1478
been reported before, and the serum CA-125 values the highest recorded for endometriosis.3 The disease process resembled that of a malignant neoplasm, and malignancy in endometriosis is a well established event, arising in about 3-8 per thousand of cases.4,5 We did not have the success with GNRH agonist to reduce oestradiol secretion that has been reported in pelvic6 and extra-pelvic endometriosis.7 Bilateral salpingooophorectomy is recommended in severe cases and is the only successful treatment in the relief of pain in sciatic endometriosis,2 but in our patient this did not control the disease. are aware not are
of Obstetrics and
Department Leiden University Hospital,
Gynaecology,
2300 RC Leiden, Netherlands, and Departments of Surgery, Radiology, and Pathology, Leiden University Hospital
S. GUID OEI ALEX A. W. PETERS KEES WELVAART PAUL J. BODE GERT-JAN FLEUREN
RL, Niloff JM, Bast RC, Schaetzl E, Kistner RW, Knapp RC. Elevated concentrations of CA 125 in patients with advanced endometriosis. Fertil Steril 1986; 45: 630-34. 2. Hibbard J, Schreiber JR. Footdrop due to sciatic nerve endometriosis. Am J Obstet Gynecol 1984; 149: 800-01. 3. Check JH, Coates TE, Nowroozi K. Extreme elevation of serum CA-125 in two women with severe endometriosis. Gynecol Endocrinol 1991; 5: 217-20. 4. Brunson GL, Barclay DL, Sanders M, Araoz CA. Malignant extraovarian endometriosis: two case reports and a review of the literature. Gynecol Oncol 1988;
patients have now successfully completed this treatment (Hepatology, in press). In our experience, ursodeoxycholic acid is the only drug used in intrahepatic cholestasis of pregnancy that reduced itch and, at the same time, significantly diminished abnormalities in bile acid and ALT. Similar results in patients from different countries is further evidence of the efficacy of ursodeoxycholic acid in this disease. A randomised, double-blind, placebo-controlled study is now being done to verify these findings. Supported by Fondecyt, Chile (Grant 91-1107). Department of Medicine, Experimental Medicine, and Obstetrics, University of Chile School of Medicine, Hospital del Salvador, Santiago 9, Chile
JOAQUIN PALMA HUMBERTO REYES JOSE RIBALTA JOAQUIN IGLESIAS MANUEL GONZALEZ
1. Barbieri
serum
30: 123-30. 5. Hitti IF, Glasberg SS, Lubicz S. Clear cell carcinoma arising in extraovarian endometriosis: report of three cases and a review of the literature. Gynecol Oncol 1990; 39: 314-20 6. Editorial. LHRH analogues in endometriosis. Lancet 1986; ii: 1016-18. 7. Hellberg D, Fors B, Bergquist C. Renal endometriosis treated with a gonadotrophin releasing hormone agonist. Br J Obstet Gynaecol 1991; 98: 406-07.
Percutaneous needle decompression of small bowel SIR,-A 40-year-old woman presented with massive abdominal distension due to distal small-bowel obstruction a few years after subtotal colectomy. Shortly after admission she had cardiorespiratory arrest and resuscitative efforts were unsuccessful at first because massive abdominal distension impeded ventilation. We then recalled an ancient veterinary procedure in horses and a previous report of emergency percutaneous needle decompression of the stomach with gas bloat syndrome.’ We punctured the hugely distended small intestine with a 16G needle. As air emerged under pressure the abdomen flattened instantly and cardiorespiratory resuscitation was then successful. Subsequently, after small-bowel resection, the patient recovered uneventfully. DORON KOPELMAN ZEEV LOBERMAN MOSHE SCHEIN MOSHE HASHMONAI
Department of Surgery B, Rambam Medical Center, Haifa, Isreal 1. Ovnat A, Peiser J, Charusi I. Gas bloat syndrome.
Surgery 1983; 93: 725-26.
