Methylation and uracil interference assays for analysis of protein-DNA interactions

Interference assays identify specific residues in the DNA binding site that, when modified, interfere with binding of the protein. The protocols use end-labeled DNA probes that are modified at an average of one site per molecule of probe. These probes are incubated with the protein of interest, and protein-DNA complexes are separated from free probe by the mobility shift assay. A DNA probe that is modified at a position that interferes with binding will not be retarded in this assay; thus, the specific protein-DNA complex is depleted for DNA that contains modifications on bases important for binding. After gel purification, the bound and unbound DNA are specifically cleaved at the modified residues and the resulting products analyzed by electrophoresis on polyacrylamide sequencing gels and autoradiography. In the methylation interference protocol presented here, probes are generated by methylating guanines (at the N-7 position) and adenines (at the N-3 position) with DMS; these methylated bases are cleaved specifically by piperidine. In the uracil interference protocol, probes are generated by PCR amplification in the presence of a mixture of TTP and dUTP, thereby producing products in which thymine residues are replaced by deoxyuracil residues (which contains hydrogen in place of the thymine 5-methyl group). Uracil bases are specifically cleaved by uracil-N-glycosylase to generate apyrimidinic sites that are susceptible to piperidine. These procedures provide complementary information about the nucleotides involved in protein-DNA interactions.

Uterine artery embolization for management of interstitial twin ectopic pregnancy: case report

Interstitial pregnancy is rare and dangerous variation of ectopic pregnancy. We describe a case of unilateral interstitial viable twin pregnancy treated by selective uterine artery embolization. A 23-year-old women with clinical and ultrasonic diagnosis of viable twin interstitial pregnancy was treated by selective uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-HCG was undetectable 2 months after the procedure and the ultrasound scan 70 days after embolization showed only multiple echogenic spots in the right uterine cornua. This therapeutic modality seems to be effective for conservative management of interstitial ectopic pregnancy, and as a prophylactic measure before surgical intervention to prevent major bleeding.

Induction of labor in women with previous cesarean section using the double balloon device

BACKGROUND AND METHODS

To evaluate the efficacy and safety of labor induction by the double balloon device in women with previous cesarean section. Induction of labor was carried out in 37 women with previous cesarean section for various indications. All the inductions of labor were performed using the Atad double balloon device (ARD).

RESULTS

Cervical ripening (Bishop scores above 5) was achieved in 82.3% of the induced women with subsequent vaginal delivery in 78.6% and repeat cesarean section in 22.3%. An important observation of the results was the chances to achieve a vaginal delivery according to the second Bishop score that was recorded 12 hours following the insertion of the device. When the second was above 5 the chances for vaginal delivery were 79.4%. The mean time from removal of the device to delivery was 10.8 hours. No complications were noted using the device.

CONCLUSIONS

The double balloon device appears to be a safe and effective method of inducing labor in women with a previous lower segment cesarean section. Wide scale studies and further use of the device for induction of labor in women who have had previous cesarean sections are warranted.

Successful pregnancy in a patient with polycystic kidney disease and advanced renal failure without prophylactic dialysis

Pregnancies in women suffering from advanced chronic renal failure are frequently associated with deterioration of maternal renal function, premature births and low birth weights. Prophylactic dialysis is sometimes instituted since this intervention ameliorates the uremic milieu and improves maternal status and fetal uterine environment. This report describes a successful pregnancy and delivery in a hypertensive woman with advanced chronic renal failure due to polycystic kidney disease without accelerating the natural deterioration of renal function and without instituting prophylactic dialysis. The infant was delivered at full term with a normal birth weight. Thirty months after delivery, growth and development of the child were normal and the rate of deterioration of maternal renal function, assessed by 1/creatinine, was unaffected by pregnancy. Conservative management and effective control of blood pressure may be sufficient to achieve successful pregnancy outcome when women with advanced chronic renal failure become pregnant.

Maternal obesity and pregnancy outcome

BACKGROUND

Obesity, a common condition in developed countries, is recognized as a threat to health.

