Sebum measurements for rapid identification of hyperandrogenism due to an ovarian Leydig cell tumor.

Direct measurements of sebum with the Sebumeter were used in a patient with a benign androgen-producing tumor of the ovary. Androgen levels fell immediately after surgery, whereas the markedly elevated sebum levels found preoperatively dropped to normal after a delay of more than 2 weeks. Therefore, the Subumeter, due to its simplicity, may be useful for the preliminary screening and follow-up of patients with hyperandrogenic states.

The effect of smoking and menopause on the small blood vessels.

The small blood vessels were examined in 31 premenopausal and 31 postmenopausal women. In each group there were 14 non-smokers and 17 smokers of age groups 35-45 and 45-59. The women underwent full gynecological examination. Blood pressure was normal in each. The small blood vessels were examined by capillaroscopy of conjunctivae and nailfolds, by oscillometry of the radial artery, skin thermometry of the wrist and terminal phalanx, and by capillary fragility. When all abnormalities in non-smokers were compared with those in smokers in the menopausal groups, a significant difference was found, (Table 4), to the disadvantage of the smokers.

In vitro fertilization. Correlation of vaginal cytology and hormonal profile with success rates.

Cytologic parameters of the vaginal epithelium in 59 women undergoing in vitro fertilization-embryo transfer (ET) were correlated with plasma levels of 17-beta estradiol and progesterone on the oocyte pickup (OPU) and ET days. On the OPU day a late proliferative/late proliferative-early secretory pattern was observed in 84.6% of the 13 women who conceived (group 1) but in only 52% of the 46 who failed to conceive (group 2) (P less than .04). On the ET day a secretory phase appeared in 100% and 61% of group 1 and 2 patients, respectively (P less than .01). Between the OPU and ET days the mean karyopyknotic index dropped by 60% and 13% in group 1 and 2 patients, respectively (P less than .001). It seems that a high estrogenic effect followed by an advanced progestational environment, on the OPU and ET days, respectively, can provide a favorable milieu for implantation.

Lipid cell tumor of the ovary: steroid hormone secretory pattern and localization using 75Se-selenomethylcholesterol.

Ovarian lipid cell tumors are rare and can be difficult to localize by conventional means. We report a postmenopausal patient where rapid progression of symptoms and very high sebum levels suggested the presence of such a tumor which could not be visualized by computed tomography or ultrasound. Localization was accomplished noninvasively using 75Se-selenomethylcholesterol. Peripheral and ovarian vein steroid concentrations suggest that the tumor produced androgens preferentially by way of the delta 4 steroidogenesis pathway.

The cytology of vaginal, cervical and endometrial smears obtained at the time of embryo transfer during in vitro fertilization.

Seventy-four women enrolled in an in vitro fertilization (IVF) program had cytologic smears of the vagina, cervix and endometrium obtained at the time of embryo transfer (ET). Of these, 68 vaginal, 46 cervical and 25 endometrial smears were available for cytologic examination. Of the 68 vaginal smears, 4% showed a proliferative pattern, 40% were early secretory and 56% were advanced secretory. The 46 cervical smears demonstrated a delayed hormonal effect, with 70% showing a proliferative pattern, 23% early secretory and 7% advanced secretory cytology. Endometrial cells were obtained only when the Jones catheter, which has a side opening, was used. Twenty-two patients had both vaginal smears and suitable endometrial smears. Of these, 8 of the 9 patients with early secretory vaginal cytology had secretory endometrium while 10 of the 12 patients with mid-secretory vaginal cytology had secretory endometrium. The value of endometrial cytology in predicting conception following IVF-ET is unknown. It seems, however, that a good correlation exists between endometrial and vaginal cytology and that the latter may be of value as an additional, noninvasive tool for the evaluation of endometrial development.

Vacuum extraction at cesarean section--neonatal outcome.

The use of the vacuum extractor at cesarean section has been advocated in order to avoid extension of the uterine incision and to facilitate the delivery of a floating head. We have evaluated, prospectively and retrospectively, the neonatal outcome of vacuum extraction at cesarean section in comparison with regular cesarean section. The interval between the final uterine incision and complete delivery (U-D interval) was significantly prolonged (P less than 0.01) in 8 cases of vacuum extraction (Group A) when prospectively compared with 10 cases of regular cesarean section (Group B). The Apgar scores, the acid-base values at delivery and the clinical course of the two groups were not significantly different. Although analysis of our prospective data suggests a trend of an association between prolongation of the U-D interval and neonatal depression, our retrospective data of 34 neonates delivered by vacuum extraction at cesarean section and 44 neonates delivered by regular cesarean section, showed no significant untoward effect when the vacuum extractor was utilized. Since prolongation of the U-D interval may have an undesireable effect on the fetus, we advocate extra caution in the use of this method.

Vaginal and oral cytology of the menopause. A comparative study.

A comparative cytologic study was made of the hormonal content of the vaginal and oral mucosa of menopausal women. Twenty-three women between one and ten years (early menopause) and 33 patients more than ten years (late menopause) after cessation of menstruation had oral and vaginal smears taken. Comparable smears from 21 young women, and oral smears from 18 males served as controls. The smears were evaluated by the maturation value method, and averages were established for each group. The vaginal smears had low maturation values of 40 and 22 in the early and late menopausal groups, respectively. In these women, the buccal smears' maturation values were high, above 70. Similar high maturation values were found in buccal smears of the young women and men. It was concluded that the high maturation values found in the oral smears of the menopausal women are not the result of hormonal effect but that of local mechanisms or irritative factors.

