Hyperprolactinemia and contraception: a prospective study.

The authors measured serum concentrations by single and multiple sampling techniques in 347 women before, during, and after treatment with either hormonal or barrier methods of contraception. The prolactin responses to an intramuscular injection of estrogen also were evaluated in control and selected study patients. The incidence of hyperprolactinemia in oral contraceptive users was higher than control subjects (12 versus 5%). Hyperprolactinemia was best assessed by multiple blood sampling, it is often transient and resolves spontaneously in about 50% of women. The estrogen provocation study suggests that some women who develop hyperprolactinemia while taking oral contraceptives are more sensitive to the effects of exogenous estrogen and may be at greater risk of developing pill-related menstrual aberrations and hyperprolactinemia.

Evaluation of commonly used adjuvants in the prevention of postoperative adhesions.

The uterine horns of 30 rats were subjected to both division and microsurgical anastomosis of the proximal segment and division only of the distal segment. They were equally assigned to three groups, of which group 2 received dexamethasone and group 3 received ibuprofen preoperatively and postoperatively for a total of eight doses. During operation, five rats of each group were irrigated with normal saline and the other five, with 32% dextran 70 (Hyskon). The left uterine horn was anastomosed with 7-0 coated Vicryl, and the right horn, with 7-0 Dexon-S sutures. At repeat laparotomy 2 weeks later, the intraperitoneal adhesions were graded blindly according to their severity. Tissue blocks were obtained from the areas of anastomosis and division only for histologic assessment. Total adhesion scores were 104 for group 1, 53 for group 2 (p less than 0.05), and 90 for group 3 (p = 0.7). The histologic evaluation showed no difference between the three groups. The inflammatory tissue reaction was least around the areas of division only and greatest at the anastomotic sites, where it was most pronounced around the surgical knots. No difference in gross adhesions or histologic assessment was observed between the left horn and the right horn. Adhesions were significantly less in the Hyskon-treated animals (p less than 0.05) but the histologic evaluation showed similar inflammatory reactions. These results suggest that in this species there is no difference between Dexon-S and coated Vicryl sutures, that dexamethasone and Hyskon are effective in preventing postoperative adhesions, and that the inflammatory tissue reaction is not altered by these adjuvants but is significantly augmented by the presence and quantity of suture material.

Effects of danazol on plasma lipid and lipoprotein levels in healthy women and in women with endometriosis.

Previous studies of the effects of danazol on lipid and lipoprotein levels have been conflicting and limited to women with endometriosis. In the present study, plasma levels of lipids and lipoprotein-cholesterol and triglycerides were determined in 25 infertile women with endometriosis and in eight normal women before, during, and after treatment with danazol at daily doses of 200 to 800 mg for 2 to 6 months. Pretreatment values of cholesterol, triglycerides, and lipoprotein were within the normal range in all subjects except three (one with type III and two with type IV hyperlipoproteinemia). During treatment, the mean levels of total cholesterol and triglycerides decreased slightly, while no significant changes in low-density and very low-density lipoproteins were seen. However, a marked (40%) reduction in the mean levels of high-density lipoprotein cholesterol and triglycerides occurred (P less than 0.001) within 4 weeks of therapy in all subjects, which persisted for the duration of the treatment. Patients with pretreatment hyperlipoproteinemia experienced a substantial fall in plasma lipids and lipoprotein and had normal lipoprotein profiles during treatment. Within 4 weeks after danazol was discontinued, all changes in plasma lipid and lipoprotein levels returned to pretreatment levels. These findings have important implications for the atherogenic potential of danazol, a new treatment for hyperlipidemia, and the relationship between gonadal hormones and lipoprotein levels.

Danazol: endocrine consequences in healthy women.

We studied the effects of danazol on pituitary and gonadal function in seven normal women who volunteered to take danazol, 400 mg twice daily, for 2 months. We measured circulating levels of sex steroids, gonadotropins, and prolactin on alternate days throughout a control menstrual cycle and during treatment. Danazol inhibited ovulation in all subjects. The amenorrheic state induced by danazol was characterized by normal basal levels of gonadotropins, prolactin, and estrogen. Serum androgen levels were significantly increased as was the urinary excretion of 17-ketosteroids. The LH and FSH responses to gonadotropin-releasing hormone were enhanced during treatment, and there was a normal LH rise following administration of estradiol valerate, indicative of intact positive feedback. These observations fail to support the contention that danazol suppresses pituitary gonadotropin secretion or directly inhibits steroidogenesis. The results suggest that danazol may have a primary site of action at the ovary by suppressing the normal, orderly process of follicular maturation.

hPL: physiologic and pathophysiologic observations.

Serum human placental lactogen (hPL) levels were studied in 806 women in late pregnancy. The hPL levels were positively correlated with birth weight but were unrelated to maternal age, parity, socioeconomic status, or the sex of the newborn. The hPL levels peaked at 37 weeks' gestation and then declined moderately. An individual's hPL levels in late pregnancy are quite constant week to week. Patients with severe chronic hypertension have low hPL values; those carrying twins have high values.

Human placental lactogen: a predictor of perinatal outcome?

Serial human placental lactogen (hPL) determinations were performed on 806 women with normal and abnormal pregnancies late in the pregnancy. These results were not reported to the clinicians involved. For the study population as a whole, low hPL levels did not effectively predict those adverse perinatal outcome variables evaluated. Further analysis revealed that this was true both for the normal and abnormal pregnancy groups. Our data do not support the routine use of antepartum hPL screening, as advocated by others, as a means of improving perinatal outcome. In certain at-risk patients, there was an association between low hPL values and the presence of 1 or more of the adverse outcome variables. However, these patients had been recognized clinically as having fetuses in jeopardy.