Hepatitis B immunity in Australia: a comparison of national and prisoner population serosurveys.

In Australia, hepatitis B (HBV) vaccination is recommended for injecting drug users (IDUs), Indigenous adults and prisoners. We compared immunity to HBV in prisoners and the general population obtained from national serosurveys in 2007. Individuals with HBV surface antibody (HBsAb) positive sera were considered immune from past infection [HBV core antibody (HBcAb) positive] or from vaccination (HBcAb negative). Male prisoners aged 18-58 years had a higher HBsAb seroprevalence than the general population (46·4% vs. 39·4%, P = 0·061). Comparison of HBcAb results was possible for males aged 18-29 years. In this group, higher HBsAb seroprevalence was due to past infection (12·9% vs. 3·0%, P < 0·001), rather than vaccine-conferred immunity (35·3% vs. 43·4%, P = 0·097). All prisoner groups, but especially IDUs, those of Indigenous heritage or those with a previous episode of imprisonment had higher levels of immunity from past infection than the general population (19·3%, 33·0%, 17·1%, respectively, vs. 3·0%, P < 0·05). Indigenous prisoners, non-IDUs and first-time entrants had significantly lower levels of vaccine-conferred immunity than the general population (26·4%, 26·2% and 20·7% respectively vs. 43·4%, P < 0·05). Improving prison-based HBV vaccination would prevent transmission in the prison setting and protect vulnerable members of the community who are at high risk of both infection and entering the prison system.

Anatomical variations and developmental insights of tendons in the first extensor compartment of the hand: Cadaveric study with surgical implications.

Background: Anatomical variations in first extensor compartment play a role in the development of de Quervain's disease. This study delves into the detailed examination of these anatomical variations. Methods: 50 upper limbs (28 male and 22 female) from 25 for-malin-embalmed adult human cadavers were dissected to investigate variations in tendons of first extensor compartment. Results: Accessory tendons to main tendon of abductor pollicis longus (APL) were reported in 49 (98%) cases, with 34% having two accessory tendons, 52% having three, and 12% having four. Terminal ends of these accessory tendons were generally consistent, except in one case where it split into two tendinous bands at insertion site, which was most commonly at base of first metacarpal. Extensor pollicis brevis (EPB) was found as a single tendon in 48 cases, with one case each of duplication and absence. In 19 cases (38%), muscle belly of EPB was fused with that of APL to some extent and it typically inserted at base of the proximal phalanx of the thumb. Average length of muscle belly, tendon, and muscle tendon ratio (MTR) of APL was 15.99±0.62 cm, 5.91±0.76 cm and 2.71 and of EPB was 6.39±0.29 cm, 9.15±0.74 cm and 0.70 respectively. Conclusion: APL variations range from accessory tendons, splitting of tendons to various insertion points. Additionally, length and insertions points of these accessory tendons are key factors in deciding their usability as graft sources for tendon reconstruction and in surgical treatments of conditions like de Quervain's tenosynovitis.

Correlation of bone mineral density with biochemical markers in post menopausal women.

To evaluate the magnitude of bone loss in postmenopausal women and to study the effect of a selective estrogen Receptor Modulator, raloxifene, on bone loss by quantitative ultrasound of calcaneus and serum bone specific alkaline phosphatase (BAP). Postmenopausal women with ostesopenia/osteoporosis were assigned randomly to receive placebo (n=30) or raloxifene (60mg/d, n=30) with calcium (500mg/day) and vitamin D (250 IU/day). The bone mineral density (BMD) and BAP levels were measured at the beginning of therapy and six months later. They were subjected to statistical analysis (t test, p value) using SPSS statistical package. 70% of postmenopausal women suffered from osteopenia/osteoporosis. After raloxifene therapy, there was improvement in the BMD but this was not statistically significant (p>0.05). There was a fall in the value of serum BAP by 26.6% (p<0.05). Raloxifene has a favourable effect on bone turnover as evident from changes in BMD and a significant fall in serum BAP.

QSAR analysis for 6-arylpyrazine-2-carboxamides as Trypanosoma brucei inhibitors.

