Nicola Garcea

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.

Biochemistry of Cervical Mucus: A Comparative Analysis of the Secretion from Preovulatory, Postovulatory, and Pregnancy Periods

Cervical mucus samples were obtained from 20 healthy ovulating women during different phases of their menstrual cycles and in the last trimes ter of pregnancy. Techniques of processing the samples are described. The recovery of protein after solubilization with mercaptoethanol follow ed by centrifugation was between 62% and 81% of the starting material. The chemical composition of purified cervical mucus from each period is given. Protein hexose fucose sialic acid and sulfate were determined. Protein concentration ranged from 450 to 480 and 490 mcg/mg of dry mucus in the 3 different periods. Hexose fucose and sulfate were unchanged. Sialic acid concentration was found to vary fro m 30 mcg/mg of dry mucus in preovulatory samples to 46 mcg/mg in postovu latory and 49 mcg/mg in pregnancy samples. With fractionation by column chromatography samples from all periods exhibited a similar chromatogra phic behavior. Each specimen was separated into a major peak eluted in the void volume defined as Fraction A and 3 minor peaks of retarded material defined as Fraction B. Fraction was a glycoprotein of large molecular weight. In all samples this fraction constantly represented about 65% of the total recovery from the column. Immunoelectrophoresis with total human antiserum failed to reveal serumtype proteins in Fraction A as separated by Sephadex G-200 chromatography. Fraction G consisted mainly of serum-type proteins. The patterns of fucose sialic acid and hydroxyamino acids varied in the specimens taken at different periods. Findings suggest that in cervical mucus constituents exist in different concentrations each regulated by a particular hormone. Biologic properties of cervical mucus are related to physical changes. The significance of the chemical changes is not yet determined.

Laparoscopic convervative 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.

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.

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.

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.

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.

Ovarian hyperstimulation after administration of triptorelin therapy to a patient with polycystic ovary syndrome

Ovarian hyperstimulation syndrome (OHSS) may occur after ovarian stimulation induction using various drugs. Patients with polycystic ovary syndrome (PCOS) have a higher risk of developing OHSS because of the increased endogenous levels of LH. The proposed mechanism is that increased endogenous LH levels induce the synthesis of vascular endothelial growth factor, which mediates neovascularization and increased vascular permeability (1).

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.