Detailed ultrasonographic findings in Greenberg dysplasia.

A case of Greenberg dysplasia [hydrops fetalis, ectopic calcifications, "moth-eaten" skeletal dysplasia (HEM)] is presented. Fetal ultrasonography at 20 weeks' gestation showed hydrops fetalis, severe micromelia, irregular hyperechogenic foci in the ribs and vertebral bodies, irregular hypo- and hyperechogenic areas and abnormal contour within the long bones, and flattened and "T"-shaped appearance of the vertebrae. Findings on postmortem histological and radiographic examination were consistent with Greenberg dysplasia.

Effect of different types of intrauterine devices on intrauterine activity.

OBJECTIVE: To compare the effects of various IUDs on intrauterine activity. PATIENTS AND METHODS: 57 women volunteers aged 18 to 25 in the outpatient clinic of the Department of Obstetrics and Gynecology at Cerrahpasa Medical Faculty of Istanbul University were included in the study. All were in good health and menstruating normally. The subjects were introduced to different types of IUDs on the fifth to eighth days of their menstrual cycle. Intrauterine activities with and without naproxen were recorded, for at least 20 minutes each time, with a micro-tip transducer before insertion, just after insertion, and 1 month later. RESULTS: Intrauterine activity increased just after insertion of both IUDs and disappeared 1 month later in copper-T wearing women, but persisted in multiload wearers. Naproxen seemed to be useful in preventing intrauterine activity caused by the IUD. CONCLUSIONS: The IUD itself causes an increase in intrauterine activity which is preventable by naproxen, suggesting the possible role of prostaglandins. Persistence of intrauterine activity depends upon the type of device. Optimal designing of IUDs is required to decrease side effects and make them more acceptable.

Human Fallopian tube epithelial cell co-culture increases fertilization rates in male factor infertility but not in tubal or unexplained infertility.

In order to investigate the effect of human Fallopian tube epithelial cell co-culture on fertilization and cleavage rates in tubal, male and unexplained infertility, oocytes collected from 91 patients were randomized to wells containing Fallopian tube epithelial cell monolayers or conventional culture medium, and inseminated with spermatozoa. Fertilization and cleavage were assessed at 18 and 52 h, respectively. Co-culture significantly increased the fertilization rates over the control values in male infertility (41.67 versus 23.43%, P = 0.00005), but not in tubal infertility (69.33 versus 67.93%) or unexplained infertility (65.93 versus 54.36%). Cleavage rates were not different in co-culture and conventional in-vitro fertilization systems in any of the infertility subgroups. The number of blastomeres was significantly higher in the co-culture group on the day of embryo transfer (3.63 +/- 1.12 versus 3.04 +/- 1.26, P < 0.001). Pregnancy rates were similar in all infertility subgroups. There was no significant association between the number of co-cultured embryos transferred and the pregnancy, abortion and multiple pregnancy rates. It was concluded that human Fallopian tube epithelial cell co-culture clearly improves fertilization rates in male infertility but not in tubal or unexplained infertility. Improved fertilization rates in co-culture may be due to positive effect of co-culture on impaired sperm function.

Endometrial biopsy findings in infertility: analysis of 12,949 cases.

OBJECTIVE: Endometrial biopsy has been an important way of assessing infertile couples for several years. In this review of a wide-ranging series of endometrial biopsies of infertile couples in the Turkish population it was our aim to find the distribution of results according to the years 1956-1966, 1967-1980, 1981-1992. SETTING: University hospital. SUBJECTS: 12,949 endometrial biopsies, referred to our gynecological pathology laboratory for infertility investigation between 1956 and 1992. METHOD: Patient report files from pathology laboratory data, analyzed retrospectively. The assessment of the biopsies is made by the same pathologist. RESULTS: 78.8% of cases had primary infertility, 21.2% secondary. Most of them were in the age group 26-35 years (48.8%). 37.58% of cases were found to show normal secretory endometrium, 20.95% proliferative endometrial changes, and 28.22% signs of luteal phase defect (LPD). Other local endometrial factors were also encountered, but in 1.79% the sample was considered insufficient for diagnosis. Moreover, in nine cases, malignancy was diagnosed with the help of endometrial biopsy. During the study period, cases of normal secretory endometrium and tuberculous endometritis were observed to decrease and LPD to increase significantly. It is worthy to note that in only 28 (0.21%) cases had endometrial biopsies been performed during a pregnancy cycle. CONCLUSION: We conclude that endometrial biopsy not only shows the hormonal response of endometrium but gives additional information about the local factors of endometrium concerning atrophy, specific and non-specific infections, and malignancy.