Human African trypanosomiasis (HAT) is prevalent in African countries, covering 37 countries, mostly sub-Saharan. A limited number of drugs are available to cure this neglected disease. In the present work, quantitative structure-activity (toxicity) relationships (QSA(T)R) analysis has been performed for a dataset of 54 6-arylpyrazine-2-carboxamides as Trypanosoma brucei inhibitors to identify the important structural features required for future optimization of lead candidates. The QSA(T)R models satisfy OECD guidelines and have high statistical robustness. The QSA(T)R models are based on easily interpretable molecular descriptors. The QSA(T)R models indicate that Trypanosoma brucei inhibitory activity of 6-arylpyrazine-2-carboxamides has correlation with the presence of N-sec-butylformamide and substituted benzene. The results could be beneficial for further optimization of 6-arylpyrazine-2-carboxamides as Trypanosoma brucei inhibitors. Some potential candidate molecules have been proposed.

The influence of progesterone on the conversion of 17-hydroxyprogesterone to testosterone in the mouse testis.

PIP: Tritiated-progesterone and 17-hydroxyprogesterone-carbon 14 were incubated with mouse testis homogenates obtained from adult Swiss mice. The distribution of each isotope in 17-hydroxyprogesterone, androstenodione and testosterone when the 2 precursors were present in various ratios were compared with the amounts when each precursor was present alone. Formation of the major compound in these experiments occurs by a series of sequential reactions: progesterone to 17-hydroxyprogesterone to androstenodione to testosterone, and the assumption is made that the sum of the products beyond a given enzymatic step equals the amount of a particular precursor undergoing that reaction. The presence of equal amounts of progesterone and 17-hydroxyprogesterone caused a small but significant reduction in 17-hydroxyprogesterone activity. The presence of added 17-hydroxyproesterone essentially did not affect the rate at which 17-hydroxyprogesterone or 17-oxy radical formed from progesterone, but the amount of C-19 steroids progressively decreased as progesterone concentration was raised above 2.5 nmales per ml. This was probably because of the close association of active sites of the 17-hydroxylase and lyase. The presence of progesterone markedly inhibited the rate of splitting of the added 17-hydroxyprogesterone. The inhibition was probably competitive as previously reported for rat testis. The results indicate that the active site of the 17-beta-dehydrogenase was not closely associated with the lyase. At higher levels of either precursor alone the 17-beta-dehydrogenase approached saturation, but the inhibition of lyase activity by progesterone left the 1-beta-dehydrogenase unsaturated and a higher proportion of the smaller amounts of androstenodione formed was converted to testesterone.^ieng

The effect of chronic and acyclic elevation of circulating androstenedione or estrone concentrations on ovarian function in the rhesus monkey.

The concept that chronically elevated blood androstenedione concentrations increase the incidence of anovulation in the primate and that acyclic elevated basal blood androgen and/or estrogen concentrations cause abnormal gonadotropin secretion was studied. Regularly menstruating female rhesus monkeys were implanted sc with Silastic tubing filled with androstenedione or estrone and compared with controls. Androstenedione implants increased the serum androstenedione concentrations from 1.6 +/- 0.1 (SE) ng/ml to 6.30 +/- 0.27 ng/ml. By peripheral conversion the testosterone concentration increased from control values of 279 +/- 10 (SE) pg/ml to 1280 +/- 41 pg/ml. The testosterone concentration in the estrone-treated monkeys was 247 +/- 9.7 pg/ml. The estrone concentrations were: controls, 63.2 +/- 3.1 (SE) pg/ml; androstenedione-treated monkeys, 63.2 +/- 3.1 pg/ml; and estrone-treated animals, 150 +/- 5.3 pg/ml. The corresponding estradiol concentrations were: control animals, 35.1 +/- 2.1 (SE) pg/ml; androstenedione animals, 30.9 +/- 1.8 pg/ml; and estrone-treated monkeys, 65.7 +/- 3.9 pg/ml. There was no difference in the morning serum cortisol concentrations between any of the three groups or between ovulatory or anovulatory months. The chronic elevation of either androstenedione or estrone caused an increased incidence of anovulation compared with the controls. Increased estrogen concentrations caused increased anovulation during both summer and winter months; however, increased androgen concentrations caused increased anovulation only during the summer months. However, LH concentrations were unaffected in either group but were lower during anovulation months in all three groups. An LH or FSH surge followed an estradiol bolus in three of four control animals and four of six androstenedione-treated but none of the estrone-treated monkeys. Histological examination of ovarian biopsies demonstrated thickening of the tunica albuginea ovarii in androgen-treated ovaries and an apparent increased number of atretic follicles. Corpora lutea were absent in the ovaries of the estrogen-treated monkeys, but otherwise these ovaries were similar to those of controls. It is concluded that chronic acyclic elevation of blood androstenedione (and resultant testosterone) increases seasonal anovulation in the rhesus monkey. Increased blood estrone (and resultant estradiol) leads to almost complete anovulation throughout the year and renders the central nervous system-pituitary axis insensitive to positive feedback effect of estradiol. Neither treatment caused an increase in basal LH concentrations.(ABSTRACT TRUNCATED AT 400 WORDS)

