Response of Eurasian otters (Lutra lutra) to underwater acoustic harassment device sounds

Seal scarers (or acoustic harassment devices, AHDs) are designed to deter seals from fishing gear and aquaculture operations, as well as to prevent seals from entering rivers to avoid predation on valuable fish. Our study investigated the potential effects of AHDs on non-target species, specifically the Eurasian otters (Lutra lutra), by testing the reaction of two rehabilitated otters to simulated AHDs sounds at 1 and 14 kHz, with a received sound intensity of 105-145 dB re 1 µPa rms. The 1 kHz sounds were used to investigate alternative frequencies for scaring seals without scaring otters. The otters reacted to both 1 and 14 kHz tonal signals when retrieving fish from a feeding station 0.8 m below the surface. Their diving behaviour and time to extract food progressively increased as sound intensity increased for all tested sound levels. Notably, the sound levels used in our tests were significantly lower (40-80 dB) than the source levels from commercial AHDs. These findings highlight the importance of caution when using AHDs in river and sea habitats inhabited by otters, as AHDs can change their behaviour and potentially result in habitat exclusion.

Survival improvements of marine mammals in zoological institutions mirror historical advances in human longevity

An intense public debate has fuelled governmental bans on marine mammals held in zoological institutions. The debate rests on the assumption that survival in zoological institutions has been and remains lower than in the wild, albeit the scientific evidence in support of this notion is equivocal. Here, we used statistical methods previously applied to assess historical improvements in human lifespan and data on 8864 individuals of four marine mammal species (harbour seal, Phoca vitulina; California sea lion, Zalophus californianus; polar bear, Ursus maritimus; common bottlenose dolphin, Tursiops truncatus) held in zoos from 1829 to 2020. We found that life expectancy increased up to 3.40 times, and first-year mortality declined up to 31%, during the last century in zoos. Moreover, the life expectancy of animals in zoos is currently 1.65-3.55 times longer than their wild counterparts. Like humans, these improvements have occurred concurrently with advances in management practices, crucial for population welfare. Science-based decisions will help effective legislative changes and ensure better implementation of animal care.

The Self-Stranding Behavior of a Killer Whale (Orcinus orca) in Inner Danish Waters and Considerations concerning Human Interference in Live Strandings

The rescue attempts of stranded whales and euthanasia considerations must include condition assessments of the individual involved, but this is challenged by our insufficient knowledge about the health statuses of these whales. Here, we describe three separate strandings of a young male killer whale (Orcinus orca) in shallow Danish waters during 2021-2022. During the first two stranding events, the whale exhibited remarkable behavior and, after refloating attempts and several kilometers of swimming, it returned to shallow water. This suggests that it actively chose to be in this shallow water, perhaps to ensure free airways and respiration. During the last stranding, it stayed in shallow water for 30 days, during which, euthanasia was considered due to its seemingly worsened condition, including a collapsed dorsal fin. However, suddenly, the whale swam away and, a year later, he was seen alive, confirming that euthanasia would have been the wrong decision. This case raises an important question as to when and under what circumstances active human interventions, such as refloating attempts, should be launched and when euthanasia should be carried out. Every stranding is unique and decisions should be based on thorough considerations of the animal's health and the chance of a successful rescue.

Visual deprivation induces a stronger dive response in a harbor porpoise

The dive response allows marine mammals to perform prolonged breath-hold dives to access rich marine prey resources. Via dynamic adjustments of peripheral vasoconstriction and bradycardia, oxygen consumption can be tailored to breath-hold duration, depth, exercise, and even expectations during dives. By investigating the heart rate of a trained harbor porpoise during a two-alternative forced choice task, where the animal is either acoustically masked or blindfolded, we test the hypothesis that sensory deprivation will lead to a stronger dive response to conserve oxygen when facing a more uncertain and smaller sensory umwelt. We show that the porpoise halves its diving heart rate (from 55 to 25 bpm) when blindfolded but presents no change in heart rate during masking of its echolocation. Therefore, visual stimuli may matter more to echolocating toothed whales than previously assumed, and sensory deprivation can be a major driver of the dive response, possibly as an anti-predator measure.

