Serum prostaglandin F2 alpha (PGFM) and oxytocin levels correlate with sonographic changes in the cervix in patients with preterm labor.

This is a study on the correlation of maternal serum oxytocin and prostaglandin F2 alpha (PGFM) levels with sonographically measurable changes in the cervix and the internal cervical os in patients with preterm labor. Oxytocin levels significantly correlate (P = 0.03) with the width of the internal os and the PGFM values significantly correlate with the length of the cervix (P = 0.008). An increase in the oxytocin level resulted in a measurable widening of the internal os and an increase in the prostaglandin level resulted in a measurable shortening of the cervix.

Angiotensin II and monocrotaline-induced pulmonary hypertension: effect of losartan (DuP 753), a nonpeptide angiotensin type 1 receptor antagonist.

Administration of the pyrrolizidine alkaloid monocrotaline (MCT) to rats results in hypertensive pulmonary vascular disease characterized by a structurally based increase in pulmonary vascular resistance and right ventricular hypertrophy. Alterations in lung angiotensin converting enzyme activity in MCT-treated rats have suggested a role for angiotensin II (AII) in the pathogenesis of this model of hypertensive pulmonary vascular disease. To determine if increases in AII contribute to the development of pulmonary hypertension in MCT-treated rats, we examined the effect of chronic administration of the nonpeptide AII receptor antagonist Losartan on indices of pulmonary hypertension, Losartan (DuP 753; 10 mg/kg s.c.) administration for 21 days did not prevent the development of hypertensive pulmonary vascular disease in MCT-treated rats. However, 18 hr after the last dose of Losartan, AII (0.1 micrograms/kg i.v.)-induced pressor responses were inhibited by 63% in Losartan-treated rats. Losartan administration in MCT-treated rats did not prevent increases in pulmonary artery pressure or development of right ventricular hypertrophy. Additionally, increases in medial arterial thickness in pulmonary artery vessels (less than 50 microns and 50-100 microns external diameter) from MCT-treated rats were still evident in Losartan-treated rats. However, Losartan administration decreased medial pulmonary artery thickness of 50 to 100 microns external diameter vessels in control rats. These results demonstrate that AII. acting at the AT1 receptor subtype, does not contribute to pulmonary hypertension in this animal model.

Clinical study with recombinant interferon gamma versus interferon alpha-2c in patients with condylomata acuminata.

A multi-centre, randomized, open-label trial was conducted to evaluate the safety and efficacy of recombinant interferon (rIFN) alpha-2c versus rIFN gamma in patients with recurrent or persistent condylomata acuminata (CA). Thirty-three such patients were treated either with 6 micrograms rIFN alpha-2c or with 0.1 mg rIFN gamma (both equivalent to 2 x 10E6 IU), single dose, subcutaneously 3 times a week for 6 weeks. In case of no complete clearance at week 10, a second course of treatment with the other type of rIFN was given. There was no significant difference in the complete clearance proportions at week 10 between the two treatment groups (3/16 vs 6/17). No relapses occurred in these patients during the 16 weeks' follow-up. Further clearances during the follow-up resulted in a total complete clearance proportion of 14/33 at the end of study. The treatment was well tolerated. Repeated interferon therapy has its place in treating persistent or recurrent condylomas.

[The significance of prostaglandin F2 alpha (PGFM)--and plasma oxytocin level in patients with premature labor]. / Zur Bedeutung von Prostaglandin F2 alpha (PGFM)--und Oxytocinplasmaspiegel bei Patientinnen mit vorzeitigen Wehen.

In the present study, plasma oxytocin and prostaglandin F2 alpha metabolite (PGFM) concentrations were measured in 46 patients admitted for preterm labour. Gestational age ranged from 20-34 weeks. Samples were collected 12 hours before and after initiation of tocolysis. Patients with a premature rupture of the membranes and/or intra-amniotic infection were excluded in this study. There was a significant difference in the oxytocin (p = 0.05) and PGFM levels (p = 0.007, after 12 hours: p = 0.004) between a control group without preterm labour and women with preterm labour. No differences were seen between the successfully treated (delivery more than 5 days after start of tocolysis) and the failure group. There was no significantly different increase or decrease in PGFM and Oxytocin plasma levels between treatment failures and successfully treated patients.

Goserelin a GnRH-analogue as third-line therapy of refractory epithelial ovarian cancer.

Between October 1988 and March 1991, 23 ovarian cancer patients with progressive disease whilst receiving second- or third-line polychemotherapy received subcutaneously 3.6 mg Goserelin, a GnRH analogue, at monthly intervals until further tumor progression. Four patients (17.4%) achieved partial response, 7 patients (30.4%) had stable disease and 12 patients (52.2%) showed further tumor progression. Median time to tumor progression was 8.5, 5.3 and 2.1 months, respectively (Mantel test, P = 0.0003). Ten out of 11 patients who showed partial response or no change had grade 2 or grade 3 tumors. We conclude that Goserelin shows evidence of antitumor activity also in grade 2 and grade 3 ovarian carcinoma. It offers a therapeutic alternative to a group of patients, in whom we usually terminate cytotoxic treatment.