Serum levels of polychlorinated biphenyls and some organochlorine insecticides in women with recent and former missed abortions.

Polychlorinated biphenyls and some organochlorine insecticides (DDT isomers and their metabolites, lindane (gamma-BHC), dieldrin, heptachlor epoxide) were assessed in the serum of 17 women with recent missed abortions, 7 women who experienced one or several missed abortions in their past, and 7 women with normal, second trimester pregnancy. Fifty-three percent of the cases of recent missed abortion had PCB serum levels higher than the mean plus two standard deviations of the control group. The mean PCB serum level in women with recent missed abortion and relatively high PCB serum levels was significantly different from that of the control group (103.04 versus 20.69 ppb, P less than 0.001). The mean PCB serum level of the former missed abortions group was also significantly different from that of the control group (82.00 versus 20.69 ppb, P less than 0.001). The quantity of the higher chlorinated biphenyl homologues (penta- and hexachlorobiphenyls) was increased in the high PCB level, missed abortion group and in the former missed abortion group, while the lower chlorinated biphenyl homologues were decreased in these groups in comparison with the control group. The percentage of total o,p'-DDT serum level, as related to total DDT, showed an increase in the high PCB level, recent missed abortion and in the former missed abortion groups, in comparison with the control group (36.18 and 48.98 versus 25.57, respectively). The fact that the former missed abortion group showed increased PCB serum levels similar to those found in the high PCB level, recent missed abortion group confirms the existence of an association between relatively high PCB serum levels and the occurrence of missed abortion. The possible role of PCBs in the occurrence of missed abortion is discussed.

Comparative studies on the antimicrobial activity of peritoneal and ascitic fluids in human beings.

The antibacterial activity of peritoneal fluid obtained from 28 women undergoing laparoscopy was compared with that of ascitic fluid obtained from 11 patients with various pathologic conditions. Similar antibacterial activity was found in these two types of fluid. The activity varied from bactericidal to bacteriostatic and was directed mainly against gram-negative bacilli-Escherichia coli, Proteus mirabilis and Bacteroides fragilis. Candida albicans was inhibited by many of the fluids, but the activity against gram-positive cocci was much less marked. Lysozyme was present in the fluids but was not solely responsible for the antimicrobial activity. The results of this study suggest the presence of at least three groups of thermostable antibacterial substances, two of which are bactericidal and one, bacteriostatic. One of the bactericidal factors is complement-dependent.

Vaginal and urinary cytology and blood hormonal examinations in patients with premature rupture of membranes.

Vaginal smears and urinary sediments of 29 pregnant women in their third trimester with premature rupture of membranes (PRM) were examined. Plasma radioimmunoassays (RIA) for estriol, human chorionic gonadotropin, human placental lactogen and progesterone were performed. Twenty-three normal pregnant women in the third trimester, serving as controls, underwent the same examinations. The vaginal smears and urinary sediments were evaluated as reflecting disturbed, slightly disturbed and normal placental function. Good correlation was found between the vaginal smears showing the typical and suggestive aspects of PRM and the placental function reflected in the same smears and the respective urinary sediments. From the hormonal examinations performed, the plasma RIA for progesterone presented significantly lower results in the PRM cases than in the control group. The results obtained suggest a lowering of the placental function in cases with PRM as reflected in cytologic and hormonal examinations.

The cytology of the retained IUD with relation to the mechanism of action.

Cellular reactions to 82 IUDs retained for different periods of time have been examined using the "loopal smear" method. The smears were divided according to periods of retention and degree of inflammatory reaction. In 47 cases the inflammatory reaction was graded as moderate to severe, while in 35 cases the reaction was graded as mild. Since contraception was effective also in those cases presenting with mild reactions, it must be concluded that factors other than inflammation play a role in the contraceptive mechanism. Cells obtained from 15 IUD washings were incubated with Staphylococcus albus in order to identify macrophages. In none of these cases were macrophages identified, thus rendering questionable the hypothesis that the contraceptive effect of the IUD is based on phagocytosis of spermatozoa.

The cytology of the human peritoneal fluid.

A series of 19 human peritoneal fluids obtained by aspiration at laparoscopy and cul-de-sac punctures were analysed for their cellular content. Four types of cells were differentiated: macrophages, mesothelial cells, lymphocytes and polymorphonuclear leukocytes. The macrophages and mesothelial cells represented the two major types of cells, each group constituiting about 36 per cent of the population, while the lymphocytes and polymorphonuclears represented 18 and 7 per cent of the population, respectively. Macrophages were identified by their capacity to engulf alcohol-killed Staphylococcus albus. It appears that by this method of macrophage identification, a more accurate representation of the cellular content of peritoneal fluid can be obtained.

Isolation of mycoplasmas from the genital tract of women with reproductive failure, sterility or vaginitis.

The presence of mycoplasma was investigated in 77 women with infertility, 34 women complaining of sterility, 92 women with vaginitis and 66 healthy control subjects. The group of infertile women was subdivided into those with one or two spontaneous abortions, those with three or more abortions and those with missed abortions. The isolation rate of mycoplasma from the vagina and cervix of the infertile women ranged from 18 to 36%. The endometrial isolation rate was 21% in women with missed abortions but lower in women of the other two subdivisions. Mycoplasmas were infrequently found in patients investigated for sterility. They were isolated at a higher rate in patients with vaginitis, especially in those with trichomonas-associated vaginitis. They were not found in healthy control subjects. In the endometria positive for mycoplasma no specific histological features for this infection were found.