In vivo estrogen regulation of epidermal growth factor receptor in human endometrium.

The effects of estrogen and progesterone on the expression of epidermal growth factor receptor (EGFR) in human endometrium were studied in hypogonadal women under conditions that simulated a normal menstrual cycle. All women received the same regimen of estrogen and progesterone and underwent serial biopsies. In one group of women (group I), a biopsy was obtained before receiving estrogen (CD0) and after 11 days (CD11) of estrogen replacement. A second group of women was biopsied on CD11 and CD21 to assess the combined effects of progesterone and estrogen (group II). Immunohistochemistry was used to test for the presence of EGFR, and a ribonuclease protection assay was used to assess the amounts of EGFR messenger ribonucleic acid (RNA) relative to ribosomal RNA in the tissue. In group I, a significant increase in EGFR messenger RNA from CD0 to CD11 was observed. A similar increase was observed to occur between CD11 and CD21 in group II. Immunostaining for EGFR was absent in all CD0 biopsies, but was present in all estrogen-exposed endometrium. No difference in immunostaining was noted between CD11 and CD21. We conclude that estrogen stimulates the synthesis of EGFR in human endometrium and that progesterone does not appear to modulate this effect. The examination of other parameters in hormone-replaced hypogonadal subjects will be valuable in understanding the complex physiological regulation of the human endometrium.

The association of intrauterine filling defects on hysterosalpingogram with endometriosis.

OBJECTIVE: To determine whether there is a significant association between the presence of polyps or polypoid endometrium on hysterosalpingogram (HSG) with the presence of pelvic or peritoneal endometriosis. DESIGN: Retrospective chart review. SETTING: Department of Reproductive Endocrinology and Infertility at the University of Vermont, College of Medicine. PATIENTS: One hundred twenty patients, all of whom had a HSG, hysteroscopy, and laparoscopy by a member of our department between 1989 and 1993. MAIN OUTCOME MEASURE: Hysterosalpingograms were assessed for the presence of hypertrophic or polypoid endometrium. The presence of endometriosis was documented laparoscopically and scored according to The American Fertility Society classification and HSG findings were documented by hysteroscopy. RESULTS: Endometriosis was found in 27 of 32 women with polyps or polypoid endometrium but in only 19 of 88 women without. chi 2 analysis revealed a significant association between the demonstration of polyps or polypoid endometrium on HSG and the presence of endometriosis, chi 2(1) = 33.97. The predictive value of a positive test was 84% and the negative predictive value was 75%. CONCLUSION: The presence of polyps or polypoid endometrium on HSG is significantly associated with the presence of pelvic or peritoneal endometriosis.

Septate uterus with cervical duplication: a rare malformation.

This previously unreported case of complete uterine septum, cervical duplication, and a longitudinal vaginal septum is best explained by the theory of Muller et al. (5), not by classically held views of unidirectional müllerian development. According to their theory, this anomaly could develop from failure of fusion of the most caudad müllerian ducts, resulting in a normal uterine fundus, with a complete septum, cervical duplication, and a longitudinal vaginal septum. This anomaly was accurately characterized using an endoscopic approach.

Pregnancy after laparoscopic neosalpingostomy in a patient with atresia of the distal fallopian tubes.

Structural congenital anomalies of the fallopian tube are interesting clinical problems that are infrequently reported in the literature. We report a patient with congenital absence of the distal fallopian tubes. After surgical correction by laparoscopic neosalpingostomies using a new intussusception technique, a normal IUP occurred and was delivered at term.

In vitro CA-125 secretion by endometrium from women with advanced endometriosis.

OBJECTIVE: To determine if the endometrium of women with endometriosis is a potential source of the elevated serum concentrations of CA-125 associated with endometriosis. DESIGN: Secretion of CA-125 by the endometrium in tissue culture was documented and measured in response to treatment with progesterone (P), 17 beta-estradiol (E2), and progesterone and estradiol (E2+P). Sequential biopsies of the endometrium from the early and late luteal phase were obtained from women with laparoscopically documented normal anatomy or moderate to severe endometriosis. SETTING: Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology at the University of Vermont, College of Medicine, Burlington, Vermont. MAIN OUTCOME MEASURES: Secretion of CA-125 by endometrium in vitro was determined by radioimmunoassay in spent media using a commercially available kit (Centicor CA-125 Kit; Centicor, Malvern, PA). RESULTS: Secretion of CA-125 by endometrium in vitro is inhibited by the presence of P and E2+P in both the early and the late luteal phase. The amount of CA-125 secreted increases significantly from the early to the late luteal phase in all treatment groups. When compared with controls, the endometrium of women of with endometriosis secreted two to four times more CA-125 in all treatment groups, in both the early and late luteal phase. CONCLUSIONS: When compared with control endometrium, the endometrium of women with advanced endometriosis secretes significantly more CA-125 and represents a potential source of the elevated serum levels of CA-125 seen in these women.

Evaluation of fetal growth by estimation of neonatal body composition.

To characterize the variation in normal fetal growth by body composition analysis, 188 neonates from uncomplicated singleton term pregnancies were evaluated within 24 hours of birth. Anthropometric measures used to estimate lean body mass and body fat included the following: birth weight 3553 +/- 462 g, lean body mass 3060 +/- 377 g (86.3%), fat mass 495 +/- 196 g (13.7%), and ponderal index 2.65 +/- 0.25. There was a significant linear correlation between birth weight and lean body mass (r2 = 0.83, P = .0001), fat mass (r2 = 0.46, P = .0001), and ponderal index (r2 = 0.22, P = .001). Although the ponderal index has been used as an index of corpulence, the correlation between ponderal index and percent body fat was poor (r2 = 0.15). These results suggest that although neonatal fat mass constitutes only 14% of total birth weight, it explains 46% of its variance. In contrast, the ponderal index explains only 22% of the variance in birth weight and correlates poorly with percent body fat. Body composition analysis explains a significant amount of the variance in normal birth weight.

CA-125 secretion by luteal phase endometrium in vitro.

The source of CA-125 in normal women and the mechanisms which control CA-125 production remain to be defined. This study was initiated to examine the pattern of secretion of CA-125 from luteal phase endometrium. Endometrial samples were obtained during the early luteal phase (histological days 16-18) and late luteal phase (histological days 25-27) from ovulatory women with a laparoscopically normal pelvis. The tissue was maintained in explant culture using Trowell's T-8 medium with either no additions (NA), progesterone (P), oestradiol (E2), or E2 + P. The concentration of CA-125 in spent media from the second day in culture was determined by immunoradiometric assay. In early luteal endometrium, the concentration of CA-125 in spent media from the NA treated wells was significantly higher than when the endometrium was exposed to either P or E2 + P. Similar differences were noted between treatments for the late luteal endometrium. Within each treatment, there was a higher concentration of CA-125 in the spent media from the late versus the early luteal endometrium. We conclude that the endometrium is a potential source of serum CA-125 and that endometrial CA-125 is suppressed by P in both the early and the late luteal phase. Further, there appears to be an increase in endometrial CA-125 secretion from the early to the late luteal phase.