Neuroimaging of Acute Ischemic Stroke: Multimodal Imaging Approach for Acute Endovascular Therapy / 대한뇌졸중학회지

Advances in acute ischemic stroke (AIS) treatment have been contingent on innovations in neuroimaging. Neuroimaging plays a pivotal role in the diagnosis and prognosis of ischemic stroke and large vessel occlusion, enabling triage decisions in the emergent care of the stroke patient. Current imaging protocols for acute stroke are dependent on the available resources and clinicians’ preferences and experiences. In addition, differential application of neuroimaging in medical decision-making, and the rapidly growing evidence to support varying paradigms have outpaced guideline-based recommendations for selecting patients to receive intravenous or endovascular treatment. In this review, we aimed to discuss the various imaging modalities and approaches used in the diagnosis and treatment of AIS.

Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials / 대한뇌졸중학회지

Background@#and Purpose The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs). @*Methods@#We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0–3 at 3 months), secondary outcome (mRS 0–2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting. @*Results@#Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04–3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10–15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42–0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM. @*Conclusion@#In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms.

DIRECT-SAFE: A Randomized Controlled Trial of DIRECT Endovascular Clot Retrieval versus Standard Bridging Therapy / 대한뇌졸중학회지

Background@#and Purpose The benefit regarding co-treatment with intravenous (IV) thrombolysis before mechanical thrombectomy in acute ischemic stroke with large vessel occlusion remains unclear. To test the hypothesis that clinical outcome of ischemic stroke patients with intracranial internal carotid artery, middle cerebral artery or basilar artery occlusion treated with direct endovascular thrombectomy within 4.5 hours will be non-inferior compared with that of standard bridging IV thrombolysis followed by endovascular thrombectomy. @*Methods@#To randomize 780 patients 1:1 to direct thrombectomy or bridging IV thrombolysis with thrombectomy. An international-multicenter prospective randomized open label blinded endpoint trial (PROBE) (ClincalTrials.gov identifier: NCT03494920). @*Results@#Primary endpoint is functional independence defined as modified Rankin Scale (mRS) 0–2 or return to baseline at 90 days. Secondary end points include ordinal mRS analysis, good angiographic reperfusion (modified Thrombolysis in Cerebral Infarction score [mTICI] 2b–3), safety endpoints include symptomatic intracerebral hemorrhage and death. @*Conclusions@#DIRECT-SAFE will provide unique information regarding the impact of direct thrombectomy in patients with large vessel occlusion, including patients with basilar artery occlusion, with comparison across different ethnic groups.

Preparation of CI-921 mixed micelles and determination of its entrapment efficiency by method of dialysis and fitting / 中国药科大学学报

@#The aim of this research were to prepare CI-921 mixed micelles(CI-Micelles), to establish a method for determining the entrapment efficiency of CI-Micelles, to optimize the formulation and to evaluate their in vitro properties. CI-Micelles were prepared by film dispersion. Dialysis and fitting were used to calculate true entrapment efficiency(EE)and drug loading(DL)of CI-Micelles. The influences of polymer concentration, polymer radio and hydrating media on the entrapment efficiency, drug loading and particle-size were investigated. The stability at 4 °C in 6 days was evaluated. The optimal formulation of CI-921-Micelles consisting of polymer concentration of 72 mg/mL, a mass radio of Pluronic F127/Solutol HS15 at mass ratio of 1 ∶2 and 5% glucose solution as hydrating medium, showed a EE of more than 90%, and mean particle-size of 17-25 nm and PDI< 0. 210. There were no significant changes to CI-Micelles in EE and particle-size after treatment at 4 °C for 6 days. The applied method of dialysis and fitting could be used to determine EE for micelles loaded with weakly basic drug which was difficult to meet sink conditions. Adjustment of the mass radio of Pluronic F127 to Solutol HS15 had resulted in uniform particle size distribution, high entrapment efficiency and drug loading capacity and better stability of CI-Micelles.