OBJECTIVES

To describe the distribution of weight in pregnant women and evaluate the influence of obesity on pregnancy outcome in a high parity northern Israeli population.

METHODS

The study included 887 women who gave birth in the Western Galilee Medical Center during the period August to November 1995. The patients were classified as underweight, normal weight, overweight, or obese according to body mass index. Maternal demographic, obstetric, and perinatal variables were compared. A control group of 167 normal weight women were matched with the obese group for maternal age, parity, and gestational age.

RESULTS

Obese mothers had a higher incidence of gestational diabetes and pregnancy-induced hypertension compared to normal weight mothers (5.4% vs. 1.8%, and 7.2% vs. 0.6% respectively, P < 0.01), a higher rate of labor induction (20.4% vs. 10.2%, P < 0.01), and a higher cesarean section rate (19.6% vs. 10.8%, P < 0.05). There was also a significant difference in the prevalence of macrosomia in the offspring (16.8% vs. 8.4%, P < 0.05).

CONCLUSION

Obese pregnant women are at high risk for complications during delivery and therefore need careful pre-conception and prenatal counseling, as well as perinatal management.

Acute adrenal insufficiency during pregnancy and puerperium: case report and literature review

Acute adrenal dysfunction during pregnancy is rare. Nevertheless, adrenal insufficiency can present as an adrenal crisis, and may be life threatening. There is a wide range of clinical symptoms and signs, and the differential diagnosis is challenging. A full adrenal and pituitary evaluation, both structural and hormonal, must be performed to reach the correct diagnosis, and appropriate treatment must not be delayed. A case is presented of acute adrenal insufficiency that occurred 24 hours after a cesarean delivery. The initial symptoms included hypoglycemic seizures and coma. The workup, both hormonal and structural, revealed isolated adrenocorticotrophic hormone deficiency. This considers this case and reviews the differential diagnosis, diagnostic workup, and the treatment of adrenal dysfunction in pregnancy and the puerperium, as well as the obstetric outcome in women suffering from this disorder.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader will be able to understand the various presentations of hypopituitarism, the various etiologies of this condition, and the appropriate work up and management of a patient with hypopituitarism.

Creatine kinase as a biochemical marker in diagnosis of placenta increta and percreta

We describe 1 case of placenta increta and 1 of placenta percreta, both associated with elevated maternal serum creatine kinase concentration. In patients with placenta previa and ultrasonographic findings of an abnormally adherent placenta, an unexplained elevation in maternal serum creatine kinase level should alert the clinician to the possibility of placenta increta or placenta percreta, with an attendant increase in maternal morbidity.

Evidence that women with a history of cesarean section can deliver twins safely

OBJECTIVE

To determine whether a trial of labor is safe in twin pregnancies after one previous cesarean section.

STUDY DESIGN

Retrospective analysis of all cases of multiple pregnancies after cesarean section during the years 1970-1993, including twin gestations after one cesarean section.

RESULTS

Forty-six cases of multiple gestations were found, 36 of which were eligible for the study presented herein. Fifteen women (41.7%) were denied trial of labor. Twenty-one women (58.3%) were allowed trial of labor, 17 (80.9%) of whom were delivered vaginally and four (19.1%) by a repeated cesarean section. The group of trial of labor was compared to the group of elective cesarean section. Hospitalization period was 4.4 +/- 1.9 days and 8.0 +/- 2.6 days in the trial of labor group and elective cesarean section group, respectively (p<0.01). Blood transfusions required were 9.5% and 26.6% in both groups, respectively (NS). Puerperal infections were 9.5% in the trial of labor group, compared to 46.6% in the elective cesarean section group (NS). No scar dehiscence occurred in either groups. There were no statistically significant differences in age, parity, gestational age at delivery, mean newborn weight, Apgar score at one and five minutes, Neonatal Intensive Care Unit admission and mean Neonatal Intensive Care Unit stay.

