Effectiveness of the short-term use of Cimicifuga racemosa in the endothelial function of postmenopausal women: a double-blind, randomized, controlled trial.

Objective: This study aimed to assess the effects of daily use of Cimicifuga racemosa on endothelial function through flow-mediated dilation of the brachial artery, when used for 28 days by healthy postmenopausal women.Methods: The double-blind, randomized, placebo-controlled study included two groups of postmenopausal women (n = 31 each). The subjects were clinically assessed and flow-mediated dilation of the brachial artery was measured before and after 28 days of treatment. Patients received dry extract corresponding to 160 mg C. racemosa (extract with 4 mg of triterpene glycosides) or placebo.Results: Mean age, time since menopause, and body mass index in the two groups were similar. The measurements of flow-mediated dilation of the brachial artery, pre and post treatment, respectively, showed a significant increase in patients who used C. racemosa (p = 0.006), unlike patients who used placebo, who did not present changes in the outcome of flow-mediated dilation of the brachial artery after 28 days of use (p ≥ 0.05). When comparing the number of women in both groups who showed an increase in flow-mediated dilation, a significant difference was found in the measurements of the treated group after the use of the medication (p = 0.018).Conclusions: Daily use of 160 mg C. racemosa extract by postmenopausal women for 28 days beneficially influences endothelial function by promoting elasticity of the brachial artery.

Short-term tibolone does not interfere with endothelial function: a double-blinded, randomized, controlled trial.

Objective To evaluate the effect of short-term hormone replacement therapy with tibolone 2.5 mg daily on endothelial function of healthy postmenopausal women, using flow-mediated dilation (FMD) of the brachial artery. Methods We performed a randomized, double-blinded, placebo-controlled study. A total of 100 healthy postmenopausal women were randomly allocated to receive tibolone (n = 50) or placebo (n = 50) for 28 days. Measurement of the FMD of the brachial artery was performed before and after the use of tibolone and placebo. Results A total of 31 women completed the study in the tibolone group, and 32 women completed the study in the control group. The results of the FMD measurements obtained from the women in the two groups before treatment were similar (0.018 and 0.091, for tibolone and placebo, p = 0.57). The values of the FMD in women who used tibolone and placebo, before and after the treatment, were similar in both groups. The numbers of women who presented an increase in the values of the FMD in both groups were also similar. Conclusion Our results demonstrate that the administration of 2.5 mg tibolone to healthy postmenopausal women for 28 days does not promote endothelial-dependent vasodilation, measured by FMD of the brachial artery.

Hypokalemic thyrotoxic periodic paralysis in a Caucasian male with Graves' disease.

The case of a 34-yr-old Caucasian male with Graves' disease presenting with a flaccid quadriplegia and severe hypokalemia is reported. The weakness was prevalent at the lower extremities and began during nocturnal sleep, after a strenuous physical exertion performed during the day. Correction of hypokalemia promptly reversed the quadriplegia. The occurrence of hypokalemic thyrotoxic periodic paralysis several months after the beginning of thyrotoxic symptoms, and the normal insulin serum levels on admission differentiate this patient from most of the previously reported cases.

Prevalence of abnormal thyrotropin concentrations measured by a sensitive assay in patients with type 2 diabetes mellitus.

