[Quality of life in patients with advanced ovarian cancer who underwent cytoreductive surgery followed by chemotherapy]

The aim of this study was to determine the influence of cytoreductive surgery followed by chemotherapy on quality of life (QOL) in patients with advanced ovarian cancer. A total of 33 patients, who underwent the treatment after telling the truth and gave us the information on QOL 11 to 42 months after the discharge, were entered into the present study. Survival and length of hospital stay were calculated. QOL including emotional and physical well-being were assessed with a structure questionnaire which gives 110 points as full marks. The estimated 5-year survival rate was 49.6%. The mean survival time and length of hospital stay were 1,257 and 382 days, respectively. The mean QOL score was estimated to be 93.2. THe scores for both sociality and mentality showed a tendency to increase after completion of the treatment. Thirty-two of 33 cases (97.0%) obtained a good response for telling the truth. Alopecia and emesis due to chemotherapy were serious problems for patients. The present study showed that telling the truth was useful for well-informed consent and the QOL of patients with advanced ovarian cancer was not disturbed by cytoreductive surgery or chemotherapy.

The role of neoadjuvant intraarterial infusion chemotherapy with cisplatin and bleomycin for locally advanced cervical cancer

To clarify the effect of neoadjuvant intraarterial infusion chemotherapy on the cure rate in advanced cervical cancer with bulky tumor, a total of 50 patients were examined prospectively. The clinical stage according to the International Federation of Gynecology and Obstetrics (FIGO) classification included 23 IIb, 6 IIIa, and 21 IIIb. These patients were randomly divided into the neoadjuvant intraarterial infusion chemotherapy group and the control group. There were no significant differences in mean age, FIGO clinical stage, and tumor histology between groups. Twenty-five patients in the former group were given 25 mg/m2 of cisplatin and 15 mg/m2 of bleomycin via each internal iliac artery. If the results of the evaluation indicated that surgery was feasible, radical surgery was performed. The patients whose tumors were inoperable received radiation therapy consisting of external irradiation and intracavitary irradiation. Twenty-five patients in the control group also underwent the same radiation therapy. The overall response rate was 80.0%. Eighteen of 20 responders underwent surgery. The 3-year survival rate was 85.7% for operated patients, 42.9% for patients receiving neoadjuvant intraarterial infusion chemotherapy followed by irradiation, and 49.5% for the control group. In the present study, neoadjuvant intraarterial infusion chemotherapy did not improve the prognosis of patients with advanced cervical cancer compared to radiation therapy alone, and only responders who underwent surgery obtained an advantage in survival.

Altering the timing of human chorionic gonadotropin injection according to serum progesterone (P) concentrations improves embryo quality in cycles with subtle P rise

OBJECTIVE

To investigate the effect of earlier administration of hCG according to serum concentrations of P on the outcome of IVF-ET in cycles in which a subtle rise in serum P (1.0 to 2.0 ng/mL; conversion factor to SI unit, 3.180) occurred during the follicular phase.

DESIGN

Retrospective study.

PATIENTS

A total of 110 infertile women underwent 124 cycles of IVF-ET at Tottori University Hospital.

MAIN OUTCOME MEASURES

Serum was obtained daily or every 12 hours from day 7 until the administration of hCG. Serum E2 and P concentrations were measured by RIA. In 19 of 36 subtle P rise cycles, hCG injection was given when the levels of serum P exceeded 1.0 ng/mL ("rescued" subtle P rise). Parameters of IVF outcomes for the no P rise, the subtle P rise, and the rescued subtle P rise cycles were compared.

RESULTS

The mean day of hCG administration in the rescued cycles was 1 day earlier than those of the subtle P rise and no P rise cycles. The mean number of oocytes collected was significantly higher in the subtle P rise and rescued P rise cycles than in the no P rise cycles. The mean follicular diameter on the day of hCG administration was 13.9 mm in the rescued cycles, significantly smaller than those of the no P rise and subtle P rise cycles. However, there was no significant difference in the cleavage rates between the three groups. The rate of embryonic development beyond four-cell stage was increased significantly in the rescued cycles and no P rise cycles versus the subtle P rise cycles. Embryos obtained in the no P rise and rescued cycles were of better morphological quality than those obtained in the P rise cycles. The implantation rate was significantly higher in the rescued cycles than in the P rise cycles.

CONCLUSION

The data suggest that, if hCG is administered when a subtle P rise is detected, embryo quality and subsequent implantation rate can be improved.

The movements of fetuses with congenital myotonic dystrophy in utero

The movements in two fetuses with congenital myotonic dystrophy were recorded on fetal actocardiograms. The two fetuses showed gross movements associated with FHR accelerations as normal fetus. One of them showed swallowing on amniofetogram, and hiccuping on fetal actocardiogram. Both, however, were extremely hypotonic and neither displayed any gross movement, respiratory movement or swallowing postnatally. Intubation and nasal feeding were required for a long period of time after birth in both cases. The buoyancy of amniotic fluid may help the affected fetus to make gross movement in utero.

Platinum concentrations in uterus and serum after internal iliac arterial infusion of platinum compounds in rabbits

OBJECTIVE

To compare three platinum compounds, and study the pharmacokinetics of these compounds after systemic and intra-arterial infusion.

METHODS

Adult female rabbits received infusions of 1.7 mg/kg cisplatin, 10 mg/kg carboplatin, or 6 mg/kg cisdiammine(glycolato)platinum (254-S) via the internal iliac artery or jugular vein. The doses were equitoxic. Platinum tissue concentration in uterus and platinum serum levels were measured after internal iliac arterial or intravenous (i.v.) infusion with these platinum compounds.

RESULTS

Platinum uterine concentration after intra-arterial infusion was significantly higher than that after i.v. infusion for each drug (P < .05). The ratios of platinum uterine concentration after intra-arterial infusion to those after i.v. infusion were 2.24 for cisplatin, 1.83 for carboplatin, and 1.67 for 254-S measured 20 minutes after drug administration. The area under the curve of filtrated platinum (micrograms/mL.hours) was significantly lower for cisplatin compared with carboplatin and 254-S in both infusion methods (1.5 for cisplatin, 32.1 for carboplatin, and 16.0 for 254-S after i.v. administration, and 0.8, 30.9, and 15.2 after intra-arterial administration, respectively).

CONCLUSION

Cisplatin produced the highest ratio of uterine to serum concentration of platinum after intra-arterial infusion.

