Bleeding profile and endometrial safety of continuous combined regimens 1 mg 17beta-estradiol/trimegestone versus 1 or 2 mg 17beta-estradiol/norethisterone acetate in postmenopausal women

OBJECTIVE

To compare the bleeding profile and endometrial safety of continuous combined 1 mg 17beta-estradiol (17beta-E2) and 0.125 mg trimegestone (TMG) with those of two continuous combined 17beta-E2 and norethisterone acetate (NETA) regimens.

STUDY DESIGN

This was a double-blind, randomized, multicenter study conducted in 12 European countries and Israel over a 2-year period. Healthy postmenopausal women with an intact uterus were given either 1 mg 17beta-E2/0.125 mg TMG, 2 mg 17beta-E2/1 mg NETA or 1 mg 17beta-E2/0.5 mg NETA for up to 26 cycles, each of 28 days.

RESULTS

The percentage of amenorrheic women was greater in most cycles up to cycle 13 in the 1 mg 17beta-E2/0.125 mg TMG group than in the comparator groups. The mean number of bleeding days was similar in the 1 mg 17beta-E2/0.125 mg TMG and the 1 mg 17beta-E2/0.5 mg NETA groups, but greater in the 2 mg 17beta-E2/1 mg NETA group. No endometrial hyperplasia was observed for any group.

CONCLUSION

Continuous combined 1 mg 17beta-E2/0.125 mg TMG exhibits a more favorable bleeding profile than 1 mg 17beta-E2/0.5 mg NETA up to 1 year, while providing an adequate protective effect on the endometrium.

Spontaneous pregnancy after 13 years of amenorrhea in a patient with a voluminous ovarian dysgerminoma and submitted to left adnexectomy and radiotherapy

The authors illustrate the case of a 17-year-old patient who was submitted to left adnexectomy in view of an ovarian dysgerminoma 24 cm in diameter and weighing 2,800 g. She was subsequently submitted to two cycles of radiotherapy. Following a period of amenorrhea lasting 13 years and characterized by high serum levels of gonadotropins, the patient had a spontaneous pregnancy and at 33 weeks of gestation delivered a live and vital fetus. Therefore the occurrence of post-radiotherapy amenorrhea, characterized by high serum gonadotropin levels, should not always be considered pathognomonic of precocious menopause. The possibility that radiotherapy causes only a temporary alteration in ovarian activity should also be taken into consideration.

Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study

OBJECTIVE

The objective of this study was to evaluate short-term results of laparoscopically assisted vaginal hysterectomy with those of total abdominal hysterectomy in a prospective, randomized, multicenter study.

STUDY DESIGN

One hundred sixteen patients referred for abdominal hysterectomy were randomized to either laparoscopically assisted vaginal hysterectomy (58 patients) or abdominal hysterectomy (58 patients). Inclusion criteria were one or more of the following, where a vaginal hysterectomy would be traditionally contraindicated: uterine size larger than 280 g, previous pelvic surgery, history of pelvic inflammatory disease, moderate or severe endometriosis, concomitant adnexal masses or indication for adnexectomy, and nulliparity with lack of uterine descent and limited vaginal access. An upper limit of uterine size was set at 16 weeks' gestation (ie, 700 g).

RESULTS

There were no differences in terms of patient's age, parity, preoperative hemoglobin levels, mean uterine weight, and total operating time between the 2 groups. Estimated blood losses and postoperative day 1 hemoglobin drop were significantly lower for laparoscopically assisted vaginal hysterectomy than for abdominal hysterectomy (P<.05). There were 1 major and 2 minor complications in the laparoscopically assisted vaginal hysterectomy group compared with 2 major and 5 minor complications in the abdominal hysterectomy group (P not significant). Postoperative pain was lower for laparoscopically assisted vaginal hysterectomy than for abdominal hysterectomy on postoperative days 1, 2, and 3 (P<.05). Postoperative hospital stay was significantly shorter for laparoscopically assisted vaginal hysterectomy than for abdominal hysterectomy (P<.001).

CONCLUSIONS

The present study demonstrates that, given adequate training in laparoscopic surgery, laparoscopically assisted vaginal hysterectomy may replace abdominal hysterectomy in most patients who require a hysterectomy and have contraindications to vaginal hysterectomy, with all the benefits associated with the vaginal route.

