Lipid profile during pregnancy in HIV-infected women.

PURPOSE: We investigated the evolution of serum lipid levels in HIV-infected pregnant women and the potential effect of antiretroviral treatment during pregnancy using data from a national surveillance study. METHOD: Fasting lipid measurements collected during routine care in pregnancy were used, analyzing longitudinal changes and differences in lipid values at each trimester by protease inhibitors (PIs) and stavudine use. Multivariate analyses were used to control for simultaneous factors potentially leading to hyperlipidemia. Study population included 248 women. RESULTS: Lipid values increased progressively and significantly during pregnancy: mean increases between the first and third trimesters were 141.6 mg/dL for triglycerides (p < .001), 60.8 mg/dL for total cholesterol (p < .001), 13.7 mg/dL for HDL cholesterol (p < .001), and 17.8 mg/dL for LDL cholesterol (p = .001). At all trimesters, women on PIs had significantly higher triglyceride values compared to women not on PIs. The effect of PIs on cholesterol levels was less consistent. Stavudine showed a dyslipidemic effect at first trimester only. Multivariate analyses confirmed these observations and suggested a potential role of other cofactors in the development of hyperlipidemia during pregnancy. CONCLUSION: The changes observed point to the need to further explore the causes and the clinical correlates of hyperlipidemia during pregnancy in women with HIV.

Effect of passive smoking on thyroid function in infants.

OBJECTIVE: To evaluate the effect of passive smoking on thyroid function in infants. DESIGN AND METHODS: Cord serum tri-iodiothyronine (T3), free T3 (fT3), thyroxine (T4), free T4 (fT4), TSH, thyroxine binding globulin (TBG), thyroglobulin (TG) and cord plasma thiocyanate were measured at birth, and serum TG and thiocyanate after 1 year of life, in 18 infants born from parents who did not smoke (group A), in 18 infants with a father who smoked (group B) and in 18 infants with parents both being smokers (group C). RESULTS: No significant differences were observed in cord serum concentrations of T3, fT3, T4, fT4, TSH and TBG among the three groups. Median (range) TG concentrations (ng/ml) were 30.2 (5.0-102.0), 56.3 (20.5-208.0) and 76.0 (26.0-199.0) at birth (P=0.009 for groups A and B compared; P=0.0002 for groups A and C compared), and 14.9 (5.4-32.0), 19.5 (10.0-57.5) and 20.0 (14.0-40.7) at 1 year (P=0.017 for groups A and C compared), in the three groups respectively, and thiocyanate concentrations (mmol/l) were 3.3 (0.0-51.4), 12.9 (0.0-122.2) and 27.8 (3.3-184.5) at birth (P=0.015 for groups A and C compared), and 3.1 (0.0-32.7), 6.0 (0.0-47.3) and 20.3 (0.0-230.8) at 1 year (P=0.01 for groups A and C compared) in the three groups respectively. CONCLUSIONS: TG and thiocyanate concentrations at birth and at 1 year of age in infants of smoking parents are greater than in infants with non-smoking parents. These results indicate that the change in thyroid function as evaluated by serum TG concentrations observed at birth can persist at least for 1 year if the exposure to passive smoking from both parents is continued. Increased TG concentrations may be due to a direct effect of thiocyanate on the thyroid gland.

[Combined use of goserelin acetate and human menopausal gonadotropin in the induction of follicular growth in a program of fertilization in vitro and embryo transfer]. / Uso combinato del Goserelin acetato e della gonadotropina umana menopausale nell'induzione della crescita follicolare in un programma di fertilizzazione in vitro e embrio-transfer.

OBJECTIVE: to investigate the efficacy of a gonadotropin-releasing hormone analogue (GN-RH-a) in combination with human menopausal menotropin (hMG) for in-vitro fertilization. METHODS: 30 infertile women aged 32 to 37 years received a combined treatment with a long-acting slow-releasing Gn-RH-a and hMG to perform ovarian stimulation in a program of in-vitro fertilization. Serum levels of Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), 17-beta-estradiol (E2), Progesterone (P), were evaluated and transvaginal ultrasonographic examinations were performed during the treatment to assess the ovarian volume, the mean number and diameter of growing follicles and the endometrial morphology and thickness. Oocyte retrieval was performed by transvaginal-ultrasound-guided approach, 24-36 hours after the administration of human chorionic gonadotropin (hCG). RESULTS: our data suggest that the combined use of Gn-RH-a and exogenous gonadotropins is associated with a more uniform ovarian response and with the absence of premature LH discharge. Moreover, the Gn-RH-a as polymer implant provides a controlled delivery per day over a one-month period and avoids the inconvenience of a daily administration. CONCLUSIONS: this kind of Gn-RH-a formulation, in in-vitro fertilization programs, appears very effective in inducing a reversible hypogonadic state, easy to manage and well tolerated by the patient. Its association with exogenous gonadotropins appears to be effective in increasing the success rate of good quality oocyte retrieval.

[Contribution of pelvic ultrasonography in the diagnosis and follow-up of Turner's syndrome]. / Apport de l'échographie pelvienne dans le diagnostic et dans le follow-up du syndrome de Turner.

Between 1983 and 1988, 40 patients with Turner's syndrome, aged 8 to 26 years, underwent serial pelvic ultrasonography, in order to evaluate the morphofunctional parameters of the internal genital apparatus and correlate them with the karyotype and gonadotropin levels. Correlation of uterine and gonadal sonograms (site, size and echogenic potential) with the karyotype and the gonadotropin assays, permits the definition of each case and a personalized therapeutic approach as well as a control of its efficacy and/or its side-effects.

Variations of growth factors in pregnant women during labor and in newborns at delivery.

To study physiological variations in serum growth factors during peripartal period, we have measured levels of a serum growth-promoting activity (thymidine activity, TA) and radioimmunoassayable somatomedin C (Sm-C) during labor in 39 women who delivered spontaneously (group A), by caesarean section (group B) and by legal abortion (LA) (group C). TA values were higher in the group A than in the group B and C, suggesting an important effect of uterine contractions in TA generation. A major role in Sm-C production seems to be played by the length of gestation since Sm-C concentrations were significantly higher in mothers delivered by caesarean section than in LA women. During labor influence of estrogens and progesterone in growth factor production seems unlikely because of the lack of correlation with TA and Sm-C levels. The lower TA values in placental flow than in the capillary blood of newborn suggest that serum growth factors, measured as TA, are produced by the newborn and do not cross through the placenta. These data suggest that the absolute dependence of the fetus on the mother does not preclude instances of fetal autonomy.

Treatment of hyperprolactinemic amenorrhea by intermittent administration of bromocryptine (CB 154).

The results obtained with intermittent bromocryptine treatment from the fifth day after the beginning of menstruation until the second day after the basal temperature rise, in 14 women with hyperprolactinemic amenorrhea-galactorrhea and in whom menses had previously been induced by continuous treatment, are presented. All women had menses without reappearance of galactorrhea; serum FSH, LH, estradiol, and progesterone followed a normal physiologic trend. Only prolactin rose again in the second phase of the cycle, in which lower levels of progesterone were also found, but without any significant interference in the clinical and hormonal trend. It is stressed that administration of bromocryptine during the first part of the cycle might substitute for continuous administration, thereby reducing drug consumption and hence possible side-effects as well as the cost of treatment.