Ovarian Cyst Homeopathic Cure
Questions arise as to the importance of a pelvic ultrasound in the diagnosis of polycystic ovarian syndrome. This test can be nonspecific, in that women with normal androgens may have ovarian cysts and conversely, women with hyperan-drogenism and other findings associated with polycystic ovarian syndrome may not have ovarian cysts at the time of pelvic ultrasound. For this reason, the diagnosis of polycystic ovarian syndrome is more heavily based upon the serum hormonal profile and associated clinical findings.
Some authors advocate percutaneous aspiration with fluid analysis for viscosity, CA-125, carcinoembryonic antigen (CEA) and cytology. CA-125 and CEA levels have been found to be elevated in neoplastic cysts, and lower in pseudocysts (22). Cytologic analysis has an accuracy of approx 88 for mucinous cysts and its diagnostic value in serous cystadenomas appears to be limited (23).
Nonemergent surgery should be avoided to protect the developing fetus. If a procedure must be done, the second trimester is the safest time, avoiding organogenesis and minimizing the risk of preterm labor. Surgery during pregnancy increases perinatal mortality, and manipulation of the uterus should be minimized to decrease the risk of premature labor. The most common surgical condition during pregnancy is appendicitis, followed by torsion, rupture, or hemorrhage of ovarian cysts and cholecystectomy.
A particular form of malignant disease affecting pregnancy is that arising from the placenta itself (gestational trophoblastic neoplasia), comprising hydatiform mole, invasive mole, choriocarcinoma and placental site trophopbastic tumour. It is more common at the extremes of reproductive age, in the Far East and Asia and if previous pregnancies have been affected. The pregnancy itself is non-viable and concerns about the fetus do not apply. These tumours generally respond well to chemotherapy, even if metastatic spread has occurred, with a mortality of
In trophoblastic neoplastic disease, uterine evacuation may be adequate surgical management but hysterectomy may be required in more invasive disease, especially in older women. Surgery may also be required for torsion of, or haemorrhage into, ovarian cysts. Chemotherapy maybe required if human chorionic gonadotro-phin levels remain elevated or in metastatic disease. In terms of anaesthetic management, the above considerations should be taken into account and appropriate measures taken regarding investigation (including liver and thyroid function blood tests and chest radiography), monitoring and management. General anaesthesia is usually recommended since uterine bleeding may be rapid and severe, and blood should be cross-matched and ready before surgery.
Along these lines, SERMs such as tamoxifen 1 and raloxifene 2 have been clinically evaluated for the treatment of leiomyoma. Tamoxifen lacks sufficient efficacy to reduce tumor size in pre-menopausal women due, in part, to the uterine agonist characteristics exhibited by this SERM 28,29 . In addition, treatment with tamoxifen has resulted in ovarian cysts, an undesired side-effect that severely limits the use of this compound for the treatment of fibroids in ovulatory women. These stimulatory effects on the ovaries have been attributed to the inhibitory properties that tamoxifen has on the hypothalamic-pituitary-ovarian (HPO) axis, i.e., this SERM acts as an estrogen antagonist at the hypothalamus resulting in increased gonadotropin levels (luteinizing hormone, follicle-stimulating hormone) and, ultimately, in hyperstimulation of the ovaries. In fact, inhibition of the HPO axis by SERMs such as clomiphene has been clinically exploited to induce ovulation in women 30 .
Clomiphene is an oral synthetic triphenylethylene derivative with estrogen agonist antagonist characteristics (19). The clinically available preparations contain an approximate 3 2 mixture of two stereoisomers, enclomiphene and zuclomiphene, which show distinctly different patterns of agonistic and antagonistic activity in vitro (20). Clomiphene is metabolized in the liver, and its biological half-life is reported to be 5 days (21). The drug is contraindicated in patients with liver disease, endometrial carcinoma, undiagnosed abnormal uterine bleeding, ovarian cysts not rrelated to PCOS, and during pregnancy.
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