Correlation between integrated LH and FSH levels and the response to luteinizing hormone relasing factor (LRF).

Integrated blood plasma levels of LH and FSH and their response to the iv administration of 100 mug synthetic LRF were studied in 29 normal subjects, 12 women with Stein-Leventhal syndrome, 8 subjects with primary gonadal failure, 7 women with Sheehan's syndrome, 20 subjects with pituitary tumors, 10 subjects with idiopathic gonadotropin deficiency and 5 subjects with hypothalamic tumors. Within each group there was considerable variation in the response of LH and FSH levels to LRF. In each group there was a statistically significant positive correlation between basal integrated gonadotropin levels and the response of the levels to LRF. Both within groups and between groups, the best indicator of the response to LRF was the basal levels of FSH and LH. In subjects with hypogonadotropic hypogonadism there was no significant difference in mean basal LH levels and mean response to LRF between patients with primarily pituitary disease (pituitary tumors or Sheehan's syndrome) and conditions which might represent hypothalamic disease (hypothalamic tumors or idiopathic gonadotropin deficiency). The response to an acute, single, injection of LRF appears to more directly reflect basal gonadotropin levels rather than disease category.

PIP: The diagnostic value of LRF was assessed by measuring the response of plasma levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) to a single iv injection of synthetic LRF in 29 normal subjects, 12 women with Stein-Leventhal syndrome, 8 patients with primary gonadal failure, 7 women with Sheehan's syndrome, 20 patients with pituitary tumors, 10 subjects with idiopathic gonadotropin deficiency, and 5 patients with hypothalamic tumors. The response of plasma LH and FSH levels to LRF varied considerably within each group. Each group showed a positive correlation between basal LH and FSH levels and the response to LRF. There was no marked difference in basal LH values and the mean response to LRF between patients with pituitary tumors of Sheehan's syndrome and patients with hypothalamic tumors or idopathic gonadotropin deficiency. It is concluded that the response to a single, acute iv injection of LRF provides little information of disease states beyond that provided by basal gonadotropin levels.

Maternal plasma and amniotic fluid levels of estradiol, estrone, progesterone, and prolactin in early pregnancy.

During the 16th to 20th weeks of gestation, maternal plasma (mean) level of estradiol is 5.2 ng/mL; estrone, 3.0 ng/mL; estriol, 2.1 ng/mL; progesterone, 4235 ng/dL; and prolactin, 74 ng/mL. Amniotic fluid levels are: estradiol, 446.8 pg/mL; estrone, 234.1 pg/mL; progesterone, 5200 ng/dL; and prolactin, 2633.5 ng/mL. Maternal prolactin concentrations correlate with plasma estradiol. Amniotic fluid prolactin levels correlate significantly with maternal plasma concentrations of estradiol and estrone. The mechanisms for the possible relationship between maternal estradiol and pituitary and decidual tissue production of prolactin are discussed.

Studies of maternal plasma prolactin and amniotic fluid prolactin. Effects of chlorpromazine and prostaglandin F2alpha.

We have studied the effect of chlorpromazine and PGF2alpha on the blood and amniotic fluid levels of prolactin over a 1-hour period of time in women who were in the 14th-20th week of gestation. Following intramuscular injection of chlorpromazine, maternal plasma prolactin rose 1.0- to 2.5-fold. No significant change was noted in maternal plasma after PGF2alpha administration. Amniotic fluid prolactin declined by 6 to 56%. These changes may be dilutional.

Progesterone levels in amniotic fluid and maternal plasma in prostaglandin F2alpha-induced midtrimester abortion.

Progesterone concentrations in amniotic fluid and maternal plasma were determined in 11 midtrimester pregnant patients following the intraamniotic administration of prostaglandin F2alpha. Samples were obtained at 3-hour intervals until abortion or spontaneous rupture of membranes occurred or fetal heart tones disappeared. In amniotic fluid, the mean progesterone concentrations increased throughout the sampling period. The plasma progesterone levels declined by about one-third of basal values in the first 3 hours after prostaglandin administration. The paradoxic increase in amniotic fluid progesterone is probably secondary to alterations in uterine blood flow and intrauterine pressure.

Ultrasonic findings in fetal cyclopia. A case report.

The sonographic picture of fetal cyclopia at 33 weeks' gestation consists of a small fetal head, a central cavity replacing the cerebral lateral ventricles, lack of midline structures, absence of hemispheral vascular pattern and hydramnios. In addition, in our case a structure projecting from the fetal face correlated well with the proboscis. This sonographic feature is the clue in differentiating fetal cyclopia from other forms of alobar prosencephaly.

Retroperitoneal hematoma from a ruptured tubal pregnancy as an unusual cause of a pelvic mass. A case report.

Retroperitoneal hematoma can result from a ruptured tubal pregnancy and present as a pelvic mass. Such a case has not been described previously.

Pararenal hematoma as a complication of vaginal hysterectomy. A case report.

Following a vaginal hysterectomy, a woman developed a pelvic hematoma that expanded in the retroperitoneum to the level of the right kidney. Such a complication, a pararenal hematoma after vaginal hysterectomy, has not been reported on previously. The cuff hematoma was demonstrated clearly by ultrasonography. However, the extent and dimensions of the retroperitoneal hematoma were disclosed only by computed tomographic (CT) scanning. We recommend that a the CT scan be considered in the evaluation of any large posthysterectomy pelvic hematoma.

