Termination of early pregnancy by the 3 beta-hydroxysteroid dehydrogenase inhibitor epostane.

Progesterone is essential to sustain pregnancy in the first eight weeks. Its synthesis requires the enzyme 3 beta-hydroxysteroid dehydrogenase (3-HSD). We tested the efficacy of an orally administered 3-HSD inhibitor, epostane, in terminating unwanted early pregnancy. Fifty women in the fifth through eight weeks of pregnancy took epostane (200 mg orally every six hours) for seven days. By day 14, pregnancy had been terminated in 42 of the 50 patients (84 percent). Eight women (16 percent) did not abort and underwent dilation and curettage. Vaginal blood loss occurred on average on the third day of epostane treatment, and abortion on the fifth day. Two patients had incomplete abortions; one required a transfusion because of blood loss. Nausea was frequent (in 86 percent), but 76 percent of the participants concluded that epostane was preferable to dilation and curettage. The mean (+/- SD) pretreatment progesterone level (76 +/- 16 nmol per liter) decreased by day 7 (to 16 +/- 11 nmol per liter) and day 14 (to 10 +/- 9 nmol per liter) in those who aborted; levels of human chorionic gonadotropin also decreased from the mean at base line (73 +/- 72 kIU per liter) to 18 +/- 7 kIU per liter on day 7 and 9 +/- 5 kIU per liter on day 14. In those who did not abort after epostane treatment, progesterone levels decreased only slightly by day 7 (to 52 +/- 21 nmol per liter) and rose again (to 81 +/- 18 nmol per liter) by day 14. Among women who responded to epostane, normal menstrual periods had resumed by day 42 after the beginning of treatment in 72 percent. We conclude that epostane taken orally is an effective and safe method for the noninvasive termination of undesired early pregnancy.

PIP: The efficacy of the 3 beta-hydroxysteroid dehydrogenase inhibitor epostane in terminating early pregnancy was investigated in 50 women who were in the 5th-8th weeks of pregnancy. In previous studies, epostane has been shown to reduce progesterone levels significantly in pregnant and nonpregnant women without disruption of subsequent menstrual cycles or adverse effects on adrenal steroidogenesis or hepatic function. The study subjects received 200 mg of epostane orally every 6 hours for 7 days. In 42 women (84%), the pregnancy was terminated by the 14th day after epostane treatment was initiated. There were more responders among primigravidas (90%) than among multigravidas (76%), although the difference was not statistically significant. On average, vaginal blood loss occurred on the 3rd day of treatment and abortion on the 5th day. The mean pretreatment progesterone level (76 + or - 16 nmol/liter) decreased by day 7 to 16 + or - 11 nmol/liter and by day 14 to 10 + or - 9 nmol/liter in women who aborted, while levels of human chorionic gonadotropin decreased from a baseline mean of 73 + or - kIU/liter to 18 + or - 7 kIU/liter on day 7 and 9 + or - 5 kIU/liter on day 14. In women who did not abort, progesterone levels decreased only slightly 7 days after epostane treatment (to 52 + or - 21 nmol/liter) and rose again to 81 + or - 18 nmol/liter by day 14. 86% of study subjects reported treatment-related nausea; however, in 64%, the nausea was no worse than pretreatment nausea. 76% indicated epostane was preferable to dilation and curettage. Normal menstrual periods were resumed by day 42 after the initiation of treatment in 72% of the women who responded to epostane. Overall, these findings suggest that epostane is an effective alternative method for the termination of unwanted pregnancy in the 1st 8 weeks of gestation and should be given serious consideration as a noninvasive alternative to dilation and curettage.

Incomplete hydrolysis of cholesteryl esters during the enzymatic cholesterol determination as evidenced by aqueous cholesteryl ester solutions: comparison of six enzymatic procedures with the Liebermann-Burchard method.

Aqueous solutions of cholesterol and some cholesteryl esters were prepared. The hydrolysis of cholesteryl esters with enzymatic methods could therefore be studied in some detail. The total cholesterol concentration of the aqueous cholesterol and cholesteryl ester solutions was determined by 6 different enzymatic procedures as well as the Liebermann-Burchard method. For some esters (acetate and arachidonate esters) the esterase reaction is not complete within the usual reaction time, whereas most other esters gave analytical results lower than the theoretical. With the Liebermann-Burchard method all esters reacted completely within the reaction time. The esterase have very different specificities for the various cholesteryl esters. With the enzymatic method several commercial control sera as well as human sera gave lower cholesterol concentrations than the Liebermann-Burchard method. These differences can be explained mainly by this incomplete hydrolysis. Some practical recommendations are given.

Bromocresol purple, a non-specific colour reagent for the determination of serum albumin.

The determination of serum albumin with the dye reagent bromocresol purple was investigated. We found that bromocresol purple is not a specific reagent for albumin, but that serum proteins in the alpha-, beta-, and gamma-globulin fractions also react with this dye. Similar results were obtained for bromocresol green. Furthermore there is a great difference in absorbance between human and bovine albumin solutions (having the same concentration) when using the bromocresol purple reagent. Most probably this is a result of the difference in interaction of the reagent with the substrate. Although the standard curves with the bromocresol purple method were more linear (especially at higher albumin concentrations) than those obtained with the bromocresol green method, we still prefer the bromocresol green technique to the bromocresol purple technique, because its results are more comparable with those of other methods. Moreover in quality control and calibration procedures, strong deviations from the recommended values are obtained when non-human sera are analyzed with the bromocresol purple method. For reasons of accuracy more specific methods are preferable.

Electrophoresis of gamma-glutamyltranspeptidase on cellogel. The appearance of the alpha2-beta band in positive LP-X sera.

Fractionations of serum gamma-glutamyltranspeptidase (gamma-GT) and determinations of the "abnormal serum lipoprotein X" (LP-X) have been carried out in sera from patients with different hepatobiliary disorders. LP-X was used to demonstrate or exclude cholestasis. One gamma-GT fraction, alpha2-beta, may be of interest to distinguish between extrahepatic obstruction and intrahepatic cholestasis as was revealed by statistical analysis.