Donald E. Pittaway

The use of CA-125 in the diagnosis and management of endometriosis

CA-125, a cell-surface antigen, was measured by a radioimmunoassay in the serum of 414 women to determine its potential usefulness in the diagnosis and management of endometriosis. In women with minimal, mild, moderate, and severe endometriosis, the mean levels (+/- standard deviation) were 13.6 +/- 6.8, 22.8 +/- 15.5, 27 +/- 17, and 50 +/- 28 U/ml, respectively, and were significantly higher than mean levels (7.8 +/- 4.1) in 46 women with a normal laparoscopic examination. Higher mean CA-125 values also were observed in acute pelvic inflammatory disease, unexplained fertility, and pregnancy and during menstruation. The mean CA-125 value in women with treated endometriosis and a negative second-look laparoscopy was significantly lower than in women with untreated endometriosis. With the use of the 95% upper limit of 16 U/ml, the test had a sensitivity of 53% and specificity of 93%. The frequencies of elevated levels in minimal, mild, moderate, and severe endometriosis were 27%, 68%, 73%, and 100%, respectively. Changes in the CA-125 levels correlated with the clinical course of endometriosis in 37 of 44 (84%) women (P less than 0.001). The determination of CA-125 levels may assist in the evaluation and treatment of women with endometriosis.

Serum CA-125 antigen levels increase during menses

Serum CA-125 antigen levels were measured by radioimmunoassay before and during menses in women with and without endometriosis. Mean CA-125 levels were significantly increased in both groups during menses. Samples obtained during menses represent a potential source of elevated levels and false positive results.

Doubling times of human chorionic gonadotropin increase in early viable intrauterine pregnancies

Although the doubling time of serum human chorionic gonadotropin has been assumed to be constant in early viable intrauterine pregnancy (prior to 6 to 7 weeks after menses), the range has varied between 1.4 and 3.5 days in the literature. To evaluate this variability of the doubling time, the mean doubling times at different ranges of human chorionic gonadotropin concentrations were determined in 49 normal pregnancies, and the doubling times at different intervals of gestation from both the day of the basal body temperature shift and the last menstrual period. The data obtained from the three different methods indicate that the doubling time of human chorionic gonadotropin is not constant but rather increases with increasing human chorionic gonadotropin concentration or gestational age. In addition, statistical analysis of the semilogarithmic plots of serum human chorionic gonadotropin concentrations indicated that the exponential rate of increase of serum human chorionic gonadotropin significantly decreases with gestational age. Since serum human chorionic gonadotropin doubling times increase and the exponential rate decreases with gestational age, estimates of normal values should be established for small sampling ranges and/or short intervals of gestation.

Laparoscopic adnexectomy: A comparison with laparotomy

OBJECTIVEnOur purpose was to compare the newer technique of laparoscopic adnexal excision with conventional laparotomy.nnnDESIGNnWith the same entry criteria, a retrospective, consecutive series of 26 women who underwent adnexectomy by laparotomy was compared with a later prospective consecutive series of 64 women who had laparoscopic adnexectomy in a university referral practice. The two groups were similar in all characteristics examined. The ages of the women ranged from 18 to 70 years, but only two women were postmenopausal. Pelvic pain with or without an ovarian cystic mass was the surgical indication in 91% to 92% of the women. Seven women had a persistent adnexal cystic mass and one woman had a unilateral androgen-secreting ovary. Bipolar coagulation was the laparoscopic method used.nnnRESULTSnMedian operating time (88 vs 107 minutes), blood loss (72 vs 222 ml), days in the hospital (1 day vs 3 days), total costs (

Evaluation of early pregnancy by serial chorionic gonadotropin determinations: a comparison of methods by receiver operating characteristic curve analysis

4573 vs

Ovarian surgery in an infertility patient as an indication for a short-interval second-look laparoscopy: a preliminary study

6044), and recovery time (1 week vs 4 weeks) were significantly less with laparoscopic adnexectomy. There were no differences between the two techniques in major complications (one in each group), blood transfusions, adhesion formation, or the proportion of women noting improvement of pain symptoms.nnnCONCLUSIONnIn this preliminary assessment of laparoscopic adnexectomy, this surgical procedure offers significant advantages to laparotomy in selected patients when performed by a laparoscopist experienced in advanced techniques.