The utilisation of assays for TSH with improved sensitivity has revealed that abnormal TSH results are frequently observed in patients with nonthyroidal illnesses, such as trauma, renal diseases, liver diseases or sepsis. The aim of this study was to investigate the prevalence of abnormal TSH concentrations, using a sensitive immunometric assay, in patients with type 2 (non-insulin-dependent) diabetes mellitus. The study population consisted of 290 type 2 diabetics, 159 females and 131 males aged 40 to 93 years (mean 60.6 +/- 11.9 years), hospitalised because of poor diabetic control or recent-onset diabetes (mean HbA1c value = 9.6 +/- 2.2%). All patients with TSH values outside the normal range (0.45 to 3.66 mlU/l) had FT4 assay and thyroid microsomal autoantibody assay performed on the same specimen of serum. Abnormal TSH concentrations were detected in 91 patients (31.4%). Subclinical hypothyroidism (high TSH, normal FT4) was most common (48.3%), followed by subclinical hyperthyroidism (low TSH, normal FT4) (24.2%) and by definite hypothyroidism (high TSH, low FT4) (23.1%). Definite hyperthyroidism (low TSH, raised FT4) was found in 4 patients (4.4%). None of the patients with low TSH values had increased FT3 concentrations. The prevalence of abnormal thyroid function test results was significantly higher in the female than in the male patients (40.9% vs. 19.8%, p < 0.0005) and in the insulin-treated patients than in those receiving oral hypoglycaemic agents (OHA) (37.3% vs. 23.1%, p < 0.02). Thirty patients with abnormal thyroid function test results (33.0%) had evidence of thyroid autoimmunity (titre of thyroid microsomal autoantibodies > 250 IU/l). Five thyroid microsomal antibody-negative patients had non-autoimmune thyroid diseases, 7 had nonthyroidal illnesses other than diabetes mellitus and 4 were receiving drugs known to affect the hypothalamic-pituitary-thyroid axis. Twenty-seven thyroid microsomal auto-antibody-negative patients with abnormal TSH values (17 with subclinical hypothyroidism and 10 with subclinical hyperthyroidism), who were not receiving drugs known to affect TSH secretion and were free of diseases other than diabetes mellitus, were retested after two months of adequate treatment of diabetes with OHA or insulin. TSH concentrations decreased in all but one patient with initial subclinical hypothyroidism and increased in all patients with initial subclinical hyperthyroidism. These changes were coupled with a significant fall of glycated haemoglobin values. In view of the transient changes in TSH secretion, we suggest that the diagnosis of thyroid dysfunction in type 2 diabetics should be delayed until improvement of the metabolic status.

Levothyroxine suppressive therapy in the medical management of nontoxic benign multinodular goiter.

The aim of this investigation was to evaluate the efficacy of levothyroxine suppressive therapy in the medical management of nontoxic benign multinodular goiter. We studied 104 patients with multiple (2 to 5, mean = 2.5 +/- 0.7), solid (96%) or predominantly solid (4%), nonfunctional (68%) or hypofunctional (32%) thyroid nodules. The benign (colloid) nature of 94% of the nodules was confirmed by fine-needle aspiration biopsy. All the patients received suppressive (2.2 micrograms per Kg body weight) daily oral doses of levothyroxine for 6 months. To confirm the effectiveness of the suppressive therapy, TSH levels were measured by an ultrasensitive immunometric assay at 3 and 6 month of treatment. For each patient, the volume of each nodule before and after levothyroxine therapy was evaluated by high-resolution ultrasonography. After 3 and 6 months of treatment, TSH levels were suppressed (lower than 0.1 mIU/l) in 75 patients and detectable in 29. At the end of the study, the volume of all the nodules was decreased by 50% or more (responder group) in 20/75 (27%) of the patients with suppressed TSH levels, and in 3/29 (10%) of those with detectable TSH values. In the latter group the proportion of patients in which one or more nodule(s) showed an increase in volume (48%) was significantly higher (p < 0.0005) than in patients with suppressed TSH (29%). We can conclude that an effective TSH suppressive therapy is an useful tool in the treatment of nontoxic benign multinodular goiter.

[A clinical comparative study of crystalline pure lactulose and powder pure lactitol in portasystemic encephalopathy of cirrhotic patients]. / Studio clinico di confronto tra lattulosio puro in cristalli e lactitolo puro in polvere nella encefalopatia porto-sistemica del paziente cirrotico.

