Accuracy of the preoperative diagnosis in 100 emergency laparoscopies performed due to acute abdomen in nonpregnant women

STUDY OBJECTIVE

To assess the validity of preoperative diagnosis in the emergency room in relation to the surgical diagnosis at laparoscopy.

DESIGN

Retrospective study (Canadian Task Force classification II-2).

SETTING

University-affiliated hospital.

PATIENTS

One hundred consecutive nonpregnant women who underwent emergency laparoscopy for acute abdomen between 1997 and 1999. Intervention. Emergency diagnostic laparoscopy.

MEASUREMENTS AND MAIN RESULTS

The preoperative diagnosis was confirmed by laparoscopy in 29 (44%) of 66 cases of ovarian torsion, 9 (82%) of 11 cases of ovarian cyst, and 12 (80%) of 15 cases of bleeding corpus luteum. Unsuspected diagnoses among nonconfirmed cases were ovarian cysts (24), adhesions (5), bleeding corpus luteum (3), degenerative myomas (3), pelvic inflammatory disease (2), and appendicitis (1). The preoperative diagnosis was confirmed by emergency laparoscopy in 56% of all patients. Diagnoses most likely to be predicted accurately were ovarian cysts and bleeding corpora lutea. Ovarian torsion was most difficult to diagnose preoperatively, as it was not confirmed during laparoscopy in over half patients. Ovarian cysts and adhesions were the most common unsuspected findings.

CONCLUSION

Patients and surgeons alike should be aware of difficulty making accurate preoperative diagnoses of acute gynecologic pathologies in the emergency room. (J Am Assoc Gynecol Laparosc 8(1):92-94, 2001)

A randomized prospective comparative study of general versus epidural anesthesia for transcervical hysteroscopic endometrial resection

OBJECTIVE

This study was undertaken to compare general versus epidural anesthesia during hysteroscopic endometrial resection for dysfunctional uterine bleeding.

STUDY DESIGN

In a prospective comparative study, 24 women with abnormal uterine bleeding that was unresponsive to conservative medical management were randomly assigned to undergo hysteroscopic endometrial resection with either general or epidural anesthesia.

RESULTS

The durations of the endometrial resection procedure were similar for women who had general and epidural anesthesia (28.3 +/- 4.2 minutes vs 27.5 +/- 5.4 minutes, respectively). However, there was a statistically significantly lower absorption of distention fluid in women who underwent the procedure with general rather than epidural anesthesia (380.8 +/- 158.2 mL vs 648.3 +/- 157.1 mL, respectively; P < .0005).

CONCLUSION

A significantly lower amount of glycine distention fluid was absorbed during endometrial resection in women who underwent the procedure with general rather than epidural anesthesia.

Sonographic and clinical characteristics of struma ovarii

Our objective was to evaluate the preoperative clinical, laboratory, and sonographic characteristics of struma ovarii in comparison to ovarian dermoid cysts. A retrospective review of gynecologic patients operated on for mature cystic teratoma over a 10 year period identified 12 cases of struma ovarii. These cases, combined with 4 additional cases from an earlier report, were the subject of this study. Results were compared to 32 cases of ovarian dermoid cysts. Ovarian struma ovarii occurred in 12 (4.8%) of 251 cases of ovarian dermoid cysts. Most patients were premenopausal, and the mean lesion diameter was 57.3 mm (range, 30-95 mm). Struma ovarii occurred more frequently (68.8%) in the right adnexa and was seen with a normal CA-125 level. Blood flow, assessed by Doppler ultrasonography, was located in the center of the lesion in all cases of struma ovarii. Rare cases were seen with elevated tumor markers and low resistance blood flow. With regard to dermoid cysts, blood flow had a higher resistive index. In addition, no blood flow could be detected from the center of the echoic lesion in dermoid cysts (P < 0.0001). In summary, it is difficult to distinguish between struma ovarii and dermoid cysts on the basis of their sonographic appearance. Nevertheless, Doppler flow may aid in the preoperative diagnosis of struma ovarii. Blood flow signals, detected from the center of the echoic lesion, and low resistance to flow may be more common in struma ovarii.

Management of women with polycystic ovary syndrome who experienced premature luteinization during clomiphene citrate treatment

OBJECTIVE

To determine the preferred treatment modality in patients with PCOS who experienced premature luteinization during CC treatment.

