Umbilical cord fluoride serum levels may not reflect fetal fluoride status.

OBJECTIVE: To evaluate the reliability of fluoride levels in the umbilical cord as reflecting neonate fluoride status. DESIGN: Prospective study of fluoride levels of pregnant women at term and their neonates. SETTING: Delivery room and maternity unite of Hadassah Hospital Mount Scopus. PATIENTS: Fluoride serum levels were determined in the sera of 20 women with normal pregnancies at term, during delivery, in the corresponding mixed cord sera and neonatal sera at 24 hours after delivery. RESULTS: The mean maternal fluoride serum level was 0.0303 microgram/ml (SD 9.015), mean cord fluoride serum level 0.0183 microgram/ml (SD 0.012), and mean neonatal fluoride serum 0.0380 microgram/ml (SD 0.016). CONCLUSION: The significantly (p < 0.001) low mixed cord serum levels of fluoride as compared with neonatal and maternal serum levels may be explained by placental sequestration of fluoride. It is suggested that cord serum fluoride levels to not reflect fetal fluoride status.

High concentration of soluble interleukin-2 receptors in ejaculate with low sperm motility.

The various cytokines are involved in infection and immunological reactions and thus may be involved in impairment of sperm function. The present study determined the concentrations of interleukin-1, interleukin-6 and soluble interleukin-2 receptors in ejaculates of normal donors and patients suffering from pure asthenozoospermia and patients suffering from oligoteratoasthenozoospermia. Ejaculates of patients attending the fertility clinic in Hadassah Mount Scopus Hospital, Israel, were evaluated. The patients were divided into three groups: (i) controls (n = 20), (ii) pure asthenozoospermia (n = 30), (iii) oligoteratoasthenozoospermia (n = 36). Significantly higher concentrations of soluble interleukin-2 receptors were found in the ejaculates of patients with pure asthenozoospermia 2243.1 +/- 473.6 mu/ml (mean +/- SE) as compared with controls 673.5 +/- 281.3 mu/ml (P < 0.05) and oligoteratoasthenozoospermic patients 1012.3 +/- 206.9 mu/ml (P < 0.05). Interleukin-1 and interleukin-6 concentrations were comparable in all groups studied. Our results show that human ejaculates contain interleukin-1, interleukin-6 and soluble interleukin-2 receptors. High concentrations of soluble interleukin-2 receptors in the ejaculates of asthenozoospermic patients may be related to either infectious or immunological processes.

Ultrasound transmission gel in the vagina can impair sperm motility.

The effect of ultrasound transmission gel on sperm motility was assessed because of a few unsatisfactory post-coital tests, encountered after vaginal ultrasonography in otherwise normal couples. Swim-up samples of spermatozoa from donors and patients with asthenozoospermia were incubated in ultrasonic transmission gel at various concentrations. Sperm progressive motility and viability were checked. Donor sperm progressive motility declined from 90.9 +/- 2.5% (mean +/- SD) to 30.6 +/- 2.7% (P < or = 0.001) within 18 h at a gel concentration of only 10% (by volume). There were no progressive motile spermatozoa after incubation in 80% gel. In the swim-up fraction from asthenozoospermic patients, motility declined from 92.2 +/- 2.5% to 11.6 +/- 2.1% (P < or = 0.001) within 130 min at a gel concentration of 10% (by volume). Eosin staining for viability demonstrated that the loss of motility was mostly due to loss of viability. The use of ultrasound transmission gel should be avoided during follicular follow-up close to the date of expected ovulation in couples who practise dated natural intercourse or cervical insemination. Normal saline is an adequate substitute in this period with relatively large follicles.

[Adverse effects of tamoxifen on the female genital tract].

Tamoxifen is an established adjuvant therapy for breast cancer. It exerts both estrogenic agonist and antagonist effects on target tissues. Since the use of tamoxifen is expanding, it is expected that more women will suffer from its side-effects. 3 women aged 48, 48, and 65, respectively, who were treated with tamoxifen, were referred for evaluation of possible side-effects. They had, respectively, endometrial hyperplasia, a unique sonographic appearance of the endometrium resembling neoplasia, and an ovarian cyst.

Growth hormone status in patients with maturation arrest of spermatogenesis.

The growth hormone levels of 11 azoospermic patients with histological evidence of maturation arrest of unknown aetiology were studied using the clonidine test. The results were compared with the results from clonidine tests on 10 healthy fertile men and on a group of patients with severe oligozoospermia of various aetiologies. The results demonstrated that 10 patients (91%) in the azoospermic group had non-reactive, pathological responses while none of the control group had a pathological response. Of the severe oligozoospermic group, 82% had normal reactive clonidine tests (P < 0.005). We suggest that growth hormone deficiency may be associated with maturation arrest, and the possibility of treatment with growth hormone should be considered.

Rupture of ectopic pregnancy following disappearance of serum beta subunit of hCG.

The introduction of sensitive assays for the beta subunit of hCG (beta-hCG) and improved ultrasound technology for diagnosis and monitoring of ectopic pregnancy have changed the clinical approach to the management of ectopic pregnancy. Only a few reports have been published of patients with ectopic gestation and negative serum beta-hCG levels. None of these described rupture of ectopic pregnancy following the decline of beta-hCG levels to below 10 mIU/mL. We describe a case of ectopic pregnancy, managed expectantly, in which rupture and hemoperitoneum occurred after the decline of beta-hCG levels to below 10 mIU/mL.