Management of intrahepatic cholestasis in pregnancy
SIR,-Ursodeoxycholic acid has been shown to be of benefit in a patient with intrahepatic cholestasis of pregnancy.1 Clinical and biochemical improvement with this bile acid has also been shown in patients with other cholestatic liver diseases, and this fact and the need to identify a drug that could improve cholestasis of pregnancy, a disease that endangers fetal prognosis, prompted us to start an open trial in carefully monitored inpatients with a well documented diagnosis of intrahepatic cholestasis of pregnancy. The results obtained in the first 6 patients were promising.2.3 Our patients received oral ursodeoxycholic acid, 1 g daily for 3 weeks. With only one exception, pruritus was clearly reduced and serum
concentrations of bile acids and alanine aminotransferase
(ALT) progressively fell (from 55 [SEM 15] to 12 [2] pmot/1, 226 [49] to 71 [22] U/l, p < 001, p
been reported before, and the serum CA-125 values the highest recorded for endometriosis.3 The disease process resembled that of a malignant neoplasm, and malignancy in endometriosis is a well established event, arising in about 3-8 per thousand of cases.4,5 We did not have the success with GNRH agonist to reduce oestradiol secretion that has been reported in pelvic6 and extra-pelvic endometriosis.7 Bilateral salpingooophorectomy is recommended in severe cases and is the only successful treatment in the relief of pain in sciatic endometriosis,2 but in our patient this did not control the disease. are aware not are
of Obstetrics and
Department Leiden University Hospital,
Gynaecology,
2300 RC Leiden, Netherlands, and Departments of Surgery, Radiology, and Pathology, Leiden University Hospital
S. GUID OEI ALEX A. W. PETERS KEES WELVAART PAUL J. BODE GERT-JAN FLEUREN
RL, Niloff JM, Bast RC, Schaetzl E, Kistner RW, Knapp RC. Elevated concentrations of CA 125 in patients with advanced endometriosis. Fertil Steril 1986; 45: 630-34. 2. Hibbard J, Schreiber JR. Footdrop due to sciatic nerve endometriosis. Am J Obstet Gynecol 1984; 149: 800-01. 3. Check JH, Coates TE, Nowroozi K. Extreme elevation of serum CA-125 in two women with severe endometriosis. Gynecol Endocrinol 1991; 5: 217-20. 4. Brunson GL, Barclay DL, Sanders M, Araoz CA. Malignant extraovarian endometriosis: two case reports and a review of the literature. Gynecol Oncol 1988;
patients have now successfully completed this treatment (Hepatology, in press). In our experience, ursodeoxycholic acid is the only drug used in intrahepatic cholestasis of pregnancy that reduced itch and, at the same time, significantly diminished abnormalities in bile acid and ALT. Similar results in patients from different countries is further evidence of the efficacy of ursodeoxycholic acid in this disease. A randomised, double-blind, placebo-controlled study is now being done to verify these findings. Supported by Fondecyt, Chile (Grant 91-1107). Department of Medicine, Experimental Medicine, and Obstetrics, University of Chile School of Medicine, Hospital del Salvador, Santiago 9, Chile
JOAQUIN PALMA HUMBERTO REYES JOSE RIBALTA JOAQUIN IGLESIAS MANUEL GONZALEZ
1. Barbieri
serum
30: 123-30. 5. Hitti IF, Glasberg SS, Lubicz S. Clear cell carcinoma arising in extraovarian endometriosis: report of three cases and a review of the literature. Gynecol Oncol 1990; 39: 314-20 6. Editorial. LHRH analogues in endometriosis. Lancet 1986; ii: 1016-18. 7. Hellberg D, Fors B, Bergquist C. Renal endometriosis treated with a gonadotrophin releasing hormone agonist. Br J Obstet Gynaecol 1991; 98: 406-07.
Percutaneous needle decompression of small bowel SIR,-A 40-year-old woman presented with massive abdominal distension due to distal small-bowel obstruction a few years after subtotal colectomy. Shortly after admission she had cardiorespiratory arrest and resuscitative efforts were unsuccessful at first because massive abdominal distension impeded ventilation. We then recalled an ancient veterinary procedure in horses and a previous report of emergency percutaneous needle decompression of the stomach with gas bloat syndrome.’ We punctured the hugely distended small intestine with a 16G needle. As air emerged under pressure the abdomen flattened instantly and cardiorespiratory resuscitation was then successful. Subsequently, after small-bowel resection, the patient recovered uneventfully. DORON KOPELMAN ZEEV LOBERMAN MOSHE SCHEIN MOSHE HASHMONAI
Department of Surgery B, Rambam Medical Center, Haifa, Isreal 1. Ovnat A, Peiser J, Charusi I. Gas bloat syndrome.
Surgery 1983; 93: 725-26.
Management of intrahepatic cholestasis in pregnancy
SIR,-Ursodeoxycholic acid has been shown to be of benefit in a patient with intrahepatic cholestasis of pregnancy.1 Clinical and biochemical improvement with this bile acid has also been shown in patients with other cholestatic liver diseases, and this fact and the need to identify a drug that could improve cholestasis of pregnancy, a disease that endangers fetal prognosis, prompted us to start an open trial in carefully monitored inpatients with a well documented diagnosis of intrahepatic cholestasis of pregnancy. The results obtained in the first 6 patients were promising.2.3 Our patients received oral ursodeoxycholic acid, 1 g daily for 3 weeks. With only one exception, pruritus was clearly reduced and serum
concentrations of bile acids and alanine aminotransferase
(ALT) progressively fell (from 55 [SEM 15] to 12 [2] pmot/1, 226 [49] to 71 [22] U/l, p < 001, p