Stabilizing effects of a particulate demineralized bone matrix in the L4 interbody space with and without PEEK Cage: a literature review and preliminary results of a cadaveric biomechanical study / Estabilización de los efectos de una matriz osea desmineralizada Particulada en el espacio intersomático a nivel L4 con o sin cajetín PEEK: revisión de la literatura y resultados preliminares de un estudio biomecánico cadavérico

We reviewed the biological elements supporting the usefulness of a specifically designed particulate form of demineralized bone matrix (DBM) in spinal fusion, and report some limitations of its use described in the medical literature and in the interbody space using a cadaveric biomechanical model. A literature review and description of the techniques used to augment spinal fusion are presented, including a more thorough review of recent findings of cadaveric biomechanical flexibility studies using DBM alone at different percentage fills of the existing disc space and DBM with a polyetheretherketone (PEEK) interbody cage. The need for DBM was established by reviewing limitations of autografts and allografts in spinal fusion. Demineralized bone matrix used alone did not increase stability post discectomy at L4-L5, but was demonstrated to exhibit satisfactory stability when used with a PEEK interbody cage. There may be a future role for DBM that hardens and fills disc space more rigidly, overcoming this limitation to its use.

Examinamos los elementos biológicos que respaldan la utilidad de una forma particulada específicamente diseñada de matriz ósea desmineralizada (MOD) con fusión espinal. Asimismo reportamos algunas limitaciones de su uso en el espacio intersomático descritas en la literatura médica, mediante un modelo biomecánico cadavérico. Se presenta una revisión de la literatura, acompañada de una descripción de las técnicas utilizadas para aumentar la fusión espinal, incluyendo una revisión más exhaustiva de los hallazgos recientes de los estudios de flexibilidad biomecánico cadavérica, utilizando sólo MOD en diferentes rellenos de porcentajes del espacio discal existente, y MOD con cajetines intervertebrales de polieteretercetona (PEEK). La necesidad de MOD se estableció examinando las limitaciones de los autoinjertos y los aloinjertos en la fusión espinal. El uso de la matriz ósea desmineralizada sola, no aumentaba la estabilidad post-disectómica a nivel L4-L5, pero se demostró que presentaba una estabilidad satisfactoria cuando se utilizaba con un cajetín intervertebral PEEK. Puede haber un papel futuro para un MOD que se endurezca y rellene el espacio del disco más rígidamente, venciendo así esta limitación a su uso.

The establishment of an Intracranial Tumour Registry at the University Hospital of the West Indies / Establecimiento de un registro de Tumor Intracraneal en el Hospital Universitario de West Indies

In March 2010, the first Intracranial Tumour Registry (ITR) in the English-speaking Caribbean was started at the University Hospital of the West Indies (UHWI). This was deemed necessary as the already established Jamaica Cancer Registry only reports on malignant brain tumours. The ITR will collect data on all prospective intracranial tumours, benign and malignant, which are diagnosed histologically at the UHWI. Retrospective information dating back five years was also collected. Data collected so far reveal that between the years 2006 to 2010, a total of 317 cases were entered into the database. Of these, only 45 cases were considered eligible. The issues surrounding this discrepancy are discussed in this paper along with the many challenges experienced in the establishment of the ITR. From these experiences, the authors have also put forward several recommendations that may be useful to other researchers who wish to implement similar systems.

En marzo del 2010, en el Hospital Universitário de West Indies (HUWI), se inició elprimer Registro de Tumor Intracraneal (RTI) del Caribe anglófono. La creación de este registro fue considerada una necesidad por cuanto el ya establecido Registro de Cáncer de Jamaica solamente reporta tumores malignos del cerebro. El RTI recogerá datos de todos los tumores intracraneales prospectivos, tanto benignos como malignos, que sean histológicamente diagnosticados en HUWI. También se recopiló en retrospectiva información de cinco anos atrás. Datos coleccionados hasta ahora revelan que entre los anos 2006 a 2010, un total de 317 casos fueron introducidos en el banco de datos. De éstos, sólo 45 casos fueron considerados elegibles. En el presente trabajo se discuten los problemas en torno a esta discrepancia, junto con los numerosos retos enfrentados con la creación del RTI. A partir de estas experiencias, los autores hacen también varias recomendaciones que pueden ser útiles a otros investigadores deseosos de implementar sistemas similares.