Reduced implantation rate associated with a subtle rise in serum progesterone concentration during the follicular phase of cycles stimulated with a combination of a gonadotrophin-releasing hormone agonist and gonadotrophin

Our objective was to assess the effects of subtle increases in serum progesterone concentration (1.0-2.0 ng/ml) on the outcome of in-vitro fertilization (IVF), particularly on the quality of embryos, during the follicular phase of cycles stimulated with gonadotrophin-releasing hormone agonist (GnRHa) and human menopausal gonadotrophin (HMG). A total of 97 patients underwent 116 cycles of IVF and were stimulated with a combination of HMG and GnRHa. They were divided into two groups: those with a subtle progesterone rise and those with no progesterone rise. The two groups were compared with respect to serum oestradiol, progesterone, immunoreactive luteinizing hormone (I-LH), bioactive LH (B-LH), and results of IVF. The groups did not differ significantly in mean age or in total dose of HMG received. On the day that human chorionic gonadotrophin was administered, concentrations of oestradiol and progesterone were significantly higher in the subtle progesterone rise cycles than in the no progesterone rise cycles. In the no progesterone rise cycles, the percentages for embryos beyond the 4-cell stage, grade 1 embryos, and implantation rates were significantly higher than those in subtle progesterone rise cycles. The combination of GnRHa and HMG eliminated any significant rise in serum I-LH or B-LH concentration during the follicular phase, but did not suppress the subtle rise in progesterone. These results confirm our previous finding that a subtle progesterone rise adversely affects the outcome of IVF. It is also suggested that a reduction in embryo quality may influence the lower rate of implantation in subtle progesterone rise cycles.

Lipoadenofibroma of the uterine corpus. Report of a new variant of adenofibroma (benign müllerian mixed tumor)

This report documents an uncommon case of uterine adenofibroma with a fatty component, for which the term lipoadenofibroma is proposed. Abdominal computed tomography and echography revealed a cystic submucosal lesion in the uterine corpus of a 67-year-old woman. Microscopically, the tumor was composed of benign epithelial cells of a proliferative-endometrial type and nonepithelial stromal cells. The latter mesenchymal elements contained scattered foci of mature adipose cells. The present case is considered to be a new variant of adenofibroma (benign müllerian mixed tumor) of the uterine corpus.

Effect of gonadotropin-releasing hormone agonists, nafarelin, buserelin, and leuprolide, on experimentally induced endometriosis in the rat

OBJECTIVE -- The purpose of this study was to compare the potency of the gonadotropin-releasing hormone (GnRH) agonists nafarelin, buserelin, and leuprolide in a newly developed model of experimental endometriosis, thus further characterizing the model. METHODS -- Endometriosis was induced in female rats by autotransplantation of endometrium to a site under the renal capsule. The effect of the GnRH agonists on explant volume and fluid accumulation was evaluated. Binding affinities of the compounds for GnRH receptors in pituitary homogenates of female rats was also measured. RESULTS -- The three GnRH agonists induced significant atrophy and regression of endometriosis. The volume of endometriosis in intact control was 26.1 +/- 4.7 cu.-mm (n = 13), 1.7 +/- 0.1 cu.-mm (n = 12) after therapy with nafarelin, 4.8 +/- 1.8 cu.- mm (n = 7) with buserelin, and 3.7 +/- 1.2 cu.-mm (n = 13) with leuprolide. The effects of these compounds were comparable to that of castration (1.9 +/- 0.5 cu.-mm; n = 10). There was no significant difference in the binding affinities of leuprolide and buserelin for pituitary GnRH receptors. CONCLUSION -- The model was found to be responsive to the GnRH agonist agents evaluated and could discriminate between dosage levels. Potency of the compound seems to correlate with binding affinity to pituitary GnRH

Quantitative analysis of endometrial stromal cells including behavioral changes related to the menstrual cycle in smear specimens

We aimed to obtain quantitative data regarding certain characteristics of stromal cells in smear specimens of normal endometrium, including the cytological changes associated with progression through the menstrual cycle. Eleven histological and 25 cytological specimens of normal endometrium were examined immunochemically using monoclonal antibodies to vimentin and keratin by streptavidin-biotin method. As a result, we decided to use the antibody to vimentin for the differential staining of endometrial smears: cells showing positive staining to vimentin were considered stromal cells. The quantitative nuclear measurements in the smear specimens revealed that the nuclei of endometrial stromal cells were more elongated and had a more dispersed distribution than the glandular cells in the proliferative phase. Although a part of the nuclei of stromal cells became rounder in shape in the secretory phase, they were larger in size than those of glandular cells.

Growth inhibition of uterine cervical cancer cells by a sequential administration of anticancer drugs and irradiation

We investigated the growth-inhibitory effects of anticancer drugs and irradiation in relation to the cell cycle of cervical cancer. Irradiation 0 and 24 h after cisplatin administration significantly decreased cell growth. The number of cells in the G0G1 phase decreased 0-24 h and recovered 48 h after cisplatin or bleomycin administration. The present study suggests that irradiation for cervical cancer is preferable when the cancer cells accumulate during the proliferation phase after administration of cisplatin combined with bleomycin.

Murine fibroblast growth factor receptor 1 gene generates multiple messenger RNAs containing two open reading frames via alternative splicing

The arrangement of exons and introns encoding 5'-side of murine fibroblast growth factor (FGF) receptor 1 (FGFR-1) gene was mapped. A large intron with a size of 14 kb was identified between exon 1 and exon 2. In addition, all FGFR-1 subtypes including a unique variant form with 12 amino acids insertion and two amino acids deletion were observed to be able to be generated through alternative splicing. Furthermore, complete sequencing of the 5'-region of FGFR-1 mRNA revealed that a relatively large open reading frame precedes the major open reading frame encoding FGFR-1. These results indicate that FGFR-1 mRNAs are uniquely translated from an internal translation start site.

Laparoscopic unwinding of adnexal torsion caused by ovarian hyperstimulation

A case of laparoscopic unwinding of a twisted enlarged ovary and Fallopian tube caused by ovarian hyperstimulation is presented. The laparoscopic unwinding was simple and was carried out in a short time. The patient's post-operative course was uneventful. Complications such as thromboembolism were not observed and the post-operative ovarian function was well preserved after such procedures. Preservation of the ovary is highly important in young infertile women. Prompt diagnosis with an immediate unwinding of the twisted adnexa by a laparoscopic technique can produce a valuable outcome.

Synergistic enhancement of cisplatin cytotoxicity by SN-38, an active metabolite of CPT-11, for cisplatin-resistant HeLa cells

A cisplatin (cis-diamminedichloroplatinum(II); CDDP)-resistant HeLa cell line (HeLa/CDDP cells), which showed more than 8-fold resistance to CDDP compared to the parent cells, was newly established for this study. HeLa/CDDP cells accumulated 50% less platinum than the parent cells. There was no difference in intracellular glutathione (GSH) content between the parent and HeLa/CDDP cells. The dose modification factor by DL-buthionine-S,R-sulfoximine (BSO) pretreatment was similar in both cell lines. HeLa/CDDP cells had cross-resistance to diammine(1,1-cyclobutanedicarboxylato)platinum(II) (CBDCA), (cis-diammine(glycolato)platinum (254-S), but not to (-)-(R)-2-aminomethylpyrrolidine(1,1-cyclobutanedicarboxylato++ +)platinum(II) (DWA2114R), adriamycin, or VP-16. HeLa/CDDP cells showed a collateral sensitivity to 7-ethyl-10-hydroxycamptothecin (SN-38), an active metabolite of 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin (CPT-11). Furthermore, isobologram analysis indicated synergistic interaction of CDDP and SN-38 only for HeLa/CDDP cells. The present study suggests that combination therapy with CDDP and CPT-11 may be potentially useful in the treatment of some patients with CDDP-resistant cancer.

