Showing papers on "Endometriosis published in 1976"

Incidence of endometriosis in diagnostic laparoscopy.

Abstract: Endometriosis is a common finding at laparoscopy. In order to make a correct diagnosis and institute appropriate management it is recommended that laparoscopy be performed on all patients with chronic pelvic pain and on most patients with infertility or acute pelvic pain.

Perianal endometrioma: report of five cases.

Abstract: One of the gynecologists' commonest findings at pelvic laparotomy is endometriosis. Despite the fact that the presence of endometrial tissue in ectopic locations is commonplace, the finding of a perianal endometrioma is no more than a surgical curiosity. Very few cases have been reported. The present report describes five such verified cases. Interestingly enough, only two of the five cases were diagnosed preoperatively. The pathogenesis of endometriosis has been, and continues to be, controversial. The prevailing theories include 1) transtubal regurgitation of menstrual blood, 2) the coelomic metaplasia doctrine, 3) lymphatic dissemination, and 4) hematogenous spread. Pathologically the lesions may vary grossly from red-blue to yellowish-brown implants, ranging in size from microscopic to 1-2 cm in diameter. The definitive histologic diagnosis requires two of the following three features-glands, stroma, and hemosiderin pigment. The clinical manifestations depend upon the functional activity of the involved tissue and may range from an asymptomatic mass to the classic presentation of a mass increasing in size and becoming acutely painful during menstruation but subsiding in size and decreasing in tenderness between menstrual periods. These protean manifestations are readily illustrated by the cases presented. Anatomically the lesions are usually found in old episiotomy scars. Because these lesions are usually readily accessible, and because their exact nature is frequently not known preoperatively, the treatment of choice is local excision. Complementary hormonal therapy has been suggested, but the value of such treatment is not yet proven. Ovarian ablative therapy is also considered.

Endometriosis therapy with medroxyprogesterone acetate.

Abstract: Use of orally administered medroxyprogesterone acetate (MPA) 10 mg 3 times a day for 90 days was undertaken to assess its effect in patients with endometriosis. Subjects were 24 patients with symptoms of premenstrual pain suggestive of endometriosis. No patient had a large palpable adnexal mass. Patient interviews and pelvic and breast examinations were done before treatment at 30-day intervals during treatment and 30 days after treatment. Routine hematology urinalysis and blood chemistries were evaluated at the same periods. Endoscopic examinations were done before treatment and after 90 days of MPA therapy. Plasma progesterone was measured by radioimmunoassay at 2-week intervals during treatment and for 4 weeks after treatment. Endometrial biopsies were done in the pretreatment cycle and again on the last day of treatment. Symptomatic relief was total in 24 cases and improved in 3. In 1 case premenstrual pain recurred 11 months after treatment. Of 22 patients who had follow-up endoscopy examinations 15 had complete healing and 7 showed improvement. Plasma progesterone values showed ovulatory suppression during therapy and prompt restoration of ovulatory function later. Other examinations showed no significant changes. There were not drug-related side effects except occasional spotting. The MPA therapy was considered as somtimes palliative only but effective and preferable to other forms of medical management of endometriosis.

Cyclic sciatica of endometriosis. Case report.

Abstract: A 27-year-old woman with right-sided cyclic sciatica and stiffness of the right hip joint, unresponsive to orthopaedic measures, is presented. An exploratory laparotomy revealed pelvic endometriosis. On oestrogen suppression therapy, she has been symptom-free for eleven months.

Recurring spontaneous pneumothorax associated with menses.

Abstract: A case of catamenial pneumothorax in a 34-year-old woman is presented. Typically recurrent, right-sided pneumothorax associated with menses occurs in a 30- to 40-year-old woman with endometriosis. The right-sided occurrence is attributed to the frequency of congenital perforations of the right hemidiaphragm. Aberrant endometrial tissue is thought to gain access to the right hemithorax and cause pneumothorax with the menstrual slough. Therapy consists of ovulation-suppressing drugs or thoracotomy with pleural ablation for recurrent pneumothoraces. The physician should be aware of the syndrome to make a proper diagnosis.

Experience of a comprehensive infertility clinic in the Department of Obstetrics and Gynaecology, University of Singapore.

