupture of the femoral artery due to recurrent vulvar cancer is reported. It is suggested that vascular bypass procedures may be considered as alternatives to surgical amputation in the management of a few selected patients with recurrent vulvar cancer and vascular injury.

The rare indication for splenectomy as part of cytoreductive surgery in ovarian cancer.

Advanced ovarian carcinoma is being treated with aggressive debulking surgery including complete removal of the tumor whenever possible followed by adjuvant therapy. Secondary debulking including splenectomy in a patient with recurrent ovarian carcinoma is reported. It is suggested that splenectomy may have a place in the management of a few patients with ovarian cancer. The technique and complications of splenectomy are described.