Confocal scanning laser microscopy of morphometric human sperm parameters: correlation with acrosin profiles and fertilizing capacity

OBJECTIVES

To develop quantitative criteria for assessing sperm morphology and to determine the correlation between the percentage of morphologically normal spermatozoa and the outcome of the sperm hypo-osmotic swelling test, sperm acrosin profile, and sperm capacity for fertilization.

DESIGN

The maximal length and width of the sperm head, the length of the midpiece and principal piece of the sperm tail, and the ratio of the surface of the acrosomal region to the total surface of the head were determined in specimens obtained from a group of infertile men and a group of fertile men using a confocal scanning laser microscope. Group A consisted of 53 infertile men who were participating in an IVF program, and group B consisted of 98 fertile men. The mean +/- 2 SD of the morphometric parameters in group B was established as representing the lowest and highest normal values in both groups. A normal spermatozoon was defined as one with morphometric parameters within normal levels. The lowest percentage of morphologically normal spermatozoa, hypo-osmotic swelling test result, and acrosin activity in group B were also taken as the lowest normal values in group A.

SETTING

In vitro fertilization program at the Tottori University School of Medicine, Yonago, Japan.

MAIN OUTCOME MEASURES

Sperm morphometric parameters, percentage of morphologically normal spermatozoa, hypo-osmotic swelling test, and acrosin activity.

RESULTS

The length of the midpiece, ratio (x 100) of the surface of the acrosomal region to the total surface of the sperm head, percentage of morphologically normal spermatozoa, outcome of hypo-osmotic swelling test, and acrosin activity were significantly higher in group B than in group A. The maximal width of the head was significantly lower in group B than in group A. Strongly positive correlations were observed between percentage of morphologically normal spermatozoa or length of midpiece and the proportion of fertilized oocytes in group A and between ratio (x 100) of the surface of the acrosomal region to the total surface of the head and acrosin activity in groups A and B. Sperm morphology showed high positive and negative predictive values for acrosin activity (normal/abnormal) and fertility potential (present/absent).

CONCLUSIONS

Using quantitative strict criteria, we found that sperm morphology was an important predictor of sperm fertilizing capacity. The confocal scanning laser microscope provided useful information about the sperm cytoskeleton and its importance in fertilization.

Retroperitoneal lymphadenectomy, including the para-aortic nodes in patients with stage III ovarian cancer

The role of lymphadenectomy in patients with advanced ovarian cancer is controversial. To evaluate the effect of lymphadenectomy, we retrospectively assessed the outcome of 53 patients with stage III epithelial ovarian cancer who were divided into two groups, which were matched for age distribution and postoperative chemotherapy, but received different surgical procedures. A total of 29 patients (group A) underwent hysterectomy, bilateral salpingoophorectomy, omentectomy, and retroperitoneal lymphadenectomy, including resection of the para-aortic nodes. The remaining 24 patients (group B) received hysterectomy, bilateral salpingoophorectomy, and omentectomy without retroperitoneal lymphadenectomy. Postoperative chemotherapy consisted of a combination of cisplatin, Adriamycin, and cyclophosphamide in both groups. The 2-year survival rate for group A was significantly greater than that for group B, but there was no significant difference between the groups with regard to the estimated 5-year survival rate. The 2-year survival rate of patients with positive nodes who underwent lymphadenectomy was similar to that of patients with negative nodes. Multivariate analysis indicated that lymph node involvement did not relate to prognosis of the patients undergoing lymphadenectomy. While a defined randomized trial is required to reach substantive conclusion, it is suggested that lymphadenectomy may be useful for improvement of the prognosis of patients with advanced ovarian cancer.

The hypothalamic-pituitary-ovarian axis in patients with endometriosis is suppressed by leuprolide acetate but not by danazol

OBJECTIVE

To investigate the effects of leuprolide acetate (LA), a GnRH agonist (GnRH-a), and of danazol on the hypothalamic-pituitary-ovarian axis in patients with endometriosis.

DESIGN

Ten patients were divided into LA and danazol treatment groups.

MEASURES

Serum levels of E2, immunoreactive and bioactive LH, pulsatility of LH, and gonadotropins release by GnRH. Changes in serum E2 levels by hMG administration during LA treatment.

RESULTS

Serum E2 level decreased to near castrated levels during the LA treatment, while it remained unchanged during the danazol treatment. Leuprolide acetate administration resulted in a significant suppression of the serum level of bioactive LH, of the pulsatility of LH release, of the pituitary response to GnRH injection, and of the elevation in the serum E2 level by hMG administration, but danazol treatment did not show these suppressive effects.

CONCLUSION

Our results suggest that the hormonal actions of LA and danazol on endometriosis are different from each other, especially in the suppression of serum E2 level.

Transvaginal ultrasonographic diagnosis of bladder-wall invasion in patients with cervical cancer

OBJECTIVE

To evaluate the use of transvaginal ultrasonography for diagnosing invasion of the bladder by cervical cancer.

METHODS

Twenty-one women with stages Ib-IIIb cervical cancer underwent radical hysterectomy or staging laparotomy. All had computed tomography (CT) scans and cystoscopic examinations, and five also underwent magnetic resonance imaging (MRI). During transvaginal ultrasonography, a transvaginal transducer was inserted into the anterior fornix of the vagina and the bladder wall was studied in the sagittal plane. The moveability of the bladder wall was assessed by the ability of the bladder to slide along the uterine cervix when the probe was pushed up against the bladder from the anterior fornix. Moveability was considered to indicate an intact bladder wall.

RESULTS

The accuracy of transvaginal ultrasonography was superior to that of the other methods for detecting bladder-wall invasion by cervical cancer. The accuracy was 95% for transvaginal ultrasonography, 76% for CT, 86% for cystoscopy, and 80% for MRI.

CONCLUSION

Transvaginal ultrasonographic examination is useful for detecting invasion of the bladder wall by cervical cancer.