DESIGN

Prospective randomized study.

SETTING

Tertiary medical center.

PATIENTS

Twenty-two infertile women with PCOS demonstrating premature luteinization during at least two consecutive CC cycles.

INTERVENTIONS

Randomized induction of ovulation either with FSH alone or with GnRH agonist combined with FSH for a single treatment cycle.

MAIN OUTCOME MEASURES

Premature luteinization was defined as serum progesterone >1.5 ng/mL before hCG administration.

RESULTS

Premature luteinization occurred in eight of the 10 patients (80%) in group A and in two of the 12 patients in group B (16.6%). This result corresponds to the higher mean (+/-SD) progesterone level present in group A patients as compared to those in group B (2.0 +/- 1.2 ng/mL vs. 1.2 +/- 0.6 ng/mL, P=0.03). No pregnancies were achieved in group A, whereas the pregnancy rate per cycle observed in group B was 33.3% (4/12). On the day of hCG administration, the maximum mean (+/-SD) estradiol level was significantly lower (P<0.0001) in group A (210.6 +/- 37.9 pg/mL) than in group B (600.3 +/- 253.8 pg/mL). The treatment duration and the number of FSH ampules used did not differ between the groups.

CONCLUSIONS

Pituitary desensitization with GnRH analog in combination with FSH is superior to FSH-only treatment in PCOS patients who demonstrate premature luteinization during CC treatment.

Clinical, radiographic, and genetic evaluation of a novel form of autosomal-dominant oligodontia

A frameshift mutation recently identified within the paired domain of the transcription factor, PAX9, has been linked to a unique form of oligodontia in a single, multigenerational family (Stockton et al., 2000). We now describe the phenotypic and segregation analyses of this remarkable kindred, the initial approach taken to identify a candidate gene involved in this form of oligodontia, and the power of this single-family pedigree to generate significant linkage in a genome search. Of the 43 family members enrolled in this study, 21 individuals were affected with several congenitally missing permanent teeth. The pattern of inheritance of the oligodontia trait suggested the involvement of a single gene bearing a dominant mutation. To various degrees, affected members lacked permanent first, second, and third molars in all four quadrants. Several individuals with missing molars also lacked second premolars- most commonly, maxillary second premolars and mandibular central incisors. To the best of our knowledge, this pattern of non-syndromic, familial tooth agenesis has not been previously described in the literature. Since a missense mutation in the homeobox gene, MSX1, was previously linked to tooth agenesis in a single family lacking second premolars and third molars, we performed a mutational analysis of MSX1 by PCR. The absence of a mutation in exons 1 and 2 of MSX1 suggested that allelic mutations in the coding region of MSX1 are not associated with this phenotypically distinct form of oligodontia. Computer simulation of linkage analysis further proved that this pedigree alone was sufficient to generate a significant result for a total genome scan.

Anti-cardiolipin antibodies in fetal blood and amniotic fluid derived from patients with the anti-phospholipid syndrome

The aim of this study was to investigate whether, in patients with antiphospholipid syndrome, anticardiolipin antibodies pass from mother to offspring sera and amniotic fluid. Eleven patients with antiphospholipid syndrome (study group) and 11 healthy controls, matched by maternal and gestational age (control group) were prospectively examined for the presence of anticardiolipin antibodies in the cord blood during labour, and amniotic fluid during vaginal or Caesarean delivery. Three neonates (27.3%) in the study group had anticardiolipin antibodies in the cord blood, while none had them in the control group. Anticardiolipin antibodies were detected in the amniotic fluid in six (54.5%) of the study group pregnancies, compared with none in the control group. No adverse neonatal outcome was noted except for significantly lower (P < 0.0006) mean birth weight in the study group. Anticardiolipin antibodies can pass the placenta and be detected in fetal cord blood and amniotic fluid. This finding might be used in the future for the assessment of pregnancies with antiphospholipid syndrome.

The effect of increasing age on the outcome of hysteroscopic endometrial resection for management of dysfunctional uterine bleeding

STUDY OBJECTIVE

To determine the outcome of hysteroscopic endometrial resection for dysfunctional uterine bleeding according to women's age.

DESIGN

Long-term follow-up by telephone interview (Canadian Task Force classification II-2).

SETTING

University-affiliated medical center. Patients. One hundred sixty-nine women with abnormal uterine bleeding unresponsive to conservative medical management.