[Treatment concepts in tubal pregnancy]. / Behandlungskonzepte der Eileiterschwangerschaft.

The incidence of tubal pregnancy has increased markedly over the past years. Reasons for this are increased infections of and operations on the tubes and also improved diagnosis of the condition. The development of sensitive pregnancy tests, a constant improvement in ultrasound, introduction of laparoscopy and last, but not least, an increase in the degree of awareness amongst the general public have led to a much earlier diagnosis of tubal pregnancies. Therefore, it is possible to treat tubal pregnancies in a more conservative fashion operatively but also medically.

[Clomiphene citrate ointment in the local treatment of condylomata acuminata]. / Clomiphenzitratsalbe zur Lokalbehandlung von Condylomata acuminata.

The hypothesis underlying local treatment of Condylomata acuminata with clomiphene citrate is based on the assumption that susceptibility to this disease in women depends on the relative amount of oestrogen receptors in the affected, as opposed to the unaffected areas. We postulate blockade of these skin receptors after local application of clomiphene citrate ointment. A pilot study was conducted in 15 patients aged 20-33 with Condylomata acuminata. After only 2 months a complete remission was recorded in 12 patients (= 80%).

[Tumor markers and creatine kinase in the differential diagnosis of tubal pregnancy]. / Tumormarker und Kreatinkinase zur Differentialdiagnose der Tubargravidität.

In the present study we tried to evaluate the cancer marker CA 19-9, CA 12-5, CA 15-3 as well as the enzyme creatine-kinase (CK) whether they are of any diagnostic value in cases of tubal pregnancies. 15 patients with laporoscopically verified tubal pregnancy were compared with 15 patients with normal intrauterine pregnancies of the same age. Except one case of elevated CK in a patient with tubal pregnancy all other values were within the normal range. We concluded, that tumor markers and CK are inefficient for preoperative differential diagnosis in cases of tubal pregnancies.

[Initial experiences with a levonorgestrel-ethinyl estradiol combination for interception]. / Erste Erfahrungen mit einer Levonorgestrel-Ethinyl-Estradiol-Kombination zur Interzeption.

Several authors have reported on reliable postcoital contraception, using an estrogen/gestagen combination. These studies in more than a hundred women showed, that the unprotected intercourse in less than 50% took place around ovulation. Pregnancy rates from 0.7 to 2.6% were observed. From October 1987 to July 88, 50 women after unprotected intercourse around ovulation were included in our study. From one to 44 hours after intercourse, 0.5 mg levonorgestrel + 0.1 mg ethinylestradiol (Tetragynon) were administered orally. The same dose was repeated 12 hours later. Cervical secretion, LH- and E2 and P-serum levels at the time of the first administration were determined and side effects and bleeding patterns were registered. In one third of the women, we observed slight side effects. The bleeding resulted 5 to 29 days after the first tablet administration. Shortened menstruation cycles were seen more often than prolonged cycles. Bleeding duration was only slightly prolonged. Two pregnancies occurred - both women vomited immediately after the first medication and disregarded the order to visit our department again as quickly as possible. Tetragynon is not appropriate for regular contraception and should only be used in emergency situations.

[The course of atrial natriuretic peptide, aldosterone and antidiuretic hormone in normal pregnancy]. / ANP-, Aldosteron und ADH-Verlauf während der normalen Schwangerschaft.

Atrial natriuretic peptide (ANP), consisting of 28 aminoacids, is a recently discovered cardiac hormone involved in blood-volume homeostasis. Pregnancy is associated with an increase in blood volume expansion, therefore an increase in ANP-concentration would have been expected. To test this hypothesis ANP, Aldosterone and Vasopressin, concentrations of 229 women with normal pregnancies at different gestational ages were measured and compared with values found in a non-pregnant control group of 24 women. Mean plasma ANP was increased during pregnancy, but significant differences were noted only after 36 weeks of gestation. Also plasma aldosterone increased significantly during pregnancy, whilst vasopressin levels showed no significant change compared to the non-pregnant group.

[Atrial natriuretic peptide, antidiuretic hormone and aldosterone during delivery and the puerperium]. / Das atriale natriuretische Peptid (ANP), das antidiuretische Hormon (ADH) und Aldosteron während Geburt und Wochenbett.

Plasma concentrations of ANP, Aldosteron and ADH were determined immediately ante- and post-partum and on the second day of puerperium in 36 healthy women, 12 primiparous and 24 multiparous. These parameters were also measured by RIA in umbilical cord plasma obtained at the time of delivery. The values were compared with an age-matched group of non pregnant women. The mean ANP-values before and after birth showed no significant difference but they were higher than in the non pregnant controls, and in umbilical cord plasma. The mean Aldosteron values during pregnancy and puerperium were significantly elevated against the non pregnant women, but they showed a marked decrease on the second day of puerperium. The mean Aldosteron levels in umbilical cord plasma were higher than all pregnant values. The mean ADH-levels before and after birth were also elevated against the non pregnant group, but on the second day of puerperium a significant decrease was established. The mean values of umbilical cord plasma were significantly elevated against all other maternal and non pregnant values.