Assessment of functional integrity of frozen-thawed mouse embryos by albumin and leucine uptake

To assess the effects of freezing-thawing on metabolic functions of embryos prior to implantation, we measured the uptake of [125I]bovine serum albumin (BSA) and [3H]leucine in 2-cell mouse embryos, that were freshly collected (control), exposed to cryoprotectants (non-frozen), and frozen-thawed, and in morulae and blastocysts cultured from these 2-cell embryos. No significant difference in [125I]BSA uptake by 2-cell embryos was observed among the three groups. However, [125I]BSA uptake by blastocysts in the frozen-thawed group was significantly reduced compared with the control and non-frozen groups. [3H]leucine uptake by 2-cell embryos in the frozen-thawed and non-frozen groups was significantly less than in the control group. Fluorescein diacetate staining was performed in the control and frozen-thawed 2-cell embryos. The intensity of fluorescence after fluorescein diacetate exposure did not differ between the control and frozen-thawed embryos. The present study with mouse embryos suggests that freezing-thawing procedures impair the metabolic functions, in particular the membrane transport system, of embryos. Measurements of BSA and leucine uptake in embryos may be useful for evaluating the quality of frozen-thawed embryos.

Differentiation between physiologic and pathologic sinusoidal FHR pattern by fetal actocardiogram

Two cases of physiologic sinusoidal FHR pattern and one case of pathologic sinusoidal FHR pattern recorded on fetal actocardiograms are reported. The physiologic sinusoidal FHR patterns were recorded during periodic fetal respiratory movements and sucking movements. The physiologic sinusoidal FHR patterns were accompanied and synchronized with periodic fetal movement bursts. The pathologic sinusoidal FHR pattern observed in a case of severe fetal anemia due to massive fetal-to-maternal hemorrhage was not accompanied by any fetal movement bursts. It is suggested that with the use of fetal actocardiogram physiologic sinusoidal FHR pattern can be distinguished from pathologic sinusoidal FHR pattern.

Tumor DNA ploidy and prognosis of patients with serous cystadenocarcinoma of the ovary

BACKGROUND

Although it is important to determine any relationship between tumor DNA ploidy and its biologic behavior, the correlation between DNA ploidy and the prognosis of patients with ovarian cancer is not conclusive. Accordingly, the authors evaluated the clinical application of DNA ploidy in ovarian cancer.

METHODS

Flow cytometric measurements were performed in 45 selected patients with well-differentiated serous cystadenocarcinoma of the ovary, Stages Ic-IV. All of them had the same surgical procedure, with retroperitoneal lymphadenectomy including paraaortic nodes, followed by the same postoperative chemotherapeutic regimen.

RESULTS

Of the 45 ovarian cancers, 28 were diploid and 17 were aneuploid. The 2-year survival rate and the estimated 5-year survival rate for patients with diploid tumors were significantly greater than those for patients with aneuploid tumors (73.2% versus 46.7% and 29.1% versus 22.4%, respectively). The 2-year survival rate in patients with advanced disease (Stage III or IV) was also significantly higher for those with diploid tumors (53.3% versus 37.4%, respectively), but the estimated 5-year survival rate was similar in both groups (8.9% versus 9.1%, respectively). Patients with advanced disease had aneuploid tumors more frequently than those with early-stage disease. A significantly higher incidence of retroperitoneal lymph node metastasis was observed in aneuploid tumors than in diploid tumors (43.8% in diploid tumors versus 86.7% in aneuploid tumors). The authors found no difference in the response to chemotherapy between diploid and aneuploid tumors.

CONCLUSIONS

Although tumor DNA ploidy was not as reliable as conventional parameters such as surgical stage in establishing prognosis, it may provide an indicator of lymph node involvement.

Autocrine growth mechanism by transforming growth factor (TGF)-beta 1 and TGF-beta 1-receptor regulation by epidermal growth factor in a human endometrial cancer cell line IK-90

Transforming growth factor-beta 1 (TGF-beta 1) enhanced cell proliferation in a concentration-dependent manner in a human endometrial cancer cell line, IK-90. Scatchard analysis of TGF-beta 1 receptor in IK-90 cells, using 125I-TGF-beta 1 as a ligand, revealed the presence of a class of high-affinity TGF-beta 1 receptors (2,000 sites per cell, KD = 74pM). Moreover, IK-90 cells produced and secreted TGF-beta 1: TGF-beta 1 messenger RNA was detected at 2.5 and 4.0 kb by Northern-blot analysis using 32P-labeled TGF-beta 1 cDNA as a probe, and TGF-beta 1 activity in conditioned medium by the inhibition of 3H-thymidine uptake into CCl 64 mink lung epithelial cells. We investigated the regulation of TGF-beta 1 receptor by 4 kinds of growth factor: epidermal growth factor (EGF) but not TGF-beta 1, insulin or insulin-like growth factor-1 increased the level of TGF-beta 1 binding sites in a concentration- and time-dependent manner. These findings suggest that TGF-beta 1 may be a potential autocrine growth factor in a human endometrial cancer cell line IK-90 and that this autocrine mechanism may be affected by EGF.

Evaluation of cytoreductive surgery with lymphadenectomy including para-aortic nodes for advanced ovarian cancer

The prognosis of 84 patients with advanced ovarian cancer who received the same regimen of postoperative chemotherapy but who received different surgical procedures, was evaluated retrospectively. Of those patients, 41 underwent cytoreductive surgery with lymphadenectomy, including removal of the para-aortic nodes (group A). The other 43 patients received hysterectomy, bilateral salpingoophorectomy and omentectomy (group B). Overall the patients in group A showed a significantly greater survival than those in group B. The performance of lymphadenectomy in patients with positive nodes improves the prognosis to equal that of patients with negative nodes. It is suggested that cytoreductive surgery with lymphadenectomy may be useful for the improvement of the prognosis of patients with advanced ovarian cancer.

Tumor cell kinetics in elderly patients with cervical cancer

OBJECTIVE

To determine whether cell kinetics in cervical cancer differ by patient age.

METHODS

We analyzed specimens from 118 women who had been treated for cervical squamous cell carcinoma. In a preliminary study, labeling indices were determined in 16 patients using bromodeoxyuridine in vitro. Adjacent portions of the same specimens were analyzed by flow cytometry. Proliferation indices were calculated and compared with labeling indices for 12 diploid tumors. For the remaining 102 tumors, paraffin-embedded specimens were analyzed by flow cytometry to determine DNA ploidy and proliferation index. Using these findings, we examined the relationship between tumor cell kinetics and age.

RESULTS

There was a significant correlation between the labeling index and age (r = 0.86, P < .001) and a weak but statistically significant correlation between the proliferation index and the labeling index (r = 0.58, P < .05). The proportion of aneuploid tumors increased with age. The cutoff point of highest statistical significance was 65 years (P = .025). The proliferation index showed an age-dependent shift, and the cutoff point of highest statistical significance was also 65 years. Aneuploid tumors were more common in elderly patients aged 65 or more years. Proliferation indices were also significantly larger in the elderly patients (P < .005). Although stage III tumors were more common in the elderly, stage was not related to ploidy pattern or to proliferation index.

CONCLUSION

Tumor cell kinetics of cervical squamous cell carcinomas differ between elderly and younger women.

