Serum androgen changes during meal-induced hyperinsulinemia and after acute sequential blockade and hyperstimulation of insulin release in women with polycystic ovary syndrome.

To investigate if acute changes in endogenous insulin release are associated with similar changes in serum androgen, 13 healthy ovulatory women (group 1) and six women with polycystic ovary syndrome (PCOS) and hyperinsulinemia, three with acanthosis nigricans (group 2) were studied. On day 1 all women ingested a 725 kilocalories breakfast between 7:30 and 8:00 A.M. The next day (day 2) only PCOS women had the breakfast and a simultaneous 90-min intravenous infusion of epinephrine (E, 6 micrograms/min) and propranolol (P, 80 micrograms/min). On both days serum glucose, insulin, cortisol, 17 alpha hydroxyprogesterone (17 OHP), dehydroepiandrosterone sulfate (DHEAS), free testosterone (free T), and androstenedione (A) were determined every 30 min for a period of 3 h. In group 1, glucose, insulin, free T, and DHEAS simultaneously rose (p < or = 0.026) while cortisol and 17 OHP fell (p < or = 0.020). Group 2 on day 1 had fasting and meal-stimulated hyperinsulinemia but all serum steroids progressively decreased. In only one woman free T rose. On day 2 during the E + P infusion, glucose increased yet fasting insulin remained constant and serum steroids decreased again. During the 90 min post-infusion, insulin sharply increased but no acute elevation in any steroid occurred. In conclusion, in PCOS women no parallel changes in serum androgen concentrations were seen in association with acute truly physiologic endogenous hyperinsulinemia or during the acute pharmacologically induced hypoinsulinemia and subsequent hyperinsulinemia.

[Ovulation induction with human menopausal gonadotropins in hypothalamic-hypophyseal disfunction]. / Inducción de ovulación con gonadotropinas menopáusicas humanas en disfunción hipotálamo-hipofisiaria.

This is a report on the institutional experience of the use of Human Menopausal Gonadotropins (HMG) in anovulatory women diagnosed as hypothalamic-hypophysiary dysfunction of Group II of WHO with previous failure to chlomifen citrate therapy. In a period of three years 180 patients were gathered with 420 cycle of treatment, obtaining ovulation in 340 cycles (81%). The ovarian hyperstimulation syndrome (OHS) was present in 15 cases (3.5%). There were 115 pregnancies that correspond to 33.8% of oculatory cycles and to 63.8% of the amount of patients. Multiple pregnancy incidence was 10.4%, and the gestational loses rate was 26%; these results are similar to what has been reported in literature. It is concluded that this medication is a good option of treatment for this type of patients, provided that there are the necessary means to expert and adequate surveillance.

[Unexplained sterility. Treatment with superovulation and intrauterine insemination]. / Esterilidad inexplicable. Tratamiento con superovulación e inseminación intrauterina.

Fifty couples with unexplainable sterility, were selected for study. They were treated following a uniform treatment protocol, consisting in inducin superovulation by human menopausic gonadotropins hormones, followed by intrauterine insemination with husband's fresh semen. One hundred and thirty six cycles of treatment, were obtained; 15 pregnancies were achieved, corresponding to 30% of the total of couples, and to 11% of amount of treatment cycles. These figures were similar to other author's, and similar to the ones obtained by intrauterine gametes transference. It is concluded that this a new alternative of treatment that may be used before IGT, or in places where there is not such methodology.

[C-reactive protein as early marker of chorioamnionitis in premature rupture of membranes]. / Proteína C reactiva como detector temprano de corioamnioitis en ruptura prematura de membranas.

This study was done in order to correlate the C-Reactive Protein levels (CRP) determined by nephelometric technique, with other infection indicators, and to know its exactness in early detection of chorioamnioitis. Thirty patients were prospectively studied with pregnancies from 28 to 35 weeks of gestation with diagnosis of premature rupture of membranes (PRM); and were compared to control group (30 patients) with similar gestation without PRM, infection, autoimmune diseases or chronic inflammation. The value for CRP was 2 mg/dl. The study group included 17 patients considered as positive, and 13 negative; the differences in CRP values in infected women was significant and not infected ones with a probability less than 0.001 (Fisher), with a sensitivity of 94.12%, and specificity of 100% positive predictive value of 100%, and a negative predictive value of 98.86%. The present data show that CRP is an early detector of amniotic infection.