The response of patients with polycystic ovarian disease to human menopausal gonadotropin therapy after ovarian electrocautery or a luteinizing hormone-releasing hormone agonist

The response of patients with polycystic ovarian disease to human menopausal gonadotropin therapy after ovarian electrocautery or a luteinizing hormone-releasing hormone agonist

154 Citations from the Literature Department of Anatomy, University of Leicester Medical School, University Road, Leicester LEl ?RH, GBR PLACENTA 19...

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Department of Anatomy, University of Leicester Medical School, University Road, Leicester LEl ?RH, GBR PLACENTA 1991 12/6 (573-595) Confocal and conventional indirect immunofluorescence and immunogold electron microscopic methods were applied to examine the distribution of extracellular matrix constituents (collagens types III and IV) in the villi of immature and term human placentas. The immunotluorescence study revealed that collagen type III is more distinct in the villous stroma of term placenta as compared with that of the first trimester. Collagen type IV was detected mainly in endothelial and epithelial basement membranes and interestingly also to a certain extent in the stroma. Results obtained using immunoelectron microscopy support the proposal that collagen types III and IV are characteristic of stromal and basement membranes, respectively. Stromal collagen type IV is apparently localized in association with the interstitial types of collagen (I and III) in the villous stroma of term placenta. Identification of two subtypes of protein kmase C in human placenta Nomura S; Tokumitsu H; Mizutani S; Narita 0; Tomada Y; Hidaka H Department of Pharmacology, Nagoya University School of Medicine, 65 Tsurumai-cho: Showa-ku. Nagoya 466, JPN PLACENTA 1991 1216(605-613) A purified protein kinase C (PKC) has been isolated from term human placental tissue, which is phospholipid and Ca’+dependent. Two subtypes of the enzyme were identified by hydroxyapatite column chromatography and using monoclonal antibodies with immunohistochemical techniques; subtype III is present in higher concentration than subtype II. Their ratio of 2.5 is very similar in second and third trimester placentas, but is higher, 6.5, in the first trimester. The subtype I was never expressed. Synthesis and secretion of apolipoprotein E by human placenta and choriocarcinomacell lines Rindler MJ; Traber MG; Esterman AL; Bersinger NA; Dancis J Department of Pediatrics, NYU Medical Center, 550 First Avenue, NY 10016. USA PLACENTA 1991 12/6 (615-624) The synthesis and secretion of apolipoproteins (apos) by cells from a human choriocarcinoma cell line, JAR, were examined by [3sS]methionine labeling followed by immunoprecipitation and SDS/PAGE. Apo E, but not apos A-I, A-IV, or B, was synthesized and secreted. Apo E was also synthesized by fragments of chorionic villi from human placenta and by another choriocarcinoma line BeWo. Pulse-chase experiments with JAR cells revealed that apo E was initially synthesized as a 33 kDa protein followed by a 34 kDa protein, probably the result of glycosylation. The latter was secreted into the medium where it was detected coincident with a 21/22 kDa doublet, possibly proteolytic fragments of apo E. Approximately 50% of the apo E in the medium was complexed with lipid as indicated by ultracentrifugation at a density of 1.21 g/ml. The amount of

Int J Gynecol Obstet 39

apo E produced by JAR was not affected by preincubation with dibutyryl CAMP and theophylline, or by the cholesterol content of the cells. Following perfusion of an isolated lobule of human placenta with [i4C]-labelled amino acids [ i4C]apo E was detected by immunoprecipitation of the maternal and fetal perfusates with 88% in the maternal perfusate. These studies suggest that apo E, which promotes receptor-mediated lipoprotein uptake, is secreted by the trophoblast to facilitate uptake of maternal lipoproteins. Syncytiotrophoblastmembraneprotein glycosylation patterns in normal human pregnancy and changes with gestational age and parturition Arkwright PD, Redman CWG; Williams PJ; Dwek RA; Rademacher TW Nuffield Department of Obstetrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU GBR PLACENTA 1991 12J6 (637-651) The fetally derived syncytiotrophoblast in the placenta form the major interface with the maternal circulation. Cell surface N-linked oligosaccharides are known to influence cell-cell interactions in a variety of ways. The N-linked oligosaccharide component of the human syncytiotrophoblast membrane has been purified from term placentas and its biochemical structure analyzed. Ninety-five percent of structures were complex Nlinked oligosaccharides, with the remaining 5% being of the oligomannose type. Seventy-two percent of oligosaccharides were sialylated; 50% having two or more sialic acid residues. Such a population of N-linked oligosaccharides would be expected to provide a surface which inhibits interactions between trophoblast and maternal leukocytes. The temporal changes in syncytiotrophoblast N-linked oligosaccharides from the end of the second and through the third trimester (25-41 weeks) were analyzed, as were the changes which occur during parturition. There was no change in the degree of sialylation of these structures. The only significant change was a 37% decrease in core fucosylation of complex N-linked sugars during gestation (P < 0.005). Women delivered by cesarean section at term, had significantly higher levels of fucosylation (equivalent to women with a gestational age of 31-36 weeks), than those who laboured at term. Present knowledge of core fucosylation of N-linked oligosaccharides is discussed in relation to trophoblast functioning.

