Moshe Ron

The effect of ethinyl estradiol on endometrial thickness and uterine volume during ovulation induction by clomiphene citrate

OBJECTIVE To assess the deleterious effect of clomiphene citrate (CC) on the development of the endometrium and its improvement by the addition of ethinyl estradiol (E2). PARTICIPATING PATIENTS: Infertility-treated patients, monitored for induction of ovulation or timing of insemination (control group). DESIGN We studied four groups of women during an ovulatory cycle with various treatment schedules. Group 1: untreated patients; group 2: patients treated by CC; group 3: patients treated by CC + ethinyl E2; group 4: patients treated by human menopausal gonadotropin. Follow-up of the patients was done by vaginal ultrasonography and measurements of blood E2. RESULTS In the group treated by CC, both endometrial thickness and uterine volume growth during the follicular phase were lower as compared with untreated controls and menotropin-treated patients. The addition of ethinyl E2 to these patients reversed this deleterious effect of CC without interfering with ovulation. CONCLUSION Ethinyl E2 may reverse the deleterious effect of CC on endometrial development during the follicular phase.

Premature delivery and organochlorine compounds: polychlorinated biphenyls and some organochlorine insecticides.

Abstract Some organochlorine compounds (OCC), DDT and metabolites, γ-HCH, dieldrin, heptachlor epoxide and polychlorinated biphenyls were assessed in the serum of 17 women with premature delivery (PD) and 10 women with normal, third-trimester pregnancy. Out of 17 cases of PD, 8 cases were associated with high PCB serum levels (128.0 ppb versus 19.25 ppb in the control group), and 5 cases with high DDT serum levels (119.6 ppb versus 26.5 ppb in the control group). Two of the cases with high PCB serum levels also had high total DDT serum levels. The 5 cases with high total DDT serum levels also had high γ-HCH and heptachlor epoxide serum levels and 4 out of these 5 cases also had high dieldrin serum levels. The higher chlorinated PCB isomers constituted a higher percentage of total PCBs in the study group in comparison with the control group (about 30% versus 8.94%). At the same time, the percentage of total o,p ′-DDT was unusually high (50% of total DDT in the study group versus 30% in the control group[tiThe possible role of the relatively high serum levels of the organochlorine compounds assessed in this study, in the occurrence of PD, is discussed.

Organochlorine compounds in mother and fetus during labor

Abstract Some features of the storage of organochlorine compounds in mother and fetus as assessed during labor are reported in this paper. Organochlorine insecticides (DDT and metabolites, dieldrin, y-BHC, and heptachlor expoxide) and polychlorinated biphenyls were assessed in maternal adipose tissue, maternal blood, fetal blood, maternal uterine muscle, placenta, and amniotic fluid. The concentration of total DDT, y-BHC, and PCBs was greater in extracted lipids of fetal blood than in maternal blood and still higher in the uterine muscle. The concentration of dieldrin and heptachlor expoxide was higher in extracted lipids of fetal blood and placenta than in maternal blood and uterine muscle. The metabolites of DDT were found in different ratios in mother and fetus. The ratios for individual polychlorinated biphenyl compounds were similar for maternal and fetal plasma on the one hand and placenta and uterine muscle on the other. These facts suggest quantitative differences in the ability of these tissues to metabolize and/or store organochlorine compounds. These data emphasize the importance of the maternal organism in protection of the fetus against environmental hazards.