Increasing incidence of admissions to a General Hospital for deliberate self-harm in trinidad / Aumento de la incidencia de ingresos al Hospital General por auto-daño deliberado en trinidad

BACKGROUND: Deliberate self-harm and suicidal behaviour have become an increasingly common form of morbidity in the developing world. Suicidal behaviour is a major public health problem in Trinidad as the country has the second highest completed suicide rate in the English-speaking Caribbean. The objectives of this study were to determine the epidemiology of attempted suicide and self-harm at a specified site (the Port-of-Spain General Hospital) and compare it to previous studies done at the same site. SUBJECTS AND METHODS: This was investigated through a review of one years' admissions to the Port-of-Spain General Hospital for suicidal behaviour. Incidence was compared with a previous study completed at this site and reported in 1974. Comparison of the demographic characteristics of the sample with that of the previous study was also undertaken using chi-square analysis and significance testing through the use of t tests. RESULTS: A total of 368 referrals were made for attempted suicide or deliberate self-harm over the period indicating a fourfold increase in the incidence of this behaviour with a greater increase among males where the female to male ratio has declined from 4 to 1 to 2 to 1, p < 0.001; the mean age of males was 34 years compared to females 22 (p < 0.0001). The males were more likely to use violent means compared to females who were more likely to ingest tablets or bleach. Relationship difficulties were most commonly cited by both males and females as the reason for their attempt. There was a trend to greater propensity for this behaviour among Indo-Trinidadians as compared to Afro-Trinidadians in both females and males. CONCLUSIONS: Increasing numbers of men are engaging in self-harm behaviour and are using more violent and physically harmful methods suggesting a greater degree of suicidal risk while women mainly engage in acts of ingestion with a much lower risk of death. The older mean age of these men suggests that their problems are presenting in middle adulthood while women are engaging in this behaviour in young adulthood. Suicidal behaviour or deliberate self-harm is a major public health problem in Trinidad.

ANTECEDENTES: El auto-daño deliberado y el comportamiento suicida se han convertido cada vez más en una forma común de morbosidad en el mundo en vías de desarrollo. El comportamiento suicida es un serio problema de salud pública en Trinidad, como país que tiene la tasa más alta de suicidios efectuados en el Caribe anglófono. Los objetivos de este estudio fueron determinar la epidemiología del suicidio efectuado y el auto-daño en un lugar específico (el Hospital General de Puerto España) y compararla con estudios previos realizados en el mismo lugar. SUJETOS Y MÉTODOS: Esto fue investigado mediante una revisión de los ingresados de un año al Hospital General de Puerto España por comportamiento suicida. La incidencia fue comparada con un estudio previo terminado en este sitio y reportado en 1974. La comparación de las características demográficas de la muestra con la del estudio previo se llevó a cabo usando un análisis de chi-cuadrado y pruebas de significatividad mediante el uso de tests t. RESULTADOS: Se produjeron un total de 368 casos referidos por intento de suicidio o auto-daño deliberado en el período en cuestión, lo cual indica que la incidencia de esta conducta aumentó en cuatro veces, con un mayor incremento entre los varones, y una disminución de la proporción hembras-varones de 4:1 a 2:1; p < 0.001); la edad promedio de los varones fue 34 años en comparación con la de las hembras, 22 (p < 0.0001). Los varones mostraron una tendencia mayor a usar medios violentos en comparación con las hembras, entre las que había una mayor probabilidad de ingerir tabletas o lejía. Las dificultades en las relaciones constituyeron la explicación más comúnmente dada como causa del intento, tanto por los varones como por las hembras. Hubo tendencia a una mayor propensión a este comportamiento entre los indo-trinitenses en comparación con los afro-trinitenses, tanto en hembras como varones. CONCLUSIONES: Un número cada vez mayor de hombres se involucran en conductas auto-agresivas y están usando métodos más violentos y físicamente dañinos, lo que sugiere un grado mayor de riesgo de suicidio, mientras que las mujeres se entregan principalmente a actos de ingestión con riesgo mucho menor de muerte. La edad promedio mayor de estos hombres sugiere que sus problemas se presentan en medio de su adultez, mientras que las mujeres se entregan a estas conductas como adultos jóvenes. La conducta suicida y el auto-daño deliberado constituyen un problema principal de salud pública en Trinidad.

Transfer of head-injured patients in Jamaica: is there a problem? / Transferencia de pacientes con heridas de cabeza en Jamaica: ¿hay problema?