Effects of an inhibitor of adenylate cyclase on acrosome reaction induced by protein kinase C activators

To determine whether the adenylate cyclase and the protein kinase C pathways act independently to modulate the human sperm acrosome reaction, we studied the effects of 2'-O-methyladenosine (adenylate cyclase inhibitor) on acrosome reactions induced by protein kinase C activators (phorbol diesters and synthetic diacylglycerols) or an adenylate cyclase stimulator (forskolin:FR). Fifty aliquots of capacitated spermatozoa were divided into 5 groups (A, B, C, D, and E), each containing 10 samples. One control aliquot (CN) and five experimental aliquots (EX1, EX2, EX3, EX4, and EX5) were prepared from each sample. Phorbol 12-myristate, 13-acetate (PMA, 10 mumol/L), 4 beta-phorbol 12,13-didecanoate (PDD, 0.1 mumol/L), 1-oleoyl-2-acetyl-sn-glycerol (OAG, 50 mumol/L), 1,2-dioctanoyl-sn-glycerol (DOG, 50 mumol/L), or FR (10 mumol/L) was added to each of the experimental aliquots in groups A, B, C, D, and E, respectively. Increasing concentrations of 2'-O-methyladenosine were added to aliquots EX2, EX3, EX4, and EX5. After an incubation period of 25 min at 37 degrees C, it was found that the percentage of acrosome-reacted spermatozoa (%ARS) was significantly and dose-dependently decreased by 2'-O-methyladenosine concentrations of 1 mM or more. Within each group, the %ARS was significantly higher in EX1 aliquots than in CN aliquots. The reduction of acrosome reactions induced by protein kinase C activators by the adenylate cyclase inhibitor suggests that the protein kinase C pathway interacts with the adenylate cyclase pathway to modulate the human sperm acrosome reaction.

No inhibitory effects of danazol estrogen production by ovaries of hypophysectomized rats stimulated by gonadotropins

The effects of danazol on estrogen production by rat ovaries were investigated. Hypophysectomized immature female rats were injected daily with 2.5 or 5 IU of pregnant mare serum gonadotropin (PMS) and simultaneously daily given vehicle only or danazol (100 mg/kg body weight) for 14 days. Danazol did not decrease the activities of 3 beta-hydroxysteroid dehydrogenase, 17 alpha-hydroxylase, 17, 20-lyase and aromatase in the ovaries of rats stimulated by 5IU of PMS. Danazol also did not decrease the activities of 3 beta-hydroxysteroid dehydrogenase and aromatase, and the production of aromatizable androgens (androstenedione plus testosterone) from progesterone in the ovaries of rats stimulated by 2.5 IU of PMS. In accordance with these results, danazol did not reduce the level of estradiol-17 beta in the sera of rats stimulated by 2.5 and 5 IU of PMS. The present results suggest that danazol does not inhibit estrogen production by the rat ovary through its direct action on the ovary.

Involvement of the local immune response in a case of advanced cervical cancer in a patient with systemic lupus erythematosus

Although patients with systemic lupus erythematosus (SLE) have frequently accompanying malignancies, there are few documented cases in the literature of advanced cervical cancer patients with SLE. This report describes a case of advanced cervical cancer in a 39-year-old patient with a 20-year history of SLE (FIGO stage IIIb) and evaluates the immunological response of the tumor. The clinical course of this patient with SLE, with rapid growth of cervical cancer and a poor prognosis, may suggest that T cells play a key role in the growth of cancer.

Strangulated herniation through a defect of the broad ligament of the uterus

Among internal hernias, those through the foramen of Winslow are most commonly observed. The least frequently occurring is that through the broad ligament of the uterus. The present case presented with bowel strangulating obstruction due to a defect of the left broad ligament which could be diagnosed prior to laparotomy. The patient had no significant past history, and had symptoms of colicky pain, nausea, and vomiting. Emergency laparotomy was performed. Gangrenous ileum was resected, and a defect of the broad ligament was observed bilaterally. Past history in this case supported congenital defect of the broad ligament.

No inhibitory effects of gestrinone and medroxyprogesterone acetate on the estrogen production by ovaries of hypophysectomized rats stimulated by gonadotropins

The in vivo effects of gestrinone (R2323) and medroxyprogesterone acetate (MPA) on the estrogen production by rat ovaries were investigated. Hypophysectomized immature female rats treated with 2.5 or 5 IU of pregnant mare serum gonadotropin (PMS) were daily given vehicle only, gestrinone (0.5 mg/kg body weight) or MPA (10 mg/kg body weight), and the activities of 3 beta-hydroxysteroid dehydrogenase, 17 alpha-hydroxylase, 17, 20-lyase, 17 beta-hydroxysteroid dehydrogenase and aromatase in ovaries of these rats were measured. Gestrinone suppressed the 3 beta-hydroxysteroid dehydrogenase activity and increased activities of 17 alpha-hydroxylase, 17, 20-lyase and aromatase in ovaries stimulated by 5 IU of PMS, while MPA suppressed activities of 17 alpha-hydroxylase and aromatase in these ovaries. On the other hand, the aromatase activity in ovaries stimulated by 2.5 IU of PMS was suppressed by gestrinone and increased by MPA, and neither gestrinone nor MPA affected the production of aromatizable androgens from progesterone by these ovaries. Thus, gestrinone and MPA administrated in vivo showed divergent influences on steroidogenic enzyme activities in ovaries, but they did not affect the serum concentration of estradiol-17 beta. The present results suggest that neither gestrinone nor MPA reduced estrogen production by the rat ovary under the gonadotropin stimulation although they influenced some process of its steroidogenesis.

Measurement of uptake and incorporation of nucleic acid precursors by preimplantation mouse embryos after development in vivo and in vitro

PURPOSE

To assay DNA and RNA synthesis by developing mouse embryos in vitro and in vivo, we measured the uptake and incorporation of 3H-thymidine and 3H-uridine by morulae and blastocysts. We also evaluated the effect of adding EDTA to the culture medium on the uptake and incorporation of nucleic acid precursors by blastocysts.

RESULTS

Thymidine and uridine incorporation increased after morulae developed into early blastocysts both in vitro and in vivo. However, the rates of uptake and incorporation were significantly lower by embryos grown in vitro than by those grown in vivo. The ratios of incorporation to total uptake were similar in embryos grown in vitro and in vivo. EDTA (100 microM) added to the culture medium significantly increased the incorporation of uridine into RNA by blastocysts grown in vitro (P < 0.01) but did not increase the total uptake of uridine.

CONCLUSION

These observations showed that both DNA and RNA synthesis increased during the early development of preimplantation embryos and that those activities were reduced in embryos undergoing development in vitro. The results also suggested that through the mechanism of EDTA effect in embryo culture remains unknown, it appeared to reduce the retardation of RNA synthesis by embryos cultured in vitro through a selective stimulation of uridine incorporation.

