Effect of transitory hyperprolactinemia on in vitro fertilization of human oocytes

OBJECTIVE

To examine the changes in plasma prolactin (PRL) during ovarian hyperstimulation (OH) and the influence of hyperprolactinemia on folliculogenesis, oocyte retrieval and in vitro fertilization (IVF) success rates and the usefulness of the metoclopramide (MCP) test in predicting the onset of hyperprolactinemia.

STUDY DESIGN

Forty-nine cycles of OH were induced in 32 infertile women using follicle-stimulating hormone, human menopausal gonadotropin and human chorionic gonadotropin (GI) (n = 36), also in association with gonadotropin-releasing hormone (GII) (n = 13). The MCP test (10 mg, intravenously) was performed on fertile control women (control group, n = 9) and in GI (n = 21) and GII (n = 8) patients.

RESULTS

Plasma PRL and estradiol levels increased during OH, reaching maximum levels on the day preceding oocyte retrieval in GI and GII. Since these two groups exhibited similar PRL curves, they were evaluated as a single group. Patients showing an increase in PRL of > 200% presented a greater number of follicles with a mean diameter > or = 12 mm and more mature oocytes and better IVF success rates than patients with a PRL increase < or = 200%. Oocyte retrieval did not differ between the groups. The MCP test showed hyperresponsiveness in the three groups studied, but no correlation was found between the PRL increase in this test and that during OH.

CONCLUSION

Plasma PRL and estradiol levels increase during OH, while the MCP test cannot predict the onset of hyperprolactinemia. Transitory hyperprolactinemia seems to be associated with an increase in the numbers of follicles with a mean diameter > or = 12 mm and with more mature oocytes and better IVF success rates.

Hypogonadotropic hypogonadism: retrospective analysis of 19 cases

OBJECTIVES

To survey the clinical data of patients with isolated gonadotropin deficiency.

METHODS

We retrospectively surveyed the medical records of 19 patients with isolated gonadotropin deficiency aged 16-31 years (mean: 20 years). The major complaint was primary amenorrhea in 100% of the patients, with 42.1% of them also reporting absence of secondary sex traits, and 10% reporting anosmia or hyposmia. Seventy-four percent of the patients had been submitted to hormonal replacement therapy.

RESULTS

Bone densitometry was determined in 5 patients and revealed lumbar spine osteopenia in 3 patients and femoral osteopenia in 1. An association with urologic malformations was detected in 10.5% of cases and an association with gynecologic malformations was detected in 31.6%.

CONCLUSIONS

Isolated gonadotropin deficiency can be easily diagnosed but requires early estrogen replacement therapy because of a higher risk of osteopenia and consequently of osteoporosis. Concomitant urogenital malformations are frequent and should be investigated.

Hemorrhagic ascites associated with endometriosis. A case report

BACKGROUND

Endometriosis associated with massive, bloody ascites is an unusual occurrence. This report draws attention to this condition as a complication of endometriosis, with the description of a case and a review of 31 others.

CASE

A 41-year-old, black nulligravida with massive, bloody ascites and a pelvic mass underwent laparotomy, and an intraoperative microscopic examination ruled out malignancy. The histologic report was compatible with endometriosis. The patient was treated with a GnRH analog, with progressive reduction of ascitic fluid and full remission after six months.

CONCLUSION

Bloody ascites should be considered a complication of endometriosis, especially in nulliparous women of childbearing age with abdominal distention, a pelvic mass, dysmenorrhea, abdominal pain, weight loss and eventual pleural effusion, suggesting a diagnosis of ovarian malignancy.

Factor V leiden and factor II G20210A mutations in patients with recurrent abortion

Recurrent abortion (RA) represents an intriguing problem in obstetric practice in which genetic and acquired factors may play a role. In the present investigation we sought to assess the possibility that inherited thrombophilia might determine the risk of RA. We therefore investigated the prevalence of two genetic abnormalities frequently associated with venous thrombosis [factor V Leiden (FVL) and factor II G20210A] in 56 patients with primary or secondary abortion and in 384 healthy control women. Polymerase chain reaction amplification followed by digestion with the restriction enzymes MnlI and HindIII was used to define the FVL and FII G20210A genotypes respectively. FVL was found in 4/56 patients (7.1%) and in 6/384 controls (1.6%), yielding an odds ratio (OR) for RA related to FVL of 4.9 [95% confidence interval (CI): 1.3-17.8]. FII G20210A was detected in 2/56 (3.6%) patients and in 4/384 (1%) controls (OR for RA: 3.5, CI: 0.6-19.7). In conclusion, FVL and FII G20210A mutations in patients with RA were more prevalent in comparison with controls. These data support a role for both mutations as determinants of the risk of RA and strengthen the notion that thrombophilia plays a role in this clinical entity.