Head-injured patients are often transferred to the University Hospital of the West Indies (UHWI) for tertiary care. There is no standardized, agreed protocol governing their transfer. During the three-year period January 1998 to December 2000, 144 head injured patients were transferred to the UHWI from other institutions. They were 70male, had a mean age of 34 years and spent a mean of 13 days in hospital. Eighteen per cent were admitted to the Intensive Care Unit, where they spent a mean of nine days. On arrival, mean pulse rate was 92 +/- 22 beats/minute, mean systolic blood pressure was 130 +/- 27 mmHg and mean diastolic was 76 +/- 19mmHg. Twenty-eight per cent of patients had a pulse rate above 100/min on arrival and 13.8had systolic blood pressure below 60 mmHg. The Glasgow Coma Scale score was unrecorded at the referring institution in 70of cases and by the receiving officers at the UHWI in 23of cases. Intubation was done on only half of those who were eligible. Junior staff members initiated and carried out transfers whenever this was documented. The types of vehicles and monitoring equipment used could not be determined in most instances. Fifty-eight per cent of patients had minor head injuries, 12, severe injury and 33, associated injuries requiring a variety of surgical procedures by multiple specialties. Most patients (80.6) were discharged home but 11.8died in hospital. Transfer of head-injured patients, many with multiple injuries is not being performed in a manner consistent with modern medical practice. There is urgent need for implementation of a standardized protocol for the transfer of such patients in Jamaica.

Los pacientes con heridas en la cabeza son a menudo transferidos al Hospital Universitario de West Indies (UHWI) para su cuidado terciario. No existe ningún protocolo acordado en relación con las normas que deben regir la transferencia. En el trienio de enero de 1998 a diciembre 2000, 144 pacientes con heridas de cabeza, fueron transferidos al HUWI desde otras instituciones. El 70% de ellos eran varones de 34 años de edad promedio, y el período de permanencia en el hospital fue 13 días como promedio. El 18% fue ingresado en la Unidad de Cuidados Intensivos, donde permaneció un promedio de 9 días. Al llegar al hospital, su pulso medio era de 92 ± 22 pulsaciones/minuto, la presión arterial sistólica media era de 130 ± 27 mmHg, y la media diastólica de 76 ± 19 mmHg. El 28% de los pacientes tenía un ritmo de pulsaciones por encima de 100/min al momento del ingreso, y un 13.8% tenía la presión arterial sistólica por debajo de 60 mmHg. No había constancia de la aplicación de la Escala de Coma de Glasgow en las instituciones que remitieron a los pacientes en el 70% de los casos, ni por parte de los funcionarios médicos que recibieron a los pacientes en el HUWI en el 23% de los casos. La entubación se realizó solamente en la mitad de los pacientes elegibles. El personal subalterno inició y llevó a cabo las transferencias en todos los casos docu-mentados. En la mayor parte de los casos no fue posible determinar los tipos de vehículos ni el equipo de monitoreo utilizados. El 58% por ciento de los pacientes presentaba heridas menores de la cabeza, el 12% tuvo heridas graves, y un 33% acudió con heridas asociadas que requerían diversos procedimientos quirúrgicos de múltiples especialidades. La mayoría de los pacientes (80.6%) regresó de alta a sus casas, pero el 11.8% murió en el hospital. La transferencia de pacien-tes con heridas en la cabeza – muchos de ellos con lesiones múltiples – no se está realizando de manera consistente con la práctica médica moderna...

Neuroendoscopy in Jamaica / Neuroendoscopía en Jamaica

This retrospective, descriptive study reviewed the patient profile, disease spectrum, indications for and results of treatment and complications of all 27 patients who had neuroendoscopy at the University Hospital of the West Indies (UHWI) over the three-year period between November 2000, when the service was first introduced, and November 2003. Nineteen (67.9) were males and eight were females. Their mean age was 27.5 +/- 21.4 years with a range of four months to 70 years. Of the entire group, 20 had hydrocephalus with raised intracranial pressure, of which 15 had endoscopic third ventriculostomy (ETV) for the treatment of obstructive hydrocephalus, using two different techniques for ventricular floor fenestration. There was no demonstrable difference in outcome between the water jet and blunt forceps techniques. Three procedures failed to relieve the hydrocephalus, requiring subsequent ventriculo-peritoneal shunts. Three patients had successful cyst fenestrations. Six patients had endoscope assisted trans-sphenoidal resection for pituitary tumours. There were five complications and no deaths. Mean hospital stay was 18.4 +/- 16.7 days and mean follow-up was 29 weeks. There were no late failures. Neuroendoscopy is the treatment of choice for obstructive hydrocephalus due to aqueduct stenosis or posterior fossa tumours and has the advantage of avoiding shunt related complications. It is safe and effective for the majority of patients and has a significant role in the management of neurosurgical patients in the Caribbean