Changes in the concentration of 17 alpha,20 alpha-dihydroxypregn-4-en-3-one during pregnancy, labor, and delivery and the effect of dexamethasone treatment during the third trimester of pregnancy.

To study whether an alteration of placental steroid metabolism occurs during human pregnancy similar to that in the ewe, we measured the concentration of 17 alpha,20 alpha-dihydroxypregn-4-en-3-one (17,20 alpha-OHP) in peripheral plasma. As the pregnant ewe nears term, the utero-ovarian venous concentrations of 17,20 alpha-OHP increase, suggesting induction of placental 17 alpha-hydroxylase. The mean plasma concentration of 17,20 alpha-OHP measured by RIA in normal menstruating women was 1.1 +/- 0.12 (+/- SE) ng/ml. Similar values were found in plasma from ovariectomized women. In the first and second trimesters of pregnancy, the plasma values of 17,20 alpha-OHP were not significantly different from those in the nonpregnant women, while in the third trimester, the mean plasma concentration was significantly increased (mean +/- SE, 2.6 +/- 0.3 ng/ml). The plasma concentration of 17,20 alpha-OHP was studied in 15 women in late pregnancy, during labor, at delivery, and postpartum. The concentration increased during labor as delivery approached and reached a maximum at the time of delivery, ranging from 4.1-11.2 ng/ml, followed by a significant decrease within 1-4 h postpartum. The mean (+/- SE) 17,20 alpha-OHP concentrations in the venous and arterial cord blood were 8.7 +/- 1.6 and 5.8 +/- 2.0 ng/ml, respectively. To study the effect of increased circulating level of corticosteroids on the serum concentration of progestins, 74 women with premature labor with or without premature rupture of membranes were treated with either placebo or 4 im injections of dexamethasone phosphate (5 mg each) at 12-h intervals. Blood samples were drawn at 0, 14, 26, and 46 h, approximately 2 h after each dexamethasone dose. Plasma progesterone, 17 alpha-hydroxyprogesterone (17-OHP), and 17,20 alpha-OHP values at zero time were 140 +/- 15.8 (+/- SE; n = 21), 7.8 +/- 1.5 ng/ml (n = 16), and 2.3 +/- 0.3 ng/ml (n = 20), respectively. In patients treated with dexamethasone, the plasma progesterone values tended to increase at 14, 20, and 46 h, but 17-OHP and 17,20 alpha-OHP values decreased significantly compared to levels in placebo-treated patients. In conclusion, the concentration of plasma 17,20 alpha-OHP increased during the third trimester of pregnancy, and the increment continued through labor and delivery. During antenatal dexamethasone administration, progesterone in the maternal circulation tended to increase, while 17-OHP and 17,20 alpha-OHP decreased significantly. In the human, in contrast to the ewe, dexamethasone treatment in the third trimester does not appear to stimulate placental 17 alpha-hydroxylase activity.

Steroidogenesis in human polycystic ovary.