Laparoscopic myomectomy in premenopausal women with and without preoperative treatment using gonadotrophin-releasing hormone analogues

The present study was undertaken in order to evaluate the usefulness or otherwise of preoperative gonadotrophin-releasing hormone (GnRH) analogue treatment prior to laparoscopic myomectomy. From June 1993 through December 1996, 60 premenopausal women aged between 25 and 42 years and with a sonographic diagnosis of intramural or subserous myomas were selected for laparoscopic myomectomy at the Department of Obstetrics and Gynaecology of the Catholic University of The Sacred Heart, Rome. According to a computer-generated sequence, 30 patients were submitted to three cycles of GnRH analogue treatment prior to surgery, whereas no preoperative treatment was prescribed to the other 30 patients. Laparoscopic myomectomy was successfully performed in all patients for a total of 174 myomas excised laparoscopically. The patients' mean age, the number of myomas per patient, the mean diameter of the myomas, parity and estimated blood loss were similar in both groups. The operative time was significantly longer in the group of patients submitted to GnRH analogue treatment than that of the group of patients not submitted to any preoperative medical therapy (157.5 +/- 74.71 versus 112.33 +/- 54.71 min; P = 0.01). No intra-operative complications occurred. In no case was blood transfusion necessary. Two patients developed post-operative fever (temperature > 38 degrees C.). The mean length of hospital stay was 2.39 days and was similar in both groups. Thirteen spontaneous pregnancies occurred among 24 infertile patients (54.1%). The pregnancy rate for these patients was similar in both groups. The viable term delivery rate was 45.8%. The authors conclude that laparoscopic myomectomy is a feasible and safe procedure. The post-operative pregnancy rate for infertile patients is similar to that following laparotomic myomectomy. The present study suggests that preoperative GnRH analogue treatment does not offer any significant advantages for laparoscopic myomectomy.

Laparoscopic gonadectomy in two patients with gonadal dysgenesis

Individuals with androgen insensitivity syndrome have a high risk (20-30%) of developing malignancy in their gonads. Accordingly, bilateral gonadectomy is recommended. In a 17-year-old woman with Swyer syndrome gonads were located as streaks above the pelvic brim. In a 13-year-old with Morris syndrome they were located within the inguinal canals. Bilateral laparoscopic gonadectomy was performed under general anesthesia in both patients without complications. We suggest that in phenotypic females with 46,XY karyotype, the procedure may be performed safely, even with gonads located in inguinal canals.

Efficacy assessment of highly purified follicle-stimulating hormone alone or in combination with human menopausal gonadotropin during pituitary suppression in patients undergoing GIFT for unexplained infertility

The purpose of this study was to compare the efficacy of highly purified follicle-stimulating hormone (FSH-HP) alone versus the combination of FSH-HP + human menopausal gonadotropin (hMG) treatment during pituitary suppression with gonadotropin-releasing hormone (GnRH) analog on the clinical outcome and endocrine parameters in 120 randomized women undergoing gamete intra-Fallopian transfer (GIFT) for unexplained infertility. Our data did not show any significant difference between the two groups as regards dose of administered gonadotropins, duration of treatment, estradiol 17 beta 17 beta increase curves, number of follicles > 16 mm, number of recruited and transferred oocytes, and endometrial thickness. The percentages of clinical pregnancies (33.3% with FSH-HP and 31.6% with FSH-HP + hMG), of miscarriages and twin gestations were also similar in the two groups. It is concluded that, during GnRH analog suppression, FSH-HP treatment alone is effective in inducing normal follicular steroidogenesis and adequate oocyte maturation, but no detrimental effect of luteinizing hormone (LH) activity of hMG on the outcome of the outcome of ovarian stimulation was found.

[The ICSI (Intracytoplasmic Sperm Injection)]

ICSI (Intracytoplasmic Sperm Injection) is the latest known assisted reproduction technique (ART) and it already appears to be mature. In fact the analysis of the results presented by the researchers over the years has shown that the most specific indication for this ART is the sterility of the couple with serious male pathology, up to ejaculatory azoospermia where it is possible to perform MESA, PESA or TESE. Any kind of sterility could be solved with ICSI whose only limit presently known is the high technology and therefore high costs involved. The percentage of oocytes that undergo ICSI without being damaged varies from 87% to 94% and the percentage of fertilization varies from 33% to 71%. The transfer rate is 59-100%. The rate of pregnancies per couple ranges from 12% to 40% of the couples, from 11% to 41% for the transfers. Since abortions are similar to the values of the normal population (10-15%), ICSI is actually the assisted fertilization technique with the highest incidence of pregnancies and "take home babies". The percentage incidence of the two sexes, of the malformations and the typologies of malformations corresponds to those observed in the population with spontaneous pregnancies. Since there is no natural selection of the gametes in ICSI, one may be sure that when spermatozoa with any kind of pathology are injected, the pregnancy does not take place at all.