Primary ovarian pregnancy two years after bilateral tubal ligation. A case report.

This is the first documented case of intrafollicular ovarian pregnancy following bilateral tubal ligation. The patency of the previously ligated tube was demonstrated by hysterosalpinography. It appears that the incidence of ovarian pregnancy is not related to the rising incidence of tubal pregnancy.

Prenatal ultrasound diagnosis of intestinal obstruction: a case report.

A case of intrauterine intestinal obstruction diagnosed at 31 weeks' gestation by sonographic examination is presented. Unlike other reported cases, the diagnosis was made early in the third trimester and before the development of polyhydramnios. The patient was managed conservatively until delivery at 33.5 weeks. At exploratory laparotomy, immediately after birth, ileal atresia was found and resected. The infant recovered uneventfully.

Serum hormone changes in parturients given steroid preparations to suppress lactation.

Prior to the introduction of bromocriptine as the drug of choice for the suppression of puerperal lactation, long-acting sex steroid preparations, especially estrogen-androgen combinations, were utilized for many years to suppress postpartum lactation. In spite of the popularity of these steroids, little information is available concerning serum hormonal levels following their postpartum administration. In this study, 31 postpartum women were divided into three groups: group C, 12 women receiving no hormone therapy; group E + T, 10 women receiving an estrogen-testosterone preparation; group E, 9 women receiving an estrogen preparation. Immediately after delivery, serum estradiol, testosterone, and prolactin levels were elevated--and similar--in the three groups. Following treatment, serum estradiol levels were higher in groups E + T and E than in group C. In group E + T, serum testosterone levels increased to the high adult male range by 24 hours after injection and rose further to as high as 7,000 ng% (mean 2,000 ng%) by 72 hours. At 2 weeks, serum testosterone levels in this group of patients were still above the upper limit of the normal adult male range. After 6 weeks, the mean serum testosterone level was still five times the normal level for a nonpregnant female.

Risk factors for pregnancy loss apparent at conception in infertile couples.

Charts of 206 consecutive pregnancies occurring in couples seen because of infertility were analyzed in an attempt to identify factors, apparent at the time of conception, which may impose risks on pregnancy outcome. These factors were compared in 34 spontaneous abortions and 172 full-term pregnancies. Although the mean age was similar in both groups, women 35 years or older had a significantly higher incidence of spontaneous abortion than younger women. Menstrual history, gravidity, and parity and incidence of previous induced abortions were not different in the spontaneous abortion and term groups. Data collected from basal body temperature charts suggested a slightly higher risk for spontaneous abortion in women with previous anovulatory cycles. The mean follicular phase in the conception cycle was 16 days in both groups. However, a twofold increase in abortion rate was noticed in conceptions with follicular phases shorter than 12 days or longer than 16 days, in comparison with those with follicular phases of 13-15 days' duration. The mean daily temperature increment in the early luteal phase was the same in both groups. No relation between sperm count or motility and spontaneous abortion was observed. Different treatment modalities during the conception cycle had no effect on abortion rate, except for a trend toward lower spontaneous abortion incidence in women who received only prednisone.

Pituitary response to bolus and continuous intravenous infusion of luteinizing hormone-releasing factor in normal women and women with polycystic ovarian syndrome.

Plasma luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were measured in response to luteinizing hormone-releasing factor (LRF), given as a 100 microgram intravenous bolus and/or as a 4 hour infusion of 0.2 microgram per minute to 27 normal menstruating women and 15 women with the polycystic ovarian syndrome (PCOS). In PCOS, LH response to bolus LRF was significantly greater than those of normal women at days 1 to 4 and 8 to 10 of the cycle, whereas FSH responses were similar in all women studied. Continuous LRF infusion resulted in a biphasic LH release pattern. In normal women, the early phase was low until days 12 to 14 of the normal cycle, whereas the second phase rose progressively from the early follicular to the periovulatory period. In PCOS, the early phase was relatively large and qualitatively resembled the normal periovulatory pattern. The increased pituitary LH response to LRF in PCOS is associated with a relatively large early releasable LH pool and a low FSH response.

Spontaneous clostridia gas gangrene of uterus associated with endometrial malignancy.

Only four patients with clostridia sepsis in association with gynecologic malignancy have been reported, all of whom had prior diagnostic or therapeutic intervention. Our patient is the first documented case of such clostridium sepsis that occurred spontaneously, i.e., without previous trauma, instrumentation, radiation or chemotherapy. The value of aggressive management is reviewed.

Cortisol levels in amniotic fluid in prostaglandin F2alpha-induced midtrimester abortion.

Cortisol concentrations in amniotic fluid and maternal plasma were determined by a competitive protein-binding assay in 14 patients in the midtrimester of pregnancy before and after intra-amniotic administration of prostaglandin F2alpha. Samples were obtained at three-hour intervals until abortion or until the fetal heartbeat ceased. The mean plasma levels of cortisol increased from 324 +/- 173 ng. per milliliter at hour 0 to 524 +/- 272 ng. per milliliter at 6 hours (the peak elevated value). In amniotic fluid, the mean levels of cortisol increased from 4.71 +/- 2.5 ng. per milliliter to a maximum at 9 hours of 10.24 +/- 2.5 ng. per milliliter. We concluded that at 16 to 20 weeks' gestation the fetoplacental unit is capable of responding to prostaglandin F2alpha instillation by increased levels of cortisol in the amniotic fluid.