Haematology and clinical blood chemistry in harbour porpoises (Phocoena phocoena) from the inner Danish waters

Harbour porpoises (Phocoena phocoena) in the Baltic Sea are under increasing pressure from anthropogenic activities, which affect the overall health of populations. Individuals' haematologic and biochemistry parameters are known to be linked to a population's health status and are therefore useful tools for cross-population comparisons and to assess health patterns of a population through time. However, it is often difficult to acquire data representing the full range of values and assess the influence of intrinsic and extrinsic factors. Here, we present the range of haematology and blood chemistry values obtained from 46 wild (n = 54 blood samples) individuals incidentally caught in pound-nets and five porpoises in long-term human care (n = 449 blood samples) from an outdoor semi-open facility in Denmark. Although it was not possible to formally test the differences between samples from free-ranging and captive individuals, lymphocyte values were lower for free-ranging animals whereas eosinophils and white blood cell values were higher in captive individuals. Aspartate aminotransferase and alanin aminotransferase values were also lower for captive individuals compared to free-ranging ones. Age group did not influence any of the blood parameters tested for free-ranging individuals. Sodium values were higher for males compared to females. Values were higher and lower in the fall for platelets and lactic acid dehydrogenase, respectively, compared to the other seasons. Based on samples yielded by individuals in long-term human care, haemoglobin, mean cell volume, white blood cells, absolute lymphocyte count, and alkaline phosphatase values were all influenced by health status based on clinical examination. These are therefore candidate parameters to assess health status of wild porpoises. Our results underline that it is essential to obtain ranges of reference values for all haematologic and biochemistry markers in order to assess health status of free-ranging individuals. Individuals in human care provide the opportunity to observe biological and ecological determinates (e.g. age, season) of long-term biomarker response patterns and to assess the suite of biomarkers best suited to predict individual health status.

A field study of auditory sensitivity of the Atlantic puffin, Fratercula arctica

Hearing is vital for birds as they rely on acoustic communication with parents, mates, chicks and conspecifics. Amphibious seabirds face many ecological pressures, having to sense cues in air and underwater. Natural noise conditions have helped shape this sensory modality but anthropogenic noise is increasingly impacting seabirds. Surprisingly little is known about their hearing, despite their imperiled status. Understanding sound sensitivity is vital when we seek to manage the impacts of man-made noise. We measured the auditory sensitivity of nine wild Atlantic puffins, Fratercula arctica, in a capture-and-release setting in an effort to define their audiogram and compare these data with the hearing of other birds and natural rookery noise. Auditory sensitivity was tested using auditory evoked potential (AEP) methods. Responses were detected from 0.5 to 6 kHz. Mean thresholds were below 40 dB re. 20 µPa from 0.75 to 3 kHz, indicating that these were the most sensitive auditory frequencies, similar to other seabirds. Thresholds in the 'middle' frequency range 1-2.5 kHz were often down to 10-20 dB re. 20 µPa. The lowest thresholds were typically at 2.5 kHz. These are the first in-air auditory sensitivity data from multiple wild-caught individuals of a deep-diving alcid seabird. The audiogram was comparable to that of other birds of similar size, thereby indicating that puffins have fully functioning aerial hearing despite the constraints of their deep-diving, amphibious lifestyles. There was some variation in thresholds, yet animals generally had sensitive ears, suggesting aerial hearing is an important sensory modality for this taxon.

The common murre (Uria aalge), an auk seabird, reacts to underwater sound

Marine mammals have fine-tuned hearing abilities, which makes them vulnerable to human-induced sounds from shipping, sonars, pile drivers, and air guns. Many species of marine birds, such as penguins, auks, and cormorants, find their food underwater where light is often limited, suggesting sound detection may play a vital role. Yet, for most marine birds, it is unknown whether they are using, and can thereby be affected by, underwater sound. The authors conducted a series of playback experiments to test whether Alcid seabirds responded to and were disrupted by, underwater sound. Underwater broadband sound bursts and mid-frequency naval 53 C sonar signals were presented to two common murres (Uria aalge) in a quiet pool. The received sound pressure levels varied from 110 to 137 dB re 1 μPa. Both murres showed consistent reactions to sounds of all intensities, as compared to no reactions during control trials. For one of the birds, there was a clearly graded response, so that more responses were found at higher received levels. The authors' findings indicate that common murres may be affected by, and therefore potentially also vulnerable to, underwater noise. The effect of man-made noise on murres, and possibly other marine birds, requires more thorough consideration.