CONCLUSIONS

Vaginal delivery in twin gestation after one previous cesarean section may be considered in appropriate cases. A large multicentral randomized prospective study may further confirm this conclusion.

Progesterone levels in preterm labor are not affected by ritodrin treatment

Several in vitro studies reported on increased levels of progesterone secretion from placental tissue. This was not tested in vivo. To study the issue we examined progesterone levels in women presenting with premature labor before treatment, and 24 h and 48 h after beginning ritodrin treatment. A control group consisted of women treated with indomethacin for preterm labor. There were 13 women in the ritodrin group and 12 in the control group. The mean concentration of progesterone in the ritodrin group was 161.7 +/- 74.2, 132 +/- 50.2 and 145 +/- 49.8 ng/ml before treatment, and 24 and 48 h after ritodrin treatment, respectively. The mean progesterone concentration of the group treated with indomethacin was 129 +/- 45.6, 132 +/- 49.5 and 138.6 +/- 53.5 ng/ml before treatment, and 24 and 48 h after treatment, respectively. There were no statistically significant differences between the groups or within each group before and after treatment. Ritodrin treatment does not affect progesterone levels in vivo as demonstrated by in vitro studies.

Role of the karyopherin pathway in human immunodeficiency virus type 1 nuclear import

The interaction of the human immunodeficiency virus type 1 (HIV-1) nucleoprotein complex with the cell nuclear import machinery is necessary for viral replication in macrophages and for the establishment of infection in quiescent T lymphocytes. The karyophilic properties of two viral proteins, matrix (MA) and Vpr, are keys to this process. Here, we show that an early step of HIV-1 nuclear import is the recognition of the MA nuclear localization signal (NLS) by Rch1, a member of the karyopherin-alpha family. Furthermore, we demonstrate that an N-terminally truncated form of Rch1 which binds MA but fails to localize to the nucleus efficiently blocks MA- but not Vpr-mediated HIV-1 nuclear import. Correspondingly, NLS peptide inhibits the nuclear migration of MA but not that of Vpr and prevents the infection of terminally differentiated macrophages by vpr-defective virus but not wild-type virus. These results are consistent with a model in which Rch1 or another member of the karyopherin-alpha family, through the recognition of the MA NLS, participates in docking the HIV-1 nucleoprotein complex at the nuclear pore. In addition, our data suggest that Vpr governs HIV-1 nuclear import through a distinct pathway.

Anaphylactic shock during hysteroscopy using Hyskon solution: case report and review of adverse reactions and their treatment

Dextran 70 (Hyskon) solution, as many other substances, is in current use as distension medium during hysteroscopy. The advantages of Hyskon solution are its nonconductivity and immiscibility with blood, allowing good visibility during operative hysteroscopy. Adverse reactions to Hyskon are mainly attributable to the drug's antigenic properties and include severe anaphylactic reactions and fatalities. We report a case of anaphylactic shock during hysteroscopy using Hyskon solution as the distension medium, review the adverse reactions of Hyskon and summarize the treatment modalities used to decrease the incidence of the rare but serious adverse reactions with its use.

Does the electrocardiographic pattern of "anteroseptal" myocardial infarction correlate with the anatomic location of myocardial injury?

The current electrocardiographic (ECG) definition of anteroseptal acute myocardial infarction (AMI) is a Q wave or QS wave > 0.03 second in leads V1 to V3, with or without involvement of lead V4. To verify whether there is a correlation between the ECG pattern of anteroseptal AMI and the location of an AMI, we compared ECG, echocardiographic, and cardiac catheterization findings of 80 patients who fit the traditional definition of anteroseptal AMI. We found that 48 of 52 patients (92%) who presented with ST elevation in leads V1 to V3 had an anteroapical infarct and a normal septum. The culprit narrowing was more frequently found (in 85% of patients) in the mid to distal left anterior descending artery. We conclude that there is no correlation and that the ECG pattern traditionally termed anteroseptal AMI should be called an anteroapical AMI; the term anteroseptal AMI should be defined as extensive anterior wall AMI associated with diffuse ST changes involving the anterior, lateral, and occasionally, inferior leads.