Tolerability, safety and efficacy of two formulations of Parlodel--a slow release oral form (SRO) versus registered Parlodel capsules.

Twenty hyperprolactinemic patients who entered a randomized parallel-group, double-blind, double-dummy study were investigated regarding safety, tolerability and efficacy. Half of the patients received 5 mg Parlodel SRO plus placebo for Parlodel while the other half received 2.5 mg Parlodel b.i.d. and placebo for Parlodel SRO for a period of 15 days. In the second following period of 15 days, the daily dose was increased to 10 mg Parlodel administered either as a single dose of Parlodel SRO or two doses of Parlodel 5 mg. The plasma prolactin levels, clinical signs and symptoms of hyperprolactinemia, physical examination, blood pressure, heart rate assessments and adverse events were recorded during the study. Complete blood count, blood chemistry and standard ECG were performed before and at the end of treatment. In conclusion, both formulations are equally efficacious, well tolerated and safe. Due to the comfort of once-a-day administration and the excellent compliance, one could recommend to replace the b.i.d. or t.i.d. administration of Parlodel with the once-a-day Parlodel SRO in hyperprolactinemic patients.

The prognostic significance of maternal serum CA125 measurement in threatened abortion.

The prognostic predictive value of maternal serum CA125 measurement was investigated in 25 cases of threatened abortion. The women were non-smoker, had a ultrasonographically verified viable single fetus, and the gestational ages ranged from 7 to 12 weeks. Twenty-five healty pregnant women, with the same characteristics were used as the control group. The overall abortion rate was found to be 20% (5/25) in the study group. In serial measurements the mean serum CA125 level of the patients with an unfavorable pregnancy outcome was significantly higher than that of the patients with a favorable outcome. When the cut-off level of maternal serum CA125 was taken as > 65 U/ml in the first and > 60 U/ml in the second measurements of the study group, the risk of termination of the pregnancy by spontaneous abortion was 83.3% in the patients with elevated serum CA125 levels. No statistically significant difference was observed with respect to the duration of vaginal bleeding between the aborters and the patients with a favorable outcome. Nevertheless, when vaginal bleeding had been present for 3 days or more and there was high maternal serum CA125 activity, the abortion risk was found to be 100% (3/3). These findings suggest that the maternal serum CA125 measurement in threatened abortion can be useful to determine the extent of decidual destruction which is directly related to the outcome of pregnancy.

The effect of intrauterine insemination on uterine activity.

Intrauterine insemination (IUI) may lead to very painful uterine cramps, which are due to the effect of the prostaglandin (PG) content of human semen. The purpose of this study is to present the reactivity of the human uterus to the placement of raw semen in the intrauterine space and to evaluate the related response patterns. A statistically significant uterine activity change was observed between the periods before and after intrauterine insemination. Three minutes after IUI, an increase in uterine activity was observed; it became most prominent at five to ten minutes. This stimulation was sustained for 30 minutes and decreased gradually. Although there is an increase in uterine activity following intrauterine insemination, neither pelvic pain nor abdominal discomfort was reported. According to this observation, we suggest that a semen volume of 1 mL might be used safely for intrauterine insemination.

Maternal, umbilical, uterine and amniotic prostaglandin E and F2 alpha levels in labour.

This paper confirms the important role played by prostaglandins in the induction of uterine contractions and the initiation of human labour, although the exact mechanism of action in labour remains unclear. Seventeen pregnant women at term were studied. Of these nine were in labour and the remainder underwent elective section. Prostaglandin E and F2 alpha levels were measured in maternal, umbilical and uterine plasma and amniotic fluid by radioimmunoassay. Levels of prostaglandin E were generally higher than prostaglandin F2 alpha but they were significantly lower in maternal and uterine plasma. Levels of prostaglandin F2 alpha were significantly higher in maternal plasma during labour. The highest levels of prostaglandin were found in amniotic fluid. Measurements indicate that the decreasing ratio of prostaglandin E/F2 alpha is more important in the initiation of labour than absolute levels of either prostaglandin.