Response rate and cell-cycle changes due to intra-arterial infusion chemotherapy with cisplatin and bleomycin for locally recurrent uterine cervical cancer

Intra-arterial infusion with cisplatin (CDDP) and bleomycin (BLM) was carried out in 21 patients with locally recurrent uterine cervical cancer who were previously treated with irradiation alone. Patients were treated with a bolus infusion into both internal iliac arteries of 50 mg/m2 of CDDP and 30 mg/m2 of BLM. Two to four courses of the infusion therapy were given to each patient, and the response rate, the tumor and serum drug concentrations, and the cell kinetics in tumor tissue were evaluated. The response rate (CR+PR) was 71.4% according to the WHO criteria. There was no difference, in the tumor tissue concentrations of CDDP and BLM between responders and nonresponders. Although the DNA ploidy of tumor cells was not significantly different between the two groups before treatment, both the labeling index with BrdU and the proliferation index with flow cytometry significantly increased 24 hours after treatment in responding tumors but not in nonresponding tumors. These results show that intra-arterial infusion with CDDP and BLM improves the prognosis of recurrent cervical cancer and that labeling and proliferation indices may be useful for determining the response of cervical cancer to intra-arterial chemotherapy.

The importance of the hypoosmotic swelling test and acrosin activity assay for identifying subpopulations of idiopathic infertile men

Semen samples collected from fertile donors (n = 13) and pooled samples from idiopathic infertile men (n = 19) were used in this study. Measurements of the total sperm acrosin activity and the hypoosmotic swelling test (HOST) were performed in all the samples. The percentage of swollen spermatozoa and acrosin profiles were significantly lower in the infertile men than in the fertile donors. Considering the lowest values of the outcome of the HOST and the acrosin activity assay in the group of fertile men as the lowest normal values, it was proven that HOST and acrosin activity assay could identify subpopulations of infertile men of 37 and 26%, respectively. The results tend to support the employment of the HOST and the acrosin activity assay in the evaluation of idiopathic infertile men.

Evaluation of measurement of fetal crown-rump length from ultrasonically timed ovulation and fertilization in vitro

To assess with accuracy the development and maturity of the fetus, we evaluated fetal growth in 46 pregnant women who had conceived subsequent to ultrasonically timed ovulation. Fetal crown-rump length (CRL) was measured at gestational ages that differed by about 1 day from those previously reported. The variance in CRL measurements at each gestational age was small, and the data were normally distributed. The CRL growth curves of this and previous studies were tested using measurements from 7 pregnancies derived from in vitro fertilization (IVF). The data from IVF pregnancies were consistent with our curve, having 1 day difference to those previously reported. The gender of the fetus did not influence the CRL during the first trimester. The results suggest that fetal growth is uniform during the first trimester.

Subtle rise in serum progesterone during the follicular phase as a predictor of the outcome of in vitro fertilization

OBJECTIVE

To investigate the effects of subtle rises in serum progesterone (P) during the follicular phase on the outcome of in vitro fertilization and embryo transfer (IVF-ET).

DESIGN, PATIENTS

One hundred one patients underwent IVF-ET for 170 cycles and were stimulated with a combination of clomiphene citrate and human menopausal gonadotropin. Based on their hormonal data, we divided the patients into two groups: those who had a cycle with an increase in serum P concentration (1.0 to 2.0 ng/mL) that was not associated with a pituitary LH release (subtle P rise) and those who had a cycle without any increase in serum P concentration (no P rise).

MAIN OUTCOME MEASURES

The daily serum estradiol (E2) concentration and the results of IVF-ET (number of developed and collected oocytes, rates of mature oocytes, fertilization, and pregnancy) were compared between the two groups.

RESULTS

Subtle P rises were observed in 31.7% (32/101) of the patients and 20.5% (36/170) of the cycles evaluated during the IVF-ET programs. A significantly higher serum E2 concentration (P less than 0.001) and a greater number of developed and collected oocytes (P less than 0.001 and P less than 0.05, respectively) also were observed in those cycles with a subtle P rise. The rates of mature oocyte formation and fertilization were significantly lower in cycles with a subtle P rise (P less than 0.001 and P less than 0.05, respectively). A lower pregnancy rate was observed in cycles with a subtle P rise, and all 12 ongoing pregnancies occurred only in cycles with a no P rise.

CONCLUSION

These results suggest that the development of an increased number of follicles may not necessarily improve the outcome of IVF-ET and that the measurement of serum P may be a better predictor for successful pregnancy.

Luteinized unruptured follicle in the early stages of endometriosis as a cause of unexplained infertility

OBJECTIVE

We attempted to clarify the relationship between luteinized unruptured follicle, which occurs in the early stages of endometriosis, and unexplained infertility.

STUDY DESIGN

Seventy patients who had unexplained infertility were reviewed.

RESULTS

Laparoscopic examination showed that 47 patients (67%) had endometriosis; of these, 40 (85%) had minimal or mild disease. The incidence of luteinized unruptured follicle was higher (p < 0.05) in patients who had endometriosis (35%/patient and 25%/cycle) compared with patients who did not have endometriosis (11%/patient and 7%/cycle). Degenerated oocyte cumuli were collected in 6 (43%) of 14 luteinized unruptured follicles diagnosed by transvaginal ultrasound.

CONCLUSIONS

These results show that luteinized unruptured follicle is common in patients who have mild or minimal endometriosis and that it may be one of the causes of endometriosis-associated infertility. Transvaginal ultrasound-guided follicular puncture of luteinized unruptured follicle during the mid luteal phase may be useful in establishing a definitive diagnosis of luteinized unruptured follicle.

Inhibitory effect of medroxyprogesterone acetate on angiogenesis induced by human endometrial cancer

OBJECTIVE

The purpose of this study was to investigate the effect of medroxyprogesterone acetate on angiogenesis induced by endometrial cancer and to elucidate the possible mechanisms by which it inhibits the growth of the cancer.

STUDY DESIGN

Tumors were obtained from 29 patients with endometrial adenocarcinoma, and angiogenesis was assayed in corneas of white rabbits.

RESULTS

Transplantation of tumor tissues into rabbit corneas induced angiogenesis in 70.4% of the corneas, but their transplantation with a pellet of medroxyprogesterone acetate induced angiogenesis in only 21.5% of the corneas. This compound also inhibited angiogenesis induced by acidic fibroblast growth factor and transforming growth factor-alpha.

CONCLUSION

Inhibition of angiogenesis may be one mechanism by which medroxyprogesterone acetate inhibits the growth of endometrial adenocarcinoma, and its inhibition of neovascularization induced by adenocarcinoma may be through its direct action on endothelial cells.