The efficacy and the tolerability of the new crystalline pure lactulose formulation (Laevolac Cristalli) vs lactitol is evaluated in 40 patients suffering from liver cirrhosis and treated for the associated encephalopathy (PSE). Both disaccharides proved to be effective in the maintenance therapy of PSE. With respect to the previous formulation of lactulose, the crystalline one has a significantly lower incidence of side-effects. Pure crystalline lactulose, showing a similar efficacy and rise of side-effects, proved to be better accepted by the subjects of this study.

On the usefulness of levothyroxine suppressive therapy in the medical treatment of benign solitary, solid or predominantly solid, thyroid nodules.

The efficacy of levothyroxine suppressive therapy in the treatment of benign solitary thyroid nodules is controversial. In order to investigate this issue further we studied 122 patients with a solitary, solid or predominantly solid, thyroid nodule. The benign (colloid) nature of all nodules was proved by fine-needle aspiration biopsy. At the pertechnetate-99m thyroid scanning 91% of the nodules were "cold" and 9% "warm". All the patients received suppressive oral doses of levothyroxine (0.1 to 0.2 mg/day). Fifty-three patients were treated with levothyroxine for 6 months, 31 for 9 months and 38 for 12 months. The size of each nodule before and after treatment was evaluated by high-resolution ultrasonography. The actual suppression of TSH secretion was monitored at 3-month intervals using an ultrasensitive immunometric assay. At the end of levothyroxine treatment, patients were classified as responders (decrease in nodule volume greater than or equal to 50%, 68/122 = 55.7%; mean percent change in nodule volume = -77.1 +/- 15.7%), partially responders (decrease in nodule volume less than 50%, 24/122 = 19.7%; mean percent change in nodule volume = -27.5 +/- 10.1%), and nonresponders, when either no change in nodule volume (16/122 = 13.1%) or an increase in nodule volume (14/122 = 11.5%) was observed. In each group serum free T4 rose significantly in response to levothyroxine therapy, whereas serum free T3 remained unchanged. TSH levels were undetectable in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of football on the pituitary-testicular axis (PTA): differences between professional and non-professional soccer players.

Basal levels of LH, FSH, PRL and T, as well as LH, FSH and PRL relative maximum responses (RMRs = peak values/basal values) to an iv bolus of GnRH (0.1 mg) plus TRH (0.2 mg) were evaluated in 7 professional soccer players (PSP) examined on 3 occasions: after a 30 days rest period and 14-15 h from the end of both a customary training session and a strenuous football match, performed at the end of a 3 months regular training program. In 5 out of the 7 PSP a semen analysis was carried out after each endocrine evaluation. The results were compared with those obtained in 10 non-professional soccer players (NPSP) subjected to a similar study protocol, and with the data from 10 healthy, sedentary men. Basal LH values in the rest period were significantly higher (P less than 0.05) in PSP than in control men, whereas LH RMR and sperm motility were significantly lower (P less than 0.02) in the former group. No significant differences in basal hormone concentration and in the RMRs to GnRH-TRH were observed between PSP and NPSP. The training session performed by the PSP after 3 months of regular training did not significantly affect the hormonal parameters. In contrast, the football match induced a significant increase in PRL basal levels (P less than 0.02 vs. controls) and a significant fall in PRL RMR (P less than 0.02 vs. controls).(ABSTRACT TRUNCATED AT 250 WORDS)

A rise in haemoglobin levels may enhance serum triiodothyronine (T3). Concentrations in prepubertal patients with beta-thalassaemia major.