INTERVENTION

Hysteroscopic endometrial resection.

MEASUREMENTS AND MAIN RESULTS

Questionnaires were completed for 162 (95.9%) patients with mean +/- SD follow-up of 32 +/- 17 months. The frequency of postoperative complications was not related to age. After ablation, the rate of amenorrhea was significantly higher in 31 women age 50 years or older than in younger women (p <0.001), and also in 72 women age 45 to 49 than in 59 age 44 or less (p <0.05). Complete relief of dysmenorrhea was achieved significantly more often in women age 45 to 49 (p <0.005) and 50 or older (p <0.05) than in those age 44 or younger. Dissatisfaction with the outcome of endometrial resection was uncommon, but most frequent among women age 44 or younger (p <0.10). There was no difference in the proportion of women requiring second ablation or hysterectomy in any age group.

CONCLUSION

Significantly higher rates of amenorrhea and complete relief of dysmenorrhea after endometrial resection are achieved in older than in younger women.

Preferred treatment of infertile women older than 37 years of age who demonstrate premature luteinization in the first evaluation cycle

OBJECTIVE

To evaluate the efficacy of various treatments in abolishing premature luteinization in infertile women over 37 years old who are undergoing ovulation induction.

DESIGN

Prospective, nonrandomized study.

SETTING

Tertiary care medical clinic.

PATIENT(S)

Seventeen infertile women >37 years old in whom premature luteinization was detected during their evaluation (pretreatment) cycle.

INTERVENTION(S)

The patients underwent three consecutive treatment cycles with clomiphene citrate (group A), hMG (group B), and a GnRH agonist plus hMG (group C).

MAIN OUTCOME MEASURE(S)

Premature luteinization, defined as a progesterone/E2 ratio of >1 on the day of hCG administration.

RESULT(S)

Fifteen (88%) of the 17 patients in group A and 13 (76%) of the 17 patients in group B demonstrated premature luteinization. In contrast, only 1 (6%) of the 17 patients in group C had a progesterone/E2 ratio of >1 on the day of hCG administration. The mean (+/-SD) E2 level on the day of hCG administration was significantly higher in group C (1.236 +/- 772.7 pg/mL) than in group A (214.02 +/- 104.46 pg/mL) or group B (412.5 +/- 337 pg/mL).

CONCLUSION(S)

Pituitary desensitization with a GnRH agonist in conjunction with hMG may be of benefit for older infertile women who demonstrate early luteinization in their first evaluation cycle.

A randomized, prospective study of endometrial resection to prevent recurrent endometrial polyps in women with breast cancer receiving tamoxifen

STUDY OBJECTIVE

To assess the role of endometrial resection in preventing recurrence of tamoxifen-associated endometrial polyps in women with breast cancer.

DESIGN

Randomized, prospective study (Canadian Task Force classification I).

SETTING

Tertiary university-affiliated medical center.

PATIENTS

Twenty consecutive women (age range 43-61 yrs).

INTERVENTIONS

Hysteroscopic removal of tamoxifen-associated endometrial polyps with or without simultaneous resection of the endometrium.

MEASUREMENTS AND MAIN RESULTS

Patients were randomized to undergo (10 women) or not undergo (10) concomitant endometrial resection. They were followed for at least 18 months (range 18-24 mo), including transvaginal ultrasonography every 6 months and hysteroscopy when endometrial irregularity was noted. The main outcome variable was recurrence of endometrial polyps; occurrence of uterine bleeding was also noted. In women who underwent endometrial resection, only one had a 1 x 1-cm endometrial polyp diagnosed and removed during follow-up. Seven women remained amenorrheic, and three experienced spotting for a few days every month. In the control group, six women had recurrent endometrial polyps requiring hysteroscopic removal (two-tail Fisher's exact test p <0.06).

CONCLUSION

Recurrence of endometrial polyps, one of the most common problems in patients with breast cancer receiving long-term treatment with tamoxifen, may be reduced by performing endometrial resection at the time of hysteroscopic removal of polyps. The possible risk of occult endometrial cancer is yet to be determined. (J Am Assoc Gynecol Laparosc 6(3):285-288, 1999)

Laparoscopic detorsion allows sparing of the twisted ischemic adnexa

STUDY OBJECTIVE

To determine the safety and outcome of laparoscopic detorsion in the management of the twisted ischemic, hemorrhagic adnexa.

