ABSTRACT Objective: To evaluate the value of ovarian suppression by administration of combined oral contraceptives for two months followed by ovulation induction using a minimal stimulation protocol in patients who failed to ovulate in response to clomiphene citrate treatment. Design: Prospective, randomized observational study. Setting: Infertility clinic, Woman's Health Center, Assiut University. Materials and methods: Sixty patients with evidence of anovulation documented by transvaginal ultrasonographic monitoring were included in the study. Baseline serum levels of Follicle stimulating hormone, luteinising hormone and estradiol were estimated in all patients at study entry. Patients were equally divided into two groups. The study group was given low dose combined oral contraceptive pills for two cycles to induce hypothalamo-pituitary–ovarian suppression. In the third cycle, patients were given 100 mg clomiphene citrate daily from day 3-7 and a single dose of 150 IU highly purified human follicle stimulating hormone at day 9. When one leading follicle attained a diameter ≥18 mm, human chorionic gonadotropin 10,000 IU was given to trigger ovulation and then timed intercourse was advised. The second (control) group was given the same treatment without previous ovarian suppression. Follicle stimulating hormone, luteinising hormone and estradiol levels were measured in the study group before and after combined oral contraceptive administration. Follicular growth, ovulation, occurrence of pregnancy and hyper-stimulation syndrome were looked for in both groups. Clinical pregnancy was defined as positive gestational sac with positive fetal heart beat viewed by transvaginal ultrasound. Results: Follicle stimulating hormone, luteinising hormone and estradiol levels were significantly lower in the study group after two months of combined oral contraceptive treatment compared to pretreatment levels. Mono-ovulatory cycles and pregnancy rates were significantly higher in the study group. Conclusion: The use of combined oral contraceptive pills to induce ovarian suppression followed by clomiphene citrate, highly purified human follicle stimulating hormone and human chorionic gonadotropin treatment can induce ovulation among cases with chronic anovulation resistant to clomiphene citrate treatment.

ABSTRACT OBJECTIVE: To evaluate the effect of corticosteroids for the treatment of sever form of hyperemsis gravidarum. STUDY DESIGN: Patients with hyperemsis gravidarum not responding to outpatient therapy were enrolled in the study. Outpatient therapy is standardized as metoclopramide 10 mg every 6 hours. The treatment includes hospital admission and intravenous hydration with crystaloid. Cinventional treatment with metoclopramide 10 mg intravenously every 6 hours for 24 hours followed by the same regimen orally till discharge from hospital. The women are randomely adminstered, in a double blind fashion, methylprednisolone 125 mg followed by tapering regimen of oral prednisone or no further treatment. Patients were evaluated by clincal (duration of admission, nausea, vomiting, weight and hospital readmission) and laboratory data (liver function tests, renal function tests and electrolytes). RESULTS: Seventy women were enrolled in the study within a duration of about 1 year and 2 months divided into 2 groups (35 patients in each group). Patients in corticosteroids groups had significantly shorter duration in hospital stay, lower number of nausea & vomiting and better wieght gain than patient with no furteher treatment. CONCLUSION:Cortoicosteroids is of beneficial effect on patients with sever form of hyperemsis gravidarum with no known harmful effect on short regimen.

ABSTRACT OBJECTIVE: To evaluate the effect of corticosteroids for the treatment of sever form of hyperemsis gravidarum. STUDY DESIGN: Patients with hyperemsis gravidarum not responding to outpatient therapy were enrolled in the study. Outpatient therapy is standardized as metoclopramide 10 mg every 6 hours. The treatment includes hospital admission and intravenous hydration with crystaloid. Cinventional treatment with metoclopramide 10 mg intravenously every 6 hours for 24 hours followed by the same regimen orally till discharge from hospital. The women are randomely adminstered, in a double blind fashion, methylprednisolone 125 mg followed by tapering regimen of oral prednisone or no further treatment. Patients were evaluated by clincal (duration of admission, nausea, vomiting, weight and hospital readmission) and laboratory data (liver function tests, renal function tests and electrolytes). RESULTS: Seventy women were enrolled in the study within a duration of about 1 year and 2 months divided into 2 groups (35 patients in each group). Patients in corticosteroids groups had significantly shorter duration in hospital stay, lower number of nausea & vomiting and better wieght gain than patient with no furteher treatment. CONCLUSION:Cortoicosteroids is of beneficial effect on patients with sever form of hyperemsis gravidarum with no known harmful effect on short regimen.

