Control of perinatal infection by traditional preventive measures.

A 9-year review of nosocomial infections occurring in the department of obstetrics and gynecology of a major teaching hospital demonstrated the dramatic effect of strict asepsis and isolation on postoperative infection rates. With rigidly enforced preventive measures and without the use of prophylactic antibiotics, the rates of wound infection and endometritis and the relative prevalence of gram-negative aerobic organisms cultured from these infections could be reduced substantially. The role of anerobes in these infections was not established, since adequate techniques for the accurate diagnosis of anaerobic infection were not available at the time of this study. The relative importance of the numerous infection-control measures used is unclear. It is apparent, however, that by implementing all traditional methods of asepsis, virtually all types of nosocomial infection could be controlled, and the increased prevalence of gram-negative infections observed during the past decades could be reversed.

Experimental design for the surgical relocation of the ovary into the vaginal fornix.

After translocation into the vaginal vault while attached to a pedicle consisting of the infundibulo-pelvic ligament, the ovary was found to maintain its function in laboratory primates. In the majority of the baboons the ovulatory pattern returned within a few weeks after the surgical procedure. The only significant complication was a transitory, and self-limited, infection which was evident on inspection and on the biopsy specimens, but caused no clinical symptoms. By comparing the surgical outcome in two primate species, namely Papio Cynocephalus and Macaca Arctoides, it could be deduced that the Homo Sapiens would be a more suitable experimental model than either of the laboratory primates used in this research. Because there are potentially effective methods for reducing the likelihood of postoperative infection in the relocated ovary, the experience gained by this new method suggests the possibility that it could be utilized in the future for the purpose of collecting ova for in vitro fertilization in carefully selected, and otherwise untreatable, cases of female sterility.

The role of phosphate esters in male fertility.

Spermatozoa do not achieve full maturation and fertilizing capacity until passage through the epididymis. During this time they also gain motility, although spermatozoa do not move until after ejaculation. The organic fraction of human seminal plasma contains phosphate esters, particularly glycerylphosphorylcholine (GPC), phosphorylcholine (PCh), and inorganic phosphate (Pi). GPC is found in relatively high concentrations in the semen of many male animals, including man. GPC is synthesized by the epithelial cells of the epididymis, apparently under androgenic control. Consequently, it has been suggested that GPC might be a useful indicator of epididymal function. We have measured GPC, Pi, and PCh in fresh and frozen semen samples, using phosphorus nuclear magnetic resonance (31P NMR). All samples were assayed for phosphate esters. It was found that PCh was totally hydrolized to Pi. The average ratio of GPC to total phosphate (TP = GPC + Pi) remained constant at a value of about 0.1 for sperm counts over 20 million/ml. The ratio for azoospermic specimens was 0.02 or less; the same results were obtained from vasectomy specimens. This finding indicates that most of the GPC comes from the epididymis. There was a significant correlation between motility, progression, and the GPC ratio. Poor motility and progression in the specimens were accompanied by low GPC ratios regardless of the sperm counts.

Time-course relationships between serum LH, serum progesterone and urinary preganediol concentrations in normal women.

A specific and sensitive gas chromatographic method was used to investigate the concentration of pregnanediol glucuronide in urine in relation to the time of ovulation. Serum LH and progesterone concentrations in the same subjects were used as evidence for the occurrence of ovulation. The urinary concentration of pregnanediol glucuronide in 24-hour collections and in overnight specimens increased 2-fold or more from the day of the midcycle LH peak to the time of predicted ovulation (24-48 hour after the LH peak) in parallel with the rise in serum progesterone concentration.

Vaginal transposition of the ovary in primates (Papio cynocephalus and Macaca arctoides).

Experimental data indicate that the time and mechanism of ovulation play a significant role in some cases of infertility and in a broad range of reproductive abnormalities. In order to establish a new experimental model for the study of these phenomena in primates, transposition of the ovary from the pelvis into the vaginal fornix was attempted in 2 species of monkeys: (a) Macaca Arctoides and (b) Papio Cynocephalus. Particularly in the latter species, ovarian relocation into the anterior and the posterior vaginal fornices proved feasible. Most ovaries continued functioning in their new location during the 2-5 months of the follow-up, despite macroscopic and microscopic evidence of infection. Post mortem examination of one of the experimental animals several years after the surgical procedure revealed the presence of an intact functioning ovary still in close contact with the vaginal fornix.

Effect of prostaglandin F2alpha on the luteal phase of the cycle in nonpregnant women.

PIP: 11 healthy nonpregnant female volunteers were treated with (PGF) prostaglandin F2alpha as the THAM salt in aqueous solution administratered intravaginally. (HCG) Human chorionic gonadotropins was also administered to 9 of these women prior to or following the PG therapy to simulate secreting the phoblast. It was considered that luteolysis occurred if serum progestin declined to preovulatory levels, if there was no increase of serum progestin levels following HCG, and if there was shortening of the menstrual cycle by at least 3 days. Plasma LH, progesterone, 17-hydroxyprogesterone, 20alpha dihydroprogesterone, and PG were measured by radioimmunoassay techniques. When administered early in the luteal phase, PGF2alpha did not alter the length of the cycle. When administered in midluteal phase followed by HCG, there was an increase in cycle length and in serum progesterone levels. If no HCG was given, the cycle length was increased after PGF2alpha. When administered late in the cycle, the progesterone levels rose, but the cycle length remained unaltered despite HCG. The PG plasma levels varied significantly among the patients despite a uniform route/dose administration. However, with low plasma levels, there was evidence of increased progesterone production, while with high plasma levels, progesterone output rapidly diminished. The side effects accompanying elevated PGF2alpha plasma levels were pronounced.^ieng