Laparoscopic conservative excision of ovarian dermoid cysts with and without an endobag

STUDY OBJECTIVE

To compare outcomes of conservative laparoscopic treatment of dermoid cysts removed from the abdominal cavity without (group A) and with an endobag (group B).

DESIGN

Prospective, randomized, 4-year (June 1992-June 1996) study (Canadian Task Force classification I).

SETTING

Department of Obstetrics and Gynecology of the Catholic University of the Sacred Heart in Rome.

PATIENTS

Fifty-five premenopausal women with dermoid cysts. Intervention. Patients were randomly assigned to removal of dermoid cysts from the abdominal cavity with or without an endobag through a 10- to 12-mm cannula sleeve.

MEASUREMENTS AND MAIN RESULTS

We assessed surgical time, spillage, complications, length of hospitalization, recurrences, and pregnancies. In the 55 women, 58 dermoid cysts (mean diameter 5.6 +/- 2.03 cm) were enucleated and removed at operative laparoscopy through a 10- to 12-mm cannula sleeve without intraoperative or postoperative complications. Mean operating time was 73 minutes. When cysts were removed with an endobag, operating time was significantly reduced over removal without the endobag (63 vs 81 min, p <0.05). Obvious spillage of endocystic contents occurred in 13 (43.3%) patients in group A but in only 1 patient in group B because the bag ruptured (p <0.05). No signs or symptoms of peritonitis were observed in women with evident cystic spillage or in those in group A in whom spillage was possible. Average postoperative hospital stay was 1.7 days and did not differ between groups. Among 20 infertile women, 9 (45%) experienced spontaneous pregnancy within a year, with no differences between groups. Echographic follow-up did not reveal cyst recurrence.

CONCLUSIONS

Laparoscopic conservative cystectomy of dermoid cysts in premenopausal women is safe and effective and appears to be a valuable alternative to laparotomy. Removing cysts in an endobag significantly reduced both operating time and spillage. However, controlled intraperitoneal spillage of cyst contents does not increase postoperative morbidity as long as the peritoneal cavity is thoroughly washed.

[Surgical treatment of ovarian cysts: economic analysis as a means for the evaluation of alternative technics. Results of a biennial study]

The large use of new gynaecological technologies such as the operative laparoscopy, requires both efficacy and efficiency evaluation. The aim of this work is to compare costs of the surgical treatment of ovarian cysts between two groups of patients--35 patients undergone to laparotomic cystectomy (age: mean 27.5) and 34 operated by laparoscopic technique (age: mean 27). The analysis of the costs, related to three steps of health care (pre-operative, operative, post-operative) shows that the laparoscopic cystectomy results the more efficient intervention (L. 6,244,808 vs L. 8,310,002). This economic analysis may offer a planning tool for health care to hospital managers and represent an efficiency evaluation criterion of surgical techniques employed by the gynaecologists.

[Outcome of drug-induced pregnancies]

The authors analysed 153 pregnancies achieved after different drug treatment to induce ovulation. The outcome of single and multiple pregnancies, the fetal malformation and male/female ratio were considered. The results obtained show that induction of ovulation seem to raise the risk of miscarriage when compared with outcome of spontaneous pregnancies; the malformation risk is not considerable.

Dicentric chromosome Y associated with Leydig cell agenesis and sex reversal

The nature of a non-mosaic marker Y chromosome observed in a pseudohermaphrodite patient with Leydig cell agenesis was investigated by high-resolution chromosome analysis and molecular probes from the Y chromosome. Cytogenetically, the marker chromosome appeared to be an isodicentric, with breakage in Yq11.21. Double copies of all Yp-specific loci tested, including SRY, were present. The most distal Yq portion detected in patient DNA was DXS278-C, which maps to interval D in the chromosome Yq deletion map. Fragment DXS278-B, which maps to deletion interval E, was absent. The possible relationship between this cytogenetic abnormality and Leydig cell agenesis, a finding never reported in association with Y chromosome rearrangements, is discussed.

