Læknablaðið - 15.11.1982, Blaðsíða 45

LÆKNABLAÐIÐ
283
unar á pvagi voru kannaðar niðurstöður allra rútínu
þvagrannsókna, sem gerðar höfðu verið á Rann-
sóknastofu Landspítalans í maí 1977. Niðurstöður
dýfuprófa (dip-stix) og smásjárskoðunar voru bornar
saman, tíðni normal svara og afbrigðilegra fundin og
hún könnuð með tilliti til einstakra deilda. Helstu
niðurstöður: 40-50 % sýna frá konum eru menguð
flöguepitheli, 20-40 % sýna hafa sýkla og cylindra.
Normal gildi sýndust verulega hferri en álitið var á
rannsóknastofunni. Ræktunarbeiðnir byggjast ekki
á niðurstöðum smásjárskoðunar.
HVÍT BLÓÐKORN í PVAGI FUNDIN MEÐ
DÝFUPRÓFI (DIP-STIX)
Matthías Kjeld. Rannsóknastofa Landspítalans,
Hormóna- og Iyfjaeining.
Nýtt dýfupróf, sem finnur hvít blóðkorn (hv. blk) í
pvagi (10 hv. blk./ul) hefur verið próað af Boehrin-
ger-Mannheim. Próf petta byggir á sérhæfum ester-
asa á hv. blk. Dýfuprófið var borið saman við
smásjárskoðun á hv. blk. í pvagi. Geymslupol
pvagsýnanna var kannað við stofuhita og við 4-6° C.
Gott samræmi var milli dýfuprófs og smásjárskoð-
unar. Þvagsýnin poldu geymslu í a.m.k. 25 klst. við
stofuhita. Hér virðist pví um hentugt og handhægt
próf að ræða.
RECENT DEVELOPMENTS IN THE INVESTI-
GATION AND THERAPY OF INFERTILITY
Jorgen Starup. Afdeling YA, Rigshospitalet,
Kobenhavn.
I. Anovulation and corpus luteum insufficiency.
These endocrine disturbances are the main cause of
infertility in about 20 % of the cases. The prognosis
is very good, as about 70% of these patients will
conceive during treatment. The diagnosis is estab-
lished by means of a basal body temperature-curve
and repeated determinations of se-progesterone or
urinary pregnanediol, whereas endometrial biopsies
are of less importance. Determination of se-prolac-
tin should always be performed in these cases, but
also se-FSH and se-oestradiol may be of interest in
cases of amenorrhoea. Bromocryptine is the drug of
choice in all cases of hyperprolactinaemia, except
for the very few cases with an expansive pituitary
tumour. The normoprolactinaemic patients should,
however, be stimulated with clomiphene + hCG or
in more severe cases with human gonadotrophins.
The principles of these 3 treatments are explained.
II. Artificial insemination by donor (AID). Markedly
decreased semen quality is the main cause of
infertility in about 35 % of the cases, and unfortun-
ately the possibility of treating male infertility is still
rather limited. There has therefore been an increas-
ing interest for AID, and both frozen and fresh
semen has been used. During the period 1973-1980
we performed AID with fresh semen in 927 women,
but only 712 women completed the planned treat-
ment. Group I consisted of 582 women without any
demonstrable infertility factors. Group II comprised
98 women, who were stimulated either because of
anovulation or corpus luteum insufficiency, and
group III consisted of 32 women, in whom tubal
surgery had been performed prior to AID. The
pregnancy rate in the 3 groups was 57 %, 35 % and
28 %, respectively. In addition, the pregnancy rate
showed a pronounced decrease with age. The 376
pregnancies resulted in 316 (84 %) normal 'deliveries
at term, 4 sets of twins, 14 premature deliveries and
42 (11 %) spontaneous abortions.
III. Disturbances of the tubal function. Such distur-
bances are the main infertility factor in about 25 %
of all cases, and the prognosis of these patients is
worse than that of the already mentioned patients.
A thorough infertility investigation is absolutely
necessary for a reliable counselling of the couple
before the operation. The introduction of microsur-
gical technique has improved the results somewhat,
but the results of terminal salpingostomy are still
disappointing. The principles of microsurgery are
discussed. During the period 1974-1980 we have
performed tubal surgery this technique in 102
patients without any other infertility factors. 71
patients underwent their first tuboplasty, whereas
the remaining 31 patients were óperated on for the
second time. The pregnancy rate in group I was
59 % and the 42 pregnancies resulted in 31 (74 %)
live births, 6 (14 %) tubal pregnancies and 5 (12 %)
spontaneous abortions. The pregnancy rate in group
II was only 16 %, and the 5 pregnancies resulted in 3
live births, 1 tubal pregnancy and 1 spontaneous
abortions. The importance of using a microsurgical
technique for the first tuboplasty is therefore
stressed.
In cases of intractable tubal failure, pregnancy
has been achieved in a few cases in England and
Australia, using in vitro fertilization and subsequent
embryo transfer. I will briefly mention the steps in
the complicated procedure and show some of our
preliminary results.
INTERMITTENT REGIONAL INFUSION OF
PANCREATIC ADENOCARCINOMA - PHASE
I AND II, PILOT STUDY
Ásgeir Theodórs, Ronald M. Bukowski, James S.
Hewlett, Robert B. Livingston, James K. Weick og
Carl W. Groppe. Department of Hematology and
Medical Oncology, Cleveland Clinic Foundation,
Cleveland, Ohio 44106.
Nineteen patients with unresectable and metastatic
adenocarcinoma of the pancreas and ampulla of
Vater were treated with intermittent regional infu-
sion of the celiac axis with the combination of 5-