Polycystic ovarian disease (PCOD) is a heterogenous condition with a broad clinical and pathologic spectrum that may reflect the effects of diverse etiologic factors. Depending on the diagnostic data available from patients, various steroidogenic enzyme blocks have been postulated, mostly implicating higher-than-normal production of circulating delta 4-androstenedione, testosterone, and, in some cases, dehydroisoandrosterone. These high levels of androgens, because of their peripheral conversion to estrogens, lead to inappropriate secretion of gonadotropins in PCOD. Whatever may be the etiologic factors, the common entity is a polycystic ovary. Such an ovary contains preantral follicles, few antral follicles, many atretic follicles, and follicular and degenerative cysts. The follicles lack a sufficient number of mature granulosa cells to produce enough estrogens. On the other hand, there is a hypertrophy of stromal and thecal tissue continuously producing androgens. The steroid analysis of the follicular fluid obtained from the cystic follicles of the polycystic ovary revealed high concentration of delta 4-androstenedione and absence of, or only minute amounts of, estrogens. Early studies of biosynthesis of steroids in the polycystic ovary demonstrated conversion of progesterone mainly to androgens. Arising from these observations was the suggestion that an aromatase enzyme block existed. That suggestion was corroborated in the findings of higher-than-normal circulating androgens in PCOD. Later, other partial enzymatic blocks of beta-hydroxydehydrogenase and 17-hydroxylase were also suggested. However, it is known that the therapies such as wedge resection, administration of FSH, or FSH/LH (Pergonal) and LHRH leads to ovulation and, in most cases, normal cyclicity in the polycystic ovary. The knowledge gained from these therapies clearly indicates that the enzymatic blocks or abnormal steroidogenesis in the polycystic ovary may be due to the absence of proper gonadotropin response, and the main defect may be at the hypothalamic-pituitary axis. In PCOD with hyperinsulinemia, insulin and IGF-I have been implicated in the production of androgens by the polycystic ovary. The mechanism of the action of insulin or IGF-I is not yet known, however.

Polycystic ovarian disease: animal models.

The reproductive systems of human beings and other vertebrates are grossly similar. In the ovary particularly, the biochemical and physiologic processes are identical not only in the formation of germ cells, the development of primordial follicles and their subsequent growth to Graafian follicles, and eventual ovulation but also in anatomic structure. In a noncarcinogenic human ovary, hypersecretion of androgen causes PCOD. Such hypersecretion may result from a nonpulsatile, constant elevated level of circulating LH or a disturbance in the action of neurotransmitters in the hypothalamus. In studying the pathophysiology of PCOD in humans, one must be aware of the limitations for manipulating the hypothalamic-pituitary axis. Although the rat is a polytocous rodent, the female has a regular ovarian cyclicity of 4 or 5 days, with distinct proestrus, estrus, and diestrus phases. Inasmuch as PCOD can be experimentally produced in the rat, that species is a good model for studying the pathophysiology of human PCOD. These PCOD models and their validity have been described: (1) estradiol-valerate, (2) DHA, (3) constant-light (LL), and (4) neonatally androgenized. Among these, the LL model is noninvasive and seems superior to the others for study of the pathophysiology of PCOD. The production of the polycystic ovarian condition in the rat by the injection of estrogens or androgens in neonate animals, or estradiol or DHA in adult rats, or the administration of antigonadotropins to these animals all cause a sudden appearance of the persistent estrus state by disturbing the metabolic and physiologic processes, whereas exposure of the adult rat to LL causes polycystic ovaries gradually, similar to what is seen in human idiopathic PCOD. After about 50 days of LL, the rat becomes anovulatory and the ovaries contain thickened tunica albuginea and many atretic follicles, and the tertiary follicles are considerably distended and cystic. The granulosa and theca cells appear normal histologically, although some of the stromal cells appear hypertrophic. The anatomic features consequent to polycystic ovaries resulting from LL are similar to those in human PCOD, and both rat and human PCOD ovarian cells still retain the ability to respond to FSH/LH, LHRH, and unilateral ovariectomy. In the estradiol valerate rat model, although the anatomy and physiology of the ovary resemble those of PCOD patients, the progressive degeneration of the hypothalamus and the altered response of the pituitary to LHRH make this model inappropriate for studying the hypothalamic-pituitary-ovarian axis in the polycystic ovary condition.(ABSTRACT TRUNCATED AT 400 WORDS)

Dietary fat up-regulates the apolipoprotein E mRNA level in the Zucker lean rat brain.

High-fat diet alters apo E-dependent processing of beta-amyloid precursor protein. Here we have evaluated the effects of dietary fat on brain apo E mRNA in Zucker lean and obese rats. After approximately 2 months on a high-fat diet, there was significant up-regulation of brain apo E mRNA in the Zucker lean rat in parallel with weight gain. Densitometric quantification revealed a 17% increase in apo E mRNA in the brains of lean rats fed high-fat diet compared with those of lean rats fed rat chow. No significant difference in brain apo E mRNA of Zucker obese rats fed different diets was found. These results suggest that dietary fat alters brain apo E levels, which may be regulated, in part, through the leptin receptor.

