A Lanzone

DILUTE ORNITIN VASOPRESSIN AND A MYOMA DRILL FOR LAPAROSCOPIC MYOMECTOMY

To improve enucleation of uterine myomas, we designed a reusable 5-mm laparoscopic drill with a distal forked pin and locking system. Because the device is jointed, it can apply traction not only along its own axis, but also along planes, depending on its bending radius. We compared enucleation time for myomas 5 to 8 cm in size before and after introduction of the drill. The last 23 procedures performed with this instrument were easier, with a reduction in operating time of about 28.5% for the enucleation part of the procedure (p <0.001). (J Am Assoc Gynecol Laparosc 6(2):189-193, 1999)

The hypothalamic-pituitary-luteal axis in women: Effects of long-term orally active opioid antagonist (naltrexone) administration

Aim of our study is to assess the effect of a long-term oral opiate antagonist treatment during the luteal phase on the hypothalamic-pituitary-ovarian axis. Fourteen normovulatory women partecipated to the study. Immediately after the ovulation, the patients were randomly divided in two groups: in the first one women received naltrexone 50 mg/die orally (Antaxone Zambon Italy) from day 1 of the luteal phase for 7 days. In the second patients were treated with placebo for the same period and served as control group. On day 7, patients were hospitalized for a pulse pattern study followed by a GnRH test. LH, FSH, Estradiol, Progesterone were assayed. The naltrexone administration strongly increased the number as well as the amplitude of the gonadotropin pulses. The circulating P levels were also significantly higher in treated patients. The GnRH injection significantly increases the gonadotropin secretion in all patients. The stimulated LH and FSH secretion was significantly greater in treated patients when compared to controls. Such discharge of LH determined a significant increase of progesterone production in controls, but failed to stimulate the corpus luteum in treated patients. In conclusion the present paper strengtheen an important role of the opioidergic system in the regulation of GnRH pulsatility in luteal phase. Moreover, our findings confirms the sensibility of the corpus luteum to LH and the possibility to stimulate the P secretion during the luteal phase.

The impact of dosage on ovulation induction by pulsatile gonadotropin-releasing hormone (Gn-RH) in hypothalamic amenorrhea

Ten patients with hypothalamic amenorrhea (HA) were treated to induce ovulation with i.v. pulsatile Gn-RH. Twentysix cycles were administered with doses ranging from 2.5 (A; no. = 10) to 5 (B; no. = 13) to 10–12.5 μg/90 mm (C; no. = 3). Ovulation rate was 80% in A, 92.3% in Band 100% in C and pregnancy rate 25% in A and 41.6% in B. Furthermore, both the onset of ovarian response and follicular growth were found to be more suitable in groups B and C with respect to group A. Estradiol pattern as well as mid-luteal progesterone plasma levels were superimposable in the different groups. It is concluded that all doses used are effective in inducing ovulation in HA patients. However, small pulsatile doses (2.5 μg/90 min) might constitute a critical threshold for adequate ovarian response.