ENDOCRINOLOGY The responseof patients with polycystic ovarian disease to human menopausalgonadotropintherapy after ovarian electrocauteryor a lutebdzing hormone-releasinghormone agonist Gadir AA; Alnaser HMI; Mowati RS; Shaw RW Academic Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, London NW3 2QG GBR FERTIL STERIL 1992 57/2 (309-313) Objective: To compare the effect of ovarian electrocautery versus an intranasal (IN) luteinizing hormone-releasing hormone agonist (LH-RH-a) in the response of patients with

Citations

polycystic

ovarian

gonadotropin

disease

(hMG)

(PCOD)

therapy.

with serial randomization

to

human

Design; + hMG

or LH-RH-a

Setting: A teaching hospital reproductive ceive after

cycles with

+ hMG.

endocrinology

women with PCOD

six treatment

Main

rates (PRs),

was no difference

and miscarriage

in the ovulation

groups. However,

Outcome

riage rate were lower PCOD IO

in the group

Conclusions:

and the miscar-

pretreated

Pretreatment

with ovarian electrocautery

IN LH-RH-a

the two

the number of cycles with multiple dominant

follicles, the lutcal phase serum testosterone electrocautcry.

ovulation.

rates. Results: There

or PRs between

with ovarian

of

patients

wtth

may be a better alternative

therapy for induction of ovulation

valcrate

(2 mg) plus cyproterone

with hMG.

rhe Lireroture

(I

acetate

During

fig). or placebo.

the 2 years of the study, bone mineral content of the ultradistal

regions of the forearm

(measured

remained unchanged m the hor-

mone

mmeral

groups,

whereas

bone

content

at these sites

decreased by 5 and 6%. respectively. m the placebo group. Bone mineral density in the spine (measured by dual-photon tiometry and dual-energy 3-4%

in the hormone

X-ray

absorpttometry)

groups and decreased

by 2% in the

placebo group. Biochemical estimates of bone turnover alkaline

phosphatasc

and fasting urinary

decreased significantly IO premcnopausal

levels m the hormone

groups, but remained unchanged in the placebo group. Serum concentrations

of total and low-density

were significantly

acetate

J; Pate1 A: Hall

ML;

Cobbold

<

group

WIN

FERTIL

8AA

STERIL

Middlesex

Hospiral.

Morrlmer

Street.

in the

by

10-15’~~

valerate + levonorgestrel

cholesterol in the hormone groups. Virtually flushes were significantly

cholesterol

0.05-.Ol)

and

observed in the placebo group. Climacteric

Lobororories.

London

in the cstradiol

(P

There were no significant changes in high-density

Z: MacDougall

0.001)

lipoprotein

reduced by S-IO%

(P <

C: Shoham

(serum

calcium/crcatininc)

Polycystic ovaries as a rclrtivc protective frctor for bone mineral Di Carlo

absorp-

increased by

loa3 io yang Jacobs HS

by

single-photon absorptiomctry)

estradiol + cypoterone womcII with amenorrhea

I55

mg). sequential

estradiol valeratc (2 mg) plus levonorgestrel(75 distal and

clinic.

who failed to con-

hMG.

Measures: Midcycle and lutcal phase endocrinology. pregnancy

study

of patients in two groups for treat-

ment with ovarian electrocautcry Patients: Thirty-three

menopausal

A prospective

from

reduced

group.

lipoprorem

no changes were symptoms and hot

in both

hormone

groups

GBR

compared with the placebo group. Episodes of uterine bleeding

1992 5712 (314-319)

occurred in all women in the estradiol valerate + lcvonorgestrcl

Objective: To examine the Impact of polycystic ovaries (PCO)

group. occurring regularly m 84% of the women. Two women

on bone mineral density in amenorrheic

(I L’S)in

age.