Familial risk among patients with endometriosis

PURPOSE

The objective of the present study was to determine the prevalence of endometriosis among the relatives of patients with confirmed endometriosis.

METHODS

We analyzed the prevalence of endometriosis among first-, second-, and third-degree relatives in a group of 101 patients with varying symptoms related to endometriosis seen at two public hospitals and submitted to laparoscopy and/or laparotomy. The control group consisted of 43 women submitted to laparoscopy without a diagnosis of endometriosis.

RESULTS

Among the patients with endometriosis, we detected nine families with a positive history of endometriosis, comprising one mother, six sisters, three aunts, and two cousins, as opposed to no case among the controls.

CONCLUSIONS

These data confirm a familial tendency for endometriosis and suggest that this disorder has a genetic basis.

Induction of ovulation with clomiphene citrate in combination with metoclopramide in patients with amenorrhea of hypothalamic origin

Literature data have demonstrated that the chronic use of metoclopramide (MCP), a dopamine antagonist, causes increased gonadotropin secretion in patients with hypothalamic amenorrhea but without triggering ovulation. It has also been observed that women with hypothalamic amenorrhea respond poorly to ovulation induction with clomiphene citrate (CC). On this basis, the objective of the present study was to determine the effect of MCP on the response to CC in patients with hypothalamic amenorrhea in order to evaluate the validity of the simultaneous use of these drugs as ovulation inducers in this type of chronic anovulation. Twenty-two patients with amenorrhea of hypothalamic origin were submitted to a randomized double blind study in which one tablet of 5 mg MCP or placebo was administered every 8 hours for 2 months. After the 30th day of medication (MCP or placebo), CC, 100 mg orally, was additionally administered to both groups for 5 days. Blood samples were collected on days 1, 15 and 30 during the first month of the study and on days 7, 14 and 21 after the last CC tablet during the second month, for later measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol and progesterone by radioimmunoassay. The group that received MCP showed a significant increase in LH and FSH during the first month of the study, as well as a slighter increase in estradiol. Prolactin increased only during the second stage of treatment. No significant increases in gonadotropins, prolactin or estradiol occurred in the placebo group. In the group treated with MCP, 40% of the patients ovulated after CC, with menstruation occurring in 60% of them. In the placebo group, 33.3% of the women ovulated after CC and 44.4% menstruated at the end of the study. We conclude that MCP increases the circulating levels of LH, FSH, estradiol and prolactin in patients with hypothalamic amenorrhea and low estrogen levels, supporting the hypothesis that an increase in hypothalamic dopaminergic tonus occurs in these patients. On the other hand, the combination of MCP and CC does not improve the rate of ovulation compared to placebo.

Activation of human endometrial phospholipase D by bradykinin

Bradykinin may act as a promoter of endometrial regeneration. In [3H]myristate-labelled endometrial stromal cells, bradykinin and tetradecanoylphorbol acetate (TPA) mediated activation of phospholipase D (PLD) as measured by the accumulation of [3H]phosphatidylbutanol ([3H]PtdBut). Kinetics of bradykinin-evoked PLD activation was rapid and transient, whereas the TPA response was relatively slow in onset. Bradykinin induced a dose-dependent (EC50 0.11 nM) [3H]PtdBut accumulation at concentrations at which it stimulated DNA synthesis. In [3H]inositol-labelled cells, bradykinin evoked a rapid increase in inositol phosphates which preceded the increase in [3H]PtdBut formation. Chronic pretreatment with 400 nM TPA abolished PLD activation to subsequent treatment with either TPA and bradykinin. Staurosporine, an inhibitor of protein kinase C, strongly inhibited (IC50 96 nM) TPA-induced [3H]PtdBut formation, but bradykinin-stimulated [3H]PtdBut accumulation was only partially inhibited (IC50 65 microM). The effect of bradykinin and TPA on PLD activity was synergistic, suggesting that the two agents may act via different mechanisms. These results suggest PKC-dependent and independent pathways are involved in bradykinin-induced PLD activation and that the mitogenic activity of this vasoactive peptide on endometrial stromal cells may in part be mediated via the PLD pathway. This may have significance both to implantation and endometrial cancer.

