Gray matter anomalies in pedophiles with and without a history of child sexual offending.

Pedophilia is a psychiatric disorder that is inter-related with but distinct from child sexual offending (CSO). Neural alterations reportedly contribute to both pedophilia and CSO, but until now, no study has distinguished the brain structural anomalies associated with pedophilia from those specifically associated with CSO in pedophilic men. Using high-resolution T1-weighted brain images and voxel-based morphometry, we analyzed the gray matter (GM) volume of the following 219 men recruited at four acquisition sites in Germany: 58 pedophiles with a history of CSO, 60 pedophiles without any history of CSO and 101 non-pedophilic, non-offending controls to control for the effects of age, education level, verbal IQ, sexual orientation and the acquisition site. Although there were no differences in the relative GM volume of the brain specifically associated with pedophilia, statistical parametric maps revealed a highly significant and CSO-related pattern of above vs below the 'normal' GM volume in the right temporal pole, with non-offending pedophiles exhibiting larger volumes than offending pedophiles. Moreover, regression analysis revealed that the lower GM volume of the dorsomedial prefrontal or anterior cingulate cortex was associated with a higher risk of re-offending in pedophilic child molesters. We believe our data provide the first evidence that CSO in pedophilia rather than pedophilia alone is associated with GM anomalies and thus shed new light on the results of previous studies on this topic. These results indicate the need for new neurobehavioral theories on pedophilia and CSO and may be potentially useful for treatment or prevention approaches that aim to reduce the risk of (re)offending in pedophilia.

Leuprolide acetate for inducing ovulation in women undergoing ovarian stimulation.

OBJECTIVE: To determine whether leuprolide acetate (LA), given subcutaneously at the time of follicular maturity in stimulated cycles, can result in ovulation and in vivo fertilization. STUDY DESIGN: Sixty-seven women underwent 91 cycles of ovarian stimulation (OS) and received a single subcutaneous injection of 1 mg of LA when follicular maturity was reached. Only clomiphene citrate (CC) was used for 15 cycles, CC/FSH for 66 cycles and human menopausal gonadotropin only for 10 cycles. Thirty-four cycles were in oligoovulatory women. Eighty-two cycles were combined with intra-uterine insemination. RESULTS: Viable pregnancies occurred in 21/91 cycles (23%). Forty-two women testing with home urinary luteinizing hormone (LH) kits noted a surge. Seventy-one or 71 cycles demonstrated a biphasic curve. Sixty-eight of 75 cycles demonstrated follicular collapse (91%). Six women had serum LH levels of 12 +/- 4, 136 +/- 22 and 17 +/- 3 mIU/mL before and 12 and 36 hours after LA, respectively. CONCLUSION: LA successfully induced ovulation, fertilization and luteinization in women receiving OS. The pituitary LH response to LA appeared to be normal in women having OS. The pregnancy rate was similar to that generally observed with human chorionic gonadotropin (hCG). A large, prospective, randomized study may be warranted to compare LA to hCG since the subcutaneous route of LA administration and potential for reduced hyperstimulation could be significant advantages, making OS more practical and safe.