ABSTRACT OBJECTIVE: To evaluate the effect of corticosteroids for the treatment of sever form of hyperemsis gravidarum. STUDY DESIGN: Patients with hyperemsis gravidarum not responding to outpatient therapy were enrolled in the study. Outpatient therapy is standardized as metoclopramide 10 mg every 6 hours. The treatment includes hospital admission and intravenous hydration with crystaloid. Cinventional treatment with metoclopramide 10 mg intravenously every 6 hours for 24 hours followed by the same regimen orally till discharge from hospital. The women are randomely adminstered, in a double blind fashion, methylprednisolone 125 mg followed by tapering regimen of oral prednisone or no further treatment. Patients were evaluated by clincal (duration of admission, nausea, vomiting, weight and hospital readmission) and laboratory data (liver function tests, renal function tests and electrolytes). RESULTS: Seventy women were enrolled in the study within a duration of about 1 year and 2 months divided into 2 groups (35 patients in each group). Patients in corticosteroids groups had significantly shorter duration in hospital stay, lower number of nausea & vomiting and better wieght gain than patient with no furteher treatment. CONCLUSION:Cortoicosteroids is of beneficial effect on patients with sever form of hyperemsis gravidarum with no known harmful effect on short regimen.

a b s t r a c t Study Objective: To report the existence and management of retroperitoneal functioning uterine horn in a case with unicornuate uterus and to emphasis the significance of its misdiagnosis. Study Design: Case report. Setting: Assiut University, Woman’s Health Hospital. Participants: An adolescent female with progressive pains related to menstruation. Interventions: Extraperitoneal resection of the obstructed uterine horn. Main Outcome Measure: Operative time, complications and postoperative pains. Results: A patient aged 11 years presented with severe lower abdominal pains, history of correction of ectopia vesicae in infancy, and recent history of nephrectomy for ipsilateral obstructed pelvic kidney. MRI and transrectal ultrasonography showed a pelvic mass with thick wall. Laparoscopy showed unicornuate uterus with only the left horn was being visualized. Hysteroscopy showed normal vagina and cervical canal communicating with normal left hemi-cavity. Extraperitoneal approach via extending the incision of previous nephrectomy was done under laparoscopic monitoring. Excision of the horn was done totally extraperitoneal without puncturing its covering parietal peritoneum within 65 min. No operative or postoperative complications were reported. Menstrual pains showed dramatic improvement after the procedure. Conclusions: The present report is the first to describe the existence of a retroperitoneal functioning uterine horn with description of a successful extraperitoneal approach for its excision. Nephrectomy in the present case might be attributed to misdiagnosis of this problem.

a b s t r a c t Study Objective: To report the existence and management of retroperitoneal functioning uterine horn in a case with unicornuate uterus and to emphasis the significance of its misdiagnosis. Study Design: Case report. Setting: Assiut University, Woman’s Health Hospital. Participants: An adolescent female with progressive pains related to menstruation. Interventions: Extraperitoneal resection of the obstructed uterine horn. Main Outcome Measure: Operative time, complications and postoperative pains. Results: A patient aged 11 years presented with severe lower abdominal pains, history of correction of ectopia vesicae in infancy, and recent history of nephrectomy for ipsilateral obstructed pelvic kidney. MRI and transrectal ultrasonography showed a pelvic mass with thick wall. Laparoscopy showed unicornuate uterus with only the left horn was being visualized. Hysteroscopy showed normal vagina and cervical canal communicating with normal left hemi-cavity. Extraperitoneal approach via extending the incision of previous nephrectomy was done under laparoscopic monitoring. Excision of the horn was done totally extraperitoneal without puncturing its covering parietal peritoneum within 65 min. No operative or postoperative complications were reported. Menstrual pains showed dramatic improvement after the procedure. Conclusions: The present report is the first to describe the existence of a retroperitoneal functioning uterine horn with description of a successful extraperitoneal approach for its excision. Nephrectomy in the present case might be attributed to misdiagnosis of this problem.

