[Intraperitoneal high dose chemotherapy as consolidation treatment for advanced ovarian carcinoma: a pilot study]. / Traitement de clôture des adénocarcinomes ovariens de stade avancé: étude pilote de chimiothérapie haute dose par voie intrapéritonéale.

Consolidation treatment of advanced ovarian carcinoma, especially the place of intraperitoneal chemotherapy, remains a controversial subject. From January 1988 to July 1995, 39 patients, median age 54 years, received intraperitoneal chemotherapy as consolidation treatment after second-look surgery. At the time of intraperitoneal chemotherapy, 30 patients had no residual disease. Intraperitoneal drug administration used a Tenckoff catheter or a lumbar needle. Treatment combined 5 fluorouracil 1 g/m2 and cisplatin 200 mg/m2, associated with a systemic sodium thiosulfate rescue as nephroprotector. A pharmacological analysis was done for 9 patients: the exposure of peritoneal cavity to cisplatin exceeded that of the plasma by 11 fold. Hematologic and nephrologic toxicity were acceptable. The median follow-up is 43 months. The disease free survival is 36,6 months, but 48,5 months if no residual disease at the time of intraperitoneal chemotherapy. Consolidation treatment by intense intraperitoneal chemotherapy is a feasible approach and might be beneficial in chemosensitive patients devoid of macroscopic remnants, but must be compared with others approaches.

Neurotransmitters and sex-hormone profiles in the human serum and ovarian follicular fluid of in vitro fertilization participants.

From the data presented, it can be assumed that the increase in catecholamines and decrease in melatonin in the ovarian follicular fluid of IVF participants has physiological significance, particularly in the process of steroidogenesis. Furthermore, it is worthy of note that low SHBG levels in follicular fluid were associated with atretic oocytes. Therefore, NE, EP, ME, and SHBG titer, as well as E2 and LH measurements might usefully index prognoses for IVF.

Acquired hypertrichosis lanuginosa. A case report.

A 62-year-old, postmenopausal woman had rapidly appearing lanugo-type hair on her face and extremities. Adenocarcinoma of the colon was diagnosed. The patient underwent partial hemicolectomy and liver biopsy. Serum androgen levels were normal. Carcinoembryonic antigen and alpha-fetoprotein were undetected. These cases are rare, and acquired hypertrichosis lanuginosa can be a clinical tumor marker.

Use of antisera to follicle-stimulating hormone (FSH) to detect non-FSH factors in human serum which modulate rat granulosa cell steroidogenesis.

We measured the ability of serum from women to stimulate steroidogenesis in cultured granulosa cells. Serum promoted estradiol and progesterone synthesis in proportion to its FHS content measured by RIA [i.e. serum from postmenopausal women (PM) greater than serum from the midcycle at the time of the gonadotropin surge (MC) greater than serum from the first day of the menstrual cycle (D1) greater than serum from a hypophysectomized woman (AP)]. The FSH activity of these sera was reduced but not eliminated when we included excess antisera to ovine or human FSH in the culture medium (i.e. PM greater than MC greater than D1 greater than AP). These antisera completely neutralized the actions of ovine FSH, human FSH, and menopausal gonadotropin (Pergonal) added to serum. In contrast to the stimulation seen with 5% or lower concentrations of serum in the culture medium, we observed that 10-20% serum inhibited FSH-induced androgen aromatization and progesterone accumulation. The degree of stimulation or inhibition of steroidogenesis depended on the number of granulosa cells added to each culture. High initial cell concentrations inhibited the ability of the cells to respond to either serum or PMSG. In addition to factors which stimulate or inhibit FSH-induced steroidogenesis, human serum contains factors distinct from FSH which cause the cells to flatten and adhere more tightly to the culture dishes. Although progesterone synthesis was increased in cells which had flattened on the surface of the culture dishes, this phenomenon was not a prerequisite for serum-induced steroidogenesis. We conclude that serum contains factors immunologically distinct from FSH, possibly of pituitary origin, which induce granulosa cell steroidogenesis. In addition, serum contains inhibitory substances which block hormone-induced steroidogenesis and which tend to obscure the stimulatory effects of FSH. Detection of both factors depends in part on the number of granulosa cells used to innoculate the cell cultures.

