How old am I? Age estimation in living adults: a case report.

Age estimation is a common task in forensic medicine. Odontologists are frequently involved in the age assessment of human remains or living juveniles. The need to estimate the age of living individuals is becoming more frequent, because of the increasing number of immigrants (illegal or otherwise) without acceptable identification documents and with missing or uncertain birth dates. Whereas age estimation in subadults is usually performed by methods based on the physiological growth of bones and teeth, in the case of living adults age determination is more difficult, because body maturation has come to an end and the most commonly used procedures in forensics on human remains are too invasive for the living individual. The following case report aims at highlighting the difficulties of performing age estimation in the living adult and the importance of a multidisciplinary approach including forensic odontology: a middle-aged woman from Ethiopia who was supposed to be 62 years old (according to one set of documents), was removed from employment lists as she had reached the retirement age for Italy. However another set of documents indicated a younger age (46 years). Hormonal dosage of E2 (17-ß estradiol) and FSH (Follicle Stimulating Hormone) showed an age close to the begininng of menopause. An experimental dental method, based on the decrease of canine pulp chamber with age, was performed in order to obtain more information: the result was an estimation of a 47-57 age range. Combined results suggested that it was more likely that the actual age of the woman was closer to 46 than to 62.

Poor reproductive prognosis in severe teratozoospermia with a predominant sperm anomaly.

A retrospective examination of the semen analyses performed in our clinic from January 1979 to September 1986 revealed that approximately 15% of the patients were affected by severe teratozoospermia (greater than 80% abnormal forms and greater than 5 x 10(6) sperm/ml). In approximately 8% of these cases, a single predominant anomaly (same defect in greater than 50% of the sperm) was reported and confirmed by subsequent analyses (n = 37). The types of monomorphic teratozoospermia encountered in this study included round head (n = 6), amorphous head (n = 16), small head (n = 6), tapering head (n = 2), pin head (n = 1) and midpiece anomaly (n = 6). The clinical data suggest that familial genetic factors are probably involved in round head-monomorphic teratozoospermia, whereas testicular factors may be associated with amorphous head-monomorphic teratozoospermia. No matter what type of monomorphic teratozoospermia, the data in vivo (no pregnancies recorded in the follow-up period ranging from 2-8 years) and in vitro (negative SPAs) suggest a poor prognosis for the couples affected by this syndrome.

Effects of clomiphene citrate on cervical mucus: analysis of some influencing factors.

A multicenter study was performed to investigate the effects of a standard dose of clomiphene citrate (100 mg/day from day 5 of the cycle for five days) on the quality of cervical mucus. A total of 82 cervical mucus samples from 60 infertile patients (15 with secondary amenorrhea, 16 with delayed ovulation, 15 with anovulatory cycles, 14 with oligomenorrhea) was examined on the day of maximum follicular diameter. As a control we studied 54 cervical mucus samples from 47 patients with documented tubal sterility or infertile partners, who had spontaneous cycles with normal rhythm. Cervical mucus was unfavorable in 59% of the treatment cycles compared with 11% of the control cycles. Clomiphene citrate's antiestrogenic effect on cervical mucus was found to be related to the length of time between the last drug administration and the day of maximum follicular diameter (delta days), since cervical mucus was favorable in 64% of the cycles with a delta days more than 6 and in only 16% of the cycles with a delta days of 6 or less. Clomiphene citrate thus seems able to decrease cervical mucus quality. This could be one of the causes of the discrepancy between the rates of ovulation and pregnancy reported in patients treated with this drug.

Wish for a child and infertility: study on 116 couples. I. Interview and psychodynamic hypotheses.

The authors wish to stress the importance of the psychosomatic approach in the investigation of infertility. Following the hypothesis that infertile patients may present emotional conflicts with regard to the wish of having a child, psychodynamic interviews were carried out with 116 infertile couples concomitantly with their first consultation at the Sterility Department. The psychological findings show that severe conflicts with regard to wish of parenthood were present in the majority of the female patients and especially in those without clinically defined organic infertility factors. The relationship between clinical diagnosis and psychological outcome was less evident in the male partners. The 11 pregnancies which occurred in the study group are also discussed with regard to the motivational quality of the wish of child of these patients. A recommendation is made that psychological interviews should be included in any infertility investigation as a matter of routine and that therapeutic procedures should take into account both the clinical and psychological diagnosis to prevent unsuccessful situations.