Design:

A

retrospective

analysis

polycystic ovarian syndrome (PCOS) rheic women.

A subgroup

women of reproductive and

comparison

with non-PCOS

amenor-

of patients with ultrasound

diagnosed PC0

was also investigated.

in reproductive

endocrinology.

of

Six hun-

adequately

prevent postmenopausal

bone turn-

over. Alterations

current

decreased

come Measure: IO

of various causes. Main

Bone mineral density in the lumbar spme (LI

L4) as measured

by dual energy x-ray absorpttometry.

relation IO PCOS. US-diagnosed mal ovaries.

OUI-

PC0

Results: Amcnorrheic

in

and US findings of nor-

patients with PCOS

were

The results of this study suggest that

these new estrogen and progestogcn comhinatlons

dred ten consecutive cases, mean age of 29.8 * 7.5 years. with history of amenorrhea

acetate group did

had more than 6 bleedmg

episodes during the 2 years. No changes in blood pressure and weight were observed.

(US)-

Setting: Specialist chnic

Patients. Participants:

the estradiol valerate + cyproteronc

not bleed at all; 6 women (32%)

bone loss and normalize

in strum lipoproteins

risk of cardiovascular

provided

relief from climactertc

levonorgestrcl

brought

in an acceptable

under

with

Both combinations

symptoms

bleeding

regimen with cyproteronc

were compattblc

disease

The regimen wtth

control.

whereas

the

acetate did not produce amenorrhea

number of women.

found to be younger (P < 0.001). with higher body mass index (P < 0.001). were more estrogenized.

as measured by endomc-

Low-dosage

micronized

trial thickness and uterine cross-sectional area (P < 0.001) and

pcWmmq8uwl

had higher bone mineral density (P < 0.001) non-PCOS

amenorrhcic

amenorrhea PC0

patients.

because of PCOS

prevents

compared

with

Ettinger

Patients

wtth

Dnvislon of Research. Kuiser Founuklon

Conclusions:

and those wtth USdIagnosed

have a higher bone density compared

17atradiol

with amenorrhetc

patients with normal ovaries as detected by US scan.

B; Genant

HK:

mom Ave , Oakland. AM

J OBSTET

With

Stetger P: Madvtg

Two new coctiatiom

of estrogen and prqestqen

cakium and lipid actholism. Marslew

U; Overgaard

Deportment Glosrrup

of Clinicul

climacteric symptoms and bkeding

K; Riis BJ: Christianxn Chemisrr.v.

Glostrup

C

(‘A

94611-5463.

GYNECOL

Hospirul.

DK-26011

postmenopausal

I7&cstradiol

I year

of follow-up

blood

pressure

and

studied in 62 healthy postmenopausal 2 years of treatment

climactertc

weight

changes

symp were

women at 3-month intcrwith continuous cstradiol

randomized.

dose-ranging

period the degree of probone

Fifty-one

loss

afforded

IO ensure

a minimum

subjects completed

17&estradiol

mcreases

estradrol group.

of

at least

and by single- and dual-photon

In the placebo group spinal trabecular

micronized

by

bone densny measurements by quantitative

decreased 4.9% annually (p < 0.001). (annual

Plan. 345 I Pled-

L’S.4

in dosages of 0.5. I .O and 2.0 mg. All

subjects recetved supplementation

ttometry.

1992 7912 (202-210)

Bone mass, calcium and lipid metabolism.

vals throughout

against

computed tomography

GYNECOL

bleeding.

tection

micronized

in

1992 I6612 (479-488)

the use of a double-blind.

1500 mg calcium daily

DNK

OBSTET toms.

for prcven-

effects on boaah

loss

P

Health

destgn. we tested during an Il-month tbm of postmenopausal bone loss: Long-tmn

bone

women

bone

of 0.3%

I .R”A~ in

absorp

bone density

whereas in thov

density

in the 0.5

tended

IO

taking increase

mg mtcronizcd

the I .O mg mtcromzcd

17&

I’IS-estradtol

In! J Gwtecol

Ohster 39