Germ cell tumors of the ovary arising after dermoid cyst resection : a long-term follow-up study

Objective: To study the long‐term ovarian neoplastic consequences of resection of a dermoid cyst. Methods: The study population comprised 99 patients who were operated on for an ovarian dermoid cyst. Follow‐up information was obtained for 91 women for a mean period of 5.06 ± 2.46 years. Results: Of the 99 women, 18 had bilateral dermoid cysts. Multiple dermoid cysts in a single ovary were found in nine of the women with bilateral cysts and in one of the remaining patients. Two patients developed malignant germ cell tumors, and three developed a recurrent dermoid cyst in an ovary from which a dermoid cyst had previously been extracted. Bilateral or multiple ovarian dermoid cysts were present at the initial operation in four (80%) of these patients. Conclusions: Women with bilateral or multiple dermoid cysts may include a subgroup of patients with a greater tendency to develop future ovarian germ cell neoplasms. (Obstet Gynecol 1994;83:605‐8)

Some organochlorine insecticide and polychlorinated biphenyl blood residues in infertile males in the general Israeli population of the middle 1980's

Organochlorine insecticide (OCI) and chlorinated biphenyl (CB) blood residues were measured in 29 men with oligoastenospermia and in 14 matched control subjects. Although both OCI and CB residue levels were generally low, infertile patients, in comparison with healthy individuals, exhibited significantly higher levels ofp,p′-DDT metabolites in the blood, as well as elevated residues of lindane, tetra- and penta-CBs. These increases were found more frequently in patients with oligospermia (spermatozoa count below 20 million/mL) than in those with astenospermia and normal counts. However, residue levels ofo,p′-DDD and heptachlor epoxide were lower in the study group than in the control group. Correlations between DDT isomers and metabolites and other OCI blood residues were stronger in infertile patients than in the control group, whereas OCI-CB correlations were weaker in the study group. There are several possible mechanisms of Organochlorine compound interference with male fertility functions.

Fetal high output cardiac failure and acute hydramnios caused by large placental chorioangioma. Case report

A 31-year-old woman was admitted to the highrisk obstetric unit in the 25th week of her third pregnancy, because of rapidly developing hydramnios. Her two previous pregnancies had resulted in normal deliveries. Thc present pregnancy was uneventful up till 22 weeks gestation. Ultrasound studies at that time revealed a single normal fetus, with an excessive amount of amniotic fluid. The placenta was located posteriorly, and contained an 8 X 8 X 9 cm solid and partially cystic mass (Fig. l ) , compatible with a placental chorioangioma. During the next 2 weeks, the patient complained of rapid increase in the size of her abdomen, severe dyspnoea, backache and uterine contractions. Upon examination, the uterine size corresponded to 40 weeks gestation. Ultrasonography disclosed severe hydramnios and a normal fetus, whose size was appropriate for gestational age. The placental mass was unchanged. Two-dimensional direct M-mode echocdrdiography with Doppler analysis revealed normal fetal cardiac anatomy, persistent sinus tachycardia (170-180 beatdmin) and a moderate amount of pericardial effusion (Fig. 2). Pulsed Doppler echocardiography (PDE) was performed. the fetal cardiac output, calculated as described by Wladimiroff et al. (1984) and

The hormonal response of patients with polycystic ovarian disease to subcutaneous low frequency pulsatile administration of luteinizing hormone-releasing hormone.

Four patients with oligoamenorrhea manifesting hormonal and clinical features of polycystic ovarian disease (PCOD) were selected for treatment. All patients had high luteinizing hormone (LH) levels and a basal LH/follicle-stimulating hormone (FSH) ratio of greater than 3. Three of them had high androgen levels with normal adrenal cortical function. The four patients were treated for 12 cycles by pulsatile LH-releasing hormone (LH-RH) subcutaneously. Frequency of pulses varied between once in every 120 to once in every 400 minutes in consecutive cycles, in an attempt to reverse LH/FSH ratio. The dose of LH-RH varied between 20 and 40 micrograms/pulse. Treatment was monitored hormonally by the determinations of LH, FSH, 17 beta-estradiol, prolactin, progesterone, testosterone (T) (total and free), androstenedione (delta 4A), dehydroepiandrosterone sulfate (DHEA-S), and sex hormone-binding globulin (SHBG) every 2 days. The most striking change was the lowering of the LH/FSH ratio to the normal range, due to LH decrease and FSH increase with a pulse frequency of 180 to 240 minutes. DHEA-S levels reversed to normal in two patients and were reduced in one patient. T and delta 4A levels returned to normal with elevation to normal of SHBG. These hormonal improvements did not result in ovulation as expected (2 of 12 cycles). It may be assumed that either subcutaneous administration is inadequate in PCOD patients or that the frequency of pulses needed to correct the hormonal disturbances in PCOD patients differs from that needed for ovum maturation and ovulation.