Memory for own behaviour in pinnipeds

Pinnipeds are aquatic predators feeding on a vast range of prey, and their social behaviour differs greatly between species (from extreme polygyny in some sea lions to monogamy in some true seals). It has been hypothesised that the foraging and social complexity of their lifestyle should drive the evolution of their cognitive abilities. To investigate how aware pinnipeds are of their own behaviour, a grey seal (Halichoerus grypus), two harbour seals (Phoca vitulina) and four South American sea lions (Otaria flavescens) were trained to repeat their own behaviour on command. Three already trained behaviours were used, and the animal was asked to repeat the behaviour twice to ensure that the animal recalled its own behaviour and not the command given for the previous behaviour. All three species could recall their own behaviour significantly better than by chance. The duration for which the animals could recall their behaviour was tested using a staircase paradigm. A delay was implemented between the completion of the behaviour and the command to repeat it. The delay was increased after correct responses and decreased after incorrect responses. The performance of all species fell towards chance level after 12-18 s, with no significant difference between species. These results indicate that sea lions and true seals are aware of their own behaviour and that true seals have similar short-term memory abilities. It also shows that pinnipeds have less developed short-term memory abilities compared to other aquatic predators, such as the bottlenose dolphin. The complexity of pinniped foraging and social behaviour does not seem to have driven the evolution of short-term memory abilities in these animals but might have contributed to their ability to recall their own behaviour.

Field-based hearing measurements of two seabird species

Hearing is a primary sensory modality for birds. For seabirds, auditory data is challenging to obtain and hearing data are limited. Here, we present methods to measure seabird hearing in the field, using two Alcid species: the common murre Uria aalge and the Atlantic puffin Fratercula arctica. Tests were conducted in a portable semi-anechoic crate using physiological auditory evoked potential (AEP) methods. The crate and AEP system were easily transportable to northern Iceland field sites, where wild birds were caught, sedated, studied and released. The resulting data demonstrate the feasibility of a field-based application of an established neurophysiology method, acquiring high quality avian hearing data in a relatively quiet setting. Similar field methods could be applied to other seabirds, and other bird species, resulting in reliable hearing data from a large number of individuals with a modest field effort. The results will provide insights into the sound sensitivity of species facing acoustic habitat degradation.

Great cormorants (Phalacrocorax carbo) can detect auditory cues while diving

In-air hearing in birds has been thoroughly investigated. Sound provides birds with auditory information for species and individual recognition from their complex vocalizations, as well as cues while foraging and for avoiding predators. Some 10% of existing species of birds obtain their food under the water surface. Whether some of these birds make use of acoustic cues while underwater is unknown. An interesting species in this respect is the great cormorant (Phalacrocorax carbo), being one of the most effective marine predators and relying on the aquatic environment for food year round. Here, its underwater hearing abilities were investigated using psychophysics, where the bird learned to detect the presence or absence of a tone while submerged. The greatest sensitivity was found at 2 kHz, with an underwater hearing threshold of 71 dB re 1 μPa rms. The great cormorant is better at hearing underwater than expected, and the hearing thresholds are comparable to seals and toothed whales in the frequency band 1-4 kHz. This opens up the possibility of cormorants and other aquatic birds having special adaptations for underwater hearing and making use of underwater acoustic cues from, e.g., conspecifics, their surroundings, as well as prey and predators.

In-air hearing of the great cormorant (Phalacrocorax carbo)

Many aquatic birds use sounds extensively for in-air communication. Regardless of this, we know very little about their hearing abilities. The in-air audiogram of a male adult great cormorant (Phalacrocorax carbo) was determined using psychophysical methods (method of constants). Hearing thresholds were derived using pure tones of five different frequencies. The lowest threshold was at 2 kHz: 18 dB re 20 µPa rms. Thresholds derived using signal detection theory were within 2 dB of the ones derived using classical psychophysics. The great cormorant is more sensitive to in-air sounds than previously believed and its hearing abilities are comparable to several other species of birds of similar size. This knowledge is important for our understanding of the hearing abilities of other species of sea birds. It can also be used to develop cormorant deterrent devices for fisheries, as well as to assess the impact of increasing in-air anthropogenic noise levels on cormorants and other aquatic birds.

Baseline non-fasting serum leptin concentration to body mass index ratio is predictive of IVF outcomes

BACKGROUND

The present study was designed to determine whether circulating leptin concentrations and/or body mass index (BMI) in women undergoing IVF are predictive of outcomes.

METHODS

IVF cycle outcomes, e.g. fertilization, embryo development, implantation, pregnancy, were analysed relative to baseline (i.e. day gonadotrophin stimulation was initiated) non-fasting serum leptin concentrations and BMI.

