Persistent primary hypogonadism associated with anabolic steroid abuse.

OBJECTIVE: To report a case of primary gonadal failure due to the chronic abuse of anabolic steroids used for bodybuilding. DESIGN: Case report. SETTING: Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, Wales, United Kingdom. PATIENT(S): A 40-year-old man. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical symptoms, levels of serum T, FSH, and LH. RESULT(S): Primary gonadal failure resulting from anabolic steroid use. CONCLUSION(S): We describe a case of initially secondary gonadal failure resulting from anabolic steroid use with subsequent primary gonadal failure and infertility. This case adds to the current literature and illustrates that the side effects of anabolic steroids can be prolonged and irreversible.

Progesterone induces nano-scale molecular modifications on endometrial epithelial cell surfaces.

BACKGROUND INFORMATION: The endometrial epithelial cell membrane is a key interface in female reproductive biology. Steroid hormones play a predominant role in cyclic changes which occur at this interface during the female menstrual cycle. Specific changes in the morphology of the endometrial epithelial cell surface become apparent with the epithelial transition that drives the switch from a non-receptive to receptive surface due to the action of progesterone on an oestrogen primed tissue. AFM (atomic force microscopy) allows the high-resolution characterization of the endometrial epithelial cell surface. Its contact probe mechanism enables a unique imaging method that requires little sample preparation, yielding topographical and morphological characterization. By stiffening the cell membrane, low concentrations of fixatives allow the surface detail of the cell to be resolved while preserving fine ultra-structural details for analysis. RESULTS: In the present study we use high resolution AFM analysis of endometrial epithelial cells to monitor the effect of progesterone on the nanoscale structure of the endometrial cell surface. High-resolution imaging reveals similar topographical nanoscale changes in both the Hec-1-A and Ishikawa model cell lines. Hec-1-B cells, used in the present study as a progesterone receptor negative control, however, exhibit a flattened cell surface morphology following progesterone treatment. Changes in average cell height and surface convolution correlate with increased surface roughness measurements, demonstrating alterations in molecular structure on the cell surface due to hormonal stimulation. CONCLUSIONS: Progesterone treatment induces changes to the cell surface as a result of nanoscale molecular modifications in response to external hormonal treatments. AFM provides the basis for the identification, visualization and quantification of these cell surface nanoscale changes. Together these findings demonstrate the utility of AFM for use in reproductive science and cancer biology where it could be applied in both in vitro analysis of protein structure-function relationships and clinical diagnosis.

Inversion of the uterus at caesarean section.

INTRODUCTION: Inversion of the uterus through the uterine incision during caesarean section is a rare event. Therapy is usually simple and maternal morbidity is low when re-inversion of the uterus can be accomplished immediately. In cases of prolonged uterine inversion thereof, haemodynamic instability and shock, often out of proportion to the degree of blood loss, have been reported as serious sequelae. CASE REPORT: We describe such a case with a prolonged inversion to re-inversion interval where the patient suffered an intraoperative cardiovascular arrest during unrepositioned uterine inversion. Reposition of the uterus led to an immediate return of the patient's vital signs and improvement of her haemodynamic status. DISCUSSION: The mechanisms of haemodynamic instability and the technical aspects of manual reduction of the inverted, heavily contracted uterus during caesarean section are discussed.

Perimortem surgical intervention in cardiorespiratory arrest secondary to ruptured ovarian neoplasm.

Perimortem caesarean section is the intervention of choice for unresponsive cardiorespiratory arrest during the third trimester of pregnancy. We present a case of emergent surgical intervention in an arrested patient with an abdominopelvic mass, which revealed a ruptured granulosa cell ovarian neoplasm with haemoperitoneum.

Cohort study of the neonatal outcome of twin pregnancies that were treated with prophylactic or rescue antenatal corticosteroids.

OBJECTIVE: The purpose of this study was to compare the neonatal outcome of 2 approaches to antenatal corticosteroid therapy for threatened preterm delivery in twins: a prophylactic approach in which corticosteroids were administered every 2 weeks from 24 to 32 weeks of gestation and a rescue approach in which corticosteroids were given to women at immediate risk of preterm delivery. STUDY DESIGN: A retrospective cohort study of 1038 twin babies delivered between 1990 and 1996 in a University Teaching Hospital. One hundred thirty-six babies were exposed to prophylactic therapy, and 902 babies were treated expectantly with rescue therapy. RESULTS: Prophylactic corticosteroids were not associated with a significant reduction in respiratory distress syndrome (adjusted odds ratio, 0.7; 95% CI, 0.2-2.0). Unnecessary therapy was more likely with a prophylactic policy (relative risk, 7.5; 95% CI, 5.3-10.7) and was associated with a reduction in mean birth weight in term babies of 129 g (95% CI, -218 to -33; P =.008). CONCLUSION: Prophylactic corticosteroids have no proven beneficial effect on the risk of respiratory distress syndrome in preterm twin babies. Such a policy exposes a large number of babies to unnecessary treatment that adversely affects growth.