Halvard Gjønnæss

The course and outcome of pregnancy after ovarian electrocautery in women with polycystic ovarian syndrome: the influence of body-weight

Summary. In 89 women with polycystic ovary syndrome (PCOS) who conceived after ovarian electrocautery, the pregnancy continued beyond 31 weeks in 62. In this group the frequency of pre‐eclampsia and diabetes was 12·9 and 8·1% respectively. The increased frequencies were confined to overweight women. The frequency of major and minor malformations was 1% and 3·8% respectively. The rate of early miscarriage of the first pregnancy after ovarian electrocautery was 15%, and when later pregnancies were included the rate reduced to 10·3%. These data do not indicate any impact upon the course or outcome of pregnancy from the state of PCOS per se or the ovarian electrocautery that induced ovulation in this series.

Ovarian electrocautery in the treatment of women with polycystii ovary syndrome (PCOS): Factors affecting the results

During ihe years 1979-91 252 women with polycystic ovarian syndrome (PCOS) have been treated with ovarian electrocautery through the laparoscope in Aker University Hospital. Ovulation was obtained in 92% of the total series, and pregnancy in 84% of the women with PCOS as the sole cause of their infertility. Additional treatment with clomiphene citrate to the non-responders increased the pregnancy rate to 89% The response to ovarian electrocautery was inlluenced by body weight, with an ovulation rate of 96-97% in the slim and moderately obese women decreasing to 70% in the really obese ones. When ovulation was established. the pregnancy rate per se was independent of body weight - when ovulation was established. the pregnancy rates of slim and overweight women with PCOS being 92% and 95%, respectively. In the responders (who ovulated following ovarian electrocautery), the annual rate of cessation of ovulation was 3-4% only. Even after a period of contraceptive use following the ovarian electrocautery, ovul...During ihe years 1979‐91 252 women with polycystic ovarian syndrome (PCOS) have been treated with ovarian electrocautery through the laparoscope in Aker University Hospital. Ovulation was obtained in 92% of the total series, and pregnancy in 84% of the women with PCOS as the sole cause of their infertility. Additional treatment with clomiphene citrate to the non‐responders increased the pregnancy rate to 89% The response to ovarian electrocautery was inlluenced by body weight, with an ovulation rate of 96‐97% in the slim and moderately obese women decreasing to 70% in the really obese ones. When ovulation was established. the pregnancy rate per se was independent of body weight ‐ when ovulation was established. the pregnancy rates of slim and overweight women with PCOS being 92% and 95%, respectively. In the responders (who ovulated following ovarian electrocautery), the annual rate of cessation of ovulation was 3‐4% only. Even after a period of contraceptive use following the ovarian electrocautery, ovulation was resumed and pregnancy obtained within a few months. Therefore, ovarian electrocautery is proposed as the primary treatment in women with PCOS undergoing laparoscopy for any reason, infertility being a present, future oi hypothetical problem only. When, on the other hand, infertility is not an issue, PCOS per se constitutes no reason to perform laparoscopy.

Hormonal response to electrocautery of the ovary in patients with polycystic ovarian disease

Summary. Fifty‐eight women with polycystic ovarian syndrome (PCO) were treated with electrocautery of the ovarian capsule and then studied by hormone analysis for 12 months. In 72% ovulation appeared to occur within 4 weeks and in this group mean serum LH and FSH levels showed a statistically significant increase the day after electrocautery, followed by a gradual decline in LH lo a level significantly below the pretreatment value. No changes in LH and FSH were seen in those who did not ovulate. The mean levels of testosterone, androstenedione and dihydrotestosterone which were in the upper normal range or slightly above before treatment were significantly reduced after electrocautery. Serum oestradiol levels showed a significant increase after 1 week, when progesterone levels were still unchanged, suggesting that follicular development was already in progress. The mean serum level of sex hormone binding globulin was slightly below the normal range before treatment and then increased gradually. Endocrine responses to electrocautery were similar to those described previously after wedge resection. The simplicity of this treatment and the good response make it an attractive alternative for treating infertility associated with PCO.

Endocrine effects of ovarian electrocautery in patients with polycystic ovarian disease

Summary. The mechanism by which ovarian electrocautery induces regular ovulatory cycles was studied in 16 women with polycystic ovarian disease (PCO) and compared with 25 normal fertile women who were undergoing sterilization by tubal electrocautery. Gonadotrophins (LH and FSH), prolactin, androgens, oestrogens, 17‐hydroxy‐progesterone and progesterone were determined immediately before operation and 24 h later. Following the sampling of blood for these tests, 100 μg of gonadotrophin releasing hormone (GnRH) was given intravenously and the LH and FSH responses were measured at 30 min. In the PCO‐group, these tests were repeated after the first induced ovulatory cycle. After operation, LH increased only in the patients with PCO and this increase was associated with an enhanced response to GnRH, FSH showed a similar response to GnRH, also confined to the PCO‐group. These pituitary responses are best explained by a change in ovarian feedback induced by the direct electrocautery of the glands in the PCO‐group. There was little change in serum oestrogen. Prolactin showed an increment in all cases and serum androgens were reduced in all groups, most pronounced in the PCO patients, possibly as a result of the stress of operation. An ovarian factor—released or reduced by the electrocautery—seems to be responsible for the changes.

Comparison of ovarian electrocautery and oral contraceptives in the treatment of hyperandrogenism in women with polycystic ovary syndrome.