The role of prolactin in luteal inadequacy: treatment of hyperprolactinaemia with bromocriptine.

Endometrial biopsy carried out in 628 women presenting for routine investigation of infertility showed that 268 had luteal phase deficiency and 46 of them also had hyperprolactinaemia, without evidence of any other cause of their infertility. These 46 patients were given treatment with bromocriptine, starting with a dose of 1.25 mg/day and increasing to 5 mg/day, depending on how well the drug was tolerated. Serum prolactin levels were assayed every month in all women who had not conceived and endometrial biopsy was repeated in those who had still not conceived after 3-months' treatment. The levels were shown to have decreased to within normal limits in all patients and 18 (39%) of the women had become pregnant, 13 of them during the first 3 months of treatment. No abnormality was detected in any of the babies. The remaining patients who did not become pregnant had normal prolactin levels and normal endometrial secretion after bromocriptine treatment.

[Anti-prostaglandins in therapy for side effects of intrauterine contraceptive devices]. / Rahim ici kontraseptif araclarin yan etkilerinin tedavisinde anti-prostaglandinler.

PIP: 43 women aged 21-35 with 0-4 parity wearing Lippes Loop IUD were studied in a double-blind trail during 3 menstrual cycles to find out if proquazon, a prostaglandin (PG) synthesis inhibitor, prevented the adverse effects of the IUD. IUDs increase the PG level in the endometrium. Higher PG levels result in pain through uterine cramping and endometrial bleeding caused by increased vascular permeability (70- 10-0 ml. blood loss vs. the normal amount of 35 ml). 200 mg of proquazon was administered 3/day (t.i.d.) for 79 cycles and 1 capsule of placebo was given for 50 cycles. Proquazon mitigated pain and reduced the incidence of severe pain: pain was absent in 33 (42% cycles with proquazon vs. 7 (14%) with placebo; light pain occurred in 29 (37%) vs. 15 (30%) respectively; medium strong pain occurred in 12 (15%) vs. 17 (34%), respectively; and severe pain was observed in 5 (6.3%) vs. 11 (22%), respectively.^ieng

Hyperprolactinemia and its effect on female sterility.

Starting with the isolation and purification of human prolactin, several studies have been conducted in order to understand prolactin (PRL) physiology and pathology in the human. Results of research effected since then have shown that high levels of PRL could cause sterility either through its effects on ovulation at the hypothalamic, hypophyseal or gonadal level or through the inhibition of steroid synthesis in the ovaries which leads to amenorrhea. In parallel with these findings, bromocriptine, a dopamin agonist inhibiting PRL secretion has been used in the clinic for the treatment of hyperprolactinemic states and the positive results obtained confirmed the role of PRL in human reproduction. The aim of our study is to investigate the causative mechanisms of sterility in hyperprolactinemic patients. For this purpose, in hyperprolactinemic cases with sterility a possible correlation between the PRL values and endometrial changes is investigated. Our findings indicate that effects of PRL on the receptors of distal organs show individual variations and depend on the degree of receptor sensitivity. It is believed that the effects of PRL through receptor mediation deserve further investigation.

Hepatic cirrhosis and hepatic ultrastructure in pregnancy.

Hepatic cirrhosis rarely occurs with pregnancy. Since no report has been made on hepatic cirrhosis and hepatic ultrastructure in pregnancy, we present a case of cirrhosis and pregnancy in which a study of hepatic ultrastructure was carried out.

[Tubular adenoid granulosa cell tumours - their histogenesis (author's transl)]. / Tubularadenomähnliche Granulosazelltumoren und deren Histogenese.

A brief general review of granulosa cell tumours is followed by reference to more specific data obtained from hospitalised patients of the authors over the past 36 years. A tumour form observed in one female patient, but never before reported, is described under the name of "tubular adenoid granulosa cell tumor". - Histogenetic theories and functionally paradoxical tumours are discussed, in that context. The point is made that histopathological results may be confusing under certain circumstances. - An attempt is made to find an explanation for the functional behaviours of the above paradoxical tumours.