Beta-HCG concentration in peritoneal fluid and serum in ectopic and intrauterine pregnancy

OBJECTIVE

To evaluate the significance of beta-HCG levels in peritoneal fluid and serum in the diagnosis of ectopic pregnancy. STUDY DESIGN SETTING: Obstetrics and Gynecology department of a regional general hospital.

SUBJECTS

Sixty-two women who presented with a differential diagnosis of ectopic pregnancy vs. nonviable intrauterine pregnancy.

INTERVENTIONS

All patients underwent D & C and culdocentesis. beta-HCG was measured in simultaneously obtained peritoneal fluid (PF) and serum (S), and the PF/S ratio calculated.

RESULTS

Twenty-three patients had an ectopic pregnancy (Group I). All 23 had higher beta-HCG concentrations in the PF than in the serum, with a mean PF/S ratio of 19.1 +/- 16.9. Twenty-four patients had an intrauterine pregnancy (Group II). The beta-HCG levels in the PF and serum were similar (mean PF/S 1.1 +/- 0.2). The difference in PF/S ratio between groups I and II was statistically significant (p < 0.001).

CONCLUSION

The measurement of beta-HCG in peritoneal fluid and serum is a useful diagnostic tool in differentiating ectopic from intrauterine pregnancy.

Is removal of the tube mandatory after coagulation in ectopic pregnancies

Laparoscopic treatment of ectopic pregnancy is gaining wide acceptance. We report a new simple laparoscopic technique involving grasping the tube with forceps and coagulating on both sides of the ectopic pregnancy site, leaving the fertilized ovum in situ. This method is suitable for multiparous women and women who request tubal sterilization. Sixteen patients (mean age 32.6 +/- 4.4 years) were treated by using this method. The mean duration of hospitalization was 1.94 +/- 1.12 days. No complications occurred.

Acceptability and skin reactions to transdermal estrogen replacement therapy in relation to climate

The acceptability and skin reaction of Estraderm Transdermal Therapeutic Systems as a function of climatic variability were examined in various zones which alter considerably in their temperature and humidity. An open, noncomparative prospective study was carried out in four institutional out-patient menopausal clinics in varying climatic areas. Eighty symptomatic postmenopausal patients without previous estrogen replacement were examined. Estraderm T.T.S. 50 was applied twice weekly in four weekly cycles. Norethisterone-acetate tablets (1 mg), were taken orally for 12 consecutive days. Using a questionnaire, the subjects were asked about the efficacy of the treatment on postmenopausal symptoms, the adhesiveness and tolerability. The results were matched with the meteorological conditions. The duration of the study was 6 months. Acceptability of Estraderm T.T.S. is high (78.7%). Discontinuation of treatment was found in 21.3% of the study group. The main reason for discontinuation is due to skin reactions which occurred in 14 of the 80 patients (17.5%). Meteorological conditions in this study did not influence the rate of skin reactions. No difference in acceptability of the treatment was found in relation to the mean temperature and mean humidity as registered in the dry desert and the humid coastal areas.

Tubal anastomosis in the rat using the tissue adhesive cyanoacrylate (Histoacryl)

n-Butyl-2-cyanoacrylate (Histoacryl) is said to be as effective as microsurgery for tubal anastomosis. In a prospective controlled study at the regional teaching hospital research laboratories, 40 female laboratory rats underwent laparotomy, with ligation of the uterine horns, and reanastomosis by microsurgery or cyanoacrylate tissue adhesive. Main outcome measures were patency of uterine horns following anastomosis, histologic examination of anastomotic sites and pregnancy rate following anastomosis by each of the two methods. Patency rates were 100% with both methods of anastomosis, although foreign-body granulomas were more prominent in horns anastomosed by microsurgery. When cyanoacrylate was used on one horn and the contralateral horn ligated, a 90% pregnancy rate was achieved; when microsurgery was used, the pregnancy rate was 80%. In microsurgically anastomosed tubes there was a longer narrow segment, resulting in a lower number of embryos per rat. Cyanoacrylate tissue adhesive is successful in tubal reanastomosis and has certain advantages over classical microsurgical techniques: fewer foreign-body granulomas occur; there is less narrowing of the uterine horn; less skill is required in its use.