DESIGN

Retrospective chart review and prospective follow-up (Canadian Task Force classification II-2).

SETTING

University-affiliated hospital.

PATIENTS

Fifty-eight women with twisted black-bluish ischemic adnexa encountered at laparoscopy.

INTERVENTION

Laparoscopic detorsion with adnexal sparing.

MEASUREMENTS AND MAIN RESULTS

All patients had a benign immediate postoperative course. Transient temperature elevation occurred in seven women (12.1%). No signs of pelvic or systemic thromboembolism were detected in any patient. Long-term follow-up included transvaginal ultrasound, which revealed follicular development in the previously twisted adnexa in 54 women; normal macroscopic appearance at incidental subsequent surgery in 9; and in vitro fertilization with retrieval of oocytes from the previously twisted side in 4.

CONCLUSION

Laparoscopic detorsion of the twisted ischemic, hemorrhagic adnexa is a safe procedure with minimal postoperative morbidity and a potential for the ovary to recuperate fully with preservation of normal function. Laparoscopic adnexa-sparing procedures should be performed in place of traditional salpingo-oophorectomy in women with this disorder who desire future fertility. (J Am Assoc Gynecol Laparosc 6(2):139-143, 1999)

Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy

OBJECTIVE

To compare the outcome of pregnancy after operative laparoscopy or laparotomy for the management of adnexal pathology during pregnancy.

DESIGN

Retrospective comparative study.

SETTING

University tertiary care referral center for endoscopic surgery.

PATIENT(S)

Eighty-eight pregnant women who underwent 93 operations for suspected adnexal pathology at our institute. Laparoscopy was performed during the first trimester in 39 patients. The remaining 54 patients underwent laparotomy, 25 during the first trimester and 29 during the second trimester.

INTERVENTION(S)

Laparoscopy or laparotomy for the management of adnexal masses during pregnancy.

MAIN OUTCOME MEASURE(S)

Operative and postoperative maternal complications, miscarriage, congenital malformations, and newborn long-term outcome.

RESULT(S)

No operative or postoperative maternal complications occurred in the pregnant women who underwent laparoscopic surgery. In this group of 39 women, 5 women had a first-trimester miscarriage and 2 newborns had congenital malformations (hypospadias and cleft lip and palate). Two miscarriages occurred in the first-trimester laparotomy group, and 1 congenital malformation (transposition of the great vessels) was diagnosed in the second-trimester laparotomy group.

CONCLUSION(S)

Laparoscopic gynecologic surgery appears to be safe during pregnancy, although prospective controlled studies and national registries encompassing larger numbers of cases are needed.

Endometrial resectoscopic ablation in patients with menometrorrhagia as a side effect of anticoagulant therapy

OBJECTIVE

The study was conducted to examine the effect of endometrial ablation therapy for patients suffering from coagulation abnormalities and presenting with failed medical treatment for menometrorrhagia.

STUDY DESIGN

Eleven patients with a mean age of 42 years (range 39-45) and with coagulation disorders in whom medical therapy for abnormal uterine bleeding was unsuccessful, were treated by the ablation procedure under video monitoring. Complications, length of hospitalisation and long-term follow-up were noted. The age of the patients ranged from 39-45 years. Menstrual characteristics were scored, but blood loss before and after the procedure was not quantified.

RESULTS

Uterine fibroids were found in two patients. The duration of the ablation procedure was 20 min and was prolonged for 30 to 40 min when fibroids were diagnosed. During the operation, no excessive bleeding was noted in ten patients and postoperative recovery was rapid in all. After a one-year follow-up the overall satisfaction of the patients was high (10/11).

CONCLUSIONS

Our initial experience with a selected group of patients suffering from coagulation abnormalities is promising. Bearing in mind the risks of a major operation in this group of patients, endometrial ablation should be seriously considered.

Preoperative evaluation of cystic teratoma: what does color Doppler add?

The aim of this prospective study lasting 4 years was to develop a scoring system using clinical parameters, sonographic findings, and transvaginal color and pulsed Doppler impedance values for the preoperative recognition of cystic teratoma. A total of 887 benign and malignant adnexal masses, among which 102 were histologically proved to be cystic teratomas, were evaluated. Using morphological criteria, cystic teratoma was successfully predicted in 95 patients. The sensitivity and specificity of a morphological scoring system were 93.1% and 99.4%, respectively, while positive and negative predictive values were 95.0% and 99.1%. A scoring system using both morphology and vascular assessment demonstrated higher sensitivity and specificity (99.02%, 99.75%). The application of a scoring system combining morphology and vascularity improves the accuracy of diagnosing cystic teratoma and of separating this entity preoperatively from other benign and malignant ovarian conditions.

