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Between January 1984 and August 1991, 511 cases of extrauterine pregnancies were diagnosed by laparoscopy in our department. In 374 cases salpingectomy was performed: 184 by explorative laparotomy, and 190 by operative laparoscopy. Patients were scheduled for salpingectomy if one or more of the following criteria were fulfilled: (i) a ruptured tube which was surgically unsuitable for conservation; (ii) no interest in future fertility; (iii) tubes with ectopic gestation previously operated on; (iv) a previous tubal pregnancy on the same side, which was treated expectantly. Salpingectomy was performed via operative laparoscopy with bipolar diathermy forceps and laparoscopic scissors. Pregnancy rates, i.e. intra-uterine and repeat extra-uterine, were evaluated. The reproductive performance following salpingectomy did not differ significantly, whether by laparotomy or laparoscopy: the intra-uterine pregnancy rate was 78 and 64%, respectively and the repeat ectopic pregnancy rate was 12 and 6%, respectively. Salpingectomy via laparoscopy can be performed safely with a low incidence of complications, with subsequent reproductive performance comparable to laparotomy.

To study the effect of pregnancy on kidney function in patients with familial Mediterranean fever (FMF) with amyloidosis.A retrospective analysis relating kidney function at term to kidney function at conception and to blood pressure and colchicine treatment before and during pregnancy in 17 patients with 29 pregnancies found among more than 3000 patient files in our FMF clinic.Following pregnancy, 7 patients (24% of pregnancies) experienced a decline in renal function. Urine proteinor = 2 g/24 h at conception was present in all pregnancies which sustained deterioration in contrast to 6 of 22 which did not (p0.001). Serum creatinineor = 1.5 mg/dl at conception was present in 3 patients, all of whom experienced deterioration of renal function during pregnancy (p0.01). Neither colchicine dose nor elevated blood pressure correlated with status of renal function at term.Our findings suggest a possible deleterious effect of pregnancy on amyloid nephropathy and that this effect may be associated with more advanced renal disease at conception.

A case of parovarian serous tumor of borderline malignancy inadvertently found during cesarean section in a 27-year-old multigravida is reported. Seventeen months after diagnosis there is no clinical evidence of disease. The histologic appearance of the tumor was identical with that of tumors of ovarian origin, however, whether its biologic behavior is similar as well is not known.

Whether restoration of tubal function following conservative surgery for ectopic pregnancy was achieved can only be estimated in patients with a single tube. Between 1978 and 1983, 22 women with a tubal pregnancy in their single tube underwent conservative microsurgical treatment. In 18 women dorsal salpingotomy was performed, in 3 the tube was gently milked (squeezing the products of conception through the fimbria), and in 1 the segment containing the products of conception was excised and the tube anastomosed. Twenty-one patients desired pregnancy. The mean follow-up period was 21.4 months. Of the patients desiring pregnancy, 76% conceived. The intrauterine pregnancy rate was 47.6%, and the repeat ectopic pregnancy rate was 42.8%. This ectopic pregnancy rate was significantly higher than those quoted in recent literature. Although the study group was a very-high-risk group, restoration of tubal function was achieved in a high proportion of cases. The intrauterine pregnancy rate was high and higher than the best results available with in vitro fertilization and embryo transfer, which is the only treatment available after bilateral salpingectomy. Therefore, conservative surgery is definitely indicated in such patients despite the high incidence of repeat ectopic pregnancy.

Ciprofloxacin (Bay 0 09867) is a new quinolone carboxylic acid derivative which has a broad spectrum of antibacterial activity and is highly active against both gram-negative and gram-positive organisms (1). The high volume of distribution of ciprofloxacin (2 1/kg) suggests that it is distributed in both the intravascular and extravascular spaces (2).

Prenatal real-time ultrasonographic diagnosis of exophthalmus is presented. Diagnosis was made at the 35th week of gestation in a fetus of a patient affected with Crouzon syndrome (craniofacial dysotosis). Recognition of exophthalmus as a part of Crouzon syndrome and the easy visualization of the eye balls and palpebrae in the third trimester made the diagnosis possible.

A successful GnRH treatment for hypogonadotropic hypogonadism is described. A 40 year old infertile patient due to Kallmann's syndrome, associated with obesity and NIDDM, was treated with HCG (5,000 IU/week) for 8 years. In an attempt to induce spermatogenesis HMG (75 IU/daily) was added for 2 years. During the combined gonadotropin treatment semen analysis indicated an improvement from azoospermia to 2 x 10(6) sperm/ml. Since semen quality remained poor and obviously no pregnancy was achieved, the last regime was replaced by a pulsatile GnRH treatment (5 mcg/90 minutes). Following 6 months sperm count increased up to 15 x 10(6) associated with normal motility and morphology. Patient's wife conceived after the second intrauterine insemination and delivered a full term healthy baby.