Abstract: The diagnosis treatment and pregnancy outcome for 709 infertile couples who attended the comprehensive infertility clinic of the University of Singapores Department of Obstetrics and Gynecology from 1970-1974 are presented. Investigations for most of the couples were completed within 3 months. This short investigative period was attributable primarly to the use of laparoscopy to diagnose female infertility. In 22.5% of the 709 cases infertility was due to ovulation problems. After treatment eith either clomiphene human pituitory gonadotrophin or a combination of clomiphene and human chorinic gonadotrophin pregnancy was achieved in 30.6% of the cases. 11.7% or 83 of the 709 infertility cases were attributed to blocked tubes. 28 of these patients received tubal surgery but only 14.3% or 4 of these cases resulted in pregnancy. In 14.7% of the 709 cases infertility was attributed to endometriosis. 90% of the patients with endometriosis were asymptomatic and the liesons discovered by laparoscopy were very small. Pregnancy eventually occurred in 27.6% of the cases treated for endometriosis. In 5.8% of the 709 cases infertility was due to mixed gynecological problems and after treatment conception occurred among 31.7% of the cases. For 23.1% or 147 of the 709 couples infertility was attributed to either oligospermia or azoospermia. 85 of the 147 patients were given hormone therapy and in 12.9% of these cases pregnancy was achieved. 14 of the 147 patients were treated with antibotics for 3-6 months and in 14.3% of these cases pregnancy was achieved. 9 of the 147 patients were surgically treated and in 4 of these cases pregnancy later occurred. 20 of the 147 couples were treated with artifical insemination of donor semen and in 25.0% of these cases pregnancy occurred. Another 19 of the 147 cases were treated with artificial insemination with the husbands semen and conception occurred in 26.8% of these cases. The remaining 22.1% of the 709 couples were apparently normal and 47.8% of these untreated couples later achieved pregnancy.

Endometriosis in laparotomy scars.

Abstract: Endometriosis of laparotomy scars has been described as rare. Interruption of pregnancy by abdominal hysterotomy affords an opportunity for its development. The two cases which are reported were admitted to the hospital within one month, which suggests that this diagnosis may not be rare.

The Glycogen Content of Blood and Uterine Tissue in Women with Myoma and Endometriosis

Abstract: Summary The amount of glycogen in venous blood and uterine tissue from 135 women undergoing gynecologic surgery was quantitatively determined One group had myoma (n = 48), another endometriosis (n = 30) 18 women had myoma combined with endometriosis of the myometrium 39 women served as control group The following samples of the uterus were obtained immediately after removal: endometrium, myometrium, cervix and "tumour" The glycogen content in pathological cases was compared to normal tissue of comparative endocrine state, parity status and glucose tolerance The significance levels were determined by standard analysis of variance and "t" tests In the group with endornetriosis, a significant difference occurred in the amount of blood glycogen, while a significant decrease was observed in the myometrial tissue The cervical tissue glycogen levels of patients with myoma or endometriosis were significantly higher and did not exhibit cyclic or menopausal changes There were no significant cyclic differences in the amount of endometrial tissue glycogen in women with myoma or endometriosis In these cases the glycogen content was significantly higher than in healthy endometrial tissue Blood glucose and plasma insulin levels were found to be in a normal spectrum Pathological glucose tolerance and parity status showed no correlation to the variation of uterine tissue

Dydrogesterone and endometriosis

Abstract: Summary The results are reported of the administration of dydrogesterone, 5 mg twice daily, to 49 patients with endometriosis. All but five patients were symptom-free after nine months of therapy. Most subjective symptoms had disappeared within four to eight weeks; dyspareunia usually took longer. In 30 out of 32 patients who had a culdoscopy after one or two treatment courses, a ‘cure’ of endometriosis was confirmed. Ten out of nineteen infertile patients became pregnant following treatment. The only side-effects were transient mastalgia and dizziness in two patients. No amenorrhoea or other disturbances of the menstrual cycle were reported.

Grey Scale Patterns in Pelvic Inflammatory Disease

Abstract: The patient with pelvic inflammatory disease is often difficult to evaluate both from history and physical examination. Distinguishing clinically between the various forms of pelvic inflammatory disease, ectopic pregnancy, twisted or ruptured ovarian cyst, missed or impending abortion, ovarian carcinoma, and endometriosis, is sometimes impossible. By means of commercially available second generation grey scale ultrasound, a more precise set of criteria for distinguishing between these entities based on intra-organ internal echo patterns has been developed.

Surgical treatment of female infertility.

Abstract: Surgery plays a vital role in overcoming identifiable problems of infertility Problems such as incompetent cervix can be repaired by cerclage procedures with a 70-80% chance of carrying a gestation to the stage of viability The septateuterus a congenital uterine abnormality is the cause of most reproductive failure However regardless of the technique used for excision of the uterine septum selected patients can achieve an 85% chance of a living child For fibromyomata uteri a myomectomy offers a term delivery in 50% of the cases; although recurrence of fibrimyomata following myomectomy occurs in 20-30% of the cases Uterine synechiae treated by transcervical release of adhesion and insertion of a uterine device to prevent recurrence results in a 40-50% successful pregnancy rate Mid-segment reconstruction is used to resect the obstructed oviduct usually due to prior tubal ligation Uterotubal implantation by cornual wedge excision or the reamer technique relieve corneal obstruction with a 30-40% pregnancy success Ovarian surgery is limited to benign cyst resection wedge resection in sclerocystic ovarian syndrome and perhaps paridoxical oophorectomy A therapeutic approach for endometriosis using estrogenic hormone preparations to eliminate ovulation progestogens to maintain a decidual state in the endometrium and androgens to relieve symptoms and promote pregnancy provide generally lower pregnancy rates than surgery alone which provides a 50-60% pregnancy rate

Endometriosis and infertility: an aggressive surgical approach.