Mifepristone (RU486): a review.

OBJECTIVE: To review the literature concerning the mechanism of action and pharmacodynamics of mifepristone (RU486), potential new uses of RU486, and its current use not only as an abortifacient but also as therapy for endometriosis, leiomyoma, breast cancer, and meningioma. DATA IDENTIFICATION AND SELECTION: Studies that relate to RU486 were identified through a MEDLINE search. CONCLUSION(S): RU486 is an 11 beta-dimethyl-amino-phenyl derivative of norethindrone with a high affinity for P and glucocorticoid receptors. The receptor binding is not followed by transcription of P-dependent genes. Mifepristone effectively blocks P receptors in the placenta, resulting in the termination of pregnancy. In addition, it has been used in the treatment of leiomyomata, endometriosis, advanced breast cancer, and meningioma. It is a powerful tool to study the molecular action of P and in the future may be used as an estrogen-free contraceptive.

PIP: Through an online search of MEDLINE, the authors reviewed the literature on the development of mifepristone (RU-486); RU-486's mechanism of action, pharmacodynamics, and distribution; the physiologic action of RU-486; potential new uses for RU-486; and its current use as both an abortifacient and therapy for endometriosis, leiomyoma, breast cancer, and meningioma. RU-486 is an 11beta-dimethyl-amino-phenyl derivative of norethindrone with a high affinity for P and glucocorticoid receptors. Receptor binding is not followed by the transcription of P-dependent genes. RU-486 effectively blocks P receptors in the placenta, resulting in the termination of pregnancy. It has also been used to treat leiomyomata, endometriosis, advanced breast cancer, and meningioma. The following therapeutic uses of RU-486 are discussed: the termination of early pregnancy, treatment with RU-486 in combination with prostaglandins, the termination of second-trimester pregnancy, cervical ripening, labor induction, postcoital contraception, uterine leiomyomata, endometriosis, breast cancer, and meningioma.

Inhibition of 17,20(17-hydroxyprogesterone)-lyase by progesterone.

14C-17-hydroxyprogesterone was incubated with 7000 times g times 20 min supernatants of rat testis homogenates in the presence of various concentrations of 3H-progesterone, both under conditions where metabolism would take place and where it would be prevented. When metabolism was prevented, the ratio of progesterone to 17-hydroxyprogesterone in the microsomal fraction was 3 times that which was added to the incubation medium. Progesterone competitively inhibited 17,20-lyase action on added 17-hydroxyprogesterone but not on 17-hydroxyprogesterone formed from the added progesterone. The rate of formation of 17-hydroxyprogesterone from progesterone, however, was inhibited by added 17-hydroxyprogesterone. The results indicate that there is no free exchange of an intermediate between progesterone and androstenedione with the soluble fraction, either inside or outside the microsomal vesicle. The limited exchange with 17-hydroxyprogesterone in solution probably represents exchange with an enzyme-bound intermediate.

Risk factors for coronary heart disease in two similar Indian population groups, one residing in India, and the other in Sydney, Australia.

OBJECTIVE: To identify the prevalence of coronary risk factors among South Asian Indians in Australia and India. DESIGN: Cross-sectional intercountry comparison. SUBJECTS: Healthy volunteers aged 23-75 y recruited from the Indian community in Sydney Australia (n=125), and their nominated relatives in India, (n=125). RESULTS: The two groups were of similar background with over 90% of the group in India being siblings, parents or relatives of the group in Australia. There was no difference in the populations between India and Australia with regard to mean age (40+/-11.5 vs 39+/-10.3 y), body mass index (BMI) (25+/-3.3 vs 25+/-3.5 kg/m(2)), lipoprotein (a) (178 vs 202 mg/l), total cholesterol (5.3+/-1.3 vs 5.3+/-1.2 mmol/l) or triglyceride (1.7+/-0.8 vs 1.7+/-0.8 mmol/l). The group in India had higher insulin (median values) (139 vs 83 pmol/l, P=0.0001), waist-to-hip ratio (WHR) (0.88+/-0.08 vs 0.85+/-0.09, P=0.01), exercise time (23.7+/-32.7 vs 17.2+/-23.2 h/week, P=0.07), lower waist (83+/-10.0 vs 85+/-11.1 cm, P=0.05) and high-density lipoprotein (0.9+/-0.3 vs 1.1+/-0.6 mmol/l, P=0.02). Women in India had lower BMI (22.7+/-2.9 vs 25.3+/-4.2 kg/m(2), P<0.001), higher insulin (182 vs 90 pmol/l, P<0.001), WHR (0.86+/-0.08 vs 0.77+/-0.06, P<0.001)) and prevalence of abdominal obesity (% WHR >0.8, 73 vs 23%, P<0.001; odds of waist >90 cm=2.3, P<0.05). Men in India had the same BMI, lower waist (85.5+/-8.8 vs 92.9+/-7.2 cm, P<0.001) and WHR (0.89+/-0.09 vs 0.93+/-0.05, P<0.01) but higher insulin (137 vs 76 pmol/l). CONCLUSION: The group in Australia (especially women) have a more favourable disease risk profile than those in India. The fact that the groups are of such similar background and partly related, make it unlikely that changes due to migration have a strong genetic bias. In contrast to other studies, the absence here of excessive weight gain on migration may be a key factor in disease risk prevention.