Utilization of long and short acting GnRH-A: effects on multiple ovulation induction for gift preparation

The authors show the advantages of the use of GnRH-Analogues in assisted procreation: reduction of cycle cancellation; better ovulatory timing without premature luteinization; syncronous follicular recruitment with high number of mature oocytes.

[Curettage vs. hysteroscopic resection]

The aim of the present study was to evaluate the therapeutic efficacy of curettage vs hysteroscopic resection in the treatment of endometrial polyps. A group of 25 patients were examined and during surgery underwent diagnostic hysteroscopy, curettage of the uterine cavity, control hysteroscopy and resectoscopy in the event of residual polyps. Thirteen cases revealed the total persistence of the polyp after curettage and in 6 cases the polyp was only partially removed; the polyp was detached but not removed from the uterine cavity in 4 cases and the polyp was fully removed using the curette in only 2 cases. The considerable limits of curettage which emerge from this study appear to be linked to three main factors: the localization, nature and size of endometrial polyps. Curettage may therefore now be considered a method which has been surpassed in not only diagnostic but also therapeutic terms by hysteroscopic techniques.

Endocrine changes and clinical outcome after laparoscopic ovarian resection in women with polycystic ovaries

Ovarian laparoscopic resection was applied to 23 sterile patients affected with polycystic ovarian disease (PCOD) resistant to different pharmacological treatments, in order to induce ovulation. After resection, 56% of the patients had spontaneous ovulatory cycles and 13 pregnancies arose. Ten of the pregnancies were spontaneous and three followed treatment with clomiphene. Hormone changes were assessed in 15 patients, including five with spontaneous menstruation but without ovulation and five with persistent amenorrhoea for 3 months after resection. A significant decrease in both androstenedione and testosterone levels occurred in all patients. These decreases were not related to the clinical results of resection. Luteinizing hormone (LH) did not vary greatly in any group after resection. Mean values and mean pulsatility of follicle stimulating hormone (FSH) increased significantly only in pregnant patients or those with spontaneous ovulatory cycles. The results of gonadotrophin-releasing hormone (GnRH) assays did not change after resection. The mechanisms involved in the resumption of cyclic function of the hypophyseal-ovarian axis after resection are discussed briefly.

Indomethacin and fertility in experimental endometriosis

Clinical and experimental evidence showed an increased concentration of prostaglandins in peritoneal fluid in cases of endometriosis. The aim of this study was to verify whether an antiprostaglandin drug can restore fertility in cases of endometriosis. For this reason endometriosis was induced in 4 groups of 10 rats. Group A was treated with indomethacin both in the pre-ovulatory and in the post-ovulatory phase. Group B was treated in the pre-ovulatory phase. Group C was treated in the post-ovulatory phase. Group D was not treated. Ten other rats (group E) underwent a sham operation and were used as a control. Twelve days after mating, gestational sacs and corpora lutea were counted and the nidation index was calculated. Only indomethacin administered during the pre-ovulatory phase completely restored fertility in these rats.

Current therapeutic possibilities of GIFT

We have used GIFT in 74 couples affected with unexplained sterility, male hypofertility, endometriosis, phymosis of the fimbria and adhesions impeding oocyte pick-up. We systematically desensitized the pituitary using a GnRH analog from the 20th day of the cycle preceding GIFT. All the patients were hyperstimulated with purified FSH and hMG (Metrodin and Pergonal-Serono) from the 3rd day of the cycle. When several follicles were obtained woth a diameter greater than 16 mm together with serum estradiol values of 300 pg/ml per follicle, 10,000 IU hCG were administered intramuscularly in a single dose (Profasi-Serono). A maximum of 5 oocytes per patient were transferred (2-3 per tube). Our results confirm the validity of the GIFT method, with an average success rate of 19% in all pathological conditions and a far greater success rate in couples with unexplained sterility than in those with male hypofertility (31% and 10% respectively). The Authors stress that the best results of GIFT were achieved when the ratio between E2 and follicles with a diameter greater than 16 mm was in excess of 500 pg/ml.

GNRH therapy in hypothalamic primary amenorrhea

Pulsatile administration of GnRH appears to be the most rational and physiological treatment of infertility in patients affected by hypothalamic amenorrhea. The authors conclude that the results obtained with this method of treatment (all patients became pregnant) suggest that the choice of pulsatile GnRH therapy is an effective and practical method for induction of ovulation.