Betamethasone and intrauterine fetal death

Three cases of intrauterine fetal death occurring shortly (within 24 h) after betamethasone administration are described. Two of the women were diabetic, and the third had secondary infertility due to hyperprolactinemia. None of the stillborns had evidence of gross malformations. In view of the fact that infants born prematurely now have a better chance of survival in intensive-care units than in previous years, we believe that for certain high-risk mothers, the policy of betamethasone administration for preventing respiratory distress syndrome in premature babies must be revised.

Is cesarean section necessary for delivery of a breech first twin?

Eighty-two pregnancies involving a breech first twin were retrospectively analyzed over two study periods during which the cesarean section rates were 20.9 and 94.9%, respectively. The neonatal and maternal morbidity in both study periods was compared. There were no neonatal deaths during either study period and no cases of interlocking twins among patients delivered vaginally. Neonatal morbidity was unrelated to the mode of delivery. The incidence of maternal fever was, however, significantly higher in the cesarean section group compared with the vaginal delivery group (p < 0.001). Our study suggests that vaginal delivery of selected twin gestations with a breech first twin should be an alternative to cesarean delivery.

Asymptomatic paroxysmal atrial fibrillation during intravenous magnesium sulfate treatment in preeclampsia

Magnesium sulfate is commonly used as the anticonvulsant drug of choice for preeclampsia and eclampsia. It is effective, nontoxic to both mother and fetus, and side effects are rare within the therapeutic range. This report describes paroxysmal atrial fibrillation occurring at low serum levels of the drug during the treatment of preeclampsia.

A link between double-strand break-related repair and V(D)J recombination: the scid mutation

We show here that mammalian site-specific recombination and DNA-repair pathways share a common factor. The effects of DNA-damaging agents on cell lines derived from mice homozygous for the scid (severe combined immune deficiency) mutation were studied. Surprisingly, all scid cell lines exhibited a profound hypersensitivity to DNA-damaging agents that caused double-strand breaks (x-irradiation and bleomycin) but not to other chemicals that caused single-strand breaks or cross-links. Neutral filter elution assays demonstrated that the x-irradiation hypersensitivity could be correlated with a deficiency in repairing double-strand breaks. These data suggest that the scid gene product is involved in two pathways: DNA repair of random double-strand breaks and the site-specific and lymphoid-restricted variable-(diversity)-joining [V(D)J] DNA rearrangement process. We propose that the scid gene product performs a similar function in both pathways and may be a ubiquitous protein.

[Aortic dissecting aneurysm during pregnancy]

Aortic dissecting aneurysm is a rare, serious complication of pregnancy. This condition was diagnosed in a 34-year-old woman in the 38th week of pregnancy. Cesarean section was immediately performed, and was followed by surgical repair of the dissection. A normal male infant was delivered.

[Right ventricular dysplasia]

Right ventricular dysplasia (RVD) is characterized by partial or total replacement of part of the right ventricular musculature by fatty and fibrous tissue. In its typical form it presents with ventricular tachycardia, usually in the fourth decade of life. 6 men and 2 women (mean age 55.6 years), referred for evaluation of arrhythmias or other cardiac symptoms, were diagnosed as having RVD on echocardiography after other causes of right ventricular enlargement were excluded. The mean age was 55.6 years, older than originally reported. 5 presented with supraventricular arrhythmias, including atrial flutter, atrial fibrillation, supraventricular tachycardia and sick-sinus syndrome. Only 2 had ventricular tachycardia; in 1 patient no arrhythmia was found. We conclude that RVD includes a wide spectrum of arrhythmias, of which ventricular tachycardia is probably not the most common. The incidence of RVD in the older population may be greater than originally reported, and may include a slowly developing form of the disease. In some cases RVD may be the pathophysiological basis of lone atrial fibrillation and sick-sinus syndrome.

