[Pharmacologic therapy of urinary retention after vaginal operations].
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Animals↗
Biomedical subjects
M P David
Publications and source records attributed to M P David.
Sonohysterography for distinguishing endometrial thickening from endometrial polyps in postmenopausal bleeding.
Sonohysterography, or sonographic uterine cavity visualization by uterine cavity distension, may help to distinguish true endometrial thickening from other intracavitary pathological conditions, assuming the same sonographic appearance. We examined 1.5 women with a thickened endometrium (range 10-25 mm) in sonography performed for postmenopausal bleeding. Sonohysterography revealed a polypoid structure in seven women, a normal uterine cavity in four women, and a thickened endometrium in four women. All the women underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 women (93.3%). Hysteroscopic resection of the polypoid structure was performed while the other patients underwent diagnostic curettage. Histological examination of the seven polypoid structures revealed benign endometrial polyps in six patients, and one pedunculated submucous fibroid. In the patients undergoing diagnostic curettage, histological examination revealed three cases of glandular hyperplasia, one of cystic (atrophic) hyperplasia, and one of papillary endometrial adenocarcinoma. Two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyps or fibroids was clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.
Journal Article↗
Transabdominal ultrasonographic evaluation of endometrial thickness in clomiphene citrate-stimulated cycles in relation to conception.
The possible antiestrogenic effect of clomiphene citrate on endometrial growth was assessed by serial transabdominal ultrasonographic measurements in 46 women with unexplained infertility. A significantly higher (p < 0.05) rate of endometrial growth was observed in the 8 women who conceived compared with the 38 women who failed to conceive. A thicker endometrium (4.6 +/- 0.3 mm) was observed from the third day before ovulation as well as a higher average growth rate in the three days prior to ovulation (0.7 +/- 0.1 mm/day) in the group that achieved pregnancy compared to a lower endometrium (2.1 +/- 0.2 mm) from the third day before ovulation and a slower growth rate in the three days prior to ovulation (0.2 +/- 0.0 mm/day) in the group that did not achieve pregnancy (p < 0.05). These data suggest that clomiphene citrate may exert an antiestrogenic effect on the endometrium, and thus interfere with implantation.
Adult↗
Cystadenofibroma of the ovary in young women.
Cystadenofibroma of the ovary, a relatively rare benign tumor, usually appears during the fourth and fifth decades. This tumor has malignant ultrasonographic features and may also macroscopically appear as malignant during surgery. Since this tumor has a rare malignant potential, it is well-advised to be aware of the possibility of a cystadenofibroma before selecting an aggressive surgical approach in young patients. We present five cases of young patients with cystadenofibromas of the ovary.
Adenofibroma↗
Endometrial receptivity in the light of modern assisted reproductive technologies.
OBJECTIVE: To review the different aspects of endometrial receptivity as it is reflected in the various modalities of modern assisted reproductive technologies. DESIGN: The importance of endometrial receptivity and the factors that affect it such as the type of treatment, age, and ovarian function are discussed in this review. Novel approaches to determine receptivity such as Doppler ultrasonography and molecular biology are considered; assisted hatching is also discussed. CONCLUSIONS: Endometrial receptivity cannot, as yet, be directly assessed. Circumstantial evidence suggests that receptivity declines with age, is adversely affected by controlled ovarian hyperstimulation, and is possibly affected by ovarian function. Future studies will have to focus on molecular cell biology and physiology of the endometrium.
Aging↗
Vaginismus: an important factor in the evaluation and management of vulvar vestibulitis syndrome.
Dyspareunia is a common complaint in general gynecological practice. Many patients with dyspareunia suffer from vulvar vestibulitis syndrome (VVS). This syndrome constitutes severe pain on vestibular contact or attempted vaginal entry, tenderness to pressure within the vulvar vestibule and physical findings of vulvar erythema of various degrees. As a last resort, and only when all conservative treatments have failed, surgery is attempted. It has been our observation that a considerable percentage of patients with VVS present with concomitant vaginismus. Furthermore, surgery is less successful in this subgroup of patients unless the vaginismus is first treated. This report describes the evaluation and treatment of 14 patients with VVS.
Adult↗
Persistence of polyhydramnios during pregnancy--its significance and correlation with maternal and fetal complications.