Amenorrhea associated with carotenemia.

Data are presented for ten women with anovulation, nine of them with amenorrhea, who have associated carotenemia. Classic explanations for carotenemia in amenorrheic patients have been weight loss or anorexia nervosa, yet carotenemia in our patients appeared to be diet induced. All patients consumed a pure or predominantly vegetarian diet; there was no intake of red meats. Clinical and laboratory data of the patients are presented. The amenorrhea of the patient is consistent with hypothalamic hypogonadotropic anovulation (HHA). It appeared that diet modification not only led to reduction in carotene levels, but also improved the menstrual status. The association of carotenemia and menstrual disorders is reviewed. The possibility that carotenemia is related to the development of HHA is discussed.

Postcoital testing in women during menotropin therapy.

The authors were interested in determining the predictive value of postcoital testing in women who undergo human menopausal gonadotropin (hMG) therapy for the induction of ovulation. Fifty consecutive patients were studied whose husbands had acceptable semen analyses; 24 of the patients conceived. Postcoital testing was done after hMG stimulation on the day human chorionic gonadotropins (hCG) were given or the day before. All but one patient had excellent cervical mucus quality. Sperm characteristics in cervical mucus were analyzed in regard to overall motility, number of active sperm per high-power field (HPF), and quality of movement. These data were correlated with outcome in terms of conception. A linear correlation could be shown between overall motility and pregnancy outcome once at least 40% motility was present; no pregnancy occurred in patients with 20% or less sperm motility. Once five or more active sperm/HPF were noted, the chance of pregnancy was about 60%; this chance was not increased with higher density rates. In all but one patient who conceived, sperm with maximum quality (+3 motility) were noted. Data were compiled in a postcoital score (range 0 to 12). Patients with a high score had a pregnancy rate of 70%, patients with an intermediate score, 23%, and none of the seven women with low scores conceived. Because menotropin therapy is costly, demanding, and potentially risky, it is suggested that one utilize results of postcoital testing as a guide in decisions about the continuation of such therapy.

Androgenic response in anovulatory women during menotropins stimulation.

Menotropins (human menopausal gonadotropin [hMG]) are used to induce follicular maturation and ovulation in anovulatory infertile women. To determine how hMG stimulation affected ovarian androgen production during such therapy, plasma androstenedione (A) and testosterone (T) levels were measured at the beginning and end of hMG therapy in 5 patients with anovulatory hypogonadotropism (group 1) and 15 patients with anovulatory polycystic ovary syndrome (group 2). Mean pretreatment levels of plasma estradiol (E2), T, and A were significantly higher in group 2 compared with group 1. Stimulation with hMG caused E2 levels to reach the same maximum value in both groups. Testosterone levels increased from 0.2 +/- 0.03 ng/ml (mean /+- SE) to 0.4 %/- 0.038 ng/ml for group 1 patients, and from 0.53 +/- 0.06 ng/ml to 0.8 +/- 0.1 ng/ml for group 2 patients. Androstenedione levels increased from 1.5 +/- 0.47 ng/ml to 2.1 +/- 0.4 ng/ml and from 4.37 +/- 0.77 ng/ml to 5.8 +/- 1.1 ng/ml in groups 1 and 2, respectively. The influence of hMG on plasma androgen levels was studied in women who received several treatment cycles before they became pregnant. In these women plasma androgen levels reached the same values in all cycles, including the final cycle in which the patient became pregnant. The data indicate that patients treated with hMG become pregnant despite marked gonadal androgen production. These observations suggest that hMG therapy promotes steroidogenesis in both the granulosa and theca cells of the follicle.