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Endometriosis is a condition in which endometrial tissue, the cells lining the inside of the uterus, become implanted in other parts of the body. It can cause pain, bleeding and infertility. Although the disease is not well understood, it is thought that menstrual blood carrying endometrial cells flows backwards into the fallopian tubes and out into the abdominal cavity. Treatment is aimed at reducing the amount of the sex steroid hormone estrogen, which reduces the response of endometrial tissue. Danazol, a drug which blocks the production of the hormones, is used to treat patients with endometriosis. Gonadotropin-releasing hormone (GnRH) agonists, drugs which block the production of GnRH, have also been shown to be an effective treatment. A diagnosis of endometriosis was made in 62 infertile women, who were divided into two groups receiving either danazol or a GnRH agonist, buserelin. Reduction of estrogen was greatest in the group receiving buserelin. Laparoscopy, in which a small tube affixed with a magnifying lens is inserted into a surgical opening in the abdomen to visualize internal structures such as the uterus, fallopian tubes and peritoneal (abdominal) cavity, was used to evaluate treatments in 13 danazol-treated patients and 12 buserelin-treated patients. There were no differences between the two treatments at follow-up laparoscopic examination of the endometrial implants. Pregnancy was achieved in 48 percent of the infertile patients treated with buserelin and 43 percent treated with danazol. The pain of endometriosis returned after one year in 50 percent of the patients receiving either treatment. Fewer side effects were reported in the buserelin-treated group. The buserelin treatment was found to be as effective as danazol with respect to improved fertility.

The reproductive history of 19 women with a diagnosis of unicornuate uterus confirmed by laparoscopy or laparotomy is analyzed. The patients were followed for 2 to 10 years. One patient had a cavitary communicating rudimentary horn, four a cavitary noncommunicating rudimentary horn, seven a noncavitary rudimentary horn, and seven no rudimentary horn. Six of the patients presented with primary infertility. The other 13 women had a total of 29 pregnancies, 1 (3.4%) in a rudimentary horn determining rupture; abortions occurred in 17 (58.6%), premature labor in 3 (10.3%), and term births in 8 (27.6%), with a live birth rate of 38%. Of the 11 births, 6 (54.5%) were breech presentations, and 9 (81.8%) were cesarean sections. In five cases the rudimentary horn was removed, with associated salpingooophorectomy in three patients. Cervical cerclage was not performed in any of the patients.

Fourteen infertile women with hysterographic diagnoses of unicomuate uterus underwent pelvic ultrasonography and, subsequently, laparoscopy to evaluate the ability of ultrasound to diagnose the subclasses of this malformation. Seven women underwent laparotomy to remove a rudimentary horn. Ultrasound demonstrated a sensitivity of 85.7 and a specificity of 100 in diagnosing the presence of a rudimentary horn, and a sensitivity of 80 and a specificity of 100 in diagnosing the presence of a cavity in the rudimentary horn. Urography confirmed the supplementary information on the urinary tract provided by ultrasound. Ultrasound appears to have a role in the clinical management of women with unicornuate uterus.

From January 1973 to May 1974, 117 patients with ovarian carcinomas were evaluated with lymphography. The tumors were staged and classified histopathologically according to FIGO (1971). Considering all cases, lymphography showed nodal metastases in 44 patients (38%). Lymphography was positive in 36% of serous cystoadenocarcinomas, in 26 % of mucinous cystoadenocarcinomas, in 48 % of endometrioid carcinomas and in 36 % of unclassified carcinomas. Of the 10 cases not identified by cell type, lymphography was positive in 40 % of cases. In 68 % of cases bilateral involvement was found. The site of metastatic nodes was in 32 % of cases only in the iliac chains were both involved. Considering the single node chains we found 36 % of para-aortic, 27 % of common iliac, 35 % of external iliac and 2 % of inguinal involvement. Metastases were observed, regardless of histological type, in 25 % of cases in stage III, 62 % in stage IV, 54 % in recurrences and only in 5 % of cases in stage I. Therefore the lymphatic spread seems to occur in more advanced stages and in recurrences. In 28 of 117 patients node biopsy was performed. Histological-lymphographic correlation was correct in 7/7 positive cases and in 19/21 negative cases (93 %). These results show that lymphography is a reliable tool in the evaluation of ovarian cancer.

Thirty-nine infertile patients with laparoscopic diagnosis of endometriosis were allocated randomly to treatment with gestrinone 2.5 mg twice weekly (20 patients) or danazol 600 mg/day (19 patients) for 6 months. If amenorrhea was not obtained after 1 month of treatment, the gestrinone dose was increased to 2.5 mg three times a week (7 patients) and the danazol dose to 800 mg/day (2 patients). One month after the end of the treatment, a repeat laparoscopy was performed only in the women who agreed (7 of the gestrinone treated group, 9 of the danazol group). All of the patients were followed for at least 12 months after the end of the treatment, during which time they attempted to conceive. There was a marked improvement of pain symptoms during the treatment in the patients of both groups. The repeat laparoscopy did not reveal significant differences between the two groups in the reduction of the disease extent. Eighteen months after treatment suspension, the cumulative pregnancy rate was 33% in the patients treated with gestrinone and 40% in those treated with danazol. Pain symptoms recurred during the followup in 57% of the gestrinone and 53% of the danazol group. The side effects were more frequent and severe with the danazol treatment, whereas those caused by gestrinone were mostly weight gain and acne. The results of this study suggest that gestrinone is as effective as danazol in the treatment of infertility associated with endometriosis and is better tolerated.

Cancer that originates in the fallopian tubes is rare and occurs most frequently among postmenopausal women. The case of a 29-year-old woman with this cancer is reported. She underwent surgery due to infertility, and abnormal tubercular infection of the fallopian tubes was found. Cancer was diagnosed six months later, and her fallopian tubes were removed. Further treatment was not considered on the basis of a lack of cancerous cells in the washes of the abdominal cavity. One year later, biopsies were negative, and using eggs from the patient, she was treated with in vitro fertilization and embryo transfer. She was successfully delivered of a healthy infant, and remains negative for cancer. The study notes that fallopian tube carcinoma is associated with inflammatory processes such as tubercular infection. (Consumer Summary produced by Reliance Medical Information, Inc.)