A collectin-like protein from tunicates.

Collectins are a sub-family of C-type lectins from mammals and birds that are characterized by their collagen-like domains. The mammalian collectin, mannose binding lectin, has attracted considerable interest because it can activate complement components via a lectin-mediated complement pathway that is independent of immunoglobulins. In this study, we have identified a calcium-dependent lectin from the invertebrate (tunicate), Styela plicata, that bears substantial similarities to mammalian collectins. The tunicate lectin, which was isolated by carbohydrate affinity chromatography, has a reduced apparent molecular mass of 43 kDa. The 43 kDa reduced polypeptide appeared as dimers, trimers and hexamers when analyzed by non-reducing and two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis, while gel filtration suggested that the native form of the protein was a nonamer. Amino acid sequence and amino acid composition analysis revealed obvious similarities between the tunicate lectin and mammalian collectins, notably the inclusion of a collagenous domain and a short, cysteine bearing N-terminal domain. The identification of a collectin-like protein in an invertebrate such as S. plicata, which does not express immunoglobulin, indicates that lectin-mediated complement pathways may predate the origin of antibodies.

Anti-66 kDa antileishmanial antibodies as specific immunodiagnostic probe for visceral leishmaniasis.

A 66 kDa plasma membrane associated molecule of promastigotes of Leishmania donovani (MHOM/IN/1978/UR6) was affinity purified under acidic conditions. Employing purified 66 kDa antigen in micro ELISA, 36 (97.3%) of the 37 patients of visceral leishmaniasis (bone marrow aspirates positive for Leishman Donovan bodies) had detectable levels of anti 66 kDa anti leishmanial antibodies. The sera of the patients confirmed to have visceral leishmaniasis had significantly (P < 0.001) higher optical density values (0.636 +/- 0.230) as compared to sera (OD 0.185 +/- 0.131) from patients clinically suspected to have visceral leishmaniasis (bone marrow aspirates negative for Leishman Donovan bodies). None of the 35 sera from apparently healthy subjects from non endemic area had anti 66 kDa antibodies. However, sera from one (8.3%) of the 12 healthy subjects, who was a first degree relative of a patient of visceral leishmaniasis and residing in an area endemic for visceral leishmaniasis, had anti 66 kDa antibodies. It is felt that detection of anti 66 kDa antibodies in a micro ELISA assay provides a highly sensitive and specific tool for confirming ongoing visceral leishmaniasis.

Fertility on synchronized estrus in crossbred (Bos taurus x Bos indicus) heifers.

This study was performed in Western Maharastra (India). The 272 crossbred heifers were randomly allocated within herds to one of the four following groups: 1) silastic coils, 10 days treatment (n = 65); 2) Norgestomet implants, 10 days treatment (n = 71); 3) prostaglandin F(2alpha) two injections 11 days apart (n = 70); and 4) control (n = 66). Almost all heifers in the treated groups were detected in heat during the four days following treatment (88-100%) vs 26% in the control group in the first 21 days. Mean conception rates at first AIs were respectively 62,48 and 60% in groups 1,2 and 4 (p > 0.05) and only 29% in group 3. By 90 days after treatment, 66, 59, 46 and 33 per cent of the females were pregnant for groups 1 to 4, respectively (p < 0.001). In conclusion, progestogen treatments seemed to be highly satisfactory both in terms of conception rates and intervals from treatment to pregnancy.