The aim of the present study was to investigate the effects of increased haemoglobin (Hb) levels on the thyroid function in patients with beta-thalassaemia major. Basal levels of thyroid hormones (T4, T3) and free thyroid hormones (fT4, fT3), basal TSH concentrations and the TSH responses to a TRH bolus (0.2 mg iv) were studied in ten euthyroid thalassaemic patients, aged 8 to 19 years, and in one 12 years-old thalassaemic girl with primary hypothyroidism. Five euthyroid thalassaemic patients (aged 8 to 12 years), as well as the hypothyroid thalassaemic girl, were prepubertal, whereas five euthyroid thalassaemic patients (aged 15 to 19 years) had delayed puberty. In each patient, the endocrine evaluation was carried out under conditions of low Hb levels (31 days after the last blood transfusion, mean Hb = 9.8 +/- 1.5 g/dl), and 11 days after the transfusion of 2 units packed red blood cells (PRBC). The latter increased significantly Hb concentrations in all the thalassaemic patients (mean Hb = 12.8 +/- 2.5 g/dl, P less than 0.001). Twelve normal prepubertal subjects, aged 6 to 11 years, served as the control group. Before the PRBC transfusion, basal T4, T3, fT4, fT3 and TSH concentrations were similar in euthyroid prepubertal thalassaemic patients (EPT) and in euthyroid patients with delayed puberty (EDPT), and were comparable to those in control subjects. The TSH responses to TRH (TSH peak, area and delta area) observed in EPT patients were similar to those in the EDPT group, but significantly higher in comparison with the normal children.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in the bioactivity to immunoreactivity ratio of circulating luteinizing hormone in impotent men treated with testosterone undecanoate.

Testosterone undecanoate was administered orally (80 mg twice daily) for 30 days to 10 impotent men with mild Leydig cell failure, age 28 to 42 years. Placebo was administered for 30 days both before and at the end of testosterone undecanoate therapy. Serum levels of bioactive LH, immunoreactive LH and testosterone were determined in basal conditions (day zero), 30 days after the first placebo administration, at the 15th and 30th day of testosterone undecanoate therapy, and at the end of the second treatment with placebo (90th day). Bioactive LH was measured by a sensitive and specific in vitro bioassay based on testosterone production by mechanically dispersed mouse Leydig cell preparations. Immunoreactive LH and testosterone were determined by a double-antibody RIA technique. The results were compared with those obtained in 30 untreated normal young men. In the basal state, serum concentrations of immunoreactive LH were significantly higher in the patients (P less than 0.02) than in control subjects, whereas testosterone levels were significantly lower (P less than 0.001) in the impotent men. In contrast, bioactive LH levels and the bioactive LH to immunoreactive LH ratios were similar in the two groups. In the patients, at the 15th day of treatment with testosterone undecanoate, serum levels of testosterone and bioactive LH were significantly higher (P less than 0.01) than basal values, whereas immunoreactive LH concentrations showed no significant changes. Consequently, the bioactive LH to immunoreactive LH ratios rose significantly (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The pituitary-testicular axis in non-professional soccer players.

In European countries, football is one of the most popular forms of physical exercise. However, the possibility that endocrine changes can arise in football players has not been investigated completely. Therefore, the aim of the present study was to evaluate the effects of a training program and the consequences of a football match on the pituitary-testicular axis in ten trained non-professional soccer players. Basal levels of LH, FSH, PRL and T, as well as LH, FSH and PRL responses to an iv bolus of GnRH (0.1 mg) plus TRH (0.2 mg), were measured in each subject. The endocrine evaluation was performed before the beginning of the seasonal training (after a 30 days rest period), and repeated on 2 consecutive days at the end of a 3 months regular training program, 14-15 h from the end of both a customary 3 h training session and a 90 min strenuous soccer match. In 5 out of the 10 athletes a semen analysis was performed after each endocrine evaluation. Ten age-matched, healthy, sedentary men served as a control group. Basal serum levels of LH (10.4 +/- 1.3 mIU/ml), FSH (8.7 +/- 1.1 mIU/ml), PRL (9.7 +/- 1.6 ng/ml) and T (6.3 +/- 0.9 ng/ml) measured in the soccer players before the beginning of the seasonal training were similar to those found in the control subjects (LH = 9.2 +/- 1.7 mIU/ml, FSH = 8.5 +/- 1.4 mIU/ml, PRL = 8.8 +/- 1.8 ng/ml, T = 6.4 +/- 1.1 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of increased haemoglobin levels on growth hormone (GH) secretion in beta-thalassaemia major: differences between prepubertal subjects and patients with delayed puberty.