Met-enkephalin enhances follicle-stimulating hormone-dependent progesterone production from cultured granulosa cells.

beta-Endorphin (beta-EP) and methionine-enkephalin (Met-Enk) have been detected in human follicular fluid in concentrations several times higher than those in plasma. These data stimulated us to study the possible physiological role of ovarian opioids. We, therefore, determined the effects of both beta-EP and Met-Enk, alone or in combination with naloxone, on FSH-induced progesterone (P) secretion by cultured granulosa cells. Granulosa cells were collected from follicular fluid recovered at laparoscopy in seven superovulated women. The cells were preincubated with RPMI-1640 medium containing 20% fetal calf serum in 5% CO2 for 48 h, followed by the addition of 100 mU purified FSH and the various test substances for 48 more h. beta-EP (10 nM to 1 pM) had no effect on P secretion either alone or in combination with FSH and/or naloxone. Micro- to picomolar amounts of Met-Enk increased FSH-induced P secretion up to 186.9 +/- 35.1% (+/- SEM). Met-Enk had no affect in the absence of FSH, and its action was significantly blunted by the concomitant addition of 10(-5) M naloxone. These data provide evidence for a dose-dependent naloxone-reversible synergistic action of Met-Enk and FSH on P secretion by cultured granulosa cells. This finding supports the hypothesis of the existence of an ovarian opioid system.

Endogenous opioid peptides in uterine fluid.

The present study demonstrates the presence of the endogenous opioid peptides beta-endorphin (beta-EP) and methionine-enkephalin (MET-ENK), in the uterine fluid of fertile women and normally cycling and superovulated cows. The two peptides are undetectable in the uterine fluid of untreated postmenopausal women, whereas they are present following estrogen-progesterone treatment. Immunoreactive (IR) MET-ENK concentrations were higher in the secretory than in the proliferative phase of the menstrual cycle. IR beta-EP and IR MET-ENK are present also in the follicular, oviductal, and uterine fluid of cows, and in the uterine fluid, concentrations of IR MET-ENK are higher in the superovulated than in the control animals. Because opioids play important roles on endocrine and immune functions, the present data support the potential physiologic role of endometrial secretions.

Reduced testosterone levels in cluster headache: a stress-related phenomenon?

The circadian changes in testosterone (T) and cortisol secretion and morning luteinizing hormone (LH) levels were evaluated in nine episodic cluster headache (CH) patients in active phase and in seven healthy volunteers, with collection of blood samples every 2 h for 24 h. CH showed a significant reduction of the 24-h integrated mean T value (mesor) (4.4 + 1.1 ng/ml; chi +/- SD) in comparison with controls (6.6 +/- 0.8 ng/ml) (P less than 0.01). Both groups had plasma T circadian rhythm with peak values in early morning, but in CH single cosinor analysis showed its absence in three out of nine CH patients. The rhythm showed an acrophase delay of 101 min in CH. Both patients and controls had a significant circadian rhythm of plasma cortisol concentration. CH patients, however, showed an acrophase delay of 106 min and significantly increased concentrations from 1200 h to 2000 h. Morning LH values were similar in the two groups. The reduced secretion of plasma T in CH patients in the active phase coexisted with an acrophase delay of its circadian rhythm. A similar delay was found in 24-h plasma cortisol levels. We suggest that stress accompanying attack expectancy in the active phase is the mechanism behind the elevated plasma cortisol levels. This in turn could reduce T concentrations, acting at the testicular level. These disturbances in internal chronoorganization support the hypothesis that cluster headache is basically a dyschronic disorder.

Beta-endorphin and met-enkephalin in peritoneal and ovarian follicular fluids of fertile and postmenopausal women.

Immunoreactive (IR) beta-endorphin (beta-EP) and met-enkephalin (MET-ENK) have been found in peritoneal fluid (PF) and ovarian follicular fluid (FF). Gel chromatography also revealed the presence of coeluting IR beta-lipotropin and gamma-lipotropin. IR beta-EP and IR MET-ENK levels in healthy menstruating women were from 10 to 40 times higher than those present in circulating plasma, which indicated a possible local production. The highest concentrations of IR beta-EP in FF were found in the largest follicles, whereas in the PF they correlated with the luteal period of the menstrual cycle and with progesterone concentrations. No relevant changes in IR MET-ENK were detected in the FF or in the PF in relation to the phase of the menstrual cycle. In postmenopausal women, the concentrations of the two IR opioid peptides were undetectable in both fluids.