[Treatment of tubal pregnancy with prostaglandins: a multicenter study]. / Behandlung der Eileiterschwangerschaft mit Prostaglandinen: eine Multizenterstudie.

In this prospective multi-centre-study, the new treatment of tubal pregnancies by means of local prostaglandin (PG) F2 alpha and systemic PG E2 application was compared to the usual surgical technique of eliminating the conceptus. In 71 patients treated with PG, the method proved to be successful in 81%; 21 patients (19%) required surgical intervention later. With an initial beta-hCG level of 2500 mIE/ml, the success rate increased to 88%. The duration of hospitalisation was significantly reduced in the PG group compared to the patients treated by primary operation (3 +/- 1 versus 6 +/- 2 days). In the PG-group, only 2 of 24 hysterosalpingograms showed tubal occlusions after treatment, whereas occlusion was present in 3 of 8 patients of the surgically treated group. Four subsequent intrauterine pregnancies in the PG-group occurred compared to none in the surgical group. PG treatment of tubal pregnancy in patients with a low initial beta-hCG value (less than 2500 mIE/ml) revealed promising results with regard to reduced postoperative morbidity and future fertility.

PIP: In this prospective, multicenter study, the new treatment of tubal pregnancies by means of local prostaglandin (PG) F2alpha and systemic PGE2 application was compared to the usual surgical technique of eliminating the conceptus. In 71 patients treated with PGs, the method proved to be successful in 81%; 21 patients (195) required surgical intervention at a later date. With an initial beta-hCG level of 2500 mIE/ml, the success rate increased to 88%. The duration of hospitalization was significantly reduced in the PG group compared to the patients treated by primary operation ()3 +or- 1 vs 6+or- 2 days). In the PG group, only 2 of 24 hysterosalpingograms showed tubal occlusions after treatment, whereas occlusion was present in 3 of 8 patients of the surgically treated group. 4 subsequent intrauterine pregnancies in the PG group occurred compared to none in the surgical group. PG treatment of tubal pregnancy in patients with a low initial beta-hCG value (2500 mIE/ml) revealed promising results with regard to reduced postoperative morbidity and future fertility. (author's)

Prostaglandin injection for termination of tubal pregnancy: preliminary results.

A variety of conservative surgical techniques is available for the termination of ectopic pregnancy with preservation of the tube. We report on a new treatment by means of intratubal prostaglandin F2 alpha application followed by intramuscular administration of a prostaglandin E2 derivative (sulprostone) for 3 days. Only 5 of the 30 patients enrolled had to undergo laparotomy later. The results were compared with those obtained by different surgical procedures during the 2 preceding years. Hysterosalpingography was performed in 12 patients of the prostaglandin treated group and 14 of the surgically treated group. Tubal patency was demonstrated in 11 patients of the PG group but only in two patients of the surgically treated group.

PIP: Injection of PGF2alpha intratubally, with other conservative management, was compared in 30 consecutive women with proven ectopic pregnancy, to 100 prior women treated surgically. The patient group were all 45 admitted after November 1987 to University of Vienna Hospital with suspected ectopic pregnancy, later proven in 30 by history, positive hCG, ultrasound and laparoscopy; the controls were 74 confirmed cases out of 101 suspected ectopic pregnancies admitted from January 1986- October 1987. They were treated with 5 or 10 mg PGF2alpha (Miniprostin F2alpha, Upjohn, Vienna), injected transabdominally with a 17-gauge needle, during laparoscopic visualization. In 6 patients, 2-3 mg Pgf2alpha was injected into the corpus luteum, but this practice was discontinued when 3 developed tachycardia, hypertension and extrasystole. 25 mg estrogen was injected into the ovary as a luteolytic subsequently. Most women also received PGE2 (Sulprostone, Schering, Berlin) twice daily im, although 4 could not tolerate side effects of nausea and vomiting. All women had hCG levels daily. 5 were treated by laparotomy because of rising hCG or clinical indications. In the control group 74 (73.3%) had laparotomy, and of these, 39 had total or partial salpingectomy, and 21 salpingotomy. Hysterosalpingography demonstrated tubal patency in 11 of 12 PG treated women tested to date; in contract, of 14 of the controls tested, none had patent tubes. 4 of the PG group have since conceived and delivered term infants. The benefits of this conservative method of treating ectopic pregnancy are apparent in the reduced morbidity, shorter hospital stay, simpler treatment technique, lower costs, and especially the higher rate of subsequent tubal patency and fertility.

[A new method of treating tubal pregnancy using prostaglandin F2a and E2]. / Neue Behandlungsmethode der Tubargravidität durch Prostaglandin F2a und E2.

The present paper reports on the treatment of 30 tubal pregnancies verified by laparoscopy by means of intratubal prostaglandin (PG) F2a and systemic PG E2. Tubal pregnancy was successfully treated in 25 patients; three patients exhibited side effects. The comparison with surgical management showed better results concerning the tubal patency in the PG-treated group. Further studies should clarify whether this technically simple procedure is superior to the existing methods.