Basal and L-dopa-stimulated secretion of growth hormone (GH) was investigated in 10 patients with beta-thalassaemia major. Five patients were prepubertal (chronological age 8 to 12 years), whereas 5 patients had delayed puberty (chronological age 15 to 19 years). Ten normal prepubertal subjects (chronological age 8 to 11 years) served as the control group. Each thalassaemic patient was subjected to two L-dopa tests (0.5 g L-dopa plus 0.7 mg/Kg body weight propranolol, orally): one was performed under conditions of low haemoglobin (Hb) levels (30 days after the last blood transfusion), and the second in the presence of increased Hb concentrations (10 days after the transfusion of packed red blood cells). Before the transfusion of packed red blood cells, basal GH concentrations were significantly higher in the patients with delayed puberty (4.3 +/- 1.6 ng/ml), than in prepubertal thalassaemic (1.8 +/- 0.9 ng/ml, p less than 0.05) and control (1.9 +/- 1.0 ng/ml, p less than 0.02) subjects. In contrast, the pituitary responsiveness to L-dopa, expressed as the relative maximum response for GH (GH delta %), was significantly higher in the latter two groups (8.5-fold, p less than 0.05, and 10.9-fold, p less than 0.02, respectively). The transfusion of packed red blood cells increased significantly Hb concentrations in both groups of thalassaemic patients (prepubertal +27%, p less than 0.05, delayed puberty +33%, p less than 0.025, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Subnormal prolactin responsiveness to thyrotropin-releasing hormone (TRH) in women with primary empty sella syndrome.

Basal prolactin (PRL) levels and PRL responsiveness to thyrotropin-releasing hormone (TRH) were studied in 10 women with primary empty sella (PES) syndrome (mean age 38.2 yr). Hyperprolactinemia (34 to 72 ng/ml) was found in 5 patients (hyperprolactinemic PES, H-PES), whereas 5 patients showed normal (9.5 to 19 ng/ml) PRL levels (normoprolactinemic PES, N-PES). The results were compared with those obtained in 10 healthy women (mean age 32.8 yr, PRL = 7 to 15 ng/ml) and in 8 women with a PRL-secreting pituitary microadenoma (MA) (mean age 37.5 yr, PRL = 39 to 85 ng/ml). The mean basal levels of PRL were significantly higher in patients with H-PES (50.8 +/- 13.2 ng/ml) or MA (64.0 +/- 18.3 ng/ml) than in the control group (10.9 +/- 2.6 ng/ml, p less than 0.02) and in the patients with N-PES (13.9 +/- 3.7 ng/ml, p less than 0.02). In contrast, the relative maximum response (RMR) of PRL to TRH (peak PRL/basal PRL) was significantly lower in the patients with PES (both H-PES and N-PES) or MA (1.4 +/- 0.4, 2.3 +/- 0.7 and 1.2 +/- 0.2, respectively) than in the control subjects (3.6 +/- 1.1; p less than 0.02, less than 0.05 and less than 0.02, respectively). Our results show that the pituitary responsiveness to the acute stimulation with TRH is significantly decreased both in patients with a PRL-secreting pituitary MA and in those with PES. Therefore, the clinical value of the TRH test in distinguishing the PES syndromes from prolactinomas seems to be questionable.

LRH-stimulated release of bioactive and immunoreactive LH in a patient with the XX male syndrome.

Serum levels of biologically active LH (bLH) and immunoreactive LH (iLH) under basal conditions and in response to the iv injection of 0.1 mg synthetic LRH were measured in a 15-year-old boy with the 46,XX karyotype. LH bioactivity was assessed "in vitro" on mouse Leydig cell preparations, whereas iLH levels were measured by a double antibody RIA technique. High basal levels of both bLH and iLH were shown in the XX male. Following LRH administration, the relative maximum response of LH above basal levels (LH delta %) was higher for iLH than for bLH. Consequently, the LH bioactivity to immunoreactivity (b/i) ratio decreased from basal values. Since a similar decrease in the b/i ratio of LRH-stimulated LH has been observed in patients with Klinefelter's and Turner's syndrome, we can suppose that in the chromosomal disorders of sex differentiation the pituitary gland possesses a lower responsiveness for bLH than the normal pituitary.