RESULTS

Serum leptin concentrations correlated with BMI (r = 0.739, P < 0.0001) as expected. Multiple logistic regression analyses showed correlation between serum leptin and pregnancy success (likelihood ratio = 5.198, P < 0.05), but there was no association between pregnancy and BMI. However, the serum leptin to BMI ratio was more strongly correlated (likelihood ratio = 7.258, P < 0.01) with pregnancy success than was leptin alone. Moreover, women with a low leptin:BMI ratio (< or =0.3) had significantly more superior quality embryos on day 3 post-retrieval (2.5 versus 1.4, P < 0.05, Kruskal-Wallis) and a greater implantation rate (26.7 versus 13.2%, P < 0.025, chi(2)) than women with a high leptin:BMI ratio (> or =0.7).

CONCLUSIONS

The leptin:BMI ratio appears to be highly predictive of IVF success. Elevated leptin concentrations, particularly relative to BMI, may negatively impact fertility by assisted reproduction, possibly through direct ovarian actions resulting in impaired oocyte quality and/or early embryo development.

Pelvic adhesion formation after intraperitoneal installation of gallstones in a rabbit model

OBJECTIVE

To investigate whether intraperitoneal gallstones increase the risk of pelvic adhesions in a rabbit model.

DESIGN

Prospective, randomized, blinded, sham and human antigen controlled trial.

SETTING

An academic research environment.

SUBJECT(S)

Twelve New Zealand white rabbits.

INTERVENTION(S)

Twelve rabbits were divided into three groups of four each; a sham operation group, a gallstone and bile group (study group), and a human serum albumin and bile group (antigenic control). Three weeks after the operation individual subjects were randomized, with groups concealed to observers, and a necropsy was performed on each rabbit.

MAIN OUTCOME MEASUREMENT(S)

Necropsy was performed on each rabbit, and the adhesions were scored for extent, type, tenacity, inflammation, and gallstone involvement.

RESULT(S)

There was a statistically and biologically significant increase in gallstone involvement in adhesions, especially pelvic adhesions, in the study group.

CONCLUSION(S)

This study, along with an increasing number of case reports, suggests that gallstones inadvertently left in the peritoneal cavity may increase the morbidity of laparoscopic cholecystectomy. In females of reproductive age these gallstones may induce pelvic adhesions that may interfere with fertility or be associated with pelvic pain.

Nonfunctioning pituitary macroadenoma presenting with mild hyperprolactinemia and amenorrhea

OBJECTIVE

To describe a patient with a clinically nonfunctioning pituitary macroadenoma who presented with mild hyperprolactinemia and amenorrhea.

DESIGN

Case report.

SETTING

Tertiary care medical facility.

PATIENT(S)

A 44-year-old woman with a 6-month history of amenorrhea.

INTERVENTION(S)

Pituitary testing, magnetic resonance imaging of the sella turcica, and transsphenoidal surgery.

MAIN OUTCOME MEASURE(S)

Pituitary function testing, magnetic resonance imaging, and return of menstrual cycles.

RESULT(S)

Baseline laboratory data revealed a serum prolactin level of 34 ng/mL (normal range, 3-20 ng/mL), normal thyroid function test results, and an FSH level of 6.7 mIU/mL. A second fasting prolactin level was 48 ng/mL. Magnetic resonance imaging of the sella turcica revealed a pituitary macroadenoma measuring 1.4 x 3.2 cm. Further testing of baseline pituitary function revealed normal findings. The patient underwent an uncomplicated transsphenoidal resection of the pituitary tumor and maintained normal pituitary function. Pathologic evaluation revealed a pituitary adenoma that stained positive for FSH and focally for the alpha subunit. The adenoma stained negative for GH, prolactin, ACTH, LH, and TSH.

CONCLUSION(S)

This patient had a nonsecreting gonadotroph macroadenoma that resulted in hypogonadotropic hypogonadism along with mild hyperprolactinemia, presumably secondary to interruption of normal transport down the pituitary stalk.

Androgens and bone health

Osteoporosis is one of the most common metabolic bone diseases in the adult population and its prevalence will continue to rise as our population grows older. In both sexes, hypogonadism is associated with accelerated loss of bone and development of osteoporosis. Adrenal and gonadal androgen levels decline with advancing age in both sexes. Androgens act by either directly binding to androgen receptors, or by aromatization of androgens to estrogens and subsequently interacting with estrogen receptors. Both pathways are important for skeletal health. Direct androgen binding to an androgen receptor may play a more important role in early skeletal development and determination of sexual dimorphic traits. While bone remodeling, which is important in maintaining healthy bone through life, is primarily stimulated by estrogen, studies in the rat and human support the complex action of androgens and estrogens in bone modeling and remodeling, and hence the development and maintenance of healthy bone. In postmenopausal females, the addition of androgens to hormone replacement therapy results in significant additional improvement in bone mineral density compared to estrogen replacement alone. Accumulating evidence indicate that androgens play an important role in the health of bone and the potential benefit of adding these agents to hormone replacement regimens.