Background. Endocrine treatment of hyperandrogenism in women with polycystic ovary syndrome (PCOS) aims at reduction of androgens and increasing sex hormone binding globuline (SHBG), which are also side effects of ovarian electrocautery (OE) when used for induction of ovulation. Methods. Hormonal effects of ovarian electrocautery were compared with the effects of oral contraceptives (OC) containing desogestrel (DG) or cyproteron acetate (CPA). OCs were given to 18 women with PCOS as their sole treatment (group A) and to 23 women after the restoration of regular ovulatory cycling by ovarian electrocautery (group B). Results. Ovarian electrocautery induced ovulation and increased the concentration of estrogens and especially progesterone, while OC induced the opposite effects. In the androgens and SHBG the two treatments induced changes that were in the same direction, but OC treatment induced changes that exceeded those of OE. The concentration of SHBG increased from 27.9 to 127.7 nmol/L on OC treatment (Group A), compared with 37.2 to 44.9 after OE (Group B). The androgens decreased, for testosterone the decreases were 2.1 and 0.99 nmol/L, respectively, for androsterone 5.36 and 3 nmol/L, for dihydrotestosterone 0.12 and 0.1 nmol/L, and for DHEAS 3.28 and 1.8 umol/L. No further gain was obtained by the combination of the two treatments. Conclusions. Hyperandrogenism in women with PCOS can be effectively treated with OCs containing DG or CPA. In women with concurrent infertility, however, ovarian electrocautery can be recommended. The only indication for the combination of these two treatments is ambivalence with regard to the fertility after ovulation induction by OE. A temporary delay of ovulatory cycling with OC-treatment after OE has no negative impact upon the future fertility.

Doxycycline (Vibramycin®) in Pelvic Inflammatory Disease

Abstract. Using standardized laparoscopy technique, fluid was aspirated from the pouch of Douglas, from the Fallopian tubes and from ovarian cysts in 85 cases with clinical diagnosis of pelvic inflammatory disease (PID). The concentration of doxycycline in the aspirates was measured after oral ingestion of 200 mg of doxycycline (Vibramycin®). A therapeutic level was achieved in the tubes and in ovarian cysts within a few hours, and on continuation of the treatment these values followed the plasma concentration closely, still being within the therapeutic range 24 hours after the final dose. The clinical effect was excellent, 94% (60/64) of the cases with verified PID being cured by doxycycline.

The influence of pregnancy and contraceptive pills upon oxygen consumption during phagocytosis by human leukocytes.

Abstract. Oxygen consumption during phagocytosis by leukocytes was examined in pregnant women and women taking the contraceptive pill. In pregnancy, oxygen consumption during phagocytosis was increased, while oral contraception produced a decrease.

AMOXYCILLIN ABSORPTION AND PENETRATION IN PELVIC INFLAMMATORY DISEASE

Abstract. Five patients with pelvic inflammatory disease (PID) had thin polyethylene catheters introduced percutaneously through the abdominal wall into the pouch of Douglas for sampling of peritoneal fluid. At hourly intervals specimens were aspirated, simultaneously with the sampling of finger tip capillary blood. In both the concentration of amoxycillin was determined by the micromethod of Jailing et al (1972). One hour after the oral ingestion of 0.5 grams of amoxycillin, a therapeutic level was recorded in blood plasma, the peak level being achieved in 2 hours. The concentration of amoxycillin in the peritoneal fluid showed some delay, mainly in the cases with a thick purulent exsudate, but the peak levels were similar to those in blood plasma. After a single dose of 0.5 gram of amoxycillin, a therapeutic level was maintained in blood and in peritoneal fluid for 7‐8 hours. The drug was well tolerated and showed and excellent clinical effect.

Antibiotic Levels in Plasma and Peritoneal Fluid after Amoxycillin, Ampicillin, and Bacampicillin Treatment for Pelvic Inflammatory Disease

Abstract. Fifteen patients with pelvic inflammatory disease had a thin polyethylene catheter inserted through the abdominal wall into the pouch of Douglas for sampling of peritoneal fluid. At hourly intervals peritoneal fluid and capillary blood were collected. Five patients each received a single oral dose of either 0.5 g of ampicillin or amoxycillin, or 0.8 g of bacampicillin (approximately equimolar doses). The highest median peak plasma level was observed after bacampicillin. Bacampicillin also showed less variation in individual plasma concentration. The area below the plasma curve was similar for amoxycillin and bacampicillin, whereas that of ampicillin was significantly smaller (p<0.01). The rate of penetration into peritoneal fluid was slower for amoxycillin than for bacampicillin, even though the area below the peritoneal fluid curve was similar for the two drugs. Therapeutic levels were maintained for 5–8 hours, longer after amoxycillin than after bacampicillin.

Possibility of Immunodiagnosis in Ovarian Cancer

An antigenic material possibly associated with ovarian cancer has been demonstrated by the Ouchterlony technique in the sera from 42(66.7%) of 63 patients with primary ovarian malignancy of various histological types. It was more frequently found in the sera of preoperative patients in the later stages of the disease and those in relapse. Positive reactions could also be elicited from control sera of a very few persons without ovarian cancer. in none of the sera examined could the corresponding antibodies by demonstrated. The antigenic material was found to be an alpha2- or beta-glycoprotein on preliminary identification. There is an antigenic relationship between this material and fetal or normal adult ovaries. The possibility of immunodiagnosis of ovarian cancer is briefly discussed.