Ultrastructural basis for continued steroidogenesis in the rat polycystic ovary.

Because constant light causes persistent estrus in the rat, that animal provides a suitable experimental model for studying the pathogenesis of polycystic ovary disease. We studied the scanning and transmission electron microscopic features of the rat polycystic ovary along with changes in serum estradiol and progesterone concentrations to further elucidate the mechanism of chronic anovulation during persistent estrus. The surface epithelium of the polycystic ovary showed no ovulatory stigmas and contained focal areas of degenerating and proliferating cells. The tunica albuginea was conspicuous, with many fibrils, collagenous materials and fibroblastlike cells adjoining the theca externa layer. The cytoplasm of theca interna cells contained numerous lipid vacuoles and images of extracted cholesterol crystals. The granulosa cells were atrophic and lacked the prominent Golgi apparatus typically found in granulosa cells of proestrous ovaries in cycling rats. With an increasing duration of constant light and chronic anovulation, the mean serum estradiol concentration in persistent-estrus rats was significantly higher and the mean serum progesterone concentration significantly lower than in age-matched controls. Alterations in estradiol-progesterone metabolism in the ovaries may be important etiologic factors in the pathogenesis of chronic anovulation found in polycystic ovary disease in rats.

Effect of obesity on the clinical and hormonal characteristics of the polycystic ovary syndrome.

The polycystic ovary (PCO) syndrome is frequently associated with obesity. That subset of women reportedly shows a much higher incidence of hirsutism and menstrual irregularities than do nonobese women with PCO syndrome. We evaluated the clinical features and hormonal profiles of 56 women with PCO syndrome and correlated them with the presence or absence of obesity. Thirty-eight (67.8%) of these women were obese (body mass index > or = 25 kg/m2). While presenting with the classic manifestations of PCO, they did not differ significantly from the manifestations of nonobese women with PCO syndrome. Although obese women with PCO had a lower incidence of oligomenorrhea as compared to nonobese women with PCO (57.9% vs. 83.3%, respectively) and amenorrhea was more frequent in the former group (42.1% vs. 16.6%, respectively), these findings are not statistically significant. The incidences of hirsutism and anovulatory infertility in the obese group as compared to the nonobese group were 81.6% vs. 77.8% and 28.9% vs. 27.8%, respectively (not statistically significantly different). The mean (+/- SE) serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH ratios, prolactin and testosterone were not statistically significantly different among the two groups. The present study found that obesity is common in PCO syndrome but that there are no significant differences in the clinical and hormonal characteristics of obese and nonobese women with it. Further studies are warranted to clarify the impact of obesity on clinical, metabolic and hormonal changes in PCO syndrome.

Clomiphene-dexamethasone treatment of clomiphene-resistant women with and without the polycystic ovary syndrome.

We used clomiphene and dexamethasone in 40 infertile women to treat chronic anovulation resistant to the use of clomiphene alone. Eighteen (45%) of the women had the polycystic ovary (PCO) syndrome; the remaining 22 (55%) had clomiphene-resistant anovulation from idiopathic causes. Both groups of women were similar in regard to age, parity, duration of infertility and absence of other causes of infertility besides chronic anovulation. Ovulation could be induced in approximately 90% of the women in each group. Altogether, 19 of 36 women (52.8%) conceived without any side effects or complications. The cumulative probability of conception at nine months of treatment was 87.5% in PCO patients and 46% in the non-PCO group. Clomiphene plus dexamethasone was highly effective in the treatment of clomiphene-resistant anovulation associated with infertility in women with and without the PCO syndrome.

Cor triloculare biatriatum--A case report.

Cor triloculare biatriatum or double inlet single ventricle is a congenital heart defect in which both atria are connected to a common or dominant ventricle. The present report presents an index case and describes the embryological basis and clinical aspects of this extremely rare anomaly. A three months old infant presented with extreme respiratory distress without cyanosis and repeated chest infections. The patient was diagnosed to be a case of single ventricle with both atria opening in the common ventricular chamber. The common ventricular chamber (single ventricle) was connected to a rudimentary outflow tract. The great arteries were in a position of d-transposition of great arteries. However, there was no pulmonary or aortic stenosis. A clear concept and awareness regarding this condition and its clinical manifestations is bound to facilitate timely intervention with improved success rates.