Paternal somatic and germ-line mosaicism for a sex-determining region on Y (SRY) missense mutation leading to recurrent 46,XY sex reversal

OBJECTIVE

To determine the etiology for recurrent 46,XY sex reversal in a family with two Swyer siblings.

DESIGN

Deoxyribonucleic acid (DNA) from peripheral lymphocytes and sperm were analyzed for duplication of the dosage sensitive sex locus (DSS) and for mutations in sex-determining region on Y (SRY).

SETTING

An academic teaching hospital.

PATIENTS

A family consisting of mother, father, and five phenotypic daughters, of which two were 46,XY sex-reversed females.

INTERVENTION

Deoxyribonucleic acid (DNA) extraction, polymerase chain reaction (PCR), Southern blotting, dosage densitometry, single-strand conformation polymorphism (SSCP), and sequencing.

MAIN OUTCOME MEASURE

Comparison of control and subject DNA.

RESULTS

Deoxyribonucleic acid (DNA) analysis of SRY in genomic DNA from the 46,XY sex-reversed siblings revealed identical missense mutations (T-->G) in both sisters. Analysis of the SRY gene in paternal lymphocyte and sperm DNA revealed mosaicism for wild and mutant (T-->G) SRY sequences. SRY analysis of sperm DNA also demonstrated the same mosaicism for the T-->G missense mutation.

CONCLUSION

A postembryonic SRY mutation gave rise to paternal mosaicism for two distinct cell populations (SRY+/SRY-). The presence of a wild type SRY in the somatic cell line may account for a normal pattern of male sexual differentiation, whereas the presence of a mutated SRY in the germ line resulted in two 46,XY sex-reversed offspring. These results confirm a proposed mechanism for the condition of recurrent 46,XY sex-reversed females.

Massive ovarian enlargement in primary hypothyroidism

OBJECTIVE

To report a case of ovarian cyst formation and myxedematous infiltration of the ovary in a subject with primary hypothyroidism.

DESIGN

Retrospective case report.

SETTING

University hospital.

PATIENT(S)

A 16-year-old female adolescent with pelvic pain, galactorrhea, irregular menses, and ovarian cysts on pelvic examination.

INTERVENTION(S)

Laparotomy with bilateral ovarian wedge resection and thyroid replacement therapy.

MAIN OUTCOME MEASURE(S)

Ovarian histopathology, thyroid function tests, and menstrual history.

RESULT(S)

Resolution of patient's pain, galactorrhea, and resumption of normal menses.

CONCLUSION(S)

Ovarian cyst formation may accompany primary hypothyroidism in the child with accelerated or delayed sexual maturation. To date, the underlying pathophysiology of the morphological changes in the ovary remain enigmatic. This case report provides the first insight into the actual histologic changes that occur in ovaries of subjects with primary hypothyroidism without secondary ovarian pathology such as torsion. There is clear evidence of myxedematous infiltration into the ovarian stroma without luteinization of the theca interna. These microscopic findings suggest that local changes occurring independent of gonadotropin stimulation may contribute significantly to altered morphology of the ovaries in primary hypothyroidism.

Ovarian cholelithiasis after laparoscopic cholecystectomy associated with chronic pelvic pain

OBJECTIVE

To report a case of chronic pelvic pain associated with ovarian cholelithiasis and discuss prevention and management of this condition.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S)

A 39-year-old woman who presented with right lower abdominal pain after a laparoscopic cholecystectomy.

INTERVENTION(S)

Diagnostic laparoscopy followed by laparotomy with lysis of adhesions and removal of three to four dozen gallstones.

MAIN OUTCOME MEASURE(S)

Patient's subjective report of pain.

RESULT(S)

Resolution of patient's pain.

CONCLUSION(S)

Gallstones spilled into the peritoneal cavity may migrate and adhere to the dependent portions of the pelvis, potentially resulting in pelvic pain or infertility. This suggests the importance of removing inadvertently spilled gallstones at the time of surgery or using nonsurgical methods of gallstone management in reproductive-aged females.