Fluoride concentration in amniotic fluid and fetal cord and maternal plasma

Fluoride concentrations were determined in plasma of 50 pregnant women, 44 samples of amniotic fluid and fetal cord blood of 29 fetuses at various stages of normal pregnancies, from an area with a relatively low water fluoride (less than 0.5 ppm) content. The mean concentrations of fluoride from maternal plasma, cord plasma and amniotic fluid (+/- S.D.) were 0.033 +/- 0.003, 0.028 +/- 0.005 and 0.017 +/- 0.003 ppm, respectively. Maternal and fetal plasma fluoride concentrations did not differ significantly. In the older age group fetal cord plasma fluoride concentration was significantly lower than maternal plasma levels (0.012 +/- 0.08 ppm vs. 0.023 +/- 0.001, respectively; p less than 0.05). Amniotic fluid fluoride levels were significantly higher at term than in midtrimester pregnancy, 0.017 +/- 0.0018 vs. 0.010 +/- 0.009 ppm (P less than 0.05), respectively. This higher concentration may imply higher fetal urinary excretion of fluoride at term due to the lower sequestration of fluoride as the process of bone calcification is more complete.

Vitamin D3 metabolites in rat epididymis: high 24,25-dihydroxy vitamin D3 levels in the cauda region.

Normal male rats received six subcutaneous injections of 8.0 pmoles of tritiated 25-hydroxy vitamin D3 ([3H]25(OH)D3) or one intrajugular injection of 8.0 pmoles of high specific radioactivity [3H]-25(OH)D3. Lipid extracts of several tissues including the reproductive organs were subjected to sephadex LH-20 chromatography to determine the tissue distribution of the injected material and of the in vivo produced dihydroxylated cholecalciferol metabolites. The nature of the putative 25(OH)D3 and the 24,25-dihydroxy vitamin D3 (24,25(OH)2D3) from epididymis tissue was confirmed by high performance liquid chromatography (HPLC). The epididymis levels of 24,25(OH)2D3 were considerably higher in the cauda epididymis compared to kidney and caput epididymis levels. The other metabolites levels in this tissue were similar to those determined in the kidneys. The amounts of the three metabolites found in all other tissues were well below the cauda epididymis or kidney levels. The findings suggest a possible physiological role for 24,25(OH)2D3 in the epididymis, and are also consistent with data of others which indicated a possible action of 1,25-dihydroxy vitamin D3 (1,25(OH)2D3) in rat reproductive tissues.

Umbilical cord fluoride serum levels may not reflect fetal fluoride status

OBJECTIVE To evaluate the reliability of fluoride levels in the umbilical cord as reflecting neonate fluoride status. DESIGN Prospective study of fluoride levels of pregnant women at term and their neonates. SETTING Delivery room and maternity unite of Hadassah Hospital Mount Scopus. PATIENTS Fluoride serum levels were determined in the sera of 20 women with normal pregnancies at term, during delivery, in the corresponding mixed cord sera and neonatal sera at 24 hours after delivery. RESULTS The mean maternal fluoride serum level was 0.0303 microgram/ml (SD 9.015), mean cord fluoride serum level 0.0183 microgram/ml (SD 0.012), and mean neonatal fluoride serum 0.0380 microgram/ml (SD 0.016). CONCLUSION The significantly (p < 0.001) low mixed cord serum levels of fluoride as compared with neonatal and maternal serum levels may be explained by placental sequestration of fluoride. It is suggested that cord serum fluoride levels to not reflect fetal fluoride status.