Cortisol levels alter the response to metoclopramide in patients with hypothalamic amenorrhea

The reduction in frequency and/or amplitude of gonadotropin-releasing hormone (GnRH) pulses in patients with amenorrhea of hypothalamic origin has been attributed to increased dopamine activity. The objective of the present study was to determine the role of dopamine in the pathogenesis of hypothalamic amenorrhea. Fourteen patients with hypothalamic amenorrhea, nine of whom had psychogenic amenorrhea and five anorexia nervosa, were studied and compared with nine normal women during the early follicular phase. Metoclopramide (10 mg), a dopamine antagonist, was infused intravenously and blood samples were collected at 15-min intervals for 2 h for follicle-stimulating hormone (FSH) and luteinizing hormone (LH) measurement by radioimmunoassay. Both the hypothalamic amenorrhea (psychogenic amenorrhea and anorexia nervosa) and control groups were unresponsive to FSH, suggesting that dopamine may have little or no effect on FSH secretion. Five patients of the psychogenic amenorrhea group responded to LH (responsive psychogenic amenorrhea) and four did not (non-responsive psychogenic amenorrhea). No anorexia nervosa or control patient responded to the stimulus. Responsive psychogenic amenorrhea patients showed decreased basal cortisol levels compared to the non-responsive psychogenic amenorrhea and anorexia nervosa groups. It is possible that patients with exclusive alterations in the dopaminergic system are those who respond to metoclopramide (responsive psychogenic amenorrhea group), whereas patients who also have involvement of the hypothalamic-adrenal axis like the women with anorexia nervosa, are not responsive to metoclopramide and tend to have elevated cortisol levels. The non-responsive psychogenic amenorrhea group, with elevated cortisol levels, probably represents an intermediate step between the responsive psychogenic amenorrhea and anorexia nervosa patients.

Insulin secretion in obese and non-obese women with polycystic ovary syndrome and its relationship with hyperandrogenism

Insulin resistance has been reported to be associated with hyperandrogenism and polycystic ovaries. To study the prevalence of insulin resistance in patients with polycystic ovary syndrome (PCO) and the correlation between hyperinsulinemia and hyperandrogenism, 48 patients were divided into four groups: group 1, non-obese ovulatory women (n = 10); group 2, obese ovulatory women (n = 9); group 3, non-obese women with PCO (n = 14); group 4, obese women with PCO (n = 15). Each patient was submitted to an oral glucose tolerance test (OGTT). Glucose, insulin, androstenedione and testosterone levels were determined and the blood glucose and insulin response of women with PCO and normal women were compared. Glucose intolerance was observed in group 3 (28.6%) and group 4 (40%) but not in groups 1 or 2, and hyperinsulinemia was observed in group 2 (66.7%), group 3 (64.3%) and group 4 (86.6%). There was a correlation between androstenedione and testosterone levels and insulinemia in group 4. There was also a high prevalence of insulin resistance in patients with PCO regardless of obesity, and hyperandrogenism-aggravated insulin resistance.

Localisation of bradykinin-like immunoreactivity and modulation of bradykinin-evoked phospholipase D activity by 17 beta-oestradiol in human endometrium