Scanning electron microscopy of rabbit tubes at different intervals after anastomosis using fibrin glue

Eighteen New Zealand White rabbits were submitted to tubal anastomosis using fibrin glue. The animals were then killed at different intervals (2-56 days) and the tubes were removed for analysis with the scanning electron microscope in order to study re-epithelialization and ciliogenesis. For the first 4 days after the operation the epithelium seemed to suffer considerable traumatic effects and was de-epithelialized. On the 6th day cells with microvilli appeared and towards the 10th day the first cilia were seen. Ciliogenesis was complete between 2 and 4 weeks after the operation, at which time the cilia re-acquired the ability to beat in coordination, as well as attaining normal quantity and length. The time required for recovery by the epithelium after anastomosis with fibrin glue would thus seem similar to that required when other suture materials are used. Fibrin glue thus combines the advantage of a considerable reduction in operating times with the ability to be rapidly reabsorbed, with complete restitutio ad integrum of the tissues.

A prostaglandin analogue (ONO-802) in treatment of missed abortion, intrauterine fetal death and hydatiform mole: a dose-finding trial

Forty-eight patients affected with missed abortion, intrauterine fetal death and hydatiform mole were treated with vaginal suppositories containing 1 mg of 16,16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802). The patients were divided into two treatment groups. The first, Group A, was given one vaginal suppository every 3 h to a maximum of five suppositories. The product of conception was expelled in 95.8% of patients. In Group B the maximum number of suppositories was reduced to three. The product of conception was expelled in 100% of cases and the average duration of treatment was similar to that for the first group. Although side-effects were mild in both groups, they were reduced in the patients of Group B.

Fibrin glue vs. nylon in the anastomosis of rabbit fallopian tubes

Fibrin glue was used in end-to-end tubal anastomosis on eight sexually mature female New Zealand white rabbits. The right fallopian tubes were anastomosed with 10/0 nylon and the left with fibrin glue (Tissucol). The animals were mated with males of proven fertility six weeks after surgery and killed two weeks later. The gestational sacs and corpora lutea on the right and left sides were counted separately and the nidation index calculated for each. The presence of adhesions was also evaluated. All the tubes were finally examined under a scanning electron microscope. The fibrin glue was satisfactory in terms of patency, pregnancy and morphology of the epithelium.

Pharmacological prevention of postoperative adhesions experimentally induced in the rat

In order to evaluate the preventive action of certain drugs in the formation of adhesions, three different types of trauma were induced in the uterine horns of 105 female Wistar rats. The animals were divided into six groups of 15 rats each and to each group was administered respectively: aprotinin i.p.; hydrocortisone i.p.; dextran 70 i.p.; colchicine i.p.; saline i.p.; colchicine i.m. One more group of 15 rats was left without treatment, as control. Four weeks later the adhesions were evaluated according to a qualitative/quantitative score and the results analysed using advanced statistical analysis. Aprotinin achieved the best results both in and around the trauma areas. Dextran produced an overall reduction of adhesions, but showed no specific effect on the trauma areas. The other substances failed to improve the adhesion situation.

Polydioxanone in anastomosis of rabbit tubes. A morphological study of the epithelium

Eight NZW rabbits were submitted to end-to-end tubal anastomosis using polydioxanone (PDS), (Ethicon). The animals were sacrificed at two-week intervals between the second and sixteenth week after operating. The tubes were removed and analysed with the scanning electron microscope for the purpose of studying the morphology of the epithelium. Ciliogenesis was completed between the second and fourth weeks. After this period the epithelial conditions observed were completely normal, except for an abundant mucous secretion which, however, was totally normal after sixteen weeks.

Induction of ovulation with purified urinary follicle-stimulating hormone in patients with polycystic ovarian syndrome

Purified urinary follicle-stimulating hormone was used to induce ovulation in 18 patients with polycystic ovarian syndrome. Each ampule contained 75 IU of follicle-stimulating hormone and less than 0.11 IU of luteinizing hormone. Initial doses were 150 to 225 IU/day, later increased to a maximum of 375 IU, according to daily clinical controls and estradiol values. After 12 to 16 days, follicle-stimulating hormone treatment was suspended. Within 36 to 48 hours each patient received 5000 or 10,000 IU of human chorionic gonadotropin, rarely more. Ovulation occurred in 39 of 43 treatment cycles and hyperstimulation in nine. Seven patients had normal pregnancies with viable fetuses, including one pair of twins. Two had abortions. Analysis of the endocrine situation during therapy does not permit either pregnancy or hyperstimulation to be predicted. However, hyperstimulation is frequently accompanied by endogenous luteinizing hormone peaks and greater estradiol increases during the final phase of induction. Purified follicle-stimulating hormone has thus demonstrated its validity in inducing ovulation in patients with polycystic ovarian syndrome, apparently with equal or lower risks of hyperstimulation than with other gonadotropin preparations.