Operative laparoscopy for management of ectopic pregnancy in patients with hypovolemic shock

STUDY OBJECTIVE

To determine the safety of operative laparoscopy in the management of ectopic pregnancy in women with hypovolemic shock.

DESIGN

Retrospective chart review.

SETTING

University-affiliated hospital.

PATIENTS

Two hundred eleven women with tubal pregnancy, of whom 33 were suffering from hypovolemic shock, based on a combination of signs and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill.

INTERVENTION

Laparoscopic surgery.

MEASUREMENTS AND MAIN RESULTS

Mean +/- SEM intraabdominal blood loss was significantly (p <0.01) higher in women with hypovolemic shock, 1369 +/- 149 versus 114 +/- 14 ml. Blood transfusions were given to 88% and 0.5%, respectively (p <0. 01). Laparoscopic salpingectomy was performed in all hemodynamically compromised women compared with 87% of stable women. Conversion to laparotomy was required in three patients in the hypovolemic shock group and five in the stable group. All patients had an uncomplicated postoperative course and made a full recovery.

CONCLUSION

The availability of optimal anesthesia and advanced cardiovascular monitoring, and the ability to convert rapidly to laparotomy if required, allow safe performance of operative laparoscopic surgery in most women in hypovolemic shock. In fact, the superior exposure of laparoscopy, providing rapid diagnosis and control of the source of bleeding, makes it a highly suitable approach.

Kinetics and role of alpha 1-acid glycoprotein-dependent osmotic transport of water and ions in palmitoyl-L-oleoyl phosphatidylcholine liposomes

alpha 1-Acid glycoprotein isolated from human blood plasma is known to influence cell permeability, although the mechanisms of this process are unclear. Here, the glycoprotein effects on the permeability of osmotically stressed phospholipid liposomes are studied as a model of membrane permeability. Liposomes containing glycoprotein were found to be osmotically sensitive to water and chloride salts of some monovalent (Na+, K+) and bivalent (Mg2+, Ca2+) ions. The permeations of these substances were determined by light-scattering measurements of the volume changes in liposomes after mixing with hyperosmotic solutions of chloride salts. The time courses of scattered light were recorded by means of stopped-flow spectrophotometry. Two processes were studied: the fast water outflow from liposomes and slower ion permeations through the lipid membrane. The second order permeation rate constants were determined at different glycoprotein concentrations for both processes. Values from 66 to 250 x 10(3) for water outflow and 2-500 M-1 sec-1 for the different ion permeations were obtained in order to characterize the permeations of solutes across the lipid membrane. The apparent activation energies also were calculated between 18 and 33 degrees C. The mercurial sulphydryl reagent pCMBS inhibited the ion permeations in the slow phase. When pCMBS was present in this phase, higher activation energies were obtained, indicating more difficult permeations. An interpretation of these results is that membrane permeability is mediated by aqueous pores. Membrane selectivity to monovalent metal ions also was demonstrated, but no correlation was observed between the ion radius of the corresponding metal cation and permeation rate constants. The discovery of non-specific pores in liposomes containing glycoprotein shows that they can serve as vehicles for the water and ions in the processes of passive transport through lipid membranes.

Managing residual trophoblastic tissue. Hysteroscopy for directing curettage

OBJECTIVE

To describe our experience with selective removal of residual intrauterine trophoblastic tissue via hysteroscopy.

METHODS

This is a descriptive report. Eighteen patients, 16 postabortion and 2 postpartum, underwent a hysteroscopic procedure for removal of residual trophoblastic tissue causing continuous bleeding. At hysteroscopy, a cutting loop was used as a curette for selective removal of the adherent residual tissue, while interference with the rest of the endometrial surface was avoided.

RESULTS

Complete removal of the suspected residual tissue was achieved in all patients. Histology confirmed the curettings as trophoblastic remnants. No complications were reported during or immediately after the procedure. The median operative time was 10 minutes (range, 8-20). In all cases the bleeding stopped shortly after the procedure. In each patient, postoperative ultrasonography revealed a uterine cavity free of residual tissue. Five of the patients underwent second-look hysteroscopy several weeks later, and no signs of further residual tissue were observed.