Differential effects of plasma from normal and ectopic gestation on lymphocyte proliferation

This study investigated immunoregulatory differences as a result of anatomical changes in the fetomaternal interface. Thirty-one female subjects were recruited from a military tertiary-care facility. Ten subjects were non-pregnant while 21 were pregnant (nine normal and 12 ectopic gestations). Immune tests included one-way mixed lymphocyte cultures with and without maternal plasma, phytohemagglutinin stimulation and lymphocyte phenotypes. Basic statistics and a one-way ANOVA using Tuckey's HSD model were employed. Autologous plasma significantly enhanced the allogeneic responses of first-trimester pregnant females with normal gestations to spouses as well as to control male lymphocytes. This enhancement was not observed in either ectopically-pregnant or non-pregnant subjects. Mitogen stimulation and lymphocyte populations were similar in all three groups. The first trimester of normal pregnancy is characterized by the presence of soluble intrauterine pregnancy-specific lymphocyte-enhancing factors. Ectopic gestation lacks this phenomenon.

Lack of magainin-like activity in human cervical tissue

PROBLEM

The cervix plays an integral role in innate immunity of the human reproductive tract. Magainins are antimicrobial and spermicidal peptides recently described in human submandibular glands. We investigated the human cervix for magainin-like peptides.

METHOD

Histologic sections of frozen and paraffin embedded cervical tissue from nine subjects were separately incubated with two rabbit, polyclonal, anti-magainin antibodies (CB-2 and CB-7) to investigate for magainin-like activity in the human cervix.

RESULTS

There was no specific staining of cervical columnar cells within the endocervical canal or in the endocervical crypts. Magainin-like immunoreactivity in the human submandibular gland confirmed previous observations.

CONCLUSION

Antigen related to magainin-like peptides were not discovered in the human cervix.

Calcium-activated sodium and chloride fluxes modulate platelet volume: role of Ca2+ stores

An increase in cytosolic ionized Ca2+ concentration ([Ca2+]i) initiates volume changes in various types of cells. In response to increases in [Ca2+]i most cell types contract by efflux of K+ and Cl-, whereas platelets expand in response to rises in [Ca2+]i. This study examined the importance of the source of Ca2+, the flux of ions responsible for the volume change, and the role of Ca(2+)-dependent protein kinases in regulating these ionic fluxes. The baseline platelet volume was independent of extracellular Ca2+ but when stimulated by the Ca2+ ionophore A-23187 (50 nM) the volume increased in both the presence and absence of extracellular Ca2+ (1.18 +/- 0.08 vs. 0.83 +/- 0.06 fl, respectively). The increased volume was caused by the gain of Na+ and Cl-. Na+ entered through both conductive and nonconductive (Na+/H+ exchange) pathways, whereas the influx of Cl- was conductive and inhibited by the Cl- channel blocker 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid. The Ca(2+)-induced volume change was blocked by both calmodulin and protein kinase inhibitors. Thus the activation of Ca(2+)-dependent protein kinases promotes platelet swelling by stimulating Na+ and Cl- influx.

An unusual complication of laparoscopic cholecystectomy

Laparoscopic cholecystectomy is gaining increasing acceptance as a mode of minimally invasive surgery. We describe a peculiar gynecologic complication following uncomplicated laparoscopic cholecystectomy. Our patient presented with a four-month history of subacute pelvic pain, primarily located in the right lower quadrant, two years after laparoscopic cholecystectomy. Diagnostic laparoscopy revealed a hemaclip embedded in the right ovarian capsule of an otherwise normal pelvis. The hemaclip had probably dislodged from its original site of placement in the upper abdomen, and migrated to the dependent portions of the pelvis, where it implanted in a follicular stigma and became affixed to the ovarian capsule. The hemaclip was removed without complications, and the patient's symptoms improved.

Suboptimal progesterone production in pathologic pregnancies

Serum progesterone (P) levels were determined at the time of routine prenatal registration (227 patients) or upon presentation for evaluation of vaginal bleeding and/or abdominopelvic cramping/pain (135 patients). P associated with a normal intrauterine gestation was 24.63 +/- 4.19 (SD) ng/mL as compared with 6.29 +/- 2.43 ng/mL and 6.02 +/- 2.39 ng/mL for spontaneous abortions and ectopic gestations, respectively. Further, P differed between asymptomatic (11.92 +/- 9.61 ng/mL) and symptomatic patients (4.81 +/- 3.92 ng/mL) who were subsequently shown to have an abnormal gestation. By establishing a P cutoff point of < or = 14.2 ng/mL and < or = 10.5 ng/mL in asymptomatic and symptomatic patients, respectively, 100% screening sensitivity was reached, and therefore no abnormal gestations would escape detection in our study population. P was either in the normal or abnormal range as early as four weeks' estimated gestational age and persisted as such through the luteal-to-placental shift and up to the time of pregnancy loss or 12 weeks' estimated gestational age. Although there was no significant correlation between P and chorionic gonadotropin levels and pregnancy outcome, the binding constant for native chorionic gonadotropin was 15-52 times lower in 12 of 41 cases of spontaneous abortion but not ectopic gestation, suggesting a possible molecular basis for suboptimal P production. P is therefore an excellent adjunctive marker for prediction of early pregnancy outcome, and in some cases qualitative abnormalities in chorionic gonadotropin may dictate its production.

