Anti-Mullerian hormone confirms the novel classification of female functional androgenization including polycystic ovary syndrome.

OBJECTIVE: Functional androgenization (FA) can be divided into five groups corresponding to the predominant organ pathology as recently shown by our group: functional cutaneous androgenization (FCA, skin) and FA syndrome (FAS) I (ovary, lean individual), II (adrenal gland), III (ovary, fat tissue, pancreas, and hyperinsulinemia), and IV (residual FA dysfunctions). Group-specific clusters are based on primary variables such as LH, testosterone, DHEAS, sex hormone-binding globulin (SHBG), body mass index (BMI), glucose, insulin, and enlarged polyfollicular ovaries. Because anti-Müllerian hormone (AMH) positively correlates with the antral follicle count, its relevance as an additional primary variable for classifying FA was investigated. DESIGN: In this study, 178 patients with FA were consecutively enrolled and classified into the five FA groups as described earlier and 30 women with regular menstrual cycles served as control. METHODS: Primary variables and serum AMH were analyzed in the early follicular phase. RESULTS: FA patients showed significantly elevated AMH levels (11.1±6.7 ng/ml) versus control (3.0±2.0 ng/ml; P<.0001). AMH was significantly increased in groups FAS I (15.6±5.8 ng/ml) and FAS III (11.6±6.6 ng/ml) compared with groups FCA (7.0±3.8 ng/ml), FAS II (5.05±3.0 ng/ml), and FAS IV (6.9±4.6 ng/ml) and correlated positively (P<.0001) with LH (r=0.538) and testosterone (r=0.368). In regression and multivariate analyses, AMH was not dependent on SHBG, DHEAS, BMI, glucose, or insulin. In receiver operating characteristic analysis, 9.21 ng/ml AMH showed 90% specificity with 71.2% sensitivity for the diagnosis of the two ovarian FA groups, FAS I and III. CONCLUSION: AMH confirms the novel stratification system and constitutes a useful primary variable in the algorithm of FA classification.

On physical nanoscale aspects of compatibility of steels with hydrogen and natural gas.

The possibilities of effective solutions of relevant technological problems are considered based on the analysis of fundamental physical aspects, elucidation of the nano-structural mechanisms and interrelations of aging and hydrogen embrittlement of materials (steels) in the hydrogen industry and gas-main industries. The adverse effects which these mechanisms and processes have on the service properties and technological lifetime of materials are analyzed. The concomitant fundamental process of formation of carbohydride-like and other segregation nanostructures at dislocations (with the segregation capacity 1 to 1.5 orders of magnitude greater than in the widely used Cottrell 'atmosphere' model) and grain boundaries is discussed in the context of how these nanostructures affect technological processes (aging, hydrogen embrittlement, stress corrosion damage, and failure) and the physicomechanical properties of the metallic materials (including the technological lifetimes of pipeline steels).

Carcinoma of the stomach. Why are we falling to improve survival?

Review of 298 cases of primary gastric malignancy from 1958 to 1978 revealed 265 cases of adenocarcinoma. Overall 5-year survival rate was a disappointing 5.5%, which was less than the earlier series of Oschner Clinic (7.5%). Curative resections produced a five-year survival rate of 26%. Patients presented with advanced disease; 84% had Stage III or IV disease at time of initial observation. The introduction of fiberoptic endoscopy during this period greatly enhanced the accuracy of preoperative diagnosis of tissue-proven cancer from 6% before fiberoptic to 58% since. Worldwide experience is much better, with overall five-year survival rate of 17.9%. Excellent survival statistics from Japanese studies reflect both the effects of mass surveying and early surgery and the prevalence of superficial spreading type of cancer. Improvement of results in this country will require more aggressive evaluation and earlier surgical intervention.

Cancer of the stomach.

Carcinoma of the stomach, although its incidence is decreasing in the United States, is still a fatal disease. The results today are actually no better than they were 30 years ago because we are still making late diagnoses. In order to improve our results in the treatment of cancer of the stomach, we must perform fiberoptic gastroscopy in individuals over age 40 who have gastric complaints that do not respond readily to conservative medical therapy. At the time of endoscopy, multiple biopsies of gastric mucosa must be taken. Only in this way can early enough diagnoses be made to increase the survival rate in gastric carcinoma.

The relative merits of temporary gastrostomy and nasogastric suction of the stomach.

Nasogastric suction is usually employed for gastric decompression because of its ease of application. However, it is associated with greater discomfort and more complications than temporary gastrostomy, especially in the young, the elderly, those who smoke, and those in whom prolonged decompression is necessary.

Effects of bilateral amygdaloid lesions on gonadal and pituitary hormones in serum and on sexual behavior in female rhesus monkeys.

Bilateral lesions that destroyed the amygdaloid nuclear complex failed to alter either serum concentrations of luteinizing hormone (LH), estradiol (E2), progesterone, and testosterone or sexual behavior in female rhesus monkeys. In 3 of 5 females ovulation occurred in the postoperative cycle, and in 4 of 5 females exogenous E2 treatment released a surge of LH whose pattern was indistinguishable from the normal preovulatory surge. A postcastration rise in serum LH also occurred in the 5 lesioned monkeys, and E2 again induced an LH release. The data suggest that the amygdala does not play a major role in regulation of LH or ovarian steroid secretion during the menstrual cycle. Moreover amygdaloid lesions in female monkeys do not alter their sexual behavior.

Aging.

Aging, a wearing-out process which affects everything inanimate and animate, is accelerated by abuse of decelerated by care. The psychologic reaction of aging persons vary considerably. The concept of growing older is much more satisfactory and pleasant than the concept of being old, since the former is applicable to everyone regardless of age whereas the latter carries a finite significance as deterioration progresses. Chronologic age is much less important than biologic age. The desideratum is not longevity but rather a long, useful and meaningful life. Although heredity is of importance in longevity, it is a factor over which at present we have no control. However, we can influence the aging process according to whether we care for or abuse the body. The principal factors in accelerated aging, in order of importance, are: 1) tobacco use (particularly cigarette smoking), 2) lack of exercise, and 3) obesity. Conversely, abstinence from tobacco, exercise within tolerance, and avoidance of obesity not only decelerate aging but result in a better quality of life.

Appraising current therapy for breast cancer; 1. surgery.

Breast cancer is an extremely unpredictable type of lesion, due in part to its hormone dependence. Although minimal resection may suffice for those patients with great host resistance, radical or modified radical mastectomy is the treatment of choice unless distant metastases are evident.

Diseases of the breast.

As a result of health education programs that have stressed self-examination and the importance of early diagnosis and treatment, less than 5 percent of breast lesions seen in clinical practice today are malignant. Nevertheless, breast cancer is the leading cause of deaths due to cancer in women and the second most common breast lesion. Chronic cystic mastitis, the most common breast lesion seen in women, can often be treated conservatively by aspirating the cystic fluid. Close follow-up is necessary so that if carcinoma develops, it can be treated early. Carcinoma is unpredictable but not hopeless. Although controversy exists regarding treatment, radical mastectomy is still the preferred treatment in most cases. Other breast diseases include adenofibroma, a common lesion requiring excisional biopsy for positive diagnosis; nipple discharge, which should be carefully examined cytologically; and relatively rare breast lesions, including intraductal papilloma, adenosis, traumatic fat necrosis, and cystosarcoma phylloides.