In vivo evidence for increased adrenal sensitivity to adrenocorticotropin-(1-24) in the lamb fetus late in gestation.

Plasma concentrations of immunoreactive ACTH and cortisol were monitored daily in chronically cannulated sheep fetuses during the last 3 weeks of gestation. A prepartum increase in fetal plasma cortisol occurred without a concomitant rise in fetal plasma ACTH. When fetal lambs were injected with various doses of ACTH-(1-24) and the plasma cortisol responses were integrated over time, the resulting changes in the log dose-response curves indicate that fetal adrenal sensitivity increases late in gestation. Thus, the marked rise in fetal plasma cortisol before birth can be explained, at least in part, by an increase in fetal adrenal sensitivity to ACTH.

Perineal Crohn's disease.

Crohn's disease has frequent perineal manifestations, including rectovaginal fistulas. This association is not widely recognized, especially in the gynecologic literature. Six cases of presumptive or documented Crohn's disease associated with rectovaginal fistulas and a review of the literature are presented. The need for a high degree of suspicion and a gastroenterologic evaluation is emphasized. Conservative management is stressed in view of the poor healing characteristics of perineal tissue in these patients. Alternative surgical approaches, including local repair, proximal diversion, and curative total proctocolectomy/ileostomy, are presented. Local repair is fraught with problems including postoperative breakdown and recurrence, yet proctocolectomy is a radical, but curative, procedure. An understanding of the ramifications of surgical intervention along with thorough patient counseling are required in managing these patients.

Vulvar pyoderma gangrenosum.

Pyoderma gangrenosum is an idiopathic dermatologic disease manifested by painful cutaneous ulceration. The ulcers are characterized by their undermined, violaceous borders and necrotic tissue at the ulcer base. The lesions may have an unusual response to physical manipulation known as pathergy, a phenomenon that is manifested by rapid progression following debridement. Pyoderma gangrenosum is frequently associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis, chronic active hepatitis and hematologic malignancies. Conservative wound care and systemic corticosteroids are usually effective therapy. We report the second case in the gynecologic literature of a patient with vulvar pyoderma gangrenosum.

MRI findings of sciatic endometriosis.

Endometriosis is a rare cause of sciatic mononeuropathy. We report a woman with cyclic, menstruation-related hip pain associated with right leg weakness and sensory loss. Examination and electrodiagnostic studies suggested sciatic nerve dysfunction. Magnetic resonance imaging (MRI) revealed abnormal signal consistent with endometriotic tissue in the region of the right sciatic nerve. The abnormal signal partially regressed after treatment of the endometriosis. This case further illustrates the utility of MRI in the assessment of rare pelvic disorders.

Glycosaminoglycans: their distribution and potential vasoactive action in the nonpregnant and pregnant ovine uterus.

The effects of direct uterine artery infusions of glucosamine-hydrochloric acid, dextrose, and mannitol were evaluated in ewes that had undergone oophorectomy. Glucosamine-hydrochloric acid caused a prompt dose-related increase in uterine blood flow which approximated uterine blood flow rates induced by estradiol. Infusions of dextrose caused similar but transient vasodilatation, whereas infusions of mannitol had no effect. The glycosaminoglycans content of endometrium, myometrium, and caruncles/cotyledons (placentomes) was measured in nonpregnant and early pregnant ewes between 19 and 45 days' gestation. In endometrium and myometrium, total hexosamine levels were similar in nonpregnant and pregnant ewes. In the placentomes, total hexosamine levels increased steadily after 20 to 25 days' gestation. The hyaluronic acid fraction of total glycosaminoglycans hexosamine increased similarly and paralleled the total hexosamine levels. Galactosamine levels were unchanged in all tissues. It is postulated that a function of Wharton's jelly may be to provide the mechanism for shunting of uterine blood flow to the ovine placentomes.

Effects of Cis- and trans-clomiphene on the uterine blood flow of oophorectomized ewes.

Changes in the left uterine artery blood flow (YBF) after intraarterial administration of estradiol-17beta and cis- and trans-clomiphene citrate to conscious, oophorectomized ewes were monitored by chronically implanted electromagnetic flow probes. Cis-clomiphene produced UBF increases comparable to or greater than those produced by estradiol-17beta but at dose levels 20 times greater. Comparison of UBF response curves for cis-clomiphene with those for estradiol-17beta showed a delayed onset of initial vasodilation and a delayed peak response. The duration of uterine vasodilation produced by cis-clomiphene was dose-dependent and exceeded that produced by estradiol-17beta. Similar reponses were observed with trans-clomiphene but at dose levels at least 1,000 times those of estradiol-17beta. The characteristics of clomiphene-induced UBF responses that differed from those after estradiol-17beta may reflect differences in estrogen receptor activation between the compounds.

Appendictiis in pregnancy.

Twenty-nine cases of acute appendicitis during pregnancy are presented, and the recent literature is reviewed. Occurring once in 1,600 gestations, appendicitis carries a pregnancy loss of 10.8%. Difficulties in diagnosis and delays in treatment increase with advancing gestational age. Aggressive management may minimize the resultant maternal morbidity and fetal mortality.