Breech presentation after cesarean section: always a section?

A retrospective review of 71 breech deliveries after previous cesarean was done to determine the need for repeat cesarean section. Twenty-four (33.8%) women were allocated to the elective repeat cesarean section group and forty-seven (66.2%) patients were allocated to a trial of labor group. Thirty-seven (78.7%) were delivered of their infants vaginally. A total of 37 of the 71 women (52.1%) had successful vaginal deliveries. Neonatal morbidity did not differ for women who were delivered vaginally or by cesarean section. Maternal febrile morbidity was significantly higher in the cesarean section group than in the vaginal delivery group (p less than 0.001). On the basis of these data, a trial of labor seems reasonable in carefully selected cases of breech presentation after a previous cesarean section.

Isometric exercise test for predicting gestational hypertension

One hundred normotensive young primigravidas underwent an isometric handgrip exercise test between 28 and 32 weeks of gestation. The same individual performed the tests and the results were withheld from the physician taking care of the patient. The study demonstrates a sensitivity of 81% and a specificity of 96.5%. These results demonstrate a reliable predictive ability of this simple exercise test for gestational hypertension.

Lipid and lipoprotein levels following pure estradiol implantation in post-menopausal women

8 post-menopausal, post-oophrectomy and hysterectomy women had a 100-mg pure 17 beta-estradiol pellet installed in their subcutaneous abdominal tissue. The pellet caused a marked systemic hormonal effect in these patients causing an up to 30-fold increase in plasma estradiol and a marked decrease in follicle-stimulating hormone levels. It showed a significant increase in plasma high density lipoprotein (HDL) and HDL to total cholesterol ratio levels, no change in plasma triglycerides and very low density lipoprotein levels and some decrease in total cholesterol and low density lipoprotein cholesterol concentrations. These results differ from the previously reported influence of synthetic hormonal preparations on the same plasma lipids and lipoproteins.

Hormonal profile of endometrial cancer

Out of all the risk factors of endometrial carcinoma, the 'Oestrone Theory' is especially fascinating. This theory assumes that prolonged uninterrupted stimulation of the endometrial cell by oestrone, without the competition of oestradiol and oestriol, brings about neoplasia. There is also some evidence of a protective effect of androgens and progesterone. In order to verify this theory in vivo, oestrone (E1), oestradiol (E2), testosterone (T) and progestogen levels were examined from the serum of 36 post-menopausal women suffering from endometrial carcinoma, and compared with a healthy group of women. Oestrone levels were found to be significantly higher in patients with endometrial carcinoma. A correlation was also found between oestrone levels and previous infertility. With the intention of tracking the origin of oestrone in those suffering from endometrial cancer, hormone levels were checked before and after total hysterectomy and oophorectomy. The high oestrone values dropped to normal after the operation, except in those who had previously suffered from infertility. In those patients, high oestrone values were found a year after the operation. No significant differences of testosterone or progesterone were found between the cancer patients and the healthy women. The operation did not have any influence on these values.

The effect of oestrogen implants on high density lipoproteins and its subfractions in women in their pre-mature menopause

Oestrogen is recognized as having profound effects on lipid and lipoprotein levels. It is also considered as the agent protecting the pre-menopausal woman from arteriosclerotic cardiovascular disease. High density lipoprotein (HDL) has also been ascribed a protective role against the development of arteriosclerosis. The effect of natural oestrogen (17 beta-oestradiol) administered in the form of a subcutaneous pellet on concentrations of lipids and lipoproteins, particularly high density lipoproteins and its subfractions were determined in three young women with premature menopause. Plasma cholesterol, low density lipoprotein and very low density lipoprotein and very low density lipoprotein levels decreased following oestrogen implantation. High density lipoproteins and in particular subfraction 2 (density cut 1.063-1.125 gm/ml) and subfraction 3 (density cut 1.125-1.21 gm/ml) increased profoundly but there was a slight fall in the HDL 2/HDL 3 cholesterol ratio. The HDL/LDL cholesterol ratio increased from 0.21 to 0.46. A decrease in the urinary FSH levels paralleled these changes in the lipoprotein concentrations. Oestrogen administered in this form, unlike other oestrogen or mixed oestrogen--progestogen compounds is a definite modifier of arteriosclerotic risk, and as such could be given therapeutically in menopausal hypercholesterolemic females.

