Previous surveys of the prevalence and natural history of ovarian cysts have been based on those ascertained by clinical examination. This study examines the fate of 137 adnexal cysts discovered during the course of 26 110 ultrasound scans in early pregnancy. Of these 10% were operated on in the first instance, and a further 2% required operation during pregnancy for painful complications. In 3% cysts were removed at caesarean section or in the puerperium. Half the removed cysts were neoplastic including one low grade carcinoma. Of the 120 cysts treated conservatively, 89% could not be detected on ultrasound examination later in pregnancy. All cysts >8 cm should be removed, as should smaller cysts that are multilocular, thick-walled or semi-solid.
DiscussionThese findings show that ranitidine 150 mg at bedtime is superior to enprostil 35 tg at bedtime in preventing relapse of duodenal ulcer. The extreme differences in relapse rates were surprising because enprostil 35 [tg has been claimed to have antisecretory effects comparable'0 or superior" to those of cimetidine 600 mg. Relapse rates in the ranitidine group were comparable with rates reported in other recent trials.3 4By contrast, the relapse rates in the enprostil group were ofthe same magnitude as those described after placebo2 and similar to rates found in our population after treatment for duodenal ulcer healing." 21 Hence enprostil, which is also inferior to ranitidine for duodenal ulcer healing,'5 22 cannot be recommended for the prevention of ulcer relapse.The dose of enprostil used in this study inhibits acid secretion, and the therapeutic benefit, if any, is explicable by this effect rather than by any mythical "cytoprotection" which may be achieved at lower doses.'4 These results and our previous findings in studies on duodenal ulcer healing'5 and duodenal ulcer haemorrhage23 question the clinical relevance of promoting cytoprotective properties of prostaglandin analogues for duodenal ulcer treatment.We thank Mrs Rigmor Petersen for secretarial help; the staff of our endoscopy units for valuable support; and Syntex Inc, Palo Alto, California, for the study drugs.
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