Short term treatment with leuprolide acetate is a successful adjunct to surgical therapy of leiomyomas of the uterus

Gonadotropin releasing hormone analogs (GnRHa) have been used to induce a reduction in the size of leiomyomas of the uterus after three to six months of therapy. However, none of the studies have noted a significant decrease in size by the first month. Additionally, the results of two reports have suggested long term therapy with GnRHa induced significant aberrations of serum lipoproteins. To evaluate whether or not analog treatment for a short course (two months) would be efficacious, 27 patients with leiomyomas documented by examination of the pelvic area and vaginal ultrasound, who desired to preserve reproductive potential, had myomectomies two and one-half months after commencing depot leuprolide acetate therapy. The reduction in size of the uterus was 35 percent by the first month and the average reduction in the total volume was 44 percent after two months of treatment (474 +/- 364 to 265 +/- 173 milliliters; p less than 0.01). Furthermore, the size of the uterus, determined by examination, decreased significantly from 13.6 +/- 4.0 weeks initially to 10.1 +/- 3.0 weeks preoperatively (p less than 0.0001). Estradiol levels became menopausal by one month of therapy and remained suppressed preoperatively. Menopausal symptoms were well tolerated. Cholesterol, high density lipoprotein, extremely low density lipoprotein and triglyceride levels were not altered by analog treatment, although low density lipoprotein increased from 117 to 130 milligrams per deciliter. A short course of depot leuprolide acetate reduced the size of leiomyomas and surgical tissue planes were preserved, facilitating removal of leiomyomas, and furthermore, there was no significant clinical alteration in lipoprotein or triglyceride levels.

Changes in T-cell regulation of responses to self antigens in women with pelvic endometriosis

OBJECTIVE

To study autoimmune aspects of endometriosis.

DESIGN

Lymphoblast transformation and hemolytic plaque formation were used to assess specific T- and B-cell activity against endometrial antigens.

SETTING

Military teaching hospital.

PATIENTS

Ninety-four healthy women of reproductive age undergoing diagnostic laparoscopy as part of an evaluation for infertility or chronic pelvalgia were accordingly grouped into those with normal pelvic peritoneum (20), mild endometriosis (50), and severe endometriosis (24).

MAIN OUTCOME MEASURE

The study assessed the proliferative and humoral responses of lymphocytes from women with and without endometriosis to endometrial antigens and quantified the number of B-cell precursors, T-helper cells, and T-suppressor cells to these antigens.

RESULTS

Unfractionated endometrial antigens were similarly blastogenic for lymphocytes from women with and without endometriosis. Despite equivalent numbers of B-cell precursors to these antigens, antiendometrial antibody responsiveness appears to have increased in women with mild endometriosis because of a decrease in T-suppressor cell activity and declined in women with severe endometriosis because of a further drop in T-suppressor cell activity and an increase in T-helper cell activity, as compared with women without endometriosis.

CONCLUSIONS

Taken together, these experiments support the possibility that pelvic endometriosis may result from a break in specific T-cell tolerance rather than nonspecific polyclonal activation of responder lymphocytes.

Natural killer cell activity from pregnant subjects is modulated by RU 486

Natural killer cells form an integral component of the body's innate immune system. Natural killer cell activity is reduced during pregnancy, especially in the latter half. To investigate the role progesterone may play in immunomodulating natural killer cell activity during pregnancy, we evaluated the effect of RU 486 on natural killer cells isolated from pregnant subjects. Natural killer cell activity was measured with an 18-hour, Chromium 51 release, microcytotoxicity assay with K-562 cells as target cells. We demonstrated that RU 486, in a concentration range from 5 to 40 mumol/L, augmented natural killer activity threefold to fivefold over baseline. This augmentation of activity was suppressed to baseline by the addition of excess progesterone. The addition of hydrocortisone resulted in an insignificant reduction in this augmented activity. This study suggests that progesterone may play a role as an immunomodulating factor in maternal acceptance of the fetal allograft.

