Hysterosalpingography and selective salpingography in the differential diagnosis of chemical intrauterine versus tubal pregnancy

Citations from the Literature used postoperatively. Success rates within the adjuvant 5fluorouracil and laser alone arms were essentially the same (9 of 18 vs. 8 of 20). In contrast, outcome in the interferon group was significantly better than that for the other two arms combined (27 of 33 [82%] vs. 17 of 38 [45%]; chi* 10.31; P < 0.002). Moreover, 18 of 21 failures (86%) in the first two arms and 3 of 6 failures (50%) in the interferon arm were ‘rescued’ from the need for a second laser surgical procedure by crossover to either the 1 or 3 MIU interferon regimen. Results from this open-label, randomized clinical trial suggest that even a relatively low dose of recombinant interferon, used in combination with effective surgical debulking, can markedly reduce the risk of postoperative recurrence.

Helvacioghr A; Weis R USA FERTIL STERIL 1992 57/3 (548-552) Objective: To evaluate the immediate postoperative pain and discomfort in patients who underwent operative laparoscopy under general anesthesia with or without peritoneal lidocaine and incisional bupivacaine instillations. Design: Fifty-four participants were prospectively randomized to three groups: group I, intraperitoneal (IP) lidocaine + intraincisional bupivacaine; group II, intraincisional bupivacaine; and group III, no additional drugs after general anesthesia (controls). Setting: University Hospital, Reproductive Endocrinology and Infertility Clinics. Patients: Private patients needing operative laparoscopy. Interventions: One hundred milligrams of lidoCaine were instilled with the irrigation device into the peritoneal cavity at the completion of surgery. Twenty-five milligrams of bupivacaine were injected into infraumbilical and suprapubic incisions. Main Outcome Measures: The analgesic use and modified McGill Present Pain Intensity scores were used for pain evaluation. Results: McGill Present Pain Intensity scores for pain and narcotic use in the recovery room were less in the IP lidocaine-instilled group of patients (P < 0.05). The mean maximum plasma lidocaine level achieved was 1.01 f 0.25 &ml. Conclusions: Peritoneal lidocaine and incisional bupivaCaine use in operative laparoscopy as described after general anesthesia is safe and effective in reducing postoperative pain in the recovery room. HysternsaIpingogra@sy and selective salpingography in the differential

diagnosis

of

chemical

intrauterine

versus

nant infertility patients who demonstrated declining @-hCG levels before pregnancy could be confirmed by ultrasound (chemical pregnancies). Results: Three of four patients demonstrated a characteristic tubal opacitication pattern in conjunction with a normally appearing endometrial cavity, considered diagnostic of an early tubal pregnancy. In contrast, a missed intrauterine pregnancy (IUP) demonstrated a characteristically abnormal endometrial cavity. Conclusions: Some early (chemical) pregnancy losses are intratubal rather than intrauterine. The correct differential diagnosis of early missed, IUPs versus intratubal pregnancies is important because of it prognostic significance.

GYNECOLOGICAL

Operative laparoscopy and postoperative pain relief

tubal

PregopacY

Gleicher N; Parrilli M; Pratt DE USA FERTIL STERIL 1992 5713 (553-558) Objective: To determine the validity of hysterosalpingography (HSG) and/or bilateral selective salpingography in the differential diagnosis of early (biochemical) intrauterine versus intratubal abortions. Design: The study design involved the performance of HSG and selective salpingography in sequential with low declining beta-human chorionic patients gonadotropin (&hCG) values. Setting: Medical Schoolaffiliated Infertility Center. Participants: Four sequential Preg-

253

ENDOCRINOLOGY

Long-term administration of gooadotropia-releasing hormone agonist and dexametbasone: Asseavm ent of the adrenal role in ovarian dysfunction

Cedars MI; Steingold KA; De Ziegler D; Lapolt PS; Chang RJ; Judd HL USA FERTIL STERIL 1992 57/3 (495-500) Objective: To examine the possible impact of abnormal adrenal steroidogenesis on the ovarian dysfunction seen in polycystic ovarian disease (PCOD). Design: Prospective analysis of blood sampling monthly for 6 months, then three times weekly for 90 days. Setting: Tertiary institutional outpatient care. Participants: Six anovulatory women with a diagnosis of PCOD. Intervention: Six-month suppression with gonadotropin-releasing hormone agonist (GnRH-a) followed by suppression with dexamethasone (DEX) for 90 days. Main Outcome Measures: Serum levels of testosterone (T) androstenedione (A), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), cortisol, estradiol (E2), progesterone (P), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and bioactive LH. Results: Gonadotropinreleasing hormone agonist administration suppressed >60% of the circulating levels of T and A, suggesting an ovarian origin. Minimal changes of DHEA, DHEAS, and cortisol were seen. With the addition of DEX, there was >90% suppression of the total circulating A, T, DHEA, DHEAS and cortisol, supporting the adrenal origin of the non-GnRH-a suppressible androgens. Excessive ovarian T and A secretion returned during the 90-day recovery study period in spite of rises of FSH concentrations that changed the ratio of FSH to LH in all subjects. Four of the six women failed to ovulate. In comparison of the women who did and did not ovulate during recovery, no differences in absolute levels or changes in concentrations of steroids or gonadotropins could be detected. Conclusions: Using sequential and simultaneous administration of GnRH-a and DEX, we were able to delineate the contributions of the ovaries and adrenals to the abnormal steroidogenesis seen in PCOD. Despite prolonged suppression of ovarian and then adrenal steroidogenesis, ovarian dysfunction, evidenced by abnormal androgen production, returned with cessation of agonist administration. Int J Gynecol Obstet 39