One hundred and thirteen cases of polyhydramnios diagnosed by repeated ultrasonic examinations in singleton pregnancies were divided into two groups according to the trend of change in the amniotic fluid volume between the first and the second ultrasonic examination. Group A patients (65 cases) showed an increase or no change in amniotic fluid volume, and in group B (48 cases) a reduction in amniotic fluid volume to mild polyhydramnios or to normal amniotic fluid volume was observed. A significantly increased rate (p < 0.05) of maternal complications such as diabetes mellitus, pregnancy-induced hypertension, urinary tract infections, premature rupture of membranes and premature delivery was observed in group A. More abdominal deliveries and an increased rate of fetal anomalies, fetal abnormal presentations, intrauterine fetal death and neonatal death also occurred in this group. Group B patients, most of whom were idiopathic, showed a very favorable outcome.
Diabetes Mellitus↗
Cervical polyp: evaluation of current treatment.
The removal of a cervical polyp is routinely accompanied by a fractionated dilatation and curettage (D&C) in various institutions. In order to assess the necessity of performing a D&C on all the patients admitted with the diagnosis of a cervical polyp, we reviewed the charts of 362 patients admitted for a cervical polypectomy and D&C during a 5-year period. The procedure was performed on a day clinic basis under general anesthesia. No serious complications were noted. In 218 women (60%) the discovery of the cervical polyp was incidental and in this group no malignant change was found in the polyp or in the endometrium. Six cases of atypical hyperplasia and 2 cases of adenocarcinoma of the endometrium were found in the symptomatic group of patients (40%). Removal of the polyp as an outpatient procedure is recommended of the asymptomatic patient. Hospitalization and removal of the polyp under general anesthesia, accompanied by D&C should be reserved for the symptomatic patients only, or even then, replaced by ambulatory polypectomy and endometrial sampling.
Adult↗
Post-cesarean-section necrotizing fasciitis: report of a case and review of the literature.
Necrotizing fasciitis is a rare but potentially lethal, rapidly progressive, soft-tissue infection. Cure is dependent on early diagnosis and prompt surgical intervention. A case of necrotizing fasciitis in a patient after cesarean section is herein reported and the treatment and outcome discussed. An extensive review of the literature revealed a single case report of necrotizing fasciitis after cesarean section.
Adult↗
Oligohydramnios: maternal complications and fetal outcome in 145 cases.
One hundred and forty-five cases of oligohydramnios in the second and third trimester were diagnosed by ultrasonography out of 25,000 obstetrics patients (0.58%). In this group, pregnancy complications included hypertension (22.1%) and bleeding in the second trimester (4.1%). We found a high incidence of meconium-stained amniotic fluid (29.1%), fetal distress (7.9%) and premature placental separation (4.2%). IUGR occurred in 24.5% of cases. Asphyxia during labor occurred in 11.5% and different other perinatal problems in 23.5%. Cesarean section was performed in 35.2% of these pregnancies. Seventeen percent of the cases presented as breech. Intrauterine fetal death occurred in 5.5% of these pregnancies. The gross perinatal mortality was 16% and the corrected perinatal mortality was 10.7%. The overall rate of fetal malformations was 11% and that of lethal malformations 4.8%. The skeletal (7.6%) and urinary system (4.1%) were the predominant systems affected. Oligohydramnios is associated with a higher rate of pregnancy complications and increased fetal morbidity and mortality, and thus termination should be considered when pulmonary maturity is present or in cases of fetal distress.
Abortion, Spontaneous↗
Epidural morphine bupivacaine combination for the control of autonomic hyperreflexia during labor.
The improvement in rehabilitation of young women with spinal cord lesions, combined with the fact that libido, fertility and child bearing remain intact, enables more such patients to conceive. The obstetric team is therefore bound to meet with such patients. Among the various complications of this condition during pregnancy is an acute life-threatening syndrome called autonomic hyperreflexia (AH), caused by an uncontrolled massive sympathetic discharge, which occurs in response to stimuli that reach the spinal cord below the lesion. Most authors agree that the best method of controlling AH during labor is by an epidural block which impends stimuli from reaching the spinal cord and thus provoking AH. Most authors could not completely abolish AH episodes using different medication epidurally. Herein we present a successful delivery using a combination of morphine bupivacaine epidurally.