Bradykinin may act as a promoter of endometrial regeneration. Bradykinin-like immunoreactivity was detected immunocytochemically in the glandular epithelium and stroma of human endometrium. The staining was localized around the stroma and especially in the cells undergoing mitosis. Relatively weak staining was seen in the stromal cells of secretory endometrium, which was predominantly localised around the basal vacuoles of endometrial glands. During the late secretory phase, the intensity of staining was diminished throughout the endometrium: the glandular epithelium showed weak staining and stroma appeared negative. As phosphatidate, the product of phospholipase D pathway, may mediate cell proliferation, the effect of 17 beta-oestradiol on bradykinin-evoked phospholipase D activity assayed as accumulation of [3H]phosphatidylbutanol ([3H]PtdBut) was examined in [3H]myristic acid-labelled primary cultures of human endometrial stromal cells. Bradykinin induced a rapid accumulation of [3H]PtdBut in a time-dependent manner, indicating phospholipase D activation. Pretreatment of stromal cells with 17 beta-oestradiol enhanced the bradykinin-evoked phospholipase D activity. These results suggest that bradykinin-like immunoreactivity is strongly associated with proliferative stromal cells undergoing mitosis, a process that may be mediated by phospholipase D activation as the magnitude of this enzyme's activation in vitro appears to be regulated by 17 beta-oestradiol.

Basic FGF activates phospholipase D in endothelial cells in the absence of inositol-lipid hydrolysis

In the absence of inositol-lipid hydrolysis, mitogenic concentrations of basic fibroblast growth factor (bFGF) stimulated phosphatidylbutanol formation in the presence of butan-1-ol in [3H]myristate-labeled human umbilical vascular endothelial (HUVE) cells, indicating that the fibroblast growth factor receptor was able to couple to the activation of phospholipase D (PLD). The ability of bFGF and 12-O-tetradecanoylphorbol-13-acetate (TPA) to stimulate PLD activity was completely abolished in cells pretreated with 400 nM TPA for 48 h to downregulate protein kinase C (PKC). bFGF-stimulated PLD activity was inhibited by genistein (5 microM; P < 0.02) and the PKC inhibitor 1-(5-isoquinolinylsulfonyl)-2-methylpiperazine (H-7, 5 microM; P < 0.001) as well as by the removal of calcium from extracellular environment. bFGF induced DNA synthesis in a dose-dependent manner, and pretreatment of cells with H-7 inhibited the mitogenic activity of bFGF. These results indicate that activation of PKC is responsible for bFGF-induced PLD activation and the mitogenic activity of bFGF in HUVE cells. A coupled PLD/3-sn-phosphatidate phosphohydrolase pathway may play a role in the regulation of endothelial cell proliferation.

Colocalization of acidic and basic fibroblast growth factor (FGF) in human placenta and the cellular effects of bFGF in trophoblast cell line JEG-3

The placenta undergoes extensive angiogenesis and cellular proliferation to establish adequate blood supply to the fetus. The aim of this study was to compare and contrast the immunolocalization of acidic and basic fibroblast growth factor (FGF) in both first trimester and term placenta and gestational decidua. Human choriocarcinoma cell line JEG-3 were employed as a model of cytotrophoblast and the effect of basic FGF on cell proliferation and phospholipase C and D activation investigated. Basic FGF-immunoreactivity (IR) was detected in or around cytotrophoblast cells and in extravillous trophoblast in first trimester placenta by immunohistochemistry using primary polyclonal rabbit antibodies. Identical staining patterns were produced by acidic FGF antibodies indicating colocalization of acidic FGF and basic FGF. At term, weaker and more diffuse staining was seen in the syncytiotrophoblast surrounding the placenta villi and strong staining was present in the smooth muscle cells of mid and large size placental vessels and in some endothelial cells. Endothelial cells and extravillous trophoblast stained strongly within the decidua at first trimester, whereas the glandular epithelium was weakly stained. Basic FGF induced [3H]thymidine incorporation in JEG-3 cells in a dose dependent manner and caused an increase in inosital phosphate accumulation in cells pre-labelled with myo-[3H]inosital at similar concentrations, suggesting a role of phospholipase C in JEG-3 cell proliferation. However, basic FGF failed to stimulate phospholipase D activity in cells pre-labelled with [3H]myristic acid. The detection of acid FGF and basic FGF on both maternal and fetal side of the placenta during early pregnancy suggests a role for FGF in angiogenesis, whereas localisation of the growth factor at term, when extensive angiogenesis has diminished, would indicate that FGF may be associated with more differentiated functions of the trophoblast. The nuclear localization of basic FGF in dividing but not non-dividing placental cells together with the effect of basic FGF on JEF-3 cells, strongly supports a role for basic FGF in cytotrophoblast proliferation in vivo.