The effect of ethinyl estradiol on endometrial thickness and uterine volume during ovulation induction by clomiphene citrate.

OBJECTIVE: To assess the deleterious effect of clomiphene citrate (CC) on the development of the endometrium and its improvement by the addition of ethinyl estradiol (E2). PARTICIPATING PATIENTS: Infertility-treated patients, monitored for induction of ovulation or timing of insemination (control group). DESIGN: We studied four groups of women during an ovulatory cycle with various treatment schedules. Group 1: untreated patients; group 2: patients treated by CC; group 3: patients treated by CC + ethinyl E2; group 4: patients treated by human menopausal gonadotropin. Follow-up of the patients was done by vaginal ultrasonography and measurements of blood E2. RESULTS: In the group treated by CC, both endometrial thickness and uterine volume growth during the follicular phase were lower as compared with untreated controls and menotropin-treated patients. The addition of ethinyl E2 to these patients reversed this deleterious effect of CC without interfering with ovulation. CONCLUSION: Ethinyl E2 may reverse the deleterious effect of CC on endometrial development during the follicular phase.

Increased middle cerebral artery blood flow impedance in fetal subdural hematoma.

This case describes the prenatal diagnosis at 30 weeks' gestation of a posterior fossa subdural hematoma. Doppler velocimetry studies of the middle cerebral artery at that time showed an abnormally high resistance pattern with reverse end-diastolic flow. Ultrasonic assessment of the fetus indicated that there was associated quadriplegia. No cause for the lesion was demonstrated. A fetal blood sample, obtained by cordocentesis, revealed a normal karyotype. Fetal blood gas analysis was also normal. The pregnancy was terminated at the parents' request.

Successful conservative management of primary nonmetastatic cervical choriocarcinoma.

Primary cervical choriocarcinoma is a rare disease; since 1915 only about 60 cases have been published. The case presented here can be defined as primary cervical choriocarcinoma since it fulfills all the criteria delineated previously.

Characterization and localization of human placental mononuclear phagocytes by monoclonal antibodies and other cell markers.

Human first-trimester placental macrophages were identified in frozen tissue sections and following cultivation as single-cell suspensions. In placental sections, the placental macrophages were shown to be the main cell type of the stromal zone. They clearly expressed macrophage-specific antigen, identified by EBM 11 monoclonal antibody; all were positive for nonspecific esterase (NSE), and 40-60% of them expressed the HLA-DR antigen. These cells were negative to anti-alpha-human chorionic gonadotropin (HCG) monoclonal antibody. After preparation of the placental single-cell suspension, the macrophages comprised about 15% of the total cell population. This fact was established by the following findings: 15% of the placental cell suspension expressed the antigen recognized by the OKM5 antibody, 16% expressed the EBM 11 antigen, 13% expressed the HLA-DR antigen, 5.5% were positive for NSE, and 24% phagocytosed Staphylococcus albus. Thirty percent of the cells were positive to anti-alpha-HCG antibody. After 48 h of cultivation in defined tissue culture conditions, the macrophages comprised more than 95% of the culture cell population. In the 48-h cultures, 98% of the cells expressed the macrophage antigens identified by OKM5 and EBM 11 monoclonal antibodies, and 75% expressed the HLA-DR antigen; 95% were positive for NSE, 88% of the cells had Fc receptors, and 95% of them were able to phagocytose S. albus. Only 0.1% of the culture cell population were positive to anti-alpha-HCG monoclonal antibody. These assays showed that the placental macrophages are the main cells in the placental stroma. In our tissue culture conditions, incubation time was shown to be the dominant factor in selecting macrophages over other cell types, most probably because the macrophages are the only placental cells that have the ability to adhere to plastic dishes. This observation might also explain the contradictory results in various studies over the last decade, regarding the incidence of the placental mononuclear macrophages.

Prolongation of the latent period in patients with premature rupture of the membranes by avoiding digital examination.

Fifty three women with PROM between 26 and 34 weeks of gestation were examined. Twenty five women (group A) underwent one digital examination for cervical assessment while in 28 women (group B) the cervix was evaluated by speculum. No pelvic examinations were performed throughout the latent period. The latent period increased from 3.1 days in group A to 9.5 days in group B (P less than 0.005). Chorioamnionitis developed in 24% in group A and in 18% in group B (N.S.).

In utero ponderal index as a prognostic factor in the evaluation of intrauterine growth retardation.

The in utero ponderal index has become a method of estimating fetal growth. Several methods have been used in the formulation of the in utero ponderal index. In the present study, 1040 pregnant women underwent ultrasonic examination between 24 and 41 weeks of gestation, and the in utero ponderal index was determined by dividing the estimated fetal weight by the third power of the femur length, rendering a relatively constant value of 8.345 +/- 2.5 (2 SD). Fifty-one cases were defined as intrauterine growth retardation due to an estimated fetal weight lower than the tenth percentile for gestational age. The in utero ponderal index proved to be a valuable index in the prediction of fetal outcome in those cases of intrauterine growth retardation in which the in utero ponderal index was smaller than 1 SD from the average of 8.345. Fetal and neonatal well-being was clearly compromised when intrauterine growth retardation was associated with a low in utero ponderal index.