Changes in mouse Leydig cell steroidogenesis following infrared and helium-neon laser irradiation.

The effects on mouse Leydig cell steroidogenesis of infrared (IR) laser rays, in the presence or absence of helium-neon (He-Ne) radiations, were investigated. Testosterone (T) production in response to luteinizing hormone (LH) by mouse Leydig cells exposed to IR (4.2 X 10(-3) J/cm2/min) plus He-Ne (8.0 X 10(-7) J/cm2/min) laser radiations was significantly higher than that by control Leydig cells. The Leydig cell responsiveness to LH (T delta %), as well as the secretion of cyclic AMP (cAMP) and androstenedione (A) in response to the highest dose of LH (0.5 mIU), were also significantly increased by the IR plus He-Ne irradiation. In contrast, the He-Ne irradiation (8.0 X 10(-7) J/cm2/min) in the absence of IR rays failed to affect T production by mouse Leydig cells. Similar results were obtained by adding to the He-Ne rays a low dose of IR radiation (3.4 X 10(-3) J/cm2/min), whereas higher doses of IR radiations (4.2 X 10(-3) and 5.1 X 10(-3) J/cm2/min) elicited a similar significant increase of T production by mouse interstitial cells.

Biologically active luteinizing hormone (LH) in Klinefelter's syndrome: response to gonadotropin-releasing hormone (GnRH) and effects of testosterone undecanoate.

Basal and gonadotropin-releasing hormone (GnRH)-stimulated levels of biologically active and immunoreactive LH (bLH and iLH) were measured in six patients with Klinefelter's syndrome (KS) (mean age 24.7 years). In the same patients the diurnal rhythm of serum testosterone (T) was investigated (morning values vs. evening values). The results were compared with those obtained in ten normal young men (mean age 29.3 years). Moreover, in one patient with KS we studied the effects of testosterone undecanoate (TU) administration on bLH and iLH basal levels. A sensitive "in vitro" bioassay, based on T production by mechanically dispersed mouse Leydig cells, was employed to assess LH bioactivity. Levels of iLH and T were determined by a double antibody radio-immunoassay technique. Mean basal levels of bLH and iLH were significantly higher (p less than 0.001) in the Klinefelter patients than in normal men, whereas the mean bioactivity to immunoreactivity (b/i) ratio of LH was similar in the two groups. The mean morning T concentration was significantly higher in normal men (p less than 0.001) than in the Klinefelter group. The diurnal T rhythm was lost in the patients with KS. In the Klinefelter patients the relative maximum response of bLH to GnRH (bLH delta%) was significantly lower (p less than 0.02) than in the control men. In addition, the b/i ratio of GnRH-stimulated Lh decreased significantly (p less than 0.05) from basal values in the Klinefelter patients, whereas it remained unchanged in the control group. In the patient with KS treated with androgen replacement therapy, TU decreased iLH serum levels more than bLH concentrations, thereby increasing the b/i ratio of basally secreted LH.

Further studies on the effects of pentoxifylline on sperm count and sperm motility in patients with idiopathic oligo-asthenozoospermia.

To further investigate the effectiveness of pentoxifylline (trental) treatment in male infertility, we studied 22 young men (mean age 28.4 years) with "idiopathic" oligo-asthenozoospermia treated for 6 months with the drug (1200 mg daily orally). Sperm concentration and sperm motility were determined before therapy, as well as after 3 and 6 months of pentoxifylline administration. Moreover, fructose concentrations in seminal fluid and sperm ATP levels were assayed before and at the end of the treatment in five semen samples. Pentoxifylline therapy significantly increased both sperm concentration and sperm motility. Sperm concentration showed a 1.5-fold increase (p less than 0.01) at the 3rd month of therapy, and a 2.0-fold increase (p less than 0.001) at the 6th month, whereas sperm motility increased by 1.8-fold (p less than 0.001) and by 2.8-fold (p less than 0.001) respectively. At the end of the treatment, fructose concentrations in seminal fluid were significantly higher (p less than 0.001) than pretreatment values; in contrast, sperm ATP levels showed a significant (p less than 0.05) fall. These results suggest that pentoxifylline, probably acting on the cAMP metabolism, may be an useful drug in the treatment of idiopathic oligo-asthenozoospermia.