Evolution and reversibility of damage to rabbit fallopian tubes after five sterilization methods

The authors used a scanning electron microscope to study epithelial damage to the rabbit fallopian tube after sterilization with different methods and its subsequent capacity to regenerate after recanalization. Thirty female NZW rabbits were divided into five groups and sterilized using the following methods: 1) Madlener 2) Pommeroy, 3) clips, 4) unipolar coagulation, 5) bipolar coagulation. Each group was divided into subgroups of two and submitted at differing intervals to a second laparotomy, during which one tube was removed and the other anastomosed according to Winston's method. Four weeks after the second laparotomy all the rabbits were sacrificed, the remaining tube removed, and all tubes examined with the scanning electron microscope. The results indicate that mechanical methods of occlusion such as clips offer greater recovery possibilities than those in which the lesion is extended to the mesosalpinx. There further exists a correlation between the time that elapses after sterilization and regeneration of the epithelium.

Canalization of human cervical mucus

Cervical mucus forms channels when dried under a coverslip. The aim of the present work was: 1) to prove mucus canalization both in spontaneous ovulatory cycles and during ovulation induction with gonadotropins; 2) to prove the estrogen dependence of this phenomenon; 3) to check the importance of the proteidic and electrolytic concentration on chaneling; and 4) to use this phenomenon clinically, shortening the time in which it occurs. The number and arrangement of channels vary during the cycle. The phenomenon is estrogen-dependent. The comparison between estradiol values and the number of channels during spontaneous ovulatory cycles and treatment with gonadotropins showed a linear relationship. Treatment with estradiol 17 beta-valerate and ethinyl estradiol induced channel formation in women with primary amenorrhea. Canalization and ferning disappeared after dialysis or treatment with proteolytic enzymes. It follows that the two phenomena have similar characteristics. Canalization increases daily, as does estradiol, whereas ferning maintains the same grade for a longer period, and when a grade of + + + is reached, it provides no further indications. With the use of a thermostat, canalization occurred in only a few hours. Chaneling, a more precise index, could therefore substitute for ferning, particularly when monitoring the induction of ovulation.

LH-HCG receptors: a study of the human corpus luteum of pregnancy

Experiments on binding 125I-LH and 125I-HCG by the human luteal tissue of early pregnancy showed no certain presence of receptors. On the other hand, studies performed with cyclic luteal tissue demonstrated the presence of high specificity, significant affinity receptors. Possible interpretations with reference to the physiological increase in HCG and/or to the characteristics of extrauterine pregnancy are discussed.

Effect of celioscopic ovarian resection in patients with polycystic ovaries

Ovarian resection was performed by means of celioscopy in 12 patients with polycystic ovaries (PCO), who had not responded to clomiphene + HCG therapy. This therapy had induced ovulation in only 14% of 56 therapeutic cycles. Ovarian resection through celioscopy induced ovulation in 45% of cycles. Clomiphene + HCG therapy after resection in patients with no spontaneous ovulation induced ovulation in 44% of cycles. Seven pregnancies followed in 5 women, equal to 41% of patients. Hormonal patterns (FSH, LH, E2, progesterone, dehydroepiandrosterone sulfate, testosterone) before and after resection showed no significant variation. The authors emphasize other advantages of this technique, such as fewer surgical injuries than laparotomy, relative harmlessness of the treatment, the possibility of repeating it and of performing subsequent laparotomy.