Effectiveness of laparoscopic varicocelectomy.

Two methods of evaluating early pregnancies by serial human chorionic gonadotropin (hCG) determinations were evaluated by receiver operating characteristic (ROC) curve analysis. The first method used normal values (mean and upper confidence limits) of the hCG doubling time (DT) determined by a linear regression analysis of hCG concentrations from 35 normal pregnancies during the first 42 postmenstrual days. In the second method, normal values were determined at multiple sampling ranges of hCG concentrations from 49 normal pregnancies. In the evaluation of 91 pregnancies of which 58 progressed to viability, 25 spontaneously aborted, and 8 were ectopic gestations, the ROC curves demonstrated that for any given false-positive rate, the use of multiple normal values of DT was more sensitive than the use of a single mean DT determined by linear regression analysis. The study indicates that a more precise definition of the normal values of the hCG-DT results in improved early detection of abnormal pregnancies.

Serum CA-125 in women with endometriosis and chronic pelvic pain.

The usefulness of a short-interval second-look laparoscopy (SLL) after ovarian surgery was examined. In 23 infertile women who had either bilateral wedge resection (BWR) of polycystic ovaries, an oophorocystectomy (OC), or resection of endometriomata (RE), adhesions were graded before and after surgery and before and after laparoscopic lysis for each ovary. At SLL, periovarian adhesions involving at least one ovary were observed in all women. Of the 22 women who wanted to become pregnant, 3 of 3 with BWR, 1 of 3 with OC, and 6 of 16 with RE conceived. In the women with residual adhesive disease in both or the only remaining adnexa after SLL, there were no pregnancies; whereas 67% of the women with at least one adnexa free of disease became pregnant (P = 0.005). This preliminary study indicates that ovarian surgery does result in significant adhesion formation and that SLL offers an opportunity to reassess the pelvis, to lyse adhesions, and to establish a postoperative prognosis.

Spironolactone in combination drug therapy for unresponsive hirsutism.

Laparoscopic varicocelectomy is a new technique which has been described in a limited number of clinical reports. We reviewed the results of 46 patients undergoing laparoscopic repair of 75 varicoceles over a two-year period to assess the effectiveness of this operative technique. The internal spermatic artery was preserved in 80 percent of the varicoceles and two arteries were present in 5 percent. Our ability to preserve the internal spermatic artery improved significantly with the use of the intraoperative Doppler probe after the first six months of performing this operation (p < 0.01). Nineteen infertile patients had a minimum follow-up of twelve months with seminal improvement in 68 percent and a pregnancy rate of 26 percent. Complications occurred in 2 patients (4%), inferior epigastric vessel bleeding in one, and genitofemoral nerve injury in the other. There was one persistent varicocele (1%). Our results with laparoscopic varicocelectomy are comparable with those reported with standard open surgical approaches.

Spontaneous abortions in women with endometriosis

Since serum CA-125 concentrations are increased in women with endometriosis, the authors evaluated CA-125 levels to determine whether this serum test would be useful in differentiating between pelvic pain due to endometriosis and other causes. During a 30-month period, 163 women who had had pelvic pain for at least 3 months had a CA-125 level obtained prior to surgery. Serum CA-125 was measured by an immunoradiometric assay. Of the 82 women with endometriosis, 66 (80%) had CA-125 concentrations greater than or equal to 16 U/ml (95% upper limit). The frequencies of elevated levels in minimal, mild, moderate, and severe endometriosis were 52, 86, 100, and 100%, respectively. Of the 81 women without endometriosis, 5 (6%) had elevated concentrations. With the use of serum CA-125 determinations for the detection of endometriosis, the sensitivity was 80%, the specificity was 94%, and the accuracy was 93% when the prevalence of endometriosis was 50%. The authors conclude that determination of CA-125 levels may assist in the evaluation and treatment of women with chronic pelvic pain.