Assessment of fetal lung maturity by a microviscosimeter

A new method of rapid antenatal assessment of fetal lung maturity was evaluated in relation to the newborn outcome and two other accepted test. This method is based on fluorescence depolarization (FD) technique. The special instrumentation required for this method (the Microviscosimeter) was found to be simple and easy to handle even to nonprofessional personnel. Analysis of 47 samples of amniotic fluid received within 48 hours of delivery demonstrated that lung maturity threshold may be related to a numeric value (P value) measured by this technique. With a P value of less than 0.320 respiratory distress syndrome (RDS) is unlikely to develop. With a P value greater than 0.340, chances for RDS, usually severe, are high. With a P value of less than 0.340 but greater than 0.320, RDS may or may not develop. This method did not prove to be more reliable then the determination of L/S ratio by thin layer chromatography, but its advantage is that it supplies the results in less then an hour. The FD technique proved to be more reliable then the commonly used foam stability test.

Estrogen-androgen levels in aging men and women: therapeutic considerations

The influence of aging on serum levels of gonadotropins (FSH and LH), testosterone and estradiol was studied in the following groups: 4 normal men (ages 30 to 50), 38 men with symptoms of the male climacteric (ages 51 to 84), 25 men with relative impotence (ages 31 to 50), 10 normal women (ages 24 to 31), and 6 menopausal women (ages 58 to 76). FSH and LH levels began to rise in men in their 40's, and the increase became more conspicuous in the later age decades. The degree of elevation was nowhere comparable to that observed in the aging women. In the male, the serum testosterone levels showed a progressive decrease from the fifth age decade onward, whereas in the female there was an increase after the menopause. Estradiol levels showed no significant change in the aged male, but they were somewhat higher than in the aged female. Exceptions to the low-testosterone and low-gonadotropin relationship were observed in individual cases and might be explained by relatively high estradiol values. Proper replacement therapy by means of estrogens for the postmenopausal female and androgens for the aging male is often of great benefit, physically and emotionally.

FSH and LH response to LHRF in Kallman's syndrome

The olfacto-genital syndrome (Kallman's syndrome) is believed to be primarily an hypothalamic disorder resulting in hypogonadotropic hypogonadism or hypo-ovarianism and anosmia. The pituitary response in 2 patients was measured on dialy subcutaneous injections of 100 mug of LHRF. One of the patients was also studied in a similar fashion by administration of LHRF intravenously for 4 consecutive days. A greater response occurred with the subcutaneous route.

Use of propranolol in dysfunctional labour

Labour pains associated with fear and anxiety increase the blood level of catecholamines. This in turn causes dysfunctional labour due to the weak uterine contractions which follow stimulation of uterine adrenergic beta receptors. Intravenous propranolol was administered to ten primigravidae with typical dysfunctional labour. This was shortly followed by normal uterine activity and delivery without any significant maternal or fetal complications. To the best of our knowledge this is the first attempt to treat dysfunctional labour by the intravenous administration of a beta-blocking agent, and our preliminary results are encouraging.

Effect of LHRH stimulation in anovulatory women

Serum FSH and LH and levels were determined at different time intervals after the subcutaneous administration of 100 mug LHRH to 24 females. Serum FSH levels were of the same order in the oligomenorrhea-amenorrhea and the Stein-Leventhal group of patients but elevated in gonadal failure. There was a great degree of overlap between serum LH values in the three groups. Gondal failure patients, however, could be distinguished from the other two groups because these patients had an elevation of both serum FSH and LH, and the response to LHRH was considereably exaggerated in comparison to the other two groups.