Long-term treatment with cimetidine does not essentially affect the hypothalamic-pituitary-gonadal axis in man.

The effect of cimetidine maintenance treatment on gonadal function has been assessed by seminal analysis plus prolactin and gonadotropin blood level concentrations. Nine patients, all with duodenal ulcer, 5 of whom had received 400 mg cimetidine at night for 18, 3 for 24 and 1 for 36 months, were studied. All patients were presumably fertile, having fathered a child born not more than 3 years before the start of cimetidine treatment. In all patients two seminal analyses were performed and blood specimens were obtained for radioimmunoassay estimation of FSH, LH and prolactin concentrations both in basal conditions and 20', 30' and 60' after the i.v. injection of Gn-RH (100 micrograms) and TRH (200 micrograms). All but one patient, in whom mild oligoasthenozoospermia was detected, had normal sperm counts and motility; moreover hormonal levels both in basal conditions and after releasing factor stimulation were found to be similar to those observed in a control group. Cimetidine maintenance treatment has no effect on sexual activity, the quality of seminal fluid or the pituitary secretion of gonadotropins or prolactin.

Measurement of pH in the lower female genital tract during the periovulatory period: comparison of electrometric and colorimetric procedures.

In 53 patients with regular ovulatory cycles, the pH in the lateral vaginal fornix, at the external uterine orifice and in the cervical canal was measured daily in the periovulatory period. The values of pH measured by the colorimetric and the electrometric methods did not show any statistically significant difference. The relationship between pH values of cervical mucus and the estradiol peak is discussed.

Abnormal semen quality and low serum testosterone in men with inflammatory bowel disease treated for a long time with sulfasalazine.

Our purpose was to study the effects of long-term salazopyrine treatment on male fertility. Seven patients, 21-37 years old, who had been treated for ulcerative colitis with 3 g/day of salazopyrine for more than 6 months, were examined. All their semen samples showed abnormal sperm motility (17% +/- 9.3) and abnormal morphology (36.3% +/- 14.4) with the predominance of large-headed spermatozoa. The endocrine picture and pituitary reserve were evaluated by GnRH and TRH tests. The basal values of testosterone were lower than the normal in our laboratory (greater than 3 ng/ml) and significantly lower (2.4 +/- 0.7 ng/ml, p less than 0.025) than in the control group (fertile men). LH was significantly higher (9 +/- 2 mIU/ml, p less than 0.005) but still within the limits of normal. The responses of FSH and LH to GnRH and of PRL to TRH were normal. The mechanisms by which salazopyrine may affect fertility are discussed.

Relationship between fertility, semen analysis and human sperm penetration of zona-free hamster eggs.

Spermatozoa from 12 fertile donors, 37 infertile patients with normal spermiogram and 61 infertile men with abnormal semen analysis were assessed with zona-free hamster eggs penetration test, according to Barros. We obtained significant differences in positive penetrations in the 3 groups tested: 96 per cent of positive results for the first group, 59 per cent for the second and 21 per cent for the third group. A significant relationship between penetration results and sperm count, motility and morphology is evidenced.

Post-coital test in subfertile men.

Twenty-two patients with border-line spermiograms (moderate oligoasthenozoospermia or asthenozoospermia) were studied by the post-coital test (PCT) to determinate the behaviour in vivo of semen with modest dysspermia (spermatozoa counts between 10 and 20 million/ml, with 20-40% forward motility). All the female partners were normal morphologically and functionally. The PCT were always carried out when the cervical mucus was favorable (mean score 12.2-12.3) and the endocervical pH was 7.25-7.30. The positive results for the asthenozoospermic semen samples were 6.75% and for the oligozoospermic one 10%, when the classification were based on the W.H.O. criteria. When the semen samples were classified according to Kremer's criteria positive results were found in 37.5% and 40% of the cases respectively. The effects of both cervical mucus properties and pH on the results of the PCT were found to be important. The high percentage of the favorable results emphasizes the usefulness of completing studies of border-line spermiograms with an in vivo test, since it is difficult to define normality and predict the fertility potential from semen examination alone.