International Journal of Gynecology & Obstetrics

Circular prolapse of the urethral mucosa in the elderly female is rarely reported in the literature, but is a common clinical entity. During the years 1972–1983 thirteen women with urethral prolapse were operated upon in our department, in all of whom differentiation of the benign lesion from malignancy could not be done on clinical grounds only. The following survey is meant to draw attention to the entity and its clinical implications.

The main female anatomical causes of infertility include post‐infectious tubal damage, endometriosis, and congenital/acquired uterine anomalies. Congenital (septate uterus) and acquired (myomas and synechiae) diseases of the uterus may lead to infertility, pregnancy loss, and other obstetric complications. Pelvic inflammatory disease represents the most common cause of tubal damage. Surgery still remains an important option for tubal factor infertility, with results in terms of reproductive outcome that compare favorably with those of in vitro fertilization. Endometriosis is a common gynecologic condition affecting women of reproductive age, which can cause pain and infertility. The cause of infertility associated with endometriosis remains elusive, suggesting a multifactorial mechanism involving immunologic, genetic, and environmental factors. Despite the high prevalence of endometriosis, the exact mechanisms of its pathogenesis are unknown. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. In the majority of cases, surgical treatment of endometriosis has promoted significant increases in fertilization rates. There are obvious associations between endometriosis and the immune system, and future strategies to treat endometriosis might be based on immunologic concepts.

Objective: To evaluate the surgical management and outcome of stage‐I borderline ovarian tumors. Methods: A series of 95 cases of FIGO stage‐I borderline ovarian tumors was retrospectively reviewed. Results: The age of the patients ranged from 17.6 to 88.9 years (mean 52.7 years). Serous and mucinous tumors were equally represented (47.5% and 47.4%, respectively), endometrioid and clear cell tumors comprising the remaining three (3.2%) and two (2.1%) cases. Extirpative primary surgery was performed on all patients. Three patients received postoperative chemotherapy. Nineteen of the 28 patients (67.9%) who were younger than 40 years underwent conservative surgery in which ovarian tissue and the uterus were preserved in order to maintain reproductive potential, and nine of them had successful pregnancies later. Ninety patients were followed regularly for 0.75–21.3 years (average 7.3 years). Seven patients suffered a tumor relapse (7.8%) within 0.6–4.3 years, and four (57.1%) of them (three with mucinous tumors, one with clear cell tumor) died of the disease within 1–10.8 years. The 5‐ and 10‐year overall survival rates were 97.0% and 86.3%, respectively, and the disease‐free survival rates were 90.8% in both 5‐ and 10‐year follow‐ups. Conclusions: Even though the prognosis of surgically treated stage‐I borderline ovarian tumors is excellent, mucinous and clear cell sub‐types are associated with potential mortality.

Two cases of intractable postpartum hemorrhage could be controlled by Gelfoam embolization via an angiographic catheter. The data presented here indicate that transcatheter embolization for postpartum hemorrhage is a safe and effective method compared to surgical ligation of the injured artery.

Objectives: To compare the accuracy of laparoscopy performed within 24 h of admission and the conventional method based on clinical observation in the etiological diagnosis of non‐specific acute lower abdominal pain (NSLAP) in women of reproductive age. Methods: A total of 110 patients who met the selection criteria and were seen from November 1997 to June 2000 at the Instituto Materno Infantil, a referral hospital for maternal and perinatal care in Bogotá, were randomly divided into two groups. The effectiveness of each method was evaluated according to number of diagnoses reached, length of in‐patient stay before diagnosis, complications, and diagnostic accuracy when compared with a standard given by microbiological and histopathological findings as well as clinical course. Results: The early laparoscopy group did not experience more accurate diagnoses (85% vs. 79%, P=0.61) or a greater number of complications (11% vs. 9%, P=0.48), although the patients’ stay was shorter (1.3 vs. 2.3 days, P=0.008) than the stay of the conventional‐diagnosis group. Sensitivity analysis showed more accurate judgements with laparoscopy in four of the five NSLAP causes, but only in two of the cases did this greater accuracy have clinical significance. Conclusions: Early laparoscopy did not show a clear benefit in women with NSLAP.

Objective: To observe the behavior of endometrial prolactin in hyper‐ and normoprolactinemic women. Method: Forty women were selected due to alterations in menstrual cycle and/or galactorrhea and/or sterility. Patients were divided into two groups: Group A, 19 hyperprolactinemic women; and Group B, 21 normoprolactinemic women. Their mean age was 28.3 years. Laboratory assessments were carried out in the initial follicular phase (days 3–9), initial luteal phase (days 15–21), and late luteal phase (days 22–29) in menstruating women (samples 1, 2 and 3, respectively). In the non‐menstruating women, samples were collected on days 1, 14 and 21 after the initial appointment (samples 1, 2 and 3, respectively). LH, FSH, prolactin and estradiol were measured in sample 1, while prolactin and progesterone were measured in samples 2 and 3. All women were submitted to two biopsies of the endometrium for observing the menstrual cycle, dating, and immunohistochemical detection of endometrial prolactin. Biopsies were obtained simultaneously to samples 2 and 3. To compare the two groups, Student's t‐tests or Mann–Whitney statistics were performed. Result: Results showed that the mean percentage of endometrial prolactin were higher in the late luteal phase compared to the initial one in hyper‐ and normoprolactinemic women. Conclusion: The data allowed us to conclude that serum prolactin is not correlated to endometrial prolactin, and that the synthesis of the latter is directly correlated to the differentiation of stromal cells, that is induced by progesterone in a decidualized endometrium.