Este estudio retrospectivo y descriptivo, examinó el perfil del paciente, el espectro de la enfermedad, las indicaciones y resultados del tratamiento, así como las complicaciones de un total de 27 pacientes sometidos a neuroendoscopía en el Hospital Universitario de West Indies (UHWI) por un período de tres años, de noviembre de 2000 de noviembre - cuando se introdujo el servicio por primera vez - hasta noviembre de 2003. Diecinueve (67.9%) eran hombres y ocho mujeres. Su edad promedio fue de 27.5 ± 21.4 años con un rango de cuatro meses a 70 años. De la totalidad del grupo, 20 presentaban hidrocéfalo con presión intracraneal alta, y de ellos 15 tuvieron ventriculostomía endoscópica del tercer ventrículo (VET) para el tratamiento de hidrocéfalo obstructivo, usando dos técnicas diferentes para la fenestración del piso ventricular. No hubo diferencia demostrable en cuanto a resultados, entre la técnica de chorro de agua y la de fórceps romos. Tres procedimientos no lograron aliviar el hidrocéfalo, haciéndose necesarios subsiguientes derivaciones ventrículo-peritoneales. Tres pacientes tuvieron fenestraciones de quiste exitosas. Seis pacientes fueron sometidos a resección trans-esfenoidal con asistencia endoscópica para los tumores pituitarios. Se presentaron cinco complicaciones y no hubo muertes. La estancia promedio en el hospital fue de 18.4±16.7 días y el seguimiento medio fue de 29 semanas. No hubo ningún fallo a última hora. La neuroendoscopía es el tratamiento elegido para el hidrocéfalo obstructivo debido a estenosis del acueducto o tumores en la fosa posterior, y tiene la ventaja de evitar complicaciones relacionadas con las derivaciones. La neuroendoscopía es segura y efectiva para la mayoría de los pacientes, y desempeña un papel significativo en el tratamiento de los pacientes neuroquirúrgicos en el Caribe

Civilian cranial gunshot wounds: a Jamaican experience

Gunshot injuries are an escalating social and medical dilemma in many Western and some developing countries. Of 40 patients arriving at the University Hospital of the West Indies (UHWI), Jamaica, from 1993 to 1998, with gunshot wounds of the head, 30 were admitted. Six of those admitted died within 24 hours, five with poor Glasgow Coma scores. Ten patients had surgery, two of whom died. Six complications occurred: two patients each developed an infection, cerebrospinal fluid fistula or seizures. All patients were victims of an assault and all had intracranial penetration, the most common sites of which were facial and frontal. Median hospital stay was eleven days. The Glasgow Coma Score on admission was a good prognostic indicator. Fourteen patients had associated injuries, four of which were in the neck. Surgery was considered inappropriate for moribund patients and those with inaccessible bone and bullet fragments. Young males were the most common victims of this devastating form of assault

Infections in neurosurgical patients admitted to the intensive care unit at the University Hospital of the West Indies