Abstract: A review of 2 series of endometriosis patients under 31-years-old 56 from 1942 to 1961 and 86 form 1962-1974 with a discussion of the authors preference for agressive surgery for this disorder is presented. The most common symptoms were pelvic or rectal pain dysmenorrhea dyspareunia (30-40%) hypermenorrha (20%) infertility (60%) and secondary infertility (30%) Surgical procedures were intensified in Group 2 e.g. numbers of endometriomal resections ovarian resections presacral neurectomies and bowel resections were increased in the more recnt series. Oophorectomy was performed in those with over 80% of an ovary involved. It is emphasized that both involved surfaces should be excised in case of adhesions. In these groups 65-75% of complaints were relieved 66 and 70% of those desiring pregnancy conceived although 27% of the 2nd series aborted. Only about 50% of the patients whose uterus was suspended conceived. Similarly presacral neurectomy did not improve pregnancy rates. Recurrent endometrosiss was equally frequent. The following are recommended: examining young women for endometriosis encouraging early pregnancy in case of a diagnosis excising lesions especially in ovarian intestinal or colonic involvement and early surgery rather than hormone treatment.

Clinical assessment of danazol for endometriosis.

Abstract: Infertility frequently results from endometriosis. Conservative therapy should be used for those women who need to preserve or enhance their childbearing potential. Therapy for women who have completed their childbearing is surgical. Endometriosis may be of mild moderate or severe degree. In mild cases treatment should be limited to analgesics. Moderate endometriosis is best treated by hormone therapy. Severe endometriosis requires surgical treatment to enhance fertility but preliminary hormonal therapy may promote a better surgical result. Diethylstilbestrol has been used but due to possible neoplastic changes is now of very limited use. Estrogen-progestin combinations as in oral contraceptives exert a beneficial effect. Progestins (Depo-Provera) 10 0 mg every 2 weeks for 4 doses than 100 mg monthly for 6-8 months are well tolerated and give a good response. Breakthrough bleeding can be controlled by use of oral estrogens. Prolonged amenorrhea and anovulation may follow this therapy. Testosterone used continuously over a period of several months is effective but there may be androgen-produced symptoms and masculinizing of a female fetus should pregnancy occur. Surgical treatment is usually hysterectomy and oophorectomy lysis of adhesions and removal of endometriomata. Molecular structures of testosterone ethisterone and danazol are shown. Danazol is a 23-isoxazole derivative of ethisterone. This compound exerts very slight androgenic action. 800 mg daily is associated with reduction in plasma levels of follicle stimulating hormone and a marked reduction of estradiol and progesterone. Therapy with 200-800 mg daily for 3-6 months produced marked reduction or disappearance of signs of endometriosis. A high conception rate has been reported to follow this therapy. Side effects have been minor and reversible. Ovulation begins promptly after stopping the drug. The agent is not yet available in the U.S. but is used in Great Britain. It is as effective as other agents and lacks some of their drawbacks.

Endometriosis externa extraperitonealis in einer Niere

Abstract: A case of extraperitoneal, isolated, intrarenal endometriosis observed by the author is described. The diagnostic problems are discussed; usually these concern complaints related to menstruation.

[Chronic lower abdominal complaints in the woman - a postlaparoscopic analysis].

Abstract: 2000 laparoscopies were performed between 1968 and 1975. 253 from 493 patients with unexplained pelvic pain were followed up a half till 5 years after laparoscopy concerning the pains. The discrepancy of clinical diagnosis and laparoscopie statement is compared and discussed. The most clinical diagnosis were: chronic pelvic pain (149 cases) and unexplained pelvic pain (32 cases). Postlaparoscopic findings were: inconspicuous statements (27,3%), pelvic adhesions (27,3%), chronic disease of the fallopian tubes (21,1%), chronic appendix diseases (10,3%), ovary cysts (9,8%), endometriosis (4,3%).52,9% of the patients were cured by specific treatment a half till 5 years after laparoscopy. The laparoscopy is considered to be a diagnostic and therapeutic acurate method. 14,2% of the patients with little or inconspicuous statements were cured after instruction. The laparoscopy may be the base for acurate diagnostic and team-work of several branches of knowledge.