Ovulation induction with low doses of "pure" follicle stimulating hormone using a fixed protocol in patients with polycystic ovarian disease

OBJECTIVE

Use of a low, fixed dose of purified FSH to induce ovulation in polycystic ovarian syndrome.

DESIGN

Fixed protocol, using 75 IU/day of "pure" FSH starting on day 1-5 of menses.

SETTING

University outpatient clinic.

PATIENTS AND INTERVENTIONS

Seventeen patients, aged 18-38, with clomiphene-resistant polycystic ovarian syndrome, for 23 cycles. All received 50 mg medroxyprogesterone to induce menstrual flow. "Pure" FSH given i.m. for eight to ten days. If follicle reached > or = 18 mm, hCG (5,000 IU) was given, in one-half of cases, in a single dose to induce rupture.

MAIN OUTCOME MEASURES

Hormonal measurements (plasma LH, FSH, estradiol, testosterone, progesterone); daily, LH/FSH ratio; daily abdominal sonogram.

RESULTS

I: No follicular growth (3 cycles; 13%); II: Inadequate follicular growth (< or = 14 mm--6 cycles; 26%); IIIa: Follicle > or = 18 mm, hCG given; 100% ovulatory; IIIb: Follicle > or = 18 mm, no hCG given; 2/7 ovulatory. Hyperstimulation: one (moderate) in IIIa; one (mild) in IIIb.

CONCLUSIONS

Fixed protocol of low-dose, "pure" FSH produces good results, especially combined with hCG, which is effective up to 48 hours after last injection of FSH.

Immunohistochemical localization of acidic and basic fibroblast growth factors in normal human endometrium and endometriosis and the detection of their mRNA by polymerase chain reaction

Growth factors play a role in the cyclical growth and vascularization of normal endometrium. Abnormal endometrial proliferation and neovascularization may result in endometriosis. This study determines the presence and localization of acidic and basic fibroblast growth factors (aFGF and bFGF respectively) in endometrium of normal women, and in normal and ectopic endometrium of women with endometriosis. Endometrium was obtained at curettage or hysterectomy for benign disease, or laparoscopy for endometriosis. aFGF- and bFGF-immunoreactivity was detected at different phases of the menstrual cycle by immunohistochemistry using primary polyclonal rabbit antibodies. Expression of mRNA for aFGF and bFGF was determined in normal endometrium by nested reverse transcriptase polymerase chain reaction (RT-PCR). aFGF- and bFGF-immunoreactivity were both detected in endometrium from normal women, and in normal and ectopic endometrium of women with endometriosis. The pattern of staining with the two different FGFs was the same: immunoreactivity was predominantly confined to glandular epithelial cells and did not change throughout the menstrual cycle. Little or only light staining was seen in stromal cells and myometrium, and the pattern of staining did not differ between endometriotic and normal tissue. The presence of mRNA for aFGF and bFGF was demonstrated in normal endometrium. The detection of aFGF and bFGF mRNA in normal endometrium and aFGF- and bFGF-immunoreactivity in normal and endometriotic tissues suggests that these peptides may play a role in the proliferation and angiogenesis of normal and ectopic human endometrium.

Prevalence of anti-cardiolipin antibody in habitual aborters

An enzyme-linked immunosorbent assay was developed for the detection of anticardiolipin antibody (ACA) in habitual aborters. Results above the 98th percentile of a distribution of 100 blood donors were considered to be positive. Specific binding index for ACA was higher in 20 patients with at least 3 consecutive spontaneous abortions (group A) than in 20 women with at least one live birth without pregnancy wastage (group B). ACA was detected in 4 patients of group A and in none of the women of group B. Most of the pregnancy wastages occurred after the first trimester in ACA-positive patients and during the first trimester in ACA-negative patients.