Effect of drug-induced hyper- and hypoprolactinemia on human corpus luteum

This study was performed on 8 patients with normal levels of PRL and ovulatory cycles. Three of these patients were treated with 5 mg/day Bromocriptine and three of them with 60 mg/day Metoclopramide from the beginning of the cycle in order to induce hypo- and hyperprolactinemia respectively. The other two women were left as control. Daily blood samples were collected for the determination of PRL, LH 17 beta-Estradiol and Progesterone. Patients were operated on between the 6th and the 8th day after the LH peak and corpora lutea enucleated and frozen for subsequent 125I-LH binding tests. An analysis of our data demonstrates that hypo- and hyper- prolactinemia induced with Bromocriptine and Metoclopramide respectively may cause luteal insufficiency, which is revealed by decreased blood levels of progesterone. Furthermore we have observed that specific binding for LH in human luteal tissue is always present (in normal, hypo- and hyperprolactinemic women) but is reduced in presence of very high or very low levels of PRL.

Retrograde ejaculation: a more convenient method for artificial insemination

A case of retrograde ejaculation not responding to medical treatment is described in which the problem of sterility was overcome by artificial insemination. The semen was collected from urine after coitus by previous alkalinization with 1.63 g NaHCO3 once daily. Pregnancy occurred at the 4th insemination during the 1st treatment cycle. This technique seems to be the most suitable for artificial insemination in cases of retrograde ejaculation.

Effect of antiblastokinin on rabbit pregnancy

On different days following coitus, i.e., during the first stages of pregnancy, adult female rabbits were treated with antiblastokinin obtained from a chicken. A high prenatal mortality was observed and a reduction of the weight in the stillborn of the rabbits treated. The antiblastokinin produces evident biological effect about the 4th day following coitus, during the period of maximum production of blastokinin by the endometrium in vivo.

Menometrorrhagia of the puberty: therapy with Clomiphene (Clomiphene and puberal menometrorrhagia)

The authors administrated the Clomiphene, in different doses, to 8 patients among 27 observed. These patients were checked for a long time by basal body temperature and in some cases, measuring total urinary estrogens and pregnandioluria. The therapy was administrated in 38 cicles of the 163 cicles observed. This drug got evident results on flux duration, less significant results on the cicle length. The Clomiphene produced ovulatory cicles in 58 per cent of the cases, against 7 per cent of spontaneous ovulatory cicles of the same patients. The drug effect is better in the cases with normo or moderate hypo or hyper estrogenism, not so good in the cases with a remarcable hypoestrogenism. The therapy with Clomiphene did not produce any inconvenient. The results got were put in comparison with those of the other drug (Ciclophenile) and the superiority of Clomiphene was confirmed.

Iatrogenic hyperstimulation of the ovary with ascites. Report of a case and considerations and management

The authors describe a case of iatrogenic hyperstimulation of the ovary with ascites in a patient with primary amenorrhea and hypogonadotropic hypogonadism. They present the results of total urinary estrogen assays stressing the advisability of a technical check in the presence of an apparently abnormally high estrogen excretion during HMG therapy. The patient's biochemical and hematological data during the stage of clinical hyperstimulation are set out and management is discussed. Finally, the usefulness of timely and adequate albumin administration under CVP control is stressed and the possibility of clinical application of the result of recent experimental research (viz. antihistamines is discussed.

In vitro biosynthesis of rabbit blastokinin

The authors have incubated, in vitro, estrous rabbit endometrium with 3H-leucine and pseudopregnant rabbit endometrium with 14C-leucine. By the double-labeling technique and the use of the 14C:3H ratio, it was shown that blastokinin (BKN) is neosynthesized in vitro and that this neosynthesis probably also affects other protein components. By ion exchange chromatography of the supernatant of the pseudopregnant endometrium and previously purified BKN, it was possible to confirm the in vitro biosynthesis and to exclude interfering phenomena. Time dynamics showed that biosynthesis was more marked between the 18th and 24th hours of incubation.

"Timing" of ovulation by laparoscopy and evaluation of some physico-chemical parameters

The Authors describe the laparoscopic aspects of spontaneous human ovulation and correlate it with the evaluation of basal body temperature, the total urinary oestrogens, pregnanediol and urinary LH and some hematic values of 17-beta-estradiol, 17-alpha-Hydroxyprogesterone and rogesterone. They find that the rise in temperature and the oestrogenuria peak precede ovulation by some hours in the great ovulation by sompe hours in the great majority of cases. They analyze the validity of the other parameters studied, and show a relatively constant behavior, with regard to ovulation, in the mean evaluation of several cases. In the individual analysis, on the contrary, this relation is difficult to find and less significant. The Authors stress the importance of comparing the physico-chemical evaluations with the biological phenomenon of ovulation directly ascertained by means of laparoscopy.