Cellular and humoral suppressor activity induced by concanavalin A-stimulated human fetal liver cells.

Incubation of human fetal liver cells (HFLC), obtained from 8-12-week-old fetuses, with mitogenic doses of Concanavalin A (Con A) resulted in generation of a population that could suppress alloantigen-induced lymphoproliferation. The supernatant media in which these cells were activated suppressed DNA synthesis, both in mitogen and alloantigen induced peripheral blood lymphocyte cultures. Suppression was achieved only when the Con A-activated cells or the supernatants were added during the early stages of sensitization. Treatment of the cells with mitomycin C after Con A activation did not alter their ability to mediate suppression. This study indicates the presence of suppressor or presuppressor cells in the liver in the early period of fetal life. If the suppressor activity of HFLC in vitro is also induceable in vivo, it may contribute to the fetal defense mechanism against maternal rejection.

Percutaneous catheter drainage of tubo-ovarian abscesses.

We present the successful treatment of tubo-ovarian abscesses in three young patients by continuous percutaneous drainage, inserted under the guidance of real-time ultrasonography using only local anesthesia. Each patient had been diagnosed laparoscopically as suffering from acute pelvic inflammatory disease, but had formed abscesses despite extensive broad-spectrum antibiotic therapy. One case involved a complication of the ovum pick-up procedure; the woman had tubo-ovarian abscesses with infected hematomas. Because the abscesses were localized anteriorly in the lower abdomen and did not reach the pouch of Douglas, they could not be drained through a posterior colpotomy. Ultrasound guidance allowed us to drain all the areas of the multioculated abscesses. We suggest that percutaneous abscess drainage be the initial treatment of choice for tubo-ovarian abscesses before laparotomy is considered.

Necrotizing fasciitis.

Two cases of necrotizing fasciitis, a disease poorly documented in the gynecologic literature because of its extreme rarity, are described. These are the only cases of this entity seen in our department during the last 24 years. Both patients underwent major surgical procedures for uterine stromal sarcoma and mixed mesodermal tumor. In both, the pathognomonic signs, undermining of the skin, and extensive necrosis of the subcutaneous tissue and the underlying fascia, were present. Later gangrene occurred, and both patients died. The literature is briefly reviewed, which emphasizes the importance of immediate surgery when the disease is recognized. The possibility is suggested that the development of such local processes in cases of mixed mesodermal tumor may be an immunologic reaction and the cultured organisms contaminants.

Intravascular leiomyomatosis.

Two cases of intravascular leiomyomatosis are described. In 1 case, a 66-year-old woman was seen with an extension of the tumor to the myometrium, cervix, and left parametrium and with radiologic evidence of tumor extension to the left external and common iliac veins and the inferior vena cava; subsequently, the tumor invaded the left renal, suprarenal and ovarian veins, hepatic veins, and the right atrium, causing severe heart failure and death. The second case is that of a 28-year-old woman with an advanced tumor in the interior vena cava, right atrium, and ventricle who died during cardiac surgery. Review of the literature is presented, with special comment on the management of this disease entity.

Progesterone receptor levels and distribution in different phases of the menstrual cycle and in estrogen-primed postmenopausal endometrium.

Progesterone receptor levels were measured in the cytosol and in the 0.4 M KCl nuclear extract of normal cyclic endometria in 49 women, classified into four categories: proliferative, midcycle, secretory, and estrogen-primed (four to 11 days); [3H]R5020 was used as a ligand. The women in each category were further subdivided into test and control groups; the women in the test group received a progesterone injection one to three hours before tissue collection. Both the nuclear progesterone receptor levels and the portion of the progesterone receptor in the nuclear extract were significantly higher in the test than in the control groups; among the test groups in the four categories, however, these changes were significantly smaller in women in the secretory category than in the other three categories. These results indicate that the progesterone receptor activation-translocation dynamics in human endometrium are dependent upon the hormonal status of the woman.

Progesterone (P) receptor dynamics in estrogen primed normal human cervix following P injection.

Progesterone (P) receptor levels were measured in the cytosol and in the 0.4 M KCl nuclear extract in human cervical tissues with [3H]-R5020 as a ligand and the results compared with those obtained in the myometrium and endometrium of the same uteri. Tissue samples were obtained from 28 women, grouped as follows: group A, 12 premenopausal controls; group B, 7 perimenopausal women who received estrogen 7 to 11 days before operation; and group C, 9 perimenopausal and postmenopausal women who received estrogen as in group B plus P injection 1 to 3 hours before operation. Estrogen administration resulted in a significant rise in total P receptor levels in the cervix, compared with the endometrium and myometrium. P injection after estrogen priming resulted in down-regulation of the P receptor in the cervix to undetectable levels, whereas in the endometrium and myometrium it resulted only in redistribution of the P receptor, with higher nuclear levels and lower cytosol levels. These results indicate the possibility of a different mechanism of regulation of the P receptor in the human cervix, compared with that in the endometrium and myometrium.