Adult↗
Pseudo-sinusoidal heart rate associated with major cardiac anomalies.
Pseudo-sinusoidal fetal heart rate (pseudo-SHR) pattern, characterised by intermittent episodes of sinusoidal heart rate and normal fetal heart rate (FHR), is considered benign although its pathophysiologic mechanism remains obscure. We present a case of pseudo-SHR episodes throughout all stages of labor associated with multiple major cardiac anomalies. We suggest that when confronted with repeated episodes of pseudo-SHR pattern, the possibility of an underlying cardiac anomaly should be considered.
Abnormalities, Multiple↗
Outpatient versus inpatient cervical cerclage.
The outcomes in 125 cases of elective, outpatient cerclage placement were compared to those in 101 cases of elective, inpatient cerclage placement with the same technique at the same institution. There was no difference between the two groups in the rates of early and late complications or in the effect of the procedure on the duration of gestation. As expected, a statistically significantly shorter hospital stay occurred in the outpatient group. The outpatient procedure is as effective as the inpatient one, with no increased risk of early and late complications, and offers patients a shorter absence from home, thus possibly decreasing their anxiety, and considerable financial savings.
Adult↗
[Tuberculosis in pregnancy: diagnosis, natural history and treatment].
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Antitubercular Agents↗
[Pelvic inflammatory disease in pregnancy].
Although pelvic inflammatory disease (PID) is a common complaint in young, fertile women, it is quite rare during pregnancy. Clinically it is characterized by abdominal pain, sometimes presenting as an acute abdomen with fever. Since PID has no characteristic clinical or laboratory findings, and is rare during pregnancy, it is understandable why the diagnosis is missed in most cases, and the patient is treated as an abdominal emergency. Since surgery during pregnancy in the presence of an infection leads to abortion in most cases, accurate diagnosis and appropriate treatment is of the greatest importance. A case of PID during pregnancy is presented.
Abdomen, Acute↗
Ectopic pregnancy after in vitro fertilization-embryo transfer (IVF-ET): the possible role of the ET technique.
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Embryo Transfer↗
When multiple gestational sacs are seen on ultrasound, 'take-home baby' rate improves with in-vitro fertilization.
During a 5.5 year period, 309 clinical pregnancies were recorded in our in-vitro fertilization (IVF) unit. A single gestational sac was identified by early ultrasonography in 233 patients, while in 76 others, multiple gestational sacs were noted. 'Take-home baby' rate, in patients in whom multiple sacs were observed, was higher than that in patients with a single sac. Delivery of at least one live newborn occurred in only 73.8% of patients with a single sac, compared with 93.3% and 91.7% in patients with two and three gestational sacs, respectively. Conversely, the early and late abortion rates were decreased in patients with multiple sacs. Embryonic implantation rate, defined as the ratio of gestational sacs observed to the number of embryos transferred, was found to be a valuable prognostic factor for a live delivery, and can serve as a tool in assaying the prognosis of pregnancy detected by early sonography. The observation of a higher 'take-home baby' rate in cases with multiple sacs identified by ultrasound and with higher embryonic implantation rate, might be the result of a better embryo quality and/or improved uterine receptivity, promoted by a favourable hormonal milieu or by as yet unknown endometrial factors.
Abortion, Spontaneous↗
Repeated aspiration of ovarian follicles and early corpus luteum cysts in an in-vitro fertilization programme reduces the risk of ovarian hyperstimulation syndrome in high responders.
A retrospective analysis of ovarian hyperstimulation syndrome in high responders undergoing in-vitro fertilization (IVF) is presented. High responders were defined as having > 20 follicles and serum oestradiol > 3000 pg/ml after treatment with human menopausal gonadotrophin. Of the initial 30 IVF cycles in high responders, 23 developed a moderate-to-severe ovarian hyperstimulation syndrome (76.7%). Subsequently, 15 other IVF cycles in high responders were combined with a repeated aspiration of ovarian follicles and corpus luteum cysts just prior to embryo transfer. Only three patients (20%) developed a moderate ovarian hyperstimulation syndrome (P = 0.0004). We conclude that repeated follicular aspiration is safe and results in a significant reduction in the incidence and severity of this condition in high responders undergoing IVF.
Adult↗