Low-dose follicle-stimulating hormone treatment for polycystic ovarian disease.

OBJECTIVE: An attempt was made to induce ovulation with low-dose follicle-stimulating hormone (FSH) in clomifene-resistant women with anovulatory polycystic ovarian disease (PCOD). METHODS: Twenty-two PCOD patients were treated with a low-dose protocol of purified urinary FSH, starting with 75 IU/day and increasing every 7 days by 37.5 IU/day, if necessary. Monitoring was based on ultrasound scanning and estradiol measurements. RESULTS: Twenty-eight of the thirty-one cycles induced were ovulatory, the majority being uniovulatory (58%). No multiple pregnancies occurred. There was a small number of cancelled cycles (12.9%). The prevalence of complications was low, with one case of ovarian hyperstimulation syndrome. Ovulation was induced by a small amount of FSH (15.1 +/- 4.9 ampules). CONCLUSION: The use of the low-dose protocol permitted induction of ovulation safely and successfully in a selected group of PCOD patients. This therapy was associated with a high incidence of single dominant follicles and a very low multiple pregnancy rate.

Comparison of abdominal and vaginal hysterectomy. Study of complications.

BACKGROUND: To compare patent characteristics, diagnoses and complications associated with vaginal or abdominal hysterectomy in the last two decades. STUDY DESIGN: From 1974 to 1994, 6,420 women were included in the study. Complications were classified in two categories: intraoperative and postoperative, and psychosexual complications. RESULTS: Women who underwent vaginal hysterectomy experienced significantly fewer complications than women who had undergone abdominal hysterectomy. Vagina hysterectomy was associated with less febrile morbidity, bleeding requiring transfusion and convalescence than abdominal hysterectomy. CONCLUSIONS: Hysterectomy is highly effective for relief of symptoms associated with common non-malignant gynecologic conditions. There is a minimal risk of complications among women undergoing hysterectomy by the abdominal and vaginal route.

Is color Doppler necessary in the evaluation of tubal patency by hysterosalpingo-contrast sonography.

BACKGROUND: To evaluate the diagnostic efficacy of hysterosalpingo-contrast sonography (HyCoSy) and to establish whether, in doubtful cases, the additional use of transvaginal Color Doppler can improve the tubal diagnosis reached with gray scale imaging alone. STUDY DESIGN: Ninety-six cases of unknown tubal function with infertility complaints were included. Within four weeks after sonographic hydrotubation, hysterosalpingography was performed. The diagnostic efficacy of gray scale and Color Doppler were compared with each other and against HSG. RESULTS: We calculated a sensitivity value of 82.9% and a specificity value of 86.1% for both tubes. The concordance value was of 83.5%. The total number of Color Doppler examinations compared with those of HSG showed a sensitivity of 91% for the right tube and 93% for the left tube and a specificity of 100% for both tubes. CONCLUSIONS: HyCoSy provides reproducible findings for the evaluation of uterine abnormalities and tubal patency. The additional use of Color Doppler is recommended as a supplement to gray scale imagin in cases of suspected tubal occlusion.

Vaginal hysterectomy: technique and results in the last twenty years.

The objective of this work was to describe patient characteristics and the effect of vaginal hysterectomy in a University hospital in the last two decades. A retrospective review of women undergoing vaginal hysterectomy was performed. The type of hysterectomy and complications were determined. From 1974 to 1994, a total of 6420 hysterectomies were performed. The vaginal route was used for 1530 patients. In the last decade, the Heaney method was used. A comparison of the periods 1974-1984 and 1984-1994 revealed that with the Heaney technique, we had significantly fewer complications, including less febrile morbidity, bleeding requiring transfusion, and injuries. Vaginal hysterectomy, specially using the Heaney method, is a rewarding challenge for any gynecologic surgeon. There are a low postoperative morbidity rate and a low mortality rate, which is well below the average mortality rate associated with abdominal hysterectomy.