Patients admitted to the Intensive Care Unit (ICU) are at risk of developing life-threatening nosocomial infections, especially with organisms resistant to commonly used antibiotics. Neurosurgical patients are particularly vulnerable because of the serious nature of their illness, the frequency of associated trauma and the presence of invasive devices. Of 120 neurosurgical patients admitted to the ICU of the University Hospital of the West Indies (UHWI) between September 1995 and December 1999, the records of 73 patients were available for analysis. All had prophylactic antibiotics. Twenty-one of these 73 patients (28.8) developed 22 infections after a mean of five days in the ICU: nine with chest infection, seven with urinary tract infection, four with central nervous system (CNS) infection and one each with wound and skin infection. This is an incidence of 11.6/1000 patient-days. The responsible organisms included Pseudomonas (7/21), Acinetobacter (3/21), E. coli 2/21, Enterobacter (2/21), and Klebsiella (2/21), and one each with Staphylococcus aureus, methicillin resistant Staphylococcus aureus, coagulase negative Staphylococcus, group D Streptococcus and bacteroides (1/21). Infection was significantly related to length of hospital stay, length of ICU stay, duration of intubation, duration of ventilation and the presence of diabetes mellitus. All patients who had surgery after ICU admission developed infection, seven with chest infection, two with urinary tract infection, two with CNS and one with skin infection. The three patients who were admitted with intracranial infections all developed other infections. Infected patients had a significantly longer hospital stay. Five patients died, none directly attributable to infection, while 55 (75.5) made a good recovery. The problem of ICU infection may be expected to escalate with the increased use of intensive care, increasingly more complex surgical procedures and the growing problem of antibiotic resistance. Since infection is related to the length of ICU stay, earlier discharge of neurosurgical patients to an appropriately staffed high dependency unit is likely to result in reduction of the infection rate. Reinforcement of infection control strategies within the ICU may be expected to further minimize the infection rate

Conocimientos y actitudes sobre SIDA en escolares rurales de la Séptima Región del Maule / Knowledge and attitudes towards AIDS in rural students from The Maule 7th region

El trabajo pretende definir el grado de conocimientos sobre el Sida y precisar las actitudes frente a la enfermedad de una población adolescente principalmente rural, a fin de poder planificar campañas preventivas de carácter educativo. Para ello se aplica un cuestionario ya probado anteriormente en nuestro medio a 128 estudiantes (71 mujeres y 57 hombres) de 3§ y 4§ años de educación media del Liceo de Teno (Séptima Región). En términos generales, los resultados de la encuesta son parecidos a los observados en adolescentes de sectores urbanos y revelan un 70% de respuestas acertadas. La información sobre sexualidad es obtenida por los hombres de sus amigos y por las mujeres de sus padres. Con respecto a los conocimientos sobre el Sida destaca el rol educativo de la televisión

Epithelial cell function during blastocyst implantation.

In response to the ovarian secretion of progesterone and estrogen during early pregnancy, the mammalian uterus develops the capacity to perform complex cellular activities which occur before and after blastocyst implantation. Luminal epithelial cells participate in regulation of the metabolism of the blastocyst through the control of its humoral environment, provide an appropriate matrix for changes to occur at the interface between trophoblast and epithelium, and appear to transmit information from the blastocyst to the underlying stroma to initiate decidualization. With the completion of these functions during implantation in rodents, the epithelial cells self-destruct and are removed by phagocytic activity of the trophoblast. Control of both the endocytotic and secretory activity of luminal epithelial cells and their eventual self-destruction would require regulation of the Golgi-endoplasmic reticulum-lysosomes system within these cells. Progesterone secretion during early pseudopregnancy increases levels of cathepsin D, a lysosomal proteinase, in luminal epithelial cells by increasing the rate of enzyme synthesis. Progesterone pretreatment of ovariectomized rats followed by estradiol treatment results in the development of uterine sensitivity to deciduogenic stimuli. The number of proteins which are synthesized by luminal epithelial cells in response to estradiol to achieve this sensitivity has been determined. Epithelial cytosol proteins from rats treated with medroxyprogesterone acetate (3·5 mg sc) or medroxyprogesterone acetate plus estradiol (200 ng sc) were separated by two dimensional polyacrylamide gel electrophoresis. The synthesis of two proteins increased after 8 h of estradiol treatment and the synthesis of another three was increased by 12 h. The increased synthesis of these proteins could be related to changes in the capacity of the luminal epithelial cell for prostaglandin synthesis. The epithelial capacity for prostaglandin synthesis increases during pseudopregnancy to maximum levels at the time of maximum sensitivity to deciduogenic stimuli. Epithelial prostaglandin synthetic capacity may also depend upon the accumulation of prostaglandin precursors within these cells. Estradiol treatment of medroxyprogesterone acetate pretreated ovariectomized rats increased the arachidonic acid content and composition of epithelial phosphatidyl choline but the increases were not statistically significant. These changes in protein and lipid synthesis controlled by progesterone and estrogen would appear to contribute to the cellular activities of the luminal epithelium during early pregnancy.