Acrosin profiles of human spermatozoa recovered from the new Sperm Prep II filtration column

Twenty semen samples were collected and two aliquots of 1.5 ml were prepared from each sample. One sample of each pair (fraction-one) was used for evaluation of semen parameters and total acrosin activity of spermatozoa. The other sample of each pair (fraction-two) was mixed with an equal volume of Ham's F-10 medium and filtered through the Sperm Prep II. At the end of the filtration, the filtrate was pooled, sperm parameters were evaluated and total acrosin activity was assessed. Percentage of normal spermatozoa, sperm motility, and total acrosin activity of spermatozoa were significantly higher in the postfiltered fraction-two than in the fresh fraction-one. Considering the great importance of acrosin for fertilization, it is suggested that Sperm Prep II filtration method may be beneficial in preparing spermatozoa from infertile men with low acrosin profiles for assisted reproduction programs. Further studies will be necessary, however, in order to confirm this, since the present study concerned men with known fertility.

Transvaginal ultrasound-guided follicular aspiration in the management of anovulatory infertility associated with polycystic ovaries

STUDY OBJECTIVE

To investigate whether or not transvaginal ultrasound (US)-guided follicular aspiration can effectively induce ovulation and facilitate pregnancy in anovulatory patients with polycystic ovaries (PCO).

DESIGN

Eight patients with polycystic ovarian disease (PCOD) and 10 patients with PCO were participants who failed to ovulate by the medical therapies. Most of persistent follicles were punctured, and their contents were thoroughly aspirated during the midluteal phase. The same ovarian stimulation regimen as used in the previous cycles were administered in the cycles after the aspiration.

MAIN OUTCOME MEASURES

Evidence of ovulation and a subsequent pregnancy was ultrasonically monitored after the aspiration, and the responsiveness of pituitary gonadotropins to gonadotropin-releasing hormone was tested in these patients.

RESULTS

The ovulation rates were 87.5% per patient, 52.6% per cycle monitored in PCOD patients and 100% per patient, 63.3% per cycle monitored in PCO patients, respectively. Half of the patients both with PCOD and PCO achieved pregnancy after the aspiration. A significant decrease (P less than 0.05) of the basal and peak levels of serum luteinizing hormone was observed after the aspiration.

CONCLUSIONS

The US-guided follicular aspiration seems to be a new surgical method for treating anovulatory patients with PCO.

Epidermal growth factor attenuates cell proliferation by down-regulating the transforming growth factor-beta receptor in the osteoblastic cell line MC3T3-E1

We investigated the role of transforming growth factor beta 1 (TGF-beta 1) in growth regulation of the murine osteoblastic cell line, MC3T3-E1. We detected TGF-beta activity in the conditioned medium of MC3T3-E1 cells and its activity was increased by acid treatment of the bioassay system using CC1 64 cells. Northern blot analysis revealed the expression of TGF-beta 1 precursor messenger ribonucleic acid (mRNA). MC3T3-E1 cells possessed a single class of high affinity TGF-beta 1 receptor (2.8 x 10(4) sites per cell, Kd = 196 pM). Cross-linking studies revealed three specific TGF-beta receptors with molecular masses of 65, 95 and 280 kDa. Both TGF-beta and epidermal growth factor (EGF) stimulated [3H]-thymidine incorporation into cells. EGF decreased the number of TGF-beta receptor dose-dependently, and pretreatment of cells with 10 nM EGF attenuated cell growth by TGF-beta. All these data suggested that TGF-beta might be an autocrine growth factor in murine osteoblastic MC3T3-E1 cells and that EGF might modulate the growth of cells by down-regulating the TGF-beta receptor level.

Decrease in epidermal growth factor receptor and its messenger ribonucleic acid levels in intrauterine growth-retarded and diabetes mellitus-complicated pregnancies

We measured the amounts of epidermal growth factor receptor (EGFR) in plasma membranes from human placentas at term delivery in three groups: appropriate for gestational age (AGA), intrauterine growth-retarded (IUGR), and diabetes mellitus-complicated (DM) pregnancies. At the same time, EGFR mRNA levels were examined in three groups by dot and Northern blot analyses. Binding studies were performed using 125I-labeled human EGF as a ligand, and two classes (high and low) of binding sites were found in all specimens. Although dissociation constants (Kd) were not significantly different among three groups, the number of binding sites was significantly decreased in IUGR and DM placentas compared to that in the AGA group. Total cellular RNA was isolated from a part of the placentas used for binding studies using the guanidinium CsCl method, denatured, and dot blotted onto nitrocellulose filter. Poly(A)+ RNA was selected from the total RNA, electrophoresed in 1% agarose gel, and transferred onto nitrocellulose filters. Then, hybridization with 32P-labeled pE7 (a cDNA of EGFR), autoradiography, and densitometry were performed. The amounts of mRNA hybridized with pE7 were reduced in IUGR and DM placentas compared to that in the AGA group. The molecular sizes of EGFR mRNA were 10 and 5.6 kilobases in all three groups. These results suggest possible physiological actions of EGF on adequate feto-placental growth and development in human pregnancy.

The effect of kallikrein on human sperm membrane function

To illustrate the influence of kallikrein on the hypoosmotic swelling test, 84 human semen samples were classified into 4 groups: normospermia (n = 34, group A), oligospermia (n = 18, group B), asthenospermia (n = 8, group C), and oligoasthenospermia (n = 24, group D). Two aliquots of 0.45 ml were prepared from each specimen in all the groups: one was incubated for 3 hr in a glass tube containing kallikrein and the other was incubated without kallikrein (control). Quantitative and qualitative assessment of sperm motility and the hypoosmotic swelling test (HOST) were subsequently performed in each pair of samples. Percentage of motile spermatozoa, speed of forward progression of motile spermatozoa and the percentage of swollen sperm were significantly lower in the control samples than in samples treated with kallikrein in all the groups. Kallikrein was also proved effective in increasing the outcome of the HOST, the percentage of motile spermatozoa and the speed of forward progression of washed spermatozoa received from normospermic men (n = 15). It seems that kallikrein has a direct effect on sperm membrane and improves its properties and functions.

Effect of dexamethasone on uterine cell death

Oestrogen, progesterone and androgen inhibit uterine cell death after the depletion of oestrogen. In the present study, we investigated effects of glucocorticoid on death of mouse uterine cells. Castrated female mice were given a daily injection of 17 beta-oestradiol (0.2 microgram/mouse/day) for 3 days, and then an injection of 5'-[125I]iodo-2'-deoxyuridine ([125I]IdUrd) to label DNAs of uterine cells with 125I. Mice were killed at intervals during subsequent treatments, and the retention of [125I]IdUrd incorporated into the whole uterus was determined. On subsequent injection of vehicle only, the 125I-radioactivity retained in the whole uterus rapidly decreased. Injections of dexamethasone (50 micrograms/mouse/day) reduced the loss of 125I-radioactivity slightly but significantly. Dexamethasone also showed synergistic effects on the retention of 125I-radioactivity when it was daily injected together with 17 beta-oestradiol, progesterone or 5 alpha-dihydrotestosterone. The present results suggest that glucocorticoid may affect the processes involved in the uterine cell death, in a manner such as inhibiting the uterine cell death or delaying the removal of DNAs of dead cells from the uterus.