CONCLUSION

Selective curettage of residual trophoblastic tissue directed by hysteroscopy is an easy and short procedure and might be preferable to conventional, nonselective, blind curettage.

Outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence

A retrospective, descriptive study was conducted to evaluate the outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence. Thirty-two women with singleton pregnancies were studied. All had undergone emergency cervical McDonald cerclage at 17 to 25 weeks' gestation because of cervical dilation and effacement. The procedure was carried out after a rest period of 6 or more hours, during which none of the patients demonstrated uterine activity. The mean procedure-to-delivery interval was 6.9 +/- 5.6 (median 5.5, range 0.2 to 18) weeks. Thirteen pregnancies (41%) terminated before 24 weeks. The mean gestational age at delivery was 28.5 +/- 5.8 weeks for the entire group, and 32.3 +/- 4.4 (range 25 to 38) weeks for the 19 who achieved viability. The mean birthweight of the live infants was 1935 +/- 958 g (median 1670, range 905 to 3710 g). Four infants died during the neonatal period. The total survival rate was 47%, and the survival rate corrected for major anomalies was 48.4%. The perinatal mortality rate was significantly higher among patients with membranes protruding through the-cervix on admission, compared to those without (75% vs 17%; p = .003). We concluded that emergency midtrimester cervical cerclage among patients with no prior evidence of cervical incompetence is associated with an approximately 50% survival rate. Membranes protruding through the dilated cervix are a poor prognostic factor for survival in these cases.

Dexamethasone as an adjuvant therapy for anovulatory, normoandrogenic patients during ovulation induction with exogenous gonadotropins

OBJECTIVE

The objective of our study was to explore the effect of dexamethasone (DEX), a highly potent, long-acting glucocorticoid, on the treatment outcome of 74 anovulatory women aged 21 to 29 years, with normal gonadotropins, androgen, and prolactin (PRL) serum levels who failed to conceive on antiestrogen therapy.

METHODS

The patients received human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) for ovulation induction. Starting on day 4 of the induced menstruation, hMG was administered in combination with DEX, 0.5 mg at night, or without DEX as an adjuvant treatment. The total amount of gonadotropins used, time required for stimulation, percentage of fertilization, serum estradiol levels, pregnancy rate, cumulative pregnancy rate, and abortions were recorded.

RESULTS

There were no differences in either the cumulative pregnancy rate (54.1% in the DEX group and 52.7% in the untreated group) or the abortion rates (21.7% in the DEX group compared to 20.8% in the untreated group). The other parameters investigated also did not differ significantly between the groups.

CONCLUSIONS

The overall results did not support DEX as a clinically useful adjuvant therapy for anovulatory, normoandrogenic patients.

The effect of intracervical vasopressin on the systemic absorption of glycine during hysteroscopic endometrial ablation

OBJECTIVE

To examine the effect of paracervical injection of vasopressin on the absorption of glycine during transcervical endometrial ablation.

METHODS

Thirty-three consecutive women scheduled for elective hysteroscopic endometrial ablation were randomized to either the study or control group. All procedures were performed with a myoma resectoscopy using 1.5% glycine as the irrigating medium at a flow rate of 100 mL/minute. In the study group, a solution of 0.2 mg vasopressin diluted with 20 mL saline was injected paracervically. Blood samples were obtained through an indwelling intravenous catheter every 5 minutes until the completion of the operation. Serum sodium, potassium, and magnesium levels were measured at 20-minute intervals. In addition, glycine concentrations were determined by both rapid screening and quantitative amino acid analysis.

RESULTS

Plasma glycine maximal concentrations were significantly lower (P < .001) in patients who received vasopressin, compared with controls (8.8 +/- 4.5 versus 16.0 +/- 6.3 mmol/L, respectively). The calculated extent of glycine absorption within the first 20 minutes of the procedure was 59.6 +/- 30.0 versus 179.8 +/- 66.2 mmol/L.minute in the study and control groups, respectively (P < .001). The differences in plasma sodium, potassium, and magnesium levels were not significant.

CONCLUSION

Intracervical vasopressin administration significantly decreased systemic glycine absorption in patients undergoing hysteroscopic endometrial ablation.