a b s t r a c t Study Objective: To report the existence and management of retroperitoneal functioning uterine horn in a case with unicornuate uterus and to emphasis the significance of its misdiagnosis. Study Design: Case report. Setting: Assiut University, Woman’s Health Hospital. Participants: An adolescent female with progressive pains related to menstruation. Interventions: Extraperitoneal resection of the obstructed uterine horn. Main Outcome Measure: Operative time, complications and postoperative pains. Results: A patient aged 11 years presented with severe lower abdominal pains, history of correction of ectopia vesicae in infancy, and recent history of nephrectomy for ipsilateral obstructed pelvic kidney. MRI and transrectal ultrasonography showed a pelvic mass with thick wall. Laparoscopy showed unicornuate uterus with only the left horn was being visualized. Hysteroscopy showed normal vagina and cervical canal communicating with normal left hemi-cavity. Extraperitoneal approach via extending the incision of previous nephrectomy was done under laparoscopic monitoring. Excision of the horn was done totally extraperitoneal without puncturing its covering parietal peritoneum within 65 min. No operative or postoperative complications were reported. Menstrual pains showed dramatic improvement after the procedure. Conclusions: The present report is the first to describe the existence of a retroperitoneal functioning uterine horn with description of a successful extraperitoneal approach for its excision. Nephrectomy in the present case might be attributed to misdiagnosis of this problem.

ABSTRACT OBJECTIVE: To evaluate peritoneal fluid hemosiderin-laden macrophages (H-LMs) in patients with endometriosis compared to controls. STUDY DESIGN: Consecutive series of 46 patients during a year undergoing laparoscopy for benign gynecologic conditions were included. The presence of H-LMs in peritoneal fluid was evaluated. We compared clinical factors in patients with or without endometriosis in respect to H-LM status. To assess the potential of H-LMs to diagnose endometriosis, the sensitivity and specificity were calculated. RESULTS: Patients with endometriosis were significantly more likely to have positive H-LM test results than controls (p = 0.0013). The presence of H-LM has a low sensitivity of 52% but an acceptable specificity of 87% in diagnosing endometriosis. The presence of H-LMs was not related with any other of the clinical factors studied. CONCLUSION: The presence of specific findings of H-LMs related to endometriosis strongly suggests abnormalities in peritoneal iron metabolism.

ABSTRACT OBJECTIVE: To evaluate peritoneal fluid hemosiderin-laden macrophages (H-LMs) in patients with endometriosis compared to controls. STUDY DESIGN: Consecutive series of 46 patients during a year undergoing laparoscopy for benign gynecologic conditions were included. The presence of H-LMs in peritoneal fluid was evaluated. We compared clinical factors in patients with or without endometriosis in respect to H-LM status. To assess the potential of H-LMs to diagnose endometriosis, the sensitivity and specificity were calculated. RESULTS: Patients with endometriosis were significantly more likely to have positive H-LM test results than controls (p = 0.0013). The presence of H-LM has a low sensitivity of 52% but an acceptable specificity of 87% in diagnosing endometriosis. The presence of H-LMs was not related with any other of the clinical factors studied. CONCLUSION: The presence of specific findings of H-LMs related to endometriosis strongly suggests abnormalities in peritoneal iron metabolism.

ABSTRACT OBJECTIVE: To evaluate peritoneal fluid hemosiderin-laden macrophages (H-LMs) in patients with endometriosis compared to controls. STUDY DESIGN: Consecutive series of 46 patients during a year undergoing laparoscopy for benign gynecologic conditions were included. The presence of H-LMs in peritoneal fluid was evaluated. We compared clinical factors in patients with or without endometriosis in respect to H-LM status. To assess the potential of H-LMs to diagnose endometriosis, the sensitivity and specificity were calculated. RESULTS: Patients with endometriosis were significantly more likely to have positive H-LM test results than controls (p = 0.0013). The presence of H-LM has a low sensitivity of 52% but an acceptable specificity of 87% in diagnosing endometriosis. The presence of H-LMs was not related with any other of the clinical factors studied. CONCLUSION: The presence of specific findings of H-LMs related to endometriosis strongly suggests abnormalities in peritoneal iron metabolism.