Effects of danazol, gonadotropin-releasing hormone agonist, and a combination of danazol and gonadotropin-releasing hormone agonist on experimental endometriosis

Effects of danazol, gonadotropin-releasing hormone agonist (leuprolide), and danazol-leuprolide combination on experimental endometriosis were evaluated in female rats. A complete resorption of the fluid and a marked decrease in the volume of endometrium autotransplanted under the renal capsule were found after castration (1.4 +/- 0.1 mm3 in castrated, n = 14, vs 26.7 +/- 5.6 mm3 in intact control, n = 16). Histologic examination indicated atrophy and regression of the endometrial explant. These atrophic changes of endometrial explant were also induced by danazol, leuprolide, and the combination treatment. However, the volume of explants after combination therapy with danazol and leuprolide (1.8 +/- 1.0 mm3, n = 17) was significantly less than that after therapy with danazol (11.6 +/- 2.8 mm3, n = 20) or leuprolide alone (5.9 +/- 1.4 mm3, n = 24). The combination therapy (16/17) was also shown to be superior to danazol (9/20) or leuprolide alone (14/24) to induce the regression of fluid in experimental endometriosis. As expected, administration of leuprolide decreased the serum estradiol level, but use of danazol did not. These findings suggest that a combination therapy of danazol and gonadotropin-releasing hormone agonist, which show different modes of action, may be a potential modality in treatment of patients with advanced endometriosis.

K-ras activation in neoplasms of the human female reproductive tract

The role of cellular oncogenes in the development of epithelial tumors of the human female reproductive tract has not previously been extensively studied. DNAs isolated from ten human uterine, 13 ovarian, and four cervical neoplasms and from three cell lines derived from endometrial adenocarcinoma were investigated by dot blot hybridization after polymerase chain reaction amplification of ras gene sequences and in some cases by NIH 3T3 transfection. Transforming activity was found in two of nine endometrial adenocarcinomas, but none of seven ovarian carcinomas and none of four cervical carcinomas showed transforming activity. K-ras sequences with a GGT----GAT mutation in codon 12 were demonstrated in both transformants derived from endometrial carcinoma. K-ras codon 12 mutations were similarly detected in six of 13 endometrial carcinomas (one GAT and GCT, one GTT and GCT, two GAT, two GTT) and two of 13 ovarian tumors (GAT and GCT, GAT), both mucinous adenocarcinomas. Point mutation of K-ras in codon 12 is thus comparably frequent in uterine endometrial carcinomas and in colorectal carcinomas and may have similar significance as an event that contributes to progression of these tumors. Cervical carcinomas and ovarian tumors in general, with the possible exception of mucinous adenocarcinoma of the ovary, do not appear to have this characteristic.

Inhibitory effect of androgen on cell death of mouse uterine epithelium

The protective effect of androgen against the cell death of mouse uterine epithelium was evaluated by examining the retention of 5'-[125I]iodo-2'-deoxyuridine ([125I]IdUrd) incorporated into the whole uterus and the apoptotic index (percentage of the apoptotic cells to the total cells) which is a good index of physiological cell death. Castrated adult female mice were daily injected with oestradiol-17 beta for 3 days, followed by the injection of [125I]IdUrd. Thereafter, these mice were daily injected with only the vehicle or 5 alpha-dihydrotestosterone (DHT), and the 125I-radioactivity retained in the whole uterus was determined. When only the vehicle was injected, the 125I-radioactivity retained in the whole uterus rapidly decreased but injections of DHT reduced the loss of 125I-radioactivity. The effect of DHT on the retention of 125I-radioactivity depended on doses of DHT and was abolished by the pure antiandrogen, flutamide. The apoptotic index of uterine cells was examined by a similar experimental protocol, but without an injection of [125I]IdUrd. Injections of only the vehicle caused marked increases in the apoptotic indices of both luminal and glandular epithelia, but injections of DHT decreased them significantly. The apoptotic index of stroma was not affected by the injection of DHT. The present results indicated that androgen reduces the cell death of mouse uterine epithelium through the androgen receptor.

Changes of bioactive luteinizing hormone after laparoscopic ovarian cautery in patients with polycystic ovarian syndrome

The serum levels of bioactive luteinizing hormone (LH), immunoreactive LH, follicle-stimulating hormone, androstenedione (A), and testosterone (T) were determined in nine anovulatory women with polycystic ovarian syndrome (PCOS) before and after laparoscopic ovarian cautery. Eight ovulated spontaneously and three conceived after treatment. Before treatment, the mean (+/- SEM) levels of bioactive LH, immunoreactive LH, A, and T were 51.4 +/- 8.6 mIU/mL, 36.0 +/- 4.5 mIU/mL, 1.98 +/- 0.35 ng/mL, and 1.18 +/- 0.13 ng/mL, respectively, which were significantly higher than those of five control women (19.2 +/- 1.6 mIU/mL, 21.4 +/- 1.2 mIU/mL, 0.54 +/- 0.03 ng/mL, 0.28 +/- 0.03 ng/mL). After treatment, the mean levels of these hormones had significantly decreased. Decreases in the levels of these hormones by laparoscopic ovarian cautery in women with PCOS may result in both restoration of the ovulatory cycle and achievement of pregnancy.

Inhibitory effect of progesterone on cell death of mouse uterine epithelium

The protective effect of progesterone against cell death of mouse uterine epithelium was evaluated by examining the retention of 5'-[125I]iodo-2'-deoxyuridine [( 125I]IdUrd) incorporated into the whole uterus and the apoptotic index (percentage of apoptotic cells in total cells), which is a good index of physiological cell death. Castrated adult female mice were given a daily injection of oestradiol-17 beta for 3 days, and then an injection of [125I]IdUrd. They were then divided into 4 groups, which received a daily injection of vehicle only, oestradiol-17 beta (E), progesterone (P), or both oestradiol-17 beta and progesterone (EP), and were killed at intervals during these treatments for determination of 125I radioactivity retained in the whole uterus. On treatment with vehicle only, the 125I radioactivity retained in the uterus decreased rapidly, but treatment with E, P or EP reduced the loss of 125I radioactivity significantly. Progesterone did not antagonize the effect of oestradiol-17 beta on the 125I radioactivity retained in the uterus. The apoptotic index of uterine cells was examined by a similar experimental protocol, but without injection of [125I]IdUrd. In the group treated with vehicle only, the apoptotic indices of both luminal and glandular epithelia increased markedly, but the injection of E, P or EP suppressed these increases significantly. Progesterone did not antagonize the effect of oestradiol-17 beta on the apoptotic index. The apoptotic index of stroma was not affected by the injection of E, P or EP. On the other hand, progesterone completely inhibited the increase in the mitotic index of uterine epithelia induced by oestradiol-17 beta. These results show that progesterone alone or in combination with oestrogen reduced cell death in mouse uterine epithelium and that the effects of oestrogen and progesterone on uterine cell death were independent of their actions on cell division.