Antisperm antibodies to sperm surface antigens in women with genital tract infection

Antisperm antibodies to sperm surface antigens in nulligravid women with primary upper genital tract infections were measured by the sperm mixed agglutination reaction assay. As many as 56% of women with a primary episode of pelvic inflammatory disease had antisperm antibodies. In addition, 69% of those women with no history of genital tract infection but with laparoscopic evidence of past pelvic infection had significant levels of circulating antisperm antibodies. Electroimmunoblots of sperm preparations probed with the sera of women who had either known or presumed upper genital tract infection revealed a uniformly recognized 69 kd antigen. In contrast, women with circulating antisperm antibodies before primary upper genital tract infection recognized up to five distinct sperm antigen determinants of 27, 54, 131, 146, and 174 kd. It is a distinct possibility that genital tract infections may lead to immunopotentiation of antisperm antibodies that could affect fertility.

Calcium-activated potassium channels in human platelets

The cationic fluorescent probe, DiSC3(5) was used to measure the membrane potential in human platelets. Hyperpolarization was induced by the addition of Ca2+ to the medium and also by the addition of the Ca2+ ionophore, A23187. In the absence of extracellular Ca2+ ([Ca2+]o) there was no response to A23187. The threshold concentration for [Ca2+]o was 20 microM and for A23187 was 12 nM. The increase polarity induced by [Ca2+]o was not affected by various K+ channel blockers. However, the effect of A23187 was inhibited by quinine and charybdotoxin, while apamin, tetraethylammonium, and the calmodulin inhibitors trifluoperazine and compound R24571 were ineffective. The resting membrane potential was -66 +/- 0.9 mV and was decreased by quinine. There are three conclusions from this study: (i) Ca2+-activated K+ channels exist in human platelets; (ii) they are the type that are apamin insensitive, charybdotoxin sensitive; and (iii) they may contribute to the resting membrane potential.

Teledyne Sleep Sentry: evaluation in pediatric patients for detection of nocturnal hypoglycemia

Twenty-four insulin-dependent diabetic pediatric subjects were studied for 1444 nights for detection of nocturnal hypoglycemia with the Teledyne Sleep Sentry (Teledyne Avionics, Charlottesville, Virginia): a wristwatch-like unit that measures absolute changes in skin temperature and decreases in galvanic skin resistance, indicators of hypoglycemia. The device detected 42 of 46 recognized hypoglycemic episodes. One hundred fifty alarms were sounded without evidence of hypoglycemia, probably due to night sweating. Twenty-five percent of the subjects experienced unacceptable cutaneous reactions, presumably due to metallic iontophoresis.

Changes in 25-hydroxyvitamin D3 alpha- and 24-hydroxylase activities of kidney cells isolated from rats with either unilateral kidney damage or acute renal insufficiency

25-Hydroxyvitamin D3 1 alpha- and 24-hydroxylase, NADPH-cytochrome c reductase, heme oxygenase, and ATPase activities were studied in viable kidney cells isolated from rats submitted to unilateral kidney damage (cortical electrocoagulation) and during the development of acute renal failure subsequent to excision of the contralateral undamaged kidney. Measurements of blood pH, plasma total and ionized calcium, phosphorus, creatinine, kidney histology, and phosphorus nuclear magnetic resonance spectroscopy determinations of phosphorus-containing compounds in kidney tissue were also performed. Seventy-two hours after unilateral kidney damage, no significant changes were observed in blood pH or in the plasma parameters studied. During this period, a significant increase in the activity of the 25-hydroxyvitamin D3 hydroxylases could be demonstrated in the cells of the contralateral undamaged kidney. A similar pattern of compensatory rise in the activity of the other enzymes studied was not detected. However, in the damaged kidney viable cells, the hydroxylase activities remained unchanged relative to those in sham-operated controls, despite a 5-fold increase in the inorganic phosphate content and a marked decrease in the organophosphorus and ATP content of this tissue. During the development of acute renal failure, a significant decrease in the activity of the hydroxylases occurred only when the rise in plasma creatinine concentration suggested severe renal insufficiency.

Trends in return migration to the South

The rate of return migration to the South rose by nearly 19 percent between the late 1950's and the late 1960's and was an important factor in changing the South's overall migration pattern. But an increase in the rate of return migration was somewhat less important in changing Southern migration than (1) a decline in the rate of out-migration of native Southerners and (2) an increase in the rate at which non-Southern-born persons move to the South. The probability of former migrants returning to the South was over four times greater for whites than for blacks in the 1955-1960 period and three and one-fourth times greater in the 1965-1970 period. Since 1970 the rate of return migration has apparently continued to rise at a faster rate for blacks, but the black rate of return migration is still below the white rate.