Effects of luteinizing hormone-releasing hormone (LRH) upon bioactive and immunoreactive serum LH in patients with Turner's syndrome before and after oestrogen treatment.

One daily dose of 0.05 mg ethinyl oestradiol was administered to 5 patients with Turner's syndrome (mean age +/- SEM = 16.4 +/- 0.7 years) for 10 days. The effects of acute stimulation with luteinizing hormone-releasing hormone (LRH) (0.1 mg iv) on biologically active and immunoreactive LH were analysed before therapy and at the end of oestrogen treatment. Bioactive LH (BIO-LH) was measured by a sensitive and specific in vitro bioassay based upon testosterone production by mechanically dispersed mouse Leydig cell preparations. Immunoreactive LH (RIA-LH) was evaluated by a double antibody RIA method. Prior to oestrogen treatment, LRH induced a prompt rise in BIO-LH and RIA-LH levels, which reached peak values at 30 and 45 min, respectively. After oestrogen treatment, a delayed response (with peak values at 120 min) was observed for both BIO-LH and RIA-LH. Before oestrogen treatment, the mean bioactivity to immunoreactivity (B/I) ratio of LRH-stimulated LH showed a significant decrease from basal values (P less than 0.05). In contrast, after ethinyl oestradiol administration the mean LH B/I ratio increased significantly from basal values in response to LRH (P less than 0.05). The mean relative maximum response (delta %) for BIO-LH was significantly higher (P less than 0.05) in oestrogen-treated than in untreated patients, whereas the mean BIO-LH delta area was significantly lower in the former group (P less than 0.01). Similarly, oestrogens decreased significantly the mean RIA-LH delta area (P less than 0.05), whereas they did not affect significantly the mean RIA-LH delta %. The results further emphasize that oestrogens may change the quality of circulating LH.

[Intra-uterine contraceptive devices in nulliparous women: a retrospective study]. / Dispositivo intra-uterino na contracepcao de mulheres nuligestas: um estudo retrospectivo.

PIP: The insertion of intrauterine devices (IUDs) in nulliparous women is a controversial subject, with no unanimous opinion on whether or not to use this method. A study was undertaken to analyze retrospectively the complications of the TCu-200 IUD in nulliparous women compared to complications encountered in multiparous women using the same device. In 1982 and 1983, the Family Planning and Human Reproduction Clinic of the UFMG Medical School in Belo Horizonte, Brazil, inserted 114 IUDs in nulliparas. The principle characteristics of the study group were a low socioeconomic condition, regularity of menstrual flow, and absence of vaginal infection at the time of examination. The choice of method was the spontaneous decision of the women. It was noted that nulliparas requested IUD insertion after previous unsatisfactory experience with other contraceptive methods. 56% of the group were single and 38% married. For comparison, 300 records of multiparous TCU-200 IUD users were studied retrospectively. All insertions were made by the same clinic. The racial, social, and economical characteristics were typical of the users of any free family planning service. Among early complications, pain and lipothymia were encountered at an elevated incidence in nulliparous women when compared to multiparas (p0.01). Among late complications, the appearance of vaginal discharge and metrorrhagia were significant when compared to multiparas (p0.05). Pelvic infection and dysmenorrhea, although more frequent in nulliparas, were not statistically significant. The authors concluded that the IUD should not be used as the contraceptive method of 1st choice in nulliparous women, using it only in exceptional situations.^ieng