Activation of phospholipase A2 and phospholipase C by endothelin-1 in human endometrium

Human endometrium contains specific binding sites for iodinated endothelin (ET)-1, ET-2 and ET-3, and ET-1 stimulates prostaglandin (PG) F2 alpha synthesis from explants of proliferative endometrium in short-term culture. This study has investigated the cellular responses of normal proliferative endometrium to ET-1. Radioimmunoassay was used to measure PG release and Dowex anion-exchange column chromatography was utilized to assess the accumulation of inositol phosphates. Endothelin-1 induced a significant increase in PGF2 alpha release (basal median: 1465 pg/mg per 60 min (range: 541-3935 pg/mg per 60 min); ET-1-stimulated: 1813 pg/mg per 60 min (1021-5714 pg/mg per 60 min); P < 0.04 using Wilcoxon signed rank test). The effect of ET-1 was attenuated in the presence of the phospholipase A2 inhibitor quinacrine. Endothelin-1 induced a rapid, transient and concentration-dependent hydrolysis of phosphatidylinositol 4,5-bisphosphate (PtdIns(4,5)P2), measured by the accumulation of tritiated inositol phosphates. Following a 1-min stimulation with ET-1 (100 nmol/l), [3H]inositol mono-, bis- and trisphosphate fractions increased from median values of 490.0 d.p.m./mg dry wt (range: 348.0-807.0 d.p.m./mg dry wt), 120.0 d.p.m./mg dry wt (93.6-144.1 d.p.m./mg dry wt) and 67.0 d.p.m./mg dry wt (54.2-85.0 d.p.m./mg dry wt) to 939.0 d.p.m./mg dry wt (635.9-1596.0 d.p.m./mg dry wt; P < 0.03), 145.0 d.p.m./mg dry wt (127.0-293.9 d.p.m./mg dry wt; P < 0.05) and 146.0 d.p.m./mg dry wt (77.5-187.0 d.p.m./mg dry wt; P < 0.03) respectively. These results suggest that ET-1 activates the phospholipase A2 and PtdIns(4,5)P2-specific phospholipase C in human proliferative endometrium, resulting in the generation of PGF2 alpha and second messengers respectively which are pivotal to endometrial function.

Effects of clomiphene citrate on pituitary luteinizing hormone and follicle-stimulating hormone release in women before and after treatment with ethinyl estradiol

OBJECTIVE

To evaluate the effects of clomiphene citrate (CC) on pituitary luteinizing hormone (LH) and follicle-stimulating hormone (FSH) release in hypoestrogenic women and in the same women after treatment with ethinyl estradiol (EE2).

DESIGN

The study was of a prospective nature and was conducted on selected patients.

SETTING

Volunteer women were studied in a tertiary care public hospital.

PATIENTS

The 10 patients studied were selected on the basis of hypogonadal status (menopause, premature ovarian failure, or gonadal dysgenesis and Turner phenotype) and no hormonal treatment.

INTERVENTIONS

Gonadotropin-releasing hormone (GnRH) was continually infused at the dose of 0.2 micrograms/min for 4 hours before and after the use of CC and/or EE2.

MAIN OUTCOME MEASURE

The study was performed with the objective of determining the effect of estrogen (E) levels on the action of CC on in vivo gonadotropin release.

RESULTS

In the presence of hypoestrogenic conditions, CC had no pituitary action. However, after EE2 treatment CC promoted greater FSH release and a significant inhibition of LH release from the pituitary.

CONCLUSION

Clomiphene citrate needs a basal E level to be able to act on the pituitary. In normoestrogenic states and under GnRH stimulation, CC preferentially promotes FSH release while presenting a predominantly inhibitory effect on LH release.

Platelet-activating factor mediates phosphatidylcholine hydrolysis by phospholipase D in human endometrium