Characterization and assay of the nuclear and cytosolic progesterone (P) receptors in Premarin-primed human endometrium and myometrium after single-dose P administration.

Progesterone receptors (RP) were characterized and measured in the 0.4 M KCl nuclear extract and in the cytosol of 7 to 11 days Premarin (Premarin, Ayerst Laboratories, New York, NY) primed human endometrium and myometrium with [3H]R5020 as the ligand. The test group comprised 12 women who received progesterone injection 1 to 3 hours before tissue collection; the control group numbered 10 women. Receptor characteristics in both the endometrium and the myometrium, in the nuclear extract and cytosol in the test group and in the cytosol in the control group, were similar and were demonstrated by (1) high specificity, (2) sedimentation constant of 4.7 to 6.5S in the cytosols and 2.8 to 3.9S in the nuclear extract, (3) saturable affinity with Kd of 2.2 to 3.5 nM and 1.9 to 3.3 nM, respectively. Total RP levels (nuclear extract and cytosol) ranged from 1030 to 13,270 and 1280 to 17,300 fmol/mg DNA, respectively, in the endometria of women in the test and control groups. In 13 of 14 women myometrial total RP levels were higher than in the endometrium. There was a significant difference in the distribution of the RP between the test and the control groups: 50% and 48% of the receptor were measured in the nuclear extract in the endometrium and myometrium, respectively, in the test group, compared with 25% and 21% in the control group (P less than 0.001).

Evaluation of ketanserin as a tocolytic agent in third trimester pregnant rats.

Ketanserin, as a 5HT2 selective antagonist, was evaluated for its tocolytic effects in pregnant Charles River (CR) rats, at total doses of 1.5 and 3.5 mg/kg IU from day 22 to day 25 of pregnancy. After 18 hours of ethenyl estradiol induction, tocolytic evaluation was carried out by recording uterine activity. When compared to the control group, the administration of Ketanserin resulted in an apparent, nondose dependent suppression of uterine contractility.

Placental site trophoblastic tumors (trophoblastic pseudotumors): pathology and clinical importance.

Placental site trophoblastic tumor (PSTT), which can be regarded as a subtype of gestational trophoblastic neoplasia is discussed. The histopathological features include trophoblastic proliferation without the typical organization of the bilamelar cyto and syncytiotrophoblastic villus. Ultrastructural investigation has demonstrated a clone structural relationship between the infiltrating cells and those of the trophoblastic components of the normal human placenta. Clinical management should be based on the complete surgical resection of the mass and a follow-up by measuring the serum levels of beta-human chorionic gonadotropin fractions.

Cytologic evaluation of hormonal dynamic in the postmenopause.

There is increasing evidence that the postmenopausal ovary retains some endocrine function and thus can contribute a certain extent to the persistence of the vaginal epithelium proliferation a long time after the cessation of menstruations. Vaginal cytology plays an important role in the assessment of the vaginal epithelium response to hormonal stimuli, though less accurate than the blood and the urine estimations. It was established that there was a good correlation between the vaginal cytology and the biochemical estimations [2]. The fact that vaginal cytology cannot distinguish the proliferative patterns induced by estrogens, progesterone and androgens is true. With this in mind we did a cytological study in postmenopausal women, using our classification for the cytological typing based on the depth of the epithelial atrophy. The findings are discussed with special reference to the ethnic origin, reproductive life and concurrent illnesses.

Characterization of the nuclear progesterone receptor in normal Premarin-primed post-menopausal endometrium.

Nuclear progesterone receptors (RPN) were characterised in a 0.4 M KCl nuclear extract of Premarin-primed normal post-menopausal human endometrium after progesterone injection using [3H]R5020 as a ligand. The receptor character of the binding was demonstrated by the following findings: the high specificity for progesterone binding; the high saturable affinity (dissociation constant approx. 2.5 nM) for R5020; the sedimentation coefficient at high salt concentration (approx. 3 S); and the change in distribution of the RP following progesterone administration. These results indicate that normal post-menopausal human endometrium retains the property of translocation (2-step model) or nuclear activation and retention (nuclear receptor model) of the RP if it is exposed to the appropriate oestrogenic and progestational hormonal milieu.

Effect of progesterone injection on progesterone receptor levels and distribution in untreated and short-term Premarin-primed pre-menopausal and post-menopausal endometrium.

