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Notes: Summary. Five women presenting with amenorrhoea (three with secondary amenorrhoea and galactorrhoea, and two with primary amenorrhoea) were shown to have suprasellar abnormalities by computed tomography. Organic hypothalamic disease was confirmed at surgery (craniopharyngioma in three, intra- and suprasellar Rathke's cleft cyst in one, aqueductal stenosis and suprasellar arachnoid cyst in one). Moderate hyperprolactinaemia was present in the first four, while the last had isolated gonadotrophin deficiency of hypothalamic origin. One o f the hyperprolactinaemic women had entirely normal residual pituitary function, visual fields and tomography of the sella. Two of the patient, with secondary amenorrhoea and galactorrhoea had resumption of menses during bromocriptine therapy before operation. Spontaneous menarche and subsequent pregnancy occurred after ventriculoatrial shunt in the girl with aqueduetal stenosis. Organic hypothalamic diseases may present with amenorrhoea (sometimes as the only symptom) more commonly than previously appreciated. Computed tomography should replace conventional tomography of the sella and should be an essential part of the clinical investigation in all patients with amenorrhoea of hypothalamo-pituitary origin.

Notes: Serum prolactin (PRL) was estimated for up to 2 months after discontinuation of therapy with either bromocriptine (n=33; 15 with idiopathic disease, 12 with pituitary microadenoma, and six with macro-adenoma) or metergoline (n=23; 11 with idiopathic disease, and 12 with microadenoma) that had been administered for 8–30 months. Only five patients treated with bromocriptine and two treated with metergoline had PRL levels that remained normal or below 50% of pretreatment values. Among the patients followed-up for up to 12 months, four showed a fall in PRL at 3–4 months, but this was followed by a rise in one patient. Five patients showing persistently lower or normal PRL after drug withdrawal were retested with thyrotrophin-releasing hormone; the two responsive women also had a normal response before treatment. Of 10 patients followed for 9 months, three had persistently normal PRL levels. Amenorrhoea and anovulation recurred, with some delay, in all the patients showing PRL rebound except one. Medical treatment of hyperprolactinaemia only rarely results in permanent benefit.

Notes: To investigate the left- and right-sided distribution of ovarian malignant surface epithelial tumours, data were collected on 209 women undergoing first-line surgery for Stage I and II disease. Considering the unilateral cancers, the observed proportion of left-sided lesions was 35/54 (65%) in the endometrioid, 20/45 (44%) in the serous, 19/35 (54%) in the clear cell, 13/29 (45%) in the mucinous, 2/8 (25%) in the mixed, and 2/5 (40%) in the undifferentiated histological type group. The proportion of left-sided unilateral endometrioid cancers was significantly different from the expected 50% (χ21, 4.74, P= 0.03) and very similar to that previously observed for benign endometriotic cysts, constituting further evidence in favour of a possible development of endometrioid cancers from the latter lesions.

Notes: Six cases of endometriosis obstructing the left ureter were observed among 1054 consecutive patients undergoing surgery in an eight-year period. In addition, 125 women with ureteral endometriosis (left-sided, n= 66; right-sided, n= 40; bilateral, n= 19) were described in 62 articles identified in a systematic review of the English language literature between 1980 and 1998. Considering only the patients with unilateral ureteral endometriosis and combining the published figures with those of our surgical series, the observed proportion of left lesions (72/112, 64%; 95% CI 55% to 73%) was significantly different from the expected proportion of 50% (χ2i, 9.14, P= 0.002). The lateral asymmetry found in the location of ureteral endometriosis is compatible with the menstrual reflux theory and with the anatomical differences of the left and right hemipelvis

Notes: To investigate the left- and right-sided distribution of nonendometriotic benign ovarian cysts, data were collected on 406 women undergoing first-line surgery for tumours with various histotypes. Considering the unilateral cysts, the observed proportion of left lesions was 65/129 (50.4%) in the serous, 38/79 (48.1%) in the mucinous, 59/134 (44.0%) in the dermoid, 11/21 (52.4%) in the parovarian, and 3/7 (42.9%) in the miscellaneous cysts group, without significant differences from the expected 50%. This contrasts with the finding of a significantly more frequent development of endometriomas on the left ovary, and suggests that the pathogenesis of endometriotic and nonendometriotic cysts is different.

Notes: Objective To ascertain whether the frequency of pelvic pain recurrence is reduced and time to symptoms recurrence is prolonged in women with symptomatic endometriosis undergoing conservative surgery and post-operative hormonal therapy compared with women treated with surgery only. Pregnancy rates and time to conception in women wanting children were also evaluated.Design A multicentre, prospective, randomised controlled study.Setting Nineteen Italian academic departments and teaching hospitals specialising in reparative and reconstructive surgery.Population A total of 269 women undergoing conservative surgery for mild to severe symptomatic endometriosis.Methods After surgery the women were assigned to treatment with subcutaneous goserelin depot injections for six months or to expectant management. Dysmenorrhoea, deep dyspareunia, nonmenstrual pain and general discomfort were graded according to a verbal rating scale from 0 (absent) to 3 (severe) and the scores summed to give a total symptoms score. Only patients with at least one preoperative moderate or severe symptom were enrolled. The women were evaluated regularly for two years.Main outcome measures Post-operative pain recurrences (total symptoms scores ≥ 5), time to recurrence, pregnancy rates and time to conception in the two study groups.Results At oneand two-year follow up visits, 14/107 (13.1%) and 19/81 (23.5%) patients had moderate or severe symptoms recurrence in the goserelin group compared with, respectively, 22/103 (21.4%) and 27/74 (36.5%) in the expectant management group (P= 0.143 at 1 year and 0.082 at 2 years). Time to symptoms recurrence was significantly longer in the goserelin group according to survival analysis (Wilcoxon test, P= 0.041). Among women wanting children, few conceptions occurred in both the goserelin (8/69, 11.6%) and the expectant management group (14/76, 18.4%). There was no significant difference at survival analysis (Wilcoxon test, P= 0.427).Conclusion Post-operative treatment with goserelin significantly prolonged the pain-free interval after conservative surgery for symptomatic endometriosis and did not influence reproductive prognosis.

Notes: Objective To investigate whether asymmetry exists in the left- and right-handed distribution of ovarian cystic lesions in a large series of women with endometriosis.Design Retrospective evaluation of a case series.Setting Tertiary care and referral academic centre for the study and treatment of endometriosis.Population A total of 1054 consecutive women undergoing first-line surgical treatment for endometriosis in an eight-year period.Methods Data were collected on indication for the intervention, age at surgery, parity and disease stage as well as side and size of ovarian endometriomas.Main outcome measure Frequency of left- and right-sided ovarian endometriomas.Results Histologically confirmed endometriotic ovarian cysts were present in 561 women, which were on the left side in 255 instances, on the right in 148, and bilateral in 158. In the patients with unilateral endometriomas, the observed proportion of left cysts (255/403, 63%; 95% confidence interval, 58% to 68%) was significantly different from the expected proportion of 50% (χ21, 28.41, P 〈 0.001). Including also the bilateral endometriotic cysts gave a total of 413/719 (57%) left-sided and 306/719 right-sided endometriomas. The magnitude of these proportions did not vary appreciably during the eight years considered. The difference in proportion of left- and right-sided endometriotic cysts was virtually similar in subgroups of women with different indications for surgery. Cyst side was not related to age, parity or cyst diameter.Conclusions The finding of a lateral asymmetry in the occurrence of ovarian endometriotic cysts is compatible with the anatomical differences of the left and right hemipelvis and supports the menstrual reflux theory.