Human preimplantation embryos and endometrium secrete platelet-activating factor (PAF). The mechanism of phosphatidylcholine (PC) degradation stimulated by PAF was investigated in endometrial explants prelabeled with [methyl-3H]choline or preincubated with [3H]butan-1-ol. Analysis of the water-soluble metabolites of PAF-induced PC hydrolysis in secretory endometrium demonstrated that the stimulated generation of [3H]choline ([3H]Cho) precedes that of [3H]choline phosphate ([3H]ChoP) and [3H]glycerophosphocholine ([3H]GPC). Within 30 sec there was a rapid rise in PAF-induced [3H]Cho generation and by 2 min this had increased to 59.9% +/- 10.6% (p less than 0.02), with no effect upon [3H]ChoP and [3H]GPC during this period. Both [3H]GPC and [3H]ChoP, however, were increased at a later time point. The slower [3H]ChoP generation may suggest that PC-specific phospholipase C activation as well as delayed [3H]GPC rise may be due to PC-specific phospholipase A2 and lysophospholipase activation. Phospholipase D activity was confirmed by the incorporation of high-specific-activity [3H]butan-1-ol into [3H]phosphatidylbutanol ([3H]PBut). The rapid generation of [3H]PBut, which paralleled the rise in intracellular [3H]Cho, strongly suggests that PC breakdown is catalyzed by the phospholipase D pathway. It is proposed that PAF induces PC hydrolysis as a consequence of an early phospholipase D-catalyzed breakdown of PC in human secretory endometrium. This may be an alternative source for prostaglandin synthesis and an important pathway essential for long-term activation of local cellular events at the time of implantation.

Association of microscopic gonadoblastoma and contralateral ovarian fibroadenoma in patients with gonadal dysgenesis and Turner phenotype

A rare case of microscopic gonadoblastoma associated with gonadal fibroadenoma in a patient with gonadal dysgenesis and Turner phenotype is reported. The higher incidence of tumor pathologies in patients with gonadal dysgenesis presenting a Y chromosome in their karyotype is discussed, and the need for judicious microscopic analysis of the gonadal streaks of these patients for the detection of possible incipient tumors is emphasized.

Ureteral blockage as a complication of Burch colposuspension: report of 6 cases

Burch colposuspension for correction of urinary incontinence is rarely followed by complications. A very rarely described complication is ureteral kinking, which tends to occur in patients with previous pelvic surgeries. We present 6 additional cases of this rare complication and recommend appropriate intraoperative dissection as well as postoperative alert for early diagnosis, which improves prognosis.

Dopamine might not be involved in the pathogenesis of polycystic ovary syndrome

The possible alteration in dopamine (DA) metabolism as an etiological factor was investigated in 31 normoprolactinemic patients with typical polycystic ovary syndrome (PCOS) in comparison with 14 normal women (early follicular phase). Subjects were submitted to intravenous infusion of 4 micrograms/kg DA per minute over a period of 3 hours and blood samples were collected every 30 minutes over a period of 5 hours. Two days later subjects were submitted to intravenous infusion of 10 mg metoclopramide (MCP) as a bolus and blood samples were collected every 15 minutes over a period of 2 hours. Dopamine infusion caused a similar maximum decrease (MD) in LH levels in both the PCOS and control groups (50.9% and 47.5%, respectively). No changes in plasma LH levels were observed in either group after MCP infusion. Dopamine caused a 50.2% and 60.4% MD in prolactin (PRL) in the PCOS and control groups, respectively, the difference being statistically non-significant. Metoclopramide increased PRL levels by 1261.0% and 1832.0% in the PCOS and control groups, respectively (not significant). In a double-blind study, the PCOS patients were treated with 5 mg/day bromocriptine (n = 16) or placebo (n = 15) over a period of 3 months and evaluated in clinical and laboratory terms during and after treatment. Seven patients in each group had monthly menstrual periods, but only 1 in each group had an ovulatory cycle (progesterone greater than 5 ng/ml). During treatment, median plasma PRL levels were significantly decreased only in bromocriptine-treated patients (10.8 vs 7.3 ng/ml). The present results lead us to question whether dopamine is indeed involved in the pathogenesis of normoprolactinemic PCOS and whether bromocriptine treatment is of benefit in this type of patients.

Progesterone alters the pituitary response to luteinizing hormone releasing hormone in postmenopausal women previously treated with estradiol

The effect of luteinizing hormone-releasing hormone (LHRH) on LH release was studied in 5 menopausal women injected with progesterone. Each patient received 2 x 100 micrograms doses of LHRH administered intravenously 120 minutes apart under the following conditions: without any previous treatment (test 1); 16 hours after intramuscular injection of 10 mg progesterone (test 2); after 3-4 weeks of oral treatment with 50 micrograms/day of ethinyl estradiol (EE2) (test 3); 16 hours after intramuscular injection of 10 mg progesterone following treatment with 50 micrograms/day oral EE2 for 3-4 weeks (test 4). The interval between tests was at least 1 month. Progesterone decreased the total plasma hormonal increment (PHIt) of hypogonadal women, with a reduction in plasma hormonal increment both after the 1st stimulus (PHI1) and after the 2nd stimulus (PHI2), whereas estradiol increased PHIt, mainly due to an increase of PHI2. The administration of progesterone to hypogonadal women previously treated with EE2 maintained the increased PHIt caused by the latter, but not owing to a greater increase in PHI1.

