[Interleukin 2. Nursing care protocol].
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Early surgical intervention in ectopic pregnancy is desirable. However, occasionally some patients do not benefit from this approach, as the natural history of ectopic pregnancy is not always tubal rupture or any other catastrophic event. A retrospective as well as a prospective analysis of 144 cases of suspected ectopic pregnancies was performed. The results of this study support expectant management in cases where serum beta-HCG levels are declining, provided the patient is stable and has no acute abdominal symptoms.
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Fifty anovulatory women were selected for treatment with gonadotropins. Sixty-five were monitored by serum 17-beta estradiol (E2) levels and human chorionic gonadotropin was administered accordingly. Retrospective evaluation of cycles indicates that the overstimulation syndrome and the number of undesired multiple pregnancies can be reduced after both ovaries have been visualized by ultrasound if, regardless of E2 serum levels, human chorionic gonadotropin is administered when one or two mature follicles are seen and withheld when three or more mature follicles are seen.
Between December 1981 and June 1986, 52 women examined by ultrasonography were found to have clear pelvic cysts more than 5 cm in average diameter, without septa or solid areas. The cysts were persistent and did not respond to contraceptive pills for four to eight weeks. In all cases, there were histologic or cytologic results from surgical specimens or fluid aspirated from the cysts. In 15 women, the cysts were aspirated and revealed no malignant cells. Thirty-seven women underwent laparotomy, of whom 11 (29%) were found to have benign ovarian neoplasms (nine cystadenomas and two dermoid cysts). Because benign ovarian neoplasms are potentially malignant, and because a large number was found in our study, we recommend removal of the cysts by excision rather than aspiration.
In a family with five daughters, three suffered from primary amenorrhea. The diagnosis of familial idiopathic gonadotropin deficiency (FIGD) was established. The entire family underwent HLA evaluation, and no linkage between the HLA and FIGD was found.
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Serum beta HCG, progesterone, and 17 alpha hydroxy progesterone values were determined in cases of ectopic pregnancy. They were found to be significantly lower than in normal intrauterine pregnancies of the same gestational age. No correlation was found between serum beta HCG and 17 hydroxy progesterone values or between serum progesterone and 17 hydroxy progesterone values. Our results tend to support the theory that a normal feto placental unit is needed for the preservation of the function of the corpus luteum.