Cytosolic and nuclear progesterone receptors (RPC, RPN) were measured in post-menopausal endometria, using [3H]R5020 as the radioligand, and the findings compared with those in pre-menopausal endometria. Total RP levels (RPC + RPN) in post-menopausal endometria were low, i.e. less than 2000 fmol/mg DNA. A 7-11 day course of Premarin (conjugated equine oestrogen) treatment in post-menopausal subjects resulted in RP levels in 11818 +/- 3008 fmol/mg DNA, which were higher than those in proliferative, mid-cycle and Premarin-primed pre-menopausal endometria. Progesterone injection 1-3 h before tissue collection resulted in a change in the distribution of the RP in both premenopausal and post-menopausal Premarin-primed endometria and pre-menopausal proliferative and mid-cycle endometria. Following the progesterone injection RPN levels increased to 57 +/- 9% of the total as compared with 23 +/- 8% in endometrial samples from women who received no progesterone.

The diagnostic value of laparoscopy in women with chronic pelvic pain.

Laparoscopy was performed in 130 patients with chronic pelvic pain. Laparoscopy confirmed the preoperative diagnosis of pelvic inflammatory disease (PID) in 41 of 63 women with preoperative diagnosis of chronic PID (65%), whereas in 8 (13%), no pathologic findings were revealed. Laparoscopy directed the management in all 67 women who underwent the procedure to establish a diagnosis; in 16 (24%) of these, no pathologic findings were revealed. Of the total group, laparoscopy prevented laparotomy in 20 cases. These results are in accord with those of previous studies and emphasize the importance of laparoscopy in the management of women with chronic pelvic pain.

Tubal pregnancy--reappraisal of incidence.

A longitudinal study of tubal pregnancies diagnosed and treated from 1967 to 1980 revealed a biphasic incidence with a rise after 1975. This rise was in effect due to a 'jump' in the rate of early diagnosed unruptured tubal pregnancies. The study results suggest that with the use of modern diagnostic methods, we are now detecting early cases of tubal pregnancy some of which, had they not been diagnosed, might have self-terminated.

Placenta previa--the identification of low- and high-risk subgroups.

Among a group of 155 women with placenta previa (PP), two subgroups were identified: subgroup A consisted of 56 pregnancies (56 newborns) in women who had an asymptomatic antenatal course and who were delivered following a single episode of uterine bleeding; subgroup B consisted of 99 pregnancies (103 newborns) in women who had multiple antepartum bleeding episodes. The women in subgroup B were older, more parous, had more abortions and caesarean sections compared to those in subgroup A. Although the distribution of women in both subgroups with respect to the types of PP was similar, the prognosis in subgroup A was better with respect to various maternal and perinatal aspects. The recognition of low- and high-risk subgroups among women with PP may have practical implications for management protocols.

Characterization of the nuclear progesterone receptor in human uterine leiomyoma.

Progesterone binding components were characterized and measured in the 0.4 M KCl nuclear extract of Premarin-primed human leiomyoma (LM) following progesterone injection (n = 5) using [3H]R5020 as the ligand. The receptor character of the binding was demonstrated by: high specificity for progesterone and R5020 binding, high saturable affinity (Kd approximately 2.5 nM) for R5020, sedimentation coefficient in high salt concentration (approximately 3 S), change of distribution of the receptor after progesterone administration, i.e. an increase in the nuclear and decrease in the cytosolic receptor levels. Similar results were demonstrated in the corresponding myometria and endometria. The characteristics of the nuclear progesterone receptor in all three tissues of the test group were similar to those of the cytosolic progesterone receptor in the test group and in the control group (no treatment before operation, n = 5). These results indicate that the nuclear progesterone receptor in human uterine LM shares similar characteristics to those of the myometrium and endometrium.

Normal pregnancy complicated by vaginal ectopic trophoblastic implantation; a case report.

We describe a rare case of ectopic placental tissue, presenting as a vaginal tumor during normal intra-uterine pregnancy. Its clinicopathological features, and its possible relation to placental site trophoblastic tumors are discussed. To the best of our knowledge, this is the first case to be reported in the English literature of such a lesion occurring at this site.

Conservative approach to multiple pregnancy with intrauterine fetal death of one or more fetuses.

One of the less common complications of multiple gestation is intrauterine demise of one or more fetuses. Despite the many case reports in the literature, there are no firm guidelines regarding the management of this problem. We herein report the favorable outcome of the conservative approach we chose for managing four patients; two with twins, one with triplets and one with quadruplets (first report in the literature). Strict follow-up based on frequent physical examinations, ultrasonographic assessment of fetal growth and well being, and coagulation profiles is mandatory. Individualization of delivery dates and mode is recommended.

Third-trimester uterine rupture after prostaglandin E2 use for labor induction.

Prostaglandin E2 is a powerful oxytoxic agent that reliably initiates labor, even in the presence of an unripened cervix. The very low incidence of obstetric and neonatal side effects contributes to its universal use. Only nine cases of uterine rupture during the third trimester of pregnancy after application of various prostaglandin E2 preparations have been reported in English. Although uterine rupture after prostaglandin administration is a very rare complication, no prostaglandin compound seems to be exempt from it.