Lack of evidence of prolonged human immunodeficiency virus infection before antibody seroconversion

Recently, considerable concern has been raised regarding the possibility that antibody-based screening tests for the human immunodeficiency virus (HIV) may fail to detect certain high-risk individuals for prolonged periods of time. It has been proposed that testing for HIV-related antigen may be a necessary procedure to detect such individuals. To address this issue, we longitudinally studied two groups of homosexual men: direct sexual partners of acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) patients and individuals who ultimately sero-converted. There was no evidence of prolonged infection with HIV in the absence of detectable antibody in these two groups. It appears at this time that, even among subjects at very high risk for HIV infection, currently available antibody-based assays are sufficient to identify infected individuals.

Prolactin levels in blood from the intervillous space of the human placenta

The secretory products of the human placenta are released in the intervillous space (IS), which also represents the main site of maternal-fetal exchange. This compartment, however, has not been studied in terms of prolactin (PRL) metabolism during gestation. In the present study we determined PRL levels in maternal peripheral (MP) blood, in blood from the IS and in blood from the umbilical artery (UA) and vein (UV) of 24 clinically normal parturients and their concepti. PRL levels in MP plasma (means = 111.7 +/- 5.5 ng/ml) did not differ significantly (p greater than 0.05) from those in IS plasma (means = 131.6 +/- 64.3 ng/ml). PRL levels in UA plasma (means = 206.2 +/- 67.5 ng/ml) also showed no significant difference (p greater than 0.05) from those in UV plasma (means = 243.8 +/- 86.1 ng/ml) but both were significantly higher than MP and IS plasma levels (p less than 0.01). These data permit us to conclude that the placenta may not be the source of PRL circulating in maternal peripheral blood.

Effect of venipuncture stress on plasma prolactin levels

Venipuncture for blood collection is postulated to be a stress factor that can increase circulating prolactin (PRL) and therefore produce false results. Seven normal non-pregnant women and 44 gravidae were submitted to venipuncture with a butterfly needle connected to a syringe for vein maintenance. Blood was collected immediately (zero time) and 15 and 30 min after venipuncture. After the last collection, a vein in the contralateral arm was punctured in the non-pregnant women only and a new blood sample was collected. PRL, measured by immunoassay, varied from 7 to 13.2 ng/ml in the non-pregnant women and from 7 to 300 ng/ml in the gravidae. No significant difference in PRL values was detected at any of the collection times. It is concluded that the stress or pain caused by venipuncture is not sufficient to alter plasma PRL levels in normal (non-pregnant) or hyperprolactinemic (gravidae) women.

Detection of cytomegalovirus antibody with two commercially available assays, an indirect hemagglutination test and an enzyme immunosorbent assay

By the use of two reference procedures, an indirect hemagglutination assay and a complement fixation test, the presence or absence of cytomegalovirus (CMV) antibody was determined for 221 human sera. Ninety-nine sera (44.8%) were found to contain CMV antibody. The remaining 122 sera (55.2%) lacked detectable CMV antibody. These same sera were then analyzed by two recently introduced, commercially available CMV antibody assays, an indirect hemagglutination test (IHA-c; Cetus Corp., Emeryville, Calif.) and an enzyme-linked immunosorbent assay (ELISA; M. A. Bioproducts, Walkersville, Md.). With the results of the reference procedures as true evidence of the presence or absence of CMV antibody, the sensitivity of the IHA-c was found to be 100%; the specificity was 98.4%. The sensitivity of the ELISA was also 100%; the specificity was 96.7%. The overall accuracies of these procedures were 99.1 and 98.2%, respectively. Time and motion studies revealed the IHA-c procedure to be faster and technically less demanding than the ELISA procedure.